Osteoarthritis Increases the Frequency and Duration of Postoperative Hand Clinic Visits after Carpal Tunnel Release.

Background: Carpal tunnel syndrome affects up to 6% of the general population, and surgical intervention is often required to ameliorate symptoms. Osteoarthritis (OA) is a common condition that often coexists with carpal tunnel syndrome. We hypothesized that patients with preexisting OA use more healthcare resources after carpal tunnel release (CTR) than patients without arthritis. Methods: This was a retrospective cohort study at a single academic center between January 1, 2018 and November 1, 2021. Patients who underwent CTR were included. Preoperative carpal tunnel symptoms, diagnostic tests, medications, and concomitant OA were abstracted. Hand, wrist, and basal joint arthritis were specified. The primary outcome was healthcare utilization represented by duration and frequency of hand clinic and occupational therapy (OT) follow-up. In total, 312 hands were included. Multivariable analysis was performed. Results: The average duration of hand clinic follow-up among patients without arthritis was 25.3 days compared with 87.1 days for patients with any arthritis (P = 0.0375) and 172 days for patients with wrist arthritis (P = 0.012). The average number of postoperative surgeon visits was increased in patients with hand arthritis, with an average of 2.3 visits versus 1.34 visits for patients without arthritis (P = 0.003). Both the number of OT visits and the duration of OT follow-up did not differ between cohorts. Conclusion: After CTR, patients with preexisting OA use more healthcare resources than patients without OA.

Cesarean rate in selected hospital network of private sector: A retrospective study.

INTRODUCTION: In Spain over the last two decades, cesarean section (CS) rates have increased from 15 to 25% in the Public Health Sector and from 28 to 38% in the private sector. There are multiples causes for this rise, which are often unclear. The aim of our study is to collect and analyze all the CS rates data from a hospital network of the 42 Quirónsalud Hospitals (private sector) and to assess its distribution regarding the different types of hospitals and patient characteristics. MATERIAL AND METHODS: An observational retrospective study between 2017 and 2018 was performed. Hospitals are classified into three groups: large hospitals (11), medium hospitals (17) and small hospitals (14). The cesarean section rate was measured by patient categorization into three groups: total deliveries, low risk cesarean sections and low risk cesarean sections without previous cesarean delivery. RESULTS: We analyzed 62,685 deliveries: 42,987 were vaginal deliveries (68.6%) and 19,698 CS (31.4%). The mean age for the total number of deliveries was 34.18 years old, whilst the mean age for the low-risk group was 34.12. Of the 19,698 CS, 18.36% (3618) were in high-risk population and 81.63% (16,080) in low risk population. 69.54% (11,183) of the low-risk CS were in patients without a previous CS. CONCLUSIONS: The overall rate of CS in the Quirónsalud group is slightly higher than the one from the Public Healthcare. The older maternal age as well as the hospital resources involved in the delivery attendance can explain this difference.

First-trimester fasting glycemia as a predictor of gestational diabetes (GDM) and adverse pregnancy outcomes.

AIMS: Studies to prevent gestational diabetes (GDM) have shown the best results when lifestyle measures have been applied early in pregnancy. We aimed to investigate whether first-trimester fasting plasma glucose (FPG) could predict GDM risk and adverse pregnancy outcomes. METHODS: A retrospective analysis of prospectively collected data from singleton pregnancies who were attended at our hospital between 2008 and 2018 (n = 27,198) was performed. We included patients with a recorded first-trimester FPG and complete pregnancy data (n = 6845). Patients under 18, with pregestational diabetes or reproductive techniques, were excluded. First-trimester FPG was evaluated as a continuous variable and divided into quartiles. GDM was diagnosed by NDDG criteria. The relationship between first- and second-trimester glucose > 92 mg/dL was also investigated. The relationship between FPG and pregnancy outcomes was assessed in 6150 patients who did not have GDM. RESULTS: Maternal age was 34.2 ± 3.9 years, BMI 23.1 ± 3.7 kg/m2 and mean FPG 83.0 ± 7.3 mg/dL. Glucose quartiles were: ≤ 78, 79-83, 84-87 and ≥ 88 mg/dL. First-trimester FPG predicted the risk of GDM (7%, 8%, 10.2% and 16% in each quartile, p < 0.001) and the risk of second-trimester glucose > 92 mg/dL (2.6%, 3.8%, 6.3% and 11.4% in each quartile, p < 0.001). FPG was significantly associated with LGA (8.2%, 9.3%, 10% and 11.7% in each quartile, p = 0.011) but not with other obstetrical outcomes. In a multivariate analysis including age, BMI, tobacco use, number of pregnancies and weight gained during pregnancy, first-trimester FPG was an independent predictor of LGA. CONCLUSIONS: First-trimester FPG is an early marker of GDM and LGA.

Delayed-onset paraparesis in Lassa fever: A case report.

Lassa fever (LF) is an endemic viral hemorrhagic fever in West Africa. Among the serious complications of the disease are neurological manifestations whose spectrum is incompletely known. Here we report the case of a 61-year-old man who developed a delayed-onset paraparesis a few weeks after getting infected with Lassa virus, thereby suggesting a possible association between LF and spinal cord disorders.

Maternal fasting glycemia and adverse pregnancy outcomes in a Mediterranean population.

AIMS: The hyperglycemia and adverse pregnancy outcome study demonstrated a continuous association between fasting plasma glucose (FPG) levels below those diagnostic of diabetes and adverse neonatal outcomes. We aimed to investigate whether the same association was found in a Mediterranean population. METHODS: A retrospective analysis of singleton pregnancies attended at our Hospital between 2008 and 2015 (n = 5203). FPG was evaluated in the second trimester, and it was divided into 7 categories (1 < 75, 2 75-79, 3 80-84, 4 85-89, 5 90-94, 6 95-99 and 7 100-124 mg/dL). Pregnancy outcomes included elective cesarean delivery, gestational hypertensive disorders (GHD), large for gestational age (LGA), small for gestational age (SGA), macrosomia, prematurity, severe prematurity and APGAR at 1 min <7. RESULTS: Maternal age was 33.8 ± 3.8 years, and BMI at first antenatal visit was 22.9 ± 3.5 kg/m2; mean FPG was 79 ± 7 mg/dL. A positive association was observed between FPG and LGA (p < 0.001), GHD (p = 0.004) and prematurity both <37 and <34 weeks of gestation (p = 0.001 and p = 0.004). FPG and SGA were inversely related (p = 0,038). FPG was not significantly related to rate of C-section or APGAR. Adjusted odds ratios associated with 1 standard deviation increase in the fasting plasma glucose (7 mg/dL) were 1.26 (1.15 to 1.37) for LGA, 1.28 (1.09 to 1.49) for GHD and 0.83 (0.74-0.93) for SGA. In a multivariate analysis controlling for confounders, FPG remained associated with LGA. CONCLUSIONS: We found an association between FPG levels, below those diagnostic of gestational diabetes according to our guidelines, and adverse maternal and neonatal outcomes in a Mediterranean population.

The TITAN-AMI multicenter registry evaluating the usage of Titan2 stent in patients with ST segment elevation myocardial infarction. Final result at 12-month follow-up.

AIM: Primary percutaneous coronary intervention with stent implantation is the recommended treatment for patients with ST elevation myocardial infarction (STEMI). Data from randomised trials showed good performance by a titanium-nitric-oxide coated stent in this context. The aim of this study was to confirm these data. METHODS: A multicentre registry was compiled in 23 hospitals in Spain in an all-comers population. We selected patients with STEMI from a global Titan AMI registry that included patients with acute coronary syndrome. Primary endpoint was the composite of cardiac death, non-fatal myocardial infarction, stent thrombosis and target lesion revascularisation, at 12-month follow-up. RESULTS: The study included 893 patients with STEMI. We included all possibilities for PCI: 86.6% primary, 5% facilitated after successful fibrinolysis and 8.4% rescue PCI after failed fibrinolysis. The primary endpoint was reached in 8.4% of the patients: cardiac death 2.7%, reinfarction 3.4%, target lesion revascularisation 3.5% and definite or probable stent thrombosis 2.8%. The majority of stent thromboses presented in the first 30 days after PCI. CONCLUSION: A bioactive stent (titanium-nitric-oxide coated stent) is a possible alternative for the treatment of patients with STEMI. One-year follow-up showed better results than those presented by a regular bare-metal stent or first-generation drug-eluting stent in terms of stent thrombosis.

Analysis of quality of nuchal translucency measurements: its role in prenatal diagnosis.

OBJECTIVE: Quantitative analysis of the quality of nuchal translucency (NT) measurements. METHODS: First-trimester combined screening for Down syndrome was performed to all pregnant women attended in our Department from October 2003 to November 2009. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians. The performance of NT measurements was retrospectively analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown rump length (CRL) values, and FMF certification was statistically tested. RESULTS: A total of 14978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0,98. (2) Mean percentage of cases >95th and <5th centiles were 5,0% and 4,2%, respectively. (3) Logarithmic mean and SD of the NT MoM values were 0,00 and 0,13, respectively. (4) The DR for trisomy 21 at screening time was 90,7% for a FPR of 6,7% for standard screening strategy. (5) According to Cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators. CONCLUSION: Overall, quality standards show optimal NT measurements in our unit. Operator experience, a dedicated profile to fetal medicine, CRL over 60 mm, and FMF certification have a significant positive impact on the quality standards.

A rapid method for detection of catalase-positive and catalase-negative bacteria based on monitoring of hydrogen peroxide evolution at a composite peroxidase biosensor.

The rapid detection of catalase-positive and catalase-negative bacteria in complex culture media has been accomplished by monitoring of hydrogen peroxide consumption or generation with a graphite-Teflon-peroxidase-ferrocene composite electrode. Escherichia coli and Streptococcus pneumoniae have been used as model catalase-positive and catalase-negative bacteria, respectively. Hydrogen peroxide evolution was amperometrically measured at 0.00 V. Experimental conditions, including the working solution composition, the incubation time and the hydrogen peroxide concentration, were optimized. The reusability of the biosensor was improved by placing a nylon membrane on the bioelectrode surface to prevent fouling caused by the bacterial medium. The developed methodology allowed the detection of E. coli and S. pneumoniae at concentration levels of approximately 2x10(6) and 2x10(5) cfu/mL, in assays taking 10 and 15 min, respectively, without any pre-concentration step or pre-enrichment procedure.

Lectin-modified piezoelectric biosensors for bacteria recognition and quantification.

The use of lectins for microorganism biosensors fabrication is proposed. Lectins are immobilised onto a gold-plated quartz crystal for direct piezoelectric label-free transduction of the bacteria-lectin binding event using an electrochemical quartz crystal microbalance (EQCM). Concanavalin A (Con A) and Escherichia coli were used for the evaluation of the lectin immobilisation method and the biosensor performance. Adsorption on nonpolarised and polarised (-0.200 V) gold-coated quartz crystals and immobilisation through avidin-biotin binding were checked for Con A surface attachment. Lectin-bacteria binding was evaluated in all cases. With a crystal modified with Con A via avidin-biotin immobilisation we obtained a linear calibration plot between 5.0 x 10(6) and 2.0 x 10(7) cfu mL(-1) by measuring frequency changes with E. coli concentration 1 h after bacteria addition. A remarkable increase in sensitivity was achieved when the analytical solution contained free biotinylated Con A, as a consequence of multiple lectin adhesion to Escherichia coli cell wall, which produced an accumulation of Con A-E. coli conjugates in the form of multilayers at the electrode surface. A detection limit of approximately 1.0 x 10(4) cfu mL(-1) was achieved. Moreover nonspecific adsorptions were minimised. Using Con A and lectin from Arachis hypogaea, different response profiles were achieved for Escherichia coli, Staphylococcus aureus and Mycobacterium phlei, thus demonstrating the feasibility of bacteria discrimination. An approach involving filtering of free and lectin-bound bacteria and introduction of a filter in the measuring cell allowed a significant frequency change to be obtained for an E. coli concentration of 1.0 x 10(3) cfu mL(-1) in order to further increase the sensitivity and discriminate between viable and nonviable cells; an approach using electrochemical measurements of bacterial catalase activity was also checked.

[Scrotal hair in infants]. / Vello escrotal en lactantes.

The presence of pubic hair is exceptional in healthy infants of both sexes. In most of the cases described in the literature, the process was self-limited and no etiology was found. Nevertheless, in some patients, this finding has been associated with other manifestations of hyperandrogenism related to potentially serious diseases such as congenital adrenal hyperplasia or virilizing tumors. In the present article, we describe seven infants followed-up in the Pediatric Endocrine Clinic because of scrotal hair. In all patients, the process was self-limited and resolved spontaneously and no hormonal or developmental alterations were observed. Key words: Scrotal hair, infants, virilization.

[Tracheal agenesis associated with laryngeal malformations as an unusual cause of airway failure]. / Agenesia traqueal asociada a malformaciones laríngeas como causa inusual de fracaso de la vía aérea.

Tracheal agenesis is an uncommon congenital malformation with an extremely high mortality rate. This malformation manifests after delivery as severe respiratory distress, cyanosis, lack of crying and impossibility of endotracheal respiratory support. This anomaly is usually associated with cardiovascular, respiratory and gastrointestinal malformations. Only a high index of suspicion and early surgical management will prevent death. An early diagnosis may also help the parents and the medical team to take appropriate decisions. Currently, there is no effective therapy that guarantees long-term survival.

[Group therapy for the treatment of obesity in children and adolescents]. / Terapia de grupo para el tratamiento de la obesidad infantil.

THERAPY: Although obesity is one of the leading health problems in developed countries, effective treatment is lacking. The aim of the present study was to determine whether group therapy is more efficient in inducing weigh loss than individual therapy in the pediatric age group. EXPERIMENTAL DESIGN: Fifty obese patients, 15 preadolescents and 33 adolescents (12 boys and 23 girls) were studied. In all patients, dietary intake was modified to reduce calorie intake. Initially all patients were followed-up individually every 3 months (individual therapy) until the beginning of group therapy when the patients were seen monthly in groups of 10-15 patients with their parents (preadolescents) or alone (adolescents). In the group sessions, talks were given about diet and exercise. In each session, the patient who had shown the greatest improvement in habits and weight loss received a prize. The patients were followed-up for 2 years, with individual therapy in the first year and group therapy in the second. Differences in body mass index (BMI) z-score before the beginning of therapy and during therapy were analyzed using Student's paired T test. RESULTS: With individual therapy, no changes in BMI z-score were observed throughout the study. In contrast, with group therapy, BMI z-score decreased in all the groups studied. During the 1-year follow-up with individual therapy, 60 % of the patients gained more than 5 kg. With group therapy, only 10 % of patients gained more than 5 kg. CONCLUSIONS: In obese children and adolescents, group therapy was more efficient than individual therapy in inducing weight loss.

Prenatal ultrasound diagnosis of vasa praevia and analysis of risk factors.

OBJECTIVE: To evaluate the role of ultrasound in prenatal diagnosis of vasa praevia (VP) and to asses the risk of VP associated with different causal factors. MATERIAL AND METHODS: A retrospective study of the incidence of VP in a series of 12,063 deliveries between January 2000 and March 2005. We also studied the factors that predisposed for VP and the perinatal outcome of pregnancies. RESULTS: The prevalence of VP in our centre during this period was 0.07% (9 cases). All cases were prenatally diagnosed. The mean gestational age at diagnosis was 26 weeks. Multivariate analysis revealed the following associated factors: IVF pregnancies, bilobate or succenturiate placenta, and second-trimester placenta praevia, with an odds ratio of 7.75, 22.11 and 22.86, respectively. CONCLUSIONS: In our series, the prenatal diagnosis of all cases of VP achieved during the second-trimester scan allowed us to avoid any prenatal death related to this condition.

Molecularly imprinted polymer solid-phase extraction coupled to square wave voltammetry at carbon fibre microelectrodes for the determination of fenbendazole in beef liver.

A molecularly imprinted polymer was developed and used for solid-phase extraction (MISPE) of the antihelmintic fenbendazole in beef liver samples. Detection of the analyte was accomplished using square wave voltammetry (SWV) at a cylindrical carbon fibre microelectrode (CFME). A mixture of MeOH/HAc (9:1) was employed both as eluent in the MISPE system and as working medium for electrochemical detection of fenbendazole. The limit of detection was 1.9x10(-7) mol L-1 (57 microg L-1), which was appropriate for the determination of fenbendazole at the maximum residue level permitted by the European Commission (500 microg kg-1 in liver). Given that the SW voltammetric analysis could not be directly performed in the sample extract as a consequence of interference from some sample components, a sample clean-up with a MIP for selectively retaining fenbendazole was performed. The MIP was synthesized using a 1:8:22 template/methacrylic acid/ethylene glycol dimethacrylate ratio. A Britton-Robinson Buffer of pH 9.0 was selected for retaining fenbendazole in the MIP cartridges, and an eluent volume of 5.0 mL at a flow rate of 2.0 mL min-1 was chosen in the elution step. Cross-reactivity with the MIP was observed for other benzimidazoles. The synthesized MIP exhibited a good selectivity for benzimidazoles with respect to other veterinary drugs. The applicability of the MISPE-SWV method was tested with beef liver samples, spiked with fenbendazole at 5,000 and 500 microg kg-1. Results obtained for ten different liver samples yielded mean recoveries of (95+/-12)% and (96+/-11)% for the upper and lower concentration level, respectively.

Integrated electrochemical gluconic acid biosensor based on self-assembled monolayer-modified gold electrodes. Application to the analysis of gluconic acid in musts and wines.

An integrated amperometric gluconic acid biosensor constructed using a gold electrode (AuE) modified with a self-assembled monolayer (SAM) of 3-mercaptopropionic acid (MPA) on which gluconate dehydrogenase (GADH, 0.84 U) and the mediator tetrathiafulvalene (TTF, 1.5 micromol) were coimmobilized by covering the electrode surface with a dialysis membrane is reported. The working conditions selected were Eapp=+0.15 V and 25+/-1 degrees C. The useful lifetime of one single TTF-GADH-MPA-AuE was surprisingly long. After 53 days of continuous use, the biosensor exhibited 86% of the original sensitivity. A linear calibration plot was obtained for gluconic acid over the 6.0x10(-7) to 2.0x10(-5) M concentration range, with a limit of detection of 1.9x10(-7) M. The effect of potential interferents (glucose, fructose, galactose, arabinose, and tartaric, citric, malic, ascorbic, gallic, and caffeic acids) on the biosensor response was evaluated. The behavior of the biosensor in a flow-injection system in connection with amperometric detection was tested. The analytical usefulness of the biosensor was evaluated by determining gluconic acid in wine and must samples, and the results obtained were validated by comparison with those provided by using a commercial enzyme test kit.

[Lipid lowering goals in high risk and very high cardiovascular risk patients: a reasonable challenge?]. / Objetivos del tratamiento hipolipemiante en pacientes con alto riesgo y muy alto riesgo cardiovascular: un reto posible?

OBJECTIVE: The last modifications of the National Cholesterol Education Program (NCEP) indicate some lower therapeutic targets of low density protein cholesterol (LDL-c) in patients with very high vascular risk. Our study aims to establish the degree of compliance of the therapeutic targets defined by these modifications. PATIENTS AND METHOD: Descriptive and cross sectional study of patients from a cardiovascular clinic. Low-density lipoprotein cholesterol (LDL-c) was calculated and targets were established according the new update of NCEP-ATP III. RESULTS: 836 patients, 625 (75%) with HR and 211(25%) with VHR were studied 45% of HR and 67% of VHR were receiving treatment with statins (p < 0.001) but only 38% of HR and 15% of VHR achieved target LDL-c levels. The percentage of patients who could achieve LDL-goals using the maximum approved dose of the statins plus other lipid lowering drug was calculated: The 31% of HR and 51% of VHR were unable to achieve the LDL-c targets. CONCLUSIONS: Only 15% of very high risk patients achieve target levels of LDL-c according to the new NCEP-ATP III recommendations. Even using maximum dose of statins in combination with other lipid lowering drugs, less than half of the patients will be able to achieve LDL-c goal (< 70 mg/dl).