SUPERhip Reconstruction Treatment in Patients with Congenital Femoral Deficiency of Paley's Classification Type 1b.

BACKGROUND: Congenital femoral deficiency (CFD) is a challenging and complex condition that causes limb lengthening. We focused on the clinical and radiographic results of SUPERhip procedures in patients with congenital femoral deficiency type 1b, according to Paley's classification, prior to femoral lengthening. METHODS: We reviewed all records and radiographs of patients who underwent this procedure between 2005 and 2020. We included 26 patients, with clinical and radiographic assessments performed during pre- and post-operative evaluations. RESULTS: There were twenty-six patients (15 right vs. 11 left), with a mean age of 7 years (1-18). Most of the patients were female (17 patients; 65.4%). Twenty (76.9%) patients were undergoing their first procedure and six (23.1%) had already undergone a previous surgery. There was a significant improvement in all radiographic parameters, with the mean preoperative and postoperative Neck-Shaft Angle (NSA) being 72.3 ± 7.1° vs. 133.1 ± 12.7°, the Center-Edge Angle (CEA) 16.8 ± 9.8° vs. 33.5 ± 14.1°, and the Acetabular Index (AI) 27.8 ± 6.9° vs. 16.4 ± 6.8°, respectively. The complication rate was 15.4%, predominantly affecting patients under 5 years old. CONCLUSIONS: The SUPERhip procedure is an effective and reproducible technique for clinical and radiographic correction to a significant degree in patients with Paley's type 1b CFD, in preparation for bone lengthening surgery.

Catching a resurgence: Increase in SARS-CoV-2 viral RNA identified in wastewater 48 hours before COVID-19 clinical tests and 96 hours before hospitalizations

Curtailing the Spring 2020 COVID-19 surge required sweeping and stringent interventions by governments across the world. Wastewater-based COVID-19 epidemiology programs have been initiated in many countries to provide public health agencies with a complementary disease tracking metric and facile surveillance tool. However, their efficacy in prospectively capturing resurgence following a period of low prevalence is unclear. In this study, the SARS-CoV-2 viral signal was measured in primary clarified sludge harvested every two days at the City of Ottawas water resource recovery facility during the summer of 2020, when clinical testing recorded daily percent positivity below 1%. In late July, increases of >400% in normalized SARS-CoV-2 RNA signal in wastewater were identified 48 hours prior to reported >300% increases in positive cases that were retrospectively attributed to community-acquired infections. During this resurgence period, SARS-CoV-2 RNA signal in wastewater preceded the reported >160% increase in community hospitalizations by approximately 96 hours. This study supports wastewater-based COVID-19 surveillance of populations in augmenting the efficacy of diagnostic testing, which can suffer from sampling biases or timely reporting as in the case of hospitalization census.

Cognitive and Functional Decline among Individuals 50 Years of Age or Older in Cambé, Paraná, Brazil: A Population-Based Study.

AIMS: To identify the frequency of cognitive and functional decline (CFD) among adults 50 years of age and older by a population-based study. METHODS: Cognitive function was analyzed by the Mini-Mental State Examination, and the functional conditions were based on instrumental activities of daily living (IADL). Cases of CFD included individuals with cognitive decline and 2 or more compromised IADL. RESULTS: A total of 693 individuals were studied. The frequency of CFD was 16.3%. A low socioeconomic profile was associated with greater CFD independent of gender, age, education, and presence of depression (OR = 2.46; 95% CI: 1.53-3.97). CONCLUSIONS: These data show a high frequency of CFD among adults 50 years and older. Individuals with less education and a lower socioeconomic level exhibited poorer cognitive and functional conditions.

Calidad de la certificación de la causa básica de la muerte / The cuality of the certificate of basic cause of death

Con el propósito de determinar la calidad de la certificación de la causa básica de la muerte y su relación con: el médico firmante, mecanismo de la muerte, práctica de autopsia y sitio de ocurrencia, se diseñó un estudio explicativo de corte transversal, para lo cual se seleccionó la muestra de 967 certificados de defución que fueron escogidos aleatoriamente. Los resultados encontrados muestran: Cuarenta y seis por ciento (46 por ciento) de los diagnósticos certificados fueron codificados en las categorías residuales de la CIE-9;50 por ciento de las defunciones extra hospitalarias correspondieron a los códigos antes mencionados. Se observó una diferencia estadísticamente significativa (p=0,001) de la especialidad diagnóstica por Distritos Sanitarios. En 86,5 por ciento de los certificados que se les aplicaron reglas, la causa básica fue seleccionada aplicando el principio o regla general. En las defunciones ocurridas en los servicios de salud, se observó una diferencia estadísticamente significativa (p=0.0003) de la especificidad diagnóstica y el mecanismo de la muerte. Con respecto al médico firmante más de la mitad de los certificados firmados por médicos no tratantes tenían diagnósticos discordantes con los asentados en las historias. No se observaron diferencias estadísticamente significativas en cuanto a la especificidad diagnóstica. Se sub-registraron dos defunciones maternas. Se espera que este estudio sirva de base para futuras investigaciones, que pongan en evidencia la baja calidad de la certificación de la causa básica y que sirva de fundamento para la puesta en marcha de los correctivos necesarios por parte de las autoridades sanitarias