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Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Although periodontal disease is the most frequent reason for extraction in endodontically treated teeth, few studies have evaluated patients with Type 2 diabetes (T2D). In this study, we compared the success of endodontic treatment and the evolution of periapical lesion (PL) in patients with and without T2D. Materials and Methods: We performed a retrospective cohort including 58 patients who received endodontic treatment (31 with and 27 without T2D) 12 months before. Success of endodontic treatment, evolution of PL, and type of restoration were evaluated. Results: Treatment success was found in 16 (64%) and 23 (85%) patients with and without T2D, respectively (P = 0.07). Patients with diabetes had an increased failure to endodontic treatment risk (relative risk 1.68 [95% confidence interval 1.001-2.845]). The PL reduced or disappeared in 20 (74%) patients without and in 12 (48%) with T2D (P = 0.02). In patients with T2D, HbA1c levels were lower in those with successful treatment than in those with failure in treatment (6.23 ± 0.37 vs. 6.88 ± 0.34, P = 0.001), respectively. Conclusion: Diabetes mellitus has a negative impact on the evolution of endodontic treatment and PL after 12-month follow-up, and it is related to metabolic control. [ABSTRACT FROM AUTHOR]

Background: The crevicular fluid contains biomarkers that allow the identification of periodontal disease, anticipation of its risk, and prediction of its progression. Purpose: The purpose of this study is to correlate interleukin-1β (IL-1β) and matrix metalloproteinase-1 (MMP-1) levels in crevicular fluid with periodontal disease severity in schoolchildren. Methods: A cross-sectional study was conducted in 82 schoolchildren between 9 and 12 years. The biofilm percentage, attachment level, gingival recession, dental calculus, and bleeding on probing were measured in the teeth 16, 26, 36, 41, and 46. These five parameters obtained were considered to propose a disease score between 0 and 10 points. In crevicular fluid from the tooth with the highest score, IL-1β and MMP-1 levels were measured. Results: According to the proposed score, mild gingivitis was identified in 20 schoolchildren, moderate gingivitis in 30, and severe gingivitis in 32. Biofilm percentage, IL-1β, and MMP-1 levels increased as the severity of the disease increase. The mean and 95% confidence interval were 23.2 pg/μl (18.6–27.7), 37.3 pg/μl (27.8–46.9), and 44.6 pg/μl (34.4–58.8) (P = 0.01) for IL-1β and 2.69 mol/min (2.51–2.87), 4.43 mol/min (3.9–4.95), and 5.59 mol/min (4.81–6.38) (P < 0.001) for MMP-1 in each group, respectively. The proposed clinical score correlated with biofilm percentage (r = 0.63), IL-1β (r = 0.50), and MMP-1 (0.45) levels, P < 0.001 in all cases. Conclusions: The proposed clinical score for periodontal disease in children correlated with percentage of biofilm, IL-1β, and MMP-1 levels. [ABSTRACT FROM AUTHOR]

HIV-seropositive patients show high incidence of coronary heart disease and oxidative stress has been described as relevant key in atherosclerosis development. The aim of this study was to assess the effect of omega 3 fatty acids on different markers of oxidative stress in HIV-seropositive patients. We performed a randomized parallel controlled clinical trial in The Instituto Mexicano del Seguro Social, a public health hospital. 70 HIV-seropositive patients aged 20 to 55 on clinical score A1, A2, B1 or B2 receiving highly active antiretroviral therapy (HAART) were studied. They were randomly assigned to receive omega 3 fatty acids 2.4 g (Zonelabs, Marblehead MA) or placebo for 6 months. At baseline and at the end of the study, anthropometric measurements, lipid profile, glucose and stress oxidative levels [nitric oxide catabolites, lipoperoxides (malondialdehyde plus 4-hydroxialkenals), and glutathione] were evaluated. Principal HAART therapy was EFV/TDF/FTC (55%) and AZT/3TC/EFV (15%) without difference between groups. Treatment with omega 3 fatty acids as compared with placebo decreased triglycerides (-0.32 vs. 0.54 mmol/L; p = 0.04), but oxidative stress markers were not different between groups. Trial Registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

Objective: Intensified management of gestational diabetes mellitus can normalize birth weight. However, it is still unknown whether intrauterine exposure to maternal diabetes is a risk factor for changing hormone levels involved in the development of insulin resistance in these infants. We compared insulin and leptin levels in appropriate for gestational age (AGA) infants of diabetic and non diabetic mothers. Methods: We performed a cross-sectional study in the department of Neonatology of the Hospital of Gynecology-Pediatrics, in Leon, Mexico. We evaluated 182 full term AGA newborns (86 infants of diabetic and 96 of non-diabetic mothers). A venous blood sample was taken from cord blood immediately after the separation of the placenta and glucose, insulin and leptin levels were measured. In all diabetic mothers HbA1c was also evaluated immediately post-partum. Findings: Leptin, insulin and insulin resistance index were significantly higher in infants of diabetic mothers. Leptin levels were positive correlated with insulin, parents` body mass index and age in the entire group. In infants of diabetic mothers only insulin levels showed a significantly correlation, whereas in those of nondiabetic mothers only mothers` age was significantly correlated with leptin levels. Conclusion: AGA infants of diabetic mothers showed higher leptin, insulin levels and insulin resistance index than those of non-diabetic mothers. [ABSTRACT FROM AUTHOR]

Background: Iron overload can affect cardiac structure and function by the production of free radicals in addition to iron deposits in heart muscle. The purpose of this study was to compare traditional and non-traditional cardiovascular risk factors (CVRF) in children and adolescents on renal replacement with and without iron overload. Also, we evaluated the relationships between iron overload and left ventricular mass (LVM). Methods: First, in a cross-sectional study, we evaluated traditional and non-traditional CVRF in 143 children and adolescents, 48 on peritoneal dialysis (PD), 53 on hemodialysis (HD) and 42 after renal transplantation according to iron overload. In a second phase with a case-control study, we measured LVM in 12 case patients and 12 matched controls. Results: Iron overload was identified in 15 patients (10.5%), 11 in HD and 4 in PD (P = 0.002). The group with iron overload had lower body mass index (17 versus 19; P = 0.01), total cholesterol (132 versus 165 mg/dL; P = 0.03) and hemoglobin (8.5 versus 10.6 g/dL; P = 0.003) but higher interleukin (IL)-6 levels (4.8 versus 3.6 ng/L; P = 0.04) and hypertension diagnosis (79 versus 48%; P < 0.001) than those without iron overload. Ferritin showed a positive correlation with C-reactive protein (CRP) and IL-6 levels. In a subgroup of 24 patients (12 with and 12 without iron overload), LVM was not different. However, ferritin levels showed a borderline positive correlation (r = 0.44, P = 0.05) with LVM. Conclusion: Children and adolescents with iron overload show more CVRFs, especially if they received replacement therapy with HD. Ferritin is related to CRP and IL-6 levels. [ABSTRACT FROM AUTHOR]

In patients with renal anemia, iron therapy can be administered intermittently or regularly at a low dose. We performed a randomized clinical trial in pediatric patients with end-stage renal failure on hemodialysis and absolute or functional iron deficiency. The study group received maintenance iron therapy according to the ferritin serum levels and the control group received intermittent 10-weekly doses. Success was defined as stabilization of ferritin levels between 100 and 800 μg/l and transferrin saturation (TSAT) between 20% and 50%, in addition to an increase in the hemoglobin level. The major reason for exclusion was iron overload. The study group received 6 mg/kg per month of parenteral iron [95% confidence interval (CI) 3.3–8.8] and the control group 14.4 mg/kg per month (95% CI 12–16.8) (P<0.001). After 4 months of treatment, ferritin levels increased to 66 μg/l (95% CI 69–200) in the study group and to 334 μg/l (95% CI 145–522) in the control group (P=0.009). Maintenance therapy and intermittent weekly doses were successful in 73% and 38%, respectively. After 3 months of treatment, hemoglobin levels increased to 10 g/dl, with no difference between the groups. However, in the control group the increase in hemoglobin levels was unsustained, and 3 patients needed transfusion. Patients in the control group had a higher risk of iron overload than patients in the study group (70% vs. 19%). Thus, the regimen based on assessment of serum ferritin levels was more efficient than the intermittent regimen because it increased and maintained the hemoglobin levels with lower iron doses and a lower risk of iron overload. [ABSTRACT FROM AUTHOR]

Background: The impact of air pollution on the respiratory system has been estimated on the basis of respiratory symptoms and lung function. However; few studies have compared lung inflammation in healthy and asthmatics children exposed to high levels of air pollution. The aim of the study was to elucidate the modulatory effect of air pollution on Cysteinyl-leukotrienes (Cys-LTs) levels in exhaled breath condensate (EBC) among healthy and asthmatic children.Methods: We performed a cross-sectional comparative study. Children between 7-12 years of age, asthmatics and non-asthmatics, residents of a city with high levels of PM10 were included. In all cases, forced spirometry, Cys-LTs levels in EBC, and the International Study of Asthma and Allergies in Childhood questionnaire were evaluated. We also obtained average of PM10, CO, SO2 and O3 levels during the period of the study by the State Institute of Ecology.Results: We studied 103 children (51 asthmatics and 52 non-asthmatics). Cys-LTs levels were higher in asthmatics than in non-asthmatics (77.3 ± 21.6 versus 60.3 ± 26.8 pg/ml; p = 0.0005). Also, Cys-LTs levels in children with intermittent asthma were lower than in children with persistent asthma (60.4 ± 20.4 versus 84.7 ± 19.2 pg/ml; p = 0.0001). In the multiple regression model, factors associated with levels of Cys-LTs were passive smoking (β = 13.1, p 0.04) and to be asthmatic (β = 11.5, p 0.03).Conclusions: Cys-LTs levels are higher in asthmatic children than in healthy children in a contaminated city and its levels are also associated with passive smoking. [ABSTRACT FROM AUTHOR]

Background: Pulse oximetry has been suggested as a screening test for congenital heart disease (CHD) in asymptomatic newborns. However, most newborns in Mexico are discharged from the hospital without this evaluation., Objective: To evaluate pulse oximetry as a screening test for critical congenital heart disease (CCHD) in term newborns., Methods: We conducted a cross-sectional study in term newborns between July 2010 and April 2011. Pulse oximetry was determined before hospital discharge; in case of post-ductal oxygen saturation < 95%, a Doppler echocardiogram was performed., Results: From 1,037 newborns screened, two had CCHD, one had pulmonary atresia and ventricular septal defect, and one Ebstein´s anomaly. Minor CHD was present in 10 babies. The overall prevalence of CHD was 11.5 per 1000 live births, and the prevalence of CCHD was 3.9 per 1000 live births. For those with critical disease, pulse oximetry had a sensitivity of 100%, specificity 98.8%, positive predictive value 14.2%, negative predictive value 100%, and positive likelihood ratio of 86.2. In regression analysis, oxygen saturation, respiratory frequency, and postnatal age were related with CCHD., Conclusions: Pulse oximetry had a good sensitivity and specificity for the identification of critical congenital heart disease in term newborns. Low oxygen saturation, higher respiratory frequency, and early postnatal age were related with congenital heart disease.

Objectives: To determine the effectiveness of a motivational interviewing-based educational program in reducing the number and intensity of new caries and bacterial dental plaque levels at 6 months post randomization., Study Design: A randomized and single blind clinical trial in 100 schoolchildren between 6-10 years of age presenting the highest risk score of caries according to the Caries Management by Risk Assessment (CAMBRA) criteria was performed. These patients were randomized to two groups: control (in which the mothers initially received an oral prevention informative session) and experimental (in which the mothers received the initial informative session, followed by individual motivational interviewing sessions during a period of 6 months). The International Caries Detection and Assessment System (ICDAS) scores and bacterial plaque were evaluated at baseline, at 6 and 12 months., Results: After 12 months, children in the experimental group had 2.12 ± 0.8 new caries versus 3.5 ± 0.9 in the control group (t=7.39; p<0.001). Caries in the experimental group was seen to be limited to the enamel, with a median intensity of 2 (range 0-3) versus 3 (0-6) in the control group (U=1594; p<0.0001). Bacterial plaque determined by the O'Leary index decreased in both groups; however, it decreased more in the experimental than in the control group (34.3 vs. 20.6; t=-3.12, p= 0.002) respectively., Conclusions: Motivational interviewing is better than traditional educational programs in preventing caries and decreasing bacterial plaque. Key words:Health educational, motivational interviewing, caries risk.

Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous midazolam. We evaluated sedation, tolerance to the procedure, hemodynamic stability, and adverse symptoms. Results. We studied 46 men and 54 women, from 17 to 78 years of age. The procedure was reported without discomfort in 48 patients (88%) in the GFNB group and 32 (64%) in the TAAS group; 6 patients (12%) in GFNB group and 18 (36%) in TAAS group reported the procedure as little discomfort (χ (2) = 3.95, P = 0.04). There was no difference in frequency of nausea (4% in both groups) and retching, 4% versus 8% for GFNB and TASS group, respectively (P = 0.55). Conclusions. The use of glossopharyngeal nerve block provides greater comfort and tolerance to the patient undergoing upper gastrointestinal endoscopy. It also reduces the need for sedation.

Background: Recent studies have reported an increase in the prevalence of obesity and metabolic syndrome in children and adolescents. However, few have focused how diabetes mellitus and metabolic syndrome together in parents can influence on obesity and metabolic disturbances in offspring., Objective: To know the risk obesity and metabolic disturbance in children, adolescents, and young adults whose parents have diabetes mellitus and metabolic syndrome., Methods: A comparative survey was made in healthy children of parents with diabetes mellitus and metabolic syndrome compared with offspring of healthy parents. We performed anthropometry and evaluated blood pressure, glucose, total cholesterol, HDL cholesterol, and triglycerides levels in plasma. We registered parent antecedents to diabetes mellitus and metabolic syndrome and investigated the prevalence of overweight, obesity, and metabolic disturbances in offspring., Results: We studied 259 subjects of 7 to 20 years of age. The prevalence of overweight and obesity was 27% and 37%, respectively. The highest proportion of BMI >95th of the entire group was found in offspring with both diabetic parents. Glucose and total cholesterol levels were lower in the group with healthy parents compared with the group with diabetic mother and metabolic syndrome but with healthy father. HDL cholesterol was higher in the group with both healthy parents than in the group with diabetic mother and metabolic syndrome but healthy father., Conclusions: The offspring of parents with diabetes plus metabolic syndrome showed higher proportion of variables related to metabolic syndrome compared with healthy parents.

Background: Adhesion molecules in sepsis syndrome are correlated with the severity of illness and may be considered as predictors of survival outcome in adults. However, only few studies have been performed in infants and none using international criteria for sepsis., Objective: To determine whether adhesion molecules during the first 7 days of the disease could predict sepsis outcome and its severity., Material and Methods: We performed a prospective study in 88 infants with sepsis and 30 controls. Soluble intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, and E-selectin levels were determined at days 1, 3 and 7 of follow-up in those patients with sepsis and only one determination in the control group. The main outcome measure was mortality during 10 days of monitoring., Results: Positive hemoculture was reported in 64(72.7%). ICAM-1, VCAM-1, and E-selectin levels were higher in the group of sepsis than in the control group. However, no association was found between ICAM-1, VCAM-1 or E-selectin levels with sepsis severity. Mortality linked to sepsis was observed in 9 patients (10.2%). In the logistic regression analysis, those variables positively associated with mortality were the increase in ICAM-1 levels > 250 ng/mL between day 1 to 3, number of amines and the baseline severity of sepsis. However, we did not identify in those patients who died a specific pattern in adhesion molecules levels during follow up., Conclusions: ICAM-1 levels, number of amines and severity of sepsis levels predict mortality during 10 days of monitoring in infants younger than 1 year of age with sepsis.