Pericapsular nerve group (PENG) block for hip fracture in the emergency department: a case series.

Guidelines for the management of hip fractures recommend timely identification, analgesia and optimisation, in order to facilitate prompt surgical repair. In achieving these aims, multidisciplinary care is essential. In this case series, we present five patients who received bedside pericapsular nerve group (PENG) blocks by emergency physicians in collaboration with the anaesthesia team for pain management following hip fracture. The PENG block is a novel motor- and opioid-sparing technique, which offers long-lasting analgesia and requires less volume than other blocks. In all of the cases in this series, the blocks were performed successfully in a short period of time, without complication. All patients reported a clinically important reduction in pain scores. Patients with hip fracture are often medically complex, and while early surgery is not always possible, pain management should be addressed from an early point in their hospital admission. Multidisciplinary input into peri-operative pathways can enhance the provision of analgesia in the emergency department, by allowing anaesthetists and emergency physicians to work together for the benefit of these often-frail patients.

COVID-19 vaccination intent among London healthcare workers.

BACKGROUND: The 10-month timeline from conception to regulatory approval of the Pfizer-BioNTech vaccine against SARS-CoV-2 is unprecedented in modern medicine. However, the climate of the pandemic has also seen anti-vaccination sentiments flourish. AIMS: To determine the intent to accept COVID-19 vaccination among healthcare workers at a London Hospital Trust and examine variation in uptake between demographic groups. METHODS: We conducted a cross-sectional survey open to staff working at the trust. Staff rated on a five-point scale the likelihood of them accepting COVID-19 vaccination. RESULTS: We received 514 responses, representing 16% of the workforce. About 59% of staff intended to seek vaccination, 24% to reject and 17% were unsure. There was significantly reduced intended uptake in females, younger age groups, healthcare assistants, nurses, staff of black ethnic backgrounds and those who rejected influenza vaccination. Safety was the dominant concern. CONCLUSIONS: Our study finds COVID-19 vaccinate hesitancy is prevalent among healthcare workers at a London Hospital Trust. It is particularly concerning that hesitancy was highest amongst groups most exposed to COVID-19 and most at risk of severe disease. Reasons behind disparities in uptake must be addressed to protect staff and prevent deepening inequalities within the healthcare workforce.

Hospital mortality in cirrhotic patients at a tertiary care center. / Mortalidad hospitalaria en pacientes cirróticos en un hospital de tercer nivel.

INTRODUCTION: Cirrhosis of the liver is known for its high risk of mortality associated with episodes of acute decompensation. There is an even greater risk in patients that present with acute-on-chronic liver failure. The identification of patients at higher risk for adverse outcomes can aid in making the clinical decisions that will improve the prognosis for these patients. AIMS: To determine in-hospital mortality and evaluate the epidemiologic and clinical characteristics of patients with cirrhosis of the liver seen at a tertiary referral hospital. METHODOLOGY: A descriptive, observational, cohort study was conducted on adult patients with cirrhosis of the liver, admitted to a tertiary care center in Bucaramanga, Colombia, within the time frame of March 1, 2015 and February 29, 2016. RESULTS: Eighty-one patients with a mean age of 62 years were included in the study. The main etiology of the cirrhosis was alcoholic (59.3%). In-hospital mortality was 23.5% and the most frequent cause of death was septic shock (68.4%), followed by hypovolemic shock (10.5%). A MELD score≥18, a leukocyte count>12,000/ul, and albumin levels below<2.5g/dl were independent factors related to hospital mortality. CONCLUSIONS: In-hospital mortality in cirrhotic patients is high. Sepsis and bleeding are the 2 events leading to acute-on-chronic liver failure and death. A high MELD score, elevated leukocyte count, and low level of albumin are related to poor outcome during hospitalization. Adjusted prevention-centered public health measures and early and opportune diagnosis of this disease are needed to prevent the development of complications and to improve outcome in cirrhotic patients.

MicroRNAs Association in the Cardiac Hypertrophy Secondary to Complex Congenital Heart Disease in Children.

Complex congenital heart disease (CHD) affects cardiac blood flow, generating a pressure overload in the compromised ventricles and provoking hypertrophy that over time will induce myocardial dysfunction and cause a potential risk of imminent death. Therefore, the early diagnosis of complex CHD is paramount during the first year of life, with surgical treatment of patients favoring survival. In the present study, we analyzed cardiac tissue and plasma of children with cardiac hypertrophy (CH) secondary to CHD for the expression of 11 miRNAs specific to CH in adults. The results were compared with the miRNA expression patterns in tissue and blood of healthy children. In this way, we determined that miRNAs 1, 18b, 21, 23b, 133a, 195, and 208b constitute the expression profile of the cardiac tissue of children with CHD. Meanwhile, miRNAs 21, 23a, 23b, and 24 can be considered specific biomarkers for the diagnosis of CH in infants with CHD. These results suggest that CH secondary to CHD in children differs in its mechanism from that described for adult hypertrophy, offering a new perspective to study the development of this pathology and to determine the potential of hypertrophic miRNAs to be biomarkers for early CH.

Cartilage stress-relaxation is affected by both the charge concentration and valence of solution cations.

OBJECTIVE: Understanding the mechanical functions of specific cartilage molecules such as aggrecan is important for understanding both healthy cartilage and disease progression. Cartilage is primarily composed of chondrocytes and an extracellular matrix consisting of multiple biopolymers, ions, and water. Aggrecan is one matrix biopolymer which consists of a core protein and multiple anionic glycosaminoglycans. Previous research has demonstrated that the stiffness of extracted aggrecan decreases under increased solution cation concentration, and the purpose of this study was to determine whether changes in solution ion concentration resulted in changes in tissue-level viscoelastic properties. METHODS: Middle-zone explants of bovine calf patellofemoral cartilage were harvested and cultured overnight before mechanical testing. Repeated stress-relaxation and cyclical loading tests were performed after equilibration in solutions of 0.15 M and 1 M NaCl and 0.075 M and 0.5 M CaCl(2). A stretched exponential model was fit to the stress-relaxation data. Storage and loss moduli were determined from the cyclical loading data. RESULTS: Changes in ionic strength and species affected both stress-relaxation and cyclical loading of cartilage. Stress-relaxation was faster under higher ionic strength. CaCl(2) concentration increases resulted in decreased peak stress, while NaCl increases resulted in decreased equilibrium stress. Storage and loss moduli were affected differently by NaCl and CaCl(2). CONCLUSIONS: These results show that cartilage stress-relaxation proceeds faster under higher concentrations of solution cations, consistent with the theory of polymer dynamics. These data demonstrate the complexity of cartilage mechanical properties and suggest that aggrecan stiffness may be important in tissue-level cartilage viscoelastic properties.

Identification and evaluation of Peruvian plants used to treat malaria and leishmaniasis.

Households in eleven geographically and ethnically distinct areas in Loreto, Peru, were interviewed about their knowledge and use of plants, for the treatment of malaria and leishmaniasis. The survey resulted in 988 use records representing 118 plant-taxa for malaria and 289 use-records representing 85 plant-taxa for leishmaniasis. In both cases the 10 most frequently reported taxa accounted for about half of all the use-records. Plant material was collected and extracts were screened for in vitro inhibition of Plasmodium and Leishmania parasites. In the case of Plasmodium, extracts of 11 of the 13 most frequently reported plants showed significant growth inhibitory activity, while only a few plant extracts inhibited the growth of Leishmania parasites.