Tiempo de progresión de lesiones cariosas proximales en dentición primaria. Una revisión narrativa

32 p.La progresión de lesiones de caries proximales en dientes primarios es un proceso que varía no sólo entre personas sino también entre lesiones de un mismo individuo. La lesión de caries en el diente primario se desarrolla de diferente forma con respecto al permanente, siendo más rápida en la dentición primaria por las características estructurales y químicas propias, además de la presencia de áreas de contacto amplias en la superficie proximal. Es fundamental complementar los métodos de inspección y diagnosticar previo a la cavitación ya que esta condición aumenta la probabilidad de actividad y progresión de la lesión. También debemos evaluar ciertos factores moduladores, tanto protectores y/o de riesgo presentes en cada niño, los que no solo influyen en la probabilidad de generar lesiones cariosas proximales, sino que en niños de alto riesgo cariogénico podrían provocar mayor severidad y avance más rápido de las mismas. Tener conocimiento sobre el tiempo de progresión, favorecería a la toma de decisiones para el tratamiento enfocado en la odontología de mínima intervención. Por lo que está descrito en la literatura, el tiempo de progresión de lesiones de caries proximales en la dentición primaria es variable y no es posible definirlo ya que los estudios presentan distintas falencias metodológicas. El tiempo de progresión de la lesión cariosa proximal en dientes primarios debe ser considerado como una estimación, y es deseable y necesario la realización de nuevos estudios prospectivos con una muestra representativa y métodos diagnósticos estandarizados. // ABSTRACT: The progression of proximal caries lesions in primary teeth is a process that varies not only among people but also among lesions of the same person. The caries lesion in the primary tooth develops differently from the permanent one, being faster in the primary dentition due to its own structural and chemical characteristics besides the presence of wide contact areas on the proximal surface. It is essential to complement the inspection and diagnosis methods prior to cavitation since this condition increases the probability of activity and progression of the lesion. We must also evaluate certain modulating factors, both protective and/or risk factors from each child, which not only influence the probability of developing proximal carious lesions, but in children with high cariogenic risk could result greater severity and faster progression of the lesions. Knowing the progression time would favor decision-making for treatment focused on minimal intervention dentistry. From what is described in the literature, the time to progression of proximal caries lesions in the primary dentition is variable and inconclusive since the studies have different methodological shortcomings. The time to progression of proximal carious lesion in primary teeth should be considered as an estimate and it is desirable and necessary that new prospective studies with a representative sample and standardized diagnostic methods are carried out

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

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

La pandemia en/desde Jujuy: reflexiones situadas

Acaso no podrí amos afirmar que la pandemia llego a nuestra sociedad mundial causando un pandemo - nium?. En cierto modo, ma s alla del juego de palabras, gran parte de nosotros lo sentimos así . Es claro, una pandemia, es una enfermedad que afecta a la sociedad. Perturba intensamente la cotidianeidad, las ocupaciones, y, en general, lo que en estos dí as an oramos como la “vida normal” de todos. Si contraemos una enfermedad ma s o menos aguda, todas nuestras actividades se ven afectadas, se desordenan. Cuando ello ocurre, pra cticamente debemos concentrarnos, casi con exclusividad, en superar la afeccio n con la ayuda de profesionales de la salud, cualquiera sea el abordaje disciplinario que nos resulte ma s adecuado y confiable. Así , del mismo modo, la pandemia afecta a toda la comunidad, a todas sus actividades. Y, en este caso tambie n la principal preocupacio n es superar la afeccio n. Entonces hay que buscar alternativas para el resto de las tareas, que deben transcurrir entre los estrechos ma rgenes que nos permiten tanto el cuidado personal como el social, ambos imprescindibles.Fil: Aramayo, Anahí. Universidad Nacional de Jujuy; ArgentinaFil: Lopez, Andrea Noelia. Universidad Nacional de Jujuy; ArgentinaFil: Díaz, Rodrigo Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Astorga, Farid Diego. Universidad Nacional de Jujuy; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Assad, Lucas Gabriel. Universidad Nacional de Jujuy; ArgentinaFil: Hoyos, Gustavo Daniel. Universidad Nacional de Jujuy; ArgentinaFil: Balut, Jorgelina. No especifíca;Fil: Angulo Villán, Florencia Raquel. No especifíca;Fil: Brailovsky, Sofia Miriam. No especifíca;Fil: Carrizo, María José. No especifíca;Fil: Bustamante, Patricia. No especifíca;Fil: Jaled, Daniela Alejandra. No especifíca;Fil: Castillo, Silvina Ana Lia. No especifíca;Fil: Díaz, Enrique Antonio. No especifíca;Fil: Cieza, Fernanda. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Cuva, Cecilia Alejandra. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Rivas, Rosana Verónica. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Altea, Laura. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Garzon, Analia Soledad. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mamani, Claudia. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Villarroel, Viviana Mabel. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Costas Frison, Celeste. No especifíca;Fil: Montenegro, Erica Maricel. No especifíca;Fil: Guzmán, Vilma Roxana. No especifíca;Fil: Donaire, Claudia. No especifíca;Fil: Herrera, Ana Soledad. No especifíca;Fil: Cardozo, Juana Griselda. No especifíca;Fil: Nieva, Nuria Noelia. No especifíca;Fil: Miranda , Ana Lía. Universidad Nacional de Jujuy; ArgentinaFil: Patagua, Patricia Evangelina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Gomez, Carina Elizabeth. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Bustamante, Patricia. Universidad Nacional de Jujuy; ArgentinaFil: Navarro Suárez, Camila. Universidad Nacional de Jujuy; ArgentinaFil: Yufra, Laura Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Massari, María Justina. Universidad Nacional de Jujuy; ArgentinaFil: Cortez, Carla Melisa. Universidad Nacional de Jujuy; ArgentinaFil: Rovetta, Ana Inés. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Zinger, Sabrina. Universidad Nacional de Jujuy; ArgentinaFil: Alba, Juan Pablo. Universidad Nacional de Jujuy; ArgentinaFil: Arrueta, Patricia Marisel. Universidad Nacional de Jujuy; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Constant, Juan. Universidad Nacional de Jujuy; ArgentinaFil: Gumiel, Silvina. Universidad Nacional de Jujuy; ArgentinaFil: Zazzarini, Susana. Universidad Nacional de Jujuy; ArgentinaFil: Valente, Verónica. Universidad Nacional de Jujuy; ArgentinaFil: Bergesio, Liliana del Carmen. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; ArgentinaFil: González, Natividad María. Universidad Nacional de Jujuy. Facultad de Ciencias Económicas. Instituto de Investigaciones Económicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Nieva, Florencia Antonella. Universidad Nacional de Jujuy; ArgentinaFil: Callieri, Ivanna Gabriela. Universidad Nacional de Jujuy; ArgentinaFil: Montes, Elena Patricia. Universidad Nacional de Jujuy; ArgentinaFil: Civila Orellana, Fabiola Vanesa. Universidad Nacional de Jujuy; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Villarrubia Gómez, Álvaro Patricio. Universidad Nacional de Jujuy; ArgentinaFil: Quispe, Gloria. Universidad Nacional de Jujuy; ArgentinaFil: Cosme, María Cristina. Universidad Nacional de Jujuy; ArgentinaFil: Quispe, Ariadna Vanesa. Universidad Nacional de Jujuy; ArgentinaFil: Galián, Víctor Joel. Universidad Nacional de Jujuy; ArgentinaFil: Vazquez, Omar Eduardo. Universidad Nacional de Jujuy; ArgentinaFil: Cerpa, Daniela Soledad. Universidad Nacional de Jujuy; ArgentinaFil: Martínez, Luis Gustavo. Universidad Nacional de Jujuy; ArgentinaFil: Fernández, Laura Soledad. Universidad Nacional de Jujuy; ArgentinaFil: Tolaba, Gladys Sarai. Universidad Nacional de Jujuy; ArgentinaFil: Escalante, Norberto Oscar. Universidad Nacional de Jujuy; ArgentinaFil: Cazón, Mariela. Universidad Nacional de Jujuy; ArgentinaFil: Ugarte, María Adela. Universidad Nacional de Jujuy; ArgentinaFil: García Vargas, Alejandra. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; ArgentinaFil: Gaona, Melina. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Centro de Estudios de Historia, Cultura y Memoria; ArgentinaFil: Zubia, Gonzalo Federico. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Centro de Estudios de Historia, Cultura y Memoria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kulemeyer, Jorge Alberto. No especifíca;Fil: Pantoja, Rodrigo. No especifíca;Fil: Paz, María Elisa. No especifíca;Fil: Rivero, Ariel Rodolfo. No especifíca;Fil: Rocabado, Cecilia Inés. Universidad Nacional de Jujuy; ArgentinaFil: Villagra, Gabriela Soledad. Instituto de Ciencia y Tecnología Regional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rodríguez, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Ciencia y Tecnología Regional; ArgentinaFil: Adi Barrionuevo, Ana Carolina. Universidad Nacional de Jujuy; ArgentinaFil: Adi Barrionuevo, Irene. Universidad Nacional de Jujuy; ArgentinaFil: Aramayo, Natalia. Universidad Nacional de Jujuy; ArgentinaFil: Fernández, Gabriel. Universidad Nacional de Jujuy; ArgentinaFil: Morales, Miriam Mariana. Universidad Nacional de Jujuy. Instituto de Ecorregiones Andinas. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Ecorregiones Andinas; ArgentinaFil: Rios, Natalia Fatima. Facultad Latinoamericana de Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rocabado, Zaida Nadia. Universidad Nacional de Jujuy; ArgentinaFil: Sandoval, Cecilia. No especifíca;Fil: Soto, Mercedes. No especifíca;Fil: Osores, Noelia Andrea del Valle. No especifíca;Fil: Revollo, Jimena ;Citterio. No especifíca;Fil: Gutiérrez, Ivone Belén. Universidad Nacional de Jujuy; ArgentinaFil: Juste, Stella Maris. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Vidal, José Fernando. Universidad Nacional de Jujuy; ArgentinaFil: Karasik, Gabriela Alejandra. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; ArgentinaFil: Bruce, Beatriz Maria. Universidad Nacional de Jujuy; Argentin

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally