[Prevalence of X-ray signs of femoroacetabular impingement in Mexican population]. / Prevalencia de datos radiográficos de pinzamiento femoroacetabular en adultos mexicanos.

BACKGROUND: Femoroacetabular impingement (FAI) is a suggested diagnosis for pain in the hip in the absence of other apparent causes. It is thought to be a cause of progressive arthrosis of the hip. Our objective was to determine the prevalence of radiographic data of FAI in the adult population without hip pathology over a period of six months. MATERIAL AND METHODS: Analytical, observational, multicentric, ambispective and transverse study based on digital X-rays analysis. Measurements of the lateral center-edge angle of Wiberg, acetabular inclination, Tönnis angle and the neck shaft angle of the proximal femur were made; a pistol grip deformity of the femoral head, the triangular index and the shape of the coxofemoral joint were also evaluated. RESULTS: From a total of 212 hips evaluated, 104 were in males and 108 in females, with an average age of 42.81 years; 21 had a pistol grip deformity and a positive triangular index for cam type. The pincer type was found in 12 hips. DISCUSSION: In this multicentric study, the FAI cam type predominated in men on the right side; the pincer type predominated in women on the left side; this is similar to what has been reported in other populations. This study is limited by the wide variation in the femoral rotation; as an advantage, it was randomly carried out and provides some data on the prevalence of deformities of the hip, not previously registered.

INTRODUCCIÓN: El pinzamiento femoroacetabular (PFA) se considera actualmente la causa principal de osteoartritis idiopática o primaria de cadera. Nuestro objetivo fue determinar la prevalencia de datos radiográficos de PFA en la población adulta sin patología coxofemoral en un período de seis meses. MATERIAL Y MÉTODOS: Estudio analítico, observacional, multicéntrico, ambispectivo y transversal realizado en archivos radiográficos digitales. Se midieron los ángulos de cobertura acetabular, cervicodiafisario, inclinación acetabular y ángulo de Tönnis; el tipo de coxa, índice triangular y deformidad en mango de pistola. RESULTADOS: De 212 articulaciones coxofemorales, 49.1% (104/212) correspondieron a hombres y 50.9% (108/212) a mujeres, con edad promedio de 42.81 ± 17.9 años; 21 articulaciones (21/212, 9.9%) presentaron deformidad en mango de pistola más índice triangular positivo para cam. Para determinar el tipo pincer, correlacionamos sobrecobertura acetabular, horizontalización acetabular, ángulo de Tönnis negativo ( 0°) y tipo de coxa profunda y/o protrusio, con una prevalencia de 5.66% de pincer (12/212). DISCUSIÓN: Nuestra población es muy pequeña a pesar de involucrar varias instituciones; la prevalencia del PFA tipo cam predominó en hombres, del lado derecho. El tipo pincer predominó en mujeres, del lado izquierdo. Este estudio está limitado por la amplia variación radiológica de la rotación femoral. Por otro lado, se aportan algunos datos sobre la prevalencia de deformidades de la cadera, previamente no registrada.

Perfil epidemiológico de los ingresos al Módulo de Cirugía de Cadera y Pelvis del Hospital General Xoco de la Secretaría de Salud / Epidemiological profile of admissions to the hip and pelvic surgery module in a general hospital

Resumen: Antecedentes: El presente estudio fue realizado con la finalidad de conocer, evaluar y clasificar las fracturas de cadera tratadas en un servicio ortopédico de un hospital general. Material y métodos: Estudio retrospectivo, transversal y descriptivo, con base en los archivos del Módulo de Cirugía de Cadera y Pelvis de un hospital general, en el período comprendido de Julio de 2009 a Diciembre de 2016. Resultados: Se obtuvo un total de 1,545 pacientes con edades entre 14 y 107 años; de cada paciente se analizó el lado afectado, la causa de ingreso, sus patologías de base previas, el tipo de fractura, el tipo de tratamiento otorgado y el resultado final. El análisis estadístico fue realizado con el programa SPSS versión 18. Debido a la relevancia del tema, se examinaron las causas de las defunciones registradas (n = 58); en relación con los datos registrados, se obtuvo χ2 y regresión logística binaria. Conclusiones: Las fracturas de cadera continúan siendo un tema infravalorado, con grandes repercusiones económicas y sociales; conocer el tipo de fractura más frecuente, así como la población mayormente afectada, ayudará a establecer medidas de prevención eficaces para disminuir la morbimortalidad de esta enfermedad en un hospital general.

Abstract: Background: The present study was carried out in order to know, evaluate and classify hip fractures treated by the orthopedic service of a general hospital. Material and methods: Retrospective, cross-sectional and descriptive study based on the files of the hip and pelvic surgery module of a general hospital in the period from July 2009 to December 2016. Results: We included a total of 1,545 patients aged between 14 and 107 years; the affected side, the reason for admission, their previous underlying pathologies, the type of fracture, the type of treatment given and the end result were analyzed for each patient. Statistical analysis was performed with the program SPSS version 18. Due to the relevance of the topic, the causes of the registered deaths were examined (n = 58); in relation to the data gathered, χ2 and binary logistic regression were obtained. Conclusions: Hip fractures are still an undervalued subject with great economic and social impact; knowing the most frequent fracture type as well as the population most affected will help to establish effective preventive measures to decrease the morbidity and mortality of this disease in a general hospital.

Prevalencia de datos radiográficos de pinzamiento femoroacetabular en adultos mexicanos / Prevalence of X-ray signs of femoroacetabular impingement in Mexican population

Resumen: Introducción: El pinzamiento femoroacetabular (PFA) se considera actualmente la causa principal de osteoartritis idiopática o primaria de cadera. Nuestro objetivo fue determinar la prevalencia de datos radiográficos de PFA en la población adulta sin patología coxofemoral en un período de seis meses. Material y métodos: Estudio analítico, observacional, multicéntrico, ambispectivo y transversal realizado en archivos radiográficos digitales. Se midieron los ángulos de cobertura acetabular, cervicodiafisario, inclinación acetabular y ángulo de Tönnis; el tipo de coxa, índice triangular y deformidad en mango de pistola. Resultados: De 212 articulaciones coxofemorales, 49.1% (104/212) correspondieron a hombres y 50.9% (108/212) a mujeres, con edad promedio de 42.81 ± 17.9 años; 21 articulaciones (21/212, 9.9%) presentaron deformidad en mango de pistola más índice triangular positivo para cam. Para determinar el tipo pincer, correlacionamos sobrecobertura acetabular, horizontalización acetabular, ángulo de Tönnis negativo (< 0o) y tipo de coxa profunda y/o protrusio, con una prevalencia de 5.66% de pincer (12/212). Discusión: Nuestra población es muy pequeña a pesar de involucrar varias instituciones; la prevalencia del PFA tipo cam predominó en hombres, del lado derecho. El tipo pincer predominó en mujeres, del lado izquierdo. Este estudio está limitado por la amplia variación radiológica de la rotación femoral. Por otro lado, se aportan algunos datos sobre la prevalencia de deformidades de la cadera, previamente no registrada.

Abstract: Background: Femoroacetabular impingement (FAI) is a suggested diagnosis for pain in the hip in the absence of other apparent causes. It is thought to be a cause of progressive arthrosis of the hip. Our objective was to determine the prevalence of radiographic data of FAI in the adult population without hip pathology over a period of six months. Material and methods: Analytical, observational, multicentric, ambispective and transverse study based on digital X-rays analysis. Measurements of the lateral center-edge angle of Wiberg, acetabular inclination, Tönnis angle and the neck shaft angle of the proximal femur were made; a pistol grip deformity of the femoral head, the triangular index and the shape of the coxofemoral joint were also evaluated. Results: From a total of 212 hips evaluated, 104 were in males and 108 in females, with an average age of 42.81 years; 21 had a pistol grip deformity and a positive triangular index for cam type. The pincer type was found in 12 hips. Discussion: In this multicentric study, the FAI cam type predominated in men on the right side; the pincer type predominated in women on the left side; this is similar to what has been reported in other populations. This study is limited by the wide variation in the femoral rotation; as an advantage, it was randomly carried out and provides some data on the prevalence of deformities of the hip, not previously registered.

[Epidemiological profile of admissions to the hip and pelvic surgery module in a general hospital]. / Perfil epidemiológico de los ingresos al Módulo de Cirugía de Cadera y Pelvis del Hospital General Xoco de la Secretaría de Salud.

BACKGROUND: The present study was carried out in order to know, evaluate and classify hip fractures treated by the orthopedic service of a general hospital. MATERIAL AND METHODS: Retrospective, cross-sectional and descriptive study based on the files of the hip and pelvic surgery module of a general hospital in the period from July 2009 to December 2016. RESULTS: We included a total of 1,545 patients aged between 14 and 107 years; the affected side, the reason for admission, their previous underlying pathologies, the type of fracture, the type of treatment given and the end result were analyzed for each patient. Statistical analysis was performed with the program SPSS version 18. Due to the relevance of the topic, the causes of the registered deaths were examined (n = 58); in relation to the data gathered, 2 and binary logistic regression were obtained. CONCLUSIONS: Hip fractures are still an undervalued subject with great economic and social impact; knowing the most frequent fracture type as well as the population most affected will help to establish effective preventive measures to decrease the morbidity and mortality of this disease in a general hospital.

ANTECEDENTES: El presente estudio fue realizado con la finalidad de conocer, evaluar y clasificar las fracturas de cadera tratadas en un servicio ortopédico de un hospital general. MATERIAL Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo, con base en los archivos del Módulo de Cirugía de Cadera y Pelvis de un hospital general, en el período comprendido de Julio de 2009 a Diciembre de 2016. RESULTADOS: Se obtuvo un total de 1,545 pacientes con edades entre 14 y 107 años; de cada paciente se analizó el lado afectado, la causa de ingreso, sus patologías de base previas, el tipo de fractura, el tipo de tratamiento otorgado y el resultado final. El análisis estadístico fue realizado con el programa SPSS versión 18. Debido a la relevancia del tema, se examinaron las causas de las defunciones registradas (n = 58); en relación con los datos registrados, se obtuvo 2 y regresión logística binaria. CONCLUSIONES: Las fracturas de cadera continúan siendo un tema infravalorado, con grandes repercusiones económicas y sociales; conocer el tipo de fractura más frecuente, así como la población mayormente afectada, ayudará a establecer medidas de prevención eficaces para disminuir la morbimortalidad de esta enfermedad en un hospital general.

A dermatomyositis and scleroderma overlap syndrome with a remarkable high titer of anti-exosome antibodies.

An overlap syndrome of dermatomyositis and scleroderma is reported. The case corresponded to a 27-year-old female with a clinical picture of 14 months evolution, characterized by proximal muscles weakness, erythematous rash in wrists, knees, ankles, Gottron sign, heliotrope periorbital rash and dysphagia. A muscle biopsy was compatible with dermatomyositis; meanwhile the skin biopsy was compatible with scleroderma. Muscle enzymes were increased. Interestingly, the antinuclear antibody determination in HEp-2 cells was positive with a remarkable titer of 81,920 exhibiting a nucleolar pattern. Anti-Jo1 antibody was negative, but anti-PM/Scl-100 positive. The patient received methylprednisolone and cyclophosphamide pulses, with gradual improvement. Present report constitutes a case of overlap dermatomyositis-scleroderma syndrome, with anti-PM/Scl autoantibodies (anti-exosome). The remarkable of this case was the exceptional high antinucleolar antibody titer.

Digestive haemorrhage in patients with anti-Anisakis antibodies.

OBJECTIVE: Anisakis simplex parasite causes anisakidosis, a disease that often mimics other gastrointestinal diseases such as peritonitis, appendicitis, Crohn's disease, ulcer, etc. Patients with digestive haemorrhage caused by ulcers, varices or Mallory syndrome were analysed for antibodies to the worm A. simplex. METHODS: Antibody detection was carried out by enzyme-linked immunosorbent assay (ELISA) and immunoblot using crude extracts of antigen and excretory/secretory products. Total immunoglobulin (Ig), IgG, IgM, IgA and IgE were studied. RESULTS: Eighty-seven patients were studied. The following prevalence rates were found with crude antigen: total Ig 30% (95% confidence interval 21-40), with values for IgG, IgM, IgA and IgE of 22 (CI 14-31), 17 (CI 10-26), 37 (CI 27-47) and 12% (CI 6-20), respectively. Twenty-four positive sera for total Ig response and crude products were selected for determination of specific antibodies with excretory/secretory antigens. We obtained 8, 13, 3 and 16 positive cases for total Ig, IgG, IgM and IgA respectively. The percentages of positivity within the varices and Mallory groups of patients were higher although differences were not significant (35 and 50% respectively). In a healthy population, the prevalence for total Ig is much lower (6%). Twenty-five positive sera for total Ig response were tested by means of immunoblot analysis against crude larval antigen. Concerning total Ig antibody response, 12 of the sera showed an immuno-recognition pattern concordant with the human anisakidosis reference serum (E17). Specific IgG bands were visualized in 30 sera; specific IgM and IgA in 6 and 12, respectively. Different clinical variables of these patients were studied: leucocytes, eosinophils, haemoglobin, prothrombin activity, thromboplastin time, fibrinogen, platelets and erythrocyte sedimentation rate. There were a few significant differences: for total Ig in prothrombin activity and platelets, and for IgM in eosinophils. CONCLUSIONS: The prevalence of detectable antibodies against A. simplex is higher in patients with digestive haemorrhage than in the healthy population.

Anti-anisakis antibodies in the clinical course of Crohn's disease.

BACKGROUND: Human anisakidosis is a parasitic disease whose intestinal form shares several characterictics with Crohn's disease (CD), like the ileocolonic location predominantly and the presence of granuloma. METHODS: 73 CD patients diagnosed according to Lennard-Jones' criteria were studied. The disease activity was measured by means of Harvey-Bradshaw Index. Different clinical variables were analyzed. Antigenic extract of Anisakis simplex larvae extracted from blue whiting was prepared. Determination of IgG, IgM, IgA and total specific immunoglobulin against A. simplex were carried out in sera by enzyme-linked immunosorbent assay. Immunorecognition patterns of these sera were realized by immunoblotting analysis. Results were compared with prevalence of antibodies anti-Anisakis in 251 healthy controls. RESULTS: 29% of CD patients showed detectable specific total Ig (G+M+A) against A. simplex (95% CI, 19-41). For IgG, IgM and IgA the percentages were 44, 18 and 53% (95% CI, 32-56, 10-26, and 41-65) respectively. In positive specific total Ig cases CD was localized mainly in ileum. In IgG-, IgM- and IgA-positive cases the location was predominantly ileocolonic. CD activity index was higher for groups with positive IgA (2.86 vs. 5.55; p < 0.05). CONCLUSION: Patients with CD have high prevalence of specific immunoglobulin against A. simplex. Specific IgA are associated to higher activity index of CD.

Detection of antibodies to Anisakis simplex larvae by enzyme-linked immunosorbent assay and immunoelectrophoresis using crude or purified antigens.

The enzyme-linked immunosorbent assay (ELISA) and immunoelectrophoresis (IEP) were used for the serodiagnosis of larval Anisakis simplex infections in man and immunized rabbits. Sephacryl S-300 gel filtration was used for separating crude antigen. Four fractions were obtained. Sera from patients with other helminth infections sometimes cross reacted with Anisakis larval antigens. With IEP, crude antigen is more sensitive than purified antigens. With ELISA, the third fraction is the most sensitive for detecting antibodies to Anisakis larvae in the sera of humans and immunized rabbits.