MSH-5: malignant knee tumors timely detection index.

BACKGROUND: Bone neoplasms are usually misdiagnosed causing a delay in their treatment. Bone neoplasms are usually confused with tendinitis, 31% of the cases corresponds to osteosarcomas and in 21% to Ewing's sarcomas. OBJECTIVE: To create a clinical-radiographic instrument of high diagnostic suspicion of knee bone neoplasms to prevent a delay in diagnosis. METHOD: A clinimetric study (sensitivity, consistency and validity) was performed in the bone tumor service, Hospital de Ortopedia de la Unidad Médica de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, in México City. RESULTS: Characteristics of 153 patients were collected. For the sensitivity phase, 3 domains (signs, symptoms, and radiology) and 12 items were included. Consistency was evaluated with ICC (0.944), 95%CI (0.865-0.977), p < 0.001 and a-Cronbach (0.863). Index obtained a sensitivity of 0.80 and a specificity of 0.882 were obtained. The positive predictive value of the test was 66.6% and the negative predictive value was 93.75%. The positive likelihood ratio was 6.8 and the negative likelihood ratio was 0.2. Validity was evaluated using r-Pearson (0.894; p < 0.001). CONCLUSIONS: A high suspicion clinical-radiographic index was designed to detect malignant knee tumors with adequate sensitivity, specificity, appearance, content, criteria, and construct validity.

ANTECEDENTES: Los tumores óseos suelen ser subdiagnosticados, provocando un retraso en su tratamiento. El diagnóstico erróneo más frecuente es tendinitis, en el cual el 31% corresponden a osteosarcomas y el 21% a sarcomas de Ewing. OBJETIVO: Crear un instrumento clínico-radiográfico de alta sospecha diagnóstica de tumores óseos de rodilla. MÉTODO: Se realizó un estudio clinimétrico (sensibilidad, consistencia y validez) en el servicio de tumores óseos del Hospital de Ortopedia de la Unidad Médica de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, en Ciudad de México. RESULTADOS: El índice se realizó tomando las características de 153 pacientes. Para la fase de sensibilidad se incluyeron tres dominios (signos, síntomas y radiología) y 12 ítems. La consistencia se evaluó con coeficiente de correlación intraclase (0.944), intervalo de confianza del 95% (0.865-0.977), p < 0.001 y α de Cronbach (0.863). Se obtuvo una sensibilidad del instrumento de 0.80 y una especificidad de 0.882. El valor predictivo positivo de la prueba fue del 66.6% y el valor predictivo negativo fue de 93.75%. La razón de verosimilitud positiva fue de 6.8 y la razón de verosimilitud negativa fue de 0.2. La validez se evaluó mediante r-Pearson (0.894; p < 0.001). CONCLUSIONES: Se diseñó un índice clínico-radiográfico de alta sospecha para detectar tumores malignos de rodilla con adecuada sensibilidad, especificidad y validez de apariencia, de contenido, de criterio y de constructo.

Asociación entre las características radiográficas y los tumores óseos de rodilla.

BACKGROUND: Bone neoplasms require an adequate clinical-radiographic evaluation for their diagnosis. Plain radiographs are the usual method to establish the diagnosis and evaluate differential diagnoses in the study of bone tumor pathology. OBJECTIVE: To recognize the frequency of radiographic characteristics and associate them with bone tumor pathology. METHOD: Radiographic data were collected from 132 patients with tumor pathology confirmed by biopsy from bone tumors service of the Traumatology and Orthopedics Hospital Unidades Médicas de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, Ciudad de México, during 2019. RESULTS: 132 patients were registered. The most frequent benign tumor was osteochondroma (27.3%), and malignant was osteosarcoma (9.8%). Active lytic lesions (odds ratio [OR]: 6.9; 95% confidence interval [95% CI]: 2.83-16.85) or aggressive (OR: 26.85; 95% CI: 3.21-224) were associated with giant cells tumors. Poorly differentiated intraosseous blast lesions of bone lineage (OR: 36.15; 95% CI: 4.4-295.5) were associated with osteosarcoma. The periosteal reaction (OR: 36.15; 95% CI: 4.4-295.5), the moth-eaten or permeative pattern (OR: 11.75; 95% CI: 1.26-109) and the central location of the lesion (OR: 3.03; 95% CI: 1.37-6.69) were associated with malignant tumor lesions. CONCLUSIONS: Poorly defined intraosseous blast lesions of bone lineage, periosteal reaction, and moth-eaten or permeative pattern of destruction are associated with malignant lesions.

ANTECEDENTES: Los tumores óseos requieren una adecuada evaluación clínico-radiográfica para su diagnóstico. Las radiografías simples son el método incruento usual para establecer el diagnóstico y evaluar diagnósticos diferenciales en el estudio de la patología tumoral ósea. OBJETIVO: Reconocer la frecuencia de las características radiográficas y asociarlas con patología tumoral ósea. MÉTODO: Se recolectaron datos radiográficos de 132 pacientes con patología tumoral confirmada mediante biopsia del servicio de tumores óseos del Hospital de Traumatología y Ortopedia Unidades Médicas de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, en Ciudad de México, durante el año 2019. RESULTADOS: Integraron la muestra 132 pacientes. El tumor benigno más frecuente fue el osteocondroma (27.3%), y el maligno, el osteosarcoma (9.8%). Las lesiones líticas activas (odds ratio [OR]: 6.9; intervalo de confianza del 95% [IC95%]: 2.83-16.85) o agresivas (OR: 26.85; IC95%: 3.21-224) se asociaron a tumor de células gigantes. Las lesiones blásticas de estirpe ósea mal diferenciadas intraóseas (OR: 36.15; IC95%: 4.4-295.5) se asociaron a osteosarcoma. La reacción perióstica (OR: 36.15; IC95%: 4.4-295.5), el patrón apolillado o permeativo (OR: 11.75; IC95%: 1.26-109) y la ubicación central (OR: 3.03; IC95%: 1.37-6.69) se asociaron a lesiones tumorales malignas. CONCLUSIONES: Las lesiones blásticas de estirpe ósea mal definidas intraóseas, la reacción perióstica y el patrón de destrucción apolillado o permeativo se asocian a lesiones malignas.

Quality of life related to both general and oral health two years after treatment for subcondylar fracture.

The success of treatment for condylar fractures is usually assessed by functional outcomes, while studies on patient perceptions are scarce. A cross-sectional study was performed to assess the middle-term quality of life, related to both general health and oral health, of patients treated for subcondylar fracture, either by open reduction or by closed fixation, compared to healthy volunteers. In a single trauma centre, among 226 consecutive patients with subcondylar fractures that were treated in years 2018-2019 (two to three years prior to the survey), 148 fulfilled the selection criteria. They were classified as those with other facial fractures that were treated by open reduction (n = 79), and those without other fractures that were treated either by open reduction (n = 34) or by closed fixation (n = 35). An age matched group of healthy volunteers (n = 65) also participated in the study. All participants replied to the Short-Form-Health-Survey (SF-36) and the Oral-Health-Impact-Profile (OHIP-49), using the social messenger platform WhatsApp. The SF-36 showed that patients with closed-fixation reported better mental health than patients with open reduction, but worse than healthy volunteers. Contrariwise, on the OHIP-49, compared to patients with open reduction (with/without other facial fractures) and to healthy volunteers, patients with closed-fixation reported worse quality of life on physical pain, psychological discomfort, and physical disability. The influence of age was evident just on the OHIP-49, on the report of physical limitation and physical pain. Two to three years after the subcondylar fracture, patients treated either by open reduction or closed fixation might report decreased quality of life compared to healthy volunteers; patients treated by open reduction might report lesser mental health related quality of life (SF-36), but superior oral health related quality of life (OHIP-49) than patients treated by closed fixation.

[Effect of rehabilitation on functionality/quality of life in stroke due to COVID-19]. / Efecto de la rehabilitación sobre funcionalidad/calidad de vida en ictus por COVID-19.

Background: COVID-19 can present neurological complications of the central nervous system. Ischemic-type strokes have been reported in this population. Neurological rehabilitation participates in the functional recovery and improvement of the quality of life of these patients. Objective: To measure the functionality and quality of life of patients with ischemic stroke due to COVID-19. Material and methods: An observational, prospective and longitudinal study of patients with ischemic stroke admitted to a neurological rehabilitation program was carried out. The Barthel index, the modified Rankin Scale and the SF-12 were used to monitor functionality and quality of life. To compare the proportions of patients with functional independence, the McNemar test was used; for SF-12 scores, Student's t test was used for related data or Wilcoxon test, depending on their normality. A p < 0.05 was significant. Results: 21 patients were included; mean age was 53.57 ± 12.2 years; they were predominantly male (66.7%). The percentage of patients with higher degrees of independence in daily and functional life increased, both in the Barthel index (p < 0.01) and in the modified Rankin scale (p < 0.01) at the third month of follow-up. There was an improvement in the quality of life in its physical component (p = 0.02), as well as in the dimensions of general health (p = 0.01) and mental health (p = 0.04). Conclusions: Patients with stroke due to COVID-19 admitted to the neurological rehabilitation program presented improvement in functional independence and increased their quality of life in their physical component at 3-month follow-up.

Introducción: la COVID-19 puede presentar complicaciones neurológicas del sistema nervioso central. Se han reportado ictus de tipo isquémico en esta población. La rehabilitación neurológica participa en la recuperación funcional y en la mejoría de la calidad de vida (CV) de estos pacientes. Objetivo: medir el efecto de la rehabilitación neurológica en la funcionalidad y CV de los pacientes con evento vascular cerebral (EVC) isquémico por COVID-19. Material y métodos: estudio observacional, prospectivo y longitudinal de los pacientes con EVC isquémico ingresados a un programa de rehabilitación neurológica (PRN). Se utilizaron el Índice de Barthel (IB), la Escala de Rankin (ER) modificada y el SF-12 para el seguimiento de funcionalidad y CV. Para comparar las proporciones de pacientes con independencia funcional, se utilizó la prueba de McNemar; para puntajes de la SF-12, t de Student para datos relacionados o prueba de Wilcoxon, dependiendo de su normalidad. Una p < 0.05 fue significativa. Resultados: se incluyeron 21 pacientes; la media de edad fue de 53.57 ± 12.2 años; predominó el sexo masculino (66.7%). El porcentaje de pacientes con mayores grados de independencia en la vida diaria y funcional incrementó, tanto en el IB (p < 0.01) como en la ER modificada (p < 0.01), al tercer mes de seguimiento. Mejoró la CV en su componente físico (p = 0.02) y en las dimensiones de salud general (p = 0.01) y salud mental (p = 0.04). Conclusiones: los pacientes con EVC por COVID-19 ingresados al PRN presentaron mejoría en la independencia funcional e incremento de la CV en su componente físico a tres meses de seguimiento.

A Novel Technique for the Evaluation and Interpretation of Elastography in Salivary Gland Involvement in Primary Sjögren Syndrome.

Ultrasound (US) of major salivary glands (MSG) evaluates echogenicity, border features and vascularization, with elastography, it can detect tissue elasticity and glandular fibrosis, related to inflammation in Primary Sjögren's syndrome (pSS). This study aimed to develop a novel technique by pixel analysis for evaluation and interpretation of elastography in MSG in pSS. A cross-sectional and observational multicenter study was conducted. The US of MSG performed in orthogonal planes in grayscale, Doppler, and shear-wave elastography. For elastography images of each gland were analyzed with the open-source program ImageJ to perform a pixel analysis. Statistical analysis was performed with the IBM-SPSS v25 program. Fifty-nine women with a mean age of 57.69 (23-83) years were recruited; pSS mean duration of 87 (5-275) months, and 12 healthy women without sicca symptoms as a control group with a mean age of 50.67 (42-60) years. Intragroup analysis showed p-values >0.05 between sicca symptoms, ocular/dryness tests, biopsy, US, and pixel analysis; correlation between Hocevar and pixel analysis was not found (rho < 0.1, p >0.5). MSG anatomical size was 41.7 ± 28.2 mm vs. 67.6 ± 8.8 mm (p ≤ 0.0001); unstimulated whole saliva flow rate was 0.80 ± 0.80 ml/5 min vs. 1.85 ± 1.27 ml/5 min (p = 0.016). The elastography values (absolute number of pixels) were 572.38 ± 99.21 vs. 539.69 ± 93.12 (p = 0.290). A cut-off point risk for pSS identified with less than 54% of red pixels in the global MSG mass [OR of 3.8 95% CI (1.01-15.00)]. Pixel analysis is a new tool that could lead to a better understanding of the MSG chronic inflammatory process in pSS.

Influence of Work Hardening on the Surface of Backup Rolls for a 4-High Rolling Mill Fractured during Rolling Campaign.

Backup rolls are the main tool in a four-high rolling mill; the rolling forces applied in load cells promote the fatigue of the material due to mechanical contact between backup rolls and work rolls. This work investigated the causes of recurrent failures in backup rolls, with cracking always initiated on the surface of the roll body and finishing in the main radius between neck and roll body. Aiming to find the causes of failure, visual inspection and morphology of the fracture were performed, complemented with mechanical tests of hardness on the stress concentration area, in addition to validating the results by applying the finite element method, using ANSYS Mechanical Static Structural Software. It was concluded that the fatigue crack initiated on the surface of BUR due to work hardening continued growing up over the fatigued material, creating beach marks, and finally, a fracture occurred in the main radius of BUR due to stress concentration. The work hardening is the main cause of spalling on BURs and other mechanical components exposed to mechanical contact.

Correction to: Serum substance P: an indicator of disease activity and subclinical inflammation in rheumatoid arthritis.

Following publication, it was brought to the authors' attention by Dr. Julia Toscano-Garibay that she did not participate as a reviewer of the final version of this manuscript prior to its submission and publication in Clinical Rheumatology.

A prospective randomized trial of total synovectomy versus limited synovectomy in primary total knee arthroplasty: evaluation of bleeding, postoperative pain, and quality of life with SF-12 v2.

BACKGROUND: During total knee arthroplasty (TKA), total synovectomy (TS) as a part of the surgical technique has been proposed to reduce the inflammatory tissue after the procedure, but there is a controversy about it because of the risk of major postsurgical bleeding. The aim of this study was to compare postoperative bleeding, pain, and health-related quality of life (HRQOL) after a TKA when a TS is performed and when it is not. METHODS: The difference in pre and postoperative hemoglobin was measured, as well as postoperative pain using visual analogue scale (VAS) scores at 24 and 48 h post-surgical, HRQOL was measured prior to surgery and at one year using the SF-12V2 questionnaire. RESULTS: We assessed a total of 148 patients (73 for TS and 75 for limited synovectomy). We have found a difference of 0.9 mg/dl of pre- and postoperative hemoglobin between both groups, with a higher bleeding amount for the TS group (P = 0.0000647); VAS scores were slightly lower for the TS group at 24 and 48 h after surgery, but not relevant. The TS group required transfusion in 13.3% and the limited synovectomy group in 6.8%. No significant differences in HRQOL were found in both groups at 1 year follow-up. CONCLUSIONS: Performing a TS in TKA in patients with osteoarthrosis does not result in a relevant lower postoperative pain, or in an improvement in HRQOL, and it does increase the amount of bleeding after the procedure.

High Serum Levels of High-Mobility Group Box 1 (HMGB1) and Low Levels of Heat Shock Protein 70 (Hsp70) are Associated with Poor Prognosis in Patients with Acute Pancreatitis.

INTRODUCTION: Cell damage in Acute Pancreatitis (AP) lead to release of cytokines and HMGB1 and Hsp70. While Hsp70 plays a role in cytoprotection, when released to extracellular milieu constitutes, as HMGB1, a danger signal and trigger pro-inflammatory responses. These molecules seem to be related to the clinical progression; but because no evidence exists about them as molecular network in AP development, we quantify HSP70, HMGB1, and cytokines in patients with AP and search for correlations with severity and prognosis. METHODS: Fifteen patients with AP were included. The average age was 52 years. Six patients had mild pancreatitis, 4 were moderately severe and 5 with a severe form. Blood samples were taken within the first 24 h, at 3d and 7d from the start. Serum HMGB1 and Hsp70 were determined using ELISA; TNF-α, IL-1ß, IL-6, IL-8, IL-10 and IL-12p70 were determined by bead based immuassay. RESULTS: Of all 15 patients recruited, 4 were women. Eight patients had APACHEII score higher than 8. Two patients died from AP related complications. Increase in serum HMGB1 and decrease of Hsp70 were associated with the severity and mortality. TNF-α, IL-6 and IL-8 were higher in patients that did not survive, in those with an APACHE II >8, and in those with severe AP. CONCLUSIONS: High HMGB1 and low Hsp70 were associated with poor prognosis. Hsp70 might play a protective role in AP. TNF-α, IL-6, IL-8, HMGB1 and Hsp70 during hospital admissions might serve to evaluate risk of death due to AP.

Serum substance P: an indicator of disease activity and subclinical inflammation in rheumatoid arthritis.

The aim of the is study is to examine the role of serum substance P (SP) levels as a simple biomarker for rheumatoid arthritis (RA) disease activity, its correlation with other markers of disease activity, and with selected clinical parameters. The study comprised 90 RA patients and 24 healthy controls. RA activity was assessed by means of the disease activity 28-C-reactive protein (DAS28-CRP) index and ultrasound power Doppler (USPD) by the German ultrasound score based on seven joints. SP serum values were obtained by means of an ELISA commercial kit. Statistics were achieved by the Student's t test and Spearman correlation analysis with Bonferroni correction. As a group, RA patients had significantly increased levels of SP compared with healthy controls (p < 0.0001). SP levels correlated with DAS28-CRP (r = 0.5050, p < 0.0001), number of tender joints (NTJ, r = 0.4668, p < 0.0001), number of swollen joints (NSJ, r = 0.4439, p < 0.0001), visual analogue scale (VAS, r = 0.5131, p < 0.0001). However, SP did not correlate with CRP levels (r = 0.0468, p = 0.6613), nor with the USPD (r = 0.1740, p = 0.1009). Elevated serum SP is a common feature of RA patients, which also appears to correlate with clinical measurements of disease activity and with subjective clinical data (NTJ and VAS). Thus, although SP is higher in RA patients with high disease activity, it also detects subtle RA disease activity even in patients in apparent remission, which suggests its usefulness for therapeutic decisions.

FACTORS ASSOCIATED WITH COMPLEX REGIONAL PAIN SYNDROME IN SURGICALLY TREATED DISTAL RADIUS FRACTURE.

OBJECTIVE: The aim of this study was to identify factors associated with developing complex regional pain syndrome (CRPS) after surgical treatment for distal radius fracture (DRF). METHODS: This case-control study analyzed patients seen from January 2014 to January 2016. Results: In our sample of 249 patients, 4% developed CRPS. Associated factors were economic compensation via work disability (odds ratio [OR] 14.3), age (OR 9.38), associated fracture (OR 12.94), and level of impact (OR 6.46), as well as psychiatric history (OR 7.21). CONCLUSIONS: Economically-productive aged patients with a history of high-impact trauma and patients with a history of psychiatric disorders have greater risk of developing CRPS after DRF. Level of Evidence III, Case-Control Study.

OBJETIVO: Este estudo tem como objetivo identificar fatores de risco associados ao desenvolvimento de síndrome de dor regional complexa (CRPS) após o tratamento cirúrgico da fratura distal do rádio (DRF). MÉTODOS: Este estudo de caso/controle analisou pacientes atendidos de janeiro de 2014 a janeiro de 2016. Resultados: Em nossa amostra de 249 pacientes, 4% desenvolveram CRPS. Os fatores associados foram compensação econômica (razão de chances [RC] 14,3), idade (RC 9,38), fratura associada (RC 12,94) e nível de impacto (RC 6,46), bem como história psiquiátrica (RC 7,21). CONCLUSÕES: Os pacientes com idade produtiva e história de trauma de alto impacto e os com história de transtornos psiquiátrico têm maior risco de desenvolver CRPS depois de DRF. Nível de Evidência III, Estudo de Caso Controle.

Factors associated with complex regional pain syndrome in surgically treated distal radius fracture / Fatores associados à síndrome de dor regional complexa em fratura do distal do rádio tratada cirurgicamente

ABSTRACT Objective: The aim of this study was to identify factors associated with developing complex regional pain syndrome (CRPS) after surgical treatment for distal radius fracture (DRF). Methods: This case-control study analyzed patients seen from January 2014 to January 2016. Results: In our sample of 249 patients, 4% developed CRPS. Associated factors were economic compensation via work disability (odds ratio [OR] 14.3), age (OR 9.38), associated fracture (OR 12.94), and level of impact (OR 6.46), as well as psychiatric history (OR 7.21). Conclusions: Economically-productive aged patients with a history of high-impact trauma and patients with a history of psychiatric disorders have greater risk of developing CRPS after DRF. Level of Evidence III, Case-Control Study.

RESUMO Objetivo: Este estudo tem como objetivo identificar fatores de risco associados ao desenvolvimento de síndrome de dor regional complexa (CRPS) após o tratamento cirúrgico da fratura distal do rádio (DRF). Métodos: Este estudo de caso/controle analisou pacientes atendidos de janeiro de 2014 a janeiro de 2016. Resultados: Em nossa amostra de 249 pacientes, 4% desenvolveram CRPS. Os fatores associados foram compensação econômica (razão de chances [RC] 14,3), idade (RC 9,38), fratura associada (RC 12,94) e nível de impacto (RC 6,46), bem como história psiquiátrica (RC 7,21). Conclusões: Os pacientes com idade produtiva e história de trauma de alto impacto e os com história de transtornos psiquiátrico têm maior risco de desenvolver CRPS depois de DRF. Nível de Evidência III, Estudo de Caso Controle.

[Evidence and recommendation of empirical antimicrobial treatment in pyogenic spondylodiscitis: systematic review]. / Evidencia y recomendación del tratamiento antimicrobiano empírico en espondilodiscitis piógena: revisión sistemática.

BACKGROUND: Pyogenic spondylodiscitis is the infectious process that affects the vertebral body and the intervertebral disc. It has an incidence between 2 and 7%. To prescribe antibiotic treatment, it is required to identify the causative organism on the basis of the epidemiology of the etiologic agent, as well as the ability of the antibiotic to penetrate the bone tissue and the intervertebral disc. The objective was to identify the level of evidence and the grade of recommendation for the empiric initial treatment. METHODS: A systematic review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. PubMed articles were evaluated to assess their level of evidence and the grade of recommendation according to the Jadad scale and the classification of Sackett. On the basis of those two scales, it was analyzed the agreement by two observers and a Kappa value of 0.750 (p = 0.0001) was considered statistically significant. RESULTS: 642 studies were analyzed, out of which only 19 met the inclusion criteria. In these it was identified a level of evidence 4 and a degree of recommendation C for the use of fluoroquinolones in association with rifampicin in the empirical treatment of pyogenic spondylodiscitis and the use of vancomycin for the treatment of methicillin-resistant strains. CONCLUSION: There is not enough information concerning the use of empiric antibiotics in pyogenic spondylodiscitis; however, the existing information is favorable, even though it is not conclusive.

Introducción: la espondilodiscitis piógena es el proceso infeccioso que afecta al cuerpo vertebral y al disco intervertebral, con una incidencia de 2 a 7% de todas las osteomielitis. Para indicar tratamiento antibiótico se requiere identificar el germen causal a partir de la epidemiología del agente etiológico y de la capacidad del antibiótico de penetrar en el tejido óseo y en el disco intervertebral. El objetivo fue identificar el nivel de evidencia y el grado de recomendación del tratamiento antibiótico empírico inicial. Métodos: se hizo una revisión sistemática con base en los criterios PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Se evaluó en las publicaciones de PubMed el nivel de evidencia y el grado de acuerdo respecto a la escala de Jadad y a la clasificación de Sackett. Se analizó la concordancia entre los evaluadores y hubo significación estadística en los valores de Kappa de 0.750 con valor de p = 0.0001. Resultados: se analizaron 642 artículos, de los cuales solo 19 cumplieron con los criterios de selección. En estos últimos se identificó un nivel de evidencia 4 y un grado de recomendación C para la utilización de fluoroquinolonas en asociación con rifampicina en el tratamiento empírico de la espondilodiscitis piógena y el uso de vancomicina en caso de cepas resistentes a la meticilina. Conclusión: no existe información suficiente al respecto, pero la información existente es favorable, aunque no concluyente, para el uso de antibióticos empíricos en los casos de espondilodiscitis piógena.

[Mixed knee arthrodesis a rescue alternative in knee periprosthetic joint infection]. / Artrodesis mixta de rodilla: una alternativa de salvamento en infecciones periprotésicas de rodilla.

BACKGROUND: Knee arthrodesis is a rescue procedure for patients with knee periprosthetic joint infection who are not candidates for a revision surgery. The actual methods present a high complication rate with only moderate efectivity. METHODS: We retrospectively analyzed 17 cases, of patients with knee periprosthetic joint infection and bone loss treated by intramedular expandable nail and monoplanar external fixator with a mínimum evolution of 1 year, evaluating the medical records and digitalized X-rays by 2 sub specialized doctors in osteoarticular rescue surgery. RESULTS: From the 17 patients, 88.2% were classified as Anderson Orthopaedic Research Institute classification grade (III) and the 11.2% IIB. We obtained fusion in 82.5%, staged Hammer (I-II) in a mean time of 6.33 months. Achieving independent gait was reported in 88.2%. Our complication rate was 47.1%, most of them minor complications except for a supracondylar amputation. Our infection recurrence rate was 35.4%. Mean intervention rate was 2.47 surgeries, all without any operative room complication. CONCLUSIONS: We achieved a fusion rate similar to other available knee arthrodesis methods in a similar treatment time; with lower complication rate, making it a suitable rescue alternative for knee arthrodesis in patients with significant bone loss and knee periprosthetic joint infection.

Introducción: la artrodesis es una cirugía de salvamento para la infección periprotésica de rodilla; este procedimiento reporta moderada efectividad, alto índice de complicaciones y es la última alternativa antes de la amputación. El objetivo de este estudio fue identificar si la artrodesis de rodilla con clavo expandible y fijador externo es un tratamiento seguro y efectivo. Métodos: estudio observacional, retrospectivo, en 17 pacientes con infección periprotésica y pérdida ósea importante, tratados mediante artrodesis con clavo centro-medular expandible autobloqueante y fijador externo monoplanar con evolución mínima de 1 año; la información se obtuvo del expediente clínico e imágenes de rayos X, siendo estas evaluadas por 2 ortopedistas especializados en rescate osteoarticular. Resultados: de 17 pacientes, con una pérdida ósea grado III en un 88.2% de los casos, se obtuvo una fusión en el 82.5%. Logrando la deambulación independiente en el 88.2%. Con un promedio de 2.4 intervenciones quirúrgicas por paciente. Sin complicaciones transquirúrgicas reportadas. Con un índice de complicaciones global del 47.1% incluyendo una amputación por sepsis. La evaluación inter-observador tuvo un valor de Kappa del 0.90 y la muestra alcanzó un poder estadístico del 60%. Conclusiones: se obtuvo una consolidación similar a otros métodos, en un tiempo promedio de 6.3 meses, con un menor índice de complicaciones al reportado con otras técnicas. Siendo esta una alternativa de salvamento para la realización de artrodesis de rodilla, antes de considerar la amputación de la extremidad.

[Sensitivity and antibiotic resistance in infections of the musculoskeletal system]. / Sensibilidad y resistencia antibiótica en infecciones de sistema musculoesquelético.

BACKGROUND: Infections of the musculoskeletal system are a devastating complication for patients, due to it's long rehabilitation process and even sometimes the removal of the implant, the chronicity of infection, is often due to lack of coverage in empirical antibiotics. METHODS: A retrospective, observational, descriptive cohort study was performed. All cultures form musculoskeletal system infected patients reported of sensitivity and resistance of germs isolated were analyzed. RESULTS: A total of 143 positive results were included. Reported more frequent germ Staphylococcus aureus accounted for 75 positive cases, followed by Escherichia coli with 31 positive results. Antibiotics with better sensitivity according to the type of microorganisms were trimethoprim-sulfamethoxazole and vancomycin, levofloxacin and linezolid, gentamicin, erythromycin and amikacin. Regarding antibiotic resistance, those reported with the highest percentage were penicillin G, amoxicillin with clavulanic acid and ampicillin. CONCLUSIONS: We recommend using empirical treatments in musculoskeletal system infections, trimethoprim-sulfamethoxazole are the best choice because they have the same sensitivity compare with vancomycin and a resistance rate of 7.6%. Betalactamics have a high percentage of resistance and low sensitivity so we must consider alternatives.

Introducción: las infecciones de sistema musculoesquelético son una complicación grave para el paciente, debido a que prolongan el tiempo de recuperación y pueden llegar al retiro del implante o a la cronicidad de la infección con gasto excesivo para la institución y desgaste para el paciente y su familia. Métodos: estudio observacional en cirugías limpias programadas por patología crónicadegenerativa en el 2015. Se seleccionaron 225, que fueron reportadas como infectadas, a las que se les realizó cultivo. Se revisó la sensibilidad y resistencia de los microorganismos aislados con mayor frecuencia. Resultados: se incluyeron los cultivos y antibiogramas realizados a 225 pacientes, cumpliendo criterios de selección 143 resultados positivos. Se reportó Staphylococcus aureus, y Escherichia coli. Los antibióticos con mejor sensibilidad de acuerdo al tipo de microorganismos fueron trimetoprim-sulfametoxazol y vancomicina, levofloxacino y linezolid, gentamicina, eritromicina y amikacina. Respecto a la resistencia antibiótica, los de mayor porcentaje fueron la penicilina, amoxicilina con ácido clavulánico y ampicilina. Conclusiones: en las infecciones del sistema musculoesquelético estudiadas con cultivo y antibiograma, los dos microorganismos con mayor incidencia fueron S. aureus y E. coli, mostrando una mayor sensibilidad antibiótica para el trimetoprim-sulfametoxazol, muy similar a la vancomicina, así también el TMP-SMX mostró una resistencia baja. Los betalactámicos mostraron un alto porcentaje de resistencia y baja sensibilidad.

Guidelines for treatment of degenerative lumbar spondylolisthesis / Diretrizes para tratamento de espondilolistese lombar degenerativa / Guía de tratamiento de la espondilolistesis lumbar degenerativa

ABSTRACT Objectives: To determine the standard of treatment of degenerative lumbar spondylolisthesis in its different clinical presentations in UMAE Dr. Victorio de la Fuente Narváez. Methods: Six cases found in the literature were presented to 36 experts in spine surgery, along with treatment options, to thereby obtain a standard prescription for the treatment of degenerative lumbar spondylolisthesis. Analytical observational cross-sectional descriptive study. Results: It was found that the treatment of choice in cases of degenerative lumbar spondylolisthesis with axial symptoms is conservative. The surgical treatment of choice for both stable and unstable patients with radiculopathy and/or claudication is decompression + posterolateral graft + transpedicular instrumentation + discectomy (graft). Conclusions: We managed to define the degenerative lumbar spondylolisthesis treatment guidelines in our unit, which can serve as a basis for the development of a clinical practice guide.

RESUMO Objetivos: Determinar o padrão de tratamento de espondilolistese lombar degenerativa em suas diversas apresentações clínicas em UMAE Dr. Victorio de la Fuente Narváez. Métodos: Seis casos encontrados na literatura foram apresentados a 36 médicos especialistas em cirurgia de coluna, juntamente com opções de tratamento, para assim, obter um padrão de prescrição para o tratamento de espondilolistese degenerativa lombar. Estudo descritivo transversal observacional analítico. Resultados: Verificou-se que o tratamento de escolha para os casos de espondilolistese lombar degenerativa com sintomas axiais são conservadores. O tratamento cirúrgico de escolha para casos estáveis ou instáveis com radiculopatia e/ou claudicação é descompressão + enxerto posterolateral + instrumentação transpedicular + discectomia (enxerto). Conclusões: Foi possível definir as diretrizes de tratamento de espondilolistese lombar degenerativa em nossa unidade, que pode servir de base para o desenvolvimento de um guia de prática clínica.

RESUMEN Objetivos: Conocer el patrón de tratamiento de la espondilolistesis lumbar degenerativa en sus diferentes presentaciones clínicas en la UMAE Dr. Victorio de la Fuente Narváez. Métodos: Se presentaron a 36 médicos expertos en cirugía de columna 6 casos basados en la literatura, junto con las posibilidades de tratamiento, para obtener de este modo un patrón de prescripción para el tratamiento de espondilolistesis lumbar degenerativa. Estudio observacional descriptivo transversal analítico. Resultados: Se encontró que el tratamiento de elección para los casos de espondilolistesis lumbar degenerativa con sintomatología axial es conservador. El tratamiento quirúrgico de elección para los casos estables o inestables con radiculopatía y/o claudicación es la descompresión + injerto posterolateral + instrumentación transpedicular + discectomía (injerto). Conclusiones: Se logró definir la guía de tratamiento de espondilolistesis lumbar degenerativa en nuestra unidad, lo que puede servir como fundamento en la elaboración de una guía de práctica clínica.

[Prophylaxis of venous thromboembolic disease in high-risk orthopedic surgery]. / Profilaxis de la enfermedad tromboembólica venosa en cirugía ortopédica de alto riesgo.

Venous thromboembolism (VTE) is a worldwide public health problem, with an annual incidence of 1-2 cases/1,000 individuals in the general population and a 1-5% associated mortality. Orthopedic surgery is a major surgical risk factor for VTE, but the problem is more important for patients with hip and knee joint replacement, multiple traumatisms, severe damage to the spine, or large fractures. Thromboprophylaxis is defined as the strategy and actions necessary to diminish the risk of VTE in high-risk orthopedic surgery. Antithrombotics may prevent VTE. At the end of this paper, we describe a proposal of thromboprophylaxis actions for patients requiring high-risk orthopedic surgery, based on the opinion of specialists in Orthopedics and Traumatology who work with high-risk orthopedic surgery patients. A search for evidence about this kind of surgery was performed and a 100-item inquiring instrument was done in order to know the opinions of the participants. Then, recommendations and considerations were built. In conclusion, this document reviews the problem of VTE in high-risk orthopedic surgery patients and describes the position of the Colegio Mexicano de Ortopedia y Traumatología related to VTE prevention in this setting.

[Characteristics of pain in oncologic disease of the knee]. / Caracterización del dolor de la rodilla con patología oncológica.

BACKGROUND: 10% of > 55-year-old adults suffer some kind of non-neoplastic knee pain and 75% of the musculoskeletal neoplastic disease develops in the knee. OBJECTIVE: to identify clinical characteristics of knee pain in neoplastic knee pathology. METHODS: after appropriate authorization of the Local Committee of Investigation and under informed consent, we made a crosssectional and a risk analysis study. We included 160 patients who were seeking medical help due to knee pain. They answered a standardized questionnaire relating to the characteristics of their pain symptomatology. Data were integrated into two groups with knee pain; a) neoplasic (cases, n = 65), b) non-neoplasic (controls, n = 95) and analyzed (SPSS v.15™). We used homogeneity tests between groups (p > 0.05); inferential analysis (Student t test, χ(2)) and risk assessment (OR), p ≤ 0.05, (CI 95%), Statistical power was > 0.80. RESULTS: female gender predominated (55%); age was 40.3 ± 19.6 years. The most prevalent diagnoses were knee osteoarthritis 37% for non-neoplasic group; giant cell tumor 10% for benign neoplasic group and osteosarcoma 6.1% for neoplasic malignant group. Knee pain lasting < 4 months (OR 7.6; CI 95% 3.48-16.5) and severe intensity (OR 5.7; CI 95% 2.82-11.64), constant pain (OR 2.9; CI 95% 1.37-6.36), rapidly progressive fluctuation (OR 31; CI 95% 7.01-137) and nocturnal predominance (OR 7.72; CI 95% 3.2-18.5) were characteristics of neoplasic knee pain. CONCLUSIONS: the neoplasic knee pain was characterized for a rapid onset, severe and constant pain, progressive, fluctuation and predominantly by night-time.