Interrelación entre la enfermedad periodontal y el infarto agudo de miocardio. Evaluación clínica

La periodontitis es el resultado de la respuesta crónica inflamatoria a la acumulación del biofilm en las superficies dentarias, lo que provoca inflamación gingival, sangrado y la destrucción del hueso alveolar y del tejido conectivo, que podría desencadenar en la pérdida de dientes. Las infección prolongada por las bacterias del complejo rojo (Pg, Tf y Td) y la subsecuente respuesta inmune son considerados los mayores factores etiopatogénicos en la periodontitis. Sujetos con diabetes, HIV positivos, fumadores, inmunodeprimidos y genéticamente susceptibles (polimorfismos del gen IL-1) son más propensos a desarrollar enfermedades periodontales destructivas. En las últimas décadas ha aumentado el interés por el impacto que la salud oral tiene sobre la enfermedad cardiovascular y por las relaciones que puedan existir entre la enfermedad periodontal y ésta. La enfermedad cardiovascular es la primera causa de muerte en los países desarrollados. El desarrollo de la enfermedad cardiovascular puede ser el resultado de factores de riesgo genéticos y ambientales (elevación de LDL, HTA, tabaco, sexo masculino y bajo nivel socioeconómico). Se ha demostrado que estos factores, de manera independiente o asociados, están involucrados en el IAM y en la ateroesclerosis. Estudios recientes han demostrado que los microorganismos involucrados en la enfermedad periodontal pueden participar en la formación de las placas de ateroma. Los principios biológicos que relacionan la enfermedad periodontal con el IAM incluyen el efecto directo de las bacterias, el efecto indirecto de los mediadores del huésped, el efecto de los LPS o endotoxinas de bacterias y el efecto de la activación de los PMN. La HDL tiene muchas propiedades aterógenas, entre ellas promueve la salida del colesterol de las células, funcionando así́ como un antioxidante, ya que inhibe las LDL y retarda la actividad inflamatoria. OBJETIVO: evaluar el estado periodontal y las variables antropométricas y bioquímicas de los pacientes con IAM y compararlos con los de los pacientes que no han sufrido IAM. Además se pretende determinar qué factores de riesgo cardiovascular se relacionan con estas patologías. MATERIAL Y MÉTODO: Se trata de un estudio observacional descriptivo en el que participan 2 grupos de pacientes: • Grupo test: pacientes que han sufrido infarto agudo de miocardio (IAM),. Este grupo se divide en 2 subgrupos: pacientes con enfermedad periodontal y pacientes sin enfermedad periodontal, según los criterios de Machtei, 1992. • Grupo control: pacientes, sin IAM, que acuden a la Facultad de Odontología de la Universidad de Sevilla. Este grupo se divide en 2 subgrupos: pacientes con enfermedad periodontal y pacientes sin enfermedad periodontal, según los criterios de Machtei, 1992. Criterios de exclusión: sujetos que hayan tomado tratamiento antibiótico 6 meses antes del estudio y/o que hayan recibido tratamiento periodontal reciente. Criterios de inclusión: pacientes hayan firmado el consentimiento del estudio y que hayan sufrido infarto entre 2 y 6 meses anteriores al momento del estudio para el grupo test y que no hayan sufrido IAM, para el grupo control. A todas los pacientes se les realizó una historia médica y social. El examen periodontal lo llevó a cabo un solo explorador. Se realizó un periodontograma (con una sonda periodontal manual tipo PCP 11/ Michigan con una presión de 20-25gr/cm2) en el que se registró la profundidad de sondaje, recesión, nivel de inserción y el sangrado al sondaje en 6 localizaciones de cada diente. Además se registró la edad, sexo, antecedentes médicos, peso, altura y una serie de variables antropométricas y bioquímicas (obtenidas mediante analítica) RESULTADOS: Los resultados de esta investigación, revelan que los pacientes del grupo control sin periodontitis tienen un BMI menor que los pacientes del grupo test, tanto con periodontitis como sin ella. Además, los parámetros periodontales PS, NI, SS y el nº de dientes son significativamente menores en el grupo control sin periodontitis que en el grupo test con periodontitis. Además, se demuestra la influencia del tabaco en la predicción del riesgo de IAM. CONCLUSIONES: Los pacientes que han padecido IAM muestran un mayor BMI, circunferencia de la cintura y niveles de glucosa. Así mismo, presentan un menor nº de dientes, pliegue suprailiaco y niveles de colesterol total, HDL y LDL. El tabaco es un predictor del riesgo de IAM. Se necesitan realizar nuevos estudio bien controlados y aleatorizados para determinan cual es el mecanismo o mecanismos por los que esta asociación se produce y si esta es causal o casual

Thickness of the buccal bone wall and root angulation in the maxilla and mandible: an approach to cone beam computed tomography

Background: The objective of this paper is to anatomically describe the bone morphology in the maxillary and mandibular tooth areas, which might help in planning post-extraction implants. Methods: CBCT images (Planmeca ProMax 3D) of 403 teeth (208 upper teeth and 195 lower teeth) were obtained from 49 patients referred to the Dental School of Seville from January to December 2014. The thickness of the facial wall was measured at the crest, point A, 4mm below, point B, and at the apex, point C. The second parameter was the angle formed between the dental axis and the axis of the basal bone. Results: A total of 403 teeth were measured. In the maxilla, 89.4% of incisors, 93.94% of canines, 78% of premolars and 70.5% of molars had a buccal bone wall thickness less than the ideal 2mm. In the mandible, 73.5% of incisors, 49% of canines, 64% of premolars and 53% of molars had <1mm buccal bone thickness as measured at point B. The mean angulation in the maxilla was 11.67±6.37° for incisors, 16.88±7.93° for canines, 13.93±8.6° for premolars, and 9.89±4.8° for molars. In the mandible, the mean values were 10.63±8.76° for incisors, 10.98±7.36° for canines, 10.54±5.82° for premolars and 16.19±11.22° for molars. Conclusions: The high incidence of a buccal wall thickness of less than 2mm in over 80% of the assessed sites indicates the need for additional regeneration procedures, and several locations may also require custom abutments to solve the angulation problems for screw-retained crowns

Culture of sustainability, cooperation and development: realities and perspectives in Galicia and Dominican Republic

[Resumo] O propósito deste artigo é presentar unha das metodoloxías de estudo -e resultados iniciais- nas que se sustenta o proxecto de investigación “Cultura da sostibilidade e cooperación ao desenvolvemento: realidade e perspectivas educativas en Galicia e República Dominicana (PR815 A 2014-17, Convocatoria 2014 de Subvencións en Investigación para o Desenvolvemento da Direción Xeral de Relacións Exteriores da Xunta de Galicia). O proxecto ten entre os seus obxectivos analizar o discurso referido á cultura da sustentabilidade e a cooperación ao desenvolvemento integrado nos libros de texto correspondentes ao nivel de bacharelato en Galicia, mediante a selección de 8 libros de texto, catro do ámbito das Ciencias Sociais e outro catro de Ciencias Naturais e exactas, en ambos territorios. Enténdese o libro de texto como ferramenta básica na orientación da práctica docente e dos contidos transmitidos, partindo de que toda selección e abordaxe supón un posicionamento ideolóxico en relación ao tipo de persoas que queremos formar e para que sociedades. A continuación preséntase a ferramenta de análise e se reflicte en torno a súas posibilidades de aplicación, tomando como exemplo de estudo o libro de Bioloxía e Xeoloxía de 1º de Bachalerato de Galicia e outro Bioloxía, de 3º medio, da República Dominicana.[Abstract] The purpose of this article is to present one of the study methodologies -and its initial resultsin which is sustained the project of research “Culture of sustainability and development cooperation: reality and educational perspectives in Galicia and Dominican Republic" (PR815 A 2014-17, Call 2014 for grants in Research for the Development for the Direción Xeral de Relación Exteriores of Xunta de Galicia). The project has among his goals to analyze the speech related to the culture of sustainability and cooperation to the integrated development in Galicia in the text books of high school, through the selection of 8 text books, four of the area of the Social Sciences and another four of Natural and Exact Sciences, in both territories. We understand the text book as a basic tool in the orientation of the educational practice and its contents, assuming that every selection and approach requires an ideological positioning related to the type of people and society we want

Accuracy of implant casts generated with conventional and digital Impressions: an in vitro study

Purpose: The aim of this study was to compare the accuracy of digital dental impressions with the accuracy of impressions obtained via conventional techniques. Methods: Two different master models were created, one with parallel implants (model 1) and the other with non-parallel implants (model 2). These reference master models included 4 Klockner KL RP implants (Klockner Implant System SA, Barcelona, Spain), which were juxta-placed and equidistant in the intermentoneal region. In model 1 the implants were placed parallel to each other, whereas in model 2 the implants were placed such that there was a divergence angle of 15° between the more distal implants, and a convergence angle of 15° between the two central implants. A total of four types of impressions were obtained from model 1 (four groups, n = 10 each), including closed tray impressions with replacement abutments; open tray impression groups for dragging copings, without splinting; open tray impressions for ferrules; and impressions obtained using the 3MTM True Definition Scanner system. For model 2 three groups were created (three groups, n = 10 each), including closed tray impressions with replacement abutments; open tray impression for dragging copings, without splinting; and impressions obtained using the 3MTM True Definition Scanner system. The master models and the models obtained using conventional methods were digitalized in order to compare them via an extraoral high-resolution scanner (Imetric IScan D104i, Porretruy, Switzerland). The STL (Stereo Lithography (format for transferring 3 dimensional shape information)) digital values were loaded into reverse-engineering software and superimposed with their respective STL master models in order to evaluate deviations in three dimensions. We then analyzed the squares of the deviations in the three axes and evaluated the median and the sum of the deviation square. Statistical analysis was performed using the IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp. The normality of the distributions was analyzed according to a Kolmogorov-Smirnov test. The median comparison was performed using the differences between the medians, analyzed using non-parametric Kruskal-Wallis and Mann-Whitney tests with a significance level of p < 0.05. Results: For model 1, the deviations of the digital impressions were smaller than those associated with the conventional techniques. The sum value in group D was 1,068,292, which was significantly lower than those of groups A, B, and C, which were shown to be 2,114,342, 2,165,491, and 1,265,918, respectively. This improvement was not observed when using model 2, however, where the conventional techniques yielded similar results. Group F simultaneously presented the lowest total square sum of the three deviations (1,257,835), indicating a significantly higher accuracy for this group in model 2, while the sum values were 1,660,975 and 1,489,328 for groups E and G, respectively. Conclusion: Digital impressions of full-arch models were able to achieve the accuracy of conventional impressions in an in vitro model. Nevertheless, further in vivo studies are needed to validate these in vitro results

Intramolecular hydrogen-bond activation for the addition of nucleophilic imines: 2-hydroxybenzophenone as a chemical auxiliary

The addition of nucleophilic imines, using 2-hydroxybenzophenone as a chemical auxiliary, is presented. An intramolecular six-membered ring via hydrogen bonding that enhances the reactivity and selectivity is the key of this strategy, which is supported by DFT calculations and experimental trialsSpanish Government (CTQ2015-64561-R, CTQ2016-76061-P, and MDM-2014-0377), Prodep (UJAT-PTC-247) and CCC-UAM are acknowledged. A. G. thanks MINECO for a PhD fellowship (FPI) and A. M. S. thanks CAM for a postdoctoral contract (2016-T2/IND-1660

Targeting Protein Kinase C in Glioblastoma Treatment

Glioblastoma (GBM) is the most frequent and aggressive primary brain tumor and is associated with a poor prognosis. Despite the use of combined treatment approaches, recurrence is almost inevitable and survival longer than 14 or 15 months after diagnosis is low. It is therefore necessary to identify new therapeutic targets to fight GBM progression and recurrence. Some publications have pointed out the role of glioma stem cells (GSCs) as the origin of GBM. These cells, with characteristics of neural stem cells (NSC) present in physiological neurogenic niches, have been proposed as being responsible for the high resistance of GBM to current treatments such as temozolomide (TMZ). The protein Kinase C (PKC) family members play an essential role in transducing signals related with cell cycle entrance, differentiation and apoptosis in NSC and participate in distinct signaling cascades that determine NSC and GSC dynamics. Thus, PKC could be a suitable druggable target to treat recurrent GBM. Clinical trials have tested the efficacy of PKC beta inhibitors, and preclinical studies have focused on other PKC isozymes. Here, we discuss the idea that other PKC isozymes may also be involved in GBM progression and that the development of a new generation of effective drugs should consider the balance between the activation of different PKC subtypes

Preoperative oral antibiotic prophylaxis reduces Pseudomonas aeruginosa surgical site infections after elective colorectal surgery: a multicenter prospective cohort study

BACKGROUND: Healthcare-associated infections caused by Pseudomonas aeruginosa are associated with poor outcomes. However, the role of P. aeruginosa in surgical site infections after colorectal surgery has not been evaluated. The aim of this study was to determine the predictive factors and outcomes of surgical site infections caused by P. aeruginosa after colorectal surgery, with special emphasis on the role of preoperative oral antibiotic prophylaxis. METHODS: We conducted an observational, multicenter, prospective cohort study of all patients undergoing elective colorectal surgery at 10 Spanish hospitals (2011-2014). A logistic regression model was used to identify predictive factors for P. aeruginosa surgical site infections. RESULTS: Out of 3701 patients, 669 (18.1%) developed surgical site infections, and 62 (9.3%) of these were due to P. aeruginosa. The following factors were found to differentiate between P. aeruginosa surgical site infections and those caused by other microorganisms: American Society of Anesthesiologists' score III-IV (67.7% vs 45.5%, p = 0.001, odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.44-4.39), National Nosocomial Infections Surveillance risk index 1-2 (74.2% vs 44.2%, p < 0.001, OR 3.6, 95% CI 2.01-6.56), duration of surgery ≥75thpercentile (61.3% vs 41.4%, p = 0.003, OR 2.2, 95% CI 1.31-3.83) and oral antibiotic prophylaxis (17.7% vs 33.6%, p = 0.01, OR 0.4, 95% CI 0.21-0.83). Patients with P. aeruginosa surgical site infections were administered antibiotic treatment for a longer duration (median 17 days [interquartile range (IQR) 10-24] vs 13d [IQR 8-20], p = 0.015, OR 1.1, 95% CI 1.00-1.12), had a higher treatment failure rate (30.6% vs 20.8%, p = 0.07, OR 1.7, 95% CI 0.96-2.99), and longer hospitalization (median 22 days [IQR 15-42] vs 19d [IQR 12-28], p = 0.02, OR 1.1, 95% CI 1.00-1.17) than those with surgical site infections due to other microorganisms. Independent predictive factors associated with P. aeruginosa surgical site infections were the National Nosocomial Infections Surveillance risk index 1-2 (OR 2.3, 95% CI 1.03-5.40) and the use of oral antibiotic prophylaxis (OR 0.4, 95% CI 0.23-0.90). CONCLUSIONS: We observed that surgical site infections due to P. aeruginosa are associated with a higher National Nosocomial Infections Surveillance risk index, poor outcomes, and lack of preoperative oral antibiotic prophylaxis. These findings can aid in establishing specific preventive measures and appropriate empirical antibiotic treatment

Cortical thinning over two years after first-episode psychosis depends on age of onset

First-episode psychosis (FEP) patients show structural brain abnormalities at the first episode. Whether the cortical changes that follow a FEP are progressive and whether age at onset modulates these changes remains unclear. This is a multicenter MRI study in a deeply phenotyped sample of 74 FEP patients with a wide age range at onset (15-35 years) and 64 neurotypical healthy controls (HC). All participants underwent two MRI scans with a 2-year follow-up interval. We computed the longitudinal percentage of change (PC) for cortical thickness (CT), surface area (CSA) and volume (CV) for frontal, temporal, parietal and occipital lobes. We used general linear models to assess group differences in PC as a function of age at FEP. We conducted post-hoc analyses for metrics where PC differed as a function of age at onset. We found a significant age-by-diagnosis interaction effect for PC of temporal lobe CT (d = 0.54; p = 002). In a post-hoc-analysis, adolescent-onset (≤19 y) FEP showed more severe longitudinal cortical thinning in the temporal lobe than adolescent HC. We did not find this difference in adult-onset FEP compared to adult HC. Our study suggests that, in individuals with psychosis, CT changes that follow the FEP are dependent on the age at first episode, with those with an earlier onset showing more pronounced cortical thinning in the temporal lobe

A genome-wide association study follow-up suggests a possible role for PPARG in systemic sclerosis susceptibility

Introduction: A recent genome-wide association study (GWAS) comprising a French cohort of systemic sclerosis (SSc) reported several non-HLA single-nucleotide polymorphisms (SNPs) showing a nominal association in the discovery phase. We aimed to identify previously overlooked susceptibility variants by using a follow-up strategy.&lt;p&gt;&lt;/p&gt; Methods: Sixty-six non-HLA SNPs showing a P value &#60;10-4 in the discovery phase of the French SSc GWAS were analyzed in the first step of this study, performing a meta-analysis that combined data from the two published SSc GWASs. A total of 2,921 SSc patients and 6,963 healthy controls were included in this first phase. Two SNPs, PPARG rs310746 and CHRNA9 rs6832151, were selected for genotyping in the replication cohort (1,068 SSc patients and 6,762 healthy controls) based on the results of the first step. Genotyping was performed by using TaqMan SNP genotyping assays. Results: We observed nominal associations for both PPARG rs310746 (PMH = 1.90 × 10-6, OR, 1.28) and CHRNA9 rs6832151 (PMH = 4.30 × 10-6, OR, 1.17) genetic variants with SSc in the first step of our study. In the replication phase, we observed a trend of association for PPARG rs310746 (P value = 0.066; OR, 1.17). The combined overall Mantel-Haenszel meta-analysis of all the cohorts included in the present study revealed that PPARG rs310746 remained associated with SSc with a nominal non-genome-wide significant P value (PMH = 5.00 × 10-7; OR, 1.25). No evidence of association was observed for CHRNA9 rs6832151 either in the replication phase or in the overall pooled analysis.&lt;p&gt;&lt;/p&gt; Conclusion: Our results suggest a role of PPARG gene in the development of SSc

Competencias para el ejercicio de la dirección de instituciones educativas : reflexiones y experiencias en Iberoamérica

El presente texto es el resultado de las aportaciones al encuentro realizado por los miembros de la Red de Apoyo a la Gestion Educativa (http://www.redage.org) en junio de 2011 en la ciudad de Lima. Constituye el tercer documento de la Serie Informes que ha producido la RedAGE y es expresión del compromiso constitutivo por analizar y difundir temáticas relacionadas con la organizaciÓn y dirección de los sistemas y centros educativos. El ejercicio directivo analizado desde la perspectiva de las competencias es la temática que se aborda en esta ocasión. Por una parte, se continúa la reflexión iniciada con el segundo informe, dedicado a la Dirección de centros educativos en Iberoamérica (http://www.redage.org/files/adjuntos/ Libro%20Red_AGE%20vd.pdf); por otra, se profundiza desde la perspectiva de las competencias con la idea de difundir e impulsar el nuevo enfoque. Tratamos así de un tema incipiente en algunos de los países, pero presente y parte de la agenda de los responsables de la política educativa, con la idea de aportar elementos para las posibles acciones a desarrollar o a mejorar al respecto. Hablamos de competencias y sobre competencias1 y con ello nos referimos a las características de la persona relacionadas con una actuación de éxito en su lugar de trabajo. Se identifican así con la activación y aplicación de manera coordinada de elementos de diferente naturaleza (cognoscitivos, afectivos y procedimentales) para resolver situaciones profesionales concretas. El concepto de competencia es utilizado desde hace tiempo en el campo de la formación profesional, abriéndose camino, poco a poco, en todo el sistema educativo y en los procesos de formación continua, donde la gestión por competencias se ha convertido en un modelo integrador y orientador de las diferentes políticas de recursos humanos