Real-World Balance Assessment While Standing for Fall Prediction in Older Adults.

OBJECTIVE: Postural control naturally declines with age, leading to an increased risk of falling. Within clinical settings, the deployment of balance assessments has become commonplace, facilitating the identification of postural instability and targeted interventions to forestall falls among older adults. Some studies have ventured beyond the controlled laboratory, leaving, however, a gap in our understanding of balance in real-world scenarios. METHODS: Previously reported algorithms were used to build a finite-state machine (FSM) with four states: walking, turning, sitting, and standing. The FSM was validated against video annotations (gold standard) in an independent dataset with data collected on 20 older adults. Later, the FSM was applied to data from 168 community-dwelling older people in the InCHIANTI cohort who were evaluated both in the laboratory and then remotely in real-world conditions for a week. A 70/30 data split with recursive feature selection and resampling techniques was used to train and test four machine-learning models. RESULTS: In identifying fallers, duration, distance, and mean frequency computed during standing in real-world settings revealed significant relationships with fall risk. Also, the best-performing model (Lasso Regression) built on real-world balance features had a higher area under the curve (AUC, 0.76) than one built on lab-based assessments (0.57). CONCLUSION: Real-world balance features differ considerably from laboratory balance assessments (Romberg test) and have a higher predictive capacity for identifying patients at high risk of falling. SIGNIFICANCE: These findings highlight the need to move beyond traditional laboratory-based balance measures and develop more sensitive and accurate methods for predicting falls.

Fall risk stratification of community-living older people. Commentary on the world guidelines for fall prevention and management.

The Task Force on Global Guidelines for Falls in Older Adults has put forward a fall risk stratification tool for community-dwelling older adults. This tool takes the form of a flowchart and is based on expert opinion and evidence. It divides the population into three risk categories and recommends specific preventive interventions or treatments for each category. In this commentary, we share our insights on the design, validation, usability and potential impact of this fall risk stratification tool with the aim of guiding future research.

Estimation of the Difference in Colistin Plasma Levels in Critically Ill Patients with Favorable or Unfavorable Clinical Outcomes.

In recent decades, antimicrobial resistance (AMR) has led to an increased use of therapeutic alternatives. Among these options, colistin continues to be an option for the treatment of multi-resistant (MDR) Gram-negative bacterial infections. However, due to its high toxicity (nephrotoxicity and neurotoxicity) and narrow therapeutic window, colistin treatment must be utilized carefully. Colistin-treated patients have been observed to have higher mortality due to inadequate therapeutic levels. The objective of this study was to estimate the difference in colistin plasma levels in critically ill patients, and its relationship to favorable or unfavorable clinical outcomes. This prospective observational study was conducted between September 2017 and June 2020 at the Universidad de La Sabana Clinic, in patients who had been treated with colistimethate sodium (CMS) for at least 72 h until day 7 of drug treatment in the critical care unit of a university hospital. There were no statistically significant differences in colistin levels between groups with favorable or unfavorable clinical outcomes (0.16 SD vs. 0.54 SD p-value = 0.167). There was higher mortality in patients with subtherapeutic levels (18% vs. 0%), and additionally, there was a greater rate of renal failure in the group with higher therapeutic levels (50% vs. 20.7%). Due to the loss of power of the study, we were unable to demonstrate a possible difference between colistin levels related to favorable or unfavorable clinical outcomes at day 7. However, we recommend further studies to evaluate the impact of measuring levels in terms of mortality and security.

Cortical control of a tablet computer by people with paralysis.

General-purpose computers have become ubiquitous and important for everyday life, but they are difficult for people with paralysis to use. Specialized software and personalized input devices can improve access, but often provide only limited functionality. In this study, three research participants with tetraplegia who had multielectrode arrays implanted in motor cortex as part of the BrainGate2 clinical trial used an intracortical brain-computer interface (iBCI) to control an unmodified commercial tablet computer. Neural activity was decoded in real time as a point-and-click wireless Bluetooth mouse, allowing participants to use common and recreational applications (web browsing, email, chatting, playing music on a piano application, sending text messages, etc.). Two of the participants also used the iBCI to "chat" with each other in real time. This study demonstrates, for the first time, high-performance iBCI control of an unmodified, commercially available, general-purpose mobile computing device by people with tetraplegia.

Relationship between the severity of penile curvature and the presence of comorbidities in men with Peyronie's disease.

PURPOSE: We investigated the relationship between penile curvature severity and co-morbidities in men with Peyronie's disease (PD) and assessed whether the severity of curvature had an impact on penile vascular status and/or erectile function. MATERIALS AND METHODS: Based on a 10-year period 469 patients with PD were retrospectively evaluated in regard to age at diagnosis, type and degree of penile curvature, erectile dysfunction (ED) and other comorbidities, such as diabetes mellitus, hypertension, serum lipid abnormalities, smoking and ischemic heart disease. To assess penile vascular status all men with PD underwent penile duplex Doppler ultrasound evaluation. The severity of penile curvature was classified using the Kelami system, that is grade 1--curvature 30 degrees or less, grade 2--30 to 60 degrees and grade 3--greater than 60 degrees. RESULTS: Mean patient age was 54.8 +/- 4.3 years (range 18 to 79) and the mean duration of symptoms was 24.8 +/- 13.7 months (range 3 to 120). The most common penile abnormality was dorsal curvature in 47.1% of patients. The most frequently documented co-morbid conditions in association with PD were hypertension in 27.2% of cases, smoking in 25.5%, hypercholesterolemia in 18.3%, diabetes mellitus in 17.2%, hyperlipidemia in 15.7% and a history of penile trauma in 13.2%. There was no relationship between the number or severity of each of these co-morbid conditions and the severity of the penile abnormality. In addition, there was no relationship between the severity of penile curvature and penile vascular status in patients with PD. Moreover, the prevalence of these comorbidities, except smoking and penile trauma history, was significantly higher in patients with PD and concurrent ED than in patients with PD only. CONCLUSIONS: While co-morbid conditions, such as hypertension, smoking, hypercholesterolemia, diabetes mellitus and hyperlipidemia, are commonly seen in patients with PD and may seem to be risk factors for PD, there was no statistical relationship between penile curvature severity and any of these comorbidities. Similarly there was no statistically significant relationship between the severity of curvature and penile vascular status or ED. The fact that the prevalence of associated comorbidities is higher in patients with PD and ED than in patients with PD only indicates that these comorbidities are more likely related to ED than to the pathogenesis of PD.

Patient and partner satisfaction and long-term results after surgical treatment for Peyronie's disease.

OBJECTIVES: To assess the long-term functional outcome, patient and partner satisfaction, and predictive factors for unfavorable results in men treated with a surgical approach for severe Peyronie's disease. METHODS: Sixty-one patients underwent surgical treatment for Peyronie's disease between 1997 and 2001 and were retrospectively evaluated. All patients were assessed preoperatively with a detailed sexual and medical history, focused physical examination, and penile duplex ultrasonography. Nineteen patients underwent penile plaque excision/incision and grafting with Tutoplast cadaveric pericardial grafting material (group 1). Penile prosthesis implantation and manual modeling was performed in 31 patients (group 2a), and 11 men were treated with penile prosthesis implantation and pericardial grafting (group 2b). RESULTS: The mean follow-up of the patients was 21.9 +/- 13.6 months (range 12 to 48). Complete penile straightening was achieved in 15 patients (78.9%) in the excision/incision and grafting group. In the 42 men who underwent reconstruction using penile prosthesis implantation (group 2a,b), penile curvature resolved completely in 37 patients (88%). Long-term postoperative residual curvatures greater than 30 degrees occurred in 3 patients (15.7%) and 2 patients (4.8%) in groups 1 and 2a,b, respectively. One penile prosthesis (2.3%) was explanted in the second group for erosion. Patient responses to our questionnaire showed that overall 83.6% of the patients and 76.9% of the partners were satisfied with the surgical result. CONCLUSIONS: According to the results of this long-term, retrospective study, pericardial grafting can be used successfully after plaque excision/incision procedures in men undergoing surgical treatment for severe Peyronie's disease. In patients with Peyronie's disease and erectile dysfunction, implantation of a penile prosthesis and correction of the curvature with a graft can provide an acceptable, functionally straight penis without any increased risk of complications compared with penile prosthesis implantation alone.

Antibioticoterapia profilactica en neurocirugía: estudio prospectivo y controlado, en doscientas craneotomías / Prophylactic antibiotictherapy in neurosurgery: prospective study and controlated in 200 craniotomy

La utilidad de la Oxacilina como antibiótico profiláctico en neurocirugía fue estudiado en forma prospectiva, en el Servicio de Neurocirugía del Hospital Vargas de Caracas. Este grupo de estudio fue conformado por 100 casos de craneotomías limpias realizadas entre enero de 1989 y junio de 1990, presentándose un 2 por ciento de infecciones postoperatorias. Este resultado se comparó con el grupo control, constituido por 100 casos de craneotomías limpias, realizadas antes del inicio de este estudio, sin profilaxia con antibióticos preoperatorio, los cuales presentaron un 13 por ciento de infecciones postoperatorias. Esta diferencia en el porcentaje de infecciones entre los dos grupos fue estadísticamente significativa (p<0,05), demostrando la eficacia de la profilaxia antibiocoterápica preoperatoria en la prevención de infecciones postoperatorias.

Paracoccidioidomicosis diseminada con invasión al sistema nervioso central y manifestaciones de tipo convulsivo / Disseminated paracoccidioidomycoses with invasion to central nervous system and manifestations of convulsive type

Presentamos un caso de Paracoccidiodomicosis diseminada con manifestaciones neurológicas caracterizadas por convulsiones tónico-clónicas generalizadas y demostración de lesiones de ocupación de espacios cerebrales a través de la tomografía computarizada de cráneo (TC). Recibió tratamiento con trimetropin sulfametoxasol (TMO-SMX) y anticonvulsionantes con la desaparición de los síntomas. La TC de control realizada 6 meses después de tratamiento continuo demostró desaparición completa de las lesiones cerebrales. Se mantuvo el tratamiento con TMP-SMX durante 3 años con excelente tolerancia. En la forma visceral diseminada de la enfermedad existe invasión al sistema nervioso central (SNC) e un porcentaje apreciable de pacientes (12 por ciento), muchos de ellos asintomáticos. Sugerimos la exploración neurorradiológica de todos los casos de infección con signos clínicos sugestivos de invasión al SNC a fin de poder escoger una modalidad de tratamiento con penetración adecuada al líquido cefalorraquídeo.

Ciprofloxacina vs cefotaxima en infecciones de piel y tejidos blandos / Ciprofloxacin vs cifotaxine in skin and bland tissues infections

Se realizó un estudio clínico abierto, prospectivo, comparativo y aleatorio en el cual se evaluó la seguridad y efectividad de la ciprofloxacina por vía oral (500 mg/12 horas) vs cefotaxima por vía parenteral (1 gr/8 horas) en el tratamiento de infecciones de piel y tejidos blandos. Del total de 60 pacientes incluidos en el estudio, 47 fueron evaluables, 25 pacientes en el grupo de ciprofloxacina y 22 en el grupo de cefotaxina. Ambos grupos fueron comparables en cuanto a sus características clínicas. En los dos grupo predominaron los microorganismos gram positivos, siendo el Staphylociccus aureus la cepa aislada con mayor frecuencia. Se obtuvo la curación en 23 pacientes (92%) y 22 pacientes (100%) en el grupo de ciprofloxamina y cefotaxima, respectivamente. Se apreció mejoría clínica en 2 pacientes con ciprofloxacina (8%). La erradicación bacteriológica se observó en el 92% en el grupo que recibió ciprofloxacina y en el 86,9% en el grupo que recibió cefotaxima. No hubo efectos colaterales importantes en nigún paciente. La ciprofloxacina es equivalente a la cefotaxima, en cuanto a su efectividad y tolerabilidad en este tipo de infecciones

Aspectos psicosociales de nuestro adolescente infractor / Psychosocial aspects of adolescent violator

Se señalan las principales tareas que debe enfrentar el adolescente en la época actual: 1. Definición de un rol sexual. 2. Definición de una vocación para seguir un trabajo que le garantice independencia económica. 3. Desarrollo mental que favorezca la reflexión y la crítica. 4. Elaboración de un concepto propio para lograr su adecuada emancipación. Para el autor es injusto hablar del adolescente como infractor. Este término debe atribuirse a desórdenes de la conducta que correspondan a un déficit formativo y a una incapacidad para mejor respuesta. Palabras claves: Adolescente infractor, aspectos psicosociales de la adolescencia.

Síndrome de Budd-Chiari, tromboembolismo pulmonar y trombosis venosa profunda, asociado con "anticoagulante lupico" y uso reciente de anticonceptivos orales / Budd-Chiari syndrome, pulmonary thromboembolism and deep venous thrombosis associated with \"lupus anticoagulant\" and recent use of oral contraceptives

El sínrome de Budd-Chiari es la manifestación clínica de la obstrucción total o parcial de las venas hepáticas y/o de la vena cava inferior. Es una forma poco frecuente de hipertensión portal, siendo la forma de presentación crónica la más frecuente y se caracteriza por dolor en hipocondrio derecho, hepatomegalia y ascitis e instalación gradual. Se presenta el caso de una mujer de 26 años con este síndrome asociado a ingesta reciente de anticonceptivos orales y la presencia de un anticoagulante lúpico. Además presentó trombosis venosa profunda en miembro inferior izquierdo y tromboembolismo pulmonar, falleciendo casi 6 años después de iniciado el cuadro clínico

Síndrome febril prolongado en drogadicto coincidiendo con depósitos de cristales de basuco / Prolonged fever syndrome in a drug addict: effects and complications of bazooko

El auge de la Drogadicción en las últimas décadas, ademas de evidenciar una intensa problemática social, ha dado lugar a la aparición de una serie de nuevas patologías, las cuales requieren constante investigación. Presentamos en este trabajo la historia clínica de un paciente adicto al Basuco (pasta de coca) en quien se estudio la aparición de granulomas a cuerpo extraño, en tejido linfático cervical. Estos granulomas, han sido aislados en otros tejidos como Celular Subcutáneo, Hígado, Médula Osea, Bazo y Gánglios Linfáticos de diversa localización. Al ser estudiados con luz polarizada, se hallaron cristales birrefringentes en su parte central. Dichos cristales serían resultados del depósito de restos de Hidróxido de Magnesio, contenido en la cocaína no refinada, procesada con diversas sustancias para el logro de la pasta de coca (Basuco o Crack). Para producir granulomas una partícula debe medir entre 1 y 100 Nm en su forma colonial, tomando la transformación de silicato, varios años. Otro aspecto de interés en el caso presentado, lo constituye la coexistencia de Mielofibrosos con la ya mencionada; demostrado una vez más la afectación sistemica producida porla droga. Pensamos que para el Internista de hoy, así como para el médico de otras especialidades, reviste gran interés la descripción de cuadros de este tipo, el cual puede servir de punto de partida para investigaciones ulteriores, en la lucha contra este gran flagelo de la sociedad

Gangrena gaseosa. presentación de 6 casos / Gas gangrene: presentation of 6 cases

Se realiza un estudio de 6 pacientes atendidos en el Hospital Pediátrico Docente "Eliseo 'Noel' Caamaño" de Matanzas, de los cuales uno vino amputado traumático y 5 evolucionaron sin necesidad de amputación. Se expone el método de trabajo colectivo intensivo ante esos pacientes, en que se realiza la innovación de trasladar el medio quirúrgico a la habitación aislada del paciente, donde se le realiza cura y debridamiento total diario, con anestesia general, cultivos diarios y seguidamente de laboratorio. Se expone nuestra experiencia y se compara con la bibliografía al respecto. Se estimula en el estudio de estos pacientes, la evolución favorable alcanzada (AU)

Gangrena gaseosa: presentación de 6 casos / Gas gangrene: presentation of 6 cases

Se realiza un estudio de 6 pacientes atendidos en el Hospital Pediátrico Docente "Eliseo 'Noel' Caamaño" de Matanzas, de los cuales uno vino amputado traumático y 5 evolucionaron sin necesidad de amputación. Se expone el método de trabajo colectivo intensivo ante esos pacientes, en que se realiza la innovación de trasladar el medio quirúrgico a la habitación aislada del paciente, donde se le realiza cura y debridamiento total diario, con anestesia general, cultivos diarios y seguidamente de laboratorio. Se expone nuestra experiencia y se compara con la bibliografía al respecto. Se estimula en el estudio de estos pacientes, la evolución favorable alcanzada

Clasificación serológica de estreptococos betahemolíticos / Serologic classification of beta-hemolytic streptococci

Se estudian 164 cepas de estreptococos betahemolíticos que proceden de exudados faríngeos, nasales y de materiales purulentos, con el fin de agruparlos serológicamente según la técnica de Ouchterlony. Todas las cepas fueron clasificadas en los grupos A, C o G(AU)

Clasificación serológica de estreptococos betahemolíticos

Se estudian 164 cepas de estreptococos betahemolíticos que proceden de exudados faríngeos, nasales y de materiales purulentos, con el fin de agruparlos serológicamente según la técnica de Ouchterlony. Todas las cepas fueron clasificadas en los grupos A, C o G(AU)