Unhealthy Levels of Phthalates and Bisphenol A in Mexican Pregnant Women with Gestational Diabetes and Its Association to Altered Expression of miRNAs Involved with Metabolic Disease.

Several studies indicate that bisphenol A (BPA) and phthalates may have a role in the development of metabolic diseases using different molecular pathways, including epigenetic regulatory mechanisms. However, it is unclear whether exposure to these chemicals modifies serum levels of miRNAs associated with gestational diabetes mellitus (GDM) risk. In the present study, we evaluated the serum levels of miRNAs associated with GDM (miR-9-5p, miR-16-5p, miR-29a-3p and miR-330-3p) and urinary levels of phthalate metabolites (mono-n-butyl phthalate (MBP), mono-isobutyl phthalate (MiBP), mono-benzyl phthalate (MBzP) and mono(2-ethyl hexyl) phthalate (MEHP)) and bisphenol A in GDM patients and women without GDM during the second trimester of gestation. We observed higher levels of miR-9-5p, miR-29a-3p and miR-330-3p in sera of patients with GDM compared to non-diabetic subjects. Phthalates were detected in 97-100% of urine samples, while BPA only in 40%. Urinary MEHP and BPA concentrations were remarkably higher in both study groups compared to previously reported data. Unadjusted MEHP levels and adjusted BPA levels were higher in non-diabetics than in GDM patients (p = 0.03, p = 0.02). We found positive correlations between adjusted urinary MBzP levels and miR-16-5p expression levels (p < 0.05), adjusted MEHP concentrations and miR-29a-3p expression levels (p < 0.05). We also found negative correlations between unadjusted and adjusted MBP concentrations and miR-29a-3p expression levels (p < 0.0001, p < 0.05), unadjusted MiBP concentrations and miR-29a-3p expression levels (p < 0.01). Urinary MEHP levels reflect a striking exposure to di(2-ethylhexyl) phthalate (DEHP) in pregnant Mexican women. This study highlights the need for a regulatory strategy in the manufacture of several items containing endocrine disruptors in order to avoid involuntary ingestion of these compounds in the Mexican population.

Perinatal Outcomes in Mexican Women with Untreated Mild Gestational Diabetes Mellitus Diagnosed by the International Association of Diabetes and Pregnancy Study Groups Criteria.

PURPOSE: To compare the risk of adverse perinatal outcomes (APO) between pregnant women with mild gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, on no specific treatment, versus pregnant women without GDM. PATIENTS AND METHODS: A retrospective cohort study of pregnant women referred to the Instituto Nacional de Perinatología, in Mexico City, for prenatal care and delivery. Eligibility criteria were singleton pregnancy, age >18 years, gestational age 20-28 weeks, and no history of pre-gestational diabetes. The study population was divided into two groups: Group 1, comprising women with mild GDM defined by one abnormal glucose value at the oral glucose tolerance test (OGTT) according to IADPSG criteria [fasting: 5.1-5.2 mmol/L (92-94 mg/dL) or 2h 8.5-8.56 mmol/L (153-154 mg/dL)], who did not receive specific treatment for GDM, and Group 2, comprising women without GDM, matched for maternal age and pre-gestational body mass index (BMI). Women with two or more abnormal OGTT values, pre-gestational diabetes, any chronic disease, or multiple pregnancies were excluded. RESULTS: As many as 282 women were included in each group. There were no significant differences in basal characteristics between groups. APO analysis showed that newborn weight was significantly higher in Group 1 (3042.4±499g) vs Group 2 (2910±565g) p=0.003; conversely, the incidence of large for gestational age (LGA) and macrosomic neonates was similar in both groups (6 vs 5.7% and 2.1 vs 2.2%, respectively). There were no differences in rates of preeclampsia and gestational hypertension, cesarean and preterm delivery, or premature rupture of membranes. A sub-analysis by maternal pre-gestational BMI showed that LGA incidence was significantly higher among babies born to women with pre-gestational BMI ≥30 kg/m2 in both groups. CONCLUSION: The risk of APO was similar among Mexican women with mild untreated GDM diagnosed by IADPSG criteria, compared to pregnant women without GDM. Pre-gestational BMI was an independent risk factor for LGA.

Reference intervals for hemoglobin A1c (HbA1c) in healthy Mexican pregnant women: a cross-sectional study.

BACKGROUND: The reference intervals for hemoglobin A1c (HbA1c) in pregnant Mexican women without diabetes are not well defined. The study aims to determine the reference intervals for HbA1c at each trimester in healthy Mexican pregnant women. METHODS: This cross-sectional study included healthy Mexican pregnant women in trimester 1 (T1), 6-13.6 weeks of gestation (WG), trimester 2 (T2), 14-27 WG, and trimester 3 (T3), ≥27-36 WG, with a maternal age > 18 years, and pregestational body mass index (BMI) ranging between 18.5-24.9 kg/m2. Women with gestational diabetes mellitus, pregestational diabetes, anemia, a pregestational BMI < 18.5 or ≥ 25 kg/m2, and any hematologic, hepatic, immunological, renal, or cardiac disease were excluded. HbA1c was measured using high-performance liquid chromatography based on the National Glycohemoglobin Standardization Program-certified PDQ Primus guidelines. The HbA1c reference intervals were calculated in terms of the 2.5th to the 97.5th percentiles. RESULTS: We analyzed the HbA1c values of 725 women (T1 n = 84, T2 n = 448, and T3 n = 193). The characteristics of the participants were expressed as mean ± standard deviation and included: maternal age (28.2 ± 6.7 years), pregestational weight (54.8 ± 5.9 Kg), pregestational BMI (22.2 ± 1.7 Kg/m2), and glucose values using a 75 g-2 h oral glucose tolerance test; fasting 4.5 ± 0.3 mmol/L (81.5 ± 5.5 mg/dL), 1 h 6.4 ± 1.5 mmol/L (115.3 ± 26.6 mg/dL), and 2 h 5.7 ± 1.1 mmol/L (103.5 ± 19.6 mg/dL). Reference intervals for HbA1c, expressed as median and 2.5th to 97.5th percentile for each trimester were: T1: 5.1 (4.5-5.6%), T2: 5.0 (4.4-5.5%), and T3: 5.1 (4.5-5.6%). CONCLUSIONS: The reference range of HbA1C in healthy Mexican pregnant women during pregnancy was 4.4% to 5.6%. We suggest as upper limits of HbA1c value ≤5.6%, 5.5%, and 5.7% for T1, T2, and T3, respectively among Mexican pregnant women.

Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis.

OBJECTIVE: To evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria. DESIGN: Retrospective cohort study. SETTING: Level-three medical institution in Mexico City. PARTICIPANTS: The study population comprised 1061 adolescent women aged 12-19 years with singleton pregnancies, who underwent a 75 g oral glucose tolerance test (OGTT) between 11 and 35 weeks of gestation. PRIMARY AND SECONDARY OUTCOME MEASURES: The sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios LR (+) and LR (-), respectively) with 95% CIs for selected FPG cut-off values were compared. Secondary measures were perinatal outcomes in women with and without GDM. RESULTS: GDM was present in 71 women (6.7%, 95% CI 5.3% to 8.4%). The performances of FPG at thresholds of ≥80 (4.5 mmol/L), 85 (4.7 mmol/L) and 90 mg/dL (5.0 mmol/L) were as follow (95% CI): Sn: 97% (89% to 99%), 94% (86% to 97%) and 91% (82% to 95%); Sp: 50% (47% to 53%), 79% (76% to 81%) and 97% (95% to 97%); PPV: 12% (9% to 15%), 23% (18% to 28%) and 64% (54% to 73%); NPV: 99% (98.5% to 99.9%) for all three cut-offs; LR (+): 1.9 (1.8 to 2.1), 4.3 (3.8 to 5.0) and 26.7 (18.8 to 37.1) and LR (-): 0.06 (0.02 to 0.23), 0.07 (0.03 to 0.19) and 0.09 (0.04 to 0.19), respectively. No significant differences in perinatal outcomes were found between adolescents with and without GDM. CONCLUSIONS: An FPG cut-off of ≥90 mg/dL (5.0 mmol/L) is ideal for GDM screening in Mexican adolescent women. An FPG threshold of 90 mg/dL would miss 6 (8.5%) women with GDM, pick up 34 (3.4%) women without GDM and avoid 962 (90.7%) OGTTs.

Association of obesity and overweight with the prevalence of insulin resistance, pre-diabetes and clinical-biochemical characteristics among infertile Mexican women with polycystic ovary syndrome: a cross-sectional study.

OBJECTIVE: To study the association of obesity and overweight with the prevalence of insulin resistance (IR), pre-diabetes and clinical-biochemical characteristics among infertile Mexican women with polycystic ovary syndrome (PCOS). DESIGN: Retrospective cross-sectional study. SETTING: Level-three medical institution, an infertility clinic in Mexico City. PARTICIPANTS: We included infertile Mexican women with diagnosis of PCOS according to the Rotterdam criteria: group 1 (n=83), normal weight (body mass index (BMI) 18.5-24.9 kg/m(2)); group 2 (n=217), overweight (BMI 25-29.9 kg/m(2)); and group 3 (n=238), obese (BMI≥30 kg/m(2)). PRIMARY AND SECONDARY OUTCOME MEASURES: IR was determined by homeostatic model assessment (HOMA) >2.5 and pre-diabetes by fasting glucose between 5.6 and 6.9 mmol/L and/or glucose value between 7.8 and 11 mmol/L at 2 hours during an oral glucose tolerance test. We compared clinical-biochemical characteristics among groups. RESULTS: Prevalence of IR for groups 1, 2 and 3 was 19.3%, 56.2% and 78.2%; overweight and obesity increase the IR OR (CI 95%) to 5.3 (2.9 to 9.8) and 14.9 (8.0 to 28), respectively. Prevalence of pre-diabetes for groups 1, 2 and 3 was 7.2%, 17.5% and 31.5%; overweight and obesity increase the pre-diabetes OR (CI 95%) to 2.7 (1.1 to 6.7) and 5.9 (2.4 to 14), respectively. Acanthosis nigricans was more frequent in group 3 than group 1. Free Androgen Index (FAI) and thyroid-stimulating hormone (TSH) levels were lower in group 1 than in groups 2 and 3. Progesterone and sex hormone-binding globulin (SHBG) levels were higher in group 1 than in groups 2 and 3. Dehydroepiandrosterone sulfate (DHEA-S) was higher in group 1 than group 3. CONCLUSIONS: Obese and overweight infertile Mexican women with PCOS, attending to an infertility clinic, have a higher prevalence of IR and pre-diabetes compared with normal-weight women with PCOS. Therapeutic interventions should include those that improved metabolic functioning prior to attempting pregnancy in these groups of women.

Reducción asistida por artroscopia en pacientes con fractura de la meseta tibial / Reduction assisted by arthroscopy in patients with tibial plateau fractures

Fundamento: las fracturas de la meseta tibial pueden ser de bajo o alto grado; las de bajo grado, que se corresponden con los tipos I al III de la clasificación de Schatzker J., pueden ser tratadas mediante reducción asistida por artroscopia.Métodos: se realizó un estudio observacional descriptivo en el Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey desde el 1ro de enero de 2013 al 31 de marzo de 2014. El universo estuvo conformado por 32 pacientes de los cuales 11 reunieron los criterios de selección.Resultados: el promedio de edades fue de 46, 3 años; la razón sexo masculino-femenino fue de 1, 75 a 1. Predominó el tipo de fractura tipo II en el 54, 4 por ciento de los pacientes estudiados. Las lesiones de menisco asociadas predominaron al ser encontradas en el 54, 5 por ciento de los pacientes. Se encontró significación estadística entre las evaluaciones hechas antes de la cirugía y las de 12 meses después, según las escalas de Rasmussen PS y Lysholm J.Conclusiones: la reducción asistida por artroscopia en pacientes con fractura de la meseta tibial de los grados I al III es un método efectivo desde el punto de vista funcional y para aliviar el dolor.(AU)

Background: tibial plateau fractures can be of low or high degree. Fractures of low degree, corresponding to types I to III of Schafzker J classification, can be treated by means of reduction assisted by arthroscopy.Methods: an observational, descriptive study was conducted in Manuel Ascunce Domenech Teaching Hospital, Camagüey city from January 1st, 2013 to March 31st, 2014. The universe was composed of 32 patients, 11 of which matched the selection criteria.Results: the average age was of 46, 3 years. The ratio of male to female sex was 1, 75 to 1. Associated lesions of the meniscus predominated being present in the 54, 5 percent of the patients. A statistical significance was found between the presurgical evaluations and the ones made 12 months later, according to Rasmussen PS and Lyshol J scales.Conclusion: reduction assisted by arthroscopy in patients with tibial plateau fractures type I to III, is an effective method from the functionalpoint of view and to relieve pain.(AU)

Reducción asistida por artroscopia en pacientes con fractura de la meseta tibial / Reduction assisted by arthroscopy in patients with tibial plateau fractures

Fundamento: las fracturas de la meseta tibial pueden ser de bajo o alto grado; las de bajo grado, que se corresponden con los tipos I al III de la clasificación de Schatzker J., pueden ser tratadas mediante reducción asistida por artroscopia. Métodos: se realizó un estudio observacional descriptivo en el Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey desde el 1ro de enero de 2013 al 31 de marzo de 2014. El universo estuvo conformado por 32 pacientes de los cuales 11 reunieron los criterios de selección. Resultados: el promedio de edades fue de 46, 3 años; la razón sexo masculino-femenino fue de 1, 75 a 1. Predominó el tipo de fractura tipo II en el 54, 4 % de los pacientes estudiados. Las lesiones de menisco asociadas predominaron al ser encontradas en el 54, 5 % de los pacientes. Se encontró significación estadística entre las evaluaciones hechas antes de la cirugía y las de 12 meses después, según las escalas de Rasmussen PS y Lysholm J. Conclusiones: la reducción asistida por artroscopia en pacientes con fractura de la meseta tibial de los grados I al III es un método efectivo desde el punto de vista funcional y para aliviar el dolor.

Background: tibial plateau fractures can be of low or high degree. Fractures of low degree, corresponding to types I to III of Schafzker J classification, can be treated by means of reduction assisted by arthroscopy. Methods: an observational, descriptive study was conducted in Manuel Ascunce Domenech Teaching Hospital, Camagüey city from January 1st, 2013 to March 31st, 2014. The universe was composed of 32 patients, 11 of which matched the selection criteria. Results: the average age was of 46, 3 years. The ratio of male to female sex was 1, 75 to 1. Associated lesions of the meniscus predominated being present in the 54, 5 % of the patients. A statistical significance was found between the presurgical evaluations and the ones made 12 months later, according to Rasmussen PS and Lyshol J scales. Conclusion: reduction assisted by arthroscopy in patients with tibial plateau fractures type I to III, is an effective method from the functional point of view and to relieve pain.

Artritis séptica del hombro: a propósito de un caso / Septic arthritis of the shoulder: a case report

Fundamento: la artritis séptica del hombro, aunque presenta la misma fisiopatología de otras articulaciones, es una enfermedad infrecuente. Objetivo: presentar el caso de un paciente con artritis séptica del hombro. Caso clínico: paciente masculino de 70 años. El paciente acudió a la consulta de urgencia de ortopedia y traumatología por presentar dolor e incapacidad funcional del hombro derecho, después de haber sido intervenido en cirugía menor por una lesión de piel hacía siete días. En la exploración física se apreció aumento de volumen marcado en la articulación del hombro derecho, acompañado de limitación del arco de movimiento articular. Mediante la palpación se constató aumento de la temperatura local de la articulación. En el examen ultrasonográfico de urgencia se detectó la presencia de gran cantidad de líquido en la articulación glenohumeral. Al paciente se le diagnosticó artritis séptica del hombro derecho y se le indicó tratamiento quirúrgico. Conclusiones: la artritis séptica del hombro es una enfermedad infrecuente; el tratamiento indicado es el quirúrgico que consiste en el lavado y desbridamiento de la articulación.

Background: although septic arthritis of the shoulder has the same physiopathology of other joints, it is an infrequent condition. Objective: to present the case of a patient with septic arthritis of the shoulder. Case report: a seventy-year-old white male patient. The patient came to the orthopedic emergency department for presenting pain and physical disability in the right shoulder after undergoing a minor surgery for a skin lesion seven days before. In the physical examination, marked increased volume in the joint of the right shoulder could be found, associated with limitations in the articular movement arc. Palpation revealed increased local temperature. The emergency ultrasonographic examination showed a great quantity of liquid inside the glenohumeral joint. The patient was diagnosed with septic arthritis of the right shoulder and surgical treatment was indicated. Conclusions: septic arthritis of the shoulder is an infrequent condition. Surgical treatment, consisting in articular wash and debridement, is indicated.

[Consensus of diagnosis and treatment of obesity in women in reproductive age and climacterium]. / Consenso de diagnóstico y tratamiento de la obesidad en la mujer en edad reproductiva y en el climaterio.

BACKGROUND: The development of obesity is complex and multifactorial, with genetic, biological, environmental and lifestyle of each individual etiology. The different changes in metabolism of women, amongst other factors, lead to disorganization in the distribution of lipids, which gathered in large quantities within the viscera, increases cardiovascular mortality and it is a major determinant factor of the metabolic syndrome. OBJECTIVE: To homologate and to apply concepts of evidence-based clinical practice in diagnosis and treatment of obesity in women in reproductive age and climacterium. METHOD: The experts' consensus was done by specialized physicians properly endocrinologists, gynecologists, surgeons, psychologists, nutrition specialists, physical activity and public health, according to their expertise and clinical judgment. The recommendations were based in diagnostic criteria aside from the level of evidence of previously established treatment guidelines, controlled clinical trials and standardized guides for women in reproductive age and climacterium with obesity. RESULTS: The establishment of a nutritional intervention amongst other aspects of lifestyle is the first-line in the treatment of obesity. Current pharmacological treatments offer modest results in efficiency and security in weight reduction so these must go along with real changes in lifestyle in order to obtain better results in the short and long term. CONCLUSION: The high prevalence of overweight and obesity in our country, especially in women in reproductive age, compels us to pose and work in prevention strategies as well as diverse therapeutic plans favoring safe weight loss and results in the long term.

Reparación de menisco: a propósito de un caso / Meniscus repair: clinical case

FUNDAMENTO: las lesiones de los meniscos de la rodilla son muy frecuentes y pueden estar localizadas desde la periferia hasta la zona más interna de la articulación. Los desgarros de meniscos en ocasiones pueden ser suturados en dependencia de varios factores, para este fin existen diferentes técnicas según la dirección de las suturas. OBJETIVO: mostrar la presentación de un enfermo, al que se le realizó la modalidad de sutura de afuera a adentro. CASO CLINICO: paciente de 18 años de edad, blanco, masculino con antecedentes de salud anterior, que sufrió trauma por torsión a nivel de la rodilla derecha hace seis meses, después de lo cual comenzó con dolor e inflamación a nivel de la interlínea articular del lado medial. A la exploración física se detectó a la inspección aumento de volumen a nivel de la interlínea articular medial de la rodilla derecha. Mediante la palpación se constató chasquido articular. Las maniobras de Appley y McMurray resultaron ser positivas en la articulación afectada en relación con daño del menisco interno. Durante la artroscopia se observó lesión periférica de menisco interno en la zona media de 10 milímetros en la zona roja-roja, para la cual se realizó sutura de afuera a adentro. CONCLUSIONES: la reparación de menisco es un método quirúrgico factible y práctico que permite el alivio del dolor y conservar la estructura del menisco, para que pueda desempeñar sus funciones anatómicas.

BACKGROUND: meniscal lesions are very common and may be located in the peripheral and the inner part of the knee joint. Meniscal tears can be sutured depending on different factors. There are several techniques and are usually classified according to the direction of the suture. OBJECTIVE: to show a case in which an inward suture was conducted. CASE REPORT: an eighteen-year-old, white male patient who suffered from a trauma caused by torsion on his right knee six months ago. After the trauma, the patient presented pain and inflammation in the medial side of the knee, especially in the articular line. During the examination, volume increase and inflammation were perceived in the medial side. During palpation, articular snaps were detected. Appley and McMurray maneuvers were positive in the affected articulation indicating damage of the medial meniscus. In the arthroscopy a ten-millimeter peripheral lesion of the medial meniscus was found in the medial area, in the red-red zone. In order to treat the lesion, an inward suture was performed. CONCLUSIONS: meniscus repair is a practical, feasible method to reduce pain and keep the meniscal structure so it can carry out its anatomical function.

Reparación de menisco: a propósito de un caso / Meniscus repair: clinical case

Fundamento: las lesiones de los meniscos de la rodilla son muy frecuentes y pueden estar localizadas desde la periferia hasta la zona más interna de la articulación. Los desgarros de meniscos en ocasiones pueden ser suturados en dependencia de varios factores, para este fin existen diferentes técnicas según la dirección de las suturas.Objetivo: mostrar la presentación de un enfermo, al que se le realizó la modalidad de sutura de afuera a adentro.Caso clínico: paciente de 18 años de edad, blanco, masculino con antecedentes de salud anterior, que sufrió trauma por torsión a nivel de la rodilla derecha hace seis meses, después de lo cual comenzó con dolor e inflamación a nivel de la interlínea articular del lado medial. A la exploración física se detectó a la inspección aumento de volumen a nivel de la interlínea articular medial de la rodilla derecha. Mediante la palpación se constató chasquido articular. Las maniobras de Appley y McMurray resultaron ser positivas en la articulación afectada en relación con daño del menisco interno. Durante la artroscopia se observó lesión periférica de menisco interno en la zona media de 10 milímetros en la zona roja-roja, para la cual se realizó sutura de afuera a adentro.Conclusiones: la reparación de menisco es un método quirúrgico factible y práctico que permite el alivio del dolor y conservar la estructura del menisco, para que pueda desempeñar sus funciones anatómicas(AU)

Background: meniscal lesions are very common and may be located in the peripheral and the inner part of the knee joint. Meniscal tears can be sutured depending on different factors. There are several techniques and are usually classified according to the direction of the suture.Objective: to show a case in which an inward suture was conducted.Case report: an eighteen-year-old, white male patient who suffered from a trauma caused by torsion on his right knee six months ago. After the trauma, the patient presented pain and inflammation in the medial side of the knee, especially in the articular line. During the examination, volume increase and inflammation were perceived in the medial side. During palpation, articular snaps were detected. Appley and McMurray maneuvers were positive in the affected articulation indicating damage of the medial meniscus. In the arthroscopy a ten-millimeter peripheral lesion of the medial meniscus was found in the medial area, in the red-red zone. In order to treat the lesion, an inward suture was performed.Conclusions: meniscus repair is a practical, feasible method to reduce pain and keep the meniscal structure so it can carry out its anatomical function(AU)

Plicatura medial asistida por artroscopia a propósito de un caso / Arthroscopically-a medial plication: a case report / Plicature médiale assistée par arthroscopie, à propos d'un cas

La plicatura medial asistida por artroscopia constituye una variedad quirúrgica empleada en pacientes que presentan mala alineación patelofemoral. El paciente de 44 años de edad, blanca, femenina con antecedentes de salud anterior, la cual desde hace aproximadamente un año refiere dolor a nivel de la cara anterior de la rodilla izquierda, para lo cual ha llevado tratamiento en múltiples ocasiones con analgésicos, antiinflamatorios no esteroideos y varias sesiones de terapia de rehabilitación con respuesta muy limitada a sus síntomas. Se realizó liberación del retináculo lateral acompañada de plicatura medial, esta técnica se describe por pasos. La plicatura medial asistida por artroscopia, es un procedimiento simple, que no necesita de una curva larga de aprendizaje y presenta un mínimo de complicaciones.

Arthroscopically-assisted medial placation is a surgical variety used in patients with poor patellofemoral alignment. 44-year-old, white female patient, with previous health history of concerns, refers pain at the anterior aspect of her left knee for about a year. She has been treated with analgesics, NSAIDs multiple times and several rehabilitation therapy sessions with very limited response to her symptoms. Release of the lateral retinaculum accompanied by medial plication was performed on this patiente. This technique is described by steps. Assisted arthroscopic medial plication is a simple procedure which does not require long learning curve and it has a minimum of complications.

La plicature médiale assistée par arthroscopie constitue une technique chirurgicale employée chez les patients atteints d’un mauvais alignement fémoro-pathélaire. Le cas d’un patient (femme âgée de 44 ans, blanche) avec une historie de santé antérieure, référant depuis un an à peu près une douleur au niveau de la face antérieure du genou gauche, plusieurs traitements (analgésiques, antiinflammatoires non stéroïdiens), et pas mal de sessions de rééducation sans réponse satisfaisante, est présenté. On a effectué la libération du rétinaculum latéral, conjointement avec une plicature médiale. La plicature médiale assistée par arthroscopie est une procédure simple n’ayant pas besoin d’une longue courbe d’apprentissage et présentant très peu de complications.

Plicatura medial asistida por artroscopia a propósito de un caso / Arthroscopically-a medial plication: A case report

La plicatura medial asistida por artroscopia constituye una variedad quirúrgica empleada en pacientes que presentan mala alineación patelofemoral. El paciente de 44 años de edad, blanca, femenina con antecedentes de salud anterior, la cual desde hace aproximadamente un año refiere dolor a nivel de la cara anterior de la rodilla izquierda, para lo cual ha llevado tratamiento en múltiples ocasiones con analgésicos, antiinflamatorios no esteroideos y varias sesiones de terapia de rehabilitación con respuesta muy limitada a sus síntomas. Se realizó liberación del retináculo lateral acompañada de plicatura medial, esta técnica se describe por pasos. La plicatura medial asistida por artroscopia, es un procedimiento simple, que no necesita de una curva larga de aprendizaje y presenta un mínimo de complicaciones(AU)

Arthroscopically-assisted medial placation is a surgical variety used in patients with poor patellofemoral alignment. 44-year-old, white female patient, with previous health history of concerns, refers pain at the anterior aspect of her left knee for about a year. She has been treated with analgesics, NSAIDs multiple times and several rehabilitation therapy sessions with very limited response to her symptoms. Release of the lateral retinaculum accompanied by medial plication was performed on this patiente. This technique is described by steps. Assisted arthroscopic medial plication is a simple procedure which does not require long learning curve and it has a minimum of complications.

La plicature médiale assistée par arthroscopie constitue une technique chirurgicale employée chez les patients atteints dun mauvais alignement fémoro-pathélaire. Le cas dun patient (femme âgée de 44 ans, blanche) avec une historie de santé antérieure, référant depuis un an à peu près une douleur au niveau de la face antérieure du genou gauche, plusieurs traitements (analgésiques, antiinflammatoires non stéroïdiens), et pas mal de sessions de rééducation sans réponse satisfaisante, est présenté. On a effectué la libération du rétinaculum latéral, conjointement avec une plicature médiale. La plicature médiale assistée par arthroscopie est une procédure simple nayant pas besoin dune longue courbe dapprentissage et présentant très peu de complications(AU)

Microfracturas por vía artroscópica en pacientes con lesiones de cartílago de la rodilla / Microfractures in patients with cartilage lesions of the knee treated by arthroscopy

Las lesiones de los cartílagos de la rodilla son difíciles de tratar debido a su escasa posibilidad de reparación, de allí que la mayoría de los tratamientos para esta enfermedad son de tipo quirúrgico.Objetivo: evaluar los resultados de las microfracturas en pacientes con lesiones de los cartílagos de la rodilla.Método: se realizó un estudio de tipo cuasi experimental, modalidad antes y después sin grupo control. El universo estuvo conformado por 65 enfermos con lesiones de los cartílagos de la rodilla diagnosticados y tratados por artroscopia en el Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey desde el 1ro de enero de 2012 hasta el 31 de enero de 2013. La muestra no probabilística quedó constituida por 43 enfermos que reunieron los criterios de selección.Resultados: predominó el sexo femenino sobre el masculino en una razón de 2,9 a 1. El compartimento tibiofemoral medial presentó la mayor incidencia con 23 pacientes para un 53,4 por ciento. Las lesiones de tamaño entre uno y dos centímetros fueron las más encontradas con 24 enfermos para un 75 por ciento. De los 43 pacientes estudiados 32 presentaron enfermedades intrarticulares asociadas a la lesión de cartílagos para un 74,4 por ciento. El 65,1 por ciento de los enfermos presentaron otros factores asociados a la lesión de cartílagos de la rodilla. El 18,3 por ciento de los enfermos presentó resultados desfavorables al tratamiento.Conclusiones: las microfracturas mostraron ser efectivas en más de las terceras cuartas partes de los pacientes estudiados...

Cartilage lesions of the knee are difficult to treat because the healing process of this tissue is very low; that is why surgical procedures are the most used treatment for this complaint. Objective: to evaluate the results of microfractures in patients suffering from cartilage lesions of the knee.Methods: a cuasi-experimental study, before and after modality, without a control group was performed. The universe of investigation involved 65 patients with cartilage lesions of the knee diagnosed and treated by arthroscopy at Manuel Ascunce Domenech Provincial Teaching Hospital in Camaguey from January 1st, 2012 to January 31th, 2013. The non-probabilistic sample was composed of 43 patients who fitted the selection criteria. Results: female sex predominated with a female-male proportion of 2, 9 to 1. Medial tibiofemoral compartment was the most affected with 23 patients for a 53, 4 percent . Cartilage lesions between one and two centimeters were found in 24 patients for a 75 percent . Of 43 studied patients, 32 presented associated intrarticular diseases for a 74, 4 percent. The 65, 1 percent of the patients had others factors associated to cartilage lesions of the knee. Unfavorable results were obtained in the 18, 3 percent of the cases.Conclusions: microfractures proved to be effective in more than three fourths of the studied patients...

Algoritmo terapéutico para pacientes con gonartrosis primaria / Therapeutic algorithm for patients with primary

La gonartrosis primaria es una enfermedad muy frecuente que requiere de varias modalidades de tratamiento entre conservadores y quirúrgicos. La selección del tratamiento no es simple una vez que han fracasado las modalidades conservadoras, de allí la importancia de llegar a un consenso sobre el tratamiento de pacientes con esta enfermedad.Objetivo: validar un algoritmo de tratamiento para pacientes con gonartrosis primaria.Métodos: para la validación del algoritmo, se empleó el método de Delphi, mediante la consulta a un grupo de expertos constituido por 16 especialistas en Ortopedia y Traumatología y Reumatología, pertenecientes a ocho instituciones médicas del país. Los profesionales consultados presentaron como promedio 19, 3 años de experiencia profesional, un Doctor en Ciencias Médicas, 13 con categoría científica de Máster, nueve especialistas de Segundo Grado, dos Profesores Titulares y cinco Auxiliares.Resultados: los resultados de los cálculos de diferentes matrices se mostraron en cuatro de las seis tablas.Conclusiones: el algoritmo propuesto por los autores resultó validado en cuanto a: diseño, aplicabilidad y pertinencia...

Primary gonarthrosis is a very frequent disease that requires some treatment modalities, whether conservative or surgical. The selecting of the treatment is not a simple matter once the conservative modalities have not been successful; hence the importance of getting to a consensus about the treatment of patients with this disease.Objective: to validate an algorithm of treatment for patients with primary gonarthrosis.Methods: for the validation of the algorithm, the Delphi method was employed by consulting a group composed of 16 specialists in Orthopedics and Traumatology and in Rheumatology from eight medical institutions in the country. The professionals consulted had an average of 19.3 years of professional experience. They was a PhD in Medical Sciences, 13 have a master’s degree, nine are 2nd degree specialists; there were two professors and five assistant professors.Results: the results of the calculations of different matrices were shown in four tables of six.Conclusions: the algorithm for patients suffering from primary gonarthrosis was validated in regards to design, application and pertinence...

Plasma rico en plaquetas en pacientes con gonartrosis / Plasma rich in platelets in patients with gonarthrosis

La aplicación del plasma rico en plaquetas se ha convertido en una modalidad de tratamiento para pacientes con gonartrosis, tanto de forma aislada como en combinación con otros procedimientos. Objetivo: actualizar al personal médico sobre aspectos esenciales relacionados con la aplicación del plasma rico en plaquetas en pacientes con gonartrosis.Método: se realizó una revisión bibliográfica de un total de 300 artículos originales publicados en Pubmed, Hinari y Medline, mediante el localizador de información Endnote, de ellos se utilizaron 44 citas seleccionadas para realizar la revisión, todas ellas de los últimos tres años.Desarrollo: se discutieron aspectos relacionados con la aplicación del plasma rico en plaquetas, los factores de crecimiento presentes en el mismo y las funciones específicas de cada uno. Se muestran los resultados de las principales investigaciones hasta la fecha, así como el tiempo de seguimiento y las escalas utilizadas por estos autores para expresar sus resultados. El último acápite aborda la relación entre la aplicación de plasma rico en plaquetas y la gonartrosis.Conclusiones: el cartílago articular hialino de la rodilla es un tejido avascular, aneural y alinfático con escasas posibilidades de cicatrización por sí mismo, debido a su escasa población celular. La aplicación del PRP ayuda en la reparación del daño de este tejido, en especial en los estadios más incipientes de la enfermedad (AU)

The application of plasma rich in platelets has become a method of treatment for patients with gonarthrosis, whether as an isolated mode or in combination with other procedures. Objective: to bring the medical staff up to date about essential aspects related to the application of plasma rich in platelets in patients with gonarthrosis. Method: a bibliographic review of a total of 300 articles published in PubMed, Hinari, and Medline was made through the information localizator EndNote; 44 quotes selected for making the review, all from the last three years, were used.Development: aspects related to the application of plasma rich in platelets, to the growth factors present in it and to the specific functions of each are discussed. The results of the main investigations conducted till the present date, as well as the monitoring time and the scales used by these authors to express their results are shown. The last section deals with the relation between the applications of plasma rich in platelets and gonarthrosis.Conclusions: the hyaline articular cartilage of the knee is an avascular, aneural, and alymphatic tissue with small possibilities of cicatrizing by itself due to the scarcely cellular population. The application of plasma rich in platelets helps with the reparation of damage in this tissue, especially in the most incipient stages of the disease (AU)

Artroscopia combinada con osteotomía tibial alta abierta en un paciente con gonartrosis: a propósito de un caso / Arthroscopy combined with open-wedge high tibial osteotomy in a patient with osteoarthritis of the knee: a case report

La gonartrosis del compartimento medial de la rodilla asociada a desviación en varo requiere de la combinación de procedimientos quirúrgicos para su tratamiento. Una de las variantes más utilizadas es la artroscopia y osteotomías en un mismo tiempo quirúrgico. Objetivo: mostrar la combinación de la artroscopia con la osteotomía tibial alta abierta en el tratamiento de la gonartrosis. Caso clínico: paciente de 56 años de edad, blanco, masculino, ingresado en el servicio de Ortopedia y Traumatología del Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey, por presentar gonartrosis izquierda con predominio del compartimento tibiofemoral medial. En el mismo tiempo quirúrgico se realizó artroscopia mediante la cual se llevó a cabo meniscectomía parcial y microfracturas del cóndilo medial, luego se realizó osteotomía tibial alta abierta.Conclusiones: la combinación de artroscopia y osteotomía permite actuar simultáneamente en pacientes con gonartrosis, al tratar las lesiones articulares y corregir las deformidades angulares que presentan. Las dos técnicas pueden ser realizadas en el mismo tiempo quirúrgico sin prolongar su duración (AU)

Knee osteoarthritis of the medial compartment is usually associated to varus deformity, and the patients will need a combination of different surgical procedures for treatment. One of the most common combinations in the same surgical time is: arthroscopy and osteotomy. Objective: to show the combination of arthroscopy and high open wedge medial osteotomy of the tibia in patients with the diagnosis of osteoarthritis of the knee. Case report: a 56 year old male, white patient was admitted to the department of Orthopedics and Traumatology at Manuel Ascunce provincial teaching hospital in Camaguey city, because of osteoarthritis of the left knee affecting predominantly the medial tibiofemoral compartment. At the same surgical time, an arthroscopy was carried out to perform a partial meniscectomy and microfracture of the medial condyle, later a high open wedge medial osteotomy of the knee was performed. Conclusions: the combination of arthroscopy and osteotomy, let to treat lesion inside the joint and correct angular deformities of the limb at the same time. These techniques can be done together without a long surgical time (AU)

Artroscopia combinada con osteotomía tibial alta abierta en un paciente con gonartrosis: a propósito de un caso / Arthroscopy combined with open-wedge high tibial osteotomy in a patient with osteoarthritis of the knee: a case report

Fundamento: la gonartrosis del compartimento medial de la rodilla asociada a desviación en varo requiere de la combinación de procedimientos quirúrgicos para su tratamiento. Una de las variantes más utilizadas es la artroscopia y osteotomías en un mismo tiempo quirúrgico. Objetivo: mostrar la combinación de la artroscopia con la osteotomía tibial alta abierta en el tratamiento de la gonartrosis. Caso clínico: paciente de 56 años de edad, blanco, masculino, ingresado en el servicio de Ortopedia y Traumatología del Hospital Universitario Manuel Ascunce Domenech de la ciudad de Camagüey, por presentar gonartrosis izquierda con predominio del compartimento tibiofemoral medial. En el mismo tiempo quirúrgico se realizó artroscopia mediante la cual se llevó a cabo meniscectomía parcial y microfracturas del cóndilo medial, luego se realizó osteotomía tibial alta abierta. Conclusiones: la combinación de artroscopia y osteotomía permite actuar simultáneamente en pacientes con gonartrosis, al tratar las lesiones articulares y corregir las deformidades angulares que presentan. Las dos técnicas pueden ser realizadas en el mismo tiempo quirúrgico sin prolongar su duración.

Background: Knee osteoarthritis of the medial compartment is usually associated to varus deformity, and the patients will need a combination of different surgical procedures for treatment. One of the most common combinations in the same surgical time is: arthroscopy and osteotomy. Objective: to show the combination of arthroscopy and high open wedge medial osteotomy of the tibia in patients with the diagnosis of osteoarthritis of the knee. Case report: A 56 year old male, white patient was admitted to the department of Orthopedics and Traumatology at Manuel Ascunce provincial teaching hospital in Camaguey city, because of osteoarthritis of the left knee affecting predominantly the medial tibiofemoral compartment. At the same surgical time, an arthroscopy was carried out to perform a partial meniscectomy and microfracture of the medial condyle, later a high open wedge medial osteotomy of the knee was performed. Conclusions: the combination of arthroscopy and osteotomy, let to treat lesion inside the joint and correct angular deformities of the limb at the same time. These techniques can be done together without a long surgical time.

Plasma rico en plaquetas en pacientes con gonartrosis / Plasma rich in platelets in patients with gonarthrosis

Fundamento: la aplicación del plasma rico en plaquetas se ha convertido en una modalidad de tratamiento para pacientes con gonartrosis, tanto de forma aislada como en combinación con otros procedimientos. Objetivo: actualizar al personal médico sobre aspectos esenciales relacionados con la aplicación del plasma rico en plaquetas en pacientes con gonartrosis. Método: se realizó una revisión bibliográfica de un total de 300 artículos originales publicados en Pubmed, Hinari y Medline, mediante el localizador de información Endnote, de ellos se utilizaron 44 citas seleccionadas para realizar la revisión, todas ellas de los últimos tres años. Desarrollo: se discutieron aspectos relacionados con la aplicación del plasma rico en plaquetas, los factores de crecimiento presentes en el mismo y las funciones específicas de cada uno. Se muestran los resultados de las principales investigaciones hasta la fecha, así como el tiempo de seguimiento y las escalas utilizadas por estos autores para expresar sus resultados. El último acápite aborda la relación entre la aplicación de plasma rico en plaquetas y la gonartrosis. Conclusiones: el cartílago articular hialino de la rodilla es un tejido avascular, aneural y alinfático con escasas posibilidades de cicatrización por sí mismo, debido a su escasa población celular. La aplicación del PRP ayuda en la reparación del daño de este tejido, en especial en los estadios más incipientes de la enfermedad.

Background: the application of plasma rich in platelets has become a method of treatment for patients with gonarthrosis, whether as an isolated mode or in combination with other procedures. Objective: to bring the medical staff up to date about essential aspects related to the application of plasma rich in platelets in patients with gonarthrosis. Method: a bibliographic review of a total of 300 articles published in PubMed, Hinari, and Medline was made through the information localizator EndNote; 44 quotes selected for making the review, all from the last three years, were used. Development: aspects related to the application of plasma rich in platelets, to the growth factors present in it and to the specific functions of each are discussed. The results of the main investigations conducted till the present date, as well as the monitoring time and the scales used by these authors to express their results are shown. The last section deals with the relation between the applications of plasma rich in platelets and gonarthrosis. Conclusions: the hyaline articular cartilage of the knee is an avascular, aneural, and alymphatic tissue with small possibilities of cicatrizing by itself due to the scarcely cellular population. The application of plasma rich in platelets helps with the reparation of damage in this tissue, especially in the most incipient stages of the disease.

Validación de instrumental para microfracturas en lesiones de cartílago de la rodilla / Validation of instruments for microfractures in knee cartilage lesions

Las lesiones del cartílago de la rodilla son frecuentes debido a causas traumáticas y degenerativas, el potencial de recuperación de este tejido es pobre lo que responde a su escasa población celular; por esta razón se necesita de la aplicación de tratamientos quirúrgicos para lograr la reparación o reconstrucción del cartílago. La microfractura es una técnica de primera línea en esta enfermedad, sin embargo la ausencia de los instrumentos adecuados para su realización impide ser llevada a cabo.Objetivo: validar el instrumental propuesto por los autores para la realización de microfracturas en la articulación de la rodilla.Método: para la validación del instrumental diseñado y utilizado por el autor en la realización de microfracturas, se empleó el método de Delphy mediante la consulta a un grupo de expertos constituido por 16 especialistas de Ortopedia y Traumatología con 15,3 como promedio de años de experiencia profesional, un Doctor en Ciencias, 13 Máster y cinco especialistas de segundo grado, dos profesores titulares y tres auxiliares.Resultados: se mostraron los valores correspondientes a la matriz de frecuencias absolutas, matriz de frecuencias acumuladas, matriz de frecuencias relativas acumuladas y matriz indicativa de los puntos de corte.Conclusiones: el instrumental propuesto por los autores resultó validado en cuanto a: aplicación, diseño y reproducibilidad (AU)

Knee cartilage lesions are very frequent due to traumatic and degenerative causes. The possibility of recovery of this tissue is low because of its limited cellular population. That`s the reason why is necessary the application of surgical treatments to get the reparation or reconstruction of the cartilage. Microfractrure is a first-line technique for treating this disease; however, the absence of proper instruments hinders its carrying out.Objective: to validate the proposed instruments for carrying out microfractures in the knee joint.Method: for the validation of the designed instruments used for carrying out microfractures, the Delphy method was applied through a consultation to a group of experts composed of 16 specialists in Orthopedics and Traumatology with an average of 15.3 years of professional experience, a Doctor of Sciences, 13 Masters of Sciences, five specialists of second degree, three associate professors and two full professors.Results: values corresponding to the absolute-frequency matrix, to the accumulated-frequency matrix, to the accumulated-relative-frequency matrix, and to the indicative matrix of cutting points were displayed.Conclusions: the proposed instruments by the authors were validated regarding: application, design, and reproducibility (AU)