Luxación tibio astragalina posteromedial sin fractura de maleolos: a propósito de un caso

Se describe un caso de luxación tibioastragalina posteromedial abierta sin fractura asociada de maleolos, en un paciente de 28 años. A los dos años del desbridamiento quirúrgico, reducción manual y reparación capsuloligamentosa, el paciente estaba libre de dolor y presentaba una función semejante a la del tobillo contralateral. Se revisa la literatura sobre el tema y se discuten los factores etiopatológicos, complicaciones y principios de tratamiento

Fracturas de cadera y diáfisis femoral ipsilaterales

Se aportan 10 casos de fracturas de cadera y diáfisis femoral ipsilaterales tratados quirúrgicamente de forma diferida con un tiempo medio de demora de 12 días (rango: 3 a 22 días). Nueve fracturas diafisarias fueron tratadas con placa AO de fémur, y una, donde la fractura de cadera asociada pasó inicialmente inadvertida, mediante un clavo de Küntscher. Las fracturas de cadera se fijaron con tornillos de esponjosa (8 casos) o clavo-placa de Richards (2 casos). En todos los pacientes se inició un programa de rehabilitación precoz. El seguimiento medio ha sido de 31 meses (rango: 12 a 84 meses). Todas las fracturas consolidaron. Las complicaciones fueron un caso de acortamiento femoral y otro de artrosis coxofemoral post-traumá- tica. En nuestra experiencia, la fijación de la fractura diafisaria con placa AO, combinada con tornillos de esponjosa o clavo-placa de Richards para la síntesis de la fractura de cadera, proporciona resultados satisfactoriosWe review 10 cases of ipsilateral hip and femoral shaft fractures. Operative treatment was performed in all cases, with an average delay of 12 days (range: 3 to 22 days). Nine femoral shaft fractures were stabilizated with an AO plate, and one, where the associated hip fracture was initially missed, with a Küntscher rod. Hip fractures were fixed with cancellous screws (8 cases) or Richards compression screw (2 cases). An early rehabilitation program was carried out in all patients. The average follow-up was 31 months (range: 12 to 84 months). All fractures healed. Complications were a case of femoral shortening an a case of post-traumatic hip osteoarthritis. In our study, the combination of AO plate for the shaft fracture with cancellous screws or Richards compression screw for the hip fracture provides good results

Lesiones traumáticas de la columna vertebral en niños

—Se ha realizado un estudio retrospectivo de los casos de traumatismo raquídeo atendidos en urgencias de nuestro centro desde 1987 hasta 1995. Del total de 159.202 niños atendidos en dicho período, el 1,8% sufría algún tipo de patología traumática de la columna, de los cuales requirieron ingreso 45 casos. Se analizan la distribución por edad, los factores etiológicos y la localización de la lesión. En 4 casos existió afectación neurológica, 2 de ellos con paraplejía completa. Los traumatismos del raquis en el niño son lesiones poco frecuentes, siendo aún más rara la afectación neurológica. fin nuestra serie el grupo más afectado fueron varones de 8 a 13 años de edad. El tratamiento conservador generalmente da resultados satisfactorios, recurriendo a la cirugía sólo en casos de severa inestabilidad o compromiso neurológico.We report the results of a restrospective study of cases with spinal trauma in children treated in our institution from 1987 until 1995. From 159,202 children under fourteen, only in 1.8% spinal traumatism was present being necessary hospitalization in 45 cases. We analized age distribution, etiologic factors, and level of the lesion. In four patients a neurologic deficit was present, two of them had complete paraplegia. Pediatric spinal trauma is a rare lesion, and associated neurologic deficit is still less common. In our scries, the most affected group was boys, from 8 to 13. Usually conservative treatment provides satisfactory results. Surgery is required only when severe unstability or neurologic deficit are present

Prospective cohort study of patients with COVID-19 hospitalized in the Internal Medicine ward of Hospital Durand: study protocol

Fil: Melendi, Santiago E. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Pérez, María M. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Salas, Cintia E. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Aguirre, Camila. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Baleta, María L. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Balsano, Facundo J. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Caldano, Mariano G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Colignon, María G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Oliveira Brasil, Thayana De. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Wolodimeroff, Nicolás de. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Déramo Aquino, Andrea I. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Fernández de Córdova, Ana G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Fontan, María B. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Galvagno, Florencia I. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Haedo, Mariana F. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Iturrieta Araya, Noelia S. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Mollinedo Cruz,Volga S. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Olivero, Agustín. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Pestalardo, Ignacio. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Ricciardi, María. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Saltos Navarrete, Jandry D. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Vera Rueda, María L. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Villaverde, María C. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Xavier, Franco B. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Lauko, Marcela. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Ujeda, Carlos. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Leis, Rocío. Hospital General de Agudos Carlos G. Durand; Argentina.INTRODUCCIÓN: Conocer los predictores de mala evolución en pacientes con Enfermedad por Coronavirus 2019 (COVID-19) permite identificar de forma temprana a los pacientes con peor pronóstico, aportando mejores herramientas a la hora de tomar decisiones clínicas. Se presenta el protocolo de un estudio de cohorte cuyo objetivo principal es identificar factores de riesgo de infección severa, critica y mortalidad en pacientes con COVID-19 internados en el Servicio de Clínica Médica del Hospital Durand (Buenos Aires, Argentina). MÉTODOS: Estudio de cohorte prospectivo con base en un único centro. Se incluirá a todos los pacientes que ingresen al servicio de Clínica Médica con diagnóstico de COVID-19 durante el periodo de estudio. Se recolectarán las características epidemiológicas, clínicas, de laboratorio, radiológicas y los datos de tratamiento, al ingreso y al momento del alta o muerte hospitalaria. El evento final primario es la muerte en la internación; los eventos secundarios son el desarrollo de enfermedad grave y enfermedad crítica, la internación en unidad cerrada y el requerimiento de asistencia respiratoria mecánica

Prospective cohort study of patients with COVID-19 hospitalized in the Internal Medicine ward of Hospital Durand: study protocol

Fil: Melendi, Santiago E. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Pérez, María M. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Salas, Cintia E. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Aguirre, Camila. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Baleta, María L. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Balsano, Facundo J. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Caldano, Mariano G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Colignon, María G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Oliveira Brasil, Thayana De. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Wolodimeroff, Nicolás de. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Déramo Aquino, Andrea I. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Fernández de Córdova, Ana G. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Fontan, María B. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Galvagno, Florencia I. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Haedo, Mariana F. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Iturrieta Araya, Noelia S. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Mollinedo Cruz,Volga S. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Olivero, Agustín. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Pestalardo, Ignacio. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Ricciardi, María. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Saltos Navarrete, Jandry D. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Vera Rueda, María L. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Villaverde, María C. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Xavier, Franco B. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Lauko, Marcela. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Ujeda, Carlos. Hospital General de Agudos Carlos G. Durand; Argentina.Fil: Leis, Rocío. Hospital General de Agudos Carlos G. Durand; Argentina.INTRODUCCIÓN: Conocer los predictores de mala evolución en pacientes con Enfermedad por Coronavirus 2019 (COVID-19) permite identificar de forma temprana a los pacientes con peor pronóstico, aportando mejores herramientas a la hora de tomar decisiones clínicas. Se presenta el protocolo de un estudio de cohorte cuyo objetivo principal es identificar factores de riesgo de infección severa, critica y mortalidad en pacientes con COVID-19 internados en el Servicio de Clínica Médica del Hospital Durand (Buenos Aires, Argentina). MÉTODOS: Estudio de cohorte prospectivo con base en un único centro. Se incluirá a todos los pacientes que ingresen al servicio de Clínica Médica con diagnóstico de COVID-19 durante el periodo de estudio. Se recolectarán las características epidemiológicas, clínicas, de laboratorio, radiológicas y los datos de tratamiento, al ingreso y al momento del alta o muerte hospitalaria. El evento final primario es la muerte en la internación; los eventos secundarios son el desarrollo de enfermedad grave y enfermedad crítica, la internación en unidad cerrada y el requerimiento de asistencia respiratoria mecánica

Reproducibility in the absence of selective reporting : An illustration from large-scale brain asymmetry research

Altres ajuts: Max Planck Society (Germany).The problem of poor reproducibility of scientific findings has received much attention over recent years, in a variety of fields including psychology and neuroscience. The problem has been partly attributed to publication bias and unwanted practices such as p-hacking. Low statistical power in individual studies is also understood to be an important factor. In a recent multisite collaborative study, we mapped brain anatomical left-right asymmetries for regional measures of surface area and cortical thickness, in 99 MRI datasets from around the world, for a total of over 17,000 participants. In the present study, we revisited these hemispheric effects from the perspective of reproducibility. Within each dataset, we considered that an effect had been reproduced when it matched the meta-analytic effect from the 98 other datasets, in terms of effect direction and significance threshold. In this sense, the results within each dataset were viewed as coming from separate studies in an "ideal publishing environment," that is, free from selective reporting and p hacking. We found an average reproducibility rate of 63.2% (SD = 22.9%, min = 22.2%, max = 97.0%). As expected, reproducibility was higher for larger effects and in larger datasets. Reproducibility was not obviously related to the age of participants, scanner field strength, FreeSurfer software version, cortical regional measurement reliability, or regional size. These findings constitute an empirical illustration of reproducibility in the absence of publication bias or p hacking, when assessing realistic biological effects in heterogeneous neuroscience data, and given typically-used sample sizes

Mapping cortical brain asymmetry in 17,141 healthy individuals worldwide via the ENIGMA Consortium.

Hemispheric asymmetry is a cardinal feature of human brain organization. Altered brain asymmetry has also been linked to some cognitive and neuropsychiatric disorders. Here, the ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Consortium presents the largest-ever analysis of cerebral cortical asymmetry and its variability across individuals. Cortical thickness and surface area were assessed in MRI scans of 17,141 healthy individuals from 99 datasets worldwide. Results revealed widespread asymmetries at both hemispheric and regional levels, with a generally thicker cortex but smaller surface area in the left hemisphere relative to the right. Regionally, asymmetries of cortical thickness and/or surface area were found in the inferior frontal gyrus, transverse temporal gyrus, parahippocampal gyrus, and entorhinal cortex. These regions are involved in lateralized functions, including language and visuospatial processing. In addition to population-level asymmetries, variability in brain asymmetry was related to sex, age, and intracranial volume. Interestingly, we did not find significant associations between asymmetries and handedness. Finally, with two independent pedigree datasets (n = 1,443 and 1,113, respectively), we found several asymmetries showing significant, replicable heritability. The structural asymmetries identified and their variabilities and heritability provide a reference resource for future studies on the genetic basis of brain asymmetry and altered laterality in cognitive, neurological, and psychiatric disorders

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030