Factores etiopatogénicos y tratamiento de la enfermedad de Müller-Weiss / Etiopathogenic factors and treatment of Müller-Weiss disease

Antecedentes y objetivo: La enfermedad de Müller-Weiss (EMW) es una anomalía poco frecuente del escafoides tarsiano. Maceira y Rochera propusieron la teoría etiopatogénica más comúnmente aceptada, en la que estarían implicados factores displásicos, mecánicos y ambientales socioeconómicos. Se pretende describir las características clínicas y sociodemográficas de los pacientes de nuestro entorno con EMW, corroborar su asociación con los factores socioeconómicos descritos previamente, estimar la influencia de otros factores descritos en el desarrollo de la EMW, así como describir el tratamiento realizado. Materiales y métodos: Estudio retrospectivo de 60 pacientes diagnosticados de EMW en 2 hospitales terciarios de Valencia (España) entre los años 2010 y 2021. Resultados: Se incluyeron 60 pacientes, 21 (35,0%) hombres y 39 (65,0%) mujeres. En 29 (47,5%) casos la afectación fue bilateral. La media de edad de inicio de la sintomatología fue de 41,9±20,3 años. Durante la infancia, 36 (60,0%) pacientes sufrieron movimientos migratorios, y 26 (43,3%) problemas dentarios. La edad media de inicio laboral fue de 14,6±4,5 años. Se trataron de forma ortopédica 35 (58,3%) casos frente a 25 (41,7%) tratados quirúrgicamente, 11 (18,3%) mediante osteotomía de calcáneo y 14 (23,3%) con artrodesis. Conclusiones: Al igual que en la serie de Maceira y Rochera, encontramos una mayor prevalencia de EMW entre los nacidos alrededor de la Guerra Civil española y el periodo de movimientos migratorios masivos acontecidos en la quinta década del siglo xx. El tratamiento sigue sin estar bien establecido.(AU)

Background and aim: Müller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out. Materials and methods: Retrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021. Results: Sixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis. Conclusions: As in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established.(AU)

[Translated article] Aetiopathogenic factors and treatment of Müller-Weiss disease / Factores etiopatogénicos y tratamiento de la enfermedad de Müller-Weiss

Antecedentes y objetivo: La enfermedad de Müller-Weiss (EMW) es una anomalía poco frecuente del escafoides tarsiano. Maceira y Rochera propusieron la teoría etiopatogénica más comúnmente aceptada, en la que estarían implicados factores displásicos, mecánicos y ambientales socioeconómicos. Se pretende describir las características clínicas y sociodemográficas de los pacientes de nuestro entorno con EMW, corroborar su asociación con los factores socioeconómicos descritos previamente, estimar la influencia de otros factores descritos en el desarrollo de la EMW, así como describir el tratamiento realizado. Materiales y métodos: Estudio retrospectivo de 60 pacientes diagnosticados de EMW en 2 hospitales terciarios de Valencia (España) entre los años 2010 y 2021. Resultados: Se incluyeron 60 pacientes, 21 (35,0%) hombres y 39 (65,0%) mujeres. En 29 (47,5%) casos la afectación fue bilateral. La media de edad de inicio de la sintomatología fue de 41,9±20,3 años. Durante la infancia, 36 (60,0%) pacientes sufrieron movimientos migratorios, y 26 (43,3%) problemas dentarios. La edad media de inicio laboral fue de 14,6±4,5 años. Se trataron de forma ortopédica 35 (58,3%) casos frente a 25 (41,7%) tratados quirúrgicamente, 11 (18,3%) mediante osteotomía de calcáneo y 14 (23,3%) con artrodesis. Conclusiones: Al igual que en la serie de Maceira y Rochera, encontramos una mayor prevalencia de EMW entre los nacidos alrededor de la Guerra Civil española y el periodo de movimientos migratorios masivos acontecidos en la quinta década del siglo xx. El tratamiento sigue sin estar bien establecido.(AU)

Background and aim: Müller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out. Materials and methods: Retrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021. Results: Sixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis. Conclusions: As in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established.(AU)

[Translated article] Aetiopathogenic factors and treatment of Müller-Weiss disease.

BACKGROUND AND AIM: Müller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out. MATERIALS AND METHODS: Retrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021. RESULTS: Sixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis. CONCLUSIONS: As in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established.

Etiopathogenic factors and treatment of Müller-Weiss disease. / Factores etiopatogénicos y tratamiento de la enfermedad de Müller-Weiss.

BACKGROUND AND AIM: Müller-Weiss disease (MWD) is a rare anomaly of the tarsal scaphoid. Maceira and Rochera proposed the most commonly accepted etiopathogenic theory, in which dysplastic, mechanical, and socioeconomic environmental factors would be involved. The aim is to describe the clinical and sociodemographic characteristics of patients with MWD in our setting, corroborate their association with the socioeconomic factors previously described, estimate the influence of other factors involved in the development of MWD, and describe the treatment carried out. MATERIALS AND METHODS: Retrospective study of 60 patients diagnosed with MWD in 2 tertiary hospitals of Valencia (Spain) between 2010 and 2021. RESULTS: Sixty patients were included, 21 (35.0%) men and 39 (65.0%) women. In 29 (47.5%) cases, the disease was bilateral. The mean age of onset of symptomatology was 41.9±20.3 years. During childhood, 36 (60.0%) patients suffered migratory movements, and 26 (43.3%) had dental problems. The mean age of onset was 14.6±4.5 years. Thirty-five (58.3%) cases were treated orthopedically versus 25 (41.7%) treated surgically, 11 (18.3%) by calcaneal osteotomy, and 14 (23.3%) with arthrodesis. CONCLUSIONS: As in the series of Maceira and Rochera, we found a higher prevalence of MWD among those born around the Spanish Civil War and the period of massive migratory movements that occurred in the fifth decade of the 20th century. Treatment is still not well established.

Characterization and mobilization of toxic metals from electrolytic zinc waste.

The natural and forced mobilization of lead, cadmium and arsenic in zinc hydrometallurgy waste is studied with the purpose of establishing potentially environmentally damaging levels and associated risks in uncontrolled situations. Differential X-Ray diffraction is used to study, in simulated environmental situations, the relevant role played by several mineralogical and amorphous phases. The study of potential mobility shows that all the samples considered are susceptible of releasing a significant amount of potentially toxic elements (PTEs) depending of the particular environmental conditions. Two situations can be considered the most problematic: the natural mobilization of the released cadmium and zinc as a result of rain, and a change in the redox conditions caused by an anoxic environment (flooding and/or incorporation of organic matter). The presence of massive quantities of soluble salts increases the hazard potential of these residues, mobilizing the PTEs and creating a potential carcinogenic risk caused by a possible oral intake for both children and adults.

A NodD-like protein activates transcription of genes involved with naringenin degradation in a flavonoid-dependent manner in Herbaspirillum seropedicae.

Herbaspirillum seropedicae is an associative, endophytic non-nodulating diazotrophic bacterium that colonises several grasses. An ORF encoding a LysR-type transcriptional regulator, very similar to NodD proteins of rhizobia, was identified in its genome. This nodD-like gene, named fdeR, is divergently transcribed from an operon encoding enzymes involved in flavonoid degradation (fde operon). Apigenin, chrysin, luteolin and naringenin strongly induce transcription of the fde operon, but not that of the fdeR, in an FdeR-dependent manner. The intergenic region between fdeR and fdeA contains several generic LysR consensus sequences (T-N11 -A) and we propose a binding site for FdeR, which is conserved in other bacteria. DNase I foot-printing revealed that the interaction with the FdeR binding site is modified by the four flavonoids that stimulate transcription of the fde operon. Moreover, FdeR binds naringenin and chrysin as shown by isothermal titration calorimetry. Interestingly, FdeR also binds in vitro to the nod-box from the nodABC operon of Rhizobium sp. NGR234 and is able to activate its transcription in vivo. These results show that FdeR exhibits two features of rhizobial NodD proteins: nod-box recognition and flavonoid-dependent transcription activation, but its role in H. seropedicae and related organisms seems to have evolved to control flavonoid metabolism.

Estudio mediante densitometría y ergoespirometría de los efectos de un programa de ejercicio físico en pacientes con cirrosis hepática y sobrepeso / Study by densitometry and ergospirometry of the effects of an exercise programme in overweight patients with liver cirrhosis

Objetivo: Estudiar los efectos del programa de ejercicio físico moderado sobre la composición corporal y la capacidad de esfuerzo evaluadas mediante densitometría y ergoespirometría, respectivamente, en pacientes con cirrosis y sobrepeso. Pacientes y metodología: Se incluyeron 14 pacientes con cirrosis y sobrepeso compensados que realizaron un programa de ejercicio físico moderado durante tres meses de una hora, tres días/semana. Se midió la variación antropométrica, la composición corporal mediante densitometría, la capacidad de esfuerzo mediante ergoespirometría y la calidad de vida (SF-36). Resultados: Al final del estudio, respecto al inicio, no hubo diferencias en el índice de masa corporal. Encontramos aumento de la masa muscular total y disminución de la masa grasa total. Aumentó el tiempo de esfuerzo total y el tiempo de esfuerzo aerobio. La presión arterial media y la creatinina sérica disminuyeron. La calidad de vida mejoró en todos los dominios del SF-36 aunque alcanzó significación estadística en la función física. Conclusiones: Un programa de ejercicio físico moderado disminuye la masa grasa y aumenta la masa muscular y la capacidad de esfuerzo en pacientes con cirrosis y sobrepeso (AU)

Objective: To study the effects of a moderate exercise programme on body composition and effort capacity evaluated by means of densitometry and ergospirometry, respectively, in overweight patients with cirrhosis. Patients and methods: Fourteen compensated overweight patients with cirrhosis underwent a moderate exercise programme during 3 months one hour 3 days/week. We analyzed the changes in anthropometric measures, body composition by densitometry, effort capacity by ergospirometry and quality of life by SF-36 questionnaire. Results: At the end of the study there were not differences in body mass index with respect to basal values, but we observed an increase in total body muscle mass evaluated by densitometry and a decrease in total fat body mass. Ergospirometry showed an increase in effort time and in aerobic effort time. Mean arterial pressure and serum creatinine decreased at the end of the study. With respect to quality of life, there was an improvement in all SF-36 domains that reached statistical significance in physical functioning. Conclusions: A moderate exercise programme decreases total body fat and increases total body muscle mass and effort capacity in overweight patients with cirrhosis (AU)

Naringenin degradation by the endophytic diazotroph Herbaspirillum seropedicae SmR1.

Several bacteria are able to degrade flavonoids either to use them as carbon sources or as a detoxification mechanism. Degradation pathways have been proposed for several bacteria, but the genes responsible are not known. We identified in the genome of the endophyte Herbaspirillum seropedicae SmR1 an operon potentially associated with the degradation of aromatic compounds. We show that this operon is involved in naringenin degradation and that its expression is induced by naringenin and chrysin, two closely related flavonoids. Mutation of fdeA, the first gene of the operon, and fdeR, its transcriptional activator, abolished the ability of H. seropedicae to degrade naringenin.

Biogeochemical cycling in terrestrial ecosystems of the Caatinga Biome.

The biogeochemical cycles of C, N, P and water, the impacts of land use in the stocks and flows of these elements and how they can affect the structure and functioning of Caatinga were reviewed. About half of this biome is still covered by native secondary vegetation. Soils are deficient in nutrients, especially N and P. Average concentrations of total soil P and C in the top layer (0-20 cm) are 196 mg kg(-1) and 9.3 g kg(-1), corresponding to C stocks around 23 Mg ha(-1). Aboveground biomass of native vegetation varies from 30 to 50 Mg ha(-1), and average root biomass from 3 to 12 Mg ha(-1). Average annual productivities and biomass accumulation in different land use systems vary from 1 to 7 Mg ha(-1) year(-1). Biological atmospheric N2 fixation is estimated to vary from 3 to 11 kg N ha(-1) year-1 and 21 to 26 kg N ha(-1) year(-1) in mature and secondary Caatinga, respectively. The main processes responsible for nutrient and water losses are fire, soil erosion, runoff and harvest of crops and animal products. Projected climate changes in the future point to higher temperatures and rainfall decreases. In face of the high intrinsic variability, actions to increase sustainability should improve resilience and stability of the ecosystems. Land use systems based on perennial species, as opposed to annual species, may be more stable and resilient, thus more adequate to face future potential increases in climate variability. Long-term studies to investigate the potential of the native biodiversity or adapted exotic species to design sustainable land use systems should be encouraged.

Functional outcome and quality of life in victims of terrorist explosions as compared to conventional trauma.

BACKGROUND: Following trauma, the number of preventable deaths is low. Outcome should also be measured in terms of quality of life (QoL). Studies analyzing QoL in trauma patients have been published, but little is known about the long term QoL of victims of terrorist attacks. METHODS: This is a case-control study of casualties of the March 11, 2004 attacks in Madrid. Patients treated for other trauma with similar age and Injury Severity Score (ISS), served as controls. Patients were assessed using the POLO-Chart (VAS, SF-36 and TOP). RESULTS: Fifty-eight patients were included, 32 casualties admitted following the March 11, 2004 attacks and 26 controls. Both groups were comparable in age (average = 37), ISS (average = 23) and time from trauma (average = 1,770 days). Subjects demonstrated lower scores for the VAS, and the SF-36 clusters social functioning, role emotional and mental health. There was a tendency towards higher prevalence of symptoms associated to posttraumatic stress disorder (PTSD) in subjects (p = 0.056). Subjects suffered from higher residual pain in the head region (p = 0.032). Strong association was found between the presence of symptoms associated to depression, anxiety and PTSD and worse QoL (p < 0.001). CONCLUSION: Subjects present more emotional distortions, residual pain in the head region and a tendency towards a worsened perception of their own health and wellness. They also present symptoms associated to PTSD more frequently. The presence of symptoms associated to PTSD, depression or anxiety was an independent variable related to lower QoL in both groups.

Trasplante hepático, manejo en la Unidad de Cuidados Intensivos: una opinión de dos continentes / Liver transplantation: post-surgical care in the intensive care units

Desde el descubrimiento de la ciclosporina, los avances en el manejo de los pacientes trasplantados han sido parte fundamental del cuidado postoperatorio en las unidades de cuidados intensivos. Lentamente, la recuperación de estos pacientes paso de un simple cuidado posquirúrgico a un detallado enfoque y manejo por sistemas, con énfasis en la recuperación fisiopatológica de los pacientes con enfermedad hepática. Por lo tanto, la frecuente aparición de complicaciones pulmonares, cardiovasculares, hematológicas, infecciosas, etc., en este grupo de pacientes ha hecho del cuidado pos-trasplante hepático una parte fundamental de la especialización del cuidado crítico. Los avances en tecnología genética, quirúrgica y farmacológica harán del paciente trasplantado un paciente común en las unidades de cuidado intensivo

Prevalence of allergy to latex in the pediatric population.

Latex is a substance that is extracted from the plant Hevea Brasiliensis, and world production is 6 million metric tons per year. After gathering it undergoes a series of processes in which ammonia, vulcanization-accelerating additives or anti-oxidants are added. All of this may constitute the antigenic load that latex contains. It is used in medicine for gloves, drainage tubes, dental implants and a growing number of products from condoms to sport products or automobile components. Over fifteen different allergenic bands have been described, with molecular weights of between 2 and 100 kDa. In a joint study, USA-Finland identified three antigenic bands that predominate according to the population type studied (2). In children with spina bifida, congenital urogenital abnormalities or those submitted to multiple surgical interventions, the band of 27 kDa is predominant. This antigen has not been detected in adult serum, which suggests that contact with the antigen is through the mucous membranes and the sensitization is triggered from here. The incidence of allergy to latex in the general population is not known, but it seems to be lower than 1%. Turjanmaa (1) establishes a frequency of 0.125% (1/800) in patients submitted to general surgery. The incidence of sensitization to latex varies according to the population studied. Among the population considered to be at risk are the workers of the health environment, where the incidence is between 2.6 and 16.9%, whereas in the general population the percentage is around 1%. Sensitivity to latex is of great importance in patients suffering from spina bifida, in whom an incidence of between 28 and 67% has been found. We present our experience in a group of children attending our service for the first time for diverse reasons of supposed allergic etiology. The objective is to determine the incidence of sensitization to latex according to the diagnostic methodology [cutaneous test or by determination of specific IgE (CAP)]; according to the type of patient (atopic or non-atopic), the direct relationship with latex material and the role that can be played by a history of surgical intervention. In our experience with 282 children studied in our pediatric allergology service using diverse methods, the incidence of allergy to latex is 3.19%. Nevertheless, if we analyze this percentage we observe that if the diagnosis is based exclusively on cutaneous tests, it is only 1.08%; if to establish a diagnosis we used exclusively the determination of specific IgE (CAP) we would label 7. 2% of our children as allergic. Atopy is a factor that facilitates sensitization. In our sample, the incidence among the atopic population is 4.4%, though this percentage may vary between 1.69% and 9.5% depending on the methodology used. There are several hypotheses for explaining these discrepancies in the diagnostic tests. Although there do not seem to be differences regarding the ammonia content of the different lots, it seems that the differential factor could lie in the type of extract and in whether it is commercial or a natural latex extract. It could be a consequence of the existence of a prophyllin, so it has not been ruled out that a part of the IgE is an antiprophyllin. The presence of different epitopes would mean that each of them has the ability to produce its own specific IgE, though the RAST/CAP was not able to differentiate them and identified them as whole. The rate of allergy to latex in a group of children suffering from myelomeningocele is 80%. At a paediatric level, sensitization to latex is influenced by the means of contact, the duration of the exposure to the antigen and the fact that the exposure occurs early, which in the case of children with myelomeningocele is associated with the immaturity of the defence mechanism of the mucous membranes.

Perforación instrumental en estenosis esofágica / Esophageal perforation during dilatation

La perforación esofágica es rara en los niños,siendo la causa más frecuente el accidente durante una dilatación por estenosis.El objetivo del trabajo es analizar la evolución de los pacientes con esta complicación sometidos a tratamiento conservador.En el período comprendido entre Junio de 1984 y Junio de 1998 se realizó un estudio retrospectivo de 14 niños con preforación esofágica post-dilatación en el servicio de cirugía.La etiología de las estenosis fue:por ingesta de cáusticos en 7 pacientes,postoperatorio de atresia de esófago en 4 y estenosis congénita en 3.El diagnóstico se confirmó con esofagograma.En todos los casos el tratamiento inicial consistió en la supensión de la ingesta por vía oral,antibióticos endovenosos y analgésicos.Se efectuaron estudios radiológicos contrastados semanales para conocer la evolución.El 100 por ciento de los pacientes cursaron con dolor e hipertemia en las primeras 24 horas.Ocho pacientes evolucionaron favorablemente con tratamiento médico(57 por ciento).Seis pacientes (42 por ciento)presentaron derrame pleural y neumomediastino tratados con tubo de drenaje bajo agua.Tres evolucionaron favorablemente pero en 2 se rellizó toracotomía y tolette y en otro,portador de atresia de esófago,se efectuó resección de la estenosis reanastomosis.Uno requirió esofagostoma de derivación.El tiempo promedio de internación fue de 29,7 días con un rango entre 16 y 70 días.No se registraron caso fatales y el 50 por ciento resolvió su estenosis,el resto necesitó continuar con dilataciones

Perforación instrumental en estenosis esofágica / Esophageal perforation during dilatation

La perforación esofágica es rara en los niños,siendo la causa más frecuente el accidente durante una dilatación por estenosis.El objetivo del trabajo es analizar la evolución de los pacientes con esta complicación sometidos a tratamiento conservador.En el período comprendido entre Junio de 1984 y Junio de 1998 se realizó un estudio retrospectivo de 14 niños con preforación esofágica post-dilatación en el servicio de cirugía.La etiología de las estenosis fue:por ingesta de cáusticos en 7 pacientes,postoperatorio de atresia de esófago en 4 y estenosis congénita en 3.El diagnóstico se confirmó con esofagograma.En todos los casos el tratamiento inicial consistió en la supensión de la ingesta por vía oral,antibióticos endovenosos y analgésicos.Se efectuaron estudios radiológicos contrastados semanales para conocer la evolución.El 100 por ciento de los pacientes cursaron con dolor e hipertemia en las primeras 24 horas.Ocho pacientes evolucionaron favorablemente con tratamiento médico(57 por ciento).Seis pacientes (42 por ciento)presentaron derrame pleural y neumomediastino tratados con tubo de drenaje bajo agua.Tres evolucionaron favorablemente pero en 2 se rellizó toracotomía y tolette y en otro,portador de atresia de esófago,se efectuó resección de la estenosis reanastomosis.Uno requirió esofagostoma de derivación.El tiempo promedio de internación fue de 29,7 días con un rango entre 16 y 70 días.No se registraron caso fatales y el 50 por ciento resolvió su estenosis,el resto necesitó continuar con dilataciones