Oral pathology and oral medicine in Latin American countries: current stage.

BACKGROUND: Oral Pathology (OP) and Oral Medicine (OM) are specialties in dentistry whose main objective is the diagnosis and treatment of oral and maxillofacial diseases, and aspects related to the academic training of professionals and fields of practice are distinct and heterogeneous around the world. This study aimed to evaluate professional training and areas of activity in OP and OM in Latin American countries. MATERIAL AND METHODS: A questionnaire was sent to 11 countries, with a professional in each country responsible for answering it. The questionnaire had 21 questions related to the process of professional training, areas of practice, the existence of scientific events in each country, and also collected demographic and population information. RESULTS: OP and OM are practiced in all the countries studied, but the specialty is not recognized in all of them. Brazil was the first to recognize both as a specialty. Postgraduate programs designed to train specialists are available in various countries. Two countries offer residency programs, 6 countries provide specialization courses, 6 offer master's programs, and 3 have doctoral programs. Brazil boasts the highest number of undergraduate courses (n=412), while Uruguay has the lowest (n=2). Professional societies representing the specialty exist in ten countries. Brazil has the highest number of OP and OM specialists (n=422 and 1,072), while Paraguay has the smallest number (n=1 and 3). CONCLUSIONS: Although both specialties are widely practiced around the globe, professional training, the number of dentists trained and the fields of professional practice are very different between the countries studied.

Unveiling the vulnerability of C57BL/6J female mice to HFpEF and its related complications.

Introduction: The impact of female biological sex on the development of heart failure with preserved ejection fraction (HFpEF) and its associated kidney disease and vascular endothelial dysfunction is still controversial. Whether females are protected from HFpEF and associated complications is not well established. Previous studies report conflicting prevalence between genders. We hypothesize that female mice are unprotected from HFpEF and its associated kidney disease and vascular endothelial dysfunction. Methods: Eight-week-old female mice were divided into four groups: control groups receiving a standard diet and water for either 5 or 16 weeks, and HFpEF groups fed a high-fat diet (HFD, Rodent Diet With 60 kcal% Fat) and N [w]-nitro-l-arginine methyl ester (L-NAME - 0.5 g/L) in the drinking water for 5 or 16 weeks. Various measurements and assessments were performed, including echocardiography, metabolic and hypertensive evaluations, markers of heart and kidney injury, and assessment of vascular endothelial function. Results: Female mice with HFD and L-NAME developed HFpEF at 5 weeks, evidenced by increased E/E' ratio, reduced cardiac index, left ventricular mass, and unchanged ejection fraction. After 16 weeks, HFpEF worsened. Metabolic disorders, hypertension, lung wet/kidney weight increase, exercise intolerance, and cardiac/renal injury markers were observed. Vascular endothelial dysfunction was associated with ER stress and fibrosis induction. Conclusions: We found that female mice are susceptible to the development of HFpEF and its associated kidney disease and vascular endothelial dysfunction. Our data support the concept that the female sex does not protect from HFpEF and its associated kidney disease and vascular endothelial dysfunction when disease risk factors are present.

Evolución de la funcionalidad y la fuerza muscular desde cuidado intensivo a hospitalización en sobrevivientes por COVID-19 / Evolution of functionality and muscle strength from intensive care to hospitalization in survivors of COVID-19

Introducción El paciente crítico hospitalizado en cuidado intensivo (UCI) tiene más riesgo de deterioro en la función física. Una forma de contrarrestarlo está relacionada con la intervención temprana de fisioterapia, pero son escasos los reportes en pacientes con enfermedad severa por COVID-19. Objetivo Describir el compromiso y cambio en la funcionalidad y en la fuerza muscular en pacientes con COVID-19 que recibieron intervención temprana de fisioterapia en UCI hasta el alta hospitalaria, y comparar la evolución de acuerdo con si recibieron ventilación mecánica invasiva o no. Metodología Estudio retrospectivo de pacientes con COVID-19 que ingresaron a UCI entre marzo y septiembre del 2020 y recibieron intervención de fisioterapia. La funcionalidad se evaluó con el índice Barthel (IB) y la fuerza muscular con el Medical Research Council Sum Score (MRC-SS), los cuales fueron medidos por el fisioterapeuta de turno en dos momentos, al egreso de UCI y de hospitalización. Se consideró el valor p < 0,05 como significativo. Resultados Se revisaron 66 registros; la edad promedio fue de 53,3 (32 ± 11,5) años; 32 (48,5%) requirieron ventilación mecánica. Se observó compromiso en la funcionalidad y en la fuerza muscular, con mejoría progresiva antes del egreso hospitalario: IB [64,1 (± 34,7) vs. 87,7 (± 18,4) p = 0,000], MRC-SS [40,5 (± 11) vs. 48 (± 9) p = 0,000]. El grupo de pacientes ventilados presentó mayor compromiso IB [34,2 (± 24,7) vs. 76,7 (± 21,2) p = 0,000] y MRC-SS [31,5 (± 7,2) vs. 42,3 (± 8,3) p = 0,000]. Los días de ventilación mecánica, de relajación, y mayor APACHE II mostraron una correlación negativa significativa con las variables de resultado (p = 0,000). Conclusiones Los pacientes con enfermedad severa por COVID-19 que recibieron intervención de fisioterapia mostraron cambios significativos en la funcionalidad y en la fuerza muscular. Los pacientes que requirieron ventilación mecánica presentaron mayor compromiso funcional (AU)

Introduction The critically ill patient hospitalized in intensive care unit (ICU), has a higher risk of deterioration in physical function. One way to counteract its related to early physiotherapy intervention, but there are few reports in patients with severe disease from COVID-19. Objective To describe the compromise and change in functionality and muscle strength in patients with COVID-19 who received early physiotherapy intervention in ICU until hospital discharge and compare the evolution according to whether or not they received invasive mechanical ventilation. Methodology Retrospective study of patients with COVID-19 admitted to the ICU between March and September 2020 and received physiotherapy intervention. Functionality was assessed with the Barthel Index (BI) and muscle strength with the Medical Research Council Sum Score (MRC-SS), which were measured by the physiotherapist at two moments, upon discharge from ICU and from hospitalization. For the correlations, a value P<.05 was considered significant. Results Sixty-six records were reviewed; the mean age was 53.3 (32±11.5) years; 32 (48.5%) required mechanical ventilation. Compromise in functionality and muscle strength was observed, with progressive improvement before hospital discharge: IB [64.1 (± 34.7) vs. 87.7 (± 18.4), P = .000], MRC-SS [40.5 (± 11) vs. 48 (± 9), P = .000]. The group of ventilated patients presented greater compromise: IB [34.2 (± 24.7) vs. 76.7 (± 21.2), P = .000] and MRC-SS [31.5 (± 7.2) vs. 42.3 (± 8.3), P = .000]. The days of mechanical ventilation, relaxation, and higher APACHE II showed a significant negative correlation with the outcome variables (P = .000). Conclusions Patients with severe disease from COVID-19 who received physiotherapy intervention, showed significant changes in functionality and muscle strength. The patients who required mechanical ventilation presented greater functional compromise (AU)

A Review of Formulations, Boundary Value Problems and Solutions for Numerical Computation of Transcranial Magnetic Stimulation Fields.

Since the inception of the transcranial magnetic stimulation (TMS) technique, it has become imperative to numerically compute the distribution of the electric field induced in the brain. Various models of the coil-brain system have been proposed for this purpose. These models yield a set of formulations and boundary conditions that can be employed to calculate the induced electric field. However, the literature on TMS simulation presents several of these formulations, leading to potential confusion regarding the interpretation and contribution of each source of electric field. The present study undertakes an extensive compilation of widely utilized formulations, boundary value problems and numerical solutions employed in TMS fields simulations, analyzing the advantages and disadvantages associated with each used formulation and numerical method. Additionally, it explores the implementation strategies employed for their numerical computation. Furthermore, this work provides numerical expressions that can be utilized for the numerical computation of TMS fields using the finite difference and finite element methods. Notably, some of these expressions are deduced within the present study. Finally, an overview of some of the most significant results obtained from numerical computation of TMS fields is presented. The aim of this work is to serve as a guide for future research endeavors concerning the numerical simulation of TMS.

Climate change, large fires, and cultural landscapes in the mediterranean basin: An analysis in southern Spain.

Understanding the factors that influence fire regimes in Mediterranean climates is essential to reduce their risk. This research uses Climate Hazards Group InfraRed Precipitation with Station (CHIRPS) and Moderate-Resolution Imaging Spectroradiometer (MODIS) satellite resources to evaluate recent changes in land surface temperature, precipitation, and vegetation and their effects in the occurrence of large fires in the Mediterranean Basin. The results of the analysis of 335 fire events occurred in southern Spain from 2001 to 2020 show an increase in hazardous meteorological factors linked to droughts and thermal anomalies. The study also examines the potential of preserving traditional landscapes to minimize such risk. In fact, the maintenance and recovering of traditional agro-pastoral activities is an effective option to reduce flammability and increase the resilience of cultural landscapes in hazardous climatic conditions.

The effect of an abdominal binder on postoperative outcome after open incisional hernia repair in sublay technique: a multicenter, randomized pilot trial (ABIHR-II).

INTRODUCTION: Although the evidence is minimal, an abdominal binder is commonly prescribed after open incisional hernia repair (IHR) to reduce pain. This study aimed to investigate this common postoperative treatment. METHODS: The ABIHR-II trial was a national prospective, randomized, multicenter non-AMG/MPG pilot study with two groups of patients (wearing an abdominal binder (AB) for 2 weeks during daytime vs. not wearing an AB following open IHR with the sublay technique). Patient enrollment took place from July 2020 to February 2022. The primary endpoint was pain at rest on the 14th postoperative day (POD) using the visual analog scale (VAS). The use of analgesics was not systematically recorded. Mixed-effects linear regression models were used. RESULTS: A total of 51 individuals were recruited (25 women, 26 men; mean age 61.4 years; mean body mass index 30.65 kg/m2). The per-protocol analysis included 40 cases (AB group, n = 21; No-AB group, n = 19). Neither group showed a significant difference in terms of pain at rest, limited mobility, general well-being, and seroma formation and rate. Patients among the AB group had a significantly lower rate of surgical site infection (SSI) on the 14th POD (AB group 4.8% (n = 1) vs. No-AB group 27.8% (n = 5), p = 0.004). CONCLUSION: Wearing an AB did not have an impact on pain and seroma formation rate but it may reduce the rate of postoperative SSI within the first 14 days after surgery. Further trials are mandatory to confirm these findings.

Analysis of the impact of green urban areas in historic fortified cities using Landsat historical series and Normalized Difference Indices.

Urban green areas minimize the negative effects of climatic change and improve the sustainability of historic cities. Despite this, green areas have traditionally been considered a threat to heritage buildings because they cause humidity changes, that accelerate degradation processes. Within this context, this study evaluates the trends in the inclusion of green areas in historic cities and the effects it causes on humidity and conservation of earthen fortifications. To achieve this goal, vegetative and humidity information has been obtained since 1985 from Landsat satellite images. The historical series of images has been statistically analysed in Google Earth Engine to obtain maps that show the means, 25th, and 75th percentiles of the variations registered in the last 35 years. The results allow visualizing spatial patterns and plotting the seasonal and monthly variations. In the decision-making process, the proposed method allows to monitor whether the presence of vegetation is an environmental degradation agent in the nearby earthen fortifications.The analysis of the historic fortified cities of Seville and Niebla (Spain) shows a gradual increase in green areas and an interest in locating them near the earthen fortifications. The impact on the fortifications is specific to each type of vegetation and can be positive or negative. In general, the low humidity registered indicates low danger, and the presence of green areas favours drying after heavy rains. This study suggests that increasing green spaces to historic cities does not necessarily endanger the preservation of earthen fortifications. Instead, managing both heritage sites and urban green areas together can encourage outdoor cultural activities, reduce the impacts of climate change, and enhance the sustainability of historic cities.

[The morbidity of the posterior iliac crest bone graft harvesting could be an overestimated fact. Study in patients with open posterolateral lumbar fusion]. / La morbilidad del sitio donante de injerto de cresta ilíaca posterior podría ser un hecho sobreestimado. Estudio en pacientes con fusión lumbar posterolateral abierta.

INTRODUCTION: spinal fusion is used to treat, among other pathologies, the degenerative intervertebral disc disease. Autologous iliac crest bone grafting is the golden standard treatment for increasing the rate of fusion; however, it isn't free of complications. OBJECTIVES: to investigate whether patients who have posterior iliac crest graft harvesting and are blinded to the donor site, can identify from which side the graft was harvested, and whether the intensity of this pain is related to the amount of graft obtained. MATERIAL AND METHODS: prospective, experimental, randomized and comparative, single-blind study. Adult patients who underwent primary instrumented open posterolateral lumbar fusion with autologous iliac crest bone graft between July 2019 and April 2020 were included. Patients were divided into two randomized groups. The amount of graft to be harvested was according to surgical needs. The patients were asked about pain according to the visual analogue scale in the first, third and sixth months after surgery, always requesting that the most painful side be identified. RESULTS: a total of 44 patients (n = 23 right crest, n = 21 left crest) were analyzed. Most patients were unable to identify the side from which the bone graft was harvested, with a statistically significant difference (p-value 0.0001). CONCLUSION: iliac crest bone graft harvesting is an effective and safe procedure that improves the rates of fusion without increasing the patient's morbidity.

INTRODUCCIÓN: la fusión espinal es utilizada para tratar, entre otras patologías, las enfermedades degenerativas discales. El injerto óseo autólogo de cresta ilíaca es el estándar de oro para aumentar las probabilidades de fusión; sin embargo, no está exento de complicaciones. OBJETIVOS: investigar si los pacientes a los que se les recolecta injerto de cresta ilíaca posterior y son cegados al lado del sitio donante, pueden identificar de qué lado se tomó dicho injerto y si la intensidad de este dolor está en relación con la cantidad de injerto obtenido. MATERIAL Y MÉTODOS: trabajo prospectivo, experimental, aleatorizado y comparativo, simple ciego. Se incluyeron pacientes adultos operados entre Julio de 2019 hasta Abril de 2020, a los cuales se les realizó una cirugía primaria de artrodesis lumbar posterolateral abierta instrumentada, con colocación de injerto óseo autólogo de cresta ilíaca. Se dividió a los pacientes en dos grupos aleatorizados. La cantidad de injerto a recolectar fue de acuerdo a las necesidades quirúrgicas. Se interrogó por el dolor según escala visual analógica al primer, tercer y sexto mes de la cirugía, siempre solicitando que se identifique el lado más doloroso. RESULTADOS: se analizaron 44 pacientes (n = 23 cresta derecha, n = 21 cresta izquierda). La mayoría de los pacientes no lograron identificar el lado del cual se obtuvo el injerto óseo, con una diferencia estadística ampliamente significativa (p = 0.0001). CONCLUSIÓN: la obtención de injerto óseo de cresta ilíaca es un procedimiento efectivo y seguro, que mejora las probabilidades de fusión sin aumentar la morbilidad del paciente.

[Is the Michigan State University lumbar disc herniation classification reliable among spine surgeons?] / ¿Es confiable la clasificación de la hernia de disco lumbar de la Universidad Estatal de Míchigan entre cirujanos de columna?

INTRODUCTION: there are numerous classifications for herniated discs, such classifications guide professionals about the severity of the lesion, the possible clinical picture of the patient, the most appropriate treatment and are undoubtedly a predictive tool to project the possible results of the therapies used. The main purpose of this work is to validate the inter- and intra-observer reliability of the Michigan State University (MSU) classification among the spine surgeons of our service and also to know the risk factors associated with the patients who underwent lumbar discectomy, the most affected disc level, the clinical presentation and the previous treatments performed in the patients treated by our team. MATERIAL AND METHODS: 50 nuclear magnetic resonance (MR) images in axial T2 section corresponding to the "maximum disc herniation" level were selected from patients diagnosed and submitted to meningo-radicular release surgery and single level lumbar discectomy retrospectively in the last two years from our database; these images were distributed among three spine surgeons of our institution. The three spine surgeons gave a specific classification for each MR image based on the MSU classification, then at an interval of seven days one of the three surgeons reclassified the images. The degree of agreement between surgeons was analyzed by calculating interobserver and intraobserver reliability using kappa statistical analysis. RESULTS: the analysis of the kappa coefficient indicated that most of the comparisons by observer gave a "good" concordance strength, the kappa index was higher than 0.64 in all the possible comparisons of the observations. In relation to the number of coincidences, in 60% of the patients there was a total coincidence between the three surgeons, with two coincidences in 24%, and in 16% there was no coincidence at all. For the intraobserver analysis the kappa index was 0.953 with a very good concordance strength, the observed agreement was 96%. CONCLUSION: our research shows a good reliability in the MSU classification among spine surgeons of our institution, as well as very good when reclassifying the intraobserver; we believe that having a sagittal MRI slice to classify them would be very useful, more research is needed to give a prognostic value to the location and size of the hernia and its relation with the surgical indication.

INTRODUCCIÓN: existen numerosas clasificaciones para las hernias de disco, dichas clasificaciones orientan a los profesionales acerca de la gravedad de la lesión, del posible cuadro clínico del paciente, del tratamiento más adecuado y constituyen, sin lugar a dudas, una herramienta predictiva para proyectar los posibles resultados de las terapias utilizadas. El propósito principal de este trabajo es validar la confiabilidad interobservador e intraobservador de la clasificación de la Universidad Estatal de Míchigan (MSU) entre los cirujanos de columna de nuestro servicio y además, conocer los factores de riesgo asociados con los pacientes que fueron intervenidos con discectomía lumbar, el nivel de disco más afectado, la presentación clínica y los tratamientos previos realizados en los pacientes tratados por nuestro equipo. MATERIAL Y MÉTODOS: fueron seleccionadas 50 imágenes de resonancia magnética nuclear (RM) en el corte axial de T2 correspondiente al nivel de "hernia discal máxima" de pacientes diagnosticados y sometidos a cirugía de liberación meningo radicular y discectomía lumbar de un solo nivel de manera retrospectiva en los últimos dos años de nuestra base de datos, estas imágenes se distribuyeron entre tres cirujanos especialistas en columna de nuestra institución. Los tres cirujanos de columna dieron una clasificación específica para cada imagen de RM basada en la clasificación de la MSU, luego en un intervalo de siete días uno de los tres cirujanos volvió a clasificar las imágenes. El grado de acuerdo entre los cirujanos se analizó calculando la confiabilidad interobservador e intraobservador mediante el análisis estadístico kappa. RESULTADOS: el análisis del coeficiente de kappa indicó que en la mayoría de las comparaciones por observador dieron una fuerza de concordancia "buena", el índice de kappa fue superior a 0.64 en todas las posibles comparaciones de las observaciones. En relación con la cantidad de coincidencias, en 60% de los pacientes hubo una coincidencia total entre los tres cirujanos, con dos coincidencias 24% y en 16% no hubo ninguna coincidencia. Para el análisis intraobservador el índice de kappa fue de 0.953 con una fuerza de concordancia muy buena, el acuerdo observado fue de 96%. CONCLUSIÓN: nuestra investigación demuestra una confiabilidad buena en la clasificación de la MSU entre cirujanos de columna de nuestra institución así como muy buena al reclasificar el intraobservador. Creemos que tener un corte sagital de RM para clasificarlas sería de gran utilidad. Se necesitan más investigaciones para dar un valor pronóstico a la ubicación y tamaño de la hernia y su relación con la indicación quirúrgica.

Dientes supernumerarios: reporte de un caso / Supernumerary teeth: report of a case

Los dientes supernumerarios son unidades dentales que numéricamente exceden la cantidad de dientes normal, un fenómeno también conocida como hiperdontia, los dientes supernumerarios más comunes son mesiodens, que ocurren entre los incisivos centrales. El presente artículo tiene como objetivo describir un reporte de caso de una paciente de género femenino, de 21 años de edad, que presenta 13 dientes incluidos, de los cuales 6 son supernumerarios, los mismos que fueron extraídos en dos tiempos quirúrgicos. (AU)

Supernumerary teeth are dental units that numerically exceed the normal number of teeth, a phenomenon also known as hiperdontia. The most common supernumerary teeth are mesiodens, which occur between the central incisors. This article aims to describe a case report of a female patient, 21 yearsold, who has 13 included teeth, of which 6 are supernumerary, thesameones that were extracted in two surgical times. (AU)

Impacts of an early childhood obesity prevention program in Mexico.

The Healthy Change Program aimed to improve the accuracy of maternal perceptions of children's weight (MPCW), maternal feeding style (MFS) and feeding practices. Using a randomized control trial design, the intervention group received 4-weekly group sessions focusing on MPCW, MFS and healthy behaviors. The control group received the same dose of attention-control sessions on food hygiene. Data were collected at the baseline and at the end of the program via self-administered questionnaires and anthropometric measurements. Participants included 294 mother-child dyads with 149 in the intervention group and 145 in the control group. The accuracy of MPCW significantly increased at the study end point in the intervention group (57.0-67.1%, P < 0.05) but not in the control group (67.6-69.7%, P > 0.05), with no between-group difference in pre- and post-change (P > 0.05). At the study end point, more mothers of overweight and obese children in the intervention group had accurate MPCW than their control counterparts (31.4% versus 11.1%, P < 0.01). The intervention group had a shift toward an authoritative style at the study end point (17.4% versus 26.2%, P < 0.001) and favorable changes in feeding practices. The Healthy Change Program contributed to improving the accuracy of MPCW and shifts toward favorable MFS and feeding practices.

¿Es confiable la clasificación de la hernia de disco lumbar de la Universidad Estatal de Míchigan entre cirujanos de columna? / Is the Michigan State University lumbar disc herniation classification reliable among spine surgeons?

Resumen: Introducción: Existen numerosas clasificaciones para las hernias de disco, dichas clasificaciones orientan a los profesionales acerca de la gravedad de la lesión, del posible cuadro clínico del paciente, del tratamiento más adecuado y constituyen, sin lugar a dudas, una herramienta predictiva para proyectar los posibles resultados de las terapias utilizadas. El propósito principal de este trabajo es validar la confiabilidad interobservador e intraobservador de la clasificación de la Universidad Estatal de Míchigan (MSU) entre los cirujanos de columna de nuestro servicio y además, conocer los factores de riesgo asociados con los pacientes que fueron intervenidos con discectomía lumbar, el nivel de disco más afectado, la presentación clínica y los tratamientos previos realizados en los pacientes tratados por nuestro equipo. Material y métodos: Fueron seleccionadas 50 imágenes de resonancia magnética nuclear (RM) en el corte axial de T2 correspondiente al nivel de «hernia discal máxima¼ de pacientes diagnosticados y sometidos a cirugía de liberación meningo radicular y discectomía lumbar de un solo nivel de manera retrospectiva en los últimos dos años de nuestra base de datos, estas imágenes se distribuyeron entre tres cirujanos especialistas en columna de nuestra institución. Los tres cirujanos de columna dieron una clasificación específica para cada imagen de RM basada en la clasificación de la MSU, luego en un intervalo de siete días uno de los tres cirujanos volvió a clasificar las imágenes. El grado de acuerdo entre los cirujanos se analizó calculando la confiabilidad interobservador e intraobservador mediante el análisis estadístico kappa. Resultados: El análisis del coeficiente de kappa indicó que en la mayoría de las comparaciones por observador dieron una fuerza de concordancia «buena¼, el índice de kappa fue superior a 0.64 en todas las posibles comparaciones de las observaciones. En relación con la cantidad de coincidencias, en 60% de los pacientes hubo una coincidencia total entre los tres cirujanos, con dos coincidencias 24% y en 16% no hubo ninguna coincidencia. Para el análisis intraobservador el índice de kappa fue de 0.953 con una fuerza de concordancia muy buena, el acuerdo observado fue de 96%. Conclusión: Nuestra investigación demuestra una confiabilidad buena en la clasificación de la MSU entre cirujanos de columna de nuestra institución así como muy buena al reclasificar el intraobservador. Creemos que tener un corte sagital de RM para clasificarlas sería de gran utilidad. Se necesitan más investigaciones para dar un valor pronóstico a la ubicación y tamaño de la hernia y su relación con la indicación quirúrgica.

Abstract: Introduction: There are numerous classifications for herniated discs, such classifications guide professionals about the severity of the lesion, the possible clinical picture of the patient, the most appropriate treatment and are undoubtedly a predictive tool to project the possible results of the therapies used. The main purpose of this work is to validate the inter- and intra-observer reliability of the Michigan State University (MSU) classification among the spine surgeons of our service and also to know the risk factors associated with the patients who underwent lumbar discectomy, the most affected disc level, the clinical presentation and the previous treatments performed in the patients treated by our team. Material and methods: 50 nuclear magnetic resonance (MR) images in axial T2 section corresponding to the «maximum disc herniation¼ level were selected from patients diagnosed and submitted to meningo-radicular release surgery and single level lumbar discectomy retrospectively in the last two years from our database; these images were distributed among three spine surgeons of our institution. The three spine surgeons gave a specific classification for each MR image based on the MSU classification, then at an interval of seven days one of the three surgeons reclassified the images. The degree of agreement between surgeons was analyzed by calculating interobserver and intraobserver reliability using kappa statistical analysis. Results: The analysis of the kappa coefficient indicated that most of the comparisons by observer gave a «good¼ concordance strength, the kappa index was higher than 0.64 in all the possible comparisons of the observations. In relation to the number of coincidences, in 60% of the patients there was a total coincidence between the three surgeons, with two coincidences in 24%, and in 16% there was no coincidence at all. For the intraobserver analysis the kappa index was 0.953 with a very good concordance strength, the observed agreement was 96%. Conclusion: Our research shows a good reliability in the MSU classification among spine surgeons of our institution, as well as very good when reclassifying the intraobserver; we believe that having a sagittal MRI slice to classify them would be very useful, more research is needed to give a prognostic value to the location and size of the hernia and its relation with the surgical indication.

Traumatismo toracolumbar: fijación in situ vs descompresión y fijación en fracturas por estallido con compromiso neurológico / Thoracolumbar trauma: in situ fixation vs decompression and fixation in neurologically involved burst fractures

Resumen: Las fracturas por estallido toracolumbar son un gran desafío para los cirujanos de columna, es por ello que el objetivo de este estudio fue realizar una revisión sistemática analizando la literatura actual respecto a los diferentes factores a tener en cuenta en el manejo de las mismas. Material y métodos: Búsqueda sistemática en los sitios PubMed, Cochrane, MedlinePlus. «Thoracolumbar Burst Fractures¼ fueron las palabras claves. Se analizaron los títulos, resúmenes y texto completo a partir de dos observadores independientes. Resultados: Seis estudios han sido incluidos, cinco (83.33%) fueron de cohorte prospectivos y sólo uno (16.67%) retrospectivo. Hubo un total de 289 pacientes entre todas las muestras. La media de edad fue 38.48 años y la relación respecto al sexo fue masculino-femenino de 1.7:1. Conclusión: Las fracturas por estallido toracolumbar siguen siendo controversiales en su tratamiento con bibliografía publicada de bajo nivel de evidencia y sin establecer un consenso en el momento de la toma de decisiones con diferentes opciones según la experiencia y preferencia del cirujano. Sin embargo, la mayoría de los mismos se inclinan hacia el tratamiento con fijación posterior de segmento corto pero sin seguimiento a largo plazo. Respecto al déficit neurológico, la descompresión quirúrgica logró consenso entre todos los cirujanos.

Abstract: Thoracolumbar burst fractures are a great challenge for spine surgeons and that is why the aim of this study was to perform a systematic review analyzing the current literature regarding the different factors to take into account in their management. Material and methods: Systematic search in PubMed, Cochrane, MedlinePlus sites. «Thoracolumbar Burst Fractures¼ were the keywords. Titles, abstracts and full text were analyzed from two independent observers. Results: Six studies were included, five (83.33%) were prospective cohort studies and only one (16.67%) was retrospective. There were a total of 289 patients among all samples. The mean age was 38.48 years and the sex ratio was male to female of 1.7:1. Conclusion: Thoracolumbar burst fractures remain controversial in their treatment with published literature of low level of evidence and without establishing a consensus at the time of decision making with different options depending on the surgeon's experience and preference. However, most of them are inclined towards treatment with short segment posterior fixation but without long-term follow-up. Regarding neurological deficit, surgical decompression achieved consensus among all surgeons.

Spread of the fascioliasis endemic area assessed by seasonal follow-up of rDNA ITS-2 sequenced lymnaeid populations in Cajamarca, Peru.

Fascioliasis is a worldwide emerging snail-borne zoonotic trematodiasis with a great spreading capacity linked to animal and human movements, climate change, and anthropogenic modifications of freshwater environments. South America is the continent with more human endemic areas caused by Fasciola hepatica, mainly in high altitude areas of Andean regions. The Peruvian Cajamarca area presents the highest human prevalences reported, only lower than those in the Bolivian Altiplano. Sequencing of the complete rDNA ITS-2 allowed for the specific and haplotype classification of lymnaeid snails collected in seasonal field surveys along a transect including 2007-3473 m altitudes. The species Galba truncatula (one haplotype preferentially in higher altitudes) and Pseudosuccinea columella (one haplotype in an isolated population), and the non-transmitting species Lymnaea schirazensis (two haplotypes mainly in lower altitudes) were found. Climatic seasonality proved to influence G. truncatula populations in temporarily dried habitats, whereas L. schirazensis appeared to be more climatologically independent due to its extreme amphibious ecology. Along the southeastern transect from Cajamarca city, G. truncatula and L. schirazensis shared the same site in 7 localities (46.7% of the water collections studied). The detection of G. truncatula in 11 new foci (73.3%), predominantly in northern localities closer to the city, demonstrate that the Cajamarca transmission risk area is markedly wider than previously considered. Lymnaea schirazensis progressively increases its presence when moving away from the city. Results highlight the usefulness of lymnaeid surveys to assess borders of the endemic area and inner distribution of transmission foci. Similar lymnaeid surveys are still in need to be performed in the wide northern and western zones of the Cajamarca city. The coexistence of more than one lymnaeid transmitting species, together with a morphologically indistinguishable non-transmitting species and livestock movements inside the area, conform a complex scenario which poses difficulties for the needed One Health control intervention.

Tuberculosis del sistema nervioso central / Tuberculosis of the central nervous system

RESUMEN La meningitis por Mycobacterium tuberculosis es la forma extrapulmonar más letal de la tuberculosis activa, con alta prevalencia en los países en desarrollo, lo que constituye un problema de salud pública. Las formas de presentación extrapulmonar que comprometen el sistema nervioso incluyen la tuberculosis meníngea, el granuloma tuberculoso, el absceso tuberculoso y la radiculomielitis, con una presentación clínica inespecífica que dificulta su oportuno diagnóstico, sumado a la falta de pruebas rápidas con alta sensibilidad y especificidad, el alto costo y la pobre asequibilidad a las pruebas en muchos países. El diagnóstico se basa en pruebas microbiológicas, moleculares y en aquellas basadas en la respuesta del huésped. El diagnóstico microbiológico se basa en la tinción de Ziehl-Neelsen y en el cultivo, este último considerado durante mucho tiempo la prueba diagnóstica de oro. El diagnóstico molecular es más preciso utilizando las pruebas de amplificación de ácidos nucleicos, la reacción en cadena de la polimerasa, la prueba de GeneXpert MTB/RIF y la prueba Xpert MTB/ RIF Ultra. Debido a la ausencia de una prueba rápida, existen escalas que ayudan a orientar el diagnóstico del paciente, dentro de las cuales merecen citarse la de Thwaites y la de Marais. El tratamiento de la tuberculosis de cepas sensibles incluye un esquema estructurado con isoniazida, rifampicina, pirazinamida y etambutol, sin embargo, en la actualidad la resistencia a los antimicrobianos constituye un problema, por lo cual el tratamiento en la tuberculosis multirresistente debe ser individualizado, con un régimen de tratamiento prolongado.

SUMMARY Mycobacterium tuberculosis meningitis is the most lethal extrapulmonary form of active tuberculosis with high prevalence in developing countries, which constitutes a public health problem. The extrapulmonary presentation that compromise the nervous system include meningeal tuberculosis, tuberculous granuloma, tuberculosis abscess and radiculomyelitis. A nonspecific clinical presentation, the lack of rapid tests with high sensitivity and specificity, the high cost and poor affordability of testing in many countries make the diagnosis more complicated. The diagnosis is based on microbiological, molecular, and host response based testing. Microbiological diagnosis is based on Ziehl - Neelsen staining and culture, the latter long considered the gold standard diagnostic test. Molecular diagnosis is more accurate using nucleic acid amplification tests, the chain reaction of polymerase, the GeneXpert MTB / RIF test, and the Xpert MTB / RIF Ultra test. Given the absence of a rapid test, there are scales that help guide the patient's diagnosis, within which the Thwaites Scale and the Marais Scale deserve to be mentioned. The treatment of tuberculosis of susceptible strains includes a structured regimen with isoniazid, rifampicin, pyrazinamide and ethambutol, however, antimicrobial resistance is currently a problem for which the treatment of multidrug-resistant tuberculosis must be individualized, with a long-term treatment regimen.

Short- and long-term effects of temporary early cow-calf separation or restricted suckling on well-being and performance in zebu cattle.

Information on weaning techniques in the tropics is scarce, particularly regarding the long-term effect of temporary early cow-calf separation or restricted suckling. Therefore, we studied the effects of these two handling practices on well-being and performance at 150 days postpartum in fifteen zebu cow-calf pairs randomly assigned to three treatments. Continuous suckling (CS) where calves remained with their dams from birth to weaning; restricted suckling (RS) calves were allowed to suckle 30 min/day from Day 34 until weaning at Day 150 and kept separated the rest of the time; temporary separation (TS) calves were separated for 72 h from their dams from Day 33 to 36 but remained with their dams the rest of the time. Blood samples and behavioral data were collected on Days 32-36 (1st period) and 149-153 (2nd period). In the 1st period, a greater percentage of RS and TS calves were observed close to the fence line (<10 m) that separated them from their dams (P < 0.0001) and vocalized more than CS calves (P < 0.0001), while in the 2nd period, RS calves had the highest cortisol concentration and vocalization rate (P < 0.05). Similarly, during the 1st period, a greater percentage of RS and TS cows were observed close to the fence line than CS cows (P < 0.0001), with TS cows vocalizing the most (P = 0.001). In the 2nd period, RS cows had greater cortisol concentration than TS (P = 0.037) and CS cows (P = 0.003). More TS and CS cows than RS were observed close to the fence line (P = 0.03 and P = 0.05). On Day 150, TS calves and cows vocalized more than RS and CS animals (P < 0.0001). Before calf-cow separation, 27 out of 45 cows were cycling (CS = 10; RS = 6; TS = 11). After separation, 12 of the remaining 18 cows resumed ovarian activity (CS = 3; RS = 5; TS = 4), and all cows were cycling after estrous synchronization treatment. The pregnancy rate was similar between CS, RS, and TS (60, 53, and 60% respectively). In conclusion, temporary separation increased calf distress response to definitive weaning even four months later, while restricted suckling seemed to reduce it.

Aplicación, comprobación y corrección a partir de un checklist elaborado con algunas de las recomendaciones («hacer y no hacer») de los grupos de trabajo de la SEMICYUC / Application, verification and correction from an elaborate checklist with some of the recommendations («do and do not do») of the SEMICYUC working groups

Objetivo Con algunas de las recomendaciones de los grupos de trabajo de la SEMICYUC elaboramos un checklist y lo aplicamos en 2 periodos. Analizamos su comportamiento como herramienta de mejora en la seguridad. Diseño Estudio longitudinal, comparativo pre- y postintervención. Ámbito Unidad de Cuidados Intensivos de un hospital universitario de 400 camas. Pacientes Serie de casos aleatorios en 2 periodos separados por 6 meses. Intervenciones Elaboramos un checklist con 24 indicadores seleccionados que aplicamos de forma aleatoria a 50 pacientes. La verificación fue conducida por un profesional no relacionado con el cuidado (prompter). Analizamos los resultados y el índice de cumplimiento y realizamos medidas correctoras con formación. Con 6 meses de preparación, aplicamos de nuevo el checklist aleatorio a 50 pacientes (periodo postintervención) y comparamos el índice de cumplimiento entre ambos. Resultados No observamos diferencias en características demográficas ni en la evolución entre periodos. El índice de cumplimiento en el periodo basal fue de 0,86±0,12 y en el periodo de postintervención de 0,91±0,52; p=0,023. Obtuvimos un índice de cumplimiento aceptable de los 24 indicadores, pero en el basal en 5 recomendaciones el índice de cumplimiento fue menor a 0,85. Estos incumplimientos detectados se trabajaron formativamente en la segunda fase. En el checklist postintervención observamos una mejoría en el cumplimiento de las recomendaciones. Conclusiones El checklist utilizado para comprobar el cumplimiento de una selección de recomendaciones de la SEMICYUC aplicado y moderado por un prompter fue un instrumento útil que permitió establecer puntos de mejora en la atención de los pacientes de una unidad de cuidados intensivos, aumentando la calidad y la seguridad. (AU)

Objective Based on some of the recommendations of the SEMICYUC working groups, we developed a checklist and applied it in 2 periods, analyzing their behavior as a tool for improving safety. Design A comparative pre- and post-intervention longitudinal study was carried out. Setting The Intensive Care Unit (ICU) of a 400-bed university hospital. Patients Random cases series in 2 periods separated by 6 months. Interventions We developed a checklist with 24 selected indicators that were randomly applied to 50 patients. Verification was conducted by a professional not related to care (prompter). We analyzed the results and compliance index and carried out corrective measures with training. With 6 months of preparation, we again applied the random checklist to 50 patients (post-intervention period) and compared the compliance indexes between the two timepoints. Results There were no differences in demographic characteristics or evolution between the periods. The compliance index at baseline was 0.86±0.12 versus 0.91±0.52 in the post-intervention period (P=.023). An acceptable compliance index was obtained with the 24 indicators, though at baseline the compliance index was<0.85 for 5 recommendations. These detected non-compliances were worked upon through training in the second phase of the study. The post-intervention checklist evidenced improvement in compliance with the recommendations. Conclusions The checklist used to assess compliance with a selection of recommendations of the SEMICYUC applied and moderated by a prompter was seen to be a useful instrument allowing us to identify points for improvement in the management of Intensive Care Unit patients, increasing the quality and safety of care. (AU)

Hallazgos ecográficos para la determinación de nódulos tiroideos malignos / Ultrasound findings for the determination of malignant thyroid nodules

Resumen Introducción: Los nódulos tiroideos son un crecimiento localizado en el tejido tiroideo, aproximadamente el 8 % son malignos, y el ultrasonido es el método ideal para detectarlos. Objetivo: Determinar cuáles son los hallazgos ecográficos que pueden sugerir una mayor probabilidad de malignidad del nódulo tiroideo. Metodología: Estudio descriptivo de tipo corte transversal en pacientes con nódulo tiroideo en una institución prestadora de salud de Neiva. Resultados: Se evaluaron 63 pacientes con un promedio de edad de 52 años, 95 % fueron femeninos y el 5 % masculinos. El 71 % presentaron nódulos tiroideos benignos, y el 10 % nódulos malignos. En el 100 % de los nódulos tiroideos malignos se encontró vascularidad aumentada, microcalcificaciones, adenopatías asociadas, bordes irregulares y componente sólido, y los hallazgos con respecto a hipoecogenicidad y diámetro anteroposterior mayor al transverso (más alto que ancho), se encontró en el 83 % siendo estadísticamente significativos. La sensibilidad de los hallazgos ecográficos supera el 80 %, excepto la variable "tamaño del nódulo mayor a 1 centímetro". Conclusiones: Los hallazgos ecográficos como adenopatías y el diámetro anteroposterior mayor al transverso son indicadores potenciales de nódulos tiroideos malignos, el tamaño mayor a un centímetro no siempre es predictor de malignidad, sin embargo debido al tamaño de la muestra en nuestro estudio no es posible generalizarlo como un factor determinante para la realización de biopsia, por ende recomendamos el seguimiento de los nódulos teniendo en cuenta los criterios ecográficos de malignidad y la clasificación TIRADS para tomar decisiones con respecto a las biopsias tiroideas.

Abstract Introduction: Thyroid nodules are a localized growth in the thyroid tissue, approximately 8% are malignant, and an ultrasound is the ideal method to detect them. Objective: Determine which are the ultrasound findings that may suggest an increased probability of thyroid nodule malignancy. Methodology: Descriptive cross-sectional study amongst patients with thyroid nodule in a healthcare institution in Neiva. Results: A total of 63 patients were evaluated with an average age of 52 years, 95% were female and 5% male. Seventy-one percent had benign thyroid nodules, and 10% malignant nodules. In 100% of malignant thyroid nodules, increased vascularity, microcalcifications, associated adenopathies, irregular borders and solid component were found, and the findings regarding hypoechogenicity and anteroposterior diameter greater than the transverse (higher than wide), were found in 83%, being statistically significant. The sensitivity of ultrasound findings exceeds 80%, except for the variable nodule size greater than 1 centimetre. Conclusions: Ultrasound findings such as adenopathies and anteroposterior diameters greater than the transverse one are potential indicators of malignant thyroid nodules, the size greater than one centimetre is not always a predictor of malignancy; however, due to the size of the sample in our study it is not possible to generalize it as a determining factor for biopsy. Therefore, we recommend monitoring the nodules considering the ultrasound criteria for malignancy and the TIRADS classification to make decisions regarding thyroid biopsies.

Relationship between type 2 diabetes mellitus and markers of cutaneous melanoma aggressiveness: an observational multicentric study in 443 patients with melanoma.

BACKGROUND: Some studies have suggested a relationship between type 2 diabetes mellitus (T2DM) and increased incidence of melanoma. Efforts are under way to identify preventable and treatable factors associated with greater melanoma aggressiveness, but no studies to date have examined the relationship between T2DM and the aggressiveness of cutaneous melanoma at diagnosis. OBJECTIVES: To explore potential associations between T2DM, glycaemic control and metformin treatment and the aggressiveness of cutaneous melanoma. METHODS: We conducted a cross-sectional multicentric study in 443 patients diagnosed with cutaneous melanoma. At diagnosis, all patients completed a standardized protocol, and a fasting blood sample was extracted to analyse their glucose levels, glycated haemoglobin concentration and markers of systemic inflammation. Melanoma characteristics and aggressiveness factors [Breslow thickness, ulceration, tumour mitotic rate (TMR), sentinel lymph node (SLN) involvement and tumour stage] were also recorded. RESULTS: The mean (SD) age of the patients was 55·98 (15·3) years and 50·6% were male. The median Breslow thickness was 0·85 mm. In total, 48 (10·8%) patients were diagnosed with T2DM and this finding was associated with a Breslow thickness > 2 mm [odds ratio (OR) 2·6, 95% confidence interval (CI) 1·4-4·9; P = 0·004)] and > 4 mm (OR 3·6, 95% CI 1·7-7·9; P = 0·001), TMR > 5 per mm2 (OR 4·5, 95% CI 1·4-13·7; P = 0·009), SLN involvement (OR 2·3, 95% CI 1-5·7; P = 0·038) and tumour stages III-IV (vs. I-II) (OR 3·4, 95% CI 1·6-7·4; P = 0·002), after adjusting for age, sex, obesity, alcohol intake and smoking habits. No significant associations emerged between glycated haemoglobin levels, metformin treatment and melanoma aggressiveness. CONCLUSIONS: T2DM, rather than glycaemic control and metformin treatment, is associated with increased cutaneous melanoma aggressiveness at diagnosis.

The negative pressure wound therapy may salvage the infected mesh following open incisional hernia repair.

BACKGROUND: s: Incisional hernias may occur in 10-25% of patients undergoing laparotomy. In cases of a surgical site infection (SSI) after incisional hernia repair (IHR) secondary operative intervention with mesh removal are often needed. There is only minimal data available in the literature regarding the treatment of a wound infection with negative pressure wound therapy (NPWT). Conducting the study at hand, we aimed to provide more evidence on this topic. METHODS: From April to June 2020 a monocentric retrospective study has been performed. Patients who underwent NPWT due to a SSI with mesh involvement following open IHR from 2007 to 2020 were included. The primary endpoint was the mesh removal rate in the end of NPWT. Main secondary endpoints were the duration of NPWT and the amount of NPWT procedures. RESULTS: The data of 30 patients were extracted. The average age was 65.9 years (9.9). A total of 13 individuals were male and 17 females. The BMI was on average 31.1 kg/m2 (4.9). All patients received a polypropylene mesh. The average duration of NPWT was 31.3 days (22.1). The first wound revision with initiation of a NPWT was conducted on average 31.1 days (34.0) after IHR. The average amount of NPWT procedures was 8.3 (7.2). In 5 of 30 patients (16.6%) the mesh was removed (Open sublay group n = 4 (36.34%) vs. open onlay group n = 1 (5.26%), p = 0.047). CONCLUSION: In cases of SSI following IHR the NPWT may facilitate mesh selvage. Further trials with a larger sample size are mandatory to confirm our hypothesis.