Sintomatología de pacientes hospitalizados por SARS-CoV-2 en un hospital de segundo nivel / Symptoms of SARS-CoV-2 patients in a second level hospital

Introduction: T he COVID-19 p andemic caused by t he SARS-CoV-2 coronavirus h as shaken the world since the beginning of 2020, causing a huge number of patient deaths. Objective: To evaluate the main symptoms of patients hospitalized for SARS CoV-2 in th e H.G.Z No.1 of the IMSS in Nayarit. Methodology: It is a retrospective, observational and cross-sectional study, with information collected from the clinical records of patients admitted through the respiratory triage area with a diagnosis of SARS Cov-2, confirmed with PCR. Results: 433 patients were included, of these 267 male patients (62%) and 166 female patients (38%), with an average age of 62 years. Within the main symptomatology is dyspnea (96%), fever (78%), attack to the general state (78%), cough (76%) and headache (67%). In addition, 102 (23.6%) patients required advanced airway management, of whom 89 died (87%). Of the total number of patients, 208 (48%) died and 225 (54%) showed improvement. Conclusions: The main symptoms of patients hospitalized for SARS CoV-2 are dyspnea, fever, general condition attack, cough and headache.

Introducción: la pandemia de COVID-19 provocada por el coronavirus SARS-CoV-2 ha sacudido al mundo desde el comienzo del año 2020, provocando un número ingente de fallecimientos de pacientes. Objetivo: evaluar la principal sintomatología de los pacientes hospitalizados por SARS-CoV-2 en el Hospital General de Zona No.1 del IMSS. Metodología: estudio retrospectivo, observacional y transversal, con información recabada de los expedientes clínicos de pacientes que ingresaron por área de triage respiratorio con diagnóstico de SARS-CoV-2 confirmado mediante prueba PCR. Resultados: se incluyeron 433 pacientes, de estos 267 pacientes de sexo masculinos (62%) y 166 pacientes del femenino (38%), con una edad promedio de 62 años. Dentro de la principal sintomatología se encuentra la disnea (96%), fiebre (78%), ataque al estado general (78%), tos (76%) y cefalea (67%). Además, 102 (23.6%) pacientes necesitaron manejo avanzado de la vía aérea, de los cuales 89 fallecieron (87%). Del total de pacientes, 208 (48%) fallecieron y 225 (54%) mostraron mejoría. Conclusiones: los principales síntomas de pacientes hospitalizados por SARS CoV-2 son disnea, fiebre, ataque del estado general, tos y cefalea.

Identifying engagement and associated factors in nursing students: An exploratory study.

BACKGROUND: Burnout and engagement in health students surpass work life. Although levels of burnout in Nursing students are high, academic engagement is an understudied topic in Nursing, which has shown benefits. The aims were to know the level of engagement of Nursing students and to identify factors that prompt higher levels of engagement. METHODS: An exploratory study was conducted during 2019 in three Universities in Spain. The UWES-S-17 questionnaire was used. RESULTS: The sample consisted of 808 Nursing students. An average level of engagement was found. Engagement differed significantly by gender and age, with females and older students showing greater attitudes. Participants in the second year showed lower scores in the willingness to dedicate effort and persistence than those in the first and third year (p < 0.05). CONCLUSIONS: The identification of the level of engagement and factors involved are an opportunity to probe into this approach by reinforcing positive attitudes in Nursing students. These findings show the need to seek strategies through specific educational interventions and policies. Engagement should be upheld throughout the degree and once they enter the job market to ensure the well-being during academic and future work life, a high-quality nursing care and patient safety.

A modified CALGB 10403 in adolescents and young adults with acute lymphoblastic leukemia in Central America.

Mexico and Central America have a high incidence of acute lymphoblastic leukemia (ALL) in adolescents and young adults. Historically, this patient group has been treated using adult-based regimens, which entails a high rate of treatment-related mortality and a poor overall survival (OS). The use of the CALGB 10403, a pediatric-inspired regimen, has been proven effective in this patient subgroup. Nonetheless, low- and middle-income countries (LMICs) may present limited access to standard care treatments implemented elsewhere, warranting the need for further research to improve outcomes among vulnerable populations. In this study, we present the outcomes in terms of safety and effectiveness of using a modified CALGB 10403 regimen to reflect drug and resource availability in LMICs. Modifications included the use of Escherichia coli asparaginase,6-mercaptopurine instead of thioguanine and the use of rituximab among patients with CD20+. A total of 95 patients with a median age of 23 (range, 14-49) years treated with this modified scheme were prospectively assessed at 5 centers in Mexico and 1 in Guatemala. Among these, 87.8% achieved a complete response after induction. During follow-up, 28.3% of patients relapsed. Two-year OS rate was 72.1%. Factors associated with worse OS included hyperleukocytosis (hazard ratio [HR], 4.28; 95% confidence interval [CI], 1.81-10.10) and postinduction minimal residual disease (HR, 4.67; 95% CI, 1.75-12.44). Most patients presented hepatotoxicity (51.6% and 53.7% during induction and consolidation, respectively), and the treatment-related mortality was 9.5%. Overall, results highlight that implementing a modified CALGB 10403 regimen in Central America is feasible, and it is associated with improvements in clinical outcomes and a manageable safety profile.

Effect of Spatial Contiguity on Learning Sequences of Positions / Efecto de la contigüidad espacial sobre el aprendizaje de secuencias de posiciones

Abstract Four conditions of spatial contiguity of positions were used to assess sequence learning. Two sequences of 16 and 25 positions presented in two matrices of 4x4 and 5x5 respectively were used. Within each matrix, 4 (in the 4x4 matrix) or 6 positions (in the 5x5 matrix) presented spatial contiguity. The place at the sequence in which contiguous positions occurred varied across groups. In this way, spatial contiguity of the 4 or 6 positions was presented at the beginning of the sequence (Group 1), in the middle part (Group 2), at the end of the sequence (Group 3) or it was presented a sequence in which all positions occurred without spatial contiguity (Group 4). 28 undergraduate students participated. Results showed no differences among groups in the number of trials required to reproduce the sequence correctly. Number of errors was lower when contiguous positions were presented at the beginning of the sequence. These findings are explained as a possible effect of accentuation of primacy given by the occurrence of contiguous positions at the beginning of the sequence.

Resumen Cuatro condiciones de contigüidad espacial de posiciones fueron empleadas para evaluar el aprendizaje de secuencias. Se emplearon dos secuencias de 16 y 25 posiciones presentadas en dos matrices de 4x4 y 5x5, respectivamente. Dentro de cada matriz, 4 (en la matriz de 4x4) o 6 posiciones (en la matriz de 5x5) presentaron contigüidad espacial. Entre grupos, se varió el punto de la secuencia en el que se presentaron las posiciones contiguas. De este modo, la contigüidad espacial de las 4 o 6 posiciones se presentó al inicio de la secuencia (Grupo 1), en la parte media (Grupo 2), al final de la secuencia (Grupo 3), o bien, se presentó una secuencia en la que todas las posiciones ocurrieron sin contigüidad espacial (Grupo 4). Participaron 28 estudiantes de licenciatura. Los resultados no mostraron diferencias entre grupos en cuanto al número de ensayos requeridos para reproducir la secuencia correctamente. El número de errores fue menor cuando las posiciones contiguas se presentaron al inicio de la secuencia. Los hallazgos se explican a partir de un posible efecto de acentuación de la primacía, dado por la ocurrencia de posiciones contiguas al inicio de la secuencia.

Antimicrobial properties of poly (vinyl alcohol) films with zeolitic imidazolate framework (ZIF-8) nanoparticles for food packaging.

Antimicrobial packaging films are of interest to the fresh produce industry due to the high number of foodborne illness outbreaks associated with these products. This study evaluated the antimicrobial effectiveness of poly (vinyl alcohol) (PVA) films with embedded zeolitic imidazolate framework (ZIF-8) nanoparticles carrying trans-cinnamaldehyde (TC) against Escherichia coli MG1655 in spinach leaves. PVA films were synthesized using distilled water and mixed at 90°C for 1 h. The synthesized nanoparticles were introduced at various mass ratio concentrations (0%-5% weight of ZIF-8@TC nanoparticles to PVA), namely PVA-Z8-0 (control) through PVA-Z8-5. The PVA and ZIF-8@TC solution was mixed for 24 h until it seemed homogenous, cast, and dried in a ventilated oven at 35°C for 24 h. The release rate of TC from the PVA/ZIF-8@TC into both ethanol and methanol was characterized using HPLC methods. Disk diffusion and growth studies were performed to quantify the films antimicrobial effectiveness. Disk diffusion test showed that antimicrobial activity against E. coli MG1655 increased (p < 0.05) with increased nanoparticles concentration. Growth characteristics were described by the Baranyi model with some variations. About 0.26, 0.73, and 1.65 log reductions were achieved with the PVA-Z8-1 to PVA-Z8-3 films, respectively, while total inactivation was achieved with both the PVA-Z8-4 and PVA-Z8-5 films (p < 0.05). Similarly, the Baranyi model described the inhibitory profiles of the different films. This study contributes to the overall food safety body of knowledge regarding fresh produce and other packaged foods through the development of biopolymeric films with embedded nanoparticles to entrap natural antimicrobials. PRACTICAL APPLICATION: This study paves the way for further research on the development of active polymeric films for food packaging applications.

Properties of poly (vinyl alcohol) films with embedded zeolitic imidazolate framework (ZIF-8) nanoparticles for food packaging applications.

This study evaluated the physical, mechanical, barrier properties, and transition temperatures of poly (vinyl alcohol) (PVA) films with embedded zeolitic imidazolate framework-8 (ZIF-8) nanoparticles carrying a natural antimicrobial, trans-cinnamaldehyde (TC). The ZIF-8 nanoparticles were synthesized using a sonochemical method and incorporated into polymeric matrices at mass ratio concentrations of 0% (control film) to 5% weight of ZIF-8@TC to PVA. Solutions were mixed, cast onto Petri dishes and dried for 12 h at 37°C in a ventilated oven. The film samples were stored in airtight containers at room temperature and used within 1 week. The engineering properties of the PVA/ZIF-8@TC films were compared with those of low-density polyethylene (LDPE) film commonly used for packaging of spinach leaves. The glass transition, melting, and crystallization temperatures of PVA compositive films all increased (p < 0.05) with ZIF-8@TC concentration. When exposed to high relative humidity environments, the PVA/ZIF-8@TC films had lower equilibrium moisture content (p < 0.05) than the LDPE film. Although the composite films have different tensile properties from the LDPE film, embedding ZIF-8@TC into PVA films improved the tensile strength by 17%, making the PVA/ZIF-8@TC films suitable for low load-bearing applications such as food packaging. The gas barrier properties of PVA-based films differed only slightly with added ZIF-8@TC (p < 0.05). PRACTICAL APPLICATION: PVA/ZIF-8@TC films are appropriate environment-friendly alternatives to polymeric food packaging in terms of their functional properties.

Quiste óseo aneurismático en el cuboides de un niño de 13 años. Presentación de un caso clínico / Aneurysmal bone cyst of the cuboid. Case report and review of the literature

Se presenta un caso clínico poco frecuente de un quiste óseo aneurismático localizado en el cuboides de un niño de 13 años. Se llegó al diagnóstico mediante la tríada de síntomas, estudios por imágenes (radiografía, resonancia magnética) y anatomía patológica. El tratamiento consistió en el abordaje y curetaje minuciosos dentro de la lesión, el fresado de alta velocidad, la electrocauterización y el relleno con aloinjerto óseo liofilizado con chips cortico-esponjosos. Pese al diagnóstico tardío, la evolución clínica fue favorable con remisión completa de los síntomas y retorno a las actividades deportivas, sin recidiva local. Nivel de Evidencia: IV

A rare clinical case of an aneurysmal bone cyst located at the level of the cuboid in a 13-year-old boy is presented. The diagnosis was reached through clinical evaluation, imaging studies (radiograph-MRI), and a pathological anatomy analysis. Its treatment consisted of thorough intralesional curettage, high speed burring, electrocautery, and filling with lyophilized bone allograft with cortical/cancellous chips. Despite the late diagnosis, we would like to highlight the favorable clinical evolution of the patient, with ad integrum remission of the symptoms and return to his sport activities, without elements of local recurrence. Level of Evidence: IV

trans-Cinnamaldehyde-encapsulated zeolitic imidazolate framework-8 nanoparticle complex solutions to inactivate Escherichia coli O157:H7 on fresh spinach leaves.

This study synthesized and characterized ZIF-8 nanoparticles encapsulated with trans-cinnamaldehyde oil (TC) and evaluated their antimicrobial effectiveness against Escherichia coli O157:H7 on fresh spinach leaves. The antimicrobial activity of different mass ratios of TC-encapsulated ZIF-8 against E. coli O157:H7 (ATCC 43895) strain was assessed and the best mass ratio of 1:2 TC to ZIF-8 identified. Spinach leaves were treated with (1) 0.5TC@ZIF-8_PL nanoparticle complexes solution, (2) 200 ppm chlorine, (3) free TC, and (4) sterilized distilled water (control). All sample groups were rinsed for 1 min, dried in a biosafety cabinet, weighted, and packed in sterilized Whirl-pkTM Stand-Up sampling bags, and stored at 4°C for 15 days for shelf life studies. Samples were dipped into a solution of nanoparticles and another group was sprayed. The quality of spinach samples was assessed by monitoring changes in moisture content (MC), water activity (Aw), color, pH, texture (firmness and work), vitamin C content, total carotenoid, and chlorophyll content. Spinach leaves treated with 0.5TC@ZIF-8_PL had less (p < 0.05) water, total chlorophyll, and total carotenoid losses, with minimal changes in pH. However, treatment did not prevent the color degradation (p > 0.05) and adversely affected spinach firmness. The spinach samples treated with 200 ppm chlorine and free TC had higher (p < 0.05) total chlorophyll degradation than the samples treated with the nanoparticles. The mass ratio of TC-encapsulated ZIF-8 must be readjusted to reduce potential toxicity issues while maintaining the antimicrobial properties. PRACTICAL APPLICATION: Zeolitic imidazolate framework-8 (ZIF-8) nanoparticle complex can be used to encapsulate natural antimicrobials to inhibit growth of pathogens on fresh produce. A 2-log reduction in populations of Escherichia coli O157:H7 on fresh spinach leaves was achieved using trans-cinnamaldehyde at low concentrations. The results can be used to embed the compounds into polymeric films for antimicrobial packaging applications.

Role of ß-Klotho and Malondialdehyde in Metabolic Disorders, HIV Infection, and Antiretroviral Therapy.

Metabolic alterations, resulting from factors such as obesity or infections (HIV), generate inflammation in the body, affecting the immune system and causing oxidative stress. Prolonged exposure to antiretroviral therapy (ART) conditions the appearance of alterations considered risk factors for metabolic syndrome (MetS), affecting the quality of life in people living with HIV/AIDS (PLWHA). ß-klotho is a protein that can counteract levels of oxidative stress. The aim was to determine the relation of ß-klotho and oxidative stress with metabolic alterations in PLWHA. We hypothesized that levels of ß-klotho and malondialdehyde (MDA) are related in PLWHA on ART with overweight/obesity. As a result of comparing cases versus controls, significant differences were obtained in levels of ß-klotho (p = 0.011), MDA (p < 0.0001), body mass index (p = 0.001), and weight (p < 0.0001). The presence of MetS in PLWHA was 21.2% and 10.6% according to the World Health Organization and ATP III (National Cholesterol Education Program Adult Treatment Panel III) criteria, respectively. The founded correlations were of ß-klotho (r = 0.019) and MDA (r = 0.0001), both with CD4+ cells in PLWHA. In controls, ß-klotho was correlated with very low-density lipoprotein (r = 0.035) and atherogenic index (AI; r = 0.037), MDA with AI (r = 0.039), cholesterol, and low-density lipoprotein (r = 0.002). The increase of inflammation in the organism, owing to HIV infection and/or the presence of obesity, conditions metabolic disruption or depletion of elements needed for homeostasis in the human body.

FGF21 serum levels are related to insulin resistance, metabolic changes and obesity in Mexican people living with HIV (PLWH).

BACKGROUND: Antiretroviral therapy has significantly improved prognosis in treatment against HIV infection, however, prolonged exposure is associated to cardiovascular diseases, lipodystrophy, type 2 diabetes, insulin resistance, metabolic alteration, as obesity which includes the accumulation of oxidative stress in adipose tissue. FGF21 is a peptide hormone that is known to regulate glucose and lipid metabolism. FGF21 is expressed and secreted primarily in the liver and adipose tissue, promoting oxidation of glucose/fatty acids and insulin sensitivity. Alterations in FGF21 may be associated with the development of insulin resistance, metabolic syndrome and cardiovascular disease. We hypothesized that FGF21 protein levels are associated with metabolic abnormalities, placing special attention to the alterations in relation to the concurrence of overweight/obesity in people living with HIV (PLWH). DESIGN: Serum FGF21 was analyzed in 241 subjects, 160 PLWH and 81 unrelated HIV-uninfected subjects as a control group. Clinical records were consulted to obtain CD4+ cell counting and number of viral RNA copies. Serum FGF21 levels were tested for correlation with anthropometric and metabolic parameters; glucose, cholesterol, HDL, LDL, VLDL, triglycerides, insulin and indexes of atherogenesis and insulin resistance (HOMA). RESULTS: The participants were classified into four groups: (i) PLWH with normal weight, (ii) PLWH with overweight/obesity, (iii) HIV-uninfected with normal weight, and (iv) HIV-uninfected with overweight/obesity. Insulin levels were higher in normal-weight PLWH than in the HIV-uninfected group but not statistically significant, however, for the overweight/obesity PLWH group, insulin levels were significantly higher in comparison with the other three groups (p<0.0001). For FGF21, serum levels were slightly higher in the overweight/obesity groups in both patients and controls. In HIV-infected subjects, FGF21 levels showed a strong positive correlation with triglycerides, insulin levels and insulin resistance with a p-value <0.0001. In the seronegative group, FGF21 was only correlated with weight and waist circumference, showing an important association of FGF21 levels with the degree of obesity of the individuals. CONCLUSION: Insulin resistance and FGF21 elevations were observed in overweight-obese PLWH. FGF21 elevation could be viewed as a compensation mechanism as, in the control group, FGF21 correlations appeared to be confined to weight and waist circumference. This can be explained based on the action of FGF21 promoting the uptake of glucose in adipose tissue. In PLWH, FGF21 was low, possibly as a result of a change in adiposity leading to a metabolic disruption.

Experimental observations on the reductive cleavage of endo and exo 3,4-O-benzylidene fucopyranoside derivatives.

Reductive cleavage of methyl 3,4-O-benzylidene-α-L-fucopyranosides with BH3·THF-TfOH and NaCNBH3-TfOH systems resulted in enhanced reaction rates and selectivity compared to BH3·THF-Bu2BOTf. With this latter system, the nature of the O-2 substituent exerted a clear control on the reactivity but practically did not affect the regioselectivity. With TfOH the direction of cleavage was determined, as expected, by the configuration of the acetal carbon atom, but slightly influenced by its competitive epimerization. Protic conditions provided higher regioselectivity in the openings of the exo isomers, affording a useful approach to the practical synthesis of 3-O-benzyl ethers.

Serum electrolytes and renal alterations in HIV-seropositive Mexican subjects.

ABSTRACT: To examine potential risk factors associated with biochemical alterations in renal function in a population diagnosed with HIV/AIDS undergoing antiretroviral treatment.This is an observational, transversal, and relational design study that included 179 HIV-seropositive subjects. Glucose serum, cholesterol, triglycerides, total proteins, albumin, creatine, urea, blood urea nitrogen (BUN), and electrolytes levels were determined for each individual. Renal function was evaluated through the glomerular filtration rate (GFR), using the CKD-EPI equation. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate  < 60 mL/min/1.73 m2. Univariate model significant variables, with a 95% confidence interval (CI), were included in a multivariate logistic regression analysis.CKD prevalence in patients was 7.3%, with comorbidities of 7.8% for type 2 diabetes mellitus, 7.3% for arterial hypertension, and 35.2% for dyslipidemia. Additionally, both hypernatremia and hypophosphatemia were detected in 57% (n = 102) of the patients. Multivariate logistic regression suggested that CD4+ T cell count < 200 (P = .02; OR 0.2; CI 95% 0.08-0.8) was associated to hyponatremia; similarly, detectable viral load was associated to hypokalemia (P = .02; OR 5.1; CI 95% 1.2-21.3), hypocalcemia (P = .01; OR 4.1; CI 95% 1.3-12.3), and hypermagnesemia (OR 3.9; CI 95% 1.1-13.6). Patient age was associated to both hypophosphatemia (P = .01; OR 2.4; CI 95% 1.1-5.0) and hypermagnesemia (P = .01; OR 2.8; IC 95% 1.1-7.0), and high creatinine levels were associated to nucleoside reverse transcriptase inhibitor treatment (P = .001; OR 42.5; CI 95% 2.2-806.9). Lastly, high BUN levels were associated to age (P = .03; OR 3.8; CI 95% 1.0-14.4), while GFR 60 to 89 mL/min/1.73 m2 was associated to dyslipidemia (P = .02; OR 2.2; CI 95% 1.1-4.5).CD4+ T cell and viral load were the main factors associated with renal biochemical alterations.

Frequency and Risk Factors for Spontaneous Pneumomediastinum in COVID-19 Patients.

Background: Spontaneous pneumomediastinum (SPM) is an uncommon condition in COVID-19 patients. No information about outcome or risk factors is available at the time. The aim of this research is to report on the frequency and risk factors of spontaneous pneumomediastinum in COVID-19 patients. Materials and Methods: An unmatched case-control study was carried out in a tertiary health-care facility for patients with COVID-19. Electronic files were reviewed to identify patients with confirmed COVID-19 infection by RT-PCR. Univariate analysis was used to describe demographic data. Mean differences were calculated using the Mann-Whitney test. Frequency and odds ratios were calculated by standard operations. Results: A total of 271 patients were included in the study. Nine patients showed spontaneous pneumomediastinum and four of them presented associated spontaneous pneumothorax. The most common risk factors associated with poor outcomes in COVID-19 patients were not considered as risk factors for spontaneous pneumomediastinum development. Conclusion: Spontaneous pneumomediastinum is an uncommon clinical feature in COVID-19 patients. More research is necessary to formulate statements regarding prevalence, risk factors, and outcome.

Microbiomes in agricultural and mining soils contaminated with arsenic in Guanajuato, Mexico.

In this report, physical and chemical properties, and total arsenic (As) concentrations were analyzed in agricultural (MASE) and mining soils (SMI) in the State of Guanajuato, México. Additionally, a metagenomic analysis of both types of soils was the bases for the identification and selection of bacteria and fungi resistant to As. The SMI soil showed higher concentration of As (39 mg kg-1) as compared to MASE soil (15 mg kg-1). The metagenome showed a total of 175,240 reads from both soils. MASE soil showed higher diversity of bacteria, while the SMI soil showed higher diversity of fungi. 16S rRNA analysis showed that the phylum Proteobacteria showed the highest proportion (39.6% in MASE and 36.4% in SMI) and Acidobacteria was the second most representative (24.2% in SMI and 11.6% in MASE). 18S rRNA analysis, showed that the phylum Glomeromycota was found only in the SMI soils (11.6%), while Ascomycota was the most abundant, followed by Basidiomycota, and Zygomycota, in both soils. Genera Bacillus and Penicillium were able to grow in As concentrations as high as 5 and 10 mM, reduced As (V) to As (III), and removed As at 9.8% and 12.1% rates, respectively. When aoxB, arsB, ACR3(1), ACR3(2,) and arrA genes were explored, only the arsB gene was identified in Bacillus sp., B. simplex, and B. megaterium. In general, SMI soils showed more microorganisms resistant to As than MASE soils. Bacteria and fungi selected in this work may show potential to be used as bioremediation agents in As contaminated soils.

Inestabilidad tibioperonea proximal atraumática en pacientes con fisis abiertas. Reporte de caso / Atraumatic proximal tibiofibular joint instability in patient with open physis. Case report

La inestabilidad de la articulación tibioperonea proximal puede presentarse con una luxación, con escasos síntomas laterales de la rodilla, dolor, malestar e incomodidad durante distintas actividades o síntomas relacionados con la irritación del nervio peroneo común. Un preciso diagnóstico prequirúrgico es imperativo, así como el tratamiento conservador con inmovilización y kinesiología por cuatro a seis semanas. En la población adolescente, el planeamiento prequirúrgico puede ser dificultoso por la presencia de los cartílagos abiertos, por lo tanto, se debe tomar precaución en la realización de los túneles y en la colocación de implantes en relación con la fisis abierta. El objetivo del siguiente trabajo es presentar el caso de un niño de once años con inestabilidad tibioperonea proximal recurrente, además mostrar detalles de la técnica quirúrgica, protocolo postoperatorio y sus excelentes resultados

Instability of the proximal tibiofibular joint (PTFJ) can present as dislocations, vague symptoms of lateral knee pain, discomfort during activity, or symptoms related to irritation of the common peroneal nerve. An accurate preoperative diagnosis is imperative and should include a trial of taping of the PTFJ for a 4- to 6-week time frame before surgical reconstruction is indicated. In the adolescent population, surgical planning can be complicated by the presence of open physes; therefore, caution must be taken to avoid drilling through or placing screw fixation across the physes. Potential complications include growth arrest and limb length discrepancy. Therefore, the purpose of this case report is to describe the surgical technique for addressing PTFJ instability in adolescent patients. The aim of this case report is to present a case of instability of the proximal tibiofibular joint (PTFJ) treated surgically in an eleven-year-old male soccer player, focused on technical tips, strict rehab protocol with excellent results

Klotho-HIV and Oxidative Stress: The Role of Klotho in Cardiovascular Disease Under HIV Infection-A Review.

Combined antiretroviral therapy has improved quality and life expectancy of people living with human immunodeficiency virus (HIV). However, this therapy increases oxidative stress (OS), which in turn causes alterations in lipid and carbon metabolism, kidney disease, liver cirrhosis, and increased risk of cardiovascular disease. The Klotho gene has been implicated in cardiovascular risk increase. Klotho protein expression at X level decreases the risk of heart disease. HIV-positive people usually present low plasma levels of Klotho; thus, contributing to some extent to an increase in cardiovascular risk for these types of patients, mostly by favoring atherosclerosis. Therefore, our aim is to provide an overview of the effect of OS on Klotho protein and its consequent cardiometabolic alterations in HIV-positive patients on antiretroviral therapy.

Analysis of orthopedic surgical procedures in children with cerebral palsy.

BACKGROUND: Orthopedic surgery in children with cerebral palsy (CP) aims to improve function and prevent deformities. Each child's condition in CP is unique and many co-variables influence surgical decision-making including a patient's age and their functional level. Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels, particularly in countries from Latin America. AIM: To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP. METHODS: This retrospective study included all children with CP (n = 245) treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database. Eighteen children (7%) were lost to follow-up due to missing medical charts. Demographics, gross motor function classification (GMFCS), and orthopedic surgeries were obtained from the medical records of 227 children. Chi-squared tests and analysis of variance were used to assess the frequency of surgery, accounting for GMFCS levels. Mean age for soft tissue vs bone surgery was compared with the independent samples t-test. RESULTS: A total of 711 surgical procedures were performed between 1998 and 2016. On average, children had 3.1 surgical procedures and the mean age at first surgery was 8.0 years. There were no significant differences in age at first surgery among GMFCS levels (P = 0.47). The most common procedures were lower leg soft tissue surgery (n = 189, 27%), hip tenotomy (n = 135, 19%), and hamstring tenotomy (n = 104, 14%). For children with GMFCS level I, the mean number of surgeries per child [1.8 (range 1-9)] differed significantly at P < 0.05 in children with GMFCS levels II [3.2 (1-12)], III [3.2 (1-8)], IV [3.3 (1-13)], and V [3.6 (1-11)]. Within II, III, IV, and V, there was no significant difference in mean number of surgeries per child when comparing across the groups. The proportion of soft tissue surgery vs bone surgery was higher in GMFCS levels I-III (80%-85%) compared to levels IV (68%) and V (55%) (P < 0.05). CONCLUSION: The frequency of surgical procedures per child did not increase with higher GMFCS level after level I. However, the proportion of bone surgery was higher in GMFCS levels IV-V compared to I-III.

Effect of microbiota on the physiology of blood-tissue barriers.

Las uniones estrechas (UE) son estructuras altamente complejas que se localizan en la porción más apical de la membrana basolateral y están compuestas por una serie de proteínas, como claudinas, ocludinas y proteínas de la familia ZO. Las UE restringen el paso de sustancias potencialmente dañinas o microorganismos a lo largo del espacio paracelular, y participan de manera importante en procesos de mecanotransducción y señalización intercelular. Aunque la ultraestructura de las UE les permiten funcionar como una barrera en varios tejidos, como en la barrera hematoencefálica y la barrera hematotesticular, estas son propensas a cambios en su composición, lo cual podría disminuir sus características de permeabilidad. En este sentido, se ha demostrado que ciertos microorganismos enteropatógenos son capaces de desensamblar o modificar las propiedades de permeabilidad de las UE en las barreras hematotisulares. En particular, se ha estudiado cómo la microbiota contribuye a la formación, la función y el mantenimiento de las UE en varios nichos inmunitariamente privilegiados, tales como el tracto gastrointestinal, el sistema nervioso central y los testículos. Por lo tanto, resulta primordial comprender los mecanismos fisiológicos por los cuales la microbiota puede modificar la función de las barreras hematotisulares, con el -objetivo de diseñar nuevas estrategias terapéuticas que mejoren los efectos dañinos de varias enfermedades sobre nichos inmunitariamente privilegiados en el humano.Tight-junctions (TJ) are a highly complex structure located in the most apical portion of the basolateral membrane, composed of series of proteins, such as claudins, occludins and proteins of the ZO family. TJ restrict the passage of potentially harmful substances or microorganisms through paracellular space and participate importantly in the mecanotransduction and intercellular signaling processes. Although the complex structure of TJ, allow them function as barrier in various tissues, such as brain-blood-barrier and testicular-blood-barrier, these barriers are prone to changes decreasing its permeability features. The contribution of microbiota in the formation, function and maintenance of TJ in various immunologically privileged niches, such as gastrointestinal tract, central nervous system and testicles have been recently studied. Nevertheless, it has been demonstrated that certain pathogenic microorganisms are able to disassemble or modify the permeability of TJ in blood-tissue barrier. Thereby, it is central to understand the physiological mechanisms of how microbiota could modify the function of epithelial blood barriers in order to design new therapeutic strategies to ameliorate harmful effects of many human diseases.

Epifisiólisis de fémur proximal: resultados y calidad de vida / Epiphysiolysis of the proximal femur: results and quality of life / Epifisiólise proximal do fémur: Resultados e qualidade de vida

Resumen: Introducción: el impacto sobre la calidad de vida de los pacientes con deslizamientos de epífisis femoral proximal inestables y estables es poco conocido. El objetivo de este estudio fue conocer los resultados terapéuticos utilizando un score de calidad de vida y las complicaciones de la población afectada en un centro de referencia ortopédico. Material y método: estudio de cohorte que incluyó 28 niños tratados en el Centro Hospitalario Pereira Rossell entre 2010 y 2016. Se evaluaron los pacientes clínica y radiológicamente con un mínimo de dos años de seguimiento posoperatorio. Fue utilizado el cuestionario International Hip Outcome Tool (iHOT-12), para medir resultados reportados por el paciente. Se evaluaron las complicaciones necrosis avascular, condrolisis y pinzamiento femoroacetabular. Resultados: se identificaron 38 caderas tratadas por deslizamiento epifisario femoral proximal; 28 clasificadas estables (74%) y 10 inestables (26%). La fijación in situ fue el tratamiento quirúrgico más frecuentemente utilizado. Al final del seguimiento se evaluaron 27 pacientes y el iHOT-12 mostró una diferencia significativa entre deslizamientos estables y deslizamientos inestables 70 (rango 38-95) y 86 (57-100); p=0,017), respectivamente. No se observó necrosis avascular ni condrolisis y el pinzamiento femoroacetabular fue de 19% (n=7 caderas; 6 estables y 1 inestable). Conclusiones: los resultados clínicos de calidad de vida a través de scores reportados por los pacientes (PROM) utilizados eran significativamente mejores en los deslizamientos de la epífisis femoral proximal (DEFP) inestables en comparación con los DEFP estables. La ausencia de necrosis avascular en caderas inestables y la mayor proporción de pinzamiento femoroacetabular en los deslizamientos estables, a pesar de una remodelación femoral notoria luego de fijación in situ, podría explicarnos estos hallazgos inesperados.

Summary: Introduction: the impact on the quality of life of patients with unstable and stable slipped capital femoral epiphysis is rather unknown. The study aims to learn about therapeutic outcomes in a quality of life score and the complications of the affected population in an orthopedics reference center. Method: this cohort study included 28 children treated at the Pereira Rossell Hospital Center between 2010 and 2016. Patients were assessed both clinically and with x-rays, with a 2-year minimum postoperative follow-up. The "International Hip Outcome Tool" (iHOT-12) questionnaire was used to measure the results reported by patients. Avascular necrosis, chondrolysis and femoroacetabular impingement were the complications evaluated by the study. Results: the study identified 38 hips treated for slipped capital femoral epiphysis. 28 of them were classified as stable (74%) and 10 as unstable (26%). In-situ fixation was the most frequently used surgical treatment. Upon completion of follow-up, 27 patients were assessed and the iHOT12 showed a significant difference between stable and unstable slips (70 (range 38-95) and 86 (57-100); P=0,017) respectively. No avascular necrosis or chondrolysis were observed and femoroacetabular impingement was 19% (n=7 hips; 6 stable and 1 unstable). Conclusions: quality of life clinical results obtained by PROM were significantly better in the unstable slipping epiphysis of the proximal femur than in the stable epiphysis. Absence of avascular necrosis in unstable hips and the greater proportion of femoroacetabular impingements in stable slips despite a noticeable femoral remodeling following in-situ fixation could explain these surprising results.

Resumo: Introdução: o impacto sobre a qualidade de vida dos pacientes com deslizamentos de epífise proximal do fêmur instáveis e estáveis é pouco conhecido. O objetivo deste trabalho foi conhecer os resultados terapêuticos utilizando um indicador de qualidade de vida e as complicações da população afetada em um centro ortopédico de referência. Materiais e métodos: este estudo de coorte incluiu 28 crianças tratadas no Centro Hospitalario Pereira Rossell no período 2010-2016. Foram avaliados os aspectos clínicos e radiológicos com um seguimento pós-operatório mínimo de 2 anos. O questionário International Hip Outcome Tool (iHOT-12) foi utilizado para medir os resultados descritos pelo paciente. Foram avaliadas as complicações por necrose avascular, condrólise e pinçamento femoroacetabular. Resultados: foram identificados 38 quadris tratados por deslizamento epifisário proximal de fêmur. 28 foram classificados como estáveis (74%) e 10 como instáveis (26%). A fixação in situ foi o tratamento cirúrgico mais frequentemente utilizado. No término do seguimento 27 pacientes foram avaliados e o iHOT12 mostrou uma diferença significativa entre deslizamentos estáveis e instáveis (70 (intervalo 38-95) e 86 (57-100); P=0,017) respectivamente. Não foram observadas necrose avascular nem condrólise e o pinzamiento femoroacetabular foi de 19% (n=7 quadris; 6 estáveis e 1 instável). Conclusões: os resultados clínicos de qualidade de vida através do PROM (desfechos medidos pelo paciente) utilizado eram significativamente melhores nos DEFP instáveis comparados com os estáveis. A ausência de necrose avascular nos quadris instáveis e a maior proporção de pinçamento femoroacetabular nos deslizamentos estáveis apesar de uma remodelação femoral notória depois da fixação in situ, poderia explicar estes achados inesperados.

La efectividad de la crema Calendula officinalis L como tratamiento de la estomatitis aftosa recurrente / Calendula officinalis L cream effective treatment for recurrent aphthous stomatitis

RESUMEN Introducción: la estomatitis aftosa recurrente es una enfermedad habitual en las urgencias de Periodontología. Objetivo: evaluar la efectividad de la crema de Calendula officinalis L. al 10%, en el tratamiento de la estomatitis aftosa recurrente, en una clínica estomatológica. Método: se realizó un ensayo no controlado- no aleatorizado, en una población de 15 a 34 años de edad; que acudieron a la consulta de periodoncia de la Clínica Estomatológica Docente "Manuel Angulo Farrán" en Holguín, Cuba, en el período comprendido del año 2015 al 2017. La muestra fue de 100 pacientes, tratada durante 6 días, con consultas cada 48 horas. Resultados: el 59% de los pacientes fueron del sexo femenino, el 63% entre los 25 y 34 años, y en el 97% predominaron las aftas menores. La crema en estudio mejoró los síntomas en el 97% de los pacientes, y el 94% se curó. Conclusiones: la crema de Calendula officinalis L al 10% parece eficaz en el tratamiento de la estomatitis aftosa recurrente, aunque se requieren ensayos clínicos controlados y aleatorizados que lo demuestren de forma definitiva.

ABSTRACT Introduction: recurrent aphthous stomatitis is a frequent disease in periodontology emergencies. Objective: to evaluate the Calendula officinalis L at 10% cream effectiveness, as treatment for recurrent aphthous stomatitis, in a stomatological clinic. Method: non-control, non-randomized trial was conducted in a population between 15 and 34 years old, who attended "Manuel Angulo Farrán" Stomatological Teaching Clinic in Holguín, Cuba, from 2015 to 2017. Sample was 100 patients, treated in consultations every 48 hours, for 6 days. Results: the 59% of the patients were female, 63% between 25 to 34 years, and minor aphthae predominated in the 97%. The studied cream improved symptoms in 97% of patients and 94% were completely cured. Conclusions: Calendula officinalis L at 10% cream seems effective in the treatment of recurrent aphthous stomatitis, although controlled and randomized clinical trials would definitively demonstrate it.