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Geometric morphometrics was used to determine whether geographic isolation could explain differences in wing size and shape between and within continental (27°S to 41°S) and insular (Rapa Nui) populations of Culex pipiens s.s. Linnaeus and their biotypes (f. pipiens and f. molestus). Molecular protocols based on polymorphisms in the second intron of nuclear locus ace-2 (acetylcholinesterase-2) were used to differentiate Cx. pipiens s.s. from Cx. quinquefasciatus Say, and an assay based on polymorphisms in the flanking region of a microsatellite locus (CQ11) was used to identify biotypes. Culex pipiens f. molestus and hybrids shared larval habitats in all continental sites, while Cx. pipiens f. pipiens was found in 5 of the 10 sites. Only biotype molestus was found in Rapa Nui (Easter Island) Pipiens and molestus biotypes occur sympatrically in aboveground locations, and only molestus was found in the underground site (ME). Biotype molestus was dominant in rural locations and preferably anthropophilic. These results agree with the ecological descriptions previously reported for the biotypes of Cx. pipiens s.s. Procrustes ANOVA only showed differences in centroid size between biotypes in females and males and did not show significant differences in wing shape. However, we found significant differences among the geographic areas in the centroid size and wing shape of both females and males. Particularly, the population of Rapa Nui Island had shorter wings than the continental populations. The results highlight the effects of geographic and environmental processes on morphotypes in vector mosquitoes.

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OBJECTIVES: Lack of sufficient physical activity (PA) has been associated with an increased risk of several non-communicable diseases (NCDs) and all-cause mortality. This study aimed to estimate the number of preventable incidence cases of NCDs attributable to insufficient PA in the Chilean population. STUDY DESIGN: Comparative risk assessment modelling study. METHODS: This study examined data from 5834 participants aged ≥20 years from the Chilean National Survey (2016-2017). PA was assessed by the Global Physical Activity Questionnaire (GPAQ), and metabolic equivalent of tasks (METs) were assigned according to PA intensity. Estimated incidence cases of NCDs in Chile in 2019 were obtained from the Global Burden of Disease study. Relative risks for breast cancer, colon cancer, ischaemic heart disease, diabetes and stroke were obtained from a published meta-analysis and applied to the prevalence of insufficient PA estimates through the potential impact fraction equation. RESULTS: High levels of PA (≥8000 MET-min/week) could potentially avoid more than 22,000 (64.6 %) incidence NCD cases, ranging from 498 (10.1 %) preventable cases of breast cancer to 5629 (14.7 %) cases of diabetes. Other modelled scenarios also showed to reduce the incidence cases of all five NCDs but to a lesser extent; where at least PA recommendation was achieved, preventable NCDs were reduced by 6522 cases (18.7 %), and where a 10 % relative reduction in insufficient PA level in the population was achieved, preventable NCDs were reduced by 651 (1.8 %) cases. CONCLUSIONS: The study results provide estimates for the incidence cases of preventable NCDs attributable to insufficient PA, highlighting the important role of PA in NCD prevention in Chile.

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Las quemaduras son un problema de interés en salud pública ya que generan un alto índice de morbimortalidad a nivel mundial, las quemaduras térmicas son las más prevalentes y pueden alterar la integridad anatómica, funcional y estética de la piel, aspectos fundamentales para la autoestima del paciente y su capacidad para reintegrarse a la sociedad. Al revisar la literatura sobre el tratamiento de estas afecciones encontramos diversos tratamientos, entre ellos el uso de membrana amniótica humana, la cual ha tenido un impacto importante en el manejo de quemaduras al funcionar como andamio biológico con cualidades regenerativas y antiinflamatorias. El presente artículo tiene como objetivo sintetizar la información actual que describe las aplicaciones de membranas amnióticas humanas en quemaduras, realizamos una revisión exploratoria sistemática de la literatura desde 2010 hasta 2021.

Burns are a problem of interest in public health since they generate a high rate of morbidity and mortality worldwide, thermal burns are the most prevalent and can alter the anatomical, functional and aesthetic integrity of the skin, fundamental aspects for the patient's self-esteem and their ability to reintegrate into society. At review literature about the treatment of these conditions, we find various treatments, including the use of human amniotic membrane, which has had a significant impact on burn management by functioning as a biological scaffold with regenerative and anti-inflammatory qualities. The present article aims to synthesize the current information that describes the applications of human amniotic membranes in burns. We carry out a systematic exploratory review of the literature from 2010 to 2021.

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BACKGROUND: The prevalence of overweight/obesity has been increasing globally and in people with Intellectual Disabilities (IDs), this problem is exacerbated even more, which added to a low physical condition that contributes to the deterioration of functionality and increases the risk of developing chronic diseases in the course of life. Therefore, the aim of this study was to establish cut-off points for levels of isometric handgrip and low limb explosive strength in children, adolescents and adults, which identify overweight/obesity in people with IDs and their respective associations. METHODS: The sample was made up of 131 individuals with IDs, belonging to four special and community educational centres in the city of Santiago, Chile. Body mass index (BMI) and waist-to-height ratio (WHR) were used as indicators of overweight/obesity. Handgrip strength was used as a measure of isometric strength, and countermovement jump was used as a measure of low limb explosive strength. For the comparison of variables by age group, the analysis of Ancova, Kruskal-Wallis and chi-square tests were used. The total area under the receiver operating characteristic curve of isometric handgrip and low limb explosive strength was identified as an indicator of overweight/obesity according to age groups. A logistic regression model was used to quantify the effect that strength categories below the cut-off point have on the risk of overweight and obesity. RESULTS: Significant differences were observed between the age groups for body weight, height, BMI and WHR, as well as in the levels of absolute handgrip strength and vertical jump with countermovement (P ≤ 0.05). Children showed the lowest cut-off points for absolute and relative strength. The adolescent group showed the highest cut-off points for relative strength and countermovement jump and adults showed the highest value for absolute strength as indicators of overweight/obesity. Different associations between cut-off points with BMI and WHR were found. CONCLUSIONS: Adolescents showed the highest cut-off point for relative strength and countermovement jump, and adults showed the highest value for absolute strength, according to overweight/obesity indicators (BMI and WHR). It is suggested to adjust resistance training programmes according to age categories for the prevention of overweight/obesity in people with IDs.

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Bergmann's rule relates the trend of increasing body size with higher latitudes, where colder climates are found. In the Mexican Pacific, three marine ecoregions are distinguishable across a latitudinal gradient. Stenoplax limaciformis is an abundant chiton species that is distributed on rocky shores in these ecoregions. Geometric morphometric analyses were performed to describe the shape and size variation of S. limaciformis between marine ecoregions that vary in sea surface temperature with latitude, thus testing Bergmann's rule. Individuals' body shape ranged from elongated to wide bodies. Although there was variation in chitons' body shape and size, the was no evidence of allometry among localities. The Gulf of California is the northernmost ecoregion evaluated in this work, where larger chitons were observed and lower sea surface temperature values were registered. The results suggest that S. limaciformis follows a trend to Bergmann's rule, such as endotherms. These mollusks do not need heat dissipation, but they do need to retain moisture. In addition, larger chitons were observed in zones with high primary productivity, suggesting that chitons do not delay their maturation due to food shortage.

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Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago. Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma. In this second part of the document, the topics related to the treatment of HCC are presented.

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Hepatocellular carcinoma (HCC) is more frequently manifesting as one of the main complications of cirrhosis of the liver, its principal risk factor. There have been modifications in its incidence over the past decade, related to an epidemiologic transition in the etiology of cirrhosis, with a decrease in the prevalence of hepatitis C and an increase in nonalcoholic fatty liver disease (NAFLD) as a cause, as well as the development of HCC in the non-cirrhotic liver due to NAFLD. Genetic markers associated with the disease have been identified, and surveillance and diagnosis have improved. Regarding treatment, surgical techniques, in both resection and transplantation, have advanced and radiologic techniques, at the curative stage of the disease, have enhanced survival in those patients. And finally, there have been radical changes in the systemic approach, with much more optimistic expectations, when compared with the options available a decade ago. Therefore, the Asociación Mexicana de Hepatología decided to carry out the Second Mexican Consensus on Hepatocellular Carcinoma, which is an updated review of the available national and international evidence on the epidemiology, risk factors, surveillance, diagnosis, and treatment of the disease, to offer the Mexican physician current information on the different topics regarding hepatocellular carcinoma. In this first part of the document, the topics related to epidemiology and diagnosis are presented.

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Imperial County, California, is a high-need, medically underserved area that has some of the worst overall health outcomes of all California counties. Given this and the high depression and anxiety rates in agricultural occupations, Imperial County farmers and ranchers may be at an increased risk of stress and poor mental health outcomes. An exploratory mixed methods assessment was used to collect information from 24 farmers and ranchers in Imperial County. Survey topics included questions about farm or ranch operations, farm-related stress, mental health, community support, and health behaviors. The results indicate that most respondents perceive unpredictable factors, such as government regulations, as the most impactful stressors related to their farm or ranch operations. Additionally, depression symptomatology scores were positively correlated with respondents' ability to obtain credit. Efforts to understand farm-related stress and how community support can help Imperial County farmers and ranchers mediate adverse physical and mental health effects through formal and informal networks are considered.

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Introduction. Bone mineral disease in patients with chronic kidney disease (CKD-MBD) is a clinical syndrome involving bone, biochemical changes, and extraosseous calcification. These complications increase morbidity and mortality. Prevalence reports are rare. Case Report. This case shows a young woman on peritoneal dialysis (PD) for 10 years with severe secondary hyperparathyroidism and soft-tissue calcifications in the hands, pelvis, and right knee, as well as severe vascular calcification, managed with calcimimetics without success. We decided to perform subtotal parathyroidectomy (STPTX). Three months after surgery, she had satisfactory evolution, despite notable hungry bone disease, without bone pain or functional limitation and almost no calcifications. Discussion. The benefit of hemodialysis has been shown with better volume management and improvement of calcium/phosphate products. STPTX allowed biochemical control and calcification improvement, with an evident better quality of life for our patient. Therapeutic alternatives need to be tailored to the patient's characteristics in the calcimimetics era.

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RESUMEN Objetivo. El objetivo de este estudio fue describir las medidas corporales e índices zoométricos de Ovinos de Pelo Criollos Colombianos (OPC), en dos de sus variedades, Sudán Bayo y Sudán Blanco. Materiales y métodos. Esta investigación fue llevada a cabo en los departamentos de Córdoba, Cesar y La Guajira, se visitaron dos granjas en cada uno de los primeros dos departamentos y una en el tercero. 21, 75 y 14 animales por departamento fueron evaluados, respectivamente. Se estudiaron 29 variables morfoestructurales y el peso corporal en 110 ovejas Sudán, y con estas variables evaluadas, se construyeron 15 índices zoométricos. A la información recolectada se le aplicó estadística descriptiva mediante el software InfoStat®. Resultados. Las Sudán Bayo presentaron valores superiores a las Sudán Blanco para el peso (40.8 y 40.57 kg), al igual que para todas las medidas zoométricas relativas a la cabeza, las extremidades y la mayoría de las del tronco; para la primera variedad se emplearon 83 ejemplares y para la segunda 27. En cuanto a los índices zoométricos, las Sudán se caracterizaron por ser dolicocraniotas, dolicocéfalas, eumétricas, de tórax con tendencia elíptica, de grupas convexilíneas y de acuerdo a dos índices etnológicos longilíneas, mientras que con base en un índice funcional brevilíneas. Conclusiones. A través de esta investigación se conoció de manera detallada el estado morfométrico actual de las OPC Sudán, así como también la proporcionalidad entre las regiones corporales de estas, cuya inclinación es hacia el biotipo cárnico. Esta información es de importancia para el conocimiento, caracterización racial, definición de biotipo, conservación, fomento y mejora genética de los OPC.

ABSTRACT Objective. The objective of this study was to describe the body measurements and zoometric indices of Sudán Bayo and Sudán Blanco, two breed varieties of Colombian creole woolless sheep (OPC). Materials and methods. This research was carried out in the departments of Córdoba, Cesar, and La Guajira. Two farms were visited in each of the first two departments and one farm in the third department. Twenty-one, 75, and 14 animals were evaluated in each department, respectively. Twenty-nine morphostructural variables and body weight were studied in 110 Sudán sheep. Based on this, 15 zoometric indices were also estimated. Descriptive statistic was applied to the information collected through the InfoStat® software. Results. Sudán Bayo sheep had higher values than Sudán Blanco sheep for the body weight (40.8 and 40.57 kg), as well as for all the zoometric measurements relative to the head and extremities, and most of the trunk morphometric measurements; in the first breed variety 83 ewes were used and in the second 27 individuals. Regarding the zoometric indices, Sudán sheep were characterized as dolichocranial, dolichocephalic, eumetric, of thorax with elliptical tendency, convex rump, and longilineal animals according to two ethnological indices while brevilineal animals based on one functional index. Conclusions. Through this investigation, the current morphometric status of Sudán OPC sheep was known in detail, as well as the proportionality between the corporal regions of these, whose inclination is towards the meat biotype. This information is of importance for the breed recognition and characterization, biotype definition, conservation, development, and genetic improvement of OPC sheep.

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The new Coronavirus (SARS-CoV-2) appeared in China in December 2019. Since then and until April 2020 it spread worldwide affecting more than three million people. Its exponential rise is still growing all over the world, taking thousands of lives. SARS-CoV-2 is very contagious, person to person, by droplets which can generate a respiratory infection known as COVID-19. Some patients are at higher risk: Older people, those with cardiovascular disease, diabetes and hypertension are the most prone to an unfavorable outcome. Our Inflammatory Bowel Disease (IBD) patients are a special cluster, with many of them taking immunosuppressive treatment for long periods, which could pose an important risk. Scientifics societies all over the world have joined efforts to generate data, share experiences and make recommendations for good clinical management. This is a review of the available evidence, expert opinion, and proposed ways of working during the pandemic

El nuevo coronavirus (SARS-CoV-2) apareció en China en diciembre de 2019. Desde su inicio hasta abril de 2020 se ha expandido por todo el mundo, afectando a más de tres millones de personas. Su ascenso exponencial sigue creciendo, generando miles de muertes. Su contagiosidad es persona a persona por gotitas, pudiendo llegar a generar un cuadro clínico de infección respiratoria conocido como COVID-19. Algunos pacientes tienen más riesgos de tener un curso desfavorable; adultos mayores, pacientes con enfermedad cardiovascular, hipertensos y diabéticos. Nuestros pacientes con enfermedad inflamatoria intestinal son un grupo de pacientes con características particulares, muchos de ellos reciben tratamiento inmunosupresor por largos períodos, lo que pudiese suponer un riesgo específico. Las sociedades científicas de Europa y Norteamérica han realizado un esfuerzo conjunto para generar datos, compartir experiencias y dictar recomendaciones de buen manejo clínico. Esta es una revisión de la evidencia disponible, opiniones de expertos y formas de trabajo propuestos durante la pandemia.

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RESUMEN Objetivo. Esta investigación tuvo como objetivo describir la morfología cualitativa y faneróptica de hembras Ovino de Pelo Criollo Colombiano (OPC) Sudán. Materiales y métodos. Se evaluaron seis características fanerópticas y siete morfológicas cualitativas en 115 hembras Sudán Bayo y Sudán Blanco, de los departamentos Córdoba, Cesar y La Guajira. Los datos obtenidos se analizaron a través del programa estadístico InfoStat® y se estimaron las frecuencias relativas y absolutas para cada uno de los caracteres evaluados. Resultados. Los OPC Sudán Bayo se distinguieron por ser de un color de capa bayo amarillo. Los Sudán Blanco fueron de capa overo castaño, pero predominando siempre el blanco sobre el castaño. Estos ovinos se caracterizaron por poseer mucosas negra-rosadas y en menor proporción habían individuos con mucosas rosadas. Además, presentaron orejas horizontales siempre, perfiles subconvexos en más del 80% de los casos, cuellos generalmente medianos y poco musculados, grupas usualmente inclinadas, ubres parcialmente pigmentadas y también despigmentadas. Asimismo, se caracterizaron por ostentar pezuñas veteadas mayoritariamente, aunque con un alto porcentaje de pezuñas claras en las Sudán Blanco. Conclusiones. Este trabajo ha permitido caracterizar de manera específica a las OPC Sudán desde la morfología y la faneróptica, obteniéndose así información de importancia para delimitar los parámetros de pertenencia a este grupo y para la propuesta de creación de un estándar racial.

ABSTRACT Objective. The objective of this research was to describe the qualitative morphology and phaneroptic of Sudán Colombian creole woolless sheep (OPC). Materials and methods. Six phaneroptic and seven qualitative morphological characteristics were evaluated in a total of 115 Sudán Bayo and Sudán Blanco ewes, from the departments Córdoba, Cesar and La Guajira. The data obtained were analyzed through the statistical program InfoStat®, relative and absolute frequencies were estimated for each evaluated trait. Results. Sudán Bayo OPC were distinguished by being yellow coat color. Sudán Blanco were white-and-chestnut spotted coat color, but white always predominated over chestnut. These ovines usually had black-rosy mucosae and in lesser amount there were individuals with rosy mucosae. Besides, they presented horizontal ears always, sub-convex profile in more than 80% of cases, generally medium-sized and scant muscled necks, usually inclined rumps, partially pigmented and depigmented udders as well. Likewise, they were characterized by showing marbled hooves mostly, but with a high percentage of clear hooves in Sudán Blanco sheep. Conclusions. This research has allowed to characterize specifically. Sudán OPC sheep from morphology and phaneroptic; thus, important information has been obtained to delimit the parameters of belonging to this group and for proposing the creation of a breed standard.

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BACKGROUND: Quality improvement (QI) methods are recommended to address healthcare-associated infections (HCAIs) in hospitals, but whereas internal initiatives have been widely studied, there is little evidence on the application and effect of a QI approach from an external system-wide perspective. AIM: To analyse the effect of a national system-wide QI initiative aimed at promoting HCAI prevention via regulatory interventions in Brazil. METHODS: A QI cycle approach designed and assessed with a before-and-after quasi-experimental design was implemented by the Brazilian Health Regulatory Agency (ANVISA), targeting 1869 hospitals. Eleven evidence-based quality indicators related to HCAI prevention and a composite measure were assembled, shared, and assessed; the intervention to improve was then based on participatory multifaceted regulatory actions. Absolute and relative improvements were estimated after the intervention. FINDINGS: In all, 563 hospitals (30.1% response) totalling 86,837 beds participated in the baseline assessment, and 681 hospitals (36.4% response) totalling 101,231 beds in the second. Ten of the 11 criteria improved (P < 0.05), as well as the composite indicator (P = 0.001) in all the regions of the country, particularly in the group of hospitals participating at baseline. 'Hand hygiene (HH) infrastructure' reached 100% (baseline: 97.9; P = 0.001), 'HH protocol' 96.9% (baseline: 92.9; P = 0.001), 'HH monitoring' 70% (baseline: 60.7; P < 0.001) and 'existence of antimicrobial prescription protocol' 80.7% (baseline: 73.2; P < 0.001), among others. The HCAI rates of the participating hospitals decreased after the intervention (P < 0.05). CONCLUSION: The QI cycle approach was useful in guiding system-wide interventions for patient safety. External regulation was feasible and effective in promoting internal HCAI prevention nationwide.

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We describe an experimental system based on optical microscopy, permitting the analysis of the four dimensional structure of the flow inside evaporating sessile droplets by monitoring the motion of tracers in horizontal planes localized at different heights. Inter-plane particle identification is accomplished via 3D tracking algorithms. The multiple plane observation is achieved using a piezoelectric device to make the microscope objective oscillate vertically, while a high-speed camera captures images. The droplet evaporation process lasts several minutes and greatly accelerates as the fluid advances toward complete evaporation. In order to capture the dynamics of the whole process, two cameras with the same optical output but different temporal resolution are used sequentially. Using image processing algorithms, we obtain the full trajectories of multiple tracers, velocities of particles on the free surface of the droplets, and velocity fields. The information available may be used to understand the geometry of the sedimentation pattern.

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Introducción: El nevus de Ota es un hamartoma melanocítico dérmico benigno de aspecto macular, mal delimitado y en parche de color negrogrisáceo que generalmente afecta unilateralmente la primera y segunda rama del trigémino. Objetivo: Evaluar la eficacia, seguridad y los eventos adversos ocasionados por la aplicación de láser Alexandrita de 755 nm para el tratamiento del nevus de Ota. Métodos: Serie de casos de 10 pacientes de fototipo IV con Nevus de Ota unilateral atendidos entre enero 2017 y diciembre 2018, los cuales fueron tratados con esta energía lumínica y con parámetros definidos. Resultados: La media de edad fue de 29 años., Los pacientes que completaron el tratamiento no presentaron repigmentación en la lesión tratada y el índice de satisfacción fue aceptable. Se observó que el promedio de sesiones para obtener resultados favorables varió entre 8 y 10 aplicaciones. Dentro de los efectos adversos más importantes resalta la hiperpigmentación postinflamatoria y la eliminación del estrato superficial de la piel post láser. Todos fueron controlados sin dejar lesiones residuales permanentes. Conclusión: El láser Q-switched Alexandrita de 755 nm es una tecnología efectiva para lograr un alto grado de despigmentación en el tratamiento del nevus de Ota y puede ser considerado como un tratamiento de primera línea para el manejo de esta patología.

Introduction: Ota nevus is a benign dermal melanocytic hamartoma with a macular appearance, poorly defined and in a gray-black patch that generally affects the first and second branches of the trigeminal unilaterally. Objective: To evaluate the efficacy, safety and adverse events caused by the application of 755 nm Alexandrite laser for the treatment of Ota nevus. Methods: Case series of 10 phototype IV patients with unilateral Ota Nevus treated between January 2017 and December 2018, which were treated with this light energy and with defined parameters. Results: The mean age was 29 years. The patients who completed the treatment did not show repigmentation in the treated lesion and the satisfaction index was acceptable. It was observed that the average of sessions to obtain favorable results varied between 8 and 10 applications. Among the most important adverse effects, post-inflammatory hyperpigmentation and the removal of the superficial layer of the post laser skin stand out. All were controlled without leaving permanent residual lesions. Conclusion: The 755 nm Alexandrite Q-switched laser is an effective technology to achieve a high degree of depigmentation in the treatment of Ota nevus and can be considered as a first-line treatment for the management of this pathology.

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OBJECTIVES: 100 mcg intrathecal morphine (ITM) for hip arthroplasty provides adequate functional recovery and reduces associated complications but is not exempt from opioid-related adverse effects. We evaluate efficacy of a reduced dose of ITM (80 mcg) in terms of anesthetic quality, postoperative analgesia, complication rates and early recovery. METHODS: Case control study. Patients under hip arthroplasty were treated on a specific protocol, using neuraxial anesthesia with hyperbaric bupivacaine 10.5-13.5 mg plus 80 mcg ITM versus controls with 100 mcg ITM. Demographic variables, intra and perioperative course were extracted from medical records. Pain severity and morphine associated complications were blindly assessed at regular intervals postoperatively. p < 0.01 were considered significant. RESULTS: 82 patients were analyzed. Mean age was 64.21 years, 62.20% women and 70.73% ASA-2. Main endoprosthesis indication was arthrosis (58.53%). No statistically significant differences in demographic and operative data were found between groups, including surgical time, ambulation time, length of stay, and patient satisfaction for pain management. Mean VAS for pain during first 24 hours was 0.24 for the low ITM group and 0.22 for control. Rescue intravenous morphine was the same between groups. Compared to 80 mcg ITM, 100 mcg showed trends for higher complication rates for respiratory depression (OR 2.58, CI 95% 0.4514.54, p = 0.28), nausea without vomiting (OR 1.82, CI 95% 0.82-4.01, p = 0.13), urinary retention (OR 2.02, CI95% 0.88-4.61, p = 0.09) and significantly higher rates of pruritus (OR 3.55, CI 95% 1.61-7.82, p < 0.01). CONCLUSIONS: 80 mcg ITM during spinal anesthesia for hip arthroplasty provided comparable postoperative analgesia and lower incidence of opioid-related adverse effects.

OBJETIVOS: 100 mcg morfina intratecal (ITM), en artroplastía de cadera, proporciona una recuperación funcional adecuada y reduce complicaciones asociadas, pero no está exento de efectos adversos conocidos asociados a opioides. Evaluamos eficacia de reducir dosis (80 mcg ITM) en términos de calidad anestésica, analgesia, complicaciones y recuperación postoperatoria. MÉTODOS: Estudio de casos y controles. Pacientes sometidos a artroplastía de cadera fueron tratados con anestesia espinal con bupivacaína hiperbárica 10,5-13,5 mg más 80 mcg ITM y controles de manera similar, pero con 100 mcg ITM. Variables demográficas, así como intra y perioperatorio, se extrajeron de registros médicos. Severidad del dolor, y complicaciones asociadas a ITM, se evaluaron a ciegas según protocolo. p < 0,01 fue considerado significativo. RESULTADOS: 82 pacientes analizados. Edad promedio fue 64,21 años, 62,20% fueron mujeres y 70,73% ASA-2. Principal indicación de prótesis fue artrosis (58,53%). No se encontraron diferencias estadísticas entre variables demográficas, tiempo quirúrgico, tiempo deambulación, duración hospitalización y satisfacción paciente. EVA promedio dolor, primeras 24 horas, fue 0,24 para grupo 80 mcg ITM y 0,22 para control (100 mcg ITM). Morfina intravenosa de rescate fue similar entre grupos. En comparación con 80 mcg, 100 mcg presentó mayores tasas de complicaciones para depresión respiratoria (OR 2,58, IC 95% 0,45-14,54, p = 0,28), náuseas y vómitos (OR 1,82, CI 95% 0,82-4,01, p = 0,13), retención urinaria (OR 2,02, CI 95% 0,88-4,61, p = 0,09) y prurito (OR 3,55, CI 95% 1,61-7.82, p < 0,01). CONCLUSIONES: 80 mcg ITM, en anestesia espinal para artroplastía cadera, proporciona analgesia postoperatoria comparable a 100 mcg, pero con menor incidencia de efectos adversos relacionados a opioides.

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OBJECTIVES: The purpose of this study was to examine the bactericidal efficacy of hydrogen peroxide (H2O2) on Cutibacterium acnes (C. acnes). We hypothesize that H2O2 reduces the bacterial burden of C. acnes. METHODS: The effect of H2O2 was assessed by testing bactericidal effect, time course analysis, growth inhibition, and minimum bactericidal concentration. To assess the bactericidal effect, bacteria were treated for 30 minutes with 0%, 1%, 3%, 4%, 6%, 8%, or 10% H2O2 in saline or water and compared with 3% topical H2O2 solution. For time course analysis, bacteria were treated with water or saline (controls), 3% H2O2 in water, 3% H2O2 in saline, or 3% topical solution for 5, 10, 15, 20, and 30 minutes. Results were analyzed with a two-way analysis of variance (ANOVA) (p < 0.05). RESULTS: Minimum inhibitory concentration of H2O2 after 30 minutes is 1% for H2O2 prepared in saline and water. The 3% topical solution was as effective when compared with the 1% H2O2 prepared in saline or water. The controls of both saline and water showed no reduction of bacteria. After five minutes of exposure, all mixtures of H2O2 reduced the percentage of live bacteria, with the topical solution being most effective (p < 0.0001). Maximum growth inhibition was achieved with topical 3% H2O2. CONCLUSION: The inexpensive and commercially available topical solution of 3% H2O2 demonstrated superior bactericidal effect as observed in the minimum bactericidal inhibitory concentration, time course, and colony-forming unit (CFU) inhibition assays. These results support the use of topical 3% H2O2 for five minutes before surgical skin preparation prior to shoulder surgery to achieve eradication of C. acnes for the skin.Cite this article: P. Hernandez, B. Sager, A. Fa, T. Liang, C. Lozano, M. Khazzam. Bactericidal efficacy of hydrogen peroxide on Cutibacterium acnes. Bone Joint Res 2019;8:3-10. DOI: 10.1302/2046-3758.81.BJR-2018-0145.R1.