Utilización de la cestilla de Moss en el tratamiento de fracturas patológicas vertebrales

Las fracturas patológicas vertebrales pueden inducir radículo o mielopatía compresiva, inestabilidad y deformidad, de tal forma que el objetivo del tratamiento consistiría en restablecer lo más rápidamente posible la anatomía y función. En este sentido la utilización de una malla cilindrica de titanio como la «cestilla de Moss» consigue una estabilidad inmediata y permite la carga precoz. Presentamos un estudio retrospectivo de 6 pacientes afectos de fractura patológica vertebral intervenidos mediante abordaje anterior y estabilización instrumentada combinada con la «cestilla de Moss» rellena de injerto óseo o cemento acrílico. La valoración clínica se realiza subjetivamente por la presencia de dolor y neurológicamente según los grados de Frankel pre y postoperatorios. Radiológicamente se valora la corrección de la cifosis/lordosis/acuñamiento según el método de Cobb. La utilización de la «cestilla de Moss» en fracturas patológicas vertebrales consigue una estabilidad completa sin dependencia de la fusión ósea.Pathological spinal fractures could induce neurological deficit, instability and deformity. Therefore, the objective of the treatment consists of re-establishing the most quickly possible the anatomy and normal function. In this sense, the utilization of a cylindrical mesh of titanium, like the Moss's mesh, provide an immediate stability permiting early loading. We report a retrospective study of 6 patients with pathological spinal fracture operated by anterior decompression and spine stabilization using the Moss's mesh padded of bone graft acrylic cement. Clinical assessment was made subjectively for the presence of pain and neurologic ally according to pre and postoperatively Frankel's grades. The correction of the kyphosis, lordosis and vertebral collapse was assessed according to the Cobb's method. The utilization of the Moss's mesh in pathological spinal fractures provides a complete stability without dependence of the status of bone fusion

Prospective Telehealth Analysis of Functional Performance, Frailty, Quality of Life, and Mental Health after COVID-19 hospitalization

Background COVID-19 is a global pandemic with poorly understood long-term consequences. Determining the trajectory of recovery following COVID-19 hospitalization is critical for prioritizing care, allocating resources, facilitating prognosis, and informing rehabilitation. The purpose of this study was to prospectively evaluate recovery following COVID-19 hospitalization. Methods Participants age 18 years or older who were hospitalized for ≥24 h due to COVID-19 completed phone/video call virtual assessments (including the 10-time chair rise test) and survey forms at three time points (2–6, 12, and 18 weeks) after hospital discharge. Univariate logistic and linear regression models assessed the associations of the outcomes with primary predictors (categorical age, sex, race/ethnicity group, and categorical pre-hospitalization frailty) at baseline; the same were used to assess differences in change from week 2–6 (continuous outcomes) or outcome persistence/worsening (categorical) at last contact. Results One hundred nine adults (age 53.0 [standard deviation 13.1]; 53% female) participated including 43 (39%) age 60 or greater; 59% identified as an ethnic and/or racial minority. Over 18 weeks, the mean time to complete the 10-time chair rise test decreased (i.e., improved) by 6.0 s (95% CI: 4.1, 7.9 s; p \u3c 0.001); this change did not differ by pre-hospital frailty, race/ethnicity group, or sex, but those age ≥ 60 had greater improvement. At weeks 2–6, 67% of participants reported a worse Clinical Frailty Scale category compared to their pre-hospitalization level, whereas 42% reported a worse frailty score at 18 weeks. Participants who did not return to pre-hospitalization levels were more likely to be female, younger, and report a pre-hospitalization category of ‘very fit’ or ‘well’. Conclusions We found that functional performance improved from weeks 2–6 to 18 weeks of follow-up; that incident clinical frailty developed in some individuals following COVID-19; and that age, sex, race/ethnicity, and pre-hospitalization frailty status may impact recovery from COVID-19. Notably, individuals age 60 and older were more likely than those under age 45 years to return to their pre-hospitalization status and to make greater improvements in functional performance. The results of the present study provide insight into the trajectory of recovery among a representative cohort of individuals hospitalized due to COVID-19. Background Coronavirus disease (COVID)-19 is a global pandemic with poorly understood long-term consequences. Recent data suggest that even mild cases of COVID-19 can result in significant long-term morbidity [1]. Determining the trajectory of recovery in patients following COVID-19 hospitalization is critical for prioritizing care, allocating resources, facilitating prognosis, and informing rehabilitation

Beyond undetectable: modeling the clinical benefit of improved antiretroviral adherence in persons with human immunodeficiency virus with virologic suppression

BACKGROUND: Incomplete antiretroviral therapy (ART) adherence has been linked to deleterious immunologic, inflammatory, and clinical consequences, even among virally suppressed (<50 copies/mL) persons with human immunodeficiency virus (PWH). The impact of improving adherence in the risk of severe non-AIDS events (SNAEs) and death in this population is unknown. METHODS: We estimated the reduction in the risk of SNAEs or death resulting from an increase in ART adherence by (1) applying existing data on the association between adherence with high residual inflammation/coagulopathy in virally suppressed PWH, and (2) using a Cox proportional hazards model derived from changes in plasma interleukin 6 (IL-6) and D-dimer from 3 randomized clinical trials. Comparatively, assuming 100% ART adherence in a PWH who achieves viral suppression, we estimated the number of persons in whom a decrease in adherence to <100% would need to be observed for an additional SNAE or death event to occur during 3- and 5-year follow-up. RESULTS: Increasing ART adherence to 100% in PWH who are suppressed on ART despite imperfect adherence translated into a 6%-37% reduction in the risk of SNAEs or death. Comparatively, based on an anticipated 12% increase in IL-6, 254 and 165 PWH would need to decrease their adherence from 100% to <100% for an additional event to occur over 3- and 5-year follow-up, respectively. CONCLUSIONS: Modest gains in ART adherence could have clinical benefits beyond virologic suppression. Increasing ART adherence (eg, via an intervention or switch to long-acting ART) in PWH who remain virally suppressed despite incomplete adherence should be evaluated

Ciudades populares en disputa: ¿Acceso a suelo urbano para todos?

La presente colección Ciudades de la Gente representa a hombres y mujeres cuya cultura popular, producto de las mezclas de todos aquellos que vivían y otros que han llegado a nuestros territorios, han hecho de lugares declarados como no aptos, lugares donde vivir, y han creado dentro de nuestras ciudades, la extensión de lo distinto. Son hombres y mujeres cuyo trabajo, el que tienen para aportar, junto al de otros y otras de su misma condición, les ha permitido autoproducir interesantes y sin duda bellos espacios donde convivir. Los profesores e investigadores miembros del Grupo de Trabajo Habitat Popular e Inclusión Social de CLACSO, nos unimos a todos aquellos hacedores que, superando los miedos y con deseos de avanzar, se atreven a caminar por lo desconocido y a no conformarse con lo conocido de otras realidades, buscando en conjunto afirmar, como derechos universales, las posibilidades de vidas dignas y de construcciones colectivas dentro de nuestras ciudades. Emprendemos la tarea de describir e interpretar el habitat popular y la inclusión social, abriendo posibilidades para que, experimentados y debutantes líderes populares e investigadores, hablen sobre "las ciudades de la gente" de muy diversos modos

Association of Suboptimal Antiretroviral Therapy Adherence With Inflammation in Virologically Suppressed Individuals Enrolled in the SMART Study

Suboptimal (ie, <100%) antiretroviral therapy (ART) adherence has been associated with heightened inflammation in cohort studies, even among people with virologic suppression. We aimed to evaluate this association among participants in the Strategies for Management of Antiretroviral Therapy (SMART) study who had virologic suppression (HIV-1 VL < 200 copies/mL) at enrollment. Based on self-reported adherence (7-day recall), plasma concentrations of interleukin 6 and D-dimer were 9% (95% confidence interval [CI], 1%-18%; P = .02) and 11% (95% CI, 1%-22%; P = .03) higher in participants who reported suboptimal vs 100% adherence, respectively. These findings confirm previous observations and support the hypothesis that suboptimal ART adherence, even in the context of virologic suppression, may have significant biological consequences. ClinicalTrials.gov number NCT00027352

Incomplete ART adherence is associated with higher inflammation in individuals who achieved virologic suppression in the START study

INTRODUCTION: Suboptimal ART adherence, despite HIV viral suppression, has been associated with chronic residual inflammation. Whether this association extends to individuals who initiate ART during early HIV infection remains unknown, which was the objective of this study. METHODS: Plasma levels of interleukin‐6 (IL‐6), high‐sensitivity C‐reactive protein, serum amyloid A protein (SAA), IL‐27, soluble intercellular adhesion molecule‐1, soluble vascular adhesion molecule‐1, D‐dimer and the CD4+/CD8+ T‐cell ratio, were analysed at baseline and eight months after ART initiation in treatment‐naïve participants with HIV and CD4+ T‐cells >500 cells/mm^{3} enrolled in the immediate arm of START. Adherence was assessed by seven‐day self‐report. Multivariable linear regression was utilized to analyse the association between ART adherence and each biomarker at the eight‐month visit in participants who achieved virologic suppression (<50 copies/mL). RESULTS: We evaluated 1627 participants (422 female) who achieved virologic suppression at the eight‐month visit in the period between 2009 and 2013. Median (IQR) CD4+ T‐cell count before ART was 651 (585, 769) cells/mm^{3}. Incomplete adherence was reported in 109 (7%) participants at the eight month visit. After adjusting for covariates, plasma IL‐6 was 1.12 (95% CI, 1.00 to 1.26; p = 0.047) fold higher in participants reporting incomplete versus 100% adherence. A similar association for SAA was observed in an exploratory analysis (1.29 (95% CI 1.04 to 1.60); p = 0.02). No significant differences in other biomarkers were observed. CONCLUSIONS: Incomplete ART adherence was associated with higher IL‐6 levels in individuals who achieved virologic suppression early after ART initiation in START. A potential similar association for SAA requires confirmation. These findings suggest a role for identifying strategies to maximize ART adherence even during virologic suppression. ClinicalTrials.gov number: NCT00867048

Dose Response for Starting and Stopping HIV Preexposure Prophylaxis for Men Who Have Sex With Men

Background. This study estimated the number of daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) doses required to achieve and maintain (after discontinuation) intracellular drug concentrations that protect against human immunodeficiency virus (HIV) infection for men who have sex with men (MSM). Methods. Tenofovir diphosphate (TFV-DP) concentrations in peripheral blood mononuclear cells (PBMCs) and rectal mononuclear cells from an intensive pharmacokinetic study (&quot;Cell-PrEP&quot; [ preexposure prophylaxis]) of 30 days of daily TDF/FTC followed by 30 days off drug were evaluated. A regression formula for HIV risk reduction derived from PBMCs collected in the preexposure prophylaxis initiative study was used to calculate inferred risk reduction. The time required to reach steady state for TFV-DP in rectal mononuclear cells was also determined. Results. Twenty-one HIV-uninfected adults participated in Cell-PrEP. The inferred HIV risk reduction, based on PBMC TFV-DP concentration, reached 99% (95% confidence interval [CI], 69%-100%) after 5 daily doses, and remained &gt;90% for 7 days after stopping drug from steady-state conditions. The proportion of participants reaching the 90% effective concentration (EC 90 ) was 77% after 5 doses and 89% after 7 doses. The percentage of steady state for natural log [TFV-DP] in rectal mononuclear cells was 88% (95% CI, 66%-94%) after 5 doses and 94% (95% CI, 78%-98%) after 7 doses. Conclusions. High PrEP activity for MSM was achieved by approximately 1 week of daily dosing. Although effective intracellular drug concentrations persist for several days after stopping PrEP, a reasonable recommendation is to continue PrEP dosing for 4 weeks after the last potential HIV exposure, similar to recommendations for postexposure prophylaxis

Status of QUBIC, the Q&U Bolometer for Cosmology

The Q&U Bolometric Interferometer for Cosmology (QUBIC) is a novel kind of polarimeter optimized for the measurement of the B-mode polarization of the Cosmic Microwave Back-ground (CMB), which is one of the major challenges of observational cosmology. The signal is expected to be of the order of a few tens of nK, prone to instrumental systematic effects and polluted by various astrophysical foregrounds which can only be controlled through multichroic observations. QUBIC is designed to address these observational issues with a novel approach that combines the advantages of interferometry in terms of control of instrumental systematics with those of bolometric detectors in terms of wide-band, background-limited sensitivity.Comment: Contribution to the 2022 Cosmology session of the 33rd Rencontres de Blois. arXiv admin note: substantial text overlap with arXiv:2203.0894