Informe de pasantía internacional Argentina - Uruguay julio de 2010

Este trabajo es un informe de la pasantía en Argentina y Uruguay en el que se hace una descripción detallada de las actividades agropecuarias de ambos países

Efectividad del anclaje esquelético temporal para el cierre de espacios: Revisión sistemática de literatura.

Introducción y Objetivo: El manejo del anclaje es fundamental para el éxito del tratamiento en ortodoncia fi ja, sin embargo no hay consenso acerca de la efectividad del anclaje esquelético para la retracción de los dientes anteriores. El objetivo fue evaluar la efectividad del anclaje esquelético para el cierre de espacios en el arco maxilar. Materiales y Métodos: Se realizó una revisión sistemática de literatura a partir de las bases de datos PubMed, Lilacs, Cochrane, Scielo. Se incluyeron ensayos clínicos controlados, donde el anclaje esquelético fuera utilizado para el cierre de espacios; tres revisores analizaron los resúmenes y textos completos para considerar el cumplimiento de los criterios de inclusión y exclusión de manera independiente, en un formato de extracción de datos. Resultados: Se identifi caron 324 artículos, de los cuales 316 fueron rechazados después de la evaluación, de los ocho estudios inicialmente seleccionados, cinco fueron excluidos. Sólo tres estudios cumplieron con los criterios de inclusión. Se realizó un metanálisis con el método de efectos aleatorios para el movimiento mesial del molar superior, en el cual los dispositivos de anclaje esquelético temporal mostraron ser más efectivos en el control del anclaje en -2,72 mm (-4,10,- 1,33 IC95%) al compararlos con los métodos de anclaje ortodóntico convencional, esta diferencia fue estadísticamente signifi cativa. Conclusiones: El anclaje esquelético temporal parece ser más efectivo para controlar el movimiento mesial del molar durante el cierre de espacios, comparado con el anclaje ortodóntico convencional, sin embargo la evidencia científi ca en la literatura es escasa.Introduction and Objetive: Anchorage management is essential for successful fi xed orthodontic treatment; however there is no consensus about the effectiveness of skeletal anchorage for anterior teeth retraction. The aim of this review was to evaluate the effectiveness of skeletal anchorage for space closure in the maxillary arch. Materials and Methods: A systematic review of the literature was performed in PubMed, Cochrane, Lilacs, Scielo databases. Controlled clinical trials were included, where skeletal anchorage was used for space closure. Three reviewers examined the abstracts and full texts to determine fulfi llment of the inclusion and exclusion criteria independently in a data extraction form. Results: 324 papers, out of which 316 were excluded after the evaluation of title and abstract of the eight initially selected trials. Only three trials met the inclusion criteria. A meta-analysis was performed with a random effects method for the mesial movement of upper molars in which the temporary skeletal anchorage devices showed to be more signifi cantly more effective in controlling anchorage -2,7 mm (-4,10,-1,33 CI 95%) when compared to the conventional anchorage control methods. Conclusions: Temporary skeletal anchorage seems to be more effective in controlling the movement of molars during mesial space closure, when compared to the conventional orthodontic anchorage although evidence in the literature is limited

Prevalencia de trastornos de la articulación temporomandibular según los criterios diagnósticos para la investigación en pacientes preortodónticos /Prevalence of Temporomandibular Disorders based on Diagnostic Research Criteria on Pre-Orthodontic Patients

Antecedentes: es necesario evaluar la condición articular antes de iniciar el tratamiento de ortodoncia para establecer el pronóstico del tratamiento. Objetivo: determinar la prevalencia de los trastornos de la articulación temporomandibular (TTM) según los criterios diagnósticos para la investigación (CDI/TTM) en una población de pacientes preortodónticos. Métodos: estudio descriptivo de corte transversal. La muestra consistió en 158 pacientes (100 mujeres y 58 hombres), promedio de edad: 26,32 ± 9,089 años, que acudieron para tratamiento ortodóntico; previa calibración teórica y clínica, tres investigadores aplicaron el instrumento CDI/TTM, que evalúa clínicamente trastornos musculares, articulares y otras alteraciones articulares (eje I) y el perfil psicosocial: dolor crónico, somatización, depresión y limitación del funcionamiento mandibular (eje II). Resultados: la prevalencia de TTM fue de 38 % (n = 60); los más frecuentes corresponden a los trastornos articulares (n = 55). El diagnóstico combinado muscular y articular se presentó en 1,3 % (n = 2). No se identificó diagnóstico de TMM en 62 % (n = 98). El promedio de edad para los pacientes con diagnóstico de TTM fue de 28,95 años (± 10,32), mayor que el promedio de edad de los que no presentaron diagnóstico con 24,71 años (± 7,86); esta diferencia fue estadísticamente significativa (p = 0,008). La mayor proporción de gravedad del dolor crónico fue grado 0 (96,8 %; n = 153). Se presentó asociación estadísticamente significativa (p = 0,01) entre diagnóstico simple y escala de dolor crónico grado 0. El 49,1 % (n = 27) de los pacientes con diagnóstico de trastorno articular reportaron limitación en el funcionamiento mandibular. Conclusión: los CDI/TTM son una herramienta útil y sencilla para identificar los TTM en pacientes preortodónticos. Background: Is necessary to assess the joint condition before initiating orthodontic treatment to determine the prognosis of the treatment. Objective: To determine the prevalence of Temporomandibular Joint Disorders (TMD) according to the Research Diagnostic Criteria (RDC/TMD) in a preorthodontic patient population. Methods: A descriptive cross-sectional study was designed. The sample consisted of 158 patients (58 men and 100 women), mean age: 26.32±9.089 years, who came for orthodontic treatment. After a theoretical and clinical calibration, three researchers applied the instrument RDC/TMD, which clinically evaluates muscle and joint disorders and/or other joint alterations (Axis I) and the psychosocial profile: chronic pain, somatization, depression, and restrained mandibular function (Axis II). Results: The prevalence of TMD was 38% (n=60), the most common temporomandibular joint disorders correspond to (n=55). The combined muscle and joint diagnosis occurred in 1.3% (n=2). Not identified TMM diagnosis in 62% (n=98). The average age for patients diagnosed with TMD, was 28.95 years (± 0.32), higher than the average age of diagnosis showed that 24.71 years (±7.86), this difference was statistically significant (p=0.008). The higher proportion of chronic pain severity was grade 0 (96.8%; n=153). Presented statistically significant (p=0.01) between simple diagnosis of chronic pain scale grade 0. 49.1% (n=27) of patients diagnosed with TMJ disorders reported limitation in jaw function. Conclusion: RDC/TMD is a useful and easy-to-use tool for identifying TMD in preorthodontic patients.

Prevalencia de trastornos de la articulación temporomandibular según los criterios diagnósticos para la investigación en pacientes preortodónticos /Prevalence of Temporomandibular Disorders based on Diagnostic Research Criteria on Pre-Orthodontic Patients

Antecedentes: es necesario evaluar la condición articular antes de iniciar el tratamiento de ortodoncia para establecer el pronóstico del tratamiento. Objetivo: determinar la prevalencia de los trastornos de la articulación temporomandibular (TTM) según los criterios diagnósticos para la investigación (CDI/TTM) en una población de pacientes preortodónticos. Métodos: estudio descriptivo de corte transversal. La muestra consistió en 158 pacientes (100 mujeres y 58 hombres), promedio de edad: 26,32 ± 9,089 años, que acudieron para tratamiento ortodóntico; previa calibración teórica y clínica, tres investigadores aplicaron el instrumento CDI/TTM, que evalúa clínicamente trastornos musculares, articulares y otras alteraciones articulares (eje I) y el perfil psicosocial: dolor crónico, somatización, depresión y limitación del funcionamiento mandibular (eje II). Resultados: la prevalencia de TTM fue de 38 % (n = 60); los más frecuentes corresponden a los trastornos articulares (n = 55). El diagnóstico combinado muscular y articular se presentó en 1,3 % (n = 2). No se identificó diagnóstico de TMM en 62 % (n = 98). El promedio de edad para los pacientes con diagnóstico de TTM fue de 28,95 años (± 10,32), mayor que el promedio de edad de los que no presentaron diagnóstico con 24,71 años (± 7,86); esta diferencia fue estadísticamente significativa (p = 0,008). La mayor proporción de gravedad del dolor crónico fue grado 0 (96,8 %; n = 153). Se presentó asociación estadísticamente significativa (p = 0,01) entre diagnóstico simple y escala de dolor crónico grado 0. El 49,1 % (n = 27) de los pacientes con diagnóstico de trastorno articular reportaron limitación en el funcionamiento mandibular. Conclusión: los CDI/TTM son una herramienta útil y sencilla para identificar los TTM en pacientes preortodónticos. Background: Is necessary to assess the joint condition before initiating orthodontic treatment to determine the prognosis of the treatment. Objective: To determine the prevalence of Temporomandibular Joint Disorders (TMD) according to the Research Diagnostic Criteria (RDC/TMD) in a preorthodontic patient population. Methods: A descriptive cross-sectional study was designed. The sample consisted of 158 patients (58 men and 100 women), mean age: 26.32±9.089 years, who came for orthodontic treatment. After a theoretical and clinical calibration, three researchers applied the instrument RDC/TMD, which clinically evaluates muscle and joint disorders and/or other joint alterations (Axis I) and the psychosocial profile: chronic pain, somatization, depression, and restrained mandibular function (Axis II). Results: The prevalence of TMD was 38% (n=60), the most common temporomandibular joint disorders correspond to (n=55). The combined muscle and joint diagnosis occurred in 1.3% (n=2). Not identified TMM diagnosis in 62% (n=98). The average age for patients diagnosed with TMD, was 28.95 years (± 0.32), higher than the average age of diagnosis showed that 24.71 years (±7.86), this difference was statistically significant (p=0.008). The higher proportion of chronic pain severity was grade 0 (96.8%; n=153). Presented statistically significant (p=0.01) between simple diagnosis of chronic pain scale grade 0. 49.1% (n=27) of patients diagnosed with TMJ disorders reported limitation in jaw function. Conclusion: RDC/TMD is a useful and easy-to-use tool for identifying TMD in preorthodontic patients.

Prevalencia de trastornos de la articulación temporomandibular según los criterios diagnósticos para la investigación en pacientes preortodónticos /Prevalence of Temporomandibular Disorders based on Diagnostic Research Criteria on Pre-Orthodontic Patients

Antecedentes: es necesario evaluar la condición articular antes de iniciar el tratamiento de ortodoncia para establecer el pronóstico del tratamiento. Objetivo: determinar la prevalencia de los trastornos de la articulación temporomandibular (TTM) según los criterios diagnósticos para la investigación (CDI/TTM) en una población de pacientes preortodónticos. Métodos: estudio descriptivo de corte transversal. La muestra consistió en 158 pacientes (100 mujeres y 58 hombres), promedio de edad: 26,32 ± 9,089 años, que acudieron para tratamiento ortodóntico; previa calibración teórica y clínica, tres investigadores aplicaron el instrumento CDI/TTM, que evalúa clínicamente trastornos musculares, articulares y otras alteraciones articulares (eje I) y el perfil psicosocial: dolor crónico, somatización, depresión y limitación del funcionamiento mandibular (eje II). Resultados: la prevalencia de TTM fue de 38 % (n = 60); los más frecuentes corresponden a los trastornos articulares (n = 55). El diagnóstico combinado muscular y articular se presentó en 1,3 % (n = 2). No se identificó diagnóstico de TMM en 62 % (n = 98). El promedio de edad para los pacientes con diagnóstico de TTM fue de 28,95 años (± 10,32), mayor que el promedio de edad de los que no presentaron diagnóstico con 24,71 años (± 7,86); esta diferencia fue estadísticamente significativa (p = 0,008). La mayor proporción de gravedad del dolor crónico fue grado 0 (96,8 %; n = 153). Se presentó asociación estadísticamente significativa (p = 0,01) entre diagnóstico simple y escala de dolor crónico grado 0. El 49,1 % (n = 27) de los pacientes con diagnóstico de trastorno articular reportaron limitación en el funcionamiento mandibular. Conclusión: los CDI/TTM son una herramienta útil y sencilla para identificar los TTM en pacientes preortodónticos. Background: Is necessary to assess the joint condition before initiating orthodontic treatment to determine the prognosis of the treatment. Objective: To determine the prevalence of Temporomandibular Joint Disorders (TMD) according to the Research Diagnostic Criteria (RDC/TMD) in a preorthodontic patient population. Methods: A descriptive cross-sectional study was designed. The sample consisted of 158 patients (58 men and 100 women), mean age: 26.32±9.089 years, who came for orthodontic treatment. After a theoretical and clinical calibration, three researchers applied the instrument RDC/TMD, which clinically evaluates muscle and joint disorders and/or other joint alterations (Axis I) and the psychosocial profile: chronic pain, somatization, depression, and restrained mandibular function (Axis II). Results: The prevalence of TMD was 38% (n=60), the most common temporomandibular joint disorders correspond to (n=55). The combined muscle and joint diagnosis occurred in 1.3% (n=2). Not identified TMM diagnosis in 62% (n=98). The average age for patients diagnosed with TMD, was 28.95 years (± 0.32), higher than the average age of diagnosis showed that 24.71 years (±7.86), this difference was statistically significant (p=0.008). The higher proportion of chronic pain severity was grade 0 (96.8%; n=153). Presented statistically significant (p=0.01) between simple diagnosis of chronic pain scale grade 0. 49.1% (n=27) of patients diagnosed with TMJ disorders reported limitation in jaw function. Conclusion: RDC/TMD is a useful and easy-to-use tool for identifying TMD in preorthodontic patients.

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society