Compartment Syndrome Related to Patient Positioning in the Surgical Treatment of Urolithiasis

The incidence of urolithiasis is progressively increasing worldwide, as is the surgical treatment of urinary stones. The most frequent surgery for urolithiasis is ureterorenoscopy, which is performed in the lithotomy position. This position is also used in the endoscopic approach to bladder stones. Lateral decubitus is rarely used in the treatment of urinary stones. In the case of complex kidney stones, the gold standard treatment is percutaneous nephrolithotomy. This surgery has traditionally been performed in the prone position. However, the use of the supine (Valdivia) position is increasing in recent times. Furthermore, the Galdakao-modified supine Valdivia position has been widely used for percutaneous nephrolithotomy since it was described by Ibarluzea et al. in 2007. Treatment of kidney and ureteral stones simultaneously is allowed in both supine positions. In addition, they allow the removal of encrusted stents and the easy placement of double J stents and, in the case of the Galdakao-modified supine Valdivia position, percutaneous nephrostomies. Compartment syndrome is a rare complication in the lithotomy position, but scarcely described in the supine position. This especially applies to the Galdakao-modified supine Valdivia position, in which the lower limbs are in moderate flexion, with the ipsilateral lower limb in a slightly lower position relative to the other. This complication can lead to skin necrosis, myoglobinuric renal failure, amputation, permanent neuromuscular dysfunction, and even death. Risk factors include Body Mass Index, male gender, obesity, increased muscle mass, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, lack of operative experience, significant bleeding during surgery, hypothermia, acidemia, combination general-spinal anesthesia, prolonged surgical time, systemic hypotension, ASA (American Society of Anesthesiologists) class or vasoconstrictor drugs. Therefore, compartment syndrome of the leg is a potentially devastating complication that must be suspected and treated through early decompression of the compartment by four compartment fasciotomy. Preventive measures reduce the incidence of this condition

The effect of early treatment with ivermectin on viral load, symptoms and humoral response in patients with non-severe COVID-19: A pilot, double-blind, placebo-controlled, randomized clinical trial.

Background Ivermectin inhibits the replication of SARS-CoV-2 in vitro at concentrations not readily achievable with currently approved doses. There is limited evidence to support its clinical use in COVID-19 patients. We conducted a Pilot, randomized, double-blind, placebo-controlled trial to evaluate the efficacy of a single dose of ivermectin reduce the transmission of SARS-CoV-2 when administered early after disease onset. Methods Consecutive patients with non-severe COVID-19 and no risk factors for complicated disease attending the emergency room of the Clínica Universidad de Navarra between July 31, 2020 and September 11, 2020 were enrolled. All enrollments occurred within 72 h of onset of fever or cough. Patients were randomized 1:1 to receive ivermectin, 400 mcg/kg, single dose (n = 12) or placebo (n = 12). The primary outcome measure was the proportion of patients with detectable SARS-CoV-2 RNA by PCR from nasopharyngeal swab at day 7 post-treatment. The primary outcome was supported by determination of the viral load and infectivity of each sample. The differences between ivermectin and placebo were calculated using Fisher's exact test and presented as a relative risk ratio. This study is registered at ClinicalTrials.gov: NCT04390022. Findings All patients recruited completed the trial (median age, 26 [IQR 19-36 in the ivermectin and 21-44 in the controls] years; 12 [50%] women; 100% had symptoms at recruitment, 70% reported headache, 62% reported fever, 50% reported general malaise and 25% reported cough). At day 7, there was no difference in the proportion of PCR positive patients (RR 0·92, 95% CI: 0·77-1·09, p = 1·0). The ivermectin group had non-statistically significant lower viral loads at day 4 (p = 0·24 for gene E; p = 0·18 for gene N) and day 7 (p = 0·16 for gene E; p = 0·18 for gene N) post treatment as well as lower IgG titers at day 21 post treatment (p = 0·24). Patients in the ivermectin group recovered earlier from hyposmia/anosmia (76 vs 158 patient-days; p < 0.001). Interpretation Among patients with non-severe COVID-19 and no risk factors for severe disease receiving a single 400 mcg/kg dose of ivermectin within 72 h of fever or cough onset there was no difference in the proportion of PCR positives. There was however a marked reduction of self-reported anosmia/hyposmia, a reduction of cough and a tendency to lower viral loads and lower IgG titers which warrants assessment in larger trials. Funding ISGlobal, Barcelona Institute for Global Health and Clínica Universidad de Navarra

ClinPrior: an algorithm for diagnosis and novel gene discovery by network-based prioritization

BackgroundWhole-exome sequencing (WES) and whole-genome sequencing (WGS) have become indispensable tools to solve rare Mendelian genetic conditions. Nevertheless, there is still an urgent need for sensitive, fast algorithms to maximise WES/WGS diagnostic yield in rare disease patients. Most tools devoted to this aim take advantage of patient phenotype information for prioritization of genomic data, although are often limited by incomplete gene-phenotype knowledge stored in biomedical databases and a lack of proper benchmarking on real-world patient cohorts.MethodsWe developed ClinPrior, a novel method for the analysis of WES/WGS data that ranks candidate causal variants based on the patient's standardized phenotypic features (in Human Phenotype Ontology (HPO) terms). The algorithm propagates the data through an interactome network-based prioritization approach. This algorithm was thoroughly benchmarked using a synthetic patient cohort and was subsequently tested on a heterogeneous prospective, real-world series of 135 families affected by hereditary spastic paraplegia (HSP) and/or cerebellar ataxia (CA).ResultsClinPrior successfully identified causative variants achieving a final positive diagnostic yield of 70% in our real-world cohort. This includes 10 novel candidate genes not previously associated with disease, 7 of which were functionally validated within this project. We used the knowledge generated by ClinPrior to create a specific interactome for HSP/CA disorders thus enabling future diagnoses as well as the discovery of novel disease genes.ConclusionsClinPrior is an algorithm that uses standardized phenotype information and interactome data to improve clinical genomic diagnosis. It helps in identifying atypical cases and efficiently predicts novel disease-causing genes. This leads to increasing diagnostic yield, shortening of the diagnostic Odysseys and advancing our understanding of human illnesses

Intervención capacitante sobre lactancia materna en mujeres con edad reproductiva

Se realiza un estudio con el objetivo de elevar el nivel de conocimiento de mujeres en edad reproductiva a través de una intervención educativa sobre lactancia materna pertenecientes al área de salud Costa Rica, municipio El Salvador, provincia Guantánamo, durante los meses de septiembre-noviembre de 2009. Se escogen 101 mujeres que cumplen con los criterios de inclusión durante el período de estudio. Se estudian las siguientes variables: grupos de edades, uso de la lactancia materna antes y después de la intervención, estado nutricional de los lactantes, ventajas de la lactancia materna para el niño y la madre. Antes de la intervención se encontró un nivel de conocimiento inadecuado, luego de aplicado el programa se obtuvo un incremento del conocimiento al finalizar la intervención de más del 50 %. Se logra aumentar el uso de la lactancia materna al finalizar la capacitación.

Lactancia materna. Aspectos generales

Se realiza una revisión bibliográfica actualizada sobre aspectos generales de lactancia materna. Se abordan temas, tales como: lactancia materna y psicología, sexualidad y lactancia, papel protector de la leche materna, ventajas y contraindicaciones, leche materna y sus sabores, lactancia y embarazo, farmacología y lactancia.

La crisis en el sector del automóvil

La industria del automóvil es un sector vital para la economía mundial y dentro de la actividad industrial en general, ya que, a su vez, influye en otros sectores industriales: sectores de bienes de equipo, tecnologías de la información, plásticos, caucho, entre muchos otros. Por este y otros motivos que expondremos más adelante hemos decidido encaminar este trabajo hacia un análisis exhaustivo de ese sector, a partir de su evolución histórica y su situación actual. Cabe decir que nuestro trabajo se centra exclusivamente en el ámbito español ya que, en otro caso, nuestro análisis hubiese sido muy generalizado y no hubiésemos podido profundizar más en el tema estudiad

La crisis en el sector del automóvil

La industria del automóvil es un sector vital para la economía mundial y dentro de la actividad industrial en general, ya que, a su vez, influye en otros sectores industriales: sectores de bienes de equipo, tecnologías de la información, plásticos, caucho, entre muchos otros. Por este y otros motivos que expondremos más adelante hemos decidido encaminar este trabajo hacia un análisis exhaustivo de ese sector, a partir de su evolución histórica y su situación actual. Cabe decir que nuestro trabajo se centra exclusivamente en el ámbito español ya que, en otro caso, nuestro análisis hubiese sido muy generalizado y no hubiésemos podido profundizar más en el tema estudiad

Comportamiento de bajo peso en niños de la provincia Guantánamo

Se realiza una revisión documental  acerca del comportamiento del BPN en la provincia en el año 2008, relacionándolo con algunos aspectos propios de la madre y/o del recién nacido, que favorecen la aparición del bajo peso. Se revisaron las encuestas de los nacidos con estas características en los municipios con mayor índice en el año: Guantánamo, Yateras, Maìsi, Imias, San Antonio, Caimanera y Niceto Pérez. Entre los resultados más importantes se recogen, peso al nacer  entre 2000 y 2499 grs. en el  70 %  de los niños, la  mortalidad en  los nacidos con peso inferior 1000 grs. para un 42 %,con  predominio  del parto  pretèrmino  sobre  el CIUR, etc. Se recomienda continuar el estudio específico de las causas en los municipios más afectados para modificar los parámetros del PAMI.       

Overview of harm reduction in prisons in seven European countries.

While the last decade has seen a growth of support for harm reduction around the world, the availability and accessibility of quality harm reduction services in prison settings is uneven and continues to be inadequate compared to the progress achieved in the broader community. This article provides a brief overview of harm reduction in prisons in Catalonia (Spain), Greece, Ireland, Italy, Latvia, Poland, and Portugal. While each country provides a wide range of harm reduction services in the broader community, the majority fail to provide these same services or the same quality of these services, in prison settings, in clear violation of international human rights law and minimum standards on the treatment of prisoners. Where harm reduction services have been available and easily accessible in prison settings for some time, better health outcomes have been observed, including significantly reduced rates of HIV and HCV incidence. While the provision of harm reduction in each of these countries' prisons varies considerably, certain key themes and lessons can be distilled, including around features of an enabling environment for harm reduction, resource allocation, collection of disaggregated data, and accessibility of services