Reabsorción ósea en mesialización de molares con miniimplantes: Cadeneta elastomérica versus resorte cerrado. Una revisión de la literatura.

The objective of this literature review was to evaluate bone resorption in mesialization of molars with mini-implants with the use of elastomeric chain or closed spring using Cone Bean Computed Tomography (CBCT) technology and panoramic radiography, with the aim of providing the orthodontist with a bibliographic base on this factor for which variables were evaluated, such as: traction force, amount in millimeters of protraction and degree of bone resorption: The databases were PubMed, Scopus, Chocrane, with the use of verified descriptors in DeCS and MeSH, the conclusion that mesialization performed with a closed spring presented a greater degree of bone resorption, even though the difference was not clinically significant compared to elastomeric chain, More clinical evidence is needed so that this biomechanics can be used in the future to suprime prosthetic overtreatment and improve longevity by giving a functional and multidisciplinary harmony architecture of the stomatognathic system.Esta revisión de la literatura tuvo como objetivo mediante la recopilación de datos bibliográficos evaluar la reabsorción ósea en mesialización de molares anclado a miniimplantes con el uso de cadeneta elastómera y resorte cerrado, analizado mediante tecnología de la tomografía axial computarizada Cone Bean (CBCT) y radiografía panorámica, con la finalidad de dar a conocer al profesional ortodoncista una base bibliográfica acerca de este factor, se evaluaron variables como: la fuerza de tracción, la cantidad en milímetros de protracción y grado de reabsorción ósea, las bases de datos fue PubMed, Scopus, Chocrane, con descriptores verificados en DeCS y MeSH. Se concluye que la mesialización realizada con resorte cerrado presentó mayor grado de reabsorción ósea aunque la diferencia no fue clínicamente significativa comparada con cadeneta elastomérica, se necesita mayor evidencia clínica con el propósito de que ésta biomecánica permita suprimir en un futuro sobretratamientos protésicos y mejorar la longevidad ofreciendo un arquitectura armónica multidisciplinaria del sistema estomatognátic

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030