Optimización de la antibioterapia en cirugía del tercer molar incluido

OBJETIVOS. El objetivo de este trabajo fue comparar el uso de amoxicilina 1.000 mg frente a amoxicilina/clavulánico 875/125 mg tras la extracción de terceros molares mandibulares incluidos para la prevención de complicaciones infecciosas, estudiar qué pauta antibiótica de las propuestas es más efectiva en la prevención de las complicaciones inflamatorias postoperatorias (entendiendo como complicaciones inflamatorias el dolor, la inflamación, el trismo y la fiebre) y analizar la influencia de variables demográficas y radiológicas en la aparición de complicaciones infecciosas e inflamatorias postoperatorias. MATERIAL Y MÉTODO. Se ha realizado un estudio experimental prospectivo en 385 pacientes que requirieron la extracción de un tercer molar mandibular incluido, durante los años 2011-2012 en la Unidad de Gestión Clínica de Cirugía Oral y Maxilofacial del Hospital Virgen del Rocío de Sevilla y la Facultad de Odontología de la Universidad de Sevilla. Tras la realización de las exodoncias, se administraron 2 pautas diferentes de profilaxis antibiótica: amoxicilina/clavulánico 875/125 mg cada ocho horas durante siete días y amoxicilina 1.000 mg según la misma pauta. Los pacientes fueron entrevistados telefónicamente a los seis días de la intervención, indagando la posibilidad de infección, mediante un cuestionario sobre la presencia de criterios de sospecha de infección (presencia de exudado purulento intraoral, Fiebre mayor de 38°C, dolor severo y persistente, inflamación severa y persistente, persistencia de limitación de apertura oral) la presencia de diarrea y la toma de analgésicos de refuerzo. Ante la presencia de un criterio de sospecha de infección los pacientes fueron revidados al día siguiente por el investigador para confirmar la presencia de infección. Se analizaron los datos demográficos (sexo y edad) de los pacientes y las características radiológicas de los cordales (clasificación de Winter, clasificación de Pell y Gregory, e índice de Koerner). Se realizaron análisis estadísticos mediante los test de Chi cuadrado, t de Student y ANOVA. RESULTADOS. En los 385 pacientes del estudio, la frecuencia de aparición de infección postoperatoria fue del 1,04 %, sin diferencias estadísticamente significativas entre ambos grupos, siendo del 0,6% en el grupo tratado con amoxicilina y ácido clavulánico versus 1,4% en el grupo tratado amoxicilina (p=0,45). Los pacientes tratados con amoxicilina refirieron con mayor frecuencia que los pacientes tratados con amoxicilina y clavulánico la presencia de inflamación severa y persistente (8,7% vs 3%; p= 0,013) y limitación de la apertura oral (7,8% vs 2,4 %; p=0,02; respectivamente). En relación con el sexo y la edad, no existieron diferencias significativas entre los pacientes. En relación a la clasificación Pell y Gregory, las inclusiones más profundas tuvieron una mayor presencia de exudado purulento (p=0,049), fiebre mayor a 38 grados tras la cirugía (p=0,003) e infección (p=0,009) que el resto de inclusiones. Respecto al índice de Koerner y la clasificación de Winter, no se relacionaron con valores distintos de complicaciones postoperatorias El grupo de pacientes tratado con amoxicilina y ácido clavulánico presentó mayor porcentaje de diarrea que el grupo tratado con amoxicilina (12% versus 0,9%; p=0,0001). CONCLUSIONES. Los resultados de nuestro estudio muestran que el uso de amoxicilina sin asociar a ácido clavulánico es adecuado para el control de las complicaciones postoperatorias de la extracción del tercer molar inferior, no presentando ventajas sustanciales el uso de la amoxicilina asociada a ácido clavulánico y sí un mayor coste y diarrea asociados a su uso

Ectopic third molar in the mandibular condyle: a review of the literature

Objectives: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle. Study design: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients. Results: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined. Conclusions: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery

Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery

Background: The authors present a technique for selected cases of CBCL. The primary repair of the CBCL with a severely protruding premaxilla in one stage surgery is very difficult, essentially because a good muscular apposition is difficult, forcing synchronously to do a premaxillary setback to facilitate subsequent bilateral lip repair and, thus, achieving satisfactory results. We achieve this by a reductive ostectomy on the vomero- premaxillary suture. Material and Methods: 4 patients with CBCL and severely protruding premaxilla underwent premaxillary setback by vomerine ostectomy at the same time of lip repair in the past 24 months. The extent of premaxillary setback varied between 9 and 16 mm. The required amount of bone was removed anterior to the vomero-premaxillary suture. The authors did an additional simultaneous gingivoperiosteoplasty in all patients, achieving an enough stability of the premaxilla in its new position, to be able to close the alveolar gap bilaterally. The authors have examined the position of premaxilla and dental arch between 6 and 24 months. We did not do the primary nose correction, because this increased the risk of impairment of the already compromised vascularity of the philtrum and premaxilla. Results : The follow-up period ranged between 6 and 24 months. None of the patients had any major complication. During follow-up, the premaxilla was minimally mobile. We achieved a good lip repair in all cases: adequate muscle repair, symmetry of the lip, prolabium and Cupid’s bow, as well as good scars. Conclusions : To our knowledge, there are few reports of one stage surgery with vomerine ostectomy to repair CBCL with severely protruding premaxilla. Doing this vomerine ostectomy, we don’t know how it will affect the subsequent growth of the premaxila and restrict the natural maxillary growth. Applying this alternative treatment for children with CBCL and protruded premaxilla without any preoperative orthopedic, we can successfully perform, in a single-stage surgery, a good primary lip repair at our center. Further confirmations of this surgery with follow up and anthropometric studies of these patients during childhood and adolescence are require

Advantages of surgical simulation in the surgical reconstruction of oncological patients

Stereolithography, which consists of computer-aided designed/computer-aided manufactured (CAD-CAM) and computer simulations, is a manufacturing technologies used for the production of definitive models and prototypes printed in three dimensions, and is widely used in Oral and Maxillofacial Surgery. Surgical procedures using models made by these technologies offer several advantages. This article describes three clinical cases of our experiences with patients diagnosed with squamous cell carcinoma and mandibular osteosarcoma, who underwent surgical removal of the lesions and subsequent mandibular reconstruction with a free fibula graft using surgical guides. In all three clinical cases, surgical guides were used for the mandibular osteotomy, fibula osteotomy, and graft placement in the recipient area. Surgical guidelines are useful for improving the accuracy of surgical interventions and are appropriate for many types of resection and mandibular reconstruction

Detection of NOTCH1 mutations in paraffin samples in patients with potentially malignant lesions

On certain occasions, oral cancer is preceded by potentially malignant lesions. The degree of dysplasia in Guinea pigs attempts to determine the risk of developing a malignant lesion. The search for genetic mutations, biomarkers, as a more truthful and r

Comparative trial between the use of amoxicillin and amoxicillin clavulanate in the removal of third molars

Objectives: The purpose of this study was to compare the use of amoxicillin (1g) vs amoxicillin and clavulanate (875/125mg) after extraction of retained third molars for prevention of infectious complications. Study Design: The study involved 546 patients attending for removal a retained third molar and divided in to two groups: Group 1 - amoxicillin and clavunate (875/125mg) group (n=257) and Group 2 - amoxicillin (1g) group (n=289). All patients were recalled for investigating the possibility of infection, presence of diarrhea and further analgesic intake. Results: From a total of 546 patients, the frequency of infection was 1.4%, without no statistically differences be - tween the two groups. Group 1 showed statistically higher presence of patients with gastrointestinal complications ( p>0.05). In 546 patients, 2.7% of patients reported severe pain that would not relieve with medication. Conclusions: The results of our study show that the use of amoxicillin (1g) and amoxicillin and clavunate (875/125mg) is similar efficacious in preventing infection after retained third molar extraction but amoxicillin and clavunate (875/125mg) produces more gastrointestinal discomfort

Education knowledge transfer: Report on in-school placements needs and possibilities of the technologies

The WP2 of the EKT project aimed at describing how in-school placement (ISP) is organised and developed in the initial teacher education in the countries participating in the EKT project (Austria, England, Ireland, Portugal and Spain). In order to achieve this goal, two main pr ocedures were developed: 1. The characterization of national ISP systems, based on the analysis of institutional documentation (legislation, tools, guides, regulations, protocols, reports...) identified and described by the EKT academic teams in each country 2. The identification of the perspectives and conceptions of academic and school mentors involved in ISP, working either Higher Education Institutions (HEI) where Initial Teacher Education (ITE) is developed or at the schools where ISP takes place. For this sake, a questionnaire was designed and applied to a sample of 347 mentors from the different countries involved in the project. The analysis of the different ITE systems enabled the identification of many common features. In fact, all the countries have ITE systems that involve the HEI and nursery/primary/ secondary schools where ISP takes place. In most situations, ITE involves consecutive programmes (at graduation and post-graduation levels). And despite some variation in the length of these consecutive programmes (6 + 3/4 semesters or 8 + 2/3 semesters), the extension of the whole ITE process is less variable, the same happening with the global number of ECTS units involved in any ITE process regardless of the country. In some countries (e.g., Spain), and concerning, mainly but not exclusively, nursery and primary school teachers’ preparation, ITE may take place at the graduation level. It is also worth mentioning the case of England, where two different teacher training paths can be found: HEI routes and School-led postgraduate (consecutive) routes that involve different kinds of programmes: • School-centred initial teacher training (SCITT) programmes (no salaried); • School Direct Training programmes (non-salaried); • School Direct Training programmes (salaried); • Teach First (salaried); • Postgraduate Teaching; Apprenticeship (PGTA) (salaried). No matter the country, ITE processes imply in-school placement. The characteristics of these placements may vary according not only to the features of each national educational system but also to the respective ITE programmes and the school level training refers to. In general ISP is developed under agreements established between HEI where ITE programmes are developed and schools where ISP takes place and involves both HEI teachers and school teachers as mentors. The selection of these school mentors varies from country to country as well as the role they play and their participation in the students´ evaluation. There also seems to be some variation regarding the tasks, the number of hours involved and the kind of materials students have to produce and deliver as a result of their practices during ISP. Despite this variation, it is possible to recognize that there is, in most cases, a concern with the promotion of a reflection on the practice by the use of adequate practices and instruments, such as the construction of portfolios that make possible a critical attitude towards the teaching activities developed. Report on in-school placements needs and possibilities of the technologies Página 5 1. Executive summary The questionnaire enabled the identification of academic and school mentors’ perspectives and conceptions about ISP and focused on different aspects involved in the process, such as: • The relevance of different internship activities and the degree of collaboration between academic and school mentors in their development. • The responsibility for the definition of the curricular framework of isp. • The aspects included in isp guides. • The relation between the student teacher and the mentors and the kind of activities they are involved in during the whole isp process. • The structure of student teachers’ final report or dissertation; the aspects focused on mentors’ observation and supervision during isp. • The structure and content of the Portfolio of in-school placement teaching practice. Due to the diversity of approaches in the countries involved in the study, the design of the questionnaire took into account the complexity of the ISP process and the multiplicity of aspects involved in the process by offering the respondents rather long lists of the items they should express their position about. As far as the relevance of the activities involved in ISP, all the items were valued above 3,10 in a scale that varied from 1 (nothing) to 5 (very much), regardless of the group (country), what may be seen as the recognition of the diversity and complexity of ISP. Despite the existing significant statistical differences, it is possible to say that there are some items, whose relevance is recognized (generally rated above 4), namely those related to the definition of standards and procedures and those concerning classroom observation, feedback, student-teacher evaluation, and collaborative work involving students and mentors. Collaboration between academic and school mentors throughout the ISP process and regarding the different activities involved is highly valued although the comparison of data regarding the degree of real cooperation and the data regarding the degree of cooperation that should exist suggests the necessity of its enhancement. Regardless of the country, the definition of the curricular framework of ISP depends mainly on the HEI, either the HEI coordinator or their mentors. In-school placement guides tend to include several items, but mentors responding to the questionnaire highlight those related to the definition of the different roles involved and to the teaching practices and their assessment. The planning of activities integrated into the school activity emerges as the most important aspect of the relationship between the student teacher and the mentors. Before the placement, activities concerning class teaching planning and the selection of materials and other resources seem to be the most frequent activities involving mentors, either from HEI or schools and student teachers. During the in-school placement, the most frequent activities involving mentors and student teachers concern not only teaching planning and materials selection but also teaching activities; pupils’ assessment is also highlighted as a frequent activity that involves school mentors and student teachers. Activities developed after the placement are valued in the questionnaire; the most highlighted regard pupils´ assessment and the production of students´ progress reports. The model for the student teacher’s final report or dissertation includes not only the monitoring procedures during its preparation and presentation but also writing rules and procedures, as well as guidelines and rules for the use of data collected by the trainee, the extent/ length of the report and formatting standards and references. The structure and content of this report dissertation are defined at the HEI level

Host adaptive immunity deficiency in severe pandemic influenza

INTRODUCTION: Pandemic A/H1N1/2009 influenza causes severe lower respiratory complications in rare cases. The association between host immune responses and clinical outcome in severe cases is unknown. METHODS: We utilized gene expression, cytokine profiles and generation of antibody responses following hospitalization in 19 critically ill patients with primary pandemic A/H1N1/2009 influenza pneumonia for identifying host immune responses associated with clinical outcome. Ingenuity pathway analysis 8.5 (IPA) (Ingenuity Systems, Redwood City, CA) was used to select, annotate and visualize genes by function and pathway (gene ontology). IPA analysis identified those canonical pathways differentially expressed (P < 0.05) between comparison groups. Hierarchical clustering of those genes differentially expressed between groups by IPA analysis was performed using BRB-Array Tools v.3.8.1. RESULTS: The majority of patients were characterized by the presence of comorbidities and the absence of immunosuppressive conditions. pH1N1 specific antibody production was observed around day 9 from disease onset and defined an early period of innate immune response and a late period of adaptive immune response to the virus. The most severe patients (n = 12) showed persistence of viral secretion. Seven of the most severe patients died. During the late phase, the most severe patient group had impaired expression of a number of genes participating in adaptive immune responses when compared to less severe patients. These genes were involved in antigen presentation, B-cell development, T-helper cell differentiation, CD28, granzyme B signaling, apoptosis and protein ubiquitination. Patients with the poorest outcomes were characterized by proinflammatory hypercytokinemia, along with elevated levels of immunosuppressory cytokines (interleukin (IL)-10 and IL-1ra) in serum. CONCLUSIONS: Our findings suggest an impaired development of adaptive immunity in the most severe cases of pandemic influenza, leading to an unremitting cycle of viral replication and innate cytokine-chemokine release. Interruption of this deleterious cycle may improve disease outcome.The study was scientifically sponsored by the Spanish Society for Critical Care Medicine (SEMICYUC). Funding: MICCIN-FIS/JCYL-IECSCYL-SACYL (Spain): Programa de Investigación Comisionada en Gripe, GR09/0021-EMER07/050- PI081236-RD07/0067. CIHR-NIH-Sardinia Recherché-LKSF Canada support DJK.S

New regulations regarding Postgraduate Medical Training in Spain: perception of the tutor's role in the Murcia Region

<p>Abstract</p> <p>Background</p> <p>Recently introduced regulatory changes have expanded the Tutor role to include their primary responsibility for Postgraduate Medical Training (PMT). However, accreditation and recognition of that role has been devolved to the autonomic regions. The opinions of the RT may be relevant to future decisions;</p> <p>Methods</p> <p>A comprehensive questionnaire, including demographic characteristics, academic and research achievement and personal views about their role, was sent to 201 RTs in the Murcia Region of Spain. The responses are described using median and interquartile ranges (IQR);</p> <p>Results</p> <p>There were 147 replies (response rate 73%), 69% male, mean age 45 ± 7 yrs. RTs perception of the residents' initial knowledge and commitment throughout the program was 5 (IQR 4-6) and 7 (IQR 5-8), respectively. As regards their impact on the PMT program, RTs considered that their own contribution was similar to that of senior residents. RTs perception of how their role was recognised was 5 (IQR 3-6). Only 16% did not encounter difficulties in accessing specific RT training programs. Regarding the RTs view of their various duties, supervision of patient care was accorded the greatest importance (64%) while the satisfactory completion of the PMT program and supervision of day-to-day activities were also considered important (61% and 59% respectively). The main RT requirements were: a greater professional recognition (97%), protected time (95%), specific RT training programs (95%) and financial recognition (86%);</p> <p>Conclusions</p> <p>This comprehensive study, reflecting the feelings of our RTs, provides a useful insight into the reality of their work and the findings ought to be taken into consideration in the imminent definitive regulatory document on PMT.</p

Design and integration of lower ports for ITER diagnostic systems

All around the ITER vacuum vessel, forty-four ports will provide access to the vacuum vessel for remotehandling operations, diagnostic systems, heating, and vacuum systems: 18 upper ports, 17 equatorialports, and 9 lower ports. Among the lower ports, three of them will be used for the remote handlinginstallation of the ITER divertor. Once the divertor is in place, these ports will host various diagnosticsystems mounted in the so-called diagnostic racks. The diagnostic racks must allow the support andcooling of the diagnostics, extraction of the required diagnostic signals, and providing access and main-tainability while minimizing the leakage of radiation toward the back of the port where the humans areallowed to enter. A fully integrated inner rack, carrying the near plasma diagnostic components, will bean stainless steel structure, 4.2 m long, with a maximum weight of 10 t. This structure brings water forcooling and baking at maximum temperature of 240?C and provides connection with gas, vacuum andelectric services. Additional racks (placed away from plasma and not requiring cooling) may be requiredfor the support of some particular diagnostic components. The diagnostics racks and its associated exvessel structures, which are in its conceptual design phase, are being designed to survive the lifetimeof ITER of 20 years. This paper presents the current state of development including interfaces, diagnos-tic integration, operation and maintenance, shielding requirements, remote handling, loads cases anddiscussion of the main challenges coming from the severe environment and engineering requirements