Italian S3-Guideline on the treatment of Atopic Eczema - Part 1: Systemic therapy, adapted from EuroGuiDerm by the Italian Society of Dermatology and STD (SIDEMAST), the Italian Association of Hospital Dermatologists (ADOI) and the Italian Society of Allergological and Environmental Dermatology (SIDAPA).

SIDeMaST (Società Italiana di Dermatologia Medica, Chirurgica, Estetica e delle Malattie Sessualmente Trasmesse) contributed to the development of the present guideline on the systemic treatment of chronic plaque psoriasis. With the permission of EuroGuiDerm, SIDeMaST adapted the guideline to the Italian healthcare context to supply a reliable and affordable tool to Italian physicians who take care of patients affected by atopic dermatitis. The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This first part of the guideline includes general information on its scope and purpose, the health questions covered, target users and a methods section. It also provides guidance on which patients should be treated with systemic therapies, as well as recommendations and detailed information on each systemic drug. The systemic treatment options discussed in the guideline comprise conventional immunosuppressive drugs (azathioprine, ciclosporin, glucocorticosteroids, methotrexate and mycophenolate mofetil), biologics (dupilumab, lebrikizumab, nemolizumab, omalizumab and tralokinumab) and janus kinase inhibitors (abrocitinib, baricitinib and upadacitinib). Part two of the guideline will address avoidance of provocation factors, dietary interventions, immunotherapy, complementary medicine, educational interventions, occupational and psychodermatological aspects, patient perspective and considerations for pediatric, adolescent, pregnant and breastfeeding patients.

Italian S3-Guideline on the treatment of Atopic Eczema - First Update, adapted from EuroGuiDerm by the Italian Society of Dermatology and STD (SIDEMAST), the Italian Association of Hospital Dermatologists (ADOI) and the Italian Society of Allergological and Occupational Dermatology (SIDAPA).

The evidence- and consensus-based guideline on atopic eczema, published in JEADV on 18 August 2022 (part 1) and 3 September 2022 (part 2) was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. To reflect the most recent evidence on novel systemic medications, an update was published in October 2022. According to the purpose of the Italian Society of Dermatology and STD (SIDEMAST), the Italian Association of Hospital Dermatologists (ADOI) and the Italian Society of Allergological and Environmental Dermatology (SIDAPA) to adapt the EuroGuiDerm guideline on the treatment of atopic eczema into the Italian Healthcare setting, the original update has been supplemented by inserting notes, well highlighted by the original text, to emphasize the laws, rules, procedures and suggestions of the Italian Ministry of Health and regional Health authorities.

Italian S3-Guideline on the treatment of Atopic Eczema - Part 2: non-systemic treatments and treatment recommendations for special AE patient populations, adapted from EuroGuiDerm by the Italian Society of Dermatology and STD (SIDEMAST), the Italian Association of Hospital Dermatologists (ADOI) and the Italian Society of Allergological and Occupational Dermatology (SIDAPA).

SIDeMaST (Società Italiana di Dermatologia Medica, Chirurgica, Estetica e delle Malattie Sessualmente Trasmesse) contributed to the development of the present guideline on the systemic treatment of chronic plaque psoriasis. With the permission of EuroGuiDerm, SIDeMaST adapted the guideline to the Italian healthcare context to supply a reliable and affordable tool to Italian physicians who take care of patients affected by atopic dermatitis. The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This second part of the guideline includes recommendations and detailed information on basic therapy with emollients and moisturizers, topical anti-inflammatory treatment, antimicrobial and antipruritic treatment and UV phototherapy. Furthermore, this part of the guideline covers techniques for avoiding provocation factors, as well as dietary interventions, immunotherapy, complementary medicine and educational interventions for patients with atopic eczema and deals with occupational and psychodermatological aspects of the disease. It also contains guidance on treatment for pediatric and adolescent patients and pregnant or breastfeeding women, as well as considerations for patients who want to have a child. A chapter on the patient perspective is also provided. The first part of the guideline, published separately, contains recommendations and guidance on systemic treatment with conventional immunosuppressive drugs, biologics and janus kinase (JAK) inhibitors, as well as information on the scope and purpose of the guideline, and a section on guideline methodology.

Cierre de mordida abierta con alineadores / Open bite closure with aligners

Los avances tecnológicos referidos a los alineadores nos demuestran que pueden ser utilizados tanto en tratamientos simples como en maloclusiones complejas, como en este caso de una mordida abierta. En este artículo presentamos un caso clínico de una paciente de 36 años, quien concurre a la consulta expresando no estar conforme con su estética y con el funcionamiento de su boca.

Protocolo biodigital aplicado al tratamiento de Ortodoncia con alineadores: caso clínico / Biodigital protocol applied to orthodontic treatment with aligners: a clinical case

En la actualidad, contamos con softwares de diseño que nos permiten planificaciones precisas y eficientes de nuestros tratamientos; por lo tanto, nuestros diagnósticos deben estar a la altura. En este artículo presentaremos un caso clínico que se ha desarrollado en el marco de la Diplomatura en Ortodoncia con Alineadores de la Sociedad Argentina Ortodoncia (SAO), donde trabajamos cada pieza dentaria de manera independiente, mediante la técnica de Ortodoncia con alineadores. Teniendo en cuenta que contamos con un stock óseo reducido, utilizamos como aliado un gran recurso: la tomografía computada de haz cónico (CBCT). Esta nos garantiza trabajar con seguridad en casos donde las limitaciones óseas nos dificultan los movimientos dentarios.

We currently find design softwares that allows us to plan our treatments accurately and efficiently; therefore, our diagnoses must be up to par. In this article we will present a clinical case that has been developed within the framework of the Subspeciality in Orthodontics with Aligners Argentine Society of Orthodontics (SAO), where we work, through the orthodontic technique with aligners, each tooth independently. Considering that we have a reduced bone stock, we use as an ally a great resource, the cone beam computed tomography (CBCT), which guarantees us to work safely in these cases where bone limitations hinder tooth movements.

Self-applied topical interventions for melasma: a systematic review and meta-analysis of data from randomized, investigator-blinded clinical trials.

BACKGROUND: Melasma is a common dermatological condition. Although its relevance as a skin condition is primarily of a cosmetic nature, it may affect the patient's wellbeing and quality of life. A broad range of treatment options is available, which makes it difficult to choose the most appropriate of those treatments. OBJECTIVES: To summarize and critically appraise evidence from investigator-blinded randomized controlled trials (RCTs) on the efficacy and safety of self-applied topical interventions for melasma. METHODS: We systematically searched MEDLINE and the Cochrane CENTRAL trials database for RCTs on topical, self-administered interventions for patients diagnosed with melasma. Eligibility was limited to RCTs that explicitly stated in their methods section (i) how they generated the random allocation sequence, and (ii) that the study outcome assessor was blinded to the participants' group allocation. Outcomes of interest included evaluator-assessed clinical scores (such as the Melasma Area and Severity Index), quality of life and patient-reported outcomes, as well as safety outcomes. The study findings were meta-analysed, pooling data from studies on the same comparisons, if this was possible. We assessed confidence in effect estimates using the GRADE approach. RESULTS: Our searches yielded 1078 hits. We included 36 studies reporting on 47 different comparisons of interventions. These included medical treatments such as 'triple combination cream' (TCC), over-the-counter cosmetic and herbal products, as well as sun creams covering different light spectra. Pooling data was possible for only two comparisons, topical tranexamic acid (TXA) vs. hydroquinone (HQ) and cysteamine vs. placebo. Direct comparisons were available for a variety of interventions; however, the reported outcomes varied greatly. Overall, our confidence in the effect estimates ranged from very low to high. CONCLUSIONS: Our findings indicate that TCC and its individual components HQ and tretinoin are effective in lightening melasma. Besides these established self-applied treatment options, we identified further medical treatments as well as promising cosmetic and herbal product treatment approaches. Furthermore, evidence suggests that using broad-spectrum sunscreen covering both the visible and ultraviolet-light spectrum enhances the treatment efficacy of HQ. However, with mostly small RCTs comparing treatments directly using a broad range of outcomes, further research is needed to draw conclusions about which treatment is most effective. What is already known about this topic? Melasma is a common dermatological disease. Although it is primarily a cosmetic condition, it can severely affect the patient's wellbeing and quality of life. Treatment options for melasma include a broad range of medical, cosmetic and herbal products. Given the large number of available interventions, it is difficult for clinicians and for patients to make informed decisions about which treatment to choose. What does this study add? We systematically assessed data from investigator-blinded randomized controlled trials of self-applied topical interventions. Our GRADE evaluations of confidence in the findings ranged from very low to high and may help clinicians and patients navigate treatment decisions. Besides the established self-applied medical treatment options, we identified promising cosmetic and herbal treatment approaches. Evidence suggests sunscreen covering the ultraviolet (UV)- and visible light spectra increases treatment efficacy compared with UV-only protection.

German evidence and consensus-based (S3) guideline: Vaccination recommendations for the prevention of HPV-associated lesions.

Anogenital and oropharyngeal infections with human papilloma viruses (HPV) are common. Clinically manifest disease may significantly impact quality of life; the treatment of HPV-associated lesions is associated with a high rate of recurrence and invasive neoplasms, such as cervical, anal, vulvar, penile, and oropharyngeal cancers, which are characterized by significant morbidity and mortality. Vaccination against HPV is an effective and safe measure for the primary prevention of HPV-associated lesions, but immunization rates are still low in Germany. The present publication is an abridged version of the German evidence and consensus-based guideline "Vaccination recommendations for the prevention of HPV-associated lesions", which is available on the website of the German Association of the Scientific Medical Societies (AWMF). On the basis of a systematic review with meta-analyses, a representative panel developed and agreed upon recommendations for the vaccination of different populations against HPV. In addition, consensus-based recommendations were developed for specific issues relevant to everyday practice. Based on current evidence and a representative expert consensus, these recommendations are intended to provide guidance in a field in which there is often uncertainty and in which both patients and health care providers are sometimes confronted with controversial and emotionally charged points of view.

State of the art treatment for stage I to III anal squamous cell carcinoma: A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: This systematic review summarised and critically appraised evidence on the efficacy and safety of interventions for anal cancer to support the panel of experts developing the national evidence-based anal cancer guideline in Germany. MATERIALS AND METHODS: We conducted a systematic review and meta-analyses of interventions for the treatment of stage I to III anal squamous cell carcinoma (SCCA). We systematically searched several databases and included any randomised controlled trial (RCT) assessing the pre-specified patient populations, regardless of the interventions studied. Non-randomised controlled studies of selected, pre-specified interventions were included if RCTs were not available or contained insufficient information. Where possible, we conducted meta-analyses and critically assessed confidence in the effect estimates using the GRADE approach. RESULTS: Our searches yielded 10,325 (25 October 2018) and 889 hits (update search on 18 July 2019). Among the 41 studies (47 publications) included, we identified 19 comparisons of interventions for SCCA, and confidence in the effect estimates ranged from very low to high. Most RCTs compared various chemoradiation regimes. For other treatment options, such as local excision in early stages or different radiotherapies, we mostly identified comparative cohort studies. CONCLUSION: Our findings indicate that, in most clinical situations, primary chemoradiation based on 5-FU and MMC is still the gold standard. However, treatment options for stage I anal cancer, particularly of the anal margin, as well as newer treatment approaches should be investigated in future RCTs. Overall, our findings may help health care professionals and patients make informed decisions about treatment choices.

Tratamiento de mordida abierta con placas alineadoras. Reporte de un caso clínico / Open bite treatment with aligners. Case report

Este artículo describe el tratamiento de ortodoncia con placas alineadoras, realizado en la Cátedra de Ortodoncia de la Facultad de Odontología de la Universidad de Buenos Aires, en una paciente de 25 años de edad, con mordida abierta anterior dentoalveolar y ligero apiñamiento dentario, quien concurre por recidiva de su tratamiento completado anteriormente. Se planificó el tratamiento con placas alineadoras. Luego de 17 meses de uso, se lograron los objetivos, y se logró el cierre de la mordida. Se corrigió el apiñamiento y se obtuvieron guías funcionales. El caso es acompañado de registros fotográficos y tomográficos iniciales y finales.

This paper describes the orthodontics treatment with aligners, performed in the course of Orthodontics at the University of Buenos Aires, on a female 25-years-old patient who attends for consultation due to the recurrence of a previously treated dentoalveolar open bite and mild crowding problem. Treatment with aligners was planned. The objectives were achieved after 17 months of treatment, and the bite closure was obtained. The crowding was corrected and functional guides were obtained. The case is accompanied by initial and final photographic and tomographic records.

Major liver resection as definitive treatment in post-cholecystectomy common bile duct injuries.

BACKGROUND: Common bile duct injuries (CBDI) are serious complications of cholecystectomies which are often associated with vascular involvement, meaning that their management represents a major challenge to the physician. We present our experience in major hepatectomy due to CBDI, highlighting indications, postoperative complications, and long-term outcomes. METHODS: From August 1993 to September 2013, 287 patients with CBDI were treated in our centre. In 15 patients of this group (5 %), a major hepatectomy was performed. Eleven patients presented E4 and four presented E5 injuries of Strasberg classification. Seven patients presented vascular involvement. In 12 patients, prior treatment attempts, either biliodigestive anastomosis, endoscopic or percutaneous drainage, was performed without success. The median time delay between lesional surgery and hepatectomy was 24 months. RESULTS: Right hepatectomy was performed in 10 patients and left hepatectomy in 5. Postoperative morbidity was 60 %. The incidence of serious complications (≥ grade IIIa of DC classification) was 40 %. There was no mortality in our study. The mean follow-up was 43.5 months and the overall survival was 100 %. Three patients had a single episode of ascendant cholangitis who were successfully treated with medical treatment. All other patients were asymptomatic during follow-up. No patients required further surgical procedures. CONCLUSION: In our series, major hepatectomy due to CBDI was a successful treatment with high rates of postoperative morbidity and excellent long-term outcomes which require a multidisciplinary approach in referral centres of HPB surgery.

Fatores epidemiológicos do dengue na região central do estado do Rio Grande do Sul, Brasil, 2007 - 2010 / Epidemiological features of dengue in the central region of Rio Grande do Sul state, Brazil, from 2007 to 2010

O objetivo deste estudo foi avaliar fatores epidemiológicos do dengue, nos municípios da 4ª Coordenadoria Regional de Saúde/RS (4a CRS/RS), nos anos de 2007 a 2010. Trata-se de um estudo descritivo, empregando como variáveis: município de notificação; ano de notificação; sexo e faixa etária do paciente; índice de infestação predial (IIP) e índice de Breteau (IB). Foram constatados 13 casos importados da doença, em cinco municípios, sendo a maior ocorrência em Santa Maria. Houve notificação de casos em ambos os sexos e em diferentes faixas etárias. Focos positivos do Aedes aegypti foram encontrados em armadilhas instaladas em pontos estratégicos de Santa Maria e Santiago. O IIP e IB, em ambos os municípios, não representaram risco à saúde pública. Conclui-se, portanto, que as ações de vigilância em saúde devem ser fomentadas com o objetivo de orientar as práticas de controle do vetor, bem como promover a educação sanitária e ambiental, a fim de impedir a instalação de casos autóctones nos municípios estudados.

The aim of this study was to evaluate the epidemiological issues of dengue in the counties of the 4th Coordenadoria Regional de Saúde (government agency to surveillance on public health) of Rio Grande do Sul state, Brazil, during 2007 to 2010. This is a descriptive study, using as variables: cities where dengue was reported; year; sex and age of the patient; infestation (IIP) and Breteau (BI) index. A total of 13 imported cases of the dengue was reported in five cities and higher occurrence was in Santa Maria city. There were notifications of dengue in both sex and in different age groups. Positive foci of Aedes aegypti were found in the traps at strategic points in both cities, Santa Maria and Santiago. BII and BI varied during the studied period in both cities, and, so far, they did not constitute a risk to public health. We conclude that the health surveillance should be enhanced with the purpose of guiding vector control practices, as well as promote health and environmental education in order to prevent the installation of autochthonous dengue cases in the cities studied.

O paradigma conexionista aplicado às pesquisas em linguagem / The connectionist paradigm applied to language researches

O estudo trata da Teoria Conexionista e suas vertentes e de como este modelo teórico pode contribuir para a prática fonoaudiológica. O objetivo do trabalho foi reunir e discutir diversos estudos sobre a teoria conexionista aplicada à aprendizagem da linguagem, com o intuito de promover uma reflexão sobre as contribuições que esta teoria pode trazer à prática fonoaudiológica. A partir disso, verificou-se que os estudos baseados na teoria conexionista relacionados à Fonoaudiologia são predominantes na área de aquisição e terapia da linguagem, processamento auditivo e de leitura. Porém, os mesmos são escassos e pouco aplicados. Além disso, não há uma relação direta com as técnicas que podem ser utilizadas, mas sim com a análise da evolução terapêutica, especialmente na interpretação de como se dá o processo de aprendizagem da língua falada e/ou escrita.

The study deals with the Connectionist Theory and its branches, and how this theoretical model can contribute to the speech and language practice. This was aimed to collect and discuss several studies on the Connectionist Theory applied to language acquisition aiming at promoting the reflection on the contributions that this theory may bring out to speech and language therapy. It was found that the studies based on the connectionist theory related to speech and language therapy are prevalent in the area of language acquisition and language therapy, auditory and reading processing. However, they are scarce and little applied. Moreover, there is no direct relation between this theory and the techniques that can be used, but yes, with the analysis of therapeutic outcome, especially with the interpretation of how the process concerning learning the spoken and written language is carried out.

Pesquisa neonatal de fenilcetonuria e hiperfenilalaninemias: diagnóstico y seguimiento / Neonatal screening for phenylketonuria and hyperphenylalaninaemia: diagnosis and follow-up

Introducción.Se realizó la pesquisa neonatal de fenilcetonuria(PKU)e hiperfenilalaninemias(HFA)desde agosto de 1985,en la Fundación de Endocrinología Infantil(FEI)El objetivo de este trabajo es comunicar la experiencia en la realización de la misma hasta diciembre de 1993 en cuanto a resultados de incidencia ,opotunidad del diagnóstico y tratamiento,características y evolución de los pacientes detectados.Materialy métodos.Se estudiaron 255.412 recién nacidos.De ellos 74.280 pertenecen al grupo de niños estudiados sitemáticamente(al alta de la maternidad)Los otros 181132 estudios son de una población cuya pesquisa es requerida por padres y pediatras(demanda espontánea)El diagnóstico se realizo utilizando el método de Guthrie en sangre obtenida después de las 48 hs de vida y fue confirmado con el método fluorométrico.Los niños detectados fueron seguidos por un grupo interdisciplinario.Conclusiones.Se enfatiza la importancia de la pesquisa neonatal para PKU y HFA en nuestro país a pesar de las dificultades existentes para la implementación nacional de un sistema a tal fin

Pesquisa neonatal de fenilcetonuria e hiperfenilalaninemias: diagnóstico y seguimiento / Neonatal screening for phenylketonuria and hyperphenylalaninaemia: diagnosis and follow-up

Introducción.Se realizó la pesquisa neonatal de fenilcetonuria(PKU)e hiperfenilalaninemias(HFA)desde agosto de 1985,en la Fundación de Endocrinología Infantil(FEI)El objetivo de este trabajo es comunicar la experiencia en la realización de la misma hasta diciembre de 1993 en cuanto a resultados de incidencia ,opotunidad del diagnóstico y tratamiento,características y evolución de los pacientes detectados.Materialy métodos.Se estudiaron 255.412 recién nacidos.De ellos 74.280 pertenecen al grupo de niños estudiados sitemáticamente(al alta de la maternidad)Los otros 181132 estudios son de una población cuya pesquisa es requerida por padres y pediatras(demanda espontánea)El diagnóstico se realizo utilizando el método de Guthrie en sangre obtenida después de las 48 hs de vida y fue confirmado con el método fluorométrico.Los niños detectados fueron seguidos por un grupo interdisciplinario.Conclusiones.Se enfatiza la importancia de la pesquisa neonatal para PKU y HFA en nuestro país a pesar de las dificultades existentes para la implementación nacional de un sistema a tal fin