Critical appraisal of the Colombian clinical practice guide for the prevention, diagnosis and treatment of suicidal ideation and/or behaviour (adoption).

INTRODUCTION: Suicide is a complex, global public health problem. The Colombian clinical practice guideline provides relevant input for its prevention, diagnosis and treatment. The objective was to evaluate the methodological quality, credibility and applicability of the Colombian clinical practice guideline for suicidal behaviour. METHODS: An academic group of 12 evaluators was established to assess the guide and its recommendations in a standardised way, using the AGREE-II and AGREE-REX instruments. The evaluations were given in the range of 0.0-1.0 with 0.7 as a cut-off point for appropriate quality. RESULTS: The global assessment of the AGREE-II was greater than 0.7 in the dimensions: "scope and objective" (0.86), "clarity of presentation" (0.89), "applicability" (0.73) and "editorial independence" (0.89). The lowest scores were for "participation of those involved" (0.67) and "rigour in preparation" (0.69). With the AGREE-REX, the results in all dimensions were below 0.70, which indicates lower quality and suitability for use. CONCLUSIONS: The adoption process of the Colombian guideline for suicidal behaviour was a rigorous methodological process, while the practice recommendations were valued as of low applicability due to low support in local evidence. It is necessary to strengthen the generation and synthesis of evidence at the national level to give greater support and applicability to the practice recommendations.

Rasch analysis of the dermatology life quality index (DLQI) in patients with mild to moderate-severe psoriasis.

Background The Dermatology Life Quality Index (DLQI) is a valuable tool for assessing the quality of life in adult patients with psoriasis. Aims To analyse the reliability and validity of the DLQI to measure the quality of life in patients with mild to moderate-severe psoriasis. Methods This was a secondary validation study nested in a follow-up study. The Rasch-Andrich model was utilised to perform response function, item and person fit, differential item functioning, dimensionality, and reliability analyses. Results A total of 1439 patients were analysed, 52.1% male, mean age of 48.7 years (SD 16.1). Psoriasis vulgaris was the phenotype in 43.1% of patients, and 86% had a mild Psoriasis Area Severity Index (PASI). Adequate adjustment of the response function and the items was observed in the best-fit sample, except for item 7 (work and study). The measure explained 60.9% of the variance and presented a reliability of 0.86. Differential item functioning was identified by age, with a relevant bias in the estimation for older adults. Item-person maps are provided. Limitations This study was performed at a single centre, with most patients presenting a mild PASI score, limiting generalisation of the findings. Conclusion The validity evidence favours the use of the DLQI in moderate-severe psoriasis. However, the instrument biases the estimate of older adults. This population group should consider a specific version of the instrument.

Development of undergraduate students' diagnostic accuracy for the classification of molar incisor hypomineralization.

INTRODUCTION: One of the major difficulties with respect to molar incisor hypomineralization (MIH) is its classification and differentiation from other enamel development defects (EDDs). The aim of this study was to evaluate diagnostic accuracy in dental students to classify MIH as well as its differentiation from other EDDs by combining conventional theoretical classes and e-learning-assisted pre-clinical practices. METHODS: In this one-group pre-test and post-test study, 59 second-year students assessed 115 validated photographs using the MIH Index on the Moodle learning platform. This index assesses the clinical features and extent of MIH, differentiating it from other EDDs. Students received automatic feedback after the pre-test. Two weeks later, students re-evaluated the same photographs. Both pairwise accuracy and overall diagnostic accuracy were estimated and compared for pre- and post-testing, with the area under the curve AUC, along with 95% confidence intervals (95% CI). RESULTS: The lowest diagnostic accuracy was for the ability to discriminate between white or cream-coloured demarcated opacities and hypomineralization-type defect that is not MIH. The overall pre-test accuracy was AUC = 0.83 and increased significantly post-test to AUC = 0.99 (p < .001). The overall accuracy to discriminate the extent of the lesion also increased significantly post-test (p < .001). CONCLUSION: Diagnostic skills to classify MIH can be developed by combining conventional theoretical classes and e-learning-assisted pre-clinical practices.

Characterization of enamel developmental defects in patients with orofacial clefts and their relationship to surgical procedures.

AIMS: This study aimed to characterize the prevalence of development defects of enamel (DDE) in patients with cleft based on the cleft phenotype and explore the relationship between surgical procedures and different types of DDE. MATERIAL AND METHODS: In this cross-sectional study, 290 standardized orthodontic documentation and medical records from a reference hospital were evaluated, which treated patients with: cleft lip (CL), cleft lip with alveolar bone involvement (CLa), cleft lip and palate (CLP), cleft palate (CP), cleft median (CM), and considering laterality as unilateral or bilateral. DDE was assessed using the Ghanim Index (2015). Information on surgical intervention periods was obtained from medical records. Statistical analyses were performed using prevalence ratio (PR) for DDE comparisons between cleft phenotypes and surgical procedures. RESULTS: The prevalence of DDE was 77.2%. Demarcated hypomineralization was associated with CP and CLP, while hypoplasia was associated with CLa, especially when bilateral. Hypoplasia was also associated with the labial adhesion surgery. CONCLUSION: Demarcated hypomineralization was the most common DDE in this population, and the cleft phenotype influenced the type of DDE manifested. The lip adhesion surgery increased the chances of hypoplasia manifestation. CLINICAL RELEVANCE: The type of DDE in patients with cleft depends on the cleft phenotype. Understanding this susceptibility enables the multidisciplinary team to monitor dental development, thus allowing early diagnosis and timely referral to the pediatric dentist and better prognoses.

Manejo neurocognitivo en cardiopatía congénita: revisión sistemática de recomendaciones de práctica clínica / Neurocognitive management in congenital heart disease: a systematic review of clinical practice recommendations

Resumen Objetivo: Sintetizar y valorar críticamente las recomendaciones sobre manejo neurocognitivo del paciente con cardiopatía congénita presentadas en guías de práctica clínica y declaraciones científicas. Método: Revisión sistemática de recomendaciones de práctica (PROSPERO CRD42020205202). Se realizó una búsqueda en PubMed, SCOPUS, Ovid/Cochrane, y LILACS y se revisaron repositorios de sociedades científicas y referencias de los documentos incluidos. La valoración crítica se hizo mediante el AGREE-II (escenario ideal) para las guías y declaraciones, y mediante el AGREE-REX para las recomendaciones (escenarios ideal y local). Se presentan la matriz de recomendaciones y el análisis de barreras potenciales para su implementación en Colombia. Resultados: Se incluyeron 18 recomendaciones relacionadas. La media en el AGREE-II fue 89.6. La media en el AGREE-REX fue 90.1 en el escenario ideal y 69.9 en el escenario local. Las recomendaciones incluidas se centran en vigilancia, tamizaje, evaluación y consejería; no se identificaron recomendaciones sobre intervención neurocognitiva. Las principales barreras de implementación en Colombia son la no disposición a pagar por parte del sistema de salud y la ausencia de oferta integral de atención para el manejo neurocognitivo en cardiopatía congénita. Conclusión: Las recomendaciones identificadas podrían ser adaptadas en una guía de práctica colombiana, realizando modificaciones en reconocimiento del contexto local.

Abstract Objective: To synthesize and critically assess the recommendations on neurocognitive management of patients with congenital heart disease presented in clinical practice guidelines and scientific statements. Method: A systematic review of practice recommendations (PROSPERO CRD42020205202). PubMed, SCOPUS, Ovid/Cochrane, and LILACS were searched, and repositories of scientific societies and references of included documents were reviewed. Critical appraisal was performed using the AGREE-II (ideal scenario) for the guidelines and statements, and recommendations were assessed using the AGREE-REX (ideal and local scenarios). A matrix of recommendations and analysis of potential barriers for its implementation in Colombia is presented. Results: Eighteen related recommendations were included. The average AGREE-II was 89.6. The average AGREE-REX was 90.1 in the ideal setting and 69.9 in the local setting. The included recommendations focus on surveillance, screening, evaluation, and counseling; no recommendations on neurocognitive intervention were identified. The main implementation barriers in Colombia are the unwillingness to pay on the part of the health system and the absence of a comprehensive health care offer for neurocognitive management in congenital heart disease. Conclusion: The identified recommendations could be adapted into a Colombian practice guideline, making modifications that recognize the local context.

Efficacy and safety of antipsychotics and antidepressants in the treatment of anorexia nervosa: a systematic review.

INTRODUCTION: The recommendations of the current guidelines are based on low quality evidence. Periodic updating is required, taking recent evidence into consideration. OBJECTIVE: To synthesise the best available clinical evidence on the efficacy and safety of second-generation antidepressants and antipsychotics in patients with anorexia nervosa. METHODS: Systematic review (CRD42020150577). We searched PubMed, SCOPUS, Ovid(Cochrane), EMBASE and LILACS for randomised clinical trials performed in patients with anorexia nervosa that evaluated the use of second-generation antipsychotics or oral antidepressants, at any dose and for any length of time, in outpatient and/or hospital treatment, taking weight (body mass index), psychopathological entities and safety as results. RESULTS: Five studies were included, with four assessed as having a high risk of bias. The evidence indicates that patients receiving treatment with olanzapine or fluoxetine tend to stay in treatment programmes for longer. Olanzapine showed favourable results (one study) in terms of weight gain, but did not show the same results in psychopathology, where the evidence is contradictory. CONCLUSIONS: In accordance with previous reviews, our work allows us to conclude that there is contradictory information on the efficacy of psychotropic drugs in the treatment of anorexia nervosa. Future work should focus on developing clinical trials of high methodological quality.

Altered B cell phenotype and CD27+ memory B cells are associated with clinical features and environmental exposure in Colombian systemic lupus erythematosus patients.

Background: B lymphocytes are dysregulated in Systemic Lupus Erythematosus (SLE) including the expansion of extrafollicular B cells in patients with SLE of African American ancestry, which is associated with disease activity and nephritis. The population of Colombia has a mixture of European, Native American, and African ancestry. It is not known if Colombian patients have the same B cell distributions described previously and if they are associated with disease activity, clinical manifestations, and environmental exposures. Objective: To characterize B cell phenotype in a group of Colombian Systemic Lupus Erythematosus patients with mixed ancestry and determine possible associations with disease activity, clinical manifestations, the DNA methylation status of the IFI44L gene and environmental exposures. Materials and methods: Forty SLE patients and 17 healthy controls were recruited. Cryopreserved peripheral B lymphocytes were analyzed by multiparameter flow cytometry, and the DNA methylation status of the gene IFI44L was evaluated in resting Naive B cells (rNAV). Results: Extrafollicular active Naive (aNAV) and Double Negative type 2, DN2 (CD27- IgD- CD21- CD11c+) B cells were expanded in severe active patients and were associated with nephritis. Patients had hypomethylation of the IFI44L gene in rNAV cells. Regarding environmental exposure, patients occupationally exposed to organic solvents had increased memory CD27+ cells (SWM). Conclusion: aNAV and DN2 extrafollicular cells showed significant clinical associations in Colombian SLE patients, suggesting a relevant role in the disease's pathophysiology. Hypomethylation of the IFI44L gene in resting Naive B cells suggests that epigenetic changes are established at exceedingly early stages of B cell ontogeny. Also, an alteration in SWM memory cells was observed for the first time in patients exposed to organic solvents. This opens different clinical and basic research possibilities to corroborate these findings and deepen the knowledge of the relationship between environmental exposure and SLE.

Eficacia y seguridad de antipsicóticos y antidepresivos en el tratamiento de la anorexia nerviosa: revisión sistemática / Efficacy and Safety of Antipsychotics and Antidepressants in the Treatment of Anorexia Nervosa: a Systematic Review

RESUMEN Introducción: Las recomendaciones de las guías vigentes están basadas en evidencia de baja calidad. Se requiere su actualización periódica considerando la evidencia reciente. Objetivo: Sintetizar la mejor evidencia clínica disponible sobre eficacia y seguridad de antidepresivos y antipsicóticos de segunda generación en pacientes con anorexia nerviosa. Métodos: Revisión sistemática (CRD42020150577). Se buscaron en PubMed, SCOPUS, Ovid(Cochrane), EMBASE y LILACS los ensayos clínicos aleatorizados realizados en pacientes con anorexia nerviosa que evaluasen el uso de antipsicóticos de segunda generación o antidepresivos orales a cualquier dosis y por cualquier tiempo en el tratamiento ambulatorio y/u hospitalario tomando como resultados el peso (índice de masa corporal), las entidades psicopatológicas y la seguridad. Resultados: Se incluyeron 5 estudios, 4 catalogados como con alto riesgo de sesgo. La evidencia indica que los pacientes que reciben tratamiento con olanzapina o fluoxetina tienden a mantenerse por más tiempo dentro de los programas de tratamiento. La olanzapina mostró resultados favorables (un estudio) en cuanto al aumento de peso, pero no mostró los mismos resultados en psicopatología, donde la evidencia es contradictoria. Conclusiones: En concordancia con las revisiones anteriores, nuestro trabajo permite concluir que hay información contradictoria sobre la eficacia de los psicofármacos para la anorexia nerviosa. El trabajo futuro debe enfocarse en desarrollar ensayos clínicos de alta calidad metodológica.

ABSTRACT Introduction: The recommendations of the current guidelines are based on low quality evidence. Periodic updating is required, taking recent evidence into consideration. Objective: To synthesise the best available clinical evidence on the efficacy and safety of second-generation antidepressants and antipsychotics in patients with anorexia nervosa. Methods: Systematic review (CRD42020150577). We searched PubMed, SCOPUS, Ovid(Cochrane), EMBASE and LILACS for randomised clinical trials performed in patients with anorexia nervosa that evaluated the use of second-generation antipsychotics or oral antidepressants, at any dose and for any length of time, in outpatient and/or hospital treatment, taking weight (body mass index), psychopathological entities and safety as results. Results: Five studies were included, with four assessed as having a high risk of bias. The evidence indicates that patients receiving treatment with olanzapine or fluoxetine tend to stay in treatment programmes for longer. Olanzapine showed favourable results (one study) in terms of weight gain, but did not show the same results in psychopathology, where the evidence is contradictory. Conclusions: In accordance with previous reviews, our work allows us to conclude that there is contradictory information on the efficacy of psychotropic drugs in the treatment of anorexia nervosa. Future work should focus on developing clinical trials of high methodological quality.

Association between hypomineralization of deciduous and molar incisor hypomineralization and dental caries.

This study aimed to evaluate the association between the severity of hypomineralized second primary molars (HSPM), molar-incisor hypomineralization (MIH) and dental caries in children. 450 children between the ages of 6 and 7 years were included in this cross-sectional study. A calibrated examiner classified the enamel hypomineralizations and dental caries lesions using the MIH and HSPM and the Nyvad criteria, respectively. The primary outcome was the severity of MIH according to the severity of HSPM. Statistical analysis was performed using the generalized linear model and ordinal logistic regression. The prevalence of concomitant MIH and HSPM was 26% sex and age adjusted. Mild enamel defects were more frequent than severe enamel defects. An association was found between the severity of MIH and HSPM, both for mild defects (OR=87.54; 95%CI: 55.87, 137.17) and severe defects (OR=82.15; 95%CI: 45.72, 147.61). The severity of hypomineralization in permanent molars was associated with the activity of dental caries lesions (OR=29.85; 95%CI: 12.95, 68.83). To conclude, there is a strong association between the severity of HSPM and MIH, which is more significant in the presence of active dental caries lesions.

Association between hypomineralization of deciduous and molar incisor hypomineralization and dental caries

Abstract This study aimed to evaluate the association between the severity of hypomineralized second primary molars (HSPM), molar-incisor hypomineralization (MIH) and dental caries in children. 450 children between the ages of 6 and 7 years were included in this cross-sectional study. A calibrated examiner classified the enamel hypomineralizations and dental caries lesions using the MIH and HSPM and the Nyvad criteria, respectively. The primary outcome was the severity of MIH according to the severity of HSPM. Statistical analysis was performed using the generalized linear model and ordinal logistic regression. The prevalence of concomitant MIH and HSPM was 26% sex and age adjusted. Mild enamel defects were more frequent than severe enamel defects. An association was found between the severity of MIH and HSPM, both for mild defects (OR=87.54; 95%CI: 55.87, 137.17) and severe defects (OR=82.15; 95%CI: 45.72, 147.61). The severity of hypomineralization in permanent molars was associated with the activity of dental caries lesions (OR=29.85; 95%CI: 12.95, 68.83). To conclude, there is a strong association between the severity of HSPM and MIH, which is more significant in the presence of active dental caries lesions.

Resumo O objetivo desse estudo foi avaliar a associação entre a severidade da Hipomineralização de Segundos Molares decíduos (HSMD), da Hipomineralização de Molares e Incisivos (HMI) e cárie dentária em crianças. Neste estudo transversal foram incluídas 450 crianças entre 6 e 7 anos de idade. Um examinador calibrado classificou as hipomineralizações e lesões de cárie dentária utilizando o índice da HMI/HMD e o critério Nyvad, respectivamente. O desfecho primário foi a severidade da HMI de acordo com a severidade da HSMD. As análises estatísticas foram realizas usando o modelo linear generalizado e regressão logística ordinal. A prevalencia concomitante da HMI e HMSD foi de 26 % ajustada por sexo e idade. Defeitos leves foram mais frequentes que os defeitos severos. Foi encontrada a associação entre a severidade da HMI e da HSMD para defeitos leves (OR=87.54; IC95%: 55.87, 137.17) e severos (OR=82.15; IC95%: 45.72, 147.61). A severidade da hipomineralização em molares permamentes foi associada a atividade da lesão de cárie dentária (OR=29.85; IC95%: 12.95, 68.83). Conclui-se que existe uma forte associação entre a severidade da HSMD e da HMI, a qual foi mais significante na presença lesões ativas de cárie.

Brain functional connectivity in takotsubo cardiomyopathy patients. A systematic review of magnetic resonance imaging studies / Conectividad funcional cerebral en pacientes con miocardiopatía de takotsubo: Revisión sistemática de estudios de imagen por resonancia magnética

Abstract Background: Functional neuroimaging studies may aid to our understanding of the pathophysiology of the takotsubo cardiomyopathy. Objective: The aim of the study was to review the available evidence of brain functional connectivity in takotsubo cardiomyopathy patients. Methods: This was a systematic review. We searched MEDLINE, LILACS, Ovid (Cochrane), Scopus, and Science Direct for studies conducting functional magnetic resonance imaging (fMRI) in takotsubo patients. After reviewing title/abstract and full text, we selected relevant studies, extracted methodological characteristics, and their main findings, and assessed their risk of bias with the Newcastle-Ottawa scale. We present a narrative review. Results: We included five case-control studies from 600 registries. The risk of bias was low; comparability was the main issue. Resting-state fMRI findings suggest significant differences for the hippocampus, the Insula, the amygdala, and the para-hippocampal gyrus. Task fMRI findings suggest significant differences for the Insula, the superior occipital gyrus, and the amygdala. Studies were heterogeneous about the laterality and directionality of these differences. Conclusion: Brain connectivity alterations involving elements relevant for autonomic control like the Insula and the Amygdala provide evidence in favor of the role of functional networks in the neurocardiology of stress-related cardiomyopathies. However, it is not possible to determine if this role is causal or consequential.

Resumen Antecedentes: Los estudios de neuroimagen funcional podrían ayudar a clarificar la fisiopatología de la miocardiopatía de takotsubo. Objetivo: Revisar la evidencia disponible sobre conectividad funcional cerebral en pacientes con cardiomiopatía de takotsubo. Métodos: Revisión sistemática. Se buscaron en MEDLINE, LILACS, Ovid (Cochrane), Scopus, y ScienceDirect estudios de imagen por resonancia magnética funcional (IRMf) en pacientes con cardiomiopatía de takotsubo. Tras revisar títulos, resúmenes y textos completos se seleccionaron los estudios relevantes, se extrajeron sus características metodológicas y resultados principales, y se valoró su riesgo de sesgo mediante la escala Newcastle-Ottawa. Se presenta revisión narrativa de los resultados. Resultados: Se incluyeron cinco estudios de casos y controles de entre 600 registros. El riesgo de sesgo fue bajo, la comparabilidad fue la principal limitante. Los estudios de IRMf en estado de reposo sugieren diferencias significativas en el Hipocampo, la Ínsula, la Amígdala y el Giro parahipocampal. Los estudios de IRMf bajo paradigma sugieren diferencias en la Ínsula, el Giro occipital superior y en la Amígdala. Los estudios fueron heterogéneos respecto a la lateralización y direccion de estas diferencias. Conclusión: Alteraciones en la conectividad cerebral de zonas relevantes para el control autonómico como la ínsula y la Amígdala provén evidencia a favor del rol de redes funcionales en la neurocardiología de miocardiopatías relacionadas con el estrés. Sin embargo, aún no es posible determinar si esto obedece a un rol causal o consecuencial.

Inequalities in COVID-19 inequalities research: Who had the capacity to respond?

The COVID-19 pandemic has been testing countries' capacities and scientific preparedness to actively respond and collaborate on a common global threat. It has also heightened awareness of the urgent need to empirically describe and analyze health inequalities to be able to act effectively. In turn, this raises several important questions that need answering: What is known about the rapidly emerging COVID-19 inequalities research field? Which countries and world regions have been able to rapidly produce research on this topic? What research patterns and trends have emerged, and how to these compared to the (pre-COVID-19) global health inequalities research field? Which countries have been scientifically collaborating on this important topic? Where are the scientific knowledge gaps, and indirectly where might research capacities need to be strengthened? In order to answer these queries, we analyzed the global scientific production (2020-2021) on COVID-19 associated inequalities by conducting bibliometric and network analyses using the Scopus database. Specifically, we analyzed the volume of scientific production per country (via author affiliations), its distribution by country income groups and world regions, as well as the inter-country collaborations within this production. Our results indicate that the COVID-19 inequalities research field has been highly collaborative; however, a number of significant inequitable research practices exist. When compared to the (pre-COVID-19) global health inequalities research field, similar inequalities were identified, however, several new dynamics and partnerships have also emerged that warrant further in-depth exploration. To ensure preparedness for future crises, and effective strategies to tackle growing social inequalities in health, investment in global health inequalities research capacities must be a priority for all.

Developing diagnostic skills from preclinical dental education: Caries detection and assessment using e-learning assisted practice.

PURPOSE: To evaluate the feasibility of developing visual diagnostic skills for detecting and assessing dental caries using e-learning assisted practice in preclinical dental education. METHODS: A one-group before and after the study was conducted. After a theoretical lesson on cariology, 53 inexperienced second-year preclinical students assessed 78 clinical photographs using the Nyvad criteria; they received automated feedback upon completion of the test. After a week, all students reassessed the same set of photographs, which were randomly reordered. Differential diagnostic accuracy was analyzed category-pairwise, and overall accuracy measures were based on the receiver operator curve. Diagnostic accuracy in both attempts was evaluated and compared through estimation and pooling of individual student accuracies. RESULTS: Pooled category-pairwise accuracy was lower for discriminating Sound surface from Non-cavitated-active caries, and for discriminating inactive caries (surface discontinuity) from intact surface inactive caries and Cavitated-active caries. Pooled overall accuracy, after the theoretical lesson, was 0.79 (95% confidence interval [CI] 0.77-0.81), and it increased to 0.99 (95% CI 0.98-0.99) after feedback. Between-student variability in accuracy was reduced from I2  = 0.66 to 0.55. CONCLUSION: E-learning assisted practice is a feasible alternative to start developing visual diagnostic skills for detecting and assessing dental caries using the Nyvad criteria from preclinical dental education in cariology. However, further studies are required to evaluate its effectiveness in improving real-world practice knowledge and skills.

Desempeño del método de suma de discos comparado con el método bidimensional en la estimación cuantitativa del derrame pericárdico / Performance of the method of disks compared to the bidimensional method in the quantitative estimation of pericardial effusion

Resumen Introducción: La ecocardiografía bidimensional es la técnica más efectiva para el diagnóstico del derrame pericárdico, gracias a sus altas sensibilidad y especificidad. Objetivo: Analizar la superioridad del método de suma de discos comparado con el método bidimensional en la estimación del derrame pericárdico por medio de ecocardiografía, tomando como referencia el volumen de líquido pericárdico extraído por pericardiocentesis o cirugía abierta. Método: Estudio retrospectivo de seguimiento de una cohorte basado en registros médicos y archivos de ecocardiografía. Se empleó un diseño pareado en el que cada imagen fue leída por el método bidimensional y por el método de suma de discos. Se incluyeron derrames pericárdicos graves, definidos clínicamente o por parámetros ecocardiográficos, que requirieran drenaje. El desempeño de los métodos de estimación bidimensional y de suma de discos, tomando como referencia la extracción por intervención, se cuantificó mediante áreas bajo la curva operador-receptor (auROC). Resultados: Se analizaron 40 registros, tomando como referencia el volumen obtenido por extracción; con un auROC de 0.81 (intervalo de confianza del 95% [IC95%]: 0.73-0.89), el desempeño diagnóstico del método de suma de discos fue significativamente mayor (p = 0.0335) que el del método bidimensional (auROC: 0.73; IC95%: 0.63-0.83). La estimación realizada por el método de suma de discos subestimó en promedio 51.3 ml (IC95%: −156.2-53.5). Conclusiones: En pacientes con derrame pericárdico e indicación de drenaje o taponamiento cardíaco, el método de suma de discos es superior en comparación con el método bidimensional en el estudio ecocardiográfico para la estimación cuantitativa del derrame pericárdico, ya que discrimina mejor respecto al método bidimensional.

Abstract Introduction: Two-dimensional echocardiography is the most effective technique for diagnosing pericardial effusion due to its high sensitivity and specificity. Objective: The superiority of the method of disks was compared with the bidimensional method in the estimation of pericardial effusion by echocardiography, taking as reference the volume of pericardial fluid removed by pericardiocentesis or open surgery. Method: Retrospective follow-up study of a cohort, based on medical records and echocardiography files. A paired design was used, each image was read by the bidimensional method and by the method of disks. Severe pericardial effusions defined clinically or by echocardiographic parameters, that required drainage were included. The performance of the bidimensional and disks estimation methods, taking the volume removed as a reference, was quantified using areas under the receiver operating characteristic curve (auROC). Results: 40 records were analyzed, taking as a reference the volume obtained by extraction, with an auROC of 0.81 (95% CI: 0.73-0.89) the diagnostic performance of the disks method was significantly higher (p = 0.0335) than the bidimensional method (auROC 0.73, 95% CI: 0.63-0.83). The estimate made by the disks method underestimated an average of 51.3 ml (95% CI: -156.2-53.5). Conclusions: In patients with pericardial effusion with indication of cardiac drainage or tamponade, the disks method is superior in comparison with the bidimensional method in the echocardiographic study of the quantitative estimation of pericardial effusion, discriminating better than the bidimensional method.

Association Between Frequency and Severity of Dental Fluorosis and Molar Incisor Hypomineralization.

OBJECTIVE: To assess the association between the frequency and severity of dental fluorosis (DF) and molar incisor hypomineralization (MIH) in a fluoridated salt region. STUDY DESIGN: In this retrospective cross-sectional study, we evaluated the buccal, occlusal/incisal, and palatal/lingual surfaces of first permanent molars and permanent incisors of 453 patients aged 13-16 years through intraoral standardized photographs. Two standardized examiners evaluated DF and MIH independently, utilizing the Thylstrup-Fejerskov (TF) index and the MIH index. The statistical analysis was performed using a generalized linear model and logistic regression adjusted for age, sex, and dental caries experience. RESULTS: The MIH frequency at the surface level was lower in the presence of DF (PR= 0.03; P= 0.00, 95% CI: 0.01-0.08). At the surface level, MIH severity was lower among those presenting mild DF (aOR= 0.02; 95% IC: 0.01-0.07). Regarding severe DF, we found no significant difference in MIH severity (P= 0.174). CONCLUSION: MIH frequency and severity tend to be lower in the presence of DF.

Efficacy of Transversus Abdominis Plane Block in the Reduction of Pain and Opioid Requirement in Laparoscopic and Robot-assisted Hysterectomy: A Systematic Review and Meta-analysis.

OBJECTIVE: To summarize the available evidence of TAP Block in efficacy in laparoscopic or robotic hysterectomy. DATA SOURCES: We searched databases and gray literature for randomized controlled trials in which transversus abdominis plane (TAP) block was compared with placebo or with no treatment in patients who underwent laparoscopic or robot-assisted hysterectomy. METHOD OF STUDY SELECTION: Two researchers independently evaluated the eligibility of the selected articles. TABULATION, INTEGRATION, AND RESULTS: Seven studies were selected, involving 518 patients. Early postoperative pain showed a difference in the mean mean difference (MD): - 1.17 (95% confidence interval [CI]: - 1.87-0.46) in pain scale scores (I2 = 68%), which was statistically significant in favor of using TAP block, but without clinical relevance; late postoperative pain: DM 0.001 (95%CI: - 0.43-0.44; I2 = 69%); opioid requirement: DM 0.36 (95%CI: - 0.94-1.68; I2 = 80%); and incidence of nausea and vomiting with a difference of 95%CI = - 0.11 (- 0.215-0.006) in favor of TAP. CONCLUSION: With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that TAP block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores. CLINICAL TRIAL NUMBER AND REGISTRY: PROSPERO ID - CRD42018103573.

OBJETIVO: Resumir as evidências disponíveis sobre a eficácia do bloqueio TAP em histerectomia laparoscópica ou robótica. FONTES DE DADOS: Pesquisamos bancos de dados e literatura cinza por ensaios clínicos randomizados nos quais o bloqueio do plano transverso do abdome (TAP na sigla em inglês) foi comparado com placebo ou com nenhum tratamento em pacientes que foram submetidos a histerectomia laparoscópica ou assistida por robô. MéTODOS DE SELEçãO DE ESTUDOS: Dois pesquisadores avaliaram independentemente a elegibilidade dos artigos selecionados. TABULAçãO, INTEGRAçãO E RESULTADOS: Sete estudos foram selecionados envolvendo 518 pacientes. A dor pós-operatória precoce apresentou diferença nas médias (DM) de: -1 17 (intervalo de confiança [IC] de 95%: - 1 87­0 46) nos escores da escala de dor (I2 = 68%) o que foi estatisticamente significativo a favor do uso do bloqueio TAP mas sem relevância clínica; dor pós-operatória tardia: DM 0001 (IC95%: - 043­044; I2 = 69%); necessidade de opioides: DM 0 36 (95%CI: - 0 94­168; I2 = 80%); e incidência de náuseas e vômitos com diferença de 95% CI = - 011 (- 0215­0006) a favor do TAP. CONCLUSãO: Com moderada força de evidência devido à alta heterogeneidade e ao desequilíbrio nas características basais entre os estudos os resultados indicam que o bloqueio do TAP não deve ser considerado como uma técnica analgésica clinicamente relevante para melhorar a dor pós-operatória em histerectomia laparoscópica ou robótica apesar da significância estatística nas pontuações da escala de dor pós-operatória inicial. NúMERO E REGISTRO DO ENSAIO CLíNICO:: PROSPERO ID - CRD42018103573.

Efficacy of Transversus Abdominis Plane Block in the Reduction of Pain and Opioid Requirement in Laparoscopic and Robot-assisted Hysterectomy: A Systematic Review and Meta-analysis / Eficácia do bloqueio transverso do plano abdominal na redução da dor e da necessidade de opioides em histerectomia laparoscópica e assistida por robô: Uma revisão sistemática e metanálise

Abstract Objective To summarize the available evidence of TAP Block in efficacy in laparoscopic or robotic hysterectomy. Data Sources We searched databases and gray literature for randomized controlled trials in which transversus abdominis plane (TAP) block was compared with placebo or with no treatment in patients who underwent laparoscopic or robot-assisted hysterectomy. Method of Study Selection Two researchers independently evaluated the eligibility of the selected articles. Tabulation, Integration, and Results Seven studies were selected, involving 518 patients. Early postoperative pain showed a difference in the mean mean difference (MD): - 1.17 (95% confidence interval [CI]: - 1.87-0.46) in pain scale scores (I2=68%), which was statistically significant in favor of using TAP block, but without clinical relevance; late postoperative pain: DM 0.001 (95%CI: - 0.43-0.44; I2=69%); opioid requirement: DM 0.36 (95%CI: - 0.94-1.68; I2=80%); and incidence of nausea and vomiting with a difference of 95%CI=- 0.11 (- 0.215-0.006) in favor of TAP. Conclusion With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that TAP block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores. Clinical Trial Number and Registry: PROSPERO ID - CRD42018103573.

Resumo Objetivo Resumir as evidências disponíveis sobre a eficácia do bloqueio TAP em histerectomia laparoscópica ou robótica. Fontes de Dados Pesquisamos bancos de dados e literatura cinza por ensaios clínicos randomizados nos quais o bloqueio do plano transverso do abdome (TAP na sigla em inglês) foi comparado com placebo ou com nenhum tratamento em pacientes que foram submetidos a histerectomia laparoscópica ou assistida por robô. Métodos de Seleção de Estudos Dois pesquisadores avaliaram independentemente a elegibilidade dos artigos selecionados. Tabulação, Integração e Resultados Sete estudos foram selecionados envolvendo 518 pacientes. A dor pós-operatória precoce apresentou diferença nasmédias (DM) de: -1 17 (intervalo de confiança [IC] de 95%: - 1 87-0 46) nos escores da escala de dor (I2=68%) o que foi estatisticamente significativo a favor do uso do bloqueio TAP mas sem relevância clínica; dor pós-operatória tardia: DM 0001 (IC95%: - 043-044; I2=69%); necessidade de opioides: DM0 36 (95%CI: - 0 94-168; I2=80%); e incidência de náuseas e vômitos com diferença de 95% CI=- 011 (- 0215-0006) a favor do TAP. Conclusão Com moderada força de evidência devido à alta heterogeneidade e ao desequilíbrio nas características basais entre os estudos os resultados indicam que o bloqueio do TAP não deve ser considerado como uma técnica analgésica clinicamente relevante para melhorar a dor pós-operatória em histerectomia laparoscópica ou robótica apesar da significância estatística nas pontuações da escala de dor pósoperatória inicial. Número e Registro do Ensaio Clínico: PROSPERO ID - CRD42018103573.

Does molar-incisor hypomineralization (MIH) affect only permanent first molars and incisors? New observations on permanent second molars.

BACKGROUND: The second permanent molar plays an important role when considering extraction of first permanent molars severely affected by molar-incisor hypomineralization (MIH). AIM: To assess the association between MIH and enamel hypomineralization of the second permanent molars in terms of presence and severity. DESIGN: In this retrospective cross-sectional study, permanent teeth were evaluated in 453 patients between the ages of 13 and 16 at a dental clinic, using intraoral photographs. A calibrated examiner classified enamel hypomineralization using the MIH index and dental caries experience using the DMFT and DMFS indices. Statistical analyses were performed using a linear generalized model and ordinal logistic regression. RESULTS: The most commonly affected teeth by enamel hypomineralization were permanent molars, whereas incisors, premolars, and canines were less affected. The presence of severe defects in the first permanent molars was associated with mild defects in the second permanent molars (OR = 4.01; 95% CI: 2.50-7.77). Enamel hypomineralization was associated with increased caries experience (PR = 5.54; 95% CI: 3.81-9.06). CONCLUSION: Enamel hypomineralization mainly affects the first and second permanent molars. Mild defects in the second permanent molars tend to be more frequent in patients with severe MIH in the first permanent molars. The presence of enamel hypomineralization was associated with higher dental caries experience.

Survival of stainless-steel crowns and composite resin restorations in molars affected by molar-incisor hypomineralization (MIH).

BACKGROUND: Currently, there is no consensus on the superiority of any material for the restorative treatment of molars affected by molar-incisor hypomineralization (MIH). AIM: To evaluate the survival of restorations with stainless-steel crown (SSC) or composite resin (CR) in first permanent molars affected by MIH for 24 months. DESIGN: In this retrospective cohort study, 61 CR and 54 SSC restorations placed on molars affected by MIH of patients, aged between 7 and 10, that were treated and overseen at a university dental clinic in the period of 2017-2020 were evaluated. The primary outcome was the failure-free survival time. Parametric survival models were used for data censored by interval, and the comparison between SSC and CR was performed using the hazard ratio function with a 95% confidence interval. RESULTS: The survival of SSC and CR restorations after 24 months was 94.4% and 49.2%, respectively. This difference was influenced by the presence of previous restoration (aHR = 3.4; 95% CI: 1.2-9.4) and cusp involvement (aHR = 4.0; 95% CI: 1.5-11.2). CONCLUSION: In molars with MIH and the need for restorative treatment, SSC had a significantly higher survival rate than CR over 24 months.