DISEÑO DE UN UTILLAJE PARA LA EXTRACCIÓN DE TORNILLOS MILIMÉTRICOS DE FIJACIÓN ÓSEA BAJO LA NORMA ASTM F543 (DESIGN OF A FIXTURE FOR PULL OUT TEST OF MILLIMETRIC BONE FIXING SCREWS GUIDED BY ASTM F543 STANDARD)

Resumen Los tornillos corticales son elementos utilizados en osteosíntesis para la fijación de fracturas, la estabilidad de la fijación del tornillo es principalmente el resultado del anclaje efectivo del tornillo, una mala estabilidad lleva al fracaso de la unión del hueso. Con base en las normas ASTM F543, se diseñó un herramental para la realización de pruebas de la resistencia a la extracción en tornillos corticales, esto con la finalidad de comparar diferentes tornillos médicos utilizados en osteosíntesis. Se identificaron los principales parámetros que influyen en la resistencia a la extracción de los tornillos y se diseñó un herramental para la realización de las pruebas, el cual cumple con los parámetros asignados por la norma ASTM F 543. Palabras clave:Espuma de poliuretano, fuerza de extracción, tornillo cortical. Abstract Cortical screws are elements used in osteosynthesis for the fixation of fractures, the stability of the fixation of the screw is mainly the result of the effective anchoring of the screw, poor stability leads to failure of the bone union. Based on the ASTM F543 standards, a tool was designed to carry out tests of the resistance to extraction in cortical screws, in order to compare different medical screws used in osteosynthesis. The main parameters that influence the resistance to extraction of the screws were identified and a fixture was designed to carry out the tests, which complies with the parameters assigned by the ASTM F 543 standard. Keywords:Cortical screw, pull-out force, rigid polyurethane foam

Utilization of mechanical power and associations with clinical outcomes in brain injured patients: a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

Background: There is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes. Methods: In this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale ≤ 12 before intubation) who required mechanical ventilation (MV) ≥ 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS). Results: We included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22). Conclusions: Exposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Procedimiento administrativo en materia aduanera

El Proceso Administrativo en Materia Aduanera (PAMA), se define como el procedimiento que lleva a cabo la autoridad fiscal y que es determinado por la misma, en el cual se debe garantizar la tendencia de mercancías de procedencia extranjera y que de acuerdo a este sistema el ingreso o la salida de mercancías se haya efectuado de manera legal

Evolution of wound management throughout history

<p><strong>Background</strong></p><p>Wound management practices have evolved significantly over the course of human history. From the early remedies of the Neanderthals in 60,000 B.C. to the sophisticated techniques of contemporary medicine, the treatment of wounds has undergone various phases of evolution. This paper delves into the intricate history of wound management, spanning from ancient civilizations to the modern era.</p><p>Beginning with the significance of wound classification, the study traces the development of wound management practices in different historical periods. It highlights the role of various civilizations, such as the Sumerians and the ancient Egyptians, in the early advancements of wound care. The document extensively covers the contributions of key figures like Hippocrates and Galen, who made significant strides in the understanding and treatment of wounds.</p><p>The paper also emphasizes the critical transition from traditional and empirical wound care to a more scientific approach, as demonstrated by the works of Joseph Lister and Louis Pasteur. It discusses pivotal moments in the timeline, such as the advent of antiseptics and the recognition of the role of microorganisms in wound infections. Furthermore, it underlines the contemporary efforts to integrate advanced technologies, such as artificial intelligence, into wound management for early identification of non-healing wounds.</p><p>Overall, the paper reflects on the profound historical context of wound care and the persistent advancements that continue to shape contemporary medical practices, emphasizing the importance of understanding the historical trajectory for the effective treatment of wounds in modern medicine.</p><p> </p><p><strong>Keywords: </strong>Wounds, history of wound management, wound dressings.</p&gt

Ilustración del proceso constructivo de vías primarias, secundarias y terciarias basado en las especificaciones técnicas de construcción de carreteras del Instituto Nacional de vías (INVIAS)

: figuras, tablas ; 28 cmEsta cartilla metodológica describe a través de ilustraciones el proceso constructivo de vías primarias, secundarias y terciarias, basado en las especificaciones técnicas de construcción de carreteras del Instituto Nacional de Vías (INVIAS)PregradoIngeniero CivilIngeniería Civi

Extubation in neurocritical care patients: the ENIO international prospective study

Purpose: Neurocritical care patients receive prolonged invasive mechanical ventilation (IMV), but there is poor specific information in this high-risk population about the liberation strategies of invasive mechanical ventilation. Methods: ENIO (NCT03400904) is an international, prospective observational study, in 73 intensive care units (ICUs) in 18 countries from 2018 to 2020. Neurocritical care patients with a Glasgow Coma Score (GCS) ≤ 12, receiving IMV ≥ 24 h, undergoing extubation attempt or tracheostomy were included. The primary endpoint was extubation failure by day 5. An extubation success prediction score was created, with 2/3 of patients randomly allocated to the training cohort and 1/3 to the validation cohort. Secondary endpoints were the duration of IMV and in-ICU mortality. Results: 1512 patients were included. Among the 1193 (78.9%) patients who underwent an extubation attempt, 231 (19.4%) failures were recorded. The score for successful extubation prediction retained 20 variables as independent predictors. The area under the curve (AUC) in the training cohort was 0.79 95% confidence interval (CI95) [0.71-0.87] and 0.71 CI95 [0.61-0.81] in the validation cohort. Patients with extubation failure displayed a longer IMV duration (14 [7-21] vs 6 [3-11] days) and a higher in-ICU mortality rate (8.7% vs 2.4%). Three hundred and nineteen (21.1%) patients underwent tracheostomy without extubation attempt. Patients with direct tracheostomy displayed a longer duration of IMV and higher in-ICU mortality than patients with an extubation attempt (success and failure). Conclusions: In neurocritical care patients, extubation failure is high and is associated with unfavourable outcomes. A score could predict extubation success in multiple settings. However, it will be mandatory to validate our findings in another prospective independent cohort