[Stress hip fractures in men in military training]. / Fracturas de cadera por estrés en hombres en entrenamiento militar.

INTRODUCTION: Stress fractures are common injuries in the military population, they begin with the imposition of repetitive and excessive effort on the bone. This leads to the acceleration of bone remodeling and production of microfractures. The incidence, during their basic combat training, is 0.8 to 5.1% for men compared to 1.1 to 18% among women. We present a series of hip stress fractures in young male military men with progressive training of 8 hours a day over a period of 14 weeks. RESULTS: Mean age 19.72 years, 4 transcervical and 7 basicervical fractures, 6 displaced and 5 no, 54.5 % right. All treated with osteosynthesis, DHHS (blockable compression plate system with hip spiral blade) in 3, cannulated screws in 3 and the proximal femoral fixation system with trochanteric nail (TFN) in five patients. The only common factor in all of them was intensive military training, pathology of metabolic or endocrine origin was ruled out. Onset of symptomatology measured in weeks with an average of 5. All patients had a delay in diagnosis with an average of 12.09 days at the time of definitive diagnosis. CONCLUSION: The diagnosis in stress fractures should be made based on clinical suspicion since the pain is insidious and in the report of the current condition patients fail to identify an exact moment as the onset of injury. The functional results were good and all of them managed to finish their military training.

INTRODUCCIÓN: Las fracturas por estrés son lesiones comunes en la población militar, inician con la imposición de esfuerzo repetitivo y excesivo al hueso. Esto conduce a la aceleración de la remodelación del hueso, la producción de microfracturas. La incidencia durante su entrenamiento básico de combate es de 0.8 a 5.1% para hombres comparado contra 1.1 a 18% entre mujeres. Presentamos una serie de fracturas por estrés de cadera en jóvenes militares masculinos con entrenamiento progresivo de ocho horas al día durante un período de 14 semanas. RESULTADOS: Media de edad 19.72 años, cuatro fracturas transcervicales y siete basicervicales, seis desplazadas y cinco no, 54.5% derechas. Todos tratados con osteosíntesis, sistema de placa de compresión bloqueable con hoja espiral de cadera (DHHS) en tres, tornillos canulados en tres y el sistema de fijación femoral proximal con clavo trocantérico (TFN) en cinco pacientes. El único factor común en todos ellos fue el entrenamiento militar intensivo, se descartó patología de origen metabólico o endocrino. Inicio de la sintomatología medido en semanas con una media de 5. Todos los pacientes presentaron un retraso del diagnóstico con una media de 12.09 días en el momento del diagnóstico definitivo. CONCLUSIÓN: El diagnóstico en las fracturas por estrés debe realizarse con base en la sospecha clínica, ya que el dolor es insidioso y en el relato del padecimiento actual los pacientes no logran identificar un momento exacto como inicio de lesión. Los resultados funcionales fueron buenos y todos ellos lograron terminar su entrenamiento militar.

Fracturas de cadera por estrés en hombres en entrenamiento militar / Stress hip fractures in men in military training

Resumen: Introducción: Las fracturas por estrés son lesiones comunes en la población militar, inician con la imposición de esfuerzo repetitivo y excesivo al hueso. Esto conduce a la aceleración de la remodelación del hueso, la producción de microfracturas. La incidencia durante su entrenamiento básico de combate es de 0.8 a 5.1% para hombres comparado contra 1.1 a 18% entre mujeres. Presentamos una serie de fracturas por estrés de cadera en jóvenes militares masculinos con entrenamiento progresivo de ocho horas al día durante un período de 14 semanas. Resultados: Media de edad 19.72 años, cuatro fracturas transcervicales y siete basicervicales, seis desplazadas y cinco no, 54.5% derechas. Todos tratados con osteosíntesis, sistema de placa de compresión bloqueable con hoja espiral de cadera (DHHS) en tres, tornillos canulados en tres y el sistema de fijación femoral proximal con clavo trocantérico (TFN) en cinco pacientes. El único factor común en todos ellos fue el entrenamiento militar intensivo, se descartó patología de origen metabólico o endocrino. Inicio de la sintomatología medido en semanas con una media de 5. Todos los pacientes presentaron un retraso del diagnóstico con una media de 12.09 días en el momento del diagnóstico definitivo. Conclusión: El diagnóstico en las fracturas por estrés debe realizarse con base en la sospecha clínica, ya que el dolor es insidioso y en el relato del padecimiento actual los pacientes no logran identificar un momento exacto como inicio de lesión. Los resultados funcionales fueron buenos y todos ellos lograron terminar su entrenamiento militar.

Abstract: Introduction: Stress fractures are common injuries in the military population, they begin with the imposition of repetitive and excessive effort on the bone. This leads to the acceleration of bone remodeling and production of microfractures. The incidence, during their basic combat training, is 0.8 to 5.1% for men compared to 1.1 to 18% among women. We present a series of hip stress fractures in young male military men with progressive training of 8 hours a day over a period of 14 weeks. Results: Mean age 19.72 years, 4 transcervical and 7 basicervical fractures, 6 displaced and 5 no, 54.5 % right. All treated with osteosynthesis, DHHS (blockable compression plate system with hip spiral blade) in 3, cannulated screws in 3 and the proximal femoral fixation system with trochanteric nail (TFN) in five patients. The only common factor in all of them was intensive military training, pathology of metabolic or endocrine origin was ruled out. Onset of symptomatology measured in weeks with an average of 5. All patients had a delay in diagnosis with an average of 12.09 days at the time of definitive diagnosis. Conclusion: The diagnosis in stress fractures should be made based on clinical suspicion since the pain is insidious and in the report of the current condition patients fail to identify an exact moment as the onset of injury. The functional results were good and all of them managed to finish their military training.

Development of a clinical risk score to diagnose concurrent bacterial infections in children with dengue

Background@#The clinical course of dengue can be adversely affected by bacterial coinfection. Because of this, clinical manifestations may be severe and may lead to morbidity and mortality. Little is known about this dual infection in the pediatric population. @*Objectives@#This study was conducted to evaluate the clinical characteristics and risk factors of patients with dengue infection and coinfection and subsequently develop a scoring system to diagnose bacterial coinfection in patients with dengue.@*Methods@#A prospective cross-sectional observational study was conducted among hospitalized pediatric patients with confirmed dengue infection between January 2019 to August 2019. Baseline characteristics, risk factors, clinical parameters, laboratory findings, management and outcomes were recorded. Cases with concurrent bacterial infections were further analyzed. A scoring system was created which assigned 1 point each for the following risk factors -age ≤9 years, fever >5 days, dengue severe, and 2 points for CRP >12 mg/l) @*Results@#A total of 154 pediatric dengue patients were enrolled with a mean age of 8.54 ± 4.15 years, and 99 patients (64%) had bacterial coinfection. Patients with coinfection were A total of 154 pediatric dengue patients were enrolled with a mean age of 8.54 ± 4.15 years, and 99 patients (%) had bacterial co-infection. Patients with coinfection were younger, have prolonged fever (>5 days), and were more frequently observed to have hypotension, tachycardia, desaturations and bleeding. Patients with coinfection also had higher white blood cell counts (>8 x109 cells/L), higher neutrophil counts (58.80 ± 18.42 % count), and elevated CRP (>12 mg/l) and procalcitonin (>4.01 ng/L). Utilizing the scoring system developed, a score of ≥3 had a sensitivity of 66.67% and specificity of 76.36%, in diagnosing concurrent bacterial infection in children with dengue. @*Conclusions@#Patients with dengue and bacterial coinfections were younger with comorbidities. They presented with significantly abnormal vital signs, physical examination findings, and elevated acute phase reactants. Using age ≤ 9 years, fever >5 days, dengue severe, and CRP >12mg/l, a scoring system was developed to diagnose bacterial coinfection in patients with dengue. A score of ≥3 can help diagnose patients with dengue and bacterial coinfection who will most likely need early empiric antimicrobial therapy.

Oncobiome at the Forefront of a Novel Molecular Mechanism to Understand the Microbiome and Cancer.

The microbiome comprises all the genetic material within a microbiota, that represents tenfold higher than that of our cells. The microbiota it includes a wide variety of microorganisms such as bacteria, viruses, protozoans, fungi, and archaea, and this ecosystem is personalized in any body space of every individual. Balanced microbial communities can positively contribute to training the immune system and maintaining immune homeostasis. Dysbiosis is a change in the normal microbiome composition that can initiate chronic inflammation, epithelial barrier breaches, and overgrowth of harmful bacteria. The next-generation sequencing methods have revolutionized the study of the microbiome. Bioinformatic tools to manage large volumes of new information, it became possible to assess species diversity and measure dynamic fluctuations in microbial communities. The burden of infections that are associated to human cancer is increasing but is underappreciated by the cancer research community. The rich content in microbes of normal and tumoral tissue reflect could be defining diverse physiological or pathological states. Genomic research has emerged a new focus on the interplay between the human microbiome and carcinogenesis and has been termed the 'oncobiome'. The interactions among the microbiota in all epithelium, induce changes in the host immune interactions and can be a cause of cancer. Microbes have been shown to have systemic effects on the host that influence the efficacy of anticancer drugs. Metagenomics allows to investigate the composition of microbial community. Metatranscriptome analysis applies RNA sequencing to microbial samples to determine which species are present. Cancer can be caused by changes in the microbiome. The roles of individual microbial species in cancer progression have been identified long ago for various tissue types. The identification of microbiomes of drug resistance in the treatment of cancer patients has been the subject of numerous microbiome studies. The complexity of cancer genetic alterations becomes irrelevant in certain cancers to explain the origin, the cause or the oncogenic maintenance by the oncogene addiction theory.

Enhanced ER proteostasis and temperature differentially impact the mutational tolerance of influenza hemagglutinin.

We systematically and quantitatively evaluate whether endoplasmic reticulum (ER) proteostasis factors impact the mutational tolerance of secretory pathway proteins. We focus on influenza hemaggluttinin (HA), a viral membrane protein that folds in the host's ER via a complex pathway. By integrating chemical methods to modulate ER proteostasis with deep mutational scanning to assess mutational tolerance, we discover that upregulation of ER proteostasis factors broadly enhances HA mutational tolerance across diverse structural elements. Remarkably, this proteostasis network-enhanced mutational tolerance occurs at the same sites where mutational tolerance is most reduced by propagation at fever-like temperature. These findings have important implications for influenza evolution, because influenza immune escape is contingent on HA possessing sufficient mutational tolerance to evade antibodies while maintaining the capacity to fold and function. More broadly, this work provides the first experimental evidence that ER proteostasis mechanisms define the mutational tolerance and, therefore, the evolution of secretory pathway proteins.

Feasibility and Safety of Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) for Malignant Biliary Obstruction Associated with Ascites: Results of a Pilot Study.

BACKGROUND: It has been suggested that EUS-BD may be a feasible and safer alternative to percutaneous transhepatic biliary drainage (PTBD) after failed ERCP in patients with ascites. To date, no study has specifically evaluated the performance of EUS-BD in this context. METHODS: Retrospective analysis was done for patients with and without ascites who underwent EUS-BD for malignant biliary obstruction after failed ERCP between July 2010 and September 2014. Complications and technical and clinical successes between the two groups were compared. RESULTS: A total of 31 patients were included: 20 patients without ascites (group 1) and 11 with ascites (group 2). Nineteen patients underwent EUS-hepaticogastrostomy (six in group 2), and 12 underwent EUS-choledochoduodenostomy (five in group 2). Technical success was achieved in all patients. Clinical success was observed in 95% (n = 19) in group 1 and 64% (n = 7) in group 2 (p = 0.042). In three out of four patients without clinical success in group 2, the follow-up period was not long enough to observe the clinical response because of early death within the 2 weeks after EUS-BD secondary to disease progression or preprocedural unresponsive sepsis. No significant differences were observed between groups 1 and 2 either in the overall rates of procedural-related complications (20 and 9%, respectively, p = 0.63) or in the rates of major complications (15 vs 9%, respectively, p = 0.639). Stent migration occurred in one patient in each group, intra- or post-procedural bleeding occurred in two patients in group 1, which was conservatively managed, and one patient in group 1 presented biliary leakage. Stent patency and the number of re-interventions were not significantly different. CONCLUSIONS: EUS-BD is technically feasible in patients with ascites. Our results suggest that EUS-BD may be a clinically effective and safe alternative after failed ERCP in patients with ascites.

Host proteostasis modulates influenza evolution.

Predicting and constraining RNA virus evolution require understanding the molecular factors that define the mutational landscape accessible to these pathogens. RNA viruses typically have high mutation rates, resulting in frequent production of protein variants with compromised biophysical properties. Their evolution is necessarily constrained by the consequent challenge to protein folding and function. We hypothesized that host proteostasis mechanisms may be significant determinants of the fitness of viral protein variants, serving as a critical force shaping viral evolution. Here, we test that hypothesis by propagating influenza in host cells displaying chemically-controlled, divergent proteostasis environments. We find that both the nature of selection on the influenza genome and the accessibility of specific mutational trajectories are significantly impacted by host proteostasis. These findings provide new insights into features of host-pathogen interactions that shape viral evolution, and into the potential design of host proteostasis-targeted antiviral therapeutics that are refractory to resistance.

Implementing nursing grand rounds in a community hospital.

PURPOSE: The purpose of this article is to describe the process of implementing Nursing Grand Rounds in a community hospital. METHODS: The Advanced Practice Council of clinical nurse specialists and nurse practitioners used Benner's theoretical framework of skill acquisition to guide the process. The development and implementation included the following: (1) conducting a convenient interest survey, (2) establishing targeted marketing strategies and a delivery format template for Nursing Grand Rounds, (3) mentoring clinical nurses, and (4) evaluation. CONCLUSION: Our institution has established Nursing Grand Rounds as a forum "For our Nurses, By our Nurses." The forum was held quarterly with survey feedback demonstrating increased awareness by clinical nurses and growing attendance. IMPLICATIONS: As a designate Magnet hospital, our Advanced Practice Council established a forum to promote and demonstrate excellence in nursing. The attributes of advanced practice nursing are the cornerstone to successful implementation of Nursing Grand Rounds. The involvement of clinical nurses across the 5 stages of proficiency in skill acquisition is a means to retain clinical experts and foster the development of nurses from novice to expert.

Encefalocele anterior en un embrión humano producto de un embarazo ectópico / Anterior encephalocele in a human embryo resulting from an extopic pregnancy

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Estudio morfométrico del riñón metanéfrico en embriones humanos

Se realizó un estudio descriptivo en una serie de nueve embriones de diferentes semanas del desarrollo embrionario. Se procesaron mediante técnicas histológicas y se les practicaron cortes en sentido cráneo-caudal. Se midieron utilizando técnicas morfométricas las áreas de riñón metanéfrico, el área total de órganos que ocupan el espacio retroperitoneal y el área total del espacio retroperitoneal. Se pudo precisar mediante el estudio que no existen diferencias significativas entre las estructuras del lado derecho y las del lado izquierdo, que existe una dinámica de cambio en las estructuras que forman el espacio retroperitoneal y que el proceso de formación y desarrollo del espacio retroperitoneal embrionario humano en la séptima semana presenta un momento crítico dado por el arribo del riñón metanéfrico a esta zona.

Estudio morfométrico de gónadas en embriones humanos

Se realizó un estudio descriptivo en una serie de nueve embriones de diferentes semanas del desarrollo embrionario. Se procesaron mediante técnicas histológicas y se les practicaron cortes en sentido cráneo-caudal. Se midieron, utilizando técnicas morfométricas, las áreas de gónadas, el área total de órganos que ocupan el espacio retroperitoneal y el área total del espacio retroperitoneal. Se pudo precisar mediante el estudio que no existen diferencias significativas entre las estructuras del lado derecho y las del lado izquierdo, que existe una dinámica de cambio en las estructuras que forman el espacio retroperitoneal y que el proceso de formación, y que el espacio retroperitoneal conforma una unidad desde el punto de vista morfométrico durante el período embrionario

Evolución morfométrica de algunos diámetros de la porción caudal del tubo neural humano durante el período embrionario / Morphometric evolution of some diameters of the caudal part of the human neural tube during the embryonic period

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Oral rehabilitation of a bulimic patient: a case report.

Bulimia nervosa is among the most common health problems in contemporary society. It is a self-induced weight loss syndrome associated with distinct dental manifestations involving physical and psychologic symptoms. It is characterized by recurrent binge-purge episodes that occur at least once a day. This article describes the complete-mouth rehabilitation of a bulimic patient with a generalized enamel erosion of her dentition and a poor esthetic appearance. Porcelain-fused-to-metal restorations were used as the definitive treatment. Good esthetics and high self-esteem were the final results. Comprehensive restorative therapy was applied in this clinical case report to achieve both function and esthetics in a demanding situation.

Morfometría de las paredes del tubo neural en embriones humanos de sexta y octava semana / Morphometry of the walls of the neural tube in human embryos 6 and 8 weeks old

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Hallazgo de anencefaliaen aborto temprano / Anencephaly found in an early miscarriage

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