Latin American formal consensus on the indications for the surgical treatment of massive and irreparable rotator cuff tears.

OBJECTIVES: To implement the Formal Consensus Method among a group of experts in shoulder surgery in Latin America, in order to establish appropriate indications for the surgical treatment of massive and irreparable rotator cuff injuries. METHODS: The Formal Consensus Method was used to develop surgical treatment recommendations for massive and irreparable rotator cuff tears (MIRCT). Three independent groups of experts in shoulder surgery were confirmed. The steering group conducted a systematic literature review and constructed a voting matrix consisting of 348 clinical scenarios. The rating group, composed of 15 members, rated each scenario on two occasions: first anonymously and then during an in-person discussion meeting. The median and voting ranges were used to classify each scenario as inappropriate, uncertain, or appropriate for each surgical technique. Finally, the reading group, consisting of 10 surgeons, reviewed, evaluated and rated the recommendations derived from the detailed analysis of the voting grids. RESULTS: The main finding of the study reveals a high percentage (70%) of clinical scenarios in which consensus was achieved regarding the appropriateness or inappropriateness of different surgical alternatives for the treatment of massive and irreparable rotator cuff injuries. Through a detailed analysis of the voting grids, a total of 20 recommendations were elaborated concerning the appropriateness of various surgical techniques in addressing irreparable rotator cuff tears. CONCLUSIONS: The indications for the operative treatment of MIRCT were determined based on expert consensus and the best available evidence, they seek to provide guidance on the appropriateness of various surgical techniques for different clinical scenarios. LEVEL OF EVIDENCE: V.

¿Debemos re-evaluar el término PASTA en lesiones del Manguito Rotador? / Should the term PASTA for rotator cuff injuries be reassessed?

Sr. Editor: La primera descripción de las lesiones parciales del manguito rotador fue hecha por Codman en 19341. Sin embargo, fue hasta el 2001 que Snyder acuñó el término PASTA (Partial Articular-Side Supraspinatus Avulsion) para referirse a una lesión, tipo avulsión, del lado articular del tendón del supraespinoso, que ocasiona dolor e incapacidad funcional y que en algunos pacientes debía ser intervenida quirúrgicamente para mejorar los síntomas y evitar la progresión de la enfermedad2. Con el advenimiento de la RMN se pudo comprobar que estas lesiones son mucho más frecuentes que las lesiones del lado bursal, debatiendo el concepto estrictamente mecánico de Neer que atribuía el daño a un pinzamiento subacromial3. Se han diseñado numerosas estrategias de tratamiento para las lesiones tipo PASTA, consistentes todas ellas en re-insertar el "tendón" a la tuberosidad mayor por vía transtendón o completándola por vía bursal.

Should the term PASTA for rotator cuff injuries be reassessed? / ¿Debemos re-evaluar el término PASTA en lesiones del Manguito Rotador?

Partial tears of the rotator cuff were initially described by Codman in 1934.1 However, it was not until 2001 that Snyder coined the term PASTA to describe an avulsion-type injury on the articular side of the supraspinatus tendon, causing pain and functional disability, for which some patients had to undergo surgery for symptom relief and for avoidance of disease progression.2 The advent of magnetic resonance imaging allowed confirming that articular side tears are much more frequent than bursal side ones, questioning the strictly mechanical concept by Neer, who said that the rotator cuff damage was because the subacromial impingement.3 Many surgical strategies for PASTA lesions have been designed, all of which consist of re-attachment the tendon in the greater tuberosity either transtendon or completing it through the bursal side. Snyder started from the premise that what he observed in the arthroscopic view of the glenohumeral joint, was the supraspinatus tendon; consequently, any lesion in the crescent area, distal to the rotator cable seen through the articular side was considered as a tendinous lesion.

The single water-surface sweep estimation method accurately estimates very low (n = 4) to low-moderate (n = 25-100) and high (n > 100) Aedes aegypti (Diptera: Culicidae) pupae numbers in large water containers up to 13 times faster than the exhaustive sweep and total count method and without any sediment contamination.

OBJECTIVE: To confirm that a single water-surface sweep-net collection coupled with three calibration factors (2.6, 3.0 and 3.5 for 1/3, 2/3 and 3/3 water levels, respectively) (WSCF) could accurately estimate very low to high Aedes aegypti pupae numbers in water containers more rapidly than the exhaustive 5-sweep and total count (ESTC) method recommended by WHO. METHODS: Both methods were compared in semi-field trials using low (n = 25) to moderate (n = 50-100) pupae numbers in a 250-l drum at 1/3, 2/3 and 3/3 water levels, and by their mean-time determinations using 200 pupae in three 220- to 1024-l water containers at these water levels. Accuracy was further assessed using 69.1% (393/569) of the field-based drums and tanks which contained <100 pupae. RESULTS: The WSCF method accurately estimated total populations in the semi-field trials up to 13.0 times faster than the ESTC method (all P < 0.001); no significant differences (all P-values ≥ 0.05) were obtained between the methods for very low (n = 4) to low-moderate (n = 25-100) and high (n > 100) pupae numbers/container and without sediment disturbance. CONCLUSION: The simple WSCF method sensitively, accurately and robustly estimated total pupae numbers in their principal breeding sites worldwide, containers with >20 l water volumes, significantly (2.7- to 13.0-fold: all P-values <0.001) faster than the ESTC method for very low to high pupae numbers/container without contaminating the clean water by sediment disturbance which is generated using the WHO-recommended ESTC method. The WSCF method seems ideal for global community-based surveillance and control programmes.

Three calibration factors, applied to a rapid sweeping method, can accurately estimate Aedes aegypti (Diptera: Culicidae) pupal numbers in large water-storage containers at all temperatures at which dengue virus transmission occurs.

The ability of a simple sweeping method, coupled to calibration factors, to accurately estimate the total numbers of Aedes aegypti (L.) (Diptera: Culicidae) pupae in water-storage containers (20-6412-liter capacities at different water levels) throughout their main dengue virus transmission temperature range was evaluated. Using this method, one set of three calibration factors were derived that could accurately estimate the total Ae. aegypti pupae in their principal breeding sites, large water-storage containers, found throughout the world. No significant differences were obtained using the method at different altitudes (14-1630 m above sea level) that included the range of temperatures (20-30 degrees C) at which dengue virus transmission occurs in the world. In addition, no significant differences were found in the results obtained between and within the 10 different teams that applied this method; therefore, this method was extremely robust. One person could estimate the Ae. aegypti pupae in each of the large water-storage containers in only 5 min by using this method, compared with two people requiring between 45 and 90 min to collect and count the total pupae population in each of them. Because the method was both rapid to perform and did not disturb the sediment layers in these domestic water-storage containers, it was more acceptable by the residents, and, therefore, ideally suited for routine surveillance purposes and to assess the efficacy of Ae. aegypti control programs in dengue virus-endemic areas throughout the world.

[Fertility decline in Colombia: expression of a profound social change]. / El descenso de la fecundidad en Colombia: expresion de un profundo cambio social.

PIP: Demographers have identified 3 phases in the evolution of human population growth: 1) high mortality and high fertility resulting in very slow growth, 2) declining mortality and high fertility, resulting in rapid growth, and 3) declining mortality and fertility, resulting in slower growth. From the beginning of the century until the 1930s, Colombia was in the 1st phase, while the greatest mortality declines were registered from 1930-60. Fertility did not decline commensurately, and from 1951-64 the rate of population increase was 3.14%. The National Fertility Survey in 1969 and the 1973 census indicated that the country had at last begun its fertility decline. The 1969 survey showed that the total fertility rate (TFR) had dropped from 7.0 in the early 1960s to 6.0 in 1967-68, with fertility declining in both rural and urban areas. The 1973 census showed a rate of growth of 2.8% and an average number of children/woman of 4.7, showing that the fertility decline was structural and reflected profound changes in the values, norms, and attitudes regarding children of the Colombian population. Urbanization, the increased educational level and labor force participation of women, and the influence of the mass media in propagating the values of a consumer society are factors in the reduction of family size. Fertility differentials by region and social group have been declining progressively. The TFR in 1960-64 was 7.0 overall, 6.1 in urban areas, and 7.9 in rural areas, while in 1980 it was 3.6 overall, 3.0 in urban areas, and 5.1 in rural areas. In 1968-69, the TFR was 7.8 in the Atlantic region, 7.9 in the Oriental, 6.8 in the Central, 5.9 in the Pacific, and 4.5 in Bogota, while in 1980 it was 4.1 in the Atlantic, 4.0 in the Oriental, 3.5 in the Central, 3.3 in the Pacific, and 2.8 in Bogota. The number of women using family planning programs increased from 83 in 1965 to 1,790,484 in 1980. The proportion using contraception increased from 53% in 1976 to 55% in 1980. The TFR at the end of the century is expected to be 2.4.^ieng

[Population dynamics and population projections for the country, national territories, Bogota, departments, and 30 major cities: methodological aspects and main results]. / Dinamica demografica y proyecciones de poblacion del pais, los territorios nacionales, Bogota, los departamentos y las 30 principales ciudades: aspectos metodologicos y principales resultados.

PIP: Population estimates and projections for Colombia are presented for the period 1973-2003. The data are shown for the country as a whole, the 23 departments and the national territories, and the 30 major cities. These projections have been compiled using the component method and data taken primarily from the 1973 census. An analysis of the resulting projections is also presented, and some implications are considered.^ieng