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Objetivos: Revisar el uso y eficacia de la termografía infrarroja como instrumento diagnóstico y de medida de las quemaduras. Metodología: Se realizan 2 búsquedas, una general y otra específica, utilizando estrategia de búsqueda mediante un lenguaje controlado con términos MESH. Para seleccionar los artículos se filtra por título, resumen y palabras clave, además de aplicarse los criterios de inclusión y exclusión. Resultados: Durante la búsqueda general, se encontraron 165 artículos en PubMed, de los cuales 7 han sido seleccionados y 6 han sido incluidos. Mientras que con la búsqueda específica se obtienen 28 artículos, de los cuales se seleccionan 7 que no aparecían en la búsqueda general y se incluyen finalmente 6 de ellos. Conclusiones: La termografía infrarroja es un instrumento con mucho potencial y que ha mostrado buenos resultados, pero en ocasiones mucha variabilidad e inconsistencia, por lo que es necesaria la estandarización de una serie de medidas que nos permitan contrarrestar las dificultades a las que se expone y minimizar los sesgos, hecho que podrá mejorar más los resultados. Además, es necesaria una mayor investigación aplicando las variables térmicas encontradas para identificar el grado de influencia e importancia que tienen y comparar las diferentes modalidades de termografía infrarroja, estática y dinámica., Objectives: To review the use and efficacy of infrared thermography as a diagnostic instrument and measurement of burns. Methodology: Two searches were carried out, one general and the other specific, using a controlled language search strategy with MESH terms. To select the articles we filtered them by title, abstract and key words, besides applying the inclusion and exclusion criteria. Results: During the general search, 165 articles were found in PubMed, of which 7 were selected and 6 were included. The specific search yielded 28 articles, of which 7 were selected that did not appear in the general search and 6 were finally included. Conclusions: Infrared thermography is an instrument with great potential that has shown good results but much variability and inconsistency at times, so it is necessary to standardize a series of measures that allow us to counteract the difficulties to which it is exposed and minimize biases, a fact that could further improve the results. In addition, further research is needed by applying the thermal variables found to identify the degree of influence and importance that they have and by comparing the different infrared thermography modalities, static and dynamic.

Introduction: Esophageal atresia (EA) has an estimated incidence of 1 in 3000-4500 live births, with a higher frequency in premature newborns. The etiology is multifactorial and genetic. Prenatal diagnosis is crucial, and postnatal confirmation is done clinically and through imaging studies. The treatment is surgical, with survival rates of 90%. It is associated with syndromes such as VACTERL or CHARGE. Materials and Methods: Descriptive, observational, cross-sectional, and retrospective study conducted on patients with EA admitted to a neonatal unit from January 2016 to January 2021. Descriptive statistical methods and the SPSS software were used for data analysis. Results: 40 records were analyzed. 95% had type III EA. 10% had VACTERL association. Post-surgical complications included pneumonia (57.5%) and tracheomalacia (30%). Mortality was 5%. Discussion: Results align with the literature regarding incidence, types of EA, and associations. Post-surgical complications are similar, with pneumonia being noteworthy. The importance of prenatal diagnosis is emphasized to enhance management and reduce morbidity and mortality. Prognostic classification is useful for risk stratification. Conclusion: This study contributes to understanding EA and emphasizes the need for multidisciplinary management to improve long-term outcomes., Introducción: la atresia esofágica (AE) tiene una incidencia estimada de 1 en 3000-4500 nacidos vivos, con mayor frecuencia en recién nacidos prematuros. La etiología es multifactorial y genética. El diagnóstico prenatal es crucial, y su confirmación postnatal se realiza clínicamente y mediante estudios de imagen. El tratamiento es quirúrgico, con tasas de supervivencia del 90%. Se asocia con síndromes como VACTERL o CHARGE. Materiales y Métodos: estudio descriptivo, observacional, transversal y retrospectivo, realizado en pacientes con AE admitidos en una unidad neonatal de enero de 2016 a enero de 2021. Se emplearon métodos de estadística descriptiva y el software SPSS para el análisis de los datos. Resultados: se analizaron 40 expedientes. El 95% presentó AE tipo III. El 10% tuvo asociación VACTERL. Las complicaciones postquirúrgicas incluyeron neumonía (57.5%) y traqueomalacia (30%). La mortalidad fue del 5%. Discusión: los resultados concuerdan con la literatura respecto a incidencia, tipos de AE y asociaciones. Las complicaciones postquirúrgicas son similares, destacando la neumonía. Se destaca la importancia del diagnóstico prenatal para mejorar la gestión y reducir la morbimortalidad. La clasificación pronóstica es útil para estratificar riesgos. Conclusión: este estudio contribuye a la comprensión de la AE y destaca la necesidad de una gestión multidisciplinaria para mejorar los resultados a largo plazo.

The most important challenges in assuming transformations of all kinds in the face of a global crisis is to change the bond we maintain with nature, and this involves, first of all, analyzing how we relate to humans. David Cronenberg, Julio Huayamave and David Jara share in common the performativity of their visual poetics that observe the body linked to a harmful bio-robotic notion; his allegories have an ecocritical character and are nihilistic with respect to supposed technological progress. These authors address the annulment of the human in the face of its transhuman competitor, as well as the deconfiguration of the community as an area where, at some point, we imagine redeeming ourselves and moving forward, Um dos desafios fundamentais para assumir transformações de todo tipo diante de uma crise global é mudar o vínculo que mantemos com a natureza, e isso envolve, antes de tudo, analisar como nos relacionamos com os humanos. David Cronenberg, Julio Huayamave e David Jara partilham em comum a performatividade das suas poéticas visuais que observam o corpo ligado a uma noção bio-robótica nociva; Suas alegorias têm caráter ecocrítico e são niilistas em relação ao suposto progresso tecnológico. Estes autores abordam a anulação do humano face ao seu concorrente transumano, bem como a desconfiguração da comunidade como espaço onde, em algum momento, imaginamos redimir-nos e avançar., Uno de los desafíos fundamentales para asumir las transformaciones de toda índole de cara a una crisis global es cambiar el vínculo que mantenemos con la naturaleza, y ello comporta, en primer lugar, analizar cómo nos relacionamos entre humanos. David Cronenberg, Julio Huayamave y David Jara comparten en común la performatividad de sus poéticas visuales que observan al cuerpo vinculado a una perjudicial noción bio-robótica; sus alegorías tienen un carácter ecocrítico y son nihilistas respecto al supuesto progreso tecnológico. Estos autores abordan la anulación de lo humano ante su contendiente transhumano, así como la desconfiguración de lo comunitario como ámbito donde, en algún momento, imaginamos redimirnos y avanzar.

Received: 16 November 2023; Accepted: 29 January 2024; Published: 08 April 2024; Issue Date: June 2024, Introduction: The PRESERFLO™ MicroShunt (PMS) has been proven to significantly lower intraocular pressure (IOP) in patients with glaucoma and has been available for use since 2019. With increasing published evidence and growing experience of glaucoma surgeons, the aim of this modified Delphi panel was to build on the findings of a previous Delphi panel conducted in 2021 and provide further guidance on the role of the PMS to treat patients with glaucoma in Europe. Methods: Thirteen European glaucoma surgeons experienced in the PMS procedure participated in a 3-round modified Delphi panel. A targeted literature review and expert steering committee guided Round 1 questionnaire development. Consensus was pre-defined at a threshold of ≥ 70% of panellists selecting 'strongly agree'/'agree' or 'strongly disagree'/'disagree' for 6-point Likert scale questions or ≥ 70% selecting the same option for multiple or single-choice questions. Questions not reaching consensus were restated/revised for the next round, following guidance from free-text responses/scoping questions. Results: In total, 28% (n = 9/32), 52% (n = 16/31) and 91% (n = 10/11) of statements reached consensus in Rounds 1, 2 and 3, respectively. There was agreement that the PMS may be used in patients with pigmentary, post-trauma or post-vitrectomy glaucoma and for patients with uveitic glaucoma without active inflammation. The PMS may be more suitable for patients with contact lenses than other subconjunctival filtering surgeries, without eliminating bleb-associated risks. Consensus was reached that combining PMS implantation and phacoemulsification may be as safe as standalone PMS surgery, but further efficacy data are required. Following a late rise in IOP ≥ 4 months post-surgery, topical aqueous suppressant drops or bleb revision may be suitable management options. Conclusions: This Delphi panel builds on the considerations explored in the 2021 Delphi panel and provides further detailed guidance for glaucoma s, Santen SA, Lister Institute, Alcon Research Institute, UK Research and Innovation, Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub, Pagado por el autor

Submitted: July 31, 2023 | Final revision submitted: February 1, 2024 | Accepted: February 5, 2024, Purpose: To evaluate visual and refractive outcomes, as well as patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens (IOL) with emmetropia as a target refraction. Setting: San Carlos Hospital, Madrid, Spain. Design: Prospective, monocentric, non-comparative study. Methods: Adults 21 years or older suitable for cataract surgery and with corneal astigmatism < 1.50D were bilaterally implanted with the RayOne EMV IOL and followed up for 3-months. Outcomes measures included refraction, monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance corrected intermediate visual acuity (DCIVA), and defocus curve, aberrometry, and satisfaction. Visual symptoms were assessed using the CatQuest-9SF questionnaire. Results: 50 eyes of 25 patients were included. At Month-3, the mean manifest spherical equivalent was -0.39 ± 0.28 D, with all eyes within 1.00 D. Binocularly, uncorrected, at distance, 68% of patients could read ≤ 0.0 logMAR and 95% ≤ 0.2 logMAR; at intermediate 59% of patients could read ≤0.1 and 100% ≤ 0.2 logMAR. Mean monocular CDVA was -0.03 ± 0.06 logMAR and mean monocular DCIVA was 0.28 ± 0.07 logMAR. Binocular defocus curve demonstrated a visual acuity ≤ 0.2 logMAR over a 2 D range from +1.00 D to -1.25 D. Satisfaction was good in 96% of patients. Conclusion: Bilateral implantation of an enhanced monofocal IOL with emmetropia as a target provided excellent binocular CDVA and good DCIVA, with a high level of satisfaction., Depto. de Optometría y Visión, Depto. de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, Fac. de Medicina, TRUE, pub, Pagado por el autor

Introducción: la osteomielitis es una infección ósea, que afecta con frecuencia a pacientes en edades pediátricas, con comportamiento variado en dependencia de la vía de llegada al hueso, tipo de germen y respuesta del huésped. Objetivo: describir el comportamiento de un grupo de pacientes pediátricos con osteomielitis. Método: se realizó estudio observacional descriptivo en 39 pacientes atendidos en el Hospital Pediátrico Provincial “Dr. Eduardo Agramonte Piña” de la ciudad de Camagüey, en el periodo comprendido desde el primero de enero de 2018 al 31 de diciembre del año 2022, y un total de 60 meses con diagnóstico de osteomielitis. Resultados: de los 39 pacientes investigados predominó el sexo masculino sobre el femenino (2,2:1). La edad promedio fue de 9 años. El promedio de estadía hospitalaria fue de 14,8 días. Las zonas más afectadas fueron las manos, el fémur y tibia distal. Predominó el tratamiento quirúrgico (2,2:1) con relación al conservador. La vía hematógena de llegada al hueso fue la más frecuente en el 86,4 % de los casos. El paso a la cronicidad fue la complicación más encontrada (el 33 %). El germen aislado con mayor frecuencia fue el Staphylococcus aureus (en el 85 % de los enfermos). Los antimicrobianos más indicados fueron la cefazolina, amikacina y fosfocina. Conclusiones: los resultados obtenidos en la investigación aportan elementos importantes desde el punto de vista epidemiológico en pacientes pediátricos que sufren de osteomielitis, lo que permite implementar estrategias de diagnósticas y terapéuticas en este grupo de pacientes.

We describe a case presenting a rare combination of parasitic, metastasizing anddisseminated peritoneal leiomyomatosis, challenging diagnosis and treatment. Thepatient initially presented with symptoms related to compression of pelvic structures,followed by the appearance of leiomyomas in the abdominal wall and finallyleiomyomas distributed throughout the peritoneum and eventually associated withascites. The differential diagnosis is broad and complex and includes metastasesof primary tumors, among others. Moreover, the lack of a standard of treatmentunderlines the complexity of these pathologies, advocating a comprehensive surgicalapproach and considering pharmacological treatment options if there is gestationaldesire., Se describe un caso que presenta una rara combinación de leiomiomatosisparasitaria, metastatizante y peritoneal diseminada, desafiando el diagnósticoy tratamiento. La paciente presentó síntomas relacionados con la compresión deestructuras pélvicas inicialmente, seguidos de la aparición de leiomiomas en la paredabdominal y finalmente de leiomiomas distribuidos por el peritoneo que terminaronasociando ascitis. El diagnóstico diferencial es amplio y complejo e incluye lasmetástasis de tumores primarios, entre otros. Además, la falta de un estándar detratamiento subraya la complejidad de estas patologías, abogando por un enfoquequirúrgico integral y considerando las opciones de tratamiento farmacológico siexiste deseo gestacional.

Distal radius fractures are the most common in adults. The criteria to define whether its management is surgical, or conservative are not entirely clear. Traditionally, the Lafontaine criteria have been established as the tool to segregate patients who require surgical management from those who can be managed conservatively. The current literature shows us that the only criteria that really predict the possible displacement of a Distal Radius fracture are the dorsal comminution, female gender, and age greater than 60 years. Intra-articular tracings may not predict instability, but they should be taken as definitive criteria for surgical management due to early associated osteoarthritis in patients who are not operated on. Even though age over 60 years is a criterion that predicts displacement, it should rather be considered as a factor against surgery, since the evidence shows that after 12 months, the functional results are the same in operated patients and those managed with immobilization., Las fracturas de radio distal son las más frecuentes en adultos. Los criterios para definir si su manejo es quirúrgico o conservador no están del todo claros. Tradicionalmente, se han establecido los criterios de Lafontaine como la herramienta para segregar los pacientes que ameritan manejo quirúrgico de los que pueden manejarse conservadores. La literatura actual demuestra que los únicos criterios que realmente predicen el posible desplazamiento de una fractura de radio distal son la conminución dorsal, el sexo femenino, y la edad mayor a 60 años. Los trazos intraarticulares pueden no predecir inestabilidad, pero deberían ser tomados como criterio definitivo para el manejo quirúrgico debido a la artrosis temprana asociada en los pacientes que no son intervenidos. A pesar de que la edad mayor a 60 años es un criterio que predice desplazamientos, debería ser considerado, más bien, como un factor en contra de la cirugía, ya que la evidencia demuestra que después de los 12 meses, los resultados funcionales son exactamente iguales en pacientes operados y los manejados con inmovilización.

INTRODUCTION: Opioids are the classic basis of intraoperative analgesia, but they have known undesirable effects: nausea, vomiting, sedation, ileus, respiratory depression, hyperalgesia, tolerance, chronic postoperative pain, addiction... Opioid-free anesthesia is based on using Ketamine. , Dexmedetomidine, Lidocaine and other adjuvant drugs such as NSAIDs, corticosteroids, magnesium, hypotensives, together with regional blocks managed with local anesthetics, to achieve multimodal anesthesia that replaces opioids as much as possible. METHOD: We present a case of a patient chronically addicted to opiates, who underwent a laparotomy for abdominoperineal amputation. Initially, a lumbar epidural catheter was placed through which bolus 0.25% levobupivacaine was administered during the intraoperative period. In addition, the patient was successfully managed with the protocol that we describe in the article, using a mixture of drugs as preemptive analgesia, before the surgical incision, in order to prevent CNS sensitization to pain; It consists of NSAIDs, Dexamethasone and magnesium sulfate. Subsequently, during anesthetic induction and maintenance, a mixture of Lidocaine, Dexmedetomidine and Ketamine is administered at low doses, together with the usual doses of Propofol and relaxation with Rocuronium. RESULT: OFA allowed adequate anesthetic management, with optimal hemodynamic stability and no notable side effects. CONCLUSION: OFA is a very adequate alternative in the anesthetic management of patients addicted to opioids, achieving excellent results. Extensive familiarization of the anesthesiologist with the pharmacology of the various formulas used is required, as well as their protocolization., INTRODUCCIÓN: Los opiáceos tienen efectos indeseables conocidos: náuseas, vómitos, sedación, íleo, depresión respiratoria, hiperalgesia, tolerancia, dolor crónico postoperatorio, adicción… La anestesia libre de opiáceos se basa en utilizar Ketamina, Dexmedetomidina, Lidocaína y otros fármacos coadyuvantes como AINES, corticoides, magnesio, hipotensores, junto con bloqueos regionales manejados con anestésicos locales, para conseguir una anestesia multimodal que sustituya en lo posible a los opiáceos. MÉTODO: Presentamos un caso de un paciente adicto crónico a opiáceos, que fue sometido a una laparotomía para amputación abdómino-perineal. Se colocó inicialmente un catéter epidural lumbar por el que se administró Levobupivacaína 0,25% en bolos, durante el período intraoperatorio. Además, el paciente fue manejado exitosamente con el protocolo que describimos en el artículo, utilizando una mezcla de fármacos como analgesia preemptiva, antes de la incisión quirúrgica, con objeto de prevenir la sensibilización al dolor del SNC; consta de AINES, Dexametasona y sulfato magnésico. Posteriormente se administró durante la inducción y mantenimiento anestésico, una mezcla de Lidocaína, Dexmedetomidina y Ketamina, a dosis bajas, junto con las dosis habituales de Propofol y relajación con Rocuronio, RESULTADO: La OFA permitió un adecuado manejo anestésico, con estabilidad hemodinámica óptima y ningún efecto secundario reseñable. CONCLUSIÓN: La OFA es una alternativa muy adecuada en el manejo anestésico de pacientes adictos a opiáceos, consiguiéndose excelentes resultados. Se requiere una amplia familiarización del anestesiólogo con la farmacología de las diversas fórmulas empleadas, así como su protocolización.

Introduction: Currently, anastomosis dehiscence represents one of the major complications in both elective colorectal surgery and urgent surgery. This is associated with high morbidity and mortality, increased hospital stay, and greater consumption of resources. The search for acute phase reactants as inducers for the arrest and anticipation of anastomotic dehiscence after surgery continues to be studied. Procalcitonin and C-Reactive Protein are the markers used in our center to monitor postoperative complications. The need for reoperation and anastomotic dehiscence are two closely linked concepts; every Colorectal Surgery unit should know and follow protocols to carry out a more effective, efficient and safe treatment. Methods: Observational and retrospective study nested in a cohort of 435 patients operated on for colorectal cancer at the Complejo Hospitalario Universitario de Ferrol (CHUF) between 2017-2020. Statistical analysis consisted of contrast tests and regression models. Results:The incidence of anastomotic dehiscence was 7.59%; PCT and PCR measurement on the second and fourth postoperative day showed an upward trend in cases that required reintervention, especially PCR seriation which, in terms of Odd ratio (OR), implies 3.30 times more probability of said event. Conclusions: The PCT and PCR serialization on the second and fourth postoperative days did not have a great impact on the time until surgery. However, the increasing values of both PCR and PCT suggest the need for additional tests., Introducción: Actualmente, la dehiscencia de anastomosis representa una de las grandes complicaciones tanto en la cirugía colorrectal programada como en la cirugía urgente. Esta se asocia a una gran morbimortalidad, aumento de la estancia hospitalaria y mayor consumo de recursos. Continúa en estudio la búsqueda de reactantes de fase aguda como inductores para la detención y la anticipación de la dehiscencia de anastomosis tras la cirugía. La Procalcitonina y la Proteína-C-Reactiva son los marcadores utilizados en nuestro centro para el seguimiento de complicaciones postoperatorias. La necesidad de reintervención y la dehiscencia de anastomosis son dos conceptos íntimamente ligados; toda unidad de Cirugía Colorrectal debería conocer y protocolizar para realizar un tratamiento más eficaz, eficiente y seguro. Métodos: Estudio observacional y retrospectivo anidado en una cohorte de 435 pacientes intervenidos por cáncer colorrectal del Complejo Hospitalario Universitario de Ferrol (CHUF) entre 2017-2020.El análisis estadístico consistió en test de contraste y modelos de regresión. Resultados: La incidencia de dehiscencia de anastomosis fue del 7,59%; la medición de PCT y PCR al segundo y al cuarto día postoperatorio mostró una tendencia al alza en los casos que necesitaron reintervención, sobre todo la seriación PCR que, en términos de Odd ratio (OR), implica 3,30 veces más probabilidad de dicho evento. Conclusiones: La seriación de PCT y PCR al segundo y cuarto día postoperatorio no presenta un gran impacto en el tiempo hasta la reintervención. No obstante, los valores en ascenso tanto de la PCR como de la PCT sugieren la necesidad de realización de pruebas complementarias.

Esophageal duplication cysts account for 0,5-2,5% of esophageal tumors and up to 20% of all duplication cysts. In turn, esophageal duplication cysts can be located at the cervical, thoracic, thoracoabdominal and intra-abdominal levels. The most frequent locations are thoracic and thoracoabdominal. However, the location of esophageal duplication cysts exclusively intra-abdominal is extremely rare. Due to its infrequency, we present the case of a patient with an exclusively intra-abdominal esophageal duplication cyst., Los quistes de duplicación esofágica suponen el 0,5-2,5% de las tumoraciones esofágicas y hasta el 20% de todos los quistes de duplicación. A su vez, los quistes de duplicación esofágica pueden localizarse a nivel cervical, torácico, toracoabdominal e intraabdominal, siendo las localizaciones más frecuentes la torácica y la toracoabdominal. Sin embargo, la localización de los quistes de duplicación esofágica a nivel intraabdominal exclusivamente es extremadamente rara. Debido a su infrecuencia, se presenta el caso de un paciente con un quiste de duplicación esofágica exclusivamente intraabdominal.

Aims: To study the role of lipocalin-2 (Lcn2) and the effect of Lcn2 blockade via anti-Lcn2 antibody in the development of abdominal aortic aneurysm (AAA). Methods and results: Expression mRNA and protein levels of Lcn2 and its human orthologue neutrophil gelatinase-associated lipocalin (NGAL) in aortic wall samples from experimental mouse and human AAA samples, respectively, were analysed by real-time PCR and immunohistochemistry. Experimental AAA was induced by aortic elastase perfusion in wild-type mice (WT) and Lcn2-deficient mice (Lcn2-/-). NGAL/Lcn2 mRNA and protein levels in human and murine AAA samples were increased compared with healthy aortas. Decreased AAA incidence and reduced aortic expansion were observed in Lcn2-/- mice or mice preoperative treated with a polyclonal anti-Lcn2 antibody compared with WT mice or mice treated with control IgG, respectively, at Day 14 after elastase perfusion. Moreover, immunohistochemical analysis of AAA tissues from Lcn2-/- or anti-Lcn2-treated mice showed diminished elastin damage, reduced microvessels and polymorphonuclear neutrophil (PMN) infiltration, and enhanced preservation of vascular smooth muscle cells compared with WT aortas. Fluorescent molecular tomography revealed decreased MMP activity in AAA of Lcn2-/- mice compared with WT controls. Therapeutic administration of anti-Lcn2 antibody to WT mice 3 days after elastase perfusion decreased aortic dilatation and PMN infiltration compared with WT mice treated with control IgG. Conclusion: Either Lcn2 deficiency or anti-Lcn2 antibody blockade limits AAA expansion in mice by decreasing PMN infiltration in the aorta. Lcn2 modulation may therefore be a viable new therapeutic option for the treatment of AAA., Depto. de Bioquímica y Biología Molecular, Fac. de Ciencias Químicas, TRUE, pub, Pagado por el autor

Depto. de Enfermería, Depto. de Medicina, Fac. de Enfermería, Fisioterapia y Podología, Fac. de Medicina, TRUE, pub

Background Nail disorders are frequent among the geriatric population and unfortunately, repeat avulsionprocedures often result in complications.Objective To utilize a phenol-based total matricectomy technique for permanent nail ablation and evaluate itseffectiveness.Methods We performed total nail ablation on 34 toenails of the hallux (30 patients) with a gauze–phenolapplication technique and evaluated the degree of pain reported by the patient 12 months postoperatively comparedwith the preoperative stage. Furthermore, we evaluated the patients’ satisfaction with the final cosmetic appearanceas well as their satisfaction with the overall procedure.Results All patients reported ‘too much’ or ‘severe’ pain prior to surgery and 94.11% reported ‘no pain’ 12 monthspost-surgery. A vast majority of the patients (82.35%) felt pleased with the cosmetic results and all patients reportedthat they were ‘very satisfied’ or ‘strongly satisfied’ with the procedure when interviewed at their 12 month follow-upexamination.Limitations There were a limited number of participants in this study across an extensive timeframe.Conclusion Phenol-based total nail ablation with specific gauze application is safe, inexpensive and has a highrate of patient satisfaction., Depto. de Enfermería, Depto. de Medicina, Fac. de Enfermería, Fisioterapia y Podología, Fac. de Medicina, TRUE, pub

En la inmensa mayoría de casos, las fracturas supracondíleas y supraintercondíleas de húmero distal deben ser tratadas quirúrgicamente mediante reducción abierta y fijación interna (RAFI) utilizando placas y tornillos y asociando normalmente osteotomía de olécranon. Para tratar de evitar la neuropatía cubital postoperatoria, la más frecuente de las complicaciones, se ha propuesto la trasposición anterior intraoperatoria del nervio como alternativa a la clásica descompresión in situ. El presente estudio tiene como objetivo comparar las técnicas de trasposición y descompresión respecto al riesgo asociado de neuropatía cubital, así como analizar diversas variables referentes al procedimiento quirúrgico y los resultados postoperatorios y comparar estos resultados con la literatura científica disponible actualmente., Grado en Medicina

Background: total hip and knee replacement surgeries are relatively safe, but their volume represents a high consumption of resources. Accelerated recovery or ERAS protocols attempt to improve outcomes by speeding recovery and decreasing complications. Material and methods: national multicenter prospective observational study, in which hospitals were invited to participate regardless of the existence of an ERAS protocol. During a single 2-month recruitment period in 2018, all adult patients undergoing total hip or knee arthroplasty were included, with a 30-day follow-up. The primary objectives were the association of adherence to ERAS protocols with postoperative complications; to determine the time until mobilization after surgery, and to identify the preoperative hemoglobin level associated with a lower incidence of complications. The secondary objectives were to determine the association between adherence to ERAS protocols and length of stay, readmissions, and mortality; to identify factors associated with early mobilization, and to determine the relationship between preoperative anemia and blood transfusion, readmissions, hospital stay and mortality. Results: 6146 patients were included (3580 women (58.2%); median age 71 [IQR 63 – 76] years). Of these, 680 (11.1%) presented postoperative complications. The entire cohort was divided into quartiles according to adherence to the individual ERAS elements regardless of the center where they had undergone surgery. Patients in the quartile with the highest adherence had a lower number of total postoperative complications (144 (10.6%) vs. 270 (13.0%); OR 0.80; 95% CI 0.64-0.99; P < 0.001 ), moderate or severe complications (59 (4.4%) vs 143 (6.9%); OR 0.62; 95% CI 0.45-0.84; P< 0.001) and a shorter hospital lenght of stay (4 [IQR 3-5] versus 5 [IQR 4-6] days; OR 0.97; 95% CI 0.96-0.99; P< 0.001) compared to the lowest adherence quartile. The median time to achieve mobilization after surgery was 24 hours [16-30]. 4, Antecedentes: Las cirugías de artroplastia de cadera y rodilla son relativamente seguras, pero su volumen supone un alto consumo de recursos. Los protocolos de recuperación acelerada o ERAS intentan mejorar los resultados acelerando la recuperación y disminuyendo las complicaciones. Material y métodos: estudio observacional prospectivo multicéntrico a nivel nacional, al que fueron invitados a participar hospitales independientemente de la existencia de un protocolo ERAS. Durante un periodo único de reclutamiento de 2 meses en 2018 se incluyeron todos los pacientes adultos intervenidos de artroplastia total de cadera o rodilla, con un seguimiento a 30 días. Los objetivos primarios fueron la asociación de la adherencia a los protocolos ERAS con las complicaciones postoperatorias; determinar el tiempo hasta la movilización tras la cirugía, e identificar el nivel de hemoglobina preoperatoria asociado con una menor incidencia de complicaciones. Los objetivos secundarios fueron determinar la asociación entre la adherencia a los protocolos ERAS y la estancia, los reingresos y la mortalidad; identificar los factores asociados con la movilización precoz, y determinar la relación entre la anemia preoperatorios y la transfusión sanguínea, los reingresos, la estancia hospitalaria y la mortalidad. Resultados: se incluyeron 6146 pacientes, (3580 mujeres (58,2%); mediana de edad 71 [RIQ 63 – 76] años). De estos, 680 (11,1%) presentaron complicaciones postoperatorias. Se dividió toda la cohorte en cuartiles según la adherencia a los elementos individuales ERAS independientemente del centro donde hubieran sido intervenidos. Los pacientes del cuartil con mayor adherencia tuvieron un menor número de complicaciones postoperatorias totales (144 (10,6%) frente a 270 (13,0%); OR 0.80; IC 95% 0,64-0,99; P< 0,001), moderadas o graves (59 (4,4%) frente a 143 (6,9%); OR 0,62; IC 95% 0,45-0,84; P< 0,001) y una menor estancia hospitalaria (4 [RIQ 3-5] frente a 5 [RIQ 4-6] días; OR 0,97; I, Escuela de Doctorado, Doctorado en Investigación en Ciencias de la Salud

El Glioblastoma es el tumor primario cerebral más frecuente y con el peor pronóstico. La mediana de supervivencia es de 12 a 18 meses tras el diagnóstico a pesar del tratamiento oncológico adyuvante. El objetivo de nuestro estudio es desarrollar modelos predictivos de supervivencia pretratamiento, mediante análisis de clasificación y regresión, utilizando las características radiómicas de la resonancia magnética (RM), en combinación con algoritmos de aprendizaje automático. Hemos utilizado una muestra multi-institucional formada por un total de 1124 pacientes y sus estudios de RM preoperatoria, divididos en dos cohortes, una de entrenamiento y otra de prueba. Tras la extracción de características radiómicas de diversas subregiones tumorales y modalidades de RM del grupo de entrenamiento, realizamos una selección de variables aplicando una regresión LASSO (least absolute shrinkage and selection operator - operador de selección y reducción absoluta mínima) penalizada, y empleamos el grupo de prueba para evaluar el rendimiento de los modelos. Los resultados han mostrado una precisión del 61% y un área bajo la curva (AUC) de 0.75 en el modelo de clasificación entrenado utilizando el algoritmo XGBoost (Aumento de Gradiente Extremo). En la regresión, el modelo obtuvo un Índice C de 0.63 y un Spearman Rho de 0.45, indicando una moderada capacidad para predecir la supervivencia en días. De acuerdo con nuestros resultados, nuestros modelos de predicción de supervivencia emplean características de imagen reproducibles y sus resultados son generalizables dentro de la amplia muestra de pacientes utilizada. Futuras investigaciones deberán ser encaminadas a mejorar el rendimiento del modelo, y conseguir así elaborar una herramienta pronóstica potencialmente aplicable en la práctica clínica., Grado en Medicina

Juvenile nasopharyngeal angiofibroma is a rare and highly vascularized benign neoplasm. It represents 0.05% to 0.5% of head and neck neoplasms. In more advanced stages, it presents intracranial involvement with facial deformity and ocular proptosis. Histopathologically, they are non-encapsulated and well-circumscribed polypoid masses formed by vascular and fibrous stromal tissue. Evaluation is based on diagnostic imaging, mainly with computed tomography (CT) or magnetic resonance imaging (MRI). The Le Fort I osteotomy approach has been used for the treatment of midface deformities. This procedure has the advantage of offering excellent exposure of difficult-to-access sites, it does not generate facial scars, and pre-surgical biopsy is not recommended. The prognosis is good. The objective of this article is to present the case of a patient diagnosed with juvenile nasofibroangioma, according to the Radkowski classification system, corresponding to III according to Chandler and II according to Fish. A Le Fort I approach is performed, the tumor is resected and osteosynthesis is performed with titanium plates and screws to restore the patient's dental occlusion. Go for periodic check-ups to verify the absence of mass in the nasal passages.

Juvenile nasopharyngeal angiofibroma is a rare and highly vascularized benign neoplasm. It represents 0.05% to 0.5% of head and neck neoplasms. In more advanced stages, it presents intracranial involvement with facial deformity and ocular proptosis. Histopathologically, they are non-encapsulated and well-circumscribed polypoid masses formed by vascular and fibrous stromal tissue. Evaluation is based on diagnostic imaging, mainly with computed tomography (CT) or magnetic resonance imaging (MRI). The Le Fort I osteotomy approach has been used for the treatment of midface deformities. This procedure has the advantage of offering excellent exposure of difficult-to-access sites, it does not generate facial scars, and pre-surgical biopsy is not recommended. The prognosis is good. The objective of this article is to present the case of a patient diagnosed with juvenile nasofibroangioma, according to the Radkowski classification system, corresponding to III according to Chandler and II according to Fish. A Le Fort I approach is performed, the tumor is resected and osteosynthesis is performed with titanium plates and screws to restore the patient's dental occlusion. Go for periodic check-ups to verify the absence of mass in the nasal passages.

Background: Acute cholecystitis is due to the formation of stones in the gallbladder causing acute abdomen, which requires timely diagnosis and treatment. Objective: To determine the degrees of severity of acute cholecystitis according to the 2018 Tokyo Guidelines in patients who were seen in the emergency department of the Vicente Corral Moscoso Hospital during the period January 2023 - June 2023. Methodology: A cross-sectional descriptive study was carried out, with the participation of 40 patients attended in the emergency department of the Vicente Corral Moscoso Hospital, from January 2023 to June 2023 with acute cholecystitis. Data were collected by a form developed by the authors and analyzed with Epidata 4.2 and Microsoft Excel 2019. Means, standard deviation, frequencies and percentages were determined. Results: The mean age was 42.55 years with ±16.28 standard deviation and the majority were women representing 77.5%. The main diagnosis was acute cholecystitis with 52.5% and 42.5% was associated with cholelithiasis. None of the patients presented systemic complications and 67.5% presented local signs of inflammation. The 72.5% evolved in less than 72 hours and 60% were mild cases. The 87.5% of the cases were treated before 72 hours and 95% with laparoscopic technique. Conclusions: acute cholecystitis is more common between 20-40 years of age, in women and in most cases, it is classified as mild, with an evolution time of less than 72 hours and mostly laparoscopic cholecystectomy is applied

Background: Acute cholecystitis is due to the formation of stones in the gallbladder causing acute abdomen, which requires timely diagnosis and treatment. Objective: To determine the degrees of severity of acute cholecystitis according to the 2018 Tokyo Guidelines in patients who were seen in the emergency department of the Vicente Corral Moscoso Hospital during the period January 2023 - June 2023. Methodology: A cross-sectional descriptive study was carried out, with the participation of 40 patients attended in the emergency department of the Vicente Corral Moscoso Hospital, from January 2023 to June 2023 with acute cholecystitis. Data were collected by a form developed by the authors and analyzed with Epidata 4.2 and Microsoft Excel 2019. Means, standard deviation, frequencies and percentages were determined. Results: The mean age was 42.55 years with ±16.28 standard deviation and the majority were women representing 77.5%. The main diagnosis was acute cholecystitis with 52.5% and 42.5% was associated with cholelithiasis. None of the patients presented systemic complications and 67.5% presented local signs of inflammation. The 72.5% evolved in less than 72 hours and 60% were mild cases. The 87.5% of the cases were treated before 72 hours and 95% with laparoscopic technique. Conclusions: acute cholecystitis is more common between 20-40 years of age, in women and in most cases, it is classified as mild, with an evolution time of less than 72 hours and mostly laparoscopic cholecystectomy is applied

Objective: To compare two surgical techniques, the Wendler glottoplasty (GP) and its modification, the vocal fold shortening, and retrodisplacement of the anterior commissure (VFSRAC) associated with laser assisted voice adjustment (LAVA) cordotomy, used to feminize the voice of transgender women by increasing the fundamental frequency (F0). Methods: A retrospective study of 22 trans-women (20-62 years-old) was carried out. 12 of them were treated with GP and 10 with the VFSRAC+LAVA technique. They were evaluated before surgery and 6 months after surgery and the postoperative speech therapy. Laryngostroboscopy examination, F0 measurements, Transgender Woman Voice Questionnaire (TWVQ) assessment and the perceptual assessment using a visual analog scale (PA-VAS) were obtained from all patients. Results: Laryngostroboscopic findings showed normal vocal folds before surgery and a shortening of the vocal folds, due to the anterior glottic synechia, after surgery. Significant increases of F0 were found in both groups but they were higher in the VFSRAC+LAVA group (47.75Hz in GP group vs 69.70Hz in VFSRAC+LAVA group). TWVQ scores showed a significant decrease in both groups although the difference was greater in the VFSRAC+LAVA group. Similarly, PA-VAS scores lowered significantly in both groups but VFSRAC+LAVA group presented the biggest decreases. Conclusion: Both surgical techniques produce the shortening of the vocal folds through an endoscopic approach and result in voices with higher vocal pitch. Of the two techniques presented, the VFSRAC+LAVA produces better results although when compared with previous studies it seems that the LAVA technique may not significantly contribute to the postoperative results. So, the VFSRAC technique followed by postoperative speech therapy could be recommended for trans-women who wish to feminize their voice., Depto. de Inmunología, Oftalmología y ORL, Fac. de Medicina, TRUE, inpress

Fundamento y objetivo La polineuropatía amiloidótica familiar (PAF) constituye el tipo más prevalente de amiloidosis sistémica hereditaria. Es una enfermedad autosómica dominante que se caracteriza por el depósito de una variante anómala de la transtiretina. Tiene una distribución mundial, con zonas endémicas localizadas en Portugal, Suecia y Japón. En España hay un foco endémico, localizado en Mallorca. El trasplante hepático es la única opción curativa para los pacientes con PAF. El objetivo de este estudio fue describir las características clínicas y demográficas de los pacientes trasplantados con diagnóstico de PAF. Material y método Se evaluaron 6 pacientes trasplantados por PAF entre abril de 1986 y diciembre de 2012. Resultados La edad media fue de 57,7+16 años, los pacientes de origen español eran mayores de 60 años. Todos los pacientes presentaban síntomas progresivos en forma de polineuropatía mixta. En 2 pacientes se realizó un doble trasplante hepatocardiaco secuencial, efectuándose en primer lugar el trasplante hepático. La supervivencia del paciente y del injerto fue del 80% a los uno, 3 y 5 años. Conclusiones El único tratamiento etiológico eficaz para la PAF es el trasplante hepático. Una detección temprana es la clave para el tratamiento y el control, evitándose el daño orgánico irreversible., Depto. de Cirugía, Fac. de Medicina, TRUE, pub

The aim of this study was to analyze whether endogenous male sex hormones influence the release of thromboxane A2(TXA2) and its role in the electrical field stimulation (EFS)-induced response, as well as the mechanism involved. For this purpose, endothelium-denuded mesenteric arteries from control and orchidectomized male Sprague-Dawley rats were used to measure TXA2 release; EFS-induced response, nitric oxide (NO), norepinephrine (NA), and prostaglandin (PG) I2 release were also measured in the presence of the TXA2 synthesis inhibitor furegrelate. Orchidectomy increased basal and EFS-induced TXA2 release. Furegrelate decreased the EFS-induced contraction in arteries from control rats, but did not modify it in arteries from orchidectomized rats. The EFS-induced neuronal NO release and vasodilator response were increased by furegrelate in arteries from control rats, but were not modified in arteries from orchidectomized rats. Furegrelate did not modify the EFS-induced NA release or vasoconstrictor response in arteries from either control or orchidectomized rats. The EFS-induced PGI2 release was not modified by furegrelate in arteries from control rats, but was increased in arteries from orchidectomized rats. The results of the present study show that endogenous male sex hormone deprivation i) increases non-endothelial TXA2 release and ii) regulates the effect of endogenous TXA2 on the EFS-induced response through different mechanisms that, at the least, involve the NO and PGI2 systems. In arteries from control rats, inhibition of TXA2 formation decreases the EFS-induced response by increasing neuronal NO release. In arteries from orchidectomized rats, the EFS-induced response is unaltered after the inhibition of TXA2 formation, by increasing PGI2 release., Fondo de Investigaciones Sanitarias, Fundación de Investigación Médica Mutua Madrileña, Depto. de Biología Celular, Fac. de Odontología, TRUE, pub

Hepatocyte transplantation would offer an attractive alternative to liver transplantation in the treatment of inborn errors of liver metabolism. However, a major problem in most transplantation studies to date has been the limited growth of transplanted cells in the recipient organ. We performed a strategy for selective proliferation of transplanted cells by interfering with the proliferative capacity of resident hepatocytes, using the pyrrolizidine alkaloid retrorsine and then transplanting liver cells in conjunction with repeated administration of triiodothyronine, an inducer of hepatocyte proliferation in rats. In the present study, foetal and adult syngeneic hepatocyte transplantation into spleen was performed in retrorsine-treated hyperbilirubinemic Gunn rats. In parallel, repeated injections of triiodothyronine were given to recipients. Rats were sacrificed at 1, 7, 30 and 90 days after transplantation and blood and bile samples were taken to assess the functionality of transplanted cells. The proliferative activity of transplanted hepatocytes was evaluated using proliferating cell nuclear antigen labelling index. In summary, both adult and foetal hepatocyte transplantation were effective in correcting a metabolic abnormality in Gunn rats for as long as 3 months. The RS/T3 model, as a measure to increase graft function, could represent an important advance to future clinical application of hepatocyte transplantation., Spanish Social Security Funds for Research, Depto. de Inmunología, Oftalmología y ORL, Fac. de Medicina, TRUE, pub

Complement component 3 (C3) presents both slow (C3S) and fast (C3F) variants, which can be locally produced and activated by immune system cells. We studied C3 recipient variants in 483 liver transplant patients by RT-PCR-HRM to determine their effect on graft outcome during the first year post-transplantation. Allograft survival was significantly decreased in C3FF recipients (C3SS 95% vs C3FS 91% vs C3FF 83%; P=.01) or C3F allele carriers (C3F absence 95% vs C3F presence 90%, P=.02). C3FF genotype or presence of C3F allele independently increased risk for allograft loss (OR: 2.38, P=.005 and OR: 2.66, P=.02, respectively). C3FF genotype was more frequent among patients whose first infection was of viral etiology (C3SS 13% vs C3FS 18% vs C3FF 32%; P=.04) and independently increased risk for post-transplant viral infections (OR: 3.60, P=.008). On the other hand, C3FF and C3F protected from rejection events (OR: 0.54, P=.03 and OR: 0.63, P=.047, respectively). Differences were not observed in hepatitis C virus recurrence or patient survival. In conclusion, we show that, independently from C3 variants produced by donor liver, C3F variant from recipient diminishes allograft survival, increases susceptibility to viral infections, and protects from rejection after transplantation. C3 genotyping of liver recipients may be useful to stratify risk., Depto. de Cirugía, Fac. de Medicina, TRUE, pub

Background: Liver abscess after orthotopic liver transplantation (OLT) is a rare, life-threatening complication. The aim of this study is to analyze the incidence, risk factors, clinical manifestations, treatment and outcomes of liver abscesses after OLT. Methods: We perform a retrospective review of the patients who developed one or more liver abscesses among a series of 984 patients who underwent OLT between January 2000 and December 2016. Results: Fourteen patients (1.5%) developed 18 episodes of liver abscesses, and the median time from OLT to the diagnosis of liver abscess was 39.7 months. Major predisposing factors were biliary strictures in 11 patients, hepatic artery thrombosis in 8, re-OLT in 3, choledochojejunostomy in 2, living donor OLT in 2, donor after cardiac death in 1, split liver in 1, and liver biopsy in 1. All patients were managed by intravenous antibiotics; percutaneous drainage was performed in 10 patients, while 2 patients underwent re-OLT. The mortality rate related to liver abscesses was 21.4%. The mean hospital stay was 30 ± 19 days, and during a mean follow-up of 93 ± 78 months, three other patients died. Conclusions: Liver abscesses must be managed with antibiotic therapy and percutaneous drainage, but when these conservative measures fail (persistent abscess and sepsis), a re-OLT must be performed in order to prevent the high mortality associated with this severe complication., Depto. de Cirugía, Fac. de Medicina, TRUE, pub

En los últimos años, el número de pacientes anticoagulados y antiagregados está aumentando significativamente. Al ser un tratamiento crónico, es de esperar que a lo largo de su vida necesiten un procedimiento quirúrgico o intervencionista que pueda requerir la interrupción del fármaco antitrombótico. La decisión de retirar o mantener dicho tratamiento estará determinada, por un lado, por el riesgo trombótico y, por otro, por el hemorrágico. De la interacción entre estos 2 factores dependerá la actitud ante la anticoagulación y la antiagregación. El objetivo de este documento de consenso, coordinado desde el Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología y certificado por un amplio número de sociedades científicas que participan en el proceso asistencial del paciente durante el periodo perioperatorio o periprocedimiento, consiste en proponer una serie de recomendaciones prácticas y sencillas con el fin de homogeneizar la práctica clínica diaria., Depto. de Cirugía, Fac. de Medicina, TRUE, pub

Methods We performed subtotal (90%) hepatectomies in 10 female MiniPigs using a simplified transection technique with a tourniquet. Blood tests, hepatic and systemic hemodynamics, and hepatic function and histology were assessed before (Bas), 15 min (t-15 min) and 24 h (t-24 h) after the operation. Some pigs underwent computed tomography (CT) scans for hepatic volumetry (n = 4) and intracranial pressure (ICP) monitoring (n = 3). Postoperative care was performed in an intensive care unit environment. Results All hepatectomies were successfully performed, and hepatic volumetry confirmed liver remnant volumes of 9.2% [6.2–11.2]. The hepatectomy resulted in characteristic hepatic hemodynamic alterations, including portal hyperperfusion, relative decrease of hepatic arterial blood flow, and increased portal pressure (PP) and portal-systemic pressure gradient. The model reproduced major diagnostic features including the development of cholestasis, coagulopathy, encephalopathy with increased ICP, ascites, and renal failure, hyperdynamic circulation, and hyperlactatemia. Two animals (20%) died before t-24 h. Histological liver damage was observed at t-15 min and at t-24 h. The degree of histological damage at t-24 h correlated with intraoperative PP (r = 0.689, p = 0.028), hepatic arterial blood flow (r = 0.655, p = 0.040), and hepatic arterial pulsatility index (r = 0.724, p = 0.066). All animals with intraoperative PP > 20 mmHg presented liver damage at t-24 h. Conclusion The present 90% hepatectomy porcine experimental model is a feasible and reproducible model for investigating the “Small-for-Flow” syndrome., Sociedad Española de Trasplante Hepático (SETH), Instituto de Salud Carlos III, Depto. de Farmacología y Toxicología, Fac. de Veterinaria, TRUE, pub

Purpose:The aim of this study was to assess the long-term outcomes of implanting intrastromal corneal ring segments (ICRSs) using a femtosecond laser for correcting astigmatism in patients who had previous deep anterior lamellar keratoplasty (DALK) throughout a 5-year follow-up period.Methods:This retrospective study included 40 eyes of 40 patients with previous DALK and astigmatism ≥3.00 D who underwent Ferrara-type ICRS implantation. The manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity (logMAR), and corneal topography were recorded preoperatively and at 6, 12, 36, and 60 months postoperatively.Results:The mean UDVA (logMAR scale) improved from 1.39 ± 0.55 preoperatively to 0.71 ± 0.37 at 6 months postoperatively (P < 0.0001). The mean CDVA (logMAR) significantly improved from 0.36 ± 0.17 to 0.22 ± 0.12 at 6 months after surgery (P < 0.0001). Both UDVA and CDVA remained unchanged throughout the follow-up (P = 0.09). Postoperatively, no eyes lost lines of CDVA compared to preoperatively, and around 80% of the eyes gained lines of CDVA. The safety index remained stable at a value of 1.4 throughout the follow-up. The refractive cylinder decreased from -6.86 ± 2.62 D preoperatively to -2.33 ± 1.09D at 6 months postoperatively (P < 0.0001), and subsequently, it was stable over the postoperative period (P = 0.2). The maximum and minimum keratometry measurements significantly decreased after surgery and remained stable over the postoperative follow-up period (P > 0.07).Conclusions:This study shows the long-term viability of Ferrara-type ICRS implantation using a femtosecond laser as a surgical alternative for astigmatism correction in post-DALK eyes., Depto. de Optometría y Visión, Fac. de Óptica y Optometría, TRUE, pub

Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplant (KT) with short-term outcomes similar to those obtained from donation after brain death (DBD) donors. However, heterogeneous results in the long term have been reported. We compared 10-year outcomes between 237 KT recipients from uDCD donors maintained by normothermic extracorporeal membrane oxygenation (nECMO) and 237 patients undergoing KT from standard criteria DBD donors during the same period at our institution. We further analyzed risk factors for death-censored graft survival in the uDCD group. Delayed graft function (DGF) was more common in the uDCD group (73.4% vs 46.4%; P < .01), although glomerular filtration rates at the end of follow-up were similar in the 2 groups. uDCD and DBD groups had similar rates for 10-year death-censored graft (82.1% vs 80.4%; P = .623) and recipient survival (86.2% vs 87.6%; P = .454). Donor age >50 years was associated with graft loss in the uDCD group (hazard ratio: 1.91; P = .058), whereas the occurrence of DGF showed no significant effect. uDCD KT under nECMO support resulted in similar graft function and long-term outcomes compared with KT from standard criteria DBD donors. Increased donor age could negatively affect graft survival after uDCD donation., Depto. de Cirugía, Fac. de Medicina, TRUE, pub

Background: One method for increasing the donor pool for orthotopic liver transplantations (OLTs) is to use uncontrolled donation after circulation death (uDCDs). Methods: From January 2006 to December 2016, we performed 75 OLTs using uDCD livers. The control group comprised a sample of 265 OLTs using livers of donations after brain death (DBDs). A comparative study was performed. Results: Of 256 potential uDCD donors cannulated, 75 (29.3%) livers were accepted for OLT. The amount of hemoderivatives transfused was significantly higher in the uDCD group. The rate of primary nonfunction was also significantly higher (P = 0.031) in uDCD recipients (8%) than DBD recipients (1.5%). The overall rate of biliary complications was significantly higher (P = 0.001) in uDCD recipients (23 cases, 30.6%) than DBD recipients (28 cases, 10.6%). In the uDCD group, 1-, 3-, and 5-year patient survival rates were 82.7%, 73%, and 71.5%, respectively; in the DBD group, they were 89%, 83.7%, and 78.8%, respectively (P = 0.180). In the uDCD group, 1-, 3-, and 5-year graft survival rates were 73.3%, 65.1%, and 63.6%, respectively; in the DBD group, they were 87.1%, 81.9%, and 76.5%, respectively (P = 0.013). Multivariate analysis showed that independent risk factors for patient and graft survival were intraoperative transfusion of >6 units of packed red blood cell concentrates and recipients who were older than 60 years. Conclusions: Although graft survival is significantly lower using uDCD livers, 5-year patient survival in recipients of DBD and uDCD livers is similar. After careful selection, the livers of uDCD can be selectively used for OLT., Depto. de Cirugía, Fac. de Medicina, TRUE, pub

Purpose: This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma. Methods: We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6-15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate. Results: Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months (P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg (P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg (P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population (P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week. Conclusion: The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable, Depto. de Inmunología, Oftalmología y ORL, Fac. de Medicina, Fac. de Óptica y Optometría, TRUE, inpress

Background: Since the description of the arthroscopic Latarjet technique, discussion about the superiority of the open or arthroscopic procedure has arisen. The appropriate placement of the coracoid graft (CG) on the anterior glenoid neck is reported to be the most important step of the Latarjet procedure. Purpose: To verify if there are differences in the parameters that may affect the final position and fixation of CG obtained from the open and arthroscopic Latarjet techniques. Study Design: Controlled laboratory study. Methods: Twenty fresh-frozen human paired cadaveric shoulder specimens were randomly distributed in 2 surgery groups (open group [OG] and arthroscopic group [AG]) with 10 specimens in each. Two surgeons, each with experience performing open and arthroscopic Latarjet techniques, executed these procedures: one surgeon performed all open techniques, and the other performed all arthroscopic techniques, respectively. After surgery, a computerized tomography scan was performed. The surgical time, the position of each CG, a series of variables that might affect the CG fixation, and the level of the subscapularis muscle split were evaluated. Results: The mean surgical time was significantly longer in the AG (mean, 26 minutes for OG and 57 minutes for AG). Three intraoperative complications (30%) were identified in the AG, consisting of graft fractures. The CG was determined to be in an optimal cranial-caudal position in 90% of specimens of the OG and 44% of the AG (Fisher, P = .057). In both groups, the CG was placed in an optimal medial-lateral position in all specimens. In the OG, the degree of parallelism between the major axes of the glenoid surface and CG was significantly greater than in the AG (mean, 3.88 for OG and 15.18 for AG). No significant differences were observed in superior and inferior screw orientation between the groups. In the longitudinal and transverse directions, significant differences were found in the centering of the superior scr, Arthrex Spain and Portugal under article 83 of the Organic Law of Universities from the Complutense University of Madrid, Depto. de Anatomía y Embriología, Fac. de Medicina, TRUE, pub

Background. Portal vein embolization is performed weeks before extended hepatic resections to increase the future liver remnant and prevent posthepatectomy liver failure. Portal vein embolization performed closer to the operation also could be protective, but worsening of portal hyper-perfusion is a major concern. We determined the hepatic hemodynamic effects of a portal vein embolization performed 24 hours prior to hepatic operation. Methods. An extended (90%) hepatectomy was performed in swine undergoing (portal vein embolization) or not undergoing (control) a portal vein embolization 24 hours earlier (n = 10/group). Blood tests, hepatic and systemic hemodynamics, hepatic function (plasma disappearance rate of indocyanine green), liver histology, and volumetry (computed tomographic scanning) were assessed before and after the hepatectomy. Hepatocyte proliferating cell nuclear antigen expression and hepatic gene expression also were evaluated. Results. Swine in the control and portal vein embolization groups maintained stable systemic hemodynamics and developed similar increases of portal blood flow (302 ± 72% vs 486 ± 92%, P = .13). Portal pressure drastically increased in Controls (from 9.4 ± 1.3 mm Hg to 20.9 ± 1.4 mm Hg, P < .001), while being markedly attenuated in the portal vein embolization group (from 11.4 ± 1.5 mm Hg to 16.1 ± 1.3 mm Hg, P = .061). The procedure also improved the preservation of the hepatic artery blood flow, liver function, and periportal edema. These effects occurred in the absence of hepatocyte proliferation or hepatic growth and were associated with the induction of the vasoprotective gene Klf2. Conclusion. Portal vein embolization preconditioning represents a potential hepato-protective strategy for extended hepatic resections. Further preclinical studies should assess its medium-term effects, including survival. Our study also supports the relevance of hepatic hemodynamics as the main pathogenetic factor of post-hepatectomy liver fa, Mineco, ISCIII-Fondos FEDER, Sociedad Española de Trasplante Hepático, Depto. de Farmacología y Toxicología, Fac. de Veterinaria, TRUE, pub

Este artículo se ocupa de las representaciones de disecciones anatómicas en libros medievales, habiendo seleccionado para ello una serie de obras especialmente relevantes. Los ejemplos conocidos se adscriben mayoritariamente a la Baja Edad Media occidental y están relacionados esencialmente con dos tipos de libros, los médico-quirúrgicos y los inspirados en la Antigüedad romana. La escasez de ejemplos anteriores a estas fechas se debe a que la disección como práctica médica cayó en desuso entre los siglos II y XIII tanto en la Europa latina como en el Mediterráneo árabe. El silencio artístico fue, por tanto, paralelo al silencio documental. Por otra parte, las disecciones localizadas en manuscritos medievales han quedado eclipsadas en la historiografía del arte por los ejemplos adscritos a la Edad Moderna, localizados estos segundos en libros impresos y estampas. No obstante, los medievales constituyen un precedente esencial de los modernos sin los cuales no es posible comprender un fenómeno científico y sociológico absolutamente revolucionario, y por ello merecen una revisión y puesta en valor., Depto. de Historia del Arte, Fac. de Geografía e Historia, TRUE, pub

The main objective is to reduce the cancellations of scheduled surgeries ina Health-Sevices-Provider Institution (aka IPS because its spanish language acronym)through the Lean Six Sigma DMAIC methodology. The proposed approach is based onthe DMAIC methodology: define, measure, analyze, improve and control. In the firststage of this methodology; define, data from the months July to December 2019 wasanalyzed, the number of scheduled surgeries was found, how many were performed andhow many were cancelled, considering all the medical specialties. In the second stage;measure, the surgical variables were studied and a process diagram was established forthe scheduling of surgeries. In the third stage, analyze, the obtained data was analyzedand the possible cause-effect relationships of surgery cancellations were established through the use of statistical tools. In the fourth stage; improve, a list of improvementsor strategies facing the opportunities for improvement is generated and in the fift hand last stage; control, the necessary controls were established to ensure that the implemented system remains more relevant over time in order to decrease the number of surgical cancellations. With the improvements implemented, it is possible to identify theservice problems and what causes delays in the scheduling of surgeries or their cancellation., El objetivo principal fue reducir las cancelaciones de cirugías programadas en una IPS a través de la metodología DMAIC de Lean Seix Sigma, la cual se basa en definir, medir, analizar, mejorar y controlar. En la primera etapa, definir, se analizaron los datos del periodo de julio-diciembre de 2019 y se definió el número de cirugías programadas, cuántas fueron realizadas y cuántas canceladas teniendo en cuenta todas las especialidades. En la segunda etapa, medir, se estudiaron las variables de cirugías y se estableció un diagrama de proceso para la programación de cirugías. Para la tercera etapa, analizar, dichos datos fueron analizados y se establecieron las posibles relaciones causa-efecto de cancelaciones de cirugía mediante el uso de herramientas estadísticas. En la cuarta etapa, mejorar, se genera una lista de mejoras o estrategias que ataquen las oportunidades de mejora, por último, en la quinta, controlar, se establecieron los controles necesarios para asegurar que el sistema implantado se mantenga en el tiempo más pertinente para la disminución de cancelaciones de cirugías. Con las mejoras implementadas, se lograron identificar los problemas presentes en el servicio y qué ocasionaba retraso en el programa o cancelaciones de cirugías.

Citrobacter spp. has scarcely been described as an etiological agent of abscesses in the psoas muscle. Because of its infrequency, the case report of a patient with an abscess in the psoas muscle due to Citrobacter Braaki is presented., Citrobacter spp. ha sido escasamente descrito como agente etiológico de los abscesos en el músculo psoas. Debido a su infrecuencia, se presenta el caso de una paciente con un absceso en el músculo psoas por Citrobacter Braaki.

Finally, doctors Lina Restrepo-Giraldo, Laura Tapia-Vela, and doctor Humberto Zapata-Lopera, present five clinical cases of patients from the Laboratory Hematological Clinic of the city of Medellín, where it was possible to carry out a interdisciplinary diagnosis in less than two working days, which facilitated care of patients, optimizing diagnosis and treatment times., Finalmente, las doctoras Lina Restrepo-Giraldo, Laura Tapia-Vela, y el doctor Humberto Zapata-Lopera, presentan cinco casos clínicos de pacientes del Laboratorio Clínico Hematológico de la ciudad de Medellín, donde se consiguió realizar un diagnóstico interdisciplinario en menos de dos días hábiles, que facilitó la atención de los pacientes, optimizando los tiempos de diagnóstico y tratamiento.

Hernias that contain Caecal appendix are a rarity in routine medical practice. The femoral hernia containing the appendix was first described by René-Jacques Croissant de Garengeot in 1731. We present a clinical case of Garengeot’s hernia, an intraoperative finding of a hernial sac that contains this organ, that’s why we are presenting this case report of a 71-year-old male patient who enters surgery scheduled at the Clinica Misericordia Internacional of Barranquilla for an inguinal herniorrhaphy, an at the time of performing the procedure a Garengeot’s hernia was found., Las hernias contenedoras del apéndice cecal constituyen una rareza en la práctica médica habitual. La hernia femoral que contiene el apéndice fue descrita por primera vez por René-Jacques Croissant De Garengeot en 1731. Presentamos un caso clínico de una hernia de Garengeot, un hallazgo intraoperatorio de un saco herniario que contiene este órgano motivo por el cual se realiza el reporte del caso de un paciente masculino de 71 años quien ingresa a cirugía programado en la Clínica Misericordia Internacional de Barranquilla para herniorrafía inguinal derecha, al momento de realizar el procedimiento se encontró una hernia de Garengeot.

Skin cancer is the most common tumor, with basal cell carcinoma being the most common. It is a slow-growing tumor that occurs mainly in photoexposed skin, with a low percentage of metastasis. But, if it is not treated in time, it can be destructive and even disfigure the anatomy if treatment is delayed.1 The worldwide incidence for the year 2000 was 93.1 and 77.4 per 100,000 men and women respectively.2 According to the latest statistics, the incidence The CBC in the European population ranges between 77 and 158 per 100,000 inhabitants per year, while in the United States, a figure that ranges between 226 and 362 per 100,000 inhabitants per year is considered.3 In Ecuador, according to the latest Statistics, the cumulative incidence of non-melanoma skin cancer is 16.56 per 100,000 inhabitants, of which basal cell carcinoma occupies first place with 11.82 per 100,000 inhabitants 4. Therefore, in addition to knowing the different therapeutic methods that exist For this type of tumor, it is important to determine the conditioning factors to choose the most appropriate one according to the type of patient and their risk of recurrence based on the chosen treatment., El cáncer de piel es el tumor más común, siendo el carcinoma basocelular el más frecuente. Es un tumor de crecimiento lento que se produce principalmente en la piel fotoexpuesta, con un porcentaje bajo de metástasis. Pero, si no es tratado a tiempo puede llegar ser destructivo e incluso desfigurar la anatomía si el tratamiento se retrasa.1 La incidencia mundial para el año 2000 fue de 93.1 y 77.4 por 100000 hombres y mujeres respectivamente.2 Según las últimas estadísticas la incidencia del CBC en la población europea oscila entre 77 y 158 por 100 000 habitantes por año, mientras en que en Estados Unidos, se considera una cifra que va entre los 226 a 362 por cada 100.000 habitantes por año.3 En Ecuador, según las últimas estadísticas, la incidencia acumulada de cáncer de piel no melanoma es de 16.56 por cada 100.000 habitantes, de los cuales, el carcinoma basocelular ocupa el primer puesto con 11.82 por 100.000 habitantes 4. Por lo tanto, además de conocer los diferentes métodos terapéuticos que existen para este tipo de tumor, es importante determinar los factores condicionantes para elegir el más apropiado de acuerdo con el tipo de paciente y su riesgo de recurrencia en base al tratamiento elegido.

Purpose: The aim of this study was to describe a case of spontaneous Descemet layer dissection without pneumodissection in femtosecond laser-assisted mushroom-type deep anterior lamellar keratoplasty. Methods: This study is a case report. Results: A 46-year-old woman diagnosed with reticular dystrophy underwent, in her left eye, mushroom configuration femtosecond laser-assisted DALK (F-DALK). After laser trephination and removal of the superficial stroma using manual dissection, a type 2 BB formation was observed intraoperatively in the AS-OCT without signs of an associated microperforation. A deeper stromal removal was accomplished by layer-by-layer manual dissection, while the BB persisted. After stromal dissection, the donor cornea was secured with 8 interrupted 10-0 nylon sutures. The next day AS-OCT showed a detachment of DM. After 1 week, a spontaneous resolution of the DM detachment was observed. Conclusions: This unknown F-DALK intraoperative complication has been detected through intraoperative AS-OCT images which may improve our understanding of F-DALK surgery and possible complications associated with femtolaser-assisted procedures., Depto. de Inmunología, Oftalmología y ORL, Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, Fac. de Medicina, TRUE, pub

Propósito de la revisión: ante la necesidad de realizar una facoemulsificación, una cirugía filtrante o la combinación de ambas, pueden plantearse dudas sobre la conveniencia de mantener determinados fármacos antiglaucomatosos. El objetivo del presente trabajo es unificar criterios que puedan orientar la práctica clínica diaria y que permitan desarrollar algoritmos de actuación en el preoperatorio y el postoperatorio de la cirugía filtrante o de catarata. Protocolos propuestos: en el preoperatorio de la cirugía de catarata, el uso de antiinflamatorios no esteroideos queda a criterio del cirujano, recomendándose el formato de monodosis. Se plantea la suspensión de las prostaglandinas unos días antes de la cirugía. Los fármacos sin conservantes favorecen la mejor recuperación de la superficie ocular (SO) tras la cirugía de catarata. Una vez eliminados todos los aspectos modificadores de la presión intraocular (PIO), se debe reevaluar la PIO basal, prefiriendo los fármacos hipotensores sin conservantes, en caso de necesitarlos. La utilización de hipotensores oculares y corticoides libres de conservantes en el preoperatorio de la cirugía de glaucoma reduce el riesgo de fracaso quirúrgico. Se recomienda interrumpir las prostaglandinas. En el postoperatorio de la cirugía de glaucoma los corticoides constituyen el tratamiento antiinflamatorio de elección, siendo preferibles aquellos libres de conservantes. Al reintroducir un tratamiento antiglaucomatoso, se deben evitar los conservantes para no potenciar la cicatrización. Conclusiones: el presente protocolo de consenso persigue la unificación de las pautas de actuación con el fin de disminuir la incidencia de acontecimientos adversos y maximizar el resultado quirúrgico., Review's aim: When a phacoemulsification, a filtration surgery or a combined surgery are necessary, questions about the convenience of continuing certain antiglaucomatous drugs could appear. The aim of this review article is to unify criteria that will guide daily clinical practice and including the developing algorithms of action in the preoperative and postoperative periods of filtration surgery and/or cataract surgery. Proposed protocols: In the preoperative period of cataract surgery, the use of non-steroidal anti-inflammatory drugs is at the discretion of the surgeon, with the monodose presentation being recommended. The suspension of prostaglandines a fewdays before the surgery should be considered. Preservative-free drugs ensure a better recovery of the ocular surface (OS) after cataract surgery. Once all modifying factors of the intraocular pressure (IOP) have been removed, baseline IOP should be evaluated again, choosing preservative-free antiglaucomatous drugs when needed. The use of preservative-free ocular antihypertensive drugs and steroids in the preoperative period of glaucoma surgery reduces the risk of surgical failure. The interruption of prostaglandines is recommended. In the postoperative period of glaucoma surgery, steroids are the anti-inflammatory treatment of choice, the preservative-free ones being preferred. When reintroducing antiglaucomatous treatment, preservatives should be avoided to prevent scarring. The appropriate perioperative management of patients with glaucoma is essential to obtain a correct control of IOP, improve the situation of the OS, prevent complications and improve the result of the filtration surgery and cataract surgery. Conclusions: this protocol aims to unify the different lines of action in order to decrease the incidence of adverse events and maximize the surgical outcome., Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

To assess the effectiveness and safety of the Preserflo Microshunt (PMS) implantation combined with cataract surgery in open-angle glaucoma (OAG) patients. Retrospective, open-label study conducted on insufficiently controlled OAG patients, who underwent a PMS implant procedure with mitomycin-C 0.2%, either alone or in combination with cataract surgery, and were followed for at least 12 months. Success was defined as an intraocular pressure (IOP) ≤ 18 mmHg and a reduction of at least 20% without (complete) or with (qualified) hypotensive medication. Fifty-eight eyes were included in the study, 35 eyes underwent PMS alone and 23 underwent PMS + Phaco. In the overall study sample, mean IOP was significantly lowered from 21.5 ± 3.3 mmHg at baseline to 14.6 ± 3.5 mmHg at month 12 (p < 0.0001). The IOP was significantly reduced in both groups; p < 0.0001 each, respectively. Ocular hypotensive medication was significantly reduced (p < 0.0001) in both groups. No significant differences were observed in IOP lowering or medication reduction between groups. At month 12, 62.1% eyes were considered as complete success and 82.8% eyes as qualified success. The most common adverse events were device close-to-endothelium, conjunctival fibrosis, and wound leakage. PMS, either alone or in combination with phacoemulsification, may be considered as a valuable option for treating OAG patients., Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

Presented in part as a poster at the European Glaucoma Society Meeting in Florence, 2018 and as an oral communication at the Spanish Glaucoma Society Congress in Madrid, 2019., Purpose: To evaluate the efficacy and safety profile of Kahook Dual Blade ab interno trabeculectomy combined with phacoemulsification compared to stand-alone conventional cataract surgery. Methods: A single-center longitudinal, randomized controlled trial was conducted. Patients older than 18 years with coexisting cataract and open-angle glaucoma or ocular hypertension were invited to participate. Preoperative and postoperative clinical data were collected and analyzed preoperatively and at months 1, 3, 6, and 12 after the procedure. Main outcome measures included best corrected visual acuity, intraocular pressure, number of glaucoma medications, endothelial cell count, and standard automated perimetry. Results: Forty-two eyes from 33 patients were randomly allocated to the combined cataract and KDB (treatment, n = 21) or cataract alone (control, n = 21) groups. Intraocular pressure decreased from 17.9 ± 3.5 to 16.0 ± 2.2 mmHg and from 17.3 ± 2.5 to 15 ± 3.2 mmHg at the last visit in the treatment and control groups (p = 0.47). The use of glaucoma medications was reduced from a median (IQR) 1 (1–2) to 0 (0–0) in the treatment group and from 1 (1–2) to 0 (0–1) in the control group, with no significant differences between groups at the 12-month visit (p = 0.47). Best corrected visual acuity, endothelial cell count, and standard automated perimetry remained similar during follow-up in both groups. Conclusions: In patients with well-controlled, mild-to-moderate glaucoma, adding ab interno trabeculectomy with KDB to phacoemulsification might not be more effective than phacoemulsification alone to reach mid-teens IOP values. Both procedures showed similar safety profiles., Depto. de Inmunología, Oftalmología y ORL, Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Medicina, Fac. de Óptica y Optometría, TRUE, pub

Background: Genioplasty as an isolated surgical technique is a highly demanded procedure in the maxillofacial surgery area. Advances in facial reconstructive surgery have been associated with less morbidity and more predictable results. In this paper, “conventional” genioplasty and genioplasty by means of virtual surgical planning (VSP), CAD-CAM cutting guides, and patient custom-made plates are compared. Methods: A descriptive observational study was designed and implemented, and 43 patients were treated, differentiating two groups according to the technique: 18 patients were treated by conventional surgery, and 25 patients were treated through virtual surgical planning (VSP), CAD-CAM cutting guides, STL models, and titanium patient-specific plates. Results: The operation time ranged from 35 to 107 min. The mean operative time in the conventional group was 60.06 + 3.74 min.; in the custom treatment group it was 42.24 + 1.29 min (p < 0.001). The difference between planned and obtained chin changes in cases of advancement or retrusion was not statistically significant (p = 0.125; p = 0.216). In cases of chin rotation due to asymmetry, guided and personalized surgery was superior to conventional surgery (p < 0.01). The mean hospital stay was equal in both groups. A decrease in surgical complications was observed in the group undergoing VSP and customized treatment. Conclusions: Multi-stage implementation of VSP with CAD-CAM cutting guides, STL models, and patient-specific plates increased the accuracy of the genioplasty surgery, particularly in cases of chin asymmetry, reducing operation time and potential complications., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub, Descuento UCM

Purpose. To evaluate the long-term efficacy and safety of the iStent inject device (Glaukos Corporation, Laguna Hills, CA) combined with phacoemulsification in patients with coexistent cataract and open-angle glaucoma or ocular hypertension (OHT). Methods. A prospective, uncontrolled, nonrandomized, interventional case series study was conducted in patients with both mild or moderate open-angle glaucoma or OHT and cataract. Patients underwent cataract surgery along with the implant of two iStent inject devices. Outcome measures were intraocular pressure (IOP), topical hypotensive medications required, and best-corrected visual acuity (BCVA). Results. 20 patients were enrolled. Mean follow-up was months. Mean baseline IOP was mmHg with medication and mmHg after washout. Mean end-follow-up IOP was mmHg, representing an IOP decrease of 36.92%, mmHg (), from baseline washout IOP. The mean number of medications was significantly reduced from to (). 45% of patients were medication-free by the end of follow-up. Mean BCVA improved significantly from to (). No complications of surgery were observed. Conclusion. The iStent inject device combined with cataract surgery served to significantly reduce both IOP and medication use in the long term in patients with coexistent open-angle glaucoma or ocular hypertension (OHT) and cataract., Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

This study is part of the research funded by: Sociedad Española de Neumología y Cirugía de Tórax (SEPAR), Research Aid 2022, Project number 1309; and Sociedad Madrileña de Neumología y Cirugía de Tórax (NEUMOMADRID), XXII Awards Edition, 2022, and by: Convenio V-PRICIT de la Comunidad de Madrid y la Universidad Complutense de Madrid (“Programa de Excelencia para el Profesorado Universitario” INV.AY.20.2021.1E126), and by: Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970)., (1) Background: To examine the clinical characteristics and hospital outcomes of hospitalization for lung transplantation in COPD patients in Spain from 2016 to 2020; and to assess if the COVID-19 pandemic has affected the number or the outcomes of lung transplantations in these patients. (2) Methods: We used the Spanish National Hospital Discharge Database to select subjects who had a code for COPD (ICD-10: J44) and had undergone a lung transplantation (ICD-10 codes OBYxxxx). (3) Results: During the study period, 704 lung transplants were performed among COPD patients (single 31.68%, bilateral 68.32%). The absolute number of transplants increased with raising rates of 8%, 14% and 19% annually from 2016 to 2019. However, a marked decrease of −18% was observed from 2019 to year 2020. Overall, 47.44% of the patients suffered at least one complication, being the most frequent lung transplant rejection (24.15%), followed by lung transplant infection (13.35%). The median length of hospital stay (LOHS) was 33 days and the in-hospital-mortality (IHM) was 9.94%. Variables associated with increased risk of mortality were a Comorbidity Charlson Index ≥ 1 (OR 1.82; 95%CI 1.08–3.05) and suffering any complication of the lung transplantation (OR 2.14; 95%CI 1.27–3.6). COPD patients in 2020 had a CCI ≥ 1 in a lower proportion than 2019 patients (29.37 vs. 38.51%; p = 0.015) and less frequently suffered any complications after the lung transplantation (41.26 vs. 54.6%; p = 0.013), no changes in the LOHS or the IHM were detected from 2019 to 2020. (4) Conclusions: Our study showed a constant increase in the number of lung transplantations from 2016 to 2019 in COPD patients, with a drop from 2019 to 2020, probably related to the COVID-19 pandemic. However, no changes in LOHS or IHM were detected over time., Sociedad Española de Neumología y Cirugía de Tórax (SEPAR), Sociedad Madrileña de Neumología y Cirugía de Tórax (NEUMOMADRID), Convenio V-PRICIT, Universidad Complutense de Madrid, Universidad Complutense de Madrid. Grupo de Investigación en Epidemiología de las Enfermedades Crónicas de Alta Prevalencia en España (970970), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

The objective of the present case is to describe a variation in the Preserflo Microshunt surgical technique, placing it in the posterior chamber to minimise the risk of endothelial cell loss in cases with a compromised endothelium. The patient was a 72-year-old pseudophakic woman, with granular dystrophy and a primary diagnosis of open-angle glaucoma presenting with a progressive visual field defect and an IOP of 26 mmHg with maximal medical therapy. The cornea had incipient stromal folds with an endothelial count of 700 cells/mm2. A Preserflo Microshunt was implanted in the posterior chamber to minimise the possibility of further damage to the corneal endothelium. Six months after surgery, the implant remains functional. The IOP is 9 mmHg without medications. As far as we know, this is the first Preserflo implanted in the posterior chamber described in the literature., El objetivo del presente caso es describir una variación en la técnica quirúrgica del Preserflo Microshunt colocándolo en la cámara posterior para minimizar el riesgo de pérdida de células endoteliales en casos con endotelio comprometido. Se trata de una mujer de 72 años pseudofáquica con una distrofia granular y diagnóstico primario de glaucoma de ángulo abierto que presentaba un defecto campimétrico que había progresado y una PIO de 26 mmHg con tratamiento médico máximo. La córnea presentaba pliegues estromales incipientes con un recuento endotelial de 700 células/mm2. Se implantó un Preserflo Microshunt en la cámara posterior para minimizar la posibilidad de daño adicional al endotelio corneal. Seis meses después de la cirugía el implante permanece funcionante, con una PIO de 9 mmHg sin medicamentos. Hasta donde sabemos, este es el primer Preserflo implantado en la cámara posterior descrito en la literatura., Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub

Background and objective: To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. Materials and methods: A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1 year. The comparators considered (trabeculectomy, deep non-penetrating sclerectomy, Ahmed valve, iStent inject, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (€ 2021) were obtained from the ESALUD database. Results: The inclusion of XEN®63 could generate savings of €2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (−€423,120; −0.7%), follow-up visits (−€777,407; −4.5%), additional procedures (−€1,048,145; −20.6%) and post-surgery complications (−€321,065; −14.2%). Conclusions: The incorporation of XEN63®in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS., Antecedentes y objetivo: Evaluar el impacto económico en España derivado de la introducción del implante XEN®63 como alternativa quirúrgica en el manejo del glaucoma primario de ángulo abierto (GPAA) con o sin cataratas en pacientes refractarios. Materiales y métodos: Se diseñó un análisis de impacto presupuestario para estimar los costes del tratamiento quirúrgico del GPAA desde la perspectiva del Sistema Nacional de Salud (SNS) español, en un horizonte temporal de 1 año. Los comparadores considerados (trabeculectomía, esclerectomía profunda no perforante, válvula de Ahmed, iStent inject®, Preserflo® microshunt y XEN®45) se corresponden a los empleados en la práctica clínica pública española. Para el cálculo de la población diana, cuotas de mercado y uso de recursos en términos de visitas de seguimiento, procedimientos adicionales y complicaciones post-cirugía, se emplearon datos de la literatura y se validaron con un panel de 4 expertos. Los costes unitarios (€ del 2021) se obtuvieron de la base de datos ESALUD. Resultados: La inclusión de XEN®63 podría generar un ahorro de 2.569.737€ tras un año desde su introducción, derivado del ahorro en el coste del implante y procedimiento (-423.120€; -0,7%), visitas de seguimiento (-777.407€; -4,5%), procedimientos adicionales (-1.048.145€; -20,6%) y complicaciones post-cirugía (-321.065€; -14,2%). Conclusiones: La incorporación de XEN®63 en el arsenal quirúrgico para el tratamiento del GPAA refractario con y sin cataratas podría generar ahorros para el SNS., Unidad Docente de Inmunología, Oftalmología y ORL, Fac. de Óptica y Optometría, TRUE, pub