RESUMEN
BACKGROUND: Edentulism and sleep disturbances are commonly seen among older people and cause serious negative effects on their daily lives. Edentulism can induce sleep problems by changing maxillo-mandibular anatomy and surrounding soft tissues. The effect of the treatment of complete edentulism on sleep disturbances is not sufficiently understood. The purpose of this cohort study is to detect how different treatment options affect sleep quality, daytime fatigue and sleep disorder breathing in totally edentulous elderly people. MATERIAL AND METHODS: Ninety-six individulas (50 male and 46 female) participated in this prospective cohort study. The patients were non-randomly assigned to three groups, fixed implant-supported prostheses (FP), removable implant-supported prostheses (RP) and conventional total prostheses (CP). The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the STOP-Bang questionnaire were calculated before (T0) and one year after (T1) their prosthetic rehabilitations. RESULTS: Although there was no statistically significant difference between groups in terms of mean PSQI (p=0.524), ESS (p=0.410) and STOP-Bang (p=0.697) scores at T0, there was a significant difference between groups in terms of mean PSQI (p=0.011), ESS (p=0.030) and STOP-Bang (p=0.024) scores at T1. The FP group, when compared to CP group was associated with significantly better scores in the PSQI (Δ = -3.399, 95% CI= -4.612 to -2.187), ESS (Δ = -1.663, 95% CI= -3.149 to -0.176) and STOP-Bang (Δ = -0.994, 95% CI= -1.592 to -0.397). CONCLUSIONS: Within the limitations of this study FP was associated with a positive influence on sleep disturbances. Randomized controlled trials will be needed to provide reliable inference on this association.
Asunto(s)
Implantes Dentales , Trastornos del Sueño-Vigilia , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Estudios Prospectivos , Sueño , Encuestas y CuestionariosRESUMEN
Distraction osteogenesis is usually performed in cleft lip and palate patients with severe maxillary sagittal discrepancies, considering the stability of surgical maxillary advancement and the limited complications of velopharyngeal valve insufficiency. Moreover, interdental distraction osteogenesis is a successful treatment protocol for repairing large clefts. Herein, we report a multidisciplinary approach for the treatment of two patients with cleft lip and palate using an archwise distraction appliance (AWDA). AWDA is a tooth-supported, custom-made appliance for closing the alveolar cleft and providing sagittal correction of the maxilla. Using it, the curve of the dental arch is maintained during distraction, and there is no need for a second operation to activate and remove the appliance. Few cases in which archwise distraction was performed have been reported so far. AWDA is a functional and inexpensive appliance used to reduce the alveolar cleft width and produce maxillary advancements in patients with cleft lip and palate.
Asunto(s)
Labio Leporino , Fisura del Paladar , Osteogénesis por Distracción , Humanos , MaxilarRESUMEN
The aim of this prospective randomised study was to estimate the effect of saline wound irrigation before wound closure in the prevention of infection following caesarean delivery. Participants with indications for elective or emergency caesarean section were randomly allocated to two groups. A total of 260 women who underwent wound irrigation before wound closure and 260 did not. No demographic differences were identified between the groups. There were also no significant differences between the groups in terms of factors known to influence wound infection. The incidence of wound infection was 7.3% for the control group and 6.5% for the saline group; however, the difference was not significant (relative risk: 0.88; 95% confidence interval: 0.45-1.74; p=0.86). In conclusion, saline wound irrigation before wound closure did not reduce the infection rate in patients undergoing caesarean delivery.
Asunto(s)
Cesárea/efectos adversos , Cloruro de Sodio/uso terapéutico , Infección de la Herida Quirúrgica/prevención & control , Irrigación Terapéutica/métodos , Adulto , Cesárea/estadística & datos numéricos , Femenino , Humanos , Incidencia , Embarazo , Estudios Prospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/epidemiología , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
This study determined the rate, risk factors, management and outcome of bladder injury during caesarean section and suggests ways to improve the quality of care and reduce maternal morbidity and mortality. During the study period, there were 76 bladder injuries in 56,799 caesarean deliveries for an overall incidence of 0.13%. Women with a bladder injury were more likely to have had a prior caesarean delivery, as compared with the control group (72.4% vs 34.2%; p < 0.001). Cases were also more likely than controls to have had prior pelvic surgery. The presence of adhesions during the procedure was greater in the bladder injury group than the controls. In conclusion, our study suggests that a previous caesarean delivery is the most common risk factor for bladder injury during caesarean delivery. Moreover, the presence of labour, station of the presenting fetal part deeper than or equal to +1, and a large baby were independent risks for a bladder injury during caesarean delivery. Women requesting primary caesarean deliveries should be counselled about the potential for significant surgical complications in repeat caesarean deliveries when discussing the indications for a primary elective caesarean delivery.