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BACKGROUND: Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 highlights the need to explore aetiotypes of chronic obstructive pulmonary disease (COPD) beyond the tobacco-smoking COPD. Exposure to wood smoke (WS) is a risk factor for COPD in women, but the effect of the combined exposure to tobacco smoke (TS) in the general population and among COPD patients, and the characteristics of WS-COPD are unclear. METHOD: This was an analysis of data from PREPOCOL (Prevalence of COPD in Five Colombian Cities Situated at Low, Medium, and High Altitude), a random cross-sectional population-based study (n = 5,539) focusing on the effect of combined WS and TS exposure and WS-COPD characterisation. RESULTS: Prevalence of COPD was significantly higher in those exposed to both WS and TS (16.0%) than in those exposed to WS (6.7%) or TS (7.8%) only (P < 0.001). Exposure to WS was associated with COPD in men (OR 1.53, P = 0.017). WS-COPD individuals were more frequently female, older, shorter and had higher forced expiratory volume in 1 sec (FEV1) (all P < 0.05). Those exposed to both WS and TS had more symptoms and worse airflow limitation (P < 0.001). CONCLUSIONS: This was the first random population-based study showing that WS is an associated risk factor for COPD also in men, and that people exposed to both WS and TS have a significantly higher prevalence of COPD. Similarly, COPD subjects exposed to both types of smoke have more symptoms and greater airflow obstruction. This suggests an additive effect of WS and TS.
CONTEXTE: L'Initiative mondiale pour les maladies pulmonaires obstructives chroniques (Global Initiative for Chronic Obstructive Lung Disease, GOLD) 2023 met en évidence l'importance d'explorer les différents étiotypes de la maladie pulmonaire obstructive chronique (COPD, pour l'anglais « chronic obstructive pulmonary disease ¼) en dehors de la COPD liée au tabagisme. L'exposition à la fumée de bois (WS, pour l'anglais « wood smoke ¼) représente un facteur de risque de la COPD chez les femmes, cependant, l'impact de l'exposition simultanée à la fumée de tabac (TS, pour l'anglais « tobacco smoke ¼) chez la population générale et chez les patients atteints de COPD, ainsi que les caractéristiques spécifiques de la WS-COPD, demeurent peu clairs. MÉTHODES: Il s'agit d'une étude transversale aléatoire basée sur la population (n = 5 539) qui analyse les données de PREPOCOL (Prevalence of COPD in Five Colombian Cities Situated at Low, Medium, and High Altitude). L'étude se concentre sur l'effet de l'exposition combinée à la WS et à la TS ainsi que sur la caractérisation de la WS-COPD. RÉSULTATS: La prévalence de la COPD était significativement plus élevée chez les personnes exposées à la fois à la WS et à la TS (16,0%) que chez celles exposées uniquement à la WS (6,7%) ou à la TS (7,8%) (P < 0,001). L'exposition à la WS était associée à la COPD chez les hommes (OR 1,53 ; P = 0,017). Les personnes atteintes de WS-COPD étaient plus fréquemment des femmes, d'un âge plus avancé, de plus petite taille et présentaient un volume expiratoire maximal en 1 seconde (FEV1) plus élevé (tous P < 0,05). Les personnes exposées à la fois à la WS et à la TS ont montré plus de symptômes et une plus grande limitation du débit d'air (P < 0,001). CONCLUSION: Il s'agit de la première étude aléatoire basée sur la population qui démontre que la WS est un facteur de risque lié à la COPD, même chez les hommes, et que les individus exposés à la fois à la WS et à la TS présentent une prévalence significativement plus élevée de la COPD. De plus, les personnes souffrant de COPD qui sont exposés aux deux types de fumée manifestent davantage de symptômes et une obstruction pulmonaire plus sévère. Cela laisse supposer qu'il y a un effet cumulatif de la WS et de la TS.
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"Implicit bias," also called "unconscious bias," refers to associations outside of conscious awareness that adversely affect one's perception of a person or group. Awareness of implicit bias has been increasing in the realm of diabetes care. Here, the authors highlight several types of unconscious bias on the part of clinicians and patients, including biases based on race, ethnicity, and obesity. They discuss how these biases can negatively affect patient-centered clinical interactions and diabetes care delivery, and they recommend implementation of evidence-based interventions and other health system policy approaches to reduce the potential impact of such biases in health care settings.
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This article is adapted from the address Dr. Caballero delivered as the recipient of the American Diabetes Association's Outstanding Educator in Diabetes Award for 2023. He delivered the address in June 2023 during the Association's 83rd Scientific Sessions in San Diego, CA. A webcast of this speech is available for viewing on the DiabetesPro website (https://events.diabetes.org/live/25/page/186).
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Background: Differences in the prevalence of four diabetes subgroups have been reported in Mexico compared to other populations, but factors that may contribute to these differences are poorly understood. Here, we estimate the prevalence of diabetes subgroups in Mexico and evaluate their correlates with indicators of social disadvantage using data from national representative surveys. Methods: We analyzed serial, cross-sectional Mexican National Health and Nutrition Surveys spanning 2016, 2018, 2020, 2021, and 2022, including 23,354 adults (>20 years). Diabetes subgroups (obesity-related [MOD], severe insulin-deficient [SIDD], severe insulin-resistant [SIRD], and age-related [MARD]) were classified using self-normalizing neural networks based on a previously validated algorithm. We used the density-independent social lag index (DISLI) as a proxy of state-level social disadvantage. Findings: We identified 4204 adults (median age: 57, IQR: 47-66, women: 64%) living with diabetes, yielding a pooled prevalence of 16.04% [95% CI: 14.92-17.17]. When stratified by diabetes subgroup, prevalence was 6.62% (5.69-7.55) for SIDD, 5.25% (4.52-5.97) for MOD, 2.39% (1.95-2.83) for MARD, and 1.27% (1.00-1.54) for SIRD. SIDD and MOD clustered in Southern Mexico, whereas MARD and SIRD clustered in Northern Mexico and Mexico City. Each standard deviation increase in DISLI was associated with higher odds of SIDD (OR: 1.12, 95% CI: 1.06-1.12) and lower odds of MOD (OR: 0.93, 0.88-0.99). Speaking an indigenous language was associated with higher odds of SIDD (OR: 1.35, 1.16-1.57) and lower odds of MARD (OR 0.58, 0.45-0.74). Interpretation: Diabetes prevalence in Mexico is rising in the context of regional and sociodemographic inequalities across distinct diabetes subgroups. SIDD is a subgroup of concern that may be associated with inadequate diabetes management, mainly in marginalized states. Funding: This research was supported by Instituto Nacional de Geriatría in Mexico.
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OBJECTIVE: To analyze the accuracy of cell ratios in the diagnosis of pediatric acute appendicitis while introducing a new one -the derived neutrophil-to-lymphocyte ratio (dNLR). MATERIALS AND METHODS: An observational, retrospective study of patients aged 0-15 years old diagnosed with acute appendicitis (AA) and with non-surgical abdominal pain (AP) treated in our institution from 2021 to 2022 was carried out. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and dNLR were compared between groups. RESULTS: 98 AA patients (30% of whom were female; age: 10 ± 3.3 years) and 97 AP patients (53% of whom were male; age: 9.3 ± 3.7 years) were included. NLR, MLR, PLR, and dNLR values were higher in AA patients than in AP patients: 9.6 IQR (interquartile range) 9.5 vs. 3.3 IQR 5.3: p< 0.0001; 0.7 IQR 0.6 vs. 0.46 IQR 0.7: p< 0.023; 199.8 IQR 163.9 vs. 134.0 IQR 129.2: p< 0.0001; and 5.29 IQR 3.9 vs. 2.39 IQR 2.7; p< 0.0001, respectively. Sensitivity, specificity, positive-negative predictive value, area under the ROC curve, and dNLR cut-off point for AA diagnosis were 70%, 78%, 77-72%, 0.811, and 3.98, respectively. CONCLUSIONS: Cell ratios are useful and cost-effective inflammatory parameters in the diagnosis of pediatric acute appendicitis. The results of this study suggest dNLR has the greatest clinical accuracy.
OBJETIVOS: Analizar la precisión de los índices celulares en el diagnóstico de la apendicitis aguda pediátrica, introduciendo uno nuevo, el índice neutrófilo/linfocito derivado (INLd). MATERIAL Y METODOS: Estudio retrospectivo observacional de los pacientes de 0-15 años diagnosticados de apendicitis aguda (AA) y con dolor abdominal no quirúrgico (DA) tratados en nuestro centro entre 2021-2022. Se comparó el índice neutrófilo/linfocito (INL), índice monocito/linfocito (IML), índice plaqueta/linfocito (IPL) y el INLd entre los grupos. RESULTADOS: Se incluyeron 98 casos con AA (30% mujeres, edad 10 ± 3,3 años) y 97 pacientes con DA (53% hombres, edad 9,3 ± 3,7 años). Los valores de INL, IML, IPL e INLd fueron mayores en pacientes con AA respecto a niños con DA: 9,6 rango intercuartil (RIC) 9,5 vs. 3,3 RIC 5,3: p< 0,0001; 0,7 RIC 0,6 vs. 0,46 RIC 0,7: p< 0,023; 199,8 RIC 163,9 vs. 134,0 RIC 129,2: p< 0,0001; y 5,29 RIC 3,9 vs. 2,39 RIC 2,7: p< 0,0001; respectivamente. La sensibilidad, especificidad, valor predictivo positivo-negativo, área bajo la curva ROC y el punto de corte del INLd para el diagnóstico de AA fue de 70%, 78%, 77-72%, 0,811 y 3,98; respectivamente. CONCLUSIONES: Los índices celulares son parámetros inflamatorios útiles y coste-efectivos que pueden contribuir al diagnóstico de la apendicitis aguda pediátrica. Los resultados de este estudio sugieren que el INLd es el de mayor precisión clínica.
Subject(s)
Appendicitis , Humans , Child , Female , Male , Adolescent , Child, Preschool , Infant, Newborn , Infant , Appendicitis/diagnosis , Neutrophils , Retrospective Studies , Abdominal Pain , Acute Disease , LymphocytesABSTRACT
INTRODUCTION: Cutis marmorata telangiectatica congenita (CMTC) is a rare capillary malformation characterized by persistent reticular and violaceous erythema. We present two cases of CMTC. CLINICAL OBSERVATION: The first case involved a 13-month-old male with a reticular violaceous macule on the left gluteal region and a brownish papule with Darier's sign on the inner malleolus of the left foot, which was biopsied, revealing > 15 mast cells per field, leading to a diagnosis of CMTC and solitary cutaneous mastocytoma. The second case involved a newborn with a characteristic CMTC lesion without other malformations at birth, who subsequently developed two cutaneous tumors consistent with infantile hemangiomas during follow-up. DISCUSSION: CMTC is a benign condition. However, approximately 50% of cases exhibit associated anomalies. When CMTC is suspected, musculoskeletal, ophthalmological, and cutaneous malformations should be ruled out. To the best of our knowledge, this is the first report of CMTC associated with mastocytoma and one of the few cases associated with infantile hemangioma.
INTRODUCCION: La cutis marmorata telangiectásica congénita (CMTC) es una rara malformación capilar caracterizada por eritema reticular y violáceo persistente. Presentamos dos casos de CMTC. OBSERVACION CLINICA: Un varón de 13 meses presentaba una mácula violácea reticular en glúteo izquierdo y una pápula parduzca con signo de Darier en el maléolo interno del pie izquierdo, que fue biopsiada identificando > 15 mastocitos/campo, con lo cual se diagnosticó de CMTC y mastocitoma cutáneo solitario. El segundo caso, una recién nacida con una lesión característica de CMTC sin otras malformaciones al nacer, que durante el seguimiento desarrolló dos tumoraciones cutáneas compatibles con hemangiomas infantiles. COMENTARIOS: La CMTC es una condición benigna, sin embargo, aproximadamente el 50% de los casos presentan anomalías asociadas. Ante la sospecha de CMTC se deben descartar malformaciones musculoesqueléticas, oftalmológicas y cutáneas. Hasta donde tenemos conocimiento, este es el primer reporte de CMTC asociada con mastocitoma y uno de los pocos con hemangioma infantil.
Subject(s)
Livedo Reticularis , Mastocytoma , Infant, Newborn , Male , Humans , Infant , Biopsy , Livedo Reticularis/etiologyABSTRACT
Objetivo: Analizar la precisión de los índices celulares en el diagnóstico de la apendicitis aguda pediátrica, introduciendo uno nuevo, el índice neutrófilo/linfocito derivado (INLd). Material y métodos: Estudio retrospectivo observacional de los pacientes de 0-15 años diagnosticados de apendicitis aguda (AA) y con dolor abdominal no quirúrgico (DA) tratados en nuestro centro entre 2021-2022. Se comparó el índice neutrófilo/linfocito (INL), índice monocito/linfocito (IML), índice plaqueta/linfocito (IPL) y el INLd entre los grupos. Resultados: Se incluyeron 98 casos con AA (30% mujeres, edad 10 ± 3,3 años) y 97 pacientes con DA (53% hombres, edad 9,3 ± 3,7 años). Los valores de INL, IML, IPL e INLd fueron mayores en pacientes con AA respecto a niños con DA: 9,6 rango intercuartil (RIC) 9,5 vs. 3,3 RIC 5,3: p = < 0,0001; 0,7 RIC 0,6 vs. 0,46 RIC 0,7: p = < 0,023; 199,8 RIC 163,9 vs. 134,0 RIC 129,2: p = < 0,0001; y 5,29 RIC 3,9 vs. 2,39 RIC 2,7: p = < 0,0001; respectivamente. La sensibilidad, especificidad, valor predictivo positivo-negativo, área bajo la curva ROC y el punto de corte del INLd para el diagnóstico de AA fue de 70%, 78%, 77-72%, 0,811 y 3,98; respectivamente. Conclusiones. Los índices celulares son parámetros inflamatorios útiles y coste-efectivos que pueden contribuir al diagnóstico de la apendicitis aguda pediátrica. Los resultados de este estudio sugieren que el INLd es el de mayor precisión clínica.(AU)
Objective: To analyze the accuracy of cell ratios in the diagnosis of pediatric acute appendicitis while introducing a new one the derived neutrophil-to-lymphocyte ratio (dNLR). Materials and methods: An observational, retrospective study of patients aged 0-15 years old diagnosed with acute appendicitis (AA) and with non-surgical abdominal pain (AP) treated in our institution from 2021 to 2022 was carried out. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and dNLR were compared between groups. Results. 98 AA patients (30% of whom were female; age: 10 ± 3.3 years) and 97 AP patients (53% of whom were male; age: 9.3 ± 3.7 years) were included. NLR, MLR, PLR, and dNLR values were higher in AA patients than in AP patients: 9.6 IQR (interquartile range) 9.5 vs. 3.3 IQR 5.3: p < 0.0001; 0.7 IQR 0.6 vs. 0.46 IQR 0.7: p < 0.023; 199.8 IQR 163.9 vs. 134.0 IQR 129.2: p < 0.0001; and 5.29 IQR 3.9 vs. 2.39 IQR 2.7; p < 0.0001, respectively. Sensitivity, specificity, positive-negative predictive value, area under the ROC curve, and dNLR cut-off point for AA diagnosis were 70%, 78%, 77-72%, 0.811, and 3.98, respectively. Conclusions. Cell ratios are useful and cost-effective inflammatory parameters in the diagnosis of pediatric acute appendicitis. The results of this study suggest dNLR has the greatest clinical accuracy.(AU)
Subject(s)
Humans , Male , Female , Child , Appendicitis/surgery , Biomarkers , Abdominal Pain/diagnosis , Lymphocytes , Monocytes , Retrospective Studies , Pediatrics , General Surgery , Appendicitis/classification , Appendicitis/diagnosisABSTRACT
Introducción: La cutis marmorata telangiectásica congénita (CMTC) es una rara malformación capilar caracterizada por eritema reticular y violáceo persistente. Presentamos dos casos de CMTC. Observación clínica: Un varón de 13 meses presentaba una mácula violácea reticular en glúteo izquierdo y una pápula parduzca con signo de Darier en el maléolo interno del pie izquierdo, que fue biopsiada identificando > 15 mastocitos/campo, con lo cual se diagnosticó de CMTC y mastocitoma cutáneo solitario. El segundo caso, una recién nacida con una lesión característica de CMTC sin otras malformaciones al nacer, que durante el seguimiento desarrolló dos tumoraciones cutáneas compatibles con hemangiomas infantiles. Comentarios. La CMTC es una condición benigna, sin embargo, aproximadamente el 50% de los casos presentan anomalías asociadas. Ante la sospecha de CMTC se deben descartar malformaciones musculoesqueléticas, oftalmológicas y cutáneas. Hasta donde tenemos conocimiento, este es el primer reporte de CMTC asociada con mastocitoma y uno de los pocos con hemangioma infantil.(AU)
Introduction: Cutis marmorata telangiectatica congenita (CMTC) is a rare capillary malformation characterized by persistent reticular and violaceous erythema. We present two cases of CMTC. Clinical observation: The first case involved a 13-month-old male with a reticular violaceous macule on the left gluteal region and a brownish papule with Dariers sign on the inner malleolus of the left foot, which was biopsied, revealing > 15 mast cells per field, leading to a diagnosis of CMTC and solitary cutaneous mastocytoma. The secondcase involved a newborn with a characteristic CMTC lesion without other malformations at birth, who subsequently developed two cutaneous tumors consistent with infantile hemangiomas during follow-up. Discussion. CMTC is a benign condition. However, approximately 50% of cases exhibit associated anomalies. When CMTC is suspected, musculoskeletal, ophthalmological, and cutaneous malformations should be ruled out. To the best of our knowledge, this is the first report of CMTC associated with mastocytoma and one of the few cases associated with infantile hemangioma.(AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Livedo Reticularis/diagnostic imaging , Buttocks/injuries , Skin/injuries , Erythema/diagnostic imaging , Hemangioma/diagnosis , Mastocytoma , Pediatrics , Inpatients , Physical Examination , Symptom AssessmentABSTRACT
Human papillomavirus is the ethological agent of various tumors, including plantar warts as one of the most frequent clinical presentations. Diagnosis of these warts continues to be mainly clinical, and a significant incidence of misdiagnosis leads to inadequate treatment. The aim of this study is to implement and validate a multiplex PCR detection method in the clinical setting to detect HPV in samples and to study genotype distribution in Spain to improve future molecular diagnostics. Viral DNA was extracted from 128 samples of clinically suspected plantar warts from various locations in Spain. A multiplex PCR was run alongside internal controls, and amplicons were processed for sequencing and HPV genotyping. The method was validated by assessing both inter- and intra-run repeatability. The PCR detection method returned 81.2 % (n = 104) positive results in the samples tested. Inter- and intra-run repeatability tests showed excellent intra-run agreement (κ = 1.00, p < 0.001) and good inter-run agreement (κ = 0.737, p < 0.001). The most frequent HPV type was HPV1, followed by HPV27, showing a statistical difference between the distribution of HPV genotypes in different areas of Spain. Clinical implementation of a DNA PCR detection method for plantar warts can avoid 18.8 % of unnecessary treatments in doubtful cases, and the method is reliable and validated for the purpose. HPV types show an asymmetric geographical distribution that should be considered for diagnosis and treatment.
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AIMS: To describe the effect of three classes of GLP1 analogues on HbA1c and weight over one year in a homogenous group of patients at the Dubai Diabetes Center in Dubai, United Arab Emirates. The specific objectives are to study the extent of change in HbA1c and weight loss on these medications as well as the sustainability of change over one year. METHODS: A retrospective audit of patients diagnosed Type 2 diabetes receiving one of the three following GLP-1 agonists (Exenatide LA 2 mg weekly, liraglutide 1.8 mg once daily, Dulaglutide 1.5 mg) over one year and documenting changes in HbA1c and weight at 3-, 6-, 9-, and 12-months intervals. RESULTS: The study shows that while there was significant reduction in HbA1c and weight in the first 3 months, this change was not clinically significant. Also, the change was not maintained at the end of the year. By the final quarter, the effect of the medication diminishes, accompanied by a partial regain of weight. CONCLUSION: GLP1 agonists favorable initial effect on HbA1c and weight may not be sustainable beyond a certain period. The exact reason and factors contributing to this need further exploration.
Subject(s)
Diabetes Mellitus, Type 2 , Humans , Diabetes Mellitus, Type 2/drug therapy , Exenatide/pharmacology , Exenatide/therapeutic use , Glucagon-Like Peptide-1 Receptor/agonists , Glucagon-Like Peptide-1 Receptor/antagonists & inhibitors , Glucagon-Like Peptide-1 Receptor/metabolism , Glycated Hemoglobin , Glycemic Control , Hypoglycemic Agents/pharmacology , Hypoglycemic Agents/therapeutic use , Liraglutide/pharmacology , Liraglutide/therapeutic use , Retrospective Studies , United Arab Emirates/epidemiology , Weight LossABSTRACT
Urban sewage sludge (SL) is a major concern due to the number of environmental problems it causes. Its application for different purposes is strictly regulated, limiting the possibilities of recycling and reusing this material. Thus, in this work, a complete study of a simple method to convert SL into activated carbon (AC) was carried out. The comprehensive study involves an evaluation of the main process parameters, such as the activating agent (AA) content (25 %, 33 %, 50 %), using the lowest amount of AA as novelty, different pyrolysis temperatures (600 and 800 °C), and purification conditions (6 M HCl:AC ratio, v:w). Under controlled and optimised conditions and through a single combined activation and pyrolysis step followed by acid purification, ACs with well-developed porosity can be obtained. Surface area values of around 870 m2/g and over 60 % carbon content were achieved, demonstrating that the prepared ACs could have applications in a wide variety of fields as high-value products. As an innovative aspect in this research, the gases streams and liquid effluents generated during the global process were analysed, achieving elimination of over 63 % of the concentration of the chemical elements contained in the SL during the chemical purification stage. Finally, mass, energy, and economic balances were carried out to estimate the production cost of AC derived from SL (< 8/kg AC).
Subject(s)
Charcoal , Sewage , Sewage/chemistry , Porosity , Charcoal/chemistry , Gases , RecyclingABSTRACT
Cobalt supported on mesostructured TiO2 catalysts has been prepared by a wet-impregnation method. The Co/TiO2 catalytic system showed better catalytic performance after support calcination at 380 °C. Co nanoparticles appeared well distributed along the mesopore channels of TiO2. After reduction pretreatment and reaction, a drastic structural change leads to mesopore structure collapse and the dispersion of the Co nanoparticles on the external surface. Along this complex process, Co species first form discrete nanoparticles inside the pore and then diffuse out as the pore collapses. Through this confinement, a strong metal-support interaction effect is hindered, and highly stable metal active sites lead to better performance for Fischer-Tropsch synthesis reaction toward C5+ products.
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Antecedentes: El granuloma de cèlulas plasmáticas (GCP) es una patología poco común que se caracteriza por una lesión roja e hiperplasia que presenta una gran afinidad a cualquier tejido blando con mayor frecuencia a nivel pulmonar y de manera poco usual a nivel oral como los labios, lengua y encía como un caso muy singular, histológicamente se caracteriza por un gran número de cèlulas plasmáticas. Objetivo: Reportar un caso poco común de GCP en encía con el abordaje, complicaciones y èxito del tratamiento del mismo. Descripción del caso: paciente femenino de 60 años de edad, acude a consulta por una lesión roja nivel de la encía marginal y adherida del maxilar superior. Al examen intraoral se observa una hiperplasia localizada Con diagnostico presuntivo de granuloma de cèlulas plasmáticas, donde se le realizaron exámenes radiográficos, posteriormente una biopsia, confirmando dicho diagnóstico. Conclusión: GCP se caracteriza clínicamente por presentar una hipertrofia gingival en la encía adherida, una de los lugares menos frecuentes a nivel oral. Esta patología al presentar ciertas similitudes clínica e histológicamente es muy difícil realizar un correcto diagnóstico de dicha patología (AU)
Background: Plasma cell granuloma (PCG) is an uncommon pathology characterized by a red lesion and hyperplasia that has a high affinity to any soft tissue, more frequently at the lung level and in an unusual way at the oral level such as lips, tongue and gingiva as a very unique case, histologically characterized by a large number of plasma cells. Objective: To report a rare case of GCP in the gingiva with the approach, complications and success of its treatment. Description of the case: a 60-year-old female patient comes to the clinic for a red lesion at the level of the marginal and attached gingiva of the upper jaw. Intraoral examination revealed localized hyperplasia with a presumptive diagnosis of plasma cell granuloma, where radiographic examinations were performed, followed by a biopsy, confirming said diagnosis. Conclusion: GCP is clinically characterized by presenting gingival hypertrophy in the attached gingiva, one of the least frequent places at the oral level. This pathology, as it presents certain clinical and histological similarities, is very difficult to make a correct diagnosis of said pathology. (AU)
Subject(s)
Humans , Female , Middle Aged , Granuloma, Plasma Cell/complications , Granuloma, Plasma Cell/diagnosis , Granuloma, Plasma Cell/drug therapy , Inflammation , Gingiva/injuriesABSTRACT
Introducción: La utilización de tornillos cementados en la fijación interna de fracturas de húmero proximal con placas bloqueadas parece mejorar la estabilidad del implante y disminuir las complicaciones asociadas al fracaso de síntesis. Sin embargo, la combinación óptima de tornillos cementados se desconoce. El objetivo de este estudio fue analizar la estabilidad relativa de dos configuraciones de tornillos cementados sometidos a una fuerza de compresión axial en una fractura simulada de húmero proximal. Material y métodos: Se realizó una osteotomía del cuello quirúrgico en cinco pares de húmeros embalsamados con una edad media de 74 años (rango 46-93), fijados con una placa de acero inoxidable con tornillos bloqueados. En cada par de húmeros, en el húmero derecho se cementaron los tornillos A y E, y en el lado contralateral se cementaron los tornillos B y D. Cada espécimen fue testado inicialmente mediante una carga cíclica de compresión axial durante 6.000 ciclos para evaluar el movimiento interfragmentario (estudio dinámico). Al final de la prueba, los especímenes se sometieron a una carga de compresión axial progresiva para medir la rigidez de la construcción (estudio estático). Resultados: No se encontraron diferencias estadísticamente significativas en la movilidad interfragmentaria entre las dos configuraciones de tornillos cementados en el estudio dinámico (p=0,463). Cuando se sometieron a rotura, los especímenes con tornillos cementados en las hileras B y D presentaron una carga de rotura mayor (2218N vs. 2105, p=0,901) y una mayor rigidez (125N/mm vs. 106N/mm, p=0,672); sin embargo, ninguna de estas diferencias fue estadísticamente significativa. Conclusiones: La configuración de los tornillos cementados utilizadas en este estudio no influyen en la estabilidad del implante cuando se aplica una carga cíclica de baja energía. La cementación de los tornillos de las hileras B y D proporciona una resistencia similar a la cementación de los tornillos...(AU)
Introduction: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. Material and methods: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 4693 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6,000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). Results: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. Conclusions: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.(AU)
Subject(s)
Humans , Male , Female , Aged , 28574 , Bone Screws , Humeral Fractures/diagnostic imaging , Humeral Fractures/surgery , Prosthesis Implantation , Osteotomy , General Surgery , Traumatology , OrthopedicsABSTRACT
Introducción: La utilización de tornillos cementados en la fijación interna de fracturas de húmero proximal con placas bloqueadas parece mejorar la estabilidad del implante y disminuir las complicaciones asociadas al fracaso de síntesis. Sin embargo, la combinación óptima de tornillos cementados se desconoce. El objetivo de este estudio fue analizar la estabilidad relativa de dos configuraciones de tornillos cementados sometidos a una fuerza de compresión axial en una fractura simulada de húmero proximal. Material y métodos: Se realizó una osteotomía del cuello quirúrgico en cinco pares de húmeros embalsamados con una edad media de 74 años (rango 46-93), fijados con una placa de acero inoxidable con tornillos bloqueados. En cada par de húmeros, en el húmero derecho se cementaron los tornillos A y E, y en el lado contralateral se cementaron los tornillos B y D. Cada espécimen fue testado inicialmente mediante una carga cíclica de compresión axial durante 6.000 ciclos para evaluar el movimiento interfragmentario (estudio dinámico). Al final de la prueba, los especímenes se sometieron a una carga de compresión axial progresiva para medir la rigidez de la construcción (estudio estático). Resultados: No se encontraron diferencias estadísticamente significativas en la movilidad interfragmentaria entre las dos configuraciones de tornillos cementados en el estudio dinámico (p=0,463). Cuando se sometieron a rotura, los especímenes con tornillos cementados en las hileras B y D presentaron una carga de rotura mayor (2218N vs. 2105, p=0,901) y una mayor rigidez (125N/mm vs. 106N/mm, p=0,672); sin embargo, ninguna de estas diferencias fue estadísticamente significativa. Conclusiones: La configuración de los tornillos cementados utilizadas en este estudio no influyen en la estabilidad del implante cuando se aplica una carga cíclica de baja energía. La cementación de los tornillos de las hileras B y D proporciona una resistencia similar a la cementación de los tornillos...(AU)
Introduction: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. Material and methods: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 4693 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6,000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). Results: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. Conclusions: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.(AU)
Subject(s)
Humans , Male , Female , Aged , 28574 , Bone Screws , Humeral Fractures/diagnostic imaging , Humeral Fractures/surgery , Prosthesis Implantation , Osteotomy , General Surgery , Traumatology , OrthopedicsABSTRACT
OBJECTIVE: To compare the perioperative results of single-port laparoscopic cholecystectomy (SPLC) with those of laparoscopic cholecystectomy (LC), and to analyze whether there were any differences between both techniques in our patients. MATERIALS AND METHODS: A retrospective, observational analysis was carried out in non-homogeneous groups of patients under 15 years of age undergoing LC and SPLC over a 6-year period. LC was conducted using four ports, while SPLC was performed through an umbilical incision using a wound retractor to which a surgical glove was coupled for the insertion of 3 ports and instruments curved as required. 15 clinical, surgical, and economic variables were compared by means of a univariate and bivariate analysis. RESULTS: 11 patients underwent surgery - 5 through SPLC and 6 through LC. No significant differences were found in terms of mean operating time (SPLC: 144 minutes vs. LC: 139, P= 0.855) or hospital stay, but a slight increase in hospital cost was noted (SPLC: 1,160 vs. LC: 1,177 ). The cost of LC was 1,322 vs. 1,367 for SPLC, with a premium of 44.30 owing to the use of the wound retractor. None of the patients had perioperative complications, and all of them felt the cosmetic result was excellent. CONCLUSIONS: In our limited experience, the differences between SPLC and LC do not clearly support one or the other. SPLC could provide patients with a better cosmetic result and allow surgeons to improve their skills. However, we believe cholecystectomy is not the most adequate procedure to start a career in single-port laparoscopy because potential complications may be severe.
OBJETIVO: Comparar los resultados perioperatorios de la colecistectomía laparoscópica por puerto único (CLPU) respecto a la colecistectomía laparoscópica (CL) y analizar si, en nuestra casuistica, existen diferencias entre estas tecnicas. MATERIAL Y METODO: Análisis retrospectivo y observacional en grupos no homogeneos de pacientes menores de 15 años sometidos a CL y CLPU durante un periodo de 6 años. La CL se realizó con cuatro puertos y la CLPU mediante una incisión umbilical y colocación de un retractor de heridas al que se acopló un guante quirúrgico, a través del cual se insertaron 3 trócares para el instrumental convenientemente curvado. Se compararon 15 variables clínicas, quirúrgicas y económicas mediante análisis univariado y bivariado. RESULTADOS: Fueron intervenidos 11 pacientes, cinco mediante CLPU y 6 por CL. No hubo diferencias significativas en el tiempo operatorio medio (CLPU: 144 minutos vs. CL: 139, P= 0,855) ni en estancia hospitalaria, aunque sí un ligero aumento del coste hospitalario (CLPU:1.160 , CL:1.177 ). El coste de la CL fue de 1.322 frente a 1.367 de la CLPU, con un sobreprecio de +44,30 debido al uso del retractor de heridas. Ningún paciente presentó complicaciones perioperatorias y todos percibían un resultado cosmético excelente. CONCLUSIONES: Las diferencias entre CLPU y CL, en nuestra reducida experiencia, no justifican decidirse claramente por una u otra técnica. La CLPU podría aportar al paciente un mejor resultado cosmético y al cirujano una mejora de sus habilidades, aunque creemos que la colecistectomía no es la intervención adecuada para iniciarse en laparoscopia por puerto único debido a la gravedad de las posibles complicaciones.
Subject(s)
Cholecystectomy, Laparoscopic , Laparoscopy , Surgeons , Humans , Child , Retrospective Studies , Cholecystectomy, Laparoscopic/methods , Operative Time , Treatment OutcomeABSTRACT
Introducción: Se denomina síndrome de Terson (ST) a cualquier tipo de hemorragia intraocular (HIO), identificada en pacientes con patología aguda intracraneal. El ST parece estar relacionado con la gravedad clínica en la hemorragia subaracnoidea (HSA), pero en pacientes con trauma craneoencefálico (TCE) y hemorragia intracerebral (HIC), su asociación está por definir. Diseñamos este estudio para evaluar el rendimiento de la ecografía ocular (EO) y su utilidad en la práctica clínica.Materiales y métodosRealizamos un estudio observacional prospectivo, unicéntrico en pacientes neurocríticos. Analizamos los casos con respecto a los controles, identificados con oftalmoscopia indirecta (OI), y por EO. Determinamos las características diagnósticas de la EO. Hicimos un análisis multivariante para determinar asociaciones clínicamente relevantes.ResultadosSe incluyeron 91 pacientes con diagnósticos de HIC (41,76%), HSA (29,67%) y TCE (28,57%). El ST fue identificado por EO en ocho pacientes (8,79%) y en 24 pacientes (24,37%) por OI. La mortalidad ajustada para los pacientes con ST tuvo una OR 4,15 con IC 95% (1,52 - 11,33). Todos los pacientes con ST identificados por EO presentaron una escala de coma de Glasgow < 9 y tuvieron un riesgo elevado de precisar craniectomía descompresiva, una OR 9,84 (1,64 - 59). La EO alcanzó una sensibilidad global de 30,43%, una especificidad del 98,53%, con una precisión diagnóstica de 81,32. Para la detección de la hemorragia vítrea, una sensibilidad y especificidad del 87,5 y 98,5%, respectivamente.ConclusionesEl ST diagnosticado por EO discrimina pacientes neurocríticos de extrema gravedad que pueden requerir el máximo escalón terapéutico y es un factor independiente de mortalidad intrahospitalaria. (AU)
Introduction: Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice.Material and methodsWe performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations.ResultsThe sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively.ConclusionsOU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality. (AU)
Subject(s)
Humans , Brain Injuries, Traumatic , Subarachnoid Hemorrhage , Cerebral Hemorrhage , Eye Hemorrhage , UltrasonographyABSTRACT
Objetivo: Comparar los resultados perioperatorios de la colecistectomía laparoscópica por puerto único (CLPU) respecto a la colecistectomía laparoscópica (CL) y analizar si, en nuestra casuistica, existendiferencias entre estas tecnicas. Material y métodos: Análisis retrospectivo y observacional engrupos no homogeneos de pacientes menores de 15 años sometidos aCL y CLPU durante un periodo de 6 años. La CL se realizó con cuatropuertos y la CLPU mediante una incisión umbilical y colocación deun retractor de heridas al que se acopló un guante quirúrgico, a travésdel cual se insertaron 3 trócares para el instrumental convenientementecurvado. Se compararon 15 variables clínicas, quirúrgicas y económicasmediante análisis univariado y bivariado. Resultados: Fueron intervenidos 11 pacientes, cinco medianteCLPU y 6 por CL. No hubo diferencias significativas en el tiempooperatorio medio (CLPU: 144 minutos vs. CL: 139, P= 0,855) ni enestancia hospitalaria, aunque sí un ligero aumento del coste hospitalario(CLPU:1.160 , CL:1.177 ). El coste de la CL fue de 1.322 frentea 1.367 de la CLPU, con un sobreprecio de +44,30 debido al uso delretractor de heridas. Ningún paciente presentó complicaciones perioperatorias y todos percibían un resultado cosmético excelente. Conclusiones: Las diferencias entre CLPU y CL, en nuestra reduci-da experiencia, no justifican decidirse claramente por una u otra técnica.La CLPU podría aportar al paciente un mejor resultado cosmético y alcirujano una mejora de sus habilidades, aunque creemos que la colecistectomía no es la intervención adecuada para iniciarse en laparoscopiapor puerto único debido a la gravedad de las posibles complicaciones.(AU)
Objective: To compare the perioperative results of single-portlaparoscopic cholecystectomy (SPLC) with those of laparoscopic cholecystectomy (LC), and to analyze whether there were any differencesbetween both techniques in our patients. Materials and methods: A retrospective, observational analysis wascarried out in non-homogeneous groups of patients under 15 years ofage undergoing LC and SPLC over a 6-year period. LC was conductedusing four ports, while SPLC was performed through an umbilical incision using a wound retractor to which a surgical glove was coupled forthe insertion of 3 ports and instruments curved as required. 15 clinical,surgical, and economic variables were compared by means of a univariate and bivariate analysis. Results: 11 patients underwent surgery 5 through SPLC and 6through LC. No significant differences were found in terms of meanoperating time (SPLC: 144 minutes vs. LC: 139, P= 0.855) or hospitalstay, but a slight increase in hospital cost was noted (SPLC: 1,160 vs.LC: 1,177 ). The cost of LC was 1,322 vs. 1,367 for SPLC, witha premium of 44.30 owing to the use of the wound retractor. Noneof the patients had perioperative complications, and all of them felt thecosmetic result was excellent. Conclusions: In our limited experience, the differences betweenSPLC and LC do not clearly support one or the other. SPLC couldprovide patients with a better cosmetic result and allow surgeons toimprove their skills. However, we believe cholecystectomy is not themost adequate procedure to start a career in single-port laparoscopybecause potential complications may be severe.(AU)
Subject(s)
Humans , Male , Female , Adolescent , Cholecystectomy , General Surgery , Perioperative Period , Cholecystectomy, Laparoscopic , Umbilicus/surgery , Pediatrics , Retrospective StudiesABSTRACT
INTRODUCTION: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. MATERIAL AND METHODS: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46-93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). RESULTS: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. CONCLUSIONS: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.
ABSTRACT
INTRODUCTION: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. MATERIAL AND METHODS: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46-93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6,000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). RESULTS: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. CONCLUSIONS: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.