The need for a socioecological harm reduction approach to reduce illegal wildlife trade.

The burgeoning illegal trade in succulents in southern Africa presents a critical conservation and social development challenge. Drawing parallels with the trajectory of the response to rhinoceros poaching, we considered the consequences of conservation law enforcement measures, particularly the militarization of antipoaching efforts. The response to rhinoceros poaching not only resulted in so-called green militarization, but also led to extrajudicial killings, human rights abuses, and the disproportionate targeting of low-level poachers. The nature of wildlife trade prohibition is complex and often contested, and many actors operating in illegal wildlife trades dispute the label of illegal for socioeconomic, cultural, historical, or political reasons. This contestation is crucial when considering Indigenous cultural and medicinal values of succulents, with Indigenous Peoples and local communities questioning the criminalization of traditional plant harvesting practices. As the illegal trade in succulents continues to grow, it is imperative for conservationists to consider a nuanced approach. We call for a socioecological harm reduction approach that emphasizes community engagement, sustainable use, and codesigned interventions. Such an approach could help balance the scales of ecological conservation and human dignity in the face of growing wildlife trade challenges.

La necesidad de una estrategia socioecológica de reducción de daño para disminuir el mercado ilegal de fauna Resumen El emergente mercado ilegal de suculentas en el sur de África representa un reto importante para la conservación y el desarrollo social. Partimos de las similitudes con la trayectoria de la respuesta a la caza furtiva de rinocerontes para considerar las consecuencias de la aplicación de las leyes de conservación, en particular la militarización de los esfuerzos contra la caza furtiva. La respuesta a la caza furtiva no sólo derivó en la llamada militarización verde, sino también llevó a ejecuciones extrajudiciales, abuso de los derechos humanos y a la selección desproporcionada de cazadores de bajo nivel. La naturaleza de la prohibición del mercado de fauna es compleja y con frecuencia se impugna, y muchos actores que operan en los mercados ilegales disputan la etiqueta ilegal por razones socioeconómicas, culturales, históricas o políticas. Esta impugnación es crucial cuando consideramos los valores culturales y medicinales que los indígenas dan a las suculentas, sobre todo cuando los pueblos indígenas y las comunidades locales cuestionan la criminalización de las prácticas tradicionales de recolección de plantas. Conforme el mercado ilegal de suculentas sigue creciendo, es imperativo que los conservacionistas consideren una estrategia con matices. Pedimos una estrategia socioecológica de reducción de daños que resalte la participación comunitaria, el uso sustentable y las intervenciones con co­diseño. Dicha estrategia podría ayudar a equlibrar la balanza de la conservación ecológica y la dignidad humana de cara al incremento de retos en el mercado de fauna.

Fractura craneal deprimida congénita ("fractura ping-pong") en neonatos como diagnóstico diferencial de maltrato físico / Congenital depressed skull fracture ("ping-pong" fracture) in newborn infants as a differential diagnosis of physical abuse

Las fracturas con hundimiento de cráneo sin una explicación clara sobre su origen orientan al traumatismo con un objeto romo y a la sospecha de maltrato infantil. En el caso de los bebés recién nacidos, su corta edad es un factor de vulnerabilidad y obliga a una exhaustiva evaluación. Ante la sospecha de maltrato infantil, resulta importante evaluar los diagnósticos diferenciales para realizar la intervención más adecuada posible. Es necesario evitar tanto intervenciones excesivas como omitir la intervención que sea necesaria. Las fracturas craneales deprimidas congénitas, descritas como "fracturas pingpong", son raras (0,3 a 2/10 000 partos). Pueden aparecer sin antecedentes traumáticos o en partos instrumentalizados. Se describe en este artículo el caso de un recién nacido con una fractura ping-pong como ejemplo de una fractura no intencional.

Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.

Predictors of adherence to follow-up and treatment success in childhood obesity.

INTRODUCTION: Management of childhood obesity, based upon behavioural, physical activity and dietary guidance, usually achieves limited success and is hindered by a high attrition rate. The identification of potential predictors of either weight loss or early weight management attrition could help develop personalised management plans in order to improve patient outcomes. PATIENTS AND METHODS: We conducted a retrospective study in a cohort of 1300 patients with obesity managed in speciality clinics for up to 5 years with outpatient conservative treatment. We studied the family background and personal characteristics (demographic, behavioural, psychosocial, anthropometric and metabolic) of patients who dropped out before completing the first year of the programme and patients who achieved significant weight loss, with a separate analysis of patients who achieved substantial reductions in weight compared to the rest of the cohort. RESULTS: The mean age of the patients in the cohort was 10.46 years (SD, 3.48) the mean BMI z-score 4.01 (SD, 1.49); 52.8% of the patients were male, 53.3% were prepubertal, 75.8% were Caucasian and 19% Latin. We found a higher proportion of Latinla ethnicity and compulsive eating in the group of patients with early attrition from the weight management follow-up. In the group of patients with substantial weight loss, a greater proportion were male, there was a higher frequency of dietary intake control at home and obesity was more severe, and the latter factor was consistently observed in patients who achieved substantial weight loss at any point of the follow-up. CONCLUSIONS: Some family and personal characteristics in childhood obesity are associated with an increased risk of early withdrawal from follow-up or a greater probability of successful outcomes; however, the predictive value of these variables is limited.

Nailing intertrochanteric fractures in geriatric population: Do we know it all?

INTRODUCTION AND OBJECTIVES: Pertrochanteric fractures constitute an important part of the daily activity of the orthopedic surgeon. The aim of this study was to carry out an analysis of pre-, intra- and post-operative radiographic parameters and to analyze the results of stable and unstable intertrochanteric fractures treated with short nails with dynamic distal locking. MATERIALS AND METHODS: Retrospective study in our center, between the years 2017-2021 of patients over 65 years of age with pertrochanteric fracture. We included 272 patients treated with Gamma3 Nail (Stryker®) with dynamic distal locking. As variables, we recorded: age, medical comorbidities, fracture pattern according to AO/OTA, osteopenia according to Singh's classification, pre-operative (such as diaphyseal extension), intra-operative (such as tip-to-the-apex or medial cortical support) and post-operative radiographic parameters (such as time to consolidation or loss of reduction), pre- and post-operative Barthel, quality of life and complications and reinterventions, such as non-union or cut-out. RESULTS: The mean age was 83.28 years (65-102). Two hundred four cases were women (75%). The average follow-up was 18.2 months (12-24). The distribution according to AO/OTA classification was 85.7% 31.A1; 12.5% 31.A2; 1.9% 31.A3. Radiographic consolidation was obtained in 97.4% of cases. Tip to apex distance was less than 25mm in 95.6% of cases. Medial cortical support was positive or neutral in 88.6% of cases. Sixty cases (22.1%) of screw back-out were recorded. Eight reinterventions (2.9%) were performed, corresponding to three cut-outs (1.1%), three non-unions (1.1%), one avascular necrosis (0.4%) and one secondary hip osteoarthritis (0.4%). CONCLUSIONS: Short nail with dynamic distal locking offers good clinical, radiological and functional results in all types of AO/OTA patterns, without increasing the complication rate, as long as there is an appropriate tip-to-the-apex distance and good medial cortical support.

Designing celebrity-endorsed behavioral interventions in conservation.

The use of celebrity endorsement in environmental conservation interventions aiming to influence human behavior has increased in recent decades. Although good practice in designing, implementing, and evaluating behavioral interventions is outlined in recent publications, guidance on developing conservation interventions with celebrity endorsement remains limited. To fill this gap, we devised a guide for decision-making relating to celebrity-endorsed behavioral interventions based on the behavioral, project design, and celebrity endorsement literatures. The guide advises conducting research to understand the behavior system in question; defining endorser selection models and celebrities based on the research; developing an endorsement strategy with the appropriate communication channels; testing the celebrity, channels, and strategy with the target audience and making adjustments as needed; and, finally, evaluating the intervention after implementation. We applied this strategy to a case study, the aim of which was to design a celebrity-endorsed intervention to reduce consumption of wild meat in Ho Chi Minh City, Vietnam. Following our guide, we found that employing evidence-based decision-making substantially enhanced our ability to understand the complexity and potential cost associated with using celebrity endorsements in behavioral interventions.

Diseño de intervenciones conductuales para la conservación apoyadas por celebridades Resumen En las últimas décadas se ha incrementado el uso del apoyo de celebridades en las intervenciones de conservación ambiental que buscan influir sobre la conducta humana. Aunque las publicaciones recientes describen las buenas prácticas en el diseño, implementación y evaluación de las intervenciones conductuales, todavía son limitadas las directrices sobre el desarrollo de intervenciones de conservación apoyadas por celebridades. Para llenar este vacío, diseñamos una guía para decidir en relación con las intervenciones conductuales apoyadas por celebridades con base en la literatura sobre las conductas, diseño de proyectos y apoyo de celebridades. La guía recomienda investigar para entender el sistema conductual en cuestión; definir los modelos de selección de patrocinadores y celebridades con base en esta investigación; desarrollar una estrategia de apoyo con los canales adecuados de comunicación; probar los canales, estrategia y celebridades con el público objetivo y realizar los ajustes necesarios; y, por último, la evaluación de la intervención posterior a la implementación. Aplicamos esta estrategia a un estudio de caso, cuyo objetivo era diseñar una intervención con apoyo de celebridades para reducir el consumo de fauna en Ciudad Ho Chi Minh, Vietnam. Con nuestra guía encontramos que el uso de decisiones basadas en evidencias mejoró sustancialmente nuestra capacidad para entender la complejidad y el costo potencial asociado con el uso de apoyo de celebridades en las intervenciones conductuales.

Treatment of displaced intra-articular calcaneal fractures using a sinus tarsi approach. Surgical technique. / Técnica quirúrgica del manejo de las fracturas de calcáneo a través de un abordaje del seno del tarso.

Calcaneal articular fractures are fractures classically associated with a high rate of complications and poor outcomes. Osteosynthesis of the calcaneus through a sinus tarsi approach has shown results equal to or superior to those of the extended approach, having become the new gold standard. The objective of this article is to detail step by step the surgical technique of osteosynthesis of intra-articular fractures of the calcaneus through a sinus tarsi approach, from the selection of the fracture, positioning of the patient, layout of the operating room and the fluoroscope, the entire surgical process until postoperative treatment. The surgical technique described below is described in 6 steps. Anatomical reduction of complex calcaneal fractures through an Sinus Tarsi Approach requires an understanding of the fracture and its associated deformities. Following the described sequence step by step will help to achieve a better reduction in order to achieve better functional results.

[Translated article] Subtalar dislocations: Analysis of a case series. Our urgent treatment algorithm.

INTRODUCTION AND OBJECTIVES: Subtalar dislocations are a rare entity (<1%) in traumatic foot injuries. There is a loss of anatomical relationship between the talus, calcaneus and scaphoid. There are only small-published series. MATERIAL AND METHODS: We present a series of patients (N=13) with subtalar dislocations in which a descriptive analysis of the main epidemiological, clinical and radiological variables was carried out, from which an urgent treatment algorithm is proposed. Cases with fractures of the neck of the talus, body of the calcaneus, or isolated Chopart fracture-dislocations were excluded. RESULTS: The median age was 48.5 years with a predominance of males (69.23%). Five patients suffered falls or sprained ankles and the other eight suffered high-energy mechanisms. The medial dislocations (nine) predominated over the lateral ones (four). In addition, four patients presented open dislocations, two of them type IIIC that required amputation. CT scans were requested in 76.93% of patients and 10 presented associated bone lesions of the foot. Open reduction surgery was performed in all open lesions and in one case in which closed reduction failed. Five patients required a delta-type external fixator. Subchondral articular sclerosis was observed in 77.77% of cases; although only one required subtalar arthrodesis. CONCLUSIONS: Subtalar dislocations are a traumatic emergency that require early reduction and subsequent immobilisation. Transarticular temporary external fixation is a good immobilisation option in open dislocations. They are serious lesions with a high probability of early osteoarthritis.

Subtalar dislocations: Analysis of a case series. Our urgent treatment algorithm. / Luxaciones periastragalinas: análisis de una serie de casos. Nuestro algoritmo de tratamiento urgente.

INTRODUCTION AND OBJECTIVES: Subtalar dislocations are a rare entity (<1%) in traumatic foot injuries. There is a loss of anatomical relationship between the talus, calcaneus and scaphoid. There are only small-published series. MATERIAL AND METHODS: We present a series of patients (N=13) with subtalar dislocations in which a descriptive analysis of the main epidemiological, clinical and radiological variables was carried out, from which an urgent treatment algorithm is proposed. Cases with fractures of the neck of the talus, body of the calcaneus, or isolated Chopart fracture-dislocations were excluded. RESULTS: The median age was 48.5 years with a predominance of males (69.23%). Five patients suffered falls or sprained ankles and the other eight suffered high-energy mechanisms. The medial dislocations (nine) predominated over the lateral ones (four). In addition, four patients presented open dislocations, two of them type IIIC that required amputation. CT scans were requested in 76.93% of patients and 10 presented associated bone lesions of the foot. Open reduction surgery was performed in all open lesions and in one case in which closed reduction failed. Five patients required a delta-type external fixator. Subchondral articular sclerosis was observed in 77.77% of cases; although only one required subtalar arthrodesis. CONCLUSIONS: Subtalar dislocations are a traumatic emergency that require early reduction and subsequent immobilization. Transarticular temporary external fixation is a good immobilization option in open dislocations. They are serious lesions with a high probability of early osteoarthritis.

Situaciones transoperatorias en pacientes pediátricos con fractura supracondílea del húmero

Introducción: Las fracturas supracondíleas del húmero en el niño, por lo general, son tratadas de manera quirúrgica, durante esa intervención se pueden presentar situaciones específicas en este tipo de enfermos. Objetivo: Actualizar y brindar información sobre algunas de las situaciones transoperatorias en pacientes con fractura supracondílea del húmero. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 61 días (primero de septiembre al 31 de octubre de 2022) y se emplearon palabras de búsqueda relacionadas con la investigación. A partir de la información obtenida, se realizó una revisión bibliográfica de un total de 245 artículos publicados en las bases de datos: PubMed, Hinari, SciELO y Medline, mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos, se utilizaron 29 citas seleccionadas para realizar la revisión, 28 de los últimos cinco años. Resultados: Se hace referencia a cuatro de las situaciones transoperatorias más frecuentes en este tipo de fractura. Se mencionan la conminución de la pared medial, como identificar esta situación y su conducta. En relación a las lesiones asociadas, se recomienda primero estabilizar el antebrazo y luego la fractura supracondílea. Para las fracturas inestables en flexión se recomienda la técnica a emplear. Por su parte, la conversión de la reducción cerrada a abierta está justificada en ciertas circunstancias que de forma detallada se describen en el trabajo. Conclusiones: Las fracturas supracondíleas del húmero en el niño son tratadas en su mayoría mediante tratamiento quirúrgico. Durante el transoperatorio se pueden presentar situaciones para las cuales el médico tratante debe estar preparado.

Introduction: Supracondylar fractures of the humerus in children are generally treated surgically, during surgery intervention may occur specific situations in this type of patient. Objective: To update and provide information on some of the intraoperative situations in patients with supracondylar fracture of the humerus. Methods: The search and analysis of the information was carried out in a period of 61 days (September 1st to October 31st, 2022) and search words related to the investigation were used. Based on the information obtained, a bibliographic review of a total of 245 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search manager and reference administrator, of which 29 selected citations were used to carry out the review, 28 of the last five years. Results: Reference is made to four of the most frequent intraoperative situations in this type of fracture. Comminution of the medial wall, how to identify this situation and its behavior are mentioned. In relation to associated injuries, it is recommended to first stabilize the forearm and then the supracondylar fracture. For unstable fractures in flexion, the technique to be used is recommended. For its part, the conversion from closed to open reduction is justified in certain circumstances that are described in the article. Conclusions: Supracondylar fractures of the humerus in children are mostly treated by surgical treatment. During the trans-operative period situations may arise for which the treating physician must be prepared.

Influence of the leukoreduction moment of blood components on the clinical outcomes of transfused patients in the emergency department / Influencia del momento de la leucorreducción de hemocomponentes en la evolución clínica de pacientes transfundidos en la emergencia / Influência do momento da leucorredução de hemocomponentes na evolução clínica de pacientes transfundidos na emergência

ABSTRACT Objectives: to investigate the influence of the leukoreduction moment (preor post-storage) of blood components on the clinical outcomes of patients transfused in the emergency department. Methods: retrospective cohort study of patients aged 18 years or older who received preor post-storage leukoreduced red blood cell or platelet concentrate in the emergency department and remained in the institution for more than 24 hours. A generalized mixed-effects model was applied in the analyses. Results: in a sample of 373 patients (63.27% male, mean age 54.83) and 643 transfusions (69.98% red blood cell), it was identified that the leukoreduction moment influenced the length of hospital stay (p<0.009), but was not dependent on the transfused blood component (p=0.124). The leukoreduction moment had no effect (p>0.050) on transfusion reactions, healthcare-associated infections, or mortality. Conclusions: patients who received pre-storage leukoreduced blood components in the emergency department had a shorter length of hospital stay.

RESUMEN Objetivos: verificar la influencia del momento de la leucorreducción (pre o post-almacenamiento) de hemocomponentes en la evolución clínica de pacientes transfundidos en la emergencia. Métodos: cohorte retrospectiva de pacientes de 18 años o más que recibieron, en el departamento de emergencia, concentrado de eritrocitos o plaquetas leucorreducidas pre o post-almacenamiento. Se aplicó un modelo de efectos mixtos generalizado en los análisis. Resultados: en la muestra de 373 pacientes (63,27% hombres, edad media 54,83) y 643 transfusiones (69,98% concentrado de eritrocitos) se identificó que el momento de la leucorreducción influyó en el tiempo de internación hospitalaria de los pacientes (p<0,009), pero no dependió del hemocomponente transfundido (p=0,124). El momento de la leucorreducción no tuvo efecto (p>0,050) en las variables de reacción transfusional, infección relacionada con la atención de la salud y óbito. Conclusiones: los pacientes que recibieron hemocomponentes leucorreducidos pre-almacenamiento en la emergencia presentaron un menor tiempo de internación hospitalaria.

RESUMO Objetivos: verificar a influência do momento da leucorredução (pré ou pós-armazenamento) de hemocomponentes na evolução clínica de pacientes transfundidos na emergência. Métodos: coorte retrospectiva de pacientes com idade igual ou maior de 18 anos que receberam, no departamento de emergência, concentrado de hemácias ou plaquetas leucorreduzidas pré ou pós-armazenamento. Modelo de efeitos mistos generalizado foi aplicado nas análises. Resultados: na amostra de 373 pacientes (63,27% homens, idade média 54,83) e 643 transfusões (69,98% concentrado de hemácias) foi identificado que o momento da leucorredução influenciou o tempo de internação hospitalar dos pacientes (p<0,009), porém não foi dependente do hemocomponente transfundido (p=0,124). O momento da leucorredução não teve efeito (p>0,050) nas variáveis reação transfusional, infecção relacionada à assistência à saúde e óbito. Conclusões: pacientes que receberam na emergência hemocomponente leucorreduzido pré-armazenamento apresentaram menor tempo de internação hospitalar.

Complementary training in disasters for healthcare professionals: an analysis of the official offer in brazil and mexico / Formación complementaria en desastres para profesionales de la salud: un análisis de la oferta oficial en brasil y méxico / Formação complementar em desastres para profissionais da saúde: uma análise da oferta oficial no brasil e méxico

ABSTRACT Objective: to identify courses available online by national civil defense bodies in Brazil and Mexico to assist in the additional training of healthcare professionals for disasters. Method: an exploratory descriptive study, based on a qualitative approach, using technological prospecting methodology, carried out on the official Civil Defense websites in Brazil and Mexico. Results: ten courses offered by the Government of Mexico's National Center for Disaster Prevention were found, nine of which were short-term and one offered as vocational training. All of these courses were synchronous. In Brazil, 36 courses were located, all in asynchronous formats, with durations varying between 20 and 50 hours. Although the courses presented programmatic content that included activities inherent to healthcare professionals, none of them made specific mention of professionals in this area as the target audience. Conclusion: the prospective study reinforces that Information and Communication Technologies for distance education present themselves as an alternative present in both countries in terms of additional training for disasters, although not yet specifically aimed at healthcare professionals. The need to include this area of interdisciplinary and multi-professional content reflects gaps in sector integration.

RESUMEN Objetivo: identificar cursos disponibles en línea por los organismos nacionales de defensa civil en Brasil y México para ayudar en la capacitación adicional de profesionales de la salud para desastres. Método: estudio descriptivo exploratorio, de enfoque cualitativo, utilizando metodología de prospección tecnológica, realizado en los sitios web oficiales de la Defensa Civil de Brasil y México. Resultados: se encontraron 10 cursos ofrecidos por el Centro Nacional para la Prevención de Desastres del Gobierno de México, nueve de los cuales fueron de corta duración y uno se ofreció como formación vocacional. Todos estos cursos fueron sincrónicos. En Brasil se ubicaron 36 cursos, todos en formato asincrónico, con duraciones que variaron entre 20 y 50 horas. Aunque los cursos presentaron contenidos programáticos que incluyeron actividades inherentes a los profesionales de la salud, ninguno de ellos hizo mención específica a los profesionales de esa área como público objetivo. Conclusión: el estudio prospectivo refuerza que las Tecnologías de la Información y las Comunicaciones para la educación a distancia se presentan como una alternativa presente en ambos países en términos de capacitación adicional para desastres, aunque aún no dirigida específicamente a los profesionales de la salud. La necesidad de incluir esta área de contenidos interdisciplinarios y multiprofesionales refleja brechas en la integración del sector.

RESUMO Objetivo: identificar cursos disponíveis on-line pelos órgãos de defesa civil nacional do Brasil e do México visando auxiliar na formação complementar de profissionais de saúde para desastres. Método: estudo descritivo exploratório, a partir de uma abordagem qualitativa, utilizando a metodologia de prospecção tecnológica, realizada nos sites oficiais de Defesa Civil do Brasil e do México. Resultados: foram encontrados 10 cursos oferecidos pelo Centro Nacional de Prevenção de Desastres do Governo do México, sendo nove de curta duração e um oferecido como curso técnico. Todos esses cursos na modalidade síncrona. No Brasil, localizaram-se 36 cursos, todos em formatos assíncronos, com duração variável entre 20 e 50 horas. Embora os cursos apresentassem conteúdo programático que incluía atividades inerentes aos profissionais de saúde, nenhum deles fazia menção específica aos profissionais desta área como público-alvo. Conclusão: o estudo prospectivo reforça que as Tecnologias da Informação e da Comunicação para educação a distância se apresentam como uma alternativa presente em ambos os países quanto à formação complementar para desastres, porém, ainda não direcionados especificamente aos profissionais da saúde. A necessidade de inclusão desta área de conteúdos interdisciplinares e multiprofissionais reflete lacunas de integração de setores.

A case of closed isolated medial subtalar dislocation / Un caso de luxación subastragalina medial aislada y cerrada

Introduction: Closed isolated subtalar dislocations are very rare and major cause of subtalar dislocation remains to be road traffic accidents. Objective: Identify isolated medial subtalar closed dislocations and their forms a management. Presentation of case: 22-year-old male sustained road traffic accident following which he had deformed foot with inability to bear weight. On evaluation he was found to have medial subtalar dislocation reduced with manual traction. One year follow up showed, no residual deformity or pain and had very good functional outcome. Conclusions: It is of great importance to identify the difference between medial subluxation or dislocation and medial swivel injury which have different mechanisms as well as different reduction maneuvers(AU)

Introducción: Las luxaciones subastragalinares aisladas cerradas son muy raras y la principal causa de luxación subastragalina resultan los accidentes de tráfico. Objetivo: Identificar las luxaciones cerradas subastragalina medial aisladas y su tratamiento. Presentación del caso: Un paciente hombre de 22 años sufrió un accidente de tránsito tras el cual quedó deformado el pie sin poder soportar peso. En la evaluación se encontró la luxación subastragalina medial que se redujo con tracción manual. El seguimiento al año no mostró deformidad residual ni dolor y tuvo muy buen resultado funcional. Conclusiones: Es de gran importancia identificar la diferencia entre subluxación o luxación medial y lesión por giro medial, las cuales tienen diferentes mecanismos, así como diferentes maniobras de reducción(AU)

Cirugía de reducción de base alar: aspectos fundamentales y técnica quirúrgica / Alar base reduction surgery: fundamental aspects and surgical technique

La cirugía de remodelación o reducción de la base alar, también conocida como aloplastía o alotomía, es un procedimiento orientado a modificar el ancho, la forma de las narinas y la base de la nariz. El objetivo de esta revisión es describir las indicaciones generales de una alotomía, sus consideraciones anatómicas y las técnicas quirúrgicas más frecuentemente utilizadas.

Alar base remodeling or reduction surgery, also known as alloplasty or allotomy, is a procedure aimed at modifying the width and shape of the nostrils and the base of the nose. The objective of this review is to describe the general indications for an allotomy, its anatomical considerations, and the most frequently used surgical techniques.

Contributions of the IUCN Red List of Ecosystems to risk-based design and management of protected and conserved areas in Africa.

Protected and conserved areas (PCAs) are key ecosystem management tools for conserving biodiversity and sustaining ecosystem services and social cobenefits. As countries adopt a 30% target for protection of land and sea under the Global Biodiversity Framework of the United Nations Convention on Biological Diversity, a critical question emerging is, which 30%? A risk-based answer to this question is that the 30% that returns the greatest reductions in risks of species extinction and ecosystem collapse should be protected. The International Union for Conservation of Nature (IUCN) Red List protocols provide practical methods for assessing these risks. All species, including humans, depend on the integrity of ecosystems for their well-being and survival. Africa is strategically important for ecosystem management due to convergence of high ecosystem diversity, intense pressures, and high levels of human dependency on nature. We reviewed the outcomes (e.g., applications of ecosystem red-list assessments to protected-area design, conservation planning, and management) of a symposium at the inaugural African Protected Areas Congress convened to discuss roles of the IUCN Red List of Ecosystems in the design and management of PCAs. Recent progress was made in ecosystem assessment, with 920 ecosystem types assessed against the IUCN Red List criteria across 21 countries. Although these ecosystems spanned a diversity of environments across the continent, the greatest thematic gaps were for freshwater, marine, and subterranean realms, and large geographic gaps existed in North Africa and parts of West and East Africa. Assessment projects were implemented by a diverse community of government agencies, nongovernmental organizations, and researchers. The assessments have influenced policy and management by informing extensions to and management of formal protected area networks supporting decision-making for sustainable development, and informing ecosystem conservation and threat abatement within boundaries of PCAs and in surrounding landscapes and seascapes. We recommend further integration of risk assessments in environmental policy and enhanced investment in ecosystem red-list assessment to fill current gaps.

Contribuciones de la Lista Roja de Ecosistemas de la UICN al diseño y manejo basados en riesgos de las áreas conservadas y protegidas en África Resumen Las áreas protegidas y conservadas (APC) son herramientas clave del manejo de ecosistemas para conservar la biodiversidad y mantener los servicios ambientales y los cobeneficios sociales. Conforme los países adoptan un objetivo de 30% para la protección del suelo y el mar bajo el Marco Mundial de Biodiversidad de la Convención sobre la Diversidad Biológica de las Naciones Unidas, surge una pregunta crítica: ¿cuál 30%? Una respuesta basada en riesgos a esta pregunta es que se debe proteger el 30% que rinda la mayor reducción del riesgo de extinción de especies y del colapso del ecosistema. Los protocolos de la Lista Roja de la Unión Internacional para la Conservación de la Naturaleza (UICN) proporcionan métodos prácticos para evaluar estos riesgos. Todas las especies, incluidos los humanos, dependen de la integridad de los ecosistemas para su bienestar y supervivencia. África tiene una importancia estratégica para el manejo de ecosistemas debido a la convergencia de una gran diversidad de ecosistemas, presiones intensas y un nivel elevado de dependencia del humano hacia la naturaleza. Revisamos los resultados (p. ej.: aplicaciones de las valoraciones de las listas rojas de ecosistemas al diseño de áreas protegidas, planeación de la conservación y manejo) de un simposio en el primer Congreso de Áreas Protegidas Africanas convocado para discutir el papel de la Lista Roja de Ecosistemas de la UICN en el diseño y manejo de las APC. Existen avances recientes en la evaluación de los ecosistemas, con 920 tipos de ecosistemas evaluados bajo los criterios de la Lista Roja de la UICN en 21 países. Mientras estos ecosistemas comprenden una diversidad de ambientes en todo el continente, los principales vacíos temáticos los encontramos para los dominios subterráneos, de agua dulce y marina, además de que existe un gran vacío geográfico en el norte de África y en partes del este y oeste africano. Los proyectos de evaluación fueron implementados por una comunidad diversa de agencias gubernamentales, organizaciones no gubernamentales e investigadores. La influencia de las evaluaciones sobre las políticas y el manejo se da con la información que proveen a las extensiones y el manejo de las redes de áreas protegidas formales, el apoyo para la toma de decisiones de desarrollo sustentable y la guía para la conservación de ecosistemas y el abatimiento de amenazas dentro de los límites de las APC y en los paisajes terrestres y marinos adyacentes. Recomendamos una mayor integración de las evaluaciones de riesgo dentro de las políticas ambientales y más inversión para las evaluaciones de lista roja de los ecosistemas cubrir los vacíos existentes.

Effect of dental distance from implant and MAR algorithm on the detection of vertical root fracture in CBCT images

Three-dimensional cone-beam computed tomography (CBCT) has an important role in the detection of vertical root fractures (VRFs). The effect of artifact generation by high-density objects like dental implants on image quality was well documented. This study aimed to assess the effect of tooth-implant distance and the application of metal artifact reduction (MAR) algorithm on the detection of VRFs on CBCT scans. This study was conducted on 20 endodontically treated single-rooted teeth. VRFs were induced in 10 teeth, while the other 10 remained intact. The implant was inserted in the right second premolar socket area, and two teeth were inserted in right canine and right first premolar sockets area randomly and underwent CBCT with and without the application of MAR algorithm. SPSS 21 was used to analyze the results (alpha=0.05). According to the findings of this study, all four variables of sensitivity, specificity, accuracy, and positive predictive values in diagnosis were higher in cases without MAR software at both close(roots in first premolar sockets) and far distances (roots in canine sockets) from the implant. However, the highest rate of diagnosis accuracy of the first and second radiologists was in the far distance group from the implant without MAR, and the lowest rate of diagnosis accuracy in the first and second radiologists was in the close distance to the implant. Applying MAR algorithm had no positive effect on detection of VRFs on CBCT scans in both close and distant scenarios.

La tomografía computarizada de haz cónico tridimensional (CBCT) tiene un papel importante en la detección de fracturas radiculares verticales (VRF). El efecto de la generación de artefactos por objetos de alta densidad como los implantes dentales en la calidad de la imagen está bien documentado. Este estudio tuvo como objetivo evaluar el efecto de la distancia entre el diente y el implante y la aplicación del algoritmo de reducción de artefactos metálicos (MAR) en la detección de VRF en escaneos CBCT. Este estudio se realizó en 20 dientes uniradiculares tratados endodónticamente. Se indujeron VRF en 10 dientes, mientras que los otros 10 permanecieron intactos. El implante se insertó en el área del alveolo del segundo premolar derecho, y dos dientes se insertaron en el canino derecho y en el área del alvéolo del primer premolar derecho al azar y se sometieron a CBCT con y sin la aplicación del algoritmo MAR. Se utilizó SPSS 21 para analizar los resultados (alfa=0,05). De acuerdo con los hallazgos de este estudio, las cuatro variables de sensibilidad, especificidad, precisión y valores predictivos positivos en el diagnóstico fueron más altas en los casos sin el software MAR tanto en distancias cercanas (raíces en las cavidades de los primeros premolares) como lejanas (raíces en las cavidades de los caninos) del implante. Sin embargo, la tasa más alta de precisión diagnóstica del primer y segundo radiólogo fue en el grupo de mayor distancia al implante sin MAR, y la tasa más baja de precisión diagnóstica en el primer y segundo radiólogo fue en la distancia cercana al implante. La aplicación del algoritmo MAR no tuvo un efecto positivo en la detección de VRF en escaneos CBCT en escenarios cercanos y distantes.

Resolución de maloclusión con severo escalón anterior empleando fuerzas diferenciales / Resolution of a malocclusion with a severe anterior step employing differential forces

Paciente de 21 años de sexo masculino con una distoclusión esqueletal y alveolo dentaria severa, hábito de succión del dedo que contribuye a agravar el escalón de 15 mm. Demanda tratamiento para mejorar su oclusión y estética. Si bien lo indicado es un tratamiento ortodóncico con cirugía ortogná- tica para modificar su perfil muy convexo con una distancia mentocervical acortada, no es aceptado por el paciente, planificándose entonces camuflaje ortodóncico con exodoncias de PD 14 y 24 y reduc- ción del escalón mediante anclaje diferencial que emplea fuerzas de volcamiento para no perderlo dado el gran overjet a reducir. Habiendo varias piezas dentarias con anomalías de color, defectos en el esmalte, una corona metálica en PD 36 y limitacio- nes presupuestarias se realizó la estética final con reconstrucciones de resina (AU)

A 21-year-old male patient with a severe skeletal and alveolar distoclusion, finger sucking habit that contributes to aggravate the 15 mm step. He demands treatment to improve its occlusion and aesthetics. Although orthodontic treatment with orthognathic surgery is indicated to modify its highly convex profile with a shortened mentocervical distance, it is not accepted by the patient, so orthodontic camouflage is planned with extractions of 14 and 24 and reduction of the step by means of differential anchorage that uses overturning forces so as not to lose anchorage due to the great overjet. Having several dental pieces with color anomalies, enamel defects, a metallic crown in 36 and budgetary limitations, the final aesthetics was performed with resin reconstructions (AU)

[Translated article] The haematoma block is not enough as method of anaesthesia in reduction of displaced distal radius fractures.

BACKGROUND: Two out of three wrist fractures seen in an emergency department are displaced but most can be treated conservatively after closed reduction. Patient-reported pain during closed reduction of distal radius fractures varies widely and the best method to decrease the perceived pain has not been well established. The purpose of this study was to assess pain during closed reduction of distal radius fractures after using haematoma block as method of anaesthesia. PATIENTS AND METHODS: Cross-sectional clinical study including all patients who presented an acute fracture of the distal radius requiring closed reduction and immobilisation during a six-month period in two University Hospitals. Demographic data, fracture classification, perceived pain using a visual analogue scale at different times of reduction and complications were registered. RESULTS: Ninety-four consecutive patients were included. Mean age was 61 years. Mean pain score at initial assessment was 6 points. After the haematoma block, the perceived pain during the reduction manoeuvre improved to 5.1 points at the wrist, but increased to 7.3 points at the fingers. Pain decreased to 4.9 points during cast placement and reached 1.4 point after sling placement. The reported pain was higher in women at all times. There were no significant differences according to the according to the type of fracture. No neurological or skin complications were observed. CONCLUSIONS: Haematoma block is only a mildly effective method to reduce wrist pain during closed reduction of distal radius fractures. This technique slightly decreases the perceived pain in the wrist and does not reduce the pain in the fingers. Other reduction methods or other analgesic techniques may be more effective options. LEVEL OF EVIDENCE: Therapeutic study. Cross-sectional study - Level IV.

Realidades intersubjetivas de la reducción de daños en Costa Rica: Voces polifónicas del sinhogarismo / Intersubjective realities of harm reduction in Costa Rica:Polyphonic voices of homelessness and drug consumption

Resumen: Objetivo: Comprender las experiencias de Reducción de Daños en las voces de personas costarricenses en situación de calle, consumidoras de sustancias psicoactivas. Materiales y métodos: Investigación cualitativa con diseño fenomenológico que contó con la participación de 10 personas en situación de calle que visitaban diferentes centros de atención en reducción de daños en tres provincias de Costa Rica durante los años de 2019 y 2020. Resultados: La efectivación del derecho a la salud y el reconocimiento de la ciudadanía y la humanidad de las personas en situación de calle consumidoras de sustancias, estuvieron siempre presentes en las experiencias vividas dentro de las instituciones de Reducción de Daños. Además, se explicitó que, los ejes de derechos humanos, cuidados centrados en la persona y el reconocimiento del fenómeno de las drogas como una dimensión perteneciente al ámbito de la Salud Pública fueron puntos neurálgicos "del ser" dentro de la Reducción de Daños en Costa Rica. Conclusión: Una de las mayores contribuciones de este estudio fue la comprensión del progreso de la Reducción de Daños en un no-lugar como la calle. La comprensión fenomenológica social nos mostró también que el sentido de "ser y estar" en el mundo no es algo pasible de ser determinado por estructuras primitivas y punitivas. Por lo tanto, cualquier tentativa de cuidado a la salud que deslegitime al ser humano en cualquier momento o (no) lugar estará destinada al fracaso.

Abstract: Objective: To understand the experiences of Harm Reduction among the voices of homeless people and drug users in Costa Rica. Materials and Methods: A qualitative research with a phenomenological approach that worked with 10 homeless people in Costa Rica during 2019-2020. Results: The materialization of the right to health and the recognition of the citizenship/humanism of homeless people-drug user were always present in the lived experiences of the participants. In addition, it was explicit that the axes of Humanism, Person-centered Care and the recognition of the Drug Phenomenon as a dimension belonging to the field of Public Health were neuralgic points of being within the Harm Reduction in Costa Rica. Conclusion: One of the major contributions of this study was the understanding of the progress of Harm Reduction in a non-place like the street. The social phenomenological understanding also showed us that the sense of "being" in the world is not something that can be determined by primitive and punitive structures. Therefore, any health care attempt that delegitimizes the human being at any time or (no) place will be doomed to failure.

Luxación del tendón tibial posterior oculta tras un esguince de tobillo: reporte de caso / Hidden posterior tibial tendon dislocation after ankle sprain: case report

Resumen: Introducción: la luxación traumática del tendón tibial posterior es una entidad poco frecuente que puede pasar desapercibida en nuestra práctica clínica habitual. Material y métodos: un hombre de 31 años, sin antecedentes médicos de interés, sufrió un accidente de tráfico de alta energía. Presentaba una luxación del tendón tibial posterior que pasó desapercibida. Tras un diagnóstico precoz se consiguió realizar una reparación primaria del retináculo flexor y se logró la reducción anatómica del tendón. Resultados: el paciente pudo retomar la actividad deportiva a los tres meses de la lesión con buen resultado funcional. Conclusiones: debemos sospechar esta entidad tras un traumatismo de alta energía con entorsis de tobillo. El tratamiento quirúrgico de esta lesión ofrece buenos resultados funcionales.

Abstract: Introduction: traumatic posterior tibial tendon dislocation is a rare entity that can go unnoticed in our usual clinical practice. Material and methods: a 31-year-old man, with no relevant medical history, suffered a high-energy traffic accident. He presented a dislocation of the posterior tibial tendon that went unnoticed. After an early diagnosis, a primary repair of the flexor retinaculum was performed and the anatomical reduction of the tendon was achieved. Results: the patient was able to resume sports activity three months after the injury with good functional results. Conclusions: we should suspect this entity after high-energy trauma with ankle sprains. Surgical treatment of this lesion offers good functional results.