[Main causes of orthopedic external consultation in a Second Level Clinic in Mexico]. / Principales motivos de consulta externa ortopédica en un hospital de segundo nivel en México.

INTRODUCTION: The epidemiology of diseases allows the generation of preventive measures, for the modification of their natural evolution or to prevent their appearance. In second-level hospitals of care, most of the pathologies of each medical specialty are treated. Therefore, knowing the main reasons for external consultation in orthopedics and their seasonal predominance is a tool for implementing strategies for the benefit of patients. MATERIAL AND METHODS: Observational study carried out with the patient population of the external orthopedic consultation service of a second-level hospital of care, from January to December 2017. Patients over the age of 18 who first attended consultation were included. RESULTS: 11,704 consultations granted in the period, 7,862 (67.17%) women and 3,842 (32.82%) men. The average age of patients was 51.84 ± 0.14. The most common cause of consultation was arthropathies (47.65%). During the autumn, the largest number of consultations (32.33) were granted. CONCLUSIONS: Arthropathies, specifically gonarthrosis, were the main reason for external consultation, accounting for nearly half of the consultations granted. It is transcendental to identify the modifiable risk factors of these pathologies with the aim of reducing the negative impact it generates at the functional, economic and quality of life level. Clinical relevance: Further epidemiological studies on orthopedic pathologies will improve preventive strategies and optimize resources to improve patient care.

INTRODUCCIÓN: La epidemiología de las enfermedades permite la generación de medidas preventivas para la modificación de su evolución natural o para evitar su aparición. En los hospitales de segundo nivel de atención se tratan la mayor parte de las patologías de cada especialidad médica. Por lo tanto, saber los principales motivos de consulta externa en ortopedia y su predominio estacional es una herramienta para la implementación de estrategias en beneficio de los pacientes. MATERIAL Y MÉTODOS: Estudio observacional realizado con la población de pacientes del servicio de consulta externa de ortopedia de un hospital de segundo nivel de atención de Enero a Diciembre del año 2017. Se incluyeron pacientes mayores de 18 años que acudieron a consulta por primera vez. RESULTADOS: De 11,704 consultas otorgadas en el período, 7,862 (67.17%) fueron mujeres y 3,842 (32.82%) hombres. La edad promedio de los pacientes fue de 51.84 ± 0.14. La causa más frecuente de consulta fueron las artropatías (47.65%). Durante el otoño se otorgó el mayor número de consultas (32.33%). CONCLUSIONES: Las artropatías, específicamente la gonartrosis, fue el principal motivo de consulta externa, representando casi la mitad de las consultas otorgadas. Es transcendental identificar los factores de riesgo modificables de estas patologías con el objetivo de disminuir el impacto negativo que genera a nivel funcional, económico y de calidad de vida. Importancia clínica: La realización de más estudios epidemiológicos sobre las patologías ortopédicas permitirá mejorar las estrategias preventivas y optimizar los recursos para mejorar la atención de los pacientes.

[Basis for the multidisciplinary approach to shoulder pseudoparesis and pseudoparalysis due to rotator cuff pathology]. / Bases para el abordaje multidisciplinario de la seudo paresia y seudo parálisis de hombro por patología del manguito rotador.

INTRODUCTION: The painful shoulder is an entity that generates much of the orthopedic consultations worldwide, although it can affect at any stage of life, its prevalence is higher as age increases. Rotator cuff condition is often the most relevant cause of pain and dysfunction. Two common consequences of rotator cuff condition are pseudoparesis and pseudoparalysis, and even though they share similar etiology and symptomatology, their clinical differentiation is critical for optimal management and timely resolution. OBJECTIVE: To review the theoretical and clinical bases for the differentiation and management of pseudoparesis and pseudoparalysis due to rotator cuff pathology. MATERIAL AND METHODS: Descriptive review of the concepts of pseudoparesis and pseudoparalysis from the orthopedic, physiotherapy and rehabilitation perspective. RESULTS: Once the differences in rotator cuff injury mechanisms and how they translate into painful shoulder semiology are understood, it is possible to integrate a differential diagnosis between pseudoparesia and pseudoparalysis. Diagnosis should integrate specific evaluations and exercises to identify both conditions and, once distinguished and identified, allow optimal guidance of therapeutic approach. CONCLUSION: The differentiation between pseudoparalysis and pseudoparesis allows us to understand the mechanisms of injury and, finally, to provide the optimal treatment for patients with painful shoulder due to rotator cuff pathology.

INTRODUCCIÓN: El hombro doloroso es una entidad que genera gran parte de las consultas de ortopedia a nivel mundial, si bien puede afectar en cualquier etapa de la vida, su prevalencia es mayor conforme aumenta la edad. La afección del manguito rotador suele ser la causa más relevante de dolor y disfunción. Dos consecuencias comunes de la afección del manguito rotador son la seudo paresia y la seudo parálisis y aun cuando comparten una etiología y sintomatología semejantes, su diferenciación clínica es fundamental para su manejo óptimo y resolución oportuna. OBJETIVO: Revisar las bases teóricas y clínicas para la diferenciación y manejo de la seudo paresia y seudo parálisis por patología del manguito rotador. MATERIAL Y MÉTODOS: Revisión descriptiva de los conceptos de seudo paresia y seudo parálisis desde la perspectiva ortopédica, de fisioterapia y rehabilitación. RESULTADOS: Una vez que se comprenden las diferencias en los mecanismos de lesión del manguito rotador y el modo en el que se traducen en la semiología del hombro doloroso, es posible integrar un diagnóstico diferencial entre seudo paresia y seudo parálisis. El diagnóstico debe integrar las evaluaciones y ejercicios específicos para que permitan identificar ambas condiciones y, una vez que se han distinguido e identificado, permitirá orientar el abordaje terapéutico de manera óptima. CONCLUSIÓN: La diferenciación entre seudo parálisis y seudo paresia permite comprender los mecanismos de lesión y, finalmente, proporcionar el tratamiento óptimo a los pacientes con hombro doloroso por patología del manguito rotador.

[Posterior instability of the shoulder]. / Inestabilidad posterior del hombro.

No Abstract available.

Artroplastía total de hombro bajo monitoreo de la perfusión cerebral. Reporte del primer caso en México / Total shoulder arthroplasty under monitoring of cerebral perfusion. Report of the first case in Mexico

Resumen: Introducción: Desde hace algún tiempo es tema de controversia el mantenimiento de la perfusión cerebral durante la cirugía de hombro realizada en posición de silla de playa. El objetivo de este reporte es presentar el primer caso en México de una artroplastía total de hombro realizada con bloqueo interescalénico y monitoreo de la saturación cerebral de oxígeno. Este monitoreo se describió en 1977, pero sólo hasta la última década ha alcanzado relevancia desde el punto de vista clínico. Caso clínico: Paciente de 84 años programado para artroplastía total de hombro en posición de silla de playa bajo anestesia regional tipo bloqueo interescalénico guiado por ultrasonido, en la cual se monitoreó la saturación regional de oxígeno (CrSO2). Discusión: El monitoreo de la oximetría cerebral es una herramienta adecuada que nos permite tener una valoración continua durante todo el transanestésico, con lo que podemos tomar decisiones de forma más expedita. Con base en esto consideramos que este tipo de monitoreo debe ser básico en pacientes colocados en posición de silla de playa, así como el uso preponderante de anestesia regional; en los casos donde ésta no se pueda utilizar, este monitor es primordial.

Abstract: Introduction: The maintenance of cerebral perfusion during shoulder surgery performed in the beach chair position is controversial. The aim of this report is to present the first case in Mexico of a total shoulder arthroplasty performed with interscalene block and monitoring of the cerebral oxygen saturation. This monitoring was described in 1977, but only until the last decade has it reached relevance from the clinical point of view. Clinical case: We present an 84-year-old patient scheduled for total shoulder arthroplasty in beach chair position under regional anesthesia (ultrasound-guided interscalene block) in which the regional oxygen saturation (CrSO2) was monitored. Discussion: Monitoring of cerebral oximetry is a suitable tool that allows us to have a continuous assessment throughout the transanesthetic, so we can make decisions more expeditiously. On this basis, we believe that this type of monitoring should be fundamental in patients placed in a beach chair position, as well as predominantly use regional anesthesia. In cases where it cannot be used, this monitor is absolutely essential.

[Total shoulder arthroplasty under monitoring of cerebral perfusion. Report of the first case in Mexico]. / Artroplastía total de hombro bajo monitoreo de la perfusión cerebral. Reporte del primer caso en México.

INTRODUCTION: The maintenance of cerebral perfusion during shoulder surgery performed in the beach chair position is controversial. The aim of this report is to present the first case in Mexico of a total shoulder arthroplasty performed with interscalene block and monitoring of the cerebral oxygen saturation. This monitoring was described in 1977, but only until the last decade has it reached relevance from the clinical point of view. CLINICAL CASE: We present an 84-year-old patient scheduled for total shoulder arthroplasty in beach chair position under regional anesthesia (ultrasound-guided interscalene block) in which the regional oxygen saturation (CrSO2) was monitored. DISCUSSION: Monitoring of cerebral oximetry is a suitable tool that allows us to have a continuous assessment throughout the transanesthetic, so we can make decisions more expeditiously. On this basis, we believe that this type of monitoring should be fundamental in patients placed in a beach chair position, as well as predominantly use regional anesthesia. In cases where it cannot be used, this monitor is absolutely essential.

INTRODUCCIÓN: Desde hace algún tiempo es tema de controversia el mantenimiento de la perfusión cerebral durante la cirugía de hombro realizada en posición de silla de playa. El objetivo de este reporte es presentar el primer caso en México de una artroplastía total de hombro realizada con bloqueo interescalénico y monitoreo de la saturación cerebral de oxígeno. Este monitoreo se describió en 1977, pero sólo hasta la última década ha alcanzado relevancia desde el punto de vista clínico. CASO CLÍNICO: Paciente de 84 años programado para artroplastía total de hombro en posición de silla de playa bajo anestesia regional tipo bloqueo interescalénico guiado por ultrasonido, en la cual se monitoreó la saturación regional de oxígeno (CrSO2). DISCUSIÓN: El monitoreo de la oximetría cerebral es una herramienta adecuada que nos permite tener una valoración continua durante todo el transanestésico, con lo que podemos tomar decisiones de forma más expedita. Con base en esto consideramos que este tipo de monitoreo debe ser básico en pacientes colocados en posición de silla de playa, así como el uso preponderante de anestesia regional; en los casos donde ésta no se pueda utilizar, este monitor es primordial.

Metformin and cancer: Between the bioenergetic disturbances and the antifolate activity.

For decades, metformin has been the first-line drug for the treatment of type II diabetes mellitus, and it thus is the most widely prescribed antihyperglycemic drug. Retrospective studies associate the use of metformin with a reduction in cancer incidence and cancer-related death. However, despite extensive research about the molecular effects of metformin in cancer cells, its mode of action remains controversial. In this review, we summarize the current molecular evidence in an effort to elucidate metformin's mode of action against cancer cells. Some authors describe that metformin acts directly on mitochondria, inhibiting complex I and restricting the cell's ability to cope with energetic stress. Furthermore, as the drug interrupts the tricarboxylic acid cycle, metformin-induced alteration of mitochondrial function leads to a compensatory increase in lactate and glycolytic ATP. It has also been reported that cell cycle arrest, autophagy, apoptosis and cell death induction is mediated by the activation of AMPK and Redd1 proteins, thus inhibiting the mTOR pathway. Additionally, unbiased metabolomics studies have provided strong evidence to support that metformin alters the methionine and folate cycles, with a concomitant decrease in nucleotide synthesis. Indeed, purines such as thymidine or hypoxanthine restore the proliferation of tumor cells treated with metformin in vitro. Consequently, some authors prefer to refer to metformin as an "antimetabolite drug" rather than a "mitochondrial toxin". Finally, we also review the current controversy concerning the relationship between the experimental conditions of in vitro-reported effects and the plasma concentrations achieved by chronic treatment with metformin.

Artroplastía de hombro en el medio privado: Análisis de las variables demográficas y de comorbilidad en una muestra de 120 pacientes / Shoulder arthroplasty in the private practice: Analysis of demographics and comorbid conditions in a sample of 120 patients

Objetivo: Describir las variables demográficas de una serie de casos de artroplastía de hombro operadas en un solo hospital y por un solo equipo quirúrgico. Material y métodos: Se incluyeron 120 artroplastías de hombro de Enero de 2006 a Noviembre del 2014 obteniéndose las variables de edad, género, diagnóstico de base, tipo de prótesis utilizada, comorbilidades, lado afectado, ocupación, tiempo de evolución y cirugías previas. Resultados: 66% de los casos fueron mujeres y 34% hombres, el promedio de edad fue de 66 años y el diagnóstico más frecuente fue la artropatía por desgarro del manguito rotador (30%). La prótesis total de anatomía reversa se realizó en 51% de los casos, seguida por la hemiprótesis en 38%. 70% de la población fue originario del D.F. La hipertensión arterial se presentó en 23% los casos. 36% de los casos tenía antecedentes de cirugías previas. En 40% de los casos la ocupación fue trabajo en el hogar. Conclusión: La artroplastía de hombro es un procedimiento que se realiza con un alto volumen en este centro hospitalario. Nuestra serie reporta un número significativo de casos en donde las variables demográficas obtenidas pueden representar un panorama inicial en la artroplastía de hombro en pacientes mexicanos, y presentar el perfil del paciente candidato a este procedimiento al no contar con registros previos.

Objective: To describe the demographics in a series of shoulder arthroplasty cases operated in a single hospital and by the same surgical team. Material and methods: 120 shoulder arthroplasties performed between January 2006 and November 2014 were included. The following variables were analyzed: age, gender, baseline diagnosis, type of prosthesis used, comorbid conditions, involved side, occupation, follow-up time, and surgical history. Results: Females accounted for 66% and males 34%; mean age was 66 years and the most frequent diagnosis was arthropathy resulting from rotator cuff tear (30%). The reverse total shoulder prosthesis was used in 51% of cases, followed by the hemiprosthesis in 38%. Seventy per cent of patients were from the Federal District. Arterial hypertension occurred in 23% of cases; 36% of cases had undergone prior surgery; 40% of cases worked at home. Conclusion: Shoulder arthroplasty is a procedure frequently performed at this hospital. Our case series reports a significant number of cases in which the demographics may give us an overview of shoulder arthroplasty in Mexican patients and describe the characteristics of patients eligible for this procedure, as there are no other registries available.

[Shoulder arthroplasty in the private practice. Analysis of demographics and comorbid conditions in a sample of 120 patients]. / Artroplastía de hombro en el medio privado. Análisis de las variables demográficas y de comorbilidad en una muestra de 120 pacientes.

OBJECTIVE: To describe the demographics in a series of shoulder arthroplasty cases operated in a single hospital and by the same surgical team. MATERIAL AND METHODS: 120 shoulder arthroplasties performed between January 2006 and November 2014 were included. The following variables were analyzed: age, gender, baseline diagnosis, type of prosthesis used, comorbid conditions, involved side, occupation, follow-up time, and surgical history. RESULTS: Females accounted for 66% and males 34%; mean age was 66 years and the most frequent diagnosis was arthropathy resulting from rotator cuff tear (30%). The reverse total shoulder prosthesis was used in 51% of cases, followed by the hemiprosthesis in 38%. Seventy per cent of patients were from the Federal District. Arterial hypertension occurred in 23% of cases; 36% of cases had undergone prior surgery; 40% of cases worked at home. CONCLUSION: Shoulder arthroplasty is a procedure frequently performed at this hospital. Our case series reports a significant number of cases in which the demographics may give us an overview of shoulder arthroplasty in Mexican patients and describe the characteristics of patients eligible for this procedure, as there are no other registries available.

Key proteins in the polyamine-trypanothione pathway as drug targets against Trypanosoma cruzi.

In trypanosomatids, redox homeostasis is centered on trypanothione (N(1),N(8)-bis(glutathionyl)spermidine, T(SH)2), a low molecular weight thiol that is distinctive for this taxonomic family and not present in the mammalian host. Thus, the study of the metabolism of T(SH)2 is interesting as a potential therapeutic target. In this review, we summarize the existing evidence about the metabolism of thiols in Trypanosoma cruzi, focused on those proteins that can be considered the best candidates for selective therapy. Herein, we examine the biosynthetic pathway of T(SH)2, identifying three key points that are susceptible to attack pharmacologically: the activity of the trypanothione reductase (TR), the function of glutamate-cysteine ligase (GCL) and polyamine transport in T. cruzi. TR has been widely studied and is a good example for the development of the medicinal chemistry of antichagasic compounds. Conversely, GCL and the polyamine uptake system are high flow points in the reductive metabolism of the parasite. However, very little is known at the molecular level about these two systems. Therefore, their potential as targets for drug development is discussed, and it is suggested that research should focus on the production of alternative drugs for Chagas' disease treatment.

Dehydroepiandrosterone effect on Plasmodium falciparum and its interaction with antimalarial drugs.

Dehydroepiandrosterone (DHEA) inhibits glucose 6-phosphate dehydrogenase (G6PDH) of different species and may potentially decrease intracellular glutathione. Therefore, it can have and enhance anti-parasitic action against Plasmodium spp. We evaluated the antiplasmodial activity and the interaction of DHEA with several antimalarial drugs. The inhibitory effect of DHEA on erythrocytic and G6PDH activity and changes in the content of total and reduced gluthatione Plasmodium falciparum content were also evaluated. DHEA showed antiplasmodial activity in vitro, but the potency was low (IC(50) 118.5 µM). DHEA inhibits G6PDH from healthy erythrocyte and decreases GSH content in both erythrocytes and P. falciparum. DHEA did not synergize or antagonize the antiplasmodial effect of several antimalarial drugs. The most important actions of DHEA were the inhibition of G6PDH activity, and the decrease in both P. falciparum and erythrocyte GSH. Since most of the GSH in Plasmodium spp. infected erythrocytes comes from the parasite itself, it is possible that DHEA analogs could act with higher selectivity, better potency, and might interact synergistically with antimalarials drugs.

Role of matrix metalloproteinases 2 and 9 in ex vivo Trypanosoma cruzi infection of human placental chorionic villi.

BACKGROUND: Chagas' disease is caused by the haemophlagelated protozoan Trypanosoma cruzi (T. cruzi). During congenital transmission the parasite breaks down the placental barrier. In the present study we analyzed the participation of matrix metalloproteases (MMPs) in the extracellular matrix (ECM) remodeling during T. cruzi ex vivo infection of human placental chorionic villi explants. METHODS: Chorionic villi from healthy woman placentas were incubated in the presence or absence of 105 or 106 T. cruzi trypomastigotes (Y strain) with or without the MMPs inhibitor doxycycline. Effective infection was tested measuring parasite DNA by real time PCR (qPCR). MMP-2 and MMP-9 expression were determined by western blotting and immunohistochemistry and their activities were measured by zymography. The effect of MMPs on ECM structure was analyzed histochemically. RESULTS: T. cruzi induces the expression and activity of MMP-2 and MMP-9 in chorionic villi. Inhibition of the MMPs prevents the tissue damage induced by T. cruzi and partially decreases the ex vivo infection of the chorionic villi. CONCLUSION: MMPs are partially responsible for the ECM changes observed in human chorionic villi during T. cruzi infection and participate in tissue invasion. On the other hand, MMPs may be part of a local placental antiparasitic mechanism.

Trypanosoma cruzi induces apoptosis in ex vivo infected human chorionic villi.

Chagas' disease, produced by the haemoflagellated protozoan Trypanosoma cruzi (T. cruzi), is one of the most frequent endemic diseases in Latin America. In spite that in the past few years T. cruzi congenital transmission has become of epidemiological importance, studies about this mechanism of infection are scarce. The placental tissue undergoes apoptosis throughout gestation, as part of its normal turnover. On the other hand, it is known that T. cruzi induces, delays or inhibits apoptosis in other mammalian tissues. In order to determine the effect of parasite invasion on normal apoptosis in the placenta, explants of human chorionic villi were incubated with 105 trypomastigotes for 24 h. Effective infection was tested by visualizing T. cruzi antigens in histological preparations and by PCR. Upon infection, apoptotic cell death was determined by light and transmission electron microscopy, TUNEL analysis, measurement of caspase-3 like activity and immunohistochemical detection of caspase 3 cleaved cytokeratin 18. Our results clearly show that T. cruzi induces apoptosis in the chorionic villi and suggest that this is one of mechanisms used by the parasite to insure infection and invasion of human placenta and fetus.