Risk factors for complications in total hip arthroplasty. / Factores de riesgo para complicaciones en artroplastia total de cadera.

INTRODUCTION AND OBJECTIVE: Hip arthroplasty represents a significant advancement in the treatment of refractory chronic joint pain, improving quality of life and functionality. The objective of this study is to identify the risk factors associated with local and systemic complications in patients treated with total hip arthroplasty. METHODS: Observational, analytical, retrospective cohort study, which included 304 participants treated with total hip replacement. Comparison of variables between two groups was performed; 38 participants in the group with complications and 266 participants in the group without complications. RESULTS: The mean age in the complication group was 66 years (SD 18.7) and in the uncomplicated group it was 67,1 years (SD 15.1) (p 0,686). Female sex was observed in 73.3% of the group with complications and 65% in the group without complications. (p 0.292). Risk factors were: hip fracture as an indication for arthroplasty RR 1.33 [ 95% CI 1.004;1.775 p 0.047], coronary heart disease RR 1.31 [95% CI 1.067;1.616 p 0.010] and surgical bleeding equal to or greater than 400 cc RR 1.11 [95% CI 1.012;1.218 p 0.028]. CONCLUSIONS: The risk factors for complications in total hip arthroplasty were: hip fracture as the indication for arthroplasty, coronary artery disease, and surgical bleeding equal to or greater than 400 cc.

Adverse drug reactions in paediatric surgery: prospective study on frequency and risk related factors.

BACKGROUND: Paediatric patients are especially prone to experiencing adverse drug reactions (ADRs), and the surgical environment gathers many conditions for such reactions to occur. Additionally, little information exists in the literature on ADRs in the paediatric surgical population. We aimed to quantify the ADR frequency in this population, and to investigate the characteristics and risk factors associated with ADR development. METHODS: A prospective observational study was conducted in a cohort of 311 paediatric patients, aged 1-16 years, admitted for surgery at a tertiary referral hospital in Spain (2019-2021). Incidence rates were used to assess ADR frequency. Odds ratios (ORs) were calculated to evaluate the influence of potential risk factors on ADR development. RESULTS: Distinct ADRs (103) were detected in 80 patients (25.7%). The most frequent being hypotension (N = 32; 35%), nausea (N = 16; 15.5%), and emergence delirium (N = 16; 15.5%). Most ADRs occurred because of drug-drug interactions. The combination of sevoflurane and fentanyl was responsible for most of these events (N = 32; 31.1%). The variable most robustly associated to ADR development, was the number of off-label drugs prescribed per patient (OR = 2.99; 95% CI 1.73 to 5.16), followed by the number of drugs prescribed per patient (OR = 1.26, 95% CI 1.13 to 1.41), and older age (OR = 1.26, 95% CI 1.07 to 1.49). The severity of ADRs was assessed according to the criteria of Venulet and the Spanish Pharmacovigilance System. According to both methods, only four ADRs (3.9%) were considered serious. CONCLUSIONS: ADRs have a high incidence rate in the paediatric surgical population. The off-label use of drugs is a key risk factor for ADRs development.

Prognostic factors for deterioration of quality of life one year after admission to ICU for severe SARS-COV2 infection.

PURPOSE: Patients with COVID-19 present long-term symptoms collectively known as "post-COVID syndrome". Long-term manifestations are more frequent in patients requiring admission to Intensive Care Units (ICU), but the risk factors for their development are still unknown. This study explores the quality of life of patients with severe COVID-19 one year after their discharge from ICU. METHODS: Prospective observational study including 106 patients admitted to the ICU of a tertiary care hospital between March and August 2020. We analysed quality of life using the EuroQol-5D index (EQ-5D). We evaluated as possible risk factors associated with a worse value of the EQ-5D index the medical record, the clinical situation at hospital admission, the clinical situation at ICU admission and evolution in the ICU. As a secondary objective, we explored the presence of other frequent symptoms. RESULTS: Most patients (55.4%) reported that their quality of life worsened one year after admission. The mean perceived health status, on the EQ-VAS scale (0-100), was 70.4, with a median of 70 (RI 60-90). The median EQ-5D index was 0.91 (RI 0.76-1). The factors independently related to lower quality of life were female sex and duration of mechanical ventilation. Almost all (91%) of the patients had sequelae one year after discharge from the ICU. The most frequent manifestations were neuropsychiatric (71%). CONCLUSIONS: Critically ill COVID-19 patients worsen their quality of life more than one year after discharge. Female sex and duration of mechanical ventilation predict a lower quality of life assessed by the EQ-5D index.

The COVID-19 pandemic and non-COVID-19 healthcare utilization in Mexico.

OBJECTIVES: This study aimed to analyze the effects of the COVID-19 pandemic on non-COVID-19 healthcare utilization in Mexico, including oral health, mental health, communicable disease visits, health checkups, chronic degenerative disease visits, postpartum care, prenatal care, and family planning visits. STUDY DESIGN: This was a retrospective ecological analysis during the COVID-19 pandemic. During the pandemic, the Mexican government recommended non-essential consultations be suspended or rescheduled to accommodate the new demand for healthcare services from COVID-19 patients. METHODS: This study uses administrative data from Mexico's Ministry of Health from January 2017 to December 2022. These data cover 14,299 consultation units and 775 hospitals from the 32 Mexican States, all of which are public institutions. A difference-in-differences strategy and an event study specification are used to study the impacts of the pandemic on non-COVID-19 healthcare utilization. RESULTS: The findings reveal a decrease in the utilization of all healthcare services: oral health (69%), mental health (27%), communicable diseases (46%), chronic degenerative diseases (36%), health checkups (62%), family planning (45%), prenatal care (36%), and postpartum care (44%). Furthermore, the event study indicates that most services follow a U-shaped trend, although only mental health services clearly return to prepandemic levels. The remainder of services remain below prepandemic levels at the end of 2022. CONCLUSIONS: The 2020 pandemic had detrimental effects on non-COVID-19 healthcare utilization. The healthcare interruptions will likely impact short- and long-term morbidity and mortality. Programs intended to remediate these negative consequences may be of interest to public health policymakers.

Tarsal tunnel ganglion cyst: intraneural or extraneural site?

Intraneural ganglion cysts are very uncommon lesions, whose diagnosis has increased since the articular theory and the description of the MRI findings were established. We present a case report of a 59-year-old man with symptoms of tarsal tunnel syndrome. Foot and ankle MRI demonstrated the presence of an intraneural cystic lesion in the posterior tibial neve and its connection with the subtalar joint through an articular branch. The identification of the specific radiological signs like the «signet ring sign¼ allowed establishing an adequate preoperative diagnosis, differentiating it from an extraneural lesion and facilitating the articular disconnection of the nerve branch during surgery.

Seguridad del paciente en Resonancia Magnética / Patient safety in magnetic resonance imaging

El uso de campos magnéticos estáticos, gradientes de campo y ondas de radiofrecuencia suponen un reto de seguridad diferente a otras modalidades de imagen. Cada vez más centros trabajan con equipos de 3,0T que presentan mayores riesgos para el paciente frente a los de 1,5T. Hay una necesidad de actualización para el personal de radiología que le permita entender los riesgos y disminuirlos, pues pueden producirse incidentes graves e incluso mortales. El objetivo de este trabajo es presentar una revisión y actualización de los riesgos a los que se ven sometidos los pacientes durante la realización de un estudio de resonancia magnética.(AU)

Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging study.(AU)

Patient safety in magnetic resonance imaging.

Image acquisition involves the use of static magnetic fields, field gradients and radiofrequency waves. These elements make the MRI a different modality. More and more centers work with 3.0 T equipment that present higher risks for the patient, compared to those of 1.5 T. Therefore, there is a need for updating for radiology staff that allows them to understand the risks and reduce them, since serious and even fatal incidents can occur. The objective of this work is to present a review and update of the risks to which patients are subjected during the performance of a magnetic resonance imaging (MRI) study.

Shielding behavior of artisanal bricks against ionizing photons.

In the work reported in this article, were determined the shielding capabilities of three artisanal bricks used massively in the construction industry in Mexico. The linear attenuation coefficients for photons between 1 keV and 100 GeV are reported; and the half-value layers for energies used in the medical field, show that the three typical artisanal bricks have good shielding capabilities for photons below 50 keV. We compared the effective atomic numbers of one of our bricks against two widely used materials in the construction industry, and our results suggest that the greater the effective atomic number, the less material attenuation capacity. A comparison of the half-value layer of one of our bricks against the half-value layers of two clay bricks with different percentages of fly ash particles published in the literature, suggests that in the region between 0.001 and 2.8 MeV, all the three bricks have practically the same attenuation capacity and that from 2.8 MeV to 100 GeV the clay bricks with different percentages of fly ash particles, need less material to show the same attenuation capacity than our artisanal bricks. Energy Dispersed X-Ray Fluorescence suggests that regardless of the number of constituent elements in a sample, a critical mass per atom is required to have a positive impact on density; and as a consequence, in the capacity of attenuation of the materials. Normalized half-value layers suggest on the other hand, that the uncooked bricks have better shielding capabilities than cooked.

Ascorbic acid inhibits vascular remodeling induced by mental stress in overweight/obese men.

BACKGROUND: Mental stress (MS) is related to endothelial dysfunction in overweight/obese men. It is believed that the pro-oxidant profile, associated with an imbalance in the vascular remodeling process, may contribute to deleterious effects of MS on endothelial function. However, it is unknown whether administration of ascorbic acid (AA), a potent antioxidant, can prevent oxidative and remodeling dysfunction during MS in these subjects. METHODS: Fourteen overweight/obese grade I men (27 ± 7 years; 29.7 ± 2.6 kg·m-2) underwent the Stroop Color Word Test for 5 min to induce MS after AA (3 g) or placebo (PL, 0.9% NaCl) intravenous infusions. Venous blood samples were collected at baseline and the last minute of MS to measure nitrite concentration (chemiluminescence), protein carbonylation, thiobarbituric acid reactive substances (TBARS) and catalase activity (colorimetric assays), superoxide dismutase (SOD; immunoenzymatic assay), activities of active/inactive (pro) forms of metalloproteinases-9 and -2 (MMP; zymography) and its respective tissue inhibitors concentration (TIMP-1 and TIMP-2; immunoenzymatic assays). RESULTS: At baseline, MMP-9 activity (p < 0.01), the MMP-9/proMMP-9 ratio (p = 0.02) and TIMP-1 concentration (p = 0.05) were reduced, whereas proMPP-9 activity was increased (p = 0.02) after AA compared to PL infusion. After PL infusion, MS increased protein carbonylation (p < 0.01), catalase (p < 0.01), and the MMP-9/proMMP-9 ratio (p = 0.04) when compared to baseline. AA infusion reduced protein carbonylation (p = 0.02), MMP-9 activity (p < 0.01), and MMP-9/pro-MMP-9 ratio (p < 0.01), while SOD (p = 0.04 vs baseline), proMPP-9 (p < 0.01 vs PL), MMP-2 (p < 0.01 vs PL) and TIMP-2 (p = 0.02 vs baseline) remained elevated during MS. CONCLUSIONS: AA appears to minimize the oxidative imbalance and vascular remodeling induced by MS.

Effects of suspended mineral coal dust on the energetic physiology of the Caribbean scallop Argopecten nucleus (Born, 1778).

The effects of increasing concentrations of suspended mineral coal dust on the energetic physiology of the Caribbean scallop Argopecten nucleus were studied, at a concentration range that is environmentally relevant and representative of areas proximate to coal loading and shipping ports. Adult hatchery-produced animals were exposed to different concentrations of coal dust, i.e. 0, 2, 9 and 40 mg L-1. At increasing concentrations of coal dust, the rates of filtration and pseudofeces production increased, while the rates of ingestion and absorption remained constant. The rates of oxygen consumption and ammonium excretion decreased, as well as the absorption efficiency and the scope for growth. Suspended coal dust particles, at concentrations higher than or equal to 2 mg L-1, were ingested preferentially over microalgae by A. nucleus, causing reductions in its absorption capability, metabolism and in the amount of energy for growth and reproduction, thus generating physiological stress.

T-tube Systematic Use in the Biliary Anastomosis: Comparison of Two Consecutive Series of Liver Transplantation.

OBJECTIVES: The authors sought to check the frequency of biliary complications with the use of a T-tube. In 2012, throughout the year, it was carried out systematically in all liver transplantations regardless of the characteristics of the bile duct. Despite the long experience, biliary complications remain a common cause of postoperative morbidity and mortality. MATERIAL AND METHODS: In this study we compared complications in 23 consecutive transplantation cases using T-tube biliary anastomosis during the year 2012 with 23 consecutive transplantation cases without T-tube during the year 2013. We evaluated postoperative complications and long-term outcomes (for 2 years to 3 years). RESULTS: Of the 23 patients with anastomosis with a T-tube, 2 patients (8.69%) had biliary stricture that required prosthesis by endoscopic retrograde cholangiopancreatography, 1 of them (4.34%) was operated by incorrect placement of the T-tube, and in 4 patients (17.39%) bile leakage (endoscopic retrograde cholangiopancreatography prostheses in 3 cases and hepaticojejunostomy in 1). During follow-up at 3 years, only 2 patients had minimal bile duct dilatation without clinical relevance. In the patients who underwent transplantation without a T-tube, 18 (78.26%) had no complications, 3 (13.04%) showed stenosis (prosthesis placement), and 2 (8.69%) had bile leakage (hepaticojejunostomy and prosthesis). During follow-up at 2 years to 3 years, no patient had biliary dilatation or alteration of cholestatic parameters. In the comparative study of both groups we found no statistically significant differences. CONCLUSIONS: We have not seen an improvement in complications with the use of T-tube (69.56% vs. 78.23%) that encourage us to work systematically, although the small number of cases does not allow statistically significant conclusions.

Collateral Development in Thrombosis of the Hepatic Artery After Transplantation.

OBJECTIVES: The authors sought to identify strictures or hepatic artery obstruction with posterior collateral transformation in our series of liver transplantation, treatment, and evolution. The thrombosis or severe hepatic artery stenosis sometimes presents a compensation mechanism, the collateral transformation of the artery. MATERIAL AND METHODS: From April 2002 to December 2011 we collected 18 cases of collateral transformation. We analyzed data regarding the transplantation, diagnosis, treatment, clinical evolution, liver function, and Doppler-ultrasound. RESULTS: The main indication was alcoholic cirrhosis, followed by hepatocellular carcinoma - hepatitis C virus. The mean cold ischemia time was 292.2 minutes mean hot ischemia was 48.8. The anastomosis was performed on the gastroduodenal-splenic patch donor in 14 cases, the celiac trunk in 2 cases, and on grafts to the aorta in another 2. Doppler ultrasound showed 8 cases without complications, 8 with low flows, and 2 cases with alterations of the right hepatic artery. Computed tomographic (CT) angiography was performed in patients with impaired eco-Doppler and found 4 obstructions, 2 cases with kinking, 1 stenosis, and 3 normal cases. Three patients with low flows were re-operated and another re-transplanted. After diagnosis of collateral transformation, all were treated with antiplatelet agents. Two cases of angioplasty were associated. The collaterals were diagnosed 1 month to 44.8 months after transplantation. Five patients died. In the latest data, 10 patients do not have analytical alteration. The Doppler ultrasound shows 7 cases being normal and 6 with flow but low resistances. CONCLUSIONS: In our series, all patients with collateral transformation, except one who was transplanted, maintain good liver function with permeable vessels.

Towards a carrier SDN: an example for elastic inter-datacenter connectivity.

We propose a network-driven transfer mode for cloud operations in a step towards a carrier SDN. Inter-datacenter connectivity is requested in terms of volume of data and completion time. The SDN controller translates and forwards requests to an ABNO controller in charge of a flexgrid network.

A new single nucleotide polymorphism in the calpastatin (CAST) gene associated with beef tenderness.

First we looked for putative causative mutations in the CAST and CAPN1 genes associated with meat tenderness and found a total of 31 and 7 polymorphisms, respectively, in the Parda de Montaña and Pirenaica breeds. Tenderness was not affected by mutations in CAPN1. However, three SNPs located at intron 5 (BTA7: g.98533962C>G on UMD 3.0), exon 7 (g.98535683A>G) and intron 12 (g.98545188T>A) of the CAST gene were significantly associated with meat tenderness at 7 days post-mortem in the Parda de Montaña breed. The haplotypes h2 and h5 showed significant associations with meat toughness being consistent with the SNP association results, which showed that the g.98535683A>G SNP in CAST might be the causative mutation of the effect found in this study. This mutation changes the amino acid sequence at position p.Thr182Ala (NM_174003). This amino acid substitution could affect the interacting regions between the calpastatin L-domain and calpain, and then could generate a more stable union between calpain and calpastatin.

Evolución del porcentaje de episiotomía en un hospital comarcal entre los años 2003–2009. Factores de riesgo de los desgarros graves de periné / Evolution of the episiotomy rate in a community hospital, between 2003–2009. Severe perineal tears risk factors

Objetivo El objetivo primario de este trabajo es presentar la evolución del porcentaje de episiotomías entre los años 2003-2009, siguiendo una política de uso restrictivo y su posible influencia en el porcentaje de desgarros graves y en la morbilidad perinatal a corto plazo. Material y método El diseño del estudio es de cohorte retrospectiva, constituida por las mujeres que acuden a parir a nuestro centro (9.023 gestantes). Los parámetros que valoramos son: evolución del porcentaje de episiotomías y de desgarros graves de periné, según se realice episiotomía o no, en los partos eutócicos frente a los instrumentales y según el tipo de parto instrumental. Para valorar la relación entre los factores de riesgo y la incidencia de desgarros graves se realiza una regresión logística multivariante. Resultados La tasa de episiotomía osciló entre el 40,37% en el año 2003 y el 8% en el año 2009, siendo la tendencia a la disminución estadísticamente significativo. El porcentaje de desgarros graves se mantuvo entre el 0,49 y el 1,04% sin que la variación fuera estadísticamente significativa ((X2 = 3,47, p = 0,32). No hubo variación significativa en el porcentaje de Test de Apgar menor de 7, a los 5 min. La Odds ratio (OR) de presentar un desgarro grave de periné es 2,99 (IC 95% 1,47-6,05) en las mujeres que se realizó episiotomía frente a las que no se les realizó, de 2,40 (IC 95% 1,16-4,99) en los partos instrumentales frente a partos eutócicos es y de 6,43 (IC 95% 1,50-27,49) en los partos con fórceps, frente a los partos por ventosa. Conclusiones En un periodo de 7 años se ha reducido el porcentaje de episiotomías en un 80% sin modificarse la proporción de desgarros graves de periné, así mismo no ha habido aumento en la morbilidad perinatal a corto plazo (AU)

Objective The primary objective of this paper is to present the evolution of the episiotomy rate between the years 2003-2009, following a policy of restrictive use and its possible influence on the rate of severe lacerations and perinatal morbidity in the short term. Methods This is a retrospective study based on a cohort made up of women who gave birth in our hospital (9023 women). The valued parameters are: changes in the episiotomy rate, percentage of severe perineal tears according to the use of episiotomy or not. Normal vaginal deliveries versus instrumental ones and the type of instrumental delivery. Apgar score below 7 at five minutes. A multivariable logistic regression was performed in order to assess the relationship between risk factors and the incidence of severe tears. Results The episiotomy rate ranged between 40.37% in 2003 and 8% in 2009, the downward trend was statistically significant. The rate of severe tears remained between 0.49% and 1.04% that change was not statistically significant. There was no significant variation in the rate of Apgar score less than 7 at 5 minutes. The odds ratio (OR) of having a serious perineal tear is 2.99 (95% CI 1.47 to 6.05) in women who had an episiotomy compared with those that did not have it, the 2.40 (95% CI 1.16 to 4.99) in the instrumental delivery versus eutocic delivery and the 6.43 (95% CI 1.50 to 27.49) in forceps deliveries compared with vacuum deliveries. Conclusions Over a period of 7 years the episiotomy rate was reduced by 80% without modifying the rate of serious perineal tears, and the short-term perinatal morbidity remained constant (AU)

Complete nucleotide sequence of a severe isolate of cucumber vein yellowing virus from Jordan.

The complete genome of a severe isolate of Cucumber vein yellowing virus (CVYV) from Jordan was sequenced. Comparison with the genome of a Spanish CVYV isolate inducing very mild symptoms in cucumber cultivars revealed a nucleotide identity of 94% for the complete genome and an amino acid identity of 96% for the coding region. Comparison of synonymous and non-synonymous substitutions suggested a negative selection at amino acid and nucleotide levels with different degrees depending on the different coding regions. Finally, specific amino acid changes in the zinc finger domain of P1b and in the P1-P3 proteolytic site were found which could be involved in the virulence of CVYV.