Nineteen-Year-Old Woman with Symptomatic Intramuscular Thigh Hemangioma-Radiographic Changes and Management: A Case Report.

CASE: We report a case of an intramuscular thigh hemangioma in a 19-year-old woman with a several year history of atraumatic thigh pain. Radiographs obtained by her primary care physician demonstrated periosteal bone reaction, prompting referral to Orthopaedic Oncology department. The patient had successful symptomatic management with propranolol. CONCLUSION: The case highlights the diagnosis and potential treatments. In a stepwise approach to care for symptomatic benign vascular lesions, propranolol has been a proven therapeutic option and may be a useful first-line therapy for symptomatic hemangiomas.

Trends and outcomes in the surgical management of young adults with knee osteoarthritis using high tibial osteotomy and unicompartmental knee arthroplasty.

INTRODUCTION: A significant portion of knee osteoarthritis is diagnosed in patients under the age of 55, where greater activity demands make total knee arthroplasty less desirable. High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are useful alternatives, but there is little understanding of which procedure is advantageous. Hence, this study examines the utilization, complication, and reoperation rates among the HTO vs. UKA in young patients with primary osteoarthritis. METHODS: A retrospective review of the National Surgical Quality Improvement Program was performed to identify 2318 patients < 55 years of age who received either a HTO or UKA for primary osteoarthritis between 2011 and 2021. Bivariate analyses compared preoperative and intraoperative characteristics among each procedure. Then, multivariate analyses examined if either procedure was associated with worse 30-day postoperative complications or need for reoperation, independent of the statistically significant pre- and intraoperative disparities. RESULTS: UKAs were performed 14.2 times more commonly than HTOs, and the patients selected for HTO were more likely to be younger, have a lower BMI, have the healthiest ASA Class score, and less likely to have hypertension requiring medication (p < 0.001). HTOs took 17.5% longer to perform and had a longer average length of stay (p < 0.001), while UKAs were more likely to be performed out-patient (p < 0.001). HTOs also had higher rates of serious complications (p = 0.02), overall complications (p = 0.004), and need for reoperation (p = 0.004). Multivariate modelling demonstrated that procedure type was not a predictor of serious complications, but the use of HTO was significantly associated with any complications (odds ratio = 3.63, p = 0.001) and need for reoperation (3.21, p = 0.029). CONCLUSION: Although healthier patients were selected for HTOs, UKAs were found to have a lower risk of complications and immediate reoperation. Additionally, UKAs had the advantage of lower operative burden, shorter length of stay, and a higher efficacy in outpatient settings.

Importancia de la lectoescritura académica en la formación de estudiantes de enfermería

Objetivo: interpretar las experiencias relacionadas con la adquisición de competencias en lectoescritura académica de estudiantes de la carrera de enfermería que cursan el último año en dos universidades públicas de Colombia y Ecuador. Metodología: estudio con enfoque interpretativo, cualitativo, de tipo fenomenológico hermenéutico, de corte transversal. La recolección de datos fue mediante entrevista semiestructurada hasta la saturación de datos. La muestra fue seleccionada de forma intencional. Resultados: el desarrollo de competencias en lectoescritura académica de estudiantes en enfermería se realiza de forma autónoma, por imitación o tomando como guía lo enseñado por el docente. Las mayores dificultades se presentan a inicios de la carrera al no comprender la terminología disciplinar, así como la escritura académica sin usar el lenguaje coloquial, por lo que experimentan distintos sentimientos y experiencias según el grado de adquisición de competencias genéricas o de las específicas de enfermería. Conclusión: la lectoescritura académica es una de las primeras competencias por desarrollar en los estudiantes de enfermería, con un aprendizaje significativo para poder culminar sus estudios de grado sin mayores dificultades en el momento de elaborar sus trabajos de titulación. Es importante retomar las voces de los estudiantes a partir de sus vivencias, ya que permite buscar estrategias adecuadas para mejorar el proceso en la adquisición de competencias en lectoescritura académica.

Objective: To interpret the experiences related to the acquisition of academic literacy skills of nursing students in their last year at two public universities in Colombia and Ecuador. Methodology: Study with an interpretive, qualitative, hermeneutic phenomenological, cross-sectional approach. Data collection was through a semi-structured interview until data saturation. The sample was selected intentionally. Results: The development of academic literacy skills in nursing students is done autonomously, by imitation or taking as a guide what is taught by the teacher. The greatest difficulties occur at the beginning of the course when they do not understand the disciplinary terminology, as well as academic writing without using colloquial language, so they experience different feelings and experiences according to the degree of acquisition of generic or specific nursing competencies. Conclusion: Academic literacy is one of the first competencies to develop in nursing students, with significant learning to be able to complete their degree studies without major difficulties at the time of preparing their degree works. It is important to take up the students voices from their experiences, since it allows search for appropriate strategies to improve the process in the acquisition of academic literacy skills.

Dilemas éticos en enfermería desde una reflexión multicéntrica / Ethical dilemmas in nursing from a multicentre reflection / Dilemas éticos na enfermagem a partir de uma reflexão multicêntrica

Objetivo: Describir la percepción de los estudiantes de enfermería respecto a los dilemas éti-cos en el ejercicio de su profesión. Materiales y Métodos: Se realizó un estudio cualitativo, de tipo fenomenológico, con paradigma sociocrítico que involucra los juicios, los valores y los intereses de la sociedad. Para obtener la información, se aplicó una entrevista semiestruc-turada a un grupo focal, organizada mediante preguntas abiertas, las cuales se realizaron me-diadas por la virtualidad; posteriormente fueron grabadas previo consentimiento informado, para finalmente transcribirlas para su análisis desde la perspectiva del discurso. El análisis se efectuó mediante un proceso de reducción, con codificación abierta en un inicio y axial después para su categorización, con la ayuda del ATLAS.ti, Versión 9, a prueba. Resultados: Luego del análisis de los discursos, emergieron 5 categorías que fueron: Percepciones éticas de los profesionales de la enfermería; comités de bioética y el posicionamiento de la enfer-mería; dilemas éticos y bioéticos que persisten en el tiempo; retos que representan los dilemas éticos en la humanización de la enfermería y de la persona que está detrás de la profesión. Todas con sus respectivas subcategorías y códigos. Conclusiones: Hay una realidad común sobre los dilemas éticos más frecuentes que enfrentan los estudiantes de enfermería desde su formación hasta el ejercicio profesional. Así mismo, existen diferencias según el marco legal de cada país o situación en particular. Es importante resaltar que la participación de la enfermería en los Comités de bioética aporta significativamente a los debates internos a la hora de abordar las problemáticas o dilemas éticos; igualmente, orientan el actuar del equipo de salud, en sus diferentes cargos desde la consultoría hasta la presidencia de estos equipos interdisciplinarios

Objective: Describe the perception of nursing students regarding the ethical dilemmas in the practice of their profession. Materiales y Methods: A qualitative, phenomenological study was carried-out, with socio-critical paradigm that involves the judgements, values and inter-ests of society. To obtain the information, a semi-structured interview was applied in a focus group, organized through open questions, which were mediated by virtual meetings; these were subsequently recorded with previous informed consent, to finally transcribe the inter-views for a discourse analysis from their perspective. The analysis was completed through a reduction process, firstly with open coding and then using axial coding for its categorization, with help using ATLAS.ti, Version 9, trial. Results: After the discourse analysis, 5 catego-ries emerged: Ethical perceptions of nursing professionals, bioethics committees and nursing positioning; ethical and bioethical dilemmas that persist over time; challenges that ethical di-lemmas represent in the humanization of nursing and the person behind the profession. Each category with its respective subcategories and codes. Conclusions: There is a common reality about the most frequent ethical dilemmas that nursing students face from their education to their professional practice. Similarly, there are differences according to the legal framework of each country or particular situation. It is important to note that the participation of nursing in bioethical Committees significantly contributes to internal discussions to address the eth-ical dilemmas or issues; likewise, orientating the actions taken by the health teams, in their different positions from consultancy to presidency of these interdisciplinary teams.

Objetivo: Descrever a percepção dos alunos de enfermagem em relação aos dilemas éticos no exercício de sua profissão. Materiais e Métodos: Estudo qualitativo e fenomenológico, realizado com um paradigma sociocrático que envolve os julgamentos, valores e interesses da sociedade. Para obter as informações, foi aplicada uma entrevista semiestruturada a um grupo focal, empregando perguntas abertas, realizadas mediadas pela virtualidade; posteriormente, foram gravadas com permissão obtiva mediante consentimento livre e esclarecido, finalmente transcritas para análise na perspectiva do discurso. A análise foi realizada por meio de um processo de redução, com codificação aberta realizada inicialmente e depois axial para cate-gorização, com a ajuda do ATLAS.ti, Versão 9. Resultados: Após a análise, surgiram 5 cate-gorias que foram: Percepções éticas dos profissionais de enfermagem; comitês de bioética e o posicionamento da enfermagem; dilemas éticos e bioéticos que persistem ao longo do tempo; desafios que representam os dilemas éticos na humanização da enfermagem e da pessoa por trás da profissão. Todos com suas respectivas subcategorias e códigos. Conclusões: Há uma realidade comum sobre os dilemas éticos mais frequentes enfrentados pelos estudantes de enfermagem desde sua formação até a prática profissional. Da mesma forma, há diferenças do contexto legal específico de cada país ou situação em particular. É importante ressaltar que a participação da enfermagem nos Comitês de Bioética contribui significativamente para os debates internos na abordagem de problemas ou dilemas éticos; da mesma forma, orientam as ações da equipe de saúde, em suas diferentes posições, desde a consultoria até a presidência dessas equipes interdisciplinares.

Association of Demographic Factors and Medical School Experiences With Students' Intention to Pursue a Surgical Specialty and Practice in Underserved Areas.

Importance: The surgical workforce shortage is a threat to promoting health equity in medically underserved areas. Although the Health Resources and Services Administration and the American College of Surgeons have called to increase the surgical pipeline for trainees to mitigate this shortage, the demographic factors associated with students' intention to practice in underserved areas is unknown. Objective: To evaluate the association between students' demographics and medical school experiences with intention to pursue surgery and practice in underserved areas. Design, Setting, and Participants: This cross-sectional study surveyed graduating US allopathic medical students who matriculated between 2007-2008 and 2011-2012. Analysis began June 2020 and ended December 2020. Main Outcomes and Measures: Intention to pursue surgery and practice in underserved areas were retrieved from the Association of American Medical Colleges graduation questionnaire. Logistic regression models were constructed to evaluate (1) the association between demographic factors and medical students' intention to pursue surgical specialties vs medical specialties and (2) the association between demographic factors and medical school electives with intention to practice in underserved areas. Results: Among 57 307 students who completed the graduation questionnaire, 48 096 (83.9%) had complete demographic data and were included in the study cohort. The mean (SD) age at matriculation was 23.4 (2.5) years. Compared with students who reported intent to pursue nonsurgical careers, a lower proportion of students who reported intent to pursue a surgical specialty identified as female (3264 [32.4%] vs 19 731 [51.9%]; χ2 P < .001). Multiracial Black and White students (adjusted odds ratio [aOR], 1.72; 95% CI, 1.11-2.65) were more likely to report an intent for surgery compared with White students. Among students who reported an intention to pursue surgery, Black/African American students (aOR, 3.24; 95% CI, 2.49-4.22), Hispanic students (aOR, 2.00; 95% CI, 1.61-2.47), multiracial Black and White students (aOR, 2.27; 95% CI, 1.03-5.01), and Indian/Pakistani students (aOR, 1.31; 95% CI, 1.02-1.69) were more likely than White students to report an intent to practice in underserved areas. Students who reported participating in community health (aOR, 1.61; 95% CI, 1.42-1.83) or global health (aOR, 1.83; 95% CI, 1.61-2.07) experiences were more likely to report an intention to practice in underserved areas. Conclusions and Relevance: This study suggests that diversifying the surgical training pipeline and incorporating health disparity and community health in undergraduate or graduate medical education may promote students' motivation to practice in underserved areas.

Ecological and reproductive characteristics of holothuroids Isostichopus badionotus and Isostichopus sp. in Colombia.

Isostichopus badionotus and Isostichopus sp. are two holothuroids exploited in the Caribbean region of Colombia. Until recently, they were considered a single species. During one year, 222 individuals of Isostichopus sp. and 114 of I. badionotus were collected in two bays of the Santa Marta region to study their reproductive biology and collect information on their size, weight and habitat. Both sea cucumber morphotypes showed an annual reproductive cycle, with a reproductive season from September to November, closely related to the increase in water temperature and rainfall. In both sea cucumbers the population structure exhibited a unimodal distribution composed of mature individuals and a sex ratio of 1:1. Isostichopus sp. had an average size and weight (193 ± 52 mm and 178 ± 69 g) and size and weight at first maturity (175 mm and 155 g) that was much lower than I. badionotus (respectively, 324 ± 70 mm and 628 ± 179 g; 220 mm and 348 g). While 98% of Isostichopus sp. individuals were collected in the upper 2.5 m, on rocky bottoms between cracks, 73% of I. badionotus individuals were found between 3 and 7.8 m depth, exposed on sandy bottoms. These differences imply that management measures (e.g. minimum catch size) should not be the same for both sea cucumbers morphotypes.

Direct Anterior Approach Total Hip Arthroplasty Is Not Associated with Increased Infection Rates: A Systematic Review and Meta-Analysis.

BACKGROUND: The direct anterior approach (DAA) for primary total hip arthroplasty (THA) has recently increased in popularity. Recent evidence has raised concerns about whether use of the DAA is associated with increased rates of superficial and deep infection. The aim of this study was to systematically assess the literature and comparatively evaluate the rate of superficial and deep infection following primary THA using the DAA and non-direct anterior (non-DAA) approaches. METHODS: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. Primary outcome measures evaluated were rates of superficial and deep infection in patients undergoing DAA and non-DAA primary THA. RESULTS: A total of 1,872 studies were identified in the original search, of which 15 studies satisfied inclusion criteria. Our analysis evaluated 120,910 primary THAs, including 14,908 DAA and 106,002 non-DAA. The rate of superficial infection was 1.08% for DAA compared with 1.24% for non-DAA (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.79 to 1.30, p = 0.921). The rate of deep infection was 0.73% for DAA compared with 0.51% for non-DAA (OR = 1.03, 95% CI = 0.80 to 1.32, p = 0.831). CONCLUSIONS: This study found no difference in the rate of superficial or deep infection after primary THA using the DAA versus other surgical approaches. Our results suggest that comparative infection risk need not be a primary driver in the choice of surgical approach. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Providing Compassionate Care: The Role of Medical Students and Videoconference Technology in the COVID-19 Pandemic.

Patient and family communication is a well-known factor associated with improved patient outcomes. During the COVID-19 pandemic, visitation restrictions meant communication with patients and their families became a challenge, particularly with intubated patients in the intensive care unit. As the hospital filled with COVID-19 patients, medical students and physicians at Albany Medical Center identified the urgent need for a better communication method with families. In response, the COVID-19 Compassion Coalition (CCC) was formed. The CCC's goal was to decrease the distress felt by families unable to visit their hospitalized loved ones. They developed a streamlined process for videoconferencing between patients on COVID-19 units and their families by using tablets. Having medical students take responsibility for this process allowed nurses and physicians to focus on patient care. Incorporating videoconferencing technology can allow physicians and nurses to better connect with families, especially during unprecedented times like a pandemic.

Anti-vimentin antibodies in transplant and disease.

Non-HLA antibodies are recognized as a potential source of antibody mediated rejection following transplantation. The epitopes which lead to production of these antibodies are a result of tissue disruption, specifically endothelium, secondary to inflammation and injury. Vimentin is a cytoskeletal protein involved in many aspects of cellular organization, signaling, and proliferation. Recently, antivimentin antibodies have been shown to be important not only for rheumatological autoimmune diseases, but also cardiac and renal transplant dysfunction. In cardiac transplant recipients, antivimentin antibodies are associated with coronary artery vasculopathy and chronic graft loss. In renal transplantation, antivimentin antibodies are detected prior to transplantation and are also correlated with chronic graft dysfunction. In renal transplant recipients, antivimentin antibodies seen prior to transplantation are thought to be secondary to chronic endothelial injury during hemodialysis and therefore more prevalent prior to renal transplant than cardiac transplantation. In this review, we will examine the generation and pathogenesis of antivimentin antibodies. Given that these antibodies appear to be associated with both post-cardiac and -renal transplant dysfunction, developing standard detection paradigms may be important for risk stratification prior to transplantation. Finally, understanding the pathogenesis of antivimentin antibodies may lead to the development potential therapies in order to improve long-term survival.

Dermatofilosis humana en Costa Rica / Human dermatophilosis in Costa Rica

Se reporta un caso de dermatofilosis en un hombre de 26 años de edad, Médico Veterinario, diagnosticado en la Escuela de Medicina Veterinaria, de la Universidad Nacional. El paciente presentó en la superficie dorsal de la mano derecha, una lesión dérmica, circular, de 20 mm de diámetro, bordes hiperémicos, descamativos y pequeñas pústulas de 2 a 5 mm de diámetro, que secretaban un líquido claro. El agente etiológico fue puesto de manifiesto con tinciones de Wright y su aislamiento se realizó siguiendo la técnica descrita por Haalstra. Se instauró tratamiento oral a base de Ampicilina en dosis de 750 mg diarios por seis días, después de los cuales la lesión se redujo y finalmente desapareció