Sub-chondroplasty Reduces Pain, Improves Function and Delays the Conversion to Arthroplasty in Patients with Advanced Knee Osteoarthritis: A Stratified Meta-analysis and Quality Assessment.

There is an ongoing interest in alternatives to total knee arthroplasty, as a means to delay inevitable replacement. A possible, minimally invasive, alternative is a sub-chondroplasty, involving interosseous injection of bone substitute materials such as calcium phosphate (CaPo4), platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC) or Injectable demineralized bone matrix (iDBM) into the subchondral bone. Eleven clinical trials were found, investigating the effectiveness of sub-chondroplasties performed using CaPo4, PRP, BMAC, and iDBM. A non-stratified and stratified meta-analysis of the included studies were conducted to test for confounding variables across the trials. Non-stratified analysis, regardless of injectable type, revealed a significant improvement in the average Visual Analog Scale (VAS) score and postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) in patients post sub-chondroplasty, as compared to baseline. This analysis demonstrates that the sub-chondroplasty procedure reduces pain, improves function, and has lower risk of conversion to arthroplasty. (Journal of Surgical Orthopaedic Advances 32(2):065-074, 2023).

Clinical Outcomes of Medical Management Options for Chronic Anal Fissures in a Long-Term Follow-up: Systematic Review and Meta-Analysis.

BACKGROUND: Topical treatments and botulinum toxin injections are valid options for the management of patients with chronic anal fissures (CAF), but little is known about the efficacy of these techniques in long-term follow-up. The aim of this meta-analysis was to evaluate the effectiveness, given to clinical outcomes, of medical treatments with calcium antagonists, nitroglycerin, and botulinum toxin on CAF treatment in adults. METHOD: A systemic review and meta-analysis developed according to PRISMA [PLoS Med. 2009 Jul 21;6(7):e1000100; BMJ. 2010 Mar 23;340:c332] and registered in PROSPERO (Registration number: CRD42020120386). A systematic literature search was conducted through MEDLINE, EMBASE, Web of Science, and Cochrane Library databases. Randomized control trials that compared medical treatment were identified; publications had to have a clinical definition of CAF with at least one of the following signs or symptoms: visible sphincter fibers at the base of the fissure, anal papillae, sentinel piles, and indurated margins. The symptoms had to be chronic for at least 4 weeks. Data were independently extracted for each study, and a meta-analysis was drawn using fixed- and random-effects models. RESULTS: 17 randomized trials met the inclusion criteria. Diltiazem showed a superior effect compared with glycerin (RR = 1.16 [95% CI = 1.05-1.30]; I2 = 18%) and with fewer adverse effects (RR = 0.13 [95% CI = 0.04-0.042]; I2 = 87%). Similar results were evidenced with the use of nifedipine compared with lidocaine (RR = 4.53 [95% CI = 2.99-6.86]; I2 = 28%). Botulinum toxin did not show statistically significant differences compared to glycerin (RR = 0.81 [95% CI = 0.02-29.36]; I2 = 93%) or isosorbide dinitrate (RR = 1.45 [95% CI = 0.32-6.54]; I2 = 85%). Regarding recurrence, nifedipine was superior to lidocaine (RR = 0.18 [95% CI = 0.08-0.44]; I2 = 31%). CONCLUSIONS: Calcium channel blockers performed well regarding the healing of CAF when compared to others in long-term follow-up. The superiority of botulinum toxin was not evidenced compared to topical treatments. More studies are needed to better assess recurrence rates.

Colangiopancreatografía retrógrada endoscópica asistida por enteroscopia de doble balón en un paciente con gastrectomía total y reconstrucción en Y-de-Roux: reporte de caso / Double-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in a patient with total gastrectomy and roux-en-y reconstruction: A case report

Resumen La colangiopancreatografía retrógrada endoscópica (CPRE) es un procedimiento útil en el manejo de enfermedades biliopancreáticas. Los pacientes con alteración anatómica del tracto gastrointestinal representan un desafío técnico por múltiples razones. Con técnicas como la enteroscopia de doble balón (EDB) es posible realizar una CPRE en estos pacientes. El caso que se presenta es el primero de este tipo publicado en Colombia sobre una paciente con gastrectomía total con reconstrucción en Y-de-Roux y coledocolitiasis.

Abstract Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable procedure in managing biliopancreatic diseases. Patients with anatomical alteration of the gastrointestinal tract represent a technical challenge for multiple reasons. With techniques such as double-balloon enteroscopy (DBE), it is possible to perform ERCP in these patients. The case was first published in Colombia on a female patient with total gastrectomy with Roux-en-Y reconstruction and choledocholithiasis.

Genetic Polymorphisms Associated with Perioperative Joint Infection following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.

The number of orthopedic procedures, especially prosthesis implantation, continues to increase annually, making it imperative to understand the risks of perioperative complications. These risks include a variety of patient-specific factors, including genetic profiles. This review assessed the current literature for associations between patient-specific genetic risk factors and perioperative infection. The PRISMA guidelines were used to conduct a literature review using the PubMed and Cochrane databases. Following title and abstract review and full-text screening, eight articles remained to be reviewed­all of which compared single nucleotide polymorphisms (SNPs) to periprosthetic joint infection (PJI) in total joint arthroplasty (TJA). The following cytokine-related genes were found to have polymorphisms associated with PJI: TNFα (p < 0.006), IL-6 (p < 0.035), GCSF3R (p < 0.02), IL-1 RN-VNTR (p = 0.002), and IL-1B (p = 0.037). Protein- and enzyme-related genes that were found to be associated with PJI included: MBL (p < 0.01, p < 0.05) and MBL2 (p < 0.01, p < 0.016). The only receptor-related gene found to be associated with PJI was VDR (p < 0.007, p < 0.028). This review compiled a variety of genetic polymorphisms that were associated with periprosthetic joint infections. However, the power of these studies is low. More research must be conducted to further understand the genetic risk factors for this serious outcome.

Hidropesía fetal y enfermedad hemolítica del feto y el recién nacido / Hydrops Fetalis and Hemolytic Disease of the fetus and the newborn. Update

Introducción: la enfermedad hemolítica del feto y el recién nacido (EHFRN) consiste en la incompatibilidad presente entre los antígenos eritrocitarios maternos y los fetales, que desencadena en la madre una reacción inmunitaria contra los eritrocitos fetales produciendo su destrucción. La complicación más grave es la hidropesía fetal, la cual consiste en síntomas de origen hemodinámico, derivados de una falla cardíaca por la disminución en el aporte de oxígeno o por la falta de producción de albúmina. Objetivo: realizar una revisión actualizada de la EHFRN, exponiendo principalmente la hidropesía fetal como una de sus grandes complicaciones. Metodología: se realizó una revisión bibliográfica desde 2018 hasta 2021 en bases de datos tales como Science Direct, Pubmed y Medline con base en los siguientes términos MeSH: anemia hemolítica, isoinmunización Rh, eritroblastosis fetal, hidropesía fetal. Conclusión: la EHFRN es una causa frecuente de enfermedad hemolítica grave en estos pacientes, pero gracias a la Inmunoglubulina G anti-D se ha logrado prevenir la mayoría de casos de incompatibilidad Rh. Sin embargo, la hidropesía fetal presenta una alta mortalidad, lo cual hace importante promover un diagnóstico oportuno y el uso de profilaxis

Introduction: Hemolytic disease of the fetus and newborn (EHFRN) consists of the incompatibility present between maternal and fetal erythrocyte antigens, which triggers an immune reaction in the mother against fetal erythrocytes, causing their destruction. The most serious complication is hydrops fetalis, which consists of symptoms of hemodynamic origin, derived from heart failure due to the decrease in oxygen supply or the lack of albumin production. Objective: Make an updated review of the EHFRN, exposing mainly hydrops fetalis as one of its major complications. Methodology: Bibliographic review was carried out from 2018 to 2021 in databases such as Science Direct, Pubmed and Medline based on the following MeSH terms: hemolytic anemia, Rh isoimmunization, erythroblastosis fetalis, hydrops fetalis. Conclusion: EHFRN is a frequent cause of severe hemolytic disease in these patients; but thanks to the anti-D Immunoglobulin G, the majority of cases of Rh incompatibility have been prevented. However, hydrops fetalis has a high mortality rate, which makes it important to promote timely diagnosis and the use of prophylaxis

A single session of EUS directed transgastric ERCP and EUS FNB in a patient with RYGB, pancreatic head tumor and biliary obstruction.

The alteration of the gastrointestinal anatomy represents a challenge for the performance of endoscopic procedures in case of bile duct obstruction. Follow we present the technique used in a patient with altered anatomy and a mass in the head of the pancreas with obstruction of the bile duct through endoscopic ultrasound-guided trans gastric retrograde cholangiopancreatography.

Apoptotic colopathy as a manifestation of Good's syndrome.

The case was a 44-year-old patient with four years of evolution of respiratory infections, fever, weight loss of 30 kg and chronic diarrhea with inconclusive colonoscopy studies, managed as inflammatory bowel disease (IBD), with a history of thymomectomy four years previously. On physical examination, there was severe protein-calorie malnutrition, skin lesions compatible with herpes simplex infection and lower limb edema. Blood tests were requested when pancytopenia and hypoalbuminemia were negative for human immunodeficiency virus (HIV). Chest tomography showed a budding tree pattern and bronchiectasis, but SARS-CoV-2 was negative. A colonoscopy was performed, showing the presence of ulcers in the sigmoid colon with an infectious aspect vs IBD.

Hereditary hemorrhagic telangiectasia diagnosed by enteroscopy: a case report.

Hereditary hemorrhagic telangiectasia (HHT) is a very rare autosomal dominant multisystemic disease. Patients with this disease usually present with punctate mucocutaneous telangiectasias and arteriovenous malformations. The diagnostic criteria currently in use are the Curaçao criteria. HHT is considered a clinical diagnosis; thus, no imaging or preclinical laboratory is mandatory, and diagnosis and management are performed according to the experience of the treating team. We herein describe a 58-year-old man with no significant medical history who presented with a 15-day history of intermittent hematochezia. He was admitted to the hospital and underwent a series of laboratory tests, including colonoscopy, which showed normal results. Therefore, the patient was discharged with a diagnosis of gastrointestinal bleeding. During his second visit to the emergency room, the doctors requested video capsule endoscopy because of the patient's history, and a diagnosis of HHT was made. The entire approach and treatment were completed with antegrade double-balloon enteroscopy. This case highlights the importance of endoscopic methods for timely diagnosis and proper management.

Acute surgical-like abdomen as a gastrointestinal manifestation of COVID-19 infection: a case report in Colombia.

BACKGROUND: The SARS-CoV-2 pandemic is a considerable public health problem, which has caused a burden on health systems in many countries. Despite the existence of multiple studies on the different digestive symptoms and their relationship with this disease, it is still vital to highlight the severity of the different symptoms, the need to diagnose it properly and quickly. Currently in Colombia there are no writings that highlight the above. CASE PRESENTATION: This article reports the case of a 37-year-old female patient, with no important history, who consulted for 10 h of a generalized intense abdominal pain, of sudden onset, associated with multiple stools of diarrheal consistency, and no respiratory symptoms and no epidemiological exposure. Physical examination with intense pain in the colic frame with tenderness. It was decided to rule out surgical pathology and a CT scan was performed finding no evidence of acute intra-abdominal pathology, but with a peripheral alveolar, and ground-glass opacities at lung bases, classic COVID-19 radiological pattern, confirmed by a positive RT-PCR for SARS-CoV-2, leading to consider that the gastrointestinal symptoms were secondary to this infection. Symptomatic management was given with subsequent improvement. CONCLUSIONS: It is extremely important to present this first case report of a young female COVID-19 patient with an acute abdominal pain as the main clinical manifestation, that almost culminates in a surgical procedure; demonstrating the scope of gastrointestinal symptoms secondary to SARS-CoV-2 infection.

Peripancreatic lymph node tuberculosis diagnosed by endoscopic ultrasound.

Peripancreatic lymph node tuberculosis is a rare disease. Correct diagnosis is a challenge, and endoscopic ultrasound and fine-needle aspiration biopsy (FNB) allow rapid diagnosis with high precision. In this report, we present a 45-year-old female patient with abdominal pain and the presence of peripancreatic adenopathy who underwent FNB, which diagnosed peripancreatic lymph node tuberculosis.

"Hospital donante" una estrategia educativa: experiencia de un centro latinoamericano de trasplantes / "Donor hospital" an educational strategy: experience at a Latin American transplant center

Introducción. Los trasplantes de órganos son el único tratamiento para pacientes con enfermedades crónicas avanzadas. Sin embargo, existe una disparidad entre el número de pacientes en lista de espera y el número de donantes. Una forma de solucionar esto es mediante la educación y la sensibilización de la comunidad. El objetivo de este estudio fue evaluar el impacto que tuvo una campaña de promoción de la donación en un centro de trasplantes colombiano. Métodos. Se hizo una encuesta en la institución sobre el conocimiento previo y las creencias sobre la donación. Posteriormente, se diseñó una estrategia para informar, educar y promover la donación y, finalmente, se llevó a cabo un estudio transversal para evaluar el impacto de la campaña. Resultados: hubo un incremento del 56 % de potenciales donantes, así como de la obtención de órganos y tejidos: 100 % de órganos sólidos, 200 % de tejido ocular y 850 % de tejido óseo. Discusión. El conocer la actitud hacia la donación permite determinar factores que influyen en la toma de decisiones y así elaborar campañas que generen un aumento en los índices de donación. Según nuestro estudio, el generar una cultura a favor de la donación tiene un alto impacto en los índices de donación, y una posible causa de los bajos índices podría corresponder a la falta de información que tienen las personas, incluyendo los trabajadores de la salud. Este trabajo puede ser extrapolado a nivel nacional para conocer las causas de las negativas a donar y adoptar políticas que aumenten los índices de donación.

Introduction: Organ transplant is the only effective treatment for patients with advanced chronic disease. Although there is a gap between the number of patients in the transplant waiting lists and the number of donors, one way to diminish the waiting lists is by educating and creating awareness in the community. The objective of this study was to evaluate the impact of an institutional campaign that encourages organ donation at a Colombian transplant center. Methodology: An institutional survey was carried out in order to assess the prior knowledge, myths and beliefs around organ and tissue donation. Subsequently, a plan was designed to inform, educate and promote organ donation within the institution. Finally, a cross-sectional study was carried out to evaluate the impact of the campaign during the years of 2014-2015. Results: There was an increase of 56% in the number of potential donors as well of as of organ and tissue procurements: 100% of solid organs, 200% ocular tissue and 850% bone tissue. Discussion: Knowing the attitude towards organ and tissue donation allows to determine factors that influence decision making and to develop campaigns that generate an increase in donation rates. According to our study, generating a culture for organ donation has a high impact on donation rates, and a possible cause of the low rates could correspond to the lack of information that people have, including health workers. This work could be extrapolated nationally in order to recognize the causes of donation denials and to adopt policies that increase donation rates