Injectable Flowable Resin-based Composite Veneers Prior to Ceramic Veneers.

OBJECTIVES: This case report describes the clinical protocols for using injectable flowable resin-based composite veneers without tooth reduction as long-term prototype restorations, followed by conservative feldspathic veneer restorations. CLINICAL CONSIDERATION: The patient's primary concern was to improve her smile. After clinical evaluation, injectable flowable resin composite veneers were recommended as long-term prototypes followed by conservative tooth preparation and ceramic veneers. Flowable composite veneers were created with a transparent silicone index fabricated from a diagnostic wax-up approved by the patient. No tooth reduction was required to place this type of composite veneer. Later, a printed reduction guide was used to provide conservative tooth preparation followed by the cementation of thin feldspathic porcelain veneers under full isolation with a rubber dam. CONCLUSIONS: Injectable flowable resin-based composite veneers can successfully act as long-term esthetic prototypes before ceramic veneers. The outcome of these restorations is very predictable because the diagnostic wax-up anatomy is transferred to the mouth through the transparent silicone index, and they can be placed without tooth reduction. Conservative tooth preparation can be performed on the composite veneers so that minimal tooth structure is removed to maximize the bonding performance of ceramic veneers.

Effects of treatment with monacolin K, berberine and coenzyme Q10 on lipid metabolism in patients with moderate cardiovascular risk / Efectos del tratamiento con un suplemento nutricional a base de monacolina K, berberina y coenzima Q10 (lipoK®) sobre el metabolismo lipídico en pacientes con hipercolesterolemia y riesgo cardiovascular moderado

Objective The use of nutritional supplements to treat hypercholesterolemia is gradually increasing, however further studies on their efficacy and safety are required. Patients and methods The present clinical trial included patients with moderate hypercholesterolemia and cardiovascular risk who were treated either with a nutraceutical preparation containing 3.75mg of monacolin K, 515mg of berberine and 50mg of coenzyme Q10 per tablet (Lipok®) or with a placebo. The clinical and laboratory variables were analyzed at baseline and at three and six months. None of the patients was diabetic, and none was being treated with lipid-lowering drugs or with any other nutritional supplements affecting lipid metabolism. Results In patients of the intervention group and of the placebo group, baseline LDL-C was 134.7mg/dL (14.4) and 138.7mg/dL (15.2), respectively. At three months after treatment start, LDL-C had decreased by 26.1mg/dL (−32.4 to 19.7) and increased by 4.5mg/dL (−1.5 to 10.5) in the respective groups. In the intervention group, a similar decrease in non-HDL-C and total cholesterol was observed, while no significant changes were observed in either group for HDL-C, triglycerides and lipoprotein(a). A good tolerance and safety profile was observed. Conclusion In conclusion, this study demonstrates that the combination of monacolin K, berberine and coenzyme Q10 is effective and safe for treating hypercholesterolemia in patients with a moderate degree of excess LDL-C and cardiovascular risk (AU)

Objetivo El uso de suplementos nutricionales para tratar la hipercolesterolemia está aumentando de forma progresiva; sin embargo son necesarios más estudios sobre su eficacia y seguridad. Pacientes y métodos En el presente ensayo clínico fueron incluidos pacientes con hipercolesterolemia y riesgo cardiovascular moderados que fueron tratados con un preparado nutracéutico que contenía 3,75mg de monacolina K, 515mg de berberina y 50mg de coenzima Q10 por comprimido (Lipok®) o con placebo. Se analizaron las variables clínicas y de laboratorio en situación basal y a los 3 y 6 meses. Ningún paciente era diabético y ninguno seguía tratamiento con fármacos hipolipidemiantes u otros suplementos nutricionales con efectos sobre el metabolismo lipídico. Resultados En los pacientes del grupo de intervención y del grupo placebo, el c-LDL basal era de 134,7mg/dL (14,4) y 138,7mg/dL (15,2), respectivamente. A los 3 meses de tratamiento el c-LDL había disminuido 26,1mg/dL (de –32,4 a 19,7) y aumentado 4,5mg/dL (de –1,5 a 10,5) en ambos grupos, respectivamente. En el grupo de intervención se observó un descenso similar del c-no HDL y del colesterol total, mientras que no ocurrieron cambios significativos en ninguno de los 2 grupos en el c-HDL, los triglicéridos y la lipoproteína (a). Se observó un buen perfil de tolerancia y seguridad. Conclusión Este estudio demuestra que la combinación de monacolina K, berberina y coenzima Q10 es eficaz y segura para tratar la hipercolesterolemia en los pacientes con un grado de exceso de c-LDL y de riesgo cardiovascular moderados (AU)

Effects of treatment with monacolin K, berberine and coenzyme Q10 on lipid metabolism in patients with moderate cardiovascular risk.

OBJECTIVE: The use of nutritional supplements to treat hypercholesterolemia is gradually increasing, however further studies on their efficacy and safety are required. PATIENTS AND METHODS: The present clinical trial included patients with moderate hypercholesterolemia and cardiovascular risk who were treated either with a nutraceutical preparation containing 3.75mg of monacolin K, 515mg of berberine and 50mg of coenzyme Q10 per tablet (Lipok®) or with a placebo. The clinical and laboratory variables were analyzed at baseline and at three and six months. None of the patients was diabetic, and none was being treated with lipid-lowering drugs or with any other nutritional supplements affecting lipid metabolism. RESULTS: In patients of the intervention group and of the placebo group, baseline LDL-C was 134.7mg/dL (14.4) and 138.7mg/dL (15.2), respectively. At three months after treatment start, LDL-C had decreased by 26.1mg/dL (-32.4 to 19.7) and increased by 4.5mg/dL (-1.5 to 10.5) in the respective groups. In the intervention group, a similar decrease in non-HDL-C and total cholesterol was observed, while no significant changes were observed in either group for HDL-C, triglycerides and lipoprotein(a). A good tolerance and safety profile was observed. CONCLUSION: In conclusion, this study demonstrates that the combination of monacolin K, berberine and coenzyme Q10 is effective and safe for treating hypercholesterolemia in patients with a moderate degree of excess LDL-C and cardiovascular risk.

Minimally Invasive Multidisciplinary Restorative Approach to the Esthetic Zone Including a Single Discolored Tooth.

OBJECTIVES: The case report describes a minimally invasive, multidisciplinary approach to a single discolored anterior tooth, with internal bleaching using traditional Japanese paper (Washi), a gingivoplasty with a three-dimensional (3D) printed surgical guide, and ultrathin feldspathic porcelain veneers. CLINICAL CONSIDERATION: The patient's primary concern was improving her smile. After clinical evaluation, internal tooth bleaching for the discolored tooth and gingivoplasty with restoration of the maxillary anterior six teeth and first premolars was recommended. The internal tooth whitening was accomplished with sodium perborate mixed with 30% hydrogen peroxide impregnated in Washi and sealed in the root canal with glass ionomer. Once the tooth bleaching was completed, the 3D printed surgical guide was placed in the patient's maxillary anterior region and used to guide soft tissue recontouring. After 6 months, ultrathin feldspathic porcelain veneers were placed. CONCLUSION: Well-planned restorative procedures combining internal tooth bleaching using Washi, gingivoplasty performed with electrosurgery using a 3D printed surgical guide, and ultrathin feldspathic porcelain veneers can achieve the desired results in the esthetic zone and remain successful for 4 years.

Assessment of Alimentación Normal con Ajuste de Insulina (ANAIS), a Spanish version of the DAFNE programme, in people with Type 1 diabetes: a randomized controlled parallel trial.

AIM: To evaluate the effects of Alimentación Normal con Ajuste de Insulina (ANAIS), a group-based, therapeutic education programme for Type 1 diabetes based on a flexible insulin regimen adjusted to the individual's food intake. METHODS: Participants with Type 1 diabetes and HbA1c levels of 53-86 mmol/mol (7-10%) were recruited from outpatient clinics at a tertiary care centre. They were randomized (using opaque, sealed envelopes, with a 2:1 treatment allocation ratio) to attend the training course immediately (immediate ANAIS; intervention group) or a year later (delayed ANAIS; control group). The main outcome was HbA1c level at 1 year. Secondary outcomes included lipid levels, weight, hypoglycaemic events, insulin dose, treatment satisfaction, self-perceived dietary freedom, quality of life and participant-defined goals. RESULTS: A total of 48 participants were assigned to the intervention group and 32 to the control group. Twelve months after completing the training, adjusted HbA1c was not significantly different in the intervention group [64 ± 1.3 vs 68 ± 1.6 mmol/mol (8.0 ±0.1% vs 8.4 ±0.1%); P=0.081]. Treatment satisfaction was significantly higher in the intervention group, but no differences were found in hypoglycaemic events, weight, insulin dose or changes in dietary freedom. At 1 year after the intervention, 72% of the participants (vs 33% in the control group; P=0.046) reported exceeding their expectations regarding achievement of their main personal goal. CONCLUSION: Promoting dietary freedom and empowering people with Type 1 diabetes through structured education programmes, such as ANAIS, improves treatment satisfaction and self-defined goals. No significant improvement in HbA1c level was achieved.

MUSCLE INFARCTION AND SEVERE DETERIORATION OF RENAL FUNCTION IN A PATIENT WITH TYPE 1 DIABETES MELLITUS AND CHRONIC KIDNEY DISEASE.

CONTEXT: Spontaneous muscle infarction is a rare complication of diabetes mellitus, mainly affecting women and patients with long-lasting type 1 diabetes. OBJECTIVE: This report is aimed to describe the case of a patient with type 1 diabetes and diabetic nephropathy in whom a severe deterioration of renal function was triggered by a muscle infarction. SUBJECT AND METHODS: Subject of the study was a 33-years-old woman with an 18 years history of type 1 diabetes mellitus, proliferative diabetic retinopathy, nephropathy at stage 3 chronic kidney disease, somatic sensory-motor polyneuropathy and autonomic neuropathy. RESULTS: The patient presented with severe pain and dysfunction of the left thigh without prior trauma plus progressive deterioration of the renal function. Nuclear magnetic resonance of the thigh showed inflammatory changes in the external vastus with hyperintensity on T2 sequence and edema of the subcutaneous cellular tissue. After other possible etiologies were ruled out, a clinical diagnosis of spontaneous muscle infarction was established. The patient needed hospital admission for two months, during which the renal function worsened until she required hemodialysis. No other possible triggers of kidney injury were identified. CONCLUSIONS: Up to our knowledge, this is the first described case where muscle infarction is suspected to have caused exacerbation of an existing chronic kidney failure. Monitoring the renal function should be considered in patients with diabetic nephropathy presenting with this rare complication of diabetes.

Hemodiálisis 4 díasa la semana: una alternativa eficaz en el control de la tensión arterial y en alcanzarel peso objetivo posterior a la diálisis / No disponible

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La gripe A (H1N1) en el paciente nefrológico. La pandemia que nos ha puesto en guardia / No disponible

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Depresión ansiosa como causa de hipertensión arterial de difícil control con el tratamiento antihipertensivo convencional / Anxious depression as cause of hypertension that is difficult to control with antihypertensive agents

Presentamos el caso de una mujer estudiada por hipertensión arterial de reciente aparición,sin causas orgánicas que la justifi caran. El tratamiento antihipertensivo no fueefi caz por lo que la paciente acudió en repetidas ocasiones al servicio de urgencias porcrisis hipertensivas junto con cefalea y mareos. Tras instaurar tratamiento ansiolítico,conseguimos normalizar las cifras de presión arterial, así como una mejoría clínica. Nodeberíamos olvidar el componente emocional en los casos de hipertensión arterial esencialde reciente aparición que no responden al tratamiento antihipertensivo(AU)

We present the case of a woman studied due to recent onset high blood pressure, withno known justifying organic cause. The antihypertensive treatment was not effective,the patient repeatedly coming to the Emergency Department due to hypertensiveepisodes together with headache and dizziness. After establishing anxiolytic treatment,her blood pressure normalized and there was clinical improvement. The emotionalcomponent should not be overlooked in those cases of recent onset essential hypertensionthat do not respond to antihypertensive treatment(AU)

Manejo de la hemorragia perioperatoria en el paciente renal / No disponible

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Mejoría de arritmias intradialíticas trasaplicación de perfiles combinados deconductividad y ultrafiltración sin expansión de volumen secundaria / No disponible

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Enfermedad Renal Crónica: novedades y alcance del seguimiento por el médico de Atención Primaria / No disponible

La enfermedad renal crónica (ERC) es un problema de salud pública a nivel mundial, no sólo por el riesgo de progresión hacia la ERC terminal (ERCT) sino también por el elevado riesgo de morbimortalidad, sobre todo de naturaleza cardiovascular. En los últimos años la relevancia epidemiológica de la ERC ha suscitado el interés no sólo de los nefrólogos, sino también de otras áreas de la medicina y muy especialmente de la Atención Primaria. Los objetivos fundamentales de esta presentación son, por un lado valorar el impacto que ha tenido en los últimos años la ERC como problema epidemiológico a nivel de Atención Primaria, y por otro describir las estrategias que se van a emplear para intentar abordar dicho problema. El conocimiento de los factores más relevantes que afectan con la edad a la función renal y, en concreto, al filtrado glomerular (FG), son fundamentales a la hora de definir qué grupo de pacientes tiene un mayor riesgo de mortalidad, de complicaciones cardiovasculares y de progresión hacia la ERCT, facilitando de este modo el manejo conjunto o individualizado de dichos pacientes. Afortunadamente ya disponemos de Guías de Consenso clarificadoras a nivel nacional para abordar conjuntamente el problema. La ERC es un factor amplificador de la mortalidad, no sólo en los pacientes con enfermedad cardiovascular sino también en aquellos con infecciones crónicas y en los pacientes oncológicos. En este sentido las nuevas guías KDIGO recomiendan valorar de modo especial la función renal en dichos pacientes y realizar cardioprotección enérgica desde estadíos iniciales de la ERC (AU)

Chronic kidney disease (CKD) is a public health problem worldwide, not only because of the risk of progression to end-stage kidney disease (ESKD) but also because of the high risk of morbidity and mortality, especially from cardiovascular disease. In recent years, the epidemiological relevance of CKD has not only raised the interest of nephrologists, but of other areas of medicine and in particular of primary care. The primary objectives of this presentation are to assess the impact that CKD has had in recent years as an epidemiological problem in the primary care setting and to describe the strategies that will be used to try to address this problem. Knowledge of the most relevant factors affecting kidney function with age, and specifically glomerular filtration rate (GFR), is essential for defining the patient group at most risk of mortality, cardiovascular complications and progression to ESKD, thereby facilitating overall and individualized management of these patients. Fortunately, we already have clarifying consensus guideline son a national scale to address this problem jointly. CKD in a mortality amplifying factor, not only in patients with cardiovascular disease but also in patients with chronic infections and in cancer patients. In this regard, the new KDIGO guidelines place particular emphasis on the need to assess renal function in these patients and to perform vigorous cardioprotection from the initial stages of CKD (AU)

[Chronic kidney disease: novelties and scope of follow-up by the primary care physician]. / Enfermedad Renal Crónica: Novedades y alcance del seguimiento por el médico de Atención Primaria.

Chronic kidney disease (CKD) is a public health problem worldwide, not only because of the risk of progression to end-stage kidney disease (ESKD) but also because of the high risk of morbidity and mortality, especially from cardiovascular disease. In recent years, the epidemiological relevance of CKD has not only raised the interest of nephrologists, but of other areas of medicine and in particular of primary care. The primary objectives of this presentation are to assess the impact that CKD has had in recent years as an epidemiological problem in the primary care setting and to describe the strategies that will be used to try to address this problem. Knowledge of the most relevant factors affecting kidney function with age, and specifically glomerular filtration rate (GFR), is essential for defining the patient group at most risk of mortality, cardiovascular complications and progression to ESKD, thereby facilitating overall and individualized management of these patients. Fortunately, we already have clarifying consensus guidelines on a national scale to address this problem jointly. CKD in a mortality amplifying factor, not only in patients with cardiovascular disease but also in patients with chronic infections and in cancer patients. In this regard, the new KDIGO guidelines place particular emphasis on the need to assess renal function in these patients and to perform vigorous cardioprotection from the initial stages of CKD.

Genética y ambiente: ¿factores etiopatogénicos de las vasculitis? / No disponible

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Hiponatremia secundaria a síndrome pierde sal cerebral asociado a meningitis bacteriana / No disponible

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