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OBJECTIVES: The Global Activity Limitation Indicator (GALI) is an instrument that measures long-term overall disability. The objective of this study was to evaluate GALI's predictive value on mortality while examining variations according to sex, age, and educational level. STUDY DESIGN: Longitudinal study. METHODS: This longitudinal study was based on 42,991 individuals aged ≥15 years who participated in the 2011-2012 National Health Survey and the 2014 European Health Survey in Spain. These records were linked to mortality data up to December 2021. GALI assessed self-reported functional limitation in the past 6 months and classified individuals into three categories: severely limited, limited but not severely, and not limited. Incidence rate ratios (IRR) were calculated using Poisson regression models, adjusting for sociodemographic, lifestyle, and health status variables. RESULTS: Compared to individuals with no limitations, those with non-severe limitations had an IRR for mortality of 1.27 (95% CI: 1.16-1.38), and 2.04 (95% CI: 1.81-2.31) in those with severe limitations. Women with severe limitations exhibited a higher IRR (2.32; 95% CI: 1.98-2.71) compared to men (1.73; 95% CI: 1.45-2.08) (P for interaction = 0.005). Individuals <65 years with severe limitations showed a greater association (2.22; 95% CI: 1.58-3.10) than those ≥65 (1.49; 95% CI: 1.32-1.69) (P for interaction <0.001). Among individuals with lower educational attainment, the IRR was 2.08 (95% CI: 1.83-2.37), and 1.87 (95% CI: 1.37-2.56) for the higher education group (P for interaction = 0.017). CONCLUSIONS: GALI is a robust predictor of all-cause mortality in the general population and subgroups. The association is stronger in women, individuals <65 years, and those with lower educational levels.
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Pessoas com Deficiência , Indicadores Básicos de Saúde , Masculino , Humanos , Feminino , Estudos Longitudinais , Nível de Saúde , Inquéritos EpidemiológicosRESUMO
The bulk photovoltaic effect is an experimentally verified phenomenon by which a direct charge current is induced within a non-centrosymmetric material by light illumination. Calculations of its intrinsic contribution, the shift current, are nowadays amenable from first-principles employing plane-wave bases. In this work, we present a general method for evaluating the shift conductivity in the framework of localized Gaussian basis sets that can be employed in both the length and velocity gauges, carrying the idiosyncrasies of the quantum-chemistry approach. The (possibly magnetic) symmetry of the system is exploited in order to fold the reciprocal space summations to the representation domain, allowing us to reduce computation time and unveiling the complete symmetry properties of the conductivity tensor under general light polarization.
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INTRODUCTION: all-in meniscal suture devices have evolved and simplified meniscal repair. In this study we will formulate the following research questions: what is the rate of survival and failure? What are the risk factors associated with failure? And what are the functional results after meniscal repair surgery? MATERIAL AND METHODS: ambispective study from 2001 to 2021 of patients with repairable meniscal injury with all-in meniscal suture devices. The survival and failure ratio were obtained with the Kaplan-Meier test, the risk factors associated with meniscal suture failure were assessed with the logistic regression test, and the pre- and post-surgical functional results were estimated with the test. t-Student. RESULTS: in 20 years of follow-up of 316 menisci repaired with all-in meniscal sutures, a survival rate of 95.9% was obtained. The absence of injury to the anterior horn of the meniscus was shown to be a protective factor [OR = 0.12], together with not practicing impact sports [OR = 0.2]. Post-surgery IKDC and Tegner-Lysholm results were shown to be very good to excellent (p < 0.0001). CONCLUSION: all-in meniscal suture devices are and will continue to be front-line weapons in the repair of meniscal tears. In 20 years of follow-up, a lower failure rate was evidenced, associated with excellent functional results.
INTRODUCCIÓN: los dispositivos de suturas meniscal todo adentro han evolucionado y simplificado la reparación meniscal. En este estudio formulamos las siguientes preguntas de investigación: ¿cuál es la tasa de supervivencia y falla?, ¿cuáles son los factores de riesgo asociado a falla? y ¿cuáles son los resultados funcionales posterior a la cirugía de reparación meniscal? MATERIAL Y MÉTODOS: estudio ambispectivo desde el 2001 al 2021 de pacientes con lesión meniscal reparable con dispositivos meniscales de sutura todo adentro. La razón de supervivencia y falla se obtuvo con el test de Kaplan-Meier, los factores de riesgo asociado con falla de la sutura meniscal se valoraron con el test de regresión logística y los resultados funcionales pre y postquirúrgicos fueron estimados con la prueba t-Student. RESULTADOS: en 20 años de seguimiento de 316 menisco reparados con suturas meniscal todo adentro se obtuvo que la razón de supervivencia de 95.9%. La ausencia de lesión del cuerno anterior del menisco se mostró como un factor protector [OR = 0.12], junto a la no práctica de deportes de impacto [OR = 0.2]. Se mostraron resultados del IKDC y Tegner-Lysholm posterior a la cirugía de muy buenos a excelentes (p < 0.0001). CONCLUSIÓN: los dispositivos de sutura de meniscal todo adentro son y seguirán siendo armas de primera línea en la reparación de las roturas meniscales. En 20 años de seguimiento se evidenció una menor tasa de falla, asociados con excelentes resultados funcionales.
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Meniscos Tibiais , Lesões do Menisco Tibial , Humanos , Artroscopia , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Técnicas de Sutura , Suturas , Lesões do Menisco Tibial/cirurgiaRESUMO
INTRODUCTION: Vascular disease (VD) is the most frequent cause of morbidity and mortality and its prevalence increases with age. Old patients are not included in studies on VD, their characteristics and treatments being unknown. OBJECTIVE: Know the clinical characteristics of nonagenarian patients hospitalized in Internal Medicine services with a diagnosis of established VD and the adequacy of their pharmacological management. MATERIAL AND METHODS: The NONAVASC-2 registry is an observational, prospective, multicentre study. Hospitalized patients for any cause were included. Data collection was carried out through an anonymous online database with sociodemographic, clinical, analytical, therapeutic and evolutionary parameters. RESULTS: One thousand forty-nine patients with a mean age of 93.14 years (57.8% women) were included. The prevalence of risk factors and VD was high: hypertension (84.9%), dyslipidemia (50.9%) and diabetes mellitus (29.4%). 33.4% presented severe-total dependency. 82.9% received antithrombotic treatment (53.7% antiplatelets, 25.4% anticoagulation and 3.8% double therapy). Only 38.2% received statins. The percentage of severe dependence (39.2% vs 24.1%; pâ¯=â¯0.00) and severe cognitive impairment (30.8% vs 13.8%; pâ¯=â¯0.00) was significantly higher among patients who did not receive them. 19% died during admission. CONCLUSIONS: Nonagenarian patients with VD present high comorbidity, dependence and mortality. Despite being in secondary prevention, 17% did not receive antithrombotics and only 38% received statins. The underprescription is conditioned, among other factors, by the functional status. More studies are necessary to determine the impact of this issue on their prognosis.
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Inibidores de Hidroximetilglutaril-CoA Redutases , Doenças Vasculares , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Hospitalização , Nonagenários , Estudos Prospectivos , Sistema de Registros , Doenças Vasculares/epidemiologia , Doenças Vasculares/terapiaRESUMO
OBJECTIVE: Human papillomavirus (HPV) is associated with cervical cancer. For the infection to occur, most HPV types depend on interactions with heparan sulfate proteoglycans (HSPGs); however, non-HSPGs receptors are also involved. Laminin 332 is a crucial component of the epidermis's base membrane. It has shown interactions with HPV that suggest its function as a transient viral receptor in the extracellular matrix (ECM). We provide new information about Laminin 332 and HPV by identifying LAMA3 gene allelic variants from exons 30 and 31 and their distribution among women with and without HPV infection. PATIENTS AND METHODS: We included 192 cervical cancer scrape samples from two groups of patients, 96 samples from patients with a low-grade squamous intraepithelial lesion (LSIL) and 96 samples from HPV-negative samples without LSIL. Identification of the HPV type was performed using an LCD-Array kit. Exons 30 and 31 of LAMA3 were amplified by PCR and analyzed by Sanger's sequencing. RESULTS: We identified a wide range of HPV types. The most frequent low-risk (lrHPV) HPV types were 6, 42, 44, and 90. For high-risk (hrHPV) HPV were 16, 31, 56, and 66. Only the genetic variant rs1131521 was identified in both groups. However, no significant association was observed between rs1131521 and the study groups. CONCLUSIONS: A single silent polymorphism was identified in both groups with similar frequency, whereas no mutations related to increased epithelial friability were identified.
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Resumen: Introducción: los dispositivos de suturas meniscal todo adentro han evolucionado y simplificado la reparación meniscal. En este estudio formulamos las siguientes preguntas de investigación: ¿cuál es la tasa de supervivencia y falla?, ¿cuáles son los factores de riesgo asociado a falla? y ¿cuáles son los resultados funcionales posterior a la cirugía de reparación meniscal? Material y métodos: estudio ambispectivo desde el 2001 al 2021 de pacientes con lesión meniscal reparable con dispositivos meniscales de sutura todo adentro. La razón de supervivencia y falla se obtuvo con el test de Kaplan-Meier, los factores de riesgo asociado con falla de la sutura meniscal se valoraron con el test de regresión logística y los resultados funcionales pre y postquirúrgicos fueron estimados con la prueba t-Student. Resultados: en 20 años de seguimiento de 316 menisco reparados con suturas meniscal todo adentro se obtuvo que la razón de supervivencia de 95.9%. La ausencia de lesión del cuerno anterior del menisco se mostró como un factor protector [OR = 0.12], junto a la no práctica de deportes de impacto [OR = 0.2]. Se mostraron resultados del IKDC y Tegner-Lysholm posterior a la cirugía de muy buenos a excelentes (p < 0.0001). Conclusión: los dispositivos de sutura de meniscal todo adentro son y seguirán siendo armas de primera línea en la reparación de las roturas meniscales. En 20 años de seguimiento se evidenció una menor tasa de falla, asociados con excelentes resultados funcionales.
Abstract: Introduction: all-in meniscal suture devices have evolved and simplified meniscal repair. In this study we will formulate the following research questions: what is the rate of survival and failure? What are the risk factors associated with failure? And what are the functional results after meniscal repair surgery? Material and methods: ambispective study from 2001 to 2021 of patients with repairable meniscal injury with all-in meniscal suture devices. The survival and failure ratio were obtained with the Kaplan-Meier test, the risk factors associated with meniscal suture failure were assessed with the logistic regression test, and the pre- and post-surgical functional results were estimated with the test. t-Student. Results: in 20 years of follow-up of 316 menisci repaired with all-in meniscal sutures, a survival rate of 95.9% was obtained. The absence of injury to the anterior horn of the meniscus was shown to be a protective factor [OR = 0.12], together with not practicing impact sports [OR = 0.2]. Post-surgery IKDC and Tegner-Lysholm results were shown to be very good to excellent (p < 0.0001). Conclusion: all-in meniscal suture devices are and will continue to be front-line weapons in the repair of meniscal tears. In 20 years of follow-up, a lower failure rate was evidenced, associated with excellent functional results.
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Infecções Comunitárias Adquiridas , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Humanos , Cefalosporinas/uso terapêutico , Antibacterianos/uso terapêutico , Testes de Sensibilidade Microbiana , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , CeftarolinaRESUMO
Single immune checkpoint blockade in advanced neuroendocrine neoplasms (NENs) shows limited efficacy; dual checkpoint blockade may improve treatment activity. Dune (NCT03095274) is a non-randomized controlled multicohort phase II clinical trial evaluating durvalumab plus tremelimumab activity and safety in advanced NENs. This study included 123 patients presenting between 2017 and 2019 with typical/atypical lung carcinoids (Cohort 1), G1/2 gastrointestinal (Cohort 2), G1/2 pancreatic (Cohort 3) and G3 gastroenteropancreatic (GEP) (Cohort 4) NENs; who progressed to standard therapies. Patients received 1500 mg durvalumab and 75 mg tremelimumab for up to 13 and 4 cycles (every 4 weeks), respectively. The primary objective was the 9-month clinical benefit rate (CBR) for cohorts 1-3 and 9-month overall survival (OS) rate for Cohort 4. Secondary endpoints included objective response rate, duration of response, progression-free survival according to irRECIST, overall survival, and safety. Correlation of PD-L1 expression with efficacy was exploratory. The 9-month CBR was 25.9%/35.5%/25% for Cohorts 1, 2, and 3 respectively. The 9-month OS rate for Cohort 4 was 36.1%, surpassing the futility threshold. Benefit in Cohort 4 was observed regardless of differentiation and Ki67 levels. PD-L1 combined scores did not correlate with treatment activity. Safety profile was consistent with that of prior studies. In conclusion, durvalumab plus tremelimumab is safe in NENs and shows modest survival benefit in G3 GEP-NENs; with one-third of these patients experiencing a prolonged OS.
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Tumor Carcinoide , Tumores Neuroendócrinos , Humanos , Antígeno B7-H1 , PulmãoRESUMO
INTRODUCTION: Safety Rounds (SR) are an operational tool that allow knowing adherence to good practices, help identify risks and incidents in patient safety (PS), allowing improvement actions to be implemented. The objective of this work was the design of a procedure to perform SR in an Intensive Care Unit (ICU). METHODS: Preparation of a checklist for the development of SR in the ICU through the nominal group technique, with the participation of managers, middle managers and professionals from different disciplines and categories. In the first place, a group of experts agreed, based on the recommendations on good practices in PS, the definition of items, their coding, the criteria for compliance and the impact of non-compliance. Subsequently, its viability was determined through a cross-sectional study through the piloting of two SRs to adjust the items in real clinical practice conditions. RESULTS: A specific SR model for ICUs has been obtained through a checklist. The group of experts prepared a first list made up of 39 items of 6 essential dimensions and defined the method of implementation. Mean time to complete the two SRs was 85â¯min, including the briefing and subsequent debriefing. After the validation pilot, the dimensions were reduced to 5, 3 items were deleted, 2 items were transferred to another dimension and 3 items related to nosocomial infections and informed consent were modified. In addition, the data sources, the compliance criteria and their relative weight were redefined. The final list was considered useful and relevant to improve practice. CONCLUSIONS: Through a consensus methodology, a checklist has been built to be used in the RS of an ICU. This model can serve as a basis for its use in healthcare services with similar characteristics.
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Cuidados Críticos , Unidades de Terapia Intensiva , Humanos , Estudos Transversais , Segurança do Paciente , Lista de ChecagemRESUMO
OBJECTIVE: The aim of the present study was to evaluate the diagnostic performance of monocyte distribution width (MDW) as a biomarker for sepsis diagnosis in severe patients attended in the Emergency Department for different conditions and not only infections. METHODS: We performed an observational study in a consecutive prospective cohort including severe patients attending the Emergency Department with different conditions. MDW and other biomarkers were determined from samples obtained during the first care of patients. The diagnostic performance of the different biomarkers was determined based on the final diagnosis at patient discharge. RESULTS: One hundred two patients, with a mean age of 76.7 (SD 16.5) years were included, 53 being (51.9%) male. Among the patients included, 65 (63.7%) had an infectious disease while the remaining had other different conditions. A MDW cut-off of 20.115 provided the best accuracy to identify infected patients, with a sensitivity of 89.2 (95% CI 79.4-94.7), a specificity of 89.2 (95% CI 75.3-95.7), a positive predictive value of 93.5 (95% CI 84.6-97.5), a negative predictive value of 82.5% (95% CI 68.0-91.3), a positive likelihood ratio of 8.25 (3.26-20.91), and a negative likelihood ratio of 0.12 (0.06-0.24). The area under the receiver operating characteristic curve for infection according to MDW was 0.943 (95% CI 0.897-0.989; p<0.001). CONCLUSIONS: A MDW > 20.115 may be associated with infection and could help to distinguish between infected and non-infected patients in severe patients. These results must be confirmed in new studies due to the limited patient sample included.
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Monócitos , Sepse , Humanos , Masculino , Idoso , Feminino , Projetos Piloto , Estudos Prospectivos , Sepse/diagnóstico , Biomarcadores , Serviço Hospitalar de EmergênciaRESUMO
Transposition flaps are some of the most commonly used flaps for reconstructing scalp defects. Limberg first described his rhomboid transposition flap in 1946. Dufourmentel flap was an improved version of the Limberg flap published in 1962 in which the base of the flap is widened to improve vascularisation. Transposition flaps are one of the best known and most widely used transposition flaps in reconstructive surgery. They have proven successful in different types of reconstructive and aesthetic situations as a full-thickness random transposition flap. Combination of three Dufourmentel flaps to reconstruct hexagonal defects has not been reported in the literature. It is a modification of the triple Limberg flap, in which, after removing a hexagonal defect, we reconstruct the primary defect with a triple Dufourmentel flap. This flap is very useful for reconstructing large scalp defects as it provides a large amount of skin tissue with high viability; however, given its versatility, it could be used in other anatomical areas. Ann Med Surg (Lond) 2021 7:102544; Plast Reconstr Surg 2015 136:163-164; Atlas Oral Maxillofac Surg Clin North Am 2020 28:17-22.
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Displasia Ectodérmica , Procedimentos de Cirurgia Plástica , Humanos , Couro Cabeludo , Retalhos CirúrgicosRESUMO
The generalizability of findings from Clinical Trials (CTs) investigating lymphedema treatment modalities requires an accurate representation of the target population. This study aims to evaluate racial and ethnic reporting and representation in lymphedema CTs. A comprehensive systematic literature search was conducted during May 2023 using multiple databases, following the PRISMA guidelines. All CTs published from 2018 to 2023 were included. A total of 84 articles were included in this review, from which 6,546 participants were included in the analysis. Seventy-four (88.1%) articles addressed secondary lymphedema, of which 60 (81.1%) were related to breast cancer. Only 12 (13%) of CTs reported at some extend race or ethnicity. Of these, five (41.6%) reported race and two (16.6%) reported ethnicity according to FDA guidelines. White race had the highest pooled prevalence (80%; 95% CI 72-86%; I2=90%), followed by Black (7%; 95% CI 2- 15%; I2= 94.3%) and Asian (4%; 95% CI 1-8%; I2= 89.9%). In studies reporting ethnicity, participants were predominantly non-Hispanic (92.1%; 95% CI 90 - 94%). There is an underreporting and underrepresentation of racial and ethnic minorities among lymphedema CTs, limiting their generalizability. It is imperative to future development of strategies to enhance diversity in the study sample.
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Ensaios Clínicos como Assunto , Minorias Étnicas e Raciais , Linfedema , Humanos , Linfedema/terapia , Linfedema/etnologia , Linfedema/epidemiologia , Minorias Étnicas e Raciais/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , FemininoRESUMO
Introducción: El accidente cerebrovascular (ACV) es una afección con alta morbimortalidad, producida por la interrupción de la perfusión cerebral. Este artículo tiene como objetivo analizar la tendencia de egresos hospitalarios por ACV agudo en el periodo 2018-2021 en Chile. Metodología: Estudio descriptivo observacional, que incluyó egresos hospitalarios con diagnóstico de ACV agudo en el periodo 2018-2021, en Chile (n=19.274), según datos del Departamento de Estadísticas e Información de Salud de Chile. Se calculó la tasa de egreso hospitalario (TEH) según variable, utilizando datos del censo chileno 2017. No requirió comité de ética. Resultados: El 2018 tuvo la mayor TEH por ACV agudo (28,99) y el 2021 la menor (26,39). El grupo de "80 años y más" presenta la mayor TEH, mientras que el de "5-9 años" la menor. La mayor y menor TEH las tienen las regiones de Ñuble (263,00) y Tarapacá (10,29), respectivamente. Discusión: La disminución de TEH durante dicho periodo podría deberse al fortalecimiento de la Ley de Urgencia, al Programa Nacional de Telesalud y el impacto de la reciente pandemia. A mayor edad, aumenta la prevalencia y gravedad de las comorbilidades, lo cual explicaría la mayor TEH en el grupo más longevo. La mayor TEH masculina podría ser porque los hombres presentan mayor cantidad y severidad de factores de riesgo. La mayor TEH en la región del Ñuble posiblemente sea por los elevados niveles de pobreza y ruralidad, y la menor TEH en Tarapacá podría relacionarse con la presencia de una población nacional más joven.
Introduction: Stroke (CVA) is a condition with high morbidity and mortality, produced by the interruption of cerebral perfusion. This article aims to analyze the trend of hospital discharges for acute stroke in the period 2018-2021 in Chile. Methodology: Descriptive observational study, which included hospital discharges with a diagnosis of acute stroke in the period 2018-2021, in Chile (n=19,274), according to data from the Chilean Department of Health Statistics and Information. The hospital discharge rate (HTE) was calculated according to variable, using data from the 2017 Chilean census. No ethics committee was required. Results: 2018 had the highest HTE for acute stroke (28.99) and 2021 the lowest (26.39). The group aged "80 years and older" had the highest TEH, while the group aged "5-9 years" had the lowest TEH. The regions of Ñuble (263.00) and Tarapacá (10.29) have the highest and lowest HTE, respectively. Discussion: The decrease in HTE during this period could be due to the strengthening of the emergency law, the National Telehealth Program and the impact of the recent pandemic. The higher the age, the higher the prevalence and severity of comorbidities, which would explain the higher HTE in the older group. The higher male HTE may be due to the fact that men have a greater number and severity of risk factors. The higher HTE in the Ñuble region is possibly due to the high levels of poverty and rurality, and the lower HTE in Tarapacá would be related to having a younger national population.
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/epidemiologia , Hospitalização/estatística & dados numéricos , Chile/epidemiologia , Distribuição por Idade e SexoRESUMO
INTRODUCTION: the tibial slope has been identified as one of the factors associated with graft failure after anterior cruciate ligament (ACL) reconstruction; however, its relationship with functional results has been little studied. The main purpose of this study is to determine the effect of the tibial slope on functional recovery in patients undergoing reconstruction of the anterior cruciate ligament. MATERIAL AND METHODS: we included patients with a diagnosis of anterior cruciate ligament injury undergoing primary reconstruction, from May 2018 to May 2019, who had a complete radiographic and clinical record; also, the scores from questionnaires of the International Knee Documentation Committee (IKDC) and Lysholm scores were collected pre surgical procedures and throughout the one-year follow-up. The measurement of the tibial slope was performed in lateral knee X-rays from the electronic clinical record. A descriptive analysis of first intention was done, and to achieve the objectives, we compared 25 patients who had normal tibial slope that were selected randomly with 25 patients who had increased tibial slope. RESULTS: a total of 98 patients were included, 73 had a normal tibial slope (equal to or less than 12 degrees) and 25 with an increased tibial slope (greater than 12 degrees), the average age in both groups was 28.43 years for the group with normal tibial slope and 28.26 for patients with increased tibial slope. Regarding the functional assessment, the IKDC and Lysholm scores at the end of the follow-up were better for patients with normal tibial slope. Graft failure was only identified in the group with increased tibial slope. On the other hand, the comparative analysis with the control group randomly selected who had normal tibial slope, showed a better functional result assessed by IKDC score at the end of the follow-up for the group with normal tibial slope. CONCLUSION: patients undergoing ACL reconstruction and increased Tibial Slope have an inferior functional result at one year of follow-up assessed by IKDC, when compared with patients with normal tibial slope.
INTRODUCCIÓN: el slope tibial (inclinación) se ha identificado como uno de los factores asociados a la falla del injerto tras una reconstrucción de ligamento cruzado anterior (LCA); sin embargo, su relación con los resultados funcionales ha sido poco estudiada. El objetivo de este estudio es determinar el efecto del slope tibial en la recuperación funcional, en pacientes sometidos a reconstrucción de LCA. MATERIAL Y MÉTODOS: se incluyeron los pacientes con lesión de LCA sometidos a reconstrucción primaria, de Mayo de 2018 a Mayo de 2019, midiendo el slope tibial y recabando los puntajes de IKDC y Lysholm. Se elaboró un análisis descriptivo de primera intención y para alcanzar los objetivos se realizó una comparativa de 25 pacientes con slope tibial normal seleccionados aleatoriamente contra 25 pacientes con slope tibial aumentado. RESULTADOS: se incluyeron 98 pacientes, 73 contaban con un slope tibial normal y 25 con un slope tibial aumentado. Los puntajes de IKDC y Lysholm al final del seguimiento fueron mejores en los pacientes con slope tibial normal. La falla del injerto sólo se identificó en el grupo con slope tibial aumentado. Por otro lado, al análisis comparativo con el grupo control demostró un mejor resultado funcional al final del seguimiento valorado por IKDC en el grupo con slope tibial normal. CONCLUSIÓN: los pacientes sometidos a reconstrucción de LCA y slope tibial aumentado tienen un resultado funcional inferior al año de seguimiento evaluado por IKDC en comparación con pacientes con slope tibial dentro de parámetros normales.
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Reconstrução do Ligamento Cruzado Anterior , Adulto , HumanosRESUMO
Introducción. La pandemia por COVID-19 ha evidenciado la importancia de la metodología epidemiológica, por lo que es significativo fortalecer su aprendizaje en todos los niveles formativos del área de ciencias de la salud. Objetivo. Aplicar metodología epidemiológica de carácter descriptivo y analítico para el estudio de una base de datos de casos COVID-19 en la República Mexicana. Material y métodos. Se realizó una búsqueda de bases de datos en sitios web oficiales sobre los casos de COVID-19, y se recuperó un archivo en formato Excel con la información de 65,536 casos al día 10 de abril del 2021 a las 01:14hrs. Posteriormente, se realizó análisis estadístico de las diferentes variables mediante el programa SPSS, versión 21 en español, consistente en cálculo de prevalencias, razón de productos cruzados (RPC) y medidas de asociación, en lo cual participaron alumnos del cuarto semestre de enfermería. Resultados. La prevalencia para el género masculino fue de 53 %, y para el femenino de 47 %, con una media aritmética de edad de 35 años. La Chi cuadrada entre género y resultado de laboratorio positivo fue de 6527.9, con un 99 % de probabilidad de que haya asociación entre las variables. Asimismo, para la relación hipertensión y resultado de laboratorio positivo la Chi cuadrada fue de 51.97. La RPC para diabetes y resultado de laboratorio positivo fue de 1.4. Conclusiones. La aplicación de indicadores epidemiológicos básicos representa una herramienta importante para el fenómeno epidemiológico COVID-19, pues establece una caracterización de la epidemia en nuestro país.
Introduction: The COVID-19 pandemic has evidenced the importance of epidemiological methodology, so it is significant to strengthen its learning at all educational levels in the area of health sciences. Objetive. Apply descriptive and analytical epidemiological methodology for the study of a database of COVID-19 cases in the Mexican Republic. Material and methods: A search of databases on official websites on COVID-19 cases was carried out, and an Excel format file was recovered with the information of 65,536 cases as of April 10, 2021 at 01:14 a.m. Subsequently, a statistical analysis of the different variables was carried out using the SPSS program, version 21 in Spanish, consisting of calculation of prevalence, ratio of cross products (RPC) and measures of association, in which fourth semester nursing students participated. Results: The prevalence for the male gender was 53%, and for the female 47%, with an arithmetic mean age of 35 years. The Chi square between gender and positive laboratory result was 6527.9, with a 99% probability of an association between the variables. Likewise, for the relationship between hypertension and a positive laboratory result, the Chi square was 51.97. The RPC for diabetes and positive laboratory result was 1.4. Conclusions: The application of basic epidemiological indicators represents an important tool for the epidemiological phenomenon COVID-19, since it establishes a characterization of the epidemic in our country.
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Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Indicadores de Morbimortalidade , Base de Dados , COVID-19RESUMO
The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm2for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm2for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm2for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm2for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.
Assuntos
Cardiologia , Níveis de Referência de Diagnóstico , Cardiologia/métodos , Criança , Fluoroscopia , Humanos , América Latina , Doses de Radiação , Radiografia Intervencionista/métodos , Radiologia Intervencionista , Valores de ReferênciaRESUMO
Despite modern perioperative care, postoperative complications continue to play a significant role in patient's recovery. Implementation of enhanced recovery pathways has consistently demonstrated better outcomes, reduced complications, and improved length of stay across the globe. However, the literature is scarce with regard to the peaks and valleys encountered during the implementation of these programs in Latin America. The purpose of this review is to shed light on the development and establishment of enhanced recovery pathways in the region. Moreover, it discusses current challenges and future perspectives on perioperative optimization.
Assuntos
Recuperação Pós-Cirúrgica Melhorada , Humanos , Tempo de Internação , Assistência Perioperatória/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologiaRESUMO
Exogenous lipoid pneumonia is a rare entity with non-specific clinical presentation. Early diagnosis is key to prevent pulmonary fibrosis in cases of chronic exogenous lipoid pneumonia . Here, we present the diagnostic process in a 51-year-old female with chronic cough and yellow sputum, no fever nor signs of infection. The computerized axial tomography scan showed alveolar infiltrates in both lungs. We performed a bronchoalveolar lavage and collected a yellowish material, but no clear result were obtained from its analysis. Cryobiopsy of lung tissue was key for the diagnosis of exogenous lipoid pneumonia . This may be related to the chronic anorexia nervosa that the patient suffers, associated with purgative habits. After identifying the cause of the symptoms, the patient is recovering, changing her habits, and has no cough nor sputum.
Assuntos
Anorexia Nervosa , Broncopneumonia , Pneumonia Lipoide , Anorexia Nervosa/complicações , Lavagem Broncoalveolar/efeitos adversos , Lavagem Broncoalveolar/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Pneumonia Lipoide/diagnóstico , Pneumonia Lipoide/etiologia , Pneumonia Lipoide/patologia , Tomografia Computadorizada por Raios X/efeitos adversosRESUMO
The TJ-II stellarator presently in operation at the National Laboratory of Fusion is subject to radiological surveillance in compliance with the Spanish Nuclear Regulation. During its pulsed operation hard X-rays are emitted by the runaway electrons, and soft X-rays are generated by bremsstrahlung of thermalized electrons. Inside the experimental hall, the plasma heating systems and some active diagnostics are additional sources of radiation. Outside the experimental hall, some auxiliary systems, such as high-voltage power supplies, must be checked for radiological influence. In order to verify the adequate radiological classification of the different working areas, 15 dosemeters are distributed in radiologically controlled areas close to the machine, as well as in areas of public use in the TJ-II building. The integrated dose equivalent is analyzed to help establish the range of radiological influence of the stellarator. The results of the period 2015-20 are presented and analyzed.