Experience, prevalence, need for treatment and cost of care for caries: A multicenter study in a developing country.

OBJECTIVE: To assess the experience, prevalence, need for treatment and economic impact of caries among students 6-12 years old in four cities in Mexico. BASIC RESEARCH DESIGN: Cross-sectional clinical study. SETTING: Elementary public schools. PARTICIPANTS: 500 schoolchildren aged 6 to 12 years. METHOD: Oral clinical examinations using WHO criteria for caries in the primary (dmft) and permanent (DMFT) dentitions. MAIN OUTCOME MEASURES: Indicators of caries in the primary and permanent dentitions: experience, prevalence, severity and the Significant Caries Index. In addition, we calculated the treatment needs, dental care rate and cost of care. RESULTS: dmft in the primary dentition was 2.59±2.83, and DMFT was 0.82±1.44 in the permanent dentition. Caries prevalence reached 67.7% in the primary and 34.1% in permanent dentition. The treatment needs index was 85.9% and 91.3% in the primary and permanent dentitions, respectively; the dental care index was 13.9% and 8.5%, respectively. The cost of care for caries in the primary dentition was estimated at $22.087 millions of international dollars (PPP US$) when amalgam was the restorative material used, and PPP US$19.107 millions for glass ionomer. For the permanent dentition, the cost was PPP US$7.431 millions when amalgam was used and PPP US$7.985 millions when resin/composite was used as restorative material. CONCLUSIONS: The prevalence and experience of caries in the primary dentition were 50% greater than those of other studies carried out in Mexico. In the permanent dentition they were less. There is considerable need for the treatment of caries and minimal experience with restorative care. The cost of care for caries may be assumed to be high for a health system such as Mexico's.

Minimized analysis of costs applied to antimicrobial consumption in a rural area.

PURPOSE: Antimicrobial agents constitute one of the most utilized groups of drugs in daily clinical practice and, therefore they involve a significant expense. The aim of this study was to evaluate the economic cost of the antimicrobials prescribed in a rural area as well as to search for some cheaper alternatives. METHODS: Retrospective study. The economic cost of antimicrobial agents prescribed at a health centre over 18 months was studied. To do this, clinical histories of 800 people were reviewed. Afterwards, a minimized analysis of costs was carried out. RESULTS: The total cost of antimicrobial consumption came to 2,080.752 pts. The average expenditure per patient came to 6,433.85 +/- 14 269.29 pts. Significant differences between the sexes were not found; however, the expenditure in patients of 65 years of age or over was significantly higher than the rest. After applying the ABC analysis it was noticed that macrolides, cephalosporins, antimicrobial combinations and quinolones were the most important groups from an economic point of view. The use of monodose containers would allow us to save up to 7.83% of the total expenditure. In addition, by prescribing the cheapest marketed pharmaceutical product we could save a further 6.54%, and, finally, by combining these two measures the total possible saving would reach 299,052 pts, a 14.37% of the total expenditure. CONCLUSION: We consider important the elaboration of pharmacoeconomic guides as well as the introduction of monodose containers not only at hospitals but also at community pharmacists.

Analysis of beta-casein-monopalmitin mixed films at the air-water interface.

The surface pressure (pi)-area (A) isotherms and Brewster angle microscopy (BAM) images of monopalmitin and beta-casein mixed films spread on buffered water at pHs 5 and 7 and at 20 degrees C were determined as a function of the mass fraction of monopalmitin in the mixture (X). The structural characteristics and morphology of monopalmitin-beta-casein mixed films are dependent on surface pressure, pH, and monolayer composition. The prevalence of monopalmitin in the interface increases with the amount of monopalmitin in the mixture and at higher pi. At the monopalmitin monolayer collapse the mixed film is practically dominated by the presence of monopalmitin. However, some degree of interactions exist between monopalmitin and beta-casein in the mixed film, and these interactions are more pronounced as the monolayer is compressed at the highest surface pressures.

Adsorption of whey protein isolate at the oil-water interface as a function of processing conditions: a rheokinetic study.

In this paper we present surface dynamic properties (interfacial tension and surface dilational properties) of a whey protein isolate with a high content of beta-lactoglobulin (WPI) adsorbed on the oil-water interface as a function of adsorption time. The experiments were performed at constant temperature (20 degrees C), pH (5), and ionic strength (0.05 M). The surface rheological parameters and the interfacial tension were measured as a function of WPI concentration (ranging from 1 x 10(-)(1) to 1 x 10(-)(5)% w/w) and different processing factors (effect of convection and heat treatment). We found that the interfacial pressure, pi, and surface dilational modulus, E, increase and the phase angle, phi, decreases with time, theta, which should be associated with WPI adsorption. These phenomena have been related to diffusion of the protein toward the interface (at short adsorption time) and to the protein unfolding and/or protein-protein interactions (at long-term adsorption) as a function of protein concentration in solution and processing conditions.

Mortalidad operatoria en vólvulo de sigmoides / Operatory mortality in sigmoid volvulus

Este estudio retrospectivo evaluó a 123 pacientes operados por vólvulo de sigmoides en el Hospital Belén, Trujillo, Perú desde el 01 de enero de 1967 al 31 de diciembre de 1992 con el fin de identificar por análisis univariado la combinación de factores predictivos que influyen en la mortalidad operatoria. Los procedimientos quirúrgicos efectuados fueron destorsión más pexia ( n=19 ), resección intestinal más anastomosis primaria ( n=69 ) y resección más colostomía ( n=35 ), con una mortalidad operatoria de 0 por ciento, 13 por ciento y 31.4 por ciento respectivamente ( p=0.005 ). La mortalidad operatoria para todos los pacientes fue de 19.4 por ciento. Los siguientes parámetros fueron evaluados edad, sexo, tiempo de enfermedad, presión arterial media, recuento leucocitario, tipo de secreción peritoneal, estado del intestino y técnica quirúrgica. El análisis de la mortalidad post-operatoria mostró a los siguientes factores asociados con aumento de la mortalidad: edad mayor que 40 años ( p=0.008 ), presión arterial media menor de 70 mmHg ( p=0.0001 ), presencia de secreción peritoneal purulenta o fecaloide ( p=0.001 ) o evidencia de gangrena asociada a perforación ( p=0.0001 ). No hubo relación estadísticamente significativa entre sexo, tiempo de enfermedad, recuento leucocitario y mortalidad quirúrgica. Nosotros sugerimos que un cirujano debe tener en cuenta todos estos factores de riesgo para la estratificación de pacientes que conduzca a resultados satisfactorios

Further experience with the syndromes produced by coca paste smoking.

Cocaine base or white coca paste was smoked heavily by 188 patients who came to four hospitals of Lima, Peru. The length of hospitalization varied from two days to six months. All patients were admitted because coca paste smoking had become a serious problem for their health or for social adjustment. Coca paste was smoked mixed with tobacco or marihuana. The main symptoms were anxiety mingled with euphoria and a rapidly developing compulsion to continue smoking. Frequently the patients developed irritability, illusions, hallucinations. When the use of the drug was heavy and continued for many hours or several days, the patients developed successively four stages of psychological reaction: euphoria, dysphoria, hallucinosis, and acute paranoid psychosis. The main symptoms and signs of all of these phases are discussed.