Closure of a large lumbosacral myelomeningocele post operative defect with a human cadaveric split-thickness skin graft: a case report

Spina bifida is the most common birth defect of the central nervous system that is compatible with life, and myelomeningocele represents its most frequent form. Congenital myelomeningocele (CMM) has a worldwide incidence of 0.5 to 0.8 per 1,000 live newborns. CMM is a complex condition resulting from incomplete closure of the neural tube, mainly in the lumbosacral region. The objective of the surgical repair of the CMM is the reconstruction of all the tissue layers of the defect, avoiding possible postoperative complications. The aim of this case review is to present a re-epithelialization closure in a patient with a large CMM defect in who primary hermetic closure was not possible because there was too much tension at the edges of the defect. Therefore, human cadaveric split-thickness skin grafts were placed over the dura mater and the aponeurotic layer, covering the entire defect and an adequate healing and completely closure of the defect were observed in eight weeks. The surgical management of large meningomyelocele defects represents a major challenge and no single protocol exists for its reconstruction. The repair of an MMC defect should be performed during the first 72 hours after birth. After neurosurgical closure of the neural tube and dura, the myelomeningocele defect requires good quality skin and subcutaneous tissue with minimal wound tension for stable coverage. Human cadaveric skin grafts are considered a useful technique for temporary wound coverage because they lead to a more natural healing environment, possess ideal properties, and provide a physiological barrier that reduces microbiological contamination, in addition, it acts as a bridge to adhere to and to seal wound beds

Consumo de azúcar y eventos cardiovasculares mayores: revisión sistemática

Contexto: Factores dietarios poco saludables se han asociado con aumento de riesgo cardiovascular, uno de ellos; consumo de azúcar.  Objetivo: Búsqueda, evaluación y análisis de la mejor evidencia disponible sobre el consumo de azúcar y desenlaces mayores cardiovasculares. Metodología: Revisión sistemática de la literatura. Evaluación cuantitativa entre consumo de azúcar y alguno de los siguientes eventos cardiovasculares mayores (muerte cardiovascular, infarto agudo de miocardio no fatal o accidente cerebrovascular no fatal). Se incluyeron participantes mayores de 18 años no gestantes, sin cardiopatía congénita.  Resultados: Se incluyeron 31 estudios primarios (27 estudios de cohortes y 4 estudios de casos y controles). Veintiuno evaluaron el consumo de azúcar e infarto agudo de miocardio, 12 consumo de azúcar y accidente cerebrovascular y 6 consumo de azúcar y muerte cardiovascular. Para los 3 desenlaces los resultados fueron controversiales, sin embargo, con significancia estadística en varios estudios para la asociación en cuestión, al evaluarse el consumo de azúcar por carga glucémica, índice glucémico, carbohidratos totales, entre otros. Conclusiones: Sin bien la evidencia es contradictoria, sugiere de forma consistente a partir de estudios de cohorte que los carbohidratos con alto índice glucémico, azucares añadidos y bebidas azucaradas, aumentan el riesgo de presentar eventos adversos cardiovasculares mayores como infarto agudo de miocardio, ataque cerebrovascular y muerte cardiovascular

3D printing for surgical planning in bone grafts for cleft-palate: a case report

3D printing has been used for teaching purposes. Creating models for simulating surgeries. Gong et al presented a workflow for digital planning for surgery and Rendon et al previously presented a low-cost method with acceptable precision.  This paper aims to present a case where 3D printing surgical planning was applied for bone graft shape and dimensions. A 16-year-old female patient with a history of bilateral cleft lip and palate has received 6 surgical interventions to treat her congenital pathology. She begins orthodontic management at the age of 6 years and is referred to the plastic surgery service 10 years later, presenting oral and nasal fistula on the nasal floor with mainly liquid leakage. A bone graft was taken and applied from the patient's left iliac crest. the iliac crest is taken and the bone graft is molded Assisted with 3D printed model which is fixed in the premaxilla with a 14-hole linear plate. We proposed a new application for low-cost 3D printed models. Patient specific models have applications in cleft palate bone grafting. We present a case and more studies are required to measure variables as time, graft integration, and patient satisfaction

Pabellón-Puente. EXPO 2008. Construcción y lanzamiento.

Voladizos sucesivos, penínsulas, pretensado, carros de avance, control geométrico La construcción de una obra de estas características en tan sólo 17 meses siempre es un reto. A la complejidad inherente del montaje de 62500 piezas metálicas se une la necesidad de realizar una complicada maniobra de lanzamiento de una estructura de 140 m de longitud y 2100 toneladas de peso por encima de un río de 120 m de ancho sin situar ningún apoyo intermedio en el cauce. Esto sólo ha sido posible gracias a un trabajo minucioso de todo el equipo humano que ha intervenido en la concepción, diseño, fabricación, montaje y lanzamiento de la estructura. Lo más singular de esta obra es, sin duda, la maniobra de lanzamiento. Éste fue un proceso sin precedentes, ya que el tramo de puente lanzado era curvo en planta, de canto y anchura variables y totalmente asimétrico. El diseño de la maniobra supuso meses de trabajo de un equipo formado por gente de FHECOR, DRAGADOS, URSSA y ALE LASTRA. La maniobra se prolongó durante tres meses y durante todo el proceso se realizó una auscultación en tiempo real de la geometría y de los esfuerzos en determinados elementos

Valor pronóstico del descenso absoluto de la porción N-terminal del propéptido natriurético tipo B en insuficiencia cardiaca descompensada: análisis secundario del estudio CLUSTER-HF

Objective. The purpose of this study is to determine the prognostic value of the absolute decrease in the N-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) to prevent fewer clinical events, in the population of CLUSTER-HF (efficacy of ultrasound lung to guide therapy and prevent readmissions in heart failure). Materials and methods. This study was conducted in a subgroup of ninety-four patients with available NT-proBNP information at hospital discharge and prior to randomization in the CLUSTER-HF study. The primary objective of the study was to determine the prognostic value of absolute NT-proBNP decline below which fewer events of all-cause death, emergency room visits, and rehospitalization for heart failure at 180 days. Results. The absolute decrease in NT-proBNP below 3,350 pg/mL has a moderate discriminative capacity with AUC= 0.602, with a prognostic value in the combined event at 180 days (log-rank test, p=0.01). Also, according to the multivariable analysis, it is an independent marker of clinical events at 180 days OR 0.319 (0.102-0.995, p=0.04) above other clinical variables. Conclusions. An absolute decrease to 3,350 pg/mL of NT-proBNP or less at discharge from the hospitalization due to heart failure, was associated with fewer clinical events at 180 days.Objetivo. Determinar el valor pronóstico del descenso absoluto de la porción N-terminal del propéptido natriurético tipo B (NT–proBNP) para prevenir menos eventos clínicos en la población del estudio CLUSTER-HF (eficacia del ultrasonido pulmonar para guiar la terapia y prevenir las rehospitalizaciones en insuficiencia cardiaca). Materiales y métodos. El presente estudio fue realizado en un subgrupo de 94 pacientes con información disponible de NT-proBNP al alta hospitalaria y previo a la aleatorización del estudio CLUSTER-HF. El objetivo primario del estudio fue determinar el valor pronóstico de descenso absoluto de NT - pro-BNP por debajo del cual se prediga menos eventos de muerte por todas las causas, visitas a urgencias y rehospitalización por insuficiencia cardiaca a 180 días. Resultados. El descenso absoluto de NT-proBNP por debajo de 3 350 pg/mL tiene una capacidad discriminativa moderada con un AUC= 0,602, con un valor pronóstico significativo en el evento combinado a 180 días (log rank test, p=0,01). Asimismo, de acuerdo al análisis multivariado es un marcador independiente de eventos clínicos a 180 días OR 0,319 (0,102-0,995, p=0,04) por encima de otras variables clínicas. Conclusiones. El tener un descenso absoluto menor a 3 350 pg/mL de NT - pro-BNP al alta de la hospitalización por insuficiencia cardiaca se asoció a menos eventos clínicos a 180 días

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed

Discapacidad, conflicto armado y construcción de paz

ilustrciones, fotografíasEn la Maestría de Discapacidad e Inclusión Social desde el 2013 se ha convocado a autoras y autores a participar con sus escritos en la reflexión sobre temáticas relevantes. Entretejiendo sus aportes, se han construido hasta el momento seis publicaciones de la Serie Temática que versan sobre asuntos como discapacidad e inclusión (n.º 1, 2013), discapacidad y política (n.º 2, 2013), diversas maneras de escribir acerca de los procesos investigativos vividos (n.º 3, 2016), atajos para comunicar los atajos de la investigación (n.º 4, 2016), encuentros pedagógicos desde la experiencia universitaria (n.º 5, 2017) y en la denuncia de una visualidad hegemónica (n.º 6, 2017). La actual Serie Temática número 7, Discapacidad, conflicto armado y construcción de paz, surge como respuesta a la invitación de la Comisión para el Esclarecimiento de la Verdad, la Convivencia y la No Repetición, a través de su Mesa de Curso de Vida y Discapacidad, para aportar en el cumplimiento de su mandato. Cabe recordar que la Comisión de la Verdad forma parte del Sistema Integral de Verdad, Justicia, Reparación y No Repetición creado a partir del Acuerdo Final para la Terminación del Conflicto y la Construcción de una Paz Estable y Duradera, que firmaron el Gobierno colombiano y las Fuerzas Armadas Revolucionarias de Colombia - Ejército del Pueblo (farc-ep) en noviembre de 2016, transcurridos más de 50 años desde el levantamiento armado de esta guerrilla

Guía de práctica clínica para la atención prehospitalaria de pacientes adultos con trauma craneoencefálico severo

En esta guía de práctica clínica, se revisarán las pautas críticas para el abordaje integral del paciente adulto con trauma craneoencefálico en el ámbito de atención prehospitalaria, generando recomendaciones basadas en evidencia científica dentro de un marco de seguridad del paciente.In this clinical practice guide, the critical guidelines for the comprehensive approach to the adult patient with head trauma in the prehospital care setting will be reviewed, generating recommendations based on scientific evidence within a patient safety framework.Alcance y objetivos -- Alcance del tema de la GPC -- Objetivo general de la GPC -- Objetivos específicos -- Usuarios -- Población -- Ámbito asistencial -- Aspectos clínicos centrales -- Aspectos clínicos abordados por la guía -- Aspectos clínicos no abordados por la guía -- Actualización de la GPC -- Metodología -- Construcción de preguntas -- Entrevista exploratoria para la identificación de dudas en el personal prehospitalario -- Formulación de preguntas clínicas -- Definición de los desenlaces -- Construcción del conjunto de la evidencia -- Formulación -- Perspectiva de los pacientes familiares y cuidadores -- Preguntas, evidencia y recomendacionesna107 página

Multicentric study of cervical cancer screening with human papillomavirus testing and assessment of triage methods in Latin America : the ESTAMPA screening study protocol

Q1Q1Introduction Human papillomavirus (HPV) testing is replacing cytology in primary screening. Its limited specificity demands using a second (triage) test to better identify women at high-risk of cervical disease. Cytology represents the immediate triage but its low sensitivity might hamper HPV testing sensitivity, particularly in low-income and middle-income countries (LMICs), where cytology performance has been suboptimal. The ESTAMPA (EStudio multicéntrico de TAMizaje y triaje de cáncer de cuello uterino con pruebas del virus del PApiloma humano; Spanish acronym) study will: (1) evaluate the performance of different triage techniques to detect cervical precancer and (2) inform on how to implement HPV-based screening programmes in LMIC. Methods and analysis Women aged 30–64 years are screened with HPV testing and Pap across 12 study centres in Latin America. Screened positives have colposcopy with biopsy and treatment of lesions. Women with no evident disease are recalled 18 months later for another HPV test; those HPV-positive undergo colposcopy with biopsy and treatment as needed. Biological specimens are collected in different visits for triage testing, which is not used for clinical management. The study outcome is histological high-grade squamous intraepithelial or worse lesions (HSIL+) under the lower anogenital squamous terminology. About 50 000 women will be screened and 500 HSIL+ cases detected (at initial and 18 months screening). Performance measures (sensitivity, specificity and predictive values) of triage techniques to detect HSIL+ will be estimated and compared with adjustment by age and study centre. Ethics and dissemination The study protocol has been approved by the Ethics Committee of the International Agency for Research on Cancer (IARC), of the Pan American Health Organisation (PAHO) and by those in each participating centre. A Data and Safety Monitoring Board (DSMB) has been established to monitor progress of the study, assure participant safety, advice on scientific conduct and analysis and suggest protocol improvements. Study findings will be published in peer-reviewed journals and presented at scientific meetings. Trial registration number NCT01881659Revista Internacional - Indexad