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Introducción. La coxa vara es una disminución del ángulo cervicodiafisiario (<110°) y se puede presentar hasta en el 10% de los pacientes con osteogénesis imperfecta (OI), siendo más frecuente en el tipo III. Sus manifestaciones clínicas son alteración en la marcha, acortamiento de la pierna, genu valgo y dolor.Presentación de los casos. Varones de 13 años y 8 años con OI tipo III, signo positivo de Trendelenburg, movilidad articular adecuada y antecedentes de fracturas recurrentes y cirugías previas por deformidades en los que se realizó cirugía para la corrección de coxa vara. Se realizó una evaluación radiográfica y una funcional (escala de Harris) a los 6 y 68 meses de la cirugía, respectivamente.En el caso 1 se logró una corrección de 46° en el ángulo cervicodiafisiario (ángulo inicial: 84°; ángulo final: 130°) y el puntaje en la escala de Harris fue de 70 puntos. En el caso 2, se logró una corrección de 50° (82° vs. 132°), con un puntaje en la escala de Harris de 68 puntos. Conclusiones. la técnica de corrección mediante osteotomía subtrocantérica y la utilización de clavo endomedular y agujas de Kirschner es una opción efectiva para el tratamiento de coxa vara en pacientes con osteogénesis imperfecta
Introduction. Coxa vara is a deformity characterized by a decrease in the neck-shaft angle (<110°) that can occur in up to 10% of patients with osteogenesis imperfecta (OI), being more frequent in type III OI. Its clinical manifestations are gait disturbance, leg shortening, genu valgum, and pain.Case presentation. Male patients aged 13 and 8 years presenting with type III OI, positive Trende-lenburg sign, adequate joint mobility, and a history of recurrent fractures and previous surgeries for deformities, including surgery for coxa vara correction. Radiographic and functional evaluation (Harris scale) were performed 6 and 68 months after surgery, respectively.In the first case, a correction of 46° was obtained (initial angle: 84°; final angle: 130°), as well as a Harris score was 70. In the second case, a correction of 50° (82° vs. 132°) was achieved, with a Harris score of 68 points. Conclusions. Subtrochanteric osteotomy and intramedullary K-wire nailing are effective options for the treatment of coxa vara in patients with osteogenesis imperfecta
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Low-cost video surveillance systems are attractive for Smart Home applications (especially in emerging economies). Those systems use the flexibility of the Internet of Things to operate the video camera only when an intrusion is detected. We are the only ones that focus on the design of protocols based on intelligent agents to communicate the video of an intrusion in real time to the guards by wireless or mobile networks. The goal is to communicate, in real time, the video to the guards who can be moving towards the smart home. However, this communication suffers from sporadic disruptions that difficults the control and drastically reduces user satisfaction and operativity of the system. In a novel way, we have designed a generic software architecture based on design patterns that can be adapted to any hardware in a simple way. The implanted hardware is of very low economic cost; the software frameworks are free. In the experimental tests we have shown that it is possible to communicate to the moving guard, intrusion notifications (by e-mail and by instant messaging), and the first video frames in less than 20 s. In addition, we automatically recovered the frames of video lost in the disruptions in a transparent way to the user, we supported vertical handover processes and we could save energy of the smartphone's battery. However, the most important thing was that the high satisfaction of the people who have used the system.
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Plastic surgery has a tradition of caring for patients with facial deformity and hand deformity related to leprosy. The approach, however, to the progressive deformity and disability related to chronic nerve compression is underappreciated in the world today. A cohort of patients with leprous neuropathy from an indigenous area of leprosy in Ecuador was evaluated for the presence of chronic peripheral nerve compression, and 12 patients were chosen for simultaneous upper and lower extremity, unilateral, nerve decompression at multiple levels along the course of each nerve. The results at 1 year of follow-up show that 6 patients improved into the excellent category and 4 patients improved into the good category for improved function. Based on the early results in this small cohort of patients with leprous neuropathy, an approach to peripheral nerve decompression, encompassing the concept of multiple crush at multiple levels of each nerve, seems to offer optimism to improve upper and lower extremity limb function. Long-term studies with quality-of-life outcomes would be welcome.
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BACKGROUND: In modern operating rooms, clean and unused medical supplies are routinely discarded and can be effectively recovered and redistributed abroad to alleviate the environmental burden of donor hospitals and to generate substantial health benefits at resource-poor recipient institutions. METHODS: We established a recovery and donation program to collect clean and unused supplies for healthcare institutions in developing nations. We analyzed items donated over a 3-year period (September 2010-November 2013) by quantity and weight, and estimated the projected value of the program under potential nationwide participation. To capture the health benefits attributable to the donated supplies at recipient institutions, we partnered with two tertiary-care centers in Guayaquil, Ecuador and conducted a pilot study on the utility of the donated supplies at the recipient institutions (October 2013). We determined the disability-adjusted life years (DALY) averted for all patients undergoing procedures involving donated items and estimated the annual attributable DALY as well as the cost per DALY averted both by supply and by procedure. RESULTS: Approximately, 2 million lbs (907,185 kg) per year of medical supplies are recoverable from large non-rural US academic medical centers. Of these supplies, 19 common categories represent a potential for donation worth US $15 million per year, at a cost-utility of US $2.14 per DALY averted. CONCLUSIONS: Hospital operating rooms continue to represent a large source of recoverable surgical supplies that have demonstrable health benefits in the recipient communities. Cost-effective recovery and need-based donation programs can significantly alleviate the global burden of surgical diseases.