Cronología de la erupción dentaria en caninos superiores e inferiores

Objectives: To establish the chronological sequence of the dental eruption in canines, carrying out various investigations in different studies that indicate, according to their analyzes, that there is a direct relationship with the factors that cause their eruption to be altered. Methods: A bibliographic review was carried out from October to December 2020, using the following search strategy in the database: Scielo, Repository, Medical journals, within which 22 articles related to the subject were considered, taking into account that 90% of the publications and bibliographic reviews were from 2010-2020. Results: In different studies a close relationship was found in the different factors that tend to cause the advance or delay in its appearance. That is why it is necessary to consider investigating the biological factors that can affect the development of the tooth bud. Conclusion: All the information that has been obtained in this investigation, we conclude that the order of eruption of the mentioned teeth, whether they are upper and lower canines, is affected and is influenced by components such as malnutrition, geographical environment, climate, race, factor environmental, sex and age.Objetivos: Establecer la secuencia cronología de la erupción dentaria en caninos, realizando diversas investigaciones en diferentes estudios que indican según sus análisis que existe relación directa con los factores que hacen que su erupción se vea alterada. Métodos: Se realizó una revisión bibliográfica a partir de octubre hasta diciembre del 2020, empleando la siguiente estrategia de búsqueda en la base de datos: Scielo, Repositorio, Revistas médicas dentro de los cuales se consideró 22 artículos relacionados con el tema, tomando en cuenta que el 90% de las publicaciones y revisiones bibliográficas fueron del 2010 – 2020. Resultados: En diferentes estudios se encontraron una estrecha relación en los diferentes factores que tienden a provocar el adelanto o retraso en su aparición. Es por ello que se necesita considerar investigar los factores biológicos que pueden afectar el desarrollo del brote de los dientes. Conclusión: Toda la información que se ha podido obtener en esta investigación, concluimos que el orden de erupción de los dientes mencionados, sean caninos superiores e inferiores se ve afectada e influyen los componentes como la desnutrición, el medio geográfico, el clima, la raza, factor ambiental, sexo y edad

Quality of life, tuberculosis and treatment outcome; a case-control and nested cohort study

BACKGROUND: Global tuberculosis policy increasingly emphasises broad tuberculosis impacts and highlights the lack of evidence concerning tuberculosis-related quality of life (QOL). METHODS: Participants were recruited in 32 Peruvian communities 13/7/2016-24/2/2018 and followed-up until 8/11/2019. Inclusion criteria were: age ≥15 years for "patients" (n=1545) starting treatment for tuberculosis disease in health centres; "contacts" (n=3180) who shared a patient's household for ≥6 h·week-1; and randomly-selected "controls" (n=277). The EUROHIS-QOL questionnaire quantified satisfaction with: QOL; health; energy; activities of daily living (ADL); self; relationships; money; and living place. FINDINGS: Newly-diagnosed tuberculosis was most strongly associated with lower QOL scores (p<0.001). Patients initially had lower QOL than controls for all EUROHIS-QOL questions (p≤0.01), especially concerning health, ADL and self. Lower initial QOL in patients predicted adverse treatment outcomes and scores <13-points had 4.2-times (95%CI=2.3,7.6) increased risk of death versus those with higher QOL scores (both p<0.001). Patient QOL was re-assessed 6 months later and for patients with successful treatment, QOL became similar to participants who never had tuberculosis, whereas patients who did not complete treatment continued to have low QOL (p<0.001). Multidrug-resistant tuberculosis was associated with lower QOL before and during treatment (both p<0.001). Contacts had lower QOL if they lived with a patient who had low QOL score (p<0.0001) or were a caregiver for the patient (p<0.001). CONCLUSIONS: Tuberculosis was associated with impaired psycho-socio-economic QOL which recovered with successful treatment. Low QOL scores predicted adverse treatment outcome. This brief EUROHIS-QOL 8-item questionnaire quantified the holistic needs of tuberculosis-affected people, potentially guiding patient-centred care

Percutaneous mitral valve repair : Outcome improvement with operator experience and a second-generation device

Background and aim: Recent randomized data comparing percutaneous mitral valve repair (PMVR) versus optimal medical treatment in patients with functional MR (FMR) seemed to highlight the importance of the learning curve not only for procedural outcomes but also for patient selection. The aim of the study was to compare a contemporary series of patients undergoing PMVR using a second-generation Mitraclip device (Mitraclip NT) with previous cohorts treated with a first-generation system. Methods: This multicenter study collected individual data from 18 centers between 2012 and 2017. The cohort was divided into three groups according to the use of the first-generation Mitraclip during the first (control-1) or second half (control-2) or the Mitraclip NT sys-tem. Results: A total of 545 consecutive patients were included in the study. Among all, 182 (33.3%), 183 (33.3%), and 180 (33.3%) patients underwent mitral repair in the control-1, control-2, and NT cohorts, respectively. Procedural success was achieved in 93.3% of patients without differences between groups. Major adverse events did not statistically differ among groups, but there was a higher rate of pericardial effusion in the control-1 group (4.3%, 0.6%, and 2.6%, respectively; p = 0.025). The composite endpoint of death, surgery, and admission for congestive heart failure (CHF) at 12 months was lower in the NT group (23.5% in control-1, 22.5% in control-2, and 8.3% in the NT group; p = 0.032). Conclusions: The present paper shows that contemporary clinical outcomes of patients undergoing PMVR with the Mitraclip system have improved over time

Dependencia funcional, deterioro cognitivo y características de la marcha en adultos mayores con enfermedades crónicas

Objetivo: Identificar el nivel y relación de dependencia funcional (DF), deterioro cognitivo (DC) y características de la marcha en adultos mayores (AM) con enfermedades crónicas, habitantes del área metropolitana de Saltillo, Coahuila. Método: Diseño descriptivo correlacional. Muestra constituida por 105 AM de 60 años o más, usuarios de los Centros de Atención e Integración Familiar (CAIF). El tamaño de la muestra se determinó a través del paquete estadístico nQuery Advisor 7.0 considerando análisis de correlación bivariada, nivel de significancia de 0.5 y potencia del 95%. El muestreo fue por conveniencia. La recolección de datos se realizó a través de una cédula de datos socio-demográficas conjuntamente con cuatro instrumentos: para DF 1. Actividades Básicas de la Vida Diaria (AVD) y 2. Actividades Instrumentales de la Vida Diaria (AIVD); para DC 3. Mini Mental State Examination MMS-E; para las características de la marcha, 4. Sistema para Análisis de Marcha GaitRite ©, alphas de 0.730, 0.765, 0.720 y 0.811, respectivamente. Resultados. La edad promedio de los AM participantes es de 75 años (X = 75 ± 6) y escolaridad de 5 años (X = 5 ± 3). La mayor parte son mujeres (81.9%); que viven sin pareja (74.3%) y reportan alguna enfermedad crónico-degenerativa (65%) como Diabetes, 32.4%; Hipertensión, 61% y Enfermedades Articulares, 42%. La prevalencia de: dependencia severa en ABVD 5.7% y AIVD 21.9 %; DC 24 %; Los AM con mayor edad y menor escolaridad, reportan mayor grado de DC (r= .251; p<.05; r= -.259; p<.05, respectivamente) y dependencia para realizar ABVD (r=.297; p<.05) y AIVD (r=.351; p<.05); Por lo menos, el 30% de AM presentabó dificultades para mantener el equilibrio. Además, el 60% presentó dificultades para sentarse porque tienen problemas al medir la distancia entre su propio cuerpo y la silla, caen en la silla o se apoye en él con movimientos inseguros. 29% presentaba dificultades para elevar su pie derecho completamente. Discusión y Conclusiones. Los resultados de este estudio confirman lo que la literatura reporta acerca de la prevalencia y asociación de DF, DC y presencia de enfermedades crónicas características del AM como Diabetes e Hipertensión. Es necesario profundizar en el análisis de este estudio incorporando mediciones acerca del tiempo de diagnóstico de la enfermedad crónica, co-morbilidad, síntomas de depresión y diferencias de género, entre otros aspectos. También los factores asociados a la problemática de la marcha. Para el profesional de Enfermería, la continuidad de este fenómeno de estudio, fortalecerá el cuerpo de conocimientos disciplinares y la atención a las complejas necesidades de cuidado a la salud que demanda este segmento de la población. Palabras Clave: Adulto Mayor, Dependencia Funcional, Deterioro Cognitivo, Marcha

Associated factors to serious infections in a large cohort of juvenile-onset systemic lupus erythematosus from Lupus Registry (RELESSER).

Objective: To assess the incidence of serious infection (SI) and associated factors in a large juvenile-onset systemic lupus erythematosus (jSLE) retrospective cohort. Methods: All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet =4 ACR-97 SLE criteria and disease onset <18 years old (jSLE), were retrospectively investigated for SI (defined as either the need for hospitalization with antibacterial therapy for a potentially fatal infection or death caused by the infection). Standardized SI rate was calculated per 100 patient years. Patients with and without SI were compared. Bivariate and multivariate logistic and Cox regression models were built to calculate associated factors to SI and relative risks. Results: A total of 353 jSLE patients were included: 88.7% female, 14.3 years (± 2.9) of age at diagnosis, 16.0 years (± 9.3) of disease duration and 31.5 years (±10.5) at end of follow-up. A total of 104 (29.5%) patients suffered 205 SI (1, 55.8%; 2-5, 38.4%; and =6, 5.8%). Incidence rate was 3.7 (95%CI: 3.2–4.2) SI per 100 patient years. Respiratory location and bacterial infections were the most frequent. Higher number of SLE classification criteria, SLICC/ACR DI score and immunosuppressants use were associated to the presence of SI. Associated factors to shorter time to first infection were higher number of SLE criteria, splenectomy and immunosuppressants use. Conclusions: The risk of SI in jSLE patients is significant and higher than aSLE. It is associated to higher number of SLE criteria, damage accrual, some immunosuppressants and splenectomy

Relevance of gastrointestinal manifestations in a large Spanish cohort of patients with systemic lupus erythematosus: what do we know?

SLE can affect any part of the gastrointestinal (GI) tract. GI symptoms are reported to occur in >50% of SLE patients. To describe the GI manifestations of SLE in the RELESSER (Registry of SLE Patients of the Spanish Society of Rheumatology) cohort and to determine whether these are associated with a more severe disease, damage accrual and a worse prognosis. METHODS: We conducted a nationwide, retrospective, multicentre, cross-sectional cohort study of 3658 SLE patients who fulfil =4 ACR-97 criteria. Data on demographics, disease characteristics, activity (SLEDAI-2K or BILAG), damage (SLICC/ACR/DI) and therapies were collected. Demographic and clinical characteristics were compared between lupus patients with and without GI damage to establish whether GI damage is associated with a more severe disease. RESULTS: From 3654 lupus patients, 3.7% developed GI damage. Patients in this group (group 1) were older, they had longer disease duration, and were more likely to have vasculitis, renal disease and serositis than patients without GI damage (group 2). Hospitalizations and mortality were significantly higher in group 1. Patients in group 1 had higher modified SDI (SLICC Damage Index). The presence of oral ulcers reduced the risk of developing damage in 33% of patients. CONCLUSION: Having GI damage is associated with a worse prognosis. Patients on a high dose of glucocorticoids are at higher risk of developing GI damage which reinforces the strategy of minimizing glucocorticoids. Oral ulcers appear to decrease the risk of GI damage. © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks