Phase Angle as a Predictor of Mortality in Older Patients with Hip Fracture.

The aim of our study is to determine if there is an association between phase angle obtained by bioelectrical impedance analysis (BIA) and mortality in older patients with fragility hip fractures. A prospective study of patients over 65 years old and hospitalized with a diagnosis of hip fracture was conducted. BIA was performed 24 to 48 h after surgery. Mortality was recorded, and the optimal phase angle cut-off value for predicting mortality was determined by using receiver operating characteristic (ROC) curves. A total of 262 patients were included. Of the patients studied, 10 (3.8%), 21 (8%), 39 (14.9%) and 53 (20.2%) died at 1, 3, 6 and 12 months after surgery, respectively. The phase angle cut-off for mortality at 12 months was 4.05° in women and 4.65° in men. A total of 94 patients (35.9%) were considered to have a low phase angle. After adjustment for possible confounders, mortality in patients with a low phase angle was 5.1 times higher at 1 month, 3.1 times higher at 3 months, 2.9 times higher at 6 months, and 2.8 times higher at 12 months. Phase angle is associated with prognosis in patients admitted for hip fracture regardless of age and comorbidities and can be positioned as a prognostic tool for mortality at 1, 3, 6 and 12 months.

Overuse Injury to Proximal Phalanx in Throwing Athlete (Little Leaguer's Finger): A Case Report.

ABSTRACT: The young, overhead throwing athlete is prone to overuse injuries because of their variable skeletal maturity and often improper technique. An overuse injury to the digit(s) in the overhead throwing athlete, Little Leaguer's Finger, has never been discussed in the literature to our knowledge. We present a case of a 14-year-old man with atraumatic pain, swelling, and edema to his dominant pitching index finger after throwing greater than 90 pitches in one setting. Initial workup of the patient, including an MRI, ruled out an infectious process, and it was determined that there was a stress epiphysitis within the proximal phalanx of the digit. Symptoms within the digit resolved given time, rest, and cessation of throwing activities. The purpose of this report was to stress the importance of establishing the etiology of finger pain in the throwing athlete and to describe a previously unreported overuse injury, Little Leaguer's Finger.

Silent speech of vowels in persons of different cognitive styles / Habla silenciosa de las vocales en personas de diferente estilo cognitivo

Abstract Introduction: This research measures the differences in silent speech of the vowels / a / - / u / in Spanish, in students with different cognitive styles in the Field Dependence - Independence (FDI) dimension. Method: Fifty-one (51) adults participated in the study. Electroencephalographic (EEG) signals were taken from 14 electrodes placed on the scalp in the language region located in the left hemisphere. Previously, the embedded figures test (EFT) was applied in order to classify them into dependent, intermediate and field independent persons. To analyse the EEG data, the signals were decomposed into intrinsic mode functions (IMF) and a mixed repeated measures analysis was performed. Results: It was found that the Power Spectral Density (PSD) in the vowels is independent of the cognitive style and its magnitude depends on the position of the electrodes. Conclusions: The results suggest that there are no significant differences in PSDs in the silent speech of vowels /a/-/u/ in persons of different cognitive styles. Significant differences were found in the PSDs according to the position of the 14 electrodes used. In our configuration, the silent speech of vowels can be studied using electrodes placed in premotor, motor and Wernicke areas.

Resumen Introducción: La investigación mide las diferencias en el habla silenciosa de las vocales /a/-/u/ en español, en estudiantes de diferente estilo cognitivo en la dimensión Dependencia - Independencia de campo (DIC). Método: En el estudio participaron 51 adultos. Se tomaron señales electroencefalográficas (EEG), a partir de 14 electrodos dispuestos sobre el cuero cabelludo de la región del lenguaje ubicada en el hemisferio izquierdo. Previamente les fue aplicado el test de figuras enmascaradas EFT con el fin de clasificarlos en personas dependientes, intermedios e independientes de campo. Para analizar los datos del EEG se descompusieron las señales en funciones de modo intrínseco (IMF) y se realizó un análisis mixto de medidas repetidas. Resultados: Se halló que la densidad espectral de potencia (PSD) en las vocales es independiente del estilo cognitivo y su magnitud depende de la posición de los electrodos. Conclusión: Los resultados sugieren que no existen diferencias significativas en los PSD en el habla silenciosa de las vocales /a/-/u/ en las personas de diferente estilo cognitivo. Se hallaron diferencias significativas en los PSD de acuerdo con la posición de los 14 electrodos utilizados. En nuestra configuración, el habla silenciosa de las vocales puede ser estudiada mediante electrodos situados en las áreas premotora, motora y de Wernicke.

Posterior Humeral Circumflex Artery Aneurysms in Two Collegiate Pitchers.

Posterior humeral circumflex artery aneurysms in upper extremity athletes are a rarely described entity now beginning to gain wider recognition in the medical literature. Recent studies have demonstrated that these aneurysms may be underdiagnosed and that appropriate recognition with early diagnosis is imperative for improved outcomes. This case report aims to increase awareness of posterior humeral circumflex artery aneurysms and to educate physicians on the appropriate recognition of symptoms, diagnosis, and treatment. We describe two presentations of the same injury, as well as an approach to diagnosis and treatment. We also discuss new diagnostic techniques and future research plans. LEVEL OF EVIDENCE: Level III diagnostic study.

[Patient with testosterone deficit syndrome after external beam radiotherapy]. / Paciente con síndrome de déficit de testosterona tras radioterapia externa.

Testosterone deficit syndrome is a clinical and biochemical syndrome associated with advanced age and characterized by some symptomsassociated with serum testosterone levels deficiency, which may result in a decrease of quality of life and negatively affect the function of multiple organs or systems. Clinical guidelines recommend testosterone replacement therapy (TRT) in patients with testosterone decrease that associate muscle mass and strength loss, lumbar spinal column bone density decrease, or libido and erection decrease. Contraindications for treatment would include active prostate cancer or without treatment, PSA >4 ng/ml waiting for diagnostic workup, breast cancer, severe sleep apnea, infertility, hematocrit over 50% or severe lower urinary tract symptoms secondary to benign prostatic hypertrophy. In certain situations there is still great controversy, without enough evidence to establish an action. References in case of patientstreated with brachytherapy or radiotherapy are unspecific: they only recommend caution in the treatment with TRT in these patients and strict monitoring of the possible recurrence. In our opinion, low-intermediate risk prostate cancer patients treated with radiotherapy only, without evidence of residual or recurrent disease, are candidates for TRT if symptoms justify it, leaving a free period of never less than one year after nadir (or 24 months after the end of therapy) which guarantees, on the possible means, the absence of biochemical or clinical recurrence,with strict follow up of clinical and biochemical usual parameters (hematocrit, hemoglobin, DRE, PSA).

Paciente con SDT tras radioterapia externa / Patient with testosterone deficit syndrome after external beam radiotherapy

El síndrome de déficit de testosterona es un síndrome clínico y bioquímico asociado a la edad avanzada y caracterizado por unos síntomas asociados con una deficiencia en los niveles de testosterona sérica, lo que puede resultar en una disminución de la calidad de vida y afectar de modo negativo a la función de múltiples órganos o sistemas. Las guías clínicas recomiendan el tratamiento sustitutivo con testosterona (TST) en pacientes con disminución de la misma y que asocien pérdida de masa muscular y fuerza, descenso de la densidad ósea en columna lumbar o disminución de la libido y erección. Las contraindicaciones para el tratamiento incluirían el cáncer de próstata activo o no tratado, el PSA > 4 ng/ml pendiente de valoración, el cáncer de mama, la apnea de sueño severa, la infertilidad, el hematocrito por encima de 50% o los síntomas severos del tracto urinario inferior debidos a hipertrofia prostática benigna. En determinadas situaciones existe todavía gran controversia, sin que dispongamos de niveles de evidencia suficientes para establecer una actuación. Las referencias en el caso de los pacientes tratados con braquiterapia o radioterapia son poco concretas: se aconseja únicamente la cautela en el tratamiento con TST de estos pacientes con monitorización estricta de la posible recidiva. En nuestra opinión, los pacientes tratados con radioterapia sola por cáncer de próstata de bajo o medio riesgo, sin evidencia de enfermedad residual o recidiva, son susceptibles de TST si la sintomatología lo justifica, dejando un período libre nunca inferior a un año tras su nadir (o 24 meses tras el final del tratamiento) que garantice, en la medida de lo posible, la ausencia de recidiva bioquímica o clínica, con seguimiento estricto de los parámetros clínicos y bioquímicos habituales (hematocrito, hemoglobina, TR, PSA) (AU)

Testosterone deficit syndrome is a clinical and biochemical syndrome associated with advanced age and characterized by some symptoms associated with serum testosterone levels deficiency, which may result in a decrease of quality of life and negatively affect the function of multiple organs or systems. Clinical guidelines recommend testosterone replacement therapy (TRT) in patients with testosterone decrease that associate muscle mass and strength loss, lumbar spinal column bone density decrease, or libido and erection decrease. Contraindications for treatment would include active prostate cancer or without treatment, PSA > 4 ng/ml waiting for diagnostic workup, breast cancer, severe sleep apnea, infertility, hematocrit over 50% or severe lower urinary tract symptoms secondary to benign prostatic hypertrophy. In certain situations there is still great controversy, without enough evidence to establish an action. References in case of patients treated with brachytherapy or radiotherapy are unspecific: they only recommend caution in the treatment with TRT in these patients and strict monitoring of the possible recurrence. In our opinion, low-intermediate risk prostate cancer patients treated with radiotherapy only, without evidence of residual or recurrent disease, are candidates for TRT if symptoms justify it, leaving a free period of never less than one year after nadir (or 24 months after the end of therapy) which guarantees, on the possible means, the absence of biochemical or clinical recurrence, with strict follow up of clinical and biochemical usual parameters (hematocrit, hemoglobin, DRE, PSA) (AU)

Resultados de una encuesta epidemiológica de hábitos de higiene íntima en mujeres latinoamericanas / Resultof of an epidemiological survery about hygiene habits in latin american women

Describir los hábitos higiénicos íntimos femeninos de algunas mujeres de Latinoamérica durante 2008. Se aplicó una encuesta piloto, previamente diseñada, a un total de mil mujeres que acudieron a la consulta de un grupo de ginecólogos de Latinoamérica durante 2008 y aceptaron contestar voluntariamente la encuesta. Los países participantes fueron: Colombia, Costa Rica, Ecuador, Guatemala, Honduras, México, Panamá, Perú, República Dominicana y Venezuela. El 95,4 por ciento de las mujeres refirió realizar aseo corporal una o más veces al día y 2,8 por ciento, una o dos veces por semana. El 71 por ciento realiza aseo del área genital de adelante hacia atrás (de vulva a ano). El tipo de jabón más comúnmente usado es el jabón en barra, seguido de la presentación líquida. Se evidenció un porcentaje de 66,9 por ciento de mujeres que depilan su área genital. El área circunscrita al bikini es la más depilada con 32,8 por ciento y la depilación del área genital en su totalidad es de 28,8 por ciento. El material de la ropa interior en la región vulvar más utilizado por las mujeres latinoamericanas encuestadas es el algodón (65,5 por ciento), que sumado a 20,2 por ciento de las mujeres que utilizan ropa interior de cualquier material con algodón fue cercano al 86 por ciento. En relación con el uso de elementos de aseo genital durante las relaciones sexuales, 29,7 por ciento de las mujeres encuestadas refiere utilizar duchas vaginales; de las cuales 42 por ciento refirió su uso siempre que tiene relaciones sexuales y 43 por ciento, ocasionalmente. A la costumbre de orinar antes y después de tener relaciones sexuales se encontró que 37,9 por ciento de las mujeres orina después del coito; 17 por ciento, antes y 11,8 por ciento orina antes y después. Las mujeres realizan en un gran porcentaje lavado de manos después de orinar o defecar, pero el hábito de lavarse las manos antes, sigue siendo bajo. En cuanto a la técnica de aseo genital, el porcentaje de técnica inadecuada...

To describe the intimate hygienic feminine habits of some women of Latin-America during 2008. A previously designed pilot survey was applied to a total of one thousand women who assisted to the office of a group of gynecologists of Latin America during 2008 and agreed to voluntarily answer the survey. The participant countries were: Colombia, Costa Rica, Ecuador, Guatemala, Honduras, Mexico, Panama, Peru, Dominican Republic and Venezuela.95.4 percent of these women practiced corporal hygiene at least once daily and 2.8 percent, once or twice a week. 71 percent cleaned their genital area backwards (from vulva to anus). The type of soap most commonly used is the bar soap followed by liquid body wash. Evidence showed that 66.9 percent of women depilate their genital area. The bikini surrounding area is the most depilated one, with a 32.8 percent and the total depilation of the genital area is 28.8 percent. Cotton is the most commonly used material for underwear on the vulvar area by surveyed Latin American women (65.5 percent), which added to a 20.2 percent of women who use underwear of any material with cotton was nearly 86 percent. When the use of genital hygiene devices during sexual intercourse is questioned, 29.7 percent of the surveyed women opted to use vaginal showers; of which 42 percent used it every time they had sexual intercourse and 43 percent just occasionally. In relation to the habit of urinating before and after having sexual intercourse it was established that 37.9 percent of women urinate after the coitus; 17 percent before it, and 11.8 percent urinates before and after. Women, in a great percentage, wash their hands after urinating or defecating, but the habit of washing their hands before is still not as frequent. Regarding the genital (feminine) hygiene technique, the percentage of "inadequate" hygiene technique is surprisingly as low as about 28 percent. With this in mind, it is fundamental to reinforce training, improve information...

Emotional changes in men treated with sildenafil citrate for erectile dysfunction: a double-blind, placebo-controlled clinical trial.

INTRODUCTION: Erectile dysfunction (ED) has been associated with several comorbidities and can cause significant loss of quality of life and self-esteem. AIM: In men with ED, to use the validated Self-Esteem and Relationship (SEAR) questionnaire to evaluate changes in self-esteem associated with sildenafil treatment of ED and to assess changes dependent on concomitant comorbid conditions. METHODS: This was a 14-week, international, randomized, parallel-group, double-blind, flexible-dose (25, 50, or 100 mg), placebo-controlled study of sildenafil in men aged >or=18 years with a clinical diagnosis of ED (score

Efficacy and tolerability of vardenafil in men with mild depression and erectile dysfunction: the depression-related improvement with vardenafil for erectile response study.

OBJECTIVE: Erectile dysfunction and depression are highly associated. Previous studies have shown benefits of phosphodiesterase-5 inhibitor treatment for erectile dysfunction associated with antidepressant therapy or subsyndromal depression. The present study assessed the safety and efficacy of vardenafil in men with erectile dysfunction and untreated mild depression. METHOD: In this 12-week, multicenter, randomized, flexible-dose, parallel-group, double-blind study, 280 men with erectile dysfunction for at least 6 months and untreated mild major depression received placebo or vardenafil, 10 mg/day, for 4 weeks, with the option to titrate to 5 mg/day or 20 mg/day after each of two consecutive 4-week intervals. Endpoints included International Index of Erectile Function erectile function domain and 17-item Hamilton Depression Rating Scale (HAM-D) scores. RESULTS: Vardenafil produced statistically significant and clinically meaningful improvement in all erectile function parameters. The International Index of Erectile Function erectile function domain score was 22.9 with vardenafil compared to 14.9 with placebo. The HAM-D score was lower in the vardenafil group (7.9) than in the placebo group (10.1). Treatment with vardenafil was the most important predictor for return to normal erectile function. Improvement in International Index of Erectile Function erectile function domain score was the most important predictor of remission in depressive symptoms. CONCLUSIONS: Vardenafil was well tolerated and highly efficacious in men with erectile dysfunction and untreated mild major depression. Significant improvements in erectile function and depression were observed in patients treated with vardenafil versus placebo. Erectile dysfunction treatment should be considered a component of therapy for men with depression and erectile dysfunction.

[The treatment of varicocele by microsurgical techniques]. / Tratamiento del varicocele por técnicas microquirúrgicas.

We performed an extensive bibliographic search, and review the alternatives for surgical treatment of varicocele, especially microsurgical techniques. The surgical techniques for varicocele have not suffered much variation over the last years, being their use generalized among urologists. The lower incidence of relapse and secondary hydrocele to lymphatic lesion make retroperitoneal techniques be used less frequently in favour of inguinal or subinguinal techniques, microsurgical or not. For better understanding of the surgical indications and development of techniques we offer some short anatomical and physiopathological comments about varicocele.

Impotencia e hipertensión arterial / Impotence and hypertension

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Neoplasia intraepitelial cervical III, tratada con laser CO2: seguimiento citológico, colposcópico e histopatológico / Intraepithelial cervical neoplasia III treated with CO2 laser. Cytologic, colposcopic and histopathological follow up

Se llevó a cabo un estudio prospectivo en el cual se incluyeron a 52 pacientes del servicio de colposcopia del Hospital "Lic. Adolfo López Mateos" que presentaron un diagnóstico histológico de carcinoma in situ del cervix (CIS), las cuales previamente habían sido sometidas a un protocolo de estudio mediante citología y colposcopia. Todas las pacientes fueron tratadas mediante la extirpación o extracción de un cilindro cervical con rayo laser de CO2, el seguimiento postoperatorio reportó los siguientes resultados, sumados los reportes de normal e inflamatorio en la citología, la colposcopia y la histología, mostraron 78.2 por ciento, 89.1 por ciento y 91.2 por ciento respectivamente. Por lo tanto el método de tratamiento es adecuado y con un índice de curación satisfactorio