Ameloblastoma mandibular: revisión de la literatura y presentación de seis casos

El ameloblastoma es un tumor odontogénico benigno de origen epitelial sin inducción en el tejido conectivo. En el tratamiento del mismo se debe valorar el tipo clínico (sólido y multiquístico, uniquístico, periférico), la localización y el tamaño del tumor, así como la edad del paciente. Recientemente se han publicado algunos artículos con el fin de actualizar los conocimientos y actitudes terapéuticas frente al ameloblastoma. Se presentan seis casos de pacientes afectos de ameloblastomas localizados en la mandíbula, tratados en los últimos siete años. Se aportan datos acerca de su aparición clínica, sus características histológicas, el manejo terapéutico realizado que consistió en la extirpación de la lesión, fresado perilesional del hueso o resección en bloque, según el tipo de ameloblastoma. Finalmente analizamos el seguimiento y la aparición de recidivas en los pacientes presentados. El objetivo de este artículo es revisar los conceptos respecto al ameloblastoma que se han publicado recientemente y valorar su influencia en la actitud del clínico a la hora de actuar frente a esta patología, tomando como punto de partida para ilustrar está discusión la presentación de nuestra experiencia respecto al ameloblastoma.Ameloblastoma is a benign odontogenic tumour of epithelial origin without induction in the connective tissue. In treating this type of tumour, it is important to assess the clinical type (solid, multicystic, unicystic, peripheral), localisation, and size of the tumour as well as age of the patient. Articles have recently been published with the purpose of providing updated knowledge and therapeutic approaches to ameloblastoma. We present six cases of patients with localised mandibular ameloblastoma who were treated during the last seven years. We present data on clinical appearance, histological characteristics, and therapeutic approach that was used, which included excision of the lesion, perilesional drilling of the bone, or block resection, according to the type of ameloblastoma. Lastly, we analysed follow-up measures and the rate of recurrence in these patients. The aim of this paper is to review the concepts relating to ameloblastoma that have been published recently and to assess their influence on the clinical attitude taken when facing this pathology, using our experience with ameloblastoma as a starting point to illustrate this discussion

Assessment of quality of life in oral cancer

Quality of life (QL) in oral cancer patients has become one of the most important parameters to consider in the diagnosis and post-treatment follow-up. The purpose of this article has been to review the papers published that study the QL in oral cancer patients, the different QL questionnaires used, the clinical results obtained, and the systematic revisions available in the indexed literature for the last 10 years. The term QL appears as a keyword in an increasing number of articles throughout the past 10 years; however, few studies focus on oral cancer. Most of them assess all head and neck cancers, which conform to a heterogeneous group with several different features depending on location (oral cavity, oropharynx, larynx, hypopharynx, nasopharynx and salivary glands). Most studies evaluate QL in short periods of time, normally within the first year after the diagnosis. Series do not discern between different therapeutic options, and they generally center on Northern European or Northern American populations. There are few instruments translated and validated into Spanish that measure QL, a fundamental characteristic to link QL to own patients? socio-cultural parameters. Data related with QL are mostly related to patient (age, sex, co-morbidity), tumour (location, size), and treatment (surgical treatment, radiotherapy association, reconstruction, cervical dissection, and/or feeding tube). Nowadays QL?s assessment is considered an essential component of an oral cancer patient as well as the survival, morbidity and years free of disease. Although many aspects related to QL in oral cancer patients have been published throughout the past 10 years, more systematic research is needed to be able to apply it on a daily basis

Conservative management of dentigerous cysts in children

Purpose and Introduction: Dentigerous cysts are epithelial in origin and are the most commonly found cyst in children. The majority of these lesions are usually a radiological finding and are capable of quite large before being diagnosed. The standard treatment for these cysts is the enucleation and the extraction of the affected tooth. However, if the patient is a child and the affected tooth is not developed, a more conservative attitude should be considered. Material and Methods: (Clinical case): A 7-year-old patient is presented with an eruptive backlog of the lower permanent first molars. Radiological examination reveals two radiolucid lesions in relation to them, which are compatible with a dentigerous cyst, and in relation to the inferior aveolar nerve and various germs. A partial enucleation is carried out, maintaining all the dental germs related to the cyst in mouth and monitoring the patient until the case study is over. Results and Discussion: Diagnosis and early treatment of these lesions in children is of great importance, especially in cases where the lesions enclose permanent teeth. Conclusions: Whenever possible, a conservative attitude should be taken, one that allows for the maintenance of the dentition and treatment of the associated cyst in order to not compromise either the occlusion or the mental state of these patients

Insulin and HOMA in Spanish prepubertal children: Relationship with lipid profile.

Objective: The effects of insulin or insulin resistance on the lipid profile seem to change with age. The aim of this study was to analyze insulin levels and an insulin resistance index and to investigate the relationship between these and the lipid profile in a population-based sample of Spanish prepubertal children. Methods: 1048 (524 boys and 524 girls) randomly selected prepubertal children were studied. Children were 6 to 8 years old with a mean age of 6.7. Plasma lipid, FFA and insulin levels were measured. The homeostatic model assessment (HOMA) was calculated as an indicator of insulin resistance. Results: When analyzing percentile values of insulin, HOMA and FFA by sex, we observed that girls had significantly higher insulin concentrations than boys (except at the 10th percentile) and significantly higher FFA (except at the 90th percentile) with no significant differences between sexes for HOMA. Multivariate regression analyses showed that insulin was positively associated with glucose, triglycerides and apoB in boys but not in girls, and negatively associated with FFA in both genders. Conclusions: We report here data about the distribution of insulin in the Spanish prepubertal population. The higher levels of insulin in prepubertal girls could indicate that girls start to be more insulin resistant than boys at this age, although other manifestations of insulin resistance are not yet detectable.pre-print211 K

SARS-CoV-2 infection in a pediatrics STAT1 GOF patient under Ruxolitinib therapy-a matter of balance?

Recently, 94 inborn errors of immunity (IEI) patients suffering from COVID-19 have been described, overall demonstrating a mild phenotype [1] although more severe disease manifestations have been suggested for patients with alterations in the interferon (IFN) signaling pathway, including auto-antibodies against type I IFN [2]. Patients with STAT1 GOF mutations show a complex and often severe phenotype, combining an increased susceptibility of fungal, (myco-) bacterial and viral infections as well as autoimmune and autoinflammatory manifestations [3]. Characteristically, in response to type I and type II IFN stimulation, these patients show STAT1 hyperphosphorylation [3, 4]. Whether in the context of SARS-CoV-2 infection, the hyperactivation of the IFN-JAK1/2-STAT1 pathway would be protective (antiviral effect) or deleterious (hyperinflammation) is unclear. Ruxolitinib (a selective JAK1/2 inhibitor) has been successfully used in STAT1 GOF patients controlling many disease manifestations [5] and also resulted in improved pulmonary function and faster recovery from lymphopenia in previously healthy individuals suffering from severe COVID-19 [6].This work was supported by the Instituto de Salud Carlos III, Madrid (Spain) [Sara Borrell, CD20/00124 to P.B.L, Juan Rodés JR18/00042 to P.O, FIS PI19/01471 to O.N] and the Consejería de Salud, Junta Andalucía [SA0051/2020 to O.N]. A.G-V was supported by the Instituto de Salud Carlos III, cofinanced by the European Development Regional Fund (“A way to achieve Europe”), Subprograma Miguel Servet (CP19/00159).Peer reviewe

Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study

Background: We aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19. Methods: International, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections. Results: 684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa. Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections. Conclusions: Infectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized

Product–process matrix and complementarity approach

The relationship between different types of innovation is analysed from three different approaches. On the one hand, the distinctive view assumes that the determinants of each type of innovation are different and therefore there is no relationship between them. On the other hand, the integrative view considers that the different types of innovation are complementary. Finally, the product–process matrix framework suggests that the relationship between product innovation and process innovation is substitutive. Using data from Spain belonging to the Technological Innovation Panel (PITEC) for the years 2008, 2009, 2010, 2011 and 2012, we tested which of the three approaches is predominant. To perform the hypothesis test, we used the so-called complementarity approach. We find that there is no unique relation. The nature of the relationship depends on the types of innovation that interact. Our most significant finding is that the relationship between product innovation and process innovation is complementary. This finding contradicts the proposal of the product–process matrix framework. Consequently, the joint implementation of both types of innovation generates a greater impact on the performance of a company than the sum of their separate implementation

Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components. Dendritic cells (DCs) play a key role in the defense against viral infections, for instance plasmacytoid DCs (pDCs), have the capacity to produce vast amounts of interferon-alpha (IFN-α). In COVID-19 there is a deficit in DC numbers and IFN-α production, which has been associated with disease severity. In this work, we described that in addition to the DC deficiency, several DC activation and homing markers were altered in acute COVID-19 patients, which were associated with multiple inflammatory markers. Remarkably, previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+ myeloid DCs and pDCs seven months after SARS-CoV-2 infection. Moreover, the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients, while no restoration of integrin β7 and indoleamine 2,3-dyoxigenase (IDO) levels were observed. These findings contribute to a better understanding of the immunological sequelae of COVID-19

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate´s phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.J.T.S. holds a research contract from the Fundación para la Formación e Investigación de los Profesionales de la Salud de Extremadura (FundeSalud), Instituto de Salud Carlos III. M.F.R. holds a clinical research contract “Juan Rodés” (JR14/00036) from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III