Reparación del tendón del supraespinoso con técnica transósea equivalente en población sujeta a compensación laboral. ¿Cuál es el porcentaje de cicatrización? / Supraspinatus tendon repair using an equivalent transosseous technique to workers compensation. What is the percentage of cicatrization?

Introducción: El objetivo de este trabajo es evaluar el porcentaje de cicatrización y los resultados funcionales de una cohorte de pacientes sometidos a reparación artroscópica del tendón del supraespinoso mediante una técnica de doble fila transósea equivalente. Materiales y métodos: durante el período de enero de 2015 a diciembre de 2017, se realizó una reparación artroscópica del supraespinoso a cuarenta y ocho pacientes utilizando una técnica transósea equivalente, todas por el mismo cirujano; al cuarto mes de evolución, se evaluó la tasa de cicatrización del tendón mediante ecografía. Los resultados funcionales se analizaron mediante la escala de Constant-Murley (CS), valoración subjetiva del hombro (SSV) y la escala visual análoga (EVA) para objetivar el dolor. Para el análisis estadístico se utilizó t test para muestras pareadas. Población sometida a compensación laboral.Resultados: el seguimiento ecográfico objetivó una tasa de re-ruptura del 6%. El promedio de incremento en la escala de Constant-Murley fue de 55 puntos, del SSV de 55%, de flexión anterior 32° y de rotación externa de 13°. La escala visual análoga tuvo un descenso de 6 puntos. Todos estos cambios fueron estadísticamente significativos (p < 0.05). Conclusión: la reparación del tendón del supraespinoso, mediante una técnica transósea equivalente mejora los resultados clínicos y funcionales de los pacientes, objetivados con los índices de Constant-Murley y SSV. En nuestra serie obtuvimos una tasa de cicatrización en el 94% de los pacientes. Tipo de estudio: Serie de casos. Nivel de Evidencia: IV

Introduction: the objective of this work was to evaluate the healing rate and functional results in a retrospective cohort of patients undergoing arthroscopic repair of the supraspinatus tendon, using a double row transosseous equivalent technique. Materials and methods: during the period from January 2015 to December 2017, an arthroscopic repair of the supraspinatus was performed on forty-eight patients, using a transosseous technique, by the same surgeon. We evaluated the healing rate by an ultrasound exam at the fourth month of evolution. Functional results were evaluated using the Constant-Murley scale (CS), subjective shoulder assessment (SSV) and the visual analog scale (VAS) to objectify the pain. For the statistical analysis, t-tests were used for paired samples. This cohort of patients is subject to workers compensation. Results: the ultrasound follow-up showed a 6% re-rupture rate. The average increase in the Constant scale was 55 points, the SSV had a mean increase of 55% and the VAS score decrease 6 points. All these changes were statistically significant (p < 0.05).Conclusions: the supraspinatus tendon repair, using an equivalent transosseous technique, improves the clinical and functional results of patients, objectified with the Constant-Murley and SSV scores. In our series we obtained a healing rate on 94% of the patients. Type study: Case Series. Level of Evidence: IV

Colonic atresia in a newborn

ABSTRACT Introduction: Colonic atresia is the least common type of intestinal atresia; however, it must be suspected in patients with partial or complete intestinal obstruction, failure to pass meconium, vomit and abdominal distension. Good prognosis has been described in patients with timely treatment. Case report: This paper reports the case of a newborn patient presenting with vomit, abdominal distension, failure to pass meconium and a rapid progressive clinical deterioration. A colonic atresia was found during exploratory laparotomy, which required a temporary colostomy due to the discrepancy of the proximal and distal calibers. Subsequently, colonic anastomosis was performed using a protective colostomy that was finally closed. This patient had a good post-operative recovery. Conclusion: Colonic atresia must be considered as an important cause of distal intestinal obstruction in pediatric patients and, therefore, it should always be suspected. Ruling out other associated abnormalities is also recommended, as well as performing a rectal biopsy for Hirschsprung's disease to avoid complications.

Multi-criteria decision analysis and spatial statistic: an approach to determining human vulnerability to vector transmission of Trypanosoma cruzi

BACKGROUND Chagas disease (CD), caused by the protozoan Trypanosoma cruzi, is a neglected human disease. It is endemic to the Americas and is estimated to have an economic impact, including lost productivity and disability, of 7 billion dollars per year on average. OBJECTIVES To assess vulnerability to vector-borne transmission of T. cruzi in domiciliary environments within an area undergoing domiciliary vector interruption of T. cruzi in Colombia. METHODS Multi-criteria decision analysis [preference ranking method for enrichment evaluation (PROMETHEE) and geometrical analysis for interactive assistance (GAIA) methods] and spatial statistics were performed on data from a socio-environmental questionnaire and an entomological survey. In the construction of multi-criteria descriptors, decision-making processes and indicators of five determinants of the CD vector pathway were summarily defined, including: (1) house indicator (HI); (2) triatominae indicator (TI); (3) host/reservoir indicator (Ho/RoI); (4) ecotope indicator (EI); and (5) socio-cultural indicator (S-CI). FINDINGS Determination of vulnerability to CD is mostly influenced by TI, with 44.96% of the total weight in the model, while the lowest contribution was from S-CI, with 7.15%. The five indicators comprise 17 indices, and include 78 of the original 104 priority criteria and variables. The PROMETHEE and GAIA methods proved very efficient for prioritisation and quantitative categorisation of socio-environmental determinants and for better determining which criteria should be considered for interrupting the man-T. cruzi-vector relationship in endemic areas of the Americas. Through the analysis of spatial autocorrelation it is clear that there is a spatial dependence in establishing categories of vulnerability, therefore, the effect of neighbors' setting (border areas) on local values should be incorporated into disease management for establishing programs of surveillance and control of CD via vector. CONCLUSIONS The study model proposed here is flexible and can be adapted to various eco-epidemiological profiles and is suitable for focusing anti-T. cruzi serological surveillance programs in vulnerable human populations.

Estrategia para determinar la línea base en áreas de interrupción vectorial de la enfermedad de Chagas / Strategy for determining a baseline in areas of vector interruption for Chagas disease

RESUMEN Objetivos Presentar una estrategia para determinar la línea de base en áreas endémicas en el proceso de interrupción vectorial de la enfermedad de Chagas (ECh). Métodos Con un cuestionario socioambiental y una encuesta entomológica, se evaluaron las condiciones físicas de los domicilios, el conocimiento de los habitantes sobre la ECh, los indicadores entomológicos de triatominos y la relación estadística entre estas variables. Resultados Existe colonización e infección natural con Trypanosoma cruzi en Rhodnius prolixus, el principal vector de la ECh en Colombia. La colonización estuvo relacionada con casas de techos de hojas de palma y paredes de adobe o bahareque. Se encontró el vector Panstrongylus geniculatus con hábitos de colonización. Casi 50% de la población encuestada asociaba el término ECh con una enfermedad humana y 37%, con los triatominos. Conclusiones R. prolixus puede considerarse el principal vector de T. cruzi en ambientes domésticos y el proceso de interrupción vectorial es factible dentro del municipio priorizado. Se necesitan nuevos estudios que comprueben la existencia de poblaciones silvestres de R. prolixus que puedan afectar las etapas futuras del proceso y demostrar si hay una participación de P. geniculatus en la dinámica de transmisión de T. cruzi. Los anteriores escenarios pueden ser viabilizados con la inclusión de los habitantes en todo el proceso, ya que han sido altamente sensibles en la detección de vectores dentro de sus casas. El diseño del estudio aquí presentado puede ser adaptado en otras áreas endémicas de la Región de las Américas.

ABSTRACT Objectives Present a strategy to determine the baseline in endemic areas in the process of vector interruption for Chagas disease (CHD). Methods A social and environmental questionnaire and an entomological survey evaluated the physical conditions of dwellings, the inhabitants’ knowledge of CHD, the entomological triatomine indicators and the statistical relationship among these variables. Results Colonization and natural infection with Trypanosoma cruzi exist in Rhodnius prolixus, the principal vector of CHD in Colombia. Colonization was related to palm-thatched houses constructed with adobe or wattle and daub. The Panstrongylus geniculatus vector was found to be colonizing. Almost 50% of the surveyed population associated the term CHD with human disease and 37%, with triatomines. Conclusions R. prolixus can be considered to be the principal vector of T. cruzi in domestic environments and the process of interruption is feasible within the prioritized municipality. New studies are needed to verify the existence of wild populations of R. prolixus that could affect future stages of the process and demonstrate whether P. geniculatus is a factor in the transmission of T. cruzi. These scenarios can be made viable by including the inhabitants throughout the process, since they have been highly sensitive in vector detection inside their houses. The study design presented here can be adapted to other endemic areas of the Region of the Americas.