Why and What Happens to Patients Younger Than 60 Years Who Need Revision Total Knee Arthroplasty?

BACKGROUND: With the increasing number of young patients undergoing primary total knee arthroplasty (TKA), there will be an increase in the number of patients who require revision. While the results of TKA in younger patients are well known, there is little information regarding to the outcomes of revision TKA in this population. The purpose of this study was to evaluate the clinical outcomes in patients <60 years of age undergoing aseptic revision TKA. METHODS: We retrospectively reviewed 433 patients undergoing aseptic revision TKA between 2008 and 2019. There were 189 patients <60 years compared to a group of 244 patients >60 years undergoing revision TKA for aseptic failures in terms of implant survivorships, complications, and clinical outcomes. Patients were followed for a mean of 48 months (range, 24 to 149). RESULTS: A total of 28 (14.8%) patients less than 60 years of age required repeat revision compared to 25 (10.2%) 60 years or older (odds ratio (OR) 1.94, 95% confidence interval (CI) 0.73-5.22, P = .187). There were no differences regarding postprocedural Patient-Reported Outcomes Measurement Information System (PROMIS) physical health scores (72.3 ± 13.7 versus 72.0 ± 12.0, P = .66) and PROMIS mental health scores (66.6 ± 17.4 versus 65.8. ± 14.7, P = .72), at an average of 32.9 and 30.7 months, respectively. Postoperative infection occurred in 3 (1.6%) patients <60 years of age, while 12 (4.9%) postoperative infections occurred in patients 60 years or older (OR 0.75, 95% CI 0.06-10.2, P = .83). CONCLUSION: There were no statistically significant differences in clinical outcomes between patients <60 versus > 60 years of age undergoing aseptic revision TKA.

Wound complications following revision total knee arthroplasty: Prevalence and outcomes.

BACKGROUND: Wound complications following revision TKA can be catastrophic and can compromise joint and even limb. The purpose of this study was to determine the prevalence of superficial wound complications requiring return to the OR in revision TKA, rates of subsequent deep infection, factors that increase the risk of superficial wound complications, and the outcomes of revision TKA following development of superficial wound complications. METHODS: We retrospectively reviewed 585 consecutive TKA revisions with at least two years follow-up, including 399 aseptic revisions and 186 reimplantations. Superficial wound complications without deep infection requiring return to the OR within 120 days were compared to controls. RESULTS: Fourteen patients following revision TKA (2.4%) required return to the OR for a wound complication, including 7 of 399 (1.8%) patients who underwent aseptic revision TKA and 7 of 186 (3.8%) patients undergoing reimplantation TKA (p = 0.139). Aseptic revisions with wound complications were more likely to develop subsequent deep infection (HR 10.04, CI 2.24-45.03, p = 0.003), but this did not hold true for reimplantations (HR 1.17, CI 0.28-4.91, p = 0.829). Risk factors for wound complication included atrial fibrillation when all patients were combined (RR 3.98, CI 1.15-13.72, p = 0.029), connective tissue disease in the aseptic revision group (RR 7.1, CI 1.1-44.7, p = 0.037), and a history of depression in the re-implantation group (RR 5.8, CI 1.1-31.5, p = 0.042).

Factors Associated with Early Sexual Activity in Adolescents Residing in an Urban Area of Northeastern Mexico Who Use WhatsApp or Facebook.

Early sexual activity has been associated with unplanned pregnancy and sexually transmitted infections. In recent decades, the prevalence of early sexual activity and social media use has increased. However, the relationship between these variables has been little studied. Consequently, we examined the relationships of some factors present in the family and personal environment with early sexual activity in adolescents who use and do not use the WhatsApp and Facebook platforms. Through a cross-sectional study, data from 1328 adolescents aged 13 to 19 years were analyzed. Data collection was carried out using a self-administered questionnaire. Of the total participants, 35.7% reported early sexual activity, and 37.7% reported using social networks such as WhatsApp and Facebook. The mean age of onset of sexual activity was 15.59 ± 1.56 years. Multivariate logistic regression analysis showed significant associations of not studying (adjusted OR 4.70; CI 95% 1.31-16.78), consuming alcohol (adjusted OR 3.71; CI 95% 2.44-5.65) and having parents who consumed alcoholic beverages in the home (adjusted OR 1.48; 95% CI 1.03-2.12) with ESA. In the family and personal environment, some factors favored early sexual activity in young people who used the WhatsApp and Facebook applications. This information should be used by authorities in the health and education sectors to strengthen preventive programs targeting health risk habits and behaviors in adolescents.

Neurological Involvement in Pediatric Patients with Acute Leukemia: A Retrospective Cohort.

Acute leukemia (AL) is an important cause of morbidity and mortality in children, and neurological manifestations (NM) are frequent. The objective of this study was to analyze neurological manifestations in children with acute leukemia from cases attended in the last five years at the Centro Médico Nacional "20 de Noviembre". METHODS: Conducting a retrospective and analytical study from 1 January 2015 to 31 December 2020 in children with AL classified according to sex, age range and AL type. Participants were grouped according the presence of NM. RESULTS: We analyzed 607 patients: 54.85% boys and 44.14% girls, with a mean age of 7.27 ± 4.54 years. When comparing groups, the NM group was significantly older (p = 0.01), and the highest prevalence was between 6 and 12 years old. ALL was predominant over the other lineages (p ≤ 0.01). The most frequent NM was CNS infiltration, seizures, headache and neuropathy. Death outcomes occurred in 18.7% of children with AML, 11.8% with ALL and 50% with MPAL (p ≤ 0.002). The NM group was associated with higher mortality during a follow-up time of 77.9 ± 49 months (44.4% vs. 8.9% deaths, NM vs. non-NM, respectively; OR = 3.3; 95% CI 2.4 to 4.6; p ≤ 0.0001). CONCLUSIONS: ALL was the most prevalent leukemia type. CNS infiltration, seizures, headache, neuropathy and PRES were the most frequent symptoms in the NM group. NM was associated with a higher mortality rate.

Local Trends in Total Joint Arthroplasty and Orthopaedic Surgeon Distribution in the United States.

INTRODUCTION: Total joint arthroplasty (TJA) volume and the number of orthopaedic surgeons in the United States have increased in recent years, but local growth variation has not been studied. This study assesses recent changes in state-level distribution of orthopaedic surgeons in the United States and corresponding local trends in TJA volume. METHODS: Data from the National Inpatient Sample database (2000 to 2014) were reviewed. Urban versus rural setting and teaching versus nonteaching hospitals were identified among TJA procedures for comparison. Data from the American Academy of Orthopaedic Surgeons (2002 to 2016) detailing orthopaedic surgeon practice location were evaluated, and linear regression analysis was used to correlate state population data with orthopaedic surgeon density. RESULTS: From 2000 to 2014, there was a 0.1% to 0.3% (P < 0.01) annual decrease in the proportion of TJA procedures conducted in rural hospitals. No notable change was observed in the proportion of TJA procedures conducted at urban teaching versus nonteaching hospitals. Linear regression analysis demonstrated that decreased state population was associated with higher orthopaedic surgeon density (adjusted R2 = 0.114, P < 0.01). States with a higher percentage of population living in rural areas had a lower density of orthopaedic surgeons in the South region and a higher density of orthopaedic surgeons in the remainder of the county. CONCLUSIONS: Less populated, rural states have a higher density of orthopaedic surgeons than states with increased population and less rural areas. Although TJA volume has increased since 2000, the proportion of TJA procedures conducted at rural hospitals has decreased. No change was found in the proportion of TJA procedures conducted at urban teaching versus nonteaching hospitals. This may indicate that more patients living in rural areas are seeking TJA care in urban centers. Future studies are needed to confirm this and ensure that patients living in rural areas have appropriate access to TJA care.

Neurological Manifestations in Pediatric Patients Hospitalized for COVID-19: Experiences of the National Medical Center "20 de Noviembre" in Mexico City.

COVID-19 has affected millions of children and, while it was previously considered as a respiratory disease, neurologic involvement has also been documented. The objective of this study was to identify the neurological manifestations (NMs) and the outcomes of children with COVID-19 who attended the National Medical Center "20 de Noviembre". METHODS: A retrospective cohort study of children hospitalized for COVID-19 from April 2020 to March 2021 was conducted. Clinical-demographic data were registered. Neurologic manifestations were defined as any clinical neurological expression of the central and/or peripheral nervous system that occurred during admission or hospitalization. RESULTS: In total, 46 children with a confirmed COVID-19 result, 26 (56.5%) boys and 20 (43.5%) girls with a median age of 8.9 ± 4.6 years, constituted the study population. Half of the children showed some NMs, and this group of patients concomitantly showed acute lymphoblastic leukemia (ALL, 56%), obesity (17.3%), or acute myeloblastic leukemia (AML, 4.3%). The most frequently described NMs were headache (13, 56%), encephalopathy (10, 43.47%), and epilepsy (4, 17.39%). The mortality rate in children with NMs was 21.7% and they had a higher mortality rate when compared to those without NM p ≤ 0.025. CONCLUSIONS: NMs occurred predominantly in male children aged 6 to 12 years; ALL was the most frequent comorbidity. Headache prevailed and hypoxemia, hypocalcemia, elevated ferritin, and C-reactive protein were associated with NM. Finally, NMs were a risk factor for mortality.

Profound Impact of Insurance Payor and Socioeconomic Status in Total Hip Arthroplasty Outcomes: Results From a High Volume Tertiary Care Center.

BACKGROUND: Dual eligible Medicare/Medicaid patients undergoing total hip arthroplasty (THA) have worse outcomes compared to other insurance payors. Prior literature fails to control for the heterogeneity of care provided amongst a large cohort of hospitals and surgeons as well as differences in patient populations treated. This study compares dual eligible THA patients and Medicaid and Medicare only THA patients at a single high volume tertiary center. METHODS: We retrospectively reviewed patients who underwent THA for aseptic osteoarthritis of the hip over a three-year period with either Medicaid or Medicare insurance. 3,329 THA patients were included, of which 439 were Medicaid payor, 182 were dual eligible, and 2,708 were Medicare payor. Groups were compared using appropriate tests for direct comparisons and regression analysis. RESULTS: Dual eligible patients were less likely to be white and married, and were more likely to be current smokers and have COPD, liver disease, renal disease, and human immunodeficiency virus (HIV) compared to Medicare patients. These patients also had a lower age-adjusted Charleson Comorbidity Index when compared to Medicare patients (2.4 vs 3.4, P < .001). When controlling for smoking status, age, BMI and major medical comorbidities, dual eligible and Medicaid patients had increased length of stay (LOS) (0.58, 0.66 days, P < .001), higher risk of discharge to subacute rehabilitation (RR 1.97, 3.19, P < .001), and dual eligible patients more often returned to the ED within 90 days (RR 2.74, P < .001) compared to Medicare patients. CONCLUSION: This study supports the implementation of socioeconomic risk stratification efforts to properly evaluate value-based healthcare metrics in total hip arthroplasty patients.

Does a 2-Stage Debridement Result in Higher Rates of Implant Retention Compared With Single Debridement Alone?

BACKGROUND/METHODS: We retrospectively reviewed 89 patients with acute prosthetic joint infection treated with debridement, antibiotics, and implant retention (DAIR) or 2-DAIR. Patients had <3 weeks of symptoms and met Musculoskeletal Infection Society criteria for infection. Sixty-three patients were treated with DAIR, whereas 26 patients were managed using a 2-DAIR protocol where patients underwent initial debridement, antibiotic bead placement, and subsequent return to the operating room at an average of 16.3 days for repeat debridement and modular component exchange. Patients received a 6-week course of intravenous antibiotics and 3 months of oral antibiotics for suppression. Demographics, comorbidities, implant retention rates, and complications were compared between the groups. The McPherson host type and infection type classification system were used to categorize patients in both the DAIR and 2-DAIR groups. Regression analysis was performed to control postoperative vs acute hematogenous infection, procedure, and comorbidities. The McPherson host types and infection types were not different between DAIR and 2-DAIR patients, P = .728 and P = .061, respectively. RESULTS: There was no difference in the overall implant retention rate between DAIR and 2-DAIR (63.49% vs 69.23%, P = .605). The average days to reinfection was significantly longer for the 2-DAIR cohort compared with DAIR (271.3 vs 165.3, P = .024) in patients who failed treatment. However, when controlling for infection, microorganism, index procedure, and comorbidities, there was no difference in days to reinfection (P = .679). There were no differences in complications, 90-day readmission, or revision rates between the groups. CONCLUSIONS: A staged debridement for acute prosthetic joint infection did not improve the rates of infection control. Randomized trials are needed to define indications and potential benefits of 2-DAIR.

Does Dual-Eligible Medicare/Medicaid Insurance Status as a Surrogate for Socioeconomic Status Compromise Total Knee Arthroplasty Outcomes?

BACKGROUND: Medicare/Medicaid dual-eligible patients who undergo primary total knee arthroplasty (TKA) demonstrate poor outcomes when compared to patients with other payers. We compare Medicare/Medicaid dual-eligible patients vs Medicare and Medicaid only patients at a single hospital center. METHODS: All patients who underwent TKA for aseptic arthritis between August 9, 2016 and December 30, 2020 with either Medicare or Medicaid insurance were retrospectively reviewed. 4599 consecutive TKA (3749 Medicare, 286 Medicare/Medicaid dual eligibility, and 564 Medicaid) were included. Groups were compared using appropriate tests for direct comparisons and regression analysis. RESULTS: Patients with dual eligibility and Medicaid insurance were less likely to be white and married, more likely to be female and current smokers, and more likely to have COPD, mild liver disease, diabetes mellitus, malignancy, and HIV/AIDS, but had a lower age-adjusted Charleson Comorbidity Index when compared to Medicare patients. When controlling for smoking status and medical comorbidities, patients with dual eligibility and Medicaid insurance stayed in the hospital 0.64 and 0.39 additional days (P < .001), respectively, were more likely to be discharged to subacute rehab (RR 2.01, 1.49, P < .001) and acute rehab (RR 2.22, 2.46, P = .007, < .001), and were 2.14 and 1.73 times more likely to return to the ED within 90 days (P < .001) compared to Medicare patients. CONCLUSION: Value-based healthcare may disincentivize treating patients with low socioeconomic status, represented by Medicaid and dual-eligible insurance status, by their association with increased postoperative healthcare utilization, and less risky patients may be prioritized.

[Compliance with post-cesarean section thromboprophylaxis recommendations. A cross sectional study in 233 women]. / Adherencia a las recomendaciones de tromboprofilaxis post-cesárea: estudio de corte transversal.

BACKGROUND: Cesarean section increases four times the risk of venous thromboembolism compared to vaginal delivery. The Royal College of Obstetricians and Gynecologists guidelines are used at our service. A written alert was designed to stratify patients at high, intermediate or low risk making a suggestion for thromboprophylaxis. AIM: To assess the compliance with the guidelines and to evaluate the impact of a written alert in the thromboprophylaxis compliance in women subjected to caesarean section. PATIENTS AND METHODS: Review of medical records of 233 women aged 19 to 32 years, subjected to a caesarean section in a Gynecology Service, between 2016-2017. RESULTS: Compliance with recommendations was observed in 29% of patients (68/233), 86% in the low-risk group, 26% in the intermediate risk group and 100% in the high risk group. In 41/233 (18%) of patients, a written alert was included in the medical record. Compliance with recommendations in the presence of the written alert was 61% (25/41 women) compared to 22% (43/192) in those lacking the alert (p < 0.01). In women whose emergency caesarean section was the only risk factor, the compliance with the recommendation was 8%, compared with 30% among those who had at least one thrombotic risk factor associated with caesarean section (p < 0.01). CONCLUSIONS: In this cross-sectional study, we observed a low compliance with thromboprophylaxis guidelines in cesarean women. We observed that the use of a written alert improved the compliance with thromboprophylaxis.

Genome-wide profiles of UV lesion susceptibility, repair, and mutagenic potential in melanoma.

Exposure to the ultraviolet (UV) radiation in sunlight creates DNA lesions, which if left unrepaired can induce mutations and contribute to skin cancer. The two most common UV-induced DNA lesions are the cis-syn cyclobutane pyrimidine dimers (CPDs) and pyrimidine (6-4) pyrimidone photoproducts (6-4PPs), both of which can initiate mutations. Interestingly, mutation frequency across the genomes of many cancers is heterogenous with significant increases in heterochromatin. Corresponding increases in UV lesion susceptibility and decreases in repair are observed in heterochromatin versus euchromatin. However, the individual contributions of CPDs and 6-4PPs to mutagenesis have not been systematically examined in specific genomic and epigenomic contexts. In this study, we compared genome-wide maps of 6-4PP and CPD lesion abundances in primary cells and conducted comprehensive analyses to determine the genetic and epigenetic features associated with susceptibility. Overall, we found a high degree of similarity between 6-4PP and CPD formation, with an enrichment of both in heterochromatin regions. However, when examining the relative levels of the two UV lesions, we found that bivalent and Polycomb-repressed chromatin states were uniquely more susceptible to 6-4PPs. Interestingly, when comparing UV susceptibility and repair with melanoma mutation frequency in these regions, disparate patterns were observed in that susceptibility was not always inversely associated with repair and mutation frequency. Functional enrichment analysis hint at mechanisms of negative selection for these regions that are essential for cell viability, immune function and induce cell death when mutated. Ultimately, these results reveal both the similarities and differences between UV-induced lesions that contribute to melanoma.

Depresión materna como mediadora en el desarrollo de sobrepeso y obesidad infantil: una revisión integrativa / Maternal depression as a mediator in the development of childhood overweight and obesity: an integrative review

Introducción: la depresión materna interfiere en la crianza y la alimentación de los hijos a través de conductas de alimentación infantil. Objetivo: examinar cómo la depresión materna predispone al desarrollo de sobrepeso y obesidad infantil. Metodología: revisión integrativa empleando la metodología de Whittemore y Knafl, y la declaración PRISMA, en PubMed y CONRICyT, utilizando los descriptores "depression", "depressive symptoms","mothers" y "childhood obesity", e incluyendo artículos con metodología cuantitativa publicados entre 2013 y 2020 cuyos indicadores fueran peso y conductas en la población infantil. Resultados: en 22 artículos se identificaron vías conductuales, como conductas maternas de alimentación, estilos de alimentación, prácticas de alimentación infantil, inseguridad alimentaria y recurrencia de la depresión. Conclusión: seis vías conductuales poco aptas para la alimentación y el desarrollo se identificaron como mediadoras entre la depresión y el aumento de peso infantil.

Introduction: Maternal depression interferes with raising and feeding children through infant feeding behaviors. Objective: To examine how maternal depression predisposes to the development of childhood overweight and obesity. Methods: An integrative review with the Whittemore & Knafl methodology and the PRISMA background in PubMed and CONRICyT, using descriptors "depression","depressive symptomatology","mothers" and "childhood obesity". Articles with a quantitative methodology, from 2013 to 2020, with analysis of weight or behavior indicators in the child population were included. Results: In 22 articles, behavioral pathways were identified, such as: maternal eating behaviors, feeding styles, feeding practices, food insecurity and recurrence of depression. Conclusions: Six behavioral pathways unsuitable for eating and development were identified as mediators between depression and infant weight gain.

Exposure to second-hand cigarette smoke exacerbates the progression of osteoarthritis in a surgical induced murine model.

Osteoarthritis (OA), formerly understood to be a result of passive wear, is now known to be associated with chronic inflammation. Cigarette smoking promotes systemic inflammation and has been implicated in increased joint OA incidence in some studies, though the recent observational data on the association are contradictory. We hypothesize that second-hand smoke (SHS) treatment will increase the incidence of OA in a mouse model that has been subjected to a surgical destabilization of the medial meniscus (DMM). To test this hypothesis, we applied either SHS treatment or room air (RA) to mice for 28 days post-DMM surgery. Histopathology findings indicated that the knees of SHS mice exhibited more severe OA than their control counterparts. Increased expression of matrix metalloprotease-13 (MMP-13), an important extracellular protease known to degrade articular cartilage, and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), an intracellular effector of inflammatory pathways, were observed in the SHS group. These findings provide greater understanding and evidence for a detrimental role of cigarette smoke on OA progression and systemic inflammation.

Efectos del ejercicio físico y el ayuno intermitente en la salud: una revisión sistemática / Effects of physical exercise and intermittent fasting for health: a Systematic review

OBJETIVOS: Esta investigación tuvo como objetivo revisar sistemáticamente la evidencia científica al respecto de los efectos que tiene en la salud el hecho de combinar ejercicio físico y ayuno intermitente, así como determinar si su impacto es mayor que cuando ambas actividades se realizan de forma separada. MATERIAL Y MÉTODO: Se llevó a cabo una búsqueda en MEDLINE a través de PubMed, Scopus, SportDiscus, Cochrane Library y CINAHL, mediante la combinación de las siguientes palabras clave "Intermittent Fasting", "Ramadan", "Time Restricted Feeding" y "Physical Exercise". La calidad metodológica fue determinada mediante la escala Physiotherapy Evidence Database (PEDro). RESULTADOS: De los 711 resultados obtenidos tras la primera búsqueda, cuatro ensayos clínicos aleatorizados (ECAs) fueron definitivamente incluidos en el estudio. La calidad metodológica de los ensayos analizados resultó ser "regular" en tres es-tudios y "buena" en uno de ellos. Los resultados obtenidos muestran que el ayuno combinado con ejercicio resulta ser más eficaz en la mejora de parámetros relacionados con la composición corporal, tales como el peso corporal, el índice de masa corporal (IMC), la circunferencia de cintura, la masa grasa y el porcentaje de masa grasa. También se observó una mejora en la glucosa, la resistencia a la insulina, el colesterol HDL y LDL, la presión arterial sistólica y diastólica, los triglicéridos y el consumo máximo de oxígeno. CONCLUSIONES: La combinación de ayuno intermitente con ejercicio físico tiene efectos beneficiosos en la salud cardiovascular y metabólica. Dicha estrategia parece ser un método efectivo para mejorar la salud de las personas a través de variables relacionadas con la composición corporal, así como con el nivel de glucosa, colesterol y triglicéridos

OBJECTIVES: This research aimed to systematically review the scientific evidence regarding the effects on health of combining exercise and fasting, as well as to determine if their impact is greater than when both activities are performed separately. MATERIAL AND METHOD: A search of following databases was performed: MEDLINE through PubMed, Scopus, SportDiscus, Cochrane Library and CINAHL, by combining the keywords "Intermittent Fasting", "Ramadan", "Time Restricted Feeding" and "Physical Exercise". The methodological quality was determined using the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Of the 711 results found in the first search, only four studies were definitely selected. The methodological quality of the analyzed trials turned out to be "fair" in three studies and "good" in one of them. The results obtained show that fasting combined with exercise turns out to be more effective in improving the body composition-related parameters, such as body weight, body mass index (BMI), waist circumference, fat mass and fat mass percentage. An improvement in glucose, insulin resistance, HDL and LDL cholesterol, systolic and diastolic blood pressure, triglycerides and maximal oxygen uptake were also observed. CONCLUSIONS: The combination of intermittent fasting with physical exercise is an effective and interesting strategy to improve cardiovascular and metabolic health. This strategy appears to be an effective method to improve people's health through variables related to body composition, as well as the level of glucose, cholesterol and triglycerides

Screening and Identification of Metacaspase Inhibitors: Evaluation of Inhibition Mechanism and Trypanocidal Activity.

A common strategy to identify new antiparasitic agents is the targeting of proteases, due to their essential contributions to parasite growth and development. Metacaspases (MCAs) are cysteine proteases present in fungi, protozoa, and plants. These enzymes, which are associated with crucial cellular events in trypanosomes, are absent in the human host, thus arising as attractive drug targets. To find new MCA inhibitors with trypanocidal activity, we adapted a continuous fluorescence enzymatic assay to a medium-throughput format and carried out screening of different compound collections, followed by the construction of dose-response curves for the most promising hits. We used MCA5 from Trypanosoma brucei (TbMCA5) as a model for the identification of inhibitors from the GlaxoSmithKline HAT and CHAGAS chemical boxes. We also assessed a third collection of nine compounds from the Maybridge database that had been identified by virtual screening as potential inhibitors of the cysteine peptidase falcipain-2 (clan CA) from Plasmodium falciparum Compound HTS01959 (from the Maybridge collection) was the most potent inhibitor, with a 50% inhibitory concentration (IC50) of 14.39 µM; it also inhibited other MCAs from T. brucei and Trypanosoma cruzi (TbMCA2, 4.14 µM; TbMCA3, 5.04 µM; TcMCA5, 151 µM). HTS01959 behaved as a reversible, slow-binding, and noncompetitive inhibitor of TbMCA2, with a mechanism of action that included redox components. Importantly, HTS01959 displayed trypanocidal activity against bloodstream forms of T. brucei and trypomastigote forms of T. cruzi, without cytotoxic effects on Vero cells. Thus, HTS01959 is a promising starting point to develop more specific and potent chemical structures to target MCAs.

In Kinematically Aligned Total Knee Arthroplasty, Failure to Recreate Native Tibial Alignment Is Associated With Early Revision.

BACKGROUND: The goal of kinematically aligned (KA) total knee arthroplasty (TKA) is to restore native knee anatomy. However, there are concerns about patellofemoral tracking problems with this technique that lead to early revision. We measured the differences between preoperative anatomic alignment and postoperative component alignment in a consecutive series of KA TKA and evaluated the association between alignment changes and the likelihood of early revision. METHODS: The charts of 219 patients who underwent 275 KA TKA procedures were reviewed. Preoperative anatomic alignment and postoperative tibial and femoral component alignment were measured radiographically. The difference in component alignment compared with preoperative anatomic alignment was compared between patients who underwent aseptic revision and those who did not at a minimum of 12 months of follow-up. Receiver operating characteristic curves were created for statistically significant variables, and the Youden index was used to determine optimal alignment thresholds with regard to likelihood of revision surgery. RESULTS: Change in tibial component alignment compared with native alignment was greater (P = .005) in the revision group (5.0° ± 3.7° of increased varus compared with preoperative anatomic tibial angle) than in the nonrevision group (1.3° ± 4.2° of increased varus). The Youden index indicated that increasing tibial varus by >2.2° or more is associated with increased likelihood of revision. Preoperative anatomic alignment and change in femoral alignment and overall joint alignment (ie, Q angle) were not associated with increased likelihood of revision. CONCLUSION: Small increases in tibial component varus compared with native alignment are associated with early aseptic revision in patients undergoing KA TKA.

Impact of gender and race on expectations and outcomes in total knee arthroplasty.

BACKGROUND: Total joint arthroplasty is one of the most common surgeries performed in the United States with total knee arthroplasty (TKA) being one of the most successful surgeries for restoring function and diminishing pain. Even with the demonstrated success of TKA and a higher prevalence of arthritis and arthritis related disability among minorities, racial and gender disparity remains a constant issue in providing care for the adult reconstruction patient. AIM: To assess the role of demographics and expectations on differences in perioperative patient reported outcomes (PRO) following TKA. METHODS: One hundred and thirty-three patients scheduled for primary unilateral TKA secondary to moderate to severe osteoarthritis were enrolled in this two-institution prospective study. Validated PRO questionnaires were collected at four time points. Statistical analysis was conducted to determine the impact of gender, ethnic background and expectation surveys responses to assess PRO at these time points. RESULTS: Females were associated with worse preoperative Knee Injury and Osteoarthritis Outcome Scores (KOOS) for symptoms, pain, and activities of daily living. African Americans were associated with worse KOOS for pain, activities of daily living, and quality of life. Despite worse preoperative scores, no difference was noted in these categories between the groups postoperatively. Additionally, all pre-operative psychometric scales were equivalent across groups except Geriatric Depression scale, which was significantly different between groups within the Race and Age Group (P < 0.05). Conversely, Pain Catastrophizing Scale, was significantly different for all subscales and total score within Age Group (P < 0.05), and the Magnification, Helplessness subscales as well as the Total score were significantly different between groups for Race and Relationship Status (P < 0.01). CONCLUSION: We conclude that female and African American patients have lower preoperative KOOS scores compared to white male patients. No postoperative differences in outcomes between these groups.

Sarkosyl: A milder detergent than SDS for identifying proteins with moderately high hyperstability using gel electrophoresis.

Sodium dodecyl sulfate (SDS) is a detergent used as a strong denaturant of proteins in gel electrophoresis. It has previously been shown that certain hyperstable, also known as kinetically stable, proteins are resistant to SDS and thus require heating for their denaturation in the presence of SDS. Because of its high denaturing strength, relatively few proteins are resistant to SDS thereby limiting the current use of SDS-PAGE for identifying hyperstable degradation-resistant proteins. In this study, we show that sarkosyl, a milder detergent than SDS, is able to identify proteins with moderately high kinetic stability that lack SDS-resistance. Our assay involves running and subsequently comparing boiled and unheated protein samples containing sarkosyl, instead of SDS, on PAGE gels and identifying subsequent differences in protein migration. Our results also show that sarkosyl and SDS may be combined in PAGE experiments at varying relative percentages to obtain semi-quantitative information about a protein's kinetic stability in a range inaccessible by probing through native- or SDS-PAGE. Using protein extracts from various legumes as model systems, we detected proteins with a range of protein stability from nearly SDS-resistant to barely sarkosyl resistant.

Cost to ambulatory care for schizophrenia in Family Medicine / Costo de la atención ambulatoria para esquizofrenia en Medicina Familiar

Background: The groups related to ambulatory care (GRAA, according to its initials in Spanish) are a classification of clinical diagnoses performed on patients receiving medical care in primary care; it is a comprehensive treatment for one year. Objective: To determine the costs of ambulatory care and sociodemographic characteristics of patients with schizophrenia attended in Family Medicine (FM). Material and methods: Cross-sectional study which included adult patients with complete electronic clinical record, who had confirmed diagnosis of schizophrenia and received medical attention in a FM unit from January to December 2017. The variables were: age, sex, sociodemographic data, drug addiction and employment status. To determine the annual cost of schizophrenia based on GRAA, the economic medical card was applied, which includes family medicine consultations, inter-consultations, medications, medical supplies, and the time of use of installed capacity for one year. Results: Out of all patients, 56.2% were men (n = 172). Age was 48.42 ± 14.4 years. Of women, 21.2% were married and 21.2% homemakers, 4.2% smokers, and 1.3% alcohol drinkers. Of men, 30.4% were unmarried, 15% unemployed, 13.1% smokers, and 6.9% alcohol drinkers. The total annual cost of schizophrenia for FGRAA-MH for men was $ 7 613 236.00. Conclusions: The use of FGRAA-MH revealed the total annual cost for the care of schizophrenia in the medical unit, which provides important information for better understanding the magnitude of this health problem in that area, and will improve planning and economic medical management.

Introducción: los grupos relacionados con la atención ambulatoria (GRAA) son una clasificación de diagnósticos clínicos que reciben los pacientes atendidos en consultorios de primer nivel; se trata de un tratamiento integral por un año. Objetivo: determinar los costos de atención ambulatoria y las características sociodemográficas de pacientes con esquizofrenia atendidos en Medicina Familiar (MF). Material y métodos: estudio transversal que incluyó pacientes adultos con expediente clínico electrónico completo y vigente, los cuales tuvieron diagnóstico de esquizofrenia y fueron atendidos en una unidad de MF de enero a diciembre de 2017. Las variables fueron: edad, sexo, datos sociodemográficos, toxicomanías y situación laboral. Para determinar el costo anual de la esquizofrenia con base en los GRAA se aplicó la cédula médico-económica, que incluye consultas de MF, interconsultas, medicamentos, insumos médicos y tiempos de uso de capacidad instalada durante un año. Resultados: 56.2% de los pacientes fueron hombres (n = 172). La edad fue 48.42 ± 14.4 años. De las mujeres, 21.2% eran casadas y 21.2% dedicadas al hogar; 4.2% fumaba y 1.3% consumía alcohol. De los hombres, 30.4% eran solteros, 15% desempleados, 13.1% fumadores y 6.9% consumían alcohol. El costo anual total de la esquizofrenia por FGRAA-SM para los hombres fue de $7 613 236.00. Conclusiones: el uso de los FGRAA-SM reveló el costo anual total para la atención de la esquizofrenia en la unidad médica, lo cual brinda información importante para conocer mejor la magnitud del problema de salud en la zona y permitirá mejorar la planeación y la gestión médico-económica.

Incidencia de los trastornos hipertensivos en el embarazo, y características clínico-demográficas en gestantes en tres instituciones en Bogotá, D. C., Colombia / Incidence of hypertensive disorders in pregnancy and clinical-demographic characteristics in pregnant women in three institutions in Bogotá, D. C., Colombia / Incidência de transtornos hipertensivos na gravidez e características clínico-demográficas em gestantes de três instituições em Bogotá, D. C., Colômbia

Objetivo: describir la incidencia de trastornos hipertensivos de las gestantes en 3 instituciones en Bogotá durante el periodo 2014-2016. Método: estudio observacional prospectivo, realizado entre 2014 y 2016 en 3 centros hospitalarios de la ciudad de Bogotá, D. C., Colombia. Fueron incluidas 252 gestantes, a quienes se les hizo seguimiento ecográfico trimestral, toma de variables clínicas y demográficas e indagación de resultados materno- perinatales en el momento del parto. Los datos fueron analizados a través del cálculo de medidas de tendencia central y dispersión para las variables cuantitativas, frecuencias y porcentajes para las variables cualitativas. Resultados: se encontró una incidencia de trastornos hipertensivos del 11,8 % en las gestantes incluidas en el estudio; de estos, el 62,1 % fueron preeclampsia, y el 37,9 %, hipertensión gestacional. La preeclampsia se presentó en el 7,4 % del total de la población estudiada; de dichas pacientes, el 50 % presentó preeclampsia severa. La incidencia de preeclampsia temprana fue del 17,2 %. Conclusión: la incidencia de los trastornos hipertensivos en gestantes en la población estudiada es mayor que en países desarrollados, y similar a lo descrito en la población colombiana

Objective: To describe the incidence of hypertensive disorders during pregnancy in three health institutions in Bogotá-Colombia during 2014-2016. Methods: This observational and prospective study were done in three institutions from 2014 to 2016 in Bogotá (Colombia). 252 patients were included. Fetal and maternal ultrasonography evaluations were done in each trimester of pregnancy, multiples demographic and clinical factors were evaluated, and maternal and perinatal outcomes were done at the delivery time. The data were analyzed using measures of central tendency and dispersion for the quantitative variables, and frequencies and percentages for qualitative variables. Results: The incidence of hypertensive disorders of pregnancy was 11.8 %, of these, pre-eclampsia was 62.1 % and 37.9 % of gestational hypertension. In relation to preeclampsia group, 7.4 % was presented when it was compared with the total of the study population, and form this 50 % of pregnant women were severe preeclampsia. The incidence of early pre-eclampsia was 17.2 %. Conclusion: The incidence of hypertensive disorders in pregnancy at the study population is higher than the prevalence reported in developed countries and similar than reported in Colombia

Objetivo: Descrever a incidência de hipertensivos de deficiências orgânicas do criando em três instituições em Bogotá durante o período 2014 -2016. Método: Eu estudo de observação prospectivo, levou a cabo entre 2014 e 2016 entre três hospital centra da cidade de Bogotá - a Colômbia. 252 eram criando incluídos a quem foi levado trimestralmente fora ecográfico de perseguição, enquanto levando de variáveis clínicas e demográficas e investigação perinatal materna de resultados no momento do parto. Os dados foram analisados pelo cálculo de medidas de tendência central e dispersão para as variáveis quantitativas, freqüências e porcentagens para as variáveis qualitativas. Resultados: Ele/ela era uma incidência de hipertensivos de deficiências orgânicas de 11,8% no criando incluído no estudo, destes, 62,1% preeclampsia e 37,9% gestacional de hipertensão. O preeclampsia mostraram para cima dentro um 7.4% do total da população instruída, destes pacientes, 50% apresentaram preeclampsia severo. A incidência de preeclampsia cedo era de 17,2%. Conclusão: A incidência do hipertensivos de deficiências orgânicas criando na população instruída é maior que em países desenvolvidos e semelhante a isso descrito na população colombiana