Manifestaciones orales del síndrome de Maroteaux-Lamy (Mucopolisacaridosis VI)

La mucopolisacaridosis tipo VI, también conocida como síndrome de Maroteaux-Lamy, es un trastorno lisosómico autosómico recesivo, causado por la deficiencia de la enzima arilsulfatasa B, lo que conduce a la acumulación de dermatán sulfato en los tejidos y su excreción urinaria. La deposición de mucopolisacáridos genera un trastorno progresivo que afecta a múltiples órganos y que, a menudo, resulta en la muerte a temprana edad. Esta enfermedad tiene varias manifestaciones orales, entre las que destacan las complicaciones dentales, que pueden ser graves e incluir folículos similares a quistes dentígeros, maloclusiones, defectos condilares e hiperplasia gingival, además de características clínicas como cuello corto, opacidad corneal, macroglosia y agrandamiento del cráneo, dimensión anteroposterior larga y mano en garra. Se presenta el caso de un paciente de 14 meses de edad que acudió a consulta de odontopediatría por episodios de fiebre, bajo peso e hiperplasia gingival severa. El examen físico evidenció facies tosca, cuello corto, pectus excavatus, manos con disminución en agarre y retardo en el neurodesarrollo. El examen intraoral halló retardo de la erupción dental, hiperplasia gingival generalizada y paladar con poco crecimiento transversal. El examen radiográfico detectó órganos dentarios incluidos y mala posición en el sector anterior, molares superiores dentro del seno maxilar y caninos inferiores rotados. El paciente fue remitido a medicina para exámenes bioquímicos y genéticos para definir el diagnóstico. La bioquímica reveló MPS tipo VI, lo que fue confirmado mediante prueba molecular. Las manifestaciones clínicas en este caso corresponden a la forma clínica de progresión rápida reportada en estos pacientes: talla baja, malformaciones esqueléticas y alteraciones a nivel oral. Los niños con MPS VI grave comienzan temprano y progresan rápidamente, las radiografías óseas y la medición de GAG en orina son útiles para el diagnóstico con actividad de la enzima ARSB y genética. Es necesario fortalecer el conocimiento en odontología y la población en general sobre las características clínicas de mucopolisacáridos tipo VI para tener un diagnóstico temprano y un mejor manejo de patologías en estos pacientes.Mucopolysaccharidosis type VI, also known as Maroteaux-Lamy syndrome, is an autosomal recessive lysosomal disorder, due to the deficiency of the enzyme arylsulfatase B that leads to the accumulation of dermatan sulfate in the tissues and its urinary excretion. Mucopolysaccharide deposition leads to a progressive disorder affecting multiple organs that often results in death at a young age. This disease has several oral manifestations, among which dental complications can be serious and include follicles similar to dentigerous cysts, malocclusions, condylar defects and gingival hyperplasia, in addition to a short neck, corneal opacity, macroglossia, skull enlargement, anteroposterior dimension long, claw hand is some of the clinical features. A case of a 14-monthold patient is presented, who attended a pediatric dentistry consultation for episodes of fever, low weight, severe gingival hyperplasia. Physical examination revealed coarse facies, short neck, pectus excavatus, hands with decreased grip, and neurodevelopmental delay. On intraoral examination, dental eruption delayed, generalized gingival hyperplasia, palate with little transverse growth. On radiographic examination, dental organs included and poor position in the anterior sector, upper molars within the maxillary sinus, rotated lower canines. He is referred to medicine for biochemical tests and genetics for diagnosis. Detailed biochemistry MPS type VI, confirmed by molecular testing. The clinical manifestations in this case correspond to the clinical form of rapid progression reported in these patients. They report: short stature, skeletal malformations and alterations at the oral level. Children with severe MPS VI start early and progress rapidly, bone radiographs and urine GAG measurement are helpful for diagnosis with genetic and ARSB enzyme activity. It is necessary to strengthen the knowledge in dentistry and the general population about the clinical characteristics of type VI mucopolysaccharides in order to have an early diagnosis and management of pathologies in these patients

Análisis de ciclo de vida en el sector agrícola: el caso del municipio de Viotá, Cundinamarca (Colombia)

The objective of this article is to propose several recommendations about paths to explore regarding the strengthening of the Lifecycle Analysis ( acv ) studies on agriculture. Methodologically, we considered identifying in the literature the main specific barriers for the acv on agriculture and its contrast with the experience of the authors in the development of a study of the “from the ranch to the market” on agricultural chains in the municipality of Viota. We identified two particular issues on the agriculture acv : i) difficulties regarding the absence of data and, ii) limitations derived from the variety of contexts regarding the scale, technique and limitations of the production system. The recommendations were thought from the Colombian institutional framework and for contexts of informal production and weak application of technical and management criteria.L’objectif de cet article est de postuler quelques recommandations sur les voies à explorer dans le renforcement de l’étude sur l’Analyse du Cycle de Vie ( acv ) dans l’agriculture. Méthodologiquement on a considéré l’identification en littérature des principales lisières spécifiques à l’ acv agricole et son contraste avec l’expérience des auteurs dans le développement d’une étude de la « ferme au marché » sur les chaînes agricoles du municipe de Viota. On a identifié deux particularités sur l’ acv agricole: i) les difficultés par rapport à l’absence de données et ii) les limitations dérivées de la variété de contextes en ce qui concerne à l’échelle ; la technique et les limites du système de production. Les recommandations ont étés pensées depuis le cadre institutionnel colombien et pour les contextes de production informel et la débilité d’application de critères techniques et administratifs.El objetivo de este artículo es hacer algunas recomendaciones sobre las vías que espreciso explorar en el fortalecimiento de estudios sobre análisis de ciclo de vida (acv)en agricultura. Metodológicamente, se consideró la identificación en la literatura delas principales barreras específicas al acv agrícola y su contraste con la experienciade los autores en el desarrollo de un estudio de la “finca al mercado”, sobre cadenasagrícolas del municipio de Viotá. Se identificaron dos particularidades sobre elacv agrícola: i) dificultades sobre ausencia de datos y ii) limitaciones derivadasde la variedad de contextos en cuanto a escala, técnica y límites del sistema deproducción. Las recomendaciones fueron pensadas desde el marco institucionalcolombiano y para contextos de producción informal y débil aplicación de criteriostécnico-administrativos

Indicadores de riesgo para la caries dental en niños preescolares de la boquilla, cartagena

Objetivo Describir la ocurrencia de la caries en niños preescolares del corregimiento de La boquilla, Cartagena y relacionarlo con los factores reportados en la literatura como de riesgo.Métodos La muestra fue de 238 niños entre 3 y 5 años. El promedio de edad fue 4.1 (DE=0.82). En cuanto al género, los niños fueron 116 y las niñas 122. La selección individual fue realizada en forma probabilística proporcional al tamaño de la población de cada institución educativa. Para la evaluación de las variables explicatorias y el evento se utilizó un cuestionario y un instrumento clínico respectivamente y los datos fueron analizados a partir de las ocurrencias, realizando un análisis bivariado a través de los Odd Ratios y análisis multivariable por medio de regresión logística.Resultados La prevalencia de caries fue de 60 %, siendo mayor para los niños de 5 años. Los factores asociados de mayor ocurrencia fueron los padres con escolaridad inferior a secundaria y la experiencia de caries.  Al realizar los ajustes de los estimadores por la regresión logística, para la experiencia de caries se obtuvo un OR de 26,6, el consumo de dulces diariamente OR=3.37 y la no exposición a fluorizaciones OR=2.17.  Conclusiones La presencia de la caries en esta población se puede explicar por estos tres factores asociados; sin embargo, esta evidencia puede cambiar cuando estén involucrados otras circunstancias, momentos y lugares en niños con las mismas características

Gafas de realidad virtual como ayuda de distracción y disminución de la ansiedad en niña de 7 años que se somete a procedimiento de extracción dental. Reporte de caso

Virtual reality in Pediatric Dentistry has enormous potential, in the treatment of phobia of dental treatments, this technology is also promising, since it shows satisfactory results and in the surgical area it has a high potential for complex treatments, allowing predictable and safe results. However, future studies should have to establish technological standards with high data quality and in the development of applications approved for clinical routine. Distraction is a non-pharmacological pain management technique commonly used by Pediatric Dentists to control pain and anxiety. There are some new techniques that use audio and video stimulation and distract the patient by exposing him to three-dimensional videos. These techniques are called virtual reality audiovisual systems. The objective of this case was to evaluate the effectiveness of virtual reality glasses as a distraction aid to reduce anxiety in a 7-year-old girl who attends the pediatric dentistry office to perform a dental extraction procedure.La realidad virtual tiene un enorme potencial para el tratamiento de la fobia a los tratamientos dentales en la odontopediatría. Esta tecnología también es prometedora porque muestra resultados satisfactorios y, en el área quirúrgica, tiene un alto potencial para tratamientos complejos, que permite resultados predecibles y seguros. Sin embargo, los estudios futuros deberían centrarse en establecer estándares tecnológicos con alta calidad de datos y en el desarrollo de aplicaciones aprobadas para la rutina clínica. La distracción es una técnica de manejo del dolor no farmacológica, comúnmente utilizada por los odontopediatras para controlar el dolor y la ansiedad. Hay algunas técnicas nuevas que utilizan la estimulación de audio y video, y distraen al paciente exponiéndolo a videos tridimensionales; estas técnicas se denominan sistemas audiovisuales de realidad virtual. El objetivo de este reporte de caso fue evaluar la efectividad de los anteojos de realidad virtual como una distracción para reducir la ansiedad en una niña de 7 años que acudió a la consulta de odontopediatría para un procedimiento de extracción dental

Relación del fraude académico con situaciones personales que enfrentan los estudiantes en la Facultad de Odontología de la Universidad de Cartagena (Colombia)

Introducción: El fraude académico es una práctica deshonesta muy frecuente, difundida en el ambiente universitario, en el que se encuentran afectados los valores y el sentido de responsabilidad con la academia y su formación profesional, el cual se verá reflejado en una posible mal praxis. Objetivos: Identificar las situaciones personales que hace a los estudiantes propensos a cometer fraude académico y establecer si tienen conocimiento sobre las consecuencias que puede traer para su calidad como profesional.Materiales y métodos: Se efectuó un estudio descriptivo de enfoque cualitativo. El mues­­treo utilizado fue en avalancha, que consiste en pedirles a los participantes que sugirieran otros posibles informantes, a los cuales se realizó entrevistas individuales en profundidad, entrevistas estructuradas y entrevistas a grupos focales. Posteriormente se realizó el análisis de los resultados a partir de triangulación de datos. Resultados: El fraude académico afecta comúnmente a la población estudiantil que es propensa a problemas familiares y personales, lo que los hace incurrir en esta opción como la única alternativa para lograr los objetivos académicos, al encontrar que no existe aparente solución ante sus problemas personales y familiares, confrontados a la situación académica.Conclusión: Los estudiantes que cometen acciones fraudulentas justifican sus actos al explicar los principales motivos resaltando la importancia de la familia y de su entorno social, a la vez aceptan que esto afecta su calidad como profesional, pero aun así lo siguen realizando, porque el único objetivo es aprobar la asignatura o el semestre.Palabras clave: Fraude, ética, mala conducta científica, educación en odontología.AbstractIntroduction: Academic fraud is a frequent dishonest practice in the college environment which affects traditional values, the sense of responsibility with academia and professional attitudes which eventually, could become a possible reason for malpractice. Objectives: To identify the personal situations that make students prone to fraud and to establish if they have knowledge of the consequences on their professional development. Materials and methods: A descriptive qualitative analysis was done. The sample was taken by the method of avalanche which consisted in asking the participants to suggest other possible informants who answered individually in depth interviews, structured in­­terviews and interviews to focal groups. The results were then analyzed by means of data triangulation. Results: Academic fraud affects more frequently the student population prone to personal and family problems, which in turn, makes them predisposed to fraud as the only alterna­­tive to achieve their academic objectives when they find that there is no solution for their personal and family problems, when faced to academic conditions. Conclusion: The students that commit fraud justify their acts by explaining the motives that relate to the importance of their family and their social environment, in turn, they ac­­cept that this affects their professional quality, but still keep on doing it because their only objective is to approve the academic period or the semester. Key words: Fraud, ethical, motivation, feelings, students dental

Plan de Auditoría Para la Empresa Carnecitas Basado en el Sistema de Gestión HACCP

No aplicaEl proyecto abordó el análisis y evaluación a través de una auditoría interna en relación con los resultados de las listas de verificaciones del plan HACCP, la cual se empleó una empresa inexistente denominada “Carnecitas”. El desarrolló de este documento se realizó con base a la normativa ISO 19011:2028 con la respectiva estructuración, indicaciones, criterios que la rigen y se consideró normatividad de Colombia para cada hallazgo, así mismo dándole un orden especifico a la auditoria mediante la planificación, trabajo en sitio, generación de informes y seguimiento. En cuanto a los resultados de la auditoria se encontraron varias oportunidades de mejora para la empresa “Carnecitas”, con respecto a las condiciones básicas mínimas que se deben tener para operar una planta de procesamiento de alimentos, cabe destacar que para la superación de estas mismas deben realizar un seguimiento adecuado junto con acciones para abordar riesgos y oportunidades y el compromiso de todo el personal que conforma la empresa.The project addressed the analysis and evaluation through an internal audit in relation to the results of the HACCP plan checklists, which was used by a non-existent company called “Carnecitas”. The development of this document was carried out based on the ISO 19011:2028 regulations with the respective structuring, indications, criteria that govern it and Colombian regulations were considered for each finding, also giving a specific order to the audit through planning, site work, reporting and monitoring. Regarding the results of the audit, several opportunities for improvement were found for the company “Carnecitas”, with respect to the minimum basic conditions that must be met to operate a food processing plant, it should be noted that to overcome these same They must carry out adequate monitoring along with actions to address risks and opportunities and the commitment of all personnel that make up the company

Riesgo en el manejo de la amalgama dental en las entidades odontológicas medianas y pequeñas en el departamento de Antioquia, Colombia

ABSTRACT: This article is based on the applied research “Environmental Management of the Dental Amalgam in Antioquia, Colombia”, which was financed by the company New Stetic S. A. and the University of Antioquia. The research was carried out between 2005 and 2007 by the following groups: Biomedical Science and Technology, Precious Materials, and Pyrometallurgical and Materials Researches, and the Research and Development Division of the mentioned company. Objetive: to describe and characterize the activities about handling mercury, dental amalgam and its waste in 107 dental offices defined as medium and small, that is to say those with less than five dental chairs in the same workplace. Methodology: a poll was made in each institution filling a questionnaire about personal details of the interviewee, mercury and amalgam handling, occupational health, training, environmental conditions, and waste management. Each dental office was visited by a research engineer and an advanced engineering student who were trained in advance in order to collect the information. Results: a reflection aimed to establish integral actions and safe methodologies in the short term to promote a better quality service and a minimum risk for the people exposed to mercury and the ecosystem must be encouraged by dental and administrative staff, as well as by surveillance and control institutions and the educational institutions devoted to the formation of dental professionals.RESUMEN: Este artículo se deriva de la investigación aplicada “Gestión ambiental de la amalgama dental en el departamento de Antioquia”, financiada por la empresa New Stetic S. A. y la Universidad de Antioquia, realizado desde el año 2005 hasta principios del 2007 por los grupos de ciencia y tecnología biomédica (ctb), materiales preciosos (mapre) e investigaciones pirometalúrgicas y de materiales (gipimme) y la división de investigación y desarrollo de la mencionada empresa. Objetivo: describir y caracterizar las actividades relacionadas con el manejo del mercurio, la amalgama y sus residuos en 107 entidades prestadoras de servicios en salud oral, clasificadas entre medianas y pequeñas, y definidas como aquellas que tienen menos de cinco sillas o unidades odontológicas en el mismo sitio de trabajo. Metodología: en cada institución se realizó una encuesta personalizada, diligenciando un cuestionario sobre los datos del entrevistado, el manejo del mercurio y la amalgama, salud ocupacional, capacitación, condiciones ambientales y gestión de los residuos. Cada entidad fue visitada por un ingeniero investigador y un estudiante avanzado de ingeniería, previamente capacitados para recoger la información. Resultados: debe producirse una reflexión en el personal odontológico y administrativo de las instituciones prestadoras de servicios en salud oral, las entidades de vigilancia y control y las instituciones académicas formadoras del talento humano, con el fin de implementar acciones integrales y metodologías seguras a corto plazo que generen un servicio de mejor calidad y mínimo riesgo para el personal laboralmente expuesto y para el ecosistema

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe