Clinical practice guideline of the Spanish society of oral surgery for dental care in patients with oral cancer / Guía de práctica clínica de la sociedad española de cirugía bucal para el cuidado dental en pacientes con cáncer oral

Background: Oral cancer is the sixteenth most common malignant neoplasm worldwide, with a high mortalityrate, greater than 50% at five years, and high morbidity. The effect of oncological treatment in the oral cavity isbroad and has multiple levels, therefore knowing these effects and preventing them is essential for avoiding anincrease in the oral pathology related with oncological therapy, maintaining the quality of life of the patient, andimproving the efficacy of the treatment itself.Material and Methods: A group of experts belonging to the fields of Dentistry, Maxillofacial Surgery and Oncol-ogy of the University of Seville and the Virgen del Rocío University Hospital of Seville in collaboration with theUniversity of Valencia, University of Barcelona, and University of the Basque Country, developed this ClinicalPractice Guideline for the proper clinical management of patients diagnosed with oral cancer. The clinical ques-tions were formulated in PICO format. The databases consulted were Medline/PubMed and Embase/Elsevier. Thesystematic reviews published on the topic were identified on Tripdatabase, Cochrane Library and CRD (Centre forReviews and Dissemination). The recommendations were prepared based on the GRADE methodology.Results: Various recommendations were defined, derived from the 21 PICO questions, referring to prevention,treatment and care for alterations arising from the pathology of oral cancer itself and its treatment.Conclusions: The preparation of this clinical practice guideline allows recommendations to be generated basedon the scientific evidence available, on dentistry actions in patients with oral cancer and undergoing oncologicaltreatment, which may be of use to the multidisciplinary team treating this type of patient.(AU)

A Systematic Review and Meta-Analysis of Systemic and Local Antibiotic Therapy in the Surgical Treatment of Peri-Implantitis.

(1) Background: Given the existing controversy regarding the use of antibiotics in the treatment of peri-implantitis, this systematic review and meta-analysis aim to ascertain how beneficial the role of systemic and local antibiotics is in peri-implant surgical therapy, considering the harmful effects that they represent and the abuse of antibiotics in terms of global health. (2) Methods: To determine the therapeutic efficacy of the administration of antibiotics in the surgical treatment of peri-implantitis in terms of probing pocket depth (PPD) and bleeding on probing (BoP), electronic and manual bibliographic searches were carried out in the Embase and PubMed databases, collecting data that related to before and after treatment. (3) Results: The adjunctive use of local antibiotics provides significant improvements in PPD (MD = 1.29; 95% CI: 0.56 to 2.02; p ≤ 0.0006; I2 = 0%) when compared with surgical treatment alone. No significant differences were found in the other subgroup; that is, the use of systemic antibiotics did not significantly improve PPD changes in the surgical treatment of peri-implantitis (MD = 0.40; 95% CI: -0.15 to 0.95; p = 0.15; I2 = 0). (4) Conclusions: The use of local antibiotics in the surgical treatment of peri-implantitis seems to offer treatment improvements in terms of PPD and BoP, unlike that observed with the use of systemic antibiotics. However, these results should be taken with caution as they also depend on the type of surgical technique used, whether regenerative or resective. More research is needed on this topic to understand the role of local and systemic antibiotics in the treatment of peri-implantitis.

Uterine necrosis following hemostatic compression suture: case report and review of the literature / Necrosis uterina tras sutura de compresión hemostática: reporte de caso y revisión de la literatura

Objectives: To present a case of uterine necrosis following hemostatic suturing to control postpartum bleeding, and to review the literature in order to identify the suture techniques employed, clinical findings, diagnostics and treatment in the clinical cases described. Material and methods: A 34-year-old woman presenting with abdominal pain eight days after cesarean delivery due to placenta previa who required B-Lynch compression suture due to uterine atony, and who was diagnosed with uterine necrosis. The patient underwent total abdominal hysterectomy with a satisfactory recovery. A systematic literature search was conducted in the Medline vía Pubmed, Embase and Web of Science databases. The search included case series and reports, and cohorts of women with uterine necrosis following the use of uterine compression sutures for postpartum bleeding. The analysis included sociodemographic and clinical variables at the time of diagnosis, suturing technique, diagnostic tests and treatment. Results: Overall, 23 studies with 24 patients were included. Of all necrosis cases, 83% occurred following cesarean section. B-Lynch was the suturing technique most frequently used (66 %), followed by the Cho suture (25 %). The most frequent symptoms were fever and abdominal pain. The most commonly used diagnostic test was computed tomography (9/24 cases). Hysterectomy was performed in the majority of cases (75 %). Conclusions: Although rare, uterine wall necrosis is a serious complication. It would be advisable to design follow-up cohort studies of women undergoing these procedures in order to determine the incidence of associated complications.

Objetivos: presentar un caso de necrosis uterina tras técnica de sutura hemostática por hemorragia posparto y hacer una revisión de la literatura para determinar la técnica de sutura utilizada, los hallazgos clínicos, la técnica diagnóstica y el tratamiento realizado en los casos clínicos descritos. Materiales y métodos: se presenta el caso de una mujer de 34 años que consultó por dolor abdominal al octavo día tras cesárea por placenta previa, que precisó sutura de B-Lynch por atonía uterina y cuyo diagnóstico fue necrosis uterina. La paciente requirió histerectomía abdominal total, con evolución satisfactoria. Se realizó una búsqueda sistemática de la literatura en las bases de datos Medline vía Pubmed, Embase y Web of Science. Se buscaron series y reportes de casos y cohortes de mujeres con necrosis uterina posterior al uso de suturas de compresión uterina para control de hemorragia posparto. Se analizaron variables sociodemográficas y clínicas al diagnóstico, técnica de sutura, pruebas diagnósticas y tratamiento. Resultados: se incluyeron 23 estudios con 24 pacientes. El 83 % de las necrosis ocurrieron tras cesárea. La técnica más utilizada fue B-Lynch (66 %), seguida de Cho (25 %). Los síntomas más frecuentes fueron fiebre y dolor abdominal. La prueba diagnóstica más utilizada fue la tomografía computarizada (9 de 24 casos). En la mayoría de casos se realizó histerectomía (75 %). Conclusiones: la necrosis de la pared uterina es una complicación infrecuente pero grave. Sería recomendable el diseño de cohortes de seguimiento de mujeres sometidas a estos procedimientos para determinar la incidencia de complicaciones asociadas.

Efficacy of different surgical techniques for peri-implant tissue preservation in immediate implant placement: a systematic review and meta-analysis.

INTRODUCTION: Preserving peri-implant tissues after immediate implant placement (IIP), especially in aesthetic zones, is a topic of interest. OBJECTIVES: This systematic review investigated the effects of currently available surgical procedures for preserving peri-implant tissue or ensuring dimensional stability following immediate implant placement. MATERIALS AND METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement's guidelines were followed, and articles were sought on the PubMed and Cochrane databases with no date restrictions. Only randomised clinical trials that evaluated changes in soft and hard tissues around immediately placed implants were included. Statistical analyses were performed, and the studies´ quality was assessed using the Cochrane Collaboration tool. The agreement between reviewers was assessed based on Cohen's kappa statistics. RESULTS: Of the 14 studies that met the inclusion criteria, 11 were analysed in the meta-analysis (kappa = 0.814; almost perfect agreement). The use of connective tissue grafts resulted in a significantly greater improvement of the facial gingival level (MD = -0.51; 95% CI: -0.76 to -0.31; p = < .001), and the placement of bone grafts significantly reduced the horizontal resorption of the buccal bone (MD = -0.59; 95% CI: -0.78 to -0.39; p < .001). CONCLUSION: Connective tissue grafts and bone grafts positively influence tissue preservation around immediately placed implants. Neither the flapless technique nor palatal implant positioning resulted in significant improvements to any of the investigated parameters. Additional longitudinal studies are required. CLINICAL RELEVANCE: This meta-analysis is useful for discerning the effects of soft tissue augmentation, bone grafting, the flapless technique, and palatal implant positioning on preserving peri-implant tissues after immediate implant placement.

Effect of Milking Maneuver in Preterm Infants: A Randomized Controlled Trial.

OBJECTIVE: To assess the short and medium-term effects of milking maneuver (MM) compared with early cord clamping for infants born before 37 weeks of pregnancy. MATERIAL AND METHODS: 138 infants between 24+0 and 36+6 weeks of gestation were allocated to MM or early cord clamping. Primary outcomes were the requirement of red blood cell transfusions or phototherapy. RESULTS: Initial hemoglobin was significantly higher in the MM group by 1.675 g/dL (p < 0.05) and initial hematocrit by 5.36% (p < 0.05), but no differences in the need of transfusion during the first 30 days after delivery were found (RR 0.8; 95% CI 0.22-2.85). Peak serum bilirubin was similar in both groups (11,097 ± 3.21 vs. 11,247 ± 3.56 mg/dL, p = 0.837). Phototherapy requirements were higher in the MM group (RR 1.62; 95% CI 1.1-2.38). No differences regarding the need of oral iron supplementation, platelet transfusion, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, meconium aspiration syndrome, use of surfactant, days of oxygen supplementation, need of vasopressors, length of stay in the neonatal intensive care unit, or postpartum hemorrhage were found. CONCLUSION: MM does not reduce the need for red blood cell transfusions and increases phototherapy requirements in preterm infants.

Síndrome de encefalopatía posterior reversible durante el puerperio / Posterior reversible encephalopathy and puerperium

El síndrome de encefalopatía posterior reversible se describió por primera vez en 1996 por Hinchey y cols. Puede presentarse durante la gestación y puerperio. Se expone un caso clínico y se revisa la evidencia para el diagnóstico, tratamiento y pronóstico de la encefalopatía posterior reversible. Se realizó una búsqueda electrónica en término de diagnóstico, tratamiento y pronóstico del síndrome de encefalopatía posterior reversible durante y fuera de la gestación. No se encontró ningún estudio analítico, únicamente se hallaron series de casos, lo que no aporta suficiente evidencia científica para establecer recomendaciones sólidas acerca de esta entidad. Poco se conoce acerca del síndrome de encefalopatía posterior reversible y de su comportamiento en la gestación por lo que es necesario acumular mayor evidencia respecto a este síndrome (AU)

Posterior reversible encephalopathy was introduced into clinical practice in 1996 by Hinchey and cols. Clinically can be expressed during pregnancy and postpartum. To review evidence available of diagnosis and treatment of posterior reversible encephalopathy we expose a clinical case and we carried out an electronic search in order to find the best evidence available in terms of diagnosis, treatment and prognosis of posterior reversible encephalopathy during and out of pregnancy. No analytical studies were found, only case reports. These results do not allow establishing recommendations. There is not enough information regard to Posterior reversible encephalopathy syndrome. It is mandatory to accumulate more information that allows us to comprehend and establish evidence about this entity (AU)