[Prognostic factors associated with failure of modular knee arthroplasty in oncologic patients]. / Factores pronósticos asociados al fracaso de la artroplastía modular de rodilla en pacientes oncológicos.

INTRODUCTION: reconstruction of large bone defects using modular knee arthroplasty (MKA) presents a significant challenge in terms of functionality. The objective of the present work was to identify the different prognostic factors associated with failure of MKA in cancer patients. MATERIAL AND METHODS: a retrospective cohort study was conducted, including patients with a diagnosis of musculoskeletal tumor in the distal femur or proximal tibia, who underwent MKA between January 1, 2010, and December 31, 2021. RESULTS: 49 patients were included, of which 25 (51.02%) were women and 24 (48.98%) men, with a mean age of 29.57 years. Of these, 14 (28.57%) patients experienced some type of MKA failure. The most frequent complication that led to failure was periprosthetic infection, observed in seven (14.29%) patients. Variables associated with MKA failure included biopsies performed outside our hospital (HR 3.2, 95% CI 1.4-6.4, p = 0.02), the length of the long axis of the tumor (HR 2.1, 95% CI 1.2-4.6, p = 0.01) and a prolonged surgical time (HR 3.37, 95% CI 1.1-8.6, p = 0.04). CONCLUSION: the most significant prognostic factors associated with MKA failure in our cohort were tumor size, prolonged surgical time, and performance of the diagnostic biopsy in a center not specialized in the management of this type of patient. These findings highlight the importance of considering these variables to improve outcomes in patients undergoing MKA.

INTRODUCCIÓN: la reconstrucción de grandes defectos óseos mediante artroplastía modular de rodilla (AMR) representa un desafío significativo en términos de funcionalidad. El objetivo del presente trabajo fue identificar los diferentes factores pronósticos asociados al fracaso de la AMR en pacientes oncológicos. MATERIAL Y MÉTODOS: se realizó un estudio de cohorte retrospectiva, incluyendo pacientes con diagnóstico de tumor musculoesquelético en el fémur distal o la tibia proximal, que fueron sometidos a AMR entre el 1 de Enero de 2010 y el 31 de Diciembre de 2021. RESULTADOS: se incluyeron 49 pacientes, de los cuales 25 (51.02%) eran mujeres y 24 (48.98%) hombres, con una edad media de 29.57 años. De éstos, 14 (28.57%) pacientes experimentaron algún tipo de fracaso de la AMR. La complicación más frecuente que condicionó el fracaso fue la infección periprotésica, observada en siete (14.29%) pacientes. Las variables asociadas con el fracaso de las AMR incluyeron biopsias realizadas fuera de nuestro hospital (HR 3.2, IC95% 1.4-6.4, p = 0.02), longitud del eje mayor del tumor (HR 2.1, IC95% 1.2-4.6, p = 0.01) y tiempo quirúrgico prolongado (HR 3.37, IC95% 1.1-8.6, p = 0.04). CONCLUSIÓN: los factores pronósticos asociados al fracaso de las AMR en nuestra cohorte fueron el tamaño del tumor, un tiempo quirúrgico prolongado y la realización de la biopsia diagnóstica en un centro no especializado en el manejo de este tipo de pacientes. Estos hallazgos resaltan la importancia de considerar estas variables en pacientes sometidos a AMR.

Endometriosis: «Nivel de conocimiento y expectativas de formación específica entre profesionales especialistas en medicina de familia y comunitaria y matronas en atención primaria en la isla de Gran Canaria» / Endometriosis: “Level of knowledge and expectations of specific training among primary care doctors and midwives on the island of Gran Canaria, Spain”

Objetivo: Analizar el nivel de conocimiento entre profesionales sanitarios de atención primaria sobre endometriosis e identificar sus necesidades formativas en esta materia. Diseño: Estudio descriptivo realizado en atención primaria del Área de Salud de Gran Canaria, mediante cuestionario online anónimo. Resultados: Ciento diecinueve especialistas en medicina de familia y comunitaria y 37 matronas respondieron el cuestionario. El 54,6% de profesionales médicos y el 67,6% de matronas consideran escaso su conocimiento sobre endometriosis. Menos del 50% de profesionales conoce la guía de atención a las mujeres con endometriosis en el Sistema Nacional de Salud. Los síntomas más frecuentes relacionados con endometriosis son: dismenorrea moderada/severa, dolor pélvico crónico, esterilidad. Los menos relacionados son los digestivos y las alteraciones urinarias catameniales. Un 80% de profesionales médicos señalan como menor de 10 el número anual de pacientes en las que piensan que puedan tener endometriosis y menos de 20 para el 75% de matronas. El 40% de profesionales médicos trataría a una paciente con solo dismenorrea y sin planes de gestación con anticonceptivos orales; el 8% considera que el dolor con la menstruación es algo común. El 25% de profesionales especialistas en medicina de familia y comunitaria señalan la terapia de larga duración con antiinflamatorios no esteroideos como tratamiento de primera línea. Menos del 25% de ellos derivarían al especialista en Ginecología con solo sospechar endometriosis. Mayoritariamente los profesionales manifiestan interés en mejorar su formación en endometriosis. El 94,6% de las matronas consideran que tienen un papel estratégico en el manejo de pacientes con endometriosis. Conclusión: La demora en el diagnóstico de la endometriosis se debe en parte al desconocimiento de la enfermedad. Los profesionales de atención primaria constituyen la primera línea de atención sanitaria.(AU)

Objective: To analyze the level of knowledge of endometriosis in primary care doctors and midwives and to identify their training needs in this area. Design: Descriptive study conducted in the primary care services of the Health Area of Gran Canaria, through an anonymous online questionnaire. Results: One hundred and nineteen doctors and 37 midwives completed the questionnaire; 54.6% of doctors and 67.6% of midwives considered that their knowledge about endometriosis was poor. Less than 50% of healthcare professionals knew the National System of Health's guidelines for the management of women with endometriosis. Symptoms most frequently associated to endometriosis included: moderate/severe dysmenorrhea, chronic pelvic pain and sterility. Less frequently related ones included: digestive symptoms and catamenial urinary disorders; 80% of doctors suspected endometriosis in <10 women per year; 75% of midwives suspected this condition in <20 women per year; 40% of doctors would prescribe oral contraceptives to patients with dysmenorrhea who were not planning pregnancy; 8% of doctors considered that menstruation-associated pain was common. Medical therapy was the most frequently chosen first-line treatment; 25% of doctors would choose long-term NSAIDs therapy as a first-line treatment; less than 25% of them would refer a patient to the Gynecology service only for suspected endometriosis. Most health professionals expressed their interest in improving their knowledge about endometriosis; 94.6% of midwives considered that they played a strategic role in the identification and management of patients with endometriosis. Conclusion: Delays in the diagnosis of endometriosis are partially due to ignorance of the disease. Primary care professionals constitute the first line of health care. In this context, it is essential to develop specific training strategies, which would be welcome by health professionals.(AU)

CH bond activation in aromatic ketones mediated by iridium-tris(pyrazolyl)borate complexes.

Reaction of complex [TpMe2Ir(η4-CH2C(Me)C(Me)C2)] (1) with a series of aromatic ketones at 130 °C renders, by means of a selective ortho-CH activation, Ir(III)-metallacycles 2-5, which display an Ir-H bond. When [TpMe2Ir(C6H5)2N2] (6) is treated with 2-(trifluoromethyl)acetophenone and 2-fluoroacetophenone at 80 °C, the formation of dimeric (7) and trimeric architectures (8) is achieved through the meta- and para-CH activation of the aromatic ketone, respectively. The generation of complexes 2-5 is proposed to occur by the initial formation of Ir(III) η1-ketone adducts as key intermediates, followed by aromatic CH activations and the release of a butadiene ligand. The formation of complexes 7 and 8 involves an assisted process in which a metal center activation of the less sterically hindered C-H bond of the aromatic ketone takes place (releasing a benzene molecule), followed by the coordination of the carbonyl group, which generates the respective dimeric and trimeric structures. Complexes 7 and 8 are efficient catalysts for the transfer hydrogenation of ketones and aldehydes using isopropanol as the hydrogen source. All complexes have been fully characterized by NMR spectroscopy, FT-IR, elemental analysis and, in the cases of 7 and 8, X-ray crystallography. Details of the reaction conditions, isolation of the products, and proposals for the pathways of formation of complexes 2-5 and 7-8 are discussed.

Effects of Deposition Temperature and Working Pressure on the Thermal and Nanomechanical Performances of Stoichiometric Cu3N: An Adaptable Material for Photovoltaic Applications.

The pursuit of efficient, profitable, and ecofriendly materials has defined solar cell research from its inception to today. Some materials, such as copper nitride (Cu3N), show great promise for promoting sustainable solar technologies. This study employed reactive radio-frequency magnetron sputtering using a pure nitrogen environment to fabricate quality Cu3N thin films to evaluate how both temperature and gas working pressure affect their solar absorption capabilities. Several characterization techniques, including X-ray diffraction (XRD), Rutherford backscattering spectrometry (RBS), Raman spectroscopy, scanning electron microscopy (SEM), nanoindentation, and photothermal deflection spectroscopy (PDS), were used to determine the main properties of the thin films. The results indicated that, at room temperature, it is possible to obtain a material that is close to stoichiometric Cu3N material (Cu/N ratio ≈ 3) with (100) preferred orientation, which was lost as the substrate temperature increases, demonstrating a clear influence of this parameter on the film structure attributed to nitrogen re-emission at higher temperatures. Raman microscopy confirmed the formation of Cu-N bonds within the 628-637 cm-1 range. In addition, the temperature and the working pressure significantly also influence the film hardness and the grain size, affecting the elastic modulus. Finally, the optical properties revealed suitable properties at lower temperatures, including bandgap values, refractive index, and Urbach energy. These findings underscore the potential of Cu3N thin films in solar energy due to their advantageous properties and resilience against defects. This research paves the way for future advancements in efficient and sustainable solar technologies.

Fitting parameters and therapies of ODE tumor models with senescence and immune system.

This work is devoted to introduce and study two quasispecies nonlinear ODE systems that model the behavior of tumor cell populations organized in different states. In the first model, replicative, senescent, extended lifespan, immortal and tumor cells are considered, while the second also includes immune cells. We fit the parameters regulating the transmission between states in order to approximate the outcomes of the models to a real progressive tumor invasion. After that, we study the identifiability of the fitted parameters, by using two sensitivity analysis methods. Then, we show that an adequate reduced fitting process (only accounting to the most identifiable parameters) gives similar results but saving computational cost. Three different therapies are introduced in the models to shrink (progressively in time) the tumor, while the replicative and senescent cells invade. Each therapy is identified to a dimensionless parameter. Then, we make a fitting process of the therapies' parameters, in various scenarios depending on the initial tumor according to the time when the therapies started. We conclude that, although the optimal combination of therapies depends on the size of initial tumor, the most efficient therapy is the reinforcement of the immune system. Finally, an identifiability analysis allows us to detect a limitation in the therapy outcomes. In fact, perturbing the optimal combination of therapies under an appropriate therapeutic vector produces virtually the same results.

Toothpaste use in Peruvian children during COVID-19 pandemic: results from a National Demographic and Health Survey.

PURPOSE: To determine the impact of COVID-19 pandemic on use of toothpaste in Peruvian children. METHODS: A national database of Peruvian children from 0 to 11 years old was used to develop a cross-sectional study, with a final sample of 51, 013 subjects. Data were obtained of results of the Demographic and Family Health Survey (ENDES); the questionnaire was self-reported. The use of toothpaste and fluoride concentration in toothpaste were dependent variables, and for the independent variable, the year was considered; in addition, other covariates were included. The statistical analyses applied were descriptive, bivariate, and multivariate tests. RESULTS: Use of toothpaste was 98.99% (n = 50,134), while fluoride toothpaste with < 1000 ppm was used by 77.29% (n = 27,366). For bivariate analysis, use of toothpaste was associated with place and area of residence, altitude, natural region, and age; for use of fluoride toothpaste with minimum 1000 ppm, there was an association with place and area of residence, natural region, wealth index, and age. In a multivariate manner, year only presented a positive association with use of fluoride toothpaste < 1000 ppm (RPa:1.04; 95%CI 1.01-1.07). CONCLUSIONS: Year 2020 of COVID-19 pandemic had a positive impact on the use of < 1000 ppm fluoride toothpaste in Peruvian children.

Implicación ocular en el tratamiento con radiofrecuencia pulsada del ganglio esfenopalatino / Ocular involvement in sphenopalatine ganglion pulsed radiofrequency

El tratamiento con radiofrecuencia pulsada del ganglio esfenopalatino es una opción importante a tener en cuenta respecto al tratamiento intervencionista en casos refractarios de neuralgia del trigémino o dolores faciales atípicos, dado el fácil acceso a su localización. A pesar de que las complicaciones de esta técnica son raras y es un procedimiento bastante seguro, a nivel oftalmológico cabe reseñar su importancia por las relaciones anatómicas de este ganglio (AU)

Pulsed radiofrequency treatment of the sphenopalatine ganglion is an important interventional treatment in refractory cases of trigeminal neuralgia or atypical facial pain, given the easy access to its location. Despite the fact that complications from this technique are rare and it is a fairly safe procedure, ophthalmologists should know about it due to the anatomical relations of this ganglion (AU)

Establishment of a desirable dose using neutral argon plasma to eradicate miliary peritoneal implants: A phase I/II controlled trial.

INTRODUCTION: Neutral argon plasma (NAP) system could meet the requirements to achieve oncological cytoreduction of peritoneal carcinomatosis with miliary lesions, minimizing the associated morbidity. This phase I/II trial aims to establish the desirable dose that is safe and effective in eliminating tumor cells with lower penetration. METHODS: Patients diagnosed with different origins for peritoneal carcinomatosis and miliary implants were selected for the study. The safe and potentially effective dose (desirability) of NAP was evaluated according to three factors: distance (mm), application time (s) and power (%), to evaluate the response variables such as the presence of tumor cells (Y/N) and the depth of penetration. RESULTS: Ten patients and 120 samples were evaluated and treated with NAP. There was no vascular or organ injury intraoperative using a pre-established dose of 100% (coagulation mode) at a distance of 2-3 cm. The distance was found to be correlated with the presence of the tumor cells in ex-vivo analysis, with an OR of 15.4 (4.0-111.4). The time and energy used were protective factors to eliminate tumor cells with an OR of 0.4 (0.1-0.9) and 0.8 (0.8-0.9), respectively. The safest and most effective desirability results were as follows i) energy 80% during 2-4 s with a distance of 2 cm (0.89), and ii) energy 100% during 2-4 s with a distance of 3 cm (0.90). CONCLUSIONS: The use of NAP during a CRS and HIPEC is safe and effective for eradicating tumor cells on the peritoneal surface at suggested doses of energy, distance and duration. TRIAL IDENTIFICATION: ClinicalTrials.gov Identifier: NCT04904042.

Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

Background: In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim: To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods: A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results: One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion: BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

Ocular involvement in sphenopalatin ganglion pulsed radiofrequency.

Pulsed radiofrequency (PRF) treatment of the sphenopalatine ganglion is an important interventional treatment in refractory cases of trigeminal neuralgia (TN) or atypical facial pain, given the easy access to its location. Despite the fact that complications from this technique are rare and it is a fairly safe procedure, ophthalmologists should know about it due to the anatomical relations of this ganglion.

Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial / Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care

Objetivo: Analizar las derivaciones dirigidas desde Atención Primaria a Cirugía Ortopédica y Traumatología. Como objetivo secundario, establecer 2escenarios de derivación, con el fin de conocer el impacto de la variabilidad en la derivación. Material y métodos: Estudio observacional de carácter transversal de análisis de las derivaciones de Atención Primaria a Cirugía Ortopédica y Traumatología durante el primer semestre de los años 2018, 2019 y 2021. Se ha examinado el número de derivaciones que emite cada facultativo y cada centro de salud de Atención Primaria, atendiendo a la clasificación de las distintas zonas básicas de salud. Resultados: Existe una gran variabilidad en el número de derivaciones, tanto según el tipo de zona básica de salud (p < 0,001) como por cada facultativo (p < 0,001). Las ratios de derivación se comportan de forma uniforme en el tiempo (p < 0,001). Debido al alto número de derivaciones, se han construido dosescenarios: en el primero de ellos la ratio de derivación se situaría en la zona media del espectro de la tasa de derivación. En el segundo escenario, se han tomado como referencia las menores ratios de derivación registradas. La reducción de la variabilidad en los 2escenarios supuestos proporciona una disminución importante de la demanda asistencial. Conclusiones: La reducción de la variabilidad tendría un efecto beneficioso sobre la capacidad asistencial del servicio de Cirugía Ortopédica y Traumatología.

Objective: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. Material and methods: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. Results: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. Conclusion: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.(AU)

[Translated article] Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care / Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial

Objetivo: Analizar las derivaciones dirigidas desde Atención Primaria a Cirugía Ortopédica y Traumatología. Como objetivo secundario, establecer 2escenarios de derivación, con el fin de conocer el impacto de la variabilidad en la derivación. Material y métodos: Estudio observacional de carácter transversal de análisis de las derivaciones de Atención Primaria a Cirugía Ortopédica y Traumatología durante el primer semestre de los años 2018, 2019 y 2021. Se ha examinado el número de derivaciones que emite cada facultativo y cada centro de salud de Atención Primaria, atendiendo a la clasificación de las distintas zonas básicas de salud. Resultados: Existe una gran variabilidad en el número de derivaciones, tanto según el tipo de zona básica de salud (p < 0,001) como por cada facultativo (p < 0,001). Las ratios de derivación se comportan de forma uniforme en el tiempo (p < 0,001). Debido al alto número de derivaciones, se han construido dosescenarios: en el primero de ellos la ratio de derivación se situaría en la zona media del espectro de la tasa de derivación. En el segundo escenario, se han tomado como referencia las menores ratios de derivación registradas. La reducción de la variabilidad en los 2escenarios supuestos proporciona una disminución importante de la demanda asistencial. Conclusiones: La reducción de la variabilidad tendría un efecto beneficioso sobre la capacidad asistencial del servicio de Cirugía Ortopédica y Traumatología.

Objective: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. Material and methods: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. Results: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. Conclusion: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.(AU)

Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care. / Análisis de la demanda asistencial desde atención primaria a traumatología: propuestas para la mejora del continuo asistencial.

OBJECTIVE: To analyze referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2referral scenarios in order to determine the impact of variability on referral. MATERIAL AND METHODS: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. RESULTS: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (P<0.001). Due to a large number of referrals, 2scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2scenarios assumed provides a significant reduction in the demand for care. CONCLUSION: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.

Reaching Ambulatory Older Adults with Educational Tools: Comparative Efficacy and Cost of Varied Outreach Modalities in Primary Care.

BACKGROUND: Providing patients with access to health information that can be obtained outside of an office visit is an important part of education, yet little is known about the effectiveness of outreach modalities to connect older adults to online educational tools. The objective was to identify the effectiveness and cost of outreach modalities providing online information about advance care planning (ACP) for older adults. METHODS: Six different outreach modalities were utilized to connect patients to online educational tools (ACP video decision aids). Participants were 13,582 patients aged 65 and older of 185 primary care providers with appointments over a 30-month period within a large health system in the greater New York City area. Main outcome measures were number of online video views and costs per outreach for each modality. KEY RESULTS: There were 1150 video views for 21,407 remote outreach events. Text messages, sent to the largest volume of patients (8869), had the highest outcome rate (9.6%) and were the most economical ($0.09). Characterization of phone calls demonstrated 21.7% engagement in the topic of ACP but resulted in minimal video views (<1%) and incurred the highest cost per outreach ($2.88). In-office handouts had negligible results (<1%). CONCLUSIONS: Text was the most cost-effective modality to connect older adults to an online educational tool in this pragmatic trial, though overall efficacy of all modalities was low.

[Translated article] Analysis of the demand of care from Primary Care to Traumatology: Proposals for the improvement of the continuous care.

OBJECTIVE: To analyse referrals from Primary Care consultation to Orthopaedic Surgery reference department. As a secondary objective, to establish 2 referral scenarios in order to determine the impact of variability on referral. MATERIAL AND METHODS: Cross-sectional observational study, analyzing referrals from Primary Care to Orthopaedic Surgery during the first half of the years 2018, 2019, and 2021. The number of referrals issued by each doctor and each Primary Care Healthcare Center was examined, according to the classification of the different Basic Healthcare Zones. RESULTS: There is great variability in the number of referrals, both according to the type of Basic Healthcare Zone and by each Primary Care facultative. The referral ratios behaved uniformly over time (p<0.001). Due to a large number of referrals, 2 scenarios have been constructed: In the first scenario, the referral ratio would be in the middle of the referral rate spectrum. In the second scenario, the lowest referral ratios recorded have been taken as a reference. The reduction of variability in the 2 scenarios assumed provides a significant reduction in the demand for care. CONCLUSION: Reducing variability would have a beneficial effect on the capacity of the Orthopaedic Surgery service to provide care.

[Surgical margins as prognostic factor in pelvis chondrosarcoma. Cohort study in a sarcoma unit]. / Márgenes quirúrgicos como factor pronóstico del condrosarcoma de pelvis. Estudio de cohorte en una unidad de sarcomas.

INTRODUCTION: chondrosarcoma is the second most common primary malignant tumor, constitutes approximately one quarter of all primary bone sarcomas. Surgical margins in pelvic chondrosarcoma have a direct impact as a prognostic factor, both on overall survival and on recurrence-free survival of this disease. OBJECTIVES: to analyze the impact of surgical margins as a prognostic factor in pelvic chondrosarcoma. MATERIAL AND METHODS: a retrospective database cohort with prospective follow-up of sarcomas in patients diagnosed with primary pelvic chondrosarcoma who underwent surgical treatment. Clinical-demographic variables were obtained, a descriptive analysis of each variable was performed, and these were contrasted with the outcome variables. RESULTS: seventeen patients were included, of which nine were female. The median age was 41 years, ranging from 23 to 65 years. The average tumor size was 20.9 cm (range 5 to 46 cm). The average surgical margin was 5.3 mm, ranging from 1 to 30 mm, with 58% positive margins. The average overall survival was 64 months (range 7 to 108 months). The distribution of pelvic involvement was as follows: zone I in nine patients (52.9%), zone II in two (11.8%), a combination of zones I-III in two (11.8%), I+II in one (5.9%), II+III in one (5.9%), I-III plus sacrum in one (5.9%) and I plus sacrum in one (5.9%). Tumor grades were classified as low in seven patients (41.2%), intermediate in sven (41.2%), high in two (11.8%), and dedifferentiated in one (5.9%). Regarding the type of resection, 12 patients (70.6%) underwent internal hemipelvectomy and five (29.4%) external hemipelvectomy. Recurrence was recorded in five cases (29.4%), metastasis in three (17.6%), and mortality in four (23.5%). CONCLUSIONS: this series represents the largest cohort reported in Latin America of primary pelvic chondrosarcomas. A more favorable prognosis was observed in patients with surgical margins greater than 1 mm. The presence of chondrosarcoma in multiple pelvic zones was associated with a worse oncological prognosis. Additionally, a higher incidence of positive surgical margins and local recurrence rates were identified in pelvic chondrosarcomas compared to those located in the extremities.

INTRODUCCIÓN: el condrosarcoma (CS), el segundo tumor maligno óseo primario más común, constituye aproximadamente una cuarta parte de todos los sarcomas óseos primarios. Los márgenes quirúrgicos en el condrosarcoma pélvico tienen un impacto directo como factor pronóstico, tanto en la supervivencia global como en la supervivencia libre de recurrencia de esta enfermedad. OBJETIVOS: analizar el impacto de los márgenes quirúrgicos como factor pronóstico en el condrosarcoma de la pelvis. MATERIAL Y MÉTODOS: cohorte de base de datos retrospectiva con seguimiento prospectivo de sarcomas de pacientes con diagnóstico de condrosarcoma primario de la pelvis que fueron sometidos a tratamiento quirúrgico. Se obtuvieron variables clínico-demográficas, se realizó un análisis descriptivo de cada variable y se contrastaron con las variables desenlace. RESULTADOS: se incluyeron 17 pacientes, de los cuales nueve eran mujeres. La mediana de edad fue de 41 años (rango de 23 a 65 años). El tamaño promedio del tumor fue de 20.9 cm (rango de 5 a 46 cm). El margen quirúrgico promedio fue de 5.3 mm, variando entre 1 y 30 mm, con 58% de márgenes positivos. La supervivencia global promedio fue de 64 meses (rango de 7 a 108 meses). La distribución de la afectación pélvica fue: zona I en nueve pacientes (52.9%), zona II en dos (11.8%), combinación de zonas I-III en dos (11.8%), I+II en uno (5.9%), II+III en uno (5.9%), I-III más sacro en uno (5.9%) y I más sacro en uno (5.9%). Los grados tumorales se clasificaron en bajo en siete pacientes (41.2%), intermedio en siete (41.2%), alto en dos (11.8%) y desdiferenciado en uno (5.9%). Respecto al tipo de resección, 12 pacientes (70.6%) se sometieron a hemipelvectomía interna y cinco (29.4%) a hemipelvectomía externa. Se registró recurrencia en cinco casos (29.4%), metástasis en tres (17.6%) y mortalidad en cuatro (23.5%). CONCLUSIONES: esta serie representa la cohorte más extensa reportada en Latinoamérica de condrosarcomas primarios de la pelvis. Se observó un pronóstico más favorable en pacientes con márgenes quirúrgicos superiores a 1 mm. La presencia de condrosarcoma en múltiples zonas pélvicas se asoció con un peor pronóstico oncológico. Además, se identificó una mayor incidencia de márgenes quirúrgicos positivos y tasas de recurrencia local en condrosarcomas de la pelvis en comparación con aquellos ubicados en las extremidades.

Granulocitos de baja densidad: Un nuevo marcador de deterioro óseo en pacientes en diálisis peritoneal / Low-density granulocytes: A new marker of bone deterioration in peritoneal dialysis patients

Objetivo: En enfermos renales, la enfermedad ósea-metabólica, la inflamación sistémica y la malnutrición exacerban el riesgo de calcificación vascular (CV) y la morbimortalidad. Dada la fuerte asociación entre CV y fracturas por fragilidad, el objetivo de este estudio es evaluar la contribución de los mayores determinantes de CV al deterioro óseo en pacientes en diálisis peritoneal (DP).Métodos: En 31 pacientes no diabéticos en DP (>6 meses), se estudiaron marcadores de alteraciones del metabolismo óseo, daño vascular, inflamación y desnutrición, y, su impacto en el deterioro óseo (osteopenia radiológica y/o antecedentes de fractura por fragilidad).Resultados: En estos pacientes, (20 varones y 11 mujeres; edad=54±15 y 60±11 años respectivamente (p=0,24)), la prevalencia de fracturas por fragilidad fue de 5% en hombres y del 27% en mujeres. El deterioro óseo fue mayor en personas de edad avanzada, sexo femenino, índices de Charlson y Kauppila elevados, menor masa muscular y con expansión de una subpoblación altamente inflamatoria de granulocitos inmaduros de baja densidad (LDGi). Un análisis de regresión logística demostró que el riesgo de deterioro óseo está más influenciado por el sexo femenino que por la edad y que, de los múltiples factores asociados a mayor deterioro óseo estudiados, sólo la expansión de LDGi estima el riesgo de alteraciones óseas en estos pacientes independientemente de su edad y sexo.Conclusión: La expansión de LDGi provee de un biomarcador certero para el diagnóstico de deterioro óseo y para monitorizar estrategias que atenúen su progresión en pacientes en DP de cualquier edad y sexo. (AU)