Impact of pregnancy on women's health-related lifestyle habits: Diet, physical activity, alcohol consumption, and smoking.

OBJECTIVES: To explore health-related lifestyles in women before and during pregnancy, and to determine the potential differences between both and the relevant factors. MATERIALS AND METHODS: A cross-sectional observational study including 348 women with a child <5 years of age was conducted in six health areas. The following variables were recorded: sociodemographic (age, educational level, marital status, social class, type of cohabitation, nationality), health-related habits (physical activity, diet, tobacco use, alcohol consumption), health conditions, and medication intake. RESULTS: Four lifestyle habits were compared between the pre-conception and pregnancy periods: diet, physical activity, and alcohol and tobacco use. The proportion of women who consumed alcohol (42.8 % vs 3.4 %) or smoked (19.3 % vs 12.4 %) was significantly higher before conception (p < 0.01). Conversely, the proportion of inactive women was lower before pregnancy, with 23.3 % (CI95%: 18.7-27.9) formerly classified as active versus 35.3 % (CI95%: 30.2-40.5) (p < 0.01). Similarly, adherence to the Mediterranean diet increased during pregnancy (62.9 % vs 75.0 %; p < 0.01). Furthermore, 53.2 % (CI95%: 47.8-58.5) of women reported a change from non-healthy to healthy in at least one of the evaluated habits. Logistic regression analyses revealed the variables associated with a positive change, which were being national Spanish (OR: 6.9) and experiencing the first pregnancy (OR: 1.8). CONCLUSIONS: The lifestyles of women undergo changes between the pre-gestation and pregnancy periods. However, such variations do not affect all health-related habits similarly. A positive change was observed in diet, alcohol consumption, and smoking habit, whereas pregnancy negatively impacted on physical activity and sedentary behaviours.

Pediatric invasive fungal rhinosinusitis.

Pediatric invasive fungal rhinosinusitis (PIFR) is a rapidly progressive, potentially fatal disease. Previous medical literature demonstrates that its early diagnosis significantly reduces the risk of mortality in these patients. This study aims to present an updated clinical algorithm for optimized diagnosis and management of PIFR. A comprehensive review was conducted with only original, full-text articles published in English and Spanish from Cochrane Library, Pub-Med/MEDLINE, Embase, Scopus, and Google Scholar between January 2010 and June 2022. Relevant information was extracted and then integrated to develop a clinical algorithm for a proper diagnosis and management of PIFR.

Outcomes of lung and liver transplantation after simultaneous recovery using abdominal normothermic regional perfusion in donors after the circulatory determination of death versus donors after brain death.

Normothermic regional perfusion (NRP) in controlled donation after the circulatory determination of death (cDCD) is a growing preservation technique for abdominal organs that coexists with the rapid recovery of lungs. We aimed to describe the outcomes of lung transplantation (LuTx) and liver transplantation (LiTx) when both grafts are simultaneously recovered from cDCD donors using NRP and compare them with grafts recovered from donation after brain death (DBD) donors. All LuTx and LiTx meeting these criteria during January 2015 to December 2020 in Spain were included in the study. Simultaneous recovery of lungs and livers was undertaken in 227 (17%) donors after cDCD with NRP and 1879 (21%) DBD donors (P < .001). Primary graft dysfunction grade-3 within the first 72 hours was similar in both LuTx groups (14.7% cDCD vs. 10.5% DBD; P = .139). LuTx survival at 1 and 3 years was 79.9% and 66.4% in cDCD vs. 81.9% and 69.7% in DBD (P = .403). The incidence of primary nonfunction and ischemic cholangiopathy was similar in both LiTx groups. Graft survival at 1 and 3 years was 89.7% and 80.8% in cDCD vs. 88.2% and 82.1% in DBD LiTx (P = .669). In conclusion, the simultaneous rapid recovery of lungs and preservation of abdominal organs with NRP in cDCD donors is feasible and offers similar outcomes in both LuTx and LiTx recipients to transplants using DBD grafts.

Rhabdomyolysis following Nuss Procedure: A Prospective Study in Children.

INTRODUCTION: Postoperative rhabdomyolysis (RML) has been documented after several surgical procedures in adults. Musculoskeletal remodeling after Nuss procedure for pectus excavatum (PE) could cause RML. We evaluated the incidence of RML after Nuss procedure in children. METHODS: This study was a prospective study from 2018 to 2021. We enrolled all otherwise healthy patients who underwent PE correction with only one bar. Studied variables included demographic and clinical data, duration of surgery, complications, and length of hospitalization. The patients included underwent serial measurements of serum creatine kinase (CK), troponin I, N terminal pro B-type natriuretic peptide (NT-proBNP), serum creatinine, urea, and glomerular filtration rate at 6 and 48 hours postoperatively, and hospital discharge. RESULTS: Forty-six patients met criteria (40 males/6 females), with a mean age of 15.1 ± 1.4 years. Mean duration of surgery was 74 ± 28 minutes, and length of hospitalization was 4.6 ± 1.6 days. RML was diagnosed in 30.4% of patients at 6 hours, 91.3% at 48 hours, and 21.7% at hospital discharge. Mean preoperative CK value was 181.1 ± 141.6 IU/L, and postoperative values were 863.3 ± 302.6 IU/L at 6 hours, 1,675.2 ± 561 IU/L at 48 hours, and 850 ± 683.7 IU/L at hospital discharge, with statistically significant differences (p = 0.001). High-sensitivity troponin I and NT-proBNP levels increased significantly during the postoperative time (p = 0.001). Renal function remained stable (p = 0.55). CONCLUSION: Nuss technique produces RML without kidney injury in healthy patients. This knowledge should be considered for patients at increased risk of developing acute kidney injury and other complications.

Influencia de los estilos de vida de la madre en el inicio de la lactancia materna: estudio de casos y controles / Influence of the mother's lifestyles on the initiation of breastfeeding: A case-control study

Introducción: La lactancia materna es la alimentación óptima durante los primeros meses de vida. El objetivo principal de este estudio fue analizar los factores relacionados con no iniciar la lactancia materna, tanto referidos a los estilos de vida maternos como a las características epidemiológicas y la información sobre lactancia. Material y método: Estudio analítico observacional de casos y controles en 6 centros de salud. Se seleccionaron mujeres con algún hijo menor de 5 años, estimando un tamaño muestral de 166 casos (mujeres que no iniciaron lactancia materna) y 166 controles (que iniciaron lactancia). Se midieron variables sociodemográficas y estilos de vida maternos antes y durante la gestación, como la actividad física mediante el cuestionario BPAAT, la dieta con el cuestionario MEDAS-14 y el consumo de tabaco y alcohol. Se valoró la información y opiniones sobre lactancia, así como la experiencia previa. Resultados: Se incluyeron 348 mujeres (174 casos y 174 controles) con una edad media de 33,4 años (DE 5,4). Fueron variables asociadas de manera independiente con no iniciar lactancia: ausencia de experiencia previa con lactancia (OR: 12,75), tomar la decisión durante la gestación o el parto (OR: 10,55), no estar casada o con pareja (OR: 3,42) y permanecer sedentaria≥2h/día durante la gestación (OR: 1,77). Conclusiones: En nuestro estudio, los factores determinantes que se asocian a no iniciar lactancia materna son la ausencia de experiencia previa con lactancia, el momento de la decisión sobre la lactancia y el estado civil. Entre los estilos de vida, solo el sedentarismo se asocia a no iniciar lactancia materna, mientras que no tienen influencia los hábitos alimentarios u otros. (AU)

Introduction: Breast milk is the optimal food during the first months of life. The main objective was to analyse the factors associated with not initiating breastfeeding in terms of maternal lifestyles, epidemiological characteristics and information on breastfeeding. Material and method: Observational analytical study of cases and controls in 6 primary care centres. The sample included women with a child under 5 years, with an estimated necessary sample size of 166 cases (women who did not initiate breastfeeding) and 166 controls (women who began breastfeeding). Sociodemographic and maternal lifestyle variables were measured before and during pregnancy, such as physical activity using the BPAAT questionnaire, diet with the MEDAS-14 questionnaire, and tobacco and alcohol consumption. We assessed the information and opinions about breastfeeding as well as previous experience with it. Results: The study included 348 women (174 cases and 174 controls) with a mean age of 33.4 years (SD 5.4). The variables independently associated with not initiating breastfeeding were: absence of previous experience with breastfeeding (OR 12.75), making the decision during pregnancy or delivery (OR 10.55), not being married or in a partnership (OR 3.42) and being sedentary for periods of 2h or greater/day during pregnancy (OR 1.77). Conclusions: In our study, the determining factors associated with not initiating breastfeeding were the lack of previous experience with breastfeeding, the timing of the decision about breastfeeding, and marital status. When it came to lifestyle, only a sedentary lifestyle was associated with not initiating breastfeeding, while dietary or other habits had no influence. (AU)

Actitudes y opiniones de la población adolescente sobre las recomendaciones de protección de la salud frente a la COVID-19 / Attitudes and opinions of adolescents on recommendations for health protection against COVID-19

Objetivo: determinar las opiniones y actitudes de los estudiantes de enseñanza secundaria sobre las medidas de prevención frente al virus SARS-CoV-2, así como analizar los factores asociados a una mejor actitud hacia ellas.Diseño: estudio descriptivo transversal.Emplazamiento: centros de enseñanza secundaria.Participantes: 1.886 adolescentes que cursaban enseñanza secundaria de quince institutos de cinco comunidades autónomas.Mediciones principales: mediante encuesta anónima autocumplimentada, se valoraron aspectos sociodemográficos, hábitos de salud (actividad física, consumo de alcohol y tabaco) y opiniones, percepciones y actitudes sobre las recomendaciones preventivas durante la pandemia de la COVID-19.Resultados: edad media: 13,8 años (desviación estándar [DE]:1,3). El 88,6% (intervalo de confianza [IC] 95%: 87,1-90,1) conocía las recomendaciones. El 43,4% (IC 95%: 41,2-45,7) cumplió todas las medidas durante el confinamiento y el 31,3% (IC 95%: 29,2-33,5) cumplió todas las medidas durante el resto de pandemia. La medida peor considerada fue el adelanto del cierre de establecimientos (36,1%), seguida del cierre entre ciudades (35%) y de evitar reuniones (26,6%). Mediante regresión logística, fueron variables asociadas de forma independiente a una mejor actitud hacia las medidas durante la pandemia: menor edad (odds ratio [OR]: 1,14), no consumir alcohol (OR: 2,11), conocer las recomendaciones (OR: 2,11) y creer que existirán consecuencias negativas para el país (OR: 1,48).Conclusiones: los jóvenes y las jóvenes mostraron una actitud positiva hacia las medidas frente a la COVID-19 y una mayoría las conocía. Cumplieron en gran medida las recomendaciones preventivas, aunque no en su totalidad, siendo superior su cumplimiento durante el confinamiento. La opinión sobre las medidas se relaciona con la edad, la actitud con el alcohol, el conocimiento de las medidas y las posibles consecuencias de la pandemia.(AU)

Objective: to determine the opinions and attitudes of secondary school students about prevention measures against the SARS-CoV-2 virus, as well as to analyze the factors associated with a better attitude towards them.Design: cross-sectional descriptive study.Site: cecondary schools.Participants: a total of 1886 adolescents in secondary education at fifteen secondary schools in five Autonomous Communities.Main measures: sociodemographic aspects, health habits (physical activity, alcohol and tobacco consumption) and opinions, perceptions and attitudes about the preventive recommendations to follow during the COVID-19 pandemic were evaluated by means of an anonymous self-completed survey.Results: mean age of 13.8 years (SD: 1.3). A total of 88.6% (95% CI: 87.1-90.1) were aware of the recommendations; 43.4% (95% CI: 41.2-45.7) complied with all the measures during confinement and 31.3% (95% CI: 29.2-33.5) during the rest of the pandemic. The worst considered measure was early closure of establishments (36.1%), followed by closure between cities (35%) and avoiding meetings (26.6%). Using logistic regression, variables independently associated with a better attitude towards the measures during the pandemic were: younger age (OR: 1.14), not consuming alcohol (OR: 2.11), familiarity with the recommendations (OR: 2.11) and the belief that there will be negative consequences for the country (OR: 1.48).Conclusions: young people showed a positive attitude towards the measures against COVID-19 and most were aware of them. By and large they complied with the preventive recommendations, although not in their entirety; compliance was higher during confinement. Opinion about the measures was related to age, attitude towards alcohol, knowledge of the measures and possible consequences of the pandemic.(AU)

Country data on AMR in Mexico in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome.

BACKGROUND: Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. OBJECTIVES: To review AMR in Mexico and initiatives addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rises in AMR and to improve patient outcomes. METHODS: National AMR initiatives in Mexico, antibiotic use and prescribing, and availability of susceptibility data, particularly the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used in Mexico for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, along with local antibiotic availability. Insights from a local clinician were sought to contextualize this information. CONCLUSIONS: The Mexican national AMR strategy was published in 2018. This comprised similar objectives to the Global Action Plan from the World Health Assembly (2015) and was compulsory, requiring full compliance from members of the National Health System. Historically, antibiotic consumption in Mexico has been high, however, between 2000 and 2015, consumption fell, in sharp contrast to the majority of countries. Mexico lacks a national surveillance network for AMR, however there are several ongoing global surveillance studies providing local antibiotic susceptibility data. International and local antibiotic prescribing guidelines for CA-RTIs are used. A more standardized inclusive approach in developing local guidelines, using up-to-date local surveillance data of isolates from community-acquired infections, could make guideline use more locally relevant. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development in Mexico and improve patient outcomes.

Influence of the mother's lifestyles on the initiation of breastfeeding: A case-control study.

INTRODUCTION: Breast milk is the optimal food during the first months of life. The main objective was to analyse the factors associated with not initiating breastfeeding in terms of maternal lifestyles, epidemiological characteristics and information on breastfeeding. MATERIAL AND METHOD: Observational analytical study of cases and controls in 6 primary care centres. The sample included women with a child under 5 years, with an estimated necessary sample size of 166 cases (women who did not initiate breastfeeding) and 166 controls (women who began breastfeeding). Sociodemographic and maternal lifestyle variables were measured before and during pregnancy, such as physical activity using the BPAAT questionnaire, diet with the MEDAS-14 questionnaire, and tobacco and alcohol consumption. We assessed the information and opinions about breastfeeding as well as previous experience with it. RESULTS: The study included 348 women (174 cases and 174 controls) with a mean age of 33.4 years (SD, 5.4). The variables independently associated with not initiating breastfeeding were: absence of previous experience with breastfeeding (odds ratio [OR], 12.75), making the decision during pregnancy or delivery (OR, 10.55), not being married or in a partnership (OR, 3.42) and being sedentary for periods of 2 hours or greater/day during pregnancy (OR, 1.77). CONCLUSIONS: In our study, the determining factors associated with not initiating breastfeeding were the lack of previous experience with breastfeeding, the timing of the decision about breastfeeding, and marital status. When it came to lifestyle, only a sedentary lifestyle was associated with not initiating breastfeeding, while dietary or other habits had no influence.

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery.

INTRODUCTION: In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. MATERIALS AND METHODS: Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with "patient-controlled analgesia" (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55-127), with no differences between the groups. RESULTS: PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). CONCLUSION: PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.

Manifestaciones cutáneas por COVID-19 en paciente polisintomática / Cutaneous manifestations of COVID-19 in a polysymptomatic patient

La infección por SARS-CoV-2 se caracteriza por manifestaciones múltiples, entre las que las más habituales son la fiebre, la tos y la dificultad respiratoria. Sin embargo, se ha observado la presencia, cada vez más frecuente, de diferentes lesiones cutáneas que pueden persistir durante el curso de toda la enfermedad, constituyendo la principal o única sintomatología en determinados casos. No se ha demostrado que la presencia ni el grado de afectación de estas manifestaciones cutáneas estén relacionados con el pronóstico. Presentamos el caso de una mujer de 25 años, con fiebre de cinco días de evolución, acompañada de clínica respiratoria. Tras la desaparición de dicha sintomatología, comenzó con un exantema maculopapular, de doce días de duración. La aparición de nuevas enfermedades, especialmente con la gravedad e importancia epidemiológica de la infección ocasionada por SARS-CoV-2, obliga al especialista en Medicina de Familia a considerar en su sospecha diagnóstica cualquier tipo de sintomatología, aunque no se incluya entre la que habitualmente caracteriza a la nueva patología

SARS-CoV-2 virus infection is characterized by multiple manifestations, among which fever, cough, and shortness of breath are the most frequent. However, an increasing presence of different skin lesions has been observed, which may persist over the whole course of the disease, and which in certain cases are the main or only symptom. The connection of the presence or the degree of affectation of these cutaneous manifestations with prognosis has not been confirmed. We present the case of a 25-year-old woman, who had had fever for five days, together with respiratory symptoms. After those symptoms had resolved, a maculopapular rash appeared, lasting for twelve days. The emergence of new diseases, especially those with the severity and epidemiological significance of the SARS-CoV-2 infection, compels the Family Medicine specialist to consider any type of symptomatology in their suspected diagnosis, even if it is not included among the usual symptoms of the new disease

Síndrome metabólico y otros modificadores de riesgo cardiovascular en adultos hipertensos de 65 o menos años de edad / Metabolic syndrome and other cardiovascular risk modifiers in hypertensive adults aged 65 or younger

OBJETIVOS: Describir la prevalencia de síndrome metabólico, de cada uno de sus componentes y de otros modificadores del riesgo cardiovascular (RCV) en hipertensos ≤ 65 años, así como analizar su relación con el grado de control de la presión arterial (PA). MATERIAL Y MÉTODOS: Estudio descriptivo observacional transversal realizado en 267 adultos de ≤ 65 años, diagnosticados de hipertensión arterial (criterios Guías Europeas hipertensión y riesgo cardiovascular), atendidos en consultas de medicina de familia de cuatro Zonas Básicas de Salud. La variable principal fue la presencia de síndrome metabólico (ATPIII/AHA-2004). Se recogieron variables sociodemográficas, problemas de salud, consumo de fármacos, cumplimiento terapéutico, actividad física (IPAQ-breve y BPAAT), consumo de tabaco, determinaciones analíticas, riesgo cardiovascular, cifras de presión arterial y su grado de control. RESULTADOS: Edad media 56,7 años (DE: 6,6). La prevalencia de síndrome metabólico fue del 40,4% (IC95%: 34,4%-46,5%). Un 76,8% mostró obesidad abdominal, 36,7% hipertrigliceridemia, 25,8% c-HDL disminuido y 26,2% hiperglucemia. El 55,8% presentaba dislipemia, 54,3% obesidad, 24,7% diabetes y 21,3% fumaba. Un 40,2% (IC95%: 33,9%-45,8%) no mostró adecuado control de PA. Mediante regresión logística, fueron variables asociadas a inadecuado control de presión arterial: menor puntuación cuestionario-BPAAT (OR:1,19; p = 0,027), menor número de problemas de salud (OR:1,20; p = 0,009), incumplimiento terapéutico (OR:1,93; p = 0,043) y síndrome metabólico (OR:2,85; p < 0,001). CONCLUSIONES: Más de un tercio de hipertensos adultos presentan síndrome metabólico y tres cuartos obesidad abdominal. El síndrome metabólico no sólo es un factor modificador de RCV, sino que también se debe considerar en el control de la PA en adultos hipertensos junto con el cumplimiento terapéutico, la comorbilidad y la actividad física

OBJECTIVES: To describe the prevalence of metabolic syndrome, of each of its components, and of other cardiovascular risk (CVR) modifiers in hypertensive patients ≤ 65 years of age, as well as to analyze its relationship with the degree of control of blood pressure (BP). MATERIAL AND METHODS: Descriptive cross-sectional observational study carried out in 267 adults aged ≤ 65 years, diagnosed with arterial hypertension (European Guidelines criteria for hypertension and cardiovascular risk), seen in family medicine consultations in four Basic Health Zones. The main variable was the presence of metabolic syndrome (ATPIII / AHA-2004). Sociodemographic variables, health problems, drug consumption, therapeutic compliance, physical activity (IPAQ-brief and BPAAT), tobacco consumption, analytical determinations, cardiovascular risk, blood pressure readings and their degree of control were collected. RESULTS: Average age 56.7 years (SD: 6.6). The prevalence of metabolic syndrome was 40.4% (95% CI: 34.4%-46.5%). 76.8% showed abdominal obesity, 36.7% hypertriglyceridemia, 25.8% decreased HDL-c, and 26.2% hyperglycemia. 55.8% had dyslipidemia, 54.3% obesity, 24.7% diabetes, and 21.3% smoked. 40.2% (95% CI: 33.9%-45.8%) did not show adequate BP control. Using logistic regression, variables associated with inadequate blood pressure control were: lower BPAAT-questionnaire score (OR: 1.19; p = 0.027), fewer health problems (OR: 1.20; p = 0.009), therapy non-compliance (OR: 1.93; p = 0.043) and metabolic syndrome (OR: 2.85; p < 0.001). CONCLUSIONS: More than one third of hypertensive adults have metabolic syndrome and three quarters have abdominal obesity. Metabolic syndrome is not only a modifying factor of CVR, but it should also be considered in the control of BP in hypertensive adults along with therapeutic compliance, comorbidity and physical activity

New Intravenous Calcimimetic Agents: New Options, New Problems. An Example on How Clinical, Economical and Ethical Considerations Affect Choice of Treatment.

BACKGROUND: Dialysis treatment is improving, but several long-term problems remain unsolved, including metabolic bone disease linked to chronic kidney disease (CKD-MBD). The availability of new, efficacious but expensive drugs (intravenous calcimimetic agents) poses ethical problems, especially in the setting of budget limitations. METHODS: Reasons of choice, side effects, biochemical trends were discussed in a cohort of 15 patients (13% of the dialysis population) who stared treatment with intravenous calcimimetics in a single center. All patients had previously been treated with oral calcimimetic agents; dialysis efficacy was at target in 14/15; hemodiafiltration was employed in 10/15. Median Charlson Comorbidity Index was 8. The indications were discussed according to the principlist ethics (beneficience, non maleficience, justice and autonomy). Biochemical results were analyzed to support the clinical-ethical choices. RESULTS: In the context of a strict clinical and biochemical surveillance, the lack of side effects ensured "non-maleficence"; efficacy was at least similar to oral calcimimetic agents, but tolerance was better. Autonomy was respected through a shared decision-making model; all patients appreciated the reduction of the drug burden, and most acknowledged better control of their biochemical data. The ethical conflict resides in the balance between the clinical "beneficience, non-maleficience" advantage and "justice" (economic impact of treatment, potentially in attrition with other resources, since the drug is expensive and included in the dialysis bundle). The dilemma is more relevant when a patient's life expectancy is short (economic impact without clear clinical advantages), or when non-compliance is an issue (unclear advantage if the whole treatment is not correctly taken). CONCLUSIONS: In a context of person-centered medicine, autonomy, beneficence and non-maleficence should weight more than economic justice. While ethical discussions are not aimed at finding "the right answer" but asking "the right questions", this example can raise awareness of the importance of including an ethical analysis in the choice of "economically relevant" drugs.

Hamartoma of the Vallecula in a Five-Month-Old Infant- A Case Report.

INTRODUCTION: Hamartomas is a neoplasms composed of mature tissue elements from the affected site with disproportion between their components. Although lingual hamartomas are traditionally infrequent in the head and neck, a significant number of case reports with this disorder in infancy are arising from the literature. CASE REPORT: We present a remarkable case of a vallecular hamartoma in a 5-month-old infant. Moreover, the value of histopathological diagnosis was highlighted regarding the differentiation between hamartomas and other benign/reactive lesions. CONCLUSION: Surgical excision is regarded as the treatment of choice for vallecular hamartomas; in addition, no recurrence has been reported after complete resection.

Chemically Assisted Dissection With Sodium 2-Mercaptoethanesulfonate (MESNA) in the Surgical Management of Pediatric Cholesteatoma.

OBJECTIVE: To evaluate the effectiveness of the chemically assisted dissection with sodium 2-mercaptoethanesulfonate (MESNA), in the reduction of residual and recurrent cholesteatoma after mastoidectomy in children with chronic cholesteatomatous otitis media (CCOM). STUDY DESIGN: Retrospective case-control study. SETTING: Tertiary referral center. POPULATION: One hundred forty mastoidectomies performed in patients under 18 years of age for the treatment of CCOM. INTERVENTIONS: Chemically assisted dissection (CAD) with MESNA compared with surgical dissection without MESNA. MAIN OUTCOME MEASURES: Recidivism of cholesteatoma (recurrence and residual disease), variations in the average of bone conduction threshold after treatment, and complications. RESULTS: Recidivism of cholesteatoma was significantly lower when CAD with MESNA was used (p < 0.0001). No difference was found in the mean variation of the average of bone conduction thresholds between the groups, confirming its safety profile regarding auditory function. Meatoplasty stenosis after surgery was more prevalent within CAD with MESNA group (p: 0.049). CONCLUSION: Recurrent and residual cholesteatoma remains a problem, especially in children and despite surgical techniques such as canal wall down mastoidectomy and endoscopic ear surgery. CAD with MESNA can be safe and effective to reduce recurrence rates. Multicenter and prospective studies with larger number of patients are needed to validate these findings. The higher rate of meatoplasty stenosis after CAD with MESNA merits additional clinical research to confirm these findings, as well as in vitro studies evaluating the effect of the drug on the activity of fibroblasts and other growth factors that may be involved.

Clinical and sociodemographic characteristics associated with disease severity in juvenile recurrent respiratory papillomatosis: A study of 104 patients in a tertiary care pediatric hospital.

BACKGROUND: Juvenile recurrent respiratory papillomatosis (JRRP) is generally aggressive and with a high recurrence rate. Currently, there is no definite curative treatment for JRRP. Therefore, a greater understanding of the aspects that influence the severity and prognosis of the disease is required. OBJECTIVE: The aim of this study was to establish the clinical and socioeconomic characteristics of pediatric patients with JRRP and its relationship with the severity of the disease in a tertiary care pediatric hospital. RESULTS: A strong relationship was observed between the severity of the disease and the age at the time of diagnosis, and having a tracheostomy. A moderate association was found between the severity of the disease and the age at the time of the study, the area of origin and the recurrence rate. None of the socioeconomic statuses had a correlation with the severity of the JRRP. CONCLUSIONS: JRRP is associated with multiple surgeries due to the recurrence and aggressiveness of the disease. The socioeconomic status does not seem to influence the severity of the disease, whereas younger patients and users of tracheostomy should receive a more strict follow-up given the increased risk of severe disease.

Nuss Procedure for a Patient with Negative Haller Index.

Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed. All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.

Surgical Emergencies in Intestinal Venous Malformations.

BACKGROUND: Venous malformations (VMs) can occur in any part of the body; however, the gastrointestinal tract is a frequent location. These are usually asymptomatic, thus, representing a challenge to diagnosis. Intestinal location of VMs can be associated with severe complications that ultimately require an emergency surgery. Our aim was to analyze all patients with an intestinal VM with special focus on those who required emergency surgery. MATERIALS AND METHODS: A retrospective study of patients presenting complication caused by intestinal VM was performed. Clinical records, associated anomalies, physical findings, and treatment were assessed. RESULTS: Twenty-one patients had a diagnosis of intestinal VM, 16 (76%) were associated to blue rubber bleb nevus syndrome (BRBNS) and 5 (24%) were isolated. Only four (19%) of the total cases presented an episode of acute abdomen with hemodynamic instability that required an emergency surgery. Findings included two gastrointestinal bleedings, one volvulus, and one intussusception of small bowel. All patients underwent an uneventful recovery and are presently doing well. CONCLUSION: Intestinal VM can be challenging to diagnose in emergency situations, such as gastrointestinal situation or acute abdomen. The complications associated with it must be kept in mind, regardless of its low incidence.

Advantages of Cardiac Magnetic Resonance Imaging for Severe Pectus Excavatum Assessment in Children.

AIM: Cardiac function can be impaired in patients with pectus excavatum (PE) due to anatomic and dynamic compression of the heart. Efforts for radiation dose reduction in imaging techniques have allowed cardiac magnetic resonance imaging (c-MRI) to play a major role in PE assessment. The aim of our study is to describe the findings of c-MRI 18 months after we changed the PE assessment protocol from chest computed tomography to c-MRI. PATIENTS AND METHODS: Since mid-2015 all patients with severe PE (suspected Haller's index > 3.2) were assessed with inspiratory and expiratory c-MRI. A retrospective analysis of these patients was performed evaluating the following parameters: (1) Radiologic PE indexes (Haller's, correction and asymmetry indexes; and sternal rotation) and (2) cardiac function (including left and right ventricle ejection fraction). RESULTS: A total of 20 patients met the inclusion criteria. Dynamic imaging showed a significant difference during inspiration and expiration of the Haller's index 3.85 (range: 3.17-7.3) versus 5.10 (range: 3.85-10.8) (p < 0.05), and correction index (26.86% vs. 36.84%, respectively, p < 0.05). The sternal rotation was 14.5 (range: 0-36). c-MRI analysis disclosed a right ventricle ejection fraction of 50.3%. (normal range: 61% [54-71%]). Echocardiographic imaging underestimated the functional repercussion of PE in all patients. CONCLUSION: Initial results show that PE assessment by c-MRI allows a radiation-free image of the chest wall deformity during the entire breathing process. Also, it permitted the evaluation of the influence of sternum impingement on cardiac function. These findings allowed us a careful surgical evaluation and preoperative planning.