Mónica López-Ratón

Epidemiology, mortality rate and survival in a homogeneous population of hypopituitary patients

Hypopituitarism is associated with higher prevalence of cardiovascular risk factors and premature death. Furthermore, some clinical and therapeutic features of hypopituitarism have been associated with a worse prognosis.

Surface raw electromyography has a moderate discriminatory capacity for differentiating between healthy individuals and those with TMD: A diagnostic study

The use of surface electromyography (sEMG) to identify subjects with chronic temporomandibular disorders (TMD) is controversial. The main objective of this study is to determine the diagnostic accuracy of EMG to differentiate between healthy subjects and those with TMD. This study evaluated 53 individuals with TMD who were referred to the university service and who fulfilled the eligibility criteria during the period of the study. Thirty-eight dental students were also recruited satisfying same eligibility criteria but without TMD. The inclusion criteria were to be fully dentate, have normal occlusion, and be righthanded. The exclusion criteria were periodontal pathology, caries or damaged dental tissues, orthodontic therapy, maxillofacial disease, botulinum A toxin therapy, and psychological disorders. The means of the masseter muscles, right (RM) and left (LM), and temporalis muscles, right (RT) and left (LT), and intraindividual indexes during resting and during clenching were calculated. Raw sEMG activity was used to determine the cutoff points and calculate the diagnostic accuracy of sEMG. The diagnostic accuracy of these variables for a diagnosis of TMD was evaluated by using the Receiver Operating Characteristic (ROC) curve and the area under it (AUC). A new transformed diagnostic variable was obtained by using the Generalized Additive Models (GAM). Optimal cutoff points were obtained where the sensitivity and specificity were similar and by the Youden index. The highest estimated AUC was 0.660 (95% CI 0.605-0.871) corresponding to the rLT variable during rest. When rLT and rACTIVITY (differences divided by sums of temporalis versus masseter muscles) were considered as a linear combination, the AUC increased to 0.742 (95% CI; 0.783-0.934). In conclusion, the raw sEMG evaluation of rest provided moderate sensitivity and specificity to discriminate between healthy individuals and those with TMD. The use of the indexes (mainly assessing the dominance of temporalis over masseter muscles during rest) is strongly recommended to increase the discriminatory capacity of raw sEMG evaluation.

Temporal and spatial patterns in the rate of alcohol withdrawal syndrome in a defined community

There is a paucity of data about the epidemiology of alcohol withdrawal syndrome (AWS) and, particularly, with regard to temporal trends and sociodemographic factors. This study included 7,195 episodes of AWS in a defined community (Galicia, Spain) over a 11-year period. We looked for geographical correlations between AWS rate and sociodemographic factors (education and socioeconomic levels and rates of occupational activity and unemployment) within respective districts. We also investigated the inter- and intra-annual time trends for AWS. The median age of the participants was 49 years (interquartile range, 41-60 years), and 85% were men. The annual frequency of AWS episodes remained stable during the study period, with a consistent peak in episodes during the summer months and lowest frequency of episodes in winter months (P<.001). The age- and sex-adjusted geographical distribution of the AWS rate was uneven; districts with high rate tended to cluster. The mean education level was negatively correlated with AWS rate within a given district after adjusting for socioeconomic level, occupational activity rate, and unemployment rate (P<.001). In conclusion, we identified characteristic temporospatial patterns of AWS rate in this defined community. The rate of AWS tended to be higher in the summer months and lower in the winter months. The rate of AWS was higher in districts with low education levels.

Mandibular Second Molar Periodontal Healing After Impacted Third Molar Extraction in Young Adults

PURPOSE To estimate the prevalence of preoperative periodontal defects and analyze 12-month spontaneous healing on the distal aspect of the mandibular second molar (M2) after impacted mandibular third molar (M3) extraction. MATERIALS AND METHODS This prospective clinical study was conducted in 25 healthy young patients (21.03 ± 4.38 yr old) with 40 extractions of higher-risk periodontal impacted M3s. Plaque and gingival indexes, recession, bleeding on probing, probing depth (PD), and attachment level were recorded before surgery and at 3, 6, and 12 months after surgery at 5 sites on the distal aspect of the M2. RESULTS The initial mean PD was 5.70 ± 3.80 mm, with the deepest mean PD at the lingual side. At 12 months, a mean PD average of 3.77 ± 2.86 mm was recorded, with a total average recovery of 1.93 ± 2.46 mm (P < .001), that was higher at 3 months (-1.62 mm, P < .001). The PD and attachment level improvements were statistically significant (P < .001) and nearly clinically significant from baseline to 12-month follow-up and from the buccal to the lingual side of the distal aspect of the M2. CONCLUSIONS Impacted M3s adjacent to M2s lead to periodontal defects that are deepest at the lingual side and almost recover at 12 months after extraction. The first 3 months is considered the cutoff for periodontal healing. Young adults with high-risk periodontal M3 impactions may benefit from early extraction, which increases spontaneous periodontal healing.

Radiological infrabony defects after impacted mandibular third molar extractions in young adults.

PURPOSE To estimate the prevalence of infrabony defects and their healing at the distal aspect of mandibular second molars (M2s) after extraction of impacted mandibular third molars (M3s). MATERIALS AND METHODS This prospective clinical study included 22 young healthy patients (21.03 ± 4.51 yr old). Thirty-seven surgical extractions of high-risk periodontal and mesioangular impacted M3s in close contact with adjacent M2s were performed. Radiographic bone height (RBH), radiographic infrabony defects (RIDs), and bone loss (BL) were recorded at baseline and 3, 6, and 12 months after surgery. RBH and RIDs were measured from the tip of a periodontal gauge to the root apex and to the cementoenamel junction of the M2, respectively; BL was calculated by dividing the length of the M2 root into thirds and categorized as slight, moderate, or severe. RESULTS Only 26 extracted teeth were included in all radiographic assessments. Mean RID size at baseline was 4.54 ± 1.87 mm. At 12 months, an average recovery of 2.80 ± 2.36 mm (P < .001) was recorded, for a mean RID size of 1.78 ± 1.65 mm. Statistically significant differences in RBH and RIDs were found at all assessments (P < .05). Improved bone healing was registered during the postoperative period, with higher values during the first 3 months (1.3 mm; P < .01). Most RIDs of at least 4 mm associated with moderate or slight BL decreased to no larger than 3 mm without BL. For moderate BL, the bone gain pattern was gradual and continuous, whereas for slight BL, the pattern was variable. CONCLUSIONS In young healthy patients, a high-risk periodontal impacted M3 leads to an RID of at least 4 mm associated with slight or moderate BL at the distal aspect of the M2, which decreases to no larger than 3 mm 12 months after surgery. Bone healing is clinically and statistically significant at 12 months, with the most notable changes at the first 3-month follow-up.

Confidence intervals for the symmetry point: an optimal cutpoint in continuous diagnostic tests

Continuous diagnostic tests are often used for discriminating between healthy and diseased populations. For this reason, it is useful to select an appropriate discrimination threshold. There are several optimality criteria: the North-West corner, the Youden index, the concordance probability and the symmetry point, among others. In this paper, we focus on the symmetry point that maximizes simultaneously the two types of correct classifications. We construct confidence intervals for this optimal cutpoint and its associated specificity and sensitivity indexes using two approaches: one based on the generalized pivotal quantity and the other on empirical likelihood. We perform a simulation study to check the practical behaviour of both methods and illustrate their use by means of three real biomedical datasets on melanoma, prostate cancer and coronary artery disease.