Extended septal myectomy versus alcohol septal ablation: clinical results at a national referral centre.

OBJECTIVES: Extended septal myectomy and alcohol septal ablation are 2 invasive treatments for hypertrophic obstructive cardiomyopathy. Our goal was to compare which of these techniques achieved a higher reduction in gradients, improvement in New York Heart Association (NYHA) functional class and reduction in medical treatment. METHODS: It is a single-centre observational and retrospective analysis. We used multivariable regression analyses to assess the association of ablation/myectomy with different outcomes. The odds ratio or coefficient along with the 95% confidence interval was estimated according to the group and adjusted for the corresponding preprocedural variables and EuroSCORE II. RESULTS: A total of 78 patients underwent septal myectomy, and 25 patients underwent alcohol septal ablation. Basal and Valsalva gradients after myectomy were reduced to a higher degree in comparison to ablation: 21.0 mmHg [P < 0.001, 95% confidence interval -30.7; -11.3], and 34.3 mmHg (P < 0.001, -49.1; -19.5) respectively. Those patients who received a myectomy had a lower probability of having moderate mitral regurgitation (odds ratio = 0.18, P = 0.054). Patients after septal myectomy were more likely to be NYHA functional class I (80.4%), whereas patients after ablation were more likely to be NYHA functional class III (48%). Both groups continued with beta-blocker therapy, but disopyramide could be discontinued after the myectomy in more cases (20%-36% vs 59%-1.3%; P < 0.001), and there was a tendency to discontinue calcium channel blockers (48%-16% vs 15.4-3.8%; P = 0.054). CONCLUSIONS: After adjustment using preprocedural gradients and EuroSCORE II, myectomy achieves greater reduction in left ventricular outflow tract gradients compared to septal ablation.

Adicción al tabaco y adolescencia: riesgos psicobiológicos / Psychobiological risks of tobacco during adolescence. A narrative review

Resumen La investigación moderna, tanto en humanos como preclínica, que utiliza modelos animales indica que fumar durante la edad adolescente resulta en cambios cerebrales y psicológicos a corto y largo plazo en el fumador, así como en un aumento significativo en los riesgos de desarrollar adicción al tabaco durante la vida. Por lo tanto, en la presente revisión narrativa se describirán y profundizarán los hallazgos investigativos modernos de la psicobiología de la adolescencia y los efectos del tabaco en el desarrollo, con un énfasis particular en la comprensión de los efectos psicológicos y cerebrales del consumo de tabaco durante la adolescencia, tanto a corto como a largo plazo. Se considerarán de manera detallada los avances investigativos sobre la psicobiología de la adolescencia y sus riesgos en las adicciones desde los aspectos: conductual, cognitivo, reactividad al estrés y psicobiología. Sobre esta base, se revisará la investigación sobre la psicobiología de la adolescencia y la evidencia de vulnerabilidad a la adicción durante esta etapa. Al final, se abordarán los efectos del tabaco en el cerebro y conducta durante el desarrollo adolescente y vida posterior, ya que se ha encontrado evidencia relacionada con alteraciones cerebrales crónicas en los sistemas colinérgicos y regiones cerebrales asociadas con la dependencia de la nicotina. Se espera que la revisión y divulgación de esta información en el idioma español sea de valor para la comprensión de los problemas de vulnerabilidad y predisposiciones a la adicción al tabaco en el contexto de Latinoamérica.

Abstract Tobacco use and its harmful health-related problems have become one of the largest modern preventable public health issues. Current research strongly suggests that smoking during adolescence enhances addictive smoking behaviors during life, which can be related to adolescence as a critical ontogenetic period characterized by behaviors that can increase the probability of risk-related behaviors such as sensation and novelty seeking. Adolescent development is also a period of maturation of frontal and subcortical neural systems, brain changes that underlie higher impulsivity tendencies to promote adequate learning and adaptations necessary to succeed the novel challenges of the adult life, but those changes also enhance vulnerabilities to the addictive effects of drugs. Consistent with this, tobacco use affects brain development processes which underlie long-term psychobiological alterations and the enhanced risks for tobacco addiction during adult life. Thus, the present review describes current psychobiological approaches to understand general addiction processes and tobacco addiction, highlighting the behavioral and neural short-term effects of tobacco use during adolescence and its long-term effects during adulthood. Current research has advanced on four aspects for the understanding of both the psychobiology of adolescent development and the effects of drugs of abuse during this time. The first aspect is behavioral, as adolescence is related to important changes on motivational and emotional behaviors such as sensation seeking. Other important behavioral changes are social approach, a higher variety of opportunity for personal choices, and development of personal independence. Research on a second aspect has focused on cognition. A review of research is presented showing enhanced abilities during adolescence development for reading, abstract and logical thinking, and novel problem solving. Stress reactivity is the third aspect of reviewed psychobiological mechanisms. The stress biological system undergoes important changes during adolescence, including changes on stress-related hormones and neural architecture. An important issue is that exposure to early and/or chronic stressful circumstances during adolescence could be related to higher risk to the start and maintenance of addiction states, as suggested by research assessing the disruptive effects of stress on psychobiological homeostatic processes needed to maintain stable biological and emotional regulation. The fourth aspect is psychobiology. In this section research is reviewed related to the development of monoaminergic brain circuits underlying motivation, novelty-seeking, impulsivity, and addiction processes. Using as model the previous review integration, the effects of nicotine are discussed, the essential addictive component of tobacco, on the neurochemical systems underlying tobacco addiction. Following this, important research is introduced that describes psychobiological changes during adolescence and evidence of vulnerability to addiction during this life stage. Then, current research on both short-term and long-term effects of tobacco or nicotine administration during adolescence on the brain, behavior, and cognition is introduced. The current research advances and discussions on the psychobiology of addictions in general, and tobacco addiction in particular, have been possible to a large extent from the use of animal models and preclinical research, since animal models have become crucial to identify learning, motivational, emotional, and cognitive mechanisms that underlie addictive processes, and making possible to perform experimental procedures to discover the functioning and participation of biological components. One example of such components is the cholinergic system, which is activated by nicotine and is part of the neurochemical machinery on different brain areas important for both tobacco addiction and adolescence development such as the dorsal striatum, amygdala, ventral tegmental area, nucleus accumbens, prefrontal cortex, and hippocampus. The present review and research divulgation written in Spanish are expected to clarify modern research on addiction and encourage current scientific education on the vulnerabilities and predispositions for tobacco abuse in Latin-American countries.

Clinical impact of del Nido cardioplegia in adult cardiac surgery: A prospective randomized trial.

OBJECTIVE: The study objective was to assess the benefits of del Nido cardioplegia compared with cold blood cardioplegia solution in terms of myocardial protection during adult cardiac surgery. METHODS: A total of 474 adult patients undergoing coronary artery bypass grafting, heart valve surgery, thoracic aortic surgery, or combined procedures were randomized to the del Nido cardioplegia group (n = 234) or the cold blood cardioplegia solution group (n = 240) after provided informed consent. The primary end points assessed inotropic support requirements, severe cardiovascular events, and troponin trend within the first 48 hours of intensive care unit stay. Reperfusion arrhythmias, aortic crossclamp and cardiopulmonary bypass times, and other clinical perioperative variables were considered as secondary end points. RESULTS: No statistically significant differences were found regarding postoperative inotropic support requirements or the incidence of severe cardiovascular events. The del Nido cardioplegia group showed a higher return to spontaneous sinus rhythm (P< .001), a lower number of defibrillation attempts (P< .001), and an earlier peak troponin value in the postoperative period. Peak blood glucose levels and intravenous insulin requirements were significantly lower in the del Nido cardioplegia group. We found no significant differences regarding aortic crossclamp or cardiopulmonary bypass time. We did observe a lower incidence of postoperative stroke in the del Nido cardioplegia group (2.6% vs 6.7%; P= .035). CONCLUSIONS: del Nido cardioplegia can be used safely and with comparable outcomes compared with traditional cardioplegia solutions. Additional advantages over glycemic control, reperfusion arrhythmias, and its comfortable redosing interval make del Nido an interesting alternative for myocardial protection in adult cardiac surgery. A significant decrease in postoperative stroke will require further research to shed light on the results of this study. VIDEO ABSTRACT.

Aortic valve reimplantation in patients with connective tissue syndromes: A 15-year follow-up.

OBJECTIVES: The goal of this study was to analyse early- and long-term outcomes of aortic valve reimplantation (David operation) in patients with heritable thoracic aortic disease. METHODS: This is a retrospective observational analysis using data from a prospectively maintained surgical database from March 2004 to April 2021. Patients with heritable thoracic aortic disease were included in the study. RESULTS: A total of 157 patients with aortic root aneurysm with the diagnosis of heritable thoracic aortic disease received the David procedure. Marfan syndrome was found in 143 (91.1%) patients, Loeys-Dietz in 13 and Ehler-Danlos in 1 patient. The median age was 35.0 (IQR: 17.5) years and the median ascending aorta diameter in the Valsalva sinuses was 48 mm (IQR: 4). A Valsalva graft was used in 8 patients; the David V technique was performed in the rest of the cases. The median follow-up time was 7.3 years [standard deviation: 0.58, 95% confidence interval (CI): 6.12-8.05]. Only 2 patients died during the follow-up period. The overall survival was 99% (95% CI: 95%; 99%); 98% (95% CI: 92%; 99%); and 98% (95% CI: 92%; 99%) at 5, 10 and 15 years. Freedom from significant aortic regurgitation (AR> II), reintervention and postoperative type-B dissection was 90% (95% CI: 77%; 95%), 96% (95% CI: 91%; 99%) and 87% (95% CI: 68%; 95%) at 15 years, respectively. No differences were found in any outcome between Marfan syndrome and Loeys-Dietz syndrome. No statistically significant differences in survival were found when we compared expected gender- and age-specific population survival values. CONCLUSIONS: The David operation is an excellent option for the treatment of patients with heritable thoracic aortic disease and dilatated aortic root. Surgical expertise in referral centres is essential to achieve the best long-term results.

Long-term survival of mechanically ventilated patients with severe COVID-19: an observational cohort study.

BACKGROUND: Information is lacking regarding long-term survival and predictive factors for mortality in patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) and undergoing invasive mechanical ventilation. We aimed to estimate 180-day mortality of patients with COVID-19 requiring invasive ventilation, and to develop a predictive model for long-term mortality. METHODS: Retrospective, multicentre, national cohort study between March 8 and April 30, 2020 in 16 intensive care units (ICU) in Spain. Participants were consecutive adults who received invasive mechanical ventilation for COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected in positive testing of a nasopharyngeal sample and confirmed by real time reverse-transcriptase polymerase chain reaction (rt-PCR). The primary outcomes was 180-day survival after hospital admission. Secondary outcomes were length of ICU and hospital stay, and ICU and in-hospital mortality. A predictive model was developed to estimate the probability of 180-day mortality. RESULTS: 868 patients were included (median age, 64 years [interquartile range [IQR], 56-71 years]; 72% male). Severity at ICU admission, estimated by SAPS3, was 56 points [IQR 50-63]. Prior to intubation, 26% received some type of noninvasive respiratory support. The unadjusted overall 180-day survival rates was 59% (95% CI 56-62%). The predictive factors measured during ICU stay, and associated with 180-day mortality were: age [Odds Ratio [OR] per 1-year increase 1.051, 95% CI 1.033-1.068)), SAPS3 (OR per 1-point increase 1.027, 95% CI 1.011-1.044), diabetes (OR 1.546, 95% CI 1.085-2.204), neutrophils to lymphocytes ratio (OR per 1-unit increase 1.008, 95% CI 1.001-1.016), failed attempt of noninvasive positive pressure ventilation prior to orotracheal intubation (OR 1.878 (95% CI 1.124-3.140), use of selective digestive decontamination strategy during ICU stay (OR 0.590 (95% CI 0.358-0.972) and administration of low dosage of corticosteroids (methylprednisolone 1 mg/kg) (OR 2.042 (95% CI 1.205-3.460). CONCLUSION: The long-term survival of mechanically ventilated patients with severe COVID-19 reaches more than 50% and may help to provide individualized risk stratification and potential treatments. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04379258. Registered 10 April 2020 (retrospectively registered).

Prevalence and clinical consequences of atelectasis in SARS-CoV-2 pneumonia: a computed tomography retrospective cohort study.

BACKGROUND: The aim of the study is to estimate the prevalence of atelectasis assessed with computer tomography (CT) in SARS-CoV-2 pneumonia and the relationship between the amount of atelectasis with oxygenation impairment, Intensive Care Unit admission rate and the length of in-hospital stay. PATIENTS AND METHODS: Two-hundred thirty-seven patients admitted to the hospital with SARS-CoV-2 pneumonia diagnosed by clinical, radiology and molecular tests in the nasopharyngeal swab who underwent a chest computed tomography because of a respiratory worsening from Apr 1 to Apr 30, 2020 were included in the study. Patients were divided into three groups depending on the presence and amount of atelectasis at the computed tomography: no atelectasis, small atelectasis (< 5% of the estimated lung volume) or large atelectasis (> 5% of the estimated lung volume). In all patients, clinical severity, oxygen-therapy need, Intensive Care Unit admission rate, the length of in-hospital stay and in-hospital mortality data were collected. RESULTS: Thirty patients (19%) showed small atelectasis while eight patients (5%) showed large atelectasis. One hundred and seventeen patients (76%) did not show atelectasis. Patients with large atelectasis compared to patients with small atelectasis had lower SatO2/FiO2 (182 vs 411 respectively, p = 0.01), needed more days of oxygen therapy (20 vs 5 days respectively, p = 0,02), more frequently Intensive Care Unit admission (75% vs 7% respectively, p < 0.01) and a longer period of hospitalization (40 vs 14 days respectively p < 0.01). CONCLUSION: In patients with SARS-CoV-2 pneumonia, atelectasis might appear in up to 24% of patients and the presence of larger amount of atelectasis is associated with worse oxygenation and clinical outcome.

Effect of mesenchymal stem cells combined with chondroitin sulfate in an in vitro model of osteoarthritis.

Osteoarthritis (OA) is a degenerative joint disease affecting the whole joint structure. The specific molecules responsible for the inflammatory processes involved in the development of OA have been the focus of many studies. Adipose tissue-derived mesenchymal stem cells (ASCs) constitute a promising cell-based therapy which could be used as an alternative to or in combination with drug therapies. Chondroitin sulfate (CS) plays a protective role in the joint by decreasing concentrations of pro-inflammatory cytokines and therefore has an important part in moderating chondrocyte metabolism. The aim of this study is to use an in vitro model of OA to evaluate the combined effectiveness of CS and ASCs as a treatment. We give a detailed discussion of the roles of cytokines and other key molecules involved in OA. In addition, we report the effects of treating inflamed chondrocytes with ASCs and CS on the expression of specific cartilage genes. Findings show that both treatments reduced expression of all genes associated with the pro-inflammatory cytokines we analyzed. However, we saw no increase in the expression of the specific genes encoding for cartilage matrix proteins, such as collagen type II and aggrecan. This study shows the effectiveness of combining ASCs and CS in the treatment of OA.

Dolor abdominal como motivo de consulta pediátrica durante la pandemia del SARSCoV- 2 (COVID-19) en Guayaquil, Ecuador / Abdominal pain as a reason for pediatric visiting during the SARS-CoV-2 (COVID-19) pandemic in Guayaquil, Ecuador

Objetivo: el objetivo de este estudio fue describir los casos de pacientes con dolor abdominal y diagnóstico confirmado de COVID-19. En países de Latinoamérica la pandemia ha tenido un gran impacto por el alto índice de mortalidad. Ecuador es el quinto país más afectado en la región en número de casos confirmados con una tasa de 223 fallecidos por cada millón de habitantes, ubicándose en el primer lugar de letalidad. En la población pediátrica el comportamiento del COVID-19 sigue siendo inespecífico. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo en el cual se incluyó a todos los pacientes menores de 18 años exceptuando neonatos, que ingresaron por dolor abdominal a un hospital pediátrico de la ciudad de Guayaquil entre los meses de abril y mayo de 2020 y obtuvieron diagnóstico confirmado COVID-19. Resultados: fueron incluidos 30 pacientes con diagnóstico confirmado de COVID-19 y dolor abdominal. La edad promedio fue 8,46 años a predomino del sexo masculino (70%). En la valoración del dolor 19 (63%) tuvieron un EVA moderado-severo y 11 (37%) EVA leve. 7 pacientes (23.33%) requirieron intervención quirúrgica, 21 (70%) necesitaron de unidad de cuidados críticos, y 1 (3.33%) falleció.Conclusiones: el dolor abdominal constituye un desafío diagnóstico en este tiempo de pandemia y debería ser considerado dentro de las posibles manifestaciones clínicas de COVID-19 en la población pediátrica..Au

Objective: the objective of this study was to describe the cases of paediatric patients with abdominal pain and confirmed diagnosis of COVID-19. In Latin American countries the pandemic has had a major impact from the high mortality rate. Ecuador is the fifth most affected country with a rate of 223 deaths per million inhabitants, ranking at the top of the fatality. In the paediatric population, the behavior of COVID-19 remains nonspecific. Materials and methods: an observational, descriptive and retrospective study was conducted, in which patients under the age of 18 were included except for newborns, admitted by abdominal pain and who obtained a confirmed diagnosis COVID-19. Results: 30 patients with confirmed diagnosis of COVID-19 and abdominal pain were included. The average age was 8.46 years at the predomin of the male sex (70%). In the pain assessment 19 (63%) had a moderate-severe EVA and 11 (37%) Mild EVA. 7 (23.33%) required surgery, 21 (70%) needed a critical care unit, and 1 (3.33%) Died. Conclusions: abdominal pain is a diagnostic challenge in this time of pandemic and should be considered within the possible clinical manifestations of COVID-19 in the paediatric population..Au

Sleep patterns and physical function in older adults attending primary health care.

BACKGROUND: Sleep disturbances may contribute to physical function impairment among older adults. OBJECTIVE: To examine the associations between sleep quality and duration and impaired physical function among older adults. METHODS: Cross-sectional study involving 392 non-institutionalized adults aged ≥65 years, who were recruited from primary health care centres in Spain. Sleep quality and duration were assessed with the Pittsburgh Sleep Quality Index (PSQI). The FRAIL scale was used to identify physical frailty, the short physical performance battery to assess lower extremity functional impairment (LEFI) and grip strength was measured using a hand-held dynamometer to assess muscle weakness. Statistical analyses were performed with logistic regression models adjusted for potential confounders. RESULTS: Participants with poor sleep quality (PSQI global score ≥10) were more likely to have functional limitations; the odds ratio (95% confidence interval) was 2.90 (1.10-7.64) for physical frailty, 2.73 (1.34-5.58) for LEFI and 2.32 (1.14-4.75) for muscle weakness. Sleep quality components associated with frailty were sleep disturbances, use of sleeping medication and daytime dysfunction. The only quality component associated with LEFI was poor sleep efficiency, while subjective poor sleep quality and daytime dysfunction were linked to muscle weakness. No associations were observed between night-time sleep duration and physical function indicators. CONCLUSIONS: Poor self-reported sleep quality, but not sleep duration, was associated with an increased frequency of physical frailty, LEFI and muscle weakness. Interventions to improve sleep quality could contribute to healthy ageing.

Del Nido Cardioplegia Versus Cold Blood Cardioplegia in Adult Cardiac Surgery: Protocol for a Randomized Controlled Trial.

BACKGROUND: The use of cardioplegia solutions as a myocardial protection technique is essential during cardiac surgery with cardiopulmonary bypass. The del Nido cardioplegia solution (DNS) has been widely used as a myocardial preservation technique for pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Its unique pharmacological features have created growing interest for adult cardiac surgery, especially for elderly patients or those with ventricular dysfunction who are more prone to ischemia-reperfusion injury. Ever since its implementation, several retrospective studies have been published to validate the efficacy, safety, and efficiency of DNS in adult patients undergoing coronary revascularization, valve replacement, or combined procedures. Recently, a meta-analysis based on nine retrospective studies was published claiming the noninferiority of DNS compared to other conventional cardioplegia solutions. Few prospective randomized studies have been conducted whose primary outcome was the assessment of DNS clinical efficacy compared to other solutions commonly used in adult patients. OBJECTIVE: The aim of this randomized clinical trial is to assess the benefits of DNS compared to Cardi-Braun blood cardioplegia solution in clinical and biochemical terms regarding myocardial protection during adult cardiac surgery. METHODS: This is the protocol of a controlled, randomized, single-center clinical trial carried out at the Puerta de Hierro Majadahonda University Hospital in Spain. A total of 474 participants over the age of 18 years undergoing elective cardiac surgery with cardiopulmonary bypass will be assigned to groups by simple randomization to receive either DNS or Cardi-Braun blood cardioplegia solution. The primary outcome will be the differences between groups in myocardial protection in biochemical terms (ie, perioperative troponin levels) and clinical terms (ie, presence of the composite variable acute cardiovascular event). The clinical trial will be carried out under conditions of respect for the fundamental rights of the person and the ethical principles that affect biomedical research with human beings, as well as in accordance with international recommendations contained in the Declaration of Helsinki and its subsequent revisions. RESULTS: The inclusion process started in 2018. Data cleaning and analyses are expected to take place in the fall of 2020 and the results are expected in January 2021. CONCLUSIONS: This study is particularly relevant as it will be one of the first to analyze the clinical effects of del Nido cardioplegia on the basis of direct myocardial protection parameters. In light of published studies, carrying out prospective studies based on primary clinical objectives with a larger sample, high-risk patients, and longer cardiopulmonary bypass times continues to be necessary. We believe that our study addresses an important gap in the knowledge of del Nido cardioplegia in adult patient cardiac surgery and will be able to clarify the possible benefits of this method in a large population of patients undergoing these procedures. TRIAL REGISTRATION: European Union Drug Regulating Authorities Clinical Trials Database (EudraCT) 2017-005144-14; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2017-005144-14+; ClinicalTrials.gov NCT04094168; https://clinicaltrials.gov/ct2/show/NCT04094168. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17826.

Habitat use, fruit consumption, and population density of the black-headed night monkey, Aotus nigriceps, in southeastern Peru

The black-headed night monkey, Aotus nigriceps, has one of the largest distribution ranges of the 11 night monkey species found across Central and South America. Yet, only three studies have focused on their ecology, describing considerable variation in habitat, group composition, and population density. Therefore, we analyzed habitat use, group composition, population density, and diet of 14 groups at two field sites in southeastern Peru. All sampled groups were found in secondary tropical rainforest, often dominated by native bamboo species. Half of the observed sleeping sites were in bamboo stands, though groups also emerged from cane thickets and lianas. This contrasts with other Aotus studies which have found groups living in tree cavities and lianas. Population density estimates for both sites were 19 and 50 individuals per km2, outside the range previously reported for A. nigriceps (31−34 individuals per km2). We recovered seeds of 12 species from fecal samples over the course of two field seasons, belonging mainly to Cecropiaceae, Piperaceae and Moraceae. Our results suggest that the black-headed night monkey in Peru can survive and even thrive in secondary forest, feeding extensively on pioneer species, occupying a range of forest types, all while living near human settlements. (AU)

Resultados del tratamiento de pie equinovaro congénito con el método de Ponseti / Outcomes of congenital clubfoot treatment using the Ponseti method

Introducción El pie equinovaro congénito es la deformidad congénita más frecuente del pie. Actualmente, el método Ponseti es el método de referencia para el tratamiento de esta anomalía, pues provee de una corrección completa de las deformidades con buena movilidad y función del pie. Existen muchos estudios en el mundo que muestran resultados funcionales del método. Sin embargo, en Colombia no hay publicaciones de este tipo con el método Ponseti. Materiales y métodos Este es un estudio descriptivo, retrospectivo, de tipo serie de casos en pacientes entre 0 y 12 años diagnosticados con pie equinovaro congénito, tratados con el método Ponseti entre julio de 2002 y diciembre de 2015. Con un seguimiento mínimo de menos 6 meses, se midió la gravedad según la escala de Dimeglio y la funcionalidad según la escala de Laaveg-Ponseti. Resultados 123 pacientes (183 pies) con un seguimiento medio de 8 años. Edad de inicio del tratamiento: entre 0 y 24 meses. Según la clasificación del grado de gravedad de Dimeglio, el 6,5% eran leves, el 74% moderados, el 13% graves y el 6,5%, muy graves. La mayoría de los pies estudiados era de origen idiopático (96%). El 20% presentaron recidiva. Los resultados funcionales según la escala de Laaveg-Ponseti fueron excelentes (71%), buenos (23%) o regulares (6%). Discusión Nuestros resultados con desenlaces buenos y excelentes del 94% son similares a reportes previos. Con una recidiva del 17,8%, en la bibliografía se reportan el 20 y el 40%, respectivamente. Este estudio, a diferencia de los demás, no encontró relación directa entre el uso del aparato de abducción y la recidiva. No hubo sobrecorrecciones y ningún paciente tuvo un resultado malo según la escala de Laaveg-Ponseti. Nivel de evidencia clínica Nivel IV.

Background Congenital clubfoot is the most common congenital deformity of the foot. The Ponseti method is currently the gold standard for the treatment of this anomaly, as it provides a complete correction of the deformities with good foot mobility and function. There are many studies from all over the world that present the functional results of the method. However, in Colombia there are no publications of this type using the Ponseti method. Materials and methods This is a descriptive, retrospective, case series-type study in patients between 0 and 12 years old diagnosed with clubfoot, and treated using the Ponseti method between July 2002 and December 2015, and with a minimum follow-up of at least 6 months. Severity was measured according to the Dimeglio scale, and functionality with the Laaveg-Ponseti scale. Results The study included a total of 123 patients (183 feet) with a mean follow-up of 8 years. Treatment was started between 0 and 24 months. According to Dimeglio severity rating, 6.5% were mild, 74% moderate, 13% severe, and 6.5% very severe. Most (96%) of the studied feet were of idiopathic origin. There was a relapse in 17.8%. The functional results, according to the Laaveg-Ponseti scale were excellent in 71%, good in 23%, and average in 6%. Discussion The results with good and excellent outcomes of 94% are similar to previous studies. With a relapse rate of 17.8%, compared to the 20% and 40%, respectively, reported in the literature. This study, unlike the others, found no direct relationship between the use of the abduction apparatus and relapse. There were no over-corrections and no patient had a poor outcome according to the Laaveg-Ponseti scale. Evidence level IV.

Tuberculosis de la mano en mujer embarazada: raro caso de manifestación extrapulmonar / Tuberculosis of the hand in pregnant women: A rare extrapulmonary manifestation

Introducción Se presentaron 8,6 millones de nuevos casos de tuberculosis en 2013 según la OMS. La incidencia de tuberculosis en mujeres embarazadas se calcula en 60 casos por cada 100.000 habitantes en países endémicos. El compromiso musculoesquelético representa el 10-20% de los casos y el de la mano y el pie, el 1-2% de los casos. Materiales y métodos Paciente femenina de 42 años con 23 semanas de embarazo que consulta por cuadro de 5 meses de evolución de dolor, edema y eritema en mano derecha. Se diagnostica inicialmente síndrome del túnel carpiano. Después de 15 días vuelve a consultar por persistencia de los síntomas. Se inicia manejo antibiótico con diagnóstico de celulitis. Después de 7 semanas se evidencia lesión con absceso de 3×4 cm, reactantes de fase aguda elevados y se realiza drenaje quirúrgico, tras el cual se obtienen 8 ml de pus. Se procede a manejo antibiótico. Se realiza resonancia magnética y baciloscopia de secreción en la mano positiva para tuberculosis. Reporte de cultivo positivo para Mycobacterium tuberculosis. Resultados Después del manejo tetraconjugado, presenta mejoría de los síntomas; 6 meses después se realiza artrodesis de la muñeca como consecuencia de las alteraciones articulares en los huesos del carpo. Discusión El compromiso del aparato musculoesquelético por la tuberculosis es infrecuente. Las manifestaciones clínicas se pueden confundir con otros diagnósticos. Por su baja incidencia, pasa inadvertida y el diagnóstico es tardío. El pronóstico y las secuelas dependen del inicio precoz del tratamiento. Por tanto, debe sospecharse en pacientes que presenten factores de riesgo, como inmunosupresión, y en el embarazo. Nivel de evidencia clínica. Nivel IV.

Background A total of 8.6 million new cases of tuberculosis were reported in 2013, according to the WHO, with the incidence of tuberculosis in pregnant women is estimated at 60 cases per 100,000 inhabitants in endemic countries. Skeletal muscle involvement represents 10% to 20% of cases, with hand and foot in 1% to 2% of cases. Materials and methods A 42-year-old female patient in her 23rdweek of pregnancy who consulted due to pain, oedema, and erythema after 5 months of the onset of symptoms in the right hand. She was initially diagnosed with a carpal tunnel syndrome. After 15 days, she returned to the clinic with persistence of the symptoms. Antibiotic management was started with the diagnosis of cellulitis. Seven weeks later she had a 3×4cm abscess, with elevated acute phase reactants. Surgical drainage was performed, obtaining 8 ml of pus, and antibiotic management was re-started. A magnetic resonance scan was performed, and a smear was taken for microscopy of the secretion, with a hand tuberculosis abscess being confirmed. Positive culture reports for Mycobacterium tuberculosis were also conclusive in diagnosis. Results After surgery and tetra-conjugate antibiotic management, the symptoms improved. After 6 months, an arthrodesis of the wrist was performed as a consequence of the articular alterations in the carpal bones. Discussion The involvement of the musculoskeletal system due to tuberculosis is uncommon. Clinical findings may be confusing, and a diagnostic bias could easily occur. Due to its low incidence, it is usually unnoticed and the diagnosis is often delayed. Nevertheless, the prognosis and sequelae depend on the early onset of treatment, and it should be suspected in patients with risk factors such as immunosuppression and pregnancy in endemic populations. Evidence level. IV.

Accounting for the impact of parent internalizing symptoms on Parent Training benefits: The role of positive parenting.

Parent Training (PT) is not as effective for parents with histories of internalizing symptoms as it is for other parents. This study aimed to determine which dimensions of parenting, notably parenting efficacy, positive parenting, inconsistent discipline, and poor supervision, mediate the association between parent lifetime internalizing symptoms and post-PT child emotional and behavioral difficulties. One hundred fourteen parents (82% biological mothers) of children aged 9-12 years received PT at an urban children's mental health clinic. Parents reported their lifetime internalizing symptoms, pre- and post- PT parenting skills, and pre- and post- PT child difficulties. Positive parenting fully mediated the relation between parent lifetime internalizing symptoms and elevated child post-PT emotional and behavioral difficulties. Specifically, parents higher in internalizing symptoms reported lower positive parenting post-PT, which in turn predicted more child difficulties post-PT. Findings suggest that fostering positive parenting in PT may be particularly important for parents with histories of internalizing symptoms.