Radiología intervencionista en pediatría: no es un juego de niños / Pediatric interventional radiology: It's not a child's play

La radiología intervencionista pediátrica es una subespecialidad dinámica y en crecimiento. Las nuevas vías de formación en radiología intervencionista, el mantenimiento de las competencias con un pequeño volumen de casos o procedimientos complejos, la disponibilidad limitada de equipos y material pediátrico específico, los efectos de la sedación o de la anestesia sobre el neurodesarrollo y la protección radiológica suponen importantes retos y oportunidades.(AU)

Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials, the effects of sedation or anesthesia on neurodevelopment or radiological on neurodevelopment or radiation protection pose significant challenges and opportunities.(AU)

Paediatric interventional radiology: it's not child's play.

Pediatric interventional radiology is a dynamic and growing subspecialty. The new training pathways in interventional radiology, the maintenance of skills with a small volume of cases or complex procedures, the limited availability of specific pediatric equipment and materials pose significant challenges and opportunities.

Factors influencing teamwork in healthcare applicable to interventional and diagnostic radiology.

Teamwork in healthcare has been analysed extensively in the literature, mainly in acute healthcare settings such as the operating room, emergency room, and intensive care unit, with limited evidence related to diagnostic and interventional radiology. Multiple factors that affect teamwork in different domains have been described, such as communication, hierarchy, and distractions. Teamwork is an important patient safety, job satisfaction and patient outcome determinant, with interprofessional and interdisciplinary healthcare education playing a relevant role in the different domains affecting team performance. The aim of this article is to review the literature to describe domains and specific factors that influence teamwork in diagnostic and interventional radiology practice. This is of particular interest for radiologist involved in quality improvement and/or patient safety initiatives development and implementation. The review will conclude with a summary table highlighting the most important factors that, according to the authors, appear relevant to the radiology practice.

COVID-19 in donation and transplant.

SARS-CoV-2 infection has had a major impact on donation and transplantation. Since the cessation of activity two years ago, the international medical community has rapidly generated evidence capable of sustaining and increasing this neccesary activity. This paper analyses the epidemiology and burden of COVID-19 in donation and transplantation, the pathogenesis of the infection and its relationship with graft-mediated transmission, the impact of vaccination on donation and transplantation, the evolution of donation in Spain throughout the pandemic, some lessons learned in SARS-CoV-2 infected donor recipients with positive PCR and the applicability of the main therapeutic tools recently approved for treatment among transplant recipients.

Niveles de inseguridad alimentaria y características asociadas en mujeres gestantes de Colombia en el 2015 / Food insecurity levels and associated characteristics in pregnant women in Colombia in 2015

Introducción La inseguridad alimentaria es la incapacidad que tienen los hogares para adquirir alimentos inocuos, nutricionalmente adecuados que satisfagan las necesidades fisiológicas de una vida sana y activa. Objetivo Describir los niveles de inseguridad alimentaria y factores asociados en mujeres gestantes de Colombia. Metodología Estudio transversal-analítico; es un análisis secundario de la Encuesta de Situación Nutricional de Colombia del año 2015. Se evaluaron 1393 gestantes de entre 12 y 48 años, mediante la Escala Latinoamericana y Caribeña de Seguridad Alimentaria. Se examinaron características sociodemográficas, antropométricas y micronutrientes. Se realizó la descripción de la distribución de la inseguridad alimentaria por cada una de las variables seleccionadas, a través de frecuencias absolutas y porcentuales. Para estimar la asociación entre las diferentes características de interés y la inseguridad alimentaria se utilizaron modelos de regresión de Poisson multivariados. Resultados El 60,4% (IC95% 55,6-64,7%) de las gestantes residían en hogares con algún grado de inseguridad alimentaria; severa: 9,4% (IC95% 7,4-11,9%); moderado: 17,6% (IC95% 13,5-22,8%) y leve del 33,2% (IC95% 28,9-37,8%). Se encontró que las gestantes en la categoría negra/mulata/afrodescendiente (RP 1,22 IC95% 1,01-1,47), pertenecer al cuartil 1 de riqueza (RP 2,23 IC95% 1,41-3,68) y residir en la región Atlántica (RP 1,34; IC95%; 1,08-1,67) se asociaba con algún grado de inseguridad alimentaria. Conclusión Se identificó una alta proporción de gestantes residentes de hogares con algún grado de inseguridad alimentaria. Las gestantes de los bajos niveles socioeconómicos y aquellas pertenecientes a la etnia negra/mulata/afrodescendiente mostraron ser las principales características asociadas con residir en hogares con algún grado de inseguridad alimentaria (AU)

ntroduction Food insecurity is the inability of households to acquire safe, nutritionally adequate food that meets physiological needs for leading a healthy and active life. Objectiv To describe the levels of food insecurity and associated factors in pregnant women in Colombia. Methodolog Cross-sectional-analytical study; is a secondary analysis of the 2015 Nutritional Situation Survey of Colombia. 1393 pregnant women between 12 and 48 years old were examined. Food insecurity was assessed using the Latin American and Caribbean Food Security Scale. Sociodemographic, anthropometric and micronutrient characteristics were evaluated. The description of food insecurity distribution was made for each of the selected variables, through absolute and percentage frequencies. To estimate the association between the different variables and food insecurity, we used multivariate Poisson regression models. Results 60.4% (CI95% 55.6%–64,7%) of pregnant women resided in homes with some degree of food insecurity; severe: 9.4% (CI95% 7.4%–11.9%), moderate: 17.6% (CI95% 13.5%–22.8%) and light: 33.2% (CI95% 28.9%–37.8%); we found that Black/Mulatto/Afro-descendant pregnant women (PR 1.22 CI95% 1.01–1.47), belong to quartile 1 of wealth (PR 2.23 CI95% 1.41–3.68), and residing in the región Atlántica (PR 1.34 CI95% 1.08–1.67), was associated with some food insecurity level. Conclusion A high proportion of pregnant women living in households with some food insecurity level. The pregnant women of low socioeconomic levels and those belonging to the black/mulatto/Afro-descendant ethnic group showed to be the main characteristics associated with residing in households with some degree of food insecurity (AU)

[Food insecurity levels and associated characteristics in pregnant women in Colombia in 2015]. / Niveles de inseguridad alimentaria y características asociadas en mujeres gestantes de Colombia en el 2015.

INTRODUCTION: Food insecurity is the inability of households to acquire safe, nutritionally adequate food that meets physiological needs for leading a healthy and active life. OBJECTIVE: To describe the levels of food insecurity and associated factors in pregnant women in Colombia. METHODOLOGY: Cross-sectional-analytical study; is a secondary analysis of the 2015 Nutritional Situation Survey of Colombia. 1393 pregnant women between 12 and 48 years old were examined. Food insecurity was assessed using the Latin American and Caribbean Food Security Scale. Sociodemographic, anthropometric and micronutrient characteristics were evaluated. The description of food insecurity distribution was made for each of the selected variables, through absolute and percentage frequencies. To estimate the association between the different variables and food insecurity, we used multivariate Poisson regression models. RESULTS: 60.4% (CI95% 55.6%-64,7%) of pregnant women resided in homes with some degree of food insecurity; severe: 9.4% (CI95% 7.4%-11.9%), moderate: 17.6% (CI95% 13.5%-22.8%) and light: 33.2% (CI95% 28.9%-37.8%); we found that Black/Mulatto/Afro-descendant pregnant women (PR 1.22 CI95% 1.01-1.47), belong to quartile 1 of wealth (PR 2.23 CI95% 1.41-3.68), and residing in the región Atlántica (PR 1.34 CI95% 1.08-1.67), was associated with some food insecurity level. CONCLUSION: A high proportion of pregnant women living in households with some food insecurity level. The pregnant women of low socioeconomic levels and those belonging to the black/mulatto/Afro-descendant ethnic group showed to be the main characteristics associated with residing in households with some degree of food insecurity.

Agresores sexuales seriales en Colombia: dos estudios de casos de las ciudades de Bogotá y Cali / Serial sex offenders in Colombia: two case studies from the citiesof Bogotá and Cali

El presente artículo, luego de ilustrar al lector sobre la naturaleza de los agresores sexuales seriales, desarrolla puntualmente dos casos de estudio documentados por la Procuraduría Delegada para el Ministerio Público en Asuntos Penales y la Policía Nacional, extraídos de las líneas investigativas que implementan estas instituciones desde años atrás. Este ejercicio investigativo conforma un estudio de caso múltiple que busca ampliar el conocimiento disponible sobre la materia, haciendo los respectivos análisis frente a la naturaleza de los individuos que cometen esta clase de transgresiones y a sus dinámicas delincuenciales. Se encuentran los resultados de diferentes entrevistas, revisión de expediente judicial, aplicación de pruebas psicométricas en dos sujetos capturados y condenados por la comisión de agresiones sexuales de similares características. En ambos casos, el delito sexual es el objetivo de la actividad, en el que predomina amenaza con arma cortopunzante. En los dos casos estos comportamientos se presentan después de los 18 años, el sujeto (1) presenta 23 víctimas registradas en el sistema judicial, y el sujeto (2), 15 víctimas reconocidas; en cuanto a las características psicológicas, los dos tuvieron problemas en el acatamiento de normas, con baja tolerancia a la frustración y actitudes machistas durante su infancia y adolescencia.

Capacidad de investigación en obesidad infantil en Latinoamérica y en las poblaciones latinas de Estados Unidos: estado de la investigación, problemas, oportunidades y líneas de trabajo para el futuro / Research capacity in childhood obesity in Latin America and in the Latino populations of the United States: state of research, problems, opportunities and lines of work for the future

La obesidad infantil es un problema grave en Latinoamérica y entre la población latina de EE. UU. Para ser eficaces, las políticas de salud pública tienen que estar guiadas por evidencias contextuales pertinentes, lo cual exige una capacidad de investigación sostenida a través del tiempo. Los objetivos de este estudio son determinar la productividad de la investigación enfocada en las poblaciones latinas en Latinoamérica y Estados Unidos, y examinar los dominios de la capacidad de investigación (infraestructuras, programas de formación, mentoría, financiamiento y redes de contactos). Realizamos una revisión exploratoria de artículos indexados relacionados con la obesidad infantil publicados entre junio de 2015 y diciembre de 2019. Recabamos información sobre las percepciones de los investigadores latinoamericanos respecto a la capacidad de investigación en obesidad infantil a través de una encuesta en línea. Identificamos 612 artículos relacionados con la obesidad infantil (505 de Latinoamérica, 124 de EE. UU. y 17 de colaboraciones entre EE. UU. y Latinoamérica). Brasil, México, Chile, Colombia y Estados Unidos son los países con más publicaciones. Encontramos aproximadamente el mismo número de artículos sobre obesidad, nutrición y actividad física; sin embargo, observamos que la capacidad de investigación sobre actividad física está rezagada en otros dominios (formación en investigación, financiamiento y oportunidades para establecer contactos). Otras áreas de investigación complementarias, como el comportamiento sedentario, la ciencia de sistemas y los estudios de políticas, son poco frecuentes en Latinoamérica, pero más habituales en Estados Unidos, mientras que la investigación sobre el sueño es incipiente en ambas regiones. Para cumplir la promesa de crear un programa eficaz de colaboración transfronteriza para la prevención de la obesidad infantil será necesario invertir en todos los dominios de la capacidad de investigación y en todos los temas pertinentes.

Root morphology of mandibular molars: a cone-beam computed tomography study.

BACKGROUND: The aim of the study was to assess the number and anatomical classification of roots and root canals of first and second mandibular molars using cone-beam computed tomography (CBCT) in a Chilean population. MATERIALS AND METHODS: This study evaluated the CBCT scans of 289 patients aged between 14 and 86 years, obtaining a sample of 1022 mandibular first and second molars. The number of roots and root canals was evaluated according to the anatomical classification proposed by Ahmed in 2016. Data were analysed using Pearson's chi-squared test and ANOVA. RESULTS: Nine hundred fifty-one (93.05%) molars had two roots, while the remaining 71 (6.95%) molars had one root. The most frequent root and root canal morphologies found were: ²MM M² D¹ (29.65%), ²MM M²â»¹ D¹ (22.3%) and ²MM M¹ D¹ (13.4%) (M - mesial, D - distal), with a total of 32 different anatomical distributions. C-shaped canals were present in 56 molars and were more frequently found in women than in men (7.1% vs. 3.88%; p = 0.024). CONCLUSIONS: The analysis of internal anatomy using CBCT revealed a highly variable distribution of root canals. The most frequent morphology found in mandibular molars in a Chilean population was two roots and three canals.

Multilevel correlates of household anthropometric typologies in Colombian mothers and their infants.

BACKGROUND: The aim of this study was to establish the association of maternal, family, and contextual correlates of anthropometric typologies at the household level in Colombia using 2005 Demographic Health Survey (DHS/ENDS) data. METHODS: Household-level information from mothers 18-49 years old and their children <5 years old was included. Stunting and overweight were assessed for each child. Mothers were classified according to their body mass index. Four anthropometric typologies at the household level were constructed: normal, underweight, overweight, and dual burden. Four three-level [households (n = 8598) nested within municipalities (n = 226), nested within states (n = 32)] hierarchical polytomous logistic models were developed. Household log-odds of belonging to one of the four anthropometric categories, holding 'normal' as the reference group, were obtained. RESULTS: This study found that anthropometric typologies were associated with maternal and family characteristics of maternal age, parity, maternal education, and wealth index. Higher municipal living conditions index was associated with a lower likelihood of underweight typology and a higher likelihood of overweight typology. Higher population density was associated with a lower likelihood of overweight typology. CONCLUSION: Distal and proximal determinants of the various anthropometric typologies at the household level should be taken into account when framing policies and designing interventions to reduce malnutrition in Colombia.

Creencias irracionales como riesgo psicosocial de la adicción al trabajo desde la perspectiva de la Psicología de la Salud Ocupacional / Irrational beliefs as psychosocial risk of work addiction from the perspective of Occupational Health Psychology

El objetivo principal de esta investigación es identificar las creencias obsesivas, recurrentes o intrusivas de las personas con alto riesgo de adicción al trabajo y que se convierten en factores de riesgo psicosocial derivados del trabajo asalariado que facilitan, mantienen y refuerzan el comportamiento adictivo del trabajador. La metodología fue de corte transversal-descriptiva con la aplicación de una entrevista grupal estructurada, a una muestra poblacional de 8 empleados del sector de servicios educativos. Los resultados muestran que las características personales (ideas de perfeccionismo, utilización del tiempo libre, necesidad de aprobación social, sentimiento de culpa, miedo a perder el trabajo y ansiedad generalizada), junto con las características organizacionales, del puesto de trabajo (tareas y responsabilidades) y del empleo en general, al igual que el proceso de socialización organizacional y el manejo de las relaciones interpersonales con los mandos son desencadenantes del comportamiento adictivo. Las conclusiones indican que el comportamiento adictivo de los trabajadores asalariados de esta institución educativa se configura como una estrategia poco efectiva de afrontamiento (basada en un conjunto de ideas obsesivas y comportamiento compulsivo (repetitivo e irracional) frente a la angustia y el estrés generados por el miedo a perder el trabajo (percepción de alta inestabilidad laboral).

The main objective of this research is to identify the obsessive, recurrent or intrusive beliefs of people with high risk of work addiction and who become psychosocial risk factors derived from salaried work that facilitate, maintain and reinforce the worker's addictive behavior. The methodology was cross-descriptive with the application of a structured group interview, to a population sample of 8 employees of the educational services sector. The results show that personal characteristics (ideas of perfectionism, use of free time, need for social approval, feeling guilty, fear of losing work and generalized anxiety), along with the organizational characteristics of the job (tasks and responsibilities) and of employment in general, as well as the process of organizational socialization and the management of interpersonal relationships with commanders are triggers of addictive behavior. The conclusions indicate that the addictive behavior of the salaried workers of this educational institution is configured as an ineffective coping strategy (based on a set of obsessive ideas and compulsive behavior (repetitive and irrational) against the anguish and stress generated by the fear of losing work (perception of high job instability).

Ophthalmic features of spinocerebellar ataxia type 7.

PurposeTo analyze the relation between ophthalmologic and motor changes in spinocerebellar ataxia type 7 (SCA7).Patients and methodsThis was a case series study. Sixteen SCA7 patients underwent a comprehensive ophthalmic examination, including ocular extrinsic motility testing, color vision test, and optical coherence tomography of the optic nerve and macula. Changes in the corneal endothelium, electroretinographic patterns, and a complete neurologic evaluation using the Scale for the Assessment and Rating of Ataxia (SARA) were evaluated. Correlations of endothelial cell density (ECD) with number of CAG repetitions and the SARA scores were estimated.ResultsAll patients showed various degrees of visual impairment mainly due to macular deterioration. Notably, they also presented decreased ECD. Pairwise correlations of ECD with number of CAG repeats and severity of motor symptoms quantified with the SARA scores were inverse (r=-0.46, P=0.083 and r=-0.64, P=0.009, respectively). Further analyses indicated an average ECD decrease of 48 cells/mm2 (P=0.006) per unit of change on the number of CAG repeats, and of 75 cells/mm2 (P=0.001) per unit of change on the SARA scores.ConclusionsThe results agree with previous ophthalmological findings regarding the widespread effect of SCA7 mutation on the patient's visual system. However, the results also show a significant negative correlation of decreased ECD with both CAG repetitions and SARA scores. This suggests that motor systems could degenerate in parallel with visual systems, although more research is needed to determine whether the degeneration is caused by the same mechanisms.

A GHEP-ISFG collaborative study on the genetic variation of 38 autosomal indels for human identification in different continental populations.

A collaborative effort was carried out by the Spanish and Portuguese Speaking Working Group of the International Society for Forensic Genetics (GHEP-ISFG) to promote knowledge exchange between associate laboratories interested in the implementation of indel-based methodologies and build allele frequency databases of 38 indels for forensic applications. These databases include populations from different countries that are relevant for identification and kinship investigations undertaken by the participating laboratories. Before compiling population data, participants were asked to type the 38 indels in blind samples from annual GHEP-ISFG proficiency tests, using an amplification protocol previously described. Only laboratories that reported correct results contributed with population data to this study. A total of 5839 samples were genotyped from 45 different populations from Africa, America, East Asia, Europe and Middle East. Population differentiation analysis showed significant differences between most populations studied from Africa and America, as well as between two Asian populations from China and East Timor. Low FST values were detected among most European populations. Overall diversities and parameters of forensic efficiency were high in populations from all continents.

Hemangioma coroideo y terapia fotodinámica. Respuesta anatómica y funcional de los pacientes con hemangioma coroideo tratados con terapia fotodinámica / Choroidal haemangioma and photodynamic therapy. Anatomical and functional response of patients with choroidal hemangioma treated with photodynamic therapy

Objetivo: Estudiar la eficacia y las limitaciones de la terapia fotodinámica (TFD) como tratamiento de primera elección en pacientes con hemangioma coroideo circunscrito sintomático. Métodos: Se realizó un estudio retrospectivo de 16 pacientes (13 varones y 3 mujeres, con una media de edad de 54,88 años) con hemangioma coroideo circunscrito visitados en nuestro centro y tratados con TFD en los últimos 7 años. Resultados: Todos los pacientes presentaban hemangioma coroideo circunscrito, que ocasionaba sintomatología secundaria a la presencia de edema microquístico intrarretiniano o desprendimiento neurosensorial. La agudeza visual (AV) media inicial del grupo era de 0,23 y la AV media posterior a la realización de TFD fue de 0,38 (todas las AV fueron medidas en escala decimal). Cabe destacar que los pacientes necesitaron una media de 1,69 sesiones de TFD. Tres de los pacientes necesitaron un tratamiento de rescate con termoterapia transpupilar, inyección intravítrea de antifactor de crecimiento endotelial vascular (ranibizumab, aflibercept) o implante intravítreo de dexametasona (Ozurdex®). La indicación de cambio de tratamiento fue la persistencia de edema microquístico intrarretiniano y/o desprendimiento neurosensorial (o su resolución incompleta) tras 3 sesiones de TFD. Como resultados generales, destacamos que un 62,5% de los pacientes evolucionó hacia la resolución anatómica y funcional (incremento de AV o estabilidad). Conclusiones: La TFD es un procedimiento dirigido y rápido, con buena respuesta anatómica y funcional, que ocasiona un mínimo daño a los vasos adyacentes a la lesión (AU)

Objective: To study the effectiveness and limitations of photodynamic therapy (PDT) as treatment of choice in patients with symptomatic circumscribed choroidal haemangioma. Methods: A retrospective study was conducted on 16 patients (13 men and 3 women, with mean age of 54.88 years) with circumscribed choroidal haemangioma, who attended our centre and were treated with PDT in the last 7 years. Results: All patients had circumscribed choroidal haemangioma, which caused a decrease in visual acuity (VA) secondary to the presence of intraretinal microcystic oedema or neurosensory detachment. The mean initial VA was 0.23, and the final mean VA after performing PDT was 0.38 (all the VA were measured in decimal scale). It should be noted that patients needed a mean of 1.69 PDT sessions. Three of the patients needed rescue treatment with trans-pupillary thermotherapy, intravitreal injection of anti-vascular endothelial growth factor (ranibizumab, aflibercept) or a dexamethasone intravitreal implant (Ozurdex®). The indication for a change of treatment was the persistence of intraretinal microcystic oedema and/or neurosensory detachment (or incomplete resolution) after 3 PDT sessions. As overall results, 62.5% of patients evolved into anatomical and functional (increase in AV or stability) resolution. Conclusions: PDT is a straight forward and fast procedure, with a good anatomical and functional response, causing minimal damage to adjacent vessels (AU)

Choroidal haemangioma and photodynamic therapy. Anatomical and functional response of patients with choroidal hemangioma treated with photodynamic therapy. / Hemangioma coroideo y terapia fotodinámica. Respuesta anatómica y funcional de los pacientes con hemangioma coroideo tratados con terapia fotodinámica.

OBJECTIVE: To study the effectiveness and limitations of photodynamic therapy (PDT) as treatment of choice in patients with symptomatic circumscribed choroidal haemangioma. METHODS: A retrospective study was conducted on 16 patients (13 men and 3 women, with mean age of 54.88 years) with circumscribed choroidal haemangioma, who attended our centre and were treated with PDT in the last 7 years. RESULTS: All patients had circumscribed choroidal haemangioma, which caused a decrease in visual acuity (VA) secondary to the presence of intraretinal microcystic oedema or neurosensory detachment. The mean initial VA was 0.23, and the final mean VA after performing PDT was 0.38 (all the VA were measured in decimal scale). It should be noted that patients needed a mean of 1.69 PDT sessions. Three of the patients needed rescue treatment with trans-pupillary thermotherapy, intravitreal injection of anti-vascular endothelial growth factor (ranibizumab, aflibercept) or a dexamethasone intravitreal implant (Ozurdex®). The indication for a change of treatment was the persistence of intraretinal microcystic oedema and/or neurosensory detachment (or incomplete resolution) after 3 PDT sessions. As overall results, 62.5% of patients evolved into anatomical and functional (increase in AV or stability) resolution. CONCLUSIONS: PDT is a straight forward and fast procedure, with a good anatomical and functional response, causing minimal damage to adjacent vessels.