Sindesmose tibiofibular: diagnóstico, métodos de fixação e artroscopia

Introdução: as lesões da sindesmose tibiofibular são frequentes isoladamente ou associadas a fraturas do maléolo posterior. O diagnóstico clínico é confirmado por exames de imagem. Os métodos de fixação podem ser rígidos ou dinâmicos. bjetivo: atualizar aspectos das lesões da sindesmose tibiofibular quanto ao diagnóstico, métodos de fixação e uso da abordagem artroscópica. Método: a busca e análise das informações foi realizada em um período de 61 dias (1º de outubro a 30 de novembro de 2022) e foram utilizadas as seguintes palavras: syndesmosis injury, ankle syndesmosis instability, syndesmosis instability AND tight rope ankle instability, posterior maleolar fracture. Com base nas informações obtidas, foi realizada uma revisão bibliográfica de um total de 258 artigos publicados nas bases de dados PubMed, Hinari, SciELO e Medline, utilizando o gerenciador de busca e Gerenciador de referências do EndNote. Desenvolvimento: foi feita referência a manobras clínicas para diagnóstico e classificações tomográficas em caso de fractura associada do maléolo posterior. Foram citados métodos de fixação rígidos e dinâmicos, onde foram descritas as características de cada um com base em vários fatores. As vantagens da abordagem artroscópica tanto para o diagnóstico quanto para o tratamento foram discutidas. Conclusões: as lesões da sindesmose tibiofibular distal são frequentes. Os estudos tomográficos oferecem vantagens na determinação da extensão da fratura do maléolo posterior. A abordagem artroscópica oferece múltiplas vantagens diagnósticas e terapêuticas

Fracture of the distal epiphysis of the femur

Introduction: traumatic injuries of the epiphysis are frequent in the pediatric age groups. The knee joint is one of the most involved, especially, distal femoral epiphysis. Objective: update and provide information concerning fractures of the distal femoral epiphysis. Method: search and analysis of information was gathered over a period of 61 days (April 1 to May 31, 2022) and the following words were used as a key: physeal injuries, physeal injuries and knee, physeal fractures aroundtheknee, distal femoral physeal fracture. Based on the information obtained, a bibliographic review was made of a total of 153 articles published in the PubMed, Hinari, SciELO and Medline databases, using the search engine and reference manager EndNote: 34 selected citations were used for the review, 33 of them from the last five years. Development: the most important anatomical characteristics related to the mechanism of production were mentioned. The Salter Harris classification was pointed too. The main treatment modalities, both conservative and surgical, based on the classification, were presented. Regarding complications, the most reported in the literature were described. Conclusions: fractures of the distal femoral epiphysis are complex injuries. For a better understanding, it is important to know the mechanisms of production, as well as the classification based on the degree of severity. Both conservative and surgical therapeutics have precise indications based on the degree and displacement of epiphysis affection

Behavior of osteomyelitis in pediatric patients

Introduction: osteomyelitis is an infection in the bone, most frequently affecting patients in pediatric ages, with a variety of behavior on how to reach the bone, type of germ and host response. Objective: to describe the behavior of a group of pediatric patients affected with osteomyelitis. Method: a descriptive observational study was conducted in 39 patients attended at the Hospital Provincial Pediátrico Dr. Eduardo Agramonte Piña in the city of Camagüey, from January 1 2018 to December 31 2022. Patients diagnosed with osteomyelitis throughout 60 months in total. Results: of the 39 patients studied, the male sex predominated over the female (2.2 to 1). The average age was 9 years old. The average lenght of hospital stay was 14.8 days. The most affected areas were the hands, femur and distal tibia. Surgical treatment predominated (2.2 to 1) in relation to conservative treatment. In the 86.4% of cases, hematogenous osteomyelitis was the most frequent infection. The transition to chronic osteomyelitis was the most common complication (33%). The most common isolated germ was staphylococcus aureus (in 85 % of the patients). The most indicated antimicrobials agents were cefazolin, amikacin and fostomycin (Fosfocin). Conclusions: the results of this research provided some important elements base on the epidemiological point of view for pediatric patients with osteomyelitis, also allowed the implementation of diagnostic and therapeutic strategies in this group of patients

Biodiesel Production From Bovine Tallow

Biodiesel is produced from vegetable oils, animal fats and waste oils and fats. This is a newer experience, because in 2004 the National Program for Production and Use of Biodiesel (NPPB) was created by the Ministry of Agrarian Development (MDA), but released only in 2005. This study was a micro-scale plant to process beef tallow into biodiesel, to add value to these products. It also aims to bring a gain in environmental quality for the region, as a social and environmental program to collect and saturated fat frying in oil and neighborhood associations within the school community, restaurants and hotels will be implemented. This oil is also processed into biodiesel, which will be used by the fleet of the refrigerator itself, in Santa Vitoria do Palmar, pretty or totally reducing the consumption of diesel derived from petroleum. The study of unit operations and layout for equipment sizing was performed. The economic and financial analysis was also performed to establish whether the deployment feasibility of this micro-distillery. As the economic analysis, it was observed that it is not feasible the implementation of micro-plant if the need to hire an employee to work on it only because it will increase their spending for the production of biodiesel, compared to what is spent on fuel today. Came to the conclusion that if the refrigerator to continue with the same number of existing employees, and to designate a micro-distillery only in days of production, the project becomes interesting, as there will be a salary to be paid more. Taking into account that increase the consumption of meat, or that the campaigns to collect waste oils and fats have a great impact in the municipalities, and thereby doubling the batch production, even hiring an employee, the project becomes viable Excess biofuel produced can be used in generators to reduce the amount spent on electricity. The use of tallow for biodiesel production in this refrigerator is an alternative to reduce the cost of fossil fuels and also to add value to a by-product, since it shows good yield for biofuel processing. The socio-environmental appeal that this micro-power plant will bring to the region is also important, since the whole community will benefit from the action of collecting waste oils, relieving the environment of this type of pollution

A Novel Therapy for Melanoma Developed in Mice: Transformation of Melanoma into Dendritic Cells with Listeria monocytogenes

Listeria monocytogenes is a gram-positive bacteria and human pathogen widely used in cancer immunotherapy because of its capacity to induce a specific cytotoxic T cell response in tumours. This bacterial pathogen strongly induces innate and specific immunity with the potential to overcome tumour induced tolerance and weak immunogenicity. Here, we propose a Listeria based vaccination for melanoma based in its tropism for these tumour cells and its ability to transform in vitro and in vivo melanoma cells into matured and activated dendritic cells with competent microbicidal and antigen processing abilities. This Listeria based vaccination using low doses of the pathogen caused melanoma regression by apoptosis as well as bacterial clearance. Vaccination efficacy is LLO dependent and implies the reduction of LLO-specific CD4+ T cell responses, strong stimulation of innate pro-inflammatory immune cells and a prevalence of LLO-specific CD8+ T cells involved in tumour regression and Listeria elimination. These results support the use of low doses of pathogenic Listeria as safe melanoma therapeutic vaccines that do not require antibiotics for bacterial removal

SARS-COVID-19 antibodies in pregnant women at a level III hospital in Peru

Introducción. La enfermedad de COVID-19 se propaga rápidamente. Se desconoce la seroprevalencia en mujeres embarazadas que ingresan a hospitalización y sus características propias en este tipo de población en Perú. Objetivo. Determinar la prevalencia y características clínico-epidemiológicas de gestantes con anticuerpos anti-SARS-CoV-2 en un hospital nivel III de Perú. Métodos. Estudio observacional de tipo transversal, realizado en el Instituto Nacional Materno Perinatal de Perú, entre el 15 de abril y 15 de mayo de 2020. Participaron todas las gestantes que ingresaron a hospitalización y fueron tamizadas para la infección por SARS-CoV-2 mediante pruebas serológicas, cuyos resultados fueron analizados conjuntamente con sus características clínicas y epidemiológicas, utilizando estadígrafos descriptivos e intervalos de confianza al 95%, y mediante la prueba de independencia de chi cuadrado con una significancia de 0,05

Trabectedin and low-dose radiation therapy in patients with advanced leiomyosarcoma

© The Author(s), 2024. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the Sage and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).Background and objectives: Dimensional response is an unmet need in second lines of advanced soft tissue sarcomas (STS). Indeed, the three approved drugs, pazopanib, trabectedin, and eribulin, achieved an overall response rate (ORR) of less than 10%. This fact potentially hinders the options for fast symptomatic relief or surgical rescue. The combination of trabectedin plus low-dose radiation therapy (T-XRT) demonstrated a response rate of 60% in phase I/II trial, while real-life data achieved 32.5% ORR, probably due to a more relaxed timing between treatments. These results were obtained in progressing and advanced STS. In this study, the merged databases (trial plus real life) have been analyzed, with a special focus on leiomyosarcoma patients. Design and methods: As responses were seen in a wide range of sarcoma histologies (11), this study planned to analyze whether leiomyosarcoma, the largest subtype with 26 cases (30.6%) in this series, exhibited a better clinical outcome with this therapeutic strategy. In addition, four advanced and progressing leiomyosarcoma patients, all with extraordinarily long progression-free survival of over 18 months, were collected. Results: A total of 847 cycles of trabectedin were administered to 85 patients, with the median number of cycles per patient being 7 (1–45+). A trend toward a longer progression-free survival (PFS) was observed in leiomyosarcoma patients with median PFS (mPFS) of 9.9 months [95% confidence interval (CI): 1.1–18.7] versus 5.6 months (95% CI: 3.2–7.9) for the remaining histologies, p = 0.25. When leiomyosarcoma and liposarcoma were grouped, this difference reached statistical significance, probably due to the special sensitivity of myxoid liposarcoma. The mPFS for L-sarcomas was 12.7 months (95% CI: 7–18.5) versus 4.3 months (95% CI: 3.3–5.3) for the remaining histologies, p = 0.001. Cases with long-lasting disease control are detected among leiomyosarcoma patients. Conclusion: Even when extraordinarily long-lasting responses do exist among leiomyosarcoma patients treated with T-XR, we were unable to demonstrate a significant difference favoring leiomyosarcoma patients in clinical outcomes.The present study was funded by PharmaMar.Peer reviewe

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

El Banco nacional de San Carlos en el Virreinato del Perú

La primera institución que emitió billetes en el Perú fue el Banco Auxiliar de PapelMoneda, mejor conocido como el Banco de la Emancipación, fundado el 14 de diciembre de 1821,por decreto del general José de San Martín, no obstante, muy pocas fuentes se refieren al primerintento de instalar una institución bancaria en el Perú, que se produjo a principios de la década de1780, y que respondió a la iniciativa del rey Carlos III de España, con el propósito de salvar laangustiosa situación financiera del erario hispano como consecuencia, entre otras razones, de lalarga guerra sostenida con la Gran Bretaña. El objetivo de este artículo es desarrollar un primeracercamiento a los eventos que sucedieron en el virreinato del Perú, respecto a la fallida instalacióndel Banco Nacional de San Carlos, muchos de los cuales han permanecido inéditos, incluso para losinvestigadores de la notafilia y de nuestra historia bancaria.The first institution that issued banknotes in Peru was the Auxiliary Bank of Papel Moneda, better known as the Bank of Emancipation, founded on December 14, 1821, by decree of General José de San Martín, however, very few sources refer to the first attempt to install a banking institution in Peru, which occurred in the early 1780s, and which responded to the initiative of King Carlos III of Spain, with the purpose of saving the anguished financial situation of the hispanic treasury as consequence, among other reasons, of the long war with Great Britain. The objective of this article is to develop a first approach to the events that took place in the viceroyalty of Peru, with respect to the failed installation of the National Bank of San Carlos, many of which have remained unpublished, even for the researchers of notafilia and our banking history