Complications of digestive ostomies derived from marking of the stoma site and high output debit (Systematic review)

Las complicaciones de las ostomías digestivas de eliminación son frecuentes y generan un impacto negativo en la calidad de vida. Existen diversos factores que pueden influir en las complicaciones relacionadas con el marcaje del sitio del estoma y con las complicaciones derivadas por el alto débito. El papel del profesional es importante en la detección precoz de dichas complicaciones así como el asesoramiento y el seguimiento. Objetivo: Identificar a partir de una revisión sistemática de artículos originales, los factores que pueden influir en las complicaciones derivadas del marcaje del sitio del estoma y las derivadas por el alto débito.The surgical treatment of cancer or inflamatory bowel disease can lead to the need to carry out a stoma procedure. Currently there are more than 100.000 ostomy patients living in Spain and every year there are 15.000 new cases. Complications of digestive elimination ostomies are frequent and have a negative impact on quality of life. There are several factors that can influence the complications related to the marking of the stoma site and the complications caused by high output. The role of the professional stoma therapist is important both in the early detection of such complication

Simulación mediante elementos finitos del comportamiento de un clavo intramedular para fracturas de tibia

El objetivo fundamental de este proyecto consiste en el análisis mediante Elementos Finitos (EF) del comportamiento biomecánico del hueso tibial y las variaciones que se producen en el mismo como resultado de la inserción de un clavo intramedular como consecuencia de una fractura tibial. Para ello se realiza un modelo de EF de una tibia sana para estudiar su comportamiento mecánico ante diversos procesos de carga. Posteriormente, se realiza un modelo de EF de un clavo intramedular comercial para simular un ensayo de flexión de tres puntos y se valida con los resultados obtenidos mediante ensayos experimentales de cara a caracterizar su rigidez. Del mismo modo, se simula mediante EF la tibia con el clavo intramedular insertado para analizar las modificaciones en el comportamiento biomecánico de una tibia operada. Por último, se realiza un análisis comparativo de resultados entre el modelo sano y el modelo fracturado con clavo, extrayendo las conclusiones oportunas en lo que se refiere a la capacidad resistente y de estabilización del clavo intramedular analizado

Influence of Kinematics on the Wear of a Total Ankle Replacement

Total ankle replacement (TAR) is an alternative to fusion, replacing the degenerated joint with a mechanical motion-preserving alternative. Minimal pre-clinical testing has been reported to date and existing wear testing standards lack definition. Ankle gait is complex, therefore the aim of this study was to investigate the effect on wear of a range of different ankle gait kinematic inputs. Five Zenith (Corin Group) TARs were tested in a modified knee simulator for twelve million cycles (Mc). Different combinations of IR rotation and AP displacement were applied every 2Mc to understand the effects of the individual kinematics. Wear was assessed gravimetrically every Mc and surface profilometry undertaken after each condition. With the initial unidirectional input with no AP displacement the wear rate measured 1.2±0.6 mm3/Mc. The addition of 11° rotation and 9 mm of AP displacement caused a statistically significant increase in the wear rate to 25.8±3.1 mm3/Mc. These inputs seen a significant decrease in the surface roughness at the tibial articulation. Following polishing three displacement values were tested; 0, 4 and 9 mm with no significant difference in wear rate ranging 11.8–15.2 mm3/Mc. TAR wear rates were shown to be highly dependent on the addition of internal/external rotation within the gait profile with multidirectional kinematics proving vital in the accurate wear testing of TARs. Prior to surface polishing wear rates were significantly higher but once in a steady state the AP displacement had no significant effect on the wear

Investigation of wear and wear particles from a UHMWPE/multi-walled carbon nanotube nanocomposite for total joint replacements

Ultra high molecular weight polyethylene (UHMWPE) has been extensively used as a bearing surface in joint prostheses. However, wear debris generated from this material has been associated with osteolysis and implant loosening. Alternative materials, such as polymer composites, have been investigated due to their exceptional mechanical properties. The goal of the present work was to investigate the wear rate, size and volume distributions, bioactivity and biocompatibility of the wear debris generated from a UHMWPE/Multi-walled carbon nanotube (MWCNT) nanocomposite material compared with conventional UHMWPE. The results showed that the addition of MWCNTs led to a significant reduction in wear rate. Specific biological activity and functional biological activity predictions showed that wear particles from the UHMWPE/MWCNT nanocomposite had a reduced osteolytic potential compared to those produced from the conventional polyethylene. In addition, clinically relevant UHMWPE/MWCNT wear particles did not show any adverse effects on the L929 fibroblast cell viability at any of the concentrations tested over time. These findings suggest that UHMWPE/MWCNT nanocomposites represent an attractive alternative for orthopaedic applications

A cluster-randomized trial of hydroxychloroquine for prevention of Covid-19

Background: current strategies for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited to nonpharmacologic interventions. Hydroxychloroquine has been proposed as a postexposure therapy to prevent coronavirus disease 2019 (Covid-19), but definitive evidence is lacking. Methods: we conducted an open-label, cluster-randomized trial involving asymptomatic contacts of patients with polymerase-chain-reaction (PCR)-confirmed Covid-19 in Catalonia, Spain. We randomly assigned clusters of contacts to the hydroxychloroquine group (which received the drug at a dose of 800 mg once, followed by 400 mg daily for 6 days) or to the usual-care group (which received no specific therapy). The primary outcome was PCR-confirmed, symptomatic Covid-19 within 14 days. The secondary outcome was SARS-CoV-2 infection, defined by symptoms compatible with Covid-19 or a positive PCR test regardless of symptoms. Adverse events were assessed for up to 28 days. Results: the analysis included 2314 healthy contacts of 672 index case patients with Covid-19 who were identified between March 17 and April 28, 2020. A total of 1116 contacts were randomly assigned to receive hydroxychloroquine and 1198 to receive usual care. Results were similar in the hydroxychloroquine and usual-care groups with respect to the incidence of PCR-confirmed, symptomatic Covid-19 (5.7% and 6.2%, respectively; risk ratio, 0.86 [95% confidence interval, 0.52 to 1.42]). In addition, hydroxychloroquine was not associated with a lower incidence of SARS-CoV-2 transmission than usual care (18.7% and 17.8%, respectively). The incidence of adverse events was higher in the hydroxychloroquine group than in the usual-care group (56.1% vs. 5.9%), but no treatment-related serious adverse events were reported. Conclusions: postexposure therapy with hydroxychloroquine did not prevent SARS-CoV-2 infection or symptomatic Covid-19 in healthy persons exposed to a PCR-positive case patient. (Funded by the crowdfunding campaign YoMeCorono and others; BCN-PEP-CoV2 ClinicalTrials.gov number, NCT04304053.)

Prospective individual patient data meta-analysis of two randomized trials on convalescent plasma for COVID-19 outpatients

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when = 50 years and symptomatic for <= 7days were included. The intervention consisted of 200-300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo; they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311); OR for hospitalization or death was 0.919 (CI 0.592-1.416). CP effect on hospital admission or death was largest in patients with <= 5 days of symptoms (OR 0.658, 95%CI 0.394-1.085). CP did not decrease the time to full symptom resolution

Hydroxychloroquine for Early Treatment of Adults With Mild Coronavirus Disease 2019: A Randomized, Controlled Trial

No effective treatments for coronavirus disease 2019 (COVID-19) exist. We aimed to determine whether early treatment with hydroxychloroquine (HCQ) would be efficacious for outpatients with COVID-19.The authors thank Gerard Carot-Sans, PhD, for providing medical writing support during the revisions of the subsequent drafts of the manuscript; the personnel from the Fights Aids and Infectious Diseases Foundation for their support in administration, human resources and supply chain management; Eric Ubals (Pierce AB) and Òscar Palao (Opentic) for website and database management; Óscar Camps and OpenArms nongovernmental organization for nursing home operations; and Anna Valentí and the Hospital Germans Trias i Pujol Human Resources Department for telephone monitoring. We thank Consorci Sanitari del Maresme, Centre Sociosanitari El Carme, l'Hospital General de Granollers and occupational hazards department of Hospital Germans Trias i Pujol for their contribution with patient enrollment. We are very grateful to Marc Clotet and Natalia Sánchez who coordinated the JoEmCorono crowd-funding campaign. We thank the Hospital Germans Trias Pujol Institutional Review Board and the Spanish Agency of Medicines and Medical Devices for their prompt action for consideration and approvals to the protocol. Financial support. This work was mainly supported by the crowd-funding campaign JoEmCorono (https://www.yomecorono.com/) with contributions from more than 72 000 citizens and corporations. The study also received financial support from Laboratorios Rubió, Laboratorios Gebro Pharma, Zurich Seguros, SYNLAB Barcelona, and Generalitat de Catalunya. Laboratorios Rubió also contributed to the study with the required doses of hydroxychloroquine (Dolquine®). Foundation Dorneur partly funded lab equipment at Irsi-Caixa.Peer reviewe

Investigation of Carbon Reinforced UHMWPE Nanocomposites for use in Orthopaedics

Over the lifetime of a person, the function of the natural hip joint can be altered due to trauma or disease and an artificial hip replacement may eventually be required. Ultra high molecular weight polyethylene (UHMWPE) is considered the gold standard material for the acetabular cup in hip arthroplasties. However, problems associated with the release of UHMWPE wear particles, due to the relative motion between the bearing components, can lead to the eventual failure of the implant. The first part of this thesis focuses on reviewing the current status of total joint replacement research, with particular attention to implant bearing materials, implant wear particles and biological responses to wear particles. Subsequently, the thesis focuses on the potential of UHMWPE-based nanocomposites as an alternative to UHMWPE. A suitable method to prepare carbon nanoparticle reinforced UHMWPE materials was developed, and the possibilities of multi-walled carbon nanotubes (MWCNTs) and graphene oxide (GO) as reinforcements of UHMWPE were investigated.The results of this thesis showed that, under optimised conditions, carbonnanoparticles have the ability to improve the overall performance of UHMWPE,without adversely affecting the biocompatibility. However, further investigations into appropriate GO and MWCNT surface modification methods are necessary to enhance the filler/matrix interaction and further improve the performance of the resulting nanocomposites. This thesis has provided an insight into the potential of UHMWPE-based nanocomposites as an alternative to UHMWPE for use in total joint replacements and further work concerning biological and mechanical characterisation has been suggested in order to fully understand the behaviour of these nanocomposites.Godkänd; 2015; 20150508 (vith); Nedanstående person kommer att disputera för avläggande av teknologie doktorsexamen. Namn: Silvia Suñer Moreno Ämne: Maskinelement/Machine Elements Avhandling: Investigation of Carbon Reinforced UHMWPE Nanocomposites for Use in Orthopaedics Opponent: Professor Robert S Dwyer-Joyce, Dept of Mechanical Engineering, University of Sheffield, Sheffield, UK Ordförande: Bitr professor Nazanin Emami, Avd för maskinelement, Institutionen för teknikvetenskap och matematik Luleå tekniska universitet, Luleå Tid: Måndag 8 juni kl 09.00 Plats: E231, Luleå tekniska universite

Carbon reinforced UHMWPE composites for orthopaedic applications : characterization and biological response to wear particles

Joint replacements have considerably improved the quality of life of patients with joints damaged by disease or trauma. However, problems associated with wear particles generated due to the relative motion between the components of the bearing are still present and can lead to the eventual failure of the implant. Ultra high molecular weight polyethylene (UHMWPE) has been extensively used as a bearing surface in total joint replacements. Although in the short- to medium term UHMWPE provides excellent clinical performance, in the longer term, problems associated with its high wear characteristics and biological responses to polyethylene wear particles leads to the failure of the implants.The first part of the thesis focuses on the current status of total joint replacements (hard-on-soft and hard-on-hard bearings), with particular attention on implant wear debris and the biological response to wear debris, as well as on the tribological behaviour of the potential materials currently under investigation. The aim of the second part of the thesis consists of an analysis of the wear rate and the size and volume distributions, morphology and biocompatibility of the wear debris generated from a multiwalled carbon nanotube (MWCNT) reinforced polyethylene material compared with conventional UHMWPE. The results showed that MWCNT’s can improve the characteristics of UHMWPE, in terms of both wear rate and biocompatibility. UHMWPE-MWCNT composite material was shown to generate low wear rates and a reduced osteolytic and cytotoxic potential compared to conventional virgin polyethylene of the same grade.The final part of the thesis focuses on the possibilities of graphene oxide (GO) as reinforcement of UHMWPE. The aim of this work is to investigate the manufacturing procedure to prepare a homogeneous UHMWPE/GO composite under optimised conditions that might improve the performance of UHMWPE in artificial joints. In this study, composites prepared under different mixing conditions were thermally and morphologically characterised and compared with conventional UHMWPE. The results showed that, under optimized manufacturing conditions, GO has the ability to improve the performance of conventional UHMWPE. This thesis has provided an insight into the potential of carbon based composites as an alternative to conventional UHMWPE for use in total joint replacements and further work concerning the influence of graphene oxide on the tribological performance of UHMWPE/GO composites is currently under investigation.Godkänd; 2013; 20130110 (silmor); Tillkännagivande licentiatseminarium 2013-01-30 Nedanstående person kommer att hålla licentiatseminarium för avläggande av teknologie licentiatexamen. Namn: Silvia Suñer Moreno Ämne: Maskinelement/Machine Elements Uppsats: Carbon Reinforced UHMWPE Composites for Orthopaedic Applications Characterization and Biological Response to Wear Particles Examinator: Biträdande professor Nazanin Emami, Institutionen för teknikvetenskap och matematik, Luleå tekniska universitet Diskutant: Professor Jeffrey Dixon, Department of Physiology & Pharmacology, Schulich School of Medicine & Dentistry, the University of Western Ontario London, Ontario, Canada Tid: Torsdag den 14 februari 2013 kl 10.00 Plats: E632, Luleå tekniska universite

Biological Response to Wear Debris and Wear Properties of Prosthetic Joint Materials : a review

Godkänd; 2013; 20130925 (andbra