Drug-Coated Balloon Angioplasty vs Plain Balloon Angioplasty in patients with coronary In-Stent Restenosis: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: In-stent restenosis (ISR) remains a significant challenge in interventional cardiology despite advancements in stent technology. Drug-coated balloons (DCBs), which deliver antiproliferative agents directly to the vessel wall, have emerged as a promising alternative to plain balloon angioplasty for ISR treatment. This meta-analysis evaluates the efficacy of DCBs compared to plain balloon angioplasty in patients with coronary ISR. METHODS: A comprehensive search of PubMed and Embase was conducted on June 27, 2024. The search identified randomized controlled trials comparing DCBs and plain balloon angioplasty for ISR treatment. Six trials involving 1,322 patients met the inclusion criteria. Quality was assessed with the Cochrane Risk of Bias tool. Data extraction and statistical analysis were performed using RevMan software, assessing heterogeneity with the I2 statistic and publication bias using funnel plots. RESULTS: The analysis showed that DCBs significantly reduced late in-stent and in-segment luminal loss (P < 0.001) and target lesion revascularization (P = 0.02) compared to plain balloon angioplasty. Major adverse cardiovascular events and the combined endpoint of target lesion revascularization, myocardial infarction, and death also showed highly significant improvements with DCB treatment (P < 0.00001 and P = 0.0002, respectively). However, no significant effect was observed on myocardial infarction and mortality rates. CONCLUSION: DCBs significantly reduce in-stent late luminal loss, target lesion revascularization, and major adverse cardiovascular events compared to plain balloon angioplasty.

Thermodynamic and Structural Study of Budesonide-Exogenous Lung Surfactant System.

The clinical benefits of using exogenous pulmonary surfactant (EPS) as a carrier of budesonide (BUD), a non-halogenated corticosteroid with a broad anti-inflammatory effect, have been established. Using various experimental techniques (differential scanning calorimetry DSC, small- and wide- angle X-ray scattering SAXS/WAXS, small- angle neutron scattering SANS, fluorescence spectroscopy, dynamic light scattering DLS, and zeta potential), we investigated the effect of BUD on the thermodynamics and structure of the clinically used EPS, Curosurf®. We show that BUD facilitates the Curosurf® phase transition from the gel to the fluid state, resulting in a decrease in the temperature of the main phase transition (Tm) and enthalpy (ΔH). The morphology of the Curosurf® dispersion is maintained for BUD < 10 wt% of the Curosurf® mass; BUD slightly increases the repeat distance d of the fluid lamellar phase in multilamellar vesicles (MLVs) resulting from the thickening of the lipid bilayer. The bilayer thickening (~0.23 nm) was derived from SANS data. The presence of ~2 mmol/L of Ca2+ maintains the effect and structure of the MLVs. The changes in the lateral pressure of the Curosurf® bilayer revealed that the intercalated BUD between the acyl chains of the surfactant's lipid molecules resides deeper in the hydrophobic region when its content exceeds ~6 wt%. Our studies support the concept of a combined therapy utilising budesonide-enriched Curosurf®.

Polymyxin B-Enriched Exogenous Lung Surfactant: Thermodynamics and Structure.

The use of an exogenous pulmonary surfactant (EPS) to deliver other relevant drugs to the lungs is a promising strategy for combined therapy. We evaluated the interaction of polymyxin B (PxB) with a clinically used EPS, the poractant alfa Curosurf (PSUR). The effect of PxB on the protein-free model system (MS) composed of four phospholipids (diC16:0PC/16:0-18:1PC/16:0-18:2PC/16:0-18:1PG) was examined in parallel to distinguish the specificity of the composition of PSUR. We used several experimental techniques (differential scanning calorimetry, small- and wide-angle X-ray scattering, small-angle neutron scattering, fluorescence spectroscopy, and electrophoretic light scattering) to characterize the binding of PxB to both EPS. Electrostatic interactions PxB-EPS are dominant. The results obtained support the concept of cationic PxB molecules lying on the surface of the PSUR bilayer, strengthening the multilamellar structure of PSUR as derived from SAXS and SANS. A protein-free MS mimics a natural EPS well but was found to be less resistant to penetration of PxB into the lipid bilayer. PxB does not affect the gel-to-fluid phase transition temperature, Tm, of PSUR, while Tm increased by ∼+ 2 °C in MS. The decrease of the thickness of the lipid bilayer (dL) of PSUR upon PxB binding is negligible. The hydrophobic tail of the PxB molecule does not penetrate the bilayer as derived from SANS data analysis and changes in lateral pressure monitored by excimer fluorescence at two depths of the hydrophobic region of the bilayer. Changes in dL of protein-free MS show a biphasic dependence on the adsorbed amount of PxB with a minimum close to the point of electroneutrality of the mixture. Our results do not discourage the concept of a combined treatment with PxB-enriched Curosurf. However, the amount of PxB must be carefully assessed (less than 5 wt % relative to the mass of the surfactant) to avoid inversion of the surface charge of the membrane.

Loss of 15-Lipoxygenase in Retinodegenerative RCS Rats.

Retinitis pigmentosa (RP) is a retinal degenerative disease associated with a diversity of genetic mutations. In a natural progression study (NPS) evaluating the molecular changes in Royal College of Surgeons (RCS) rats using lipidomic profiling, RNA sequencing, and gene expression analyses, changes associated with retinal degeneration from p21 to p60 were evaluated, where reductions in retinal ALOX15 expression corresponded with disease progression. This important enzyme catalyzes the formation of specialized pro-resolving mediators (SPMs) such as lipoxins (LXs), resolvins (RvDs), and docosapentaenoic acid resolvins (DPA RvDs), where reduced ALOX15 corresponded with reduced SPMs. Retinal DPA RvD2 levels were found to correlate with retinal structural and functional decline. Retinal RNA sequencing comparing p21 with p60 showed an upregulation of microglial inflammatory pathways accompanied by impaired damage-associated molecular pattern (DAMP) clearance pathways. This analysis suggests that ALXR/FPR2 activation can ameliorate disease progression, which was supported by treatment with an LXA4 analog, NAP1051, which was able to promote the upregulation of ALOX12 and ALOX15. This study showed that retinal inflammation from activated microglia and dysregulation of lipid metabolism were central to the pathogenesis of retinal degeneration in RP, where ALXR/FPR2 activation was able to preserve retinal structure and function.

Oseltamivir phosphate interaction with model membranes.

Oseltamivir belongs to the neuraminidase inhibitors, developed against the influenza virus, and registered under the trademark Tamiflu. Despite its long-term acquaintance, there is limited information in the literature about its physicochemical and structural properties in a lipid-water system. We present an experimentally determined partition coefficient with structural information on the interaction of oseltamivir with the model membrane, its possible location, and its effect on the membrane thermodynamics. The hydrophobic part of the lipid bilayer is affected to a moderate extent, which was proved by slight changes in thermal and structural properties. Hereby, interaction of oseltamivir with the phospholipid bilayer induces concentration dependent decrease of lateral pressure in the bilayer acyl chain region. Oseltamivir charges the bilayer surface positively, which results in the zeta potential increase and changes in anisotropic properties studied by the polarised light microscopy. At the highest oseltamivir concentrations studied, the multilamellar structure is extensively disturbed, likely due to electrostatic repulsion between the adjacent bilayers.

Efecto cicatrizante en incisiones periodontales por extracto hidroalcohólico de Morinda citrifolia / Healing effect on periodontal incisions by hydroalcoholic extract of Morinda citrifolia / Efeito cicatrizante do extrato hidroalcoólico de Morinda citrifolia em incisões periodontais

Los tratamientos periodontales implican cortes y sangrado de la mucosa gingival; la Morinda citrifolia, específicamente sobre los fragmentos encargados de la cicatrización (plaquetas), tiene un efecto más significativo en los procesos curativos de las lesiones. Objetivo. Identificar el potencial cicatrizante de los extractos hidroalcohólicos de Morinda citrifolia (noni peruano) en los procesos regenerativos de las incisiones periodontales al 70% a diversas concentraciones (1%; 5; y 10%) y su efecto coadyuvante acelerador en la vía oral como curación de tejidos. Materiales y Métodos. Se realizó una investigación aplicada, bajo el diseño experimental. Para ello, se llevó a cabo un estudio previo para el análisis farmacognóstico, porcentaje de humedad, pruebas de solubilidad y el análisis fitoquímico cualitativo para garantizar que el análisis farmacológico y la prueba experimental se completaran adecuadamente. Se administraron dosis a cinco ratas albinas macho Holtzman divididas en cuatro grupos a los cuales se les aplicó las concentraciones en cantidades de 0,5 ml dos veces al día en la incisión, la cual se evaluó durante siete días para obtener parámetros específicos, como infección, tono de piel gingival, cierre de heridas, reducción del tamaño de la incisión y porcentaje de curación. Resultados. Indicaron que todos los grupos que se le suministró el extracto hidroalcohólico al 70% en varias concentraciones mejoró su actividad curativa al reducir el tamaño de la incisión en la encía al séptimo día, donde resultó que la mejor concentración fue del 5% en comparación con las otras concentraciones (1% y 10%). Investigación que indica la eficacia de la Morinda citrifolia peruana como acelerador del proceso de curación en la terapia periodontal.

Periodontal treatments involve cuts and bleeding of the gingival mucosa; Morinda citrifolia, specifically on the fragments in charge of healing (platelets), has a more significant effect on the healing processes of the lesions. Objective. To identify the healing potential of hydroalcoholic extracts of Morinda citrifolia (Peruvian noni) in the regenerative processes of periodontal incisions at 70% at various concentrations (1%; 5; and 10%) and its accelerating coadjuvant effect in the oral route as tissue healing. Materials and Methods. An applied research was carried out under an experimental design. For this purpose, a previous study was carried out for pharmacognostic analysis, moisture percentage, solubility tests and qualitative phytochemical analysis to ensure that the pharmacological analysis and experimental test were properly completed. Doses were administered to five male Holtzman albino rats divided into four groups to which the concentrations were applied in 0.5 ml amounts twice daily to the incision, which was evaluated for seven days for specific parameters, such as infection, gingival skin tone, wound closure, incision size reduction and percentage healing. Results. They indicated that all groups that were given the 70% hydroalcoholic extract in various concentrations improved their healing activity by reducing the size of the gingival incision on the seventh day, where it turned out that the best concentration was 5% compared to the other concentrations (1% and 10%). Conclusion. Research indicating the efficacy of Peruvian Morinda citrifolia as an accelerator of the healing process in periodontal therapy.

Os tratamentos periodontais envolvem corte e sangramento da mucosa gengival; a Morinda citrifolia, especificamente sobre os fragmentos responsáveis pela cicatrização (plaquetas), tem um efeito mais significativo nos processos de cicatrização das lesões. Objetivo. Identificar o potencial cicatrizante de extratos hidroalcoólicos de Morinda citrifolia (noni peruano) nos processos regenerativos de incisões periodontais a 70% em diversas concentrações (1%; 5; e 10%) e seu efeito coadjuvante acelerador na via oral como cicatrizante tecidual. Materiais e métodos. Foi realizada uma pesquisa aplicada sob um desenho experimental. Para esse fim, foi realizado um pré-estudo para análise farmacognóstica, porcentagem de umidade, testes de solubilidade e análise fitoquímica qualitativa para garantir que a análise farmacológica e o teste experimental fossem adequadamente concluídos. Cinco ratos albinos Holtzman machos divididos em quatro grupos foram dosados e as concentrações foram aplicadas em quantidades de 0,5 ml duas vezes ao dia na incisão, que foi avaliada por sete dias quanto a parâmetros específicos, como infecção, tônus gengivais da pele, fechamento da ferida, redução do tamanho da incisão e porcentagem de cicatrização. Resultados. Eles indicaram que todos os grupos que receberam extrato hidroalcoólico a 70% em várias concentrações melhoraram sua atividade de cicatrização ao reduzir o tamanho da incisão gengival no sétimo dia, sendo que a melhor concentração foi de 5% em comparação com as outras concentrações (1% e 10%). Conclusão. A pesquisa indica a eficácia da Morinda citrifolia peruana como um acelerador do processo de cicatrização na terapia periodontal.

Diversidad y ecología de Tephritoidea (Insecta: Diptera) en el norte de la Orinoquía colombiana / Diversity and ecology of Tephritoidea (Insecta: Diptera) on the north of the Colombian Orinoquía

Resumen Introducción: Los Tephritoidea, como grupo, tienen un impacto ecológico porque se alimentan de hongos, insectos, flores, frutas en descomposición, excrementos, sudor, nódulos de raíces, carroña (incluidos cadáveres humanos) y otros materiales en descomposición. Las moscas de la fruta son insectos de gran importancia en la agricultura y la investigación genética. En Colombia existen 58 géneros y 224 especies, pero no existe un estudio general del grupo en la Orinoquía colombiana. Objetivo: Caracterizar las comunidades de Tephritoidea (aspectos taxonómicos y ecológicos) y aportar información básica de las especies de importancia económica en la Orinoquía colombiana. Métodos: Semanalmente desde agosto 2017 hasta febrero 2018 recolectamos moscas de la fruta en trampas McPhail cebadas con proteína de maíz, en un huerto doméstico y un fragmento de bosque en Arauca, y también en Saravena, Orinoquía, Colombia. Resultados: Identificamos 27 especies (12 Tephritidae, 11 Richardiidae y 4 Lonchaeidae), nueve de ellas plagas agrícolas. Euarestopsis paupera, Hemixantha lutea, Melanoloma affinis, Melanoloma cyanogaster, Melanoloma varians y Sepsisoma anale se reportan por primera vez para Colombia. Se calcularon los índices de diversidad para las comunidades estudiadas, encontrando diferencias entre las localidades y ambiente. Se discute la influencia de las condiciones ambientales sobre la variabilidad encontrada. Se encontraron nueve especies de moscas consideradas como plagas de producciones agrícolas y para estas especies se estudió su relación con plantas hospederas y la dinámica poblacional. Conclusiones: Seis meses de muestreo produjeron varios primeros registros, lo que sugiere que la fauna de Tephritoidea está submuestreada en la región. La temporada de lluvias y las actividades humanas se correlacionan con la diversidad y abundancia de especies en la Orinoquía colombiana.

Abstract Introduction: The Tephritoidea as a group, have an ecological impact because they feed on fungi, insects, flowers, decaying fruit, excrement, sweat, root nodules, carrion (including human corpses), and other decomposing materials. The fruit-flies are insects of great importance in agriculture and genetic research. In Colombia, there are 58 genera and 224 species, but there is no general study of the group in the savannas of Orinoquía. Objective: To characterize the Tephritoidea communities (taxonomic and ecological aspects) and to provide basic information about the economically important species in the Colombian Orinoquía. Methods: Weekly from August 2017 to February 2018 we collected flies from fruits and McPhail traps baited with corn protein, in a domestic orchard and a forest fragment in Arauca, and also in Saravena, Orinoquía, Colombia. Results: We identified 27 species (12 Tephritidae, 11 Richardiidae and 4 Lonchaeidae), nine of them agricultural pests. Euarestopsis paupera, Hemixantha lutea, Melanoloma affinis, Melanoloma cyanogaster, Melanoloma varians and Sepsisoma anale are reported for the first time from Colombia. A diversity index was calculated for studied communities, being differences between localities and sites. Influence of climatic conditions over variability was found and is discussed. Nine species of fruit flies, which are considered agricultural pests, were identified. For these species their relationship with host plants and population dynamics were studied. Conclusions: Six months of sampling produced several first reports, suggesting that the fauna of Tephritoidea is undersampled in the region. The rainy season, and human activities, correlate with species diversity and abundance in the Colombian Orinoquía.

Tumores del estroma gastrointestinal en un Hospital de México / Gastrointestinal stroma tumor in a hospital of Mexico

Introducción: Los tumores del estroma gastrointestinal son neoplasias de comportamiento benigno o maligno. Se originan de las células intersticiales de Cajal del tubo digestivo. Objetivo: Describir dos formas distintas de presentación clínica de los tumores del estroma gastrointestinal. Casos clínicos: El caso 1, paciente femenina de 65 años de edad que acudió por síntomas compresivos del tubo digestivo superior a causa de un gastrointestinal gástrico. El caso 2, paciente masculino de 56 años de edad que acudió por sangrado de tubo digestivo medio ocasionado por un gastrointestinal intestinal. Conclusiones: Los tumores del estroma gastrointestinal tienen distinta presentación clínica. Su tratamiento es esencialmente quirúrgico y en algunos casos complementados con terapia molecular dirigida(AU)

Introduction: Gastrointestinal stromal tumors are neoplasms of benign or malignant behavior. They originate from the interstitial cells of Cajal in the digestive tract. Objective: The objective of this work is to describe two different forms of clinical presentation. Case report: case 1: 65-year-old female patient who presented for compression symptoms of the upper digestive tract due to gastric GIST; case 2: 56-year-old male who presented with bleeding from the middle digestive tract caused by intestinal GIST. Conclusions: GISTs have different clinical presentation. Its treatment is essentially surgical and in some cases supplemented with targeted molecular therapy(AU)

¿Sabemos Cuántos Profesionales Especialistas En Psicología Clínica Trabajan En El Sistema Nacional De Salud Español? / Do We Know How Many Professional Specialists In Clinical Psychology Work In The Spanish National Health System?

En este artículo se revisan, analizan y discuten los datos existentes a partir de diferentes fuentes de datos desde 2003 sobre el número de profesionales especialistas en Psicología clínica que trabajan en el Sistema Nacional de Salud español. Los datos hay que tomarlos con mucha cautela por la diversidad de fuentes y metodología utilizada; pero se concluye que el número total estimado de Psicólogos Especialistas en Psicología clínica más los «PESTOS» que trabajan en el SNS puede estar en torno a 2600-2800, con una ratio por 100000 habitantes en torno al 5,58, con grandes diferencias entre Comunidades Autónomas. En los últimos 15 años, el incremento medio de la ratio de psicólogos por 100000 habitantes se sitúa en algo más de un psicólogo. Se recomienda realizar estudios detallados para saber no solo cuántos especialistas en Psicología clínica hay en cada Comunidad Autónoma, sino en qué tipo de niveles y en qué tipo de dispositivos se ubican. (AU)

This article reviews, analyzes, and discusses existing data since 2003 on the number of psychologists who are specialists in clinical psychology working in the Spanish National Health System (SNS) from different data sources. The data must be taken with great caution due to the diversity of sources and methodology used, but it is concluded that the total estimated number of Specialist Psychologists in Clinical Psychology plus «PESTOS» [specialist psychologists without an official qualification] who work in the SNS may be around 2,600-2800, with a ratio per 100,000 inhabitants around 5.58, with great differences between autonomous communities. In the last 15 years, the average increase in the ratio of psychologists per 100,000 inhabitants is slightly more than one psychologist. It is recommended to carry out detailed studies to find out not only how many specialists in clinical psychology there are in each autonomous community, but also at what levels and in what type of units they are located. (AU)

Neoplasia endocrina múltiple IIA: feocromocitoma bilateral. A propósito de un caso y revisión de la literatura / Multiple Endocrine Neoplasia IIA: Bilateral Pheochromocytoma. About a Case and Literature Review

Resumen: Presentamos el caso de una paciente del sexo femenino, de 54 años de edad, con antecedente familiar de neoplasia endocrina múltiple tipo II, con estudio genético positivo para NEM 2 IIA EXON 11, c634 CGCIB. Inició padecimiento con cardiopatía hipertensiva y disfunción diastólica, hallazgo to mográfico de tumor suprarrenal bilateral por imagenología, se realizó adrenalectomía convencional transabdominal, se encontró tumor derecho con cápsula correspondiente a feo cromocitoma con un peso de 1,100 g de 14.5 cm de diámetro mayor con invasión a cápsula sin romperla, tumor suprarrenal izquierdo correspondiente a feocromocitoma con un peso de 950 g de 15 cm de diámetro mayor.

Abstract: We present the case of a 54-year-old female patient with a family history of multiple endocrine neoplasia type II, with a genetic study for MEN 2 IIA EXON 11, CG6B c634, onset with hypertensive heart disease and diastolic dysfunction, tomographic finding of bilateral adrenal tumor by imaging. A conventional transabdominal adrenalectomy was performed, finding a right tumor with a capsule corresponding to pheochromocytoma with a weight of 1,100 g of 14.5 cm of greater diameter with invasion of the capsule without breaking it, and a left adrenal tumor corresponding to pheochromocytoma with a weight of 950 g of 15 cm of greater diameter.

Leucoencefalopatía megalencefálica con quistes: importancia de la descripción clínica en la era genética / Megalencephalic leukoencephalopathy with cysts -the clinical importance in the genetic era

INTRODUCCIÓN: La leucoencefalopatía megalencefálica con quistes es una leucodistrofia de origen genético que produce una alteración de la homeostasis del agua e iones en el cerebro, generando formas vacuolares y edema crónico en la sustancia blanca con deterioro neurológico progresivo. Debe sospecharse en los lactantes que presentan macrocefalia progresiva durante el primer año de vida, retraso motor y hallazgos característicos en la resonancia magnética cerebral. CASO CLÍNICO: Niña en seguimiento desde los 9 meses por macrocefalia progresiva y retraso del desarrollo psicomotor con presencia en la resonancia magnética cerebral de hallazgos compatibles con leucoencefalopatía megalencefálica con quistes, y aparición de epilepsia en su evolución. Los estudios genéticos habituales (secuenciación de nueva generación y array) fueron negativos, pero, al cumplir los criterios diagnósticos, se procedió al estudio del ARN mensajero y el ADN complementario, que confirmó la presencia de dos variantes patogénicas en MLC1. CONCLUSIONES: La leucoencefalopatía megalencefálica con quistes es una entidad infrecuente. Es característica la macrocefalia progresiva en el primer año de vida, la ausencia de deterioro o deterioro lento, y la posibilidad de desarrollar epilepsia, espasticidad y ataxia en su evolución. Cobra importancia en dichos pacientes la realización de una prueba de imagen que muestre hallazgos propios de la entidad, lo que, junto con la clínica, permite diferenciarla de otras leucodistrofias y establecer un diagnóstico confirmatorio. Los estudios genéticos pueden constatar la mutación asociada que posibilita predecir el fenotipo clinicorradiológico

INTRODUCTION: Megalencephalic leukoencephalopathy with cysts is a leukodystrophy of genetic origin that produces an alteration in the water and ion homeostasis in the brain, generating vacuolar forms and chronic oedema in the white matter with progressive neurological deterioration. It should be suspected in infants who present progressive macrocephaly during the first year of life, motor retardation and characteristic findings in magnetic resonance brain scans. CASE REPORT: We report the case of a girl who was followed up from the age of 9 months due to progressive macrocephaly and delayed psychomotor development and brain MRI findings consistent with megalencephalic leukoencephalopathy with cysts, and the appearance of epilepsy during its development. The usual genetic studies (new generation sequencing and array) were negative, but as the diagnostic criteria were met, a complementary messenger RNA and DNA study was conducted, which confirmed the presence of two pathogenic variants in MLC1. CONCLUSIONS: Megalencephalic leukoencephalopathy with cysts is a rare condition. Progressive macrocephaly in the first year of life, the absence of deterioration or slow deterioration, and the possibility of developing epilepsy, spasticity and ataxia are characteristic signs in its course. It is important for these patients to undergo an imaging test that shows findings that characterise this condition, which, together with the clinical features, makes it possible to differentiate it from other leukodystrophies and to establish a confirmatory diagnosis. Genetic studies can confirm the associated mutation that makes it possible to predict the clinicoradiological phenotype

Ruptura de vena cava inferior secundaria a uso de sonda de ecografía intracardiaca tratada de manera exitosa con balón de alta distensibilidad / Inferior vena cava rupture associated with the use of an intracardiac echocardiography probe and successfully treated with a high-compliance balloon

Resumen La ruptura de la vena cava inferior durante los procedimientos de intervencionismo percutáneo es una complicación infrecuente que se asocia con alta tasa de mortalidad aunque sea detectada a tiempo y se realice reparo quirúrgico, el cual es hoy el estándar de manejo. No existen hasta el momento casos reportados de manejo percutáneo de perforación de la vena cava durante procedimientos de electrofisiología. Se describe el caso de una paciente llevada a aislamiento eléctrico de venas pulmonares para el manejo de fibrilación auricular paroxística, en quien, durante el procedimiento, se produjo perforación accidental de la vena cava inferior con la sonda de ecocardiografía intracardiaca, la cual fue tratada exitosamente mediante el uso de un balón de alta distensibilidad con lo que se logró adecuada hemostasia sin necesidad de intervención quirúrgica. Se considera que el uso de un balón de alta distensibilidad puede ser una herramienta útil en el control del sangrado asociado a lesiones vasculares iatrogénicas, y que por consiguiente todo intervencionista debería tener presente.

Abstract Rupture of the inferior vena cava during percutaneous intervention procedures is an uncommon complication. It is associated with a high rate of mortality, even when it is detected at the time and the current standard management, surgical repair is performed. At present there are no cases reported of the percutaneous management of a vena cava perforation during electrophysiology procedures. The case is described of a patient subjected to electric ablation of pulmonary veins for the management of paroxysmal atrial fibrillation. During the procedure there was an accidental rupture of the inferior vena cava with the echocardiography cardiac catheter. She was successfully treated using a high-compliance balloon, with adequate haemostasis being achieved without surgical intervention. The use of a high-compliance balloon is considered as a useful tool in the control of bleeding associated with iatrogenic vascular injuries, and for this reason all interventionist should be aware of it.

Evaluación de la implantación de un protocolo de recuperación intensificada en cirugía electiva de colon y recto: un estudio cuasiexperimental / No disponible

INTRODUCCIÓN: Los protocolos de recuperación intensificada (PRI) en cirugía de colon y recto disminuyen la estancia hospitalaria y las complicaciones, pero son pocos los estudios acerca de si son coste-efectivos. MÉTODOS: Comparamos un grupo de 121 pacientes (grupo RICA) operados de forma consecutiva de cirugía electiva de colon y recto según un PRI, con una cohorte histórica de 135 pacientes (grupo preRICA) operados antes de la implantación del PRI de forma tradicional. Se realizó un análisis univariante para comparar los datos de estancia, complicaciones, reingresos y coste efectividad, y un análisis multivariante para comprobar si la realización de cirugía laparoscópica, el PRI, las complicaciones, el sexo y la edad influían de forma independiente en la estancia hospitalaria, los reingresos y los costes. RESULTADOS: Los dos grupos fueron homogéneos, realizándose más cirugía laparoscópica en el grupo RICA (27 (20%) vs 45 (37,2%), p = 0,006). En el grupo RICA se objetivó una disminución de la estancia hospitalaria de 1,2 días (11 ± 3,8 vs 9,8 ± 3,7, p = 0,018), sin aumentar la tasa de complicaciones (49 (36,3%) vs 38 (31,4%), p = 0,49), de reingresos a los 30 días tras el alta hospitalaria (15 (11,1%) vs 12 (9,9%), p = 0,756), la mortalidad (1 (0,7%) vs 2 (1,7%), p = 0,498) ni el gasto sanitario (1618,8 € ± 830,5 ± 1578,6 ± 491,1, p = 0,634). La laparoscopia redujo de forma independiente la estancia hospitalaria y la tasa de reingresos, mientras que la presencia de complicaciones severas lo aumentó. CONCLUSIONES: La aplicación de un PRI en cirugía electiva de colon y recto es coste-efectiva, pues mejora los resultados obtenidos sin incrementar el gasto sanitario

INTRODUCTION: ERAS (Enhanced Recovery After Surgery) protocols in colorectal surgery reduce hospital stay and com-plications, but there are few studies on whether they are cost-effective. METHODS: We compared a group of 121 patients (ERAS group) consecutively operated on elective colorectal surgery according to an ERAS protocol, with a historical cohort of 135 patients (preERAS group) operated prior to the implantation of the protocol in a traditional manner. A univariate analysis was performed to compare the data of stay, complications, readmissions and cost effectiveness, and a multivariate analysis to check whether laparoscopic surgery, the ERAS protocol, complications, sex and age had an independent influence hospital stay, readmissions rate and costs. RESULTS: The two groups were homogeneous, with more laparoscopic surgery performed in the ERAS group (27 (20%) vs 45 (37.2%), p = 0.006). In the ERAS group, a decrease in hospital stay was observed in 1,2 days (11 ± 3.8 vs 9.8 ± 3.7, p = 0.018), without increasing the complication rate (49 (36.3%) vs 38 (31.4%), p = 0.49), readmissions at 30 days after hospital discharge (15 (11.1%) vs 12 (9.9%), p = 0.756), mortality (1 (0.7%) vs 2 (1.7%), p = 0.498) and healthcare costs (1618.8 € ± 830.5 vs 1578.6 € ± 491.1, p = 0.634). Laparoscopic surgery independently reduced the hospital stay and the rate of readmissions, while the presence of severe complications increased them. CONCLUSIONS: The application of an ERAS protocol in elective colorectal surgery surgery is cost-effective, since it improves the results obtained without increasing healthcare costs

Incidencia De Factores Clínicos Y Sociodemográficos De Hemorragia Postparto En Pacientes Atendidas En El Hospital Niño Jesús En Barranquilla. Enero 2017-Enero 2018 / Incidence of Clinical and Sociodemographic Factors of Postpartum Hemorrhage in Patients Served at the Niño Jesús Hospital in Barranquilla. January 2017-January 2018

Objective: To determine the incidence of clinical and sociodemographic factors related to postpartum hemorrhage in the puerperal women attended in the OB / GYN service of the Niño Jesús Hospital in the city of Barranquilla. Materials and methods: Descriptive, cross-sectional and retrospective study. The sample was made up of the total population that had a vaginal delivery and caesarean section (5,384), a total of 280 patients were recruited, which is equivalent to 5.2%, the difference of 5,104 were excluded from the study because they did not meet the criteria for inclusion and / or lack of information that they presented immediate postpartum hemorrhages attended at the Hospital Niño Jesús in Barranquilla, which was chosen through a non-probability sampling for convenience and the results obtained from the documentary review of the patients' records between January 2017 to January 2018. Results: The advanced age of the patients is considered a risk factor associated with postpartum hemorrhages, being evident in 70% between the ages of 30 to 47 years. Regarding sociodemographic factors such as marital status, it was observed that free union predominated with 47% and in occupation, 79% of the patients are housewives. The deed is an important factor of the patients; it was evident that 80% have already had more than 3 previous deliveries. Conclusions: Prenatal control during pregnancy is of vital importance to avoid postpartum hemorrhages, allowing early identification of risk factors, danger signs and symptoms, and timely treatment of complications.

Objetivo: Determinar la incidencia Factores Clínicos Y Sociodemográficos relacionados con Hemorragia post parto en las puérperas atendidas en el servicio de Gineco-obstetricia Del Hospital Niño Jesús de la ciudad de Barranquilla. Materiales y métodos: Estudio descriptivo, de corte transversal y retrospectivo. La muestra estuvo constituida por el total de la población que tuvieron parto vaginal y cesárea (5384) se reclutaron un total de 280 pacientes lo que equivale al 5.2%, se excluyeron del estudio la diferencia de 5104 debido a que no cumplieron con los criterios de inclusión y/o falta de información que presentaron hemorragias postparto inmediato atendidas en el Hospital Niño Jesús de Barranquilla, la cual fue escogida a través de un muestreo no probabilístico por conveniencia y los resultados obtenidos de la revisión documental de los expedientes de las pacientes entre enero 2017 a enero 2018. Resultados: La edad avanzada de las pacientes, se considera un factor de riesgo asociado a las hemorragias posparto, evidenciándose en un 70% entre las edades de 30 a 47 años. Con respecto a los factores sociodemográficos como el estado civil, se observó que predominó la unión libre con 47% y en la ocupación, el 79% de las pacientes son amas de casa. La gesta es un factor importante de las pacientes, se evidenció que el 80% ya han tenido más de 3 partos anteriores. Conclusiones: El control prenatal durante el embarazo es de vital importancia para evitar hemorragias pospartos, permitiendo identificar tempranamente factores de riesgo, signos y síntomas de peligro y atender las complicaciones de manera oportuna.

Evaluación de la Saturación Venosa de Oxígeno (SvO2) desde la teoría de los sistemas dinámicos / Evaluation of SvO2 from the Theory of Dynamic Systems

Introducción: La evolución de un sistema dinámico se puede caracterizar a partir de la construcción de atractores caóticos. Objetivo: Desarrollar una metodología de evaluación de la saturación venosa de oxígeno, fundamentada en los sistemas dinámicos, para pacientes en Unidad de Cuidados Intensivos. Metodología: Se seleccionaron 10 pacientes con diferentes patologías de la Unidad de Cuidados Intensivos Postquirúrgicos, y registró la saturación venosa de oxígeno durante su tiempo de estancia. Con base en estos valores se construyeron atractores caóticos en el mapa de retardo y se evaluaron los valores mínimos y máximos ocupados por el atractor. Resultados: Se halló que la saturación venosa de oxígeno tiene un comportamiento caótico; los valores máximos y mínimos de los atractores en el mapa de retardo variaron entre 22,10 mmHg y 93,70 mmHg. Conclusiones: Se plantea una nueva metodología capaz de caracterizar el comportamiento de la variable monitorizada para la evaluación del paciente crítico(AU)

Introduction: The evolution of a dynamic system can be characterized from the construction of chaotic attractors. Objective: To develop a methodology based on dynamic systems, for the evaluation of venous oxygen saturation of patients in the Intensive Care Unit. Methodology: 10 patients with different pathologies of the Post-surgical Intensive Care Unit were selected, and recorded venous oxygen saturation during their time of stay. Based on these values, chaotic attractors were constructed on the delay map and the minimum and maximum values occupied by the attractor were evaluated. Results: It was found that venous oxygen saturation has a chaotic behavior; the maximum and minimum values of the attractors on the delay map varied between 22.10 mmHg and 93.70 mmHg. Conclusions: A new methodology is proposed capable of characterizing the behavior of this monitored variable for the evaluation of the critical patient(AU)

Osteosarcoma de alto grado originado en un tumor filodes maligno / High grade osteosarcoma originated in a malignant phyllodes tumor

Resumen El tumor filodes maligno con componente estromal (sic) de osteosarcoma es un tumor de muy baja incidencia. La identificación de esta enfermedad se ha convertido en un desafío para la medicina actual debido a su difícil diagnóstico histopatológico, imagenológico y clínico. El tratamiento principal se basa en el manejo quirúrgico y las opciones de terapia adyuvante aún no presentan un sustento científico sólido para su utilización como tratamiento estándar. Su pronóstico no es bueno y la variante osteoblástica presenta un comportamiento muy agresivo, con un riesgo del 38% para compromiso metastásico y riesgo de muerte debido a la enfermedad del 33%. Se presenta el caso de una paciente y se describe cómo se diagnosticó y se trató la enfermedad.

Abstract Malignant phyllodes tumor with osteosarcomatous differentiation has a very low incidence. The assessment of this tumor has become a challenge for current medicine due to its difficult histopathological, imaging and clinical diagnosis. The main treatment is based on surgical management, and the options of adjuvant therapy have not yet presented a solid evidence for its use as standard of care. Its prognosis is not good. The osteoblastic subtype, especially, has a very aggressive behavior, with a risk of 38 % for metastatic compromise and risk of death due to pathology of 33 %. We present the case of a patient and describe how the disease was diagnosed and treated.

Implementation of an Enhanced Recovery After Surgery program in elective colorectal surgery: a prospective cohort study / Implantação de um programa de recuperação aprimorada após cirurgia colorretal eletiva: um estudo prospectivo de coorte

ABSTRACT Objective: To evaluate the results of an Enhanced Recovery After Surgery (ERAS) protocol in elective colorectal surgery compared to the historical cohort of this hospital with standard care, in terms of hospital Length Of Stay (LOS), 30 days readmissions rate and 3-5 Clavien-Dindo Complications (CDC). Methodology: Data were collected from consecutive patients during 2 time periods, before (135 patients from hospital database) and after implementation of an ERAS protocol (121 with prospective follow up). Multivariate lineal or logistic regressions were used to assess the impact of ERAS program, adjusting by gender, age, laparoscopy and 3-5 CDC. Results: The two groups were homogeneous in terms of demographic and surgery details, with the exception of the operative approach, with increased use of laparoscopy in the ERAS group. The ERAS protocol decreased LOS (9.8 ± 3.7 vs. 11 ± 3.8, p = 0.018) without increasing 30 days readmission rate or the number of severe CDC. In a multivariate analysis, age and 3-5 CDC were independently associated with a longer LOS while male gender, ERAS protocol and laparoscopic surgery with a decreased LOS. 3-5 CDC increased readmissions (OR = 3.5, 95% CI 1.2-10.2) while laparoscopic surgery decreased them (OR = 0.2, 95% CI 0.1-0.8). ERAS improved compliance with secondary variables in a statistically significant way: more laparoscopic surgery; more regional analgesia in the intraoperative period; earlier adherence to ambulation; faster onset of oral liquid diet and analgesia by mouth; and lower requirements of opioids. Conclusions: ERAS protocol and laparoscopic surgery decreased LOS without increasing 30 days readmission rate. Severe CDC increased LOS and readmissions.

RESUMO Objetivo: Avaliar os resultados de um protocolo de recuperação aprimorada após a cirurgia (enhanced recovery after surgery [ERAS]) em cirurgia colorretal eletiva em comparação com a coorte histórica deste hospital, que recebeu o tratamento padrão, em termos de hospitalização, taxa de readmissão de 30 dias e graus 3 a 5 na escala de complicações cirúrgicas de Clavien-Dindo (CCD). Metodologia: Os dados foram coletados de pacientes consecutivos em dois períodos de tempo: antes (135 pacientes do banco de dados do hospital) e depois da implementação de um protocolo ERAS (121 pacientes com acompanhamento prospectivo). Regressões lineares ou logísticas multivariadas foram usadas para avaliar o impacto do protocolo ERAS, ajustando por sexo, idade, uso de laparoscopia e graus 3 a 5 na escala CCD. Resultados: Os dois grupos foram homogêneos em termos de características demográficas e cirúrgicas, com exceção da abordagem operatória, com o aumento do uso de laparoscopia no grupo ERAS. O protocolo ERAS diminuiu o tempo de internação (9,8 ± 3,7 vs. 11 ± 3,8; p = 0,018) sem aumentar a taxa de readmissão de 30 dias ou a severidade na escala CCD. Na análise multivariada, a idade e os graus 3 a 5 na escala CCD foram independentemente associados a uma hospitalização mais longa, enquanto o sexo masculino, o protocolo ERAS e a cirurgia laparoscópica foram independentemente associados a uma hospitalização mais curta. Graus 3 a 5 na escala CCD foram associados a um aumento nas readmissões (OR = 3,5; IC 95%: 1,2-10,2), enquanto a cirurgia laparoscópica foi associada a uma diminuição nesse número (OR = 0,2; IC 95%: 0,1-0,8). O ERAS melhorou a adesão às variáveis secundárias de uma forma estatisticamente significativa: aumento no número de cirurgias laparoscópicas; maior uso de analgesia regional no período intraoperatório; adesão precoce à deambulação; início mais rápido da dieta líquida oral e analgesia por via oral; finalmente, menor uso de opioides. Conclusões: O protocolo ERAS e a cirurgia laparoscópica diminuíram o tempo de internação sem aumentar a taxa de readmissão de 30 dias. Um grau severo na escala CCD aumentou a hospitalização e readmissões.

Encuesta de satisfacción tras aplicación de un protocolo de recuperación intensificada ERAS (Enhanced Recovery After Surgery) en cirugía electiva colorrectal en mayores de 70 años / Satisfaction survey after an ERAS (Enhanced Recovery After Surgery) protocol in colorectal elective surgery in patients over 70 years of age

Abstract Introduction: Enhanced Recovery After Surgery (ERAS) programs have been shown to reduce hospital stay, without increasing the rate of complications or readmissions 30 days after discharge; however, there is limited information about patient satisfaction. Objective: To determine the satisfaction of our patients following the implementation of an ERAS protocol in elective colorectal surgery. Materials and methods: A period of 4 days after discharge, a telephone survey was conducted based on the enhanced recovery in abdominal surgery clinical survey of the first 55 patients aged 70 years or older, who underwent elective colorectal surgery according to an ERAS protocol at the Hospital Universitario de Guadalajara, Spain. This is a cross-sectional analytical study. Results: Most of our patients are very satisfied with the care and the way they were treated by the health staff during their hospitalization, and they would be willing to undergo surgery again following this protocol. Most of them consider that the information received in the pre-anesthesia and surgery consultation is very good, and they value this consultation as one of the most positive aspects of the protocol. More than half of the patients did not experience any nausea or vomiting and rated their pain as <3 (minimum 0 and maximum 10). Most considered the introduction of oral feeding and ambulation as on time or somewhat early. Conclusion: Elderly patients undergoing elective colorectal surgery according to an ERAS protocol are highly pleased with the care received. Standardized surveys are required to be able to contrast outcomes.

Resumen Introducción: los programas de recuperación intensificada postoperatoria (Enhanced Recovery After Surgery (ERAS)) reducen la estancia hospitalaria, sin aumentar la tasa de complicaciones ni de reingresos a los 30 días tras el alta, pero hay poca información acerca del grado de satisfacción de los pacientes. Objetivo: conocer la satisfacción de nuestros pacientes tras la aplicación de un protocolo ERAS en cirugía electiva colorrectal. Materiales y métodos: cuatro días tras el alta, se realizó una encuesta telefónica basada en la encuesta de la guía clínica RICA (Recuperación Intensificada en Cirugía Abdominal) a los 55 primeros pacientes con edad mayor o igual a 70 años operados de cirugía electiva colorrectal según un protocolo ERAS. Es un estudio analítico transversal. Resultados: la mayor parte de nuestros pacientes están muy satisfechos con la asistencia y con el trato recibido por el personal sanitario durante su ingreso hospitalario, y se volverían a operar siguiendo este protocolo. La mayoría consideran que la información recibida en la consulta de preanestesia y cirugía es muy buena, y valoran esta consulta como uno de los aspectos más positivos del protocolo. Más de la mitad de los pacientes no tuvieron náuseas ni vómitos y calificaron su dolor como <3 (mínimo 0 y máximo 10). La mayoría consideraron el inicio de tolerancia oral y deambulación como a tiempo o algo pronto. Conclusiones: Los pacientes ancianos operados de cirugía electiva colorrectal según un protocolo ERAS están muy satisfechos con la asistencia prestada. Se necesitan encuestas estandarizadas para poder comparar resultados.

Trombosis venosa subclavia asociada a electrodo de marcapasos y síndrome de la plaqueta pegajosa / Subclavian venous thrombosis associated with pacemaker electrode and sticky platelet syndrome

Resumen El síndrome de la plaqueta pegajosa en un trastorno cualitativo plaquetario en el que bajas concentraciones de epinefrina y adenosina difosfato producen hiperagregabilidad plaquetaria considerable. Se ha especulado mucho sobre la etiología de este trastorno sin que sean claros sus mecanismos fisiopatológicos. Desde el punto de vista clínico, se asocia a trombosis arteriales y venosas recurrentes en pacientes jóvenes, pérdidas gestacionales, otras complicaciones obstétricas y cefalea recurrente.En la literatura se ha descrito su presentación familiar, lo que hace sospechar su comportamiento hereditario autosómico dominante; también se ha reportado un fenotipo adquirido de la enfermedad en algunas poblaciones especiales como pacientes con enfermedad renal crónica en terapia de reemplazo renal o posterior al trasplante renal y en pacientes con cuadros inflamatorios o inmunosupresión. Se expone el caso de una paciente con antecedente de cefalea de difícil manejo, síndrome hipertensivo asociado al embarazo y mortinato, con síndrome del nodo enfermo y disautonomía manejadas con implantación de marcapasos definitivo bicameral con sensor CLS, que desarrolló trombosis de la vena subclavia, asociada al electrodo de marcapasos, recurrente a pesar de anticoagulación con warfarina y rivaroxabán e incluso a pesar de antiagregación con ácido acetilsalicílico, con posterior diagnóstico de síndrome de la plaqueta pegajosa.

Abstract Sticky platelet syndrome is a qualitative platelet disorder in which low concentrations of adrenaline and adenosine diphosphate produce considerable platelet hyperaggregability. There has been much speculation on the origin of this disorder as its pathophysiological mechanisms of action are not yet clear. From a clinical point of view, it is associated with recurrent arterial and venous thrombosis in young patients, miscarriages, other obstetric complications and recurrent headaches.Its familial presentation has been described in the literature, suspecting that it is of a dominant autosomal hereditary nature. An acquired phenotype of the disease has also been reported in some particular patients, such as patients with chronic kidney disease on renal replacement therapy or after a kidney transplant, as well as in patients with inflammatory processes or immunosuppression. The case is presented of a patient with a history of difficult to manage headaches, a hypertensive syndrome associated with the pregnancy, and a foetal death. She also had sick sinus node syndrome and dysautonomia managed with a definitive dual-chamber pacemaker with a CLS sensor. There was then a thrombosis in the subclavian vein associated with the pacemaker electrode, being recurrent despite anticoagulation with warfarin and rivaroxaban, and even despite anti-aggregation treatment with acetyl salicylic acid. She was subsequently diagnosed with sticky platelet syndrome.

Prevalencia de preeclampsia en embarazadas en el servicio de ginecología y obstetricia del Hospital Central del Instituto de Previsión Social, 2017 / Prevalence of preeclampsia in pregnant women in the gynecology and obstetrics service of the Central Hospital of the Social Security Institute, 2017

Introducción: Los trastornos hipertensivos son la primera causa de muerte materna en los países desarrollados y la tercera causa de muerte materna en los países en vías de desarrollo. La preeclampsia es una enfermedad de origen desconocido y multifactorial cuyo tratamiento definitivo es el parto, además de ser causal de repercusiones sobre la madre y el recién nacido. Objetivo: El objetivo general del estudio fue determinar la Prevalencia de preeclampsia en embarazadas en el servicio de ginecología y obstetricia del hospital central del instituto de previsión social, 2017. Materiales y métodos: Estudio observacional descriptivo retrospectivo de corte transversal, con muestreo no probabilístico de casos consecutivos. Fueron incluidas todas las embarazadas con preeclampsia que acudieron al Servicio de Ginecología y Obstetricia del Hospital Central de Instituto de Previsión Social en el periodo comprendido entre los meses de enero a diciembre del año 2017. Resultados: Se realizó un estudio observacional descriptivo retrospectivo en 375 pacientes que acudieron al Hospital Central del Instituto de Previsión Social en el año 2017. Los resultados arrojaron que el 38,4% presentó preeclampsia de las cuales 63,2% presentaba en preeclampsia leve y 36,8% presentaba preeclampsia severa Entre los factores de riesgo el que apareció en mayor cantidad fue la Hipertensión Arterial Crónica. En cuanto a las complicaciones maternas se presentan en mayoría Hepáticas, Neurológicas y Renales. Conclusión: Los resultados de este estudio realizado en un centro de referencia nacional y de alta complejidad coinciden con estudio previo, determina datos importantes acerca de la prevalencia de preeclampsia.