Protocolo exitoso de separación quirúrgica de gemelos isquiopagus

Se presenta el caso de separación quirúrgica exitosa de pacientes gemelos isquiopagus en el Hospital Universitario San Ignacio. Se conformó un grupo interdisciplinario dividido en dos equipos con igual número de especialistas integrando a Cirugía Pediátrica, Cirugía Plástica, Urología, Anestesia, Cuidados Intensivos, Pediatría, Psiquiatría y Ortopedia. Se planeó cuidadosamente un proceso prequirúrgico durante 4 meses para llevar exitosamente a cirugía a estos pacientes de 18 meses de edad. La cirugía se completó después del manejo inicial con expansores tisulares para generar tejido adicional de cubrimiento. La separación tomó en total 14 horas y se requirió de un colgajo libre de dorsal ancho para cierre de pared abdominal en uno de los pacientes. Se presenta la preparación completa, planeamiento, secuencia quirúrgica, seguimiento y resultado.Artículo de investigación1-13A case of successful surgical separation of ischiopagus conjoined twins at the Hospital Universitario San Ignacio is presented. An interdisciplinary group was conformed, divided into two teams with equal number of specialists integrating Pediatric Surgery, Plastic Surgery, Urology, Anaesthesia, Intensive Care, Pediatrics, Psychiatry and Orthopedics. The process was carefully planned preoperatively 4 months prior to surgery. The surgery was completed after initial treatment with tissue expansion, to generate additional options of coverage. The separation surgery took a total of 14 hours, and required an additional free latissimus dorsi flap for closure of the abdominal wall in one of the twins. The complete preparation, planning, surgical sequence, monitoring and outcome is presented

What benefit-risk trade-offs are acceptable to rheumatoid arthritis patients during treatment selection? Evidence from a multicountry choice experiment

Objective Understanding preferences of patients with rheumatoid arthritis (RA) can facilitate tailored patient-centric care. This study elicited trade-offs that patients with RA were willing to make during treatment selection. Methods Patients with RA completed an online discrete choice experiment, consisting of a series of choices between hypothetical treatments. Treatment attributes were selected based on literature review and qualitative patient interviews. Eligible patients were ≥18 years old, diagnosed with RA, receiving systemic disease-modifying antirheumatic drug therapy, and residents of Europe or USA. Male patients were oversampled for subgroup analyses. Data were analysed using a correlated mixed logit model. Results Of 2090 participants, 42% were female; mean age was 45.2 years (range 18-83). Estimated effects were significant for all attributes (p&lt;0.001) but varied between patients. Average relative attribute importance scores revealed different priorities (p&lt;0.001) between males and females. While reducing pain and negative effect on semen parameters was most important to males, females were most concerned by risk of blood clots and serious infections. No single attribute explained treatment preferences by more than 30%. Preferences were also affected by patients' age: patients aged 18-44 years placed less importance on frequency and mode of treatment administration (p&lt;0.05) than older age groups. Patients were willing to accept higher risk of serious infections and blood clots in exchange for improvements in pain, daily activities or administration convenience. However, acceptable trade-offs varied between patients (p&lt;0.05). Conclusion Treatment preferences of patients with RA were individual-specific, but driven by benefits and risks, with no single attribute dominating the decision-making.</p

Improving Cr (VI) Extraction through Electrodialysis

A laboratory study has been carried out to determine the feasibility of in situ remediation of chromium (VI) contaminated soil using electrodialysis. In a classic setup, this technique implies the application of a low intensity direct current to the soil, which is separated from the electrode compartments by ion-exchange membranes. If the pollutants are ionic compounds, they can be forced to migrate to the oppositely charged electrode by electro-migration. Membranes selectively impede the flow of ions in the electrode compartments back to the soil. If a metal species is naturally present as an anion, mobilization from the soil at alkaline pH can be realized and, at the same time, the mobilization of other metal cations that occur at low pH can be minimized. Experiments have been carried out with clayey soils (kaolinite clay and soil clay mixtures) that have been characterized and then contaminated by mixing with a potassium dichromate solution for several days. Initial Cr (VI) content ranges from 500 to 4000 mg/kg. Treatment tests were carried out in an acrylic laboratory cells consisting of a central soil compartment and two electrode compartments located at both ends of the column. Dimensionally stable titanium electrodes coated with mixed metal oxides were placed in the electrode compartments. 0.01M Na2SO4 electrolytes were recirculated through them from two 1-liter deposits using a peristaltic pump. Two commercial ion exchange membranes separated the anolyte and catholyte compartments from the soil in the standard configuration. A programmable DC: power supply was connected to the electrodes and a computer for data acquisition.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. The authors acknowledge the financial support from the "Plan Propio de Investigación de la Universidad de Málaga" with project numbers PPIT.UMA.D1; PPIT.UMA.B1.2017/20 and PPIT.UMA.B5.2018/17. This work has also received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 778045

Expert panel consensus recommendations for diagnosis and treatment of secondary osteoporosis in children

Background: Osteoporosis incidence in children is increasing due to the increased survival rate of patients suffering from chronic diseases and the increased use of drugs that can damage bones. Recent changes made to the definition of childhood osteoporosis, along with the lack of guidelines or national consensuses regarding its diagnosis and treatment, have resulted in a wide variability in the approaches used to treat this disease. For these reasons, the Osteogenesis Imperfecta and Childhood Osteoporosis Working Group of the Spanish Society of Pediatric Rheumatology has sounded the need for developing guidelines to standardize clinical practice with regard to this pathology. Methods: An expert panel comprised of 6 pediatricians and 5 rheumatologists carried out a qualitative literature review and provided recommendations based on evidence, when that was available, or on their own experience. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A Delphi survey was conducted for those recommendations with an evidence level of IV or V. This survey was sent to all members of the SERPE. All recommendations that had a level of agreement higher or equal to 70% were included. Results: Fifty-one recommendations, categorized into eight sections, were obtained. Twenty-four of them presented an evidence level 4 or 5, and therefore a Delphi survey was conducted. This was submitted electronically and received a response rate of 40%. All recommendations submitted to the Delphi round obtained a level of agreement of 70% or higher and were therefore accepted. Conclusion: In summary, we present herein guidelines for the prevention, diagnosis and treatment of secondary childhood osteoporosis based on the available evidence and expert clinical experience. We believe it can serve as a useful tool that will contribute to the standardization of clinical practice for this pathology. Prophylactic measures, early diagnosis and a proper therapeutic approach are essential to improving bone health, not only in children and adolescents, but also in the adults they will become in the future

Prognostic significance of lymphangiogenesis in pharyngolaryngeal carcinoma patients

<p>Abstract</p> <p>Background</p> <p>Lymphatic vessel spread is considered a major route for head and neck squamous cell carcinoma metastasis. Formation of new lymphatic vessels could facilitate the process, raising the malignant potential of these tumours. Recent identification of lymphatic markers allows the study of the lymphangiogenesis phenomenon. We searched for molecular events involved in the lymphangiogenic process that could have prognostic value in laryngeal/pharyngeal carcinoma patients.</p> <p>Methods</p> <p>104 paraffin-embedded pharyngeal/laryngeal tumour samples were studied. Immunohistochemical analysis of podoplanin and double immunofluorescence analysis of Ki-67 and D2-40 were performed. Lymph vessel density (inside the tumour mass, at its periphery or considered as a whole) and the presence of tumour emboli inside lymphatics were recorded. The proliferative state of endothelial lymphatic cells was evaluated.</p> <p>Results</p> <p>Lymphatic vessels were detected inside the tumour mass (75%) and in the surrounding tissue (80%); some of them in a proliferative state. Tumour emboli were detected in a high proportion of the cases (45%). Lymphatic vessel density was higher in the pharyngeal cases (p = 0.0029), in greater size (p = 0.039), more advanced stage primary tumours (p = 0.006) and in carcinomas of patients with affected nodes (p = 0.019). The presence of tumour emboli and a high global vessel density were indicators of poor prognosis (recorded as death from tumour) in the laryngeal group (p = 0.015 and p = 0.027, respectively), but notably not in the pharyngeal one. Interestingly, high global vessel density showed a negative prognostic value among pathologically staged N0 laryngeal carcinomas (p = 0.03).</p> <p>Conclusions</p> <p>The lymphangiogenic process correlated with aggressive tumour features (pN category, tumour size, tumour stage), but might play different roles in tumours arising from different anatomic sites.</p> <p>Our results suggest that detection of tumour emboli and assessment of global vessel density using the D2-40 antibody, may be useful in the clinical practice, as predictors of reduced survival among pN0 laryngeal carcinoma patients.</p

Enfrentando los riesgos socionaturales

El objetivo del libro es comprender la magnitud de los Riesgos Socionaturales en México y Latinoamérica, para comprender el peligro que existe por algún tipo de desastre, ya sea inundaciones, sismos, remoción en masa, entre otros, además conocer qué medidas preventivas, correctivas y de contingencias existen para estar atentos ante alguna señal que la naturaleza esté enviando y así evitar alguna catástrofe. El libro se enfoca en los aspectos básicos de análisis de los peligros, escenarios de riesgo, vulnerabilidad y resiliencia, importantes para la gestión prospectiva o preventiva

Memoria del segundo simposium sobre historia, sociedad y cultura de México y América Latina

La presente obra reúne 20 ponencias de las 27 que se presentaron en el “Segundo simposium sobre historia, sociedad y cultura de México y América Latina”, realizado el 8 y 9 de noviembre de 2006, en el Centro de Investigación en Ciencias Sociales y Humanidades (CICSyH) de la Universidad Autónoma del Estado de México (UAEM), en Toluca, Estado de México

Risk factors and outcome of COVID-19 in patients with hematological malignancies

Background: Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defned. Patients and methods: This was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confrmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020. Results: We included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n=58) or allogeneic stem cell transplantation (allo-SCT) (n=65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1-93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p=0.02). Prognostic factors identifed for day 45 overall mortality (OM) by logistic regression multivariate analysis included age>70 years [odds ratio (OR) 2.1, 95% con‑ fdence interval (CI) 1.2-3.8, p=0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6-5.2, p20 mg/dL (OR 3.3, 95% CI 1.7-6.4, p<0.0001). In multivariate analysis of 216 patients with very severe COVID-19, treatment with azithromycin or low dose corticosteroids was associated with lower OM (OR 0.42, 95% CI 0.2-0.89 and OR 0.31, 95% CI 0.11-0.87, respectively, p=0.02) whereas the use of hidroxycloroquine did not show signifcant improvement in OM (OR 0.64, 95% CI 0.37-1.1, P=0.1). Conclusions: In most patients with hematological malignancies COVID-19 mortality was directly driven by older age, disease status, performance status, as well as by immune (neutropenia) parameters and level of infammation (high CRP). Use of azithromycin and low dose corticosteroids may be of value in very severe COVID-19