Temporomandibular disorders: the habitual chewing side syndrome

Background:Temporomandibular disorders are the most common cause of chronic orofacial pain, but, except where theyoccur subsequent to trauma, their cause remains unknown. This cross-sectional study assessed chewing function (habitualchewing side) and the differences of the chewing side and condylar path and lateral anterior guidance angles in participantswith chronic unilateral temporomandibular disorder. This is the preliminary report of a randomized trial that aimed to testthe effect of a new occlusal adjustment therapy.Methods:The masticatory function of 21 randomly selected completely dentate participants with chronic temporoman-dibular disorders (all but one with unilateral symptoms) was assessed by observing them eat almonds, inspecting the lateralhorizontal movement of the jaw, with kinesiography, and by means of interview. The condylar path in the sagittal plane andthe lateral anterior guidance angles with respect to the Frankfort horizontal plane in the frontal plane were measured onboth sides in each individual.Results:Sixteen of 20 participants with unilateral symptoms chewed on the affected side; the concordance (Fisher’s exacttest, P = .003) and the concordance-symmetry level (Kappa coefficientk= 0.689; 95% confidence interval [CI], 0.38 to 0.99;P = .002) were significant. The mean condylar path angle was steeper (53.47(10.88) degrees versus 46.16(7.25) degrees;P = .001), and the mean lateral anterior guidance angle was flatter (41.63(13.35) degrees versus 48.32(9.53) degrees P = .036)on the symptomatic side.Discussion:The results of this study support the use of a new term based on etiology, ‘‘habitual chewing side syndrome’’,instead of the nonspecific symptom-based ‘‘temporomandibular joint disorders’’; this denomination is characterized inadults by a steeper condylar path, flatter lateral anterior guidance, and habitual chewing on the symptomatic sideThis study was financed with a grant PI11/02507 from the Institute of Health Carlos III of the Ministry of Science and Innovation of the Government of Spain. It was completed with the equipment granted by the General Directorate of Universities and Research; Department of Education and University. Xunta de Galicia. Official Journal No. 143 Galicia, July 22, 1996. And the Department of Innovation, Industry and Commerce. Xunta de Galicia, April 30, 2004S

Asymmetry of dental or joint anatomy or impaired chewing function contribute to chronic temporomandibular joint disorders

Introduction: The etiologies of most chronic temporomandibular joint disorders are unknown. However, an association between habitual chewing on a particular side and chronic temporomandibular joint disorders has been reported. The aim of this study was to investigate the differences between sides (affected vs unaffected) of biodynamic factors (including lateral dental guidance determined by dental anatomy) or condylar path angles (determined by temporomandibular joint morphology) and chewing function (physiological alternate chewing vs single habitual chewing side). The study scope was to investigate possible etiological factors to improve the understanding of temporomandibular joint disorders. The null hypothesis was that no difference would be found between sides that are or are not affected by chronic temporomandibular joint disorders in chewing function or in levels of dental or temporomandibular joint remodeling. Methods: This cross-sectional, double-blind study involved 24 adults with substantial, chronic, unilateral symptoms diagnosed as temporomandibular joint disorders. Chewing function, temporomandibular joint remodeling (using axiography) and dental anatomy (lateral guidance angles using kinesiography) were assessed. Results: Habitual chewing on one particular side was observed in 17 of 24 participants; significantly more (n = 15) chewed on the affected side than on the unaffected side (P = 0.002 in a two-tailed Fisher’s exact test; risk estimate = 4.5; 95% CI 1.326–15.277). The condylar path (CP) angle was steeper on the affected side than on the unaffected side (mean (standard deviation) = 50.52° (9.98°) versus 45.50° (7.98°); P = 0.002 in a two-tailed t-test). The lateral guidance (LG) angles were flatter on the affected side in all 24 participants. Conclusion: Our results suggest that habitual chewing on one side may be associated with increasing condylar path, with flattening lateral guidance angles, and also with chronic temporomandibular joint disorder on the habitual chewing sideThis study was supported by the Carlos III Institute of Health (Ministry of Science and Innovation of the Government of Spain and the European Development Fund, ‘Una manera de hacer Europa’) (grant no. PI11/02507). The design, management, analysis, and reporting of the study are entirely independent of the Carlos III Institute of HealthS

Guía de actuación en las anomalías de la diferenciación sexual (ADS) / desarrollo sexual diferente (DSD)

Las anomalías de la diferenciación sexual (ADS) engloban un amplio espectro de discordancias entre los criterios cromosómico, gonadal y fenotípico (genital) que definen la diferenciación sexual; actualmente, se aboga por la denominación de «desarrollo sexual diferente» (DSD). Su origen es congénito; se clasifican en función de los cromosomas sexuales presentes en el cariotipo; las causas genéticas conocidas son muy diversas y heterogéneas, aunque algunos casos pueden ser secundarios a factores maternos o medioambientales. Su diagnóstico y tratamiento requieren siempre una atención médica y psicosocial multidisciplinar. El diagnóstico etiológico precisa la interacción entre las exploraciones clínicas, bioquímicas (hormonales), genéticas, de imagen y, eventualmente, quirúrgicas. El tratamiento debe abordar la asignación de género, la posible necesidad de tratamiento hormonal substitutivo (suprarrenal si hay insuficiencia suprarrenal y con esteroides sexuales si hay insuficiencia gonadal a partir de la edad puberal), la necesidad de intervenciones quirúrgicas sobre las estructuras genitales (actualmente se tiende a diferirlas) y/o sobre las gónadas (en función de los riesgos de malignización), la necesidad de apoyo psicosocial y, finalmente, una adecuada programación de la transición a la atención médica en las especialidades de adultos. Las asociaciones de personas afectadas tienen un papel fundamental en el apoyo a familias y la interacción con los medios profesionales y sociales. La utilización de Registros y la colaboración entre profesionales en Grupos de Trabajo de sociedades médicas nacionales e internacionales es fundamental para avanzar en mejorar los medios diagnósticos y terapéuticos que precisan los DSD.Disorders of Sex Development (DSD) include a wide range of anomalies among the chromosomal, gonadal, and phenotypic (genital) characteristics that define sexual differentiation. At present, a definition as Different Sexual Development (DSD) is currently preferred. They originate in the pre-natal stage, are classified according to the sex chromosomes present in the karyotype. The known genetic causes are numerous and heterogeneous, although, in some cases, they may be secondary to maternal factors and/or exposure to endocrine-disrupting chemicals (EDCs). The diagnosis and treatment of DSD always requires multidisciplinary medical and psychosocial care. An aetiological diagnosis needs the interaction of clinical, biochemical (hormonal), genetic, imaging and, sometimes, surgical examinations. The treatment should deal with sex assignment, the possible need for hormone replacement therapy (adrenal if adrenal function is impaired, and with sex steroids from pubertal age if gonadal function is impaired), as well as the need for surgery on genital structures (currently deferred when possible) and/or on gonads (depending on the risk of malignancy), the need of psychosocial support and, finally, an adequate organisation of the transition to adult medical specialties. Patient Support Groups have a fundamental role in the support of families, as well as the interaction with professional and social media. The use of Registries and the collaboration between professionals in Working Groups of national and international medical societies are crucial for improving the diagnostic and therapeutic tools required for the care of patients with DSD

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Çédille, revista de estudios franceses

Presentació

Guía de actuación en las anomalías de la diferenciación sexual (ADS) / desarrollo sexual diferente (DSD).

Disorders of Sex Development (DSD) include a wide range of anomalies among the chromosomal, gonadal, and phenotypic (genital) characteristics that define sexual differentiation. At present, a definition as Different Sexual Development (DSD) is currently preferred. They originate in the pre-natal stage, are classified according to the sex chromosomes present in the karyotype. The known genetic causes are numerous and heterogeneous, although, in some cases, they may be secondary to maternal factors and/or exposure to endocrine-disrupting chemicals (EDCs). The diagnosis and treatment of DSD always requires multidisciplinary medical and psychosocial care. An aetiological diagnosis needs the interaction of clinical, biochemical (hormonal), genetic, imaging and, sometimes, surgical examinations. The treatment should deal with sex assignment, the possible need for hormone replacement therapy (adrenal if adrenal function is impaired, and with sex steroids from pubertal age if gonadal function is impaired), as well as the need for surgery on genital structures (currently deferred when possible) and/or on gonads (depending on the risk of malignancy), the need of psychosocial support and, finally, an adequate organisation of the transition to adult medical specialties. Patient Support Groups have a fundamental role in the support of families, as well as the interaction with professional and social media. The use of Registries and the collaboration between professionals in Working Groups of national and international medical societies are crucial for improving the diagnostic and therapeutic tools required for the care of patients with DSD

Emprendimiento e innovación para la competitividad internacional : dimensiones, factores y esquemas empíricos sobre sus causas y efectos

En las dos últimas décadas uno de los ejes centrales de investigación en la Escuela de Relaciones Internacionales ha sido el Comercio y los Negocios Internacionales. El auge de esta línea de investigación puede apreciarse en la consolidación, hace pocos años, de una nueva carrera en ese ámbito y el surgimiento de sobresalientes programas de investigación en esa línea. Dichos espacios han permitido la constitución de un grupo de académicos y una profusa discusión académica en este ámbito. Dos de las iniciativas de mayor influencia en ese transitar han sido el Programa “Comercio, tecnología e innovación” y el Proyecto “Dínamo Innovador”. El logro fundamental de ambas propuestas ha sido sistematizar de forma permanente los componentes más relevantes para comprender los fenómenos de innovación y competitividad, junto con sus consecuencias prácticas. Este proceso sigue adelante con el tercero de una serie de libros dedicados a difundir los hallazgos en la materia. Titulado “Emprendimiento e innovación para la competitividad internacional”, este volumen aborda y expone para su discusión cuatro temas de notable actualidad y relevancia: la economía del conocimiento; la relación entre innovación y comercio exterior; la relación entre comercio exterior y tecnologías; así como la innovación y la propiedad industrial. Una de las grandes virtudes que acompaña el texto es que su vinculación con casos reales. En este sentido, junto con los desarrollos teóricos necesarios, se analizan situaciones específicas, que demuestran cómo pueden ser llevados a la práctica diversos modelos de gestión. Este elemento constituye una relación fundamental entre academia y sector productivo, la cual debe ser explotada cada vez con uno de los pilares del desarrollo nacional. Adicionalmente, el trabajo no se contenta con un abordaje nacional. El texto incluye la colaboración de estudiosos de México y España, lo cual refleja el trabajo metódico del Dr. Juan Carlos Bermúdez Mora por construir redes de conocimiento en beneficio de la Universidad Nacional, en general, y de la Escuela de Relaciones Internacionales, en particular.In the last two decades one of the central axes of research in the School of Relations International has been Commerce and International Business. The rise of this line of research can be seen in the consolidation, a few years ago, of a new career in this field and the emergence of outstanding research programs in that field line. These spaces have allowed the constitution of a group of academics and a profuse academic discussion in this area. Two of the initiatives with the greatest influence in this journey have been the “Commerce, technology and innovation ”and the“ Innovative Dynamo ”Project. The fundamental achievement of both proposals has been to permanently systematize the most relevant components to understand the phenomena of innovation and competitiveness, together with their consequences practices. This process continues with the third in a series of books dedicated to disseminating the findings in the matter. Titled "Entrepreneurship and innovation for international competitiveness", This volume addresses and exposes for discussion four issues of notable relevance and relevance: the knowledge economy; the relationship between innovation and trade Exterior; the relationship between foreign trade and technologies; as well as innovation and industrial property. One of the great virtues that accompanies the text is that it is linked to real cases. In this sense, along with the necessary theoretical developments, specific situations are analyzed, that demonstrate how various management models can be put into practice. This element constitutes a fundamental relationship between academia and the productive sector, which must be exploited each time with one of the pillars of national development. Additionally, the work is not content with a national approach. Text includes collaboration of scholars from Mexico and Spain, which reflects the methodical work of Dr. Juan Carlos Bermúdez Mora for building knowledge networks for the benefit of the University National, in general, and the School of International Relations, in particular.Universidad Nacional, Costa RicaEscuela de Relaciones Internacionale

Guía de actuación en las anomalías de la diferenciación sexual (ADS) / desarrollo sexual diferente (DSD)

Las anomalías de la diferenciación sexual (ADS) engloban un amplio espectro de discordancias entre los criterios cromosómico, gonadal y fenotípico (genital) que definen la diferenciación sexual; actualmente, se aboga por la denominación de «desarrollo sexual diferente» (DSD). Su origen es congénito; se clasifican en función de los cromosomas sexuales presentes en el cariotipo; las causas genéticas conocidas son muy diversas y heterogéneas, aunque algunos casos pueden ser secundarios a factores maternos o medioambientales. Su diagnóstico y tratamiento requieren siempre una atención médica y psicosocial multidisciplinar. El diagnóstico etiológico precisa la interacción entre las exploraciones clínicas, bioquímicas (hormonales), genéticas, de imagen y, eventualmente, quirúrgicas. El tratamiento debe abordar la asignación de género, la posible necesidad de tratamiento hormonal substitutivo (suprarrenal si hay insuficiencia suprarrenal y con esteroides sexuales si hay insuficiencia gonadal a partir de la edad puberal), la necesidad de intervenciones quirúrgicas sobre las estructuras genitales (actualmente se tiende a diferirlas) y/o sobre las gónadas (en función de los riesgos de malignización), la necesidad de apoyo psicosocial y, finalmente, una adecuada programación de la transición a la atención médica en las especialidades de adultos. Las asociaciones de personas afectadas tienen un papel fundamental en el apoyo a familias y la interacción con los medios profesionales y sociales. La utilización de Registros y la colaboración entre profesionales en Grupos de Trabajo de sociedades médicas nacionales e internacionales es fundamental para avanzar en mejorar los medios diagnósticos y terapéuticos que precisan los DSD.Disorders of Sex Development (DSD) include a wide range of anomalies among the chromosomal, gonadal, and phenotypic (genital) characteristics that define sexual differentiation. At present, a definition as Different Sexual Development (DSD) is currently preferred. They originate in the pre-natal stage, are classified according to the sex chromosomes present in the karyotype. The known genetic causes are numerous and heterogeneous, although, in some cases, they may be secondary to maternal factors and/or exposure to endocrine-disrupting chemicals (EDCs). The diagnosis and treatment of DSD always requires multidisciplinary medical and psychosocial care. An aetiological diagnosis needs the interaction of clinical, biochemical (hormonal), genetic, imaging and, sometimes, surgical examinations. The treatment should deal with sex assignment, the possible need for hormone replacement therapy (adrenal if adrenal function is impaired, and with sex steroids from pubertal age if gonadal function is impaired), as well as the need for surgery on genital structures (currently deferred when possible) and/or on gonads (depending on the risk of malignancy), the need of psychosocial support and, finally, an adequate organisation of the transition to adult medical specialties. Patient Support Groups have a fundamental role in the support of families, as well as the interaction with professional and social media. The use of Registries and the collaboration between professionals in Working Groups of national and international medical societies are crucial for improving the diagnostic and therapeutic tools required for the care of patients with DSD

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Altres ajuts: Alliance Bristol-Myers Squibb/Pfizer.Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation