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OBJECTIVE: To determinate the association between of albumin, neutrophil-lymphocyte ratio and lymphocytes (NLR) with clinical stage in cervical cancers. METHODS: Design a retrospective cross-sectional study of consecutive subjects diagnosed with cervical cancer for the first time. The Bethesda system was used for histological diagnosis and the subjects were stratified with the FIGO system, considering stages IA to IIB as localized; while, IIIA and IVB as advanced stages. Albumin, NLR and lymphocytes were evaluated as inflammatory biomarkers and the cut-off points generated by the ROC curves were albumin < 3 mg/dL, NLR ≥ 2.0 and lymphocytes < 1.2 103/ul. The association was calculated by Odds Ratios (OR) with 95% confidence intervals. RESULTS: A total of 152 patients were analyzed, with mean age of 49.3 ± 14.0 years. Epidermoid cancer was the most frequent in 70.6% and 51.3% were classified as advanced clinical stages. A bivariate analysis showed significant relationships between advanced clinical stages and albumin < 3 mg/dL with OR 5.72 (CI95% 2.62-12.4; p < 0.001); for NLR ≥ 2.0 an OR 2.53 (CI95% 1.34-4.89; p = 0.005) and for lymphocytes < 1.2 103/ul of OR 3.39 (CI95% = 1.73-6.65; p < 0.001). CONCLUSIONS: Albumin levels < 3 mg/dL, NLR ≥ 2.0 and lymphocytes < 1.2 103/ul, were associated with advanced stages in subjects with cervical cancer.

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OBJECTIVE: Hepatic steatosis is associated with increased surgical complications in bariatric surgery patients. We aimed to evaluate the effect of phentermine in reducing hepatic steatosis, adipose tissue, and surgical complications in patients undergoing bariatric surgery. METHODS: This was a two-arm, double-blind, randomized, controlled pilot trial of 64 adult subjects with BMI >35 kg/m2 selected for bariatric surgery randomized into phentermine group (15 mg once daily) or placebo group for 8 weeks. Both groups adhered to a hypocaloric diet (500 calories/day) and an individualized exercise program. The primary endpoint was reducing the frequency of hepatic steatosis measured by ultrasound and reducing adipose tissue through fat mass in total kilograms or percentage. Key secondary points were the prevalence of surgical complications. Baseline and final biochemical parameters and blood pressure too were assessments. RESULTS: In the phentermine group, the frequency of hepatic steatosis decreased by 19%, and the percentage of patients with a normal ultrasound increased from 9% to 28% (p = 0.05). Likewise, the decrease in fat mass in kilograms was more significant in the phentermine group (56.1 kg vs. 51.8 kg, p = 0.02). A significant reduction in the HOMA-IR index was observed regardless of weight loss. No differences in surgical complications were observed between groups. Phentermine was well-tolerated; no differences were observed in the frequency of adverse events between the groups. CONCLUSIONS: Phentermine decreased the proportion of individuals with hepatic steatosis by 19% and promoted a more significant fat mass loss in kilograms among candidates for bariatric surgery.

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OBJECTIVE: To evaluate the antimicrobial activity of a silver nanoparticles/carboxymethyl-cellulose (AgNPs/CMC) composite on in vitro and dentine disc heterogeneous biofilms. DESIGN: AgNPs/CMC composite effect on normal human gingival fibroblast cells (HGF) viability was determined by the MTT reduction assay. In addition, we evaluated the antimicrobial effect of AgNPs/CMC composite on Candida albicans, Enterococcus faecalis, and Fusobacterium nucleatum growth in vitro and heterogeneous biofilms, as well as dentine disc biofilms. RESULTS: Quasi-spherical AgNPs/CMC composites, with a mean 22.3 nm particle-size were synthesized. They were not toxic to HGF cells at concentrations tested that were antimicrobial, however they caused significant cytotoxicity (89 %, p <  0.05) at concentrations > 15 µg/mL. In vitro, they inhibited up to 67 %, 66 %, and 96 % C. albicans, E. faecalis, and F. nucleatum growth at concentrations ranging from 1.2 µg/mL to 9.6 µg/mL, as compared with untreated control. We also demonstrated significant (p <  0.05) 58 % biofilm reduction by 4.8 µg/mL AgNPs/CMC composite on human dentine discs. CONCLUSION: AgNPs/CMC composite showed anti biofilm activity on monocultures, heterogenous cultures, and dentine discs, resulting a potentially effective alternative to prevent and eliminate infections after endodontic treatment.

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Diabetes mellitus is a highly prevalent disease in the world and in Mexico. Due to its chronic evolution it causes multiple sequelae, disability and mortality. An adequate control of diabetic patients based on reaching glycemic targets, maintenance of healthy weight, as well as lipid and blood pressure control is essential to reduce the risk of progression of its complications. Lifestyle changes are also key for preventing and treating the disease. Knowledge of the relationship and mechanism involved between diabetes and alterations in nutrient metabolism should be considered to provide an adequate nutritional program. This article aims to bring healthcare professionals the concepts and strategies, proposed by several scientific societies, about nutritional management of adult patients with diabetes mellitus.

La diabetes mellitus es una enfermedad altamente prevalente en el mundo y en México. Debido a su evolución crónica, es también causa de múltiples secuelas, discapacidad y mortalidad. Un adecuado control del paciente diabético que se logre a partir de metas de glucemia, mantenimiento de peso sano, así como control de lípidos y presión arterial es indispensable a fin de disminuir el riesgo de progresión de las complicaciones de la diabetes mellitus. Los cambios en el estilo de vida son clave en la prevención y el tratamiento de la enfermedad. El conocimiento de la relación y el mecanismo involucrados entre la diabetes y las alteraciones en el metabolismo de los nutrientes debe ser considerado para brindar un programa nutricional adecuado. Este artículo pretende aproximar a los profesionales de la salud los conceptos y las estrategias nutricionales actuales, propuestos por diversas sociedades científicas, para el manejo nutricional de pacientes adultos con diabetes mellitus.

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INTRODUCTION: The aim of this in vivo study was to compare the accuracy of 3 electronic apex locators (EALs) (Root ZX mini [J Morita Corp, Tokyo, Japan], Apex ID [SybronEndo, Glendora, CA], and Propex Pixi [Dentsply Maillefer, Ballaigues, Switzerland]) to determine the working length. METHODS: Thirty single-rooted human teeth that were scheduled for extraction were selected for the study. Electronic measurements were performed with the 3 EALs. After the teeth had been extracted, a #10 K-file was used to determine the actual working length, which was established at 0.5 mm short of the major foramen. The data were statistically analyzed with analysis of variance (α = 0.05). RESULTS: No significant differences were found among the experimental groups (P > .05). The mean distance from the actual working length to the file tip was 0.163 ± 0.032 mm when Root ZX mini was used, 0.343 ± 0.032 mm for Propex Pixi , and 0.012 ± 0.008 mm for Apex ID. CONCLUSIONS: Under the in vivo conditions of this study, no statistically significant differences were observed among the 3 EALs.

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INTRODUCTION: Clostridium difficile infection (CDI) causes potentially lethal diarrhea. OBJECTIVE: To identify the risk factors for mortality in hospitalized patients with CDI. METHOD: Cross-sectional, retrospective study. The analyzed risk factors were age, comorbidities, nutritional status, past and current use of antibiotics, proton pump inhibitors, steroids, immunosuppressive therapy and chemotherapy, as well as development of acute kidney injury (AKI). RESULTS: Sixty-eight cases were assessed. Mean age was 51.4 ± 19.37 years. Mortality was 22.2 %. Moderate to severe undernutrition (Odds ratio [OR] = 20.15; 95% confidence interval [CI] = 1.13-35; p = 0.004), use of more than 2 antibiotics (OR = 1.61; 95% CI = 0.39-6.65; p = 0.01), AKI as determined by creatinine levels (OR = 1.34; 95% CI = 0.09-2.21; p = 0.02), hypotension with vasopressor use (OR = 1.28; 95% CI = 0.30-1.23; p = 0.001) and multiple organ failure (OR = 1.13; 95% CI = 0.31-4.92; p = 0.002) were associated with mortality. CONCLUSIONS: CDI represents an important problem in hospitalized patients and confers them an additional morbidity and mortality risk.

INTRODUCCIÓN: La infección por Clostridium difficile (ICD) es causa de diarrea hospitalaria potencialmente letal. OBJETIVO: Identificar los factores de riesgo para mortalidad en pacientes hospitalizados con ICD. MÉTODO: Estudio transversal y retrospectivo. Se analizaron factores de riesgo: edad, comorbilidades, estado nutricional, antecedente y uso de antibióticos, de inhibidores de bomba de protones, esteroides, inmunosupresores, quimioterapia y desarrollo de lesión renal aguda (LRA). RESULTADOS: Fueron evaluados 68 casos (incidencia de 25.7/10 000 egresos hospitalarios). La edad fue de 51.4 ± 19.37 años y la mortalidad de 22.2 %. La desnutrición moderada a severa mostró RM = 20.15, IC 95 % = 1.13-35, p = 0.004; el uso de más de dos antibióticos, RM = 1.61, IC 95 % = 0.39-6.65, p = 0.01; la LRA determinada por elevación de los niveles de creatinina, RM = 1.34, IC 95 % = 0.09-2.21, p = 0.02; la hipotensión con uso de vasopresores, RM = 1.28, IC 95 % = 0.30-1.23, p = 0.001; y el desarrollo de falla orgánica múltiple (FOM), RM = 1.13, IC 95 % = 0.31-4.92, p = 0.002. CONCLUSIONES: La desnutrición moderada a severa, el uso de más de dos antibióticos, la LRA, la hipotensión con uso de vasopresores y la FOM se asocian con incremento en la mortalidad en pacientes con ICD.

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Resumen Introducción: La infección por Clostridium difficile (ICD) es causa de diarrea hospitalaria potencialmente letal. Objetivo: Identificar los factores de riesgo para mortalidad en pacientes hospitalizados con ICD. Método: Estudio transversal y retrospectivo. Se analizaron factores de riesgo: edad, comorbilidades, estado nutricional, antecedente y uso de antibióticos, de inhibidores de bomba de protones, esteroides, inmunosupresores, quimioterapia y desarrollo de lesión renal aguda (LRA). Resultados: Fueron evaluados 68 casos (incidencia de 25.7/10 000 egresos hospitalarios). La edad fue de 51.4 ± 19.37 años y la mortalidad de 22.2 %. La desnutrición moderada a severa mostró RM = 20.15, IC 95 % = 1.13-35, p = 0.004; el uso de más de dos antibióticos, RM = 1.61, IC 95 % = 0.39-6.65, p = 0.01; la LRA determinada por elevación de los niveles de creatinina, RM = 1.34, IC 95 % = 0.09-2.21, p = 0.02; la hipotensión con uso de vasopresores, RM = 1.28, IC 95 % = 0.30-1.23, p = 0.001; y el desarrollo de falla orgánica múltiple (FOM), RM = 1.13, IC 95 % = 0.31-4.92, p = 0.002. Conclusiones: La desnutrición moderada a severa, el uso de más de dos antibióticos, la LRA, la hipotensión con uso de vasopresores y la FOM se asocian con incremento en la mortalidad en pacientes con ICD.

Abstract Introduction: Clostridium difficile infection (CDI) causes potentially lethal diarrhea. Objective: To identify the risk factors for mortality in hospitalized patients with CDI. Method: Cross-sectional, retrospective study. The analyzed risk factors were age, comorbidities, nutritional status, past and current use of antibiotics, proton pump inhibitors, steroids, immunosuppressive therapy and chemotherapy, as well as development of acute kidney injury (AKI). Results: Sixty-eight cases were assessed. Mean age was 51.4 ± 19.37 years. Mortality was 22.2 %. Moderate to severe undernutrition (Odds ratio [OR] = 20.15; 95% confidence interval [CI] = 1.13-35; p = 0.004), use of more than 2 antibiotics (OR = 1.61; 95% CI = 0.39-6.65; p = 0.01), AKI as determined by creatinine levels (OR = 1.34; 95% CI = 0.09-2.21; p = 0.02), hypotension with vasopressor use (OR = 1.28; 95% CI = 0.30-1.23; p = 0.001) and multiple organ failure (OR = 1.13; 95% CI = 0.31-4.92; p = 0.002) were associated with mortality. Conclusions: CDI represents an important problem in hospitalized patients and confers them an additional morbidity and mortality risk.

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Background: The use of smart pump technology has shown to be profitable in the intensive care unit (ICU) because it avoids costs from prevented medication errors and allows for savings on disposables and medications by establishing standardized concentrations and dosing units. Objective: The objective of the study is to evaluate the economic impact of the implementation of smart infusion pumps in the consumption of intravenous (IV) solutions in an ICU. Methods: A retrospective observational study was conducted with a pre-post design. The study occurred in the adult ICU of the Hospital Juárez de México. The pattern of consumption of IV solutions (sodium chloride 9%, Hartmann's solution, dextrose 5% and 10%, sodium chloride 0.9% with dextrose 5%) was analyzed preimplementation and postimplementation of 50 Plum A+™ pumps with Hospira MedNet™ security software. Using the TreeAge Pro 2016 software, deterministic and probabilistic analyses were carried out (10 000 Monte Carlo simulations) to confirm the robustness of the annual consumption comparison and the associated expenses before and after implementing smart technology. Results: The implementation of the smart pumps reduced the annual consumption of IV solutions to 8994 units (18%) and 3649 liters (22.3%). In the first year, MXN$55 850.97 were saved. From an institutional perspective and with a probability of 0.63, the use of MedNet™ technology proved to be a lower cost alternative (17.1% saved) with respect to the conventional infusion systems. Conclusion: The implementation of smart infusion pumps allows savings, specifically for the IV solutions used in ICU.

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BACKGROUND: The use of malnutrition screening tools (MSTs) among hospitalized pediatric patients is a simple practice that may allow the identification of patients at nutrition risk. There are different tools developed in the English language, but there are limited data available on their validity when translated into other languages. The aim of this study was to construct a Spanish version (SV) of the STRONGkids MST and determine its validity and reliability in a pediatric population. METHODS: The translation and cross-cultural adaptation of the tool was performed, followed by the reliability, feasibility, and validity of the SV of the STRONGkids MST. Anthropometric assessment was used as the reference standard to evaluate the criterion validity of the MST. The length of hospital stay was used to determine predictive validity. RESULTS: A total 400 children were included in the study, 90 of whom took part in the reliability phase. The interrater agreement between dietitians and nursing staff was kappa (κ) = 0.67, while the intrarater agreement among dietitians was κ = 0.82. The feasibility of the MST was adequate for clinical use. The results for criterion validity between STRONGkids and anthropometric assessment was κ = 0.56, and the criterion validity between STRONGkids and length of hospital stay was κ = 0.20. The sensitivity of the MST was 86% and the specificity was 72%. CONCLUSIONS: The SV of the MST showed good reliability and feasibility. The validity is moderate, and the MST could be considered a useful resource for early detection of malnutrition risk.

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OBJETIVO: Comparar la efectividad de un plan de alimentación hipocalórico hiperproteico con otro normoproteico sobre la composición corporal, los parámetros bioquímicos y las citocinas inflamatorias en pacientes obesos precirugía bariátrica sometidos a un tratamiento integral. MÉTODO: Se estudiaron 76 pacientes con un índice de masa corporal (IMC) ≥ 40 kg/m² previamente a la cirugía bariátrica. Un grupo fue tratado con una dieta hipocalórica hiperproteica y se comparó con una dieta hipocalórica normoproteica. Se evaluaron parámetros bioquímicos, parámetros antropométricos, composición corporal y valores de citocinas inflamatorias en suero al inicio y después de 4 meses de tratamiento. RESULTADOS: En ambos grupos se observó una disminución de peso, de IMC y de masa grasa, así como un incremento de la masa muscular respecto al momento basal (p < 0.05), sin diferencias entre los grupos estudiados. No se encontraron cambios en los parámetros bioquímicos ni en las concentraciones séricas de factor de necrosis tumoral (TNF) e interleucina (IL)-6 antes y después de 4 meses de tratamiento, ni entre los grupos evaluados (p > 0.05). Las concentraciones séricas de IL-1ß disminuyeron únicamente con la dieta hipocalórica normoproteica (p = 0.02). CONCLUSIONES: La dieta hipocalórica hiperproteica no muestra ventajas en la reducción de peso y grasa corporal, ni en la ganancia de masa muscular, en comparación con la dieta hipocalórica normoproteica en pacientes con obesidad mórbida precirugia bariátrica sometidos a un tratamiento integral. OBJECTIVE: Compare the effectiveness of a hyperproteic hypocaloric feeding plan with a normoproteic on body composition, biochemical parameters and inflammatory cytokines in obese pre-bariatric surgery patients in the integral treatment. METHOD: Seventy-six pre-bariatric surgery patients with body mass index (BMI) ≥ 40 kg/m² were studied. One group was treated with a hyperproteic hypocaloric diet and compared with a normoproteic hypocaloric diet. Biochemical parameters, anthropometric parameters, body composition and levels of tumor necrosis factor (TNF), interleukin (IL)-6 and IL-1ß in serum were evaluated at the initiation of treatment and after 4 months. RESULTS: In both groups studied, a decrease in weight, BMI and fat mass was observed, as well as an increase in muscle mass compared to baseline (p < 0.05), no differences showed between the groups studied. No change was found in the biochemical parameters and serum levels of TNF and IL-6 before and after 4 months of treatment, nor among the groups evaluated (p > 0.05). Serum IL-1ß levels decreased after treatment with only a normoprotein hypocaloric diet (p = 0.02). ­. CONCLUSIONS: Hyperproteic hypocaloric diet does not show advantages in weight reduction and body fat or in muscle mass gain compared to the normoproteic hypocaloric diet in patients with morbid obesity bariatric pre-surgery in the integral treatment.

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Resumen: ANTECEDENTES Los pacientes con enfermedades neurológicas son susceptibles a padecer disfagia frecuentemente no diagnosticada. OBJETIVO Determinar la existencia de disfagia en pacientes con enfermedad neurológica atendidos en la consulta externa y su relación con el riesgo de desnutrición. MATERIAL Y MÉTODO Estudio descriptivo transversal, efectuado de enero a diciembre de 2016. Se realizó valoración clínica de las fases de la deglución, se aplicó el cuestionario EAT-10 versión en español, se tomaron medidas antropométricas, se estimó la ingesta calórica y se determinó el riesgo nutricional, el índice de Quetelet y la Evaluación Global Subjetiva. RESULTADOS Se analizaron 55 pacientes, 54.5% mujeres, con edad media de 47.29 años. La disfagia afectó a 49.1% de los pacientes; los pacientes con riesgo de desnutrición representaron 25.5%. Los pacientes con disfagia representaron 33.3% y tuvieron mayor riesgo de desnutrición vs 17.9% sin disfagia (p < 0.001). El género femenino (OR 1.23; IC95% 0.42-3.58; p = 0.451), la diabetes mellitus (OR 2.95; IC95% 0.52-16.75; p = 0.196), el antecedente de neumonía (OR 2.12; IC95% 1.59-2.81; p = 0.236) y la enfermedad neurológica crónica (OR 1.65; IC95% 0.49-5.53; p = 0.301) se relacionaron con incremento de disfagia. CONCLUSIONES La prevalencia de disfagia no diagnosticada es elevada y se asocia con mayor desnutrición.

Abstract: BACKGROUND Neurological diseases patients are susceptible to dysphagia, frequently not diagnosed. OBJECTIVE To determine the presence of dysphagia in patients attending for neurological pathology of extern consult and its relation with malnutrition. MATERIAL AND METHOD A prospective, cross-sectional study, performed from January to December 2016, that evaluated dysphagia symptoms, clinically phases of swallowing, and EAT-10 questionnaire validated to Spanish was applied. Risk factors were determined, as well as nutritional risk, Quetelet Index, Global Subjective Assessment, and demographics data. RESULTS Of the 55 patients, 54.5% were women; mean age was of 47.29 years. The prevalence of dysphagia was 49.1%; patients with risk malnutrition represented 25.5%. Dysphagia patients accounted for 33.3% and had a higher risk of malnutrition vs 17.9% without dysphagia (p < 0.001). The risk of dysphagia increased in women (OR 1.23, 95% CI 0.42-3.58, p = 0.45), diabetes mellitus (OR 2.95, 95 % CI 0.52-16.75, p = 0.19), patients with history of pneumonia (OR 2.12, 95% CI 1.59-2.81; p = 0.236) and chronic neurological disease (OR 1.65, 95% CI 0.49-5.53, p = 0.30). CONCLUSIONS There is high prevalence of undiagnosed dysphagia and it's associated with greater risk of malnutrition.

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Objective: To determine the nutritional status and its association with functional capacity in patients with digestive tract cancer. Methods: We retrospectively studied all adult patients hospitalized who were diagnosed as having a cancer of the digestive tract. Nutritional status and functional capacity were assessed. Descriptive statistic and odds ratio were used to determine the association in SPSS 14.0. Results: 57 patients were included, 96% had weight loss. Using subjective global assessment (SGA) as a method of screening, 82.5% of the patients were found malnutrition and by biochemical and immunological test 82% and 65% respectively. Functional capacity was assessed by Karnofsky index, finding that 75.5% of the patients have some activity limitation. Results show an association between malnutrition by SGA and limitation in functional capacity (c2 = 1.56; p = 0.212; OR: 2.46; 95% confidence interval [95% CI]: 0.581-10.465). In addition, we observe an association between the total lymphocyte count and limitation in functional capacity (χ2 = 6.94; p = 0.008; OR: 5.23; 95% CI: 1.441-19.025). Conclusions: Malnutrition in patients with digestive tract cancer was associated with limitation in functional capacity.

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La epidermólisis bullosa se refiere a un grupo de enfermedades poco frecuentes de la piel caracterizadas por la aparición de úlceras y ampollas después de un traumatismo menor o una presión tangencial mínima. Se presenta el caso de un menor que fue sometido a rehabilitación bucal bajo anestesia general en el Instituto Nacional de Pediatría, donde se utilizó un equipo especial que incluyó adhesivos con base de algodón, apósitos de gasas para la colocación de los monitores de signos vitales, y emolientes oleicos sobre tejidos blandos. Con el principal objetivo de evitar la formación de bullas, vesículas y úlceras, el manejo específico de la cavidad bucal, los tejidos periorales e intraorales, y los programas preventivos que deben diseñarse para este grupo de pacientes.

Epidermolysis bullosa encompasses a group of infrequent skin diseases characterized by the appearance of ulcers and blisters after an event of minor trauma of tangential minimal pressure. This study presents the case of a child treated at the Instituto Nacional de Pediatría (National Pediatrics Institute). The patient was subjected to oral rehabilitation under general anesthesia. A specially tailored team participated; they used devices such as cotton based adhesives and gauze dressings to place vital signs monitors, as well as oil emollients on soft tissues. All the aforementioned items were used with the main objective of avoiding ulcers, blisters or bullae formation. For this group of patients, specific handling of the oral cavity as well as tissues within and around the mouth is required. Tailor made preventive programs must also be designed.

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Se realizó una revisión bibliográfica sobre la adherencia terapéutica en la que se valoró: la repercusión personal y social que tiene la conducta del incumplimiento terapéutico, el concepto de adherencia terapéutica, el modelo explicativo de lo que significa, los métodos para su evaluación, los factores que la determinan, las estrategias para incrementarla y las investigaciones más recientes sobre esta temática.

A review of the literature on adherence assessing the impact on the personal and social behavior have poor compliance, adherence concept, explanatory model of what it means, methods for evaluation, determinants, and strategies to increase recent research on this subject.

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The periodontal probe remains the best clinical diagnostic tool for the collection of information regarding the health status and the attachment level of periodontal tissues. The aim of this study was to evaluate intra- and inter-examiner reproducibility of probing depth (PD) measurements made with a manual probe. With the approval of an Ethics Committee, 20 individuals without periodontal disease were selected if they presented at least 6 teeth per quadrant. Using a Williams periodontal probe, three calibrated thesis-level students (k > 0.6) assessed PD at 6 sites per tooth, from the gingival margin to the bottom of the periodontal sulcus (rounded to the next 0.5 mm). Initial and repeated measurements were performed by the same three examiners. The intra-examiner agreement (± 1 mm > 90%) was 99.85%, 100%, and 100% for the three examiners, respectively. When the variables vestibular/lingual surfaces, mesial/distal surfaces, or superior/inferior jaws were evaluated, no significant differences in reproducibility were detected at the inter-examiner level (p < 0.05). At this level, the only significant differences observed were in the three examiners' measurements of the anterior and posterior sites. While high intra-examiner reproducibility was detected, inter-examiner level proved to be low. We can conclude that measurement of PD with a manual periodontal probe produced high reproducibility in healthy individuals. The operators position can affect the reproducibility of repeated measures of PD. Calibration and operator training, rather than operator experience, were fundamental for reproducibility. Other factors, such as individual technique and probing depth force, can affect inter-examiner reproducibility.

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The periodontal probe remains the best clinical diagnostic tool for the collection of information regarding the health status and the attachment level of periodontal tissues. The aim of this study was to evaluate intra- and inter-examiner reproducibility of probing depth (PD) measurements made with a manual probe. With the approval of an Ethics Committee, 20 individuals without periodontal disease were selected if they presented at least 6 teeth per quadrant. Using a Williams periodontal probe, three calibrated thesis-level students (k > 0.6) assessed PD at 6 sites per tooth, from the gingival margin to the bottom of the periodontal sulcus (rounded to the next 0.5 mm). Initial and repeated measurements were performed by the same three examiners. The intra-examiner agreement (± 1 mm > 90%) was 99.85%, 100%, and 100% for the three examiners, respectively. When the variables vestibular/lingual surfaces, mesial/distal surfaces, or superior/inferior jaws were evaluated, no significant differences in reproducibility were detected at the inter-examiner level (p < 0.05). At this level, the only significant differences observed were in the three examiners' measurements of the anterior and posterior sites. While high intra-examiner reproducibility was detected, inter-examiner level proved to be low. We can conclude that measurement of PD with a manual periodontal probe produced high reproducibility in healthy individuals. The operator's position can affect the reproducibility of repeated measures of PD. Calibration and operator training, rather than operator experience, were fundamental for reproducibility. Other factors, such as individual technique and probing depth force, can affect inter-examiner reproducibility.

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El objetivo de la investigación fue evaluar el efecto de la intervención educativa sobre el nivel de conocimientos y actitudes frente al cáncer de cuello uterino y el virus del papiloma humano en estudiantes de Ciencias Médicas de la Universidad Nacional Santiago Antúnez de Mayolo (UNASAM) -Filial Barranca. El estudio fue cuasi experimental, longitudinal, prospectivo, de casos y controles. La muestra fueron 60 universitarias del primer ciclo de la Facultad de Ciencias Médicas de la Filial Barranca y 60 controles. Se usó el Programa SPSS versión 15.0. Para la significancia estadística se tomó la prueba t-student y la prueba de McNemar, con un valor de p<0.05 y un intervalo de confianza al 95 por ciento. Se encontró, que la edad promedio en el grupo control (19.84 años) fue ligeramente mayor que el experimental (17.80 años). El 100 por ciento de las alumnas de Enfermería fueron solteras a diferencia de un 96.67 por ciento de Obstetricia. En cuanto a la prueba de conocimiento sobre el Cáncer de Cuello Uterino y el Virus del Papiloma Humano, el 90 por ciento desaprobó la prueba antes de la intervención y al final solo el 28.33 por ciento, lo que fue significativo (p=0.00) con la prueba t-student, al igual que a los dos meses (p=0.00), mientras que la evaluación final y a los dos meses de la intervención no evidenció un incremento significativo (p=0.94). La Prueba de McNemar demostró que al Final de la intervención educativa hubo cambios significativos (p=0.00), mientras que a los dos meses no se mejoró el nivel de conocimientos (p=0.629). Así se obtuvo que el promedio basal del grupo experimental (X=6.82, DE=3.12) aumento al final de la intervención (X=11.33, DE=1.30), comparado con el grupo control que fue (X=7.50, DE=2.68) y (X=7.43, DE=2.90) respectivamente. Respecto a la actitud, con la prueba t-student se encontró un incremento significativo (p=0.00) en el promedio del puntaje de la prueba de actitud a los dos meses de concluida la intervención. Se vio una diferencia media entre la prueba basal y a dos meses de la intervención de 2,70 puntos en el control y 35,60 puntos el experimental. La actitud fue positiva en el grupo experimental a diferencia del control que tuvo actitudes negativas. Cuando las universitarias tuvieron más conocimiento, su actitud mejoró positivamente, por ello es importante que tengan una mayor información sobre el tema lo que podría tener un efecto protector sobre su salud y en sus pares.

The research objective was to evaluate the effect of educational intervention on the level of knowledge and attitudes towards cervical cancer and human papillomavirus among students of Medical Sciences of the University Santiago Antúnez de Mayolo-Subsidiary Barranca. A study quasi-experimental, longitudinal, prospective, case-control study. Participants were junior college of the Faculty of Medical Sciences of the Subsidiary Barranca. The sample was 60 cases and 60 controls. The data were processed in the computer program SPSS version 15.0. We used t-student test and McNemar test, with a value of p<0.05 and confidence interval 95 per cent for statistical significance. It was found that the average age in the control group (19.84 years) was slightly larger than the experimental (17.80 years). Ofthe nursing students, 100 per cent were single as opposed to a 96.67 per cent of obstetrics. As a test of knowledge about cervical cancer and Human Papilloma Virus, 90 per cent disapproved the test before the intervention and at the end only 28.33 per cent, which was significant (p=0.00) with the test t-student, like two months (p=0.00), while the final evaluation and two months after intervention no significant increase (p=0.94). The McNemar test showed that the End of the educational intervention there were significant changes (p=0.00), while two months did not improve the knowledge level (p=0.629). Thus it was found that the average baseline in the experimental group (X=6.82, DE=3.12) increase at the end of the intervention (X=11.33, DE=1.30), compared with the control group was (X=7.50, DE=2.68) and (X=7.43, DE=2.90) respectively. Regarding the attitude, the student t-test found a significant increase (p=0.00) in average test score of attitude after two months of completion of the intervention. He was a mean difference between the baseline test and two months after surgery of 2.70 points and 35.60 points control the experimental. The attitude was positive in the experimental group in contrast to the control that had negative attitudes. When the university had more knowledge, improved their attitude positively, so it is important to have more information on the subject which could have a protective effect on their health and their peers.

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Con el objetivo de evaluar el sistema de cama profunda para la crianza porcina a pequeña escala en Cuba, se realizó un experimento en el que se utilizaron 72 cerdos (machos castrados y hembras) de la raza YL (Camborough) de aproximadamente 21 kg de peso vivo y 75 días de edad distribuidos en un diseño de experimentos en bloques al azar en dos tratamientos (T1, cama profunda basada en heno de gramíneas y T2, piso de concreto) con cuatro repeticiones por tratamiento. Los animales de ambos tratamientos consumieron un alimento balanceado de mediana calidad basado en harina de soya y maíz y un 30 por ciento del subproducto cubano del trigo (subproducto de la molinería del trigo en la industria alimenticia cubana), con miel enriquecida de caña de azúcar. Se midieron los rasgos de comportamiento animal hasta el peso de sacrificio (100 kg). Hubo diferencias significativas en el consumo y la conversión alimentaria (P<0,05) entre los cerdos alojados en cama profunda y piso de concreto: 2,53; 2,74; 3,42 y 3,63, respectivamente. Se observaron diferencias significativas (P<0,01) para el nitrógeno y fósforo en el material de la cama al final de la experiencia en comparación al inicio: 1,79 y 0,58, respectivamente. No hubo presencia de Salmonella spp ni huevos de helmintos, por lo que la calidad sanitaria de la cama al final del estudio permitió continuar con el segundo ciclo de crianza. Se ahorraron 177 m³ de agua con este sistema. Se concluye que el sistema de crianza porcina en cama profunda evaluado genera un impacto económico y ambiental importante con respecto al sistema de crianza convencional que sienta las bases para la generalización de esta tecnología a pequeña y mediana escala en Cuba.

To evaluate the deep bedding system for the swine production in Cuba at small scale, it was carried out this experiment. Seventy two pigs (castrated males and females), YL (Camborough) cross, of approximately 21 Kg live weight and 75 days average age were used. The pigs were distributed into a random block design with two treatments (T1, deep bedding based on gramineous hay and T2, concrete floor). The animal performance traits (up to approximately 100 kg live weight) were studied. The animals of both treatments consumed a balanced feed based on soybean and corn meal and 30 percent of the wheat Cuban byproduct (byproduct of the wheat milling in the Cuban feeding industry), with enriched sugar cane molasses. There were significant differences for the consumption and the alimentary conversion (P<0.05) to the pigs housed in deep bedding system respecting to the pigs housed in concrete floor: 2.53, 2.74; 3.42 and 3.63, respectively. Significant differences were obtained (P<0.01) for the nitrogen and the phosphorous in the bedding material at the end of the experience: 1.79 and 0.58, respectively. There was not presence of Salmonella spp. neither helmints eggs. The sanitary quality of the bedding material, at the end of the study guaranteed to continue with a second production cycle. It was saved 177 m³ of water with this system. It was conclude that the evaluated deep bedding system for the swine production generates an important economic and environmental impact respecting to the conventional housing system and offers the main aspects to generalize this technology to the small and medium scale in Cuba.

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Se presentó el caso de una paciente con diagnóstico tardío de aneurisma disecante de la aorta, que ingresó en este centro con un cuadro clínico de dolor precordial intenso e hipotensión arterial y se le detectó en el electrocardiograma inicial un bloqueo auriculo-ventricular completo transitorio sin signos de isquemia asociado. Evolutivamente, se observó anemia importante con lesiones equimóticas en regiones lumbares. Se revisó el tema del síndrome aórtico agudo. Se destacó el valor de mantener la sospecha sobre esta identidad y el papel de la ecocardiografía y la tomografía axial computadorizada en el diagnóstico

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In adults, diffuse haemangiomatosis of the liver is a very rare condition. The aetiology and clinical evolution are not well understood, and the literature records isolated cases with different behaviours and treatments. Here we present the case of a 45-year-old patient with haemangiomatose lesions in both lobes of the liver, causing moderate to intense abdominal pain and a bloated sensation in the presence of an abdominal mass, but with hepatic and haematological functions remaining largely intact. Conventional ultrasound and CAT scan revealed diffuse lesions in both hepatic lobes, and this required the performance of a diagnostic laparoscopy to rule out hepatic metasteses or multiple liver abscess. As the findings consisted of large blue-black spongy masses involving both lobes of the liver, radical treatment of a resective type was not possible. After two years of follow-up, the patient still complains of diffuse abdominal pain of varying intensity, which is being treated with analgesics. Liver function tests have demonstrated a gradual increase in both liver enzymes and alkaline phosphatase, but without frank clinical evidence of clinical liver insufficiency.

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