Treatment strategies for managing cervical spine injuries in rugby players.

BACKGROUND: Cervical spine fractures are potentially catastrophic injuries in rugby players. Here, we reviewed seven patients who sustained rugby-related cervical spine fractures. Notably, three of seven fractures were missed on initial X-rays, but were ultimately documented on CT studies obtained an average of 10 days later. METHODS: Seven patients sustained cervical spine fracture attributed to rugby (2009-2016) and were followed an average of 52 posttrauma months. Most injuries occurred at the C6-C7 level, and six of seven patients required surgery. Further, only two of seven patients exhibited resultant neurological deficits (e.g., one myelopathy and one radiculopathy). RESULTS: Although the rugby injury was sufficiently documented on initial X-rays in four patients, three initial X-rays missed fractures, which were documented on the CT studies obtained an average of 10 days later. CONCLUSION: Rugby-related cervical fractures must be considered where players continue to complain of pain following trauma. Notably, routine X-rays may miss fractures in 3 of 7 cases (43%), thus warranting supplemental CT examinations to definitively rule out fractures.

Cross-cultural adaptation and validation of the VISA-A questionnaire for Chilean Spanish-speaking patients.

BACKGROUND: The purpose of this study is to translate, culturally adapt, and validate the VISA-A questionnaire for Chilean Spanish speakers with Achilles tendinopathy (AT), which has been originally developed for English-speaking population. METHODS: According to the guidelines published by Beaton et al., the questionnaire was translated and culturally adapted to Chilean patients in six steps: initial translation, synthesis of the translation, back translation, expert committee review, test of the pre-final version (cohort n = 35), and development of VISA-A-CH. The resulting Chilean version was tested for validity on 60 patients: 20 healthy individuals (group 1), 20 patients with a recently diagnosed AT (group 2), and 20 with a severe AT that already initiated conservative treatment with no clinical improvement (group 3). The questionnaire was completed three times by each participant: at the time of study enrollment, after an hour, and after a week of the initial test. RESULTS: All six steps were successfully completed for the translation and cultural adaptation of the VISA-A-CH. VISA-A-CH final mean scores in the healthy group was significantly higher than those in the other groups. Group 3 had the lowest scores. Validity showed excellent test-retest reliability (rho c = 0.999; Pearson's r = 1.000) within an hour and within a week (rho c = 0.837; Pearson's r = 0.840). CONCLUSIONS: VISA-A was translated and validated to Chilean Spanish speakers successfully, being comparable to the original version. We believe that VISA-A-CH can be recommended as an important tool for clinical and research settings in Chilean and probably Latin-American Spanish speakers.

Five-Strand Hamstring Autograft Versus Quadruple Hamstring Autograft With Graft Diameters 8.0 Millimeters or More in Anterior Cruciate Ligament Reconstruction: Clinical Outcomes With a Minimum 2-Year Follow-Up.

PURPOSE: To compare the outcomes of 2 groups of patients undergoing anterior cruciate ligament (ACL) reconstruction: the first with a quadrupled semitendinosus gracilis (ST-G) autograft larger than 8 mm diameter and the second with a 5-strand ST-G autograft larger than 8 mm due to an insufficient diameter graft harvesting. METHODS: This was a retrospective study with 70 patients divided into 2 groups. Inclusion criteria included ACL ruptures of less than 3 months, ST-G ACL reconstructions, and final (4-strand or 5-strand) graft size larger than 8 mm. Exclusion criteria included multiligament knee injuries, meniscal or chondral pathology, ACL re-ruptures, inflammatory joint disease, or other procedures in the knee. RESULTS: Group A comprised 33 patients with a quadruple ST-G graft, and group B comprised 37 patients with an insufficient graft diameter (<8 mm) in which a 5-strand graft was used. Mean age in group A was 29.7 (range 17-52) years and in group B was 30.6 (range 13-53) years (P = .78). Average follow-up in group A was 32.2 (range 24-48) months and in group B was 30.35 (range 24-48) months (P = .75). Average graft diameter in group A was 8.5 mm (range 8-10) and in group B when the graft was measured as quadruple was 7.2 mm (range 6.5-7.5) and 9.2 mm (range 8-10) when it was converted to 5-strand (P = .00596). Group A had 3 (9%) re-ruptures, and group B had 2 (5.4%) (P = .55). The average postoperative Lysholm score in group A was 93.3 (range 71-100) and in group B was 97.1 (range 80-100) (P = .79). Mean postoperative International Knee Documentation Committee in group A was 91 (range 75.9-100) and in group B was 96.8 (range 82-100) (P = .18). CONCLUSIONS: In our study, the 5-strand hamstring autograft in ACL reconstruction was clinically comparable with the quadruple autograft larger than 8 mm. The differences in re-rupture and clinical outcomes were not statistically significant between the 2 groups, suggesting that it is a valid option when we have a graft of insufficient diameter. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Comportamiento de factores relacionados con la estadía hospitalaria en ancianos con neumonía extrahospitalaria / Behavior of factors related with the hospital stay in elderly with community-acquired pneumonia

Introducción: la neumonía extrahospitalaria representa un azote para el hombre, con seria repercusión social. Objetivo: determinar el comportamiento de factores relacionados con la estadía hospitalaria en ancianos con neumonía extrahospitalaria. Métodos: se realizó un estudio analítico de casos-control, en ancianos de 65 años y más, egresados en el servicio de medicina interna del Hospital General Docente Aleida Fernández Chardiet del municipio de Güines, provincia Mayabeque con diagnóstico de neumonía extrahospitalaria, en el período comprendido entre el 1 de mayo de 2011 hasta el 30 de abril de 2012. El universo estuvo constituido por 132 ancianos y la muestra 104. Se excluyeron los fallecidos y los reingresados. Los pacientes fueron divididos en dos grupos, menos de 10 días de estadía control y los de 10 y más días casos. Ambos fueron comparados según la edad, comorbilidades, severidad de la neumonía y las complicaciones.Resultados: predominó la estadía media 76 y el grupo de 75 y más años 51,92 por ciento. La mayoría tuvo comorbilidades 80,7 por ciento más evidente en el grupo de casos 82,1 por ciento citándose la insuficiencia cardíaca como la más frecuente. La neumonía no severa predominó 71,43 por ciento y las formas severas fueron más frecuentes en el grupo de mayor estadía 28,57 por ciento. Las complicaciones predominaron en el grupo de casos 53,5 por ciento, en particular la pleuresía 32,14 por ciento.Conclusión: la mayor edad no condicionó una mayor estadía hospitalaria, pero la presencia de comorbilidades, el desarrollo de neumonía severa y de complicaciones fueron más frecuentes en el grupo de estadía prolongada (AU)

Introduction: community acquired pneumonia represents a scourge for mankind, with serious social repercussion. Objective: to determine the behavior of factors related with hospital stay in elderly with community acquired pneumonia. Methods: an analytical case-control study was performed in elderly aged 65 years and over, graduates in the service of internal medicine of Aleida Fernández Chardiet Teaching General Hospital of Güines municipality, Mayabeque province with diagnostic of community-acquired pneumonia, in the period comprised between May 1st, 2011 until April 30th, 2012. The universe was constituted by 132 elderly and the sample 104. Those deceased and re-admitted were excluded. The patients were divided into two groups, less than 10 days of stay control and the ones of 10 and more days cases. Both were compared according to the age, comorbilities, severity of the pneumonia and complications.Results: there was predominance of mean stay 76 and the group of 75 and older 51,92. The majority had comorbilities 80,7 per cent more evident in the group of cases 82,1 per cent quoting the cardiac insufficiency as the most frequent one. Non-severe pneumonia predominated 71,43 per cent and the severe forms were more frequent in the group of greater stay 28,57 per cent. The complications predominated in the group of cases 53,5 per cent, in particular pleurisy 32,14 per cent.Conclusion: the greater age did not condition a greater hospital stay, but the presence of comorbilities, the development of severe pneumonia and complications were more frequent in the group of prolonged stay (AU)

Multiple sclerosis in Latin America: A different disease course severity? A collaborative study from the MSBase Registry.

Limited data suggest that multiple sclerosis (MS) in Latin America (LA) could be less severe than in the rest of the world. The objective was to compare the course of MS between LA and other regions. METHODS: Centers from 18 countries with >20 cases enrolled in the MSBase Registry participated. Patients with MS with a disease duration of >1 year and <30 years at time of EDSS measurement were evaluated. The MS Severity Score (MSSS) was used as a measure of disease progression. Comparisons among regions (North America, Europe, Australia and LA), hemispheres and countries were performed. RESULTS: A total of 9610 patients were included. Patients were from: Europe, 6290 (65.6%); North America, 1609 (16.7%); Australia, 1119 (11.6%); and LA, 592 (6.1%). The mean MSSS in patients from LA was 4.47 ± 2.8, 4.53 ± 2.8 in North America, 4.51 ± 2.8 in Europe and 4.49 ± 2.7 in Australia. Mean MSSS in the northern hemisphere was 4.51 ± 1.6 compared to 4.48 ± 1.9 in the southern hemisphere. No differences were found for MSSS among hemispheres (p = 0.68), regions (p = 0.96) or countries (p = 0.50). CONCLUSIONS: Our analyses did not discover any difference in mean MSSS among patients from different regions, hemispheres or countries.

Steatotic livers. Can we use them in OLTX? Outcome data from a prospective baseline liver biopsy study.

INTRODUCTION: Steatotic livers have been associated with greater risk of allograft dysfunction in liver transplantation. Our aim was to determinate the prevalence of steatosis in grafts from deceased donors in Chile and to assess the utility of a protocol-bench biopsy as an outcome predictor of steatotic grafts in our transplant program. MATERIAL AND METHODS: We prospectively performed protocol-bench graft biopsies from March 2004 to January 2009. Biopsies were analyzed and classified by two independent pathologists. Steatosis severity was graded as normal from absent to < 6%; grade 1: 6-33%; grade 2: > 33-66% and grade 3: > 66%. RESULTS: We analyzed 58 liver grafts from deceased donors. Twenty-nine grafts (50%) were steatotic; 9 of them (16%) with grade 3. Donor age (p < 0.001) and BMI over 25 kg/m 2 (p = 0.012) were significantly associated with the presence of steatosis. There were two primary non-functions (PNF); both in a grade 3 steatotic graft. The 3-year overall survival was lower among recipients with macrovesicular steatotic graft (57%) than recipients with microvesicular (85%) or non-steatotic grafts (95%) (p = 0.026). CONCLUSION: Macrovesicular steatosis was associated with a poor outcome in this series. A protocol bench-biopsy would be useful to identify these grafts.

Experiencia en el tratamiento de la leptospirosis / Experience in the leptospirosis treatment

Se realizó un estudio descriptivo longitudinal retrospectivo de los pacientes confirmados con leptospirosis en el período comprendido entre 1994-1995 en el Hospital General Docente “Aleida Fernández Chardiet” de Güines. Se observó que el 84,3 porciento de las pacientes ingresados evolucionaron satisfactoriamente a la terapéutica con penicilina, el tratamiento alternativo con tetraciclina ocupo el segundo lugar, seguido por la estreptomicina, que se utilizó en pacientes alérgicos a la penicilina y a la tetraciclina o con insuficiencia hepática, siendo el resultado satisfactorio, sugiriendo el uso de la estreptomicina como tratamiento alternativo en esta enfermedad. La morbilidad fue de un 5 porciento. La causa de los fallecidos fue por el síndrome de Weil, confirmados por necropsia. Se encontró un promedio de estadía de cuatro días disminuyendo los costos hospitalarios, se demostró la importancia del diagnóstico y tratamiento precoz de esta enfermedad en los cuatro días de la aparición de los síntomas y signos, ya que esto disminuye las posibilidades de complicaciones (AU)

Incidencia de enfermedades infecciosas en un servicio de Medicina Interna / Incidence of infectious diseases in Internal Medicine in-patients

Con la finalidad de conocer la incidencia de las enfermedaes infecciosas en un Servicio de Medicina Interna del Hospital Rebagliati de Lima, Perú, se revisaron los archivos de los diagnósticos de egreso del 1 de enero de 1980 al 31 de diciembre de 1989. Del total, 3386 diagnósticos, 34.3 por ciento correspondieron a enfermedades cardiovasculares con 16.1 por ciento. Del total de enfermedades infecciosas, 1162 casos, la primera enfermedad diagnosticada fue infección del tracto urinario con 19 por ciento, seguidos por Fiebre Tifoidea ( 15 por ciento ), Neumonías ( 11 por ciento ), TBC ( 8.5 por ciento ), Celulitis ( 8.5 por ciento ), Hepatitis Viral ( 8 por ciento ), Brucellosis ( 5 por ciento ), Enterocolitis ( 5 por ciento ) y otras ( 20 por ciento ). Las enfermedades infecciosas representarían la primera gran causa diagnosticada en los Servicios de Medicina Interna, lo que sugiere la necesidad de integrar el criterio epudemiológico en la práctica diaria del médico internista