Técnica quirúrgica con Zigoma quad con carga inmediata en maxilar atrófico: a propósito de un caso / Surgical technique with quad Zygoma with immediate loading in an atrophic maxilla: a case report

Introducción: En la actualidad existen técnicas quirúrgicas predecibles y reproducibles para los tratamientos en pacientes con atrofias de rebordes maxilares, los implantes cigomáticos son unas de las alternativas. El trabajo interdisciplinario entre el rehabilitador oral y el cirujano maxilofacial es fundamental para el éxito de la rehabilitación del paciente. El presente caso clínico reporta un paciente de sexo femenino de 60 años, sin antecedentes médicos, donde se observa en el conebean atrofia del reborde alveolar por lo que se planifica cuatro implantes cigomáticos. Objetivo: El objetivo del informe clínico es mostrar una alternativa de tratamiento quirúrgico implantologico en paciente con maxilar atrofiado. Resultados: Los resultados demostraron la eficacia de los implantes cigomáticos en pacientes edéntulos con atrofia del reborde alveolar más la colocación de una prótesis inmediata. Conclusión: Unas de las alternativas de tratamiento en maxilares con rebordes atróficos son la colocación de implantes cigomáticos junto a una buena planificación digital. varios estudios han descrito que la tasa de éxito de estos implantes es muy alta, debido a que la técnica es segura, reproducible y genera alta satisfacción en los pacientes. (AU)

Introduction: At present there are predictable and reproducible surgical techniques for treatments in patients with maxillary rim atrophy, zygomatic implants are one of the alternatives. The interdisciplinary work between the oral rehabilitator and the maxillofacial surgeon is fundamental for the success of the patient's rehabilitation. The present clinical case reports a 60 year old female patient, with no medical history, where atrophy of the alveolar ridge was observed in the conebean and four zygomatic implants were planned. Objective: The objective of the clinical report is to show an alternative implantological surgical treatment in a patient with atrophied maxilla. Results: The results demonstrated the efficacy of zygomatic implants in edentulous patients with alveolar ridge atrophy plus immediate prosthesis placement. Conclusion: One of the treatment alternatives in maxillae with atrophic rims is the placement of zygomatic implants together with a good digital planning. Several studies have described that the success rate of these implants is very high, due to the fact that the technique is safe, reproducible and generates high patient satisfaction, (AU)

Epidemiología y curso clínico de la hepatitis A en Cantabria antes y después del brote epidémico de junio 2016 / Epidemiology and clinical course of hepatitis A in Cantabria before and after the epidemic outbreak of June 2016

ANTECEDENTES Y OBJETIVOS: Desde junio de 2016 se han producido brotes de hepatitis A en diversos países europeos, afectando principalmente a hombres que tienen sexo con hombres (HSH). El objetivo del presente trabajo fue valorar su impacto clínico y epidemiológico en Cantabria. MATERIAL Y MÉTODOS: Se recogieron retrospectivamente todos los casos de hepatitis A diagnosticados en Cantabria entre enero de 2013 y septiembre de 2018. Se compararon dos periodos (enero 2013-mayo 2016 y junio 2016-septiembre 2018). RESULTADOS: Se diagnosticaron un total de 156 casos, objetivándose un aumento de la incidencia a partir de octubre de 2016. Con respecto al periodo 2013-2016, se observó una mayor proporción de varones (50,0 vs. 84,5%; p = 0,012) con una predominancia de la orientación sexual homosexual (80,6%) y una mayor frecuencia de transmisión sexual (0 vs. 48,3%; p = 0,061) en los pacientes del periodo 2016-2018. Desde el punto de vista clínico destacó que todos los casos de hepatitis grave ocurrieron en este último periodo. CONCLUSIONES: Nuestros resultados reafirman el elevado impacto clínico y epidemiológico del brote epidémico en Cantabria y ponen de relieve la necesaria optimización de las actuales medidas de prevención contra la hepatitis A

BACKGROUND AND OBJECTIVES: Since June 2016, there have been outbreaks of hepatitis A in various European countries, mainly affecting men who have sex with men (MSM). The aim of this study was to assess their clinical and epidemiological impact in Cantabria, Spain. MATERIAL AND METHODS: We retrospectively collected all cases of hepatitis A diagnosed in Cantabria between January 2013 and September 2018. We compared 2 periods: January 2013-May 2016 and June 2016-September 2018. RESULTS: A total of 156 cases were diagnosed, observing an increase in the incidence starting in October 2016. With regard to 2013-2016, we observed a higher proportion of men (50.0% vs. 84.5%; p=.012) with a predominance of the homosexual orientation (80.6%) and a higher rate of sexual transmission (0% vs. 48.3%; p=.061) for the patients in the 2016-2018 period. From the clinical standpoint, all cases of severe hepatitis occurred during this latter period. CONCLUSIONS: Our results reaffirm the high clinical and epidemiological impact of the epidemic outbreak in Cantabria and emphasizes the need for optimising the current prevention measures against hepatitis A

Epidemiology and clinical course of hepatitis A in Cantabria before and after the epidemic outbreak of June 2016. / Epidemiología y curso clínico de la hepatitis A en Cantabria antes y después del brote epidémico de junio 2016.

BACKGROUND AND OBJECTIVES: Since June 2016, there have been outbreaks of hepatitis A in various European countries, mainly affecting men who have sex with men (MSM). The aim of this study was to assess their clinical and epidemiological impact in Cantabria, Spain. MATERIAL AND METHODS: We retrospectively collected all cases of hepatitis A diagnosed in Cantabria between January 2013 and September 2018. We compared 2 periods: January 2013-May 2016 and June 2016-September 2018. RESULTS: A total of 156 cases were diagnosed, observing an increase in the incidence starting in October 2016. With regard to 2013-2016, we observed a higher proportion of men (50.0% vs. 84.5%; p=.012) with a predominance of the homosexual orientation (80.6%) and a higher rate of sexual transmission (0% vs. 48.3%; p=.061) for the patients in the 2016-2018 period. From the clinical standpoint, all cases of severe hepatitis occurred during this latter period. CONCLUSIONS: Our results reaffirm the high clinical and epidemiological impact of the epidemic outbreak in Cantabria and emphasizes the need for optimising the current prevention measures against hepatitis A.

Características morfométricas de disco óptico y espesor de capa de fibras nerviosas de la retina mediante tomografía de coherencia óptica Cirrus 5000 en pacientes sanos atendidos en el Instituto Nacional de Oftalmología / Morphometric characteristics of the optical disc and thickness of retinal nerve fibre layer using Cirrus 5000 optical coherence tomography in healthy patients attending the National Institute of Ophthalmology

OBJETIVO: Describir las características morfométricas y espesor de la capa de fibras nerviosas de la retina (CFNR) en pacientes sanos usando la tomografía de coherencia óptica. MÉTODOS: Estudio transversal y descriptivo. Un total de 184 ojos de 184 personas de etnia mestiza fueron inscritos después de una evaluación oftalmológica completa en el Instituto Nacional de Oftalmología, Lima-Perú. Se midieron los parámetros morfométricos del disco óptico y espesor de la CFNR mediante tomografía de coherencia óptica ZEISS CIRRUS(TM) HD-OCT Modelo 5000 (Carl Zeiss Inc., Dublin, CA, EE.UU). Megalopapila fue definida como: área del disco óptico > 2,5 mm2 y área mayor que la media más 2 desviaciones estándar. RESULTADOS: Se obtuvo un área de disco óptico de 2,21 ± 0,43 mm2, anillo neurorretinal de 1,37 ± 0,25 mm2, excavación de 0,84 ± 0,48 mm2; promedio de ratio excavación/disco de 0,58 ± 0,16, ratio excavación/disco vertical de 0,55 ± 0,15 y un espesor de CFNR 100,30 ± 8,54 μm. La prevalencia de megalopapila fue del 24 y 4%, considerando un área de disco > 2,5 mm2 y 3,07 mm2 respectivamente. Al comparar megalopapilas con discos normales, el área del anillo (p = 0,08) y espesor de CFNR (p = 0,73) no mostraron diferencias estadísticamente significativas. CONCLUSIÓN: El área de disco fue 2,21 ± 0,43 mm2 con un espesor de CFNR 100,30±8,54μm. La prevalencia de megalopapila fue del 24 y 4%, considerando un área de disco>2,5mm2 y 3,07mm2 respectivamente. Las megalopapilas y los discos normales son similares en términos de área del anillo y espesor de CFNR

OBJECTIVE: To describe the morphometric characteristics and thickness of the retinal nerve fibre layer (CFNR) in healthy patients using optical coherence tomography. METHODS: A cross-sectional and descriptive study was conducted on a total of 184 eyes of 184 people of mestizo origin enrolled after a complete ophthalmological evaluation at the National Institute of Ophthalmology, Lima-Peru. The morphometric parameters of the optic disc and thickness of the CFNR were measured by optical coherence tomography ZEISS CIRRUS(TM) HD-OCT Model 5000 (Carl Zeiss Inc., Dublin, CA, EE.UU). Megalopapilla was defined as: area of the optical disc greater than 2.5 mm2 and area greater than the mean plus 2 standard deviations. RESULTS: The areas obtained were: optical disc of 2.21 ± 0.43 mm2, neuroretinal ring of 1.37 ± 0.25 mm2, 0.84 ± 0.48 mm2 cup; mean cup/disc ratio of 0.58 ± 0.16, vertical cup/disc ratio of 0.55 ± 0.15, and a CFNR thickness of 100.30 ± 8.54 μm. The prevalence of megalopapilla, being considered as a disc area greater than 2.5 mm2 and 3.07, was 24% and 4%, respectively. When comparing megalopapilla with normal discs, the area of the ring (P = .08) and thickness of CFNR (P = .73) did not show statistically significant differences. CONCLUSION: The mean disc area was 2.21±0.43mm2 with a CFNR thickness of 100.30 ± 8.54 μm. The prevalence of megalopapilla was 24% and 4%, considering a disc area greater than 2.5 mm2 and 3.07 mm2, respectively. These results show that the megalopapilla and normal discs are similar in terms of ring area and CFNR thickness

Morphometric characteristics of the optical disc and thickness of retinal nerve fibre layer using Cirrus 5000 optical coherence tomography in healthy patients attending the National Institute of Ophthalmology. / Características morfométricas de disco óptico y espesor de capa de fibras nerviosas de la retina mediante tomografía de coherencia óptica Cirrus 5000 en pacientes sanos atendidos en el Instituto Nacional de Oftalmología.

OBJECTIVE: To describe the morphometric characteristics and thickness of the retinal nerve fibre layer (CFNR) in healthy patients using optical coherence tomography. METHODS: A cross-sectional and descriptive study was conducted on a total of 184 eyes of 184 people of mestizo origin enrolled after a complete ophthalmological evaluation at the National Institute of Ophthalmology, Lima-Peru. The morphometric parameters of the optic disc and thickness of the CFNR were measured by optical coherence tomography ZEISS CIRRUS™ HD-OCT Model 5000 (Carl Zeiss Inc., Dublin, CA, EE.UU). Megalopapilla was defined as: area of the optical disc greater than 2.5 mm2 and area greater than the mean plus 2 standard deviations. RESULTS: The areas obtained were: optical disc of 2.21±0.43mm2, neuroretinal ring of 1.37±0.25mm2, 0.84±0.48mm2 cup; mean cup/disc ratio of 0.58±0.16, vertical cup/disc ratio of 0.55±0.15, and a CFNR thickness of 100.30±8.54µm. The prevalence of megalopapilla, being considered as a disc area greater than 2.5mm2 and 3.07, was 24% and 4%, respectively. When comparing megalopapilla with normal discs, the area of the ring (P=.08) and thickness of CFNR (P=.73) did not show statistically significant differences. CONCLUSION: The mean disc area was 2.21±0.43mm2 with a CFNR thickness of 100.30±8.54µm. The prevalence of megalopapilla was 24% and 4%, considering a disc area greater than 2.5 mm2 and 3.07 mm2, respectively. These results show that the megalopapilla and normal discs are similar in terms of ring area and CFNR thickness.

Effectiveness and safety of sofosbuvir-based regimens plus an NS5A inhibitor for patients with HCV genotype 3 infection and cirrhosis. Results of a multicenter real-life cohort.

Patients with HCV genotype 3 (GT3) infection and cirrhosis are currently the most difficult to cure. We report our experience with sofosbuvir+daclatasvir (SOF+DCV) or sofosbuvir/ledipasvir (SOF/LDV), with or without ribavirin (RBV) in clinical practice in this population. This was a multicenter observational study including cirrhotic patients infected by HCV GT3, treated with sofosbuvir plus an NS5A inhibitor (May 2014-October 2015). In total, 208 patients were included: 98 (47%) treatment-experienced, 42 (20%) decompensated and 55 (27%) MELD score >10. In 131 (63%), treatment was SOF+DCV and in 77 (37%), SOF/LDV. Overall, 86% received RBV. RBV addition and extension to 24 weeks was higher in the SOF/LDV group (95% vs 80%, P=.002 and 83% vs 72%, P=.044, respectively). A higher percentage of decompensated patients were treated with DCV than LDV (25% vs 12%, P=.013). Overall, SVR12 was 93.8% (195/208): 94% with SOF+DCV and 93.5% with SOF/LDV. SVR12 was achieved in 90.5% of decompensated patients. Eleven treatment failures: 10 relapses and one breakthrough. RBV addition did not improve SVR (RR: 1.08; P=.919). The single factor associated with failure to achieve SVR was platelet count <75×10E9/mL (RR: 3.50, P=.019). In patients with MELD <10, type of NS5A inhibitor did not impact on SVR12 (94% vs 97%; adjusted RR: 0.49). Thirteen patients (6.3%) had serious adverse events, including three deaths (1.4%) and one therapy discontinuation (0.5%), higher in decompensated patients (16.7% vs 3.6%, P<.006). In patients with GT3 infection and cirrhosis, SVR12 rates were high with both SOF+DCV and SOF/LDV, with few serious adverse events.

¿Es posible la eliminación del virus de la hepatitis C en el entorno penitenciario? / Is HCV elimination possible in prison?

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Galectin-1 in stable liver transplant recipients.

INTRODUCTION: The achievement of a state of tolerance and minimization of the immunosuppressive load form part of the "Holy Grail" in solid organ transplantation. Galectin-1 recently has been described to be involved in the maintenance of a tolerant environment, but there is no evidence of its role in human liver transplantation. The aim of our study was to measure the serum levels of galectin-1 in stable liver transplant recipients. METHODS: Serum levels of galectin-1 were determined in 30 stable liver transplant recipients who had been free of rejection episodes for at least 8 years. Fifteen patients with an acute rejection episode and 34 healthy subjects were used as the control group. RESULTS: The concentrations of galectin-1 were significantly higher in stable liver transplant recipients compared with healthy subjects and with the acute rejection group. CONCLUSIONS: These preliminary results indicate that galectin-1 is upregulated in stable liver transplant recipients. Thus, our results extend the recent findings that galectin-1 may play an immune-suppressive role in liver transplantation. It remains to be established whether it might help to induce tolerance in liver transplantation.

[Serologic markers of viral hepatitis B in drug addicted++ patients at the Hermilio Valdizán Hospital]. / Marcadores serológicos de hepatitis viral B en pacientes drogadictos del Hospital Hermilio Valdizán.

A study was done in 36 drug addict patients at the H. Valdizan Hospital We studied serological markers for Hepatitis B: HBsAg Anti-HBc, and anti-HIV was also made. They were not IV abusers. Five patients (13.8%) were positive for HBsAg and 6 (16.6%) for anti-HBc. Anti-HIV was negative in all the cases, that obtained from our results compared with the general adult population from peruvian coast are high. In relation to the information obtained, the transmission route would be diverse, considering an important one the sexual route. 44 drug addicts were seen in 1988 at this Hospital, 36 cases could be a representative number, although we think we need to extend this study to a bigger population to establish the actual prevalence of this infection among these particular patients. This information could help to advice preventive and control health measures.