Clinical practice guideline of the spanish society of oral surgery for oral surgery in patients with coagulation disorders.

BACKGROUND: The number of patients treated with coagulation disorders, and more specifically with anticoagulant therapy, has increased worldwide in recent years due to increased life expectancy in developed countries. The protocols for managing this type of patient in oral surgery has varied over recent years, especially after the appearance of new direct-acting oral anticoagulants (DOACs). The assessment of risk of bleeding in this type of patient when undergoing a surgical procedure continues to be a controversial issue for patients, dentists and general practitioners. The objective of this document is to offer recommendations, based on evidence, for decision making for patients with coagulopathies who require dental surgical intervention. MATERIAL AND METHODS: Based on the indications of the "Preparation of Clinical Practice guidelines in the National Health System. Methodological manual", we gathered a group of experts who agreed on 15 PICO questions based on managing patients with coagulation disorders in dental surgical procedures, such as fitting of implants or dental extractions. RESULTS: The 15 PICO questions were answered based on the available evidence, being limited in most cases due to the lack of a control group. Two of the PICO questions were answered by the experts with a grade C recommendation, while the rest were answered with grade D. CONCLUSIONS: The results of this review highlight the need to undertake well designed clinical trials with control groups and with a representative sample size.

Counselling toward reducing alcohol use, knowledge about its morbidity and personal consumption among students of medical and dental courses in north-western Spain.

BACKGROUND: Alcohol use disorder (AUD) is directly linked to high-risk consumption. Healthcare students have a crucial role to play in its prevention and management. The aim of this study is to analyse alcohol consumption, as well as to consider the knowledge and attitudes regarding morbidity, and the stage of change when providing assistance to quit AUD. MATERIAL AND METHODS: A cross-sectional study was conducted among Dentistry and Medical students using specific and validated questionnaires in an anonymous and voluntary way. Initially, 925 students were invited to participate, of them 500 were reached. RESULTS: Among them 85.9% suffered from AUD of whom 75% were women (p<0.001), and it was considered that the female gender constituted an independent risk factor (OR=2.63, CI 95% 1.55-4.45, p<0.001). The majority of the participants did not achieve the pass mark, nonetheless, the results showed improved levels of knowledge among participants in the latter years of their studies (p<0.001). Dental students demonstrated greater shortcomings in terms of their knowledge of general pathology, whereas the medical students' knowledge of oral pathologies proved worse (p<0.001). Most of students believed that identifying cases of AUD-affected patients falls within their competence, nonetheless, they believed that they do not have the necessary competencies. Among participants 58.2% were in a stage of change regarding AUD attitudes. CONCLUSIONS: The majority of respondents presented AUD. In general, the participants' knowledge about alcohol was low. Reviewing the syllabuses and evaluating the implementation of gender-differentiated training programmes in both degrees would be considered necessary.

A new morphologic classification of the alveolar ridge after distraction osteogenesis in human patients. A 17 years retrospective case series study.

BACKGROUND: To perform a morphologic classification based on the results of bone augmentation after a distraction osteogenesis. MATERIAL AND METHODS: Thirty-four (34) patients (24 women and 10 men; mean age, 47.1 years (SD=9.5); age range, 23 to 62 years) underwent a total of 42 alveolar ridge distractions before the placement of a total of 89 dental implants. Ridge bone morphology was evaluated as the main ordinal variable. Chi-squared, Kruskal-Wallis and ANOVA one-way test were used. RESULTS: Category I (30.95%): consisted of wide alveolar rim and no bone defects Category II (28.57%): wide alveolar rim, lateral bone surface concavity. Category III (23.81%): narrow alveolar rim, lateral bone surface concavity. Category IV (2.38 %): distraction transport segment forming a bridge, without bone formed beneath and requiring guided bone regeneration. Category V (9.52%): return of the transport segment to its initial position due to the reverse rotation of the distractor screw. Category VI (4.76 %): distraction transport segment completely lost. Subcategory D (28.57%), consisted of lingual deviation of the distraction axis, occurring in any of the categories I to IV. More men (76.9 %) presented with category I (p<0.001). The use of the chisel resulted mainly in categories I and II (69.4 %) (p<0.001). GBR was only required in 23.1 % of the cases in Category I (p=0.011). The bone height achieved decreases as the category increases, due to the accompanying osteogenic limitations (p<0.001). The implants placed in category I were longer 11.5 ± 0.9 mm (CI95% 10.9-11.9 mm) compared to those placed in category III with a length of 10.4 ± 1.5 mm (CI95% 9.5-11.4 mm) (p=0.035). CONCLUSIONS: The alveolar ridge after distraction osteogenesis could be divided into six morphologic categories which provide a useful basis for decision-making regarding implant placement.

Respuesta favorable al tratamiento con alopurinol de reacción granulomatosa a relleno / Foreign-Body Reaction to Dermal Filler: Good Response to Treatment with Allopurinol

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Lesiones anaranjadas de aparición progresiva en cuero cabelludo / Progressive Orange Lesions on the Scalp

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Necrosis cutánea por heparina con afectación a distancia del punto de administración / Heparin-Induced Skin Necrosis Occurring at a Distance From Injection Sites

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Nevus lipomatoso superficial gigante / Giant Nevus Lipomatosus Cutaneous Superficialis

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Oral hygiene instructions and professional control as part of the treatment of desquamative gingivitis. Systematic review.

BACKGROUND: The aim of this present article was to evaluate the scientific evidence on the efficacy of daily hygiene and professional prophylaxis for treatment of desquamative gingivitis. MATERIAL AND METHODS: The present systematic review was conducted following the PRISMA protocol. Searches were carried out in Pubmed, Embase, Web of Science and Cochrane Library up to July 2018, randomized clinical trials and cohort studies on desquamative gingivitis (DG), and oral diseases joined to DG. RESULTS: After screening, we found that nine publications met the eligibility criteria eight cohort studies and one randomized control trial. The diagnosis of the diseases corresponded to oral lichen planus (n=185), mucous membrane pemphigoid (n=13); plasma cell gingivitits (n=15) and pemphigus vulgar (n=11). The follow-up was between a week and a year after instructing patients. Dental daily hygiene and professional prophylaxis, at least with supragingival scaling and polishing have significantly improved the extension of the lesion and reduced the activity of DG, and gingival bleeding in all patients. Furthermore, these techniques have also reduced pain and gingival plaque. CONCLUSIONS: In conclusion the studies presented support the efficacy of maintaining personal and professional oral hygiene in patients with GD, reducing the clinical signs of the disease, regardless of its pathogenesis.

Lengua geográfica: factores predisponentes, diagnóstico y tratamiento. Revisión sistemática / Geographic tongue: Predisposing factors, diagnosis and treatment. A systematic review

Introducción: La lengua geográfica (LG) es una lesión de origen desconocido asociada a enfermedades sistémicas, por lo que su atención plantea una validez multidisciplinar. Métodos: La búsqueda de los artículos fue realizada a partir de las bases de datos de PubMed, Embase, Web of Science y Cochrane Database. Los criterios de selección fueron en concordancia con el protocolo Preferred Reporting Items for Systematic Reviews. Hemos considerado como criterios de inclusión los artículos en revistas diseñados sobre casos de cohortes, estudios transversales, casos y controles, y ensayos clínicos aleatorizados en el contexto patogénico, clínico y terapéutico. Resultados: Un total de 33 artículos cumplieron dichos criterios. El número de pacientes analizados con LG fue de 4.998 con un rango de edad entre los 0 y 85 años. La sintomatología de sensación de ardor estuvo presente en entre el 9,2% y el 47% de los pacientes. El diagnóstico de la LG fue clínico en el 98,81%. Se ha manifestado en la LG una asociación con la psoriasis, las alergias y la ansiedad. La infección por Candida se presentó en el 7,6% (24/315) y la presencia de caries fue estadísticamente significativa. El único ensayo clínico analizado propone como tratamiento el uso tópico de acetónido de triamcinolona al 0,1%, combinado o no con el ácido retinoico al 0,05%. Conclusiones: El diagnóstico de la lengua geográfica es principalmente clínico. Es un desorden asintomático que habitualmente no requiere tratamiento. El conocimiento de la LG es necesario debido a las enfermedades comórbidas intra y extraorales que la acompañan

Introduction: Geographic tongue (GT) is a lesion of unknown origin associated with systemic diseases and therefore involves multidisciplinary care. Methods: We performed a literature search of the PubMed, EMBASE, Web of Science and Cochrane databases. The selection criteria were consistent with the Preferred Reporting Items for Systematic Reviews protocol. We considered as inclusion criteria journal articles designed on cases of cohorts, cross-sectional studies, cases and controls and randomised clinical trials in the pathogenic, clinical and therapeutic context. Results: A total of 33 articles met these criteria. We analysed 4998 patients with GT, with an age range of 0 to 85 years, and the burning sensation symptom was present in 9.2-47% of these patients. The GT diagnosis was clinical in 98.81% of the cases, and GT displayed an association with psoriasis, allergies and anxiety. Candida infection was present in 7.6% (24/315) of the cases, and the presence of caries was statistically significant. The only analysed clinical trial proposed treatment through the topical application of 0.1% triamcinolone acetonide combined or not with 0.05% retinoic acid. Conclusions: The diagnosis of GT is mainly clinical. GT is an asymptomatic disorder that usually requires no treatment. Understanding GT is necessary due to the comorbid intraoral and extraoral diseases that accompany the condition

20 years of alveolar distraction: A systematic review of the literature.

BACKGROUND: The Vertical Alveolar Distraction Osteogenesis (VADO) technique is an excellent solution for bone and soft tissue neoformation in areas in which there has been significant bone atrophy that hinders normal rehabilitation using dental implants. The goal of this systematic review is to analyze the most relevant articles published on VADO in the literature over the past 20 years. MATERIAL AND METHODS: The review was performed by using the keywords: "alveolar ridge", "distraction ostegenesis" and "dental implant". This search produced a total result of 240 articles. The clinical studies and cases reported in humans amounted to 113 articles, 18 articles referred to studies developed on animals and 33 review articles. The presentation of this systematic analysis follows the criteria described in the PRISMA declaration. RESULTS: 22 articles complied with the inclusion criteria and 7 articles more were added manually, reaching a total sample of 29 studies. Following the analysis of the studies, they were classified into 18 high-quality, 10 mediumquality and 1 low-quality study. Only 4 studies achieved a maximum score of 9 (according to NewCastle Ottawa Scale, NOS). CONCLUSIONS: VADO is a technique with greater potential in vertical gain. The performance of dental implants has a success and survival rate similar to dental implants placed on bones that are not subject to increase techniques.

Medición del impacto psicológico en pacientes con psoriasis en tratamiento sistémico / Measurement of the Psychological Impact of Psoriasis on Patients Receiving Systemic Treatment

ANTECEDENTES Y OBJETIVOS: El impacto negativo que la psoriasis tiene en la calidad de vida del paciente puede ser tan importante como sus consecuencias físicas. Podríamos suponer que el blanqueamiento de la enfermedad conllevaría también una mejoría de su impacto psicosocial. El presente estudio valora el estado psicológico de los pacientes con psoriasis controlados con tratamiento sistémico en una Unidad de Psoriasis, especialmente en aquellos con una afectación leve o nula de la enfermedad. MÉTODOS: Estudio epidemiológico observacional y trasversal, sin intervención, con dos cohortes (casos y controles). Los pacientes autocompletaron datos demográficos y 4 cuestionarios (Cuestionario de autoestima de Rosenberg, Skindex-29, HADS y COPE-28) en una única visita. RESULTADOS: Se reclutaron 111 pacientes diagnosticados de psoriasis y 109 pacientes control. En autoestima, el promedio y la desviación estándar (DE) del grupo de psoriasis fue de 33,5 (4,8) y de 33,3 (6,7) para el grupo control, sin diferencias significativas. En el Skindex-29, la puntuación media del grupo de pacientes con psoriasis fue casi 3 veces mayor que la media del grupo control (30 vs. 11). Se encontraron diferencias significativas en las puntuaciones del HADS de ambos grupos (12,7 vs. 9,0; p < 0,001). Las puntuaciones promedio del HADS-A fueron de 8,0 (4,78) en el grupo de psoriasis frente a 5,7 (3,8) en el grupo control (p < 0,001), mientras que las del HADS-D fueron de 4,7 (3,9) frente a 3,2 (3,1) (p < 0,004), respectivamente. CONCLUSIONES: Los resultados obtenidos indican que es necesario medir el estado psicológico de nuestros pacientes con psoriasis, pues incluso con un control casi total de la enfermedad la afectación psicológica permanece

BACKGROUND AND OBJECTIVES: The negative impact of psoriasis on patient quality of life can be as important as the physical consequences of the disease. We could assume that clearance of the disease would also lead to an improvement in its psychosocial impact. The present study assesses the psychological state of patients with psoriasis receiving systemic treatment in a psoriasis unit, especially those with mild or no disease involvement. METHODS: We performed a cross-sectional, observational, noninterventional epidemiological study of 2 cohorts (cases and controls). The patients self-completed demographic data and 4 questionnaires (Rosenberg Self-Esteem Scale, Skindex-29, HADS, and COPE-28 questionnaire) at a single visit. RESULTS: We recruited 111 patients diagnosed with psoriasis and 109 control patients. In self-esteem, the mean and standard deviation (SD) score was 33.5 (4.8) for the psoriasis group and 33.3 (6.7) for the control group, with no significant differences. In the Skindex-29, the mean score for the psoriasis group was almost 3 times higher than that of the control group (30 vs. 11). Significant differences were found in the HADS scores of both groups (12.7 vs. 9.0, P<.001). The mean HADS-A scores were 8.0 (4.78) for the psoriasis group compared with 5.7 (3.8) for the control group (P<.001). In the case of HADS-D, the scores were 4.7 (3.9) compared with 3.2 (3.1) (P<.004), respectively. CONCLUSIONS: Our findings indicate that it is necessary to assess the psychological state of patients with psoriasis, because psychological effects persist even in cases where the disease is almost totally controlled

Tratamiento endovascular de lesión iatrogénica en aorta torácica causada por tornillo de artrodesis / Endovascular treatment of iatrogenic injury in the thoracic aorta caused by an arthrodesis screw

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Afectación ocular en un síndrome hemolítico urémico atípico / Ocular involvement in atypical haemolytic uraemic syndrome

Caso clínico: Varón joven con síndrome hemolítico urémico atípico (SHUa) complicado con la presencia de desprendimientos serosos retinianos bilaterales (DSR), múltiples exudados algodonosos y una oclusión de rama arterial. El tratamiento con terapia plasmática, hemodiálisis y posteriormente con eculizumab, permitió una rápida normalización de los parámetros sanguíneos y urinarios y la resolución de las alteraciones retinianas. El análisis genético mostró 2 mutaciones en el factor H y C3 del sistema complemento. Discusión: El síndrome hemolítico urémico (SHU) es una microangiopatía trombótica con anemia hemolítica, trombocitopenia e insuficiencia renal aguda, que se denomina atípico cuando está causado por una alteración genética del sistema complemento. La afectación ocular es una rara manifestación de este infrecuente síndrome (AU)

Case report: The case is presented of a young man with an atypical haemolytic-uraemic syndrome (aHUS), complicated with bilateral serous retinal detachment, cotton wool spots, and a branch artery occlusion. Treatment with plasmapheresis, haemodialysis and systemic eculizumab led to the blood and urine parameters returning to normal, as well as resolution of the retinal anomalies. Genetic analysis show both mutations in complement factor H and C3. Discussion: Haemolytic-uraemic syndrome (HUS) is a thrombotic microangiopathy characterised by microangiopathic haemolytic anaemia, thrombocytopenia, and acute renal failure. Atypical HUS is caused by genetic mutation of complement system. Ocular involvement is an unusual manifestation of this rare syndrome (AU)

Novedades en inmunología del melanoma / Novel Immunologic Approaches to Melanoma Treatment

Desde la introducción de la inmunoterapia el tratamiento del melanoma ha sufrido una revolución, consiguiéndose cifras de supervivencia superiores a las que se alcanzaban con los tratamientos previos. Los fármacos inmunomoduladores disponibles actualmente van dirigidos principalmente frente a las moléculas de superficie CTLA-4 y PD-1, que ejercen un efecto inhibidor sobre la respuesta inmune antitumoral. Se trata de un tratamiento en pleno proceso de expansión, y la investigación se dirige hacia el descubrimiento de nuevas moléculas, las combinaciones de los fármacos disponibles o la identificación de biomarcadores que permitan seleccionar a los pacientes idóneos para cada terapia (AU)

Approaches to treating melanoma have changed radically since the introduction of immunotherapy, and survival figures are now higher than possible with earlier therapies. The immunomodulators currently available mainly block CTLA-4 (cytotoxicT lymphocyte-associated molecule-4) and PD-1 (programed cell death protein 1) translocated to the cell surface, where they inhibit the antitumor immune response. Treatments blocking these molecules are being more widely used. Research now seeks new molecular targets, the best combinations of available drugs, and biomarkers that can identify ideal candidates for each one (AU)

Utilidad de la azitromicina en la hiperplasia gingival inducida por ciclosporina / Azithromycin for the treatment of ciclosporin-induced gingival hyperplasia

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Distance of the alveolar antral artery from the alveolar crest. Related factors and surgical considerations in sinus floor elevation.

BACKGROUND: In a variable proportion of maxillary sinuses alveolar antral artery is located close to the residual ridge, increasing the chances for haemorrhagic complications during sinus floor elevation procedures. MATERIAL AND METHODS: Retrospective observational study of CBCT explorations performed for implant-treatment planning. The upper first molar area was selected for this study. The relative uncertainty (standard deviation of the measurement divided by its mean and expressed as a percentage from 0% to 100%) was chosen for determining the observational errors. For modeling the chances of AAA detection, the generalized additive models (GAM) approach was chosen. RESULTS: A total of 240 maxillary sinuses were studied (46.25% males) whose median median age was 58 years old (IQR: 52-66). Univariate models showed that the chances for an AAA-alvelar crest distance ≤15mm increase in wider sinuses with lower, subsinusally edentulous crests. When distance is considered as a continuous variable, the best mutivariate model showed an explained deviance of 67% and included AAA diameter, distance AAA-sinus floor, sinus width, and shape, height and width of the residual ridge. Thinner AAAs are found closer to the crest (within the ≤15mm safe distance). CONCLUSIONS: Bearing in mind the inclusion criteria and the limitations of this investigation, it is concluded that there is a high proportion of maxillary sinuses where AAA describes a course close to the alveolar crest (≤15mm), which was classically considered a safe distance for SFE. This position is related to the presence of atrophic crests (depressed ridge form) and wide maxillary sinuses where the distance of the vessel to the floor of the sinus is small. This information may permit a better surgical planning of SFE procedures.

Remisión espontánea de verrugas recalcitrantes en niñas tras vacunación frente al virus del papiloma humano / Spontaneous Remission of Recalcitrant Warts in Girls After Human Papillomavirus Vaccination

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Duplicación de arteria femoral superficial en paciente con claudicación intermitente / Duplication of superficial femoral artery in a patient with intermittent claudication

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Facomatosis pigmentoqueratótica atípica como expresión de rasopatía en mosaicismo con mutación en gen BRAF Glu586Lys / Atypical Phacomatosis Pigmentokeratotica as the Expression of a Mosaic RASopathy With the BRAF-Glu586Lys Mutation

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