Outcomes of basicervical femoral neck fracture treated with percutaneous compression plate (PCCP).

INTRODUCTION: Basicervical femoral neck fracture is associated with high rates of failure due instability patterns, mainly collapse and rotational instability. The purpose of this study was to evaluate the clinical-radiological results of a group of patients with a bascervical proximal femoral fractures treated with Percutaneous Compression Plate (PCCP). MATERIAL AND METHODS: Among 5817 patients with a hip fracture who were admitted in our hospital from January 2005 to December 2017, 234 factures (4%) were diagnosed of basicervical femoral fracture. 30 of them were treated with a PCCP, 22 women and 8 men, mean age was 81.2 years (63-94). Demographic and perioperative variables were collected. The patients were followed up at 1, 3 and 6 months clinically and radiologically. RESULTS: There were no intra-operative complications and no conversions to open surgery. There was no early implant failure. No surgical wound infection was diagnosed. Crude mortality was 13% the first year and 87% were able to walk at the 6 months. The last follow-up x-rays revealed 97% fracture healing and the collapse at fracture site occurred in 4 hips. No instances of cut-out were observed. In one case, a fatigue failure of the lag screws of a PCCP plate was observed at 3 months from osteosynthesis. CONCLUSION: PCCP is an appropriated implant for basicervical femoral neck fractures.

Effects of radiotherapy on plasma energy metabolites in patients with breast cancer who received neoadjuvant chemotherapy.

PURPOSE: Neoadjuvant chemotherapy (NACT) is employed in patients with breast cancer (BC) with the aim of reducing tumor burden and improving surgical outcomes. We evaluated the levels of energy metabolites pre- and post-radiotherapy (RT) in breast cancer (BC) patients who previously received NACT and investigated the alterations of these metabolites in relation to the patient achieving a pathologic complete response to NACT. MATERIALS AND METHODS: We included 37 BC patients who were treated with NACT following surgery and analyzed the concentrations of energy balance-related metabolites using targeted metabolomics before and one month after the end of RT. The control group was composed of 44 healthy women. RESULTS: Pre-radiotherapy, patients had significant decreases in the plasma levels of 12 metabolites. RT corrected these alterations and the improvement was superior in patients with a pathologic complete response. CONCLUSION: Our results highlight the importance of metabolism in the outcomes of patients with BC.

Detection of clinical and neurological signs in apparently asymptomatic HTLV-1 infected carriers: Association with high proviral load.

Several studies suggest that HTLV-1 infection may be associated with a wider spectrum of neurologic manifestations that do not meet diagnostic criteria for HAM/TSP. These conditions may later progress to HAM/TSP or constitute an intermediate clinical form, between asymptomatic HTLV-1 carriers and those with full myelopathy. Our aim was to determine the prevalence of HTLV-1-associated disease in subjects without HAM/TSP, and the relationship between these findings with HTLV-1 proviral load (PVL). METHODS: 175 HTLV-1-infected subjects were submitted to a careful neurological evaluation, during their regular follow up at the HTLV outpatient clinic of the Institute of Infectious Diseases "Emilio Ribas", São Paulo city, Brazil. Clinical evaluation and blinded standardized neurological screening were performed for all the subjects by the same neurologist (MH). RESULTS: After the neurological evaluation, 133 patients were classified as asymptomatic and 42 fulfilled the criteria for intermediate syndrome (IS). The mean age of the enrolled subjects was 46.3 years and 130 (74.3%) were females. Clinical classification shows that neurological symptoms (p<0.001), visual disorders (p = 0.001), oral conditions (p = 0.001), skin lesions (p<0.001), bladder disorders (p<0.001), and rheumatological symptoms (p = 0.001), were strongly associated to IS, except for disautonomy (p = 0.21). A multivariate analysis revealed that HTLV-1 proviral load, oral conditions, bladder disorders and rheumatological symptoms were independently associated with the IS. CONCLUSIONS: We found some early alterations in 42 patients (24%), particularly the presence of previously not acknowledged clinical and neurological symptoms, among subjects previously classified as "asymptomatic", who we reclassified as having an intermediate syndrome.

Cognitive impairment is frequent among symptomatic carriers of human T-cell lymphotropic virus type 1 (HTLV-1), regardless of their clinical status.

The main goal of this study was to investigate the presence of cognitive impairment in patients infected with HTLV-1 presenting or not TSP/HAM. METHODS: Cross-sectional study including 104 participants: 37 asymptomatic HTLV-1 carriers, 37 patients diagnosed with TSP/HAM and 30 HTLV-1 negative control patients. Within the HTLV-1 positive group, 53 were female and 21 were male, the average age was 46 (SD=13.5) and the average schooling time was 7.7years (SD=3.3).The sociodemographic variables (genre, age and education) were compared between the three groups. The assessment tools used were: Beck Depression Inventory, Lawton's Activities of Daily Life Scale and a complete neuropsychological battery. The application of these assessment tools was carried out in blind. Both HTLV-1 asymptomatic subjects and HAM/TSP patients showed a lower performance on neuropsychological tests and higher depression scores when compared to the control group. HTLV-1 patients performed poorly in several cognitive domains, but only fluid intelligence, estimated intellectual functioning, immediate and delayed recall of visual memory and information processing speed (in the specific case of patients with TSP/HAM) reached statistical significance when compared with controls. Depression was not associated with cognitive impairment. HTLV-1 carriers presented a higher frequency of cognitive impairment than normal controls.

Pre- and postnatal exposure to tobacco smoke and respiratory outcomes during the first year.

The different role of prenatal and postnatal exposure to tobacco smoke in respiratory outcomes in infants has not yet been clearly established. Our objective is to assess the effects of these exposures on the risk of respiratory outcomes during the first year of life of infants from a Spanish multicenter cohort study. A total of 2506 women were monitored until delivery. About 2039 infants made up the final population. The outcomes were caused by the occurrence of the following: otitis, cough persisting for more than 3 weeks, lower respiratory tract symptoms (wheezing or chestiness), and lower respiratory tract infections (bronchitis, bronchiolitis, or pneumonia). The relationship between prenatal and postnatal exposure and health outcomes was explored using logistic regression analysis. Maternal smoking during pregnancy increased the odds for wheezing (OR: 1.41, 95% CI: 0.99-2.01) and chestiness (OR: 1.46, 95% CI: 1.03-2.01). Postnatal exposure from fathers was associated with otitis (OR: 1.25, 95% CI: 1.01-1.54). Passive exposure at work of non-smoking mothers during pregnancy was related to cough (OR: 1.62, 95% CI: 1.05-2.51). Exposure to tobacco smoke was related to a higher risk of experiencing respiratory outcomes in young infants. Prenatal exposure was that most clearly associated with the respiratory outcomes analyzed.

[Ureterectomy in the treatment of urothelial carcinoma of the distal ureter]. / La ureterectomía distal laparoscópica en el tratamiento del carcinoma urotelial del uréter distal.

INTRODUCTION: Segmental ureterectomy with preservation of the kidney is a treatment option for the low grade urothelial carcinoma (LG-UC) in distal ureter that is not a candidate for endoscopic resection. Laparoscopic distal ureterectomy (LDU) with ureteral reimplantation is common in benign conditions (stenosis, iatrogenic lesion, endometriosis). However, it has been hardly described in malignant ureteral condition. The literature is reviewed in this regards and the surgical technique described. MATERIAL AND METHODS: The experience regarding two cases of LDU due to low grade urothelial carcinoma in distal ureter is presented. In both, previous bladder transurethral resection (RTU) was performed. The urinary cytology was negative and the imaging studies identified urinary obstruction and distal ureter filling defect. One of the patients had a background of T1G3 bladder cancer and suffered renal failure. In both, the ureter was ligated early. Segmental ureterectomy was performed using a combined endoscopic and laparoscopic procedure with ureteral desinsertion in one case. In the other, it was exclusively laparoscopic. Both were done with 4 trocars. Ureteral reimplantation was conducted with continuous hermetic suture and without tension. In one case with background of high grade bladder tumor, pelvic lymphadenectomy was also performed. RESULTS: Operating time was 180 and 240 min, respectively, with estimated bleeding of 100 and 250 ml. Hospitalization time was 6 and 4 days. The only post-operatory complication was paralytic ileum (Clavien I) in the first case. With a 20 and 12 month follow-up, there is no evidence of recurrence or dilatation. In the patient with renal failure, creatinine clearance improved. CONCLUSIONS: The LDU with ureteral reimplantation is a complex technique. However, it represents a feasible and effective alternative for the treatment of LG-UC in distal ureter, as long as the oncological and reconstructive principles are respected.

[Efectiveness of long-term consumption of nuts, seeds and seeds' oil on glucose and lipid levels; systematic review]. / Efecto del consumo de nueces, semillas y aceites sobre marcadores bioquímicos y el peso corporal; revisión sistemática.

OBJECTIVE: The aim of this study was to determine the effectiveness of long-term consumption of nuts, seeds and vegetable oil (NSO) on weight, glucose, and lipid levels. METHODS: We searched English articles published in Pubmed and Ebsco up to May 2011. Studies were included if they were randomized clinical trials, and had an intervention period of 24 or more weeks. Search terms include: "diabetes mellitus", "Nuts", "Diet Mediterranean", "Seeds", "Oils", "Canola oil", "Olive oil","Walnut", "Almond", "Pistachio", "Paleolithic diet", "High monounsaturated diet", "High polyunsaturated diet", "Soya" and "Sunflower". RESULTS: Thirteen studies met the inclusion criteria; eight studies had a 24 weeks intervention period, one had 42 weeks, one had 48 weeks, and for the other three the intervention lasted 52 or more weeks. At 24 weeks a consistent increase of HDL levels and inconsistent improvement of weight, BMI, waist to hip index, A1C, total cholesterol, LDL: HDL, LDL, triglycerides, and diastolic blood pressure was observed. Four studies with an intervention ≥ 48 weeks showed no statistical difference, and in one study a reduction of weight, BMI, waist hip index, glucose, insulin, total cholesterol, HDL: cholesterol, triglycerides, and blood pressure was observed. CONCLUSION: No evidence of long-term improvement of NSO on weight, glucose or lipids in the adult population was found.

[Evidence of social support as therapy for weight loss: a systematic review]. / Evidencias del soporte social como terapia para la pérdida de peso: una revisión sistemática.

INTRODUCTION: Social Support (SS) therapy can be an effective method of weight loss compared with conventional treatment (CT). OBJECTIVE: To evaluate RCT's using SS therapy on weight in subjects with overweight or obesity. METHODOLOGY: We reviewed all original articles published in MEDLINE/PubMed, SciELO, EBSCO, Google Scholar, from 2000 to August 2011, and one referred in a previous metanalisis, of RCT's of the effect of SS therapy on weight loss, with at least five months of treatment, compared with another therapy or a CT. RESULTS: Eight articles were analyzed. It was observed heterogeneity in the design, differences in the components of the interventions, and cultural characteristics of the population. The difference between groups in weight loss in five out of seven studies, ranged from 2.3 kg (24 m) to 8.3 kg (12 m). However, the treatment in the control groups did not meet the accepted recommended guidelines. There was no allocation concealment in two studies, and no blindness in four. Most studies showed large dispersion in the results. Therefore, the quality of the evidence is low. CONCLUSIONS: These results warrant further and better design and longer term studies to generate higher quality evidence.

Parents perception of weight status of Mexican preschool children using different tools

The aim of this study was to evaluate the ability of parents to estimate the weight status of preschool children attending the Instituto Mexicano del Seguro Social (IMSS) day-care centers using three different tools. A total of 100 parent-child pairs attending to all the existing IMSS day-care centers in Ensenada (n=9) completed a questionnaire on the perception of children’s weight status using verbal description, sketches, and pictures. Chi squared test and univariate logistic regression was applied to assess the difference in perception between the tools used, the factors associated with the weight status perception and to identify predictors of parental underestimation of their child’s weight. The sample size was estimated for a significance level of 0.05 with statistical power of 80%. No significant differences were found in the perception of weight status using different tools. The parents’ underestimation of the child’s weight status ranged from 51 to 59%, this percentage jumps to 79 to 84% in overweight children and 82 to 91% in obese children. Being a young mother and having a daughter increased the risk of underestimation. Higher odds of underestimation were found in > 2BMI z-score. The high underestimation found in this study shows that the ability of parents in signaling an alert to prevent childhood obesity might be highly reduced and preventive health programs should include increasing the weight status perception.

El objetivo de este estudio es evaluar la habilidad de los padres para estimar el peso corporal de niños preescolares que acuden a guarderías del Instituto Mexicano del Seguro Social utilizando tres instrumentos diferentes. Un total de 100 parejas padre-hijo que acudían a todas las guarderías del IMSS en Ensenada (n=9) completó un cuestionario acerca de la percepción del peso corporal utilizando descripción verbal, pictogramas y fotografías. Se usó la prueba de Ji cuadrada y regresión logística univariada para valorar la diferencia en la percepción entre los instrumentos utilizados, los factores asociados con la percepción del peso corporal y para identificar los predictores de la subestimación por parte de los padres del peso corporal de sus hijos. El tamaño de la muestra se estimó para un nivel de significancia de 0.05 con un poder estadístico del 80%. No se encontraron diferencias significativas en la percepción del peso con el uso de las diferentes herramientas. La subestimación de los padres del peso de los niños con las diferentes herramientas osciló entre 51 y 59%, y este porcentaje se incrementó a 79 al 84% en niños con sobrepeso y a 82 al 91% en niños con obesidad. El riesgo a subestimar se incrementa en las niñas, cuando las madres son más jóvenes, y cuando los niños tienen un puntaje z de IMC > 2. El alto grado de subestimación encontrado en este estudio indica que la habilidad de los padres para detectar la obesidad en los niños es muy baja, por lo que los programas de prevención a la salud deben incluir mejorar la percepción del peso.

[Intervention programs to promote physical activity in school children: systematic review]. / Programas de intervención para la promoción de actividad física en niños escolares: revisión sistemática.

OBJECTIVE: The purpose of this systematic review was to assess physical activity promotion programs in school children from 6 to 12 years old. METHODS: Randomized and non-randomized controlled trials of physical activity studies with an intervention period equal to or more than 12 months, published in the databases of MEDLINE/PubMed, SciELO, EBSCO and SPORTDiscus through may 2010 were searched. RESULTS: Seven studies were analyzed. Overall, the study design, the follow-up periods, the ethnic characteristics of the population, and the instruments used to evaluate the interventions were heterogeneous. The outcomes showed moderate impact of intervention programs to increase the physical activity in children and adolescents. In two of the studies was observed an increase in the physical activity and in five of the studies no significant difference in the physical activity assessed with accelerometers and pedometers. CONCLUSION: In five out of seven studies it was not shown statistical differences in cpm, including the longest experimental study. These results suggest the need of designing studies including modifications in different environments.

Lack of effect of oral administration of resveratrol in LPS-induced systemic inflammation.

PURPOSE: The high mortality index due to sepsis and the lack of an effective treatment requires the search for new compounds that can serve as therapy for this disease. Resveratrol, a well-known anti-inflammatory natural compound, might be a good candidate for the treatment of sepsis. The aim of this work was to study the effects of oral administration of resveratrol, before and after sepsis initiation, on inflammation markers in a murine model of endotoxin-induced sepsis. METHODS: Sprague-Dawley male rats were treated with resveratrol the 3 days prior to LPS administration and 45 min later. Hematological parameters, TNF-α, IL-1ß and CINC-1, FRAP and TBARS levels were determined. Resveratrol and resveratrol-derived metabolites profile in plasma was compared after oral and intraperitoneal administration. RESULTS: Oral treatment with resveratrol had no apparent systemic protective effects. However, resveratrol reduced the levels of lipid peroxidation in the small intestine and colon. Importantly, the administration of LPS caused a decrease in resveratrol absorption. When resveratrol bioavailability after i.p. administration was compared to that observed after oral administration, a different profile of resveratrol metabolites was found in plasma. CONCLUSION: These results highlight the importance of studying the bioavailability of the assayed compounds in the experimental models used to be able to choose the best route of administration depending on the target organ and to determine which compounds or derived metabolites are effective treating the studied disease.

Effect of weight loss on metabolic control in people with type 2 diabetes mellitus: systematic review.

OBJECTIVE: The aim of this systematic review was to examine randomized clinical trials (RCT) regarding long-term effects of weight loss (WL) on biological markers in people with type 2 diabetes mellitus (T2DM). METHODS: We searched for articles published in English and Spanish recorded in the databases of Pubmed and Cochrane , and the journal collections platforms of Ebsco and Scielo between January 1, 2000 and January 1, 2010. Inclusion criteria included RCT with follow-up ≥ 12 months. RESULTS: A total of 842 articles were identified, 95 of them contained information on the effect of WL on biological markers. Twenty studies fulfilled the inclusion criteria. WL percentage ranged from 0.8 to 20%. A reduction of A1C was observed in nine studies, blood glucose in seven, of total cholesterol and LDL in four, systolic and diastolic blood pressure in three, and the use of hypoglycemic drugs in four; an increase of HDL was observed in seven studies. Remission of T2DM was reported in only one study, which included surgical treatment. The quality of the studies ranged from very low to high; however, the study with the longest follow-up that did not involve surgical treatment, was 52 months. CONCLUSION: The evidence of the beneficial effect of WL on biological markers on long-term studies in people with T2DM is inconclusive. These results warrant longer and better designed studies.

[Meal replacement efficacy on long-term weight loss: a systematic review]. / La eficacia a largo plazo de los reemplazos dietéticos en la pérdida de peso: revisión sistemática.

UNLABELLED: Meal replacement (MR) has been frequently used to substitute one or more meals during the day. However, few randomized long-term studies have assessed its efficacy. OBJECTIVE: To asses meal replacement use and its effectiveness on long-term weight loss (> 1 year) in overweight and obese people with or without diabetes. METHODS: A search of randomized clinical trials with an intervention period equal to or more than a year, published on Pubmed, EBSCO host and SciELO through November 2010 was performed. Mesh terms such as "meal replacement", "weight loss," "overweight," "obesity" and "diabetes" were used, plus the term "meal replacement." GRADE scale was used to assess the quality of the studies. RESULTS: Seven studies met the inclusion criteria and were analyzed. It was observed that four of the studies showed a major weight loss in meal replacement groups, but in the other four studies no significant difference in weight loss was found. CONCLUSION: The evidence of the beneficial effect of meal replacement on long-term weight loss is inconclusive. These results warrant longer and better design studies.

Efectividad del uso de suplementos de proteína en entrenamientos de fuerza: Revisión sistemática / Effectivity in the use of protein supplements in resistance training: Systematic review

Para incrementar la fuerza y la masa muscular, la proteína se ha convertido en uno de los suplementos más populares entre los atletas. El propósito de este trabajo fue analizar el efecto de la suplementación proteica sobre la composición corporal. Se realizó una revisión de la literatura de estudios aleatorios controlados, publicados en MEDLINE/PubMed y SciELO hasta el 10 de abril de 2009. Se incluyeron todos los estudios realizados en sujetos sanos con intervenciones >6 semanas. Nueve estudios cumplían con los criterios de inclusión y tres de ellos presentaron nivel de evidencia 3. Entre esos estudios, el aumento de masa muscular osciló de 0.8 a 1.9 kg. Sin embargo, el estudio de más largo plazo fue de 12 semanas. Por lo que las evidencias no son suficientes para recomendar el consumo de suplementos proteínicos entre individuos sanos.

To increase strength and lean body mass, protein has become one of the most popular supplements among athletes. The aim of this study was to analyze the effect of protein supplementation on body composition. A systematic review of the randomized controlled trials (RCT), published in MEDLINE/PubMed and SciELO up to April 10, 2009, was conducted. All RCT conducted in healthy subjects with interventions of six or more weeks were included. Nine studies fulfilled the inclusion criteria, and three of them had level 3 of evidence. Among these studies, the increase of lean mass ranged from 0.8 to 1.9 kg. However, the study with the longest term had duration of 12 weeks. Therefore, the evidence does not support the recommendation for the consumption of protein supplements among healthy individuals.

[Long-term efficacy and safety of Roux-en-Y gastric bypass and gastric banding: systematic review]. / Efectividad y seguridad a largo plazo del bypass gástrico en "Y" de Roux y de la banda gástrica: revisión sistemática.

BACKGROUND: Bariatric surgery has increased substantially in the last years. However, there are controversies of the long-term efficacy and safety. OBJECTIVE: To evaluate the long-term efficacy and safety of Roux-en-Y gastric bypass (BGRY) and gastric banding (Band) in randomized controlled trials and cohort studies. METHODS: We searched for randomized controlled trials and cohort studies of BGRY and Band, with a follow-up > 48 months, with description of weight loss, complications and mortality. RESULTS: Four randomized trials and one cohort study met the inclusion criteria. Mean weight loss was greater with BGRY (27%-39%) than with Band (13%-35%). In both procedures the complication rate is high. Second operation rate is higher with Band. CONCLUSIONS: The outcomes observed from this revision are not sufficient to generalize the efficacy and safety of bariatric surgery to population attended at different health care systems.

[The effect of weight loss on mortality: a systematic review from 2000 to 2009]. / Efecto de la pérdida de peso sobre la mortalidad: revisión sistemática de 2000 a 2009.

The beneficial effect of intentional weight loss on mortality is controversial. The purpose of this study was to conduct a systematic review and analyze the quality of prospective studies that assess weight loss on mortality. An electronic search at MEDLINE/PubMed, SciELO, and EBSCO data base, of studies with a follow-up of five or more years, published from January, 2000 to October, 2009, was conducted. Quality of the studies was assessed by Simonsen's criteria. Twenty studies were analyzed. At the beginning of the studies, the age of the subjects ranged from 20 to 101 years. Nine studies included those who intended to loose weight. The quality of the studies ranged from 8 to 17 points (out of 20). Weight loss increased the mortality rate in 15 studies and decreased it in 5. Seven of the studies assessing intention to loose weight showed that weight loss increased the mortality rate, whereas in two the mortality rate decreased. In three out of the four studies that assessed weight fluctuation, the mortality rate increased. These results underline the importance of preventing weight increase, as well as the need to avoid gaining or loosing weight more than 4%.