A new species of Caecilia Linnaeus, 1758 (Amphibia: Gymnophiona: Caeciliidae) from the Pacific lowlands of Colombia, with comments on the status of C. tenuissima Taylor, 1973.

We here describe a new species of the genus Caecilia from the Pacific lowlands of Colombia that was mistaken in previous literature as C. tenuissima, but which has more primary and secondary grooves than that species (among other differences). The description of Caecilia wilkinsoni sp. nov. restricts the known distribution of C. tenuissima to Guayaquil, Ecuador, re-establishing its status as an endemic species. We comment on the type locality of C. tenuissima, the current condition of its holotype, and on the distributions of the Caecilia that inhabit the Pacific region of Colombia.

A new Bolitoglossa (Amphibia, Caudata, Plethodontidae) from the Cordillera Oriental of Colombia.

A new salamander species of the genus Bolitoglossa is here described from the cloud forests of the western slopes of the Cordillera Oriental of Colombia, in the Cundinamarca department. The most salient characters of this new species are its numerous maxillary and vomerine teeth, its moderate webbing on hands and feet, its short and robust tail, and its chromatic variation. Based on molecular analyses this new species is assigned to the adspersa species group and its status established as the sister species of B.adspersa, with which it was previously confused. Lastly, the distribution, natural history, and conservation status of the new species are discussed.

ResumenDescribimos una nueva especie de salamandra del género Bolitoglossa proveniente de los bosques nublados de la vertiente occidental de la Cordillera Oriental de Colombia, en el departamento de Cundinamarca. Los caracteres más sobresalientes de esta nueva especie son sus numerosos dientes maxilares y vomerinos, su palmeadura moderada en pies y manos, su cola corta pero robusta, y su variación cromática. Basados en análisis moleculares asignamos esta nueva especie al grupo de especies adspersa y establecemos su estatus como especie hermana de B.adspersa, con la cual era previamente confundida. Finalmente, discutimos algunos aspectos de su distribución, historia natural y su estado de conservación.

On the identities of Caecilia degenerata Dunn, 1942 and of C. corpulenta Taylor, 1968 (Amphibia: Gymnophiona: Caeciliidae) with descriptions of three new species of Caecilia Linnaeus, 1758 from the Cordillera Oriental of Colombia.

The Central portion of the Cordillera Oriental of Colombia is currently reported to harbor two species of Caecilia distributed at comparable elevations on opposite versants of these Mountains. These are C. corpulenta, known from Virolín, Santander, at 1700-2000 m on the western slopes of the Cordillera Oriental and C. degenerata, known from Garagoa, Boyacá, and Choachí and Fomequé, Cundinamarca, at 1800-2100 m on the eastern slopes of the Cordillera Oriental. Both species have dermal scales and lack secondary grooves, and have been subjected to misidentifications by herpetologists studying the Gymnophiona of the Eastern Andes of Colombia. Our results indicate that only the latter species is found in Colombia and the former is restricted to Peru, leaving those populations previously referred to C. corpulenta and those distinct from C. degenerata pending names. We here present an account for C. degenerata based on material from Choachí and Fómeque, Cundinamarca, as well as descriptions of three new species from the Cordillera Oriental and adjacent Venezuela: C. atelolepis sp. nov., C. epicrionopsoides sp. nov., and C. macrodonta sp. nov. We also provide additional morphological information for the recently described C. pulchraserrana.

Restauraciones indirectas para el manejo de la Hipomineralización de Molares e Incisivos: un abordaje conservador / Restaurações indiretas para o tratamento da hipomineralização de molares e incisivos: uma abordagem conservadora / Indirect restorations for the management of hypomineralization of molars and incisors: a conservative approach

Introducción: Técnicas adhesivas contemporáneas permiten la rehabilitación conservadora y estética de dientes afectados por caries dental, trauma dentoalveolar y defectos del desarrollo del esmalte. Para el tratamiento restaurador de la hipomineralización de molares e incisivos (HMI) se ha recomendado el uso de restauraciones indirectas. Reporte de caso: Paciente sintomático de sexo femenino, 8 años, portadora de HMI severa y comportamiento levemente negativo. Los dientes 16, 36 y 46 presentaban opacidades demarcadas asociadas a dolor provocado. El tratamiento se enfocó en educar a la familia con respecto a la HMI, orientar el comportamiento, controlar la sintomatología y restaurar la función y estética de los dientes afectados por la HMI. Debido a la extensión, severidad y localización de los defectos en los dientes 16, 36 y 46, se optó por realizar restauraciones indirectas con resina compuesta. Luego de 12 meses la paciente presentaba comportamiento definitivamente positivo, no relataba sintomatología dolorosa, las restauraciones estaban sin cambio de color, bien adaptadas, con buena salud gingival y con adecuada anatomía oclusal, lisas y sin signos de lesiones de caries dental. Conclusión: En este caso de HMI severa, la restauración con resina indirecta fue una estrategia estética, conservadora, viable y efectiva durante un periodo de seguimiento de 12 meses.

Introdução: As técnicas adesivas atuais permitem a reabilitação conservadora e estética de dentes acometidos por cáries, traumas dentoalveolares e defeitos de desenvolvimento do esmalte. Para o tratamento restaurador da hipomineralização de molares e incisivos (HMI), o uso de restaurações indiretas tem sido recomendado. Relato de caso: Paciente do sexo feminino, sintomática, 8 anos, com HMI severa e comportamento levemente negativo. Os dentes 16, 36 e 46 apresentaram opacidades acentuadas associadas à dor provocada. O tratamento teve como foco a educação da família sobre a HMI, orientando o comportamento, controlando os sintomas e restaurando a função e a estética dos dentes afetados pela HMI. Devido à extensão, severidade e localização dos defeitos nos dentes 16, 36 e 46, optou-se pela realização de restaurações indiretas com resina composta. Após 12 meses, a paciente apresentou um comportamento definitivamente positivo, não relatou sintomatologia dolorosa, as restaurações estavam sem alteração de cor, bem adaptadas, com boa saúde gengival e anatomia oclusal adequada, lisas e sem sinais de lesões de cárie. Conclusão: Neste caso de MHI severa, a restauração indireta em resina foi uma estratégia estética, conservadora, viável e eficaz com um período de acompanhamento de 12 meses.

Introduction: Contemporary adhesive techniques allow the conservative and aesthetic rehabilitation of teeth affected by dental caries, dentoalveolar trauma, and enamel development defects. For the restorative treatment of hypomineralization of molars and incisors (HMI), indirect restorations have been recommended. Case report: Symptomatic female patient, 8 years old, with severe HMI and slightly negative behavior. Teeth 16, 36, and 46 presented marked opacities associated with provoked pain. The treatment focused on educating the family regarding the HMI, guiding behavior, controlling the symptoms, and restoring the function and aesthetics of the teeth affected by the HMI. Due to the extension, severity, and location of the defects in teeth 16, 36, and 46, it was decided to perform indirect restorations with composite resin. After 12 months, the patient presented definitively positive behavior, and did not report painful symptoms, the restorations were without color change, well adapted, with good gingival health and adequate occlusal anatomy, smooth and without signs of dental caries lesions. Conclusion: In this case of severe MHI, indirect resin restoration was an esthetic, conservative, viable, and effective strategy during a 12-month follow-up period

Microabrasión e infiltración como alternativa de tratamiento para Fluorosis Dental severa: reporte de caso / Microabrasão e infiltração como tratamento alternativo para Fluorose Dentária severa: relato de caso / Microabrasion and resin infiltration for treatment of severe Dental Fluorosis: a case report

Resumen La Fluorosis Dental (FD) es un defecto del desarrollo del esmalte tipo hipomineralización atribuido a la exposición crónica y excesiva de fluoruro durante el período de amelogénesis. Clínicamente, en los casos más leves se pueden observar finas líneas blancas y opacas, mientras que en casos moderados y severos las líneas se pueden fundir y formar bandas más gruesas comprometiendo toda la superficie del diente pudiendo estar asociadas con pérdidas de estructura y cambios de color. El tratamiento de la FD puede incluir desde microabrasión, infiltración, aclaramiento y restauraciones con resina compuesta hasta carillas y coronas. El objetivo de este caso clínico fue asociar la técnica de microabrasión e infiltración como alterantiva de tratamiento estético para el manejo de la FD. Paciente de sexo femenino y 9 años que presentaba opacidades blancas en forma de bandas gruesas y pérdidas de estructura dental en los incisivos superiores permanentes (FD severa). Para el tratamiento se optó por realizar microabrasión con ácido clorhídrico, seguido de infiltración con resina de baja viscosidad, logrando un resultado estético favorable y estable a tres meses. Se concluye que la combinación de estas dos técnicas micro-invasivas es una estrategia viable y efectiva para enmascarar efectivamente opacidades producidas por la FD.

Resumo A Fluorose Dentária (FD) é um defeito de desenvolvimento do esmalte do tipo hipomineralização atribuído à exposição crônica e excessiva de fluoreto durante a amelogênese. Clinicamente, os casos leves apresentam finas linhas brancas que acompanham a formação dentária, enquanto casos moderados ou severos apresentam faixas brancas mais amplas acometendo toda a superfície e podem estar associados à perdas estruturais e pigmentações. O tratamento da FD inclui desde microabrasão, infiltração e aclaramento até restaurações com resina composta, facetas e coroas. O objetivo deste caso clínico foi associar as técnicas de microabrasão e infiltração como alternativa de tratamento estético para a abordagem da FD. Paciente do sexo feminino de 9 anos que apresentava nos incisivos superiores permanentes áreas brancas opacas e perda de estrutura (FD severa). Para o tratamento, optou-se por realizar microabrasão com ácido clorídrico, seguido de infiltração com uma resina de baixa viscosidade, atingindo um resultado estético e favorável. Conclui-se que a combinação da microabrasão e da infiltração é uma estratégia viável e efetiva para mascar efetivamente opacidades produzidas pela FD.

Abstract Dental Fluorosis (DF) is a developmental defect of the enamel type hypomineralization attributed to chronic and excessive fluoride exposure during the period of amelogenesis. Clinically, in the mildest cases fine white and opaque lines can be observed, while in moderate and severe cases the lines can melt and form thicker bands, compromising the entire tooth surface, which may be associated with loss of structure and color changes. Treatment of DF can range from microabrasion, infiltration, dental whitening, and composite resin restorations to veneers and crowns. The objective of this clinical case was to associate the microabrasion and infiltration technique as an alternative to aesthetic treatment for the management of dental fluorosis. A 9-year-old female patient presented white opacities in the form of thick bands and loss of tooth structure in the permanent upper incisors (severe dental fluorosis). For the treatment, it was decided to perform microabrasion with hydrochloric acid, followed by infiltration with low viscosity resin, achieving a favorable and stable aesthetic result after three months. It is concluded that the combination of these two micro-invasive techniques is a viable and effective strategy to effectively mask opacities produced by DF.

Consideraciones diagnósticas para la exodoncia de primeros molares permanentes severamente afectados por la Hipomineralización de Molares e Incisivos / Considerações diagnósticas para a exodontia de primeiros molares permanentes severamente afetados pela Hipomineralização de Molares e Incisivos / Diagnostic considerations for extraction of first permanent molars severely affected by Molar-Incisor Hypomineralization

Resumen La Hipomineralización de Molares e Incisivos (HMI) es un defecto de desarrollo del esmalte de origen multifactorial que afecta de uno a cuatro primeros molares permanentes y frecuentemente está asociada con incisivos permanentes. Clínicamente se caracteriza por presentar opacidades demarcadas de color blanco-crema y/o amarillo-café. En casos severos puede haber dolor, fracturas posteruptivas, lesiones de caries dental y/o restauraciones atípicas. Entre las opciones de tratamiento se encuentran restauraciones temporales con cemento de ionómero de vidrio, restauraciones en resina compuesta, coronas, restauraciones indirectas y exodoncia. El objetivo de este caso es analizar las consideraciones diagnósticas de la exodoncia de primeros molares permanentes severamente afectados por la HMI. Paciente de sexo femenino, 9 años de edad, patrón esquelético Clase I, maloclusión Clase I bilateral e HMI severa. Para el tratamiento se optó por realizar la exodoncia de los cuatro primeros molares permanentes bajo anestesia general. Luego de 10 meses, se observa que los segundos molares permanentes están clínicamente sanos y presentan inclinaciones y posiciones favorables para el cierre espontáneo del espacio. Se concluye que la exodoncia de primeros molares permanentes severamente afectados por la HMI es una estrategia que mejora el pronóstico del paciente y para realizarla, se requiere trabajar en conjunto con el ortodoncista para diagnosticar y planear individualmente cada caso.

Resumo A Hipomineralização de Molares e Incisivos (HMI) é um defeito de desenvolvimento do esmalte, de origem multifatorial que afecta de um a quatro primeiros molares permanentes e frequentemente está associada aos incisivos permanentes. Clinicamente se caracteriza como opacidades demarcadas de coloração branco-creme e/ou amarelo-café. Em casos severos pode haver dor, fraturas pós-irruptivas, lesões de cárie dentária e restaurações atípicas. Dentre as opções de tratamento estão as restaurações temporárias com cimento de ionômero de vidro, restaurações em resina composta, coroas, restaurações indiretas e a exodontia. Esta última opção permite que o segundo molar permanente se reposicione espontaneamente desde que realizada a tempo, portanto, é considerada uma alternativa viável e custo-efetiva. O objetivo deste caso foi analisar as considerações diagnósticas de exodontia de primeiros molares permanentes severamente afetados pela HMI. Paciente do sexo feminino, 9 anos de idade, padrão esquelético Classe I, maloclusão Classe I bilateral e HMI severa. Para o tratamento, optou-se por realizar a exodontia dos quatro primeiros molares permanentes sob anestesia geral. Após 10 meses, se observa que os segundos molares permanentes estão clinicamente saudáveis e apresentam inclinações e posicionamentos favoráveis para o fechamento espontâneo do espaço. Conclui-se que a exodontia de primeiros molares permanentes melhora o prognóstico do paciente e para realizá-la requer um trabalho em conjunto com o ortodontista para diagnosticas e planejar individualmente cada caso.

Abstract Molar and Incisor Hypomineralization (MIH) is an enamel development defect of multifactorial origin that affects one-to-four permanent first molars and is frequently associated with permanent incisors. Clinically it is characterized by demarcated white-cream and/ or yellow-brown opacities. In severe cases, there may be tooth pain, posteruptive fractures, dental caries lesions, and/ or atypical restorations. Treatment options include temporary restorations with glass ionomer cement, restorations with composite resin, crowns, indirect restorations, and tooth extraction. When extractions are performed at the right time, it allows the spontaneous replacement of the second permanent molar, therefore, it is considered a viable and cost/effective treatment. The objective of this case report is to analyze the diagnostic considerations for the extraction of first permanent molars severely affected by MIH. Female patient, 9 years old, Class I skeletal pattern, Class I malocclusion, and severe MIH. For the treatment, it was decided to perform the extraction of the first four permanent molars under general anesthesia. After 10 months, it is observed that the second permanent molars are clinically healthy and have favorable inclinations and positions for spontaneous closure of the space. It is concluded that the extraction of first permanent molars severely affected by MIH is a strategy that improves the patient's prognosis and to carry out, it is necessary to work together with the orthodontist to diagnose and plan each case individually.

Uso de Biodentine para restaurar un molar permanente severamente afectado por la Hipomineralización de Molares e Incisivos / Use of Biodentine to restore a affected permanent molar severely by Molar-Incisor Hypomineralization / Uso de Biodentine para restaurar um molar permanente severamente afetado pela Hipomineralização de Molares e Incisivos

Resumen La Hipomineralización de Molares e Incisivos (HMI) es un defecto cualitativo del desarrollo del esmalte que afecta de uno a cuatro primeros molares permanentes, pudiendo estar asociado con los incisivos permanentes. Se estima que la prevalencia mundial es del 14.2%, siendo América del Sur la región con mayor prevalencia (18%). Clínicamente, los dientes afectados por la HMI presentan esmalte poroso y blando, acúmulo de biopelícula, lesiones de caries dental e hipersensibilidad. Los cambios estructurales y químicos pueden afectar los procedimientos restauradores. El objetivo del caso fue reportar el uso de un material bioactivo para la restauración de un primer molar permanente severamente afectado por la HMI. Paciente femenino de 7 años de edad que presenta en el diente 36 una lesión de caries activa cavitada, hipomineralización severa con fractura posteruptiva y exposición de dentina e hipersensibilidad. Luego de realizar la remoción selectiva del tejido cariado, se puso un substituto bioactivo de dentina a base de silicato tricálcico (Biodentine). Un mes después, el diente se restauró definitivamente con resina compuesta. Al seguimiento clínico de 12 meses la restauración presenta adecuada adaptación marginal, forma anatómica adecuada y sin evidencia de lesión de caries dental secundaria. Radiográficamente se observa adecuada adaptación de la restauración y sin cambios en el espacio del ligamento periodontal y región periapical. El uso de materiales bioactivos muestra ser una alternativa promisoria para la restauración de molares severamente afectados por la HMI.

Abstract Molar Incisor Hypomineralization (MIH) is a qualitative defect in the development of dental enamel that affects one to four first permanent molars and it might be associated with permanent incisors. Worldwide prevalence is estimated around 14.2%, being the highest in South America (18%). Clinical signs include porous and soft enamel, excessive biofilm formation, dental caries and hypersensitivity. Structural and chemical changes may affect restorative procedures. The objective of this case report was to describe the use of a bioactive restorative material on a severely-affected first permanent molar. A 7-year-old female patient presented with active dental caries lesion, severe hypomineralization with post-eruptive fracture, dentine exposure and hypersensitivity in tooth 36. After selective removal of carious tissue, a bioactive dentine substitute containing tricalcium silicate (Biodentine) was placed. One month later, the tooth was restored using resin composite. A follow-up exami- nation at 12 months showed good marginal adaptation, proper anatomical shape and no evidence of secondary caries. Radiographical examination showed correct adaptation of the restoration and normal space of the periodontal ligament and the periapical region. The use of bioactive materials seems to be a promising alternative for restoration of molars severely affected by MIH.

Resumo A Hipomineralização de Molares e Incisivos (HMI) é um defeito qualitativo do desenvolvimento do esmalte que afeta de um a quatro primeiros molares permanentes, podendo estar ou não associado aos incisivos permanentes. Estima-se que a prevalência mundial é de 14,2%, sendo a América do Sul a região com a maior prevalência (18%). Clinicamente, os dentes afetados pela HMI apresentam esmalte poroso e macio, acúmulo de biofilme, lesões de cárie dentária e hipersensibilidade. As alterações estruturais e químicas podem afetar os procedimentos restauradores. O objetivo deste caso foi reportar o uso de um material bioativo para a restauração de um primeiro molar permanente severamente afetado pela HMI. Paciente do sexo feminino de 7 anos de idade apresentava no dente 36 uma lesão de cárie cavitada e ativa, hipomineralização severa com fratura pós-irruptiva, com exposição de dentina e hipersensibilidade. Após a remoção seletiva do tecido cariado, colocou-se um substituto bioativo de dentina a base de silicato de cálcio (Biodentine). Um mês depois, o dente foi restaurado definitivamente com resina composta. No acompanhamento clínico de 12 meses, a restauração apresentava adaptação marginal e for- ma anatômica adequada e sem evidência de lesão de cárie secundária. Radiograficamente, observou-se adequada adaptação da restauração e sem alterações no espaço do ligamento periodontal e região periapical. O uso de materiais bioativos demonstram ser uma alternativa promissora para a restauração de molares severamente afetados pela HMI.

Rehabilitación de incisivos deciduos con pernos en fibra de vidrio y resina compuesta: reporte de caso / Rehabilitation of deciduous incisors using glass fiber core post and composite resin: case report / Reabilitação de incisivos decíduos com pinos em fibra de vidro e resina composta: relato de caso

Resumen La caries de la infancia temprana hace referencia a la presencia de una o más superficies cariadas, perdidas o restauradas en dientes deciduos en niños menores de 6 años de edad, siendo clasificada como severa cuando afecta a niños menores de 3 años. En dientes deciduos con gran destrucción coronal por caries dental, pero con integridad radicular, la rehabilitación puede ser compleja debido a la calidad y cantidad de estructura remanente. El objetivo de este caso, fue reportar la rehabilitación de cuatro incisivos deciduos severamente afectados por caries dental de la infancia temprana utilizando pernos en fibra de vidrio y restauraciones directas en resina compuesta. Paciente masculino de tres años de edad que presenta lesiones de caries dental activas y cavitadas y necrosis pul- par en los cuatro incisivos deciduos superiores. En la fase higiénica se realizaron actividades de educación, motivación en higiene y adecuación del medio bucal; en la fase restauradora se realizaron los tratamientos endodónticos, cementación de pernos en fibra de vidrio y restauraciones en resina compuesta con matrices anatómicas de celuloide y en la fase de mantenimiento se realizaron controles clínicos, radiográficos y actividades específicas de prevención. La rehabilitación con pernos de fibra de vidrio y resina compuesta logró reestablecer la forma, función y estética de los dientes del paciente.

Abstract The early childhood caries refers to the presence of one or more decayed, lost or restored surfaces in deciduous teeth in children under 6 years, being classified as severe when it affects children under 3 years of age. In deciduous teeth with several coronal destruction due to dental caries but with root integrity, rehabilitation can be complex due to the quality and/or quantity of the remaining structure. The aim of this case was to report the rehabilitation of four deciduous incisors severely affected by early childhood caries using fiberglass posts and direct restorations with composite resin. A three-year-old male patient with active and cavitated dental caries lesions and pulpal necrosis in the four upper deciduous incisors. In the hygienic phase, activities in education and motivation in oral hygiene were carried out; in the corrective phase, endodontic treatments were performed, cementation of glass fiber posts and were made restorations with composite resin using anatomical celluloid matrices; in the maintenance phase, the patient received support and reinforcement of the recommendations in the diet and the oral hygiene. The rehabilitation using fiber posts and composite resin reestablished the shape, function and esthetics of the teeth of the patient.

Resumo A cárie da primeira infância referee a presença de uma ou mais superfícies cariadas, perdidas ou restauradas em dentes decíduos de crianças menores de 6 anos de idade, sendo classificada como severa quando afeta menores de 3 anos. Em dentes decíduos com extensa destruição coronária pela cárie dentária mas que apresentam integridade radicular, a reabilitação pode ser considerada complexa devido a qualidade e quantidade da estrutura remanescente. O objetivo deste caso foi reportar a reabilitação de quatro incisivos decíduos superiores severamente afetados pela cárie da primeira infância, utilizando pinos de fibra de viro e restaurações diretas em resina composta. Paciente do sexo masculino de 3 anos de idade apresentava lesões de cárie dentária ativas, cavitadas e com necrose pulpar nos quatro incisivos decíduos permanentes. Na fase de adequação do meio bucal, foi realizada a instrução e orientação de higiene oral; na fase restauradora foram realizados os tratamentos endodônticos, cimentação de pinos de fibra de vidro e restaurações em resina composta com matrizes anatômicas de celulose. Na fase de manutenção, foram realizados os controles clínicos, radiográficos e atividades específicas de prevenção. A reabilitação com pinos de fibra de vidro e resina composta foram capazes de reestabelecer a forma, função e estética dos dentes do paciente.

Farmacovigilancia de vacunas y su aplicación en Chile / Vaccine pharmacovigilance and its application in Chile

La inmunización se encuentra entre las intervenciones en salud pública más exitosas y costo efectivas de todas las épocas, siendo su beneficio tan importante como su seguridad. Las vacunas, como cualquier otro medicamento, pueden generar eventos adversos, los que deben ser monitorizados permanentemente por sistemas de vigilancia. Esta disciplina recibe el nombre de Farmacovigilancia de Vacunas (FVV), encargada de estudiar los Eventos Supuestamente Atribuidos a la Vacunación ó Inmunización (ESAVI). El objetivo de este trabajo es revisar la evolución del sistema de farmacovigilancia de vacunas en Chile. El sistema de FVV chileno se basa en la vigilancia pasiva, y contempla la notificación obligatoria al Instituto de Salud Pública (ISP) de todos los ESAVI detectados, por parte de profesionales de la salud, directores de establecimientos y titulares de registro sanitario, priorizando las notificaciones de ESAVI serios e incluyendo la monitorización de todas las vacunas usadas en el país, tanto las que se encuentran incorporadas al Programa Nacional de Inmunización (PNI), como las que se encuentran fuera de este. El sistema de FVV chileno se caracteriza por un trabajo colaborativo permanente entre el ISP y el PNI, y parte de sus desafíos incluyen generar capacidades y alianzas estratégicas con la academia para la realización de estudios post comercialización sobre seguridad de vacunas. Finalmente, es importante destacar que tanto el marco normativo promulgado el año 2010, como la elaboración de procedimientos, el trabajo permanente con el PNI, y la conformación de un comité de expertos de ESAVI, y las diferentes estrategias de retroalimentación, son medidas implementadas que han contribuido a mejorar la tasa de reporte nacional y el análisis de los casos.

Immunization is among the most successful and cost-effective public health interventions of all times, its benefits being as important as its safety. Vaccines, like any other medicine, can generate adverse events, which must be permanently monitored by surveillance systems. Vaccine Pharmacovigilance (VPV) is the discipline responsible for studying Adverse Events Following Immunization (AEFI). The objective of this article is to review the evolution of the pharmacovigilance system of vaccines in Chile. The Chilean VPV system is based on passive surveillance, and establishes the mandatory reporting of all AEFI detected by healthcare workers, directors of healthcare facilities, and Marketing Authorization holders, to the Public Health Institute of Chile (PHI), prioritizing the reporting of serious ESAVI and including the monitoring of all vaccines used in the country, both those that are incorporated into the National Immunization Program (NIP), and those that are outside of it. The Chilean VPV system is characterized by a permanent collaborative work between the PHI and the NIP, and its challenges include generating capacities and strategic alliances with the academy to carry out post-marketing studies on vaccine safety. Finally, it's important to point out that the regulatory framework promulgated in 2010, as well as the elaboration of procedures, the permanent work with the NIP, the formation of an AEFI expert committee, and the different feedback strategies implemented, have contributed in improving case analysis and the national reporting rate.

Síndrome de Bean y albinismo: reporte del primer caso en Ecuador / Bean Syndrome and Albinism: First Case Report in Ecuador

El síndrome de Blue Rubber Bleb Nevus (BRBNS) o su acrónimo Síndrome de Bean se caracteriza por malformaciones venosas (MV) distribuidas en múltiples zonas anatómicas, con predominio en piel y tracto gastrointestinal (GI). La sintomatología se manifesta comúnmente con episodios hemorrágicos y consecuente anemia crónica secundaria por défcit. Se presenta el caso clínico de una paciente albina de sexo femenino de 68 años de edad, quien acudió por dolor abdominal agudo más rectorragia crónica, al realizar el examen físico llama la atención la presencia de malformaciones venosas (MV) caracterizadas por nódulos azulados, compresibles y heterogéneos, localizados en labio inferior, mentón, región perianal y extremidades, además de dolor a la palpación en hipocondrio derecho. El análisis de laboratorio reveló valores de hemoglobina y hematocrito bajos y otros parámetros sugerentes de anemia por défcit de hierro, en el reporte de colonoscopia se lograron evidenciar múltiples malformaciones venosas (MV), diseminadas con predominio rectal, el diagnóstico fue compatible con Síndrome de Bean por la asociación de MV en piel y tracto Gastrointestinal, además de anemia crónica secundaria. El manejo fue clínico sintomático y quirúrgico paliativo, con una evolución favorable. La asociación de albinismo y el síndrome de Bean no están reportadas en la literatura médica internacional, considerándose este el primer caso en Ecuador como una patología no muy frecuente, pero con complicaciones secundarias importantes. Se debería incluir este síndrome como una causa de malformaciones venosas inocuas, sangrado digestivo, anemia crónica y efectos oclusivos de vísceras huecas.

Blue Rubber Bleb Nevus syndrome (BRBNS) or its acronym Bean syndrome is characterized by venous malformations (MV) distributed in multiple anatomical areas, predominantly in the skin and gastrointestinal (GI) tract. Symptomatology is commonly manifested with hemorrhagic episodes and consequent chronic secondary anemia due to defcit. We present the clinical case of a female albino patient of 68 years of age, who came for acute abdominal pain to this we add a chronic rectorrhagia, when performing the physical examination, the presence of venous malformations (MV) characterized by bluish, compressible and heterogeneous nodules, located in the lower lip, chin, perianal region and extremities, as well as pain on palpation in the right hypochondrium. The laboratory analysis revealed low hemoglobin and hematocrit values and other parameters suggestive of iron defciency anemia, in the colonoscopy report multiple venous malformations (MV) were disseminated, disseminated with rectal predominance, the diagnosis was compatible with Bean Syndrome by the association of MV in skin and Gastrointestinal tract and secondary chronic anemia. The management was clinical symptomatic and palliative surgery, with a favorable evolution. The association of albinism and Bean syndrome are not reported in the international medical literature, considering this the frst case in Ecuador as a not very frequent pathology but with important secondary complications, this syndrome should be included as a cause of harmless venous malformations, digestive bleeding, chronic anemia and occlusive effects of hollow viscera.

Increased C-reactive protein plasma levels are not involved in the onset of post-operative atrial fibrillation.

BACKGROUND: Increased inflammation biomarkers plasma levels, including C-reactive protein (CRP), have been associated with the initiation and perpetuation of atrial fibrillation (AF). However, it is not known whether an increased CRP plasma level, without concomitant inflammation, is sufficient to induce AF. We investigated whether higher CRP plasma levels, determined by the presence of +219G>A CRP gene polymorphism, is associated with an increased risk of post-operative AF. METHODS: One hundred and fifteen adult patients submitted to elective coronary surgery were genotyped for the CRP +219G>A polymorphism. CRP plasma levels were determined by enzyme-linked immunosorbent assay. RESULTS: CRP plasma levels before surgery were higher in GG than in GA+AA patients (3.4±3.1 vs. 1.7±1.8, p<0.015). Thirteen percent of the patients presented post-operative AF. Despite the positive correlation between the polymorphism and CRP levels, there was no significant difference in the occurrence of post-operative AF between the different genotypes. CONCLUSIONS: These results suggest that increased CRP plasma levels that are not associated with an inflammatory process are not sufficient to trigger AF after cardiac surgery.

Heat stress induces ferroptosis-like cell death in plants.

In plants, regulated cell death (RCD) plays critical roles during development and is essential for plant-specific responses to abiotic and biotic stresses. Ferroptosis is an iron-dependent, oxidative, nonapoptotic form of cell death recently described in animal cells. In animal cells, this process can be triggered by depletion of glutathione (GSH) and accumulation of lipid reactive oxygen species (ROS). We investigated whether a similar process could be relevant to cell death in plants. Remarkably, heat shock (HS)-induced RCD, but not reproductive or vascular development, was found to involve a ferroptosis-like cell death process. In root cells, HS triggered an iron-dependent cell death pathway that was characterized by depletion of GSH and ascorbic acid and accumulation of cytosolic and lipid ROS. These results suggest a physiological role for this lethal pathway in response to heat stress in Arabidopsis thaliana The similarity of ferroptosis in animal cells and ferroptosis-like death in plants suggests that oxidative, iron-dependent cell death programs may be evolutionarily ancient.

In vitro inhibition of incompatible pollen tubes in Nicotiana alata involves the uncoupling of the F-actin cytoskeleton and the endomembrane trafficking system.

In the S-RNase-based self-incompatibility system, subcellular events occurring in the apical region of incompatible pollen tubes during the pollen rejection process are poorly understood. F-actin dynamics and endomembrane trafficking are crucial for polar growth, which is temporally and spatially controlled in the tip region of pollen tubes. Thus, we developed a simple in vitro assay to study the changes in the F-actin cytoskeleton and the endomembrane system at the apical region of incompatible pollen tubes in Nicotiana alata. Growth but not germination of pollen tubes of S c10-, S70-, and S75-haplotypes was selectively inhibited by style extracts carrying the same haplotypes. Pollen F-actin cytoskeleton and endomembrane system, visualized by fluorescent markers, were normal during the initial 60 min of pollen culture in the presence of compatible and incompatible style extracts. Additional culture resulted in complete growth arrest and critical alterations in the integrity of the F-actin cytoskeleton and the endomembrane system of incompatible pollen tubes. The F-actin ring and the V-shaped zone disappeared from the apical region, while distorted F-actin cables and progressive formation of membrane aggregates evolved in the subapical region and the shank. The vacuolar network of incompatible pollen tubes invaded the tip region, but vacuolar membrane integrity remained mostly unaffected. The polar growth machinery of incompatible pollen tubes was uncoupled, as evidenced by the severe disruption of colocalization between the F-actin cytoskeleton and the endomembrane compartments. A model of pollen rejection integrating the main subcellular events occurring in incompatible pollen is discussed.

Abordaje odontopedátrico de un paciente con Displasia Ectodérmica / Tratamento odontológico de criança com Displasia Ectodérmica / Dental treatment for a pedatric patient with Ectodermal Dysplasia

a Displasia Ectodérmica hace parte un grupo de afecciones o síndromes, que tienen en común defectos en el desarrollo normal de dos o más tejidos derivados del ectodermo, en los cuales hay un desarrollo anormal de la piel, dientes, pelo, uñas o glándulas sudoríparas. Presenta oligodoncia, dientes en clavija y reabsorción de procesos alveolares, se le realizó un tratamiento integral odontológico, consiguiendo una estética, funcionalidad y adaptación excelente así como una considerable mejora de la autoestima.

Displasia Ectodérmica é parte de um grupo de condições ou síndromes, que têm em comum, defeitos comuns no desenvolvimento normal de dois ou mais tecidos derivados de ectoderma, podendo haver desenvolvimento anormal da pele, dentes, unhas e cabelo, glândulas sudoríparas. Este artigo descreve um caos de criança com 4 anos de idade com displasia do ectoderma, apresentando oligodontia, dentes conóides e reabsorção de processos alveolares. Foi realizado tratamento odontológico integral, alcançando resultado estético, funcionalidade e excelente adaptação, bem como uma melhoria significativa na auto-estima.

Ectodermal Dysplasias forms are a group of diseases or syndromes in which defects are common in the ordinary development of two or more tissues derived from ectoderm are common in which there is abnormal development of the skin, teeth, hair, nails and sweat glands may be observed. This article describes, the case of a 4 year old child with Ectodermal Dysplasia who presented oligodontia, peg teeth and resorption of alveolar processes. Comprehensive dental treatment was is exposed, To Whom Realized is an integrated dental treatment, Achieving aesthetics, excellent functionality and adaptation as well as a significant improvement in his self-esteem.

Manejo laparoscópico de miomatosis uterina en pacientes con Síndrome de Rokitansky: Reporte de un caso y revisión de la literatura / Laparoscopic management of uterine myomatosis in a patient with Rokitansky syndrome: Case report and review of the literature

Introducción: el síndrome de Mayer-Rokitansky-Küster-Hauser (SMRKH) es un espectro de anomalías de los conductos müllerianos caracterizado por la la ausencia congénita de útero y vagina en mujeres fenotípicamente normales, con cariotipo 46 XX, con un estado endocrino normal. Muchas de estas mujeres poseen remanentes uterinos. La presencia de miomas en dichos remanentes es un hallazgo de muy escasa ocurrencia por lo que se reporta el caso. Objetivo: describir la técnica quirúrgica laparoscópica y revisar el diagnóstico clínico y el diagnóstico diferencial. Materiales y métodos: se presenta el caso de una mujer con diagnóstico previo de síndrome de Mayer-Rokitansky-Küster-Hauser (SMRKH), quien consulta a la la Unidad de Endoscopia Ginecológica de la Clínica del Prado en Medellín, institución privada de tercer nivel de complejidad y que es centro de referencia para manejo laparoscópico de pacientes con dolor pélvico crónico del departamento de Antioquia, Colombia. La ecografía reporta una masa sólida de ocho centímetros en la pelvis. Durante la laparoscopia se encuentra un mioma en uno de los remanentes uterinos. Se realiza miomectomía y se resecan ambos remanentes por laparoscopia. Se realizó una búsqueda sistemática de la literatura a través de Medline en la página de Pubmed utilizando los siguientes términos: “Mayer-Rokitansky-Hauser una mujer con diagnóstico previo de síndrome de Syndrome”, “leiomyoma” y “laparoscopy”. Resultados: se encontraron 25 artículos en los últimos 20 años de los cuales 17 estaban relacionados con el tema de manera directa; de estos, 2 incluían el manejo con laparoscopia. Conclusiones: la presencia de leiomioma en un remanente uterino de una paciente con MRKH es poco frecuente. El caso aquí presentado es el segundo reportado en Colombia y el primero manejado por vía laparoscópica. En pacientes con síndrome de Mayer-Rokitansky-Küster-Hauser y masas pélvicas, la laparoscopia es una opción diagnóstica y terapéutica por considerar.

Introduction: The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a spectrum of müllerian duct anomalies characterized by the congenital absence of the uterus and vagina in phenotypically normal women with a 46 XX karyotype and normal endocrine status. Many of these women have uterine remnants. The presence of fibroids in those remnants is a very rare finding, hence this case report. Objective: To describe the laparoscopic surgical technique and review the clinical and differential diagnoses. Materials and methods: Female patient with a prior diagnosis of MRKH syndrome who presented to the Gynecological Endoscopy Unit at Clinica del Prado, a private, level 3 institution in Medellin, which is a referral center for the laparoscopic management of patients with chronic pelvic pain in the Department of Antioquia, Colombia. A solid, nine-centimeter pelvic mass was found on ultrasound. During laparoscopy, a leiomyoma was found in one of the uterine remnants. Laparoscopic myomectomy was performed and the two remnants were resected. A systematic review of the literature was conducted through Medline in the Pubmed site using the following terms: “Mayer-Rokitansky-Hauser Syndrome”, “leiomyoma” and laparoscopy. Results: In total, 25 articles of the past 20 years were found; of those, 17 were related directly to the topic, and 2 of these included laparoscopic management. Conclusions: The presence of leiomyoma in a uterine remnant in a patient with MRKH syndrome is infrequent. The case presented here is the second reported in Colombia and the first managed laparoscopically. In patients with the Mayer-Rokitansky-Küster-Hauser syndrome and pelvic masses, laparoscopy is a diagnostic and therapeutic option.

NnSR1, a class III non-S-RNase constitutively expressed in styles, is induced in roots and stems under phosphate deficiency in Nicotiana alata.

BACKGROUND AND AIMS: Non-S-ribonucleases (non-S-RNases) are class III T2 RNases constitutively expressed in styles of species with S-RNase-based self-incompatibility. So far, no function has been attributed to these RNases. The aim of this work is to examine if NnSR1, a non-S-RNase from Nicotiana alata, is induced under conditions of phosphate (Pi) deprivation. The hypothesis is that under Pi-limited conditions, non-S-RNase functions may resemble the role of S-like RNases. To date, the only RNases reported to be induced by Pi deficiency are class I and class II S-like RNases, which are phylogenetically different from the class III clade of RNases. METHODS: Gene and protein expression of NnSR1 were assayed in plants grown hydroponically with and without Pi, by combining RT-PCR, immunoblot and enzymatic activity approaches. KEY RESULTS: NnSR1 transcripts were detected in roots 7 d after Pi deprivation and remained stable for several days. Transcript expression was correlated based on Pi availability in the culture medium. Antiserum against a peptide based on a hypervariable domain of NnSR1 recognized NnSR1 in roots and stems but not leaves exposed to Pi shortage. NnSR1 was not detected in culture medium and was pelleted with the microsomal fraction, suggesting that it was membrane-associated or included in large compartments. The anti-NnSR1 inhibited selectively the enzymatic activity of a 31-kDa RNase indicating that NnSR1 was induced in an enzymatically active form. CONCLUSIONS: The induction of NnSR1 indicates that there is a general recruitment of all classes of T2 RNases in response to Pi shortage. NnSR1 appears to have regained ancestral functions of class III RNases related to strategies to cope with Pi limitation and also possibly with other environmental challenges. This constitutes the first report for a specific function of class III RNases other than S-RNases.

Early F-actin disorganization may be signaling vacuole disruption in incompatible pollen tubes of Nicotiana alata.

Self-incompatibility (SI) systems appeared early in plant evolution as an effective mechanism to promote outcrossing and avoid inbreeding depression. These systems prevent self-fertilization by the recognition and rejection of self-pollen and pollen from closely related individuals. The most widespread SI system is based on the action of a pistil ribonuclease, the S-RNase, which recognizes and rejects incompatible pollen. S-RNases are endocyted by pollen tubes and stored into vacuoles. By a mechanism that is still unknown, these vacuoles are selectively disrupted in incompatible pollen, releasing S-RNases into the cytoplasm and allowing degradation of pollen RNA. Recently, we have studied the timing of in vivo alterations of pollen F-actin cytoskeleton after incompatible pollinations. Besides being essential for pollen growth, F-actin cytoskeleton is a very dynamic cellular component. Changes in F-actin organization are known to be capable of transducing signaling events in many cellular processes. Early after pollination, F-actin showed a progressive disorganization in incompatible pollen tubes. However by the time the F-actin was almost completely disrupted, the large majority of vacuolar compartments were still intact. These results indicate that in incompatible pollen tubes F-actin disorganization precedes vacuolar disruption. They also suggest that F-actin may act as an early transducer of signals triggering the rejection of incompatible pollen.

Disorganization of F-actin cytoskeleton precedes vacuolar disruption in pollen tubes during the in vivo self-incompatibility response in Nicotiana alata.

BACKGROUND AND AIMS: The integrity of actin filaments (F-actin) is essential for pollen-tube growth. In S-RNase-based self-incompatibility (SI), incompatible pollen tubes are inhibited in the style. Consequently, research efforts have focused on the alterations of pollen F-actin cytoskeleton during the SI response. However, so far, these studies were carried out in in vitro-grown pollen tubes. This study aimed to assess the timing of in vivo changes of pollen F-actin cytoskeleton taking place after compatible and incompatible pollinations in Nicotiana alata. To our knowledge, this is the first report of the in vivo F-actin alterations occurring during pollen rejection in the S-RNase-based SI system. METHODS: The F-actin cytoskeleton and the vacuolar endomembrane system were fluorescently labelled in compatibly and incompatibly pollinated pistils at different times after pollination. The alterations induced by the SI reaction in pollen tubes were visualized by confocal laser scanning microscopy. KEY RESULTS: Early after pollination, about 70 % of both compatible and incompatible pollen tubes showed an organized pattern of F-actin cables along the main axis of the cell. While in compatible pollinations this percentage was unchanged until pollen tubes reached the ovary, pollen tubes of incompatible pollinations underwent gradual and progressive F-actin disorganization. Colocalization of the F-actin cytoskeleton and the vacuolar endomembrane system, where S-RNases are compartmentalized, revealed that by day 6 after incompatible pollination, when the pollen-tube growth was already arrested, about 80 % of pollen tubes showed disrupted F-actin but a similar percentage had intact vacuolar compartments. CONCLUSIONS: The results indicate that during the SI response in Nicotiana, disruption of the F-actin cytoskeleton precedes vacuolar membrane breakdown. Thus, incompatible pollen tubes undergo a sequential disorganization process of major subcellular structures. Results also suggest that the large pool of S-RNases released from vacuoles acts late in pollen rejection, after significant subcellular changes in incompatible pollen tubes.

Manejo laparoscópico de la enfermedad pélvica inflamatoria severa: reporte de tres casos y revisión de la literatura / Laparoscopic management of severe pelvic inflammatory disease: a report of three cases and a literature review

Objetivo: hacer una revisión de la literatura sobre la utilidad de la laparoscopia en el tratamiento del absceso tubovárico en términos de mejoría, estancia y fertilidad posterior. Materiales y métodos: se presentan tres casos de pacientes con enfermedad pélvica inflamatoria severa que consultaron a una institución privada de referencia ubicada en Medellín (Colombia), a quienes se les practicó una laparoscopia operatoria, además de la administración de un antibiótico parenteral como manejo. Se realizó una búsqueda en la base de datos Medline vía PubMed con las palabras clave: “tubo-ovarian abscess, treatment, laparoscopy, fertility”. Se realizó además una búsqueda de textos clásicos y guías de manejo. Resultados: se encontraron 49 artículos de los cuales 13 eran relevantes al problema en cuestión. De estas publicaciones, 8 eran artículos de revisión, 4 series de casos, y 1 un estudio de cohortes retrospectivas. Conclusión: el manejo laparoscópico conservador del absceso tubovárico en el período inicial de la enfermedad, adicional a los antibióticos, surge como una alternativa que podría mejorar los resultados a corto y largo plazo. Se requieren estudios de alta calidad que respalden esta observación...

Objective: carrying out a literature review about the usefulness of laparoscopy in treating tubo-ovarian abscesses in terms of improvement, hospital stay and subsequent fertility.Materials and methods: three cases of patients suffering from severe pelvic inflammatory disease are presented; they consulted at a private reference institution in Medellín, Colombia, and were then submitted to laparoscopy, accompanied by parenteral antibiotics as management. A search was made in the Medline database via PubMed using the following key words: “tubo-ovarian abscess, treatment, laparoscopy, fertility.” A search was also made in classical texts on the subject and management guidelines. Results: 49 pertinent articles were found, of which 13 were relevant to the matter in hand; 8 were review articles, 4 were case-series and 1 was a retrospective cohort study. Conclusion: conservative laparoscopic management of tubo-ovarian abscess during the disease’s initial period, accompanied by the appropriate antibiotic regime, emerged as an alternative which could improve short- and long-term results. High-quality studies are thus needed to confirm such observation...