Analysis of surgical delay and its influence on morbimortality in patients with hip fracture. / Análisis de las causas de demora quirúrgica y su influencia en la morbimortalidad de los pacientes con fractura de cadera.

INTRODUCTION: Surgical delay for hip fractures (>48h) has been associated with greater adverse clinical events. However, the influence of the reasons for delay is unclear. The objective of this study was to analyse the causes of surgical delay and its influence on morbidity and mortality, in patients with hip fracture with indication for surgical treatment. MATERIAL AND METHOD: A cohort of 376 hip fractures operated at our centre between January 2012 and December 2016 was retrospectively reviewed. Patients younger than 65 years and pathological fractures were excluded. Of these, 280 patients were operated with a surgical delay>48h. The causes of the delay were: antiaggregation (AG), anticoagulation (AC), medical reasons (MM), preoperative cardiac tests or administrative/organizational reasons. Surgical wound complications, general complications and mortality were compared. RESULTS: There was a greater proportion of surgical wound complications in the AC group (P=.063). Patients in the AG, AC, and MM groups had higher rates of general associated complications (P=.3). Seven point fifty-one percent of the patients included died one year after surgery. The mortality rate at one year was highest in the MM group (P=.005). CONCLUSION: The mortality rate was statistically significantly higher in the MM group. When comparing results, patients in the AG, AC, and MM groups presented higher rates of general complications.

Primer estudio argentino de correlación en ecografía musculoesquelética / First argentine study of musculoskeletal ultrasonography correlation

Si bien existe evidencia de la potencial aplicación de la ecografía musculoesquelética en la evaluación de las articulaciones con artritis, sonlimitados los datos acerca de su exactitud y reproducibilidad. El objetivo de este estudio es conocer la correlación interobservador e intermáquinas de un grupo de radiólogos y reumatólogos ecografistas de diferentes centros del país. Métodos: Seis reumatólogos y 1 radiólogo se reunieron para definir los lineamientos a ser usados para la lectura e interpretación de imágenes. Las articulaciones evaluadas fueron: carpo (radiocarpiana, intracarpiana), 2 MCF dorsal, ventral y lateral, 3 MCF dorsal, ventral, 2 PIF. Se consignó sinovitis cuando se detectó al menos una de las siguientes lesiones ecográficas: presencia de derrame articular (DA), hipertrofia sinovial (HS) o señal Doppler+. Se vieron 36 imágenes en 2 oportunidades con 1 mes de diferencia para determinar la correlación interobservador de las imágenes de banco. Se evaluaron 3 pacientes para determinar correlación interobservador en tiempo real y uno de los observadores evaluó al mismo paciente en las 3 máquinas para determinar la correlación intermáquinas. Resultados: En las correlaciones de lectura de imágenes de banco, el valor de kappa fue regular a moderado siendo el coeficiente de correlación intraclase (CCI) para señal doppler 0,91. Las correlaciones en tiempo real mostraron un kappa moderado tanto para la detección de líquido como para la hipertrofia sinovial con valores de 0,51 y 0,46, respectivamente, siendo (CCI) para señal doppler en tiempo real de 0,68.

The dexamethasone suppression test in prepubertal depressed children.

The authors evaluated 18 dysphoric children aged 6--12 years by structured clinical assessments and an overnight dexamethasone suppression test (DST) administered on an outpatient basis. Nine children met diagnostic criteria for major depressive disorder, and 8 of the 9 also met the Research Diagnostic Criteria for endogenous depression. Of the 9 depressed children, 5 had abnormal DST results; 8 of the 9 nondepressed children had normal test results. The results suggest that endogenous depression in childhood is not a rare condition and that it is clinically and neuroendocrinologically similar to the adult disorder. The DST may be useful as a diagnostic aid with depressed children.