Full-endoscopic foraminotomy in low-grade degenerative and isthmic spondylolisthesis: a patient-specific tailored approach.

PURPOSE: To describe the surgical technique and methodology to successfully plan and execute an endoscopic foraminotomy in patients with isthmic or degenerative spondylolisthesis, according to each patient's unique characteristics. METHODS: Thirty patients with degenerative or isthmic spondylolisthesis (SL) with radicular symptoms were included from March 2019 to September 2022. Treating physician registered patients' baseline and imaging characteristics, as well as preoperative back pain VAS, leg pain VAS and ODI. Subsequently, authors treated the included patients with an endoscopic foraminotomy according to a "patient-specific" tailored approach. RESULTS: Nineteen patients (63.33%) had isthmic SL and 11 patients (36.67%) had degenerative SL. 75.86% of the cases had a Meyerding Grade 1 listhesis. One of the transforaminal foraminotomies with lateral recess decompression in degenerative SL had to be aborted because of intense osseous bleeding. Of the remaining 29 patients, one patient experienced recurrence of the sciatica pain that required subsequent reintervention and fusion. No other intraoperative or post-operative complications were observed. None of the patients developed post-operative dysesthesia. In 86.67% of the patients, the foraminotomy was implemented using a transforaminal approach. In the remaining 13.33% of the cases, an interlaminar contralateral approach was used. Lateral recess decompression was performed in half of the cases. Mean follow-up time was 12.69 months, reaching a maximum of 40 months in some patients. Outcome variables such as VAS for leg and back pain, as well as ODI, showed statistically significant reduction since the 3-month follow-up visit. CONCLUSION: In the presented case series, endoscopic foraminotomy achieved satisfactory outcomes without sacrificing segmental stability. The proposed patient-specific "tailored" approach allowed to successfully design and execute the surgical strategy to perform an endoscopic foraminotomy through transforaminal or interlaminar contralateral approaches.

Bibliometric analysis and description of research trends on transforaminal full-endoscopic approach on the spine for the last two-decades.

OBJECTIVE: The study aims to assess the current development status of transforaminal full-endoscopic spine surgery (TFES) by exploring and analyzing the published literature to obtain an overview of this field and discover the evolution and emerging topics that are underrepresented. METHODS: Using Bibliometrix, CiteSpace, and VOSviewer, we analyzed the bibliometric data selected from the Web of Science Core Collection between January 2002 and November 2022. The descriptive and evaluative analyses of authors, institutes, countries, journals, keywords, and references are compiled. The quantity of research productivity was measured by the number of publications that were published. A quality indicator was thought to be the number of citations. In the bibliometric analysis of authors, areas, institutes, and references, we calculated and ranked the research impact by various metrics, such as the h-index and m-index. RESULTS: A total of 628 articles were identified in the field of TFES by the 18.73% annual growth rate of research on the subject from 2002 to 2022, constituting the documents are by 1961 authors affiliated with 661 institutions in 42 countries or regions and published in 117 journals. The USA (n = 0.20) has the highest international collaboration rate, South Korea has the highest H-index value (h = 33), and China is ranked as the most productive country (n = 348). Brown univ., Tongji univ., and Wooridul Spine represented the most productive institutes ranked by the number of publications. Wooridul Spine Hospital demonstrated the highest quality of paper publication. The Pain Physician had the highest h-index (n = 18), and the most cited journal with the earliest publication year in the area of FEDS is Spine (t = 1855). CONCLUSION: The bibliometric study showed a growing trend of research on transforaminal full-endoscopic spine surgery over the past 20 years. It has shown a significant increase in the number of authors, institutions, and international collaborating countries. South Korea, the United States, and China dominate the related areas. A growing body of evidence has revealed that TFES has leapfrogged from its infancy stage and gradually entered a mature development stage.

[User Profiles for the Integrated Family and Community Health Care Model in the Alto Hospicio, a commune of a northern region of Chile]. / Construcción de Perfiles de Usuario para el Modelo Integral de Salud Familiar y Comunitario en la Comuna de Alto Hospicio, Región de Tarapacá.

BACKGROUND: The study presents comprehensive profiles of Primary Health Care Centers of the Alto Hospicio Commune users. OBJECTIVE: To characterize users registered in the Health Centers of Alto Hospicio Commune from a comprehensive perspective, including satisfaction indicators and knowledge about the Comprehensive Family and Community Health Care Model (MAIS). METHODS: A questionnaire of 8 dimensions and 73 items was designed and applied in 4 Primary Health Care Centers in the commune. Four simple random samplings were applied. In total, 1,124 users were surveyed. The confidence and significance levels were between 95%-93% and 5%-7%, respectively. RESULTS: The user profile highlights the diversity in each Health Care Center and reveals general problems such as the lack of information regarding the family care model and services provided by the Health Care Centers and the difficulty of facing mental health situations in the context of the COVID-19 pandemic. CONCLUSIONS: Those Health Centers that provide more information about MAIS show better indicators regarding knowledge of health services and user satisfaction. The changes in public health policies and the implementation of the Comprehensive Family and Community Health Care Model require clarifying user profiles according to the characteristics of each health center, its population, and the territory, as well as sharing best practices between health centers.

The pace of modern life, revisited.

Wild populations must continuously respond to environmental changes or they risk extinction. Those responses can be measured as phenotypic rates of change, which can allow us to predict contemporary adaptive responses, some of which are evolutionary. About two decades ago, a database of phenotypic rates of change in wild populations was compiled. Since then, researchers have used (and expanded) this database to examine phenotypic responses to specific types of human disturbance. Here, we update the database by adding 5675 new estimates of phenotypic change. Using this newer version of the data base, now containing 7338 estimates of phenotypic change, we revisit the conclusions of four published articles. We then synthesize the expanded database to compare rates of change across different types of human disturbance. Analyses of this expanded database suggest that: (i) a small absolute difference in rates of change exists between human disturbed and natural populations, (ii) harvesting by humans results in higher rates of change than other types of disturbance, (iii) introduced populations have increased rates of change, and (iv) body size does not increase through time. Thus, findings from earlier analyses have largely held-up in analyses of our new database that encompass a much larger breadth of species, traits, and human disturbances. Lastly, we use new analyses to explore how various types of human disturbances affect rates of phenotypic change, and we call for this database to serve as a steppingstone for further analyses to understand patterns of contemporary phenotypic change.

Global urban signatures of phenotypic change in animal and plant populations.

Humans challenge the phenotypic, genetic, and cultural makeup of species by affecting the fitness landscapes on which they evolve. Recent studies show that cities might play a major role in contemporary evolution by accelerating phenotypic changes in wildlife, including animals, plants, fungi, and other organisms. Many studies of ecoevolutionary change have focused on anthropogenic drivers, but none of these studies has specifically examined the role that urbanization plays in ecoevolution or explicitly examined its mechanisms. This paper presents evidence on the mechanisms linking urban development patterns to rapid evolutionary changes for species that play important functional roles in communities and ecosystems. Through a metaanalysis of experimental and observational studies reporting more than 1,600 phenotypic changes in species across multiple regions, we ask whether we can discriminate an urban signature of phenotypic change beyond the established natural baselines and other anthropogenic signals. We then assess the relative impact of five types of urban disturbances including habitat modifications, biotic interactions, habitat heterogeneity, novel disturbances, and social interactions. Our study shows a clear urban signal; rates of phenotypic change are greater in urbanizing systems compared with natural and nonurban anthropogenic systems. By explicitly linking urban development to traits that affect ecosystem function, we can map potential ecoevolutionary implications of emerging patterns of urban agglomerations and uncover insights for maintaining key ecosystem functions upon which the sustainability of human well-being depends.

Lumbar Tubular Decompression: Barriers and Limitations Hampering the Technique's Dissemination Across Latin America.

OBJECTIVES: We sought to explore the barriers and limitations preventing the widespread use of tubular lumbar spine decompressions in Latin America. METHODS: A cross-sectional study was performed using a survey designed specifically by the authors. This survey was mailed to all spine surgeons who are members of AO Spine Latin America. Eighty-seven surgeons spanning 15 Latin American countries answered the survey. RESULTS: Thirty-one percent of participating surgeons claimed they needed to adapt their technique to perform minimally invasive tubular surgeries. Meanwhile, though 70.5% answered they do not consider tubular surgery expensive, 32.8% lacked access to standard equipment like a complete set of retractors or curved high-speed drill. CONCLUSIONS: Several barriers limit the development of tubular spine surgery in Latin America. The most important discrepancies between surgeons' preferred equipment and their availability for such operations are high-speed drills, bayoneted instruments, and hemostatic agents.

Invasive salmonids and lake order interact in the decline of puye grande Galaxias platei in western Patagonia lakes.

Salmonid fishes, native to the northern hemisphere, have become naturalized in many austral countries and appear linked to the decline of native fishes, particularly galaxiids. However, a lack of baseline information and the potential for confounding anthropogenic stressors have led to uncertainty regarding the association between salmonid invasions and galaxiid declines, especially in lakes, as these have been much less studied than streams. We surveyed 25 lakes in the Aysén region of Chilean Patagonia, including both uninvaded and salmonid-invaded lakes. Abundance indices (AI) of Galaxias platei and salmonids (Salmo trutta and Oncorhynchus mykiss) were calculated using capture-per-unit-effort data from gillnets, minnow traps, and electrofishing. We also measured additional environmental variables, including deforestation, lake morphometrics, altitude, and hydrological position (i.e., lake order). An information-theoretic approach to explaining the AI of G. platei revealed that by far the strongest effect was a negative association with the AI of salmonids. Lake order was also important, and using structural equation modeling, we show that this is an indirect effect naturally constraining the salmonid invasion success in Patagonia. Supporting this conclusion, an analysis of an independent data set from 106 mountain lakes in western Canada showed that introduced salmonids are indeed less successful in low-order lakes. Reproductive failure due to insufficient spawning habitat and harsh environmental conditions could be the cause of these limits to salmonid success. The existence of this effect in Chilean Patagonia suggests that low-order lakes are likely to provide natural ecological refugia for G. platei. Finally, pristine, high-order lakes should be actively protected as these have become rare and irreplaceable unspoiled references of the most diverse, natural lake ecosystems in Patagonia.

Atmospheric corrosion maps as a tool for designing and maintaining building materials: A review.

Atmospheric corrosion maps can be used to conduct a fast and graphical assessment of material deterioration in specific geographic environments. These maps are a key tool for selecting the most adequate materials in terms of corrosion resistance, maintenance, and cost-efficiency in outdoor constructions. Several studies have evaluated the effects of environmental factors and pollutants on building materials at local, regional, national, and international levels. However, not enough atmospheric corrosion maps are readily available, possibly due to the complexity of the variables that should be considered to construct them, which include weather, meteorological, and pollution-related factors that vary in space and time. This article presents a thorough literature review of atmospheric corrosion maps published between 1971 and 2021 mainly indexed in the Scopus database. It is complemented with a detailed review of books, journals, and projects by research centers that focuses on the methodologies, parameters, and tools that have been used to construct said maps. Most of the available maps are outdated, which highlights the need for new maps that reflect recent global changes in atmospheric pollution and temperature that can intensify metal deterioration in some places.

A global horizon scan for urban evolutionary ecology.

Research on the evolutionary ecology of urban areas reveals how human-induced evolutionary changes affect biodiversity and essential ecosystem services. In a rapidly urbanizing world imposing many selective pressures, a time-sensitive goal is to identify the emergent issues and research priorities that affect the ecology and evolution of species within cities. Here, we report the results of a horizon scan of research questions in urban evolutionary ecology submitted by 100 interdisciplinary scholars. We identified 30 top questions organized into six themes that highlight priorities for future research. These research questions will require methodological advances and interdisciplinary collaborations, with continued revision as the field of urban evolutionary ecology expands with the rapid growth of cities.

Socio-eco-evolutionary dynamics in cities.

Cities are uniquely complex systems regulated by interactions and feedbacks between nature and human society. Characteristics of human society-including culture, economics, technology and politics-underlie social patterns and activity, creating a heterogeneous environment that can influence and be influenced by both ecological and evolutionary processes. Increasing research on urban ecology and evolutionary biology has coincided with growing interest in eco-evolutionary dynamics, which encompasses the interactions and reciprocal feedbacks between evolution and ecology. Research on both urban evolutionary biology and eco-evolutionary dynamics frequently focuses on contemporary evolution of species that have potentially substantial ecological-and even social-significance. Still, little work fully integrates urban evolutionary biology and eco-evolutionary dynamics, and rarely do researchers in either of these fields fully consider the role of human social patterns and processes. Because cities are fundamentally regulated by human activities, are inherently interconnected and are frequently undergoing social and economic transformation, they represent an opportunity for ecologists and evolutionary biologists to study urban "socio-eco-evolutionary dynamics." Through this new framework, we encourage researchers of urban ecology and evolution to fully integrate human social drivers and feedbacks to increase understanding and conservation of ecosystems, their functions and their contributions to people within and outside cities.

Otolith microchemistry and diadromy in Patagonian river fishes.

Coastal habitats in Chile are hypothesized to support a number of diadromous fish species. The objective of this study was to document migratory life histories of native galaxiids and introduced salmonids from a wide latitudinal range in Chilean Patagonia (39-48°S). Otolith microchemistry data were analysed using a recursive partitioning approach to test for diadromy. Based on annular analysis of Sr:Ca ratios, a diadromous life history was suggested for populations of native Aplochiton taeniatus, A. marinus, and Galaxias maculatus. Lifetime residency in freshwater was suggested for populations of A. zebra and G. platei. Among introduced salmonids, populations of Oncorhynchus tshawytscha and O. kisutch exhibited patterns consistent with anadromy, whereas the screened population of O. mykiss appeared restricted to freshwater. Salmo trutta exhibited variable patterns suggesting freshwater residency and possibly anadromy in one case. The capacity and geographic scope of hydropower development is increasing and may disrupt migratory routes of diadromous fishes. Identification of diadromous species is a critical first step for preventing their loss due to hydropower development.

Induction of pigment production through media composition, abiotic and biotic factors in two filamentous fungi.

In addition to plant-derived, fungal pigments have become an alternative in respect to synthetic ones. Besides Monascus sp., several pigment-producing fungi do not have culture conditions well-established yet. In this research, media composition, light wavelength and co-culture were evaluated, results were reported in Absorbance Units per gram of biomass (AU/Bgr). For Fusarium oxysporum a C:N ratio above 7 was advantageous, using both complex and defined media; blue LED light increased the AU/Bgr value from 18013 to 344; co-culture did not enhance pigment production. In Aspergillus chevalieri a high C:N ratio with glucose as carbon source was ideal. When exposing cultures to light, UV and red light gave the highest pigmentation; moreover, differential UV-VIS spectra in all wavelengths suggested production of additional pigments. Particularly a pigment observed when cultured in green light was also found in co-culture with yeast and there was an improvement of AU/Bgr value of 52549%. This is the first report regarding light effect and co-culture for these fungi, as well as C:N ratio for A. chevalieri.

Construcción de Perfiles de Usuario para el Modelo Integral de Salud Familiar y Comunitario en la Comuna de Alto Hospicio, Región de Tarapacá

Introducción: El estudio presenta perfiles integrales para usuarios de los Centros de Salud primaria de la comuna de Alto Hospicio. Objetivo: Conocer los perfiles de usuarios inscritos en los Centros de Salud de la comuna de Alto Hospicio desde una perspectiva integral e incorporando indicadores de satisfacción y conocimiento acerca del Modelo de Atención Integral de Salud Familiar y Comunitaria (MAIS). Material y Método: Se elaboró un instrumento conformado por ocho dimensiones y 73 ítems, el cual se aplicó en cuatro centros de Atención de Salud Primaria de la comuna. Se realizó un muestreo aleatorio simple por cada Centro. En total se encuestaron a 1.124 personas, se obtuvo una representatividad de entre 95% y 93% de confianza, con niveles de significación que van de 5% a 7%. Resultados: La caracterización usuaria pone en relevancia la diversidad de perfiles atendidos en cada Centro de Salud y revela problemáticas generales como la escasa información recibida respecto del modelo de atención familiar, el desconocimiento de los servicios prestados por los Centros de Salud y la dificultad de enfrentar situaciones de salud mental en el contexto de la pandemia COVID-19. Conclusiones: Aquellos Centros de Salud que transmiten mayor información del MAIS presentan mejores indicadores respecto al conocimiento de los servicios de salud y de satisfacción usuaria. En el marco de la implementación del Modelo de Salud Familiar, es relevante conocer los perfiles de usuarios según las características de cada Centro de Salud, su población y territorio, y compartir buenas prácticas entre los Centros.

Background: The study presents comprehensive profiles of Primary Health Care Centers of the Alto Hospicio Commune users. Objective: To characterize users registered in the Health Centers of Alto Hospicio Commune from a comprehensive perspective, including satisfaction indicators and knowledge about the Comprehensive Family and Community Health Care Model (MAIS). Methods: A questionnaire of 8 dimensions and 73 items was designed and applied in 4 Primary Health Care Centers in the commune. Four simple random samplings were applied. In total, 1,124 users were surveyed. The confidence and significance levels were between 95%-93% and 5%-7%, respectively. Results: The user profile highlights the diversity in each Health Care Center and reveals general problems such as the lack of information regarding the family care model and services provided by the Health Care Centers and the difficulty of facing mental health situations in the context of the COVID-19 pandemic. Conclusions: Those Health Centers that provide more information about MAIS show better indicators regarding knowledge of health services and user satisfaction. The changes in public health policies and the implementation of the Comprehensive Family and Community Health Care Model require clarifying user profiles according to the characteristics of each health center, its population, and the territory, as well as sharing best practices between health centers.

Polyphyletic ancestry of expanding Patagonian Chinook salmon populations.

Chinook salmon native to North America are spreading through South America's Patagonia and have become the most widespread anadromous salmon invasion ever documented. To better understand the colonization history and role that genetic diversity might have played in the founding and radiation of these new populations, we characterized ancestry and genetic diversity across latitude (39-48°S). Samples from four distant basins in Chile were genotyped for 13 microsatellite loci, and allocated, through probabilistic mixture models, to 148 potential donor populations in North America representing 46 distinct genetic lineages. Patagonian Chinook salmon clearly had a diverse and heterogeneous ancestry. Lineages from the Lower Columbia River were introduced for salmon open-ocean ranching in the late 1970s and 1980s, and were prevalent south of 43°S. In the north, however, a diverse assembly of lineages was found, associated with net-pen aquaculture during the 1990s. Finally, we showed that possible lineage admixture in the introduced range can confound allocations inferred from mixture models, a caveat previously overlooked in studies of this kind. While we documented high genetic and lineage diversity in expanding Patagonian populations, the degree to which diversity drives adaptive potential remains unclear. Our new understanding of diversity across latitude will guide future research.

Abordaje quirúrgico para verticalización de tercer molar a través de minitornillo. ¿es necesaria la extracción? / Surgical approach for the verticalization of the third molar through a miniature screw. Is extraction necessary?

RESUMEN Anteriormente se reportaba en la literatura que terceros molares en mala posición como horizontales, mesio y disto angulados, era indicación clara para la extracción del diente. La verticalización de molares con minitornillo en la rama mandibular, corresponde a una técnica ortoquirúrgica en la cual a través de movimientos sobre el eje longitudinal de un diente, se logra un buen posicionamiento en la arcada y la preservación del diente, evitando la extracción. El propósito del trabajo es describir el abordaje quirúrgico y resultados, de la verticalización de un tercer molar inferior incluido en posición mesioangular, a través de la colocación de minitornillo utilizando la rama mandibular como anclaje de un paciente femenino de 35 años de edad.

ABSTRACT Previously, it was reported in the literature that third molars in poor position, such as horizontal, mesial and disto angulated, were a clear indication for tooth extraction. The verticalization of molars with a miniscrew in the mandibular branch corresponds to an ortho-surgical technique in which, through movements on the longitudinal axis of a tooth, a good positioning in the arch and preservation of the tooth is achieved, avoiding extraction. The purpose of this work is to describe the surgical approach and results of the verticalization of an included lower third molar in the mesioangular position, through the placement of a miniature screw using the mandibular branch as anchorage in a 35-year-old female patient.

Genomic patterns of diversity and divergence of two introduced salmonid species in Patagonia, South America.

Invasive species have become widespread in aquatic environments throughout the world, yet there are few studies that have examined genomic variation of multiple introduced species in newly colonized environments. In this study, we contrast genomic variation in two salmonid species (anadromous Chinook Salmon, Oncorhynchus tshawytscha, 11,579 SNPs and resident Brook Charr Salvelinus fontinalis, 13,522 SNPs) with differing invasion success after introduction to new environments in South America relative to populations from their native range in North America. Estimates of genetic diversity were not significantly different between introduced and source populations for either species, indicative of propagule pressure that has been shown to maintain diversity in founding populations relative to their native range. Introduced populations also demonstrated higher connectivity and gene flow than those in their native range. Evidence for candidate loci under divergent selection was observed, but was limited to specific introduced populations and was not widely evident. Patterns of genomic variation were consistent with general dispersal potential of each species and therefore also the notion that life history variation may contribute to both invasion success and subsequent genetic structure of these two salmonids in Patagonia.

Biología del tejido óseo y cambios morfológicos en su regeneración / Biology of bone tissue and morphological changes in its regeneration

Introducción: La regeneración ósea permite la reintegración y conformación de tejidos posteriores a la extracción o corrección de un defecto óseo. Es considerada una técnica de estimulación para la formación de hueso nuevo, donde se favorece la construcción y la preservación del coágulo con el fin de evitar la infiltración en la zona de reparación, de componentes celulares (células epiteliales y conjuntivas). Objetivos: Describir los cambios a nivel morfológico durante el proceso de regeneración ósea y mencionar distintas técnicas de preservación ósea y los factores necesarios para su realización. Presentación de caso: Paciente femenina con periodontitis apical asintomática en órganos dentarios 34 y 37, que se sometió a preservación alveolar mediante la práctica de exodoncia atraumática y regeneración ósea con xenoinjerto, colocación de membrana colágeno e implante posextractivo inmediato. Principales comentarios: La colocación inmediata de implantes posexodoncia permite una buena preservación del alveolo, siempre y cuando las condiciones clínicas del paciente así lo permitan, por ejemplo, la ausencia de procesos infecciosos agudizados como en el presente caso. La regeneración ósea, en el defecto producido por el proceso inflamatorio periapical, implicó una correcta detoxificación de la zona a través del curetaje y la aplicación de antibióticos. La respuesta inmunológica exagerada ante injertos óseos no es frecuente; sin embargo, en este caso llevó a una pérdida parcial del sustituto óseo sin comprometer el pronóstico de los implantes(AU)

Introduction: Bone regeneration allows the reintegration and conformation of tissues after the extraction or correction of a bone defect. It is considered a stimulation technique for the formation of new bone, where the construction and preservation of the clot is favored in order to avoid infiltration in the repair area of cellular components (epithelial and conjunctiva cells). Objective: Describe the changes at the morphological level during the bone regeneration process and mention different bone preservation techniques and the necessary factors for their implementation. Case presentation: Female patient with asymptomatic apical periodontitis in dental organs 34 and 37, who underwent alveolar preservation through the practice of atraumatic exodontics and bone regeneration with xenograft, collagen membrane placement and immediate post-extraction implant. Main comments: The immediate placement of post-exodontic implants allows a good preservation of the alveolus, as long as the clinical conditions of the patient allow it, for example, the absence of exacerbated infectious processes as in the present case. Bone regeneration, in the defect produced by the periapical inflammatory process, involved a correct detoxification of the area through curettage and the application of antibiotics. Exaggerated immune response to bone grafts is not common; however, in this case it led to a partial loss of bone substitute without compromising the prognosis of the implants(AU)

Manifestaciones craneofaciales en pacientes con osteodistrofia renal / Craneofacial manifestaciones in patients with renal osteodystrophy

Introducción: La osteodistrofia renal es una osteopatía metabólica difusa, relacionada con la insuficiencia renal crónica, que incluye diversas patologías en el sistema musculoesquelético. Se produce en respuesta a trastornos metabólicos generados por cambios electrolíticos, la inflamación crónica y la alteración hormonal. Estas variaciones modifican el proceso de remodelación ósea. Las manifestaciones clínicas incluyen alteración en el parénquima y estroma óseo, y van desde lesiones expansivas, produciendo deformidad, hasta fracturas patológicas del hueso. Objetivo: Relacionar las manifestaciones clínicas, imagenológicas e histológicas en el componente óseo cráneo facial para el diagnóstico de la osteodistrofia renal. Presentación de caso: Se presentan dos casos clínicos de pacientes con enfermedad renal crónica e hiperparatiroidismo secundario de base, con múltiples masas en maxilares que causan asimetría facial y alteración funcional. Las imágenes tomográficas revelan alteración en la morfología ósea cortical y trabecular. Ambos individuos evidenciaron alteraciones en niveles de hormona paratiroidea, fosfatasa alcalina, fósforo y calcio sérico. La histopatología comprobó tejido fibroóseo con hueso neoformado y gran vascularización, con células multinucleadas tipo osteoclastos sin presencia de hemosiderina. Pacientes manejados de forma interdisciplinaria entre medicina interna, endocrinología y cirugía maxilofacial. Conclusiones: Los pacientes con enfermedad renal crónica avanzada presentan alteración de la estructura y del metabolismo óseo y mineral. Tal situación puede comprometer el complejo óseo craneofacial. Los casos graves de osteodistrofia renal se caracterizan por una marcada expansión de los maxilares, que genera asimetría y rasgos de leontiasis. Las imágenes tomográficas asociadas a osteodistrofia renal presentan óseos trabeculares con expansión de cortical, que evidencia el recambio óseo inmaduro presente. La histopatología no es específica y puede ser similar a los casos de displasia ósea craneofacial. Ante lo anteriormente planteado es fundamental relacionar estos hallazgos con la clínica para definir un diagnóstico adecuado(AU)

(AU)Introduction: Renal osteodystrophy is a diffuse metabolic osteopathy, related to chronic renal failure, which includes various pathologies in the musculoskeletal system. It occurs in response to metabolic disorders generated by electrolyte changes, chronic inflammation and hormonal alteration. These variations modify the process of bone remodeling. Clinical manifestations include alteration in the parenchyma and bone stroma, and range from expansive lesions, producing deformity, to pathological fractures of the bone. Objective: Relate the clinical, imaging and histological manifestations in the skull-facial bone component for the diagnosis of renal osteodystrophy. Case Presentation: Two clinical cases of patients with chronic kidney disease and secondary underlying hyperparathyroidism are presented, with multiple masses in the jaws that cause facial asymmetry and functional alteration. Tomographic images reveal alteration in cortical and trabecular bone morphology. Both individuals showed alterations in levels of parathyroid hormone, alkaline phosphatase, phosphorus and serum calcium. Histopathology verified fibro-bone tissue with neoformed bone and great vascularization, with multinucleated osteoclast-like cells without the presence of hemosiderin. Patients were attended in an interdisciplinary way between internal medicine, endocrinology and maxillofacial surgery. Conclusions: Patients with advanced chronic kidney disease present alteration of the structure and bone and mineral metabolism. Such a situation can compromise the craniofacial bone complex. Severe cases of renal osteodystrophy are characterized by a marked expansion of the jaws, which generates asymmetry and traits of leonthiasis. The tomographic images associated with renal osteodystrophy present trabecular bones with cortical expansion, which evidences the immature bone turnover present. Histopathology is not specific and may be similar to cases of craniofacial bone dysplasia. Given the above, it is essential to relate these findings to the clinic to define an adequate diagnosis(AU)

Covid-19 y cirugía ortopédica: revisión de la literatura y evidencias / Covid-19 and orthopedic surgery: review of the literature and evidence

Se ha declarado una pandemia ante la propagación de un nuevo virus con alta contagiosidad, llamado síndrome respiratorio agudo severo coronavirus 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV2). El mundo ha quedado detenido ante la rápida expansión del virus, con una letalidad que en algunos países llega a 15%. En Chile, el gobierno ha tomado medidas rápidas y agresivas que han permitido mantener la curva de contagios a un nivel que permita atender de manera adecuada a la población. Dentro de estas medidas, se contempla la suspensión de cirugías y consultas ambulatorias. Como cirujanos ortopédicos, nos hemos visto afectados por estas medidas, y existe confusión respecto a cuál es la conducta más adecuada. Quisimos hacer esta guía para resumir parte de las evidencias disponibles y orientar a los cirujanos ortopédicos respecto a esta patología. El comportamiento de esta guía es dinámico, dadas las múltiples opiniones, experiencias y evidencias, que surgen diariamente, por lo que recomendamos mantenerlo como referencia, no como certeza.

A pandemic has been declared due to a new highly contagious virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The world has come to a halt due to the rapid expansion of a virus whose lethality has reached 15% in some countries. In Chile, the government has taken decisive, aggressive measures in an attempt to control disease spread and provide healthcare to those who need it. These decisions include the suspension of elective surgeries and other ambulatory procedures. As Orthopedic surgeons we have been affected by these measures and there is doubt regarding the best course of action. We prepared this guide to summarize available evidence and orient our colleagues regarding this pathology. This guide is meant to be dynamic, as new opinions, evidence and experiences arise every day. Therefore, we advise the reader to keep it as a reference, not an undisputable truth.

Exclusión renal por endometriosis profunda ureteral: a propósito de un caso / Renal exclusion due to deep infiltrating ureteral endometriosis: a case report

INTRODUCCIÓN: La endometriosis ureteral es una afección rara que afecta al 0.01-1,7% de las mujeres con endometriosis. Hasta un 30% cursa de forma asintomática y un 11,5-14,7% pueden evolucionar con falla renal. La falta de diagnóstico de la enfermedad puede terminar en una uropatía obstructiva y falla renal irreversible. Se presenta el caso de una paciente con afectación grave de la función renal secundaria a endometriosis profunda con compromiso ureteral. CASO CLÍNICO: Mujer de 35 años con endometriosis que consultó por exacerbación de los síntomas. En su estudio destaca, en la resonancia magnética, el hallazgo de endometriosis pélvica profunda y compromiso endometriósico intrínseco del uréter distal derecho, provocando una acentuada hidroureteronefrosis. El cintigrama renal demuestra acentuado compromiso de la función renal derecha, con una función relativa del 7%. Se realizaron nefrectomía total derecha y resección de enfermedad pélvica profunda laparoscópica, sin incidentes. CONCLUSIONES: La endometriosis ureteral representa un desafío diagnóstico y terapéutico. El manejo multidisciplinario entre radiólogos, ginecólogos y urólogos, mediante el diseño de una estrategia quirúrgica individualizada, es imprescindible para definir el tratamiento óptimo de estas pacientes.

INTRODUCTION: Ureteral endometriosis is a rare entity that affects 0.01-1,7% of women with endometriosis. Up to 30% of the patients are asymptomatic and 11.5-14.7% will develop renal failure. Misdiagnosis can lead to obstructive uropathy and permanent renal failure. We present the case of a patient with severe compromise of renal function secondary to deep infiltrating endometriosis with ureteral involvement. CASE REPORT: A 35-year-old woman with endometriosis presented with exacerbation of symptoms. Magnetic resonance showed deep pelvic endometriosis and intrinsic endometriotic involvement of the right distal ureter, causing a marked hydroureteronephrosis. Renal scintigram showed a severe compromise of the right renal function, with a relative function of 7%. Through laparoscopy a total right nephrectomy and resection of deep infiltrating endometriosis was performed. The patient had a satisfactory recovery in the postoperative period. CONCLUSIONS: Ureteral endometriosis presents a diagnostic and therapeutical challenge. Joint multidisciplinary management between radiologists, gynecologists and urologists through the design of an individualized surgical strategy is essential to define the optimal treatment for these patients.