Complicaciones tras el enclavado de Ender en las fracturas trocantéreas

—Se realizó el análisis de las complicaciones de 100 casos consecutivos de pacientes con fractura trocantérea del fémur intervenidos mediante clavos de Ender, con un seguimiento postoperatorio medio de 10 meses. Hubo 75 mujeres y 25 hombres, con una media de edad de 81 años. Según la clasificación de Jensen un 27% eran estables y un 73% inestables. Se obtuvieron un 32% de complicaciones y errores de técnica intraoperatorios, un 39% de migraciones distales, un 3% de migraciones proximales y un 11% de consolidaciones viciosas en varo. Todo ello se tradujo en un 21% de reintervenciones.The rate and type of complications following Ender nailing in a series of 100 consecutive patients with trochanteric hip fractures were analysed. There were 75 women and 25 men with a mean age of 81 years. According to Jensen classification, 27% were stable fractures and 73% unstable. There were registered 32% of intraoperative complications and technical errors, 39% of distal migration of nails, 3% of proximal migrations with perforations of the femoral head and 11% of healing malpositions in varus. The rale of reoperations was 21%

Técnica de Ender y tornillo-placa deslizante a compresión en el tratamiento de las fracturas trocantéreas

Se realizó un estudio comparativo de 195 fracturas troncantéreas del fémur tratadas quirúrgicamente de las que 112 lo fueron mediante enclavado endomedular de Ender y 83 mediante tornillo-placa deslizante a compresión (TPDC). No encontramos diferencias significativas de las pérdidas sanguíneas entre las dos técnicas. El TPDC presentó mejores resultados funcionales salvo en pacientes mayores de 80 años en que son similares ambas técnicas. El enclavado Ender presentó mayor número de complicaciones mecánicas y reintervenciones.A comparative study on 195 throchanttric hip fractures treated Esther by Ender's mailing (112 cases) and slidding screw-plate (83 cases) were performed. There were no statistically significant differences between the two techniques regarding blood loosening. The slidding screw-plate showed better functional results, except in cases over 80 years old where both techniques were found to be similar. Ender's nailing disclosed a higher number of mechanical and reoperations

Prevalencia en nuestro medio de las deformidades dinámicas posicionales del hallux como secuela de las fracturas de tercio medio y distal de tibia

Dynamic positional deformity of the hallux is a relatively new disease, precisely because of its innovative nature and dynamics may go unnoticed to clinicians. It is because of this, that the limited literature available stresses the importance of making an active search for this pathology in our daily practice. The purpose of this study is to estimate the prevalence of these deformities at the University Hospital Dr. Peset of Valencia as well as make an analysis of their management. An analytical, descriptive and retrospective study was designed in which patients admitted in our center during 2014 and 2015 with medium and distal third tibia fracture were analyzed searching for dynamics positional deformities of the hallux. We found a total of 5 compatible cases from 42 analyzed tibia fractures. This may indicate that as expected dynamic positional deformity of the hallux could be an underrated disease in our medium

Selective Pressure by Rifampicin Modulates Mutation Rates and Evolutionary Trajectories of Mycobacterial Genomes

Resistance to the frontline antibiotic rifampicin constitutes a challenge to the treatment and control of tuberculosis. Here, we analyzed the mutational landscape of Mycobacterium smegmatis during long-term evolution with increasing concentrations of rifampicin, using a mutation accumulation assay combined with whole-genome sequencing. Antibiotic treatment enhanced the acquisition of mutations, doubling the genome-wide mutation rate of the wild-type cells. While antibiotic exposure led to extinction of almost all wild-type lines, the hypermutable phenotype of the ΔnucS mutant strain (noncanonical mismatch repair deficient) provided an efficient response to the antibiotic, leading to high rates of survival. This adaptative advantage resulted in the emergence of higher levels of rifampicin resistance, an accelerated acquisition of drug resistance mutations in rpoB (β RNA polymerase), and a wider diversity of evolutionary pathways that led to drug resistance. Finally, this approach revealed a subset of adaptive genes under positive selection with rifampicin that could be associated with the development of antibiotic resistance. IMPORTANCE Rifampicin is the most important first-line antibiotic against mycobacterial infections, including tuberculosis, one of the top causes of death worldwide. Acquisition of rifampicin resistance constitutes a major global public health problem that makes the control of the disease challenging. Here, we performed an experimental evolution assay under antibiotic selection to analyze the response and adaptation of mycobacteria, leading to the acquisition of rifampicin resistance. This approach explored the total number of mutations that arose in the mycobacterial genomes under long-term rifampicin exposure, using whole-genome sequencing. Our results revealed the effect of rifampicin at a genomic level, identifying different mechanisms and multiple pathways leading to rifampicin resistance in mycobacteria. Moreover, this study detected that an increase in the rate of mutations led to enhanced levels of drug resistance and survival. In summary, all of these results could be useful to understand and prevent the emergence of drug-resistant isolates in mycobacterial infections.This research was funded by MCIN/AEI/10.13039/501100011033, grant PID2020-112865RB-I00, and Instituto de Salud Carlos III, grant FIS PI17/00159 (ISCIII/FEDER, UE). E.C.-S. is the recipient of a PFIS predoctoral research fellowship (FI18/00036) cofinanced by the Instituto de Salud Carlos III and the European Social Fund. A.C.-G. acknowledges financial support from the Spanish State Research Agency, AEI/10.13039/501100011033, through the “Severo Ochoa” Program for Centers of Excellence in R&D (SEV-2013-0347, SEV-2017-0712). Editorial assistance was provided by Stuart L. Rulten. Statistical consultancy was provided by Applied Statistical Department-SGAI-CSIC.S

Fracturas de Astrágalo: Evaluación Clínico-Quirúrgica

Se han revisado 13 pacientes diagnosticados de fractura de astrágalo recogidos en nuestro Servicio de Urgencias y tratados quirúrgicamente en todos los casos. De ellos se ha realizado un seguimiento clínico y radiológico. En el 46% de los casos se obtuvieron resultados satisfactorios (23% excelentes y 23% buenos). Los restantes se repartieron entre regulares (38%) y malos (16%). La necrosis avascular apareció en 3 de los 13 casos, discutiéndose el origen de esta seria complicación. Siguiendo la clasificación de WEBER, los tipos de fractura más frecuentes fueron el tipo III (38%) y el II (31%). La congruencia articular postquirúrgica del astrágalo fracturado y el tiempo de demora en la cirugía que debe ser de urgencia, se muestran como factores a considerar en la evolución ulterior del "Aviators astragalus". Se discute así mismo el valor del signo de Hawkins.Areview of 13 patients diagnosed of Talus fracture has been colected in our service of trauma emergency. All of them have been managed by surgical methods and clinical and radiologically followed up. Satisfactory results wer e obtained in 46% of the cases (23%, excellents and 23%, good results). The rest wer e regular (38%) and bad (16%). Avascular necrosis was observed in 3 of the 13 cases, discussing the origin of this serious complication. The most frequent types of fracture were type III (38%) ant type II (31%) following Weber's classification. The postsurgical articular congruency of the fractured talus and the delayed time on the surgery which must be an emergency, seem to be factors to conside r in the later evolution of the "aviators astragalus". The value of Hawkins sign is also discussed

Sperm survival and heterogeneity are correlated with fertility after intrauterine insemination in superovulated ewes

Abstract Efficient animal production involves accurate estimations of fertilizing ability. One key factor is the plasma membrane of the sperm cell, which is actively involved in the cascade of events before oocyte fusion. Many methods are used to analyze the characteristics of this membrane, including partition in aqueous two-phase systems which is an efficient method to analyze sperm surface changes accounting for loss of viability and different functional states. Centrifugal countercurrent distribution (CCCD) analysis can also be used in an aqueous two-phase system to determine the relationship between sperm parameters and in vivo fertility in ewes. In a previous work, we found a significant correlation between two post-CCCD parameters (heterogeneity and recovered viability) and field fertility when the same sample was used after cervical AI. The present study was intended to find out whether the control of several external factors that affect reproductive efficiency is able to increase the correlation coefficient between post-CCCD parameters and fertility. Thus, 90 Rasa aragonesa ewes were controlled on the same farm and received intrauterine inseminations using the same technical equipment. The fertilizing ability of the raw semen and sperm samples selected by a dextran/swim-up process was compared using a low number of spermatozoa per insemination (7 Â 10 7 ) to enhance possible fertility differences. A new post-CCCD parameter was considered; the loss of viability (LV) occurred during the CCCD process. This variable denotes the sperm surviving ability and corresponds to the difference between the total number of viable cells loaded and recovered after the CCCD run. The mean fertility of eight sperm control samples was 60% (range: 25-76%), and there was no significant correlation between standard parameters and in vivo fertility. LV ranged from 2 to 69% (average 27%) and was negatively correlated with fertility (r ¼ À0.914, P < 0.01). Ejaculate heterogeneity (H) ranged from 20 to 47% and was positively, but not significantly, correlated with fertility (r ¼ 0.391). A predictive equation for fertility was deduced by multiple analysis with a very high correlation coefficient (r ¼ 0.967), and level of significance (P < 0.005): predictive fertility PF ¼ 52.546 À 0.594 LV þ 0.665 H. The mean fertility of 13 swim-up selected samples was 63% (range: 25-86%). Again, only parameters derived from the CCCD analysis were highly correlated with fertility, especially LV and H (P < 0.05)

A multistate model and its standalone tool to predict hospital and ICU occupancy by patients with COVID-19

Objective: This study aims to build a multistate model and describe a predictive tool for estimating the daily number of intensive care unit (ICU) and hospital beds occupied by patients with coronavirus 2019 disease (COVID-19). Material and methods: The estimation is based on the simulation of patient trajectories using a multistate model where the transition probabilities between states are estimated via competing risks and cure models. The input to the tool includes the dates of COVID-19 diagnosis, admission to hospital, admission to ICU, discharge from ICU and discharge from hospital or death of positive cases from a selected initial date to the current moment. Our tool is validated using 98,496 cases positive for severe acute respiratory coronavirus 2 extracted from the Aragón Healthcare Records Database from July 1, 2020 to February 28, 2021. Results: The tool demonstrates good performance for the 7- and 14-days forecasts using the actual positive cases, and shows good accuracy among three scenarios corresponding to different stages of the pandemic: 1) up-scenario, 2) peak-scenario and 3) down-scenario. Long term predictions (two months) also show good accuracy, while those using Holt-Winters positive case estimates revealed acceptable accuracy to day 14 onwards, with relative errors of 8.8%. Discussion: In the era of the COVID-19 pandemic, hospitals must evolve in a dynamic way. Our prediction tool is designed to predict hospital occupancy to improve healthcare resource management without information about clinical history of patients. Conclusions: Our easy-to-use and freely accessible tool (https://github.com/peterman65) shows good performance and accuracy for forecasting the daily number of hospital and ICU beds required for patients with COVID-19