Ultrasound-guided botulinum toxin for the treatment of chronic anal fissure: technical notes.

We are thrilled to present a new technique for treating chronic anal fissures using ultrasound-guided botulinum toxin injections. Our approach involves injecting botulinum toxin into the internal anal sphincter (IAS) guided by ultrasound for maximum effectiveness. We believe that our technique has significant potential to improve outcomes. We could not find any studies where ultrasound-guided TB puncture was used to treat chronic anal fissures.

[Electrocardiographic interval as a predictor of life-threatening arrhythmias in dilated cardiomyopathy patients]. / Intervalo electrocardiográfico como predictor de arritmias graves en pacientes con miocardiopatía dilatada.

Background: The Tpe interval (Tp-e) in the surface electrocardiogram represents ventricular repolarization, a key phase in the pathogenesis of severe ventricular arrhythmias. However, there are few studies evaluating changes in this electrocardiographic interval as a risk factor for serious arrhythmias in patients with dilated cardiomyopathy. Objective: To determine whether the Tp-e interval prolongation predicts the presence of life-threatening arrhythmias in patients with dilated cardiomyopathy (DCM) with implantable cardioverter-defibrillator (ICD). Material and methods: Analytical, cross-sectional study in patients with DCM with ICDs. The Tp-e interval was measured in the V2 electrocardiographic lead and correlated with the incidence of life-threatening arrhythmias identified by the ICD. Results: 53 patients were recruited, 10 (18.8%) presented life-threatening arrhythmias. Prolongation of Tp-e interval was related to an increase in the incidence of ventricular tachycardia/fibrillation tachycardia (VT/FT) with a mean of 93 ± 20.5 ms (p = 0.003), using ROC curves to determine the thereshold of 90 ms for increased risk of VT/VF with sensitivity of 70% and specificity of 84%, with an area under the curve of 0.798. Conclusion: The prolongation of the ITp-e interval greater than 90 ms in a population with dilated cardiomyopathy predicts the presence of arrhythmic episodes, such as VT and/or VT/FT.

Introducción: el intervalo Tpe (ITp-e) en el electrocardiograma de superficie representa la repolarización ventricular, fase clave en la patogénesis de arritmias ventriculares graves. Sin embargo, existen pocos estudios que evalúen la alteración de este intervalo electrocardiográfico como factor de riesgo de arritmias graves en pacientes con miocardiopatía dilatada. Objetivo: determinar si la prolongación del ITp-e predice la presencia de arritmias potencialmente mortales en pacientes con miocardiopatía dilatada (MCD) portadores de desfibrilador automático implantable (DAI). Material y métodos: estudio, transversal analítico en pacientes con MCD portadores de DAI. Se midió el ITp-e en la derivación electrocardiográfica V2 y se correlacionó con la incidencia de arritmias potencialmente letales identificadas por el DAI. Resultados: se incluyeron 53 pacientes, 10 (18.8%) presentaron arritmias potencialmente mortales. La prolongación del ITp-e se relacionó con aumento de incidencia de taquicardia ventricular/fibrilación ventricular (TV/FV) con media de 93 ± 20.5 ms (p = 0.003), por lo que se determinó mediante curvas ROC el punto de corte de 90 ms para el aumento de riesgo de TV/FV con sensibilidad de 70% y especificidad de 84%, con área bajo la curva de 0.798. Conclusión: la prolongación del intervalo ITp-e > 90 ms en población con miocardiopatía dilatada predice la presencia de episodios arrítmicos como TV o FV.

Continuous Positive Airway Pressure Effect on Albuminuria Progression in Patients with Obstructive Sleep Apnea and Diabetic Kidney Disease: A Randomized Clinical Trial.

Rationale: Obstructive sleep apnea (OSA) is associated with impaired glycemic control and a higher risk of vascular complications, such as diabetic kidney disease (DKD). However, the effect of apnea-hypopnea suppression on DKD progression is unclear. Objectives: To assess the effect of continuous positive airway pressure (CPAP) on the urinary albumin-to-creatinine ratio (UACR) in patients with DKD and OSA. Methods: In a 52-week, multicentric, open-label, parallel, and randomized clinical trial, 185 patients with OSA and DKD were randomized to CPAP and usual care (n = 93) or usual care alone (n = 92). Measurements and Main Results: UACR, estimated glomerular filtration rate, serum concentrations of creatinine and glycated hemoglobin, insulin resistance, lipid concentrations, sleepiness, and quality of life. A 52-week change in UACR from baseline did not differ significantly between the CPAP group and the usual-care group. However, in per-protocol analyses that included 125 participants who met prespecified criteria for adherence, CPAP treatment was associated with a great reduction in UACR (mean difference, -10.56% [95% confidence interval, -19.06 to -2.06]; P = 0.015). CPAP effect on UACR was higher in nonsleepy patients with more severe OSA, worse renal function, and a more recent diagnosis of DKD. CPAP treatment also improved glycemic control and insulin resistance, as well as sleepiness and health-related quality of life. Conclusions: In patients with OSA and DKD, the prescription of CPAP did not result in a statistically significant reduction in albuminuria. However, good adherence to CPAP treatment in addition to usual care may result in long-term albuminuria reduction compared with usual care alone. Clinical trial registered with www.clinicaltrials.gov (NCT02816762).

Relationship between resilience, optimism, and burnout in Pan-American athletes.

Aim: A series of knowledge has been developed on burnout syndrome in the sports context that has allowed to generate a solid theoretical structure that requires new contributions to delve into those aspects that have been less addressed, as is the case of optimism and resilience when it comes to linking them to the syndrome in top-performance athletes. For this purpose, the Burnout Inventory for Athletes (IBD-r), the Resilience Scale adapted to Spanish, and the Life Orientation Scale-Revised (LOT-R) for optimism were used. Methods: From this perspective, the study was approached with 121 Uruguayan athletes who participated in the last Pan-American Games, assuming practically all the subjects who have this level of sport (142) considering gender and type of sport. Results: The results indicate that 67% of the sample presents burnout symptoms for the emotional exhaustion dimension, and moderate resilience and optimism. Although there are no significant differences attributable to gender or type of sport, this contribution allows us to continue focusing on future work and further analysis. The type of sport presented statistically significant differences in relation to the personal competence dimension and the type of sport. Conclusion: Resilience and optimism obtained a clear influence on the occurrence of burnout, in a statistically negative sense, showing themselves as interesting prevention strategies for future lines of research, where it is essential to design interventions that teach emotional skills to manage adversity and prevent burnout.

Efficacy of a transdiagnostic guided internet-delivered intervention for emotional, trauma and stress-related disorders in Mexican population: study protocol for a randomized controlled trial.

BACKGROUND: Emotional and stress-related disorders show high incidence, prevalence, morbidity, and comorbidity rates in Mexico. In recent decades, research findings indicate that cognitive behavioral interventions, from a disorder-specific perspective, are the effective front-line treatment for anxiety and depression care. However, these treatments are not often used. Reasons include limited access and low availability to effective interventions and comorbidity between mental disorders. Emotional deregulation of negative affectivity has been found to be a mediating factor in addressing emotional disorders from a transdiagnostic perspective, aimed at two or more specific disorders. In addition, technological advancement has created alternatives for psychological assistance, highlighting the possibilities offered by technologies since Internet-supported intervention programs have been empirically tested for effectiveness, efficiency and efficacy and can be key to ensuring access to those who are inaccessible. The aim of the study is to evaluate the efficacy, moderators of clinical change and acceptability of a transdiagnostic guided Internet-delivered intervention versus a transdiagnostic self-guided Internet-delivered intervention for emotional, trauma and stress-related disorders, and waiting list in community sample. METHODS: A three-armed, parallel group, superiority randomized controlled clinical trial with repeated measurements at four times: pretest, posttest, follow-up at 3, 6 and 12 months. Outcomes assessor, participant, care provider and investigator will be blinded. Participants aged 18 to 70 years will be randomly allocated 1:1:1 to one of three study arms: a) Transdiagnostic guided internet-delivered intervention with synchronous assistance, b) Transdiagnostic self-guided internet-delivered intervention, c) Waiting list group. Based on sample size estimation, a minimum of 207 participants (69 in each intervention group) will be included. DISCUSSION: The study could contribute to improving the efficacy of transdiagnostic internet-delivered interventions to promote the dissemination of evidence-based treatments and eventually, to decrease the high prevalence of emotional and trauma-related disorders in the Mexican population. TRIAL REGISTRATION: ClinicalTrial.gov: NCT05225701 . Registered February 4, 2022.

Obstructive sleep apnea is associated with impaired renal function in patients with diabetic kidney disease.

Obstructive sleep apnea (OSA) is a recognized risk factor for the development of diabetic kidney disease (DKD). Our objectives were to compare the urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) of patients with DKD according to OSA severity, and to evaluate the contribution of sleep parameters to their renal function. In a multicenter, observational, cross-sectional study, 214 patients with DKD were recruited. After a sleep study, UACR and eGFR were measured, as well as serum creatinine, fasting glucose, glycated hemoglobin, insulin resistance, lipid profile and C-reactive protein. UACR was higher in severe OSA patients (920 ± 1053 mg/g) than in moderate (195 ± 232 mg/g, p < 0.001) or mild OSA/non-OSA subjects (119 ± 186 mg/g, p < 0.001). At the same time, eGFR showed an OSA severity-dependent reduction (48 ± 23 vs. 59 ± 21 vs. 73 ± 19 ml/min per 1.73 m2, respectively; p < 0.001). Apnea-hypopnea index (AHI and desaturation index (ODI) were identified as independent predictors for UACR and eGFR, respectively. Therefore, in patients with DKD under optimized treatment, severe OSA is associated with a higher UACR and a lower eGFR, reflecting an additional contribution to the impairment of their renal function, although no causality can be inferred.

The impact of frailty in aortic valve surgery.

BACKGROUND: Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty in cardiac aortic valve surgery. METHODS: Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. RESULTS: Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3 s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51, 14 and 28%. Mortality 4%. Survival at 6 m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 s were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. CONCLUSIONS: Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up.

Dietary Squalene Induces Cytochromes Cyp2b10 and Cyp2c55 Independently of Sex, Dose, and Diet in Several Mouse Models.

SCOPE: To investigate the effects of squalene, the main hydrocarbon present in extra virgin olive oil, on liver transcriptome in different animal models and to test the influence of sex on this action and its relationship with hepatic lipids. METHODS AND RESULTS: To this purpose, male C57BL/6J Apoe-deficient mice are fed a purified Western diet with or without squalene during 11 weeks and hepatic squalene content is assessed, so are hepatic lipids and lipid droplets. Hepatic transcriptomic changes are studied and confirmed by RT-qPCR. Dietary characteristics and influence of squalene doses are tested in Apoe-deficient on purified chow diets with or without squalene. These diets are also given to Apoa1 and wild-type mice on C57BL/6J background and to C57BL/6J xOla129 Apoe-deficient mice. Squalene supplementation increases its hepatic content without differences among sexes and hormonal status. The Cyp2b10 and Cyp2c55 gene expressions are significantly up-regulated by the squalene intake in all models, with independence of sex, sexual hormones, dietary fat content, genetic background and dose, and in Apoe-deficient mice consuming extra-virgin olive oil. CONCLUSION: Hepatic squalene increases the expression of these cytochromes and their changes in virgin olive oil diets may be due to their squalene content.

Competition Seriousness and Competition Level Modulate Testosterone and Cortisol Responses in Soccer Players.

This study aimed to analyze the modulating effect of competition seriousness and competition level in the testosterone and cortisol responses in professional soccer player. Ninety five (95) soccer players were included in this study (professional, n = 39; semiprofessional, n = 27; amateur, n = 29) before and after training, friendly game and official games. Repeated measures ANOVA showed higher testosterone levels (F(1,89) = 134, p < 0.0001, η2p = 0.75) in professional soccer players, when compared with semiprofessional (p < 0.0001) or amateur athletes (p < 0.0001). After winning a competition game an increase in testosterone levels was observed in professionals (t = -3.456, p < 0.001), semiprofessionals (t = -4.400, p < 0.0001), and amateurs (t = -2.835, p < 0.009). In contrast, this momentary hormonal fluctuation was not observed after winning a friendly game or during a regular training day. Additionally, statistical analysis indicated that cortisol levels were lower in professional (t = -3.456, p < 0.001) and semiprofessional athletes (t = -4.400, p < 0.0001) than in amateurs (t = -2.835, p < 0.009). In soccer players a rise in testosterone was only observable when the team was faced with an actual challenge but did not support a different response between categories. Thus, the desire to achieve a goal (and keep the social status) may be one of the key reasons why testosterone levels rise promptly. Conversely, testosterone did not change after friendly games, which suggests these situations are not real goals and the players do not perceive an actual threat (in terms of dominance) more than the preparation for their next competitive game.

Extra virgin olive oil diet intervention improves insulin resistance and islet performance in diet-induced diabetes in mice.

Dietary composition plays an important role in the pathophysiology of type 2 diabetes. Monounsaturated fatty acid consumption has been positively associated with improved insulin sensitivity and ß-cell function. We examined whether an extra virgin olive oil (EVOO) high fat diet (HFD) can improve glucose homeostasis. C57BL/6J mice were fed a standard diet or a lard-based HFD to induce type 2 diabetes. Then, HFD mice were fed with three different based HFD (lard, EVOO and EVOO rich in phenolic compounds) for 24 weeks. HFD-EVOO diets significantly improved glycemia, insulinemia, glucose tolerance, insulin sensitivity and insulin degradation. Moreover, EVOO diets reduced ß-cell apoptosis, increased ß-cell number and normalized islet glucose metabolism and glucose induced insulin secretion. No additional effects were observed by higher levels of phenolic compounds. Thus, EVOO intake regulated glucose homeostasis by improving insulin sensitivity and pancreatic ß-cell function, in a type 2 diabetes HFD animal model.

A comparison of the isometric force fatigue-recovery profile in two posterior chain lower limb tests following simulated soccer competition.

AIM: To evaluate the reliability of isometric peak force (IPF) in a novel "long-length" 90°Hip:20°Knee (90:20) strength test and to compare the simulated soccer match induced fatigue-recovery profile of IPF in this test with that of an isometric 90°Hip:90°Knee (90:90) position test. METHODS: Twenty semi-professional soccer players volunteered for the study of which 14 participated in the first part of the study which assessed 90:20 reliability (age = 21.3 ± 2.5 years, height = 1.79 ± 0.07 m, body mass = 73.2 ± 8.8 kg), while 17 completed the second part of the study evaluating fatigue-recovery (age 21.2±2.4 yrs., height = 180 ± 0.09 m, body mass 73.8 ± 8.9 kg). We evaluated the inter-session reliability of IPF in two 90:20 test protocols (hands on the wall (HW); and hands on chest (HC)) both performed on two occasions, 7 days apart. We then assessed 90:20 (HC) and 90:90 IPF immediately before (PRE) and after (POST) after a simulated soccer match protocol (BEAST90mod) and 48 (+48 h) and 72 hours (+72 h) later. RESULTS: Part one: the 90:20 showed moderate to high overall reliability (CV's of 7.3% to 11.0%) across test positions and limbs. CV's were lower in the HW than HC in the dominant (7.3% vs 11.0%) but the opposite happened in the non-dominant limb where CV's were higher in the HW than HC (9.7% vs 7.3%). Based on these results, the HC position was used in part two of the study. Part two: 90:20 and 90:90 IPF was significantly lower POST compared to PRE BEAST90mod across all testing positions (p<0.001). IPF was significantly lower at +48 h compared to PRE in the 90:20 in both limbs (Dominant: p<0.01,Non-dominant: p≤0.05), but not in the 90:90. At +72 h, IPF was not significantly different from PRE in either test. CONCLUSIONS: Simple to implement posterior IPF tests can help to define recovery from competition and training load in football and, potentially, in other multiple sprint athletes. Testing posterior chain IPF in a more knee extended 90:20 position may provide greater sensitivity to fatigue at 48 h post simulated competition than testing in the 90:90 position, but also may require greater degree of familiarization due to more functional testing position.

Double-orifice mitral valve repair.

We present the case of a 6-year-old patient with double-orifice mitral valve and severe regurgitation, which was successfully repaired. We demonstrate that mitral valve repair may be attempted even in complex anatomy such as the double-orifice mitral valve, where it can offer excellent results.

Validation of the EuroSCORE model in patients undergoing heart surgery in Regional Hospital of High Speciality of Bajio / Validación del modelo EuroSCORE en pacientes sometidos a cirugía cardiaca en el Hospital Regional de Alta Especialidad del Bajío

Abstract: Introduction: EuroSCORE is a probabilistic model with good performance in the prognosis of mortality in heart surgery in many latitudes. It is recommendable to validate it in hospitals where it is employed. Objective: To validate the EuroSCORE model in adult patients at the Hospital Regional de Alta Especialidad del Bajío (HRAEB) of León, Guanajuato, Mexico. Material and methods: We conducted an observational transversal, and retrospective study, accomplishing this through the review of the clinical files of patients submitted to heart surgery with and without extracorporeal circulation pump from 01/01/2008 to 12/31/2013 at the HRAEB. This included mortality up to hospital discharge, utilizing the on-line calculator of the EuroSCORE program to estimate risk of death. In order to validate the EuroSCORE model, we assessed discrimination and calibration through the Area Under the receiver operating characteristics (ROC) curve and χ2 test with Hosmer-Lemeshow (H-L) goodness-of-fit, respectively. Results: A total of 342 patients, aged 50.02 ± 16.66 years, 181 males (52.9%) and 161 women (47.1%). The area under the ROC curve of the additive model was 0.763, and of the Hosmer-Lemeshow test was 5.30, with p = 0.62. The area under the ROC curve of the logistic model was 0.761 and of the Hosmer-Lemeshow test, 8.78, with p = 0.36. Conclusion: The EuroSCORE model is a reliable score for estimating the probabilities of death in adult patients submitted to heart surgery with or without the pump at the HRAEB.

Resumen: Introducción: EuroSCORE es un modelo probabilístico con buen desempeño en el pronóstico de mortalidad en cirugía cardiaca en muchas latitudes. Es recomendable validarlo en los hospitales donde se emplea. Objetivo: Validar el modelo EuroSCORE en pacientes adultos en el Hospital Regional de Alta Especialidad del Bajío (HRAEB) de León, Guanajuato, México. Material y métodos: Se realizó un estudio observacional transversal y retrospectivo, que se completó con la revisión de los expedientes clínicos de pacientes sometidos a cirugía cardiaca con y sin bomba de circulación extracorpórea desde el 01/01/2008 hasta el 31/12/2013 en el HRAEB. Esto incluyó la mortalidad hasta el alta hospitalaria, utilizando la calculadora en línea del programa EuroSCORE para estimar el riesgo de muerte. Para validar el modelo EuroSCORE, evaluamos la discriminación y la calibración a través de la curva de características de operación del receptor (ROC) y la prueba de χ2 con la efectividad de ajuste de Hosmer-Lemeshow (H-L), respectivamente. Resultados: Un total de 342 pacientes, de 50.02 ± 16.66 años, 181 hombres (52.9%) y 161 mujeres (47.1%). El área bajo la curva ROC del modelo aditivo fue de 0.763, y la de la prueba Hosmer-Lemeshow fue de 5.30, con p = 0.62. El área bajo la curva ROC del modelo logístico fue 0.761 y de la prueba Hosmer-Lemeshow, 8.78, con p = 0.36. Conclusión: El modelo EuroSCORE es una herramienta confiable para estimar las probabilidades de muerte en pacientes adultos sometidos a cirugía cardiaca con o sin bomba en el HRAEB.

Prevalencia de burnout a través de dos medidas y su relación con variables sociodeportivas / Burnout's Prevalence through two Measures and its Relation with Sociodemographic's Variables

Resumen Se estudia la prevalencia del síndrome de burnout en deportistas y su relación con variables sociodeportivas. Se aplicaron los dos instrumentos de medida disponibles en España que miden el constructo: IBD-R y versión española del ABQ, en una muestra de 646 deportistas. Los resultados obtenidos muestran una prevalencia del 4.2 % para el IBD-R y 3.3 % para el ABQ, así como diferencias estadísticamente significativas para sexo, presentando los varones una realización personal más reducida que las mujeres, y niveles competitivos más altos de prevalencia general y de la subescala agotamiento físico/emocional en el nivel nacional que en el local. Estos datos son similares a los hallados en investigaciones anteriores, tanto en prevalencia como en diferencias según variables sociodeportivas.

Abstract This study aims to investigate the prevalence of burnout syndrome in athletes and their relation with different social and sporting variables. They have implemented the two instruments available in Spain for measuring burnout in athletes: IBD-R and the Spanish version of ABQ in a sample of 646 athletes with an average age of 19.73 years. The results show a prevalence of 4.2% for IBD-R and 3.3% for the ABQ and statistically significant differences for sex, presenting the smaller male self-fulfillment than women; and competitive, presenting higher prevalence levels overall and subscale physical/emotional exhaustion at the national level as home. These data are similar to those found in previous investigations, both prevalence and differences according social and sporting variables.

Incidence of surgical site infection and risk factors in rectal surgery: A prospective cohort study. / Incidencia de infección de sitio quirúrgico y factores de riesgo en cirugía de recto. Estudio de cohortes prospectivo.

INTRODUCTION: Surgical site infection (SSI) is the main cause of nosocomial infection in Spain. The aim of this study was to analyze the incidence of SSI and to evaluate its risk factors in patients undergoing rectal surgery. METHODS: Prospective cohort study, conducted from January 2013 to December 2016. Patient, surgical intervention and infection variables were collected. Infection rate was calculated after a maximum period of 30 days of incubation. The effect of different risk factors on infection was assessed using the odds ratio adjusted by a logistic regression model. RESULTS: The study included 154 patients, with a mean age of 69.5±12 years. The most common comorbidities were diabetes mellitus (24.5%), chronic obstructive pulmonary disease (17%) and obesity (12.6%). The overall incidence of SSI during the follow-up period was 11.9% (CI95%: 7.8-17.9) and the most frequent microorganism was Escherichia coli (57.9%). Risk factors associated with surgical wound infection in the univariate analysis were blood transfusion, drain tubes and vasoactive drug administration (P<.05). CONCLUSIONS: The incidence of SSI in rectal surgery was low. It is crucial to assess SSI incidence rates and to identify possible risk factors for infection. We recommend implementing surveillance and hospital control programs.

15-Hydroxygermacranolides as Sources of Structural Diversity: Synthesis of Sesquiterpene Lactones by Cyclization and Rearrangement Reactions. Experimental and DFT Study.

A study on the electrophile-induced rearrangement of two 15-hydroxygermacranolides, salonitenolide and artemisiifolin, was carried out. These compounds underwent electrophilic intramolecular cyclizations or acid-mediated rearrangements to give sesquiterpene lactones with different skeletons such as eudesmanolides, guaianolides, amorphanolides, or other germacranolides. The cyclization that gives guaianolides can be considered a biomimetic route to this type of sesquiterpene lactones. The use of acetone as a solvent changes the reactivity of the two starting germacranolides to the acid catalysts, with a 4,15-diol acetonide being the main product obtained. The δ-amorphenolide obtained by intramolecular cyclization of this acetonide is a valuable intermediate for accessing the antimalarials artemisinin and its derivatives. Mechanistic proposals for the transformations are raised, and to provide support them, quantum chemical calculations [DFT B3LYP/6-31+G(d,p) level] were undertaken.

ESBL E coli and P. aeruginosa Resistance to Ceftolozane-Tazobactam in a Patient with a Liver Abscess. The Search for an Omnipotent Antibiotic Goes On!

Multi drug resistant (MDR) Pseudomonas aeruginosa and Extended- Spectrum-lactamase (ESBL) Enterobacteriaceae are becoming an increasing difficult clinical problem. Immediate resistance to some of the new antimicrobials such as ceftolozane/tazobactam is unusual and is due to a variety of mechanisms such as hyper-production of inactivating enzymes and gene mutation. In addition, previous antimicrobial administration is a well-recognized risk factor to develop resistance. We present a patient with a liver abscess where the organism was resistant to ceftolozane/tazobactam resulting in a poor clinical outcome.

Intervención de enfermería en un caso de alta complejidad en psiquiatría / Nursing Intervention in a high complexity case in psychiatry

El siguiente artículo muestra el caso de una paciente internada en una unidad de corta estadía psiquiátrica, que enfrenta al equipo al tratamiento simultáneo de su padecimiento médico y mental. Se detalla la intervención de enfermería, destacándola como una de las partes esenciales del plan terapéutico, además de presentar un correlato a esta atención con referencias a algunas de las teoristas clásicas de la enfermería, explicando cómo sus postulados se aplican en el cuidado brindado a esta paciente.

The following article shows the case of a patient admitted in a psychiatric short stay unit, which confronts the team to the simultaneous treatment of her medical and mental illness. Nursing intervention is detailed, highlighting it as one of the essential parts of the therapeutic plan, besides presenting a correlate to this assistance with references to some of the classic theorists of nursing, explaining how their postulates are applied in the care provided to this patient.

Three-dimensional printed models for surgical planning of complex congenital heart defects: an international multicentre study.

OBJECTIVES: To evaluate the impact of 3D printed models (3D models) on surgical planning in complex congenital heart disease (CHD). METHODS: A prospective case-crossover study involving 10 international centres and 40 patients with complex CHD (median age 3 years, range 1 month-34 years) was conducted. Magnetic resonance imaging and computed tomography were used to acquire and segment the 3D cardiovascular anatomy. Models were fabricated by fused deposition modelling of polyurethane filament, and dimensions were compared with medical images. Decisions after the evaluation of routine clinical images were compared with those after inspection of the 3D model and intraoperative findings. Subjective satisfaction questionnaire was provided. RESULTS: 3D models accurately replicate anatomy with a mean bias of -0.27 ± 0.73 mm. Ninety-six percent of the surgeons agree or strongly agree that 3D models provided better understanding of CHD morphology and improved surgical planning. 3D models changed the surgical decision in 19 of the 40 cases. Consideration of a 3D model refined the planned biventricular repair, achieving an improved surgical correction in 8 cases. In 4 cases initially considered for conservative management or univentricular palliation, inspection of the 3D model enabled successful biventricular repair. CONCLUSIONS: 3D models are accurate replicas of the cardiovascular anatomy and improve the understanding of complex CHD. 3D models did not change the surgical decision in most of the cases (21 of 40 cases, 52.5% cases). However, in 19 of the 40 selected complex cases, 3D model helped redefining the surgical approach.