Objetivo: El objetivo de este estudio fue determinar las necesidades de tratamientos dentales y el análisis de los costos sanitarios odontológicos directos, en un grupo de pacientes con diabetes tipo 2, que fueron asistidos (junio 2004 - julio 2006) en el Hospital Central de Odontología de la Ciudad de Resistencia, Chaco, Argentina. Material y métodos: Un total de 300 pacientes diabéticos tipo 2 fueron incluidos en este estudio y divididos en dos grupos de 150: Grupo I, diabéticos controlados metabolitamente (hemoglobina glucosilada [HbA1c] < 8.0%, media 6.7%; edad media = 56.1 3.1 años) y grupo II, diabéticos sin control metabólico (HbA1c ≥ 8.0%, media 13,7%; edad media ± 55.4 3.2 años). La examinación clínica incluyó Índice Comunitario de Necesidades de Tratamiento Periodontal (ICNTP), Índice de Necesidades de Tratamiento de Caries (INTC) y número de dientes perdidos. Los costos del servicio de salud fueron calculados por medio de un estudio descriptivo y la aplicación de un modelo de simulación para comparar los costos de tratamientos dentales reparativos versus prevención (análisis de minimización de costos, costo- beneficio y costo efectividad). El análisis estadístico se realizó en base a distribución de frecuencias, media y desviación estándar, test de diferencia de proporciones y prueba de Chi-Cuadrado con un nivel de significancia de p < 0.05. Resultados: Bolsas periodontales de más de 5 mm, valores elevados del INTC y un alto numero de dientes perdidos fueron asociados con un alto nivel de HbA1c. Costos dentales totales y directos, claramente o probablemente atribuibles a la diabetes fueron estimados en 173.627,66 Pesos Argentinos (531.300,63 Dólares Americanos). Si este costo es dividido en categorías, las endodoncias representan aproximadamente el 27.38% del costo global, radiología 19.37%, prótesis removible 19.00%, operatoria dental 10.95%, cirugía 7.85%, periodoncia 7.63%, prevención 6.66% y consultas 1.12%. Los costos fueron particularmente altos en pacientes con elevado nivel de glucemia. Comparada con la odontología reparativa, las estrategias preventivas fueron altamente costo-efectivas. El análisis costo-beneficio estimó que, el costo de los tratamientos reparativos, es 15 veces más grande que el costo de la terapia preventiva. Conclusiones: La Hiperglucemia tiene un impacto económico sustancial sobre los costos para el manejo de las enfermedades orales en pacientes diabéticos tipo II. La implementación de un programa basado en la comunidad, para prevenir las enfermedades orales y promover la salud oral de las personas con diabetes, puede llevar a resultados clínicos positivos en el corto tiempo e importantes mejoras en los costos.

Objective: The aim of the present study was to determine dentistry necessity treatments and analyse the direct dentistry sanitary costs in type 2 diabetes patients treated (June 2004 - July 2006) at the Central Dentistry Hospital, Resistencia, Chaco, Argentina. Material and methods: A total of 300 type 2 diabetic patients were included in this study and divided into two groups of 150: Group I, diabetic with metabolic control (glycosylated haemoglobin [HbA1c] < 8.0%, mean 6.7%; mean age ± 56.1 3.1 años) and Group II, diabetic without metabolic control (HbA1c > 8.0%, mean 13,7%; mean age ± 55.4 3.2 años). Clinical examination included Community Periodontal Index of Treatment Needs (CPITN), Caries Index Treatments Needs (CITN), and the number of missing teeth. Health service costs were assessed by means of descriptive study and application of a simulation model to compare costs of reparative dental treatment versus prevention (cost-minimization, cost-benefit and cost-effectiveness analysis). The percentage frequency, mean values and standard deviations, the test of difference of proportions, and Chi Square test with significance levels of p < 0.05 were used for the statistical analysis. Results: Periodontal pockets exceeding 5 mm, elevated CITN values and a higher number of missing teeth were associated with a high level of HbA1c. Total direct dental costs clearly or probably attributable to diabetes were estimated at 173.627,66 Argentine Pesos (531.300,63 American Dollars). If this cost is divided into categories, endodontics represents approximately 27.38% of the global cost, oral radiology 19.37%, removable prosthodontics 19.00%, restorative dentistry 10.95%, surgery 7.85%, periodontology 7.63%, preventive dentistry 6.66% and checkups 1.12%. Costs were particularly high in patients with elevated level of blood glucose. Compared with reparative dentistry, preventive strategies were found to be highly cost-effective. Cost-benefit analysis estimated the cost of reparative treatment for prevalent oral diseases to be 15 times greater than that of preventive therapy. Conclusions: Hyperglycemia has a substantial economical impact on the costs of managing oral diseases in Type II diabetic patients. Implementation of a community-based program to prevent oral diseases and promoting oral health for people with diabetes can lead to clinical outcomes in the short-term and substantial improvements in costs.

No período de 1994 a 2000, durante a construção e enchimento da represa Yacyretá, foram estudadas em Ituzaingó e Posadas variáveis infecciosas (diarréias e infecções respiratórias), clínico-cirúrgicas (doenças cardiovasculares e politraumatismos) e ambientais (pluviais, temperatura e umidade). As diarréias, em Ituzaingó, tiveram um aumento 6,5%, 78,3% e 13%, respectivamente em 1995, 1996 e 1997 e nos anos seguintes os valores foram similares aos de 1994 e em Posadas mostraram uma tendência ascendente. As infecções respiratórias, em Ituzaingó em 1995, aumentaram 143% e nos períodos subseqüentes voltaram aos limites de 1994 e, em Posadas tiveram valores ascendentes. No Hospital de Ituzaingó, em 1995, as doenças incrementaram 97,6%, mostraram decréscimo em 1996 e atingiram 127% em 2000; os politraumatismos aumentaram 107% em 1995, declinaram 38% em 1996 nos anos seguintes apresentaram tendência ascendente atingindo 33% em 2000. O impacto das variáveis ambientais foi maior em Ituzaingó do que em Posadas. O aumento das doenças relacionou-se com a temperatura máxima, mas não com a umidade.

Infectious, clinical-surgical and environmental variables were studied in Ituzaingó and Posadas (Argentina) and differences were analyzed from 1994 to 2000, which corresponds to the building of the binational dam Yacyretá (Argentina-Paraguay) and to the resulting reservoir. The chosen infectious variables were diarrhea and respiratory infections and the clinical-surgical variables were cardiovascular diseases and polytraumas. Environmental variables were also investigated. Taking as a baseline the values corresponding to the year 1994, diarrhea in Ituzaingó, increased 6.5% during 1995 and 78.3% in 1996 returned to 1994 values. Posadas showed a rising tendency throughout the period investigated. In Ituzaingó, respiratory infectious rose 143% in 1995, and later returned to 1994 values. In Posadas they increased each year. Cardiovascular diseases reached 97.6% in Ituzaingó during 1995; lowered slightly in 1996 and reached 127% in the year 2000. The impact of the environmental variables was higher in Ituzaingó than Posadas. The negative impact of temperature related with the increased frequency of disease in Ituzaingó is more related to maximum temperature than with changes in humidity.

Most studies from Argentina have focused on toxocariasis as an environmental problem of big cities, and there are no available data about children infection from small or middle-sized cities. In order to assess the prevalence of anti-Toxocara antibodies in infantile population, 206 children from Resistencia, of both sexes, aged 1-14 years old were studied by Elisa testing with E/S T. canis L2 antigens. Hematological parameters and immunoglobulin levels were determined; five days' stool samples were studied and epidemiological data were obtained by means of a questionnaire to parents. Results showed that 73% of the children had one or more dogs living at home, 57% reported geophagia and 37.9% were positive for Toxocara serology, but there was no significant difference in prevalence neither for boys and girls, nor concerning age. An increased risk of infection was observed in age groups 5-6 and 7-8 for boys, and in age groups 3-4 and 5-6 for girls.

La mayoría de los estudios realizados en Argentina, han enfocado a la Toxocariosis como un problema medioambiental propio de las grandes ciudades y no existen datos acerca de esta infección entre los niños de ciudades medianas o pequeñas. A fin de determinar la prevalencia de anticuerpos anti-Toxocara en la población infantil de la ciudad de Resistencia, se estudiaron 206 niños de ambos sexos, con edades comprendidas entre los 1-14 años, mediante el test de Elisa, empleando antígenos E/S de larva L2 de Toxocara canis. También se evaluaron los niveles de inmunoglobulinas séricas y los parámetros hematológicos; se efectuaron análisis coproparasitológico seriados en heces de 5 días y se recolectó información epidemiológica mediante cuestionario a los padres. Los resultados obtenidos señalan que el 73% de los niños tenían uno o mas perros viviendo en la casa, que el 57% tenían antecedentes de geofagia y que el 37.9% tenían serología positiva para Toxocara, aunque no hubo diferencias estadísticamente significativas entre varones y mujeres ni con la edad. Un mayor riesgo de contraer la infección se observó entre los grupos etarios 5-6 y 7-8 de varones y 3-4 y 5-6 de mujeres.

Para avaliar as idades em que os agentes etiológicos das micoses sistêmicas iniciam a infecção, testes cutâneos da histoplasmina e paracoccidioidina foram realizados cm 344 crianças de ambos os sexos, com idades entre 2 e 15 anos. Foram selecionadas de amostra estatisticamente significante da população da cidade de General San Martin (Nordeste da Argentina). Os testes Foram analisados 48 horas após a injeção e considerados positivos se uma enduração de 5 mm ou mais estivesse presente. Anticorpos circulantes foram também avaliados pela imunodifusão em gel de agar. A média de infecção para o H. capsulatum foi de 9.2% e pertencia às crianças de 4 a 14 anos, sem diferença significante entre os sexos. Cinco criancas de 2 a 14 anos foram positivas para paracoccidioidina (1.6%). Nenhuma das crianças tinha anticorpos específicos nem sinais de micose ativa. Resultados mostram que infecção pelo H. capsulatum pode ser encontrada a partir da idade de 4 anos, enquanto para o P. brasiliensis o limite inferior de idade foi de 2 anos. Estes achados podem contribuir para o melhor conhecimento sobre a infecção infantil por fungos, numa região geográfica onde não foram encontradas referências anteriores.

In order to estimate ages at which etiological agents of systemic mycoses initiate infection, histoplasmin and paracoccidioidin skin tests were performed in 344 children of both sexes, between 2 and 15 years old. They were selected from a statistically significant population sample Gral. San Martín city (Northeast Argentina). Tests were read 48h after injection and considered positive if a 5 mm on larger induration was present. Circulating antibodies were also evaluated by agar gel immunodiffusion. The overall infection rate for H. capsulatum was 9.2%, belonging to children from 4 to 14 years old, without significant differences among sexes. Five children from 2 to 14 years old were positive to paracoccidioidin (1.6%). None of the children had specific antibodies neither signs of active mycosis. Results show H. capsulatum infection can be found from age 4, while for P. brasiliensis the lower limit was two years old. These findings may contribute to better knowledge on infantile fungal infection in a geographical region where no previous references can be found.