Mejoría del sueño en los pacientes operados por síndrome del túnel carpiano

Introducción: Los pacientes con síndrome del túnel carpiano suelen tener síntomas nocturnos que alteran la calidad del sueño y, muchas veces, son el motivo de consulta. Se estudiaron en profundidad los cambios objetivos luego de la liberación del túnel carpiano. Sin embargo, la evidencia sobre la mejoría del sueño tras la cirugía es escasa. Consideramos que la mejoría de la calidad del sueño está directamente relacionada con el procedimiento; nuestro objetivo primario fue comprobarlo. Como objetivo secundario se evaluó si los cambios en el sueño varían según factores constitucionales o de severidad del síndrome del túnel carpiano. Materiales y Métodos: Serie prospectiva de 67 casos con síndrome del túnel carpiano e indicación de cirugía. Se dividieron grupos según edad, sexo y severidad del síndrome por electrodiagnóstico. Se evaluó la calidad del sueño con la Escala de Insomnio de Atenas antes de la cirugía y cuatro días después. Resultados: El 74,62% de los pacientes tenía alteraciones de la calidad del sueño antes de la cirugía. Se comprobó una mejoría significativa en la calidad del sueño después de la operación, en todos los casos (p <0,05). No hubo diferencias significativas en los resultados entre los grupos. Conclusiones: Clásicamente el éxito de la liberación del túnel carpiano se resume en los cambios sensitivo-motores. Sin embargo, no se apunta a la mejoría de la calidad del sueño, aunque sea el generador de la consulta. La descompresión del túnel carpiano mejora el sueño, independientemente de la edad, el sexo o la gravedad del cuadro

Artroplastia invertida lateralizada para artropatía del manguito rotador en pacientes >60 años. Resultados y complicaciones a corto plazo

Objetivo: Comunicar los resultados y las complicaciones a corto plazo de la artropatía del manguito rotador tratada con artroplastia invertida lateralizada en pacientes >60 años. Materiales y Métodos: Se identificaron retrospectivamente las artropatías del manguito rotador tratadas con prótesis invertida lateralizada entre 2015 y 2019. Criterios de inclusión: edad >60 años, adecuada función deltoidea y seguimiento mínimo de 24 meses. Antes de la cirugía y después, se registraron el rango de movilidad activa, y los puntajes de Constant-Murley y de la escala analógica visual para dolor. En las radiografías, se determinaron los grados de artrosis glenohumeral, de muescas escapulares y de aflojamiento de la prótesis. Se documentaron las complicaciones, la satisfacción con el procedimiento y la supervivencia del implante. Resultados: La serie incluyó 40 hombros operados en 38 pacientes (edad promedio 72 años, rango 61-91), con un seguimiento promedio de 25 meses. La elevación anterior aumentó de 82,63° a 136,71° (p <0,001); la rotación externa, de 16,59° a 32,11° (p <0,001) y la rotación interna, de L5 a L3 (p <0,001). El puntaje de Constant-Murley ascendió de 28,25 a 69,97 (p <0,001) y el de dolor disminuyó de 8,34 precirugía a 1,26 poscirugía (p <0,001). La tasa de complicaciones fue del 12,5% y la supervivencia del implante, del 97,4%. Conclusiones: La artroplastia invertida lateralizada es una excelente alternativa quirúrgica para la artropatía del manguito rotador en pacientes >60 años, los resultados son satisfactorios, la tasa de complicaciones es aceptable y la supervivencia del implante es del 97,4%

Injerto perióstico vascularizado de cúbito para el tratamiento de la seudoartrosis recalcitrante de radio: A propósito de un caso

Se han desarrollado distintas técnicas para estimular la consolidación ósea en las seudoartrosis de huesos largos, como el uso de injerto óseo molido o estructural, injertos vascularizados o la técnica de membrana inducida. En 2018, Barrera-Ochoa describió la anatomía de un injerto perióstico vascularizado de cúbito con eje vascular interóseo posterior, y mostró su experiencia clínica inicial en niños utilizándolo en una seudoartrosis atrófica de radio y un defecto óseo después de la exéresis de un tumor de Ewing. Presentamos nuestra experiencia con el injerto perióstico vascularizado de cúbito para el tratamiento de una seudoartrosis recalcitrante en la diáfisis de radio de un paciente adulto

Tratamiento quirúrgico para fracturas bifocales de húmero Maresca tipo A2

Las fracturas bifocales de húmero son lesiones infrecuentes, más aun las que ocurren asociadas con fracturas en el húmero proximal y diáfisis. Presentamos a cuatro pacientes con fracturas bifocales de húmero proximal y diafisario (Maresca A2), la planificación quirúrgica, los detalles técnicos y sus resultados funcionales

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe

Combined searches for the production of supersymmetric top quark partners in proton-proton collisions at root s=13 TeV

A combination of searches for top squark pair production using proton-proton collision data at a center-of-mass energy of 13 TeV at the CERN LHC, corresponding to an integrated luminosity of 137 fb(-1) collected by the CMS experiment, is presented. Signatures with at least 2 jets and large missing transverse momentum are categorized into events with 0, 1, or 2 leptons. New results for regions of parameter space where the kinematical properties of top squark pair production and top quark pair production are very similar are presented. Depending on themodel, the combined result excludes a top squarkmass up to 1325 GeV for amassless neutralino, and a neutralinomass up to 700 GeV for a top squarkmass of 1150 GeV. Top squarks with masses from 145 to 295 GeV, for neutralino masses from 0 to 100 GeV, with a mass difference between the top squark and the neutralino in a window of 30 GeV around the mass of the top quark, are excluded for the first time with CMS data. The results of theses searches are also interpreted in an alternative signal model of dark matter production via a spin-0 mediator in association with a top quark pair. Upper limits are set on the cross section for mediator particle masses of up to 420 GeV

Probing effective field theory operators in the associated production of top quarks with a Z boson in multilepton final states at root s=13 TeV

Peer reviewe