Dermatitis crónica por sensibilización al níquel en un paciente con fractura del astrágalo tratada mediante osteosíntesis

Se presenta un varón de 25 años, con fractura del astrágalo izquierdo tratada mediante osteosíntesis con 2 tornillos de acero inoxidable con un contenido en níquel del 12-14%. A los 4 meses de la intervención, el paciente desarrolló una dermatitis pruriginosa en cara lateral externa del pie, en la zona cutánea supra-adyacente al lugar de la osteosíntesis. La lesión no cedió con el tratamiento tópico convencional a base de corticoides. Las pruebas epicutáneas realizadas con la batería estándar del Grupo Español de Investigación en Dermatitis de Contacto revelaron un parche positivo vesiculoso (+ +) al sulfato de níquel al 2,5% y al cloruro de cobalto al 1%, ambos aplicados en vaselina, en la lectura a las 48 y 96 horas. En vista de que las lesiones permanecían estables al mes de tratamiento con un potente corticoide en cura oclusiva y antihistamínicos sistémicos, se procedió a retirar los tornillos de osteosíntesis. A los pocos días de la intervención comenzó a desaparecer el prurito y, en el curso de 2 semanas, se produjo la curación completa de la dermatitisSe presenta un varón de 25 años, con fractura del astrágalo izquierdo tratada mediante osteosíntesis con 2 tornillos de acero inoxidable con un contenido en níquel del 12-14%. A los 4 meses de la intervención, el paciente desarrolló una dermatitis pruriginosa en cara lateral externa del pie, en la zona cutánea supra-adyacente al lugar de la osteosíntesis. La lesión no cedió con el tratamiento tópico convencional a base de corticoides. Las pruebas epicutáneas realizadas con la batería estándar del Grupo Español de Investigación en Dermatitis de Contacto revelaron un parche positivo vesiculoso (+ +) al sulfato de níquel al 2,5% y al cloruro de cobalto al 1%, ambos aplicados en vaselina, en la lectura a las 48 y 96 horas. En vista de que las lesiones permanecían estables al mes de tratamiento con un potente corticoide en cura oclusiva y antihistamínicos sistémicos, se procedió a retirar los tornillos de osteosíntesis. A los pocos días de la intervención comenzó a desaparecer el prurito y, en el curso de 2 semanas, se produjo la curación completa de la dermatitis

Development of the Platysma Muscle and the Superficial Musculoaponeurotic System (Human Specimens at 8–17 Weeks of Development)

There is controversy regarding the description of the different regions of the face of the superficial musculoaponeurotic system (SMAS) and its relationship with the superficial mimetic muscles. The purpose of this study is to analyze the development of the platysma muscle and the SMAS in human specimens at 8–17 weeks of development using an optical microscope. Furthermore, we propose to study the relationship of the anlage of the SMAS and the neighbouring superficial mimetic muscles. The facial musculature derives from the mesenchyme of the second arch and migrates towards the different regions of the face while forming premuscular laminae. During the 8th week of development, the cervical, infraorbital, mandibular, and temporal laminae are observed to be on the same plane. The platysma muscle derives from the cervical lamina and its mandibular extension enclosing the lower part of the parotid region and the cheek, while the SMAS derives from the upper region. During the period of development analyzed in this study, we have observed no continuity between the anlage of the SMAS and that of the superficial layer of the temporal fascia and the zygomaticus major muscle. Nor have we observed any structure similar to the SMAS in the labial region

The kinetics and acoustics of fingering and note transitions on the flute

Motion of the keys was measured in a transverse flute while beginner, amateur and professional flutists played a range of exercises. The time taken for a key to open or close is typically 10 ms when pushed by a finger or 16 ms when moved by a spring. Delays between the motion of the fingers were typically tens of ms, with longer delays as more fingers are involved. Because the opening and closing of keys will never be exactly simultaneous, transitions between notes that involve the movement of multiple fingers can occur via several possible pathways with different intermediate fingerings. A transition is classified as `safe' if it is possible to be slurred from the initial to final note with little perceptible change in pitch or volume. Some transitions are `unsafe' and possibly involve a transient change in pitch or a decrease in volume. In transitions with multiple fingers, players, on average, used safe transitions more frequently than unsafe transitions. Professionals exhibited smaller average delays between the motion of fingers than did amateurs

Penetración y degradación de la terbutilazina en el suelo. Efectos del riego de incorporación

En este experimento se trató de ver el comportamiento (degradación y lixiviación) de la terbutilazina en el suelo, bajo seis diferentes manejos de la combinación tratamiento-riego. Se observa en general, como dicho herbicida se adsorbe en los primeros cm del suelo, así como su elevada persistencia. Las mayores acumulaciones del producto al inicio del experimento se manifiestan con la herbigación, mientras que al final del mismo tiende a ser igual la acumulación de terbutilazina en los seis tipos diferentes de combinación tratamiento-riego

Multimessenger astronomy with pulsar timing and X-ray observations of massive black hole binaries

We demonstrate that very massive (>10^8\msun), cosmologically nearby (z<1) black hole binaries (MBHBs), which are primary targets for ongoing and upcoming pulsar timing arrays (PTAs), are particularly appealing multimessenger carriers. According to current models for massive black hole formation and evolution, the planned Square Kilometer Array (SKA) will collect gravitational wave signals from thousands of such massive systems, being able to individually resolve and locate in the sky several of them (maybe up to a hundred). By employing a standard model for the evolution of MBHBs in circumbinary discs, with the aid of dedicated numerical simulations, we characterize the gas-binary interplay, identifying possible electromagnetic signatures of the PTA sources. We concentrate our investigation on two particularly promising scenarios in the high energy domain, namely, the detection of X-ray periodic variability and of double broad K\alpha iron lines. Up to several hundreds of periodic X-ray sources with a flux >10^-13 erg s^-1 cm^-2 will be in the reach of upcoming X-ray observatories. Double relativistic K\alpha lines may be observable in a handful of low redshift (z<0.3) sources by proposed deep X-ray probes, such as Athena. (Abridged)Comment: 19 pages, 11 figures, submitted to MNRAS, minor revision of the reference lis

Attitudes and burden in relatives of patients with schizophrenia in a middle income country

BACKGROUND: Most studies of family attitudes and burden have been conducted in developed countries. Thus it is important to test the generalizability of this research in other contexts where social conditions and extended family involvement may be different. The aim of this study was to assess the relationship between the attitudes of caregivers and the burden they experience in such a context, namely Arica, a town located in the northernmost region of Chile, close to the border with Peru and Bolivia. METHODS: We assessed attitudes towards schizophrenia (including affective, cognitive and behavioural components) and burden (including subjective distress, rejection and competence) in 41 main caregivers of patients with schizophrenia, all of whom were users of Public Mental Health Services in Arica. RESULTS: Attitude measures differed significantly according to socio-demographic variables, with parents (mainly mothers) exhibiting a more negative attitude towards the environment than the rest of the family (t = 4.04; p = 0.000).This was also the case for caregivers with a low educational level (t = 3.27; p < 0.003), for the oldest caregivers (r = 0.546; p = 0.000) and for those who had spent more time with the patient (r = 0.377; p = 0.015). Although attitudes had significant association with burden, their explanatory power was modest (R2 = .104, F = 4,55; p = .039). CONCLUSIONS: Similar to finding developed countries, the current study revealed a positive and significant relationship between the attitudes of caregivers and their burden. These findings emphasize the need to support the families of patients with schizophrenia in this social context

Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Role of age and comorbidities in mortality of patients with infective endocarditis

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group