Outcomes following surgical management of inguinal-related groin pain in athletes: a case series.

To determine the outcomes of a limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement of adhesions based on intraoperative findings. Retrospective case series. Outpatient orthopedic/general surgery clinic. Fifty-one athletes treated surgically for inguinal-related groin pain from 2009 to 2015. Limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement based on intra-operative findings. Ability to return to sport at the same level, time to return to play. Fifty-one athletes were included in the study with an average follow-up of 4.42 years (range 2.02-7.01). The average age was 24.2 years (range 16-49) and consisted of 94.0% males and 6.0% females. Nerve entrapment was demonstrated in 96.2% of cases with involvement of the ilioinguinal in 92.5%, the iliohypogastric in 30.8% and the genitofemoral in 13.2%. Attenuation of the posterior inguinal wall was present and repaired in 79.3% of cases. Scar tissue was present around the adductor origin and required debridement in 56.7% of cases. Forty-nine (96.1%) athletes returned to sport at the same level of play at an average of 5.9 weeks. Two athletes required a revision surgery. High rates of return to sport were achieved after surgery for inguinal-related groin pain that addresses the varying pathology and associated nerve entrapment.

Distribución de la población vulnerable a la enfermedad COVID-19 en La Habana, Cuba

RESUMEN Introducción: La Habana, en su condición de capital de Cuba, muestra la mayor complejidad en el enfrentamiento a la epidemia por el virus SARS-CoV-2. Objetivo: Proporcionar un análisis de la distribución de la población vulnerable a la COVID-19 en la provincia La Habana. Métodos: Investigación estructurada en tres etapas, en las áreas de salud de los municipios de La Habana: 1. Estudio del grupo de población de 60 años y más que padece enfermedades crónicas (etapa A). 2. Análisis de factores que pudieran estar favoreciendo la transmisión del virus SARS-CoV-2 (etapa B). 3. Integración de las dos etapas anteriores y adición del análisis espacial de la enfermedad COVID-19 según la ubicación de los casos confirmados positivos entre el 12 de marzo-22 de junio de 2020 (etapa C). Resultados: Se presentan en cuatro mapas que se corresponden con las etapas del estudio. El primero aporta el grado de vulnerabilidad de la población de 60 años y más con enfermedades crónicas de mayor riesgo a la COVID-19; el segundo, ofrece el grado de vulnerabilidad a la transmisión del virus SARS CoV-2; el tercero, el grado de vulnerabilidad una vez integradas las etapas A y B y el cuarto mapa, presenta la ubicación por lugar de residencia de los pacientes confirmados con la COVID-19 en La Habana. Conclusiones: Estos resultados constituyen una herramienta eficaz para asistir a las autoridades en la toma de decisiones mediante un mejor conocimiento de la distribución de la población vulnerable a la COVID-19 en la provincia La Habana.

ABSTRACT Introduction: Being the capital city in Cuba, Havana displays the greatest complexity in the response to the SARS-CoV-2 epidemic. Objective: Provide an analysis of the distribution of the population vulnerable to COVID-19 in the province of Havana. Methods: A study was conducted of the health areas in the municipalities of Havana which was structured into three stages: 1. Study of the population group aged 60 years and over with chronic diseases (Stage A). 2. Analysis of the factors which might be facilitating transmission of the SARS-CoV-2 virus (Stage B). 3. Integration of the two previous stages and addition of a spatial analysis of COVID-19 based on the location of positive cases confirmed from 12 March to 22 June 2020 (Stage C). Results: The data collected is presented in four maps corresponding to the stages of the study. The first map presents the degree of vulnerability of the population aged 60 and over with chronic diseases of highest risk for COVID-19; the second the degree of vulnerability to SARS-CoV-2 virus transmission; the third the degree of vulnerability upon integration of Stages A and B; and the fourth the location by place of residence of the patients confirmed with COVID-19 in Havana. Conclusions: These results constitute an effective tool to assist authorities in decision making by providing broader knowledge about the distribution of the population vulnerable to COVID-19 in the province of Havana.

Surgical approaches to the calcaneus and the sural nerve: There is no safe zone.

BACKGROUND: Sural nerve related symptoms following the extensile lateral approach to the calcaneus (ELA) and the sinus tarsi approach (STA) are a known postoperative complication despite awareness of the course the sural nerve. While the main trunk of the sural nerve and its location relative to the approaches have been previously described, the nerve gives rise to lateral calcaneal branches (LCBs) and an anastomotic branch (AB) that may be at risk of injury. The purpose of this study was to describe the course of the sural nerve, its LCBs and the AB in relation to the ELA and STA. METHODS: 17 cadaveric foot specimens were dissected, exposing the sural nerve, the LCBs and the AB. A line representing the ELA and STA incision was then created. It was noted if the line crossed the sural nerve trunk, any of the LCBs, and the AB, and at what distance they were crossed using the distal tip of the fibula as a reference. RESULTS: The sural nerve was identified in all specimens, and the main trunk was noted to cross the path of the ELA in no specimens and the path of the STA in 2 (12%) specimens. At least one LCB of the sural nerve was identified in all specimens. The ELA crossed the path of at least one LCB in 15 specimens (88%). An AB was present in 9 specimens (53%). If an AB was present, this was crossed by the STA in every instance. CONCLUSIONS: The ELA and the STA traverses the path of either the main trunk of the sural nerve, the LCBs, or the AB in the majority of specimens, potentially accounting for the presence of sural nerve postoperative symptoms regardless of the approach used.

Índice C en médicos de dos centros hospitalarios chilenos según el test de competencia moral de Lind / Assessment of moral competence of physicians

Background: Moral competence (MC) in physicians is fundamental, given the increasing complexity of medicine. The "Moral Competence Test" (MCT © Lind) evaluates this feature and its indicator is the C Index (CI). Aim: To explore moral competence and its associated factors among physicians working in Chile. Material and Methods: The MCT was answered by 236 physicians from two medical centers who voluntarily participated in the study. Besides the test, participants completed an encrypted form giving information about gender, years in practice and post-graduate studies. Results: The average CI value of the participants was 20,9. Post-graduate studies had a significant positive influence on CI. There was a significant decrease in CI, between 16 and 20 years of professional exercise. Gender and the area of post-graduate studies did not have a significant influence. Conclusions: The studied physicians showed a wide range of CI which was positively affected by the postgraduate studies performed. The years of professional practice had a negative influence. Expanding training opportunities during professional practice could have a positive effect on CM as measured by CI.

Anatomical Study of the Princeps Pollicis Artery Perforator Flap.

BACKGROUND: The volar aspect of the thumb often requires local flaps for reconstruction. This study characterizes perforators of the princeps pollicis artery (PPA) and evaluates the potential of a local propeller-type flap raised using these perforators for reconstruction of these defects. METHODS: Cadavers underwent whole-body lead-oxide injection and were then imaged using a 64-slice spiral computed tomographic scanner. The DICOM images were imported into Materialise's Interactive Medical Imaging Control System (Materialise, Belgium) for 3-dimensional reconstruction of the microvasculature. The number, length, caliber, and location of perforators arising from the PPA were determined and a plot was generated illustrating the relative distribution of perforators. RESULTS: A total of 16 PPA perforators were identified in the 8 specimen hands. Perforators had a mean (SD) diameter of 1.2 (0.4) mm and mean (SD) length of 8.9 (4.8) mm. The PPA perforators were consistently identified along the radial aspect of the thenar region. Seventy percent of all PPA perforators can be found over the distal 50% of the MC [20%-54%; mean (1SD)]. CONCLUSIONS: Perforators of the PPA were found in all hands and the average caliber and length of the perforators identified is sufficient for the creation of a local perforator flap. This, coupled with the mean location of these perforators, arising near the base of the thumb, confirms that a cutaneous flap from the thenar region can be raised based on this perforator as a propeller flap to obtain coverage of distal cutaneous defects of the thumb.

National Trends in Foot and Ankle Arthrodesis: 17-Year Analysis of the National Survey of Ambulatory Surgery and National Hospital Discharge Survey.

Foot and ankle arthrodesis reliably reduces pain and functional disability among patients with arthritis and deformity. Since its introduction in 1953, improvements in surgical technique have enhanced the outcomes and reduced complications. However, little is known regarding US national trends of foot and ankle arthrodesis. The present study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the usage of inpatient and ambulatory foot and ankle arthrodesis. Cases of foot and ankle arthrodesis were identified using the National Hospital Discharge Survey and National Survey of Ambulatory Surgery, and the data were analyzed for trends in demographics, treatment, and usage. From 1994 to 2006, the population-adjusted rates of foot and ankle arthrodeses increased by 146% (8.2/100,000 capita to 20.2/100,000 capita). The number of outpatient arthrodeses performed with arthroscopic assistance increased by 858%. The population-adjusted rate of outpatient and inpatient procedures increased by 415% and 17%, respectively. The gender-adjusted rates increased by 59% for males and 209% for females. The age-adjusted rates increased among patients >35 years old in both settings. The use of peripheral nerve blocks during ambulatory procedures increased from 3.3% to 10.1%. Private insurance was the largest compensator. In conclusion, the rate of foot and ankle arthrodesis increased dramatically from 1990 to 2007 using the most up-to-date publicly available data. Knowledge of these national practice patterns could aid policy-makers and surgeons in appropriately allocating healthcare resources to ensure quality patient care.

United States National Trends in Ankle Arthroscopy: Analysis of the National Survey of Ambulatory Surgery and National Hospital Discharge Survey.

BACKGROUND: . Ankle arthroscopy is increasingly being utilized for disorders previously limited to management with open surgery. Despite uniformly good results and few complications, little is known regarding national trends in ankle arthroscopy. This study sought to investigate changes in the use of inpatient and ambulatory ankle arthroscopy in the United States. METHODS: . The National Survey of Ambulatory Surgery and the National Hospital Discharge Survey were used to identify cases of ankle arthroscopy. The data were analyzed for trends in demographics, treatment, and use. RESULTS: Between 1994 and 2006, the population-adjusted rate of ankle arthroscopy increased by 65% (4.9/100 000 capita to 8.1/100 000 capita). The rate of ambulatory procedures increased by 80%, whereas the rate of inpatient procedures decreased by 95%. Sex-adjusted rates increased by 90% for males and 32% for females. The largest increases in age-adjusted rates were among patients 35 to 54 years of age. The proportion of procedures performed in freestanding ambulatory facilities increased from 15% to 49%. Use of peripheral nerve blocks during ambulatory procedures increased from 6% to 26%. Private insurance was the largest compensator at all times, and the proportion of workers' compensation payments increased from 8% to 22% during the study period. CONCLUSIONS: . Results from the most recently available Centers for Disease Control and Prevention data demonstrated that rates of ambulatory ankle arthroscopy increased, whereas rates of inpatient ankle arthroscopy decreased dramatically between 1994 and 2006. Understanding national practice patterns can aid policy makers and surgeons in allocating health care resources, so as to ensure quality patient care. LEVELS OF EVIDENCE: N/A (descriptive epidemiology study).

El cuidado enfermero como problema ético: concepto y principios prácticos aplicados al acto de cuidado / Nursing care as an ethical problem: concepts and principles applied to the act of caring / O cuidado de enfermagem como problema ético: conceitos e princípios aplicados ao ato de cuidar

En este trabajo los autores estudian la naturaleza del acto del cuidado, destacan la importancia de la ética en las profesiones vinculadas con la salud de las personas y desarrollan, a la luz de la tradición central de la filosofía moral occidental, un conjunto de principios que deben guiar la actividad de la enfermería.

In this paper the authors study the nature of the act of care, emphasize the importance of ethics in the professions related to the health of people and develop, in the light of the central tradition of Western moral philosophy, a set of principles that should guide nursing activity.

Neste trabalho, os autores refletem sobre a natureza do ato de cuidar, enfatizam a importância da ética nas profissões relacionadas com a saúde das pessoas e desenvolvem, à luz da tradição central da filosofia moral ocidental, um conjunto de princípios que deve orientar o trabalho de enfermagem.

Local flaps, including pedicled perforator flaps: anatomy, technique, and applications.

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Discuss the types of local flaps. 2. Analyze the advantages, disadvantages, and applications for each kind of flap. 3. Perform appropriate design and dissection techniques of local flaps. 4. Describe appropriate design and dissection techniques of local perforator and propeller flaps. SUMMARY: The purpose of this article is to comprehensively review the topic of local flaps. Local flaps are those that are elevated nearby and then transferred to an adjacent wound. Options include geometric local flaps, axial pattern local flaps and a new exciting group of flaps, local perforator flaps. The principles, advantages, disadvantages, and applications for each are carefully analyzed. Local perforator flaps can be harvested virtually anywhere in the body and represent a significant clinical advance, as these can solve a wide variety of clinical challenges. These flaps do require gentle microsurgical dissection technique with careful handling for inset of the flap and simultaneously provide the same advantages of other types of local flaps because they also use nearby tissues with a similar color match, thickness, and texture, with primary donor-site closure possible. Local perforator flaps are another very useful option that undoubtedly will become more popular as more surgeons become more familiar with their use and advantages.

Multiple ERK substrates execute single biological processes in Caenorhabditis elegans germ-line development.

RAS-extracellular signal regulated kinase (ERK) signaling governs multiple aspects of cell fate specification, cellular transitions, and growth by regulating downstream substrates through phosphorylation. Understanding how perturbations to the ERK signaling pathway lead to developmental disorders and cancer hinges critically on identification of the substrates. Yet, only a limited number of substrates have been identified that function in vivo to execute ERK-regulated processes. The Caenorhabditis elegans germ line utilizes the well-conserved RAS-ERK signaling pathway in multiple different contexts. Here, we present an integrated functional genomic approach that identified 30 ERK substrates, each of which functions to regulate one or more of seven distinct biological processes during C. elegans germ-line development. Our results provide evidence for three themes that underlie the robustness and specificity of biological outcomes controlled by ERK signaling in C. elegans that are likely relevant to ERK signaling in other organisms: (i) multiple diverse ERK substrates function to control each individual biological process; (ii) different combinations of substrates function to control distinct biological processes; and (iii) regulatory feedback loops between ERK and its substrates help reinforce or attenuate ERK activation. Substrates identified here have conserved orthologs in humans, suggesting that insights from these studies will contribute to our understanding of human diseases involving deregulated ERK activity.

Efecto del tamaño de la incisión en la gravedad de la lesin de la vía biliar iatrogénica posterior a colecistectomía abierta / Association between wound size after open cholecystectomy with severity of iatrogenic biliary tract lesions

Antecedentes: La lesión transoperatoria de la vía biliar durante la colecistectomía abierta y laparoscópica es un evento catastrófico que se asocia con morbilidad y mortalidad significativas. El objetivo fue documentar si el tamaño de la incisión en colecistectomía abierta está asociado a lesiones más complejas de la vía biliar. Métodos: Estudio de cohorte prospectivo de marzo de 2006 a febrero de 2007. Se incluyeron 66 pacientes con lesiones de la vía biliar posterior a colecistectomía abierta. Se analizó el tamaño de la incisión. Resultados: Se incluyeron 66 pacientes, 70% del sexo femenino, con un promedio de edad de 44 años. El 70% fue tratado por colecistitis aguda. La mayoría tuvo sobrepeso o sufría diferentes grados de obesidad. En 76% de los casos, la lesión no fue advertida durante el procedimiento quirúrgico primario. Todos los pacientes con lesión de vía biliar grave (Strasberg E-3 y E-4) tuvieron incisiones menores a 10 cm de longitud. El tamaño de la incisión se asoció con lesiones inadvertidas (p=0.000), así como con el grado de lesión (p=0.000). No pudo demostrarse asociación estadísticamente significativa entre lesiones de la vía biliar y colecistectomía electiva o urgente, e incisión quirúrgica media o subcostal para la colecistectomía. Conclusiones: Nuestros hallazgos sugieren que el acceso quirúrgico menor durante la colecistectomía abierta puede ser un factor de riesgo, ya que incisiones pequeñas se asociaron con lesiones de la vía biliar más graves e imposibilidad para reconocer este daño durante el procedimiento. Sugerimos cumplir estrictamente los principios quirúrgicos de una adecuada exposición durante la colecistectomía abierta como medida para prevenir lesiones de la vía biliar.

BACKGROUND: Transoperative biliary tract injury during open or laparoscopic cholecystectomy is a catastrophic event associated with significant morbidity and mortality. Our objective was to determine if wound size during open cholecystectomy is associated with more complex biliary tract injuries. METHODS: Prospective cohort study performed between March 2006 and February 2007. Sixty-six patients with biliary tract injuries after open cholecystectomy were included. Wound size was analyzed. RESULTS: Sixty six patients were included, 70% were female with a median age of 44. Seventy four percent were treated for acute cholecystitis. Most participants were overweight or had various degrees of obesity. Biliary tract injuries were not recognized during the primary surgical procedure in 76% of cases. All patients with severe biliary tract injuries (Strasberg E-3 and E-4) had a wound size less than 10 cm in length. Wound size was associated with unrecognized injuries (p=0.000), as well as with injury severity (p=0.000). We were notable to demonstrate a statistically significant association between biliary tract injuries and elective or emergency surgical procedures and midline or subcostal surgical incision for cholecystectomy. CONCLUSIONS: Our findings suggest that minor surgical access during open cholecystectomy may constitute a risk factor since smaller incisions were associated with more severe biliary tract injuries and an inability to observe this damage during the surgical procedure. We suggest to adhere strictly to the guidelines of an adequate surgical exposure during open cholecystectomy to prevent biliary tract injuries.

Riesgo precoz de recidiva bioquímica en prostatectomizados radicales (T1c): aplicación de una ecuación predictiva validada / Precocious risk of biochemical recurrence in radical prostatectomy (Rp): application of a validated predictive equation

Muchos modelos predictivos de recidiva para cáncer de próstata (CaP) post prostatectomía radical (PR)son difíciles de aplicar y la tendencia es a encontrar modelos que consideren datos clínicos y patológicosde fácil y rápida obtención. El grupo de trabajo del Johns Hopkins Hospital desarrolló una ecuación deriesgo validada para identificar pacientes de alto riesgo de recidiva precoz de CaP (etapa clínica T1c),después de PR.Realizamos una revisión retrospectiva de pacientes sometidos a PR retropúbica por CaP etapa clínica T1,con un seguimiento mínimo de 6 meses. En estos pacientes aplicamos la ecuación Rw.De un total de 190 pacientes sometidos a PR en los últimos 7 años, encontramos 60 pacientes analizablesen etapa T1c. El promedio de seguimiento fue de 25,4 meses. Al aplicar la ecuación Rw encontramos unasensibilidad de 29 porciento, especificidad de 98 porciento, VPP de 83 porciento y VPN de 78 porciento. En nuestra serie la ecuación RWtiene una pobre sensibilidad pero una buena especificidad.

Caracterización clínica de la vejiga inestable motora / Clinical characterization of dynamic unstable bladder

Clínicamente, la inestabilidad del detrusor se asocia con síntomas como frecuencia miccional, nicturia,urgencia y urgeincontinencia (Sd. de Urgencia).El propósito de nuestro trabajo es objetivar la sintomatología urinaria baja de pacientes con diagnósticourodinámico confirmado de vejiga inestable motora (VIM).A un total de 19 pacientes que consultaron en un período de 6 meses por síntomas sugerentes de síndromede urgencia y cuya urodinamia demostró la presencia de una vejiga inestable motora, se les solicitó quecompletaran un diario miccional durante dos días.El promedio de edad fue de 59 años, todos los pacientes cumplieron con, al menos, un criterio clínico deSd. de Urgencia. Los síntomas que más se asocian a VIM en nuestros pacientes son la urgencia miccionaly la disminución en la capacidad vesical.

Heminefrectomías en niños: experiencia del Hospital San Juan de Dios / Heminephrectomies in children: experience at San Juan de Dios Hospital

Se realiza un estudio descriptivo, retrospectivo clínico y anatomopatológico de pacientes sometidos a heminefrectomía (HN) en el servicio de Cirugía Infantil del Hospital San Juan de Dios, entre enero 1993 y enero 2000. Se describen 16 casos en 14 pacientes operados, todos portadores de malformaciones urológicas, se describen sus indicaciones quirúrgicas, evolución y complicaciones postoperatorias

Síndrome neuroléptico maligno: informe de un caso / Neuroleptic malignant syndrome: a report of a case

Reportamos el caso de un hombre de 48 años de edad, con historia de parálisis cerebral infantil y epilepsia neonatal, al que se le dieron neurolépticos 48 horas antes del inicio de su padecimiento, el síndrome neuroléptico maligno, el cual se caracterizó por hipertermia, aumento del tono muscular, deshidratación, incremento progresivo de la creatinina fosfoquinasa (CPR) y azoados. El tratamiento elegido fue la fluidoterapia y la administración de fármacos dopaminérgicos, a los que reaccionó favorablemente. Esta afección ocurre como complicación del tratamiento con neurolépticos y su incidencia es del 0.2 al 0.5 por ciento, con una mortalidad aproximada del 20 por ciento, la cual depende directamente de la complicación desarrollada; la más grave es la insuficiencia renal aguda producida por mioglobinuria secundaria a rabdomiolisis.

Conocimiento de la utilidad, uso y lectura correcta del termómetro, y valores normales de temperatura del recién nacido / Knowledge of the usefulness, use and correct reading of thermometer, and normal values of temperature of the newborn

Objetivos: Cuantificar el número de mujeres que conoce la utilidad del termómetro. Establecer el porcentaje de mujeres que sabe los valores normales de temperatura de un recién nacido. Relacionar qué número de mujeres de las que utiliza correctamente el termómetro sabe leerlo. Conocer el número de mujeres que posee el termómetro. Diseño: Prospectivo, observacional, descriptivo, con una secuencia temporal de corte transversal. Métodos: Para la medición de las variables se utilizó una encuesta además de la observación de la técnica. Resultados: fueron encuestadas 645 mujeres. El 94,7 por ciento reconoce para qué sirve el termómetro; el 67 por ciento lo utiliza en forma correcta; el 57,5 por ciento sabe leerlo; 85,9 por ciento de las que lo utilizan correctamente, sabe leerlo; 19,5 por ciento del total conoce los valores normales de temperatura axilar del recién nacido y por último 62,9 por ciento posee termómetro.

Resultados en el empleo del clavo biodegradable Polipin en fracturas con mínima descarga mecánica / Results of treatment of diverse fractures by the biodegradable Polipin nail in fractures with minimal mechanical unloaded function by wiring of radial screw

Recientemente se ha creado un nuevo clavo en Suiza, denominado Polipin hecho de ácido poliláctico, biodegradable, de fácil aplicación y que permite mantener la reducción anatómica de fracturas, osteocondrales, huesos esponjosos, fragmentos apicales o lesiones con mínima solicitación mecánica. Se trata de un reporte preliminar con 10 pacientes intervenidos quirúrgicamente en los que hemos obtenido un resultado satisfactorio con un seguimiento de más de 10 meses

Estabilización primaria de fracturas de huesos largos con enclavamiento intramedular / Primary stabilization of long bone fractures by intramedullary nailing

El incremento de las lesiones traumáticas atendidas en los servicios de urgencias y generalmente en pacientes en edad productiva requiere de una rápida solución y estabilización temprana para evitar complicaciones propias de estas fracturas. Se realizó un estudio de los pacientes atendidos durante los meses de julio de 1996 a abril de 1997, revisando un total de 76 pacientes con 83 fracturas de diáfisis de huesos largos que fueron tratados con enclavado intramedular durante las primeras horas de su lesión, lográndose en la mayoría de los pacientes la consolidación completa y reintegración a sus labores durante las primeras 12 semanas sin presentarse complicaciones