[External fixation with reconstruction rail system as a treatment for pseudoarthrosis of the distal femur]. / Fijación externa con sistema de riel de reconstrucción como tratamiento para seudoartrosis del fémur distal.

Distal femur pseudoarthrosis also called «distal femur non-union¼ (DFNU) represents a rare complication associated with a fracture caused by high-energy trauma; its treatment is controversial, as there is a wide variety of surgical techniques that can be implemented, from open reduction plus internal fixation with plates, to the use of fixed angle plates combined with bone autograft. We expose the case of a 24-year-old man who shows up for consultation with the history of having presented a left femoral supracondylar fracture with a year of evolution, treated by osteosynthesis of the distal femur with dynamic condylar screws (DCS plate); developed a torpid evolution with severe pain in the distal third of the left thigh and functional limitation, developed a progressive varus deformity of the left thigh that caused a shortening of 3.8 cm of the limb. A focus of pseudoarthrosis was identified, which was surgically removed, the intramedullary canal was recanalized, and a lateral closed wedge osteotomy was performed to correct the angulation and allow reduction. 5.5 mm (three proximal and three distal) hydroxyapatite screws and an external fixator were placed. In addition, a review of the literature focused on the use of external fixation was carried out as a treatment for the pseudoarthrosis of the distal femur.

La seudoartrosis del fémur distal, también llamada «no unión del fémur distal¼ (NUFD), representa una complicación poco frecuente asociada a una fractura causada por un traumatismo de alta energía; su tratamiento es controversial, ya que existe una gran variedad técnicas quirúrgicas que pueden ser implementadas desde la reducción abierta más la fijación interna con placas hasta el uso de placas de ángulo fijo combinadas con autoinjerto óseo. Exponemos el caso de un hombre de 24 años de edad, el cual se presenta a la consulta con el antecedente de haber sufrido una fractura supracondílea femoral izquierda con un año de evolución, tratada mediante una osteosíntesis del fémur distal con tornillos condilares dinámicos (placa DCS); mostró una evolución tórpida con dolor severo en el tercio distal del muslo izquierdo y limitación funcional, desarrolló una deformidad en varo progresiva del muslo izquierdo que causó un acortamiento de 3.8 cm de la extremidad. Se identificó un foco de seudoartrosis, el cual se retiró quirúrgicamente, se recanalizó el canal intramedular y se realizó una osteotomía de cuña cerrada lateral para corregir la angulación y permitir la reducción. Se colocaron tornillos de hidroxiapatita de 5.5 mm (tres proximales y tres distales) y un fijador externo. Además se hizo una revisión de la literatura enfocada en el uso de la fijación externa como tratamiento de la seudoartrosis del fémur distal.

Management of the toxicity of chemotherapy and targeted therapies in elderly cancer patients.

The elderly form a very heterogeneous group in relation to their general health state, degree of dependence, comorbidities, performance status, physical reserve and geriatric situation, so cancer treatment in the older patient remains a therapeutic challenge. The physiological changes associated with aging increase the risk of developing a serious toxicity induced by chemotherapy treatment, as well as other undesirable consequences as hospitalizations, dependence and non-compliance with treatment, that can negatively affect survival, quality of life and treatment efficacy. The use of hematopoietic growth factors and other active supportive interventions in the elderly can help prevent and/or alleviate these toxicities. However, we have little data on the efficacy and tolerance of support treatments in the older patient. The objective of this work is to review the most frequent toxicities of oncological treatments in the elderly and their management.

Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte / Installed Capacity Perception Survey for the Training of Resident's Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico

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Abstract: Introduction: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. Material and methods: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. Results: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients ˂ 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients ˃ 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. Conclusions: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and ˃ 90% without regular scientific production.

General recommendations paper on the management of older patients with cancer: the SEOM geriatric oncology task force's position statement.

Population aging is associated with greater numbers of older people with cancer. Thanks to treatment advances, not only are more seniors diagnosed with cancer, but there are also more and more older cancer survivors. This upward trend will continue. Given the heterogeneity of aging, managing older patients with cancer poses a significant challenge for Medical Oncology. In Spain, a Geriatric Oncology Task Force has been set up within the framework of the Spanish Society for Medical Oncology (SEOM). With the aim of generating evidence and raising awareness, as well as helping medical oncologists in their training with respect to seniors with cancer, we have put together a series of basic management recommendations for this population. Many of the patients who are assessed in routine clinical practice in Oncology are older. CGA is the basic tool by means of which to evaluate older people with cancer and to understand their needs. Training and the correct use of recommendations regarding treatment for comorbidities and geriatric syndromes, support care, and drug-drug interactions and toxicities, including those of antineoplastic agents, as detailed in this article, will ensure that this population is properly managed.

Geriatric oncology in Spain: survey results and analysis of the current situation.

INTRODUCTION: Geriatric oncology (GO) is a discipline that focuses on the management of elderly patients with cancer. The Spanish Society of Medical Oncology (SEOM) created a Working group dedicated to geriatric oncology in February 2016. OBJECTIVES: The main goal of this study was to describe the current situation in Spain regarding the management of elderly cancer patients through an online survey of medical oncologists. METHODS: A descriptive survey was sent to several hospitals by means of the SEOM website. A personal e-mail was also sent to SEOM members. RESULTS: Between March 2016 and April 2017, 154 answers were collected. Only 74 centers (48%) had a geriatrics department and a mere 21 (14%) medical oncology departments had a person dedicated to GO. The vast majority (n = 135; 88%) had the perception that the number of elderly patients with cancer seen in clinical practice had increased. Eighteen (12%) oncologists had specific protocols and geriatric scales were used at 55 (31%) centers. Almost all (92%) claimed to apply special management practices using specific tools. There was agreement that GO afforded certain potential advantages. Finally, 99% of the oncologists surveyed believed it and that training in GO had to be improved. CONCLUSIONS: From the nationwide survey promoted by the Spanish Geriatric Oncology Working Group on behalf of SEOM, we conclude that there is currently no defined care structure for elderly cancer patients. There is an increasing perception of the need for training in GO. This survey reflects a reality in which specific needs are perceived.

Mouse model of congenital infection with a non-virulent Toxoplasma gondii strain: Vertical transmission, "sterile" fetal damage, or both?

Congenital transmission of Toxoplasma gondii may occur if the mother gets infected for the first time while pregnant. The risk of mother-to-child transmission depends on the gestation trimester at infection, being lowest in the first and highest in the last. Conversely, fetal damage is frequent and more severe at the beginning of pregnancy. The objective of this study was to evaluate congenital transmission and pathological aspects in the placenta and the fetus using a mouse model of congenital infection of the second gestation third. Forty-five female BALB/c mice were infected intravenously with 2.5-10.0 × 10(6) tachyzoites of the ME49 strain at middle gestation. Samples of maternal spleen and fetal/placental units were taken 72 h later. We determined parasite load and vertical transmission by qPCR, as well as damage macroscopically and by histopathology. With the lowest dose, 18% of the fetuses were infected. Also, 40% of fetuses/litter were altered, while this value was 10% in the control group (P < 0.05). These results are similar to those described in humans in terms of vertical transmission and fetal damage during the second third of gestation. The maternal spleen had 10-1000 times more tachyzoites than the placenta, and the later retained 90-99% of the parasites that could reach the fetus. Nevertheless, we found resorptions, abortions or fetal tissue damage in the presence but also in the absence of parasites. Our data indicate a strong protective effect of maternal organs and the placenta against fetal infection, but extensive damage of the later may led to resorption or abortion without vertical transmission.

Nanoindentation characterization of the micro-lamellar arrangement of black coral skeleton.

Black corals (antipatharians) are colonial cnidarians whose branched tree-like skeleton is mostly constituted of chitin fibrils inside a lipoproteic matrix. The skeleton exhibits growth rings formed by chitin layers (micro-lamellae). In order to know the effect of the arrangement microlamellae of chitin of black corals and to improve the understanding of the role of chitin structure in the antipatharian skeleton, the mechanical properties of the skeleton of two black corals, Antipathes caribbeana and Antipathes pennacea, were examined using nanoindentation tests. Measurements of reduced elastic modulus, nanohardness and the viscoelastic behavior were measured with a spheroconical indenter. The results indicate variations in the values of the mechanical properties clearly associated with different structures present in the skeletons, the core being the one that invariably shows the maximum values. The solid multilamellar arrangement of black coral chitin, its viscoelastic behavior, and the anisotropic mechanical response, are relevant factors contributing to the successful adaptation of black coral colonies to shallow as well as to very deep waters.

Anticholinesterasic, nematostatic and anthelmintic activities of pyridinic and pyrazinic compounds.

In the search for acetylcholinesterase inhibitors as a potential target for the discovery of anthelmintic drugs, a series of 27 pyridinic and pyrazinic compounds have been designed on the basis of molecular hybridization of two known AChE inhibitors, namely, tacrine and (-)-3-O-acetylspectaline, and on the concept of isosterism. The synthesized compounds generally presented moderate anticholinesterasic activities when compared with the positive control physostigmine, but one compound (ethyl 2-[(6-chloropyrazin-2-yl)sulfanyl] acetate) exhibited an in vitro ability to immobilize the root-knot nematode Meloidogyne incognita that was highly comparable to that of the positive control Temik. Moreover, in anthelmintic assays against the gastrointestinal parasitic nematode Nippostrongylus brasiliensis (L4), some of the compounds, such as (6-chloropyrazin-2-yl)sulfanyl ethanol (32, EC50 = 33 nM), presented activities that were considerably stronger than that of the positive control albendazole (EC50 = 340 nM). In the light of the positive results obtained in the anthelmintic evaluations, the acute oral toxicity of the representative compound diethyl 2,2'-[(3-nitropyridine-2,6-diyl) bissulfanediyl] diacetate was determined in rats, and the drug was shown to be non-toxic at a dose of 2000 mg/kg. These results, allied with the relatively simple structures of the active compounds and their facile synthesis, highlight their potential use as anthelmintic or nematicidic agents.

Progesterone treatment, FSH plus eCG, GnRH administration, and Day 0 Protocol for MOET programs in sheep.

The effect of various superstimulatory treatments on the number of corpora lutea, fertilization rate, and embryo yield was studied in sheep. Overall, data from 708 Merino donors and 4262 embryos were analyzed in four experiments. In Experiment 1, varying intervals of progesterone treatment (5 to 14 d) before follicle-stimulating hormone (FSH) administration did not significantly affect the proportion of responding donors, the mean number of corpora lutea, or the mean number of recovered and transferable embryos per donor. In Experiment 2, a single dose of equine chorionic gonadotropin (eCG, 200 or 300 IU) combined with the FSH treatment (i.e., given at CIDR removal) reduced the number and the quality of embryos compared with that for not giving eCG (P<0.05). In Experiment 3, one dose of gonadotropin-releasing hormone (GnRH) given 24h after CIDR removal improved the number of transferable embryos compared with that for not giving GnRH (P<0.05). In Experiment 4, the new superstimulatory Day 0 Protocol, which includes starting FSH treatment at the emergence of Wave 1 (i.e., soon after ovulation, in the absence of a large follicle), improved ovarian response, with a tendency to produce more embryos compared with that for the Traditional Protocol. In summary, this study, analyzing data from various pharmacologic treatments, allows an improvement from four to eight transferable embryos per treated donor in multiple ovulation and embryo transfer programs in sheep.

Nematocidal activity of natural polyphenols from bryophytes and their derivatives.

The nematocidal in vitro activity of three natural perotetins (phenolic bisbibenzyiethers) and eleven diphenyl ethers used as synthetic precursors has been assayed using two different experimental models, Caenorhabditis elegans and Nippostrongylus brasiliensis. Nine compounds showed some activity against C. elegans and nine against N. brasiliensis. For the former model, three compounds displayed an activity similar to that of the standards, whereas for N. brasiliensis none of the tested compounds was as active as the standards. From the in vitro results, five compounds (3, 4, 8, 9, 13) could be selected as lead compounds to continue the search for improved activity.

In vitro taurocholate-induced segmentation and clustering of Mesocestoides vogae (syn. corti) tetrathyridia (Cestoda)--inhibition byh cestocidal drugs.

Mesocestoides vogae (syn. M. corti) tetrathyridia were cultured in the presence of sodium taurocholate, for the purpose of exploring the suitability of this organism for the in vitro assay of cestocidal drugs. Parasite clustering and segmentation were observed as taurocholate-dependent effects in biphasic and monophasic media, respectively. Interestingly, representative members of two major classes of known cestocidal agents (namely, albendazole and praziquantel) blocked these effects. Furthermore, it was possible to determine a specific concentration of the drugs that inhibited clustering and segmentation (minimum inhibitory concentration). In contrast, no inhibition was obtained in the presence of anthelmintics without cestocidal activity. These observations open the way for further studies focused at understanding how the activity of the drugs is involved in the suppression of the taurocholate-induced effects.

New sesquiterpene derivatives from the red alga Laurencia scoparia. Isolation, structure determination, and anthelmintic activity.

Eleven sesquiterpenes (1-11) and one long chain aldehyde (12) have been isolated from the dichloromethane extract of the red alga Laurencia scoparia. Four of them are new natural products. Scopariol (1) is a new natural product with an unusual rearranged chamigrane-type structure. The other three are beta-chamigrenes: isorigidol (2), (+)-3-(Z)-bromomethylidene-10 beta-bromo-beta-chamigrene (3), and (-)-3-(E)-bromomethylidene-10 beta-bromo-beta-chamigrene (4). The in vitro activity of compounds 1-12 against the parasitant stage of Nippostrongylus brasiliensis (L4) has been studied.

Use of L4 larvae of Nippostrongylus brasiliensis for the in vivo screening of anthelmintic drugs.

Five groups of Wistar rats were subcutaneously infected with 5,000 L3 stage larvae of Nippostrongylus brasiliensis. Four groups were dosed orally with 5, 10, 15, and 20 mg/kg body weight of albendazole at 5 h postinfection, and one group served as an untreated control. The animals were euthanized and the intestines were dissected out 72 h postinfection and were incubated on a Baermann's apparatus to recover L4 stage larvae. No larvae were recovered from the 20 mg/kg albendazole-treated group, and means of 15, 33, and 175 L4 larvae were recovered from the 15, 10, and 5 mg/kg albendazole-treated groups, respectively. Levamisole and fenbendazole were also tested using the same procedure. Means of 100 and 1,887 L4 larvae were obtained from the 50 and 10 mg/kg of levamisole-treated groups respectively; while, 191 and 583 L4 larvae were recovered from rats treated with 50 and 10 mg/kg of fenbendazole, respectively. These results indicate that the L4 stage of N. brasiliensis could be useful for in vivo screening of new nematocide drugs.

Diabetes mellitus among ethnic seniors: contrasts with diabetes in whites.

Diabetes mellitus is one of the most common chronic diseases affecting older persons in the United States. It occurs in 18% of persons between 65 and 75 years of age and in as many as 40% of persons over 80 years of age. The prevalence of diabetes mellitus varies considerably by ethnic group and is higher among most minority groups in the United States than among non-Hispanic white persons. Published data also show increased complications and mortality rate from diabetes in the minority groups. In this article, we review the current literature on the prevalence, complications, and mortality-rate effects of diabetes mellitus and the results of interventions in three major minority groups in the United States, namely African Americans, Hispanic Americans, and Native Americans. Recent studies of diabetes mellitus in Mexican seniors also are described. Our review focuses primarily on patients with non-insulin-dependent diabetes mellitus, because by far this is the most prevalent type in older persons.

[Cardiovascular risk factors and carotid atherosclerosis detected by ultrasonography]. / Factores de riesgo cardiovascular y aterosclerosis carotídea detectada por ultrasonografía.

OBJECTIVES: To assess the frequency of carotid atherosclerosis and its relation to cardiovascular risk factors in a general elderly population of Mexico City. MATERIAL AND METHODS: B-mode ultrasonography was performed to investigate carotid atherosclerosis in 145 CUPA (a research project) participants, between July 1993 and January 1996. The outcome was then related to cardiovascular risk factors. RESULTS: Prevalence of ultrasound-detected carotid atherosclerosis was 64.8%. Intimal-medial thickening was detected in 64 subjects (44.1%) and carotid plaques in 82 (56.5%); Fifty-two subjects had both intimal-medial thickening and plaques. However, only 8 subjects had carotid plaques with severe stenosis (5.5%). There were no significant differences in the prevalence of atherosclerotic lesions (male 61.9%, female 66.0%). Carotid atherosclerosis was significantly associated with age (p < 0.0001), high blood pressure (p < 0.001), isolated systolic hypertension (p = 0.01), hypercholesterolemia (p = 0.04), and diabetes mellitus (p = 0.06). Prevalence of carotid atherosclerosis increased progressively with the number of vascular risk factors. CONCLUSIONS: There was a high prevalence of carotid atherosclerosis in this general elderly population of Mexico City, and was almost equal to that reported in developed western countries. Age, hypertension, hypercholesterolemia, and diabetes were the strongest predictors of atherosclerosis.

Lipidic matrix of albendazole: an alternative for systemic infections.

Albendazole is a poorly water soluble drug, with low oral bioavailability, used in pharmacological treatment of a systemic disease as hydatid parasitosis. Lipidic matrices of Gelucires (44/14 and 35/02) were developed. After "in vitro" studies, one formulation was chosen for a single dose study in 8 healthy volunteers, with a cross-over and randomised design, taking a commercially available tablet as reference. Drug absorption was followed by albendazole sulphoxide dosage in urine by high pressure liquid chromatography. Neither albendazole nor albendazole sulphoxide were recovered in urine after tablet administration while 0.18% (+/- 0.06) of dose was recovered after lipidic matrix administration in the first 24 hours. Besides ageing control were performed up to 18 months post-elaboration. Lipidic matrix with Gelucire 44/14 was revealed as a promising attempt for oral pharmaceutical form in albendazole systemic treatment.

A new indole derivative from the red alga Chondria atropurpurea. Isolation, structure determination, and anthelmintic activity.

Chondriamide C (3), a new bis(indole) amide, was isolated from the red alga Chondria atropurpurea, and its structure was established from spectroscopic data and chemical transformations. A new natural product, 3-indoleacrylamide (4), and the previously described chondriamides A and B (1, 2) and 3-indoleacrylic acid (5) were also isolated. The anthelmintic activities of compounds 1, 3, 4, and 6 (the O,N1,N1'-trimethyl derivative of compound 2) against Nippostrongylus brasiliensis in vitro were evaluated.

[Diversity in studies of the prevalence of systemic arterial hypertension]. / Diversidad en los estudios de prevalencia de hipertensión arterial sistémica.

To evaluate the information about prevalence of hypertension at a national level, several articles published either within or outside Mexico from 1933 to 1995 were reviewed. Variables about criteria and methodology were considered: the BP readings, method used, cutting points to define hypertension, year for screen. There were 30 papers out of 7 states, 16 reporting the Federal District of Mexico, 3 from Jalisco, 3 from Yucatán and 2 from Tamaulipas, there was only one referring to the State of Mexico, one to Veracruz, one to Michoacán and another referring to Mexicans in USA; as whole population there were two, one by the Instituto Mexicano del Seguro Social and another by Secretaría de Salud. A wide variation in prevalence was found (0.47 to 30.9%) mainly attributed to different sampling, measurements and reporting methodology. Few information was disclosed regarding female and elderly populations. The trend is slightly increasing, as expected accordingly to other information sources, but the problem might actually be masked by bias interference. Most of the studies performed have contributed so far to explore the gross prevalence, but may not reach scientific evidence to base evaluations of preventive interventions. The problem may not just be happening in this country. Variability may be partially controlled following the international recommendations to record arterial blood pressure, but still, there is a lack of recommendations to uniform epidemiological reports. Otherwise the values of hypertension prevalence may not be useful for hypertension surveillance.

[Prevalence of carotid atherosclerosis in a cohort of Mexico City]. / Prevalencia de aterosclerosis carotídea en una población de la ciudad de México.

In order to investigate the prevalence of atherosclerosis in Mexico, high resolution ultrasound and color Doppler flow imaging of carotid arteries were carried out in a group of participants in CUPA project, a cohort study started in 1989 among persons 60 years and older living permanently in a high rise in México City. Imaging studies included identification of 4 atherosclerosis related abnormalities: 1) intima media thickness; 2) kinkings and tortuousness; 3) non-stenosing plaques; and 4) significant carotid stenosis (> 50%). Analysis of 198 Doppler ultrasonographic studies in 56 males and 142 females showed an overall prevalence of atherosclerosis related lesions of 65.6%, with increasing frequency by age groups: 33% in younger than 65 year-old, 71% in 65-74 years, and up to 88% in the 75 years and older group. The prevalence of high grade stenosis was low (6%) whereas the overall frequency of non-stenosing plaques and intima-media thickness was higher than 60%. Intima-media thickness was more common in males while non-stenosing plaques and high grade stenosis were more frequent in females. However, there were not significant differences among women and men when atherosclerotic lesions were analyzed by age groups. This is the first report on the prevalence of atherosclerosis in a Mexican population using ultrasonography. Findings of the investigation document the high prevalence of atherosclerosis among elderly resident in Mexico City.

Lipidic matrix of albendazole sulphoxide: is it an alternative for systemic infections?

As albendazole sulphoxide (ABZS) shows better dissolution properties than albendazole (ABZ), a lipidic matrix with this drug was formulated in order to evaluate if its absorption and so systemic infection chemotherapy could be improved. A cross-over, randomised study in 8 healthy volunteers was carried out, after single administration of 1 g of albendazole or albendazole sulphoxide in lipidic matrix of Gelucire 44/14 (ABZLM and ABZSLM). Absorption was followed performing albendazole sulphoxide dosage in urine samples by high pressure liquid chromatography analysis, during 48 hours. Significant differences were found (p = 0.02) between the urinary recoveries (% E48), being 1.74% and 0.19% the percentage of dose recovered when ABZSLM or of ABZLM were respectively administered. In a previous study of our group similar values were obtained of urinary recovery percentages after albendazole sulphoxide powder administered to another group of healthy volunteers. Lipidic matrix does not improve the physicochemical properties of albendazole sulphoxide powder.