RESUMEN
BACKGROUND: Apprehensions of undocumented immigrants in the Rio Grande Valley sector of the U.S.-Mexico border have grown to account for nearly half of all apprehensions at the border. The purpose of this study is to report the prevalence, mechanism, and pattern of traumatic injuries sustained by undocumented immigrants who crossed the U.S.-Mexico border at the Rio Grande Valley sector over a span of 5 years and were treated at a local American College of Surgeons verified Level II trauma center. METHODS: A retrospective chart review was conducted from January 2014 to December 2019. Demographics, comorbidities, injury severity score (ISS), mechanism of injury, anatomical part of the body affected, hospital and ICU length of stay (LOS), and treatment costs were analyzed. Descriptive statistics for demographics, injury location and cause, and temporal trends are reported. The impact of ISS or surgical intervention on hospital LOS was analyzed using an analysis of covariance (ANCOVA). RESULTS: Of 178 patients, 65.2% were male with an average age of 31 (range 0-67) years old and few comorbidities (88.8%) or social risk factors (86%). Patients most commonly sustained injuries secondary to a border fence-related incident (33.7%), fleeing (22.5%), or motor vehicle accident (16.9%). There were no clear temporal trends in the total number of patients injured, or in causes of injury, between 2014 and 2019. The majority of patients (60.7%) sustained extremity injuries, followed by spine injuries (20.2%). Border fence-related incidents and fleeing increased risk of extremity injuries (Odds ratio (OR) > 3; p < 0.005), whereas motor vehicle accidents increased risk of head and chest injuries (OR > 4; p < 0.004). Extremity injuries increased the odds (OR: 9.4, p < 0.001) that surgery would be required. Surgical intervention was common (64%), and the median LOS of patients who underwent surgery was 3 days more than those who did not (p < 0.001). CONCLUSION: In addition to border fence related injuries, undocumented immigrants also sustained injuries while fleeing and in motor vehicle accidents, among others. Extremity injuries, which were more likely with border fence-related incidents, were the most common type. This type of injury often requires surgical intervention and, therefore, a longer hospital stay for severe injuries.
RESUMEN
BACKGROUND: Pain is the primary complaint and the main reason for prolonged recovery after laparoscopic cholecystectomy. The authors hypothesized that patients undergoing laparoscopic cholecystectomy will have less pain four hours after surgery when receiving maintenance of anesthesia with propofol when compared to isoflurane, desflurane, or sevoflurane. METHODS: In this prospective, randomized trial, 80 patients scheduled for laparoscopic cholecystectomy were assigned to propofol, isoflurane, desflurane, or sevoflurane for the maintenance of anesthesia. Our primary outcome was pain measured on the numeric analog scale four hours after surgery. We also recorded intraoperative use of opioids as well as analgesic consumption during the first 24h after surgery. RESULTS: There was no statistically significant difference in pain scores four hours after surgery (p=0.72). There were also no statistically significant differences in pain scores between treatment groups during the 24h after surgery (p=0.45). Intraoperative use of fentanyl and morphine did not vary significantly among the groups (p=0.21 and 0.24, respectively). There were no differences in total morphine and hydrocodone/APAP use during the first 24h (p=0.61 and 0.53, respectively). CONCLUSION: Patients receiving maintenance of general anesthesia with propofol do not have less pain after laparoscopic cholecystectomy when compared to isoflurane, desflurane, or sevoflurane.
Asunto(s)
Anestésicos por Inhalación/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Colecistectomía Laparoscópica/métodos , Dolor Postoperatorio/prevención & control , Adulto , Analgésicos Opioides/administración & dosificación , Desflurano , Femenino , Fentanilo/administración & dosificación , Estudios de Seguimiento , Humanos , Isoflurano/administración & dosificación , Isoflurano/análogos & derivados , Masculino , Éteres Metílicos/administración & dosificación , Persona de Mediana Edad , Morfina/administración & dosificación , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Propofol/administración & dosificación , Estudios Prospectivos , Sevoflurano , Método Simple Ciego , Factores de Tiempo , Adulto JovenRESUMEN
Background: Pain is the primary complaint and the main reason for prolonged recovery after laparoscopic cholecystectomy. The authors hypothesized that patients undergoing laparoscopic cholecystectomy will have less pain four hours after surgery when receiving maintenance of anesthesia with propofol when compared to isoflurane, desflurane, or sevoflurane. Methods: In this prospective, randomized trial, 80 patients scheduled for laparoscopic cholecystectomy were assigned to propofol, isoflurane, desflurane, or sevoflurane for the maintenance of anesthesia. Our primary outcome was pain measured on the numeric analog scale four hours after surgery. We also recorded intraoperative use of opioids as well as analgesic consumption during the first 24 h after surgery. Results: There was no statistically significant difference in pain scores four hours after surgery (p = 0.72). There were also no statistically significant differences in pain scores between treatment groups during the 24 h after surgery (p = 0.45). Intraoperative use of fentanyl and morphine did not vary significantly among the groups (p = 0.21 and 0.24, respectively). There were no differences in total morphine and hydrocodone/APAP use during the first 24 h (p = 0.61 and 0.53, respectively). Conclusion: Patients receiving maintenance of general anesthesia with propofol do not have less pain after laparoscopic cholecystectomy when compared to isoflurane, desflurane, or sevoflurane. .
Justificativa e objetivo: a dor é a principal queixa e também o motivo principal de recuperação prolongada pós-colecistectomia laparoscópica. A nossa hipótese foi que os pacientes submetidos à colecistectomia laparoscópica apresentariam menos dor quatro horas após a cirurgia se recebessem manutenção anestésica com propofol em comparação com isoflurano, desflurano ou sevoflurano. Métodos: neste estudo prospectivo e randômico, 80 pacientes agendados para colecistectomia laparoscópica foram designados para receber propofol, isoflurano, desflurano ou sevoflurano para manutenção da anestesia. Nosso desfecho primário foi dor mensurada em escala analógica numérica quatro horas após a cirurgia. Também registramos o uso intraoperatório de opiáceos, bem como o consumo de analgésicos durante as primeiras 24 horas pós-cirúrgicas. Resultados: não houve diferença estatisticamente significante nos escores de dor quatro horas após a cirurgia (p = 0,72). Também não houve diferença estatisticamente significativa nos escores de dor entre os grupos de tratamento durante as 24 horas pós-cirúrgicas (p = 0,45). O uso intraoperatório de fentanil e morfina não variou significativamente entre os grupos (p = 0,21 e 0,24, respectivamente). Não houve diferença no consumo total de morfina e hidrocodona/APAP durante as primeiras 24 horas (p = 0,61 e 0,53, respectivamente). Conclusão: os pacientes que receberam propofol para manutenção da anestesia geral não apresentaram menos dor pós-colecistectomia videolaparoscópica em comparação com os que receberam isoflurano, desflurano ou sevoflurano. .
Justificación y objetivo: el dolor es el principal motivo de queja y también la principal razón de una prolongada recuperación tras una colecistectomía laparoscópica. Nuestra hipótesis fue que los pacientes sometidos a colecistectomía laparoscópica tenían menos dolor 4 h después de la cirugía cuando recibían propofol para la anestesia en comparación con isoflurano, desflurano o sevoflurano. Métodos: en este estudio prospectivo y aleatorizado, 80 pacientes programados para colecistectomía laparoscópica fueron designados para recibir propofol, isoflurano, desflurano o sevoflurano para el mantenimiento de la anestesia. Nuestro primer resultado fue el dolor medido en escala analógica numérica 4 h después de la cirugía. También registramos el uso intraoperatorio de opiáceos y el consumo de analgésicos durante las primeras 24 h del postoperatorio. Resultados: no hubo diferencias estadísticamente significativas en las puntuaciones del dolor 4 h después de la cirugía (p = 0,72). Tampoco hubo diferencias estadísticamente significativas en las puntuaciones del dolor entre los grupos de tratamiento durante las 24 h del postoperatorio (p = 0,45). El uso intraoperatorio de fentanilo y morfina no varió significativamente entre los grupos (p = 0,21 y 0,24 respectivamente). No hubo una diferencia en el consumo total de morfina e hidrocodona/APAP durante las primeras 24 h (p = 0,61 y 0,53 respectivamente). Conclusiones: los pacientes que recibieron propofol para el mantenimiento de la anestesia general no tenían menos dolor poscolecistectomía videolaparoscópica en comparación con los que recibieron isoflurano, desflurano o sevoflurano. .
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Anestésicos por Inhalación/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Colecistectomía Laparoscópica/métodos , Dolor Postoperatorio/prevención & control , Analgésicos Opioides/administración & dosificación , Estudios de Seguimiento , Fentanilo/administración & dosificación , Isoflurano/administración & dosificación , Isoflurano/análogos & derivados , Éteres Metílicos/administración & dosificación , Morfina/administración & dosificación , Dimensión del Dolor , Estudios Prospectivos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Propofol/administración & dosificación , Método Simple Ciego , Factores de TiempoRESUMEN
Research has been conducted as part of the Small Ruminant Collaborative Research Support Program (SR-CRSP) on evaluation of genetic resources and methods of effecting genetic improvement of small ruminants in the participating countries. In Kenya, the focus has been on development of a dual-purpose goat for milk and meat production in farming areas, utilizing two locally adapted breeds, Galla and East African, and two imported dairy breeds, Anglo-Nubian and Toggenburg, into a single stock. That research now has reached the stage of field testing. In Morocco, the performance of a highly prolific breed of sheep, the D'Man, and of a less prolific but larger breed, commonly raised under extensive management, the Sardi, and of their F1, F2 and backcross progeny has been evaluated for several reproduction and growth traits. Prolificacy of the D'Man was transmitted additively, but there was favorable heterosis for age at puberty, fertility and growth rate, resulting in substantial heterosis in total performance. In Indonesia, a high degree of variability in prolificacy in sheep appears to be due to segregation of a gene with large effect on ovulation rate, similar in some respects to the Booroola gene. In Peru, work has involved evaluation of effectiveness of current selection programs and estimation of phenotypic and genetic parameters, in unimproved and improved types of sheep, with a limited amount of work also on alpacas. Fiber production is the principal economic trait in alpacas. There also has been work on evaluation of hair sheep in Brazil, Kenya and Indonesia.
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Artiodáctilos/genética , Cruzamiento , Camélidos del Nuevo Mundo/genética , Cabras/genética , Ovinos/genética , Animales , Femenino , Variación Genética , Genotipo , Indonesia , Kenia , Masculino , Marruecos , PerúRESUMEN
Ovulation rate was measured in Barbados Blackbelly (United States strain; B), Targhee (T), Barbados X Targhee (B X T) and Barbados X Dorset-Targhee (B X DT) ewes at first and second estrus following synchronization of cycles early in the breeding season. Body weight at sponge removal differed (P less than .001) between B (30.9 kg) and T ewes (54.9 kg) and was intermediate for B X T (44.9 kg) and B X DT (43.5 kg) ewes. Ovulation rate was higher (P less than .01) at first and second estrus for B (1.86, 2.04), B X T (1.93, 2.04) and B X DT (1.72, 1.80) than for T (1.29, 1.40) ewes. Regressions of ovulation rate on body weight within the breed groups did not differ significantly from each other and the average was significant (b = .049 +/- .014 CL/kg at first estrus and b = .046 +/- .011 CL/kg at second estrus, where CL = number of corpora lutea), but differences between the groups in body weight did not explain the differences in ovulation rate. Litter size for B, B X T, B X DT and T groups was 1.71, 1.84, 1.84 and 1.28, respectively. The B X T ewes were superior to the average of the B and T ewes for ovulation rate (P less than .05) and litter size (P less than .01); there was no direct estimate of embryo survival, but the results indirectly indicate superiority of the crossbreds for this component also.(ABSTRACT TRUNCATED AT 250 WORDS)