Desafíos en el tratamiento de ortodoncia en paciente con síndrome de down, reporte de caso / Challenges in orthodontic treatment in a patient with down syndrome, a case report

RESUMEN: El Síndrome de Down es una condición genética que se identifica por la presencia de un grado variable de discapacidad cognitiva, rasgos y características físicas singulares, que también repercuten a nivel estomatognático. El objetivo de este reporte de caso es reflejar los desafíos terapéuticos que podemos enfrentar para lograr un tratamiento integral en estos pacientes. Madre de paciente consulta por apiñamiento dentario. Presenta enfermedades sistémicas asociadas al Síndrome de Down, alteraciones sensoriales, gingivitis generalizada, lesiones de caries, anomalías dentomaxilares y fibroma traumático en flanco lingual. El tratamiento incluyó adaptación a la atención odontológica, odontología preventiva y restauradora, periodoncia y ortodoncia. Luego de 25 meses de tratamiento, se logró el alta integral, debiendo modificar los objetivos del tratamiento y el manejo terapéutico ortodóncico en diversas ocasiones. Es posible realizar tratamientos integrales en pacientes con Síndrome de Down, considerando una buena adaptación, objetivos alcanzables y trabajo en equipo multidisciplinario.

ABSTRACT: Down Syndrome is a genetic condition identified by the presence of a variable degree of cognitive disability and unique physical characteristics and traits, which also have an impact on the stomatognathic system. The aim of this case report is to report the therapeutic challenges that we can face to achieve a comprehensive treatment. Patient's mothers consult for dental crowding. The patient presents systemic diseases associated with Down Syndrome, sensory anomalies, generalized gingivitis, dental caries lesions, maxillary dental anomalies, and traumatic fibroma in the tongue. The treatment included adaptation to dental care, preventive and restorative dentistry, periodontics and orthodontics. After 25 months of treatment, comprehensive discharge was achieved, with modifications in the treatment objectives and orthodontic therapeutic management in several occasions. Comprehensive treatment in patients with Down Syndrome is possible, considering a good adaptation to the treatment, achievable objectives and multidisciplinary teamwork.

Morbidity and mortality of acute renal failure in the Critical Care Unit of a regional hospital. / Morbimortalidad del fracaso renal agudo en la Unidad de Cuidados Críticos de un hospital comarcal.

OBJECTIVES: The main objective of the study is to perform an analysis on the incidence, predictive variables, and severity of acute kidney injury (AKI) and its impact on the morbidity and mortality of patients in the Resuscitation and Special Care Unit (RSCU) of a regional hospital. METHODS: A retrospective observational study was conducted that included all patients admitted from 1 January 2012 to 1 January 2015 (1,115 patients). The follow-up was until 15 July 2015. A descriptive statistical analysis of clinical-epidemiological and analytical variables was carried out. An analysis was then performed AKI in RSCU and mortality, as well as the agreement between the RIFLE (Risk, Injury, Failure, Loss of Kidney Function, and End-stage Kidney Disease)/AKIN (Acute Kidney Injury Network)/KDIGO (Kidney Disease: Improving Global Outcomes) criteria (kappa index). A multivariate logistic regression analysis was performed to select the variables associated with the presentation of AKI in RSCU and a univariate (Kaplan-Meier) and multivariate survival analysis (Cox regression). The statistical analysis was carried out using the statistical package SPSS 21. RESULTS: During admission to RSCU, 486 patients presented with AKI (43.6%), of which 21% were in stage I, 13.8% in stage II, and in stage III 8.7%. A high level of agreement was observed between the RIFLE/AKIN/KDIGO criteria. The variables that were related to the presence of AKI, are male (OR: 1.37; 95% CI: 1.02-2.30), to high Charlson comorbidity index (OR: 1.17; 95% CI: 1.09-1.26), carriers of chronic kidney disease (OR: 5.99; 95% CI: 4.58-8.18), admission due to surgery (OR: 1.69; 95% CI: 1.24-2.30), and shock (OR: 4.70; 95% CI: 3.34-6.61). The probability of survival during admission in RSCU decreases in patients with AKI (HR: 5.44; 95% CI: 1.70-17.39), and as the individual severity index of Liaño increases (HR: 10.29; 95% CI: 3.34-31.76). The probability of survival at the end of follow-up after hospital discharge decreases in patients with AKI (HR: 1.72; 95% CI: 1.14-2.61), as the individual severity index of Liaño increases (HR: 9,6; 95% CI: 5.07-18.20), the Charlson comorbidity index>6 (HR: 1.09; 95% CI: 1.03-1.15), low serum albumin<2.5mg/dL (HR: 1.69; 95% CI: 1.13-2.53), age by year>70 years (HR: 1.03; 95% CI: 1.01-1.04), males (HR: 1.38; 95% CI: 1.06-1.79) and carriers of previous chronic kidney disease (HR: 1.56; 95% CI: 1.02-2.38). CONCLUSIONS: This study shows the presentation of an episode of AKI was an independent factor associated both with mortality during admission to RSCU, and later after hospital discharge. It is necessary to know the risk factors of this complication in order to adopt preventive measures.

Experience with Guillain-Barré syndrome in a neurological Intensive Care Unit. / Experiencia del síndrome de Guillain-Barré en una Unidad de Cuidados Intensivos neurológicos.

INTRODUCTION: Guillain-Barré syndrome, an acute polyradiculoneuropathy that presents with weakness and areflexia, is the most common cause of acute flaccid paralysis. In certain patients, respiratory failure is secondary to this disorder, eventually causing patients to require mechanical ventilation and experience additional complications due to diminished respiratory support and related mobility limitations. Prognoses for most of these cases are positive; treatment consists of basic support combined with plasmapheresis or administration of immunoglobulins. OBJECTIVE: This study sought to describe the socio-demographic, clinical, laboratory and neurophysiological characteristics of patients with Guillain-Barré syndrome who were hospitalised in the Intensive Care Unit of the Neurological Institute of Colombia between 2006 and 2012. METHODOLOGY: This study presents a case series. RESULTS: We surveyed 25 patients (32% female and 68% male) with Guillain-Barré syndrome and an average age of 54 years. Sixty per cent of these patients were admitted between days 3 and 7 after symptom onset; 64% had a history of respiratory infection and 20% had a history of intestinal infection. In addition, 84% of the patients presented with albuminocytological dissociation. We observed the following clinical subtypes of Guillain-Barré syndrome: inflammatory demyelinating polyneuropathy in 32%, acute motor-sensory axonal neuropathy in 28%, acute motor axonal neuropathy in 28%, and Miller Fisher syndrome in 12%. CONCLUSIONS: In this descriptive study of a group of critical care patients with GBS, results depended on patients' clinical severity at time of admission. Our findings are similar to results published in the international literature.

Guía para el cuidado de la salud oral en pacientes con necesidad de cuidados especiales de salud en México / Guidelines for oral health in patients with special health care needs in Mexico

Promover la prevención primaria y la salud oral integral hacia las personas con necesidad de cuidados especiales de salud, es una parte fundamental de la odontología. Estos individuos constituyen un grupo de riesgo, ya quedesde edades muy tempranas requieren de cuidados dentales especializados. Sin embargo, las medidas de prevención de salud oral dirigidas hacia este colectivo no han sido tan prioritarias como deberían serlo, por lo que médicos y odontólogos se deberían interesaren la importancia de garantizar que todos, incluidos aquellos que requieren de cuidados específicos de salud, tengan el máximo nivel de atención. En este trabajo se hace una revisión de temasrelacionados y se establecen los preceptos sobre el manejo de la salud oral en personas con alguna discapacidad.

Prevalencia de disfagia en unidad decuidados especiales / Prevalence of dysphagia in a special care unit

Introducción: la disfagia, que se define como la dificultad para deglutir los alimentos, sepresenta a cualquier edad y puede tener un origen orgánico, cuando responde a alteracionesestructurales; o funcional, si altera la sinergia del mecanismo de la deglución. La disfagia debe ser diagnosticada lo antes posible y valorada por un especialista para poner en marcha técnicas dedeglución seguras y estrategias dietéticas y de alimentación adecuadas.Objetivo: identificar pacientes con trastornos de la deglución, en una unidad de cuidados especialesy caracterizar las causas directas de dichos trastorno.Sujetos y métodos: se evaluaron 31 pacientes ingresados en una unidad de cuidados especialescon edades entre 18 y 88 años, 14 sujetos fueron de género masculino y 17 de género femenino. La metodología diseñada incluyó la toma de datos dela historia clínica sobre el diagnóstico y motivo de hospitalización y la aplicación de un instrumento para laevaluación de la deglución.Resultados: los diagnósticos de los pacientes evaluadosfueron: cáncer 29 %, ECV 12,9 %, EPOC 12,9 %,TEC 6,5 %. La prevalencia de la disfagia fue 35,5 %, y29 % tenían riesgo de bronco aspiración y requerían usode sonda para nutrición.Conclusiones: los indicios más frecuentes para detectarel trastorno en la deglución fueron dificultad en elmanejo de las propias secreciones, voz húmeda, latenciaen preparar el bolo y lentitud en la elevación laríngea.Los pacientes con mayor tiempo de estancia hospitalaria tuvieron ventilación mecánica prolongada y dificultadespara nutrición por vía oral.

Introduction: Dysphagia is defined as a difficulty to swallow food that can be either organic or functionalin origin. In the former case, it´s caused by tumors or structural alterations of congenital nature; in the lattercase, it affects the synergy of the swallowing process, andcan appear at any age. Dysphagia must be diagnosed as quickly as possible, and a specialist must assess itin order to implement safe swallowing techniques andappropriate dietetic and nutrition strategies.Objective: to identify the patients of a special care unitwho suffer from swallowing disorders and to characterizethe direct causes of such disorders by using the data recordedin their evaluation and clinical history.Subjects and methods: we assessed 31 patients from a special care unit (14 were male and 17 female) whoseages ranged from 18 to 88. Data regarding diagnosisand reasons for hospitalization were taken from the clinical history. Likewise, an instrument was used forswallowing assessment.Results: the diagnosis for the assessed patients was: Cancer: 29 %, CVD 12.9 %, COPD 12.9 %, TBI 6.5%. The prevalence of dysphagia was 35.5%, and 29 %of the subjects had risk of bronchoaspiration, thus requiringa catheter for feeding.Conclusions: the most frequent indications for the presenceof swallowing disorders were: difficulty to handleone’s own secretions, wet voice, delay in preparing thebolus, and slow laryngeal elevation. Patients with longerhospital stay had prolonged mechanical ventilation anddifficulty to feed orally.