A prospective randomized trial of total synovectomy versus limited synovectomy in primary total knee arthroplasty: evaluation of bleeding, postoperative pain, and quality of life with SF-12 v2.

BACKGROUND: During total knee arthroplasty (TKA), total synovectomy (TS) as a part of the surgical technique has been proposed to reduce the inflammatory tissue after the procedure, but there is a controversy about it because of the risk of major postsurgical bleeding. The aim of this study was to compare postoperative bleeding, pain, and health-related quality of life (HRQOL) after a TKA when a TS is performed and when it is not. METHODS: The difference in pre and postoperative hemoglobin was measured, as well as postoperative pain using visual analogue scale (VAS) scores at 24 and 48 h post-surgical, HRQOL was measured prior to surgery and at one year using the SF-12V2 questionnaire. RESULTS: We assessed a total of 148 patients (73 for TS and 75 for limited synovectomy). We have found a difference of 0.9 mg/dl of pre- and postoperative hemoglobin between both groups, with a higher bleeding amount for the TS group (P = 0.0000647); VAS scores were slightly lower for the TS group at 24 and 48 h after surgery, but not relevant. The TS group required transfusion in 13.3% and the limited synovectomy group in 6.8%. No significant differences in HRQOL were found in both groups at 1 year follow-up. CONCLUSIONS: Performing a TS in TKA in patients with osteoarthrosis does not result in a relevant lower postoperative pain, or in an improvement in HRQOL, and it does increase the amount of bleeding after the procedure.

[Effect of rehabilitation on functionality/quality of life in stroke due to COVID-19]. / Efecto de la rehabilitación sobre funcionalidad/calidad de vida en ictus por COVID-19.

Background: COVID-19 can present neurological complications of the central nervous system. Ischemic-type strokes have been reported in this population. Neurological rehabilitation participates in the functional recovery and improvement of the quality of life of these patients. Objective: To measure the functionality and quality of life of patients with ischemic stroke due to COVID-19. Material and methods: An observational, prospective and longitudinal study of patients with ischemic stroke admitted to a neurological rehabilitation program was carried out. The Barthel index, the modified Rankin Scale and the SF-12 were used to monitor functionality and quality of life. To compare the proportions of patients with functional independence, the McNemar test was used; for SF-12 scores, Student's t test was used for related data or Wilcoxon test, depending on their normality. A p < 0.05 was significant. Results: 21 patients were included; mean age was 53.57 ± 12.2 years; they were predominantly male (66.7%). The percentage of patients with higher degrees of independence in daily and functional life increased, both in the Barthel index (p < 0.01) and in the modified Rankin scale (p < 0.01) at the third month of follow-up. There was an improvement in the quality of life in its physical component (p = 0.02), as well as in the dimensions of general health (p = 0.01) and mental health (p = 0.04). Conclusions: Patients with stroke due to COVID-19 admitted to the neurological rehabilitation program presented improvement in functional independence and increased their quality of life in their physical component at 3-month follow-up.

Introducción: la COVID-19 puede presentar complicaciones neurológicas del sistema nervioso central. Se han reportado ictus de tipo isquémico en esta población. La rehabilitación neurológica participa en la recuperación funcional y en la mejoría de la calidad de vida (CV) de estos pacientes. Objetivo: medir el efecto de la rehabilitación neurológica en la funcionalidad y CV de los pacientes con evento vascular cerebral (EVC) isquémico por COVID-19. Material y métodos: estudio observacional, prospectivo y longitudinal de los pacientes con EVC isquémico ingresados a un programa de rehabilitación neurológica (PRN). Se utilizaron el Índice de Barthel (IB), la Escala de Rankin (ER) modificada y el SF-12 para el seguimiento de funcionalidad y CV. Para comparar las proporciones de pacientes con independencia funcional, se utilizó la prueba de McNemar; para puntajes de la SF-12, t de Student para datos relacionados o prueba de Wilcoxon, dependiendo de su normalidad. Una p < 0.05 fue significativa. Resultados: se incluyeron 21 pacientes; la media de edad fue de 53.57 ± 12.2 años; predominó el sexo masculino (66.7%). El porcentaje de pacientes con mayores grados de independencia en la vida diaria y funcional incrementó, tanto en el IB (p < 0.01) como en la ER modificada (p < 0.01), al tercer mes de seguimiento. Mejoró la CV en su componente físico (p = 0.02) y en las dimensiones de salud general (p = 0.01) y salud mental (p = 0.04). Conclusiones: los pacientes con EVC por COVID-19 ingresados al PRN presentaron mejoría en la independencia funcional e incremento de la CV en su componente físico a tres meses de seguimiento.

Asociación entre las características radiográficas y los tumores óseos de rodilla.

BACKGROUND: Bone neoplasms require an adequate clinical-radiographic evaluation for their diagnosis. Plain radiographs are the usual method to establish the diagnosis and evaluate differential diagnoses in the study of bone tumor pathology. OBJECTIVE: To recognize the frequency of radiographic characteristics and associate them with bone tumor pathology. METHOD: Radiographic data were collected from 132 patients with tumor pathology confirmed by biopsy from bone tumors service of the Traumatology and Orthopedics Hospital Unidades Médicas de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, Ciudad de México, during 2019. RESULTS: 132 patients were registered. The most frequent benign tumor was osteochondroma (27.3%), and malignant was osteosarcoma (9.8%). Active lytic lesions (odds ratio [OR]: 6.9; 95% confidence interval [95% CI]: 2.83-16.85) or aggressive (OR: 26.85; 95% CI: 3.21-224) were associated with giant cells tumors. Poorly differentiated intraosseous blast lesions of bone lineage (OR: 36.15; 95% CI: 4.4-295.5) were associated with osteosarcoma. The periosteal reaction (OR: 36.15; 95% CI: 4.4-295.5), the moth-eaten or permeative pattern (OR: 11.75; 95% CI: 1.26-109) and the central location of the lesion (OR: 3.03; 95% CI: 1.37-6.69) were associated with malignant tumor lesions. CONCLUSIONS: Poorly defined intraosseous blast lesions of bone lineage, periosteal reaction, and moth-eaten or permeative pattern of destruction are associated with malignant lesions.

ANTECEDENTES: Los tumores óseos requieren una adecuada evaluación clínico-radiográfica para su diagnóstico. Las radiografías simples son el método incruento usual para establecer el diagnóstico y evaluar diagnósticos diferenciales en el estudio de la patología tumoral ósea. OBJETIVO: Reconocer la frecuencia de las características radiográficas y asociarlas con patología tumoral ósea. MÉTODO: Se recolectaron datos radiográficos de 132 pacientes con patología tumoral confirmada mediante biopsia del servicio de tumores óseos del Hospital de Traumatología y Ortopedia Unidades Médicas de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, en Ciudad de México, durante el año 2019. RESULTADOS: Integraron la muestra 132 pacientes. El tumor benigno más frecuente fue el osteocondroma (27.3%), y el maligno, el osteosarcoma (9.8%). Las lesiones líticas activas (odds ratio [OR]: 6.9; intervalo de confianza del 95% [IC95%]: 2.83-16.85) o agresivas (OR: 26.85; IC95%: 3.21-224) se asociaron a tumor de células gigantes. Las lesiones blásticas de estirpe ósea mal diferenciadas intraóseas (OR: 36.15; IC95%: 4.4-295.5) se asociaron a osteosarcoma. La reacción perióstica (OR: 36.15; IC95%: 4.4-295.5), el patrón apolillado o permeativo (OR: 11.75; IC95%: 1.26-109) y la ubicación central (OR: 3.03; IC95%: 1.37-6.69) se asociaron a lesiones tumorales malignas. CONCLUSIONES: Las lesiones blásticas de estirpe ósea mal definidas intraóseas, la reacción perióstica y el patrón de destrucción apolillado o permeativo se asocian a lesiones malignas.

MSH-5: malignant knee tumors timely detection index.

BACKGROUND: Bone neoplasms are usually misdiagnosed causing a delay in their treatment. Bone neoplasms are usually confused with tendinitis, 31% of the cases corresponds to osteosarcomas and in 21% to Ewing's sarcomas. OBJECTIVE: To create a clinical-radiographic instrument of high diagnostic suspicion of knee bone neoplasms to prevent a delay in diagnosis. METHOD: A clinimetric study (sensitivity, consistency and validity) was performed in the bone tumor service, Hospital de Ortopedia de la Unidad Médica de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, in México City. RESULTS: Characteristics of 153 patients were collected. For the sensitivity phase, 3 domains (signs, symptoms, and radiology) and 12 items were included. Consistency was evaluated with ICC (0.944), 95%CI (0.865-0.977), p < 0.001 and a-Cronbach (0.863). Index obtained a sensitivity of 0.80 and a specificity of 0.882 were obtained. The positive predictive value of the test was 66.6% and the negative predictive value was 93.75%. The positive likelihood ratio was 6.8 and the negative likelihood ratio was 0.2. Validity was evaluated using r-Pearson (0.894; p < 0.001). CONCLUSIONS: A high suspicion clinical-radiographic index was designed to detect malignant knee tumors with adequate sensitivity, specificity, appearance, content, criteria, and construct validity.

ANTECEDENTES: Los tumores óseos suelen ser subdiagnosticados, provocando un retraso en su tratamiento. El diagnóstico erróneo más frecuente es tendinitis, en el cual el 31% corresponden a osteosarcomas y el 21% a sarcomas de Ewing. OBJETIVO: Crear un instrumento clínico-radiográfico de alta sospecha diagnóstica de tumores óseos de rodilla. MÉTODO: Se realizó un estudio clinimétrico (sensibilidad, consistencia y validez) en el servicio de tumores óseos del Hospital de Ortopedia de la Unidad Médica de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, en Ciudad de México. RESULTADOS: El índice se realizó tomando las características de 153 pacientes. Para la fase de sensibilidad se incluyeron tres dominios (signos, síntomas y radiología) y 12 ítems. La consistencia se evaluó con coeficiente de correlación intraclase (0.944), intervalo de confianza del 95% (0.865-0.977), p < 0.001 y α de Cronbach (0.863). Se obtuvo una sensibilidad del instrumento de 0.80 y una especificidad de 0.882. El valor predictivo positivo de la prueba fue del 66.6% y el valor predictivo negativo fue de 93.75%. La razón de verosimilitud positiva fue de 6.8 y la razón de verosimilitud negativa fue de 0.2. La validez se evaluó mediante r-Pearson (0.894; p < 0.001). CONCLUSIONES: Se diseñó un índice clínico-radiográfico de alta sospecha para detectar tumores malignos de rodilla con adecuada sensibilidad, especificidad y validez de apariencia, de contenido, de criterio y de constructo.

Quality of life related to both general and oral health two years after treatment for subcondylar fracture.

The success of treatment for condylar fractures is usually assessed by functional outcomes, while studies on patient perceptions are scarce. A cross-sectional study was performed to assess the middle-term quality of life, related to both general health and oral health, of patients treated for subcondylar fracture, either by open reduction or by closed fixation, compared to healthy volunteers. In a single trauma centre, among 226 consecutive patients with subcondylar fractures that were treated in years 2018-2019 (two to three years prior to the survey), 148 fulfilled the selection criteria. They were classified as those with other facial fractures that were treated by open reduction (n = 79), and those without other fractures that were treated either by open reduction (n = 34) or by closed fixation (n = 35). An age matched group of healthy volunteers (n = 65) also participated in the study. All participants replied to the Short-Form-Health-Survey (SF-36) and the Oral-Health-Impact-Profile (OHIP-49), using the social messenger platform WhatsApp. The SF-36 showed that patients with closed-fixation reported better mental health than patients with open reduction, but worse than healthy volunteers. Contrariwise, on the OHIP-49, compared to patients with open reduction (with/without other facial fractures) and to healthy volunteers, patients with closed-fixation reported worse quality of life on physical pain, psychological discomfort, and physical disability. The influence of age was evident just on the OHIP-49, on the report of physical limitation and physical pain. Two to three years after the subcondylar fracture, patients treated either by open reduction or closed fixation might report decreased quality of life compared to healthy volunteers; patients treated by open reduction might report lesser mental health related quality of life (SF-36), but superior oral health related quality of life (OHIP-49) than patients treated by closed fixation.

[Prophylaxis of venous thromboembolic disease in high-risk orthopedic surgery]. / Profilaxis de la enfermedad tromboembólica venosa en cirugía ortopédica de alto riesgo.

Venous thromboembolism (VTE) is a worldwide public health problem, with an annual incidence of 1-2 cases/1,000 individuals in the general population and a 1-5% associated mortality. Orthopedic surgery is a major surgical risk factor for VTE, but the problem is more important for patients with hip and knee joint replacement, multiple traumatisms, severe damage to the spine, or large fractures. Thromboprophylaxis is defined as the strategy and actions necessary to diminish the risk of VTE in high-risk orthopedic surgery. Antithrombotics may prevent VTE. At the end of this paper, we describe a proposal of thromboprophylaxis actions for patients requiring high-risk orthopedic surgery, based on the opinion of specialists in Orthopedics and Traumatology who work with high-risk orthopedic surgery patients. A search for evidence about this kind of surgery was performed and a 100-item inquiring instrument was done in order to know the opinions of the participants. Then, recommendations and considerations were built. In conclusion, this document reviews the problem of VTE in high-risk orthopedic surgery patients and describes the position of the Colegio Mexicano de Ortopedia y Traumatología related to VTE prevention in this setting.

Influence of Work Hardening on the Surface of Backup Rolls for a 4-High Rolling Mill Fractured during Rolling Campaign.

Backup rolls are the main tool in a four-high rolling mill; the rolling forces applied in load cells promote the fatigue of the material due to mechanical contact between backup rolls and work rolls. This work investigated the causes of recurrent failures in backup rolls, with cracking always initiated on the surface of the roll body and finishing in the main radius between neck and roll body. Aiming to find the causes of failure, visual inspection and morphology of the fracture were performed, complemented with mechanical tests of hardness on the stress concentration area, in addition to validating the results by applying the finite element method, using ANSYS Mechanical Static Structural Software. It was concluded that the fatigue crack initiated on the surface of BUR due to work hardening continued growing up over the fatigued material, creating beach marks, and finally, a fracture occurred in the main radius of BUR due to stress concentration. The work hardening is the main cause of spalling on BURs and other mechanical components exposed to mechanical contact.

A Novel Technique for the Evaluation and Interpretation of Elastography in Salivary Gland Involvement in Primary Sjögren Syndrome.

Ultrasound (US) of major salivary glands (MSG) evaluates echogenicity, border features and vascularization, with elastography, it can detect tissue elasticity and glandular fibrosis, related to inflammation in Primary Sjögren's syndrome (pSS). This study aimed to develop a novel technique by pixel analysis for evaluation and interpretation of elastography in MSG in pSS. A cross-sectional and observational multicenter study was conducted. The US of MSG performed in orthogonal planes in grayscale, Doppler, and shear-wave elastography. For elastography images of each gland were analyzed with the open-source program ImageJ to perform a pixel analysis. Statistical analysis was performed with the IBM-SPSS v25 program. Fifty-nine women with a mean age of 57.69 (23-83) years were recruited; pSS mean duration of 87 (5-275) months, and 12 healthy women without sicca symptoms as a control group with a mean age of 50.67 (42-60) years. Intragroup analysis showed p-values >0.05 between sicca symptoms, ocular/dryness tests, biopsy, US, and pixel analysis; correlation between Hocevar and pixel analysis was not found (rho < 0.1, p >0.5). MSG anatomical size was 41.7 ± 28.2 mm vs. 67.6 ± 8.8 mm (p ≤ 0.0001); unstimulated whole saliva flow rate was 0.80 ± 0.80 ml/5 min vs. 1.85 ± 1.27 ml/5 min (p = 0.016). The elastography values (absolute number of pixels) were 572.38 ± 99.21 vs. 539.69 ± 93.12 (p = 0.290). A cut-off point risk for pSS identified with less than 54% of red pixels in the global MSG mass [OR of 3.8 95% CI (1.01-15.00)]. Pixel analysis is a new tool that could lead to a better understanding of the MSG chronic inflammatory process in pSS.

Correction to: Serum substance P: an indicator of disease activity and subclinical inflammation in rheumatoid arthritis.

Following publication, it was brought to the authors' attention by Dr. Julia Toscano-Garibay that she did not participate as a reviewer of the final version of this manuscript prior to its submission and publication in Clinical Rheumatology.

Triggering receptor expressed on myeloid cells-1 expression on monocytes is associated with inflammation but not with infection in acute pancreatitis.

INTRODUCTION: Acute pancreatitis (AP) is usually a mild and self-limiting disease, but some patients develop a severe form that is associated with high mortality. In AP, local inflammation is followed first by the systemic inflammatory response syndrome and then by the compensatory anti-inflammatory response syndrome, which is defined by low human leukocyte antigen (HLA)-DR expression on monocytes, increased concentration of the anti-inflammatory cytokine IL-10, and decreased monocyte function. Our aim was to measure the expression of triggering receptor expressed on myeloid cells (TREM)-1 (a proposed marker of infection or inflammation) and HLA-DR on monocytes, and the serum concentrations of IL-6 (a proinflammatory cytokine) and IL-10 in patients with AP to determine whether these markers can identify patients at high risk of developing severe AP or infection. METHODS: Fifty healthy volunteers, 18 patients with mild AP, and 11 patients with severe AP were included in this study. Samples were taken at admission and one and three days later. TREM-1 and HLA-DR expression was evaluated by flow cytometry, and soluble TREM-1, IL-6 and IL-10 concentrations were measured by ELISA. RESULTS: TREM-1 expression was higher in patients with AP than in healthy volunteers, but there was no difference between patients with mild and severe AP. TREM-1 expression was not associated with mortality or with the presence of infection. Soluble TREM-1 concentration in serum was higher in non-survivors than in survivors. HLA-DR expression was lower and IL-6 concentration higher in patients with severe AP and in infected patients. CONCLUSIONS: Increased TREM-1 expression was associated with the presence of inflammation but not infection in AP. In patients with AP, low HLA-DR expression and high IL-6 concentration could predict severity and infection in samples taken shortly after admission.

Mycobacterium tuberculosis lipids regulate cytokines, TLR-2/4 and MHC class II expression in human macrophages.

The interaction of macrophages with Mycobacterium tuberculosis through Toll-like receptors is critical in defining the cytokine profile that may or may not control disease progression. Cell-wall lipids are the main pathogen-associated molecular ligands of mycobacteria, in this paper, we analysed how lipid fractions of three different strains of the M. tuberculosis complex (genotypes Canetti, Beijing and H37Rv) affected the innate immunity by regulating TNF-alpha and IL-10 secretion, TLR2, TLR4, and MHC class II expression of human monocyte-derived macrophages. Of note, lipid fractions from the Beijing genotype (hypervirulent phenotype) preferentially induced macrophages to secrete high amounts of TNF-alpha and IL-10, but downregulated TLR2, TLR4 and MHC class II expression. In contrast, lipids from M. tuberculosis Canetti induced lower amounts of TNF-alpha and IL-10, upregulated TLR2 and TLR4 without modifying MHC class II expression. These results indicate that the virulent mycobacterial genotype Beijing expresses lipids that negatively modified cytokine, TLR and MHC class II expression. These findings may help to unravel the complex mechanisms used by virulent mycobacteria to evade and subvert the immune response.

The increased expression of TREM-1 on monocytes is associated with infectious and noninfectious inflammatory processes.

BACKGROUND: Inflammation is the response of an organism to tissue injury or infection. It is usually limited to the affected tissue, but sometimes the inflammatory mediators reach the bloodstream and act systemically. A compensatory anti-inflammatory response syndrome, in which expression of major histocompatibility complex class II (MHC-II) molecules are decreased, regulates the resulting systemic inflammatory response syndrome (SIRS). SIRS and compensatory anti-inflammatory response syndrome can lead to the development of sepsis. Triggering receptor expressed on myeloid cells (TREM)-1 has been proposed as a biomarker of the presence of sepsis. In this study, we investigated whether TREM-1 is increased only in septic patients, and not in patients with systemic inflammatory response but no infection. We also looked for a possible correlation between TREM-1 and MHC-II expression levels and the patients' progress. MATERIALS AND METHODS: Fifty-eight surgical patients, 14 septic patients and 50 healthy volunteers, were included in this study. TREM-1 and MHC-II expression on blood monocytes was determined by flow cytometry. RESULTS: TREM-1 expression was increased in all patients after surgery, and its expression was higher in patients with preexisting SIRS. No association was found with the presence of infection. In septic patients, the increase in TREM-1 expression was transitory. MHC-II expression was decreased in both surgical and septic patients, and this decrease was greater in patients with a worse outcome. CONCLUSIONS: Increased TREM-1 expression on monocytes is associated with both infectious and noninfectious inflammatory processes, and the levels of MHC-II expression is better correlated with the patient outcome.

Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social (IMSS): Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors.

BACKGROUND: Osteoarthritis (OA) is one of the main causes of disability worldwide, especially in persons >55 years of age. Currently, controversy remains about the best therapeutic alternative for this disease when evaluated from a cost-effectiveness viewpoint. For Social Security Institutions in developing countries, it is very important to assess what drugs may decrease the subsequent use of medical care resources, considering their adverse events that are known to have a significant increase in medical care costs of patients with OA. Three treatment alternatives were compared: celecoxib (200 mg twice daily), non-selective NSAIDs (naproxen, 500 mg twice daily; diclofenac, 100 mg twice daily; and piroxicam, 20 mg/day) and acetaminophen, 1000 mg twice daily. The aim of this study was to identify the most cost-effective first-choice pharmacological treatment for the control of joint pain secondary to OA in patients treated at the Instituto Mexicano del Seguro Social (IMSS). METHODS: A cost-effectiveness assessment was carried out. A systematic review of the literature was performed to obtain transition probabilities. In order to evaluate analysis robustness, one-way and probabilistic sensitivity analyses were conducted. Estimations were done for a 6-month period. RESULTS: Treatment demonstrating the best cost-effectiveness results [lowest cost-effectiveness ratio $17.5 pesos/patient ($1.75 USD)] was celecoxib. According to the one-way sensitivity analysis, celecoxib would need to markedly decrease its effectiveness in order for it to not be the optimal treatment option. In the probabilistic analysis, both in the construction of the acceptability curves and in the estimation of net economic benefits, the most cost-effective option was celecoxib. CONCLUSION: From a Mexican institutional perspective and probably in other Social Security Institutions in similar developing countries, the most cost-effective option for treatment of knee and/or hip OA would be celecoxib.

[Clinical pattern of patients cared for at pain clinic by first time]. / Característkicas de los enfermos que acuden a clínicas del dolor por primera vez.

BACKGROUND: Epidemiological studies about frequency and prevalence of chronic pain in Mexico are scarce. However, it has been documented that chronic pain is a frequent complain in general population and mainly in older adults. It influences physical patient capacity and it impacts social health services with its expensive cost. Our objective was to identify the clinical pattern of patients attending at a Pain Clinic by first time. METHODS: We conducted a descriptive-retrospective study, in a five years period, with patients attending a Pain Clinic by first time. We collected demographic data and information about the cause of pain (malignant vs. non-malignant etiology), its intensity by visual analogue scale (VAS), and type (somatic, visceral, neuropathic and mixed). RESULTS: 1453 clinical records were analyzed. Women were more affected; the average age was 59 +/- 16 years; non-malignant pain and neuropathic pain were more frequent; the intensity average was 6 +/- 2, and it increases with age. CONCLUSIONS: It is necessary to generate epidemiological studies to fundament health policies regarding the management of these patients.

Serum substance P: an indicator of disease activity and subclinical inflammation in rheumatoid arthritis.

The aim of the is study is to examine the role of serum substance P (SP) levels as a simple biomarker for rheumatoid arthritis (RA) disease activity, its correlation with other markers of disease activity, and with selected clinical parameters. The study comprised 90 RA patients and 24 healthy controls. RA activity was assessed by means of the disease activity 28-C-reactive protein (DAS28-CRP) index and ultrasound power Doppler (USPD) by the German ultrasound score based on seven joints. SP serum values were obtained by means of an ELISA commercial kit. Statistics were achieved by the Student's t test and Spearman correlation analysis with Bonferroni correction. As a group, RA patients had significantly increased levels of SP compared with healthy controls (p < 0.0001). SP levels correlated with DAS28-CRP (r = 0.5050, p < 0.0001), number of tender joints (NTJ, r = 0.4668, p < 0.0001), number of swollen joints (NSJ, r = 0.4439, p < 0.0001), visual analogue scale (VAS, r = 0.5131, p < 0.0001). However, SP did not correlate with CRP levels (r = 0.0468, p = 0.6613), nor with the USPD (r = 0.1740, p = 0.1009). Elevated serum SP is a common feature of RA patients, which also appears to correlate with clinical measurements of disease activity and with subjective clinical data (NTJ and VAS). Thus, although SP is higher in RA patients with high disease activity, it also detects subtle RA disease activity even in patients in apparent remission, which suggests its usefulness for therapeutic decisions.

High Serum Levels of High-Mobility Group Box 1 (HMGB1) and Low Levels of Heat Shock Protein 70 (Hsp70) are Associated with Poor Prognosis in Patients with Acute Pancreatitis.

INTRODUCTION: Cell damage in Acute Pancreatitis (AP) lead to release of cytokines and HMGB1 and Hsp70. While Hsp70 plays a role in cytoprotection, when released to extracellular milieu constitutes, as HMGB1, a danger signal and trigger pro-inflammatory responses. These molecules seem to be related to the clinical progression; but because no evidence exists about them as molecular network in AP development, we quantify HSP70, HMGB1, and cytokines in patients with AP and search for correlations with severity and prognosis. METHODS: Fifteen patients with AP were included. The average age was 52 years. Six patients had mild pancreatitis, 4 were moderately severe and 5 with a severe form. Blood samples were taken within the first 24 h, at 3d and 7d from the start. Serum HMGB1 and Hsp70 were determined using ELISA; TNF-α, IL-1ß, IL-6, IL-8, IL-10 and IL-12p70 were determined by bead based immuassay. RESULTS: Of all 15 patients recruited, 4 were women. Eight patients had APACHEII score higher than 8. Two patients died from AP related complications. Increase in serum HMGB1 and decrease of Hsp70 were associated with the severity and mortality. TNF-α, IL-6 and IL-8 were higher in patients that did not survive, in those with an APACHE II >8, and in those with severe AP. CONCLUSIONS: High HMGB1 and low Hsp70 were associated with poor prognosis. Hsp70 might play a protective role in AP. TNF-α, IL-6, IL-8, HMGB1 and Hsp70 during hospital admissions might serve to evaluate risk of death due to AP.

[Pediatric traumatic injuries requiring hospitalization. A serious health problem]. / Lesiones traumáticas en niños que requieren hospitalización. Un serio problema de salud.

OBJECTIVE: To identify the age-adjusted prevalence of pediatric traumatic injuries requiring hospitalization. METHODOLOGY: A retrospective, observational cross-sectional study was carried out in the pediatric trauma department at the Hospital Magdalena de las Salinas of Instituto Mexicano del Seguro Social. Data from all pediatric patients hospitalized between January 1998 and December 2005 due to traumatic injuries were included. RESULTS: 5,987 patients analyzed; 66.9% were male, 46.0% were children; 31.3% preschoolers; 18.2% adolescents and 4.4% infants. Regarding the injuries, 48.2% were injured at home, 74.8% suffered closed fractures, particularly among preschoolers and children; 12.4% suffered open fractures. Craneoencephalic trauma occurred in 34.2%, mostly in children and adolescents. Among preschoolers and children supracondylar fractures of the humerus occurred in 23.0%; the commonest was type IV (94%); physeal fractures occurred in 2.6% and lesions due to battered children were in 0.31%. As to the treatment, infants and preschoolers were treated through cast immobilization; closed reduction and internal fixation was common in school-age children (27%) while open reduction and external fixation was used in adolescents (26.8%). CONCLUSIONS: Preventive measures should be encouraged in the group with the highest prevalence of traumatic injuries requiring hospital care: male school-age children who predominantly suffer craneoencephalic trauma and supracondylar fractures of the humerus.

[High tibial dome osteotomy complications in genu varum patients]. / Complicaciones en pacientes con osteotomía tibial proximal alta en domo por genu varo.

OBJECTIVE: To identify if pre-surgical risk factors or the surgical technique were associated with the complications of the osteotomy in genu varus patients. METHODOLOGY: A case-control study was conducted in patients that underwent Maquet proximal tibial osteotomy for treatment of genu varus between January and December 2003. The risk factors were the following: age 50 or more years old, comorbidity such as type 2 diabetes, hypertension, rheumatoid arthritis, overweight and obesity (BMI > or = 25 and > or = 30), duration of ischemia longer than 60 min and local pain. Cases were those who developed one or more complications. Descriptive and inferential statistical analyses were performed. RESULTS: One hundred and thirty-four patients were included, among which 53% had complications. None of the risk factors were statistically significant (p > 0.05). CONCLUSIONS: None of pre-surgical risk factors were associated with the complications of osteotomy; therefore, these could be attributable to the surgical technique. It is necessary to outweigh the temporary benefits of the tibial osteotomy versus the increase in the risk of complications when performing total knee arthroplasty.

[Associated factors to severe sport injuries]. / Factores asociados con la severidad de la lesión deportiva.

OBJECTIVE: To identify the risk factors associated to severe sport injuries. MATERIAL AND METHODS: Case-control study, with non probabilistic of consecutive sample cases. The risk factors criteria for severe injuries were established by experts' consensus in patients diagnosed with injury caused during sports practice between July 2004 and March 2005. These patients were attended in the emergency room at the Magdalena de las Salinas High Medical Specialty Unit in Mexico City. RESULTS: There were included 131 patients with sport injuries; there were 76.3% men and 23.7% women. The mean age was 21.6+/-8.6. There were non severe injuries, (concussions, muscle strains, sprained) in 55% of patients and 45% of patients had severe injuries (fractures, dislocation, fracture-dislocation, physeal injury). In the case of severe injuries, it was associated with working out in a non reglamentary area [odd ratio (OR) of 2.5, p=0.01, CI (1.2-5.1)], soccer practice [OR of 2.4, p=0.01, CI (1.2-4.8)], body axis injury [OR of 5.9, p=0.004, CI (1.6-21.9)], indirect injury mechanism [OR of 2.2, p=0.04, CI (0.9-5.2)], sport practice

[Evidence and recommendation of empirical antimicrobial treatment in pyogenic spondylodiscitis: systematic review]. / Evidencia y recomendación del tratamiento antimicrobiano empírico en espondilodiscitis piógena: revisión sistemática.

BACKGROUND: Pyogenic spondylodiscitis is the infectious process that affects the vertebral body and the intervertebral disc. It has an incidence between 2 and 7%. To prescribe antibiotic treatment, it is required to identify the causative organism on the basis of the epidemiology of the etiologic agent, as well as the ability of the antibiotic to penetrate the bone tissue and the intervertebral disc. The objective was to identify the level of evidence and the grade of recommendation for the empiric initial treatment. METHODS: A systematic review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. PubMed articles were evaluated to assess their level of evidence and the grade of recommendation according to the Jadad scale and the classification of Sackett. On the basis of those two scales, it was analyzed the agreement by two observers and a Kappa value of 0.750 (p = 0.0001) was considered statistically significant. RESULTS: 642 studies were analyzed, out of which only 19 met the inclusion criteria. In these it was identified a level of evidence 4 and a degree of recommendation C for the use of fluoroquinolones in association with rifampicin in the empirical treatment of pyogenic spondylodiscitis and the use of vancomycin for the treatment of methicillin-resistant strains. CONCLUSION: There is not enough information concerning the use of empiric antibiotics in pyogenic spondylodiscitis; however, the existing information is favorable, even though it is not conclusive.

Introducción: la espondilodiscitis piógena es el proceso infeccioso que afecta al cuerpo vertebral y al disco intervertebral, con una incidencia de 2 a 7% de todas las osteomielitis. Para indicar tratamiento antibiótico se requiere identificar el germen causal a partir de la epidemiología del agente etiológico y de la capacidad del antibiótico de penetrar en el tejido óseo y en el disco intervertebral. El objetivo fue identificar el nivel de evidencia y el grado de recomendación del tratamiento antibiótico empírico inicial. Métodos: se hizo una revisión sistemática con base en los criterios PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Se evaluó en las publicaciones de PubMed el nivel de evidencia y el grado de acuerdo respecto a la escala de Jadad y a la clasificación de Sackett. Se analizó la concordancia entre los evaluadores y hubo significación estadística en los valores de Kappa de 0.750 con valor de p = 0.0001. Resultados: se analizaron 642 artículos, de los cuales solo 19 cumplieron con los criterios de selección. En estos últimos se identificó un nivel de evidencia 4 y un grado de recomendación C para la utilización de fluoroquinolonas en asociación con rifampicina en el tratamiento empírico de la espondilodiscitis piógena y el uso de vancomicina en caso de cepas resistentes a la meticilina. Conclusión: no existe información suficiente al respecto, pero la información existente es favorable, aunque no concluyente, para el uso de antibióticos empíricos en los casos de espondilodiscitis piógena.