Progressive multifocal leukoencephalopathy, advanced ductal breast carcinoma, systemic sclerosis, and checkpoint inhibitors: a therapeutic dilemma.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating central nervous system disease infection by JC virus (JCV) in patients with a significant decline in cellular immunity. No specific treatment has demonstrated efficacy, and the disease progresses to death in most patients. Recent findings have shown stabilization or improvement of PML lesions after treatment with checkpoint inhibitors (CPI) based on immune reconstitution. Nevertheless, immunotherapy may specifically cause autoimmune diseases or may deteriorate pre-existing ones. We report a case of a patient under treatment for advanced ductal breast carcinoma and systemic sclerosis, who developed PML. The therapeutic approach included withdrawal of drugs with possible immunosuppressive effect and treatment with pembrolizumab. In the absence of reliable markers to predict CPIs response and a concern for an autoimmune worsening, immunotherapy was administered late in the course of the disease. Finally, she did not experience an autoimmune disease flare-up; however, pembrolizumab could not prevent disease progression. We believe that potential autoimmune complications should not delay treatment initiation with CPIs in PML.

Polygenic Profile and Exercise-Induced Muscle Damage by a Competitive Half-Ironman.

Del Coso, J, Salinero, JJ, Lara, B, Gallo-Salazar, C, Areces, F, Herrero, D, and Puente, C. Polygenic profile and exercise-induced muscle damage by a competitive half-ironman. J Strength Cond Res 34(5): 1400-1408, 2020-To date, it is still unknown why some individuals develop higher levels of muscle damage than other individuals, despite participating in exercise with comparable levels of physical intensity. The aim of this investigation was to analyze 7 single-nucleotide polymorphisms (SNPs) that are candidates to explain individual variations in the level of muscle damage attained during a half-ironman competition. Using the model of Williams and Folland (2, 1, and 0 points for optimal, intermediate, and suboptimal genotype), we determined the total genotype score from the accumulated combination of 7 SNPs (ACE = 287bp Ins/Del; ACTN3 = p.R577X; creatine kinase, muscle type = NcoI; insulin-like growth factor 2 = C13790G; interleukin-6 = 174G>C; myosin light chain kinase = C37885A; and tumor necrosis factor-α = 308G>A) in 22 experienced triathletes. Before and after the race, a sample of venous blood was obtained to measure serum markers of muscle damage. Two groups of triathletes were established according to their postcompetition serum CK concentration: low CK responders (n = 10; 377 ± 86 U·L) vs. high CK responders (n = 12; 709 ± 136 U·L). At the end of the race, low CK responders had lower serum myoglobin concentrations (384 ± 243 vs. 597 ± 293 ng·ml, p = 0.04). Although the groups were similar in age, anthropometric characteristics, and training habits, total genotype score was higher in low CK responders than in high CK responders (7.7 ± 1.1 vs. 5.5 ± 1.1 point, p < 0.01). A favorable polygenic profile can contribute to reducing the level of muscle damage developed during endurance exercise.

LAUDES Study: impact of digital ulcers on hand functional limitation, work productivity and daily activities, in systemic sclerosis patients.

The objective of this study was to evaluate the impact of digital ulcers (DUs) in daily life of systemic sclerosis (SSc) Spanish patients. We developed a multicenter observational study to compare functional disability in SSc patients with active DUs vs. those without DUs. An additional correlation between perception of patients and physicians on disability due to DUs was performed. A total of 199 patients were enrolled, 70 (35%) with DUs. Patients with DUs were younger (48 vs. 58 years; p < 0.001) and had more frequently the diffuse subtype of SSc (45 vs. 24%; p = 0.004) than patients without DUs. Patients with DUs showed significantly higher scores in the Cochin Hand Function Scale overall (p < 0.002) and for each of its five dimensions. They also showed higher scores in the Systemic Sclerosis Health Assessment Questionnaire items related to hand function such as, dress and self-care (p < 0.013), eat (p < 0.013) and grip (p < 0.03), and higher Visual Analogic Scale scores for pain (p < 0.013), trouble related with Raynaud's Phenomenon (p < 0.001) and sense of severity (p < 0.004). Impact on daily activities was significantly higher in patients with DUs (p = 0.002), with a non-significant trend to experience higher impact on work productivity (p = 0.07). A high correlation was found between DUs patients and physicians opinion on the impact of DUs (daily life: Pearson R = 0.86; work productivity: Pearson R = 0.87). Study findings show an impaired hand function and increased disability for daily life activities and work productivity in SSc patients with DUs compared with patients without DUs in Spanish population.

Tyrphostin AG17 inhibits adipocyte differentiation in vivo and in vitro.

BACKGROUND: Excessive subcutaneous adiposity in obesity is associated to positive white adipocyte tissue (WAT) differentiation (adipogenesis) and WAT expandability. Here, we hypothesized that supplementation with the insulin inhibitor and mitochondrial uncoupler, Tyrphostin (T-AG17), in vitro and in vivo inhibits adipogenesis and adipocyte hypertrophy. METHODS: We used a 3T3-L1 proadipocyte cell line to identify the potential effect of T-AG17 on adipocyte differentiation and fat accumulation in vitro. We evaluated the safety of T-AG17 and its effects on physiological and molecular metabolic parameters including hormonal profile, glucose levels, adipogenesis and adipocyte hypertrophy in a diet-induced obesity model using C57BL/6 mice. RESULTS: We found that T-AG17 is effective in preventing adipogenesis and lipid synthesis in the 3T3-L1 cell line, as evidenced by a significant decrease in oil red staining (p < 0.05). In obese C57BL/6 mice, oral administration of T-AG17 (0.175 mg/kg for 2 weeks) lead to decreased fat accumulation and WAT hypertrophy. Further, T-AG17 induced adipocyte apoptosis by activating caspase-3. In the hepatocytes of obese mice, T-AG17 promoted an increase in the size of lipid inclusions, which was accompanied by glycogen accumulation. T-AG17 did not alter serum biochemistry, including glucose, insulin, leptin, free fatty acids, creatinine, and aspartate aminotransferase. CONCLUSION: T-AG17 promotes adipocyte apoptosis in vivo and is an effective modulator of adipocyte differentiation and WAT hypertrophy in vitro and in vivo. Therefore, T-AG17 may be useful as a pharmacological obesity treatment.

ACTN3 X-allele carriers had greater levels of muscle damage during a half-ironman.

PURPOSE: Alpha-actinin-3, encoded by the ACTN3 gene, is an actin-binding protein with an important role in myofibril contraction and muscle force output. In humans, there is a relatively common deficiency of the α-actinin-3 due to homozygosity in a polymorphism of the ACTN3 gene (R577X, rs1815739), that has been related to decreased resistance to strain during voluntary muscle contractions. The purpose of this study was to investigate the influence of the ACTN3 genotype on the level of exercise-induced muscle damage attained by 23 experienced triathletes during an official half-ironman competition. METHODS: Before and after the race, a sample of venous blood was obtained and jump height was measured during a countermovement jump. The changes in serum creatine kinase (CK-MM isoform) were measured in the blood samples and muscle pain was measured with a visual analogue scale (0-10 cm). Data from RX heterozygotes and XX mutant homozygotes were grouped as X-allele carriers (n = 13) and compared to RR homozygotes (n = 10). RESULTS: Race time was very similar between groups (313 ± 31 vs. 313 ± 25 min; P = 0.45); however, pre-to-post-competition reduction in jump height was greater in X-allele carriers than RR homozygotes (-18.4 ± 11.4 vs. -8.2 ± 6.9%; P = 0.04). At the end of the race, X-allele carriers presented higher serum CK-MM concentrations (682 ± 144 vs. 472 ± 269 U/L; P = 0.03), and there was also a tendency for higher self-reported values of lower limb muscle pain (7.7 ± 1.1 vs. 6.3 ± 2.3 cm; P = 0.06). CONCLUSIONS: X-allele triathletes in the ACTN3 R577X polymorphism presented greater signs of exercise-induced muscle damage during a half-ironman race than RR homozygotes.

ACTN3 genotype influences exercise-induced muscle damage during a marathon competition.

PURPOSE: Exercise-induced muscle damage has been identified as one of the main causes of the progressive decrease in running and muscular performance in marathoners. The aim of this investigation was to determine the influence of the ACTN3 genotype on exercise-induced muscle damage produced during a marathon. METHODS: Seventy-one experienced runners competed in a marathon race. Before and after the race, a sample of venous blood was obtained and maximal voluntary leg muscle power was measured during a countermovement jump. In the blood samples, the ACTN3 genotype (R577X) and the changes in serum creatine kinase and myoglobin concentrations were measured. Data from RX heterozygotes and XX mutant homozygotes were grouped as X allele carriers and compared to RR homozygotes. RESULTS: At the end of the race, X allele carriers presented higher serum myoglobin (774 ± 852 vs 487 ± 367 U L-1; P = 0.02) and creatine kinase concentrations (508 ± 346 vs 359 ± 170 ng mL-1; P = 0.04) than RR homozygotes. Pre-to-post-race maximal voluntary leg muscle power reduction was more pronounced in X allele carriers than RR homozygotes (-34.4 ± 16.1 vs -27.3 ± 15.4%; P = 0.05). X allele carriers self-reported higher levels of lower limb muscle pain (7 ± 2 vs 6 ± 2 cm; P = 0.02) than RR homozygotes at the end of the race. CONCLUSIONS: In comparison to RR homozygotes, X allele carriers for the R577X polymorphism of the ACTN3 gene presented higher values for typical markers of exercise-induced muscle damage during a competitive marathon. Thus, the absence of a functional α-actinin-3 produced by the X allele might induce higher levels of muscle breakdown during prolonged running events.

Physical and Physiological Demands of Experienced Male Basketball Players During a Competitive Game.

Puente, C, Abián-Vicén, J, Areces, F, López, R, and Del Coso, J. Physical and physiological demands of experienced male basketball players during a competitive game. J Strength Cond Res 31(4): 956-962, 2017-The aim of this investigation was to analyze the physical and physiological demands of experienced basketball players during a real and competitive game. Twenty-five well-trained basketball players (8 guards, 8 forwards, and 9 centers) played a competitive game on an outdoor court. Instantaneous running speeds, the number of body impacts above 5 g, and the number of accelerations and decelerations were assessed by means of a 15-Hz global Positioning System accelerometer unit. Individual heart rate was also recorded using heart rate monitors. As a group mean, the basketball players covered 82.6 ± 7.8 m·min during the game with a mean heart rate of 89.8 ± 4.4% of maximal heart rate. Players covered 3 ± 3% of the total distance running at above 18 km·h and performed 0.17 ± 0.13 sprints per minute. The number of body impacts was 8.2 ± 1.8 per minute of play. The running pace of forwards was higher than that of centers (86.8 ± 6.2 vs. 76.6 ± 6.0 m·min; p ≤ 0.05). The maximal speed obtained during the game was significantly higher for guards than that for centers (24.0 ± 1.6 km·h vs. 21.3 ± 1.6 km·h; p ≤ 0.05). Centers performed a lower number of accelerations/decelerations than guards and forwards (p ≤ 0.05). In conclusion, the extraordinary rates of specific movements performed by these experienced basketball players indicate the high physiological demands necessary to be able to compete in this sport. The centers were the basketball players who showed lower physiological demands during a game, whereas there were no differences between guards and forwards. These results can be used by coaches to adapt basketball training programs to the specific demands of each playing position.

A caffeinated energy drink improves jump performance in adolescent basketball players.

This study aimed at investigating the effects of a commercially available energy drink on shooting precision, jump performance and endurance capacity in young basketball players. Sixteen young basketball players (first division of a junior national league; 14.9 ± 0.8 years; 73.4 ± 12.4 kg; 182.3 ± 6.5 cm) volunteered to participate in the research. They ingested either (a) an energy drink that contained 3 mg of caffeine per kg of body weight or (b) a placebo energy drink with the same appearance and taste. After 60 min for caffeine absorption, they performed free throw shooting and three-point shooting tests. After that, participants performed a maximal countermovement jump (CMJ), a repeated maximal jumps test for 15 s (RJ-15), and the Yo-Yo intermittent recovery test level 1 (Yo-Yo IR1). Urine samples were obtained before and 30 min after testing. In comparison to the placebo, the ingestion of the caffeinated energy drink did not affect precision during the free throws (Caffeine = 70.7 ± 11.8 % vs placebo = 70.3 ± 11.0 %; P = 0.45), the three-point shooting test (39.9 ± 11.8 vs 38.1 ± 12.8 %; P = 0.33) or the distance covered in the Yo-Yo IR1 (2,000 ± 706 vs 1,925 ± 702 m; P = 0.19). However, the energy drink significantly increased jump height during the CMJ (38.3 ± 4.4 vs 37.5 ± 4.4 cm; P < 0.05) mean jump height during the RJ-15 (30.2 ± 3.6 vs 28.8 ± 3.4 cm; P < 0.05) and the excretion of urinary caffeine (1.2 ± 0.7 vs 0.1 ± 0.1 µg/mL; P < 0.05). The intake of a caffeine-containing energy drink (3 mg/kg body weight) increased jump performance although it did not affect basketball shooting precision.

Mechanized instrumentation of root canals oscillating systems.

Cleaning and shaping are important steps in the root canal treatment. Despite the technological advances in endodontics, K and Hedstroen files are still widely used. In an attempt to be more effective in preparing the root canals, faster and more cutting efficient kinematic, alloys and design alternatives utilizing mechanically oscillating or rotary files are proposed. Even with all these technological innovating alternatives, the preparation of root canals remains a challenge.

Morphology Effect of Photoconverted Silver Nanoparticles on the Performance of Surface-Enhanced Raman Spectroscopy Substrates.

Nowadays, surface-enhanced Raman spectroscopy (SERS) substrates are of great interest for many researchers, aiming to fabricate substrates with high sensitivity and low fabrication costs. In this study, we photoconverted Ag nanoparticles by using a simple and affordable red-green-blue light-emitting diode photoreactor. The obtained dispersions were transformed into a paste of nanoparticles and used to fabricate SERS substrates by a simple drop-casting process under controlled humidity conditions. The performance of these substrates was tested using p-aminothiophenol as a Raman probe. The results indicate that the particle shape has an influence on the Raman intensities and substrate sensitivity, showing a significant enhancement as the number of faces and vertices in the particle increases.

Clinical Study of Antimicrobial Efficacy of Laser Ablation Therapy with Indocyanine Green in Root Canal Treatment.

INTRODUCTION: Laser ablation (LA) therapy is used as an adjunct to endodontic treatment to improve microbial reduction. However, studies evaluating the impact of LA with indocyanine green (ICG) are scarce. This study aimed to evaluate the antimicrobial efficacy of LA therapy with ICG in root canal treatment. METHODS: Sixty patients with periapical lesions in teeth with a single canal and absence of pain, edema, and previous treatment were selected. Patients were randomly allocated into 3 groups according to the apical sizes used (n = 20); 25/04, 30/04, and 35/04 were the final sizes used. In half the patients of each group, 2.5% sodium hypochlorite was used as an irrigating solution, and in the other half, saline solution was used. After instrumentation, all patients received LA therapy with ICG. Root canal sampling was performed before (S1) and after (S2) root canal instrumentation and immediately after LA therapy with ICG (S3). Colony-forming units were counted, and statistical tests were applied (P < .05). RESULTS: There was a significant reduction in colony-forming units from S1 to S2 in all treatment protocols (P < .05); 2.5% sodium hypochlorite as an irrigating solution showed a greater microbial reduction compared with saline solution (P < .05). LA therapy with ICG further reduced the microbial counts significantly (S2 to S3 and S1 to S3) whether sodium hypochlorite or saline was used (P < .05). CONCLUSIONS: LA therapy with ICG significantly increased microbial reduction in root canals regardless of instrumentation sizes or the irrigation solution used.

Evaluating remission and low disease activity from the perspective of the patient with axial spondyloarthritis: The cross-sectional ConREspAx study.

OBJECTIVES: To evaluate the properties of a single question to determine patient perception of remission and disease activity; to compare this with existing definitions for remission and low disease activity (LDA). METHODS: Single-center, cross-sectional study in a tertiary care hospital. Patients with axSpA (fulfilling ASAS criteria) were consecutively included. Both the patient's perception of remission and LDA and that of the physician were evaluated with a single question. Agreement between the patients' perception and other current definitions was tested using the prevalence-adjusted and bias-adjusted kappa (PABAK). The sensitivity (S) and specificity (Sp) of current definitions of disease states were tested against the patient's perception as the gold standard. RESULTS: The study population included 105 axSpA patients (63.8% males; 67.6% with radiographic sacroiliitis). Patients considered themselves to be in remission in 21% of cases and in LDA in 51.4%; physicians considered patients to be in remission in 45.7% of cases and in LDA in 35.2%. The poorest agreement was recorded for the patient's and the physician's perception of remission. The best agreement for patients' perception of remission was for a BASDAI < 2 and normal C-reactive protein values. This definition was also the most sensitive (S=72.7%) and specific (Sp=83.1%) when the patient's perception was taken as the gold standard. CONCLUSION: In a real-life setting, the evaluation of remission by the patient through a single question was the hardest criterion to achieve, although it did prove to be a feasible, valid, and specific way to assess remission.

Thiacloprid Detection by Silver Nanocubes-Based SERS Sensor.

The use of neonicotinoid insecticides leads to environmental problems such as accumulation and death of different insects and even bird species. In this work, we compared the SERS performance of Ag nanocubes- and nanospheres-based substrates for the analysis of thiacloprid, a neonicotinoid, reaching its detection at 1 mM using nanocubes as the active material.

Stratification in systemic sclerosis according to autoantibody status versus skin involvement: a study of the prospective EUSTAR cohort.

BACKGROUND: The current subclassification of systemic sclerosis into cutaneous subtypes does not fully capture the heterogeneity of the disease. We aimed to compare the performances of stratification into LeRoy's cutaneous subtypes versus stratification by autoantibody status in systemic sclerosis. METHODS: For this cohort study, we assessed people with systemic sclerosis in the multicentre international European Scleroderma Trials and Research (EUSTAR) database. Individuals positive for systemic-sclerosis autoantibodies of two specificities were excluded, and remaining individuals were classified by cutaneous subtype, according to their systemic sclerosis-specific autoantibodies, or both. We assessed the performance of each model to predict overall survival, progression-free survival, disease progression, and different organ involvement. The three models were compared by use of the area under the curve (AUC) of the receiver operating characteristic and the net reclassification improvement (NRI). Missing data were imputed. FINDINGS: We assessed the database on July 26, 2019. Of 16 939 patients assessed for eligibility, 10 711 patients were included: 1647 (15·4%) of 10 709 were male, 9062 (84·6%) were female, mean age was 54·4 (SD 13·8) years, and mean disease duration was 7·9 (SD 8·2) years. Information regarding cutaneous subtype was available for 10 176 participants and antibody data were available for 9643 participants. In the prognostic analysis, there was no difference in AUC for overall survival (0·82, 95% CI 0·81-0·84 for cutaneous only vs 0·84, 0·82-0·85 for antibody only vs 0·84, 0·83-0·86 for combined) or for progression-free survival (0·70, 0·69-0·71 vs 0·71, 0·70-0·72 vs 0·71, 0·70-0·72). However, at 4 years the NRI showed substantial improvement for the antibody-only model compared with the cutaneous-only model in prediction of overall survival (0·57, 0·46-0·71 for antibody only vs 0·29, 0·19-0·39 for cutaneous only) and disease progression (0·36, 0·29-0·46 vs 0·21, 0·14-0·28). The antibody-only model did better than the cutaneous-only model in predicting renal crisis (AUC 0·72, 0·70-0·74 for antibody only vs 0·66, 0·64-0·69 for cutaneous only) and lung fibrosis leading to restrictive lung function (AUC 0·76, 0·75-0·77 vs 0·71, 0·70-0·72). The combined model improved the prediction of digital ulcers and elevated systolic pulmonary artery pressure, but did poorly for cardiac involvement. INTERPRETATION: The autoantibody-only model outperforms cutaneous-only subsetting for risk stratifying people with systemic sclerosis in the EUSTAR cohort. Physicians should be aware of these findings at the time of decision making for patient management. FUNDING: World Scleroderma Foundation.

Risk of Severe COVID-19 Infection in Patients With Inflammatory Rheumatic Diseases.

OBJECTIVE: To describe the cohort of patients with inflammatory rheumatic diseases (IRD) hospitalized due to SARS-CoV-2 infection in the Ramón y Cajal Hospital, and to determine the increased risk of severe coronavirus disease 2019 (COVID-19) in patients with no IRD. METHODS: This is a retrospective single-center observational study of patients with IRD actively monitored in the Department of Rheumatology who were hospitalized due to COVID-19. RESULTS: Forty-one (1.8%) out of 2315 patients admitted due to severe SARS-CoV-2 pneumonia suffered from an IRD. The admission OR for patients with IRD was 1.91 against the general population, and it was considerably higher in patients with Sjögren syndrome, vasculitis, and systemic lupus erythematosus. Twenty-seven patients were receiving treatment for IRD with corticosteroids, 23 with conventional DMARDs, 12 with biologics (7 rituximab [RTX], 4 anti-tumor necrosis factor [anti-TNF], and 1 abatacept), and 1 with Janus kinase inhibitors. Ten deaths were registered among patients with IRD. A higher hospitalization rate and a higher number of deaths were observed in patients treated with RTX (OR 12.9) but not in patients treated with anti-TNF (OR 0.9). CONCLUSION: Patients with IRD, especially autoimmune diseases and patients treated with RTX, may be at higher risk of severe pneumonia due to SARS-CoV-2 compared to the general population. More studies are needed to analyze this association further in order to help manage these patients during the pandemic.

Synthesis of silver nanoparticles using a Mentha spicata extract and evaluation of its anticancer and cytotoxic activity.

In this study, silver nanoparticles (NP) were synthesized by two methods: using an aqueous extract of Mentha spicata leaves and using citrate ions as stabilizing agent, and the cytotoxicity and anticancer activity of both NP were evaluated in vitro. The particles synthesized with the aqueous extract were spherical with a size ranging from 15 to 45 nm. These NP decreased cell viability in all of the cells studied; however, the IC50 could only be estimated in the Chang liver cells (IC50 = 21.37 µg/mL). These particles also decreased the generation of reactive oxygen species in Chang and SiHa cells. Additionally, the dispersions decreased the activity of caspase-3. There was no significant difference between the biological activities of the NP obtained with the aqueous extract and the NP synthesized using citrate ions. This study showed that an aqueous extract of M. spicata is an excellent alternative for the synthesis of silver NP. These NP showed cytotoxicity and anticancer activity in vitro. Although more experiments are required, the cell death occurs probably through a mechanism different from apoptosis.

The CYP1A2 -163C>A polymorphism does not alter the effects of caffeine on basketball performance.

PURPOSE: The aim of this investigation was to analyze the influence of the genetic variations of the -163C>A polymorphism of the CYP1A2 gene on the ergogenic effects of caffeine in elite basketball players. METHODS: Nineteen elite basketball players (10 men and 9 women) ingested 3 mg⋅kg-1 of caffeine or a placebo 60 min before performing 10 repetitions of the following series: the Abalakov jump test followed by the Change-of-Direction and Acceleration Test (CODAT). The players then competed in a 20-min simulated basketball game. Self-perceived performance and side effects were recorded by questionnaires after the trials. The effects of caffeine on basketball performance were established according to players' CYP1A2 genotype (rs762551): AA homozygotes (n = 10) and C-allele carriers (n = 9). RESULTS: In the 10 repetitions, caffeine increased Abalakov jump height by a mean of 2.9±3.6% in AA homozygotes (p = 0.03) while this effect did not reach statistical significance for C-allele carriers (2.3 ± 6.8%; p = 0.33). Caffeine did not affect sprint time in the CODAT test in either genotype group but it increased the number of impacts performed during the simulated game in both AA homozygotes (4.1 ± 5.3%; p = 0.02) and C-allele carriers (3.3 ± 3.2%; p = 0.01). During the 24 h following the test, AA homozygotes tended to experience increased insomnia with caffeine while C-allele carriers did not present this effect. The remaining variables were unaffected by the genotype. CONCLUSION: The CYP1A2 -163C>A polymorphism minimally altered the ergogenicity derived from the consumption of a moderate dose of caffeine in elite basketball players.

Abordaje posterior en fracturas de meseta tibial complejas en pacientes tratados quirúrgicamente en el IAHULA / Posterior approach in complex tibial plateau fractures IAHUL A Surgically treated patients

Las fracturas de meseta tibial compleja se asocian a traumatismo de alta energía, principalmente en accidentes de motocicleta, siendo un desafío para el cirujano ortopedista. En la década de 1970, Schatzker propuso una clasificación radiológica para las fracturas de la meseta tibial, que destacaba la morfología de los seis tipos principales. Las imágenes de tomografía computarizada y tridimensional, han cambiado la comprensión y el tratamiento de las fracturas de la meseta tibial. Recientemente, esa clasificación original se complementó con una más amplia; puesto que, se introdujo el fragmento en cuña dividida y la continuidad de la columna posterior como determinantes de la estabilidad articular y el papel fundamental que desempeña en el tratamiento de las fracturas de la meseta tibial, con ellos también la importancia de abordajes quirúrgicos que permitan la visualización posterior para una adecuada reducción. El estudio documenta las técnicas de fijación interna y abordajes posteriores realizadas en el IAHULA, valorando los resultados clínicos en cuanto a dolor y satisfacción del paciente, como consolidación, pseudoartrosis o falla en la técnica de osteosíntesis realizada. El resultado a partir de las escalas de evaluación de la AO y KOOS, arrojaron que, con un efecto excelentes se agrupa un 28,6% y bueno a un 42,9%, indicando la importancia de la fijación de la columna posterior, para prevenir artrosis postraumática temprana e inestabilidad articular(AU)

A complex fracture of the posterior tibial plateau are related to high energy traumatisms, mainly during motorcycle accidents, becoming a challenge to the ortopedic surgen. During the seventies, Stchatzker proposed a radiologic classification for the tibial plateau fractures that pointed the morphology of six main types. The computarized and tridimensional tomographic images have changed the comprehension and treatment of these fractures. Recently, the original classification was complemented with a more broaded approach due to the introduction of the fragment in divided crib and the continuity of the posterior column as factors determining the articular stability and the fundamental roll played in the treatment of fractures of the tibial plateau, as well as the important roll of surgical approaches that allow the posterior visualization for a correct reduction. This research documents the technics of internal fixation and posterior approach developed in the IAHULA, evaluating the clinic results about patients' pain level and comfort, as well as the radiologic findings of consolidation, pseudoarthrosis, or fail in the technic of osteosynthesis developed. The results from a point of view of the evaluation scales of the AO and KOOS, show 28.6% with excellent outcomes, and 42.9% with good outcomes, indicating the importance of the fixation of the posterior column to prevent early start of posttraumatic arthrosis and articular instability(AU)

Paludismo en Quito-Ecuador: Hospital San Juan de Dios (1916-1925), erradicación (1940-1950) y posible retorno (2021) / Malaria in Quito-Ecuador: San Juan de Dios Hospital (1916-1925), eradication (1940-1950) and possible return (2021)

Objetivo principal: caracterizar el paludismo en el Hospital San Juan de Dios (HSJD) y su Dispensario Infantil (DI) en Quito entre 1916-1925, en el contexto histórico de la erradicación de la malaria y las posibilidades de su retorno a Quito. Metodología: estudio historiográfico médico, descriptivo y retrospectivo, de los registros clínicos del HSJD y del DI (1916-1925) del Museo Nacional de Medicina Eduardo Estrella e información del Ministerio de Salud Pública del Ecuador (MSP). Resultados principales: en 10.025 pacientes atendidos, 209 tuvieron paludismo, mayoritariamente procedentes de valles con más de 2.000 metros de altitud, cercanos a Quito. Conclusión principal: la morbilidad del paludismo en Quito y sus valles dependió directamente de las condiciones socio-económico-sanitarias de la población y climáticas del entorno. La situación actual recrea factores similares, con reportes sugerentes de un posible retorno de la malaria autóctona a Quito (AU)

Main objective: To characterize malaria in the San Juan de Dios Hospital (HSJD) and its Children's Dispensary (DI) in Quito between 1916-1925, in the historical context of the eradication of malaria and the possibilities of its return to Quito. Methodology: A descriptive and retrospective medical historiographic study of the clinical records of the HSJD and DI (1916-1925) of the Eduardo Estrella National Museum of Medicine and information from the Ministry of Public Health of Ecuador (MSP). Main results: In 10,025 patients seen, 209 had malaria, mostly from valleys near Quito with more than 2,000 meters of altitude. Main conclusion: The morbidity of malaria in Quito and its valleys depended directly on the socio-economic-sanitary conditions of the population and the climatic conditions of the environment. The current situation recreates similar factors, with reports suggesting a possible return of autochthonous malaria to Quito (AU)