Clinical Characteristics in Patients with Rheumatoid Arthritis: Differences between Genders.

OBJECTIVE: To compare the clinical characteristics of a group of men and women with rheumatoid arthritis (RA) and determine the differences between genders. MATERIALS AND METHODS: A descriptive and comparative cross-sectional study was developed with a group of 50 men and a control group of 50 women with RA, from a rheumatology center in the city of Guayaquil, Ecuador. Data collected included clinical manifestations, comorbidities, treatment, and disease activity. Clinical and activity differences between sexes were analyzed. RESULTS: Women were more devoted to housework (66%), while men consumed more tobacco (34%) and alcohol (38%). Fatigue (60%), loss of appetite (54%), and weight loss (44%) were more common in women. No differences were found in comorbidities or treatment. Women had higher values of DAS-28 (3.4 vs 2.5), HAQ-DI (1.1 vs 0.4), ESR (33.0 vs 23.2), painful joints (8 vs 3), swollen joints (6 vs 2), and overall physician assessment (3 vs 2). CONCLUSION: The results are similar to other publications that establish that women have a more aggressive disease with greater activity of the disease and disability.

Bone Mass Loss and Sarcopenia in Ecuadorian Patients.

OBJECTIVE: To study the association between osteoporosis and sarcopenia and determine the prevalence of osteosarcopenia in patients who attended a rheumatology center in Ecuador. METHODS: A cross-sectional study was conducted in a population of patients who had a densitometric study. The diagnosis of sarcopenia was determined by the DXA standard gold test, screening, and conventional methods (bioimpedance, anthropometric measurements, SARC-F, muscle function, and gait test). RESULTS: A total of 92 patients were studied. The median age was 66 ± 10, 90% females. Using the criteria of SMI, 65% had sarcopenia of which 9% had only sarcopenia and 56% had osteosarcopenia; 22% had only osteopenia/osteoporosis; and 13% none of these conditions. The prevalence of sarcopenia according to handgrip strength was 60%, gait speed 45%, and SARC-F score 40%. The prevalence of osteosarcopenia according to handgrip strength was 51%, gait speed 34%, and SARC-F score 32%. Osteoporosis was associated with a higher prevalence of sarcopenia using the criteria of SMI since 40% had sarcopenia in the normal DXA group, 64% in the osteopenia group, and 76% in the osteoporosis group (p=0.017). Of the women, 69% had sarcopenia compared to 33% of the men (p=0.034). The BMI was lower in the group with sarcopenia (25.1 ± 4.1 kg/m2) compared to the group without sarcopenia (29.4 ± 4.1 kg/m2, p < 0.001). Patients with osteosarcopenia and sarcopenia had lower BMI, handgrip strength, ASM, SMI, and total-body skeletal muscle mass than those with osteopenia/osteoporosis or normal patients. CONCLUSION: 65% of the studied population had sarcopenia. It is clear that the prevalence of sarcopenia is higher in patients with greater loss of bone mass. Identifying pathways that affect both bone and muscle could facilitate the development of treatments that simultaneously improve osteoporosis and sarcopenia.

[Changes in traditional techniques in anterior hypospadias]. / Modificaciones a las técnicas tradicionales en el hipospadias anterior.

After confirming that the Magpi and Mathieu techniques are not sufficient for the adequate treatment of 100% of the anterior forms of hypospadias and observing that they often cause defects in the appearance of the meatus, 23 patients were selected and treated with traditional urethroplasties modified by the pyramid technique (King), the Barcat technique, or both, with satisfactory results in all cases. These techniques which are easy to perform, effectively contribute to improving the final appearance of the penis, do not involve major operating time, and present a lower incidence of complications than the traditional techniques.

[Hypospadias. Onlay technique]. / Hipospadias. Técnica en onlay.

The "onlay" urethroplasty is based technically on the following principles: movilization of the urethral plate without dividing it, complete exeresis of chordee beneath it and use of a double faced mucocutaneous vascularized flap from the dorsal aspect rotated to the ventral aspect of penis. Several advantages over other technical modalities make its applicability possible in almost all varieties of hypospadias even in those with severe incurvature. Up to date we have used this technique in 9 patients between 2 and 3 years of age with proximal and middle hypospadias and in one with a considerable middle third fistula, without complications.

Mamoplastia de reducción con cicatrices pequeñas para grandes hipertrofias mamariaso gigantomastias / Reduction mammoplasty with short scars in big mammary hypertrophy or gigantomasty

En la última década, algunos cirujanos plásticos hemos procurado crear técnicas de mamoplastia de reducción con cicatrices menores tratando de no alterar la morfología y la fisiología de la mama. Algunas de ellas dejan resultados poco agradables y ptosis inmediatas en pacientes con grandes hipertrofias mamarias o gigantomastias que necesitan de cicatriz en T invertida para eliminar el exceso de tejido presente en estos casos, con una cicatriz en surco inframamario que muchas veces sobrepasa lateralmente la línea axilar anterior y llega, medialmente, hasta la región esternal. Con el objetivo de obtener cicatrices en el surco inframamario que no sean mayores de 10 cm. de longitud, presentamos una nueva técnica de mamoplastia de reducción realizada en 52 pacientes, con edades comprendidas entre los 16 y los 70 años, que presentaban grandes hipertrofias mamarias o gigantomastias. Esta técnica, con la cual hemos logrado extirpar hasta 1.500 gr. de tejido mamario, tiene una marcación que permite desde el inicio resecar el exceso de tejido del polo inferior de la mama con una cicatriz no mayor de 10 cm. de longitud en el surco inframamario, debido a que las prolongaciones medial y lateral de la mama se tratan con liposucción superficial. Un colgajo glándulo adiposo de pedículo superior ayuda a elevar la mama, a llenar el polo superior de la misma y a aumentar su proyección (AU)

In the last decade, Plastic Surgery has created reduction mammoplasty techniques with less scarring trying not to modify the normal morphology and physiology ofthe breast. Some of them leave unpleasant results and immediateptosis in patients with great hypertrophy or gigantomasty; great need of inverted T scar for removal of excess tissue present in these cases produce a scar in the inframammary crease that often exceeds the antherioraxillary line side and reach the medial sternal region. In order to have minor scars in the inframammary crease, not greater than 10 cm. length, we present a new technique of reduction mammoplasty which has been performed in 52 patients whose ages ranged from 16 to70 years old and had large mammary hypertrophy or gigantomaty. This technique, managed to withdraw up to1.500 gr. of breast tissue, has a dial that allows from the start resects excess tissue of the lower pole of the breast, resulting in a scar no more than 10 cm length in the inframammarycrease, because the medial and lateral extensions have been treated with superficial liposuction. A pedicle adipose-gland flap will help to raise the breast, filling the upper pole and increasing its projection (AU)