Trapeziometacarpal Dislocations in Pediatric Age, Is There a Better Treatment? Series of Cases and a Systematic Review.

(1) Background: Dislocations of the trapeziometacarpal joint (TMC) are uncommon in children and adolescents. Only a few isolated cases are reported in the literature. Therapeutic guidance is minimal and inconclusive. (2) Methods: The authors present four patients treated for this unusual lesion. We evaluated the evolution according to treatment, age, patient activity, and quickDASH. Despite the clear limitation of the small number of patients, it is relevant to try to better understand this lesion and its evolution. A systematic review of the literature was also conducted. (3) Results: This is the largest published series of TMC dislocations in children and adolescents. Patients included a 12-year-old girl treated conservatively with a poor quickDASH; a 9-year-old girl treated surgically with the Eaton-Littler technique for a new dislocation with a partially modified quickDASH; a 13-year-old boy with two necessary closed reductions for a new dislocation and a very good final quickDASH; and a 12-year-old boy treated with closed reduction and percutaneous fixation with excellent final results with quickDASH. (4) Conclusions: In the absence of scientific evidence, conservative treatment and ligament reconstruction did not provide good functionality. In contrast, closed reduction with percutaneous fixation provided excellent results. Therefore, the authors would recommend closed reduction and percutaneous needle fixation as an elective method to treat TMC dislocations in pediatric and adolescent patients.

Trigger thumb treatment approach: Results of a survey of EPOS members.

Purpose: The aim of this study is to analyze the clinical reality of pediatric trigger thumb among members of the European Paediatric Orthopaedic Society. Methods: A 35-question survey was sent to all European Paediatric Orthopaedic Society members, focusing on surgeon's profile and experience, trigger thumb diagnostic and trigger thumb treatment approach. Descriptive statistics were performed. Results: A total of 99 responses were analyzed. Most important factor considered in the therapeutic approach was the presence of a locked interphalangeal joint (52%). Regarding treatment, 41.4% opt for conservative approach as the first line of treatment, while 30.3% consider surgery and 28.3% just observe. Nevertheless, 76% mention to treat conservatively their patients and 99% to consider surgery at some stage. Regarding surgical technique, 96% do it open and 56% consider 2 years as the minimum age for procedure. Most surgeons perform this procedure in out-patient care (87%), don't administer prophylactic antibiotherapy (80%), use a tourniquet (75%), don't use any postoperative immobilization (64%), and report complications related to surgery (64%), mainly recurrence/incomplete division (59%) and superficial wound infection (30%). Conclusion: Our study shows a significant variability in the initial management of pediatric trigger thumb with a predominance of conservative management, followed by surgery and observation without treatment. The disparity in treatment options and timing, or waiting times before moving on to different therapeutic options, shows us that this is a controversial issue and that the development of prospective randomized controlled studies is needed to analyze the different treatment methods and determine which ones give the best outcomes.

Reverse Ishiguro Extension Block Technique as an Alternative for Irreducible Osseous Mallet Finger.

Subacute or late-presenting unstable osseous mallet finger might be hard to reduce and, therefore, remain subluxed when using the traditional Ishiguro technique. In such cases, we suggest it is best to prioritize correction of joint subluxation over step-by-step adherence to the traditional Ishiguro technique. Specifically, we contend that carrying out the procedure in reverse order typically results in an easier and more stable reduction of both joint and fracture.

Timoma cervical ectópico / Ectopic cervical thymoma

RESUMEN El timoma cervical ectópico es una patología poco frecuente, motivo por el cual su diagnóstico suele ser dificultoso. Debe ser tenido en cuenta como diagnóstico diferencial en pacientes con masas cervicales laterales, sobre todo aquellas que se ubican cerca de la glándula tiroides. El tratamiento consiste en la resección quirúrgica completa. Son tumores de crecimiento lento, la mayoría de ellos histológicamente benignos. En el caso aquí presentado, por su tamaño y ubicación, fue necesario separarlo de los grandes vasos y estructuras nerviosas cercanas, lo que hizo más compleja la cirugía.

ABSTRACT Ectopic cervical thymoma is a rare entity; therefore, its diagnosis is often difficult. It should be considered as a differential diagnosis in patients with lateral cervical masses, especially those close to the thyroid gland. Surgical treatment is indicated with complete excision of the lesion. Cervical thymomas are slow-growing tumors, usually benign. In this case report, due to tumor size and location, it was necessary to separate it from the large vessels and adjacent nerve structures, resulting in a more complex procedure.

Lateralized overgrowth as a guiding sign of abdominal neoplasms for pediatric orthopedic surgeons.

OBJECTIVES: This study aims to increase the awareness of the association between lateralized overgrowth (LO) and abdominal tumor among the pediatric orthopedic community and to evaluate its incidence in our center. PATIENTS AND METHODS: Between January 1997 and December 2021, a total of 166 patients with Wilms tumors and hepatoblastomas were retrospectively analyzed. Data including age, sex, initial clinical signs (hematuria, abdominal mass with or without general discomfort), type of asymmetric regional body overgrowth (isolated or in relation with any syndrome), and tumor stage at diagnosis were recorded. In addition, age at which asymmetric regional body overgrowth was described and age at the time of tumor diagnosis were noted. RESULTS: Of a total of 166 patients, 133 were diagnosed with Wilms tumors (nephroblastomas) and 33 were diagnosed with hepatoblastomas. In 94% of the cases, the initial clinical signs were an abdominal mass and/or hematuria. Overall, five (3%) patients presented with LO. Four patients with Wilms tumor presented it at the initial clinical examinations. In three of these cases (2.3%), we found it isolated and, in the remaining patient (0.75%), it was associated with Beckwith-Wiedemann spectrum. Only one patient affected from hepatoblastoma (3%) presented with an isolated LO at the time of tumor diagnosis. CONCLUSION: Our study results show an incidence of LO in relation to intra-abdominal tumors of 3%. The latest updates recommend genetic testing to identify subgroups with a higher risk for tumor development that are more likely to benefit from tumor protocol surveillance.

Valve in valve en posición tricuspídea: reconociendo opciones de manejo para la válvula «olvidada¼ / Valve in valve in tricuspid position: recognizing management options for the "forgotten" valve

Resumen Presentamos el caso de una paciente con bioprótesis tricuspídea disfuncionante a quien se le realizó un implante valve in valve con una prótesis transcatéter SAPIEN XT, demostrando que esta técnica es una alternativa terapéutica válida frente a la reintervención de la válvula tricúspide.

Abstract We present the case of a patient who was implanted with a transcatheter prosthesis on a dysfunctional bioprosthesis, demonstrating that it is a valid therapeutic alternative to reoperation in those patients with high surgical risk.

Poland syndrome: a new classification system based on a retrospective analysis of 74 cases.

LEVEL OF EVIDENCE: III.

Glioblastoma Cells Counteract PARP Inhibition through Pro-Survival Induction of Lipid Droplets Synthesis and Utilization.

Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in adults. Poly (ADP-ribose) polymerase inhibitors (PARPi) represent a new class of anti-neoplastic drugs. In the current study, we have characterized the mechanism by which glioblastoma cells evade the effect of PARPi as anti-tumor agents. We have found that suppression of PARP activity exerts an anti-stemness effect and has a dual impact on autophagy, inducing its activation in the first 24 h (together with down-regulation of the pro-survival mTOR pathway) and preventing autophagosomes fusion to lysosomes at later time-points, in primary glioma cells. In parallel, PARPi triggered the synthesis of lipid droplets (LDs) through ACC-dependent activation of de novo fatty acids (FA) synthesis. Notably, inhibiting ß-oxidation and blocking FA utilization, increased PARPi-induced glioma cell death while treatment with oleic acid (OA) prevented the anti-glioma effect of PARPi. Moreover, LDs fuel glioma cells by inducing pro-survival lipid consumption as confirmed by quantitation of oxygen consumption rates using Seahorse respirometry in presence or absence of OA. In summary, we uncover a novel mechanism by which glioblastoma escapes to anti-tumor agents through metabolic reprogramming, inducing the synthesis and utilization of LDs as a pro-survival strategy in response to PARP inhibition.

Seymour fracture: Better do not underestimate it.

OBJECTIVES: This study aims to analyze the functional results, management, and complications of acute Seymour fracture treatment and to generalize the understanding of Seymour fractures, as well as awareness about its controversial treatment and critical sequelae. PATIENTS AND METHODS: Between January 1994 and December 2019, a total of 29 patients (20 males, 9 females; mean age: 7.9±3.9 years; range, 1 to 15 years) who presented within the first 24 h of injury and were diagnosed with Seymour fractures and treated in the emergency setting were retrospectively analyzed. Clinical and radiological data were collected from medical records at the time of diagnosis and during follow-up, within a week after the treatment and in the visits required until fracture healing, and no sequelae were observed. In the event of complications, a minimum of one year of follow-up was carried out. Radiographs were taken of the anteroposterior and lateral views during each visit. RESULTS: The mean follow-up was 10.8±8.6 (range, 2 to 36) months. Surgical treatment in the operating room was performed in 24 (82.7%) patients using a single longitudinal Kirschner wire (K-wire) fixation through the distal phalanx and the distal interphalangeal joint in 21 patients. Non-operative treatment based on closed reduction and splinting was performed in five (17.3%) patients. There was no statistically significant difference in the final passive range of motion and physeal growth arrest in relation to the use or non-use of K-wires. The use of antibiotics in any of the three possible administrations (intravenous antibiotic regimen, intravenous and later oral antibiotic at-home or oral antibiotics), in relation to the non-use of antibiotics seemed to be a protective factor against infections (odds ratio=0.04; 95% confidence interval: 0.006-0.2; p=0.001). CONCLUSION: The identification of Seymour fractures is crucial for applying the correct treatment and reducing the risk of complications, such as osteomyelitis and physeal alterations. Based on our study results, we can suggest that the use of an antibiotic regimen causes a lower risk of infections in acute Seymour fractures. The prompt identification of these fractures with a standardized protocol covering irrigation, debridement, reduction, fixation, and prophylactic antibiotics is needed to avoid complications.

Situación ponderal de la población escolar de 6 a 9 años en España: resultados del estudio ALADINO 2019 / Weight status in the 6- to 9-year-old school population in Spain: results of the ALADINO 2019 Study

Introducción: la obesidad infantil es un problema de salud pública cuya prevalencia no ha dejado de crecer en las últimas décadas. Objetivo: describir la situación ponderal de los escolares de 6 a 9 años en España en 2019, y sus factores asociados. Métodos: ALADINO es un estudio transversal en escolares de 6 a 9 años, representativo de la población española, aplicando la metodología de la Child Obesity Surveillance Initative de la Oficina Regional para Europa de la OMS. Se midieron el peso, la talla y el perímetro abdominal de los participantes, definiendo la situación ponderal según diferentes estándares (OMS, IOTF y Orbegozo). Se pasó a los progenitores un cuestionario sobre estilo de vida y características sociodemográficas. Resultados: se midieron 16.665 escolares de 276 colegios. El 40,6 % presentaban exceso de peso -23,3 % sobrepeso y 17,3 % obesidad- , siendo la obesidad más prevalente en los niños y el sobrepeso en las niñas, y aumentando ambos con la edad. La prevalencia de la obesidad abdominal era del 22,6 %. El exceso de peso disminuyó 3,9 puntos porcentuales desde 2011, principalmente el sobrepeso de los niños. La obesidad permaneció estable. El exceso de peso fue más prevalente en los escolares con hábitos menos saludables de alimentación y actividad física, y en las familias con menor nivel socioeconómico. Conclusiones: la prevalencia del exceso de peso es elevada, aunque ha descendido desde 2011 y permanece estable desde 2015 entre los escolares de 6 a 9 años en España, debiéndose esta reducción fundamentalmente al descenso del sobrepeso en los niños. Es necesario seguir fomentando hábitos saludables desde las etapas más tempranas, reduciendo las desigualdades en salud. (AU)

Introduction: childhood obesity is a public health problem whose prevalence has grown steadily in recent decades. Objective: to describe the weight status of schoolchildren aged 6 to 9 years in Spain in 2019, and their associated factors. Methods: ALADINO is a cross-sectional study in schoolchildren aged 6 to 9 years, representative of the Spanish population, and aligned with the Child Obesity Surveillance Initative of the WHO Regional Office for Europe. Participants’ weight, height, and abdominal circumference were measured, defining weight status according to different standards (WHO, IOTF, and Orbegozo). A questionnaire on lifestyle and socio-demographic characteristics was administered to parents. Results: a total of 16,665 schoolchildren from 276 schools were measured. Excess weight was observed in 40.6 %: 23.3 % overweight and 17.3 % obesity, with obesity being more prevalent in boys and overweight in girls, both increasing with age. The prevalence of abdominal obesity was 22.6 %. Excess weight decreased by 3.9 percentage points since 2011, mainly due to overweight in boys. Obesity remained stable. Excess weight was more prevalent in schoolchildren with less healthy eating and physical activity habits, and in families with a lower socioeconomic status. Conclusions: the prevalence of excess weight is high, although it has declined since 2011 and remains stable since 2015 among schoolchildren aged 6-9 years in Spain, this reduction being mainly due to a decrease in overweight in children. It is necessary to continue promoting healthy habits from the earliest stages of life, thus reducing health inequalities. (AU)

[Dairy matrix: nutritional and sanitary benefits of the interrelation between its nutrients]. / Matriz láctea: beneficios nutricionales y sanitarios de la interrelación entre sus nutrientes.

INTRODUCTION: The effect of nutrients on health has been studied traditionally. From this point of view, milk and dairy products contribute to maintaining and improving nutritional status. Due to its high content of some nutrients such as saturated fat, among others, dairy consumption has been linked to the appearance of several diseases such as obesity or cardiovascular disease. However, food cannot be classified as good or bad based on its nutrient content. On the contrary, those interactions between nutrients and other bioactive compounds that occur in the food matrix must also be taken into account, as they can lead to different results than those expected derived from their consumption. In the case of dairy products, the scientific evidence indicates that dairy matrix could play an important role in the prevention of several non-communicable diseases.

INTRODUCCIÓN: Tradicionalmente se ha estudiado el efecto de los nutrientes en la salud. Desde este punto de vista, la leche y los derivados lácteos son alimentos que contribuyen a mantener y mejorar el estado nutricional. Por su elevado contenido en algunos nutrientes como la grasa saturada, entre otros, el consumo de lácteos se ha relacionado con la aparición de diversas enfermedades como la obesidad o la enfermedad cardiovascular. Sin embargo, los alimentos no se pueden clasificar como buenos o malos por su contenido en nutrientes, sino que también hay que tener en cuenta que en la matriz alimentaria se producen interacciones entre los nutrientes y otros compuestos bioactivos que pueden hacer que el consumo de dichos alimentos tenga resultados distintos a los esperados. En el caso de los lácteos, la evidencia científica señala que la matriz láctea podría jugar un papel importante frente a la prevención de diversas enfermedades crónicas no transmisibles.

[Importance of nutrition during pregnancy. Impact on the composition of breast milk]. / Importancia de la nutrición durante el embarazo. Impacto en la composición de la leche materna.

INTRODUCTION: The consumption of a healthy diet is essential during the preconception period, pregnancy and lactation to guarantee maternal-fetal and newborn health. It is important to take into account when configuring the maternal diet that inadequate intakes of vitamins and minerals, as well as a high consumption of foods or beverages with refined sugar increase the incidence of low birth weight infants, while the adequate consumption of micronutrients and carbohydrates (mainly integral) can decrease it. Prenatal consumption of fish is also associated with less intrauterine growth retardation. Maternal nutritional deficits that lead to intrauterine growth retardation can alter the expression of some genes, causing abnormal programming in organ and tissue development. In response, the fetus adapts to this situation of scarcity and may have difficulties adapting to an abundant consumption of food after birth, increasing its propensity to suffer from cardiovascular and metabolic diseases in adult life. After delivery, the nutrition of the infant must be guaranteed through breast milk. There is a relationship between the nutritional status of the mother and the composition of the mother's milk and, therefore, in the supply of nutrients to the infant, which may condition their health. Despite the great importance of an adequate maternal nutritional state, serum deficiencies in vitamins A, E, C, B2, B1, calcium and zinc are observed in pregnant mothers and breast milk, being important to identify and prevent these imbalances before conception and during pregnancy and lactation.

INTRODUCCIÓN: El consumo de una dieta saludable es esencial durante el periodo preconcepcional, embarazo y lactancia para garantizar la salud maternofetal y del neonato. Es importante tener en cuenta al configurar la dieta materna que ingestas inadecuadas de vitaminas y minerales, así como un elevado consumo de alimentos o bebidas con azúcar refinada, aumentan la incidencia de recién nacidos con bajo peso, mientras que el consumo adecuado de micronutrientes y de hidratos de carbono (principalmente integrales) pueden disminuirla. También el consumo prenatal de pescado se asocia con menor retraso del crecimiento intrauterino. Los déficits nutricionales maternos que conducen a un retraso del crecimiento intrauterino pueden alterar la expresión de algunos genes ocasionando una programación anormal en el desarrollo de órganos y tejidos. Como respuesta, el feto se adapta a esta situación de escasez y puede tener dificultad de adaptación ante un consumo abundante de alimentos después del nacimiento, lo cual aumenta su propensión al padecimiento de enfermedades cardiovasculares y metabólicas en la vida adulta. Después del parto, la nutrición del lactante debe estar garantizada mediante la leche materna. Existe una relación entre el estado nutritivo de la madre y la composición de la leche materna y, por lo tanto, el aporte de nutrientes al lactante, lo cual puede condicionar su salud. Pese a la gran importancia que tiene un adecuado estado nutritivo materno, se observan niveles séricos deficitarios en vitaminas A, E, C, B2, B1, calcio y zinc en madres gestantes y en leche materna, por lo que es importante identificar y prevenir estos desequilibrios antes de la concepción y durante el embarazo y la lactancia.

[Controversies and errors related to nutrition and breastfeeding. Guidelines for improvement]. / Controversias y errores en relación con la nutrición y la lactancia materna. Pautas para la mejora.

INTRODUCTION: Although the benefits of breastfeeding are clear and well documented, for both newborns and nursing mothers, breastfeeding rates worldwide are not optimal in many cases. There are multiple myths and errors related to breastfeeding: that certain foods cannot be consumed during breastfeeding, that, however, certain foods must be consumed to increase milk production, that composition of breast milk is not adequate in some cases, that breastfeeding is associated with more risk of suffering caries… Therefore, the objective of this article is to clarify the reality about these aspects of breastfeeding.

INTRODUCCIÓN: Aunque los beneficios de la lactancia materna son claros y están bien documentados tanto para los recién nacidos como para las madres lactantes, las tasas de lactancia materna a nivel mundial en muchos casos no son óptimas. Existen múltiples mitos y errores en relación con la lactancia materna, como que no pueden consumirse determinados alimentos, que deben consumirse determinados alimentos para aumentar la producción láctea, que la composición de la leche materna en algunos casos no es adecuada, que la lactancia materna se asocia a más riesgo de caries… Por todo ello, el objetivo de este artículo es aclarar la realidad acerca de estos aspectos sobre la lactancia materna.

[Nutritional problematic related to frailty and sarcopenia in older]. / Problemática nutricional relacionada con la fragilidad y la sarcopenia en personas de edad avanzada.

INTRODUCTION: Introduction: frailty and sarcopenia are prevalent conditions in older adults which diagnosis and treatment often overlap. Objective: to analyze the nutritional problematic related to frailty and sarcopenia in older adults. Methods: a literature review, about particularities of frailty and sarcopenia, diagnosis and nutritional treatment, has been carried out. Results: frailty is a geriatric syndrome that can be identified by at least three of the following criteria: weight loss, exhaustion, reduced physical activity, increased walk time, low grip strength. Sarcopenia is a muscular disease characterized by low muscle mass and reduced muscle strength as the main determinant. Both conditions can benefit from adequate protein intake (1-1.5 g/kg/day) and regular physical activity. Conclusion: identification, prevention, monitoring and nutritional treatment of frailty and sarcopenia in older adults is important because of its high prevalence. The main goal is to maintain the muscular integrity and minimize muscle loss in older adults. A healthy aging includes regular physical activity and the fulfillment of the protein requirements of this population.

INTRODUCCIÓN: Introducción: la fragilidad y la sarcopenia son dos condiciones altamente prevalentes en el adulto mayor que se solapan en diferentes vertientes del diagnóstico y del tratamiento. Objetivos: analizar la problemática nutricional relacionada con la fragilidad y la sarcopenia en personas de edad avanzada. Métodos: se ha realizado una revisión bibliográfica de las particularidades de la fragilidad y de la sarcopenia, así como del diagnóstico y del tratamiento nutricional. Resultados: la fragilidad es un síndrome geriátrico que puede identificarse si se tienen al menos tres de los siguientes criterios: pérdida de peso, fuerza de presión de la mano disminuida, velocidad de la marcha lenta, actividad física reducida y agotamiento. La sarcopenia es una enfermedad muscular que se caracteriza por una masa muscular baja y una fuerza muscular reducida como determinantes principales. Ambas condiciones pueden verse beneficiadas por un consumo adecuado de proteínas (1-1,5 g/kg/día) y una actividad física de resistencia regular. Conclusión: la identificación, prevención, seguimiento y tratamiento nutricional de la fragilidad y la sarcopenia en adultos mayores es de vital importancia dada su elevada prevalencia. El objetivo es mantener la integridad y minimizar la pérdida muscular en los adultos mayores. Un envejecimiento saludable incluye la realización de actividad física regular y el cumplimiento de los requerimientos proteicos de esta población.

[Nutritional intervention in the control of gallstones and renal lithiasis]. / Intervención nutricional en el control de la colelitiasis y la litiasis renal.

INTRODUCTION: Cholelithiasis and kidney stones are frequent pathologies in developed countries. Gallstones can be pigmentary, cholesterol (75%) or mixed. Age, female sex, obesity, rapid weight loss, consumption of refined sugars, saturated fat, iron deficiency, vitamin D and low intake of fiber and vitamin C are factors associated with an increased risk of cholelithiasis. On the other hand, the intake of ω-3 fatty acids, oleic acid, calcium, magnesium, fiber, fruits and vegetables, dairy products, nuts, coffee, moderate consumption of alcohol, vitamin C supplements, physical exercise and a regular diet have a protective paper. The most frequent kidney stones are calcium oxalate followed by mixed ones (oxalate and calcium phosphate), struvite, uric acid and cystine. A high water intake is recommended (> 2.5 l / day), varying the type of recommended or unadvisable food depending on the type of calculus. In oxalic lithiasis it is recommended to reduce the consumption of meat, moderate that of spinach, Swiss chard, asparagus, chocolate and avoid excessive sodium intake. The administration of oxalate-degrading probiotics (Lactobacillus) may reduce intestinal absorption, although further studies are necessary to corroborate these results. In calcium phosphate acidifying diet is recommended and limit the consumption of coffee and tea. The prevention of uric calculus is based on hydration with alkalizing drinks and vegetarian diet, decreasing foods rich in purines (liver, kidney, fish eggs, anchovies, sardines and seafood) and in calculus of cystine diet is recommended alkalizing. Since the formation of struvite calculi is due to urinary infections, pharmacological treatment and the consumption of acidifying diets, moderation of the intake of phosphate-rich foods and limiting the contribution of fats and citrus fruits are necessary. The nutritional intervention is an effective measure in the prevention of biliary and renal lithiasis and prevent its recurrence.

INTRODUCCIÓN: La colelitiasis y litiasis renal son patologías frecuentes en países desarrollados. Los cálculos biliares pueden ser pigmentarios, de colesterol (75%) o mixtos. La edad, el sexo femenino, la obesidad, la pérdida rápida de peso, el consumo de azúcares refinados, la grasa saturada, la deficiencia de hierro y de vitamina D y la baja ingesta de fibra y vitamina C son factores asociados a mayor riesgo de colelitiasis. Por otro lado, la ingesta de ácidos grasos ω-3, ácido oleico, calcio, magnesio, fibra, frutas y verduras, lácteos, frutos secos, café, un consumo moderado de alcohol, suplementos de vitamina C, ejercicio físico y una alimentación regular desempeñan un papel protector. Las litiasis renales más frecuentes son de oxalato cálcico, seguidas de las mixtas (oxalato y fosfato cálcico), estruvita, ácido úrico y cistina. Se aconseja una elevada ingesta hídrica (> 2,5 l/día), variando el tipo de alimentos recomendados o desaconsejados en función del tipo de cálculo. En litiasis oxálica se recomienda reducir el consumo de carne, moderar el de espinacas, acelgas, espárragos, chocolate y evitar el aporte excesivo de sodio. La administración de probióticos degradantes de oxalato (Lactobacillus) podría reducir su absorción intestinal, aunque son necesarios más estudios para corroborar estos resultados. En las de fosfato cálcico se aconseja dieta acidificante y limitar el consumo de café y té. La prevención de cálculos de úrico está basada en la hidratación con bebidas alcalinizantes y dieta vegetariana, disminuyendo los alimentos ricos en purinas (hígado, riñón, huevas de pescado, anchoas, sardinas y mariscos), y en cálculos de cistina se aconseja el consumo de dietas alcalinizantes. Dado que la formación de cálculos de estruvita se debe a infecciones urinarias, es necesario un tratamiento farmacológico y el consumo de dietas acidificantes, moderar la ingesta de alimentos ricos en fosfatos y limitar el aporte de grasas y cítricos. La intervención nutricional es una medida eficaz en la prevención de la litiasis biliar y renal y para evitar su recurrencia.

Insights into the hydrolytic activity of Asclepias fruticosa L. protease.

OBJECTIVE: To determine the enzymatic properties of asclepain f, a plant cysteine protease isolated and purified from the latex of Asclepias fruticosa, and to investigate its potential application to hydrolyze soybean proteins. RESULTS: Kinetic parameters were determined by hydrolysis of p-Glu-Phe-Leu-p-nitroanilide (PFLNA). The Km value for asclepain f was 6 to 8 times higher than those achieved for papain, bromelain and ficin, the main plant cysteine proteases. Asclepain f showed 12 cut-off points toward the oxidized B chain insulin, revealing that the enzyme possesses broad substrate specificity. The cut specificity was governed by the presence of hydrophobic residues (F, L, V) in the P2 position. Asclepain f was able to selectively hydrolyze soybean proteins at pH 10, employing an enzyme/substrate ratio of 0.2% (w/w). The enzymatic hydrolysis allowed a strong increase in the solubility, water and oil holding capacity. CONCLUSIONS: Asclepain f was revealed as a successful enzyme for biocatalysis of protein hydrolysis processes at alkaline pH. This new plant protease has a broad substrate specificity and is capable of selectively degrading the fractions of soy proteins and improving its functional properties.

Pioderma gangrenoso periestomal: A propósito de un caso / No disponible

La ostomía es la derivación de una víscera hueca al exterior. En nuestro caso se trata de una colostomía realizada tras una diverticulitis perforada con varias complicaciones postoperatorias que requieren de varias reintervenciones posteriores. A los dos meses de ser dado de alta hospitalaria, acude de forma imprevista a la consulta de Ostomías por presentar de forma súbita una herida paraestomal dolorosa, de 2x2 centímetros con lecho limpio y bordes inflamados, haciéndonos pensar en la posibilidad de estar ante un caso de Pioderma Gangrenoso. Describimos el Proceso de Atención de Enfermería mediante Diagnósticos enfermeros, Resultados e Intervenciones, junto con Problemas de Colaboración al haber tenido que consultar con otros especialistas debido al difícil manejo y la evolución tórpida. Finalmente se restablece la integridad cutánea tras 9 meses de cuidados de la piel con el tratamiento, los dispositivos y accesorios adecuados

No disponible

Structural Properties of Macrodontain I, a Cysteine Protease from Pseudananas macrodontes (Morr.) Harms (Bromeliaceae).

The primary structure of macrodontain I, a peptidase from Pseudananas macrodontes fruits, was determined using Edman's degradation. The enzyme is a non-glycosylated peptidase composed by 213 amino acids with a calculated molecular weight of 23,486.18 Da, pI value 6.99, and a molar extinction coefficient at 280 nm of 61,685 M-1 cm-1. The alignment of the sequence of macrodontain I with those cysteine peptidases from species belonging to the family Bromeliaceae showed the highest identity degree (87.74%) against fruit bromelain. A remarkable fact is that all these peptidase sequences show two Met contiguous residues (Met121 and 122) and the nonapeptide VPQSIDWRD located in the mature N-terminal region. Residues Cys26 and His159, which constitute the catalytic dyad in all cysteine peptidases, as well as active site residues Gln20 and Asn176, characteristic of Clan C1A, are conserved in macrodontain I. The 3-D model suggests that the enzyme belongs to the α + ß class of proteins, with two disulfide bridges (Cys23-Cys63 and Cys57-Cys96) in the α domain, while the ß domain is stabilized by another disulfide bridge (Cys153-Cys201). Further, we were able to establish that the cysteine peptidases from P. macrodontes are involved in the anti-inflammatory activity.

Radial Polydactyly. What's New?

BACKGROUND: Thumb duplication, also called radial or preaxial polydactyly, is classified as an alteration of the radio-ulnar axis in the formation and differentiation of the hand plate, according to the Oberg, Manske and Tonkin classification. OBJECTIVE: Radial polydactyly is a common upper limb malformation. This paper is a comprehensive analysis of radial polydactyly, its genetic explanation, classification, surgical techniques, functional results, as well as present and future scientific evidence on this congenital pathology. CONCLUSIONS: Radial polydactyly occurs most frequently as an isolated defect, but it may also occur in association with other abnormalities, or as part of a syndrome. The Wassel classification is the universal classification for thumb duplication. One of the limitations of it is the misclassification of the immature epiphysis. The Wassel classification not only refers to the pathoanatomy of the polydactyly but also guides the selection of various surgical techniques. Three well-defined surgical objectives should be ensured: thumb alignment, stability, and an acceptable final esthetic appearance. Tada score is a validated functional scale that takes into account the most common and limiting complications, namely clinodactyly and instability. Based on some recent strong research evidence, the JSSH assessment system provides the most reliable outcome of scores. More studies are required to provide evidence-based conclusions regarding the treatment of radial polydactyly.

Latex peptidases of Calotropis procera for dehairing of leather as an alternative to environmentally toxic sodium sulfide treatment.

Dehairing of crude leather is a critical stage performed at the beginning of its processing to obtain industrially useful pieces. Tanneries traditionally apply a chemical process based on sodium sulfide. Since this chemical reactive is environmentally toxic and inefficiently recycled, innovative protocols for reducing or eliminating its use in leather depilation are welcomed. Therefore, latex peptidases from Calotropis procera (CpLP) and Cryptostegia grandiflora (CgLP) were assayed for this purpose. Enzyme activity on substrates representative of skin such as hide powder azure (UHPA), elastin (UE), azocollagen (UAZOCOL), keratin (UK), and epidermis (UEP) was determined, while depilation activity was assayed on cow hide. Only CpLP was active against keratin (13.4 UK) and only CgLP was active against elastin (0.12 UE). CpLP (93.0 UHPA, 403.6 UAZOCOL, 36.3 UEP) showed higher activity against the other substrates than CgLP (47.6 UHPA, 261.5 UAZOCOL, 8.5 UEP). In pilot assays, CpLP (0.05% w/v with sodium sulfite 0.6% w/v as activator) released hairs from cow hide pieces. Macroscopic and microscopic analyses of the hide revealed that the dehairing process was complete and the leather structure was preserved. The proteolytic system of C. procera is a suitable bioresources to be exploited by tanneries.