Long-Term In Vitro Adhesive Properties of Two Universal Adhesives to Dentin.

The composition of universal adhesives, as well as the adhesive strategy, may influence bonding effectiveness and durability. This study aimed to evaluate the microtensile bond strength (µTBS) and nanoleakage (NL), immediately and after 6-month aging, and in situ degree of conversion (DC), of two universal adhesives (Scotchbond Universal Adhesive, SBU; Xeno Select, XEN) applied with etch-and-rinse (ER) and self-etch (SE) strategies, in comparison with a two-step SE adhesive (Clearfil SE Bond, CSE). Dentin surfaces of fifty human third molars were randomly assigned to the following adhesives: two universal adhesives, SBU and XEN, applied in ER or SE mode and CSE, used as control. Teeth were sectioned into beams to be tested under µTBS, half of them after 24 h, and the rest after 6 months of water aging. Selected beams from each tooth were used for NL evaluation and in situ DC quantification. SBU and CSE showed significantly higher mean µTBS and lower nanoleakage than XEN, regardless of the evaluation time and adhesion strategy. XEN-SE yielded the lowest degree of conversion. Therefore, adhesive properties of universal adhesives to dentin are material dependent, regardless of the adhesion strategy, exhibiting XEN a significantly worse performance than SBU.

Múltiples reacciones adversas graves a fármacos en un paciente luego de la infección por COVID-19: informe de un caso / Drug-induced severe cutaneous adverse reactions in a patient after COVID-19 infection: case report

Durante la pandemia por COVID-19 se observaron diversas reacciones adversas a fármacos. Esto pudo haber estado relacionado con una mayor susceptibilidad inmunológica de los pacientes con SARS-CoV-2 a presentar este tipo de cuadros, así como también con la exposición a múltiples medicamentos utilizados en su tratamiento. Comunicamos el caso de un paciente con una infección respiratoria grave por COVID-19, que presentó 2 reacciones adversas graves a fármacos en un período corto de tiempo. (AU)

During the COVID-19 pandemic, various adverse drug reactions were observed. This could have been related to a greater immunological susceptibility of patients with SARS-CoV-2 to present this type of symptoms, as well as exposure to multiple drugs used in their treatment. We report the case of a patient with a severe respiratory infection due to COVID-19, who presented 2 serious adverse drug reactions associated with paracetamol in a short period of time. (AU)

Treatment of Psoriasis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations.

OBJECTIVE: Our aim was to summarize and evaluate the current quality of evidence regarding the efficacy of therapies for cutaneous psoriasis (PsO) in patients with psoriatic arthritis (PsA). METHODS: A literature search of MEDLINE, Embase, Cochrane Library databases, and conference abstracts was conducted to identify interventional randomized controlled trials in patients with PsA between February 2013 and December 2021. Studies were included if PsO outcomes included achieving at least 75% improvement in the Psoriasis Area and Severity Index and the blinded comparison period was ≥ 10 weeks. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology was employed to assess quality of the evidence to inform and update the 2021 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations. RESULTS: A total of 116 studies and 36 abstracts identified in the initial search were screened. A total of 37 studies (40 treatment arms) met the criteria for final inclusion. Phosphodiesterase 4 inhibitors, Janus kinase inhibitors, and tyrosine kinase 2 inhibitors, interleukin 17 inhibitors (IL-17i), IL-12/23i, IL-23i, and tumor necrosis factor inhibitors (TNFi) had high-quality data broadly supporting the efficacy of each class for plaque PsO over placebo. Head-to-head studies with high-quality data supported both IL-17i and IL-23i over TNFi. CONCLUSION: Several pharmacologic therapeutic classes have high-quality evidence demonstrating efficacy for cutaneous PsO in the PsA population. The findings will be integrated into the 2021 GRAPPA treatment recommendations, intended to guide selection of a therapeutic class where efficacy in 1 or more cutaneous or musculoskeletal domains is required.

An Online Community for Patient with Psoriasis with Built-in Self-Reported Questionnaires.

This study presents an online psoriasis community developed with dermatologists in a PHR. We describe the interaction of users with this platform and the relationship between the use of self-report questionnaires, their results and users' subsequent contact with the healthcare system. Out of 2175 users that interacted with the platform, 477 visited the forums. 60% of those who completed questionnaires presented at least one abnormal result that prompted a recommendation for an outpatient visit. Although our data suggest a trend, we failed to find a statistically significant association between questionnaire severity and visits scheduling. To our knowledge, this is the first study that analyses the relationship between patient self-reported disease severity and the subsequent contact with the healthcare system.

Impact of Ocular Complications on Visual Outcomes in Adult Patients With Uveitis.

Background In this study, we aimed to assess the impact of ocular complications on visual outcomes in uveitis. Methodology We conducted a retrospective cohort study of 474 uveitis patients (655 eyes) with a mean age of 52.4 years who were followed for a median of 32 months (range: 8-80 months). Results At least one ocular complication was found in 317 eyes (48.4%), 161 of which were present at the time of diagnosis (prevalent complication). Although having an ocular complication was associated with a mean loss of 1.7 Early Treatment Diabetic Retinopathy Study (ETDRS) lines, the best-corrected visual acuity increased at the end of the study. Complications causing a decrease of ≥2 ETDRS lines were prevalent macular and peripheral retinal diseases, as well as new-onset corneal lesions, intraocular pressure alterations, and peripheral retinal diseases. Conclusions The impact of the most frequent complications (cataract and macular edema) did not reach two ETDRS lines. Macular diseases at presentation were the main risk factor for visual loss at the end of follow-up.

High impact of a national psoriasis telementoring clinic on medical practices for patients in underserved areas.

Argentina is a large country in which important asymmetries exist in the knowledge and management of psoriasis. For this reason, in 2015 we launched Project ECHO Psoriasis, a telementoring strategy for dermatologists aimed at providing best medical practices in this population. The main objective of this study was to explore the reasons why the physicians participating in Project ECHO Psoriasis Argentina sought remote assistance. Cross-sectional study of the consultations made by dermatologists to the panel of experts. 213 consultations, which involved 158 patients in 60 teleclinics, were analyzed. The most frequent reasons for consultation were to implement changes in ongoing treatment, to support the treating physician approach to the patient, and to choose a de novo treatment, which were observed in 63 (39.9%), 47 (29.7%) and 46 (29.1%) consultations, respectively. The experts suggested modifying the approach to the patients in two thirds of the consultations (69.6%; 95% CI 61.8-76.7). Complete and partial compliance with the suggestions were observed in 66.4% (95% CI 56.7-75.1) and in 4.5% (95% CI 1.5-10.3), respectively. The main barriers identified were adherence by the patients and health services access issues. Telementoring for psoriasis is useful in reducing asymmetries in knowledge between dermatologists and ensuring access to the best clinical practices.

Idiopathic sclerochoroidal calcifications: Case report, metabolic causes and differential diagnosis / Calcificações esclerocoroidais idiopáticas: relato de caso, causas metabólicas e diagnóstico diferencial

Abstract Sclerochoroidal calcifications (SC) are a rare and benign ocular condition characterized by yellow-white irregular subretinal lesions usually found in the supero-temporal arcade of the midperipheral fundus in middle-aged elderly men. We present a clinical case of a 79- year-old patient who during a fundus examination presented raised whitish nodules in the supero-temporal arcade in the right eye. After performing optical coherence tomography, ultrasound, ocular computed tomography and laboratory analysis, she was diagnosed with idiopathic sclerochoroidal calcifications The pathogenesis of sclerochoroidal calcifications remains unclear but systemic conditions should be discarded. It is important to distinguish sclerochoroidal calcifications from other conditions such as tumors.

Resumo Calcificações esclerocoroidais (SC) são uma condição ocular rara e benigna caracterizada por lesões sub-retinianas irregulares amarelo-brancas, geralmente encontradas na arcada superotemporal do fundo médio-periférico em homens idosos de meia-idade. Apresentamos um caso clínico de uma paciente de 79 anos que durante exame de fundo apresentou nódulos esbranquiçados elevados na arcada superotemporal do olho direito. Após realizar tomografia de coerência óptica, ultra-sonografia, tomografia computadorizada ocular e análise laboratorial, ela foi diagnosticada com calcificações esclerocoroidais idiopáticas A patogênese das calcificações esclerocoroidais permanece incerta, mas as condições sistêmicas devem ser descartadas. É importante distinguir calcificações esclerocoroidais de outras condições, como tumores.

Medical resource consumption of moderate/severe psoriasis in a private health organization of Buenos Aires, Argentina,

Abstract Background: Despite the economic burden of psoriasis for patients and societies, scant information exists regarding the impact and burden of the disease in Argentina. Objective: The objective of this study was to estimate medical resource consumption and direct health care costs for patients with moderate/severe psoriasis in Buenos Aires, Argentina from the perspective of the payer. Methods: Adults with moderate/severe psoriasis (severity was defined as receiving systemic treatment), during January 2010-January 2014, aged 18 years and older, members of the Italian Hospital Medical Care Program with at least 18 months of follow-up were included. All data on hospitalizations, drug prescription, outpatient episodes, consultations, and investigations/tests in the 12 months before inclusion in the study were considered for the estimation of medical resource consumption and direct health care costs. First-quarter 2018 costs were obtained from the IHMCP and converted into US dollars (using the January 2018 exchange rate). Results: A total of 791 patients were included. The mean age at diagnosis was 34 ± 12 years. Almost 65% of the patients had a dermatologist as their usual source of care, 43% had internists, and 14% had rheumatologists. The average yearly direct cost was US$ 5326 (95% CI: 4125-7896) per patient per year. Study limitation: The single center design and the retrospective nature are the main limitations. Conclusion: This is the first Argentine study that evaluated the costs of moderate/severe psoriasis by taking into consideration the direct medical costs of the disease.

Medical resource consumption of moderate/severe psoriasis in a private health organization of Buenos Aires, Argentina.

BACKGROUND: Despite the economic burden of psoriasis for patients and societies, scant information exists regarding the impact and burden of the disease in Argentina. OBJECTIVE: The objective of this study was to estimate medical resource consumption and direct health care costs for patients with moderate/severe psoriasis in Buenos Aires, Argentina from the perspective of the payer. METHODS: Adults with moderate/severe psoriasis (severity was defined as receiving systemic treatment), during January 2010-January 2014, aged 18 years and older, members of the Italian Hospital Medical Care Program with at least 18 months of follow-up were included. All data on hospitalizations, drug prescription, outpatient episodes, consultations, and investigations/tests in the 12 months before inclusion in the study were considered for the estimation of medical resource consumption and direct health care costs. First-quarter 2018 costs were obtained from the IHMCP and converted into US dollars (using the January 2018 exchange rate). RESULTS: A total of 791 patients were included. The mean age at diagnosis was 34±12 years. Almost 65% of the patients had a dermatologist as their usual source of care, 43% had internists, and 14% had rheumatologists. The average yearly direct cost was US$ 5326 (95% CI: 4125-7896) per patient per year. STUDY LIMITATION: The single center design and the retrospective nature are the main limitations. CONCLUSION: This is the first Argentine study that evaluated the costs of moderate/severe psoriasis by taking into consideration the direct medical costs of the disease.

Carcinoma mucinoso primario de piel / Primary mucinous skin carcinoma

El adenocarcinoma mucinoso primario de piel es una neoplasia anexial, maligna e infrecuente, que afecta principalmente a hombres en una relación 2:1 con respecto a las mujeres. Presenta mayor incidencia entre la sexta y séptima década de la vida, y se manifiesta como un tumor único, asintomático, de tamaño variable. La localización más frecuente es la región periorbitaria y el cuero cabelludo. Se comunica el caso de una paciente de 92 años, con diagnóstico de carcinoma mucinoso primario de piel, sin evidencia de enfermedad sistémica ni recurrencia local al año de la resección por cirugía micrográfica de Mohs. Describimos sus principales características clínicas, dermatoscópicas y hallazgos histopatológicos. (AU)

Primary mucinous adenocarcinoma of the skin is an adnexal, malignant, and infrequent neoplasm that mainly affects men with a 2: 1 ratio, with respect to women. It presents higher incidence between the sixth and seventh decade of life, and manifests as a single tumor, asymptomatic, of variable size. The most frequent location is the periorbital region and scalp. We report the case of a 92-year-old patient with a diagnosis of primary mucinous skin carcinoma, without evidence of systemic disease or local recurrence one year after resection by Mohs micrographic surgery. We describe its main clinical features, dermatoscopic and histopathological findings. (AU)

Prokaryotic and viral community of the sulfate-rich crust from Peñahueca ephemeral lake, an astrobiology analogue.

Peñahueca is an athalassohaline hypersaline inland ephemeral lake originated under semiarid conditions in the central Iberian Peninsula (Spain). Its chemical composition makes it extreme for microbial life as well as a terrestrial analogue of other planetary environments. To investigate the persistence of microbial life associated with sulfate-rich crusts, we applied cultivation-independent methods (optical and electron microscopy, 16S rRNA gene profiling and metagenomics) to describe the prokaryotic community and its associated viruses. The diversity for Bacteria was very low and was vastly dominated by endospore formers related to Pontibacillus marinus of the Firmicutes phylum. The archaeal assemblage was more diverse and included taxa related to those normally found in hypersaline environments. Several 'metagenome assembled genomes' were recovered, corresponding to new species of Pontibacillus, several species from the Halobacteria and one new member of the Nanohaloarchaeota. The viral assemblage, although composed of the morphotypes typical of high salt systems, showed little similarity to previously isolated/reconstructed halophages. Several putative prophages of Pontibacillus and haloarchaeal hosts were identified. Remarkably, the Peñahueca sulfate-rich metagenome contained CRISPR-associated proteins and repetitions which were over 10-fold higher than in most hypersaline systems analysed so far.

Correction to: Health care services use among long-term breast cancer survivors: a systematic review.

The article Health care services use among long-term breast cancer survivors: a systematic review, written by Anna Jansana, Margarita Posso, Inmaculada Guerrero, Alexandra Prados-Torres, Maria Isabel Del Cura, Xavier Castells and Maria Sala, was originally published electronically.

Health care services use among long-term breast cancer survivors: a systematic review.

PURPOSE: Long-term breast cancer survivors are women surviving at least 5 years after diagnosis. This systematic review aimed to summarize the main characteristics and patterns of healthcare service use (frequency of visits, health providers visited, and preventive care performed) among long-term breast cancer survivors. METHODS: We used standard Cochrane Collaboration methods and searched the MEDLINE and EMBASE databases up to January 2018. We included English language observational studies reporting health service use among long-term cancer survivors. The quality of the studies was appraised through the ROBINS-I assessment tool. Two independent reviewers performed both the study quality assessment and the data extraction. RESULTS: A total of 23 observational studies were included that reported data on health services use by long-term breast cancer survivors. Despite heterogeneity among studies, about half of them reported that breast cancer survivors visited a medical provider at least once a year, as recommended by breast cancer survival guidelines. Although survivors visited medical providers with the recommended frequency, a substantial number used specialist care instead of primary care during follow-up. The results showed underuse of the recommended annual mammogram. CONCLUSIONS: Long-term breast cancer survivors differ in their health services use with regard to the frequency of visits as well as the health providers seen. Our results indicate the need for active surveillance through primary care providers in coordination with specialized care. IMPLICATIONS FOR CANCER SURVIVORS: This review could help to standardize the management of breast cancer survivors and decision-makers to adapt their guidelines and clinical protocols.

Importancia del seguimiento de lesiones melanocíticas con dermatoscopia digital para el diagnóstico temprano de melanoma / Importance of monitoring melanocytic lesions with digital dermatoscopy for diagnosis early melanoma

La dermatoscopia digital es una herramienta que permite el diagnóstico de melanomas en estadios tempranos, por medio del seguimiento de las lesiones pigmentarias a largo plazo. Se comunican tres casos de pacientes con alto riesgo de melanoma, en los cuales ‒a través del seguimiento con dermatoscopia digital‒ se realizó el diagnóstico de la enfermedad mediante la detección de cambios morfológicos, arquitecturales y de pigmentación de las lesiones estudiadas. (AU)

Digital dermoscopy is a tool that allows the early diagnosis of melanomas, through the long-term follow up of pigmentary skin lesions. We report three cases of patients with high-risk of melanoma, in which the diagnosis had been made by morphological, arquitectural and pigmentary changes observed by the digital dermoscopy follow-up. (AU)

Desafíos terapéuticos en la enfermedad injerto contra huésped / Therapeutic challenges in graft versus host disease

La enfermedad injerto contra huésped es una entidad en la cual las células inmunológicas competentes de un tejido injertado reconocen y dañan antígenos presentes en el receptor del trasplante, que es incapaz de defenderse de ellas. Es una complicación frecuente del trasplante alogénico de médula ósea, y con menor frecuencia se produce luego de trasplantes de órganos sólidos o transfusiones de hemoderivados no irradiados. Se comunica el caso de una paciente de sexo femenino de 23 años, con leucemia linfoblástica aguda.y trasplante alogénico de médula ósea, que presentó una enfermedad injerto contra huésped con compromiso cutáneo y gastrointestinal dependiente de corticoides, con mejoría de los signos y síntomas cutáneos luego del tratamiento con infliximab y fotoféresis extracorpórea. (AU)

Graft versus host disease is an entity in which competent grafted immune cells recognize and damage tissue antigens present in the transplant recipient, who is unable to defend from them. It is one of the most serious complications in patients undergoing allogeneic bone marrow transplantation, although less frequently it may be associated with solid organ transplants or transfusions of not irradiated blood products. We report the case of a 23 year-old patient with acute lymphoblastic leukemia and allogeneic bone marrow transplantation, that presented graft versus host disease with skin and gastrointestinal involvement, dependent on corticosteroids, that showed improvement in signs and skin symptoms after treatment with infliximab and extracorporeal photopheresis. (AU)

Influence of proximal box elevation on bond strength of composite inlays.

OBJECTIVES: The objective of the present study was to evaluate the influence of proximal box elevation on microtensile bond strength (mTBS) of composite inlays to the proximal box floor, using either a total-etch or a self-adhesive resin cement. MATERIALS AND METHODS: Twenty-five human molars were selected, and a class II OM (inlay) cavity preparation was performed in each tooth. Cavities were randomly assigned into four experimental groups, according to the location of the proximal cervical margin (located 1 mm below cementoenamel junction (CEJ), or with proximal box elevation with composite resin) and the resin cement used for luting (a total-etch resin cement RelyX ARC or a self-adhesive resin cement G-Cem). After 1-week water storage, samples were subjected to mTBS test. Results were analyzed by Kruskal-Wallis and Mann-Whitney U tests (p < 0.05). RESULTS: Kruskal-Wallis revealed statistically significant differences among experimental groups (p = 0.007). Both resin cements showed similar bond strength values when cervical margin was located below CEJ. The proximal box elevation improved the bond strength of composite inlays for both resin cements. However, only for G-Cem was this improvement statistically significant. CONCLUSIONS: The proximal box elevation improved the bond strength attained by G-Cem resin cement. For RelyX ARC, the position of the cervical margin did not affect composite inlays bond strength. CLINICAL RELEVANCE: Proximal box elevation does not decline bond strength of composite inlays to the proximal floor when a total-etch or a self-adhesive resin cement is used.

Effect of surface treatment and aging on bond strength of composite resin onlays.

STATEMENT OF PROBLEM: Additional polymerization of indirect composite resins enhances their physical properties but lessens the potential for chemical bonding. PURPOSE: The purpose of this in vitro study was to evaluate the influence of different surface treatments and 6-month water storage on the microtensile bond strength (µTBS) of composite resin onlays. MATERIAL AND METHODS: Composite resin onlays (Filtek Z250) randomly received 6 different surface treatments: (1) airborne-particle abrasion with 27-µm alumina particles+Adper Scotchbond 1XT adhesive application, (2) airborne-particle abrasion with alumina particles+silane application (ESPE SIL)+Adper Scotchbond 1XT, (3) airborne-particle abrasion with alumina particles+Scotchbond Universal adhesive, (4) tribochemical silica coating with 30-µm particles (CoJet Sand)+Adper Scotchbond 1XT adhesive, (5) tribochemical silica coating+silane application+Adper Scotchbond 1XT, and (6) tribochemical silica coating+Scotchbond Universal adhesive. Onlays were luted to fresh composite resin specimens with RelyX Ultimate resin cement. Bonded assemblies were stored in water for 24 hours or 6 months at 37°C and subjected to the µTBS test. Additional surface-treated composite resin onlays were analyzed with a contact profilometer to determine average roughness, and micromorphologic changes were analyzed with scanning electron microscopy. RESULTS: Airborne-particle abrasion with alumina followed by Adper Scotchbond 1XT or Scotchbond Universal adhesive application provided the highest bond strength values at 24 hours. Lower values were obtained after tribochemical silica coating. After 6 months of artificial aging, airborne-particle abrasion with alumina or silica-coated alumina particles followed by Scotchbond Universal application yielded the greatest bond strength results. Airborne-particle abrasion with alumina produced the highest roughness values and a more irregular surface. CONCLUSION: Adhesive selection seems to be relevant to the µTBS of luted composite resin onlays after 6 months of water aging, as specimens treated with Scotchbond Universal, after alumina airborne-particle abrasion or tribochemical silica coating, yielded the highest values and better aging stability.

Effect of low-concentration bleaching products on enamel bond strength at different elapsed times after bleaching treatment.

This study evaluated the effects of several low-concentration bleaching products on microtensile bond strength (µTBS) to enamel at different elapsed times after the bleaching treatment. One hundred and fifty bovine incisors were divided into five groups: No treatment, 10% carbamide peroxide (Opalescence), 10% hydrogen peroxide (Opalescence Treswhite Supreme), 3% carbamide peroxide plus lactoperoxidase (WhiteKin), or 3% carbamide peroxide plus 2.7% carbamide peroxide (Clysiden Kit Express). All treatments lasted 4 weeks. After bleaching treatment or non-treatment, teeth were restored immediately, at 1, 3, 7, or 14 days after bleaching and submitted to µTBS test. Data were analyzed by ANOVA and Tukey's test (p<0.05). For WhiteKin and Clysiden, µTBS to enamel was significantly reduced immediately, at 1, 3 and 7 days after bleaching. At 14 days after bleaching, similar µTBS values were obtained regardless of bleaching product. Therefore, while over-the-counter (OTC) products might affect bond strength to enamel, this effect was no longer observed after 14 days.