Use of metatarsal hook plates in the treatment of multifragmentary patellar fractures - A case series.

The surgical management of patellar fractures typically yielded satisfactory results; however, in situations involving multifragmented patellar fractures or those affecting the inferior pole, it became imperative to employ alternative osteosynthesis techniques that enhanced stability, enabled early rehabilitation initiation, prevented implant failure, and avoided reduction loss before fracture consolidation. In this context, an unconventional osteosynthesis alternative was presented, utilizing an anatomically designed hook plate originally intended for the fifth metatarsal. This technique was successfully applied in three patients with multifragmentary patellar fractures, allowing stable fixation of small or marginal fragments through the plate's hooks without compromising vascularity. Fracture consolidation was achieved without reduction loss, and owing to its low profile, patient discomfort and irritation were minimized compared to traditional tension band or wiring techniques. This approach suggested the potential to forego early plate removal, thereby contributing to a more effective management of patellar fractures. Level of evidence: IV.

Comprehensive study of mechanical power in controlled mechanical ventilation: Prevalence of elevated mechanical power and component analysis / Estudio Integral de la Potencia Mecánica en la Ventilación Mecánica Controlada: Prevalencia de Potencia Mecánica Elevada y Análisis de Componentes

Objective To determine the prevalence of elevated mechanical power (MP) values (>17J/min) used in routine clinical practice. Design Observational, descriptive, cross-sectional, analytical, multicenter, international study conducted on November 21, 2019, from 8:00 AM to 3:00 PM. NCT03936231. Setting One hundred thirty-three Critical Care Units. Patients Patients receiving invasive mechanical ventilation for any cause. Interventions None. Main variables of interest Mechanical power. Results A population of 372 patients was analyzed. PM was significantly higher in patients under pressure-controlled ventilation (PC) compared to volume-controlled ventilation (VC) (19.20±8.44J/min vs. 16.01±6.88J/min; p<0.001), but the percentage of patients with PM>17J/min was not different (41% vs. 35%, respectively; p=0.382). The best models according to AICcw expressing PM for patients in VC are described as follows: Surrogate Strain (Driving Pressure) + PEEP+Surrogate Strain Rate (PEEP/Flow Ratio) + Respiratory Rate. For patients in PC, it is defined as: Surrogate Strain (Expiratory Tidal Volume/PEEP) + PEEP+Surrogate Strain Rate (Surrogate Strain/Ti) + Respiratory Rate+Expiratory Tidal Volume+Ti. Conclusions A substantial proportion of mechanically ventilated patients may be at risk of experiencing elevated levels of mechanical power. Despite observed differences in mechanical power values between VC and PC ventilation, they did not result in a significant disparity in the prevalence of high mechanical power values. (AU)

Objetivo Determinar la prevalencia de valores elevados de potencia mecánica (PM) (>17J/min) utilizados en la práctica clínica habitual. Diseño estudio observacional, descriptivo de corte transversal, analítico, multicéntrico e internacional, realizado el 21 de noviembre de 2019 en horario de 8 a 15 horas. NCT03936231. Ámbito Ciento treinta y tres Unidad de Cuidados Críticos. Pacientes pacientes que recibirán ventilación mecánica por cualquier causa. Intervenciones ninguna Variables de interés principales Potencia mecánica. Resultados se analizaron 372 enfermos. La PM fue significativamente mayor en pacientes en ventilación controlada por presión (PC) que en ventilación controlada por volumen (VC) (19,20+8,44J/min frente a 16,01+6,88J/min; p<0,001), pero el porcentaje de pacientes con PM>17J/min no fue diferente (41% frente a 35% respectivamente; p=0,382). Los mejores modelos según AICcw que expresan la PM para los enfermos en VC se decribe como: Strain subrogante (Presión de conducción) + PEEP+Strain Rate subrogante (PEEP/cociente de flujo) + Frecuencia respiratoria. Para los enfermos en PC se define como: Strain subrogante (Volumen tidal expiratorio/PEEP) + PEEP+Strain Rate subrogante (Strain subrogante/Ti) + Frecuencia respiratoria+Expiratory Tidal Volumen+Ti. Conclusiones Gran parte de los pacientes en ventilación mecánica en condiciones de práctica clínica habitual reciben niveles de potencia mecánica peligrosos. A pesar de las diferencias observadas en los valores de potencia mecánica entre la ventilación VC y PC, este porcentaje de riesgo fue similar en PC y VC. (AU)

Disease-free survival and response to therapy of clinically node- negative Papillary Thyroid Cancer treated without central neck dissection: Retrospective study of 321 patients.

BACKGROUND AND OBJECTIVE: Nodal metastases in the central compartment are frequent in papillary thyroid cancer (PTC). However, they are mostly micrometastases with no impact on survival and their relevance on the risk of locoregional relapse is controversial. There is no consensus regarding optimal management of the central neck in patients with PTC cN0. In our center, we do not perform prophylactic central neck dissection (pCND). The objective of this study is to review our long-term results and compare them with the most recent literature. PATIENTS AND METHODS: Retrospective review of patients with PTC who underwent total thyroidectomy (TT) without CND between 2005 and 2017. Primary result was disease-free survival in the neck (DFS). RESULTS: 321 patients were identified, mostly T1-T2 tumors (94.1%). Median follow-up was 90 months. DFS in the central compartment was excellent (96.1% at 10 year's follow-up). 19 patients had cervical recurrence, of which 15 underwent salvage surgery. On their last visit, including salvage surgery when appropriate, 77% of patients had excellent response, 18.7% had indeterminate response, 3.1% had biochemically incomplete response and 1.2% had morphologically incomplete response. Recurrent laryngeal nerve (RLN) paralysis after TT was transient in 4.7% of patients and permanent in 0.9% of patients. There were no RLN paralysis after salvage surgery. Permanent hypoparathyroidism occurred in 3.4% of patients. Only one patient had hypoparathyroidism after salvage surgery and it was permanent. CONCLUSIONS: Based on long-term results and low rate of complications associated with salvage surgery in our experience, we consider routine pCND is not justified.

Comprehensive study of mechanical power in controlled mechanical ventilation: Prevalence of elevated mechanical power and component analysis.

OBJECTIVE: To determine the prevalence of elevated mechanical power (MP) values (>17J/min) used in routine clinical practice. DESIGN: Observational, descriptive, cross-sectional, analytical, multicenter, international study conducted on November 21, 2019, from 8:00 AM to 3:00 PM. NCT03936231. SETTING: One hundred thirty-three Critical Care Units. PATIENTS: Patients receiving invasive mechanical ventilation for any cause. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Mechanical power. RESULTS: A population of 372 patients was analyzed. PM was significantly higher in patients under pressure-controlled ventilation (PC) compared to volume-controlled ventilation (VC) (19.20±8.44J/min vs. 16.01±6.88J/min; p<0.001), but the percentage of patients with PM>17J/min was not different (41% vs. 35%, respectively; p=0.382). The best models according to AICcw expressing PM for patients in VC are described as follows: Surrogate Strain (Driving Pressure) + PEEP+Surrogate Strain Rate (PEEP/Flow Ratio) + Respiratory Rate. For patients in PC, it is defined as: Surrogate Strain (Expiratory Tidal Volume/PEEP) + PEEP+Surrogate Strain Rate (Surrogate Strain/Ti) + Respiratory Rate+Expiratory Tidal Volume+Ti. CONCLUSIONS: A substantial proportion of mechanically ventilated patients may be at risk of experiencing elevated levels of mechanical power. Despite observed differences in mechanical power values between VC and PC ventilation, they did not result in a significant disparity in the prevalence of high mechanical power values.

The role of TNF receptors as mediators of chronic vasculitis in possible milder forms of the CNS tuberculosis.

INTRODUCTION: Central nervous system (CNS) tuberculosis (TB) is the most severe form of TB due to its high mortality and functional sequelae. There are several differential diagnoses for TB; and, it can also cause secondary conditions, such as vasculitis. METHODOLOGY: 155 biopsies, corresponding to 155 different patients out of 5,386 registered biopsies from 2008-2013, met the criteria of unknown etiology vasculitis and evidence of cerebral vascular disease. These were analyzed to assess the presence of central nervous system TB. The selected cases were assessed with Suzaan Marais (SM) criteria for clinical tuberculosis. After that, Ziehl-Neelsen (ZN) staining and polymerase chain reaction (PCR) were performed to amplify a fragment of the insertion sequence IS6110 of M. tuberculosis. 21 patients met the criteria for definitive tuberculosis by ZN staining and PCR, and 2 met the criteria for possible tuberculosis. Tumor necrosis factor (TNF)-α, TNF-R1, and TNF-R2 were determined by immunohistochemistry in histological sections from formalin-fixed paraffin-embedded (FF-PE) tissues in the 23 selected patients. RESULTS: Granulomatous TB was present in almost half of the cases. TNF-R1 and TNF-R2 were expressed mainly in blood vessels, histiocytes, and macrophages. TNF-R2 expression was higher than the other markers, which suggests an anti-inflammatory response against M. tuberculosis. CONCLUSIONS: The histopathological presentation of TB is not always limited to granulomas, abscesses, or meningitis; there are also clinical presentations characterized only with chronic inflammation of nervous and vascular tissue.

El método del factor de Bayes en el análisis de la energía mecánica en pacientes con insuficiencia respiratoria grave por SARS-CoV-2 / The Bayes factor in the analysis of mechanical power in patients with severe respiratory failure due to SARS-CoV-2

Objetivo: Precisar el grado de fuerza probatoria de las hipótesis estadísticas con relación a la mortalidad a 28 días y el valor umbral de 17J/min de potencia mecánica (PM) en pacientes con insuficiencia respiratoria secundaria a SARS-CoV-2. Diseño: Estudio de cohortes, longitudinal y analítico. Ámbito: Unidad de cuidados intensivos de un hospital de tercer nivel en España. Pacientes: Enfermos ingresados por infección por SARS-CoV-2 con ingreso en la UCI entre marzo de 2020 y marzo de 2022. Intervenciones: Análisis bayesiano con el modelo binomial beta. Variables de interés principales: Factor de Bayes, mechanical power. Resultados: Fueron analizados 253 pacientes. La frecuencia respiratoria inicial (BF10: 3,83×106), el valor de la presión pico (BF10: 3,72×1013) y el desarrollo de neumotórax (BF10: 17.663) fueron los valores con más probabilidad de ser diferentes entre los 2 grupos de pacientes comparados. En el grupo de pacientes con PM<17J/min se estableció un BF10 de 12,71 y un BF01 de 0,07 con un IdC95% de 0,27-0,58; Para el grupo de pacientes con PM≥17J/min el BF10 fue de 36.100 y el BF01 de 2,77e-05 con un IdC95% de 0,42-0,72. Conclusiones: Un valor de PM≥17J/min se asocia con una evidencia extrema con la mortalidad a 28 días en pacientes que necesitaron ventilación mecánica por insuficiencia respiratoria secundaria a enfermedad por SARS-CoV-2. (AU)

Objective: To specify the degree of probative force of the statistical hypotheses in relation to mortality at 28 days and the threshold value of 17J/min mechanical power (MP) in patients with respiratory failure secondary to SARS-CoV-2. Design: Cohort study, longitudinal, analytical. Setting: Intensive care unit of a third level hospital in Spain. Patients: Patients admitted for SARS-CoV-2 infection with admission to the ICU between March 2020 and March 2022. Interventions: Bayesian analysis with the beta binomial model. Main variables of interest: Bayes factor, mechanical power. Results: A total of 253 patients were analyzed. Baseline respiratory rate (BF10: 3.83×106), peak pressure value (BF10: 3.72×1013) and neumothorax (BF10: 17,663) were the values most likely to be different between the two groups of patients compared. In the group of patients with MP<17J/min, a BF10 of 12.71 and a BF01 of 0.07 were established with an 95%CI of 0.27-0.58. For the group of patients with MP≥17J/min the BF10 was 36,100 and the BF01 of 2.77e-05 with an 95%CI of 0.42-0.72. Conclusions: A MP≥17J/min value is associated with extreme evidence with 28-day mortality in patients requiring MV due to respiratory failure secondary to SARS-CoV-2 disease. (AU)

A Bibliometric Review on Candida auris of the First Fifteen Years of Research (2009-2023).

Introduction: Candida auris is a relatively novel pathogen first described in 2009 in Japan. It has increased its presence worldwide, becoming a public health concern due to its innate resistance to antifungals and outbreak potential. Methods: We performed a query using the word "Candida auris" from the Scopus database, further performing a bibliometric analysis with the open-source R package Bibliometrix. Results: 907 original articles were retrieved, allowing us to map the principal authors, papers, journals, and countries involved in this yeast research, as well as analyze current and future trends and the number of published articles. Conclusion: C. auris will continue to be a pivotal point in fungal resistance research, either for a better understanding of its resistance and pathogenic mechanisms or for developing novel drugs.

Essential Oils and Antagonistic Microorganisms as Eco-Friendly Alternatives for Coffee Leaf Rust Control.

Coffee leaf rust (CLR) is caused by the biotrophic fungus Hemileia vastatrix Berk. & Br., a disease of economic importance, reducing coffee yield up to 60%. Currently, CLR epidemics have negatively impacted food security. Therefore, the objective of the present research study is to show a current framework of this disease and its effects on diverse areas, as well as the biological systems used for its control, mode of action, and effectiveness. The use of essential plant oils and antagonistic microorganisms to H. vastatrix are highlighted. Terpenes, terpenoids, and aromatic compounds are the main constituents of these oils, which alter the cell wall and membrane composition and modify the basic cell functions. Beneficial microorganisms inhibit urediniospore germination and reduce disease incidence and severity. The antagonistic microorganisms and essential oils of some aromatic plants have great potential in agriculture. These biological systems may have more than one mechanism of action, which reduces the possibility of the emergence of resistant strains of H. vastatrix.

Multipitch estimation based on the iterative detection and separation of note events from single-channel polyphonic recordings.

Multiple fundamental frequency estimation has been extensively used in applications such as melody extraction, music transcription, instrument identification, and source separation. This paper presents an approach based on the iterative detection and extraction of note events, which are considered to be harmonic sounds characterised by a continuous pitch trajectory. Note events are assumed to be associated with musical notes being played by a single instrument, and their pitch trajectories are iteratively estimated. In every iteration, the pitch contour of the predominant note event is selected from a set of pitch estimates and used to separate its spectral energy from the input mixture in order to obtain a residual signal, which is then used as input in the next iteration. This iterative process stops when the energy of the residual is below a significance threshold. The pitch trajectories of all detected note events are then revised and reassembled to form the final set of pitch estimates for the original audio input. Evaluation of performance is conducted in different scenarios to show the potential of the proposed system, both in terms of its accuracy, and also as an initial stage in other complex tasks, such as note tracking and multipitch streaming.

Estudio retrospectivo del efecto de la vacunación frente al SARS-CoV-2 en enfermos graves que ingresan en una unidad de cuidados intensivos / Retrospective study of the effect of vaccination against SARS-CoV-2 in seriously ill patients admitted to an intensive care unit

Antecedentes y objetivo Planteamos nuestro trabajo con el objetivo de comparar las características clínico-epidemiológicas, la estancia en la UCI y la mortalidad de pacientes con COVID-19 que ingresaron en la UCI con vacunación completa, incompleta o sin vacunar. Pacientes y métodos Estudio retrospectivo de cohortes (marzo 2020-marzo 2022). Los pacientes fueron clasificados en pacientes no vacunados, pauta de vacunación completa y pauta de vacunación incompleta. Se realizó inicialmente un análisis descriptivo de la muestra, un análisis multivariable de la supervivencia ajustando un modelo de regresión de Cox y un análisis de supervivencia a 90 días con el método de Kaplan-Meier para la variable de tiempo de muerte. Resultados Fueron analizados los 894 pacientes: 179 con una pauta de vacunación completa, 32 con una pauta incompleta y 683 no estaban vacunados. Los enfermos vacunados presentaron con menor frecuencia (10 vs. 21% y 18%) un SDRA grave. La curva de supervivencia no presentó diferencias en la probabilidad de sobrevivir a los 90 días entre los grupos estudiados (p = 0,898). En el análisis de regresión de COX, únicamente la necesidad de VM durante el ingreso y el valor de LDH (por unidad de medida) en las primeras 24 h de ingreso se asociaron de forma significativa con la mortalidad a los 90 días (HR: 5,78; IC 95%: 1,36-24,48); p = 0,01 y HR: 1,01; IC 95%: 1,00-1,02; p = 0,03, respectivamente. Conclusiones Los pacientes vacunados frente a la COVID-19 con enfermedad grave por SARS-CoV-2 presentan unas tasas de SDRA grave y de VM menores que las de aquellos pacientes no vacunados (AU)

Background and objective Our study aims to compare the clinical and epidemiological characteristics, length of stay in the ICU, and mortality rates of COVID-19 patients admitted to the ICU who are fully vaccinated, partially vaccinated, or unvaccinated. Patients and methods Retrospective cohort study (March 2020-March 2022). Patients were classified into unvaccinated, fully vaccinated, and partially vaccinated groups. We initially performed a descriptive analysis of the sample, a multivariable survival analysis adjusting for a Cox regression model, and a 90-day survival analysis using the Kaplan-Meier method for the death time variable. Results A total of 894 patients were analyzed: 179 with full vaccination, 32 with incomplete vaccination, and 683 were unvaccinated. Vaccinated patients had a lower incidence (10% vs. 21% and 18%) of severe ARDS. The survival curve did not show any differences in the probability of surviving for 90 days among the studied groups (p = 0.898). In the Cox regression analysis, only the need for mechanical ventilation during admission and the value of LDH (per unit of measurement) in the first 24 hours of admission were significantly associated with mortality at 90 days (HR: 5.78; 95% CI: 1.36-24.48); p = 0.01 and HR: 1.01; 95% CI: 1.00-1.02; p = 0.03, respectively. Conclusions Patients with severe SARS-CoV-2 disease who are vaccinated against COVID-19 have a lower incidence of severe ARDS and mechanical ventilation than unvaccinated patients (AU)

Recent Advances in the Use of the Mortality Syndromic Surveillance System-New York City, 2015-2020.

OBJECTIVE: New York City's automated mortality syndromic surveillance system monitors temporal and spatial patterns in mortality. To describe the use of the syndromic surveillance system, we used the system to find mortality patterns for the 15 leading causes of death and for deaths from rare and reportable diseases in New York City from February 2015 through June 2020. We used results to find aberrations that indicate threats to public health. METHODS: We used unobserved components models to analyze time series of mortality counts for leading causes of death, historical limits methods for rare and reportable diseases, and SaTScan for temporal-spatial cluster analysis. We obtained data on the number of deaths from the electronic death registry system maintained by the city's Bureau of Vital Statistics. RESULTS: The mortality syndromic surveillance system detected an increase in the number of deaths from heart disease by April 1, 2020, when 75.0 deaths occurred on March 24, 2020, instead of an expected 45.8 deaths (95% upper prediction limit of 61.0) and an increase in the number of deaths from all causes on March 20, 2020, when 194.0 deaths were observed while 150.1 deaths were expected (95% upper prediction limit of 178.0). The number of deaths from all causes returned to normal the week beginning June 14, 2020, when 990.0 deaths were observed and 998.8 deaths were expected. PRACTICE IMPLICATIONS: When compared with efforts from New York City to provide yearly vital statistics, the automated mortality syndromic surveillance system can provide timely mortality data with fewer resources and raise the capacity to detect anomalous increases in mortality.

Análisis de las características de los pacientes mayores que ingresaron en una unidad de cuidados intensivos durante las 6 olas de la pandemia por SARS-CoV-2: implicaciones para la atención médica / Analysis of characteristics of elderly patients admitted to an intensive care unit during six waves of the SARS-CoV-2 pandemic: Implications for medical care

Objetivo Analizar las características de los enfermos adultos graves de mayor edad, durante las 6 olas de la pandemia COVID-19. Método Estudio retrospectivo, observacional y analítico sobre pacientes mayores de 70 años con ingreso en la UCI (marzo-2020/marzo-2022). Los pacientes se categorizaron en 3 grupos en función de la edad: 70-74 años, 75-79 años y >80 años. Se realizó inicialmente un análisis descriptivo y comparativo de la muestra, y un análisis de supervivencia a los 28, 60 y 90 días con el método de Kaplan-Meier. El análisis multivariable de la supervivencia se realizó ajustando un modelo de Cox. Resultados De 301 enfermos, el menor número de ingresos se produjo durante la primera ola (20 [6%]), frente a la que fue la ola con mayor número de ingresos: la sexta ola (76 [25%]). Las curvas de supervivencia a los 28, a los 60 días y a los 90 días evidenciaron una mayor probabilidad de sobrevivir en los grupos de menor edad (p<0,01 y p=0,01, respectivamente). La troponina al ingreso (por unidad, ng/l), evidenció un asociación significativa con la mortalidad a 28 y 60 días (HR: 1,00; IC 95%: 1,00-1,01; p<0,05). Tomando como referencia la 1.ª oleada de la pandemia, el ingreso en 3.ª oleada se comportó como un factor de protección frente a la mortalidad a los 28 y 60 días de seguimiento (HR: 0,18; IC 95%: 0,02-0,64; p<0,05; HR: 0,13; IC 95%: 0,02-0,64; p<0,05, respectivamente). Conclusiones El momento de ingreso y biomarcadores, como la troponina, se constituyen en marcadores pronósticos independientes de la edad en la población añosa (AU)

Objective To analyze the characteristics of seriously ill elderly patients during the six waves of the COVID-19 pandemic. Method Retrospective, observational and analytical study of patients over 70 years of age admitted to the ICU (March-2020 to March-2022). Patients were categorized into three groups based on age: 70-74 years; 75-79 years; and >80 years. A descriptive and comparative analysis of the sample was initially performed; and a 28-, 60- and 90-day survival analysis using the Kaplan–Meier method. Multivariate survival analysis was performed by fitting a Cox model. Results Of 301 patients, the lowest number of admissions occurred during the first wave (20 (6%)), compared to the wave with the highest number of admissions: the sixth wave (76 (25%)). The survival curves at 28 days, 60 days and 90 days showed a higher probability of survival in the younger age groups (P<.01 and P=.01, respectively). Troponin at admission (per unit, ng/l) showed a significant association with 28- and 60-day mortality (HR: 1.00; 95% CI: 1.00-1.01; P<.05). Taking the 1st wave of the pandemic as a reference, admission in the 3rd wave behaved as a protective factor against mortality at 28 and 60 days of follow-up (HR: 0.18; 95% CI: 0.02-0.64; P<.05; HR: 0.13; 95% CI: 0.02–0.64; P<.05, respectively). Conclusions The time of admission and biomarkers, such as troponin, constitute prognostic markers independent of age in the elderly population (AU)

[Analysis of characteristics of elderly patients admitted to an intensive care unit during six waves of the SARS-CoV-2 pandemic: Implications for medical care]. / Análisis de las características de los pacientes mayores que ingresaron en una unidad de cuidados intensivos durante las 6 olas de la pandemia por SARS-CoV-2: implicaciones para la atención médica.

OBJECTIVE: To analyze the characteristics of seriously ill elderly patients during the six waves of the COVID-19 pandemic. METHOD: Retrospective, observational and analytical study of patients over 70 years of age admitted to the ICU (March-2020 to March-2022). Patients were categorized into three groups based on age: 70-74 years; 75-79 years; and >80 years. A descriptive and comparative analysis of the sample was initially performed; and a 28-, 60- and 90-day survival analysis using the Kaplan-Meier method. Multivariate survival analysis was performed by fitting a Cox model. RESULTS: Of 301 patients, the lowest number of admissions occurred during the first wave (20 (6%)), compared to the wave with the highest number of admissions: the sixth wave (76 (25%)). The survival curves at 28 days, 60 days and 90 days showed a higher probability of survival in the younger age groups (P<.01 and P=.01, respectively). Troponin at admission (per unit, ng/l) showed a significant association with 28- and 60-day mortality (HR: 1.00; 95% CI: 1.00-1.01; P<.05). Taking the 1st wave of the pandemic as a reference, admission in the 3rd wave behaved as a protective factor against mortality at 28 and 60 days of follow-up (HR: 0.18; 95% CI: 0.02-0.64; P<.05; HR: 0.13; 95% CI: 0.02-0.64; P<.05, respectively). CONCLUSIONS: The time of admission and biomarkers, such as troponin, constitute prognostic markers independent of age in the elderly population.