Comparative Efficacy of Conservative Surgery vs Minor Amputation for Diabetic Foot Osteomyelitis

BACKGROUND: There is uncertainty regarding the optimal surgical intervention for diabetic foot osteomyelitis (DFO). Conservative surgery-amputation-free resection of infected bone and soft tissues-is gaining traction as an alternative to minor amputation. Our primary objective was to explore the comparative effectiveness of conservative surgery and minor amputations in clinical failure risk 1 year after index intervention. We also aimed to explore microbiological recurrence at 1 year, and revision surgery risk over a 10-year study period. METHODS: Retrospective, single-center chart review of DFO patients undergoing either conservative surgery or minor amputation. We used multivariable Cox regression and Kaplan-Meier estimates to explore the effect of surgical intervention on clinical failure (recurrent diabetic foot infection at surgical site within 1 year after index operation), microbiological recurrence at 1 year, and revision surgery risk over a 10-year follow-up period. RESULTS: 651 patients were included (conservative surgery, n = 121; minor amputation, n = 530). Clinical failure occurred in 34 (28%) patients in the conservative surgery group, and in 111 (21%) of the minor amputation group at 1 year (P = .09). After controlling for potential confounders, we found no association between conservative surgery and clinical failure at 1 year (adjusted hazard ratio [HR] 1.3, 95% CI 0.8-2.1). We found no between-group differences in microbiological recurrence at 1 year (conservative surgery: 8 [6.6%]; minor amputation: 33 [6.2%]; P = .25; adjusted HR 1.1, 95% CI 0.5-2.6). Over the 10-year period, the conservative group underwent significantly more revision surgeries (conservative surgery: 85 [70.2%]; minor amputation: 252 [47.5%]; P < .01; adjusted HR 1.3, 95% CI 0.9-1.8). CONCLUSION: We found that with comorbidity-based patient selection, conservative surgery in the treatment of DFO was associated with the same rates of clinical failure and microbiological recurrence at 1 year, but with significantly more revision surgeries during follow-up, compared with minor amputations. LEVEL OF EVIDENCE: Level III, retrospective comparative effectiveness study

Nonuniversality of front fluctuations for compact colonies of nonmotile bacteria

The front of a compact bacterial colony growing on a Petri dish is a paradigmatic instance of non-equilibrium fluctuations in the celebrated Eden, or Kardar-Parisi-Zhang (KPZ), universality class. While in many experiments the scaling exponents crucially differ from the expected KPZ values, the source of this disagreement has remained poorly understood. We have performed growth experiments with B. subtilis 168 and E. coli ATCC 25922 under conditions leading to compact colonies in the classically alleged Eden regime, where individual motility is suppressed. Non-KPZ scaling is indeed observed for all accessible times, KPZ asymptotics being ruled out for our experiments due to the monotonic increase of front branching with time. Simulations of an effective model suggest the occurrence of transient nonuniversal scaling due to diffusive morphological instabilities, agreeing with expectations from detailed models of the relevant biological reaction-diffusion processes.This work has been supported by Ministerio de Economía y Competitividad, Agencia Estatal de Investigación, and Fondo Europeo de Desarrollo Regional (Spain and European Union) through Grants No. FIS2015- 66020-C2-1-P, FIS2015-69167-C2-1-P, FIS2015-73337-JIN, and BIO2016-79618-R, and by Comunidad Autónoma de Madrid (Spain) Grant No. NANOAVANSENS S2013/MIT302

Certainty of the Global Burden of Disease 2019 Modelled Prevalence Estimates for Musculoskeletal Conditions: A Meta-Epidemiological Study

Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prevalence evidence.Methods: Primary studies were identified using the GBD Data Input Sources Tool and their risk of bias was assessed using a validated tool. We rated the certainty of modelled prevalence estimates based on the GRADE Guidelines 30―the GRADE approach for modelled evidence.Results: Seventy-two primary studies (LBP: 67, NP: 2, knee OA: 3) underpinned the GBD estimates. Most studies had limited representativeness of their study populations, used suboptimal case definitions and applied assessment instruments with unknown psychometric properties. The certainty of modelled prevalence estimates was low, mainly due to risk of bias and indirectness.Conclusion: Beyond the risk of bias of primary input studies for LBP, NP, and knee OA in GBD 2019, the certainty of country-specific modelled prevalence estimates still have room for improvement

Prevalencia de la vía aérea difícil, en paciente con sobrepeso en cirugía general en el Hospital Escuela Antonio Lenin Fonseca, agosto–enero del año 2022

El objetivo de esta investigación fue comprobar la prevalencia de la vía aérea difícil en pacientes con sobre peso en pacientes sometidos a cirugía general en el Hospital Escuela Antonio Lenin Fonseca en periodo de agosto – enero del año 2022.Se realizó un estudio de tipo descriptivo cuantitativo en los pacientes con sobre peso, La muestra estuvo constituida por 60 pacientes en total, 4 pacientes son vía área difícil y 56 pacientes no presentaron vía aérea difícil. Teniendo en cuenta la edad de la población que predomino entre 22 a 73 años, con un peso de 52 a 100 kilogramos y un índice de masa corporal de 25 a 29.9 sobre peso y de 30 a 34.9 obesidad grado I.Se evaluaron todos los predictores de vía aérea difícil como: Circunferencia de cuello, Mallampati, Distancia Tiromentoniana, Distancia Esternomentoniana, Distancia Interincisivos, Cormack y Lehane, Test de la Mordida y Perfil Facial. Estas valoraciones se realizaron en la visita preanestesica prequirurgica, siendo el único que no se realizó en la valoración preanestesica Cormack y Lehane este se realizó dentro de quirófano para visualizar el grado de dificultad de vía aérea difícil.En nuestro estudio de prevalencia de vía aérea difícil, en pacientes con sobre peso sometidos a cirugía general, 4 paciente presentaron vía aérea difícil tanto en obesidad grado I y sobre peso, sin embargo 56 pacientes no presentaron vía aérea difíci

Prevalencia vía aérea difícil, paciente con sobrepeso en cirugía general, Hospital Escuela Antonio Lenin Fonseca, agosto–enero del año 2022

En el campo de la Anestesiología es prioritaria la seguridad del paciente, para minimizar en lo posible los riesgos y anticiparse a los problemas que pudieran surgir. El manejo de la vía aérea es uno de los pilares fundamentales en Anestesiología también en medicina de urgencia y cuidados críticos. El manejo de la vía aérea es la “A” del “ABC “en los protocolos de Reanimación y Trauma. Como objetivo principal fue comprobar la prevalencia de la vía aérea difícil en pacientes con sobre peso en pacientes sometidos a cirugía general en el Hospital Escuela Antonio Lenin Fonseca en periodo de agosto –enero del año 2022. Se realizó un estudio de tipo descriptivo cuantitativo, el estudio se realizó en el Hospital Escuela Antonio Lenin Fonseca con una muestra de 60 pacientes, de los cuales 4 pacientes presentaron vía aérea difícil y 56 pacientes no presentaron vía aérea difícil, 1 pacientes con sobre peso 2 pacientes con obesidad grado II, y un paciente con grado II. Todos los pacientes con vía aérea difícil encontrados tenían sobre peso u obesidad I, En Mallampati mayor predominio clase II, En el cormack y lehane predomino el grado I y grado II, El peso máximo fue de 100 kilogramos, una media de 83 y un mínimo de 5

Nonuniversality of front fluctuations for compact colonies of nonmotile bacteria

The front of a compact bacterial colony growing on a Petri dish is a paradigmatic instance of non-equilibrium f luctuations in the celebrated Eden, or Kardar-Parisi-Zhang (KPZ), universality class. While in many experiments the scaling exponents crucially differ from the expected KPZ values, the source of this disagreement has remained poorly understood. We have performed growth experiments with B. subtilis 168 and E. coli ATCC 25922 under conditions leading to compact colonies in the classically alleged Eden regime, where individual motility is suppressed. Non-KPZ scaling is indeed observed for all accessible times, KPZ asymptotics being ruled out for our experiments due to the monotonic increase of front branching with time. Simulations of an effective model suggest the occurrence of transient nonuniversal scaling due to diffusive morphological instabilities, agreeing with expectations from detailed models of the relevant biological reaction-diffusion processe

Certainty of the Global Burden of Disease 2019 Modelled Prevalence Estimates for Musculoskeletal Conditions: A Meta-Epidemiological Study

Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prevalence evidence. Methods: Primary studies were identified using the GBD Data Input Sources Tool and their risk of bias was assessed using a validated tool. We rated the certainty of modelled prevalence estimates based on the GRADE Guidelines 30-the GRADE approach for modelled evidence. Results: Seventy-two primary studies (LBP: 67, NP: 2, knee OA: 3) underpinned the GBD estimates. Most studies had limited representativeness of their study populations, used suboptimal case definitions and applied assessment instruments with unknown psychometric properties. The certainty of modelled prevalence estimates was low, mainly due to risk of bias and indirectness. Conclusion: Beyond the risk of bias of primary input studies for LBP, NP, and knee OA in GBD 2019, the certainty of country-specific modelled prevalence estimates still have room for improvement

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults

PURPOSE Evaluate benefits and harms of needling therapies (NT) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS Electronic databases were searched for randomized controlled trials (RCTs) assessing NT compared with placebo/sham, usual care, or no intervention (comparing interventions where the attributable effect could be isolated). We conducted meta-analyses where indicated and graded the certainty of evidence. RESULTS We screened 1831 citations and 109 full text RCTs, yeilding 37 RCTs. The certainty of evidence was low or very low across all included outcomes. There was little or no difference between NT and comparisons across most outcomes; there may be some benefits for certain outcomes. Compared with sham, NT improved health-related quality of life (HRQoL) (physical) (2 RCTs; SMD = 0.20, 95%CI 0.07; 0.32) at 6 months. Compared with no intervention, NT reduced pain at 2 weeks (21 RCTs; MD = - 1.21, 95%CI - 1.50; - 0.92) and 3 months (9 RCTs; MD = - 1.56, 95%CI - 2.80; - 0.95); and reduced functional limitations at 2 weeks (19 RCTs; SMD = - 1.39, 95%CI - 2.00; - 0.77) and 3 months (8 RCTs; SMD = - 0.57, 95%CI - 0.92; - 0.22). In older adults, NT reduced functional limitations at 2 weeks (SMD = - 1.10, 95%CI - 1.71; - 0.48) and 3 months (SMD = - 1.04, 95%CI - 1.66; - 0.43). Compared with usual care, NT reduced pain (MD = - 1.35, 95%CI - 1.86; - 0.84) and functional limitations (MD = - 2.55, 95%CI - 3.70; - 1.40) at 3 months. CONCLUSION Based on low to very low certainty evidence, adults with CPLBP experienced some benefits in pain, functioning, or HRQoL with NT; however, evidence showed little to no differences for other outcomes