Introducción: Debido a la inestabilidad rotatoria de las fracturas basicervicales, en estudios recientes, se sugiere el uso de una hoja espiral, doble tornillo o tornillos de compresión en lugar del ...tornillo cefálico único. Objetivo: Analizar los resultados de las fracturas basicervicales tratadas con tornillo cefálico único en nuestro centro. Materiales y Métodos: Estudio retrospectivo de una serie de casos formada a partir de la revisión de todas las fracturas extracapsulares de fémur proximal tratadas con clavo intramedular con tornillo cefálico único entre 2016 y 2020. Se revisaron las historias clínicas y las radiografías de 269 pacientes, y solo 12 (6,4%) de ellos cumplieron los criterios de inclusión (fracturas en dos fragmentos no patológicas y con seguimiento mínimo de 9 meses). Se evaluaron diferentes factores, como distancia punta-ápex, posición del tornillo cefálico, calidad de la reducción, tiempo quirúrgico, complicaciones y reintervención, y se analizaron las posibles diferencias entre los pacientes que sufrieron complicaciones y los que no. Resultados: Cuatro de los 12 pacientes tuvieron una falla de la fijación que evolucionó a cut-out (única complicación identificada en la muestra). No hubo diferencias estadísticamente significativas entre pacientes con cut-out o sin cut-out respecto al resto de las variables analizadas. Conclusiones: La elevada proporción de pacientes que desarrollaron cut-out sugiere considerar la hipótesis de que debería evitarse fijar las fracturas basicervicales con tornillo cefálico único. Dada su alta tasa de inestabilidad rotatoria, podría ser más apropiado el uso de implantes que la contrarresten.
Coronavirus disease 2019 (COVID‐19) infection in elderly patients is more aggressive and treatments have shown limited efficacy. Our objective is to describe the clinical course and to analyze the ...prognostic factors associated with a higher risk of mortality of a cohort of patients older than 80 years. In addition, we assess the efficacy of immunosuppressive treatments in this population. We analyzed the data from 163 patients older than 80 years admitted to our institution for COVID‐19, during March and April 2020. A Lasso regression model and subsequent multivariate Cox regression were performed to select variables predictive of death. We evaluated the efficacy of immunomodulatory therapy in three cohorts using adjusted survival analysis. The mortality rate was 43%. The mean age was 85.2 years. The disease was considered severe in 76.1% of the cases. Lasso regression and multivariate Cox regression indicated that factors correlated with hospital mortality were: age (hazard ratio HR 1.12, 95% confidence interval CI: 1.03–1.22), alcohol consumption (HR 3.15, 95% CI: 1.27–7.84), CRP > 10 mg/dL (HR 2.67, 95% CI: 1.36–5.24), and oxygen support with Venturi Mask (HR 6.37, 95% CI: 2.18–18.62) or reservoir (HR 7.87, 95% CI: 3.37–18.38). Previous treatment with antiplatelets was the only protective factor (HR 0.47, 95% CI: 0.23–0.96). In the adjusted treatment efficacy analysis, we found benefit in the combined use of tocilizumab (TCZ) and corticosteroids (CS) (HR 0.09, 95% CI: 0.01–0.74) compared to standard treatment, with no benefit of CS alone (HR 0.95, 95% CI: 0.53–1.71). Hospitalized elderly patients suffer from a severe and often fatal form of COVID‐19 disease. In this regard, several parameters might identify high‐risk patients upon admission. Combined use of TCZ and CS could improve survival.
Highlights
The COVID‐19 disease in the elderly population (> 80 years) is severe in most cases.
We analyze which parameters at admission may be useful to better stratify the risk of mortality. Oxygen demand on admission is the most accurate parameter to determine prognosis.
A combined use of corticosteroids and tocilizumab may improve overall survival versus corticosteroids alone or standard of care.
Baricitinib and imatinib are considered therapies for coronavirus disease 2019 (COVID‐19), but their ultimate clinical impact remains to be elucidated, so our objective is to determine whether these ...kinase inhibitors provide benefit when added to standard care in hospitalized COVID‐19 patients. Phase‐2, open‐label, randomized trial with a pick‐the‐winner design conducted from September 2020 to June 2021 in a single Spanish center. Hospitalized adults with COVID‐19 pneumonia and a symptom duration ≤10 days were assigned to 3 arms: imatinib (400 mg qd, 7 days) plus standard‐care, baricitinib (4 mg qd, 7 days) plus standard‐care, or standard‐care alone. Primary outcome was time to clinical improvement (discharge alive or a reduction of 2 points in an ordinal scale of clinical status) compared on a day‐by‐day basis to identify differences ≥15% between the most and least favorable groups. Secondary outcomes included oxygenation and ventilatory support requirements, additional therapies administered, all‐cause mortality, and safety. One hundred and sixty‐five patients analyzed. Predefined criteria for selection of the most advantageous arm were met for baricitinib, but not for imatinib. However, no statistically significant differences were observed in formal analysis, but a trend toward better results in patients receiving baricitinib was found compared to standard care alone (hazard ratio HR for clinical improvement: 1.41, 95% confidence intervals CI: 0.96−2.06; HR for discontinuing oxygen: 1.46, 95% CI: 0.94−2.28). No differences were found regarding additional therapies administered or safety. Baricitinib plus standard care showed better results for hospitalized COVID‐19 patients, being the most advantageous therapeutic strategy among those proposed in this exploratory clinical trial.
En este artículo se aborda una síntesis de trabajo de varios años en Tochimilco, un lugar importante por sus recursos naturales, biodiversidad, saberes tradicionales y como un lugar que tiene uno de ...los tres edificios patrimoniales en el estado de Puebla reconocido por la UNESCO. El trabajo de investigación se hizo a través de un análisis cuantitativo y cualitativo, utilizando información oficial y entrevistas abiertas y cerradas. Se manifiesta la importancia del tequio durante el proceso de construcción de vivienda vernácula. A su vez, se establece a la vivienda vernácula, como un instrumento de solidaridad y autoproducción en las comunidades indígenas tradicionales. En cuanto a la autoproducción, se define de acuerdo a diferentes autores e instituciones y se mencionan los programas de vivienda autoproducida más importantes en México. Se establecen las condiciones del territorio y la clasificación de la vivienda existente, así como las condiciones adversas que soporta la arquitectura vernácula que propician su desaparición.
A 63-year-old man attended our department reporting a 3-month history of diffuse pain in both hands. He had been investigated for primary hyperparathyroidism because of previous episodes of ...hypercalcaemia—the last time had necessitated hospitalisation—despite taking high doses of a calcimimetic (cinacalcet). The patient's maximum serum calcium concentration had been 13·3 mg/dL (normal range 8·5–10·5). His parathyroid hormone (286 pg/mL; normal range 12–88) and 24-h urine test for calcium (491·8 mg; normal range 100–300) had also been raised; imaging studies had been inconclusive for parathyroid hyperfunction.
L'echographie mobile pour diagnostiquer la pneumonie Morales-Ortega, Alejandro; Canora-Lebrato, Jesus; Ruiz-Giardin, Jose Manuel
Canadian Medical Association journal (CMAJ),
11/2021, Letnik:
193, Številka:
47
Journal Article
L’échographie mobile pour diagnostiquer la pneumonie Morales-Ortega, Alejandro; Canora-Lebrato, Jesús; Ruiz-Giardín, José Manuel
Canadian Medical Association journal (CMAJ),
11/2021, Letnik:
193, Številka:
47
Journal Article
Bedside ultrasonography for the diagnosis of pneumonia Morales-Ortega, Alejandro; Canora-Lebrato, Jesús; Ruiz-Giardín, José Manuel
Canadian Medical Association journal (CMAJ),
09/2021, Letnik:
193, Številka:
37
Journal Article
Recenzirano
Odprti dostop
Sonographic artifacts in lung ultrasound imaging provide valuable information about pulmonary parenchyma that may be underappreciated on chest radiographs. Extensive pneumonias can be relatively ...easily identified. More subtle signs, such as unilateral, abolished pleural sliding with breathing and focal B-lines, may help identify smaller consolidations in certain clinical contexts. Here, Morales-Ortega et al examine the ultrasonography results of a 25-year-old man with pneumonia.
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