ST-elevation myocardial infarction (STEMI) secondary to splenic rupture after colonoscopy.

We have read with interest the recently published case on splenic rupture after colonoscopy. Although this complication is being observed more frequently, in the case presented here, the particularity lies in the myocardial ischemia caused as a consequence of stasis at coronary level, determining a situation of extreme gravity, a diagnostic challenge and a therapeutic emergency.

The hidden side of infective endocarditis: Diagnostic and management of 500 consecutive cases in noncardiac surgery centers (2009-2018).

BACKGROUND: We aimed to describe infective endocarditis cases from noncardiac surgery centers, as current knowledge on infective endocarditis is derived mostly from cardiac surgery hospitals. METHODS: An observational retrospective study (2009-2018) was conducted in 9 noncardiac surgery hospitals in Central Catalonia. All adult patients diagnosed with definitive infective endocarditis were included. Transferred and nontransferred cohorts were compared, and a logistic regression model was used to ascertain the prognostic factors. RESULTS: Overall, 502 infective endocarditis episodes were included: 183 (36.5%) were transferred to the cardiac surgery center, whereas 319 were not, with (18.7%) and without (45%) surgical indications. Cardiac surgery was performed in 83% of transferred patients. In-hospital (14% vs 23%) and 1-year (20% vs 35%) mortality rates were significantly lower in transferred patients (P < .001). Among the patients not undergoing cardiac surgery despite an indication, 55 (54%) died within 1 year. The multivariate analysis identified the following independent predictive factors for in-hospital mortality: Staphylococcus aureus infective endocarditis (odds ratio: 1.93 [1.08, 3.47]), heart failure (odds ratio: 3.87 [2.28, 6.57]), central nervous system embolism (odds ratio: 2.95 [1.41, 5.14]), and Charlson score (odds ratio: 1.19 [1.09, 1.30]), whereas community acquisition (odds ratio: 0.52 [0.29, 0.93]), cardiac surgery (odds ratio: 0.42 [0.20, 0.87]), but not transfer (odds ratio: 1.23 [0.84, 3.95]) were identified as protective factors. One-year mortality was associated with S. aureus infective endocarditis (odds ratio: 1.82 [1.04, 3.18]), heart failure (odds ratio: 3.74 [2.27, 6.16]), and Charlson score (odds ratio: 1.23 [1.13, 1.33]), whereas cardiac surgery (odds ratio: 0.41 [0.21, 0.79]) was identified as a protective factor. CONCLUSION: Patients not transferred to a referral cardiac surgery center have a worse prognosis compared to those ultimately transferred, as cardiac surgery is associated with lower mortality rates.

[Development and validation of BECAD. An instrument derived from the international classification of functioning, disability and health]. / Desarrollo y validación de la BECAD: un instrumento de evaluación basado en la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF) provides a useful theoretical framework for the rehabilitation of chronic diseases with complex problems that require interdisciplinary teams. The aim of this study was the development of a set of scales based on ICF for treatment planning and outcome assessment. METHODS: A group of experts conducted several changes of the elements from the Activities and Participation ICF chapter. Tasks and questions were designed and then, submitted to review from another group of experts. An online application was designed. The sample consisted of 116 participants, 34 of them with brain injury, 38 with severe mental disorders and 44 controls. Trained psychologists and other health professionals administered the scales. Exploratory factor analysis of the scales "Learning and applying knowledge and general tasks and demands", "Self-care" and "Mobility" besides reliability coefficients, MANCOVAs and regression analyses were performed. RESULTS: In the scale "Learning and applying knowledge and general tasks and demands" three factors have been extracted, which explain 52,58% of variance. In the scale "Mobility" two factors have been extracted, explaining 76,91 % of variance; and in "Self-care", another two factors were extracted, explaining 77,60 % of variance. MANCOVAs showed significant differences between the three groups in all seven new factors. All factors presented coefficients between 0.91 and 0.99. CONCLUSIONS: These results showed appropriate metric properties of the new scales, whose factors discriminate between groups and have a high reliability.

Desarrollo y validación de la becaD, un instrumento de evaluación basado en la clasificación internacional del funcionamiento, de la discapacidad y de la salud / Development and validation of BECAD. An Instrument derived from the International Classification of Functioning, Disability and Health

Fundamentos: La Clasificación Internacional del Funcionamiento, de la Discapacidad y la Salud (CIF) proporciona un marco conceptual muy útil en la rehabilitación de personas con trastornos crónicos, con problemas complejos y atendidos por equipos interdisciplinares. El objetivo de este trabajo fue el desarrollo de una batería de escalas basadas en la CIF para la planificación de tratamientos y la evaluación de resultados. Métodos: Un grupo de expertos realizó una modificación de los elementos de las Actividades de la CIF. Se diseñaron preguntas y tareas que fueron sometidas a valoración por un segundo grupo. Se diseñó una aplicación informática en línea. La muestra estuvo formada por 116 participantes, 34 con daño cerebral adquirido, 38 con trastorno mental grave y 44 controles. La administración de las escalas la realizaron psicólogos entrenados y profesionales sanitarios. Se realizaron análisis factoriales exploratorios de tres escalas: “Aprendizaje, aplicación del conocimiento y tareas y demandas generales”, “Autocuidado y “Movilidad”, análisis de consistencia interna, MANCOVAs y análisis de regresión. Resultados: En Aprendizaje, aplicación del conocimiento y tareas y demandas generales se obtuvieron tres factores que explicaron el 52,58% de la varianza. En Movilidad se obtuvieron dos factores que explicaron el 76,91 % y en “Autocuidado” se obtuvieron otros dos, que explicaron el 77,60 %. Los test de MANCOVAs mostraron diferencias entre las tres muestras en todos los factores y los coeficientes de fiabilidad tuvieron valores entre 0,91 y 0,99. Conclusiones: Los resultados de este estudio indicaron adecuadas propiedades métricas de las nuevas escalas, cuyos factores discriminaron entre muestras y tuvieron alta fiabilidad(AU)

Background: The International Classification of Functioning, Disability and Health (ICF) provides a useful theoretical framework for the rehabilitation of chronic diseases with complex problems that require interdisciplinary teams. The aim of this study was the development of a set of scales based on ICF for treatment planning and outcome assessment. Methods: A group of experts conducted several changes of the elements from the Activities and Participation ICF chapter. Tasks and questions were designed and then, submitted to review from another group of experts.An online application was designed. The sample consisted of 116 participants, 34 of them with brain injury, 38 with severe mental disorders and 44 controls. Trained psychologists and other health professionals administered the scales. Exploratory factor analysis of the scales “Learning and applying knowledge and general tasks and demands”, “Self-care” and “Mobility” besides reliability coefficients, MANCOVAs and regression analyses were performed. Results: In the scale “Learning and applying knowledge and general tasks and demands” three factors have been extracted, which explain 52,58% of variance. In the scale “Mobility” two factors have been extracted, explaining 76,91 % of variance; and in “Self-care”, another two factors were extracted, explaining 77,60%of variance.MANCOVAs showed significant differences between the three groups in all seven new factors. All factors presented coefficients between 0.91 and 0.99. Conclusions: These results showed appropriate metric properties of the newscales,whose factors discriminate between groups and have a high reliability(AU)

Una imagen sorprendente en tránsito baritado / A strange shadow in a small bowel series

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Vías accesorias auriculoventriculares múltiples en un paciente joven con fibrilación auricular sincopal y presencia de fibras fasciculoventriculares / Multiple atrioventricular accesory pathways in a young patient with syncope, atrial fibrillation and fasciculoventricular fiber

Las vías accesorias múltiples en pacientes con síndrome de Wolff-Parkinson-White son de presentación poco frecuente y en general presentan un riesgo aumentado de fibrilación ventricular. Describimos un caso excepcional en un paciente portador de 4 vías accesorias auriculoventriculares asociadas a fibras fasciculoventriculares en quien realizamos ablación por radiofrecuencia

Vías accesorias auriculoventriculares múltiples en un paciente joven con fibrilación auricular sincopal y presencia de fibras fasciculoventriculares / Multiple atrioventricular accesory pathways in a young patient with syncope, atrial fibrillation and fasciculoventricular fiber

Las vías accesorias múltiples en pacientes con síndrome de Wolff-Parkinson-White son de presentación poco frecuente y en general presentan un riesgo aumentado de fibrilación ventricular. Describimos un caso excepcional en un paciente portador de 4 vías accesorias auriculoventriculares asociadas a fibras fasciculoventriculares en quien realizamos ablación por radiofrecuencia (AU)