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.

Respuesta inmunitaria humoral en pacientes con Colitis Ulcerosa / Introduction: Ulcerative colitis is an inflammatory bowel disease. Little is known about its causes, but genetic, environmental, immunological and bacterial factors have been suggested. Objective: Describe the humoral immune response of patients with ulcerative colitis cared for at the Institute of Gastroenterology from January 2014 to April 2015. Methods: A descriptive cross-sectional prospective study was conducted at the Institute of Gastroenterology from January 2014 to April 2015 which included all the patients diagnosed with ulcerative colitis. An evaluation was performed of clinical, endoscopic and histological variables as well as the results of immunological studies. Results: A predominance was found of the female gender, the over-49 age group and white skin. There was also a predominance of alterations in complement components C3 and C4 and immunoglobulin G. Dependence and isolated correlation was observed between the results of immunological variables and the post-diagnosis time of evolution, the Truelove and Witts clinical scale, the degree of colonoscopic and histological activity, and the degree of dysplasia for p < 0.05. Conclusions: Immune response is a predictive factor for good evolution of the disease, but it does not allow to draw an inference about colonoscopic and histological activity. Immune response, on the other hand, is not related to the clinical evaluation scale of Truelove and Witts, the degree of dysplasia, clinical extraintestinal manifestations or post-diagnosis time of evolution

Introducción: la colitis ulcerosa es una enfermedad inflamatoria intestinal de causa aún poco conocida. Se postulan muchos mecanismos de producción de tipo genético, ambiental, inmunológico, bacteriano.Objetivo : describir la respuesta inmunitaria humoral en pacientes con colitis ulcerosa atendidos en el Instituto de Gastroenterología en el período enero 2014- abril 2015.Métodos: se realizó un estudio descriptivo prospectivo de corte transversal en el Instituto de Gastroenterología, en el período de enero de 2014 a abril de 2015, donde se incluyeron todos los pacientes con diagnóstico de colitis ulcerosa. Se evaluaron variables clínicas, endoscópicas, histológicas y resultado de los estudios inmunológicos.Resultados: predominó el sexo femenino, edad superior a 49 años y blancos; también hubo predominio de alteraciones de complemento C3 y C4 e inmunoglobulina G. Se halló dependencia y correlación aislada entre el resultado de las variables inmunológicas y el tiempo de evolución posdiagnóstico, la escala clínica de Truelove y Witts, el grado de actividad colonoscópica e histológica, así como el grado de displasia para p < 0,05.Conclusiones : la respuesta inmunitaria es un factor predictivo de buena evolución de la enfermedad aunque no permite realizar inferencia sobre la actividad colonoscópica e histológica; además no se encuentra relacionado con la escala de evaluación clínica de Truelove y Witts, el grado de displasia, las manifestaciones clínicas extraintestinales y el tiempo de evolución posdiagnóstico(AU)

Introduction: Ulcerative colitis is an inflammatory bowel disease. Little is known about its causes, but genetic, environmental, immunological and bacterial factors have been suggested.Objective: Describe the humoral immune response of patients with ulcerative colitis cared for at the Institute of Gastroenterology from January 2014 to April 2015.Methods: A descriptive cross-sectional prospective study was conducted at the Institute of Gastroenterology from January 2014 to April 2015 which included all the patients diagnosed with ulcerative colitis. An evaluation was performed of clinical, endoscopic and histological variables as well as the results of immunological studies.Results: A predominance was found of the female gender, the over-49 age group and white skin. There was also a predominance of alterations in complement components C3 and C4 and immunoglobulin G. Dependence and isolated correlation was observed between the results of immunological variables and the post-diagnosis time of evolution, the Truelove and Witts clinical scale, the degree of colonoscopic and histological activity, and the degree of dysplasia for p < 0.05.Conclusions: Immune response is a predictive factor for good evolution of the disease, but it does not allow to draw an inference about colonoscopic and histological activity. Immune response, on the other hand, is not related to the clinical evaluation scale of Truelove and Witts, the degree of dysplasia, clinical extraintestinal manifestations or post-diagnosis time of evolution(AU)