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The hip is the location for many disorders, such as osteoarthritis, femoroacetabular impingement syndrome, avascular necrosis of the hip, and cartilage injuries, all of which cause chronic pain, disability, and limitation. It is estimated that 10% of the population ≥40 years of age will present with hip pain. The line of treatment goes from nonsteroidal anti-inflammatory drugs, physical therapy, lifestyle modification, intra-articular injections, and hip surgery. This will depend on the pathology, age, lifestyle, and sport activity of each patient. Currently, hip joint intra-articular injections represent a viable option for those patients who are not candidates for surgery or simply those who do not want surgery. Among the controversial indications for a hip injection is moderate-to-severe arthritis (grades III and IV). Hip injections are considered a diagnostic and therapeutic procedure, with a sensitivity of 87% and specificity of 100% reported, and will differentiate between an intra-articular pathology versus an extra-articular pathology and a neuropathic pain arising from the lumbar spine. Radiofrequency nerve ablation or neurectomy of the femoral and obturator nerve has been implemented more frequently not only for patients with mild-to-moderate osteoarthritis but also in those who present with femoroacetabular impingement syndrome and cartilage lesions who do not wish to undergo surgery.
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INTRODUCTION: Umbilical hernias (UHs) are commonly underdiagnosed due to their asymptomatic presentation. The aim was to determine the prevalence of UHs by computed tomography (CT) in a trauma center, to assess the magnitude of their underdiagnosis. METHODS: A cross-sectional study was designed, using CT studies to evaluate the integrity of the abdominal wall. The images were obtained from consecutive cases of adult patients (≥18 y) from the database of the radiology and imaging service during a 4-mo period. The sociodemographic features, type of CT scan, and description of the abdominal wall were obtained and compared with the radiology report. In the case of UH presence, the transversal, cephalocaudal, and anteroposterior lengths, as well as its content, were registered. RESULTS: A total of 472 CT scans were included with a 67.6% (n = 319) prevalence of UH. These were most common in men (58.9%, n = 188/319), but women were more likely to have UH ≥ 10 mm (55%, n = 72/131). Of those with UH, 63.6% were unreported by radiology. The most common content was peritoneal fat (87.5%). UH had medians (interquartile range) of 9.1 mm (6.8, 12.5), 8.3 mm (6, 11.5), and 12.8 mm (8.6, 18.2) in its transversal, cephalocaudal, and anteroposterior lengths, respectively. Transversal length had a high positive correlation with cephalocaudal length (r = 0.877). This datum relationship can be explained by at least 76% due to this factor. Interobserver reliability analyses resulted in substantial reliability (ICC>0.85 and k > 0.85). CONCLUSIONS: CT is an effective imaging tool for diagnosing UH. There is a high prevalence among the general adult population, with a high radiologic underreporting.
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This article delves into the intricate challenges of acute kidney injury (AKI) in cirrhosis, a condition fraught with high morbidity and mortality. The complexities arise from distinguishing between various causes of AKI, particularly hemodynamic AKI, in cirrhotic patients, who experience hemodynamic changes due to portal hypertension. The term "hepatocardiorenal syndrome" is introduced to encapsulate the intricate interplay among the liver, heart, and kidneys. The narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis, unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic function. The conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed, highlighting potential risks and variable patient responses. We advocate for a nuanced algorithm for AKI evaluation in cirrhosis, prominently featuring point-of-care ultrasonography (POCUS). POCUS applications encompass assessing fluid tolerance, detecting venous congestion, and evaluating cardiac function.
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Antibiotic prophylaxis in patients with cirrhosis and acute variceal bleeding is part of the standard of care according to most clinical guidelines. However, with recent evidence arguing against antibiotic prophylaxis, the role of this intervention has become less clear.
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Anti-Bacterial Agents , Antibiotic Prophylaxis , Esophageal and Gastric Varices , Gastrointestinal Hemorrhage , Liver Cirrhosis , Humans , Antibiotic Prophylaxis/methods , Antibiotic Prophylaxis/standards , Gastrointestinal Hemorrhage/prevention & control , Gastrointestinal Hemorrhage/etiology , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/diagnosis , Liver Cirrhosis/complications , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/adverse effects , Practice Guidelines as Topic , Acute Disease , Treatment OutcomeABSTRACT
INTRODUCTION: Exercise adherence is necessary for achieving long-term benefits. Along with other elements, stories and narratives can play a role in understanding and promoting adherence. The aim of the present study was to explore how stories and narratives may affect adherence to Pilates. METHOD: 8 Pilates practitioners who had been participating in a Pilates program for 6 or more years were interviewed. Data obtained were analysed using thematic narrative analysis, (focusing on the whats of stories) and holistic narrative analysis (examining how narratives acted on adherence). RESULTS AND DISCUSSION: Results highlight pain, Pilates as a health-related method, and the social relations as characters, plots and scenarios of stories enhancing long-term participation in Pilates. Exercise is medicine and eudaimonic well-being are presented as narratives articulating the coherence to practitioners' adherence. They act for participants subjectivizing their Pilates practice into a serious commitment to health. CONCLUSION: Stories and narratives are relevant to give meaning and sense to the adherence to Pilates. A focus on stories can be added as a strategy to promote adherence to Pilates.
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Exercise Movement Techniques , Narration , Humans , Exercise Movement Techniques/methods , Female , Male , Adult , Patient Compliance/psychology , Middle Aged , Qualitative ResearchABSTRACT
Healthcare systems in Latin America are broadly heterogeneous, but all of them are burdened by a dramatic rise in liver disease. Some challenges that these countries face include an increase in patients requiring a transplant, insufficient rates of organ donation, delayed referral, and inequitable or suboptimal access to liver transplant programs and post-transplant care. This could be improved by expanding the donor pool through the implementation of education programs for citizens and referring physicians, as well as the inclusion of extended criteria donors, living donors and split liver transplantation. Addressing these shortcomings will require national shifts aimed at improving infrastructure, increasing awareness of organ donation, training medical personnel, and providing equitable access to care for all patients.
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[FeFe]-hydrogenases employ a catalytic H-cluster, consisting of a [4Fe-4S]H cluster linked to a [2Fe]H subcluster with CO, CN- ligands, and an azadithiolate bridge, which mediates the rapid redox interconversion of H+ and H2. In the biosynthesis of this H-cluster active site, the radical S-adenosyl-l-methionine (radical SAM, RS) enzyme HydG plays the crucial role of generating an organometallic [Fe(II)(CN)(CO)2(cysteinate)]- product that is en route to forming the H-cluster. Here, we report direct observation of this diamagnetic organometallic Fe(II) complex through Mössbauer spectroscopy, revealing an isomer shift of δ = 0.10 mm s-1 and quadrupole splitting of ΔEQ = 0.66 mm s-1. These Mössbauer values are a change from the starting values of δ = 1.15 mm s-1 and ΔEQ = 3.23 mm s-1 for the ferrous "dangler" Fe in HydG. These values of the observed product complex B are in good agreement with Mössbauer parameters for the low-spin Fe2+ ions in synthetic analogues, such as 57Fe Syn-B, which we report here. These results highlight the essential role that HydG plays in converting a resting-state high-spin Fe(II) to a low-spin organometallic Fe(II) product that can be transferred to the downstream maturase enzymes.
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Hydrogenase , Iron-Sulfur Proteins , Spectroscopy, Mossbauer , Methionine , Catalysis , Oxidation-Reduction , Hydrogenase/metabolism , Ferrous Compounds , Iron-Sulfur Proteins/chemistry , Electron Spin Resonance SpectroscopyABSTRACT
Background: Overwhelming requirements, a high degree of work, and prolonged exposure to emotionally demanding circumstances in work and life settings can lead to burnout syndrome. The purpose of the study is to assess burnout syndrome and its associated factors among medical students during the COVID-19 pandemic. Methods: A cross-sectional, prospective, descriptive study was conducted in a Mexican medical school during the last week of the spring semester of 2021 using the Maslach Burnout Inventory-Student Survey (MBI-SS) and an associated factors survey. Results: Based on the MBI-SS definition, most students (54.2%, n = 332) had burnout symptoms and high emotional exhaustion (79.6%, n = 448), high cynicism (57.3%, n = 351), and low academic effectiveness (36.4%, n = 223). After adjusting the associated factors, a significant correlation between the school year and the presence of burnout was identified (OR 1.127, 95% CI [1.023-1.241], p<0.05). Regarding the current pandemic, the death of a family member by COVID-19 also put students at risk of developing burnout (OR 1.598*, 95% CI [1.080-2.363, p<0.05]). Limitations: The main limitation of this study was the lack of a control group (before the pandemic); therefore, the high prevalence of burnout can only be hypothesized due to the pandemic but cannot be objectively evidenced. A prospective study after the pandemic is needed to resolve this question. Conclusion: The coronavirus pandemic represents a challenge to the academic and psychological stability of students. It essential to continue assessing burnout levels in medical students and the general population to treat them in time and improve mental health.
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We aimed to compare internal jugular vein and inferior vena cava ultrasonography as predictors of central venous pressure in cirrhotic patients. We performed ultrasound assessments of the internal jugular vein (IJV) and the inferior vena cava and then invasively measured central venous pressure (CVP). We then compared their correlation with CVP and performed area under the receiver operating characteristic curves to determine which had best sensitivity and specificity. IJV cross-sectional area collapsibility index at 30° correlated better with CVP ( r = -0.56, P < 0.001), and an IJV AP-CI at 30° ≤ 24.8% was better at predicting a CVP ≥8 mm Hg, with 100% sensitivity and 97.1% specificity. Thus, IJV point-of-care ultrasound might be superior than inferior vena cava point-of-care ultrasound as a predictor of CVP in cirrhotic patients.
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Jugular Veins , Liver Cirrhosis , Humans , Jugular Veins/diagnostic imaging , Central Venous Pressure , Sensitivity and Specificity , Ultrasonography , Liver Cirrhosis/complications , Liver Cirrhosis/diagnostic imagingABSTRACT
Near-peer teaching has been widely implemented in medical schools and the benefits for the near-peer teachers (NPTs), the students, and the institution have been well documented. However, NPT training methods and perceptions of such have been limited. A four-year clinical anatomy and surgical training program was established (est. 2019) as part of the continuous training timeline for NPTs (n > 60 total) formation at the Universidad Autónoma de Nuevo León, in Mexico. The program provides various training courses for the NPTs according to their hierarchy, including teaching skills, professional development, psychosocial aspects, and career objectives. A "Clinical Anatomy and Surgical Training Diploma" was planned with 12 modules to aid in developing these abilities, along with a higher understanding of clinical anatomy shared by expert clinical specialists, and diverse clinical and surgical skills such as suturing, catheterization, and basic surgical procedures. The program has a completion rate of approximately 15 NPTs/year. All, while creating an environment with a sense of belonging, and facilitating mentorship between fellow NPTs and educators. Near-peer teachers develop leadership, communication, and teaching skills. The program has provided a constant source of anatomy educators, avoiding any shortage.
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Anatomists , Anatomy , Education, Medical, Undergraduate , Students, Medical , Humans , Anatomy/education , Students, Medical/psychology , Education, Medical, Undergraduate/methods , Peer Group , Curriculum , TeachingABSTRACT
Scientific research and student involvement are critical to the formation of physicians, yet the number of medical researchers has decreased over time. To implement corrective strategies, the variables associated with positive research attitudes and productivity among medical students must be identified. The aim of this study was to evaluate the variables associated with students interested or involved in research. A validated questionnaire was applied to the student members of an established anatomy research group in a Mexican medical school with a six-year medical program. Data were collected and analyzed. A total of 85.5% (n = 77/90) students answered the survey with most respondents being second-year medical students. The majority of respondents indicated that the important component of conducting research was a contribution to the new knowledge (45.5%) and to the scientific community (42.9%). More than half of respondents mentioned a professor or a peer as the initial motivation to become involved in research. Lack of time was the main limitation (59.7%) to research involvement. Perceived benefits were knowledge and team work skills. Of those involved, most (85.7%) wished to continue participating in research as a complement to their clinical work. Professors and student colleagues were found to play an important motivational and recruitment role for medical research. These efforts in turn have developed into long-lasting mentor-mentee relationships. Students also anticipated that early involvement in research will positively influence the likelihood of future physicians' contribution and collaboration in research.
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Anatomy , Education, Medical, Undergraduate , Students, Medical , Anatomy/education , Humans , Mexico , Schools, MedicalABSTRACT
Two-electron reduction of the amidate-supported U(III) mono(arene) complex U(TDA)3 (2) with KC8 yields the anionic bis(arene) complex [K[2.2.2]cryptand][U(TDA)2] (3) (TDA = N-(2,6-di-isopropylphenyl)pivalamido). EPR spectroscopy, magnetic susceptibility measurements, and calculations using DFT as well as multireference CASSCF methods all provide strong evidence that the electronic structure of 3 is best represented as a 5f4 U(II) metal center bound to a monoreduced arene ligand. Reactivity studies show 3 reacts as a U(I) synthon by behaving as a two-electron reductant toward I2 to form the dinuclear U(III)-U(III) triiodide species [K[2.2.2]cryptand][(UI(TDA)2)2(µ-I)] (6) and as a three-electron reductant toward cycloheptatriene (CHT) to form the U(IV) complex [K[2.2.2]cryptand][U(η7-C7H7)(TDA)2(THF)] (7). The reaction of 3 with cyclooctatetraene (COT) generates a mixture of the U(III) anion [K[2.2.2]cryptand][U(TDA)4] (1-crypt) and U(COT)2, while the addition of COT to complex 2 instead yields the dinuclear U(IV)-U(IV) inverse sandwich complex [U(TDA)3]2(µ-η8:η3-C8H8) (8). Two-electron reduction of the homoleptic Th(IV) amidate complex Th(TDA)4 (4) with KC8 gives the mono(arene) complex [K[2.2.2]cryptand][Th(TDA)3(THF)] (5). The C-C bond lengths and torsion angles in the bound arene of 5 suggest a direduced arene bound to a Th(IV) metal center; this conclusion is supported by DFT calculations.
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Coordination Complexes/chemistry , Uranium/chemistry , Coordination Complexes/chemical synthesis , Density Functional Theory , Ligands , Models, Chemical , Oxidation-Reduction , Thorium/chemistryABSTRACT
Molybdenum nitrogenase catalyses the reduction of N2 to NH3 at its cofactor, an [(R-homocitrate)MoFe7S9C] cluster synthesized via the formation of a [Fe8S9C] L-cluster prior to the insertion of molybdenum and homocitrate. We have previously identified a [Fe8S8C] L*-cluster, which is homologous to the core structure of the L-cluster but lacks the 'ninth sulfur' in the belt region. However, direct evidence and mechanistic details of the L*- to L-cluster conversion upon 'ninth sulfur' insertion remain elusive. Here we trace the 'ninth sulfur' insertion using SeO32- and TeO32- as 'labelled' SO32-. Biochemical, electron paramagnetic resonance and X-ray absorption spectroscopy/extended X-ray absorption fine structure studies suggest a role of the 'ninth sulfur' in cluster transfer during cofactor biosynthesis while revealing the incorporation of Se2-- and Te2--like species into the L-cluster. Density functional theory calculations further point to a plausible mechanism involving in situ reduction of SO32- to S2-, thereby suggesting the utility of this reaction to label the catalytically important belt region for mechanistic investigations of nitrogenase.
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Coenzymes/chemistry , Iron-Sulfur Proteins/chemistry , Nitrogenase/chemistry , Selenious Acid/chemistry , Sulfur/chemistry , Tellurium/chemistry , Archaeal Proteins/chemistry , Density Functional Theory , Electron Spin Resonance Spectroscopy , Methanosarcina/enzymology , Models, Chemical , X-Ray Absorption SpectroscopyABSTRACT
BACKGROUND: Acquisition of Basic Surgical Skills (BSS) are essential for medical students. The objective was to determine it's fidelity impact. METHODS: Using four suturing models (SM) (pigskin, sponge, commercial pad, and orange), SM-quality and student-SM interaction were evaluated. After a 1-h class, participants were divided into groups and randomly assigned exercises in SM in 15-min intervals. The experiment included completing three individual simple stitches and a 3-stitch continuous suture in each SM. RESULTS: Eighty-two medical students participated. Suturing quality was better in pigskin and sponge, which were also the preferred models (p < 0.001). Significant differences in quality between the insertion and exit point, and firmness of knots (p < 0.05) in both simple and continuous sutures, as well as between length and distance in continuous ones (p < 0.001) were identified. CONCLUSIONS: Acquisition and quality of BSS are influenced by the intrinsic characteristics of SM. An adequate degree of resistance, consistency, and elasticity are necessary.
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Students, Medical , Suture Techniques , Clinical Competence , Humans , Perception , SuturesABSTRACT
OBJECTIVE: Clinical clerkships are a fundamental component of medical education where students' learning is aided by exposure to real patients in diverse practical settings. Countless programs use overnight call shifts as an essential part of their clerkships. There has been concerns about the negative effects these shifts have on students. The study aims to determine relations between call schedule, lecture attendance, and academic and clinical performance. METHODS: One hundred and eight medical students were followed during their surgery clerkship. Students on a Q3 schedule had an on-call shift once every 3 nights, while students on a Q4 schedule once every 4 nights. Their academic performance was evaluated using their exams grades, while their clinical performance was evaluated by their attending physicians. Burnout syndrome was measured using Maslach Inventory. RESULTS: A total of 108 medical students attended their surgical clerkship. Sixty-nine students were under the Q3 call schedule while 39 students in the Q4 call schedule. Mean lecture attendance for students in Q3 was 82.7% (17.3%) compared to 90% (11.2%) (p = 0.020). Final exam grades were different between groups, with Q3 scoring a mean 71.55 (9.3) compared to Q4 85.07 (9.8) (p = 0.001). Clinical performance score means were similar between groups (p = 0.777). Q4 had 74% and Q3 had 49.3% of the students with >90% of attendance (p = 0.008). Q4 had 2.6% students with <70% attendance compared to Q3 with 23.2% (p = 0.008). Students with >90% attendance regardless of call schedule, scored higher in both midterms and final exams (p = 0.002; p = 0.001). Burnout prevalence was higher in students on the Q3 schedule with 28.6% compared to 4.7% of those on the Q4 schedule (p = 0.003). CONCLUSIONS: Students with less call frequency were associated with an improvement in lecture attendance and academic performance, and a lower burnout syndrome rate, without impacting clinical performance. Students with higher attendance regardless of call schedules performed higher academically. Further studies should evaluate the impact on clinical performance and exposure more thoroughly.
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Academic Performance , Burnout, Professional , Clinical Clerkship , Students, Medical , Burnout, Professional/epidemiology , HumansABSTRACT
INTRODUCTION AND HYPOTHESIS: The objective was to determine the mean morphometric characteristics of the rectovaginal septum (RVS) and its variations in correlation with the number of pregnancies, method of delivery, parity, and estrogenic exposure. METHODS: An observational, cross-sectional, retrospective, descriptive, and comparative study was carried out. Pelvic MRI of Hispanic women (≥15 years of age) from the northeast of Mexico were obtained. Age and obstetric and gynecological history were registered and the sample women were categorized by their variables. Length and thickness measurements were standardized. RESULTS: A total of 102 MRI studies were included, with a mean age of 41; 24.5% were nulligravida, the rest primi- or multigravida. Vaginal delivery was the most common type (49.35%), 16.88% had a cesarean section, and 31.17% had mixed delivery. 74.5% of the women were premenopausal. The mean RVS length was 73.2 ± 15.3 mm, with a thickness of 2.8 ± 1.7, 2.2 ± 1.2, and 2.5 ± 1.3 mm for the upper, middle, and lower thirds respectively. There were tendencies to increase the length of the RVS, and the thickness of the upper and middle thirds in the non-pregnancy and the at-least-one-pregnancy groups; to increase the length and middle-third thickness in those with mixed delivery, and increased upper- and lower-third thickness in those with only a cesarean section. Multiparous women with vaginal delivery had significantly longer and thicker RVS than primiparous. Premenopausal women had significantly longer RVS with a tendency to lose thickness toward postmenopause. CONCLUSIONS: The morphology of RVS can be modified by different factors such as age, number of pregnancies, number of births, and estrogenic exposure. This structure should be evaluated and taken into account in preoperative management and surgical technique planning.
Subject(s)
Cesarean Section , Delivery, Obstetric , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Mexico , Parity , Pregnancy , Retrospective Studies , Young AdultABSTRACT
INTRODUCTION: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been utilized in wounds with positive clinical benefits. A reticulated open cell foam dressing with through holes (ROCF-CC) was developed to assist with wound cleansing by removing thick wound exudate and infectious materials, and it may be used when debridement is not possible or appropriate. Use of NPWTi-d with ROCF-CC dressings has been reported with positive outcomes in complex wounds. OBJECTIVE: The present study reports the authors' experience using NPWTi-d with ROCF-CC dressings in 19 patients with complex wounds. MATERIALS AND METHODS: Of the 19 patients, 8 underwent sharp debridement. Oral and/or intravenous antibiotic treatment was initiated as needed prior to NPWTi-d. All patients received NPWTi-d with ROCF-CC dressings with instillation of quarter-strength Dakin's solution, hypochlorous acid solution, or saline with a dwell time of 5 to 10 minutes, followed by 2 to 3.5 hours of continuous negative pressure at -125 mm Hg. Dressing changes occurred every 2 to 3 days. Measurements and assessments of wound progression were done as per institutional protocols. RESULTS: The 19 treated patients consisted of 10 males and 9 females, with an average age of 58.2 ± 15.1 years. Common patient comorbidities included hypertension, diabetes, obesity, and paraplegia. Wound types included pressure injuries, traumatic wounds, and surgical wounds. The average length of NPWTi-d use was 9.5 ± 4.1 days. In all of the patients, the wound beds showed development of healthy granulation tissue following NPWTi-d with ROCF-CC. All patients were discharged to one of the following: another hospital facility, skilled nursing facility, long-term acute care facility, or home. CONCLUSIONS: In the authors' clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of thick exudate and infectious materials and promoted development of granulation tissue.
Subject(s)
Negative-Pressure Wound Therapy , Adult , Aged , Bandages , Exudates and Transudates , Female , Granulation Tissue , Humans , Male , Middle Aged , Wound HealingABSTRACT
Reaction of (CpiPr4)2UI with NaN3 resulted in formation of tetrameric uranium(iii) azide-bridged 'molecular square' [(CpiPr4)2U(µ-η1:η1-N3)]4 (1). Addition of B(C6F5)3 to 1 induced loss of N2 at room temperature, yielding the uranium(v) borane-capped nitrido (CpiPr4)2U(µ-N)B(C6F5)3 (2).
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Surgical site infection and other common surgical site complications (dehiscence, hematoma, and seroma formation) can lead to serious and often life-threatening complications. Gauze, adhesive dressings, and skin adhesives have traditionally been utilized for incision management. However, the application of negative pressure wound therapy over clean, closed surgical incisions (closed incision negative pressure therapy, ciNPT), has become a recent option for incision management. A brief review of ciNPT clinical evidence and health economic evidence are presented. A brief literature review was performed using available publication databases (PubMed, Ovid®, Embase®, and QUOSA™) for articles in English reporting on the use of ciNPT between October 1, 2016, to March 31, 2019. The successful application of ciNPT over clean, closed wounds has been reported in a broad spectrum of patients and operative interventions, resulting in favorable clinical results. Four of the five studies that examined health economics following the use of ciNPT reported a potential reduction in the cost of care. The authors' own experience and published results suggest that patients at high risk for developing a surgical site complication may benefit from the use of ciNPT during the immediate postoperative period. Additional studies are needed across various surgical disciplines to further assess the safety, and cost-effectiveness of ciNPT use in patient populations.