Night-to-night variability of objective sleep outcomes in youth Middle Eastern football players.

OBJECTIVE: To describe components of night-to-night variation in objective measures of sleep. METHODS: We conducted a secondary data analysis of consecutive and chronologically ordered actigraphy-based measurements for time in bed (min), time asleep (min), and wake-after-sleep onset (min). This investigation examined 575 individual night-based measures available for a sub-sample of fifty-two, male youth Middle Eastern football players tracked over a 14-day surveillance period (chronological age range: 12.1 to 16 years). Distinct multivariable-adjusted generalized additive models included each objective sleep outcome measure as dependent variable and disaggregated components of variation for night measurement-by-sleep period interaction, week part (weekday or weekend), and study participant random effects from within-subject night-to-night sleep variation. RESULTS: The within-subject standard deviation (SD) of ±98 min (95% confidence interval [CI], 92 to 104 min) for time in bed, ±87 min (95%CI, 82 to 93 min) for time asleep, and ±23 min (95%CI, 22 to 25 min) for wake-after-sleep-onset overwhelmed other sources of variability and accounted for ∼44% to 53% of the overall night-to-night variation. The night measurement-by-fragmented sleep period interaction SD was ±83 min (95%CI, 44 to 156 min) for time in bed, ±67 min (95%CI, 34 to 131 min) for time asleep, and ±15 min (95%CI, 7 to 32 min) for wake-after-sleep-onset that accounted for ∼22% to 32% of each sleep outcome measure overall variability. CONCLUSIONS: Substantial random night-to-night within-subject variability poses additional challenges for strategies aiming to mitigate problems of insufficient and inconsistent sleep that are detrimental to school learning and youth athlete development processes.

A survey of organizational structure and operational practices of elite youth football academies and national federations from around the world: A performance and medical perspective.

Aim: Medical and performance units are integral components of player development programmes in elite football academies. Nevertheless, the nature of the operational processes implemented by practitioners within clubs and national federations remains unexplored. The aim of the present study, therefore, was to survey elite youth professional football academies from around the world regarding the operational processes adopted by their medical and performance units. Methods: Of the 50 organizations invited, 10 national federations and 25 clubs took part in the survey resulting in a response rate of 70% (95% confidence interval, 56%-81%). The respondents represented three groups: senior club and academy management, performance, and medical staff. Results: The majority (60%-90%) of clubs and national federations reported strategic alignment between senior and academy medical and performance units as well as between academy medical and performance units. Survey responses indicated substantial heterogeneity in the composition and number of medical and performance professionals employed in academies. The majority of respondents agreed their medical and performance departments were effective in utilizing staff knowledge and external sources of knowledge to inform their practice (56%-80%). Performance staff (40%-50%) and physiotherapists (30%-32%) were deemed most influential in injury prevention programmes. During the return-to-play process, the influence of specific practitioners in the medical and performance units was dependent upon the phase of return-to-play. Shared decision-making was common practice amongst performance and medical staff in injury prevention and return-to-play processes. Medical and performance data were generally centralized across the first team and academy in majority (50%-72%) of clubs and national federations. Data were integrated within the same data management system to a higher degree in clubs (68%) vs. national federations (40%). Research and development activity were reported for most academies (50%-72%), and generally led by the head of performance (37%) or team doctor (21%). Research activities were largely undertaken via internal staff (~100%), academic collaborations (50%-88%) and/or external consultants and industry partnerships (77%-83%) in the national federation and clubs. Conclusion: Collectively, these findings provide a detailed overview regarding key operational processes delivered by medical and performance practitioners working in elite football academies.

Base excess measured at hospital admission is useful for predicting diabetic ketoacidosis severity and resolution time in adult patients.

BACKGROUND AND AIMS: This study aimed to identify the biochemical factors measured at hospital admission that could predict diabetes ketoacidosis (DKA) resolution time in adult patients. MATERIALS AND METHODS: This retrospective study included 79 patients >18 years of age. Multivariate analyses were performed to determine which variables might predict DKA resolution time. Biochemical parameters between the two DKA resolution time groups were compared. RESULTS: Using multiple linear regression models, acidosis time was found to decrease by 29 h if the pH value increased by one unit, 0.64 h if the base excess (BE) value increased by 1 mmol, and 1.09 h if the bicarbonate (HCO3-) value increased by 1 mmol. The biochemical parameters that differed between the two groups were pH, HCO3-, and BE. Patients with delayed resolution of DKA had a blood pH of 7.1 (±0.18), HCO3- of 5.1 mmol (2.9-11.6 mmol), and BE of -21.5 mmol (-28.2 to -14.4 mmol) at hospital admission. CONCLUSIONS: Lower pH, HCO3-, and BE values at hospital admission may predict longer DKA resolution times in adult patients. In addition, BE may predict DKA severity.

Use of Indocyanine Green Angiography for Real-Time Assessment of a Sternocleidomastoid Muscle Flap During Complex Facial Reconstruction.

Indocyanine green (ICG) angiography is a procedure that uses a fluorescent dye for a variety of medical diagnostics, including the real-time examination of blood flow in tissue. Herein, we report a case in which ICG angiography was used to assess the viability of a sternocleidomastoid (SCM) muscle flap during post-parotidectomy facial reconstruction. To our knowledge, this is the first report documenting the intraoperative use of ICG for the evaluation of SCM flap perfusion. ICG angiography may prove beneficial for cases involving complex reconstructions and suspected organ hypoperfusion.

An objective description of routine sleep habits in elite youth football players from the Middle-East.

BACKGROUND AND STUDY OBJECTIVES: Adequate sleep is essential to support preparation and recovery processes for training and competition in athletes. A limited number of studies have examined whether adolescents from the Middle-East meet the minimum age-specific recommendations ranging from 8 to 9 h of night sleep based on objective measurements. This study aimed to provide an objective description of routine sleep habits in elite youth football players from the Middle-East. METHODS: Using wrist-worn actigraphy, we examined objective measures of sleep over a 14-day surveillance period from fifty-nine, male, Middle-Eastern elite youth football players (age range: 12.1 to 16 years). RESULTS: The observed median sleep duration was approximately 5.5 to 6 h during weekdays and 6.5 to 7.5 h over weekend days. Sleep intermissions resulting in two or more periods of sleep accounted for 8% and 17% of the data during weekdays and weekends, respectively. CONCLUSIONS: For the first time, we reported an objective quantification of sleep measures indicating that elite youth athletes from the Middle-East do not meet the age-specific sleep recommendations. Integration of sleep tracking into the routine training monitoring process can be valuable to inform decisions relevant to the adoption of potential multidisciplinary interventions to address sleep insufficiency and disorders in youth athletes.

A randomized controlled trial comparing high and medium power settings for holmium laser enucleation of prostate.

PURPOSE: To report the results of a randomized controlled trial comparing outcomes between medium power (MP) and high power (HP) laser settings for HoLEPs. METHODS: The primary objective was to compare the enucleation efficiency (EE) of HP- HoLEP (80-100 W) with MP-HoLEP (50 - 60 W). The secondary objectives were to compare treatment efficacy and safety between both groups. To show a 25% difference in EE, a sample size of 45 individuals per treatment arm was required (alpha = 0.05; Beta = 0.80). Patients demographic and perioperative factors were analyzed, including EE, hemoglobin drop, duration of catheterization, and length of hospital stay. The surgical outcome was evaluated with AUA symptom score, maximum flow rate, postvoid residual urine, and complications to assess differences between MP and HP HoLEP at baseline, 3 months, 1, and 5 years. Quantitative outcomes were compared with independent sample t tests (2-tailed) and qualitative outcomes were compared with chi-square tests. RESULTS: Preoperative data with the exception of indication for surgery were comparable in both treatment arms. There was no statistically significant difference in enucleation efficiency between the HP-HoLEP and MP-HoLEP laser setting (0.97 ± 0.47 vs. 0.85 ± 0.47 gm/min, p = 0.209). MP laser settings did not increase perioperative or postoperative complications and resulted in durable outcome comparable with HP laser settings at 5-year follow-up. CONCLUSIONS: MP-HoLEP is safe and efficient and does not compromise the outcome for HoLEPs when compared with HP-HoLEP.

Holmium Laser Enucleation of Prostate Within 6 Weeks of Transrectal Ultrasound Guided Prostate Biopsy is Safe and Effective.

OBJECTIVE: To evaluate the safety and efficacy of performing Holmium laser enucleation of the prostate (HoLEP) for the treatment of bladder outlet obstruction secondary to an enlarged prostate within 6-weeks of a transrectal ultrasound (TRUS) guided prostate biopsy. MATERIALS AND METHODS: We performed a retrospective review of patients who underwent a HoLEP at our institution, excluding any patients with a confounding urologic history and compared patients who underwent a TRUS-guided 6- or 12-core prostate biopsy, and then underwent a HoLEP within 6 weeks (study group) with all other patients (control group). Our primary outcomes were enucleation efficiency (EE) and perioperative complication rate. Our secondary outcomes included postoperative drop in hemoglobin, duration of catheterization, length of hospital stay, voiding metrics at 1 and 6 months and rate of incidental prostate cancer diagnosed on histopathological examination of prostate specimens after HoLEP. To test for differences between the study and control groups, we performed independent sample t-test (2-tailed) and chi-square tests for quantitative and qualitative variables, respectively. P values of < 0.05 were considered statistically significant. RESULTS: 552 patients met inclusion criteria and 84 patients underwent prostate biopsy within a period of 45 days prior to HoLEP. Enucleation efficiency was higher in the study group (P = 0.00). There was no significant difference between the 2 groups regarding perioperative complications, postoperative voiding outcomes, or rate of incidental prostate cancer detection. CONCLUSIONS: TRUS prostate biopsy performed within 6 weeks of HoLEP does not negatively impact operative difficulty or treatment outcome.

Desafíos en la implementación de la Estrategia de Gestión Integrada para la prevención y control del dengue, Costa Rica 2016 / Challenges posed by the implementation of the Integrated Management Strategy for dengue prevention and control, Costa Rica 2016

Introducción: En 2004 las autoridades de Costa Rica se comprometieron con la implementación de la Estrategia de Gestión Integrada que busca reducir la morbilidad, la mortalidad y la carga social y económica por los brotes y las epidemias del dengue. Sin embargo, tal como indican los datos de incidencia del dengue, a lo largo del tiempo no hay un descenso sostenido en los cantones. Objetivo: Identificar los niveles de cumplimiento de la Estrategia de Gestión Integrada orientada a la prevención y control del dengue en Costa Rica. Métodos: Se aplicó una lista de verificación sobre los indicadores de cumplimiento de la Estrategia de Gestión Integrada a siete áreas rectoras del Ministerio de Salud del Pacífico Central. Además, se realizaron entrevistas a funcionarios de las áreas locales. Resultados: El nivel de cumplimiento de la Estrategia de Gestión Integrada para la prevención y control del dengue en las áreas rectoras obtuvo un puntaje máximo del 78 por ciento. Los componentes con menor nivel de cumplimiento fueron manejo integrado de vectores y comunicación social. Conclusiones: A nivel local existen múltiples barreras para el cumplimiento de los indicadores propuestos en la Estrategia de Gestión Integrada. Por tanto, se requiere un mayor acompañamiento del nivel central y regional, con el fin de articular los diferentes componentes y alcanzar los objetivos y metas planteadas a nivel local(AU)

Introduction: In the year 2004 Costa Rican authorities pledged to implement an Integrated Management Strategy aimed at reducing the morbidity, mortality and social and economic burden caused by dengue outbreaks and epidemics. However, incidence data show that there has not been a sustained decrease of the disease in cantons. Objective: Identify the degree of compliance with the Integrated Management Strategy for dengue prevention and control in Costa Rica. Methods: A checklist about indicators for compliance with the Integrated Management Strategy was applied in seven leading areas of the Central Pacific Health Ministry. Additionally, interviews were conducted with local area officials. Results: Compliance with the Integrated Management Strategy for dengue prevention and control in the leading areas reached a maximum score of 78 percent. The components with the lowest compliance values were integrated vector management and social communication. Conclusions: A large number of barriers hamper compliance with Integrated Management Strategy indicators on the local level. Greater support by the central and regional levels is therefore required to articulate the various components and achieve local objectives and goals(AU)

Factores socioeconómicos y ambientales asociados a la incidencia de dengue: estudio ecológico en Costa Rica, 2016 / Socioeconomic and environmental factors associated with the incidence of dengue: an ecological study in Costa Rica, 2016

Resumen Introducción: El dengue sigue siendo un problema de salud pública presente en las regiones tropicales y subtropicales. Este estudio busca identificar la magnitud del efecto de algunos de los determinantes proximales de carácter social y ambiental asociados a la tasa de incidencia del dengue en Costa Rica durante el año 2016. Metodología: Es un estudio ecológico, tomando como variable dependiente la tasa de incidencia de dengue del 2016. Las variables independientes fueron los factores socioeconómicos y ambientales documentados en el último Censo Nacional de población realizado en 2011. La unidad de análisis fueron los cantones. Se realizó un análisis espacial por medio del Índice de Moral globales y locales, además se incluyó un análisis estadístico de regresión de poisson simple y multivariado. Resultados: El Pacífico Central concentró la mayor incidencia y razón de tasa ajustada por sexo y edad de dengue para el 2016. Los factores de riesgo que influyeron en este evento de salud fueron la concentración del ingreso medido con el coeficiente de Gini y la pobreza según Necesidades Básicas Insatisfechas; como factores protectores se identificaron los mayores niveles de escolaridad y las prácticas de recolección de residuos sólidos y reciclaje. Conclusiones: En esta investigación se evidencia que el dengue y posiblemente otras arbovirosis como el Chikungunya y zika no dependen únicamente de la buena gestión de la política pública, sino que es necesario la intervención en determinantes sociales que influyen directamente en el comportamiento de estas enfermedades.

Abstract Introduction: Dengue continues to be a public health problem present in tropical and subtropical regions. This study sought to identify the magnitude of the effect of some of the proximal determinants of social and environmental nature associated to the rate of dengue incidence in Costa Rica during 2016. Methodology: This was an ecological study, taking as dependent variable the rate of dengue incidence for 2016. The independent variables were the socioeconomic and environmental factors documented in the most-recent national population census conducted in 2011. The analysis units were the cantons. A spatial analysis was performed through the global and local Moran index, additionally including a simple and multivariate Poisson regression statistical analysis. Principal results: The Central Pacific concentrated the highest incidence and rate ratio of dengue for 2016 adjusted for gender and age. The risk factors impacting upon this health event were the concentration of income measured with the Gini coefficient and poverty according to Unsatisfied Basic Needs; as protective factors, higher levels of schooling and collection practices of solid wastes and recycling were identified. Conclusions: This research evidences that dengue and possibly other arboviruses, like Chikungunya and Zika, do not solely depend on the good management of public policy; rather, an intervention is necessary on the social determinants that influence directly on the behavior of these diseases.

Acceso a servicios de salud en un establecimiento penitenciario y carcelario masculino de Antioquia (Colombia), 2012 / Access to health services for a group man deprived of their liberty in a penitentiary and prison of Antioquia-Colombia, 2012

RESUMEN Objetivo Identificar los factores que condicionan el acceso a los servicios de salud de las personas privadas de la libertad en el establecimiento penitenciario y carcelario La Paz del municipio de Itagüí, en Antioquia (Colombia), en el 2012. Materiales y métodos Estudio descriptivo transversal soportado en encuestas a una muestra de 126 privados de la libertad de dicha institución. Se aplicaron técnicas de estadística descriptiva e inferencial: medias, proporciones y pruebas de significancia estadística. Resultados La mayoría califica adecuada o muy adecuada la continuidad, oportunidad e integralidad de la atención. Todos valoran como bueno o muy bueno el trato recibido. A cerca de un tercio le fueron negados o entregados parcialmente los medicamentos recetados. El 35,7% perdió citas médicas por problemas administrativos y la mayoría manifiesta no tener información suficiente sobre sus derechos en salud. El 66,7% declara que su salud empeoró o permaneció igual luego de haber sido atendido. Conclusiones Una alta proporción logra acceder a los servicios y califica positivamente la atención médica, pero persisten barreras de acceso a medicamentos, problemas de información sobre derechos y valoraciones negativas sobre el impacto de la atención médica recibida.(AU)

ABSTRACT Objective Identify the conditions of access to health services of persons deprived of their Liberty (PDL) in the Penitentiary and Prison La Paz in Itagüí, Antioquia in 2012. Materials and Methods It is a cross-sectional descriptive study based on primary information obtained from a survey applied to a sample of 126 inmates of this institution. Descriptive and inferential statistics techniques were used: means, proportions and tests of statistical significance. Results The majority qualify adequate or very adequate continuity, opportunity and integrality of care. Everyone values how good or very good the treatment received. About one-third were denied or partially given the prescription drugs. 35.7% lost medical appointments due to administrative problems and most of them did not have sufficient information about their health rights. 66.7% said that their health deteriorated or remained the same after having been treated. Conclusions A high proportion of this people access services and qualify medical care positively, but there are still barriers to access to medicines, problems with information about rights, and negative evaluations of the impact of medical care received.(AU)

Condiciones de trabajo y de seguridad social en asociaciones de pequeños y medianos agricultores campesinos con prácticas de economía solidaria en tres municipios del oriente antioqueño, Colombia, 2015 / Conditions of working and social security in peasant communities with solidarity economy practices in three municipalities in eastern Antioquia, Colombia 2015 / Condições de trabalho e segurança social nas comunidades camponesas com práticas de economia solidária em três municípios do leste de Antioquia, Colômbia 2015

Resumen Introducción: En algunas asociaciones de pequeños y medianos productores agropecuarios del oriente de Antioquia se identifican prácticas de economía solidaria y de producción agrícola que se han constituido en escenarios de resistencia y alternativas de trabajo para una población económica y socialmente vulnerable. La economía campesina fundamentada en el trabajo agrícola y las incertidumbres relacionadas con las transformaciones productivas que supone la cercanía del oriente antioqueño al Área Metropolitana son aspectos relevantes que deben considerarse a la hora de propender por el fortalecimiento de las organizaciones campesinas de la economía solidaria. Objetivo: Analizar las condiciones de trabajo y de seguridad social de un grupo de pequeños y medianos agricultores del sector solidario, comprometidos con la seguridad alimentaria, en tres municipios del oriente de Antioquia. Metodología: Se hizo un estudio descriptivo transversal de 111 productores, asociados activos de diez asociaciones campesinas de economía solidaria, legalmente constituidas. Se recolectó información primaria mediante encuestas. Se analizaron variables sociodemográficas, laborales y de seguridad social. Resultados: 85,6 % de los asociados pertenecen a estratos bajos y son trabajadores independientes, con ingreso promedio de $296 000 mensual; el 72 % posee seguridad social en salud en régimen subsidiado; el 91 % presenta desprotección en riesgos laborales, y el 88,3 %, en pensiones. Conclusión: Los ingresos de estos colectivos de agricultores del sector solidario son inferiores al salario mínimo legal y al ingreso promedio de los trabajadores del campo colombiano; las desigualdades son protuberantes en relación con los ingresos del resto de trabajadores del país. La protección social supone retos para el Gobierno, en cuanto a incrementar la cobertura en pensiones y riesgos laborales.

Abstract Introduction: The agricultural-based solidarity economy practiced by rural communities in Eastern Antioqua, Colombia, has become a tool for resistance, as well as an alternative source of employment for a socially and economically vulnerable population. Economies based on agriculture and the uncertainties of the productive transformations derived from a community's proximity to Medellin metropolitan area, are important factors that should be taken into account when examining the potentials of a solidary economy. Objective: To analyze the working and social conditions of a group of small and medium-scale farmers, from 3 towns in Eastern Antioquia, who follow the solidarity economy and are committed to food security. Methodology: A descriptive, transversal study was carried out with 111 active producers belonging to 10 legally consolidated solidarity economy farmers associations. Primary data was gathered through polls and workshops. Variables in respondents sociodemographics, work and social security were analyzed based on the statistical measurements of frequency, proportion and central tendency. Results: 85.6% of respondents are independent workers and belong to a lower socioeconomical strata with a mean monthly income of COP 296.000; 72% have health insurance through the country's subsidized system; 91% work without occupational hazard insurance; 88.3% do not contribute to a pension fund. Discussion: Income of the surveyed population was found to be lower than both the legal minimum wage and average wages of workers in the same field; income inequalities are very pronounced compared to other Colombian workers; increasing pension enrollment and occupational hazard coverage are challenges the government continues to face.

Resumo Introdução: As comunidades camponesas do Leste de Antioquia praticam economia de solidariedade que foi constituída em cenários de resistência e alternativas trabalho para populacoes economica e socialmente vulneráveis. A economia baseada na agricultura e as incertezas associadas com as transformações produtivas colocadas pela sua proximidade à área metropolitana de Medellin, são fatores importantes a ter em conta para demonstrar as possibilidades que tem a economia solidária, através da abordagem com as experiências das comunidades. Objetivo: O objetivo foi analisar as condições de trabalho e segurança social de um grupo do setor de pequenos e medios agricultores, comprometidos com a segurança alimentar em três municípios do Leste de Antioquia. Metodologia: Um estudo descritivo transversal foi realizado em 111 produtores associados ativos de 10 associações camponesas de economia solidária, legalmente constituídas. As informações primárias foram coletadas por meio de pesquisas e workshops. Variáveis sociodemográficas, trabalhistas e de seguranca social foram analisadas. A análise foi feita com medidas estatísticas de frequência, proporção e tendência central. Resultados: 85,6% dos associados pertencem ao estrato baixo e são trabalhadores independentes com renda média de $ 296 mil pesos por mês; 72% têm segurança social em saúde em regime subsidiado; 91% tem falta de proteção nos riscos ocupacionais e 88,3% nas posibilidades de ter aposentadoria. Discussão: A renda é menor do que o salário mínimo legal da média dos trabalhadores no campo colombiano; as desigualdades são acentuadas em relação à renda do resto dos trabalhadores do país; na proteção social apresentam-se desafios para o governo para aumentar a cobertura em pensões e riscos ocupacionais.

[Access to health services for a group man deprived of their liberty in a penitentiary and prison of Antioquia-Colombia, 2012]. / Acceso a servicios de salud en un establecimiento penitenciario y carcelario masculino de Antioquia (Colombia), 2012.

OBJECTIVE: Identify the conditions of access to health services of persons deprived of their Liberty (PDL) in the Penitentiary and Prison La Paz in Itagüí, Antioquia in 2012. MATERIALS AND METHODS: It is a cross-sectional descriptive study based on primary information obtained from a survey applied to a sample of 126 inmates of this institution. Descriptive and inferential statistics techniques were used: means, proportions and tests of statistical significance. RESULTS: The majority qualify adequate or very adequate continuity, opportunity and integrality of care. Everyone values how good or very good the treatment received. About one-third were denied or partially given the prescription drugs. 35.7% lost medical appointments due to administrative problems and most of them did not have sufficient information about their health rights. 66.7% said that their health deteriorated or remained the same after having been treated. CONCLUSIONS: A high proportion of this people access services and qualify medical care positively, but there are still barriers to access to medicines, problems with information about rights, and negative evaluations of the impact of medical care received.

OBJETIVO: Identificar los factores que condicionan el acceso a los servicios de salud de las personas privadas de la libertad en el establecimiento penitenciario y carcelario La Paz del municipio de Itagüí, en Antioquia (Colombia), en el 2012. MATERIALES Y MÉTODOS: Estudio descriptivo transversal soportado en encuestas a una muestra de 126 privados de la libertad de dicha institución. Se aplicaron técnicas de estadística descriptiva e inferencial: medias, proporciones y pruebas de significancia estadística. RESULTADOS: La mayoría califica adecuada o muy adecuada la continuidad, oportunidad e integralidad de la atención. Todos valoran como bueno o muy bueno el trato recibido. A cerca de un tercio le fueron negados o entregados parcialmente los medicamentos recetados. El 35,7% perdió citas médicas por problemas administrativos y la mayoría manifiesta no tener información suficiente sobre sus derechos en salud. El 66,7% declara que su salud empeoró o permaneció igual luego de haber sido atendido. CONCLUSIONES: Una alta proporción logra acceder a los servicios y califica positivamente la atención médica, pero persisten barreras de acceso a medicamentos, problemas de información sobre derechos y valoraciones negativas sobre el impacto de la atención médica recibida.

Evaluación del crecimiento de fibroblastos humanos en andamios de fibroma de Bombyx mori L / Evaluation of the growth of human fibroblasts on fibroin scaffolds from Bombyx mori L

RESUMEN La fibroína de Bombyx mori L., es un biomaterial que se ha utilizado por sus características físico/químicas que la hacen útil para la curación de múltiples tejidos. En el contexto de la medicina regenerativa caracterizar a nivel físico y biológico nuevos soportes preparados a partir de fibroína de seda y evaluar su capacidad para la proliferación de fibroblastos humanos, brinda una gran oportunidad para encontrar nuevos biomateriales con aplicaciones favorables en la curación de heridas. Se utilizó fibroína regenerada al 17% para la fabricación de matrices. Estas fueron caracterizadas teniendo en cuenta: estabilidad en condiciones de cultivo, ultraestructura, porosidad, ángulo de contacto y propiedades mecánicas. El grosor promedio de las matrices de fibroína fue 30,1 µm, con una estabilidad superior a 4 semanas en condiciones de cultivo, porosidad del 51% y una capacidad de retención de líquidos del 95%, un ángulo de contacto de 44,5° y un módulo de elasticidad de aproximadamente 200 MPa. Finalmente se evaluó la capacidad del andamio para soportar el crecimiento de fibroblastos humanos. Identificando que los andamios permiten la multiplicación celular, mostrando bajos índices de citotoxicidad (<5%); las células establecieron interacciones fuertes con el andamio, mediante la producción de filopodios y la producción de matriz extracelular propia. Concluyendo esto, que es un andamio compatible de fibroblastos humanos en los procesos para el crecimiento y multiplicación celular en procesos de medicina regenerativa.

ABSTRACT The fibroin of Bombyx mori L, has been used for its physical / chemical characteristics as a biomaterial with applications in the healing of multiple tissues. In the context of regenerative medicine, characterizing at a physical and biological level new supports prepared from silk fibroin and evaluating their capacity for the proliferation of human fibroblasts, offers a very attractive opportunity to find new biomaterials with favorable applications in the healing of wounds. 17% regenerated fibroin was used for the manufacture of matrices. The matrices constructed were characterized in aspects such as: stability under growing conditions, ultra-structure, porosity, contact angle and mechanical properties. Finally, the ability of the scaffold to support the growth of human fibroblasts was evaluated. The average thickness of the fibroin matrices was 30.1 µm, with a stability greater than 4 weeks under culture conditions, porosity of 51% and a liquid retention capacity of 95%, a contact angle of 44.5 ° and a modulus of elasticity of ± 200 MPa. It was identified that the scaffolds allow cell multiplication, showing low cytotoxicity indexes (<5%); the cells established strong interactions with the scaffold, through the production of filopodia and the production of their own extracellular matrix. Constructed scaffolds allow the multiplication of human cells with low cytotoxicity and these establish a close relationship at the cellular level with the biomaterial. This can be used as a compatible scaffold for the growth and multiplication of human cells in a regenerative medicine process of epithelial tissue.

[Direct service costs of diabetes mellitus hospitalisations in the Mexican Institute of Social Security]. / Costos directos de las hospitalizaciones por diabetes mellitus en el Instituto Mexicano del Seguro Social.

OBJECTIVE: To estimate the direct costs related to hospitalizations for diabetes mellitus and its complications in the Mexican Institute of Social Security METHODS: The hospital care costs of patients with diabetes mellitus using diagnosis-related groups in the IMSS (Mexican Institute of Social Security) and the hospital discharges from the corresponding E10-E14 codes for diabetes mellitus were estimated between 2008-2013. Costs were grouped according to demographic characteristics and main condition, and were estimated in US dollars in 2013. RESULTS: 411,302 diabetes mellitus discharges were recorded, representing a cost of $1,563 million. 52.44% of hospital discharges were men and 77.26% were for type 2 diabetes mellitus. The biggest cost was attributed to peripheral circulatory complications (34.84%) and people from 45-64 years of age (47.1%). Discharges decreased by 3.84% and total costs by 1.75% in the period analysed. The complications that caused the biggest cost variations were ketoacidosis (50.7%), ophthalmic (22.6%) and circulatory (18.81%). CONCLUSIONS: Hospital care for diabetes mellitus represents an important financial challenge for the IMSS. The increase in the frequency of hospitalisations in the productive age group, which affects society as a whole, is an even bigger challenge, and suggests the need to strengthen monitoring of diabetics in order to prevent complications that require hospital care.

Shoulder dystocia: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF).

Shoulder dystocia (SD) is defined as a vaginal delivery in cephalic presentation that requires additional obstetric maneuvers to deliver the fetus after the head has delivered and gentle traction has failed. It complicates 0.5-1% of vaginal deliveries. Risks of brachial plexus birth injury (level of evidence [LE]3), clavicle and humeral fracture (LE3), perinatal asphyxia (LE2), hypoxic-ischemic encephalopathy (LE3) and perinatal mortality (LE2) increase with SD. Its main risk factors are previous SD and macrosomia, but both are poorly predictive; 50-70% of SD cases occur in their absence, and most deliveries when they are present do not result in SD. No study has proven that the correction of these risk factors (except gestational diabetes) would reduce the risk of SD. Physical activity is recommended before and during pregnancy to reduce the occurrence of some risk factors for SD (Grade C). In obese women, physical activity should be coupled with dietary measures to reduce fetal macrosomia and weight gain during pregnancy (Grade A). Women with gestational diabetes require diabetes care (diabetic diet, glucose monitoring, insulin if needed) (Grade A) because it reduces the risk of macrosomia and SD (LE1). Only two measures are proposed for avoiding SD and its complications. First, induction of labor is recommended in cases of impending macrosomia if the cervix is favorable at a gestational age of 39 weeks or more (professional consensus). Second, cesarean delivery is recommended before labor in three situations and during labor in one: (i) estimated fetal weight (EFW) >4500g if associated with maternal diabetes (Grade C), (ii) EFW >5000g in women without diabetes (Grade C), (iii) history of SD associated with severe neonatal or maternal complications (professional consensus), and finally during labor, (iv) in case of fetal macrosomia and failure to progress in the second stage, when the fetal head station is above +2 (Grade C). In cases of SD, it is recommended to avoid the following actions: excessive traction on the fetal head (Grade C), fundal pressure (Grade C), and inverse rotation of the fetal head (professional consensus). The McRoberts maneuver, with or without suprapubic pressure, is recommended first (Grade C). If it fails and the posterior shoulder is engaged, Wood's maneuver should be performed preferentially; if the posterior shoulder is not engaged, it is preferable to attempt to deliver the posterior arm next (professional consensus). It appears necessary to know at least two maneuvers to perform should the McRoberts maneuver fail (professional consensus). A pediatrician should be immediately informed of SD. The initial clinical examination should check for complications, such as brachial plexus injury or clavicle fracture (professional consensus). If no complications are observed, neonatal monitoring need not be modified (professional consensus). The implementation of practical training with simulation for all care providers in the delivery room is associated with a significant reduction in neonatal (LE3) but not maternal (LE3) injury. SD remains an unpredictable obstetric emergency. All physicians and midwives should know and perform obstetric maneuvers if needed, quickly but calmly.

Clinical Utility and Safety of a Model-Based Patient-Tailored Dose of Vancomycin in Neonates.

Pharmacokinetic modeling has often been applied to evaluate vancomycin pharmacokinetics in neonates. However, clinical application of the model-based personalized vancomycin therapy is still limited. The objective of the present study was to evaluate the clinical utility and safety of a model-based patient-tailored dose of vancomycin in neonates. A model-based vancomycin dosing calculator, developed from a population pharmacokinetic study, has been integrated into the routine clinical care in 3 neonatal intensive care units (Robert Debré, Cochin Port Royal, and Clocheville hospitals) between 2012 and 2014. The target attainment rate, defined as the percentage of patients with a first therapeutic drug monitoring serum vancomycin concentration achieving the target window of 15 to 25 mg/liter, was selected as an endpoint for evaluating the clinical utility. The safety evaluation was focused on nephrotoxicity. The clinical application of the model-based patient-tailored dose of vancomycin has been demonstrated in 190 neonates. The mean (standard deviation) gestational and postnatal ages of the study population were 31.1 (4.9) weeks and 16.7 (21.7) days, respectively. The target attainment rate increased from 41% to 72% without any case of vancomycin-related nephrotoxicity. This proof-of-concept study provides evidence for integrating model-based antimicrobial therapy in neonatal routine care.

Adequate Administration of Perioperative Antibiotics in Orthopedic Patients: Quality Assessment Study.

The Centers for Disease Control and Prevention (CDC) estimate that nearly 500,000 surgical site infections (SSIs) occur annually.[3] SSIs remain a substantial cause of morbidity and mortality among hospitalized patients. For this reason, we developed a quality assessment study with a perioperative antibiotic protocol that included antibiotic type, weight dependent dose, and intraoperative re-dosing regime for the proper administration of prophylaxis antibiotics prior to orthopedic surgery. We restricted our study to knee replacement and hip replacement surgeries. All records from September 2014 to June 2015 were taken into consideration (78 cases). Before February 2015 (protocol implementation date), only 33% or 13 of 39 cases were correctly dosed. After protocol establishment: 44 % or 17 of 39 cases were correctly dosed. Although our p-value suggests no statistical significance, there was an increasing trend of adequate antibiotic administration. In conclusion, we need to educate more our nursing staff and implement monthly audits of our cases to improve our mistakes and ensure that this aspect of practice will remain in the forefront of perioperative orthopedic surgery care.

Efficacy of a first course of Ibuprofen for patent ductus arteriosus closure in extremely preterm newborns according to their gestational age-specific Z-score for birth weight.

OBJECTIVE: Therapeutic strategies for patent ductus arteriosus (PDA) in very preterm infants remain controversial. To identify infants likely to benefit from treatment, we analysed the efficacy of a first course of ibuprofen in small-for-gestational age (SGA) newborns. STUDY DESIGN: This single-centre retrospective study included 185 infants born at 24+0-27+6 weeks of gestation with haemodynamically significant PDA, who were treated by intravenous ibuprofen (Pedea): 10 mg/kg on day one and 5 mg/kg on days two and three. Birth weight and gestational age (GA) were analysed with reference to the standard deviations from the Olsen growth curve to define GA-specific Z-scores for birth weights. The efficacy of treatment was evaluated by echocardiography 48 hours after the last dose of ibuprofen. The primary outcome was failure of the first course of ibuprofen associated in a composite criterion with the most severe outcomes. RESULTS: The risk of treatment failure increased according to a continuous gradient in SGA neonates. A higher risk was observed on multiple regression analysis (crude OR: 3.8; 95% CI [1.2-12.3] p = 0.02; adjusted OR: 12.8; 95% CI [2.3-70.5] p=0.003). CONCLUSION: There is a linear relationship between infant birth weight and PDA treatment: the failure rate of a first course of ibuprofen increases with increasing degree of growth restriction.