Healing of 295 Endodontic Microsurgery Cases After Long-Term (5-9 Years) Versus Middle-Term (1-4 Years) Follow-up

Introduction: Some evidence suggests that teeth treated with endodontic surgery and considered to have healed over the short term are seen to relapse when evaluated again after 3 or more years. However, long-term evidence is limited. This study compares healing after endodontic microsurgery over long-term (5–9 years) vs middle-term (1–4 years) follow-up and assesses the influence of different healing predictors over time. Methods: A retrospective study was made, comparing the endodontic microsurgery healing rates after 1–4 vs 5–9 years of follow-up. Healing was assessed based on clinical and radiographic parameters. Simple binary logistic regression models were used to analyze the influence of patient age and gender, the type of tooth, previous radiographic lesion size, apical extent of previous root canal filling, the presence of a post, type of restoration, and interproximal bone level upon the endodontic microsurgery healing rate. A sensitivity analysis was used excluding cases of vertical root fracture. Two calibrated observers independently evaluated the periapical radiographs. Results: A total of 332 patients (60% women and 40% men) were included in the study. Of the 332 analyzed teeth, 198 were subjected to middle-term follow-up (1–4 years), with a healing rate of 86.9%, while 134 were subjected to long-term follow-up (5–9 years), with a healing rate of 67.2%. There were no statistically significant differences in terms of gender, age, type of tooth, size of the lesion, apical extent of previous root canal filling, presence of a post, or type of restoration. The regression models identified 2 statistically significant associations: cohort and interproximal bone level (P , .05). Conclusions: A success rate of 86.9% was recorded after 1-4 years of follow-up, vs 67.2% after 5–9 years. Excluding cases of vertical root fractures, in the shortest follow-up cohort (1–4 years), the healing rate was 92.5%, vs 82.6% in the cohort with longer follow-up (5–9 years). The prognosis was influenced by the crestal bone level in relation to the cementoenamel junction of the tooth, being significantly poorer when probing depth was .3 mm mesial or distal to the treated toothOdontologí

Mejoramiento del plan de inducción y entrenamiento de personal de la empresa Asiserver.Com en la Argentina Huila - 2022

En la construcción del presente informe se lleva a cabo un estudio de opción de grado donde plasmamos el propósito de adquirir el diploma de futuros administradores de empresa, del mismo modo le brindamos a la microempresa que se ha venido investigando desde la primera fase del curso un plan de mejoramiento sobre el proceso de inducción y entrenamiento el cual se ha puesto en marcha para el mejoramiento de un sistema con mejoras en sus estructuras que vayan al alineamiento de la empresa, para adquirir un cuerpo de recursos humanos capacitados y que cumplan las directrices y parámetros requeridos por la compañía. De este mismo modo en cada proceso de la construcción del informe se tuvieron diversas expectativas por parte de los participantes para que ellos contara con los conocimientos previos sobre la organización, sus políticas, deberes, objetivos, su historia y procesos de gestión en el mercado, para lograr una administración controlada en la evolución de las diversas habilidades dónde se pueda evidenciar una mejor productividad del cumplimiento de las actividades otorgadas en la empresa; Del mismo modo contar con ayudantes que sean comprometidos, eficaces, competitivos, con sentido de pertenencia organizacional y que sean un cuerpo de mano de obra rentable y productivo para la empresa que los acoge, y que a la vez reciban los instrumentos y herramientas la información que requieren para proceder de manera exhaustiva con las funciones que se les asigne, logrando que cada personal se sienta privilegiado de pertenecer a la empresa para la cual hace parte. En la medida que se llevó a cabo la investigación de la mejora ante el planteamiento del problema de la empresa se planteó que para brindarle solución se debe debería construir un método descriptivo cualitativo donde se identifiquen de manera descriptiva una trazabilidad de los procesos identificando las deficiencias y debilidades que permanecen latentes en el flujo organizacional Así mismo descubrir Cuáles son los recursos qué pueden emplearse para formular planteamientos con diferentes enfoques de mejora, dónde se hará uso de una herramienta de recolección de datos como lo son las entrevistas dónde nos podemos enterar de manera directa con los empleados cuáles han sido sus experiencias al momento de tener un ingreso a la empresa, cuáles han sido sus opiniones al momento de recibir una inducción y entrenamiento laboral, y que podrían ellos opinar para mejorar de forma interna que este proceso sea mayor calificado al momento de volver aplicar este métodoIn the construction of this report, a degree options study is carried out where we capture the purpose of acquiring the diploma of future business administrators, in the same way, we offer the micro-enterprise that has been investigated since the first phase of the course an improvement plan on the induction and training process which has been launched for the improvement of a system with improvements in its structures that go to the alignment of the company, to acquire a body of trained human resources that comply with the guidelines and parameters required by the company. In the same way, in each process of the construction of the report, different expectations were held by the participants so that they would have prior knowledge about the organization, its policies, duties, objectives, history, and management processes in the market. to achieve a controlled administration in the evolution of the various skills where better productivity of the fulfillment of the activities granted in the company can be evidenced; In the same way, having assistants who are committed, effective, competitive, with a sense of organizational belonging and who is a profitable and productive workforce for the company that hosts them, and who at the same time receive the instruments and tools and information that they require to proceed exhaustively with the functions assigned to them, making each staff feel privileged to belong to the company for which they are part. To the extent that the investigation of the improvement was carried out before the approach to the company's problem, it was stated that in order to provide a solution, a qualitative descriptive method should be built where traceability of the processes is identified in a descriptive way, identifying the deficiencies and weaknesses that remain latent in the organizational flow Also discover what are the resources that can be used to formulate approaches with different improvement approaches, where a data collection tool such as interviews will be used where we can find out directly with the employees what their experiences have been at the time of joining the company, what their opinions have been at the time of receiving an induction and job training, and what could they say to improve internally that this process could be more qualified at the moment to apply this method again

Use of the Storyboarder Tool to Reduce the Attitude Towards Machismo in High School Adolescents

Machismo is a behavior learned as a consequence of dominant cultures, it remains in force in today's society, causing discrimination towards the female gender through actions and derogatory words in relation to their weakness, physical and psychological abuse is the most characteristic relevant. Therefore, this article aims to determine to what extent the use of the Storyboarder tool reduces the attitude towards machismo in high school adolescents at the Las Delicias Educational Unit in the city of Santo Domingo. To this end, the research was framed in a quantitative approach, with a quasi-experimental design, based on real situations. The population was made up of 124 second-year high school students from the "Las Delicias" Educational Unit. The sample was 40 students (20 experimental group and 20 control group). The type of sampling is intentional non-probabilistic. A survey-type instrument was applied aimed at students from 14 years of age and older, called the Attitudes Towards Machismo Scale and includes 46 items, made up of five dimensions, under a Likert-type scaling. The instrument was subjected to expert assessment, its reliability once the pilot test was carried out was 0.93 coefficient on the Cronbach scale, it was possible to conclude that when the intervention was carried out with the Storyboarder tool, the majority of the students showed a low attitude, which indicates a positive change in their perception and disposition towards the subject of study

Tocilizumab in refractory Caucasian Takayasu's arteritis: a multicenter study of 54 patients and literature review

Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) was performed. Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5-50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0-31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5-50.0) to 5.0 (0.0-5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0-14.0) months. Twenty-three (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZCOMBO were younger [38.0 (27.0-46.0) versus 45.0 (38.0-57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0-38.0) versus 6.0 (1.0-23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7-5.6) versus 1.3 (0.3-3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal. Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.Funding: This work was partially supported by RETICS Programs, RD08/0075 (RIER), RD12/0009/0013 and RD16/0012 from “Instituto de Salud Carlos III” (ISCIII) (Spain)

Hospital-based proton therapy implementation during the COVID pandemic: early clinical and research experience in a European academic institution

Introduction A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efcient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. Methods A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities’ recommendations. The temporary trends of patients care and research projects proposals were registered. Results 3 out of 14 members of the professional staf involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientifc production was adapted to the pandemic evolution and its infuence upon professional time availability. Seven research projects based in public funding were activated in this period and preliminary data on molecular imaging guided proton therapy in brain tumors and post-irradiation patterns of blood biomarkers are reported. Conclusions Hospital-based PBT in European academic institutions was impacted by COVID-19 pandemic, although clinical and research activities were developed and sustained. In the post-pandemic era, the benefts of online learning will shape the future of proton therapy education

Autoantibodies against MHC class I polypeptide-related sequence A are associated with increased risk of concomitant autoimmune diseases in celiac patients

Background: Overexpression of autologous proteins can lead to the formation of autoantibodies and autoimmune diseases. MHC class I polypeptide-related sequence A (MICA) is highly expressed in the enterocytes of patients with celiac disease, which arises in response to gluten. The aim of this study was to investigate anti-MICA antibody formation in patients with celiac disease and its association with other autoimmune processes. Methods: We tested serum samples from 383 patients with celiac disease, obtained before they took up a gluten-free diet, 428 patients with diverse autoimmune diseases, and 200 controls for anti-MICA antibodies. All samples were also tested for anti-endomysium and anti-transglutaminase antibodies. Results: Antibodies against MICA were detected in samples from 41.7% of patients with celiac disease but in only 3.5% of those from controls (P <0.0001) and 8.2% from patients with autoimmune disease (P <0.0001). These antibodies disappeared after the instauration of a gluten-free diet. Anti-MICA antibodies were significantly prevalent in younger patients (P <0.01). Fifty-eight patients with celiac disease (15.1%) presented a concomitant autoimmune disease. Anti-MICA-positive patients had a higher risk of autoimmune disease than MICA antibody-negative patients (P <0.0001; odds ratio = 6.11). The risk was even higher when we also controlled for age (odds ratio = 11.69). Finally, we found that the associated risk of developing additional autoimmune diseases was 16 and 10 times as high in pediatric patients and adults with anti-MICA, respectively, as in those without. Conclusions: The development of anti-MICA antibodies could be related to a gluten-containing diet, and seems to be involved in the development of autoimmune diseases in patients with celiac disease, especially younger ones

Cancer Genes Hypermethylated in Human Embryonic Stem Cells

Developmental genes are silenced in embryonic stem cells by a bivalent histone-based chromatin mark. It has been proposed that this mark also confers a predisposition to aberrant DNA promoter hypermethylation of tumor suppressor genes (TSGs) in cancer. We report here that silencing of a significant proportion of these TSGs in human embryonic and adult stem cells is associated with promoter DNA hypermethylation. Our results indicate a role for DNA methylation in the control of gene expression in human stem cells and suggest that, for genes repressed by promoter hypermethylation in stem cells in vivo, the aberrant process in cancer could be understood as a defect in establishing an unmethylated promoter during differentiation, rather than as an anomalous process of de novo hypermethylation

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis