Resultados del tratamiento quirúrgico del pie plano valgo en la infancia

Se revisan los pies planos valgos infantiles que fueron tratados quirúrgicamente mediante la colocación del implante subastragalino tipo Maxwell-Brancheau, en el Servicio de Cirugía Ortopédica y Traumatología del Hospital Clínico Universitario de Valladolid desde el año 2004 al año 2009. Se han estudiado 55 pies intervenidos, con una edad media de los pacientes de 10 años y medio, y un seguimiento medio de 2 años. Se ha llevado a cabo una valoración de los principales parámetros radiológicos del pie plano valgo, como son el ángulo de Costa-Bartani, el ángulo astrágalo-escafoideo y la línea de Shade o Eje de Meari, concluyendo una normalización estadísticamente significativa de los parámetros antedichos, mantenida a los dos años desde la intervención quirúrgica.The authors review a serie of children with valgus flat feet operated in the Service of Orthophaedic Surgery and Traumatology of the Clinic Universitary Hospital of Valladolid, from 2004 to 2008, and treated surgically by the placement of the Maxwell-Brancheau subastragalin implant. We have valuated 55 feet operated, with a median age of the patients of ten and a half years, and with a follow-up of 2 years average. We performed an evaluation of the principal radiologic parameters of the valgus flatfoot, like Costa-Bartani angle, escafoid astragalin angle and the Shade´s line or Meari axis, concluding a correction of these parameters that was stadistically significant, and that remains to two years of follow-up

Artroplastia total de cadera en paciente con amputación suprageniana ipsilateral: caso clínico y revisión de la literatura

La bibliografía acerca de los resultados y el papel que desempeña la cirugía de artroplastia total de cadera en pacientes con amputación, a diferentes niveles, de la extremidad inferior, es escasa. Presentamos nuestra experiencia clínica acerca de la técnica quirúrgica de artroplastia total de cadera por coxartrosis avanzada, manejo postoperatorio y resultados, de un paciente varón, de sesenta y ocho años de edad, con amputación suprageniana de la extremidad inferior ipsilateral, de etiología vascular. Los resultados de nuestra revisión bibliográfica y de nuestra propia experiencia, sugieren que la artroplastia total de cadera, en pacientes con amputación suprageniana o infrageniana ipsilateral, puede prevenir el deterioro físico y conseguir la restauración de la capacidad funcional de la articulación de la cadera, tanto en casos de coxartrosis avanzada como de fracturas subcapitales desplazadas de fémur.Bibliography about the outcomes and the role of total hip arthroplasty surgery in patients with lowerlimb amputation at different levels, is brief. We present our clinical experience of the surgical technique for total hip arthroplasty for advanced hip osteoarthritis, outcomes and postoperative management of a male patient, sixty-eight years old, with ipsilateral supracondylar amputation of the lower extremity, of vascular aetiology. The outcomes of the literature review and our own experience, suggest that total hip arthroplasty in patients with ipsilateral supracondylar or infracondylar amputation of the lower limb, can prevent physical deterioration and obtain the restoration of the functional capability of the articulation of the hip, both in cases of advanced hip osteoarthritis and displaced subcapital femoral head fractures

Utility of prehospital electrocardiogram interpretation in ST-segment elevation myocardial infarction utilizing computer interpretation and transmission for interventional cardiologist consultation

Objectives: We examined the appropriateness of prehospital cardiac catheter laboratory activation (CCL-A) in ST-segment elevation myocardial infarction (STEMI) utilizing the University of Glasgow algorithm (UGA) and remote interventional cardiologist consultation. Background: The incremental benefit of prehospital electrocardiogram (PH-ECG) transmission on the diagnostic accuracy and appropriateness of CCL-A has been examined in a small number of studies with conflicting results. Methods: We identified consecutive PH-ECG transmissions between June 2, 2010 and October 6, 2016. Blinded adjudication of ECGs, appropriateness of CCL-A, and index diagnoses were performed using the fourth universal definition of MI. The primary outcome was the appropriate CCL-A rate. Secondary outcomes included rates of false-positive CCL-A, inappropriate CCL-A, and inappropriate CCL nonactivation. Results: Among 1088 PH-ECG transmissions, there were 565 (52%) CCL-As and 523 (48%) CCL nonactivations. The appropriate CCL-A rate was 97% (550 of 565 CCL-As), of which 4.9% (n = 27) were false-positive. The inappropriate CCL-A rate was 2.7% (15 of 565 CCL-As) and the inappropriate CCL nonactivation rate was 3.6% (19 of 523 CCL nonactivations). Reasons for appropriate CCL nonactivation (n = 504) included nondiagnostic ST-segment elevation (n = 128, 25%), bundle branch block (n = 132, 26%), repolarization abnormality (n = 61, 12%), artefact (n = 72, 14%), no ischemic symptoms (n = 32, 6.3%), severe comorbidities (n = 26, 5.2%), transient ST-segment elevation (n = 20, 4.0%), and others. Conclusions: PH-ECG interpretation utilizing UGA with interventional cardiologist consultation accurately identified STEMI with low rates of inappropriate and false-positive CCL-As, whereas using UGA alone would have almost doubled CCL-As. The benefits of cardiologist consultation were identifying “masquerading” STEMI and avoiding unnecessary CCL-As

Late Outcomes of Patients With Prehospital ST-Segment Elevation and Appropriate Cardiac Catheterization Laboratory Nonactivation

BACKGROUND: Patients with suspected ST-segment–elevation myocardial infarction (STEMI) and cardiac catheterization laboratory nonactivation (CCL-NA) or cancellation have reportedly similar crude and higher adjusted risks of death compared with those with CCL activation, though reasons for these poor outcomes are not clear. We determined late clinical outcomes among patients with prehospital ECG STEMI criteria who had CCL-NA compared with those who had CCL activation. METHODS AND RESULTS: We identified consecutive prehospital ECG transmissions between June 2, 2010 to October 6, 2016. Diagnoses according to the Fourth Universal Definition of myocardial infarction (MI), particularly rates of myocardial injury, were adjudicated. The primary outcome was all-cause death. Secondary outcomes included cardiovascular death/MI/stroke and noncardiovascular death. To explore competing risks, cause-specific hazard ratios (HRs) were obtained. Among 1033 included ECG transmissions, there were 569 (55%) CCL activations and 464 (45%) CCL-NAs (1.8% were inappropriate CCL-NAs). In the CCL activation group, adjudicated index diagnoses included MI (n=534, 94%, of which 99.6% were STEMI and 0.4% non-STEMI), acute myocardial injury (n=15, 2.6%), and chronic myocardial injury (n=6, 1.1%). In the CCL-NA group, diagnoses included MI (n=173, 37%, of which 61% were non-STEMI and 39% STEMI), chronic myocardial injury (n=107, 23%), and acute myocardial injury (n=47, 10%). At 2 years, the risk of all-cause death was higher in patients who had CCL-NA compared with CCL activation (23% versus 7.9%, adjusted risk ratio, 1.58, 95% CI, 1.24–2.00), primarily because of an excess in noncardiovascular deaths (adjusted HR, 3.56, 95% CI, 2.07–6.13). There was no significant difference in the adjusted risk for cardiovascular death/MI/stroke between the 2 groups (HR, 1.23, 95% CI, 0.87–1.73). CONCLUSIONS: CCL-NA was not primarily attributable to missed STEMI, but attributable to “masquerading” with high rates of non-STEMI and myocardial injury. These patients had worse late outcomes than patients who had CCL activation, mainly because of higher rates of noncardiovascular deaths

Radiological Decision Aid to determine suitability for medial unicompartmental knee arthroplasty: development and preliminary validation

Aims: An evidence-based radiographic Decision Aid for meniscal-bearing unicompartmental knee arthroplasty (UKA) has been developed and this study investigates its performance at an independent centre. Patients: and Methods Pre-operative radiographs, including stress views, from a consecutive cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty; TKA) by a single-surgeon were assessed. Suitability for UKA was determined using the Decision Aid, with the assessor blinded to treatment received, and compared with actual treatment received, which was determined by an experienced UKA surgeon based on history, examination, radiographic assessment including stress radiographs, and intra-operative assessment in line with the recommended indications as described in the literature. Results: The sensitivity and specificity of the Decision Aid was 92% and 88%, respectively. Excluding knees where a clear pre-operative plan was made to perform TKA, i.e. patient request, the sensitivity was 93% and specificity 96%. The false-positive rate was low (2.4%) with all affected patients readily identifiable during joint inspection at surgery. In patients meeting Decision Aid criteria and receiving UKA, the five-year survival was 99% (95% confidence intervals (CI) 97 to 100). The false negatives (3.5%), who received UKA but did not meet the criteria, had significantly worse functional outcomes (flexion p < 0.001, American Knee Society Score - Functional p < 0.001, University of California Los Angeles score p = 0.04), and lower implant survival of 93.1% (95% CI 77.6 to 100). Conclusion: The radiographic Decision Aid safely and reliably identifies appropriate patients for meniscal-bearing UKA and achieves good results in this population. The widespread use of the Decision Aid should improve the results of UKA

Effect of availability and COVID-19 vaccination on food shopping and consumption behaviors among Jordan universities students

The COVID-19 pandemic influenced the lives of university students all across the globe. Indeed, the pandemic has impacted many aspects of their daily routine, changing their social and health habits and food-related behaviors. There is now no approved therapy, and vaccination is the only clinical preventative measure that provides the highest protection against the virus. While these vaccines have been beneficial in curbing the pandemic's effect, they may also influence food-related behaviors. Accordingly, this paper aims to investigate the impact of vaccination availability on university students' food shopping and consumption habits, vaccine-related opinions, and back on-campus behaviors in Jordan. The research is based on an online survey conducted in Jordan using a structured questionnaire and distributed through Google Forms between January 1 and March 20, 2022. A total of 624 valid answers were collected. The findings revealed no significant changes in the way students consumed, shopped, and handled food compared to the pre-vaccine period. However, there is a slight post-vaccine trend toward shopping more groceries online and ordering more meals via delivery apps and takeout services. Regarding health-related food choices, there was an increase in the consumption of healthy food, water, and fruits and vegetables. Further, following the availability of the vaccination, students' adoption of COVID-19 food-related habits was maintained. Gender, engagement in food preparation activities, and living status (e.g., whether or not living with parents) substantially affected several food-related behaviors. The findings are expected to guide both current emergency preparations and long-term food-related policies in Jordan. This information may also be helpful to researchers interested in the effects of COVID-19 vaccination on student nutrition and related food behaviors.Jordan University of Science and Technolog