Comparative analysis of anthropometric indicators for diagnosing obesity and predicting cardiometabolic risk in Mexican adolescents / Análisis comparativo de indicadores antropométricos para el diagnóstico de obesidad y predicción del riesgo cardiometabólico en adolescentes mexicanos

Introduction: obesity is a cardiometabolic risk (CMR) factor in adolescents. It represents a public health problem that requires simple diagnostic strategies based on the determination of anthropometric indicators (AIs) such as body mass index (BMI), waist circumference (WC), conicity index (CONI), waist-to-height ratio (WHtR), and body fat percentage (BFP). The purpose of the current contribution was to analyze the utility of the aforementioned AIs for evaluating obesity as a CMR factor in Mexican adolescents. Materials and methods: the design of the study is descriptive and cross-sectional. Nutritional status was established by using various AIs and as a CMR factor under the criteria of WHtR. Participating in the present investigation were 2,000 adolescents from 15 to 17 years of age, of which 1,079 (53.9 %) were female and 921 (46.1 %) were male. All were high school students in Tuxtla Gutiérrez, Chiapas, Mexico. Results and conclusion: the prevalence of obesity was influenced by gender. With the WHtR and BFP, male students exhibited a greater prevalence of obesity, while with the BMI and CONI, the percentage of obesity was similar between the two genders. BMI was significantly correlated with BFP, WC and WHtR, and was one of the AIs with the greatest area under the curve, showing a good capacity to predict cardiometabolic risk. BMI is a simple and adequate tool for diagnosing obesity and predicting CMR in adolescents (AU)

Introducción: la obesidad es un factor de riesgo cardiometabolico (RCM) en los adolescentes y representa un problema de salud pública que requiere estrategias diagnosticas sencillas, basadas en la determinación de indicadores antropométricos (IA) como el índice de masa corporal (IMC), la circunferencia de la cintura (CC), el índice de conicidad (ICONI), el índice de cintura-talla (ICT) y el porcentaje de grasa corporal (PGC). El propósito del presente estudio fue analizar la utilidad de diversos IA (IMC, CC, ICONI, ICT y PGC) para evaluar la obesidad como factor de RCM en adolescentes mexicanos. Materiales y métodos: el diseño del estudio fue descriptivo y transversal. Se analizó el estado nutricional mediante varios IA y el factor de RCM bajo los criterios del ICT. Este estudio fue conducido en 2000 adolescentes de entre 15 y 17 años, de los cuales 1079 (53,9 %) eran mujeres y 921 (46,1 %) varones, todos ellos estudiantes de nivel medio superior de Tuxtla Gutiérrez, Chiapas, México. Resultados y conclusión: la prevalencia de la obesidad estuvo influenciada por el género: los varones presentaron una mayor prevalencia de obesidad con ICT y PGC, mientras que con IMC e ICONI, el porcentaje de obesidad fue similar entre ambos géneros. El IMC se correlacionó significativamente con el PGC, la CC y el ICT, y fue uno de los IA con mayor área bajo la curva, mostrando una buena capacidad para predecir el RCM. El IMC representa una herramienta sencilla y adecuada para el diagnóstico de obesidad y predecir el RCM en adolescentes (AU)

Importancia del diagnóstico precoz en policitemia vera y trombocitemia esencial. Experiencia de un centro / Relevance of early diagnosis in polycythemia vera and essential thrombocythemia: a single center's experience

Objetivos: Describir la proporción de pacientes con policitemia vera (PV) o trombocitemia esencial (TE) y trombosis previa al diagnóstico que presentaban eritrocitosis o trombocitosis antes de la trombosis. Pacientes y métodos: Revisión retrospectiva de 63 pacientes con PV y 130 con TE. Resultados: En PV, encontramos eritrocitosis previa en 7 (11,1%) de los 17 casos (27%) con trombosis previa al diagnóstico. En TE, encontramos trombocitosis previa en 10 (7,7%) de los 25 casos (19,2%) con trombosis previa al diagnóstico. La mediana de tiempo entre el hallazgo analítico y la trombosis fue de 8,2 meses y 11,8 meses para PV y TE, respectivamente. En ambas entidades, los pacientes con trombosis previa al diagnóstico tenían una supervivencia significativamente menor. Conclusión: Una proporción significativa de pacientes con trombosis previa al diagnóstico de PV y TE presenta eritrocitosis o trombocitosis previa al episodio de trombosis, lo que permitiría anticipar el diagnóstico y el tratamiento (AU)

Objectives: This work aims to describe the proportion of patients with polycythemia vera (PV) or essential thrombocythemia (ET) and thrombosis prior to the diagnosis who had erythrocytosis or thrombocytosis prior to thrombosis. Patients and methods: This is a retrospective review of 63 patients with PV and 130 with ET. Results: In regard to PV, we found prior erythrocytosis in 7 (11.1%) of the 17 cases (27%) with thrombosis prior to diagnosis. In ET, we found prior thrombocytosis in 10 (7.7%) of the 25 cases (19.2%) with thrombosis prior to diagnosis. The median time between the laboratory finding and thrombosis was 8.2 months and 11.8 months for PV and TE, respectively. In both entities, patients with thrombosis prior to diagnosis had significantly lower survival. Conclusion: A significant proportion of patients with thrombosis prior to the diagnosis of PV and ET present erythrocytosis or thrombocytosis prior to the episode of thrombosis. This could allow for anticipating diagnosis and treatment (AU)

Relevance of early diagnosis in polycythemia vera and essential thrombocythemia: A single center's experience.

OBJECTIVES: This work aims to describe the proportion of patients with polycythemia vera (PV) or essential thrombocythemia (ET) and thrombosis prior to the diagnosis who had erythrocytosis or thrombocytosis prior to the thrombosis. PATIENTS AND METHODS: This is a retrospective review of 63 patients with PV and 130 with ET. RESULTS: In regard to PV, we found prior erythrocytosis in 7 (11.1%) of the 17 cases (27%) with thrombosis prior to diagnosis. In ET, we found prior thrombocytosis in 10 (7.7%) of the 25 cases (19.2%) with thrombosis prior to diagnosis. The median time between the laboratory finding and thrombosis was 8.2 months and 11.8 months for PV and TE, respectively. In both entities, patients with thrombosis prior to diagnosis had significantly lower survival. CONCLUSION: A significant proportion of patients with thrombosis prior to the diagnosis of PV and ET present with erythrocytosis or thrombocytosis prior to the episode of thrombosis. This could allow for anticipating diagnosis and treatment.

In vivo multimodal imaging of hyaluronan-mediated inflammatory response in articular cartilage.

OBJECTIVE: One driving factor in the progression to posttraumatic osteoarthritis (PTOA) is the perpetuation of the inflammatory response to injury into chronic inflammation. Molecular imaging offers many opportunities to complement the sensitivity of current imaging modalities with molecular specificity. The goal of this study was to develop and characterize agents to image hyaluronan (HA)-mediated inflammatory signaling. DESIGN: We developed optical (Cy5.5-P15-1) and magnetic resonance contrast agents (Gd-DOTA-P15-1) based in a hyaluronan-binding peptide (P15-1) that has shown anti-inflammatory effects on human chondrocytes, and validated them in vitro and in vivo in two animal models of PTOA. RESULTS: In vitro studies with a near infrared (NIR) Cy5.5-P15-1 imaging agent showed a fast and stable localization of Cy5.5-P15-1 on chondrocytes, but not in synovial cells. In vivo NIR showed significantly higher retention of imaging agent in PTOA knees between 12 and 72 h (n = 8, Cohen's d > 2 after 24 h). NIR fluorescence accumulation correlated with histologic severity in cartilage and meniscus (ρ between 0.37 and 0.57, P < 0.001). By using in vivo magnetic resonance imaging with a Gd-DOTA-P15-1 contrast agent in 12 rats, we detected a significant decrease of T1 on injured knees in all cartilage plates at 48 h (-15%, 95%-confidence interval (CI) = [-18%,-11%]) while no change was observed in the controls (-2%, 95%-CI = [-5%,+1%]). CONCLUSIONS: This study provides the first in vivo evidence that hyaluronan-related inflammatory response in cartilage after injury is a common finding. Beyond P15-1, we have demonstrated that molecular imaging can provide a versatile technology to investigate and phenotype PTOA pathogenesis, as well as study therapeutic interventions.

Multiple trial inhibitory avoidance acquisition and retrieval are resistant to chronic stress.

Chronic mild stress (CMS) is a widely accepted animal model relevant to depression that among other consequences, is chiefly known to induce anhedonia, often assessed as decreased preference for sucrose solution. CMS is also known to affect cognition, particularly memory tasks. In this study we have employed the multiple-trial inhibitory avoidance memory task (MTIA) to assess CMS effects on memory acquisition and retrieval. MTIA consists of repeated exposures to the unconditioned stimulus until a learning criterion is reached. Wistar rats underwent CMS for 5 weeks, and sucrose consumption was assessed once a week. At the end of CMS, animals were evaluated in the MTIA task. Overall decreased sucrose solution preference was highly variable. Further analyses showed that a subset of animals expressed resilience while another subset was sensitive to stress. CMS did not affect the number of acquisition sessions before reaching criterion or retrieval latency of MTIA task in neither sensitive nor resilient groups. Although tasks that assess learning ability in animal models relevant to depression indicate cognitive deficits, the ability to learn the association between compartment crossing and the aversive electric foot shock, which is strongly dependent on emotional aspects, was intact.

Sensitivity enhancement by multiple-contact cross-polarization under magic-angle spinning.

Multiple-contact cross-polarization (MC-CP) is applied to powder samples of ferrocene and l-alanine under magic-angle spinning (MAS) conditions. The method is described analytically through the density matrix formalism. The combination of a two-step memory function approach and the Anderson-Weiss approximation is found to be particularly useful to derive approximate analytical solutions for single-contact Hartmann-Hahn CP (HHCP) and MC-CP dynamics under MAS. We show that the MC-CP sequence requiring no pulse-shape optimization yields higher polarizations at short contact times than optimized adiabatic passage through the HH condition CP (APHH-CP) when the MAS frequency is comparable to the heteronuclear dipolar coupling, i.e., when APHH-CP through a single sideband matching condition is impossible or difficult to perform. It is also shown that the MC-CP sideband HH conditions are generally much broader than for single-contact HHCP and that efficient polarization transfer at the centerband HH condition can be reintroduced by rotor-asynchronous multiple equilibrations-re-equilibrations with the proton spin bath. Boundary conditions for the successful use of the MC-CP experiment when relying on spin-lattice relaxation for repolarization are also examined.

Bombesin administration impairs memory and does not reverse memory deficit caused by sleep deprivation.

Sleep deprivation impairs performance in emotional memory tasks, however this effect on memory is not completely understood. Possible mechanisms may involve an alteration in neurotransmission systems, as shown by the fact that many drugs that modulate neural pathways can prevent memory impairment by sleep loss. Gastrin releasing peptide (GRP) is a neuropeptide that emerged as a regulatory molecule of emotional memory through the modulation of other neurotransmission systems. Thus, the present study addressed the effect of intraperitoneal (IP) administration of bombesin (BB) (2.5, 5.0 and 10.0µg/kg), a GRP agonist, on the performance of Wistar rats in a multiple trail inhibitory avoidance (MTIA) task, after sleep deprivation, using the modified multiple platforms method (MMPM). Sleep deprived animals exhibited acquisition and retention impairment that was not prevented by BB injection. In addition, non-sleep deprived animals treated with BB before and after the training session, but not before the test, have shown a retention deficit. In summary, BB did not improve the memory impairment by sleep loss and, under normal conditions, produced a memory consolidation deficit.

Effect of copulation on potentially precancerous prostate lesions, serum testosterone and prolactin levels in rats.

UNLABELLED: The prostate is an exocrine reproductive gland that participates in ejaculation and it is prone to diseases, including cancer. AIM: In the pre-sent study, we assessed the long-term effects of copulation on the development of precancerous lesions in rats, and compared them with testosterone-induced prostatic lesions. MATERIALS AND METHODS: One group of Wistar males was given 10 copulatory sessions to one ejaculation with ovariectomized, hormone-primed females. Sessions occurred twice per week for a total of ten trials. A second group was exposed to females during the same trials, but physical contact was prevented. In addition, each group received a subcutaneous implant in the back either filled with testosterone propionate (T, 100 mg/kg) or empty. This resulted in four subgroups: 1) Control + No sex, 2) Control + Sex, 3) T + No sex and 4) T + Sex. Two days after the 10(th) trial all the males were sacrificed for prostate histo-logy (H&E) and hormone analysis (testosterone and prolactin). RESULTS: Males from the group Control + No sex expressed normal histo-logy. However, those in the groups Control + Sex and T + No sex expressed metaplasia and dysplasia in both the dorsolateral and ventral portions of the prostate, respectively. Interestingly, males from the group T + Sex expressed dysplasia in the dorsolateral prostate only, but not in the ventral prostate. CONCLUSIONS: These results indicate that constant copulation may facilitate the development of prostatic lesions in males with normal levels of testosterone. However, copulation induces less lesions in the ventral prostate of males treated with testosterone.

Ovariectomy increases the age-induced hyperphosphorylation of Tau at hippocampal CA1.

One of the main hallmarks of Alzheimer's disease includes the neurofibrillary tangles formation produced by hyperphosphorylation of the Tau protein, whose expression is putatively regulated by the ovarian hormones estradiol and progesterone. Hippocampus is a brain region that participates in many functions related to learning and memory; in addition, it is abundant in both estradiol and progesterone receptors. In this study, we explore the expression of Tau hyperphosphorylation at hippocampus and the performance of rats in an autoshaping learning task at 5, 10 and 15 months after the ovaries removal. In these animals, ovariectomy was performed at 3 months of age. These data were compared with those derived from intact rats at 8, 13 and 18 months old. A clear decrease in the number of conditioned responses of both intact and ovariectomized rats in the autoshaping learning task was observed. The interaction of both factors confirms that, in this test, learning varies depending on aging and the presence or absence of ovaries. A progressive increase in hippocampal Tau phosphorylation at Ser-396 was observed in either intact or ovariectomized rats. Interestingly, an interaction between the analyzed factors shows that such hyperphosphorylation was potentiated by the absence of ovaries. These results emphasize the importance of aging and the lack of ovarian hormones for an associative learning test and for the expression of one of the most important hallmarks of Alzheimer's disease.

A novel rat model for subchondral microdamage in acute knee injury: a potential mechanism in post-traumatic osteoarthritis.

OBJECTIVE: Subchondral microdamage may play an important role in post-traumatic osteoarthritis (PTOA) development following anterior cruciate ligament (ACL) rupture. It remains unknown whether this injury mechanism causes subchondral microdamage, or whether its repair occurs by targeted osteoclast-mediated remodeling. If so these events may represent a mechanism by which subchondral bone is involved in PTOA. Our objective was to test the hypothesis that subchondral microdamage occurs, and is co-localized with remodeling, in a novel rat model of ACL rupture. DESIGN: We developed a novel non-invasive rat animal model for ACL rupture and subchondral microdamage generation. By inducing ACL rupture noninvasively rather than surgically, this more closely mimics the clinical injury. MicroCT, MRI and histological methods were used to measure microstructural changes, ligament damage, and cellular/matrix degeneration, respectively. RESULTS: We reproducibly generated ACL rupture without damage to other soft joint tissues. Immediately after injury, increased microdamage was found in the postero-medial aspect of the tibia. Microstructural parameters showed increased resorption at 2 weeks, which returned to baseline. Dynamic histomorphometry showed increased calcein label uptake in the same region at 4 and 8 weeks. Chondrocyte death and protease activity in cartilage was also noted, however whether this was directly linked to subchondral changes is not yet known. Similarly, cartilage scoring showed degradation at 4 and 8 weeks post-injury. CONCLUSIONS: This study shows that our novel model can be used to study subchondral microdamage after ACL-rupture, and its association with localized remodeling. Cartilage degeneration, on a similar time-scale to other models, is also a feature of this system.

Current opinion and consensus statement regarding the diagnosis, prognosis, and treatment of patients with essential thrombocythemia: a survey of the Spanish Group of Ph-negative Myeloproliferative Neoplasms (GEMFIN) using the Delphi method.

The current consensus on the diagnosis, prognosis, and treatment of essential thrombocythemia (ET) is based on experts' recommendations. However, several aspects of the diagnosis of, prognosis of, and therapy for ET are still controversial. The Delphi method was employed with an expert panel of members of the Spanish Group of Ph-negative Myeloproliferative Neoplasms in order to identify the degree of agreement on the diagnosis, prognosis, and treatment of ET. Nine leading experts selected a total of 41 clinical hematologists with well-known expertise in ET. An electronic questionnaire was used to collect the questions rated in a four-step scale. The questions were grouped into four blocks: diagnosis, risk stratification, goals of therapy, and treatment strategy. After the first round consisting of 80 questions, a second round including 14 additional questions focused on the recommendations advocated by experts of the European LeukemiaNet in 2011 was analyzed. The median and mean values for the first and second rounds were calculated. A summary of the conclusions considered as the most representative of each block of questions is presented. The Delphi method is a powerful instrument to address the current approaches and controversies surrounding ET.

An enriched environment and 17-beta estradiol produce similar pro-cognitive effects on ovariectomized rats.

Estrogen depletion due to aging, surgery or pathological events can cause a multitude of problems, including neurodegenerative alterations. In rodents without ovaries, 17-beta estradiol (E2) has been shown to produce beneficial effects on cognition, stimulating brain regions (e.g., the neocortex, hippocampus and amygdala) related to cognition and learning. Another treatment that stimulates these brain regions is an enriched environment (EE), which is a complex set of external factors in the immediate surroundings that facilitates greater stimulation of sensorial, cognitive and motor circuits of the brain. The aim of the present study was to test, using an animal model of ovariectomy-induced impairment of memory, the relative effect of E2 (with a time-released pellet; 1 µg/rat/day), EE exposure and a combination of both treatments. Experimental and control groups were submitted to two memory tests 18 weeks post-surgery: the autoshaping learning task (ALT) for measuring associative learning and the novel object recognition test (NORT) for evaluating short- and long-term memory. To assess potential motor impairments caused by treatments, all rats were tested after the ALT in an automatic activity counter. Results from ALT show that the ovariectomy blocked the conditioned responses displayed, an effect rescued by chronic treatment with estrogen or EE exposure. The combination of both treatments did not improve the results obtained separately. In the NORT, the exploration time for recognizing a novel object was similar in the short run with all groups, but greater in the long run with hormone administration or EE exposure. As with the ALT, in the NORT there was no improvement shown by the combination treatment. These data were not masked by changes in spontaneous activity because this parameter was not modified in the rats by either treatment. Possible action mechanisms are proposed, taking into account the role of corticosterone and BDNF on cognition.

Topographic deformation patterns of knee cartilage after exercises with high knee flexion: an in vivo 3D MRI study using voxel-based analysis at 3T.

OBJECTIVES: To implement a novel voxel-based technique to identify statistically significant local cartilage deformation and analyze in-vivo topographic knee cartilage deformation patterns using a voxel-based thickness map approach for high-flexion postures. METHODS: Sagittal 3T 3D-T1w-FLASH-WE-sequences of 10 healthy knees were acquired before and immediately after loading (kneeling/squatting/heel sitting/knee bends). After cartilage segmentation, 3D-reconstruction and 3D-registration, colour-coded deformation maps were generated by voxel-based subtraction of loaded from unloaded datasets to visualize cartilage thickness changes in all knee compartments. RESULTS: Compression areas were found bifocal at the peripheral medial/caudolateral patella, both posterior femoral condyles and both anterior/central tibiae. Local cartilage thickening were found adjacent to the compression areas. Significant local strain ranged from +13 to -15 %. Changes were most pronounced after squatting, least after knee bends. Shape and location of deformation areas varied slightly with the loading paradigm, but followed a similar pattern consistent between different individuals. CONCLUSIONS: Voxel-based deformation maps identify individual in-vivo load-specific and posture-associated strain distribution in the articular cartilage. The data facilitate understanding individual knee loading properties and contribute to improve biomechanical 3 models. They lay a base to investigate the relationship between cartilage degeneration patterns in common osteoarthritis and areas at risk of cartilage wear due to mechanical loading in work-related activities. KEY POINTS: • 3D MRI helps differentiate true knee-cartilage deformation from random measurement error • 3D MRI maps depict in vivo topographic distribution of cartilage deformation after loading • 3D MRI maps depict in vivo intensity of cartilage deformation after loading • Locating cartilage contact areas might aid differentiating common and work-related osteoarthritis.

La calidad de la información sobre escoliosis disponible online en español. Un estudio de evaluación / The quality of information on scoliosis available online in spanish. An evaluation study

Introducción. Más de un 50% de padres y/o pacientes utilizan Internet para informarse sobre aspectos de la escoliosis idiopática. Material y métodos. En 5 buscadores populares (Google, Yahoo, Bing, Lycos, Ask) se introdujo el término de búsqueda «escoliosis» y los primeros 20 resultados de cada buscador fueron utilizados para el estudio. Tras rechazar las duplicidades, archivos de vídeos o imagen, se obtuvo una lista de 25 webs, adecuadas para el análisis. La calidad se evaluó según 3 escalas: DISCERN (calidad de la información médica; rango de menor a mayor calidad es de 15 a 80), HONcode (criterios de acreditación de calidad de páginas web; rango de de menor a mayor es de 15 a 0), y grado de idoneidad de la información para padres y pacientes con escoliosis idiopática (rango de menor a mayor es de 0 a 9). Resultados. DISCERN: media 38 (DE = 10,48); el 24% de las páginas superaba el percentil 75 (> 45). HONcode: media 6,9 (DE = 1,8); el 28% de las páginas superaba el percentil 75 (< 5,5). Grado de idoneidad: media 4,3 (DE = 1,75); el 24% de las páginas superaban el percentil 75 (> 5). Conclusiones. En términos generales la calidad de la información es aceptable, pero muy pocas páginas pueden considerarse idóneas para padres y pacientes con escoliosis idiopática (AU)

Introduction. More than 50% of parents and/or patients use Internet to learn about aspects of idiopathic scoliosis. Material and methods. The search term «scoliosis» was introduced into five popular search engines (Google, Yahoo, Bing, Lycos, Ask). The first 20 results of each one were used for the analysis. After rejecting duplicates, video or image files, a list of 25 websites that were adequate for analysis was obtained. Quality was assessed with three scales: DISCERN (Quality of medical information; range of low to high quality with 15 to 80) HONcode (Quality of accreditation web criteria; range of low to high quality of 15 to 0), and Degree of Adequacy of information for parents and patients with idiopathic scoliosis (range of low to high quality going of 0 to 9). Results. DISCERN: median 38 (SD=10.48); 24% of pages exceeded the 75th percentile (>45). HONcode: median 6.9 (SD=1.8); 28% of pages exceeded the 75th percentile (<5.5). Degree of Adequacy: median 4.3 (DS=1.75); 24% pages exceeded the 75th percentile (>5). Conclusions. In general terms, the quality of the information is acceptable. However, very few pages can be considered as suitable for parents and patients with idiopathic scoliosis (AU)

Does decentralisation of tuberculosis care influence treatment outcomes? The case of Oromia Region, Ethiopia.

SETTING: Oromia Region, Ethiopia. OBJECTIVE: To investigate the effect of decentralised care on anti-tuberculosis treatment outcomes and identify factors affecting outcome among new smear-positive tuberculosis (TB) patients. DESIGN: This was a retrospective cohort study comparing patients treated in the community during the continuation phase with those managed throughout treatment in health facilities. Data were collected from TB registers and patient cards using a pre-tested data capture form. RESULTS: Of the 2226 new smear-positive TB patients registered from July 2010 to June 2012 who were included in the study, 1599 (72.6%) received treatment in health facilities, and the rest in the community. Overall treatment success was 94.7%. Patients treated in the community had comparable treatment success with those managed in health facilities (aOR 1.7, 95%CI 0.80-3.57). Missing doses (OR 0.22, 95%CI 0.08-0.55), supervision during the continuation phase (OR 2.6, 95%CI 1.34-5.05), positive sputum at month 2 (OR 0.07, 95%CI 0.04-0.13) and human immunodeficiency virus infection (OR 0.25, 95%CI 0.13-0.46) were independent predictors of treatment success. CONCLUSION: Overall treatment success is high in new smear-positive TB patients in Oromia. Patients receiving treatment in the community during the continuation phase have treatment success comparable with that of patients managed in health facilities.

Contexte : Région d'Oromia, Ethiopie.Objectif : Examiner l'effet d'un traitement décentralisé de la tuberculose (TB) sur les résultats de ce traitement et identifier les facteurs affectant les résultats parmi des patients tuberculeux nouveaux à frottis positif.Schéma : Etude rétrospective de cohorte comparant les patients traités en communauté pendant la phase de continuation avec ceux traités dans les structures de santé. Des données ont été recueillies à partir des registres de TB et des cartes de traitement des patients grâce à un formulaire de recueil de données prétesté.Résultats : De 2226 patients tuberculeux nouveaux à frottis positif enregistrés entre juillet 2010 et juillet 2012, et inclus dans cette étude, 1599 (72,6%) ont été traités dans des structures de santé et le reste en communauté. Le succès d'ensemble du traitement a été de 94,7%. Les patients traités en communauté ont eu un taux de réussite comparable à ceux traités dans les structures de santé (OR ajusté 1,7 ; IC95% 0,80­3,57). Des doses manquées (OR 0,22 ; IC95% 0,08­0,55), une supervision pendant la phase de prolongation (OR 2,6 ; IC95% 1,34­5,05), des crachats positifs au deuxième mois (OR 0,07 ; IC95% 0,04­0,13) et l'infection au virus de l'immunodéficience humaine (OR 0,25 ; IC95% 0,13­0,46) étaient des facteurs prédictifs indépendants de succès du traitement.Conclusion : Le succès d'ensemble du traitement est élevé chez les patients tuberculeux nouveaux à frottis positif de la région d'Oromia. Les patients traités en communauté pendant la phase de continuation ont un taux de réussite du traitement comparable à celui des patients traités dans des structures de santé.

Marco de referencia: La región de Oromia en Etiopía.Objtivo: Investigar el efecto de la descentralización de la atención de la tuberculosis (TB) sobre los desenlaces terapéuticos y definir los factores que modifican estos resultados en los pacientes con diagnóstico reciente de TB y baciloscopia positiva.Método: Se llevó a cabo un estudio retrospectivo de cohortes, en el cual se compararon los pacientes que recibieron el régimen antituberculoso durante la fase de continuación en la comunidad y los pacientes atendidos durante todo el tratamiento en los establecimientos de salud. Los datos se recogieron a partir de los registros de TB de los pacientes y de las tarjetas de tratamiento, mediante un formulario de captura de datos, que se ensayó previamente.Resultados: Se incluyeron en el estudio 2226 casos nuevos de TB con baciloscopia positiva registrados de junio del 2010 a junio del 2012, de los cuales 1599 recibieron el tratamiento en los establecimientos de salud (72,6%) y el resto en la comunidad. La tasa global de éxito terapéutico fue 94,7%. Los pacientes tratados en la comunidad presentaron una tasa de éxito equivalente la de los pacientes atendidos en los centros sanitarios (OR ajustado 1,7; IC95% 0,80­3,57). Aparecieron como factores pronósticos independientes del éxito terapéutico las siguientes variables: las dosis no administradas (OR 0,22; IC95% 0,08­0,55), la supervisión durante la fase de continuación (OR 2,6; IC95% 1,34­5,05), la positividad del esputo al segundo mes (OR 0,07; IC95% 0,04­0,13) y la infección por el virus de la inmunodeficiencia humana (OR 0,25; IC95% 0,13­0,46).Conclusión: Los casos nuevos de TB pulmonar y baciloscopia positiva alcanzaron globalmente una alta tasa de éxito terapéutico en Oromia. Los resultados de los pacientes que recibieron el tratamiento en la comunidad durante la fase de continuación fueron comparables con los desenlaces de los pacientes tratados en los establecimientos sanitarios.

Roturas tendinosas bilaterales del aparato extensor de la rodilla: serie de casos / Bilateral tendon tears of the extensor mechanism of the knee: a series of cases

Las roturas bilaterales del aparato extensor de la rodilla son infrecuentes y se asocian clásicamente a enfermedades sistémicas. Estas lesiones pueden ser óseas, de patela o tuberosidad tibial anterior, musculares o tendinosas. Las más comunes de todas son las fracturas de rótula, seguidas de roturas del tendón cuadricipital o rotuliano. Las roturas bilaterales tanto del tendón rotuliano como cuadricipital, al ser infrecuentes, pueden ser infradiagnosticadas retrasando el tratamiento quirúrgico y la posterior rehabilitación; suelen ser traumáticas. En la literatura existen publicaciones sobre algunos casos de roturas tendinosas bilateral del aparato extensor de la rodilla asociadas a enfermedades sistémicas como isuficiencia renal, diabetes mellitus o artritis reumatoide o al uso prolongado de quinolonas o corticoides. En este trabajo describimos 4 casos clínicos de roturas tendinosas bilaterales del aparato extensor, sin y con enfermedades sistémicas asociadas (AU)

Bilateral injuries of the knee extensor mechanism are uncommon and are generally related to systemic diseases. Such injuries may be muscle tears, bone fractures (patella and tibial tubercle) and tendinous disruptures. Patella fractures are described as being the most common of these, followed by injuries of the quadriceps and patellar tendons. As bilateral disruption of either patellar and/or quadricipital tendons is uncommon, it may be underdiagnosed, thus delaying the surgical treatment and subsequent rehabilitation. They are generally traumatic. There are publications in the literature on some cases of bilateral tendinous disruptions of the knee extensor complex associated to systemic diseases such as renal failure, diabetes mellitus or rheumatoid arthritis or the continued use of steroids or fluoroquinolones. We report four cases of bilateral knee tendon disruption in patients with and without systemic disease (AU)

Nueva estrategia para mejorar la medida de la calidad de vida en la escoliosis idiopática: adición de la dimensión de deformidad percibida al cuestionario de la Scoliosis Research Society (SRS-22) / New strategy for the improvement of the measurement of quality of life in idiopathic scoliosis: addition of a perceived deformity dimension to the questionnaire of the Scoliosis Research Society (SRS-22)

Introducción. El cuestionario de la Scoliosis Research Society (SRS-22) es un instrumento válido para valorar la calidad de vida en la escoliosis idiopática. No obstante, la correlación entre las puntuaciones del cuestionario y el valor angular de la curva escoliótica es poco relevante. Otros instrumentos de medida de la salud percibida han mostrado mejores correlaciones con el ángulo de Cobb. El objetivo del estudio es medir la relación del SRS-22 con la magnitud de la escoliosis y valorar si esta relación puede mejorar al añadir otras dimensiones medidas por otros cuestionarios. Material y método. Se estudiaron 101 pacientes con escoliosis que completaron los cuestionarios SRS-22 y Walter Reed Visual Assessment Scale (WRVAS), un cuestionario de escalas icónicas que mide la deformidad percibida. El análisis se realizó mediante regresión múltiple para calcular el coeficiente de determinación (r2), con el ángulo de Cobb como variable dependiente. También se estudió la consistencia interna del instrumento, básico y modificado. Resultados. El cuestionario SRS-22 explicó el 17% de la varianza (r2=0,17, p<0,05). Al añadir el WRVAS, se alcanzó una varianza explicada del 45% con respecto a la variable ángulo de Cobb. La consistencia interna del SRS-22 se mantuvo tras la adición del WRVAS. Discusión. El SRS-22 permite una medida válida y fiable de la calidad de vida en la escoliosis. No obstante, la capacidad de este instrumento para explicar el ángulo de Cobb, que es la medida estándar de la escoliosis, puede mejorar al añadir una nueva dimensión que mida la deformidad percibida (AU)

Background. The Scoliosis Research Society Questionnaire (SRS-22) is a valid instrument for assessing health-related quality of life (HRQOL) in patients with idiopathic scoliosis. However, the correlation between the questionnaire scores and the magnitude of the scoliotic curve is of little relevance. Other patient-reported outcome instruments have demonstrated better correlations with the Cobb angle. The purpose of this study has been to measure the relationship of the SRS-22 with the magnitude of the scoliosis and to evaluate if this relationship can be improved after adding other domains from other outcome instrument. Methods We studied 101 patients with scoliosis who filled out the SRS-22 questionnaires and the Walter Reed Visual Assessment Scale (WRVAS), the latter of which provides a deeper understanding of body image than the SRS-22 by using drawings of the deformity. The analysis was made using the multiple regression analysis to calculate the coefficient of determination (r2), with the Cobb angle as the dependent variable. Internal consistency of the modified and basic instrument was also determined. Results. The basic SRS-22 explained 17% of variance (r2=0.17, P<.05). With addition of the WRVAS, 45% of Cobb variance was explained. Internal consistency of SRS-22 was not poorer following these changes. Conclusions. The SRS-22 questionnaire accounts for 17% of the variance (r2=0.17, P<.05). When the WRVAS was added, a variance explaining 45% in regards to the variable Cobb angle was reached. The internal consistence of SRS-22 was maintained after adding the WRVAS. Discussion. The SRS-22 allows for a valid and reliable measurement of the quality of life of scoliosis. However, the ability of this instrument to explain the Cobb angle (standard measure in scoliosis) can be improved by adding a new dimension measuring perceived deformity (AU)