The application of three-dimensional printing in the management of a difficult airway due to Treacher Collins syndrome.

We describe the use of three-dimensional printing to create precise airway models for a patient with Treacher Collins syndrome who presented for bimaxillary temporomandibular joint prostheses, and for whom airway management was predicted to be difficult. The model was based on pre-operative cone beam computed tomography images and printed in the 3D Lab of Hospital Universitario La Paz. Transparent models allowed clear visualisation for simulation and iterative refinement of airway management techniques and aided in risk assessment and instrument sizing. This case report emphasises the utility of this approach in complex airway scenarios.

Positron Emission Tomography-Computed Tomography and Magnetic Resonance Imaging Assessments in a Mouse Model of Implant-Related Bone and Joint Staphylococcus aureus Infection.

Osteomyelitis is an infection of the bone, associated with an inflammatory process. Imaging plays an important role in establishing the diagnosis and the most appropriate patient management. However, data are lacking regarding the use of preclinical molecular imaging techniques to assess osteomyelitis progression in experimental models. This study aimed to compare structural and molecular imaging to assess disease progression in a mouse model of implant-related bone and joint infections caused by Staphylococcus aureus. In SWISS mice, the right femur was implanted with a resorbable filament impregnated with S. aureus (infected group, n = 10) or sterile culture medium (uninfected group, n = 6). Eight animals (5 infected, 3 uninfected) were analyzed with magnetic resonance imaging (MRI) at 1, 2, and 3 weeks postintervention, and 8 mice were analyzed with [18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)-computed tomography (CT) at 48 h and at 1, 2, and 3 weeks postintervention. In infected animals, CT showed bone lesion progression, mainly in the distal epiphysis, although some uninfected animals presented evident bone sequestra at 3 weeks. MRI showed a lesion in the articular area that persisted for 3 weeks in infected animals. This lesion was smaller and less evident in the uninfected group. At 48 h postintervention, FDG-PET showed higher joint uptake in the infected group than in the uninfected group (P = 0.025). Over time, the difference between groups increased. These results indicate that FDG-PET imaging was much more sensitive than MRI and CT for differentiating between infection and inflammation at early stages. FDG-PET clearly distinguished between infection and postsurgical bone healing (in uninfected animals) from 48 h to 3 weeks after implantation. IMPORTANCE Our results encourage future investigations on the utility of the model for testing different therapeutic procedures for osteomyelitis.

Fisiopatología del síndrome miofascial ¿qué sustenta la terapéutica actual? / Pathophysiology of myofascial syndrome: what sustains the current therapeutic?

Myofascial pain syndrome is a disorder that has had a great interest in the last years. Its pathophysiology still not completely understood makes the physiological basis of the treatment incomplete. In this paper the scientific evidence and theories that exist on every component of myofascial pain syndrome and how they can be part of the treatments used are described...

El síndrome de dolor miofascial es un trastorno cuya difusión ha ido en aumento en los últimos años; sin embargo, su fisiopatología aún sigue sin dilucidarse por completo; esto conlleva a que no se conozcan las bases fisiológicas que sustentan la terapéutica que se utiliza para su manejo. En este texto se describen la evidencia científica y las teorías que existen ante cada una de las partes que componen el síndrome de dolor miofascial y cómo pueden formar parte de los tratamientos que se emplean...

[Diffuse brain involvement in paediatrics: magnetic resonance findings]. / Afectación difusa del cerebelo en la edad pediátrica: hallazgos en resonancia magnética.

Posterior fossa involvement, which may be focal or diffuse, is an uncommon finding in paediatric patients. Acute cerebellitis is the first condition to be suspected among the diffuse forms, and ataxia is the most characteristic symptom. This condition is occasionally difficult to diagnose clinically, thus imaging tests play an important role in this. However, there are other rare conditions which may be clinically and radiologically similar to acute cerebellitis and which should be taken into account when making a differential diagnosis. The aim of this article is to present five diseases with diffuse brain involvement in paediatric patients and describe how they show up in MR imaging.

A short report on highlights of world-wide development of RIX4414: a Latin American experience.

An oral, human-derived monovalent (G1P1A) rotavirus vaccine, strain RIX4414, has been developed by GlaxoSmithKline, Rixensart, Belgium. The safety, immunogenicity and efficacy of this vaccine were evaluated in a randomized, double-blind, placebo-controlled, phase IIb trial conducted in Brazil, Mexico and Venezuela. Healthy infants were given two doses of vaccine (104.7, 105.2 or 105.8 ffu) or placebo at age 2 and 4 months, with routine DTPw-HBV and Hib vaccines. OPV was given separately, at least 2 weeks before or after administration of the study vaccine. A total of 2155 infants were enrolled, of whom 1618 received one of the three vaccine viral concentrations and 537 were given placebo. Analysis of efficacy included diarrheal episodes occurring from 2 weeks after second dose until one year of age. Efficacy rates against any rotavirus gastroenteritis, severe rotavirus gastroenteritis and hospitalizations for rotavirus disease were as high as 70% (46-84%; 95%CI), 86% (63-96%; 95%CI), and 93% (54-100%; 95%CI), respectively. For non-G1 (mainly G9) serotypes, RIX4414 vaccine conferred protection as high as 83% (40-97%; 95%CI) against severe gastroenteritis. A decrease was noted in the incidence of severe rotavirus-related gastroenteritis after first dose. It is demonstrated that two doses of RIX4414 are highly efficacious against severe rotavirus gastroenteritis and hospitalization, including disease caused by non-G1 strains, namely G9 serotypes.

Intervención psicológica en sujetos durante la reanimación de su parada cardiorrespiratoria / Psychological intervention with patients subject to cardiopulmonary resucitation

En esta investigación se estudian los aspectos psicológicos y fisiológicos relacionados con la muerte y con la parada cardiorrespiratoria. Se aporta un protocolo psicológico de estimulación verbal para aplicarlo al sujeto, durante la reanimación de su parada cardiorrespiratoria y los datos preliminares sobre la eficacia de dicha intervención, con una muestra de 30 pacientes, que presentaban una parada cardiorrespiratoria extrahospitalaria. Los resultados obtenidos aconsejan continuar con la investigación aumentando la muestra de sujetos. (AU)

Rotavirus-associated medical visits and hospitalizations in South America: a prospective study at three large sentinel hospitals.

BACKGROUND: Knowledge of the impact of rotavirus-associated disease on the health care systems of South America can aid in defining strategies for diagnosis, management and prevention. Up to date information on the impact of rotavirus disease in South America is scarce. AIM: To determine prospectively the impact of rotavirus disease as a cause of medical visits and hospitalizations at three large sentinel pediatric hospitals in Argentina, Chile and Venezuela. METHODS: A 2-year prospective surveillance for rotavirus-associated medical visits and hospitalizations was conducted during 1997 through 1998 at three large sentinel public hospitals, one each in Argentina, Chile and Venezuela. A common surveillance protocol was implemented at the three sites, and a representative number of nonbloody diarrhea stool samples from children <36 months of age were tested for rotavirus by enzyme-linked immunosorbent assay. RESULTS: For our target age group, acute diarrhea-associated medical visits/hospitalizations represented 41%/2%, 5%/6% and 9%/13% of all medical visits/all hospitalizations at the Argentinean, Chilean and Venezuelan sites, respectively (P < 0.001 for difference among the three sites). Rotavirus detection rates among a total of 5,801/1,256 medical visit/hospitalization diarrhea stool samples tested were 39%/71% in Argentina, 34%/47% in Chile and 29%/38% in Venezuela (P < 0.01 by chi square for difference among the three sites). Rotavirus was associated with a mean of 1.5, 1.8 and 3% of total medical visits and 1.6, 2.8 and 5% of hospitalizations among children <36 months of age at the Argentinean, Chilean and Venezuelan sites, respectively. Seasonality was evident for medical visits at all three sites (although less striking in Chile) with peak activity occurring between November and May. Rotavirus-associated hospitalizations had a marked peak in Venezuela, represented largely by short stays, but not in Argentina and Chile. CONCLUSIONS: Rotavirus was a significant cause of medical visits at all three sentinel sites. Rotavirus caused less hospitalizations than previously reported in Argentina and Chile. On the basis of our findings we estimate that approximately 106,000/ 21,000, 48,000/8,000 and 98,000/31,000 rotavirus-associated medical visits/hospitalizations occur yearly in Argentina, Chile and Venezuela, respectively.

Aspectos epidemiológicos de la diarrea aguda en el Hospital de Niños de la Ciudad Hospitalaria "Enrique Tejera" / Epidemiological aspects of the acute diarrhea in the Children Hospital of the Hospitalary City

El objetivo del estudio fue determinar las características clínicas y epidemiológicas de pacientes con diarrea que requirieron atención en las áreas observación-hospitalización y ambulatoria, entre noviembre 1997 y mayo 1999 de la Ciudad Hospitalaria "Enrique Tejera" (CHET), Valencia. La identificación de rotavirus y bacterias se efectuó mediante ELISA y métodos convencionales respectivamente. Las diarreas fueron mas frecuentes en varones (56 por ciento) que en hembras (44 por ciento) y sólo el 13 por ciento de los niños menores de 6 meses recibieron lactancia materna exclusiva. El 32 por ciento fue atendido en observación-hospitalización y el 68 por ciento fue ambulatorio. El 82 por ciento fueron niños menores de 2 años. Las manifestaciones clínicas fueron: deshidratación (33 por ciento), fiebre (36 por ciento), vómitos (65 por ciento) y déficit nuticional (23 por ciento). Rotavirus se identificó en 26 por ciento de los casos con un patrón estacional de dos picos en 1998: enero (56 por ciento) y noviembre (47 por ciento) y la prevalencia mas baja (2 por ciento) en junio. En una muestra seleccionada se identificó Shigella (6 por ciento), Salmonella (5 por ciento) y Campylobacter (3 por ciento). Estas enfermedades son importantes epidemiológicamente y clínicamente por el impacto y costos que generan

Polymerase chain reaction selects a novel disintegrin proteinase from CD40-activated germinal center dendritic cells.

To identify genes expressed by a specific subset of dendritic cells found in vivo a polymerase chain reaction-based cDNA subtraction technique was applied to the recently described germinal center dendritic cells. A novel member of the disintegrin metalloproteinase family was cloned which comprises a not typical zinc-chelating catalytic site most similar to a bacterial metalloproteinase. Dendritic cell precursors or immature dendritic cells express no or low levels of the message. It is induced to high levels upon spontaneous or CD40-dependent maturation and in a mixed lymphocyte reaction. In situ hybridization showed distinct expression of this gene in the germinal center. This, together with the findings that certain disintegrin metalloproteinases regulate the activity of tumor necrosis factor alpha and that metalloproteinases have also been implicated in FasL processing, suggest that this novel molecule may play an important role in dendritic cell function and their interactions with germinal center T cells.

[Social cost effectiveness of 2 systems of treatment of malnourished children, in Chile]. / Costo-efecto social de dos sistemas de tratamiento del niño desnutrido, en Chile.

Two approaches in the care of malnourished children were evaluated in order to ascertain both their medical and economical effectiveness. One was a group of 745 children under an ambulatory nutritional rehabilitation program that included health care, supplementary foods and nutrition education; a second group of 420 children attended Day Care Centers (8 hours a day and five days per week) where they received a balanced diet, psychomotor stimulation according to age, and health care. The evolution of nutritional status was followed up and plotted against the NCHS/WHO weight-for-height tables. The rate of recovery was unsatisfactory; below 50% in mild cases of malnutrition, and even less in the more severe cases. The average length of time for attaining normality was longer for moderate malnutrition and for the ambulatory program. When the calculation included a correction for the probability of recovery for each system, the advantage of the Day Care Centers became even more evident: the mean length of time for recovery was 33.2% less than the ambulatory program. The social cost per child, per day, was substantially lower in the ambulatory program. The integral calculus of social cost per child, per day, and the corrected mean time for recovery provided the social cost-effectiveness of nutritional recovery. This figure was clearly adventageous for the ambulatory program for all ages and degrees of malnutrition, exception made for moderately malnourished children below two years of age. In this case, the Day Care Centers appeared to be the most effective therapeutic alternative. This type of analysis is a contribution to the evaluation of medico-social programs for the recuperation of malnutrition. The advantage lies in the fact that it allows an optimization in the allocation of resources, when the previous step is the choice of best therapeutic alternative based upon the patient's age and nutritional status.

Diseno de una metodologia para evaluar el programa de atencion del nino con deficit nutricional. / Design of a methodology for evaluation of the program for the care of malnourished children

El proposito de este trabajo es proponer y probar una metodologia que permita una mejor evaluacion del Programa de Atencion al Desnutrido, del Ministerio de Salud, Chile, en base a informacion que actualmente se recopila.Se definieron cuatro indicadores de desnutricion (incidencia, recuperacion, recaidas e indice de variacion del stock), los que fueron aplicados a datos provenientes de las Areas Oriente y Sur-Oriente y de cinco consultorios del Area Norte (1979), de la Region Metropolitana. La incidencia fue de 7,2%, con un maximo de 20,3% en el Grupo de 6 a 11 meses. El indice de recuperacion global fue de 28,4% siendo 3 veces mas alto en los desnutridos leves en relacion a los avanzados. Las recaidas afectan al 33,0% de los recuperados, los que mayoritariamente se pesquisan en grado leve. El indice de variacion del stock revela un descenso de la desnutricion de 13,1% en las Areas analizadas. Un analisis de este tipo entrega informacion confiable acerca de la eficiencia con que opera el Programa. Se recomienda aplicar esta metodologia como un apoyo para el proceso de toma de decisiones y consecuentemente orientar mejor la asignacion de recursos, por parte del nivel planificado