Instituto Médico La Floresta

Cysts are common pathology in the maxillofacial area. The treatment of choice consists of enucleation, regeneration of the created defect and achieving a primary closure. The platelet rich fibrin (PRF), developed by Joseph Choukroun, has been commonly use in the area of oral regeneration, thanks to its biological properties; some literature suggests the application in cystic cavities to not only avoids the collapse of tissue but also help regeneration be achieved in a shorter time, however, changes in the nature of the cells and lack of evidence in the literature continue to be a controversial issue. To analyze the current state of clinical knowledge and the potential of the use of PRF in the regeneration therapy of cystic cavities either alone or as a co-adjuvant of other biomaterials through a systematic review of the literature. The selection of articles was carried out following the PRISMA statement for systematic reviews protocol, with selection of articles between 2006 to 2022, without discriminating in English or Spanish using a keyword algorithm "PRF jaw cyst," " Platelet rich fibrin jaw cyst," "platelet rich fibrin oral cyst," selected articles such as case reports, series of cases and comparative clinical studies were reviewed. A total of 33 articles were included in this review where 154 cystic cavities were evaluated, mostly radicular cysts, treated with PRF alone or as coadjutant of some biomaterial where a successful regeneration was evidenced in a period of 3-6 months, without any complications presented in post-surgical controls, but the lack of histopathological information was an issue in several articles. Although PRF seems to be a good regenerative therapy in oral surgery and no evidence was found that contraindicated its use in this cases, its applications in cystic cavities still needs more evidence in articles with less bias and more evidence such as comparative studies with control groups.

Objectives: This study aims to describe and analyze the indications and clinical results of total TMJ replacement in participants with degenerative and/or inflammatory joint diseases, defining patient and intervention conditions. Methods: A systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Intervention and reported according to the PRISMA Items update. The search strategy was from 1997 to July 2024 in Pubmed, Embase, Scopus, and Web of Science. A search for gray literature was conducted in the databases Google Scholar and Open Access Theses and Dissertations (OATD), and there were no limitations on the language or study design. We incorporated studies involving human patients over 15 years of age with degenerative and/or inflammatory joint conditions who underwent joint prosthesis replacement, either concurrently or separately from orthognathic surgery, as an initial intervention or after prosthesis installation. Participants with a postoperative follow-up of 12 months or longer were included. A risk of bias analysis was performed for non-randomized studies using the ROBINS-I tool, and GRADE profiler (GRADEpro) software was used to assess the quality of evidence and synthesize the data. Results: All the selected studies performed postoperative follow-up with quantitative and qualitative parameters; 10 performed a follow-up of 2 to 5 years. The indication for joint prosthesis replacement due to system failure was only 4.07%. Concerning diagnoses, 579 presented degenerative and/or inflammatory joint diseases, with osteoarthritis being the most frequent, followed by osteoarthrosis, juvenile idiopathic arthritis, and rheumatoid arthritis. The maximum mouth opening of the participants with TMJ disease presented an average of 24.32 ± 5.8 mm with a range of 18 to 36.4 mm. Of the 579 participants, the studies mention that they presented a soft to liquid diet and pain associated with decreased mandibular functionality. Conclusions: A total of 76.18% of the participants presented a range of moderate to severe pain associated with a decrease in functionality and, after joint replacement, all participants mentioned a decrease in pain or absence of pain, a change in diet by incorporating solid foods, and an increase in opening with an average of 40.74 ± 3.1 mm. Total joint replacement shows favorable long-term results. It is not possible to identify the best time to perform joint replacement surgery, considering the time since diagnosis of the disease, the time since the start of non-surgical treatment, or the number of previous surgeries.

AI is included in a lot of different systems. In facial surgery, there are some AI-based software programs oriented to diagnosis in facial surgery. This study aims to evaluate the capacity and training of models for diagnosis of dentofacial deformities in class II and class III patients using artificial intelligence and the potential use for indicating orthognathic surgery. The search strategy is from 1943 to April 2024 in PubMed, Embase, Scopus, Lilacs, and Web of Science. Studies that used imaging to assess anatomical structures, airway volume, and craniofacial positions using the AI algorithm in the human population were included. The methodological quality of the studies was assessed using the Effective Public Health Practice Project instrument. The systematic search identified 697 articles. Eight studies were obtained for descriptive analysis after exclusion according to our inclusion and exclusion criteria. All studies were retrospective in design. A total of 5552 subjects with an age range between 14.7 and 56 years were obtained; 2474 (44.56%) subjects were male, and 3078 (55.43%) were female. Six studies were analyzed using 2D imaging and obtained highly accurate results in diagnosing skeletal features and determining the need for orthognathic surgery, and two studies used 3D imaging for measurement and diagnosis. Limitations of the studies such as age, diagnosis in facial deformity, and the included variables were observed. Concerning the overall analysis bias, six studies were at moderate risk due to weak study designs, while two were at high risk of bias. We can conclude that, with the few articles included, using AI-based software allows for some craniometric recognition and measurements to determine the diagnosis of facial deformities using mainly 2D analysis. However, it is necessary to perform studies based on three-dimensional images, increase the sample size, and train models in different populations to ensure accuracy of AI applications in this field. After that, the models can be trained for dentofacial diagnosis.

Abstract Background Recurrence of cardiovascular (CV) events (CVe) and mortality are high after the index event. In the SECURE trial, CV Polypill Strategy (acetyl salicylic acid [ASA]+atorvastatin+ramipril) reduced CV mortality by 33% in post-acute myocardial infarction (AMI) patients over 3 years (median) compared to usual pharmacologic treatment. The 2023 ESC Guidelines recommend the CV Polypill to improve outcomes and adherence in secondary prevention after acute coronary syndrome, emphasizing early initiation for better patient prognosis post-discharge. Purpose To reach consensus among medical experts worldwide on the optimal utilisation of the CV Polypill Strategy (ASA+atorvastatin+ramipril) as baseline treatment to prevent recurrent CVe in routine clinical practice. Methods A two-round, modified Delphi method was used. A questionnaire with 30 evidence-based statements was created and validated by 8 renowned cardiologists. 50 clinicians from 19 countries in Europe, Latin America and Asia formed the Delphi panel. Panellists ranked their responses using a three-point Likert scale for agreement and importance. Consensus was reached when ≥80% agreed or deemed questions 'very important' or 'important' (Graph 1). Statements without consensus in the first round were refined based on evidence and participant feedback in the second round. Any remaining disagreements were resolved in a face-to-face meeting with the experts. Descriptive statistics were applied. Results Response rates were 76% and 74% in round 1 (March-April 2023) and round 2 (May-June 2023), respectively. Panellists were 82% cardiologists; 13% internists; 74% frequently advised the CV Polypill Strategy (ASA+atorvastatin+ramipril). 93.3% statements achieved consensus. 97.4% agreement on research findings indicating 24% relative risk reduction of CV death, AMI, stroke, or urgent revascularization over 3 years (median) with the CV Polypill Strategy, compared to usual care after a coronary heart disease event, expected to replicate in clinical practice. 100% accord on the CV Polypill Strategy implemented on hospital discharge or first follow-up visits as baseline therapy. 81.1% coincidence on its initiation as soon as symptoms stabilize. Agreement on following algorithms to start (97.3%) or switch (97.4%) to the CV Polypill Strategy from separate cardioprotective drugs. Agreement on CV Polypill Strategy in discharge plan for therapeutic goals (81.6%) and improved adherence (94.7%), and on hospital team’s awareness of CV Polypill Strategy’s CV benefits (100%). 97.4% accord on considering patients' preferences in the discharge plan. Agreement (89.5%) on the polypill strategy delivering cost savings over the patient's lifetime (Table 1). Conclusions Experienced clinicians strongly advocate early adoption of the CV Polypill Strategy (acetyl salicylic acid+atorvastatin+ramipril) to reduce recurrence, enhance prognosis, lower CV mortality, and potentially reduce lifetime costs after a CV event. Graph 1. Table 1

Keywords: COVID-19, SARS-CoV-2, Antibody, ELISA, Spike, S1, S2, RBD, epitopes, Neutralization

Abstract. This research aimed to determine the susceptibility of Aspergil-lus spp. to four antifungal agents using the Etest® method in several clinical samples (respiratory samples, soft tissue, otic tissue, and ocular tissue, among others) from a private health center in Venezuela. Thirty-three strains were evaluated: 11 Aspergillus section Flavi, eight Aspergillus section Fumigati, six Aspergillus section Nigri, four Aspergillus section Terrei, and four Aspergillus spp. A 0.5 McFarland standard suspension of a 5-day culture of each Aspergillusstrain was prepared on Potato Dextrose agar and then inoculated on Sabouraud agar plates with 2% glucose. Voriconazole (VCZ), amphotericin B (AMB), caspo-fungin (CAS), and posaconazole (PCZ) were tested. Minimal inhibitory concen-trations (MIC) in μg/mL were determined after 24 and 48 hours of incubation at 35 °C and th range (R), geometric mean (GM), MIC50, and MIC90 were calcu-lated. The results for the 33 Aspergillus spp. tested after 24 h were the follow-ing: VCZ (R = 0.031- 16; GM = 0.145; MIC50 = 0.125 and MIC90 = 0.5), AMB (R = 0.031-16; GM = 0.644; MIC50 = 0.5 and MIC90 = 8), CAS (R = 0.031-16; GM = 0.1076; MIC50 = 0.063 and MIC90 = 1), PCZ (R =0.031 - 0.5; GM = 0.0755; MIC50 = 0.063 and MIC90 = 0.25). This investigation allowed assessing the an-tifungal susceptibility profiles of Aspergillus spp. isolated from clinical samples by the Etest® method, which is practical, reproducible and easy to perform in microbiology laboratories.

El sistema intestinal posee una capacidad regenerativa intrínseca y fisiológica que tiene lugar a partir de las células madre Lgr5+ ubicadas en el fondo de las criptas intestinales, las cuales se diferencian hacia las células progenitoras secretoras y absortivas con sus respectivas células especializadas mediante la activación de señalizaciones intracelulares como Wnt, Hippo y Notch. Condiciones adversas como lesiones e infecciones tisulares inducen esta actividad regenerativa promovida por variados mecanismos que influyen en el microambiente celular. El sistema inmunológico detecta alteraciones en el tejido intestinal y, a través de la activación de células inmunocompetentes y la secreción de citoquinas proinflamatorias, favorece la desdiferenciación de células especializadas hacia células madre para desencadenar la respuesta regenerativa. En cuanto al sistema nervioso entérico, su influencia está sujeta a modificaciones en la microbiota y los hábitos alimenticios, y se encuentra determinada en gran parte, por las células gliales entéricas y la expresión de distintos marcadores de plasticidad, que permiten limitar la lesión y reparar el tejido. Por su parte, la epigenética modifica la expresión genética y consecuentemente, la capacidad regenerativa intestinal, variando de acuerdo a cada paciente por la influencia de factores externos como la dieta o el estado psicobiológico. De esta forma, la respuesta regenerativa intestinal inducida por lesiones, integra múltiples mecanismos y posee importantes repercusiones clínicas en cuanto a EII, disbiosis e incluso tumorogénesis; conocer los mecanismos que regulan esta actividad puede sentar las bases para la creación de terapias innovadoras en el mismo ámbito.

In November 2022 the Italian medical council (Federazione nazionale degli ordini dei medici chirurghi e odontoiatri) started the revision of the Italian Code of medical ethics (Cme) with the first race dating back ten years. Since then, the Italian doctors are dealing with the scientific, ethical and economic challenges together with the more recent ones posed by the Sars-CoV-2 pandemic to the National health system underlying the ongoing crisis of the medical profession. Additionally, this critical context requires the doctors to develop new technological skills, a complete and effective adherence to the Ebm principles, a new view regarding the relationship with the other health care professionals and the related changes of clinical practices fostering a responsible use of resources. In brief, what is required nowadays from doctors is to rethink about the meaning of science, ethics, economics and public health and to make new and more appropriate connections between the instances conveyed by these different disciplines. The Cme main aim consists in providing appropriate rules in step with the current transformations of medicine and society to doctors for ethically acting in clinical practice, assuring the citizens, the institutions and law of the scientific competence, the protection of the fundamental rights of the sick person in compliance with the constitutional principles. Under this assumption and in line with the above mentioned professional crisis, at least the overall guidelines aimed to solve it should have been settled before starting the Cme review also in order to ensure the necessary coherence between the new contents drawing the doctors new social function and its codal systemisation. Unfortunately this stepwise approach was not considered.Lastly, to develop the new Cme looking towards the progress of medical profession, systematic and methodologically appropriate consultations would have been necessary to know, value and balance all the different positions of doctors, allowing them to be responsible for the change of their profession. However, such a decision was not made.