Epidemiología de padecimientos frecuentes en cirugía maxilofacial: Hospital General Regional No. 1, Tijuana / Epidemiology of frequent conditions in maxillofacial surgery: Hospital General Regional No. 1, Tijuana

Introducción: uno de los servicios que el IMSS ofrece a sus derechohabientes es la cirugía maxilofacial; sin embargo, existen pocos estudios en esta área, que nos puedan proporcionar información acerca de la epidemiología de los tratamientos realizados. Objetivo: conocer la epidemiología de las intervenciones quirúrgicas en Cirugía Maxilofacial remitidas de diferentes Unidades de Medicina Familiar (UMF) al Hospital General Regional No.1 (HGR No.1) del turno vespertino en Tijuana, Baja California, México. Material y métodos: estudio descriptivo retrospectivo basado en revisión de «expedientes clínicos electrónicos¼. Se revisaron 2,945 expedientes, de los que se obtuvieron datos generales, UMF y diagnóstico, registrados bajo la plataforma Expediente Clínico Electrónico y Sistema de Información de Medicina Familiar. Se confeccionó un documento con los expedientes analizados. Fueron excluidos pacientes que no cumplieron con un diagnóstico definido por el cirujano maxilofacial o presentaron inasistencia. Debido a la pandemia por SARS-CoV-2 se excluyeron algunos meses. La muestra final la integraron 2,452 pacientes. Resultados: el 2019 fue el año con el mayor número de registros. Predomina el género femenino. La mediana de edad en el estado es 30 años, relacionando el diagnóstico más común «dientes incluidos¼ coincide con la edad predominante entre 20 y 44 años. La UMF 27 remitió más pacientes a hospital. Conclusión: estomatología y médicos familiares pueden hacer envíos a hospitales. El HGR No.1 no cuenta con el instrumental adecuado, el servicio se satura constantemente, es demasiada la demanda, continuamos con poco instrumental y falta de personal (AU)

Introduction: one of the services that the IMSS offers to its beneficiaries it is maxillofacial surgery; however, there are few studies in this area that can provide us with information about the epidemiology of the treatments carried out. Objective: to know the epidemiology of surgical interventions in Maxillofacial Surgery referred from different Family Medicine Units (UMF) to the Hospital General Regional No.1 (HGR No.1) of the evening shift in Tijuana, Baja California, México. Material and methods: retrospective descriptive study based on the review of «Electronic Clinical Files¼. 2,945 records were reviewed, obtaining general data, UMF and diagnosis, registered under the platform Electronic Clinical Record (ECE) and Family Medicine Information System (SIMF). Prepared a document with the files analyzed. Patients who did not meet a diagnosis defined by the Maxillofacial Surgeon or who were absent were excluded. Due to the SARS-CoV-2 pandemic, some months were excluded. The final sample was 2,452 patients. Results: 2019 was the year with the highest number of records. The female gender predominates. The median age in the state is 30 years, relating the most common diagnosis «included teeth¼ coincides with the predominant age between 20 and 44 years. UMF 27 referred more patients to hospital. Conclusion: stomatology and family doctors can make referrals to hospitals. HGR No.1 does not have adequate instruments, the service is constantly saturated, the demand is too high, we continue with few instruments and lack of personnel (AU)

Impact of antibiotic prophylaxis in second-stage surgery in joint prosthesis infection treated with two-stage exchange. A multicenter case-control study.

INTRODUCTION: After two-stage exchange due to prosthetic joint infection (PJI), the new prosthesis carries a high risk of reinfection (RePJI). There isn`t solid evidence regarding the antibiotic prophylaxis in 2nd-stage surgery. The objective of this study is to describe what antibiotic prophylaxis is used in this surgery and evaluate its impact on the risk of developing RePJI. METHODS: Retrospective multicenter case-control study in Spanish hospitals. The study included cases of PJI treated with two-stage exchange and subsequently developed a new infection. For each case, two controls were included, matched by prosthesis location, center, and year of surgery. The prophylaxis regimens were grouped based on their antibacterial spectrum, and we calculated the association between the type of regimen and the development of RePJI using conditional logistic regression, adjusted for possible confounding factors. RESULTS: We included 90 cases from 12 centers, which were compared with 172 controls. The most frequent causative microorganism was Staphylococcus epidermidis with 34 cases (37.8%). Staphylococci were responsible for 50 cases (55.6%), 32 of them (64%) methicillin-resistant. Gram-negative bacilli were involved in 30 cases (33.3%), the most common Pseudomonas aeruginosa. In total, 83 different antibiotic prophylaxis regimens were used in 2nd-stage surgery, the most frequent a single preoperative dose of cefazolin (48 occasions; 18.3%); however, it was most common a combination of a glycopeptide and a beta-lactam with activity against Pseudomonas spp (99 cases, 25.2%). In the adjusted analysis, regimens that included antibiotics with activity against methicillin-resistant staphylococci AND Pseudomonas spp were associated with a significantly lower risk of RePJI (adjusted OR = 0.24; 95% IC: 0.09-0.65). CONCLUSIONS: The lack of standardization in 2nd-satge surgery prophylaxis explains the wide diversity of regimens used in this procedure. The results suggest that antibiotic prophylaxis in this surgery should include an antibiotic with activity against methicillin-resistant staphylococci and Pseudomonas.

Extracellular vesicles from dental pulp mesenchymal stem cells modulate macrophage phenotype during acute and chronic cardiac inflammation in athymic nude rats with myocardial infarction.

BACKGROUND/AIMS: Extracellular vesicles (EVs) derived from dental pulp mesenchymal stem cells (DP-MSCs) are a promising therapeutic option for the treatment of myocardial ischemia. The aim of this study is to determine whether MSC-EVs could promote a pro-resolving environment in the heart by modulating macrophage populations. METHODS: EVs derived from three independent biopsies of DP-MSCs (MSC-EVs) were isolated by tangential flow-filtration and size exclusion chromatography and were characterized by omics analyses. Biological processes associated with these molecules were analyzed using String and GeneCodis platforms. The immunomodulatory capacity of MSC-EVs to polarize macrophages towards a pro-resolving or M2-like phenotype was assessed by evaluating surface markers, cytokine production, and efferocytosis. The therapeutic potential of MSC-EVs was evaluated in an acute myocardial infarction (AMI) model in nude rats. Infarct size and the distribution of macrophage populations in the infarct area were evaluated 7 and 21 days after intramyocardial injection of MSC-EVs. RESULTS: Lipidomic, proteomic, and miRNA-seq analysis of MSC-EVs revealed their association with biological processes involved in tissue regeneration and regulation of the immune system, among others. MSC-EVs promoted the differentiation of pro-inflammatory macrophages towards a pro-resolving phenotype, as evidenced by increased expression of M2 markers and decreased secretion of pro-inflammatory cytokines. Administration of MSC-EVs in rats with AMI limited the extent of the infarcted area at 7 and 21 days post-infarction. MSC-EV treatment also reduced the number of pro-inflammatory macrophages within the infarct area, promoting the resolution of inflammation. CONCLUSION: EVs derived from DP-MSCs exhibited similar characteristics at the omics level irrespective of the biopsy from which they were derived. All MSC-EVs exerted effective pro-resolving responses in a rat model of AMI, indicating their potential as therapeutic agents for the treatment of inflammation associated with AMI.

Association between several immune response-related genes and the effectiveness of biological treatments in patients with moderate-to-severe psoriasis.

Biological therapies are safer and more effective against psoriasis than conventional treatments. Even so, 30-50% of psoriatic patients show an inadequate response, which is associated with individual genetic heterogeneity. Pharmacogenetic studies have identified several single nucleotide polymorphisms (SNPs) as possible predictive and prognostic biomarkers for psoriasis treatment response. The objective of this study was to determine the link between several SNPs and the clinical response to biological therapies in patients with moderate-severe psoriasis. A set of 21 SNPs related to psoriasis and/or other immunological diseases were selected and analysed from salivary samples of patients (n = 88). Treatment effectiveness and patient improvement was assessed clinically through Relative Psoriasis Area and Severity Index (PASI), also called 'PASI response', as well as absolute PASI. Associations between SNPs and PASI factors were assessed at 3 and 12 months for every treatment category of IL-17, IL-23, IL-12&23 and TNF-α inhibitors. Multivariate correlation analysis and Fisher's exact test were used to analyse the relationship between SNPs and therapy outcomes. Several SNPs located in the TLR2, TLR5, TIRAP, HLA-C, IL12B, SLC12A8, TNFAIP3 and PGLYRP4 genes demonstrated association with increased short and long-term therapy-effectiveness rates. Most patients achieved values of PASI response ≥75 or absolute PASI<1, regardless of the biological treatment administered. In conclusion, we demonstrate a relationship between different SNPs and both short- and especially long-term effectiveness of biological treatment in terms of PASI. These polymorphisms may be used as predictive markers of treatment response in patients with moderate-to-severe psoriasis, providing personalized treatment.

Scalp Melanoma: A High-Risk Subset of Cutaneous Head and Neck Melanomas with Distinctive Clinicopathological Features.

Scalp melanomas (SM) have been previously associated with poor overall and melanoma-specific survival rates. The aim of this study was to describe and compare the clinicopathological characteristics and survival outcomes of SM and non-scalp cutaneous head and neck melanoma (CHNM). An observational multi-center retrospective study was designed based on patients with CHNM followed in two tertiary care hospitals. A hundred and fifty-two patients had CHNM, of which 35 (23%) had SM. In comparison with non-scalp CHNM, SM were more frequently superficial spreading and nodular subtypes, had a thicker Breslow index median (2.1 mm vs. 0.85 mm), and a higher tumor mitotic rate (3 vs. 1 mitosis/mm2) (p < 0.05). SM had a higher risk of recurrence and a higher risk of melanoma-specific death (p < 0.05). In the multivariate analysis, scalp location was the only prognostic factor for recurrence, and tumor mitotic rate was the only prognostic factor for melanoma-specific survival. We encourage routinely examining the scalp in all patients, especially those with chronic sun damage.

Variables académicas y de calidad de vida en estudiantes universitarios mexicanos / Academic and quality of life variables in mexican university students

Resumen. Objetivo. Analizar el efecto de las expectativas y metas de progreso académicas en las dimensiones de la calidad de vida de estudiantes universitarios mexicanos. Método. El tipo de investigación es cuantitativa con un diseño transversal, abierto, observacional con alcances descriptivos y predictivos. Las técnicas estadísticas utilizadas fueron estadística descriptiva, coeficiente de correlación y análisis de senderos con el método GLS. El muestreo fue no probabilístico por conveniencia, con un total de 465 participantes. Resultados. Se demostró que, para el modelo explicativo resultante, la variable metas de progreso académicas es un predictor directo de la dimensión función física. Asimismo, las expectativas académicas de resultado son un predictor de las dimensiones rol emocional y la función física. Respecto a los componentes de la salud física y mental, este último presentó la puntuación más baja.

Abstract. Objective. To analyze the effect of expectations and goals of academic progress on the dimensions of the quality of life of Mexican university students. Method. The research was quantitative with a cross-sectional, open, observational design with descriptive and predictive scopes. The statistical techniques used were descriptive statistics, correlation coefficient and path analysis with the GLS method. Sampling was non-probabilistic for convenience, with a total of 465 participants. Results. For the resulting explanatory model the variable academic progress goals is a direct predictor of the physical function dimension. And academic expectations of outcome are a predictor of the emotional role and physical function dimensions.

Estilos de liderazgo en profesionales sanitarios peruanos

Fundamento: el liderazgo representa un rasgo importante que debe poseer toda persona encargada de dirigir un grupo. Los cambios organizacionales generados en las oficinas farmacéuticas deben ser asumidos mediante un estilo de liderazgo que permita alcanzar los objetivos y metas planteadas, con el fin de asegurar y optimizar la atención sanitaria. Objetivo: determinar los estilos de liderazgo en profesionales Químico-Farmacéuticos que laboran en establecimientos públicos y privados de la ciudad de Trujillo (Perú). Métodos: estudio descriptivo de corte transversal que incluyó 94 profesionales colegiados que se desempeñan como directores técnicos. En la recolección de datos se empleó como técnica la encuesta y como instrumento al cuestionario Multifactor Leadership Questionnaire , que constó de 36 preguntas en escala de Likert, distribuidas en tres dimensiones: liderazgo transformacional, transaccional y correctivo/pasivo/evitador. Resultados: el 82, 9 % de los profesionales laboran como directores técnicos en el sector privado; el 57, 4 % son del género femenino y más del 60 % presentan un nivel alto de liderazgo. Unidos ambos sectores, los estilos de liderazgo transformacional y transaccional de nivel alto estuvieron presente en un 28,7 % y 61, 7 %, respectivamente; el liderazgo correctivo/pasivo/evitador de nivel medio estuvo presente en 72, 3 % de los profesionales. Asimismo, el liderazgo transformacional de nivel alto estuvo presente en 62, 5 % de los que trabajan en el sector público y en 56, 4 % de los del sector privado; el estilo de liderazgo correctivo/pasivo/evitador en un nivel medio estuvo presente en más del 60 % de los profesionales de ambos sectores. Conclusiones: el estilo de liderazgo más predominante fue el transaccional.

Foundation: leadership represents an important trait that must be presented by every person in charge of directing a group of people. The organizational changes generated in pharmaceutical offices must be assumed through a leadership style that allows achieving the objectives and goals set, in order to ensure and optimize health care. Objective: to determine the Chemist-Pharmaceutical professionals' leadership styles who work in public and private establishments in the city of Trujillo (Peru). Methods: a descriptive cross-sectional study that included 94 collegiate professionals who work as technical directors. In data collection, the survey was used as a technique and the Multifactor Leadership Questionnaire (MLQ) as an instrument, which consisted of 36 questions on a Likert scale, distributed in three dimensions: transformational, transactional, and corrective/avoidant leadership. Results: 82.9 % of the professionals work as technical directors in the private sector; 57.4 % are female and more than 60 % have a high level of leadership. Together both sectors, the high-level transformational and transactional leadership styles were present in 28.7 % and 61.7 %, respectively; mid-level corrective/passive/avoidant leadership was present in 72.3 % of the professionals. Likewise, high-level transformational leadership was present in 62.5 % of those who work in the public sector and in 56.4 % of those in the private sector; the corrective/passive/avoidant leadership style at a medium level was present in more than 60 % of the professionals in both sectors. Conclusions: the most predominant leadership style was transactional.

Description of reinfection of joint prosthesis after 2-stage replacement (infection of the 2nd stage prosthesis): A multicenter study.

INTRODUCTION: Two-stage exchange is the gold standard in the surgical management of prosthetic joint infection (PJI). However, perioperative reinfections (RePJI) can occur to newly inserted prosthesis, which highlights the importance of an adequate antibiotic prophylaxis, although there is scarce evidence in this field. Our objective was to evaluate the characteristics of RePJI, its prognosis and the antibiotic prophylaxis that is commonly used in second-stage surgery. METHODS: Multicentric retrospective observational study in Spanish hospitals including patients with RePJI between 2009 and 2018. RESULTS: We included 92 patients with RePJI from 12 hospitals. The most frequent isolated microorganism was Staphylococcus epidermidis in 35 cases (38.5%); 61.1% of staphylococci were methiciliin-resistant. In 12 cases (13%), the same microoganism causing the primary PJI was isolated in RePJI. When comparing with the microbiology of primary PJI, there were more cases caused by Gram-negative bacteria (the most frequent was Pseudomonas spp.) and less by Gram-positive bacteria. Failure occured in 69 cases (75%). There were 43 different courses of antibiotic prophylaxis after the second-stage surgery; the most frequent was a unique preoperative cefazolin dose, but most patients received prophylaxis before and after the second-stage surgery (61 cases). CONCLUSIONS: The most frequent microorganisms in RePJI are coagulase-negative staphylococci, although Gram-negative bacteria, especially Pseudomonas spp. are also common. There is a significant heterogeneity in antibiotic prophylaxis for a second-stage surgery. ReIPJI treatment has a high failure rate.

Medicamentos intercambiables en Perú. Un estudio de revisión

La intercambiabilidad de medicamentos representa una necesidad en países en vías de desarrollo, porque brinda la posibilidad de acceder a productos de menor costo, además, permite asegurar eficacia y seguridad en los tratamientos farmacoterapéuticos. El estudio recolectó investigaciones realizadas en el estado peruano, publicadas en bases de datos de alto impacto como Scielo, Sciencedirect, Scopus y Pubmed. De las 553 investigaciones encontradas, sólo diez artículos cumplieron con los criterios de inclusión y exclusión, se identificaron medicamentos como diazepam, prednisona, amoxicilina, doxiciclina, fluconazol, fenitoína sódica, alprazolam, amlodipino, carbamazepina sódica, glibenclamida, moxifloxacino y ácido acetilsalicílico. Todos los artículos analizaron el perfil de disolución mediante el cálculo del factor de similitud f2, mientras, en otros casos, estimaron parámetros como variación de peso, friabilidad, dureza, cuantificación, uniformidad de contenido y perfil de disolución. Los resultados evidencian que nueve medicamentos incluidos en el estudio fueron analizados mediante estudios in vitro a diferentes pH (1,2; 4,5 y 6,8), y cumplieron con presentar un factor de similitud f2 mayor a 50. Se concluye que aún se encuentra en proceso la intercambiabilidad de medicamentos en el estado peruano, y que, mediante alianzas estratégicas con el sector privado, se podría tener una mayor cantidad de alternativas farmacéuticas en la recuperación del paciente.

The medicines' interchangeability represents a necessity in developing countries, because it offers the possibility of accessing lower cost products, it allows to ensure efficacy and safety in pharmacotherapeutic treatments. The study gather researches carried out in the Peruvian state published in high-impact databases such as Scielo, Sciencedirect, Scopus and Pubmed. Of the 553 researches found, only 10 articles met the inclusion and exclusion criteria, drugs such as diazepam, prednisone, amoxicillin, doxycycline, fluconazole, phenytoin sodium, alprazolam, amlodipine, carbamazepine sodium, glibenclamide, moxifloxacin and acetylsalicylic acid were identified. All the articles analyzed the dissolution profile by calculating the similarity factor f2, while, in other cases, they estimated parameters such as weight variation, friability, hardness, quantification, content uniformity, and dissolution profile. The results show that 9 drugs included in the study were analyzed by in vitro studies at different pH (1.2; 4.5 and 6.8), and complied with presenting a similarity factor f2 greater than 50. It is concluded that, the interchangeability of medicines in the Peruvian state is still in process, and that, through strategic alliances with the private sector, a greater number of pharmaceutical alternatives could be had in the patient's recovery.

Cutibacterium spp. Infections after Instrumented Spine Surgery Have a Good Prognosis Regardless of Rifampin Use: A Cross-Sectional Study.

Infection after spinal instrumentation (IASI) by Cutibacterium spp. is being more frequently reported. The aim of this study was to analyse the incidence, risk factors, clinical characteristics, and outcome of a Cutibacterium spp. IASI (CG) compared with non-Cutibacterium IASI (NCG) infections, with an additional focus on the role of rifampin in the treatment. All patients from a multicentre, retrospective, observational study with a confirmed IASI between January 2010 and December 2016 were divided into two groups: (CG and NCG) IASI. Baseline, medical, surgical, infection treatment, and follow-up data were compared for both groups. In total, 411 patients were included: 27 CG and 384 NCG. The CG patients were significantly younger. They had a longer median time to diagnosis (23 vs. 13 days) (p = 0.025), although 55.6% debuted within the first month after surgery. Cutibacterium patients were more likely to have the implant removed (29.6% vs. 12.8%; p = 0.014) and received shorter antibiotic regimens (p = 0.014). In 33% of Cutibacterium cases, rifampin was added to the baseline therapy. None of the 27 infections resulted in treatment failure during follow-up regardless of rifampin use. Cutibacterium spp. is associated with a younger age and may cause both early and late IASIs. In our experience, the use of rifampin to improve the outcome in the treatment of a Cutibacterium spp. IASI is not relevant since, in our series, none of the cases had therapeutic failure regardless of the use of rifampin.

Epidemiology of Fabry disease in patients in hemodialysis in the Madrid community.

This study screened for Fabry disease (FD) in patients in hemodialysis (HD) in the region of Madrid (CAM) with a cross-sectional design to evaluate HD-prevalent patients, followed by a three-year period prospective design to analyze HD-incident patients. INCLUSION CRITERIA: patients older than 18 years on HD in the CAM, excluding patients diagnosed with any other hereditary disease with renal involvement different from FD, that sign the Informed Consent (IC). EXCLUSION CRITERIA: underaged patients or not agreeing or not being capable of signing the IC. RESULTS: 3470 patients were included, 63% males and with an average age of 67.9±9.7 years. 2357 were HD-prevalent patients and 1113 HD-incident patients. For HD-prevalent patients, average time in HD was 45.2 months (SD 51.3), in HD-incident patients proteinuria was present in 28.4%. There were no statistical differences in plasmatic alpha-galactosidase A (α-GAL-A) activity or Lyso-GL-3 values when comparing HD-prevalent and HD-incident populations and neither between males and females. A genetic study was performed in 87 patients (2.5% of patients): 60 male patients with decreased enzymatic activity and 27 female patients either with a decreased GLA activity, increased Lyso-Gl3 levels or both. The genetic variants identified were: p.Asp313Tyr (4 patients), p.Arg220Gln (3 patients) and M290I (1 patient). None of the identified variants is pathogenic. CONCLUSIONS: 76% of HD Centers of the CAM participated in the study. This is the first publication to describe the prevalence of FD in the HD-population of a region of Spain as well as its average α-GAL-A-activity and plasmatic Lyso-Gl3 levels. It is also the first study that combines a cross-sectional design with a prospective follow-up design. This study has not identified any FD patient.

Mixoma odontogénico de larga data en el maxilar. Reporte de caso / Long-Standing odontogenic myxoma of the maxilla. Case Report

Introducción: el mixoma odontogénico es una neoplasia benigna, poco frecuente, de origen mesenquimal proveniente del órgano dentario, es localmente invasivo y no hace metástasis. Su localización más frecuente es a nivel de la mandíbula y poco frecuente en el maxilar. Objetivo: describir las características que presenta un mixoma odontogénico de larga data en el maxilar. Presentación del caso: paciente de sexo masculino de 23 años de edad, soltero, de profesión comerciante, acude a la Catedra de Patología Bucal de la Facultad de Odontología de la Universidad Nacional de Asunción por presentar una deformidad en la región facial del lado derecho, presente desde la infancia con crecimiento lento sin sintomatología dolorosa. Se realizó una biopsia incisional, tomando una muestra de más de 1 cm de la capsula tumoral para su estudio histopatológico; a partir de la cual se informa sobre un tumor odontogénico mesenquimal compatible con el mixoma odontogénico. Se realizó el tratamiento de una maxilectomía con márgenes de seguridad y el estudio anatomopatológico de todo el tumor extirpado confirmó el diagnóstico de Mixofibroma odontogénico de 2,5 cm de diámetro máximo. Conclusión: un diagnóstico precoz de tumores como los mixomas, que son de crecimiento lento e infiltrante, podría garantizar terapéuticas menos agresivas e invasivas como las del caso presentado, otorgando así mejor pronóstico como calidad de vida a los pacientes.

Introduction: Odontogenic myxoma is a rare benign neoplasm of mesenchymal origin originating from the dental organ, it is locally invasive and does not metastasize. Its most frequent location is at the level of the mandible and infrequently in the maxilla. Objective: To describe the characteristics of a long-standing odontogenic myxoma in the maxilla. Presentation of the case: Male patient, 23 years of age, single, businessman, came to the Department of Oral Pathology of the Faculty of Dentistry of the National University of Asuncion for presenting a deformity in the facial region on the right side, present since childhood with slow growth and no painful symptomatology. An incisional biopsy was performed, taking a sample of more than 1cm of the tumor capsule, for histopathological study; reporting a mesenchymal odontogenic tumor compatible with odontogenic myxoma. A maxillectomy treatment with safety margins performed and the anatomopathological study of the entire excised tumor confirmed the diagnosis of odontogenic myxofibroma with a maximum diameter of 2.5 cm. Conclusion: An early diagnosis of tumors such as myxomas, which are slow-growing and infiltrative, could guarantee less aggressive and invasive therapies such as those in the case presented, thus providing patients with a better prognosis and quality of life.

Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study-The ARTHR-IS Study Group.

INTRODUCTION: Guidelines have improved the management of prosthetic joint infections (PJI). However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of Staphylococcus aureus PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome. METHODS: A retrospective cohort study of SA-PJI was performed in 19 European hospitals between 2014 and 2016. The outcome variable was TF, including related mortality, clinical failure and functional loss both after the initial surgical procedure and after all procedures at 18 months. Predictors of TF were identified by logistic regression. Landmark analysis was used to avoid immortal time bias with rifampicin when debridement, antibiotics and implant retention (DAIR) was performed. RESULTS: One hundred twenty cases of SA-PJI were included. TF rates after the first and all surgical procedures performed were 32.8% and 24.2%, respectively. After all procedures, functional loss was 6.0% for DAIR and 17.2% for prosthesis removal. Variables independently associated with TF for the first procedure were Charlson ≥ 2, haemoglobin < 10 g/dL, bacteraemia, polymicrobial infection and additional debridement(s). For DAIR, TF was also associated with a body mass index (BMI) > 30 kg/m2 and delay of DAIR, while rifampicin use was protective. For all procedures, the variables associated with TF were haemoglobin < 10 g/dL, hip fracture and additional joint surgery not related to persistent infection. CONCLUSIONS: TF remains common in SA-PJI. Functional loss accounted for a substantial proportion of treatment failures, particularly after prosthesis removal. Use of rifampicin after DAIR was associated with a protective effect. Among the risk factors identified, anaemia and obesity have not frequently been reported in previous studies. TRIAL REGISTRATION: This study is registered at clinicaltrials.gov, registration no. NCT03826108.

Staphylococcus aureus is one of the most virulent bacteria and frequently causes prosthetic joint infections.Knowledge of the treatment of this type of infection has advanced in recent years, and treatment guidelines have led to improved management. Typically, the successful treatment of these infections has been determined by clinical cure, that is, the symptoms of infection have disappeared, but has not taken into account loss of function (such as significant difficulties walking), which is critical for the patient's quality of life. Our aim in this study was to evaluate the success of current management strategies for S. aureus prosthetic joint infection, including recovery of functionality, and the factors that predict why some of these infections are not cured, to identify areas for improvement.In a multinational cohort of 128 patients with S. aureus prosthetic joint infection, rates of treatment failure were found to be high, with significant rates of loss of function, especially when the prosthesis needed to be removed. Loss of function was less frequent when the infection was initially treated with surgical cleaning without removal of the prosthesis, even when this procedure failed at first. We found that anaemia and obesity were associated with lower treatment success, and that the probability of treatment success increased when surgical cleaning without prosthesis removal was performed early, and when the antibiotic rifampicin was used in combination with another antibiotic.

Ansiedad, desesperanza y afrontamiento ante el COVID-19 en usuarios de atención psicológica

Objetivo. Identificar los niveles de síntomas de ansiedad y desesperanza, así como, las estrategias de afrontamiento durante la pandemia de COVID-19 en usuarios de servicios de atención psicológica en línea. Método. Se utilizó un diseño de tipo transversal predictivo, con una muestra de 78 personas voluntarias. Se aplicó la Escala de estrategias de afrontamiento frente a riesgos extremos, Inventario de Ansiedad de Beck (BAI) y la Escala de Desesperanza de Beck (BHS). Resultados. Al existir un alto nivel de ansiedad en las personas participantes, se tiende a manifestar mayor nivel de indefensión y de conductas de afrontamiento orientadas hacia la evitación y de naturaleza pasiva.

Objective. The main goal was to identify the levels of symptoms of anxiety and hopelessness, as well as the coping strategies during the COVID-19 pandemic in users of online psychological care services. Method. A predictive cross-sectional design was used, with a sample of 78 volunteers. The scale of coping strategies in the face of extreme risks, the Beck Anxiety Inventory (BAI) and the Beck Hopelessness Scale (BHS) were applied. Results. The results indicated that since there is an elevated level of anxiety in the participants, they tend to manifest a higher level of helplessness and coping behaviors oriented towards avoidance and passive nature.

Sphingolipids and Lymphomas: A Double-Edged Sword.

Lymphomas are a highly heterogeneous group of hematological neoplasms. Given their ethiopathogenic complexity, their classification and management can become difficult tasks; therefore, new approaches are continuously being sought. Metabolic reprogramming at the lipid level is a hot topic in cancer research, and sphingolipidomics has gained particular focus in this area due to the bioactive nature of molecules such as sphingoid bases, sphingosine-1-phosphate, ceramides, sphingomyelin, cerebrosides, globosides, and gangliosides. Sphingolipid metabolism has become especially exciting because they are involved in virtually every cellular process through an extremely intricate metabolic web; in fact, no two sphingolipids share the same fate. Unsurprisingly, a disruption at this level is a recurrent mechanism in lymphomagenesis, dissemination, and chemoresistance, which means potential biomarkers and therapeutical targets might be hiding within these pathways. Many comprehensive reviews describing their role in cancer exist, but because most research has been conducted in solid malignancies, evidence in lymphomagenesis is somewhat limited. In this review, we summarize key aspects of sphingolipid biochemistry and discuss their known impact in cancer biology, with a particular focus on lymphomas and possible therapeutical strategies against them.

Preoperative and perioperative risk factors, and risk score development for prosthetic joint infection due to Staphylococcus aureus: a multinational matched case-control study.

OBJECTIVES: We aim to identify the preoperative and perioperative risk factors associated with post-surgical Staphylococcus aureus prosthetic joint infections (PJI) and to develop and validate risk-scoring systems, to allow a better identification of high-risk patients for more efficient targeted interventions. METHODS: We performed a multicenter matched case-control study of patients who underwent a primary hip and knee arthroplasty from 2014 to 2016. Two multivariable models by logistic regression were performed, one for the preoperative and one for perioperative variables; predictive scores also were developed and validated in an external cohort. RESULTS: In total, 130 cases and 386 controls were included. The variables independently associated with S. aureus-PJI in the preoperative period were (adjusted OR; 95% CI): body mass index >30 kg/m2 (3.0; 1.9 to 4.8), resident in a long-term care facility (2.8; 1.05 to 7.5), fracture as reason for arthroplasty (2.7; 1.4 to 5.03), skin disorders (2.5; 0.9 to 7.04), previous surgery in the index joint (2.4; 1.3 to 4.4), male sex (1.9; 1.2 to 2.9) and American Society of Anesthesiologists index score 3 to 4 (1.8; 1.2 to 2.9). The area under the receiver operating characteristic curve was 0.73 (95% CI 0.68 to 0.78). In perioperative model, the risk factors were the previous ones plus surgical antibiotic prophylaxis administered out of the first 60 minutes before incision (5.9; 2.1 to 16.2), wound drainage for >72 hours after arthroplasty (4.5; 1.9 to 19.4) and use of metal bearing material versus ceramic (1.9; 1.1 to 3.3). The area under the receiver operating characteristic curve was 0.78 (95% CI 0.72 to 0.83). The predictive scores developed were validated in the external cohort. DISCUSSION: Predictive scores for S. aureus-PJI were developed and validated; this information would be useful for implementation of specific preventive measures.

Multiple pilomatricomas in a child with xeroderma pigmentosum: Coincidence or association?

The association of multiple pilomatricomas with xeroderma pigmentosum has not been described. We report a case of a child with multiple pilomatricomas and photosensitivity who was found to have a pathogenic variant in exon 4 of XPA and a likely pathogenic variant in COL6A1.

Bempedoic acid as a PPARα activator: new perspectives for hepatic steatosis treatment in a female rat experimental model. / El ácido bempedoico como activador PPARα: Nuevas perspectivas para el tratamiento de la esteatosis hepática en un modelo experimental de rata hembra.

INTRODUCTION: In its initial stages, nonalcoholic fatty liver disease presents hypertriglyceridemia and accumulation of lipids in the liver (hepatic steatosis). Bempedoic acid is an ATP:citrate lyase inhibitor that promotes a dual inhibition of the synthesis of cholesterol and fatty acids. However, its effect in the prevention / treatment of hepatic steatosis and hypertriglyceridemia has not been investigated. The aim of our work has been to elucidate whether bempedoic acid, through a mechanism other than ATP:citrate lyase inhibition, reverses these metabolic alterations. EXPERIMENTAL DESIGN: The study was carried out in female Sprague-Dawley rats fed, for three months, with a high fat diet supplemented with fructose (10% w/v) in drinking water. During the last month, bempedoic acid (30mg/kg/day) was administered to a group of animals. Zoometric and plasmatic parameters were analyzed, gene and protein expression analysis were performed in liver samples and PPAR-PPRE binding activity was determined. RESULTS: Our interventional model developed hepatic steatosis and hypertriglyceridemia. Despite an increase in total caloric intake, there was no increase in body weight of the animals. The administration of bempedoic acid significantly reduced hepatic steatosis and promoted a marked hepatocyte hypertrophy. There was a 66% increase in the liver weight of the animals treated with the drug that was not accompanied by modifications in the markers of inflammation, oxidative stress, or endoplasmic reticulum stress. Bempedoic acid activated the peroxisome proliferator activated nuclear receptor (PPARα) and its target genes. CONCLUSIONS: Bempedoic acid could be an effective therapy for the treatment of fatty liver and associated cardiovascular risk. Bempedoic acid has other mechanisms of action besides the inhibition of ATP: citrate lyase, such as the activation of PPARα, which could explain the reduction in hepatic steatosis and the increase in liver weight observed in animals treated with the drug.

Impact of high-flow oxygen therapy during exercise in idiopathic pulmonary fibrosis: a pilot crossover clinical trial.

BACKGROUND: Supplemental oxygen delivered with standard oxygen therapy (SOT) improves exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). Although high-flow nasal cannula oxygen therapy (HFNC) improves oxygenation in other respiratory diseases, its impact on exercise performance has never been evaluated in IPF patients. We hypothesized that HFNC may improve exercise capacity in IPF subjects compared to SOT. METHODS: This was a prospective, crossover, pilot randomized trial that compared both oxygenation methods during a constant submaximal cardiopulmonary exercise test (CPET) in IPF patients with exertional oxygen saturation (SpO2) ≤ 85% in the 6-min walking test. The primary outcome was endurance time (Tlim). Secondary outcomes were muscle oxygen saturation (StO2) and respiratory and leg symptoms. RESULTS: Ten IPF patients [71.7 (6) years old, 90% males] were included. FVC and DLCO were 58 ± 11% and 31 ± 13% pred. respectively. Tlim during CPET was significantly greater using HFNC compared to SOT [494 ± 173 vs. 381 ± 137 s, p = 0.01]. HFNC also associated with a higher increase in inspiratory capacity (IC) [19.4 ± 14.2 vs. 7.1 ± 8.9%, respectively; p = 0.04], and a similar trend was observed in StO2 during exercise. No differences were found in respiratory or leg symptoms between the two oxygen devices. CONCLUSIONS: This is the first study demonstrating that HFNC oxygen therapy improves exercise tolerance better than SOT in IPF patients with exertional desaturation. This might be explained by changes in ventilatory mechanics and muscle oxygenation. Further and larger studies are needed to confirm the benefits of HFNC in IPF patients and its potential usefulness in rehabilitation programs.