2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.

In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .

Long chain capsaicin analogues synthetized by CALB-CLEAs show cytotoxicity on glioblastoma cell lines.

Glioblastoma is one of the most lethal tumors, displaying striking cellular heterogeneity and drug resistance. The prognosis of patients suffering from glioblastoma after 5 years is only 5%. In the present work, capsaicin analogues bearing modifications on the acyl chain with long-chain fatty acids showed promising anti-tumoral activity by its cytotoxicity on U-87 and U-138 glioblastoma multiforme cells. The capsaicin analogues were enzymatically synthetized with cross-linked enzyme aggregates of lipase B from Candida antarctica (CALB). The catalytic performance of recombinant CALB-CLEAs was compared to their immobilized form on a hydrophobic support. After 72 h of reaction, the synthesis of capsaicin analogues from linoleic acid, docosahexaenoic acid, and punicic acid achieved a maximum conversion of 69.7, 8.3 and 30.3% with CALB-CLEAs, respectively. Similar values were obtained with commercial CALB, with conversion yields of 58.3, 24.2 and 22% for capsaicin analogues from linoleic acid, DHA and punicic acid, respectively. Olvanil and dohevanil had a significant cytotoxic effect on both U-87 and U-138 glioblastoma cells. Irrespective of the immobilization form, CALB is an efficient biocatalyst for the synthesis of anti-tumoral capsaicin derivatives. KEY POINTS: • This is the first report concerning the enzymatic synthesis of capsaicin analogues from docosahexaenoic acid and punicic acid with CALB-CLEAs. • The viability U-87 and U-138 glioblastoma cells was significantly affected after incubation with olvanil and dohevanil. • Capsaicin analogues from fatty acids obtained by CALB-CLEAs are promising candidates for therapeutic use as cytotoxic agents in glioblastoma cancer cells.

Batch and semi-continuous treatment of cassava wastewater using microbial fuel cells and metataxonomic analysis.

The treatment of agroindustrial wastewater using microbial fuel cells (MFCs) is a technological strategy to harness its chemical energy while simultaneously purifying the water. This manuscript investigates the organic load effect as chemical oxygen demand (COD) on the production of electricity during the treatment of cassava wastewater by means of a dual-chamber microbial fuel cell in batch mode. Additionally, specific conditions were selected to evaluate the semi-continuous operational mode. The dynamics of microbial communities on the graphite anode were also investigated. The maximum power density delivered by the batch MFC (656.4 µW m - 2 ) was achieved at the highest evaluated organic load (6.8 g COD L - 1 ). Similarly, the largest COD removal efficiency (61.9%) was reached at the lowest organic load (1.17 g COD L - 1 ). Cyanide degradation percentages (50-70%) were achieved across treatments. The semi-continuous operation of the MFC for 2 months revealed that the voltage across the cell is dependent on the supply or suspension of the organic load feed. The electrode polarization resistance was observed to decreases over time, possibly due to the enrichment of the anode with electrogenic microbial communities. A metataxonomic analysis revealed a significant increase in bacteria from the phylum Firmicutes, primarily of the genus Enterococcus.

Cytokine profile levels and their relationship with parasitemia and cardiomyopathy in people with Chagas disease in Spain. A prospective observational study.

Immunoregulatory networks may have a role in controlling parasitemia in the chronic phase of human Chagas disease. The aim was to describe the serum cytokine profile of Trypanosoma cruzi in chronically infected patients and to evaluate its relationship with parasitemia and Chagas cardiomyopathy.This prospective observational study included adult patients with chronic Chagas disease. Demographic and clinical data were collected, and peripheral blood samples were used to perform T. cruzi real-time polymerase chain reaction (RT-PCR) and determine the serum cytokine profile.Fifty-eight patients were included; 17 (29.3%) had positive RT-PCR results. This group had a higher median concentration of TNF-α (p = 0.003), IL-6 (p = 0.021), IL-4 (p = 0.031), IL-1ß (p = 0.036), and IL-17A (p = 0.043) than those with a negative RT-PCR. Patients with cardiac involvement had a higher median concentration of IL-5 (p = 0.016) than those without.These results reinforce the key role that cytokines play in Chagas disease patients with parasitemia and cardiac involvement.

Intracardiac Echocardiography-guided Left Atrial Appendage Occlusion.

Left atrial appendage occlusion (LAAO) is a suitable alternative to oral anticoagulant therapy to prevent stroke in patients with AF. Most procedures are performed under transoesophageal echocardiography (TOE) guidance, which facilitates transseptal puncture, reduces the risk of procedurerelated complications and provides an additional method for device selection and real-time monitoring during device deployment. However, TOE has significant shortcomings, including the need for general anaesthesia/deep sedation as well as a significant risk of procedure-related adverse events. More recently, intracardiac echocardiography has been proposed as an alternative to TOE guidance during LAAO procedures. In this review, we summarise the available evidence as well as providing a step-by-step approach for intracardiac echocardiography-guided LAAO.

[Positioning proposal on the recommendations for the use of masks in health centers after the cessation of the mandatory use in Spain]. / Propuesta de posicionamiento sobre las recomendaciones para el uso de mascarillas en los centros sanitarios tras el cese de la obligatoriedad de su uso en España.

Since the beginning of the COVID-19 pandemic in March 2020, the use of masks has been a fundamental pillar for controlling the transmission of SARS-CoV-2 in different areas. Its mandatory nature has been regulated by different regulations, and its effectiveness in reducing the transmission of SARS-CoV-2 and other respiratory viruses has been strongly proven. In this regard, the beneficial impact stands out in healthcare centers where it has been shown to reduce the transmission of respiratory infections, both in patients and healthcare professionals. This document proposes recommendations for the use of masks in health centers at the current time when we find ourselves with an end to the mandatory use of masks in Spain. They are aimed at healthcare professionals, patients and companions/visitors and aim to protect them from acquiring acute respiratory infections as a result of the complex relationships established in the healthcare field.

Desde el inicio de la pandemia de la COVID-19 en marzo de 2020, el uso de la mascarilla ha constituido un pilar fundamental para el control de la transmisión del SARS-CoV-2 en diferentes ámbitos. Su obligatoriedad ha sido regulada por diferentes normativas, y la efectividad de la misma para la reducción de la transmisión del SARS-CoV-2 y de otros virus respiratorios ha sido fuertemente probada. Al respecto, destaca el impacto beneficioso en los centros sanitarios en los que ha demostrado reducir la transmisión de las infecciones respiratorias, tanto en pacientes como en profesionales sanitarios. Este documento plantea una propuesta de recomendaciones para el uso de la mascarilla en los centros sanitarios en el momento actual en el que nos encontramos con un cese de la obligatoriedad de su uso en España. Están dirigidas a profesionales sanitarios, pacientes y acompañantes/visitantes y pretenden protegerles de adquirir infecciones respiratorias agudas como consecuencia de las complejas relaciones establecidas en el ámbito sanitario.

Comparison of Different Methods for Assaying the In Vitro Activity of Cefiderocol against Carbapenem-Resistant Pseudomonas aeruginosa Strains: Influence of Bacterial Inoculum.

Carbapenem-resistant Pseudomonas aeruginosa infections represent a critical public health concern, highlighting the need for the development of effective antibiotics. Cefiderocol demonstrated potent in vitro activity against Pseudomonas aeruginosa, particularly in strains that are resistant to other drugs. However, concerns regarding the emergence of drug-resistant strains persist. This study, conducted with 109 carbapenem-resistant Pseudomonas aeruginosa strains from the Spanish Hospital (Dr. Balmis, Alicante). The study evaluated susceptibility to cefiderocol in comparison to alternative antibiotics and including their susceptibility to bacterial inoculum, while assessing various testing methods. Our findings revealed high susceptibility to cefiderocol against carbapenem-resistant strains, with only 2 of 109 strains exhibiting resistance. Comparative analysis demonstrated superiority of cefiderocol towards alternative antibiotics. Both the E-test and disk-diffusion methods showed 100% concordance with the microdilution method in classifying strains as susceptible or resistant. However, 4.6% (5/109) of disc zone diameters fell within the technical uncertainty zone, so the E-test technique was found to be more useful in routine clinical practice. Additionally, escalating bacterial inoculum correlated with decreases in vitro activity, so this parameter should be adjusted very carefully in in vivo studies. This study underscores cefiderocol's potential as a therapeutic option for carbapenem-resistant Pseudomonas aeruginosa infections. However, the emergence of drug-resistant strains emphasizes the critical need for a wise use of antibiotics and a continuous monitoring of resistance to antibiotics. Based on our in vitro data, further investigation concerning the impact of bacterial inoculum on drug efficacy is warranted in order to detect resistance mechanisms and optimize treatment strategies, thereby mitigating the risk of resistance.

Activated carbon adsorption for mitigating the harmful effects of antibiotics on the biological activated sludge: Effect on heterotrophic kinetics through respirometry.

Conventional wastewater treatment plants (WWTPs) are not designed for the abatement of antibiotics, and their effluents are one of the main entry ways of these emerging contaminants to the aquatic environment, causing major concern due to their toxicity, persistence, and bioaccumulation. When wastewater containing antibiotics enters the bioreactor, they can impact microbial communities of the activated sludge, affecting biodegradation processes of organic matter and nutrients. There is scarce information about the effect of activated carbon on the activated sludge within the bioreactor in presence of antibiotics. In light of this, the effect of representative antibiotics, ciprofloxacin (CIP), nalidixic acid (NAL), and erythromycin (ERY), on the performance of a conventional activated sludge of a WWTP was analyzed by respirometry with and without activated carbon. NAL and ERY negatively affected the net heterotrophic biomass growth rate (r'x,H), with reduction percentages of 26%-90% and 31%-81%, respectively. The addition of activated carbon mitigated this effect, especially for ERY, with increments of even 8% in the r'x,H for the hybrid process when working with 5 ppm of ERY and 80 ppm of activated carbon compared with the value in the absence of antibiotic and activated carbon. This effect was attributed to the enhanced retention of ERY, in comparison to NAL, on the surface of the activated carbon, probably due to its higher molecular size and affinity towards the activated carbon (log Kow = 3.06). This effect was more marked at low sludge retention times (below 8 days). PRACTITIONER POINTS: Ciprofloxacin (CIP), nalidixic acid (NAL), and erythromycin (ERY) were studied. NAL and ERY exerted negative impact on heterotrophic growth rate. Effect of antibiotics on microorganisms in the presence of activated carbon was studied. Activated carbon was mainly relevant for ERY due to its adsorption retention. Enhancement by activated carbon was more significant at low sludge retention times.

Clinico-pathological evaluation of tumor budding in the oncological progression of colorectal cancer. / Evaluación clínico-patológica del tumorbudding en la progresión oncológica del cáncer colorrectal.

INTRODUCTION: Tumor budding (TB), defined as the presence of individual neoplastic cells or isolated groups of up to 4 cells at the front of tumor invasion, has become an adverse prognostic marker in colorectal cancer (CRC) in recent decades. The prognostic impact of TB in CRC remains not clearly defined and histological methods for its evaluation vary depending on the center. The objective of this study is to investigate the association between TB and CRC, in terms of oncological evolution and pathological stage. METHODS: A retrospective observational study was conducted, including patients undergoing curative oncological surgery for CRC between January 2017 and December 2022. The effects of TB on disease-free survival (DFS) and overall survival (OS) were evaluated according to the Kaplan-Meier curves. RESULTS: In 78 cases TB was described in the pathology report. TB was present in 56 patients (71.8%), divided into the following categories: low grade in 22 (39.3%), intermediate grade in 17 (30.4%) and high grade in 17 (30.4%). The proportion of patients who presented lymph node metastases, lympho-vascular and perineural invasion was significantly higher in patients with TB (26.8% vs 0%, P=.008; 41.1% vs 4.5%, P=.002; 16.1% vs 0% P=.054; respectively). DFS was 86.3% in low-grade TB, 75.3% in intermediate-grade TB, and 70.3% in high-grade TB. Cases with intermediate and high grade were associated with a shorter OS compared to the low grade group (93.7% and 75.4% vs 100% P=.012, respectively). CONCLUSION: These results suggest that TB expression may be a useful risk factor as a prognostic factor for the detection of lymph node metastasis, local recurrence, and distant metastasis in CRC.

Impact of influenza related hospitalization in Spain: characteristics and risk factor of mortality during five influenza seasons (2016 to 2021).

Background: Estimating the global influenza burden in terms of hospitalization and death is important for optimizing prevention policies. Identifying risk factors for mortality allows for the design of strategies tailored to groups at the highest risk. This study aims to (a) describe the clinical characteristics of hospitalizations with a diagnosis of influenza over five flu seasons (2016-2017 to 2020-2021), (b) assess the associated morbidity (hospitalization rates and ICU admissions rate), mortality and cost of influenza hospitalizations in different age groups and (c) analyze the risk factors for mortality. Methods: This retrospective study included all hospital admissions with a diagnosis of influenza in Spain for five influenza seasons. Data were extracted from the Spanish National Surveillance System for Hospital Data from 1 July 2016 to 30 June 2021. We identified cases coded as having influenza as a primary or secondary diagnosis (International Classification of Diseases, 10th revision, J09-J11). The hospitalization rate was calculated relative to the general population. Independent predictors of mortality were identified using multivariable logistic regression. Results: Over the five seasons, there were 127,160 hospitalizations with a diagnosis of influenza. The mean influenza hospitalization rate varied from 5/100,000 in 2020-2021 (COVID-19 pandemic) to 92.9/100,000 in 2017-2018. The proportion of influenza hospitalizations with ICU admission was 7.4% and was highest in people aged 40-59 years (13.9%). The case fatality rate was 5.8% overall and 9.4% in those aged 80 years or older. Median length of stay was 5 days (and 6 days in the oldest age group). In the multivariable analysis, independent risk factors for mortality were male sex (odds ratio [OR] 1.14, 95% confidence interval [95% CI] 1.08-1.20), age (<5 years: OR 1; 5-19 years: OR 2.02, 95%CI 1.17-3.49; 20-39 years: OR 4.11, 95% CI 2.67-6.32; 40-59 years: OR 8.15, 95% CI 5.60-11.87; 60-79 years: OR 15.10, 95% CI 10.44-21.84; ≥80 years: OR 33.41, 95% CI 23.10-48.34), neurological disorder (OR 1.97, 95% CI 1.83-2.11), heart failure (OR 1.85, 95% CI 1.74-1.96), chronic kidney disease (OR 1.33, 95% CI 1.25-1.41), chronic liver disease (OR 2.95, 95% CI 2.68-3.27), cancer (OR 1.85, 95% CI 1.48-2.24), coinfection with SARS-CoV2 (OR 3.17, 95% CI 2.34-4.28), influenza pneumonia (OR 1.76, 95% CI 1.66-1.86) and admission to intensive care (OR 7.81, 95% CI 7.31-8.36). Conclusion: Influenza entails a major public health burden. People aged over 60-and especially those over 80-show the longest hospital stays. Age is also the most significant risk factor for mortality, along with certain associated comorbidities.

Non-biofilm-forming Staphylococcus epidermidis planktonic cell supernatant induces alterations in osteoblast biological function.

Staphylococcal biofilms significantly contribute to prosthetic joint infection (PJI). However, 40% of S. epidermidis PJI isolates do not produce biofilms, which does not explain the role of biofilms in these cases. We studied whether the supernatant from planktonic S. epidermidis alters osteoblast function. Non-biofilm-forming S. epidermidis supernatants (PJI- clinical isolate, healthy skin isolate (HS), and ATCC12228 reference strain) and biofilm-forming supernatants (PJI+ clinical isolate, ATCC35984 reference strain, and Staphylococcus aureus USA300 reference strain) were included. Osteoblasts stimulated with supernatants from non-biofilm-forming isolates for 3, 7, and 14 days showed significantly reduced cellular DNA content compared with unstimulated osteoblasts, and apoptosis was induced in these osteoblasts. Similar results were obtained for biofilm-forming isolates, but with a greater reduction in DNA content and higher apoptosis. Alkaline phosphatase activity and mineralization were significantly reduced in osteoblasts treated with supernatants from non-biofilm-forming isolates compared to the control at the same time points. However, the supernatants from biofilm-forming isolates had a greater effect than those from non-biofilm-forming isolates. A significant decrease in the expression of ATF4, RUNX2, ALP, SPARC, and BGLAP, and a significant increase in RANK-L expression were observed in osteoblasts treated with both supernatants. These results demonstrate that the supernatants of the S. epidermidis isolate from the PJI- and HS (commensal) with a non-biofilm-forming phenotype alter the function of osteoblasts (apoptosis induction, failure of cell differentiation, activation of osteoblasts, and induction of bone resorption), similar to biofilm-forming isolates (PJI+, ATCC35984, and S. aureus USA300), suggesting that biofilm status contributes to impaired osteoblast function and that the planktonic state can do so independently of biofilm production.

Improved all-cause mortality with left bundle branch area pacing compared to biventricular pacing in cardiac resynchronization therapy: a meta-analysis.

BACKGROUND: Left bundle branch area pacing (LBBAP) has emerged as a physiological alternative pacing strategy to biventricular pacing (BIVP) in cardiac resynchronization therapy (CRT). We aimed to assess the impact of LBBAP vs. BIVP on all-cause mortality and heart failure (HF)-related hospitalization in patients undergoing CRT. METHODS: Studies comparing LBBAP and BIVP for CRT in patients with HF with reduced left ventricular ejection fraction (LVEF) were included. The coprimary outcomes were all-cause mortality and HF-related hospitalization. Secondary outcomes included procedural and fluoroscopy time, change in QRS duration, and change in LVEF. RESULTS: Thirteen studies (12 observational and 1 RCT, n = 3239; LBBAP = 1338 and BIVP = 1901) with a mean follow-up duration of 25.8 months were included. Compared to BIVP, LBBAP was associated with a significant absolute risk reduction of 3.2% in all-cause mortality (9.3% vs 12.5%, RR 0.7, 95% CI 0.57-0.86, p < 0.001) and an 8.2% reduction in HF-related hospitalization (11.3% vs 19.5%, RR 0.6, 95% CI 0.5-0.71, p < 0.00001). LBBAP also resulted in reductions in procedural time (mean weighted difference- 23.2 min, 95% CI - 42.9 to - 3.6, p = 0.02) and fluoroscopy time (- 8.6 min, 95% CI - 12.5 to - 4.7, p < 0.001) as well as a significant reduction in QRS duration (mean weighted difference:- 25.3 ms, 95% CI - 30.9 to - 19.8, p < 0.00001) and a greater improvement in LVEF of 5.1% (95% CI 4.4-5.8, p < 0.001) compared to BIVP in the studies that reported these outcomes. CONCLUSION: In this meta-analysis, LBBAP was associated with a significant reduction in all-cause mortality as well as HF-related hospitalization when compared to BIVP. Additional data from large RCTs is warranted to corroborate these promising findings.

Antithrombotic Therapy for Patients Undergoing Cardiac Electrophysiological and Interventional Procedures: JACC State-of-the-Art Review.

Electrophysiological and interventional procedures have been increasingly used to reduce morbidity and mortality in patients experiencing cardiovascular diseases. Although antithrombotic therapies are critical to reduce the risk of stroke or other thromboembolic events, they can nonetheless increase the bleeding hazard. This is even more true in an aging population undergoing cardiac procedures in which the combination of oral anticoagulants and antiplatelet therapies would further increase the hemorrhagic risk. Hence, the timing, dose, and combination of antithrombotic therapies should be carefully chosen in each case. However, the maze of society guidelines and consensus documents published so far have progressively led to a hazier scenario in this setting. Aim of this review is to provide-in a single document-a quick, evidenced-based practical summary of the antithrombotic approaches used in different cardiac electrophysiology and interventional procedures to guide the busy clinician and the cardiac proceduralist in their everyday practice.

Differential antigenicity of individual Mycoplasma hyorhinis variable lipoproteins.

The Mycoplasma hyorhinis (Mhr) variable lipoprotein (Vlp) family, comprising Vlps A, B, C, D, E, F, and G, are highly variable in expression, size, and cytoadhesion capabilities across Mhr strains. The 'Vlp system' plays a crucial role in cytoadhesion, immune evasion, and in eliciting a host immunologic response. This pilot study described the development of Vlp peptide-based ELISAs to evaluate the antigenic reactivity of individual Vlps against Mhr antisera collected throughout a longitudinal study focused on Mhr strain 38983, reproducing Mhr-associated disease under experimental conditions. Specifically, serum samples were collected at day post-inoculation 0, 7, 10, 14, 17, 21, 24, 28, 35, 42, 49, and 56 from Mhr- and mock (Friis medium)-inoculated cesarean-derived, colostrum-deprived pigs. Significant Mhr-specific IgG responses were detected at specific time points throughout the infection, with some variations for each Vlp. Overall, individual Vlp ELISAs showed consistently high accuracy rates, except for VlpD, which would likely be associated with its expression levels or the anti-Vlp humoral immune response specific to the Mhr strain used in this study. This study provides the basis and tools for a more refined understanding of these Vlp- and Mhr strain-specific variations, which is foundational in understanding the host immune response to Mhr.

Dynamics of antibody response and bacterial shedding of Mycoplasma hyorhinis and M. hyosynoviae in oral fluids from experimentally inoculated pigs.

Mycoplasma hyorhinis (Mhr) and M. hyosynoviae (Mhs) are commensal organisms of the upper respiratory tract and tonsils but may also cause arthritis in pigs. In this study, 8-week-old cesarean-derived colostrum-deprived (CDCD) pigs (n = 30; 3 groups, 10 pigs per group, 2 pigs per pen) were inoculated with Mhr, Mhs, or mock-inoculated with culture medium and then pen-based oral fluids were collected at different time points over the 56 days of the experimental study. Oral fluids tested by Mhr and Mhs quantitative real-time PCRs revealed Mhr DNA between day post inoculation (DPI) 5-52 and Mhs DNA between DPI 5-15. Oral fluids were likewise tested for antibody using isotype-specific (IgG, IgA, IgM) indirect ELISAs based on a recombinant chimeric polypeptide of variable lipoproteins (A-G) for Mhr and Tween 20-extracted surface proteins for Mhs. Mhr IgA was detected at DPI 7 and, relative to the control group, significant (p < 0.05) antibody responses were detected in the Mhr group between DPI 12-15 for IgM and DPI 36-56 for both IgA and IgG. In the Mhs group, IgM was detected at DPI 10 and significant (p < 0.05) IgG and IgA responses were detected at DPI 32-56 and DPI 44-56, respectively. This study demonstrated that oral fluid could serve as an effective and convenient antemortem sample for monitoring Mhr and Mhs in swine populations.

The Emerging Role of Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy.

Cardiac resynchronisation therapy (CRT) reduces the risk of heart failure-related hospitalisations and all-cause mortality, as well as improving quality of life and functional status in patients with persistent heart failure symptoms despite optimal medical treatment and left bundle branch block. CRT has traditionally been delivered by implanting a lead through the coronary sinus to capture the left ventricular epicardium; however, this approach is associated with significant drawbacks, including a high rate of procedural failure, phrenic nerve stimulation, high pacing thresholds and lead dislodgement. Moreover, a significant proportion of patients fail to derive any significant benefit. Left bundle branch area pacing (LBBAP) has recently emerged as a suitable alternative to traditional CRT. By stimulating the cardiac conduction system physiologically, LBBAP can result in a more homogeneous left ventricular contraction and relaxation, thus having the potential to improve outcomes compared with conventional CRT strategies. In this article, the evidence supporting the use of LBBAP in patients with heart failure is reviewed.

Reconstrucción de alas nasales con técnica de colgajo invertido. Presentación de dos casos

RESUMEN La reconstrucción nasal nace en la India, 3000 años antes de nuestra era. La reconstrucción nasal ha seguido tres líneas básicas: el método indiano, utilizando el colgajo frontal mediano; el método francés con el colgajo lateral de la mejilla; y el método italiano con el colgajo braquial. Los colgajos permiten reconstruir defectos restaurando la forma y función nasal. El método clásico para reconstruir el ala nasal es el colgajo nasogeniano. El colgajo nasogeniano tiene características determinadas en cuanto a localización, tamaño, patrón circulatorio, vascularización, inervación y función. Se presentan dos casos de pacientes tratados en el Princess Marina Hospital de Botswana en África, los cuales necesitaron colgajos nasogenianos invertidos para la reconstrucción de sus alas nasales. Luego de la aplicación del procedimiento se logró recuperar el ala nasal afectada devolviendo en ambos casos funcionabilidad, armonía, simetría y orden con relación a la contralateral en ausencia de complicaciones. Se presentan los casos por lo interesante que resulta este tipo de intervención realizada por especialistas cubanos en su colaboración médica en un país africano.

ABSTRACT Nasal reconstruction was born in India, 3000 years before our era. Nasal reconstruction has followed three basic lines: the Indian method, using the median frontal flap; the French method with the lateral cheek flap; and the Italian method with the brachial flap. Flaps allow the reconstruction of defects by restoring nasal shape and function. The classic method for reconstructing the ala nasal is the nasolabial flap. The nasolabial flap has specific characteristics in terms of location, size, circulatory pattern, vascularization, innervation, and function. We present two cases of patients treated at the Princess Marina Hospital in Botswana in Africa, who required inverted nasolabial flaps for the reconstruction of their nasal wings. After the application of the procedure, the affected nasal wing was recovered, returning functionality, harmony, symmetry and order in both cases in relation to the contralateral wing in the absence of complications. The inverted nasolabial flap is useful to restore the contour of the nasal wing, as well as to support the wing and to shape the nasal floor. This flap can have a minimum of complications if the structures are handled gently and the sutures are handled without tension. That cases are presented because of how interesting this type of intervention is, carried out by Cuban specialists in their medical collaboration in an african country.

Ectopia cordis abdominal. Apropósito de un caso

Resumen Introducción: La ectopia cordis es una malformación congénita poco frecuente y grave caracterizada por el desplazamiento del corazón fuera de la cavidad torácica, Existe discreto predominio en el sexo femenino y se asocia a teratógenos no potentes y relacionado también a factores genéticos, su diagnóstico prenatal es muy importante y su pronostico es desfavorable en casi la totalidad de los casos. Objetivo: Describir el manejo con una paciente con ectopia cordis en Letsholathebe Memorial Hospital II Republica de Botswana. Descripción: Se describe el manejo por parte del pediatra y el cardiólogo desde su diagnóstico desde su nacimiento hasta sus ingresos hospitalarios. Conclusiones: Ectopia cordis es una malformación congénita rara que tiene un mal pronóstico incluso después del enfoque quirúrgico y su gravedad está relacionada con la presencia de otras anomalías.

ABSTRACT Introduction: Ectopia cordis is a rare and severe congenital malformation characterized by the displacement of the heart outside the chest cavity, there is discreet predominance in the female sex and is associated with non-potent teratogens and also related to genetic factors, its prenatal diagnosis is very important and its prognostic is unfavorable in almost all cases. Objective Describe management with a patient with ectopia cordis at Letsholathebe Memorial Hospital II Republic of Botswana. Description: It describes the management by the pediatrician and the cardiologist from his diagnosis from birth to his hospital admissions. Conclusions: Ectopia Cordis is a rare congenital malformation that has a poor prognosis even after the surgical approach and its severity is related to the presence of other abnormalities.

Fracturas maxilofaciales en pacientes atendidos en el Princess Marina Hospital, de Gaborone

RESUMEN Fundamento Las fracturas del complejo maxilofacial constituyen cerca de la mitad de todas las fracturas, y en un gran número de pacientes se asocian a otras fracturas y lesiones. La etiología es variada, y exigen diagnóstico y tratamiento rápidos, precisos y oportunos. Resulta relevante el estudio de esta entidad, para conocer sus características como parte de la atención de urgencias; así como sus implicaciones clínica y social. Objetivo describir el comportamiento de las fracturas maxilofaciales en pacientes atendidos en el servicio de Cirugía Maxilofacial del Princess Marina Hospital, de Gaborone, Botswana. Métodos se realizó un estudio descriptivo y retrospectivo, en el servicio de Cirugía Maxilofacial del Princess Marina Hospital, en Gaborone, Botswana, durante el período de junio de 2018 a junio de 2020. Fueron incluidos todos los pacientes (N=423) con diagnóstico de trauma maxilofacial, y por consiguiente, de algún tipo de fractura de esta parte del cuerpo. Para la presentación de la información se utilizaron tablas de frecuencias absolutas y relativas. Resultados se atendieron 423 pacientes con fracturas maxilofaciales, entre los cuales predominó el sexo masculino. El grupo de edades más afectado fue el de 26-35 años; la violencia interpersonal, la causa más frecuente; y las heridas y fracturas de cráneo, las lesiones asociadas más comunes. Conclusión Se observó similitud de los resultados respecto a otros estudios publicados. La violencia interpersonal superó a los accidentes del tránsito como la causa más frecuente de fracturas maxilofaciales.

ABSTRACT Background Fractures of the maxillofacial complex constitute about half of all fractures, and in a large number of patients they are associated with other fractures and injuries. The etiology is varied, and requires fast, accurate, and timely diagnosis and treatment. The study of this entity is relevant to know its characteristics as part of emergency care; as well as its clinical and social implications. Objective to describe the behavior of maxillofacial fractures in patients treated at the Maxillofacial Surgery service of Princess Marina Hospital, Gaborone, Botswana. Methods a descriptive and retrospective study was carried out in the Maxillofacial Surgery service of the Princess Marina Hospital, in Gaborone, Botswana, from June 2018 to June 2020. All patients (N = 423) with diagnosis were included of maxillofacial trauma, and consequently, of some type of fracture of this part of the body. Absolute and relative frequency tables were used to show the information. Results 423 patients with maxillofacial fractures were attended, among which the male sex predominated. The age group most affected was 26-35 years old; interpersonal violence, the most frequent cause; and skull injuries and fractures, the most common associated injuries. Conclusion Results were similar to other published studies. Interpersonal violence exceeded traffic accidents as the most common cause of maxillofacial fractures.

Reconstrucción palpebral tras resección tumoral del globo ocular / Palpebral Reconstruction after Tumor Resection of the Eyeball

Los defectos palpebrales creados tras la resección tumoral pueden ser parciales o totales, afectar a la lamela externa, a la interna o a ambas y requerir diferente técnica reconstructiva, simple o compleja. El objetivo es presentar los resultados cosméticos y funcionales en una paciente que se le realzó una técnica combinada para resolver un problema complejo del aparato palpebral después de una enucleación. Se logró un aparato palpebral armónico, en el que sus estructuras tienen orden, funcionabilidad y simetría con el lado contralateral. La reconstrucción de los defectos complejos del aparato palpebral solo es posible con la combinación de varias técnicas. Se logró armonía, simetría contralateral y orden de las estructuras(AU)

The palpebral defects created after tumor resection can be partial or total, affect the external lamella, the internal lamella or both, and require different reconstructive techniques, simple or complex. The objective is to present the cosmetic and functional results in a patient who underwent a combined technique to solve a complex problem of the palpebral apparatus after enucleation. A harmonic palpebral apparatus was achieved, in which its structures have order, functionality and symmetry with the contralateral side. The reconstruction of complex defects of the palpebral apparatus is only possible with the combination of several techniques. Harmony, contralateral symmetry and order of the structures were achieved(AU)