Laboratory Features of Hospitalised Patients with COVID-19 in Jersey, UK.

COVID-19 is an acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date, more than 550 million cases and 6 million deaths have been reported worldwide. This study investigated the laboratory features in hospitalised patients with COVID-19 and determined risk factors for in-hospital mortality. This retrospective observational study included laboratory results of confirmed cases of hospitalised patients with SARS-CoV-2 infection in Jersey (UK) between March-December 2020 (subject to inclusion criteria), and a control group. Furthermore, COVID-19 patients were split into two sub-groups, based on outcome (non-survivors vs. survivors). Logistic regression was used to determine risk factors for in-hospital mortality. A total of 81 COVID-19 cases and 100 controls were included in this study. In the COVID-19 group, 59.3% of subjects were male, and the overall mortality was 33.3%. The main laboratory changes were the following: 95.1% of patients presented with raised C-reactive protein (p<0.001), 85% showed increased fibrinogen (p<0.001), 70% had prolonged prothrombin time (p=0.014), 51.9% suffered from lymphopenia (p<0.001), 42% had elevated gamma glutamyl transferase (p=0.011) and 35.8% demonstrated raised creatinine concentration (p=0.002). Non-survivors were older than survivors (median age: 82 vs. 74 years, p=0.003) with substantial lymphopenia (p=0.018), high creatinine level (p=0.009), and leukocytosis (p=0.018). Increased in-hospital mortality risk was 6.7-fold in patients presenting with a lymphocyte count <0.85 x109/L, 5.3-fold with red blood cell distribution width >14%, 4.9-fold with white cell count >9.5 x109/L, and 3.3-fold for those presenting with creatinine >100 µmol/L. Age ≥82 years was significantly associated with death, and male gender a risk factor for hospital admission in COVID-19. These results demonstrate that routine haematology and biochemistry tests may allow for risk-stratification of hospitalised patients with COVID-19.

Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units.

Objective: To validate the PIM3 score in Brazilian PICUs and compare its performance with the PIM2. Methods: Observational, retrospective, multicenter study, including patients younger than 16 years old admitted consecutively from October 2013 to September 2019. We assessed the Standardized Mortality Ratio (SMR), the discrimination capability (using the area under the receiver operating characteristic curve - AUROC), and the calibration. To assess the calibration, we used the calibration belt, which is a curve that represents the correlation of predicted and observed values and their 95% Confidence Interval (CI) through all the risk ranges. We also analyzed the performance of both scores in three periods: 2013-2015, 2015-2017, and 2017-2019. Results: 41,541 patients from 22 PICUs were included. Most patients aged less than 24 months (58.4%) and were admitted for medical conditions (88.6%) (respiratory conditions = 53.8%). Invasive mechanical ventilation was used in 5.8%. The median PICU length of stay was three days (IQR, 2-5), and the observed mortality was 1.8% (763 deaths). The predicted mortality by PIM3 was 1.8% (SMR 1.00; 95% CI 0.94-1.08) and by PIM2 was 2.1% (SMR 0.90; 95% CI 0.83-0.96). Both scores had good discrimination (PIM3 AUROC = 0.88 and PIM2 AUROC = 0.89). In calibration analysis, both scores overestimated mortality in the 0%-3% risk range, PIM3 tended to underestimate mortality in medium-risk patients (9%-46% risk range), and PIM2 also overestimated mortality in high-risk patients (70%-100% mortality risk). Conclusions: Both scores had a good discrimination ability but poor calibration in different ranges, which deteriorated over time in the population studied.

Use of superficial peroneal nerve graft for treating peripheral nerve injuries.

OBJECTIVE: To evaluate the clinical results from treating chronic peripheral nerve injuries using the superficial peroneal nerve as a graft donor source. METHODS: This was a study on eleven patients with peripheral nerve injuries in the upper limbs that were treated with grafts from the sensitive branch of the superficial peroneal nerve. The mean time interval between the dates of the injury and surgery was 93 days. The ulnar nerve was injured in eight cases and the median nerve in six. There were three cases of injury to both nerves. In the surgery, a longitudinal incision was made on the anterolateral face of the ankle, thus viewing the superficial peroneal nerve, which was located anteriorly to the extensor digitorum longus muscle. Proximally, the deep fascia between the extensor digitorum longus and the peroneal longus muscles was dissected. Next, the motor branch of the short peroneal muscle (one of the branches of the superficial peroneal nerve) was identified. The proximal limit of the sensitive branch was found at this point. RESULTS: The average space between the nerve stumps was 3.8 cm. The average length of the grafts was 16.44 cm. The number of segments used was two to four cables. In evaluating the recovery of sensitivity, 27.2% evolved to S2+, 54.5% to S3 and 18.1% to S3+. Regarding motor recovery, 72.7% presented grade 4 and 27.2% grade 3. There was no motor deficit in the donor area. A sensitive deficit in the lateral dorsal region of the ankle and the dorsal region of the foot was observed. None of the patients presented complaints in relation to walking. CONCLUSIONS: Use of the superficial peroneal nerve as a graft source for treating peripheral nerve injuries is safe and provides good clinical results similar to those from other nerve graft sources.

OBJETIVO: Avaliar resultados clínicos do tratamento das lesões crônicas de nervos periféricos com o nervo fibular superficial como fonte doadora de enxerto. MÉTODOS: Estudo de 11 pacientes com lesões de nervos periféricos nos membros superiores tratados com enxerto do ramo sensitivo do nervo fibular superficial, com intervalo médio de 93 dias entre a data de registro da lesão e a cirurgia. Foram observadas lesões do nervo ulnar em oito pacientes e do nervo mediano em seis. Em três ambos os nervos foram lesados. Na cirurgia faz-se incisão longitudinal na face anterolateral no tornozelo, visualiza-se o nervo fibular superficial, situado anteriormente ao músculo extensor longo dos artelhos. Proximalmente disseca-se a fáscia profunda entre os músculos extensor longo dos artelhos e o fibular longo. A seguir, identifica-se o ramo motor do músculo fibular curto, um dos ramos do nervo fibular superficial. O limite proximal do ramo sensitivo encontra-se nesse ponto. RESULTADOS: A média do espaço entre os cotos nervosos foi de 3,8 cm, comprimento médio dos enxertos de 16,44 cm, número de segmentos usados de dois a quatro cabos. Na avaliação da recuperação da sensibilidade, 27,2% evoluíram para S2+, 54,5% para S3 e 18,1% para S3+. Quanto à recuperação motora, 72,7% apresentavam grau 4 e 27,2%, grau 3. Não houve déficit motor da área doadora, observou-se déficit sensitivo na região dorso lateral do tornozelo e dorsal do pé. Nenhum paciente apresentou queixas à deambulação. CONCLUSÕES: O uso do nervo fibular superficial no tratamento das lesões de nervos periféricos como fonte de enxerto é seguro e proporciona resultados clínicos semelhantes a outras fontes de enxerto de nervos.

Use of superficial peroneal nerve graft for treating peripheral nerve injuries / Emprego do enxerto do nervo fibular superficial para tratamento de lesões de nervos periféricos

To evaluate the clinical results from treating chronic peripheral nerve injuries using the superficial peroneal nerve as a graft donor source. METHODS: This was a study on eleven patients with peripheral nerve injuries in the upper limbs that were treated with grafts from the sensitive branch of the superficial peroneal nerve. The mean time interval between the dates of the injury and surgery was 93 days. The ulnar nerve was injured in eight cases and the median nerve in six. There were three cases of injury to both nerves. In the surgery, a longitudinal incision was made on the anterolateral face of the ankle, thus viewing the superficial peroneal nerve, which was located anteriorly to the extensor digitorum longus muscle. Proximally, the deep fascia between the extensor digitorum longus and the peroneal longus muscles was dissected. Next, the motor branch of the short peroneal muscle (one of the branches of the superficial peroneal nerve) was identified. The proximal limit of the sensitive branch was found at this point. RESULTS: The average space between the nerve stumps was 3.8 cm. The average length of the grafts was 16.44 cm. The number of segments used was two to four cables. In evaluating the recovery of sensitivity, 27.2% evolved to S2+, 54.5% to S3 and 18.1% to S3+. Regarding motor recovery, 72.7% presented grade 4 and 27.2% grade 3. There was no motor deficit in the donor area. A sensitive deficit in the lateral dorsal region of the ankle and the dorsal region of the foot was observed. None of the patients presented complaints in relation to walking. CONCLUSIONS: Use of the superficial peroneal nerve as a graft source for treating peripheral nerve injuries is safe and provides good clinical results similar to those from other nerve graft sources.

Avaliar resultados clínicos do tratamento das lesões crônicas de nervos periféricos com o nervo fibular superficial como fonte doadora de enxerto. MÉTODOS: Estudo de 11 pacientes com lesões de nervos periféricos nos membros superiores tratados com enxerto do ramo sensitivo do nervo fibular superficial, com intervalo médio de 93 dias entre a data de registro da lesão e a cirurgia. Foram observadas lesões do nervo ulnar em oito pacientes e do nervo mediano em seis. Em três ambos os nervos foram lesados. Na cirurgia faz-se incisão longitudinal na face anterolateral no tornozelo, visualiza-se o nervo fibular superficial, situado anteriormente ao músculo extensor longo dos artelhos. Proximalmente disseca-se a fáscia profunda entre os músculos extensor longo dos artelhos e o fibular longo. A seguir, identifica-se o ramo motor do músculo fibular curto, um dos ramos do nervo fibular superficial. O limite proximal do ramo sensitivo encontra-se nesse ponto. RESULTADOS: A média do espaço entre os cotos nervosos foi de 3,8 cm, comprimento médio dos enxertos de 16,44 cm, número de segmentos usados de dois a quatro cabos. Na avaliação da recuperação da sensibilidade, 27,2% evoluíram para S2+, 54,5% para S3 e 18,1% para S3+. Quanto à recuperação motora, 72,7% apresentavam grau 4 e 27,2%, grau 3. Não houve déficit motor da área doadora, observou-se déficit sensitivo na região dorso lateral do tornozelo e dorsal do pé. Nenhum paciente apresentou queixas à deambulação. CONCLUSÕES: O uso do nervo fibular superficial no tratamento das lesões de nervos periféricos como fonte de enxerto é seguro e proporciona resultados clínicos semelhantes a outras fontes de enxerto de nervos.

The Anatomy and Morphology of the Superficial Peroneal Nerve.

Background Knowledge on the anatomical and morphological characteristics of the superficial peroneal nerve is amenable to further refinement. This cadaveric study aimed to further evaluate anatomical and morphological characteristics of the superficial peroneal nerve. Methods In this study, 10 lower limbs from five fresh cadavers were dissected. The anatomical characteristics of the superficial peroneal nerve were identified. Nerve segments were submitted for histological and morphometric analyses, and nerve thicknesses and number of fascicles were assessed. Results Regarding the superficial peroneal nerve's bifurcation, 80% of the terminal branches were distal to the point of emergence from the fascia. In 90% limbs, two sensory branches were observed immediately after the distal bifurcation of the superficial peroneal nerve. The mean distance from the fibular head to the superficial peroneal nerve's emergence from the fascia was 24.6 cm and mean nerve thickness at this point was 0.3 cm. The mean distance between the lateral malleolus and the main nerve trunk at the ankle was 4.68 cm. The mean distance from the motor branch of the peroneus brevis to the lateral malleolus was 29.3 cm. Morphometric analyses revealed an average five nerve bundles at the broadest nerve diameter (2.6 mm). Conclusion The anatomical and morphometrical characteristics of the superficial peroneal nerve indicate that it may be a safe and useful donor for autologous graft treatment of peripheral nerve injuries. Our morphological study shows a median of five fascicles, and that the thickest diameter of the nerve was 2.6 mm at the emergence from the deep to the superficial compartment.

Treatment of Preiser disease with vascularized bone graft from the distal radius: a report of two cases.

The authors report two cases of women with Preiser disease treated with dorsal distal radius vascularized grafts. In the first case, after minor trauma, the patient had pain in the left wrist of insidious onset and evolution with significant worsening. The radiographic examination showed increased density of the proximal pole of the scaphoid, and magnetic resonance imaging (MRI) showed partial necrosis. Intraoperatively, as the integrity of the cartilage of the proximal pole of the scaphoid was observed, dorsal vascularized distal radius graft was performed using the 1,2 intercompartmental supraretinacular artery. In 4 months postoperatively, MRI showed almost total integration of the graft, and 1 year after surgery, the patient was asymptomatic, with normal mobility of the operated wrist and imaging showing a normal scaphoid. The second case had similar history and clinical picture, but the radiographs showed narrowing and diffuse sclerosis and also osteolytic areas in the proximal pole of the scaphoid; MRI showed diffuse necrosis. The same graft technique was used, considering that there was a good cartilaginous coverage of the scaphoid. After 9 years of follow-up, the patients remain free of pain or functional limitations. In such cases, the vascularized graft technique was effective and, therefore, a good therapeutic option, provided that there is no degenerative changes in the carpus and, especially, the cartilage of the proximal pole is viable.

Ambient pressure colossal magnetocaloric effect tuned by composition in Mn(1-x)Fe(x)As.

The magnetocaloric effect (MCE) is the basis for magnetic refrigeration, and can replace conventional gas compression technology due to its superior efficiency and environment friendliness. MCE materials must exhibit a large temperature variation in response to an adiabatic magnetic-field variation and a large isothermal entropic effect is also expected. In this respect, MnAs shows the colossal MCE, but the effect appears under high pressures. In this work, we report on the properties of Mn(1-x)Fe(x)As that exhibit the colossal effect at ambient pressure. The MCE peak varies from 285 K to 310 K depending on the Fe concentration. Although a large thermal hysteresis is observed, the colossal effect at ambient pressure brings layered magnetic regenerators with huge refrigerating power closer to practical applications around room temperature.

Pressure-induced colossal magnetocaloric effect in MnAs.

To present day, the maximum magnetocaloric effect (MCE) at room temperature for a magnetic field change of 5 T is 40 J/(kg K) for MnAs. In this Letter we present colossal MCE measurements on MnAs under pressure, reaching values up to 267 J/(kg K), far greater than the magnetic limit arising from the assumption of magnetic field independence of the lattice and electronic entropy contributions. The origin of the effect is the contribution to the entropy variation coming from the lattice through the magnetoelastic coupling.

Influence of highly purified preparations of hyaluronic acid on peripheral nerve regenrations in vivo

The tubulization repair technique is a useful model for studying perpheral nerve regeneration since it provides quantifiable parameters for assessing the effects of exogenously applied substances on nerve repair. In this study, we observed that the local administration of hyalutonic acid (HA) in a tubular prosthesis at the time of implantaton significantly improved the repair process, and that this effect was dependent on the viscosity of the HA preparation. The sciatic nerve of C57BL/6J mice was transected and the proximal and distal nerve stumps were sutured into a polyethylene tube (PT, 0.76mm i.d.) to bridge a nerve gap of 4 mm. The tubes were implanted either empty, or filled with a low-viscosity (MW = 450 - 1000 kDa) commercial preparatin of HA. After 4 weeks, the PT with the regenerating nerve cables were processed for histological analysis and the total number of myelinated axons was counted using a computer-controlled system. Low-viscosity HA significantly increased peripheral axon regeneration (2191 +- 82 myelinated axons, mean +- SEM) compared to the group with epty tube implants (1597 +- 80). This enhanced regeneratin was not observed in the group implanted with tubes containing high-viscosity HA (1643 +- 69). The stimulatory effect of exogenous HA on nerve regeneration could be due to its activity on non-neural cell proliferation, migration and differentiation which would lead to faster ingrowth of regenerating axons.

Dor anterior do joelho da quarta à sexta décadas da vida / Anterior knee pain from the fourth to sixth decades of life

Os autores abordam a dor anterior do joelho da quarta à sexta década da vida em 117 joelhos, de 102 indivíduos, através de estudo semiológico e epidemiológico. Inter-relacionam as diferentes patologias causadoras, suas manifestaçöes e conseqüências. Ressaltam a importância do diagnóstico diferencial, da associaçäo das patologias, da freqüência com que estas se manifestam nas diferentes faixas etárias e a sua relaçäo com a osteoartrite degenerativa e patela alta, esperando contribuir para um melhor planejamento terapêutico.