Prognostic value of systemic immune-inflammation index and serological biomarkers for deep neck infections.

BACKGROUND: Inflammatory biomarkers, including C-reactive protein, erythrocyte sedimentation rate, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and the systemic immune-inflammation index, have been proposed as prognostic factors diverse pathologies. However, their application for deep neck infections has yet to be clarified. MATERIAL AND METHODS: We performed a retrospective study of 163 adult patients with diagnosis of deep neck infections with the aim to evaluate the association between serological biomarkers with complications and outcomes of patients with DNI. Studied variables included demographic data, complications of DNI, outcomes, complications and death of the included subjects. The evaluated serological biomarkers were hemoglobin, leukocytes, neutrophils, lymphocytes, platelets, glucose, creatinine, albumin, CRP, and ESR. NLR, PLR, and SIII index were estimated. RESULTS: The patients' mean age was 40.6 ± 15.3 years. Complications of DNI were observed in 19.6% (n=32) patients, being the need for tracheostomy due to airway obstruction (11%, n=18) and mediastinitis (8.6%, n= 14) the most common. Evaluated subjects had an increased value of serological biomarkers (SII index 2639.9 ± 2062.9, NLR 11.3 ± 8.5, PLR 184.1 ± 108.5, CRP 12.6 ± 8.9 mg/dL, ESR 20.7 ± 9.1 mm/h). Patients with complications had a significantly higher value of all inflammatory parameters (p < 0.05). A SII index cut-off value of 2975 was selected from a ROC curve analysis. A sensitivity of 93.8%, specificity of 86.3%, a positive predictive value of 62.5%, and a negative predictive value of 98.3% are reported. The SII index was found to have an increased positive predictive value compared to NLR, PLR, and CRP for DNI complications. CONCLUSIONS: Our analysis concluded that the SII index, NLR, and PLR are valuable biomarkers to assess the risk of complications from DNI. SII index showed a high accuracy for prediction of DNI complications with a cut-off value of 2975.

Role of early extraction of odontogenic focus in deep neck infections.

BACKGROUND: Odontogenic deep neck infections remain a common condition that presents a challenging issue due to the complex involvement of the neck and adjacent structures and its potential life-threatening risk. Periapical infection of the second or third molar with spread to the submandibular and parapharyngeal spaces is the most commonly observed scenario. However, the time of dental extraction of the infection focus remains controversial. The aim of this study is to provide an overview of the epidemiology, clinical and radiological features, and management in patients diagnosed with ODNI and to identify the role of early dental extraction on patient outcomes and recovery. MATERIAL AND METHODS: This retrospective study included patients over 18 years old with a diagnosis of ODNI who were admitted to the University Hospital "Dr Jose Eleuterio Gonzalez" from January 2017 to January 2022. ODNI diagnosis was based on clinical and radiological evidence of the disease supplemented by dental and maxillofacial evaluation for an odontogenic aetiology. RESULTS: A total of 68 patients were included in the study. The patients' mean age was 40.96 ± 14.9. Diabetes mellitus was the most common comorbidity. The submandibular space was the most common deep neck space involved (n=59, 86.8%). Mediastinitis, marginal nerve injury and orocervical fistula were observed in 7.5% of patients, with no fatality in this series. A delay of >3 days for dental extraction of the involved tooth was associated with an increased rate of mediastinitis (n=3, 100%, p= 0.022), number of surgical interventions (1.45 ± 0.61, p= 0.006), ICU stay (n=8, 40%, p= 0.019), and ICU length of stay (0.85 ± 0.8, p= 0.001). CONCLUSIONS: Expedited management with surgical drainage and intravenous antibiotic treatment, along with early extraction of the involved tooth, is mandatory.

Comentario al original ‘Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares. Réplica / Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents. Reply

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Trophic transfer of copper decreases the condition index in Crassostrea gigas spat in concomitance with a change in the microalgal fatty acid profile and enhanced oyster energy demand.

Due to new usages and sources, copper (Cu) concentrations are increasing in the Arcachon Basin, an important shellfish production area in France. In the present paper, the trophic transfer of Cu was studied between a microalga, Tetraselmis suecica, and Crassostrea gigas (Pacific oyster) spat. An experimental approach was developed to assess Cu exposure, transfer and toxicity on both phytoplankton and spat. Exposure of microalgal cultures to Cu for 7-8 days (3.1 ± 0.1, 15.7 ± 0.2 and 50.4 ± 1.0 µg Cu·L-1 for the control, Cu15 and Cu50 conditions, respectively) led to concentrations in microalgae (28.3 ± 0.9 and 110.7 ± 11.9 mg Cu·kg dry weight-1 for Cu15 and Cu50, respectively) close to those measured in the field. Despite Cu accumulation, the physiology of the microalgae remained poorly affected. Exposed cultures could only be discriminated from controls by a higher relative content in intracellular reactive oxygen species, and a lower relative content in lipids together with a reduced metabolic activity. By contrast, the fatty acid profile of microalgae was modified, with a particularly relevant lower content of the essential polyunsaturated fatty acid 22:6n-3 (docosahexaenoic acid [DHA]). Following 21 days of spat feeding with Cu15 and Cu50 microalgal cultures, trophic transfer of Cu was observed with a high initial Cu concentration in spat tissues. No effect was observed on oxidative stress endpoints. Cu exposure was responsible for a decrease in the spat condition index, an outcome that could be related to an insufficient DHA supply and extra energy demand as suggested by the overexpression of genes involved in energy metabolism, ATP synthesis and glycogen catabolism.

Fortalecimiento de la musculatura respiratoria en mujeres mayores en Atención Primaria / Training respiratory muscle in elderly women in primary care

ANTECEDENTES Y OBJETIVO: El envejecimiento implica una reducción de la masa muscular y la fuerza muscular. El objetivo del estudio fue valorar la efectividad de un protocolo de ejercicios específicos de facilitación neuromuscular propioceptiva (FNP) sobre la fuerza muscular respiratoria. MATERIAL Y MÉTODO: Estudio experimental con 69 mujeres mayores no institucionalizadas y voluntarias participantes en un programa de ejercicio físico. Fueron divididas aleatorizadamente en 2 grupos. El grupo intervención recibió un protocolo de tratamiento respiratorio específico basado en metodología de la FNP con 2 sesiones semanales de 50 min durante 8 semanas. El grupo control no recibió intervención adicional. Se evaluó la fuerza de la musculatura respiratoria mediante la presión inspiratoria máxima (PIM) y la presión espiratoria máxima (PEM). RESULTADOS: Se registró un aumento estadísticamente significativo (p < 0,001) y clínicamente relevante en el grupo de intervención en la PIM 13,84mb (IC 95%: 9,017-18,671) y la PEM 25,69 mb (IC 95%: 20,373-31,002). Se obtuvieron diferencias con significación estadística entre los grupos: PIM 20,00mb (IC 95%: 11,13-28,88; p < 0,001) y PEM 27 mb (IC 95%: 19,75-35,012; p < 0,001). CONCLUSIÓN: El trabajo muscular respiratorio específico con FNP mejoró las presiones respiratorias, lo que puede mejorar la fuerza y la función respiratorias en adultos mayores. Este tratamiento puede utilizarse como una intervención preventiva para minimizar las implicaciones del envejecimiento sobre la pérdida de masa y fuerza muscular

BACKGROUND AND OBJECTIVE: Aging results in reduced muscle mass and strength. The aim was to evaluate the effectiveness of a proprioceptive neuromuscular facilitation (PNF) exercise protocol on respiratory muscle strength. MATERIAL AND METHODS: An experimental study of 69 elderly, non-institutionalized female volunteers who participated in a physical exercise programme. They were randomly divided into 2 groups. The intervention group performed a specific respiratory treatment protocol using the PNF technique. The control group did not receive an additional intervention. The PNF treatment consisted of 2 weekly sessions lasting 50 minutes over an 8-week time period. Respiratory muscle strength was measured for both groups by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). RESULTS: There was a statistically significant (P <. 001) and clinically relevant increase in the intervention group in MIP 13.84 mb (95% CI: 9.017-18.671) and MEP 25.69 mb (95%CI: 20.373-31.002). There was also a statistically significant difference between groups: MIP 20.00 mb (95% CI: 11.13-28.88; P < .001) and PEM 27mb (95% CI: 19.75-35.012; P < .001). CONCLUSIONS: The PNF respiratory treatment improved respiratory pressures, which may improve respiratory strength and function in older adults. This treatment can be used as prevention to minimize the loss of muscle mass and strength as a result of aging

Programa de Revitalización Geriátrica: efectos sobre la cognición en adultos mayores de 60 años / Geriatric revitalisation programme: Effects on cognition in adults over the age of 60

Antecedentes y objetivo: Las evidencias clínicas indican que los individuos mayores muestran con mayor frecuencia diversos cambios cognoscitivos, siendo leves y poco incapacitantes refiriéndose a las funciones mnésicas y a la rapidez de pensamiento y razonamiento. Numerosas evidencias científicas apoyan el papel del ejercicio físico aeróbico como pilar fundamental para prevenir o retrasar la aparición de deterioro cognitivo leve o demencia. El objetivo de este trabajo consiste en determinar el efecto duradero de la mejoría del estado cognitivo de los adultos mayores sanos a los 6 meses de la finalización de un programa de Revitalización Geriátrica (PRG). Material y métodos: La población de estudio fue tomada de los participantes en el PRG de la Universidad de Salamanca. Siguiendo las directrices de la Organización Mundial de la Salud, los sujetos realizaron 3 sesiones semanales de ejercicio físico moderado durante el periodo de intervención. Para la elección de la muestra se realizó un muestreo aleatorio por conglomerados, donde se eligieron al azar 3 asociaciones del total de asociaciones de la ciudad y en cada una de ellas del conjunto de personas que estaban dispuestas a seguir el PRG. La muestra estaba formada por 35 sujetos de ambos sexos mayores de 60 años. Para la valoración neuropsicológica de los sujetos se incluyeron una serie de pruebas neuropsicológicas validadas: Examen Cognoscitivo Mini-Mental; Test de Retención Visual de Benton; Aprendizaje Audioverbal de Rey; Test de Stroop; Test del Trazo A y B. Resultados: Los resultados nos indican la existencia de diferencias significativas entre las 3 valoraciones realizadas, obteniendo un mayor rendimiento tras la intervención, en las variables evaluadas, y volviendo a puntuaciones iniciales tras la inactividad física. Conclusiones: Se deben encontrar estrategias que limiten el tiempo de inactividad física o de sedentarismo de la población mayor de 65 años, buscando maneras de incentivar a la participación en Programas de Actividad Física

Background and aim: Clinical evidence shows that elder individuals display with greater frequency diverse cognitive changes, minor and slightly incapacitating, related to mnesic functions and speed of thought and reasoning. Much scientific evidence supports the role that aerobic physical activity plays as fundamental to prevent or delay the onset of minor cognitive damage or dementia. The aim of this paper is to determine the lasting effect of improved cognitive status in healthy older adults six months after completing a geriatric revitalization programme (GRP). Material and methods: The study population was recruited among participants in the Universidad de Salamanca GRP. Following the guidelines of the World Health Organization, subjects performed 3 weekly sessions of moderate physical exercise during the intervention period. The sample consisted of 35 subjects of both genders, all of them over 60 years old. For the selection of the sample, random sampling was carried out by conglomerates, where 3 associations of the total number of associations in the city were chosen at random, and in each of the group of people who were willing to follow the GRP. In order to assess the subjects' neuropsychological capacities, a series of validated neuropsychological tests were included: Mini-Mental State Examination; Benton Visual Retention Test; Rey Auditory Verbal Learning Test; Stroop Test; Trail Making Test. Results: The results show significant differences between the three assessments put into effect: after the intervention, performance improved in all variables assessed, and it returned to the initial scores after a period of physical inactivity. Conclusions: We must find strategies to limit spans of physical inactivity or sedentary lifestyles in people over 65 by looking for ways to encourage participation in physical activity programmes

Evaluación del videolaringoscopio Airtraq como dispositivo de rescate tras laringoscopia directa difícil / Evaluation of the Airtraq video laryngoscope as a rescue device after difficult direct laryngoscopy

Antecedentes y objetivos: La dificultad inesperada durante la intubación traqueal y la imposibilidad de intubar se encuentran entre las principales causas de morbimortalidad relacionadas con la anestesia. Este estudio se realizo para evaluar la efectividad del videolaringoscopio Airtraq para la intubación traqueal tras una laringoscopia directa difícil. Métodos: Se incluyó a 75 pacientes sometidos a cirugía electiva bajo anestesia general e intubación traqueal cuya laringoscopia directa realizada por un anestesiólogo sénior mostró un Cormack-Lehane grado 2b, 3 o 4. Resultados: La visión glótica mejoró en todos los pacientes cuando se usó el videolaringoscopio Airtraq en comparación con el laringoscopio Macintosh. La visión mejoró dos grados en el 17,3% de los casos, tres en el 60% y cuatro en el 22,7% (p <0,0001). La tasa de éxito para la intubación fue del 100% con Airtraq. Cincuenta y seis pacientes (74,7%) requirieron un solo intento, dieciséis (21,3%) 2 intentos y tres (4%) un tercer intento. La escala de dificultad de intubación indicó que la intubación traqueal se realizó fácilmente en la mayoría de los casos. No hubo eventos críticos. Conclusiones: La intubación traqueal con Airtraq fue efectiva, simple y segura en pacientes con laringoscopia difícil. Estos resultados confirman que el Airtraq es un videolaringoscopio fiable como dispositivo de rescate en casos de visión laríngea difícil con laringoscopia directa

Background and objectives: Unexpected difficult tracheal intubation and failure to intubate are among the leading causes of anesthesia-related morbidity and mortality. This study was undertaken to evaluate the effectiveness of the Airtraq video laryngoscope for tracheal intubation after difficult direct laryngoscopy. Methods: 75 patients undergoing elective surgery under general anesthesia and whose direct laryngoscopy by a senior anesthesiologist exhibited Cormack-Lehane grade 2b, 3 or 4 were enrolled. Results: The Glottic view was improved in all patients when using the Airtraq video laryngoscope, compared with Macintosh laryngoscope. The view was improved by 2 degrees in 17.3% of the cases, by three in 60% and by four grades in 22.7% (P<0.0001). The success rate for intubation was 100% with the Airtraq. Fifty-six patients (74.7%) required a single attempt, sixteen (21.3%) two attempts and three (4%) a third attempt. Intubation difficulty scale indicated that tracheal intubation was performed easily in most cases There were no critical events. Conclusions: Tracheal intubation using the Airtraq was effective, simple and safe in patients with difficult laryngoscopy. These results confirm that the Airtraq is a reliable video laryngoscope as a rescue device in cases of difficult laryngeal view with direct laryngoscopy

¿Puede la videolaringoscopia ser una primera opción en paciente con amiloidosis laríngea? / Can videolaryngoscopy be a first option in a patient with laryngeal amyloidosis?

La amiloidosis comprende un grupo de trastornos que se distinguen por el depósito de agregados fibrilares de inmunoglobulinas monoclonales de cadenas ligeras en diversos órganos, entre ellos, la laringe. A continuación presentamos el caso de un varón de 78 años derivado a nuestro hospital para tratamiento quirúrgico de una hernia umbilical estrangulada. El paciente presentaba disfonía y disfagia de 5 meses de evolución debido a la presencia de una amiloidosis laríngea. Se decidió realizar la intubación con el paciente despierto, sedado con remifentanilo y midazolan, utilizando el videolaringoscopio King Vision®. Las lesiones hemorrágicas que pueden acontecer en estos pacientes son debidas al depósito de agregados fibrilares de amiloide, que causan una fragilidad vascular que aumenta el riesgo de hemorragia durante la intubación. Por eso es importante que el anestesiólogo realice un cuidadoso manejo de la vía aérea en pacientes con esta entidad (AU)

Amyloidosis is a term that involves a group of diseases characterised by deposition of extracellular monoclonal light-chain fibrillar immunoglobulin aggregates in the body, including many organs, with the larynx among them. A case is presented of a 78 year-old man who was referred to our institution for strangulated umbilical hernia treatment. He suffered from progressive hoarseness and dysphagia for 5months. He had a history of primary laryngeal amyloidosis. Awake intubation was performed successful with the King Vision® video-laryngoscopy. Sedation was achieved using a remifentanil infusion and midazolam. Haemorrhagic lesions are caused by deposition of amyloid in and around vessels, resulting in increased vascular fragility. Therefore, anaesthetists should take care in intubating the tracheas of these patients (AU)

Growth, condition and metal concentration in juveniles of two Diplodus species in ports.

High abundances of juvenile fish in certain ports suggest they might provide alternative nursery habitats for several species. To further investigate this possibility, post-settlement growth, metal uptake and body condition were estimated in 127 juveniles of two seabream species, collected in 2014-15, inside and outside the highly polluted ports of the Bay of Toulon. This showed that differences in local pollution levels (here in Hg, Cu, Pb and Zn) are not consistently mirrored within fish flesh. Muscle metal concentrations, below sanitary thresholds for both species, were higher in ports for Cu, Pb and V only. Otherwise, fish muscle composition principally differed by species or by year. Juvenile growth and condition were equivalent at all sites. Higher prey abundance in certain ports might therefore compensate the deleterious effects of pollution, resulting in similar sizes and body conditions for departing juvenile fish than in nearby natural habitats.

Disgenesia gonadal mixta: un caso de síndrome de Turner en mosaicismo 45,X/47,XYY / Mixed gonadal dysgenesis, a case of Turner syndrome in mosaicism 45,X/47,XYY

Resumen ANTECEDENTES: Alrededor de 45% de los pacientes con síndrome de Turner tienen línea monosómica 45,X. La existencia del cromosoma Y en mosaicos corresponde a 2-5% de los casos. La severidad del fenotipo se relaciona con el porcentaje y distribución de las células normales, inclusive se estima que 90% de las presentaciones en mosaico podrían no llegar a tener diagnóstico. OBJETIVO: Reportar un caso atípico de una adulta joven con síndrome de Turner en mosaico 45,X/47,XYY. CASO CLÍNICO: Paciente de 27 años de edad, que acudió a consulta al Hospital Universitario de Santander, Colombia, debido al antecedente de amenorrea primaria, apariencia femenina normal, talla y peso promedio para la población colombiana, mamas Tanner 3 y genitales externos Tanner 5. La resonancia magnética nuclear reportó: hipoplasia uterina y ovarios atróficos. El cariotipo de alta resolución diagnóstica fue de síndrome Turner en mosaico 45,X[60%]/47,XYY [40%]. CONCLUSIÓN: En mujeres con amenorrea primaria y talla baja debe sospecharse el síndrome de Turner. En virtud de la variedad fenotípica, las condiciones en mosaico pueden retrasar el diagnóstico hasta la adultez. Incluso 90% de los mosaicos pueden no diagnosticarse.

Abstract BACKGROUND: Approximately 45% of patients with Turner syndrome have monosomic line 45, X. The existence of the Y chromosome in mosaics corresponds to 2 to 5% of the cases, the severity of the phenotype is related to the percentage and distribution of normal cells, it is even estimated that 90% of mosaic presentations may not have diagnosis. OBJECTIVE: To present an atypical case of a young adult with Turner syndrome in mosaic 45,X / 47,XYY CLINICAL CASE: A 27-year-old woman visits the University Hospital of Santander for a history of primary amenorrhea, normal female appearance, average height and weight for Colombian population, Tanner 3 breasts and external genitalia Tanner 5. Magnetic resonance imaging reports uterine hypoplasia, ovaries and discards a pituitary tumor. High-resolution karyotype diagnoses Turner mosaic syndrome 45,X [60%] / 47,XYY [40%]. CONCLUSION: Turner's syndrome should be suspected in women with primary amenorrhea and low stature, however, mosaic conditions may delay their diagnosis until adulthood due to their phenotypic variety, up to 90% of the mosaics can reach no have diagnosis.

Perfil psicosocial y sobrevaloracion en lumbalgias crónicas. importancia de las pruebas de biomecanica y valoración psiquiátrica / Psychosocial profile and overvaluation in chronic back pain. importance of biomechanic test and psychiatric evaluation

Introducción: La detección de la simulación se fundamenta en distintas fuentes de información (Exploración física, Pruebas médicas, Evaluación psiquiátrica, Pruebas biomecánicas). A mayor inconsistencias más posibilidades de sobrevaloración. Objetivos: Demostrar que los resultados inconsistentes en pruebas biomecánicas y Test de personalidad (SIMS, PAI, MMPI-2, MCMI-III), se corresponden con un perfil de personalidad característico (somatizador, histriónico, hipocondríaco). Material y Métodos: SUJETOS: 70 pacientes valorados en MAZ por lumbalgia crónica. METODO: determinación de fiabilidad en Valoración Biomecánica (Ned Lumbal) + Entrevista Psiquiátrica Estructurada + fiabilidad en Test de personalidad (MMPI-2, MCMI-III, PAI, SIMS). Resultados y Conclusiones:1) Los pacientes poco fiables muestran significativamente más rasgos de personalidad somatizadora, hipocondríaca e histriónica. 2) no diferencias significativas en pacientes con trastornos adaptativos ansioso-depresivos. 3) alta correlación entre pruebas biomecánicas y de personalidad. Conclusiones: Confirmamos un mayor perfil de personalidad premorbida (somatizador, hipocondríaco e histriónico) y sobrevaloración en lumbalgia crónicas empleando pruebas biomecánicas/psiquiátricas (AU)

Introduction: The detection of the simulation is based on different information sources (physical examination, medical tests, psychiatric evaluation, biomechanical tests). To major inconsistencies more possibilities of overvaluation. Objective:To demonstrate that inconsistent results in Biomechanical tests (Ned-Lumbar) and Personality tests (SIMS, PAI, MMPI-2, MCMI-III) correspond to a characteristic personality profile (somatization, histrionic, hypochondriac). Material and Method: SUBJECTS: 70 patients with chronic back pain valued by MAZ. METHOD: To determinate the reliability in Biomechanical Assessment (Ned Lumbal) + Structured Psychiatric Interview + Personality test (MMPI-2, MCMI-III, PAI, SIMS). Results: 1) Patients with few reliability have a personality profile of somatization, hypochondriac or histrionic statistically significant. 2) No significant differences in patients with adaptative anxiety-depressive disorders. 3) High correlation between biomechanical and personality test. Conclusions:It is confirmed a mayor profile of premorbid personality (somatization, hypochondriac and histrionic) and an overvaluation in chronic back pain using biomechanical and psychiatric tests (AU)

Motivación al deporte en adultos y personas mayores que practican cachibol / Motivação ao esporte em adultos e idosos que praticam cachibol / Motivation to sport on adults and seniors who practice cachibol

Con el propósito de comprender la motivación en un grupo de adultos y personas mayores practican cachibol y los factores para continuar o desertar en la práctica de este deporte, se realizó un estudio con diseño descriptivo, transversal y exploratorio. Para tal fin, se diseñó un instrumento denominado Escala de Motivación en el Deporte para Personas Mayores (EMDPM), fundamentado teóricamente para medir los motivos de inicio, continuidad y desmotivación, inicialmente en la práctica deportiva de personas mayores. Se encontró que la motivación más importante se centra en la salud y entre los factores de desmotivación destacan los relacionados con la enfermedad y las lesiones (AU)

É um estudo exploratório com pesquisa e desenho descritivo transversal, cujos objetivos são: Conhecer os motivos pelos quais as pessoas escolhem praticar idosos Cachibol; Quais são os fatores que os motivam a continuar a prática; Quais os fatores que os desencorajam na prática. Teste (EMDPM) que mede razões teóricamente práticas, fatores de motivação e desmotivação na prática, Cachibol foi construído em adultos mais velhos. As razões e os fatores são motivações mais importantes para a saúde e a desmotivação dos mais importantes são as relacionadas à perda de saúde (AU)

This is an exploratory study with descriptive cross-sectional survey and design whose objectives are: Know the reasons why people choose to practice seniors Cachibol; What are the factors that motivate them to continue the practice; What factors discourage them in practice. Test (EMDPM) which measures based theoretically practical reasons, factors of motivation and demotivation in practice Cachibol was built in older adults. The reasons and factors are most important motivation aimed at health and demotivating the most important are those related to the loss of health (AU)

Uso del videolaringoscopio King Vision® en una vía aérea difícil no esperada por un quiste vallecular gigante en un adulto, a propósito de un caso / Use of King Vision® videolaryngoscope in an unanticipated difficult airway in an adult patient with giant vallecular cyst, a case report

Los quistes laríngeos suelen ser asintomáticos y normalmente son un hallazgo casual durante una exploración laríngea rutinaria. Estos quistes, en adultos son raros y pueden tener consecuencias catastróficas en el paciente anestesiado si el manejo de la vía aérea no es el adecuado. A continuación, se describe el caso de una intubación difícil y el manejo de la misma, en un paciente adulto con un quiste de vallécula gigante, asintomático que se descubrió durante la inducción de secuencia rápida de una anestesia general en cirugía de urgencia. En conclusión, los quistes de vallécula pueden dificultar el manejo de la vía aérea. Es importante evitar las complicaciones asociadas a los repetidos intentos de intubación que pueden provocar edema de la vía aérea, sangrado y rotura del quiste con la consiguiente aspiración de su contenido, siendo el videolaringoscopio King Vision® una buena alternativa en estos casos. La disponibilidad de un otorrinolaringólogo es fundamental (AU)

Laryngeal cysts are largely asymptomatic and typically described in the context of incidental discovery on routine laryngoscopy. These cysts, in adults are even rarer and can have catastrophic consequences in an anaesthetized patient if airway management is inappropriate. We describe a case of difficult endotracheal intubation and the treatment of an adult patient with an asymptomatic, giant vallecular cyst that was discovered during rapid-sequence induction of general anesthesia in urgent surgery. In conclusion, vallecular cysts can cause extreme problems in securing the airway. It is important to avoid complications associated with repeated attempts at intubation, airway loss, or cyst rupture causing difficulty visualizing vocal cords and aspiration. The use of King Vision® videolaryngoscope is a good alternative in these cases. Close attention to logistics and the immediate availability of an otolaryngologist is vital (AU)

Videolaringoscopio King Vision®, ¿una alternativa en la intubación del paciente despierto? / Videolaryngoscope King Vision™, an alternative in the intubation of the awake patient?

No disponible

Uso del Clarus Video System® en una vía aérea difícil en paciente con síndrome de Rett / Use of Clarus Video System® in expected difficult airway in a patient with Rett syndrome

El manejo de la vía aérea continúa siendo uno de los puntos clave en nuestra especialidad, ya que la dificultad o imposibilidad para la intubación orotraqueal supone la principal causa de morbimortalidad atribuible a la anestesia. El síndrome de Rett es una grave enfermedad neurológica, incapacitante. Presentamos el caso de una joven de 21 años afecta de síndrome de Rett, con un retraso psicomotor importante, y con criterios de vía aérea difícil, propuesta para una colecistectomía laparoscópica bajo anestesia general. Decidimos utilizar el Clarus Video System® para la intubación de la paciente como primera opción, logrando llevarla a cabo. El uso de los dispositivos ópticos está ganando protagonismo y encontrando un lugar en los más recientes algoritmos de manejo de vía aérea difícil. Queremos resaltar el papel creciente que estos dispositivos juegan en el manejo de la vía aérea difícil, por lo que realizamos una revisión de su situación actual en el manejo de la vía aérea difícil prevista (AU)

Difficult airway management remains one of the key points in our specialty, as the difficulty or impossibility of tracheal intubation is the main cause of morbidity/mortality attributable to anaesthesia. Rett syndrome is a severe and incapacitating neurological disease. We present the case of a 21-year-old girl affected by this syndrome, with significant psychomotor retardation and difficult airway predictors, who was scheduled to have a laparoscopic cholecystectomy under general anaesthesia. We decided on one attempt of Clarus Video System® fiberoptic intubation as primary intervention. Intubation was successfully performed with the help of this optical stylet. The use of optical stylets is gaining prominence and finding a place in the latest algorithms of difficult airway management. We highlight the growing role these devices play in managing difficult airway, therefore we review the current situation of videolaryngoscopes in the management of the predicted difficult airway (AU)

Metal measurement in aquatic environments by passive sampling methods: Lessons learning from an in situ intercomparison exercise.

Passive sampling devices (PS) are widely used for pollutant monitoring in water, but estimation of measurement uncertainties by PS has seldom been undertaken. The aim of this work was to identify key parameters governing PS measurements of metals and their dispersion. We report the results of an in situ intercomparison exercise on diffusive gradient in thin films (DGT) in surface waters. Interlaboratory uncertainties of time-weighted average (TWA) concentrations were satisfactory (from 28% to 112%) given the number of participating laboratories (10) and ultra-trace metal concentrations involved. Data dispersion of TWA concentrations was mainly explained by uncertainties generated during DGT handling and analytical procedure steps. We highlight that DGT handling is critical for metals such as Cd, Cr and Zn, implying that DGT assembly/dismantling should be performed in very clean conditions. Using a unique dataset, we demonstrated that DGT markedly lowered the LOQ in comparison to spot sampling and stressed the need for accurate data calculation.

Manejo quirúrgico del pie cavo anterior en pacientes con Charcot-Marie-Tooth; evolución a 5 años / Surgical management of anterior cavus foot in Charcot-Marie-Tooth patients. Five-year follow-up

La neuropatía hereditaria motora y sensitiva presenta deformidad en los pies, como varo, cavo y dedos en garra. La enfermedad de Charcot-Marie-Tooth tiene descrita diversas técnicas quirúrgicas. Objetivo: Evaluar el resultado clínico y funcional de la osteotomía basal en "V" de los metatarsianos centrales con elevación del primer metatarsiano, osteotomía dorsal más osteotomía de cierre y elevación del quinto metatarsiano en los pacientes de Charcot-Marie-Tooth en un período de cinco años. Material y métodos: Es un estudio prospectivo, aleatorio, longitudinal, observacional y descriptivo en un período comprendido de cinco años. El total de pacientes que cumplieron los criterios de inclusión fueron 24, 16 del sexo masculino y 8 del sexo femenino. Con un total de 34 pies, a siete se les realizó el procedimiento quirúrgico en el pie derecho, a siete en el pie izquierdo y a 10 de manera bilateral, quedando un total de 34 pies tratados. Resultados: Se encontró un coeficiente de correlación de Pearson de -0.1 y una T de 1.71. Con ello se observó una diferencia estadística significativa entre las variables con lo que a los seis meses encontramos que el tratamiento quirúrgico tiene beneficios representativos. Conclusiones: El estudio realizado mostró un valor estadístico significativo tanto en la función, dolor y alineación en pacientes que se sometieron al tratamiento quirúrgico, comparado con el grado previo al evento quirúrgico, por lo que se recomienda continuar con esta técnica en todos los pacientes que sean portadores de pie cavo anterior.

Hereditary sensorimotor neuropathy involves foot deformities such as varus and cavus foot and claw toes. Several surgical techniques have been described to treat Charcot-Marie-Tooth disease. Objective: To assess the clinical and functional result of "V" basal osteotomy of the central metatarsals with elevation of the first metatarsal, dorsal osteotomy plus closing osteotomy, and elevation of the fifth metatarsal in Charcot-Marie-Tooth patients during a five-year period. Material and methods: Prospective, randomized, longitudinal, observational and descriptive study conducted during a five-year period. Twenty-four patients met the inclusion criteria: 16 males and 8 females. Seven underwent the surgical procedure in the right foot, seven in the left, and 10 in both feet, for a total of 34 feet treated. Results: The Pearson correlation coefficient was -0.1 and T = 1.71. A statistically significant difference was seen between the variables, which meant that, in the six-month follow-up, surgical treatment had representative benefits. Conclusions: The study found a statistically significant value for function, pain and alignment in patients who underwent surgical treatment, compared with their status prior to surgery. It is therefore recommended to continue using this technique in all patients presenting with anterior cavus foot.

Colgajos basados en arterias perforantes glúteas para la reconstrucción de úlceras sacras por presión en niños / Gluteal artery based perforator flaps for sacral pressure sore reconstruction in children

Introducción. Los niños tienen una incidencia menor de úlceras por presión (UPP) que los adultos y además se diagnostican en estadios más tempranos. Por ello la experiencia publicada con tratamiento quirúrgico para UPP avanzadas en niños es escasa. Material y métodos. Presentamos el tratamiento quirúrgico de 2 UPP crónicas, estadio IV, sacras, en niños de 11 y 14 años, utilizando colgajos basados en arterias perforantes glúteas: en el primer caso se utilizó un diseño personalizado (free-style), basado en una arteria perforante glútea medial izquierda y en el segundo un gran colgajo de avance-rotación reutilizable, basado en las arterias perforantes glúteas superior e inferior derechas. Resultados. En ambos casos logramos una rápida curación con una supervivencia del 100% de los colgajos y cierre estable con un seguimiento de 6 meses y 1 año, respectivamente. Conclusiones. Los colgajos basados en las arterias perforantes glúteas pueden proporcionar resultados excelentes y estables en el tratamiento reconstructivo de UPP sacras en niños. Estos colgajos tienen menor morbilidad que los colgajos musculocutáneos y son más seguros que los colgajos fasciocutáneos tradicionales. Además, mantienen mayor cantidad de opciones de rescate en caso de recidiva de UPPs a lo largo de la vida de estos niños

Introduction. Children have much lower incidence of pressure sores (PS) than adults and furthermore, they are diagnosed in earlier stages. Therefore, the reported experience with surgical treatment of advanced pediatric PS is scarce. Material and methods. We present the surgical treatment of 2 chronic PS stage IV in children aged 11 and 14 years, by means of perforator flaps based on the gluteal arteries: in the first case we used a free-style flap based on a left medial gluteal perforator and in the second a large reusable rotation-advancement flap based on both right superior and inferior gluteal artery perforators. Results. In both patients we achieved a rapid cure with 100% survival of the flaps and a stable cover over a 6 month and 1 year follow-up respectively. Conclusions. Gluteal artery perforator flaps can produce excellent and durable results in the reconstructive treatment of sacral pressure sores in children. These flaps carry lower morbidity than musculocutaneous flaps and are more reliable than traditional fasciocutaneous flaps. Furthermore they preserve more reconstructive options in case of recurrence during the children’s lifetime

Fiebre Q. Descripción de un caso / Q fever. Description of a case

La fiebre Q es una zoonosis de distribución mundial que tiene una incidencia de 3 casos por cada 100.000 habitantes/año. Una gran variedad de animales puede transmitir la enfermedad, por lo que siempre se debe sospechar ante un proceso febril en un contexto compatible. Un rápido diagnóstico y tratamiento son esenciales para mejorar el pronóstico y prevenir el desarrollo de infección crónica u otras complicaciones potenciales asociadas a la coxelliosis (AU)

Q fever is a zoonosis of global distribution with an incidence of 3 cases per 100,000 inhabitants/year. A variety of animals can be the coxiella reservoir which always must be taken into account when faced with a fever process in a compatible context. Rapid diagnosis and treatment are essential to improve the prognosis, and prevent the development of chronic infection or other potential complications associated with the coxelliosis (AU)

Application of Toxicity Identification Evaluation (TIE) procedures for the characterization and management of dredged harbor sediments.

This study refers to the performance of Phase I Toxicity Identification Evaluation (TIE) procedures to identify the contaminants (i.e. organic compounds, metals and ammonia) exerting toxicity in marine sediments from the Pasaia harbor (Oiartzun estuary, northern Spain). The effectiveness of the manipulations to reduce toxicity was proved with the marine amphipod survival test (whole-sediment) and the sea urchin embryo-larval assay (elutriates). By means of TIEs it was concluded that organic compounds were the major contaminants exerting toxicity, although toxic effects by metals was also demonstrated. Additionally, the combination of Phase I treatments allowed to investigate the toxicity changes associated to the mobility of contaminants during dredging activities. Therefore, the performance of TIE procedures as another line of evidence in the decision-making process is recommended. They show a great potential to be implemented at different steps of the characterization and management of dredged harbor sediments.