Assessment of a New Change of Direction Detection Algorithm Based on Inertial Data.

The purpose of this study was to study the validity and reproducibility of an algorithm capable of combining information from Inertial and Magnetic Measurement Units (IMMUs) to detect changes of direction (COD). Five participants wore three devices at the same time to perform five CODs in three different conditions: angle (45°, 90°, 135° and 180°), direction (left and right), and running speed (13 and 18 km/h). For the testing, the combination of different % of smoothing applied to the signal (20%, 30% and 40%) and minimum intensity peak (PmI) for each event (0.8 G, 0.9 G, and 1.0 G) was applied. The values recorded with the sensors were contrasted with observation and coding from video. At 13 km/h, the combination of 30% smoothing and 0.9 G PmI was the one that showed the most accurate values (IMMU1: Cohen's d (d) = -0.29;%Diff = -4%; IMMU2: d = 0.04 %Diff = 0%, IMMU3: d = -0.27, %Diff = 13%). At 18 km/h, the 40% and 0.9 G combination was the most accurate (IMMU1: d = -0.28; %Diff = -4%; IMMU2 = d = -0.16; %Diff = -1%; IMMU3 = d = -0.26; %Diff = -2%). The results suggest the need to apply specific filters to the algorithm based on speed, in order to accurately detect COD.

Aplicación de la técnica WALANT en las cirugías de mano / Use of WALANT Technique in Hand Surgeries

Introducción: En los últimos años la anestesia local sin torniquete y con el paciente despierto, técnica conocida por WALANT (por sus siglas en inglés), ha ganado mucha popularidad en las cirugías de la mano y la muñeca. Objetivo: Reportar nuestra experiencia con el uso de la técnica WALANT, a fin de prescindir del uso del torniquete en las cirugías de la mano. Métodos: En noviembre del 2020 fueron intervenidos 30 pacientes por diversas enfermedades ortopédicas, entre las que figuraron: dedos en resorte, síndrome del túnel carpiano, tenovaginitis estenosante del pulgar, gangliones del carpo y amputación del tercer radio por rigidez en extensión postraumática, entre otras. Para la evaluación de la técnica tuvimos en cuenta: tiempo quirúrgico, magnitud del sangrado, dolor durante la infiltración anestésica, la intervención, y en las primeras 24 horas del postoperatorio, la necesidad de refuerzo anestésico, uso de isquemia, complicaciones y nivel de satisfacción del paciente. Resultados: Los resultados obtenidos con esta técnica anestésica son semejantes a otras, con las ventajas que el sangrado es leve, no hay que utilizar isquemia, el tiempo quirúrgico es menor y el efecto anestésico duró entre 10 y 12 horas en todos los pacientes. En ninguno de los pacientes hubo necesidad de refuerzo anestésico. Conclusiones: Se demuestra la efectividad de la técnica WALANT en las cirugías de mano. Con ella se disminuye el gasto de materiales para el acto quirúrgico, así como de personal, es de fácil aplicación y disminuyen las sensaciones desagradables y los peligros del uso de isquemia en los pacientes(AU)

Introduction: Currently, the use of local anaesthetic with no tourniquet and wide awake patient (Wide Awake Local Anaesthetic No Tourniquet - WALANT) has gained popularity in surgeries of the hand and wrist. Objective: To report our experience in the use of WALANT technique in order to discard the use of tourniquet in hand surgeries. Method: In November 2020, thirty patients underwent surgery due to different orthopaedic conditions, among them trigger fingers, carpal tunnel syndrome, stenosing tenovaginitis of the thumb, carpal ganglion and amputation of the third radius due to post trauma stiffness, among others. In order to assess this technique, we considered surgical time, volume of bleeding, pain during anesthetic infiltration, intervention and the need for additional anesthetic during the first 24 hours after surgery; we considered also ischemia, complications and level patient´s satisfaction. Results: This technique had similar results to others; however, the bleeding is mild, there is no need for ischemia, the surgical time is lesser and the anesthetic effect lasted 10 to 12 hours in all patients. None of them required additional anesthetic. All subjects felt the initial infiltration but none complained of pain during the rest of the anesthetic injection or during the surgical act. There were no complications. Conclusions: The effectiveness of WALANT technique in hand surgeries is shown. The cost of materials for the surgical act is reduced with it, as well as the surgical staff, it is easy to use and unpleasant sensations and dangers of the use of ischemia in patients are reduced(AU)

Factors Associated with Surrogate Self-Efficacy in Decision-Making for Patients with End-Stage Renal Disease.

AIM: The aim of the study is to assess which factors are associated with self-efficacy for making these decisions in surrogates of end-stage kidney disease patients. MATERIALS AND METHODS: Cross-sectional study conducted in the hemodialysis clinic of a private hospital in Mexico City. A total of 124 surrogates of patients in hemodialysis were included in the study. Self-efficacy for decision-making was assessed with the Family Decision-Making Self-Efficacy Scale. As factors related to decision-making self-efficacy, sociodemographic data, health information, and professional help received for dealing with end-of-life issues were assessed in both patients and surrogates. Functional status and advanced directives of the patient as well as prior experience in decision-making of the surrogates were also included. Logistic regression models were used to establish the associations. RESULTS: The mean age of participants was 49.4 years (standard deviation: 14). Factors associated to decision-making self-efficacy were awareness of the surrogate about the terminal disease of the patient (P < 0.001), prior conversation between the surrogate and the patient about end-of-life preferences (P = 0.037), time between the patient was told dialysis was required and accepting it inferior to 1 month (P = 0.016), and visual impairment of the patient (0.040). CONCLUSIONS: This study provides information of which factors are associated with self-effectiveness in surrogates of terminally ill renal patients so that strategies based on these considerations might be implemented in the future.

Atypical clinical presentation of flavivirus. Case report / Presentación clínica atípica de infección por flavivirus. Reporte de caso

The first report of chikungunya virus (CHIKV) in Mexico was in may 2014, in Jalisco, and has disseminated along the country in such a way that now is considered a relevant emergent vector-transmitted infection. It is clinically diagnosed by abrupt onset fever, asthenia, arthralgias, myalgias, headache and rash. In the clinical case, we described a women from Guerrero that had pulmonary symptomatology associated to CHIKV, which is an atypical clinical presentation that has been reported only in a hundred cases worldwide. In the epidemiological context the only known tool that we have to prevent the disease is the eradication of vectors because we lack population immunity, thus the importance of avoiding water accumulation and using protective gear. In Mexico we are acting through media advertisements in order to avoid, in first place the acute infection, which in severe cases can cause death, and in second place the chronic complications.

El primer caso de infección por virus chikunguña (CHIKV) en México ocurrió en Jalisco, en mayo de 2014 y se ha ido diseminando a lo largo del país, por lo que hoy en día se considera una infección emergente transmitida por vectores. Se caracteriza por fiebre de inicio abrupto, astenia intensa, artralgias múltiples, simétricas, bilaterales y debilitantes, de predominio en brazos y piernas, mialgias, cefalea y rash maculopapular. En el caso expuesto describimos a una mujer originaria del estado de Guerrero, la cual presentó sintomatología pulmonar asociada a infección por CHIKV, lo que representa una manifestación atípica de esta enfermedad, ya que solo ha sido reportada en cerca de 100 casos a nivel mundial. En el contexto epidemiológico se sabe que la única herramienta que se tiene disponible en estos momentos es la erradicación de los vectores que promueven su transmisión, ya que carecemos de inmunidad poblacional, por lo que es de vital importancia evitar el estancamiento de agua y alentar el uso de ropa de protección. Por último, se debe hacer énfasis en la forma en la que se actúa en México, por medio de la difusión de información, para evitar, en primer lugar, la infección aguda que puede llevar a la muerte en casos extremos, y en segundo término, salvar las complicaciones crónicas.

The N2O activation by Rh5 clusters. A quantum chemistry study.

Nitrous oxide (N2O) is a by-product of exhaust pipe gases treatment produced by motor vehicles. Therefore, the N2O reduction to N2 is necessary to meet the actual environmental legislation. The N2O adsorption and dissociation assisted by the square-based pyramidal Rh5 cluster was investigated using the density functional theory and the zero-order regular approximation (ZORA). The Rh5 sextet ground state is the most active in N2O dissociation, though the quartet and octet states are also active because they are degenerate. The Rh5 cluster spontaneously activates the N2─O cleavage, and the reaction is highly exothermic ca. -75 kcal mol(-1). The N2─O breaking is obtained for the geometrical arrangement that maximizes the overlap and electron transfers between the N2O and Rh5 frontier orbitals. The Rh5 high activity is due to the Rh 3d orbitals are located between the N2O HOMO and LUMO orbitals, which makes possible the interactions between them. In particular, the O 2p states strongly interact with Rh 3d orbitals, which finally weaken the N2─O bond. The electron transfer is from the Rh5 HOMO orbital to the N2O antibonding orbital.

Síndrome de escleras azules / Blue sclera syndrome

Presentamos el caso de una mujer de 35 años de edad, quien tuvo múltiples fracturas óseas, talla corta, xifoescoliosis izquierda, escleras azules, limitación funcional de caderas, dentinogénesis imperfecta, osteoporosis severa e hipoacusia de conducción. Se revisa los tipos de osteogénesis imperfecta, cuadro clínico, diagnóstico diferencial, tratamiento y pronóstico.

Síndrome de Marfan. A propósito de un caso / Marfan's syndrome. A case presentation and review

El síndrome de Marfan es una enfermedad hereditaria autosómica dominante que compromete muchos sistemas (esquelético, ocular, cardiovascular, cutáneo, pulmonar, abdominal, neurológico). La causa del síndrome de Marfan es desconocida, pero recientes estudios genéticos han relacionado esta enfermedad a un defecto microfibrilar extracelular localizado en el cromosoma 15q15-q21,3. Las características asociadas al síndrome de Marfan requieren un enfoque multidisciplinario. Reportamos un caso de síndrome de Marfan esporádico y revisamos las manifestaciones clínicas, los nuevos criterios de Ghent requeridos para el diagnóstico y las estrategias de manejo, que incluyen evaluaciones periódicas, modificación de factores de riesgo, consejería genética y cirugía para pacientes seleccionados.

Silla turca vacía e hipopituitarismo / Empty sella turcica and hypopituitarism

We present the case of a multiparous and obese woman of 59 years with partial hypopituitarism having an empty sella syndrome. We describe the clinical, radiological and biochemical findings. The diagnosis of empty sella was confirmed by computarized tomography. The levels of thyroxine, cortisol and growth hormone were decreased, with pituitary hyporresponsiveness to hypoglicemia induced with insulin. The replacement therapy was successful.