Intracranial complications of sinogenic and otogenic infections in children: an ESPN survey on their occurrence in the pre-COVID and post-COVID era.

BACKGROUND: COVID-19 pandemic is thought to have changed the epidemiology of some pediatric neurosurgical disease: among them are the intracranial complications of sinusitis and otitis (ICSO). According to some studies on a limited number of cases, both streptococci-related sinusitis and ICSO would have increased immediately after the pandemic, although the reason is not clear yet (seasonal changes versus pandemic-related effects). The goal of the present survey of the European Society for Pediatric Neurosurgery (ESPN) was to collect a large number of cases from different European countries encompassing the pre-COVID (2017-2019), COVID (2020-2021), and post-COVID period (2022-June 2023) looking for possible epidemiological and/or clinical changes. MATERIAL AND METHODS: An English language questionnaire was sent to ESPN members about year of the event, patient's age and gender, presence of immune-deficit or other favoring risk factors, COVID infection, signs and symptoms at onset, site of primary infection, type of intracranial complication, identified germ, type and number of surgical operations, type and duration of medical treatment, clinical and radiological outcome, duration of the follow-up. RESULTS: Two hundred fifty-four cases were collected by 30 centers coming from 14 different European countries. There was a statistically significant difference between the post-COVID period (129 children, 86 cases/year, 50.7% of the whole series) and the COVID (40 children, 20 cases/year, 15.7%) or the pre-COVID period (85 children, 28.3 cases/year, 33.5%). Other significant differences concerned the presence of predisposing factors/concurrent diseases (higher in the pre-COVID period) and previous COVID infection (higher in the post-COVID period). No relevant differences occurred as far as demographic, microbiological, clinical, radiological, outcome, morbidity, and mortality data were concerned. Paranasal sinuses and middle ear/mastoid were the most involved primary site of infection (71% and 27%, respectively), while extradural or subdural empyema and brain abscess were the most common ICSO (73% and 17%, respectively). Surgery was required in 95% of cases (neurosurgical and ENT procedure in 71% and 62% of cases, respectively) while antibiotics in 99% of cases. After a 12.4-month follow-up, a full clinical and radiological recovery was obtained in 85% and 84% of cases, respectively. The mortality rate was 2.7%. CONCLUSIONS: These results suggest that the occurrence of ICSO was significantly increased after the pandemic. Such an increase seems to be related to the indirect effects of the pandemic (e.g., immunity debt) rather than to a direct effect of COVID infection or to seasonal fluctuations. ICSO remain challenging diseases but the pandemic did not affect the management strategies nor their prognosis. The epidemiological change of sinusitis/otitis and ICSO should alert about the appropriate follow-up of children with sinusitis/otitis.

[Translated article] Pericapsular nerves block (PENG) is an effective and safe alternative for postoperative pain management after primary total hip arthroplasty: A randomised clinical trial.

BACKGROUND: Postoperative pain after total hip arthroplasty can affect postoperative rehabilitation and delay hospital discharge. The objective of this study is to compare pericapsular nerves group (PENG) block with pericapsular infiltration (PAI) and plexus nerve block (PNB) for postoperative pain management, response to physical therapy, opioid consumption, and length of hospital stay after a primary total hip arthroplasty. METHODS: Randomised clinical trial of parallel and blinded groups was performed. Sixty patients who underwent elective THA between December 2018 and July 2020 were randomised into the different groups (PENG, PAI and PNB). The visual analogue scale was used to assess pain; and motor function was measured with the Bromage scale. We also record opioid usage, length of hospital stay, and related medical complications. RESULTS: Pain level at discharge was similar in all groups. Hospital stay was 1 day shorter in the PENG group (p<0.001) and they also had lower opioid consumption (p=0.044). Optimal motor recovery was similar in the groups (p=0.678). Pain control when performing physical therapy was better in the PENG group (p<0.0001). CONCLUSIONS: PENG block is an effective and safe alternative for patients undergoing THA as it reduces opioid consumption and hospital stay compared to other analgesic methods.

Pericapsular nerves block (PENG) is an effective and safe alternative for postoperative pain management after primary total hip arthroplasty: A randomized clinical trial. / El bloqueo de nervios pericapsulares (PENG) es una alternativa efectiva y segura para el manejo del dolor postoperatorio después de una artroplastia total de cadera primaria: ensayo clínico aleatorizado.

BACKGROUND: Postoperative pain after total hip arthroplasty can affect postoperative rehabilitation and delay hospital discharge. The objective of this study is to compare pericapsular nerves group (PENG) block with pericapsular infiltration (PAI) and plexus nerve block (PNB) for postoperative pain management, response to physical therapy, opioid consumption, and length of hospital stay after a primary total hip arthroplasty. METHODS: Randomized clinical trial of parallel and blinded groups was performed. Sixty patients who underwent elective THA between December 2018 and July 2020 were randomized into the different groups (PENG, PAI and PNB). The visual analog scale was used to assess pain; and motor function was measured with the Bromage scale. We also record opioid usage, length of hospital stay, and related medical complications. RESULTS: Pain level at discharge was similar in all groups. Hospital stay was 1 day shorter in the PENG group (p<0.001) and they also had lower opioid consumption (p=0.044). Optimal motor recovery was similar in the groups (p=0.678). Pain control when performing physical therapy was better in the PENG group (p<0.0001). CONCLUSIONS: PENG block is an effective and safe alternative for patients undergoing THA as it reduces opioid consumption and hospital stay compared to other analgesic methods.

[Lumbar plexus nerve block provides better analgesic management than periarticular infiltration in primary total hip arthroplasty. Comparative, prospective, and single-blind clinical trial]. / El bloqueo nervioso del plexo lumbar proporciona un mejor manejo analgésico que la infiltración periarticular en artroplastía total primaria de cadera. Ensayo clínico comparativo, prospectivo y simple ciego.

INTRODUCTION: joint replacement is a highly effective intervention that significantly improves the patient's quality of life, relieves symptoms, restores joint function, and improves mobility and independence. The optimal pain control after total hip replacement has become an important goal of postoperative management. The purpose of this paper is to compare periarticular infiltration (PAI) and lumbar plexus nerve block (LPNB) for the management of post-operative pain in primary total hip arthroplasty because we believe that LPNB provides better analgesic management and lower opioid consumption. We evaluated the opioid usage during hospitalization and the complications derived from either technique. MATERIAL AND METHODS: we randomized 45 patients who underwent elective total hip arthroplasty between January 2019 and January 2020. Two groups were evaluated based on the association of PAI or LPNB. Both as part of a multimodal analgesic regimen. RESULTS: a total of 45 patients were evaluated (22 PAI group, 23 LPNB group). Block group required less opioid administration (p = 0.069). Most of the patients in both groups reported mild/moderate pain. The LPNB group had lower pain scale with physiotherapy. We did not have complications derived from either technique. CONCLUSION: lumbar plexus nerve block (LPNB) in patients undergoing total hip arthroplasty provides better pain management and reduced opioid consumption compared to PAI. The performance of this technique does not delay the beginning of physiotherapy and there were not any issues with the patient's recovery.

INTRODUCCIÓN: la artroplastía es una intervención altamente eficaz que mejora de manera significativa la calidad de vida del paciente, alivia los síntomas, restaura la función articular y mejora la movilidad e independencia. El control óptimo del dolor después de la artroplastía total de cadera se ha convertido en un objetivo importante del tratamiento postoperatorio. El propósito de este trabajo es comparar la infiltración periarticular (IPA) y el bloqueo nervioso del plexo lumbar (BNPL) para el manejo del dolor postoperatorio en la artroplastía total de cadera primaria, ya que creemos que la BNPL proporciona mejor manejo analgésico y menor consumo de opioides. Se evaluó el uso de opioides durante la hospitalización y las complicaciones derivadas de cada técnica. MATERIAL Y MÉTODOS: fueron aleatorizados 45 pacientes tratados con artroplastía total de cadera electiva entre Enero de 2019 y Enero de 2020 en dos grupos: IPA o BNPL. Ambos como parte de un régimen analgésico multimodal. RESULTADOS: veintidós en el grupo IPA y 23 en el grupo BNPL. El grupo de bloqueo requirió menos administración de opioides (p = 0.069). La mayoría de los pacientes de ambos grupos reportaron dolor leve/moderado. El grupo de BNPL tuvo menor escala de dolor al realizar fisioterapia. No tuvimos complicaciones derivadas de ninguna de las técnicas analgésicas. CONCLUSIÓN: el BNPL en pacientes sometidos a artroplastía total de cadera proporciona mejor manejo del dolor y una reducción del consumo de opioides en el postoperatorio en comparación con la IPA. La realización de esta técnica no retrasa el inicio de la fisioterapia y no hubo problemas con la recuperación del paciente.

Lumboperitoneal shunting in pediatric patients and the role of imaging in its evaluation.

Lumboperitoneal shunting makes it possible to regulate the flow of cerebrospinal fluid by establishing a connection between the thecal sac and the peritoneal cavity. The main indication for lumboperitoneal shunting in children is idiopathic intracranial hypertension, but the technique is also useful in the treatment of postinfectious, posthemorrhagic, and normotensive hydrocephalus, as well as in the treatment of postsurgical pseudomeningocele or leakage of cerebrospinal fluid. This article reviews nine cases treated at our centre to show the normal imaging findings for lumboperitoneal shunts in children and to provide a succinct review of the possible neurological and abdominal complications associated with this treatment.

La derivación lumbo-peritoneal en la edad pediátrica y el papel de la imagen en su valoración / Lumboperitoneal shunting in pediatric patients and the role of imaging in its evaluation

La derivación lumbo-peritoneal permite regular el flujo de líquido cefalorraquídeo estableciendo una conexión entre el saco tecal y la cavidad peritoneal. Entre las indicaciones en la población pediátrica se encuentra principalmente la hipertensión intracraneal idiopática, siendo también útil en el tratamiento de la hidrocefalia postinfecciosa, posthemorrágica y normotensiva, en el seudomeningocele posquirúrgico o ante una fuga de líquido cefalorraquídeo.En este artículo, mediante la revisión de 9 casos de nuestro centro, se pretende mostrar la normalidad del dispositivo en las pruebas de imagen y realizar una breve revisión de las posibles complicaciones asociadas, neurológicas y abdominales.(AU)

Lumboperitoneal shunting makes it possible to regulate the flow of cerebrospinal fluid by establishing a connection between the thecal sac and the peritoneal cavity. The main indication for lumboperitoneal shunting in children is idiopathic intracranial hypertension, but the technique is also useful in the treatment of postinfectious, posthemorrhagic, and normotensive hydrocephalus, as well as in the treatment of postsurgical pseudomeningocele or leakage of cerebrospinal fluid.This article reviews nine cases treated at our center to show the normal imaging findings for lumboperitoneal shunts in children and to provide a succinct review of the possible neurological and abdominal complications associated with this treatment.(AU)

External cranial expansion as treatment of intracranial hypertension. Technical note.

Intracranial hypertension may be idiopathic or due to multiple etiologies. Some bone dysplasias and chronic shunt overdrainage syndrome may sometimes lead to intracranial hypertension associated with craniocerebral disproportion due to thickening of cranial diploe. The internal cranial expansion procedure has been used for patients with intracranial hypertension, whether or not associated with craniocerebral disproportion. Its purpose is to increase the intracranial volume by drilling down the inner table. This technique enables the craniocerebral disproportion to be improved and intracranial hypertension reduced. In other etiologies of intracranial hypertension with non-thickened diploe, internal cranial expansion may not be enough to resolve the hypertension. For these cases we propose a modification of the technique by expanding the cranial vault outwards; external cranial expansion. We describe this technique as used in a pediatric patient who presented with chronic headache, tonsillar ectopia, and sleep apnea syndrome. This patient also had a multisuture craniosynostosis, a non-thickened diploe, and intracranial hypertension.

Epiphytic hydroid community as sentinels of seagrass condition and human impacts.

Negative human actions on seagrasses affect habitat condition and its associated fauna. Epiphytic hydroid's assemblage response to seagrass condition, water quality, and human impacts was evaluated in two bays of the Sabana-Camagüey Ecosystem of Cuba, using the presence of contamination, causeways, and trawling fishing as impact level proxies to the seagrass meadows. Thirty-eight species composed the hydroid's assemblage including five new records. Symmetroscyphus intermedius was the most abundant species and sensitive to indicators of the seagrass condition. Dynamena disticha and Gastroblasta sp. were sensitive to water quality predictors. Obelia bidentata was exclusive to the most impacted sites. Species richness and abundance were low in impacted sites and were highly affected by fishing trawling and causeways construction. Salinity, depth, NO2, pH, SSV, macroalgae cover, shoot density, and wet weight of Thalassia testudinum were the best predictors for hydroid's assemblages. Results suggest epiphytic hydroids on tropical seagrass meadows as sentinel organisms.

[Continuous vs. intermitent intravenous analgesia for primary total knee replacement: analysis of the quality of the pain control, hospital stay and costs]. / Analgesia endovenosa continua versus analgesia endovenosa intermitente para reemplazo total de rodilla primario: análisis de la calidad analgésica, tiempo de hospitalización y costos económicos.

BACKGROUND: The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Total knee arthroplasty is one of the orthopedic surgeries that manifests more pain in the first 24-48 hours, needing a multimodal analgesic therapy. The objective of this work is to compare two different intravenous analgesic modes applied to patients undergoing a primary total knee arthroplasty, analyzing the quality of pain control, hospital stay and costs. MATERIAL AND METHODS: Simple blind, comparative and prospective study comprised of 42 patients operated of total knee arthroplasty secondary to degenerative arthritis in the period between May 2016 and May 2017. RESULTS: The distribution of pain showed significant differences (p 0.0401) between both groups, indicating that the application of continuous pump for analgesia controls this symptom early. The hospital stay, on average, was different in the groups (p = 0.001), estimating about 15 hours less following the use of continuous pump. This strategy is globally more economic. DISCUSSION: The continuous infusion pump of analgesia compared with intermittent formal intravenous regimen showed better control of pain, decreasing the perception of pain by the patient, bettering the tolerance to physical therapy and reducing, on average, 15 hours of hospital stay, and thus, the final costs of the surgery.

INTRODUCCIÓN: La Asociación Internacional para el Estudio del Dolor (IASP, por sus siglas en inglés) define el dolor como una experiencia sensorial y emocional desagradable asociada a un daño tisular real o potencial. La artroplastía total de rodilla es una de las cirugías ortopédicas que cursa con más dolor en las primeras 24-48 horas, por lo que precisa de una terapia multimodal de analgesia. El objetivo de este trabajo es comparar dos modos analgésicos endovenosos diferentes aplicados a pacientes sometidos a cirugía de artroplastía total de rodilla primaria, analizando la calidad analgésica, el tiempo de hospitalización y los costos económicos. MATERIAL Y MÉTODOS: Estudio prospectivo, comparativo y simple ciego conformado por 42 pacientes intervenidos quirúrgicamente de artroplastía total de rodilla secundaria a artrosis degenerativa en el período comprendido entre Mayo de 2016 y Mayo de 2017. RESULTADOS: La distribución del dolor mostró diferencias significativas (p 0.0401) entre ambos grupos, indicando que la aplicación de analgesia mediante bomba continua controla este síntoma de manera temprana. El tiempo de hospitalización promedio fue diferente en los grupos (p = 0.001); se estimaron alrededor de 15 horas menos siguiendo el protocolo de bomba continua. Además, esta estrategia es globalmente más económica. CONCLUSIÓN: La bomba de infusión continua de analgesia compara da con la analgesia endovenosa reglada intermitente logró un mejor control del dolor, disminuyendo la percepción del mismo por parte del paciente, con una mejor tolerancia a la fisioterapia y reduciendo, en promedio, 15 horas de hospitalización y, por ende, los costos finales aproximados de la cirugía.

Resultados y evolución funcional de pacientes críticos con ictus isquémico sometidos a trombectomía mecánica / Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit

OBJETIVO: Estudiar los resultados y las complicaciones del tratamiento endovascular (TEV) en pacientes con ictus isquémico agudo ingresados en una unidad de cuidados intensivos (UCI). Analizar los factores que podrían influir en la mortalidad y en el grado de discapacidad al alta y un año después del ictus. DISEÑO: Estudio prospectivo observacional. Ámbito: UCI polivalente. Hospital de tercer nivel. PACIENTES: Sesenta pacientes adultos. Muestra consecutiva. INTERVENCIONES: Ninguna. Variables de interés: Datos epidemiológicos, tiempo desde la clínica inicial hasta el TEV, resultado angiográfico, tiempo de estancia en UCI, días de ventilación mecánica, complicaciones neurológicas, National Institutes of Health Stroke Scale (NIHSS) al ingreso y al alta de UCI, escala de Rankin modificada (mRS) al año de evolución. RESULTADOS: Edad media 68,90±8,84años. Mediana de tiempo hasta el TEV: 180min. Mediana NIHSS al ingreso: 17,5; al alta: 3. Flujo distal en el 90% de los casos. Mediana estancia en UCI: 3días. Ventilación mecánica: 81,7%. Independencia funcional (mRS≤2) 50% al año del ictus. Fallecimientos: 22 (36,6%); 8 (13,3%) en la UCI y el resto durante el primer año. CONCLUSIONES: Las variables asociadas a un peor estado funcional fueron la transformación hemorrágica sintomática, la ausencia de recanalización y las complicaciones durante el procedimiento. La transformación hemorrágica y la hidrocefalia se asociaron a mayor mortalidad. Se consiguió flujo distal en la mayoría de los casos, con una baja tasa de complicaciones. La mitad de los pacientes alcanza independencia funcional al año del ictus

PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None. Variables of interest: Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. RESULTS: Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. CONCLUSIONS: The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke

IL17RA gene variants and anti-TNF response among psoriasis patients.

Polymorphisms at genes encoding proteins involved in the pathogenesis of psoriasis (Psor) or in the mechanism of action of biological drugs could influence the treatment response. Because the interleukin (IL)-17 family has a central role in the pathogenesis of Psor, we hypothesized that IL17RA variants could influence the response to anti-TNF drugs among Psor patients. To address this issue we performed a cross-sectional study of Psor patients who received the biological treatments for the first time, with a follow-up of at least 6 months. All of the patients were Caucasian, older than 18 years old, with chronic plaque Psor, and had completed at least 24 weeks of anti-TNF therapy (adalimumab, etanercept or infliximab). The treatment response to anti-TNF agents was evaluated according to the achievement of PASI50 and PASI75 at weeks 12 and 24. Those who achieved PASI75 at week 24 were considered good responders. All patients were genotyped for the selected single-nucleotide polymorphisms (SNPs) at IL17RA gene. A total of 238 patients were included (57% male, mean age 46 years). One hundred and five patients received adalimumab, 91 patients etanercept and 42 infliximab. The rs4819554 promoter SNP allele A was significantly more common among responders at weeks 12 (P=0.01) and 24 (P=0.04). We found a higher frequency of AA versus AG+GG among responders, but the difference was only significant at week 12 (P=0.03, odd ratio=1.86, 95% confidence of interval=1.05-3.27). Thus, in the study population, the SNP rs4819554 in the promoter region of IL17RA significantly influences the response to anti-TNF drugs at week 12.

Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit. / Resultados y evolución funcional de pacientes críticos con ictus isquémico sometidos a trombectomía mecánica.

PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None. VARIABLES OF INTEREST: Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. RESULTS: Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. CONCLUSIONS: The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke.

Hormonas tiroideas, TSH, cáncer de tiroides y hueso en mujeres pre y postmenopáusicas / Thyroid hormones, TSH, thyroid cancer and bones in pre- and postmenopausal women

En los últimos años se han realizado progresos en el conocimiento de la regulación del desarrollo del esqueleto y del mantenimiento de la masa ósea del adulto por el eje hipotálamo-hipófisis-tiroides. Se han hecho estudios sobre el efecto de las hormonas tiroideas sobre el osteoblasto, osteoclasto y el condrocito, que han implicado un mejor conocimiento genético y fisiológico de la acción celular de estas hormonas. Recientemente se han propuesto posibles intervenciones de las deiodinasas D2 en la osteoporosis, e incluso se ha señalado la relación entre la densidad mineral ósea, la calidad del hueso y el riesgo de fracturas con las hormonas tiroideas en mujeres postmenopáusicas normales, lo que sugiere un papel de estas hormonas, incluso dentro del rango de la normalidad tiroidea, en estas patologías. Por otro lado, la incidencia del cáncer diferenciado de tiroides, modelo experimental in vivo de la supresión de la hormona tiroidea por la terapia preventiva de recidivas, ha aumentado significativamente. Existen guías clínicas para su manejo, pero es evidente que los posibles efectos secundarios derivados requieren una precisa indicación ajustada al balance riesgo-beneficio de la dosificación de las hormonas tiroideas, prescritas a largo plazo, especialmente en los casos de baja agresividad tumoral, edad avanzada e incluso en pacientes frágiles. Las pacientes con elevado riesgo, deben ser referidas para una densitometría ósea, para considerar el tratamiento de futuras fracturas. La prevención de osteoporosis, en particular en la mujer postmenopáusica, es altamente conveniente y debe incluir dieta adecuada en calcio y suplementación de vitamina D si es necesario. No existe aún un consenso sobre el tratamiento de la osteoporosis en la paciente con cáncer de tiroides y tratamiento supresor, pero los criterios indicados para la osteoporosis postmenopáusica en general parecen aplicables (AU)

In recent years, progress has been made in regulating skeletal development and maintenance of bone mass of the adult by the hypothalamus-pituitary-thyroid axis. Studies have been carried out into the effect of thyroid hormones on the osteoblasts, osteoclast and the chondrocyte. This research has led to better genetic knowledge into the physiology of the cellular action of these hormones. Recently, possible D2 deodinase interventions in osteoporosis have been proposed. The link between bone mineral dignity, bone quality and the risk of fractures with thyroid hormones in normal postmenopausal women suggest a role for these hormones, even within the range of normal thyroid, in these diseases. On the other hand, the incidence of differentiated thyroid cancer, experimental in vivo thyroid hormone suppression by therapy, recurrent disease, has increased significantly. There are management guides, but it is clear that the secondary derivatives require a precise balance-adjusted indication, risk-benefit ratio of thyroid hormone dosage, prescribed long term, especially in cases of low tumor aggressiveness, advanced age and even in fragile patients. High risk patients should be referred for a bone densitometry, to consider treating future fractures. Prevention of osteoporosis, particularly in postmenopausal women, is highly desirable and should include adequate diet in calcium and vitamin D supplementation if necessary. There is still no consensus on osteoporosis treatment in the patient with thyroid cancer and suppressive treatment, but the indicated criteria for postmenopausal osteoporosis seem to be applicable in general (AU)

An Uncommon Association of Familial Partial Lipodystrophy, Dilated Cardiomyopathy, and Conduction System Disease.

A 46-year-old African American woman presented with severe respiratory distress requiring intubation and was diagnosed with nonischemic cardiomyopathy. She had the typical phenotype of familial partial lipodystrophy 2 (FPLD2). Sequence analysis of LMNA gene showed a heterozygous missense mutation at exon 8 (c.1444C>T) causing amino acid change, p.R482W. She later developed severe coronary artery disease requiring multiple percutaneous coronary interventions and coronary artery bypass surgery. She was later diagnosed with diabetes, primary hyperparathyroidism, and euthyroid multinodular goiter. She had sinus nodal and atrioventricular nodal disease and had an implantable cardioverter defibrillator implantation due to persistent left ventricular dysfunction. The device eroded through the skin few months after implantation and needed a re-implant on the contralateral side. She had atrial flutter requiring ablation. This patient with FPLD2 had most of the reported cardiac complications of FPLD2. This case is presented to improve the awareness of the presentation of this disease among cardiologists and internists.

Common and rare CARD14 gene variants affect the antitumour necrosis factor response among patients with psoriasis.

BACKGROUND: The CARD14 gene encodes a protein that enhances nuclear factor (NF)-κB activation and the upregulation of proinflammatory pathway genes. CARD14 is upregulated in psoriatic vs. normal skin, and rare and common CARD14 variants have been associated with the risk of developing psoriasis. Our hypothesis was that CARD14 variants could also influence the response to antitumour necrosis factor (anti-TNF) therapies among patients with psoriasis. OBJECTIVES: To determine whether CARD14 gene variants were linked to a significant positive anti-TNF response in patients with psoriasis. METHODS: DNA from 116 patients with psoriasis was subjected to next-generation sequencing of the CARD14 gene. All of the patients were nonresponders or had contraindications to conventional systemic treatments. RESULTS: A reduction of at least 75% in Psoriasis Area and Severity Index (PASI 75) at week 24 was considered a positive response to treatment. In total 116 patients (79 responders and 37 nonresponders) were next-generation sequenced, and we identified five nucleotide variants that would result in missense amino acid changes. These variants were determined in all of the patients, and allele and genotype frequencies were compared between the two groups. We found a significantly higher frequency of rs11652075 CC (p.Arg820Trp) among the group with a positive response (P = 0.01, odds ratio 3.71, 95% confidence interval 1.30-10.51). Furthermore, among responders, six patients were heterozygous carriers of the rare p.Glu422Lys variant, and two patients were heterozygous for p.Arg682Trp (P = 0.04). CONCLUSIONS: The common CARD14 p.Arg820Trp variant might have a significant effect on the response to anti-TNF therapies among patients with psoriasis. In addition, rare CARD14 missense variants could also predispose to a better response.

Minimally invasive plate osteosynthesis in distal radius fractures with metaphyseal extension: A series of 13 cases.

UNLABELLED: To evaluate objective and subjective outcomes after minimally invasive volar locked plate fixation of distal radius fractures with metaphyseal extension, we retrospectively evaluated 13 patients with unstable distal radius fractures with metaphyseal extension, treated by minimally invasive volar locked plating. Patients' average age was 41 years. Two volar incisions, 2 to 3cm long, were made; indirect reduction was performed and a volar locked T-plate was placed submuscularly under fluoroscopy guidance. Twelve fractures healed after an average of 2.46 months; one patient needed revision due to a new injury. The plate had to be removed in one patient. On X-rays, radial height averaged 12.78mm, radial inclination averaged 21.34° and volar tilt averaged 8.22°. Flexion averaged 75°, extension 71.5°, pronation 82.08° and supination 83.08°. Grip strength averaged 83.75% of the contralateral wrist. The DASH score averaged 13.91 points and pain assessed on VAS averaged 0.92 points. In unstable distal radius fractures with metaphyseal extension, minimally invasive plate osteosynthesis using volar locked plates led to good reduction and stable fixation, with low pain levels, and good functional and esthetic results. Indirect reduction techniques, fluoroscopy, and restoration of radial length, rotation and alignment, are necessary to achieve these outcomes. LEVEL OF EVIDENCE: IV.

Factores predictores de mortalidad en la sepsis urinaria con obstrucción ureteral / Mortality predictive factors in patients with urinary sepsis associated to upper urinary tract calculi

OBJETIVO: El objetivo de este estudio fue conocer las características clínicas de los pacientes con sepsis urológica obstructiva por litiasis ureteral que ingresaron en la Unidad de Cuidados Intensivos e identificar los factores predictores de mortalidad en las primeras 24 horas del ingreso. DISEÑO: Estudio observacional retrospectivo durante un periodo de 16 años (1996-2011). ÁMBITO: Unidad de Cuidados Intensivos polivalente de 20 camas de un hospital universitario de 2.° nivel. PACIENTES: Todos los pacientes que ingresaron en Unidad de Cuidados Intensivos por sepsis urológica obstructiva. INTERVENCIONES: Ninguna. VARIABLES DE INTERÉS PRINCIPALES: Variables clínicas y analíticas generales y relacionadas con el proceso urológico. Método diagnóstico, técnica desobstructiva, germen aislado y tratamiento. Análisis de factores de riesgo mediante regresión logística múltiple. RESULTADOS: Ciento siete pacientes ingresados con una mortalidad del 19,6%. El diagnóstico fue mayoritariamente por ecografía y la técnica descompresiva más utilizada fue la colocación de catéter ureteral doble J. Se aisló germen en el 48,6% de los pacientes. El 20,6% presentaron bacteriemia. En el análisis multivariante, la edad, el fallo renal agudo y el uso de drogas vasoactivas en las primeras 24 horas del ingreso se relacionaron de forma independiente con la mortalidad. CONCLUSIONES: La edad avanzada, el fallo renal agudo y la necesidad de fármacos vasoactivos se relacionaron con un aumento de riesgo de mortalidad en los pacientes con urosepsis secundaria a litiasis ureteral

PURPOSE: The aims of this study were to determine the clinical characteristics of patients with urinary sepsis associated to ureteral calculi admitted to the Intensive Care Unit (ICU), and to identify predictors of mortality in the first 24 hours of admission. DESIGN: A retrospective observational study covering a 16-year period (2006-2011) was carried out. SETTING: The combined clinical/surgical ICU of a secondary-level University hospital. PATIENTS: All patients admitted to the ICU due to obstructive urinary sepsis. INTERVENTIONS: None. MAIN VARIABLES: We analyzed general clinical and laboratory test and urological data. The diagnostic technique, affected side, decompression technique, isolated microorganism and antibiotic therapy used were also considered. The assessment of risk factors was performed by multiple logistic regression analysis. RESULTS: A total of 107 patients admitted to the ICU were included in the study, with a mortality rate of 19.6%. The diagnosis was mainly established by ultrasound, and the most commonly used decompression technique was retrograde JJ stenting. Microorganisms were isolated in 48.6% of the patients. In total, 20.6% of the patients had bacteremia. Multivariate analysis found age, acute renal failure and the use of vasoactive drugs administered continuously for the first 24hours of admission to be independently associated to mortality. CONCLUSIONS: Advanced age, acute renal failure and the need for vasoactive drugs were associated to an increased risk of mortality in patients with urinary sepsis associated to upper urinary tract calculi

Actualización de las recomendaciones para la evaluación y tratamiento de la osteoporosis asociada a enfermedades endocrinas y nutricionales. Grupo de trabajo de osteoporosis y metabolismo mineral de la SEEN / Update of recommendations for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology

Objetivo: Actualizar las recomendaciones previas formuladas por el Grupo de trabajo de osteoporosis y metabolismo mineral de la Sociedad Española de Endocrinología y Nutrición (SEEN) para la evaluación y el tratamiento de la osteoporosis asociada a diferentes enfermedades endocrinas y alteraciones nutricionales. Participantes: Miembros del Grupo de trabajo de osteoporosis y metabolismo mineral de la SEEN. Métodos: Las recomendaciones se formularon de acuerdo al sistema Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) para establecer tanto la fuerza de las recomendaciones como el grado de evidencia. Se realizó una búsqueda sistemática en PubMed de las nuevas acerca de cada enfermedad usando las siguientes palabras clave asociadas al nombre de cada proceso patológico: AND osteoporosis, fractures, bone mineral density, bone markers y treatment. Se revisaron artículos escritos en inglés con fechas de inclusión comprendidas entre el 18 de octubre de 2011 y el 30 de octubre de 2014. Tras la formulación de las recomendaciones estas se discutieron de forma conjunta por el Grupo de trabajo.Conclusiones: Esta actualización resume los nuevos datos acerca de la evaluación y tratamiento de la osteoporosis en las enfermedades endocrinas y nutricionales que se asocian a baja masa ósea o a un aumento del riesgo de fractura.(AU)

Objective: To update previous recommendations developed by the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition for the evaluation and treatment of osteoporosis associated to different endocrine and nutritional diseases. Participants: Members of the Working Group on Osteoporosis and Mineral Metabolism of the Spanish Society of Endocrinology and Nutrition. Methods: Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed) using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date between 18 October 2011 and 30 October 2014 were included. The recommendations were discussed and approved by all members of the Working Group. Conclusions: This update summarizes the new data regarding evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions.(AU)

[Mortality predictive factors in patients with urinary sepsis associated to upper urinary tract calculi]. / Factores predictores de mortalidad en la sepsis urinaria con obstrucción ureteral.

PURPOSE: The aims of this study were to determine the clinical characteristics of patients with urinary sepsis associated to ureteral calculi admitted to the Intensive Care Unit (ICU), and to identify predictors of mortality in the first 24 hours of admission. DESIGN: A retrospective observational study covering a 16-year period (2006-2011) was carried out. SETTING: The combined clinical/surgical ICU of a secondary-level University hospital. PATIENTS: All patients admitted to the ICU due to obstructive urinary sepsis. INTERVENTIONS: None. MAIN VARIABLES: We analyzed general clinical and laboratory test and urological data. The diagnostic technique, affected side, decompression technique, isolated microorganism and antibiotic therapy used were also considered. The assessment of risk factors was performed by multiple logistic regression analysis. RESULTS: A total of 107 patients admitted to the ICU were included in the study, with a mortality rate of 19.6%. The diagnosis was mainly established by ultrasound, and the most commonly used decompression technique was retrograde JJ stenting. Microorganisms were isolated in 48.6% of the patients. In total, 20.6% of the patients had bacteremia. Multivariate analysis found age, acute renal failure and the use of vasoactive drugs administered continuously for the first 24 hours of admission to be independently associated to mortality. CONCLUSIONS: Advanced age, acute renal failure and the need for vasoactive drugs were associated to an increased risk of mortality in patients with urinary sepsis associated to upper urinary tract calculi.