The global prevalence of apical periodontitis: a systematic review and meta-analysis.

BACKGROUND: Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide. OBJECTIVES: To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP. METHODS: A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome. RESULTS: The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2  = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2  = 99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I2  = 98.5%) and 3% (95% CI 2%-3%; I2  = 99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I2  = 97.8%) and hospitals (51%; 95% CI 40%-63%; I2  = 95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I2  = 96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I2  = 89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I2  = 98.3%). DISCUSSION: The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution. CONCLUSIONS: Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide.

Susceptibility of entomopathogenic nematodes to ivermectin and thiabendazole.

The objective of the present study was to determine the susceptibility of entomopathogenic nematodes to ivermectin and thiabendazole. Soil samples collected from the municipalities of Irapuato and León, Guanajuato, Mexico, were obtained, from which the entomopathogenic nematodes (EPNs) of the Steinernematidae and Heterorhabditidae families were isolated. The samples were classified from livestock and nonlivestock soils, and the susceptibility of EPNs to anthelmintics was determined with the larval motility assay (LMA, 24 h) and the larval migration inhibition assay (LMI assay, 48 h). Sterile distilled water (T1) and treatments with 1% ivermectin diluted in 5% DMSO (dimethyl sulfoxide) (T2) and 5% thiabendazole diluted in 5% DMSO (T3) were applied to infective juvenile larvae. Analysis of variance was performed with a factorial design and Tukey's test at 0.05 probability. In addition, different concentrations of ivermectin (0.1, 0.5, 1, 1.2, 1.5, and 2 µg) and thiabendazole (1, 5, 10, 12, 15, and 20 mg) were evaluated to perform a Probit analysis to determine their LC50. All strains of EPNs were susceptible to ivermectin in both the LMA and LMI assay. The results show that EPNs are susceptible to ivermectin and thiabendazole, and the degree depends on the type of test performed, the chemical product used, and the origin of the strain of EPN.

The Mexican consensus on the treatment of hepatitis C. / Consenso Mexicano para el Tratamiento de la Hepatitis C.

The aim of the Mexican Consensus on the Treatment of HepatitisC was to develop clinical practice guidelines applicable to Mexico. The expert opinion of specialists in the following areas was taken into account: gastroenterology, infectious diseases, and hepatology. A search of the medical literature was carried out on the MEDLINE, EMBASE, and CENTRAL databases through keywords related to hepatitisC treatment. The quality of evidence was subsequently evaluated using the GRADE system and the consensus statements were formulated. The statements were then voted upon, using the modified Delphi system, and reviewed and corrected by a panel of 34 voting participants. Finally, the level of agreement was classified for each statement. The present guidelines provide recommendations with an emphasis on the new direct-acting antivirals, to facilitate their use in clinical practice. Each case must be individualized according to the comorbidities involved and patient management must always be multidisciplinary.

Novel technique of temporary abdominal closure with continuous medial fascial traction dynamic for patients with open abdomen.

Open abdomen has been an effective treatment for abdominal catastrophes in trauma and general surgery, is one of the greatest advances in recent decades and has become a common procedure in both trauma and general surgery. Temporary abdominal closure techniques in managing open abdomen help to achieve many benefits without incurring many complications. We present a series of patients in which a temporary abdominal closure technique was used that generates continuous medial fascial traction dynamic in patients with open abdomen for different causes.

Relation of serum cholesterol, lipid, serotonin and tryptophan levels to severity of depression and to suicide attempts.

OBJECTIVE: To determine if there is a relation to low serum cholesterol, lipoprotein, serotonin or tryptophan levels in patients with depression who have recently attempted suicide. DESIGN: Biochemical and behavioural study. SETTING: Inpatient and outpatient treatment at the Instituto Mexicano de Psiquiatría. PARTICIPANTS: Thirty-three patients with a diagnosis of major depressive episode. Eighteen of these patients had attempted suicide in the month before the start of the study; 15 patients had never attempted suicide. OUTCOME MEASURES: Serum levels of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, serotonin (5-HT) and tryptophan. Scores on Hamilton Depression Rating Scale, Carroll Depression Rating Scale, Beck Hopelessness Scale and Beck Suicide Attempt Severity Scale. RESULTS: There were no significant differences between patients who had attempted suicide and those who had not in terms of serum cholesterol, HDL, LDL and triglyceride levels. Serum levels of 5-HT and tryptophan were significantly lower in patients with depression who had a recent suicide attempt than in those patients who had never attempted suicide. A comparison of patients not taking antidepressant medication found serum 5-HT levels to be more than 3 times lower in those patients with a recent suicide attempt than in patients with no history of suicide attempt. CONCLUSIONS: The study found no difference in lipid profiles between patients who had attempted suicide and those who had not. Low serum levels of 5-HT may increase the risk of suicide attempt in patients who are depressed.

[Electrocardiographic differences between standard 12-lead recording and modifications in exercise testing]. / Diferencias electrocardiográficas entre el registro estándar de 12 derivaciones y el modificado para prueba de esfuerzo.

Modified limb electrode positions proposed by Mason and Likar are often used in exercise electrocardiograms. In some cases, such modifications induced considerable differences in electrocardiographic waveforms of the frontal plane leads. To assess the magnitude of these changes, 55 patients were studied with standard and modified limb electrodes. We observed a significant verticalization (p less than 0.01) of all electrical axis in the modified ones: there was a difference of 19.6 +/- 1.7 grades for the P wave, 36.4 +/- 8 grades for the QRS axis and 26.0 +/- 3.3 for the T wave in the frontal plane. When classified by electrocardiographic pathology, old transmural inferior myocardial infarction and S1, S2, S3 pattern did not change electrical axis. There was also a significant increase (5 +/- 1 mseg, p less than 0.01) in the intrinsic deflection onset of the unipolar lead a VF of the modified one. Such finding suggests the recording of a more lateral region when compared with the onset of intrinsic deflection of the precordial leads. We conclude that modified limb electrode position induces a significant verticalization of the electrical axis in the frontal plane. The recorded myocardial region in such electrocardiograms seems to be different from that recorded in the standard one. For some cases, we suggest to explore the inferior myocardial region by using the standard aVF location in the postexercise recordings.

[Heart position as a determinant of the voltage of the R wave in healthy subjects]. / La posición cardíaca como determinante del voltaje de la onda R en sujetos sanos.

Although many factors have been reported to change the R wave amplitude of the electrocardiogram, the direct measurement without any consideration, has been the method of choice, which leads to controversial findings. We hypothesized that body mass index and heart position are the main modifiers of the R wave amplitude. To test this hypothesis 80 normal subjects were studied with standard electrocardiograms in which correlation with constitutional variables were performed and were also analyzed according to the electrocardiographic heart position. R wave amplitude showed a non-significant inverse relationship to body mass except in severe overweight subjects (p less than 0.05). When analyzed by position, levorotated and S1, S2, S3 hearts showed a significant increase in R wave voltage whereas horizontal and dextrorotated ones showed a diminished amplitude (p less than 0.01) independent of body weight. There was no relation between R wave voltage and body surface. We conclude that: Body mass is not an important modifier of R wave amplitude in thin, normal and light overweight subjects. Heart position may induce significant variation of R wave voltage according to the degree of the projection of the left ventricular electric field to the anterior thoracic surface.

[Electrocardiographic findings in pulmonary arterial hypertension in children]. / Hallazgos electrocardiográficos en la hipertensión arterial pulmonar en niños.

Pulmonary hypertension (PH) induces high risk of cardiovascular morbidity and mortality, mainly in the primary or essential type. Invasive studies are needed to confirm the diagnosis; among the non- invasive approach, the electrocardiogram has been used to suspect such entity with poor results due to inadequate diagnostic criteria. Twelve children with pulmonary hypertension of the essential type (PPH) and ten children with PH due to interventricular septal defect (VSD) were studied haemodynamically and electrocardiographically and compared to electrocardiographic data of 53 normal children. PPH showed higher resistances than VSD (17.2 +/- 1.9 vs 6 +/- 0.6 u/m2 p less than 0.01) with the same pressure level (99.5 +/- 10.3 vs 101.5 +/- 4.8 mmHg). Right axis deviation, peaked P wave, increased ventricular activation time and prominent ST-T changes were seen in PPH patients whereas in VSD the electrical axis was within normal limits, without P wave changes and in some cases, less conspicuous ST-T abnormalities were observed (p less than 0.01). Such changes showed good sensitivity (80%) and specificity (81%) to suspect PH with resistances higher than 10 u/m2 with a predictive value of 75% (p less than 0.02). P wave and ST-T changes could be of use to suspect PPH with elevated resistances instead of right ventricular hypertrophy voltage criteria.

[Intraventricular conduction block induced by ischemia]. / Bloqueo de la conducción intraventricular inducido por isquemia.

The electrical consequences of experimental acute myocardial ischemia were studied in 50 dogs. The study was performed through unipolar epicardial leads and at different levels of the conducting system; bundle branch and Purkinje fibers. There is evidence that the block takes place at the Purkinje-muscle union or in the muscle-muscle conduction. In none of the experiments the block appeared in any of the components of the conducting system. Also, there is evidence that with severe ischemia muscle recordings disappeared while the Purkinje potentials remained unchanged, this suggests that conducting system cells are more resistant to hypoxia than the contractile cells. Ventricular arrhythmias usually appeared simultaneously with conduction blocks that favored reentries. Arrhythmias were more frequent when the blocks were more accentuated. Our data demonstrates that the conduction disorder precedes in some instances, the positive RS-T displacement and in others it hides the such displacement. It is concluded that the RS-T displacement, the distal conduction block and arrhythmias are manifestations, at different levels, of partial diastolic depolarization induced by acute myocardial ischemia.

[Electrocardiographic diagnosis in atrioventricular discordance]. / Diagnóstico electrocardiográfico de la discordancia atrio-ventricular.

The ECG of 37 patients with atrioventricular discordance were studied and divided in two main groups: I) Situs solitus and II) situs inversus, either a) without associated defects or b) with associated defects. It was concluded: 1) The first vector of ventricular activation, oriented in the same sense of that of atrial activation is a fundamental diagnostic sign; 2) The preponderance of anatomical right ventricle, leads to the diagnosis of unassociated defects; 3) The recognition of biventricular hypertrophy obliges to the diagnosis of associated defects; 4) The AQRS deviation and the shortening in duration of the local electrical systole help to recognized the hypertrofied ventricle and its overload; 5) The presence of right bundle branch block is not in relation to the degree of overloading; 6) The primary alterations of ventricular repolarization are univocal signs of myocardial damage.

[Endocardial cushion defects in situs solitus and in asplenic and polysplenic syndromes, Anatomoembryological correlations]. / Malformación de los cojines endocárdicos en el situs solitus y en los síndromes de asplenia y polisplenia. Correlación anatomoembriológica.

The endocardial cushion defects were studied in hearts belonging to situs solitus and in the asplenia and polysplenia syndroms. WE propose that these defects must be classified by identifying persistent developmental stages. Such classification would content the anatomical varieties seen in the asplenia and polysplenia syndroms. The embryological bases are discussed.

[The electrocardiogram of high frequency in the evaluation of hypertensive cardiopathy]. / El electrocardiograma de alta frecuencia en la valoración de la cardiopatía hipertensiva.

The High-Frequency ECG was studied in 78 patients with systemic arterial hypertension and in 10 normal subjects. The study has shown: a) the P wave is altered initially, according to the disturbances in the myocardial complicance; b) the signs of LVH are mainly: delayed in the appearance of the intrinsecoid deflection, abnormal left direction of vector 3, left electrical systole diminished and counter clockwise rotation; c) the exhaustion fase is represented by increased of the electrical systole, delay in the duration of the intrinsecoid deflection and by primary disturbances of repolarization. The relationships between the ECG and the hymodynamic and metabolic disturbances, are discussed.

[Electrocardiographic manifestations of ventricular diastolic depolarization. Clinico-experimental study]. / Las manifestaciones electrocardiográficas de la despolarización diastólica ventricular Estudio clínico-experimental.

Several haemodynamic and biochemical parameters were studied in order to explain the diagnostic value of the electrocardiographic abnormalities in partial myocardial diastolic depolarization, in different conditions, as experimental coronary oclussion, adrenalinic effects, tachycardia, hypoxia and shock. It is concluded that the electrocardiographic signs of diastolic depolarization (injury tissue) are: RS-T deplacement, conduction disturbances at bundle, fascicular and muscular levels, as well as ventricular ectopic beats. The experimental findings were correlated with clinical cases showing electrocardiographic signs of ventricular diastolic depolarization, as in myocardial infarct, angina pectoris, hypertensive heart disease, pheocromocitoma and tachycardia. It is concluded that the oxygen volume available at mitochondrial level is diminished, if it is correlated to the metabolic and/or haemodynamic alterations.