El siguiente caso de estudio presenta una exenteración orbitaria por carcinoma escamoso, con reconstrucción del defecto luego de una resección amplia, que involucró la colaboración de los equipos de cirugía oncológica y reconstructiva. Para cubrir el defecto supraorbitario, se realizó la toma y aplicación del injerto cutáneo de la zona donadora (muslo derecho). Se fijó con organdí quirúrgico, que fue retirado cinco días luego de la cirugía, con una integración de 100% en el postquirúrgico y adecuada coloración, turgencia, temperatura y llenado capilar. El uso de colgajos locales e injertos cutáneos es técnicamente fácil de realizar, lo cual permitió a los autores de este caso ejecutar una reconstrucción inmediata sin requerir infraestructura especializada.
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There is limited understanding of aging experiences among transgender (trans) women in Latin America and the Caribbean. The purpose of this community-engaged, formative study was to explore lived experiences and perceptions of aging among trans women in Santo Domingo, Dominican Republic. From August to October 2024, we conducted in-depth interviews with trans women (n = 19) 45 years and older and analyzed data using narrative and thematic techniques. Tranquilidad, meaning peace or tranquility, was the central theme related to participants' experiences as older trans women and their hopes for aging. Key themes within tranquilidad included: (1) stability, (2) living freely, (3) family dynamics, and (4) peer and partner support. Salient threats to tranquilidad included economic precarity, social isolation, and the pervasive nature of intersectional stigma. Findings reflect that aging can be a joyful process and highlight the need for multi-level efforts to reduce stigma and improve quality of life for older trans women.
Mesenchymal stem/stromal cells (MSCs) hold promise for treating different equine conditions but enter senescence during culture. Using induced pluripotent stem cells (iPSCs) to derive MSC-like cells (iMSCs) can increase cell availability and diminish the need for invasive and repeated tissue harvesting. While human iMSCs are intensively studied, research on equine iMSCs (eqiMSCs) is very limited and has focused on strategies for spontaneous differentiation to obtain these cells. The aim of this study was to obtain MSC-like cells from equine iPSCs (eqiPSCs) by directing their differentiation via the neural crest pathway. The resulting eqiMSCs downregulated pluripotent gene expression compared to originating eqiPSCs, and the majority of lines met most of the standard criteria for tissue-derived MSCs (immunophenotype and tri-lineage differentiation potential). Nevertheless, eqiMSCs showed some differences from primary equine MSCs, possibly due to their different developmental origin, and displayed certain inter-line variability, which might be related to the different kinetics of independent eqiPSC lines. This study demonstrates for the first time that equine MSC-like cells (eqiMSCs) can be derived from eqiPSCs by directing their differentiation through the neural crest pathway. This constitutes an important advancement towards more sustainable sources of therapeutic cells in veterinary medicine and warrants further exploration of the functional characteristics of these novel cells.
Scalp follicular unit (FU) transplantation is a highly effective yet underutilised minimally invasive technique for promoting healing in chronic and recalcitrant cutaneous wounds. In this case series, five patients with long-standing nonhealing leg ulcers of mixed etiologies were treated exclusively with single FU grafts harvested from the scalp with a 0.9-1-mm punch. Complete re-epithelialization occurred in three cases by 6, 3 and 1 month, respectively, while the remaining two cases showed marked partial improvement at 6 months, with reduction in ulcer area and pain. Overall, all five patients experienced a favourable clinical outcome. Case reports suggest that the transplantation of a minimum of 4 FU grafts/cm2 is required to promote effective wound closure, with higher graft densities being associated with faster healing. However, the optimal graft density and placement, whether uniform distribution or targeting the wound edge to exploit an 'edge effect', require further investigation. Considered alongside prior reports, these results suggest that 1-mm single-FU grafting achieves wound healing comparable to, and often faster than, 2-3-mm punch grafts. Additionally, the technique is less invasive and causes less bleeding, overall supporting wider use as an adjunct in multidisciplinary wound care. Level of Evidence: IV.
Arthroscopic rotator cuff repair (ARCR) traditionally requires a 2-year follow-up to report results. However, most of the recovery occurs within the first year. The aim of this study was to determine if there are clinically significant changes in patient-reported outcome measures (PROMs) and clinically significant outcomes (CSOs) between the first and second postoperative years. Retrospective analysis of 140 patients. Four scales (ASES, VAS, PSQI, and SANE) were evaluated preoperatively and at 1 and 2 years postoperatively. Clinical relevance was measured using the minimal clinically important difference (MCID). Linear regression was used to identify factors associated with changes in outcomes. Improvements were observed in all scores; however, although statistically significant, these changes were minimal and lacked clinical relevance as they did not reach the minimal clinically important difference (MCID). Clinically significant outcome (CSO) rates remained stable, except for the SANE score. Factors such as diabetes, subscapularis tears, and tear size were associated with score changes during the second year. Although there are slight statistical improvements in function, pain, and sleep quality between the first and second years, these are not clinically significant. A one-year follow-up is sufficient to evaluate functional outcomes after ARCR in the majority of patients.
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To evaluate the hemodynamic effects of intravenous maropitant in dogs under general anaesthesia premedicated with dexmedetomidine or acepromazine. Prospective randomized clinical study. Twenty-six healthy Spanish Greyhounds. Dogs were randomly premedicated with dexmedetomidine (DEX; 4 μg/kg) or acepromazine (ACP; 20 μg/kg), both combined with methadone (0.3 mg/kg) administered intramuscularly. Anesthesia was induced with propofol and midazolam and maintained with sevoflurane. Once a stable anesthetic plane was achieved, maropitant (1 mg/kg IV) or saline was administered, resulting in four groups: DEX-M, ACP-M, DEX-C, and ACP-C. Invasive arterial blood pressure (systolic, diastolic, mean) and heart rate were recorded at baseline and for 20 min after administration. Changes over time were analyzed and compared with baseline values using the Friedman test (p < 0.05). In the DEX-M group, diastolic arterial pressure decreased significantly at 2 min, accompanied by a transient increase in heart rate. In the ACP-M group, systolic, diastolic and mean arterial pressures decreased significantly at 2 min, also with an increase in heart rate. Clinically relevant hypotension (mean arterial pressure 51 ± 7 mmHg) occurred only in ACP-M dogs. All changes were transient. Intravenous maropitant administration appears to be hemodynamically well tolerated in healthy dogs under general anesthesia premedicated with dexmedetomidine. In contrast, when acepromazine is used for premedication, maropitant administration results in more pronounced hemodynamic effects, including clinically relevant hypotension. These findings suggest that alternative routes of administration should be considered in the perioperative setting.
Super-refractory status epilepticus (SRSE) is a life-threatening neurological emergency associated with high morbidity and mortality. Although medical management remains the cornerstone of treatment, selected patients may benefit from surgical or neuromodulatory interventions. The role of surgery in SRSE remains incompletely defined, and the available evidence is largely limited to case reports, case series, and recent systematic reviews. We conducted a structured narrative review of the literature using PubMed, ScienceDirect, SciELO, and Google Scholar. Articles published in English or Spanish after 2000 addressing surgical or neuromodulatory treatment strategies for SRSE were included. Evidence related to refractory status epilepticus (RSE) was considered when relevant to timing of intervention, patient selection, or progression toward SRSE. Both resective/disconnective procedures and neuromodulation techniques (VNS, RNS, DBS) were evaluated. Methodological quality was assessed using the CARE checklist for case reports and AMSTAR-2 for systematic reviews. Thirty-three studies were included, comprising case reports and systematic reviews involving both adult and pediatric populations. Resective and disconnective procedures appeared to provide the most rapid and consistent SRSE termination in patients with well-defined epileptogenic lesions and were frequently associated with rapid termination of SRSE. Neuromodulation techniques demonstrated more variable and delayed responses but provided meaningful clinical benefit in selected patients with diffuse or poorly localized epileptogenic networks. Vagus nerve stimulation was the most frequently reported neuromodulation strategy, while responsive neurostimulation and deep brain stimulation showed promising results in focal and network-related epilepsies. Across studies, favorable long-term seizure outcomes were reported in a substantial proportion of surviving patients, although interpretation is limited by study heterogeneity, publication bias, and inconsistent outcome reporting. The current evidence, although limited by the low overall quality of the available studies and heterogeneity of the populations, suggests that surgical intervention may represent a valuable therapeutic option in carefully selected patients with SRSE, particularly when a focal epileptogenic lesion can be identified. Neuromodulation may serve as a rescue or palliative strategy in diffuse or non-resectable cases. Early multidisciplinary evaluation in specialized epilepsy surgery centers may be critical for optimizing outcomes. Surgical and neuromodulatory interventions may play an important role in selected patients with SRSE refractory to medical therapy. However, the available evidence remains limited and heterogeneous. Further multicenter prospective studies are needed to better define patient selection, timing of intervention, and long-term outcomes.
Hip fractures in the elderly constitute a severe public health problem. Its primary cause is a fall due to sarcopenia, sensory impairments, polypharmacy, or architectural barriers, among other factors. Prevention is based on correcting these factors, engaging in regular physical exercise, and maintaining adequate nutrition throughout life to acquire efficient muscle mass that declines as little as possible during old age and achieve peak bone mass, although bone mass will gradually decrease with age. This paper, in two parts (I. Basic Science and II. Interventions), analyzes prevention, with particular attention to sarcopenia, bone fragility, and socioeconomic status.
Point-of-care ultrasound is essential in the initial assessment of polytrauma patients. The E-FAST protocol enables rapid detection of intra-abdominal free fluid, pericardial effusion, and pneumothorax, with particular usefulness in prehospital settings. However, ultrasound training among emergency nursing staff remains limited, especially within Advanced Life Support (ALS) mobile units. To evaluate the effect of a brief, structured training program on the acquisition of competencies for obtaining E-FAST windows in ALS mobile units nurses, assessing knowledge, technical skills, scanning sequence, and perceived confidence. A quasi-experimental pre-post intervention study was conducted with nurses with ≥6 months of experience in emergency or prehospital care. The intervention included baseline assessment, a 2-h theoretical module, high-fidelity simulation with Ultrasound Mentor®, and hands-on practice with human models. Final assessment combined a theoretical test, simulator-based practical evaluation, and scanning with a real ultrasound device. Knowledge, execution times, and confidence levels were recorded. Fourteen nurses participated, most without previous ultrasound training (85.7%). Initial confidence was low and improved significantly after the intervention. Theoretical performance increased in 5 of the 6 evaluated items, reaching up to 92.9% accuracy in key content areas. Practical assessment demonstrated an organized scanning sequence and appropriate times for prehospital care (medians of 118 s [IQR 24.5] in advanced simulation and 237 s [IQR 33.3] using a real ultrasound device). The program enabled the acquisition of essential skills even in professionals without prior ultrasound experience. The combination of theory, simulation, and hands-on practice facilitated rapid competency transfer and protocol standardization. A brief training program improves ALS mobile units nurses' competence and confidence in obtaining E-FAST windows, supporting the safe integration of point-of-care ultrasound into prehospital care.
Minimally invasive esophagectomy (MIE) has been shown to reduce postoperative morbidity. In our previously published initial experience, overall morbidity was 78%, severe morbidity 21%, and mortality 0%. To describe the postoperative morbidity and mortality using our video assisted thoracoscopic surgery (VATS) MIE technique. This was a retrospective cohort study based on a prospective database. Patients who had a VATS EMI in the semi-prone position for esophageal cancer between 2013 and 2023 were included. We used the definitions proposed by the Esophagectomy Complications Consensus Group (ECCG). During the study period 66 VATS MIE (61% men, age 64 years) were performed. 82% of patients had comorbidities. Histology was squamous cell carcinoma in 34 patients (52%) and adenocarcinoma in 31 (45%). 65% of cases had neoadjuvant treatment. MIE was performed using the McKeown technique in 55 patients (83%). Overall postoperative morbidity was 68%, and severe morbidity (Clavien 3 or higher) was 16%. The main complications were respiratory in 24% and esophageal anastomotic leak in 38% of cases. The 30- and 90-day mortality rates were 1.5% and 3%. The median hospital stay was 20 days. Surgery was considered R0 in 57 (86%) patients. The average lymph node count was 27 nodes. In 10 years of experience, a standardized minimally invasive esophagectomy technique has been performed in the semi-prone position. The main complications were respiratory and anastomotic leak. The rate of severe complications and postoperative mortality is low.
Type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) share common pathophysiological mechanisms and exert reciprocal influences on each other. Bariatric surgery (BS) is the most effective treatment for the improvement and resolution of both conditions; however, little is known about the role of MASLD in diabetes remission following BS. We evaluated the Hepamet fibrosis score (HFS), a noninvasive scoring system used to assess the risk of liver fibrosis, for this endpoint, hypothesizing that a preoperative HFS < .12 (low risk for advanced fibrosis) would be associated with a higher likelihood of diabetes remission, as earlier stages of liver disease may have a positive influence on glycemic outcomes. University hospital (two-center). In a retrospective observational analysis of a prospectively collected cohort of 145 adults with T2D undergoing BS, we evaluated the association between the preoperative HFS and diabetes remission at 1 year. Among participants with a HFS < .12, 53 out of 72 (73.6%) achieved diabetes remission, compared to 38 out of 73 (52.1%) with a HFS ≥ .12, indicating a 41% higher probability of diabetes remission in the HFS < .12 group (RR = 1.41 [95% confidence interval, 1.09-1.83]; P = .007), compared to HFS ≥ .12 group. In the multivariate logistic regression analysis, HFS <.12 was independently associated with diabetes remission, after adjusting for diabetes duration, number of glucose-lowering medications, suboptimal glycemic control (HbA1c ≥ 7%), type of surgery, waist circumference, and percentage of total weight loss. We report for the first time an association between the preoperative HFS and diabetes remission following BS, potentially complementing existing predictors with a simple, accessible, and inexpensive preoperative biomarker.
Acute severe ulcerative colitis (ASUC) is a potentially life-threatening medical emergency that requires hospitalization, close multidisciplinary monitoring, and prompt, protocolized decision-making. Despite therapeutic advances, ASUC remains associated with high morbidity and mortality, substantial healthcare resource utilization, and a significant risk of colectomy. This position statement from the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) provides updated, evidence-based recommendations for the diagnosis and management of ASUC in clinical practice. Its development involved a comprehensive review of the literature, including clinical trials, observational studies, and the most recent international guidelines. Diagnosis must be rapid and standardized, with particular emphasis on the systematic exclusion of infections, especially Clostridioides difficile and cytomegalovirus. Intravenous corticosteroids remain the first-line treatment, and response should be assessed at 72 hours using validated criteria. In steroid-refractory patients, infliximab and cyclosporine are equally effective rescue therapies, and the choice between them should be individualized according to patient characteristics and comorbidities. JAK inhibitors are emerging as a promising option in selected cases, although current evidence is still limited. Supportive measures, including optimization of nutritional status, thromboprophylaxis, and continuous close monitoring, constitute essential components of care. Early surgical assessment is also crucial in patients who fail to respond to medical therapy or who develop complications. Conclusions: The management of ASUC requires a structured, interdisciplinary approach delivered in specialized centers, integrating early diagnosis, optimization of medical therapy, and timely surgical decision-making. This consensus aims to harmonize clinical practice and contribute to improving outcomes in patients with ASUC.
To describe the epidemiology of injuries resulting from accidents related to the use of electric scooters in Malaga and to analyse their economic and occupational impact. Retrospective and descriptive study of accidents attended in the emergency department of the Hospital Regional Universitario de Malaga between January 2018 and December 2023. A total of 640 patients was included. The number of cases showed an upward trend, with a higher incidence especially during the summer (45.16%). Of these, 53.28% were men and 46.72% were women. The average age was 29.41 years. The most frequent injuries were contusions (72.34%), of a minor nature (77.97%) and treated with analgesia (73.75%). The predominant mechanism was the driver's fall, mostly associated with low helmet use. One fatality was recorded. The total estimated cost of the injuries was euro974,670.32 between 2018 and 2023, reaching euro460,760.29 in the last year. This figure includes both healthcare costs from the Andalusian Health Service and work incapacities covered by Social Security. The use of electric scooters has increased substantially, becoming a common mobility alternative. Nevertheless, it is not without risks, as evidenced by the rising number of accidents in recent years, which have notable implications on both associated morbidity and the resulting economic costs.
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To establish evidence-based consensus statements on imaging of scaphoid fractures. Nineteen hand surgeons formulated a preliminary list of eleven questions on imaging of scaphoid fractures. Based on this preliminary list, radiologists crafted statements considering literature and their clinical experience, then refined them through an iterative Delphi process to revise the questions and statements. A maximum of three Delphi rounds was scheduled until group consensus was achieved for an individual statement, whichever arose first. Twenty-eight radiologists drafted the statements and acted as Delphi panellists. Panellists rated their level of agreement with each statement on an 11-point numeric rating scale, the score '0' indicated complete disagreement and the score '10' indicated complete agreement, respectively. Group consensus was specified as a score of '8' or higher for ≥ 23/28 panellists. Eight of eleven questions and statements achieved group consensus in the first Delphi round. The remaining three questions and statements achieved group consensus in the second Delphi round, indicating more controversial topics. It was agreed that radiographs are the initial imaging technique of choice for suspected scaphoid fractures. MRI or CT are advocated for suspected radiographically occult scaphoid fractures. CT is the method of choice for assessment of osseous consolidation. Contrast-enhanced MRI is the preferred imaging modality for assessing vascularisation of scaphoid nonunion. CT is the most valuable technique in the postoperative evaluation of scaphoid fractures. Delphi-based consensus statements suggest imaging pathways to diagnose scaphoid fractures, assess osseous fracture consolidation and evaluate pre- and postoperative fractures. Question How can an international and interdisciplinary team of hand surgeons and musculoskeletal radiologists develop practical consensus statements on imaging of scaphoid fractures? Findings All eleven statements achieved group consensus among experts using the Delphi technique for consensus-building. Imaging pathways were suggested to diagnose and assess scaphoid fractures. Clinical relevance statement International, interdisciplinary and evidence-based consensus statements on imaging of scaphoid fractures were achieved using the Delphi technique. The focus of the statements was to diagnose scaphoid fractures, assess osseous fracture consolidation and evaluate pre- and postoperative fractures.
Severe mitral annular calcification represents a significant challenge for valve replacement, particularly in elderly patients with comorbidities, in whom conventional surgical approaches are associated with high morbidity and mortality. In such cases, percutaneous and minimally invasive transatrial approaches have emerged as therapeutic alternatives. The latter, unlike the former, allows direct visualization of the annulus, resection of the anterior leaflet, and more accurate prosthesis positioning, reducing malposition, embolization, paravalvular leak, and left ventricular outflow tract obstruction. We present the case of an 81-year-old woman with severe mitral stenosis and extensive annular calcification, who underwent transcatheter mitral valve replacement via open transatrial access. The surgical technique and postoperative course up to hospital discharge are described. This is the first reported case in Chile using this technique, providing evidence of its feasibility in patients with severe mitral annular calcification and high surgical risk.
To analyze the prevalence of depressive symptomatology in the population between 15 and 104 years of age in Spain to study whether there are factors that may be associated with and related to its presence. To this end, data from the 2020 European Health Interview Survey (EHIS) were collected. Analytical cross-sectional study, based on secondary information obtained from this survey. General population residing in Spain, in a community context. A total of 22,072 subjects residing in family homes in the national territory in 2019, of which 47.1% were men and 52.9% women. Prevalence of depressive symptomatology (PHQ-8). Sociodemographic and behavioural factors analysed: physical activity, tobacco and alcohol consumption, frequency of use of health services, chronic diseases and functional limitations. The overall prevalence of positive depression screening in the sample was 8.7%. The multivariate analysis identified the presence of chronic diseases, physical limitations, physical inactivity, and former smoking status as the main associated factors. Likewise, subjects with depressive symptomatology had a higher frequency of use of health services. There are several modifiable behavioural factors associated with depressive symptomatology. The promotion of physical activity and the comprehensive approach to chronicity and functional capacity could be key strategies to improve the state of mental health in the population. Analizar la prevalencia de sintomatología depresiva en la población de España entre los15 y 104 años, para estudiar la existencia de factores que puedan estar asociados y relacionados con su presencia. Para ello, se recogieron datos de la Encuesta Europea de Salud (European Health Interview Survey [EHIS]) de 2020. Estudio transversal analítico, basado en la información secundaria obtenida de dicha encuesta. Población general residente en España, en un contexto comunitario. Un total de 22.072 sujetos residentes en viviendas familiares en territorio nacional en el año 2019, de los cuales el 47,1% eran hombres y el 52,9% mujeres. Prevalencia de sintomatología depresiva (PHQ-8). Factores sociodemográficos y de comportamiento analizados: actividad física, consumo de tabaco y alcohol, frecuencia de uso de servicios sanitarios, enfermedades crónicas y limitaciones funcionales. La prevalencia global de cribado positivo de depresión en la muestra fue del 8,7%. El análisis multivariante identificó como principales factores asociados la presencia de enfermedades crónicas, las limitaciones físicas, la inactividad física y el estatus de exfumador. Asimismo, los sujetos con sintomatología depresiva presentaron una mayor frecuencia de utilización de servicios sanitarios. Existen diversos factores de comportamiento modificables asociados a la sintomatología depresiva. El fomento de la actividad física y el abordaje integral de la cronicidad y la capacidad funcional podrían ser estrategias clave para mejorar el estado de salud mental en la población.