[Acute coronary syndrome provoked by a coronary intramural hematoma]. / Hematoma intramural coronario como causa de síndrome coronario agudo.

Background: Intramural coronary hematoma (ICH) is an unusual cause of acute coronary syndrome, and it represents a diagnostic challenge, especially in young patients in which it is not considered among the differential causes of acute myocardial ischemia. Clinical case: 40-year-old female, with type 2 diabetes and no other cardiovascular risk factors, who assisted to the Emergency Room with chest pain. In her first evaluation, electrocardiographic abnormalities, and troponin I elevation were found. A cardiac catheterization was performed, in which a proximal obstruction of the left anterior descending artery was observed, and then an optical coherence tomography (OCT) confirmed the presence of an ICH without a dissection flap. A stent was implanted in the obstruction area, with adequate angiographic outcome. The patient had a satisfactory evolution and was discharged to home without evidence of systolic dysfunction and is free of cardiovascular symptoms at 6-month follow-up. Conclusions: ICH must be considered within the differential diagnosis of acute myocardial ischemia in young patients, especially females. Intravascular image diagnosis is essential for the adequate diagnosis and treatment. Treatment must be individualized considering the extent of ischemia.

Introducción: el hematoma intramural coronario (HIC) es una causa poco frecuente de síndrome isquémico coronario agudo y representa un reto diagnóstico, en especial en pacientes jóvenes en los que puede llegar a no ser contemplado dentro de las causas de isquemia cardiaca no ateroesclerótica. Caso clínico: mujer de 40 años, con diabetes tipo 2 y sin otro factor de riesgo cardiovascular, quien acudió al Servicio de Urgencias manifestando dolor torácico. En su evaluación inicial se encontraron alteraciones en el electrocardiograma y elevación de troponina I. Se decidió la realización de coronariografía donde se observó lesión severa de la arteria descendente anterior. El estudio fue complementado con una tomografía de coherencia óptica intracoronaria, la cual confirmó la presencia de HIC sin disección, por lo que se decidió implantar un stent en el segmento arterial afectado con resultado angiográfico exitoso. La convalecencia posterior evolucionó sin complicaciones, lo que posibilitó su egreso a domicilio sin disfunción sistólica en el ecocardiograma y con seguimiento sin eventualidades a los 6 meses. Conclusiones: el HIC es una entidad que debe ser considerada como una causa posible de isquemia miocárdica aguda en pacientes jóvenes y que requiere de la complementación diagnóstica con estudios de imagen intravascular. Su tratamiento debe ser individualizado en el contexto de la extensión de la isquemia.

Variants Identified in the HOXC13 and HOXD13 Genes Suggest Association with Cervical Cancer in a Cohort of Mexican Women.

HOX genes have been associated with carcinogenesis. However, the molecular mechanism by which tumors are generated remains unclear. The HOXC13 and HOXD13 genes are of interest for their involvement in the development of genitourinary structures. The aim of this first study in the Mexican population was to search for and analyze variants in the coding region of the HOXC13 and HOXD13 genes in women with cervical cancer. Samples from Mexican women with cervical cancer and healthy women were sequenced (50/50). Allelic and genotypic frequencies were compared between groups. The functional impact of the proteins was determined with two bioinformatics servers (SIFT and PolyPhen-2), and the oncogenic potential of the identified nonsynonymous variants was determined using the CGI server. We identified five unreported gene variants: c.895C>A p.(Leu299Ile) and c.777C>T p.(Arg259Arg) in the HOXC13 gene and c.128T>A p.(Phe43Tyr), c.204G>A p.(Ala68Ala), and c.267G>A p.(Ser89Ser) in the HOXD13 gene. In this study, we suggest that the non-synonymous variants c.895C>A p.(Leu299Ile) and c.128T>A p.(Phe43Tyr) could represent a risk factor for the development of the disease, although additional studies in larger patient populations and in different ethnic groups are needed in order to support the results observed.

Radiofrecuencia de los nervios geniculados para el tratamiento del dolor crónico en la osteoartrosis de rodilla / Genicular nerve radiofrequency in osteoarthritis-related chronic knee pain

Introducción: El uso de radiofrecuencia de los nervios geniculados para el tratamiento del dolor crónico de la rodilla secundario a osteoartrosis inició en 2011, y desde entonces se han realizado varios estudios con diferentes metodologías. Sin embargo, continúan generándose muchas dudas con respecto a las dianas anatómicas, los criterios de selección y la evidencia de su efectividad. Materiales y métodos: Se realizó una búsqueda electrónica desde enero de 2011 hasta abril de 2020 en las siguientes bases de datos: PubMed®, Embase ®, Google Académico y Web of Science (WoS). La búsqueda inicial encontró 106 artículos, de los cuales tomamos 33 para realizar la presente revisión. Resultados: Después de analizar cinco ensayos clínicos abiertos, un estudio de corte transversal, cuatro estudios prospectivos observacionales, ocho estudios de neuroanatomía, tres estudios retrospectivos, cuatro casos clínicos, dos series de casos, tres revisiones de la literatura y tres ensayos clínicos aleatorizados, controlados y doble ciegos; encontramos que la radiofrecuencia de los nervios geniculados disminuye el dolor asociado a la osteoartrosis de rodilla, consiguiendo una mejoría funcional con una duración variable del efecto analgésico entre tres y doce meses. A pesar del avance científico en esta área, aún no hay un consenso en cuanto a la neuroanatomía de la cápsula articular de la rodilla, la ubicación de las dianas, los parámetros empleados en radiofrecuencia y la utilidad de los bloqueos diagnósticos. Conclusiones: Se necesitan más ensayos clínicos que estandaricen los parámetros utilizados y confirmen los resultados positivos de los estudios realizados con radiofrecuencia de los nervios geniculados...(AU)

Introduction: The use of genicular nerve radiofrequency procedures to treat chronic knee pain due to osteoarthritis has surged in 2011, though many questions remain regarding anatomical targets, selection criteria, and evidence for effectiveness. Materials and methods: An electronic search was performed from January 2011 to April 2020. Databases searched included PubMed®, Embase®, Google Scholar and Web of Science (WoS). The initial search found 106 articles. Thirty-three articles were taken for this review. Results: After analyzing five open clinical trials, one cross-sectional study, four prospective observational studies, eight neuroanatomy studies, three retrospective studies, four clinical cases, two case series, three literature reviews and three randomized, double blind, controlled trials; we found genicular nerve radiofrequency achieves a pain reduction and functional improvement with a variable duration, between three and twelve months. There is no consensus regarding the neuroanatomy of the knee joint capsule, the location of the targets, the radiofrequency parameters used and the usefulness of diagnostic blocks. Conclusion: More clinical trials are needed to standardize the parameters used and confirm the positive results of genicular nerve radiofrequency. Although lonthere are few cases of adverse events associated with radiofrequency of the geniculate nerves, more studies are needed to support the safety of this technique and its long-term side effects in osteoarthritis knee pain management associated that do not respond to other previous medical treatments.(AU)

Promoting Mental Health in Italian Middle and High School: A Pilot Study.

AIM: In Italy, a handbook has been developed based on the principles of cooperative learning, life skills, self-effectiveness, and problem-solving at high school level. Early studies have shown the handbook's effectiveness. It has been hypothesized that the revised handbook could be more effective in middle schools. METHOD: The study design is a "pre- and posttest" that compares the results obtained from 91 students of the high schools with those of the 38 students from middle schools. The assessment was made through "self-reporting" questionnaires of (a) learning skills including problem-solving and (b) perceived self-efficacy in managing emotions, dysfunctional beliefs, and unhealthy behaviours (i.e., drinking/smoking). RESULTS: Significant improvements were observed in both groups with the exceptions of perceived self-efficacy in managing emotions. The improvement of dysfunctional beliefs and the learning of problem-solving skills were better in middle schools. CONCLUSION: The results confirm the authors' hypothesis that the use of this approach is much more promising in middle school.

[Emotional Intelligence Index: a tool for the routine assessment of mental health promotion programs in schools]. / Indice di Intelligenza Emotiva: uno strumento per la valutazione di routine dei programmi di promozione della salute mentale nelle scuole.

AIM: After critical examination of several aspects relating to the evaluation of some dimensions of emotional intelligence through self-assessment tools, is described the procedure of construction and validation of an Index for its measurement, conceived only for the routine assessment of health promotion programs mental in schools that include among their objectives the improvement of emotional intelligence specifically "outcome-oriented". METHODS: On the basis of the two most common international tools, are listed 27 items plus 6 of control, illustrated two Focus Group (FG) of students (face validity). The scale obtained by FG was administered to 300 students, and the results were submitted to factorial analysis (construct validity). It was also evaluated the internal consistency with Cronbach's Alpha and studied concurrent validity with the emotional quotient inventory, a scale of perceived self-efficacy and a stress test rating. RESULTS: From the analysis of FG all the original items were modified, deleted 4, and reduced the encoding system from 6 to 4 levels of Likert scale. Of the 23 items included in the analysis have emerged five factors (intra-psychic dimension, interpersonal, impulsivity, adaptive coping, sense of self-efficacy) for a total of 15 items. Very satisfactory were the results of the validation process of internal consistency (0.72) and the concurrent validity. CONCLUSIONS: The results are positive. It is obtained in fact the shortest routine assessment tool currently available in Italy which constitutes a real Index, for which compilation are required on average 3 minutes. Is emphasized the characteristic of an Index, and not of questionnaire or interview for clinical use, highlighting the only specific use for mental health promotion programs in schools.

[Evaluation of the impact of the new version of a handbook to promote psychological wellbeing and emotional intelligence in the schools (students aged 12-15)]. / Valutazione dell'impatto della nuova versione di un manuale per la promozione del benessere psicologico e dell'intelligenza emotiva nelle scuole con studenti di età 12-15 anni.

AIM: A recent study has demonstrated the effectiveness of a structured intervention based on a manual of mental health promotion for students of secondary schools developed by the Istituto Superiore di Sanità based on the "cooperative learning", the "life skills" and "self-efficacy"; unfortunately, the results were less significant than expected. The Authors made changes to the Handbook for Students simplifying the language to allow its use even in middle schools. The present study aims at evaluating the effectiveness of this new version of the manual that includes a notebook. METHODS: A pre-post study design was used with also experimental vs. control group comparison. Five classes were included in the experimental group and five in the control group belonging to 5 different institutes. The efficacy has been established through several self-filled questionnaires to assess improvement of skills (effective communication, goal-setting, problem solving), psychological well-being, perceived self-efficacy in the regulation of negative and positive emotions, irrational believes, and unhealthy lifestyles such as drinking and smoking. RESULTS: Significant improvements were observed in almost all dimensions evaluated with the exception of self-efficacy and irrational believes. Of particular importance were the improvements about skills (effective communication, goal-setting and problem solving), psychological well-being and in some behaviors "at risk" as the frequent involvement in fights and smoking habit. Overall, the improvement was greater than that observed in the first study by the same authors using the manual in the original version. CONCLUSIONS: The observed data confirm the effectiveness of this approach with better results if compared to previous studies because of the use of the new edition of the manual. One of the ingredient of success, in the opinion of the authors, was the use of this manual that includes a notebook that stimulates extracurricular exercises.

Promoting the psychological well-being of Italian youth: a pilot study of a high school mental health program.

School is potentially one of the most important and effective agencies for the promotion of mental health. For this reason, in Italy, the Mental Health Department of The National Health Institute has developed an intervention based on a structured handbook. The aim of this intervention is to promote the psychological well-being of the students. In this study, we have evaluated the efficacy of this intervention through a quasi-experimental study design of four classes (two were control) of secondary education, including 79 students aged 14 to 16 years (15.35 ± 0.68). Assessments were administered before and after the intervention. The results showed improvement in perceived self-efficacy (p ≤ .001), emotional coping (p = .003), and overall well-being (p < .05). The students' perception of usefulness was also increased (p < .05); the intervention successfully promoted the idea of life as a continuous process of learning, in change and growth (p < .05). The intervention was effective despite some limitations described by authors related to a lack of involvement of relatives and the team teachers, as well as the absence of homework; however, the adoption of a program promoting life skills, problem solving, and goal definition training is recommended with the use of a revised handbook.