Management of acromegaly in Latin America: expert panel recommendations

Although there are international guidelines orienting physicians on how to manage patients with acromegaly, such guidelines should be adapted for use in distinct regions of the world. A panel of neuroendocrinologists convened in Mexico City in August of 2007 to discuss specific considerations in Latin America. Of major discussion was the laboratory evaluation of acromegaly, which requires the use of appropriate tests and the adoption of local institutional standards. As a general rule to ensure diagnosis, the patient’s GH level during an oral glucose tolerance test and IGF-1 level should be evaluated. Furthermore, to guide treatment decisions, both GH and IGF-1 assessments are required. The treatment of patients with acromegaly in Latin America is influenced by local issues of cost, availability and expertise of pituitary neurosurgeons, which should dictate therapeutic choices. Such treatment has undergone profound changes because of the introduction of effective medical interventions that may be used after surgical debulking or as first-line medical therapy in selected cases. Surgical resection remains the mainstay of therapy for small pituitary adenomas (microadenomas), potentially resectable macroadenomas and invasive adenomas causing visual defects. Radiotherapy may be indicated in selected cases when no disease control is achieved despite optimal surgical debulking and medical therapy, when there is no access to somatostatin analogues, or when local issues of cost preclude other therapies. Since not all the diagnostic tools and treatment options are available in all Latin American countries, physicians need to adapt their clinical management decisions to the available local resources and therapeutic options

Aplicación de Biodentine en Endodoncia Regenerativa

Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Odontología Integral Niños. Buenos Aires, Argentina.Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Odontología Integral Niños. Buenos Aires, Argentina.Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Odontología Integral Niños. Buenos Aires, Argentina

Análisis de trastornos temporomandibulares en niños de 10 a 15 años

Fil: Cortese, S. Universidad de Buenos Aires. Facultad de Odontología. Cátedra Odontología Integral Niños; Argentina.Fil: Guitelman, I. Universidad de Buenos Aires. Facultad de Odontología. Cátedra Odontología Integral Niños; Argentina.Fil: Farah, C. Universidad de Buenos Aires. Facultad de Odontología. Cátedra Odontología Integral Niños; Argentina.Fil: Fridman, D. Universidad de Buenos Aires. Facultad de Odontología. Cátedra Odontología Integral Niños; Argentina.Fil: Mondello, A. Universidad de Buenos Aires. Facultad de Odontología. Cátedra Odontología Integral Niños; Argentina.Fil: Biondi, A. Universidad de Buenos Aires. Facultad de Odontología. Cátedra Odontología Integral Niños; Argentina.Objetivos: Estimar la frecuencia y tipo de trastornos temporomandibulares (TTM) en niños y relacionarlos con edad, sexo, apretamiento dentario, bruxismo diurno y nocturno

Clinical characteristics and therapeutic responses in patients with Germ-line AIP mutations and pituitary adenomas : An international collaborative study

Context: AIP mutations (AIPmut) give rise to a pituitary adenoma predisposition that occurs in familial isolated pituitary adenomas and less often in sporadic cases. The clinical and therapeutic features of AIPmut-associated pituitary adenomas have not been studied comprehensively. Objective: The objective of the study was to assess clinical/therapeutic characteristics of AIPmut pituitary adenomas. Design: This study was an international, multicenter, retrospective case collection/database analysis. Setting: The study was conducted at 36 tertiary referral endocrine and clinical genetics departments. Patients: Patients included 96 patients with germline AIPmut and pituitary adenomas and 232 matched AIPmut-negative acromegaly controls. Results: The AIPmut population was predominantly young and male (63.5%); first symptoms occurred as children/adolescents in 50%. At diagnosis, most tumors were macroadenomas (93.3%); extension and invasion was common. Somatotropinomas comprised 78.1% of the cohort; there were also prolactinomas (n = 13), nonsecreting adenomas (n = 7), and a TSH-secreting adenoma. AIPmut somatotropinomas were larger (P = 0.00026), with higher GH levels (P = 0.00068), more frequent extension (P = 0.018) and prolactin cosecretion (P = 0.00023), and occurred 2 decades before controls (P < 0.000001). Gigantism was more common in the AIPmut group (P < 0.000001). AIPmut somatotropinoma patients underwent more surgical interventions (P = 0.00069) and had lower decreases in GH (P = 0.00037) and IGF-I (P = 0.028) and less tumor shrinkage with somatostatin analogs (P < 0.00001) vs. controls. AIPmut prolactinomas occurred generally in young males and frequently required surgery or radiotherapy. Conclusions: AIPmut pituitary adenomas have clinical features that may negatively impact treatment efficacy. Predisposition for aggressive disease in young patients, often in a familial setting, suggests that earlier diagnosis of AIPmut pituitary adenomas may have clinical utility

O uso de vernizes fluoretados e a redução da incidência de cárie dentária em pré-escolares: uma revisão sistemática Fluoride varnishes and decrease in caries incidence in preschool children: a systematic review

O objetivo desta revisão sistemática foi verificar se existe evidência conclusiva de que o verniz fluoretado reduz a incidência de cárie dentária em pré-escolares. Foram feitas buscas nas bases eletrônicas BBO, LILACS, MEDLINE e Cochrane para identificar ensaios clínicos controlados que avaliassem o desenvolvimento de lesões cavitadas de cárie em crianças com até seis anos de idade. Dois pesquisadores analisaram criticamente os trabalhos selecionados para inclusão. Foram encontrados 513 artigos e oito foram incluídos. Esses estudos apresentaram problemas quanto ao desenho e, além disso, eram heterogêneos quanto à experiência prévia de cárie dos participantes, ao tipo de intervenção administrada ao grupo controle, à exposição das crianças a outras fontes de fluoretos, e ao intervalo entre as aplicações de verniz. As diferenças absolutas entre as incidências de cárie nos grupos controle e teste e as frações prevenidas variaram de 0,30 a 1,64 e de 5 a 63%, respectivamente. O verniz fluoretado parece ser efetivo para reduzir a incidência de cárie dentária em pré-escolares, mas outros ensaios clínicos de melhor qualidade metodológica são necessários para se obter evidência conclusiva a esse respeito.<br>The objective of this systematic review was to evaluate whether there is conclusive evidence that the professional application of fluoride varnish decreases the incidence of dental caries in preschool children. We searched the BBO, LILACS, MEDLINE and Cochrane electronic databases to identify controlled clinical trials that evaluated the development of cavitated caries lesions in children up to six years of age. Two researchers performed a critical appraisal of the studies selected for inclusion. Five-hundred and thirteen articles were found, but only eight met our inclusion criteria. Most of these eight studies were of poor methodological quality. They were also heterogeneous in relation to participants' previous caries experience, type of intervention performed on the control group, children's exposure to other sources of fluoride, and varnish application interval. The absolute differences between caries incidences in the control and test groups ranged from 0.30 to 1.64 and the preventive fractions varied from 5% to 63%. Fluoride varnish may be effective to decrease the incidence of dental caries in preschoolers, but more randomized clinical trials with better methodological quality are necessary to provide conclusive evidence in this respect