[Radiographic measurements of acetabular component orientation with Widmer´s method in total hip arthroplasty. Descriptive case series]. / Mediciones radiográficas de la orientación del componente acetabular con el método de Widmer en la artroplastía total de cadera. Serie de casos descriptiva.

INTRODUCTION: total hip arthroplasty (THA) is one of the most performed surgeries worldwide, with high satisfaction rates. The orientation of the acetabular component has a direct impact on the risk of dislocation, recently with the support of robotic surgery the margin of error in implant placement has decreased; however, the conventional technique even without fluoroscopic support continues to have satisfactory results within the safety zone. MATERIAL AND METHODS: retrospective, cross-sectional, descriptive case series of patients treated with THA at Hospital General Xoco between 2022 and 2024. Degrees of anteversion and inclination were measured with Widmer's method on postoperative radiographs. RESULTS: the radiographs of 113 patients were studied, 80 female and 33 male, with a mean age of 63.2 ± 13.01 years (95% CI: 60.6-65.4), a mean inclination of 42.2° ± 8.1° (95% CI: 40.7-43.2) and anteversion of 14.3° ± 8.5° (95% CI: 12.5-15.4); 76% of the population was within Lewinnek safe zone; by etiology: osteoarthrosis 74%, sequelae of dysplasia 68% and intracapsular fracture 82%; difference between the values of the affected side: left 65%, right 83%, of 3.9° and 4.7°/6.4o and 9° in relation to the overall values of the population. CONCLUSION: in our population undergoing THA, without the use of robotic technique or support of imaging studies, anteversion and inclination figures were recorded within the Lewinnek safety parameters with a conventional method.

INTRODUCCIÓN: la artroplastía total de cadera (ATC) es una de las cirugías más realizadas a nivel mundial, con altos porcentajes de satisfacción. La orientación del componente acetabular tiene impacto directo en el riesgo de luxación; recientemente, con el apoyo de la cirugía robótica, el margen de error en la colocación de los implantes ha disminuido; sin embargo, la técnica convencional, incluso sin apoyo fluoroscópico, continúa teniendo resultados satisfactorios dentro de la zona de seguridad. MATERIAL Y MÉTODOS: serie de casos retrospectiva, transversal y descriptiva, de pacientes tratados con ATC en Hospital General Xoco entre 2022 y 2024. Se midieron los grados de anteversión e inclinación con el método de Widmer en las radiografías postoperatorias. RESULTADOS: se estudiaron las radiografías de 113 pacientes, 80 mujeres y 33 hombres, con edad media de 63.2 ± 13.01 años (IC95%: 60.6-65.4), se obtuvo una inclinación media de 42.2° ± 8.1° (IC95%: 40.7-43.2) y anteversión de 14.3° ± 8.5° (IC95% 12.5-15.4); 76% de la población se encontraba dentro de la zona segura de Lewinnek; por etiología: osteoartrosis 74%, secuelas de displasia 68% y fractura intracapsular 82%; diferencia entre los valores del lado afectado: izquierdo 65%, derecho 83%, de 3.9° y 4.7°/6.4° y 9° en relación con los valores globales de la población. CONCLUSIÓN: en nuestra población sometida a ATC, sin uso de técnica robótica o apoyo de estudios de imagen, se registraron cifras de anteversión e inclinación dentro de los parámetros de seguridad de Lewinnek con un método convencional.

Detecting pediatric appendicular fractures using artificial intelligence.

OBJECTIVE: The primary objective was to assess the diagnostic accuracy of a deep learning-based artificial intelligence model for the detection of acute appendicular fractures in pediatric patients presenting with a recent history of trauma to the emergency department. The secondary goal was to examine the effect of assistive support on the emergency doctor's ability to detect fractures. METHODS: The dataset was 5,150 radiographs of which 850 showed fractures, while 4,300 radiographs did not show any fractures. The process utilized 4,532 (88%) radiographs, inclusive of both fractured and non-fractured radiographs, in the training phase. Subsequently, 412 (8%) radiographs were appraised during validation, and 206 (4%) were set apart for the testing phase. With and without artificial intelligence assistance, the emergency doctor reviewed another set of 2,000 radiographs (400 fractures and 600 non-fractures each) for labeling in the second test. RESULTS: The artificial intelligence model showed a mean average precision 50 of 89%, a specificity of 92%, a sensitivity of 90%, and an F1 score of 90%. The confusion matrix revealed that the model trained with artificial intelligence achieved accuracies of 93 and 95% in detecting fractures, respectively. Artificial intelligence assistance improved the reading sensitivity from 93.7% (without assistance) to 97.0% (with assistance) and the reading accuracy from 88% (without assistance) to 94.9% (with assistance). CONCLUSION: A deep learning-based artificial intelligence model has proven to be highly effective in detecting fractures in pediatric patients, enhancing the diagnostic capabilities of emergency doctors through assistive support.

Differences between radiographic and non-radiographic axial spondyloarthritis patients in a Mexican cohort.

To compare the demographic, clinical, and laboratory characteristics, disease onset, and clinical features of radiographic axial Spondyloarthritis (r-axSpA) and non-radiographic axial Spondyloarthritis (nr-axSpA) patients. All patients who attended outpatient spondylarthritis (SpA) clinics at Hospital General de Mexico and the Instituto Nacional de la Nutrición from 1998 to 2005 and met the rheumatologist diagnostic criteria for SpA were selected. Then the SpA patients were classified by European Spondyloarthropathy Study Group criteria (ESSG). We selected SpA patients with axial presentation as axial SpA (axSpA), and they were classified as r-axSpA if they met modified New York (mNY) criteria for sacroiliitis and as nr-axSpA if they did not meet mNY criteria; to compared clinical, demographic, and laboratory test between the subgroups. It included 148 SpA patients; 55 (37.2%) patients had r-axSpA, and 70 (47.3%) had nr-axSpA. The nr-axSpA patients had a lower proportion of males (58.6% vs 78.2%, P < 0.05), lower HLA-B27 frequency (54.3%. vs. 92.7%, P < 0.05), were older at disease onset (21 vs 16 years; P < 0.01) and had a higher frequency of infections at disease onset (9.1% vs 32.9, P < 0.05) than r-axSpA. BASFI (2.9 vs 4.8; P < 0.0001), Dougados functional index (7 vs. 14; P < 0.05), and BASDAI (4.1 vs. 5.2; P < 0.001) were lower in patients with nr-axSpA than r-axSpA, respectively. The factors that most influenced the presentation of r-axSpA were history of uveitis (OR 14, 95% CI 2.3-85), HLA-B27 (OR 7.97, 95% CI, 2.96-122), male sex (OR 6.16, 95% CI, 1.47-25.7), axial enthesopathy count (OR 1.17 95% CI, 1.03-1.33). This study provides insight into the differences between nr-axSpA and r-axSpA in Mexico. Patients with r-axSpA were mainly male, with a younger presentation age, a higher prevalence of HLA-B27, more history of uveitis, fewer episodes of dactylitis, more axial enthesopathy, and higher disease activity than nr-axSpA.

[Design and application of a device for radiographic projection of the tibio-astragalangeal mortise]. / Diseño y aplicación de dispositivo para proyección radiográfica de la mortaja tibio-astragalina.

INTRODUCTION: ligamentous injuries of the distal tibiofibular syndesmosis resulting in its opening are common occurrences in traumatology; however, their diagnosis poses a challenge for orthopedic surgeons. The tibioastragaloid mortise radiograph view is the most commonly used method for diagnosing this type of injury, but its reliability is compromised due to variations in ankle positioning during the study, which often depend on the operator. OBJECTIVE: to demonstrate that the designed device achieves a correct and consistent radiographic image of the distal tibiofibular syndesmosis in the mortise view. MATERIAL AND METHODS: we present a prospective, longitudinal, observational study. We designed a polypropylene device that maintains the ankle at 90 degrees of dorsiflexion and 15 degrees of internal rotation. The device was used to take mortise view radiographs of healthy ankles, and corresponding measurements were taken to assess the syndesmosis. RESULTS: we evaluated a total of 46 radiographs of healthy ankles, with a predominance of left ankles. The obtained measurements were as follows: anterior tibiofibular distance (ATFD) ranged from 3 to 6 mm, posterior tibiofibular distance (PTFD) ranged from 1 to 3 mm, tibiofibular clear space (TFCS) ranged from 2 to 3 mm, and a Merle D'Aubigne ratio of 2:1 was observed in all ankles. When comparing the measurements obtained with those established by Harper and Keller, no statistically significant difference was found (2 < 5). CONCLUSION: with the use of the designed device, we achieved a correct and consistent radiographic image of the mortise and the distal tibiofibular syndesmosis.

INTRODUCCIÓN: las lesiones ligamentarias de la sindesmosis tibioperonea distal que ocasionan apertura de la misma son muy frecuentes en traumatología; sin embargo, su diagnóstico es un reto para el cirujano ortopedista. La radiografía de la mortaja tibioastragalina es el método más utilizado para el diagnóstico de este tipo de lesiones, pero es poco confiable ya que la posición del tobillo durante el estudio suele variar dependiendo del operador. OBJETIVO: demostrar que con el uso del dispositivo diseñado se logra una imagen radiográfica correcta y constante de la sindesmosis tibioperonea distal en la proyección de la mortaja. MATERIAL Y MÉTODOS: estudio prospectivo, longitudinal y observacional. Diseñamos un dispositivo de polipropileno que mantiene el tobillo a 90 grados de dorsiflexión y rotación interna de 15 grados. Aplicamos el dispositivo para tomar radiografías de la mortaja en tobillos sanos y les realizamos las mediciones correspondientes para valorar la sindesmosis. RESULTADOS: valoramos un total de 46 radiografías de tobillos sanos, con un predominio de tobillos izquierdos. Las mediciones conseguidas fueron las siguientes: espacio tibioperoneo (ETP) de 3 a 6 mm, la superposición tibioperonea (STP) de 1 a 3 mm, espacio astrágalo-tibial medial (EATM) de 2 a 3 mm y una relación de Merle D'Aubigne de 2:1 en todos los tobillos. Al comparar las mediciones obtenidas con las establecidas por Harper y Keller, no se encontró una diferencia estadísticamente significativa (2 < 5). CONCLUSIÓN: con el uso del dispositivo diseñado, obtuvimos una correcta y constante imagen radiográfica de la mortaja y la sindesmosis tibioperonea distal.

Clinical, Laboratory, and Imaging Features Between Men and Women With Axial Spondyloarthritis in a Specialized Center in Argentina.

OBJECTIVES: The aims were to estimate the frequency of axial spondyloarthritis (axSpA) in women and to analyze the clinical, laboratory, and imaging differences with respect to men at the time of diagnosis. METHODS: Consecutive patients older than 18 years with a diagnosis of axSpA admitted to the "Reumacheck" SpA program were included between 2017 and 2022. At baseline, all patients underwent clinical assessment, laboratory tests including C-reactive protein and human leukocyte antigen B27, and imaging (plain radiography and magnetic resonance imaging of sacroiliac joints, and ultrasound of heel entheses). All evaluators were blinded to the results of the other evaluations. RESULTS: One hundred sixteen patients with a diagnosis of axSpA were included. The frequency at diagnosis in women was 61.55%. In the univariate analysis, the significant differences between women and men at diagnosis of axSpA were good response to nonsteroidal anti-inflammatory drugs, elevated C-reactive protein, New York Criteria (+), enthesis ultrasound (+), years of education, number of swollen joints, erythrosedimentation rate, and the very low frequency of bone bridges in the magnetic resonance imaging of the sacroiliac joints. In the logistic regression analysis, the dependent variable was "men," and the only feature that was independently associated was having radiographic compromise according to the New York criteria (odds ratio, 2.6). CONCLUSIONS: The frequency of axSpA in women was 61.55%; clinical, laboratory, and imaging differences were observed. Women experienced less radiographic compromise.

Adolescent idiopathic scoliosis: is there a relationship between Risser staging and the proximal humerus ossification system?

PURPOSE: To evaluate whether there is a mismatch between Risser staging and the proximal humerus ossification system (PHOS); and to analyze the correlation in the skeletal maturity stages between the two humeral epiphyses. METHODS: Data from patients aged 10 to 18 years with adolescent idiopathic scoliosis (AIS) seen between 2018 to 2021 were analyzed. In an anteroposterior (AP) spine radiograph the ossification process was evaluated using the Risser classification method and bilateral PHOS (if both humeral epiphyses were visualized). A mismatch between methods was defined as a Risser 0-1 (relatively skeletally immature) with a PHOS 4-5 (skeletally mature), or a Risser 2-5 (relatively skeletally mature) with a PHOS 1-3 (skeletally immature). The McNemar test was used to calculate the significance of the mismatch. RESULTS: A mismatch between Risser and PHOS stages was observed in 28.5% of 105 patients, which was statistically significant (p < 0.001). Of the 49 patients with a Risser 0-1, 55.1% (n = 27) had a PHOS 4-5. None of the patients with a Risser 2-5 had a PHOS 1-3. In the 47 patients in whom both humeri were visualized, the absolute correlation between the left and right PHOS values was 95.7%. CONCLUSION: Of AIS patients who are relatively skeletally immature according to Risser staging, more than half may be skeletally mature when measured with PHOS. In patients with a Risser 0-1, it is recommended to measure skeletal maturity in an AP spine radiograph using the PHOS method, which may more accurately guide treatment decision-making, without the need to visualize both humeral epiphyses in this radiographic projection. LEVEL OF EVIDENCE: IV.

Informe de caso: tuberculosis peritoneal en una mujer de 26 años simulando cáncer de ovario / Case report: peritoneal tuberculosis in a 26-year-old woman simulating ovarian cancer

Introducción: La tuberculosis peritoneal es una enfermedad reemergente, de evolución insidiosa y arduo diagnós- tico. La afectación peritoneal tiene una baja incidencia, afectando por igual ambos sexos figurando entre edades de 35 a 45 años. El alto índice de sospecha debe ser un factor importante en el diagnóstico precoz, para que una vez establecido, se pueda iniciar el tratamiento y disminuir las tasas de morbimortalidad. Descripción del caso clínico: Paciente de 26 años, con clínica inespecífica; dolor abdominal, ascitis y fiebre. Fue ingresada por servicio de medicina interna para abordaje etiológico de ascitis, posteriormente fue abordada como sospecha de cáncer de ovario, se presentó al servicio de cirugía quienes determinaron practicarle laparotomía y cuya biopsia intraoperatoria reporto hallazgos su- gestivos de tuberculosis peritoneal. Conclusión: La tuberculosis peritoneal es una enfermedad poco frecuente, las manifestaciones clínicas pueden sugerir la presencia de una enfermedad tumoral; la sospecha clínica es baja y en muchas ocasiones el diagnóstico es incidenta...(AU)

Radiographic findings in the coxofemoral joint of Australian Cattle Dogs / Achados radiográficos em articulação coxofemoral de cães da raça Australian Cattle Dog

Australian Cattle Dogs (ACD) are medium-sized animals widely used in fieldwork for managing cattle and sheep. There needs to be more information about the conditions these dogs can develop despite being well-characterized animals since the beginning of the 20th century. Hip dysplasia (HD) is a developmental abnormality between the femoral head and the acetabular fossa, which can be debilitating. However, the available literature has no studies on the prevalence of this condition in dogs of this breed. This study aimed to evaluate radiographs of ACD qualitatively and quantitatively. For this purpose, 49 dogs considered healthy without clinical signs of HD were radiographically assessed, and the animals were classified as dysplastic (D) and non-dysplastic (ND). A frequency of 46.9% of dysplastic dogs was observed, with males being more affected. The cortical index (CI) and angle of inclination (AI) could not differentiate D from ND animals; only the Norberg angle (NA) was effective in this differentiation. No correlation was observed between AI, CI, and AN.(AU)

Os cães da raça Autralian Cattle Dog (ACD) são animais de porte médio, muito utilizados no trabalho de campo para manejo de gado e ovelha. Apesar de serem animais bem caracterizados desde o início do século XX, há poucas informações sobre afecções que esses cães podem desenvolver. A displasia coxofemoral (DCF) é uma anormalidade do desenvolvimento entre a cabeça do fêmur e a fossa acetabular podendo ser debilitante. Contudo, não há estudos, na literatura disponível, sobre a prevalência desta afecção em cães dessa raça. O objetivo deste trabalho foi avaliar qualitativamente e quantitativamente radiografias de cães da raça ACD. Para tanto, foram avaliados radiograficamente 49 cães considerados hígidos e sem sinais clínicos de DCF. Os animais foram classificados em displásicos (D) e não displásicos (ND). Observou-se a frequência de 46,9% de cães displásicos, sendo os machos mais acometidos. O índice cortical (IC) e o ângulo de inclinação (AI) não foram capazes de diferenciar os animais D dos ND, apenas o ângulo de Norberg (AN) foi eficaz nessa diferenciação. Não houve correlação entre AI, IC e AN.(AU)

Artritis reumatoide de la columna cervical: aspectos clave para el cirujano ortopédico / Rheumatoid arthritis of the cervical spine: key aspects for the orthopedic surgeon

La artritis reumatoide es una enfermedad inflamatoria autoinmune crónica que afecta con frecuencia a la columna cervical. El diagnóstico clínico de la afección cervical puede ser difícil; por lo tanto, se recomienda la evaluación radiográfica sistemática de todos los pacientes. El tratamiento oportuno de estas lesiones es importante para preservar la independencia, la función neurológica, e, incluso, la vida de los pacientes. Este artículo es una revisión actualizada de todos los aspectos de la artritis reumatoide de la columna cervical relevantes para el cirujano ortopédico.

Rheumatoid arthritis is a chronic inflammatory autoimmune disease that frequently affects the cervical spine. The clinical diagnosis can be difficult; therefore, a systematic radiographic evaluation of all patients is recommended. The timely treatment of these lesions is important to preserve the self-reliance, the neurological function, and even the lives of the patients. The present article is an update of all the aspects pertaining to cervical spine rheumatoid arthritis that are relevant to the orthopedic surgeon.

Estudio radiológico simple de quiste óseo simple y aneurismático: diagnóstico diferencial / Plain radiologic assessment of unicameral and aneurysmal bone cyst: differential diagnosis

OBJETIVO Dar a conocer nuestra experiencia en el diagnóstico diferencial de los quistes óseos simple y aneurismático mediante estudio radiológico simple. MATERIALES Y METODOS Se incluyeron pacientes menores de 20 años con radiografía de quiste óseo simple o aneurismático histológicamente confirmado pertenecientes al Registro Nacional de Tumores Óseos. Las radiografías fueron analizadas por dos radiólogos experimentados. Se compararon las variables demográficas de los pacientes, y las variables clínicas y radiológicas de ambos quistes. RESULTADOS Un total de 97 pacientes cumplieron los criterios de inclusión (65% presentaba quistes óseos simples y 35%, aneurismáticos). No se observaron diferencias en cuanto a la edad, al hueso comprometido, al tamaño de la lesión, a la expansión ósea, ni al adelgazamiento cortical. El género, la forma de presentación, la presencia de interrupción de la cortical, y la localización de la lesión en los ejes longitudinal y transversal del hueso son parámetros que podrían ser útiles en el diagnóstico diferencial de ambos quistes. DISCUSIÓN Los quistes óseos simple y aneurismático son lesiones benignas frecuentes que, de acuerdo con la literatura, serían difíciles de diferenciar únicamente con radiografía simple. La resonancia magnética permite una mejor caracterización anatómica, y aporta sensibilidad y especificidad al diagnóstico. Sin embargo, debe ser precedida por la radiografía simple, y su disponibilidad es limitada. CONCLUSIÓN Aun en centros con disponibilidad de resonancia magnética, la radiografía simple sigue siendo el estudio inicial de elección en el diagnóstico de tumores óseos. Ciertas características demográficas y radiográficas permiten orientar el diagnóstico diferencial inicial entre el quiste óseo simple y el aneurismático

OBJETIVE To describe our experience in the differential diagnosis of unicameral and aneurysmal bone cysts using plain radiography. PATIENCES AND METHODS We included patients under 20 years of age with radiographs of histologically-confirmed unicameral or aneurysmal bone cysts found on the Chilean National Bone-Tumor Registry. The radiographs were evaluated by two experienced radiologists. We compared the demographic variables of the patients, and the clinical and radiological variables of both tumors.. RESULTADOS A total of 97 patients met the inclusion criteria, 65% of whom had simple bone cysts, and 35%, aneurysmal bone cysts. No differences were found regarding age, the bone affected, the size of the lesion, bone expansion, nor cortical thinning. Gender, clinical presentation, cortical interruption, and location of the lesion on the longitudinal and transverse bone axes are parameters that could be used in the differential diagnosis of both cysts. DISCUSSION According to the literature, unicameral and aneurysmal bone cysts are frequent benign lesions that are difficult to differentiate merely through plain radiographs. Magnetic resonance imaging enables a better anatomical characterization and provides sensitivity and specificity to the diagnosis. However, its availability is limited, and it should be preceded by plain radiography. CONCLUSION Plain radiography is still the initial imaging study of choice in patients with clinical suspicion of bone tumor, even in those centers where magnetic resonance imaging is available. Certain demographic and radiological characteristics guide physicians in the differential diagnosis of unicameral and aneurysmal bone cysts.

Artropatía enteropática y fractura de platillos tibiales. Reporte de un caso / Enteropathic Arthropathy and tibial plateau fracture. Report of a case

Introducción: la artropatía enteropática representa una manifestación derivada de complicaciones inflamatorias intestinales. Presentación del caso: paciente de 53 años de edad, de piel blanca, femenina, que sufrió caída de sus pies, con trauma en rodilla izquierda que le ocasionó fractura de meseta tibial izquierda. Discusión: los estudios radiológicos fueron positivos y confirman el diagnóstico de la artropatía enteropática y fractura de platillos tibiales, se aplicaron pautas de tratamientos integradores funcionales. Conclusiones: con los tratamientos el paciente reportó efectos beneficiosos, se lograron los objetivos propuestos en la rehabilitación, así como la incorporación de la paciente a la sociedad con un mínimo de discapacidad e independencia(AU)

Introduction: enteropathic arthropathy represents a manifestation derived from intestinal inflammatory complications. Case presentation: 53-year-old white-skinned female patient who suffered a fall from her feet, with trauma to the left knee that caused a fracture of the left tibial plateau. Discussion: the radiological studies were positive and confirm the diagnosis of enteropathic arthropathy and tibial plateau fractures, functional integrative treatment guidelines were applied. Conclusions: with the treatments the patient reported beneficial effects, the objectives proposed in the rehabilitation were achieved, as well as the incorporation of the patient into society with a minimum of disability and independence(EU)

Fisioterapia respiratoria en pacientes post Covid-19 / Respiratory physiotherapy in post Covid-19 patients

La pandemia de Covid-19 ha modificado pautas en la práctica clínica de especialidades como la Medicina Física y Rehabilitación. Se realizó esta comunicación con el objetivo de abordar las principales técnicas de fisioterapia respiratoria en convalecientes de Covid-19 y la evidencia generada de sus resultados(AU)

The Covid-19 pandemic has modified guidelines in the clinical practice of specialties such as Physical Medicine and Rehabilitation. This communication was carried out with the aim of addressing the main respiratory physiotherapy techniques in convalescents from Covid-19 and theevidence generated from their results(EU)

Clasificación de Imágenes de Neumonía a causa de Covid-19 utilizando Transfer-Learning basado en Redes Convolucionales / Classification of Images of Pneumonia Due to Covid-19 Using TransferLearning, Based on Convolutional Networks

La Inteligencia Artificial ha ayudado a lidiar diferentes problemas relacionados con los datos masivos y a su vez con su tratamiento, diagnóstico y detección de enfermedades como la que actualmente nos preocupa, la Covid-19. El objetivo de esta investigación ha sido analizar y desarrollar la clasificación de imágenes de neumonía a causa de covid-19 para un diagnostico efectivo y óptimo. Se ha usado Transfer-Learning aplicando ResNet, DenseNet, Poling y Dense layer para la elaboración de los modelos de red propios Covid-UPeU y Covid-UPeU-TL, utilizando las plataformas Kaggle y Google colab, donde se realizaron 4 experimentos. El resultado con una mejor clasificación de imágenes se obtuvo en el experimento 4 prueba N°2 con el modelo Covid-UPeU-TL donde Acc.Train: 0.9664 y Acc.Test: 0.9851. Los modelos implementados han sido desarrollados con el propósito de tener una visión holística de los factores para la optimización en la clasificación de imágenes de neumonía a causa de COVID-19(AU)

Artificial Intelligence has helped to deal with different problems related to massive data in turn to the treatment, diagnosis and detection of diseases such as the one that currently has us in concern, Covid-19. The objective of this research has been to analyze and develop the classification of images of pneumonia due to covid-19 for an effective and optimal diagnosis. Transfer-Learning has been used applying ResNet, DenseNet, Poling and Dense layer for the elaboration of the own network models Covid-Upeu and Covid-UpeU-TL, using Kaggle and Google colab platforms, where 4 experiments have been carried out. The result with a better classification of images was obtained in experiment 4 test N ° 2 with the Covid-UPeU-TL model where Acc.Train: 0.9664 and Acc.Test: 0.9851. The implemented models have been developed with the purpose of having a holistic view of the factors for optimization in the classification of COVID-19 images(AU)

Manejo no quirúrgico de la artrosis de rodilla: ¿Son efectivos los medicamentos orales complementarios? / Non-surgical management of knee osteoarthritis: are complementary oral medications effective?

La artrosis es una enfermedad progresiva de las articulaciones sinoviales que causa dolor, impotencia funcional, discapacidad, y degeneración progresiva de la articulación. En sus tratamientos, sobre todo en etapas tempranas, existen distintas intervenciones para evitar tanto su desarrollo y progresión como también para lograr un adecuado manejo de los síntomas, y hay tratamientos médicos orales no convencionales con evidencia controvertida. El objetivo de este trabajo es proporcionar una actualización, dirigida a especialistas en Ortopedia y Traumatología, respecto a la evidencia actual sobre las terapias complementarias orales en el tratamiento de la artrosis de rodilla. Se hace referencia a los métodos fármacológicos complementarios más usados y estudiados, mencionando el método de acción y las consecuencias estudiadas sobre la artrosis de rodilla. Se finaliza con una tabla de recomendaciones basada en evidencia actual.

Osteoarthritis (OA) is a progressive disease of the synovial joints that causes pain, functional impairment, disability, and progressive degeneration of the joint. Regarding its treatments, especially in early stages, there are different interventions to avoid its development and progression and also to achieve an adequate management of symptoms, and there are unconventional oral medical treatments with controversial evidence. The objective of the present paper is to provide an update, to specialists in Orthopedics and Traumatology, regarding the current evidence on complementary oral therapies in the treatment of knee osteoarthritis. References are made to the most widely used and studied complementary pharmacological methods, mentioning the method of action and the consequences studied on knee osteoarthritis. The article ends with a table of recommendations based on current evidence.

Tratamiento de la fractura conminuta de patela: ¿existen diferencias entre realizar o no una eversión? / Treatment of comminuted patellar fracture: are there differences between performing or not performing an eversion?

OBJETIVO Comparar los resultados clínicos, funcionales e imagenológicos de dos técnicas quirúrgicas para el manejo de fracturas conminutas de patela: con y sin eversión patelar. MÉTODOS En una serie de casos retrospectivos de fracturas conminutas de patela tratadas en el mismo centro entre 2014 y 2017, con un seguimiento ≥ 3 meses, se hizo una comparación entre el grupo con eversión y el grupo sin eversión. Los criterios de exclusión fueron patelectomía parcial o total, reinserción tendínea, o rehabilitación incompleta. Las variables analizadas fueron edad, sexo, tabaquismo, diabetes mellitus, energía del accidente, tipo de fractura, variables quirúrgicas (banda de tensión, tornillos, alambres, nudos, cerclaje circular), rango de movimiento (RDM) articular postoperatorio, presencia de osteosíntesis sintomática, puntaje de escalas funcionales (de Tegner-Lysholm y de Kujala) al alta definitiva, complicaciones (rigidez articular, infección, trombosis venosa profunda), y variables imagenológicos con tomografías computarizadas pre- y postoperatorias (brecha, desnivel articular > 2 mm, elementos de fijación intraarticular). RESULTADOS En total, 20 de 22 pacientes, 13 con eversión y 7 sin eversión, cumplieron con los criterios de selección. El seguimiento fue de 3 a 12 meses, y no hubo diferencias estadísticamente significativas respecto a las variables demográficas entre ambos grupos, lo cual los hace comparables. Destacaron el tiempo desde el ingreso al alta, con 7 meses para los pacientes con eversión y 5 meses para los sin eversión (p = 0.032), la proporción de pacientes con desnivel articular > 2 mm, con 7.7% para los con eversión y 14.3% para los sin eversión (p = 0.016), y una tendencia a resultados superiores en escalas funcionales para el grupo con eversión. CONCLUSIÓN El tratamiento de fracturas conminutas de patela con eversión parece ser una alternativa viable dados sus resultados imagenológicos y funcionales superiores a los de la técnica habitual.

PURPOSE To compare the clinical, functional and imaging outcomes of two surgical techniques for the treatment of comminuted patellar fractures: with and without eversion. METHODS In a retrospective series of cases of comminuted patellar fractures treated at a single center between 2014 and 2017, with a follow-up 3 months , we performed a comparison between the eversion group and the non-eversion group. The exclusion criteria were partial or total patellectomy, tendon reinsertion, or incomplete rehabilitation. The variables analyzed were age, gender, smoking, diabetes mellitus, the energy of the accident, the fracture type, surgical variables (tension band, screws, wires, knots, circular cerclage), postoperative joint range of motion (ROM), presence of symptomatic osteosynthesis, the scores on the functional scales (of Tegner-Lysholm and of Kujala) at the final discharge, complications (joint stiffness, infection, deep vein thrombosis), and pre- and postoperative computed tomography imaging variables (gap, step-off > 2mm, intra-articular fixation elements). RESULTS In total, 20 out of 22 patients, 13 undegoing eversion and 7 not undergoing eversion, met the selection criteria.. The follow-up ranged from 3 to 12 months, and there were no statistically significant differences regarding the demographic variables between both groups, which makes them comparable. The most remarkable results were the time from admission to final discharge, of 7 months for the patients in the eversion group, and of 5 months for those in the non-eversion group (p » 0.032), the proportion of patients with a step-off > 2 mm, with 7.7% for the eversion group and 14.3% for the non-eversion group (p » 0.016), and a tendency towards higher scores in the functional scales for the eversion group. CONCLUSION The treatment of comminuted patellar fractures with eversion seems to be a viable alternative, given its superior imaging and functional results compared to those of the usual technique.

Leiomiosarcoma primario de hueso en fémur distal metastásico a clavícula: reporte de un caso / Primary leiomyosarcoma of bone in the distal femur with clavicle metastasis: a case report

El leiomiosarcoma (LMS) es un tipo de tumor de células fusiformes de muy baja incidencia, que tiene un comportamiento agresivo, con alta tasa de mortalidad, por lo que el manejo debe ser quirúrgico, con una resección amplia de la lesión. No está claro el papel de la radio ni de la quimioterapia en su manejo. Presentamos a una paciente de 28 años que consultó por dolor de 2 meses en la rodilla derecha. Radiográficamente, se caracterizó como una lesión osteolítica pura en el fémur distal. La resonancia nuclear magnética (RNM) contrastada mostró áreas hipervasculares dentro del tumor. La gammagrafía mostró un marcado aumento en la captación de radiotrazadores. Se tomó una biopsia, con un informe de patología de LMS óseo bien diferenciado. Se trató con 3 ciclos de quimioterapia neoadyuvante preoperatoria con ifosfamida 1.000 mg/m2 en los días 1 a 3, además de doxorrubicina 70 mg/m2 , y resección quirúrgica de la lesión y salvamento de la extremidad con endoprótesis de rodilla. Una vez que se resecó la lesión, la paciente recibió quimioterapia adyuvante con 4 ciclos de gencitabina 1.000 mg/m2 entre los días 1 y 8, y doxetacel 70 mg/m2 el día 1. Durante los dos meses de seguimiento, la paciente presenóa una fractura en el tercio medio de la clavícula, compatible con una lesión patológica en radiografías y tomografía por emisión de positrones (TEP). La biopsia reveló una lesión metastásica de LMS óseo que fue tratada mediante resección quirúrgica de la clavícula. Este es un caso único, dado que, durante el seguimiento, recibió tratamiento adyuvante con quimioterapia y se evaluó con una TEP, con una evolución clínica satisfactoria y sin evidencia de nuevas lesiones

Leiomyosarcoma (LMS) is a type of spindle-cell tumor of very low incidence that tumor has an aggressive behavior, with high mortality rates; therefore, its management must be surgical, with a wide resection of the lesion. The role of radio and chemotherapy in its management is not clear. We present the case of a 28-year-old female patient who consulted for pain lasting 2 months in the right knee. Radiographically, it was characterized as a pure osteolytic lesion in the distal femur. Contrast magnetic resonance imaging (MRI) showed hypervascular areas within the tumor. The scintigraphy showed a marked increase in radiotracer uptake. A biopsy was taken, with a pathology report of well-differentiated osseous LMS. It was treated with 3 cycles of preoperative neoadjuvant chemotherapy with ifosfamide 1,000 mg/m2 in the first 3 days, as well as doxorubicin 70 mg/m2 , and surgical resection of the lesion and limb salvage with knee endoprosthesis. Once the lesion was resected, the patient underwent adjuvant chemotherapy, with 4 cycles of gencitabine 1,000 mg/m2 between days 1 and 8, and doxetacel 70 mg/m2 on day 1. During the 2-month follow-up, the patient presented a fracture in the middle third of the clavicle, which was compatible with a pathological lesion on radiographs and positron-emission tomography (PET) scans. The biopsy showed a metastatic lesion of bone LMS, which was treated by surgical resection of the clavicle. This is a unique case, given that, during the follow-up, the patient underwent adjuvant treatment with chemotherapy, and was evaluated with a PET scan, with a satisfactory clinical evolution and no evidence of new lesions.

Miositis osificante traumática en recién nacido: reporte de caso / Traumatic myositis ossificans in newborn: a case report

La miositis osificante traumática (MOT) es una enfermedad en la que ocurre osificación heterotópica en dos a cuatro semanas tras uno o múltiples traumatismos. El objetivo de este artículo es describir las características clínicas y radiológicas de un caso de MOT en un recién nacido (RN) después de la canulación intravenosa de vía periférica, poco frecuente en la práctica clínica en neonatología. Presentamos a un RN pretérmino de 33 semanas en que, a los 20 días de vida, se evidenció lesión tumoral en el tercio distal del antebrazo izquierdo de 3 cm por 2 cm, que no impresionaba dolor, ni limitación a la movilización, y en la que no había signos infecciosos. El resto del examen físico osteomuscular era normal. En la zona de lesión, tres semanas antes, se había instalado un catéter intravenoso periférico (CIVP). Una radiografía del antebrazo izquierdo demostró lesión calcificada al nivel de las partes blandas, sin disrupción de las estructuras óseas adyacentes; la ecografía del antebrazo reveló una imagen focal ovalada, de contornos parcialmente definidos, con sombra acústica posterior; el resto de los estudios de huesos largos era normal. Los niveles séricos de fosfatasa alcalina, calcio, fósforo también eran normales. En vista de la lesión tumoral al examen físico y la imagen calcificada en partes blandas a través de radiografía simple, con antecedente de microtraumas de VVP, se concluyó MOT. Se hizo seguimiento, con disminución del tamaño hasta que la lesión desapareció a los cuatro meses. No requirió control radiológico. La MOT es infrecuente en el RN, y, en general, la resolución es autolimitada y tiene buen pronóstico

Traumatic myositis ossificans (TMO) is a disorder in which heterotopic ossification occurs two to four weeks after one or multiple traumas. The goal of the present article is to describe the clinical and radiological characteristics of a case of TMO in a newborn (NB) after a peripheral intravenous cannulation, a rare procedure in the clinical practice of neonatology. The patient is a premature 33-week-old NB who, 20 days after birth, presented with a 3 cm x 2 cm lump in the distal third of the left forearm that did not seem to cause pain or to limit movements, and with no evidence of infection. The rest of the physical exam was within normal limits. Three weeks before the lesion, a peripheral intravenous catheter (PIVC) was placed in that area. A radiograph of the left forearm showed soft-tissue calcification without disruption of adjacent bone structures. Ultrasound revealed a focal, oval soft tissue lesion with partially-defined borders and posterior acoustic shadow; the rest of study showed normal long bones. The serum levels of alkaline phosphatase, calcium, and phosphorus were all normal. In view of the tumor lesion on the physical examination and the calcified image in softtissue on plain X-ray and a recent history of PIVC microtrauma, we reached to the diagnoses of TMO. During the follow-up, the lesion decreased in size until it completely disappeared four months after the diagnosis. No radiological control was needed. Uncommon in NBs, TMO is generally self-limited and with a good prognosis

Trauma craneoencefálico penetrante por una herida de arpón. Presentación de un caso / Penetrating cranioencephalic trauma due to harpoon wound. Presentation of a case

RESUMEN Las heridas craneocerebrales penetrantes más frecuentes son las provocadas por armas de fuego; las restantes resultan de rara frecuencia. Se presentó un caso que recibió agresión craneoencefálica por arpón, de forma accidental, fuera del agua. Se describieron los detalles del suceso, los exámenes complementarios, la conducta adoptada, el manejo neuroquirúrgico, y la sorprendente evolución postoperatoria del paciente (AU).

ABSTRACT The most frequent penetrating craniocerebral wounds are those caused by firearms; the remaining ones are rare. We presented a case that received accidental cranioencephalic aggression by harpoon, an event that occurred out of the water. Details of the event, complementary examinations, adopted behavior and neurosurgical management that were decided, as well as the surprising post-operative evolution of the patient were described (AU).

Nutrição enteral: posicionamento adequado das sondas / Enteral nutrition proper positioning of the probes

Elucidar, em tempo oportuno, as diferenças, riscos e benefícios, da administração da NE com tubos em posição nasogástrica ou pós-pilórica, bem como informar o que traz a literatura acerca das técnicas para confirmação do posicionamento da sonda com eficácia e segurança.

Elucidate, in a timely manner, the differences, risks and benefits of the administration of tubes in nasogastric or post-pyloric position, as well as inform what the literature about the techniques to confirm the positioning of the probe effectively and safely.