Executive summary on the optimization of the multidisciplinary and integrated approach to polymyalgia rheumatica and giant cell arteritis in Madrid region.

Polymyalgia rheumatica and giant cell arteritis can be a medical emergency in which a delay in correct diagnosis and therapeutic management can cause serious complications. With the aim of improving the care of patients with these pathologies in the Community of Madrid, a study was designed to identify the causes and possible solutions to address the problems related to the diagnosis of these pathologies. After the analysis, 11 areas of improvement related to four different aspects of the care process were identified: coordination and protocols, equipment, training and awareness of pathologies, and patient experience. Of all the areas identified, it was considered a priority to resolve those related to the generation of protocols for the comprehensive management of the pathologies, which include all the specialties and levels of care involved. Another crucial aspect is the increase in the degree of clinical suspicion of these pathologies.

Techno-economic analysis of torrefied fuel pellet production from agricultural residue via integrated torrefaction and pelletization process.

Torrefied pellets have gained more commercial importance due to their excellent performance in combustion, co-firing and gasification. The present investigation provides a conceptual design for torrefied fuel pellets production via combined torrefaction and pelletization technologies with and without additives. The entire design contains torrefaction unit, grinding, preparation of pellet formulation, pelletizing, and finally cooling of pellets. Two scenarios, scenario 1 (pelletization of torrefied biomass with additives) and scenario 2 (pelletization of torrefied biomass without any external additives) were tested and compared. The economic analysis suggests that both scenarios are profitable. Both scenarios were simulated using Aspen plus™, and economic feasibility was estimated using a complete cash flow analysis for a base case plant with 40,080 tonne/y capacity. For both cases, a discounted cash flow is a useful tool for estimating the minimal selling price for torrefied pellets as well as the capital investment, production cost and operating costs. The cost of the reactor used for torrefaction was found to be the most important component of combined torrefaction and pelletization system. The lowest selling price of generated torrefied pellets was found to be $103.4 and $105.1 per tonne at the plant gate for scenarios 1 and 2, respectively. Sensitivity analysis shows that, among all variable costs, labor cost has the highest influence on both net present value (NPV) and minimum selling price (MSP) in making pellets for both the scenarios. Furthermore, the internal rate of return was found to be25% and 22% at 10% discounted cash flow rate for scenarios 1 and 2, respectively. The framework that was created was found to lessen over-dependence on wood or fossil fuels and facilitate the promotion of bioenergy in rural areas.

Analysis of the Direct Cost of Medical and Surgical Care for Testicular Cancer in Early and Advanced Stages in a Third Level Medical Facility of the Mexican Social Security Institute

Background: The testicular cancer prevails in the third decade of life, the care cost increases with higher staging of the disease. Objective: Compare the direct costs of medical and surgical attention for testicular cancer in early and advanced stages in a Third Level Medical Facility. Material and Methods: Process study, direct costs of medical attention are evaluated. Number of laboratory studies, imaging studies, and medical and surgical treatment were analyzed. The patients were divided into 2 groups: group 1 early stages and group 2 advanced stages. Mann Whitney U test was used for the difference between groups. Results: There were 10 patients in each group, Group 1: 8 (80%) seminomas and 2 (20%) non-seminoma, Group 2: 4 (40%) seminomas and 6 (60%) non-seminomas. The average cost of care in Group 2 is higher than in Group 1, 288,827.90 and 145,911.70 Mexican pesos respectively (p=0.00578). Conclusions: The direct cost of medical attention is higher in the advanced stages compared to the early stages (AU)

Objetivo: Comparar los costes directos de atenciónmédica y quirúrgica del cáncer testicular en etapa tempranay avanzada en un hospital de tercer nivel.Material y Métodos: Estudio de proceso, se evalúancostes directos de atención médica. Se analizaron númerode estudios de laboratorio, gabinete y tratamiento médico yquirúrgico. Los pacientes se dividieron en 2 grupos: grupo1 estadios tempranos y grupo 2 estadios avanzados. Se utilizó la prueba de U de Mann Whitney para diferencia entregrupos.Resultados: Fueron 10 pacientes en cada grupo,Grupo 1: 8 (80%) seminomas y 2 (20%) no seminomas,Grupo 2: 4 (40%) seminomas y 6 (60%) no seminomas. Elcoste promedio de atención en el Grupo 2 es mayor que enel Grupo 1, $288,827.90 y $145,911.70 pesos mexicanosrespectivamente (p=0.00578).Conclusiones: El coste directo de atención médica esmayor en los estadios avanzados comparado con los estadios tempranos. (AU)

Fisiopatología de la osteoporosis en las enfermedades articulares inflamatorias crónicas / Pathophysiology of osteoporosis in chronic inflammatory joint diseases

El sistema inmune y el hueso comparten con frecuencia los mismos nichos y espacios anatómicos, existiendo una estrecha relación funcional entre ambos. Esto hace que haya una interacción constante entre ellos, con un flujo bidireccional de información entre las células inmunes y las del tejido óseo (osteoclastos, osteoblastos y osteocitos), muchas veces desconocida, en la que intervienen múltiples mediadores inflamatorios y diversos factores de crecimiento y diferenciación celular. Ello conduce a una interacción muy estrecha entre inflamación y pérdida ósea. De hecho, la osteoporosis (OP) es una de las complicaciones sistémicas más frecuentes en las enfermedades inflamatorias crónicas (EIC). La prevalencia de OP en las EIC es variable y depende de cada escenario patológico. La artritis reumatoide (AR) es una de las enfermedades paradigmáticas de inflamación crónica, donde la presencia de OP es frecuente, apareciendo incluso antes de que aparezcan los primeros síntomas de la enfermedad. La patogenia de la OP asociada a la AR es compleja e incluye la colaboración de múltiples citoquinas proinflamatorias que favorecen la osteoclastogénesis e inhiben la formación ósea. Entre todas destacan el factor de necrosis tumoral alfa (conocido en inglés como TNF-α) y diversas interleuquinas (IL) como IL-1, IL-6 e IL-17. De todas, IL-6 tiene un papel jerárquico relevante. En esta revisión se repasa el papel de las citoquinas proinflamatorias en la destrucción ósea y articular en diferentes EIC, con especial énfasis en la AR, planteándose las bases de posibles vías que abran nuevos horizontes terapéuticos en el marco de las EIC. (AU)

The immune system and the bone often share the same anatomical niches and spaces, as there is a close functional relationship between both of them. As a consequence, there is a constant interaction between them and a bidirectional flow of information between the immune cells and those of the bone tissue (osteoclasts, osteoblasts and osteocytes) often unknown, in which multiple inflammatory mediators and various growth and cell differentiation factors are involved. This leads to a very close interaction between inflammation and bone loss. In fact, osteoporosis (OP) is one of the most frequent systemic complications in chronic inflammatory diseases (CIDs). The prevalence of OP in CIDs depends on each pathological scenario. Rheumatoid arthritis (RA) is a paradigmatic disease which causes chronic inflammation, where the presence of OP is frequent and shows even prior to the appearance of the first symptoms of the RA. The pathogenesis of RA-associated OP is complex and includes the cooperation of multiple pro-inflammatory cytokines that promote osteoclastogenesis and inhibit bone formation. Tumor necrosis factor alpha (TNF-α) and different interleukins (IL), such as IL-1, IL-6 and IL-17, stand out among all, IL-6 having a relevant hierarchical role. In this study, we review the role of pro-inflammatory cytokines in bone and joint destruction in different CIDs, giving special emphasis to RA, as we set out the bases of possible pathways that open new therapeutic horizons in the their framework. (AU)

Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

[Medullar thoracic compression by tophaceous gout: presentation of a case and review of the literature]. / Compresion medular dorsal por tofos gotosos: presentacion de un caso y revision de la bibliografia.

INTRODUCTION: Spine involvement in gout is an extremely uncommon complication. Dorsalgia and quadriplegia are some manifestations that may occur, although these symptoms are seen more frequently in other more prevalent pathologies, such as spinal tumors. CASE REPORT: We present an unusual case of thoracic spinal cord compression at T10-T11 level caused by the extradural deposit of tophaceous material in a 52-year-old woman with uncontrolled chronic tophaceous gout. In addition to intensive medical treatment, the patient required surgery (hemilaminectomy and spinal decompression) and subsequent rehabilitation. Overall and neurological evolution were satisfactory.

TITLE: Compresion medular dorsal por tofos gotosos: presentacion de un caso y revision de la bibliografia.Introduccion. La afectacion de la columna vertebral en la gota es una complicacion extremadamente infrecuente. La dorsalgia y la cuadriplejia son algunas manifestaciones que se pueden presentar, aunque estos sintomas se ven con mas frecuencia en otras patologias mas prevalentes, como los tumores medulares. Caso clinico. Se presenta un caso inusual de compresion medular dorsal en D10-D11 causado por el deposito extradural de material tofaceo en una paciente de 52 años con gota tofacea cronica incontrolada. Ademas de un tratamiento medico intensivo, la paciente requirio cirugia (hemilaminectomia y descompresion medular) y rehabilitacion posterior. La evolucion general y neurologica fue satisfactoria.

Comienzo del hábito tabáquico en la adolescencia y factores relacionados / Beginning smoking habit in adolescence and related factors

Estudio: Estudio descriptivo del consumo de tabaco en la adolescencia, que forma parte de un estudio más amplio sobre un estilo de vida saludable en la adolescencia temprana e intermedia. Personas y métodos. Profesores de educación física estudiaron a 1.112 adolescentes de 10 a 17 años de edad de los centros educativos mediante una encuesta de hábitos saludables y pruebas objetivas antropométricas y de condición física. Resultados. El 9% (IC-95%: 7,4% a 10,8%) de los adolescentes han fumado alguna vez, solo el 4,7% cuando no fuma ninguno de sus padres, el 12,6% cuando solo fuma uno de ellos y el 15,4% (IC-95%: 10,7% a 21,8%) cuando fuman ambos padres. El contacto con el tabaco empieza al inicio de la adolescencia, va aumentando hasta el 40,9% en los varones de 17 años y el 50,0% en las mujeres de igual edad. Las mujeres empiezan algo más tarde (13,8 años, IC-95%: 13,3 a 14,3) que los varones (12,7 años, IC-95%: 11,8 a 13,6), pero fuman más (5,1 cig/día, DE = 2,6) que los varones (4,4 cig/día, DE = 2,9). Actualmente fuma el 7,7% (IC-95%: 6,3% a 9,5%), unos ocasionalmente y otros habitualmente, con un consumo medio de 4,7 (DE = 2,74) cigarrillos diarios, dedicando las mujeres una media de 7,3 euros/sem (DE = 4,56) mientras que los varones solo 6,1 euros/sem (DE = 5,15). El 65,1% de los adolescentes piensan que el tabaco limita su actividad física, aunque no se evidencia en las pruebas de condición física, excepto en la prueba de course-navette en la que los varones fumadores rinden menos. Los fumadores duermen significativamente menos que los no fumadores (casi una hora menos los días laborables). Los fumadores valoran peor su satisfacción corporal, tanto los chicos (p = 0,013) como las chicas (p < 0,001). Otro hallazgo en este estudio es el distinto patrón en el test EnKid de alimentación sana, en el que los fumadores toman más bollería industrial, más alcohol, más comidas en fast-food y más chucherías, mientras que los no fumadores desayunan, desayunan un lácteo y un cereal, toman frutas a diario y toman verduras. No se observó asociación entre el estado nutricional y el hábito tabáquico y sí con el hábitat urbano. Conclusiones. El hábito tabáquico empieza en la primera etapa de la adolescencia, se consolida en la etapa intermedia y se caracteriza por su mayor predominio en las mujeres. Dicho hábito se asocia con dormir menos y cambios hacia una alimentación menos saludable y con una menor resistencia en las pruebas anaerobias en los varones

Aims: To analyze tobacco consumption, by age and sex, in primary and secondary school adolescents in Cantabria. Methodology. A cross-sectional study was carried out, analyzing a sample of 1,112 adolescents: 574 (51.6%) were men and 538 (48.4%) were women, aged between 10 and 17, attending 16 different primary and secondary education public centres in Cantabria, by means of a health habit questionnaire, objective anthropometric and physical condition trials. Results. 9% of adolescents from 10 to 17 years old have smoked sometime; only 4.7% of them do it when their parents are non-smokers, but this percentage rises to 12.6% when one of the two parents is a smoker and to 15.4% when both parents are smokers. The first contact with tobacco is at the beginning of adolescence and it is increases to 40.9% in 17 years old males and to 50.0% in females of the same age. The 7.7% of adolescents are current smokers, some of them are occasional users, but others are frequent users with an average consumption of 4.7 cigarettes per day. This consumption means an average expense of 7.3 euros per week in females and 6.1 euros in males. 65% of adolescents think tobacco limit their physical activity. Smokers sleep less than non-smokers; moreover, those have a worse valuation of their self-image. Finally, smokers eat more factory-produced cakes, rolls and buns, fast food and sweet candy, and consume more alcohol than non-smokers. Conclusions. The tobacco habit begins in the first stage of adolescence. It is consolidated at the intermediate stage and it is characterized by its greater predominance in females. This habit is associated with fewer hours of sleep and with changes towards a less healthy nutrition and less anaerobic trials resistance in males

Estrategia de salud bucal para niños con discapacidad visual / Oral health strategy for visually impaired children

El propósito de este trabajo es presentar una propuesta de la Guía de Salud Bucal para niños con discapacidad visual ya que es una preocupación del Programa de Maestría en Odontopediatría de la UCSUR la inclusión de personas en este caso con discapacidades visuales, al acceso de información sobre la importancia de la salud bucal y no habiendo encontrado en nuestro medio este material educativo, es que esta Guía fue desarrollada dentro de uno de los proyectos de innovación y producción académica; esto es un inicio, que con seguridad servirá como base para desarrollar futuros trabajos. (AU)

The aim of this paper is to present an approach of an Oral Health Guide for children with visual disabilities. One of the concern of the Master Program in Pediatric Dentistry of UCSUR is the inclusion of people with disabilities. Nowadays this kind of educative material is missing. This guide was developed into one of the innovation projects and academic production of the Pediatric Dentistry Master Program; this is a start, which certainly will serve as basis for developing future works. (AU)

Prácticas alimentarias de los adolescentes de Cantabria / Eating practices of adolescents of Cantabria

Objetivo: Analizar determinadas prácticas alimentarias en adolescentes escolarizados en centros de educación pública de Cantabria, participantes en el Proyecto 'Promoción de Hábitos Saludables en Adolescentes desde el Ámbito Educativo'. Sujetos: Se realizó un estudio transversal, analizando una muestra de 1.101 adolescentes: 568 (51,6%) varones y 533 (48,4%) mujeres, de edades comprendidas entre los 10 y los 17 años, escolarizados en dieciséis centros de enseñanza primaria y secundaria, mediante un cuestionario autocumplimentado. Resultados: Los adolescentes suelen realizar entre cuatro (41,5%) y cinco (31,6%) ingestas diarias. Durante los días de colegio, el 34% emplea entre diez y quince minutos en desayunar, y entre 30 y 35 minutos en comer (33,5%) y cenar (23%). Un elevado porcentaje (49,4%) de adolescentes desayunaba en soledad durante los días lectivos. Las principales ingestas alimenticias se realizan en el hogar. Las bebidas no alcohólicas (53,6%) y los dulces (42%) son los principales destinos de su dinero de bolsillo. En la casi totalidad de los hogares, es la madre la que se encarga de la compra de los alimentos, de la preparación de las comidas y de decidir tanto el almuerzo como la merienda. La pizza (72,6%) y las patatas fritas (70,8%) son los alimentos considerados más ricos entre los analizados, mientras que el perrito caliente (49,4%) y la hamburguesa (48,5%) son considerados como los menos sanos. El 58,6% de los encuestados cena viendo la televisión. Conclusión: En el estudio del comportamiento alimentario es necesario analizar la influencia de otros factores que, en muchas ocasiones, están detrás de las recomendaciones dietéticas y que casi siempre son ignorados. Prácticas alimentarias como las analizadas en el presente estudio, permiten, cuando estas se desarrollan de forma adecuada, una mejora sustancial en la salud alimentaria y nutricional de las personas

Objetive: To analyse some food practices, by age and sex, in primary and secondary schools adolescents in Cantabria, who are participating in the "Adolescents Health Habits Promotion since Education field" project. Methodology: A cross-sectional study was carried out, analysing a sample of 1101 adolescents: 568 (51.6%) were men and 533 (48.4%) were women, aged between 12 and 17, attending 16 different primary and secondary education centers in Cantabria, by means of questionnaire. Results: Adolescents usually eats between 4 and 5 times a day. They use between 10 to 15 minutes in having breakfast, between 30 to 35 minutes in having lunch and dinner on school days. A high percentage have breakfast alone on school days. The main eats were carried on at home. Soft drinks and sweet are the main purchase with their pocket money. Almost always, the mother is charged of buying the foods, preparing the meals and decide the morning and the afternoon snacks. Pizza and fried potatoes are considerated as most taste, whereas hot dog and hamburger are considerated as less healthy. The 58.6% of adolescents having dinner watching television. Conclusions: In the food behavior study, it is necessary to analyse the influence of other factors which, in many occasions, are behind of dietetic recommendations and the almost always are ignored. Food practices as we have analysed permit, when these are carry out in a right way, an important improve in the people nutritional health

Sigmoidectomía videoasistida como opción de manejo del vólvulo del sigmoides en la población pediátrica / Video-assisted sigmoidectomy as an option for Sigmoid volvulus management in the pediatric population

Introducción. El objetivo del estudio es evaluar la presentación y el manejo del vólvulo del Colon Sigmoides (VS) en pacientes pediátricos. El (VS) es una de las tres principales causas de obstrucción aguda del colon y constituye entre el 50 y 90% de todos los vólvulos del intestino grueso. En la población pediátrica, solo del 3 al 5% de las obstrucciones intestinales son causadas por vólvulo, y son menos de 100 los casos publicados en la literatura médica. La etiología en la población pediátrica se considera secundaria a la presencia de un meso amplio con una base estrecha asociado a una fijación anormal del colon. Otros factores incluyen historia de malformación anorectal, síndrome de Prune Belly, malrotacion intestinal y enfermedad de Hirschsprung. El manejo inicial por vía endoscópica, seguido de la sigmoidectomía mínimamente invasiva, han demostrado ser seguros y efectivos. Material y Métodos. El presente trabajo recoge la experiencia de 4 pacientes entre los 9 y 14 años manejados en nuestro servicio, en el año 2013, con diagnóstico de vólvulo del sigmoides, los cuales inicialmente fueron llevados a un primer tiempo quirúrgico para descompresión endoscópica del vólvulo y en un segundo tiempo fueron llevados a sigmoidectomía, la cual se llevó a cabo de forma videoasistida. En esta serie no se documentaron complicaciones intraoperatorias y, en el seguimiento a más de 6 meses, solo uno de los pacientes ha requerido nuevas intervenciones, en un caso especial, dado que el paciente presenta asociada una miopatía (leiomioscitis inflamatoria), la cual lo predispone a episodios de obstrucción intestinal. Conclusión. Consideramos que la devolvulación endoscópica seguida de una pronta sigmoidectomía videoasistida es la técnica ideal para el manejo de estos pacientes

Introduction. The aim of the present study was to evaluate clinical presentation and management of sigmoid volvulus in children. Sigmoid volvulus is one of the three leading causes of acute obstruction of the colon and is between 50 and 90% of all large bowel volvulus. In the pediatric population only 3 to 5% of bowel obstructions are caused by volvulus and there are less than 100 cases reported in the literature. The presence of a redundant sigmoid with a narrow mesentery (dolicosigmoide) is a prerequisite for the volvulus formation. The etiology in the pediatric population is considered secondary to the presence of a broad meso with a narrow base associated with abnormal fixation colon. Other factors include history of anorectal malformation, Prune Belly syndrome, intestinal malrotation and Hirschsprung disease. Initial management followed by endoscopic minimally invasive sigmoidectomy has proven safe and effective. Materials and Methods. This paper presents the experience of 4 patients between 9 and 14 managed in our department in 2013, with a diagnosis of volvulus of the sigmoid, which were initially taken to a first surgical endoscopic decompression of volvulus and a second half were carried sigmoid which took place in a video-assisted. In this series, no intraoperative complications were documented and monitoring more than six months only one patient has required new interventions, in a special case because the patient has associated myopathy; inflammatory leiomioscitis, which predisposes to episodes of intestinal obstruction. Conclusion. We believe that endoscopic detorsion followed by an early video-assisted sigmoid is the ideal technique for the management of these patients

Painful legs and moving toes syndrome responsive to pregabalin.

Report three cases of painful legs and moving toes (PLMT) syndrome responsive to pregabalin along with a review of its literature. Three patients with PLMT syndrome improved with pregabalin. The first and third patient reported improvement in pain scores, quality of life, and quality of sleep sustained over time. The second and third patient had near complete remission of toe movements, but pregabalin was discontinued in the second patient due to aggravation of leg edema. PLMT is a rare and debilitating disorder characterized by lower limb pain and involuntary toes or feet movements. Its pathophysiology remains unknown and its therapy refractory to most drugs, except for pregabalin, as shown in this case series. PLMT is a rare and incapacitating syndrome due to the lack of an effective pain therapy. We report three patients with PLMT who favorable responded to pregabalin. We propose pregabalin be considered in the management of PLMT.

Self-reported and accelerometer-measured physical activity by body mass index in US Hispanic/Latino adults: HCHS/SOL.

The association between obesity and physical activity has not been widely examined in an ethnically diverse sample of Hispanic/Latino adults in the US. A cross-sectional analysis of 16,094 Hispanic/Latino adults 18-74 years was conducted from the multi-site Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Body mass index (BMI) was measured and categorized into normal, overweight, and obese; underweight participants were excluded from analyses. Physical activity was measured using the 16-item Global Physical Activity Questionnaire and by an Actical accelerometer. Minutes/day of physical activity and prevalence of engaging in ≥ 150 moderate-vigorous physical activity (MVPA) minutes/week were estimated by BMI group and sex adjusting for covariates. No adjusted differences were observed in self-reported moderate (MPA), vigorous (VPA), or MVPA across BMI groups. Accelerometry-measured MPA, VPA, and MVPA were significantly higher for the normal weight (females: 18.9, 3.8, 22.6 min/day; males: 28.2, 6.1, 34.3 min/day, respectively) compared to the obese group (females: 15.3, 1.5, 16.8 min/day; males: 23.5, 3.6, 27.1 min/day, respectively). The prevalence of engaging in ≥ 150 MVPA minutes/week using accelerometers was lower compared to the self-reported measures. Efforts are needed to reach the Hispanic/Latino population to increase opportunities for an active lifestyle that could reduce obesity in this population at high risk for metabolic disorders.

[Video-assisted sigmoidectomy as an option for Sigmoid volvulus management in the pediatric population]. / Sigmoidectomía videoasistida como opción de manejo del vólvulo del sigmoides en la población pediátrica.

INTRODUCTION: The aim of the present study was to evaluate clinical presentation and management of sigmoid volvulus in children. Sigmoid volvulus is one of the three leading causes of acute obstruction of the colon and is between 50 and 90% of all large bowel volvulus. In the pediatric population only 3 to 5% of bowel obstructions are caused by volvulus and there are less than 100 cases reported in the literature. The presence of a redundant sigmoid with a narrow mesentery (dolicosigmoide) is a prerequisite for the volvulus formation. The etiology in the pediatric population is considered secondary to the presence of a broad meso with a narrow base associated with abnormal fixation colon. Other factors include history of anorectal malformation, Prune Belly syndrome, intestinal malrotation and Hirschsprung disease. Initial management followed by endoscopic minimally invasive sigmoidectomy has proven safe and effective. MATERIALS AND METHODS: This paper presents the experience of 4 patients between 9 and 14 managed in our department in 2013, with a diagnosis of volvulus of the sigmoid, which were initially taken to a first surgical endoscopic decompression of volvulus and a second half were carried sigmoid which took place in a video-assisted. In this series, no intraoperative complications were documented and monitoring more than six months only one patient has required new interventions, in a special case because the patient has associated myopathy; inflammatory leiomioscitis, which predisposes to episodes of intestinal obstruction. CONCLUSION: We believe that endoscopic detorsion followed by an early video-assisted sigmoid is the ideal technique for the management of these patients.

INTRODUCCION: El objetivo del estudio es evaluar la presentación y el manejo del vólvulo del Colon Sigmoides (VS) en pacientes pediátricos. El (VS) es una de las tres principales causas de obstrucción aguda del colon y constituye entre el 50 y 90% de todos los vólvulos del intestino grueso. En la población pediátrica, solo del 3 al 5% de las obstrucciones intestinales son causadas por vólvulo, y son menos de 100 los casos publicados en la literatura médica. La etiología en la población pediátrica se considera secundaria a la presencia de un meso amplio con una base estrecha asociado a una fijación anormal del colon. Otros factores incluyen historia de malformación anorectal, síndrome de Prune Belly, malrotacion intestinal y enfermedad de Hirschsprung. El manejo inicial por vía endoscópica, seguido de la sigmoidectomía mínimamente invasiva, han demostrado ser seguros y efectivos. MATERIAL Y METODOS: El presente trabajo recoge la experiencia de 4 pacientes entre los 9 y 14 años manejados en nuestro servicio, en el año 2013, con diagnóstico de vólvulo del sigmoides, los cuales inicialmente fueron llevados a un primer tiempo quirúrgico para descompresión endoscópica del vólvulo y en un segundo tiempo fueron llevados a sigmoidectomía, la cual se llevó a cabo de forma videoasistida. En esta serie no se documentaron complicaciones intraoperatorias y, en el seguimiento a más de 6 meses, solo uno de los pacientes ha requerido nuevas intervenciones, en un caso especial, dado que el paciente presenta asociada una miopatía (leiomioscitis inflamatoria), la cual lo predispone a episodios de obstrucción intestinal. CONCLUSION: Consideramos que la devolvulación endoscópica seguida de una pronta sigmoidectomía videoasistida es la técnica ideal para el manejo de estos pacientes.

Development of an autoimmune syndrome affecting the skin and internal organs in P-selectin glycoprotein ligand 1 leukocyte receptor-deficient mice.

OBJECTIVE: To define and characterize the progression of the spontaneous autoimmune disease that develops in mice in the absence of the leukocyte adhesion receptor P-selectin glycoprotein ligand 1 (PSGL-1). METHODS: Skin-resident immune cells from PSGL-1-deficient mice and C57BL/6 control mice of different ages were isolated and analyzed by flow cytometry. Biochemical parameters were analyzed in mouse serum and urine, and the presence of serum autoantibodies was investigated. Skin and internal organs were extracted, and their structure was analyzed histologically. RESULTS: Skin-resident innate and adaptive immune cells from PSGL-1(-/-) mice had a proinflammatory phenotype with an imbalanced T effector cell:Treg cell ratio. Sera from PSGL-1(-/-) mice had circulating autoantibodies commonly detected in connective tissue-related human autoimmune diseases. Biochemical and histologic analysis of skin and internal organs revealed skin fibrosis and structural and functional abnormalities in the lungs and kidneys. Furthermore, PSGL-1(-/-) mice exhibited vascular alterations, showing loss of dermal vessels, small vessel medial layer remodeling in the lungs and kidneys, and ischemic processes in the kidney that promote renal infarcts. CONCLUSION: Our study demonstrates that immune system overactivation due to PSGL-1 deficiency triggers an autoimmune syndrome with characteristics similar to systemic sclerosis, including skin fibrosis, vascular alterations, and systemic organ involvement. These results suggest that PSGL-1 expression contributes to the maintenance of the homeostasis of the immune system and could act as a barrier for autoimmunity in mice.

Influence of the IL17A locus in giant cell arteritis susceptibility.

OBJECTIVE: Different lines of evidence have highlighted the role of IL-17A in the inflammatory process occurring in giant cell arteritis (GCA). The aim of the present study was to assess whether the IL17A locus influences GCA susceptibility and its clinical subphenotypes. METHODS: We carried out a large meta-analysis including a total of 1266 biopsy-proven GCA patients and 3779 healthy controls from four European populations (Spain, Italy, Germany and Norway). Five IL17A polymorphisms (rs4711998, rs8193036, rs3819024, rs2275913 and rs7747909) were selected by tagging and genotyped using TaqMan assays. Allelic combination and dependency tests were also performed. RESULTS: In the pooled analysis, two of the five analysed polymorphisms showed evidence of association with GCA (rs2275913: PMH=1.85E-03, OR=1.17 (1.06-1.29); rs7747909: PMH=8.49E-03, OR=1.15 (1.04-1.27)). A clear trend of association was also found for the rs4711998 variant (PMH=0.059, OR=1.11 (1.00-1.23)). An independent effect of rs2275913 and rs4711998 was evident by conditional regression analysis. In addition, the haplotype harbouring the risk alleles better explained the observed association than the polymorphisms independently (likelihood p value <10(-05)). CONCLUSIONS: Polymorphisms within the IL17A locus show a novel association with GCA. This finding supports the relevant role of the Th17 cells in this vasculitis pathophysiology.