ABSTRACT Mercury (Hg) is one of the most toxic heavy metals, and it is largely used in illegal gold extraction in Peru. We evaluated the tolerance to Hg in Paronychia microphylla Phil, Ambrosia artemisioides Willd and Croton ruizianus Müll. Arg. plants, using controlled concentrations (5, 10 and 80 mg Hg L-1). Two groups were identified according to the antioxidant enzymatic and bioaccumulation response, but the changes in the soluble protein suggest other tolerance mechanisms in the species. P. microphylla has an accumulator performance (BCF = 1.16 at 10 mg Hg L-1); in contrast, C. ruizianus has a exclusor behavior with low BCF and better antioxidant response. In that sense, the concentration of 5 mg Hg L-1 triggers the oxidative stress and increases the levels of malondialdehyde and proline, but when treatment concentration increases there is regulation in the antioxidant system. Among the three species, C. ruizianus Müll. Arg. has the better antioxidant response, but the lower bioaccumulation.

RESUMEN El mercurio (Hg) es uno de los metales pesados más tóxicos y se utiliza principalmente en la extracción ilegal de oro en Perú. Se evaluó la tolerancia a Hg en en plantas de Paronychia microphylla Phil, Ambrosia artemisioides Willd y Croton ruizianus Müll. Arg., utilizando concentraciones controladas (5, 10 y 80 mg Hg L -1 ). Se identificaron dos grupos, según la respuesta antioxidante enzimática y de bioacumulación, pero los cambios en la proteína soluble sugieren otros mecanismos de tolerancia en las especies. P. microphylla tiene un desempeño acumulador (BCF = 1,16 a 10 mg Hg L-1); por el contrario, C. ruizianus tiene un comportamiento excluyente con bajo BCF y mejor respuesta antioxidante. En ese sentido, la concentración de 5 mg Hg L- 1 , desencadena estrés oxidativo y aumenta los niveles de malondialdehído y prolina, pero cuando aumenta la concentración del tratamiento hay regulación en el sistema antioxidante. Entre las tres especies, C. ruizianus Müll. Arg. tiene la mejor respuesta antioxidante, pero la menor bioacumulación.

RESUMEN Objetivo: Describir los hallazgos endoscópicos de las vías de ventilación encontrados durante la timpanoplastías tipo I en pacientes con OMC (Otitis media crónica) no colesteatomatosa. Materiales y métodos: Investigación transversal descriptiva, evaluamos 32 pacientes con OMC no colesteatomatosa con y sin retracción epitimpánica (RE) (Grado I-III, según clasificación de Mirko Tos), con antecedente de timpanoplastía tipo I (junio, 2018 - enero, 2020) en el servicio de otorrinolaringología del Hospital Nacional Arzobispo Loayza. Se excluyeron pacientes con cirugías previas de oído medio, con OMC colesteatomatosa, con RE grado IV y actos quirúrgicos no almacenados digitalmente. Resultados: El 71,8% de pacientes presentaron RE (Grado I 3,0%, grado II 30,0% y grado III 56,5%), todos presentaron istmo timpánico (IT) bloqueado. El 68,8% de participantes con RE, presentaron tensor fold (TF) completo. Se observó una relación significativa entre TF completo e IT bloqueado con RE (p=0,026 y 0,003 respectivamente). Conclusiones: Los hallazgos más frecuentes fueron el TF completo e IT bloqueado, estos tuvieron asociación significativa con la presencia de RE en pacientes con OMC no colesteatomatosa.

ABSTRACT Objective: To describe the endoscopic findings of the ventilation pathways found during type I tympanoplasty in patients with non-cholesteatomatous COM (chronic otitis media). Materials and methods : Cross-sectional descriptive study, we evaluated 32 patients with non-cholesteatomatous COM with and without epitympanic retraction (ER) (Grade I-III, according to Mirko Tos classification), with a history of type I tympanoplasty (June, 2018 - January, 2020) in the otorhinolaryngology service of the Arzobispo Loayza National Hospital. Patients with previous middle ear surgeries, with cholesteatomatous COM, with ER grade IV and surgical acts not digitally stored were excluded. Results: 71.8% of patients presented ER (Grade I 3.0%, grade II 30.0% and grade III 56.5%), all presented blocked tympanic isthmus (TI). 68.8% of participants with ER presented complete tensor fold (TF). A significant relationship was observed between complete TF and blocked IT with ER (p=0.026 and 0.003, respectively). Conclusions: The most frequent findings were complete TF and blocked IT, these had a significant association with the presence of ER in patients with non-cholesteatomatous COM.

RESUMEN Casi 20 años después del lanzamiento de la iniciativa "América libre de humo" de la Organización Panamericana de la Salud en el año 2001, en diciembre del 2020, América del Sur se convirtió en la primera subregión de la Región de las Américas en lograr que 100% de los entornos sean libres de humo, en consonancia con el Artículo 8 del Convenio Marco para el Control del Tabaco de la Organización Mundial de la Salud (CMCT). Algunos de países de la subregión adoptaron medidas legales más sólidas e incluyeron en su legislación la prohibición de fumar en lugares al aire libre concretos (como Argentina y Uruguay) o de introducir nuevos productos de nicotina y tabaco en su alcance jurídico (como Ecuador y Paraguay). Los diez países tomaron diferentes caminos para adoptar esta medida de salud pública, ya fuera mediante disposiciones ejecutivas, legislativas o una combinación de ambas. Algunos países, como Argentina, Brasil y Venezuela, empezaron a nivel subnacional y luego, de un modo similar al del resto de países, pasaron al nivel nacional. Para lograr este hito fue crucial un contexto adecuado: una amplia ratificación del CMCT y la relevancia dada al derecho humano a la salud, los esfuerzos de la sociedad civil, los compromisos asumidos por los órganos intergubernamentales, los medios y las estrategias de comunicación, y el progreso de la evidencia científica. Los países se enfrentaron a obstáculos, entre ellos la conocida interferencia de la industria tabacalera, que entre otras estrategias empleó el uso de litigios; sin embargo, distintos tribunales y jueces respaldaron medidas legales integrales de ambientes libres de humo de tabaco. El proceso mediante el cual América del Sur ha logrado este objetivo representa un modelo a seguir para otras subregiones de las Región de las Américas y el mundo.

ABSTRACT Almost 20 years after the launching by the Pan American Health Organization of its “Smoke-Free Americas” initiative in 2001, in December 2020, South America became the first subregion in the Americas to accomplish 100% smoke-free environments in line with Article 8 of the World Health Organization Framework Convention on Tobacco Control (FCTC). Some of these countries adopted legal measures that are more robust than others, including in their laws specific outdoor places in the smoking ban (like Argentina and Uruguay) and/or novel nicotine and tobacco products under their scope (like Ecuador and Paraguay). The 10 countries took different paths to adopt this public health measure, either through executive or legislative measures or a combination of both. A few countries, like Argentina, Brazil, and Venezuela, started at the subnational level and then moved on to the national level, similar to the rest of the countries. For achieving this milestone, an adequate context was crucial: the broad ratification of the FCTC and the relevance given to the human right to health, civil society efforts, commitments made by intergovernmental bodies, media and communication strategies, and the development of scientific evidence. Countries faced obstacles, including the well-known interference of the tobacco industry, which among other strategies used litigation; however, courts and judges upheld comprehensive legal measures on smoke-free environments. The process by which South America achieved this milestone represents a role model for other subregions of the Americas and the world.

RESUMO Em dezembro de 2020, quase 20 anos depois do lançamento da iniciativa “Américas sem Fumo” pela Organização Pan-Americana da Saúde, em 2001, a América do Sul tornou-se a primeira sub-região das Américas a alcançar ambientes 100% livres de fumaça de tabaco, em conformidade com o Artigo 8 da Convenção-Quadro para o Controle do Tabaco da Organização Mundial da Saúde (CQCT). Alguns desses países adotaram medidas legais mais robustas que outros, com a inclusão da proibição de fumar em determinados locais ao ar livre (como Argentina e Uruguai) e/ou de novos produtos de nicotina e tabaco no escopo de suas leis (como Equador e Paraguai). Os dez países seguiram caminhos diferentes ao adotarem essa medida de saúde pública, por meio de medidas executivas ou legislativas ou ainda por uma combinação de ambas. Alguns países, como Argentina, Brasil e Venezuela, começaram no âmbito subnacional e depois passaram ao âmbito nacional, de maneira semelhante aos demais países. Para alcançar esse marco, foi crucial ter um contexto adequado: a ampla ratificação da CQCT, bem como a importância dada ao direito humano à saúde, os esforços da sociedade civil, os compromissos assumidos por organismos intergovernamentais, as estratégias de mídia e comunicação e o desenvolvimento de evidências científicas. Os países enfrentaram obstáculos, incluindo a conhecida interferência da indústria do tabaco, que, entre outras estratégias, recorreu ao litígio; entretanto, os tribunais e juízes mantiveram medidas legais abrangentes sobre ambientes livres de fumo. O processo pelo qual a América do Sul alcançou esse marco constitui um exemplo para outras sub-regiões das Américas e para o mundo.

RESUMEN El presente artículo reporta los resultados de la síntesis de material zeolítico con capacidad adsorbente a partir de una roca de origen volcánico proveniente de sillar, Arequipa, Perú. La experimentación se efectuó en un reactor de acero inoxidable utilizando soluciones con diferentes concentraciones de KOH (2.0, 2.5 y 3.0 M), a una temperatura constante de 150°C y con un tiempo de contacto entre el material volcánico y la solución de 24, 48 y 72 horas. El producto obtenido se caracterizó mediante, análisis microscópico de barrido (SEM) y capacidad de intercambio catiónico (CIC). Los resultados demostraron que se produjo zeolita sintética en función de la concentración de KOH como variable independiente más influyente. La mayor capacidad de intercambio catiónico (CIC) observada fue de 27.91 meq/100g y correspondió a la formación de zeolita Linde F obtenida con una solución de KOH 3.0 M y por un tiempo de 72 horas usando un material cuyo tamaño de partícula fue de 4 mm. Se realizaron pruebas de adsorción utilizando soluciones conteniendo cationes Cu2+ a fin de evaluar su capacidad y cinética de adsorción.

ABSTRACT This article reports the results of the synthesis of zeolitic material with adsorbent capacity, from rocks of volcanic origin from sillar, Arequipa, Peru. The experimentation was carried out in a stainless steel reactor using solutions with different concentrations of KOH (2.0, 2.5 and 3.0 M) at a constant temperature of 150 ° C. The contact time between the volcanic material and the solution was 24, 48 and 72 hours. The obtained product was characterized by means of scanning microscopic analysis (SEM) and cation exchange capacity (CEC). The results showed that synthetic zeolite was produced as a function of the concentration of KOH as the most influential independent variable. The highest cation exchange capacity (CEC) observed was 27.91 meq / 100g and corresponded to the formation of Linde F zeolite obtained with a 3.0 M KOH solution and for a time of 72 hours using a material whose particle size was 4 mm. Adsorption tests were carried out using solutions containing cations Cu2+ in order to evaluate their capacity and adsorption kinetics.

Background: Chilean higher education students have faced highly stressful events in 2020, including confinement and remote education. This population is particularly susceptible to mental health problems, such as high levels of stress, anxiety, and depression. Aim: To evaluate possible negative impacts of confinement by COVID-19 on Chilean higher education students’ mental health. Material and Methods: The Center for Epidemiologic Studies Depression Scale (CES-D) Scale and the Profile of Mood States (POMS) were applied to 315 students during 2016 and to 301 students during 2020. Results: In 2020, depression mean scores for men (24.1) and women (29.7) exceeded the cutoff point, therefore suggesting the presence of depressive disorder. Women had higher depressive and anxious symptoms in both years, however, in 2020 a significant increase was observed for depression, indicating interaction between the year of assessment andgender (0 = 6.74; p <.001). In both samples, first-year students hadsignificantly higherdepressionscores (fl = −1,909;p = 0.05). Conclusions: An increase in depression was observed in 2020. Confinement by COVID-19 had a high impact on mental health in female students. Women and first-year students appear to be high risk groups for developing depressive symptoms.

Abstract Small cell lung cancer is usually associated with paraneoplastic syndromes due to hormonal secretion, the most frequent, the syndrome of inappropriate antidiuretic hormone secretion. A case of a hyperaldosteronism and ectopic secretion of adrenocorticotropic hormone associated with small cell lung cancer is presented. A 59-year-old patient was studied for a constitutional syndrome diagnosing a metastatic small cell lung cancer. In the course of the oncological process, he manifests a clinic of hypertension, hypernatremia and hypokalemia. After a hormonal study he is diagnosed with a paraneoplastic hyperaldosteronism that is controlled with antihypertensives and antialdosteronics. The patient finally died due to liver progression of his tumor disease.

Resumen El cáncer microcítico de pulmón se encuentra asociado a síndromes paraneoplásicos como el síndrome de secreción inadecuada de hormona antidiurética (o arginina vasopresina). Se presenta el caso de un hiperaldosteronismo y secreción ectópica de hormona adrenocorticotrópica (o corticotropina) asociados a cáncer microcítico de pulmón. Un paciente de 59 años fue estudiado por un síndrome constitucional, diagnosticándose un cáncer microcítico de pulmón enfermedad extendida. En el transcurso de su proceso oncológico manifiesta una clínica de hipertensión, hipernatremia e hipopotasemia. Tras un estudio hormonal es diagnosticado de un hiperaldosteronismo paraneoplásico que se controla con antihipertensivos y antialdosterónicos. El paciente finalmente falleció por progresión hepática de su enfermedad tumoral.

We report a previously healthy 34-year-old woman, presenting with a seven-month history of arterial hypertension, amenorrhea, weight gain, facial edema, acne, hirsutism and low back pain. A CT scan showed a right adrenal mass of 18 × 13 × 12.5 cm, and multiple vertebral and rib fractures. The hormonal study confirmed Cushing's Syndrome. Ketoconazole, spironolactone, cotrimoxazole, calcium / vitamin D were started. An adrenalectomy with a right nephrectomy were performed. The excised tumor measured 16 cm and weighed 1.55 kg. There was tumor embolism and a 4 mm soft tissue involvement (pT3NxMx). The right kidney was free of tumor. The patient was treated with chemotherapy (etoposide plus cisplatin). Study of vertebral fractures with magnetic resonance (MRI) showed crush fractures, without images of metastatic bone lesions. One year after surgery, a CT scan showed no signs of tumor recurrence. The patient was lost from follow-up thereafter.

ABSTRACT This paper summarizes the clinical practice guidelines (CPG) for the screening, diagnosis, and management of patients with chronic kidney disease (CKD) stages 1-3 in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 08 clinical questions. Systematic searches of systematic reviews and, when considered necessary, primary studies were conducted to answer each question; and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 08 recommendations (04 strong and 04 conditional), 29 points of good clinical practice, and 03 flowcharts were formulated.

RESUMEN El presente artículo resume la guía de práctica clínica (GPC) para tamizaje, diagnóstico y manejo de los pacientes con enfermedad renal crónica (ERC) en los estadios 1 al 3 en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló ocho preguntas clínicas. Para responder cada pregunta se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue considerado pertinente, de estudios primarios; y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron ocho recomendaciones (cuatro fuertes y cuatro condicionales), 29 puntos de buena práctica clínica, y tres flujogramas.

El desarrollo de la cirugía video - asistida aplicada a la cavidad torácica, ha revolucionado drásticamente el enfoque de la cirugía de tórax en los últimos 30 años. Inicialmente la operación se llevaba a cabo con éxito utilizando tres o más incisiones, posteriormente se evolucionó utilizando dos, y en la actualidad, en diversos lugares del mundo, se ha logrado eliminar la segunda incisión para optar por un solo puerto, incluso para procedimientos de alta complejidad con buenos resultados. Describimos el reporte de un caso de un hombre de 30 años operado por abordaje de puerto único para una lobectomía VATS de lóbulo inferior derecho.

The development of video - assisted surgery applied to the thoracic cavity, has dramatically revolutionized the approach of thoracic surgery in the last 30 years. Initially, the operation was carried out successfully using three or more incisions, later it was developed using two, and at present, in different parts of the world, it has been possible to eliminate the second incision to perform highly complex procedures using a single port, with good results. We describe the case report of a 30-year-old man operated on by a single-port approach for VATS lobectomy of the right lower lobe.

ABSTRACT OBJECTIVE To evaluate the effectiveness of adherence to a multidisciplinary renal health program in reducing mortality and progression to hemodialysis. METHODS We used a database that included patient monitoring (2013-2017), dialysis admissions and all cause of mortality in Peru. Adherence to the program was established by meeting minimum visits during the first year of monitoring. The outcome of interest was hemodialysis admissions or all cause-mortality. Kaplan-Meier curves, Log-Rank test and competing survival analysis methods were used to estimate the differential risk between adherent and non-adherent patients. RESULTS A total of 20,354 participants was evaluated; 54.1% were male, 72.1 years old in average, 2.2 years average follow-up, and 15,279 (75.1%) belonged to the early stages (1 to 3a) of Chronic Kidney Disease. Adherence decreased the risk of renal replacement therapy in 41.0% (HR = 0.59, 95%CI 0.41–0.85) in the low-risk group and mortality in the high-risk group was 31.0% (HR = 0.69, 95%CI 0.57–0.83). CONCLUSIONS The multidisciplinary care strategy with standardized assessments by stage is effective in reducing admission to .0when the patient is identified in early stages and in reducing mortality in advanced stages.

RESUMEN OBJETIVO Evaluar la efectividad de la adherencia a un programa de salud renal en la reducción de mortalidad y progresión a hemodiálisis. MÉTODOS Utilizamos una base de datos que condensaba el seguimiento de los pacientes (2013-2017), los ingresos a diálisis de los mismos y la mortalidad por todas las causas en Perú. La adherencia al programa se estableció con el cumplimiento de visitas mínimas durante su primer año de seguimiento. La efectividad de la adherencia al programa se midió en términos de debut a hemodiálisis o muerte por todas las causas. Se utilizaron curvas de Kaplan-Meier, test de diferencias en la distribución (Log-Rank test) y métodos de análisis de supervivencia. Los análisis se realizaron utilizando R estudio 3.5.0 RESULTADOS Fueron evaluados 20.354 participantes, 54,1% varones, edad media de 72,1 años, con un seguimiento medio de 2,2 años; 15.279 (75.1%) tuvieron ERC en estadios tempranos (estadio 1 al 3a). La adherencia disminuyó en un 41,0% el riesgo de terapia de reemplazo renal (HR = 0,59; IC95% 0,41–0,85) en el grupo de bajo riesgo y en un 31,0% (HR = 0,69; IC95% 0,57–0,83) la mortalidad en el grupo de alto riesgo. CONCLUSIONES La estrategia de cuidado multidisciplinario con evaluaciones estandarizadas según estadio es efectiva en reducir el ingreso a terapia de reemplazo renal cuando se identifica al paciente en estadios tempranos y en reducir la mortalidad en estadios avanzados.

ABSTRACT OBJECTIVE To evaluate the effectiveness of adherence to a multidisciplinary renal health program in reducing mortality and progression to hemodialysis. METHODS We used a database that included patient monitoring (2013-2017), dialysis admissions and all cause of mortality in Peru. Adherence to the program was established by meeting minimum visits during the first year of monitoring. The outcome of interest was hemodialysis admissions or all cause-mortality. Kaplan-Meier curves, Log-Rank test and competing survival analysis methods were used to estimate the differential risk between adherent and non-adherent patients. RESULTS A total of 20,354 participants was evaluated; 54.1% were male, 72.1 years old in average, 2.2 years average follow-up, and 15,279 (75.1%) belonged to the early stages (1 to 3a) of Chronic Kidney Disease. Adherence decreased the risk of renal replacement therapy in 41.0% (HR = 0.59, 95%CI 0.41–0.85) in the low-risk group and mortality in the high-risk group was 31.0% (HR = 0.69, 95%CI 0.57–0.83). CONCLUSIONS The multidisciplinary care strategy with standardized assessments by stage is effective in reducing admission to .0when the patient is identified in early stages and in reducing mortality in advanced stages.

RESUMEN OBJETIVO Evaluar la efectividad de la adherencia a un programa de salud renal en la reducción de mortalidad y progresión a hemodiálisis. MÉTODOS Utilizamos una base de datos que condensaba el seguimiento de los pacientes (2013-2017), los ingresos a diálisis de los mismos y la mortalidad por todas las causas en Perú. La adherencia al programa se estableció con el cumplimiento de visitas mínimas durante su primer año de seguimiento. La efectividad de la adherencia al programa se midió en términos de debut a hemodiálisis o muerte por todas las causas. Se utilizaron curvas de Kaplan-Meier, test de diferencias en la distribución (Log-Rank test) y métodos de análisis de supervivencia. Los análisis se realizaron utilizando R estudio 3.5.0 RESULTADOS Fueron evaluados 20.354 participantes, 54,1% varones, edad media de 72,1 años, con un seguimiento medio de 2,2 años; 15.279 (75.1%) tuvieron ERC en estadios tempranos (estadio 1 al 3a). La adherencia disminuyó en un 41,0% el riesgo de terapia de reemplazo renal (HR = 0,59; IC95% 0,41–0,85) en el grupo de bajo riesgo y en un 31,0% (HR = 0,69; IC95% 0,57–0,83) la mortalidad en el grupo de alto riesgo. CONCLUSIONES La estrategia de cuidado multidisciplinario con evaluaciones estandarizadas según estadio es efectiva en reducir el ingreso a terapia de reemplazo renal cuando se identifica al paciente en estadios tempranos y en reducir la mortalidad en estadios avanzados.

Objective: To evaluate the therapeutic success of endoscopic therapy with N-butyl-2-cyanoacrylate and to determine the rebleeding and mortality rates. Materials and methods: Prospective analytical observational study of 47 cases of patients with gastric varices who were treated with N-butyl-2-cyanoacrylate, using a 1: 1 mixture with lipiodol between 2013 and 2017 in a level III public hospital in Lima - Peru. The therapeutic indication was active hemorrhage, primary or secondary prophylaxis. Results: Of the 47 patients, 5 (10.6%) had active hemorrhage, control was obtained in all cases, 24 (51.1%) had stigmas of recent bleeding during endoscopy. Secondary prophylaxis was performed in 16 (34%) patients and primary prophylaxis in 2 (4.7%). 59.6% required a single session with a total volume of cyanoacrylate (ml / patient) of 1.28 ± 0.44. The endoscopic finding was GOV-2 in 78.7% of the cases, IGV-1 in 12.8% and GOV-1 in 8.5%. Seven patients (14.8%) presented late rebleeding, with successful new therapy in 6 of them, one dying due to therapy failure. Of the six (12.76%) patients who died in total, 5 (83.3%) were due to other causes. No adverse events related to the therapy were reported. No adverse events were reported. Variceal obturation was observed in 28 (59.5%) patients. Conclusions: Endoscopic management of gastric varices with cyanoacrylate is a safe and effective treatment, with low recurrence and mortality rates.

Objetivo: Evaluar el éxito de la terapia endoscópica con N-butil-2-cianoacrilato sobre las várices gástricas y determinar las tasas de resangrado y mortalidad. Materiales y métodos: Estudio observacional prospectivo de 47 casos de pacientes con várices gástricas que fueron tratados con N-butil-2-cianoacrilato, utilizando una dilución 1:1 con lipiodol entre febrero de 2013 a marzo de 2017 en un hospital público de nivel III en Lima- Perú. La indicación terapéutica fue hemorragia activa, profilaxis primaria o secundaria. Resultados: De los 47 pacientes, 5 (10,6%) presentaban hemorragia activa, se obtuvo control de la misma en todos los casos, 24 (51,1%) tuvieron estigmas de sangrado reciente durante la endoscopía. Se realizó profilaxis secundaria en 16 (34%) pacientes y profilaxis primaria en 2 (4,7%), 59,6% requirió una sola sesión. El volumen total de cianoacrilato (ml/paciente) promedio fue 1,28 ± 0,44. Se aplicó una sola inyección por sesión en el 87,2% de los pacientes. El hallazgo endoscópico fue GOV-2 en el 78,7% de los casos, IGV-1 en el 12,8% y GOV-1 en el 8,5%. Siete pacientes (14,8%) presentaron resangrado tardío, con nueva terapia exitosa en 6 de ellos, uno fallece por fracaso de la terapia. Seis (12,76%) pacientes fallecen en total, cinco (83,3%) por otras causas. Se realizó 18 meses de seguimiento. No se reportaron eventos adversos relacionados con la terapia. Se constata obturación en 28 (59,5%) pacientes. Conclusiones: El manejo endoscópico de várices gástricas con cianoacrilato es un tratamiento seguro y eficaz, con baja tasa de recurrencia y mortalidad.

SUMMARY: The aim of this report was to endoscopically evaluate bone quality in vivo in the immediate installation of temporary small-diameter implants, and again after 6 months of function, through an attachments system for overdenture, in the atrophic mandible of a patient. We also histologically evaluated bone-implant interaction in these temporary small-diameter implants, once the success of the osseointegration of the submerged implants was guaranteed. A patient received a total of 6 implants in the atrophic mandible, two of which were immediately loaded with a provisional prosthesis, and four were left to heal in a submerged way. Further, an immersion endoscopic evaluation was performed during bone drilling, and this showed a compact bone structure with limited vascularization and predominantly cortical structure.This immediate loading protocol involving an overdenture retained by two small-diameter implants of 2.9 mm in the atrophic mandible proved to be successful after 6 months of loading. Clinical and histologic osseointegration was consistently achieved for both of the retrieved immediately loaded implants. This modality allows the patient to be restored with a stable, functional, and aesthetic prosthesis during the osseointegration period of submerged implants and soft-tissue healing, before the removal of the provisional implants. The histological evaluation of bone-implant contact found that the space between the implant threads closer to the surface was filled with woven bone and lamellar bone, but the tissue in contact with the cervical portion of the implants was compatible with cortical bone organization. Also, the newly formed bone has a regular cell distribution and characteristics of advanced maturation after 6 months of function in the atrophic mandible. Anchored overdentures in 2 to 4 small-diameter implants (2.9 mm) for edentulous patients with severe atrophy of the mandible with cortical bone would be a minimally invasive alternative.

Abstract A 77-years-old patient came to the emergency department due to a two-day history of rash, blisters and ulcers in both skin and mouth. With presumptive diagnosis of Steven-Johnson syndrome/toxic epidermal necrolysis, the patient is admitted to the ICU. Her evolution was favorable, receiving the hospital discharge a week later. A biopsy of the lesions confirmed the diagnosis.

Resumen Paciente de 77 años que acude a Urgencias por cuadro de eritrodermia de dos días de evolución, acompañado de ampollas, úlceras cutáneas y en mucosa yugal. Con diagnóstico presuntivo de síndrome de Steven-Johnson/necrólisis epidérmica tóxica, la paciente es ingresada en la Unidad de Cuidados Intensivos. Su evolución fue favorable y recibió el alta una semana después. Una biopsia de las lesiones confirmó el diagnóstico.