Does fracture of the dominant shoulder have any effect on functional and quality of life outcome compared with the nondominant shoulder?

HYPOTHESIS: Proximal humeral fractures involving the dominant arm are not predisposed to worsen the functional outcome and the quality of life compared with proximal humeral fractures of the nondominant arm. METHODS: This was a retrospective study including 179 consecutive proximal humeral fractures divided into 2 groups: fractures involving the dominant arm (n = 97) and fractures involving the nondominant arm (n = 82). Both groups were prospectively assessed for 2 years, and at the end of the follow-up, all patients underwent functional assessment by Constant score and quality of life assessment through the 36-Item Short Form Health Survey (SF-36). RESULTS: At the 2-year follow-up, the mean Constant score of the whole series was 65.5 (64.1 in the dominant group and 66.8 in the nondominant group). No significant differences were noted between groups in the total Constant score or among any of the items of the Constant score (total Constant score, P = .43; pain, P = .63; activities of daily living, P = .70; forward elevation, P = .57; abduction, P = .52; lateral rotation; P = .90; internal rotation, P = .32; and strength, P = .24). The mean physical component summary score of the SF-36 at the 2-year follow-up was 40.8 (39.7 in the dominant group and 41.9 in the nondominant group). The mean mental component summary score of the SF-36 at the 2-year follow-up was 43.5 (44.2 in the dominant group and 42.7 in the nondominant group). No significant differences were noted between groups in any item of the SF-36 (physical component summary score, P = .29; mental component summary score, P = .51). CONCLUSION: No significant difference could be found relating to dominance in functional outcome and in the quality of life perception in proximal humeral fractures. Dominance of the affected shoulder has no influence and should not be used to make treatment decisions.

Insights into the spatial ecology of severely injured free-living felids: Iberian lynx, bobcat, and snow leopard.

Severe musculoskeletal diseases, such as those associated with congenital or traumatic events, that result in missing limbs may compromise the fitness and survival of free-living felids. Here we report the space use of four amputee individuals from three felid species captured from 2017 to 2022 in Missouri (USA), Toledo and Badajoz (Spain), and Suitai Khairkhan Mountain (Mongolia). We describe home ranges and daily travel distances post-release of free-living felids that had either suffered a traumatic amputation or following a surgical amputation. We compared these data with those reported in the literature for felids without amputations. Forelimb or hindlimb amputation did not affect the hunting, mating, or territory patrolling behavior of any of the individuals. However, we recorded significant differences in the daily movement before and after the traumatic event of the Iberian lynx forelimb amputee. We attribute this difference to the physical impairment, although we consider other variables that may have played a role. Nevertheless, all animals appeared to cope well with their limb loss, showing home ranges and daily distances within those recorded for their sex and species. Unless amputee felids represent a threat to domestic livestock or humans, our data suggest these individuals may remain free-living as they contribute to local population persistence and appear to maintain good general health and welfare.

Body composition in adolescent idiopathic scoliosis.

STUDY DESIGN: A controlled prospective cross-sectional case study. OBJECTIVE: To investigate body mass index (BMI) and corporal composition in girls with adolescent idiopathic scoliosis (AIS) and compare them with a normal population matched by sex and age. There is controversy as to whether there are real anthropometric alterations in patients with AIS. Relative to the weight or the BMI, some studies find differences and other studies do not detect them. AIS and anorexia nervosa (AN) make their debut during adolescence and both may be associated with an alteration of their subjective physical perception. Some authors propose a link between AIS and AN supported both by an alteration of physical perception and lower BMI. No studies on body composition in AIS have been published. METHODS: Adolescent idiopathic scoliosis patient surgery candidates during 2008 were studied. Body composition was evaluated using the bioelectrical impedance analysis (Bodystat, Isle of Man, UK). A study population of more than 5,000 patients that was published by Kyle et al. (Nutrition 17:534-541, 2001) was chosen as a control (group 1). Another control group (group 2) of healthy volunteers matched by sex and age was selected among a school age and university population in Barcelona, Spain. A variance analysis was used to analyze differences between the mean values of the control group 1, the European control group, and the AIS patient surgery candidates (Epiinfo 6.2001). Comparisons between the AIS patients and control group 2 were performed with the T Student test of unpaired samples using the SPSS 15.0 (Statistical Package Social Science) software. RESULTS: Twenty-seven women with a mean age of 17.4 years. BMI was 18.9 kg/m(2) (SD 1.7; 95 % CI 18.31-19.73). In the variance analysis, a significant difference between AIS and group 1 in BMI was observed (21.0 vs. 18.9, p = 0.000004); fat-free mass (FFM = 42.6 vs. 38.9, p = 0.0000009) and fat mass (FM = 15.6 vs. 13.7, p = 0.03). Significant differences in BMI (22.13 vs. 18.9, p = 0.001; 95 % CI difference 1.85-4.60), fat mass index (FMi = 7.17 vs. 4.97, p = 0.000; 95 % CI difference 1.36-3.05) and fat-free mass index (FFMi = 14.95 vs. 13.09, p = 0.001; 95 % CI difference 0.26-1.86) between AIS and group 2 were also seen. CONCLUSION: The conclusion is that there is a real alteration of body composition in AIS. The BMI, FFMi and FMi are lower than in the general population in the series under study.

A pre-Hispanic canoe or Wampo burial in Northwestern Patagonia, Argentina.

The burial of Individual 3 at the Newen Antug site, a young adult woman, with a pottery grave offering characteristic of the Late Pottery period and dated to 880 years BP, is an indirect burial in a wooden structure. The form and design comprise a wooden wampo or small canoe, or a symbolic representation of one, a metaphor in current and historical Mapuche society for the voyage to the final abode of the dead, located beyond a water body which must be crossed in a boat. This is the first find of a burial in a canoe structure in Argentinian Patagonia, and the most southern example on the whole continent. It is also the earliest record in Argentina of pottery of the Red on White Bichrome tradition used as a grave offering, extending the repertoire of characteristics shared between the two slopes of the Andes mountains during the pottery periods, including ritual as well as material aspects.

[Diagnostic rentability of close pleural biopsy: Tru-cut vs. Cope]. / Rentabilidad diagnóstica de la biopsia pleural cerrada: Tru-cut frente a Cope.

BACKGROUND: The prevalence of pleural effusion in Mexico is over 400 per 100 000 inhabitants. The etiology is infectious in 45.7% and neoplastic in 32.6%. Closed pleural biopsy sensibility is 48-70% in cancer and 50-59% in tuberculosis using Cope or Abrams needle. In 1989, Tru-cut needle biopsy was described in a small study for massive pleural effusions with a sensibility of 86%. Our Institute has a wide experience with this infrequently procedure with reliable results than using Cope needle. Diagnostic yield should be evaluated. We aimed to evaluate the diagnostic yield of Tru-cut vs. standard Cope biopsy in the histopathological diagnosis of pleural effusion. METHODS: Experimental, not blinded, analytical, cross-sectional study. We studied 44 patients (24 male and 20 female) with exudative pleural effusion over a period of 14 months. Every patient underwent four Tru-cut and four Cope needle biopsies. The diagnostic yield of both methods was compared. RESULTS: The mean age of patients was 61.4 ± 12.2 years. The diagnosis was achieved in 25 (57%) of patients using Tru-cut and 22 (50%) of patients using Cope's closed pleural biopsy. The diagnostic value was not significantly higher (p = 0.41). The most common diagnoses were adenocarcinoma (20.5%), mesothelioma (15.9%) and tuberculosis (15.9%). CONCLUSIONS: The diagnostic yield of Tru-cut needle biopsy is slightly higher than Cope pleural biopsy, very similar to that reported previously. The experience in this procedure is an advantage in our clinical practice.

Introducción: la prevalencia del derrame pleural en México es superior a 400 por 100 000 habitantes. Entre los exudados encontramos etiología infecciosa en 45.7% y neoplásica en 32.6%. La biopsia pleural tiene una sensibilidad de 48-70% en cáncer y 50-90% en tuberculosis si se utiliza aguja de Cope o Abrams. En 1989, se describió la biopsia con aguja cortante (Tru-cut) en un estudio con una sensibilidad de 86%. En nuestro hospital contamos con amplia experiencia en este procedimiento poco practicado actualmente. El objetivo fue comparar la rentabilidad diagnóstica y la seguridad de las biopsias pleurales con aguja de Tru-cut contra aguja de Cope en pacientes con patología pleural. Métodos: estudio experimental, no ciego, analítico, transversal. Se incluyeron 44 pacientes con exudado pleural. A cada paciente se le realizaron cuatro biopsias pleurales con aguja de Tru-cut y cuatro con aguja de Cope para comparar la rentabilidad diagnóstica con ambos procedimientos. Resultados: la media de edad de los pacientes fue de 61.4 ± 12.2 años. La rentabilidad diagnóstica con la aguja de Tru-cut fue de 57% y con Cope de 50% (p = 0.411). El valor diagnóstico no fue significativamente alto (p = 0.41). Los diagnósticos más comunes fueron: adenocarcinoma (20.5%), mesotelioma (15.9%) y tuberculosis (15.9%). Conclusiones: la rentabilidad diagnóstica de las biopsias pleurales cerradas con aguja de Tru-cut es ligeramente mayor a la obtenida con aguja de Cope. Se trata de una fortaleza en nuestra práctica clínica.

Decreased axial coracoid inclination angle is associated with rotator cuff tears.

PURPOSE: Coracoid morphology has been related to coracoid impingement mainly resulting in anterior shoulder pain aggravated by forward flexion and internal rotation. However, the coracoid process morphology can also affect the inclination of the coracoacromial ligament and subsequently the subacromial space in the same way that acromial slope does. The purpose of this study was to evaluate the influence of the coracoid body-glenoid surface, coracoid tip-glenoid surface, and coracoid body-coracoid tip angles (coracoid inclination angles) on rotator cuff tears (RCTs). METHODS: Fifty patients with documented RCT and 50 patients with normal rotator cuff (control) were included. The coracoid inclination angles were determined in both groups by measuring on computed tomography scans the angle created by the coracoid body and the glenoid surface (A1), the angle created by the coracoid tip and the glenoid surface (A2), and the angle created by the coracoid body and the coracoid tip (A3). RESULTS: All angles were significantly lower in the RCT group compared to the control group: mean A1 angle of 49.7° and 54.61°, respectively ( p = 0.011); mean A2 angle of 76.45° and 93.6°, respectively ( p < 0.001); and mean A3 angle of 132.33° and 144.34°, respectively ( p < 0.001). CONCLUSIONS: Decreased coracoid body-glenoid surface, coracoid tip-glenoid surface, and coracoid body-coracoid tip angles are associated with RCT. Decreased angles may reduce subacromial space by projecting the coracoacromial ligament more vertically.

Influence of common associated forefoot disorders on preoperative quality of life in patients with hallux valgus.

BACKGROUND: Hallux valgus (HV) is frequently associated with other forefoot disorders, but its influence on preoperative quality of life (QOL) has not been well characterized. The main purpose of this study was to assess the influence of common associated forefoot disorders (metatarsalgia and lesser toe deformities) on preoperative QOL in patients with HV. METHODS: Preoperative QOL assessed through the Short Form-36 (SF-36, version 2) was obtained from 94 patients with HV from a database. Patients were classified according to their condition: HV alone, HV and metatarsalgia, HV and lesser toe deformities, and HV and both metatarsalgia and lesser toe deformities. Values of each domain were compared among groups. In addition, a correlational study between SF-36 and radiographic severity of HV was performed. The mean age of the 94 patients was 62.6 ± 12.3 years. There were 42.6% patients with HV alone, 30.8% with HV and metatarsalgia, 16% with HV and lesser toe deformities, and 10.6% with HV and both metatarsalgia and lesser toe deformities. RESULTS: Patients with HV and associated metatarsalgia and lesser toe deformities had significantly worse physical function (P = .029), role-physical (P = .017), bodily pain (P = .045), role-emotional (P = .016), mental health (P = .001), and mental component summary (P = .003) compared to patients with HV alone. There were no significant correlations between radiographic HV and intermetatarsal angles and any of the domains or summaries of the SF-36. CONCLUSION: Patients with HV and both metatarsalgia and lesser toe deformities have significantly worse QOL compared to patients with HV alone. The presence of associated forefoot deformities may be a discriminating factor for the prioritization of surgical treatment of HV. LEVEL OF EVIDENCE: Level III, cross-sectional study.

Molecular taxonomy of Anopheles (Nyssorhynchus) benarrochi (Diptera: Culicidae) and malaria epidemiology in southern Amazonian Peru.

Anopheline specimens were collected in 2011 by human landing catch, Shannon and CDC traps from the malaria endemic localities of Santa Rosa and San Pedro in Madre de Dios Department, Peru. Most specimens were either Anopheles (Nyssorhynchus) benarrochi B or An. (Nys.) rangeli, confirmed by polymerase chain reaction-restriction fragment length polymorphism-internal transcribed spacer 2 (PCR-RFLP-ITS2) and, for selected individuals, ITS2 sequences. A few specimens from Lupuna, Loreto Department, northern Amazonian Peru, were also identified as An. benarrochi B. A statistical parsimony network using ITS2 sequences confirmed that all Peruvian An. benarrochi B analyzed were identical to those in GenBank from Putumayo, southern Colombia. Sequences of the mtDNA COI BOLD region of specimens from all three Peruvian localities were connected using a statistical parsimony network, although there were multiple mutation steps between northern and southern Peruvian sequences. A Bayesian inference of concatenated Peruvian sequences of ITS2 + COI detected a single clade with very high support for all An. benarrochi B except one individual from Lupuna that was excluded. No samples were positive for Plasmodium by CytB-PCR.

Atención primaria como elemento de planificación y evaluación académica de la función vinculación Universidad-Sociedad / Primary care as a planning and academic evaluation of university/society linkages function

El modelo educativo de la Universidad Nacional Autónoma de Honduras reformula la educación como una actividad social y concibe los procesos educativos con la finalidad de obtener en la comunidad aprendizajes significativos, contribuir al bienestar integral y al desarrollo humano sostenible de la población y del país. Para lograr esto es necesario incorporar en la planificación académica de vinculación y en los proyectos de intervención en salud; dos elementos de suma importancia: Promoción de la Salud y Atención Primaria de Salud. Orientar las acciones de vinculación con estos elementos permite evaluar a nivel docente-estudiantil, los conocimientos generales que tienen en la formulación de proyectos educativos de vinculación, con el fin de realizar aprendizajes significativos y adquirir las competencias necesarias para trabajar en equipos de Atención Primaria de Salud. Honduras amerita enfoques que busquen el desarrollo del bienestar humano de manera sostenible, que la salud sea vista como un derecho; que los estudiantes se formen bajo el paradigma de la democratización del conocimiento y haciendo acciones que le permitan obtener ese aprendizaje significativo y transformador...(AU)

[Endoscopic sclerosis of bleeding caused by Dieulafoy's lesion]. / Esclerosis endoscópica de lesión de Dieulafoy Gástrica Sangrante.

The upper gastrointestinal bleeding by Dieulafoy's lesion is a rare cause of bleeding, it is a massive haemorrhage and it is difficult to diagnose. Endoscopy is the diagnostic method of choice, in many cases are necessary repeated examinations. Endoscopic therapy is the therapeutic approach of choice, it can achieve the hemostasis in more than 90% of cases; combined therapy methods being more effective than single monotherapy. Surgical treatment remains for cases of uncontrolled hemorrhaging. Dieulafoy's lesion is a rare condition. We have only two nation wide reports. We present two cases of patients with gastric Dieulafoy's lesion with active bleeding which were successfully treated with injection endoscopic of epinephrine and absolute alcohol therapy, showing no relapse of bleeding after 12 months. They did not present other episode of haemorrhage during the twelve months after initial bleeding.

[Peutz-Jeghers syndrome and colon adenocarcinoma]. / Síndrome de Peutz-Jeghers y adenocarcinoma de colon.

The Peutz-Jeghers syndrome is an autosomal dominant disorder characterized by the presence of hamartomatous polyps and characteristic mucocutaneous pigmentations. It is a rare syndrome and its associated to high risk for both gastrointestinal and non-gastrointestinal malignancies. The case of a patient, 32 years old, with symptoms of abdominal pain and rectal bleeding is reported. The upper gastric endoscopy and colonoscopy showed hamartomatous polyps and a tumor in the colon. Reported as a tubular polyp with severe dysplasia, the patient underwent surgical treatment. The final anatomopathologic diagnosis was colon adenocarcinoma.

Esclerosis endoscópica de lesión de Dieulafoy gástrica sangrante / Endoscopic sclerosis of Bleeding Dieulafoy lesion

La hemorragia digestiva alta por Lesión de Dieulafoy es una causa rara de sangrado, siendo en la gran mayoría de casos masiva y de diagnóstico difícil. El método diagnóstico de elección es el endoscópico, requiriéndose a veces endoscopias repetidas. La terapia endoscópica es el método terapéutico de elección, alcanzando la hemostasia en más del 90 por ciento de los casos, siendo los métodos combinados más eficaces que la monoterapia endoscópica; quedando la cirugía para aquellos casos de sangrado incontrolado. Por ser la lesión de Dieulafoy una entidad rara y al encontrar sólo dos publicaciones nacionales, es que se presentan éstos dos casos de pacientes con Lesiones de Dieulafoy gástricas con sangrado activo, que fueron exitosamente tratadas con terapia endoscópica de inyección con adrenalina y alcohol absoluto, no existiendo recidiva del sangrado 12 meses después.

The upper gastrointestinal bleeding by Dieulafoy’s lesion is a rare cause of bleeding, it is a massive haemorrhage and it is difficult to diagnose. Endoscopy is the diagnostic method of choice, in many cases are necessary repeated examinations. Endoscopic therapy is the therapeutic approach of choice, it can achieve the hemostasis in more than 90 per cent of cases; combined therapy methods being more effective than single monotherapy. Surgical treatment remains for cases of uncontrolledhemorraghe. Dieulafoy’s lesion is a rare condition. We have only two nation widereports. We present two cases of patients with gastric Dieulafoy’s lesion with active bleeding which were successfully treated with injection endoscopic of epinephrine and absolute alcohol therapy, showing no relapse of bleeding after 12 months. They did not present other episode of haemorrhage during the twelve months after initialbleeding.

Síndrome de Peutz-Jeghers y adenocarcinoma de colon / Syndrome of Peutz-Jeghers and adenocarcinoma of colon

El síndrome de Peutz-Jeghers es un desorden autosómico dominante, caracterizado por la presencia de pólipos hamartomatosos intestinales y pigmentaciones mucocutáneas características. Es un síndrome raro y se halla asociado a un alto riesgo de malignidad gastrointestinal y no gastrointestinal. Presentamos el caso de una paciente de 32 años con historia de dolor abdominal y sangrado rectal. La endoscopia digestiva alta y colonoscopia revelaron pólipos hamartomatosos y una tumoración en el colon, informada como pólipo tubular con displasia severa, por lo que fue indicado el tratamiento quirúrgico. El diagnóstico anátomo-patológico final fue un adenocarcinoma de colon.

The Peutz-Jeghers syndrome is an autosomal dominant disorder characterized by the presence of hamartomatous polyps and characteristic mucocutaneous pigmentations. It is a rare syndromeand its associated to high risk for both gastrointestinal and non-gastrointestinal malignancies. The case of a patient, 32 years old, with symptoms of abdominal pain and rectal bleeding is reported.The upper gastric endoscopy and colonoscopy showed hamartomatous polyps and a tumor in the colon. Reported as a tubular polyp with severe dysplasia, the patient underwent surgical treatment. The final anatomopathologic diagnosis was colon adenocarcinoma.