Integrando Sonrisas

El estado de salud bucal de los niños con discapacidad, que concurren a la Fundación Florecer (Florencia, Prov. De Santa Fe),   presenta una perspectiva desoladora.  Se cree que la atención odontológica a personas con discapacidad, requiere preparación especial y equipo adicional. Quizás sí, pero no para orientar, educar a los padres y enseñar estrategias con alto componente preventivo de enfermedades bucales futuras. Impulsando actividades que determinen patrones de conductas favorables, considerando a todas las personas como sujetos con derechos y deberes. Entre esas actividades, se realizan talleres sobre prevención y cuidados de la salud, general y bucal. Se organizan grupos de trabajo, uno de promoción y educación para la salud con las familias y otro de atención clínica odontológica no convencional. Se efectúan  evaluaciones de proceso, las cuales son transversales a todas las actividades y al finalizar cada jornada, con encuestas ad hoc sobre las actividades realizadas. La salud bucal es parte de la salud general, y como tal debe expresarse al considerar las necesidades de las personas, es decir, involucra al paciente como una unidad armónica, íntimamente unido a su familia o a quien se ocupa de él, además adaptado a su ambiente geográfico, social, cultural, y económico. El abandono, la falta de planificación y el desinterés son la constante habitual. Las personas con discapacidad en nuestro país se ven forzados a sufrir una pésima higiene bucodental, debido a la falta de instrucción adecuada por el profesional. Asimismo se producen odontalgias recidivantes, dado la presencia de restos alimenticios adheridos a mucosas y dientes. Debido al  predominio de dietas blandas, cariogénicas, ricas en hidratos de carbono y con un alto contenido de sacarosa. Se debe considerar que el desconocimiento de los problemas bucodentales de los pacientes con discapacidad, asociado a sus propias reacciones emocionales y las de sus familiares, patologías, así como las actitudes del profesional, van a crear con toda seguridad la mayor barrera para acceder a su atención. Además hay que agregar a estos factores la coexistencia de inconvenientes psicosociales que agravan el cuadro general de salud de estos pacientes y de su comprensión para que la profesión odontológica pueda plantearse el problema e idear soluciones a la medida de estas necesidades, que no son las mismas en todos los pacientes según diferentes características, situación y tipo de discapacidad. Es necesario que todos los niveles de los sistemas de salud existentes sean más inclusivos y accesibles, sin discriminar,  y generando ajustes razonables que incluyan a todos.    

Life Quality Impairment Caused by Hookworm-Related Cutaneous Larva Migrans in Resource-Poor Communities in Manaus, Brazil

Hookworm-related cutaneous larva migrans (CLM) is a parasitic skin disease common in developing countries with hot climates. In resource-poor settings, CLM is associated with considerable morbidity. The disease is caused by animal hookworm larvae that penetrate the skin and migrate aimlessly in the epidermis as they cannot penetrate the basal membrane. Particularly in the rainy season, the intensity of infection is high with up to 40 larval tracks in an affected individual. Tracks are very itchy and are surrounded by a significant inflammation of the skin. Bacterial superinfection is common and intensifies the inflammation. The psychosocial consequences caused by CLM have never been investigated. We showed that CLM causes skin disease-associated life quality impairment in 91 patients with CLM. Skin disease-associated life quality was significantly impaired. The degree of impairment correlated to the intensity of infection and the number of body areas affected. After treatment with ivermectin, life quality was rapidly restored

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Diagnosis of venous disease with duplex ultrasound

The advent of duplex ultrasound (DU) has changed vascular practice over the years. Venous anatomy, valve function and obstruction can be evaluated in real time using DU. It is a low cost, portable, non-invasive, safe and operator-friendly device that can be used for diagnosis, treatment guidance and follow-up. This paper defines the patterns, location and characteristics of venous reflux and also provides insightful information on acute and chronic venous obstruction. </jats:p

Re-modelling of venous thrombosis

Venous thromboembolism is one of the most common causes of morbidity and mortality in modern societies. The entirety of events involved in venous thrombus formation and resolution remains to be elucidated. Temporal relation between the initial cellular insult, thrombus formation and resolution is critical for instituting a prompt treatment. This paper analyses the current basic knowledge and the events involved in venous remodelling after an episode of venous thrombosis. </jats:p

Pattern and types of non-saphenous vein reflux

Venous reflux often originates from saphenous trunks and their tributaries. In about 10% of the patients reflux derived from non-saphenous veins (NSV) such as those located in the buttock, posterolateral thigh, vulva, lower posterior thigh, popliteal fossa, knee or along the peripheral nerves such as the tibial and sciatic nerve. It is also important to note that patients who had saphenous vein stripping or ablation have higher odds of presenting with NSV reflux. The majority of patients with NSV reflux have varicose veins and lower extremity oedema; however, about 10% of those patients present with skin damage. This paper analyses the patterns and types of NSV reflux for diagnosis and treatment purposes. </jats:p