Onabotulinumtoxina en el tratamiento de la odontalgia atípica: Descripción de un caso clínico

La odontalgia atípica (OA) se define como un dolor dental continuo en uno o varios dientes, en ocasiones precedido por procedimientos dentales, y que tras un examen completo no se detecta patología dental. Se presupone un origen neuropático cuya respuesta a tratamientos locales y sistémicos es insatisfactoria. Presentamos el caso clínico de una paciente de 50 años con OA tras extracción dental, que presentó una reducción significativa del dolor después del tratamiento local con OnabotulinumtoxinA (OnabotA) en el área sintomática. La respuesta a la administración de OnabotA en esta paciente concuerda con las observadas previamente en series reducidas de casos, por lo que podría ser una alternativa terapéutica en este tipo de dolores de difícil control. Atypical odontalgia (AO) is defined as a continuous dental pain in the area of one or several teeth, sometimes preceded by dental procedures in the absence of signs of dental pathology after complete examination. It is thought to have a neuropathic origin in which the response to local and systemic treatment is insufficient. We present the case of a 50-year-old patient with AO after dental extraction, who presented a significant reduction in pain after local treatment with OnabotulinumtoxinA (OnabotA) in the symptomatic area. The response to the administration of OnabotA in this patient is in line with what had previously been observed in small series of cases, so it could be a therapeutic alternative in this type of pain that is difficult to control

Aplicación práctica de los test cognitivos breves

Resumen: Introducción: Los test cognitivos breves (TCB) pueden ayudar a detectar el deterioro cognitivo (DC) en el ámbito asistencial. Se han desarrollado y/o validado varios TCB en nuestro país, pero no existen recomendaciones específicas para su uso. Desarrollo: Revisión de estudios sobre el rendimiento diagnóstico en la detección del DC llevados a cabo en España con TCB que requieran menos de 20 min y recomendaciones de uso consensuadas por expertos, sobre la base de las características de los TCB y de los estudios disponibles. Conclusión: El Fototest, el Memory Impairment Screen (MIS) y el Mini-Mental State Examination (MMSE) son las opciones más recomendables para el primer nivel asistencial, pudiendo añadirse otros test (Test del Reloj [TR] y test de fluidez verbal [TFV]) en caso de resultado negativo y queja o sospecha persistente (aproximación escalonada). En el segundo nivel asistencial es conveniente una evaluación sistemática de las distintas áreas cognitivas, que puede llevarse a cabo con instrumentos como el Montreal Cognitive Assessment, el MMSE, el Rowland Universal Dementia Assessment o el Addenbrooke's Cognitive Examination, o bien mediante el uso escalonado o combinado de herramientas más simples (TR, TFV, Fototest, MIS, Test de Alteración de la Memoria y Eurotest). El uso asociado de cuestionarios cumplimentados por un informador (CCI) aporta valor añadido a los TCB en la detección del DC.La elección de los instrumentos vendrá condicionada por las características del paciente, la experiencia del clínico y el tiempo disponible. Los TCB y los CCI deben reforzar —pero nunca suplantar— el juicio clínico, la comunicación con el paciente y el diálogo interprofesional. Abstract: Introduction: Brief cognitive tests (BCT) may help detect cognitive impairment (CI) in the clinical setting. Several BCT have been developed and/or validated in our country, but we lack specific recommendations for use. Development: Review of studies on the diagnostic accuracy of BCT for CI, using studies conducted in Spain with BCT which take less than 20 min. We provide recommendations of use based on expert consensus and established on the basis of BCT characteristics and study results. Conclusion: The Fototest, the Memory Impairment Screen (MIS) and the Mini-Mental State Examination (MMSE) are the preferred options in primary care; other BCT (Clock Drawing Test [CDT], test of verbal fluency [TVF]) may also be administered in cases of negative results with persistent suspected CI or concern (stepwise approach). In the specialised care setting, a systematic assessment of the different cognitive domains should be conducted using the Montreal Cognitive Assessment, the MMSE, the Rowland Universal Dementia Assessment, the Addenbrooke's Cognitive Examination, or by means of a stepwise or combined approach involving more simple tests (CDT, TVF, Fototest, MIS, Memory Alteration Test, Eurotest). Associating an informant questionnaire (IQ) with the BCT is superior to the BCT alone for the detection of CI.The choice of instruments will depend on the patient's characteristics, the clinician's experience, and available time. The BCT and IQ must reinforce — but never substitute — clinical judgment, patient-doctor communication, and inter-professional dialogue. Palabras clave: Test cognitivos breves, Deterioro cognitivo, Detección, Cribado, Atención primaria, Atención especializada, Keywords: Brief cognitive tests, Cognitive impairment, Detection, Screening, Primary care, Specialised car

Statistical Analysis of Solar Events Associated with Storm Sudden Commencements over One Year of Solar Maximum During Cycle 23: Propagation from the Sun to the Earth and Effects

International audienceTaking the 32 storm sudden commencements (SSCs) listed by the International Service of Geomagnetic Indices (ISGI) of the Observatory de l’Ebre during 2002 (solar activity maximum in Cycle 23) as a starting point, we performed a multi-criterion analysis based on observations (propagation time, velocity comparisons, sense of the magnetic field rotation, radio waves) to associate them with solar sources, identified their effects in the interplanetary medium, and looked at the response of the terrestrial ionized and neutral environment. We find that 28 SSCs can be related to 44 coronal mass ejections (CMEs), 15 with a unique CME and 13 with a series of multiple CMEs, among which 19 (68%) involved halo CMEs. Twelve of the 19 fastest CMEs with speeds greater than 1000 km s−1 are halo CMEs. For the 44 CMEs, including 21 halo CMEs, the corresponding X-ray flare classes are: 3 X-class, 19 M-class, and 22 C-class flares. The probability for an SSC to occur is 75% if the CME is a halo CME. Among the 500, or even more, front-side, non-halo CMEs recorded in 2002, only 23 could be the source of an SSC, i.e. 5%. The complex interactions between two (or more) CMEs and the modification of their trajectories have been examined using joint white-light and multiple-wavelength radio observations. The detection of long-lasting type IV bursts observed at metric–hectometric wavelengths is a very useful criterion for the CME–SSC events association. The events associated with the most depressed Dst values are also associated with type IV radio bursts. The four SSCs associated with a single shock at L1 correspond to four radio events exhibiting characteristics different from type IV radio bursts. The solar-wind structures at L1 after the 32 SSCs are 12 magnetic clouds (MCs), 6 interplanetary coronal mass ejections (ICMEs) without an MC structure, 4 miscellaneous structures, which cannot unambiguously be classified as ICMEs, 5 corotating or stream interaction regions (CIRs/SIRs), one CIR caused two SSCs, and 4 shock events; note than one CIR caused two SSCs. The 11 MCs listed in 3 or more MC catalogs covering the year 2002 are associated with SSCs. For the three most intense geomagnetic storms (based on Dst minima) related to MCs, we note two sudden increases of the Dst, at the arrival of the sheath and the arrival of the MC itself. In terms of geoeffectiveness, the relation between the CME speed and the magnetic-storm intensity, as characterized using the Dst magnetic index, is very complex, but generally CMEs with velocities at the Sun larger than 1000 km s−1 have larger probabilities to trigger moderate or intense storms. The most geoeffective events are MCs, since 92% of them trigger moderate or intense storms, followed by ICMEs (33%). At best, CIRs/SIRs only cause weak storms. We show that these geoeffective events (ICMEs or MCs) trigger an increased and combined auroral kilometric radiation (AKR) and non-thermal continuum (NTC) wave activity in the magnetosphere, an enhanced convection in the ionosphere, and a stronger response in the thermosphere. However, this trend does not appear clearly in the coupling functions, which exhibit relatively weak correlations between the solar-wind energy input and the amplitude of various geomagnetic indices, whereas the role of the southward component of the solar-wind magnetic field is confirmed. Some saturation appears for Dst values <−100 nT on the integrated values of the polar and auroral indices

Κορώνη -- Μοσχάτον

A joint measurement is presented of the branching fractions $B^0_s\to\mu^+\mu^-$ and $B^0\to\mu^+\mu^-$ in proton-proton collisions at the LHC by the CMS and LHCb experiments. The data samples were collected in 2011 at a centre-of-mass energy of 7 TeV, and in 2012 at 8 TeV. The combined analysis produces the first observation of the $B^0_s\to\mu^+\mu^-$ decay, with a statistical significance exceeding six standard deviations, and the best measurement of its branching fraction so far, and three standard deviation evidence for the $B^0\to\mu^+\mu^-$ decay. The measurements are statistically compatible with SM predictions and impose stringent constraints on several theories beyond the SM