Effectiveness of Whey Protein Supplementation during Resistance Exercise Training on Skeletal Muscle Mass and Strength in Older People with Sarcopenia: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine the effectiveness of whey protein (WP) supplementation during resistance exercise training (RET) vs. RET with or without placebo supplementation on skeletal muscle mass, strength, and physical performance in older people with Sarcopenia. METHODS: Electronic searches in the PubMed, Embase, Scopus, Web of Science, LILACS, SPORTDiscus, Epistemonikos, and CINAHL databases were performed until 20 January 2023. Randomized clinical trials conducted on sarcopenic adults aged 60 or older were included. The studies had to compare the effectiveness of the addition of supplements based on concentrated, isolated, or hydrolyzed whey protein during RET and compare it with RET with or without placebo supplementation on skeletal muscle mass and strength changes. The study selection process, data extraction, and risk of bias assessment were carried out by two independent reviewers. RESULTS: Seven randomized clinical trials (591 participants) were included, and five of them provided data for quantitative synthesis. The overall pooled standardized mean difference (SMD) estimate showed a small effect size in favor of RET plus WP for skeletal muscle mass according to appendicular muscle index, with statistically significant differences compared with RET with or without the placebo group (SMD = 0.24; 95% CI, 0.05 to 0.42; p = 0.01; I2 = 0%, p = 0.42). The overall pooled mean difference (MD) estimate showed a significant difference of +2.31 kg (MD = 2.31 kg; 95% CI, 0.01 to 4.6; p = 0.05; I2 = 81%, p < 0.001) in handgrip strength in the RET plus WP group compared with the RET group with or without placebo. The narrative synthesis revealed discordance between the results of the studies on physical performance. CONCLUSIONS: WP supplementation during RET is more effective in increasing handgrip strength and skeletal muscle mass in older people with Sarcopenia compared with RET with or without placebo supplementation. However, the effect sizes were small, and the MD did not exceed the minimally important clinical difference. The quality of the evidence was low to very low according, to the GRADE approach. Further research is needed in this field.

Biomechanical Comparison of First Tarsometatarsal Arthrodesis Constructs Over Prolonged Cyclic Testing.

BACKGROUND: Traditionally, a lengthy period of nonweightbearing is required following arthrodesis of the first tarsometatarsal (TMT) joint in order to provide a stable healing environment for the bones. The goal of this research was to determine the resistance to plantar gapping of 2 locked intramedullary devices and a medial plate with crossing screw, all specifically designed for hallux valgus correction, and compare them to traditional 2-crossing screw fixation under a cyclic testing protocol. We hypothesized the locked intramedullary devices and the medial plate with crossing screw would better resist plantar gapping. METHODS: Forty cadaver specimens received 1 of 4 operative treatments: a locked intramedullary device with 2 points of fixation in the cuneiform, a locked intramedullary device with 1 point of fixation in the cuneiform, a medial plate with crossing screw, or 2 crossing screws. We applied dorsiflexion bending forces to the first TMT joint using a cadaveric fatigue model for 20 000 cycles. The plantar gap between the metatarsal and cuneiform was measured at the beginning and end of cyclic testing. Thirty-six specimens were included in the final data set. RESULTS: Both locked intramedullary device groups and the medial plate with crossing screw group exhibited significantly less gap widening compared to the 2-crossing screw group (vs 3-hole intramedullary device, P = .014; vs 4-hole intramedullary device, P = .010; and vs medial plate with crossing screw, P = .044). The intramedullary device groups were the most stable during the cyclic fatigue test, exhibiting the smallest gap widening. The medial plate with crossing screw fixation was also more stable than crossing screws in the cyclic fatigue model. CONCLUSIONS: The locked intramedullary devices and medial plate with crossing screw resisted plantar gapping better than 2 crossing screws when used for first TMT arthrodesis. CLINICAL RELEVANCE: These results indicate that locked intramedullary devices and medial plates with crossing screws may promote superior bone healing and may better tolerate early weightbearing compared with 2 crossing screws.

Carotid Artery Angioplasty and Stenting Without Distal Embolic Protection Devices.

BACKGROUND: Embolic protection devices are used during carotid artery stenting procedures to reduce risk of distal embolization. Although this is a standard procedural recommendation, no studies have shown superiority of these devices over unprotected stenting procedures. OBJECTIVE: To assess the periprocedural outcome and durability of carotid artery stenting without embolic protection devices and poststent angioplasty. METHODS: We performed a retrospective chart review of 174 carotid angioplasty stent procedures performed at our institution. One hundred sixty-six patients underwent angioplasty and stenting without distal protection devices or poststent angioplasty. Complications related to stenting, including procedural complications, postoperative stroke and/or myocardial infarction, and stent restenosis were analyzed. RESULTS: One hundred thirty-five stents (78%) were performed in symptomatic patients, whereas 22% of stents were placed for asymptomatic internal carotid artery stenosis. The degree of stenosis was 80% or greater in 75% of patients and 90% or greater in 55% of patients. Following the stenting procedure, the 24-hour and 30-day rate of transient ischemic attack, intracranial hemorrhage, or ischemic stroke was 0. Three (2%) patients had a perioperative, non-ST elevation myocardial infarction. Five patients (2.8%) required treatment for restenosis (>50% stenosis from baseline), 1 of which was symptomatic. CONCLUSION: Our data show that carotid artery stenting without the use of embolic protection devices and without postangioplasty stenting, in experienced hands, can be performed safely. Furthermore, this technique does not result in a higher degree of in-stent restenosis than series in which poststenting angioplasty is performed.

Concordancia entre la percepción materna y el estado nutricional de sus hijos antes y después de una intervención educativa / Concordance between maternal perception and child's nutritional status before and after an educational intervention

RESUMEN La malnutrición por exceso es un problema de salud y su rápida pesquisa mediante percepción materna (PM), permite intervenciones tempranas enfocadas a disminuir sus consecuencias y costos asociados. El objetivo fue determinar la concordancia entre PM y estado nutricional (EN) de sus hijos, antes y después de una intervención educativa. Participaron 116 diadas madre-hijo de 2 a 5 años, de 4 jardines de Viña del Mar, donde se determinó EN y PM mediante imágenes corporales de los niños. Posteriormente, 57 madres con PM erradas respecto a estado nutricional de su hijo participaron de una intervención educativa de 40 minutos cada 15 días por 3 meses. La concordancia entre el PM y estado nutricional fue evaluada con el test de Kappa. El EN de los niños fue: 3,4% bajo peso; 49,1% normal; 28,4% sobrepeso y 19,0% obesidad. Para la PM el 99,1% subestimó el EN de su hijo (Kappa= 0,022 y p= 0,610). Posterior a la intervención, mejoró la PM en 59,6% y un 40,3% continuó subestimando el EN (kappa= 0,362 y p= 0,000). En este estudio, la PM tiende a subestimar el EN de sus hijos y una intervención educativa mejoró la PM y la concordancia entre PM y el EN de ellos.

ABSTRACT Overnutrition is a health problem and its rapid diagnosis through maternal perception (MP), allows for early intervention focused on reducing consequences and associated costs. The objective of this study was to determine the concordance between MP and child's nutritional status, before and after an educational intervention. Participants were 116 mother-child (2 to 5 years old) dyads from, from 4 daycare centers in Viña del Mar, Chile. Nutritional status was determined and MP was performed using children's body images. Subsequently 57 mothers with MP discordant with child's nutritional status participated in a 40-minute educational intervention every 15 days for 3 months. Concordance between MP and child's nutritional status was evaluated with Kappa. Nutritional status of the 116 children was: 3.4% underweight; 49.1% normal; 28.4% overweight, 19.0% obesity. MP indicated that 99.1% underestimated their child's nutritional status (Kappa = 0.022 and p= 0.610). After intervention, MP improved to 59.6% and 40.3% continued to underestimating child's nutritional status (kappa= 0.362 and p= 0.000). In this study, mothers tended to underestimate the nutritional status of their children. An educational intervention improved MP and the agreement between MP and child's nutritional status.

Improved door-to-needle times and neurologic outcomes when IV tissue plasminogen activator is administered by emergency physicians with advanced neuroscience training.

BACKGROUND: The neurologic emergency department (neuro ED) at our medical center is staffed by emergency medicine physicians who have specialized neuroscience training and give intravenous (IV) tissue plasminogen activator (tPA) independently for acute ischemic stroke patients. Door-to-needle (DTN) times, discharge location, and discharge National Institute of Health Stroke Scale (NIHSS) scores were studied between the neuro ED and main emergency department (ED) with the hypothesis that all measures would be better in the neuro ED group. METHODS: This is a retrospective study evaluating DTN time, discharge outcomes, and discharge location in acute stroke patients who received IV tPA at our comprehensive stroke center. These outcome measures were compared between patients who were evaluated and treated in our neuro ED to those treated in our main ED. RESULTS: From 2012 to 2014, 67 acute stroke patients received IV tPA in our ED. Thirty-five patients were evaluated in the neuro ED, and 32, in the main ED. Average DTN times were significantly faster in the neuro ED at 35 minutes, compared to main ED DTN times of 83 minutes. Discharge NIHSS score was significantly lower, and more patients were discharged to home in the neuro ED group compared to the main ED group. CONCLUSIONS: Trained neuro ED physicians can safely give IV tPA independently for stroke patients with improved DTN times, lower discharge NIHSS, and higher likelihood of being discharged to home compared to the main ED physicians who used teleneurology consultation. This suggests utility in training emergency medicine physicians to administer tPA independently based on clinical practice guidelines.

Early postmarket experience after US Food and Drug Administration approval with the Trevo device for thrombectomy for acute ischemic stroke.

BACKGROUND: TREVO 2 showed the Trevo stent retriever to be more successful for revascularization than Merci for acute stroke intervention in patients treated within 8 hours of symptom onset. These results led to US Food and Drug Administration approval of Trevo. OBJECTIVE: To report the first postmarket experience with Trevo since US Food and Drug Administration approval at a single high-volume comprehensive stroke center in the United States. METHODS: A retrospective analysis of prospectively collected data was conducted in patients who underwent intervention for ischemic stroke with the Trevo device. Trevo was used alone or in conjunction with other intra-arterial devices. Two groups of patients were identified: those with symptom onset within (group 1) and those with symptom onset beyond (group 2) 8 hours. Recanalization, outcome, symptomatic intracranial hemorrhage, and in-hospital and 90-day mortality were assessed. RESULTS: Fifty-two patients were identified, 27 in group 1 and 25 in group 2. Thrombolysis in Cerebral Infarction grade 2 to 3 revascularization was achieved in 93% of group 1 and 84% of group 2 patients. In-hospital mortality and symptomatic intracranial hemorrhage rates were 3.8% and 12% for groups 1 and 2, respectively. Ninety-day mortality was 15% and 24% for groups 1 and 2, respectively. In groups 1 and 2, 48% and 42% of patients, respectively, had good outcomes (modified Rankin Scale score, 0-2), and 50% in both groups of patients achieved Thrombolysis in Cerebral Infarction grade 3 revascularization. Group 2 had longer revascularization times and required adjuvant devices more frequently. CONCLUSION: Our postmarket experience shows that in highly selected patients Trevo is safe and effective, even beyond 8 hours, despite longer procedure times and the need for adjuvant devices.

The neurological emergency room and prehospital stroke alert: the whole is greater than the sum of its parts.

BACKGROUND: Emergency medical services (EMS) prenotification to hospitals regarding the arrival of patients who have had a stroke is recommended to facilitate the workup once the patient arrives. Most hospitals have the patient enter the emergency department (ED) before obtaining a head computed tomography (CT) scan. At Capital Health, prehospital stroke-alert patients are delivered directly to CT and met by a neurological emergency team. The goal of bypassing the ED is to reduce the time to treatment. OBJECTIVE: To evaluate (1) door-to-CT and door-to-needle time in patients with an acute stroke who arrive as prehospital stroke alerts and (2) the accuracy of EMS assessment. METHODS: A prospective database of all prehospital stroke alert patients was kept and data retrospectively reviewed for patients who were seen between July 2012 and July 2013. RESULTS: Between July 2012 and July 2013, 141 prehospital stroke alerts were called to our emergency department, and the patients were stable enough to bypass the ED and go directly to CT. EMS assessment of stroke was accurate 66% of the time, and the diagnosis was neurological 89% of the time. The average time between patient arrival and acquisition of CT imaging was 11.8 minutes. Twenty-six of the 141 patients (18%) received intravenous tissue plasminogen activator. The median time from arrival to intravenous tissue plasminogen activator bolus was 44 minutes. CONCLUSION: Trained EMS responders are able to correctly identify patients who are experiencing neurological/neurosurgical emergencies and deliver patients to our comprehensive stroke center in a timely fashion after prenotification. The prehospital stroke alert protocol bypasses the ED, allowing the patient to be met in CT by the neurological ED team, which has proven to decrease door-to-CT and door-to-needle times from our historical means. ABBREVIATIONS: ASLS, Advanced Stroke Life SupportDTN, door-to-needleED, emergency departmentEMS, emergency medical servicesEMT, emergency medical technicianIV, intravenousMEND, Miami Emergency Neurological DeficitPHSA, prehospital stroke alerttPA, tissue plasminogen activator.

Miocarditis por Virus de Epstein Barr en un Recién Nacido séptico. Reporte de caso / Myocarditis due to Epstein Barr Virus in Septic Newborns. a Case Report

Se presenta el reporte de caso de un paciente recién nacido de sexo masculino nacido por parto cesárea de urgencia por desprendimiento normoplacentario. Hijo de una madre de 30 años de edad, sin patologías de base, con una gestación anterior, terminada por cesárea, sin abortos y con controles prenatales suficientes, que recibió dosis de corticoides para maduración pulmonar. La presentación del caso obedece a la rareza del recién nacido portador de una inflamación miocárdica comprobada por ecocardiografía doppler y elevación de enzimas musculares, que junto a las citopenias constituye una característica de los casos reportados de miocarditis por el virus de Epstein-Barr. Se hace un llamado de atención sobre esta posibilidad diagnóstica, especialmente en pacientes con plaquetopenia progresiva sin causa explicada y afectación miocárdica concomitante .

We present the case of a newborn male child delivered by Emergency Caesarean section, due to abruptio placentae. The mother, aged 30, was without underlying disease, had one previous pregnancy also delivered by Caesarian, without abortions, and with adequate prenatal monitoring, had received doses of corticosteroids for fetal lung maturation. The case represents a rare case of a newborn with myocardial inflammation confirmed by Doppler echocardiography and high muscle enzyme levels, which together with cytopenia are characteristics typical of previously reported cases of EpsteinBarr virus myocarditis. We call for increased alertness to this diagnosis, particularly in patients with unexplained progressive thrombocytopenia and concurrent myocardial involvement

Restricción del Crecimiento Intrauterino Diagnosticado Durante el Embarazo / Intrauterine Growth Restriction Diagnosed During Pregnancy

RESUMEN Introducción: la Restricción del crecimiento intrauterino (RCIU) es una patología caracterizada por una limitación del potencial del crecimiento fetal. Esta afección aumenta 6 a 10 veces el riesgo de mortalidad. Objetivos: determinar la prevalencia de la RCIU e investigar los resultados perinatales adversos que se presentan con mayor frecuencia. Metodología: estudio observacional, retrospectivo, de corte transverso. Población de estudio: gestantes que acudieron a la Cátedra de Ginecología y Obstetricia, en el periodo comprendido entre enero 2000 y diciembre 2003. Resultados: entre 8991 partos se hallaron 48 casos de RCIU. Fue más frecuente en las mujeres con más de 3 embarazos y con insuficiente control prenatal. La mayoría de los recién nacidos tenían bajo peso (menos de 2500 gr). El 62% eran recién nacidos a término con la prueba de Capurro. El 20,8% fueron hospitalizados por enfermedades respiratorias y hubo una muerte. La principal enfermedad de la madre fue la hipertensión arterial severa. Conclusiones: La prevalencia de RCIU fue del 0,53 %.

ABSTRACT Introduction: Intrauterine growth restriction (IUGR) is a disorder characterized by limited potential of fetal growth. This condition has a 6 to 10 fold increased mortality risk. Objectives: To determine the prevalence of IUGR and investigate adverse perinatal outcomes that occurs more frequently. Methodology: An observational, retrospective cross-sectional study. Study population: pregnant women attending the Department of Gynecology and Obstetrics during the period between January 2000 and December 2003. Results: 48 cases of IUGR were found among 8991 deliveries. It was more common in women with more than 3 pregnancies and inadequate prenatal care. Most infants had low birth weight (less than 2500 gr). 62% were term infants with the Capurro test. 20.8% were hospitalized due to respiratory disease and there was one death. The main maternal disease was severe hypertension. Conclusions: The prevalence of IUGR was 0.53%.

Sobrepeso y obesidad en adolescentes dominicanos de alto nivel socioeconómico / Overweigh and obesity in Dominican adolescents with high socioeconomic level

Con fines de conocer la prevalencia de sobrepeso en adolescentes dominicanos de grupos económicos medio y alto de 12 a 18 años de edad, de ambos sexos y apreciar su tendencia en los últimos años, se compararon los datos de dos estudios que incluían peso y tallas de niños de esa edad, con 10 años de diferencia, encontrándose un incremento significativo de la prevalencia de sobrepeso de 2.8 por ciento en el estudio de 1978 a 13.8 por ciento en el presente. La prevalencia de obesidad (peso/talla>97p y pliegue cutáneo tricipital>95 p) fue de 3.8 por ciento . Los casos de sobrepeso/obesidad identificados fueron mas frecuentes en varones y mostraron una tendencia a talla alta y la encuesta familiar de los mismos señaló el exceso de ingesta alimentaria en la mayoría de los niños así como una alta frecuencia de familiares cercanos con exceso de peso; así mismo factores conductuales familiares respecto a la alimentación del niño de riesgo potencial. Se comenta sobre las perspectivas del estudio para fundamentar acciones de prevención en los niños de riesgo

Displasia osteo-fibrosa

Se presenta el caso de una niña con displasia osteo-fibrosa de tipo poleostósico, situación poco frecuente, comentándose sobre sus características clínicas