[Translated article] Better results in consolidation of hallux metatarsophalangeal arthrodesis with dorsal plate and interfragmentary compression screw.

BACKGROUND AND AIMS: The first metatarsophalangeal joint arthrodesis is indicated for the treatment of various pathologies as a technique to reduce pain and improve the support of the first radius. Numerous surgical techniques and fixation methods have been described, with the combination of a dorsal plate and an interfragmentary screw being the one that has shown to be the most stable construct in biomechanical studies. Our aim is to analyze the radiological results after metatarsophalangeal arthrodesis of the hallux using a dorsal plate associated or not with an interfragmentary screw. The differences in terms of consolidation rates and complications in patients diagnosed with hallux rigidus, hallux valgus, hallux varus and failure of previous surgeries were evaluated. MATERIALS AND METHODS: A retrospective cohort study of 55 patients with a mean age of 65.10 years in whom a dorsal plate was used was performed. Patients were divided into two groups depending on whether or not an interfragmentary screw was used. The minimum follow-up was 6 months after surgery. The assessment of the pre and postoperative radiological results was based on the variation of the hallux angle, the intermetatarsal angle and the dorsal metatarsophalangeal angle of the hallux, as well as the cases of nonunion identified in each study group. RESULTS: The radiological results, statistically significant differences (p<0.05) were only found in the dorsal metatarsophalangeal angle between both study groups. No statistically significant differences were found regarding the radiological evaluation of the pre and postoperative hallux angle and intermetatarsal angle. An equal decrease of each angles was observed in both study groups. Regarding the consolidation rate, statistically significant differences (p<0.05) were found between group A, which associated an interfragmentary screw, presenting a consolidation rate of 92%, and group B, which did not associate an interfragmentary screw, and that presented a union rate of 63%. CONCLUSION: Hallux metatarsophalangeal arthrodesis of the hallux with a dorsal plate and interfragmentary screw show best results regarding consolidation rate and complications compared to those cases in which an interfragmentary screw was not used.

Critical overview on the use of hydrophobic (deep) eutectic solvents for the extraction of organic pollutants in complex matrices.

During the last decades, many efforts have been devoted to the adaptation of sample preparation techniques and methods to the principles of Green Analytical Chemistry. Among them, this article review focusses on those aimed to green the solvents involved in sample treatment. Research in this field started in the late 1990s with the synthesis of room temperature ionic liquids, which were later replaced by the deep eutectic solvents (DESs). During the last years, a subclass of DESs, the so-called hydrophobic deep eutectic solvents (HDESs) have attracted attention. HDESs have contributed to circumventing some of the limitations of early-synthesised hydrophilic DESs regarding the cost of raw materials, the simplicity of synthesis, and the biocompatibility and, apparently, the biodegradability of the mixtures. In addition, these mixtures allowed the treatment of aqueous samples and the extraction of non-polar analytes. This article discusses fundamental aspects regarding the nomenclature used concerning HDESs, summarises the main physicochemical properties of these mixtures, and through discussion of key application studies, describes current progress in the use of these green solvents for the extraction of trace organic contaminants from a variety of matrices. Remaining gaps and possible lines of future development in this emerging, active and attractive research area are also identified and critically discussed.

Better results in consolidation of hallux metatarsophalangeal arthrodesis with dorsal plate and interfragmentary compression screw. / Mejores resultados en la consolidación de la artrodesis metatarsofalángica del hallux con placa dorsal y tornillo de compresión interfragmentario.

INTRODUCTION AND AIMS: The first metatarsophalangeal joint arthrodesis is indicated for the treatment of various pathologies as a technique to reduce pain and improve the support of the first radius. Numerous surgical techniques and fixation methods have been described, with the combination of a dorsal plate and an interfragmentary screw being the one that has shown to be the most stable construct in biomechanical studies. Our aim is to analyze the radiological results after metatarsophalangeal arthrodesis of the hallux using a dorsal plate associated or not with an interfragmentary screw. The differences in terms of consolidation rates and complications in patients diagnosed with hallux rigidus, hallux valgus, hallux varus and failure of previous surgeries were evaluated. MATERIAL AND METHODS: A retrospective cohort study of 55 patients with a mean age of 65.10 years in whom a dorsal plate was used was performed. Patients were divided into 2 groups depending on whether or not an interfragmentary screw was used. The minimum follow-up was 6 months after surgery. The assessment of the pre and postoperative radiological results was based on the variation of the hallux angle, the intermetatarsal angle and the dorsal metatarsophalangeal angle of the hallux, as well as the cases of nonunion identified in each study group. RESULTS: The radiological results, statistically significant differences (p<0.05) were only found in the dorsal metatarsophalangeal angle between both study groups. No statistically significant differences were found regarding the radiological evaluation of the pre and postoperative hallux angle and intermetatarsal angle. An equal decrease of each angles was observed in both study groups. Regarding the consolidation rate, statistically significant differences (p<0.05) were found between group A, which associated an interfragmentary screw, presenting a consolidation rate of 92%, and group B, which did not associate an interfragmentary screw, and that presented a union rate of 63%. CONCLUSIONS: Hallux metatarsophalangeal arthrodesis of the hallux with a dorsal plate and interfragmentary screw show best results regarding consolidation rate and complications compared to those cases in which an interfragmentary screw was not used.

Workplace aggressions on hospital workers: A current and prevalent problem with a high demand for training.

BACKGROUND: Workplace aggressions on hospital workers is a very frequent and under-reported problem. OBJECTIVE: The novel objective of our study was to analyze the number of workplace aggressions per hospital worker. Other objectives of the study were to analyze the management knowledge and interest in receiving training on aggressions by hospital workers. METHODS: An anonymous survey was handed out among all professionals in a university hospital. RESULTS: A total of 1118 anonymous surveys were collected. The responders declared that throughout their working life they had suffered some sort of verbal aggression in the hospital in 766 cases (68.5%) and physical aggression in 393 cases (35.2%). Multiple logistic regression analyses found higher risk of receiving physical and verbal aggression in the nursing category and in the Emergency, Critical Care or Psychiatry Units, and a higher risk of receiving physical aggression in women. The score on the level of personal knowledge regarding the legal, physical, and psychological management of aggressions (score 0-10 for each of the 3 aspects) was 2.91±2.68 in legal management, 2.97±2.77 in psychological management and 2.91±2.76 in physical management. The opinion about the interest of receiving training (score from 0 to 10) on the legal management of hospital aggressions was 8.90±1.72, on psychological management was 8.85±1.78 and on physical management was 8.88±1.78. CONCLUSIONS: Workplace aggression on hospital workers mainly affects women, the nursing category and the Emergency, Critical Care or Psychiatry Units. Hospital workers showed little knowledge on the topic but a great interest in receiving training.

Electrical performance enhancement of MHD microgenerators through the longitudinal shaping of the cross-section.

In the present work, the impact that the longitudinal shape of channels has on the current produced in the flow of a magneto-hydrodynamic microgenerator (MHDMG) is studied. The goal is to find the micro-channel geometry via modeling to maximize the current output for low Reynolds and Mach regimes. To carry out this study, a 3D dynamic numerical tool relying on the finite volume method was handled with the open-source software OpenFOAM. It is the base model to study the impact of intricate geometries on the ability to produce energy. An additional steady-state 2D analytical model was also developed to check some basic modeling assumptions. Both models have been experimentally validated on the simplest flow system having a constant square cross-section throughout. The results produced by both models cross-check very well and compare favorably with respect to experimental data. Hence, using the validated numerical tool, three shapes have been further investigated, namely, progressive (linear decrease of the cross-section), arc (parabolic decrease of the cross-section), and wavy (sinusoidal shape). It was found that the arc channel provides the greatest current output for the same volumetric flow. It is therefore the preferred choice for developing high current gain and more efficient MHDMG used in micro-scaled actuators and sensors.

Elastofibroma dorsi: diagnóstico y seguimiento en atención primaria / Elastofibroma dorsi: Diagnosis and follow-up in primary care

Objetivo Presentar una serie de pacientes con elastofibroma dorsi (ED) para recordar la patología y justificar su manejo diagnóstico y terapéutico en el ámbito de la atención primaria. Materiales y métodos Estudio retrospectivo observacional y longitudinal de 12 pacientes con 18ED. Se analizaron las características epidemiológicas, clínicas y de imagen. Los resultados del tratamiento se evaluaron atendiendo al dolor (escala EVA), la función del hombro (escala de Constant y Murley) y la calidad de vida (escala EuroQol-5 dimension [EQ-5D]). El tiempo medio de seguimiento de los casos fue de 60,5meses (5años, RIC: 1-161meses). Resultados Seis pacientes fueron hombres y seis fueron mujeres, con edad media al diagnóstico de 59años. El diagnóstico de sospecha en todos los casos fue clínico y de imagen. Solo tres precisaron intervención quirúrgica. Los resultados de todos fueron satisfactorios. Conclusiones Tanto el diagnóstico como la indicación del tratamiento de un ED puede hacerse en el ámbito de la atención primaria. En los casos típicos, que son mayoría, la historia clínica y una ecografía permiten un diagnóstico de certeza. La indicación terapéutica conservadora o quirúrgica depende de la decisión del paciente informado. Cuando existen dudas diagnósticas o el paciente desea la resección quirúrgica de la tumoración, habría que derivar al paciente al especialista hospitalario (AU)

Objective To present a series of patients with elastofibroma dorsi (ED) in order to recall the pathology and justify its diagnostic and therapeutic management in the primary care setting. Materials and methods Retrospective observational and longitudinal study of 12 patients with 18ED. Epidemiological, clinical and imaging characteristics were analysed. Treatment outcomes were assessed in terms of pain (VAS scale), shoulder function (Constant and Murley scale) and quality of life (EuroQol-5 dimension scale, EQ-5D). The mean follow-up of the cases was 60.5months (5years, range 1-161months). Results Six patients were male and six were female, with a mean age at diagnosis of 59years. The diagnosis of suspicion in all cases was based in clinical and imaging findings. Only three required surgery. The results of all were satisfactory. Conclusions Both the diagnosis and the indication for treatment of an ED can be made in the primary care setting. In typical cases, which are the majority, the clinical history and an ultrasound study allow a diagnosis of certainty. The indication for conservative or surgical treatment depends on the informed patient. When there are diagnostic doubts or the patient wishes surgical resection of the tumour, the patient should be referred to a hospital specialist (AU)

Medicamentos inductores a reacciones cutáneas severas reportados en países de Iberoamérica / Severe cutaneous adverse reactions drugs reported in Ibero-American countries

Objetivos: Identificar los medicamentos inductores a reacciones adversas cutáneas severas que se han reportado hasta el año 2020 en países de Iberoamérica, identificando los medicamentos inductores que se asocian a cada síndrome (SSJ, NET, DRESS y PEAG). Métodos: Estudio retrospectivo, no experimental. Se realizó una revisión sistemática de la literatura médica relacionada a los medicamentos inductores de reacciones adversas cutáneas severas en Iberoamérica, expuesta en la base de datos PubMed, Scopus, Scielo y Google académico, limitando la búsqueda a artículos publicados en español y sin límites de tiempo. 27 de 574 publicaciones identificaron los medicamentos inductores a reacciones adversas cutáneas severas, excluyendo los casos de estas reacciones en las que no se especificó su asociación secundaria a medicamentos. Resultados: Los hallazgos incluyeron reportes de los siguientes países: Argentina, Costa Rica, Guatemala, México, Paraguay, Ecuador, Perú y España. Entre los medicamentos inductores a reacciones adversas cutáneas severas reportados, se incluyeron aquellos pertenecientes a diversos grupos terapéuticos: anticonvulsivos, AINES, inhibidores de la xantina oxidasa, antimicrobianos, antirretrovirales, sales de oro y antagonistas de canales de calcio, todos ellos con un pronóstico entre grave y mortal. Conclusiones: Se determinó que los medicamentos inductores a reacciones adversas cutáneas severas comprendieron una amplia variedad, pertenecientes a diversos grupos terapéuticos, siendo los más frecuentes: anticonvulsivantes, alopurinol y algunos antibióticos. No se observó una tendencia específica de algún medicamento por país o región. (AU)

Aim: Identify induce severe skin reaction´s drugs that have been reported up to 2020 in Iberoamerican countries, recognizing the associated drugs with each syndrome (SSJ-NET, DRESS and AGEP). Data selection and methodology: A retrospective, non-experimental study was performed based on a systematic review of the medical literature related to induce sever skin reation´s drugs available in the databases of PubMed, Scopus, Scielo and Google scholar. The search and data selection were limited on reviewed articles published in Spanish, with no time limit. 27 of 574 clinical cases identified the drugs that induce serious skin reactions, excluding the cases of patients with skin reactions that do not specify whether they are secondary to drugs. Results: The findings included the report from the following countries: Argentina, Costa Rica, Guatemala, Mexico, Paraguay, Ecuador, Peru and Spain. The reported drugs that cause server skin reactions, belong to the following therapeutic groups: anticonvulsants, antibacterials, antiretrovirals, minocycline, lamotrigine, gold sales, beta-lactams, macrolides, quinolones, antifungals, calcium channel blockers, protease inhibitors, nonsteroidal anti-inflammatory drugs and acetaminophen; presenting pharmacological interactions, all of them between serious and fatal prognosis. Conclusions: When comparing the findings, it was determined that the drugs that cause server skin reactions belong to many diverse therapeutic groups, being the more frequently: anticonvulsants, alopurinol and some antibiotics. No specific tendency was found related on a specific drug reported on the analyzed countries. (AU)

Three-year efficacy of switching to dolutegravir plus lamivudine: A real-world study.

BACKGROUND: Dolutegravir (DTG) plus lamivudine (3TC) has proven highly efficacious as a switching strategy in virologically suppressed people with HIV (PWH). As this strategy was introduced relatively recently, real-world, long-term durability studies are lacking. METHODS: We performed a retrospective review of treatment-experienced patients who started DTG + 3TC in a cohort of PWH. HIV-RNA <50 copies/mL was analysed at 144 weeks in an intention-to-treat (ITT) analysis (missing = failure) and a per-protocol (PP) analysis (patients with missing data or changes for reasons other than virological failure were excluded). RESULTS: The study population comprised 358 PWH (19% women). Median age and time with HIV infection were 51.7 and 13.4 years, respectively. The median number of previous antiretroviral combinations was three. Previous virological failure was reported in 27.1% of patients, and the M184V resistance mutation was detected in 17 patients. At 144 weeks, the percentage of individuals with HIV-RNA <50 copies/mL was 77.4% (277/358) in the ITT analysis and 95.5% (277/290) in the PP analysis. A total of 68 participants were excluded from the PP analysis (data missing, 25, discontinuation due to toxicity, 19; other, 16; death, 8). Two people with virological failure selected resistance-associated mutations (M184V and M184V + R263K). HIV-RNA remained undetectable in 17 patients with a previous history of the M184V mutation. CONCLUSION: Our results confirm the real-world, long-term efficacy, tolerability and high genetic barrier of DTG + 3TC in treatment-experienced PWH. Although scarce, mutations causing resistance to nucleosides and integrase can emerge.

Prevalence of metabolic associated fatty liver disease (MAFLD) in patients with gallstone disease. Study on a cohort of cases in South-Southeastern Mexico.

INTRODUCTION: Metabolic (dysfunction) associated fatty liver disease (MAFLD) and gallstone disease are entities that share similar risk factors. Numerous publications confirm their elevated frequency, but few studies have considered their prevalence and possible association. AIMS: To determine the prevalence of MAFLD in patients with gallstone disease and the usefulness of liver biopsy for diagnosing the liver disease. MATERIALS AND METHODS: A prospective study was conducted on patients that underwent laparoscopic cholecystectomy, in whom liver biopsy was performed. VARIABLES ANALYZED: Anthropometric characteristics, biochemical profile, conventional ultrasound, risk factors, and histopathologic study of the liver biopsy. STATISTICAL ANALYSIS: Descriptive statistics were carried out for the quantitative variables and the Student's t test and multivariate analysis through binary logistic regression were employed for the continuous variables, utilizing IBM-SPSS, 25.0 (Windows) software. RESULTS: A total of 136 patients were classified into 2 groups: 40 (29.41%) with normal liver and 96 (70.59%) with MAFLD. Of the 136 patients, 71 patients (52.21%) corresponded to hepatic steatosis, 21 (15.44%) to steatohepatitis, and 4 (2.94%) to cirrhosis. Perisinusoidal inflammation was found in 39 cases (28.68%) and fibrosis was found in 10 (7.35%). The risk factors for both groups were age, diabetes, high blood pressure, and obesity. Glucose, triglyceride, and aminotransferase levels were significantly higher in the MAFLD group and conventional ultrasound demonstrated moderate concordance for its detection. DISCUSSION AND CONCLUSIONS: The results confirmed the elevated frequency of MAFLD associated with gallstone disease, justifying liver biopsy during cholecystectomy for diagnosing MAFLD.

Clinical outcomes of uninterrupted embryo culture with or without time-lapse-based embryo selection versus interrupted standard culture (SelecTIMO): a three-armed, multicentre, double-blind, randomised controlled trial.

BACKGROUND: Time-lapse monitoring is increasingly used in fertility laboratories to culture and select embryos for transfer. This method is offered to couples with the promise of improving pregnancy chances, even though there is currently insufficient evidence for superior clinical results. We aimed to evaluate whether a potential improvement by time-lapse monitoring is caused by the time-lapse-based embryo selection method itself or the uninterrupted culture environment that is part of the system. METHODS: In this three-armed, multicentre, double-blind, randomised controlled trial, couples undergoing in-vitro fertilisation or intracytoplasmic sperm injection were recruited from 15 fertility clinics in the Netherlands and randomly assigned using a web-based, computerised randomisation service to one of three groups. Couples and physicians were masked to treatment group, but embryologists and laboratory technicians could not be. The time-lapse early embryo viability assessment (EEVA; TLE) group received embryo selection based on the EEVA time-lapse selection method and uninterrupted culture. The time-lapse routine (TLR) group received routine embryo selection and uninterrupted culture. The control group received routine embryo selection and interrupted culture. The co-primary endpoints were the cumulative ongoing pregnancy rate within 12 months in all women and the ongoing pregnancy rate after fresh single embryo transfer in a good prognosis population. Analysis was by intention to treat. This trial is registered on the ICTRP Search Portal, NTR5423, and is closed to new participants. FINDINGS: 1731 couples were randomly assigned between June 15, 2017, and March 31, 2020 (577 to the TLE group, 579 to the TLR group, and 575 to the control group). The 12-month cumulative ongoing pregnancy rate did not differ significantly between the three groups: 50·8% (293 of 577) in the TLE group, 50·9% (295 of 579) in the TLR group, and 49·4% (284 of 575) in the control group (p=0·85). The ongoing pregnancy rates after fresh single embryo transfer in a good prognosis population were 38·2% (125 of 327) in the TLE group, 36·8% (119 of 323) in the TLR group, and 37·8% (123 of 325) in the control group (p=0·90). Ten serious adverse events were reported (five TLE, four TLR, and one in the control group), which were not related to study procedures. INTERPRETATION: Neither time-lapse-based embryo selection using the EEVA test nor uninterrupted culture conditions in a time-lapse incubator improved clinical outcomes compared with routine methods. Widespread application of time-lapse monitoring for fertility treatments with the promise of improved results should be questioned. FUNDING: Health Care Efficiency Research programme from Netherlands Organisation for Health Research and Development and Merck.

[Elastofibroma dorsi: Diagnosis and follow-up in primary care]. / Elastofibroma dorsi: diagnóstico y seguimiento en atención primaria.

OBJECTIVE: To present a series of patients with elastofibroma dorsi (ED) in order to recall the pathology and justify its diagnostic and therapeutic management in the primary care setting. MATERIALS AND METHODS: Retrospective observational and longitudinal study of 12 patients with 18ED. Epidemiological, clinical and imaging characteristics were analysed. Treatment outcomes were assessed in terms of pain (VAS scale), shoulder function (Constant and Murley scale) and quality of life (EuroQol-5 dimension scale, EQ-5D). The mean follow-up of the cases was 60.5months (5years, range 1-161months). RESULTS: Six patients were male and six were female, with a mean age at diagnosis of 59years. The diagnosis of suspicion in all cases was based in clinical and imaging findings. Only three required surgery. The results of all were satisfactory. CONCLUSIONS: Both the diagnosis and the indication for treatment of an ED can be made in the primary care setting. In typical cases, which are the majority, the clinical history and an ultrasound study allow a diagnosis of certainty. The indication for conservative or surgical treatment depends on the informed patient. When there are diagnostic doubts or the patient wishes surgical resection of the tumour, the patient should be referred to a hospital specialist.

Non-target analysis of organohalogenated contaminants in deep-sea fishes from the Mediterranean Sea by comprehensive two-dimensional gas chromatography-time-of-flight mass spectrometry.

The enhanced separation power and identification capabilities make comprehensive two-dimensional gas chromatography-time-of-flight mass spectrometry (GC × GC - ToF MS) a valuable instrumental alternative for non-target analysis (NTA). In the present study, GC × GC - ToF MS has been used for the NTA of chlorine- and bromine-containing compounds in composite livers of two scarcely investigated Mediterranean deep-sea fish species, hollowsnout grenadier (Coelorinchus caelorhincus) and roughsnout grenadier (Trachyrhinchus trachyrhinchus). Attention focused on the identification of organohalogenated compounds with structural characteristics similar to those of persistent organic pollutants (POPs). In total, 116 Cl-, Br- and mixed Cl/Br-compounds were either positively or tentatively identified in the analyzed liver samples. Up to 88 of these compounds were legacy POPs, being polychlorinated biphenyls (PCBs) and organochlorinated pesticides (OCPs) the most abundant and frequently detected families. The other 28 identified POP-like compounds were analytes not considered by current regulation and environmental monitoring programs, including, among others, degradation products of specific OCPs, naturally produced organohalogen compounds and several perchlorinated diethyldiphenylmethane-derivatives whose presence in the investigated species is reported here for the first time. The presence of other naturally occurring brominated and mixed halogenated compounds in these fish species is also described for the first time. Our results also showed differences in the accumulation profile of the identified compounds in both species. Thereby, anthropogenic POPs showed higher relative abundances in the livers of roughsnout grenadiers than those in hollowsnout grenadiers, while for naturally occurring compounds the opposite trend or similar levels were found in both species.

Dimorphic frataxin and its gene regulation by sex steroids in hamsters.

The role of frataxin (FXN) has been studied extensively in Friedreich ataxia patients, however, the molecular bases underlining the sex steroid-dependent gene expression profiles of FXN in adult tissues are unknown. I describe the molecular characterization of hamster FXN by examining the sexually dimorphic expression and its regulation by sex steroids. Sequence analysis of FXN cDNA showed 630 bp-long ORF encoding 209 amino acids. qPCR analysis revealed that FXN is detected in a wide range of tissues, with the highest expression in the heart, liver, and epididymis, and the weakest expression in the lung, spleen, uterus, and gut. In the male Harderian gland (HG), castration decreased FXN expression, while dihydrotestosterone (DHT) administration reestablished levels. FXN expression levels were higher in the male HG than the female HG. Expression levels in endocrine tissues showed a certain degree of sexual dimorphism; the transcript in the testis was significantly higher than those in the ovary. The effects of the estrous cycle on FXN expression remained unchanged in the HG, ovary, and adrenal glands; however, in the pancreas, the FXN mRNA was overexpressed during proestrus and exhibited sexual dimorphism as compared to the male pancreas. The mRNA expression results indicated that Harderian FXN may play a dynamic role in intracellular Fe of heme required for processing cytochromes and other hemeproteins, also suggesting that the moderate sexual dimorphism present in the HG and gonads could be regulated by androgens, while sexually dimorphic expression of FXN in the female pancreas may be controlled by sex steroids.

Tratamiento quirúrgico del pie plano valgo adquirido del adulto en estadio IIB: papel de la reparación del «spring ligament» / Surgical treatment at adult acquired flatfoot stage IIB: Spring ligament repair

Antecedentes y objetivos: En el desarrollo del pie plano valgo adquirido del adulto ha cobrado gran importancia el fallo de la columna medial, y no tanto la rotura del tibial posterior, siendo principalmente la lesión del ligamento en hamaca calcaneonavicular (spring ligament) el determinante del desarrollo de esta deformidad. Nuestro objetivo es analizar los resultados clínico-radiológicos de la reparación del ligamento en hamaca y valorar la utilidad e integración de las cuñas de titanio poroso en las osteotomías a las que se asocia la reparación ligamentosa. Material y métodos: Realizamos un estudio retrospectivo de 23 casos con una edad media de 63 años, diagnosticados de pie plano valgo adquirido del adulto estadio IIB de la clasificación RAM tras fallo de tratamiento ortoprotésico, valorando los resultados clínicos mediante la escala de la American Orthopaedic Foot and Ankle Society y los resultados radiológicos pre- y postoperatorios basándose en la variación de los ángulos estudiados (cobertura talonavicular y ángulo talar - 1.° metatarsiano en la proyección dorsoplantar y línea de Meary en la proyección lateral). Resultados: Los puntuación media en escala de la American Orthopaedic Foot and Ankle Society pasó de 52±10 preoperatorio a 88±6 (p<0,05). En cuanto a los resultados radiológicos, se demostró una mejoría estadísticamente significativa (p<0,05) en la variación de los ángulos en el postoperatorio. Conclusiones: La reparación de los estabilizadores mediales, asociada a técnicas óseas ofrece excelentes resultados clínico-radiológicos en el tratamiento del pie plano valgo adquirido del adulto estadio IIB.Además, las cuñas de titanio poroso presentan una adecuada integración, evitando los problemas de pinzamiento de los peroneos asociada al uso de placas y la necesidad posterior de retirada.(AU)

Background and aims: The spring ligament has paramount role in supporting the arches and its fail causes the collapse of the medial longitudinal arc, inducing adult acquired flatfoot deformity. Our aim was to analyze the clinical and radiological outcomes of spring ligament repair and titanium wedges integration used in surgical osteotomies. Material and methods: We performed a retrospective study of 23 cases with middle ages of 63, diagnosed with adult acquired flatfoot deformity stage IIB in RAM classification after ortho-prosthetic treatment failure, assessing the functional outcomes using the American Orthopedic Foot and Ankle Society scale and the radiological outcomes studying angles variation (talonavicular uncoverage, talo-first metatarsal angle and Meary axis). Results: The mean preoperative American Orthopedic Foot and Ankle Society score of the sample was 52±10 and the postoperative 88±6 (p<0.05). The radiological outcomes showed a statistically significant improvement. Conclusion: Spring ligament repair associated to bone reconstruction offers large functional and radiological outcomes to adult acquired flatfoot deformity stage IIB treatment. Titanium wedges present an excellent bone integration.(AU)

[Translated article] Surgical treatment at adult acquired flatfoot stage IIB: Spring ligament repair / Tratamiento quirúrgico del pie plano valgo adquirido del adulto en estadio IIB: papel de la reparación del «spring ligament»

Background and aims: The spring ligament has paramount role in supporting the arches and its fail causes the collapse of the medial longitudinal arc, inducing adult acquired flatfoot deformity. Our aim was to analyze the clinical and radiological outcomes of spring ligament repair and titanium wedges integration used in surgical osteotomies. Material and methods: We performed a retrospective study of 23 cases with middle ages of 63, diagnosed with adult acquired flatfoot deformity stage IIB in RAM classification after ortho-prosthetic treatment failure, assessing the functional outcomes using the American Orthopedic Foot and Ankle Society scale and the radiological outcomes studying angles variation (talonavicular uncoverage, talo-first metatarsal angle and Meary axis). Results: The mean preoperative American Orthopedic Foot and Ankle Society score of the sample was 52±10 and the postoperative 88±6 (p<0.05). The radiological outcomes showed a statistically significant improvement. Conclusion: Spring ligament repair associated to bone reconstruction offers large functional and radiological outcomes to adult acquired flatfoot deformity stage IIB treatment. Titanium wedges present an excellent bone integration.(AU)

Antecedentes y objetivos: En el desarrollo del pie plano valgo adquirido del adulto ha cobrado gran importancia el fallo de la columna medial, y no tanto la rotura del tibial posterior, siendo principalmente la lesión del ligamento en hamaca calcaneonavicular (spring ligament) el determinante del desarrollo de esta deformidad. Nuestro objetivo es analizar los resultados clínico-radiológicos de la reparación del ligamento en hamaca y valorar la utilidad e integración de las cuñas de titanio poroso en las osteotomías a las que se asocia la reparación ligamentosa. Material y métodos: Realizamos un estudio retrospectivo de 23 casos con una edad media de 63 años, diagnosticados de pie plano valgo adquirido del adulto estadio IIB de la clasificación RAM tras fallo de tratamiento ortoprotésico, valorando los resultados clínicos mediante la escala de la American Orthopaedic Foot and Ankle Society y los resultados radiológicos pre- y postoperatorios basándose en la variación de los ángulos estudiados (cobertura talonavicular y ángulo talar - 1.° metatarsiano en la proyección dorsoplantar y línea de Meary en la proyección lateral). Resultados: Los puntuación media en escala de la American Orthopaedic Foot and Ankle Society pasó de 52±10 preoperatorio a 88±6 (p<0,05). En cuanto a los resultados radiológicos, se demostró una mejoría estadísticamente significativa (p<0,05) en la variación de los ángulos en el postoperatorio. Conclusiones: La reparación de los estabilizadores mediales, asociada a técnicas óseas ofrece excelentes resultados clínico-radiológicos en el tratamiento del pie plano valgo adquirido del adulto estadio IIB.Además, las cuñas de titanio poroso presentan una adecuada integración, evitando los problemas de pinzamiento de los peroneos asociada al uso de placas y la necesidad posterior de retirada.(AU)

Surgical treatment at adult acquired flatfoot stage IIB: Spring ligament repair. / Tratamiento quirúrgico del pie plano valgo adquirido del adulto en estadio IIB: papel de la reparación del «spring ligament¼.

BACKGROUND AND AIMS: The spring ligament has paramount role in supporting the arches and its fail causes the collapse of the medial longitudinal arc, inducing adult acquired flatfoot deformity. Our aim was to analyze the clinical and radiological outcomes of spring ligament repair and titanium wedges integration used in surgical osteotomies. MATERIAL AND METHODS: We performed a retrospective study of 23 cases with middle ages of 63, diagnosed with adult acquired flatfoot deformity stage IIB in RAM classification after ortho-prosthetic treatment failure, assessing the functional outcomes using the American Orthopedic Foot and Ankle Society scale and the radiological outcomes studying angles variation (talonavicular uncoverage, talo-first metatarsal angle and Meary axis). RESULTS: The mean preoperative American Orthopedic Foot and Ankle Society score of the sample was 52±10 and the postoperative 88±6 (p<0.05). The radiological outcomes showed a statistically significant improvement. CONCLUSION: Spring ligament repair associated to bone reconstruction offers large functional and radiological outcomes to adult acquired flatfoot deformity stage IIB treatment. Titanium wedges present an excellent bone integration.

[Translated article] Surgical treatment at adult acquired flatfoot stage IIB: Spring ligament repair.

BACKGROUND AND AIMS: The spring ligament has paramount role in supporting the arches and its fail causes the collapse of the medial longitudinal arc, inducing adult acquired flatfoot deformity. Our aim was to analyze the clinical and radiological outcomes of spring ligament repair and titanium wedges integration used in surgical osteotomies. MATERIAL AND METHODS: We performed a retrospective study of 23 cases with middle ages of 63, diagnosed with adult acquired flatfoot deformity stage IIB in RAM classification after ortho-prosthetic treatment failure, assessing the functional outcomes using the American Orthopedic Foot and Ankle Society scale and the radiological outcomes studying angles variation (talonavicular uncoverage, talo-first metatarsal angle and Meary axis). RESULTS: The mean preoperative American Orthopedic Foot and Ankle Society score of the sample was 52±10 and the postoperative 88±6 (p<0.05). The radiological outcomes showed a statistically significant improvement. CONCLUSION: Spring ligament repair associated to bone reconstruction offers large functional and radiological outcomes to adult acquired flatfoot deformity stage IIB treatment. Titanium wedges present an excellent bone integration.

Using digital chatbots to close gaps in healthcare access during the COVID-19 pandemic.

INTRODUCTION: Chatbots have emerged as a first link to care in recent years. The COVID-19 pandemic, and consequent health system disruptions, expanded their use. Socios En Salud (SES) introduced chatbots in Peru, which experienced one of the highest excess COVID mortalities in the world. METHODS: SES and the government identified unmet population health needs, which could be amenable to virtual interventions. Chatbots were developed to screen individuals for these conditions; we describe the period of deployment, number of screenings, and number of people who received services. RESULTS: Between April 2020 and May 2021, SES deployed nine ChatBots: four for mental health, two for maternal and child health, and three for chronic diseases: breast cancer, hypertension, diabetes mellitus, and obesity. Mental health services were provided to 42,932 people, 99.99% of those offered services. The other ChatBots reached fewer people. Overall, more than 50% of eligible people accepted chatbot-based services. DISCUSSION: ChatBot use was highest for mental health. Chatbots may increase connections between a vulnerable population and health services; this is likely dependent on several factors, including condition, population, and penetration of smart phones. Future research will be critical to understand user experience and preferences and to ensure that chatbots link vulnerable populations to appropriate, high-quality care.

INTRODUCTION: Les chatbots se sont imposés comme un premier lien aux soins ces dernières années. La pandémie de COVID-19, et les perturbations du système de santé qui en ont résultées, ont élargi leur champ d'application. Socios En Salud (SES) a introduit les chatbots au Pérou, qui a connu l'une des surmortalités dues au COVID les plus élevées au monde. MÉTHODES: SES et le gouvernement ont identifié des besoins non satisfaits en matière de santé de la population, qui pourraient faire l'objet d'interventions virtuelles. Des chatbots ont été développés pour dépister des individus pour ces conditions ; nous décrivons la période de leur déploiement, le nombre de dépistages et le nombre de personnes qui ont reçu ces services. RÉSULTATS: Entre avril 2020 et mai 2021, SES a déployé neuf ChatBots : quatre pour la santé mentale, deux pour la santé maternelle et infantile et trois pour les maladies chroniques, comme le cancer du sein, l'hypertension, le diabète et l'obésité. Des services de santé mentale ont été fournis à 42 932 personnes, soit 99,99% des personnes proposées. Les autres ChatBots ont touché moins de personnes. Dans l'ensemble, plus de 50% des personnes éligibles ont accepté les services proposés par les chatbots. DISCUSSION: L'utilisation des ChatBots était la plus élevée pour la santé mentale. Les chatbots peuvent augmenter les connexions entre une population vulnérable et les services de santé, mais cela dépende de plusieurs facteurs, dont la condition, la type de population et la pénétration des smartphones. Les recherches futures seront essentielles pour comprendre l'expérience et les préférences des utilisateurs et pour s'assurer que les chatbots relient les populations vulnérables vulnérables aux soins appropriés et de qualité.