Análisis de los métodos de detección de lesiones orales potencialmente malignas

Propósito: determinar la efectividad de detección de lesiones orales potencialmente malignas de cuatro métodos por medio de revisión sistemática tipo paraguas. Fuente de los datos: la búsqueda fue realizada con bases de datos Pubmed y EBSCOhost. Restricción de los años 2013-2018. Estrategia de búsqueda: (early detection of cáncer) AND (mouth neoplasms), (early detection of cáncer) AND (diagnostic techniques and procedures), (mouth neoplasms) AND (diagnostic techniques and procedures). Selección de los estudios: fueron seleccionadas a través de lectura crítica y la lista de chequeo del formato PRISMA, aquellas revisiones sistemáticas cuyo objetivo sea evaluar la efectividad de al menos uno de los métodos de detección de lesiones orales potencialmente malignas, seis estudios cumplieron con los criterios de inclusión. Extracción de datos: mediante la realización de lectura crítica de las revisiones sistemáticas seleccionadas previamente. Resultado de síntesis de los datos: se determina la efectividad a través de la comparación de las medias de porcentajes de sensibilidad y especificidad. Las medias de sensibilidad y especificidad de Vizilite fueron de 81.31 y 25.4%, de Microlux DL de 82.63 y 69.52%, de azul de toluidina de 82.07 y 66.27% y de citología exfoliativa de 76.77 y 80.87%, respectivamente. Conclusiones: los métodos de detección de lesiones orales premalignas evaluados en el presente estudio requieren mayor respaldo de evidencia científica para validar su efectividad. El método con mayor eficacia es el Microlux/DL, debido a sus altos niveles de sensibilidad y especificidad

Bayesian Tragedy and Categorical Medical Error in Prostate Cancer

The Bayesian concept is complex and contrary to intuition, but it is fundamental in the practice of medicine as well as in biotechnological development. We expect that a tragedy of ignoring the Bayesian concept will result clear to the reader who should acquire the tools to recognize its meaning, as well as, its use; but especially, to visualize the serious consequences of ignoring it. The physician is not mystically fascinated for knowing what percentage of patients who has prostate cancer have no symptoms (47%), urinary frequency (38%), urinary urgency (10%), decreased urine stream (23%) or hematuria (1.4%). What the physician and every patient want and vitally need to know is the probability of having prostate cancer, giving that he has one or more of those symptoms. Keywords: Medical Errors; Iatrogenic disease; Sensitivity and specificity; Diagnostic Techniques and procedures

Reliability of ICDAS to Detect Occlusal Caries among Master’s Degree students of Dentistry

The objective of this study was to investigate the reproducibility of the International System for the Detection and Evaluation of Caries (ICDAS) for the diagnosis of caries by students of the Master's Degree in Dentistry (n = 25). The occlusal surfaces of human third molars (n = 14) were evaluated by twenty-five (n = 25) students using the ICDAS index and later a questionnaire was applied on demographic and professional context data. The dental crowns were sectioned in mesial to distal direction to obtain slices of 1mm in thickness which were observed in a stereomicroscope (40X) to identify the greatest extension of caries lesion. Data were analyzed by the Chi-Square, Fisher's Exact and Spearman's Correlation Coefficient at a significance level of 5%. There was an influence in the diagnosis of caries among students and teeth, where the majority of those who declared themselves to be safe missed the diagnosis. There was variability between the diagnosis and the proposed treatment for caries, with a better diagnosis for tooth VII and less for X; greater fit for treatment of teeth XIII, XIV and lower for IV, VI. The histological cut showed that the teeth were more affected by caries than the ICDAS. It was concluded that the ICDAS reproducibility was partially satisfactory when the occlusal surface was evaluated by the master’s degree students. Keywords: Dental Caries. Diagnostic Techniques and Procedures. Therapeutics. ResumoEste trabalho teve o objetivo de investigar a reprodutibilidade do Sistema Internacional de Detecção e Avaliação de Cárie (ICDAS) para o diagnóstico da cárie, por estudantes de curso de Mestrado em Odontologia (n=25). As superfícies oclusais de terceiros molares humanos (n=14) foram avaliadas por vinte e cinco (n=25) estudantes, utilizando o índice ICDAS, e posteriormente foi aplicado questionário sobre dados demográficos e de contexto profissional. As coroas dentárias foram seccionadas no sentido mésio distal para obter fatias de 1 mm de espessura, que foram observadas em estereomicroscópio (40X) para identificar a maior extensão da lesão de cárie. Os dados foram analisados pelos Testes Qui-Quadrado, Exato de Fisher e Coeficiente de Correlação de Spearman, em nível de significância de 5%. Houve influência do grau de instrução dos estudantes no diagnóstico da cárie em relação ao dente avaliado e a maioria que se declarou segura errou o diagnóstico. Houve variabilidade entre o diagnóstico e o tratamento proposto para a cárie, com maior acerto para diagnóstico do dente VII e menor para o X; maior acerto para tratamento dos dentes XIII, XIV e menor para IV, VI. O corte histológico mostrou que os dentes estavam mais comprometidos pela cárie que o ICDAS. Concluiu-se que a reprodutibilidade do ICDAS foi satisfatória quando a superfície oclusal foi avaliada pelos mestrandos. Palavras-chave: Cárie Dentária. Técnicas e Procedimentos Diagnósticos. Terapêutica.

Cancer of Unknown Primary Site Syndrome‐CUP Syndrome - Diagnostic and Therapeutical Dillemas

Summary Metastatic carcinomas of unknown primary origin (cancer of unknown primary-CUP) represent 3-5% of all cancers. This term includes all patients presented with metastatic disease in whom the primary site could not have been identified. Despite the use of modern and comprehensive diagnostic techniques and procedures, there is no improvement in efficacy (efficiency) of indentifying the primary site of disseminated disease. That is why a diagnostic procedure should be rational and should include the basic diagnostic examination (analyses) with the aim to define biological and clinical characteristics of diagnosed disease, as well as an optimal therapeutic approach. Although the overall prognosis of the majority of these patients is poor, it is possible, nowadays, to distinguish the subgroups of patients with favorable prognosis. Results of new basic research, better understanding of pathogenesis at the molecular level and introduction of new drugs through clinical trials suggest an advance in this disease treatment and outcome.

Mycotoxins in poultry production

All poultry is sensitive to mycotoxins. This partly depends on the type, age and production categories of poultry, their living conditions and nutritive status and partly on the type, quantity and duration of mycotoxin ingestion. The presence of mycotoxins results in significant health disorders and a decrease in production performances. This leads to considerable economic loss for the poultry industry - either direct losses, i.e. death of the poultry or the indirect ones, i.e. the decrease in body mass, number and quality of eggs, greater food conversion, and immunosuppression. Immunosuppression results in increased sensitivity to infective agents and a bad vaccinal response. Morevover, mycotoxin residues in poultry meat, eggs and products derived from them pose a threat to human health. In order to prevent and reduce the negative implications of mycotoxins in the poultry production, it is necessary to create both global and national strategies for combatting mycotoxins, advance diagnostic techniques and procedures, intensify the control of food quality, introduce new limits on the maximum amount of mycotoxins allowed in food and poultry feed used for certain species and categories of animals, and synchronise it with the European standards.