The Isosceles Nasal Tip-Laser-Assisted Midline Assessment in Rhinoplasty.

The accurate determination of the nasal tip's spatial location is crucial for achieving symmetry in rhinoplasty. Even minor deviations can result in asymmetrical lengths and configurations of the nostrils. Our approach centers on defining the nasal tip position by establishing the midline of the nasal base and projecting an isosceles triangle. This triangle, with the tip as the vertex and alar creases as angles, ensures symmetric sidewalls. The symmetry axis, derived from the isosceles triangle, guides the placement of the tip sidewalls and columella. To implement this, we use anatomical benchmarks such as the implantation of the nasal base and position of the alar creases, considering inherent facial asymmetries. We introduce a laser gadget as an auxiliary tool, projecting perpendicular lines to guide precise midline alignment. Marking specific points, including interbrow midpoint and alar creases, ensures accuracy. In the past 12 months, we applied this methodology in 247 rhinoplasty cases, observing improved outcomes and patient satisfaction. Our proposal of utilizing isosceles triangles provides a streamlined approach to achieving symmetry. The laser device, while beneficial, should be viewed as supportive rather than an absolute guiding measure.

Rhinomanometry with and without decongestant used to select children for adenoidectomy: a cohort study.

OBJECTIVE: Adenoid hypertrophy may coexist, and often does, with rhinitis. Therefore, in some cases, adenoidectomy alone, despite the fact that it reduces nasal resistance, may be insufficient to restore nasal breathing. Juliusson et al. suggested using rhinomanometry with and without nasal decongestant as a method for selecting patients for adenoidectomy. In this study, we aim to assess whether the decongestant test, when using normative data, is useful to select children for adenoidectomy. METHODS: Children between 4 and 15 years old undergoing adenoidectomy were selected from two tertiary referral university hospitals. Participants underwent anterior active rhinomanometry with and without nasal decongestant before and after surgery. Parents fill in the sinus and nasal quality-of-life survey (SN5). RESULTS: 47 participants were included, and mean age 6.5 ± 2.15. 2 cohorts were defined according to the result of the nasal decongestant test (> 40% improvement in nasal resistance or not). There is a statistically significant difference between groups, with a higher improvement in nasal resistance and airflow after adenoidectomy in the group with less than 40% improvement in nasal resistance. CONCLUSIONS: In conclusion, this study supports the use of the decongestant test with rhinomanometry to select children for adenoidectomy; especially as it has proven to be a simple technique, harmless, fast, and easily performed on collaborative children.

Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians.

BACKGROUND: Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability. METHODS AND FINDINGS: A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks. Questions focused on the availability and use of currently available POCTs. Data were analysed descriptively and using Median Odds Ratio (MOR) to measure variation between countries. Multilevel regression modelling using changes in the area under the receiver operating characteristic curve of models were used to assess the contribution of individual or workplace versus country level factors, to the observed variation. The commonest POCT was urine dipsticks (UD) which were available to >80% of primary care and hospital paediatricians in 68% (13/19) and 79% (23/29) countries, respectively. Availability of all POCTs varied between countries. In primary care, the country (MOR) varied from 1.61 (95%CI: 1.04-2.58) for lactate to 7.28 (95%CI: 3.04-24.35) for UD. In hospitals, the country MOR varied from 1.37 (95%CI:1.04-1.80) for lactate to 11.93 (95%CI:3.35-72.23) for UD. Most paediatricians in primary care (69%, 795/1154) and hospital (81%, 962/1188) would use a diagnostic test in the case scenario of an infant with undifferentiated fever. Multilevel regression modelling showed that the country of work was more important in predicting both the availability and use of POCTs than individual or workplace characteristics. CONCLUSION: There is substantial variability in the adoption of POCTs for the management of acute infections in children across Europe. To inform future implementation of both existing and innovative tests, further research is needed to understand what drives the variation between countries, the needs of frontline clinicians, and the role of diagnostic tests in the management of acute childhood infections.

Electroconvulsive therapy, catatonia, deep vein thrombosis and anticoagulant treatment: a case report.

Electroconvulsive therapy (ECT) is considered an effective treatment for pharmacotherapy-resistant severe mental disorders. Catatonia is a complex syndrome characterised by important psychomotor disturbances. Deep vein thrombosis (DVT) and pulmonary embolism (PE) are frequent side effects of prolonged immobility in catatonic patients. Therefore, it is important to resolve the catatonia as soon as possible. ECT is the most effective therapy available and is generally considered a safe procedure. Nevertheless, its use in patients with DVT or PE and anticoagulant treatment remains controversial. We describe a case of a woman in her 40s with a previous diagnosis of bipolar disorder and dysfunctional personality traits. She was hospitalised with persecutory and reference delusions, high emotional lability, anxiety, somatisation and regressive conduct. She later developed catatonic symptoms. No progress was achieved after a month of hospitalisation, despite several pharmacological treatments. She suffered multiple complications of prolonged bedding, such as an extensive DVT of the left common femoral, the external iliac and the common iliac veins. ECT was conducted under treatment with bemiparin. After the third administration, she showed improvement. No major bleeding or PE was developed. The safety of ECT while receiving anticoagulant therapy has been documented, though dosage and type of anticoagulant must be considered. Location of DVT (proximal or distal) may be an important topic to take into account. This report provides further evidence about the efficacy and safety of undergoing ECT in the context of concomitant serious medical conditions, such as DVT and anticoagulant therapy administration.

Influence of substance use and cognitive impairment on adherence to antiretroviral therapy in HIV+ patients. / Influencia del consumo de sustancias y el deterioro cognitivo en la adherencia al tratamiento antirretroviral en pacientes VIH.

Strict adherence to antiretroviral treatment (ART) is needed to ensure the effectiveness of HIV treatment. The adverse effects of substance abuse and neurocognitive impairment on medication adherence have both been suggested by several studies. Therefore, the aim of this research is to study the relationship among adherence to ART, cognitive dysfunction, and abuse of certain substances (alcohol, heroin, cocaine, other stimulants, cannabis and benzodiazepines) and/or methadone treatment in our social environment. We performed an observational case-control study with a sample of 125 HIV+ patients, who were classified as patients with poor adherence (cases) and subjects with adequate compliance (controls). Adherence was defined by the Hospital Pharmacy and verified with the Simplified Medication Adherence Questionnaire (SMAQ) and the reference physician's clinical impression. Cognitive functioning was measured with the Zoo Map Test and Trail Making Test (TMT). Substance abuse was collected through a semi-structured clinical interview protocol. Statistical analysis was made using a binary logistic regression model. The results indicate that both alcohol abuse and neurocognitive impairment measured by Zoo Map Test were significantly associated with poorer adherence to ART. No significant association was found between adherence and other substance use, or between adherence and TMT score. Screening of cognitive impairment measured by the Zoo Map Test and alcohol abuse may lead to the development of strategies to improve de adherence to ART in HIV+ patients.

La adherencia estricta al tratamiento antirretroviral (TAR) es imprescindible para que este sea eficaz en la disminución de la morbimortalidad asociada al VIH. Se ha sugerido que el consumo de sustancias y el deterioro cognitivo constituyen factores de riesgo para una mala adherencia. En este sentido, el objetivo de este estudio es evaluar cuál es la influencia sobre la adherencia al TAR de la disfunción cognitiva, así como del consumo de determinadas sustancias (alcohol, heroína, cocaína, otros estimulantes, cannabis y benzodizepinas) y/o el tratamiento con metadona, en el marco concreto de una población española de referencia. Se realizó un estudio observacional tipo casos y controles con una muestra de 125 pacientes VIH+, que se dividieron en sujetos malos adherentes (casos) y buenos adherentes al TAR (controles). La adherencia se evaluó mediante el reporte de Farmacia Hospitalaria, contrastada con la escala Simplified Medication Adherence Questionnaire (SMAQ) y la opinión del profesional médico de referencia. La función cognitiva fue evaluada con el Test del Mapa del Zoo y el Trail Making Test (TMT), y el consumo de sustancias, mediante un protocolo de historia clínica semi-estructurada. El análisis estadístico se realizó mediante regresión logística binaria. Los resultados mostraron que el abuso de alcohol y el deterioro en la función cognitiva ejecutiva, medida por el Test del Mapa del Zoo, constituyen factores de riesgo independientes para una mala adherencia. No se ha demostrado relación de la adherencia al TAR con el consumo de otras sustancias ni con la puntuación obtenida en el TMT. La detección de deterioro cognitivo mediante el Test del Mapa del Zoo, así como del consumo de alcohol, podrían ayudar a desarrollar estrategias de mejora del cumplimiento terapéutico en pacientes VIH+.

Influencia del consumo de sustancias y el deterioro cognitivo en la adherencia al tratamiento antirretroviral en pacientes VIH+ / Influence of substance use and cognitive impairment on adherence to antiretroviral therapy in HIV+ patients

La adherencia estricta al tratamiento antirretroviral (TAR) es imprescindible para que este sea eficaz en la disminución de la morbimortalidad asociada al VIH. Se ha sugerido que el consumo de sustancias y el deterioro cognitivo constituyen factores de riesgo para una mala adherencia. En este sentido, el objetivo de este estudio es evaluar cuál es la influencia sobre la adherencia al TAR de la disfunción cognitiva, así como del consumo de determinadas sustancias (alcohol, heroína, cocaína, otros estimulantes, cannabis y benzodizepinas) y/o el tratamiento con metadona, en el marco concreto de una población española de referencia. Se realizó un estudio observacional tipo casos y controles con una muestra de 125 pacientes VIH+, que se dividieron en sujetos malos adherentes (casos) y buenos adherentes al TAR (controles). La adherencia se evaluó mediante el reporte de Farmacia Hospitalaria, contrastada con la escala Simplified Medication Adherence Questionnaire (SMAQ) y la opinión del profesional médico de referencia. La función cognitiva fue evaluada con el Test del Mapa del Zoo y el Trail Making Test (TMT), y el consumo de sustancias, mediante un protocolo de historia clínica semi-estructurada. El análisis estadístico se realizó mediante regresión logística binaria. Los resultados mostraron que el abuso de alcohol y el deterioro en la función cognitiva ejecutiva, medida por el Test del Mapa del Zoo, constituyen factores de riesgo independientes para una mala adherencia. No se ha demostrado relación de la adherencia al TAR con el consumo de otras sustancias ni con la puntuación obtenida en el TMT. La detección de deterioro cognitivo mediante el Test del Mapa del Zoo, así como del consumo de alcohol, podrían ayudar a desarrollar estrategias de mejora del cumplimiento terapéutico en pacientes VIH+

Strict adherence to antiretroviral treatment (ART) is needed to ensure the effectiveness of HIV treatment. The adverse effects of substance abuse and neurocognitive impairment on medication adherence have both been suggested by several studies. Therefore, the aim of this research is to study the relationship among adherence to ART, cognitive dysfunction, and abuse of certain substances (alcohol, heroin, cocaine, other stimulants, cannabis and benzodiazepines) and/or methadone treatment in our social environment. We performed an observational case-control study with a sample of 125 HIV+ patients, who were classified as patients with poor adherence (cases) and subjects with adequate compliance (controls). Adherence was defined by the Hospital Pharmacy and verified with the Simplified Medication Adherence Questionnaire (SMAQ) and the reference physician’s clinical impression. Cognitive functioning was measured with the Zoo Map Test and Trail Making Test (TMT). Substance abuse was collected through a semi-structured clinical interview protocol. Statistical analysis was made using a binary logistic regression model. The results indicate that both alcohol abuse and neurocognitive impairment measured by Zoo Map Test were significantly associated with poorer adherence to ART. No significant association was found between adherence and other substance use, or between adherence and TMT score. Screening of cognitive impairment measured by the Zoo Map Test and alcohol abuse may lead to the development of strategies to improve de adherence to ART in HIV+ patients

False Vaccine Contraindications Among Healthcare Providers in Europe: A Short Survey Among Members of The European Society of Pediatric Infectious Diseases.

Some healthcare providers hold or delay vaccination because of false vaccine contraindications. This study suggests that in 21.4% of scenarios (877/4096) physicians would postpone or contraindicate the vaccination, and 24.2% (237/978) of scenarios would be vaccinated despite the existence of a true contraindication or reason for delay. Addressing false contraindications may result in increasing vaccination uptake in Europe.

La investigación en Pediatría en España: retos y prioridades. Plataforma INVEST-AEP / Paediatric research in Spain: Challenges and priorities. INVEST-AEP Platform

La investigación clínica es la piedra angular para el desarrollo de la Medicina, y, en el ámbito de la Pediatría, supone un reto adicional debido a las peculiaridades que diferencian a los niños de los adultos. A pesar del enorme impacto de la salud infantil en el resto de la vida, nuestra sociedad aún no está suficientemente concienciada sobre la importancia de la investigación pediátrica, que, en general, se encuentra también muy alejada del día a día de quienes nos dedicamos a esta profesión. Desde la Asociación Española de Pediatría (AEP) se ha creado una plataforma específica de investigación -INVEST-AEP- para dar respuesta específica a los retos de la investigación en el seno de nuestra sociedad. En este artículo se retrata el escenario actual de la investigación pediátrica en España y se objetivan las metas alcanzadas en los últimos años, gracias al esfuerzo de los pediatras investigadores. Además, se realiza un análisis en profundidad sobre las barreras cotidianas que dificultan el desarrollo amplio y competitivo de la investigación pediátrica, como la falta de incentivación y ausencia de formación específica de pre y posgrado, la elevada carga asistencial o la falta de infraestructuras y financiación específicas. Definimos la misión, visión y valores de INVEST-AEP para tratar de diseñar una "hoja de ruta" para la investigación pediátrica española de los próximos años

Research is the cornerstone of medical progress. Paediatric research has its own nuances and represents an additional challenge due to the intrinsic characteristics of the paediatric population compared with adults. Despite the tremendous importance of childhood health and its impact during adulthood, society is still not convinced about the importance of conducting research in paediatrics. This also applies to paediatricians themselves, who think about research as a discipline that does not directly involve them. The Spanish Academy of Paediatrics has developed a specific research platform- INVEST-AEP- to try to help and answer the challenges associated with paediatric research in the society This article reflects the current status of paediatric research in Spain, and the goals achieved over the last few years due to the effort of paediatric researchers. In addition, a deeper analysis is provided as regards: a) the barriers that represent a hurdle for the development of broad and competitive paediatric research in our day to day work; b) the limited incentives and specific pre- and post-doctoral training; c) the high clinical burden for paediatricians or; d) the lack of specific infrastructure and dedicated funding for paediatrics. The mission, vision and values of INVEST-AEP are to develop an accessible roadmap for the development and implementation of paediatric research in Spain for the next few years

[Paediatric research in Spain: Challenges and priorities. INVEST-AEP Platform]. / La investigación en Pediatría en España: retos y prioridades. Plataforma INVEST-AEP.

Research is the cornerstone of medical progress. Paediatric research has its own nuances and represents an additional challenge due to the intrinsic characteristics of the paediatric population compared with adults. Despite the tremendous importance of childhood health and its impact during adulthood, society is still not convinced about the importance of conducting research in paediatrics. This also applies to paediatricians themselves, who think about research as a discipline that does not directly involve them. The Spanish Academy of Paediatrics has developed a specific research platform- INVEST-AEP- to try to help and answer the challenges associated with paediatric research in the society This article reflects the current status of paediatric research in Spain, and the goals achieved over the last few years due to the effort of paediatric researchers. In addition, a deeper analysis is provided as regards: a) the barriers that represent a hurdle for the development of broad and competitive paediatric research in our day to day work; b) the limited incentives and specific pre- and post-doctoral training; c) the high clinical burden for paediatricians or; d) the lack of specific infrastructure and dedicated funding for paediatrics. The mission, vision and values of INVEST-AEP are to develop an accessible roadmap for the development and implementation of paediatric research in Spain for the next few years.

Impact of comorbid conditions on participation in an organised colorectal cancer screening programme: a cross-sectional study.

BACKGROUND: There is controversy regarding how comorbidity impacts on colorectal cancer screening, especially in the context of organised programmes. The aim of this study is to assess the effect of comorbidities on participation in the Barcelona population-based colorectal cancer screening programme (BCCSP). METHODS: Cross-sectional study carried out in ten primary care centres involved in the BCCSP. Individuals aged 50 to 69, at average risk of colorectal cancer, who were invited to participate in the first round of the faecal immunochemical test-based BCCSP were included (2011-2012). The main variable was participation in the BCCSP. Comorbidity was assessed by clinical risk group status. Other adjusting variables were age, sex, socioeconomic deprivation, visits to primary care, smoking, alcohol consumption and body mass index. Logistic regression models were used to test the association between participation in the programme and potential explanatory variables. The results were given as incidence rate ratios (IRR) and their 95% confidence intervals (CI). RESULTS: Of the 36,208 individuals included, 17,404 (48%) participated in the BCCSP. Participation was statistically significantly higher in women, individuals aged 60 to 64, patients with intermediate socioeconomic deprivation, and patients with more medical visits. There was a higher rate of current smoking, high-risk alcohol intake, obesity and individuals in the highest comorbidity categories in the non-participation group. In the adjusted analysis, only individuals with multiple minor chronic diseases were more likely to participate in the BCCSP (IRR 1.14; 95% CI [1.06 to 1.22]; p < 0.001). In contrast, having three or more dominant chronic diseases was associated with lower participation in the screening programme (IRR 0.76; 95% CI [0.65 to 0.89]; p = 0.001). CONCLUSIONS: Having three or more dominant chronic diseases, was associated with lower participation in a faecal immunochemical test-based colorectal cancer screening programme, whereas individuals with multiple minor chronic diseases were more likely to participate. Further research is needed to explore comorbidity as a cause of non-participation in colorectal cancer screening programmes and which individuals could benefit most from colorectal cancer screening.

Síndrome de secreción inadecuada de hormona antidiurética, hiponatremia y antipsicóticos. Revisión de la literatura a propósito de un caso / Syndrome of inappropriate antidiuretic hormone secretion, hyponatraemia and antipsychotics. Review of the evidence and case report

Introducción. La hiponatremia es un efecto secundario asociado al uso de psicofármacos, entre ellos, los antipsicóticos. El síndrome de secreción inadecuada de hormona antidiurética y la polidipsia se han postulado como mecanismos etiopatogénicos subyacentes. Asimismo, se propone que exista una afectación biológica en la esquizofrenia que promueva la hiponatremia. Caso clínico. Presentamos a una paciente de 45 años con diagnóstico de esquizofrenia que comienza con un síndrome de secreción inadecuada de hormona antidiurética probablemente secundario a palmitato de paliperidona. Discusión. A partir de este caso, realizamos una revisión de la literatura disponible y planteamos la interrelación de la hiponatremia, el síndrome de secreción inadecuada de hormona antidiurética, la polidipsia, la propia psicosis y otros mecanismos etiopatogénicos. Conclusiones. La hiponatremia es una complicación importante e impredecible, de la que desconocemos su fisiopatología exacta en pacientes psicóticos. Son necesarios más estudios que esclarezcan su patogenia y determinen la necesidad de seguimiento analítico de pacientes que reciben tratamiento antipsicótico, sobre todo aquellos con diagnóstico de esquizofrenia (AU)

Introduction. Hyponatraemia is an adverse drug reaction to psychotropic medication, among them the antipsychotics. Syndrome of inappropriate antidiuretic hormone secretion and polydipsia have been suggested as aetiopathogenic mechanisms. Moreover, it has been postulated that there is a biological dysfunction in schizophrenia that induces hyponatraemia. Case report. A case is presented on a 45-year old woman with schizophrenia who has an syndrome of inappropriate antidiuretic hormone secretion, which was suspected of being due to paliperidone palmitate. Discussion. A review was made of the available published evidence and proposed the relationship between hyponatraemia, syndrome of inappropriate antidiuretic hormone secretion, polydipsia, the psychosis itself, and other aetiopathogenic mechanisms. Conclusions. Hyponatraemia is an important and unpredictable complication, for which its pathophysiology remains unknown. Further studies are needed to establish its pathogenic mechanisms and to determine the need of analytical monitoring in patients who are on treatment with antipsychotics, especially those with schizophrenia (AU)

Alerts in electronic medical records to promote a colorectal cancer screening programme: a cluster randomised controlled trial in primary care.

BACKGROUND: Participation rates in colorectal cancer screening are below recommended European targets. AIM: To evaluate the effectiveness of an alert in primary care electronic medical records (EMRs) to increase individuals' participation in an organised, population-based colorectal cancer screening programme when compared with usual care. DESIGN AND SETTING: Cluster randomised controlled trial in primary care centres of Barcelona, Spain. METHOD: Participants were males and females aged 50-69 years, who were invited to the first round of a screening programme based on the faecal immunochemical test (FIT) (n = 41 042), and their primary care professional. The randomisation unit was the physician cluster (n = 130) and patients were blinded to the study group. The control group followed usual care as per the colorectal cancer screening programme. In the intervention group, as well as usual care, an alert to health professionals (cluster level) to promote screening was introduced in the individual's primary care EMR for 1 year. The main outcome was colorectal cancer screening participation at individual participant level. RESULTS: In total, 67 physicians and 21 619 patients (intervention group) and 63 physicians and 19 423 patients (control group) were randomised. In the intention-to-treat analysis screening participation was 44.1% and 42.2% respectively (odds ratio 1.08, 95% confidence interval [CI] = 0.97 to 1.20, P = 0.146). However, in the per-protocol analysis screening uptake in the intervention group showed a statistically significant increase, after adjusting for potential confounders (OR, 1.11; 95% CI = 1.02 to 1.22; P = 0.018). CONCLUSION: The use of an alert in an individual's primary care EMR is associated with a statistically significant increased uptake of an organised, FIT-based colorectal cancer screening programme in patients attending primary care centres.

El síntoma en el cuerpo. Psicosis monosintomática e hipocondría: a propósito de dos casos / The symptom in the body. Monosymptomatic psychosis and hypochondriasis: A report of two cases

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