Retorno a la actividad completa tras cirugía de reconstrucción de ligamento cruzado anterior en personal militar: metaanálisis / Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis

Objetivo: Se realizó un metaanálisis para evaluar los resultados clínico-funcionales de la cirugía de ligamento cruzado anterior en militares, así como las complicaciones asociadas a la misma. Material y métodos: Se realizó una búsqueda en las 3 principales fuentes de bases de datos hasta diciembre de 2022 (PubMed, Google Scholar y ScienceDirect) en cuanto a los resultados tras la cirugía de ligamento cruzado anterior en personal militar. La revisión sistemática se realizó siguiendo las normas Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA–, y los criterios de inclusión siguieron la estrategia PICO. Los datos de los estudios incluidos se analizaron mediante el software Review Manager 5.4. Resultados: Se seleccionaron un total de 7 estudios retrospectivos. La tasa general de retorno a la actividad completa en el personal militar fue del 62,3% (61,5% para el grupo de no oficiales frente a 68,3% para el grupo de oficiales), sin ser esta diferencia significativa (p=0,92). La tasa general de lesión meniscal en los militares fue del 58,8%, sin ser esta diferencia significativa (p=0,88). La homogeneidad en ambos casos fue buena (I2=0%, p=0,99). Conclusión: El regreso a la actividad militar completa puede usarse en la población militar como un marcador de éxito después de una reconstrucción de ligamento cruzado anterior. Hay que destacar que una gran cantidad de militares experimentan limitaciones permanentes en la actividad que impiden el regreso completo al servicio.(AU)

Objective: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. Material and method: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA– standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. Results: A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). Conclusion: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.(AU)

[Translated article] Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis / Retorno a la actividad completa tras cirugía de reconstrucción del ligamento cruzado anterior en personal militar: metaanálisis

Objetivo: Se realizó un metaanálisis para evaluar los resultados clínico-funcionales de la cirugía de ligamento cruzado anterior en militares, así como las complicaciones asociadas a la misma. Material y métodos: Se realizó una búsqueda en las 3 principales fuentes de bases de datos hasta diciembre de 2022 (PubMed, Google Scholar y ScienceDirect) en cuanto a los resultados tras la cirugía de ligamento cruzado anterior en personal militar. La revisión sistemática se realizó siguiendo las normas Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA–, y los criterios de inclusión siguieron la estrategia PICO. Los datos de los estudios incluidos se analizaron mediante el software Review Manager 5.4. Resultados: Se seleccionaron un total de 7 estudios retrospectivos. La tasa general de retorno a la actividad completa en el personal militar fue del 62,3% (61,5% para el grupo de no oficiales frente a 68,3% para el grupo de oficiales), sin ser esta diferencia significativa (p=0,92). La tasa general de lesión meniscal en los militares fue del 58,8%, sin ser esta diferencia significativa (p=0,88). La homogeneidad en ambos casos fue buena (I2=0%, p=0,99). Conclusión: El regreso a la actividad militar completa puede usarse en la población militar como un marcador de éxito después de una reconstrucción de ligamento cruzado anterior. Hay que destacar que una gran cantidad de militares experimentan limitaciones permanentes en la actividad que impiden el regreso completo al servicio.(AU)

Objective: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. Material and method: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA– standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. Results: A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). Conclusion: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.(AU)

Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis. / Retorno a la actividad completa tras cirugía de reconstrucción de ligamento cruzado anterior en personal militar: metaanálisis.

OBJECTIVE: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. RESULTS: A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.

[Translated article] Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis.

OBJECTIVE: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. MATERIAL AND METHOD: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA- standards, and the inclusion criteria following the PICO strategy. Data from included studies were analysed using Review Manager 5.4 software. RESULTS: A total of seven retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group versus 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). CONCLUSION: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.

Diagnostic tests for alcoholism in primary health care: compared efficacy of different instruments.

BACKGROUND: Alcoholism is an uncommon diagnosis in normal medical activity despite being a prevalent health problem in Spain. One of the main obstacles that make diagnosis difficult is the lack of valid, reliable instruments of detection. The aim of the present study is to validate different tests for diagnosing alcoholism (CAGE, Alcohol Clinical Index, MCV, GGT, GOT/GPT and GGT/AP) in primary care and compare their diagnostic efficacy. METHODS: The diagnostic efficacy and discriminating power of each of the tests were calculated from the results obtained from 219 patients (out of 698 aged over 15 years) who answered the CAGE questionnaire. Patients were selected from doctors surgeries in an urban health centre. The diagnosis of alcoholism was based on the presence of DSM-III criteria and/or a daily alcohol consumption of 60 grams or more in men and 30 or more in women. RESULTS: The CAGE questionnaire showed a sensitivity of 69.86% and specificity of 80.46%, with the cut-off point at 1. The remaining tests showed a poorer diagnostic efficacy. The CAGE questionnaire scoring was the parameter that best distinguished alcoholic patients from non-alcoholic patients. CONCLUSIONS: The CAGE questionnaire demonstrates the greatest efficacy and discriminating power for diagnosing patients with alcoholism in primary care.

[Alcohol consumption and the diagnosis of alcoholic patients in primary care]. / Investigación del consumo de alcohol y diagnóstico de los pacientes alcohólicos en atención primaria.

OBJECTIVE: To find the frequency of investigation of alcohol-related problems and how often alcoholic patients are identified in primary care. DESIGN: A descriptive cross-sectional [correction of crossover] study. SETTING: An urban health centre. PATIENTS: 219 patients over 15 who attended an appointment occasioned by a CAGE questionnaire validation study. 108 had answered affirmatively some of the questions in the test and 111 had answered the four questions negatively. MEASUREMENTS AND MAIN RESULTS: Diagnoses of alcoholism based on the fulfillment of the DSM-III criteria and/or on the presence of alcoholic consumption of > or = 60 grammes per day for men or 30 grammes per day for women were investigated. Additionally, each patient's medical records were checked to see whether their habitual alcohol consumption or a diagnosis of alcoholism were recorded. 54 patients were diagnosed as alcoholic. Previous inquiries into consumption of alcohol were recorded in the medical records of 167 patients (76.2%). A diagnosis of alcoholism was found to be recorded in 19 of the 54 patients who fulfilled the diagnostic criteria of our study (35.2%) and in 3 patients who did not fulfil those criteria. CONCLUSIONS: Although good records of patients' habits of alcohol consumption existed, 64.8% of those diagnosed as alcoholic in our study had not been previously identified as such. This must lead us to question the efficacy of our usual diagnostic methods.

Investigación del consumo de alcohol y diagnóstico de los pacientes alcohólicos en atención primaria / Research on alcohol consumption and diagnosis of alcoholism in a primary health care setting

Objetivos: conocer la frecuencia con que se investiga la presencia de problemas relacionados con el consumo de alcohol y la tasa de identificación de los pacientes alcohólicos en atención primaria. Material y métodos: se investigó en 219 pacientes la existencia de un diagnóstico de alcoholismo basado en el cumplimiento de los criterios diagnósticos del DSM-III y/o en la presencia de un consumo de alcohol mayor a igual a 60 gramos al día para los hombres o 30 gramos al día para las mujeres, y se revisó la historia clínica de cada paciente para investigar si figuraba su consumo habitual de alcohol, así como se había registrado la existencia de un diagnóstico de alcoholismo. El análisis estadístico se realizó por medio del test de X2, y la comparación de medias por el test de Student en el caso de la edad. Resultados: fueron diagnosticados de alcoholismo 54 pacientes. En la historia clínica de 167 pacientes (76,2 por ciento) constaba la investigación previa del consumo de alcohol. Se encontró un diagnóstico de alcoholismo registrado en la historia de 19 de los 54 pacientes que cumplían los criterios diagnósticos fijados en nuestro estudio (35,2 por ciento), así como en 3 pacientes que no los cumplían. Conclusiones: a pesar de que existía un buen registro de los hábitos de consumo de alcohol, el 64,8 por ciento de los pacientes diagnosticados de alcoholismo en nuestro estudio no eran conocidos previamente, lo que hace que debamos cuestionarnos la eficacia de los métodos diagnósticos que utilizamos habitualmente

Investigación del consumo de alcohol y diagnóstico de los pacientes alcohólicos en atención primaria / Research on alcohol consumption and diagnosis of alcoholism in a primary health care setting

Objetivos: conocer la frecuencia con que se investiga la presencia de problemas relacionados con el consumo de alcohol y la tasa de identificación de los pacientes alcohólicos en atención primaria. Material y métodos: se investigó en 219 pacientes la existencia de un diagnóstico de alcoholismo basado en el cumplimiento de los criterios diagnósticos del DSM-III y/o en la presencia de un consumo de alcohol mayor a igual a 60 gramos al día para los hombres o 30 gramos al día para las mujeres, y se revisó la historia clínica de cada paciente para investigar si figuraba su consumo habitual de alcohol, así como se había registrado la existencia de un diagnóstico de alcoholismo. El análisis estadístico se realizó por medio del test de X2, y la comparación de medias por el test de Student en el caso de la edad. Resultados: fueron diagnosticados de alcoholismo 54 pacientes. En la historia clínica de 167 pacientes (76,2 por ciento) constaba la investigación previa del consumo de alcohol. Se encontró un diagnóstico de alcoholismo registrado en la historia de 19 de los 54 pacientes que cumplían los criterios diagnósticos fijados en nuestro estudio (35,2 por ciento), así como en 3 pacientes que no los cumplían. Conclusiones: a pesar de que existía un buen registro de los hábitos de consumo de alcohol, el 64,8 por ciento de los pacientes diagnosticados de alcoholismo en nuestro estudio no eran conocidos previamente, lo que hace que debamos cuestionarnos la eficacia de los métodos diagnósticos que utilizamos habitualmente

Problems related to alcohol consumption in primary health care: prevalence and clinical profile.

The objective of this study was to discover the medical prevalence of alcoholism in our primary care centres, the sociodemographic and clinical profile of these patients and their use of medical resources at our level of health care. The study was an observational one of a cross-sectional descriptive nature, and was set in an urban health centre. Six-hundred and ninety-eight patients aged over 15 years were selected randomly from doctors surgeries. The prevalence of alcoholism among the patients participating in our study estimated from the answers to the CAGE questionnaire, was 17.18%. Of the alcoholic patients, 90.7% were male, with a significantly lower average age than the non-alcoholics; diagnosis was more frequent in production workers than in other occupational groups. The alcoholic patients generally drank daily and consumed drinks with a high percentage of alcohol; 74.1% were smokers. The alcoholic patients were more likely to present a history of neoplasms and injuries or adverse effects than the non-alcoholics. There was a higher attendance rate among alcoholic patients who presented more severe symptoms. It was concluded that alcoholism is a highly prevalent health problem at our level of health care, and fundamentally affects young males.

Determinación de volumen corpuscular medio, gamma-glutamil transpeptidasa y creatinfosfokinasa en la valoración de la abstinencia alcohólica / Mean corpuscular volume, gamma-glutamyl transpeptidase and creatine phosphokinase determination in the evaluation of alcoholic with drawal

Se han determinado VCM, GGT y CPK en 220 pacientes alcohólicos ingresados en la Unidad de Alcoholismo del Hospital Psiquiátrico, a fin de estudiar su interés en el seguimiento de la abstinencia alcohólica. Los resultados fueron comparados con los de un grupo de 48 voluntarios sanos procedentes del personal sanitario de este hospital. Se establecieron dos grupos clínicos en función de la severidad de la hepatopatía: grupo A, formado por 144 pacientes con índice de Orrego inferior a 5. Grupo B: 76 pacientes con índice igual o superior a 5 o bien filiados de hepatitis/cirrosis mediante biopsia. Se llega a la conclusión de que la alta sensibilidad diagnóstica y su precoz normalización, hacen de la CPK el marcador más útil para dar por terminada una cura de desintoxicación. Por otro lado, la de GGT no puede ser utilizada como índice de cese de ingesta de alcohol en todos los pacientes, al menos para valorar precozmente la abstinencia, pues su normalización se ve influenciada de forma apreciable por la severidad de la enfermedad hepática

Correlation of cardiovascular and neuroendocrine tests of autonomic function in diabetes.

Six normal subjects and 16 insulin-dependent diabetics with varying degrees of autonomic damage each had blood sampled for norepinephrine and pancreatic polypeptide for fifteen minutes after a mixed meal and intravenous (IV) edrophonium (Tensilon). The normal subjects showed a brisk but short-lived rise in norepinephrine after edrophonium (average maximum increase 70% between 2 and 6 minutes), as did most diabetics. However, diabetics with cardiovascular reflex evidence of sympathetic damage showed no rise in norepinephrine. Pancreatic polypeptide concentrations increased up to 400% above baseline after a mixed meal in both the normal and the diabetic group with normal cardiovascular reflexes. There was no significant rise in pancreatic polypeptide either in the diabetics with parasympathetic damage alone or in those with additional sympathetic damage. These results provide further evidence for the diffuse nature of the damage in diabetic autonomic neuropathy.

Testing for heart rate variation in diabetes: single or repeated deep breaths?

Heart rate variation during three periods of single deep breaths and three periods of repeated deep breathing at 6 breaths/min was compared in 14 normal and 40 diabetic subjects. There were no differences between the two methods in either normals or diabetics, but the coefficient of variation was significantly smaller using the repeated deep breaths method. When the 6 periods of breathing were analysed separately, no 'training' effect could be detected. The first breath of the repeated deep breaths consistently produced the largest heart rate variation in 29% of the normals and 17% of the diabetics. We conclude that there is no advantage in using the single deep breath method to assess cardiac parasympathetic function in diabetics over the currently used 6 repeated deep breaths/min.

[Use of antibiotics in a general hospital (author's transl)]. / Utilización de antibióticos en un hospital general.

The utilization of antibiotics at a general hospital has been assessed by retrospectively studying the clinical histories of all patients admitted during the month of April 1978 to the Residencia General de la Ciudad Sanitaria Virgen de la Arrixaca (Murcia, Spain). Medical records were reviewed according to a preestablished protocol. Out of 1.057 patients admitted antibiotics were used in 419 (46%), of whom 189 belonged to the medical services and 302 to the surgical ones. Overall, the surgical services utilized more antibiotics and had less bacteriologic data on their patients. Antibiotics more utilized were ampicillin, which use was generally correct, followed by gentamicin, the G-penicillins, and trimethoprim-sulfamethoxazol. Undesirable side-effects of antibiotic treatment were found in 13 cases (2,6%). Infectious disease of bacterial origin was correctly diagnosed in 40% of the cases, while the diagnosis was doubtful or incorrect in the remaining 60% of cases treated with antibiotics. Appropriate bacteriological data were obtained only in 164 cases (33,4%), with positive results in 75 (49,9%). Independent antibiotics were given in association in 157 cases (31,9%). From this study it can be concluded that the more frequent causes of improper antibiotic utilization were the incorrect clinical diagnosis of bacterial infectious disease, the prophylactic use of antibiotics and the scarcity of bacteriological data. It is therefore suggested that systems of supervision of in-hospital antibiotic prescription be updated and continuous education programs for hospital staff be instituted.