Screws versus plate with screws for osteosynthesis of the posterior malleolus: a systematic review and meta-analysis.

INTRODUCTION: fractures involving the posterior malleolus (PM) of the ankle can have significant functional and clinical implications if not properly treated. The optimal treatment approach for these fractures remains uncertain. This review aims to compare the use of cannulated screws versus plate with screw fixation in terms of their impact on the development of postoperative ankle osteoarthritis and functional outcomes in patients with PM fractures. MATERIAL AND METHODS: a comprehensive search was conducted in PubMed, EMBASE, and Cochrane Library databases to identify studies directly comparing cannulated screws versus plate with screw fixation for PM fractures and their association with the development of postoperative osteoarthritis and functional outcomes. The quality of the included studies was assessed using appropriate assessment tools. The data on osteoarthritis development and functional outcomes were extracted and analyzed. RESULTS: a total of 691 articles were screened, and several studies were included for analysis. The findings revealed no statistically significant difference in the development of postoperative ankle osteoarthritis between the cannulated screws and plate with screw fixation groups. Similarly, there was no significant difference in functional outcomes between the two treatment approaches. CONCLUSION: based on the available evidence, there is no significant difference in the development of postoperative ankle osteoarthritis or functional outcomes between cannulated screws and plate with screw fixation for PM fractures. However, further research is needed to strengthen these findings and provide more conclusive evidence.

INTRODUCCIÓN: las fracturas que involucran el maléolo posterior (MP) del tobillo pueden tener importantes implicaciones funcionales y clínicas si no se tratan adecuadamente. El enfoque de tratamiento óptimo para estas fracturas sigue siendo incierto. El objetivo de esta revisión es comparar el uso de tornillos canulados versus placa con fijación de tornillos en cuanto a su impacto en el desarrollo de la osteoartrosis de tobillo postoperatoria y los resultados funcionales en pacientes con fracturas del MP. MATERIAL Y MÉTODOS: se realizó una búsqueda exhaustiva en las bases de datos de PubMed, EMBASE y Cochrane Library para identificar estudios que compararan directamente tornillos canulados versus placa con fijación de tornillos para fracturas de MP y su asociación con el desarrollo de osteoartrosis postoperatoria y los resultados funcionales. La calidad de los estudios incluidos se evaluó utilizando herramientas de evaluación adecuadas. Los datos sobre el desarrollo de osteoartrosis y los resultados funcionales se extrajeron y analizaron. RESULTADOS: se revisaron un total de 691 artículos y se incluyeron varios estudios para su análisis. Los hallazgos revelaron que no hay una diferencia estadísticamente significativa en el desarrollo de osteoartrosis de tobillo postoperatoria entre los grupos de tornillos canulados y placa con fijación de tornillos. Del mismo modo, no hubo una diferencia significativa en los resultados funcionales entre los dos enfoques de tratamiento. CONCLUSIÓN: según la evidencia disponible, no hay una diferencia significativa en el desarrollo de osteoartrosis de tobillo postoperatoria o en los resultados funcionales entre los tornillos canulados y la placa con fijación de tornillos para las fracturas del MP. Sin embargo, se necesita más investigación para fortalecer estos hallazgos y proporcionar evidencia más concluyente.

Screws versus plate with screws for osteosynthesis of the posterior malleolus: a systematic review and meta-analysis / Tornillos frente a placa con tornillos para la osteosíntesis del maléolo posterior: una revisión sistemática y meta-análisis

Abstract: Introduction: fractures involving the posterior malleolus (PM) of the ankle can have significant functional and clinical implications if not properly treated. The optimal treatment approach for these fractures remains uncertain. This review aims to compare the use of cannulated screws versus plate with screw fixation in terms of their impact on the development of postoperative ankle osteoarthritis and functional outcomes in patients with PM fractures. Material and methods: a comprehensive search was conducted in PubMed, EMBASE, and Cochrane Library databases to identify studies directly comparing cannulated screws versus plate with screw fixation for PM fractures and their association with the development of postoperative osteoarthritis and functional outcomes. The quality of the included studies was assessed using appropriate assessment tools. The data on osteoarthritis development and functional outcomes were extracted and analyzed. Results: a total of 691 articles were screened, and several studies were included for analysis. The findings revealed no statistically significant difference in the development of postoperative ankle osteoarthritis between the cannulated screws and plate with screw fixation groups. Similarly, there was no significant difference in functional outcomes between the two treatment approaches. Conclusion: based on the available evidence, there is no significant difference in the development of postoperative ankle osteoarthritis or functional outcomes between cannulated screws and plate with screw fixation for PM fractures. However, further research is needed to strengthen these findings and provide more conclusive evidence.

Resumen. Introducción: las fracturas que involucran el maléolo posterior (MP) del tobillo pueden tener importantes implicaciones funcionales y clínicas si no se tratan adecuadamente. El enfoque de tratamiento óptimo para estas fracturas sigue siendo incierto. El objetivo de esta revisión es comparar el uso de tornillos canulados versus placa con fijación de tornillos en cuanto a su impacto en el desarrollo de la osteoartrosis de tobillo postoperatoria y los resultados funcionales en pacientes con fracturas del MP. Material y métodos: se realizó una búsqueda exhaustiva en las bases de datos de PubMed, EMBASE y Cochrane Library para identificar estudios que compararan directamente tornillos canulados versus placa con fijación de tornillos para fracturas de MP y su asociación con el desarrollo de osteoartrosis postoperatoria y los resultados funcionales. La calidad de los estudios incluidos se evaluó utilizando herramientas de evaluación adecuadas. Los datos sobre el desarrollo de osteoartrosis y los resultados funcionales se extrajeron y analizaron. Resultados: se revisaron un total de 691 artículos y se incluyeron varios estudios para su análisis. Los hallazgos revelaron que no hay una diferencia estadísticamente significativa en el desarrollo de osteoartrosis de tobillo postoperatoria entre los grupos de tornillos canulados y placa con fijación de tornillos. Del mismo modo, no hubo una diferencia significativa en los resultados funcionales entre los dos enfoques de tratamiento. Conclusión: según la evidencia disponible, no hay una diferencia significativa en el desarrollo de osteoartrosis de tobillo postoperatoria o en los resultados funcionales entre los tornillos canulados y la placa con fijación de tornillos para las fracturas del MP. Sin embargo, se necesita más investigación para fortalecer estos hallazgos y proporcionar evidencia más concluyente.

Elastomeric biodegradable starch/bentonite nanocomposites. Structure-thermo-mechanical correlation and degradation behavior.

We developed layered silicate nanocomposite films based on corn starch (CS) and bentonite nanoclay, plasticized with glycerol. The films were elastomeric with stretchability of ca. 60-90 % and Tg = -75 to -85 °C. The nanocomposites were exfoliated if cbentonite < 2 wt%, and intercalated if cbentonite > 3 wt%. The exfoliated morphology induced thermal stability as shown by TGA. Interestingly, bentonite induced a reduction of Tg while increasing the Young's modulus E and reducing the extensibility. The fracture energy was a decreasing function of cbentonite except at 2.9 wt%, where the nanocomposite exhibited maximum Young's modulus and toughness, as demonstrated by the Ashby-style plot. The nanocomposite films were biodegradable in anaerobic and aerobic conditions, and in anaerobic conditions the intercalated nanocomposite of cbentonite = 2.9 wt% exhibited slower rate of degradation. These results provide insights into the development of bio-degradable elastomeric food packaging and coatings suitable for sub-ambient conditions.

Decline of tuberculosis notification rate in different populations and regions in Portugal, 2010-2017.

BACKGROUND: Tuberculosis (TB) incidence declined in Portugal in recent decades, but trends differ between regions and population subgroups. We investigated these differences to inform prevention and control programmes. METHODS: We extracted TB notifications from the Portuguese National TB Surveillance System (SVIG-TB) in 2010-2017, disaggregated by region, age group, nationality and HIV status. We calculated notification rates using denominators from the Portuguese National Institute of Statistics and the Joint United Nations Programme on HIV/AIDS and performed stratified time series analysis. We estimated interannual decline percentages and 95% confidence intervals (CI) using Poisson and binomial negative regression models. RESULTS: The overall TB notification rate decreased from 25.7 to 17.5/100,000 population from 2010 to 2017 (5.2%/year) in Portugal. Interannual decline did not differ significantly between regions, but it was smaller amongst non-Portuguese nationals (-1.57% [CI: -4.79%, 1.75%] vs -5.85% [CI: -6.98%, -4.70%] in Portuguese nationals); children under five years of age (+1.77% [CI: -4.61%, 8.58%] vs -5.38% [CI: -6.33%, -4.42%] in other age groups); and HIV-negative people (-6.47% [CI: -9.10%, -3.77%] vs -11.29% [CI; -17.51%, -4.60%] in HIV-positive). CONCLUSIONS: The decline in TB notification rates in Portugal during the study period has been steady. However, the decline amongst non-Portuguese nationals, children under five years of age and non-infected-HIV patients was lower. No significant differences were observed between regions. Changes in TB epidemiology in specific risk groups and geographical areas should be closely monitored to achieve the objectives of the End TB Strategy. We recommend intensifying screening of TB in the subpopulations identified.

Photodegradation of 2,4-D (dichlorophenoxyacetic acid) with Rh/TiO2; comparative study with other noble metals (Ru, Pt, and Au).

In this work the effect of noble metal on the photodegradation of 2,4-dichlorophenoxyacetic acid herbicide using TiO2 as support was studied. The metals and concentration were: Rh, Ru, Pt and Au and 1, 0.98, 1.89, and 1.91 wt% respectively. Rhodium was taken as reference for this experiment. The samples were characterized by X-Ray Diffraction (XRD), UV-vis absorption spectra, N2 physisorption (BET Specific Surface Area), High Annular Angle Analysis Darkfield (HAADF) and Transmission Electron Microscopy Scanning (STEM), H2 chemisorption, optical emission spectroscopy with inductive coupling plasma analysis (ICP-OES), solid fluorescence, X-ray Photoelectron Spectroscopy (XPS) and OH quantification. The presence of the anatase crystalline phase was mostly confirmed in all samples. The band gap decreased with the presence of metal (from 3.24 to 2.92 eV). The specific area was a function of the metal particle size. The metal particle diameter showed the following sequence Pt > Ru > Au > Rh. By XPS, TiO2 does not manifest changes in oxidation states, but when impregnated with metals, only Pt shows the highest abundance of any oxidized state (Pt2+). The presence of metal reveals less electron-hole recombination compared with titanium oxide. The results of photocatalytic activity showed that Pt and Rh are the two metals with the highest mineralization (99.0 and 98.3%, respectively).

High frequency properties of a planar ion trap fabricated on a chip.

We report on the measurement of the high frequency properties of a planar Penning ion trap fabricated on a chip. Two types of chips have been measured: the first manufactured by photolithographic metal deposition on a p-doped silicon substrate and the second made with printed circuit board technology on an alumina substrate. The input capacitances and the admittances between the different trap's electrodes play a critical role in the electronic detection of the trapped particles. The measured input capacitances of the photolithographic chip amount to 65-76 pF, while the values for the printed circuit board chips are in the range of 3-5 pF. The latter are small enough for detecting non-destructively a single trapped electron or ion with a specifically tuned LC resonator. We have also measured a mutual capacitance of ∼85 fF between two of the trap's electrodes in the printed circuit board chip. This enables the detection of single, or very few, trapped particles in a broader range of charge-to-mass ratios with a simple resistor on the chip. We provide analytic calculations of the capacitances and discuss their origin and possible further reduction.

Pilot study for low-cost model validation in laparoscopic pediatric pyeloplasty simulation. / Estudio piloto para la validación de un modelo de bajo coste en la simulación de la pieloplastia laparoscópica pediátrica.

OBJECTIVE: To describe the creation of an original 3D-printed liquid latex model designed for laparoscopic pyeloplasty (LP) simulation in infants, and to assess its usefulness. MATERIALS AND METHODS: A 3D model of a dilated pelvis and a ureter with ureteropelvic junction obstruction (UPJO) was designed. It was covered in liquid latex, which allowed flexible models to be achieved in order to conduct pyeloplasty in a pelvitrainer. The total price of each model was 6 euros. A nearly-experimental, non-randomized, blind study was carried out, while measuring operating times and OSATS (Objective Structured Assessment of Technical Skills) scores. Following simulation completion, a survey based on Likert scale was conducted to assess overall appearance, texture, usefulness, and probability of recommending the model for regular training. RESULTS: 8 pediatric surgeons spent a median of 71.5 minutes (range: 50-86), and rated the model with a median 20.1/30 (range: 17-24) OSATS score. The model received a 4.25 (range: 3-5) score in terms of overall appearance, a 4.37 (range: 3-5) score in terms of texture, a 4.5 (range: 4-5) score in terms of usefulness, and a 4.6 (range: 4-5) score in terms of probability of recommending the model for regular training. CONCLUSIONS: Our liquid latex model for laparoscopic pyeloplasty simulation is feasible, with favorable preliminary results. Its usefulness in laparoscopic pyeloplasty training is promising.

OBJETIVOS: Describir la creación de un modelo original de látex líquido diseñado para la simulación de la pieloplastia laparoscópica (PL) en lactantes, construido a partir de una impresión tridimensional (3D), y valorar su utilidad. MATERIAL Y METODOS: Se diseñó un modelo 3D de una pelvis dilatada y un uréter con estenosis pieloureteral (EPU), que fue recubierto por látex líquido obteniendo modelos flexibles para realizar la pieloplastia en un pelvitrainer. El precio total de cada modelo fue de 6 euros. Se realizó un estudio cuasiexperimental, ciego y no aleatorizado, midiendo el tiempo quirúrgico y la puntuación OSATS (Objective Structured Assessment of Technical Skills). Tras completar la simulación, se realizó una encuesta utilizando la escala de Likert, en la cual se valoró el aspecto general, la textura, la utilidad del modelo y el grado de recomendación en el entrenamiento habitual. RESULTADOS: 8 cirujanos pediátricos dedicaron una mediana de 71,5 minutos (R 50-86), y puntuaron una mediana de 20,1/30 (R 17-24) en la escala OSATS. El modelo obtuvo una valoración de 4,25 (R3-5) en aspecto general, 4,37 (R3-5) en textura, 4,5 (R 4-5) en utilidad y 4,6 (R 4-5) en recomendación para incorporar al entrenamiento habitual. CONCLUSIONES: El uso de nuestro modelo de látex líquido para la simulación de la pielopalstia laparoscópica es factible y los resultados preliminares han sido favorables. Su utilidad como herramienta en el entrenamiento de la pieloplastia laparoscópica es prometedora.

Estudio piloto para la validación de unmodelo de bajo coste en la simulación de la pieloplastia laparoscópica pediátrica / Pilot study for low-cost model validation in laparoscopic pediatric pyeloplasty simulation

Objetivos: Describir la creación de un modelo original de látex líquido diseñado para la simulación de la pieloplastia laparoscópica (PL) en lactantes, construido a partir de una impresión tridimensional (3D), y valorar su utilidad. Material y métodos: Se diseñó un modelo 3D de una pelvis dilataday un uréter con estenosis pieloureteral (EPU), que fue recubierto por látex líquido obteniendo modelos flexibles para realizar la pieloplastia en un pelvitrainer. El precio total de cada modelo fue de 6 euros. Se realizó un estudio cuasiexperimental, ciego y no aleatorizado, midiendo el tiempo quirúrgico y la puntuación OSATS (Objective Structured Assessment of Technical Skills). Tras completar la simulación, se realizó una encuesta utilizando la escala de Likert, en la cual se valoró el aspecto general, la textura, la utilidad del modelo y el grado de recomendación en el entrenamiento habitual. Resultados: Ocho cirujanos pediátricos dedicaron una mediana de71,5 minutos (R 50-86), y puntuaron una mediana de 20,1/30 (R 17-24)en la escala OSATS. El modelo obtuvo una valoración de 4,25 (R3-5) en aspecto general, 4,37 (R3-5) en textura, 4,5 (R 4-5) en utilidad y 4,6(R 4-5) en recomendación para incorporar al entrenamiento habitual. Conclusiones: El uso de nuestro modelo de látex líquido para lasimulación de la pielopalstia laparoscópica es factible y los resultados preliminares han sido favorables. Su utilidad como herramienta en el entrenamiento de la pieloplastia laparoscópica es prometedora.(AU)

Objective: To describe the creation of an original 3D-printed liquid latex model designed for laparoscopic pyeloplasty (LP) simulation in infants, and to assess its usefulness. Materials and methods: A 3D model of a dilated pelvis and a ureter with ureteropelvic junction obstruction (UPJO) was designed. It was covered in liquid latex, which allowed flexible models to be achieved in order to conduct pyeloplasty in a pelvitrainer. The total price of each model was 6 euros. A nearly-experimental, non-randomized, blind study was carried out, while measuring operating times and OSATS (Objective Structured Assessment of Technical Skills) scores. Following simulation completion, a survey based on Likert scale was conducted to assess overall appearance, texture, usefulness, and probability of recommending the model for regular training. Results.: 8 pediatric surgeons spent a median of 71.5 minutes (range: 50-86), and rated the model with a median 20.1/30 (range: 17-24) OSATS score. The model received a 4.25 (range: 3-5) score in terms of overall appearance, a 4.37 (range: 3-5) score in terms of texture, a 4.5 (range: 4-5) score in terms of usefulness, and a 4.6 (range: 4-5) score in terms of probability of recommending the model for regular training. Conclusions: Our liquid latex model for laparoscopic pyeloplasty simulation is feasible, with favorable preliminary results. Its usefulness in laparoscopic pyeloplasty training is promising.(AU)

End-of-life transfusions in patientswith an oncological diagnosis / Transfusiones al final de la vida en pacientes con diagnóstico oncológico

Introduction: Cancer patients in terminal stages present symptoms related to anemia, other cytopenias, and coagulopathies that deteriorate the quality of life. These symptoms can be multicausal and do not improve in most cases. Objective: Describe the use of blood transfusions in the six months before death as an alternative palliative treatment in patients with an oncological diagnosis in the city of Medellin during the period 2013-2018. Methods: Retrospective cohort, in patients with a cancer diagnosis who received transfusions in the last six months of life, a non-probabilistic sampling of consecutive cases was executed. The analysis was carried out in SPSS, estimating absolute and relative frequencies and median with interquartile ranges. Results: Out of 3,254 medical records of cancer pa­tients, 151 were included. The time to oncological diagnosis had a median of 2 years (IQR 1 and 3). The symptoms observed in patients before and after the first transfusion were pain, present in 32.1 % (46) and 16.9 % (25) respectively, besides drowsiness was distinguished in 25 % (36) before transfusion and 14.3 % (21) after. Finally, the clinical outcomes before and after the last transfusion prior to death, were a decrease in pain, asthenia/adynamia, drowsiness, among others. Conclusions: The findings of this research allow us to appreciate the current panorama in the institutions in which palliative care medical services are being provided and consider when to offer the blood products to a patient at the end of life as a therapeutic measure in the context of a human being cared by physicians.(AU)

Introducción: Los pacientes con cáncer en fase terminal presentan síntomas relacionados con la anemia, otras citopenias y coagulopatías que deterioran la calidad de vida. Estos síntomas pueden ser multicausales y no mejoran en la mayoría de los casos. Objetivo: Describir el uso de transfusiones sanguíneas en los seis meses previos a la muerte como alternativa de tratamiento paliativo en pacientes con diagnóstico oncológico en la ciudad de Medellín durante el periodo 2013-2018. Métodos: Cohorte retrospectiva, en pacientes con diagnóstico de cáncer que recibieron transfusiones en los últimos seis meses de vida, se ejecutó un muestreo no probabilístico de casos consecutivos. El análisis se realizó en SPSS, estimando frecuencias absolutas y relativas y mediana con rangos intercuartílicos.Resultados: De 3254 historias clínicas de pacientes con cáncer, 151 fueron incluidas. El tiempo hasta el diagnóstico oncológico tuvo una mediana de 2 años (IQR 1 y 3). Los síntomas observados en los pacientes antes y después de la primera transfusión fueron el dolor, presente en el 32,1 % (46) y el 16,9 % (25) respectivamente, además de la somnolencia que se distinguió en el 25 % (36) antes de la transfusión y el 14,3 % (21) después. Finalmente, los resultados clínicos antes y después de la última transfusión antes de la muerte, fueron una disminución del dolor, astenia/adinamia, somnolencia, entre otros. Conclusiones: Los hallazgos de esta investigación permiten apreciar el panorama actual en las instituciones en las que se prestan servicios médicos de cuidados paliativos y considerar cuándo ofrecer los hemoderivados a un paciente al final de la vida como medida terapéutica en el contexto de un ser humano atendido por los médicos.(AU)

Transfusiones al final de la vida. Revisión de algunas consideraciones importantes / Transfusions at the end of life. Review of some important considerations

La trasfusión de hemoderivados se utiliza con más frecuencia en pacientes con neoplasias hematológicas que en pacientes con tumores sólidos, y de forma variable en el caso de pacientes terminales con otro tipo de patologías. La anemia y trombocitopenia son frecuentes en este grupo diverso de pacientes, que reciben tratamientos hasta el final de la vida, siendo la transfusión de componentes sanguíneos, como los glóbulos rojos o las plaquetas, una intervención necesaria para el alivio de síntomas y mejoras en el estado clínico. Sin embargo, en pacientes con enfermedad terminal, los síntomas son de origen multifactorial y los valores hematológicos no necesariamente se convierte en un criterio para transfundir. No obstante, la evidencia científica que apoya que las transfusiones mejoren significativamente los síntomas de los pacientes paliativos aún no es concluyente.A pesar de que la literatura define algunas indicaciones para transfundir las dificultades, empiezan en el contexto de la selección del tipo de transfusión, la cantidad de las mismas y el fin de vida. En la literatura científica se encuentran diferentes comunicaciones que relacionan las últimas unidades de hemoderivados administrados, previo a la muerte del paciente; sin embargo, poco se encuentra con relación a criterios uniformes que apoyen la decisión al final de la vida y la relación riesgo beneficio no es clara.Las trasfusiones sanguíneas, además de ser procedimientos comunes en la práctica clínica, son terapias que generan riesgos y costes considerables para el sistema, por lo que la búsqueda de opciones alternas se hace imperativo a la hora de evitar terapias innecesarias.(AU)

Transfusion of blood products is used more frequently in patients with hematological malignancies than in patients with solid tumors, and variably in the case of terminally ill patients with other types of pathologies. Anemia and thrombocytopenia are frequent in this diverse group of patients, who receive treatments until the end of life, the transfusion of blood components, such as red blood cells or platelets, being a necessary intervention for the relief of symptoms and improvements in condition. clinical. However, in terminally ill patients, symptoms are multifactorial in origin and hematological values do not necessarily become a criterion for transfusing, however, the scientific evidence supporting that transfusions significantly improve the symptoms of palliative patients has not yet is conclusive.Although the literature defines some indications for transfusing difficulties, they begin in the context of the selection of the type of transfusion, the amount of the transfusion, and the end of life. In the scientific literature there are different reports that list the last units of blood products administered, prior to the death of the patient; however, little is found in relation to uniform criteria that support the decision at the end of life and the risk benefit ratio is not clear.Blood transfusions, in addition to being common procedures in clinical practice, are therapies that generate considerable risks and costs for the system, so the search for alternative options becomes imperative when it comes to avoiding unnecessary therapies.Patients with end-of-life transfusion needs generally have a history of known chronic disease; It is for this reason that the mobilization of individual and family resources becomes the challenge for healthcare personnel, since this will largely depend on the way in which the situation is dealt with and the links that are generated, so the approach must be carried out in an interdisciplinary way.(AU)

Conservative parenchymal surgery in testicular tumors. / Cirugía conservadora de parénquima en tumores testiculares.

OBJECTIVES: Orchiectomy is the most widely used surgical technique in testicular tumors (TT). However, according to tumor size, tumor markers, and histology, tumorectomy can be considered as the technique of choice, since these tumors are mostly benign. We present our experience with conservative surgery. MATERIAL AND METHODS: A retrospective study of 21 TT cases in 19 patients under 14 years of age treated in our healthcare facility from 1998 to 2018 was carried out. The following variables were analyzed: age, laterality, histological type, evolution, presence or absence of recurrence, and ultrasound and analytical follow-up. The therapeutic attitude used was reviewed while assessing the possibility of testicular preservation in selected patients. RESULTS: Conservative surgery was performed in 9 TT cases in 7 patients (2 bilateral cases). Mean age was 6 years (0-13 years). 86% of cases started as an asymptomatic scrotal mass. No significant differences were found in terms of laterality. Tumor markers were negative before and after surgery, except in an infant with high alpha-fetoprotein, which was normalized in the postoperative period. The histological study diagnosed 7 stromal TTs (three Leydig cell stromal TTs, one bilateral Sertoli cell stromal TT, one hamartoma, and one fibroma) and 2 germ cell TTs (bilateral epidermoid cyst). Evolution was favorable in all cases, without clinical or ultrasound recurrence. CONCLUSIONS: Conservative surgery of the testicular parenchyma using tumorectomy can be the first therapeutic option in benign tumors and in selected patients with bilateral tumor, since it allows future hormonal and reproductive function to be preserved.

OBJETIVOS: La orquiectomía ha sido la técnica quirúrgica clásicamente más empleada en tumores testiculares (TT). Sin embargo, en función del tamaño del tumor, marcadores tumorales e histología, se puede considerar la tumorectomía como técnica de elección, ya que en su mayoría se trata de tumores benignos. Presentamos nuestra experiencia en cirugía conservadora. MATERIAL Y METODOS: Estudio retrospectivo de 21 casos de TT en 19 pacientes menores de 14 años, tratados en nuestro centro entre 1998-2018. Analizamos las siguientes variables: edad, lateralidad, tipo histológico, evolución, existencia o no de recidivas, seguimiento ecográfico y analítico. Revisamos la actitud terapéutica empleada, con énfasis en la posibilidad de preservación testicular en pacientes seleccionados. RESULTADOS: Se realizó cirugía conservadora en nueve casos de TT tratados que correspondían a siete pacientes (dos bilaterales). La edad media de presentación fue de seis años (0-13 años). El 86% de los casos debutaron como masa escrotal asintomática. No existieron diferencias significativas en cuanto a lateralidad. Los marcadores tumorales fueron negativos antes y después de la intervención, salvo en un lactante con alfafetoproteína elevada, normalizada en el posoperatorio. El estudio histológico diagnostica 7TT estromales (tres de células de Leydig y uno bilateral de células de Sertoli, un hamartoma y un fibroma) y 2TT de células germinales (quiste epidermoide bilateral). Evolución favorable en todos ellos, sin recidivas clínicas ni ecográficas. CONCLUSIONES: La cirugía conservadora del parénquima testicular, mediante tumorectomía, puede ser la primera opción terapéutica en tumores benignos y en pacientes seleccionados con tumores bilaterales, con el objetivo de preservar la función hormonal y reproductora futura.

Cirugía conservadora de parénquima en tumores testiculares / Conservative parenchymal surgery in testicular tumors

OBJETIVOS: La orquiectomía ha sido la técnica quirúrgica clásicamente más empleada en tumores testiculares (TT). Sin embargo, en función del tamaño del tumor, marcadores tumorales e histología, se puede considerar la tumorectomía como técnica de elección, ya que en su mayoría se trata de tumores benignos. Presentamos nuestra experiencia en cirugía conservadora. MATERIAL Y MÉTODOS: Estudio retrospectivo de 21 casos de TT en 19 pacientes menores de 14 años, tratados en nuestro centro entre 1998-2018. Analizamos las siguientes variables: edad, lateralidad, tipo histológico, evolución, existencia o no de recidivas, seguimiento ecográfico y analítico. Revisamos la actitud terapéutica empleada, con énfasis en la posibilidad de preservación testicular en pacientes seleccionados. RESULTADOS: Se realizó cirugía conservadora en nueve casos de TT tratados que correspondían a siete pacientes (dos bilaterales). La edad media de presentación fue de seis años (0-13 años). El 86% de los casos debutaron como masa escrotal asintomática. No existieron diferencias significativas en cuanto a lateralidad. Los marcadores tumorales fueron negativos antes y después de la intervención, salvo en un lactante con alfafetoproteína elevada, normalizada en el posoperatorio. El estudio histológico diagnostica 7TT estromales (tres de células de Leydig y uno bilateral de células de Sertoli, un hamartoma y un fibroma) y 2TT de células germinales (quiste epidermoide bilateral). Evolución favorable en todos ellos, sin recidivas clínicas ni ecográficas. CONCLUSIONES: La cirugía conservadora del parénquima testicular, mediante tumorectomía, puede ser la primera opción terapéutica en tumores benignos y en pacientes seleccionados con tumores bilaterales, con el objetivo de preservar la función hormonal y reproductora futura

OBJECTIVES: Orchiectomy is the most widely used surgical technique in testicular tumors (TT). However, according to tumor size, tumor markers, and histology, tumorectomy can be considered as the technique of choice, since these tumors are mostly benign. We present our experience with conservative surgery. MATERIALS AND METHODS: A retrospective study of 21 TT cases in 19 patients under 14 years of age treated in our healthcare facility from 1998 to 2018 was carried out. The following variables were analyzed: age, laterality, histological type, evolution, presence or absence of recurrence, and ultrasound and analytical follow-up. The therapeutic attitude used was reviewed while assessing the possibility of testicular preservation in selected patients. RESULTS: Conservative surgery was performed in 9 TT cases in 7 patients (2 bilateral cases). Mean age was 6 years (0-13 years). 86% of cases started as an asymptomatic scrotal mass. No significant differences were found in terms of laterality. Tumor markers were negative before and after surgery, except in an infant with high alpha-fetoprotein, which was normalized in the postoperative period. The histological study diagnosed 7 stromal TTs (three Leydig cell stromal TTs, one bilateral Sertoli cell stromal TT, one hamartoma, and one fibroma) and 2 germ cell TTs (bilateral epidermoid cyst). Evolution was favorable in all cases, without clinical or ultrasound recurrence. CONCLUSIONS: Conservative surgery of the testicular parenchyma using tumorectomy can be the first therapeutic option in benign tumors and in selected patients with bilateral tumor, since it allows future hormonal and reproductive function to be preserved

Apendicectomía profiláctica en la dotación Antártica: experiencia del Hospital de la Fuerza Aérea de Chile / Prophylactic appendectomy in the Antarctic endowment: experience of the Chilean Air Force Hospital

Resumen Objetivo: Reportar y caracterizar las complicaciones quirúrgicas de las apendicectomías laparoscópicas electivas profilácticas, realizadas a pacientes destinados a dotación antártica, realizadas en Hospital clínico de la Fuerza Aérea de Chile (FACh). Materiales y Método: Análisis retrospectivo descriptivo de fichas clínicas de todos los pacientes sometidos a apendicectomía laparoscópica profiláctica entre los años 2013 y 2017 en Hospital FACh. Se registraron variables demográficas y quirúrgicas de los pacientes. Las complicaciones fueron registradas y clasificadas de acuerdo a Clavien-Dindo. Resultados: Se incluyeron 200 pacientes, 96% hombres y solo 4% mujeres. Se registraron 6 pacientes (3%) con complicaciones quirúrgicas, clasificadas como grado I según Clavien-Dindo. Discusión: No existen reportes de complicaciones en apendicectomías profilácticas. En nuestra serie éstas alcanzan el 3%. Conclusiones: La apendicectomía profiláctica es una cirugía segura, con escasas complicaciones, pero existen y se desarrollan en un paciente que estaba previamente sano.

Aim: To present and characterize surgical complications of elective prophylactic appendectomies, performed in patients for the Antarctic endowment at the Hospital Clínico de la Fuerza Aérea de Chile. Materials and Method: Retrospective descriptive analysis of all patients operated of prophylactic laparoscopic appendectomy between 2013 and 2017. Demographic and surgical variables of the patients were recorded and analysed. Complications were classified according Clavien-Dindo. Results: 200 patients were included, 96% mens. Six patients (3%) had a surgical complication, all classified as Grade I. Discussion: There are no previous reports of surgical complications on prophylactics appendectomies. The complications rate is 3%. Conclusions: The prophylactic appendectomy is a safe surgery with a low rate of complications, although its exists and develops in a previously healthy patient.

Disentangling the evolutionary and biogeographical history of the freshwater fish trematode genus Creptotrema (Digenea: Allocreadiidae) using an integrative taxonomy approach: the case of Creptotrema agonostomi in Middle American mountain mullets.

Species of the allocreadiid genus Creptotrema are parasites of freshwater fishes in the Americas. Species in the genus possess one pair of muscular oral lobes on the oral sucker. Currently, the genus contains eight species, six distributed in South America, one in Middle America and one in North America. Genetic data are only available for the North American species, Creptotrema funduli, a parasite of fundulids originally described from Oneida Lake, New York State. In this study, we obtained 28S ribosomal DNA sequences of trematodes morphologically similar to Creptotrema agonostomi from the mountain mullet, Dajaus monticola, across a wide geographical range in Middle America. Our molecular phylogenetic analyses showed that (1) the genus Creptotrema, as currently conceived, is not monophyletic; (2) the allocreadiids in mountain mullets should be re-allocated in the genus Pseudoparacreptotrema; and (3) the allocreadiid trematodes from D. monticola across Middle America represent four morphologically similar species, three of which can be distinguished genetically. These three new species are described herein using an integrative taxonomy approach. We contend that accurate estimates of species diversity and phylogenetic relationships among allocreadiids, and most likely other species of trematodes, necessarily require an integrative taxonomy approach that should consider at least DNA sequences and scanning electron microscopy.

A Case Series of X-Linked Deafness-2 with Sensorineural Hearing Loss, Stapes Fixation, and Perilymphatic Gusher: MR Imaging and Clinical Features of Hypothalamic Malformations.

X-linked deafness-2 (DFNX2) is an X-linked recessive disorder characterized by profound sensorineural hearing loss and a pathognomonic temporal bone deformity. Because hypothalamic malformations associated with DFNX2 have been rarely described, we aimed to further describe these lesions and compare them with features of a nonaffected population. All patients diagnosed with DFNX2 between 2006 and 2019 were included and compared with age-matched patients with normal MR imaging findings and without hypothalamic dysfunction. MR imaging features differing between groups were selected to help identify DFNX2. Sensitivity and specificity were calculated for these features. Agreement among 3 radiologists was quantified using the index κ. Information on the presence or absence of gelastic seizures, precocious puberty, or delayed puberty was also gathered. We selected distinctive MR imaging features of hypothalamic malformations in DFNX2. The feature selected on axial T2 images was the folded appearance of the ventromedial hypothalamus (sensitivity, 100%; specificity, 95.8%) characterized by an abnormal internal/external cleft (sensitivity, 100%; specificity, 95.7%). On coronal T2, the first distinctive feature was a concave morphology of the medial eminence (sensitivity, 100%; specificity, 97.1%), the second feature was at least 1 hypothalamic-septum angle ≥90° (sensitivity, 90%; specificity, 72.5%), and the third feature was a forebrain-hypothalamic craniocaudal length of ≥6 mm (sensitivity, 70%; specificity, 79.7%). Clinical features were also distinctive because 9 patients with DFNX2 did not present with gelastic seizures or precocious puberty. One patient had delayed puberty. The κ index and intraclass correlation coefficient ranged between 0.78 and 0.95. Imaging and clinical features of the hypothalamus suggest that there is a hypothalamic malformation associated with DFNX2. Early assessment for pubertal delay is proposed.

Túnica vaginal autógena para herniorrafia perineal em cães / Autogenous tunica vaginalis for perineal herniorrhaphy in dogs

A túnica vaginal possui características ideais para enxertia e já foi empregada na reparação de diversos tecidos, inclusive do diafragma pélvico. Objetivou-se avaliar a aplicabilidade da túnica vaginal como enxerto autógeno livre, em dupla camada, para a reparação do diafragma pélvico em 14 cães portadores de hérnia perineal, das quais, nove eram unilaterais e cinco, bilaterais. Após a orquiectomia, as túnicas de ambos os testículos foram coletadas, sobrepostas e fixadas entre si por meio de quatro pontos de reparo. Foi realizada abordagem ao saco herniário, inspeção, redução do conteúdo herniário, desbridamento muscular e síntese primária mediante sutura. O enxerto foi fixado à musculatura remanescente por meio de pontos simples separados e, posteriormente, encoberto pela sutura intradérmica e por síntese cutânea. Observações transoperatórias e, posteriormente, avaliações clínicas e ultrassonográficas, por período de um ano, permitiram sugerir que a túnica vaginal possui atributos ideais para a reparação do diafragma pélvico. Conclui-se que o enxerto autógeno livre de túnica vaginal, em dupla camada, é exequível e aplicável para o reparo do diafragma pélvico no tratamento da hérnia perineal em cães.(AU)

The tunica vaginalis has ideal characteristics for grafting and has already been used to repair several tissues, including the pelvic diaphragm. The aim of this study was to evaluate the applicability of the tunica vaginalis as a free double-layer autogenous graft to repair the pelvic diaphragm in 14 dogs with perineal hernia, of which, nine were unilateral and five, bilateral. After orchiectomy, the tunics of both testicles were collected, overlapped and fixed to each other by four repair points. The hernial sac was approached, followed by inspection, reduction of the hernia content, muscle debridement and primary synthesis through suture. The graft was attached to the remaining musculature by simple interrupted stitches and later hidden by intradermal suture and cutaneous synthesis. Intraoperative observations and, later, clinical and sonographic evaluations over a one-year period, allow to suggest that the tunica vaginalis has ideal attributes for the pelvic diaphragm repair. It is concluded that the autogenous graft-free of tunica vaginalis in double layer is feasible and applicable in order to repair the pelvic diaphragm in the perineal hernia treatment in dogs.(AU)

[Factors that influence compliance with hand hygiene in healthcare professionals: A concept mapping study]. / Factores que influyen en el cumplimiento de la higiene de manos en profesionales sanitarios: un estudio de mapeo de conceptos.

OBJECTIVE: To identify factors that may influence hand hygiene compliance by professional category and clinical department. MATERIALS AND METHODS: Use was made of concept mapping methodology, a tool that combines a qualitative analysis with a quantitative statistical analysis, in order to identify the most influential and important factors for the fulfilment of hand hygiene in 2 clinical departments (Infectious and General Surgery) of the Hospital del Mar. RESULTS: The study included a total of 42 volunteer professionals from General Surgery (6 doctors and 10 nurses) and from Infectious Diseases (11 doctors and 10 nurses) clinical departments, as well as 5 hospital porters. High correlations of influential and important factors for hand hygiene compliance were observed between nurses and doctors in the Infectious Diseases Department (r=0.93 vs. r=0.69, respectively). In contrast, the correlation was lower among surgical professionals (r=-0.17 for influence and r=0.51 for importance). Professionals identified the most influential factors in compliance as training and adequate resources, taking into account professional category and clinical department. CONCLUSION: The design of interventions to improve compliance with hand hygiene should take into account the perceptions of different professionals in order to adapt actions to each professional group.

Morphologic changes of the fifth phalange secondary to smartphone use.

BACKGROUND: The use of smart phones is now part of the daily routine throughout the world. Morphological alterations have been described associated with telephone holding technique, as well as clinically significant alterations related to their use. OBJECTIVE: The objective was to determine the macroscopic morphological changes due to smartphone use in the fifth finger of the hand with which the smartphone is commonly used. METHODS: University students were invited to participate. Photographs of the dorsal region of both hands were taken using a millimeter paper as background. After calibrating the ImageJ software, photographs were analyzed in pairs obtaining areas of asymmetry. Sociodemographic information and technique of use was collected through a survey. The data were analyzed using SPSS ver. 20. RESULTS: A total of 143 participants were included. The mean age was 20 years. No significant differences were found between the area of asymmetry and the miniferet of both fingers of the subjects compared with age, gender, BMI, daily time of use, years using a smartphone or the type of holding technique. CONCLUSIONS: No asymmetric changes were evident between left and right small fingers in relation to the holding technique of a smartphone in a young adult population.

[Correction of the pre- and post-surgical rotational component of the first metatarsal secondary to modified Chevron osteotomy]. / Corrección del componente rotacional prequirúrgico y postquirúrgico del primer metatarsiano secundario a osteotomía de Chevron modificado.

INTRODUCTION.: Hallux valgus (HV) is a complex forefoot pathology, in which interest has recently been shown in the distal rotational component (CR) of the first metatarsal due to its relationship with postsurgical relapses of the deformity. The selection of surgical technique is controversial with little current literature on the correction of rotation with common osteotomies. The aim of this study is to evaluate preoperative and postoperative radiological characteristics regarding CR of the first metatarsal using long Chevron osteotomy for moderate to severe HV. MATERIAL AND METHODS: An observational, prospective and comparative study was carried out in which the CR of the first metatarsal was evaluated in nine feet belonging to six patients with a mean age of 45 years. The RC was evaluated based on the proximal metaphysis of the first metatarsal in axial fluoroscopies of unloaded metatarsals and standing AP. Measurements were performed by an Orthopedic and Traumatology resident and a Foot and Ankle Surgery subspecialist. RESULTS: Significant differences (p = 0.05) were documented in the preoperative and postoperative pronation angle when using long Chevron osteotomy. The functional result of the evaluated patients was excellent at 11 months of follow-up. CONCLUSIONS: Radiologically, the rotational correction is variable and has not previously been reported in the literature with this osteotomy. We establishes the morphological bases for the performance of subsequent studies in the evaluation of head rotation of the 1st metatarsal with different osteotomies.

INTRODUCCIÓN: Hallux valgus (HV) es una patología compleja del antepié, recientemente se ha mostrado interés en el componente rotacional (CR) distal del primer metatarsiano por su relación con recidivas postquirúrgicas de la deformidad. La selección de la técnica quirúrgica es controversial con escasa literatura acerca de la corrección de rotación con osteotomías comunes. Nuestro objetivo es evaluar características radiológicas prequirúrgicas y postquirúrgicas respecto a CR del primer metatarsiano en la cirugía de corrección de HV moderado a severo usando osteotomía de Chevron largo. MATERIAL Y MÉTODOS: Estudio observacional, prospectivo y comparativo en el que se evaluó el CR del primer metatarsiano en nueve pies pertenecientes a seis pacientes con una edad media de 45 años. El CR fue evaluado con base en la metáfisis proximal del primer metatarsiano en fluoroscopías axiales sin carga y AP de pie. Las mediciones se realizaron por un residente de ortopedia y traumatología y un subespecialista en cirugía de pie y Tobillo. RESULTADOS: Se documentaron diferencias significativas (p = 0.05) en el ángulo de pronación prequirúrgico y postquirúrgico al utilizar osteotomía de Chevron largo. El resultado funcional de los pacientes evaluados fue excelente a 11 meses de seguimiento. CONCLUSIONES: Radiológicamente, la corrección rotacional es variable y previamente no se ha reportado en la literatura con esta osteotomía. Se establecen bases morfológicas para la realización de estudios posteriores en la evaluación de rotación de cabeza del primer metatarsiano con diferentes osteotomías.

Retorno a las básicas, músculo como órgano anti-inflamatorio en paciente con artritis reumatoide

RESUMEN Mujer en cuarta década de la vida, con antecedente de hipotiroidismo, tuberculosis latente y artritis reumatoide, quien no responde a manejo inmunomodulador crónico con distintos esquemas terapéuticos, es valorada por grupo interdisciplinar de endocrinología, medicina interna, medicina del deporte y psicología evidenciando sobrepeso, con alteración de la masa muscular esquelética, masa grasa, grasa visceral y en exámenes complementarios una inadecuada excursión de la glucosa con insulina basal elevada. Se orienta manejo con estrategia nutricional, deportiva y cognitivo conductual logrando resolución de los síntomas y suspensión del tratamiento farmacológico.

ABSTRACT 35 years old woman, with personal history of hypothyroidism, latent tuberculosis and rheumatoid arthritis, who does not respond to chronic immunomodulatory management with different therapeutic schemes, is valued by an interdisciplinary group of endocrinology, internal medicine, sports medicine and psychology, evidencing overweight, with alteration in skeletal muscle mass, fat mass, visceral fat and laboratories with inadequate excursion of glucose with high basal insulin. The management was oriented with nutritional, sports and cognitive behavioral strategy achieving resolution of symptoms and suspension of pharmacological treatment.