Pre-Diagnosis Diet Predicts Response to Exclusive Enteral Nutrition and Correlates with Microbiome in Pediatric Crohn Disease.

Exclusive enteral nutrition (EEN) is effective in inducing remission in pediatric Crohn disease (CD). EEN alters the intestinal microbiome, but precise mechanisms are unknown. We hypothesized that pre-diagnosis diet establishes a baseline gut microbiome, which then mediates response to EEN. We analyzed prospectively recorded food frequency questionnaires (FFQs) for pre-diagnosis dietary patterns. Fecal microbiota were sequenced (16SrRNA) at baseline and through an 18-month follow-up period. Dietary patterns, Mediterranean diet adherence, and stool microbiota were associated with EEN treatment outcomes, disease flare, need for anti-tumor necrosis factor (TNF)-α therapy, and long-term clinical outcomes. Ninety-eight patients were included. Baseline disease severity and microbiota were associated with diet. Four dietary patterns were identified by FFQs; a "mature diet" high in fruits, vegetables, and fish was linked to increased baseline microbial diversity, which was associated with fewer disease flares (p < 0.05) and a trend towards a delayed need for anti-TNF therapy (p = 0.086). Baseline stool microbial taxa were increased (Blautia and Faecalibacterium) or decreased (Ruminococcus gnavus group) with the mature diet compared to other diets. Surprisingly, a "pre-packaged" dietary pattern (rich in processed foods) was associated with delayed flares in males (p < 0.05). Long-term pre-diagnosis diet was associated with outcomes of EEN therapy in pediatric CD; diet-microbiota and microbiota-outcome associations may mediate this relationship.

Lipoinjerto en gluteoplastia. ¿Es un procedimiento seguro? / Fat grafting in gluteoplasty. Is it a safe procedure?

Introducción y objetivo: La gluteoplastia de aumento con lipoinjertos es uno de los procedimientos estéticos más realizados en el mundo, sin embargo, dada su alta tasa de mortalidad frente a los demás procedimientos estéticos, durante la última década se han publicado varios estudios y artículos en busca de recomendaciones para reducir desenlaces fatales. Revisamos la literatura actual para identificar índices de mortalidad, consensuar las recomendaciones encontradas e identificar estudios cadavéricos que permitan cuestionar si este procedimiento es seguro y si las medidas tomadas hasta el momento son suficientes para la seguridad de los pacientes. Material y método: Revisión mediante búsqueda exhaustiva en bases de datos científicas de artículos en cuyo contenido hubiera datos sobre casos nuevos, fisiopatología de complicaciones mayores y menores y estrategias para prevenirlas. Resultados: Obtuvimos 11 documentos: boletines, artículos de revisión, reportes de caso, revisiones sistemáticas y estudios experimentales en cadáveres. Conclusiones: En la lipoinyección glútea, la inyección del lipoinjerto en planos submúsculares supone aumento del riesgo de presentación de complicaciones macroscópicas y microscópicas por la migración de grasa al torrente sanguíneo. A pesar de las múltiples recomendaciones ya establecidas, abogamos por el desarrollo de técnicas que permitan asegurar la lipoinyección en plano subcutáneo. (AU)

Background and objective: Augmentation gluteoplasty with fat grafting is one of the most performed aesthetic procedures in the world, however, given its high mortality rate compared to other aesthetic procedures, during the last decade several studies and articles have been published in search of recommendations for reduce their fatal outcomes. We conduct a literature review in order to identify mortality rates, reach a consensus on the recommendations found, and identify cadaveric studies that may question whether this procedure is safe and whether the measures taken to date will be sufficient for patient safety. Methods: A review article was carried out through an exhaustive search in scientific databases, which included data on new reported cases, pathophysiology of major and minor complications and presented strategies. prevention of these complications. Results: A total of 11 documents were obtained, among which we found bulletins, review articles, case reports, systematic reviews, and experimental studies in cadavers. Conclusions: In gluteal lipoinjection, the injection of the lipograft in submuscular planes implies an increased risk of macroscopic and microscopic complications of fat migration through the bloodstream. Despite the multiple recommendations already established, we advocate the development of techniques that allow graft injection to be ensured subcutaneously. (AU)

Seguimiento de la actividad clínica y del daño orgánico acumulado en una cohorte de pacientes con lupus eritematoso sistémico de la península de Yucatán, México (1995-2016) / Follow-up of clinical activity and accumulated organic damage in a cohort of patients with Systemic Lupus Erythematosus from the Yucatán peninsula, México (1995-2016)

Introducción: El lupus eritematoso sistémico (LES) es una enfermedad autoinmune con severidad variable, frecuente en individuos hispanos y afroamericanos. Objetivo: Conocer la actividad clínica y el daño acumulado, así como la prevalencia e incidencia, en una cohorte dinámica de pacientes con LES de la península de Yucatán (1995 a 2016). Pacientes y métodos: Se analizaron 200 pacientes con LES, beneficiarios del servicio médico del Hospital Regional ISSSTE de Mérida, Yucatán, durante 22 años. Se evaluó la actividad de la enfermedad y el daño acumulado mediante la escala MEX-SLEDAI y SLICC-ACR-DI, respectivamente, y su correlación con variables clínicas y demográficas. Resultados: Se analizaron 185 pacientes mujeres y 15 hombres. Los índices promedio de actividad y daño acumulado durante el seguimiento fueron de 4,63 y 1,10, respectivamente. El índice de actividad se observó significativamente menor en las mujeres respecto de los hombres (4,36 vs. 7,43), y el daño acumulado no presentó diferencia por sexo. Las manifestaciones asociadas con mayor actividad fueron las mucocutáneas y articulares, y los órganos con mayor daño acumulado el musculoesquelético, el neurológico y el gonadal. Se encontró relación de los índices con el tiempo de evolución, las remisiones/reactivaciones y la actividad persistente. La mortalidad se relacionó con actividad persistente por complicaciones vasculares sistémicas e insuficiencia renal y hepática. La incidencia y prevalencia anual del LES calculada fue de 2,86% y 48,43% en la península de Yucatán. Conclusiones: Los pacientes presentaron actividad persistente, con reactivaciones leves a moderadas y daño acumulado más agresivo en hombres. La actividad clínica disminuye e incrementa el daño acumulado a mayor tiempo de evolución, con menor afección renal y mayor sobrevida, lo que sugiere un curso más benigno en la población de la península de Yucatán.(AU)

IntroductionSystemic lupus erythematosus (SLE) is an autoimmune with variable severity, common in Hispanic and African-American individuals.Objective: To know the clinical activity and the accumulated damage, as well as the prevalence and incidence, in a dynamic cohort of patients with SLE from the Yucatan Peninsula (1995-2016). Patients and methods: A cohort of 200 patients with SLE, medical service beneficiaries of the ISSSTE Regional Hospital of Mérida, Yucatán, was analyzed for 22 years. Disease activity and accumulated damage were evaluated using the MEX-SLEDAI scale and the SLICC-ACR-DI, respectively, and its correlation with clinical and demographic variables. Results: 185 female and 15 male patients were analyzed. Average accumulated damage and activity indices during follow-up were 4.63 and 1.10, respectively. The activity index was significantly lower in females compared to males (4.36 vs 7.43), and the accumulated damage did not present a difference by sex. The manifestations associated with greater activity were the mucocutaneous and articular ones, and the organs with the greatest accumulated damage were the musculoskeletal, neurological and gonadal. A relationship between the indices was found with the evolution time, remissions / reactivations, and persistent activity. Mortality was related to persistent activity due to systemic vascular complications and kidney and liver failure. The annual incidence and prevalence of SLE calculated was 2.86% and 48.43% in Yucatán Peninsula. Conclusions: The patients presented persistent activity, with mild to moderate reactivations, and accumulated damage more aggressive in men. The clinical activity decreases and increases the accumulated damage at a longer evolution time, with less kidney disease and greater survival, which suggests a more benign course in the population of the Yucatan Peninsula.(AU)

Follow-up of clinical activity and accumulated organic damage in a cohort of patients with systemic lupus erythematosus from the Yucatán Peninsula, Mexico (1995-2016).

INTRODUCTION: Systemic lupus erythematosus (SLE) is an autoimmune with variable severity, common in Hispanic and African-American individuals. OBJECTIVE: To know the clinical activity and the accumulated damage, as well as the prevalence and incidence, in a dynamic cohort of patients with SLE from the Yucatan Peninsula (1995-2016). PATIENTS AND METHODS: A cohort of 200 patients with SLE, medical service beneficiaries of the ISSSTE Regional Hospital of Mérida, Yucatán, was analysed for 22 years. Disease activity and accumulated damage were evaluated using the MEX-SLEDAI scale and the SLICC-ACR-DI, respectively, and its correlation with clinical and demographic variables. RESULTS: 185 female and 15 male patients were analysed. Average accumulated damage and activity indices during follow-up were 4.63 and 1.10, respectively. The activity index was significantly lower in females compared to males (4.36 vs 7.43), and the accumulated damage did not present a difference by sex. The manifestations associated with greater activity were the mucocutaneous and articular ones, and the organs with the greatest accumulated damage were the musculoskeletal, neurological and gonadal. A relationship between the indices was found with the evolution time, remissions/reactivations, and persistent activity. Mortality was related to persistent activity due to systemic vascular complications and kidney and liver failure. The annual incidence and prevalence of SLE calculated was 2.86% and 48.43% in Yucatán Peninsula. CONCLUSIONS: The patients presented persistent activity, with mild to moderate reactivations, and accumulated damage more aggressive in men. The clinical activity decreases and increases the accumulated damage at a longer evolution time, with less kidney disease and greater survival, which suggests a more benign course in the population of the Yucatan Peninsula.

Ambient Air Pollution and Pediatric Inflammatory Bowel Diseases: An Updated Scoping Review.

To review and discuss recent findings on the associations between pediatric/early-life exposures to ambient air pollution and the risk of pediatric-onset inflammatory bowel diseases (IBD). A scoping review was conducted using the Peters Micah et al. framework. We searched, selected, extracted, and reviewed information from published peer-reviewed papers from three bibliographic databases, chosen to cover a broad range of disciplines. Limits on date (last decade), language, and subject were placed on the database search. The search identified 109 papers from 2010 to June 2021. After screening, we identified nine articles with data on air pollution as a risk factor for IBD, but only four epidemiologic studies directly investigated the association between air pollution and IBD development in children and young adults. These four papers show that air pollution components have different associations with pediatric IBD (pIBD) incidence. Consequently, sulfur dioxide (SO2), nitrogen dioxide (NO2), and the oxidant capacity of air pollution (Ox) were positively associated with pIBD incidence, whereas the association effects of particulate matter (PM) and ozone (O3) exposures were not clear. Despite good scientific rationale and some studies, the evidence on the role that air pollution has in IBD development is limited, highlighting the need for further investigation. Future studies should include the epidemiology of air pollutants and its sources, identifying and understanding mechanisms linking air pollution and pIBD, and identifying signatures of biological responses to air pollutants.

Antithrombotic strategies in elderly patients with atrial fibrillation revascularized with drug-eluting stents: PACO-PCI (EPIC-15) registry.

BACKGROUND: We sought to investigate the antithrombotic regimens applied and their prognostic effects in patients over 75 years old with atrial fibrillation (AF) after revascularization with drug-eluting stents (DES). METHODS: Retrospective registry in 20 centers including patients over 75 years with AF treated with DES. A primary endpoint of MACCE and a co-primary endpoint of major bleeding by ISTH criteria were considered at 12 months. RESULTS: A total of 1249 patients (81.1 ±â€¯4.2 years, 33.1% women, 66.6% ACS, 30.6% complex PCI) were included. Triple antithrombotic therapy (TAT) was prescribed in 81.7% and dual antithrombotic therapy (DAT) in 18.3%. TAT was based on direct oral anticoagulants (DOAC) in 48.4% and maintained for only 1 month in 52.2%, and DAT included DOAC in 70.6%. Primary endpoint of MACCE was met in 9.6% and primary endpoint of major bleeding in 9.4%. TAT was significantly associated with more bleeding (10.2% vs. 6.1%, p = 0.04) but less MACCE (8.7% vs. 13.6%, p = 0.02) than DAT and the use of DOAC was significantly associated to less bleeding (8% vs. 11.1%, p = 0.03) and similar MACCE (9.8% vs. 9.4%, p = 0.8). TAT over 1 month or with VKA was associated with more major bleeding but comparable MACCE rates. CONCLUSIONS: Despite advanced age TAT prevails, but duration over 1 month or the use of other agent than Apixaban are associated with increased bleeding without additional MACCE prevention. DAT reduces bleeding but with a trade-off in terms of ischemic events. DOAC use was significantly associated to less bleeding and similar MACCE rates.

Frecuencia del síndrome de desgaste profesional en un grupo de especialistas en Cirugía Plástica y estudiantes del posgrado en Colombia / Frequency of burnout syndrome in a group of specialists in Plastic Surgery and postgraduate students in Colombia

Introducción y objetivo: El síndrome burnout o síndrome de desgaste profesional, fue descrito por Freudenberger, psiquiatra psicoanalista norteamericano en 1974, y empleado públicamente por primera vez por Cristina Maslach en 1976 para referirse a una situación cada vez más frecuente entre trabajadores de los servicios humanos, que por la naturaleza de su trabajo, debían mantener un contacto directo y continuo con la gente, desgastándose profesionalmente tras meses o años de dedicación. En los 80, Maslach creó un instrumento para su valoración, el Maslach Burnout Inventory (MBI), con 3 versiones, una de los cuales tiene como objetivo las personas que trabajan en el sector de servicios de la salud, que valora 3 dimensiones: agotamiento emocional, despersonalización y realización personal en el trabajo, que sigue vigente y es considerado el instrumento más utilizado y acertado para el diagnóstico de la enfermedad.El objetivo de nuestro estudio es determinar la frecuencia y factores asociados del síndrome de desgaste profesional en médicos especialistas y estudiantes de posgrado en Cirugía Plástica, Estética y Reconstructiva en Colombia.Material y método.Estudio de corte transversal durante el XX Curso Internacional de Cirugía Plástica Estética de la Sociedad Colombiana de Cirugía Plástica, Estética y Reconstructiva (SCCP) de septiembre 2018 en Barranquilla. Solicitamos consentimiento informado y utilizamos el cuestionario Maslach Burnout Inventory y un cuestionario sociodemográfico para evaluar los factores asociados con el síndrome. Definimos el burnout o síndrome de desgaste profesional como la asociación de alto agotamiento emocional, despersonalización y bajo rendimiento profesional. Realizamos el análisis multivariado después del ajuste del modelo logístico binario con la identificación de los factores de riesgo y el calculo de (OR). De los 623 médicos registrados en el curso, 132 participaron en el estudio. (AU)

Background and objective: The burnout was originally described by Freudenberger, an American psychoanalyst psychiatrist in 1974, and this term was used for the first time by Cristina Maslach in 1976 to refer to an increasingly frequent situation among workers of human services, who by the nature of their work, had to maintain direct and continuous contact with people, wasting out professionally after months or years of dedication. In the 1980s, Maslach created an instrument for its assessment, the Maslach Burnout Inventory (MBI), with 3 versions, one aimed at people who work in the human services sector (Human Services Survey). It values 3 dimensions: emotional exhaustion, depersonalization and personal accomplishment at work, is still in use and is considered the most accurate instrument for diagnosing the disease.The objective of this study was to determine the frequency and associated factors of burnout syndrome in a group of plastic surgeons and postgraduate students in Aesthetic and Reconstructive Plastic Surgery in Colombia.Methods.Cross-sectional study carried out during the XX International Course of Aesthetic Plastic Surgery of the Colombian Society of Aesthetic and Reconstructive Plastic Surgery (SCCP) carried out in September 2018 in Barranquilla. Informed consent was requested and the Maslach Burnout Inventory questionnaire and a sociodemographic questionnaire were used to evaluate the factors associated with the syndrome. Burnout syndrome was defined as the association of high emotional exhaustion, depersonalization and low personal accomplishment. The multivariate analysis was performed after fitting the binary logistic model with the identification of risk factors and the calculation of the (OR). Of the 623 physicians registered in the course, 132 participated in the study. (AU)

The different manifestations of COVID-19 in adults and children: a cohort study in an intensive care unit.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has collapsed health systems worldwide. In adults, the virus causes severe acute respiratory distress syndrome (ARDS), while in children the disease seems to be milder, although a severe multisystem inflammatory syndrome (MIS-C) has been described. The aim was to describe and compare the characteristics of the severe COVID-19 disease in adults and children. METHODS: This prospective observational cohort study included the young adults and children infected with SARS-CoV-2 between March-June 2020 and admitted to the paediatric intensive care unit. The two populations were analysed and compared focusing on their clinical and analytical characteristics and outcomes. RESULTS: Twenty patients were included. There were 16 adults (80%) and 4 children (20%). No mortality was recorded. All the adults were admitted due to ARDS. The median age was 32 years (IQR 23.3-41.5) and the most relevant previous pathology was obesity (n = 7, 43.7%). Thirteen (81.3%) needed mechanical ventilation, with a median PEEP of 13 (IQR 10.5-14.5). Six (37.5%) needed inotropic support due to the sedation. Eight (50%) developed a healthcare-associated infection, the most frequent of which was central line-associated bloodstream infection (n = 7, 71.4%). One patient developed a partial pulmonary thromboembolism, despite him being treated with heparin. All the children were admitted due to MIS-C. Two (50%) required mechanical ventilation. All needed inotropic support, with a median vasoactive-inotropic score of 27.5 (IQR 17.5-30). The difference in the inotropic requirements between the two populations was statistically significant (37.5% vs. 100%, p < 0.001). The biomarker values were higher in children than in adults: mid-regional pro-adrenomedullin 1.72 vs. 0.78 nmol/L (p = 0.017), procalcitonin 5.7 vs. 0.19 ng/mL (p = 0.023), and C-reactive protein 328.2 vs. 146.9 mg/L (p = 0.005). N-terminal pro-B-type natriuretic peptide and troponins were higher in children than in adults (p = 0.034 and p = 0.039, respectively). CONCLUSIONS: Adults and children had different clinical manifestations. Adults developed severe ARDS requiring increased respiratory support, whereas children presented MIS-C with greater inotropic requirements. Biomarkers could be helpful in identifying susceptible patients, since they might change depending on the clinical features.

Lung ultrasound findings in pediatric patients with COVID-19.

During the pandemic caused by the novel coronavirus (COVID-19), lung ultrasound has been used to diagnose and monitor respiratory condition. The aim of the study was to describe lung ultrasound findings in children with a COVID-19 infection. Patients younger than 18 years old and positive for COVID-19, admitted to pediatric tertiary referral hospital were included. They were divided into two groups depending on the presence of respiratory symptoms. Lung ultrasound results were categorized into four degrees according to Soldati et al. score (J Ultrasound Med 39:1-7, 2020) and it was also described the presence and type of consolidation. Sixteen patients were recruited. The median age was 11 years old (IQR 2.8-12). Four children (25%) required admission to the intensive care unit. Six patients (37.5%) presented with respiratory symptoms. Most of them showed S.score of 2 and subpleural consolidations were observed in four cases (66.6%). Ten patients (62.5%) presented with non-respiratory symptoms, lung ultrasound showed S.score from 0 to 2. Three (30%) were diagnosed of multisystem inflammatory syndrome and lung ultrasounds showed S.score of 2 with bilateral pleural effusion.Conclusions: Children with COVID-19 and respiratory symptoms mostly showed a S.score of 2 and 3 with subpleural consolidations, upon the lung ultrasound assessment. What is Known: • Lung ultrasound is a useful tool for monitoring patients with respiratory symptoms in both adults and children. Lung ultrasounds are altered in adult patients with COVID-19. What is New: • Lung ultrasound might improve COVID-19 assessment, it could be a useful tool to diagnose and monitor patients throughout the COVID-19 pandemic. Even COVID-19 patients with non-respiratory symptoms have lung alterations that are visible on lung ultrasound.

Clinical risk factors for the prediction of acute kidney injury post cardiac resynchronization therapy in an elderly population.

BACKGROUND: Data on the occurrence of acute kidney injury (AKI) in patients undergoing cardiac resynchronization therapy (CRT) implantation is limited and no previous studies investigated its impact in an elderly population. CRT implantation requires a relatively low quantity of contrast medium. Previous studies, however, focused primarily on contrast medium as etiological factor for AKI, reporting a high incidence (8-14%). The high incidence of AKI in absence of use of substantial amounts of contrast volume, suggests the existence of other factors that contribute to AKI. OBJECTIVES: To determine the predictive value of patient and procedure-related risk factors for the occurrence of AKI post CRT, as well as the AKIs impact on length of in-hospital stay (LOS) and 1-year mortality. METHODS: Retrospective observational study, including consecutive patients that underwent CRT implantation in a single center. RESULTS: 60 patients with a mean age of 77 ± 8.4 years were included in the study and Twelve (20%) developed AKI. Prior renal insufficiency (p = 0.03; OR = 15.4), larger procedure time (p = 0.02; OR = 1.03), intra-operative hypotension (p < 0.01; OR = 1.72) and bleeding (p = 0.01 (OR = 7.86), showed to predict AKI significantly. AKI associated a significantly longer LOS (12 vs 3 days, p < 0.01). No significant differences regarding 1-year mortality were observed (p = 0.19; HR = 2.7 for patients with AKI). CONCLUSIONS: AKI is a frequent complication of CRT implantation with an important impact on in-hospital stay, especially in the elderly. In addition to contrast administration, clinical factors could play a significant role in the occurrence of AKI.

Algunas preguntas al artículo "Mano diabética en el Hospital General de México Dr. Eduardo Liceaga. Nuestra experiencia en 42 casos" / No disponible

No disponible

Pericarditis aguda secundaria a COVID-19 / Acute pericarditis secondary to COVID-19

No disponible

Is Latin America Ready to Identify Anaplastic Large Cell Lymphoma in Breast Implants Patients? Regional Encounter During the National Plastic Surgery Meeting in Cancun, Mexico.

INTRODUCTION: Anaplastic large cell lymphoma associated with breast implants is receiving increased attention. Most cases have been reported in Europe, North America (USA and Canada), Australia and New Zealand. Fewer cases have been reported in Latin America (including Mexico), Africa and Asia. METHODS: This report was delivered during our national plastic surgery meeting in Cancun in May 2017. Before the meeting, two participants reviewed the literature. The review was performed using the following information sources: PubMed, Embase, Cochrane, Fisterra, Google Scholar and LILACS, with entries from 1980 to August 2015 in several languages (English, Spanish, French and Portuguese). The results were revealed during the meeting to the other participants. The consensus was divided into two parts. The first part included an open-ended question regarding the incidence and prevalence of the problem. The second part included clinical scenarios with different items that were rated by the participants. After this activity, accordance among the responses was evaluated. RESULTS: Seven cases were reported during the meeting (3 from Mexico, 3 from Chile and 1 from Argentina). Fifty percent of the participants reported consulting with guidelines and clinical centers to help with potential cases. Most agreed that further studies must be done in cases of chronic seroma where the capsule plays an important role. DISCUSSION: A current debate exists about the incidence of this problem in Latin America because we did not report the same number of cases as Europe, Australia or North America. More studies are required to determine the differences among reports in Latin America. CONCLUSION: Most representatives agreed that further studies must be done. Concern is increasing, and the problem is known. Other factors involved may be considered, and the problem must not be ignored. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Schwannoma del nervio mediano: enfoque diagnóstico y terapéutico, a propósito de un caso / Median nerve schwannoma: diagnostic and therapeutic approach, about a case

Los schwannomas o neurilemomas son los tumores benignos más comunes en los nervios periféricos y representan el 5% de todos los tumores de la extremidad superior. Por su parte, el schwannoma del nervio mediano tiene una incidencia de entre el 0.1 al 0.3 % de todos los tumores de la mano. Presentamos el caso de un paciente varón con schwannoma del nervio mediano con compromiso neurológico asociado a masa de crecimiento progresivo en túnel carpiano derecho; mostramos el proceso de diagnóstico clínico, radiológico y el tratamiento quirúrgico instaurado para realizar resección completa y preservación funcional, con diagnóstico anatomopatológico definitivo de schwannoma del nervio mediano. Teniendo en cuenta lo infrecuente de esta patología, realizamos también una revisión de la literatura al respecto (AU)

Schwannomas or neurilemomas are the most common bening tumours in peripheral nerves, representing 5% of all tumours of the upper extremity. Median nerve schwannomas represent an incidence between 0.1 - 0.2% of all hand tumours. We present a male patient case with schwannoma of the median nerve with neurological involvement associated to a progressive mass growth at the level of the right carpal tunnel; we show the process of clinical, radiological diagnosis and the surgical treatment established to perform complete resection and functional preservation, with a definitive anatomopathological diagnosis for median nerve schwannoma. Taking into account the infrequent nature of this pathology, we carry out a literature review (AU)

Augenbeteiligung beim Pemphigus vulgaris - retrospektive Studie an einer großen spanischen Kohorte.

HINTERGRUND UND ZIELE: Es gibt nur wenige Berichte zur Beteiligung der okulären/periokulären Region beim Pemphigus vulgaris (PV). Ziel der vorliegenden Studie war es, das Krankheitsbild des okulären PV (OPV) zu untersuchen und seinen prognostischen Wert zu definieren. PATIENTEN UND METHODIK: Zwischen 1985 und 2014 wurden insgesamt 167 Patienten mit Pemphigus vulgaris an vier tertiären spanischen Krankenhäusern behandelt. Wir haben alle Patienten mit OPV in diese retrospektive Studie aufgenommen. Klinische Daten sowie Informationen zu Begleitsymptomen wurden den Krankenakten der -Patienten entnommen. ERGEBNISSE: Lediglich 24 (14.3 %) PV-Patienten hatten okuläre Läsionen. Meist gingen dem okulären Befall PV-Läsionen an verschiedenen anderen Stellen voraus (durchschnittliche Dauer: 33,7 Monate). Okuläre PV-Läsionen traten während der Schübe eines mukokutanen Pemphigus auf und waren niemals die einzige Mukosa-Manifestation. Die häufigsten klinischen Symptome waren konjunktivale Hyperämie (87,5 %) und Erosionen an den Augenlidern (41,6 %), sowohl an der palpebralen/bulbären Konjunktiva (33,3 %) als auch am medialen Epikanthus (20,8 %). Zu den wichtigsten Begleitsymptomen gehörten lokale Schmerzen/Brennen (71,4 %), Reizung (47,6 %), Photophobie (38,1 %) und Epiphora (23,9 %). Der OPV besserte sich unter systemischer und unterstützender topischer Behandlung. Lediglich bei zwei Patienten traten Spätfolgen auf. SCHLUSSFOLGERUNGEN: Bei Patienten mit PV sind die Augen nur in Ausnahmefällen betroffen. Ein okulärer PV ist mit größerer Krankheitsaktivität assoziiert und hat in der Regel einen gutartigen Verlauf. Betroffen sind die Konjunktiva und/oder die Augenlider.

Ocular involvement in pemphigus vulgaris - a retrospective study of a large Spanish cohort.

BACKGROUND AND OBJECTIVES: Ocular/periocular involvement in pemphigus vulgaris (OPV) has rarely been reported. The objective of the present study was to investigate the pattern of OPV and define the prognostic value of its manifestation. PATIENTS AND METHODS: From 1985 to 2014, a total of 167 patients with pemphigus vulgaris (PV) were treated at four tertiary Spanish hospitals. In this retrospective study, we included all patients with OPV. Clinical data and information on associated symptoms were obtained from patients' medical records. RESULTS: Only 24 (14.3 %) of all PV patients had ocular lesions. In most cases, -ocular involvement was preceded by PV lesions at various other sites (mean duration: 33.7 months). Ocular PV lesions occurred during flares of mucocutaneous pemphigus, and was never the only mucosal manifestation. The most common clinical signs were conjunctival hyperemia (87.5 %), erosions on the eyelids (41.6 %) as well as of the palpebral/bulbar conjunctiva (33.3 %) and at the medial epicanthus (20.8 %). The most relevant associated symptoms included local pain/stinging (71.4 %), irritation (47.6 %), photophobia (38.1 %), and epiphora (23.9 %). Ocular PV improved with systemic and adjuvant topical therapies. Only two patients experienced sequelae. CONCLUSIONS: In patients with PV, ocular involvement is an exception. Ocular PV is associated with greater disease activity, and usually follows a benign course. Sites affected are the conjunctiva, the eyelids, or both.

Placa en flor para artrodesis escafo-trapecio-trapezoide como tratamiento quirúrgico de la pseudoartrosis del polo distal del escafoides. Caso clinico / Flower plate for arthrodesis schapoid-trapezium-trapezoid as surgical treatment for schapoid distal pole non union. Case report

La osteonecrosis postraumática del polo distal del escafoides es una complicación rara, ya que hasta donde hemos podido conocer solo se encuentran recogidos 3 casos en la literatura mundial. Presentamos un paciente con fractura de polo distal de escafoides que evoluciono a osteonecrosis y el tratamiento quirúrgico realizado con artrodesis escafo-trapecio-trapezoide con placa en flor. A los 6 meses de postoperatorio el paciente presenta mejoría del dolor y rango adecuado de movilidad de muñeca y pulgar, realizando pinza sin dificultad y con buen agarre. Obtuvimos por tanto un buen resultado en la mejoría del dolor y en la funcionalidad de la mano. Entre los casos reportados en la literatura no hemos encontrados tratamientos similares al que presentamos (AU)

Posttraumatic osteonecrosis of the distal pole of the scaphoid bone is a rare complication; up to this point we could only find 3 reported cases in world literature. We present a rare case of scaphoid distal pole osteonecrosis that after a year presented avascular necrosis of the involved segment, and the performed treatment with scaphoid-trapezium-trapezoid arthrodesis with flower plate. After 6 months evolution there is a clear improvement of pain and movement, with complete recovery of range mobility of wrist and thumb. We got very good results regarding pain resolution and improvement in hand function. We could not find any other case reported that has used the same approach (AU)

Pleistocene climatic oscillations rather than recent human disturbance influence genetic diversity in one of the world's highest treeline species.

PREMISE OF THE STUDY: Biological responses to climatic change usually leave imprints on the genetic diversity and structure of plants. Information on the current genetic diversity and structure of dominant tree species has facilitated our general understanding of phylogeographical patterns. METHODS: Using amplified fragment length polymorphism (AFLPs), we compared genetic diversity and structure of 384 adults of P. tarapacana with those of 384 seedlings across 32 forest sites spanning a latitudinal gradient of 600 km occurring between 4100 m and 5000 m a.s.l. in Polylepis tarapacana (Rosaceae), one of the world's highest treeline species endemic to the central Andes. KEY RESULTS: Moderate to high levels of genetic diversity and low genetic differentiation were detected in both adults and seedlings, with levels of genetic diversity and differentiation being almost identical. Four slightly genetically divergent clusters were identified that accorded to differing geographical regions. Genetic diversity decreased from south to north and with increasing precipitation for adults and seedlings, but there was no relationship to elevation. CONCLUSIONS: Our study shows that, unlike the case for other Andean treeline species, recent human activities have not affected the genetic structure of P. tarapacana, possibly because its inhospitable habitat is unsuitable for agriculture. The current genetic pattern of P. tarapacana points to a historically more widespread distribution at lower altitudes, which allowed considerable gene flow possibly during the glacial periods of the Pleistocene epoch, and also suggests that the northern Argentinean Andes may have served as a refugium for historical populations.