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Abstract: Introduction: the management of adhesive capsulitis (AC) remains a topic of debate among orthopedic surgeons, with a wide variation in the literature. Conservative treatment relies as the first-line option as clinical studies report positive outcomes. However, there is variability in the effectiveness of different treatment modalities. Material and methods: this study aimed to analyzed functional and clinical outcomes of patients with AC who underwent the arthrodilation protocol, including three ultrasound-guided injections administered on a weekly basis: two corticosteroid injections and one injection of hyaluronic acid combined with corticosteroids. Additionally, patients received a specific rehabilitation therapy. Visual analogue scale (VAS), the university of California-Los Angeles shoulder score (UCLA) and Constant-Murley score were assessed before treatment and after 3-month follow-up period. Results: 23 patients were included, receiving the same treatment protocol with a mean onset of symptoms of 4.9 ± 1.7 months. Among these patients, there was a clear predominance of females (65.2%). Age distribution ranged from 39 to 74 years (mean = 56) indicating that individuals in their mid-50s were more susceptible to developing this condition. Furthermore, a slight majority (52.2%) exhibited AC in their right shoulder. VAS significantly decreased (-6.09 ± 1.9 [p ≤ 0.05]). Similarly, UCLA score (10.9 ± 2.9 to 31.7 ± 2.2) and Constant-Murley score (22.3 ± 6.1 to 62.0 ± 6.2) improved significantly. Pre-to-post treatment evaluation showed improvement in both UCLA (mean = 20.8 ± 2.9 [p ≤ 0.05]) and Constant-Murley (mean = 39.7 ± 9 [p ≤ 0.05]). Conclusion: arthrodilation protocol demonstrated promising results, with patients achieving good to excellent outcomes and safely resuming their regular daily activities within a short-term follow-up period. These findings provide support for arthrodilation as a viable conservative management option and contribute valuable insights to the ongoing research aimed at identifying optimal treatment approaches for adhesive capsulitis.
Resumen: Introducción: el tratamiento de la capsulitis adhesiva (CA) sigue siendo un tema de debate entre los cirujanos ortopedistas, con una variación amplia en la literatura. El tratamiento conservador se considera la opción de primera línea, ya que los estudios clínicos muestran resultados positivos. Sin embargo, existe variabilidad en la efectividad de las diferentes modalidades de tratamiento. Material y métodos: este estudio tuvo como objetivo analizar los resultados funcionales y clínicos de pacientes con CA que se sometieron al protocolo de artrodilatación, incluyendo tres inyecciones guiadas por ultrasonido administradas semanalmente: dos inyecciones de corticosteroides y una inyección de ácido hialurónico combinado con corticosteroides. Además, los pacientes recibieron una terapia de rehabilitación específica. La escala analógica visual (EVA), la puntuación del hombro de la Universidad de California-Los Ángeles (UCLA) y la puntuación de Constant-Murley se evaluaron antes del tratamiento y después de un período de seguimiento de tres meses. Resultados: se incluyeron 23 pacientes que recibieron el mismo protocolo de tratamiento con un inicio medio de síntomas de 4.9 ± 1.7 meses. Entre estos pacientes hubo un claro predominio del sexo femenino (65.2%). La distribución por edades osciló entre 39 y 74 años (media = 56), lo que indica que las personas de alrededor de 55 años eran más susceptibles a desarrollar esta afección. Además, una ligera mayoría (52.2%) presentaba CA en el hombro derecho. La EVA disminuyó significativamente (-6.09 ± 1.9 [p ≤ 0.05]). De manera similar, la puntuación de UCLA (10.9 ± 2.9 a 31.7 ± 2.2) y la puntuación de Constant-Murley (22.3 ± 6.1 a 62.0 ± 6.2) mejoraron significativamente. La evaluación previa y posterior al tratamiento mostró una mejoría tanto en UCLA (media = 20.8 ± 2.9 [p ≤ 0.05]) como en Constant-Murley (media = 39.7 ± 9 [p ≤ 0.05]). Conclusión: el protocolo de artrodilatación demostró resultados prometedores, los pacientes lograron resultados de buenos a excelentes y reanudaron de manera segura sus actividades diarias regulares dentro de un período de seguimiento a corto plazo. Estos hallazgos respaldan la artrodilatación como una opción de tratamiento conservador viable y aportan conocimientos valiosos a la continua investigación destinada a identificar tratamientos óptimos para la capsulitis adhesiva.
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INTRODUCTION: One of the major concerns with post-acute sequelae of COVID-19 (PASC) is the development of pulmonary fibrosis, for which no approved pharmacological treatment exists. Therefore, the primary aim of this open-label study was to evaluate the safety and the potential clinical efficacy of a prolonged-release pirfenidone formulation (PR-PFD) in patients having PASC-pulmonary fibrosis. METHODS: Patients with PASC-pulmonary fibrosis received PR-PFD 1800 mg/day (1200 mg in the morning after breakfast and 600 mg in the evening after dinner) for three months. Blood samples were taken to confirm the pharmacokinetics of PR-PFD, and adverse events (AEs) were evaluated monthly using a short questionnaire. Symptoms, dyspnea, and pulmonary function tests (spirometry, diffusing capacity for carbon monoxide, plethysmography, and 6-min walk test [6MWT]) were evaluated at baseline, and one and three months after having started the PR-PFD treatment. RESULTS: Seventy subjects with mild to moderate lung restriction were included. The most common AEs were diarrhea (23%), heartburn (23%), and headache (16%), for which no modifications in the drug study were needed. Two patients died within the first 30 days of enrolment, and three opted not to continue the study, events which were not associate with PR-PFD. Pulmonary function testing, 6MWT, dyspnea, symptoms, and CT scan significantly improved after three months of treatment with PR-PFD. CONCLUSION: In patients with PASC pulmonary fibrosis, three months' treatment with PR-PFD was safe and showed therapeutic efficacy. Still, it remains to be seen whether the pulmonary fibrotic process remains stable, becomes progressive or will improve.
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COVID-19 , Fibrosis Pulmonar Idiopática , Neumonía , Humanos , COVID-19/complicaciones , Progresión de la Enfermedad , Disnea/tratamiento farmacológico , Disnea/etiología , Fibrosis Pulmonar Idiopática/complicaciones , Fibrosis Pulmonar Idiopática/tratamiento farmacológico , Fibrosis Pulmonar Idiopática/diagnóstico , Fenotipo , Neumonía/tratamiento farmacológico , Piridonas/efectos adversosRESUMEN
INTRODUCTION: the management of adhesive capsulitis (AC) remains a topic of debate among orthopedic surgeons, with a wide variation in the literature. Conservative treatment relies as the first-line option as clinical studies report positive outcomes. However, there is variability in the effectiveness of different treatment modalities. MATERIAL AND METHODS: this study aimed to analyzed functional and clinical outcomes of patients with AC who underwent the arthrodilation protocol, including three ultrasound-guided injections administered on a weekly basis: two corticosteroid injections and one injection of hyaluronic acid combined with corticosteroids. Additionally, patients received a specific rehabilitation therapy. Visual analogue scale (VAS), the university of California-Los Angeles shoulder score (UCLA) and Constant-Murley score were assessed before treatment and after 3-month follow-up period. RESULTS: 23 patients were included, receiving the same treatment protocol with a mean onset of symptoms of 4.9 ± 1.7 months. Among these patients, there was a clear predominance of females (65.2%). Age distribution ranged from 39 to 74 years (mean = 56) indicating that individuals in their mid-50s were more susceptible to developing this condition. Furthermore, a slight majority (52.2%) exhibited AC in their right shoulder. VAS significantly decreased (-6.09 ± 1.9 [p 0.05]). Similarly, UCLA score (10.9 ± 2.9 to 31.7 ± 2.2) and Constant-Murley score (22.3 ± 6.1 to 62.0 ± 6.2) improved significantly. Pre-to-post treatment evaluation showed improvement in both UCLA (mean = 20.8 ± 2.9 [p 0.05]) and Constant-Murley (mean = 39.7 ± 9 [p 0.05]). CONCLUSION: arthrodilation protocol demonstrated promising results, with patients achieving good to excellent outcomes and safely resuming their regular daily activities within a short-term follow-up period. These findings provide support for arthrodilation as a viable conservative management option and contribute valuable insights to the ongoing research aimed at identifying optimal treatment approaches for adhesive capsulitis.
INTRODUCCIÓN: el tratamiento de la capsulitis adhesiva (CA) sigue siendo un tema de debate entre los cirujanos ortopedistas, con una variación amplia en la literatura. El tratamiento conservador se considera la opción de primera línea, ya que los estudios clínicos muestran resultados positivos. Sin embargo, existe variabilidad en la efectividad de las diferentes modalidades de tratamiento. MATERIAL Y MÉTODOS: este estudio tuvo como objetivo analizar los resultados funcionales y clínicos de pacientes con CA que se sometieron al protocolo de artrodilatación, incluyendo tres inyecciones guiadas por ultrasonido administradas semanalmente: dos inyecciones de corticosteroides y una inyección de ácido hialurónico combinado con corticosteroides. Además, los pacientes recibieron una terapia de rehabilitación específica. La escala analógica visual (EVA), la puntuación del hombro de la Universidad de California-Los Ángeles (UCLA) y la puntuación de Constant-Murley se evaluaron antes del tratamiento y después de un período de seguimiento de tres meses. RESULTADOS: se incluyeron 23 pacientes que recibieron el mismo protocolo de tratamiento con un inicio medio de síntomas de 4.9 ± 1.7 meses. Entre estos pacientes hubo un claro predominio del sexo femenino (65.2%). La distribución por edades osciló entre 39 y 74 años (media = 56), lo que indica que las personas de alrededor de 55 años eran más susceptibles a desarrollar esta afección. Además, una ligera mayoría (52.2%) presentaba CA en el hombro derecho. La EVA disminuyó significativamente (-6.09 ± 1.9 [p 0.05]). De manera similar, la puntuación de UCLA (10.9 ± 2.9 a 31.7 ± 2.2) y la puntuación de Constant-Murley (22.3 ± 6.1 a 62.0 ± 6.2) mejoraron significativamente. La evaluación previa y posterior al tratamiento mostró una mejoría tanto en UCLA (media = 20.8 ± 2.9 [p 0.05]) como en Constant-Murley (media = 39.7 ± 9 [p 0.05]). CONCLUSIÓN: el protocolo de artrodilatación demostró resultados prometedores, los pacientes lograron resultados de buenos a excelentes y reanudaron de manera segura sus actividades diarias regulares dentro de un período de seguimiento a corto plazo. Estos hallazgos respaldan la artrodilatación como una opción de tratamiento conservador viable y aportan conocimientos valiosos a la continua investigación destinada a identificar tratamientos óptimos para la capsulitis adhesiva.
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Bursitis , Articulación del Hombro , Femenino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Masculino , Tratamiento Conservador , Bursitis/terapia , Hombro , Corticoesteroides/uso terapéutico , Resultado del Tratamiento , Rango del Movimiento Articular , Inyecciones IntraarticularesRESUMEN
Hemoglobin S is caused by a nucleotide change in HBB gene (HBB:c.20A>T, p.Glu6Val), is presented in diverse forms: simple carriers (HbSA), homozygotes (HbSS) also known as sickle cell anemia, and compound heterozygotes with other ß-hemoglobinopathies. It is worldwide distributed, in Mexico, is frequently observed in the southern states Guerrero, Oaxaca and Chiapas. Elevated fetal hemoglobin (HbF) is associated with mild phenotype; single-nucleotide variants (SNVs) in modifier genes, such as BCL11A, HBG2, HBBP1 pseudogene and HBS1L-MYB intergenic region, upregulate HbF synthesis. The aim of this study was to identify HbF regulating genetic variants in HbSS and HbSA Mexican subjects. We studied 39 individuals (HbSS = 24, 61%, HbSA = 15, 39%) from Chiapas (67%) and Guerrero (33%), peripheral blood was collected in ethylenediamine tetraacetic acid (EDTA) for molecular and hematological studies, DNA was isolated by salting-out technic and genotyping was performed through allelic discrimination by real time polymerase chain reaction (RT-PCR) using Taqman® probes for 15 SNV (in BCL11A: rs6706648, rs7557939, rs4671393, rs11886868, rs766432, rs7599488, rs1427407; HBS1L-MYB: rs28384513, rs7776054, rs9399137, rs4895441, rs9402686, rs1320963; HBG2: rs7482144; and HBBP1: rs10128556). The obtained data were analyzed using IMB SPSS v.22.0 software. All minor alleles were observed in frequencies over 0.05, the most frequent was rs9402686 (0.82), while the less frequent was rs101028556 (0.08). In HbSS group, the mean fetal hemoglobin was 11.9 ± 5.9% and was significantly elevated in BCL11A rs11886868 wildtype homozygotes and in carriers of HBS1L-MYB intergenic region rs7776054 (p = 0.04 and p = 0.03, respectively). In conclusion, in HbSS Mexican patients, two SNVs were observed related to increased HbF; BCL11A rs11886868 and HBS1L-MYB rs7776054.
Sickle cell anemia (SCA) is one of the most common types of hemoglobinopathies in people of African ancestry, it is caused by homozygosity of HbS mutation (HBB:c.20A>T). It is known that fetal hemoglobin plays a key role in decreasing HbS polymerization which damages the erythrocyte structure and is responsible for the characteristic hemolytic crises endured by these patients. Single-nucleotide variant (SNV) in genes that regulate fetal hemoglobin (HbF) after birth have been associated with its increment, thus ameliorating the hematologic phenotype of this pathology and other ß-hemoglobinopathies. Therefore, in this study, we identified, for the first time in Mexican patients with SCA (HbSS) and HbS carriers (HbSA), the presence of 15 SNVs on BCL11A, HBS1L-MYB and HBG2; all HbSS patients had anemia and elevated HbF; 2 variants were related to increased HbF rs11688888C of BCL11A and rs7776054G of HBSIL-MYB; and finally, all minor alleles were found at a frequency higher than 0.05.
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Anemia de Células Falciformes , Hemoglobina Fetal , ADN Intergénico , Ácido Edético , Hemoglobina Fetal/genética , Hemoglobina Falciforme/genética , Heterocigoto , Homocigoto , Humanos , México , Nucleótidos , Polimorfismo de Nucleótido Simple , Proteínas Represoras/genéticaRESUMEN
Resumen La mononucleosis infecciosa (MI) es un cuadro clínico generalmente benigno y autolimitado en la infancia y adolescencia debido a la primoinfección del virus de Epstein-Barr caracterizado por la triada de faringitis, fiebre y adenopatías. El riesgo de complicaciones aumenta con la edad y la inmunosupresión, siendo las complicaciones letales más frecuentes las asociadas a rotura esplénica, alteraciones neurológicas y obstrucción de la vía aérea por el aumento del tamaño amigdalar. Los abscesos cervicales asociados a MI son poco frecuentes, siendo mayoritariamente periamigdalinos e intraamigdalares. Presentamos dos casos quirúrgicos de abscesos cervicales profundos de gran tamaño con afectación retrofaríngea y parafaríngea en adolescentes sanos de corta edad (14 y 15 años), sin ningún tipo de inmunosupresión o factores de riesgo, uno de ellos asociado además, a una relevante hemorragia amigdalar espontanea, condición no descrita previamente en la literatura en relación a MI en un paciente tan joven.
Abstract Infectious mononucleosis (MI) is a generally benign and self-limited condition in childhood and adolescence due to the primary EBV infection characterized by the triad of pharyngitis, fever, and lymphadenopathies. The risk of complications increases with age and immunosuppression. The most frequent fatal complications are those associated with splenic rupture, neurological alterations, and airway obstruction due to increased tonsillar size. Cervical abscesses associated with MI are rare, being mostly peritonsillar and intra-tonsil. We present two surgical cases of big deep cervical abscesses with retropharyngeal and parapharyngeal involvement in healthy very young adolescents (14 and 15 years old), without any type of immunosuppression or risk factors, one of them associated with a clinically relevant spontaneous tonsillar bleeding, which had not been described in the literature associated with MI in such young patient.
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Humanos , Femenino , Adolescente , Absceso Peritonsilar/complicaciones , Absceso Peritonsilar/terapia , Mononucleosis Infecciosa/complicaciones , Mononucleosis Infecciosa/terapia , Faringitis/etiología , Tomografía Computarizada por Rayos X , Absceso Peritonsilar/diagnóstico por imagen , Fiebre/etiología , Hemorragia/etiología , Mononucleosis Infecciosa/diagnóstico por imagenRESUMEN
INTRODUCTION AND OBJECTIVES: The emergence of SARS-CoV-2, which causes the coronavirus disease (COVID-19) has caused a great impact on healthcare systems worldwide, including hepatitis B and C viruses screening and elimination programs. The high number of COVID-19 hospitalizations represent a great opportunity to screen patients for hepatitis B virus (HBV) and hepatitis C virus (HCV), which was the aim of this study. MATERIAL AND METHODS: Cross-sectional, retrospective study performed between April 2020 and 20201 at a referral center in Mexico dedicated to the care of adults with severe/critical COVID-19. We retrieved clinical, demographic, and laboratory results from each patient´s medical records, including antibodies against HCV (anti-HCV), HBV surface antigen (HBsAg), antibodies against the HBV core antigen (anti-HBcAg), and antibodies against HBsAg (anti-HBsAg). RESULTS: Out of 3620 patients that were admitted to the hospital, 24 (0.66%), 4 (0.11%), and 72 (1.99%) tested positive for anti-HCV, HBsAg, and anti-HBcAg, respectively. Of all seronegative patients, 954 (27%) had undetectable anti-HBsAg and 401 (12%) had anti-HBsAg at protective levels. Blood transfusion was the most relevant risk factor. Only 9.7% of the anti-HBc positive, 25% of the HBsAg positive, and 52% of the anti-HCV positive were aware of their serological status. CONCLUSIONS: In this study we found a prevalence of anti-HCV of 0.66%, HBsAg in 0.11%, and isolated anti-HBcAg in 1.99%. We also found that HBV vaccination coverage has been suboptimal and needs to be reinforced. This study gave us a trustworthy insight of the actual seroprevalence in Mexico, which can help provide feedback to the Hepatitis National Elimination Plan.
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COVID-19 , Hepatitis B , Hepatitis C , Adulto , COVID-19/diagnóstico , COVID-19/epidemiología , Estudios Transversales , Hepacivirus , Hepatitis B/diagnóstico , Hepatitis B/epidemiología , Anticuerpos contra la Hepatitis B , Antígenos del Núcleo de la Hepatitis B , Antígenos de Superficie de la Hepatitis B , Virus de la Hepatitis B , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Anticuerpos contra la Hepatitis C , Humanos , Pacientes Internos , México/epidemiología , Derivación y Consulta , Estudios Retrospectivos , SARS-CoV-2 , Estudios SeroepidemiológicosRESUMEN
Salmonella enterica can survive in surface waters (SuWa), and the role of nonhost environments in its transmission has acquired increasing relevance. In this study, we conducted comparative genomic analyses of 172 S. enterica isolates collected from SuWa across 3 months in six states of central Mexico during 2019. S. enterica transmission dynamics were assessed using 87 experimental and 112 public isolates from Mexico collected during 2002 through 2019. We also studied genetic relatedness between SuWa isolates and human clinical strains collected in North America during 2005 through 2020. Among experimental isolates, we identified 41 S. enterica serovars and 56 multilocus sequence types (STs). Predominant serovars were Senftenberg (n = 13), Meleagridis, Agona, and Newport (n = 12 each), Give (n = 10), Anatum (n = 8), Adelaide (n = 7), and Infantis, Mbandaka, Ohio, and Typhimurium (n = 6 each). We observed a high genetic diversity in the sample under study, as well as clonal dissemination of strains across distant regions. Some of these strains are epidemiologically important (ST14, ST45, ST118, ST132, ST198, and ST213) and were genotypically close to those involved in clinical cases in North America. Transmission network analysis suggests that SuWa are a relevant source of S. enterica (0.7 source/hub ratio) and contribute to its dissemination as isolates from varied sources and clinical cases have SuWa isolates as common ancestors. Overall, the study shows that SuWa act as reservoirs of various S. enterica serovars of public health significance. Further research is needed to better understand the mechanisms involved in SuWa contamination by S. enterica, as well as to develop interventions to contain its dissemination in food production settings. IMPORTANCE Surface waters are heavily used in food production worldwide. Several human pathogens can survive in these waters for long periods and disseminate to food production environments, contaminating our food supply. One of these pathogens is Salmonella enterica, a leading cause of foodborne infections, hospitalizations, and deaths in many countries. This research demonstrates the role of surface waters as a vehicle for the transmission of Salmonella along food production chains. It also shows that some strains circulating in surface waters are very similar to those implicated in human infections and harbor genes that confer resistance to multiple antibiotics, posing a risk to public health. This study contributes to expand our current knowledge on the ecology and epidemiology of Salmonella in surface waters.
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Salmonella enterica , Agricultura , Acuicultura , Genómica , Humanos , México/epidemiología , Salmonella enterica/genéticaRESUMEN
Brachial plexus injury is a lesion that results in loss of function of the arm, and there are multiple ways of surgically approaching its treatment. Controlled trials that compare all surgical repair strategies and their clinical outcomes have not been performed. A systematic review was conducted to identify all articles that reported clinical outcomes in different surgeries (nerve transfer, nerve graft, neurolysis, end-to-end, multiple interventions, and others). Advanced search in PubMed was performed using the Mesh terms "brachial plexus injury" as the main topic and "surgery" as a subtopic, obtaining a total of 2153 articles. The clinical data for eligibility extraction was focused on collecting motor, sensory, pain, and functional recovery. A statistical analysis was performed to find the superior surgical techniques in terms of motor recovery, through the assessment of heterogeneity between groups, and of relationships between surgery and motor recovery. The frequency and the manner in which clinical outcomes are recording were described. The differences that correspond to the demographics and procedural factors were not statistically significant among groups (p > 0.05). Neurolysis showed the highest proportion of motor recovery (85.18%), with significant results between preoperative and post-operative motor assessment (p = 0.028). The proportion of motor recovery in each group according to the surgical approach differed significantly (X2 = 82.495, p = 0.0001). The motor outcome was the most reported clinical outcome (97.56%), whereas the other clinical outcomes were reported in less than 15% of the included articles. Unexpectedly, neurolysis, a technique displaced by new surgical alternatives such as nerve transfer/graft, demonstrated the highest proportion of motor recovery. Clinical outcomes such as pain, sensory, and functional recovery were infrequently reported. These results introduce the need to re-evaluate neurolysis through comparative clinical trials, as well as to standardize the way in which clinical outcomes are reported.
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Neuropatías del Plexo Braquial , Plexo Braquial , Transferencia de Nervios , Plexo Braquial/cirugía , Neuropatías del Plexo Braquial/cirugía , Humanos , Procedimientos Neuroquirúrgicos , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of the study was to evaluate the clinical response and collagen remodeling in the vaginal wall after three sessions of carbon dioxide (CO2) laser application. METHODS: Fourteen postmenopausal women with vulvovaginal atrophy, aged 45-65 years and sexually active, were evaluated with clinical questionnaires, gynecological examinations and histological techniques before and after 20 weeks of treatment (ClinicalTrials.gov NCT03939078). Treatment consisted of 3-monthly sessions of the CO2 laser. Clinical questionnaires included the Vaginal Health Index, the Female Sexual Function Index and the International Consultation on Incontinence Questionnaires Short Form. Biopsies were taken from the lateral vaginal wall at week 0 (left wall) and week 20 (right wall). Tissue samples were stained with hematoxylin and eosin, Periodic Acid-Schiff, Picrosirius Red Stain and Orcein dyes. Immunohistochemical study was used to quantify collagens I and III in the samples. RESULTS: The mean age was 54.4 ± 4.5 years, and the average time of amenorrhea was 7.6 ± 5.1 years. The Female Sexual Function Index and the Vaginal Health Index Score values increased while the International Consultation on Incontinence Questionnaire Short Form score decreased after the programmed treatment. There was no significant change in vaginal pH. Histological studies showed increases in the total and superficial epithelial cell layers, and type III collagen fibers (from 10.86 ± 7.66 to 16.87 ± 3.96, p < 0.05), and immunohistochemical studies confirmed the significant increase in collagen III. CONCLUSION: Histological findings revealed epithelial atrophy reversal and collagen remodeling of the vaginal wall. Immunohistochemical analysis showed an increase in collagen type III fibers.
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Láseres de Gas , Incontinencia Urinaria , Enfermedades Vaginales , Anciano , Atrofia , Dióxido de Carbono , Colágeno Tipo I , Femenino , Humanos , Láseres de Gas/uso terapéutico , Persona de Mediana Edad , Proyectos Piloto , Posmenopausia , Síndrome , Resultado del Tratamiento , Vagina/patología , Vagina/cirugía , Enfermedades Vaginales/patología , Enfermedades Vaginales/cirugíaRESUMEN
Intraoperative acetabular fractures (IAF) is a rare complication with an incidence 2% - 5%. We present the review of a series of 13 cases, discussing diagnosis, treatment and results. MATERIAL AND METHODS: Between 2006 and 2018, we performed 4800 primary hip arthroplasties (THA) In our hospital, we identified 13 cases with FIA with a follow-up of 38.3 months. RESULTS: Two cases were stable with conservative management; 11 unstable cases: seven cases we placed trabecular metal, one case we increased acetabular diameter, one case acetabular replacement, one case revision with Ganz type ring and one case do not accept treatment. The use of trabecular metal is an implant that helps effectively and with good results in FIA. CONCLUSION: These fractures are rare, knowing the implant to use is mandatory because if the implants are oversized, with greater rigidity or hemispheric, patients have increased risk of suffering from this complication.
Las fracturas intraoperatorias acetabulares (FIA) son una complicación rara con incidencia de 2 a 5%. Presentamos la revisión de una serie de 13 casos, que aborda diagnóstico, tratamiento y resultados. Material y métodos: entre 2006 y 2018 realizamos 4,800 artroplastías primarias de cadera (ATC). En nuestro hospital identificamos 13 casos con FIA con un seguimiento de 38.3 meses. Resultados: Dos casos fueron estables con manejo conservador; 11 casos inestables: en siete casos colocamos trabecular metal, en un caso aumentamos diámetro acetabular, en un caso recambio de cotilo, en un caso revisión con anillo tipo Ganz y un caso no aceptó tratamiento. El uso de trabecular metal es un implante que ayuda eficazmente y con buenos resultados en FIA. Conclusión: Estas fracturas son raras, conocer el implante a utilizar es imperativo, ya que si los implantes están sobredimensionados, con mayor rigidez o hemisféricos, los pacientes tienen mayor riesgo de sufrir esta complicación.
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La Cannabis sativa es una planta que contiene componentes psicoactivos (principalmente tetrahidrocannabinol) y actualmente corresponde a la droga ilícita más consumida a nivel mundial. Además, desde el área de la salud mental, ha habido un creciente interés en evaluar la relación entre el consumo de marihuana y el desarrollo de trastornos mentales. En este contexto, considerando tanto este creciente aumento en su consumo a nivel mundial y el interés por conocer si está involucrada en la patogénesis de patologías de la esfera psiquiátrica, es clave analizar qué posibles riesgos de desarrollar patologías mentales presentan aquellos niños expuestos al tetrahidrocannabinol durante la gestación. A partir de esta situación, el objetivo de este FRISBEEs es determinar si los niños/as expuestos a THC durante su gestación tienen un mayor riesgo de patologías mentales, en comparación a aquellos niños no expuestos durante su gestación. Los materiales y métodos utilizados para responder esta pregunta fueron obtenidos a partir de una búsqueda bibliográfica en dos bases de datos, donde se analizó la evidencia disponible, y se seleccionó el estudio primario titulado "Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring", ya que era el que más se aproximaba a poder responder nuestra pregunta clínica. Este se analizó de forma crítica, llegando al resultado de que el estudio no fue concluyente en establecer una asociación entre el uso de cannabis y síntomas psicóticos. Como conclusión, dado que no se pudo llegar a establecer una asociación entre el uso de cannabis y el desarrollo de patologías mentales, se debería realizar más investigación sobre el tema dado la magnitud del consumo de cannabis a nivel mundial, para así poder llegar a conclusiones clínicas basadas en la evidencia y poder dar recomendaciones clínicas a las pacientes embarazadas.
Cannabis sativa is a plant that contains psychoactive components (mainly tetrahydrocannabinol) and currently corresponds to the most widely consumed illicit drug worldwide. In addition, from the area of mental health, there has been a growing interest in evaluating the relationship between marijuana use and the development of mental disorders. In this context, considering both this growing increase in its consumption worldwide and the interest in knowing if it is involved in the pathogenesis of pathologies in the psychiatric sphere, it is essential to analyze what possible risks of developing mental pathologies present those children exposed to tetrahydrocannabinol during gestation. Based on this situation, the objective of this FRISBEEs is to determine whether children exposed to THC during their pregnancy have a greater risk of mental pathologies, compared to those children not exposed during their pregnancy. The materials and methods used to answer this question were obtained from a bibliographic search in two databases, where the available evidence was analyzed, and the primary study entitled "Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring ", as he was the closest to answering our clinical question. This was critically analyzed, reaching the result that the study was not conclusive in establishing an association between the use of cannabis and psychotic symptoms. In conclusion, given that it was not possible to establish an association between the use of cannabis and the development of mental pathologies, more research should be carried out on the subject given the magnitude of cannabis use worldwide, in order to reach conclusions. evidence-based clinics and to be able to give clinical recommendations to pregnant patients
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Humanos , Masculino , Femenino , Embarazo , Niño , Trastornos Psicóticos/etiología , Cannabis/efectos adversos , Fumar/psicología , Abuso de Marihuana/psicología , Conducta Materna/efectos de los fármacos , Exposición Materna/efectos adversosRESUMEN
The identification of the presence of genotype by environment interaction effects on important traits in Holstein cattle allows for the use of international genetic evaluations and a more efficient design of regional genetic evaluation programmes. The aim of this study was to determine the genotype × environment interaction effects in Chilean Holstein dairy cattle through the analysis of records corresponding to calvings between 1998 and 2015. Herds were classified in the central and southern regions of Chile based on herd location as well as by high and low levels of production environments based on the fat plus protein yield averages per herd within each region. The central region has a Mediterranean climate and a confined production system while the southern region has a humid temperate climate and a production system based on grazing with supplementation. Traits studied were milk yield (MY), fat yield (FY), protein yield (PY), fat content (FC) and protein content (PC) by lactation, age at first calving (AFC) and calving interval (CI). Several four-trait mixed animal models were applied to environmental category data as different traits, which included herd-year-calving season (herd-year-birth season for AFC) and lactation number as fixed effects, and animal additive genetic, sire-herd, permanent environment and residual effects as random effects. Genetic correlations (rg) for MY, FY, FC, PC and CI were found to decrease as differences between environmental categories increased. The rg between the most extreme environmental categories considered in this study for AFC (0.26) was the only one found statistically lower than 0.60. Genetic correlation values statistically lower than 0.80 (P < 0.05) were observed for AFC, CI, MY, FY and PY between some environmental categories. If separate genetic evaluations are adopted as practical criteria when the value of rg is lower than 0.60, the consequence of improving a multi-trait economic breeding objective in this population is likely to be small unless extreme environmental categories are considered. However, a moderate decrease in selection response and re-ranking of selection candidates is expected for AFC, CI and yield traits when selection is performed in different environmental conditions. Genotype × environment interaction effects involving production systems in a Mediterranean climate and confinement vs. Temperate Oceanic climate and grazing with supplementation, and between two fat plus protein yield level categories within each environment, were at most moderate for the studied traits.
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Lactancia , Leche , Animales , Bovinos/genética , Femenino , Genotipo , Parto , Fenotipo , EmbarazoRESUMEN
Resumen: Las fracturas intraoperatorias acetabulares (FIA) son una complicación rara con incidencia de 2 a 5%. Presentamos la revisión de una serie de 13 casos, que aborda diagnóstico, tratamiento y resultados. Material y métodos: entre 2006 y 2018 realizamos 4,800 artroplastías primarias de cadera (ATC). En nuestro hospital identificamos 13 casos con FIA con un seguimiento de 38.3 meses. Resultados: Dos casos fueron estables con manejo conservador; 11 casos inestables: en siete casos colocamos trabecular metal, en un caso aumentamos diámetro acetabular, en un caso recambio de cotilo, en un caso revisión con anillo tipo Ganz y un caso no aceptó tratamiento. El uso de trabecular metal es un implante que ayuda eficazmente y con buenos resultados en FIA. Conclusión: Estas fracturas son raras, conocer el implante a utilizar es imperativo, ya que si los implantes están sobredimensionados, con mayor rigidez o hemisféricos, los pacientes tienen mayor riesgo de sufrir esta complicación.
Abstract: Intraoperative acetabular fractures (IAF) is a rare complication with an incidence 2% - 5%. We present the review of a series of 13 cases, discussing diagnosis, treatment and results. Material and methods: Between 2006 and 2018, we performed 4800 primary hip arthroplasties (THA) In our hospital, we identified 13 cases with FIA with a follow-up of 38.3 months. Results: Two cases were stable with conservative management; 11 unstable cases: seven cases we placed trabecular metal, one case we increased acetabular diameter, one case acetabular replacement, one case revision with Ganz type ring and one case do not accept treatment. The use of trabecular metal is an implant that helps effectively and with good results in FIA. Conclusion: These fractures are rare, knowing the implant to use is mandatory because if the implants are oversized, with greater rigidity or hemispheric, patients have increased risk of suffering from this complication.
RESUMEN
INTRODUCTION: Teledermatology (TD) is a health tool based on the application of information and communication technologies (ICT) for the care of skin diseases at a distance, allowing a better connection between primary care professionals (PCP) and specialized care. The objective of this study was to analyze the characteristics of the teleconsultations made to our service in a period of 2years (January 1, 2018 to December 31, 2019). MATERIAL AND METHODS: The data was obtained from a TD system with dermoscopy that allows teleconsultations to be carried out asynchronously. Data were analyzed over 24months. The variables studied were the health centre of origin, the diagnostic suspicion of the PCP, the time and type of response, and the clinical judgment issued by the dermatologist. RESULTS: Between January 1, 2018 and December 31, 2019, a total of 3,294 teleconsultations were received. 24.76% were referred to the dermatology consultation, while 25.63% required subsequent follow-up electronically. The most frequent diagnostic suspicion by the PCP was that of benign pathology (54.71%). The most frequent dermatological clinical judgment was that of seborrheic keratosis (20.19%), followed by actinic keratosis (14.02%), acquired common melanocytic nevi (13.24%) and basal cell carcinoma (8.98%). CONCLUSIONS: The TD system is a useful tool that allowed a quick response to a high percentage of consultations, helping to avoid unnecessary referrals and easy communication between primary and specialized care. It also allows prioritizing those patients with malignant tumour pathology.
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Dermatología , Consulta Remota , Enfermedades de la Piel , Humanos , Nevo Pigmentado , Neoplasias Cutáneas , EspañaRESUMEN
Most of the existing prediction models for COVID-19 lack validation, are inadequately reported or are at high risk of bias, a reason which has led to discourage their use. Few existing models have the potential to be extensively used by healthcare providers in low-resource settings since many require laboratory and imaging predictors. Therefore, we sought to develop and validate a multivariable prediction model of death in Mexican patients with COVID-19, by using demographic and patient history predictors. We conducted a national retrospective cohort study in two different sets of patients from the Mexican COVID-19 Epidemiologic Surveillance Study. Patients with a positive reverse transcription-polymerase chain reaction for SARS-CoV-2 and complete unduplicated data were eligible. In total, 83 779 patients were included to develop the scoring system through a multivariable Cox regression model; 100 000, to validate the model. Eight predictors (age, sex, diabetes, chronic obstructive pulmonary disease, immunosuppression, hypertension, obesity and chronic kidney disease) were included in the scoring system called PH-Covid19 (range of values: -2 to 25 points). The predictive model has a discrimination of death of 0.8 (95% confidence interval (CI) 0.796-0.804). The PH-Covid19 scoring system was developed and validated in Mexican patients to aid clinicians to stratify patients with COVID-19 at risk of fatal outcomes, allowing for better and efficient use of resources.
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COVID-19/mortalidad , Comorbilidad , Predicción/métodos , Medición de Riesgo/métodos , Prueba de Ácido Nucleico para COVID-19 , Humanos , México/epidemiología , Modelos Teóricos , Pandemias , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/aislamiento & purificaciónRESUMEN
INTRODUCTION: The rotator cuff tears are a very frequent condition. The rotator cuff repair is a procedure often perform by the orthopedic surgeon. There are multiple techniques and suture configurations for this type of repairs. The double row configuration is one of the most used and consider very effective for mid-size and large size rotator cuff tears. The parachute configuration for this repair is a novel technique that may be useful for mid-size and large size tears, for this repair two medial double row anchors are used and one knotless lateral anchor. Our porpoise was to compare biomechanical performance and footprint coverage of a conventional suture-bridge double-row rotator cuff repair configuration versus a double-row-parachute. METHODS: This paper shows the biomechanical behavior on a cadaver model of the parachute configuration, and also compares this conformation with a double row in a suture-bridge fashion. Our hipothesis was that the Parachute configurations biomechanical performance is equivalent to the suture-bridging double-row technique. RESULTS: The parachute configuration advantages show the advantage of using less anchors, which will decrease the surgical time and also the risks of using multiple hardware in the humeral head.
INTRODUCCIÓN: La lesión del manguito rotador es una patología común cuya reparación es un procedimiento realizado por los cirujanos ortopedistas. Existen muchas técnicas de reparación, así como múltiples configuraciones de anclas y suturas para realizar estos procedimientos. La técnica de doble fila es una de las más usadas para rupturas de tamaño mediano y grande con buenos resultados. La configuración en «paracaídas¼ para la reparación del manguito rotador puede llegar a ser útil para éstas, en este tipo de configuración se utilizan dos anclas mediales y un ancla sin nudos lateral. Nuestro objetivo fue la comparación de la eficiencia biomecánica y cobertura de la huella de una configuración convencional de doble fila «suture bridge¼ frente a una configuración en «paracaídas¼. MÉTODOS: Este trabajo revisó el comportamiento biomecánico, en piezas cadavéricas, de la configuración de paracaídas y se comparó con la configuración de doble fila tipo «suture-bridge¼. Nuestra hipótesis era que el rendimiento biomecánico de la configuración de Parachute es equivalente a la técnica de doble fila «suture bridge¼. RESULTADOS: Las posibles ventajas de la configuración de paracaídas son el uso de menos anclas, disminuyendo el tiempo quirúrgico y los riesgos de tener múltiples implantes en la cabeza humeral.
Asunto(s)
Lesiones del Manguito de los Rotadores , Fenómenos Biomecánicos , Humanos , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/cirugía , Técnicas de Sutura , SuturasRESUMEN
Resumen: La sinovitis villonodular pigmentada extraarticular, también llamada tumor de células gigantes de la vaina tendinosa, es frecuente en la mano, siendo extremadamente rara su localización en la rodilla. Se presenta el caso de un paciente con una bursitis villonodular pigmentada de la bursa de la pata de ganso sin afectación intraarticular. Extra-articular pigmented villonodular synovitis, also called giant cell tumor of the tendon sheath, is common in the hand, being extremely rare in the knee. We present the case of a patient with a pigmented villonodular bursitis of the pes anserine bursa without intraarticular involvement.
Abstract: Extra-articular pigmented villonodular synovitis, also called giant cell tumor of the tendon seath, is common in the hand, being extremely rare in the knee. We present the case of a patient with a pigmented villonodular bursitis of the pes anserine bursa without intraarticular involvement.