Tipos de prótesis sobre implantes en pacientes edéntulos planificados en la clínica dental docente de la Universidad Peruana Cayetano Heredia / Types of prosthesis on implants in patients edentulous planned in the teaching dental clinic of the Peruvian University Cayetano Heredia

Objetivo: Determinar la frecuencia de tipos de prótesis sobre implantes planificados en pacientes edéntulos en los servicios del Posgrado de Rehabilitación Oral e Implantología Oral Integral de la Clínica Dental Docente de la Universidad Peruana Cayetano Heredia durante los años 2016 y 2017. Material y métodos: La investigación fue descriptiva, retrospectiva, observacional y transversal, las variables: los tratamientos planificados, clasificándolos por género, edad, sede, servicio, tipo de prótesis sobre implantes, clasificación de edentulismo y zona edéntula. Se empleó la base de datos de todas las historias clínicas digitalizadas con presentación de caso planificada y aceptada por el docente tutor y acta de compromiso aceptada por el paciente. Resultados: Se encontraron 296 diversos tipos de prótesis sobre implantes, 68.58% en el sexo femenino, la edad promedio fue de 54,23 años, el mayor porcentaje entre los 60 y 69 años, la sede de San Isidro fueron planificados 61,15%, en el servicio de RO 60,81%, el mayor porcentaje de prótesis sobre implantes se realizó en el maxilar superior, el tipo de prótesis sobre implante con mayor porcentaje fue la prótesis unitaria 58,78%, según clasificación de edentulismo se encontró el mayor porcentaje en el edéntulo parcial, el mayor porcentaje en el edentulismo total fue la prótesis híbrida con 59,46% y en el edentulismo parcial fue la prótesis unitaria con un 66,80%. Conclusiones: La mayor frecuencia fue para las prótesis unitarias, según género fue el femenino, según sede fue San Isidro y según servicio RO, según zona edéntula el maxilar superior, en edéntulos totales la prótesis híbrida y en edéntulos parciales la prótesis unitaria.

Objective: To determine the frequency of types of prostheses on planned implants in edentulous patients in the postgraduate services of Oral Rehabilitation and Integral Oral Implantology of the Teaching Dental Clinic of the Universidad Peruana Cayetano Heredia during the years 2016 and 2017. Materials and methods: The research was descriptive, retrospective, observational and transversal, the variables: the planned treatments, classifying them by gender, age, seat, service, type of prosthesis on implants, classification of edentulism and edentulous zone. The database of all the digitalized medical histories was used with the presentation of the planned case and accepted by the tutor and commitment certificate accepted by the patient. Results: We found 296 different types of prostheses on implants, 68.58% in the female sex, the average age was 54.23 years, the highest percentage between 60 and 69 years, the San Isidro headquarters were planned 61.15%, in the service of RO 60.81%, the highest percentage of prostheses on implants was made in the upper jaw, the type of prosthesis on implant with the highest percentage was the unitary prosthesis 58.78%, according to the classification of edentulism the highest percentage was found in the partial edentulous, the The highest percentage in total edentulism was the hybrid prosthesis with 59.46% and in partial edentulism it was the unitary prosthesis with 66.80%. Conclusions: Unitary prostheses were the most frequent, according to gender was female, according to San Isidro and according to RO service, according to the upper edentulous area, in total edentulous the hybrid prosthesis and in partial edentulous the unitary prosthesis.

Outpatient Interventions That May Enhance the Care of a Patient with Co-existing Moyamoya and Down Syndromes.

Moyamoya vasculopathy is a condition of chronic, progressive occlusion of the distal internal carotid arteries and the Circle of Willis. The resultant ischemia produces compensatory angiogenesis and the growth of a network of collateral blood vessels, which on angiography resemble a "puff of smoke" or "moyamoya" in Japanese. The objective of this case report is to describe the clinical course of a patient with Down and moyamoya syndromes and to enlighten clinicians about strategies that can be taken to enhance the care of similar patients. A 55-year-old African American female presented to the hospital with complaints of headache, vision loss, dysarthria, and ataxia. She had a past medical history of Down syndrome and a stroke with residual lower extremity weakness. At her baseline, the patient was able to perform her activities of daily living but required assistance with independent activities of daily living. Computed tomography of the brain showed hypodense areas at the right occipital, temporal, and parietal lobes. Computed tomography angiography of the head and neck identified occlusion bilaterally at the supraclinoid internal carotid arteries and right posterior cerebral artery; there was collateral arterial flow within the right middle cerebral and anterior cerebral arteries that was consistent with moyamoya vasculopathy. Patients with Down syndrome experience premature accelerated aging and suffer from comorbidities seen in geriatric patients by the time they reach their 40s. Patients with moyamoya vasculopathy experience neurocognitive and neuropsychiatric deficits that correspond to the regions of the brain that are affected. This patient with Down and moyamoya syndromes had impaired neurocognitive and functional status, and we believe that she would have benefited from receiving a comprehensive geriatric assessment and neuropsychiatric testing.

Normal central retinal function and structure preserved in retinitis pigmentosa.

PURPOSE: To determine whether normal function and structure, as recently found in forms of Usher syndrome, also occur in a population of patients with nonsyndromic retinitis pigmentosa (RP). METHODS: Patients with simplex, multiplex, or autosomal recessive RP (n = 238; ages 9-82 years) were studied with static chromatic perimetry. A subset was evaluated with optical coherence tomography (OCT). Co-localized visual sensitivity and photoreceptor nuclear layer thickness were measured across the central retina to establish the relationship of function and structure. Comparisons were made to patients with Usher syndrome (n = 83, ages 10-69 years). RESULTS: Cross-sectional psychophysical data identified patients with RP who had normal rod- and cone-mediated function in the central retina. There were two other patterns with greater dysfunction, and longitudinal data confirmed that progression can occur from normal rod and cone function to cone-only central islands. The retinal extent of normal laminar architecture by OCT corresponded to the extent of normal visual function in patients with RP. Central retinal preservation of normal function and structure did not show a relationship with age or retained peripheral function. Usher syndrome results were like those in nonsyndromic RP. CONCLUSIONS: Regional disease variation is a well-known finding in RP. Unexpected was the observation that patients with presumed recessive RP can have regions with functionally and structurally normal retina. Such patients will require special consideration in future clinical trials of either focal or systemic treatment. Whether there is a common molecular mechanism shared by forms of RP with normal regions of retina warrants further study.

CERKL mutations cause an autosomal recessive cone-rod dystrophy with inner retinopathy.

PURPOSE: To define the phenotype of the retinal degeneration associated with mutations in the CERKL gene. METHODS: Six patients (ages, 26-54 years) from three unrelated families with CERKL mutations were studied clinically and by electroretinography, kinetic, and chromatic static perimetry, autofluorescence (AF) imaging, and optical coherence tomography (OCT). RESULTS: Three siblings were homozygotes for p.R257X mutation; two siblings were compound heterozygotes for p.R257X and a novel p.C362X mutation; and one patient had only p.R257X mutation identified to date. There was a spectrum of severity: from mild visual acuity loss to light perception; from full kinetic fields with relative central scotomas to remnant peripheral islands; from reduced ERGs (some with negative waveforms) to nondetectable signals. Maculopathy showed residual foveal islands or extensive central rod and cone scotomas. With AF imaging, there was evidence of hyperautofluorescence at earlier and hypoautofluorescence at later disease stages. Peripheral function was generally less affected than central function. With OCT there were small foveal islands of outer nuclear layer (ONL) in those with preserved acuity. Eccentric to an annular region with no discernible ONL, there could be ONL in the midperiphery. At early disease stages, ganglion cell layer thickness was less affected than ONL. Later disease stages were accompanied by inner nuclear layer and nerve fiber layer abnormalities. CONCLUSIONS: CERKL mutations are associated with widespread retinal degeneration with prominent maculopathy. The clinical presentation is that of an autosomal recessive cone-rod dystrophy. Photoreceptor loss appears at all stages of disease and inner laminopathy complicates the phenotype at later stages.

Leber congenital amaurosis caused by Lebercilin (LCA5) mutation: retained photoreceptors adjacent to retinal disorganization.

PURPOSE: To determine the retinal disease expression in the rare form of Leber congenital amaurosis (LCA) caused by Lebercilin (LCA5) mutation. METHODS: Two young unrelated LCA patients, ages six years (P1) and 25 years (P2) at last visit, both with the same homozygous mutation in the LCA5 gene, were evaluated clinically and with noninvasive studies. En face imaging was performed with near-infrared (NIR) reflectance and autofluorescence (AF); cross-sectional retinal images were obtained with optical coherence tomography (OCT). Dark-adapted thresholds were measured in the older patient; and the transient pupillary light reflex was recorded and quantified in both patients. RESULTS: Both LCA5 patients had light perception vision only, hyperopia, and nystagmus. P1 showed a prominent central island of retinal pigment epithelium (RPE) surrounded by alternating elliptical-appearing areas of decreased and increased pigmentation. Retinal laminar architecture at and near the fovea was abnormal in both patients. Foveal outer nuclear layer (ONL) was present in P1 and P2 but to different degrees. With increasing eccentricity, there was retinal laminar disorganization. Regions of pericentral and midperipheral retina in P1, but not P2, could retain measurable ONL and less laminopathy. P2 had a small central island of perception with >5 log units of sensitivity loss. Pupillary responsiveness was present in both LCA5 patients; the thresholds were abnormally elevated by >or=5.5 log units. CONCLUSIONS: LCA5 patients had evidence of retained photoreceptors mainly in the central retina. Retinal remodeling was present in pericentral regions in both patients. The NIR reflectance and NIR-AF imaging in the younger patient suggested preserved RPE in retinal regions with retained photoreceptors. Detailed phenotype studies in other LCA5 patients with longitudinal follow-up will help determine the feasibility of future intervention in this rare disease.

Usher syndromes due to MYO7A, PCDH15, USH2A or GPR98 mutations share retinal disease mechanism.

Usher syndrome (USH) is a genetically heterogeneous group of autosomal recessive deaf-blinding disorders. Pathophysiology leading to the blinding retinal degeneration in USH is uncertain. There is evidence for involvement of the photoreceptor cilium, photoreceptor synapse, the adjacent retinal pigment epithelium (RPE) cells, and the Crumbs protein complex, the latter implying developmental abnormalities in the retina. Testing hypotheses has been difficult in murine USH models because most do not show a retinal degeneration phenotype. We defined the retinal disease expression in vivo in human USH using optical imaging of the retina and visual function. In MYO7A (USH1B), results from young individuals or those at early stages indicated the photoreceptor was the first detectable site of disease. Later stages showed photoreceptor and RPE cell pathology. Mosaic retinas in Myo7a-deficient shaker1 mice supported the notion that the mutant photoreceptor phenotype was cell autonomous and not secondary to mutant RPE. Humans with PCDH15 (USH1F), USH2A or GPR98 (USH2C) had a similar retinal phenotype to MYO7A (USH1B). There was no evidence of photoreceptor synaptic dysfunction and no dysplastic phenotype as in CRB1 (Crumbs homologue1) retinopathy. The results point to the photoreceptor cell as the therapeutic target for USH treatment trials, such as MYO7A somatic gene replacement therapy.

Retinal laminar architecture in human retinitis pigmentosa caused by Rhodopsin gene mutations.

PURPOSE: To determine the underlying retinal micropathology in subclasses of autosomal dominant retinitis pigmentosa (ADRP) caused by rhodopsin (RHO) mutations. METHODS: Patients with RHO-ADRP (n = 17, ages 6-73 years), representing class A (R135W and P347L) and class B (P23H, T58R, and G106R) functional phenotypes, were studied with optical coherence tomography (OCT), and colocalized visual thresholds were determined by dark- and light-adapted chromatic perimetry. Autofluorescence imaging was performed with near-infrared light. Retinal histology in hT17M-rhodopsin mice was compared with the human results. RESULTS: Class A patients had only cone-mediated vision. The outer nuclear layer (ONL) thinned with eccentricity and was not detectable within 3 to 4 mm of the fovea. Scotomatous extracentral retina showed loss of ONL, thickening of the inner retina, and demelanization of RPE. Class B patients had superior-inferior asymmetry in function and structure. The superior retina could have normal rod and cone vision, normal lamination (including ONL) and autofluorescence of the RPE melanin; laminopathy was found in the scotomas. With Fourier-domain-OCT, there was apparent inner nuclear layer (INL) thickening in regions with ONL thinning. Retinal regions without ONL had a thick hyporeflective layer that was continuous with the INL from neighboring regions with normal lamination. Transgenic mice had many of the laminar abnormalities found in patients. CONCLUSIONS: Retinal laminar abnormalities were present in both classes of RHO-ADRP and were related to the severity of colocalized vision loss. The results in human class B and the transgenic mice support the following disease sequence: ONL diminution with INL thickening; amalgamation of residual ONL with the thickened INL; and progressive retinal remodeling with eventual thinning.

Retinal disease in Usher syndrome III caused by mutations in the clarin-1 gene.

PURPOSE: To determine the retinal phenotype of Usher syndrome type III (USH3A) caused by clarin-1 (CLRN1) gene mutations in a non-Finnish population. METHODS: Patients with USH3A (n = 13; age range, 24-69) representing 11 different families were studied and the results compared with those from patients with USH2A (n = 24; age range, 17-66). The patients were evaluated by ocular examination, kinetic and static perimetry, near-infrared autofluorescence, and optical coherence tomography (OCT). RESULTS: Ten of 11 families had Ashkenazi Jewish origins and the N48K CLRN1 mutation. Rod function was lost in the peripheral field in the first two decades of life, but central rod function could be retained for another decade. Peripheral cone function was detectable into the third decade of life. Central cone function had a slower decline that extended for decades. Photoreceptor layer loss and features of retinal remodeling were present in retinal regions with severe visual dysfunction, even at the youngest ages tested. Central retinal structure could be normal in younger patients but structural integrity was lost in older patients. RPE disease generally paralleled photoreceptor degeneration. Comparisons between USH3A and USH2A suggested a common rod and cone phenotype but a more accelerated time course of rod loss in USH3A. CONCLUSIONS: USH3A and USH2A share patterns of rod and cone dysfunction and retinal structural abnormalities. Peripheral function measurements showed USH3A to be more rapidly progressive than USH2A.

Satisfacción laboral de docentes universitarios del Departamento Académico de Clínica Estomatológica / Labour satisfaction of the teaching staff of the Department of Stomatology

El presente estudio determinó la satisfacción laboral del personal docente del Departamento Académico de Clínica Estomatológica de la Facultad de Estomatología Roberto Beltrán Neira de la Universidad Peruana Cayetano Heredia, tomando como grupo de estudio a 36 docentes (14 mujeres y 22 hombres) que se encontraban laborando en Febrero del 2005. Se utilizó una encuesta usando la escala de Liker, midiendo los cuatro factores de la satisfacción laboral. La satisfacción laboral por la institución fue BUENA. La satisfacción laboral por la remuneración, tensión laboral y condición laboral fue REGULAR. Además la satisfacción laboral global fue REGULAR.