Covid-19 y cirugía ortopédica: revisión de la literatura y evidencias / Covid-19 and orthopedic surgery: review of the literature and evidence

Se ha declarado una pandemia ante la propagación de un nuevo virus con alta contagiosidad, llamado síndrome respiratorio agudo severo coronavirus 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV2). El mundo ha quedado detenido ante la rápida expansión del virus, con una letalidad que en algunos países llega a 15%. En Chile, el gobierno ha tomado medidas rápidas y agresivas que han permitido mantener la curva de contagios a un nivel que permita atender de manera adecuada a la población. Dentro de estas medidas, se contempla la suspensión de cirugías y consultas ambulatorias. Como cirujanos ortopédicos, nos hemos visto afectados por estas medidas, y existe confusión respecto a cuál es la conducta más adecuada. Quisimos hacer esta guía para resumir parte de las evidencias disponibles y orientar a los cirujanos ortopédicos respecto a esta patología. El comportamiento de esta guía es dinámico, dadas las múltiples opiniones, experiencias y evidencias, que surgen diariamente, por lo que recomendamos mantenerlo como referencia, no como certeza.

A pandemic has been declared due to a new highly contagious virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The world has come to a halt due to the rapid expansion of a virus whose lethality has reached 15% in some countries. In Chile, the government has taken decisive, aggressive measures in an attempt to control disease spread and provide healthcare to those who need it. These decisions include the suspension of elective surgeries and other ambulatory procedures. As Orthopedic surgeons we have been affected by these measures and there is doubt regarding the best course of action. We prepared this guide to summarize available evidence and orient our colleagues regarding this pathology. This guide is meant to be dynamic, as new opinions, evidence and experiences arise every day. Therefore, we advise the reader to keep it as a reference, not an undisputable truth.

Efecto de un entrenamiento deportivo en el compartimiento angular de la extremidad inferior en niños futbolistas de entre 11 y 12 años / Effect of sports training in angular compartment of the lower limbs in children footballers aged 11 to 12 years old

Resumen: La lesión del ligamento cruzado anterior (LCA) constituye una causa importante de reposo en deportistas. En su mayoría, las lesiones del LCA no requieren contacto externo y se asocian con factores de riesgo biomecánicos que aumentan la tensión en el LCA: el aumento del ángulo de valgo de rodilla (VR), flexión de cadera (FC) y una menor flexión de rodilla (FR). El LCA requiere cooperación de los grupos musculares perirrodilla, por lo que la fatiga producida por el ejercicio alteraría el balance y pondría en riesgo a este ligamento. El objetivo del estudio es determinar el comportamiento angular antes y después de una carga física para FC, FR y VR en niños nacidos en los años 2002-2003. Se realizó un estudio clínico no aleatorizado. La muestra consistió en 50 alumnos de escuelas de fútbol nacidos en los años 2002 y 2003. Se comparó el comportamiento angular de FC, FR y VR antes y después de realizar un entrenamiento estandarizado. El comportamiento angular fue medido a través de la realización de la prueba DJ, con datos obtenidos por sensores inerciales. Posterior al ejercicio, aumentaron las tres variables; sólo fue significativo el incremento en la flexión de cadera. Por otra parte, destaca la diferencia encontrada tanto en reposo como postejercicios entre la extremidad de apoyo y la hábil en el peak de valgo angular. Se concluyó que el comportamiento angular de FC aumenta significativamente en ambas extremidades postentrenamiento y que se deben aplicar medidas preventivas para el manejo del valgo en la extremidad de apoyo.

Abstract: Anterior Cruciate Ligament (ACL) injury is an important cause of days lost in athletes. Most ACL injuries are non-contact and are associated with biomechanical risk factors that increase tension in the ACL: increased knee valgus (KV) and hip flexion (HF) and decreased flexion of knee (KF). Muscle around the knee contributes to knee stability, so fatigue produced by exercise could alter knee balance, increasing LCA tension. The aim of the study is to determine the angular behavior before and after a physical load for CF, RR and RV in children born in 2002-2003. A non-randomized clinical trial was conducted. The sample consisted of 50 students from soccer schools born between 2002 and 2003. The angular behavior of CF, RR and VR was compared, before and after performing standardized training. The angular behavior was measured by performing the DJ test with data obtained by inertial sensors. After exercise, the 3 variables increased, but only HF reached significant difference. Other important finding was the difference found in KV between the dominant leg and the support limb, at both times: rest and post exercise. It was concluded that the angular behavior of CF increases significantly in both limbs post-exercise and that preventive measures should be applied for the management of valgus in the supporting limb.

Reconstrucción con colgajos libres: una experiencia de 33 años / Microvascular free tissue transfer

Background: Microvascular free tissue transfer has gained world-wide acceptance as a means of reconstructive plastic surgery. Since 1979, the authors have introduced this microsurgical procedure in our country and a total of 317 free flaps have been carried out during a period of 33 years. Aim: To present the consecutive free flaps performed at Hospital Clinico Universidad de Chile and Hospital Mutual de Seguridad between 1979-2011. Patients and Methods: Retrospective analysis of 293 patients underwent 317 microsurgical flaps. Results: 293 patients. Median age 43 years old (range 12-81). The lower limb has been the most common site (181 cases), followed by head and neck, upper limb and trunk. The most frequently used flap was the gracilis flap. A survival rate of 95 percent has been achieved. Follow-up range from 6 months to 9 years. Conclusion: This pioneering series in Chile using microsurgical flaps, shows a satisfactory solution in an one-stage procedure. The authors believe that free flap would be part of the armamentarium of modern plastic surgeons, frequently as a first choice...

Introducción: La transferencia de colgajos libres se ha posicionado como una opción ampliamente aceptada en todo el mundo en la cirugía plástica reconstructiva. En el año 1979, los autores introdujeron los primeros procedimientos microquirúrgicos en nuestro país, realizando en 33 años un total de 317 colgajos libres. Objetivo: Presentar los colgajos libres consecutivos efectuados por nuestro grupo entre 1979-2011 en el Hospital Clínico de la Universidad de Chile y Hospital Mutual de Seguridad. Pacientes y Método: Análisis retrospectivo de nuestra base de datos de los 293 pacientes reconstruidos con 317 colgajos microvascularizados. Seguimiento entre 9 años y 6 meses. Resultados: La serie estuvo constituida por 293 pacientes. La mediana de edad fue 43 años (rango 12-81). La principal indicación fue reconstrucción de extremidad inferior, luego cabeza y cuello, extremidad superior y tronco. El colgajo más usado fue el colgajo de músculo gracilis (45 por ciento). El éxito vascular total fue 95 por ciento. Conclusión: En esta serie pionera en Chile, la utilización de colgajos libres demostró ser de utilidad, dando soluciones satisfactorias en un tiempo. Los autores creen que los colgajos libres deben formar parte del armamentario de los cirujanos plásticos modernos, muchas veces como primera elección...

Infección materna y transmisión transplacentaria del Trypanosoma cruzi en Chile: diagnóstico, tratamiento y control / Trypanosoma cruzi transplacental infection in Chile: diagnosis, treatment and control

Trypanosoma cruzi transplacental infection represents a serious public health concern in all the countries like Chile where recent success of insecticide spraying programs eliminated the vector. Because children infected with T. cruzi are usually asymptomatic, a study was designed including infected mothers and their children. The study was conducted for three years to establish diagnostic, treatment, and clinical observations variables. Mothers were tested for T. cruzi IgG, and the new born were examined for parasite DNA using PCR amplification. They were treated with nifurtimox and it was 100% effective, confirmed by successive PCR tests. It has been determined that there are 800 to 1000 new cases a year of transplacental Chagas' disease in Chile. This level of infection in the population should justify the establishment of a control and follow-up program for transplacental Chagas' disease.

Reconstrucción de fracturas periprotésicas femorales mediante injertos corticales masivos y ostosíntesis con placa y alambres / Periprosthetic femoral fractures reconstruction with bone cortical graft and osteosynthesis with plates and wires

El tratamiento de las fracturas periprotésicas femorales es compleja, asociado a frecuentes complicaciones. Las estrategias varían de acuerdo al tipo de fractura, la calidad del tejido óseo, la presencia o no de aflojamiento del implante y el estado general del paciente. Se presentan cinco casos de fracturas femorales periprotésicas, tratadas mediante osteosíntesis con placa y cables o asas de alambre y aloinjertos corticales diafisiarios dispuestos en forma "onlay". Las cinco pacientes eran mujeres, con edades entre los 66 y 80 años (promedio 73 años). En los cinco casos hubo consolidación de la fractura e incorporación de los injertos, con restauración del fémur proximal, lo que permitió el reimplante de un nuevo vástago en dos caoso y conservación de un vástago firme en otros dos. En el caso restante, el reimplante de defirió para un segundo tiempo por las características de la paciente. Una paciente presentó luxación de la prótesis en el postoperatorio, que fue tratada exitosamente mediante reducción ortopédica y contención externa. Las cuatro pacientes con revisiones o conservación de la prótesis recuperaron la capacidad de ambulación con uso de un bastón

Certificación serológica de la interrupción de la transmisión vectorial de la enfermedad de Chagas en Chile / Serological certification of the interruption of the vectorial transmission of Chagas disease in Chile

Background: In 1999 an International Commission of Experts evaluated the sanitary interventions that started in 1980 to eliminate Triatoma infestans, the biological vector of Chagas disease, to certify if the conditions needed to interrupt the transmission, were achieved. Aim: To report the data used by the International certification commission to certify the interruption of vectorial transmission of Chagas disease in Chile. Material and methods : A comparative evaluation of the prevalence of Trypanosoma cruzi antibodies in children surveyed between 1994 and 1995 and between 1995 and 1999. Results : In the first period, 5.948 children were surveyed and in the second, 5.069 children were studied. Twenty children (0.4 percent) were positive for Trypanosoma cruzi antibodies in the second survey. These figures were significantly lower than the 1.1 percent prevalence detected between 1994 and 1995. In only three of the 20 cases, the transmission through vectors was confirmed, which represents a 99.4 percent reduction of this way of transmission. Conclusions: Based on these findings, the Commission certified that Chile is the second country in Latin America to interrupt the vector transmission of Chagas disease. The successful public health program for Chagas disease will have a positive impact improving the quality of life of rural populations, that are most exposed to the disease

Situación epidemiológica de la enfermedad de Chagas en el área endémica de la II Región de Antofagasta, Chile / Epidemiological situation of Chagasï disease in the endemic area from the II Region of Antofagasta, Chile

During 1997 a seroepidemiological study on Chagas' disease was carried out in 18 localities of three provinces (Tocopilla,El Loa and Antofagasta) of Region II (20º 56'-26º south lat.; 70º 38'- 67º west long.), in order to asses the impact of the control program against triatoma infestans launched in 1988, based on insecticide spraying of dwellings. By means of ELISA and an indirect hemagglutination test for chagas' disease blood samples from 1,034 children under 10 years of age were examined, arising a 0.5 por ciento (3 cases) positivity. Test resulted positivite in 2 (0.9 percent) children from the locality of San Pedro de Atacama and 1 (0.4 percent) from Calama city, all in the age group 6-10 year -old. However, none of their dwellings were found infested with T.infestants. These result indicate that the control program has a good possibility to prevent new human infections. It is advisable to continue the seroepidemiological and entomological vigilance and remark the necessity of increasing the effort in the study of transmission through other routes, to adopt or reinforce the pertinent preventive measures

Estado actual de la seroprevalencia de la infección chagásica humana y canina en la comuna de San Pedro de Atacama, II Región de Antofagasta en Chile 1995 / Present status of seroprevalence of canine and human chagasic infection in San Pedro de Atacama, II Región, Antofagasta, Chile 1995

In order to assess the impact of a control program against triatoma infestans launched in 1988, based on insecticide spraying of dwellings, a serological survey for chagasic infection was carried out during 1995 in three localities from San Pedro de Atacama county (22º55' south lat., 68º12' west long.), II Region of Antofagasta in northern Chile. Blood samples from 531 children and adolescents and 65 dogs were subjected to ELISA test and indirect inmunofluorescent test for Chagas's disease respectively. Tests resulted positive in 12 (2,3 percent) persons, all above 5 years old, in contrast with the 16,8 percent serological positivity observed in 1985. Three (4,6 percent) dogs (two 0-12 months old) resulted positive. These results indicate that dwellings sprayings with long-term activity insecticides against T. infestans is a good tool to prevent new human infections with T. cruzi. However, active vector transmissiom among domestic animals (canines) could be recently acquired.

Evaluación de un programa de erradicación del triatoma infestans en viviendas rurales de la IV Región de Chile mediante serología para la enfermedad de Chagas en niños de 0 a 10 años de edad / Triatoma infestans eradication program assessment in rural dwellings from the IV Region of Chile by serology for Chagas' disease in children 0 to 10 years of age

The present study deals with the evaluation of the effectiveness of the measures employed in the control of triatoma infestans, the vector of trypanosoma cruzi infection (Chagas' disease), in the IV Region of Chile through a serological follow up program. For this reason, a serological survey has been carried out in 2,783 chidren, from 0 to 10 years, who live in rural high endemic areas of the region. The sera were tested using an indirect hemagglutination test (IHAT) and ELISA techniques with results agreeing in 99,9 for percent of the samples. In children with positive serology xenodiagnosis was perfomed and blood samples from the corresponding mothers were submitted to serology for Chagas's disease. These addicional tests should allow to distinguish between congenital infection and vectorial transmission. It was observed that vectorial transmission of T. cruzi was interrupted in some localities where entomological control has been applied for 10 years, or lowered in those which have been submitted to desinsectations in the last 5 years. On the other hand, a relatively high prevalence of the infection has been detected in some localities. These results suggest an apparent increase of vectorial transmision, indicating the need of readjusting the dwellings insecticide sprayings activities to improve the measures against the vector

Toxoplasmosis congénita: un problema vigente en Chile: análisis de 15 casos clínicos / Congenital toxoplasmosis: a current problem in Chile: analysis of 15 clinical cases

Se analiza el problema de la toxoplasmosis congénita mediante el estudio de quince casos, cuatro lactantes con infección aguda y once niños con compromiso acular. La importancia del reconocimiento oportuno de la infección en el recién nacido y lactante, basada en la sospecha clínica (síndrome de TORCH y examen de fondo de ojo) y el diagnóstico serológico precoz que confirma la etiología, se discute en relación con el efecto curativo del tratamiento específico. La mayoría de los casos se diagnosticaron y trataron en forma tardía. En cinco niños tratados precozmente se obtuvo resultado satisfactorio, evitándose la muerte del recién nacido, disminuyendo el desarrollo de la infección y la aparición de reactivaciones, aunque persistieron secuelas a nivel del SNC. En los casos restantes, se observó sólo un efecto parcial del tratamiento. Se concluye que la toxoplasmosis congénita es un problema vigente en Chile y que la mayoría de los casos no se diagnostican oportunamente. Se recomienda intensificar su detección a nivel clínico, porque se dispone de drogas específicas que, aplicadas en forma precoz, pueden prevenir o aminorar el desarrollo de secuelas en el SNC

Encuesta sobre síntomas de depresión en embarazadas de un consultorio urbano de atención primaria / Depression in pregnant women seen at an outpatient primary care facility of urban Santiago

We studied the frequency of depression as well as biomedical and social features of 179 pregnant women under control at an urban clinic in metropolitan Santiago. The random sample compriesed 38% of all controlled pregnancies. A questionnaire adapted and validated by Florenzano et al was used to appraise. The Graffar methodology was used to measure socioeconomic level. Frequency of depressive symtoms was 30% and mean age of depressed women was 27.3 years, similar to non depressed ones (26.1%). A significantly highler proportion of depression was found in single women and those having a dystocic last delivery. The high frequency of depression in this vulnerable group suggests the need for integrated obsterric-psychiatric units to provide a more comprehensive medical care to theses patients