Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors.

OBJECTIVE: To evaluate the prevalence of and factors associated with SARS-CoV-2 infection in general practitioners and nurses from primary care centers and nursing homes in the Healthcare Area of León (Spain). MATERIALS AND METHODS: Cross-sectional study in a convenience sample of professionals from 30 health centers and 30 nursing homes from the primary care management division of the Healthcare Area of Leon. The work center, type of profession, COVID-19 infection, level of exposure, compliance with preventive measures, isolation (if required) and diagnostic tests carried out were collected. The determination of infection was made by differentiated rapid diagnostic test (dRDT), using a finger-stick whole-blood sample. The association of variables with infection was assessed by multivariable non-conditional logistic regression. The true prevalence of SARS-CoV-2 infection was calculated according to two scenarios for RDT (Sensitivity=0.6 and Specificity=0.985; Sensitivity=0.8 and Specificity=1). RESULTS: The true prevalence of SARS-CoV-2 infection was between 4.9% and 11.0%. The observed prevalence was 5.9% and was higher in nursing homes than in primary care centers (9.5% vs. 5.5%). No statistically significant differences were observed by sex, type of professional, level of exposure or compliance with preventive measures. CONCLUSIONS: The prevalence of SARS-CoV-2 infection in this group is low. A high number of professionals remain susceptible to SARS-CoV-2 infection and therefore protective measures should be taken, especially for professionals working in nursing homes.

Sonographic Measurement of the Patellar Tendon Should Predict Autograft Bone Patellar Tendon Bone (BPTB) Size: Comparison of Anatomical and Clinical Findings.

The use of BPTB autograft is frequently used in ACL reconstruction, however, the risk of potential failure in patients with an anatomically unfavorable patellar tendon may predispose to reconstruction failure. Anatomical study of the extensor apparatus of the knee can provide knowledge about the best option obtain the graft and perform a better preoperative planning. Musculoskeletal ultrasound is a simple, reproducible, affordable technique that could be valid for patellar tendon evaluation. The objective of this study is to evaluate the reproducibility of the patellar tendon measurements by ultrasound and compare them with anatomical measurements, both in cadaver and patients undergoing ACLR. The study consists of two phases; first anatomical study in cadaver. The ultrasound measurement was performed by determining the length, width and thickness of the patellar tendon, both by ultrasound and anatomical dissection. The second phase is a cohort of 42 patients pending surgical ACLR. Previous ultrasound and intraoperative measurements were obtained. Regarding the anatomical study, statistical analysis did not show any differences comparing the measurements in length (p = ns) and thickness (p = ns) of the patellar tendon, although differences were obtained when comparing the results obtained for the width of the tendon after the ultrasound and anatomical measurement (p < 0.001). Same results were obtained in second phase of the study. The reproducibility of ultrasound measurements of the PT is comparable to intraoperatively measurements (without width measurement). These findings can be useful for preoperative planning in the reconstruction of ACL with BPTB Graft and to assess technical modifications prior to surgery.

Measurement of the hysteretic thermal properties of W-doped and undoped nanocrystalline powders of VO2.

Hysteresis loops exhibited by the thermal properties of undoped and 0.8 at.% W-doped nanocrystalline powders of VO2 synthesized by means of the solution combustion method and compacted in pellets, are experimentally measured by photothermal radiometry. It is shown that: (i) the W doping reduces both the hysteresis loops of VO2 and its transition temperature up to 15 °C. (ii) The thermal diffusivity decreases (increases) until (after) the metallic domains become dominant in the VO2 insulating matrix, such that its variation across the metal-insulation transition is enhanced by 23.5% with W-0.8 at.% doping. By contrast, thermal conductivity (thermal effusivity) increases up to 45% (40%) as the metallic phase emerges in the VO2 structure due to the insulator-to-metal transition, and it enhances up to 11% (25%) in the insulator state when the local rutile phase is induced by the tungsten doping. (iii) The characteristic peak of the VO2 specific heat capacity is observed in both heating and cooling processes, such that the phase transition of the 0.8 at.% W-doped sample requires about 24% less thermal energy than the undoped one. (iv) The impact of the W doping on the four above-mentioned thermal properties of VO2 mainly shows up in its insulator phase, as a result of the distortion of the local lattice induced by the electrons of tungsten. W doping at 0.8 at.% thus enhances the VO2 capability to transport heat but diminishes its thermal switching efficiency.

Modificaciones en la altura patelar por el uso del injerto hueso-tendón-hueso / Changes in patellar height due to bone-tendon-bone graft

Objetivo: Las complicaciones asociadas al uso de injertos del ligamento cruzado anterior (LCA) son frecuentes. Los cambios en la altura, sobre todo de la patela baja, pueden ser la razón de la aparición de dolor en la zona anterior de la rodilla. Diversos estudios han asociado la reconstrucción del LCA mediante la técnica de injerto hueso-tendón-hueso con patela baja. Métodos: Cuarenta y tres pacientes con reconstrucción del LCA mediante injerto hueso-tendón-hueso fueron incluidos en el presente estudio. Todos los pacientes fueron sometidos a la misma cirugía, con el cierre del paratendón del tendón rotuliano. Se realizó un estudio radiológico antes de la cirugía y 2 años después de la misma. En todos los casos se estudió el índice Insall-Salvati, el corte axial y la inclinación patelar. Como control se utilizó la rodilla sana contralateral del paciente. Resultados: No se encontraron diferencias significativas entre el estudio preoperatorio y el realizado tras 2 años de la cirugía. Conclusiones: El uso del tendón patelar con cierre del paratendón en la reconstrucción del LCA no ha demostrado modificar la altura patelar en estudios radiológicos a los 2 años de seguimiento

Purpose: Complications related to anterior cruciate ligament (ACL) graft are common. Change in height, especially patella baja, can be a cause of anterior knee pain. Several studies have related ACL reconstruction with bone-tendon-bone graft to patella baja. Methods: Forty-three patients with ACL reconstruction using a with bone-tendon-bone graft were included in this study. All patients underwent the same surgery, with closure of the paratenon of the patellar tendon. A radiological study was performed before surgery and 2 years after surgery. The Insall-Salvati index, axial view and patellar tilt were analyzed in all patients. The healthy contralateral knees were used as the control group. Results: No significant differences were observed from the preoperative measurements or at the 2-year follow-up. Conclusions: The use of patellar tendon with closure of the paratenon in ACL reconstruction was not shown to modify patellar height within the radiological follow-up of two years

Changes in patellar height due to bone-tendon-bone graft. / Modificaciones en la altura patelar por el uso del injerto hueso-tendón-hueso.

PURPOSE: Complications related to anterior cruciate ligament (ACL) graft are common. Change in height, especially patella baja, can be a cause of anterior knee pain. Several studies have related ACL reconstruction with bone-tendon-bone graft to patella baja. METHODS: Forty-three patients with ACL reconstruction using a with bone-tendon-bone graft were included in this study. All patients underwent the same surgery, with closure of the paratenon of the patellar tendon. A radiological study was performed before surgery and 2 years after surgery. The Insall-Salvati index, axial view and patellar tilt were analyzed in all patients. The healthy contralateral knees were used as the control group. RESULTS: No significant differences were observed from the preoperative measurements or at the 2-year follow-up. CONCLUSIONS: The use of patellar tendon with closure of the paratenon in ACL reconstruction was not shown to modify patellar height within the radiological follow-up of two years.

Thermal hysteresis measurement of the VO2 emissivity and its application in thermal rectification.

Hysteresis loops in the emissivity of VO2 thin films grown on sapphire and silicon substrates by a pulsed laser deposition process are experimentally measured through the thermal-wave resonant cavity technique. Remarkable variations of about 43% are observed in the emissivity of both VO2 films, within their insulator-to-metal and metal-to-insulator transitions. It is shown that: i) The principal hysteresis width (maximum slope) in the VO2 emissivity of the VO2 + silicon sample is around 3 times higher (lower) than the corresponding one of the VO2 + sapphire sample. VO2 synthesized on silicon thus exhibits a wider principal hysteresis loop with slower MIT than VO2 on sapphire, as a result of the significant differences on the VO2 film microstructures induced by the silicon or sapphire substrates. ii) The hysteresis width along with the rate of change of the VO2 emissivity in a VO2 + substrate sample can be tuned with its secondary hysteresis loop. iii) VO2 samples can be used to build a radiative thermal diode able to operate with a rectification factor as high as 87%, when the temperature difference of its two terminals is around 17 °C. This record-breaking rectification constitutes the highest one reported in literature, for a relatively small temperature change of diode terminals.

Hip arthroscopy complications regarding surgery and early postoperative care: retrospective study and review of literature.

PURPOSE: The purpose is to describe the rate of complications in a series of hip arthroscopies performed at our center, as well as perform a systematic review of the current literature in order to compare our outcomes. METHODS: Two hundred and fifty-eight patients affected of femoroacetabular impingement and treated with hip arthroscopy have been studied. All minor and major complications were studied during the first postsurgery year. Furthermore, a systematic review was performed comparing major and minor complications with our series. Two attending orthopedic surgeons selected the different studies with the same inclusion and exclusion criteria, remaining with 48 studies that have been reviewed and included in the present study. RESULTS: Mean age was 36.6 years old (SD 17.45), and the ratio men:women was 137:121. The mean complication rate observed was 14.34% (37/258) of global complications. Only three patients showed major complications: femoral neck fracture, septic arthritis and avascular necrosis of the femoral head. Any of these patients had permanent side effects. CONCLUSIONS: Hip arthroscopy has a low rate of major complications, but a higher number of minor complications that could be avoided with certain preventive measures.

Aplicación coadyuvante de plasma rico en factores de crecimiento en rotura bilateral de tendón cuadricipital / Adjuvant administration of plasma rich in growth factors for bilateral quadriceps tendon tear

Antecedentes: Las roturas bilaterales de tendones cuadricipitales son enfermedades de muy baja frecuencia. Las reparaciones quirúrgicas suelen ser los tratamientos más adecuados y exigen tiempos de recuperación de varios meses. Métodos: Presentamos el caso de un paciente con rotura bilateral de tendones cuadricipitales tras un traumatismo de baja energía, que fue tratado mediante sutura transpatelar quirúrgica reforzada con plasma rico en factores de crecimiento (PRGF-Endoret). Resultados: Los resultados a corto plazo evidenciaron una recuperación funcional y mediante imagen en poco más de dos meses. Conclusiones: La utilización de PRGF asociado a la cirugía habitual puede ayudar a la realización de una rehabilitación precoz.

Background: Bilateral quadriceps tendon tears are infrequent conditions. Surgical repairs are the most appropriate treatments and they involve several months of recovery. Methods: We report the case of a patient with bilateral quadriceps tendon tear resulting from low energy trauma. He was treated with surgical transpatellar suturing reinforced with plasma rich in growth factors (PRGF-Endoret). Results: Short-term results showed functional and radiological recovery at the two-months follow-up. The use of PRGF together with usual surgery may contribute to early rehabilitation.

[Adjuvant administration of plasma rich in growth factors for bilateral quadriceps tendon tear]. / Aplicación coadyuvante de plasma rico en factores de crecimiento en rotura bilateral de tendón cuadricipital.

BACKGROUND: Bilateral quadriceps tendon tears are infrequent conditions. Surgical repairs are the most appropriate treatments and they involve several months of recovery. METHODS: We report the case of a patient with bilateral quadriceps tendon tear resulting from low energy trauma. He was treated with surgical transpatellar suturing reinforced with plasma rich in growth factors (PRGF-Endoret). RESULTS: Short-term results showed functional and radiological recovery at the two-months follow-up. The use of PRGF together with usual surgery may contribute to early rehabilitation.

[Anterior cruciate ligament ganglion: a case report]. / Ganglión en ligamento cruzado anterior: a propósito de un caso.

Intraarticular ganglions are rare and they are usually incidental findings of MRIs and arthroscopies. We report the case of a male athlete with this condition affecting the anterior cruciate ligament. The most frequent symptoms include pain that worsens with activity, and motion limitations. The MRI shows the typical signs of a ganglion and it is the most specific and sensitive test. Arthroscopy is used for both the diagnosis and the treatment of this condition. A late diagnosis turns arthroscopic resection into a complicated or impossible procedure that at times warrants extensive debridement of the anterior cruzate ligament.

[Treatment of late onset Perthes disease with hip arthroscopy and arthrodiastasis with an external fixator. Case report]. / Tratamiento de la enfermedad de perthes tardía mediante artroscopía de cadera y artrodistasis con fijador externo. A propósito de un caso y revisión de la literatura.

BACKGROUND: The prognosis of late onset Perthes cases is usually poor and the proposed treatments vary based on the surgeon's preferences and experience, as well as on the available resources. Most of them are salvage procedures with a short follow-up and non-standardized application criteria. METHODS: Hip arthroscopy and arthrodiastasis with external fixator are indicated for certain situations in Perthes disease. Based on the results obtained with each of these techniques separately, both of them were used to treat a case of Perthes disease involving a poor prognosis. RESULTS: Results two years after surgery are good. CONCLUSIONS: The use of both techniques together may produce a good result in these patients.

Effect of CYP3A51/3 polymorphism on blood pressure in renal transplant recipients.

BACKGROUND: The cytochrome P450 3A5 (CYP3A5) enzyme has been implicated to determine blood pressure (BP) in humans. Different results have been reported concerning CYP3A5 gene polymorphisms and posttransplantation hypertension in kidney recipients. Our objective was to investigate whether CYP3A5 1/3 polymorphism was associated with ambulatory BP among a population of renal transplant recipients receiving the calcineurin inhibitor tacrolimus for immunosuppression. METHODS: Sixty primary kidney transplant recipients undergoing treatment with tacrolimus were genotyped for the CYP3A5 1/3 polymorphism. We analysed the association of the CYP3A5 alleles with ambulatory systolic and diastolic BP measured at 6 and 24 months posttransplantation. RESULTS: We observed that 23.3% of the patients were CYP3A5 1 carriers and 76.7% were homozygous for CYP3A5 3. CYP3A5 1 carriers showed higher adjusted systolic BP and diastolic BP at 6 and 24 months posttransplantation, and they were prescribed more antihypertensive drugs compared with non CYP3A5 1 carrier patients, albeit not significant. No significant differences were found comparing the distribution of the hypertension classes. CONCLUSION: We did not observe a significant association of CYP3A5 1/3 polymorphism with posttransplantation hypertension, although there were some differences in BP associated with the presence of the CYP3A5 1 allele.

[Anterior tibial tubercle fracture in teenagers. Clinical cases]. / Fractura de la tuberosidad anterior de la tibia en el adolescente. Casos clínicos.

INTRODUCTION: Anterior tibial tubercle fractures are relatively infrequent and occur mainly in young athletes 14 to 17 years old. Most fractures result from jumping during sports activities. METHODS: We describe two cases of anterior tibial tubercle fractures. The latter were Ogden IIIA and IIIB. In both cases treatment consisted of open reduction and internal fixation with cannulated screws. DISCUSSION: The mechanism of injury in the first case is more common than the one in the second case. The first case occurred after jumping to receive a pass during a basketball game. The second one occurred while playing soccer. The patient was kicked on the quadriceps musculature. Both cases involved functional disability. CONCLUSION: Biomechanically, the mechanism of injury in the second case increased the tension on the extensor apparatus. We performed synthesis with cannulated screws and obtained good results without complications.

Lack of association of immune cell function test with rejection in kidney transplantation.

BACKGROUND: The Cylex Immuknow assay provides a rapid assessment of global immune function in immunocompromised patients by measuring the global immune responses of CD4 T cells from a whole-blood sample. It may help to monitor the immune status of immunosuppressed transplant patients. However, earlier studies have shown that there is no consensus on the utility of the Immuknow assay in renal transplant rejection. METHODS: T-cell activation was determined by measuring an increase of intracellular adenosine triphosphate (iATP) from CD4 cells in 227 samples from 116 kidney transplant patients. The results were analyzed regarding patient clinical status, namely, rejection, infection, or stability. In addition, we measured the immunologic response of 108 healthy control subjects. RESULTS: There were 24 infectious and 36 rejection episodes. iATP concentrations differed significantly between stable and infected patients (180.5 ± 55.2 vs 375.3 ± 140.1 ng/mL; P < .001) and between infected patients and control subjects (180.5 ± 55.2 vs 436.5 ± 112 ng/mL; P < .001). No correlation was observed between patients suffering an acute rejection episode with this response. CONCLUSIONS: Our results confirmed that the Immuknow assay identified transplant patients at risk for infection. It may provide information to guide immunosuppressive therapy, but the assay did not seem to have the potential to differentiate subjects experiencing rejection.

Osteocartilaginous lesions of the talus in soccer players.

OBJECTIVE: The objective of this study is to describe the results of arthroscopic debridement for talar lesions in a population of soccer players. PATIENTS: Patients were sixteen soccer players with osteochondral talar lesions, treated surgically between 1999 and 2004. INTERVENTIONS: All patients were diagnosed clinically. Complementary imaging studies included X-ray, scintigraphy, and magnetic resonance imaging. All patients underwent arthroscopic debridement. MAIN OUTCOME MEASUREMENTS: At 3.56 years of follow up, patient status was assessed using a visual analog scale (VAS) and the Ogilvie-Harris scale. The mean time to return to sports at the same level as that before the start of symptoms was evaluated. RESULTS: The Ogilvie-Harris score showed 81.75% excellent results and 18.25% good results. The VAS score was 0.26 (0-2.2). Among the total, 93.75% of patients resumed sports activities at the same level as that before surgery. CONCLUSIONS: Arthroscopic debridement of talar osteochondral lesions in soccer players provides excellent results. We consider this option the treatment of choice in this population.

Impact of HLA-C on acute rejection in liver transplantation.

Although liver transplants show a special tolerogenic behaviour, rejection remains an important problem that involves several immunological mechanisms, some of which are unknown. Our study sought to analyze the influence of HLA-C polymorphism on short-term liver graft acceptance by HLA-C genotyping of 100 orthotopic liver transplant recipient-donor pairs. Recipients were statified according to the occurrence of acute rejection. HLA-Cw*06 allele appeared to be underrepresented among recipients without versus those with acute rejection or those in control groups. With regard to HLA-C allelic compatibility, the frequency of acute rejection or those in episodes decreased with fewer HLA-C mismatches. These findings suggest the participation of HLA-C molecules in liver graft alloresponses, involving HLA-C genotyping, as well as compatibility.

Interleukin-10, interleukin-6 and interferon-gamma gene polymorphisms in melanoma patients.

The immune response against melanoma can be influenced by cytokines with potentially opposite effects on tumour cell growth, such as interleukin-10 (IL10), interleukin-6 (IL6) and interferon-gamma (IFNgamma). Our objective in this study was to investigate whether polymorphisms in the regulatory regions of IL10, IL6 and IFNgamma genes are associated with the development of primary cutaneous melanoma and/or the prognosis of this tumour. We studied genotypic variations at positions -1082, -819 and -592 in the IL10 promoter, -174 in the IL6 promoter and +874 in the IFNgamma intron 1 in 42 melanoma patients and 48 healthy controls. These two populations showed very similar genotypic frequencies for IL10, IL6 and IFNgamma gene polymorphisms. There was a significant increase in the prevalence of IL10 low expression genotypes, specially the ACC/ATA genotype, among patients with a poorer prognosis. In contrast, IL6 promoter and IFNgamma intron 1 gene polymorphisms did not correlate with melanoma prognosis. These data indicate that investigation of polymorphisms in the regulatory regions of IL10, IL6 and INFgamma genes does not seem to be useful for predicting the risk of development of primary cutaneous melanoma. However, IL10 low expression genotypes may be associated with a poorer outcome in melanoma patients.