Características clínicas y epidemiológicas de las neoplasias mieloproliferativas Philadelphia negativas en el sistema público de salud de Chile / Clinical and epidemiological characteristics of the Philadelphia negative myeloproliferative neoplasms in Chile

BACKGROUND: Philadelphia-negative myeloproliferative neoplasms (Ph-MPN) are chronic hematological disorders characterized by the overproduction of one or more mature myeloid blood cell lineages. Classical Ph-MPN are polycythemia vera (PV), essential thrombocytopenia (ET) and primary myelofibrosis (PMF). AIM: To assess the epidemiological, clinical and diagnostic characteristics of Ph-MPN in Chile. Material and Methods: Retrospective review of medical records of all patients referred as MPN from 2012 to 2017. Patients with (9;21) translocation were excluded. RESULTS: Data of 462 cases with a median age of 69 years from 10 public hospitals was reviewed. ET was the most frequently Ph-MNP found. The incidence of Ph-MPN was 1.5 x 100.000 cases. The JAK2 V617F mutation study was performed in 96% of patients and only 30% had a bone marrow biopsy. Thrombotic events were observed in 29% of patients. Bleeding events were observed in 7%. Five-year overall survival was 87%. Conclusions: ET is the most frequent Ph-MPN. The mean incidence was lower than reported in the literature, in part because of a sub diagnosis.

[Clinical and epidemiological characteristics of the Philadelphia negative myeloproliferative neoplasms in Chile]. / Características clínicas y epidemiológicas de las neoplasias mieloproliferativas Philadelphia negativas en el sistema público de salud de Chile.

BACKGROUND: Philadelphia-negative myeloproliferative neoplasms (Ph-MPN) are chronic hematological disorders characterized by the overproduction of one or more mature myeloid blood cell lineages. Classical Ph-MPN are polycythemia vera (PV), essential thrombocytopenia (ET) and primary myelofibrosis (PMF). AIM: To assess the epidemiological, clinical and diagnostic characteristics of Ph-MPN in Chile. MATERIAL AND METHODS: Retrospective review of medical records of all patients referred as MPN from 2012 to 2017. Patients with (9;21) translocation were excluded. RESULTS: Data of 462 cases with a median age of 69 years from 10 public hospitals was reviewed. ET was the most frequently Ph-MNP found. The incidence of Ph-MPN was 1.5 x 100.000 cases. The JAK2 V617F mutation study was performed in 96% of patients and only 30% had a bone marrow biopsy. Thrombotic events were observed in 29% of patients. Bleeding events were observed in 7%. Five-year overall survival was 87%. CONCLUSIONS: ET is the most frequent Ph-MPN. The mean incidence was lower than reported in the literature, in part because of a sub diagnosis.

[Clinical and epidemiological characteristics of the Philadelphia negative myeloproliferative neoplasms in Chile]. / Características clínicas y epidemiológicas de las neoplasias mieloproliferativas Philadelphia negativas en el sistema público de salud de Chile.

BACKGROUND: Philadelphia-negative myeloproliferative neoplasms (Ph-MPN) are chronic hematological disorders characterized by the overproduction of one or more mature myeloid blood cell lineages. Classical Ph-MPN are polycythemia vera (PV), essential thrombocytopenia (ET) and primary myelofibrosis (PMF). AIM: To assess the epidemiological, clinical and diagnostic characteristics of Ph-MPN in Chile. MATERIAL AND METHODS: Retrospective review of medical records of all patients referred as MPN from 2012 to 2017. Patients with (9;21) translocation were excluded. RESULTS: Data of 462 cases with a median age of 69 years from 10 public hospitals was reviewed. ET was the most frequently Ph-MNP found. The incidence of Ph-MPN was 1.5 x 100.000 cases. The JAK2 V617F mutation study was performed in 96% of patients and only 30% had a bone marrow biopsy. Thrombotic events were observed in 29% of patients. Bleeding events were observed in 7%. Five-year overall survival was 87%. CONCLUSIONS: ET is the most frequent Ph-MPN. The mean incidence was lower than reported in the literature, in part because of a sub diagnosis.

Mortality of Adult Patients With Cancer Admitted to an Intensive Care Unit in Chile: A Prospective Cohort Study.

PURPOSE: Increasing numbers of reports have shown acceptable short-term mortality of patients with cancer admitted into the intensive care unit (ICU). The aim of this study was to determine the mortality of critically ill patients with cancer admitted to the ICU in a general hospital in Chile. MATERIALS AND METHODS: This was a prospective cohort trial in which we included all patients with cancer admitted to the ICU between July 2015 and September 2016. Demographic, physiologic, and treatment data were registered, and survival at 30 days and 6 months was evaluated. A prespecified subgroup analysis considering the admission policy was performed. These subgroups were (1) ICU admission for full code management and (2) ICU trial (IT). RESULTS: During the study period, 109 patients with cancer were included. Seventy-nine patients were considered in the full code management group and 30 in the IT. The mean age of patients was 60 years (standard deviation [SD], 15), and 56% were male. Lymphoma was the most frequent malignancy (17%), and 59% had not received cancer treatment because of a recent diagnosis. The mean Acute Physiology and Chronic Health Evaluation and Sequential-Related Organ Failure Assessment scores were 22.2 (SD, 7.3) and 7 (SD, 3), respectively. There were no differences in vasopressor, fluid, or transfusion requirements between subgroups. Lactate levels, Sequential-Related Organ Failure Assessment scores (day 1, 3, and 5), complications, and ICU length of stay were similar. In the entire cohort, 30-day and 6-month mortality was 47% and 66%, respectively. There was no difference in mortality between subgroups according to the admission policy. CONCLUSION: Patients admitted to the ICU in a developing country are at high risk for short-term mortality. However, there is a relevant subgroup that achieves 6-month survival, even among patients who undergo an IT.

[Predictive value of conventional immuno-histochemical biomarkers in breast cancer]. / Inmunohistoquímica convencional como predictor de respuesta y sobrevida en pacientes con cáncer de mama tratadas con quimioterapia preoperatoria: experiencia de un centro.

BACKGROUND: Pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) in breast cancer (BC) identifies patients with good prognosis. AIM: To assess if the clinico-pathological subtype, determined by classic immunohistochemical (IHC) markers, is able to predict pCR and prognosis in BC patients treated with NCT. MATERIAL AND METHODS: One hundred thirty three BC patients aged 24-80 years, were treated with NCT. Clinico-pathological subtype was defined based on classic IHC markers. pCR was defined as the absence of invasive neoplastic cells in the breast and lymph nodes, on final breast surgery. RESULTS: pCR was achieved in 8.2% of patients, 3.5 and 19.5% in luminal and hormonal receptor (HR) negative tumors respectively (p < 0.01). Median follow-up was 72.6 months (3.5-190). Patients who achieved pCR had higher overall survival (OS) (p = 0.04). A univariate analysis revealed that size of the tumor, ratio of metastatic to examined lymph nodes and absence of HR were significant predictors of pCR. These findings were not replicated in the multivariate analyses. CONCLUSIONS: Clinico-pathological subtypes were independent prognostic factors for pCR and OS in BC patients in our cohort. These findings support using classic and cheap biomarkers as a predictive tool for NCT in BC.

Early childhood caries in Switzerland: a marker of social inequalities.

BACKGROUND: Early childhood caries (ECC) is a marker of social inequalities worldwide because disadvantaged children are more likely to develop caries than their peers. This study aimed to define the ECC prevalence among children living in French-speaking Switzerland, where data on this topic were scarce, and to assess whether ECC was an early marker of social inequalities in this country. METHODS: The study took place between 2010 and 2012 in the primary care facility of Lausanne Children's Hospital. We clinically screened 856 children from 36 to 71 months old for ECC, and their caregivers (parents or legal guardians) filled in a questionnaire including items on socioeconomic background (education, occupation, income, literacy and immigration status), dental care and dietary habits. Prevalence rates, prevalence ratios and logistic regressions were calculated. RESULTS: The overall ECC prevalence was 24.8 %. ECC was less frequent among children from higher socioeconomic backgrounds than children from lower ones (prevalence ratios ≤ 0.58). CONCLUSIONS: This study reported a worrying prevalence rate of ECC among children from 36 to 71 months old, living in French-speaking Switzerland. ECC appears to be a good marker of social inequalities as disadvantaged children, whether from Swiss or immigrant backgrounds, were more likely to have caries than their less disadvantaged peers. Specific preventive interventions regarding ECC are needed for all disadvantaged children, whether immigrants or Swiss.

Inmunohistoquímica convencional como predictor de respuesta y sobrevida en pacientes con cáncer de mama tratadas con quimioterapia preoperatoria: Experiencia de un centro / Predictive value of conventional immuno-histochemical biomarkers in breast cancer

Background: Pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) in breast cancer (BC) identifies patients with good prognosis. Aim: To assess if the clinico-pathological subtype, determined by classic immunohistochemical (IHC) markers, is able to predict pCR and prognosis in BC patients treated with NCT. Material and Methods: One hundred thirty three BC patients aged 24-80 years, were treated with NCT. Clinico-pathological subtype was defined based on classic IHC markers. pCR was defined as the absence of invasive neoplastic cells in the breast and lymph nodes, on final breast surgery. Results: pCR was achieved in 8.2% of patients, 3.5 and 19.5% in luminal and hormonal receptor (HR) negative tumors respectively (p < 0.01). Median follow-up was 72.6 months (3.5-190). Patients who achieved pCR had higher overall survival (OS) (p = 0.04). A univariate analysis revealed that size of the tumor, ratio of metastatic to examined lymph nodes and absence of HR were significant predictors of pCR. These findings were not replicated in the multivariate analyses. Conclusions: Clinico-pathological subtypes were independent prognostic factors for pCR and OS in BC patients in our cohort. These findings support using classic and cheap biomarkers as a predictive tool for NCT in BC.

[The impact of childhood caries]. / Carie du biberon: un caillou dans la chaussure de la santé.

The early childhood caries affect primary dentition before the eruption of the permanent teeth. It is set to extended use of a bottle containing fermentable carbohydrates. The early childhood caries is not only a dental disease: it is a social, cultural and behavioral condition that reflects the practices and beliefs around the child. Swiss data indicate that in aged 2 children, one of for could be affected by this devastating oral disease, mainly in vulnerable populations. The primary care physician has an important role in the screening of preschool children, in determining the risk level of the child for early childhood caries. Physicians can advise families, especially pregnant women, about preventive measures and behavior, leading to a dramatic drop of early childhood caries prevalence.

Radio frequency identification (RFID) of dentures in long-term care facilities.

STATEMENT OF PROBLEM: The difficulty of identifying the ownership of lost dentures when found is a common and expensive problem in long term care facilities (LTCFs) and hospitals. PURPOSE: The purpose of this study was to evaluate the reliability of using radiofrequency identification (RFID) in the identification of dentures for LTCF residents after 3 and 6 months. MATERIAL AND METHODS: Thirty-eight residents of 2 LTCFs in Switzerland agreed to participate after providing informed consent. The tag was programmed with the family and first names of the participants and then inserted in the dentures. After placement of the tag, the information was read. A second and third assessment to review the functioning of the tag occurred at 3 and 6 months, and defective tags (if present) were reported and replaced. The data were analyzed with descriptive statistics. RESULTS: At the 3-month assessment of 34 residents (63 tags) 1 tag was unreadable and 62 tags (98.2%) were operational. At 6 months, the tags of 27 of the enrolled residents (50 tags) were available for review. No examined tag was defective at this time period. CONCLUSIONS: Within the limits of this study (number of patients, 6-month time span) RFID appears to be a reliable method of tracking and identifying dentures, with only 1 of 65 devices being unreadable at 3 months and 100% of 50 initially placed tags being readable at the end of the trial.

A pilot study combining individual-based smoking cessation counseling, pharmacotherapy, and dental hygiene intervention.

BACKGROUND: Dentists are in a unique position to advise smokers to quit by providing effective counseling on the various aspects of tobacco-induced diseases. The present study assessed the feasibility and acceptability of integrating dentists in a medical smoking cessation intervention. METHODS: Smokers willing to quit underwent an 8-week smoking cessation intervention combining individual-based counseling and nicotine replacement therapy and/or bupropion, provided by a general internist. In addition, a dentist performed a dental exam, followed by an oral hygiene treatment and gave information about chronic effects of smoking on oral health. Outcomes were acceptability, global satisfaction of the dentist's intervention, and smoking abstinence at 6-month. RESULTS: 39 adult smokers were included, and 27 (69%) completed the study. Global acceptability of the dental intervention was very high (94% yes, 6% mostly yes). Annoyances at the dental exam were described as acceptable by participants (61% yes, 23% mostly yes, 6%, mostly no, 10% no). Participants provided very positive qualitative comments about the dentist counseling, the oral exam, and the resulting motivational effect, emphasizing the feeling of oral cleanliness and health that encouraged smoking abstinence. At the end of the intervention (week 8), 17 (44%) participants reported smoking abstinence. After 6 months, 6 (15%, 95% CI 3.5 to 27.2) reported a confirmed continuous smoking abstinence. DISCUSSION: We explored a new multi-disciplinary approach to smoking cessation, which included medical and dental interventions. Despite the small sample size and non-controlled study design, the observed rate was similar to that found in standard medical care. In terms of acceptability and feasibility, our results support further investigations in this field. TRIAL REGISTRATION NUMBER: ISRCTN67470159.

[An interface between pediatrics and oral medicine: oral manifestations of gastroesophageal reflux in children]. / Lésions buccales du reflux gastro-oesophagien de l'enfant: des réalités et quelques mythes.

Gastro-oesophageal reflux (GOR) is a common disorder in the pediatric population. In association with esophagitis, GOR may impair children's quality of life. Extra-oesophageal manifestations are of specific interest in oral medicine because the refluxate may reach impair both oral mucosa and hard dental tissues. Some oral symptoms are so specific that they should raise the attention for other GOR symptoms. Dental erosion is a potential risk in children with gastroesophageal reflux: the pediatrician should routinely refer children with gastroesophageal reflux to a pediatric dentist to diagnose erosions and if needed restore the teeth. Conversely, in the presence of unexplained dental erosions the dentist and/or the pediatrician should discuss the possibility of an occult GOR.

Melanotic neuroectodermal tumour of infancy: a case report and review of the aetiopathogenic hypotheses.

The case of a 2-month-old healthy infant without relevant medical history. The patient was referred due to the aggravation of a swelling occupying the left half of the anterior maxilla. This lesion became visible approximately one month ago; it involved the buccal gingiva and alveolar bone, including the deciduous tooth germs 6.1 and 6.2. The swelling had dimensions of 20 mm x 20 mm. The surgical excision was performed under general anesthesia. The tooth buds of 6.1 and 6.2 were closely related to the tumour and so were removed. The lesion was entirely enucleated. The pathology of the lesion confirmed a melanotic neuroectodermal tumour of infancy. The melanotic neuroectodermal tumour of infancy (MNTI) has been described as a rare benign pigmented painless swelling that usually occurs in the anterior region of the maxilla and in the incisor region. The histological examination showed small basophilic cells, many containing melanin pigmentation within the cytoplasm, with a second population of larger cubical cells with abundant cytoplasm, arranged in alveolar or adenoid clusters. According to Krompecher this tumour derives from epithelial nests evolved at the time of embryonic fusion of the facial processes. It has also been suggested that the tumour arises from the retinal anlage by a pinching-off process of neuroepithelium during the formation of embryonic eye. More recently, the presence of high levels of vanillylmandelic acid suggest a neural origin of the tumour.

[Is atherosclerosis a periodontally-induced disease?]. / L'athérosclérose est-elle une maladie gingivo-induite?

Traditional risk factors do not explain all of cases of ischemic cardiovascular disease. The literature now identifies periodontal disease, a chronic oral infection, as a potential risk factor of atherosclerosis. Three plausible biologic pathways have been proposed to explain this link: a direct action of periodontal bacteria migrating by bacteriemia, an indirect action by inflammation, mediators an immunopathogenic pathway related to heat shock proteins. Clinical studies show an increase in the CRP or recirculating specific immunoglobulins in presence of advanced periodontal disease. Other interventional studies show a reduction in cardiovascular risk factors when intensive periodontal therapy is used in patients with advanced periodontal disease. Literature therefore confirms a modest link between periodontal and cardiovascular diseases even if causality is not confirmed so far.

Impact of supportive periodontal therapy and implant surface roughness on implant outcome in patients with a history of periodontitis.

OBJECTIVE: This review searched for a relationship between susceptibility to periodontitis and peri-implantitis, with implant outcome as the primary outcome variable and supportive periodontal therapy (SPT) and implant surface roughness as confounding factors. MATERIAL AND METHODS: It is based on a MEDLINE search up to June 2006. Only 16 fulfilled the selection criteria. The heterogeneity of the studies (e.g. periodontal status, SPT, prosthetic design, ...) rendered a meta-analysis impossible. The impact of a history of periodontitis on early implant loss was negligible. Only five papers reported sub-data for patients with different degrees of periodontitis. Four out of five papers indicate a higher incidence of late implant loss and/or marginal bone loss in patients with a history of periodontitis. This difference was most obvious for very rough implants (three papers), and/or when SPT was not organized (one paper). Other confounding factors were often neglected. Another 10 papers only reported the outcome of implants in patients with a history of periodontitis. In case of SPT and when avoiding roughened surfaces, late implant loss remained below 3%, and marginal bone loss remained low. CONCLUSIONS: These results seem to indicate that periodontally compromised patients can be successfully treated with minimally/moderately rough implants, in the presence of SPT.

Multidisciplinary approach in the treatment of a patient with cleft lip and palate: a case report.

Treatment of the patient with cleft lip and palate represents a real problem from both functional and esthetic points of view. Today a functional result is not enough. An esthetic result is both necessary and possible to improve the quality of life. The direct placement of an implant in the grafted alveolar cleft is not the ideal choice. Using a rational, multidisciplinary approach, it is possible to obtain esthetic results in these patients. In our case study, a 17-year-old patient previously treated for a unilateral cleft lip and palate and agenesis of the right lateral incisor was given an osseointegrated implant. Computer-assisted dental design (Procera CAD/CAM software, Nobel Biocare AB, Gothenburg, Sweden) was used for the prosthetic rehabilitation, and the end of growth was determined prior to placing the implant. No sign of failure or mobility after loading has been detected at the time of this writing, 8 months after the procedure's completion, and the esthetic result is considered satisfactory by the patient and practitioners.

Rehabilitation of a patient with cleft lip and palate with an extremely edentulous atrophied posterior maxilla using zygomatic implants: case report.

OBJECTIVE: This case report describes the clinical and surgical management of a patient with a unilateral alveolar cleft and associated extremely atrophied totally edentulous maxilla. METHOD: Two zygomatic implants and four endosseous oral implants were placed under general anesthesia in a compromised maxilla to rehabilitate a 33-year-old patient with cleft lip and palate. The two specially designed zygomatic implants were utilized to avoid the need for bone grafting in the patient. The final prosthetic rehabilitation was an esthetic and functional maxillary overdenture prosthesis supported by implants. RESULTS: Preliminary results have shown how dental prostheses supported by endosseous implants in grafted alveolar cleft are a reliable possibility in the dental rehabilitation of this malformation. CONCLUSION: The use of zygomatic implants may be considered a reliable alternative to more resource-demanding techniques such as bone grafting in patients with cleft palate.

Clinical outcome of 103 consecutive zygomatic implants: a 6-48 months follow-up study.

The purpose of this study was to evaluate retrospectively, after a period of 6-48 months follow-up of prosthetic loading, the survival rate of 103 zygomatic implants inserted in 55 totally edentulous severely resorbed upper jaws. Fifty-five consecutive patients, 41 females and 14 males, with severe maxillary bone resorption were rehabilitated by means of a fixed prosthesis supported by either 1 or 2 zygomatic implants, and 2-6 maxillary implants. This retrospective study calculated the success and survival rates at both the prosthetic and implant levels. Out of 55 prostheses, 52 were screwed on top of the implants, while 3 were modified due to loss of standard additional implants and transformed in semimovable prosthesis. Although osseointegration in the zygomatic region is difficult to evaluate, no zygomatic implant was considered fibrously encapsulated and they are still in function. This study confirms that zygoma bone can offer a predictable anchorage and support function for a fixed prosthesis in severely resorbed maxillae.