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)

Ensayo clínico aleatorizado, doble ciego, controlado con placebo sobre la utilidad del probiótico Lactobacillus reuteri en la terapia de erradicación cuádruple con bismuto de la infección por Helicobacter pylori / Randomized, double-blind, placebo-controlled clinical trial on the usefulness of probiotic Lactobacillus reuteri in bismuth-containing quadruple eradication therapy for infection with Helicobacter pylori

Introducción: el objetivo principal de este estudio fue evaluar la reducción de los síntomas gastrointestinales de pacientes con terapia de erradicación cuádruple con bismuto, complementada con cepas de Lactobacillus reuteri (DSM 17938 y ATCC PTA 6475), frente a un placebo.Materiales y métodos: ensayo clínico aleatorizado, doble ciego, de brazos paralelos y controlado con placebo. Los pacientes recibieron en primera línea el régimen erradicador basado en subcitrato de bismuto potásico, metronidazol, clorhidrato de tetraciclina (cápsulas tres en uno) y omeprazol 40 mg dos veces al día durante diez días, más un comprimido (probiótico o placebo) durante treinta días. En el seguimiento se evaluaron los síntomas gastrointestinales mediante una escala de valoración (GSRS) y los eventos adversos a los 0, 14, 28 y 56 días.Resultados: se incluyeron un total de 80 pacientes desde febrero de 2018 a mayo de 2019 en un solo centro. El tratamiento erradicador fue eficaz en el 85 % de los pacientes, sin diferencias entre los dos brazos de tratamiento. En el grupo que recibió el probiótico, el dolor abdominal se redujo en el 42 % de los pacientes, en comparación con el 19 % del grupo de control (OR: 0,27; IC 95 %: 0,13-0,58; p < 0,001), y la distensión abdominal se redujo un 25 %, frente a un 17 % en el grupo de control (OR: 0,24; IC 95 %: 0,19-0,84; p < 0,001).Conclusiones: el tratamiento con L. reuteri consiguió reducir solo el dolor y la distensión abdominal. Se necesitan más estudios para determinar la contribución de los probióticos como terapia adyuvante en la erradicación de H. pylori. (AU)

Quadruple pregnancy after post-IVF/ICSI transfer of blastocysts.

Clinical case of a quadruple pregnancy (monochorionic diamniotic and dichorionic diamniotic) after the transfer of two blastocysts generated by intracytoplasmic sperm injection (ICSI). This is the case of a 29-year-old woman patient with transfer of two blastocysts after long cultivation of 6 embryos generated by ICSI and vitrified on day +3. This revealed quadruple clinical pregnancy (monochorionic diamniotic and dichorionic diamniotic) of 56 days of evolution by transvaginal ultrasound. The couple decided to undergo a selective embryonic reduction of the monochorionic diamniotic pregnancy after receiving information about the risks arising from it. After that embryonic reduction the uncomplicated pregnancy continued until 36 weeks of gestation, achieving reproductive success with the birth of two babies alive and healthy.

Achieving quadruple aim goals through clinical networks: A systematic review.

INTRODUCTION: Clinical Networks are complex interventions that enable healthcare professionals from various disciplines to work in a coordinated manner in the context of multiple care settings, to provide a high quality response to a specific disease. The aim of this study was to evaluate if clinical networks are able to improve effectiveness, efficiency, patients' satisfaction and professionals' behavior in the health care settings, namely the "quadruple aim" quality goals. MATERIALS AND METHODS: A systematic review of documents published until February 28, 2018, in Medline, Embase and CINAHL was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. A specific research strategy was created to identify studies evaluating effectiveness, efficiency, patient satisfaction and professionals well-being obtained through clinical networks implementation. RESULTS: 14249 studies were identified; 12 of these were eligible to the evaluation of "Quadruple Aim" outcomes. 9 studies focused on patients' outcomes improvement and 4 on network efficiency. Professionals' and patients' experience were not considered in any study. CONCLUSIONS: There are some evidences that clinical network can improve patients' outcomes and health funds allocation in a small number of moderate-low quality studies. Further rigorous studies are needed to confirm these findings and to evaluate patients' and professionals' experience, taking into account also networks' structural features that could influence outcomes achievement.

Eradication of Helicobacter pylori infection with a new bismuth-based quadruple therapy in clinical practice. / Erradicación de la infección por Helicobacter pylori con una nueva terapia cuádruple basada en bismuto en la práctica clínica.

INTRODUCTION: The eradication of Helicobacter pylori infection represents a clinical challenge. OBJECTIVE: To evaluate the efficacy and safety of quadruple therapy with esomeprazole plus a 3-in-1 capsule containing bismuth subcitrate, metronidazole and tetracycline, plus probiotics in patients diagnosed with H. pylori infection in routine clinical practice. METHODS: A prospective, interventional, single-centre and open-label study in consecutive patients with a confirmed indication for eradication of H. pylori infection. Patients were treated with three capsules of Pylera® four times a day (breakfast, lunch, afternoon snack and dinner), plus 40mg of esomeprazole twice daily for 10 days (30min before breakfast and dinner) and probiotics for 30 days. Eradication of H. pylori infection was confirmed by labelled urea breath test performed at least 28 days after the end of treatment. RESULTS: A total of 100 patients were consecutively enrolled. Twenty-five patients (25.0%) had a prior history of treatment for their H. pylori infection. In the intention-to-treat population, eradication rates were 90.7% (68/75) and 80.0% (20/25) in patients treated with Pylera® as the first line or as rescue therapy, respectively. Eighteen patients (18%) had at least one adverse event, most of which (89%) were mild. CONCLUSION: Ten days of treatment with a quadruple regimen of bismuth, metronidazole and tetracycline plus esomeprazole and probiotics is an effective and safe strategy in patients with H. pylori infection.

[Cuadruple concomitant non-bismuth therapy vs. classical triple therapy as first line therapy for Helicobacter pylori infection]. / Comparación de cuádruple terapia concomitante sin bismuto con triple terapia clásica como primera línea de tratamiento para la erradicación del Helicobacter pylori.

BACKGROUND AND OBJECTIVE: In a previous study we found that the classical triple therapy for Helicobacter pylori (H. pylori) had low efficacy (under 70%) in our area. After this finding, in mid 2012 quadruple concomitant therapy started to be prescribed in our hospital. The aim of the present study is to compare the efficacy of classical triple therapy and quadruple concomitant therapy without bismuth. MATERIAL AND METHODS: Observational retrospective study of prescribed treatments between 1st January 2012 and 5th May 2014 and their efficacy. RESULTS: During the study period 510 patients were prescribed a first line therapy; in 179 cases (35,1%) the combination amoxiciline+clarithromicine+PPI was prescribed during 7-14 days, and 298 patients (58,4%) were treated with amoxicillin+clarithromycin+metronidazole+PPI for 10 days. The quadruple concomitant therapy had a higher efficacy than the classical triple therapy, both in an "intention to treat" (84.8% vs. 65.7%, P=.001) and "per protocol" (86.9% vs. 67.2%, P=.001) analysis. Triple therapy had a higher efficacy when it was prescribed for 10 days compared to 7 days (77.9% vs. 56.5%, P=.005 per "intention to treat" and 77.9% vs. 58.5%, P=.011 "per protocol"). When quadruple concomitant therapy was compared with classical triple therapy prescribed over 10 days no significant differences were found. CONCLUSIONS: In our setting, cuadruple concomitant therapy without bismuth has a high efficacy as first line therapy for H. pylori eradication, with much better results than classical triple therapy in the way that it is most widely prescribed (short courses of 7-day with a single dose of omeprazole).

[10-day triple therapy with esomeprazole 40 mg/12 h vs. quadruple concomitant non-bismuth therapy as first line treatment for Helicobacter pylori infection]. / Triple terapia 10 días con esomeprazol 40 mg/12 h vs. cuádruple concomitante sin bismuto como tratamiento de primera línea de la infección por Helicobacter pylori.

INTRODUCTION: Quadruple concomitant non-bismuth therapy has recently become the most widely prescribed first-line treatment for Helicobacter pylori infection in Spain. Whether optimized conventional triple therapy can achieve comparable efficacy rates remains to be seen. MATERIAL AND METHODS: Retrospective study comparing the efficacy of triple and quadruple concomitant therapy, and sub-analysis following administration of both for 10 days with esomeprazole 40mg/12h. RESULTS: A first-line therapy was administered to 657 patients from 1st January 2012 to 31st December 2014. Quadruple therapy (n=371) showed higher efficacy than triple therapy (n=248) for both intention-to-treat (85.9% vs. 65.7%; P<.001) and per protocol analysis (92.5% vs. 68.4%; P<.001). When both therapies included esomeprazole 40mg/12h administered for 10 days, quadruple concomitant therapy (n=108) also had higher efficacy than triple therapy (n=76) for intention-to-treat (90.7% vs. 73.6%; P=.003) and per protocol analysis (92.5% vs.74.6%; P=.002). CONCLUSIONS: Quadruple concomitant therapy with high dose proton pump inhibitor (PPI) for 10 days achieves a significantly higher eradication outcome than optimized triple therapy, with rates of over 90% when the PPI prescribed is esomeprazole 40mg/12h.

Caracterización de infección por Helicobacter pylori en pacientes asistidos en la consulta de gastroenterología / Characterization of Helicobacter pylori infection in patients treated in the gastroenterology department

Se realizó un estudio descriptivo longitudinal, para caracterizar la infección por Helicobacter pylori en los pacientes que acudieron con síntomas dispépticos a la consulta de gastroenterología del hospital Manuel Ascunce Domenech de Camagüey, durante el periodo de noviembre de 2009 a mayo de 2011. Se les indicó examen endoscópico para determinar signos sugestivos de infección por Helicobacter pylori. La muestra de estudio estuvo constituida por 205 pacientes con síntomas dispépticos e indicación endoscópica. Se midieron las variables, grupo de edad, sexo, diagnóstico endoscópico, resultados del test de ureasa y evaluación clínica y/o endoscópica. El grupo de 30 a 44 años fue el más afectado. En los pacientes predominó el sexo femenino, la endoscopia sugestiva de infección por Helicobacter pylori y el test de ureasa positivo. El diagnóstico endoscópico más frecuente fue la gastritis nodular. La mayoría de los pacientes mejoró con la triple terapia erradicadora de Helicobacter pylori, y casi la totalidad de los que no mejoraron con ella sí lo hicieron al recibir la terapia cuádruple. Ambas terapias contra el Helicobacter pylori continúan siendo efectivas y producen una favorable evolución clínica y/o endoscópica (AU)

A longitudinal descriptive study was carried out to characterize the Helicobacter pylori infection in patients who went with dyspeptic symptoms to the gastroenterology department of Manuel Ascunce Domenech Hospital in Camagüey, from November, 2009 to May, 2011. They were indicated endoscopic examination to find out signs suggestive of Helicobacter pylori infection. The study sample consisted of 205 patients with dyspeptic symptoms and endoscopic indication. Variables, age group, sex, endoscopic diagnosis, urease test results, and clinical and/or endoscopic evaluation were considered. The age group from 30 to 44 years old was the most affected one. Females, endoscopy suggestive of Helicobacter pylori infection and positive urease test prevailed. The most frequent endoscopic diagnosis was nodular gastritis. Most of the patients improved with triple eradication therapy of Helicobacter pylori and almost all those who did not improve with it, they did it when receiving the quadruple therapy. Both therapies against Helicobacter pylori remain effective and produce a favorable clinical and/or endoscopic evolution (AU)

Novel quadruple mutations in dihydropteroate synthase genes of Plasmodium falciparum in West Bengal, India.

OBJECTIVE: To evaluate the anti-folate (sulphadoxine)-resistant pattern in Kolkata, one of the malaria endemic zones of Eastern India. METHODS: At first, 107 P. falciparum suspected cases were enrolled in this study. Ninety isolates (84.11%) of 107 suspected cases were analysed, as they had mono-infection with P. falciparum. In vitro susceptibility assays were performed in all 90 isolates. Parasitic DNA was isolated by phenol-chloroform extraction method and polymerase chain reaction was followed by restriction fragment length polymorphism analysis of different codons of the pfdhps gene (436, 437, 540, 581 and 613). RESULTS: Among 90 isolates from Kolkata, dhps mutant isolates at codons 436, 437, 540, 581 and 613 were found in 53.33%, 67.78%, 46.66%, 15.56% and 45.55%, respectively. In vitro sulphadoxine resistance was found in 49 isolates (54.44%). Interestingly we found 33 isolates (36.67%) with quadruple AGEAT mutant allele, of which 32 isolates (96.97%) were highly sulphadoxine resistant (P < 0.01) in vitro. CONCLUSION: Our present findings implicate that because of enormous drug (sulphfadoxine) pressure, novel AGEAT mutation was highly correlated (P < 0.01) with sulphadoxine resistance.