[Translated article] Syringes for intraocular administration: A systematic review.

OBJECTIVE: The off-label use in clinical practice of non-approved syringes for intravitreal drug administration has resulted in the detection of silicone oil drops in the vitreous of some patients. This situation derives from the lack of approved syringes for intraocular use in the Spanish market. The aim of this work is to review the use of syringes for intraocular administration, as well as to search for alternatives that meet the legal requirements for these unmet needs. METHOD: A systematic review was performed following the PRISMA 2020 guidelines by searching PubMed with the descriptors: (silicone) AND (syringes) AND ((intraocular) OR (intravitreal)) and filtering all existing publications from January 2006 to December 2023, including all those articles dealing with silicone oil release in intravitreal injections and analysing the possible consequences. RESULTS: Sixty-eight results were found, 23 of which were excluded because they did not deal with the subject under study, leaving a total of 45 articles for the systematic review. These were classified according to the conclusions obtained in 4 groups: the adverse reactions produced by silicone; the administration technique; the physicochemical aspects of silicone release; and the characteristics of the medical device. After reviewing the current manufacturers and technical data sheets of commercialised syringes, the existing syringes for this use have been collected, finding 2 that will probably be commercialised in Spain at the beginning of 2024: Zero Residual™ 0.2 ml SiO-free and VitreJect® Ophthalmic. CONCLUSIONS: From the results obtained, it can be interpreted that the use of syringes and needles with silicone for intravitreal use is a concern for health professionals due to the implications and consequences that may arise in patients, the most important being adverse reactions, so it is necessary to have silicone-free syringes on the market that are specific for intraocular use. Safety and legality in the use of intraocular syringes and needles is essential to guarantee ocular integrity and patient health.

Effect of a topical silicone gel and a polyurethane dressing on the evolution of scars.

OBJECTIVE: To assess the effectiveness and safety of a topical silicone gel (BE + Gel reductor y reparador de cicatrices) and a polyurethane dressing (BE + Apósito reductor y reparador de cicatrices) on the evolution of scars of patients who were previously recruited in the emergency care unit while seeking wound care. METHOD: A single center, stratified observational, open label study was performed in the emergency care unit of Donostia Universitary Hospital (recruitment) and in the Biodonostia Health Research Institute (intervention). Scars located in unexposed body areas with the dressing, and scars located in exposed areas with either the gel or the dressing. Investigators assessed interventions at day 1 and on weeks 4, 8 and 12. Vancouver Scar Scale (VSS) and a photographical assessment were used to determine the scars evolution, and the subjective perception of the scar was evaluated by means of a questionnaire administered to the patients. RESULTS: Patients whose scars were treated with the silicone gel had an average initial VSS score of 5.4 ± 2.08. This value was reduced to 0.86 ± 1.17 after 90 days of treatment. Patients treated with the polyurethane dressing had an average initial VSS score of 5.8 ± 2.29. After 90 days of treatment, this average score was reduced to 0.33 ± 0.66. Positive evolution of scars was also supported by photographs and by a patient questionnaire. CONCLUSIONS: Both treatments appear to be safe and effective, objectively, and subjectively, in the context of scar evolution.

Syringes for intraocular administration: Systematic review. / Jeringas para administración intraocular: revisión sistemática.

OBJECTIVE: The off-label use in clinical practice of non-approved syringes for intravitreal drug administration has resulted in the detection of silicone oil drops in the vitreous of some patients. This situation derives from the lack of approved syringes for intraocular use in the Spanish market. The aim of this work is to review the use of syringes for intraocular administration, as well as to search for alternatives that meet the legal requirements for these unmet needs. METHOD: A systematic review was performed following the PRISMA 2020 Guidelines by searching PubMed with the descriptors: "silicone" AND "syringes" AND ("intraocular" OR "intravitreal") and filtering all existing publications from January 2006 to December 2023, including all those articles dealing with silicone oil release in intravitreal injections and analysing the possible consequences. RESULTS: Sixty-eight results were found, 23 of which were excluded because they did not deal with the subject under study, leaving a total of 45 articles for the systematic review. These were classified according to the conclusions obtained in 4 groups: the adverse reactions produced by silicone, the administration technique, the physicochemical aspects of silicone release, and the characteristics of the medical device. After reviewing the current manufacturers and technical data sheets of commercialized syringes, the existing syringes for this use have been collected, finding two that will probably be commercialized in Spain at the beginning of 2024: Zero Residual™ 0.2 ml SiO-free and VitreJect® Ophthalmic. CONCLUSIONS: From the results obtained, it can be interpreted that the use of syringes and needles with silicone for intravitreal use is a concern for health professionals due to the implications and consequences that may arise in patients, the most important being adverse reactions, so it is necessary to have silicone-free syringes on the market that are specific for intraocular use. Safety and legality in the use of intraocular syringes and needles is essential to guarantee ocular integrity and patient health.

First Experience of Plastination at 4150 Meters Above Sea Level, at the Altitude of La Paz, Bolivia / Primera Experiencia de Plastinación a 4150 Metros sobre el Nivel del Mar, en la Altura de La Paz, Bolivia

SUMMARY: Despite attempts to develop the plastination technique in Bolivia, standardized results have not yet been achieved that could be communicated via scientific publications. There is a great deal of misunderstanding around the technique, confusing it with classic techniques of inclusion in different types of resin, such as polyester and epoxy, but these protocols are not plastination. The aim of this work was to communicate the first standardized room-temperature plastination protocol with silicone in Bolivia, with the unique feature of doing so at the altitude of the city of La Paz, thus constituting the first communication of a plastination technique at 4,150 m.a.s.l. sub sede La Paz, La Paz, Bolivia.

En Bolivia, a pesar de los intentos en el desarrollo de la técnica de Plastinación, aún no se han alcanzado resultados estandarizados que pudieran ser comunicados por medio de publicaciones científicas. Existe una gran confusión al momento de desarrollar la técnica, confundiéndola con técnicas clásicas de inclusión en distintos tipos de reina, como poliéster y epoxy, pero no correspondiendo estos protocolos desarrollados a la técnica de plastinación. En este sentido, el objetivo de esta trabajo consistió en comunicar el primer protocolo estandarizado de plastinación a temperatura ambiente con silicona de Bolivia, con la particularidad de desarrollarlo en la altura de la ciudad de La Paz, constituyéndose, de esta manera, en la primera comunicación de una técnica de plastinación a 4.150 metros sobre el nivel del mar.

Gluteoplastia de aumento con implantes intramusculares para el mejoramiento del contorno corporal / Augmentation gluteoplasty with intramuscular implants to improve the physical measurement i:en

Introducción: La región glútea ha sido considerada una de las zonas más observadas tanto en mujeres como en hombres y constituye un ícono representativo de belleza corporal. En los últimos años se ha incrementado el deseo de las féminas de aumentar esta región anatómica con implantes. Objetivo: Determinar los resultados estéticos de la gluteoplastia de aumento con implantes intramusculares. Métodos: Se realizó un estudio prospectivo, longitudinal y descriptivo de 25 mujeres que acudieron a la consulta externa del Servicio de Cirugía Plástica del Hospital Clínico-Quirúrgico Hermanos Ameijeiras, desde agosto de 2016 hasta febrero de 2019, para solicitar el aumento de su región glútea con implantes. Resultados: En la serie predominaron el grupo etario de 31 a 40 años (36,0 %) y el fototipo de piel III (88,0 %); asimismo, solo 6 pacientes presentaron complicaciones (24,0 %), entre las cuales sobresalieron el seroma (20,8 %), la asimetría (12,5 %) y la dehiscencia de la sutura (8,3 %). Se observó un aumento significativo de la proyección glútea después de la intervención (α=0,05) y los resultados fueron buenos en la mayoría de las integrantes de la muestra (84,0 %). Conclusiones: La gluteoplastia de aumento con implantes intramusculares es un procedimiento seguro y ofrece resultados estéticos favorables.

Introduction: Gluteal region has been considered one of the most observed areas either in women as in men and constitutes a representative icon of corporal beauty. In the last years the desire of women to increase this anatomical region with implants has been increased. Objective: To determine the aesthetic results of the augmentation gluteoplasty with intramuscular implants. Methods: A prospective, longitudinal and descriptive study of 25 women that went to the Plastic Surgery Service outpatient consultation of Hermanos Ameijeiras Clinical Surgical Hospital was carried out from August, 2016 to February, 2019, to request the increase of the gluteal region with implants. Results: In the series there was a prevalence of the 31 to 40 age group (36.0%) and the skin phototype III (88.0%); also only 6 patients presented complications (24.0%), among which seroma (20.8%), asymmetry (12.5%) and anastomotic dehiscence (8.3%) were notable. A significant increase of the gluteal projection after the intervention was observed (α =0.05) and the results were good in most of the members of the sample (84.0%). Conclusions: The augmentation gluteoplasty with intramuscular implants is a safe procedure and offers favorable aesthetic results.

Tratamiento de las secuelas por inyección de metacrilato/biopolímero / Treatment of sequelae due to injection of mathacrylate/biopolymers

Presentamos una serie de casos en el que otros profesionales usaron biopolímeros para relleno y volumen en diferentes regiones del organismo, siendo la más frecuente la región glútea. El 60 % de las pacientes fueron de sexo femenino y el 40%, masculino. El 62% presentaba síntomas que excedían los síntomas locales; completando los estudios con laboratorio y/o imágenes, diagnosticamos síndrome de ASIA (autoimmune syndrome induced by adjuvants). El requerimiento original de los pacientes siempre fue mixto, algunos consultaron por la incomodidad de tener una región indurada y pétrea, sin movilidad y el resto por síntomas provenientes del producto inyectado. Los del primer grupo siempre referían síntomas generales. Se presenta una técnica novedosa y propia en la forma de encarar el tratamiento, que siempre es quirúrgico

We present a series of cases in which other professionals used biopolymers for filling and volume in different regions of the body, the most frequent the gluteal region. 60% of the patients were female and 40%, male. 62% had symptoms that exceeded local symptoms; completing the studies with laboratory and/or images, we diagnose ASIA (autoimmune syndrome induced by adjuvants) syndrome. The original requirement of the patients was always mixed, some consulted due to the discomfort of having an indurated and stony region, without mobility and the rest due to symptoms coming from the injected product. Those in the first group always reported general symptoms. A novel and proprietary technique is presented in the way of approaching the treatment, which is always surgical.

Integrando la Inteligencia Artificial y los nuevos modelos de lenguaje en Oftalmología: Complicaciones del uso del aceite de silicona en cirugía vítreo-retiniana / Artificial Intelligence and new language models in Ophthalmology: Complications of the use of silicone oil in vitreoretinal surgery

La inteligencia artificial (IA) es una tecnología emergente que facilita tareas cotidianas y automatiza tareas en diversos campos como medicina. Sin embargo, la irrupción de un modelo de lenguaje en el mundo académico ha generado mucho interés. En esta comunicación se evalúa el potencial de Generative Pre-trained Transformer (ChatGPT), un modelo de lenguaje desarrollado por OpenAI; y de DALL-E 2, un generador de imágenes, en la escritura de artículos científicos en Oftalmología. El tema seleccionado es el de las complicaciones del uso de aceite de silicona (AS) en cirugía vítreo-retiniana. Se utilizó ChatGPT para generar un resumen y un artículo estructurado, sugerencias para un título y referencias bibliográficas. Se puede concluir que, a pesar del conocimiento demostrado, la precisión y fiabilidad científica en temas específicos es insuficiente para la generación automática de artículos con rigor científico. Por otro lado, todo científico debe conocer las posibles implicaciones éticas y legales de estas herramientas (AU)

Artificial intelligence (AI) is an emerging technology that facilitates everyday tasks and automates tasks in various fields such as medicine. However, the emergence of a language model in academia has generated a lot of interest. This paper evaluates the potential of ChatGPT, a language model developed by OpenAI, and DALL-E 2, an image generator, in the writing of scientific articles in ophthalmology. The selected topic is the complications of the use of silicone oil in vitreoretinal surgery. ChatGPT was used to generate an abstract and a structured article, suggestions for a title and bibliographical references. In conclusion, despite the knowledge demonstrated by this tool, the scientific accuracy and reliability on specific topics is insufficient for the automatic generation of scientifically rigorous articles. In addition, scientists should be aware of the possible ethical and legal implications of these tools (AU)

Tratamiento combinado de Espongostan® y Mepitel® en heridas con pérdida de sustancia y abundante sangrado / Combined treatment of Espongostan® and Mepitel® in wounds with loss of substance and abundant bleeding: a case series

Objetivo: Las heridas por pérdida de sustancia en las yemas de los dedos son dolorosas, incapacitantes y sangran abundantemente. El tratamiento recomendado es a base de Espongostan®, aunque este producto puede combinarse con Mepitel®. La combinación de ambos tratamientos podría reducir el dolor y minimizar el sangrado en curas sucesivas. El objetivo de este estudio es describir la aplicación del tratamiento combinado de Espongostan® y Mepitel®. Además, se describirá la evolución del dolor y el sangrado en estos pacientes. Descripción del caso: Se aplicó el tratamiento combinado a 6 pacientes con heridas de pérdida de sustancia en las yemas de los dedos. Resultados: La escala EVA se mantuvo en valores moderados o se redujo a leve en curas sucesivas. Los pacientes no describen signos de dolor destacables al retirar el Espongostan®. Por otro lado, el sangrado remitió antes de 8 días. La tasa promedio de remisión del sangrado se situó en 1 caso por 4 días. Conclusión: La cura combinada es altamente positiva para minimizar el dolor y el sangrado, reduciendo por consiguiente las molestias derivadas sobre los pacientes. (AU)

Objective: Loss of substance wounds on the pads of the fingers are painful, disabling, and have profuse bleeding. The recommended treatment is based on Espongostan®, although this product may be combined with Mepitel ®. The combination of both treatments could reduce pain and minimize bleeding in successive cures. The objective of this study is to describe the application of the combined treatment of Espongostan® and Mepitel®. In addition, the evolution of pain and bleeding in these patients will be described. Description of the case: We applied the combined treatment to 6 patients with loss of substance wounds on the pads of the fingers. Results: The VAS scale remained at moderate values or was reduced to mild in successive cures. Patients do not describe noticeable signs of pain when removing the Espongostan®. Bleeding subsided before 8 days. The average bleeding remission rate was 1 case per 4 days. Conclusion: The combined cure is highly positive for minimizing pain, bleeding and reducing discomfort caused to patients. (AU)

Artificial Intelligence and new language models in Ophthalmology: Complications of the use of silicone oil in vitreoretinal surgery.

Artificial intelligence (AI) is an emerging technology that facilitates everyday tasks and automates tasks in various fields such as medicine. However, the emergence of a language model in academia has generated a lot of interest. This paper evaluates the potential of ChatGPT, a language model developed by OpenAI, and DALL-E 2, an image generator, in the writing of scientific articles in ophthalmology. The selected topic is the complications of the use of silicone oil in vitreoretinal surgery. ChatGPT was used to generate an abstract and a structured article, suggestions for a title and bibliographical references. In conclusion, despite the knowledge demonstrated by this tool, the scientific accuracy and reliability on specific topics is insufficient for the automatic generation of scientifically rigorous articles. In addition, scientists should be aware of the possible ethical and legal implications of these tools.

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA), medical treatment of severe systemic compromise: case report

Case description: A 42-year-old woman with severe pulmonary and mediastinal inflammatory involvement, secondary to infiltration of a silicone-related allogenic material with systemic migration. Clinical findings: The patient developed esophageal and bronchial stenosis, recurrent infections, malnutrition, and respiratory deterioration, making surgical removal of the allogenic material impossible. Treatment and outcome: Clinical and radiological improvement was achieved after treatment with multiple intravenous and oral immunomodulators. Clinical relevance: Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is a heterogeneous disease resulting from exposure to allogenic substances in a susceptible subject. These substances cause autoimmune or autoinflammatory phenomena. Since ASIA was described ten years ago, its diagnostic criteria are still under discussion, with an uncertain prognosis. The ideal therapy is based on eliminating the causative substance, but this is not always possible. Therefore, it is necessary to start an immunomodulatory treatment, using it in this patient, a scheme that had not been previously reported in the literature.

Descripción del caso: Mujer de 42 años con compromiso inflamatorio pulmonar y mediastinal severo, secundario a infiltración de un material alogénico relacionado con la silicona con migración sistémica. Hallazgos clínicos: La paciente desarrolló estenosis esofágica y bronquial, infecciones recurrentes, desnutrición y deterioro respiratorio, imposibilitando la extracción quirúrgica del material alogénico. Tratamiento y resultado: Mejoría clínica y radiológica lograda tras un tratamiento con múltiples inmunomoduladores intravenosos y orales. Relevancia clínica: El síndrome autoinmune / inflamatorio inducido por adyuvantes (ASIA) es una enfermedad heterogénea que resulta de la exposición a sustancias alógenas en un sujeto con susceptibilidad genética. Estas sustancias inducen fenómenos autoinmunitarios o autoinflamatorios. Desde que ASIA fue descrito hace 10 años, sus criterios diagnósticos continúan en discusión, con un pronóstico incierto. El tratamiento idóneo se basa en eliminar la sustancia causante, pero no siempre es posible, por lo cual se hace necesario iniciar un tratamiento inmunomodulador, empleándose en esta paciente un esquema que no había sido reportado previamente en la literatura.

Linfoma anaplásico de células grandes asociado a implantes fuera de la mama / Implant associated-large cell anaplastic lymphoma outside the breast

Introducción y objetivo: El linfoma anaplásico de células grandes asociado a implantes mamarios (LACG-AIM) es una enfermedad poco frecuente y parcialmente comprendida que ha despertado gran interés por el impacto social y económico que genera. Poco se conoce sobre la posible aparición de la enfermedad asociada al uso de implantes en otras localizaciones corporales. El objetivo de este artículo es caracterizar y exponer los casos de pacientes descritos en la literatura con linfoma anaplásico de células grandes asociado a implantes de silicona fuera de la mama. Material y método: Revisión de la literatura en bases de datos Pubmed, Cochrane, ScienceDirect y SciELO buscando reportes de linfoma anaplásico de células grandes asociado a implantes (LACG-AI) en sitios diferentes a la mama. Resultados: Encontramos dos reportes de caso de LACG en glúteos en pacientes con previa gluteoplastia de aumento con implantes realizada con fines estéticos. Llamó la atención el hallazgo de un número mayor de otro tipo de linfomas asociados a la colocación de diferentes dispositivos de uso médico y a la aplicación de biopolimeros glúteos en un caso adicional. Conclusiones: Es posible la existencia de una nueva enfermedad asociada a implantes de silicona en otros sitios corporales. La literatura es escasa y no permite afirmar aun su existencia. Debe tenerse un alto índice de sospecha ante cualquier caso sugerente de la entidad para su estudio, clasificación adecuada y manejo oportuno. Proponemos un algoritmo diagnóstico de utilidad en pacientes portadores de implantes glúteos que presenten alguna sintomatología asociada. (AU)

Background and objective: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare and partially understood disease that has aroused great interest due to the social and economic impact it generates. Little is known about the possible occurrence of the disease associated with the use of implants in other body locations. The objective of this article is to characterize and present the cases of anaplastic large cell lymphoma associated with implants located outside the breast described in the literature. Methods: A review of the literature was performed in PubMed, Cochrane, ScienceDirect and SciELO databases looking for reports of implant-associated anaplastic large cell lymphoma (IA-ALCL) in sites other than the breast. Results: Two case reports of IA-ALCL in the buttocks were found in patients with previous augmentation gluteoplasty with implants performed for aesthetic purposes. Additionally, the finding of a greater number of other types of lymphomas associated with the placement of different devices for medical use and the application of gluteal biopolymers in an additional case. Conclusions: The existence of a new disease associated with silicone implants in other body sites is possible. The literature is scant and does not allow us to confirm its existence. There must be a high index of suspicion in any case suggestive of the entity for its study, proper classification and timely management. We propose a diagnostic algorithm that can be very useful in patients with gluteal implants who present some associated symptoms. (AU)

Uso profiláctico de apósitos de silicona para minimizar las lesiones por presión: revisión sistemática y metaanálisis / Prophylactic use of silicone dressing to minimize pressure injuries: Systematic review and meta-analysis

Objetivo: La prevención de las lesiones por presión (LPP) adquiridas en el hospital en pacientes críticos sigue siendo un reto clínico importante debido a su alto riesgo de comorbilidad asociada. Se evaluó la eficacia preventiva de los apósitos de silicona en los pacientes ingresados en las unidades de cuidados intensivos y en entornos no relacionados con dichas unidades. Métodos: Se realizó una búsqueda bibliográfica en 3bases de datos electrónicas (MEDLINE, EMBASE, Cochrane Central) desde el inicio hasta diciembre de 2021. Se incluyeron los estudios que evaluaban la eficacia de los apósitos de silicona en la incidencia de LPP en la zona sacra. Las evaluaciones se informaron como ratios de riesgo relativo (RR) con intervalos de confianza al 95% y el análisis se hizo mediante un modelo de efectos aleatorios. Resultados: De los 1.056 artículos recuperados en la búsqueda inicial, se incluyeron 11estudios en el análisis final. Los apósitos de silicona redujeron significativamente la incidencia de LPP en comparación con la atención habitual (RR: 0,30; IC 95%: 0,19-0,45; p<0,01). No se encontraron diferencias significativas entre los resultados de los estudios en contextos de cuidados intensivos (RR=0,25; IC 95%: 0,15-0,43; p<0,01) y en contextos de cuidados no intensivos (RR=0,38; IC 95%: 0,17-0,83; p=0,01) (interacción de p: 0,39). Los apósitos de silicona redujeron el riesgo de desarrollar LPP entre los pacientes que utilizaron el apósito de espuma de 5capas Border (Mepilex® Sacrum) (RR: 0,31; IC 95%: 0,20-0,48; p<0,01) y el apósito Allevyn Gentle Border® (RR: 0,10; IC 95%: 0,01-0,73; p=0,02) sin diferencias significativas tras el análisis de subgrupos (interacción de p: 0,27). Conclusión: El presente metaanálisis señala que los apósitos de silicona reducen de forma consistente la incidencia de las LPP en entornos de cuidados intensivos y no intensivos, independientemente del tipo de apósito utilizado.(AU)

Objective: Preventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings. Methods:A literature search was conducted across 3electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model. Results: Of the 1,056 articles retrieved from the initial search, 11studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95%CI: 0.19-0.45, P<0.01). We found no significant difference between results of studies conducted in intensive care settings (RR=0.25, 95%CI: 0.15-0.43, P<0.01) and non-intensive care settings (RR=0.38, 95%CI: 0.17-0.83, P=0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95%CI: 0.20-0.48, P<0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95%CI: 0.01-0.73, P=0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27). Conclusion: The present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.(AU)

Compromiso del parénquima pulmonar secundaria a la inyección subcutánea de geles de silicona: reporte de caso

El compromiso del parénquima pulmonar secundario a la inyección subcutánea de geles de silicona es un cuadro de presentación excepcional, que se presenta con mayor frecuencia en mujeres entre los 22 a 55 años. Aunque se han planteado distintas teorías sobre su etiología, esta se desconoce y puede presentar complicaciones locales, sistémicas e incluso tener un desenlace fatal. Son pocos los casos reportados en América del Sur, y en el Perú no existe reporte alguno de esta singular entidad. Se presenta el caso de un paciente varón de 28 años, transexual, previamente sano, quien tras la inyección subcutánea de geles de silicona en la región glútea, en forma ilegal y por una persona que no es profesional de la salud, manifestó, dentro de las primeras 24 horas, un cuadro clínico caracterizado por dificultad respiratoria progresiva y dolor torácico punzante de aproximadamente 7 de 10 en la escala del dolor. Al ingresar a emergencias se evidenció de manera objetiva insuficiencia respiratoria, ya que el paciente presentó una saturación de oxígeno del 72 % a Fio₂: 21 %, asimismo, el compromiso del parénquima pulmonar tanto en la tomografía y radiografía de tórax con signos muy sugerentes de esta patología. Mediante la prueba ARN para SARS-CoV-2 en la muestra respiratoria por RT-PCR en tiempo real se descartó la neumonía secundaria al virus SARS-CoV-2, igualmente se excluyó la patología por inmunosupresión y tromboembolismo pulmonar. Debido a que no existe un tratamiento estandarizado se le brindó las medidas de soporte pertinentes, tales como administración de oxígeno suplementario a bajo flujo por cánula binasal, corticoides sistémicos vía endovenosa, además de antibioticoterapia, y se logró una evolución favorable con resolución del cuadro clínico inicial. Después de 10 días de tratamiento intrahospitalario el paciente fue dado de alta.

Pulmonary parenchymal involvement secondary to the subcutaneous injection of silicone gels is an unusual condition which occurs more frequently in women aged between 22 and 55 years. Although different theories have been put forward about its etiology, it is unknown and the condition may cause local and systemic complications and even have a fatal outcome. Few cases have been reported in South America and there is no report of this unique entity in Peru. We present the case of a previously healthy 28-year-old male transgender patient who, after an illegal subcutaneous injection of silicone gels in the gluteal region given by a non-healthcare professional, showed progressive respiratory distress and stabbing chest pain of approximately 7 out of 10 on the pain scale within the first 24 hours. Upon admission to the emergency room, respiratory failure was objectively evidenced since the patient had an oxygen saturation of 72 % at a FiO₂ of 21 %, as well as pulmonary parenchymal involvement both in the CT scan and chest X-ray with signs highly suggestive of this pathology. Using a SARS-CoV-2 RNA real-time RT-PCR test performed on a respiratory specimen, COVID pneumonia, immunodeficiency disorders and pulmonary embolism were ruled out. Since there is no standard treatment, the patient was given relevant support measures such as the administration of supplemental oxygen at a low flow rate by binasal cannula, intravenous systemic corticosteroids and antibiotic therapy, thus achieving good progress with resolution of the initial clinical presentation. Then, after 10 days of intrahospital treatment, the patient was discharged.

Prophylactic use of silicone dressing to minimize pressure injuries: Systematic review and meta-analysis.

OBJECTIVE: Preventing hospital-acquired pressure injuries (PI) in critically ill patients remains a significant clinical challenge because of its associated high risk for comorbid conditions. We assessed the preventive effectiveness of silicone dressings among patients admitted in intensive care units and non-intensive care units settings. METHODS: A literature search was conducted across 3 electronic databases (MEDLINE, EMBASE, Cochrane Central) from inception through December 2021. Studies assessing the effectiveness of silicone dressing on the incidence of PI on the sacral area were included. Evaluations were reported as risk ratios (RRs) with 95% confidence interval, and analysis was performed using a random-effects model. RESULTS: Of the 1056 articles retrieved from the initial search, 11 studies were included in the final analysis. Silicone dressings significantly reduced the incidence of PI compared to usual care (RR: 0.30, 95% CI: 0.19-0.45, P<0.01). We found no significant difference between results of studies conducted in intensive care settings (RR=0.25, 95% CI: 0.15-0.43, P<0.01) and non-intensive care settings (RR=0.38, 95% CI: 0.17-0.83, P=0.01) (P-interaction: 0.39). Silicone dressings reduced the risk of developing PI among patients using five-layer foam Border dressing (Mepilex® Sacrum) (RR: 0.31, 95% CI: 0.20-0.48, P<0.01), and dressing Allevyn Gentle Border® (RR: 0.10, 95% CI: 0.01-0.73, P=0.02) with no significant difference upon subgroup analysis (P-interaction: 0.27). CONCLUSION: The present meta-analysis suggests that silicone dressings consistently reduce the incidence of PI in intensive as well as in non-intensive care settings, regardless of the type of dressing used.

Un caso de neumonía organizada tras la ruptura intracapsular de implantes mamarios de silicona / A case of organized pneumonia after intracapsular rupture of silicone breast implants

La neumonía organizada es una entidad poco frecuente, caracterizada por la formación de conglomerados fibroblásticos intraalveolares conocidos como cuerpos de Masson, que puede ser criptogénica o secundaria a una respuesta inmunitaria a diversos estímulos, tales como enfermedades hematológicas, autoinmunitarias, exposición a sustancias químicas, fármacos, tóxicos, etc. Detectada y tratada de forma precoz, suele tener una buena respuesta a la corticoterapia, aunque si se diagnostica de forma tardía, la afectación pulmonar puede ser extensa, y, además, si el estímulo antigénico persiste, la respuesta al tratamiento será incompleta. Presentamos el caso clínico de una paciente de 65 años de edad quien hace 18 meses aproximadamente presentó la rotura intracapsular de sus implantes mamarios, 27 años después de su colocación. Con el mismo tiempo de evolución ha desarrollado progresivamente disnea, tos seca y dolor inframamario, habiendo llegado al diagnóstico de neumonía organizada bilateral difusa, asociada a dicha rotura de implantes.

Organizing pneumonia is a rare entity, characterized by the formation of intraalveolar fibroblastic conglomerates known as Masson bodies, which may be cryptogenic or secondary to an immune response to various stimuli, such as hematological, autoimmune diseases, exposure to chemical substances, drugs, toxics, etc. If it is detected and treated early, it usually has a good response to corticosteroid therapy, although if it is diagnosed late, the lung involvement can be extensive, and furthermore, if the antigenic stimulus persists, the response to treatment will be incomplete. We present the clinical case of a 65-year-old patient who had intracapsular rupture of her breast implants approximately 18 months ago, 27 years after their placement. With the same evolution time, she progressively developed dyspnea, dry cough and under mammary pain, having reached the diagnosis of diffuse bilateral organizing pneumonia, associated with implant rupture.

Hipertensión ocular secundaria a aceite de silicona / Ocular Hypertension Secondary to Silicone Oil

La silicona líquida es usada intravítrea cuando se requiere un taponamiento prolongado intraocular para mantener la retina aplicada. A pesar de sus ventajas, su uso se ha asociado a algunas complicaciones como catarata, queratopatía, hipertensión ocular, glaucoma entre otras. La hipertensión ocular secundaria por aceite de silicona aparece por varios mecanismos, la migración de partículas a la malla trabecular junto con el proceso inflamatorio que genera es un reto para los cirujanos, de ahí los diferentes criterios de tratamiento que existen para su completa resolución. A continuación, se presenta un paciente operado de desprendimiento de retina recidivado con hipertensión ocular secundario a aceite de silicona 9 meses después de su primera intervención. Llevó tratamiento con hipotensores oculares tópicos, orales y no resolvió por lo que se decide realizar ciclocrioterapia en dos cuadrantes. A pesar que este tratamiento no es el de elección en estos casos, podemos decir que en este paciente se logra controlar la presión intraocular luego de una sola sesión(AU)

Liquid silicone is used intravitreally when prolonged intraocular insulation is required to keep the retina applied. Despite its advantages, its use has been associated with some complications such as cataract, keratopathy, ocular hypertension, glaucoma, among others. Secondary ocular hypertension due to silicone oil appears by several mechanisms. The migration of particles to the trabecular meshwork, together with the inflammatory process it generates, represents a challenge for surgeons, hence the different treatment criteria that exist for its complete resolution. The following is a patient operated on for recurrent retinal detachment with ocular hypertension secondary to silicone oil 9 months after the first operation. He was treated with topical and oral ocular hypotensors and it did not resolve, so it was decided to perform cyclocriotherapy in two quadrants. Although this treatment is not the treatment of choice in these cases, we can say that in this patient intraocular pressure control was achieved after only one session(AU)

Aumento de pantorrillas con implantes subfascial

Objetivo: El objetivo del presente estudio es analizar las cirugías de aumento de pantorrillas realizadas por el autor principal describiendo características clínicas de los pacientes, tipos de implantes utilizados y detalles de la técnica quirúrgica con bolsillo subfascial. Material y Método: Estudio de tipo observacional retrospectivo de una serie de 19 pacientes que se realizaron aumento de pantorrilla bilateral por motivos estéticos en una clínica privada en el periodo 2009-2018. Resultados: Todos los pacientes consultaron por piernas delgadas de carácter estético y se les realizó aumento gemelar interno con implantes bilaterales subfascial. En 78% de los casos se utilizó implante de base simétrica y 22% implante de base asimétrica. Hubo 2 complicaciones menores. Discusión: Es necesario contar con mayor variedad de implantes que combinen diferentes medidas de longitud, ancho y proyección que se adecuen a las variables anatomías particulares de cada paciente. Conclusiones: La técnica de implantes de silicona en bolsillo subfascial es satisfactoria con pocas complicaciones. Su éxito depende del correcto balance entre bolsillo e implante. Debería existir mayor variedad de implantes ajustables para cada paciente.

Objective: The objective of the present study is to analyze the calf augmentation surgeries performed by the main author, describing patients' clinical characteristics, types of implants used and details of the surgical technique with subfascial pocket. Materials and Method: A retrospective observational study of a series of 19 patients who underwent bilateral calf augmentation for cosmetic reasons in a private clinic in the period 2009-2018. Results: All patients consulted for slim cosmetic legs, an internal calf augmentation was performed with bilateral implants. In 78% of cases, a symmetrical based implant was used and 22% asymmetric based implant. There were 2 minor complications. Discussion: It is necessary to have a greater variety of implants that combine different measures of length, width and projection that are adapted to the variable anatomies of each patient. Conclusions: Subfascial pocket silicone implant technique is satisfactory with good results and few complications. Its success depends on the correct balance between pocket and implant. It seems that there is not yet a variety of adjustable implants for each patient on the market.

Enfermedad por inyección de rellenos sintéticos permanentes (EIRSP). Recomendaciones del grupo de expertos del Capítulo de Biomateriales de la FILACP / Disease caused by permanent synthetic fillers FILACP Biomaterials Committee expert group recomendations

La enfermedad por rellenos sintéticos permanentes (EIRSP) representa un verdadero problema de salud pública sobre todo en América Latina, afectando a millones de personas, predominantemente mujeres de mediana edad de estrato económico medio-bajo. Actualmente no existe una conducta terapéutica consensuada, razón que motivó al Comité de Biomateriales de la FILACP 2020-2022 a crear un grupo de 9 expertos quienes se plantearon los siguientes objetivos: 1.- Resaltar la importancia de la enfermedad, 2.- Clasificar sus estadios clínicos, 3.- Proponer un protocolo integral de diagnóstico y tratamiento, 4.- Proponer una estrategia terapéutica multidisciplinaria y 5.- Promover campañas de prevención.El relleno sintético más utilizado con fines estéticos ha sido la silicona inyectada en cara, glúteos, mamas, miembros inferiores, manos y genitales, con alto potencial de migración. Otras substancias son el metacrilato, aceites minerales, parafina y la combinación de ellas. Ninguno de estos productos es de grado médico ni biocompatible. Al ser inyectados van a producir diversas reacciones locales y sistémicas desencadenadas por reacción de hipersensibilidad tipo IV, conduciendo al desarrollo de una enfermedad autoinmune de tejido conectivo.Se propone una clasificación basada en 6 estadios clínicos o grados. 1: Sin signos ni síntomas. 2: Cambios de coloración. 3: Inflamación, induraciones, cambios de textura y dolor. 4: Extrusión del producto con o sin infección. 5: Migración. 6: Complicaciones locales o sistémicas graves.Se establecen las pautas diagnósticas basadas en la historia clínica, exámenes de laboratorio, inmunológicos y radiológicos. Para este último, la resonancia magnética es la técnica de elección y en algunos casos, con excepción de glúteos y mamas, el ultrasonido es de gran utilidad. (AU)

Disease caused by permanent synthetic fillers (EIRSP acronym in Spanish) represents a real public health problem, especially in Latin America, affecting millions of people, predominantly middle-aged women from a medium-low economic stratum. Currently, there is no consensual therapeutic behavior, the reason that motivated the FILACP Biomaterials Committee 2020-2022 to create a group of 9 experts, who set the following objectives: 1.- Highlight the importance of the disease, 2.- Classify the clinical stages, 3.- Propose a comprehensive diagnosis and treatment protocol, 4.- Propose a multidisciplinary therapeutic strategy and 5.- Promote prevention campaigns.The most widely used synthetic filler for aesthetic purposes has been silicone injected into the face, buttocks, breasts, lower limbs, hands and genitals, with a high potential for migration. Other substances are methacrylate, mineral oils, paraffin, and a combination. None of these products have a medical grade or are biocompatible. When injected, they will produce various local and systemic reactions triggered by type IV hypersensitivity reactions, leading to the development of autoimmune connective tissue disease.A classification based on 6 clinical stages or grades is proposed. 1: No signs or symptoms. 2: Color changes. 3: Inflammation, indurations, texture changes, and pain. 4: Extrusion of the product with or without infection. 5: Migration. 6: Severe local or systemic complications.Diagnostic guidelines are established based on clinical history, laboratory, immunological and radiological tests. For the latter, magnetic resonance imaging is the technique of choice, and in some cases, except for the buttocks and breasts, ultrasound is beneficial. (AU)

Estabilidad dimensional de la silicona por adición: polivinilsiloxano un estudio in vitro / Dimensional stability of silicone by addition: polyvinylsiloxane in vitro study

Introducción: Se han realizado con el fin de evaluar la estabilidad dimensional, cada grupo de estudio confecciona su propio aditamento con el fin de determinar si existe o no una variación dimensional de los diferentes materiales de impresión utilizados en la rehabilitación oral. Esta variación va a depender de distintos factores como el tiempo, el material, la temperatura, la humedad entre otros.Objetivo: En este sentido, el objetivo del estudio fue evaluar la estabilidad dimensional de la silicona de adición / polivinilsiloxano (VPS) y para ello se tendrá en cuenta el tiempo.Métodos: Se trata de un estudio experimental. La muestra estuvo conformada por un total de 50 modelos, 25 para VPS Y 25 para el grupo control cuyo material fue la silicona por condensación. Para realizar el estudio se confecciono un modelo maestro teniendo en cuenta 6 localizaciones y 5 periodos de tiempo donde elprimer grupo a los 0 minutos, el segundo grupo a los 20 minutos, el tercer grupo a la 1 hora, cuarto grupo a las 6 horas y el quinto grupo a las 24 horas, después de tomada la impresión.Resultados: Después de la toma de impresión cuando se contabiliza a los 0 minutos, a los 60 minutos, a las 6 horas y a las 24 horas se obtiene el estadístico t ≥ 2,1318 y p≤ 0,05 confirmando que se encuentran diferencias significativas entre las dos siliconas respecto a la variación dimensional.Conclusiones: Se concluye que existe una variación de la estabilidad dimensional al ser comparada con el grupo control como lo es la silicona por condensación. (AU)

Introduction: They have been carried out in order to evaluate dimensional stability, a study group makes its own abutment in order to determine if there is no dimensional variation of the different impression materials used in oral rehabilitation. This variation will depend on different factors such as time, material, temperature, humidity among others.Objective: In this sense, the objective of the study was to evaluate the dimensional stability of the addition silicone / polyvinylsiloxane (VPS) and for this, time will be taken into account.Methods: We went on to an experimental study. The sample consisted of a total of 50 models, 25 for VPS and 25 for the control group whose material was silicone by condensation. To carry out the study, a master model was made taking into account 6 locations and 5 time periods where the first group at 0 minutes, the second group at 20 minutes, the third group at 1 hour, the fourth group at 6 hours and the fifth group at 24 hours, after the impression was taken.Results: After taking the impression when it is counted at 0 minutes, at 60 minutes, at 6 hours and at 24 hours, the statistic t ≥ 2.1318 and p≤ 0.05 is obtained, confirming that there are significant differences between the two silicones with respect to the dimensional variation.Conclusions: It is concluded that there is a variation in dimensional stability when compared with the control group such as silicone by condensation.. (AU)

Implantes de pantorrilla, obliteración del túnel de acceso entre fascias para disminuir complicaciones / Calf implants, closed access tunnel between fasciae to reduce complications

Introducción y objetivo: En la actualidad, muchas personas esperan obtener un mejor contorno y simetría de sus piernas, por lo cual en nuestra especialidad desarrollamos técnicas para satisfacer esta demanda. Presentamos nuestra experiencia y variante técnica de aumento de pantorrillas con implantes de gel de silicona asimétricos. Material y método: Estudio retrospectivo y descriptivo de 7 años (2012-2018) en práctica privada evaluando resultados en 57 pacientes de sexo femenino con pantorrillas delgadas y/o arqueadas que se sometieron a cirugía para mejorar el aspecto estético de esta zona anatómica con técnica quirúrgica en la que introdujimos como variante la obliteración del túnel de acceso entre fascias. Resultados: Al inicio, colocamos el implante bajo la fascia superficial, sin cerrar el trayecto disecado entre la fascia superficial y profunda hasta el gastrocnemio, con cierre en dos planos y vendaje elástico. La satisfacción estética final de las pacientes con esta técnica fue del 63.64 % (7 de 11 pacientes). Como complicaciones: migración del implante en 2 casos (18.18%), palpación del implante en 3 (27.27%), cicatriz hiperpigmentada en 4 (36.36%), seroma proximal a la incisión en 1 (9.09%), dehiscencia parcial de herida en 4 (36.36%), infección en 1(9.09%), aspecto estético final no aceptado en 4 (36.36%), reintervención por insatisfacción estética en 2 (18.18%). Ante estos datos modificamos la técnica colocando el implante bajo la fascia profunda, obliterando el trayecto de disección entre las fascias, con cierre dirigido y elastocompresión vascular. En estos casos la satisfacción estética final fue del 95.65% (44 de 46 pacientes). Como complicaciones:no hubo casos de migración o palpación del implante, seroma, infección o no aceptación del resultado estético final, hubo 1 caso de hiperpigmantación parcial de la cicatriz (2.17%), y 1 de dehiscencia parcial de herida (2.17%). (AU)

Background and objective: Nowadays, people currently hope to obtain a better contour and symmetry of their legs, consequently, in Plastic Surgery, we develop techniques to satisfy this demand. We present our experience and technical variant of calf augmentation using asymmetric silicone gel implants. Methods: Retrospective and descriptive study of 7 years (2012-2018) in private practice evaluating results in 57 female patients with thin and/or bowed calves who underwent surgery to improve the aesthetic appearance of this anatomical area with a surgical technique in which we introduced as a variant the obliteration of the access tunnel between fasciae. Results: Initially, we placed the implant under the superficial fascia without closing the dissected path between the superficial and deep fascia up to the gastrocnemius, with closure in two planes and an elastic bandage. The final aesthetic satisfaction of the patients with this technique was 63.64% (7 of 11 patients). As complications: migration of the implant in 2 cases (18.18%), palpation of the implant in 3 cases (27.27%), hyperpigmented scar in 4 cases (36.36%), seroma proximal to the incision in 1 case (9.09%), partial wound dehiscence in 4 cases (36.36%), infection in 1 case (9.09%), unacceptable final aesthetic appearance in 4 cases (36.36%), re-intervention due to aesthetic dissatisfaction in 2 cases (18.18%). With these data, we modified the technique by placing the implant under the deep fascia, obliterating the dissection path between the fasciae, with directed closure and vascular elastocompression. In these cases, the final aesthetic satisfaction was 95.65% (44 of 46 patients). As complications: there were no cases of migration or palpation of the implant, seroma, infection or non-acceptance of the final aesthetic result, there was 1 case of partial hyperpigmentation of the scar (2.17%) and 1 of partial wound dehiscence (2.17%). (AU)