Development of a stick-on hip protector: A multiple methods study to improve hip protector design for older adults in the acute care environment.

INTRODUCTION: Over 90% of hip fractures in older adults result from falls, and hospital patients are at especially high risk. Specific types of wearable hip protectors have been shown to reduce hip fracture risk during a fall by up to 80%, but user compliance has averaged less than 50%. We describe the development and evaluation of a "stick-on" hip protector (secured over the hip with a skin-friendly adhesive) for older patients in acute care. METHODS: An initial version of the product was evaluated with six female patients (aged 76-91) in a hospital ward, who were asked to wear it for one week. We subsequently refined the product through biomechanical testing and solicited feedback from 43 health professionals on a second prototype. RESULTS: The first prototype was worn by five of six patients for the full week or duration of their hospital stay. The second prototype (20 mm thick, surface area 19 × 15.5 cm) provided 36% force attenuation, more than common garment-based models (20-21%). Feedback from patients and health professionals highlighted usability, comfort, cost, and appearance. CONCLUSIONS: Our results from biomechanical and user testing support the need for further work to determine the value of stick-on hip protectors in acute care.

Tumores selares: grosor de la capa de fibras nerviosas en tomografía de coherencia óptica de papila como factor pronóstico de recuperación visual postoperatoria / Sellar tumors: peripapillary retinal nerve fiber layer thickness on optical coherence tomography as prognosis of postoperatory visual recovery

Purpose: To establish the prognostic value of the retinal nerve fiber layer thickness measured at Optical Coherence Tomography (OCT) as a predictor of visual function posterior to resection of sellar tumors. Material and Methods: Descriptive, retrospective study in patients undergoing microscopic transsphenoidal resection of sellar tumors with preoperative ophthalmologic evaluation (evaluation by specialist, 24-2 Sita Standard visual field (24-2 SS VF) and optic nerve head Stratus OCT) and postoperative (evaluation by specialist and 24-2 SS VF). Minimum follow-up was 3 months. For statistical analysis, Spearman and Pearson's Correlation Coefficient and linear regression was used. Results: A total of 18 patients were included. In the preoperative evaluation, patients had logMAR average Snellen visual acuity (VA) of 0.70 (0.15 logMAR, 0-4.0), an average mean deviation (MD) of -9.25 dB (0.4 to -30.4 dB) and a average retinal nerve fiber layer thickness of 83.7 microns (45.24 to 115.37). Postoperative evaluation of patients showed an Snellenaverage VA of 0.78 (0.1 logMAR, 0-1.3) and MD of 5.58 dB (2.31 -32.39 dB). A positive correlation (r = 0.51) between average retinal nerve fiber layer thickness and postoperative MD, less probably to improved in VF and VA with thicknesses below 80 microns. Conclusion: A nerve fiber layer thickness on optic nerve head Stratus OCT below 80 microns correlated with poorer visual function improvement in patients undergoing transsphenoidal resection surgery of sellar tumors.

Propósito: Establecer el valor pronóstico del grosor peripapilar de la capa de fibras de las células ganglionares (CFCG) cuantificado a la Tomografía de Coherencia Óptica (OCT) como factor pronóstico visual posterior a la resección de tumores selares. Material y Método: Estudio descriptivo, retrospectivo en pacientes sometidos a resección transesfenoidal microscópica de tumores selares con evaluación oftalmológica preoperatoria (evaluación por especialista, campo visual 24 Sita Standard (CV 24-2 SS) y OCT Stratus de papila) y postoperatoria (evaluación por especialista y CV 24-2 SS). El seguimiento mínimo fue de 3 meses. Para el análisis estadístico se utilizó el coeficiente de correlación de Pearson y Spearman, y regresión lineal. Resultados principales: Se incluyó un total de 18 pacientes. En la evaluación prequirúrgica los pacientes presentaron agudeza visual (AV) promedio de 0,70 en Snellen (0,15 en logMAR, rango 0-4 logMAR), una desviación media (DM) promedio de -9,25 dB (0,4 a -30,4 dB) y un grosor de CFCG de 83.7 μm promedio (45,24 a 115,37 μm). En la evaluación postoperatoria los pacientes presentaron AVpromedio de 0,78 Snellen (0,1 logMAR, rango 0-1,3) y una DMpromedio de -5,58 dB (2,31, -32,39 dB). Se encontró una correlación positiva (r2 = 0,51) entre el grosor de CFCG y la DM postoperatoria, con tendencia a la menor mejoría del CV y AV con grosores bajo 80 μm. Conclusión: Una capa de fibras nerviosas bajo 80 μm al OCT Stratus se correlacionó con menor mejoría visual postoperatoria en pacientes sometidos a cirugia transesfenoidal de tumores selares.

Sobrevida y factores pronósticos de 13 pacientes con carcinoma espinocelular oral diagnosticados en el CRS Cordillera Oriente, entre los años 2001 - 2015 / Survival and prognostic factors in 13 patients with oral squamous cell carcinoma diagnosed at the CRS Cordillera Oriente, between the years 2001 - 2015

Introducción: El carcinoma espinocelular (CEC) es una neoplasia maligna derivada del epitelio plano estratificado. Hoy en día ha adquirido mayor importancia debido a que es el cáncer oral más frecuente y su sobrevida sobre los 5 años se ha mantenido baja. Objetivo: Generar información que oriente a odontólogos y médicos en la detección y manejo oportuno del CEC oral analizando la sobrevida según características demográficas y clínicas de pacientes con esta enfermedad atendidos en el CRS Cordillera Oriente. Materiales y métodos: Estudio descriptivo, retrospectivo de tipo serie de casos. La muestra correspondió al total de pacientes diagnosticados con CEC oral en el CRS Cordillera Oriente entre enero de 2001 y mayo de 2015. Para el estudio epidemiológico de la muestra se utilizó estadística descriptiva y para el análisis de la sobrevida se utilizó el método de Kaplan Meier. Resultados: La mayor parte de la muestra fueron hombres (8/13) y mayores de 60 años (7/13). La edad promedio fue de 63,6 años. La presentación más común fue la úlcera crónica (6/13) y la localización más frecuente, el labio (4/13). En su mayoría fueron tumores bien diferenciados (9/13), un estado del tumor primario en etapa pT1 o pT2 (7/8) y ausencia de metástasis en nodos regionales (6/9). Se encontró una distribución homogénea respecto a la etapa TNM. La sobrevida general a los 5 años fue de 57,9%. La sobrevida más baja a los 5 años se presentó en pacientes de sexo femenino, menores de 45 años, fumadores, con presentación de masa exofítica, con tumores de menor grado de diferenciación histológica, con un estado del tumor primario avanzado, con presencia de metástasis en nodos regionales y que se encontraban en una etapa TNM avanzada. Conclusiones: La prevalencia de CEC oral en este centro es baja, sin embargo, es de relevancia dado la reducida sobrevida sobre los 5 años. Esto pone de manifiesto la necesidad de un diagnóstico y tratamiento oportunos. La información presentada es de utilidad para la identificación de la población en riesgo de CEC oral, pudiendo ayudar en el desarrollo de programas de tamizaje. El limitado número de casos puede explicar las diferencias observadas respecto a la literatura nacional e internacional lo que genera la necesidad de realizar nuevos estudios.

Introduction: Squamous cell carcinoma (SCC) is a malignant neoplasm derived from stratified squamous epithelium. Today it has become more important because it is the most common oral cancer and its survival over five years has remained low. Aim: Produce information to guide dentist and physicians in the prompt detection and management of oral SCC through the analysis of survival according to demographic and clinical characteristics of patients diagnosed at the CRS Cordillera Oriente. Methods: We perform a descriptive, retrospective study of case series. Patients diagnosed with oral SCC at the CRS Cordillera Oriente, between January 2001 and May 2015 were selected. We used descriptive statistics for the epidemiological study sample and the Kaplan Meier method for the survival analysis. Results: The study population was mainly men gender (8/13) and over 60 years (7/13). The average age was 63,6 years. The most common presentation was chronic ulcer (6/13) and the most common site, the lip (4/13). Most of the sample had a well differentiated tumor (9/13), a primary tumor stage pT1 or pT2 (7/8) and absence of metastases in regional nodes (6/9). A homogeneous distribution with respect to the TNM stage was found. The overall survival at 5years was 57,9%, the lowest rates were in the female gender, group under 45 years, smokers, exophytic mass, poorly differentiated tumor, advanced primary tumor, presence of regional metastases in nodes and advanced TNM stage. Conclusions: The prevalence of oral SCC in this center is low, however, it is relevant given the reduced survival over 5 years. This highlights the need for early diagnosis and treatment. The information presented is useful for identifying population at risk or oral SCC, and may assist in the development of screening programs. The limited number of cases may explain the observed differences regarding the national and international literature wich generates the need for further studies.

Risk factors for hip impact during real-life falls captured on video in long-term care.

UNLABELLED: Hip fracture risk is increased by landing on the hip. We examined factors that contribute to hip impact during real-life falls in long-term care facilities. Our results indicate that hip impact is equally likely in falls initially directed forward as sideways and more common among individuals with dependent Activities of Daily Living (ADL) performance. INTRODUCTION: The risk for hip fracture in older adults increases 30-fold by impacting the hip during a fall. This study examined biomechanical and health status factors that contribute to hip impact through the analysis of real-life falls captured on video in long-term care (LTC) facilities. METHODS: Over a 7-year period, we captured 520 falls experienced by 160 residents who provided consent for releasing their health records. Each video was analyzed by a three-member team using a validated questionnaire to determine whether impact occurred to the hip or hand, the initial fall direction and landing configuration, attempts of stepping responses, and use of mobility aids. We also collected information related to resident physical and cognitive function, disease diagnoses, and use of medications from the Minimum Data Set. RESULTS: Hip impact occurred in 40 % of falls. Falling forward or sideways was significantly associated with higher odds of hip impact, compared to falling backward (OR 4.2, 95 % CI 2.4-7.1) and straight down (7.9, 4.1-15.6). In 32 % of sideways falls, individuals rotated to land backward. This substantially reduced the odds for hip impact (0.1, 0.03-0.4). Tendency for body rotation was decreased for individuals with dependent ADL performance (0.43, 0.2-1.0). CONCLUSIONS: Hip impact was equally likely in falls initially directed forward as sideways, due to the tendency for axial body rotation during descent. A rotation from sideways to backward decreased the odds of hip impact 10-fold. Our results may contribute to improvements in risk assessment and strategies to reduce risk for hip fracture in older adults.

Luis Prunés Risetti: un gran maestro de la dermatología chilena: su biografía y archivo fotográfico / Luis Prunés Risetti: a great master of Chilean dermatology: his biography and photo archive

El doctor Luis Prunés fue uno de los grandes maestros de la dermatología chilena. Se formó como dermatólogo en el hospital Saint-Louis en París. En la década 1920 ingresó al Hospital San Luis de Santiago y en 1938 asumió como profesor titular de la cátedra “Clínica Universitaria de Piel y Sífilis” del Hospital San Vicente de Paul. En 1938 fue el primer presidente de la Sociedad Chilena de Dermato-sifilología. Fue un gran investigador de patologías cutáneas; estudió principalmente la lepra y las lesiones cutáneas asociadas a minerales. Es recordado por preconizar la importancia de la biopsia cutánea. Jubiló en 1954 dejándonos un importante legado dermatológico. El Dr. Prunés recopiló sus mejores casos en más de 20archivos fotográficos, los cuales se encuentran en la biblioteca del Departamento de Dermatología del Hospital Clínico de la Universidad de Chile. El objetivo de este trabajo es presentar parte de su archivo fotográfico, mostrando imágenes impresionantes de tumores cutáneos y lesiones cutáneas inducidas por arsénico.

Dr. Luis Prunés is one of the masters of the Chilean dermatology. He was trained as dermatologist at the Saint-Louis hospital in Paris. Since 1920 he worked as dermatologist at the San Luis Hospital in Santiago and in 1938 he took over as Professor and Chairman of the “University Clinic of Skin and Syphilis” at San Vicente de Paul Hospital. In 1938, he was the first president of the Chilean Society of Dermatology. He studied leprosy and skin lesions associated with minerals. He is also remembered for advocating the importance of skin biopsy. He retired in 1954, leaving an important legacy. Dr. Prunés compiled his best clinical cases in more than 20 photographic archives, which are located at the Library of the Dermatology Department in the University of Chile Clinical Hospital. The purpose of this paper is to present part of his photographic archive, showing stunning images of large cutaneous tumors and arsenic-induced skin lesions.

Carcinoma espinocelular en hospitales públicos de la Región Metropolitana de Chile: análisis de la localización anatómica, género y edad / Spinocellular carcinoma in public hospitals metropolitan region, Chile: analysis of anatomic localization, genus and age

Cutaneous squamous cell carcinoma (SCC) is the second most common skin cancer; its incidence is increasing in the last decades worldwide. The purpose of this study was to analyze 1320SCC (716 males and 604 females) from five hospitals of Santiago. The tumours were studied by gender, anatomical localization and age of the patient. For this, 600.000 histopathological reports were reviewed (1992-2001). SCC was more frequent in males than females and also more frequent in older people. The average age was 72.1 +/-14.3 years old in females and 69.5+/-13.2 years old in males. The most frequent anatomical locations in females were the face (51.2 percent), lower extremities (13.9 per cent) and genitals (12.1 percent). The most frequent anatomical locations in males were the face (62.4 percent); genitals (9.8 percent) and lower extremities (8.1 percent ). More number of facial SCC was observed in males than in females; however; more SCC in lower extremities was observed in females than in males. In relation to age, CEC was more frequent in males in the 50-59 and 70-79 years old groups, however; CEC was more frequent in females older than 80 years old. The study of 1320 SCC tumours allows us to analyze risk groups in the Chilean population that help to direct future skin cancer prevention campaigns in Chile.

Muscle compromise in diabetes.

Muscle compromise associated with diabetes includes muscle infarction, myositis, pyomyositis, and abscess formation. These conditions may also be seen in various other conditions, such as trauma, alcoholism, neoplasia, vasculopathy, HIV infection, and other immunocompromised states and hemoglobinopathies. Due to recent advances in imaging technology, these entities are readily detected and treated at an earlier stage. Different diagnostic modalities may be used, particularly magnetic resonance imaging (MRI), which is best for soft-tissue pathologies. Muscle infarction appears with acute edema and inflammatory changes on T1- and T2-weighted images, enhancing peripherally postcontrast, and nonenhancing central areas suggestive of necrosis, lacking focal fluid collections. The latter feature may help to exclude abscesses, as these mostly present with fluid collections. Pyomyositis in its early period demonstrates ill-defined muscle enlargement with increased signal on T2-weighted images. Myositis shows no signal changes or mild hypointensity on T1-weighted images, but diffuse hyperintensity on T2-weighted images, with no or minimal enhancement following intravenous contrast media. Recognition of these pathologies is important, since management approaches vary depending on the etiology of the muscle involvement and overall status of the patient.

Effectiveness of alternative treatments for reducing potential viral contaminants from plasma-derived products.

An issue of great importance and continuing concern with regard to all products derived from human plasma is their safety from potential contaminants in the source material from which they are purified. Since viral contaminants are a major safety consideration with these products, a number of different methods, including dry heating, vapor heating, filtration and nanofiltration, ultraviolet and gamma irradiation, pasteurization, solvent/detergent (S/D) treatment, sodium thiocyanate treatment, and chromatography (immunoaffinity, metal chelation, affinity, and ion exchange), have been developed to remove or inactivate potentially contaminating viruses. Pasteurization and S/D treatment have emerged as the dominant viral inactivation methods. Results summarized in this review demonstrate that pasteurization is the broadest and most rigorous currently available method for removal of potential viral contaminants from plasma-derived products. S/D treatment requires control over a large number of manufacturing parameters and has no ability to inactivate nonlipid-enveloped viruses. Pasteurization requires control over only a small number of manufacturing variables, is easily monitored, and remains effective even if deviations are encountered from specified protein and stabilizer concentrations and temperature. In addition, pasteurization is effective against a wide range of lipid- and nonlipid-enveloped viruses.

Musculoskeletal radiology: then and now.

Musculoskeletal radiologists, owing to recent advances in imaging technologies and techniques, are playing an increasingly important role in documenting, diagnosing, and treating an increasing variety of bone and soft-tissue lesions. However, improved visualization of anatomic aberrations-"seeing better"-must be paired with "knowing more," on the basis of complete familiarity with all aspects of the biology, physiology, pathophysiology, and static anatomy of the musculoskeletal system. Only with foreknowledge of the latter can the musculoskeletal radiologist fully maximize the benefits of the former.

Virus reduction in the preparation of intravenous immune globulin: in vitro experiments.

BACKGROUND: While immune globulins for intravenous administration (IGIV) have an excellent record with respect to virus safety, concern regarding these preparations has been raised by reports of transmission of hepatitis C virus (HCV) to patients treated with IGIV and the presence of genetic material for HCV in IGIV preparations. STUDY DESIGN AND METHODS: This in vitro study evaluated the effectiveness of several manufacturing steps, including ethanol precipitation and pasteurization, in reducing HIV and model viruses including encephalomyocarditis (EMC) virus, pseudorabies virus (PRV), bovine viral diarrhea virus (BVDV), Sindbis virus, vaccinia virus, and vesicular stomatitis virus (VSV), as well as HCV RNA, in IGIV. RESULTS: Ethanol precipitation carried out after pasteurization resulted in virus reductions (log10) of >3.97 for HIV, 1.95 for EMC virus, >5.39 for PRV, and 3.52 for BVDV. Pasteurization inactivated EMC virus by 4.52 log10 and resulted in a log10 reduction of >6.54 for HIV, >5.39 for PRV, >6.64 for BVDV, >7.78 for Sindbis virus, >5.84 for vaccinia virus, and >6.99 for VSV. All viruses except EMC virus were reduced below the limit of detection within 6 hours of the beginning of pasteurization. Cohn processing of Fraction II + III paste and the 4.5-percent alcohol precipitation step prior to pasteurization provided additional virus removal. Studies using the polymerase chain reaction technique found that HCV RNA was detectable in the starting fraction of Cohn Fraction II paste, but not in the final IGIV preparation. CONCLUSION: These findings strongly support the viral safety of IGIV prepared by this method and show a significant added measure of virus safety associated with pasteurization of this preparation.

Fatty infiltration of osseous structures: a long-term complication of oleothorax--case report.

Thoracic imaging of a patient treated for pulmonary tuberculosis with oleothorax therapy before the antibiotic era demonstrated a rare complication. Gross invasion by lipid with subsequent pathologic fracture of the adjacent thoracic vertebra may give rise to symptomatic spinal cord compression. Magnetic resonance imaging is a useful modality for help in diagnosing treatment complications of oleothorax.

Relationship of the meniscofemoral ligaments of the knee to lateral meniscus tears: magnetic resonance imaging evaluation.

This study sought to determine if the presence or absence of meniscofemoral ligaments exerts an influence on the prevalence of tears of the lateral meniscus. We reviewed the sagittal and coronal magnetic resonance images of 173 knees for lateral meniscus tears and the presence of the meniscofemoral ligaments. One or both meniscofemoral ligaments were present in 142 of 173 knees (82%). Fifty-four knees had lateral meniscus tears, 27 of which involved the posterior horn. Thirty-three percent of knees with meniscofemoral ligaments had a lateral meniscus tear, and 23% of knees without meniscofemoral ligaments had a lateral meniscus tear (no significant difference). We found no association between the presence of the meniscofemoral ligaments and tears of the lateral meniscus. Our study questions the importance of preserving or reconstructing these ligaments in instances of meniscal transplantation.

Immunoproliferative small intestinal disease in a 16-year-old boy presenting as severe malabsorption with excellent response to tetracycline treatment.

Immunoproliferative small intestinal disease (IPSID) is a rare lympho-proliferative disorder of the upper small intestine. It is considered a special form of MALT lymphoma with propensity to malignant transformation. This disorder is rare in pediatric literature. We report a case of IPSID in a 16-year-old boy with low-grade malignant transformation, presenting as severe malnutrition and a possible association with Helicobacter pylori. The patient responded well to an extended treatment with tetracycline and eradication of H. pylori.

Gradient-echo versus fat-suppressed fast spin-echo MR imaging of rotator cuff tears.

OBJECTIVE: The purpose of this study is to compare fat-suppressed T2-weighted fast spin-echo sequences with T2-weighted multiplanar gradient-echo sequences in revealing rotator cuff disorders. MATERIALS AND METHODS: Oblique coronal fat-suppressed fast spin-echo images and gradient-echo images of 39 patients who underwent surgery of the shoulder were retrospectively reviewed. Images from the two techniques were reviewed separately. Each set of images was interpreted twice by four musculoskeletal radiologists independently and without knowledge of the surgical findings. Sensitivity and specificity for both sequences were determined. The kappa statistic was used to calculate intraobserver and interobserver agreement of interpretations. RESULTS: For detecting any tear, the sensitivity of the four readers was 71-96% using fast spin-echo and 58-100% using gradient-echo imaging. Confidence intervals showed no difference between the two sequences. Sensitivity of detecting full-thickness tears was 83-100% for both sequences. Interobserver agreement was good. CONCLUSION: T2-weighted gradient-echo and fat-suppressed T2-weighted fast spin-echo sequences depict rotator cuff tears equally well and take less time to acquire than conventional dual-echo spin-echo sequences.