COVID y rellenos faciales ¿realmente debemos preocuparnos? / COVID-19 and Dermal Fillers: Should We Really Be Concerned?

La pandemia por COVID ha causado hoy en día millones de afectados, continuando su aumento a nivel mundial. Junto con la afectación los órganos diana clave (aparato respiratorio, anosmia, diarrea, fiebre, etc.), se han descrito reacciones inmunológicas tardías en los rellenos dérmicos por ácido hialurónico (AH), fundamentalmente a nivel facial. Estas alteraciones aparecen tanto en pacientes positivos para el virus, independientemente de la sintomatología sistémica, como en pacientes que han recibido vacunación frente al SARS-CoV-2. Aunque las reacciones suelen ser autolimitadas y autoresolutivas, es importante saber diagnosticarlas y en ocasiones establecer tratamiento con corticoides, hialuronidasa y/o antibióticos. Aunque no son graves, la Administración de Alimentos y Medicamentos de los Estados Unidos (FDA) las ha clasificado como evento adverso serio. Los mecanismos que originan están reacciones no están completamente dilucidados. Parece que son reacciones de hipersensibilidad retardada tipo IV, favorecidas por estímulos inmunológicos que se activan en presencia de la COVID o de otros virus como la gripe. Sin embargo, dado que los rellenos presentan cada vez mayor durabilidad y a que la pandemia continúa su curso, existiendo nuevas vacunas en desarrollo, es esencial la realización de estudios que describan la evolución a largo plazo tanto de los rellenos de AH, como de otros bioimplantes. Así mismo, es esencial alentar a los médicos de que reporten este tipo de reacciones, aunque no revistan gravedad con el objetivo de poder realizar un registro fidedigno de ellas (AU)

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs — leading to respiratory illness, anosmia, diarrhea, and fever and other complications — delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records (AU)

[Translated article] COVID-19 and Dermal Fillers: Should We Really Be Concerned? / COVID y rellenos faciales ¿realmente debemos preocuparnos?

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs – leading to respiratory illness, anosmia, diarrhea, and fever and other complications – delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records (AU)

La pandemia por COVID ha causado hoy en día millones de afectados, continuando su aumento a nivel mundial. Junto con la afectación los órganos diana clave (aparato respiratorio, anosmia, diarrea, fiebre, etc.), se han descrito reacciones inmunológicas tardías en los rellenos dérmicos por ácido hialurónico (AH), fundamentalmente a nivel facial. Estas alteraciones aparecen tanto en pacientes positivos para el virus, independientemente de la sintomatología sistémica, como en pacientes que han recibido vacunación frente al SARS-CoV-2. Aunque las reacciones suelen ser autolimitadas y autoresolutivas, es importante saber diagnosticarlas y en ocasiones establecer tratamiento con corticoides, hialuronidasa y/o antibióticos. Aunque no son graves, la Administración de Alimentos y Medicamentos (FDA) de los Estados Unidos las ha clasificado como evento adverso serio. Los mecanismos que originan estas reacciones no están completamente dilucidados. Parece que son reacciones de hipersensibilidad retardada tipo IV, favorecidas por estímulos inmunológicos que se activan en presencia de la COVID o de otros virus como la gripe. Sin embargo, dado que los rellenos presentan cada vez mayor durabilidad y a que la pandemia continúa su curso, existiendo nuevas vacunas en desarrollo, es esencial la realización de estudios que describan la evolución a largo plazo tanto de los rellenos de AH, como de otros bioimplantes. Así mismo, es esencial alentar a los médicos de que reporten este tipo de reacciones, aunque no revistan gravedad con el objetivo de poder realizar un registro fidedigno de ellas (AU)

COVID-19 and Dermal Fillers: Should We Really Be Concerned? / COVID y rellenos faciales ¿realmente debemos preocuparnos?

SARS-CoV-2 has caused millions of infections and deaths worldwide and case numbers continue to rise. Besides the effect of the virus on key organs - leading to respiratory illness, anosmia, diarrhea, and fever and other complications - delayed inflammatory reactions to hyaluronic acid dermal fillers, mainly in the face, have also been reported to occur after confirmed SARS-CoV-2 infections and in vaccinated individuals. While delayed inflammatory reactions tend to be self-limiting, they should be diagnosed and treated with corticosteroids, hyaluronidase, and/or antibiotics when necessary. The inflammation is generally not severe, yet these complications are classified as serious adverse events by the US Food and Drug Administration. They appear to be delayed type IV hypersensitivity reactions triggered by the immune system in the presence of SARS-CoV-2 or other viruses, such as those causing influenza, although the underlying mechanisms have not been fully elucidated. Because the longevity of dermal fillers is increasing, while the pandemic continues to evolve and new vaccines are under development, the long-term effects on hyaluronic acid fillers and other bioimplant materials should be studied. Physicians must also be encouraged to report these reactions, however mild, to ensure accurate records.

Alteración del nivel de conciencia puerperal: ¿puede el COVID-19 ser causa de síndrome de encefalopatía posterior reversible? / Postpartum consciousness disturbance: can covid-19 cause posterior reversible encephalopathy syndrome?

Describimos el caso de una gestante de 24 años de edad, sin enfermedades previas, que fue ingresada con diagnóstico de neumonía bilateral por el nuevo coronavirus 2. Por empeoramiento clínico precisó cesárea urgente con anestesia general e intubación orotraqueal por intolerancia al decúbito. Tras la extubación desarrolló un cuadro de obnubilación que obligó al diagnóstico diferencial de encefalitis/meningitis por SARS-CoV-2, con tomografía computarizada (TC) y angioTC normales, bioquímica del líquido cefalorraquídeo (LCR) inespecífica y resonancia magnética informada como «síndrome de encefalopatía posterior reversible» (al presentar características radiológicas sugestivas de edema vasogénico con alteraciones en la sustancia blanca de localización parieto-temporo-occipital, junto con alteración de nivel de conciencia) secundaria a cuadro hipertensivo del embarazo. La paciente 11 días después de la cesárea comenzó a desarrollar un cuadro hipertensivo que requirió tratamiento. La encefalopatía posterior reversible (PRES) asocia un conjunto de características clínicas (cefalea, alteración del nivel de conciencia, alteraciones visuales y convulsiones) y radiológicas (alteraciones reversibles en la sustancia blanca fundamentalmente en regiones parieto-temporo-occipitales) sugestivas de edema vasogénico. En pacientes gestantes SARS-CoV-2, el diagnóstico diferencial de la patología hipertensiva y las alteraciones de nivel de conciencia puede ser extremadamente complicado, al encontrarnos pruebas complementarias normales y ausencia de hipertensión arterial (HTA) en el periparto inmediato. Tal vez la secuenciación del genoma del SARS-CoV-2 en el LCR nos hubiera permitido un diagnóstico de certeza, aunque el tratamiento no hubiera variado

We describe the case of a 24-year-old pregnant woman with no history of note who was admitted with a diagnosis of bilateral pneumonia caused by the new coronavirus. Due to clinical worsening, she required urgent cesarean section with general anaesthesia and intubation for decubitus intolerance. After extubation, she presented altered mental state that required a differential diagnosis of encephalitis/meningitis secondary to SARS-CoV-2. CT and CT-angiography were normal, spinal fluid tests were non-specific, and magnetic resonance imaging reported posterior reversible encephalopathy syndrome (PRES) (due to radiological features suggestive of white matter vasogenic edema affecting the parietal, temporal and occipital lobes, along with altered mental state) secondary to gestational hypertension. Eleven days after the cesarean section the patient began to develop hypertension that required treatment. PRES is associated with certain clinical (headache, altered mental state, visual disturbances and convulsions) and radiological (reversible changes in white substance mainly affecting the parietal, temporal, and occipital lobes) characteristics suggestive of vasogenic oedema In pregnant SARS-CoV-2 patients, the differential diagnosis of hypertension and altered mental state is often extremely complicated because complementary tests can be normal and there is no immediate sign of peripartum hypertension. SARS-CoV-2 genome sequencing in spinal fluid could have provided a definitive diagnosis, but the treatment would not have differed

Postpartum consciousness disturbance: can covid-19 cause posterior reversible encephalopathy syndrome? / Alteración del nivel de conciencia puerperal: ¿puede el COVID-19 ser causa de síndrome de encefalopatía posterior reversible?

We describe the case of a 24-year-old pregnant woman with no history of note who was admitted with a diagnosis of bilateral pneumonia caused by the new coronavirus. Due to clinical worsening, she required urgent cesarean section with general anaesthesia and intubation for decubitus intolerance. After extubation, she presented altered mental state that required a differential diagnosis of encephalitis/meningitis secondary to SARS-CoV-2. CT and CT-angiography were normal, spinal fluid tests were non-specific, and magnetic resonance imaging reported posterior reversible encephalopathy syndrome (PRES) (due to radiological features suggestive of white matter vasogenic edema affecting the parietal, temporal and occipital lobes, along with altered mental state) secondary to gestational hypertension. Eleven days after the cesarean section the patient began to develop hypertension that required treatment. PRES is associated with certain clinical (headache, altered mental state, visual disturbances and convulsions) and radiological (reversible changes in white substance mainly affecting the parietal, temporal, and occipital lobes) characteristics suggestive of vasogenic oedema In pregnant SARS-CoV-2 patients, the differential diagnosis of hypertension and altered mental state is often extremely complicated because complementary tests can be normal and there is no immediate sign of peripartum hypertension. SARS-CoV-2 genome sequencing in spinal fluid could have provided a definitive diagnosis, but the treatment would not have differed.

Fractura-avulsión pélvica durante la actividad deportiva / Pelvic avulsion fracture during sports activity

Las fracturas pélvicas por avulsión se producen tras contracciones musculares violentas o explosivas en pacientes con esqueleto inmaduro. Tienen lugar por un desequilibrio entre la fuerza de tracción del músculo o tendón y la resistencia del cartílago apofisario donde se insertan, siendo verdaderos autotraumatismos. Estas lesiones habitualmente tienen un buen pronóstico, mediante un tratamiento conservador. Presentamos el caso clínico de un niño de 13 años que durante una actividad deportiva sufrió dolor e impotencia funcional en el muslo derecho, diagnosticándose de fractura-avulsión de la espina ilíaca anteroinferior derecha. Realizamos un seguimiento clínico y ecográfico; el paciente presentó una correcta evolución con reposo articular y analgesia y pudo reincorporarse a la actividad deportiva a los dos meses de la lesión(AU)

Avulsion fractures occur after violent or explosive muscular contractions in skeletally immature patients. They take place because of an imbalance between the pulling muscle force and the bone resistance where they are inserted. These lesions have a good prognosis with conservative treatment. We report a case of a thirteen year old male patient, who during sports activity referred acute pain and functional disability in the right thigh. An avulsion fracture of the anterior inferior iliac spine was diagnosed. A clinical and ultrasound imaging follow up was made, showing a satisfactory progress with joint rest and conventional analgesia, restoring sports activity two months after the initial injury(AU)

[Placement of a bronchial blocker through the I-gel supraglottic airway device for single-lung ventilation: preliminary study]. / Ventilación unipulmonar con bloqueador bronquial a través del dispositivo supraglótico I-gel. Estudio preliminar.

To describe the use of the I-gel supraglottic airway device when placing a bronchial blocker for single-lung ventilation, as applied in a preliminary study to explore the feasibility of adopting the technique with appropriate, selected patients undergoing certain thoracic surgery procedures. We used the technique for single-lung ventilation in 25 patients who required isolation of a lung for a variety of thoracic surgical procedures. A bronchial blocker was placed under direct visualization through a fiberoptic bronchoscope and the I-gel supraglottic device. The I-gel mask allowed us to establish a reliable, safe seal of the airway. For an anesthetist with sufficient experience in managing a flexible fiberoptic bronchoscope, it was possible to carry out all procedures without remarkable anesthetic or surgical events. Single-lung ventilation achieved by introducing a bronchial blocker through the I-gel supraglottic device can facilitate safe, effective management of selected patients who must undergo certain thoracic surgery procedures.

Ventilación unipulmonar con bloqueador bronquial a través del dispositivo supraglótico I-gel. Estudio preliminar / Placement of a bronchial blocker through the I-gel supraglottic airway device for singlelung ventilation: preliminary study

El objetivo es describir la técnica del ventilación unipulmonar utilizando el dispositivo supraglótico i-gel y un bloqueador bronquial como estudio preliminar para su posible aplicación futura en el manejo de determinados pacientes y procedimientos quirúrgicos torácicos adecuadamente seleccionados. Se describe la ventilación unipulmonar realizada en 25 pacientes sometidos a diferentes procedimientos de cirugía torácica en los que era necesario el aislamiento pulmonar selectivo. Éste se realizó con un bloqueador bronquial colocado, mediante visión directa fibrobroncoscópica, a través del dispositivo supraglótico i-gel. Gracias al diseño de la mascarilla i-gel, el cual permite un sellado fiable y seguro de la vía aérea, y a una adecuada experiencia en el manejo del fibrobroncoscopio óptico flexible se consiguió llevar a cabo la totalidad de los procedimientos sin incidencias reseñables tanto desde el punto de vista anestésico como quirúrgico. La ventilación unipulmonar conseguida con bloqueador bronquial, introducido a través del dispositivo supraglótico i-gel, puede ser una alternativa segura y eficaz para el manejo de pacientes que, adecuadamente seleccionados, sean sometidos a determinados procedimientos torácicos(AU)

To describe the use of the I-gel supraglottic airway device when placing a bronchial blocker for single-lung ventilation, as applied in a preliminary study to explore the feasibility of adopting the technique with appropriate, selected patients undergoing certain thoracic surgery procedures. We used the technique for single-lung ventilation in 25 patients who required isolation of a lung for a variety of thoracic surgical procedures. A bronchial blocker was placed under direct visualization through a fiberoptic bronchoscope and the I-gel supraglottic device. The I-gel mask allowed us to establish a reliable, safe seal of the airway. For an anesthetist with sufficient experience in managing a flexible fiberoptic bronchoscope, it was possible to carry out all procedures without remarkable anesthetic or surgical events. Single-lung ventilation achieved by introducing a bronchial blocker through the I-gel supraglottic device can facilitate safe, effective management of selected patients who must undergo certain thoracic surgery procedures(AU)

asistolia por compresión del seno carotideo tras punción accidental de arteria carótida interna / No disponible

No disponible

Fractura bilateral y simultánea del extremo proximal del fémur (subcapital y pertrocantérea) en un paciente joven: caso clínico / Simultaneous bilateral fractures (subcapital and trochanteric) of the proximal end of the femur in young patient: case report

Las fracturas simultáneas y bilaterales del extremo proximaldel fémur son raras. Presentamos un caso de fractura bilateralde fémur, subcapital y pertrocantérea, producida enel curso de un accidente de tráfico. Se describen las diferencias,tanto en su mecanismo de producción como en sutratamiento, respecto de las fracturas unilaterales

Simultaneous and bilateral fractures of the proximal partof the femur are unfrequent.We present a case of bilateral femoral fracture, trochantericand subcapital, produced in a high energy accident. Wedescribe the differences, in its mechanism of production aswell as in its treatment, related to unilateral ones

[Centrofacial lymphoma, cause of middle line granuloma syndrome. Report of a case]. / Linfoma centrofacial, causa de síndrome de granuloma de la línea media. Informe de un caso.

The male patient is in his fifth decade with a history of four months with right nasal obstruction, hematopurulent rhinorrea and scabs in the nose. The initial physical examination showed necrotic tissue and scabs in both the nasal foci. Three months later he presented a septal perforation and eroded necrotic injury in the hard palate. The two initial biopsies that were carried out showed chronic unspecified inflammation, and the third reported a polymorphic reticulosis. The histopathological analysis of the material of the third biopsy showed the existence of a non-angiocentric intermediate centrofacial lymphoma. The patient was submitted to treatment with simultaneous radiotherapy and chemotherapy with the end result of a totally successful remission of the lymphoma. These abnormalities usually appear as ulcers and erosions of the cartilage and bones of the nose, the paranasal sinuses and the palate. They are polymorphic, and there exists evidence of its association with the Ebstein Barr virus. The patient has been observed during the last five years and has shown no evidence of recurrence of any related of the disease. As a consequence of the sickness, the patient had difficulties to talk and eat, but with rehabilitation he now has adequate phonation and eating capacity. The immunohistochemistry and molecular genetic science branches of medicine have almost solved the diagnostic and therapeutic problems related to this sickness. The individual's prognosis depends mainly on the extension of the affection and seriousness of the disease from which the patient suffers.

Treatment of median cleft of the lower lip, mandible, and bifid tongue with ankyloglossia. A case report.

A case of complete median cleft of the lower lip and mandible and bifid tongue with ankyloglossia is presented. Unlike other reported cases of similar disorders, no other abnormalities were present. A satisfactory result was achieved with early surgical correction of both hard- and soft-tissue defects.

Ameloblastoma: the Zimbabwean experience over 10 years.

OBJECTIVES: A review of 117 ameloblastomas treated over a 10-year period was carried out. STUDY DESIGN: Clinical records of 117 patients treated for histologically diagnosed ameloblastoma were retrieved and analyzed for age, sex, anatomic distribution, duration of lesions, clinical features, and treatment methods with results and complications. RESULTS: Men and women were equally affected. The average age at the time of presentation was 28 years; 95.7% of the ameloblastomas occurred in the mandible; and 59% occurred in the premolar/incisor/canine region. CONCLUSION: Ameloblastoma occurs predominantly in the anterior mandible with equal frequency in men and women. Wide resection reduces recurrence.

Salivary gland tumours in Zimbabwe: report of 282 cases.

Tumours of the salivary glands are relatively uncommon. In a review of 282 black patients seen at Harare Central Hospital, Zimbabwe, the relative incidence of various tumour types and the age and sex distribution were similar to those reported in other series. There were more tumours of the minor salivary glands than in reported Western series. There were more tumours of the minor salivary glands than in reported Western series. Pain and rapid growth were significant in distinguishing malignant from benign tumours. Malignant tumours were more common in elderly than in young patients.

Pleomorphic adenoma of the salivary glands. Clinicopathologic study of 206 cases in Zimbabwe.

A review of 206 pleomorphic adenomas seen over a 10-year period was carried out. Fifty-eight percent of the tumors were in females. The tumor was common in the 3rd, 4th, and 5th decades with 39.8% of the tumors occurring in the parotid gland.