Vascular complications secondary to resuscitative endovascular balloon occlusion of the aorta placement at a Level 1 Trauma Center.

OBJECTIVE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is designed to manage severe hemorrhagic shock. Popularized in medical care during military conflicts, the concept has emerged as a lifesaving technique that is utilized around the United States. Literature on risks of REBOA placement, especially vascular injuries, are not well-reported. Our goal was to assess the incidence of vascular injury from REBOA placement and the risk factors associated with injury and death among these patients at our institution. METHODS: We performed a retrospective cohort study of all patients who underwent REBOA placement between September 2017 and June 2022 at our Level 1 Trauma Center. The primary outcome variable was the presence of an injury related to REBOA insertion or use. Secondary outcomes studied were limb loss, the need for dialysis, and mortality. Data were analyzed using descriptive statistics, χ2, and t-tests as appropriate for the variable type. RESULTS: We identified 99 patients who underwent REBOA placement during the study period. The mean age of patients was 43.1 ± 17.2 years, and 67.7% (67/99) were males. The majority of injuries were from blunt trauma (79.8%; 79/99). Twelve of the patients (12.1%; 12/99) had a vascular injury related to REBOA placement. All but one required intervention. The complications included local vessel injury (58.3%; 7/12), distal embolization (16.7%; 2/12), excessive bleeding requiring vascular consult (8.3%; 1/12), pseudoaneurysm requiring intervention (8.3%; 1/12), and one incident of inability to remove the REBOA device (8.3%; 1/12). The repairs were performed by vascular surgery (75%; 9/12), interventional radiology (16.7%; 2/12), and trauma surgery (8.3%; 1/12). There was no association of age, gender, race, and blunt vs penetrating injury to REBOA-related complications. Mortality in this patient population was high (40.4%), but there was no association with REBOA-related complications. Ipsilateral limb loss occurred in two patients with REBOA-related injuries, but both were due to their injuries and not to REBOA-related ischemia. CONCLUSIONS: Although vascular complications are not unusual in REBOA placement, there does not appear to be an association with limb loss, dialysis, or mortality if they are addressed promptly. Close coordination between vascular surgeons and trauma surgeons is essential in patients undergoing REBOA placement.

Acute myeloid leukemia with neutrophilic differentiation in a 12-year-old African lion (Panthera leo).

OBJECTIVE: To describe the clinical presentation, progression, and diagnosis of acute myeloid leukemia (AML) with neutrophilic differentiation in an African lion (Panthera leo). ANIMAL: A 12-year-old male African lion kept at a zoological institution in Colombia. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: The lion presented for anorexia, pale mucous membranes, and a hind limb lameness of acute onset. Feline leukemia virus testing was negative, and repeated blood samples revealed severe anemia, intermittent thrombocytopenia, lymphopenia, and neutrophilia. Coinfection with Anaplasma and Mycoplasma spp and chronic kidney disease were diagnosed based on clinicopathological findings. TREATMENT AND OUTCOME: The lion received symptomatic treatment, doxycycline, and methylprednisolone or prednisolone. Euthanasia was elected due to clinical deterioration and unresponsive anemia, despite the resolution of Anaplasma and Mycoplasma spp infections. AML with neutrophilic differentiation was diagnosed based on bone marrow cytology, histopathology, and immunohistochemistry. CLINICAL RELEVANCE: AML is a rare, aggressive hematopoietic disorder in domestic cats, although it has not yet been reported in nondomestic cats. This is the first description of the clinicopathological, histological, and immunohistochemical features of AML with neutrophilic differentiation in an FeLV-negative African lion that lacked circulating blasts.

Patients from distressed communities are more likely to be symptomatic at endovascular aneurysm repair and have an increased risk of being lost to long-term follow-up.

BACKGROUND: Endovascular aortic aneurysm repair (EVAR) has become the preferred modality to repair abdominal aortic aneurysms (AAAs). However, the effect of the distressed communities index (DCI) on the outcomes of EVAR is still unknown. In the present study, we investigated the effect of DCI on the postoperative outcomes after EVAR. METHODS: The Society for Vascular Surgery Vascular Quality Initiative database was used for the present study. Patients who had undergone EVAR from 2003 to 2021 were selected for analysis. The study cohort was divided into two groups according to their DCI score. Patients with DCI scores ranging from 61 to 100 were assigned to group I (DCI >60), and those with DCI scores ranging from 0 to 60 were assigned to group II (DCI ≤60). The primary outcomes included the 30-day and 1-year mortality and major adverse cardiovascular events at 30 days. Regression analyses were performed to study the postoperative outcomes. P values ≤ .05 were deemed statistically significant for all analyses in the present study. RESULTS: A total of 60,972 patients (19.5% female; 80.5% male) had undergone EVAR from 2003 to 2021. Of these patients, 18,549 were in group I (30.4%) and 42,423 in group II (69.6%). The mean age of the study cohort was 73 ± 8.9 years. Group I tended to be younger (mean age, 72.6 vs 73.7 years), underweight (3.5% vs 2.5%), and African American (10.8% vs 3.5%) and were more likely to have Medicaid insurance (3.6% vs 1.9%; P < .05 for all). Group I had had more smokers (87.3% vs 85.3%), a higher rate of comorbidities, including hypertension (84.5% vs 82.9%), diabetes (21.7% vs 19.7%), coronary artery disease (30.3% vs 28.6%), chronic obstructive pulmonary disease (36.9% vs 31.8%), and moderate to severe congestive heart failure (2.6% vs 2%; P < .05 for all). The group I patients were more likely to undergo EVAR for symptomatic AAAs (11.1% vs 7.9%; P < .001; adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.15-1.37; P < .001) with a higher risk of mortality at 30 days (aOR, 3.98; 95% CI, 2.23-5.44; P < .001) and 1 year (aOR, 1.74; 95% CI, 1.43-2.13; P < .001). A higher risk of being lost to follow-up (28.9% vs 26.3%; P < .001) was also observed in group I. CONCLUSIONS: Patients from distressed communities who require EVAR tended to have multiple comorbidities. These patients were also more likely to be treated for symptomatic AAAs, with a higher risk of mortality. An increased incidence of lost to long-term follow-up was also observed for this population. Surgeons and healthcare systems should consider these outcomes and institute patient-centered approaches to ensure equitable healthcare.

Radiographic appearance of a caudal vertebral chordoma in a domestic ferret (Mustela putorius furo).

A 7-year-old spayed female ferret was presented to the Veterinary Teaching Hospital at the Western College of Veterinary Medicine for a slow-growing mass involving the base of the tail. Radiographs revealed a large, irregularly marginated mineralized mass centered on the fifth to seventh caudal vertebrae with osteolysis of the affected caudal vertebrae. A partial caudectomy was performed, and histopathology was consistent with a chordoma. This is the first case report describing the radiographic appearance of a chordoma in the proximal tail and only the second report to describe radiographic findings in a ferret.

Implementation of Transitional Care Planning is Associated with Reduced Readmission Rates in Patients Undergoing Lower Extremity Bypass Surgery for Peripheral Arterial Disease.

BACKGROUND: Patients undergoing lower extremity bypasses (LEB) are at a high risk of developing post-discharge complications requiring readmission. Health systems have developed several strategies to mitigate this risk. One such measure is developing comprehensive Transitional Care Program (TCP), which includes phone calls to patients after being discharged from the hospital. Our study aimed to assess short-term readmission, mortality, and amputation rates of patients who participated in TCP by completing at least one post-discharge follow-up phone call after undergoing LEB for revascularization of peripheral arterial disease (PAD). METHODS: A retrospective review was completed for patients who underwent LEB surgery between January 2010 and January 2020 to treat PAD at Penn State Hershey Medical Center. Immediate discharge follow-up was done via telephone calls using a standardized script. Patients were then divided into two groups, those who did not have a successful follow-up call (Group I) and those who had at least one successful follow-up call within seven days after discharge (Group II). Univariate analysis was used to compare preoperative demographics, intraoperative variables, and postoperative outcomes. The probability of readmission and risk factors contributing to it were computed using multiple stepwise forward regression analyses. Epidemiological analysis was done to evaluate the risk of readmission in the group receiving post-discharge follow-up calls. RESULTS: A total of 457 patients underwent LEB from 2010 to 2020 and qualified for inclusion in the study. Among these patients, 126 (27.6%) did not have a successful post-discharge follow-up call (Group I), whereas, 331 (72.4%) patients did complete a successful call (Group II). The mean age of patients was 66.7 years. There were no significant differences in preoperative baseline patient characteristics or intraoperative factors. Patients who completed a successful call had lower readmission rates within thirty days of the operation (8.8 vs. 17.5%, P = 0.008), and this was sustained in multivariate analysis (adjusted odds ratio AOR: 0.18, [confidence interval CI: 0.05-0.66], P = 0.009). However, no differences were observed for thirty-day mortality (Group-I: 3.2% versus Group-II: 1.2%, P = 0.152) or amputation (Group-I: 9.6% versus Group II 5.9%, P = 0.162). Among those who had a successful call, patients with a history of smoking (AOR: 4.05 [CI: 1.21, 17.12] P = 0.025), diabetes mellitus (AOR: 3.42 [CI: 1.35, 8.7] P = 0.01) and myocardial infarction (AOR: 7.15 [CI: 1.76, 20.1] P = 0.006) had a much higher chances of readmission. Risk analysis using epidemiological methods showed that by receiving a call, the risk of readmission could be dropped to half (RR: 0.50 [CI: 0.30, 0.84]), with an attributable risk reduction of -8.7% (CI: -15.9%, -1.4%). CONCLUSIONS: This single-institution retrospective study demonstrates the importance of immediate discharge follow-up phone calls in patients who undergo open lower extremity revascularization to reduce thirty-day readmissions. Our analysis showed patients who received immediate follow-up phone calls were less likely to be readmitted to the hospital. The development of reliable and efficient systems to enhance immediate discharge follow-up in vascular surgery patients is pivotal to improving quality of care, preventing readmissions, and reducing healthcare costs.

Fenestrated endovascular abdominal aortic aneurysm repair in octogenarians is associated with higher mortality and an increased incidence of nonhome discharge.

OBJECTIVE: Fenestrated endovascular abdominal aortic aneurysm repair (FEVAR) has been increasingly becoming the endovascular treatment of choice for patients with juxtarenal abdominal aortic aneurysms with an infrarenal neck, not suitable for traditional endovascular abdominal aortic aneurysm repair. Older patients are at a high risk of developing complications after elective procedures. A review of the literature showed mixed results for FEVAR in the elderly patient population. In the present study, we investigated the occurrence of mortality (both short and long term), discharge destination, and other postoperative outcomes in the octogenarian population who had undergone FEVAR for the management of abdominal aortic aneurysms in a large, national surgical database. METHODS: A retrospective analysis of patients who had undergone FEVAR in the Society for Vascular Surgery Vascular Quality Initiative database was performed from July 2010 to June 2019. The study cohort excluded patients aged <18 years and concomitant procedures for snorkeling of visceral branches of the aorta. The final selected cohort was divided into two patient groups: group I, patients aged <80 years (nonoctogenarians); and group II, patients aged ≥80 years (octogenarians). The primary outcomes were mortality at 30 days (short term), 6 months, and 1 year (long term) and the discharge destination. The secondary outcomes included postoperative length of stay, intensive care unit stay, postoperative major cardiac events, and the need for intervention. Computation of models to measure the outcomes and identify the risk factors contributing to mortality at 30 days and discharge to a nonhome destination was performed using multiple logistic regression analyses. Cox proportional hazards regression analysis was performed to study the long-term mortality in the patient groups. RESULTS: A total of 5507 patients had undergone FEVAR in the 9-year period in the Society for Vascular Surgery Vascular Quality Initiative database (group I, nonoctogenarians, n = 4424 [80.3%]; group II, octogenarians, n = 1156 [19.7%]). Octogenarians were more likely to be women, white, Medicare insured, and hypertensive. This group also had lower rates of former or current smokers, a lower glomerular filtration rate, a lower incidence of late-stage chronic kidney disease, and an aneurysm diameter >5.5 cm. Greater estimated blood loss and longer procedures were also noted in the octogenarian group compared with the nonoctogenarian group. Multiple logistic regression analysis showed that octogenarians had had greater mortality at 30 days (7.3%; adjusted odds ratio [aOR], 1.21; 95% confidence interval [CI], 1.0-1.45; P = .044), 6 months (13.7%; aOR, 1.52; 95% CI, 1.24-1.81; P < .001), and 1 year (17.5%; aOR, 1.67; 95% CI, 1.34-2.07; P < .001). The present analysis to measure the discharge destination showed that octogenarians had a greater risk of discharge to nonhome destinations (26.7%; aOR, 1.50; 95% CI, 1.24-1.81; P < .001). Octogenarians had a lower risk of ≥2 days of an intensive care unit stay (aOR, 0.76; 95% CI, 0.67-0.91; P < .001) but a greater risk of experiencing dysrhythmia (10.1%; aOR, 1.32; 95% CI, 1.01-7.1; P = .036) following the procedure compared with the nonoctogenarians. CONCLUSIONS: In our retrospective analysis of a large, national surgical database, we found that of the patients undergoing FEVAR to manage juxtarenal abdominal aortic aneurysms, octogenarians had greater mortality and a greater risk of being discharged to nonhome locations compared with nonoctogenarians.

Percepción del comportamiento alimentario en los hogares de Cali para el primer trimestre de la cuarentena por COVID-19 en 2020 / Perception of feeding behavior in Cali homes during the first trimester of quarantine due to COVID-19 in 2020

Resumen Introducción: En 2020, la Organización Mundial de la Salud (OMS) declaró la emergencia de salud pública por SARS-CoV-21; el 11 de marzo de 2020 se notificó la pandemia global por COVID-19 y el gobierno colombiano decretó para todas las ciudades el aislamiento preventivo obligatorio2. Para el mes de mayo, Cali reportó 1635 casos de COVID confirmados y 85 fallecidos por un virus con un 4,95% de letalidad3. Lo anterior influenció de forma importante las rutinas alimentarias de las familias durante el primer trimestre del periodo de confinamiento. Considerando que esta situación era atípica en el país, era necesario describir la percepción del comportamiento alimentario durante este primer trimestre de aislamiento preventivo obligatorio en la ciudad de Cali, considerando las normas de bioseguridad establecidas para el periodo mencionado. Objetivo: Describir el comportamiento alimentario de 1814 familias en Cali durante el primer trimestre de aislamiento preventivo obligatorio. Metodología: Estudio cuantitativo, descriptivo transversal, con técnica de encuesta. Se aplicó un instrumento virtual compuesto por 28 ítems, que indagó el comportamiento alimentario de las familias. Discusión: Se encontró que el 95,1% de los hogares percibió escasez y aumento de precios en alimentos que componen la canasta alimentaria familiar, y el 67,2% de las familias estuvieron preocupadas por la alimentación. Hubo un aumento en el consumo de alimentos y se modificó el número de tiempos de comida/día. Los hábitos alimentarios, ingesta de refrescos y consumo de alcohol también se modificaron durante confinamiento. Conclusiones: Se puede afirmar que durante el primer trimestre de cuarentena por COVID-19 en Cali se modificó el comportamiento alimentario de las familias encuestadas, una de las razones estuvo relacionada con un cambio en los ingresos económicos, que afectó la cantidad de dinero disponible para alimentos. Durante este periodo se modificaron también los tiempos de comida y la variedad en la ingesta de alimentos. En general, se describieron aspectos que afectaron la seguridad alimentaria de las familias.

Abstract Introduction: In 2020, the World Health Organization (WHO) declared a public health emergency due to SARS-CoV-21. On March 11, 2020, the global pandemic due to COVID-19 was declared, with which the Colombian government decreed mandatory preventive isolation in the country2. In May, Cali reported 1,635 confirmed COVID cases and 85 deaths from a virus with a 4.95 % case fatality rate3. This situation affected families eating routines during this period. Considering that this situation was atypical in the country, it was necessary to describe the perception of feeding behavior during this first trimester of mandatory preventive isolation in the city of Cali, considering the biosafety standards established by the national government. Objetive: To describe the feeding behavior of 1,814 families in Cali during the first trimester of mandatory preventive isolation. Methodology: Cross-sectional, descriptive and quantitative study. A virtual instrument composed of 28 items was applied, which investigated the feeding behavior of the families. Convenience sampling. Results: The results show that the economic income of families, as well as the distribution of expenses within the home, were affected in the evaluated period. In addition, it was found that 95.1 % of households perceived shortages and price increases in foods that make up the family food basket; 67.2% of families were concerned about food. There was an increase in food consumption and the number of perhaps consider, meals per day was modified. Eating habits, soft drink intake and alcohol consumption also changed during confinement in the evaluated time. Conclusions: It can be affirmed families modified their feeding behaviors during the first quarter of quarantine due to COVID-19. Because the economic income of families was affected, the money available for food purchases was affected as well. During this time, perhaps consider: meal frequencies and, in general, the variety in food intake was also modified. Finally, the results suggest perhaps consider: a negative effect in the food security of families.

Prevención, manejo y seguimiento de las lesiones de la arteria vertebral. Conocimiento actual de los cirujanos de columna de la Argentina / Prevention, management and monitoring of vertebral artery injuries. Current state of knowledge of spine surgeons in Argentina

Introducción: La lesión de la arteria vertebral es un evento grave. El objetivo del estudio fue evaluar el grado de conocimiento de los cirujanos de columna en la Argentina sobre las medidas diagnósticas y terapéuticas de la lesión de la arteria vertebral. Materiales y métodos: Se realizó un estudio descriptivo observacional mediante una encuesta difundida a través de la AANC y la SAPCV. Resultados: Se recibieron 157 respuestas. El 47,4% considera relevante evaluar la anatomía de la arteria vertebral en todo tipo de patología mediante métodos angiográficos. La mitad de los encuestados diagnosticó una variante anatómica de la arteria. El 29,2% manifestó haber tenido en su práctica una lesión de la arteria. Solo el 35% tiene un protocolo de acción para el manejo de este evento adverso. El 77% adopta como primera medida el taponamiento. En el seguimiento posquirúrgico, la mayoría estudia el estado final mediante métodos angiográficos. Alrededor del 10% procuraría instaurar alguna medida de profilaxis antitrombótica. El 76,6% dispone de Servicio de Hemodinamia con cirujano endovascular. Conclusión: Esta complicación está subestimada. Menos de la mitad de los cirujanos utiliza, como rutina, herramientas de diagnóstico de posibles alteraciones anatómicas. No se han observado protocolos de manejo ni seguimiento de estas lesiones. Nivel de Evidencia: IV

Introduction: Vertebral artery injury is a serious event. The objective of this work is to evaluate the degree of knowledge of spinal surgeons in Argentina regarding the diagnostic and therapeutic measures of vertebral artery injury. Materials and methods: An observational descriptive study was carried out through a survey transmitted through AANC and SAPCV. Results: Of 157 responses, 47.4% consider it relevant to evaluate the anatomy of the vertebral artery in all types of pathology by angiographic methods. Half of those surveyed diagnosed an anatomical variant of the artery, 29.2% reported having encountered an artery injury during their practice and only 35% had an action protocol for the management of this adverse event. 77% adopted tamponade as their first measure. In the postoperative follow-up, the majority of surgeons studied the final state of the situation using angiographic methods. Around 10% would try to establish some measure of antithrombotic prophylaxis. 76.6% have an hemodynamics service with an endovascular surgeon. Conclusion: We found an underestimation of this complication. Less than half of surgeons routinely use diagnostic tools for possible anatomical changes. Management or monitoring protocols for these injuries have not been observed. Level of Evidence: IV

Completitud de inventarios rápidos de diversidad de mamíferos medianos y grandes en la Amazonía noroccidental colombiana / Completeness of rapid assessments of medium and large mammal diversity in the northwestern Amazon in Colombia

Las evaluaciones rápidas de biodiversidad son la fuente de información más común sobre biodiversidad en el noroccidente amazónico en Colombia debido a que los recursos y la logística son limitados. Estas evaluaciones son esenciales para tomar decisiones ambientales en esta área que ha sido impactada por la transformación de sus ecosistemas naturales. Diferentes evaluaciones locales rápidas con cámaras trampa de mamíferos medianos y grandes (MMG) se han realizado en el noroccidente Amazónico en Colombia, pero estas son difícilmente comparables. Nosotros recolectamos la información de 16 evaluaciones rápidas de MMG para proporcionar la primera lista de MMG del noroccidente amazónico en Colombia. Adicionalmente, evaluamos la precisión de cuatro estimadores (ICE, Chao 2, Jackknife 1 y Jackknife 2) y el esfuerzo mínimo de muestreo para la estimación de la riqueza de MMG en estudios locales en esa región. Reportamos 26 especies de MMG para la Amazonía colombiana (entre cinco y 13 especies por localidad), lo que es uns subestimación de la riqueza de MMG en la región. El mejor estimador para este tipo de estudios fue Jackknife 1, debido a su precisión y la baja influencia de singletons. Recomendamos un esfuerzo mínimo de muestreo de 350 cámaras trampa-día. Aunque las evaluaciones rápidas no proveen una estimación robusta de la riqueza de MMG, estas evaluaciones registran las especies más comunes (especies core) y la variación en su abundancia por localidad. Es necesario un mayor esfuerzo de muestreo para evaluar el efecto de la transformación del hábitat sobre los MMG, en especial sobre los parámetros poblacionales de las especies raras. (AU)

Evaluation of Factors Associated with, and Outcomes for Patients with Nonhome Discharge Destinations Following Carotid Endarterectomy.

INTRODUCTION: Following a carotid endarterectomy (CEA) procedure, patients are discharged to their homes or other locations than home such as an acute care facility or skilled nursing facility based on their functional status and level of medical attention needed. Decision-making for discharge destination following a CEA to home or nonhome locations is important due to the differences in survival and postoperative complications. While primary outcomes such as mortality and occurrence of stroke following CEA have been extensively studied, there is a paucity of information characterizing outcomes of discharge destination and the factors associated. The purpose of this study was to explore the factors associated with discharge to nonhome destinations after CEA, and outcomes after discharge. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we identified patients who underwent CEA from 2011 to 2018. Patients were divided into two groups based on their discharge destination (home versus nonhome). Univariate and multivariate analysis were performed for preoperative and intraoperative factors associated with different discharge destinations. Postoperative complications associated with discharge to nonhome destinations were analyzed and mortality after discharge from hospital was compared between the 2 groups. RESULTS: A total of 25,094 patients met the criteria for inclusion in the study, of which 39% were females and 61% were males; median age was 71 years. Twenty four thousand one hundred twenty-five patients (93.13%) were discharged to home (Group I) and 1,779 (6.87%) were discharged to nonhome destinations (Group II). Following preoperative and intraoperative factors were associated with discharge to nonhome locations: older age, diabetes mellitus, functional independent status, transfer from other hospitals, symptomatic status, need for preoperative blood transfusions, severe ipsilateral carotid stenosis, elective CEA, need for intraoperative shunt and general anesthesia (all P< 0.05). Following postoperative complications had statistically significant association with discharge to nonhome destinations: postoperative blood transfusion, pneumonia, unplanned intubation, longer than 48 hours on ventilator, development of stroke, myocardial infarction, deep vein thrombosis, and sepsis (all P< 0.05). Mortality after discharge from hospital was 0.39% (n = 100). Mortality among those who were discharged to home was 0.29% vs. 1.63% for those who were discharged to nonhome locations (P< 0.05). CONCLUSIONS: Majority of the patients after CEA are discharged back to their homes. This study identifies the factors which predispose patients discharged to locations, other than home. Patients who are not discharged home have higher mortality as compared to those who are discharged to their homes.

The genetics of recurrent hydatidiform moles in Mexico: further evidence of a strong founder effect for one mutation in NLRP7 and its widespread.

PURPOSE: To investigate the frequency of a founder mutation in NLRP7, L750V, in independent cohorts of Mexican patients with recurrent hydatidiform moles (RHMs). METHODS: Mutation analysis was performed by Sanger sequencing on DNA from 44 unrelated Mexican patients with RHMs and seven molar tissues from seven additional unrelated patients. RESULTS: L750V was present in homozygous or heterozygous state in 37 (86%) patients and was transmitted on the same haplotype to patients from different states of Mexico. We also identified a second founder mutation, c.2810+2T>G in eight (18.1%) patients, and a novel premature stop-codon mutation W653*. CONCLUSION: Our data confirm the strong founder effect for L750V, which appears to be the most common mutation in NLRP7. We also report on six healthy live births to five patients with biallelic NLRP7 mutations, two from spontaneous conceptions and four from donated ovum and discuss our recommendations for DNA testing and genetic counseling.

Immediate postoperative hyperglycemia after peripheral arterial bypass is associated with short-term and long-term poor outcomes.

OBJECTIVE: Although the impact of poorly controlled diabetes on surgical outcomes of patients undergoing lower extremity revascularization is well-known, it is not clear if immediate postoperative hyperglycemia (IPH) itself can be used as a surrogate for poor outcomes after peripheral arterial bypass. We sought to examine the effect of IPH in this patient population with its impact on short-term and long-term outcomes. METHODS: Retrospective review was completed for 505 patients who underwent either suprainguinal bypass surgery or infrainguinal bypass surgery between July 2002 and April 2018 for the treatment of peripheral arterial disease. All patients were undergoing first-time open bypass grafting. Patients were stratified into those who were normoglycemic or hyperglycemic (glucose ≥ 140 mg/dL) within 24 hours after surgery. A comparative analysis was performed on comorbidities and outcomes. RESULTS: Of 505 patients who underwent bypass grafting, 255 patients (50.5%) were hyperglycemic. The mean age of patients was 63.5 ± 14.1 years. The median follow-up was 5.2 years (range, 0.0-15.2 years). The distribution of procedures was as follows: femoral to popliteal bypasses (29%), femoral to femoral bypasses (17%), femoral to tibial bypasses (12%), aortobifemoral bypasses (10%), iliofemoral bypasses (9%), and axillofemoral bypasses (7%). At 30 days, hyperglycemic patients had an increased incidence of limb loss (8.3% vs 4.0%) and myocardial infarction (4.8% vs 0.8%) and incurred higher costs of hospital stay ($27,701 vs $22,990) (all P < .05). At 10 years, these patients had a higher incidence of needing major amputations (15.4% vs 9.4%; P = .025). Hyperglycemia after infrainguinal bypass was associated with nearly twice the risk of limb loss at 5 years (hazard ratio, 1.91; P = .034). Among the cohort of patients who required major amputations, the time duration between index revascularization and amputation was significantly shorter as compared with normoglycemic patients (P = .003). CONCLUSIONS: In this single-institution study with long-term follow-up, IPH was associated with increased rates of 30-day amputation and myocardial infarction, as well as an increased cost of hospital stay. In the long term, postoperative hyperglycemia was associated with greater major limb loss. Among the cohort of patients who required major amputations, the time period between revascularization and amputation was shorter for those patients who had IPH. IPH is an independent marker for poor outcomes after lower extremity revascularization procedures.

El uso local de vancomicina en injerto autólogo para reconstrucción de ligamento cruzado anterior. ¿Reduce la tasa de artritis séptica? Comparación en dos grupos: uso local de profilaxis con vancomicina versus sin uso / The local use of vancomycin in autologous hamstring graft for ACL reconstruction. Does it reduce the rate of septic arthritis? Comparison in two groups: local use of prophylaxis with vancomycin vs. without use

Introducción: El objetivo del trabajo es evaluar y comparar de manera retrospectiva la tasa de artritis séptica (AS) postquirúrgicas en reconstrucción de LCA entre dos grupos de estudio: A, sin el uso local de vancomicina en el injerto autólogo de isquiotibiales, versus grupo B, con profilaxis antibiótica local.Materiales y métodos: se trabajaron dos grupos compuestos por 683 pacientes en total, con diagnóstico primario de ruptura de LCA. Grupo A, operados entre 2016 y 2017, en los que no se utilizó profilaxis antibiótica del autoinjerto; y el grupo B, intervenidos entre 2018 y 2019, donde se sumergió el autoinjerto de isquiotibiales en 500 mg de vancomicina en 100 ml de solución fisiológica como profilaxis local. En ambos grupos se llevó a cabo el protocolo usual pre, intra y postquirúrgico. Resultados: se analizó la relación entre presencia de infección y las diferentes variables estudiadas, se observó que el uso local de vancomicina en el injerto autólogo de isquiotibiales está asociado a menor infección (p <0.05). La edad, el sexo y el sanatorio donde se realiza la cirugía no condicionan necesariamente la presencia de infección (p >0.05).Conclusión: presentamos este trabajo como prueba en nuestro medio del claro beneficio que se obtuvo, ya que los pacientes que fueron sometidos a la profilaxis local de vancomicina del autoinjerto mostraron una disminución notable de artritis séptica.Tipo de estudio: Artículo Original ­ Descriptivo-transversal. Nivel de evidencia: III

Introduction: The aim of the study is to evaluate and retrospectively compare the rate of postoperative septic arthritis (SA) in ACL reconstruction, between two study groups: A without local use of vancomycin in autologous hamstring graft versus group B with local antibiotic prophylaxisMaterials and methods: two groups composed of 683 patients in total, with a primary diagnosis of ACL rupture, were studied. Group A, operated on in 2016 and 2017, in which antibiotic prophylaxis of the autograft was not used; and the second group B, between 2018 and 2019, where the hamstring autograft was submerged in 500 mg of vancomycin in 100 ml of physiological solution as local prophylaxis. Preoperative intravenous antibiotic prophylaxis was carried out in both groups as the usual protocol.Results: it was obtained as a result that in group A, the two years that they worked without "pre-soaking" of antibiotics in the autograft and the relationship between the presence of infection and the different variables studied was analyzed, where they found that the use Local vancomycin in the autologous hamstring graft is associated with a minor infection (p <0.05). However, age, sex and the sanatorium where the surgery is performed do not necessarily determine the presence of infection (p >0.05)Conclusion: we present this work as proof in our environment of the clear benefit that we obtained, since the patients who underwent local prophylaxis of vancomycin of the autograft, showed a notable decrease in septic arthritis.Type of study: Original Article - Descriptive-cross-sectional. Level of Evidence: III

Sex differences in cardiovascular actions of the renin-angiotensin system.

Cardiovascular disease (CVD) remains a worldwide public health concern despite decades of research and the availability of numerous targeted therapies. While the intrinsic physiological mechanisms regulating cardiovascular function are similar between males and females, marked sex differences have been established in terms of CVD onset, pathophysiology, manifestation, susceptibility, prevalence, treatment responses and outcomes in animal models and clinical populations. Premenopausal females are generally protected from CVD in comparison to men of similar age, with females tending to develop cardiovascular complications later in life following menopause. Emerging evidence suggests this cardioprotection in females is, in part, attributed to sex differences in hormonal regulators, such as the renin-angiotensin system (RAS). To date, research has largely focused on canonical RAS pathways and shown that premenopausal females are protected from cardiovascular derangements produced by activation of angiotensin II pathways. More recently, a vasodilatory arm of the RAS has emerged that is characterized by angiotensin-(1-7) [(Ang-(1-7)], angiotensin-converting enzyme 2 and Mas receptors. Emerging studies provide evidence for a shift towards these cardioprotective Ang-(1-7) pathways in females, with effects modulated by interactions with estrogen. Despite well-established sex differences, female comparison studies on cardiovascular outcomes are lacking at both the preclinical and clinical levels. Furthermore, there are no specific guidelines in place for the treatment of cardiovascular disease in men versus women, including therapies targeting the RAS. This review summarizes current knowledge on sex differences in the cardiovascular actions of the RAS, focusing on interactions with gonadal hormones, emerging data for protective Ang-(1-7) pathways and potential clinical implications for established and novel therapies.

Meniscectomía parcial artroscópica: resultados a más de un año de seguimiento en pacientes laborales vs. no laborales / Arthroscopic partial meniscectomy. Results to more than one year of follow-up in working compensation vs. non-working compensation patients

Introducción: El objetivo del trabajo es evaluar y comparar de manera retrospectiva los resultados de una serie de pacientes laborales y no laborales con lesiones meniscales, tratadas mediante meniscectomía parcial artroscópica. Material y métodos: Se evaluaron 60 pacientes tratados en nuestro centro, entre junio 2016 y mayo 2017, los cuales presentaban lesiones meniscales agudas que no respondieron a tratamiento conservador. Todas las lesiones fueron diagnosticadas con RM previa. Se trataba de 30 pacientes laborales y 30 no laborales, 53 de sexo masculino y 7 de sexo femenino. La edad fue entre 18 y 45 años. Treinta y seis meniscos internos y veinticuatro meniscos externos. El seguimiento promedio fue 18 meses. Se realizó score de Lysholm y EVA. Resultados: De los 30 pacientes no laborales 28 evolucionaron favorablemente, con mejoría en el score de Lysholm de 53 a 93 puntos y EVA de 7 a 1 puntos en promedio, con retorno a la actividad previo a la lesión. Dos de ellos continuaron con molestias leves, sin afectar sus rutinas diarias. En los pacientes laborales 14 evolucionaron favorablemente, con mejoría en el score de Lysholm de 48 a 74 puntos y EVA 7 a 2 puntos en promedio con retorno a su actividad laboral habitual. Dieciséis de ellos presentaban dolor moderado con retorno laboral parcial o requirieron cambio de tareas. Conclusión: Los resultados de la meniscectomía parcial en pacientes no laborales fueron excelentes a buenos, con retorno a sus actividades cotidianas en un 96%. En cuanto a los pacientes laborales se obtuvieron resultados regulares, con retorno a su actividad laboral habitual en un 53%. Tipo de estudio: Serie de casos. Nivel de evidencia: IV

Introduction: The aim of the study is to evaluate and compare retrospectively the results of arthroscopic partial meniscectomy for meniscus tears in working compensation vs. non-working compensation patients Material and methods: Sixty patients treated in our institution between June 2016 and May 2017 with the diagnosis of acute meniscus tears that did not respond to conservative treatment were evaluated. All lesions were diagnosed with previous MRI. There were 30 patients under working compensation insurance and 30 under another insurance system (53 men, and 7 women). The age ranged between 18 and 45 years. Thirty-six tears were located in the internal menisci and twenty-four in the external menisci. The average follow-up was 18 months. Lysholm and EVA scores were obtained. Results: Of the 30 non-working compensation patients, 28 evolved favorably with an improvement in the Lysholm score of 53 to 93 points and EVA of 7 to 1 points on average and returned to activity prior to the injury. Two of them continued with mild discomfort, without affecting their daily routines. In working compensation, patients 14 evolved favorably, with improvement in the Lysholm score of 48 to 74 points and EVA 7 to 2 points on average and return to their usual work activity. Sixteen of them presented moderate pain with partial job return or required change of tasks. Conclusion: The results of partial meniscectomy in non-work-related patients were excellent to good, with 96% return to daily activities. Regarding work-related patients, regular results were obtained, with a return to their usual work activity of only 53%. Type of study: Case series. Level of evidence: IV

Prevalencia de microfilaria en aves silvestres de Venezuela / Prevalence of microfilaria in wild birds of Venezuela

La megadiversidad de las aves es ampliamente conocida en el Neotrópico, ocupando Venezuela el sexto lugar a escala mundial. Sin embargo, existen pocos estudios de enfermedades causadas por hemoparásitos, dentro de los cuales se encuentran las filarias, que son nematodos altamente especializados, que pueden alojarse en casi cualquier órgano o tejido de los vertebrados terrestres. Las microfilarias son sus formas larvarias, y son capaces de producir inflamación de venas y arterias. Su presencia en sangre confirma el diagnóstico positivo de esa parasitosis. El objetivo de este estudio, fue el de estimar la prevalencia de microfilarias en aves silvestres de Venezuela entre 2012 y 2014. Para ello, se seleccionaron cuatro áreas de interés de conservación de aves, con características de pasos migratorios, ecológicamente diferentes, pertenecientes a los estados Aragua, Falcón, Zulia y Guárico. Se muestrearon aves silvestres, utilizando para su captura redes de neblinas. La clasificación taxonómica del ave se basó en los caracteres físicos en campo y en los registros fotográficos de laboratorio. La población estudiada consistió de 1970 individuos de 119 especies y 18 familias. Se tomaron muestras sanguíneas de la vena ulnar, para la posterior realización de extendidos que fueron coloreados con la solución de Giemsa. Se hicieron tres extendidos por ave. El diagnóstico parasitológico se realizó por microscopía de luz (1000x), identificándose los caracteres morfológicos propios de las microfilarias. Los resultados del estudio demostraron la presencia de infección en 24 aves de 14 especies, para una prevalencia global del 1,22%, siendo el Campylorhynchus griseus, el hospedador con mayor prevalencia, con un 66,67%. Las variables ecológicas y de comportamiento ornitológico no demostraron ser factores de riesgo para la prevalencia a microfilarias; sin embargo, existen aspectos que favorecen la infección, como los ambientes cálidos y la vegetación densa.

Birds megadiversity is well known in the Neotropics and Venezuela is ranked sixth worldwide. However, there are very few studies of diseases caused by blood parasites, within which highlight the filariae, which are highly specialized nematodes that house in almost any organ or tissue of terrestrial vertebrates. Their larval forms are the microfilariae, capable of producing inflammation of veins and arteries, and their presence in peripheral blood smears confirms a positive diagnosis of that parasitosis. The aim of this study was to estimate the prevalence of microfilariae in wild birds in Venezuela during the period 2012-2014. Four areas of interest for bird conservation and the ecological characteristics of different migration paths belonging to the States of Aragua, Falcón, Zulia, and Guárico were selected. To accomplish this, wild birds were captured using mist nets. The taxonomic classification of birds was performed based on their physical characteristics in the field and in laboratory photographic records. The study population consisted of 1970 individuals of 119 species and 18 families. Blood samples from the ulnar vein were withdrawn and three Giemsa-stained blood smears were obtained from each bird. The parasitological diagnosis was made under light microscopy (1000x), identifying the specific morphological characteristics typical of microfilariae. The study results showed infection in 24 birds of 14 species, for an overall prevalence of 1.22 %, being Campylorhynchus griseus, the host with the highest prevalence, with 66.67 %. The ecological and the ornithological behavior variables did not prove to be risk factors for the prevalence of microfilariae; however, there are aspects that favor infection, such as warm environments and dense vegetation.