An unusual adverse effect during crusted scabies treatment.

Crusted scabies is a severe form of scabies infestation caused by the ectoparasite Sarcoptes scabiei. Risk factors include immunosuppression, neuropathies, and psychiatric disorders. Its management poses important challenges due to its contagius nature. Here we present a case or Acute Generalized Exanthematous Pustulosis secondary to Ivermectin therapy in a patient with crusted scabies.

The usefulness of the genetic panel in the classification and refinement of diagnostic accuracy of Mexican patients with Marfan syndrome and other connective tissue disorders.

Marfan syndrome (MFS) is a multisystem genetic disorder with over 3000 mutations described in the fibrillin 1 (FBN1) gene. Like MFS, other connective tissue disorders also require a deeper understanding of the phenotype-genotype relationship due to the complexity of the clinical presentation, where diagnostic criteria often overlap. Our objective was to identify mutations in patients with connective tissue disorders using a genetic multipanel and to analyze the genotype-phenotype associations in a cohort of Mexican patients. We recruited 136 patients with MFS and related syndromes from the National Institute of Cardiology. Mutations were identified using next-generation sequencing (NGS). To examine the correlation between mutation severity and severe cardiovascular conditions, we focused on patients who had undergone Bentall-de Bono surgery or aortic valve repair. The genetic data obtained allowed us to reclassify the initial clinical diagnosis across various types of connective tissue disorders. The transforming growth factor beta receptor 2 (TGFBR2) rs79375991 mutation was found in 10 out of 16 (63%) Loeys-Dietz patients. We observed a high prevalence (65%) of more severe mutations, such as frameshift indels and stop codons, among patients requiring invasive treatments like aortic valve-sparing surgery, Bentall and de Bono procedures, or aortic valve replacement due to severe cardiovascular injury. Although our study did not achieve precise phenotype-genotype correlations, it underscores the importance of a multigenetic panel evaluation. This could pave the way for a more comprehensive diagnostic approach and inform medical and surgical treatment decision-making.

Eicosapentaenoic and Docosahexaenoic Acid Supplementation Increases HDL Content in n-3 Fatty Acids and Improves Endothelial Function in Hypertriglyceridemic Patients.

High-density lipoproteins (HDLs) are known to enhance vascular function through different mechanisms, including the delivery of functional lipids to endothelial cells. Therefore, we hypothesized that omega-3 (n-3) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content of HDLs would improve the beneficial vascular effects of these lipoproteins. To explore this hypothesis, we performed a placebo-controlled crossover clinical trial in 18 hypertriglyceridemic patients without clinical symptoms of coronary heart disease who received highly purified EPA 460 mg and DHA 380 mg, twice a day for 5 weeks or placebo. After 5 weeks of treatment, patients followed a 4-week washout period before crossover. HDLs were isolated using sequential ultracentrifugation for characterization and determination of fatty acid content. Our results showed that n-3 supplementation induced a significant decrease in body mass index, waist circumference as well as triglycerides and HDL-triglyceride plasma concentrations, whilst HDL-cholesterol and HDL-phospholipids significantly increased. On the other hand, HDL, EPA, and DHA content increased by 131% and 62%, respectively, whereas 3 omega-6 fatty acids significantly decreased in HDL structures. In addition, the EPA-to-arachidonic acid (AA) ratio increased more than twice within HDLs suggesting an improvement in their anti-inflammatory properties. All HDL-fatty acid modifications did not affect the size distribution or the stability of these lipoproteins and were concomitant with a significant increase in endothelial function assessed using a flow-mediated dilatation test (FMD) after n-3 supplementation. However, endothelial function was not improved in vitro using a model of rat aortic rings co-incubated with HDLs before or after treatment with n-3. These results suggest a beneficial effect of n-3 on endothelial function through a mechanism independent of HDL composition. In conclusion, we demonstrated that EPA and DHA supplementation for 5 weeks improved vascular function in hypertriglyceridemic patients, and induced enrichment of HDLs with EPA and DHA to the detriment of some n-6 fatty acids. The significant increase in the EPA-to-AA ratio in HDLs is indicative of a more anti-inflammatory profile of these lipoproteins.

Prescriber Adoption of SLCO1B1 Genotype-Guided Simvastatin Clinical Decision Support in a Clinical Pharmacogenetics Program.

Pharmacogenetic implementation programs are increasingly feasible due to the availability of clinical guidelines for implementation research. The utilization of these resources has been reported with selected drug-gene pairs; however, little is known about how prescribers respond to pharmacogenetic recommendations for statin therapy. We prospectively assessed prescriber interaction with point-of-care clinical decision support (CDS) to guide simvastatin therapy for a diverse cohort of primary care patients enrolled in a clinical pharmacogenetics program. Of the 1,639 preemptively genotyped patients, 298 (18.2%) had an intermediate function (IF) OATP1B1 phenotype and 25 (1.53%) had a poor function (PF) phenotype, predicted by a common single nucleotide variant in the SLCO1B1 gene (c.521T>C; rs4149056). Clinicians were presented with CDS when simvastatin was prescribed for patients with IF or PF through the electronic health record. Importantly, 64.2% of the CDS deployed at the point-of-care was accepted by the prescribers and resulted in prescription changes. Statin intensity was found to significantly influence prescriber adoption of the pharmacogenetic-guided CDS, whereas patient gender or race, prescriber type, or pharmacogenetic training status did not significantly influence adoption. This study demonstrates that primary care providers readily adopt pharmacogenetic information to guide statin therapy for the majority of patients with preemptive genotype data.

Determinantes socioeconómicos del exceso de peso en niños preescolares y escolares colombianos. Encuesta Nacional de Situación Nutricional 2015 / Socioeconomic determinants of excess weight in Colombian preschool and school children. National Survey of Nutritional Situation 2015

Introducción: El exceso de peso infantil es un problema de salud pública, muestra una tendencia creciente, lo que repercutirá en el estado de salud y calidad de vida de los futuros adultos; se hace necesario mejorar la comprensión de los determinantes socioeconómicos de este fenómeno. Objetivo: Analizar los principales determinantes socioeconómicos intermedios y estructurales que influyen en el exceso de peso en niños en edad preescolar (3-5 años) y escolar (6-12 años) en Colombia. Materiales y métodos: Diseño descriptivo correlacional transversal con datos de la Encuesta Nacional de Situación Nutricional 2015 (ENSIN). Se realizaron modelos logísticos para explicar el exceso de peso (variable dependiente) en preescolares (puntaje Z del peso para la talla >+2DE) y escolares (IMC para la edad >+1DE). Resultados: Los niños preescolares que no consumen onces o media tarde tienen 60% menos riesgo de exceso de peso en comparación con los que si consumen. Los niños escolares tienen mayor riesgo de exceso de peso, a mayor índice de riqueza de la familia (2,09 veces), al pasar mucho tiempo frente a una pantalla (1,4 veces), al no realizar actividad física, y al estar en una familia con 2 hasta 5 integrantes. Conclusiones: Existen diferentes determinantes intermedios y estructurales para la población preescolar y escolar colombiana que influyen en el exceso de peso. Se recomienda profundizar en las políticas públicas de salud para educar y prevenir sobre alteraciones nutricionales y complicaciones a largo plazo que vayan en detrimento de la calidad de vida de los ciudadanos(AU)

Introduction: Childhood excess weight is a public health problem, it shows a growing trend, which will affect the health status and quality of life of future adults; It is necessary to improve the understanding of the socioeconomic determinants in this phenomenon. Objective: To analyze the main intermediate and structural socioeconomic determinants that influence excess weight in children of preschool age (3-5 years) and school age (6-12 years) in Colombia. Materials and methods: Cross-sectional correlational descriptive design with data from the 2015 National Nutritional Situation Survey (ENSIN). Logistic models were performed to explain excess weight (dependent variable) in preschool children (weightfor- height Z-score >+2SD) and schoolchildren (BMI-forage >+1SD). Results: Preschool children who do not consume elevenses or mid-afternoon have 60% less risk of excess weight compared to those who do consume. Schoolchildren have a higher risk of being overweight, the higher the family wealth index (2.09 times), the more time they spend in front of a screen (1.4 times), the less they do physical activity, and the more they are in a family with 2 to 5 members. Conclusions: There are different intermediate and structural determinants for the Colombian preschool and school population that influence excess weight. It is recommended to delve into public health policies to educate and prevent nutritional alterations and long-term complications that are detrimental to the quality of life of citizens.(AU)

Giant Squid (Dosidicus gigas) Meal in Chicken Diets to Enrich Meat with n-3 Fatty Acids.

The main marketed parts of squid are the mantle, the head with tentacles, and fins. However, when the whole squid does not meet quality standards for human consumption it can be used for broiler feed. The objective of the study was to include giant squid (Dosidicus gigas) meal (GSM) in broiler rations to increase the content of the n-3 fatty acids eicosapentaenoic (EPA), docosapentaenoic (DPA), and docosahexaenoic (DHA) in chicken meat. Two hundred Ross 380 chickens, half male, half female, and one day old, were randomly distributed in a 4x2x2 factorial arrangement. The factors were the treatment (0%, 1.67%, 3.34%, and 5.01% of GSM in the diet), sex, and content of n-3 in the legs with thighs and the breasts. Each treatment had five repetitions with 10 birds each. There were no differences (p > 0.05) in the production parameters for both sexes. The contents of EPA, DPA, and DHA increased in the females and in the legs with thighs (p < 0.05) with GSM. Acceptance for the flavor and texture of meat was higher in the treatment with 1.67% GSM than in the other treatments. It is concluded that GSM is an alternative for increasing the amount of n-3 in chicken meat.

Mucocutaneous manifestations and their relationship with CD4 T-lymphocyte count in hospitalized patients infected with the human immunodeficiency virus (HIV) in Medellín, Colombia / Manifestaciones mucocutáneas y su relación con el recuento de linfocitos T CD4 en pacientes infectados con el virus de inmunodeficiencia humana hospitalizados en Medellín, Colombia

Introduction: About 80-95% of patients infected with the human immunodeficiency virus (HIV) develop skin manifestations, which are markers of the patients' immune status. Objective: To describe the dermatologic manifestations and the clinical and sociodemographic factors of hospitalized patients diagnosed with HIV and their correlation with CD4 T-lymphocyte count. Materials and methods: We conducted an observational, cross-sectional, and retrospective study of the medical records of 227 adult patients with HIV diagnosis evaluated by dermatology in a hospital in Medellín, Colombia. Results: We included 227 patient records with 433 dermatologic manifestations, 64.4% of them infectious. The most frequent manifestations were oral candidiasis, condylomata acuminata, and drug reactions. Moreover, a statistically significant relationship was found between disseminated herpes zoster virus and secondary syphilis with a CD4 count between 200-499 cells/mm3 (p=0.04 and 0.028, respectively). There was also a statistically significant relationship between oral candidiasis and a CD4 count of less than 100 cells/mm3 (p=0.008). Conclusions: The relationship between disseminated herpes zoster with CD4 between 200-499 cells/mm3 suggests that, despite having high CD4 counts, severe forms of the disease may occur due to possible T-cell dysfunction and depletion of the immune system. Additionally, the relationship between oral candidiasis and CD4 less than 100 cells/mm3 indicates the potential role of oral candidiasis as an essential marker of weakened immune status in HIV patients.

Introducción. Entre el 80 y el 95 % de los pacientes infectados por el virus de inmunodeficiencia humana (HIV) desarrollan manifestaciones en la piel que sirven como marcadores de su estado inmunológico. Objetivos. Describir las manifestaciones dermatológicas y los factores clínicos y sociodemográficos de los pacientes hospitalizados con diagnóstico de HIV y su correlación con el recuento de linfocitos T CD4. Materiales y métodos. Se hizo un estudio observacional de corte transversal y retrospectivo a partir del registro de las historias clínicas de 227 pacientes mayores de edad con diagnóstico de HIV, evaluados por dermatología en un hospital de Medellín, Colombia. Resultados. Los 227 registros daban cuenta de 433 manifestaciones dermatológicas, el 64,4 % de ellas infecciosas. Las tres manifestaciones más frecuentes fueron candidiasis oral, condilomas acuminados y reacciones a medicamentos. Se encontró una relación estadísticamente significativa entre el virus del herpes zóster (HZ) diseminado y la sífilis secundaria, con un recuento de CD4 entre 200 y 499 células/mm3 (p=0,04 y 0,028, respectivamente), y entre la candidiasis oral y un recuento de CD4 menor de 100 células/mm3 (p=0,008). Conclusiones. La relación entre el herpes zóster diseminado y un recuento de CD4 entre 200 y 499 células/mm3 sugiere que, a pesar de los recuentos altos, se pueden presentar formas graves de la enfermedad debido a una posible disfunción de las células T y el agotamiento del sistema inmunológico. La relación entre la candidiasis oral y un recuento de CD4 menor de 100 células/mm3 plantea la posibilidad de considerar esta infección micótica como un marcador importante de debilitamiento inmunológico de los pacientes con HIV.

Manifestaciones mucocutáneas y su relación con el recuento de linfocitos T CD4 en pacientes infectados con el virus de inmunodeficiencia humana hospitalizados en Medellín, Colombia / Mucocutaneous manifestations and their relationship with CD4 T-lymphocyte count in hospitalized patients infected with the human immunodeficiency virus (HIV) in Medellín, Colombia

Introducción. Entre el 80 y el 95 % de los pacientes infectados por el virus de inmunodeficiencia humana (HIV) desarrollan manifestaciones en la piel que sirven como marcadores de su estado inmunológico. Objetivos. Describir las manifestaciones dermatológicas y los factores clínicos y sociodemográficos de los pacientes hospitalizados con diagnóstico de HIV y su correlación con el recuento de linfocitos T CD4. Materiales y métodos. Se hizo un estudio observacional de corte transversal y retrospectivo a partir del registro de las historias clínicas de 227 pacientes mayores de edad con diagnóstico de HIV, evaluados por dermatología en un hospital de Medellín, Colombia. Resultados. Los 227 registros daban cuenta de 433 manifestaciones dermatológicas, el 64,4 % de ellas infecciosas. Las tres manifestaciones más frecuentes fueron candidiasis oral, condilomas acuminados y reacciones a medicamentos. Se encontró una relación estadísticamente significativa entre el virus del herpes zóster (HZ) diseminado y la sífilis secundaria, con un recuento de CD4 entre 200 y 499 células/mm3 (p=0,04 y 0,028, respectivamente), y entre la candidiasis oral y un recuento de CD4 menor de 100 células/ mm3 (p=0,008). Conclusiones. La relación entre el herpes zóster diseminado y un recuento de CD4 entre 200 y 499 células/mm3 sugiere que, a pesar de los recuentos altos, se pueden presentar formas graves de la enfermedad debido a una posible disfunción de las células T y el agotamiento del sistema inmunológico. La relación entre la candidiasis oral y un recuento de CD4 menor de 100 células/mm3 plantea la posibilidad de considerar esta infección micótica como un marcador importante de debilitamiento inmunológico de los pacientes con HIV.

Introduction. About 80-95% of patients infected with the human immunodeficiency virus (HIV) develop skin manifestations, which are markers of the patients' immune status. Objective. To describe the dermatologic manifestations and the clinical and sociodemographic factors of hospitalized patients diagnosed with HIV and their correlation with CD4 T-lymphocyte count. Materials and methods. We conducted an observational, cross-sectional, and retrospective study of the medical records of 227 adult patients with HIV diagnosis evaluated by dermatology in a hospital in Medellín, Colombia. Results. We included 227 patient records with 433 dermatologic manifestations, 64.4% of them infectious. The most frequent manifestations were oral candidiasis, condylomata acuminata, and drug reactions. Moreover, a statistically significant relationship was found between disseminated herpes zoster virus and secondary syphilis with a CD4 count between 200-499 cells/mm3 (p=0.04 and 0.028, respectively). There was also a statistically significant relationship between oral candidiasis and a CD4 count of less than 100 cells/ mm3 (p=0.008). Conclusions. The relationship between disseminated herpes zoster with CD4 between 200-499 cells/mm3 suggests that, despite having high CD4 counts, severe forms of the disease may occur due to possible T-cell dysfunction and depletion of the immune system. Additionally, the relationship between oral candidiasis and CD4 less than 100 cells/mm3 indicates the potential role of oral candidiasis as an essential marker of weakened immune status in HIV patients.

NOTCH expression variability and relapse of breast cancer in high-risk groups.

BACKGROUND: In regards to breast cancer (BC), survival or disease-free periods are still compromised mainly in Triple Negative (TN) and HER2 tumors. The participation of estrogen receptor (ER) has been reported as crucial in the signaling pathways, including the NOTCH pathway. The study was aimed to evaluate the expression of NOTCH1 and NOTCH3 in BC and its relationship with the presence of ER, as well as with relapses. METHODS: NOTCH1 and NOTCH3 expression was evaluated in BC using Oncomine database, Breast Cancer Gene Expression Miner database and Kaplan Meier Plotter. Subsequently, detection of NOTCH1 and NOTCH3 in 100 paraffin-embedded BC samples from Mexican patients was achieved by immunohistochemistry (IHC) and RT-qPCR, a group of benign breast tumors were included as controls. Relapses were evaluated by BC subtypes and their relationship with NOTCH1 and NOTCH3 expression, as well as with ER expression. RESULTS: The analyses from public databases of TN and HER2 groups, which are estrogen receptor-negative (ERN), revealed NOTCH1 and NOTCH3 expression variability. The overexpression was associated with lower relapse-free survival (P = 0.00019). These data were concordant with results from tumor samples of patients included in this study, which showed overexpression of NOTCH1 and NOTCH3 in ERN tumors, as well as lower relapse-free survival (P < 0.0001). CONCLUSIONS: NOTCH1 and NOTCH3 were found to be overexpressed mainly in ERN tumors. HER2 and TN groups, are related to higher relapse rates. Therefore, anti-NOTCH therapy could be justified and implemented in conventional treatments of high-risk BC groups.

Changes in brain activity of trainees during laparoscopic surgical virtual training assessed with electroencephalography.

OBJECTIVE: Evaluate changes in brain activity of trainees during laparoscopic surgical training from electroencephalographic (EEG) signals in an ecological scenario with few restrictions for the user. DESIGN: Longitudinal study with two follow-up measurements in the first and last session of a 4-week training with LapSim laparoscopic surgery simulator. Variables analyzed include EEG neuronal activations in theta and alpha bands, tasks performance measures, and subjective measures such as perception of mental workload. SETTING: Medical School, Universidad de Antioquia, Medellin, Colombia. PARTICIPANTS: First-year surgical residents (n = 16, age = 28.0 ± 2.6 years old, right-handed, 9 females) RESULTS: Significant improvements in tasks performance were found together with changes in neuronal activity over frontal and parietal cortex. These changes were also correlated with task performance through training sessions. CONCLUSIONS: The use of neurophysiological measures such as electroencephalography combined with source separation techniques allows evaluating neural changes associated with motor training. The experiment proposed in this work establishes less controlled recording conditions leading to a more realistic analysis scenario to cognitive assessment in residents training.

Adrenal Medullary Hyperplasia: An Under the Radar Cause of Endocrine Hypertension.

Adrenal medullary hyperplasia is a cause of increased secretion of catecholamines by the adrenal gland that is rarely considered among the differential diagnoses of endocrine hypertension. We report the case of a 48-year-old Hispanic woman who presented for evaluation of resistant hypertension with several episodes of hypertensive crisis. The clinical presentation, biochemical results, and abdominal computed tomography scan suggested the possibility of a pheochromocytoma; however, an iodine-123-meta-iodobenzylguanidine (123I-MIBG) uptake study combined with single-photon emission computed tomography (SPECT) and computed tomography (CT) scan showed diffusely increased metabolic activity in both adrenal glands. The patient underwent left adrenalectomy, and the pathology study revealed the presence of adrenal medullary hyperplasia. After surgery, blood pressure control was achieved with one antihypertensive drug, and the patient did not have recurrent hypertensive crisis. Relevant findings obtained from a whole genomic sequence done on a whole blood DNA sample from the patient are discussed.

Flavonoid/Polyphenol Ratio in Mauritia flexuosa and Theobroma grandiflorum as an Indicator of Effective Antioxidant Action.

Studies on polyphenols and flavonoids in natural products reveal benefits in the prevention of multiple diseases. Proper extraction, treatment of extracts, and quantification of polyphenols and flavonoids demand attention from the scientific community in order to report more specific biological action. Total polyphenol content (TPC) and total flavonoid content (TFC) (measured at three different times) of ethanol, methanol and acetone extracts of Mauritia flexuosa (aguaje) and Theobroma grandiflorum (copoazú) fresh pulp, from the Colombian Amazon region, were evaluated with the purpose of focusing in the polyphenol/flavonoid proportion and its effective antioxidant activity. This objective could help to explain specific flavonoid biological action based on higher flavonoid proportion rather than higher total polyphenol content. Differences in extracting solvents resulted in statistically significant different yields; the highest TPC was observed with acetone 70% in Mauritia flexuosa and ethanol 80% for T. grandiflorum. The best flavonoid/polyphenol ratio in M. flexuosa was about 1:2.4 and 1:12.8 in T. grandiflorum and the antioxidant efficacy was proportionally higher for flavonoids extracted from T. grandiflorum. HPLC analysis revealed 54 µg/g of the flavonoid kaempferol in M. Flexuosa and 29 µg/g in T. grandiflorum. Further studies evaluating this proportionality, in seeds or peel of fruits, as well as, other specific biological activities, could help to understand the detailed flavonoid action without focusing on the high total polyphenol content.

Validation of a Psychosocial Intervention on Body Image in Older People: An Experimental Design.

For most people, body satisfaction is crucial to develop both a positive self-concept and self-esteem, and therefore, it can influence mental health and well-being. This idea has been tested with younger people, but no studies explore whether body image interventions are useful when people age. This research validates a specific program designed for older people (IMAGINA Specific Body Image Program). This is done by employing a mixed experimental design, with between-subject and within-subject comparisons that focus on body satisfaction before and after experimental treatment, comparing two groups. Using this experimental methodology makes it possible to identify the effect of the intervention in a group of 176 people. The score obtained with the Body Shape Questionnaire (BSQ) was the dependent variable, and the IMAGINA program was the independent one. As for age, gender, relationship status, season, and residence environment, these were controlled variables. There were significant differences in body satisfaction between the two programs, obtaining better results with IMAGINA. The controlled variables had a much less significant effect than the treatment. Therefore, it is possible to improve body satisfaction in older adults through interventions similar to the one presented here.

A systematic review on nomophobia prevalence: Surfacing results and standard guidelines for future research.

BACKGROUND: Mobile phones allow us to stay connected with others and provide us a sense of security. We can work, chat with family and friends, take pictures, buy clothes or books, and even control home appliances. They play such a significant role in our lives that we feel anxious without them. In some cases, the relationship between humans and these communication devices have become problematic. Nomophobia (NMP) is the fear of becoming incommunicable, separated from the mobile phone and losing connection to the Internet. Since this social phobia was coined in the first decade of the XXI century, a growing number of studies have studied it and reported the prevalence of this technology-related problem. However, this research activity has generated mixed results regarding how we assess and report nomophobia and who may be at a higher risk of suffering or developing it. METHODS: We conducted a systematic review of 108 studies published in English and Spanish and collected them in Parsifal. We searched for assessment and prevalence data on nomophobia. Also, we looked at gender and age differences to identify risk factors and see if these differences exist and emerge worldwide. RESULTS: In this study, we find that women and younger individuals suffer more from nomophobia. The disparity in reporting the prevalence of nomophobia is enormous since the percentages of "at-risk" participants go from 13% to 79%, and participants suffering from it are between 6% and 73%, being the score in the range of 45.5 and 93.82. Within the group of nomophobic people, moderate cases vary between 25.7% and 73.3%, and severe cases, between 1% and 87%. Such disparity is due to differences in assessment criteria. Females and young people seem to be more vulnerable to nomophobia although methodological disparity makes it difficult to reach definitive conclusions. We conclude our review by recommending some common guidelines for guiding future research.

Satisfactory clinical outcomes using a novel arthroscopic technique for fixation of tibial spine avulsion fractures: technical note.

This research aims to present a novel arthroscopic fixation technique that uses a double-row suture anchor for tibial spine avulsion and to evaluate its short-term clinical outcomes. The surgical technique is described and a retrospective case series is presented. Patients who presented with tibial spine avulsion type III and IV fractures according to the Meyers and McKeever classification and received the same surgical treatment from 2013 to 2018 in two specialised hospitals in Medellín City were included. All interventions were performed by an experienced surgeon. To determine outcomes during clinical follow-up, the Lysholm score and objective and subjective International Knee Documentation Committee scores were obtained before and at least 12 months after surgery. A total of 24 patients were followed, with a mean age of 31 years; 12 patients were female. The median time between trauma and surgical fixation was 12 days (IQR=7-23), with a median follow-up period of 13.5 months (IQR=9.5-31.5). When comparing patients' state initially and during the postoperative period, statistically significant differences were found in all the scores analysed (p<0.05). Likewise, there were no complications and no reinterventions performed during follow-up, and all patients were satisfied with the outcomes of the procedure. Fixation of tibial spine avulsion fractures using the double-row suture anchor technique results in improvement in patients' function, pain and activity level. The main conclusion is that the procedure is an anatomical technique that requires minimal access and leads to satisfactory clinical evolution of patients. Level of evidence: Level V, case series.

A Novel Method for GreenLight MoXy Laser Fiber Irrigation System to Improve Performance and Durability: A New Standard of Care?

Introduction and Objectives: The GreenLight™ MoXy® laser fiber has been used since 2010 for benign prostatic hyperplasia procedures. We tested a novel principle to increase the saline irrigation flow rates beyond the current standard of gravity drip (∼22 cc/minutes) within the fiber-attached cooling system to potentially prevent excessive tissue adherence and to eliminate the likelihood of degradation due to abnormal overheating. The objective was to assess differences between the ordinary and active pumping methods with ≥2 times flow rate after conditioning of the laser fiber. Materials and Methods: A controllable full, tissue-contact system was utilized for conditioning in a porcine model, applying 180 W of vaporization mode of GreenLight XPS console for 30 continuous minutes. Four groups were evaluated using different saline flow rates; the nominal flow rate (control group, 22 mL/minute), digital pump set (35 mL and 50 mL/minute), and a manual pressure cuff with hand pump set using a 3-L saline bag with pressure of 300 mmHg (35-80 mL/minute). At the end of the conditioning process, a mechanical pull force test was executed on the fiber metal cap to evaluate the bonding strength. A failed event was defined as the natural detachment of the metal cap during the conditioning process or a cap pull force smaller than 22.24 N resulting in detachment. Additional physical parameters, including fiber tip temperature information and laser beam power transmission efficiency, were analyzed. Results: Detachment of the cap occurred less frequently when using the 300 mmHg pressure cuff saline bag compared to the nominal flow rate (6.67% vs 50%, respectively). The average operating fiber tip temperatures were lower in the higher flow rate groups compared to nominal, measured at 315°C and 305°C. compared to 442°C. Moreover, a significantly lower FiberLife Event count and an ∼5% increase of the average final laser transmission efficiency were observed in the higher flow rate groups. Conclusions: Our study demonstrates superior results when using active pumping or high-pressure systems to increase saline flow rates in terms of laser fiber durability without any additional cost. More specifically, use of a manual pressure cuff with starting pressure at 300 mmHg, a system that is readily available in most operating rooms, increases MoXy fiber durability. Further studies are required to assess if this technique will improve user experience, clinical outcomes, and procedure costs.

Nomophobia Questionnaire (NMP-Q): Factorial structure and cut-off points for the Spanish version. / Cuestionario de Nomofobia (NMP-Q): Estructura factorial y puntos de corte de la versión española.

Nomophobia is a situational phobia leading to a deep, irrational, and disproportionate fear of not being able to use the smartphone. An instrumental study on the Spanish version of the Nomophobia Questionnaire (NMP-Q) was carried out. The objectives were: 1) To analyse its factor structure and reliability; 2) to test for the invariance of sex and age groups, and 3) to obtain specific cut-off points by sex and age non-existent to date. Sampling was incidental and non-probabilistic with 5012 participants (57.9%, females) aged 12-24 years (M = 18.04, SD = 3.3). The confirmatory factor analysis revealed a hierarchical model with four correlated factors explained by a general second-order factor. The internal validity and reliability values of the NMP-Q dimensions are satisfactory, ranging between .78, .85, .86, and .92 (Omega w). A multigroup analysis confirmed the invariance across sex and age groups. Building on the NMP-Q scores, we calculated 3 cut-off points using percentiles 15th, 80th and 95th (unnomophobic, at risk of nomophobia, and nomophobic). Females aged 12-15 years had the highest nomophobic scores. We can conclude that the proposed sex and age cut-off points will allow us to better identify nomophobic problems from a clinical point of view.

La nomofobia es una fobia situacional en la que se experimenta un miedo intenso, irracional y desproporcionado a no poder usar el smartphone. Se realizó un estudio instrumental de la versión española del cuestionario de Nomofobia (NMP-Q) con los objetivos de: 1) analizar su estructura factorial y fiabilidad; 2) analizar su invarianza con relación al sexo y la edad, y 3) obtener puntos de cortes específicos para distintas edades y sexo. El muestreo fue incidental y no probabilístico. Hubo 5012 participantes (57.9%, mujeres) de 12-24 años (M = 18,04, SD = 3,3). El análisis factorial confirmatorio mostró un modelo jerárquico de 4 factores correlacionados y explicados por uno general de segundo orden. Los índices de fiabilidad de las dimensiones del NMP-Q fueron satisfactorios oscilando entre ,78, ,85, ,86 y ,92 (Omega w). Un análisis multigrupo confirmó la invarianza por sexo y edad. A partir de las puntuaciones del NMP-Q se calcularon 3 puntos de corte siguiendo los percentiles 15, 80 y 95 (sin nomofobia, riesgo de nomofobia, y nomofóbico). Las mujeres de 12-15 años tuvieron las puntuaciones más altas en nomofobia. Podemos concluir que el NMP-Q nos permite identificar problemas de nomofobia por sexo y edad desde un punto de vista clínico.

Cuestionario de Nomofobia (NMP-Q): Estructura factorial y puntos de corte de la versión española / Nomophobia Questionnaire (NMP-Q): Factorial structure and cut-off points for the Spanish version

La nomofobia es una fobia situacional en la que se experimenta un miedo intenso, irracional y desproporcionado a no poder usar el smartphone. Se realizó un estudio instrumental de la versión española del cuestionario de Nomofobia (NMP-Q) con los objetivos de: 1) analizar su estructura factorial y fiabilidad; 2) analizar su invarianza con relación al sexo y la edad, y 3) obtener puntos de cortes específicos para distintas edades y sexo. El muestreo fue incidental y no probabilístico. Hubo 5012 participantes (57.9%, mujeres) de 12-24 años (M = 18,04, SD = 3,3). El análisis factorial confirmatorio mostró un modelo jerárquico de 4 factores correlacionados y explicados por uno general de segundo orden. Los índices de fiabilidad de las dimensiones del NMP-Q fueron satisfactorios oscilando entre ,78, ,85, ,86 y ,92 (Omega w). Un análisis multigrupo confirmó la invarianza por sexo y edad. A partir de las puntuaciones del NMP-Q se calcularon 3 puntos de corte siguiendo los percentiles 15, 80 y 95 (sin nomofobia, riesgo de nomofobia, y nomofóbico). Las mujeres de 12-15 años tuvieron las puntuaciones más altas en nomofobia. Podemos concluir que el NMP-Q nos permite identificar problemas de nomofobia por sexo y edad desde un punto de vista clínico

Nomophobia is a situational phobia leading to a deep, irrational, and disproportionate fear of not being able to use the smartphone. An instrumental study on the Spanish version of the Nomophobia Questionnaire (NMP-Q) was carried out. The objectives were: 1) To analyse its factor structure and reliability; 2) to test for the invariance of sex and age groups, and 3) to obtain specific cut-off points by sex and age non-existent to date. Sampling was incidental and non-probabilistic with 5012 participants (57.9%, females) aged 12-24 years (M = 18.04, SD = 3.3). The confirmatory factor analysis revealed a hierarchical model with four correlated factors explained by a general second-order factor. The internal validity and reliability values of the NMP-Q dimensions are satisfactory, ranging between .78, .85, .86, and .92 (Omega ω). A multigroup analysis confirmed the invariance across sex and age groups. Building on the NMP-Q scores, we calculated 3 cut-off points using percentiles 15th, 80th and 95th (unnomophobic, at risk of nomophobia, and nomophobic). Females aged 12-15 years had the highest nomophobic scores. We can conclude that the proposed sex and age cut-off points will allow us to better identify nomophobic problems from a clinical point of view

Fluctuating facial edema as a rare manifestation of cutaneous polyarteritis nodosa: Case report and review of the literature.

Polyarteritis nodosa (PAN) is a necrotizing vasculitis. The clinical manifestations are determined by the location of the compromised arteries. Cutaneous PAN can present as nodular lesions similar to erythema nodosum, palpable purpura, livedo reticularis, and ulceration. It often affects the lower limbs but other anatomical sites can also be involved. However, concomitant facial edema is an extremely rare manifestation. It has been more than 20 years since the last case report describing this unusual presentation of PAN. Furthermore, our patient is the first case presenting with hemifacial edema fluctuating every second or third day due to PAN confirmed by skin biopsy.

Multiple Myeloma Mimicking a Small Vessel Vasculitis Presentation.

Multiple myeloma can have different clinical manifestations, and not all patients present with classic CRAB component. We describe a 46-year-old woman admitted to our hospital with a complaint of a bluish-to-black discoloration of the second toe that was rapidly progressive and acute kidney injury. We documented a Kappa light chain monoclonal gammopathy, increased presence of plasmacytes in bone marrow aspiration, and multiple lytic bone lesions, which led to a diagnosis of multiple myeloma. Although multiple myeloma presenting with blue finger syndrome is uncommon, it must always be considered as a differential diagnosis with this clinical finding.