Latin American Registry of Idiopathic Pulmonary Fibrosis (REFIPI): Clinical Characteristics, Evolution and Treatment.

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a progressive, irreversible and frequently fatal disease. Currently there are national and multinational registries in Europe, United States, Australia and China to better understand the magnitude of the problem and the characteristics of the IPF patients. However, there are no national or regional registries in Latin America, so the objective of this study was to carry out a Latin American registry that would allow the identification of IPF patients in our region. METHODOLOGY: A system consisting of 3 levels of control was designed, ensuring that patients met the diagnostic criteria for IPF according to international guidelines ATS/ERS/ALAT/JRS 2011. Demographic, clinical, serological, functional, tomographic, histological and treatment variables were recorded through a digital platform. RESULTS: 761 IPF patients from 14 Latin American countries were included for analysis, 74.7% were male, with a mean age of 71.9+8.3 years. In general there was a long period of symptoms before definitive diagnosis (median 1 year). In functional tests, an average reduction of FVC (70.9%) and DLCO (53.7%) was detected. 72% received at least one antifibrotic drug (pirfenidone or nintedanib) and 11.2% of the patients had an acute exacerbation, of which 38 (45.2%) died from this cause. CONCLUSIONS: Like other registries, we found that there is difficulty in the recognition and excessive delay in the diagnosis of IPF in Latin America. Most of the patients in REFIPI received antifibrotics; these were well tolerated and associated with fewer adverse events than those reported in clinical trials.

Effect of the Nd:YAG laser on sealer penetration into root canal surfaces: a confocal microscope analysis.

OBJECTIVES: The objective of this in vitro study was to evaluate the use of the Neodymium:Yttrium-Aluminium-Garnet (Nd:YAG) laser as part of the root canal treatment on the penetration of sealer into dentinal tubules. METHODS: Eighty extracted lower premolars were randomly assigned to two groups (n=40 each): Control group (CG), subjected to a conventional protocol of endodontic instrumentation and obturation; and Laser group (LG), in which Nd:YAG laser irradiations were combined with conventional preparation and obturation. Endodonted samples were sectioned at 3 and 5 mm from the apex and observed under a confocal scanning microscope (CLSM). The penetration depth into the dentinal tubules and the extension of the intracanal perimeter infiltrated by sealer were measured. The Student-Newman-Keuls test was run for between-group comparisons (α=.05). RESULTS: The depth of sealer penetration into dentinal tubules did not differ among groups. LG samples showed the significantly highest percentage of penetrated perimeter at 3 mm from the root apex. Within each group, the greatest depth of penetration (P=.0001), and the major percentage of penetrated perimeter (P<.001), were recorded at 5 mm. CONCLUSIONS: The application of the Nd:YAG laser after instrumentation did not improve the depth of sealer penetration into the dentinal tubules. The laser enlarged the total penetrable perimeter near the apex. CLINICAL SIGNIFICANCE: The Nd:YAG laser may be an appropriate complement in root canal treatment, as it enhances the sealer adaptation to the dentinal walls in the proximity of the apex.

Tetanus immunity as a surrogate for past diphtheria-tetanus-pertussis immunization in migrant children.

BACKGROUND: Data on vaccination coverage in recently arrived refugee children are essential to formulate catch-up recommendations. "Overimmunizing" is costly and associated with risks of hyperimmunization, whereas assuming up-to-date immunizations may be misleading. METHODS: We retrospectively collected data from 92 migrant children referred to our hospital between January 2009 and May 2010. RESULTS: According to our guidelines, 68 (73.9%) children without evidence of up-to-date immunizations received a booster dose of an age-appropriate tetanus-containing vaccine. As a surrogate for diphtheria-tetanus-pertussis-poliomyelitis immunity, tetanus antibodies were measured by enzyme-linked immunosorbent assay 1 month later in 55 of 68 (80.8%) children 6 months to 16 years of age (median, 7 years) from 23 countries. All but 2 children (3.6%) had reached high antibody titers (>1.0 IU/mL) and required no further booster. Unnecessary additional tetanus immunizations thus were avoided in 53 of 55 (96.4%) patients. CONCLUSION: Assessing antitetanus antibody responses in migrant children allows individual vaccination schedules and avoids the risks of hyperimmunization.

¿Qué rol desempeña el odontólogo en el tratamiento del paciente oncológico? ¿Aporta la tecnología láser algún beneficio en el tratamiento bucal a estos enfermos? / No disponible

Introducción: La pérdida dental en sectores posteriores del maxilar, implica en muchos casos una escasa cantidad de hueso remanente que imposibilita la colocación de implantes dentales. Para solucionar este problema existen técnicas como la elevación sinusal que si bien soluciona el problema en muchos casos, no está exenta de complicaciones. La migración o el desplazamiento de implantes dentales a regiones anatómicas como el seno maxilar, es una rara pero posible complicación. Objetivo: Presentar un caso clínico de un implante dental desplazado accidentalmente al seno maxilar, para describir los factores que justifican este fenómeno y establecer una pauta terapéutica para este tipo de casos. Caso clínico: Paciente varón de 32 años al que se le realizó la colocación de implantes osteoinegrados en el segundo cuadrante, acude a nuestro servicio y se le realiza un estudio radiológico en el que evidenciamos la imagen de un implante dental a nivel del seno maxilar que fue extraído mediante abordaje intraoral. Se realizaron controles radiográficos con un seguimiento de un año es de la extracción del implante. Conclusión: Existen múltiples factores que explican la migración de un implante dental al interior del seno maxilar, la actitud siempre debe ser la de extraerlo bien sea con abordaje intraoral o mediante endoscopio por vía nasal (AU)

Introduction: Tooth loss in the maxillary posterior sites, in many cases involves a small amount of remaining bone which precludes placing dental implants. To solve this problem there are techniques such as sinus lifting, but although it solves the problem in many cases, it is not without its complications. The migration or displacement of dental implants to anatomical regions such as the maxillarysinus is a rare but possible complication. Objective: To present a clinical case of a dental implant that accidentally moved to the maxillary sinus, to describe the factors causing this phenomenon and establish guidelines for treatment of this type of case. Clinical case: Male patient, aged 32, who was given osseointegrated implants in the second quadrant, came to our service and through a radiology study we saw the image of a dental implant at the level of the maxillary sinus that was extracted using the intraoral approach. There were radiography controls monitoring progress for a year after the extraction of the implant. Conclusion: There are many factors that can explain the migration of a dental implant into the maxillary sinus, and the current approach must be to extract it well using either with intraoral approach or through nasal endoscopy (AU)

Acute disseminated fatal toxoplasmosis after haploidentical stem cell transplantation despite atovaquone prophylaxis in a young man.

We describe a case of fatal acute disseminated breakthrough toxoplasmosis in a 19-year-old adolescent after haploidentical hematopoietic stem cell transplantation for acute lymphoblastic leukemia despite continued atovaquone prophylaxis. Diagnosis was at necropsy, and confirmed by postmortem polymerase chain reaction analysis in plasma. This report illustrates the need for protozoal monitoring despite atovaquone prophylaxis, in severely immunocompromised patients with intolerance to standard treatment.

Effects of probiotic Lactobacillus casei DN-114 001 in prevention of radiation-induced diarrhea: results from multicenter, randomized, placebo-controlled nutritional trial.

PURPOSE: To determine whether a probiotic drink containing Lactobacillus casei DN-114 001 reduces the incidence of radiation-induced diarrhea in patients with gynecologic cancer. METHODS AND MATERIALS: Patients who were undergoing pelvic radiotherapy (45-50 Gy, conventional fractionation) for either cervical carcinoma (radiotherapy and weekly cisplatin) or endometrial adenocarcinoma (postoperative radiotherapy) were randomly assigned to a probiotic drink or placebo, in a double-blind fashion. The probiotic drink consisted of liquid yogurt containing L. casei DN-114 001 at 10(8) CFU/g. The patients recorded the daily the number of bowel movements and scored the stool consistency using the Bristol scale. Diarrhea was graded weekly according the Common Toxicity Criteria system. The primary endpoint was to reduce the incidence of diarrhea, defined by a Common Toxicity Criteria Grade of 2 or greater or the need for loperamide. RESULTS: A total of 85 patients were enrolled. Grade 2 or greater diarrhea and/or the use of loperamide was observed in 24 of 41 patients in the placebo group and 30 of 44 in the probiotic group (p = 0.568). No differences were found in the median time to the presentation of the primary endpoint. Probiotic intervention had a significant effect on stool consistency (p = 0.04). The median time for patients to present with Bristol scale stools of Type 6 or greater was 14 days for patients receiving the probiotic drink vs. 10 days for those receiving placebo. CONCLUSION: Nutritional intervention with the probiotic drink containing L. casei DN-114 001 does not reduce the incidence of radiation-induced diarrhea as defined by a Common Toxicity Criteria Grade 2 or greater. However, it had a significant effect on stool consistency as measured by the Bristol scale.

Influence of surround illumination on pupil size and contrast sensitivity.

Lighting plays a major role in contrast sensitivity (CS) measurements. Both the test and surround illumination influence the results although they are not usually considered in clinical practice. The effects of test luminance are well known, but the influence of surround luminance seems to be less investigated. This study aims to evaluate the differences in CS measured with two configurations of surround illumination typical of clinical practice; and to analyse the influence of the angular size of the target on pupil diameter for both surround luminances. An experimental arrangement was designed to measure CS with controlled illumination of both test and surround. An infrared pupillometer was also used to measure steady pupil size. A statistically significant increase of CS and a decrease of pupil size with higher surround illumination were found.