Manifestación clínica inicial de la lipomatosis epidural lumbar grado III de Naka: serie de casos / Initial clinical signs of Naka's grade III lumbar epidural lipomatosis: A case series

Introducción: La lipomatosis epidural espinal es una enfermedad infrecuente caracterizada por el sobrecrecimiento del tejido adiposo no encapsulado dentro del espacio epidural. Esto genera una estenosis del conducto espinal que puede provocar sintomatología compresiva. La presentación típica es insidiosa a lo largo de meses o años. El objetivo de este estudio fue realizar un análisis descriptivo de la manifestación clínica inicial en pacientes con lipomatosis epidural espinal grado III de Naka. Materiales y métodos: Estudio observacional retrospectivo en la Unidad de Patología Espinal de 4 instituciones, de 2010 a 2023. Se incluyó a pacientes >18 años, de ambos sexos, que acudieron por dolor lumbar con irradiación o sin irradiación, y presentaban lipomatosis lumbar Naka III en la resonancia magnética. Resultados: Se incorporó a 40 pacientes (edad promedio 62.5 años). El 75% era obeso, ninguno era fumador. El motivo de consulta más frecuente fue lumbalgia, con una mediana de evolución del dolor de 5.5 meses. Conclusiones:La lumbalgia fue la consulta más frecuente, con excepción del compromiso de L3-S1 que fue la lumbocruralgia. Los pacientes que sufrieron dolor más tiempo (>6 meses) eran más jóvenes y tenían un índice de masa corporal menor; sin embargo, no resultó estadísticamente significativo. Nivel de Evidencia: IV

Introduction: Spinal epidural lipomatosis (SEL) is a rare pathology characterized by the overgrowth of nonencapsulated adipose tissue within the epidural space. This generates spinal stenosis, which might result in compression symptoms. The typical presentation is insidious pain that lasts months or years. The objective of this study was to carry out a descriptive analysis of the initial clinical signs of patients with Naka's grade III lumbar SEL. materials and methods: Retrospective observational study in the Spinal Pathology Unit of 4 institutions, from 2010 to 2023. Patients over the age of 18, of both sexes, who consulted for low back pain with or without radiation and presented Naka's grade III lumbar lipomatosis on magnetic resonance imaging (MRI) were included. Results: We included 40 patients, with a mean age of 62.5 years; 75% were obese, there were no smokers. The most frequent reason for consultation was low back pain, with a median duration of 5.5 months. Conclusions: The most common reason for consultation was low back pain, with the exception of L3-S1 level involvement, which caused lumbar pain with radiation to the thigh. Patients with a longer period of pain (>6 months) were younger and had a lower BMI; although this was not statistically significant. Level of Evidence: IV

Frecuencia del dolor lumbar en médicos especialistas en Ortopedia y Traumatología: estudio transversal / Prevalence of low back pain in Orthopedics and Traumatology specialists: A cross-sectional study

Introducción: Hasta el 85% de la población padecerá, al menos, un episodio de dolor lumbar a lo largo de su vida. Representa una de las principales quejas del personal de salud, y tiene una prevalencia anual del 77%; los traumatólogos tenemos múltiples factores de riesgo para desarrollar este cuadro. El objetivo de este estudio fue evaluar la prevalencia de lumbalgia e identificar posibles factores asociados, en una muestra de médicos traumatólogos.materiales y métodos: Estudio analítico observacional transversal sobre el padecimiento de dolor lumbar en médicos especialistas en Ortopedia y Traumatología, miembros de la AAOT. El cuestionario se envió semanalmente durante un mes. Resultados: Se recibieron 393 respuestas, predominó el sexo masculino, y la media de la edad era de 46 años. Más del 50% de la muestra refirió sobrepeso, y el 43%, sedentarismo. La media de autopercepción de estrés laboral fue de 7. Un 86% afirmó haber sufrido, al menos, un episodio en el último año y un 38%, más de 4 episodios. Conclusiones: La prevalencia de lumbalgia fue alta. Predominaron los episodios agudos, no fueron necesarios estudios complementarios. Menos del 10% hizo reposo laboral. El hábito sedentario, el número de comorbilidades y la edad se asociaron con un riesgo más alto de sufrir >2 episodios de dolor. Nivel de Evidencia: III

Introduction: Up to 85% of the population will suffer at least one episode of low back pain throughout their lives. It is one of the most common complaints among healthcare workers, with a reported annual prevalence of 77%. Orthopedic surgeons have multiple risk factors for developing this condition. The objective of this study was to evaluate the prevalence of low back pain and identify possible contributing factors in a sample of orthopedic surgeons. Materials and methods: Across-sectional observational analytical study on low back pain in Orthopedics and Traumatology specialists who are members of the AAOT. Over the course of one month, a questionnaire was sent weekly. Results: 393 responses were received, the predominant sex was male, and the mean age was 46 years. More than 50% of the sample reported being overweight, whereas 43% reported being sedentary. The average self-perceived work stress was 7. 86% of respondents reported at least one episode in the previous year, with 38% reporting more than four. Conclusions: The prevalence of low back pain was high. Acute episodes predominated, and complementary studies were not necessary. Less than 10% took time off work. Sedentary habits, comorbidities, and age were all associated with an increased likelihood of suffering >2 episodes of pain. Level of Evidence: III

A hypothermia mimetic molecule (zr17-2) reduces ganglion cell death, gliosis, and electroretinogram distortion in male rats subjected to perinatal asphyxia.

Introduction: Perinatal asphyxia (PA) represents a major problem in perinatology and may cause visual losses, including blindness. We, and others, have shown that hypothermia prevents retinal symptoms associated to PA. In the present work, we evaluate whether a hypothermia mimetic small molecule, zr17-2, has similar effects in the context of PA. Methods: Four experimental groups were studied in male rats: Naturally born rats as controls (CTL), naturally born rats injected s.c. with 50 µL of 330 nmols/L zr17-2 (ZR), animals that were exposed to PA for 20 min at 37°C (PA), and rats that were exposed to PA and injected with zr17-2 (PA-ZR). Forty-five days after treatment, animals were subjected to electroretinography. In addition, morphological techniques (TUNEL, H&E, multiple immunofluorescence) were applied to the retinas. Results: A reduction in the amplitude of the a- and b-wave and oscillatory potentials (OP) of the electroretinogram (ERG) was detected in PA animals. Treatment with zr17-2 resulted in a significant amelioration of these parameters (p < 0.01). In PA animals, a large number of apoptotic cells was found in the GCL. This number was significantly reduced by treatment with the small molecule (p < 0.0001). In a similar way, the thickness of the inner retina and the intensity of GFAP immunoreactivity (gliosis) increased in PA retinas (p < 0.0001). These parameters were corrected by the administration of zr17-2 (p < 0.0001). Furthermore, injection of the small molecule in the absence of PA did not modify the ERG nor the morphological parameters studied, suggesting a lack of toxicity. Discussion: In conclusion, our results indicate that a single s.c. injection of zr17-2 in asphyctic neonates may provide a novel and efficacious method to prevent the visual sequelae of PA.

A hypothermia mimetic molecule (zr17-2) reduces ganglion cell death and electroretinogram distortion in a rat model of intraorbital optic nerve crush (IONC).

Introduction: Ocular and periocular traumatisms may result in loss of vision. Our previous work showed that therapeutic hypothermia prevents retinal damage caused by traumatic neuropathy. We also generated and characterized small molecules that elicit the beneficial effects of hypothermia at normal body temperature. Here we investigate whether one of these mimetic molecules, zr17-2, is able to preserve the function of eyes exposed to trauma. Methods: Intraorbital optic nerve crush (IONC) or sham manipulation was applied to Sprague-Dawley rats. One hour after surgery, 5.0 µl of 330 nmol/L zr17-2 or PBS, as vehicle, were injected in the vitreum of treated animals. Electroretinograms were performed 21 days after surgery and a- and b-wave amplitude, as well as oscillatory potentials (OP), were calculated. Some animals were sacrificed 6 days after surgery for TUNEL analysis. All animal experiments were approved by the local ethics board. Results: Our previous studies showed that zr17-2 does not cross the blood-ocular barrier, thus preventing systemic treatment. Here we show that intravitreal injection of zr17-2 results in a very significant prevention of retinal damage, providing preclinical support for its pharmacological use in ocular conditions. As previously reported, IONC resulted in a drastic reduction in the amplitude of the b-wave (p < 0.0001) and OPs (p < 0.05), a large decrease in the number of RGCs (p < 0.0001), and a large increase in the number of apoptotic cells in the GCL and the INL (p < 0.0001). Interestingly, injection of zr17-2 largely prevented all these parameters, in a very similar pattern to that elicited by therapeutic hypothermia. The small molecule was also able to reduce oxidative stress-induced retinal cell death in vitro. Discussion: In summary, we have shown that intravitreal injection of the hypothermia mimetic, zr17-2, significantly reduces the morphological and electrophysiological consequences of ocular traumatism and may represent a new treatment option for this cause of visual loss.

Mucopolisacaridosis tipo VI: a propósito de un caso / Mucopolysaccharidosis type VI. Case report

La mucopolisacaridosis tipo VI o síndrome de Maroteaux-Lamy se produce por la deficiencia de la enzima arilsulfatasa B que ocasiona la acumulación intracelular de dermatán sulfato. El riesgo de compresión medular es particularmente elevado y muy frecuente en la unión occipito-cervical. La terapia de reemplazo enzimático ha sido esencial para los pacientes con esta enfermedad; sin embargo, no tiene efecto sobre las alteraciones esqueléticas, y su impacto sobre la estabilidad espinal está aún en estudio. Se sugiere un examen anual (evaluación neurológica, radiografías, resonancia magnética y potenciales provocados somatosensitivos) y, en caso de anomalías, cada 6 meses. Pese al alto riesgo anestésico, la mielopatía y los síntomas progresivos indican la necesidad de una descompresión quirúrgica. Presentamos a una niña de 12 años con mucopolisacaridosis tipo VI tratada con terapia de reemplazo enzimático desde los 7 años, que acude a la consulta con síntomas compatibles con mielopatía cervical alta progresiva. Fue sometida a una descompresión y artrodesis occipito-cervical con ampliación del foramen magno. Esta enfermedad es infrecuente; por lo tanto, es imperativo el seguimiento multidisciplinario del paciente, así como conocer el riesgo de compresión medular y su oportuno tratamiento quirúrgico a cargo de cirujanos espinales. Nivel de Evidencia: IV

Mucopolysaccharidosis type VI, also known as Maroteaux-Lamy syndrome, is caused by a deficiency of the arylsulfatase B enzyme, which causes intracellular accumulation of dermatan sulfate. The risk of spinal cord compression is particularly high and frequent at the occipitocervical junction. Enzyme replacement therapy has been essential for patients with this disease; however, it has no effect on skeletal abnormalities, and its impact on spinal stability is still under study. An annual examination (neurological evaluation, radiography, magnetic resonance imaging, and somatosensory evoked potentials) is recommended. In case of anomalies, it should be repeated every 6 months. Despite the high anesthetic risk, myelopathy and progressive symptoms indicate the need for surgical decompression. We present the case of a 12-year-old girl with mucopolysaccharidosis type VI treated with enzyme replacement therapy since the age of 7, who came to the consultation with symptoms compatible with progressive high cervical myelopathy. She underwent occipitocervical decompression and fusion with enlargement of the foramen magnum. This disease is rare; therefore, multidisciplinary patient follow-up is imperative, as well as knowing the risk of spinal cord compression and its timely surgical treatment by spinal surgeons. Level of Evidence: IV

Quiste óseo aneurismático vertebral agresivo: presentación de un caso y revisión bibliográfica / Aggressive aneurysmal bone cyst of the spine. Case report and literature review

Introducción: El quiste óseo aneurismático es una lesión seudotumoral lítica, expansiva, compuesta por espacios llenos de sangre separados por tabiques. Representa el 15% de los tumores primarios en la columna, y su presentación de comportamiento agresivo es aún más infrecuente. Se han descrito diferentes opciones terapéuticas en función de su estadio y tasa de recurrencia. Presentamos a un paciente con compromiso neurológico secundario a un quiste óseo aneurismático en la columna torácica, de comportamiento agresivo, que requirió resolución quirúrgica. Conclusión: Las opciones de tratamiento del quiste óseo aneurismático se deben adecuar a cada caso en particular, según sus características. Nivel de Evidencia: IV

Introduction: An aneurysmal bone cyst is an expansive, lytic, pseudotumoral lesion that consists of blood-filled spaces separated by septa. It represents 15% of primary spinal tumors. An aggressive presentation is even rarer. Different therapeutic options are described depending on its stage and recurrence rate. We present the case of a patient with neurological involvement due to the aggressive behavior of an aneurysmal bone cyst in the thoracic spine, which required surgical treatment. Conclusion: Treatment options for aneurysmal bone cysts must adapt to each case, depending on its characteristics. Level of Evidence:IV

Expresión de proteínas inducibles por frío en la médula espinal de rata sometida a hipotermia sistémica / Expression of cold-inducible proteins in rat spinal cord subjected to systemic hypothermia

Introducción: La lesión traumática de la médula espinal es la principal causa de discapacidad motora en el mundo, y representa una prioridad para la Organización Mundial de la Salud. Se estudió, a nivel estructural y bioquímico, el efecto de la hipotermia sobre la expresión de la CIRBP (proteína activada por frío) en el asta anterior de la médula de ratas Sprague-Dawley albinas macho de 60 días, planteándola como terapéutica posible. Materiales y Métodos:Se dividió a 24 ratas en dos grupos: normotermia a 24 °C (n = 6) e hipotermia a 8 °C (n = 18), durante 180 min, sacrificadas a las 12, 24 y 48 h después del tratamiento. Se utilizó Western blot e inmunohistoquímica para la CIRBP. Resultados:Se observó un aumento progresivo de la expresión de la CIRBP de 12 a 48 h en las motoneuronas del asta anterior. Los valores fueron estadísticamente significativos entre los grupos de 24 h y 48 h comparados con los de los controles. Conclusiones: Este modelo experimental resultó eficaz, accesible y económico para generar hipotermia sistémica y abre un abanico de estrategias terapéuticas. El aumento en la expresión de las proteínas inducibles por frío en la médula espinal de ratas permite, por primera vez, estudiar el beneficio que aporta la hipotermia a nivel molecular, lo que resulta de suma importancia para estudios de terapéuticas en las lesiones medulares. Nivel de Evidencia: I

Introduction: Traumatic spinal cord injury is the main cause of motor disability in developed and underdeveloped countries, being a priority interest to the WHO. The effect of hypothermia on the expression of CIRBP (cold-activated protein) in the anterior grey column of 60-day-old male albino Sprague-Dawley rats was studied at the structural and biochemical levels and proposed as a possible therapeutic approach. Materials and Methods: 24 rats were randomly divided into two groups; normothermia (n = 6), at 24° C, and hypothermia, (n = 18) at 8° C for 180 minutes and euthanized at 12, 24, and 48 h post-treatment. Western blot and immunohistochemistry for CIRBP were used. Results: A progressive increase in the expression of CIRBP was observed from 12 to 48 hours, with statistically significant values after 24 and 48 hours compared to controls. Conclusion: This experimental model demonstrated efficacy, accessibility, and economy to generate systemic hypothermia, which provides a novel range of therapeutic strategies. The increase in the expression of cold-inducible proteins in the rats' spinal cords allows us to study the benefit of hypothermia at the molecular level for the first time, being of utmost importance for therapeutic studies in spinal cord injuries. Level of Evidence: I

Modelo de hipotermia experimental en murinos para estudios de lesión medular / Experimental hypothermia murine model for spinal cord injury studies

Introducción: Los ensayos de hipotermia sistémica en murinos son costosos, debido a la complejidad de los sistemas. El objetivo de este estudio fue evaluar si el modelo de hipotermia sistémica exógena utilizado en nuestro laboratorio para la hipotermia ocular es útil para reducir significativamente la temperatura de la médula espinal en ratas adultas. Materiales y métodos: Se utilizaron 36 ratas Sprague-Dawley albinas macho de 60 días, distribuidas en dos grupos: grupo normotermia a 24 °C (n = 18) y grupo hipotermia (n = 18) en cámara fría a 8 °C durante 180 minutos. Resultados: La temperatura rectal promedio fue de 37,71 ± 0,572 °C en el grupo normotermia y 34,03 ± 0,250 °C en el grupo hipotermia (p <0,0001). La temperatura medular promedio fue de 38,8 ± 0,468 °C en el grupo normotermia y de 36,4 ± 0,290 °C en el grupo hipotermia (p <0,0001). Conclusiones: El uso de hipotermia sistémica en ratas de laboratorio parece ser un método prometedor para evaluar los mecanismos fisiológicos y patológicos que se desencadenan en la médula espinal. La exposición al frío en cámara genera hipotermia medular significativa en ratas adultas. Los resultados sugieren que podría ser un modelo adecuado de hipotermia medular de bajo costo. Nivel de Evidencia: III

Given the complexity of hypothermal trial systems in murines, they are expensive. Our objective was to evaluate if the exogenous hypothermal model used in our laboratory for ocular hypothermia was useful for a significant reduction in medullar spine temperature in adult murines. Materials and methods: 36 60-day-old adult male Sprague-Dawley rats were used. They were separated into two groups: a normal temperature group at 24 °C (n=18) and a hypothermia group in a cold chamber at 8 °C for 180 minutes (n=18). Results: The mean rectal temperature was 37.71 °C ± 0.572 in the normothermia group and 34.03°C ± 0.250 in the hypothermia group (p <0.0001). The mean medullar temperature was 38.8 ± 0.468 °C in the normothermia group and 36.4 ± 0.290 °C in the hypothermia group (p <0.0001). Conclusion: Using systematic hypothermia in lab rats seems to be promising to evaluate physiologic and pathological mechanisms triggered in the medullar spine. Exposure to cold in the external chamber produces significant medullar hypothermia in adult rats. Results suggest this might be an adequate and inexpensive medullar hypothermal model. Level of Evidence: III

[Lumbosacral arthrodesis in construction workers. Return to work]. / Artrodesis lumbosacra en trabajadores de la construcción. Reinserción laboral.

Degenerative spinal disease is the leading cause of low back pain and sciatica in the general population. It is an important cause of absenteeism and increased expenses. Its incidence increases in people subjected to tasks that overload the spine, such as construction workers. Instrumented arthrodesis is a frequent practice with satisfactory results for its resolution. To date, in our country, we haven't found statistical data on this group of work-related patients. Our objective was to evaluate laboral impact generated by instrumented lumbosacral arthrodesis in construction workers. We did a retrospective, descriptive, comparative and monocentric study. Construction workers' patients with degenerative low back pain and instrumented lumbar or lumbosacral arthrodesis who were operated between January 2005 to August 2018 were included. Clinical and imaging evaluation and follow-up for a period of 18 to 24 months. Assessed with the Oswestry Disability Index (IDO) and the Visual Analog Pain Scale (VAS). The sample was analyzed in groups according to the functions at the time of returning to work, retirement or dismissal. We evaluated 139 patients. Mean age 42 years, degenerative spinal disease of the lumbosacral segment, 66.9% of the sample without postoperative complications resumed the same pre-surgical activity. Post-surgical IDO and VAS scores were worse in patients discharged, retired, and/or requalified. Patients under 42 years of age, without postoperative complications who improved more than 1 Oswestry category, returned to their usual tasks with satisfactory results in the medium and long term.

La enfermedad degenerativa del raquis es la causa más frecuente de lumbalgia y ciática en la población general provocando ausentismo, lo que incrementa el gasto en salud de los distintos subsistemas, así como el gasto del empleador quien deberá suplantar al trabajador. Su incidencia aumenta en personas sometidas a tareas de sobrecarga del raquis, como el caso de obreros de la construcción. La artrodesis instrumentada es una práctica frecuente y con resultados satisfactorios para su resolución. No hemos encontrado publicaciones con datos estadísticos locales sobre este tema. El objetivo fue evaluar el impacto laboral que genera la artrodesis lumbosacra instrumentada en trabajadores de la construcción. Realizamos un estudio retrospectivo, descriptivo, comparativo y monocéntrico, entre enero de 2005 y agosto de 2018, de trabajadores de la construcción con artrodesis del segmento lumbosacro por lumbalgia de origen degenerativo con evaluación y seguimiento clínico e imagenológico por un periodo de 18 a 24 meses, utilizando el Índice de Discapacidad de Oswestry (IDO) y la Escala Visual Analógica del Dolor (EVA). Se analizó la muestra en grupos según las funciones al momento del retorno laboral, jubilación o despido. Se evaluaron 139 pacientes (mediana 42 años). El 66.9% de la muestra no tuvo complicaciones postoperatorias y retomó la misma actividad prequirúrgica. Los puntajes de IDO y EVA postquirúrgicos fueron peores en los pacientes despedidos, jubilados y/o recalificados. Los menores de 42 años, sin complicaciones postoperatorias que mejoran más de 1 categoría del Oswestry retomaron sus tareas habituales con resultados satisfactorios a mediano y largo plazo.

Artrodesis lumbosacra en trabajadores de la construcción. Reinserción laboral / Lumbosacral arthrodesis in construction workers. Return to work

Resumen La enfermedad degenerativa del raquis es la causa más frecuente de lumbalgia y ciática en la población general provocando ausentismo, lo que incrementa el gasto en salud de los distintos subsistemas, así como el gasto del empleador quien deberá suplantar al trabajador. Su incidencia aumenta en personas sometidas a tareas de sobrecarga del raquis, como el caso de obreros de la construcción. La artrodesis instrumentada es una práctica frecuente y con resultados satisfactorios para su resolución. No hemos encon trado publicaciones con datos estadísticos locales sobre este tema. El objetivo fue evaluar el impacto laboral que genera la artrodesis lumbosacra instrumentada en trabajadores de la construcción. Realizamos un estudio retrospectivo, descriptivo, comparativo y monocéntrico, entre enero de 2005 y agosto de 2018, de trabajadores de la construcción con artrodesis del segmento lumbosacro por lumbalgia de origen degenerativo con evaluación y seguimiento clínico e imagenológico por un periodo de 18 a 24 meses, utilizando el Índice de Discapacidad de Oswestry (IDO) y la Escala Visual Analógica del Dolor (EVA). Se analizó la muestra en grupos según las funciones al momento del retorno laboral, jubilación o despido. Se evaluaron 139 pacientes (mediana 42 años). El 66.9% de la muestra no tuvo complicaciones postoperatorias y retomó la misma actividad prequirúrgica. Los puntajes de IDO y EVA postquirúrgicos fueron peores en los pacientes despedidos, jubilados y/o recalificados. Los menores de 42 años, sin complicaciones postoperatorias que mejoran más de 1 categoría del Oswestry retomaron sus tareas habituales con resultados satisfactorios a mediano y largo plazo.

Abstract Degenerative spinal disease is the leading cause of low back pain and sciatica in the general population. It is an important cause of absenteeism and increased expenses. Its incidence increases in people subjected to tasks that overload the spine, such as construction workers. Instrumented arthrodesis is a frequent practice with satisfactory results for its resolution. To date, in our country, we haven´t found statistical data on this group of work-related patients. Our objective was to evaluate laboral impact generated by instrumented lumbosacral arthrodesis in construction workers. We did a retrospective, descriptive, comparative and monocentric study. Construction workers' patients with degenerative low back pain and instrumented lumbar or lumbosacral arthrodesis who were operated between January 2005 to August 2018 were included. Clinical and imaging evaluation and follow-up for a period of 18 to 24 months. Assessed with the Oswestry Disability Index (IDO) and the Visual Analog Pain Scale (VAS). The sample was analyzed in groups according to the functions at the time of returning to work, retirement or dismissal. We evaluated 139 patients. Mean age 42 years, degenerative spinal disease of the lumbosacral segment, 66.9% of the sample without postoperative complications resumed the same pre-surgical activity. Post-surgical IDO and VAS scores were worse in patients discharged, retired, and/or requalified. Patients under 42 years of age, without postoperative complications who improved more than 1 Oswestry category, returned to their usual tasks with satisfactory results in the medium and long term.

Hypothermic Shock Applied After Perinatal Asphyxia Prevents Retinal Damage in Rats.

Perinatal asphyxia (PA) can cause retinopathy and different degrees of visual loss, including total blindness. In a rat model of PA, we have previously shown a protective effect of hypothermia on the retina when applied simultaneously with the hypoxic insult. In the present work, we evaluated the possible protective effect of hypothermia on the retina of PA rats when applied immediately after delivery. Four experimental groups were studied: Rats born naturally as controls (CTL), animals that were exposed to PA for 20 min at 37°C (PA), animals exposed to PA for 20 min at 15°C (HYP), and animals that were exposed to PA for 20 min at 37°C and, immediately after birth, kept for 15 min at 8°C (HYP-PA). To evaluate the integrity of the visual pathway, animals were subjected to electroretinography at 45 days of age. Molecular (real time PCR) and histological (immunohistochemistry, immunofluorescence, TUNEL assay) techniques were applied to the eyes of all experimental groups collected at 6, 12, 24, and 48 h, and 6 days after birth. PA resulted in a significant reduction in the amplitude of the a- and b-wave and oscillatory potentials (OP) of the electroretinogram. All animals treated with hypothermia had a significant correction of the a-wave and OP, but the b-wave was fully corrected in the HYP group but only partially in the HYP-PA group. The number of TUNEL-positive cells increased sharply in the ganglion cell layer of the PA animals and this increase was significantly prevented by both hypothermia treatments. Expression of the cold-shock proteins, cold-inducible RNA binding protein (CIRP) and RNA binding motif protein 3 (RBM3), was undetectable in retinas of the CTL and PA groups, but they were highly expressed in ganglion neurons and cells of the inner nuclear layer of the HYP and HYP-PA groups. In conclusion, our results suggest that a post-partum hypothermic shock could represent a useful and affordable method to prevent asphyxia-related vision disabling sequelae.

Resultados del bloqueo epidural caudal en pacientes laboralmente activos con dolor lumbar / Caudal epidural block outcomes in economically active patients with low back pain

Introducción: El dolor lumbar es una de las entidades categorizadas por la Organización Mundial de la Salud como enfermedades prioritarias y una de las principales causas de ausentismo laboral. El bloqueo caudal epidural es una técnica anestésica utilizada para tratar el dolor lumbar de diversos orígenes. Materiales y métodos: Se realizó un estudio observacional descriptivo retrospectivo en pacientes sometidos a bloqueo caudal guiado por radioscopia, entre el 1 de enero de 2017 y el 31 de enero de 2019. Se excluyó a los pacientes con bloqueo caudal previo, con antecedente de cirugía de columna lumbar y a quienes abandonaron el seguimiento. Se registraron variables relacionadas con el paciente y los resultados del procedimiento (dolor según la escala analógica visual, intervención quirúrgica posterior, actividad laboral posterior y licencia médica solicitada). Resultados: Se incluyó a 38 pacientes (media de la edad 43 años [rango 27-62]). La mediana de dolor a los tres meses fue de 3,5 (rango 2-6), con una diferencia de 4,5 (RIC de -2,7 a -7) respecto del puntaje basal. Estas diferencias fueron estadísticamente significativas (p <0,001). El 55,3% retornó al trabajo al primer mes, y el 52,4% de ellos (n = 11) solo requirió una semana de licencia. Conclusiones: Los valores del dolor a corto plazo luego del procedimiento se modificaron de forma estadísticamente significativa respecto de los valores basales. El promedio de reinserción laboral al mes fue del 55,3% (n = 21) y el 76,2% de ellos (n = 16) lo hizo a las dos semanas. Nivel de Evidencia: IV

Introduction: Low back pain is a very common health problem worldwide and a major cause of disability, affecting performance at work and general well-being. It is included in the priority diseases list of the World Health Organization (WHO). Low back pain is one of the leading causes of work absence worldwide. The caudal epidural block is a popular approach in managing lumbar pain conditions in adults. Materials and methods: An observational, descriptive, retrospective study was conducted in our institution, from January 2017 to January 2019, on patients who had undergone caudal epidural block for low back pain. We excluded patients with a history of previous epidural blocks, lumbar surgery, or who were lost to follow up. We collected patient demographic and clinical data (including age, sex, etc.) and procedure outcomes (pain score, surgery performed, lost working days, and return to work activity). Results: 38 patients were included. Mean age was 43 (27- 62) years old. Mean pain scores 3 months after treatment were 3.5 (2-6) with a difference of 4.5 (IQR -2.7 - -7) from baseline values. This was statistically significant. 55.3% (n=21) of patients returned to active duty in the first month; it is important to note that 52.4% of those (n=11) did it after the first week. Conclusions: The improvement of pain scores after the procedures was statistically significant. The mean return to work at the end of the first month was 55.3%, and 76.2% of those (n=16) did it after the first two weeks. Level of Evidence: IV

Infección paravertebral posacupuntura: reporte de un caso y revisión bibliográfica / Paravertebral infection after acupuncture: case report and literature review

La acupuntura es una técnica de origen chino que surge hace aproximadamente 2000 años. Es una modalidad terapéutica que ha cobrado gran importancia en el mundo occidental para el tratamiento de diversos cuadros, incluida la lumbalgia. Comunicamos el caso de un hombre de 74 años de edad, que consulta por reagudización de la lumbalgia crónica, luego de un tratamiento alternativo, a quien se le diagnostica una complicación infecciosa. Si bien, en manos experimentadas e instruidas, es una técnica con relativamente escasas complicaciones, se han publicado diversos reportes que describen complicaciones, en su mayoría, menores y asociadas a una técnica estéril insuficiente o a falta de conocimiento por parte del acupunturista. El auge de estas técnicas alternativas puso el foco en las medidas de seguridad, por lo cual entes, como la Organización Mundial de la Salud han creado guías para su correcto uso. Conocer las posibles complicaciones facilita el diagnóstico temprano y el tratamiento. Se analiza la presentación clínica y se realiza una revisión bibliográfica del cuadro. Nivel de Evidencia: IV

Acupuncture originated in China approximately 2000 years ago and is a growing treatment modality worldwide. Patients resort to acupuncture for a variety of conditions, including lower back pain. We discuss the case of a 74-year-old man who received acupuncture to treat lower back pain, after which the pain increased. An infection was detected and treated. Despite the fact that acupuncture can be considered generally safe if performed by well-trained practitioners, literature from around the world reports all kinds of complications, most of which are minor and usually a result of an inappropriate technique. The popularity of this alternative treatment has driven some organizations, such as World Health Organization (WHO) to draft guidelines about its safety. Being aware of possible complications allows for an early diagnosis and treatment. On this paper, we discuss the aforementioned case and include a review of the related literature. Level of Evidence: IV

[Motorcycles accidents: medical and economic cost at a public hospital in Buenos Aires City]. / Accidentes de moto: costo médico/económico en un hospital municipal de la ciudad de Buenos Aires.

Traffic accidents cause 1.25 million deaths per year worldwide, being one of the leading causes of death in young people, and the first cause between the ages of 15 - 29. There has been an increase in accidents in the last 10 years, one of the reasons for this is the increase in the sales of motorcycles and its use. We present a retrospective study about the patients who received attention at Carlos G. Durand Hospital, (CABA, Buenos Aires, Argentina) from January 2013 to December of 2015, with the intention of showing the medical and economic impact this accidents cause. Of a total of 4368 incoming patients assisted, due to traffic accidents, 67% (2926) were the result of motorcycle crashes; 18% of them required hospitalization. Males, and lower limbs lesions were predominant. Hospitalizations varied between 5 and 150 days, with 2.1 average surgeries per patient. The total cost was 16 767 037$, and in 2014 it represented 17 936 US$ per patient. These results show only partially the impact these accidents produce, because there are factors (like missing working days) that were unaccounted for. This is why it is necessary to generate awareness and develop more rigorous road safety and prevention policies, necessary to avoid accidents that increase spending on preventable conditions.

Accidentes de moto: costo médico/económico en un hospital municipal de la Ciudad de Buenos Aires / Motorcycles accidents: medical and economic cost at a public hospital in Buenos Aires City

A nivel mundial, los accidentes de tránsito aportan aproximadamente 1.25 millones de muertes anuales; es una de las principales causas de muerte en personas jóvenes y la primera entre los 15 y 29 años de edad. La tasa de accidentes aumentó en la última década, posiblemente debido al incremento del parque automotor y del uso de motocicletas. Se realizó un estudio retrospectivo descriptivo sobre los casos atendidos en el Hospital Carlos G. Durand, Buenos Aires (CABA), Argentina, desde enero de 2013 hasta diciembre de 2015, con el objetivo de representar el costo médico que estos generan en nuestro Hospital. De un total de 4368 pacientes atendidos en guardia, a causa de accidentes de tránsito, el 67% (2926 pacientes) fue provocado por motocicletas, de estos, el 18% requirió internación. Hubo predominio de varones y de lesiones en miembros inferiores. Las internaciones variaron entre 5 y 150 días, con 2.1 cirugías promedio por paciente. El gasto total del tratamiento fue de 16 767 037$, lo que en 2014 representaban unos 17 936 US$ por paciente. Estos resultados reflejan parcialmente el costo de dichos accidentes, ya que no se tiene en cuenta otros parámetros como la caída de días laborales; es por esto que se debe generar conciencia y crear políticas de prevención y educación vial más rigurosas, necesarias para poder evitar los accidentes que incrementan el gasto en afecciones evitables.

Traffic accidents cause 1.25 million deaths per year worldwide, being one of the leading causes of death in young people, and the first cause between the ages of 15 - 29. There has been an increase in accidents in the last 10 years, one of the reasons for this is the increase in the sales of motorcycles and its use. We present a retrospective study about the patients who received attention at Carlos G. Durand Hospital, (CABA, Buenos Aires , Argentina) from January 2013 to December of 2015, with the intention of showing the medical and economic impact this accidents cause. Of a total of 4368 incoming patients assisted, due to traffic accidents, 67% (2926) were the result of motorcycle crashes; 18% of them required hospitalization. Males, and lower limbs lesions were predominant. Hospitalizations varied between 5 and 150 days, with 2.1 average surgeries per patient. The total cost was 16 767 037$, and in 2014 it represented 17 936 US$ per patient. These results show only partially the impact these accidents produce, because there are factors (like missing working days) that were unaccounted for. This is why it is necessary to generate awareness and develop more rigorous road safety and prevention policies, necessary to avoid accidents that increase spending on preventable conditions.

Hypothermia Prevents Retinal Damage Generated by Optic Nerve Trauma in the Rat.

Ocular and periocular traumatisms may result in loss of vision. Hypothermia provides a beneficial intervention for brain and heart conditions and, here, we study whether hypothermia can prevent retinal damage caused by traumatic neuropathy. Intraorbital optic nerve crush (IONC) or sham manipulation was applied to male rats. Some animals were subjected to hypothermia (8 °C) for 3 h following surgery. Thirty days later, animals were subjected to electroretinography and behavioral tests. IONC treatment resulted in amplitude reduction of the b-wave and oscillatory potentials of the electroretinogram, whereas the hypothermic treatment significantly (p < 0.05) reversed this process. Using a descending method of limits in a two-choice visual task apparatus, we demonstrated that hypothermia significantly (p < 0.001) preserved visual acuity. Furthermore, IONC-treated rats had a lower (p < 0.0001) number of retinal ganglion cells and a higher (p < 0.0001) number of TUNEL-positive cells than sham-operated controls. These numbers were significantly (p < 0.0001) corrected by hypothermic treatment. There was a significant (p < 0.001) increase of RNA-binding motif protein 3 (RBM3) and of BCL2 (p < 0.01) mRNA expression in the eyes exposed to hypothermia. In conclusion, hypothermia constitutes an efficacious treatment for traumatic vision-impairing conditions, and the cold-shock protein pathway may be involved in mediating the beneficial effects shown in the retina.

Sacroileítis tuberculosa: Reporte de un caso y revisión bibliográfica / Sacroiliac joint tuberculosis. Case report and bibliographic review

La tuberculosis es una de las principales causas infecciosas de muerte en el mundo, pese a que existe un tratamiento específico. La sacroileítis representa el 10% de la afectación ósea en la tuberculosis y sigue siendo una entidad de difícil diagnóstico y de tratamiento controvertido. Presentamos el caso de una mujer de 40 años, que comienza con dolor lumbar bajo, asociado a tumoración y fiebre. Luego de una demora inicial se llega al diagnóstico por punción biopsia. Recibe tratamiento médico. El conocimiento de esta enfermedad facilitará el diagnóstico temprano y su tratamiento. Se discuten la presentación clínica, los métodos auxiliares de diagnóstico y el tratamiento, y se presenta una revisión bibliográfica de la enfermedad. Nivel de Evidencia: IV

Tuberculosis is a worldwide known cause of death, even nowadays with specific treatment. Tuberculosis of the sacroiliac joint represents 10% of bone involvement in this disease; diagnosis still remains a challenge, and treatment is controversial. We present a 40-year-old woman with lower back pain, fever and a lower back mass. After an initial delay, diagnosis of tuberculosis of the sacroiliac joint was established by fine-needle aspiration of the joint. Awareness of this particular presentation will facilitate early diagnosis and treatment. Clinical presentation, diagnostic methods and treatment are discussed, and a bibliographic review of this entity is made. Level of Evidence: IV

Cold Shock Proteins Are Expressed in the Retina Following Exposure to Low Temperatures.

Hypothermia has been proposed as a therapeutic intervention for some retinal conditions, including ischemic insults. Cold exposure elevates expression of cold-shock proteins (CSP), including RNA-binding motif protein 3 (RBM3) and cold inducible RNA-binding protein (CIRP), but their presence in mammalian retina is so far unknown. Here we show the effects of hypothermia on the expression of these CSPs in retina-derived cell lines and in the retina of newborn and adult rats. Two cell lines of retinal origin, R28 and mRPE, were exposed to 32°C for different time periods and CSP expression was measured by qRT-PCR and Western blotting. Neonatal and adult Sprague-Dawley rats were exposed to a cold environment (8°C) and expression of CSPs in their retinas was studied by Western blotting, multiple inmunofluorescence, and confocal microscopy. RBM3 expression was upregulated by cold in both R28 and mRPE cells in a time-dependent fashion. On the other hand, CIRP was upregulated in R28 cells but not in mRPE. In vivo, expression of CSPs was negligible in the retina of newborn and adult rats kept at room temperature (24°C). Exposure to a cold environment elicited a strong expression of both proteins, especially in retinal pigment epithelium cells, photoreceptors, bipolar, amacrine and horizontal cells, Müller cells, and ganglion cells. In conclusion, CSP expression rapidly rises in the mammalian retina following exposure to hypothermia in a cell type-specific pattern. This observation may be at the basis of the molecular mechanism by which hypothermia exerts its therapeutic effects in the retina.

Prophylaxis of surgical site infection with vancomycin in 513 patients that underwent to lumbar fusion / Profilaxia de infecção de sítio cirúrgico com vancomicina em 513 pacientes submetidos a fusão da coluna lombar / Profilaxis de infeccion del sitio quirúrgico con vancomicina en 513 pacientes com artrodesis lumbares

Objective: To assess the prophylactic effects of local vancomycin on an infection of the surgical site in patients undergoing lumbar instrumented fusion. Methods: Retrospective study from January 2011 to June 2014 in patients with symptomatic and refractory lumbar spine stenosis and listhesis who underwent instrumented pedicle screw spinal fusion. Two groups of patient were analyzed, one using vancomycin on the surgical site, vancomycin group (VG) and the control group (CG) without topical vancomycin. The routine prophylactic procedures were performed in both groups: aseptic scrub technique, skin preparation, preoperative intravenous antibiotic therapy. The VG received a dose of 1g of vancomycin mixed with the bone graft every three spinal levels fused and the group consisted of 232 patients. Results: 513 patients were analyzed, 232 in the VG and 281 in the CG. There was no statistical difference between the groups when the sex, mean surgery length, and mean bleeding volume were considered. The rate of infection for VG was reduced from 4.98% to 1.29% when compared with CG. Conclusion: The use of vancomycin added to the bone graft in posterior spinal fusion is associated with significantly lower rates of infection.

Objetivo: Avaliar os efeitos profiláticos de vancomicina tópica na infecção do local cirúrgico em pacientes submetidos à fusão lombar instrumentada. Métodos: Estudo retrospectivo de janeiro de 2011 a junho de 2014 com pacientes com estenose sintomática e refratária da coluna lombar e listese que foram submetidos à fusão espinhal com parafuso pedicular. Dois grupos de pacientes foram analisados, em um dos quais se utilizou vancomicina no local cirúrgico: grupo vancomicina (GV) e um grupo controle (GC), sem vancomicina tópica. Os procedimentos profiláticos de rotina foram realizados para ambos os grupos: escovação asséptica das mãos, preparação da pele, terapia antibiótica intravenosa pré-operatória. O GV recebeu uma dose de 1 g de vancomicina misturada ao enxerto ósseo a cada três níveis espinais fundidos, e o grupo consistiu em 232 pacientes. Resultados: Foram analisados 513 pacientes, 232 no GV e 281 no GC. Não houve diferença estatística entre os grupos quando sexo, tempo médio de cirurgia e volume médio de sangramento foram considerados. A taxa de infecção para o GV foi reduzida de 4,98% para 1,29% quando comparado com o GC. Conclusão: O uso de vancomicina adicionada ao enxerto ósseo na fusão espinhal posterior é associado a taxas significantemente mais baixas de infecção.

Objetivo: Evaluar los efectos profilácticos de la vancomicina local en el sitio quirúrgico en pacientes sometidos a cirugía instrumentada de columna lumbar. Métodos: Estudio retrospectivo desde enero 2011 hasta junio 2014 con pacientes con estenosis sintomática y refractaria al tratamiento y listesis intervenidos quirúrgicamente con tornillos pediculares y fusión posterior. Se analizaron dos grupos de pacientes, uno usando vancomicina en el sitio quirúrgico, grupo vancomicina (GV) y el grupo control (GC), sin vancomicina tópica. Los procedimientos de profilaxis de rutina se realizaron en ambos grupos: lavado antiséptico de manos, preparación del sitio quirúrgico, antibioticoterapia endovenosa prequirúrgica.El GV recibió 1 gr. de vancomicina mezclada con el injerto óseo cada 3 niveles espinales fusionados y dicho grupo consistió en 232 pacientes. Resultados: Se analizaron 513 pacientes, 232 en el GV y 281 en el GC. No hubo diferencias estadísticamente significativas entre ambos grupos en cuanto a sexo, tiempo quirúrgico y el volumen promedio de sangrado. La tasa de infección en el GV se redujo del 4,98 a 1,29 cuando se comparó con el GC. Conclusión: El uso de vancomicina agregada al injerto óseo en la fusión espinal posterior es asociado a una significativa disminución de las tasas de infección.