Tratamiento de las fracturas del antebrazo con placas de compresión dinámica

Introducción: Las fracturas del antebrazo comprometen la diáfisis del radio y el cúbito. Su relación anatómica desempeña un papel importante porque el antebrazo se vincula con los movimientos de la mano para garantizar la función de la extremidad y de los tejidos blandos. Objetivo: Evaluar los resultados del tratamiento de la fractura diafisiarias de antebrazo con placa de compresión dinámica. Métodos: Se realizó un estudio prospectivo, longitudinal y descriptivo en 28 pacientes con fractura diafisaria de antebrazo, intervenidos quirúrgicamente con placa de compresión dinámica en el Hospital Ortopédico Docente "Fructuoso Rodríguez". Los resultados fueron evaluados según la escala funcional de Grace-Eversmann. Resultados: La edad media fue de 38 años, con una proporción entre sexos de 2,1:1. Predominaron las fracturas del tercio medio del radio y del cúbito. Se afectó más el lado izquierdo, pero en el 75 % de los casos hubo un excelente resultado. No se registraron fallas con la técnica quirúrgica aplicada. Conclusiones: La osteosíntesis con placa de compresión dinámica en las fracturas diafisarias de antebrazo es una alternativa adecuada para garantizar tasas de consolidación elevadas y resultados funcionales excelentes.

Introduction: Fractures of the forearm compromise the diaphysis of the radius and ulna. Their anatomical relationship plays an important role because the forearm is linked to hand movements to ensure limb and soft tissue function. Objective: To evaluate the results of treating diaphyseal forearm fracture with dynamic compression plate. Methods: A prospective, longitudinal and descriptive study was carried out in 28 patients with diaphyseal fracture of the forearm. They underwent surgery with a dynamic compression plate at Fructuoso Rodríguez Teaching Orthopedic Hospital. The results were evaluated according to Grace-Eversmann functional scale. Results: The mean age was 38 years, with a gender ratio of 2.1:1. Fractures of the middle third of the radius and ulna predominated. The left side was affected more, but 75% of the cases had excellent result. No failures were recorded with the applied surgical technique. Conclusions: Osteosynthesis with dynamic compression plating in diaphyseal fractures of the forearm is a suitable alternative to guarantee high consolidation rates and excellent functional results.

Resultados del tratamiento de la fractura del húmero distal con placas perpendiculares

Introducción: La fractura del extremo distal del húmero constituye un verdadero reto para los traumatólogos. Se han diseñado numerosos métodos de tratamiento quirúrgico para restaurar anatómicamente la superficie articular y lograr una estabilidad que permita la movilidad y la pronta incorporación del paciente a sus actividades diarias. Objetivo: Evaluar los resultados del tratamiento quirúrgico de la fractura del húmero distal con placas perpendiculares Métodos: Se realizó un estudio prospectivo, longitudinal, descriptivo en 18 pacientes con fractura del húmero distal, intervenidos quirúrgicamente con el sistema de placas perpendiculares en el Hospital Ortopédico Docente "Fructuoso Rodríguez" en el período 2017-2020. Los resultados se evaluaron según la escala de la clínica Mayo para la función del codo. Resultados: Se estudiaron 18 casos con un promedio de edad de 49 años. El tipo de fractura más frecuente fue la simple articular. Al año la flexoextensión media fue de 1120/160 y la pronosupinación de 810/800. La complicación más común fue la rigidez articular. El 50 % de los resultados fueron excelentes. Conclusiones: El tratamiento de la fractura de húmero distal con placas perpendiculares ofreció buenos resultados clínicos y funcionales por lo que constituye una opción válida en el Hospital Ortopédico Docente "Fructuoso Rodríguez".

Introduction: The fracture of the distal end of the humerus is a real challenge for traumatologists. Numerous surgical treatment methods have been designed to anatomically restore the joint surface and achieve stability that allows mobility and prompt return of the patient to daily activities. Objective: To evaluate the results of the surgical treatment of the distal humerus fracture with perpendicular plates. Methods: A prospective, longitudinal, descriptive study was carried out in 18 patients with fractures of the distal humerus, who underwent surgery with the perpendicular plate system. The results were evaluated according to Mayo Clinic scale for elbow function. Results: Eighteen cases with an average age of 49 years were studied. The most frequent type of fracture was simple joint. At one year, mean flexoextension was 1120/160 and pronosupination 810/800. The most common complication was joint stiffness. 50% of the results were excellent. Conclusions: The treatment of the distal humerus fracture with perpendicular plates offered good clinical and functional results, in consequence it constitutes a valid option at Fructuoso Rodríguez Orthopedic Teaching Hospital.

Síndrome PFAPA. ¿Cuándo sospecharlo?

Introducción: El síndrome de Marshall o PFAPA, por sus siglas en inglés (Periodic fever, aphtas, pharyngitis and cervical adenopathies), es una patología que se caracteriza principalmente por cuadros de ebres periódicas asociadas a faringitis y estomatitis. Los pacientes suelen recibir múltiples cursos de antibióticos antes de ser diagnosticados. Se desconoce su causa exacta, el diagnóstico es clínico y se con rma con la mejoría del cuadro luego de la administración de prednisona oral. Caso clínico: Se presenta el caso de una paciente de 4 años de edad quien inició con episodios febriles recurrentes desde los 9 meses de edad y luego de múltiples ciclos de antibióticos se sospecha el Síndrome de Marshall el cual mejoró luego del abordaje terapeútico dirigido. Discusión: El síndrome de Marshall o PFAPA es una entidad que debe ser considerada durante la atención primaria en aquellos pacientes que acuden frecuentemente por cuadros de ebre, faringitis y estomatitis aftosas. La sospecha de este diagnóstico mejora la calidad de vida del paciente y sus familiares considerando la ansiedad que produce a los padres llevar a su niño con frecuencia al cuarto de urgencias.

Introduction: Marshall syndrome or PFAPA (Periodic fever, aphtas, pharyngitis and cervical adenopathies), is a condition that is mainly characterized by periodic fevers associated with pharyngitis and stomatitis. Patients usually receive multiple courses of antibiotics before being diagnosed. The exact cause is unknown, the diagnosis is clinical and con rmed with the improvement of the condition after administration of oral prednisone. Case report: We report a case of a 4 year old girls who started with recurrent febrile episodes from 9 months and after multiple courses of antibiotics, Marshall Syndrome was suspected and patient improved after targeted therapy. Discussion: Marshall Syndrome or PFAPA is a condition that must be considered during primary care attention of those patients who frequently consult by cyclic episodes of fever, pharyngitis and aphthous stomatitis. The suspicion of this diagnosis improves the quality of life of patients and their families considering the anxiety of parents who needs to take their child to the emergency

Prehispanic use of chili peppers in Chiapas, Mexico.

The genus Capsicum is New World in origin and represents a complex of a wide variety of both wild and domesticated taxa. Peppers or fruits of Capsicum species rarely have been identified in the paleoethnobotanical record in either Meso- or South America. We report here confirmation of Capsicum sp. residues from pottery samples excavated at Chiapa de Corzo in southern Mexico dated from Middle to Late Preclassic periods (400 BCE to 300 CE). Residues from 13 different pottery types were collected and extracted using standard techniques. Presence of Capsicum was confirmed by ultra-performance liquid chromatography (UPLC)/MS-MS Analysis. Five pottery types exhibited chemical peaks for Capsicum when compared to the standard (dihydrocapsaicin). No peaks were observed in the remaining eight samples. Results of the chemical extractions provide conclusive evidence for Capsicum use at Chiapas de Corzo during a 700 year period (400 BCE-300 CE). Presence of Capsicum in different types of culinary-associated pottery raises questions how chili pepper could have been used during this early time period. As Pre-Columbian cacao products sometimes were flavored using Capsicum, the same pottery sample set was tested for evidence of cacao using a theobromine marker: these results were negative. As each vessel that tested positive for Capsicum had a culinary use we suggest here the possibility that chili residues from the Chiapas de Corzo pottery samples reflect either paste or beverage preparations for religious, festival, or every day culinary use. Alternatively, some vessels that tested positive merely could have been used to store peppers. Most interesting from an archaeological context was the presence of Capsicum residue obtained from a spouted jar, a pottery type previously thought only to be used for pouring liquids.

Endoplasmic reticulum and the unfolded protein response: dynamics and metabolic integration.

The endoplasmic reticulum (ER) is a dynamic intracellular organelle with multiple functions essential for cellular homeostasis, development, and stress responsiveness. In response to cellular stress, a well-established signaling cascade, the unfolded protein response (UPR), is activated. This intricate mechanism is an important means of re-establishing cellular homeostasis and alleviating the inciting stress. Now, emerging evidence has demonstrated that the UPR influences cellular metabolism through diverse mechanisms, including calcium and lipid transfer, raising the prospect of involvement of these processes in the pathogenesis of disease, including neurodegeneration, cancer, diabetes mellitus and cardiovascular disease. Here, we review the distinct functions of the ER and UPR from a metabolic point of view, highlighting their association with prevalent pathologies.

Endoplasmic reticulum: ER stress regulates mitochondrial bioenergetics.

Endoplasmic reticulum (ER) stress activates an adaptive unfolded protein response (UPR) that facilitates cellular repair, however, under prolonged ER stress, the UPR can ultimately trigger apoptosis thereby terminating damaged cells. The molecular mechanisms responsible for execution of the cell death program are relatively well characterized, but the metabolic events taking place during the adaptive phase of ER stress remain largely undefined. Here we discuss emerging evidence regarding the metabolic changes that occur during the onset of ER stress and how ER influences mitochondrial function through mechanisms involving calcium transfer, thereby facilitating cellular adaptation. Finally, we highlight how dysregulation of ER-mitochondrial calcium homeostasis during prolonged ER stress is emerging as a novel mechanism implicated in the onset of metabolic disorders.

Increased ER-mitochondrial coupling promotes mitochondrial respiration and bioenergetics during early phases of ER stress.

Increasing evidence indicates that endoplasmic reticulum (ER) stress activates the adaptive unfolded protein response (UPR), but that beyond a certain degree of ER damage, this response triggers apoptotic pathways. The general mechanisms of the UPR and its apoptotic pathways are well characterized. However, the metabolic events that occur during the adaptive phase of ER stress, before the cell death response, remain unknown. Here, we show that, during the onset of ER stress, the reticular and mitochondrial networks are redistributed towards the perinuclear area and their points of connection are increased in a microtubule-dependent fashion. A localized increase in mitochondrial transmembrane potential is observed only in redistributed mitochondria, whereas mitochondria that remain in other subcellular zones display no significant changes. Spatial re-organization of these organelles correlates with an increase in ATP levels, oxygen consumption, reductive power and increased mitochondrial Ca²âº uptake. Accordingly, uncoupling of the organelles or blocking Ca²âº transfer impaired the metabolic response, rendering cells more vulnerable to ER stress. Overall, these data indicate that ER stress induces an early increase in mitochondrial metabolism that depends crucially upon organelle coupling and Ca²âº transfer, which, by enhancing cellular bioenergetics, establishes the metabolic basis for the adaptation to this response.

Glucose deprivation causes oxidative stress and stimulates aggresome formation and autophagy in cultured cardiac myocytes.

Aggresomes are dynamic structures formed when the ubiquitin-proteasome system is overwhelmed with aggregation-prone proteins. In this process, small protein aggregates are actively transported towards the microtubule-organizing center. A functional role for autophagy in the clearance of aggresomes has also been proposed. In the present work we investigated the molecular mechanisms involved on aggresome formation in cultured rat cardiac myocytes exposed to glucose deprivation. Confocal microscopy showed that small aggregates of polyubiquitinated proteins were formed in cells exposed to glucose deprivation for 6 h. However, at longer times (18 h), aggregates formed large perinuclear inclusions (aggresomes) which colocalized with gamma-tubulin (a microtubule-organizing center marker) and Hsp70. The microtubule disrupting agent vinblastine prevented the formation of these inclusions. Both small aggregates and aggresomes colocalized with autophagy markers such as GFP-LC3 and Rab24. Glucose deprivation stimulates reactive oxygen species (ROS) production and decreases intracellular glutathione levels. ROS inhibition by N-acetylcysteine or by the adenoviral overexpression of catalase or superoxide dismutase disrupted aggresome formation and autophagy induced by glucose deprivation. In conclusion, glucose deprivation induces oxidative stress which is associated with aggresome formation and activation of autophagy in cultured cardiac myocytes.

The transcription factor MEF2C mediates cardiomyocyte hypertrophy induced by IGF-1 signaling.

Myocyte enhancer factor 2C (MEF2C) plays an important role in cardiovascular development and is a key transcription factor for cardiac hypertrophy. Here, we describe MEF2C regulation by insulin-like growth factor-1 (IGF-1) and its role in IGF-1-induced cardiac hypertrophy. We found that IGF-1 addition to cultured rat cardiomyocytes activated MEF2C, as evidenced by its increased nuclear localization and DNA binding activity. IGF-1 stimulated MEF2 dependent-gene transcription in a time-dependent manner, as indicated by increased MEF2 promoter-driven reporter gene activity; IGF-1 also induced p38-MAPK phosphorylation, while an inhibitor of p38-MAPK decreased both effects. Additionally, inhibitors of phosphatidylinositol 3-kinase and calcineurin prevented IGF-1-induced MEF2 transcriptional activity. Via MEF2C-dependent signaling, IGF-1 also stimulated transcription of atrial natriuretic factor and skeletal alpha-actin but not of fos-lux reporter genes. These novel data suggest that MEF2C activation by IGF-1 mediates the pro-hypertrophic effects of IGF-1 on cardiac gene expression.

Gln(27)-->Glubeta(2)-adrenergic receptor polymorphism in heart failure patients: differential clinical and oxidative response to carvedilol.

We investigated the clinical response of chronic heart failure patients with beta(2)-adrenergic receptor Gln(27)-->Glu polymorphism treated for 6 months with carvedilol, a alpha/beta-antagonist with antioxidant properties. The 6-min. walk test, the left ventricular ejection fraction, heart rate, plasma norepinephrine and malondialdehyde, a stress oxidative marker, concentrations were evaluated at baseline and after treatment for 6 months with carvedilol in 33 stable chronic heart failure patients with the Gln(27)-->Glubeta(2)-adrenergic receptor polymorphism. Carvedilol significantly increased the left ventricular ejection fraction, while decreasing the heart rate and malondialdehyde plasma concentrations in chronic heart failure patients with the Glu(27)beta(2)-adrenergic receptor allele. There were however, no significant changes in patients with the Gln(27)beta(2)-adrenergic receptor variant.