From FUSE to a hands-on electrosurgery course using a cadaveric model.

INTRODUCTION: Surgical procedures in contemporary practice frequently employ energy-based devices, yet comprehensive education surrounding their safety and effectiveness remains deficient. We propose an innovative course for residents that aims to provide basic electrosurgery knowledge and promote the safe use of these devices. METHODS: We developed a simulated training course for first-year general surgery and orthopedic residents. First, a survey was conducted regarding their knowledge perception about energy devices. The course consisted of two online theoretical sessions, followed by three in-person practical sessions. First-year residents performed three video-recorded attempts using a cadaveric model and were assessed through a digital platform using the Objective Structured Assessment of Technical Skill (OSATS), a Specific Rating Scale (SRS), and a surgical energy-based devices scale (SEBS). Third-year residents were recruited as a control group. RESULTS: The study included 20 first-year residents and 5 third-year residents. First-year residents perceived a knowledge gap regarding energy devices. Regarding practical performance, both OSATS and checklist scores were statistically different between novices at their first attempt and the control group. When we analyzed the novice's performance, we found a significant increase in OSATS (13 vs 21), SRS (13 vs 17.5), and SEBS (5 vs 7) pre- and post-training scores. The amount of feedback referred to skin burns with the electro-scalpel reduced from 18 feedbacks in the first attempt to 2 in the third attempt (p-value = 0.0002). When comparing the final session of novices with the control group, no differences were found in the SRS (p = 0.22) or SEBS (p = 0.97), but differences remained in OSATS (p = 0.017). CONCLUSION: This study supports the implementation of structured education in electrosurgery among surgical trainees. By teaching first-year residents about electrosurgery, they can acquire a skill set equivalent to that of third-year residents. The integration of such courses can mitigate complications associated with energy device misuse, ultimately enhancing patient safety.

[Age of initiation of treatment for hip dysplasia with Pavlik harness and residual dysplasia]. / Edad de inicio del tratamiento de la displasia de caderas con correas de Pavlik y displasia residual.

The successful treatment of hip dysplasia consists of achieving a concentric reduction and avoiding residual dysplasia. One of the essential factors is early diagnosis and treatment. OBJECTIVE: Evaluate the relationship between the age at initiation of hip dysplasia treatment and the presence of residual dysplasia at one year of age. PATIENTS AND METHOD: Prognostic retrospective study. Patients with hip dysplasia treated with Pavlik harness in a tertiary healthcare center were selected. Residual dyspla sia was defined as an acetabular index greater than 28 degrees at one year of age. An association of residual dysplasia with the age at treatment initiation, bilaterality, and acetabular index more than 36 degrees was determined. The T-Student, Chi-Square, and Youden index tests were used. A p- value < 0.05 was considered significant. The STATA v.16 software was used. RESULTS: 153 patients (262 hips) were included, 84.3% (129) were females, and 71.2% (109) presented bilateral dysplasia. Fifty-nine hips (22.52%) presented residual dysplasia, finding a significant association with the age at treatment initiation (p = 0.03), bilateral dysplasia (p < 0.01), and acetabular index greater than 36 degrees (p = 0.01). Starting treatment after 4.5 months increases the risk of residual dysplasia by 2.5 times (95% CI 1.25-5.03). CONCLUSION: An increase in residual dysplasia was observed at the start of treatment after 4.5 months. It is relevant to consider this result in local clinical guidelines to achieve a successful diagnosis and treatment.

Offloader knee braces for knee osteoarthritis. / Uso de órtesis de rodilla con refuerzo en descarga en artrosis de rodilla.

INTRODUCTION: Knee osteoarthritis is a relevant health problem given its high prevalence and associated disability. Within the non-pharmacological management alternatives, the use of offloader knee braces has been proposed, however, there is no consensus in the literature regarding its indication. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 14 systematic reviews including nine studies overall, all of which were randomized trials. We conclude that the use of offloader knee braces in patients with knee osteoarthritis probably increases physical function through walking distance. However, its use may make little or no difference to physical function measured with the Hospital for Special Surgery Knee score, it may slightly worsen the quality of life and increase adverse events, but the certainty of the evidence is low. In addition, we are uncertain whether the use of offloader knee braces reduces pain as the certainty of the evidence has been assessed as very low.

INTRODUCCIÓN: La artrosis de rodilla es una enfermedad degenerativa que constituye un problema de salud relevante dada su alta prevalencia y discapacidad asociada. Dentro de las alternativas de manejo no farmacológico se ha planteado el uso de órtesis de rodilla, sin embargo no existe consenso en la literatura respecto a su utilidad. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 14 revisiones sistemáticas que en conjunto incluyeron nueve estudios primarios, de los cuales, todos corresponden a ensayos aleatorizados. Concluimos que el uso de órtesis de rodilla con refuerzo en descarga en pacientes con artrosis de rodilla probablemente aumenta la funcionalidad medida a través de la distancia caminada. Sin embargo, podría resultar en poca o nula diferencia sobre la funcionalidad evaluada con Hospital for Special Surgery Knee score, podría empeorar levemente la calidad de vida y aumentar los efectos adversos, pero la certeza de la evidencia es baja. Además, no es posible establecer con claridad si el uso de órtesis de rodilla disminuye el dolor dado que la certeza de la evidencia fue evaluada como muy baja.

Relevance of codetection of respiratory viruses in the severity of acute respiratory infection in hospitalized children. / Relevancia de la co-detección de virus respiratorios en la severidad de la infección respiratoria aguda en niños hospitalizados.

INTRODUCTION: Multiplex polymerase chain reaction (PCR) allows simultaneous detection of respiratory viruses, raising questions about their relevance in the clinical feature. OBJECTIVE: To evaluate the contribution of clinical, epidemiological, and virological factors in the clinical course of children hospitalized due to ARI with viral co-detection. PATIENTS AND METHOD: Pediatric patients ≤ 15 years old, hospitalized due to ARI at the UC-CHRISTUS Health Network Clinical Hospital between June and October 2014, and who presented a positive respiratory molecular panel test, were included. Respiratory samples (nasopharyngeal swab, tracheal aspiration, or bronchoalveolar lavage) with positive panel tests by Seeplex® RV15 OneStep ACE Detection Seegene® technique, were analyzed with a second technique (xTAG-RVP-FASTv2 Luminex®, USA), which allows simultaneous and semi-quantitative detection of 17 respiratory viruses. Clinical and epidemiological records were collected. RESULTS: One virus was identified in 42/57 children (74%) and two or more in 15/57 (26%). Intensive care unit (ICU) hospi talization was significantly more frequent in patients with viral co-detection (OR = 5,5; IC 95%: 1,5 19,6). The most frequently detected viruses were rhinovirus/enterovirus (HRV/EV) (29%) and res piratory syncytial virus (RSV) (25%), and the most common co-detection was HRV/EV-RSV (33%). In x-rays, patients with HRV/EV infection presented interstitial images more frequently, while RSV was associated with condensations (p = 0.002). For HRV/EV, median fluorescence intensity (MFI, semi-quantification) were 1788 and 2456 in co-detection and single agent, respectively (p = 0.022). Children with HRV/EV co-detection had a longer hospital stay compared to isolated identification (5 versus 3 days, p = 0,028). CONCLUSION: In children hospitalized due to ARI, viral co-detection is frequent and associated with more ICU hospitalizations. Our study highlights the presence of HRV/ EV in viral co-detection and longer length of stay. More studies are needed to define the relevance of viral co-detection in hospitalized pediatric patients.

Contralateral canes for knee osteoarthritis. / Uso de bastones contralaterales en artrosis de rodilla.

INTRODUCTION: Knee osteoarthritis is a relevant health problem given its high prevalence and associated disability. Within the non-pharmacological management alternatives, the use of canes has been proposed, however, there is no consensus in the literature regarding its indication. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including four studies overall, of which one was randomized trials. We conclude that the use of a contralateral cane in patients with knee osteoarthritis probably reduces pain. In addition, it could slightly increase function, but the certainty of the evidence is low.

INTRODUCCIÓN: La artrosis de rodilla es un problema de salud relevante dada su alta prevalencia y discapacidad asociada. Dentro de las alternativas de manejo no farmacológico se ha planteado el uso de bastones, sin embargo no existe consenso en la literatura respecto a su indicación. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, de los cuales, uno es ensayo aleatorizado. Concluimos que el uso de bastón contralateral en pacientes con artrosis de rodilla probablemente disminuye el dolor. Además, podría aumentar levemente la funcionalidad, pero la certeza de la evidencia es baja.

Resultados a corto plazo del tratamiento de fracturas de cadera en población infantil / Short-term results of the treatment of hip fractures in children

INTRODUCCIÓN Las fracturas del fémur proximal pediátricas son infrecuentes, se asocian a traumas de alta energía, y presentan complicaciones devastadoras. La mayoría de los casos se tratan en forma quirúrgica utilizando diversos tipos de fijación. El objetivo de este estudio es reportar los resultados de una serie de casos de pacientes quirúrgicos en dos hospitales de referencia en Chile. MATERIALES Y MÉTODOS Serie de casos tratados entre el 2004y el 2018, en la que se incluyeron pacientes pediátricos con diagnóstico de fractura de fémur proximal que fueron operados. Se realizó estadística descriptiva de las variables demográficas, la energía del accidente, la clasificación según Delbet, el tipo de tratamiento, la técnica de osteosíntesis, la aparición de complicaciones, y la evaluación clínico-radiológica. RESULTADOS Se evaluaron 17 casos, de los cuales un 76,5% fueron secundarios a accidentes de alta energía. La mediana de edad de la muestra fue de 7 años, y había un 58,8% de niñas. Hubo 3 casos de tipo II en la clasificación de Delbet, 9 de tipo III, y 5 de tipo IV. Como método de fijación, se utilizaron tornillos canulados (9 casos), placa de compresión de bloqueo (locking compression plate, LCP, en inglés; 5 casos), tornillo dinámico de cadera (dynamic hip screw, DHS, en inglés; 2 casos), y placa de compresión dinámica (dynamic compression plate, DCP, en inglés; 1 caso). La mediana de seguimiento fue de 2,3 años (rango: 0,5 a 12,8 años). Se presentaron complicaciones: coxa vara en un caso, y discrepancia de longitud de extremidades inferiores en otro caso, y no hubo osteonecrosis. Se realizó retiro de osteosíntesis en siete pacientes. Se obtuvieron buenos resultados en todos los pacientes según los criterios de Ratliff. CONCLUSIONES La mayoría de las fracturas se asociaron a traumas de alta energía, siendo el tipo más frecuente el III de Delbet. Todos los pacientes fueron tratados en forma quirúrgica, con buenos resultados, sin observar osteonecrosis.

INTRODUCTION Pediatric hip fractures are infrequent, associated with high-energy trauma, and present devastating complications. Most cases are treated surgically using different types of fixation. The objective of the present study is to report the results of a series of cases of surgical patients in two reference hospitals in Chile. MATERIALS AND METHODS A case series which included pediatric patients diagnosed with hip fractures and treated surgically between 2004 and 2008. We performed descriptive statistics for the demographic variables, the energy of the accident, the Delbet classification, the type of treatment, the osteosynthesis technique, of complications, and the clinico-radiological evaluation according to evaluation. RESULTS A total of 17 cases were evaluated, 76.5% of which were secondary to high-energy accidents. The median age of the sample was of 7 years, and it was composed of 58.8% of girls. There were 3 cases of Delbet type II, 9 of type III, and 5 of type IV. As fixation method, we used cannulated screws (9 cases), locking compression plates (LCPs; 5 cases), dynamic hip screws (DHSs; 2 cases), and dynamic compression plates (DCPs; 1 case). The median follow-up was of 2.3 years (range: 0.5 to 12.8 years). Complications were observed: coxa vara in one case, and discrepancy in the length of the lower extremities in another case, and there were no cases of osteonecrosis. Osteosynthesis removal was performed in seven patients. Good results were obtained in all patients according to Ratliff criteria. CONCLUSIONS Most fractures were associated with high energy trauma, with the most frequent being type III on the Delbet classification. All the patients were treated surgically, with good results, with no cases of osteonecrosis.