Phototherapy Induces an Improvement in Clinical and Biochemical Scores in Patients with Rheumatoid Arthritis

ABSTRACT Objective: Rheumatoid arthritis (RA) is a common autoimmune disease for which there is no known cure. Ultraviolet light can induce immunosuppressive effects. Our main objective was to ascertain whether a complementary treatment with phototherapy would improve changes in functional scales in patients with RA. Methods: Seven women with RA were enrolled for this study and submitted to phototherapy sessions with a 425-650 nm lamp. Results: The Karnofsky scale changed from requiring frequent medical care to being capable of normal activity with few symptoms or signs of disease (p = 0.018), the rheumatoid arthritis-specific quality of life questionnaire decreased abruptly from 29 to 0 points (p = 0.018), the Steinbrocker functional capacity rating changed from limited to little or none of the duties of usual occupation or self-care to complete ability to carry out all the usual duties without handicaps (p = 0.017). The pain was remitted after the treatment period. The acute inflammation variables showed a significant decrease after the indicated sessions, C-reactive protein (p = 0.042) and erythrocyte sedimentation rate (p = 0.018). Conclusion: The evaluated scales clearly show a benefit with the phototherapy in patients with RA. Thus, phototherapy seems to be a plausible complementary option to reduce the symptoms of RA.

Complications in pregnant women with autoimmune diseases

BACKGROUND: Autoimmune diseases complicate pregnancy in several manners. This study aimed at describing the most common complications in pregnant women with autoimmune diseases. METHODS: This was a descriptive and retrospective study. Two groups of pregnant women with autoimmune diseases were included: 1) Those who since the beginning of gestation received obstetrical care at a tertiary-level hospital and 2) Women who were treated first in a medical unit not specialized in rheumatological diseases. Odds ratio, logistic regression and multinomial logistic regression were used to determine risk of complicated pregnancy. RESULTS: The distribution of autoimmune diseases in our sample is as follows: systemic lupus erythematosus (SLE): 6, rheumatoid arthritis (RA): 4, primary anti-phospholipid syndrome (APS): 4, systemic sclerosis (SS): 2, mixed connective tissue disease (MCTD): 1. Eight patients were seen throughout their gestation at a tertiary-level hospital and nine were referred from other non-specialized hospitals. Patients in the first group had four complications, and those of the second group, 28. The Odds Ratio (OR) of having a complication in the hospitals of reference compared to the "Mónica Pretelini Sáenz" Maternal-Perinatal Hospital (HMPMPS) was of 29.8 (95% CI: 1.29-692.46; Z statistic 2.11, p = 0.03). In relation to the logistic regression, this test was not significant neither for the group nor the treatment scheme for the presence of at least one complication. The multinomial logistic regression did not show significant predictive probabilities of the different possible outcomes for the group and drug treatment scheme. CONCLUSION: Pregnant women with autoimmune diseases can have an OR up to 29.8 to develop complications when they are not cared for by specialized personnel

Lesiones intraarticulares asociadas a la fijación tibial en la reconstrucción del ligamento cruzado anterior / Intraarticular lesions associated to a tibial fixation device in anterior cruciate ligament reconstruction

Resumen: La reconstrucción del ligamento cruzado anterior es un procedimiento exigente; las complicaciones pueden presentarse en cualquiera de sus etapas. Presentamos tres casos en los cuales los dispositivos para la fijación tibial (IntraFix y Bio-IntraFix) condicionaron lesiones intraarticulares. Las complicaciones fueron detectadas, en uno de los casos, mientras el paciente se encontraba aún en la sala de operaciones, y en los otros dos, durante el seguimiento. Todos los pacientes contaban con una rodilla estable, pero tuvieron lesiones condrales causadas por la inadecuada colocación de los implantes para la fijación tibial. Se exponen algunas sugerencias para evitar complicaciones con estos dispositivos.

Abstract: Anterior cruciate ligament reconstruction is a demanding procedure; complications may arise at any of its stages. This is the report of three cases in which the tibial fixation devices (IntraFix and Bio-IntraFix) led to intraarticular lesions. The complications were detected in one of the cases while the patient was still in the operating room and in the remaining two during the follow-up. All the patients had a stable knee, but all of them sustained chondral lesions resulting from the inadequate placement of the implants used for tibial fixation. Several suggestions to avoid the complications stemming from these devices are provided.

Reemplazo femoral total, reporte de tres casos con revisión de la literatura / Total femoral replacement. Three case reports and literature review

Introducción: En la actualidad, la cirugía de recambio articular de cadera y rodilla es un procedimiento común en centros ortopédicos. Sin embargo, sabemos que este tipo de cirugía tiene vigencia y requiere procedimientos de revisión. Estos últimos generalmente conllevan complicaciones importantes como la pérdida de hueso que puede llegar a comprometer la estabilidad de los implantes. Métodos: Se realizaron tres revisiones de artroplastía tanto de cadera como de rodilla que han requerido el reemplazo total del fémur y de las articulaciones involucradas en el período comprendido del 2006 al 2011. El objetivo del presente trabajo es presentar la experiencia con estos implantes en cirugía de revisión de artroplastía. Resultados: El protocolo de manejo del postoperatorio fue estandarizado para todos y cada uno de los pacientes, requirieron manejo mediante desbridamientos y antibioticoterapia específica. Evidenciaron mejora significativa en el puntaje de la escala visual análoga del dolor (8-2.3 puntos p < 0.05) y funcional con la escala de valoración de WOMAC (21.6 preoperatorio a 55 puntos p < 0.05). Conclusiones: El reemplazo femoral total es un procedimiento quirúrgico de salvamento poco frecuente, demandante y complejo, que representa una alternativa ante la desarticulación de la extremidad pélvica en la etapa final de la enfermedad protésica. Se trata de una opción factible de realizar para mejorar la funcionalidad del paciente y disminuir la discapacidad residual para la realización de actividades de manera independiente.

Introduction: Currently hip and knee joint replacement were performed frequently at orthopedic centers. However, these surgeries do not last forever and thus revision procedures are required. The latter usually involve complications like bone loss that may compromise implant stability. Methods: Three hip and knee arthroplasty revisions were performed from 2006 to 2011, which warranted the total replacement of the femur and the joints involved. The purpose of this paper is to describe our experience with these implants used in arthroplasty revision surgery. Results: A standardized postoperative management protocol was used in all patients. They required debridement and specific antibiotic therapy. They had a significant improvement in the pain visual analog scale (VAS) (the score went from 8 to 2.3, p < 0.05) and in function, measured with the WOMAC score (from a preoperative score of 21.6 to 55, p < 0.05). Conclusions: Total femoral replacement is an infrequent, demanding and complex salvage surgery that represents an alternative to the disarticulation of the pelvic limb at the end stage of prosthetic disease. This is a feasible option used to improve patient functionality and decrease residual capacity for performing activities independently.

"Estilos de vida en adolescentes de nivel medio superior de una comunidad semiurbana" / "Lifestyles in teen top-middle level of a semi-urban comunity"

Se propuso identificar los estilos de vida en adolescentes de una comunidad semiurbana, buscando respuesta a la pregunta: ¿Cuáles son los factores que se identifican en el instrumento Fantastic, en los estudiantes de la comunidad de Ixtlahuaca? Se trabajó con la variable de estilos de vida, ocupando el instrumento FANTASTIC. La muestra la conforman 1088 estudiantes, 603 hombres y 485 mujeres. La religión de mayor prevalencia es la católica con 844. Del instrumento se obtuvo una fiabilidad de .79, con 6 factores identificados: sentimientos negativos y estrés, satisfacción y pensamiento positivo, alimentación dañina, relajación y sueño, alcohol y tabaco, cafeína. Se concluye que se requiere manejo de hábitos saludables, prevención de adicciones y alimentación.

The proposal was to identify lifestyles among adolescents in a semi-urban community, seeking answers to the question: What are the factors that are identified in the Fantastic instrument in students Ixtlahuaca community? We worked with the lifestyle variable, holding the instrument FANTASTIC. The sample is formed by 1088 students, 603 men and 485 women. The most prevalent religion is Catholic with 844. The instrument yielded a reliability of .79, with 6 factors identified: negative feelings and stress, satisfaction and positive thinking, harmful food, relaxation and sleep, alcohol and snuff, caffeine. It is concluded that it is required management of healthy habits, addictions and alimentation prevention.

Cátedra de clínica y terapéutica quirúrgica "C" del Hospital Universitario de Caracas. Escuela "Luis Razetti". Facultad de Medicina UCV génesis: desarrollo histórico y actualidad: parte II / Department of clinical and surgical therapeutics \"C\" Hospital Universitario de Caracas, Escuela Luis Razetti UCV Facultad de Medicina genesis: historical development and current: part II

Se presenta la segunda parte del Desarrollo Histórico de la Cátedra de Clínica y Terapéutica Quirúrgica “C” – Servicio de Cirugía III del Hospital Universitario de Caracas. Período que transcurre desde el Dr. Juan Godayol Rovira en el año 1969 hasta el Dr. Humberto Chacón Valecillos en el año 2011. Se describe una síntesis curricular de los aportes más importantes a la Cátedra de Clínica y Terapéutica Quirúrgica “C” – Servicio de Cirugía III en los ámbitos: Docente, Asistencial y de Investigación, aplicados al campo de la Cirugía General y Oncológica de todos estos docentes que han formado parte de ella

It then presents the second part of the Historical Development of the Department of the Chair of Clinical and Surgical Therapeutics “C” - Department of Surgery III of the Hospital University of Caracas. Time that elapses from Dr. Juan Godayol Rovira in 1969 to Dr. Humberto Chacon Valecillos in 2011. There are described a curriculum summary of the most important contributions to the Chair of Clinical and Surgical Therapeutics “C”- Department of Surgery III in the areas: Teaching, Care and Research, applied to the field of General Surgery and Oncology of these teachers that have been part of it

Características del adulto mayor que acepta ser vacunado contra la influenza en San Luis Tlaxialtemalco-2004 / Characteristics of the older adult who accepts being vaccinated against influenza in San Luis Tlaxialtemalco 2004

La influenza es una enfermedad aguda viral en las vías respiratorias altas capaz de provocar complicaciones potencialmente letales en pacientes ancianos. La vacunación anual es la intervención de salud más importante para reducir el impacto de la influenza. Existen diversos factores que influyen para la aceptación o rechazo de la aplicación de la vacuna. EI propósito de este estudio fue determinar las características de la población que acepta la vacuna de la influenza e identificar grupos de población que presentan riesgo, especialmente de no vacunarse en la comunidad de San Luis Tlaxialtemalco. EI estudio fue descriptivo y transversal. Con una muestra no probabilística y conformada por 48 personas de 60 y más años de edad. Se aplicó una encuesta estructurada de 25 preguntas y diferentes escalas. En cuanto a los resultados, el 84.48% aceptó la aplicación de la vacuna de la influenza. EI 81 .3% desconoce la enfermedad de la influenza, el 77.1 % cree que la influenza es grave, el 64.6% desconocía la vacuna contra la influenza, el 97.9% cree que previene la influenza y el 85.4% cree que la vacuna no le ocasionara problemas. Los factores que influyeron para la aceptación de la vacuna y en cuanto a quien se la recomendó el 31.3% refieren que fue la Enfermera y al 43.8% nadie.

Influenza is a high respitatory tract viral accute disease able to bring about potentially fatal complications in elderly patients. Theannual vaccination is the most important health intervention for decreasing the flu impact. There are several factors influencing the vaccine aplication acceptance or rejection. This study aims determining characteristics of the population that accepts the influenza vaccine and identifying in-risk population groups in the event they don´t receive it within San Luis Tlaxialtemalco area. It was a descriptive transversal study witha no-probalistic sample including 48 people, 60or more years old. A strctured survey with 25 questions and different scales. Regarding outcomes, 84.48% accepted the influenza vaccine application. The 81.3% are not familiar with influenza disease, 77.1% believes the flu is grave, 64.6% is not familiar with the influenza vaccine, 97.9% believes they are taking preventive actions for the influenza, and 85.4% thinks the influenza caccine will not cause them any problems, which is influencing on the vaccine acceptance. Regarding the person who recommended them the influenza vaccine, 31.3% said was the nurse and 43.8% said nobody did.

Alteraciones polisomnográficas en lactantes con reflujo gastroesofágico / Polysomnographic abnormalities in infants with gastroesophageal reflux

BACKGROUND: Infant apnea is a common problem that conveys significant burden to families and physicians. Its temporal relationship with gastroesophageal reflux (GER) is controversial. AIM: To establish whether infants with GER of different magnitude have a higher incidence of respiratory events than children without GER. PATIENTS AND METHODS: 146 consecutive patients were evaluated with polisomnography (PSG) and with an esophageal pH probe. Those infants without GER episodes or with an esophageal pH below 4.0 in less than 5 per cent of total sleep time were considered as physiologic GER (Group I), between 5-10 per cent as mild GER (Group II), and over 10 per cent as severe GER (Group III). These groups were evaluated for demographic and polysomnographic characteristics. RESULTS: There were no differences in the demographic and global PSG characteristics neither in oxymetry, heart rate or electroencephalographic abnormalities. Group III infants had a higher percentage of active sleep compared to infants of Group I (p < 0.05) and higher incidence of central pauses and apneas compared to infants of Group I (p < 0.05). CONCLUSIONS: The presence of severe GER may modify the sleep pattern in infants, increasing the percentage of active sleep. The presence of central pauses and apneas in infants with severe GER suggest an association between the inmaturity of the respiratory centers and the adaptation of the anti-reflux mechanisms.

Relación entre bronquiolitis aguda con factores climáticos y contaminación ambiental / Association of acute bronchiolitis with climate factors and environmental contamination

BACKGROUND: Annually, acute bronchiolitis (AB) occurrence peaks during winter and is probably associated with air pollution. AIM: To relate the number of ambulatory consultations, emergency and hospital admission due to AB with climatic factors and air pollution. PATIENTS AND METHODS: Patients of less than 1 year old with AB that consulted to outpatient clinics, the emergency room or were admitted to the Pediatrics ward of the Catholic University Hospital, were enrolled. Information about respiratory syncytial virus (RSV) was obtained from the Catholic University Medical Investigation Center. Indices of air pollution such as particulate matters of less than 10 microns/m3 (PM 10), of less than 2.5 microns/m3 (PM 2.5), CO, SO3 and O3 were obtained from the Metropolitan Environmental Service. Temperature, humidity and precipitations were obtained from the Chilean Meteorological Service. RESULTS: Ninety nine consultations in out patient clinics and 442 in emergency rooms were collected (55 per cent male, mean age 4.8 months). One hundred fifty two were admitted (34.4 per cent). Thirty percent of children consulting in emergency rooms were younger than 3 months and 43 per cent of them were hospitalized. The RSV study was made in 307 patients and 52 per cent were positive. There was a higher rate of hospital admissions among RSV positive than RSV negative patients (52.5 and 22 per cent respectively, p < 0.001). No association between environmental variables or air pollution and the number of consultations was observed. Young age and smoking inside the household were the main risk factors for hospital admission due to acute bronchiolitis. CONCLUSIONS: Environmental variables did not influence the number of cases of acute bronchiolitis. Young age and exposure to tobacco smoke were risk factors for hospital admission.

Tratamiento de la mano hemipléjica con el sistema handmaster / Treatament of the hemiplegia hand with Handmaster system

El Handmaster es un sistema híbrido de electroestimulación funcional y ortesis del miembro superior que se ha desarrollado como tratamiento para restaurar la función de la mano afectada en la hemiplejía del accidente cerebrovascular (ACV) y del traumatismo craneoencefálico (TCE) y en la tetraplejía C5. Hemos probado su eficacia en cuatro pacientes con hemiparesia espástica secundaria a ACV y TCE. Se evaluaron diveross parámetros en la extremidad superior afecta: postura, rangos de movimiento activo y pasivo y nivel de espasticidad según la escala modificada de Ashworth. El tratamiento se inició en el hospital, formando parte de um protocolo incluido en un equipo interdisciplinario llevado a cabo entre varios hospitales, dentro del que ha formado parte nuestro hospital.Dos de estos pacientes continúan en la actualidad en trtamiento con este sistema en nuestro hospital

Cáncer glotico : experiencia con 206 casos / Cancer glotico: experience with 206 cases

Se presenta el estudio clínico de 206 pacientes portadores de cáncer glótico atendidos en el Departamento de Cabeza y Cuello del Instituto de Enfermedades Neoplásicas (INEN) durante el periodo comprendido entre 1970, 1990. El cáncer glótico representa en las estadísticas de la institución el 74.9 por ciento de los casos de cáncer de la laringe. El 59.7 por ciento de pacientes con cáncer glotico acudieron a la institución en estadios III y IV, según la clasificación TNM del The American Joint Committe. La política de tratamiento fue administrar radioterapia a los casos considerados tempranos y medianamente avanzados (T1 - T2) y cirugía radical para los casos avanzados (T3 - 4). Las fallas del tratamiento radioterápico fueron tratadas con cirugía de rescate mediante laringectomías parciales, laterales y fronto-laterales o laringectomías totales. Los resultados obtenidos con el tratamiento son similares a los reportados en otros centros, considerando el grado de avance del tumor primario y el estado de los ganglios regionales. El porcentaje global de curación fué de 74.7 por ciento para esta localización de cáncer. La pérdida de la laringe se registro en el 66.5 por ciento de pacientes con cáncer glótico y la incidencia de segundo cáncer primario sincrónico o metacrónico ocurrió en el 7.0 por ciento de los casos.