A comparative study on the functional outcomes of patients who underwent internal versus external fixation for Tibial Plateau fractures two years post-surgery

Introduction@#Tibial plateau fractures are due to high energy trauma brought about by axial compression forces and associated varus or valgus component. @*Objective@#Patients diagnosed with tibial plateau fractures from January to December 2018 treated with internal vs. external fixation will be described according to their Schatzker classification. The study further aims to compare the functional outcomes between the two groups in terms of surgery done. @*Methods@#A chart review determined the distribution of demographics. The Modified Rasmussen Score (MRS) was used to determine the clinical and radiographic parameters after taking a new knee radiograph and assessment from the rehabilitation department. The MRS determined the functional outcomes of the said patients. Ethical considerations and proper informed consent were upheld after being reviewed by the hospital’s research committee. @*Results@#Out of 48 patients, 35 underwent internal fixation via open reduction using plates and/or screws, while 13 underwent external fixation using hybrid external fixator. The demographic profile showed mostly males between ages 20 to 49 years old. Most cases were due to vehicular accidents affecting the left lower extremity. In terms of Schatzker classification, the most common was type VI. The computed mean MRS of the internal fixation group was 30.43 while the external fixation group was 30.00, generally showing no significant difference. @*Conclusion@#Surgical intervention of tibial plateau fractures aims for anatomic reduction using internal or external fixation. There was no significant difference on the functional outcome of the two groups despite classifying the respondents according to Schatzker type, hence we can conclude that external fixation be chosen as the treatment of choice for tibial plateau fractures when properly indicated.

Caracterización físico-química y actividad antimicrobiana de la secreción mucosa de Achatina fulica / Mother-infant bonding disorders: prevalence, risk factors, diagnostic criteria and assessment strategies

Introducción: El caracol gigante africano Achatina fulica es reconocido como una plaga que afecta la biodiversidad, la Salud Pública y la productividad. Sin embargo, se ha demostrado que su secreción mucosa tiene propiedades cosméticas, cicatrizantes y antimicrobianas. Objetivo: Determinar las características físico-químicas y evaluar la actividad antimicrobiana de la secreción mucosa de Achatina fulica. Metodología: Se hicieron pruebas bioquímicas para la determinación cualitativa y cuantitativa de glúcidos, proteínas y lípidos. Se determinó el contenido de Calcio, Potasio, cloruros, Sodio y Magnesio. Se midieron los parámetros de conductividad eléctrica, potencial óxido-reducción, saturación de oxígeno, oxígeno total disuelto, pH, sólidos disueltos totales. Se realizó un ensayo de actividad antibacteriana por la técnica de microdilución en caldo. Resultados: Se encontraron glúcidos en concentraciones de 582 μg/mL en la fracción soluble y de 62.1 μg/mL en la fracción de mucinas, y proteínas en concentraciones de 836 μg/mL en la fracción soluble y de 1413 μg/mL en la fracción de mucinas. Se observó actividad antimicrobiana frente a las tres cepas ensayadas. Streptococcus agalactiae alcanzó un MIC90 a una concentración de 3,6 mg/mL con la fracción de mucinas; Staphylococcus aureus resistente a meticilina tuvo un MIC50 de 3,3 mg/mL y Escherichia coli un MIC 70 de 3.8 mg/mL. Conclusiones: Se reportan por primera vez las características físicas y los oligoelementos presente en la secreción de Achatina fulica. La actividad antibacteriana obtenida frente a cepas Gram positivas y Gram negativas plantea la necesidad de realizar estudios para purificar las moléculas con dicha actividad, conocer los mecanismos de acción y establecer la inocuidad, entre otros.

Introduction: The giant African snail Achatina fulica is recognized as a scourge affecting biodiversity, public health and productivity. However, it has been shown that the mucus has cosmetic, healing and antimicrobial properties. Objective: Determine physico-chemical characteristics and evaluate the antimicrobial activity of the mucus. Methodology: Qualitative and quantitative determinations of carbohydrates, proteins and lipids were made by biochemical tests. Using multiparameter meter parameters of electrical conductivity, redox potential, oxygen saturation, the total dissolved oxygen, pH, total dissolved solids were measured. Content of Calcium, Potassium, chloride, Sodium and Magnesium was determined. Antibacterial activity assay was performed by broth microdilution method against Gram positive and Gram negative bacteria. Results: Carbohydrates were found in concentrations of 582 μg/mL in soluble fraction and 62.1 μg/mL in mucin fraction, and protein concentration of 836 μg/mL in the soluble fraction and 1413 μg/mL in mucin fraction. Antimicrobial activity was demonstrated against the three strains tested. Streptococcus agalactiae reached MIC90 at a concentration of 3.6 μg/mL with mucin fraction; Methicillin-Resistant Staphylococcus aureus had a MIC50 of 3.3 mg / mL and Escherichia coli had a MIC70 of 3.8 mg / mL. Conclusions: This is the first report of the physical and trace elements in the secretion of Achatina fulica. The antibacterial activity obtained against Gram positive and Gram negative strains raises the need for studies to purify the molecules with such activity, understanding the mechanisms of action and establish the safety, among others.

Síndrome antisintetasa / Antisynthetase syndrome

El Síndrome Antisintetasa, es una enfermedad poco frecuente perteneciente al grupo de las miopatías inflamatorias de origen inmunológico. Su caracterización inmunológica es muy variable y de allí las distintas manifestaciones clínicas de su presentación y su difícil diagnóstico. Se presenta un paciente femenino de 42 años de edad, con diagnóstico de Artritis Reumatoide (AR), con 9/10 puntos por puntaje para AR por EULAR 2011, anti-CCP +, RF -, desde octubre de 2011, en tratamiento con Prednisona y Metotrexate. Acude en febrero de 2012 por presentar disnea progresiva y tos con expectoración verdosa. Recibe antibioticoterapia sin respuesta. Se realiza TC de Tórax dónde se evidencia fibrosis pulmonar y bronquiectasias por tracción, con imágenes en panal de abeja a predominio de segmentos inferiores y posteriores. Durante su estancia hospitalaria presenta debilidad muscular proximal con elevación de CK a 4.969 U/L. , se realiza biopsia de músculo, que reporta miopatía inflamatoria; electromiografía, con patrón característico de miopatía inflamatoria y perfil inmunológico, obteniéndose Anti-Jo1 positivo, 0,885 (Negativo < 0,250). En el contexto de un síndrome poliarticular inflamatorio, una enfermedad pulmonar intersticial y una miopatía inflamatoria proximal con Anti Jo-1 (+); se realiza diagnóstico definitivo de Síndrome Antisintetasa.

This is a rare disease, member of the inflammatory myopathies of immunological origin. It has a very variable immunologic profile which makes the diagnosis difficult. We present a female patient 42 years- old, with the diagnosis of Rheumatoid Arthritis (RA), with 9/10 points of EULAR 2011 Score for RA diagnosis and RF -, Anti CCP +, in October of 2011; her treatment at that time was prednisone and methotrexate. In February of 2012, she consulted to the emergency with dyspnea and productive cough. She received antibiotics with no response. The chest Computerized Tomography evidenced pulmonary fibrosis, traction bronchiectasis and honeycombe images in posterior and inferior segments of both lungs. During her hospitalization, she presented proximal muscular weakness with CK elevation to 4.969 U/L. The muscle biopsy, which concluded inflammatory myopathy, the electromyography had the characteristic pattern of inflammatory myopathy and the immunologic profile, with a positive Anti-Jo1 0,885 (Negative <0,250). In the context of a polyarticular syndrome, an interstitial lung disease and a proximal inflammatory myopathy with a positive Anti-Jo1, we made the final diagnosis of Antisynthetase syndrome.

Osteoporosis del embarazo y la lactancia / Osteoporosis during pregnancy and lactation

Durante el embarazo y la lactancia la mujer debe formar y mantener el esqueleto del feto y del neonato, lo que demanda importantes adaptaciones hormonales y metabólicas. La absorción intestinal de calcio aumenta desde el inicio del embarazo siendo máxima en los últimos trimestres. Se produceuna hipercalciuria que desaparece al suspender la lactancia. El calcio de la leche proviene de la reducción ensu excreción urinaria y de un aumento de la resorción ósea. Las oncentraciones de 1,25 (OH)(2) D(3) se duplican desde el comienzo del embarazo manteniéndose elevadas hasta el parto, debido a un aumento de la actividad de la 1-alfa-hidroxilasa placentaria, normalizándose durante la lactancia. Los estrógenos, prolactina y lactógeno placentario, hormonas implicadas en el aumento de la absorción intestinal de calcio, aumentan conjuntamente.La parathormona (PTH) se mantiene en rango normal o bajo, por lo tanto sus acciones fisiológicas serían ejercidas por el péptido relacionado con la PTH (PTHrP), cuyos niveles aumentan tardíamente en el embarazo y permanecen elevados durante el parto y la lactancia. La calcitonina se eleva durante el embarazo, cae durante la lactancia, y se normaliza al finalizar la misma. El papel fisiológico del factor de necrosis tumoral, interleuquina 1, interleuquina 6 y osteoprotegerina todavía no han sido aclarados. Los cambios analizados favorecen,en casos excepcionales, el desarrollo de osteoporosis generalizada y regional. El objetivo de este trabajo es revisar la bibliografía publicada sobre la fisiopatología y clínica de estas entidades.

During pregnancy and lactation women have to form and maintain fetus and newborn skeleton. These processes require maternal hormonal and metabolic adjustments. During the first weeks of pregnancy, calcium intestinal absorption rise and reach a maximum in the last trimester. Hypercalciuria can be detected until lactation is stopped. During lactation, calcium that is present in maternal milk, results from lowering maternal calcium excretion and increasing bone resorption. Plasma 1,25 (OH)(2) D(3) levels increase two-fold early in pregnancy due to high placental 1-alpha-hydroxilase activity, remain high until delivery and decline to normal values during lactation. Estrogen, prolactin and placental lactogen, which are involved in calcium absorption, increase at the same time. Normal or even low levels of parathyroid hormone (PTH) can be detected during pregnancy. This suggests that their physiological actions could be mimicked by the parathyroid- related-peptide (PTHrP), which increases in late stages of pregnancy and remain high during delivery and lactation. Calcitonin levels increase during pregnancy, decline during lactation and return to normal values after lactation is stopped. The physiological roll of tumor necrosis factor, interleukin 6 and osteoprotegerin has not been elucidated yet. The above mentioned changes can exceptionally lead to generalized or regional osteoporosis. The aim of this article is to review the published bibliography concerning the physiopathology of these diseases.

Osteoporosis del embarazo y la lactancia. Estudio de 8 casos / Osteoporosis during pregnancy and lactation. Report of eight cases

Tanto la osteoporosis generalizada como la regional son enfermedades que excepcionalmente seasocian con el embarazo. El objetivo de este trabajo es revisar nuestra experiencia en el diagnósticoy tratamiento de estas afecciones. Entre 1984 y 2004 consultaron seis puérperas por osteoporosis y dospor osteoporosis regional. En el primer grupo tres pacientes refirieron fracturas vertebrales y las restantes gravedesmineralización detectada por densitometría ósea (DEXA). Los síntomas comenzaron en el tercer trimestre o en el posparto inmediato. Cinco eran primíparas mientras que una era multípara y había amamantado porun tiempo prolongado. Los factores de riesgo detectados fueron: baja ingesta láctea, delgadez, osteoporosisfamiliar, amenorreas, tabaquismo y corticoterapia. El laboratorio mostró recambio óseo acelerado. La DEXAdocumentó marcada desmineralización especialmente en esqueleto axial. En todas se interrumpió la lactanciay se indicaron drogas anti-resortivas en cuatro, estrógenos en una y sólo calcio y vitamina D en otra. Todas, menos una, evolucionaron favorablemente independientemente del tratamiento utilizado. Dos pacientes consultaronpor dolor y limitación funcional progresiva durante el embarazo, en cadera izquierda y pie derecho respectivamente. La DEXA mostró desmineralización del lado afectado. El diagnóstico de osteoporosis regionalse confirmó por resonancia magnética nuclear. Los informes de laboratorio indicaron aumento del turnover óseo.Ambas fueron tratadas exitosamente con reposo y bifosfonatos.

Both generalized and regional osteoporosis exceptionally occur during pregnancy and lactation. The aim of this paper is to show our experience in the diagnosis and treatment of these diseases. From 1984 to 2004 six lactating women with osteoporosis and two with regional osteoporosis consulted us. In the former group, three patients had vertebral fractures and the others experienced substantial demineralization detected by dual-energy X-ray absorptiometry (DXA). In all cases, symptoms began during the third trimester of pregnancy or immediately after delivery. Five of them were primiparous and one was multiparous with a long period of lactation. Risk factors were: low calcium intake, low weight, family history of osteoporosis, amenorrhea, cigarette consumption and corticosteroid therapy. Laboratory tests evidenced increased bone turnover. DXA scan showed substantial demineralization, particularly in axial skeleton. Lactation was interrupted in all women and four received anti-resorptive drugs, one estrogen and only calcium plus vitamin D the remaining. All of them, but one, evolved successfully. The women affected by regional osteoporosis complained of unilateral pain and progressive functional limitation of right foot and left hip respectively. Reduced bone mineral density at symptomatic sites was seen by DXA. Diagnosis was confirmed by typical magnetic resonance imaging pattern. Both patients cured with rest and bisphosfonates treatment.

Gastric carcimona: A 7-year experience at the Davao Medical Center

This restrospective study reviewed 60 cases of histologically documented gastric cancer admitted at the Davao Medical Center. There were 39 (65%) males and 21 (35%) females. Epigastric pain and pallor were the most common initial complaints and findings on admission. Sixty per cent of the patients presented as acid peptic disease and only 40 per cent were correctly diagnosed upon admission. Diagnosis was verified by endoscopy with biopsy in 68.3 per cent of cases. Forty two per cent of the lesions were found at the antrum and 32 per cent were noted in the proximal stomach. Using the TNM staging, 92 per cent had stage III and IV tumor and only 8 per cent were stage II. Most patients underwent palliative surgery (73.3%) with resections for cure limited to 23.3 per cent. Ninety nine per cent were adenocarcinoma, confirmed histopathologically. The associated perioperative complications were noted, with morbidity and mortality rates at 26.67 and 5 per cent, respectively. (Author)

Aspects epidemiologiques du paludisme dans la ville de Kumba (Cameroun-Province du Sud Ouest)

L'enquete paludometrique effectuee en fin de saison des pluies en octobre 1987 a Kumba; ville du Sud Ouest du Cameroun; a partir d'un echantillon de 804 sujets etabli montre la frequence des acces febriles et des automedications inadequates pratiquees. Elle apprecie le retentissement du paludisme sur la morbidite et la mortalite dans cette region forestiere. Plasmodium falciparum est l'hematozoaire le plus frequent; present sur 26;1 pour cent des lames examinees et responsable de 97;7 pour cent des infestations

Las inmunoprevenibles PAI en Colombia: comportamiento 1981-1986 perspectivas 1987-1990 / The immunopreventible diseases (IPM) in Colombia: behavior 1981-1986 perspectives 1987-1990

Despues de todo lo estudiado, sin lugar a falacias, se puede afirmar categoricamente que entre 1981 y 1986, se ha sucedido en Colombia un sorprendente descenso en las incidencias de las inmunoprevenibles PAI. De otra parte, hay logicamente, una evidente correlacion entre el incremento paulatino de las coberturas y el descenso de las frecuencias, a tal punto, que es muy posible que las coberturas calculadas puedan estar por debajo de las reales. Esto se puede afirmar en virtud de la clara evidencia epidemiologica dada por el comportamiento de las enfermedades.