Prevalence of musculoskeletal symptoms in obese patients candidates for bariatric surgery and its impact on health related quality of life

ABSTRACT Objective This study was designed to identify the major musculoskeletal symptoms of individuals with obesity, to assess their health-related quality of life, and to evaluate the correlation between the musculoskeletal symptoms and the individuals' health-related quality of life. Materials and methods Cross-sectional study. Instruments used "Nordic Musculoskeletal Questionnaire" and "The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)". Results In total, 41 subjects were evaluated, of which 90.15% were female. The mean age of the subjects was 40.78 ± 9.85 years and their mean body-mass index was 46.87 ± 8.08. All subjects reported musculoskeletal pain in at least one anatomical region and 80.49% had pain in three or more regions. The activity limitations due to pain were reported by 75.61% of them. The most affected regions by pain were the ankles and/or feet, lower back, knees and wrists/hands/fingers. The most associated regions with activity limitations due to pain were the ankles and/or feet, knees and lower back. The presence of pain showed a negative correlation with the domains physical functioning (PF), role-physical (RP) and body pain (BP). The activity limitations showed a negative correlation with the domains PF, BP, social functioning (SF) and role-emotional (RE). Conclusion Our data showed a high prevalence of musculoskeletal pain and limitation in activities due to pain in obese subjects. The musculoskeletal symptoms had negative correlations with physical and mental components of the health-related quality of life, highlighting the importance of ensuring that patients with obesity have access to interdisciplinary care, for the prevention and rehabilitation of musculoskeletal disorders.

Traumatismo materno grave y cirugía múltiple con resultado perinatal exitoso / Multiple surgery in severe maternal trauma with successful perinatal outcome

El traumatismo mayor de la embarazada es frecuente, tiene riesgo de muerte y agrega a sus complicaciones propias, las generadas por el embarazo como prematurez, desprendimiento placentario y daño perinatal. Presentamos el caso de una embarazada de 27 semanas, con traumatismo grave por atropello, fracturas óseas y desforramiento extenso de extremidad inferior derecha, que fue sometida a tratamiento quirúrgico con reducción y corrección de luxofracturas, aseo e injertos cutáneos. Se complica con infección grave de foco cutáneo, persistente, permaneciendo 24 días en Unidad de Cuidad Intensivo (UCI) en tratamiento antibiótico, 10 drenajes quirúrgicos, nutrición enteral y manejo continuo del dolor, antes del parto. Inicia síndrome de respuesta inflamatoria sistémica y se efectúa operación cesárea. El recién nacido prematuro pesó 1500 gramos y evolucionó favorablemente. En su puerperio permanece 60 días hospitalizada en UCI con 14 cirugías de reparación y mejoría completa. Se analiza las características singulares de morbilidad materna del caso, discutiendo los aspectos obstétricos, quirúrgicos y de cuidado intensivo, la evolución materna, el manejo de la infección y el rol de la cirugía en la prolongación del embarazo y su influencia en el resultado perinatal exitoso. Se concluye la importancia de la integración multidisciplinaria en la toma de decisiones médicas y quirúrgicas en el manejo del trauma materno grave.

Maternal trauma is a leading cause of morbidity and mortality for both, fetus and mother. In addition, trauma can generate risks as premature delivery, abruptio placentae and fetal damage. A pregnant women, at 27 gestational weeks had a car accident with dislocation and fractures and extensive skinning of right leg. The first surgery for fracture-dislocations, cleaning and muscle skin flap were complicated with infection from cutaneous focus, serious and persistent. She remainded for 24 days in Intensive Care Unit (ICU) with antibiotic therapy; she had 10 procedures of surgical drainage with anesthesia, catheter enteral nutrition and continuous pain medication before delivery. Then, she presented systemic inflammatory syndrome maternal and a cesarean section was done; the newborn weighted 1500 grams and had a favorable evolution. After delivery the mother stayed 60 days in ICU, with 14 reparatives surgeries and complete recovery. In this special patient with severe maternal morbidity we discuss the etiology of the oligoamnios observed, the maternal evolution in ICU, the handling of infection, the significance of surgical treatment in prolonging pregnancy and its influence on a successful perinatal outcome. We emphasize on the importance of a multidisciplinary approach in making the medical and surgical decisions in severe maternal trauma.

Análisis de condicionantes físicas influyentes en el rendimiento o posibles lesiones durante partidos oficiales de cadetes en un club profesional de fútbol Chileno / Physical determiners that could generate alterations in the perfomance or a possible injury in cadets players during official football games

Propósito: El fútbol es un deporte de contacto con alto riesgo de lesión, que puede afectar al jugador, al equipo y la institución. Situación que adquiere mayor relevancia en el ámbito profesional, tanto en planteles de honor como en el área cadetes de un club. A nivel nacional, el comportamiento de las lesiones en divisiones menores ha sido escasamente descrito. El propósito del estudio fue establecer condicionantes físicas que pudieran generar alteraciones en el rendimiento o una posible lesión en jugadores cadetes durante partidos oficiales de fútbol. Además, identificar zonas anatómicas más afectadas y la relación entre éstas condicionantes con la posición de juego. Diseño y muestra: Se registraron todos los incidentes de orden físico que requirieran atención por parte de los jugadores de 4 categorías (Sub 15, Sub 16, Sub 17 y Juvenil), en 293 partidos oficiales correspondientes aproximadamente al 50 por ciento de los encuentros desde el 2003 al 2007. Resultados: Las EEII fueron las más afectadas con un 60 por ciento, los incidentes físicos relativos al sistema osteoarticular concentraron el 50 por ciento de las atenciones, las contusiones fueron la principal situación de atención con un 47 por ciento. Defensas y volantes presentaron mayor porcentaje de incidentes con 37por ciento y 32 por ciento respectivamente. Conclusiones: Las EEII son las zonas anatómicas más afectadas, las contusiones fueron la principal causal de solicitud de atención. Defensas y volantes registraron mayor porcentaje de incidentes físicos durante partidos oficiales.

Purpose: Football for being a sport of contact has an important risk of injury and could affect the team and the Institution. This situation acquires major relevancy in the professional area, both in the staffs of honor and in the cadets of a club. The purpose of the study was to establish physical determiners, that could generate alterations in the performance or a possible injury in cadets players during official football games. In addition, to identify the most affected anatomical zones well as the relation among these determiners and game position. Design and sample: We registered physical incidents that needed the attention of 4 categories (Sub 15, Sub 16, Sub 17 and young), in 293 official games ,corresponding approximately to 50 percent of the meetings from 2003 to 2007. Results: The IIEE were most affected in a 60 percent, the physical incidences relative to the osteoarticular system concentrated 50 percent of the attentions, the contusions were the principal situation of attentions with 47 percent, defenses and midfielders obtained major percentages of incidents with 37 percent and 32 percent respectively. Conclusions: The IIEE are the most affected anatomical zones, the contusions were the principal grounds of request of attention. Defenses and midfielders registered major percentages of physical incidents during official games.

Sarcoma de Ewing en peroné: cirugía preservadora de extremidad Servicio de Pediatría Médica. Hospital Universitario Dr. José María Vargas marzo 2008 San Cristobal Edo. Táchira / Fibula Ewing sarcoma: limb-sparing surgery Medical Pediatric Service Hospital Universitario Dr. José María Vargas march 2008 San Cristobal Edo. Tachira

Los tumores óseos primitivos son neoplasias que se originan en el hueso, siendo los mas comunes en la infancia el osteosarcoma y el sarcoma de Ewing (aproximadamente 5% del total), aparecen en la segunda década de la vida son excepcionales antes de los 5 años de edad y es mas frecuente en el sexo masculino. Se presenta el caso de un escolar masculino de 6 años que inició enfermedad actual de 25 días de evolución caracterizada por dolor de fuerte intensidad a nivel de miembro inferior izquierdo que no mejora con la administración de analgésicos, posteriormente presenta aumento de volumen, e imposibilidad para la marcha. Asimetria de miembros inferiores dada por aumento de volumen de pierna izquierda con respecto a la derecha con 3 cm. de diferencia, dolorosa a la movilización. Rx de miembro inferior izquierdo: Levantamiento del periostio en tercio medio de peroné izquierdo. RMN de miembro inferior izquierdo se evidencia LOE en diáfisis de peroné izquierdo con infiltración de masa muscular. Se realizó exéresis del TU y tejidos adyacentes. La biopsia confirma el diagnóstico de sarcoma de Ewing con compromiso de partes blandas adyacentes y bordes libres de resección ósea libres de neoplasia. Recibió quimioterapia adyuvante. Finalizó tratamiento en Octubre del 2007. Actualmente Vivo sin enfermedad con excelente evolución pos-tratamiento y en seguimiento. El Sarcoma de Ewing es poco frecuente en menores de 10 años de edad, el pronóstico depende del tamaño, localización, metástasis al diagnóstico, niveles de LDH y respuesta a la quimioterapia inicial, debe individualizarse el tratamiento con el fin de lograr control local y erradicación de la enfermedad residual.

Socioeconomic considerations regarding a land mine victim with maxillofacial injuries.

This article describes a case we experienced while doing volunteer medical work in Cambodia for six months in 2002. By examining treatment of a 14-year-old female land mine victim with maxillofacial injuries, we report on the present socio-medical situation in Cambodia. This case suggests the lack of infrastructure, facilities, human resources, and patient education make it extremely difficult to provide patients with proper treatment, including general anesthesia. A comparison of land mine victim statistics between 2002 and 2005 reveals significant problems.

Prevençäo e tratamento das osteomielites pós-traumáticas dos membros inferiores com retalhos musculares / Prevention and treatment of post-traumatic osteomyelites of the lower leg using muscle flaps

No presente trabalho säo discutidos os métodos de tratamento das lesöes tegumentares pós-traumáticas dos membros inferiores através de transposiçöes musculares e enxertos de pele, associados à reparaçäo óssea. Cinquenta e seis pacientes foram estudados no Serviço de Cirurgia Plástica e Microcirurgia Reconstrutiva da Santa Casa de Misericórdia de Porto Alegre, no período de julho de 1992 a julho de 1994. A localizaçäo mais frequente dos ferimentos foi no terço médio da perna (35,7 por cento dos casos). Setenta e cinco por cento dos pacientes tiveram como causa principal do traumatismo o envolvimento em acidente de motocicleta ou de automóvel. Cinquenta e seis pacientes (83,5 por cento) foram tratados com a transposiçäo de retalhos musculares pediculados, sendo o músculo Sóleo o mais empregado no método (50 por cento dos retalhos). Houve resoluçäo da infecçäo e estabilizaçäo dos ferimentos em 80,6 por cento dos casos. Salienta-se a importância fundamental de uma abordagem interdisciplinar e atuaçäo precoce para o sucesso do tratamento

Pig bite in Brazil: a case series from a teaching hospital

A retrospective survey done from 1987 till 1990 revealed that 23 patients bitten by pigs sought medical help at a teaching hospital in Uberl andia, in southeastern Brazil. Most cases (21) were from Uberl andia. The cases were evenly distributed by month and by year; most of them (14/16; 87.5 per cent ) occurred between 7.00 a.m. and 7.00 p.m. The male to female ratio was 6.7:1. Age ranged from 6 to 73 (mean 38.95 +/- SD 22.06, median 36). The bites were more common on the upper limbs, particularly on the forearms. In 11 (47.8 per cent ) cases the injury was described as deep. In most cases where information was available the injury was related to capture, transport or immobilisation of the pig for slaughter. The following medical procedures were performed: local cleansing in 19(82.6 per cent ) cases, rabies vaccine (12; 52.2 per cent ), antirabies serum (2; 8.7 per cent ), suturing (6; 26.1 per cent ) and tetanus vaccine (12; 52.2 per cent ). There was no case of infection at the bite site, neither of rabies or tetanus. By our data, the annual incidence of pig bite in Uberl andia can be estimated to be about 1.5/100,000