Initial Experience with the Solitaire X 3 mm Stent Retriever for the Treatment of Distal Medium Vessel Occlusions.

Endovascular therapy (EVT) is the standard treatment for ischemic stroke caused by a large vessel occlusion (LVO). The effectiveness of EVT for distal medium vessel occlusions (MDVOs) is still uncertain, but newer, smaller devices show potential for EVT in MDVOs. The new Solitaire X 3 mm device offers a treatment option for MDVOs. Our study encompassed consecutive cases of primary and secondary MDVOs treated with the Solitaire X 3 mm stent-retriever as first-line EVT device between January and December 2022 at 12 European stroke centers. The primary endpoint was a first-pass near-complete or complete reperfusion, defined as a modified treatment in cerebral infarction (mTICI) score of 2c/3. Additionally, we examined reperfusion results, National Institutes of Health Stroke Scale (NIHSS) scores at 24 h and discharge, device malfunctions, complications and procedural technical parameters. Sixty-eight patients (38 women, mean age 72 ± 14 years) were included in our study. Median NIHSS at admission was 11 (IQR 6-16). In 53 (78%) cases, a primary combined approach was used as the frontline technique. Among all enrolled patients, first-pass mTICI 2c/3 was achieved in 22 (32%) and final mTICI 2c/3 in 46 (67.6%) patients after a median of 1.5 (IQR 1-2) passes. Final reperfusion mTICI 2b/3 was observed in 89.7% of our cases. We observed no device malfunctions. Median NIHSS at discharge was 2 (IQR 0-4), and no symptomatic intracranial hemorrhages were reported. Based on our analysis, the utilization of the Solitaire X 3 mm device appears to be both effective and safe for performing EVT in cases of MDVO stroke.

Early exploration of the economic impact of transradial access (TRA) versus transfemoral access (TFA) for neurovascular procedures in Spain.

INTRODUCTION: Transfemoral access (TFA) is the primary access approach for neurointerventional procedures. Transradial access (TRA) is established in cardiology due to its lower complications, yet, it is at its early stages in neuroprocedures. This study performs an early exploration of the economic impact associated with the introduction of TRA in diagnostic and therapeutic neuroprocedures from the Spanish NHS perspective. METHODS: An economic model was developed to estimate the cost and clinical implications of using TRA compared to TFA. Costs considered access-related, complications and recovery time costs obtained from local databases and experts' inputs. Clinical inputs were sourced from the literature. A panel of eight experts from different Spanish hospitals, validated or adjusted the values based on local experience. Hypothetical cohorts of 10,000 and 1000 patients were considered for diagnostic and therapeutic neuroprocedures respectively. Deterministic sensitivity analysis was performed. RESULTS: TRA in diagnostic procedures was associated with lower costs with savings ranging between €486 and €157 depending on the TFA recovery time considered. TRA is estimated to lead to 158 fewer access-site complications. In therapeutic procedures, TRA resulted in 76.4 fewer complications and was estimated to be cost-neutral with an incremental cost of €21.56 per patient despite recovery times were not included for this group. Variation of the parameters in the sensitivity analysis did not change the direction of the results. LIMITATIONS: Clinical data was obtained from literature validated by experts therefore results generalizability is limited. In therapeutic neuroprocedures, there is an experience imbalance between approaches and recovery times were not included hence the total impact is not fully captured. CONCLUSIONS: The early economic model suggests that implementing TRA is associated with reduced costs and complications in diagnostic procedures. In therapeutic procedures, TRA lead to fewer complications and it is estimated to be cost-neutral, however its full potential still needs to be quantified.

Endovascular thrombectomy first-pass reperfusion and ancillary device placement.

BACKGROUND: Recent randomized trials have demonstrated the efficacy of mechanical thrombectomy in treating acute ischemic stroke, however, further research is required to optimize this technique. We aimed to evaluate the impact of guide catheter position and clot crossing on revascularization rates using A Direct Aspiration First Pass Technique (ADAPT). METHODS: Data were collected between January 2018 and August 2019 as part of the Spanish ADAPT Registry on ACE catheters (SARA), a multicenter observational study assessing real-world thrombectomy outcomes. Demographic, clinical, and angiographic data were collected. Subgroup analyses assessed the relationship between guide catheter/microguidewire position and modified Trombolysis in Cerebral Infarction (mTICI) scores. First pass effect (FPE) was defined as mTICI 3 after single pass of the device. RESULTS: From a total of 589 patients, 80.8% underwent frontline aspiration thrombectomy. The median score on the National Institutes of Health Stroke Scale (NIHSS) was 16.0. After adjusting for confounders, the likelihood of achieving FPE (adjusted Odds Ratio (aOR), 0.587; 95% confidence interval (CI), 0.38 to 0.92; p=0.0194) were higher among patients with more distal petrocavernous placement of guide catheter. The likelihood of achieving FPE (aOR, 0.592; 95% CI, 0.39 to 0.90; p=0.0138) and final angiogram complete reperfusion (aOR, 0.465; 95% CI, 0.30 to 0.73; p=0.0008) were higher among patients without microguidewire crossing the clot. No difference was noted for time from arterial puncture to reperfusion in any study group. At the 90-day follow-up, the mortality rate was 9.2% and 65.8% of patients across the entire study cohort were functionally independent (modified Rankin Scale (mRS) 0-2). CONCLUSIONS: Petrocavernous guide catheter placement improved first-pass revascularization. Crossing the occlusion with a microguidewire lowered the likelihood of achieving FPE and complete reperfusion after final angiogram.

A direct comparison of sound and vibration as sources of stimulation for a sensory substitution glove.

Sensory substitution devices (SSDs) facilitate the detection of environmental information through enhancement of touch and/or hearing capabilities. Research has demonstrated that several tasks can be successfully completed using acoustic, vibrotactile, and multimodal devices. The suitability of a substituting modality is also mediated by the type of information required to perform the specific task. The present study tested the adequacy of touch and hearing in a grasping task by utilizing a sensory substitution glove. The substituting modalities inform, through increases in stimulation intensity, about the distance between the fingers and the objects. A psychophysical experiment of magnitude estimation was conducted. Forty blindfolded sighted participants discriminated equivalently the intensity of both vibrotactile and acoustic stimulation, although they experienced some difficulty with the more intense stimuli. Additionally, a grasping task involving cylindrical objects of varying diameters, distances and orientations was performed. Thirty blindfolded sighted participants were divided into vibration, sound, or multimodal groups. High performance was achieved (84% correct grasps) with equivalent success rate between groups. Movement variables showed more precision and confidence in the multimodal condition. Through a questionnaire, the multimodal group indicated their preference for using a multimodal SSD in daily life and identified vibration as their primary source of stimulation. These results demonstrate that there is an improvement in performance with specific-purpose SSDs, when the necessary information for a task is identified and coupled with the delivered stimulation. Furthermore, the results suggest that it is possible to achieve functional equivalence between substituting modalities when these previous steps are met.

Economic impact of the first pass effect in mechanical thrombectomy for acute ischaemic stroke treatment in Spain: a cost-effectiveness analysis from the national health system perspective.

OBJECTIVE: The mechanical thrombectomy (MT) benefit is related to the degree of reperfusion achieved. First pass effect (FPE) is defined as complete/near revascularisation of the large-vessel occlusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after a single device pass. This study assessed the health benefit and economic impact of achieving FPE for acute ischaemic stroke (AIS) patients from the Spanish National Health System (NHS) perspective. DESIGN: A lifetime Markov model was used to estimate incremental costs and health outcomes (measured in quality-adjusted life-years (QALYs)) of patients that achieve FPE. A subanalysis of the Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischaemic Stroke (STRATIS) registry was performed to obtain clinical outcomes. The base case included all patients that achieved at least a final mTICI ≥2 b, while the alternative scenario included all patients regardless of their final mTICI (0-3). Treatment costs were updated to reflect current practice based on expert panel consensus, while other acute and long-term costs were obtained from a previous cost-effectiveness analysis of MT performed in Spain. Sensitivity analyses were performed to assess the model's robustness. SETTING: Spanish healthcare perspective. PARTICIPANTS: AIS patients in Spain. INTERVENTIONS: FPE following MT. OUTCOME MEASURES: The model estimated QALYs, lifetime costs and net monetary benefit for the FPE and non-FPE group, depending on the inclusion of reperfusion groups and formal care costs. RESULTS: STRATIS subanalysis estimated significantly better clinical outcomes at 90 days for the FPE group in all scenarios. In the base case, the model estimated lifetime cost saving per patient of €16 583 and an incremental QALY gain of 1.2 years of perfect health for the FPE group. Cost savings and QALY gains were greater in the alternative scenario (-€44 289; 1.75). In all scenarios, cost savings were driven by the long-term cost reduction. CONCLUSION: Achieving FPE after MT can lead to better health outcomes per AIS patient and important cost savings for the Spanish NHS.

Insights into the Design of Polyurethane Dressings Suitable for the Stages of Skin Wound-Healing: A Systematic Review.

Dressings made with polyurethanes have been found to exhibit good and varied biological properties that make them good candidates for this application. However, as has been seen, the wound-healing process is complex, which includes four different stages. So far, the design and evaluation of polyurethane for wound dressing has focused on achieving good properties (mechanical, physicochemical, and biological), but each of them separates from the others or even directed at only one of the stages of skin wound-healing. Therefore, the aim of this systematic review is to explore the applications of polyurethanes in wound dressings and to determine whether could be designed to cover more than one stage of skin wound-healing. The PRISMA guidelines were followed. The current research in this field does not consider each stage separately, and the design of polyurethane dressings is focused on covering all the stages of wound healing with a single material but is necessary to replace polyurethanes in short periods of time. Additionally, little emphasis is placed on the hemostasis stage and further characterization of polyurethanes is still needed to correlate mechanical and physicochemical properties with biological properties at each stage of the wound-healing. Current research demonstrates an effort to characterize the materials physiochemically and mechanically, but in terms of their biological properties, most of the literature is based on the performance of histological tests of explants morphologically probing the compromised tissues, which give an indication of the potential use of polyurethanes in the generation of wound-healing dressings.

Evaluation of three methods for betanin quantification in fruits from cacti.

In México, production of cacti fruits has increased. These fruits have high concentration of betalains (pigments), and market has increased interest in food with natural ingredients. In the near future, a sustainable method for betanin quantification in cacti fruits for rural communities will be necessary. Betanin in pulp of garambullo (Myrtillocactus geometrizan), chico fruit (Pachycereus weber), jiotilla (Escontria chiotilla) and pitaya de mayo (Stenocereus pruinosus) were quantified using three different analytical methods. The techniques were of Spectrophotometry UV-Vis (SCC), High-Performance Liquid Chromatography (HPLC) and Spectrophotometry technique using Molar Extinction Coefficient (SEC). The accuracy and intermediate precision were evaluated in SEC, SCC, and HPLC with the four cacti´s fruit. The means betanin concentration in the pulps were 0.68±0.05 (mg/g dry weight) garambullo, 1.28±0.06 (mg/g dry weight) chico fruit, 1.84±0.34 jiotilla and 2.0±0.25 pitaya de mayo (mg/g dry weight). The concentration of betanin in garambullo pulp measured by the three methods did not differ significantly (P >0.05). In this case, SEC method represents the best option to reduce costs, time and solvents in this way this method is aligned with green chemistry. In the three methods, coefficient of variation between measurements obtained are below 15%.•Robust method to quantify betanin and evaluate intermediate precision•Validation parameters such as LOD, LOQ, accuracy, intermediate precision, and HorRat were considered•The developed method enriches the valorization of underutilized national agricultural sources of Mexico.

Fibromatosis mesentérica solitaria. Reporte de caso y revisión de la literatura / Sporadic mesenteric fibromatosis. A case report. Literature review / Fibromatose mesentérica solitária. Relato de caso. Revisão da literatura

Resumen: La fibromatosis mesentérica es un subtipo profundo de tumor desmoide (TD), un tumor benigno de origen fibroblástico localmente agresivo por su tendencia a infiltrar los tejidos adyacentes. Son raros, esporádicos y pueden asociarse con el síndrome de Gardner. El tratamiento de elección es la resección completa, evitando la recurrencia local. Comunicamos el caso clínico de una paciente con fibromatosis intrabdominal mesentérica única, bien circunscripta, que simulaba por la imagenología una masa de origen pelviano.

Summary: Mesenteric fibromatosis is a deep sub-type of desmoid tumors consisting of a benign tumor of fibroblastic origin which is locally aggressive given its tendency to infiltrate adjacent tissues. They are unusual and sporadic, and may be associated to Gardner's Syndrome. Complete resection is the treatment of choice, avoiding local recurrence. The study reports the clinical case of a patient with intra-abdominal sporadic mesenteric fibromatosis, well circumscribed that appeared to be a pelvic mass in MR imaging.

Resumo: A fibromatose mesentérica é um subtipo profundo de tumor desmóide (DT); é um tumor benigno de origem fibroblástica que é localmente agressivo devido à sua tendência a infiltrar tecidos adjacentes. São raros, esporádicos e podem estar associados à síndrome de Gardner. O tratamento de escolha é a ressecção completa, evitando recidiva local. Relatamos o caso clínico de uma paciente com fibromatose mesentérica intra-abdominal única e bem circunscrita que simulava uma massa de origem pélvica na imagem.

Parental obesity and the transition from teenagers of normal-weight to young adults with obesity in Mexico.

OBJECTIVE: To estimate to what extent the parental tran-sition to obesity affects the likelihood that normal-weight teenagers also transition to obesity. We depart from the hypothesis that the transition to obesity specifically among parents is the main factor affecting the development of obesity during adolescence. MATERIALS AND METHODS: Using two rounds of the longitudinal Mexican Family Life Survey (MxFLS) and logistic regressions, we investigated how family weight-related characteristics affected the likelihood of teenagers 13 to 18 years of age in 2002 of becoming affected by obesity after seven to ten years. RESULTS: The results confirm that if any of the parents were affected by obesity during the teenage period, the adolescent is more likely to become affected by obesity. CONCLUSIONS: Results confirm that, different from childhood obesity, the transition of parents to obesity during the adolescence of teenagers is the most important family factor affecting such transition.

Parental obesity and the transition from teenagers of normal-weight to young adults with obesity in Mexico / Obesidad del padre y la madre y la transición de adolescentes de peso/talla normal hacia la obesidad en México

Abstract: Objective: To estimate to what extent the parental transition to obesity affects the likelihood that normal-weight teenagers also transition to obesity. We depart from the hypothesis that the transition to obesity specifically among parents is the main factor affecting the development of obesity during adolescence. Materials and methods: Using two rounds of the longitudinal Mexican Family Life Survey (MxFLS) and logistic regressions, we investigated how family weight-related characteristics affected the likelihood of teenagers 13 to 18 years of age in 2002 of becoming affected by obesity after seven to ten years. Results: The results confirm that if any of the parents were affected by obesity during the teenage period, the adolescent is more likely to become affected by obesity. Conclusions: Results confirm that, different from childhood obesity, the transition of parents to obesity during the adolescence of teenagers is the most important family factor affecting such transition.

Resumen: Objetivo: Calcular en qué medida la transición hacia la obesidad, específicamente del padre o la madre, tiene un impacto en el desarrollo de obesidad entre adolescentes. Material y métodos: Se utilizaron dos rondas de la Encuesta Nacional sobre Niveles de Vida de los Hogares (ENNViH) y regresiones logísticas para investigar cómo las características de peso/talla de los miembros del hogar afectan las probabilidades de que adolescentes desarrollen obesidad. Resultados: Cuando alguno de los padres desarrolla obesidad, el o la adolescente tiene más probabilidades de hacer una transición hacia la obesidad, en comparación con los casos en los que los padres mantienen un peso/talla normales. Conclusión: Se confirma que la transición de los padres durante la adolescencia es el principal factor que tiene un impacto en el desarrollo de obesidad entre adolescentes.

Family Factors Affecting the Transition of Children from Normal Weight to Obesity in Mexico.

Background: This study is a longitudinal analysis of how the transition of a mother, father, or any other family member to obesity affects the likelihood of children 5-12 years of age becoming adolescents with overweight or obesity during the 7-10-year period between 2002 and the period from 2009 to 2012 in Mexico. Methods: The study used two rounds of the Mexican Family Life Survey, a multipurpose random national survey that collected information on 8441 households, including 38,233 individuals in 2002 and successfully followed up with 3202 children until the period from 2009 to 2012. We used logistic regressions to calculate how family characteristics related to the evolution of body mass indexes among children, controlling for individual, family weight-related characteristics, and the socioeconomic level of the family. Results: The transition of any family member toward obesity is more relevant in determining the transition to obesity among normal-weight children than socioeconomic level of the family and individual characteristics, such as sex, schooling, and occupation. Conclusions: The transition of any family member toward obesity is associated with the transition to obesity among normal-weight children. A family-based approach to obesity prevention has yet to be incorporated into national policies.

[Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960)]. / Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960).

Poliomyelitis emerged in Europe as an epidemic disease at the end of the 19th century. During the thirties of the twentieth century it reached great intensity in the United States and Canada, but it was after the Second World War when the disease became a serious world public health problem, which punished several countries of the world, including Mexico. Poliomyelitis is a very contagious viral disease that invades the central nervous system (destroys motor neurons) that frightened the Mexican population in the first half of the twentieth century, not so much by high mortality and morbidity figures but by its paralytic sequels, like the disability, and by the fact that it affected one of the most vulnerable population groups: children. The disease mainly affected children under five years of age, being rare in the first months of life of the newborn due to the protective effect of immunity that the mother transfers to the son through breast milk; After eight months, at the end of the feed, the infant could be infected by poliovirus by invading the spinal cord and producing paralysis, most commonly of the legs or trunk. Likewise, it caused a paralysis in the respiratory muscles (diaphragm) of children, who had to help them to breathe since, if not, they were suffocated, so they were introduced in machines commonly known as steel lungs or lungs of Emerson type (machine that allows a person to breathe when he lost control of his respiratory muscles, such as the diaphragm, invented in 1928 by the American engineer Philip Drinker).

La poliomielitis emergió en Europa como enfermedad epidémica a finales del siglo XIX. Durante los años treinta del siglo XX alcanzó gran intensidad en los Estados Unidos y Canadá, pero fue tras la Segunda Guerra Mundial cuando la enfermedad se convirtió en un grave problema de salud pública mundial que castigó terriblemente a varios países del mundo, incluyendo a México. La poliomielitis es una enfermedad viral muy contagiosa que invade el sistema nervioso central (destruye las neuronas motoras) que atemorizó a la población mexicana en la primera mitad del siglo XX, no tanto por las altas cifras de mortalidad y morbilidad sino por sus secuelas paralíticas, como la invalidez, y por el hecho de que afectó a uno de los grupos poblacionales más vulnerables: los niños. La enfermedad afectaba principalmente a los niños menores de cinco años, siendo poco frecuente en los primeros meses de vida del recién nacido debido al efecto protector de la inmunidad que le transfiere la madre al hijo a través de la leche materna; después de ocho meses, al término de la alimentación, el infante podía ser infectado por el poliovirus invadiendo la medula espinal y produciendo la parálisis, más comúnmente de las piernas o tronco. Asimismo, ocasionaba una parálisis en los músculos respiratorios (diafragma) de los niños, a quienes había que auxiliarlos a respirar ya que, si no, se asfixiaban, por lo que se les introducía en unas máquinas conocidas comúnmente como pulmones de acero o pulmotores de tipo Emerson (máquina que permite a una persona respirar cuando esta perdió el control de sus músculos respiratorios, como el diafragma, inventada en 1928 por el ingeniero estadounidense Philip Drinker).

Evaluation of Lake Sediment Thickness from Water-Borne Electrical Resistivity Tomography Data.

Lakes are integrators of past climate and ecological change. This information is stored in the sediment record at the lake bottom, and to make it available for paleoclimate research, potential target sites with undisturbed and continuous sediment sequences need to be identified. Different geophysical methods are suitable to identify, explore, and characterize sediment layers prior to sediment core recovery. Due to the high resolution, reflection seismic methods have become standard for this purpose. However, seismic measurements cannot always provide a comprehensive image of lake-bottom sediments, e.g., due to lacking seismic contrasts between geological units or high attenuation of seismic waves. Here, we developed and tested a complementary method based on water-borne electrical-resistivity tomography (ERT) measurements. Our setup consisted of 13 floating electrodes (at 5 m spacing) used to collect ERT data with a dipole-dipole configuration. We used a 1D inversion to adjust a layered-earth model, which facilitates the implementation of constraints on water depth, water resistivity, and sediment resistivity as a priori information. The first two parameters were readily obtained from the echo-sounder and conductivity-probe measurements. The resistivity of sediment samples can also be determined in the laboratory. We applied this approach to process ERT data collected on a lake in southern Mexico. The direct comparison of ERT data with reflection seismic data collected with a sub-bottom profiler (SBP) showed that we can significantly improve the sediment-thickness estimates compared to unconstrained 2D inversions. Down to water depths of 20 m, our sediment thickness estimates were close to the sediment thickness derived from collocated SBP seismograms. Our approach represents an implementation of ERT measurements on lakes and complements the standard lake-bottom exploration by reflection seismic methods.

Aspectos históricos, clínicos y epidemiológicos de la poliomielitis en México (1946 - 1960) / Historical, clinical and epidemiological aspects of poliomyelitis in Mexico (1946-1960)

La poliomielitis emergió en Europa como enfermedad epidémica a finales del siglo XIX. Durante los años treinta del siglo XX alcanzó gran intensidad en los Estados Unidos y Canadá, pero fue tras la Segunda Guerra Mundial cuando la enfermedad se convirtió en un grave problema de salud pública mundial que castigó terriblemente a varios países del mundo, incluyendo a México. La poliomielitis es una enfermedad viral muy contagiosa que invade el sistema nervioso central (destruye las neuronas motoras) que atemorizó a la población mexicana en la primera mitad del siglo XX, no tanto por las altas cifras de mortalidad y morbilidad sino por sus secuelas paralíticas, como la invalidez, y por el hecho de que afectó a uno de los grupos poblacionales más vulnerables: los niños. La enfermedad afectaba principalmente a los niños menores de cinco años, siendo poco frecuente en los primeros meses de vida del recién nacido debido al efecto protector de la inmunidad que le transfiere la madre al hijo a través de la leche materna; después de ocho meses, al término de la alimentación, el infante podía ser infectado por el poliovirus invadiendo la medula espinal y produciendo la parálisis, más comúnmente de las piernas o tronco. Asimismo, ocasionaba una parálisis en los músculos respiratorios (diafragma) de los niños, a quienes había que auxiliarlos a respirar ya que, si no, se asfixiaban, por lo que se les introducía en unas máquinas conocidas comúnmente como pulmones de acero o pulmotores de tipo Emerson (máquina que permite a una persona respirar cuando esta perdió el control de sus músculos respiratorios, como el diafragma, inventada en 1928 por el ingeniero estadounidense Philip Drinker).

Poliomyelitis emerged in Europe as an epidemic disease at the end of the 19th century. During the thirties of the twentieth century it reached great intensity in the United States and Canada, but it was after the Second World War when the disease became a serious world public health problem, which punished several countries of the world, including Mexico. Poliomyelitis is a very contagious viral disease that invades the central nervous system (destroys motor neurons) that frightened the Mexican population in the first half of the twentieth century, not so much by high mortality and morbidity figures but by its paralytic sequels, like the disability, and by the fact that it affected one of the most vulnerable population groups: children. The disease mainly affected children under five years of age, being rare in the first months of life of the newborn due to the protective effect of immunity that the mother transfers to the son through breast milk; After eight months, at the end of the feed, the infant could be infected by poliovirus by invading the spinal cord and producing paralysis, most commonly of the legs or trunk. Likewise, it caused a paralysis in the respiratory muscles (diaphragm) of children, who had to help them to breathe since, if not, they were suffocated, so they were introduced in machines commonly known as steel lungs or lungs of Emerson type (machine that allows a person to breathe when he lost control of his respiratory muscles, such as the diaphragm, invented in 1928 by the American engineer Philip Drinker).

Perceptions and knowledge of telemedicine in Ecuadorian practicing physicians: an instrument adaptation, validation and translation from English to Spanish.

BACKGROUND: During the COVID-19 pandemic, multiple countries have taken measures, such as isolation and quarantine, to prevent person-to-person spread of disease. These actions forced many physicians to adopt new techniques, such as telemedicine, to continue patient care, which has proven to be useful in continued care for those with non-COVID-19 pathologies. Various factors, such as security, confidentiality, cost-effectiveness, comfort, and the risk of malpractice, influence the perception of telemedicine among medical practitioners. The aim of this study was to adapt an existing instrument and validate it into a new Spanish version. The instrument is about the perceptions and knowledge of telemedicine in healthcare professionals. METHODS: The original questionnaire surveyed 6 domains with 40 questions, and each question was measured with a five-point Likert scale ranging from very high [5] to very low [1]. The survey was translated to Spanish using machine translation. The translation was reviewed independently, and then, a consensus was achieved regarding minor changes in the syntax of the survey to facilitate understanding. After expert feedback and questionnaire review, the research team members proposed reducing the instrument to 13 items in 4 domains due to the similarity of some questions. The sample was divided into 2randomly selected groups. Eligibility criteria included physicians providing private or public services with active medical/clinical practice. RESULTS: In total, 382 surveys were collected and separated into two random samples, S1 and S2 (198 and 184, respectively). In exploratory factor analysis (EFA), the 13 items were grouped into four theoretical domains, and item 7 presented cross loading between factors and was removed. Confirmatory factor analysis was performed to assess the scale reliability and interscale associations; three models were tested. Global Cronbach's alpha for internal consistency was 0.76 for the EFA. The goodness of fit measures root mean square error of approximation and comparative fit index were 0.009 and 0.999, respectively, for the best model. CONCLUSIONS: The translated instrument was clear, with adequate internal consistency, readability, and appropriate for application in the physician setting. This validated questionnaire made it possible to evaluate physicians' knowledge of telemedicine to increase its use, especially during the COVID-19 pandemic.

El Dr. Felipe Alfonso Aceves Zubieta, formador de médicos y medios de comunicación / Dr. Felipe Alfonso Aceves Zubieta, trainer of physicians and media

Resumen: Felipe Alfonso Aceves Zubieta (1899-1960) fue un médico mexicano del siglo XX, profesor de varias asignaturas quirúrgicas en la Escuela Nacional de Medicina, y fundador de las Asambleas Nacionales de Cirujanos (1934), de la Revista de Cirugía del Hospital Juárez y de la Academia Mexicana de Cirugía.

Abstract: Felipe Alfonso Aceves-Zubieta (1899-1960), was a Mexican physician, who teached several surgical subjects at National School of Medicine, in Mexico City, and was the founder of Asambleas Nacionales de Cirujanos (1934), Revista de Cirugía del Hospital Juárez and Academia Mexicana de Cirugía.

Taste Masking of Granulated Acetaminophen by Water Insoluble Ethylcellulose Coating.

INTRODUCTION: Bitter tasting of drugs leads to non-compliance especially in the case of pediatric patients due to their inability to swal-low medication. AIM: In this study, we aimed to mask the bitter taste of acetaminophen (APAP) particles through coating. MATERIALS AND METHODS: A pH independent water insoluble ethylcellulose polymer was used to coat the APAP. The coating of water insoluble ethylcellulose on APAP can have a significant impact on the dissolution profile. Various grades of APAP were used for coating; fine grade, Compap L90% having wide particle size distribution (PSD), and a special granular (SG) APAP 1680 having narrow PSD. Coating was performed using top spray (Vector) for Compap L90% and SG APAP 1680 grade of APAP. RESULTS: Bitter taste of SG APAP was masked after spraying dispersion equivalent to a weight gain of 10% compared to 35% used for Compap L90%. Using bottom spray (Wurster coater, GPCP 2.0), coating was performed on SG APAP 1680 grade of APAP by spraying aqueous dispersion of ethylcellulose (Surelease) equivalent to a weight gain of 10%. The scalability of the top spray process was also evaluated in GPCG 30 and bitter taste was masked by using Surelease dispersion equivalent to a weight gain of 6%. Coated APAP was examined for particle size (PS), particle size distribution (PSD), flowability, and drug release profile. Dissolution was performed using USP apparatus 2 and 4 in phosphate buffer and evaluated for mechanism of drug release. Particle size obtained for coated SG APAP 1680 via top and bottom spray process was 404 µm d(90) and 487 µm d(90) respectively. CONCLUSIONS: The results of the study demonstrated the potential of Surelease dispersion in taste masking. The use of SG APAP 1680 having narrow PSD allowed taste masking to achieve at low weight gain without greatly affecting the dissolution profile.

Systematic approach to diagnosis and management of infected prosthetic grafts in the proximal aorta.

OBJECTIVES: Management of infected prosthetic aortic grafts in the ascending and or root is complex and multifaceted. We report our diagnostic pathway, management and outcomes, identifying successful strategies. METHODS: This was a retrospective, single center, observational study. Consecutive patients who underwent management of infected aortic grafts in the ascending and/or root at our institution between October 1998 and December 2019 were included. The main outcome measures were: discharge from hospital alive with at least 1 year survival, operative mortality and success of primary treatment strategy. RESULTS: Twenty-six patients presented with infection of proximal aortic grafts and were managed through a number of strategies with an overall hospital-survival of 81% and 1 year survival of 69%. Twenty of them ultimately underwent redo surgery with 25% operative mortality (within 24 h of surgery). Five patients underwent washout and irrigation of which two were successfully treated and cured with adjunctive antibiotics and two went on to have staged explant and definitive surgery. Interval between surgery and infection was 42.5 ± 35.8 months. All patients had at least one major criterion and three minor criterions with no diagnostic uncertainty. The commonest primary strategy was 3a (definitive surgery), (13/26, 50%). CONCLUSIONS: Adopting a systematic and flexible patient specific approach to the diagnosis and management of patients with proximal aortic graft infections results in reasonable overall 1 year survival. In the majority of patients surgery is ultimately required in an attempt to achieve a curative treatment; however this comes with high operative mortality risk.

Perceptions and Management of Allergic Rhinitis Among Ecuadorian Otorhinolaryngologists: A Survey-Based Study.

OBJECTIVE: Allergic rhinitis (AR) represents a large burden to the healthcare system due to its high prevalence and impact on patients' lives. Despite the existence of evidence-based guidelines, some studies have found that physicians do not always follow the latest recommendations. The aim of our study was to determine how Ecuadorian otorhinolaryngologists (ENTs) perceive some epidemiological aspects related to AR, as well as their preferences for managing the disease. METHODS: We conducted an observational, survey-based cross-sectional study, among 116 Ecuadorian ENTs. The survey used was adapted from a previous publication and consisted of 30 multiple choice questions, concerning several topics of AR. Descriptive statistics (frequency, and standard deviation) were performed for clinical and demographic variables. RESULTS: A total of 116 Ecuadorian ENTs completed the survey. Of them, 62.9% were male, with an average age of 42 years (SD ± 11.58). Computed tomography (CT) scan and nasal cytology were selected as the main diagnostic tests for AR by 62/91 (68.1%) and 45/91 (49.5%) of participants, respectively. Moreover, only 12/116 (10.3%) of participants performed skin prick tests (SPT). Allergen immunotherapy (AIT) was performed by 37/107 (36.4%) of participants. CONCLUSION: In general, most participants agreed that the prevalence of AR appears to be increasing, with increased exposure to allergens, irritants, and pollutants as the main probable cause. Children and adolescents were accounted as the group most affected by AR, with sinusitis and asthma identified as the most frequent comorbidities. Finally, we found unmet needs in the diagnostic and management of AR that should be addressed among Ecuadorian ENTs, in particular the high use of CT scans as part of routine evaluations, as well as the low use of allergen immunotherapy.