Pan-American League of Associations for Rheumatology-Central American, Caribbean and Andean Rheumatology Association Consensus-Conference Endorsements and Recommendations on the Diagnosis and Treatment of Chikungunya-Related Inflammatory Arthropathies in Latin America.

BACKGROUND/OBJECTIVE: Although mortality rates related with chikungunya (CHIK) outbreaks in Latin America's (LA's) dengue-endemic rural and new urban regions are low, dealing with symptoms and sequelae can both produce a significant burden of disease and diminish quality of life-from many months to years-after the acute phase of the infection, with a significant impact on public and individual health.The aim of this work was to establish Pan-American League of Associations for Rheumatology-Central American, Caribbean and Andean Rheumatology Association (ACCAR) consensus-conference endorsements and recommendations on the diagnosis and treatment of CHIK-related inflammatory arthropathies transmitted by Aedes aegypti and Aedes albopictus in LA. METHODS: Based on the Consensus Development Conference format, a panel of ACCAR rheumatologist voting members (n = 10) took part in this Pan-American League of Associations for Rheumatology initiative. Experts voted from a previous content analysis of the medical literature on CHIK, 4 subsequent topic conferences, and a workshop. Consensus represents the majority agreement (≥80%) achieved for each recommendation. RESULTS: The experts' panel reached 4 overarching principles: (1) CHIK virus (CHIKV) is a re-emergent virus transmitted by 2 species of mosquitoes: A. aegypti and A. albopictus; (2) CHIKV caused massive outbreaks in LA; (3) chronic CHIKV infection produces an inflammatory joint disease that, in some cases, can last for several months to years, and (4) currently, there are no vaccines or antivirals licensed for CHIKV infections. RECOMMENDATIONS: Pan-American League of Associations for Rheumatology-ACCAR achieved 13 endorsements and recommendations on CHIK categorized in 3 groups: (1) epidemiology and clinical manifestations, (2) diagnosis, and (3) treatment, representing the consensus agreement from the panel's members.

Historia de la implantología y la oseointegración, antes y después de Branemark / History of the implantology and osseointegration, before and aft er Branemark

En 1911 los traumatólogos inmovilizaban fracturas óseas con dispositivos de acero inoxidable con contenido férrico, teniendo como secuela la corrosión. En 1932 el Vitallium, una aleación exenta de hierro, fue considerada ideal, no corrosiva y biocompatible para estos fines. En 1940 un estudio en fémur de gatos comparó la corrosión del vitallium (gold est ndar) respecto a otros metales, entre ellos el titanio. Histológica y radiográficamente el titanio produjo menos efecto inflamatorio y corrosivo comparado al vitallium. Este estudio describe la característica inédita del titanio de “soldarse” al hueso. En 1951 se probaron tornillos experimentales de titanio en fémur de ratas, los cuales se “soldaron” al hueso, la conclusi¢n fue que estos estaban en desventaja respecto a los de acero quirúrgico, ya que debían retirarse fácilmente para evitar secuelas. En 1959 Branemark estudiando la reparación ósea mediante microscopia vital, implantó en el peron‚ de conejos, dispositivos transóseos de titanio, consciente de su biocompatibilidad. Al intentar retirar estos dispositivos, le impresionó la intensidad de la unión hueso-titanio nombrando a esta característica como óseo integracó¢n. Aplicó esta característica única para estabilizar dentaduras postizas, experimentando en mandíbulas de perros. En 1965 implantó dispositivos de titanio exitosamente en una mandíbula humana. Patentó su sistema de implantes dentales con la firma sueca Nobel Pharma

Since 1911 trauma bone fractures was immobilized with stainless appliances containing ferric, corrosion taking its wake. Since 1932 the Vitallium, iron exempt, was considered ideal, non-corrosive and biocompatible. In 1940, a study of corrosion on cat’s femur, compared vitallium (gold standard) to other metals, including titanium, never evaluated. Histologic and radio graphical y titanium produced less inflammatory and corrosive effect compared to vitallium. This study described the unprecedented feature of the titanium “welded” to the bone. In 1951 tested experimental titanium screws in the femur of rats, which are “welded” to the bone, the conclusion was that these were at a disadvantage compared to surgical steel, as it should be easily removed to prevent damage. Branemark in 1959 studying bone repair by vital microscopy, implanted in rabbit fi bulatitanium trans-osseous devices aware of their biocompatibility. When attempting to remove these devices, was impressed by the intensity of the bone-titanium welded. He named this feature osseointegration. Projected apply this unique feature to stabilize dentures, experiencing jaws of dogs, in 1965 successfully implanted titanium abutments in a human mandible. Patented his dental implant system with Swedish firm Nobel pharma.