Social support, coping strategies and sociodemographic factors in women with breast cancer.

INTRODUCTION: The aim of this study was to analyze the associations between perceived social support and sociodemographic variables on coping strategies. METHODS: A prospective, cross-sectional, multicenter study was conducted in 404 women with resected, non-metastatic breast cancer. Participants completed questionnaires: perceived social support (MSPSS), coping strategies (Mini-MAC), and psychological distress (BSI-18). RESULTS: Sociodemographic factors as age, education, and partnership status were associated with coping strategies. As for maladaptive strategies, hopelessness was more frequent in older people and lower educational level; fatalism in older and single people, and cognitive avoidance was associated with lower educational level. Suppor t from family, friends, and partners was associated with a greater fighting spirit. In contrast, high psychological distress (anxiety and depression) was associated with greater use of maladaptive strategies. CONCLUSION: Young people, a high level of education, having a partner, low psychological distress, and seeking social support were associated with the use of adaptive cancer coping strategies.

The anti-thrombotic effects of vitamin D and their possible relationship with antiphospholipid syndrome.

The importance of the immunomodulatory effects of vitamin D has recently been associated with autoimmune and chronic inflammatory diseases. Vitamin D deficiency has been linked to the development of autoimmune conditions. Antiphospholipid syndrome is an autoimmune disease characterized by thrombotic events and obstetric complications in patients with antiphospholipid antibodies. Current data show that patients with antiphospholipid syndrome have a high prevalence of vitamin D deficiency even without classic risk factors. Several studies have suggested vitamin D may have anti-thrombotic functions. In antiphospholipid syndrome, low vitamin D serum levels have been associated with thrombotic manifestations, suggesting a possible protective role of vitamin D in antiphospholipid syndrome. This literature review presents current evidence on the haemostatic functions of vitamin D and their possible relationship with the clinical manifestations of antiphospholipid syndrome.

Factors of the epidemiological triad that influence the persistence of human papilloma virus infection in women with systemic lupus erythematosus.

We studied the epidemiologic triad-related factors influencing human papilloma virus (HPV) persistence in Mexican women with systemic lupus erythematosus (SLE). Patients aged ≥18 years with SLE (American College of Rheumatology criteria), with and without HPV persistence, were selected. Groups were analyzed by (1) host: clinical disease characteristics; (2) agent: (I) infectious (prevalence, incidence, HPV genotype and co-infections (≥2 HPV genotypes or mycoplasmas)), (II) chemical (contraceptives and immunosuppressive drugs) and (III) physical (vitamin D deficiency) and (3) environment. A total of 121 SLE patients were selected over a two-year period. (1) Host: mean age 45.8 years and disease duration 12.7 years. (2) Agent: (I) infectious. HPV infection prevalence in the second sample was 26.4%, high-risk HPV genotypes 21.5% and co-infections 7.4%. HPV infection incidence was 13.2%, persistence 13.2% and clearance 15.7%. (II) Chemical: use of oral hormonal contraceptives 5% and immunosuppressive treatment 97.5%. (III) Physical: Vitamin D levels were similar in both groups. (3) Environment: (I) natural. A total of 60.6% of patients were residents of Puebla City. (II) Social: The mean education level was 10.9. Poverty levels were: III degree 52.4%, IV degree 28% and II degree 17%. (III) Cultural behavioral: Onset of sexual life was 20.5 years, 10% had ≥3 sexual partners and 51.2% were postmenopausal. In conclusion, no factor of the epidemiologic triad was associated with HPV infection prevalence.

Prevalence of functional gastrointestinal disorders in adults with systemic lupus erythematosus.

Objective (a) to assess the prevalence of functional gastrointestinal disorders (FGIDs) in female Mexican systemic lupus erythematosus (SLE) patients using the Rome III criteria and (b) to examine the effect of disease duration on FGID prevalence. Methods Female SLE outpatients aged ≥18 years with no organic gastrointestinal disorder were included. Participants were invited to upper gastrointestinal endoscopy screening and a faecal immunochemical test. FGID symptoms were evaluated using the Rome III questionnaire. Results Eighty-six SLE patients with median age of 45 (interquartile range 34-54) years were included. At least one FGID was found in 76.7% (66/88) of patients with SLE. The most prevalent domains of FGID diagnosed were functional oesophageal, gastroduodenal disorders and bowel disorders, of which functional dyspepsia (72.7%), functional heartburn (68.1%) and bloating (63.8%) were the most frequent. Fifty-nine per cent of patients had overlapping FGIDs. The most prevalent overlap was the combination of functional dyspepsia and functional heartburn. Patients with longer disease duration had a higher prevalence of FGID than those with shorter disease duration. Conclusions There was a high prevalence of FGIDs in Mexican SLE women with low disease activity. Overlapping FGIDs were frequent. Longer disease duration may be associated with FGIDs in SLE patients.

Factors Associated with Health-Related Quality of Life in Mexican Lupus Patients Using the LupusQol.

INTRODUCTION: Health-related quality of life (HRQOL) is affected by numerous clinical variables, including disease activity, damage, fibromyalgia, depression and anxiety. However, these associations have not yet been described in Mexican patients with systemic lupus erythematosus (SLE). OBJECTIVE: To evaluate the relationship between disease activity, damage, depression and fibromyalgia and HRQOL measured by the LupusQoL-instrument in Mexican patients with SLE. METHODS: A cross-sectional study was conducted in women fulfilling the 1997 ACR classification criteria for SLE. HRQOL was evaluated using a disease-specific instrument for SLE, the LupusQoL (validated for the Spanish-speaking population). Patients were evaluated clinically to determine the degree of disease activity and damage using the Mexican Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) and Systemic Lupus International Collaborating Clinics-Damage Index (SLICC), respectively. Fibromyalgia and depression were assessed using the ACR criteria and the CES-D scale, respectively. The relationship between HRQOL and these variables was measured using Spearman's rank correlation coefficient and linear regression analysis. RESULTS: A total of 138 women with SLE, age 40.3±11 years, disease duration 8.8±6.4 years, with disease activity in 51.4%, depression in 50%, damage in 43% and fibromyalgia in 19.6% were included. Poorer HRQOL correlated with depression (r = -0.61; p< 0.005), fibromyalgia (r = -0.42; p< 0.005), disease activity (r = -0.37; p < 0.005) and damage (r = -0.31; p < 0.005). In the multivariate linear regression analysis, damage (ß = -3.756, p<0.005), fibromyalgia (ß = -0.920, p<0.005), depression (ß = -0.911, p<0.005) and disease activity (ß = -0.911, p<0.005) were associated with poor HRQOL. CONCLUSION: SLE disease activity, damage, fibromyalgia and depression were associated with poor HRQOL in our sample of Mexican SLE patients.

Incidence of cervical human papillomavirus infection in systemic lupus erythematosus women.

Objectives Our objective was to study the incidence, persistence and clearance of human papillomavirus infection in systemic lupus erythematosus women and assess risk factors for persistence of human papillomavirus infection. Methods We carried out a prospective, observational cohort study of 127 systemic lupus erythematosus women. Patients were evaluated at baseline and at three years. Traditional and systemic lupus erythematosus women-related disease risk factors were collected. Gynaecological evaluations and cervical cytology screening were made. Human papillomavirus detection and genotyping were made by polymerase chain reaction and linear array. Results The cumulative prevalence of human papillomavirus infection increased from 22.8% at baseline to 33.8% at three years; p = < 0.001: 20.1% of patients experienced 43 incident infections. The risk of any human papillomavirus infection was 10.1 per 1000 patient-months. At three years, 47 (88.6%) prevalent infections were cleared. Independent risk factors associated with incident human papillomavirus infection included more lifetime sexual partners (odds ratio = 1.8, 95% confidence interval = 1.11-3.0) and cumulative cyclophosphamide dose (odds ratio = 3.9, 95% confidence interval = 1.2-12.8). Conclusions In systemic lupus erythematosus women, the cumulative prevalence of human papillomavirus infection, including high risk-human papillomavirus and multiple human papillomavirus infections, may increase over time. Most persistent infections were low risk-human papillomavirus. The number of lifetime sexual partners and the cumulative cyclophosphamide dose were independently associated with incident human papillomavirus infection.

The role of infectious diseases in the catastrophic antiphospholipid syndrome.

Catastrophic antiphospholipid syndrome (CAPS), also called "Asherson syndrome", is a variant of the antiphospholipid syndrome (APS) that occurs in less than 1% of APS cases. The etiology of CAPS is uncertain; however, several triggering factors have been recognized. The most common of these are infectious diseases, particularly those of the respiratory tract. CAPS pathogenesis is incompletely understood, but several theories have been proposed, such as the molecular mimicry theory, which describes the production of anti-ß2-glycoprotein I (GP1) antibody in response to infection. The process is complex and involves the activation of Toll-like receptor 4 (TLR-4), which triggers a cytokine storm, followed by endothelial alterations that induce a procoagulant state.

Socioeconomic status and organ damage in Mexican systemic lupus erythematosus women.

The objective of this cross-sectional study was to determine relationships between socioeconomic status and organ damage in Mexican systemic lupus erythematosus (SLE) patients. Demographic and clinical variables were assessed. Socioeconomic status was evaluated using the Graffar method and monthly household income. Lupus activity and organ damage were measured using the SLE disease activity scale, validated for the Mexican population (Mex-SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) scale. The 143 Mexican female SLE patients included (mean age 40.1 ± 8.9 years, mean disease duration 8.9 ± 6.3 years) had a mean monthly household income of $ 407.2 ± 326.5. According to the Graffar index, 18.9%, 52.5%, and 28.7% had high/medium-high, medium, and medium-low/low socioeconomic status, respectively. Organ damage was observed in 61 patients (42.7%). Patients with organ damage had lower monthly household incomes ($241.4 ± 152.4 vs. $354.8 ± 288.3) and were more frequently unemployed (57.3% vs. 35.3%; p = 0.01) than those without. Low monthly income was not associated with lupus activity or self-reported health status. In the adjusted multivariate analysis, low monthly income ( < $300) was associated with organ damage. In conclusion, low income may be associated with organ damage in Mexican SLE patients.

Lack of association between serum 25-hydroxyvitamin D levels and cervical human papillomavirus infection in systemic lupus erythematosus.

Our objective was to evaluate whether vitamin D deficiency is associated with cervical human papilloma virus (HPV) infection in women with SLE. This is a cross-sectional study of 67 women with SLE. A structured questionnaire was administered to ascertain the possible risk factors associated with cervical HPV infection. A gynaecological evaluation and cervical cytology screening were made. HPV detection and genotyping was made by PCR and linear array assay. Serum 25 hydroxyvitamin D levels were quantified by chemiluminescence immunoassay. Mean age and disease duration were 44.8 ± 10.6 and 42.5 ± 11.8 years, respectively. Demographic characteristics were similar in patients with and without deficiency (<20 ng/ml and ≥20 ng/ml). There were 28.4% of women with cervical HPV infection and 68.4% had high-risk HPV infections. Patients with 25 hydroxyvitamin D levels <20 ng/ml had a higher prevalence of cervical HPV infection than those with levels ≥20 ng/ml (30.7% vs. 25.8%; p = 0.72). We found no significant difference when high-risk HPV infection was evaluated (36.8% vs. 31.5%; p = 0.73). In conclusion, women with SLE have a high prevalence of vitamin D deficiency and cervical HPV infection. However, we found no association between vitamin D deficiency and cervical HPV.

Carotid atherosclerosis is not associated with lower bone mineral density and vertebral fractures in patients with systemic lupus erythematosus.

BACKGROUND: Low bone mineral density (BMD) and vertebral fractures (VF) have been associated with atherosclerosis in the general population. We sought to investigate the relationship between BMD and VF and carotid atherosclerosis in women with systemic lupus erythematosus (SLE). METHODS: We studied 122 women with SLE. All patients had BMD, carotid intima-media thickness (IMT), and carotid artery atherosclerotic plaque assessment by ultrasound. RESULTS: Mean age at study entry was 44 years and mean disease duration was 11 years. Carotid plaque was found in 13 (11%) patients (9 postmenopausal and 4 premenopausal). Patients in the highest IMT quartile were more likely to be older (p = 0.001), have a higher body mass index (p = 0.008), and exhibit dyslipidemia at study entry (p = 0.041), compared with the lower three quartiles. BMD at the lumbar spine was lower in patients in the highest IMT quartile compared with the lower quartiles in the multivariate logistic analysis, however, there was no association between lumbar or total hip BMD and IMT (p = 0.91 and p = 0.6, respectively). IMT measurements did not differ according to the presence or absence of VF (0.08 ± 0.12 vs. 0.06 ± 0.03 mm, p = 0.11). A trend towards higher incidence of VF was found in patients with carotid plaque compared with those without (33% vs. 21%; p = 0.2). CONCLUSIONS: In patients with SLE, the presence of carotid atherosclerosis is not associated with low BMD or VF.

Work instability in rheumatoid arthritis patients from Argentina: prevalence and associated factors.

To determine the prevalence of and associated factors to work instability (WI) in rheumatoid arthritis (RA) Argentinean patients. Observational cross-sectional study that assessing employment status in currently working RA patients. They answered the validated version of RA work instability scale (RA-WIS). High-risk WI was considered when RA-WIS was ≥17. Factors associated with high-risk WI were examined by univariable and multivariable analysis. Four-hundred and fifty RA patients were enrolled; of these, 205 patients were currently employed, but only 172 have completed questionnaires required [RA-WIS and health assessment questionnaire (HAQ-A)]. Their mean age was 49.3 ± 10.8 years; 81.3 % were female; and their mean disease duration was 8.1 ± 7.2 years. Fifty-two percent of patients were doing manual work. The mean RA-WIS score was 11.4 ± 6.8, and 41 % of patients had a high-risk WI. High-risk WI was associated with radiographic erosions (p < 0.001) and HAQ-A >0.87 (p < 0.001) in the univariable analysis, whereas in the multivariable logistic regression analysis the variables associated with a high-risk WI were as follows: HAQ-A >0.87 [odds ratio (OR) 12.31; 95 % CI 5.38-28.18] and the presence of radiographic erosions (OR 4.848; 95 % CI 2.22-10.5). In this model, having a higher monthly income (OR 0.301; 95 % CI 0.096-0.943) and a better functional class (OR 0.151; 95 % CI 0.036-0.632) were protective. Forty-one percent of RA working patients had high-risk WI. The predictors of high RA-WIS were HAQ-A ≥0.87 and radiographic erosions, whereas having a better functional class and have higher incomes were protective.

Artrodesis cervical mediante fusión intersomática con hueso autólogo versus espaciador intersomático en discopatía cervical / Cervical arthrodesis by means of interbody fusion with autologous bone and/or interbody spacer for cervical disc disease

El objetivo de este estudio fue comparar los resultados de la artrodesis cervical mediante fusión intersomática con hueso autólogo y/o espaciador intersomático en discopatía cervical. Material y métodos: Estudio comparativo transversal en 49 pacientes tratados quirúrgicamente con artrodesis anterior, en el período Enero 2011 a Diciembre 2011; revisión del expediente clínico. Resultados: Incluimos 49 pacientes de los cuales 20 (40.8%) fueron hombres y 29 (59.2%) mujeres; el diagnóstico en todos fue patología discal (hernia cervical) con uno o dos niveles de afectación; el tiempo quirúrgico promedio fue 69.12, mínimo 53 - máximo 110, ± 19.61 minutos para artrodesis cervical con injerto y promedio 61.18, mínimo 50 - máximo 96.00, ± 11.38 minutos para artrodesis cervical con espaciador intersomático (p = 0.00 t de Student); las características sociodemográficas, clínicas y complicaciones se muestran. Los pacientes operados con ambas técnicas tuvieron una adecuada integración radiológica, p = 0.015 consideramos estadísticamente significativa una p ≤ a 0.05, χ². Conclusiones: La integración ósea es buena tanto con la aplicación de caja intersomática como con la aplicación de injerto autólogo de cresta iliaca, en pacientes con patología discal cervical.

The purpose of this study was to compare the results of cervical arthrodesis performed through interbody fusion with autologous bone and/or interbody spacer for cervical disc disease. Material and methods: Comparative cross-sectional study that included 49 patients who underwent surgery for anterior arthrodesis between January and December 2011, whose clinical records were reviewed. Results: We included 49 patients: 20 (40.8%) males and 29 (59.2%) females. All of them were diagnosed with disc disease (cervical disc herniation) involving one or two levels. Mean operative time was 69.12, with a minimum of 53 and a maximum of 110 ± 19.61 minutes for cervical arthrodesis with a graft. Mean operative time was 61.18 with a minimum of 50 and a maximum of 96.00 ± 11.38 minutes for cervical arthrodesis with an interbody spacer (p = 0.00, Student t test). Patient sociodemographic and clinical characteristics and complications are shown. Patients in whom both surgical techniques were used had appropriate radiological integration, with p = 0.015, considering p ≤ a 0.05 as significant, χ2. Conclusions: In patients with cervical disc disease bone integration is appropriate with the use of either an interbody cage or an autologous iliac crest graft.

Síndromes geriátricos en pacientes con fractura de cadera no reciente en una unidad de primer nivel de atención médica / Geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit

Objetivo: Identificar la frecuencia de síndromes geriátricos en pacientes que sufrieron fractura de cadera no reciente en una unidad de primer nivel de atención médica en el estado de Puebla, México. Material y métodos: Estudio transversal realizado en 376 pacientes que sufrieron fractura de cadera no reciente, a los que se les evaluó la presencia de síndromes geriátricos. Incluimos variables demográficas, incontinencia urinaria, polifarmacia, trastornos del sueño, estado nutricional, así como depresión y autonomía. La depresión y autonomía fueron evaluadas por las escalas de Yesavage y Katz. Utilizamos estadística descriptiva. Resultados: Fueron un total de 376 pacientes, 219 (58%) femeninos, 157 (42%) masculinos; edad promedio 72.57, (65-95, ± 7.08) años, 98.7% presentó al menos un síndrome geriátrico. La depresión se detectó en 303 (80.9%), la polifarmacia se observó en 282 (75%), en cuanto a los trastornos del sueño se encontraron en 262 (69.7%), las caídas se encontraron en 63 (16.8%), la incontinencia urinaria en 19 (5.1%), en cuanto a la obesidad en 15 (4%) y pérdida de la autonomía en 3 (0.8%). Conclusión: 98.7% padecen por lo menos un síndrome geriátrico, el género femenino es el más afectado, el síndrome más frecuente es depresión, seguida de polifarmacia, trastorno del sueño, caídas, incontinencia urinaria, obesidad y pérdida de la autonomía.

Objective: To identify the frequency of geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit in the state of Puebla, Mexico. Material and methods: Cross-sectional study conducted in 376 patients with a non-recent hip fracture screened for geriatric syndromes. We included demographic variables, urinary incontinence, polypharmacy, sleep disorder, nutritional status, depression and autonomy. The two latter were assessed using the Yesavage geriatric depression scale and the Katz index. We used descriptive statistics. Results: The total number of patients was 376; 219 (58%) were females and 157 (42%) were males; mean age was 72.57 years (65-95 ± 7.08), and 98.7% had at least one geriatric syndrome. Depression was detected in 303 (80.9%), 282 (75%) were on polypharmacy, 262 (69.7%) had sleep disorders, 63 (16.8%) had experienced falls, 19 (5.1%) had urinary incontinence, 15 (4%) were obese, and 3 (0.8%) had loss of autonomy. Conclusion: 98.7% of the patients had at least one geriatric syndrome; females were the most affected sex; depression was the most frequent syndrome, followed by polypharmacy, sleep disorders, falls, urinary incontinence, obesity and loss of autonomy.

Prótesis total de rodilla por gonartrosis grado IV / Total knee replacement due to grade IV gonarthrosis

Objetivo: Describir la evolución clínica de pacientes operados de prótesis total de rodilla por gonartrosis grado IV secundaria a enfermedad angular en varo. Material y métodos: Estudio descriptivo, incluimos pacientes operados de artroplastía total de rodilla por gonartrosis secundaria a enfermedad angular en varo. Utilizamos las siguientes variables: género, edad, lado afectado, tipo de abordaje, tipo de prótesis, tipo de marcha postquirúrgica, infección, estado vascular, dolor postquirúrgico, rechazo de material protésico, deformidad angular en varoflexión pre- y postquirúrgicas. Resultados: Revisamos 13 expedientes, 69.2% hombres y 30.8% mujeres, la edad media 72.38, mínima 56-máxima 82, DE 7.11 años. Seis (46.2%) rodillas izquierdas y 7 (53.8%) derechas. A todos los pacientes se les realizó abordaje para-rotuliano medial y balance óseo, al 23.1% se le realizó balance capsuloligamentario; a 7.6% se les colocó prótesis total de rodilla posteroestabilizada y al 93.3% no posteroestabilizada; 1 (7.6%) paciente presentó infección, ninguno presentó compromiso vascular, 76.9% presentaron marcha asistida con bastón, 15.4% marcha independiente y 7.6% no presentó marcha. El grado promedio de deformidad angular prequirúrgico fue 15.77 y el postquirúrgico promedio menor o igual a 5º, la diferencia de promedios grados pre- y postquirúrgicos fue 36.719 y en flexión 0.439, p = 0.00 y p = 0.669 respectivamente (t pareada). Conclusión: Podemos concluir que la evolución clínica de los pacientes con gonartrosis secundaria a enfermedad angular en varo postoperados de ATR es buena, las complicaciones son similares a la literatura.

Objective: To describe the clinical evolution of patients with total knee replacement surgery due to grade IV gonarthrosis secondary to varus angular deformity. Material and methods: A descriptive trial where we included patients who underwent total knee arthroplasty due to gonarthrosis secondary to varus angular deformity. We used the following variables, sex, age, affected side, type of approach, type of prosthesis, type of gait post-surgically, infection, vascular status, post-surgical pain, rejection of prosthetic material, varus-flection angular deformity pre and post-surgically. Results: We reviewed 13 files, 69.2% men and 30.8% women, the mean age was 72.38, minimum 56, maximum 82, DE 7.11 years. Six (46.2%) left knees and 7 (53.8%) right knees. All patients had a medial parapatellar approach and bone balancing, 23.1% had ligament balancing; 7.6% had a total knee replacement stabilized posteriorly and 93.3% not stabilized posteriorly; 1 (7.6%) patient had infection, none had vascular involvement, 76.9% had to walk with a cane, 15.4% walked on their own and 7.6% had no gait. The average grade of the angular deformity pre-surgery was 15.77 and the average post-surgery was less than or equal to 5º, the difference of average grades pre and post-surgery was 36.719 and in flection 0.439, p= 0.00 and p= 0.669 respectively (paired t). Conclusion: We can conclude that the clinical evolution of patients with gonarthrosis secondary to varus angular deformity who underwent TKA is good, complications are similar to those in the literature.

Resultados del manejo quirúrgico en fracturas parciales de la tibia proximal / Results of surgical management in proximal partial tibia fractures

Introducción: Las fracturas parciales articulares proximales de la tibia son un gran desafío para el ortopedista por la sintomatología y la complejidad de su manejo. Objetivo: Describir los resultados del tratamiento quirúrgico de las fracturas articulares proximales de la tibia. Material y métodos: Se realizó un estudio descriptivo en un Hospital de Tercer Nivel de Atención. Se incluyó a pacientes con fractura articular parcial proximal tibial (Müeller AO/ASIF 41-B), ambos géneros, evolución postquirúrgica a seis meses, con expediente clínico completo. La evaluación postquirúrgica fue mediante la escala Orfaly & Keating. Utilizamos estadística descriptiva con medidas de tendencia central y dispersión, prueba de Fischer para riesgo relativo y regresión logística. Resultados: Fueron 25 pacientes. Edad promedio 41.6, (16-81), DE 17.03 años; 15 (60%) hombres, 10 (40%) mujeres; 1 (4%) con DM2; el lado más afectado fue el izquierdo 17 (68%); todos manejados quirúrgicamente con osteosíntesis; hubo concordancia al 100% del diagnóstico preoperatorio con el postoperatorio (Kappa 1.0); la evolución fue satisfactoria en 76%, aceptable en 24% (Orfaly & Keating), 16% con deformidad angular en valgo y 12% rigidez articular; mujeres con RR 1.33 (IC 0.869-2.045) deformidad angular en valgo, RR 0.22 (IC 0.27-1.846) rigidez articular, la osteosíntesis con placa en palo de hockey RR 2.68, osteosíntesis mínima RR 1.088 (IC 95% 0.7-3.1) para escala Orfaly & Keating no satisfactoria. Conclusión: Existe riesgo relativo positivo del género femenino para deformidad angular en valgo y del tratamiento con placa en palo de hockey y osteosíntesis mínima para evolución no satisfactoria de acuerdo a la escala Orfaly & Keating seis meses después de realizado el tratamiento quirúrgico.

Introduction: Proximal partial articular tibia fractures represent a great challenge for orthopedic surgeons due to their symptoms and complex management. Objective: To describe the results of surgical treatment of proximal articular fractures of the tibia. Material and methods: Descriptive study conducted at a tertiary care hospital. We included patients with proximal partial articular tibia fracture (Müeller AO/ASIF 41-B), of both sexes, with a six-month postoperative follow-up and a complete clinical record. Postoperative assessment was conducted with the Orfaly & Keating scale. We used descriptive statistics with central trend and scatter measurements, Fischer test for the relative risk and logistic regression. Results: The total number of patients was 25. Mean age was 41.6 (16-81), SD was 17.03 years; 15 patients were males (60%) and 10 females (40%); 1 (4%) had type-2 diabetes mellitus; the left side was affected in 17 (68%) patients; all patients underwent surgery with osteosynthesis; there was 100% match between the preoperative and postoperative diagnoses (Kappa 1.0); patient course was appropriate in 76% and acceptable in 24% (Orfaly & Keating); 16% had angular valgus deformity and 12% had joint stiffness. Females with RR 1.33 (CI 0.869-2.045) had angular valgus deformity; those with RR 0.22 (CI 0.27-1.846) had joint stiffness, RR was 2.68 for hockey stick plate osteosynthesis, and RR was 1.088 (CI 95%, 0.7-3.1) for the unsatisfactory course according to the Orfaly & Keating scale. Conclusion: A positive relative risk was found among females for angular valgus deformity, and in hockey stick plate osteosynthesis and minimal osteosynthesis for an unsatisfactory course, according to the Orfaly & Keating scale, six months after surgical treatment.

[Geriatric syndromes in patients with a non-recent hip fracture seen at a primary health care unit]. / Síndromes geriátricos en pacientes con fractura de cadera no reciente en una unidad de primer nivel de atención médica.

OBJECTIVE: To identify the frequency of geriatric syndromes in patients with a non- recent hip fracture seen at a primary health care unit in the state of Puebla, Mexico. MATERIAL AND METHODS: Cross-sectional study conducted in 376 patients with a non-recent hip fracture screened for geriatric syndromes. We included demographic variables, urinary incontinence, polypharmacy, sleep disorder, nutritional status, depression and autonomy. The two latter were assessed using the Yesavage geriatric depression scale and the Katz index. We used descriptive statistics. RESULTS: The total number of patients was 376; 219 (58%) were females and 157 (42%) were males; mean age was 72.57 years (65-95 +/- 7.08), and 98.7% had at least one geriatric syndrome. Depression was detected in 303 (80.9%), 282 (75%) were on polypharmacy, 262 (69.7%) had sleep disorders, 63 (16.8%) had experienced falls, 19 (5.1%) had urinary incontinence, 15 (4%) were obese, and 3 (0.8%) had loss of autonomy. CONCLUSION: 98.7% of the patients had at least one geriatric syndrome; females were the most affected sex; depression was the most frequent syndrome, followed by polypharmacy, sleep disorders, falls, urinary incontinence, obesity and loss of autonomy.

[Cervical arthrodesis by means of interbody fusion with autologous bone and/or interbody spacer for cervical disc disease]. / Artrodesis cervical mediante fusión intersomática con hueso autólogo versus espaciador intersomático en discopatía cervical.

UNLABELLED: The purpose of this study was to compare the results of cervical arthrodesis performed through interbody fusion with autologous bone and/or interbody spacer for cervical disc disease. MATERIAL AND METHODS: Comparative cross-sectional study that included 49 patients who underwent surgery for anterior arthrodesis between January and December 2011, whose clinical records were reviewed. RESULTS: We included 49 patients: 20 (40.8%) males and 29 (59.2%) females. All of them were diagnosed with disc disease (cervical disc herniation) involving one or two levels. Mean operative time was 69.12, with a minimum of 53 and a maximum of 110 +/- 19.61 minutes for cervical arthrodesis with a graft. Mean operative time was 61.18 with a minimum of 50 and a maximum of 96.00 +/- 11.38 minutes for cer vical arthrodesis with an interbody spacer (p = 0.00, Student t test). Patient sociodemographic and clinical characteristics and complications are shown. Patients in whom both surgical techniques were used had appropriate radiological integration, with p = 0.015, considering p < or = a 0.05 as significant, chi2. CONCLUSIONS: In patients with cervical disc disease bone integration is appropriate with the use of either an interbody cage or an autologous iliac crest graft.

[Total knee replacement due to grade IV gonarthrosis]. / Prótesis total de rodilla por gonartrosis grado IV.

OBJECTIVE: To describe the clinical evolution of patients with total knee replacement surgery due to grade IV gonarthrosis secondary to varus angular deformity. MATERIAL AND METHODS: A descriptive trial where we included patients who underwent total knee arthroplasty due to gonarthrosis secondary to varus angular deformity. We used the following variables, sex, age, affected side, type of approach, type of prosthesis, type of gait post-surgically, infection, vascular status, post-surgical pain, rejection of prosthetic material, varusflection angular deformity pre and post-surgically. RESULTS: We reviewed 13 files, 69.2% men and 30.8% women, the mean age was 72.38, minimum 56, maximum 82, DE 7.11 years. Six (46.2%) left knees and 7 (53.8%) right knees. All patients had a medial parapatellar approach and bone balancing, 23.1% had ligament balancing; 7.6% had a total knee replacement stabilized posteriorly and 93.3% not stabilized posteriorly; 1 (7.6%) patient had infection, none had vascular involvement, 76.9% had to walk with a cane, 15.4% walked on their own and 7.6% had no gait. The average grade of the angular deformity pre-surgery was 15.77 and the average post-surgery was less than or equal to 5 degrees, the difference of average grades pre and post-surgery was 36.719 and in flection 0.439, p = 0.00 and p = 0.669 respectively (paired t). CONCLUSION: We can conclude that the clinical evolution of patients with gonarthrosis secondary to varus angular deformity who underwent TKA is good, complications are similar to those in the literature.

[Results of surgical management in proximal partial tibia fractures]. / Resultados del manejo quirúrgico en fracturas parciales de la tibia proximal.

INTRODUCTION: Proximal partial articular tibia fractures represent a great challenge for orthopedic surgeons due to their symptoms and complex management. OBJECTIVE: To describe the results of surgical treatment of proximal articular fractures of the tibia. MATERIAL AND METHODS: Descriptive study conducted at a tertiary care hospital. We included patients with proximal partial articular tibia fracture (Müeller AO/ASIF 41-B), of both sexes, with a six-month postoperative follow-up and a complete clinical record. Postoperative assessment was conducted with the Orfaly & Keating scale. We used descriptive statistics with central trend and scatter measurements, Fischer test for the relative risk and logistic regression. RESULTS: The total number of patients was 25. Mean age was 41.6 (16-81), SD was 17.03 years; 15 patients were males (60%) and 10 females (40%); 1 (4%) had type-2 diabetes mellitus; the left side was affected in 17 (68%) patients; all patients underwent surgery with osteosynthesis; there was 100% match between the preoperative and postoperative diagnoses (Kappa 1.0); patient course was appropriate in 76% and acceptable in 24% (Orfaly & Keating); 16% had angular valgus deformity and 12% had joint stiffness. Females with RR 1.33 (CI 0.869-2.045) had angular valgus deformity; those with RR 0.22 (CI 0.27-1.846) had joint stiffness, RR was 2.68 for hockey stick plate osteosynthesis, and RR was 1.088 (CI 95%, 0.7-3.1) for the unsatisfactory course according to the Orfaly & Keating scale. CONCLUSION: A positive relative risk was found among females for angular valgus deformity, and in hockey stick plate osteosynthesis and minimal osteosynthesis for an unsatisfactory course, according to the Orfaly & Keating scale, six months after surgical treatment.