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OBJECTIVE: to determine the direct and indirect costs in the High Specialty Medical Unit Hospital de Traumatology y Orthopedic "Lomas Verdes" of the pathology of complex hand trauma classified as occupational risk. MATERIAL AND METHODS: 50 complete clinical records with a diagnosis of complex hand trauma were analyzed from January 2019 to August 2020. The perspective of the study is to determine the costs of medical care for complex hand trauma in active workers. RESULTS: 50 clinical records of patients with clinical and radiological diagnosis of trauma severe de mano, insured workers with a work risk opinion, were reviewed. CONCLUSION: the presence of these injuries in the active age of our patients speaks to us of the great importance of timely and adequate care for severe hand trauma, which has a significant impact on the country's economy. Hence the great need to establish methods of prevention of such injuries in companies and the need to establish medical care protocols for these injuries and seek to reduce surgical procedures to resolve this pathology.

OBJETIVO: determinar los costos directos e indirectos en la Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia "Lomas Verdes" de la patología del trauma complejo de mano calificado como riesgo de trabajo. MATERIAL Y MÉTODOS: se analizaron 50 expedientes clínicos completos con diagnóstico de trauma complejo de mano de Enero de 2019 a Agosto de 2020. La perspectiva del estudio es determinar los costos de la atención médica del trauma complejo de mano en trabajadores activos. RESULTADOS: se revisaron 50 expedientes clínicos de pacientes con diagnóstico clínico y radiológico de trauma severo de mano, trabajadores asegurados con dictamen de riesgo de trabajo. CONCLUSIÓN: la presencia de estas lesiones en la edad activa de nuestros pacientes nos habla de la gran importancia que conlleva una atención oportuna y adecuada del trauma severo de mano, que impacta de manera importante en la economía del país. De ahí de la gran necesidad de establecer métodos de prevención de dichas lesiones en las empresas y la necesidad de establecer protocolos de atención médica para estas lesiones y buscar disminuir los procedimientos quirúrgicos para resolver esta patología.

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INTRODUCTION: The biomechanical characterization of grip involves the determination of the different kinematic and dynamic variables that affect its different phases: transport, grip formation and manipulation, as well as its relationship with the anthropometric characteristics of the subject and those of the object. The contact force in the fingers during the making of bidigital or multi-digital grips but involving only the use of distal phalanges (grip type clamp) and cylindrical power grip are among the most used for daily activities. Hand grip force measurement is an essential element for follow-up during growth, injury, rehabilitation and therapeutic trials. MATERIAL AND METHODS: Descriptive, prospective, cross-sectional study with 61 patients without upper extremity pathology, 30 male, 31 female, with age range of 20 to 59 years, anthropometric measurements and Force test (kg/strength) were performed. The variables were statistically analyzed with Pearson's "r" and Mann-Whitney's U. RESULTS: The hand grip and clamp 1 Force of the dominant hand as non-dominant is correlated with weight, size, body fat percentage and wrist circumference, HGF and clamp 1 in both the dominant and non-dominant hand is higher in men than in women, with p < 0.05. CONCLUSIONS: The average HGF of the dominant hand is higher than in the non-dominant for men and women. This is related to weight, size, body fat percentage and wrist circumference.

INTRODUCCIÓN: La caracterización biomecánica de agarre supone la determinación de las diferentes variables cinemáticas y dinámicas que afectan sus distintas fases: transporte, formación del agarre y manipulación; su relación con las características antropométricas del sujeto y las propias del objeto. La fuerza de contacto en los dedos durante la realización de agarres bidigitales o multidigitales pero que involucran únicamente uso de las falanges distales (agarre tipo pinza) y el agarre de potencia cilíndrico son de los más empleados para las actividades diarias. La medición de la fuerza de presión (FPM) es un elemento esencial para seguimiento durante el crecimiento, lesiones, rehabilitación y ensayos terapéuticos. MATERIAL Y MÉTODOS: Estudio descriptivo, prospectivo, transversal con 61 pacientes sin patología de miembro torácico, 30 hombres y 31 mujeres, con rango de edad de 20 a 59 años, se realizaron mediciones antropométricas y prueba de fuerza (kg/fuerza). Se analizaron las variables estadísticamente con "r" de Pearson y U de Mann-Whitney. RESULTADOS: La fuerza de prensión de la mano y la pinza 1 de la mano dominante como la no dominante está correlacionada con el peso, talla, porcentaje de grasa corporal y circunferencia de la muñeca, la FPM y la pinza 1 tanto en la mano dominante como en la no dominante es mayor en los hombres que en las mujeres, con p < 0.05. CONCLUSIONES: La FPM promedio de la mano dominante es mayor que en la no dominante para hombres y mujeres, relacionado con el peso, talla, porcentaje de grasa corporal y circunferencia de la muñeca.

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INTRODUCTION: The management of postoperative pain in joint replacement surgery represents a challenge. Therefore, the advent of new strategies in the management of pain such as local infiltration analgesia (LIA) and the adductor canal block, allowed an adequate postoperative pain control and early rehabilitation of the patient in total knee arthroplasty. MATERIALS AND METHODS: A descriptive, observational and longitudinal study of a prospective cohort of patients operated by the group of joint replacements between September 29, 2017 and November 30, 2017 was conducted. They were evaluated with the analog pain scale for postoperative pain at 5 different times (1:Upon leaving recovery; 2:On the first postoperative day; 3:Before initiating in-hospital physical therapy; 4:At the end of physical therapy, and 5:Upon departure from the clinic). RESULTS: Of the 141 patients operated on, 70.9% of the patients were managed with LIA and 29.1% with adductor canal block. There were no differences between groups in postoperative pain assessment during the 5 different times (P≥.45). DISCUSSION: Our results indicate that LIA and the adductor canal blockade demonstrated the same efficacy for the control of postoperative pain and rehabilitation.

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Advanced scafosemilunar collapse (SLAC) and advanced scaphoid pseudoarthrosis (SNAC) collapse are the result of trauma causing scaphoid fracture and the consequent pseudoarthrosis resulting in abnormal kinematics of the wrist and a scapholunate ligament injury, respectively. Current surgical options for SLAC/SNAC treatment include partial arthrodesis, carpal proximal row resection. MATERIAL AND METHODS: Retrospective, cross-cutting and descriptive study was carried out in the period from January 2010 to December 2015. 52 patients operated on with 4-cornered arthrodesis and 19 patients with carpectomy were studied. RESULTS: 71 patients, 62 male patients and 9 female patients were analysed. For the carpectomy procedure were 5 female patients, for patients with four-corner arthrodesis 48 male patient and 4 female patient were included. 48 patients with SNAC and 23 patients with SLAC were identified. 19 carpectomies and 52 arthrodesis of four corners of the total patients 65 of them were carried without any complications, 3 patients with delay of consolidation two with residual pain, and one with superficial infectious process. DISCUSSION: The four-corner arthrodesis technique involves longer surgery and costs in relation to carpectomy, however arthrodesis has a faster return to pain-improvement work with respect to carpectomy; the final decision will depend on the case, the patients activity.

Las lesiones por el colapso escafosemilunar avanzado y el colapso avanzado por seudoartrosis del escafoides son consecuencia de un traumatismo que origina la fractura de escafoides y la consecuente seudoartrosis, resultando en una cinemática anormal de la muñeca y en una lesión de ligamento escafosemilunar, respectivamente. Las opciones quirúrgicas actuales para el tratamiento incluyen artrodesis parcial y carpectomía de la línea proximal del carpo. Material y métodos: Estudio retrospectivo, transversal y descriptivo en el período comprendido de Enero de 2010 a Diciembre de 2015. Se estudiaron 52 pacientes operados con artrodesis de cuatro esquinas y 19 pacientes manejados con carpectomía. Resultados: Del total de 71 pacientes, 62 fueron masculinos y nueve femeninos. Para el procedimiento de carpectomías, fueron 14 varones y cinco mujeres, para los pacientes con artrodesis de cuatro esquinas se incluyeron 48 masculinos y cuatro femeninos. Se identificaron 48 pacientes con colapso avanzado por seudoartrosis del escafoides y 23 pacientes con colapso escafosemilunar avanzado. Se realizaron 19 carpectomías y 52 artrodesis de cuatro esquinas del total de pacientes, 65 de ellos cursaron sin ninguna complicación, tres pacientes con retardo de la consolidación, dos con dolor residual, y uno con proceso infeccioso superficial. Discusión: La técnica de artrodesis de cuatro esquinas implica mayor tiempo de cirugía y de costos en relación con la carpectomía; sin embargo, la artrodesis tiene una reincorporación más rápida al trabajo con mejoría del dolor con respecto a la carpectomía; la decisión final en nuestra institución dependerá del caso y de la actividad del paciente.

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The arthrosis of the wrist is a degenerative, traumatic or idiopathic process, which cause problem for patient characterized by pain, loss of mobility, swelling and deformity of the affected wrist. A surgical alternative is proximal row carpectomy, which consists of resection of the lunate, scaphoid and triquetrum, forming a new joint between the radius and the distal row carpus. Material and methods: Observational, descriptive, case series. 15 patients were evaluated who underwent proximal row carpectomy during the period January 2007-August 2009, with clinical follow-up until august 2010 through mayo and DASH scores, measuring strength. Range of motion and pain. 80% of patients were between 35 and 64 years. The predominant sex was male in 67%. The result was satisfactory in 73%, according to the scale of Mayo. The DASH scale in the postoperative period also improves. Conclusions: The proximal carpectomy is a surgical alternative, it preserves some joint mobility, reduced pain and improved disability of the limb.

La artrosis de la muñeca es un proceso degenerativo, postraumático o idiopático que provoca al paciente dolor, pérdida de la movilidad, inflamación y deformidad. Las opciones quirúrgicas incluyen: artrodesis total de muñeca que produce una mejoría del dolor y disminución de la inflamación, otros tratamientos que permiten movilidad relativa son las artrodesis parciales. Otra solución quirúrgica es la carpectomía o la resección de la primera hilera del carpo, de tal manera que constituya una nueva articulación entre el radio y la segunda fila del carpo, obteniendo una congruencia articular adecuada. Material y métodos: Estudio observacional, descriptivo, serie de casos. Se valoraron 15 pacientes con carpectomía proximal durante el período de Enero de 2007 a Agosto de 2009, a quienes se realizó medición de arcos de movilidad y fuerza mediante las escalas de Mayo-DASH. Resultados: En 80% de los pacientes entre 35 y 64 años se encontró predominio del sexo masculino en 67%. La mejoría del dolor fue evidente, pasando de una media 7.7 en el preoperatorio a 2.7 en el postoperatorio, 10% de los casos presentaron dolor residual. Conclusiones: La carpectomía proximal representa una alternativa terapéutica que permite conservar la movilidad con mejora del dolor en la artrosis de muñeca.

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BACKGROUND: There are documented molecular homologies between mites from the same group, but intergroup characteristics are not. Although mites share the same taxonomic order, there are species antigenically distinct. At the present we dont know clearly the differences in cutaneous reactivity among several house dust mites species. OBJETIVE: to estimate the correlation of skin reactivity to Dermatophagoides pteronyssinus and Dermatophagoides farinae antigens with that of Blomia tropicalis in patients with allergic rhinitis and asthma. METHODS: a cross sectional, observational, prolective and interpretive study was performed in patients of both genders, aged 2 to 58 with allergic rhinitis and asthma. All patients underwent skin prick tests with allergenic extracts. RESULTS: One hundred and ten patients were included, with an age average of 24.1 years; 50% were males. There were positive skin tests with mites in 59% of the patients, 24.5% for Blomia t; 10% for D. pteronyssinus plus Blomia t. and 7.29% for D. farinae plus Blomia t. The correlation of the skin reactivity between Dermatophagoides pteronyssinus and Blomia tropicalis (r= 0.36) and between Dermatophagoides farinae and Blomia tropicalis (r= 0.27), was not significant in both cases. CONCLUSIONS: We found that most patients with allergic rhinitis and asthma showed positive skin tests with the mite extracts tested. There is a weak correlation between both species of Dermatophagoides and Blomia tropicalis.

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99mTc-MIBI is a radiopharmaceutical that has been successfully used for the detection of hyperfunctioning parathyroid glands and for radioguided surgery techniques. We report on the case of a 55 year old woman in hemodialysis, with secondary persistent hyperparathyroidism after total parathyroidectomy. The conventional double-phase 99mTc-MIBI parathyroid scintigraphy was negative. The study was repeated after sensibilization with intravenous low-dose dobutamine showing an area of increased focal uptake in the lower cervical region. With this finding, radioguided 99mTc-MIBI surgery was performed after dobutamine administration, using a hand held gamma probe. The technique was considered successful with the resection of parathyroid cervical tissue which was further confirmed as nodular hyperplasia. We conclude that this methodology has the potential of being a an useful tool for the intraoperative localization of remanent tissue in patients with secondary persistent/recurrent hyperparathyroidism.

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OBJECTIVE: To measure the difference between rural and urban primary care quality in terms of an early cervical cancer detection programme. LOCATIONS: Seven hundred and fifty smear reports from rural primary care units and 750 from urban primary care units were selected at random from three institutions: the Ministry of Health, the largest Mexican social security institution, and one University Hospital, during August 1995-March 1996. Excluded were reports from women who were pregnant, menopausal or those who had undergone hysterectomy, as well as those tested positive for dysplasia and cancer. ACTIVITIES: Quality was measured through indicators and standards set by consensus of recognized field experts, based mainly on recommended national and international parameters. RESULTS: There was no difference between the overall quality of the urban and rural units. Both registered fairly satisfactory levels (achievement: 76.2%; 95% CI: 72.7-77.0%, versus 75.2; 95% CI: 69.8-78.9%, respectively). The quality of the smear sampling was highly unsatisfactory in rural units and unsatisfactory in urban units (achievement: 64.2%; 95% CI: 58.2-70.0%, versus 47.3%, 95% CI: 42-52.7%; P < 0.00001). Quality of coverage was unsatisfactory for both regions. Quality of smear processing and timeliness were highly satisfactory for both rural and urban units. RECOMMENDATIONS: Efforts should be directed toward smear quality improvement, especially in rural units. Health care workers who take smears need training programmes and better instruments. They should receive feedback on smear adequacy from the laboratory. Health education is necessary to improve utilization and programme coverage quality.

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The clinical files were reviewed of eight pediatric patients who died between 1976 and 1990, having the pathological diagnosis of aspergillosis. During the clinical evolution seven displayed malnutrition and respiratory symptomatology, four had slow evolving fever and oral candidiasis. The image in all the chest X-Rays was opaque. In the laboratory four had leukopenia, lymphopenia and neutropenia: two with a positive culture of Aspergillus. Five received four to eight different antibiotics during the last clinical evolution. All showed a combination of diverse forms of aspergillosis, all with the invasive form, five with the disseminated form, three bronchopulmonary allergic and one with aspergilloma. All had invasion of the respiratory system. Septicemia had the cause of death in four and three was direct relation with Aspergillosis.

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The hydrophilic penta-anionic complex [Technetium (Carboxymethylisocyanide)6]-5, [Tc(CNCH2COO-)6]-5 (Tc-CAMI) was synthesized to evaluate its potential as a renal function imaging agent. The compound contains six distally arranged carboxyl groups that can act as substrates for the organic acid receptor of the renal cell to effect tubular secretion of this agent. Dynamic gamma-camera imaging of 99mTc-CAMI was performed in normal dogs to compare its bio-distribution and pharmacokinetics with those of proven tubular secretion (99mTc-MAG3) and globular filtration (99mTc-DTPA) agents. The relative difference between the observed mean renal transit times (MRTT) of 99mTc-CAMI and 99mTc-MAG3 was 0.15 compared with 1.24 for 99mTc-CAMI and 99mTc-DTPA. Pathological models of obstructive uropathy, renal arterial stenosis and renal denervation were produced in the same animals to demonstrate the diagnostic potential of the agent. These experiments and data showing that probenecid competes with 99mTc-CAMI for renal transport indicate that this compound functions as a tubular secretion agent and may be useful for monitoring renal function in various disease states.

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The possibility of using 99mTc-labelled nucleotides as tumour seeking agents has been proposed by different research groups. We have recently reported the preparation of a 99mTc-ADP complex with a high radiochemical purity (> 95%), good in vitro and in vivo stability and promising biodistribution results when injected in mice bearing spontaneous mammary adenocarcinomas. Here we report the results of further investigations in animals with spontaneous neoplastic processes, including whole-body autoradiography in mice (20 minutes and 60 minutes post injection) and gamma-camera imaging studies in Wistar rats. Dynamic studies (up to 45 minutes) and static images (up to 18 hours) were acquired to determine the pharmacokinetics of 99mTc-ADP and the tumour/muscle and tumour/blood ratios. Blood-pool studies were also performed as a control. Tumours were visualized by autoradiography as was to be expected from the biodistribution studies. Dynamic studies showed a rapid blood clearance and a behaviour that fitted to a tricompartimental model. Radioactivity was rapidly taken up by the kidneys and excreted in the urine. No evidence of in vivo instability of the complex was observed. Tumour uptake reached the maximum values after 20 minutes post-injection. Tumour/blood and tumour/muscle ratios improved over time, enhancing tumour visualization. The best images were obtained after 3 hours post injection. In summary, our studies suggest that 99mTc-ADP is a promising radiopharmaceutical for tumour diagnosis.

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A study was made to determine the prevalence of anemia in apparently healthy children of both sexes aged 6 to 24 months attending the preventive medicine service in a general hospital of the Mexican Social Security Institute in the city of Tapachula, State of Chiapas. One hundred children were studied with a capillary hemoglobin (Hb) determination: 91 had anemia (Hb less than or equal to 11 g/dL). Sixty eight of the anemic children received oral iron for 3 months (3 mg/kg/day): their Hb before and after iron therapy were compared. Considering as responders those with an increment in Hb greater than 1 g/dL, sixty four children (94%) showed a mean increment of 2.6 g/dL. Four were considered as non-responders: in 3 the iron supplementation was stopped due to infectious diseases; the fourth case had a Hb increment below 1 g/dL. The use of capillary Hb as a criterium for treating anemic children proved to be a good predictor of response in a population where the prevalence of iron deficiency is high.

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The effects of neonatal X-irradiation on cerebellar cathecholamine levels in rats were studied at different postnatal intervals. Since synaptogenesis in the cerebellar cortex is basically a postnatal phenomenon, changes in noradrenaline (NA) and dopamine (DA) levels induced by X-rays on the cerebella (CE) of adult rats (60 days old) were also studied. With 200 rad at birth there was an increase in both NA (+ 75%) and DA (+ 40%) levels at day 30, with a return to control values by day 90. CE weight did not change with this dose. Both 500 and 700 rad given at birth induced a persistent increase in NA levels, even when studied at day 390 (+ 127%) and a long-term decrease in DA levels. A marked atrophy of CE was found, even at day 390 (a 61% decrease in weight). Histologic analysis showed that the cerebellar cortex lacked its interneurons (agranular cerebellar cortex) and that Purkinje cells were randomly arranged. Rats showed dystonia, fine tremor, posterior train ataxia and microcephalia. On the other hand, X-irradiation of adult rats did not change cerebellar catecholamine levels or produced cerebellar atrophy. These animals did not show motor deficits or microcephalia. Taken together, these results suggest that the long-term changes in cerebellar catecholamine levels induced by neonatal X-irradiation may be somehow related to the loss of cerebellar interneurons which develop early in the postnatal period, although a primary change(s) in the activity of noradrenergic neurons can not be excluded.

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Estudou-se em 56 pacientes chagásicos crônicos (45 assintomáticos e os restantes portadores de transtornos cardiovasculares e digestivos) a funçäo ventrícular esquerda (ejeçäo basal, motilidade parietal segmentar e o histograma); em 29 deles, o trânsito esofagiano e em outros 25 enfermos explorou-se a via urinária, respectivamente com o 99m - TC coloidal e o 99ml - TC b + PA. Observou-se que a fraçäo de ejeçäo do ventrículo esquerdo entre os indivíduos normais era de 0,66 + ou - 0,07, enquanto nos chagásicos crônicos com alteraçöes cardiovasculares (Grupo II) verificou-se 0,49 + ou - 0,21. A motilidade parietal esteve alterada em 60% do mesmo grupo de enfermos e o desvio standard do histograma foi de 1,98 + ou - 0,45, para 1,29 + ou - 0,17 no grupo de voluntários. O trânsito esofágico foi considerado normal em 9 casos e alterado em 20, sendo que em 6 foi do tipo prolongado, em 4 adinâmico e em 10 incoordenado. Nos 25 pacientes nos quais investigaram a via urinária superior, foi encontrada alteraçäo em 22 (dilataçäo piélica uni ou bilateral) e a funçäo vesical nestes pacientes foi normal em apenas quatro casos. Concluem os pesquisadores que o 99 - TC representa um grande avanço tecnológico no estudo da funçäo cardíaca, esofágica e das vias urinárias em pacientes chagásicos crônicos e assintomáticos

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Se presentan los resultados de un estudio cooperativo sobre la exploracion de la via biliar con 99mTc diisopropil-IDA. Se estudiaron 15 voluntarios normales y 75 pacientes portadores de colecistitis aguda (CA), y cronica (CC), ictericias hepatocelulares (IHC), obstructivas coledocianas incompletas (ICI) y completas (ICC).Se determino el comportamiento biologico del radiofarmaco en los dos grupos estudiados a traves de la medida de los tiempos de captacion y aparicion en el parenquima hepatico, en la via biliar principal intra y extrahepatica, en la vesicula, en el duodeno y en los rinones. Se describen los modelos fisiopatologicos encontrados en la CA, CC, IHC, ICI, ICC. Se concluye que el procedimiento tiene indicacion de eleccion en la CA, que su valor es limitado en la CC y que en las ictericias salvo en situaciones muy especiales el metodo aporta muy poca informacion de utilidad clinica. Se destaca la posibilidad que Servicios Latinoamericanos realicen trabajos cientificos en forma conjunta acrecentando su nivel de eficacia

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Se presentan los resultados de un estudio cooperativo sobre la exploracion de la via biliar con 99mTc diisopropil-IDA. Se estudiaron 15 voluntarios normales y 75 pacientes portadores de colecistitis aguda (CA), y cronica (CC), ictericias hepatocelulares (IHC), obstructivas coledocianas incompletas (ICI) y completas (ICC).Se determino el comportamiento biologico del radiofarmaco en los dos grupos estudiados a traves de la medida de los tiempos de captacion y aparicion en el parenquima hepatico, en la via biliar principal intra y extrahepatica, en la vesicula, en el duodeno y en los rinones. Se describen los modelos fisiopatologicos encontrados en la CA, CC, IHC, ICI, ICC. Se concluye que el procedimiento tiene indicacion de eleccion en la CA, que su valor es limitado en la CC y que en las ictericias salvo en situaciones muy especiales el metodo aporta muy poca informacion de utilidad clinica. Se destaca la posibilidad que Servicios Latinoamericanos realicen trabajos cientificos en forma conjunta acrecentando su nivel de eficacia

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Con objetivo de brindar un aporte diagnostico a la interpretacion de las alteraciones del metabolismo fosfocalcico en la insuficiencia renal; se realizo el estudio combinado de PTH y centellograma oseo en un grupo de pacientes en hemodialisis cronica. Esta metodologia de estudio permitio clasificar humoralmente a los enfermos en tres grupos: normo, hipo o hipercalcemicos, frente al aumento de los niveles de PTH. A su vez la centellografia osea en la etapa prerradiologica subdividio al grupo en: normales (estadio 0), con hipercaptacion moderada (estadio I) y con hipercaptacion severa (estadio II)

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Se estudiaron 10 pacientes con el objeto de analizar el valor de la determinacion de la perdida sanguinea intestinal (PSI), en los insuficientes renales en hemodialisis cronica. Se determino la P.S.I. y la vida media globular por medio de la marcacion del globulo rojo con 51Cr. A todos los pacientes se les realizaron estudios fibrogastroscopicos.Del analisis de los resultados se concluye que el estudio de PSI es de utilidad para el "Screening test" para cuantificar la magnitud de la perdida, para sustentar la indicacion de la fibrogastroscopia y para fundamentar la exploracion distal o la biopsia del tubo digestivo a los pacientes con insuficiencia renal cronica

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Con objetivo de brindar un aporte diagnostico a la interpretacion de las alteraciones del metabolismo fosfocalcico en la insuficiencia renal; se realizo el estudio combinado de PTH y centellograma oseo en un grupo de pacientes en hemodialisis cronica. Esta metodologia de estudio permitio clasificar humoralmente a los enfermos en tres grupos: normo, hipo o hipercalcemicos, frente al aumento de los niveles de PTH. A su vez la centellografia osea en la etapa prerradiologica subdividio al grupo en: normales (estadio 0), con hipercaptacion moderada (estadio I) y con hipercaptacion severa (estadio II)

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