Peripheral microcirculatory alterations are associated with the severity of acute respiratory distress syndrome in COVID-19 patients admitted to intermediate respiratory and intensive care units.

BACKGROUND: COVID-19 is primarily a respiratory disease; however, there is also evidence that it causes endothelial damage in the microvasculature of several organs. The aim of the present study is to characterize in vivo the microvascular reactivity in peripheral skeletal muscle of severe COVID-19 patients. METHODS: This is a prospective observational study carried out in Spain, Mexico and Brazil. Healthy subjects and severe COVID-19 patients admitted to the intermediate respiratory (IRCU) and intensive care units (ICU) due to hypoxemia were studied. Local tissue/blood oxygen saturation (StO2) and local hemoglobin concentration (THC) were non-invasively measured on the forearm by near-infrared spectroscopy (NIRS). A vascular occlusion test (VOT), a three-minute induced ischemia, was performed in order to obtain dynamic StO2 parameters: deoxygenation rate (DeO2), reoxygenation rate (ReO2), and hyperemic response (HAUC). In COVID-19 patients, the severity of ARDS was evaluated by the ratio between peripheral arterial oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) (SF ratio). RESULTS: Healthy controls (32) and COVID-19 patients (73) were studied. Baseline StO2 and THC did not differ between the two groups. Dynamic VOT-derived parameters were significantly impaired in COVID-19 patients showing lower metabolic rate (DeO2) and diminished endothelial reactivity. At enrollment, most COVID-19 patients were receiving invasive mechanical ventilation (MV) (53%) or high-flow nasal cannula support (32%). Patients on MV were also receiving sedative agents (100%) and vasopressors (29%). Baseline StO2 and DeO2 negatively correlated with SF ratio, while ReO2 showed a positive correlation with SF ratio. There were significant differences in baseline StO2 and ReO2 among the different ARDS groups according to SF ratio, but not among different respiratory support therapies. CONCLUSION: Patients with severe COVID-19 show systemic microcirculatory alterations suggestive of endothelial dysfunction, and these alterations are associated with the severity of ARDS. Further evaluation is needed to determine whether these observations have prognostic implications. These results represent interim findings of the ongoing HEMOCOVID-19 trial. Trial registration ClinicalTrials.gov NCT04689477 . Retrospectively registered 30 December 2020.

Inestabilidad tras artroplastia total de rodilla: los límites de la constricción / Instability after total knee replacement: the limits to constraint

Introducción. La inestabilidad es una de las causas fundamentales de los fracasos asépticos de las prótesis de rodilla.Revisión de conceptos. En este artículo realizamos una actualización de la prevalencia, etiopatogenia, diagnóstico, formas clínicas, prevención y tratamiento de la inestabilidad protésica de rodilla.Conclusión. La elección del implante apropiado y la aplicación de técnicas y principios quirúrgicos correctos nos ayudarán a reducir la inestabilidad protésica de rodilla

Introduction. Instability is one of the most significant causes of aseptic failure in knee replacement surgery.Concept review. In this article, we provide an update on theprevalence, etiopathogenesis, diagnosis, clinical presentations,prevention and treatment of prosthetic knee instability.Conclusion. Appropriate implant choice and the application of sound surgical techniques and principles will help lower the incidence of prosthetic knee instability

Inestabilidad tras artroplastia total de rodilla: los límites de la constricción / Instability after total knee replacement: the limits to constraint

Introducción. La inestabilidad es una de las causas fundamentales de los fracasos asépticos de las prótesis de rodilla.Revisión de conceptos. En este artículo realizamos una actualización de la prevalencia, etiopatogenia, diagnóstico, formas clínicas, prevención y tratamiento de la inestabilidad protésica de rodilla.Conclusión. La elección del implante apropiado y la aplicación de técnicas y principios quirúrgicos correctos nos ayudarán a reducir la inestabilidad protésica de rodilla

Introduction. Instability is one of the most significant causes of aseptic failure in knee replacement surgery.Concept review. In this article, we provide an update on the prevalence, etiopathogenesis, diagnosis, clinical presentations, prevention and treatment of prosthetic knee instability.Conclusion. Appropriate implant choice and the application of sound surgical techniques and principles will help lower the incidence of prosthetic knee instability

Pulsed electromagnetic fields induce peripheral nerve regeneration and endplate enzymatic changes.

An experimental study was carried out in rats with the purpose of demonstrating the capacity of pulsed electromagnetic fields (PEMFs) to stimulate regeneration of the peripheral nervous system (PNS). Wistar and Brown Norway (BN) rats were used. Direct sciatic nerve anastomoses were performed after section or allograft interposition. Treatment groups then received 4 weeks of PEMFs. Control groups received no stimulation. The evaluation of the results was carried out by quantitative morphometric analysis, demonstrating a statistically significant increase in regeneration indices (P < 0.05) in the stimulated groups (9000 +/- 5000 and 4000 +/- 6000) compared to the non-stimulated groups (2000 +/- 4000 and 700 +/- 200). An increase of NAD specific isocitrate dehydrogenase (IDH) activity was found along with an increase in the activity of acetyl cholinesterase at the motor plate. The present study might lead to the search for new alternatives in the stimulation of axonal regenerative processes in the PNS and other possible clinical applications.

[Drug therapy of complex regional painful syndrome of the limbs as the cause of neuropathic pain]. / Tratamiento farmacológico del síndrome doloroso regional complejo de las extremidades como causa de dolor neuropático.

The term complex regional painful syndrome of the limbs seeks to clarify previous entities known as sympathicoreflex dystrophia and causalgia. Its diagnosis continues to be difficult despite the International Association for the Study of the Pain efforts for distinguish both entities. The predominant symptom is characteristically the neuropathic pain whose response to the current analgesic drugs is generally poor. Glucocorticoids are among the most frequent used drugs in the treatment of this syndrome; their effectiveness is, however, not entirely demonstrated and they give rise to important side effects that impede their use in patients with other concomitant conditions. Opioids are difficult to manage because of their side effects which require a strict control by the physician. The use of tricyclic antidepressants because of its analgesic effect is also associated to severe side effects that can be potentially lethal in patients with cardiopathy. In the heterogeneous group of anticonvulsant drugs gabapentin is regarded the treatment of choice because it seems to provide a high improvement of the quality of life in these patients besides a good safety profile.

A multilevel time-series model for the incidence of AIDS cases in Spain.

OBJECTIVE: The main aim of this research is to study the quantitative evolution of the incidence of AIDS in the 19 Spanish Communities. The hypothesis is that incidence follows a multilevel autoregressive model, where each Community shows random variability around a general process. METHOD: On the basis of official data on the number of existing AIDS cases, an autorregressive multilevel time-series model was developed. RESULTS AND CONCLUSIONS: Analysis shows that the hypothesis is supported, indicating that overall AIDS incidence in Spain has already reached a maximum and has a tendency to remain stable or to decline in future. Long term expected values have become stable in most Communities; a slight increase is expected only in Extremadura. However, this Community has a relatively sparse population, and its contribution on the overall Spanish incidence is small. Long term expected values are estimated to be around 152.99 new cases per million inhabitants per year. This value is slightly smaller than the maximum incidence, observed in 1994 (179.4 cases).

Influencia de la presión temporal en el trabajo en grupo en función del tipo de tarea y del canal de comunicación / Time pressure influence on group work by task type and communication channel

En este trabajo, se pretende estudiar el efecto modulador del tipo de tarea y el canal de comunicación en la influencia de la presión temporal sobre la calidad del desempeño. Para ello se llevó a cabo un experimento con 124 sujetos, que fueron distribuidos aleatoriamente en las seis condiciones creadas (3*2 canal de comunicación* presión temporal) en grupos de 4 personas. Los resultados muestran la importancia del tipo de tarea y del canal de comunicación para comprender la relación entre presión temporal y calidad del desempeño grupal. Se sugiere que futuros trabajos deberán introducir variables del ambiente o individuales como moduladoras para comprender la relación entre presión temporal y calidad del desempeño grupal, cuyos resultados en la literatura a menudo son contradictorios. (AU)

The aim of this paper is to study the modulator effects of task type (intellective, creative and bargaining) and communication channel on the influence of time pressure on group performance quality. For this reason, it was carried out an experiment using a sample of 124 subjects, that were randomly assigned into the six different experimental conditions (3*2 - communication channel*time pressure) in four-person groups. The results showed the relevance of type of task and communication channel in understanding the relation between time pressure and group performance quality. It is suggested that future research will must take into account environmental or individual variables as modulators to reach a better understanding of the relation between time pressure and group performance quality, whose literature results are often contradictory (AU)