Overfeeding polyunsaturated fat compared with saturated fat does not differentially influence lean tissue accumulation in individuals with overweight: a randomized controlled trial.

BACKGROUND: Fatty acids may influence lean tissue volume and skeletal muscle function. We previously reported in young lean participants that overfeeding PUFA compared with SFA induced greater lean tissue accumulation despite similar weight gain. OBJECTIVES: In a double-blind randomized controlled trial, we aimed to investigate if the differential effects of overfeeding SFA and PUFA on lean tissue accumulation could be replicated in individuals with overweight and identify potential determinants. Further, using substitution models, we investigated associations between SFA and PUFA concentrations with lean tissue volume in a large population-based sample (UK Biobank). METHODS: Sixty-one males and females with overweight [BMI (kg/m2): 27.3 (interquartile range (IQR), 25.4-29.3); age: 43 (IQR, 36-48)] were overfed SFA (palm oil) or n-6 (ω-6) PUFA (sunflower oil) for 8 wk. Lean tissue was assessed by MRI. We had access to n = 13,849 participants with data on diet, covariates, and MRI measurements of lean tissue, as well as 9119 participants with data on circulating fatty acids in the UK Biobank. RESULTS: Body weight gain mean (SD) was similar in PUFA (2.01 ± 1.90 kg) and SFA (2.31 ± 1.38 kg) groups. Lean tissue increased to a similar extent [0.54 ± 0.93 L and 0.67 ± 1.21 L for PUFA and SFA groups, respectively, with a difference between groups of 0.07 (-0.21, 0.35)]. We observed no differential effects on circulating amino acids, myostatin, or IL-15 and no clear determinants of lean tissue accumulation. Similar nonsignificant results for SFA and PUFA were observed in UK Biobank, but circulating fatty acids demonstrated ambiguous and sex-dependent associations. CONCLUSIONS: Overfeeding SFA or PUFA does not differentially affect lean tissue accumulation during 8 wk in individuals with overweight. A lack of dietary fat type-specific effects on lean tissue is supported by specified substitution models in a large population-based cohort consuming their habitual diet. This trial was registered at clinicaltrials.gov identifier as NCT02211612.

Diet composition, nutrient substitutions and circulating fatty acids in relation to ectopic and visceral fat depots.

BACKGROUND & AIMS: Short-term randomized trials have demonstrated that replacing saturated fat (SFA) with polyunsaturated fat (PUFA) causes a reduction or prevention of liver fat accumulation, but population-based studies on diet and body fat distribution are limited. We investigated cross-sectional associations between diet, circulating fatty acids and liver fat, visceral adipose tissue (VAT), intermuscular adipose tissue (IMAT) and other fat depots using different energy-adjustment models. METHODS: Sex-stratified analyses of n = 9119 (for serum fatty acids) to 13 849 (for nutrients) participants in UK Biobank were conducted. Fat depots were assessed by MRI, circulating fatty acids by NMR spectroscopy and diet by repeated 24-h recalls. Liver fat, VAT and IMAT were primary outcomes; total adipose tissue (TAT) and abdominal subcutaneous adipose tissue (ASAT) were secondary outcomes. Three a priori defined models were constructed: the all-components model, standard model and leave-one-out model (main model including specified nutrient substitutions). Imiomics (MRI-derived) was used to confirm and visualize associations. RESULTS: In women, substituting carbohydrates and free sugars with saturated fat (SFA) was positively associated with liver fat (ß (95% CI) = 0.19 (0.02, 0.36) and ß (95% CI) = 0.20 (0.05-0.35), respectively) and IMAT (ß (95% CI) = 0.07 (0.00, 0.14) and ß (95% CI) = 0.08 (0.02, 0.13), respectively), whereas substituting animal fat with plant fat was inversely associated with IMAT, ASAT and TAT. In the all-components and standard models, SFA and animal fat were positively associated with liver fat, IMAT and VAT whereas plant fat was inversely associated with IMAT in women. Few associations were observed in men. Circulating polyunsaturated fatty acids (PUFA) were inversely associated with liver fat, IMAT and VAT in both men and women, whereas SFA and monounsaturated fatty acids were positively associated. CONCLUSIONS: Type of dietary fat may be an important determinant of ectopic fat in humans consuming their habitual diet. Plant fat and PUFA should be preferred over animal fat and SFA. This is corroborated by circulating fatty acids and overall consistent through different energy adjustment models. TWITTER SUMMARY: In UK Biobank, intake of saturated- and animal fat were positively whereas biomarkers of polyunsaturated fat were inversely associated with liver-, visceral- and intermuscular fat. Type of dietary fat may be a determinant of ectopic fat, a risk factor for cardiometabolic disease.

Erratum for: MIMIR: Deep Regression for Automated Analysis of UK Biobank MRI Scans.

[This corrects the article DOI: 10.1148/ryai.210178.].

MIMIR: Deep Regression for Automated Analysis of UK Biobank MRI Scans.

UK Biobank (UKB) has recruited more than 500 000 volunteers from the United Kingdom, collecting health-related information on genetics, lifestyle, blood biochemistry, and more. Ongoing medical imaging of 100 000 participants with 70 000 follow-up sessions will yield up to 170 000 MRI scans, enabling image analysis of body composition, organs, and muscle. This study presents an experimental inference engine for automated analysis of UKB neck-to-knee body 1.5-T MRI scans. This retrospective cross-validation study includes data from 38 916 participants (52% female; mean age, 64 years) to capture baseline characteristics, such as age, height, weight, and sex, as well as measurements of body composition, organ volumes, and abstract properties, such as grip strength, pulse rate, and type 2 diabetes status. Prediction intervals for each end point were generated based on uncertainty quantification. On a subsequent release of UKB data, the proposed method predicted 12 body composition metrics with a 3% median error and yielded mostly well-calibrated individual prediction intervals. The processing of MRI scans from 1000 participants required 10 minutes. The underlying method used convolutional neural networks for image-based mean-variance regression on two-dimensional representations of the MRI data. An implementation was made publicly available for fast and fully automated estimation of 72 different measurements from future releases of UKB image data. Keywords: MRI, Adipose Tissue, Obesity, Metabolic Disorders, Volume Analysis, Whole-Body Imaging, Quantification, Supervised Learning, Convolutional Neural Network (CNN) © RSNA, 2022.

Multi-task convolutional neural networks for predicting in vitro clearance endpoints from molecular images.

Optimization of compound metabolic stability is a highly topical issue in pharmaceutical research. Accordingly, application of predictive in silico models can potentially reduce the number of design-make-test-analyze iterations and consequently speed up the progression of novel candidate molecules. Herein, we have investigated the question if multiple in vitro clearance endpoints could be accurately predicted from image-based molecular representations. Thus, compound measurements for four commonly investigated clearance endpoints were curated from AstraZeneca internal sources, providing a sound basis for building multi-task convolutional neural network models. Application of several increasingly challenging data splitting strategies confirmed that convolutional neural network models were successful at capturing implicit chemical relationships contained in training and test data, similar to what is commonly observed for structural fingerprints. Furthermore, model benchmarking against state-of-the-art machine learning methods, including deep neural networks and graph convolutional neural networks, trained with structure- and graph-based representations, respectively, revealed on par or increased accuracy of convolutional neural networks with clear benefit of multi-task learning across all clearance endpoints. Our findings indicate that image-based molecular representations can be applied to predict multiple clearance endpoints, suggesting a potential follow-up to investigate model interpretability from molecular images.

Acogida y proximidad como posibilidades de interrelación en teleterapia ocupacional: experiencia de práctica con niños y niñas del Jardín Infantil de la Universidad Nacional de Colombia / Reception and proximity as possibilities of interrelation in occupational teletherapy: experience from the practice with children in the Universidad Nacional de Colombia's kindergarten / Acolhimento e proximidade como possibilidades de inter-relação em teleterapia ocupacional: experiência de uma prática com crianças do Jardim de Infância da Universidade Nacional da Colômbia

Este artículo propone una reflexión a partir de las experiencias de un grupo de estudiantes de Terapia Ocupacional durante su práctica en el área de educación, en diálogo con las apuestas de la perspectiva ética de Lévinas y la construcción de horizontes de sentido en el campo educativo, que interpelan comprensiones de la educación como instrumento para el mero aprendizaje de habilidades y conceptos que se instalan en los sujetos. La práctica se realizó con dos grupos de niños y niñas del Jardín Infantil de la Universidad Nacional de Colombia durante el primer semestre del 2021, en la modalidad de teleterapia ocupacional. Se enfatiza en el proceso de constitución de espacios de aprendizaje y reflexión sobre el actuar profesional en la escuela, en tiempos de distanciamiento social por la pandemia de COVID-19, y de otras formas para construir relaciones basadas en la proximidad y la acogida en teleterapia.

This article proposes a reflection based on the experiences of a group of Occupational Therapy students in their education area practice, in dialogue with the ethical perspective of Lévinas and the construction of horizons of meaning in the educational field, who ques- tion the understanding of education as a tool for the sole learning of skills and concepts installed in individuals. The practice was carried out with two groups of children in the Universidad Nacional de Colombia's kindergarten during the first semester of 2021 in the occupational teletherapy modality. Emphasis is placed on the process of creating spaces for learning and reflection on professional conducting at school, in times of social distan- cing due to the COVID-19 pandemic, and in other ways to build relationships based on proximity and embrace in teletherapy.

Este artigo propõe uma reflexão a partir das experiências de um grupo de estudantes de Terapia Ocupacional, durante sua prática na área da educação, em diálogo com a perspectiva ética de Lévinas e a construção de horizontes de sentido no campo educativo, que questionam as compreensões da educação como instrumento para a mera aprendizagem de habilidades e conceitos que se instalam nos sujeitos. A prática foi realizada com dois grupos de crianças do Jardim de Infância da Universidade Nacional da Colômbia, durante o primeiro semestre de 2021, na modalidade de teleterapia ocupacional. A ênfase é colocada no processo de constituição de espaços de aprendizagem e de reflexão sobre a atuação profissional na escola, em tempos de distanciamento social devido à pandemia de COVID-19, e de outras formas para construir relações baseadas na proximidade e no acolhimento em teleterapia.

Conocimientos y actitudes de docentes de preescolar, primaria y secundaria sobre trauma dentoalveolar / Knowledge and Attitudes of Preschool, Primary and Secondary Teachers About Dentoalveolar Trauma

RESUMEN El trauma dentoalveolar es considerado la segunda causa de urgencias odontológicas, sien los niños y adolescentes los más afectados. La etiología está relacionada a la edad; en niños preescolares, las caídas son una causa muy común de lesiones traumáticas dentales, mientras que en los niños de edad escolar, las lesiones son más frecuentes por actividades deportivas. Suelen suceder en entornos académicos como la escuela, donde el docente es el principal sujeto a quien acuden para la atención preliminar de este tipo de eventos. Por tales argumentos son importantes los conocimientos y actitudes que posean los docentes, debido a que dichas acciones determinarán el pronóstico y tratamiento, más aun, por la relación existente entre el tiempo transcurrido y las acciones realizadas por parte del profesional odontológico. El objetivo de esta revisión sistemática fue describir la existencia de conocimientos y actitudes de docentes de primaria y secundaria sobre el manejo del trauma dentoalveolar; en la cual N=9 publicaciones cumplieron con los criterios de elegibilidad, empleando las bases de datos Pubmed, Scielo y Clinical Keys y descriptores en idioma inglés y español. Se evidencia que existe conocimiento inadecuado, mientras que la actitud del docente frente al trauma dental en la mayoría de los estudios no fue evaluada.

ABSTRACT Dentoalveolar trauma is considered the second cause of dental emergencies, with children and adolescents being the most affected. The etiology is related to age: in preschool children, falls are a very common cause of traumatic dental injuries, while in school-age children, injuries are more frequent from sports activities. Dental falls usually happen in academic environments such as school, where the teacher is the main subject to whom ones go for the preliminary attention of this type of event. For such reasons, the knowledge and attitudes possessed by teachers are important, because their actions will determine the prognosis and treatment, especially due to the relationship between the time elapsed and the actions carried out by the dental professional. The objective of this systematic review was to describe the existence of knowledge and attitudes of primary and secondary school teachers on the management of dentoalveolar trauma. In the revision we evidence N = 9 publications met the eligibility criteria, using the Pubmed databases, Scielo and Clinical Keys and descriptors in English and Spanish. It is evident that there is inadequate knowledge, while the teacher's attitude towards dental trauma in most of the studies was not evaluated.

Corrección de mielomeningocele intrautero: Reporte del primer caso en Ecuador / Case report: First intrauterine myelomeningocele correction in Ecuador

This is the case of a 26 year old patient, at week 27 of gestational age and with a prenatal diagnosis of myelomeningocele. It was decided to enter the clinic to perform the first correction of the spina bifida defect in Ecuador, with the support of a multidisciplinary team of national and foreign professionals. This procedure was carried out within international parameters and standards for the management of this pathology, with the equipment, supplies and trained personnel to carry this surgery to a successful outcome, both for the fetus and its mother. It is demonstrated that our country has the capacity of both human resources and equipment to solve highly complex pathologies.

Se trata del caso de una paciente de 26 años, en la semana 27 de edad gestacional y con un diagnóstico prenatal de mielome- ningocele. Se decide ingresar a la clínica para realizar la primera corrección de defecto de espina bífida del Ecuador, con apoyo de un equipo multidisciplinario de profesionales nacionales y extranjeros. Este procedimiento se llevó a cabo dentro de parámetros y estándares internacionales de manejo de esta patología, contando con los equipos, insumos y el personal capacitado para llevar esta cirugía a un desenlace exitoso, tanto para el feto como su madre. Queda demostrado que en nuestro país se cuenta con la capacidad tanto de recursos humanos y equipos para resolver patologías de gran complejidad.

Assessing Environmental Control Strategies in Cage-Free Egg Production Systems: Effect on Spatial Occupancy and Natural Behaviors.

Animal welfare concerns have been a challenging issue for producers and international marketing. In laying hen production, cage-free systems (CFS) have been identified as an alternative to ensure the laying hens' well-being. Nevertheless, in CFS, important environmental issues have been reported, decreasing indoor air quality. Environmental control strategies (ECS) have been designed to enhance indoor air quality in CFSs. However, little information exists about the effect of these ECSs on natural animal behaviors. Four strategies and one control were tested in an experimental CFS, previously designed to track behavioral variables using video recordings over seven time-lapses of 1 hour per day. Spatial occupancy (SO) and laying hen behaviors (LHB) were registered. One statistical analysis was applied to evaluate the effect of ECS on SO and LHB using a multinomial response model. Results show lower chances to use litter area within the reduction of litter allowance treatment (T17) (p < 0.05). Neither the four ECSs nor the control implemented in this experiment affected the natural behaviors of the hens. However, stress patterns and high activity were reported in the T17 treatment. This study shows that it is possible to use these ECSs without disrupting laying hens' natural behaviors.

Bloqueo de nervios esplácnicos para tratamiento del dolor abdominal crónico benigno. Reporte de caso con revisión temática / Splanchnic nerve block for the treatment of benign chronic abdominal pain. a case report and literature review

El dolor abdominal crónico de origen benigno puede ser incapacitante y disminuye significativamente la calidad de vida de algunos pacientes. Para su tratamiento es usual el uso crónico de opioides que se han asociado a originar otras fuentes de dolor, por lo que deberían sopesar tratamientos farmacológicos alternativos. Sin embargo, cuando estos no son efectivos, insuficientes u ocasionan efectos adversos intolerables, el manejo intervencionista del dolor debería considerarse. En este campo la inhibición de los nervios esplácnicos que es una técnica que puede ser empleada para el control del dolor oncológico, podría jugar un papel importante a pesar de que aún no cuenta con evidencia sólida de su aplicabilidad en tratar el dolor crónico de origen benigno. Hasta donde sabemos, en el Ecuador es la primera vez que se realiza este procedimiento y el presente informe sugiere que puede ofrecer buenos resultados, incluso después de terminado el efecto de los fármacos utilizados

Chronic abdominal pain of benign origin can be disabling and significantly reduces the quality of life of some patients. Common treatment includes the chronic use of opioids that have also been linked with causing different sources of pain, so alternative pharmacological treatments should be considered instead. However, when these are not effective, insufficient, or cause intolerable adverse effects, interventional pain management should be considered. In this field, the inhibition of splanchnic nerves, which is a technique that can be used to control cancer pain, could play an important role in the treatment of chronic pain of benign origin, despite the lack of solid evidence in its applicability. As far as we know, it is the first time that this procedure has been performed in Ecuador and this report suggests that it can offer positive results even after the effect of the drugs used has ended

A New Classification System for Pilon Fractures Based on CT Scan: An Independent Interobserver and Intraobserver Agreement Evaluation.

BACKGROUND DATA: A new pilon fracture classification system based on CT scan data was recently published, showing almost perfect interobserver and intraobserver agreement among the authors who developed it. However, an independent assessment has not been done. OBJECTIVE: To do an independent agreement evaluation of the new pilon fracture classification system with physicians with different levels of expertise in the management of pilon fractures. METHODS: Seventy-one cases of acute pilon fracture were retrospectively collected. Fractures were classified by six evaluators (three foot and ankle surgeons and three orthopaedic surgery residents) using CT scans according to the morphological grading of the new pilon fracture classification system developed by Leonetti et al. Cases were presented to the same evaluators in a random sequence after a 6-week interval to determine intraobserver agreement. The kappa coefficient (κ) was used to determine agreement among evaluators. RESULTS: The interobserver agreement was substantial regarding the main fracture type (I, II, III, or IV), with an overall κ value of 0.69 (0.65 to 0.72). When including the II and III subtypes, the overall agreement was still substantial, with a κ value of 0.61 (95% confidence interval: 0.58 to 0.64). The intraobserver agreement was substantial when considering the main fracture categories (I, II, III, or IV), with a κ value of 0.78 (confidence interval: 0.72 to 0.84), and full agreement at the type level was observed in 76% (324/426) of evaluations. There was no notable difference between the foot and ankle surgeons and orthopaedic surgery residents in the interobserver and intraobserver agreement. CONCLUSION: The new classification system demonstrated substantial interobserver and intraobserver agreement between evaluators with different levels of expertise in the management of pilon fractures. Prospective studies should be done to evaluate its prognostic value and utility in clinical practice.

Multiple Resistance to Synthetic Auxin Herbicides and Glyphosate in Parthenium hysterophorus Occurring in Citrus Orchards.

Dominican farmers have started to apply synthetic auxin herbicides (SAHs) as the main alternative to mitigate the impacts of the occurrence of glyphosate-resistant (GR) Parthenium hysterophorus populations in citrus orchards. A GR P. hysterophorus population survived field labeled rates of glyphosate, 2,4-dichlorophenoxyacetic acid (2,4-D), dicamba, and picloram, which showed poor control (<50%). In in vivo assays, resistance levels were high for glyphosate and moderate for picloram, dicamba, and 2,4-D. Sequencing the 5-enolpyruvylshikimate-3-phosphate synthase gene revealed the double Thr-102-Ile and Pro-106-Ser amino acid substitution, conferring resistance to glyphosate. Additionally, reduced absorption and impaired translocation contributed to this resistance. Regarding SAH, impaired 2,4-D transport and enhanced metabolism were confirmed in resistant plants. The application of malathion improved the efficacy of SAHs (control >50%), showing that metabolism of these herbicides was mediated by cytochrome P450 enzymes. This study reports, for the first time, multiple resistance to SAHs and glyphosate in P. hysterophorus.

Mid- and long-term outcomes of endoscopic resection for submucosal esophageal cancer types pT1b-SM1 and pT1b-SM2.

Background and study aims Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are promising therapeutic options for early esophageal cancer (EC). The factors that can affect mid- and long-term survival in patients with submucosal EC (SM1 and SM2) have not been described in the literature. We aim to describe clinicopathological outcomes and factors that can affect the mid- and long-term survival in patients with resected submucosal tumors. Patients and methods We performed a retrospective analysis of patients who underwent endoscopic resection (ER) for submucosal tumors over a 20-year period. The final study population included 119 cases with 137 lesions. Information was collected according to the Japanese Classification of Esophageal Cancer 11-edition and factors affecting survival for 2 and 5 years after ER were analyzed. Results EMR was performed in 99 cases (72.3 %), ESD in 38 cases (27.7 %). There were no significant complications. Two- and 5-year survival rates were 91 % and 82 %, respectively. Mean age was 67.22 years (±â€Š9.49 years), mortality caused by EC occurred in 13 cases (11 %). Factors that had a significant impact on long-term survival were age > 65 years ( P  = 0.0026), number of resected specimens ( P  = 0.0031), presence of another progressive disease (not EC) ( P  ≤ 0.001), recurrence ( P  = 0.0002), and relation between histopathological positive vertical margin and recurrence ( P  = 0.0112). Conclusions ER is viable treatment for esophageal submucosal cancer, selection between ESD/EMR can depend on tumor size and patient condition, and en bloc ER is the recommended technique for submucosal tumors. Long-term survival factors were identified.

Comparative Study of Predictive Mortality Scores in Esophagectomy with Three-Field Lymph Node Dissection in Patients with Esophageal Cancer.

BACKGROUND/AIM: Esophagectomy is still the best therapeutic option for curing resectable esophageal cancer (EC). Radical surgical resection with three-field lymphadenectomy (3FLD) is a potentially curative treatment option. We compared the predictive accuracy of 5 different scores in patients with EC who underwent 3FLD. METHODS: Five years' worth of medical records in a single institution were analyzed (January 2010 to January 2015) from 311 patients who underwent esophagectomy for EC. We selected 191 in whom 3FLD was performed. Mortality was calculated based on 5 predictive scores. Outcomes measures were intraoperative mortality, 30-day mortality, and 1- and 2-year mortality after surgery. RESULTS: Intraoperative mortality and 30-day mortality after surgery was 0%; 1 and 2-year mortality were 19.8 and 31.4%, respectively. The area under the curve showed poor discriminatory power for all 5 scores (<0.7). In one-way analysis of variance, for 1 year mortality, Portsmouth-Physiological and Operative Severity Score for mortality (P-Possum) was significant (p = 0.0424); in a multivariable analysis for 2-year mortality, P-Possum (p < 0.0001) remained significant. CONCLUSION: There is no accurate prognosis score for esophagectomy in patients who undergo high-risk procedures like 3FLD. New scores are needed to predict the mortality after 3FLD with good discriminatory power. Independent factors affect survival and may function as the baseline for obtaining a new accurate mortality score.

The Identification of Seven Chemical Warfare Mimics Using a Colorimetric Array.

Chemical warfare agents pose significant threats in the 21st century, especially for armed forces. A colorimetric detection array was developed to identify warfare mimics, including mustard gas and nerve agents. In total, 188 sensors were screened to determine the best sensor performance, in order to identify warfare mimics 2-chloro ethyl ethylsulfide, 2-2'-thiodiethanol, trifluoroacetic acid, methylphosphonic acid, dimethylphosphite, diethylcyanophosphonate, and diethyl (methylthiomethyl)phosphonate. The highest loadings in the principle component analysis (PCA) plots were used to identify the sensors that were most effective in analyzing the RGB data to classify the warfare mimics. The dataset was reduced to only twelve sensors, and PCA results gave comparable results as the large data did, demonstrating that only twelve sensors are needed to classify the warfare mimics.

Ivabradine use in patients with HFrEF in the heart failure multidisciplinary program (PIC) in a private hospital: first registration and 3-years follow up, Central American (CA) region / Uso de ivabradina en pacientes con insuficiencia cardíaca aguda en la insuficiencia cardíaca programa multidisciplinario (PIC) en un hospital privado: primer registro y seguimiento de 3 años, región de América Central (AC)

Abstract Introduction and objectives: Heart rate (HR) elevation in patients (p) with heart failure with reduced ejection fraction (HFrEF) is related to increased mortality and hospitalization for HF; its reduction improves the filling of the left ventricle, increases the myocardial oxygen supply and reduces its consumption, all of which is beneficial in p with impaired left ventricular systolic function. Use of ivabradine (IBRA) in p with HFrEF, in sinus rhythm (SR) and HR > 70 beats per minute (bpm), reduces hospitalizations for HF and mortality for HF. The management of p with advanced HF in PIC ensures a morbidity and mortality reduction with the highest levels of evidence. The first retrospective analysis in a PIC at a private hospital in CA, during 3 years of all case p with HFrEF who received treatments (tx) recommended by International Guidelines and maintained HR > 70 bpm at rest in SR, with the purpose of reducing it. The use of baseline clinical data, natriuretic peptides (NP) and LVEF at rest, compared with same variables in follow up, in a region where these PICs are borning. Methods: 26 p with HFrEF for 3 years of PIC. General data, tx, baseline clinical condition, BP, pulse, NYHA, quality of life (QoL), NP, LVEF by Doppler Echocardiography were registered, and IBRA tx response was compared baseline and end. 18 p completed data; 8 incomplete (baseline or follow-up data). Results: Ambulatory p, with HFrEF (<35%) and SR HR > 70 bpm; age 78 years, 17 men. Tx average time with IBRA 11 months, 53.5% more than 1 year. Baseline medications, 93% ACEIs or ARAs II; 85% beta-blockers and 74% MRA, maximum tolerated doses. No patient used IBRA prior baseline. 20% CRT. Variables behavior assessed: HR (baseline 89 bpm vs 62 bpm after IBRA 2 months); BP (baseline systolic 100 mmHg vs 123 mmHg end; baseline diastolic 55 mmHg vs 65 mmHg end); LVEF (baseline 29% vs 35% end); BNP baseline 7,550 pg/ml vs 1,935 pg/ml end. 5 p improved NYHA III to NYHA I, 5 p improved NYHA III to NYHA II, 3 had deterioration NYHA III; rest remained unchanged. 77% p no dose adjustment required (HR below 70 bpm). 6 p began with 2.5 mg every 12 hours and increased to 5 mg every 12 hours after 15 days. By KCCQ-12 increase 42 to 59 points. 1 discontinuation case of IBRA due to bradycardia (HR < 50 bpm). 2 p hospitalized, one pneumonia and one HF decompensation. 3 dead: 1 myocardial infarction, 2 HF progression. Conclusions: 26 p studied, registered and treated with IBRA in the PIC at private hospital in CA, most of them registered metric improvements identified as prognosis factors (HR, BP, LVEF, NP, NYHA and QoL). This assessment, registration and follow up of p with HFrEF with use of IBRA in a PIC, is the first one carried out in CA. Results reflect the usual clinical practice in a PIC, with cardiologists and nurses trained to support and follow-up p, and evidence the importance of PIC when using and prescribing drugs like IBRA, in a region where these PICs are rare.

Resumen Introducción y objetivos: La elevación de la frecuencia cardíaca (FC) en pacientes (p) con insuficiencia cardíaca (IC) con fracción de eyección reducida (ICFE) se relaciona con un aumento de la mortalidad y la hospitalización por IC; su reducción mejora el llenado del ventrículo izquierdo, aumenta el suministro de oxígeno al miocardio y reduce su consumo, todo lo cual es beneficioso en p con deterioro de la función sistólica del ventrículo izquierdo. El uso de ivabradina (IBRA) en p con ICFE, en ritmo sinusal (SR) y FC> 70 latidos por minuto (lpm), reduce las hospitalizaciones por insuficiencia cardíaca y la mortalidad por insuficiencia cardíaca. El manejo de p con FC avanzada en PIC asegura una reducción de la morbilidad y la mortalidad con los mayores niveles de evidencia. El primer análisis retrospectivo en un PIC en un hospital privado en centroamérica, durante 3 años de todos los casos p con ICFE que recibieron tratamientos (tx) recomendados por Interna tional Guidelines y mantuvieron FC> 70 lpm en reposo en SR, con el objetivo de reducirlo. El uso de datos clínicos basales, péptidos natriuréticos (NP) y FEVI en reposo, en comparación con las mismas variables en el seguimiento, en una región donde estos PIC están naciendo. Métodos: 26 p con ICFE durante 3 años de PIC. Se registraron datos generales, tx, estado clínico basal, presión arterial, pulso, NYHA, calidad de vida (QoL), NP, FEVI por ecocardiografía Doppler, y se comparó la respuesta de IBRA tx al inicio y al final. 18 p datos completados; 8 incompleto (datos iniciales o de seguimiento). Resultados: p ambulatorios, con ICFE (<35%) y SR FC> 70 lpm; 78 años de edad, 17 hombres. Tiempo promedio de Tx con IBRA 11 meses, 53.5% más de 1 año. Medicamentos de referencia, 93% IECA o IRA II; 85% de betabloqueantes y 74% de MRA, dosis máximas toleradas. Ningún paciente usó IBRA antes de la línea base. 20% de CRT. Comportamiento de las variables evaluado: FC (basal 89 lpm frente a 62 lpm después de IBRA 2 meses); BP (sistólica basal de 100 mmHg frente a 123 mmHg de extremo, línea diastólica basal de 55 mmHg frente a 65 mmHg de extremo); FEVI (línea de base 29% frente a 35% de final); BNP línea de base 7.550 pg / ml vs 1.935 pg / ml final. 5 p mejoró NYHA III a NYHA I, 5 p mejoró NYHA III a NYHA II, 3 sufrió deterioro NYHA III; el resto se mantuvo sin cambios. 77% p no se requiere ajuste de dosis (FC por debajo de 70 lpm). 6 p comenzó con 2.5 mg cada 12 horas y aumentó a 5 mg cada 12 horas después de 15 días. Por KCCQ-12 aumenta de 42 a 59 puntos. 1 caso de discontinuación de IBRA debido a bradicardia (FC <50 lpm). 2 p hospitalizados, una neumonía y una descompensación de FC. 3 muertos: 1 infarto de miocardio, progresión de 2 FC. Conclusiones: 26 p estudiados, registrados y tratados con IBRA en el PIC en un hospital privado en CA, la mayoría de ellas registraron mejorías métricas identificadas como factores pronósticos (FC, BP, FEVI, NP, NYHA y QoL). Esta evalua ción, registro y seguimiento de p con ICFE con uso de IBRA en un PIC, es la primera llevada a cabo en CA. Los resultados reflejan la práctica clínica habitual en un CFP, con cardiólogos y enfermeras capacitados para apoyar y dar seguimiento p, y evidencian la importancia del CFP al usar y prescribir fármacos como el IBRA, en una región donde estos PIC son raros.

Tratamiento médico-quirúrgico de la obesidad en el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) / Medical and surgical treatment of obesity in obstructive sleep apnea-hypopnea syndrome (OSAHS)

Resumen La obesidad es uno de los factores de riesgo más importantes en los trastornos respiratorios relacionados con el sueño. Más de 70% de los pacientes con síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) presenta algún grado de obesidad. La pérdida de peso, ya sea médica o quirúrgica, debe ser un objetivo primordial en el manejo del SAHOS al mejorar el índice de apnea-hipopnea (IAH) en un alto porcentaje, el cual se debe estimular en todos los pacientes. Siempre se debe iniciar con cambios en el estilo de vida a través de intervenciones con múltiples componentes que incluyen hábitos alimentarios, actividad física y soporte psicológico. Si después de 3 a 6 meses de tratamiento no se han alcanzado las metas de peso establecidas, se pueden formular medicamentos contra la obesidad o cirugía bariátrica. El riesgo actual de someterse a una cirugía bariátrica es bajo y los beneficios son evidentes.

Abstract Obesity is one of the most important risk factors in sleep-related respiratory disorders; more than 70% of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) show some degree of obesity. Weight loss, through medical or surgical means, should be a primary goal in the management of OSAHS since it improves the apnea-hypopnea index (AHI) in a high percentage, which should be stimulated in all patients. Changes in the lifestyle are the first step and should be done through multi-component interventions that include eating habits, physical activity, and psychological support. If after three to six months of treatment the goals established for weight loss have not been met, drugs against obesity or bariatric surgery can be formulated. The current risk of undergoing bariatric surgery is low and the benefits are evident.

Case of Superficial Cancer Located at the Pharyngoesophageal Junction Which Was Dissected by Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection.

Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here. Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection. Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection. Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction.

Morbilidad en anestesia cardíaca en el Hospital Carlos Andrade Marín durante el año 2013 / Morbility in cardiac anesthesia in the Carlos Andrade Marin Hospital during the year 2013

Introducción: la anestesia general en cirugía cardíaca debe cumplir no solo con sus pilares básicos: hipnosis, amnesia, relajación neuromuscular y analgesia sino también mantener adecuada oxigenación y perfusión tisular, aportar protección neurovegetativa, mantener equilibrio hidroelectrolítico ácido base, prevenir y tratar coagulopatías, regulación térmica y preservar la función miocárdica, neurológica, renal y respiratoria con el fin de mantener la homeostasis. Materiales y métodos: en este estudio observacional descriptivo longitudinal, se realiza el seguimiento de 114 pacientes intervenidos bajo anestesia general para cirugía cardíaca electiva hasta seis meses posoperatorios con edad promedio de 55 años, con una morbilidad de 26.32% y mortalidad del 17.54%. Resultados: las patologías intervenidas más frecuentes fueron valvulopatías (52%) con predominio de estenosis aórtica, en segundo lugar las cardiopatías congénitas (24.67%) principalmente CIA, CIV, PCA. Las dos principales comorbilidades asociadas fueron la hipertensión arterial (39%) y diabetes mellitus tipo II (16%). El 84% de pacientes tenían fracción de eyección del 55% y la clase funcional III y IV presentó mayor riesgo de mortalidad OR 3.2 (p<0.05). El 37.73% de pacientes recibieron beta bloqueadores previo al procedimiento con un efecto protector OR 0.8 (p:<0.05). Conclusiones: el tiempo de circulación extracorpórea fue menor de 120 min. En el 23.32%, un tiempo mayor de CEC mostró ser un factor de riesgo OR: 7 (p:<0.05). El 25% de pacientes requirió soporte inotrópico o vasoactivo, de los cuales solamente la epinefrina mostró significancia estadística como factor de riesgo; sin embargo puede ser un sesgo ya que el tamaño de la muestra de pacientes es relativamente pequeño y todos los grupos, exceptuando el nitroprusiato, tuvieron un OR >1. El 85% de pacientes requirió transfusión con un OR 6.82 (p:<0.05) para complicaciones posoperatorias como infección y hemorragia.

Introduction: general anesthesia in cardiovascular surgery is based not only on hypnosis, amnesia, neuromuscular blockade and analgesia; but must provide proper oxygenation, tissue perfusion, neurovegetative protection, acid base regulation, treat and prevent coagulopathy, thermic control, myocardic preserve, neurologic, renal and respiratory functions in order to keep homeostasis. Materials and methods: in this longitudinal descriptive observational trial, 114 patients who underwent cardiac surgery under general anesthesia were followed for 6 months. The median age of these patients was 55 with 26.32% morbidity and 17.54% mortality. Results: the most frequent surgeries were valvulopathies (52%) being the most common aortic stenosis; in second place congenital cardiopathies (24.67%), mainly trial communication, interventricular communication and patent ductus arteriosus. The two main co-morbilities were arterial hypertension (39%) and diabetes mellitus II (16%). 84% of patients had an ejection fraction of 55% and those with NYHA functional class III and IV had more risk of mortality OR 3.2 (p<0.05). 37.73% of patients received beta blockers before surgery with a protective effect OR 0.8 (p:<0.05). Conclusions: the time of extracorporeal circulation (EC) was less than 120 minutes in 23.32%, lengthier time of CEC showed a risk factor OR: 7 (p:<0.05). 25% of patients needed vasoactive and inotropic support. Only epinephrine reached statistical significance as a risk factor, nevertheless it could be because the number of patients that received this therapy was relatively small. All the groups, except nitroprussiade, had an OR>1. 85% of patients required transfusion with an OR 6.82 (p:<0.05) for postoperatory complications such as infection and bleeding.

Caso de fractura de cúbito en niño con osteogénesis imperfecta, implicaciones anestésicas / A case of ulna fracture in a child with osteogenesis imperfecta, anesthetic implications

Introducción: la Osteogénesis Imperfecta (OI) es una rara enfermedad congénita autosómica dominante del tejido conectivo con una incidencia aproximada de 1:21 000 a 1:60 000 nacimientos, con mayor incidencia en mujeres.1 Aunque también se han descrito casos de herencia recesiva o mutación espontánea.2 La Osteogénesis Imperfecta puede ser causada por la mutación en los cromosomas 7 o 17, en uno de los dos genes que codifcan el colágeno tipo 1A1 o 1A2. 3 Sus manifestaciones clínicas incluyen la susceptibilidad a las fracturas óseas y retraso del crecimiento, así como compromiso del tejido conectivo de otros órganos. Bajo este contexto existen múltiples implicaciones anestésicas que determinan un buen desenlace en el posoperatorio. Caso: es una revisión de caso clínico y revisión bibliográfca. Resultados: el presente caso muestra el manejo anestésico en un niño de 12 años con Osteogénesis Imperfecta, sometido a osteosíntesis por fractura de miembro superior. Patología poco frecuente en nuestro medio. Conclusiones: se puede concluir que el manejo anestésico de un paciente con Osteogénesis Imperfecta implica varios ámbitos desde su fragilidad ósea, vía aérea difícil, control de temperatura entre otros. Además que se requiere un abordaje multidisciplinario en el perioperatorio.

Introduction: Osteogenesis Imperfecta (OI) is a rare autosomal dominant congenital connective tissue disorder with an incidence of 1:21 000 to 1:60 000 births, with higher incidence in women. 1 Also we can fnd cases of recessive heritage or spontaneous 1 mutation. 2 Osteogenesis Imperfecta (OI), can be caused by mutations in chromosomes 7 or 17, in one of two genes encoding collagen type 1A1 or 1A2. 3 Its clinical manifestations include susceptibility to bone fractures and delayed growth and commitment of the connective tissue of other organs. In this context there are multiple anesthetic implications that determine a good postoperative outcome. Case: this is a clinical case review and a literature review. Results: this case shows de anesthetic management in a 12 years old boy with Osteogénesis Imperfecta, who underwent an osteosinthesis of an upper limb fracture. A rare pathology in our environment. Conclusions: we can conclude that the anesthetic management of a patient with Osteogénesis Imperfecta, involves several scopes from bone fragility, diffcult airway, core temperature control, etc. Besides that a multidisciplinary approach is required in the perioperative.