Fractura avulsión tipo sleeve de la patela / Patella sleeve avulsion fracture

Introducción: la fractura avulsión tipo sleeve o en manguito es una lesión rara que puede afectar a la patela durante la etapa de crecimiento infantil. Su diagnóstico precoz es clave para obtener un buen resultado clínico y funcional y evitar secuelas derivadas de la lesión. El diagnóstico diferencial se realiza con el síndrome de Sinding-Larsen-Johansson y la fractura del polo inferior de la rótula. Caso clínico: presentamos el caso de un varón de 12 años, sin antecedentes de interés, que acude a urgencias refiriendo gonalgia derecha tras mal movimiento mientras corría. El paciente es dado de alta orientándose como una tendinitis rotuliana. Dos semanas más tarde acude con dolor e impotencia funcional completa para la extensión de rodilla derecha tras caída de nuevo en ámbito deportivo. En la imagen de la radiografía convencional se observa una avulsión osteocondral desplazada del polo inferior de la patela, tipo sleeve. Dada la limitación funcional, se decide intervención quirúrgica mediante reinserción del polo inferior patelar mediante sutura tipo Krackow y puntos transóseos. Conclusiones: la fractura tipo sleeve es poco frecuente y puede pasar desapercibida. El mecanismo lesivo (indirecto por tracción), los antecedentes de dolor previo y las imágenes de radiología convencional deben aportar un alto nivel de sospecha y disminuir el infradiagnóstico de esta entidad para así evitar las secuelas derivadas como la patela alta, el dolor anterior de rodilla persistente o la pérdida de fuerza del cuádriceps (AU)

Introduction: the patella sleeve fracture is a rare injury that can affect the patella during the infant growth stage. Its early diagnosis is important to obtain a good clinical and functional result and to avoid sequelae derived from the injury. Differential diagnosis is made with Sinding-Larsen-Johansson syndrome and the fracture of the lower pole of the patella.Clinical Case: we present the case of a 12-year-old male, with no history of interest, who came to the emergency room reporting right knee pain after making a bad movement while running. The patient is discharged oriented as patellar tendonitis. Two weeks later, he returned with pain and complete functional impotence to extend his right knee after falling again doing sport. In the conventional X-ray image, a displaced osteochondral avulsion of the lower pole of the patella, 'sleeve' type, is observed. Because of the functional limitation, surgical intervention was decided doing reinsertion of the lower patellar pole using Krakow suture and transosseous stitches.Conclusions: patella sleeve type fracture is rare and may go unnoticed. The lesion mechanism (indirect by traction), the history of previous pain and conventional radiology images should provide a high level of suspicion and reduce underdiagnosis of this entity and thus avoid derived sequelae such as patella alta, anterior knee pain or loss of quadriceps strength. (AU)

Tumores óseos de la rótula

Introducción: Los tumores alrededor de la rodilla son frecuentes, a excepción de la rótula donde su localización es ocasional. En esta estructura anatómica existen características clínicas y epidemiológicas muy específicas según el tipo de tumor. Objetivo: Actualizar y brindar información sobre los tumores de la rótula. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 62 días (primero de noviembre al 31 de diciembre de 2022) y se emplearon las siguientes palabras: patellar bone tumors, bone tumor AND patella, knee bone tumors a partir de la información obtenida se realizó una revisión bibliográfica de un total de 153 artículos publicados en las bases de datos: PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 30 citas seleccionadas para realizar la revisión, 28 de los últimos cinco años. Resultados: Se menciona la incidencia de los tumores benignos más frecuentes que afectan esta estructura anatómica, como el tumor de células gigantes. Se hace referencia a los tumores óseos malignos más reportados y su comportamiento clínico e imagenológico en especial el osteosarcoma. Se abordaron las metástasis de la rótula en particular las provenientes del pulmón. Conclusiones: Los tumores óseos de la rótula son lesiones infrecuentes, al comparar su incidencia con otros tumores de la rodilla. La presentación depende del tipo histológico y grado de afección ósea.

Introduction: Tumors around the knee are frequent, except for the patella, where its location is occasional. In this anatomical structure there are very specific clinical and epidemiological characteristics depending on the type of condition. Objective: To update and provide information on patella tumors. Methods: The search and analysis of the information was carried out in a period of 62 days (November 1st to December 31st, 2022) and the following words were used: patellar bone tumors, bone tumor AND patella, knee bone tumors. From the information obtained a bibliographic review was carried out, a total of 153 articles published in the PubMed, Hinari, SciELO and Medline databases through the EndNote search manager and reference manager were found, of which 30 selected citations were used to carry out the review, 28 of the last five years. Results: The incidence of the most frequent benign tumors that affect this anatomical structure, such as the Giant Cell Tumor, is mentioned. Reference is made to the most reported malignant bone tumors and their clinical and imaging behavior, especially Osteosarcoma. Metastases of the patella were addressed, particularly those of the lung. Conclusions: Bone tumors of the patella are infrequent lesions, when comparing their incidence with tumors from the rest of the knee joint. Presentation depends on the histological type and degree of bone involvement.

Cytotoxic Potential of the Marine Diatom Thalassiosira rotula: Insights into Bioactivity of 24-Methylene Cholesterol.

Marine microalgae are receiving great interest as sustainable sources of bioactive metabolites for health, nutrition and personal care. In the present study, a bioassay-guided screening allowed identifying an enriched fraction from SPE separation of the methanolic extract of the marine diatom Thalassiosira rotula with a chemically heterogeneous composition of cytotoxic molecules, including PUFAs, the terpene phytol, the carotenoid fucoxanthin and the phytosterol 24-methylene cholesterol (24-MChol). In particular, this latter was the object of deep investigation aimed to gain insight into the mechanisms of action activated in two tumour cell models recognised as resistant to chemical treatments, the breast MCF7 and the lung A549 cell lines. The results of our studies revealed that 24-MChol, in line with the most studied ß-sitosterol (ß-SIT), showed cytotoxic activity in a 3-30 µM range of concentration involving the induction of apoptosis and cell cycle arrest, although differences emerged between the two sterols and the two cancer systems when specific targets were investigated (caspase-3, caspase-9, FAS and TRAIL).

Structural Characterization of Two Short Unspecific Peroxygenases: Two Different Dimeric Arrangements.

Unspecific peroxygenases (UPOs) are extracellular fungal enzymes of biotechnological interest as self-sufficient (and more stable) counterparts of cytochrome P450 monooxygenases, the latter being present in most living cells. Expression hosts and structural information are crucial for exploiting UPO diversity (over eight thousand UPO-type genes were identified in sequenced genomes) in target reactions of industrial interest. However, while many thousands of entries in the Protein Data Bank include molecular coordinates of P450 enzymes, only 19 entries correspond to UPO enzymes, and UPO structures from only two species (Agrocybe aegerita and Hypoxylon sp.) have been published to date. In the present study, two UPOs from the basidiomycete Marasmius rotula (rMroUPO) and the ascomycete Collariella virescens (rCviUPO) were crystallized after sequence optimization and Escherichia coli expression as active soluble enzymes. Crystals of rMroUPO and rCviUPO were obtained at sufficiently high resolution (1.45 and 1.95 Å, respectively) and the corresponding structures were solved by molecular replacement. The crystal structures of the two enzymes (and two mutated variants) showed dimeric proteins. Complementary biophysical and molecular biology studies unveiled the diverse structural bases of the dimeric nature of the two enzymes. Intermolecular disulfide bridge and parallel association between two α-helices, among other interactions, were identified at the dimer interfaces. Interestingly, one of the rCviUPO variants incorporated the ability to produce fatty acid diepoxides-reactive compounds with valuable cross-linking capabilities-due to removal of the enzyme C-terminal tail located near the entrance of the heme access channel. In conclusion, different dimeric arrangements could be described in (short) UPO crystal structures.

Rotula aquatica Lour. mitigates oxidative stress and inflammation in acute pyelonephritic rats.

The current study evaluates the efficacy of methanolic extract of Rotula aquatica Lour. (MERA) against inflammatory changes associated with acute pyelonephritis. The antioxidant enzymes such as SOD, CAT, GPx, GR and oxidative stress markers like GSH content, malondialdehyde (MDA) level, nitrate level, reactive oxygen species (ROS) level and renal toxicity markers were evaluated in this study. The mRNA level expression of Toll-like receptor 4 (TLR-4), nuclear transcription factor kappa B (NF-κB), tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and Tamm Horsfall protein (THP) were studied by RT-PCR analysis. The oral administration of MERA increases the antioxidant enzyme status in pyelonephritis rat. The elevated levels of oxidative stress markers in pyelonephritic rats were ameliorated by the administration of MERA at 100 mg/kg and 200 mg/kg bwt of the rat. The mRNA level expression of major genes were restored to normal level by MERA.

Luxación femorotibial abierta con fractura de rótula y tibia

RESUMEN Introducción: Las luxaciones de rodilla son poco frecuentes, lo que hace que su combinación abierta, con fracturas de rótula y del tercio superior de la tibia, sea rara y grave. Constituye una entidad causada por traumas de alta energía y se asocia a otras lesiones. Objetivo: Presentar un caso raro y complejo de luxación femorotibial posterior abierta con fractura del polo inferior de la rótula y tercio superior de la tibia. Caso clínico: Paciente masculino de 37 años de edad, que ingresó en el servicio de ortopedia y traumatología, quien como consecuencia de un accidente de tránsito, presentó luxación femorotibial posterior con fractura abierta del polo inferior de la rótula y tercio superior de la tibia, grados III-B, en el inferior derecho. Fue intervenido quirúrgicamente de urgencia; se realizó amplio desbridamiento quirúrgico, reducción de la luxación, reparación primaria de las lesiones ligamentosas, patelectomía parcial, reparación del tendón rotuliano y fijación externa para la fractura del tercio superior de la tibia. El paciente evolucionó bien, sin infección de la herida quirúrgica y recuperación total a los 4 meses. Conclusiones: La combinación de luxación femorotibial posterior abierta, con fractura del polo inferior de la rótula y tercio superior de la tibia es rara y obedece a altas energías traumáticas, como los accidentes automovilísticos. La cirugía de urgencia y la profilaxis antimicrobiana, es el método eficaz para el tratamiento definitivo de esta lesión.

ABSTRACT Introduction: Knee dislocations are infrequent, which makes the combination with open fractures of the patella and the upper third of the tibia, rare and serious. It is an entity caused by high-energy trauma and is associated with other injuries. Objective: To present a rare and complex case of open posterior femorotibial dislocation with fracture of the lower pole of the patella and the upper third of the tibia. Clinical case: A 37-year-old male patient, who was admitted to the orthopedic and trauma service, who, as a consequence of a traffic accident, presented posterior femorotibial dislocation with an open fracture of the lower pole of the patella and upper third of the tibia. grades III-B, in the lower right. He underwent emergency surgery; extensive surgical debridement, dislocation reduction, primary repair of ligamentous injuries, partial patellectomy, patellar tendon repair, and external fixation were performed for the fracture of the upper third of the tibia. The patient evolved well, without infection of the surgical wound and full recovery at 4 months. Conclusions: The combination of open posterior femorotibial dislocation, with fracture of the lower pole of the patella and upper third of the tibia is rare and is due to high traumatic energies, such as motor vehicle accidents. Emergency surgery and antimicrobial prophylaxis is the effective method for the definitive treatment of this lesion.

Algunas especificidades en torno a la rótula baja / Some specificities around the low patella

La rótula baja es una enfermedad infrecuente, de causa congénita o adquirida, caracterizada por dolor en la zona anterior de la rodilla y limitación del movimiento articular. La radiografía simple, en proyección lateral, ayuda al diagnóstico a través de determinadas mediciones; asimismo, el tratamiento conservador no resulta muy exitoso, de ahí que las modalidades quirúrgicas son más empleadas. Debido a la importancia de esta temática y a la escasa información disponible en la bibliografía nacional e internacional, en el presente artículo se comenta brevemente al respecto, con el objetivo de brindar información sobre esta enfermedad para que sirva como guía de trabajo.

The low patella is an uncommon disease, of congenital or acquired cause, characterized by pain in the anterior area of the knee and limitation of the articular movement. The simple x-ray, in lateral projection, helps to make a diagnosis through certain measurements; also, the conservative treatment is not very successful, so that surgical modalities are the most used. Due to the importance of this subject matter and the lack of information available in the national and international bibliography, it is shortly commented in this work, aimed at offering information on this disease so that it serves as working guide.

Resultado de tratamiento quirúrgico de la luxación recidivante de rótula mediante la técnica de Campbell / Result of surgical treatment of recurrent patella dislocation using the Campbell technique

Resumen: Introducción: La luxación recidivante de rótula es una condición en la cual no se mantiene la congruencia de la superficie de la rótula en su desplazamiento sobre el surco intercondíleo del fémur en los movimientos de flexoextensión de la rodilla. Los objetivos del trabajo son: mostrar la distribución de pacientes con luxación recidivante de rótula según diferentes variables sociodemográficas y evaluar los resultados con el uso de la técnica de Campbell. Material y métodos: Se llevó a cabo un estudio observacional en pacientes con luxación recidivante de rótula, en el período de Diciembre de 2017 a Diciembre de 2019. La recolección de datos se realizó con la revisión de las historias clínicas. La muestra fue de 19 pacientes, para la evaluación de la técnica quirúrgica se utilizó el sistema propuesto por los autores. El procesamiento de la información incluyó el cálculo de medidas de resumen para variables cualitativas, frecuencias absolutas y porcentajes. Resultados: El sexo femenino y el grupo de edad de 15 a 30 años fueron los más frecuentes, la cicatrización fue mala en dos pacientes. Se obtuvieron buenos resultados en 84.3% de los pacientes operados. Conclusiones: Predominó el sexo femenino y el grupo de 15 a 30 años, la cicatrización fue mala en dos pacientes. Se obtuvieron buenos resultados en los pacientes operados. A pesar de que la mayoría de los autores recomiendan la reparación del ligamento patelofemoral medial como técnica de elección o la técnica de Insall, la técnica de Campbell arroja buenos resultados cuando se aplica a luxación recidivante de rótula que necesita realineación proximal del mecanismo extensor.

Abstract: Introduction: the recurrent dislocation of the patella is a condition in which the congruence of the surface of the patella is not maintained in its displacement on the intercondyleal groove of the femur in the flexo-extension movements of the knee. The objectives of the study are: to show the distribution of patients with recurrent dislocation of patella according to different socio-demographic variables and to evaluate the results with the use of campbell's technique. Material and methods: An observational study was conducted in patients with recurrent patella dislocation in the period from December 2017 December 2019. Data collection was carried out with the review of medical records. The sample was 19 patients, the evaluation of the surgical technique was used the system proposed by the authors. Information processing included the calculation of summary measures for qualitative variables, absolute frequencies and percentages. Results: The female sex and the age group of 15 to 30 years were the most frequent, healing was poor in two patients, good results were obtained in 84.3% of the operated patients. Conclusions: Predominance of the female sex and the group of 15 to 30 years, the healing was bad in two patients, good results were obtained in the operated patients. Although most authors recommend medial patello-femoral ligament repair as a technique of choice or the Insall technique, Campbell's technique yields good results when applied to recurrent patella dislocation that need proximal realignment of the extensor mechanism.

Fractura osteocondral traumática de rodilla en edad pediátrica: reporte de un caso / Traumatic osteochondral knee fracture in pediatric age: report of a case / Fratura osteocondral traumática do joelho em idade pediátrica: relato de um caso

Las fracturas osteocondrales (FOC) traumáticas de rodilla en la edad pediátrica, son lesiones que acompañan hasta un 30% de las luxaciones agudas de rótula (LAR). Si no se mantiene una elevada sospecha clínica, es frecuente su retraso diagnóstico, pudiendo generar potenciales complicaciones. A propósito, presentamos el caso de una paciente de 12 años con una FOC post LAR que pasó inadvertida en la primera consulta, requiriendo la fijación del fragmento osteocondral con tornillos HCS a los 5 meses, logrando un excelente resultado funcional a los 54 meses de seguimiento.

Traumatic osteochondral fractures (OCF) of the knee in pediatric age are injuries that accompany up to 30% of acute patellar dislocations (APD). If high clinical suspicion is not maintained, its diagnostic delay is frequent, and may generate potential complications. Incidentally, we present the case of a 12-year-old patient with a post-APD OCF that went unnoticed in the first consultation, requiring fixation of the osteochondral fragment with HCS screws at 5 months. Achieving an excellent functional result at 54 months follow-up.

As fraturas osteocondrais traumáticas (FOC) do joelho em idade pediátrica são lesões que acompanham até 30% das luxações agudas da patela (LAP). Se uma alta suspeita clínica não for mantida, seu atraso no diagnóstico é frequente e pode gerar complicações potenciais. A propósito, apresentamos o caso de um paciente de 12 anos com FOC pós-LAP que passou despercebido na primeira consulta, exigindo fixação do fragmento osteocondral com parafusos HCS em 5 meses. Obtendo um excelente resultado funcional aos 54 de acompanhamento.

Therapeutic effect of two muscle strengthening programs in patients with patellofemoral pain syndrome. A randomized controlled clinical trial / Efecto terapéutico de dos programas de fortalecimiento muscular en pacientes con síndrome de dolor pátelofemoral. Ensayo clínico controlado aleatorizado

Abstract Introduction: Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders affecting the knee joint. Conservative treatment reduces pain and improves functional capacity in the short and medium-term. Objective: To determine the therapeutic effect of two muscle strengthening exercise programs in patients with PFPS from Bogotá, Colombia, aged between 15 and 40 years. Materials and methods: Experimental randomized controlled clinical trial conducted in 40 patients with PFPS from Bogotá, Colombia, aged 15-40 years, with a mild to moderate level of physical activity. Participants were randomly distributed into 2 intervention groups: Group A: 8-week-long core, hip and knee muscles strengthening exercises program; Group B: 8-week-long hip and knee muscles strengthening exercises program. The level of pain was measured using the Visual Analog Scale and the Kujala Anterior Knee Pain Scale. Results: The addition of core muscle strengthening exercises to the traditional treatment improved the quality of life of participants in the intervention group A, where a significant reduction of pain, with a statistically significant difference in the total score of the Kujala scale (p=0.025) was observed. Conclusions: Including core muscle strengthening exercises in the conservative management of PFPS increases its effectiveness to reduce pain and improve the quality of life of these patients. ClinicalTrials.gov Identifier: NCT04011436

Resumen Introducción. El síndrome de dolor pátelofemoral (SPF) es una de las alteraciones musculoesqueléticas más frecuentes que afectan la articulación de la rodilla. El tratamiento conservador reduce el dolor y mejora la capacidad funcional en el corto y mediano plazo. Objetivo. Establecer el efecto terapéutico de dos programas de ejercicios de fortalecimiento muscular en pacientes con SPF de Bogotá, Colombia, con edades entre 15 y 40 años. Materiales y métodos. Ensayo clínico controlado aleatorio experimental realizado en 40 pacientes con SPF de Bogotá, Colombia, con edades entre los 15 y 40 años, con nivel de actividad física leve a moderada y que fueron distribuidos de forma aleatoria en 2 grupos de intervención: Grupo A: programa de ejercicios de fortalecimiento de los músculos del core, la cadera y la rodilla con una duración de 8 semanas; Grupo B: programa de ejercicios de fortalecimiento de los músculos de la cadera y la rodilla con la misma duración. El nivel de dolor se midió a través de la Escala Visual Analógica y de la Escala de Kujala para dolor patelofemoral. Resultados. La adición de ejercicios de fortalecimiento de los músculos del core al tratamiento tradicional mejoró la calidad de vida de los participantes en el grupo de intervención A, donde se observó una reducción significativa del dolor con una diferencia estadísticamente significativa en la puntuación total de la escala Kujala (p=0.025). Conclusiones. Incluir ejercicios de fortalecimiento de los músculos del core al manejo conservador del SPF aumenta su efectividad para reducir el dolor y mejorar la calidad de vida de estos pacientes. ClinicalTrials.gov Identifier: NCT04011436

Reconstrucción del ligamento patelofemoral medial con tendón del aductor mayor en pacientes pediátricos con inestabilidad de rótula / Reconstruction of the Medial PatellofemoralLigament with Adductor Magnus Tendon in Pediatric Patients with Patella Instability

Introducción: El ligamento patelofemoral medial se considera el principal estabilizador medial de la rótula. La reconstrucción está indicada en pacientes con luxación recidivante, cuando el tratamiento conservador ha fallado. Objetivo: Describir y evaluar una técnica de reconstrucción del ligamento patelofemoral medial con el tendón del aductor mayor en pacientes con esqueleto inmaduro. Métodos: Estudio anatómico y descriptivo de pacientes en los que se empleó el tendón del aductor mayor para reconstruir el ligamento patelofemoral medial. Después de la cirugía se evaluó reluxación, inestabilidad y satisfacción, con escala de Kujala. Resultados: Se disecaron 5 piezas de cadáveres frescos. El tendón del aductor mayor fue de 8 a 9 cm de longitud. Se realizaron ocho cirugías en siete pacientes entre 8-17 años, uno de ellos con síndrome de Down. El seguimiento mínimo fue 12 meses. No hubo reluxación, el paciente con síndrome de Down presentó subluxación rotuliana. La flexión y extensión de rodillas fue completa. Conclusiones: En pacientes con esqueleto inmaduro con placa de crecimiento del fémur distal presente y cercana al punto isométrico del ligamento, acarrea dificultades para la reconstrucción del ligamento patelofemoral medial. La técnica descrita por Avikainen permite reconstrucción no anatómica del ligamento sin realizar túneles femorales que pongan en riesgo la físis. Este trabajo describe la técnica con aductor mayor. De las ocho rodillas operadas, en solo una se presentó subluxación, en las otras se obtuvo buen resultado, sin luxación, y los pacientes quedaron satisfechos con el resultado(AU)

Introduction: The medial patellofemoral ligament is considered the main medial stabilizer of the patella. Reconstruction is indicated in patients with recurrent dislocation, when conservative treatment has failed. Objective: To describe and evaluate a reconstruction technique of the medial patellofemoral ligament with the adductor magnus tendon in patients with an immature skeleton. Methods: Anatomical and descriptive study of patients in which the adductor magnus tendon was used to reconstruct the medial patellofemoral ligament. After surgery, reluxation, instability and satisfaction were evaluated with Kujala scale. Results: Five pieces of fresh corpses were dissected. The adductor magnus tendon was 8 to 9 cm long. Eight surgeries were performed in seven patients between 8-17 years old, one of them with Down syndrome. The minimum followup period was 12 months. There was no relaxation. The patient with Down syndrome had patellar subluxation. The flexion and extension of the knees was complete. Conclusions: The reconstruction of the medial patellofemoral ligament causes difficulties in patients with immature skeleton, plate growth of the distal femur close to the isometric point of the ligament. The technique described by Avikainen allows non-anatomical reconstruction of the ligament without performing femoral tunnels that put the physis at risk. This paper describes the adductor magnus technique. Only one knee, out of the eight operated, had subluxation. The rest had good result, with no dislocation, and the patients were satisfied with the result(AU)

Inestabilidad femoropatelar. Controversia y evidencia / Patellofemoral instability. Controversy and evidence

La inestabilidad rotuliana se debe a una alteración del mecanismo extensor de la rodilla, que involucra a diferentes estructuras anatómicas. La anamnesis, la exploración física y las pruebas complementarias son cruciales para determinar el manejo adecuado. Una las estructuras anatómicas más importantes es el ligamento patelofemoral medial (LPFM), siendo su reconstrucción la técnica quirúrgica más empleada para resolver el problema de la inestabilidad. Existen diversas formas de realizar la reconstrucción del LPFM y se pueden añadir otros gestos quirúrgicos según las alteraciones anatómicas del paciente.(AU)

Patellofemoral instability is due to a disorder of the knee extensor mechanism which involves several anatomic structures. Medical history, clinical examination and radiological assessment are essential to determine the right handling. One of the most important anatomic structures is the medial patellofemoral ligament (MPFL), and its reconstruction is the most practiced surgical technique to solve the instability problem. There are different options to carry out the MPFL reconstruction and some other surgical options can be used depending on the anatomic alterations of the patient.(AU)

Luxación vertical de rótula / Vertical patella dislocation / Luxação vertical da patela

RESUMEN Introducción: la luxación de la rótula es el tipo de luxación más frecuente de la rodilla y consiste en que la rótula se desplaza súbitamente hacia el lateral abandonado su posición normal en la zona anterior del fémur otro tipo de luxación es extraordinariamente raro, la misma se reduce fácilmente en la sala de emergencias con manipulaciones gentiles sin necesidad de anestesia en ocasiones el mismo paciente logra llevar la rótula a su lugar. Caso clínico: paciente masculino de 43 años de edad que en el trascurso de un partido de futbol impacta con otro jugador sufriendo trauma en la cara interna de la rodilla izquierda que lo deja tendido en el suelo con dolor intenso. El mismo presentaba bloqueo articular de la rodilla en extensión con imposibilidad para flexionarla, así como deformidad de la misma y ligero edema. Se le diagnostica un raro caso de luxación intrarticular de rótula donde la misma gira 90 grados sobre su eje vertical. Discusión: este caso de luxación intraarticular de rotula rotada en su eje vertical es característico en deportistas, como nuestro paciente, luego de sufrir un trauma severo en la articulación. Casos producidos por un trauma de menor intensidad han sido presentados, pero son extremadamente raros. Conclusiones: la luxación interarticular de rotula es una lesión rara que puede sorprender a cualquier ortopedista por lo que e indispensable realizar un examen físico adecuado y estudios radiológicos previos al tratamiento y así evitar peores consecuencias.

ABSTRACT Introduction: patella dislocation is the most common type of knee dislocation and consists of the patella suddenly moving to the side, leaving its normal position in the anterior area of the femur, another type of dislocation is extremely rare. Reduced easily in the emergency room with gentle manipulations without the need for anesthesia, sometimes the same patient is able to bring the patella into place. Clinical case: 43-year-old male patient who, in the course of a soccer match, impacted another player suffering trauma to the inside of the left knee that left him lying on the floor with intense pain. He presented joint blockage of the knee in extension with inability to flex it, as well as deformity of the knee and slight edema. A rare case of intra-articular dislocation of the patella is diagnosed where the patella rotates 90 degrees on its vertical axis. Discussion: this case of intra-articular dislocation of a patella rotated in its vertical axis is characteristic in athletes, such as our patient, after suffering severe trauma to the joint. Cases produced by a trauma of less intensity have been presented, but they are extremely rare. Conclusions: patellar inter-articular dislocation is a rare lesion that can surprise any orthopedist, so it is essential to carry out an adequate physical examination and radiological studies prior to treatment in order to avoid worse consequences.

RESUMO Introdução: a luxação da patela é o tipo mais comum de luxação do joelho e consiste na movimentação repentina da patela para o lado, deixando sua posição normal na região anterior do fêmur, outro tipo de luxação extremamente rara. reduzido facilmente na sala de emergência com manipulações suaves sem a necessidade de anestesia, às vezes o mesmo paciente é capaz de colocar a patela no lugar. Caso clínico: paciente do sexo masculino, 43 anos, que, durante uma partida de futebol, impactou outro jogador com traumatismo na parte interna do joelho esquerdo que o deixou caído no chão com fortes dores. Apresentava bloqueio articular do joelho em extensão com impossibilidade de flexioná-lo, além de deformidade do joelho e leve edema. Um caso raro de luxação intra-articular da patela é diagnosticado quando a patela gira 90 graus em seu eixo vertical. Discussão: este caso de luxação intra-articular de uma patela girada em seu eixo vertical é característico de atletas, como o nosso paciente, após sofrerem traumatismo articular grave. Foram apresentados casos produzidos por trauma de menor intensidade, mas são extremamente raros. Conclusões: a luxação interarticular patelar é uma lesão rara que pode surpreender qualquer ortopedista, sendo imprescindível a realização de exame físico e estudos radiológicos adequados antes do tratamento para evitar consequências piores.

Acute oral toxicity and anti-inflammatory evaluation of methanolic extract of Rotula aquatica roots in Wistar rats.

BACKGROUND: The plant Rotula aquatica Lour. was traditionally well known due to its large number of pharmacological action and medicinal uses. The plant is a necessary component of many Ayurvedic drug preparations since historical times. It is widely used as a crucial ancient drug for kidney and bladder stones. OBJECTIVES: The main objective of the study was to evaluate the acute toxicity and anti inflammatory efficacy of methanolic extract of R.aquatica Lour. in in vivo models. MATERIALS AND METHODS: The qualitative phytochemical analysis and invitro antioxidant activity of the roots of methanolic extract of R.aquatica Lour. (MERA) was evaluated. The acute toxicity effect of MERA was evaluated with two different doses (550, 2000 mg/kg body weight), were administrated orally to Wistar rats. The rats were observed for sign and symptoms of toxicity and mortality for 14 days. The parameters measured including relative organ weight, blood, biochemical and histopathological parameters of hepatic and renal toxicity. The anti-inflammatory effect of MERA was also evaluated in carrageenan and dextran-induced paw edema models. RESULTS: The phytochemical evaluation of MERA shows the presence of secondary metabolites like alkaloids, flavonoids, phenolics and tannins, phytosterols, reducing sugars, proteins and terpenoids. The results of in-vitro antioxidant evaluation of MERA reveal its capability to scavenging free radical at a lower concentration. The MERA did not show any visible signs of toxicity up to the dose of 2000 mg/kg body weight. The results obtained from our carrageenan and dextran-induced paw edema model study also proved the anti-inflammatory effect of MERA in rat model. CONCLUSION: The result shows the potential of MERA as an anti-inflammatory drug to reduce the signs of inflammation devoid of any toxic effect.

Rotula aquatica Lour. inhibits growth and biofilm formation of clinically isolated uropathogenic Escherichia coli

Objective: To evaluate the anti-bacteria! and anti-biofilm activity of ethyl acetate fraction of Rotula aquatica Lour. (EFRA) against clinically isolated uropathogenic Escherichia coli. Methods: In vitro antibacterial and anti-biofilm studies were employed. The antimicrobial activity of EFRA was assayed by the well diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the active fraction were determined by Resazurin method. The time-kill kinetic assay, acridine orange-ethidium bromide staining, propidium iodide uptake assay, and scanning electron microscopic (SEM) analysis were done to evaluate the efficacy of EFRA in killing uropathogenic Escherichia coli. The anti-biofilm activity was determined by 3-[4,5- dimethyl-2-thiazolyl]-2, 5-diphenyl-2H-tetrazolium-bromide (MTT) assay and specific biofilm formation assay. Results: The well diffusion assay of EFRA showed a very clear zone of inhibition against Escherichia coli BRL-17. The MIC and MBC of EFRA were 2.5 mg/mL and 5 mg/mL, respectively. The time-kill kinetic assay, fluorescence microscopic analysis, propidium iodide uptake assay, and SEM analysis displayed the effect of EFRA in killing the bacteria. The MTT assay and specific biofilm formation assay showed that EFRA prevented the formation of biofilms. Conclusions: The results of the present study confirm that EFRA could prevent bacterial growth and inhibit its biofilm formation.

Rotula aquatica Lour. inhibits growth and biofilm formation of clinically isolated uropathogenic Escherichia coli

Objective: To evaluate the anti-bacterial and anti-biofilm activity of ethyl acetate fraction of Rotula aquatica Lour. (EFRA) against clinically isolated uropathogenic Escherichia coli. Methods: In vitro antibacterial and anti-biofilm studies were employed. The antimicrobial activity of EFRA was assayed by the well diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the active fraction were determined by Resazurin method. The time-kill kinetic assay, acridine orange-ethidium bromide staining, propidium iodide uptake assay, and scanning electron microscopic (SEM) analysis were done to evaluate the efficacy of EFRA in killing uropathogenic Escherichia coli. The anti-biofilm activity was determined by 3-[4,5-dimethyl-2-thiazolyl]-2, 5-diphenyl-2H-tetrazolium-bromide (MTT) assay and specific biofilm formation assay. Results: The well diffusion assay of EFRA showed a very clear zone of inhibition against Escherichia coli BRL-17. The MIC and MBC of EFRA were 2.5 mg/mL and 5 mg/mL, respectively. The time-kill kinetic assay, fluorescence microscopic analysis, propidium iodide uptake assay, and SEM analysis displayed the effect of EFRA in killing the bacteria. The MTT assay and specific biofilm formation assay showed that EFRA prevented the formation of biofilms. Conclusions: The results of the present study confirm that EFRA could prevent bacterial growth and inhibit its biofilm formation.

Análise de rótulos de fórmulas lácteas infantis / Analysis of Labels of Children's Dairy Formulas

Objetivo: O presente estudo teve por finalidade analisar os rótulos de fórmulas lácteas infantis comercializados em um município do Estado do Maranhão. Metodologia: Trata-se de um estudo transversal, descritivo exploratório de abordagem quantitativa. As amostras foram definidas com base na RDC nº. 222/02, incluindo três grupos de interesse: Fórmulas infantis para lactentes; Fórmulas infantis de seguimento para lactentes e crianças de primeira infância e Fórmula infantil para neces-sidades dietoterápicas específicas. Resultados: No final da coleta encontrou-se 44 produtos, onde nenhuma das fórmulas lácteas analisadas conseguiu 100% de adequação. De maneira geral, a rotulagem de alimentos embalados atendeu ao que é designado na legislação na maioria dos parâmetros avaliados, onde as informações contidas nos rótulos desses produtos estavam adequadas, no entanto, quanto a RDC nº. 222/01, 29,5% dos produtos, apresentaram irregularidades. Ocorreu grande inadequação quanto aos micronutrientes, onde a maior irregularidade foi referente ao ácido pantotênico (81,7%). Os re-sultados demonstram maior atenção das indústrias de alimentos destinados a lactentes e crianças de primeira infância, quanto aos requisitos exigidos pelas normas de rotulagem geral do que com relação às legislações específicas. Conclusão: Diante do exposto, conclui-se que os objetivos do presente estudo foram alcançados com êxito, onde todos os produtos apresentavam irregularidades frente a legislação. (AU)

Objective: The purpose of this study was to analyze labels of infant formula sold in a municipality in the state of Maranhão. Methodology: This is a cross-sectional, exploratory descriptive study with a quantitative approach. Samples were defined on the basis of RDC No. 222/02, including three interest groups: infant formulas for infants; Infant follow-up formulas for infants and toddlers and Infant formula for specific dietary needs. Results: At the end of the collection, 44 products were found, where none of the analyzed milk formulas achieved 100% adequacy. In general, the labeling of packaged foods met what is designated in the legislation in most of the parameters evaluated, where the information contained in the labels of these products were adequate, however, for RDC nº 222/01, 29.5% of the products, presented irregularities. There was great inadequacy regarding micronutrients, where the greatest irregularity was related to pantothenic acid (81.7%). The results show greater attention from the food industries for infants and young children regarding the requirements of general labeling rules than specific legislation. Conclusion: In view of the above, it is concluded that the objectives of the present study were suc-cessfully achieved, where all products presented irregularities against the legislation. (AU)

Simplified technique for passing the wire in a single time for the treatment of multifragmentary patella fractures / Técnica simplificada para pasar el alambre en una sola vez para el tratamiento de fracturas multifragmentadas de rótula

Abstract: Objective: To compare the efficacy and safety of prescription pattern in treatment of multifragmentary patellar fractures in a trauma reference center. Material and methods: We conducted a cross-sectional study of patient's record with multifragmentary patellar fractures from December 2010 to December 2013, comparing treatments that include tension band wire, simple cerclage, double cerclage to bone-tendon junction and conservative treatment. Results: With a total of 92 patients, including 60 women (65.21%) and 32 men (34.78%), with an average age of 61 years. In the double cerclage, surgery time was shorter (average 38 minutes), and the range of motion showed improvement since the first month. Minor complications were observed in patients treated conservatively (arthrofibrosis). Conclusions: At our institution, the most efficient method was the double cerclage to the bone-tendon junction presenting shorter duration of surgery, less ischemic time and faster recovery with range of motion close to normal since the first month after surgery (p = 0.000). The safest method of treatment was conservative treatment, with fewer cases with complications (p = 0.184).

Resumen: Objetivo: Comparar la eficacia y seguridad del patrón de prescripción en el tratamiento de las fracturas patelares multifragmentarias en un centro de referencia de trauma. Material y métodos: Realizamos un estudio seccionado transversalmente de expedientes de pacientes con fracturas patelares multifragmentarias de Diciembre del 2010 a Diciembre del 2013, comparando los tratamientos que incluyen obenque, cerclaje simple, cerclaje doble y tratamiento no quirúrgico. Resultados: Se analizaron 92 pacientes, incluyendo 60 mujeres (65.21%) y 32 hombres (34.78%), con edad promedio de 61 años. En el cerclaje doble, el tiempo de la cirugía fue más corto (promedio 38 minutos), y la gama del movimiento demostró mejora desde el primer mes. Las complicaciones de menor importancia fueron observadas en los pacientes tratados no quirúrgicamente (artrofibrosis). Conclusiones: En nuestra institución, el método más eficiente fue el cerclaje doble a la unión hueso-tendón que presenta una duración más corta de la cirugía, menos tiempo de isquemia y recuperación más rápida con la gama del movimiento cerca de lo normal desde el primer mes después de la cirugía (p = 0.000). El método de tratamiento más seguro fue el tratamiento conservador, con menos casos con complicaciones (p = 0.184).

Protective effect of Rotula aquatica Lour against gentamicin induced oxidative stress and nephrotoxicity in Wistar rats.

Gentamicin is an aminoglycoside antibiotic widely used for the treatment of life-threatening infections caused by Gram-negative bacteria. The use of gentamicin was limited due to its ototoxic and nephrotoxic adverse effects. The current study was designed to evaluate the protective effect of ethyl acetate fraction from Rotula aquatica (EFRA) against gentamicin induced nephrotoxicity. The antioxidant enzymes status, lipid peroxidation, nitrate and ROS level, serum markers like creatinine, Urea, BUN were estimated in the present study. The histopathological analysis of renal tissues was done by H&E and PAS staining. The mRNA level expression of KIM-1, NF-κB, TNF- α, and IL-6 were measured by semi-quantitative reverse transcription-polymerase chain reaction. The changes in antioxidant parameters were restored by the treatment of EFRA at different dose (50 mg/kg bwt, 100 mg/kg bwt). The serum parameters, ROS, MDA and nitrate level were decreased by administration of EFRA. The EFRA ameliorates histological changes associated with gentamicin induced nephrotoxicity. The mRNA level expression of KIM-1, NF-κB, TNF- α, and IL-6 were downregulated in EFRA treated groups. The results from present study reveals the role of EFRA as good anti-inflammatory and nephro protective drug.