RESUMO
Latin America and the Caribbean region account for 8% of the world's total population. Experts from 18 countries were invited to contribute to this article to provide the best available data on the number, types, and quality of densitometry, DXA experts, the local/national incidence and prevalence of osteoporosis and fragility fractures, and other uses and information on the challenges and opportunities for quality densitometry with examples of local initiatives. Osteoporosis is the primary reason for densitometry in our region, which is not a priority for public health in most countries. Access and quality are major challenges, and there is a clear trend to concentrate on densitometry services in the largest cities. Urgent action is needed to face the rapidly increasing burden of osteoporosis in our region, including robust and up to date epidemiology, access to health professionals, and quality densitometry. Health professionals require better access to training, courses, and other activities at a more local or regional level.
Assuntos
Osteoporose , Região do Caribe , Densitometria , Humanos , Incidência , América Latina/epidemiologia , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologiaRESUMO
Las vias fascículo ventriculares (FV) sustentan una forma rara de preexcitation en la que la morfologia ECG recuerda a la de las vias paraseptales superiores, pero no participan en mecanismos de taquicardia ni requieren tratamiento específico. Algumas diferencias electrocardiográficas, la respuesta a la adenosina intravenosa y, sobre todo el estudio electrofisiológico sientam el diagnóstico diferencial. Se presentan los dos casos con vias FV de una serie consectiva de 62 pacientes con vias accesorias patentes remitidos a nuestro laboratorio para ablación con radiofrecuencia. En uno no se indujeron arritmias y en otro se indujo una taquicardia por reentrada nodal, que se sometió a ablación con êxito y que permitió el diagnóstico de inserción infrahisiana de la via accessoria FC.
Ventricular fascicle connections are an unusual form of pre-excitation. The 12-lead surface ECG during sinus rhythm is similar to the ECG of patients with anteroseptal and midseptal bypass tracts. These fibers do not participate in the tachycardia circuit or need any treatment. Electrocardiographic differences, the response to adenosine and particularly, the electrophysiologicstudy will guide to the correct diagnosis. We present two cases of ventricular fascicle connections in a consecutive series of 62 patients with accessory pathways referred to our service for evaluation and ablation. In one patient, no arrhythmias were induced, and in another patient an atrio-ventricular reentrant nodal tachycardia was induced, which was successfully ablated. The study also revealed theinfra-Hisian insertion of the ventricular fascicle connection.
As vias fascículo-ventriculares (FV) sustentam uma forma rara de pré-excitação em que a morfologia ECG recorda a das vias paraseptais superiores, mas não participam dos mecanismos de taquicardia nem requerem tratamento específico. Algumas diferenças eletrocardiográficas, a resposta à adenosina intravenosa e, sobretudo, o estudo eletrofisiológico estabelecem o diagnóstico diferencial. Apresentam-se os dois casos com vias FV de uma série consecutiva de 62 pacientes com viasacessórias patentes encaminhados ao nosso laboratório para ablação com radiofrequência. Em um não foram induzidas arritmias e no outro foi induzida uma taquicardia por reentrada nodal, que foi submetida à ablação com sucesso e que permitiu o diagnóstico de inserção infra-hissiana da via acessória FV.
Assuntos
Humanos , Masculino , Adolescente , Fascículo Atrioventricular/anormalidades , Taquicardia por Reentrada no Nó Sinoatrial , EletrocardiografiaRESUMO
AIMS: Reciprocating atrioventricular tachycardia can be categorized into common slow-fast atrioventricular node re-entrant (AVNRT) and orthodromic atrioventricular reciprocating tachycardia (AVRT). The electrocardiogram (ECG) during tachycardia is useful in distinguishing these two mechanisms. The presence of a pseudo-R'-wave in lead V1 or pseudo-S-wave in the inferior leads has been widely used, although the value of an isolated aVL lead has not been evaluated yet. To determine whether an isolated aVL lead of the surface 12-lead ECG is useful for the differential diagnosis between AVNRT and AVRT. METHODS AND RESULTS: Consecutive patients referred for paroxysmal regular supraventricular tachycardia radiofrequency ablation were prospectively evaluated. Patients with atrial tachycardia, bundle branch block, manifested pre-excitation, and those undiagnosed after electrophysiology study were excluded. We compared the standard criteria with the value of an isolated aVL lead to distinguish between AVNRT and AVRT. One hundred and one patients were included; 73.3% were AVNRT and 26.7% AVRT. Patients with AVNRT were older (49.4 +/- 16.4 vs. 36.0 +/- 18.7 years, P = 0.001). The aVL notch and the standard criteria were found more frequently in AVNRT than in AVRT (aVL notch: 51.3 vs. 7.4%, P< or = 0.001; pseudo-S-wave 45 vs. 8.6% P = 0.001; and pseudo-R'-wave in V1 39.7 vs. 11.5%, P = 0.008, respectively). The aVL notch sensitivity and specificity to determine the final diagnosis were higher than the standard criteria (aVL notch 48.6 and 92.6%; pseudo-S-wave 45 and 91.3%; and pseudo-R'-wave in V1 39.7 and 88.5%, respectively). CONCLUSION: The presence of a notch in aVL lead appeared to be as sensitive and specific as the standard electrocardiographic criteria for the differential diagnosis of AVNRT.
Assuntos
Eletrocardiografia/instrumentação , Eletrocardiografia/métodos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
This aim of this study was to evaluate the presence of endothelial dysfunction in patients with primary hypertension and to determine the usefulness of nebivolol, a selective beta-adrenoceptor blocking agent, as a potential treatment for endothelial dysfunction. Of 176 patients with stage I hypertension, 36 patients (20%), the majority of whom were overweight/obese, were found to have abnormal results with myocardial perfusion single-photon emission computed tomography (MP-SPECT) under cold pressor test conditions. These 36 patients were treated for 28 days with 5 mg/d nebivolol, after which only 3 (8.3%) still had abnormal MP-SPECT results. The mean ischemia score was consistent with moderate risk and decreased significantly after treatment with nebivolol. All hemodynamic variables measured (systolic and diastolic blood pressure and heart rate) were also reduced significantly by treatment with nebivolol. Endothelial dysfunction plays a key role in the pathogenesis of atherosclerosis and its reversal has considerable implications for clinical outcomes in affected patients. The cold pressor testing results of this study suggest that nebivolol may have beneficial anti-ischemic effects in the coronary arteries of patients with hypertension. However, these findings need to be confirmed in larger randomized controlled trials, ideally comparing nebivolol with other blood pressure lowering agents or NO synthase inhibitors.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Benzopiranos/uso terapêutico , Endotélio Vascular/efeitos dos fármacos , Etanolaminas/uso terapêutico , Hipertensão/tratamento farmacológico , Antagonistas Adrenérgicos beta/administração & dosagem , Adulto , Idoso , Benzopiranos/administração & dosagem , Endotélio Vascular/diagnóstico por imagem , Endotélio Vascular/fisiopatologia , Etanolaminas/administração & dosagem , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nebivolol , Sistema de Registros , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Las necesidades de tratamiento odontológico en los pacientes plantea un trabajo multidisciplinario. Se reporta un caso clínico de una persona que presenta enfermedad periodontal avanzada, con secuelas de migración de piezas dentarias en el sector antero superior. Después del tratamiento periodontal (Motivación, raspaje, alisado radicular, cirugía periodontal, injerto óseo autólogo) se realizó el tratamiento ortodóntico en el sector antero superior. Finalmente se realizó el cambio de las coronas del segmento antero superior por unas coronas ferulizadas.
corThe needs of the dental treatment in the patients foroud a mutidiscipling work. It report a clinical case of one patient who exhibilidad a advanced periodontal disease, whith migration of the anterior upper teeth after the periodontal treatment (Motivation oral periodontal hygienic, root planning, periodontal autologos bore injerto it mode the orthodontic in the anterior upper tooth. Finally the patient recivea a bridge in the upper segment.
Assuntos
Humanos , Ansiedade ao Tratamento Odontológico , Doenças Periodontais/terapia , Odontologia , Ortodontia , Prótese DentáriaRESUMO
La promoción de la salud es el proceso que proporciona la proporción, los elementos para ejercer un mayor control sobre su propia salud y mejorarla. En este proceso intervienen los individuos, familias, comunidades, servicio de salud y autoridades sanitarias. Existe escasa información sobre la promoción de la salud bucal en la U.N.M.S.M. Los resultados señalan la falta de cultura sobre la salud bucal y sus medios de prevención en los estudiantes y trabajadores no docentes de la Facultad de Medicina de la Universidad Nacional Mayor de San Macos.
The promotion of the health is a process that give to the people the instruments to lead a better control for the health care. In this process participing the patients, the family, the community, the heath services and the autority`s health. There is a little information about the promotion of the dental health at the San Marcos University. The results show that thre is not an effective program of dental diseases prevention whitin the students and workers of the Faculty of Medicine at San Marcos University
Assuntos
Humanos , Faculdades de Odontologia , Promoção da Saúde , Saúde Bucal , Serviços de Saúde do TrabalhadorRESUMO
El diagosnótico y tratamiento periodontal debe ser un objetivo en el ejercicio de la Odontología. Para lograr este propósito el paciente debe estar altamente motivado y el odontólogo realiza la etapa más importante: la terapia de mantenimiento, la cual pemitirá conserva sanos los tejidos periodontales-especialmente el hueso toda la vida, además de sus piezas dentarias.
The diagnosis and treatment of the periodontal disease must be an objctive in the dental practice. To reach this purpose, the patient ust have high motivationand the dentis must work in the maintenance periodontal therapy, this leads to have healthy periodontal tissue- specially the bone- for ever and the teeth also.