Corticoesteroide oral vs. intrarticular en el tratamiento de la capsulitis adhesiva / Oral versus intra-articular corticosteroid in the treatment of adhesive capsulitis

Introducción: La capsulitis adhesiva es una enfermedad que se caracteriza por el engrosamiento de la cápsula articular del hombro, lo que se traduce clínicamente en dolor y una pérdida progresiva de la movilidad. El tratamiento conservador es la primera opción. En este estudio, se evaluó el uso de corticoesteroides articulares para el manejo de este cuadro. Materiales y Métodos: Se llevó a cabo un estudio retrospectivo entre 2015 y 2020. Se evaluaron los registros de consulta externa de pacientes con diagnóstico de capsulitis adhesiva u hombro congelado, que recibieron tratamiento con corticoesteroides por vía oral o articular. Resultados: Se analizó a 19 pacientes, 8 recibieron tratamiento por vía oral y 11, por vía articular. Hubo una mejoría importante en ambos grupos, pero los pacientes que recibieron corticoesteroides articulares comunicaron una mejoría a largo plazo. Conclusiones: La administración de corticoesteroides tanto por vía oral como articular para tratar la capsulitis adhesiva fue eficaz; sin embargo, a largo plazo, los corticoesteroides articulares resultaron más eficaces. Nivel de Evidencia: III

Introduction: Adhesive capsulitis is a condition defined by thickening of the shoulder joint capsule, which clinically translates into discomfort and progressive loss of range of motion, with conservative therapy being the initial option. In this study, we evaluate the use of intra-articular corticosteroid injections for the treatment of this condition. Materials and Methods: A retrospective analysis was conducted between 2015 and 2020, assessing the outpatient records of patients diagnosed with adhesive capsulitis or frozen shoulder and treated with corticosteroids either orally or intra-articularly. Results: A total of 19 patients were analyzed, 8 received oral treatment and 11 received intra-articular injection, with both groups showing considerable improvement, with the difference that the patients in the articular corticosteroid group reported long-term improvement. Conclusion: Corticosteroids have been found to be effective in the treatment of adhesive capsulitis both orally and by intra-articular injection; however, intra-articular corticosteroids have proved to be more effective in the long term. Level of Evidence: III

Milk Quality Parameters of Raw Milk in Ecuador between 2010 and 2020: A Systematic Literature Review and Meta-Analysis.

With the objective of evaluating the quality parameters of raw milk in Ecuador between 2010 and 2020, a systematic review and meta-analysis of 73 studies on raw milk produced in different regions of Ecuador was performed. Under the random effects model, effect size and heterogeneity were determined vs. climatic region both among analyses and studies, with Cochran's Q, I2 and Tau (π) statistics. For all the variables, it was observed that there was great heterogeneity (I2 > 90%) among the studies; additionally, it was found that climatic region had an influence only among the variables arsenic, mercury, pH and total solids, and it was greater in the coastal region than the Inter-Andean region. The mean values of the physicochemical characteristics of the milk (titratable acidity, ash, cryoscopy, fat, lactose, pH, protein, non-fat solids and total solids) in the great majority of these studies were within the range allowed by Ecuadorian regulations. As for the hygienic quality of raw milk (total bacterial count, somatic cell count and presence of reductase), although the mean values were within those determined by local legislation, it should be noted that the range established by Ecuadorian regulations is relatively much higher compared to other regulations, which possibly means that there is a high presence of bacteria and somatic cells in raw milk. Finally, the presence of several adulterants (added water) and contaminants (AFM1, antibiotics and heavy metals) was confirmed in the milk, in addition to other substances such as eprinomectin, zearalenone and ptaquilosides, whose presence can be very dangerous, because they can be hepatotoxic, immunotoxic and even carcinogenic. In conclusion, there is great variability among the studies reviewed, with the physicochemical characteristics being the most compliant with Ecuadorian legislation; the hygienic characteristics, adulterants and contaminants of raw milk require greater attention by producers and local authorities, so that they do not harm the health of consumers and the profitability of producers in Ecuador.

Dietary aflatoxin B1-related risk factors for the presence of aflatoxin M1 in raw milk of cows from Ecuador.

Background: Aflatoxin M1 (AFM1) is hepatotoxic and carcinogenic, and it may be present in milk due to dairy cow's ingestion when feed is contaminated with Aflatoxin B1 (AFB1). Aim: The objective of this research was to determine the potential risk factors of dietary AFB1 contamination in dairy cows, which causes AFM1 contamination of the raw milk, through an epidemiological survey and statistical analysis. Methods: 209 raw milk samples were collected, and AFM1 concentrations were detected by lateral flow immunochromatographic assay. Results: It was determined that 100% of the samples contained concerning levels of this mycotoxin with a mean of 0.077 µg/kg, which exceeds the maximum allowed by the European Union legislations (0.05 µg/kg) but not Ecuadorian Regulations (0.5 µg/kg). An adjustment to a linear model by weighted least squares was used to correct the presented heteroscedasticity. Potential risk factors for dietary AFB1 contamination were analyzed in relation to the appearance of AFM1 in milk from Ecuador. Among factors including legumes consumption, the use of silage, type of production system (intensive, extensive, and mixed), and farm size (small, medium, and big), the intensive production system and the big producers presented higher levels of AFM1. Conclusion: Considering that all the milk samples presented AFM1 and since there is no specific feed determined to be a risk factor, it was concluded that any of the feed offered to dairy cows may be contaminated with AFB1. It is necessary to reduce AFB1 levels in feed by implementing good agricultural practices and improving feed storage to decrease milk AFM1 levels. This study identified that intensive systems have a lot of animals, and silage is incorporated into the diet, which can significantly increase AFM1 levels.

Determination of zearalenone in raw milk from different provinces of Ecuador.

BACKGROUND AND AIM: Zearalenone (ZEA) is a mycotoxin from the fungus Fusarium. ZEA can adopt a similar configuration to 17b-estradiol and other natural estrogens. Problems in the reproductive function of humans and animals have been reported for ZEA and its metabolites. This study aimed to determine ZEA in raw milk produced in representative milk production areas in Ecuador. MATERIALS AND METHODS: A total of 209 samples were obtained in April and November 2019 (rainy season) and June and August 201ue wa9 (dry season). A competitive enzyme-linked immunosorbent assay techniqs used to detect ZEA concentrations. RESULTS: ZEA was determined in 99.5% (208 of 209) of the samples; however, all samples were below the maximum limits allowed (0.03-1 mg/L) in food for direct human consumption according to the Food and Agriculture Organization and European legislations. The mean (range) concentration was 0.0015 (0-0.0102) mg/L. The results did not vary significantly (p≥0.05) by cantons, provinces, weather, climate regions, types of producers, and production systems according to Wilcoxon and Kruskal-Wallis non-parametric tests. There were significant differences only between the months under study (p≤0.05). CONCLUSION: ZEA in raw milk from Ecuador does not represent a threat to public health. However, it is recommended to continue analyzing ZEA due to its presence in milk. It could also be present with other mycotoxins that cause harmful synergistic and additive effects to consumers.

Determination of Aflatoxin M1 in Raw Milk from Different Provinces of Ecuador.

Aflatoxin M1 (AFM1) is a mycotoxin from Aspergillus flavus and A. parasiticus, classified as carcinogenic and hepatotoxic. The objective of the present investigation was to determine its presence in raw milk from north-central Ecuador, constituted by the provinces of Pichincha, Manabí, and Santo Domingo de los Tsáchilas. These areas represent approximately 30% of Ecuadorian milk production. By the end of the investigation, a total of 209 raw milk samples were collected, obtained both during the dry (June and August) and rainy seasons (April and November) of 2019. AFM1 concentrations were measured with lateral flow immunochromatographic assays, and 100% of the samples were positive for this mycotoxin, presenting a mean value of 0.0774 µg/kg with a range of 0.023 to 0.751 µg/kg. These AFM1 levels exceeded the European Union regulatory limit of 0.05 µg/kg in 59.3% (124/209) of samples, while only 1.9% (4/209) exceeded the Ecuadorian legal limit of 0.5 µg/kg. By using non-parametric tests, significant differences were determined (p ≤ 0.05) between the provinces for months of study, climatic season (being higher in the dry season), and climatic region (greater in the coast region). On the other hand, there were no significant differences (p ≥ 0.05) between the types of producers or between production systems. Therefore, AFM1 contamination in raw milk does not present a serious public health problem in Ecuador, but a monitoring and surveillance program for this mycotoxin in milk should be developed to prevent consumer health problems.

Luxación posterior de hombro, modificación al procedimiento de McLaughlin: Descripción de la técnica quirúrgica / Posterior dislocation of shoulder, modification of McLaughlin procedure: Description of surgical technique

La técnica de McLaughlin originalmente se describe como una solución para lesiones de Hill Sachs reversas asociadas con inestabilidad posterior de hombro, realizando una reinserción del tendón del músculo subescapular en el defecto óseo de la cabeza humeral a través de túneles trans óseos. Nosotros describimos una modificación a la técnica con la utilización de 2 anclajes de titanio (Super Revo ® CONMED, Linvantec, USA) en el defecto óseo. Presentamos el caso de un paciente con luxación posterior de hombro inicialmente inadvertida tratado exitosamente con esta técnica quirúrgica.

Reconstrucción del ligamento colateral externo de la rodilla con mínimas incisiones: descripción de la técnica / Reconstruction of the lateral collateral ligament of the knee with minimal incisions: description of technique

El ligamento colateral externo de la rodilla es el estabilizador primario contra las fuerzas de estrés en varo de la rodilla. Las deficiencias de éste, ó de la esquina posterolateral de la rodilla ocasionan incremento en las fuerzas que actúan sobre el ligamento cruzado anterior durante la rotación interna de la rodilla e incrementan las fuerzas sobre el cruzado posterior durante la rotación externa. Las lesiones no diagnósticadas en combinación con lesiones del ligamento cruzado anterior (LCA) o ligamento cruzado posterior (LCP) pueden llevar a falla en la reconstrucción del LCA o LCP. El propósito de esta descripción de técnica quirúrgica es presentar una novedosa técnica de reconstrucción del ligamento colateral externo de la rodilla para el tratamiento de pacientes con estas lesiones, con mínimas incisiones. Esta técnica requiere el uso de un tomillo de interferencia y auto injerto semitendinoso para reconstruir el ligamento colateral lateral.

Técnica de placa antideslizante para el tratamiento quirúrgico de fracturas de tobillo tipo Weber B: descripción de la técnica quirúrgica / Skid plate technique for the surgical treatment of ankle fractures Weber type B: description of surgical technique

La fractura de tobillo es frecuente. Su principal complicación es la inestabilidad residual de la articulación. El tratamiento puede ser quirúrgico o no quirúrgico. Existen diferentes técnicas de fijación para restaurar una alteración biomecánica que puede contribuir a una pérdida de la función y a una artrosis temprana del tobillo. Describimos la técnica quirúrgica de un método innovador mediante placa antideslizante que ha demostrado ser muy eficaz para el tratamiento de fractura de tobillo tipo Weber B.

Genu Valgo en Exostosis Múltiple Hereditaria: reporte de caso y revisión del tema / Genua Valga in Exostosis Multiple Hereditary: a case report and review of the topic

La exostosis múltiple hereditaria es un trastorno autosómico dominante caracterizado por la aparición de osteocondromas que afectan generalmente al antebrazo, rodilla y tobillo. Estas masas pueden producir deformidades angulares a nivel de las extremidades y alteración mecánica de las articulaciones generando dolor e incapacidad funcional. Describimos el caso de un niño de 6 años de edad que debutó con genu valgo izquierdo patológico secundario a osteocondromatosis múltiple hereditaria y la corrección quirúrgica del mismo.

Artroscopía de cadera: reporte de casos y revisión del tema / Hip arthroscopy: case report and review of the topic

Hoy en día mucha de la patología de cadera es manejada por artroscopía mientras en el pasado pasaba desapercibida y sin tratamiento con las correspondientes consecuencias para el paciente. En la actualidad las patologías que son beneficiadas con la artroscopia de cadera son múltiples, síendo las más comunes las lesiones de labrum, lesiones condrales, cuerpos libres intrarticulares, pinzamiento femoroacetabular, cadera en resorte, lesiones del ligamento redondo, laxitud capsular. Presentamos 5 casos sometidos a artroscopía de cadera en nuestra Institución por diferentes patologías que incluyen (pinzamiento femoroacetabular, lesiones condrales, fibrosis periarticular, tendón psoas tenso, labrum hipertrófico), además comentamos la técnica quirúrgica utilizada. Los pacientes tenían como edad promedio 30,8 años con edades comprendidas entre los 15 y 46 años (15, 18, 31, 44, 46); en cuanto a género 3 de las pacientes son mujeres y 2 son hombres; si nos referimos a lateralidad: 4 fueron derechas y I fue izquierda.

Colecistitis aguda

La colecistis es un patología muy común dentro de los países de occidente, así como dentro de los cuadros de dolor abdominal, razón por la cual su mejor conocimiento y revisión constante, forman parte de la diaria práctica médica. Un buen diagnostico y tratamiento adecuadamente realizados , disminuyen notablemente los valores de morbi-mortalidad de esta patología. La cirugía de las vías biliares sigue siendo uno de los temas mas apasionantes y más complejos dentro del campo de la medicina, siendo la colecistectomia una de las cirugías más comunmente realizadas, dentro de las intervenciones abdominales. Muchos son los instrumentos diagnosticos que dispone el médico actualmente, pero sin duda el mejor de ellos es el estudio clínico e individualizado del paciente, para que según sus propias caracteristicas de edad, sexo y patología asociada, se dé un mejor tratamiento y sobre todo un diagnostico preciso, que evitara en mucho, las diversas complicaciones de un cuadro de colecistitis aguda. La colecistectomía laparoscópica o la clásica abierta siguen siendo el mejor tratamiento de esta afección.