Uso de vasopresina en el postoperatorio de cirugía de Fontan: inferencias sobre morbimortalidad / Vasopressin use in postoperative Fontan surgery: implications for morbidity and mortality

Introducción: Se ha postulado que el uso de vasopresina tendría efectos beneficiosos en el postoperatorio de cirugía cardiovascular. Objetivo: Evaluar la respuesta a la vasopresina en el postoperatorio (POP) de cirugía de Fontan de nuestra población. Métodos: Estudio de casos y controles anidados en una cohorte retrospectiva. Se incluyeron pacientes con cirugía de Fontan entre 2014 y 2019. Se registraron variables demográficas, datos del cateterismo pre-Fontan, días de asistencia respiratoria mecánica (ARM), necesidad de inotrópicos, diuréticos, diálisis, dieta hipograsa, octreotide, sildenafil y nutrición parenteral total (NPT); balance de fluidos al primer y segundo día POP, necesidad de cateterismo en el POP, días de permanencia de tubo pleural, días de internación, necesidad de reinternación y mortalidad. Se compararon los grupos con y sin vasopresina utilizando la prueba de Mann- Whitney-Wilcoxon test. Se consideró significativa una p < 0.05. Resultados: Del total analizado, 35 pacientes recibieron vasopresina. En el grupo control fueron 58 pacientes con características similares de gravedad sin vasopresina. No se encontraron diferencias en la evolución postoperatoria entre ambos grupos. El grupo con vasopresina recibió en mayor proporción dieta hipograsa. Conclusiones: En nuestra serie el uso de vasopresina no marcó diferencias significativas en términos de morbimortalidad con relación al grupo control (AU)

Introduction: The use of vasopressin has been suggested to have beneficial effects in the postoperative period after cardiovascular surgery. Objective: To evaluate the response to vasopressin in the postoperative period (POP) of Fontan surgery in our population. Methods: Nested case-control study in a retrospective cohort. Patients who underwent Fontan surgery between 2014 and 2019 were included. Demographic variables, pre-Fontan catheterization data, days of mechanical ventilation (MRA), need for inotropics, diuretics, dialysis, low-fat diet, octreotide, sildenafil and total parenteral nutrition (TPN); fluid balance at first and second day POP, need for catheterization at POP, duration of chest tube drainage, days of hospitalization, need for readmission, and mortality were recorded. Groups with and without vasopressin were compared using the Mann-Whitney- Wilcoxon test. A p < 0.05 was considered significant. Results: Of all patients analyzed, 35 received vasopressin. The control group consisted of 58 patients with similar severity characteristics who did not receive vasopressin. No differences were found in the postoperative outcome between the two groups. The vasopressin group received a higher proportion of low-fat diet. Conclusions: In our series the use of vasopressin did not show significant differences in terms of morbidity and mortality compared to the control group (AU)

Update of the PANCCO clinical practice guidelines for the treatment of ulcerative colitis in the adult population.

Ulcerative colitis (US) is a chronic disease of unknown etiology. It is incurable and its clinical course is intermittent, characterized by periods of remission and relapse. The prevalence and incidence of the disease has been increasing worldwide. The update presented herein includes the participation of healthcare professionals, decision-makers, and a representative of the patients, all of whom declared their conflicts of interest. Answerable clinical questions were formulated, and the outcomes were graded. The information search was conducted on the Medline/PubMed, Embase, Epistemonikos, and LILACS databases, and covered grey literature sources, as well. The search was updated on November 30, 2020, with no restrictions regarding date or language. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification system was implemented to establish the strength of the recommendation and quality of evidence. A formal consensus was developed, based on the RAND/UCLA methodology and the document was peer reviewed. The short version of the Clinical Practice Guidelines for the Treatment of Ulcerative Colitis in the Adult Population is presented herein, together with the supporting evidence and respective recommendations. In mild-to-moderate UC, budesonide MMX is an option when treatment with 5-ASA fails, and before using systemic steroids. In moderate-to-severe UC, infliximab, adalimumab, vedolizumab, ustekinumab, and tofacitinib can be used as first-line therapy. If there is anti-TNF therapy failure, ustekinumab and tofacitinib provide the best results. In patients with antibiotic-refractory pouchitis, anti-TNFs are the treatment of choice.

El espacio muerto (VD/VT) como predictor de éxito en la extubación de pacientes postquirúrgicos de cirugía cardiovascular pediátrica / Dead space (VD/VT) as a predictor of successful extubation of patients after pediatric cardiovascular surgery

Introducción: La ventilación mecánica (VM) forma parte de la recuperación postoperatoria (PO) de niños con cirugía de cardiopatía congénita, pero su uso no está exento de riesgos. El fracaso de extubación (FE) se ha asociado con internaciones prolongadas, aumento de complicaciones y mortalidad. El objetivo es determinar un valor de Vd/Vt predictor de extubación exitosa (EE). Material y métodos: estudio de cohorte prospectivo y observacional realizado del 1 de Enero al 31 de Diciembre de 2016 en niños menores de 6 meses cursando PO de cirugía cardiovascular con circulación extracorpórea (CEC) con requerimientos de VM por más de 48 horas. En los mismo se analizó el éxito o fracaso de extubación. Previo a la extubación se registraron valores de mecánica respiratoria; Vd/Vt, CO2 espiratoria final, Vt/kg, etc. Otras variables registradas: edad, sexo, peso, requerimiento de VM antes de la cirugía, fisiología de ventrículo único, duración de VM, complicaciones, duración de la internación y mortalidad. Las variables continuas se describieron como mediana y rango intercuartilo (25-75) y se compararon con prueba de Wilcoxon, las categóricas como proporciones o porcentajes y se analizaron con chi2 . Se efectuó un análisis bivariado con diferentes puntos de corte de Vd/Vt pre extubación para realizar un análisis de sensibilidad del valor predictivo de EE. Resultados: Se evaluó Vd/Vt en 67 pacientes, tres se eliminaron por parálisis cordal (1) y parálisis del diafragma (2). Mediana de edad 23 días (10-55), peso 3.2 Kg (2.89- 3.88), días de VM 5 (3-7), días de internación 15 (2- 128), mortalidad 7,8%. Se extubaron con éxito 76% de los pacientes (50/64). Las características demográficas de los pacientes, la mecánica respiratoria, gases de sangre arterial y EtCO2 no tuvieron asociación significativa con EE. Un Vd/Vt pre extubación < 0,53 se asoció con EE. Conclusión: En la población estudiada un valor de Vd/Vt <0,53 se asoció con EE. Los pacientes con ventrículo único presentaron mayor FE.(AU)

Introduction: Mechanical ventilation (MV) is part of postoperative (PO) recovery of children with congenital heart disease surgery, but is not without risks. Extubation failure (EF) has been associated with prolonged hospital stays and increased complication and mortality rates. The goal is to determine the value of Vd/Vt as a predictor of successful extubation (SE). Material and methods: A prospective and observational cohort study was conducted from January 1 to December 31, 2016, in children under 6 months of age undergoing cardiovascular surgery with extracorporeal circulation (ECC) and requiring MV for more than 48 hours. Intubation success or failure was evaluated. Prior to extubation, respiratory mechanics values, such as Vd/Vt, final expiratory CO2, and Vt/kg, were recorded. Other variables, including age, sex, weight, VM requirement before surgery, single ventricle physiology, VM duration, complications, length of hospital stay, and mortality were also recorded. Continuous variables were described as median and interquartile range (25-75) and compared with the Wilcoxon test. Categorical variables were described as proportions or percentages and analyzed with chi2. Bivariate analysis was performed with different pre-extubation Vd/Vt cut-off points to analyze the sensitivity of the predictive value for SE. Results: Vd/Vt was evaluated in 67 patients; three were excluded because of vocal fold (1) and diaphragm paralysis (2). Median age was 23 days (10-55), weight 3.2 Kg (2.89- 3.88), days on MV 5 (3-7), length of hospital stay 15 (2- 128), and mortality rate 7.8%. Overall, 76% of patients (50/64) were successfully extubated. Patient demographics, respiratory mechanics, arterial blood gases, and EtCO2 were not significantly associated with SE. A pre-extubation Vd/ Vt < 0.53 was associated with SE. Conclusion: In this series of patients, a Vd/Vt value of <0.53 was associated with SE. EF was increased in patients with a single ventricle (AU)

Remdesivir-COVID-19: drug interactions in dentistry.

OBJECTIVE: Remdesivir is a nucleotide analogue prodrug that inhibits viral RNA polymerases. It has been recognized recently as a promising antiviral drug against a wide array of RNA viruses (including SARS/MERS-CoV5). We aimed at determining which drugs used in dentistry interact with Remdesivir in order to avoid adverse reactions that may worsen the condition of patients with COVID-19. MATERIALS AND METHODS: A literature review was conducted to identify potential drug interactions between remdesivir (used in the treatment of COVID-19) and drugs prescribed in dentistry. The search was made in the databases PubMed and MEDLINE and official websites using key terms remdesivir, drug interactions and dentistry for articles published up to 31st July 2020. RESULTS: According to the articles reviewed, a total of 279 drugs interact with Remdesivir. Two major interactions have been reported, 277 moderate drug interactions, and one with alcohol/food. The drug interactions involving drugs prescribed in dentistry are all moderate drug interactions and are (according to drug group): (1) antibiotics: azithromycin, clavulanate, doxycycline, erythromycin, levofloxacin; (2) antifungals: clotrimazole, fluconazole, itraconazole, ketoconazole; (3) non-steroidal anti-inflammatories (NAIDS): celecoxib diclofenac, etodolac, flurbiprofen, ibuprofen, ketoprofen, ketorolac, mefenamic acid, naproxen, piroxicam. CONCLUSIONS: It is clinically necessary for oral health professionals to be aware of possible drug interactions that may occur between remdesivir and drugs commonly prescribed in dentistry in order to prevent adverse reactions that may even endanger the life of a patient with COVID-19.

Severe infection due to the SARS-CoV-2 coronavirus: Experience of a tertiary hospital with COVID-19 patients during the 2020 pandemic. / Infección grave por coronavirus SARS-CoV-2: experiencia en un hospital de tercer nivel con pacientes afectados por COVID-19 durante la pandemia 2020.

OBJECTIVE: To describe the clinical and respiratory characteristics of a cohort of 43 patients with COVID-19 after an evolutive period of 28 days. DESIGN: A prospective, single-center observational study was carried out. SETTING: Intensive care. PATIENTS: Patients admitted due to COVID-19 and respiratory failure. INTERVENTIONS: None. VARIABLES: Automatic recording was made of demographic variables, severity parameters, laboratory data, assisted ventilation (HFO: high-flow oxygen therapy and IMV: invasive mechanical ventilation), oxygenation (PaO2, PaO2/FiO2) and complications. The patients were divided into three groups: survivors (G1), deceased (G2) and patients remaining under admission (G3). The chi-squared test or Fisher exact test (categorical variables) was used, along with the Mann-Whitney U-test or Wilcoxon test for analyzing the differences between medians. Statistical significance was considered for p<0.05. RESULTS: A total of 43 patients were included (G1=28 [65.1%]; G2=10 [23.3%] and G3=5 [11.6%]), with a mean age of 65 years (range: 52-72), 62% males, APACHE II 18 (15-24), SOFA 6 (4-7). Arterial hypertension (30.2%) and obesity (25.6%) were the most frequent comorbidities. High-flow oxygen therapy was used in 62.7% of the patients, with failure in 85%. In turn, 95% of the patients required IMV and 85% received ventilation in prone decubitus. In the general population, initial PaO2/FiO2 improved after 7 days (165 [125-210] vs.194 [153-285]; p=0.02), in the same way as in G1 (164 [125-197] vs. 207 [160-294]; p=0.07), but not in G2 (163 [95-197] vs. 135 [85-177]). No bacterial coinfection was observed. The incidence of IMV-associated pneumonia was high (13 episodes/1000 days of IMV). CONCLUSIONS: Patients with COVID-19 require early IMV, a high frequency of ventilation in prone decubitus, and have a high incidence of failed HFO. The lack of improvement of PaO2/FiO2 at 7 days could be a prognostic marker. .

Not every pigmented tumour is melanoma: Adenoma of the ciliary body pigment epithelium. / No todo tumor hiperpigmentado es melanoma: adenoma del epitelio pigmentario del cuerpo ciliar.

Differential diagnosis between a melanoma and a pseudomelanoma requires many years of experience and ocular studies, and requires paying attention to the smallest details. The case is presented of a 57 year-old male with an adenoma of the ciliary body pigment epithelium that was treated with an enucleation of the eye due to a suspicion of a choroidal melanoma.

Atresia congénita bilateral de coanas en una adolescente: reporte de un caso / Congenital bilateral choanal atresia in an adolescelent: a case report

La atresia congénita de coanas se caracteriza por la presencia de placas que obliteran la comunicación entre la cavidad nasal y la nasofaringe desde el nacimiento. Se considera como incompatible con la vida cuando la condición es bilateral. El siguiente es el caso de una paciente femenina, de 17 años, sin síndromes asociados, con obstrucción y descarga nasal anterior bilateral, asociado a respiración oral desde el periodo neonatal. El diagnóstico de atresia bilateral de coanas fue confirmado por medio de endoscopía nasal y tomografía computarizada (TC). La imagen confirmó la presencia de placas atrésicas de composición mixta. La paciente recibió tratamiento quirúrgicamente por vía transnasal con resección de las placas y modelado de neocoana.

Congenital choanal atresia is characterized by the presence of plates obliterating the communication between the nasal cavity and the nasopharynx from birth. If bilateral, this condition is incompatible with life. This following is the case of a 17-year-old female patient, without associated syndromes, with bilateral nasal obstruction and anterior discharge, associated to oral breathing, starting in her neonatal period. The diagnosis of bilateral choanal atresia was confirmed by nasal endoscopy and computed tomography (CT) scan, due to the presence of atretic plates of mixed composition. The patient was surgically treated with plate resection and modeling of a neochoana by means of a transnasal surgical approach.

Pharmacogenomics in medication-related osteonecrosis of the jaw: a systematic literature review.

OBJECTIVE: Medication-related osteonecrosis of the jaw (ONJ) is an adverse, severe and debilitating effect, which although infrequent, affects patients with osteoporosis or neoplasm who take bisphosphonates, antiresorptive drugs, and/or antiangiogenic drugs. Its etiopathogenesis is unknown, although genetic causes have been postulated. MATERIALS AND METHODS: This review analyzed articles published to date that have studied genetic factors associated with ONJ. Fifteen case-control studies were included, published between 2008 and 2018. RESULTS: Five set out to determine genetic causes by means of genome-centered techniques, while ten do so by investigating gene-centered variants. Nine works found statistically significant associations between one or various single nucleotide polymorphisms (SNPs) and the appearance of ONJ. None of the studies coincided as to which genes present some association. CONCLUSIONS: The review observed the moderate impact of genetic factors on the appearance of ONJ. It also showed the heterogeneity of the studies that have investigated ONJ to date. In future studies, involving international and interhospital collaboration will be necessary to recruit sample sizes of sufficient size, elaborate adequate study designs, obtain clear results, and advance our understanding of ONJ and make it possible to single out individual patients at risk.

Consensus of the Iberoamerican Oculoplastic Society for diagnosis and management of facial dystonia. / Consenso de la Sociedad Iberoamericana de Oculoplástica para el diagnóstico y manejo de las distonías faciales.

OBJECTIVE: To propose guidelines for the diagnosis and treatment of facial dystonia prepared by a group of experts in orbit and oculoplastics from the Iberoamerican Oculoplastic Society. MATERIAL AND METHODS: An interactive discussion between the expert panel and those attending the 6th Iberoamerican Society of Oculoplastics Congress, which took place at the Hospital Nuestra Señora de la Luz in Mexico City on 22 October 2018, providing their personal experience based on evidence for diagnosis and treatment of facial dystonia. Around 200 ophthalmologists specialised in oculoplastics from North, Central and South America, Spain, and Portugal were involved. Discussion was focused on the following themes: pathophysiology, diagnosis, medical management, and surgical management. CONCLUSIONS: Facial dystonia diagnosis is clinical; therefore, image studies are rarely needed. The ophthalmologist is generally the first physician to be consulted, and is able to be the treating physician, with the exception of specific cases of hemifacial spasm where management with neurosurgery may be beneficial. Botulinum toxin is the treatment of choice. Treatment with oral neuroleptics and myectomy of the orbicularis oculi muscle are reserved for refractory cases, since these do not have an adequate clinical response as first choice treatments. Persistent use of botulinum toxin does not modify the natural course of the disease.

Tuberculosis cutánea en pabellón auricular: reporte de un caso / Cutaneous tuberculosis in ear auricle: a case report

RESUMEN La tuberculosis cutánea representa menos del 2% de todos los casos de la infección por Mycobacterium tuberculosis. Su baja prevalencia, asociada a la amplia variedad en la presentación clínica de las lesiones, dificulta y retrasa el diagnóstico y, por tanto, el inicio del tratamiento. El siguiente es el caso de una paciente de 80 años, con una lesión ulcerada, crónica, en pabellón auricular izquierdo, con evolución tórpida y pobre respuesta al manejo farmacológico instaurado; con biopsia de piel que mostró reacción inflamatoria crónica y presencia de bacilos ácido-alcohol resistentes.

ABSTRACT Cutaneous tuberculosis represents less than 2% of all cases of infection with Mycobacterium tuberculosis. Its low prevalence, associated with a wide variety in clinical presentation of the lesions, hinders and delays the diagnosis and, thus, treatment initiation. The following is the case of an 80-years old, female patient with an ulcerated, chronic lesion in the left ear auricle, with a torpid evolution and poor response to established pharmacological management; with a skin biopsy that showed chronic inflammatory reaction and the presence of acid-fast bacilli.

Impacto de la cirugía cardiovascular precoz. Resultados en el Hospital Juan P. Garrahan / Impact of early cardiovascular surgery. Results at Hospital Juan P. Garrahan

Objetivos: Describir los resultados actuales en cirugía cardiovascular de pacientes portadores de cardiopatía congénita (CC) intervenidos con circulación extracorpórea (CEC) en menores de un año de vida. Métodos: Se incluyeron todos los pacientes operados de cirugía cardiovascular (CCV) en el Hospital de Pediatría Juan P. Garrahan en el periodo comprendido 2004-2017. Se analizaron los resultados actuales en términos de morbi-mortalidad de neonatos y lactantes menores de 1 año que requirieron cirugía precoz. Se excluyeron todos los pacientes operados que no requirieron cirugía con CEC y aquellos operados que ingresaron al Área de Neonatología. El análisis de mortalidad fue realizado por riesgo estratificado con la escala de RACHS-1. Los datos se obtuvieron de la base de datos de la Unidad de Recuperación Cardiovascular (UCI 35). Resultados: El número anual de pacientes intervenidos en cirugía cardiovascular ha presentado un incremento persistente desde sus comienzos. En el año 2004 se registraron 448 casos y a partir del año 2014, en forma persistente, los pacientes intervenidos superan las 500 cirugías anuales de cardiopatías. A inicios del 2004 el 75% de las cirugías totales eran con CEC, mostrando un ascenso significativo que alcanzo el 89% durante los últimos años. Los menores de 1 años representan más del 50% de las cirugías y en promedio un 15% son neonatos. También se evidenció un importante incremento de cirugías en cardiopatías más complejas, pero se mantuvo un número estable para aquellas cirugías de complejidad intermedia. En la escala RACHS-1, el 55% de las intervenciones correspondieron a un score >3 y más del 10% para categorías 5-6. La mortalidad global fue entre 5- 6% de las cirugías realizadas, y un 15% para la cirugía neonatal. El 10% de los fallecidos eran portadores de síndromes genéticos o presentaban asociación con otras malformaciones mayores. Conclusiones: Es notorio el incremento anual en frecuencia de patologías de mayor severidad que son enfrentadas en forma precoz logrando modificar la historia natural de las cardiopatías complejas. Aumenta el riesgo de morbimortalidad en CC asociadas a síndrome genético y condición clínica desfavorable pre quirúrgica. La intervención quirúrgica correctora precoz mejoraría los resultados en término de crecimiento y desarrollo del niño portador de CC (AU)

Objectives: To describe the current results in cardiovascular surgery of patients with congenital heart defects (CHD) who underwent extracorporeal membrane oxygenation (ECMO) support at less than one year of life. Methods: All patients who underwent cardiovascular surgery (CVS) at the Juan P. Garrahan Pediatric Hospital between 2004 and 2017 were included. Current results regarding morbidity and mortality in neonates and infants under 1 year who required early surgery were analyzed. Patients who did not require ECMO postoperatively and those admitted to the neonatal intensive care unit were excluded. Mortality analysis was performed stratified by risk using the RACHS-1 scale. Data were obtained from the Cardiovascular Recovery Unit (ICU 35) database. Results: The annual number of patients undergoing cardiovascular surgery has steadily increased since its beginning. In 2004, 448 cases were reported and as of 2014, yearly more than 500 patients undergo heart surgery. At the beginning of 2004, 75% of all surgeries were with ECMO, significantly increasing to 89% over the last few years. Children under 1 years of age account for more than 50% of surgeries and around 15% are neonates. A significant increase in surgeries in more complex heart disease was also evident, but a stable number was maintained for those surgeries of intermediate complexity. On the RACHS-1 scale, 55% of the interventions were score >3 and more than 10% were scores 5-6. Overall mortality was between 5-6% of all surgeries performed, and 15% for neonatal surgery. Of the children who died, 10% were carriers of genetic syndromes or had other major malformations. Conclusions: There was a remarkable yearly increase in frequency of more severe conditions that are managed early, modifying the natural history of complex heart disease. In CHD associated with a genetic syndrome and an unfavorable pre-surgical clinical condition the risk of morbidity and mortality is increased. Early surgical intervention may improve outcomes in terms of the growth and development of the child with CHD (AU)

Resolution of a case of denosumab-related osteonecrosis of the jaw after tooth extraction.

Denosumab is an antiresorptive drug that blocks osteoclast maturation, function and survival, improving bone mineral density and reducing the probability of fracture. It has adverse effects and can be the cause of hypocalcemia and osteonecrosis of the jaw. This report describes the case of a 59-year-old woman with hypothyroidism, antecedents of breast cancer, two strokes, and severe bone osteoporosis. Extraction of tooth 3.6 was performed, and within a month she was administered with a denosumab injection. One month later maxillary osteonecrosis appeared in the lingual distal area of the extraction site. Four months later the case was resolved by means of non-surgical treatment.

A novel approach to childhood obesity: circulating chemokines and growth factors as biomarkers of insulin resistance.

BACKGROUND: Insulin resistance (IR) in children with obesity constitutes a risk factor that should be precisely diagnosed to prevent further comorbidities. OBJECTIVE: Chemokines were evaluated to identify novel predictors of IR with clinical application. METHODS: We analysed the levels of cytokines (tumour necrosis factor [TNF] α and interleukins [ILs] 1ß, 4, 6 and 10), chemokines (stromal cell derived factor 1α, monocyte chemoattract protein [MCP] 1, eotaxin and fractalkine) and growth factors (brain-derived neurotrophic factor, pro-fibrotic platelet-derived growth factor [PDGF-BB] and insulin-like growth factor 1) in serum of prepubertal children with obesity (61 girls/59 boys, 50% IR and 50% non-IR) and 32 controls. Factor analysis, correlation, binary logistic regression and receiver operating characteristic analysis of combined biomarkers were used to validate their capability for preventive interventions of IR. RESULTS: Changes in MCP1, eotaxin, IL1ß and PDGF-BB were observed in IR children with obesity. Bivariate correlation between stromal cell derived factor 1α, MCP1, eotaxin, TNFα, brain-derived neurotrophic factor and/or PDGF-BB explained the high variance (65.9%) defined by three components related to inflammation and growth that contribute towards IR. The combination of leptin, triglyceride/high-density lipoprotein, insulin-like growth factor 1, TNFα, MCP1 and PDGF-BB showed a sensitivity and specificity of 93.2% for the identification of IR. The percentage of correct predictions was 89.6. CONCLUSIONS: Combined set of cytokines, adipokines and chemokines constitutes a model that predicts IR, suggesting a potential application in clinical practice as biomarkers to identify children with obesity and hyperinsulinaemia.

NT- Péptido natriurético cerebral en la evaluación de respuesta al tratamiento de la insuficiencia cardíaca con levosimendan en pacientes pediátricos / NT-brain natriuretic peptide in the assessment of response to levosimendan treatment in pediatric patients with heart failure

Introducción: El tratamiento de la insuficiencia cardiaca ha incorporado drogas inotrópicas de muy alto costo, como el levosimendan (LEVO). La evaluación de la respuesta a estas drogas en pediatría ofrece dificultades por lo que la medición de biomarcadores como la prohormona N-Terminal Péptido Natriurético Cerebral (NT-ProBNP) podrían ser de utilidad. Objetivo: describir la variación del NT-ProBNP y su correlación con parámetros ecocardiográficos en respuesta a la administración de levosimendan en pacientes pediátricos con insuficiencia cardiaca. Diseño: estudio descriptivo, observacional y prospectivo, sin intervención. Pacientes y métodos: se incluyeron pacientes con insuficiencia cardiaca de 0 a 18 años internados en terapia intensiva a los cuales se les pudo realizar dosaje de NT ProBNP pre LEVO. Se midió dicho péptido al 1°, 3° y 5° día post LEVO. Con cada determinación se realizó ecocardiograma doppler. Resultados: Se enrolaron 15 pacientes, mediana de edad 188,5 días (IQR 25-75: 56-475); de peso 5,475 kg (IQR 25-75: 2.8-7.5). El 80% fueron pacientes con reparación quirúrgica de cardiopatías congénitas, 13.3% con ventrículo único. La mediana de valor de NT ProBNPantes de la administración de LEVO fue 8924.5 pg./ml (IQR 25-75: 4096-20419,75). El 80% de la población presentó descenso en el valor de pro BNP post LEVO y en 10 (66.6%) el descenso fue mayor o igual al 30%. La evaluación global de la función miocárdica no presentó diferencias antes y después del LEVO. Conclusiones: El 66% de los pacientes presentó una disminución de al menos un 30% en los valores de NT ProBNP luego de la administración de levosimendan

Introduction: Very high-cost inotropic drugs, such as levosimendan (LEVO), have been incorporated in the treatment of heart failure. Evaluation of the response to these drugs in children is difficult and measurement of biomarkers such as the prohormone N-terminal pro b-type natriuretic peptide (NT-proBNP) may be of use. Objective: To describe variation of NT-ProBNP and its correlation with echocardiographic parameters in response to the administration of LEVO in pediatric patients with heart failure. Design: A prospective, descriptive, observational, non-interventional study. Patients and methods: Patients between 0 and 18 years of age with heart failure admitted to the intensive care unit in whom pre-LEVO NT-ProBNP levels could be measured were included. NT-ProBNP levels were measured at day 1, 3, and 5 post LEVO. At each measurement, a Doppler echocardiogram was performed. Results: 15 patients with a median age of 188.5 days (IQR 25-75: 56-475) and a weight of 5.475 kg (IQR 25-75: 2.8-7.5) were enrolled. Of the patients, 80% had undergone surgery for congenital heart defects, 13.3% with a single ventricle. Median NT-ProBNP levels before LEVO administration were 8924.5 pg./ml (IQR 25-75: 4096-20419.75). Overall, 80% of the patients had a decrease of post-LEVO NT-ProBNP levels and in 10 (66.6%) the decrease was greater than or equal to 30%. Overall evaluation of myocardial function did not show differences before and after LEVO administration. Conclusions: 66% of the patients presented with a decrease of at least 30% of NT-ProBNP levels after LEVO administration

WITHDROWN: Effect of smoking habit on crestal bone height in maxillary sinus augmentation with bone grafts.

In relation to the article with reference "Carreño-Carreño J, Gómez-Moreno G, Aguilar-Salvatierra A, Menéndez-López-Mateos C, Piattelli A, Menéndez-Núñez M. Effect of smoking habit on crestal bone height in maxillary sinus augmentation with bone grafts. Med Oral Patol Oral Cir Bucal. (2018), doi:10.4317/medoral.22439", published in Oral Medicine Oral Pathology and Oral Surgery in the modality "AHEAD OF PRINT - article in press", the authors mention that "The study was conducted according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) Statement". However, and based on the opinion of several expert reviewers who have re-evaluated the article, it is considered that although "there has not been plagiarism", these STROBE criteria are not adequately met. In addition, the mentioned article is very similar to two articles that have already been published by the same authors in Clinical Oral Implants Research. The sample is the same; many data are repeated; and the only difference is the inclusion of a variable (smoking), which does not exert a significant effect. This outcome therefore would not justify publication of the paper in the journal. Retraction of the article is therefore decided.

Infiltración subacromial de ácido hialurónico en el tratamiento del dolor crónico de hombro. Serie prospectiva de 80 pacientes seguidos durante un año / Subacromial sodium hyaluronate injection for the treatment of chronic shoulder pain: A prospective series of eighty patients

Resumen: Objetivo: Nuestro objetivo fue evaluar la efectividad de las infiltraciones subacromiales de ácido hialurónico en el tratamiento del dolor crónico de hombro como alternativa a los tratamientos quirúrgicos y no quirúrgicos actualmente disponibles. Material y métodos: Estudio prospectivo de 80 pacientes consecutivos con dolor crónico de hombro seguidos durante 12 meses. Se realizaron cinco infiltraciones subacromiales con ácido hialurónico durante cinco semanas consecutivas y se analizaron los resultados clínicos obtenidos. Resultados: La puntuación en la escala de Constant mejoró en 7.7 puntos, el cuestionario DASH disminuyó en cinco puntos y la puntuación en la escala visual analógica para el dolor disminuyó 1.6 puntos por término medio. Los pacientes que presentaban dolor de menos de 24 meses de evolución respondieron mejor al tratamiento. Las mujeres respondieron mejor. Los pacientes con disminución del espacio subacromial o lesión del manguito rotador según la resonancia magnética mejoraron, pero los pacientes que mostraron signos de artrosis acromioclavicular en la resonancia empeoraron en todas las escalas evaluadas. Discusión: Las infiltraciones subacromiales de ácido hialurónico son especialmente efectivas en el tratamiento del dolor crónico de hombro de menos de 24 meses de evolución, con disminución del espacio subacromial o lesión parcial o total del manguito rotador, pero en nuestra experiencia, su resultado no es bueno en pacientes con artrosis acromioclavicular.

Abstract: Objective: Our purpose was to assess the effectiveness of hyaluronic acid infiltrations for chronic shoulder pain as an alternative to the non-surgical and surgical treatments that are currently available. Material and methods: This is a prospective study of 80 consecutive patients suffering from chronic shoulder pain followed for twelve months. Five subacromial hyaluronic acid injections on five consecutive weeks were administrated to all patients. Results: A significant improvement within the whole group after six months was observed. Constant score improved by 7.7 points, DASH questionnaire decreased by 5 points and Visual Analog Scale for pain decreased by 1.6 points. Patients with history of less than 24 months of pain responded better to treatment. Females responded better. Patients with decreased subacromial space or cuff tear in the MRI improved but patients diagnosed by the MRI of acromioclavicular osteoarthritis worsened in all scales assessed. Discussion: Subacromial hyaluronic acid injections are specially effective in patients with history of less than 24 months of pain, a decreased subacromial space or partial or total cuff tear but, in our experience, its result is not good in patients with acromioclavicular osteoarthritis.

Advances in the knowledge of the Inocybe mixtilis group (Inocybaceae, Agaricomycetes), through molecular and morphological studies.

Inocybe mixtilis constitutes a complex of species characterized by nodulose-angulose spores, absence of cortina and a more or less bulbous marginate stipe that is not darkening when desiccated. In order to elucidate species limits within the I. mixtilis complex, an ITS-RPB2 phylogeny was performed and interpreted using morphological and ecological characters. Six supported clades were obtained in our analyses that correspond to I. mixtilis, I. subtrivialis, and four new species to science: I. ceskae, I. johannis-stanglii, I. nothomixtilis and I. occulta. Species within this complex can be morphologically recognized through a unique combination of morphological characters, such as the spore shape, cystidial length and shape, presence and development of the velipellis and pileus colour and viscidity. Nevertheless, those characters overlap, especially among I. mixtilis, I. ceskae and I. occulta, and intermediate collections are therefore more reliably identified through ITS-sequencing. Two species, I. ceskae and I. occulta are present in both North America and Europe, while the rest are so far only known in Europe, or Europe and Asia (I. mixtilis). All species, except I. johannis-stanglii, seem to be able to establish ectomycorrhizal association both with conifers and angiosperms. Descriptions, colour illustrations and a key to all known species in the I. mixtilis group are provided.

Blastoma pleuropulmonar: Presentación de un caso / Pleuropulmonary Blastoma: Case Report

El blastoma pleuropulmonar es una neoplasia mesenquimal rara que se debe considerar siempre en el escenario de una masa pulmonar sólida o quística en niños menores de 5 años. Se localiza usualmente en la periferia del pulmón; sin embargo, puede existir compromiso extrapulmonar de mediastino, diafragma y pleura. Se clasifica según su patrón histológico e imagenológico en tres tipos: quístico, mixto (sólido-quístico) y sólido. La cirugía radical es el tratamiento de elección y la única que ha demostrado disminución en la tasa de recurrencia. Se indica el uso de la quimioterapia neoadyuvante y la radioterapia según el tipo histológico y las márgenes libres de tumor. Se estudia el caso de una niña de 3 años con hallazgos, en radiografía convencional y tomografía de tórax, de masa sólida con diagnóstico histopatológico de blastoma pleuropulmonar.

Pleuropulmonary blastoma is a rare mesenchymal neoplasm that should always be considered in the setting of a solid or cystic lung mass in children under 5 years old. It is usually located in the periphery of the lung. However extra pulmonary involvement of the mediastinum, diaphragm, and pleura can exist. It is classified according to its histological and imaging pattern in three types: cystic, mixed (solidcystic) and solid. Radical surgery is the treatment of choice and the only one that has demonstrated a decrease in the rate of recurrence. The use of neoadjuvant chemotherapy and radiotherapy are defined according to the histological type and presence of tumor-free margins. We present the case of a 3-year-old female patient with findings on conventional radiography and thoracic tomography of a solid mass with histopathological diagnosis of pleuropulmonary blastoma.