Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis.

Myocarditis is defined as myocardial inflammation and its etiology is highly diverse, including infectious agents, drugs, and autoimmune diseases. The clinical presentation also varies widely, extending beyond the classic clinical picture of acute chest pain, and includes cases of cardiomyopathy of unknown cause whose etiology may be inflammatory. Because certain patients may benefit from targeted treatments, the search for the etiology should begin when myocarditis is first suspected. There remain several areas of uncertainty in the diagnosis and treatment of this disease. Consequently, this consensus document aims to provide clear recommendations for its diagnosis and treatment. Hence, a diagnostic algorithm is proposed, specifying when non-invasive diagnosis with cardiac MR is appropriate vs a noninvasive approach with endomyocardial biopsy. In addition, more novel aspects are discussed, such as when to suspect an underlying genetic etiology. The recommendations cover the management of myocarditis and inflammatory cardiomyopathy, both for general complications and specific clinical entities.

Outcome of tocilizumab treatment in corticosteroid-resistant thyroid eye disease / Resultados del tratamiento con tocilizumab en la enfermedad ocular tiroidea resistente a glucocorticoides

Introduction: Thyroid eye disease (TED) is a complex and incompletely understood rare autoimmune disorder.ObjectivesTo analyze the experience and the outcomes obtained with the use of intravenous tocilizumab in the treatment of TED.MethodsA retrospective analysis of adult patients diagnosed with active TED resistant to intravenous corticosteroids treated in a tertiary hospital between May 2012 and May 2021.ResultsEleven patients were included with a mean age of 52±12 (range 35–67) years. Nine patients were female and two were male. Patients received a median of 5±3.2 doses. Twenty out of twenty-four eyes achieved inactivation of TED at week 16. Proptosis response was achieved in 6/8 patients and diplopia response in 3/8 patients. The GO-QOL questionnaire showed clinically significant improvement in 9/11 patients. No serious adverse effects were reported during tocilizumab treatment. One patient required decompressive surgery 15 months after tocilizumab therapy.ConclusionThe results obtained show that the use of tocilizumab in the treatment of this pathology can be a good alternative. (AU)

Introducción: La orbitopatía tiroidea (OT) es una enfermedad rara autoinmune compleja que no se conoce completamente.ObjetivosAnalizar la experiencia y los resultados obtenidos con el uso de tocilizumab intravenoso en el tratamiento de la OT.MétodosAnálisis retrospectivo de pacientes adultos diagnosticados de OT activa resistente a glucocorticoides por vía intravenosa tratados en un hospital terciario entre mayo del 2012 y mayo del 2021.ResultadosSe incluyó a 11 pacientes con una edad media de 52±12 (rango 35 a 67) años. Nueve pacientes eran mujeres y 2, hombres. Los pacientes recibieron una mediana de 5±3,2 dosis. Veinte de 24 ojos lograron la inactivación de la OT en la semana 16. Se logró respuesta a la proptosis en 6/8 pacientes y respuesta a diplopía en 3/8 pacientes. El cuestionario GO-QoL mostró una mejora clínicamente significativa en 9/11 pacientes. No se notificaron efectos adversos graves durante el tratamiento con tocilizumab. Un paciente requirió cirugía descompresiva 15 meses después del tratamiento con tocilizumab.ConclusionesLos resultados obtenidos muestran que el uso de tocilizumab en el tratamiento de esta enfermedad puede ser una buena alternativa. (AU)

Outcome of tocilizumab treatment in corticosteroid-resistant thyroid eye disease.

INTRODUCTION: Thyroid eye disease (TED) is a complex and incompletely understood rare autoimmune disorder. OBJECTIVES: To analyze the experience and the outcomes obtained with the use of intravenous tocilizumab in the treatment of TED. METHODS: A retrospective analysis of adult patients diagnosed with active TED resistant to intravenous corticosteroids treated in a tertiary hospital between May 2012 and May 2021. RESULTS: Eleven patients were included with a mean age of 52±12 (range 35-67) years. Nine patients were female and two were male. Patients received a median of 5±3.2 doses. Twenty out of twenty-four eyes achieved inactivation of TED at week 16. Proptosis response was achieved in 6/8 patients and diplopia response in 3/8 patients. The GO-QOL questionnaire showed clinically significant improvement in 9/11 patients. No serious adverse effects were reported during tocilizumab treatment. One patient required decompressive surgery 15 months after tocilizumab therapy. CONCLUSION: The results obtained show that the use of tocilizumab in the treatment of this pathology can be a good alternative.

IgA vasculitis (Henoch- Schönlein purpura) with gastrointestinal involvement.

We present the case of a patient who was admitted due to jejunitis in the context of an IgA vasculitis, previously known as Schönlein-Henoch vasculitis.

Differences in the prognostic value of the electrocardiographic pattern after cardiac resynchronization therapy according to age.

OBJECTIVES: In this cohort study, we analyzed if a specific pattern in three leads of the electrocardiogram (Rs in V1, Qr in aVL, or rS in I) was associated with outcomes after cardiac resynchronization therapy (CRT) depending on age. METHODS: Patients with CRT devices were included from January 2012 to April 2019. We divided the sample into 2 groups, those with age ≥ 75 years old and those younger. The primary endpoint was a composite of all-cause death and heart failure (HF) hospitalization at 1 year. RESULTS: We included 111 patients. Patients older than 75 years (26.1%, n = 29) had a significantly higher rate of hypertension and atrial fibrillation and received less frequently optimal medical therapy. The patterns were observed in 32 (39.0%) younger patients and 11 (37.9%) older patients. Patients who presented any of them had a lower incidence of the primary endpoint in the younger group (0 vs. 14%, p = 0.029), but not in the older group (9.1 vs. 27.8%, p = 0.24). The presence of a basal QRS duration greater than 160 ms was associated with a higher rate of the primary endpoint in the elderly (50 vs. 13%, p = 0.015), but not in the younger group (16.7 vs. 7.1%, p = 0.254). CONCLUSIONS: The presence of the selected patterns after CRT is associated with a lower incidence of all-cause death and hospitalization for HF in patients younger than 75 years, but not in those older than 75 years. Conversely, baseline QRS duration was associated with worse outcomes in older patients, but not in the younger group.

Impact of the use of antibiotics on the clinical response to immune checkpoint inhibitors in patients with non-small cell lung cancer / Impacto del uso de antibióticos en la respuesta clínica de los inhibidores del punto de control en pacientes con carcinoma de pulmón no microcítico

Objectives. Recent research suggests that the use of antibiotics could reduce the efficacy of checkpoint inhibitors, in addition to other well-known factors. It could be due to gut microbiota modification, which impact over the immune system response. However, the information available so far is contradictory. The objective of this research was to clarify whether antibiotic use influences efficacy of checkpoint inhibitors treatments in non-small cell lung cancer patients in clinical practice. Methods. Therefore, a retrospective observational study was designed. Use of antibiotics among patients treated with atezolizumab, pembrolizumab or nivolumab was assessed within 2 months of checkpoint inhibitors treatments initiation. Results. A total of 140 patients were included, mostly men, with good performance status (ECOG 0-1), all of them previously treated with chemotherapy. An antibiotic prescription was identified in 31% of these patients, mainly fluoroquinolones or beta-lactams. The most frequent indication was respiratory infection. Both progression-free survival and overall survival were lower for patients treated with anti-infective drugs, although this difference was not statistically significant. Conclusion. More studies are needed to draw conclusions about the impact of antibiotics on the efficacy of immunotherapy. (AU)

Objetivos. Investigaciones recientes sugieren que el uso de antibióticos podría reducir la eficacia de los inhibidores del punto de control inmunológico, además de otros factores ya conocidos. Podría deberse a la modificación de la microbiota, por su impacto en la respuesta del sistema inmune. En cualquier caso, la información disponible hasta el momento es contradictoria. El objetivo de esta investigación es esclarecer si el uso de antibióticos influye en la eficacia de los inhibidores del punto de control para el tratamiento de pacientes con carcinoma de pulmón no microcítico en la práctica clínica. Métodos. Se diseñó un estudio observacional, retrospectivo. Se investigó el uso de antibióticos entre aquellos pacientes a tratamiento con atezolizumab, pembrolizumab o nivolumab en los 2 meses previos o posteriores a su inicio. Resultados. Se incluyeron 140 pacientes, principalmente hombres con aceptable estado general (ECOG 0-1), todos previamente tratados con quimioterapia. Se identificó una prescripción antibiótica en el 31% de la población, principalmente fluoroquinolonas o betalactámicos. La indicación más frecuente para dicha prescripción era la infección respiratoria. Tanto la supervivencia libre de progresión con la supervivencia global fue inferior en el grupo tratado con antiinfecciosos, aunque no se alcanzó significación estadística. Conclusiones. Son necesario más estudios para concluir acerca del impacto de los antibióticos en la eficacia de la inmunoterapia. (AU)

Natalizumab: safety and risk in patients with relapsing-remitting multiple sclerosis.

OBJECTIVE: To estimate the risk of progressive multifocal leukoencephalopathy (PML) and the safety of natalizumab administration in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: A descriptive retrospective observational study including all patients with RRMS treated with natalizumab followed-up after 10 years.The likelihood of developing PML was estimated based on three risk factors: anti-John Cunningham virus antibody index, previous immunosuppressive therapy, and duration of treatment. Patients were classified into five categories: minimum probability (<0.1/1000); low (0.1/1000); medium-low (0.2-0.6/1000); medium-high (0.8-3/1000); high probability (3-10/1000). RESULTS: 34 patients were included. The probability of PML in the last cycle was: 55.9% minimum, 8.8% low, 11.8% medium-low, 3% medium-high, and 20.5% high. 12 patients continue with active treatment with natalizumab. No cases of PML have been confirmed. Adverse effects were detected in 50% of patients. CONCLUSIONS: Quantifying risk factors allows us to estimate the probability of PML appearance, thus assessing the maintenance or suspension of natalizumab.

Dosificación de cefazolina prequirúrgica en pacientes obesos y no obesos. ¿Importa el peso? / Dosage of presurgical cefazolin in obese and non-obese patients. Does weight matter?

OBJETIVO: Actualmente no existe evidencia clara que guíe la dosificación de cefazolina en pacientes obesos en profilaxis quirúrgica. El objetivo fue evaluar la efectividad de este antibiótico con una dosis estándar de 2 g en la prevención de infección de herida quirúrgica (IHQ) en pacientes obesos en comparación con no obesos. MATERIAL Y MÉTODOS: Revisión retrospectiva de varones ≥100 kg con cefazolina profiláctica entre 1 enero y 30 junio de 2019 en un hospital universitario en el servicio de traumatología. Los pacientes fueron estratificados en 2 grupos: obesos (≥ 100 kg e índice masa corporal (IMC)>30 kg/m2) y no obesos. Fueron excluidos aquellos que carecían de seguimiento en los 90 días posteriores a la intervención quirúrgica (IQ), aquellos con infección activa en el momento de la IQ o tratados con inmunosupresores. Se recogieron datos demográficos, altura, peso real, tabaquismo, diabetes, uso concomitante de inmunosupresores, datos de la IQ y presencia de infección hasta el día 90. RESULTADOS: 57 pacientes fueron sometidos a IQ traumatológica con cefazolina profiláctica, 26 no obesos y 23 obesos. Ambos grupos presentaron diferencias estadísticamente significativas en cuanto a peso, IMC y uso de cefazolina post-IQ. No se observaron diferencias significativas en el resto de variables. Dos (8,7%) obesos y dos (7,7%) pacientes no obesos desarrollaron IHQ, siendo la diferencia entre los grupos estadísticamente no significativa, tras 63 días post-IQ de media. CONCLUSIÓN: Este estudio demuestra que no existe diferencia significativa en IHQ con la dosis profiláctica de 2 g de cefazolina entre obesos y no obesos

OBJECTIVE: Evaluation of the effectiveness of a standard dose of cefalozin 2 grams for surgical site infection (SSI) prevention in obese patients compared to non-obese patients. There is no still controversy surrounding which is the best dosage of this antibiotic in obese patients for surgical prophylaxis. MATERIAL AND METHODS: Retrospective review of men who received prophylactic cefazolin between January 1st, 2019 and June 30th, 2019 in a traumatology department of a university hospital. Patients were stratified into 2 groups: obese (≥ 100 kg and body mass index (BMI)> 30 kg / m2) and non-obese. Patients without a 90 days follow-up after surgery and/or with an active infection at the time of surgery and/or treated with immunosuppressants were excluded. Demographic data, height, real weight, smoking, diabetes, concomitant use of immunosuppressants, surgery data and presence of infection until day 90 were collected. RESULTS: A total of 57 patients underwent traumatic surgery with prophylactic cefazolin, 26 non-obese and 23 obese, were studied. Both groups presented statistically significant differences in weight, BMI and post-surgery use of cefazolin. No significant differences were observed in the other variables. Two obese (8.7%) and two non-obese (7.7%) patients developed SSIs after 63 days post-surgery on average, following the difference between the groups being statistically non-significant. CONCLUSION: This study shows that there is no significant difference in SSI with a standard prophylactic dose of two grams of cefazolin between obese and non-obese patients

Tratamiento conservador ante el acretismo. Estudio de un caso / Conservative management of placenta accreta. A case report

El acretismo placentario es una complicación obstétrica cada vez más frecuente y que conlleva una gran morbimortalidad perinatal. Por su difícil diagnóstico anteparto, se trata de una urgencia obstétrica temida. Se describe el caso de una gestante que presentó acretismo placentario diagnosticado intraparto a las 27 semanas de gestación. Se optó por un tratamiento conservador para conseguir preservar la fertilidad. Aunque la paciente sufrió complicaciones durante el parto y el posparto, al cabo de 8 meses fue dada de alta sin secuelas físicas

The adherent placenta is an increasingly common obstetric complication with a high maternal and neonatal morbidity and mortality. It's a feared obstetric emergency due to the difficulty of antepartum diagnosis. Here we report the case of a patient diagnosed with placenta accreta intrapartum in her 27th week of pregnancy. To preserve fertility, a conservative treatment was used. Despite the complications in delivery and postpartum, the patient was discharged 8 months later without any physical sequelae

Clinical study comparing alveolar distraction using the lead system and MODUS MDO 1.5/2.0.

This article compares 2 different alveolar distractors: Lead System (LS) and MODUS MDO 1.5/2.0 (M-MDO). This is a clinical retrospective study; 32 distractions were performed. We used the LS distractor (intraosseous) on 24 patients and the M-MDO (extraosseous) on the other 8. The variables included bone alveolar ridge height, alterations of the oral mucosa, number of distractors, implant survival, and complications. We also developed descriptive and univariate statistical analysis. The mean increase of bone height after performing the alveolar distraction was 6.15 mm, 5.74 mm with LS, and 8.36 mm with M-MDO (P < 0.0001). The survival rates of the implants in the intraosseous and extraosseous groups reached 100%. However, the use of M-MDO resulted in a significant defect in the alveolar mucosa during implant insertion (100%), an event that did not occur when using LS (P < 0.001). The most common complication in the intraosseous group was the tilting of the segment (25%), whereas, in the extraosseous group, the main difficulty was the rod interference with the opposing arch (75%). Bone defects after alveolar distraction appeared both in the intraosseous group (66.7%) and in the extraosseous group (50%). Both the LS and the M-MDO distractors are effective for alveolar bone distraction. The choice of one distractor over another depends on the clinical characteristics of each case, such as the size and shape of the defect, the patient's tolerance, the distance to the opposing arch, and the surgeon's experience.

Dental implants placed on bone subjected to vertical alveolar distraction show the same performance as those placed on primitive bone

Introduction: Vertical osteogenic alveolar distraction (VOAD) allows for the augmentation of the alveolar ridge for the placement of dental implants in atrophic alveolar ridges. The goal of this paper is to assess long-term peri-implant bone resorption in implants placed on bones subjected to VOAD, comparing it with a group of patients who had implants placed directly on the alveolar bone without previous bone regeneration. Material and Methods: We conducted a follow-up study on 32 patients who were divided into two groups: The Distraction Group (14 patients), and the Distraction-Free Group (18 patients), who received a total of 100 implants. Peri-implant bone loss was measured by means of panoramic X-rays, at the time of loading and one year later, and in 35 implants of each group after 3 years of functional loading. Results: The peri-implant bone resorption (PBR) average observed in the Distraction Group at the time of prosthetic placement is higher (0.50±0.09 mm) than in the Distraction-Free Group (0.25±0.06 mm), showing statistically significant results (p=0.047). PBR levels 1 year after loading were the same for both groups (0.66 mm). At 3 years, they were higher in the Distraction Group (1.03 ± 0.22 mm vs. 0.68 ± 0.08 mm) (AU)

Dental implants placed on bone subjected to vertical alveolar distraction show the same performance as those placed on primitive bone.

INTRODUCTION: Vertical osteogenic alveolar distraction (VOAD) allows for the augmentation of the alveolar ridge for the placement of dental implants in atrophic alveolar ridges. The goal of this paper is to assess long-term peri-implant bone resorption in implants placed on bones subjected to VOAD, comparing it with a group of patients who had implants placed directly on the alveolar bone without previous bone regeneration. MATERIAL AND METHODS: We conducted a follow-up study on 32 patients who were divided into two groups: The Distraction Group (14 patients), and the Distraction-Free Group (18 patients), who received a total of 100 implants. Peri-implant bone loss was measured by means of panoramic X-rays, at the time of loading and one year later, and in 35 implants of each group after 3 years of functional loading. RESULTS: The peri-implant bone resorption (PBR) average observed in the Distraction Group at the time of prosthetic placement is higher (0.50 ± 0.09 mm) than in the Distraction-Free Group (0.25 ± 0.06 mm), showing statistically significant results (p=0.047). PBR levels 1 year after loading were the same for both groups (0.66 mm). At 3 years, they were higher in the Distraction Group (1.03 ± 0.22 mm vs. 0.68 ± 0.08 mm).

¿Qué sabemos de los galactogogos? / What do we know about galactogogues?

El uso de las terapias complementarias en la salud ha experimentado un aumento progresivo y creciente desde la década de 1950. En este artículo se presenta una revisión bibliográfica sobre los galactogogos. A pesar de que existen numerosas evidencias empíricas con galactogogosa lo largo de la historia, no hemos encontrado en la literatura médica corroboraciones de su eficacia y seguridad (AU)

The use of complementary health therapies has grown progressively since the 1950s. This article presents a bibliographical review on galactogogues. Despite there being ample empirical evidence with galactogogues throughout history, we have found no corroboration in medical literature of their effectiveness and safety (AU)

Peri-implant bone resorption around implants placed in alveolar bone subjected to distraction osteogenesis.

PURPOSE: This study was conducted to evaluate bone resorption around implants placed in alveolar bone previously subjected to distraction osteogenesis (DO). PATIENTS AND METHODS: The study included 9 patients who had undergone alveolar DO with subsequent placement of 37 implants. None of the implants was lost. Vertical peri-implant bone deficit was measured on the distal and mesial surfaces from panoramic radiographs obtained at implant loading and again 1 year later. Resorption over the year of loading was calculated as the increase in vertical bone deficit. RESULTS: Mean peri-implant bone resorption over the first year after loading was 0.60 mm mesially and 0.68 mm distally. In both cases, the resorption (ie, the difference between the mean bone deficit at loading and 1 year later) was statistically significant (P < .05). CONCLUSION: Vertical bone resorption around implants placed in distracted alveolar bone is similar to that seen around implants placed in nondistracted bone.