Nutrition, osteoarthritis and cartilage metabolism.

BACKGROUND: Osteoarthritis (OA) is a degenerative joint disease and a leading cause of adult disability. There is no cure for OA and there is no effective treatment to stop its progression. Current pharmacologic treatments such as analgesics and non-steroidal anti-inflammatory drugs may improve the pain and offer some relief but they do not affect the progression of the disease. The chronic intake of these drugs may result in severe adverse events. The aim of this review is to revise the effects of nutrition on cartilage metabolism and OA progression. METHODS: A systematic literature search was performed including those related to macro- and micro-nutrients' actions on cartilage and OA outcome. We selected peer-reviewed articles reporting the results of human clinical trials. RESULTS: Glucosamine and chondroitin sulfate have shown to delay OA knee progression in several clinical trials. The effectiveness of some products considered nutraceuticals has been widely reviewed in the literature. This article presents a general description of the effectiveness and mechanism of action of nutrients, vitamins, antioxidants and other natural components considered as part of the normal diet. Many in vitro studies indicate the efficacy of specific nutrients in cartilage metabolism and its involvement in OA. However, rigorous clinical studies needed to evaluate the efficacy of these compounds in humans are still missing. The influence of nutrients and diet on the metabolism of cartilage and OA could represent a long-term coadjuvant alternative in the management of patients with OA. Effects of diet modifications on lipid and cholesterol profiles, adequate vitamin levels and weight reduction in obese patients could influence the course of the disease. CONCLUSION: This review demonstrates that nutrition can improve the symptoms of OA. Glucosamine and chondroitin sulfate have shown robustly to delay the progression of knee OA in several well-designed studies, however more controlled clinical trials are needed to conclude that nutritional changes slow down the progression of the disease.

What Is New in the Clinical Management of Low Back Pain: A Narrative Review.

Low back pain (LBP) is a prevalent condition associated with disability. Treating patients with LBP becomes further complicated by the potential presence of underlying conditions, such as cancer or traumatic injury, or biopsychosocial aspects. LBP usually has a neuropathic component that must be assessed and treated appropriately. Pharmacological management of LBP requires a thorough knowledge of the available agents and the mechanisms of the LBP. Although there are effective pharmacological treatments for LBP, it is important to consider safety issues. Fixed-dose combination products may be helpful, as they can reduce opioid consumption without sacrificing analgesic benefits. Neuromodulation is an important and sometimes overlooked treatment option for LBP and may be appropriate for chronic LBP requiring long-term treatment. Imaging studies support neuroplastic changes in the brain as a result of neuromodulation. Interventional approaches to chronic LBP are numerous and must be appropriately selected based on the individual patient. Evidence in support of epidural injections for LBP is strong for short-term pain control but moderate to limited for long-term relief. Rehabilitation for LBP can be an important element of long-term care, and new forms of rehabilitation programs are being developed using telemedicine. A variety of new and established treatments are available for patients with LBP, and clinicians and patients may benefit from emerging new treatment modalities.

Challenges and opportunities for quality densitometry in Latin America.

Latin America and the Caribbean region account for 8% of the world's total population. Experts from 18 countries were invited to contribute to this article to provide the best available data on the number, types, and quality of densitometry, DXA experts, the local/national incidence and prevalence of osteoporosis and fragility fractures, and other uses and information on the challenges and opportunities for quality densitometry with examples of local initiatives. Osteoporosis is the primary reason for densitometry in our region, which is not a priority for public health in most countries. Access and quality are major challenges, and there is a clear trend to concentrate on densitometry services in the largest cities. Urgent action is needed to face the rapidly increasing burden of osteoporosis in our region, including robust and up to date epidemiology, access to health professionals, and quality densitometry. Health professionals require better access to training, courses, and other activities at a more local or regional level.

Osteoporosis: a clinical and pharmacological update.

Osteoporosis is characterized by the loss of bone mass, deterioration of the bone microarchitecture, and an increased risk of fractures; these later complications are associated with significant morbidity and mortality. The asymptomatic and progressive nature of osteoporosis underscores the importance of identifying this entity in early stages. Despite the various treatments available, the prevention of the disease represents the most important aspect of management. An adequate intake of calcium and vitamin D as well as a healthy lifestyle is the basis for maintaining bone health. When osteoporosis is diagnosed, the choice of medications must be individualized considering characteristics of the patient and the risk of fractures. In this article, we review the main causes of osteoporosis, when and how to start treatment, and appropriate therapy and monitoring.

Daily Living Activities and Cognition in Aged Patients: Effect of Acute Systemic Diseases and Stroke on Leukoaraiosis.

BACKGROUND: Acute Systemic Diseases (ASD) impact on extended leukoaraiosis (ExLA) have been seldom described. We study the deterioration in daily life activities (DLA) and cognition associated with ASD events compared with the well-described impacts of stroke in patients with leukoaraiosis (L-A). METHODS: Cross-sectional surveys of aged adults from the emergency room after an acute event of ASD or stroke, hospitalized or receiving home care, were followed for one year. From 268 initial patients 206 were included in the study, all with moderate to severe L-A (Fazekas 2 and 3). The Clinical Deterioration Rating (CDR) and the modified Rankin scale with structured interview were obtained one week previous to admission and after 3 and 12 months of evolution. Comparisons were conducted within and between groups with nonparametric techniques. RESULTS: We formed three groups of similar age, A: Inpatients with one Stroke, B: Inpatients with one ASD, and C: Outpatients with one ASD. A sudden deterioration in Rankin was evident in Group A, while in B and C impairment was progressive. Impairment in CDR was smooth in all groups while in Rankin it was always greater than in cognition (CDR). No differences were found in the associations between groups and risk factors, hypertension being the most frequent one. CONCLUSION: ASD in ExL-A causes a worsening of DLA and cognition similar to that observed in ExL-A with concomitant stroke indicating the need, in ageing patients, of differential diagnosis in order to achieve the best possible treatment.

Correlación entre el porcentaje de grasa corporal y el índice de masa corporal en adultos mayores: rol del sexo y edad / Correlation between body fat percentage and body mass index in the elderly: role of sex and age

Fundamentos: Dado el aumento de la población mayor, que está predispuesta a padecer enfermedades relacionadas con la obesidad, es necesario disponer de herramientas precisas para medirla. El objetivo de este estudio fue determinar la correlación entre el porcentaje de grasa corporal (%GC) y el índice de masa corporal (IMC) en los adultos mayores, ajustando dicha correlación por edad y sexo. Métodos: Se trata de un estudio retrospectivo, transversal y analítico conformado por datos de 50 adultos mayores atendidos en el "Servicio de Geriatría del Hospital Central de la Fuerza Aérea del Perú" durante los años 2019-2020. El porcentaje de grasa corporal se determinó mediante dos métodos: absorciometría dual de rayos X (DXA) e impedancia bioeléctrica (BIA). Resultados: Utilizando el análisis de regresión logística, se observó que las variables significativas asociadas al IMC eran el %GC, determinado por BIA, tanto en hombres como en mujeres, y determinado por DXA, el %GC en mujeres. Conclusiones: Por lo general, los resultados mostraron una correlación positiva entre el IMC y el %GC, independientemente del dispositivo utilizado. Dicha relación fue mayor en el sexo femenino. La edad tuvo un efecto menos significativo. (AU)

Background: Due to the growing elderly population, more of whom have a predisposition to obesity-related diseases, there is a need for precise tools that measure obesity. The objective of this study was to determine the correlation between body mass index (BMI) and body fat percentage (BF%) in the elderly. Additionally, the correlation would be observed adjusting for age and gender. Methods: This was a retrospective, cross-sectional, analytical study comprised of 50 individuals aged ≥60 attended in the "Geriatric Care of the Central Hospital of the Air Force of Peru" during the years 2019-2020. Body fat percentage was determined by two methods: dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance (BIA). Results: Using logistic regression analysis, the significant variables associated with BMI were BF%, determined by BIA, in both men and women, as well as BF%, determined by DXA in women. Conclusions: Generally, the results showed a positive correlation between BMI and BF%, regardless of the apparatus utilized. The relationship was strongest in females. Age was reported to have a less significanteffect. (AU)

Estudios recientes sobre bebidas azucaradas en Colombia: una revisión no sistemática / Recent studies on sugar sweetened beverages in Colombia: a non-systematic review

Este artículo presenta una revisión de la literatura reciente sobre el consumo de bebidas azucaradas (BA) en Colombia. A partir de una revisión no sistemática de literatura se escogieron 20 estudios, agrupados en las siguientes categorías: 5 realizados con base en la Encuesta Nacional de Situación Nutricional; 7 estudios subnacionales y 5 relacionados con impuestos a BA; los 3 restantes corresponden al abordaje de la prensa colombiana a las BA y a estrategias regulatorias para reducir su consumo. Inicialmente se presenta una síntesis de los principales hallazgos de cada uno de los estudios incluidos,seguido de una discusión a la luz de la bibliografía regional sobre el consumo de BA y las estrategias para reducir esa práctica. La revisión realizada permite afirmar que Colombia cuenta con información importante sobre el consumo de BA, por esa razón es momento de implementar políticas públicas efectivas que reduzcan el consumo de esos productos

This article presents a review of recent literature about the consumption of sugar sweetened beverages (SSBs) in Colombia. Based on a non-systematic review, 20 studies were chosen, which were grouped into the following categories: 5 carried out based on the National Survey of Nutritional Situation; 7 subnational studies and 5 related to taxes on SSBS; the remaining 3 correspond to the Colombian press's approach to SSB sand regulatory strategies aimed at reducing their consumption. Initially, the authors show a synthesis of the main findings of every research selected, then they are discussed in the light of the regional literature about sugar SSBs consumption and the strategies to reduce it. The review of the selected literature allows to affirm that Colombia has important information about the consumption of sugar sweetened beverages, for that reason it is time to take effective measures to reduce the consumption of these products.

Implementación del Convenio Marco de la Organization Mundial de la Salud para el Control del Tabaco y la Prevention del Cáncer en Colombia / Implementation in Colombia of the Framework Convention on Tobacco Control to Prevent Cancer: Achievements and Challenges / Implementação do Convenção-Quadro para o Controle do Tabaco e a prevenção do cancro na Colômbia

Resumen Introducción: el tabaquismo es un problema global. Un problema tan importante que hizo que la Organización Mundial de la Salud liderara el Convenio Marco Para el Control del Tabaco, del cual son parte la gran mayoría de países del mundo. En ese contexto, Colombia ha realizado varias acciones para reducir la prevalencia del tabaquismo; estas acciones están enmarcadas en el Plan Decenal para el Control del Cáncer 2012-2021. Desarrollo: se analizó la implementación de las acciones planteadas por el Plan Decenal para el Control del Cáncer y su correlación con el Convenio Marco de la Organización Mundial de la Salud, bajo la implementación del Plan de Medidas MPOWER. Conclusiones: Colombia ha implementado varias estrategias para el control del tabaco, enmarcadas en el Plan Decenal para el Control del Cáncer. Entre estas estrategias, se encuentra un sistema de vigilancia del consumo de tabaco, políticas de control, espacios cien por ciento libres de humo de tabaco, el Programa para la Cesación del Consumo de Tabaco y Atención del Tabaquismo, advertencias sanitarias moderadas, campanas de comunicación, prohibición completa de publicidad, promoción y patrocinio, así como un aumento de los impuestos al tabaco. A pesar de estas implementaciones, el reto actual es intervenir aquellas medidas en las que menos se ha trabajado o que han tenido menor resultado para lograr que el control del tabaquismo sea más efectivo; también es necesario hacer frente al uso de cigarrillos electrónicos. Las medidas descritas deberían implementarse sin la interferencia de la industria tabacalera.

Abstract Introduction: Smoking is a global issue that motived the World Health Organization to lead the Framework Convention on Tobacco, adopted by many countries. In that context, Colombia has carried out some actions to reduce smoking prevalence, taking into account the Ten-Year Plan for Cancer Control 20122021. Development: This article analyzes the implementation of the actions proposed by the Ten-Year Plan for Cancer Control 2012-2021 and its correlation with the Framework Convention on Tobacco's MPOWER Package. Conclusion: Colombia has implemented some strategies to control smoking through the Ten-Year Plan for Cancer Control 2012-2021, such as the smoking monitoring system, control policies, smoke-free areas, the National Program for Smoking Cessation, moderate health warnings, communication campaigns, total restriction to any kind of advertisement and promotion, and raising tax of tobacco products. In spite of those achievements, it is necessary to strengthen the weakest strategies to reduce smoking, as well as facing electronic cigarette use. These actions must be carried out without tobacco industry interference.

Resumo Introdução: o tabaquismo é um problema global que orientou à Organização Mundial da Saúde a liderar o Convenção-Quadro para o Controle do Tabaco, do qual são parte a grande maioria de países. Nesse contexto, a Colômbia tem realizado várias ações para reduzir a prevalência do tabaquismo enquadradas no Plano Decenal para o Controle do Cancro 2012-2021. Desenvolvimento: se analisa a implementação das ações apresentadas pelo Plano Decenal para o Controle do Cancro e sua correlação com a Convenção-Quadro sob a implementação do Plano de Medidad MPOWER. Conclusões: a Colômbia tem implementado várias estratégias para o controle do tabaco enquadradas no Plano Decenal para o Controle do Cancro entre as que se encontra o sistema de vigilância de consumo de tabaco, políticas de controle, espaços 100 % livres de fumo de tabaco, o Programa Nacional para a Cessação, advertências sanitárias moderadas, campanhas de comunicação, proibição completa de publicidade, promoção e patrocínio e aumento dos impostos ao tabaco. Apesar do anterior, o desafio é intervir nas medidas com maior retrocesso para conseguir que o controle do tabaquismo seja mais efetivo; também é necessário enfrentar ao uso de cigarros eletrônicos. O anterior, sem interferência da indústria do tabaco.

Calidad de vida y prestaciones en salud de pacientes con diabetes mellitus tipo 2 según región geográfica en Argentina / Quality of life and health benefits in patients with type 2 diabetes according to geography region in Argentina

Introducción: la adherencia al tratamiento de la diabetes mellitus tipo 2 (DM2) en el adulto es un tema complejo y multifactorial que aúna aspectos propios de la enfermedad como no propios, los cuales impactan en la calidad de vida. En Argentina se presentan grandes dificultades al costear la totalidad del tratamiento de la enfermedad. El impacto del ingreso sobre el gasto en salud en DM2 es mayor para los niveles más bajos de ingresos. Objetivos: analizar en adultos con DM2 en Argentina diferencias en variables de calidad de vida y objetivos metabólicos según regiones geográficas y prestación en salud; conocer el gasto de bolsillo en salud y los costos en salud vinculados a DM2; establecer la asociación entre el gasto de bolsillo con variables socioeconómicas y el cumplimiento de los objetivos metabólicos. Materiales y métodos: sobre ocho regiones geográficas de la República Argentina se incluyeron 1.520 pacientes adultos con DM2 y se los clasificó según prestación en salud (sin prestación, con prestación o jubilados). Se aplicó cuestionario validado autorreferido. Resultados: se encontraron diferencias significativas por región geográfica para jubilación prematura por DM2, pérdida de percepción de calidad de vida y cumplimiento de los objetivos metabólicos. Se encontró significancia estadística del gasto de bolsillo con la presencia de subsidio familiar, la jubilación prematura por DM2 y el cumplimiento de los objetivos metabólicos. Conclusiones: se observó disparidad entre las variables de calidad de vida, el gasto en salud y la percepción de subsidios

Introduction: adherence to treatment of diabetes mellitus type 2 (DT2) in the adult is a complex and multifactorial issue that combines aspects of the disease as not own, which impact on the quality of life. In Argentina there are great difficulties in paying for the entire treatment of the disease. The impact of income on health spending in DT2 is greater for lower income levels. Objectives: to analyze differences in quality of life and metabolic objectives according to geographic regions and health benefits in adults with DT2 in Argentina; know the out of pocket expenses in health and health costs linked to DT2; establish an association between out of pocket spending with socioeconomic variables and compliance with metabolic objectives. Materials and methods: over eight geographic regions of the Argentine Republic, 1.520 adult patients with DT2 were classified according to health benefit (without benefit, with benefits or retirees). Validated self-reported questionnaire was applied. Results: significant differences were found by geographic region for premature retirement due to DT2, the loss of perception of quality of life and the fulfillment of metabolic objectives. Statistical significance of out-of-pocket spending was found with the presence of family allowance, early retirement by DT2 and compliance with metabolic objectives. Conclusions: disparity between the variables of quality of life, health expenditure and perception of subsidies was observed

Adherencia al tratamiento en pacientes con diabetes mellitus tipo 2 en Argentina durante 2015 / Adherence to treatment in patients with type 2 diabetes melltius in Argentina during 2015

Introducción: la interrupción en la adherencia a los tratamientos prescriptos genera obstáculos importantes los cuales impactan negativamente en los indicadores de salud. Objetivos: evaluar la adherencia al tratamiento en pacientes adultos con diabetes mellitus tipo 2 (DM2) en Argentina, y establecer la asociación con el tipo de prestación de atención en salud y la ubicación geográfica. Materiales y métodos: se incluyeron 1.520 individuos pertenecientes a ocho regiones diferentes de la República Argentina durante 2015. Se realizó un estudio transversal. Se aplicó un cuestionario validado autorreferido de opciones múltiples con respuestas policotómicas de puntuación simple. Se empleó una escala cuantitativa y un análisis multivariado de componentes principales. Resultados: la edad media fue de 60,2 años y la antigüedad de DM2 referida correspondió a 10,1 años. La media de HbA1c fue de 7,85%. La media de adherencia general para todas las características fue 4,32 (61,71%). Los resultados de adherencia encontrados se asemejan a otros países en desarrollo a excepción del cuidado de los pies. El factor cuidado de los pies en nuestro país reporta escalas de mayor adherencia. Se detectaron resultados tal vez redundantes como la mayor adherencia al monitoreo en las terapias de uso con insulina, y menores para dieta, ejercicio y solo uso de antidiabéticos orales (ADO), así como también la mayor adherencia en medicación en las terapias con insulina e insulina más ADO. Conclusiones: son alarmantes las bajas escalas referidas al grupo con solo dieta y ejercicio

Introduction: the interruption in the adherence to the prescribed treatments generates important obstacles which negatively impact on health indicators. Objectives: to evaluate adherence to treatment in adult patients with diabetes mellitus type 2 (DT2) in Argentina; associate with the type of health care provision and location. Materials and methods: we included 1.520 individuals belonging to eight different geographical regions of the Argentine Republic during 2015. A cross-sectional study was conducted. A self-reported validated questionnaire of multiple options with simple scoring polycotomic responses was applied. A quantitative scale and a multivariate analysis of main components were applied. Results: the average age was 60.2 years and the seniority of the referred DT2 corresponded to 10.1 years. The average HbA1c was 7.85%. The average general adherence for all characteristics was 4.32 (61.71%). The adherence results found are similar to other developing countries except for the care of the feet. The care factor of the feet in our country report scales of greater adherence. Redundant results are observed, such as greater adherence to monitoring in insulin therapy and less for diet and exercise and only oral antidiabetic drugs (ADO), as well as greater medication adherence in insulin and insulin therapies more ADO. Conclusions: the low scales referred to the group with only diet and exercise are alarming

Efecto de los factores relacionados al cuidado de la diabetes mellitus tipo 2 y motivos de no adhesión en Argentina / Effect of factors related to the care of type 2 diabetes mellitus and reasons for non-adherence in Argentina

Introducción: analizar la injerencia de la adherencia al tratamiento en la evaluación clínica optimiza el uso de pruebas y evita intensificar tratamientos que pueden aumentar riesgos en los pacientes. Conocer sobre las variables influyentes implica el conocimiento y el control de factores relativos al cuidado de la diabetes mellitus tipo 2 (DM2). Objetivos: analizar el efecto de la adherencia al tratamiento en adultos con DM2 en Argentina. Materiales y métodos: estudio transversal. Se incluyeron 1.520 pacientes adultos con DM2 con tres o más meses de antigüedad de enfermedad residentes en Argentina. Se aplicó un cuestionario validado autorreferido. Se evaluó el grado de adherencia reportada, las recomendaciones dadas por el equipo de salud, las formas de adhesión y los motivos de incumplimiento por medio del Summary of Diabetes Self-Care Activities (SDSCA). Resultados: representando diferentes regiones geográficas, la media de adherencia general para todas las características fue 4,32 (61,71%); los peores puntajes para la adherencia correspondieron a la actividad física, el monitoreo glucémico y la dieta en orden ascendente. Se observaron carencias en las recomendaciones por parte del equipo de salud al momento de indicar medidas higiénico dietéticas. Conclusiones: los resultados nacionales observados guardan similitud en la dieta, la actividad física y la disminución en el consumo de tabaco con respecto a los datos prevalentes proveniente de la Cuarta Encuesta Nacional de Factores de Riesgo

Introduction: analyzing the interference of adherence to treatment in clinical evaluation optimizes the use of tests and avoids intensifying treatments that may increase risks in patients. Knowing about the influential variables implies the knowledge and control of factors related to the care of diabetes mellitus type 2 (T2D). Objectives: to analyze the effect of adherence to treatment in adults with T2D in Argentina. Materials and methods: transversal study. We included 1.520 adult patients with T2D with 3 or more months of illness in Argentina. A validated self-reported questionnaire was applied. The degree of adherence reported, the recommendations given by the health team, the forms of adherence and the reasons for non-compliance through the Summary of Diabetes Self-Care Activities (SDSCA) were evaluated. Results: representing different geographical regions, the mean of general adherence for all the characteristics was 4.32 (61.71%); the worst scores for adherence corresponded to physical activity, glycemic monitoring and diet in ascending order. There were shortcomings in the recommendations by the health team when indicating hygienic dietary measures. Conclusions: the observed national results are similar in diet, physical activity and the decrease in tobacco consumption with respect to prevailing data from the Fourth National Survey of Risk Factors.

Cirugía coronaria sin circulación extracorpórea: primeros100 casos en el Hospital Regional de Concepción / Off pump coronary bypass surgery: first 100 cases at Hospital Regional de Concepcion

Introducción: La cirugía coronaria sin circulación extracorpórea (CEC) es una técnica de revascularización miocárdica comparable a la cirugía con CEC. Iniciamos su uso en marzo de 2004. Objetivo: Revisar los resultados de las primeras 100 cirugías con esta técnica en nuestro centro. Método: Los pacientes se seleccionaron según la experiencia del grupo. Se tabularon antecedentes clínicos y datos de hemodinamia. Todas las cirugías se realizaron con anestesia general y por esternotomía media. Se utilizaron estabilizadores coronarios y cardíacos por succión. Se tabuló la morbimortalidad operatoria y realizó seguimiento clínico hasta el 31 de julio de 2007. Resultados: Correspondieron a 75 hombres. Edad promedio 60.2 +/- 9.6 años. Presentaban hipertensión arterial 62 pacientes, diabetes mellitus 20, tabaquismo 23. Infarto reciente 23 pacientes, 6 de ellos trombolizados.17 pacientes con angioplastía previa. Presentaban lesión de un vaso 32 pacientes, lesión de dos vasos 31, lesión de tres vasos 29 y lesión de tronco coronario izquierdo 8. La función del ventrículo izquierdo fue normal en 82 pacientes, compromiso moderado en 12 y disfunción severa en 6. Se realizaron 2.2 +/- 1 puentes por paciente. Un paciente se consideró revascularización incompleta. Un paciente debió ser convertido por disfunción ventricular y falleció en el postoperatorio. Hubo una reoperación por sangrado y un paciente sufrió una mediastinitis. Durante el seguimiento (promedio 14.3 +/-7.6 meses) reingresó un paciente por oclusión de un bypass Conclusiones: En esta serie, la cirugía coronaria sin CEC demostró ser una técnica segura y reproducible de revascularización miocárdica.

Background: Off pump coronary bypass surgery results have been reported as similar to those of full pump surgery Aim: to review the first 100 cases with this technique at Hospital Regional de Concepcion Method: patients were selected according to prior experience from the surgical group. Clinical and hemodynamic data were recorded. All operations were performed under general anesthesia and through a medial sternotomy. Suction coronary and cardiac stabilizers were used. Operative morbidity and mortality as well as follow up data up to July 2007 were tabulated. Results: 75 out of 100 patients were males. Mean age of the series was 60.2 (SD 9.6) years. Hypertension was present in 62 patients, diabetes in 20, smoking in 23. Twenty three patients had a prior myocardial infarction, and 6 had received thrombolytics. 17 patients had prior PTCA. Single vessel disease was present in 32 patients, double vessel disease in 31, triple vessel disease in 29 and main left disease in 8. Left ventricular function was normal in82, moderately depressed in 12 and 6 had severe generalized dysfunction. A mean of 2.2 (SD 1) grafts per patient were performed. Only1 patient had incomplete revascularization. One patient was switched to full pump due to severe left ventricular dysfunction and died postoperatively. Bleeding led to reoperation in 1 patient and mediastinitis developed in another one. During follow up (mean 14 +/-7.6 months) one patients was readmitted for bypass occlusion. Conclusion: Off pump revascularization surgery was a safe and reproducible technique in this series.

Evaluación del EuroSCORE como predictor de mortalidad, complicaciones y duración de hospitalización cardíaca / Evaluation of the EuroScore as a predictor of mortality, complications and length of hospital stay in cardiac surgery

Introducción: El EuroSCORE es una escala de riesgo diseñada para predecir mortalidad en cirugía cardiaca. Objetivo: Evaluar el EuroSCORE como predictor de mortalidad, complicaciones y duración de la estadía hospitalaria. Método: Aplicación prospectiva del EuroSCORE a todos los pacientes sometidos a cirugía cardíaca en el Hospital Regional de Concepción entre enero de 2002 y diciembre de 2005 (N=698). Edad promedio 56.7 años. Correspondieron a 452 hombres, 19 pacientes con EPOC, 29 con enfermedad vascular periférica, 52 reoperaciones, 21 con endocarditis activa y 70 considerados como estado preoperatorio crítico. Presentaron angina inestable 155 pacientes, 82 disfunción moderada y 10 disfunción severa del ventrículo izquierdo. 128 pacientes tenían antecedente de infarto menor a 90 días. Se consideraron de urgencia 59 cirugías. Se efectuaron 251 cirugías distintas de bypass coronario aislado. Los pacientes se dividieron en 3 grupos (grupo I: 0-2 puntos; grupo II: 3-5 puntos; grupo III: 6 y más). Se correlacionó cada grupo con mortalidad, complicaciones y duración de la estadía post operatoria con prueba de Chi cuadrado de independencia de variables y análisis de varianza de una vía. Resultados: Grupo I: 224 pacientes, grupo II: 279 pacientes y grupo III: 195 pacientes. La mortalidad observada fue de 1.3%, 4.6% y 7.2% respectivamente (p = 0.012). Se presentaron complicaciones en un 15.2%, 26.5% y 30.2%, respectivamente (p = 0.002). Los días de estada postoperatoria promedio fueron 7.4, 7.4 y 9.2 (p = 0.01). Conclusiones: El EuroScore se correlacionó adecuadamente con la mortalidad, complicaciones y duración de la estadía post - operatoria.

Background: The EuroSCORE is a risk scale designed to predict mortality in cardiac surgery. Aim: to evaluate the EuroSCORE as a predictor of mortality, complications and length of hospital stay in patients undergoing cardiac surgery. Methods: the EuroSCORE was determined in all patients undergoing cardiac surgery at the Hospital Regional de Concepcion between January 2002 and December 2005 (n=698). Mean age was 56.7 years, 452 patients were males. Obstructive pulmonary disease was present in 19, peripheral vascular disease in 29, and active infective endocarditis in 21. Seventy patients were critically ill before surgery and 52 were reoperations. Unstable angina waspresent in 155; the left ventricular ejection fraction was severely depressed in 10 and moderately depressed in 82. Prior myocardial infarction within 90 days was present in 128. Surgery was classified as urgent in 59. According to the EuroSCORE, three groups were identified: G1 (0-2 points, n=224), G2 (3-5 points, n=279) and G3 (³ 6 points, n=195). Operative mortality, complications and length of hospital stay were compared across groups using one way ANOVA. Results: Operative mortality was 1.3%, 4.5% and 7.2% in G1, G2 and G3, respectively (p=0.012). Complications developed in 15.2%, 26.5% and 30.2%, respectively (p=0.002). Mean hospital stay was 7.4, 7.4 and 9.2 days, respectively (p=0.01). Conclusion: The EuroSCORE was a useful predictor of mortality, complications and length of hospital stay in patients undergoing cardiac surgery.

Resultados clínicos alejados del uso de prótesis Ultracor en posición aórtica / Late results of aortic valve replacement with the Ultracor prosthesis

Introducción: La prótesis Ultracor® es una válvula mecánica monodisco. Se utilizó para reemplazo valvular aórtico(RVA) en nuestro servicio entre 1995 y 2003. Objetivo: Evaluar los resultados del uso de prótesis Ultracor en posición aórtica. Método: Revisión retrospectiva de fichas clínicas de pacientes sometidos a RVA exclusivo con prótesis Ultracor entre 1995 y 2003 en el Hospital Regional de Concepción (N=117). Se tabularon los datos demográficos, patología valvular, capacidad funcional (CF) y fracción de eyección pre operatorios; y la morbi - mortalidad operatoria. En el seguimiento se evaluaron los episodios de hemorragia, tromboembolismo, endocarditis, necesidad de reoperación y defunciones tardías. Resultados: 77 pacientes (65.8 por ciento) de sexo masculino. Edad promedio 54.4 años. 62 pacientes (53 por ciento) estaban en CF I ó II. La indicación quirúrgica fue por estenosis en 59 (50.4 por ciento) e insuficiencia en 42 (53.9 por ciento). Se presentaron complicaciones en 34 pacientes (29 por ciento) y fallecieron 6 (5.1 por ciento). Seguimiento en 105 pacientes (94.6 por ciento) con un total de 402 años/paciente (promedio 3.9 años). Las tasas de complicaciones ( por ciento / año) fueron: 1.2 para tromboembolismo y 2.5 para hemorragia, 1 para endocarditis y 1 para reoperación. Fallecen 18 pacientes en el seguimiento (2.2 por ciento /año). Se realizó ecocardiograma a 75 pacientes. No hubo disfunción estructural y se presentaron 4 leak perivalvulares. Conclusiones: En esta serie observamos tasas de complicaciones similares a las publicadas para otras prótesis. La mayoría de ellas (tromboembolismo, hemorragia, endocarditis y reoperación por endocarditis) no son atribuibles directamente a la prótesis y consideramos que los resultados obtenidos con ella son satisfactorios.

Background: The Ultracor® monodisk prosthesis was used to correct aortic valve disease in our institution in the 1995-2003 period. Aim: To evaluate late results of aortic valve replacement using the Ultracor® prosthetic valve Methods: The clinical records of patients receiving an Ultracor® prosthesis as isolated valve replacement for aortic valve disease at the Hospital de Concepción from 1995 to 2003 were reviewed. A total of 117 patients were evaluated preoperatively to determine the type of aortic valve disease, functional class and LV ejection fraction. Operative mortality and morbidity were recorded. Late results were evaluated in terms of thrombo-embolic and hemorrhagic complications, infective endocarditis, need for reoperation and late death. Results: There were 77 males (66 percent) and the mean age was 54.4 years. Sixty two patients were functional class 1 or 2 (53 percent). Aortic stenosis in 50.4 percent and aortic insufficiency in 53.9 percent were the indications for surgery. Operative mortality was 5.1 percent and significant complications developed in 29 percent. Follow up was obtained in 105 patients (94.6 percent) for a total of 402 patient-years (mean 3.9). Complication rates ( percent per year) were: thrombo-embolism 1.2, bleeding 2.5, endocarditis 1 and reoperation 1. Eighteen patients died during follow up (2.2 percent per year). An echocardiogram performed in 75 patients showed a paravalvular leak in 4; there were no instances of structural damage of the prosthesis. Conclusion: Overall clinical results of aortic valve replacement with the Ultracor® prosthesis were quite satisfactory and complications occurred with rates similar to those reported for other aortic prosthesis. They were not related to the valve.

Susceptibilidad a las infecciones en las enfermedades reumáticas / Susceptibility at infections in the rheumatic diseases

En el presente artículo se revisa de manera detallada la relación entre las enfermedades reumáticas y las infecciones. En esta revisión se incluye también las alteraciones inmunológicas que provocan las enfermedades reumáticas y las infecciones más comunes en los pacientes con enfermedaes del tejido conjuntivo. Además se analizaron otros factores que pueden favorecer el desarrollo de infecciones en el paciente reumático.

Síndrome benigno de hipermovilidad articular / Benign syndrome of articular hypermovility

El síndrome benigno de hipermovilidad articular (SBHA) se caracteriza por un aumento generalizado en el rango de movimiento articular debido a laxitud ligamentaria. La prevalencia del SBHA ha sido reportada ente el 3 y 30 por ciento de diferentes poblaciones y el diagnóstico se establece mediante los criterios de Carter y Wilkinson con la modificación de Beighton y el sistema de puntuación de Bird. Las asociaciones clínicas más importantes son artralgias y mialgias, luxaciones recurrentes y el desarrollo de osteoartrosis a edad temprana. El manejo del SBHA consiste principalmente en fisioterapia y tratamiento sintomático si es necesario.

Osteoartritis: un problema común en la práctica diaria / Osteoarthritis: a problem common in the practice daily

La osteoartritis representa la enfermedad reumática más común en humanos y diferentes estudios epidemiológicos han establecido claramente que su prevalencia se incrementa con la edad. Se pueden encontrar evidencias radiológicas de osteoartritis en alrededor del 80 por ciento de sujetos mayores de 55 años. Los cambios patológicos principales ocurren en el cartílago articular y el hueso subcondral. El daño estructural del cartílago produce erosiones en su superficie y la proliferación de cartílago y hueso ocasiona la formación de osteofitos. Desde que no existen pruebas de laboratorio que definan la presencia de osteoartritis, el diagnóstico se basa en el cuadro clínico y los hallazgos radiológicos. El examen del líquido sinovial es normal o se pueden encontrar cambios inflamatorios leves. El objetivo del tratamiento se alcanza combinando diferentes medidas terapéuticas que incluyen educación del paciente, fisioterapia y rehabilitación, uso racional de fármacos y terapia intralesional.