[Medial Hoffa fracture: a case report]. / Fractura de Hoffa medial: reporte de un caso.

INTRODUCTION: knee femoral condyle coronal fractures or Hoffa fractures are among the rarest fractures of the pelvic limb, being even more rare those of the medial condyle. The success in the management of these patients lies in the timely diagnosis and the consequent anatomical reduction of the femoral articular surface. CLINICAL CASE: the objective of this article is to present a patient with right medial Hoffa fracture, registered as a single case in the archives of our hospital. The patient was referred to us on November 2011, with a 10-day course after suffering a fall from horse ridding, presenting a forced varus mechanism and direct contusion of the right knee. He shows an anteroposterior and lateral knee X-rays showing a subtle solution of continuity in the coronal plane of the base of the medial condyle, corroborated with magnetic resonance imaging and was also associated with a non-surgical partial injury of both menisci and the anterior cruciate ligament. Surgical intervention was performed on 27th/11/2011, through open reduction with a medial approach and internal fixation with 7.0 mm (x2) cannulated screws. The patient was discharged with early and continuous mobilization of the knee, deferring support and rehabilitation until the 6th week. He is currently a wandering patient, asymptomatic, with complete range of motion. Because respecting the extensor apparatus through a medial approach and the articular surface with cannulated screws, it was observed in consequence an adequate evolution of our patient, being able to return to his daily activities, even remount.

INTRODUCCIÓN: las fracturas del cóndilo femoral en el plano coronal o fracturas de Hoffa se encuentran entre las fracturas más raras del miembro pélvico, pero son aún más raras las del cóndilo medial. El éxito en el manejo de estos pacientes radica en el diagnóstico oportuno y la consecuente reducción anatómica de la superficie articular del fémur. CASO CLÍNICO: el objetivo de este reporte es presentar a un paciente con el diagnóstico de fractura de Hoffa medial derecha, registrado como caso único en los archivos de nuestro hospital. El paciente acudió referido en Noviembre de 2011, con evolución de 10 días tras sufrir caída de caballo, presentando mecanismo de varo forzado y contusión directa de la rodilla derecha. Mostró radiografías anteroposterior y lateral de rodilla derecha, donde se observó de forma sutil solución de la continuidad en el plano coronal de la base del cóndilo medial, corroborado por resonancia magnética y asociado a lesiones parciales no quirúrgicas de ambos meniscos y del ligamento cruzado anterior. Se intervino quirúrgicamente el día 27 de Noviembre de 2011 mediante reducción abierta con abordaje medial y fijación interna con dos tornillos canulados de 7.0 mm. Se egresó al paciente indicando la movilización temprana y continua de la rodilla, difiriendo el apoyo y rehabilitación hasta la sexta semana. Actualmente el paciente se encuentra con posibilidad de deambulación, asintomático y con arcos de movilidad completos. El respeto del aparato extensor mediante un abordaje medial y la superficie articular con tornillos canulados se refleja en la adecuada evolución de nuestro paciente, pudiendo regresar a sus actividades diarias, incluso el montar.

[Carpal tunnel compression syndrome and third finger in trigger secondary to an encapsulated fibrolipoma of the wrist: a case report]. / Síndrome de compresión del túnel del carpo y tercer dedo en gatillo secundarios a un fibrolipoma encapsulado de la muñeca: reporte de un caso.

INTRODUCTION: the association of carpal tunnel syndrome with stenosing tenosynovitis of the hand is very rare, even more, if it is generated by a fibrolipoma at the carpal tunnel. The imaging study useful to detect this type of hand injuries are X-ray screening for carpal tunnel, computed tomography and magnetic resonance imaging. But these are not commonly used for the study of protocolized carpal tunnel syndrome and much less trigger finger. OBJECTIVE: the aim of this work is to report a case of a middle-aged female with carpal tunnel syndrome characteristic symptoms, associated with the third trigger finger; she was handled with the release of the median nerve by a minimally invasive approach, in addition to the A1 pulley release. CLINICAL CASE: the patient persists with both problems and at a secondary surgical review, we detected wrist locking sensation. The patient was reoperated finding an ovoid encapsulated tumor, measuring 3.0 × 2.0 × 1.0 cm, with smooth outer surface, whitish appearance, and soft rubbery consistency. The biopsy pathology outlines identified an encapsulated fibrolipoma, causing nerve compression and locking flexor tendon. CONCLUSION: the importance of this writing is in adding tumors to the etiological repertoire, which can cause compression of the median nerve and even less frequent as a cause of the flexor tendons of the hand snagging.

INTRODUCCIÓN: la asociación del síndrome del túnel del carpo con tenosinovitis estenosante de la mano es muy rara, aún más, si es generada por un fibrolipoma a nivel del túnel del carpo. El estudio de imagen para detectar este tipo de lesiones en la mano incluye: desde una radiografía con proyección para el túnel del carpo, tomografía axial computarizada y resonancia magnética nuclear; pero éstos no se utilizan habitualmente para el estudio protocolizado del síndrome del túnel del carpo y mucho menos para los dedos en gatillo. OBJETIVO: el objetivo de este trabajo es reportar un caso en el cual se presenta la sintomatología característica de un síndrome de túnel del carpo, asociada a tercer dedo en gatillo, el cual se maneja con la liberación del nervio mediano por medio de un abordaje de mínima invasión, además de la polea A1. CASO CLÍNICO: la paciente persistió con ambas alteraciones y en la revisión secundaria se detectó bloqueo a nivel de la muñeca. Se intervino nuevamente a la paciente y se encontró una tumoración encapsulada, que midió 3.0 × 2.0 × 1.0 cm, con superficie externa lisa, blanquecina, de aspecto ovoide y consistencia blanda "ahulada". El estudio anatomopatológico la identificó como un fibrolipoma encapsulado que ocasionó la compresión nerviosa y el bloqueo del tendón flexor. CONCLUSIÓN: la importancia de este reporte de caso radica en agregar los tumores al repertorio etiológico, que además pueden provocar una compresión del nervio mediano y en que sean aún menos frecuentes como causa de atrapamiento de los tendones flexores de la mano.

Foodborne Parasitic Diseases in the Neotropics - A Review.

Within the Universal Declaration of Human Rights, it is stated that everyone has the right to an adequate standard of living, which ensures, as well as their family, health and well-being, and food, thereby ensuring adequate nutrition. One of the major threats to overcome this is to ensure food security, which becomes particularly challenging in developing countries due to the high incidence of parasitic diseases. The World Health Organization (WHO), considers it one of the main causes of morbidity, closely linked to poverty and related to inadequate personal hygiene, consumption of raw food, lack of sanitary services, limited access to drinking water and fecal contamination in the environment. It is estimated that more than a fifth of the world's population is infected by one or several intestinal parasites, and that in many countries of Central and South America the average percentage of infected people is 45%, being Taenia solium, Echinococcus granulosus, Toxoplasma gondii, Cryptosporidium spp, Entamoeba histolytica, Trichinella spiralis, Ascaris spp, Trypanosoma cruzi and Fasciola hepatica some of the most important ones in the neotropics. One of the main reasons why these diseases are diffi cult to control is t he ignorance of their lifecycles, as well as symptoms and current epidemiology of the disease, which contributes to a late or erroneous diagnosis. The present work aims to discuss and make public the current knowledge as well as the general characteristics of these diseases to the general audience.

Citizen Health Science: Foundations of a New Data Science Arena.

Citizen scientists with health interests have rapidly increased efforts to conduct their own health studies on themselves and in their communities, giving rise to a new transdisciplinary field of citizen health science. This science leverages long-standing traditions of single case or N-of-1 studies in psychology and also finds influential roots in the history of self-experimentation in health and medicine. These studies frequently incorporate new digital tools such as smartphone tracking and many other mobile health or "mHealth" devices. Citizen health scientists also tend to operate in social networks of people working to maintain or improve their health, increasing the complexity and richness of opportunities tied to this new platform. Population data scientists are well-positioned to seek new ways to derive scientific inferences from data generated in citizen health science projects. This paper provides an overview of citizen health science for population data scientists, including basic definitions, historical foundations, current challenges and opportunities, and future directions.

Regulation of PKD1-mediated Golgi to cell surface trafficking by Gαq subunits.

BACKGROUND INFORMATION: Heterotrimeric GTP-binding proteins play a key role in cell trafficking regulation. Above all, specific Gßγ subunits have been shown to be a major component of a signal transduction pathway, which also involves phospholipases C (PLC), protein kinases C (PKC) and D (PKD), whose main function is to regulate transport between Golgi and plasma membrane. It was the involvement of PLC which led us to study the role of the other member of this G protein family, the α subunits, in the regulation of membrane fission at the Golgi apparatus. RESULTS: Among constitutive active (QL) variants of different G protein α subunit sub-families, only GαqQL subunits were able to induce Golgi fragmentation, a phenotype that mainly reflects a membrane fission increase at this organelle. This phenotype was not observed with a GαqQL palmitoylation mutant, showing the need for a membrane-bounded subunit. Besides, GαqQL-dependent Golgi fission was blocked by specific PLC and PKC inhibitors, and in the presence of a PKD1-kinase dead variant. In addition, GαqQL was the only α subunit capable of inducing PKD1 phosphorylation. Finally, Vesicular Stomatitis Virus thermosensitive mutant glycoprotein (VSVG tsO45) transport assays have demonstrated that GαqQL acts directly on Golgi membranes to regulate trafficking between this organelle and plasma membrane. CONCLUSIONS: All these results indicate Gαq subunits for the first time as a regulator of PKD-mediated intracellular trafficking between Golgi apparatus and plasma membrane, opening new perspectives in the understanding of internal trafficking regulation by external signals through G protein-coupled receptors.

Hacia el fortalecimiento de la medicina familiar y la atención primaria en los sistemas de salud: IV Cumbre Iberoamericana de Medicina Familiar / Towards the strengthening of family medicine and primary care in health systems: IV Ibero-American Summit of Family Medicine

A treinta y tres años de la Declaración de Alma Ata en 1978, respecto de la Atención Primaria de la Salud (APS), el mundo ha podido observar diferentes grados de avance dependiendo de la región geográfica y económica que se analice; por ejemplo, los países de ingresos altos como Japón, Suecia o Finlandia, poseen actualmente una Esperanza de Vida al Nacer (EVN) de alrededor de 80 años. Los países de ingresos medios como Brasil, México, Chile, Colombia y muchos otros de América Latina, permiten una EVN por arriba de los 72 años; sin embargo, existen naciones de ingresos bajos -como algunos Estados Africanos- en que este indicador se aproxima a los 50 años. Resulta conveniente recordar que en América Latina a mediados del siglo pasado la EVN también se aproximaba a los 50 años. Por otra parte, debemos considerar que otros indicadores de calidad de vida también han sufrido modificaciones importantes, tal es el caso de la mortalidad. (AU)

[Construct validity of FACES III questionnaire in Spanish (México)]. / Validez de constructo del cuestionario FACES III en español (México).

OBJECTIVE: To determine the construct validity of FACES III in spanish (México). DESIGN: Cross-sectional study, descriptive, confirmatory. SETTING: Mexico City, South of Federal District, Tlalpan area, divided into geo- statistical zones of a primary care unit. PATIENTS AND OTHER PARTICIPANTS: A random sample of 270 families selected in their dwellings with proportional coverage based on 17 895 dwellings of the influence area. Measurements and main results. Domicile survey applying FACES III (Family Adaptability and Cohesion Evaluation Scales) in spanish, México. Twelve criteria for evaluate the construct validity of FACES III trough confirmatory factor analysis were established by the researchers. Eight criteria were surpassing appropriately and four do not surpass the minimum values established. CONCLUSIONS: FACES III in spanish (México) is an instrument with reliability of 70% with Cronbach alfa and validity measured using confirmatory Factor Analysis. Nevertheless, we found four limitations that should be analyzed and evaluated in the planning of future studies.

[A reliability analysis of FACES III (the version in Spanish). Family Adaptability and Cohesion Evaluation Scales]. / Análisis de la confiabilidad de FACES III (versión en español).

OBJECTIVE: To determine through five methods (Cronbach's alpha, split, Guttman method, parallel and strict parallel) the confidence coefficient of FACES III, instrument validated on spanish version, and to evaluate it's consistency with these five statistical methods. DESIGN: Descriptive, cross-sectional. SETTING: Tlalpan Area, south of Federal District, México, divided into geo-statistical zones. PATIENTS AND OTHER PARTICIPANTS: A randomised sample of 270 dwellings with proportional coverage, based on 17,895 ordinary dwellings of the area. INTERVENTION: Domicile survey using FACES III (Family Adaptability and Cohesion Evaluation Scales); April-May 1995. MEASUREMENTS AND MAIN RESULTS: The confidence coefficient of FACES III spanish version was calculated using no standardised Cronbach's Alpha = 0.69; split I = 0.73 and split II = 0.66; Guttman method = 0.75; parallel = 0.69 and strict parallel = 0.53. CONCLUSIONS: Cronbach's coefficient demonstrated more advantages than the other statistical methods in relation with the ordinal measurement scale of FACES III. We suggest to take into consideration three important aspects for the correct confidence analysis of this kind of instruments: Variance analysis depending on the scale of items (F test, Friedman or Cochran) Inter-items interactions analysis (nonadditivity) and the use of the balance value as purge element of error' source. Analysis of Tukey estimate, coefficient of concordance (W) and Hotelling's T squared. It's necessary the evaluation and analysis of this aspects before the report of confidence's coefficient values whose can have hidden skew.

Bacterial vaginosis a "broad overview".

Bacterial vaginosis (BV) was first reported in 1995 by Gardner and Dukes, who described the unique clinical signs and symptoms and the distinctive nature of the vaginal discharge associated with it. They also described a "new" causative organism, which they named "Haemophilus vaginalis", subsequently renamed Gardnerella vaginalis. BV is currently the most prevalent cause of infectious vaginitis among women attending for genitourinary diseases. BV has a complex microbiology. Lactobacillus populations, which are usually dominant in healthy women, are replaced by a polymicrobial group of organisms that includes G. vaginalis, anaerobic Gram-negative rods such as Prevotella species, Peptostreptococcus species, Mycoplasma hominis, Ureaplasma urealyticum, and often Mobiluncus species. Anaerobic bacteria produce enzymes, aminopeptidases, that degrade protein and decarboxylases that convert amino acids and other compounds to amines. Those amines contribute to the signs and symptoms associated with the syndrome, raising the vaginal pH and producing a discharge odor. The excessive amounts of bacteria characteristic of the syndrome attach to epithelial cell surfaces, resulting in "clue cell". Nearly half the patients report no noticeable symptoms, but many develop a characteristic copious, malodorous discharge if untreated. Results from epidemiologic studies have associated BV with serious upper genital tract infections and adverse pregnancy outcome. In particular, the presence of BV in pregnant women increases the risk of preterm delivery, and evidence is now compelling that BV is a cause of preterm delivery. The interest in potential invasiveness of G. vaginalis has increased. However, virulence determinants have not been studied enough. The most important therapy includes clindamycin and metronidazole.

[Diagnosing community health by factorial analysis]. / Diagnóstico de salud comunitaria a través del análisis factorial.

OBJECTIVE: To identify the needs of medical care and to determine priorities in the delivery of health services by the factorial analysis of the health indicators obtained from study of the demographic, economic and family features of those registered at a Primary Care Centre. DESIGN: Descriptive and crossover. SETTING: Tlalpan area, Federal District, Mexico, divided into geo-statistical zones. Patients and other participants. A randomised sample of 590 dwellings, with proportional coverage, based on 173,000 inhabitants and 17,895 ordinary dwellings. INTERVENTION: Survey conducted in the home (April-July, 1993). MEASUREMENTS AND MAIN RESULTS: 16 health markers were classified into four categories, demographic, social, health-damaging and family. Nine markers with a reading on the Pearson's correlation index over 0.40 were chosen. Factorial analysis determined two main factors. CONCLUSIONS: The identification of the main risk factors by means of factorial analysis helped in diagnosing community health. A project needs to be worked out to define a methodology for studying medically dysfunctional families and to introduce a prevention and early diagnosis programme for Diabetes Mellitus.

[A comparison of 2 clinical laboratory methods in the diagnosis of bacterial vaginosis]. / Comparación de 2 métodos de laboratorio clínico en el diagnóstico de la vaginosis bacteriana.

OBJECTIVE: To determine the sensitivity, the specificity, and positive and negative predictive values of two laboratory methods used to diagnose bacterial vaginosis; Gram stain and the Gardnerella vaginalis culture, in comparison with the clinical sings of vaginal discharge; homogeneous secretion, pH > 4.7, positive amine test and the presence of clue cells. DESIGN: A prospective, comparative and crossover type. SETTING: This study was carried out in the Health Center "Dr. José Castro Villagrana" SSA, situated in Tlalpan, México City. From January, 1992 to July, 1996. PARTICIPANTS: 3,142 women, from 16 to 55 years old with cervicovaginitis diagnosis, without previous treatment and sexual active life history. RESULTS: By means of clinical criterion (33.1%), it was diagnosed 1,041 women with bacterial vaginosis. Statistical differences were not found between the culture and Gram stain in the presence or no-presence of bacterial vaginosis diagnosed by clinical criterion (p = 0.33) The clue cells were the best predictor of bacterial vaginosis. CONCLUSIONS: The differences between both methods analysed were minimal and they didn't have statistical value so that, it is proposed the Gram stain as diagnostic method of bacterial vaginosis based on factors like speed, reproductiveness and low cost.

Can family medicine survive in Mexico?

This is a brief exposition of some aspects that we consider important to know about in terms of general health characteristics of Mexico, their relationship to the health system and the critical situation of family medicine in Mexico. In addition, we consider that the bases for solution of this crisis are both administrative and educational.