Post-operative complications affect survival in surgically treated metastatic spinal cord compression.

PURPOSE: The prevalence of metastatic epidural spinal cord compression (MESCC) is increasing globally due to advancements in cancer diagnosis and treatment. Whilst surgery can benefit specific patients, the complication rate can reach up to 34%, with limited reporting on their impact in the literature. This study aims to analyse the influence of major complications on the survival of surgically treated MESCC patients. METHODS: Consecutive MESCC patients undergoing surgery and meeting inclusion criteria were selected. Survival duration from decompressive surgery to death was recorded. Perioperative factors influencing survival were documented and analysed. Kaplan-Meier survival analysis at one year compared these factors. Univariate and multivariate Cox proportional hazard regression analyses were performed. Additionally, univariate analysis compared complicated and uncomplicated groups. RESULTS: Seventy-five patients were analysed. Median survival for this cohort was 229 days (95% CI 174-365). Surgical complications, low patient performance, and rapid primary tumour growth were significant perioperative variables for survival in multivariate analyses (p < 0.001, p = 0.003, and p = 0.02, respectively) with a hazard ratio of 3.2, 3.6, and 2.1, respectively. Univariate analysis showed no variables associated with complication occurrence. CONCLUSION: In this cohort, major surgical complications, patient performance, and primary tumour growth rate were found to be independent factors affecting one year survival. Thus, prioritizing complication prevention and appropriate patient selection is crucial for optimizing survival in this population.

Use of electromyographic biofeedback in rehabilitation following anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

BACKGROUND: Rehabilitation following anterior cruciate ligament (ACL) reconstruction surgery is essential to regain functionality and return to previous activity level. Electromyographic biofeedback may be an effective intervention for rehabilitation of patients following ACL surgery. OBJECTIVE: To synthesize the available evidence on the effect of electromyographic biofeedback in the treatment of quadriceps strength following ACL surgery. DESIGN: Systematic review with meta-analysis. DATA SOURCES: PubMed, EMBASE, CENTRAL and Epistemonikos were searched. ELIGIBILITY CRITERIA: Randomized clinical trials with patients undergoing ACL reconstruction surgery comparing biofeedback with a standard rehabilitation control group. DATA EXTRACTION AND DATA SYNTHESIS: Two authors selected articles and performed data extraction. The analysed outcomes were strength, function, pain, knee extension and balance. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. Results were combined through random-effects meta-analysis, reporting mean differences. RESULTS: Eight articles were included in the qualitative analysis, and four articles were included in the quantitative analysis. The interventions lasted between 4 and 12 weeks. Three studies evaluated the effect of biofeedback on quadriceps strength; of these, two studies showed a significant difference in favour of the biofeedback group. In addition, biofeedback was found to improve knee extension [standardized mean difference - 1.3, 95% confidence interval (CI) - 1.74 to -0.86] and balance (one study). There was no significant difference in Lysholm score (mean difference -6.21, 95% CI -17.51 to 5.08; I2 =59%) or pain between the biofeedback group and the control group. CONCLUSION: Electromyographic biofeedback in knee rehabilitation could be useful following ACL reconstruction surgery. KEY MESSAGES: SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO (CRD42020193768).

Aceptación y reticencia a las vacunas contra COVID-19 en ingresantes a una universidad pública peruana durante la tercera ola pandémica

Introducción. Los estudiantes universitarios influyen en las decisiones de su familia y comunidad a favor de la vacunación. Objetivo. Identificar las principales razones para la aceptación o reticencia vacunal contra COVID-19 en ingresantes a una universidad pública. Métodos. Estudio transversal en una muestra de 408 estudiantes. Se preguntó si había completado las tres dosis de vacuna contra COVID-19 y la principal razón para la aceptación o reticencia vacunal. Se realizó un análisis descriptivo, se aplicó la prueba chi cuadrado y exacta de Fisher. Resultados. El 85,5% aceptó la vacuna principalmente por no querer contagiar a familiares (38,1%) y no querer enfermarse (27,8%). El 14,5% fue reticente, especialmente por prolongados tiempos de espera en vacunatorios (37,3%) y lejanía de los centros de vacunación (13,6%). Conclusiones. En los universitarios estudiados, el temor a la enfermedad impulsó la aceptación de la vacuna contra COVID-19 y la inaccesibilidad a los servicios de salud generó la reticencia.

Introduction. University students influence their family and community decisions in favor of vaccination. Objective. To identify the main reasons for COVID-19 vaccine acceptance or hesitancy among university entrants. Methods. A cross-sectional study in a sample of 408 students. We asked whether the student had completed the three doses the COVID-19 vaccine and the main reason for vaccine acceptance or hesitancy. A descriptive analysis was performed, the chi-square test and Fisher's exact were applied. Results. 85.5% accepted vaccination mainly because they did not want to infect family members (38.1%) and did not want to get sick (27.8%). 14.5% were hesitancy especially due to long waiting times in vaccination centers (37.3%) and distance from vaccination centers (13.6%). Conclusions. In the university students studied, the fear of disease drove COVID-19 vaccine acceptance and inaccessibility to health services generated vaccine hesitancy among university entrants.

Biochemical, Catabolic, and PGP Activity of Microbial Communities and Bacterial Strains from the Root Zone of Baccharis linearis in a Mediterranean Mine Tailing.

The management of mine tailings (MT) is commonly workload heavy, intrusive, and expensive. Phytostabilization offers a promising approach for MT management; however, it poses challenges due to the unfavorable physicochemical properties of these wastes. Nevertheless, native microorganisms capable of supporting plant growth and development could enhance the efficacy of phytostabilization. This study assesses the biological activity of microbial communities from the root zone of Baccharis linearis, which is naturally present in MT, in order to evaluate their biotechnological potential for phytostabilization. The root zone and bulk samples were collected from B. linearis plants located within a MT in the Mediterranean zone of Chile. Enzyme activities related to the cycling of C, N, and P were assessed. The community-level physiological profile was evaluated using the MicroRespTM system. Bacterial plant growth-promoting (PGP) traits and colony forming units (CFU) were evaluated through qualitative and microbiological methods, respectively. CFU, enzyme activities, and CLPP were higher in the root zone compared with the bulk samples. Five bacterial strains from the root zone exhibited PGP traits such as P solubilization and N acquisition, among others. The presence of microbial communities in the root zone of B. linearis with PGP traits suggests their potential to enhance the ecological management of MT through phytostabilization programs.

Role of Lateral Ankle Ligaments in Vertical Stability of the Fibula: A Cadaveric Model.

BACKGROUND: In unstable ankle fractures, the role of the deltoid and syndesmosis ligaments has been widely studied. However, it is uncertain what the importance of the lateral ankle ligament complex (LALC) is in the vertical stability of the fibula. Given its anatomical position, it should prevent the proximal translation of the fibula. This study aims to evaluate the role of the LALC in stabilizing the fibula in the vertical plane. METHODS: Eleven below-knee cadaveric specimens were used in this study. Proximal traction of the fibula was performed by applying 50 N in the intact state and after sequential transection of the syndesmotic ligaments, anterior talofibular ligament (ATFL), and the calcaneofibular ligament (CFL). At each stage, the proximal displacement of the fibula was measured. One-way repeated measures analysis of variance with post hoc Bonferroni correction was carried out to determine any significant differences between the groups. A P value <.05 was considered statistically significant. RESULTS: The vertical displacement of the fibula in the intact state, and after sequential transection of syndesmotic ligaments, ATFL, and CFL was 1.96 ± 1.19 mm, 3.96 ± 1.33 mm, 5.9 ± 1.73 mm, and 10.22 ± 2.76 mm, respectively. There was no significant difference in the proximal displacement of the fibula between the intact and the syndesmotic ligaments groups (P < .05). However, when the syndesmotic ligaments were transected in conjunction with ATFL ± CFL, a significant difference was observed compared to the intact state (P < .001). CONCLUSION: The complete disruption of syndesmotic ligaments did not significantly increase the proximal displacement of the fibula. However, when the ATFL ± CFL were additionally disrupted, there was a significant increase in the vertical translation of the fibula. CLINICAL RELEVANCE: To our knowledge, this is the first study describing that LALC plays a paramount role in the vertical stability of the fibula. Concomitant syndesmosis and LALC should be suspected in an axially unstable fibular fracture with a significant proximal displacement.

Flow cytometry-detected changes in megaloblastic anemia secondary to cobalamin deficiency.

Introduction: Megaloblastic anemias secondary to Vitamin B12 deficiency are a group of pathologies produced by defective nuclear DNA synthesis. Objective: To describe the maturation alterations found in hematopoietic precursors of the bone marrow in a series of patients with megaloblastic anemia. Methods: Were included patients attended at the Regional Hospital of Concepción with bone marrow samples sent for the study of cytopenia by flow cytometry whose final diagnosis was megaloblastic anemia. The immunophenotype was performed with CD45, CD34, CD117, HLA-DR, markers of neutrophil (CD13, CD11b, CD10, CD16) and/or erythroblast (CD105, CD71, CD36) maturation. Results: From the flow cytometry laboratory database, 8 patients with megaloblastic anemia were identified, and myelodysplastic syndromes (n=9) and normal or reactive bone marrow (n=10) were used as controls. 44% were men, with a median age of 58 years. Megaloblastic anemia was associated with a higher proportion of size and complexity of erythroid and myeloid progenitors compared to lymphocytes compared to controls. The total percentage of erythroblasts and the proportion of CD34+ myeloid cells associated with erythroid lineage was higher in megaloblastic anemia, associated with a maturation arrest in the CD105+ precursor stage (69% vs 19% and 23%, p<0.001). The heterogeneity of CD36 and CD71 in megaloblastic anemia was similar to myelodysplastic syndromes. Conclusions: Megaloblastic anemia produces a heterogeneous involvement of hematopoiesis, characterized by a greater size and cellular complexity of precursors of the neutrophil and erythroid series and a maturation arrest of the erythroblasts.

Introducción: Anemias megaloblásticas secundarias a la deficiencia de vitamina B12 son patologías producidas por una síntesis defectuosa del ADN nuclear. Objetivo: Describir las alteraciones madurativas encontradas en precursores hematopoyéticos de la médula ósea de una serie de pacientes con anemia megaloblástica. Métodos: Se incluyeron pacientes atendidos en el Hospital Regional de Concepción con muestras de médula ósea enviadas para estudio de citopenias por citometría de flujo cuyo diagnóstico fue anemia megaloblástica. El inmunofenotipo se realizó con CD45, CD34, CD117, HLA-DR, marcadores de maduración de serie de neutrófilo (CD13, CD11b, CD10, CD16) y/o eritroblasto (CD105, CD71, CD36). Resultados: Se identificaron 8 pacientes con anemia megaloblástica y como controles se utilizaron síndromes mielodisplásicos (n=9) y médula ósea normal o reactiva (n=10). El 44% eran hombres, con una mediana de edad de 58 años. La anemia megaloblástica se asoció con una mayor proporción de tamaño y complejidad de progenitores eritroides y mieloides con respecto de los linfocitos en comparación a los controles. El porcentaje total de eritroblastos y la proporción de células mieloides CD34+ comprometidas con el linaje eritroide fue mayor en anemia megaloblástica, asociado a una parada madurativa en la etapa de precursor CD105+ (69% vs 19% y 23%, p <0.001). La heterogeneidad de CD36 y CD71 en anemia megaloblástica fue similar a los síndromes mielodisplásicos. Conclusiones: la anemia megaloblástica produce una afectación heterogénea de la hematopoyesis, caracterizada por un mayor tamaño y complejidad celulares de precursores de la serie neutrófilo y eritroide y una detención madurativa de los eritroblastos.

Stability of Phenolic Compounds, Antioxidant Activity and Color Parameters in Colored-Flesh Potato Chips.

Potato (Solanum tuberosum) chips are the most consumed snacks worldwide today. Colored potato chips prepared from potato cultivars with red and purple flesh are a novel alternative to traditional potato chips because of their higher phenolic compound content, such as anthocyanins and hydroxycinnamic acid derivatives (HCADs), which might make these chips healthier compared with traditional chips. There is little information on the stability of these compounds. In this study, the nutritional value of these chips was evaluated by determining phenolic profiles, antioxidant activity and color parameters with liquid chromatography diode array and mass spectrometry detection (HPLC-DAD-ESI-MS/MS) and spectrophotometric methods during storage for four months. Five anthocyanins and three HCADs were detected, with the latter compounds being the most abundant, with concentrations on average between the first (97.82 mg kg-1) and the last (31.44 mg kg-1) week of storage. Similar trends were observed in antioxidant activity and stability, with the CUPRAC method showing the highest response among all the methods employed. The color indices were stable throughout the storage time. Based on these results, colored-flesh potato chips are an optimal alternative for consumption because of their high retention of phenolic compounds and antioxidant activity during storage, providing potential benefits to human health.

Flow cytometry-detected changes in megaloblastic anemia secondary to cobalamin deficiency

Introduction: Megaloblastic anemias secondary to Vitamin B12 deficiency are a group of pathologies produced by defective nuclear DNA synthesis. Objective: To describe the maturation alterations found in hematopoietic precursors of the bone marrow in a series of patients with megaloblastic anemia. Methods: Were included patients attended at the Regional Hospital of Concepción with bone marrow samples sent for the study of cytopenia by flow cytometry whose final diagnosis was megaloblastic anemia. The immunophenotype was performed with CD45, CD34, CD117, HLA-DR, markers of neutrophil (CD13, CD11b, CD10, CD16) and/or erythroblast (CD105, CD71, CD36) maturation. Results: From the flow cytometry laboratory database, 8 patients with megaloblastic anemia were identified, and myelodysplastic syndromes (n=9) and normal or reactive bone marrow (n=10) were used as controls. 44% were men, with a median age of 58 years. Megaloblastic anemia was associated with a higher proportion of size and complexity of erythroid and myeloid progenitors compared to lymphocytes compared to controls. The total percentage of erythroblasts and the proportion of CD34+ myeloid cells associated with erythroid lineage was higher in megaloblastic anemia, associated with a maturation arrest in the CD105+ precursor stage (69% vs 19% and 23%, p<0.001). The heterogeneity of CD36 and CD71 in megaloblastic anemia was similar to myelodysplastic syndromes. Conclusions: Megaloblastic anemia produces a heterogeneous involvement of hematopoiesis, characterized by a greater size and cellular complexity of precursors of the neutrophil and erythroid series and a maturation arrest of the erythroblasts.

Introducción: Anemias megaloblásticas secundarias a la deficiencia de vitamina B12 son patologías producidas por una síntesis defectuosa del ADN nuclear. Objetivo: Describir las alteraciones madurativas encontradas en precursores hematopoyéticos de la médula ósea de una serie de pacientes con anemia megaloblástica. Métodos: Se incluyeron pacientes atendidos en el Hospital Regional de Concepción con muestras de médula ósea enviadas para estudio de citopenias por citometría de flujo cuyo diagnóstico fue anemia megaloblástica. El inmunofenotipo se realizó con CD45, CD34, CD117, HLA-DR, marcadores de maduración de serie de neutrófilo (CD13, CD11b, CD10, CD16) y/o eritroblasto (CD105, CD71, CD36). Resultados: Se identificaron 8 pacientes con anemia megaloblástica y como controles se utilizaron síndromes mielodisplásicos (n=9) y médula ósea normal o reactiva (n=10). El 44% eran hombres, con una mediana de edad de 58 años. La anemia megaloblástica se asoció con una mayor proporción de tamaño y complejidad de progenitores eritroides y mieloides con respecto de los linfocitos en comparación a los controles. El porcentaje total de eritroblastos y la proporción de células mieloides CD34+ comprometidas con el linaje eritroide fue mayor en anemia megaloblástica, asociado a una parada madurativa en la etapa de precursor CD105+ (69% vs 19% y 23%, p <0.001). La heterogeneidad de CD36 y CD71 en anemia megaloblástica fue similar a los síndromes mielodisplásicos. Conclusiones: la anemia megaloblástica produce una afectación heterogénea de la hematopoyesis, caracterizada por un mayor tamaño y complejidad celulares de precursores de la serie neutrófilo y eritroide y una detención madurativa de los eritroblastos.

Rendimiento Biomecánico de las Placas de Tibia Proximal Utilizadas en Fracturas de Platillos Tibiales evaluado a través de Modelos de Elementos Finitos: Protocolo de Revisión Sistemática / A systematic Review Protocol Examining the Biomechanical Performance of Proximal Tibial Plates used in Tibial Plate Fractures assessed by Finite Element Analysis

Objetivo. Analizar el rendimiento biomecánico de las placas de tibia proximal utilizadas en fracturas de platillos tibiales evaluado a través de modelos de elementos finitos. Métodos. Se realizará una búsqueda exhaustiva en PubMed/Medline, Embase, Lilacs, Web of Science y Google Scholar. No se utilizará ninguna restricción de idioma o estado de publicación. Dos revisores examinarán de forma independiente los posibles artículos elegibles, de acuerdo con los criterios de selección predefinidos. Se incluirán los estudios que evalúen el rendimiento de los platillos tibiales proximales utilizados en las fracturas del platillo tibial evaluadas mediante el análisis de elementos finitos. La extracción de datos sobre las características del estudio, los métodos, los resultados y la evaluación del riesgo de sesgo se realizará mediante un formulario estandarizado. Considerando el diseño de estudio no se requiere evaluación por comité de ética. Los resultados de esta revisión se difundirán a través de la publicación en revistas revisadas por pares, redes sociales y congresos de la especialidad. Se espera que los resultados de esta revisión permitan optimizar los resultados del manejo quirúrgico de las fracturas de platillos tibiales. Número de registro PROSPERO: CRD42023396015.

Objetive. To analyze the biomechanical performance of proximal tibial plates used in tibial plate fractures evaluated through finite element modeling. Methods. A comprehensive search will be conducted in PubMed/Medline, Embase, Lilacs, Web of Science, and Google Scholar. No language or publication status restrictions will be used. Two reviewers will independently review potential eligible articles according to predefined selection criteria. Studies evaluating the performance of proximal tibial splints used in tibial splint fractures assessed by finite element analysis will be included. Data extraction on study characteristics, methods, results, and risk of bias assessment will be performed using a standardized form. Considering the study design, evaluation by an ethics committee is not required. The results of this review will be disseminated through publication in peer-reviewed journals, social networks and specialty congresses. It is expected that the results of this review will allow optimizing the results of the surgical management of tibial plate fractures. PROSPERO registration number: CRD42023396015.

The Reverse Shoulder Arthroplasty Angle in MRI: Impact of the Articular Cartilage in the Estimated Inclination of the Inferior Glenoid.

Purpose: To describe the reverse shoulder arthroplasty angle (RSA angle) in magnetic resonance imaging (MRI) and compare the angle formed using bony landmarks (Bony RSA angle or B-RSA angle) with another angle formed using the cartilage margin as reference (Cartilage RSA angle or C-RSA angle). Methods: Adult patients with a shoulder MRI obtained in our hospital between July 2020 and July 2021 were included. The C-RSA angle and B-RSA angle were measured. All images were independently assessed by 4 evaluators. Intraclass correlation coefficient (ICC) was determined for the B-RSA and C-RSA to evaluate interobserver agreement. Results: A total of 61 patients were included with a median age of 59 years (17-77). C-RSA angle was significantly higher than B-RSA (25.4° ± 0.7 vs 19.5° ± 0.7, respectively) with a P-value <.001. The overall agreement was considered "good" for C-RSA (ICC = 0.74 [95% CI 0.61-0.83]) and "excellent" for B-RSA angle (ICC = 0.76 [95% CI 0.65-0.85]). Conclusions: C-RSA angle is significantly higher than B-RSA angle. In cases without significant glenoid wear neglecting to account for the remaining articular cartilage at the inferior glenoid margin may result in superior inclination of standard surgical guides.

The Reliability of Acromioclavicular Joint Dislocation Classification Systems: A Comparison Between the Rockwood and Kraus Classifications.

Background: The Rockwood system for the classification of acute acromioclavicular (AC) joint dislocations has been associated with a lack of reliability. A novel system has been proposed (Kraus classification) that is based on dynamic posterior translation of these injuries. Purpose: To assess the interobserver and intraobserver reliability of the Rockwood and Kraus classification systems and also to examine the impact of surgeon experience on the assessments. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were 45 patients with acute AC joint injuries who underwent a radiographic examination using standard bilateral AP and modified Alexander views. For interobserver reliability, 6 shoulder surgeons (expert group) and 6 orthopaedic residents (novice group) reviewed the radiographs to classify injuries according to the Rockwood and Kraus classifications; for each categorization, the participants chose between nonoperative management and surgical treatment. The evaluation was repeated 6 weeks later to determine intraobserver reliability. Kappa (κ) coefficients and their 95% CIs were used to compare interobserver and intraobserver reliability for each classification system according to assessor experience. Statistical differences were considered significant when the upper and lower boundaries of the 95% CI did not overlap. Results: The overall interobserver agreement for diagnosis (both novice and expert groups) was moderate (κ = 0.52 [95% CI, 0.51-0.54]) for the Rockwood classification and substantial (κ = 0.62 [95% CI, 0.53-0.65]) for the Kraus classification; however, no significant differences were observed between the κ values. The overall interobserver agreement for treatment selection was substantial when using both the Rockwood (κ = 0.78 [95% CI, 0.72-0.81]) and Kraus (κ = 0.77 [95% CI, 0.66-0.87]) classifications. The overall intraobserver agreement for diagnosis was substantial using both the Rockwood (κ = 0.65 [95% CI, 0.61-0.67]) and Kraus (κ = 0.73 [95% CI, 0.69-0.75]) classifications. There were no significant differences between the novice and expert groups on any of the evaluations. Conclusion: The Kraus system was slightly more reliable than the Rockwood system for classifying AC joint injuries both between assessor groups and overall. The level of surgeon experience had no impact on the evaluations.

Internal Structure and Invariance of a Brief Version of the Marijuana Motives Measure (MMM-P15) in a Peruvian Population of Marijuana users / Estructura Interna e Invarianza de una Versión Breve del Marijuana Motives Measure (MMM-P15) en Población Peruana de Consumidores de Marihuana

Antecedentes: La identificación de los motivos por los cuales se consume marihuana se ha visto apoyada por instrumentos como el MMM. A pesar de su importancia, aún no se cuenta con versiones breves válidas de este en países latinoamericanos. Este trabajo busca cubrir esta carencia aportando evidencia de validez y confiabilidad, así como la invarianza estructural del MMM. Método: La muestra comprende 1164 consumidores de marihuana, varones y mujeres, con edades entre 18 y 49 años, de Lima y Callao. Resultados: El análisis factorial halló una estructura pentafactorial. La versión breve (MMM-P15) y extensa (MMM) muestran favorables propiedades de estructura y consistencia interna (ꙍ> .88, H > .84) con adecuados índices de ajuste del instrumento corto (RMSEA = .058 [IC 90% .050, .067], SRMR = .044, GFI = .99, TLI = .99, CFI = .99). Asimismo, ambas versiones mantienen la invarianza según el sexo y se encontró evidencia de validez interna (AVE > .50) y con otros constructos (CAST y SWLS). Conclusiones: El MMM-P15 evidencia propiedades psicométricas que respaldan su uso tanto en hombres y mujeres consumidores de marihuana, además es un instrumento corto, versátil y útil para fines de investigación incluso en contextos clínicos.(AU9

Background: The identification of the reasons for marijuana use has been supported by instruments such as the MMM. Despite its importance, there are still no valid brief versions of this instrument in Latin American countries. This paper seeks to fill this gap by providing evidence of validity and reliability, as well as the structural invariance of the MMM. Method:The sample consisted of 1164 male and female marijuana users, aged between 18 and 49 years, from Lima and Callao. Results: The factor analysis found a pentafactorial structure. The brief version (MMM-P15) and the wide MMM showed favorable properties from structure and reliability (ꙍ> .88, H > .84) with appropriate indicators of the short instrument adjustment (RMSEA = .058 [CI 90% .050, .067], SRMR = .044,TLI = .99, CFI = .99). Likewise, both versions maintain the invariance of the instrument according to sex and evidence of internal validity was found (AVE > .50). Aside from bringing evidence of validity with other constructs like CAST and SWLS scale. Conclusions:The MMM-P15 shows psychometric properties that support its use in both male and female marijuana users, and it is a short, versatile, and useful instrument for research pur-poses even in clinical settings.(AU)

An independent inter- and intra-observer agreement assessment of the AOSpine upper cervical injury classification system.

BACKGROUND CONTEXT: The complex anatomy of the upper cervical spine resulted in numerous separate classification systems of upper cervical spine trauma. The AOSpine upper cervical classification system (UCCS) was recently described; however, an independent agreement assessment has not been performed. PURPOSE: To perform an independent evaluation of the AOSpine UCCS. STUDY DESIGN: Agreement study. PATIENT SAMPLE: Eighty-four patients with upper cervical spine injuries. OUTCOME MEASURES: Inter-observer agreement; intra-observer agreement. METHODS: Complete imaging studies of 84 patients with upper cervical spine injuries, including all morphological types of injuries defined by the AOSpine UCCS were selected and classified by six evaluators (from three different countries). The 84 cases were presented to the same raters randomly after a 4-week interval for repeat evaluation. The Kappa coefficient (κ) was used to determine inter- and intra-observer agreement. RESULTS: The interobserver agreement was almost perfect when considering the fracture site (I, II or III), with κ=0.82 (0.78-0.83), but the agreement according to the site and type level was moderate, κ=0.57 (0.55-0.65). The intra-observer agreement was almost perfect considering the injury, with κ=0.83 (0.78-0.86), while according to site and type was substantial, κ=0.69 (0.67-0.71). CONCLUSIONS: We observed only a moderate inter-observer agreement using this classification. We believe our results can be explained because this classification attempted to organize many different injury types into a single scheme.

No Más Fracturas - Implementación de la primera Unidad de Coordinación de Fracturas en Chile: experiencia al año de funcionamiento / Implementation of a fracture liaison service. Experience with 177 patients

BACKGROUND: Every year about 9 million fragility fractures (FF) occur worldwide and 80% of these are underdiagnosed or undertreated. Aiming to close the gap of diagnosis and treatment of osteoporosis, Fracture Liaison Services (FLS) were developed. AIM: To describe the implementation of the first FLS in Chile, its inclusion criteria, patient enrolment, treatment adherence and referrals during the first year. MATERIAL AND METHODS: A FLS was implemented at a health care network composed by two hospitals. The International Osteoporosis Foundation (IOF) guidelines were applied with a nurse practitioner as the coordinator. From May 2020 to April 2021 all patients diagnosed with a FF in the emergency rooms were invited to participate. Patients with pathological fractures and active cancer were excluded. Demographical data, fracture location, previous fractures, treatment and adherence, and mortality were recorded. RESULTS: From 443 patients with a diagnosis of FF, 177 patients (40%) accepted to participate. Their mean age was 74 ± 13 years and 84% (149) were female. Forty eight percent (84) had a lower extremity FF. Hip fractures were the most common (67). Ninety-five patients reported previous FF and 11,2% (20) had received anti-osteoporotic treatment. At four months of follow-up, 62% (50) had received vitamin D and calcium supplementation and 20% (16) of those patients with an indication of anti-osteoporotic drugs, had received them. CONCLUSIONS: The implementation of the FLS was successful with a 40% enrolment of patients, receiving certification by the IOF.

Caracterización epidemiológica de los casos humanos de ántrax en Perú, 2015 - 2019

Introducción. La epidemiología del ántrax en Perú es poco conocida. Su alto potencial epidémico y epizoótico podría amenazar la salud pública, especialmente desde sus regiones endémicas. Objetivo. Caracterizar los casos de ántrax humano en Perú del 2015 al 2019. Métodos. Se realizó un estudio transversal retrospectivo, a partir de los datos del Sistema Nacional de Vigilancia Epidemiológica e investigaciones de brotes en Perú del 2015 al 2019. Resultados. 71 casos de ántrax humano fueron registrados, 34 % (n = 24) confirmados y66 % (n = 47) probables. Los más afectados fueron varones (55 %) y el grupo etario de 30 a 59 años (45 %). Los casos estuvieron distribuidos principalmente en la costa norte del país. La forma cutánea autolimitada en miembros superiores fue la presentación clínica más frecuente. El 94 % (n = 67) de los casos tuvieron contacto con ganado vacuno infectado. Conclusión. Los casos de ántrax humano en Perú fueron en su mayoría de la forma cutánea, que se presentaron por brotes focalizados en áreas con antecedentes de trasmisión zoonótica. Este reporte pretende aportar al conocimiento epidemiológico de esta enfermedad y servir como insumo en la implementación de medidas de prevención y control.

Introduction. The epidemiology of anthrax in Peru is poorly understood. Its high epidemic and epizootic potential could threaten public health, especially in its endemic regions. Objective. To characterize cases of human anthrax in Peru from 2015 to 2019. Methods. A retrospective cross-sectional study was carried out; based on data from the National Epidemiological Surveillance System and investigations of anthrax outbreaks from 2015 to 2019 in Peru. Results. 71 cases of human anthrax were registered, 34 % (n = 24)confirmed and 66 % (n = 47) probable. The most affected were males (55 %) and the age group from 30to 59 years (45 %), distributed mainly on the north coast of the country. The self-limited cutaneous form was the most frequent clinical presentation. 94% (n = 67) of the cases had contact with infected cattle. Conclusions. The cases of human anthrax in Peru appear as focalized outbreaks in areas with a history of zoonotic transmission. This report aims to contribute to the epidemiological knowledge of this disease and serve as input in the implementation of prevention and control measures.

Management of Rhizosphere Microbiota and Plant Production under Drought Stress: A Comprehensive Review.

Drought generates a complex scenario worldwide in which agriculture should urgently be reframed from an integrative point of view. It includes the search for new water resources and the use of tolerant crops and genotypes, improved irrigation systems, and other less explored alternatives that are very important, such as biotechnological tools that may increase the water use efficiency. Currently, a large body of evidence highlights the role of specific strains in the main microbial rhizosphere groups (arbuscular mycorrhizal fungi, yeasts, and bacteria) on increasing the drought tolerance of their host plants through diverse plant growth-promoting (PGP) characteristics. With this background, it is possible to suggest that the joint use of distinct PGP microbes could produce positive interactions or additive beneficial effects on their host plants if their co-inoculation does not generate antagonistic responses. To date, such effects have only been partially analyzed by using single omics tools, such as genomics, metabolomics, or proteomics. However, there is a gap of information in the use of multi-omics approaches to detect interactions between PGP and host plants. This approach must be the next scale-jump in the study of the interaction of soil-plant-microorganism. In this review, we analyzed the constraints posed by drought in the framework of an increasing global demand for plant production, integrating the important role played by the rhizosphere biota as a PGP agent. Using multi-omics approaches to understand in depth the processes that occur in plants in the presence of microorganisms can allow us to modulate their combined use and drive it to increase crop yields, improving production processes to attend the growing global demand for food.

La mujer en las publicaciones científicas en Chile / Presence of women in medical publications in Chile

BACKGROUND: Despite recent initiatives and efforts, gender inequality still exists in medicine and academia. There is a higher proportion of male authors in international scientific publications. AIM: To compare the proportion of female and male authors in the scientific publications of the main medical journals in Chile. Material and Methods: We reviewed 1,643 Scientific articles published between 2015 and 2020 in two medical journals from Chile. Three authors analyzed the title, abstract, and authors of all published articles, recording the sex of the first author, co-authors, and corresponding author. RESULTS: The reviewed articles had a mean of 5.3 authors and there was a significant difference between men and women (a mean of 2.8 men and 2.4 women; p < 0.001). Forty-six percent (n = 761) of the articles had a female first author. In a higher proportion of papers, men completed both positions (1st and corresponding author) simultaneously. CONCLUSIONS: There are fewer female authors in scientific publications. Chile is one of the countries with a high rate of gender gap in the world. The underrepresentation of women in academia is an example of this.

Pandemia COVID-19: actitudes-facilidades como mediador entre autocuidado y bienestar mental en internos de ciencias médicas

Objetivo Determinar en internos de ciencias de la salud si el autocuidado es un factor cuyo efecto directo sobre el bienestar mental es mediado por las actitudes y facilidades durante el internado, durante la segunda ola de pandemia COVID-19. Método Investigación transversal, correlacional multivariante. Participaron 174 internos en actividad asistencial, seleccionados con muestreo por conveniencia; se aplicaron tres escalas tipo autoinforme. Resultados Entre los internos de ciencias de la salud, ser mujer, tener familiar en casa contagiado de COVID-19 y presentar una percepción del estado de salud general desfavorable son factores de riesgo que incrementan la probabilidad de estado negativo de bienestar mental (1,9>OR<3,9); en tanto que el autocuidado junto a las actitudes y facilidades durante el internado se constituyen en factores protectores para contrarrestar la existencia de estado negativo de bienestar mental (OR<1; p<0,05). El modelo de regresión estructural evidencia que las variables autocuidado como las actitudes adoptadas y facilidades experimentadas por los estudiantes tienen efectos directos en el bienestar mental; asimismo, las actitudes y facilidades cumplen un rol de mediador entre autocuidado y bienestar mental (CFI=0,96; TLI=0,95; RMSEA y SRMR<0,08). El modelo en conjunto explica en 50,7% la variabilidad de bienestar mental. Conclusión El autocuidado es un factor cuyo efecto directo sobre el bienestar mental es mediado por las actitudes y facilidades en el internado durante la segunda ola de la pandemia COVID-19 en el año 2021.

Objective To determine in health sciences interns if self-care is a factor whose direct effect on mental wellness is mediated by attitudes and facilities during internship, during the second wave of the COVID-19 pandemic. Method Cross-sectional, multivariate correlational research. 174 interns participated during the COVID-19 pandemic, selected by convenience sampling; three self-report scales were applied. Results Among the health sciences interns, being a woman, having a family member at home infected with COVID-19, and having an unfavorable general health status perception are risk factors that are likely to have a negative state of mental wellness (1.9>OR<3.9); while self-care together with attitudes and facilities during the internship are protective factors to counteract the existence of a negative state of mental wellness (OR<1; p<0.05). The structural regression model shows that self-care variables such as attitudes adopted, and facilities experienced by students in the internship have direct effects on mental wellness; likewise, attitudes and facilities play a mediating role between self-care and mental wellness (CFI=0.96; TLI=0.95; RMSEA and SRMR<0.08). The model as a whole explains 50.7% of the variability of mental wellness. Conclusion Self-care is a factor whose direct effect on mental wellness is mediated by attitudes and facilities in internship during the second wave of the COVID-19 pandemic in 2021.

Validación de medidas de resultados informados por los pacientes en ortopedia y traumatología / Validation of patient-reported outcome measures in orthopedics and traumatology

En los últimos años, ha habido un aumento en la aplicación de cuestionarios diseñados para la medición de resultados (o desenlaces) clínicos en la práctica médica. Para aplicar un cuestionario en una población distinta a la cual fue originalmente creado y diseñado, es necesario llevar a cabo un proceso riguroso de adaptación, con una determinada metodología. El objetivo de esta guía metodológica es describir el proceso de traducción, adaptación transcultural y validación de medidas de resultados informados por los pacientes (MRIPs) en Ortopedia y Traumatología.

In recent years, there has been an increase in the use of questionnaires designed to measure outcomes in the medical practice. To use a questionnaire in a population different from the one for which it was originally created and designed, it is necessary to carry out a rigorous adaptation process, with a certain methodology. The objective of the present methodological guide is to describe the process of translation, crosscultural adaptation, and validation of patient-reported outcome measures in Orthopedics and Traumatology

Lifestyle changes in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis.

BACKGROUND: Non-alcoholic fatty liver disease is a liver condition that is increasing worldwide and expected to become the number one cause of cirrhosis and hepatocellular carcinoma in the next 5 years. Currently there are no successful or approved pharmacological treatments. Weight loss is the first-line therapy as a 7 to 10% reduction improves steatosis, inflammation, hepatocyte ballooning, and fibrosis. To achieve this, lifestyle interventions including daily exercise and diet must be encouraged. We aimed to assess the effects of diet, exercise, or a combination of both compared to conventional treatment in patients with non-alcoholic fatty liver disease. METHODS AND FINDING: A literature search was performed in CENTRAL, EMBASE, and PubMed. Randomized controlled trials comparing lifestyle changes with conventional treatment were included, without date restriction. Two authors searched studies according to eligibility criteria, extracted data, and assessed study quality. Subgroup analysis was made by type of intervention, duration of intervention and supervision. We calculated mean differences between the intervention and the control group with their corresponding 95% confidence intervals. Quality of the evidence was assessed using the Cochrane Risk of bias tool. This study is registered in PROSPERO, number CRD42020184241, and checked with the PRISMA checklist. 30 RCTs met the inclusion criteria. Compared to conventional treatment, combined exercise with diet seems to elicit greater reductions in ALT (MD: -13.27 CI 95% -21.39, -5.16), AST (MD: -7.02 CI 95% -11.26, -2.78) and HOMA-IR (MD: -2.07 CI 95% -2.61, -1.46) than diet (ALT MD: -4.48 CI 95% -1.01, -0.21; HOMA-IR MD: -0.61 CI 95% -1.01, -0.21) and exercise (ALT and AST non-significant; HOMA-IR MD = -0.46 CI 95% -0.8, -0.12) alone. Additionally, exercise improved quality of life, cardiorespiratory fitness, and weight (MD: -2.64 CI 95% -5.18, -0.09). CONCLUSION: Lifestyle changes are effective in the treatment of NAFLD. Diet and exercise combined are superior to these interventions alone in improving liver enzymes and HOMA-IR.