Superior versus anteroinferior plating for mid-shaft clavicle fractures: a randomized clinical trial.

BACKGROUND: Clavicle fractures represent 2.5-4% of all fractures observed in emergency services. 80% occurs in the middle third. Treatment by plating requires a higher level of evidence. OBJECTIVE: To compare the functional outcomes of mid-shaft clavicle fractures managed with superior plating compared to anteroinferior plating. TRIAL DESIGN: A randomized, double-blind, parallel, superiority clinical trial. PATIENTS AND METHODS: Patients with fractures of the clavicles AO15B1 and AO15B2 were studied. Patients were randomized to be treated with either 3.5 mm superior or anteroinferior plating. A rehabilitation program was designed for both groups. The primary outcome measure was the Disability of Arm, Shoulder, and Hand (DASH) score; secondary outcomes included pain, union rate, and complication rates. RESULTS: Twenty-eight patients were studied and were eligible for analysis. Significant differences were found in the function assessed with the DASH score at 30 days for the superior plating compared with anteroinferior (43.74 vs. 29.26, respectively, p = 0.027), 60 days (23.97 vs. 11.18, p = 0.021), and 90 days (9.52 vs. 3.5, p = 0.016). One loosening with superficial infection was found with superior plating. CONCLUSIONS: Using an anteroinferior reconstruction plate in diaphyseal fractures offers better functional results than the upper plate in patients with fractures of the middle third of the clavicle.

ANTECEDENTES: Las fracturas de clavícula comprenden el 2.5-4% de todas las fracturas observadas en los servicios de emergencia. El 80% se presentan en el tercio medio. La posición de la placa como tratamiento requiere mayor nivel de evidencia. OBJETIVO: Comparar los resultados funcionales de las fracturas diafisarias de clavícula manejadas con placa superior versus placa anteroinferior. MÉTODO: Ensayo clínico aleatorizado, doble ciego, paralelo, de superioridad. Se estudiaron pacientes con fractura diafisaria de clavícula AO15B1 y AO15B2. Se manejaron con placa de reconstrucción de 3.5 mm colocada en forma superior o anteroinferior. Se diseñó un programa de rehabilitación para ambos grupos. El resultado primario fue medido con el cuestionario DASH y los resultados secundarios incluyeron dolor, presencia de consolidación y complicaciones. RESULTADOS: Fueron elegibles para análisis 28 pacientes. Se encontraron diferencias significativas de la escala DASH a los 30 días para la maniobra superior comparada con la inferior (43.74 vs. 29.26, respectivamente; p = 0.027), a los 60 días (23.97 vs. 11.18; p = 0.021) y a los 90 días (9.52 vs. 3.5; p = 0.016). CONCLUSIONES: El uso de placa de reconstrucción anteroinferior en las fracturas diafisarias ofrece mejores resultados funcionales en comparación con la placa superior en pacientes con fracturas de tercio medio de clavícula.

[Translated article] Current situation and evolution of the availability of drugs in the pediatric population in Spain.

OBJECTIVE: To analyze the characteristics of the new medicines approved in the pediatric population in the last 3 years, both those with studies only in the pediatric population and those that extend their indication in this population group, as well as the current situation in relation to their marketing and financing. METHODS: Descriptive observational study of all drugs that include an indication in the pediatric population in Spain (by extension of the indications of drugs already authorized or because they are new drugs that already include an indication in this population group), from January 2019 to March 2022. RESULTS: During the study period, 129 drugs included their indication in the pediatric population. 13.9% of them are not marketed, 46.5% are in a situation of non-financing, under study or without a request for financing, and 4.6% are financed for a specific pediatric subpopulation. 52.7% are original drugs, 4.7% are generic, 38.8% are biological, 3.8% are biosimilar, and 17.8% are orphan drugs. 57.36% of these medicines obtain the pediatric indication due to extension of the indication and 42.64% obtain it because they are new medicines that already include their studies in the pediatric population. CONCLUSIONS: Drugs with authorized indications are increasingly available in the pediatric population and the trend is to extend the indication of authorized drugs to the adult population. However, barriers in terms of financing and marketing need to be expedite and overcome to facilitate access to them.

[Design of a nursing assessment instrument during pregnancy monitoring in Primary Health care and the validation of its content]. / Diseño de un instrumento de valoración enfermera para el seguimiento de embarazo en Atención Primaria de salud y la validación de su contenido.

OBJECTIVE: This research aims to develop a nursing assessment tool, based on Gordon's Health Functional Patterns, through a content validation by a committee of experts, applying a Delphi technique. DESIGN: An assessment instrument with 53 items has been designed. SITE: It is carried out within the framework of a doctoral thesis, for its implementation by midwives of Primary Health Care. PARTICIPANTS: The committee was made up of 16 professionals with a hide clinical, teaching and research experience who all participated in the entire validation process. INTERVENTION: It has been assessed as a whole and in each of the items through four rounds of consultations, establishing a positive assessment of more than 60% to accept each item, as well as incorporating the suggestions provided by the committee. The final version had to reach a unanimous consensus. MAIN MEASUREMENTS: All items were accepted with a score higher than 60%. RESULTS: There were no contradictions between the inputs provided by the experts, so all of them were integrated into the final version that has a 100% approval by the committee. CONCLUSION: After this process, a new assessment tool is presented to be applied by primary care midwives in the pregnancy monitoring. The questionnaire has been piloted with 50 pregnant women, determining the most prevalent nursing diagnoses, establishing the workload for the midwife of her implementation of individualized care plans to improve some health indicators of pregnant women.

Comparison of the MIPS technique versus linear incision with tissue preservation in osseointegrated implants in the Ponto model®.

BACKGROUND AND OBJECTIVES: The surgery of osseointegrated implants has undergone different modifications over the years with the aim of achieving better results and facilitating the surgical technique. Today the most commonly used technique is the linear incision with tissue preservation and placement of the abutment and implant. The long-term success of this technique has served as the basis for the development of the so-called minimally invasive surgical approach (MIPS). This study compares the short-, medium- and long-term results between the classic linear incision technique and the MIPS technique. MATERIAL AND METHODS: A prospective study was conducted on patients who had an osseointegrated implant placed between February 2016 and February 2020. A total of 59 surgeries were performed, 32 surgeries according to the linear incision technique with tissue preservation and 27 with MIPS technique. Outcomes were evaluated at one week, one month and one year. RESULTS: Statistically significant differences were achieved between the 2 groups at one week after surgery. Eighty per cent of the MIPS patients had Holgers grades 0-1 compared to 35% of the linear technique patients (p = 0.001). No statistically significant differences were observed at one month (p = 0.457) and one year (p = 0.228). One case with grade 4 was recorded which resulted in implant extrusion one month after surgery with the MIPS technique. A new osseointegrated implant was placed 2 months after the fall using the same MIPS technique with good results. We were also able to verify that the duration of surgery was much shorter with the MIPS technique and better tolerated in terms of postoperative discomfort by the patient. CONCLUSIONS: In our experience, the MIPS technique is the technique of choice for surgery of osseointegrated Ponto model implants as it is simpler, faster and presents fewer problems in the immediate postoperative period, with similar long-term postoperative results.

Usefulness and description of the intestinal bypass technique in children with short bowel syndrome: report of a Mexican cohort.

BACKGROUND: Short bowel syndrome (SBS) is one of the most frequent causes of intestinal failure, needing parenteral nutrition to maintain an energy-protein and water-electrolyte balance. At the Hospital Infantil de México Federico Gómez (HIMFG), the formation of two stomas is a technique used for intestinal rehabilitation, where the use of residue through the bypass technique (BT) helps to maintain gastrointestinal functionality, water-electrolyte, and nutritional stability. This study aimed to describe the technique of using intestinal residue through BT as a treatment strategy in intestinal rehabilitation and its effect on the biochemical and nutritional status of pediatric patients with SBS. METHODS: An analytical and retrospective cross-sectional study was performed in patients hospitalized at HIMFG with SBS who underwent BT during their hospital stay between 2019 and 2020 and then followed up for 8 weeks. RESULTS: A total of 10 patients were included in this study, with a mean age of 24 months; 50% were female. BT was able to reduce the inflammatory process in the liver caused by the continuous use of parenteral nutrition; enteral caloric intake increased from 25.32 kcal/kg/day to 72.94 kcal/kg/day, but it was insufficient to improve their nutritional status. CONCLUSIONS: BT is a safe and effective alternative in intestinal rehabilitation in patients with SBS to stimulate trophism and intestinal functionality, allowing a progression of enteral feeding and a decrease in the hepatic inflammatory process that occurs in these patients with prolonged parenteral nutrition.

INTRODUCCIÓN: El síndrome de intestino corto (SIC) es una de las causas más frecuentes de insuficiencia intestinal que requiere del uso de nutrición parenteral para mantener un balance energético-proteico e hidroelectrolítico. En el Hospital Infantil de México Federico Gómez (HIMFG) la formación de dos estomas es una técnica empleada para la rehabilitación intestinal, donde con el aprovechamiento de residuo mediante la técnica de puenteo (TP) se ayuda a mantener la funcionalidad gastrointestinal, equilibrio hidro-electrolítico y estabilidad nutricional. El objetivo de este estudio fue describir la técnica del aprovechamiento de residuo intestinal mediante TP como estrategia de tratamiento en la rehabilitación intestinal y su efecto en el estado bioquímico y nutricional de pacientes pediátricos con SIC. MÉTODOS: Se llevó a cabo un estudio transversal analítico y retrospectivo en pacientes hospitalizados en el HIMFG con SIC en quienes se realizó la TP durante su estancia intrahospitalaria entre 2019 y 2020. RESULTADOS: Se incluyeron 10 pacientes en este estudio, con una edad promedio de 24 meses, y el 50% de sexo femenino. La TP logró disminuir el proceso inflamatorio hepático ocasionado por el uso continuo de nutrición parenteral; la ingesta calórica por vía enteral incrementó de 25.32 kcal/kg/día a 72.94 kcal/kg/día, pero fue insuficiente para mejorar el estado nutricional. CONCLUSIONES: La TP es una alternativa segura y efectiva en la rehabilitación intestinal en pacientes con SIC para estimular el trofismo y funcionalidad intestinal, permitiendo una progresión de la alimentación enteral y disminución del proceso inflamatorio hepático que se presentan en estos pacientes con nutrición parenteral prolongada.

Reconstrucción maxilofacial de la región orbitaria / Maxillofacial reconstruction of the orbital region

La región orbitaria representa una unidad estética funcional muy importante en la región facial. Se presenta un trabajo retrospectivo de un período de 20 años (2000-2020) de actividad pública-privada en el tratamiento de patología tumoral y traumática de la región orbitaria. Analizamos en 580 casos operados, 184 oncológicos y 396 traumáticos, diferentes aspectos comunes que intervienen en el tratamiento reconstructivo de la región: abordajes, técnicas quirúrgicas, consideraciones anatomofuncionales, principios básicos en cirugía maxilofacial orbitaria y complicaciones, resaltando la importancia del manejo correcto de los tejidos regionales en su reconstrucción. La mejor posibilidad para el paciente de lograr un buen resultado es con una operación primaria correcta. Sus complicaciones son de difícil tratamiento

The orbital region represents a very important functional aesthetic unit in the facial region. A retrospective study of a 20-year period (2000- 2020) of public-private activity in the treatment of tumor and traumatic pathology of the orbital region is presented. We analyzed in 580 operated cases, 184 oncological and 396 traumatic, different common aspects involved in the reconstructive treatment of the region: approaches, surgical techniques, anatomofunctional considerations, basic principles in orbital maxillofacial surgery and complications, highlighting the importance of the correct management of regional tissues in their reconstruction. The best possibility for the patient to achieve a good result is with a correct primary operation. Its complications are difficult to treat

Comparación Morfométrica de Esqueletos Transparentados de Cuatro Especies de Roedores Myomorfos / Morphometric Comparison of Transparent Skeletons of Four Species of Myomorphic Rodents

Las técnicas de doble tinción y transparentación se han usado desde 1897, pero su utilidad ha sido poco explorada en los estudios anatómicos de micromamíferos adultos. No obstante, la combinación de estas técnicas con el análisis alométrico mutivariado posibilita el estudio de esqueletos poscraneales articulados de tales grupos de micromamíferos como los roedores, los cuales son muy limitados ya que casi siempre se enfocan en los cráneos. En este estudio, analizamos y comparamos la morfometría del esqueleto de Neotomodon alstoni con la de Meriones unguiculatus, Phodopus campbelli y Rattus norvegicus. Usamos la técnica de doble tinción y transparentación para analizar las relaciones morfométricas entre estos roedores utilizando sesenta caracteres esqueléticos. Se encontró que tres especies comparten dos correlaciones comunes y compartieron el mismo tipo de crecimiento isométrico en una de ellas; además se encontraron similitudes aparentes entre los patrones de la morfometría de P campbelli con el patrón de osificación descrito para la especie relacionada Mesocricetus auratus. Las diferencias en el crecimiento alométrico pueden representar también diferencias en el ritmo de desarrollo de acuerdo con el tipo de historia de vida de cada especie. Aquí demostramos que tanto la técnica de preparación como el método de análisis morfométricos son herramientas poderosas pero simples, para realizar estudios anatómicos y morfológicos en el laboratorio. Nuestros resultados reflejan las condiciones del desarrollo ontogenético derivados delpropio patrón de heterocronía para cada especie, y además representan la historia evolutiva de este grupo analizado. Sin embargo, consideramos que es deseable más investigación.

SUMMARY: Clearing and staining techniques have been present since 1897, However, their use in anatomical studies of adult micromammals has been limited. When using such techniques in combination with allometric method, it is possible to study articulated skeletons of micromammals, instead of relying only on the skulls, which is important in morphologically complicated groups as the rodents. Research involving multivariate allometric analysis of postcranial skeleton of rodents has been limited and confined to specific items. In this study, we analyzed and compared the morphometry of the skeleton of Neotomodon alstoni with that of Meriones unguiculatus, Phodopus campbelli and Rattus norvegicus. We applied the double staining and clearing technique in order to determine the morphometric relation between these rodents using sixty skeletal characters. We found that three species share two common correlations and one isometric, with apparent similarities between the morphometry patterns of P campbelli with the ossification pattern described for the related species Mesocricetus auratus. The differences in allometric growth could represent differences in the development stages according to the type of life history for each species. In this analysis we confirmed that both the preparation technique and morphometric analysis method, are simple yet verifiable tools for anatomical and morphological studies. Our results reflect the conditions of ontogenetic development derived from the heterochrony pattern for each species, representing the evolutionary history for this group. Therefore, as this approach continues to be discussed, ongoing research is warranted.

C1–C2 intraarticular distraction with anterior cervical cages for basilar invagination realignment: Operative technique nuances and review of literature

Neurosurgical management of basilar invagination (BI) has traditionally been aimed at direct cervicomedullary decompression through transoral dens resection or suboccipital decompression with supplemental instrumented fixation. Dr. Goel introduced chronic atlantoaxial dislocation (AAD) as the etiology in most cases of BI and described a technique for distracting the C1–C2 joint with interfacet spacers to achieve reduction and anatomic realignment. We present our modification to Goel’s surgical technique, in which we utilize anterior cervical discectomy (ACD) cages as C1–C2 interfacet implants. A young adult male presented to our institution with BI, cervicomedullary compression, occipitalization of C1, and Chiari 1 malformation. There was AAD of C1 over the C2 lateral masses. This reduced some with preoperative traction. He underwent successful C1–C2 interfacet joint reduction and arthrodesis with anterior cervical discectomy (ACD) cages and concomittant occiput to C2 instrumented fusion. BI can be effectively treated through reduction of AAD and by utilizing ACD cages as interfacet spacers. (AU)

El tratamiento neuroquirúrgico tradicional para la impresión basilar es principalmente a través de un abordaje trans-oral para la resección del proceso odontoide, seguido de una descompresión suboccipital con instrumentación posterior cervical. Dr. Goel presenta la dislocación atlanto-axial (AA) como una de las etiologías principales en los casos de impresión basilar. A su vez, describió la técnica quirúrgica que incluye la distracción de la articulación AA con cajas para fusión permitiendo la reducción y reajuste anatómico cervical. En este artículo presentamos una variación a la técnica quirúrgica del Dr. Goel en el cual utilizamos implantes utilizados en la discectomía y fusión cervical anterior (DFCA) para la articulación facetaria de C1–C2. Presentamos un paciente adulto masculino que evaluamos en nuestra institución con impresión basilar, compresión cérvico-medular, fusión occipital con el atlas y malformación de Chiari tipo 1. En adición, el paciente tenía evidencia radiográfica de dislocación AA. Se logro obtener reducción mínima de la impresión basilar con tracción cervical pre-operatoria. Luego, se sometió al tratamiento quirúrgico que consistió en el uso de implantes cervicales para la reducción y fusión de la articulación facetaria de C1–C2 complementado por instrumentación y fusión craneocervical. Esta técnica presentada sugiere que la reducción y reajuste anatómico cervical de la dislocación AA con implantes utilizados para DFCA puede ser efectivo para el tratamiento de impresión basilar. (AU)

C1-C2 intraarticular distraction with anterior cervical cages for basilar invagination realignment: Operative technique nuances and review of literature.

Neurosurgical management of basilar invagination (BI) has traditionally been aimed at direct cervicomedullary decompression through transoral dens resection or suboccipital decompression with supplemental instrumented fixation. Dr. Goel introduced chronic atlantoaxial dislocation (AAD) as the etiology in most cases of BI and described a technique for distracting the C1-C2 joint with interfacet spacers to achieve reduction and anatomic realignment. We present our modification to Goel's surgical technique, in which we utilize anterior cervical discectomy (ACD) cages as C1-C2 interfacet implants. A young adult male presented to our institution with BI, cervicomedullary compression, occipitalization of C1, and Chiari 1 malformation. There was AAD of C1 over the C2 lateral masses. This reduced some with preoperative traction. He underwent successful C1-C2 interfacet joint reduction and arthrodesis with anterior cervical discectomy (ACD) cages and concomittant occiput to C2 instrumented fusion. BI can be effectively treated through reduction of AAD and by utilizing ACD cages as interfacet spacers.

Construção e validação de conteúdo de instrumento de autoavaliação da qualidade do cuidado em instituição de longa permanência para pessoas idosas / Development and content validation for a self-assessment instrument of care quality in long-term care facilities for older adults

Resumo Objetivo Desenvolver e realizar a validação de conteúdo de um instrumento de autoavaliação da qualidade do cuidado em Instituições de Longa Permanência para Idosos (ILPI), denominado QualificaILPI. Método Estudo metodológico realizado entre março e dezembro de 2021. O instrumento foi desenvolvido com base em modelo multidimensional de qualidade, legislação brasileira e pesquisa bibliográfica e contém padrões de qualidade para autoavaliação das ILPI nas dimensões: ambiente, lar, cuidado, envolvimento familiar e da comunidade, equipe de trabalho e gestão. Cada padrão é descrito e seguido por uma escala, com parâmetros para classificar o nível de qualidade da ILPI em incipiente, intermediário, consolidado. A Técnica Delphi modificada foi empregada para validação por um comitê de 10 especialistas quanto a pertinência do padrão para avaliação da qualidade da ILPI, da adequação dos objetivos e da escala de avaliação, clareza, podendo fazer comentários. O padrão foi mantido quando houve 75% de concordância entre os especialistas. O instrumento foi também avaliado pelo público-alvo, constituído por coordenadores de 10 ILPI, selecionadas por conveniência. Resultados No primeiro ciclo de avaliação, foram excluídos três padrões e dois novos foram criados. No segundo, alterou-se a dimensão de um padrão e dois padrões foram unidos. Ao final, permaneceram 29 padrões divididos em seis dimensões. O público-alvo, gestores de ILPI, sugeriu alterações na redação de alguns padrões. Houve consenso de 80% ou superior em todos os padrões. Conclusão O QualificaILPI poderá contribuir para o monitoramento das ILPI favorecendo a melhoria do cuidado ofertado aos residentes.

Abstract Objective To develop and validate the content of a self-assessment instrument for the quality of care in Long-Term Care Facilities for Older Adults (Instituições de Longa Permanência para Idosos - ILPIs), named QualificaILPI. Method A methodological study conducted between March and December 2021. The instrument was developed based on a multidimensional quality model, Brazilian legislation, and literature research. It contains quality standards for self-assessment of ILPIs in the dimensions of environment, home, care, family and community involvement, work team, and management. Each standard is described and followed by a scale with parameters to classify the level of ILPI quality as incipient, intermediate, or consolidated. The modified Delphi Technique was employed for validation by a committee of 10 experts regarding the relevance of the standard for ILPI quality assessment, the appropriateness of objectives, the evaluation scale, and clarity, allowing for comments. The standard was retained when there was 75% agreement among the experts. The instrument was also evaluated by the target audience, consisting of coordinators from 10 ILPIs selected for convenience. Results In the first assessment cycle, three standards were excluded, and two new ones were created. In the second cycle, the dimension of one standard was changed, and two standards were combined. In the end, 29 standards remained, divided into six dimensions. The target audience, ILPI managers, suggested changes in the wording of some standards. There was a consensus of 80% or higher for all standards. Conclusion QualificaILPI has the potential to contribute to monitoring ILPIs, promoting the improvement of care offered to residents.

Clinical longevity of metallic versus fiberglass intraradicular posts: a systematic review / Longevidade clínica de pinos intraradiculares metálicos versus de fibra de vidro: uma revisão sistemática

Objective: This systematic review aims to compare the clinical longevity of metallic and fiberglass intraradicular posts in teeth with severely compromised crowns, utilizing randomized clinical trials and case reports published in the last eleven years. Material and Methods: The research was conducted on PubMed, Medline, Lilacs, and BBO databases using the first search strategy with the descriptors 'dental posts,' 'longevity,' 'fiberglass-reinforced posts' or 'metallic posts.' The second search strategy involved analyzing the references of articles identified by the first search. Both studies were carried out with stringent inclusion and exclusion criteria. Results: No statistically significant and clinically relevant differences in longevity were observed between metallic and fiberglass posts. Conclusion: The clinical success and durability of the restorative procedure using intraradicular posts primarily depend on the remaining amount around the post (ferrule), the type and position of the tooth in the arch (impacting the masticatory forces exerted on the restored tooth), and the correct application of the cementation technique. It is noteworthy that fiberglass posts offer substantial advantages by presenting a modulus of elasticity similar to dental structure, ensuring a more homogeneous distribution of masticatory forces and reducing the risk of fractures. These findings have practical implications for material selection in restorative procedures involving intraradicular posts.(AU)

Objetivo: Esta revisão sistemática visa comparar a longevidade clínica de pinos intrarradiculares metálicos e de fibra de vidro em dentes com coroas severamente comprometidas, através de estudos clínicos randomizados e relatos de casos, publicados nos últimos onze anos. Material e Métodos: A pesquisa foi conduzida nas bases de dados PubMed, Medline, Lilacs e BBO, utilizando a primeira estratégia de busca com os s 'pinos dentais' e 'longevidade' e 'pinos reforçados com fibra de vidro' ou 'pinos metálicos'. A segunda estratégia de busca consistiu na análise das referências dos artigos identificados pela primeira estratégia. Ambos os estudos foram delineados com critérios rigorosos de inclusão e exclusão. Resultados: Não se constataram diferenças estatisticamente significativas e clinicamente relevantes na longevidade entre pinos metálicos e de fibra de vidro. Conclusão: O êxito clínico e a durabilidade do procedimento restaurador empregando pinos intrarradiculares dependem primordialmente da quantidade de remanescente ao redor do pino (férula), do tipo e posição do dente na arcada (o que impacta nas forças mastigatórias exercidas sobre o dente restaurado) e da aplicação correta da técnica de cimentação.Destaca-se que o pino de fibra de vidro oferece vantagens substanciais ao apresentar módulo de elasticidade similar à estrutura dentária, assegurando uma distribuição mais homogênea das forças mastigatórias e reduzindo o risco de fraturas (AU)

Desarrollo de un listado de procedimientos mínimos para certificar la competencia en endoscopia digestiva por método Delphi / Development of a list of minimum procedures to certify competence in digestive endoscopy by the Delphi method

Introducción: En el marco de referencia de cada especialidad médica, resulta un aspecto clave ofrecer un listado consensuado del tipo y número de prácticas que caracteriza el quehacer profesional de una especialidad. Es así que, el objetivo de este estudio es definir un listado de procedimientos mínimos para asegurar la competencia en Endoscopía Digestiva en base a un proceso de consenso estructurado, así como explorar las opiniones de referentes expertos en endoscopía digestiva sobre la formación de médicos endoscopistas en la Argentina y la necesidad de certificación de competencias. Materiales y métodos: Para esta investigación se realizó un estudio prospectivo de metodología mixta, a partir de la implementación del método Delphi, como técnica de investigación cualitativa grupal, seguido de la implementación de una encuesta estructurada. Resultados: El listado consolidado final incluyó 17 procedimientos considerados fundamentales para la certificación de la competencia en endoscopía digestiva. Dado la dispersión en el rango del número mínimo necesario para alcanzar la competencia se definió utilizar la mediana. En el caso de la endoscopía digestiva alta el número de procedimientos mínimo acordado fue de 200, mientras que en el caso de la videocolonoscopía fue de 150. Conclusión: Este listado es una pieza fundamental en el desarrollo de un marco formativo a nivel nacional en endoscopía digestiva, así como en un programa de certificación de la competencia (AU)

Timing of cardiac magnetic resonance and diagnostic yield in patients with myocardial infarction with nonobstructive coronary arteries.

INTRODUCTION AND OBJECTIVES: The present study sought to establish the diagnostic yield of cardiovascular magnetic resonance (CMR) in a large cohort of patients admitted with myocardial infarction (MI) with nonobstructive coronary artery disease (MINOCA) based on the timing of referral to CMR. METHODS: Consecutive patients referred to CMR from January 2009 to February 2022 with a working diagnosis of MINOCA were retrospectively evaluated. Cine, T2-weighted, early, and late gadolinium-enhanced images were acquired and analyzed. The frequency of the underlying diagnosis and the association between timing of CMR and relative frequency of each diagnosis were assessed. RESULTS: We included 207 patients (median age 50 years, 60% men). Final diagnosis after CMR was achieved in 91% of the patients (myocarditis in 45%, MI in 20%, tako-tsubo cardiomyopathy in 19%, and other cardiomyopathies in 7%). The performance of CMR within 7 days of admission with MINOCA (median, 5 days; 117 patients) allowed a higher diagnostic yield compared with CMR performed later (median, 10 days; 88 patients) (96% vs 86%, P=.02). Although myocarditis was the most frequent diagnosis in both groups according to time to CMR, its frequency was higher among patients with a CMR performed within the first 7 days (53% vs 35%, P=.02). The frequency of other underlying diagnoses was not influenced by CMR timing. CONCLUSIONS: CMR led to an underlying diagnosis of MINOCA in 91% of patients and its diagnostic yield increased to 96% when CMR was performed within 7 days of admission. The most frequent diagnosis was myocarditis..

Are abbreviations and acronyms to describe hernia repair techniques overused and helpful? A proposal for rationalisation.

Surgeons use abbreviations and acronyms frequently to describe surgical techniques. Recent advances and innovations in repair of abdominal wall hernias, have given rise to a plenitude of novel acronyms. For each small deviation of an existing technique authors have proposed a novel acronym. Since an acronym is most of times not self-explaining it is often hard to understand literature, lectures, symposia programs and discussions in social media. Regularly, we discover different acronyms used for the same procedure and sometimes the same or similar acronyms are used for different techniques. A clear and non-ambivalent description of surgical techniques in the literature is most valuable to summarize scientific evidence in systematic reviews and meta-analyses. We would like to propose a more rational use of abbreviations to describe hernia repair techniques based on the type of access, type of hernia, mesh position, type of mesh used and type of mesh fixation.

Mamas tuberosas: reconstrucción mediante tejido autólogo, sin prótesis / Tuberous breast: autologous tissue reconstruction, without implants

Introducción y objetivo: La mama tuberosa es una entidad malformativa muy frecuente en mujeres jóvenes y un reto por su frecuencia y complejidad quirúrgica. Exponemos la transición que hemos llevado a cabo en el manejo de las mamas tuberosas en el servicio público de Cirugía Plástica del Hospital General Universitario Dr. Balmis de Alicante (España), sustituyendo la técnica con prótesis por técnica que emplea en exclusiva tejido autólogo. Material y método: Estudio descriptivo, retrospectivo, revisando los últimos 101 casos realizados en nuestro servicio entre noviembre de 2010 y junio 2022. Recogemos datos acerca de las técnicas quirúrgicas, número de intervenciones necesarias, así como la tasa de complicaciones a corto y largo plazo entre la técnica con material protésico que realizamos de forma habitual hasta 2013 y la técnica con tejido autólogo que utilizamos posteriormente. Describimos la técnica utilizada para corregir la alteración de la forma y la asimetría de volumen de las mamas tuberosas mediante el uso de colgajos glandulares, lipoinjertos y pexias mamarias. Resultados: En el periodo descrito empleamos tejido autólogo de forma exclusiva en el 87% de los casos, el 81% correspondientes a grados II y III de Grolleau, con una media de 2.1 tiempos quirúrgicos. La técnica más utilizada fue la remodelación glandular asociada a lipoinjerto. El índice de complicaciones a medio y largo plazo fue menor en comparación con la reconstrucción habitual con prótesis. Conclusiones: Según nuestra experiencia, la cirugía de la mama tuberosa mediante el uso exclusivo de tejido autólogo en pacientes seleccionadas, permite corregir esta malformación sin recurrir al uso de material protésico, con resultados reproducibles y con menos complicaciones a medio y largo plazo en comparación con la reconstrucción habitual con prótesis.(AU)

Background and objective: Tuberous breast is a very common malformative entity in young women and a challenge due to its frequency and surgical complexity. We present our transition in the management of tuberous breasts of our public Plastic Surgery Service at the Dr. Balmis General University Hospital in Alicante (Spain), replacing technique with prosthetic material for exclusive technique with autologous tissue. Methods: Descriptive, retrospective study, reviewing the last 101 cases performed in our service between November 2010 and June 2022. Data have been collected about the surgical techniques, number of necessary interventions, as well as the rate of shortand long-term complications between the technique with prosthetic material that we routinely performed until 2013 and the technique with autologous tissue that we used subsequently. The technique used to correct the alteration in shape and volume asymmetry of the tuberous breast is described, through using glandular flaps, lipografts and mastopexy techniques. Results: In the period described, the use of autologous tissue exclusively has been carried out in 87% of the cases, 81% corresponding to Grolleau grades II and III, with an average of 2.1 surgical times. The most used technique was glandular remodeling associated with lipograft. The rate of complications in the medium and long term is lower compared to the usual technique with prostheses that we previously performed. Conclusions: According to our experience, treatment of the tuberous breast through the exclusive use of autologous tissue in selected patients, allows this malforation to be fixed without using prosthetic material, with a lower number of complications compared to reconstruction with prosthetic material.(AU)

Técnica de Miura modificada en pacientes con sindactilia congénita completa del primer espacio sin asociación a mano hendida / Modified Miura technique in complete congenital syndactyly of the first space not associated with cleft hand

Introducción y objetivo: La sindactilia es la anomalía congénita más frecuente de la extremidad superior. El compromiso del primer espacio es una patología rara pero genera importante deterioro funcional, por lo que el tratamiento quirúrgico es esencial para restaurar la función de prensión del pulgar. Están descritas múltiples estrategias quirúrgicas para lograr un primer espacio adecuado (igual o mayor a 90°), que incluyen desde colgajos locales y/o zetaplastias en sindactillias incompletas, hasta el uso de colgajos libres de antebrazo o expansores tisulares para sindactilias completas, con resultados funcionales variables y posible compromiso de zonas dadoras. Centramos nuestro trabajo en el empleo de la técnica de Miura modificada, presentado 2 casos clínicos. Material y método: Describimos el uso de la técnica Miura modificada en 2 pacientes de 14 y 5 meses de edad respectivamente, para la resolución de sindactilia congénita completa del primer espacio sin asociación a mano hendida. Resultados: El seguimiento fue de 40 meses para el caso 1 y de 26 meses para el caso 2. No hubo complicaciones tempranas ni tardías ni evidencia de retracción de la cicatriz, manteniendo la amplitud del primer espacio de 90° en ambos pacientes, con buen resultado funcional y estético. Conclusiones: En nuestra experiencia, el uso de la técnica de Miura modificada es una alternativa interesante para el tratamiento de la sindactilia del primer espacio no asociada a mano hendida, con un colgajo vascularmente seguro, de diseño sencillo, con buenos resultados funcionales y mínimas consecuencias estéticas.(AU)

Background and objective: Syndactyly is the most frequent congenital anomaly of the upper limb. Syndactyly of the first space is rare, but compromises functionality, so surgical treatment is essential to restore the thumb grip function. Multiple surgical strategies to achieve adequate space (equal to or greater than 90 °) have been described. These techniques include from the use of local flaps and/or zetaplasties in incomplete syndactyly, until the use of remote flaps from the forearm and tissue expanders if it is a completely absent space, with variable functional results and/or involvement of donor areas. This paper focus on the use of modified Miura technique and presents 2 clinical cases. Methods: The use of modified Miura technique in 2 patients, 14 and 5 months old respectively, is described in the resolution of complete congenital syndactyly of the first space not associated with a cleft hand,Results: Follow-up was 40 months for case 1 and 26 months for case 2. There were no early or late complications or evidence of scar retraction, maintaining the width of the first 90° space in both patients, with good functional and aesthetic results at long term follow up. Conclusions: In our experience, the use of the modified Miura technique is an interesting alternative for the treatment of first space syndactyly not associated with cleft hand, with a vascularly safe flap, of simple design, with good functional results and minimal aesthetic consequences.(AU)

Metroplastia cervical histeroscópica en útero septo completo, septo cervical y tabique vaginal. Análisis de resultados clínicos y reproductivos en serie de casos de 2011 a 2021 / Hysteroscopic cervical metroplasty in complete uterus septum, cervical septum and vaginal septum: Analysis of clinical and reproductive outcomes in a series of cases from 2011 to 2021

Antecedentes: El útero septo con septo cervical y tabique vaginal es una entidad poco frecuente únicamente descrita en clasificaciones que recogen malformaciones müllerianas complejas como son las clasificaciones de VCUAM (2005), de ESHRE/ESGE (2013) y de ASRM (2021). El objetivo de nuestro trabajo es describir los resultados en nuestras pacientes de la metroplastia cervical histeroscópica según técnica de Vercellini. Material y método: Se trata de un estudio observacional de cohortes retrospectivo con una duración de 10años. Se incluyeron solo pacientes con diagnóstico de útero septo completo, septo cervical y tabique vaginal con indicación de metroplastia cervical según técnica de Vercellini entre los años 2011 y 2021. Resultados: Se analizaron los resultados de 5 pacientes con indicación de la técnica. Analizando nuestro resultado destacamos un recién nacido vivo a término tras la realización de la técnica, la cual mantuvo seguimiento en consulta de prematuridad sin modificaciones cervicales consecuencia de la resección del tabique cervical. Conclusión: Existe muy poca evidencia disponible en cuanto al tratamiento del útero septo completo con septo cervical y tabique vaginal, debido a la escasa prevalencia del mismo y a la heterogeneidad del diagnóstico. Analizando los resultados obtenidos consideramos la intervención de Vercellini eficaz para eliminar el septo, la cual no parece asociarse a complicaciones mayores ni menores. En base a la evidencia existente, podría ser útil para mejorar el pronóstico reproductivo de las pacientes que presentan este tipo de malformación, individualizando la necesidad de un segundo retoque histeroscópico.(AU)

Background: The septum uterus with cervical septum and vaginal septum is a rare entity only described in classifications that include complex Müllerian malformations such as the VCUAM (2005), ESHRE/ESGE (2013) and ASRM (2021) classifications. The objective of our work is to describe the results of hysteroscopic cervical metroplasty according to the Vercellini technique in our patients. Material and method: This is a retrospective observational cohort study with a duration of 10years. Only patients with a diagnosis of a complete septum uterus, cervical septum, and vaginal septum with indication of cervical metroplasty according to the Vercellini technique between 2011 and 2021 were included. Results: The results of five patients with indication of the technique were analyzed. Analyzing our result, we highlight a live newborn at term after performing the technique, which was followed up in the prematurity clinic without cervical modifications because of the resection of the cervical septum. Conclusion: There is very little evidence available regarding the treatment of the uterus complete septum with cervical septum and vaginal septum due to its low prevalence and the heterogeneity of the diagnosis. Analyzing the results obtained, we consider the Vercellini intervention to be effective in removing the septum, which does not seem to be associated with major or minor complications. Based on the existing evidence, it could be useful to improve the reproductive prognosis of patients with this type of malformation; individualizing the need for a second hysteroscopic touch-up.(AU)

Nursing technicians' professional training in patient safety: A mixed-methods study / Formação profissional do técnico de enfermagem em segurança do paciente: estudo misto / Formación profesional del técnico en enfermería en seguridad del paciente: estudio mixto

Abstract Objective: to analyze nursing technicians' training in patient safety. Method: a convergent parallel mixed-methods study, where qualitative and quantitative elements were concomitantly implemented and equally prioritized, carried out in three technical colleges linked to a federal public institution in the Brazilian Northeast region. In the qualitative phase, semi-structured interviews were conducted with 24 professors and thematic analysis was applied. In the quantitative study, of the survey type, an instrument was used to screen terms about patient safety with 84 students. The results were combined during the general data interpretation, which was based on the Patient Safety Curricular Guide. Results: two thematic categories emerged: The professors' understanding about the theme of patient safety in nursing technicians' training; and Application and projection of the teaching of patient safety in nursing technicians' training. In the quantitative study, among the 46 screening terms, their identification in the theoretical-practical context predominated in Courses A and C, totaling 36 (78.3%) and 25 (54.3%), respectively. Theoretical teaching stood out in Course B, with 26 terms (56.5%). Conclusion: professional training of Nursing Technician students has a technical focus and does not fully contemplate patient safety issues in the teaching-learning process and, thus, constitutes a challenge for training institutions and professors alike.

Resumo Objetivo: analisar a formação de técnicos de enfermagem em segurança do paciente. Método: estudo de método misto paralelo convergente, em que elementos qualitativos e quantitativos foram concomitantemente implementados e igualmente priorizados, realizado em três colégios técnicos vinculados a uma instituição pública federal do Nordeste brasileiro. No qualitativo, realizou-se entrevista semiestruturada com 24 docentes e aplicou-se a análise temática. No estudo quantitativo, survey, utilizou-se instrumento para rastrear termos sobre segurança do paciente com 84 discentes. A interpretação geral dos dados realizou a combinação dos resultados e balizou-se no Guia Curricular de Segurança do Paciente. Resultados: emergiram duas categorias temáticas: Compreensão dos docentes acerca do tema segurança do paciente na formação de técnicos de enfermagem e Aplicação e projeção do ensino da segurança do paciente na formação de técnicos de enfermagem. No estudo quantitativo, dos 46 termos rastreadores, predominou a identificação de termos no contexto teórico-prático, nos Cursos A e C, totalizando 36 (78,3%) e 25 (54,3%), respectivamente. No Curso B, destacou-se ensino teórico, com 26 termos (56,5%). Conclusão: a formação profissional do discente técnico de enfermagem apresenta foco tecnicista e não contempla, integralmente, no processo ensino-aprendizagem, questões de segurança do paciente e, assim, configura-se desafio para as instituições formadoras e docentes.

Resumen Objetivo: analizar la formación de los técnicos en enfermería en seguridad del paciente. Método: estudio de método mixto paralelo convergente, en el que los elementos cualitativos y cuantitativos fueron implementados simultáneamente y considerados con el mismo nivel de prioridad, realizado en tres escuelas técnicas vinculadas a una institución pública federal en el Nordeste brasileño. En el estudio cualitativo se realizó una entrevista semiestructurada a 24 profesores y se aplicó el análisis temático. En el estudio cuantitativo, survey, se utilizó un instrumento para detectar términos sobre seguridad del paciente con 84 estudiantes. Para la interpretación general de los datos se realizó la combinación de los resultados y se tomó como base la Guía Curricular de Seguridad del Paciente. Resultados: surgieron dos categorías temáticas: Comprensión de los docentes sobre la seguridad del paciente en la formación de técnicos en enfermería e Implementación y proyección de la enseñanza de la seguridad del paciente en la formación de técnicos en enfermería. En el estudio cuantitativo, en los 46 términos indicadores, predominó la identificación de términos en el contexto teórico-práctico, en las carreras A y C, con un total de 36 (78,3%) y 25 (54,3%), respectivamente. En la carrera B se destacó la enseñanza teórica, con 26 términos (56,5%). Conclusión: la formación profesional de los estudiantes de la carrera de técnico en enfermería tiene un enfoque técnico y no considera de forma integral los temas que tienen que ver con la seguridad del paciente en el proceso de enseñanza-aprendizaje, por lo que es un desafío para las instituciones formadoras y para los docentes.

O meu estilo de vida FANTASTICO: Tradução, adaptação e validação do questionário em pré-adolescentes portugueses / The FANTASTIC questionnaire: Translation, adaptation, and validation of the lifestyle assessment instrument in Portuguese preadolescents / Mi estilo de vida FANTASTICO: traducción, adaptación y validación del cuestionario en preadolescentes portugueses

Resumo Enquadramento: Os estilos de vida construídos na pré-adolescência influenciarão todo o desenvolvimento humano ao longo do ciclo vital. O seu diagnóstico constitui uma necessidade efetiva para a prestação dos cuidados de enfermagem ao nível da saúde escolar. Objetivo: Traduzir, adaptar e validar o questionário FANTASTICO para pré-adolescentes portugueses. Metodologia: realizou-se um processo de tradução e de adaptação do questionário com recurso à Técnica de Delphi. Foi criada uma base informática específica. Realizou-se um estudo exploratório para avaliar as propriedades psicométricas do instrumento. O processo desenvolveu-se entre janeiro e julho de 2019. Resultados: A versão traduzida e adaptada em painel de peritos, manteve os 30 itens do instrumento original. O estudo exploratório revelou que o instrumento apresenta um bom alfa de Cronbach total de 0,72. Conclusão: A versão portuguesa O Meu Estilo de Vida FANTASTICO (pré-adolescentes) constitui um bom instrumento de medida para avaliar os estilos de vida dos pré-adolescentes portugueses.

Abstract Background: Lifestyles built in pre-adolescence will influence all human development throughout the life cycle. Its diagnosis constitutes an effective need for the provision of nursing care in terms of school health. Objective: To translate, adapt and validate the FANTASTICO questionnaire for Portuguese pre-adolescents. Methodology: A process of translation and adaptation of the questionnaire was carried out using the Delphi technique. A specific computer base it was created. An exploratory study was carried out to evaluate the instrument's psychometric properties. The process took place between January and July 2019. Results: The translated version and adapted by an expert panel maintained the 30 items of the original instrument. The exploratory study revealed that the instrument has good psychometric properties with a total Cronbach's alpha of 0.72. Conclusion: The Portuguese version O Meu Estilo de Vida FANTASTICO (pre-adolescents) is a good measuring instrument to assess the lifestyles of Portuguese pre-adolescents.

Resumen Marco contextual: Los estilos de vida construidos en la preadolescencia influirán en todo el desarrollo humano a lo largo del ciclo vital. Su diagnóstico es una necesidad efectiva para la prestación de cuidados de enfermería en el ámbito de la salud escolar. Objetivo: Traducir, adaptar y validar el cuestionario FANTASTICO para preadolescentes portugueses. Metodología: Se llevó a cabo un proceso de traducción y adaptación del cuestionario mediante la técnica Delphi. Se creó una base de datos informática específica. Se realizó un estudio exploratorio para evaluar las propiedades psicométricas del instrumento. El proceso se desarrolló entre enero y julio de 2019. Resultados: La versión traducida y adaptada en panel de expertos mantuvo los 30 ítems del instrumento original. El estudio exploratorio mostró que el instrumento tiene un buen alfa de Cronbach total de 0,72. Conclusión: La versión portuguesa Mi Estilo de Vida FANTASTICO (preadolescentes) constituye un buen instrumento de medida para evaluar los estilos de vida de los preadolescentes portugueses.

Efecto de la técnica de la tos durante la inyección subcutánea de heparina sobre la severidad del dolor y la satisfacción individual / Effect of the coughing technique during subcutaneous heparin injection on pain severity and individual satisfaction / Efeito da técnica de tosse durante injeção subcutânea de heparina na intensidade da dor e satisfação individual

Objetivo: examinar el efecto de la técnica de tos de mediana intensidad durante la inyección subcutánea de heparina de bajo peso molecular sobre la severidad del dolor y la satisfacción individual en pacientes de cirugía general. Método: estudio prospectivo, cuasi experimental, que incluyó a 100 pacientes a los que se les prescribió una inyección subcutánea de heparina de bajo peso molecular una vez cada 24 horas. Cada paciente recibió dos inyecciones por el mismo investigador utilizando técnica de inyección estándar con técnica de tos de intensidad media y solo técnica de inyección estándar. Resultados: hubo una diferencia estadísticamente significativa entre las puntuaciones medias de los pacientes sobre la intensidad del dolor y los niveles de satisfacción después de las inyecciones administradas por las dos técnicas (p= 0,000). Además, se encontró que el género afectó la severidad del dolor relacionado con la inyección, pero no afectó el nivel de satisfacción individual. Conclusión: se encontró que la técnica de tos de intensidad media reduce la severidad del dolor y aumenta la satisfacción del paciente de cirugía general que reciben inyecciones subcutáneas de heparina de bajo peso molecular. Registro del ensayo: NCT05681338.

Objective: to examine the effect of the medium intensity coughing technique during subcutaneous low molecular weight heparin injection on pain severity and individual satisfaction in general surgery patients. Method: the prospective, quasi-experimental study included 100 patients who had been prescribed a subcutaneous low molecular weight heparin injection once in 24 hours. Each patient received two injections by the same researcher, one using the standard injection technique with medium intensity coughing technique and the other only the standard injection technique. Results: there was a statistically significant difference between patients' mean scores on pain severity and satisfaction levels after injections administered by the two techniques (p= 0.000). Also, it was found that gender affected pain severity relating to the injection but did not affect the level of individual satisfaction. Conclusion: the medium intensity coughing technique was found to reduce pain severity and increase patient satisfaction in general surgery patients receiving subcutaneous low molecular weight heparin injections. Trial registration: NCT05681338.

Objetivo: examinar o efeito da técnica de tosse de média intensidade durante injeção subcutânea de heparina de baixo peso molecular na intensidade da dor e satisfação individual em pacientes submetidos à cirurgia geral. Método: estudo prospetivo, quasi experimental que incluiu 100 pacientes que haviam recebido uma injeção subcutânea de heparina de baixo peso molecular em 24 horas. Cada paciente recebeu duas injeções pelo mesmo pesquisador usando a técnica de injeção padrão com técnica de tosse de média intensidade e apenas técnica de injeção padrão. Resultados: houve diferença estatisticamente significativa entre as pontuações médias dos pacientes quanto à gravidade da dor e níveis de satisfação após as injeções administradas pelas duas técnicas (p = 0,000). Além disso, verificou-se que o sexo do paciente afetou a intensidade da dor relacionada à injeção, mas não afetou o nível de satisfação individual. Conclusão: a técnica de tosse de média intensidade reduz a intensidade da dor e aumenta a satisfação de pacientes submetidos à cirurgia geral recebendo injeções subcutâneas de heparina de baixo peso molecular. Registro do ensaio clínico: NCT05681338.