Interamerican Journal of Health Sciences

Allergic rhinitis and its influence on the development of mouth breathing and temporomandibular dysfunction (TMD) in children from Río Negro, Argentina

Patricia E.v Mulbany — 2022-12-26

Background: Temporomandibular dysfunction (TMD) is a pathological entity related to functional problems of the joint and/or masticatory muscles. This entity is a public health problem studied for a long time, seeking to identify, among other characteristics, early identification strategies in order to reduce its chronic consequences. Aim: The aim of this study was to describe the results obtained in clinical dental and morphometric evaluations that can be routinely performed in a dental office, in order to verify if these allow an early diagnosis in children and adolescents with probable TMD. Methods: An observational, longitudinal and prospective study was carried out evaluating 36 mouth breathing patients aged 7-14 years, divided into two equal groups according to whether or not they had allergic rhinitis. DTM was studied by means of validated questionnaires and clinical tests, together with morphometric parameters calculated on radiographic images. Results: Tests and mouth breathing questionnaire showed significant differences between both groups. All the children in the control group had a mild disorder, while in the case group the totality was distributed between moderate (89%) and severe (11%) disorders. The movement indicator (Manglione index) showed that 83% of the patients in the control group were moderately impaired and 17% were severely impaired, while 100% of the patients in the case group were severely impaired at the time of consultation. The results of the morphometric analysis of the panoramic radiographs indicated that all patients with mouth breathing, whether due to allergic rhinitis or another cause, present differences in reference to condyle, ramus, body and ramus width symmetry between left and right side of the face in linear and angular measurements, with only the Condilion to Gnation distance being significantly lower in the cases. Conclusions: The diagnosis of DTM requires an oriented clinical examination to assess functional limitation. In addition, a complementary imaging study of low complexity such as panoramic radiography can allow visualization of changes such as the presence of osteophytes, which provide clarity to the diagnosis, given that pediatric patients do not always present the signs and symptoms classically described for adult patients.

Cardiovascular risk associated with the use of selective COX-2 inhibitors: a systematic review

Raissa Costa Leite Lucio Silva — 2022-12-01

Introduction: Selective inhibitors of the enzyme cyclooxygenase-2 were developed to reduce the gastrointestinal toxicity of conventional nonsteroidal anti-inflammatory drugs. However, this class of drugs decreases prostacyclin production and can disrupt endothelial homeostatic balance, leading to a prothrombotic state that offsets potential gastrointestinal benefits.
Methods: A systematic review of all study publications linking cyclooxygenase-2 inhibitor nonsteroidal anti-inflammatory drugs and related cardiovascular events was performed.
Results: The highest overall risks were seen with rofecoxib, 1.45 (95% CI 1.33 to 1.59), and diclofenac, 1.40 (1.27 to 1.55). The lowest risks recorded were with ibuprofen, 1.18 (1.11, 1.25), and naproxen, 1.09 (1.02, 1.16). The risk of VTE increased with diclofenac [OR 1.63 (95% CI: 1.53, 1.74)], ibuprofen [OR = 1.49 (95% CI: 1.38, 1.62)], meloxicam [OR = 1.29 (95% CI: 1.11, 1.50)] and coxibs [celecoxib, OR= 1.30 (95% CI: 1.11, 1.51); rofecoxib, OR= 1.44 (95% CI: 1.18, 1.76)]. Naproxen did not increase the risk of VTE [OR = 1.00 (95% CI: 0.89, 1.12)]. Furthermore, there is a significant association with atrial fibrillation for etoricoxib (HR 1.35; 95% CI 1.19–1.54).
Conclusion: This review suggests that the risk of these adverse effects is greater in patients with an earlier history of cardiovascular disease or at considerable risk for developing it. Evidence shows that among the widely used NSAIDs, low-dose naproxen and ibuprofen are less likely to increase cardiovascular risk. Data for etoricoxib were sparse, but in pairwise comparisons this drug had a significantly higher relative risk than either naproxen or ibuprofen. Indomethacin is an older drug that is also toxic to the gastrointestinal system, and evidence of cardiovascular risk casts doubt on its continued clinical use.

The potential of the basic research laboratory experience in medical training

Maximiliano Giraud-Billoud — 2022-12-04

Scientific evidence demonstrates, year after year, the importance of consolidating knowledge through meaningful educational experiences for students. This pedagogical approach focused on learning as the construction of meaning represents a much more profitable experience in the learning process, since it implies an active role of the student, leaving the comfort zone of being a mere receiver of knowledge. In this sense, medical education is increasingly adopting this thinking and is modifying curricular plans and ways of working with students in the search for transforming traditionalist approaches to education into educational forms that accompany the current era of knowledge, crossed by technologies and ubiquitous and autonomous learning.

Relevance of the learning provided by the field of research for academic training in surgical instrumentation

Vanesa Verónica Miana — 2022-11-02

With great enthusiasm, I see that in your magazine Interamerican Journal of Health Sciences, relevance is given to the learning that the field of scientific research provides to the surgical instrumentation training. Science as human activity, creator of knowledge through observation methodologies and experimentation in order to answer questions objectively and systematically, manifests benefits at a global level with the generation of knowledge, the application of these in the development of innovative technologies and in the decision-making with the purpose of solving individual and collective human problems, among others. Scientific practice requires trained personnel to access reference sources and tools that allow critical, consensual and objective reflection in the execution of all stages in the development of an investigation. This is nothing more than a personnel that has learned to learn by itself to obtain evidence that will be useful, reliable and timely to resolve the research questions. There is where remains the main individual benefit of science.

Continuing Medical Professional Development, a look beyond the individual

Jorge Nicolás Ninno — 2022-12-03

In a context where the medical community envisions the importance of maintaining the necessary skills for professional performance, I consider it truly valuable for the Interamerican Journal of Health Sciences to be part of this debate, broadening the possible perspectives on this problem. In a changing world, where knowledge is permanently challenged, where we constantly interact with technology and where the needs of the community require an increasingly complex approach, it is worth questioning whether what we have learned in our undergraduate and postgraduate instances is enough in order to continue performing our tasks in an ideal manner. The capabilities defined in training programs seem not to be sufficient indefinitely as to guarantee an adequate and responsible response to the population.

Pneumonitis secondary to silicone lung embolism in transgender women living with HIV

Julian Garcia — 2022-11-02

Dimethylpolysiloxane (silicone) has been widely used in the last decades in soft tissue augmentation procedures. In Argentina, approximately 54% of transgender people had liquid silicone or industrial oil injection and 91% of them where applied outside the health system. Silicone particles may migrate into lung vessels generating a syndrome similar to fat embolism, usually starting within 72 hours following silicone injection, although it has been described months to years after. We hereby present two cases of pneumonitis secondary to silicone lung embolism in transgender women living with HIV. Both patients were diagnosed through CT scan and bronchoalveolar lavage, and received supportive therapy with favorable outcome. Silicone lung embolism should be included as a differential diagnosis of pneumonitis, especially in transgender population.

Hepatitis B reactivation after COVID-19: just a coincidence or a causal relationship?

Fernando Gruz — 2022-12-02

A 48 year-old man was evaluated because of a sudden raise in his liver function tests. He had a prior history of an acute hepatitis B infection, which spontaneously resolved in 2015 and a recent COVID-19 infection. As he only developed a mild disease, he did not receive steroids or convalescent plasma, or any other drugs. Seven weeks after having acquired the infection, he presented an acute hepatitis. Every known etiological factor was discarded. New serological status for hepatitis B was evaluated, and we discovered a sero-reversion. This situation could often be seen after immunosuppressive treatments, but our patient receive none of them. We started Entecavir and a rapid negativization of his viral load was observed as well as a normalization of his liver tests. If this reactivation was a consequence of COVID-19 or not is still not clear for us, but we believe that this case could raise awareness among physicians.

Disturbances of lung function in HIV positive patients

Agostini Marcela — 2022-12-02

The presence of disturbances in the respiratory function on HIV positive patients, derive from multiple causes. The principal mechanism of injury is the inflammation that triggers a flood of biomarkers, which leads to a respiratory function decline. Within the causes, we find modifiable factors such as tobacco and drugs use, and non-modifiable factors like gender, age, CD4 recount, viral burden, HIV itself, ART, co-infections such us HCV and the presence of breathing infections like Pneumocystis Jiroveci pneumonia and Tuberculosis. Facing a chronic pathology requires to control obstructive alterations so, it results convenient to request spirometry and diffusion tests.