In cosmic ray air showers, the muon lateral separation from the center of the shower is a measure of the transverse momentum that the muon parent acquired in the cosmic ray interaction. IceCube has ...observed cosmic ray interactions that produce muons laterally separated by up to 400 m from the shower core, a factor of 6 larger distance than previous measurements. These muons originate in high pT (> 2 GeV /c) interactions from the incident cosmic ray, or high-energy secondary interactions. The separation distribution shows a transition to a power law at large values, indicating the presence of a hard pT component that can be described by perturbative quantum chromodynamics. However, the rates and the zenith angle distributions of these events are not well reproduced with the cosmic ray models tested here, even those that include charm interactions. This discrepancy may be explained by a larger fraction of kaons and charmed particles than is currently incorporated in the simulations.
Our goal was to evaluate the efficacy of internal medicine consulting (CIM) in primary care (PC) for the care of patients with dyspepsia.
Prospective case-control study of a population of 87,016 ...inhabitants during a 2 years period. We included patients with dyspepsia (319) jointly attended by a family physician (FP) and consulting internists (CI). The CI went weekly to the primary care center (PCC) to attend patients who would have been referred to the hospital outpatient clinic for specialized care (SC). As control group, 775 patients with dyspepsia were randomly and simultaneously chosen among a total of 29,317 first medical referrals during the period of the study.
5.36% of the consultations for SC were patients with dyspepsia (annual incidence of 183 patients/1,000 inhabitants). We observed a significant reduction in: mean time for SC (26.4 days; 22.4-30.4), mean number of tests per patient ordered by SC (0.77; 0.42-1.12), mean time for patient information on the tests ordered by SC (27.3 days; 18.7-35,9), mean time for the resolution of the process (27.3 days; 18.4-36.2) and rate of specialized follow-up visits (25.2%; 18.5-31.9); p < 0.005 in all cases. The resolution rate of the process (37.2%; 25.7-48.7) and the discharge rate (38.7%; 28.9-48.5) were significantly higher for CIM (p < 0.01 in both cases). The referral rate for SC showed a negative correlation (r = -0.97; p < 0.01) with the quality of the management; this rate related to the type of training, age and years of medical practice of the GPs. Satisfaction of patients with the CIM was very high.
The CIM with PC improves the efficacy of the specialized medical care of patients with dyspepsia.
X ray resonant magnetic scattering (XRMS) was used to characterize the magnetization of 2D arrays of trilayer submicron magnets. The interpretation of the data required the understanding of the ...morphology of the magnets which was also deduced from the scattered intensity. The magnets consisted of two magnetostatically coupled ferromagnetic layers separated by a non-magnetic spacer. The scattered intensity from the disks resulted to be dependent on the disks surface curvature. This made the collected intensity at each Bragg reflection (BR) to be correlated to the reflected light from locations of the disk with the same angle of curvature. Due to this, quantitative information was obtained, averaged over the disks illuminated by x rays, of the variations in thickness and magnetization across the entire area of the disks. This averaged magnetization mapping of the disks served to study their vortex configuration in each of their magnetic layers, determining the average location of the vortex, the chiral symmetry of its magnetic circulation, and the specific locations where the vortex nucleation starts within the disks. Chiral asymmetry appeared in the disks when the field was oriented at an oblique angle with respect to the easy axis of the array. The local magnetic sensitivity of the technique allowed to identify a non-centrosymmetric distribution of the magnetization of the disks that explains the observed chiral asymmetry. Unexpectedly, the magnetic circulation sense of the vortex was the same in both ferromagnetic layers. In addition, the magnetization of the buried layer was different in the descent branch than in the ascent branch of its hysteresis loops.
Los accidentes ocupacionales de riesgo biológico tienen como mayor riesgo postexposición la seroconversión para el virus de la inmunodeficiencia humana (VIH) y virus de la hepatitis C (VHC) y B ...(VHB). En la literatura latinoamericana aún faltan estudios que aporten información al respecto.
Describir las características epidemiológicas de los accidentes ocupacionales de riesgo biológico.
Estudio descriptivo longitudinal.
Se describen 231 episodios de riesgo biológico. La mediana de edad fue 30 años. Un 65,8% fueron mujeres. Las principales actividades laborales fueron: auxiliares de enfermería (22,9%), aseo hospitalario (16,5%), estudiantes (14,3%), recolección de basuras (5,2%) y médicos (4,8%). El mecanismo del accidente fue: punción (77%), herida cortante (11,3%) y contacto con mucosas (9,1%). En 24% la fuente fue conocida y de estas fueron positivas para VIH un 62,5%, para VHB un 3,5% y para VHC un 5,3%. Recibieron profilaxis postexposición (PPE) un 75,8% de los 231.
Entre los expuestos a fuente VIH positiva, recibieron PPE biconjugada 85,1% y terapia triple 14,8% De los que recibieron profilaxis, 40% presentaron reacciones adversas, siendo las gastrointestinales (77,1%) y las neurológicas (45,7%) las más frecuentes. Al ingreso, un 67,1% tenían anticuerpos protectores para VHB. Durante el seguimiento se confirmó una seroconversión postexposición para VIH.
El riesgo de adquirir infecciones postexposición ocupacional es una realidad en nuestro medio; se debe hacer énfasis en estrategias de prevención de exposición, introyectar la cultura del reporte y el manejo adecuado de la profilaxis postexposición.
Occupational biohazard exposure can increase the risk of postexposure seroconversion of human immunodeficiency virus (HIV) and hepatitis C (HCV) and B virus (HBV). In Latin America, the literature lack of studies on this topic.
To describe the epidemiological characteristics of occupational biohazard exposure.
A descriptive, longitudinal study.
A total of 231 episodes of biological risk exposure are described. The median age was 30 years, and 65.8% were women. The major occupational activities were: nursing assistants 22.9%, hospital cleaning 16.5%, students 14.3%, garbage collection 5.2% and physicians 4.8%. The mechanisms of the accidents were: needle stick 77%, cutting wound 11.3% and contact with mucous membranes 9.1%. In 24% the source was known and of these, 62.5% were positive for HIV 3.5% for HBV and 5.3% for HCV. A total of 75.8% of the 231 received postexposure prophylaxis (PEP).
In those exposed to an HIV-positive source, 85.1% received a two-drug conjugate for PPE, and 14.8% received triple therapy. Of those who received prophylaxis, 40% reported adverse events with being the most frequent the gastrointestinal (77.1%) and neurological (45.7%). At admission, 67.1% had protective antibodies to HBV. During program monitoring, HIV seroconversion was confirmed in one patient.
The risk of acquiring occupational infections postexposure is a reality in our country. This emphasizes the importance of exposure prevention strategies, introjecting the reporting culture and proper management of postexposure prophylaxis.
The present study explores the possible factors related to severe cases of pandemic flu.
A retrospective cohort study was conducted in patients hospitalized with Influenza A/H1N1 2009 during the ...pandemic period.
Ramon y Cajal University Hospital (Madrid, Spain).
All hospitalized patients with positive RT-PCR (real-time polymerase chain reaction) for Influenza A/H1N1 2009 virus.
The main variables collected were: history of risk factors for severe Influenza, history of immunization, clinical presentation, laboratory tests, chest X-ray report, administration of antiviral treatment, and hospital stay.
The median age of the 100 cases was 38 years (range 4 months to 80 years). Seventy-seven percent of the patients had at least one risk factor. Asthma was the most common factor among patients younger than 18 years, versus smoking in the older subjects. Antiviral therapy was initiated a median time of three days (range 0 to 18 days) after the onset of illness. Nineteen percent of the patients were admitted to Intensive Care, and 2% died. Metabolic disease and abnormal chest X-ray findings were factors associated to admission to the ICU.
As in other studies, abnormal chest X-ray findings upon admission and metabolic disease were related to poor outcomes of 2009 pandemic Influenza A (H1N1) infection in our patients.
Introducción: Las hemorragias intracerebrales espontáneas representan entre el 10 30% de todas las variantes de
enfermedad cerebrovascular. El tratamiento quirúrgico en las hemorragias ...intracerebrales espontáneas lobares es un tema
que todavía se encuentra en debate y a pesar de los ensayos clínicos diseñados para obtener la mejor evidencia posible al
respecto, todavía no existe total consenso en lo que respecta a cuál es el paciente más beneficiado con la cirugía y cuál es
el mejor procedimiento.
Casos clínicos: Se presentan dos pacientes que fueron admitidos en la unidad de cuidados intensivos del adulto del
Hospital Roberto Rodríguez , en la ciudad de Morón, con diagnóstico de hemorragia intracerebral espontánea de
localización lobar. Ambos pacientes fueron intervenidos quirúrgicamente para evacuar la hemorragia a través de una
punción y aspiración transcortical guiada por ecografía transcortical transoperatoria. A los dos pacientes se les realizó el
diagnóstico por la Tomografía Axial Computarizada al ingreso y posteriormente se les realizaron exámenes evolutivos para
evaluar el grado de evacuación quirúrgica.
Conclusiones: El procedimiento quirúrgico empleado ha sido utilizado en el mundo con tales propósitos y es considerado
como una opción quirúrgica menos invasiva que otros procedimientos. Aunque no se ha probado su superioridad, el grado
de evacuación es similar al obtenido con los otros, la manipulación tisular es inferior, el tiempo quirúrgico es menor y los
requerimientos tecnológicos se encuentran al alcance de todos los servicios de Neurocirugía del país.
Background and ImportanceHuman Immunodeficiency Virus (HIV) infection is nowadays chronic due to antiretroviral therapy (ART).Knowledge about HIV transmission (KHIVT) empowers people living with HIV ...(PLWHIV) to engage in ART.Aim and ObjectivesTo describe KHIVT among PLWHIV on ART and to identify factors associated with lower access to this information.Material and MethodsMulticentre (5 centres), observational, prospective and cross-sectional study. We included adult PLWHIV on ART with >3 months since diagnosis.KHIVT was evaluated using an ad hoc questionnaire of 20 statements, to be replied ‘true’ or ‘false’. Results are the percentages of correct answers, considering as optimal knowledge results ≥80%.Factors collected were sexual orientation, gender identity, racialisation, religion, social support, educational level, relationship and economic status, social visibility, drug use, and involvement in sex work.Associations between quantitative and qualitative variables were analysed with Student’s T test or Mann-Whittney U test based on normality tests. Spearman correlation coefficient (r) was used between quantitative variables.P-values <5% were considered statistically significant.ResultsWe enrolled 169 participants, aged 20-81 years old ( =46.6 ± 12.2); 147 men, 19 women, and 3 non-binary people.KHIVT obtained an average result of 87.2 ± 10.4%. 77.52% of participants had optimal knowledge.Three of the four statements with the worst results were that related to HIV untransmissibility in PLHIV with undetectable viral load (U=U). STATEMENT PARTICIPANTS THAT ANSWERED CORRECTLY (%) ART could allow unprotected sex without risk of transmission (TRUE) 38.46 % There is no risk of transmission when the viral load is undetectable (TRUE) 64.50 % HIV can be transmitted through infected bodily fluids (TRUE) 72.78% Children of HIV+ pregnant persons will always be HIV+ (FALSE) 75.15 % Women achieved worse results than men (Δ =8.16|CI95%:3.3-13.0|p=0.001).Heterosexual men achieved worse results than homosexual men (Δ =6.1|CI95%:2.7-9.5|p=0.001). There were no significant differences between bisexual men and other men.PLWHIV with no/only primary education obtained worse results (Δ =7.5|CI95%:3.2-11.8|p=0.000).PLWHIV with an income <1,000€/month (gross) obtained worse results (Δ =3.7|CI95%:0.5-6.8|p=0.015).Age was inversely correlated with KHIVT (r=-0.367|p=0.000).Conclusion and RelevanceAbout a quarter of PLHIV have suboptimal KHIVT. Furthermore, the premise U=U is not yet sufficiently widespread.Women, heterosexual men, older people, people with low education level and those with a limited economical income have greater difficulty accessing this information.References and/or AcknowledgementsConflict of InterestNo conflict of interest
This study was designed to evaluate the visual and anatomical outcomes after cataract surgery in diabetic patients with different intraoperative therapeutic strategies.
The research design comprised ...of a multicentric, retrospective, interventional study conducted at 6 centers in Argentina, Brazil, Costa Rica, Puerto Rico, Spain, and Venezuela. We included 138 diabetic patients with at least 6-month follow-up following phacoemulsification and intraocular lens implantation. Best-corrected visual acuity (BCVA) and central subfield thickness were collected at baseline and at 1-, 2-, 3-, and 6-month follow-up. Of these, 42 cases were not treated with any intraoperative coadjuvant medication (Group 1), 59 patients received intraoperative bevacizumab (Group 2) and 37 patients received intraoperative triamcinolone (4 mg/0.1 ml) (Group 3).
The mean logMAR ± standard deviation (SD) BCVA improved from 0.82 (± 0.43) at baseline, to 0.14 (± 0.23) at 6-month follow-up (p<0.001) in Group 1; from 0.80 (± 0.48) to 0.54 (± 0.45) (p<0.001) in Group 2; and from 1.0 (± 0.40) to 0.46 (± 0.34) (p<0.001) in Group 3. The mean central subfield thickness increased from 263.57 µm (± 35.7) at baseline to 274.57 µm (± 48.7) at 6-month follow-up (p=0.088) in Group 1; from 316.02 µm (± 100.4) to 339.56 µm (± 145.3) (p=0.184) in Group 2; and from 259.18 µm (± 97.9) to 282.21 µm (± 87.24) (p=0.044) in Group 3.
Diabetic patients may significantly benefit from cataract surgery. This study provides evidence to support the use of intravitreal triamcinolone or bevacizumab at the time of cataract surgery in cases with pre-existent diabetic macular edema or moderate-severe non-proliferative diabetic retinopathy.
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