Estrategias diagnósticas y terapéuticas de los dentistas españoles en las lesiones profundas de caries

La caries dental es una de las enfermedades de mayor prevalencia en nuestra población. En los últimos años se ha actualizado el enfoque de la caries como enfermedad, los planteamientos diagnósticos y el tratamiento de las lesiones de caries. Esta puesta al día en cariología y operatoria dental tiene un enorme interés práctico y debe ser incorporada por el dentista en su práctica clínica diaria. Los resultados obtenidos en estudios realizados en América y Europa Central y Norte son especialmente preocupantes, en cuanto a la toma de decisiones terapéuticas en casos de lesiones profundas de caries. Sin embargo, ningún estudio ha investigado este tema en el sur de Europa. En concreto, en España hasta la fecha en la que se llevó a cabo el presente trabajo de investigación, no se había publicado ningún estudio para proporcionar datos actualizados sobre el manejo de las lesiones profundas de caries por los odontólogos. Por lo tanto, no se sabía si los dentistas españoles habían incorporado en su práctica clínica diaria los enfoques terapéuticos actuales mínimamente invasivos, basados en la evidencia científica, para la eliminación de tejido cariado y preservación de la salud pulpar. La magnitud del problema y la importancia de desarrollar estrategias que ayuden al profesional de la salud oral a la implementación e incorporación de de los nuevos enfoques en cariología basados en la evidencia científica, hacen sumamente necesario realizar estudios epidemiológicos y encuestas sobre los conocimientos y hábitos del odontólogo en el manejo de las lesiones profundas de caries para detectar posibles necesidades y en base a ellas, poder diseñar estrategias que ayuden a su actualización en beneficio de la salud oral del paciente y del resultado de los tratamientos que se llevan a cabo. El objetivo general de esta Tesis Doctoral fue realizar una encuesta para investigar los conocimientos, los criterios de diagnóstico y las decisiones terapéuticas de los odontólogos sobre el abordaje conservador de las lesiones de caries profundas. La hipótesis nula propuesta fue que las lesiones de caries profundas se abordan de acuerdo con los conocimientos y principios derivados de la evidencia científica actual y las recomendaciones de las diferentes sociedades científicas. Para del cumplimiento objetivo general propuesto se plantearon los siguientes objetivos concretos: 1.- Investigar los criterios de diagnóstico y las decisiones de tratamiento en el manejo de las lesiones de caries profundas de los odontólogos españoles (Capítulo I). 2.- Determinar los conocimientos y actitudes de los odontólogos españoles sobre los factores determinantes del abordaje conservador de dientes con pulpitis reversible y lesiones de caries profundas. (Capítulo II)

Dentist´s knowledge, attitudes and determining factors of the conservative approach in teeth with reversible pulpitis and deep caries lesions

The aim of this study was to investigate dentists` knowledge, attitudes and factors regarding the conservative approach in the management of deep caries lesions (DCLs) in teeth with reversible pulpitis. 187 dentists were contacted directly or by mail, and 125 (67%) were finally included in the study. Dentists were requested to answer an open/discursive questionnaire about the routine approach to the diagnosis and treatment of DCLs, including knowledge-related attitudinal items. Total caries excavation was the preferred treatment option for more than 80% of dentists in case of DCL with reversible pulpitis. Only a small percentage (8%) chose partial caries removal, leaving some carious dentin close to the pulp to avoid pulp exposure. More than a half (51%) of respondents considered that cariogenic microorganisms must be removed or caries would progress. Dentists teaching at the University strongly disagreed with this statement (OR = 4.6; 95% C.I. = 1.3 ? 15.8; p = 0.017). Good clinical result was the most chosen reason (83%) to choose a specific treatment. Patient?s oral health (84%) and patient?s age (70%) were the two patient-related factors most taken into account for the choice of treatment. Total caries excavation is still the most frequently chosen treatment in teeth with DCL and reversible pulpitis. The joint assessment of the answers given by respondents allows to conclude that the new knowledge and concepts about caries lesions and the more conservative approach to DCLs have not still been incorporated by dentists into their usual clinical practice

Criteria and treatment decisions in the management of deep caries lesions : is there endodontic overtreatment?

The aim of this study was to investigate the diagnostic criteria and treatment decisions in the management of deep caries lesions (DCLs). The null hypothesis tested was that DCLs are managed according to the current scientific evidence. A total of 288 dentists were contacted directly or by mail, and 125 (43%) were included in the study. Dentists were requested to answer a questionnaire about the routine approach to the diagnosis and treatment of DCLs. Logistic regression analyses were carried out to calculate odds ratios (OR). Pulp sensitivity tests were used by 65% of dentists when assessing pulpal health in cases of DCLs, particularly those who had followed courses in cariology (OR = 3.8; p = 0.005). Dentine hardness was the most frequent criterion used during DCLs excavation (98%). Two thirds of the respondents (65%) removed carious tissue until they felt hard dentine, and feeling hard dentine correlated with caries removal even at the risk of pulpal exposure (OR = 15.8; p = 0.0000). Acute transient pain or sensitivity to cold or heat (reversible pulpitis) were considered by 58% of respondents as a reason to provide endodontic therapy. The null hypothesis tested is rejected. The evidence-based more conservative approach on the management of DCLs is not being translated to clinical dentistry. Root canal treatment is being indicated in cases of DCLs in which the diagnosis is reversible pulpitis. Likewise, it can be concluded that non-conservative management of DCLs, with endodontic overtreatment, could be occurring

Educational intervention on smoking habits in patients of the Medical Clinic 60 of "Luis Augusto Turcios Lima" University Polyclinic

A longitudinal, prospective study of educational intervention was carried out in the family medical office No. 60 belonging to the University Polyclinic "Luis A. Turcios Lima" of the Pinar del Río municipality of this province, in the period from January 2020 to December 2020, with the purpose of raising the level of knowledge about smoking among patients with this habit. The universe of the research was formed by the totality (102) of smoking patients older than 15 years old and the sample after applying the exclusion criteria was formed by 87 patients. A survey and knowledge test were applied and the "Smoke-free" educational program was designed to meet the patients' learning needs, after which it was applied using educational and affective-participative techniques to achieve active participation. At the end of the intervention, a knowledge test was applied to compare the results. The data were processed in tables, the Chi-square test (X2), MacNemar test and distribution in absolute and relative frequencies were used and statistical significance and relationship of these variables was determined with a significance level of 95 % certainty. The level of knowledge about the risks and harms of smoking was increased in the population studied and the application of the educational work was significant in a qualitative way due to the changes in their reflections, thus achieving the results of the study

Antibiotics prescription habits of Spanish endodontists : impact of the ESE awareness campaign and position statement

The inadequate use of antibiotics by dentists can contribute to antibiotic resistance. The European Society of Endodontology (ESE) has published a scientific evidence-based position on antibiotic use in endodontic infections. The aim of thi

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Examining the immune signatures of SARS-CoV-2 infection in pregnancy and the impact on neurodevelopment: Protocol of the SIGNATURE longitudinal study

The COVID-19 pandemic represents a valuable opportunity to carry out cohort studies that allow us to advance our knowledge on pathophysiological mechanisms of neuropsychiatric diseases. One of these opportunities is the study of the relationships between inflammation, brain development and an increased risk of suffering neuropsychiatric disorders. Based on the hypothesis that neuroinflammation during early stages of life is associated with neurodevelopmental disorders and confers a greater risk of developing neuropsychiatric disorders, we propose a cohort study of SARS-CoV-2-infected pregnant women and their newborns. The main objective of SIGNATURE project is to explore how the presence of prenatal SARS-CoV-2 infection and other non-infectious stressors generates an abnormal inflammatory activity in the newborn. The cohort of women during the COVID-19 pandemic will be psychological and biological monitored during their pregnancy, delivery, childbirth and postpartum. The biological information of the umbilical cord (foetus blood) and peripheral blood from the mother will be obtained after childbirth. These samples and the clinical characterisation of the cohort of mothers and newborns, are tremendously valuable at this time. This is a protocol report and no analyses have been conducted yet, being currently at, our study is in the recruitment process step. At the time of this publication, we have identified 1,060 SARS-CoV-2 infected mothers and all have already given birth. From the total of identified mothers, we have recruited 537 SARS-COV-2 infected women and all of them have completed the mental health assessment during pregnancy. We have collected biological samples from 119 mothers and babies. Additionally, we have recruited 390 non-infected pregnant women.This work has received support from the Fundación Alicia Koplowitz to realize the epigenetic wide association study and to the clinical assessment to the children. This work has also received public support from the Consejería de Salud y Familias para la financiación de la investigación, desarrollo e innovación (i + d + i) biomédica y en ciencias de la salud en Andalucía (CSyF 2021 - FEDER). Grant Grant number PECOVID- 0195-2020. Convocatoria financiada con Fondo Europeo de Desarrollo Regional (FEDER) al 80% dentro del Programa Operativo de Andalucía FEDER 2014-2020. Andalucía se mueve con Europa. NG-T received payment under Rio Hortega contract CM20-00015 with the Carlos III Health Institute.Peer reviewe

Ahora / Ara

La cinquena edició del microrelatari per l’eradicació de la violència contra les dones de l’Institut Universitari d’Estudis Feministes i de Gènere «Purificación Escribano» de la Universitat Jaume I vol ser una declaració d’esperança. Aquest és el moment en el qual les dones (i els homes) hem de fer un pas endavant i eliminar la violència sistèmica contra les dones. Ara és el moment de denunciar el masclisme i els micromasclismes començant a construir una societat més igualitària. Cadascun dels relats del llibre és una denúncia i una declaració que ens encamina cap a un món millor