Unhealthy Levels of Phthalates and Bisphenol A in Mexican Pregnant Women with Gestational Diabetes and Its Association to Altered Expression of miRNAs Involved with Metabolic Disease.

Several studies indicate that bisphenol A (BPA) and phthalates may have a role in the development of metabolic diseases using different molecular pathways, including epigenetic regulatory mechanisms. However, it is unclear whether exposure to these chemicals modifies serum levels of miRNAs associated with gestational diabetes mellitus (GDM) risk. In the present study, we evaluated the serum levels of miRNAs associated with GDM (miR-9-5p, miR-16-5p, miR-29a-3p and miR-330-3p) and urinary levels of phthalate metabolites (mono-n-butyl phthalate (MBP), mono-isobutyl phthalate (MiBP), mono-benzyl phthalate (MBzP) and mono(2-ethyl hexyl) phthalate (MEHP)) and bisphenol A in GDM patients and women without GDM during the second trimester of gestation. We observed higher levels of miR-9-5p, miR-29a-3p and miR-330-3p in sera of patients with GDM compared to non-diabetic subjects. Phthalates were detected in 97-100% of urine samples, while BPA only in 40%. Urinary MEHP and BPA concentrations were remarkably higher in both study groups compared to previously reported data. Unadjusted MEHP levels and adjusted BPA levels were higher in non-diabetics than in GDM patients (p = 0.03, p = 0.02). We found positive correlations between adjusted urinary MBzP levels and miR-16-5p expression levels (p < 0.05), adjusted MEHP concentrations and miR-29a-3p expression levels (p < 0.05). We also found negative correlations between unadjusted and adjusted MBP concentrations and miR-29a-3p expression levels (p < 0.0001, p < 0.05), unadjusted MiBP concentrations and miR-29a-3p expression levels (p < 0.01). Urinary MEHP levels reflect a striking exposure to di(2-ethylhexyl) phthalate (DEHP) in pregnant Mexican women. This study highlights the need for a regulatory strategy in the manufacture of several items containing endocrine disruptors in order to avoid involuntary ingestion of these compounds in the Mexican population.

Reference intervals for hemoglobin A1c (HbA1c) in healthy Mexican pregnant women: a cross-sectional study.

BACKGROUND: The reference intervals for hemoglobin A1c (HbA1c) in pregnant Mexican women without diabetes are not well defined. The study aims to determine the reference intervals for HbA1c at each trimester in healthy Mexican pregnant women. METHODS: This cross-sectional study included healthy Mexican pregnant women in trimester 1 (T1), 6-13.6 weeks of gestation (WG), trimester 2 (T2), 14-27 WG, and trimester 3 (T3), ≥27-36 WG, with a maternal age > 18 years, and pregestational body mass index (BMI) ranging between 18.5-24.9 kg/m2. Women with gestational diabetes mellitus, pregestational diabetes, anemia, a pregestational BMI < 18.5 or ≥ 25 kg/m2, and any hematologic, hepatic, immunological, renal, or cardiac disease were excluded. HbA1c was measured using high-performance liquid chromatography based on the National Glycohemoglobin Standardization Program-certified PDQ Primus guidelines. The HbA1c reference intervals were calculated in terms of the 2.5th to the 97.5th percentiles. RESULTS: We analyzed the HbA1c values of 725 women (T1 n = 84, T2 n = 448, and T3 n = 193). The characteristics of the participants were expressed as mean ± standard deviation and included: maternal age (28.2 ± 6.7 years), pregestational weight (54.8 ± 5.9 Kg), pregestational BMI (22.2 ± 1.7 Kg/m2), and glucose values using a 75 g-2 h oral glucose tolerance test; fasting 4.5 ± 0.3 mmol/L (81.5 ± 5.5 mg/dL), 1 h 6.4 ± 1.5 mmol/L (115.3 ± 26.6 mg/dL), and 2 h 5.7 ± 1.1 mmol/L (103.5 ± 19.6 mg/dL). Reference intervals for HbA1c, expressed as median and 2.5th to 97.5th percentile for each trimester were: T1: 5.1 (4.5-5.6%), T2: 5.0 (4.4-5.5%), and T3: 5.1 (4.5-5.6%). CONCLUSIONS: The reference range of HbA1C in healthy Mexican pregnant women during pregnancy was 4.4% to 5.6%. We suggest as upper limits of HbA1c value ≤5.6%, 5.5%, and 5.7% for T1, T2, and T3, respectively among Mexican pregnant women.

[Consensus of diagnosis and treatment of obesity in women in reproductive age and climacterium]. / Consenso de diagnóstico y tratamiento de la obesidad en la mujer en edad reproductiva y en el climaterio.

BACKGROUND: The development of obesity is complex and multifactorial, with genetic, biological, environmental and lifestyle of each individual etiology. The different changes in metabolism of women, amongst other factors, lead to disorganization in the distribution of lipids, which gathered in large quantities within the viscera, increases cardiovascular mortality and it is a major determinant factor of the metabolic syndrome. OBJECTIVE: To homologate and to apply concepts of evidence-based clinical practice in diagnosis and treatment of obesity in women in reproductive age and climacterium. METHOD: The experts' consensus was done by specialized physicians properly endocrinologists, gynecologists, surgeons, psychologists, nutrition specialists, physical activity and public health, according to their expertise and clinical judgment. The recommendations were based in diagnostic criteria aside from the level of evidence of previously established treatment guidelines, controlled clinical trials and standardized guides for women in reproductive age and climacterium with obesity. RESULTS: The establishment of a nutritional intervention amongst other aspects of lifestyle is the first-line in the treatment of obesity. Current pharmacological treatments offer modest results in efficiency and security in weight reduction so these must go along with real changes in lifestyle in order to obtain better results in the short and long term. CONCLUSION: The high prevalence of overweight and obesity in our country, especially in women in reproductive age, compels us to pose and work in prevention strategies as well as diverse therapeutic plans favoring safe weight loss and results in the long term.

Early intensive obstetric and medical nutrition care is associated with decreased prepregnancy obesity impact on perinatal outcomes.

BACKGROUND/AIMS: To compare the gestational weight gain and adverse perinatal outcomes in urban Mexican women with prepregnancy overweight or obesity, under an early intensive obstetric and nutrition program versus women with prepregnancy normal weight. METHODS: A cohort of 546 pregnant women with prepregnancy normal weight (n = 201, NW), overweight (n = 171, OW) or obesity (n = 174, OB), ≤13 weeks of gestation and a singleton pregnancy. OW and OB groups were under early intensive obstetric and nutritional care and NW group was under routine prenatal care. Miscarriage, hypertensive disorders, premature rupture of membranes, preterm birth, stillbirth, gestational diabetes mellitus (GDM) and large- or small-for-gestational-age newborns, were compared between groups. RESULTS: Weight gain was smaller in OB than in OW or NW (mean ± SD): 6.1 ± 4.4, 9.5 ± 5.1, 10.3 ± 5.4 kg, respectively (p < 0.001). OB women had the highest frequency of GDM (p < 0.001), lack of spontaneous labor (p < 0.001) and preeclampsia (p < 0.001), but no other between-group differences existed. CONCLUSION: Early intensive medical-nutrition prenatal care and adequate gestational weight gain may contribute to decreasing most maternal and newborn adverse outcomes associated with prepregnancy overweight or obesity.

[Obesity and metabolic syndrome. A challenge for the Mexican Institutes of Health]. / La obesidad y el síndrome metabólico. Un reto para los Institutos Nacionales de Saluda.

Numerous efforts for the development of basic and clinical research in obesity are being made by the National Institutes of Health and Federal Reference Hospitals in Mexico. However, greater interaction among researchers and stronger efforts towards the dissemination of the results are needed. The document outlines the general ideas and proposals of the Academic Group for the Study, Prevention and Treatment of Obesity and Metabolic Syndrome of the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals (CCINSHAE). This is the first step in developing common objectives, with the aim of understanding the effect of these entities in public health and to establish guidelines to limit and eventually overcome them. We discuss the appropriateness of analyzing obesity and the metabolic syndrome together, and the current management of these entities at the National Institutes of Health in Mexico. The problems that arise in clinical practice lead to the need to generate a new model of medical care, including a new health worker and a new patient. It is imperative to establish permanent lines of communication and education with health personnel and with patients. The group proposes an integrated approach for research in these areas. Finally, a master plan that links the National Institutes of Health, particularly in the areas of research and programs within the institutions, is required as a first step in seeking answers useful in solving the problem. The second step would be linking the first and second levels of care through concrete actions needed to limit and reduce obesity and metabolic syndrome in the population.

Perinatal Outcomes in Mexican Women with Untreated Mild Gestational Diabetes Mellitus Diagnosed by the International Association of Diabetes and Pregnancy Study Groups Criteria.

PURPOSE: To compare the risk of adverse perinatal outcomes (APO) between pregnant women with mild gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, on no specific treatment, versus pregnant women without GDM. PATIENTS AND METHODS: A retrospective cohort study of pregnant women referred to the Instituto Nacional de Perinatología, in Mexico City, for prenatal care and delivery. Eligibility criteria were singleton pregnancy, age >18 years, gestational age 20-28 weeks, and no history of pre-gestational diabetes. The study population was divided into two groups: Group 1, comprising women with mild GDM defined by one abnormal glucose value at the oral glucose tolerance test (OGTT) according to IADPSG criteria [fasting: 5.1-5.2 mmol/L (92-94 mg/dL) or 2h 8.5-8.56 mmol/L (153-154 mg/dL)], who did not receive specific treatment for GDM, and Group 2, comprising women without GDM, matched for maternal age and pre-gestational body mass index (BMI). Women with two or more abnormal OGTT values, pre-gestational diabetes, any chronic disease, or multiple pregnancies were excluded. RESULTS: As many as 282 women were included in each group. There were no significant differences in basal characteristics between groups. APO analysis showed that newborn weight was significantly higher in Group 1 (3042.4±499g) vs Group 2 (2910±565g) p=0.003; conversely, the incidence of large for gestational age (LGA) and macrosomic neonates was similar in both groups (6 vs 5.7% and 2.1 vs 2.2%, respectively). There were no differences in rates of preeclampsia and gestational hypertension, cesarean and preterm delivery, or premature rupture of membranes. A sub-analysis by maternal pre-gestational BMI showed that LGA incidence was significantly higher among babies born to women with pre-gestational BMI ≥30 kg/m2 in both groups. CONCLUSION: The risk of APO was similar among Mexican women with mild untreated GDM diagnosed by IADPSG criteria, compared to pregnant women without GDM. Pre-gestational BMI was an independent risk factor for LGA.

Searching for alternative methods of diagnosing gestational diabetes mellitus in a Mexican urban population.

BACKGROUND: The aim of the study was to determine whether a predictive value for the diagnosis of gestational diabetes mellitus (GDM) could be established using different glucose screening test thresholds in Mexican urban pregnant women. MATERIAL/METHODS: A group of 635 pregnant women (12-33 weeks of gestation) with serum glucose screening values of > or = 7.2 mmol (> or = 130 mg/dl) were evaluated with a 100-g 3-h oral glucose tolerance test (OGTT). The positive predictive values (PPVs) for serum glucose screening values of > or = 7.2 mmol to > or = 11.1 mmol (> or = 130 to > or = 200 mg/dl), age, and pregestational BMI were calculated. RESULTS: Of the women, 304 (47.8%) had a normal OGTT, 126 (19.8%) had impaired glucose tolerance, and 205 (32.3%) had GDM. A serum glucose screening value of > or = 9.4 mmol (> or = 170 mg/dl) had a positive predictive value (PPV) of 0.85 and the relative risk for GDM was 6.62 (95%CI: 4.40-9.97, p=0.001). Omission of the 3-h value during OGTT yielded a sensitivity of 91.2% (187/205). CONCLUSIONS: In this group of Mexican urban pregnant women, a serum glucose screening value of > or = 9.4 mmol (> or = 170 mg/dl) had a PPV of 85%. An algorithm is proposed to reduce the number of OGTTs performed in pregnant women attending prenatal care by 36.2%.

Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis.

OBJECTIVE: To evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria. DESIGN: Retrospective cohort study. SETTING: Level-three medical institution in Mexico City. PARTICIPANTS: The study population comprised 1061 adolescent women aged 12-19 years with singleton pregnancies, who underwent a 75 g oral glucose tolerance test (OGTT) between 11 and 35 weeks of gestation. PRIMARY AND SECONDARY OUTCOME MEASURES: The sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios LR (+) and LR (-), respectively) with 95% CIs for selected FPG cut-off values were compared. Secondary measures were perinatal outcomes in women with and without GDM. RESULTS: GDM was present in 71 women (6.7%, 95% CI 5.3% to 8.4%). The performances of FPG at thresholds of ≥80 (4.5 mmol/L), 85 (4.7 mmol/L) and 90 mg/dL (5.0 mmol/L) were as follow (95% CI): Sn: 97% (89% to 99%), 94% (86% to 97%) and 91% (82% to 95%); Sp: 50% (47% to 53%), 79% (76% to 81%) and 97% (95% to 97%); PPV: 12% (9% to 15%), 23% (18% to 28%) and 64% (54% to 73%); NPV: 99% (98.5% to 99.9%) for all three cut-offs; LR (+): 1.9 (1.8 to 2.1), 4.3 (3.8 to 5.0) and 26.7 (18.8 to 37.1) and LR (-): 0.06 (0.02 to 0.23), 0.07 (0.03 to 0.19) and 0.09 (0.04 to 0.19), respectively. No significant differences in perinatal outcomes were found between adolescents with and without GDM. CONCLUSIONS: An FPG cut-off of ≥90 mg/dL (5.0 mmol/L) is ideal for GDM screening in Mexican adolescent women. An FPG threshold of 90 mg/dL would miss 6 (8.5%) women with GDM, pick up 34 (3.4%) women without GDM and avoid 962 (90.7%) OGTTs.

[Physiopathology and nutritional care of patients with gestational diabetes]. / Fisiopatología y atención nutricia de pacientes con diabetes gestacional.

Maternal risks include the development of diabetes after pregnancy, as well as having an infant with macrosomia, with elevated risk of developing obesity and diabetes in childhood. The main goal of treatment is to maintain an adequate glycemic control during pregnancy and guarantee the recommended weight gain. The first treatment strategy is diet therapy, however, some women need insulin therapy to achieve adequate glycemic control. The risk of diabetic fetopathy decreases when maintaining postprandial glycemic levels within normal ranges. These levels are directly associated with the amount and type of carbohydrates consumed during meals. So, nutrition therapy should be an integral part of gestational diabetes treatment. Nutrition therapy includes a complete nutrition assessment, an individual food plan that meets energy and protein requirements for pregnancy (in obese women never lesser than 1,700 kcal/day), in which lipids and carbohydrates may provide lesser than 40 and between 40 and 45% of total energy intake. Education about food groups that provide carbohydrates, portion sizes and how to achieve an equal carbohydrate distribution throughout the day should be provided. Orientation about eating healthy fats and increasing the consumption of high-fiber foods should also be included. This approach requires that treatment of women with gestational diabetes should be provided by a multidisciplinary team, including nutrition specialists.

Association of obesity and overweight with the prevalence of insulin resistance, pre-diabetes and clinical-biochemical characteristics among infertile Mexican women with polycystic ovary syndrome: a cross-sectional study.

OBJECTIVE: To study the association of obesity and overweight with the prevalence of insulin resistance (IR), pre-diabetes and clinical-biochemical characteristics among infertile Mexican women with polycystic ovary syndrome (PCOS). DESIGN: Retrospective cross-sectional study. SETTING: Level-three medical institution, an infertility clinic in Mexico City. PARTICIPANTS: We included infertile Mexican women with diagnosis of PCOS according to the Rotterdam criteria: group 1 (n=83), normal weight (body mass index (BMI) 18.5-24.9 kg/m(2)); group 2 (n=217), overweight (BMI 25-29.9 kg/m(2)); and group 3 (n=238), obese (BMI≥30 kg/m(2)). PRIMARY AND SECONDARY OUTCOME MEASURES: IR was determined by homeostatic model assessment (HOMA) >2.5 and pre-diabetes by fasting glucose between 5.6 and 6.9 mmol/L and/or glucose value between 7.8 and 11 mmol/L at 2 hours during an oral glucose tolerance test. We compared clinical-biochemical characteristics among groups. RESULTS: Prevalence of IR for groups 1, 2 and 3 was 19.3%, 56.2% and 78.2%; overweight and obesity increase the IR OR (CI 95%) to 5.3 (2.9 to 9.8) and 14.9 (8.0 to 28), respectively. Prevalence of pre-diabetes for groups 1, 2 and 3 was 7.2%, 17.5% and 31.5%; overweight and obesity increase the pre-diabetes OR (CI 95%) to 2.7 (1.1 to 6.7) and 5.9 (2.4 to 14), respectively. Acanthosis nigricans was more frequent in group 3 than group 1. Free Androgen Index (FAI) and thyroid-stimulating hormone (TSH) levels were lower in group 1 than in groups 2 and 3. Progesterone and sex hormone-binding globulin (SHBG) levels were higher in group 1 than in groups 2 and 3. Dehydroepiandrosterone sulfate (DHEA-S) was higher in group 1 than group 3. CONCLUSIONS: Obese and overweight infertile Mexican women with PCOS, attending to an infertility clinic, have a higher prevalence of IR and pre-diabetes compared with normal-weight women with PCOS. Therapeutic interventions should include those that improved metabolic functioning prior to attempting pregnancy in these groups of women.

Increased hypothalamic dopaminergic tone only in early parous women with either malignant or benign breast tumors.

OBJECTIVE: To investigate whether the serum prolactin (PRL) response to a dopamine antagonist was different in nonobese, euthyroid women with malignant or benign breast tumors in comparison with healthy women, considering their age at first full-term pregnancy or their nulliparity. METHODS: Serum PRL concentrations before and 60, 90, and 120 minutes after oral administration of metoclopramide (10 mg) were studied in 122 nonobese, nonsmoking, euthyroid women: 28 who had invasive breast cancer, stage I or II (group 1), 34 who had benign breast disease (group 2), and 60 who were clinically healthy (group 3). These three main groups were subdivided into early and late parous women (< or = 25 and >25 years, respectively) and nulliparous women, and the menopausal status was also considered. RESULTS: Early parous women with invasive breast cancer (both premenopausal and postmenopausal) and early parous premenopausal women with benign breast disease had significantly higher serum PRL concentrations in response to administration of metoclopramide (P<0.05) and a greater area under the PRL curve (P<0.05) than those observed in early parous healthy women. No other significant differences in the serum PRL response were noted between or within groups. CONCLUSION: The results of this study suggest the existence of an increased hypothalamic dopaminergic tone in early parous women but not in late parous or nulliparous women with malignant or benign breast tumors in comparison with similar healthy women. This finding may represent an adaptive protective mechanism attempting to prevent persistently increased serum PRL concentrations, a factor that could adversely affect the clinical evolution of the disease.

Effect of the diagnostic criteria of the International Association of Diabetes and Pregnancy Study Groups on the prevalence of gestational diabetes mellitus in urban Mexican women: a cross-sectional study.

OBJECTIVE: To explore the prevalence of gestational diabetes mellitus (GDM), defined by the previous criteria of the American Diabetes Association (ADA), as well as the criteria suggested by the International Association of Diabetes and Pregnancy Study Groups (IADPSG), in an unselected group of urban Mexican pregnant women and to analyze the frequency of large for gestational age (LGA) newborns in this same group of women with use of both diagnostic criteria. METHODS: A cross-sectional study included 803 consecutive Mexican urban women with a singleton pregnancy, without concomitant diseases and no prior history of GDM, who underwent a 2-step screening protocol for diagnosis of GDM at admission to prenatal care. RESULTS: The ADA criteria identified 83 women (10.3%) whereas the IADPSG criteria diagnosed 242 women (30.1%) having GDM (P = .0001). Fasting glucose concentrations during the 100-g 3-hour oral glucose tolerance test were abnormal in 116 women (14.4%) and in 160 women (19.9%) on the basis of ADA and IADPSG criteria, respectively (P = .004). The frequency of LGA newborns was 7.4% based on IADPSG criteria and 6.0% based on ADA criteria-no significant difference (P = .64). CONCLUSION: With use of the IADPSG criteria, the prevalence of GDM increased almost 3-fold in comparison with that for the ADA criteria. Nevertheless, no significant difference was found in the prevalence of LGA newborns.

The risk of gestational diabetes mellitus among Mexican women with a history of infertility and polycystic ovary syndrome.

OBJECTIVE: To study the incidence of gestational diabetes mellitus (GDM) in Mexican women with a history of infertility and polycystic ovary syndrome (PCOS) compared with women without PCOS matched by age, pregestational body mass index (BMI), and parity. DESIGN: Historic cohort study. SETTING: Level three medical institution. PATIENT(S): Group 1 (n = 52), women with a history of infertility and PCOS, and group 2 (n = 52), women without PCOS. Inclusion criteria were singleton pregnancy with ≤ 13 weeks of gestation. Exclusion criteria were pregestational diabetes mellitus and/or concomitant diseases. INTERVENTION(S): Diagnosis of GDM was based on a 3-hour, 100-g oral glucose tolerance test (GTT) performed during the second trimester. MAIN OUTCOME MEASURE(S): Incidence and relative risk (RR) for GDM. RESULT(S): The incidence of GDM was 26.9% and 9.6% for groups 1 and 2, respectively (RR = 2.8; 95% confidence interval 1.08-7.2). No other between-group differences were observed in the incidence of miscarriage, preterm birth, premature rupture of membranes, preeclampsia, stillbirth, fetal malformations, or small or large for gestational age newborns. CONCLUSION(S): Pregnant Mexican women with a history of infertility and PCOS are at increased risk for developing GDM. This risk should be considered beginning early in the second trimester for a timely intervention and to improve the maternal-fetal prognosis.

Reducción asistida por artroscopia en pacientes con fractura de la meseta tibial / Reduction assisted by arthroscopy in patients with tibial plateau fractures

Fundamento: las fracturas de la meseta tibial pueden ser de bajo o alto grado; las de bajo grado, que se corresponden con los tipos I al III de la clasificación de Schatzker J., pueden ser tratadas mediante reducción asistida por artroscopia. Métodos: se realizó un estudio observacional descriptivo en el Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey desde el 1ro de enero de 2013 al 31 de marzo de 2014. El universo estuvo conformado por 32 pacientes de los cuales 11 reunieron los criterios de selección. Resultados: el promedio de edades fue de 46, 3 años; la razón sexo masculino-femenino fue de 1, 75 a 1. Predominó el tipo de fractura tipo II en el 54, 4 % de los pacientes estudiados. Las lesiones de menisco asociadas predominaron al ser encontradas en el 54, 5 % de los pacientes. Se encontró significación estadística entre las evaluaciones hechas antes de la cirugía y las de 12 meses después, según las escalas de Rasmussen PS y Lysholm J. Conclusiones: la reducción asistida por artroscopia en pacientes con fractura de la meseta tibial de los grados I al III es un método efectivo desde el punto de vista funcional y para aliviar el dolor.

Background: tibial plateau fractures can be of low or high degree. Fractures of low degree, corresponding to types I to III of Schafzker J classification, can be treated by means of reduction assisted by arthroscopy. Methods: an observational, descriptive study was conducted in Manuel Ascunce Domenech Teaching Hospital, Camagüey city from January 1st, 2013 to March 31st, 2014. The universe was composed of 32 patients, 11 of which matched the selection criteria. Results: the average age was of 46, 3 years. The ratio of male to female sex was 1, 75 to 1. Associated lesions of the meniscus predominated being present in the 54, 5 % of the patients. A statistical significance was found between the presurgical evaluations and the ones made 12 months later, according to Rasmussen PS and Lyshol J scales. Conclusion: reduction assisted by arthroscopy in patients with tibial plateau fractures type I to III, is an effective method from the functional point of view and to relieve pain.

Artritis séptica del hombro: a propósito de un caso / Septic arthritis of the shoulder: a case report

Fundamento: la artritis séptica del hombro, aunque presenta la misma fisiopatología de otras articulaciones, es una enfermedad infrecuente. Objetivo: presentar el caso de un paciente con artritis séptica del hombro. Caso clínico: paciente masculino de 70 años. El paciente acudió a la consulta de urgencia de ortopedia y traumatología por presentar dolor e incapacidad funcional del hombro derecho, después de haber sido intervenido en cirugía menor por una lesión de piel hacía siete días. En la exploración física se apreció aumento de volumen marcado en la articulación del hombro derecho, acompañado de limitación del arco de movimiento articular. Mediante la palpación se constató aumento de la temperatura local de la articulación. En el examen ultrasonográfico de urgencia se detectó la presencia de gran cantidad de líquido en la articulación glenohumeral. Al paciente se le diagnosticó artritis séptica del hombro derecho y se le indicó tratamiento quirúrgico. Conclusiones: la artritis séptica del hombro es una enfermedad infrecuente; el tratamiento indicado es el quirúrgico que consiste en el lavado y desbridamiento de la articulación.

Background: although septic arthritis of the shoulder has the same physiopathology of other joints, it is an infrequent condition. Objective: to present the case of a patient with septic arthritis of the shoulder. Case report: a seventy-year-old white male patient. The patient came to the orthopedic emergency department for presenting pain and physical disability in the right shoulder after undergoing a minor surgery for a skin lesion seven days before. In the physical examination, marked increased volume in the joint of the right shoulder could be found, associated with limitations in the articular movement arc. Palpation revealed increased local temperature. The emergency ultrasonographic examination showed a great quantity of liquid inside the glenohumeral joint. The patient was diagnosed with septic arthritis of the right shoulder and surgical treatment was indicated. Conclusions: septic arthritis of the shoulder is an infrequent condition. Surgical treatment, consisting in articular wash and debridement, is indicated.

Reparación de menisco: a propósito de un caso / Meniscus repair: clinical case

FUNDAMENTO: las lesiones de los meniscos de la rodilla son muy frecuentes y pueden estar localizadas desde la periferia hasta la zona más interna de la articulación. Los desgarros de meniscos en ocasiones pueden ser suturados en dependencia de varios factores, para este fin existen diferentes técnicas según la dirección de las suturas. OBJETIVO: mostrar la presentación de un enfermo, al que se le realizó la modalidad de sutura de afuera a adentro. CASO CLINICO: paciente de 18 años de edad, blanco, masculino con antecedentes de salud anterior, que sufrió trauma por torsión a nivel de la rodilla derecha hace seis meses, después de lo cual comenzó con dolor e inflamación a nivel de la interlínea articular del lado medial. A la exploración física se detectó a la inspección aumento de volumen a nivel de la interlínea articular medial de la rodilla derecha. Mediante la palpación se constató chasquido articular. Las maniobras de Appley y McMurray resultaron ser positivas en la articulación afectada en relación con daño del menisco interno. Durante la artroscopia se observó lesión periférica de menisco interno en la zona media de 10 milímetros en la zona roja-roja, para la cual se realizó sutura de afuera a adentro. CONCLUSIONES: la reparación de menisco es un método quirúrgico factible y práctico que permite el alivio del dolor y conservar la estructura del menisco, para que pueda desempeñar sus funciones anatómicas.

BACKGROUND: meniscal lesions are very common and may be located in the peripheral and the inner part of the knee joint. Meniscal tears can be sutured depending on different factors. There are several techniques and are usually classified according to the direction of the suture. OBJECTIVE: to show a case in which an inward suture was conducted. CASE REPORT: an eighteen-year-old, white male patient who suffered from a trauma caused by torsion on his right knee six months ago. After the trauma, the patient presented pain and inflammation in the medial side of the knee, especially in the articular line. During the examination, volume increase and inflammation were perceived in the medial side. During palpation, articular snaps were detected. Appley and McMurray maneuvers were positive in the affected articulation indicating damage of the medial meniscus. In the arthroscopy a ten-millimeter peripheral lesion of the medial meniscus was found in the medial area, in the red-red zone. In order to treat the lesion, an inward suture was performed. CONCLUSIONS: meniscus repair is a practical, feasible method to reduce pain and keep the meniscal structure so it can carry out its anatomical function.

A medical nutrition therapy program improves perinatal outcomes in Mexican pregnant women with gestational diabetes and type 2 diabetes mellitus.

UNLABELLED: Diabetes in pregnancy is a major public health problem in Mexico. Nutrition therapy is an important component of treatment. Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes. Its effect on different types of diabetes mellitus has not been studied. PURPOSE: The authors assessed the effect of a medical nutrition therapy (MNT) program on perinatal complications in Mexico City. METHODS: Quasi-experimental design with a historical control. Women were assigned to a MNT program (n = 88) and were followed up with every 2 weeks until delivery (2004-2007). The control group (n = 86) was selected from medical charts (2001-2003) and the same inclusion criteria were used. In each group, 55% of women had type 2 diabetes mellitus and 45% had gestational diabetes. The MNT program included a moderate intake of carbohydrate (40%-45% of total energy) and reduction in energy intake, capillary glucose self-monitoring, and education. The control group received usual hospital routine care. Statistical analysis included descriptive statistics, chi-square, and multivariate logistic regression (OR, 95% CI) as indicated. RESULTS: Women in the MNT program had a lower risk of preeclampsia, fewer maternal hospitalization, and neonatal deaths in both types of diabetes. Low birth weight was less frequent only in women with gestational diabetes receiving MNT, while neonatal intensive care unit admissions were lower only in women with type 2 diabetes. CONCLUSIONS: An intensive MNT program, including counseling, education, and capillary glucose self-monitoring, has a positive effect over preeclampsia, maternal hospitalization, and neonatal death in women with diabetes in pregnancy. MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy.

Plicatura medial asistida por artroscopia a propósito de un caso / Arthroscopically-a medial plication: a case report / Plicature médiale assistée par arthroscopie, à propos d'un cas

La plicatura medial asistida por artroscopia constituye una variedad quirúrgica empleada en pacientes que presentan mala alineación patelofemoral. El paciente de 44 años de edad, blanca, femenina con antecedentes de salud anterior, la cual desde hace aproximadamente un año refiere dolor a nivel de la cara anterior de la rodilla izquierda, para lo cual ha llevado tratamiento en múltiples ocasiones con analgésicos, antiinflamatorios no esteroideos y varias sesiones de terapia de rehabilitación con respuesta muy limitada a sus síntomas. Se realizó liberación del retináculo lateral acompañada de plicatura medial, esta técnica se describe por pasos. La plicatura medial asistida por artroscopia, es un procedimiento simple, que no necesita de una curva larga de aprendizaje y presenta un mínimo de complicaciones.

Arthroscopically-assisted medial placation is a surgical variety used in patients with poor patellofemoral alignment. 44-year-old, white female patient, with previous health history of concerns, refers pain at the anterior aspect of her left knee for about a year. She has been treated with analgesics, NSAIDs multiple times and several rehabilitation therapy sessions with very limited response to her symptoms. Release of the lateral retinaculum accompanied by medial plication was performed on this patiente. This technique is described by steps. Assisted arthroscopic medial plication is a simple procedure which does not require long learning curve and it has a minimum of complications.

La plicature médiale assistée par arthroscopie constitue une technique chirurgicale employée chez les patients atteints d’un mauvais alignement fémoro-pathélaire. Le cas d’un patient (femme âgée de 44 ans, blanche) avec une historie de santé antérieure, référant depuis un an à peu près une douleur au niveau de la face antérieure du genou gauche, plusieurs traitements (analgésiques, antiinflammatoires non stéroïdiens), et pas mal de sessions de rééducation sans réponse satisfaisante, est présenté. On a effectué la libération du rétinaculum latéral, conjointement avec une plicature médiale. La plicature médiale assistée par arthroscopie est une procédure simple n’ayant pas besoin d’une longue courbe d’apprentissage et présentant très peu de complications.

Microfracturas por vía artroscópica en pacientes con lesiones de cartílago de la rodilla / Microfractures in patients with cartilage lesions of the knee treated by arthroscopy

Las lesiones de los cartílagos de la rodilla son difíciles de tratar debido a su escasa posibilidad de reparación, de allí que la mayoría de los tratamientos para esta enfermedad son de tipo quirúrgico.Objetivo: evaluar los resultados de las microfracturas en pacientes con lesiones de los cartílagos de la rodilla.Método: se realizó un estudio de tipo cuasi experimental, modalidad antes y después sin grupo control. El universo estuvo conformado por 65 enfermos con lesiones de los cartílagos de la rodilla diagnosticados y tratados por artroscopia en el Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey desde el 1ro de enero de 2012 hasta el 31 de enero de 2013. La muestra no probabilística quedó constituida por 43 enfermos que reunieron los criterios de selección.Resultados: predominó el sexo femenino sobre el masculino en una razón de 2,9 a 1. El compartimento tibiofemoral medial presentó la mayor incidencia con 23 pacientes para un 53,4 por ciento. Las lesiones de tamaño entre uno y dos centímetros fueron las más encontradas con 24 enfermos para un 75 por ciento. De los 43 pacientes estudiados 32 presentaron enfermedades intrarticulares asociadas a la lesión de cartílagos para un 74,4 por ciento. El 65,1 por ciento de los enfermos presentaron otros factores asociados a la lesión de cartílagos de la rodilla. El 18,3 por ciento de los enfermos presentó resultados desfavorables al tratamiento.Conclusiones: las microfracturas mostraron ser efectivas en más de las terceras cuartas partes de los pacientes estudiados...

Cartilage lesions of the knee are difficult to treat because the healing process of this tissue is very low; that is why surgical procedures are the most used treatment for this complaint. Objective: to evaluate the results of microfractures in patients suffering from cartilage lesions of the knee.Methods: a cuasi-experimental study, before and after modality, without a control group was performed. The universe of investigation involved 65 patients with cartilage lesions of the knee diagnosed and treated by arthroscopy at Manuel Ascunce Domenech Provincial Teaching Hospital in Camaguey from January 1st, 2012 to January 31th, 2013. The non-probabilistic sample was composed of 43 patients who fitted the selection criteria. Results: female sex predominated with a female-male proportion of 2, 9 to 1. Medial tibiofemoral compartment was the most affected with 23 patients for a 53, 4 percent . Cartilage lesions between one and two centimeters were found in 24 patients for a 75 percent . Of 43 studied patients, 32 presented associated intrarticular diseases for a 74, 4 percent. The 65, 1 percent of the patients had others factors associated to cartilage lesions of the knee. Unfavorable results were obtained in the 18, 3 percent of the cases.Conclusions: microfractures proved to be effective in more than three fourths of the studied patients...

Comportamiento de pacientes con gonartrosis tricompartimental / Behavior of patients suffering from tricompartimental osteoarthritis of the knee

Fundamento: la gonartrosis tricompartimental constituye un reto para todos los médicos que la enfrentan a diario, ya que está asociada a varios factores que no permiten obtener los mejores resultados en las diferentes modalidades de tratamiento. Objetivo: mostrar el comportamiento de pacientes con gonartrosis tricompartimental. Método: se realizó un estudio observacional descriptivo de corte transversal en 35 pacientes con el diagnóstico clínico, radiográfico y artroscópico de gonartrosis tricompartimental en el Hospital Universitario Manuel Ascunce Domenech de Camagüey, desde el 1ro de diciembre de 2012 hasta el 28 de febrero de 2013. Resultados: predominó el sexo femenino sobre el masculino y el grupo de edades de 40-49 años. El 51,4 % de los pacientes fueron clasificados en grado 4 según los criterios de Kellgram JH y Lawrence JS. Predominaron los pacientes con lesión de cartílago tipo IV según la clasificación de Outerbridge RE. Todos los pacientes estudiados presentaron factores asociados dentro de los que se destacó el dolor al reposo. El lavado articular fue el procedimiento artroscópico más empleado. Conclusiones: predominó el sexo femenino y la enfermedad se asoció a los más altos grados de las clasificaciones radiográficas y artroscópicas. El lavado articular fue el tratamiento más empleado.

Background: tricompartimental osteoarthritis of the knee is one of the most common conditions that medical doctors face every day, this disease is usually associated to factors that may modified the responds to different kinds of treatment. Objective: the aim of this study was to show the behavior of patients with tricompartimental osteoarthritis of the knee. Method: a descriptive and observational study was performed in 35 patients with the diagnosis of tricompartimental osteoarthritis of the knee according to clinical, radiographic and arthroscopic criteria in the provincial teaching hospital Manuel Ascunce Domenech in Camaguey city from December 1 st 2012 to February 28 th 2013. Results: female sex prevailed with a proportion female - male of 2,8 to 1. A 31,4 % of the patients were included in the age group from 40 to 49 years. The 51,4 % were graded as 4 according to the radiographic classifications of Kellgram and Lawrence. The majority of the patients were found in grade IV taking into account arthroscopic classification of Outerbridge RE. All the patients presented bad prognostic factors and of them, rest pain was found in the 80 %. Arthroscopic washout was the procedure must use in the 94,3 % of the patients. Conclusions: female sex prevailed and there is a strong association to the highest grades of Kellgram and Lawrence and Outerbridge RE classifications. Arthroscopic washout was applied in the majority of the patients.