Twins with alveolar capillary dysplasia with misalignment of pulmonary veins: Strategies for diagnosis and management.

We present a case of dichorionic-diamniotic twin females who developed hypoxemic respiratory failure. They were ultimately diagnosed by lung biopsy with alveolar capillary dysplasia with misalignment of pulmonary veins. This case highlights a practical approach to reaching a diagnosis in infants with suspected developmental lung disease.

Central nervous system activity of a Tabernaemontana arborea alkaloid extract involves serotonergic and opioidergic neurotransmission in murine models.

Tabernaemontana arborea (Apocynaceae) is a Mexican tree species known to contain ibogan type alkaloids. This study aimed at determining central nervous system-related activities of an alkaloid extract obtained from the root bark of T. arborea. A gas chromatography-mass spectrometry (GC-MS) analysis was performed to describe the alkaloid profile of the extract. A wide dosing range (0.1 to 56.2 mg/kg) of this extract was evaluated in different murine models. Electrical brain activity was examined by electroencephalography (EEG). The extract's effects on motor coordination, ambulatory activity, and memory were analyzed based on the rotarod, open field (OFT), and object recognition tests (ORT), respectively. Antidepressant and antinociceptive activities were determined using the forced swimming test (FST) and the formalin assay, respectively. In order to elucidate the underlying mechanisms of action, the 5-HT1A receptor antagonist WAY100635 (1 mg/kg) or the opioid receptor antagonist naloxone (1 mg/kg) was included in the latter experiments. GC-MS analysis (µg/mg extract) confirmed the presence of the monoterpenoid indole alkaloids (MIAs) voacangine (207.00), ibogaine (106.33), vobasine (72.81), coronaridine (30.72), and ibogamine (24.2) as principal constituents of the extract, which exhibited dose- and receptor-dependent antidepressant (0.1 to 1 mg/kg; 5-HT1A) and antinociceptive (30 and 56.2 mg/kg; opioid) effects, without altering motor coordination, ambulatory activity, and memory. EEG indicated CNS depressant activity at high doses (30 and 56.2 mg/kg). The root bark of T. arborea contains a mixture of alkaloids that may hold therapeutic value in pain relief and the treatment of psychiatric diseases without causing neurotoxic activity at effective doses.

Current vision on diagnosis and comprehensive care in hepatic encephalopathy.

The first clinical guidelines on hepatic encephalopathy were published in 2009. Almost 14 years since that first publication, numerous advances in the field of diagnosis, treatment, and special condition care have been made. Therefore, as an initiative of the Asociación Mexicana de Gastroenterología A.C., we present a current view of those aspects. The manuscript described herein was formulated by 24 experts that participated in six working groups, analyzing, discussing, and summarizing the following topics: Definition of hepatic encephalopathy; recommended classifications; epidemiologic panorama, worldwide and in Mexico; diagnostic tools; conditions that merit a differential diagnosis; treatment; and primary and secondary prophylaxis. Likewise, these guidelines emphasize the management of certain special conditions, such as hepatic encephalopathy in acute liver failure and acute-on-chronic liver failure, as well as specific care in patients with hepatic encephalopathy, such as the use of medications and types of sedation, describing those that are permitted or recommended, and those that are not.

AACVD system and protocol to fabricate CuO and Co3O4 nanostructured coatings for application as selective absorbent materials.

In the present work, an aerosol-assisted CVD (AACVD) system is described, together with a representative example of the synthesis of nanostructured coatings, which is an attractive alternative to being implemented at the industrial level. The semi-automated AACVD system synthesizes thin films or coatings of nanostructured materials, mainly metal oxides, and noble metals. Its main components, as well as its operation, are presented here. This simple AACVD method makes it possible to produce the coatings at relatively low temperatures and in a single step. Finally, the synthesis of CuO and Co3O4 nanostructured coatings deposited on stainless steel substrates is reported, which are excellent candidates for use as selective absorbent materials. The CuO and Co3O4 coatings present high quality and purity; no further thermal treatments are required to obtain the pure and crystalline phases. The main highlights of the proposed method are as follows: a)An AACVD System for depositing thin films and coatings designed and entirely fabricated at the Centro de Investigación en Materiales Avanzados, S.C.b)A low temperature (350 °C) synthesis protocol to obtain CuO and Co3O4 nanostructured coatings on stainless steel substrates.c)The CuO and Co3O4 coatings presented the optimum characteristics to be considered selective absorbent materials.

Evaluation of Pelvic Floor Muscles in Pregnancy and Postpartum With Non-Invasive Magnetomyography.

Objective: To record and characterize features of levator ani muscles (LAM) activity in pregnancy and postpartum using non-invasive and novel Magnetomyography (MMG) technique with amplitude and spectral parameters. Methods: Nulliparous women with uncomplicated pregnancies participated in the MMG data collection during rest and voluntary LAM contractions (Kegels) with modulated intensity in third trimester and approximately 2 months postpartum (PP). Simultaneous surface electromyography was recorded to document the recruitment of accessory muscles. Moderate strength Kegel (MK) MMG trials were analyzed. Amplitude and spectral parameters including root-mean square (RMS) amplitude, power spectrum density (PSD) and normalized PSD (rPSD) in three frequency bands (low, middle, high) were computed on MK epochs. Statistical comparisons between pregnancy and postpartum were calculated. Results: MMG recordings were measured from 10 pregnant women. Results showed decreased RMS and power between third trimester and postpartum, trending towards significance. rPSD values in the low frequency band decreased significantly (p = 0.028) from third trimester to postpartum, while significant increase was observed in the middle frequency band (p = 0.018). Conclusions: This study shows that MMG as non-invasive tool has the ability to detect and characterize changes of LAM activity with amplitude and spectral parameters during pregnancy and postpartum.

Tratamiento de la osteonecrosis de los maxilares asociada a medicamentos: Enfoque médico-quirúrgico de estadios II y III

Resumen Introducción: La osteonecrosis de los maxilares asociada a medicamentos (OMAM) se define como la presencia de hueso necrótico expuesto de los maxilares en pacientes con historia de tratamiento farmacológico antirresortivo o antiangiogénico. Se describen diferentes estadios se severidad, con tratamiento conservador para estadios 0 y I, y tratamiento médico-quirúrgico para II-III. Objetivo: Describir los factores desencadenantes, opciones de tratamiento médico-quirúrgico y resultados en pacientes con OMAM estadios II-III. Material y Método: Estudio retrospectivo, descriptivo, de pacientes diagnosticados con OMAM estadios II y III que requirieron manejo médico-quirúrgico en la Red de Salud UC-Christus entre los años 2007 y 2018. Resultados: Todos los pacientes presentaron historia de tratamiento con bifosfonatos intravenosos. La mayoría de los registros de seguimiento de pacientes estuvo disponible para su análisis. El tratamiento consistió en aseo quirúrgico, decorticación y secuestrectomía. Se reportó disminución de la sintomatología con resolución parcial en la mitad de los casos y cierre completo de la exposición ósea en los restantes. Conclusión: Sugerimos que el tratamiento médico-quirúrgico en pacientes con OMAM en etapas II y III es efectivo en términos de disminución de sintomatología y control de infección. Sin embargo, es necesario realizar nuevos estudios prospectivos, con mayor cantidad de pacientes y tiempo de seguimiento.

Abstract Introduction: Medication-associated osteonecrosis of the jaws (MRONJ) is defined as the presence of exposed necrotic bone of the jaws in patients with a history of antiresorptive or antiangiogenic drug treatment. Different stages of severity are described, with conservative treatment for stages 0 and I, and medical-surgical treatment for II-III. Aim: To describe the triggers, medical-surgical treatment options and outcomes in patients with stage II-III MRONJ. Material and Method: Retrospective, descriptive study of patients diagnosed with MRONJ stages II and III that required medical-surgical management in the UC-Christus Health Network between 2007 and 2018. Results: All patients had a history of treatment with intravenous bisphosphonates. Most of the patient follow-up records were available for analysis. Treatment consisted of surgical grooming, decortication, and sequestrectomy. A decrease in symptoms was reported with partial resolution in half of the cases, and complete closure of bone exposure in the remainder. Conclusion: We suggest that medical-surgical treatment in patients with MRONJ in stages II and III is effective in terms of reducing symptoms and controlling infection. However, it is necessary to carry out new prospective studies, with a greater number of patients and follow-up time.

Confiabilidad test-retest de goniometría estándar y G-pro smartphone en el movimiento flexo-extensión del hombro / Test-retest reliability of standard goniometry and the G-pro smartphone in shoulder flexion-extension

Antecedentes y objetivos En la actualidad la falta de herramientas para el fisioterapeuta y la calidad que se le da al momento de evaluar no permite hacer un buen diagnóstico. La evaluación precisa del rango articular conforma una tarea esencial en la labor diaria de los fisioterapeutas, para poder valorar correctamente la progresión del tratamiento. En esta investigación nos planteamos analizar la fiabilidad y la seguridad de una aplicación G-Pro smart bajo el sistema Android, para evaluar sus características y observar su utilidad como goniómetro en la clínica para medir los ángulos articulares. Materiales y métodos Se empleó el goniómetro estándar por un tecnólogo médico en terapia física y rehabilitación y la aplicación G-pro smartphone para medir de manera pasiva y bilateral la flexión y rotación de hombro, y la flexión de codo de 30 sujetos que toleraran la bipedestación. Resultados Existe una confiabilidad de buena a excelente (r=0,998 a 0,896; p<0,01), utilizando la aplicación G-pro smartphone, mientras que con el goniómetro universal esta confiabilidad es de aceptable a cuestionable (r=0,757 a 0,609) en el movimiento activo de flexo-extensión del hombro. Conclusiones Los resultados obtenidos en este estudio nos muestran que estos dispositivos aplicativos a través de un smartphone suponen un recurso adicional para evaluar los rangos de movilidad articular. Gracias al avance tecnológico podemos mejorar, innovar y objetivar el resultado de valoración articular para que este sea preciso, y por lo tanto los tratamientos brindados sean adecuados y diferenciados para cada paciente. Esta herramienta es de bajo costo y está al alcance del personal de salud, fácil de utilizar, dado que cuenta con un inclinómetro que es confiable tanto visual como valorativo (AU)

Background and objective Currently, the lack of tools for physiotherapists, and the quality of these tools when physiotherapists assess patients does not allow a good diagnosis. Accurate joint range evaluation is an essential task in the daily work of physiotherapists in order to correctly assess treatment progress. In this study, we examined the reliability and safety of an Android system application called G-Pro to evaluate its characteristics and observe its usefulness as a goniometer to measure joint angles in a clinic. Material and methods The standard goniometer and G-pro smartphone with the application were used to passively and bilaterally measure shoulder flexion and rotation and elbow flexion in 30 participants able to tolerate standing. Results The G-pro smartphone application showed good to excellent reliability (r=0.998 to 0.896, P<.01), while the universal goniometer showed acceptable to questionable reliability (r=0.757 to 0.609) in active shoulder flexion-extension movement. Conclusions The results obtained in this study show that these devices represent an additional resource to assess joint mobility ranges. Due to technological progress, we can improve, innovate, and demonstrate the results of joint assessments to ensure their accuracy. This, in turn, ensures that the treatment provided is appropriate and specific to each patient. This tool is low cost and is accessible for health care professionals; moreover, it is easy to use since it has an incliniometer that is reliable both visually and evaluatively (AU)

[Test-retest reliability of standard goniometry and the G-pro smartphone in shoulder flexion-extension]. / Confiabilidad test-retest de goniometría estándar y G-pro smartphone en el movimiento flexo-extensión del hombro.

BACKGROUND AND OBJECTIVE: Currently, the lack of tools for physiotherapists, and the quality of these tools when physiotherapists assess patients does not allow a good diagnosis. Accurate joint range evaluation is an essential task in the daily work of physiotherapists in order to correctly assess treatment progress. In this study, we examined the reliability and safety of an Android system application called G-Pro to evaluate its characteristics and observe its usefulness as a goniometer to measure joint angles in a clinic. MATERIAL AND METHODS: The standard goniometer and G-pro smartphone with the application were used to passively and bilaterally measure shoulder flexion and rotation and elbow flexion in 30 participants able to tolerate standing. RESULTS: The G-pro smartphone application showed good to excellent reliability (r=0.998 to 0.896, P<.01), while the universal goniometer showed acceptable to questionable reliability (r=0.757 to 0.609) in active shoulder flexion-extension movement. CONCLUSIONS: The results obtained in this study show that these devices represent an additional resource to assess joint mobility ranges. Due to technological progress, we can improve, innovate, and demonstrate the results of joint assessments to ensure their accuracy. This, in turn, ensures that the treatment provided is appropriate and specific to each patient. This tool is low cost and is accessible for health care professionals; moreover, it is easy to use since it has an incliniometer that is reliable both visually and evaluatively.

Pharmacological and toxicological effects of Ruta chalepensis L. on experimentally induced seizures and electroencephalographic spectral power in mice.

ETHNOPHARMACOLOGICAL RELEVANCE: Ruta chalepensis L. (Rutaceae) is used in traditional medicine to treat a wide variety of disorders such as rheumatism, fever, mental disorders, dropsy, neuralgia, menstrual problems, anxiety, and epilepsy. AIM OF THE STUDY: To evaluate and compare the anticonvulsant properties of an aqueous extract and ethyl acetate (AcOEt) fraction of R. chalepensis on pentylenetetrazole (PTZ)-induced seizures and maximal electroshock (MES) test in mice, by analyzing behavior and electroencephalogram (EEG), as well as GABAA receptors involvement. METHODS: The effect of an acute administration of different dosage of the aqueous extract (300 or 500 mg/kg) or AcOEt fraction (100, 300, 500 or 1000 mg/kg) of R. chalepensis was explored on two different models of acute seizure induction in mice, the PTZ and maximal electroshock (MES) tests. Behavioral and electrographic effects were quantified. Additionally, the possible involvement of the GABAA receptors was explored in the presence of picrotoxin (a non-competitive antagonist of the GABAA receptor). RESULTS: AcOEt fraction of R. chalepensis was more efficient than aqueous extract to reduce the incidence of tonic-clonic seizures and mortality in a significant and dose-dependent manner in both the PTZ and MES tests. This anticonvulsant effect was not abolished in the presence of picrotoxin. The EEG spectral power analysis revealed that aqueous extract decreased alpha and beta power, while AcOEt fraction decreased alpha and gamma power confirming previous findings of its depressant effect in the central nervous system. It is important to mention that the highest dosage of the AcOEt (1000 mg/kg) produced a severe suppression or isoelectric EEG activity (EEG flattening), recognized as a comatose state, suggesting a neurotoxic effect at this dosage. CONCLUSION: Our data reinforce that depressant and anticonvulsant effects of R. chalepensis depend in part on the presence of constituents from medium polarity. We also found that anticonvulsant effect is not mediated by GABAA receptors. In addition, cautious is emphasized when high doses of this natural product are used in traditional medicine since it might produce neurotoxic effects.

Fontan-associated liver disease. / Enfermedad hepática crónica asociada a la cirugía de Fontan.

OBJECTIVE: To review the pathophysiology of Fontan-associated liver disease, its histologic changes, and its radiologic manifestations. CONCLUSIONS: Fontan-associated liver disease is the result of a set of structural and functional changes in the liver that occur secondary to hemodynamic changes brought about by Fontan surgery. The radiologic manifestations of Fontan-associated liver disease consist of changes in the size and shape of the liver, alterations in the signal intensity or pattern of enhancement, abnormalities in the vascular structures, and focal lesions, which include benign nodules with intense uptake in the arterial phase and hepatocellular carcinoma. Radiologists need to be familiar with this disease and its complications, because the number of patients who undergo Fontan surgery continues to increase, and these patients undergo an increasing number of imaging tests.

Parkinson's Disease Master Regulators on Substantia Nigra and Frontal Cortex and Their Use for Drug Repositioning.

Parkinson's disease (PD) is among the most prevalent neurodegenerative diseases. Available evidences support the view of PD as a complex disease, being the outcome of interactions between genetic and environmental factors. In face of diagnosis and therapy challenges, and the elusive PD etiology, the use of alternative methodological approaches for the elucidation of the disease pathophysiological mechanisms and proposal of novel potential therapeutic interventions has become increasingly necessary. In the present study, we first reconstructed the transcriptional regulatory networks (TN), centered on transcription factors (TF), of two brain regions affected in PD, the substantia nigra pars compacta (SNc) and the frontal cortex (FCtx). Then, we used case-control studies data from these regions to identify TFs working as master regulators (MR) of the disease, based on region-specific TNs. Twenty-nine regulatory units enriched with differentially expressed genes were identified for the SNc, and twenty for the FCtx, all of which were considered MR candidates for PD. Three consensus MR candidates were found for SNc and FCtx, namely ATF2, SLC30A9, and ZFP69B. In order to search for novel potential therapeutic interventions, we used these consensus MR candidate signatures as input to the Connectivity Map (CMap), a computational drug repositioning webtool. This analysis resulted in the identification of four drugs that reverse the expression pattern of all three MR consensus simultaneously, benperidol, harmaline, tubocurarine chloride, and vorinostat, thus suggested as novel potential PD therapeutic interventions.

Diagnóstico de divertículo de Meckel mediante cápsula endoscópica / Diagnose of Meckel's diverticulum through endoscopic capsule

Meckel's diverticulum can be present in up to 1.2% of the population. It is usually diagnosed as an imaging finding, but it can present with complications such as digestive bleeding, intestinal obstruction, diverticulitis, ulcers, and perforation, more frequently in childhood or infancy. The diagnosis workup for this condition will depend on their clinical manifestation, the most frequent being gastrointestinal bleeding of obscure origin or small intestinal bleeding. In this context, although capsule endoscopy is the preferred technique, its diagnostic yield for the detection of Meckel's diverticulum is not entirely clear and it has not been compared in a controlled studies with other diagnostic methods. Here we report the diagnosis of a Meckel diverticulum and its intestinal complications by means of capsule endoscopy in a patient with iron deficiency anemia and gastrointestinal bleeding

El divertículo de Meckel puede estar presente en el 1,2% de la población general. Usualmente es diagnosticado como un hallazgo, pero puede presentarse con mayor frecuencia en la niñez o infancia por sus complicaciones como hemorragia digestiva, obstrucción intestinal, diverticulitis, úlceras y perforación. El enfrentamiento diagnóstico de esta condición dependerá de la manifestación clínica, siendo lo más frecuente hemorragia digestiva de origen oscuro o de intestino delgado. En este contexto, si bien la cápsula endoscópica es la técnica de elección, su rendimiento diagnóstico para la detección del divertículo de Meckel no es del todo claro y no ha sido comparado de forma controlada con otras técnicas diagnósticas. En el presente caso se reporta el diagnóstico de un divertículo de Meckel y sus complicaciones intestinales mediante cápsula endoscópica en una paciente con anemia ferropriva y hemorragia digestiva.

Prevalencia de osteonecrosis de los maxilares asociada a medicamentos en pacientes tratados con bifosfonatos intravenosos: análisis epidemiológico en Centro del Cáncer - Red de Salud UC-CHRISTUS

Resumen Introducción: La osteonecrosis de los maxilares asociada a medicamentos (OMAM) es una patología que involucra la exposición necrótica de hueso maxilar o mandibular, relacionada al uso de fármacos antirresortivos y antiangiogénicos, con una prevalencia de 0,94%-13% en pacientes oncológicos y con osteoporosis que hacen uso de ellos. Objetivo: Determinar la prevalencia de osteonecrosis de los maxilares en pacientes en tratamiento con bifosfonatos intravenosos (BFIV) en el Centro del Cáncer de la Red de Salud UC-Christus, Santiago de Chile. Material y Método: Se analizaron los datos de pacientes que recibieron tratamiento de bifosfonatos intravenoso entre marzo y septiembre de 2016, con seguimiento por los equipos tratantes. Se consideró para la extracción de datos el género, edad, diagnóstico primario, bifosfonato intravenoso utilizado, tiempo de seguimiento, presencia de metástasis óseas y diagnóstico de OMAM. Resultados: Se obtuvo una muestra de 143 pacientes, con una relación hombre:mujer de 1:2; promedio de edad de 63,2 años; 78% de ellos fueron tratados con ácido zoledrónico y un 22% con pamidronato. Del total de pacientes un 1,4% (n = 2) desarrolló OMAM. Ambos casos con diagnóstico de cáncer de mama en tratamiento con ácido zoledrónico, lo que corresponde al 1,8% de los pacientes en tratamiento con este fármaco. Conclusión: Si bien la OMAM es una patología infrecuente, esta se presenta con alta morbilidad y es de manejo complejo. La prevención y tratamiento de focos infecciosos odontogénicos de pacientes antes, durante o después del tratamiento con BFIV es fundamental para prevenir su desarrollo.

Abstract Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a disease involving exposition of necrotic maxillary and mandibular bone and it's related to antiresorptive and antiangiogenic drugs, with a prevalence that variates from 0,94%-13% in oncologic and osteoporosis patients treated with them. Aim: To determine the prevalence of MRONJ in patients that underwent treatment with intravenous bisphosphonates (IVBP) at Centro del Cancer de la Red de Salud UC-CHRISTUS of Santiago, Chile. Material and Method: Data from patients who received intravenous bisphosphonate treatment between March and September 2016 were analyzed, with follow-ups by their treating teams. Data extraction considered gender, age, primary diagnosis, intravenous bisphosphonate used, follow up time, bone metastases and diagnosis of MRONJ. Results: A sample of 143 patients was obtained with a men:women ratio of 1:2; an average age of 63,2 years, 78% of the patients were treated with zoledronic acid and 22% of the patients with pamidronate. From the total number of patients,1.4% (n = 2) developed MRONJ, both cases had breast cancer as primary diagnosis and in treatment with zoledronic acid, which corresponds to 1.8% of patients being treated with this drug. Conclusion: Although MRONJ is an infrequent disease, it presents high morbidity and complex management. Prevention and treatment of odontogenic infectious foci in patients before, during and after treatment with IVBP drugs is fundamental to prevent this pathology.

Estimación de la prevalencia de riesgo de síndrome de apneas obstructivas del sueño en funcionarios de una Institución de Salud según el cuestionario STOP-Bang / Estimation of the prevalence of risk of obstructive sleep apnea syndrome in workers of a health institution according to the stop-bang questionnaire

INTRODUCCIÓN: En Chile, se estima que 8,5% de los adultos tiene riesgo elevado de síndrome de apnea e hipopnea obstructiva del sueño (SAHOS). OBJETIVO: Estimar el riesgo de SAHOS en funcionarios de la salud. MATERIAL Y MÉTODO: Se consignaron los datos clínicos, antropométricos, presión arterial, cuestionarios STOP-Bang (CSB), índice de Flemons y escalas de Epworth y de Thornton en trabajadores de Clínica Dávila, Santiago, Chile. RESULTADOS: Se evaluaron 1.332 funcionarios, 77,1% mujeres, circunferencia de cuello: 35,7 ± 3,7 cm (26-54), circunferencia de cintura: 89,3 ± 3,7 cm, e índice de masa corporal: 27,5 ± 4,5 (17,5-49,4) kg/m2; 42% tenía sobrepeso y 26% obesidad. El Cuestionario SB los clasificó en tres categorías: Riesgo alto (RA): 43 funcionarios (3,2%), 50 ± 10,5 años; riesgo moderado: 215 (16,1%), 45,6 ± 11,4 años y riesgo bajo: 1.074 (80,6%), 36,2 ± 10,6 años. En hombres, la edad y los puntajes de los cuestionarios de sueño fueron diferentes en las tres categorías de riesgo (p = 0,003 y 0,001). En mujeres, los puntajes de los cuestionarios fueron distintos en los tres grupos de riesgo, no hubo diferencias en la escala de Epworth (p = 0,274), ni en la edad (p = 0,08). La escala Mallampati no permitió predecir el riesgo de SAHOS en ambos sexos. CONCLUSIONES: El cuestionario SB identificó a 9,8% de los hombres con riesgo alto de SAHOS. En los hombres, la edad, cuestionario SB, Flemons, Epworth y Thornton, fueron diferentes en las tres categorías de riesgo de SAHOS. En las mujeres, la edad y escala de Epworth fueron similares en las tres categorías de riesgo.

INTRODUCTION: In Chile, it is estimated that 8.5% of adults are at high risk of Obstructive Sleep Apnea (OSA). OBJECTIVE: To estimate the risk of OSA in health workers. MATERIAL AND METHOD: clinical and anthropometric data, blood pressure, STOP-Bang (CSB) questionnaires, Flemons index and Epworth and Thornton scales were assessed in workers from Clínica Dávila, Santiago, Chile. RESULTS: 1,332 workers were evaluated, 77.1% women, neck circumference: 35.7 ± 3.7 cm (26-54), waist circumference: 89.3 ± 3.7 cm, and body mass index: 27.5 ± 4.5 (17.5-49.4) kg/m2; 42% were overweight and 26% obese. The SB Questionnaire classified them into three risk categories: High risk (HR): 43 workers (3.2%), 50 ± 10.5 years-old; moderate risk: 215 (16.1%), 45.6 ± 11.4 years-old and low risk: 1,074 (80.6%), 36.2 ± 10.6 years-old. In men, age and sleep questionnaire scores were different in the three risk categories (p = 0.003 and 0.001). In women, the sleep questionnaire scores were different in the three risk groups, there were no differences in the Epworth scale (p = 0.274), nor in age (p = 0.08). The Mallampati scale did not allow predict OSA risk in both sexes. CONCLUSIONS: The SB questionnaire identified 9.8% of the men with high risk of OSA. In men, age, SB questionnaire, Flemons index, Epworth and Thornton scale, were different in the three OSA risk categories. In women, the age and Epworth scale were similar in the different risk categories.

Neoplasia papilar intraductal de la vía biliar: radiología en una nueva entidad / Intraductal papillary neoplasm of the bile duct: Radiologic findings in a new disease

La neoplasia papilar intraductal de la vía biliar (NPI-VB) es una entidad poco conocida en nuestro medio por su baja prevalencia. Hasta su nueva definición en la cuarta edición de la clasificación de la Organización Mundial de la Salud de los tumores del aparato digestivo publicada en 2010, la enfermedad se agrupaba bajo una terminología heterogénea y poco precisa. Además, en los últimos años se ha avanzado en el conocimiento de su etiopatogenia, su historia natural y sus hallazgos en imagen. El propósito de este artículo es repasar estos datos subrayando los hallazgos radiológicos de la enfermedad y su diagnóstico diferencial

Intraductal papillary neoplasm of the biliary tract (B-IPN) is a scarcely known entity in our daily practice due to its low prevalence. Until its new definition in the fourth edition of the WHO classification of the digestive tract tumors of 2010 the disease was grouped under a heterogeneous and imprecise terminology. In addition, in recent years there has been progress in the knowledge of its etiopathogenesis, its natural history and its findings in image. The purpose of this paper is to review these data underlining the radiological findings of the disease and its differential diagnosis

Intraductal papillary neoplasm of the bile duct: Radiologic findings in a new disease. / Neoplasia papilar intraductal de la vía biliar: radiología en una nueva entidad.

Intraductal papillary neoplasm of the biliary tract (B-IPN) is a scarcely known entity in our daily practice due to its low prevalence. Until its new definition in the fourth edition of the WHO classification of the digestive tract tumors of 2010 the disease was grouped under a heterogeneous and imprecise terminology. In addition, in recent years there has been progress in the knowledge of its etiopathogenesis, its natural history and its findings in image. The purpose of this paper is to review these data underlining the radiological findings of the disease and its differential diagnosis.

Terapias adyuvantes a la terapia antifibrótica en la fibrosis pulmonar idiopática: importancia del manejo multidisciplinario / Adjuvant therapies to antifibrotic therapy in IPF: importance of multidisciplinary management

La fibrosis pulmonar idiopática (FPI) se caracteriza por presentar una capacidad funcional reducida, disnea e hipoxia inducida por el ejercicio, lo que disminuye su tolerancia al esfuerzo y limita su capacidad de realizar actividades diarias. Las comorbilidades son frecuentes y su presencia contribuyen al empeoramiento de la calidad de vida y aumento de la mortalidad. Por lo anterior, es que además de las terapias antifibróticas, los pacientes con FPI se benefician de un enfoque integral de la atención que puede incluir: pesquisa, diagnóstico y tratamiento de comorbilidades, ingreso a protocolos de investigación, manejo sintomático, cuidados paliativos, oxígeno suplementario, rehabilitación pulmonar, educación y apoyo por un equipo multidisciplinario.

Idiopathic pulmonary fibrosis (IPF) is characterized by reduced functional capacity, dyspnea and exercise-induced hypoxia, which decreases tolerance to exertion and limits the ability to perform daily activities. Comorbidities are frequent and their presence contribute to worsening quality of life and increased mortality. Therefore, in addition to antifibrotic therapies, patients with IPF benefit of a comprehensive approach to care that may include: screening, diagnosis and treatment of comorbidities, admission to research protocols, symptomatic management, palliative care, supplementary oxygen, pulmonary rehabilitation, education and support by a multidisciplinary team.

Carcinoma escamocelular del canal anal metastásico en un paciente con VIH tratado con quimiorradioterapia concomitante. Reporte de un caso y revisión de la literatura / Metastatic anal canal squamous cell carcinoma in a patient with HIV treated with concomitant radiotherapy chemo. Case report and literature review

Resumen El carcinoma del canal anal es responsable de hasta el 4% de los casos de cáncer de colon, recto y ano; el tipo histológico más común es el carcinoma escamocelular. Una proporción no despreciable de pacientes se presenta con enfermedad metastásica al momento del diagnóstico. En estos estadios, el pronóstico es pobre y su tratamiento usualmente se basa en quimioterapia paliativa con cisplatino y 5-fluorouracilo, con tasas de supervivencia que no superan el 30% a 5 años. Algunos estudios recientes han sugerido que el tratamiento multidisciplinario con quimiorradiación, que se brinda en estadios más tempranos de la enfermedad, podría mejorar la supervivencia en un grupo seleccionado de pacientes. A continuación, presentamos el caso de un paciente masculino de 54 años con carcinoma escamocelular del canal anal con compromiso metastásico extenso y con VIH atendido en una institución especializada en el manejo de cáncer, en el cual se logró remisión completa de la enfermedad luego del manejo con quimiorradioterapia concomitante con mitomicina C y 5-fluorouracilo y se mantiene en remisión después de cerca de 4 años de haberse suspendido el tratamiento. Se discute el caso y se revisa la literatura al respecto.

Abstract Anal canal carcinoma is responsible for up to 4% of all cases of colon, rectum and anus cancer. The most common histological type is squamous cell carcinoma. A non-negligible proportion of patients have metastasized by the time of diagnosis. In these stages the prognosis is poor, and treatment is usually based on palliative chemotherapy with cisplatin and 5-fluorouracil. Five year survival rates do not exceed 30%. Some recent studies have suggested that multidisciplinary chemoradiotherapy (chemotherapy combined with radiation therapy) in earlier stages of the disease could improve survival for a select group of patients. We present the case of a 54-year-old male patient with squamous cell carcinoma of the anal canal with extensive metastasis who also had HIV. He was treated at an institution specializing in cancer treatment where complete remission of the disease was achieved after treatment with chemoradiotherapy with Mitomycin C and 5-fluorouracil. He remains in remission four years after discontinuation of treatment. We discuss the case and review the literature.

Differences between diabetic and non-diabetic patients with community-acquired pneumonia in primary care in Spain.

BACKGROUND: Diabetes is one of the underlying risk factors for developing community-acquired pneumonia (CAP). The high prevalence of diabetes among population and the rising incidence of this illness, converts it as an important disease to better control and manage, to prevent its secondary consequences as CAP. The objective of this research is to describe the characteristics of the patients with diabetes and the differences with the no diabetes who have had an episode of CAP in the context of the primary care field. METHODS: A retrospective, observational study in adult patients (> 18 years-old) who suffer from CAP and attended at primary care in Spain between 2009 and 2013 was developed using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP). We carried out a descriptive analysis of the first episodes of CAP, in patients with or without diabetes as comorbidity. Other morbidity (CVA, Anaemia, Arthritis, Asthma, Heart disease, Dementia, Depression, Dysphagia, Multiple sclerosis, Epilepsy, COPD, Liver disease, Arthrosis, Parkinson's disease, Kidney disease, HIV) and life-style factors were also included in the study. RESULTS: A total of 51,185 patients were included in the study as they suffer from the first episode of CAP. Of these, 8012 had diabetes as comorbidity. There were differences between sex and age in patients with diabetes. Patients without diabetes were younger, and had less comorbidities including those related to lifestyles such as smoking, alcoholism, social and dental problems than patients with diabetes. CONCLUSIONS: Patients who developed an episode of CAP with diabetes have more risk factors which could be reduced with an appropriate intervention, including vaccination to prevent successive CAP episodes and hospitalization. The burden of associated factors in these patients can produce an accumulation of risk. Health care professional should know this for treating and control these patients in order to avoid complications. Diabetes and those other risk factors associated could be reduced with an appropriate intervention, including vaccination to prevent the first and successive CAP episodes and the subsequent hospitalization in severe cases.

Diagnóstico y tratamiento de la sinusitis maxilar odontogénica / Diagnosis and treatment of odontogenic maxillary sinusitis

RESUMEN Introducción: La patología sinusal inflamatoria e infecciosa puede comprometer la mucosa sinusal maxilar, etmoidal, esfenoidal o frontal, y su etiología es variada. Se ha observado que la patología odontológica es uno de los factores causales de la sinusitis maxilar, con una incidencia del 10% al 40% según diversas series de casos. El diagnóstico y tratamiento se debe realizar de manera interdisciplinaria entre las especialidades de otorrinolaringología y de cirugía maxilofacial. Se elaboró un documento descriptivo sobre la sinusitis odontogénica y orientador sobre su manejo, de acuerdo a una revisión de la literatura. Se realizaron búsquedas en las bases de datos PubMed, Lilacs y Google Académico, utilizando términos relevantes para la sinusitis odontogénica, con el fin de elaborar el documento. Se utilizaron 43 artículos, todos publicados desde el año 1986 hasta la fecha. Se concluye que la sinusitis odontogénica difiere tanto en la clínica como en la microbiología de otras enfermedades sinusales. El tratamiento se basa en el trabajo interdisciplinario e incluye cirugía endoscópica funcional, realizada por el otorrinolaringólogo, en conjunto con el tratamiento odontológico, siendo fundamental la buena comunicación entre ambos equipos.

ABSTRACT Introduction: Infectious and inflammatory sinus diseases have a varied etiology and can be associated to the maxillary, ethmoidal, sphenoidal and frontal sinuses. Dental pathology can be one of the etiological factors associated to maxillary sinus disease, with frequency rates of 10-40%. Diagnosis and treatment require interdisciplinary work, with participation of otorhinolaryngology and oral and maxillofacial surgery. The development of a descriptive document on odontogenic sinusitis and management guidelines according to literature review. Pubmed, Lilacs and Google Academic database were searched using terms relevant to odontogenic sinusitis, in order to prepare the document. 43 articles were used, all published from 1986 onwards. We conclude that odontogenic sinusitis differs clinically and microbiologically from other sinus pathologies. Treatment modalities are based upon interdisciplinary surgery, including functional endoscopic surgery done by otolaryngologists and dental treatment, being fundamental close communication between the two teams.