The chitin-binding domain of Bacillus thuringiensis ChiA74 inhibits gram-negative bacterial and fungal pathogens of humans and plants.

The chitinase ChiA74 is synthesized by Bacillus thuringiensis and possesses a modular organization composed of four domains. In the C-terminal of the enzyme is located the chitin-binding domain (CBD), which has not been isolated as a single unit or characterized. Here, we aimed to isolate the ChiA74's CBD as a single unit, determine the binding properties, and evaluate its antimicrobial and hemolytic activities. We cloned the ChiA74's CBD and expressed it in Escherichia coli BL21. The single domain was purified, analyzed by SDS-PAGE, and characterized. The recombinant CBD (rCBD) showed a molecular mass of ∼14 kDa and binds strongly to α-chitin, with Kd and Bmax of ∼4.7 ± 0.9 µM and 1.5 ± 0.1 µmoles/g chitin, respectively. Besides, the binding potential (Bmax/Kd) was stronger for α-chitin (∼0.31) than microcrystalline cellulose (∼0.19). It was also shown that the purified rCBD inhibited the growth of the clinically relevant Gram-negative bacteria (GNB) Vibrio cholerae, and V. parahemolyticus CVP2 with minimum inhibitory concentrations (MICs) of 121 ± 9.9 and 138 ± 3.2 µg/mL, respectively, and of one of the most common GNB plant pathogens, Pseudomonas syringae with a MIC of 230 ± 13.8 µg/mL. In addition, the rCBD possessed antifungal activity inhibiting the conidia germination of Fusarium oxysporum (MIC = 192 ± 37.5 µg/mL) and lacked hemolytic and agglutination activities against human erythrocytes. The significance of this work lies in the fact that data provided here show for the first time that ChiA74's CBD from B. thuringiensis has antimicrobial activity, suggesting its potential use against significant pathogenic microorganisms. Future works will be focused on testing the inhibitory effect against other pathogenic microorganisms and elucidating the mechanism of action.

Biodegradation of agave Comiteco bagasse by Pleurotus spp.: a source of cellulases useful in hydrolytic treatment to produce reducing sugars.

This study aimed to determine the production parameters of five strains of Pleurotus spp. during their cultivation on agave Comiteco bagasse, as well as the feasibility of using cellulolytic extracts to produce reducing sugars in the same bagasse. After cultivation, the basidiome production parameters varied between 41.2 and 65.7% (biological efficiency), 0.17 and 0.30 (yield), 0.60 and 0.90% (production rate), 16.4 and 41.1% (Bioconversion) and 9.4 and 21.3 g (mean mushroom weight). At day 15 of growth, P. djamor showed the highest ß-glucosidase activity (43.95 ± 4.5 IU/g); on day 33. The same strain had the highest endoglucanase activity (21.12 ± 0.5 IU/ml). Both extracts were partially purified, and the kinetic parameters Vmax and Km were estimated (20.83 µmole/ml sec and 232.01 µmole/ml for ß-glucosidase and 685.01 µmole/ml sec and 1,240.34 µmole/ml for endoglucanase). In the enzymatic hydrolysis assay, the highest concentration of reducing sugars (43.13 ± 1.09 g/L; 0.21 g/g bagasse) was obtained by a mixture of the two partially purified extracts acting synergistically after 48 h and with a pH adjustment. The results suggest that the use of agave Comiteco bagasse for cultivating edible mushrooms while obtaining cellulolytic extracts is an alternative treatment for waste reduction and valorization of agro-industrial by-products.

Spanish cohort of VEXAS syndrome: clinical manifestations, outcome of treatments and novel evidences about UBA1 mosaicism.

BACKGROUND: The vacuoles, E1-enzyme, X linked, autoinflammatory and somatic (VEXAS) syndrome is an adult-onset autoinflammatory disease (AID) due to postzygotic UBA1 variants. OBJECTIVES: To investigate the presence of VEXAS syndrome among patients with adult-onset undiagnosed AID. Additional studies evaluated the mosaicism distribution and the circulating cytokines. METHODS: Gene analyses were performed by both Sanger and amplicon-based deep sequencing. Patients' data were collected from their medical charts. Cytokines were quantified by Luminex. RESULTS: Genetic analyses of enrolled patients (n=42) identified 30 patients carrying UBA1 pathogenic variants, with frequencies compatible for postzygotic variants. All patients were male individuals who presented with a late-onset disease (mean 67.5 years; median 67.0 years) characterised by cutaneous lesions (90%), fever (66.7%), pulmonary manifestations (66.7%) and arthritis (53.3%). Macrocytic anaemia and increased erythrocyte sedimentation rate and ferritin were the most relevant analytical abnormalities. Glucocorticoids ameliorated the inflammatory manifestations, but most patients became glucocorticoid-dependent. Positive responses were obtained when targeting the haematopoietic component of the disease with either decitabine or allogeneic haematopoietic stem cell transplantation. Additional analyses detected the UBA1 variants in both haematopoietic and non-haematopoietic tissues. Finally, analysis of circulating cytokines did not identify inflammatory mediators of the disease. CONCLUSION: Thirty patients with adult-onset AID were definitively diagnosed with VEXAS syndrome through genetic analyses. Despite minor interindividual differences, their main characteristics were in concordance with previous reports. We detected for the first time the UBA1 mosaicism in non-haematopoietic tissue, which questions the previous concept of myeloid-restricted mosaicism and may have conceptual consequences for the disease mechanisms.

Spatio-temporal velocity variations observed during the pre-eruptive episode of La Palma 2021 eruption inferred from ambient noise interferometry.

On Sept. 19th, 2021, a volcanic eruption began on the island of La Palma (Canary Islands, Spain). The pre-eruptive episode was characterized by seismicity and ground deformation that started only 9.5 days before the eruption. In this study, we applied seismic interferometry to the data recorded by six broadband seismic stations, allowing us to estimate velocity variations during the weeks preceding the eruption. About 9.5 days before the eruption, we observed a reduction in the seismic velocities is registered next to the eruptive centers that opened later. Furthermore, this zone overlaps with the epicenters of a cluster of volcano-tectonic earthquakes located at shallow depth (< 4 km) and detached from the main cluster of deeper seismicity. We interpret the decrease in seismic velocities and the occurrence of such a shallow earthquake cluster as the effect of hydrothermal fluid released by the ascending magma batch and reaching the surface faster than the magma itself.

Thurincin H Is a Nonhemolytic Bacteriocin of Bacillus thuringiensis with Potential for Applied Use.

Thurincin H, a bacteriocin produced by Bacillus thuringiensis, exhibits antibacterial activity against Gram-positive and Gram-negative bacteria. While much is known about its expression and antimicrobial spectrum, its hemolytic property has yet to be established. In this study, thurincin H was produced in a plasmid-free acrystalliferous strain of B. thuringiensis (Bt Cry-B) that naturally lacked antimicrobial and hemolytic activities. When grown in Tryptic Soy Broth (TSB), the bacteriocin's maximal production in Bt Cry-B harboring the thurincin H genetic cluster (Bt Cry-B/pThur) was observed at 24 h. Thurincin H was purified as a sole peptide of ~5 kDa using three purification steps, i.e., salt precipitation, ultrafiltration, and gel filtration chromatography. The bacteriocin showed inhibitory activity against B. cereus (5631 U), Bt Cry-B (8827 U), E. faecium wild type (11,197 U), and E. faecium ATCC 19,434 (6950 U), but not against Bt Cry-B/pThurH and Bt Cry-B/pThurHΔThnA. In addition, a minimum inhibitory concentration (MIC) of 5.0 µg/mL against B. cereus 183 was observed. In silico predictions suggested that thuricin H lacks hemolytic activity, which was validated in vitro using 4 × the MIC, i.e., 20 µg/ml. Our data lay a foundation for the potential safe use of thurincin H as an antibacterial peptide for medical use, in food products, and for expression in probiotic bacteria.

Rapid magma ascent beneath La Palma revealed by seismic tomography.

For the first time, we obtained high-resolution images of Earth's interior of the La Palma volcanic eruption that occurred in 2021 derived during the eruptive process. We present evidence of a rapid magmatic rise from the base of the oceanic crust under the island to produce an eruption that was active for 85 days. This eruption is interpreted as a very accelerated and energetic process. We used data from 11,349 earthquakes to perform travel-time seismic tomography. We present high-precision earthquake relocations and 3D distributions of P and S-wave velocities highlighting the geometry of magma sources. We identified three distinct structures: (1) a shallow localised region (< 3 km) of hydrothermal alteration; (2) spatially extensive, consolidated, oceanic crust extending to 10 km depth and; (3) a large sub-crustal magma-filled rock volume intrusion extending from 7 to 25 km depth. Our results suggest that this large magma reservoir feeds the La Palma eruption continuously. Prior to eruption onset, magma ascended from 10 km depth to the surface in less than 7 days. In the upper 3 km, melt migration is along the western contact between consolidated oceanic crust and altered hydrothermal material.

Ocular Manifestations Related to Antibodies Positivity and Inflammatory Biomarkers in a Rheumatological Cohort.

Purpose: Ocular involvement is frequent in autoimmune diseases and even can be the first manifestation. There are multiple descriptions in the literature around the world regarding this topic. However, we evidenced a lack of studies analyzing the relationship between the ocular manifestations and systemic biomarkers, especially in Latinamerica. Therefore, this study aimed to examine the relationship between the positivity of inflammatory biomarkers and the ocular manifestations in a Colombian cohort of rheumatological patients. Patients and Methods: We conducted an observational, descriptive, non-comparative cross-sectional study in a rheumatology center, in Bogotá, Colombia, from 2013 to 2019. We calculated a sample size of 797 patients to assess the prevalence of ocular manifestations and inflammatory biomarkers. We performed univariate analyses for categorical and continuous variables and bivariate analyses using the Chi-square and Fisher's exact test for categorical variables. Results: Women represented 84% of the population, and the mean age was 54.61± 15.64 years. Of 797 patients, 21.45% reported one or more ophthalmological diagnoses, being keratoconjunctivitis sicca (KCS) the most common (15.93%), followed by uveitis, and cataract (1.38%, each one). Regarding ophthalmological symptoms, 35% presented at least one, being dry eye sensation (DE) the most common (30.86%), followed by ocular pain (2.76%), red eye, and decreased visual acuity (2.63%, each one). The antibodies or inflammatory biomarkers most frequently found were antinuclear antibodies (ANAs) (35.3%), C-reactive protein (28.7%), and rheumatoid factor (27.9%). We found statistical associations between consumption of complement 3, anti-CCP, anti-RO, and anti-LA antibodies with ocular manifestations such as photophobia, DE, conjunctivitis, KCS, uveitis, retinal vasculitis, and maculopathy. Conclusion: Ocular manifestations are frequently found in patients with positive antibodies and inflammatory biomarkers. Our results suggest antibodies and inflammatory molecules could be biomarkers for ocular manifestations in patients with rheumatological diseases. This study provides the basis for future longitudinal studies.

Psychometric Properties of a Cultural Adapted Version of the Assessment of Identity Development in Adolescence in Panama.

The Assessment of Identity Development in Adolescence (AIDA) is a self-report instrument to detect pathological development of Identity. In Panamá, psychometric instruments for assessment of psychopathology in adolescence are lacking. Our aim was to develop a valid and reliable version of the AIDA Inventory for Panamanian Population. AIDA was adapted to Spanish considering cultural aspects of Panamanian population. Two pilot tests were performed prior to main test to assess item-total correlation at subscale, primary scale and total scale levels and internal consistency at subscale level. A mixed sample of students and PD patients (N = 315) completed the AIDA inventory, the "Strength and Difficulties Questionnaire" and "Defense Style Questionnaire-40." AIDA was retested in a sub sample from school population (n = 98). The Structured Clinical Interview for Axis II Disorders was used for diagnosis of personality disorders in the patient sample (n = 25). Psychometric properties were tested to assess internal consistency, reliability, factorial validity, convergent validity, and criterion validity. AIDA Panama showed excellent internal consistency for the total scale Identity Diffusion with Cronbach's α:0.94 and a retest reliability of 0.84. A Bifactorial CFA was modeled to assess the dimensionality of the inventory. The proportion between OmegaH and Omega at total scales 96% of the variance is explained by a general factor. Furthermore, the Explained Common Variance for the General Factor is 73% supporting unidimensionality. In line with theory, AIDA total scale showed a high positive correlation (r = 0.67) with Total Difficulties scale and high positive correlation (r = 0.71) with Immature Defense scale. The AIDA total score differed highly significant (p = 0.000) between the patient sample and the students with a large effect size (d = 1.02). Conclusion: The adaptation and validation of AIDA for Panamanian adolescent population was successful with good psychometric properties and significant correlations with related psychopathological constructs. AIDA showed high clinical validity by providing a valid discrimination between the school sample and a diagnosed PD sample, in line with the assumption that impaired identity functioning is at the core of personality disorders, especially in adolescence.

Propranolol degradation through processes based on the generation of hydroxyl free radical.

Pharmaceutical substances such as propranolol (PRO) are an emerging class of aquatic contaminants that have increasingly been detected in ground and surface water. For this reason, the aim of this study was to evaluate the efficiency of advanced oxidation systems for the PRO degradation. The tests started with anodic oxidation (AO), using 0.01, 0.05, and 0.1 M Na2SO4 as the supporting electrolyte and 16, 32, 48, and 64 mA cm-2 as current density. Under the best conditions obtained in AO, the electro-Fenton (EF) process was reviewed, where the effect of Fe2+ was analyzed with 5, 10, 15, and 20 mg Fe2+ L-1. The Fenton reaction (FR) was studied using the Fe2+ concentration that promoted the highest percentage of PRO removal and initial concentration of 16 mg L-1 of H2O2, in addition to these conditions, in the photo-Fenton (PF) system, the effect of UV light with wavelengths 254 and 365 nm were evaluated. The results obtained showed that the degradation efficiency of the EF > AO > PF > FR system along with a percent removal of 94.52, 90.4, 25.97, and 4.4%, respectively. The results showed that PRO can be removed through the studied systems, with the EF system being the most efficient.

Toric intraocular lens implantation vs femtosecond laser-assisted arcuate keratotomy for correction of moderate astigmatism in cataract surgery.

PURPOSE: To compare toric intraocular lens (TIOL) implantation and femtosecond laser-assisted arcuate keratotomy (FSAK) during phacoemulsification surgery in correction of moderate astigmatism. SETTING: Clinical research study. DESIGN: Prospective randomized comparison study. METHODS: Patients with age-related cataract and moderate preoperative corneal astigmatism of 1.25 to 3.0 diopters (D) were randomized into a TIOL implantation group and an FSAK group with symmetrical paired corneal arcuate keratotomies. The preoperative evaluation included corrected distance visual acuity (CDVA), corneal topography, autokeratometry, and ocular biometry. Postoperative examinations were performed at 1 month and 3 months and included CDVA and uncorrected distance visual acuity, manifest refraction, autokeratometry, and corneal topography. Vector analysis of astigmatic changes was performed using the Alpins vector method. RESULTS: This study comprised 75 eyes from 67 patients. The mean residual refractive astigmatism at 3 months was -0.63 ± 0.55 D in the TIOL group and -0.90 ± 0.53 D in the FSAK group ( P = .037) and was ≤1.00 D in 32 eyes (84%) and 25 eyes (64%), respectively. There were no statistically significant differences between the 2 groups in difference vector, angle of error, magnitude error, or correction index in the 3-month follow-up. The index of success was 0.32 ± 0.33 D in the TIOL group and 0.48 ± 0.29 D in the FSAK group ( P = .029). CONCLUSIONS: TIOL implantation showed better results in correcting moderate astigmatism. Despite this, FSAK is shown to be a safe technique for reducing astigmatism.

Colecistitis aguda durante el segundo trimestre del embarazo: reporte de un caso / Acute cholecystitis during the second trimester of pregnancy: A case report

Resumen ANTECEDENTES: La colecistitis aguda es la segunda causa más frecuente de urgencia quirúrgica no obstétrica, con una incidencia de 1 caso por cada 1600 a 10,000 embarazos. OBJETIVO: Reportar el caso de una paciente con colecistitis aguda durante el segundo trimestre del embarazo tratada mediante cirugía laparoscópica. CASO CLÍNICO: Paciente de 34 años, con 16.5 semanas de embarazo. Acudió a consulta debido a un dolor abdominal de tipo cólico en el hipocondrio derecho. A la exploración física se encontraron: abdomen blando, depresible, dolor a la palpación en el flanco e hipocondrio derechos, signo de Murphy negativo, sin datos de irritación peritoneal; no se palparon plastrones; el útero se encontraba arriba de la sínfisis del pubis. El ultrasonido abdominal mostró la vesícula debidamente delimitada, con bordes regulares y definidos, con pared delgada y múltiples cálculos en su interior. No se evidenció leucocitosis. Los reportes de la laparoscopia fueron: vesícula con paredes a tensión, el conducto cístico corto, dilatado, con un cálculo retenido. No se informaron complicaciones. La paciente fue dada de alta a las 48 horas del posoperatorio. Continuó en control prenatal y finalizó el embarazo por cesárea. El desenlace neonatal fue satisfactorio. CONCLUSIONES: La colecistitis es una de las principales alteraciones durante el embarazo. Postergar la cirugía supone consecuencias para la madre y el feto, por lo que debe establecerse el diagnóstico y tratamiento oportunos.

Abstract BACKGROUND: Bile duct pathologies, specifically acute cholecystitis, is the second most common cause of non-obstetric surgical emergency, with an incidence of 1 in 1,600 to 10,000 pregnancies. OBJECTIVE: Report of a case of a patient with acute cholecystitis during the second trimester of pregnancy treated by laparoscopic surgery. CLINICAL CASE: 34-year-old female, pregnancy 3, childbirth 2; with pregnancy of 16.5 weeks. She presented colicky abdominal pain located in the right upper quadrant. Physical examination revealed abdomen with normoaudible peristalsis, soft, depressible, pain on medium and deep palpation in the right hypochondrium, murphy sign (-), no evidence of peritoneal irritation, no plastrons palpated, uterus above symphysis of the pubis. Abdominal ultrasound reports a well-defined vesicle with regular and well-defined borders, with a thin wall, with the presence of multiple stones in its interior. There was no presence of leukocytosis. Laparoscopic surgical management was decided, during which a gallbladder with tension walls, a short, dilated cystic duct, with an impacted stone was found. No complications were reported. She continued her prenatal care in our hospital unit and the pregnancy was resolved by cesarean section. Neonatal outcomes were optimal. CONCLUSIONS: Cholecystitis is one of the main non-obstetric surgical pathologies that occur in pregnancy, it is important to consider that the fact of postponing surgery could have consequences for both the mother and the fetus, so the timely diagnosis and management of this type of pathology must be carried out.

Leachate treatment: comparison of a bio-coagulant (Opuntia ficus mucilage) and conventional coagulants using multi-criteria decision analysis.

The main aim of this research was to compare a bio-coagulant, organic coagulant, and a conventional coagulant applied to the treatment of leachates. Coagulant options were Stage 1 FeCl3, Stage 2 Polyamine, and Stage 3 Opuntia ficus mucilage (OFM). Optimal conditions for maximum chemical oxygen demand (COD) removal were determined by experimental data and Response Surface Methodology. The application of Multiple Criteria Decision Analysis using Multi-Criteria Matrix (MCM) was explored by evaluating the Coagulation-Flocculation processes. Maximum COD removal (%) and the best MCM scores (on a scale from 0 to 100) were: Stage 1: 69.2±0.9 and 48.50, Stage 2: 37.8±1.1 and 79.0, and Stage 3: 71.1±1.7, and 81.5. Maximum COD removal using FeCl3 and OFM was not statistically different (p 0.15 < 0.05). OFM extraction process was evaluated (yield 0.70 ± 1.17%, carbohydrate content 32.6 ± 1.18%). MCM allows the evaluation of additional technical aspects, besides oxygen COD removal, as well as economic aspects, permitting a more comprehensive analysis. Significant COD removals indicate that the use of OFM as a coagulant in the treatment of stabilized leachate was effective. Opuntia ficus cladodes, a residue, were used to treat another residue (leachates).

Ocular Manifestations in Colombian Patients with Systemic Rheumatologic Diseases.

PURPOSE: To establish the prevalence of ocular involvement in a Colombian population with rheumatologic diseases. DESIGN: Observational cross-sectional study. METHODS: We included a probabilistic sample size of 797 patients who attended a rheumatologic disease center in Bogotá, Colombia. Statistical analysis with descriptive measures and Chi-square independence test between rheumatologic diseases and ophthalmological symptoms and diseases was performed. RESULTS: Eighty-four percent of the population were women, and the mean age was 54.61± 15.64 years. The most common condition was rheumatoid arthritis (33.37%), followed by fibromyalgia (22.71%), Sjögren Syndrome (19.72%), and systemic lupus erythematosus (9.91%). Almost 7% of the patients presented polyautoimmunity. Thirty-five percent of the patients reported one or more ophthalmological symptoms, being dry eye sensation the most common (30.86%), followed by ocular pain (2.76%), red-eye, and decreased visual acuity (both 2.63%). Similarly, 21.45% of the patients presented one or more ophthalmological diagnoses, being keratoconjunctivitis sicca the most common (15.93%), followed by cataract, uveitis (1.38% each), and scleritis (1.25%). CONCLUSION: Almost a third of the patients reported any ocular involvement. It is crucial to be aware of the most common ophthalmic manifestations among the different rheumatologic diseases in our population, to offer early specialist referral and timely treatment.

Damage control in orthopaedical and traumatology

In Orthopedics, damage control is indicated in patients with pelvic and/or long bone fractures associated with hemodynamic instability. It is inappropriate to perform a complex definitive reduction and fixation surgery for severely injured trauma patients with hemodynamic instability. In these cases, it is recommended to perform minimally invasive procedures that temporarily stabilize the fractures and bleeding control. Closed or open fractures of the long bones such as femur, tibia, humerus, and pelvis can lead to hemodynamic instability and shock. Thus, orthopedic damage control becomes a priority. However, if the patient is hemodynamically stable, it is recommended to stabilize all fractures with an early permanent internal fixation. These patients will have a shorter hospital length of stay and a reduction in mechanical ventilation, blood components transfusions and complications. Therefore, the concept of orthopedic damage control should be individualized according to the hemodynamic status and the severity of the injuries. Open fractures, dislocations, and vascular injuries could lead to permanent sequelae and complications if a correct management and approach are not performed.

En Ortopedia se indica control del daño en pacientes que presentan fracturas de pelvis y/o huesos largos asociado a condiciones generales inestables. Dada la severidad del trauma asociada a inestabilidad hemodinámica no es adecuado realizar una cirugía definitiva compleja de reducción y fijación de todas sus fracturas. En estos casos se recomienda realizar procedimientos poco invasivos que permitan estabilizar provisionalmente las fracturas, para; disminuir el dolor, controlar la hemorragia de las fracturas, obtener una alineación adecuada de los huesos fracturados y reducir las luxaciones. Estas medidas permiten controlar el daño del primer golpe para así disminuir las complicaciones. Las fracturas de los huesos largos fémur, tibia, húmero y pelvis cerradas o abiertas pueden llevar a una inestabilidad y estado de shock. Mientras que el paciente no tenga alteración hemodinámica, se recomienda estabilizar todas sus fracturas precozmente con una fijación interna que controle esta forma el daño y la necesidad de tiempo de hospitalización. Como resultado se disminuyen los días en cuidados intensivos, la ventilación mecánica, las transfusiones y las complicaciones. El concepto de control de daño para el manejo de las lesiones ortopédicas se debe individualizar de acuerdo a las condiciones generales de cada paciente y la gravedad de sus lesiones como: fracturas abiertas, luxaciones, luxación completa de la articulación sacroíliaca, luxofractura del talo, y lesiones vasculares, ya que estas lesiones requieren un manejo prioritario inicial generalmente definitivo en la mayoría de los pacientes con politraumatismo para evitar complicaciones serias futuras que pueden dejar secuelas definitivas al no recibir el tratamiento adecuado inicial.

Enfermedad de neuro-Behçet en el Hospital Universitario Central de Asturias / Neuro-Behçet Disease in the Central University Hospital of Asturias

Objetivo: Describir frecuencia y perfil de pacientes con neuro-Behçet (NB) del Hospital Universitario Central de Asturias desde 1981 hasta junio del 2018. Pacientes y métodos: Estudio retrospectivo que incluye características: epidemiológicas, clínicas, neuroimagen, estudio de líquido cefalorraquídeo (LCR), histopatología, tratamiento y evolución. Se diferencian características clínicas entre pacientes con Behçet sin afectación neurológica y NB. Resultados: Se describen 10 casos de NB (25,6%). La edad media al diagnóstico, 29,7años, siendo más frecuente en varones. El 60% tienen afectación parenquimatosa. En la afectación no parenquimatosa se incluyen un caso con trombosis venosa cerebral y dos con meningitis aséptica aislada. Se encontraron hallazgos de vasculitis en la resonancia magnética cerebral y alteración en la bioquímica del LCR. Un paciente presentó discapacidad motora llamativa. La afectación ocular ha sido mayor en el grupo de los pacientes sin afectación neurológica (p=0,009). Conclusiones: El NB es relativamente frecuente, sobre todo en varones y en la forma parenquimatosa. No se encuentra un marcador clínico propio de la afectación neurológica.(AU)

Objective: To describe the frequency and profile of patients with neuro-Behçet's disease (NBD) at the Central University Hospital of Asturias between 1981 and June 2018. Patients and methods: Retrospective study including epidemiological, clinical, neuroimaging, cerebrospinal fluid (CSF) study, histopathology, treatment and evolution characteristics. Clinical characteristics are differentiated between patients with Behçet without neurological affectation and NBD. Results: We found 10 cases of NBD (25.6%). The mean age was 29.7years, and it was more frequent in males. Sixty percent had parenchymal involvement. The non-parenchymal involvement included a case with cerebral venous thrombosis and two cases with isolated aseptic meningitis. Findings of vasculitis were found on cerebral magnetic resonance imaging, and alteration in the biochemistry of the CSF. One patient presented a striking motor disability. Ocular involvement was greater in the group of patients without neurological involvement (P=0.009). Conclusions: NBD is a relatively frequent presentation, especially in males and in the parenchymal form. We did not find a systemic clinical marker of neurological involvement.(AU)

Damage control in orthopaedical and traumatology.

In Orthopedics, damage control is indicated in patients with pelvic and/or long bone fractures associated with hemodynamic instability. It is inappropriate to perform a complex definitive reduction and fixation surgery for severely injured trauma patients with hemodynamic instability. In these cases, it is recommended to perform minimally invasive procedures that temporarily stabilize the fractures and bleeding control. Closed or open fractures of the long bones such as femur, tibia, humerus, and pelvis can lead to hemodynamic instability and shock. Thus, orthopedic damage control becomes a priority. However, if the patient is hemodynamically stable, it is recommended to stabilize all fractures with an early permanent internal fixation. These patients will have a shorter hospital length of stay and a reduction in mechanical ventilation, blood components transfusions and complications. Therefore, the concept of orthopedic damage control should be individualized according to the hemodynamic status and the severity of the injuries. Open fractures, dislocations, and vascular injuries could lead to permanent sequelae and complications if a correct management and approach are not performed.

En Ortopedia se indica control del daño en pacientes que presentan fracturas de pelvis y/o huesos largos asociado a condiciones generales inestables. Dada la severidad del trauma asociada a inestabilidad hemodinámica no es adecuado realizar una cirugía definitiva compleja de reducción y fijación de todas sus fracturas. En estos casos se recomienda realizar procedimientos poco invasivos que permitan estabilizar provisionalmente las fracturas, para; disminuir el dolor, controlar la hemorragia de las fracturas, obtener una alineación adecuada de los huesos fracturados y reducir las luxaciones. Estas medidas permiten controlar el daño del primer golpe para así disminuir las complicaciones. Las fracturas de los huesos largos fémur, tibia, húmero y pelvis cerradas o abiertas pueden llevar a una inestabilidad y estado de shock. Mientras que el paciente no tenga alteración hemodinámica, se recomienda estabilizar todas sus fracturas precozmente con una fijación interna que controle esta forma el daño y la necesidad de tiempo de hospitalización. Como resultado se disminuyen los días en cuidados intensivos, la ventilación mecánica, las transfusiones y las complicaciones. El concepto de control de daño para el manejo de las lesiones ortopédicas se debe individualizar de acuerdo a las condiciones generales de cada paciente y la gravedad de sus lesiones como: fracturas abiertas, luxaciones, luxación completa de la articulación sacroíliaca, luxofractura del talo, y lesiones vasculares, ya que estas lesiones requieren un manejo prioritario inicial generalmente definitivo en la mayoría de los pacientes con politraumatismo para evitar complicaciones serias futuras que pueden dejar secuelas definitivas al no recibir el tratamiento adecuado inicial.

Neuro-Behçet Disease in the Central University Hospital of Asturias. / Enfermedad de neuro-Behçet en el Hospital Universitario Central de Asturias.

OBJECTIVE: To describe the frequency and profile of patients with neuro-Behçet's disease (NBD) at the Central University Hospital of Asturias between 1981 and June 2018. PATIENTS AND METHODS: Retrospective study including epidemiological, clinical, neuroimaging, cerebrospinal fluid (CSF) study, histopathology, treatment and evolution characteristics. Clinical characteristics are differentiated between patients with Behçet without neurological affectation and NBD. RESULTS: We found 10 cases of NBD (25.6%). The mean age was 29.7years, and it was more frequent in males. Sixty percent had parenchymal involvement. The non-parenchymal involvement included a case with cerebral venous thrombosis and two cases with isolated aseptic meningitis. Findings of vasculitis were found on cerebral magnetic resonance imaging, and alteration in the biochemistry of the CSF. One patient presented a striking motor disability. Ocular involvement was greater in the group of patients without neurological involvement (P=0.009). CONCLUSIONS: NBD is a relatively frequent presentation, especially in males and in the parenchymal form. We did not find a systemic clinical marker of neurological involvement.