Partial traumatic amputation of an upper limb with excellent functional recovery: A 13-year follow-up clinical case.

Introducción: Se han publicados pocos informes sobre el seguimiento a largo plazo de la reparación quirúrgica de una amputación parcial. Algunos estudios de largo plazo han registrado tasas similares de discapacidad entre los pacientes con amputaciones y los sometidos a operación reconstructiva. Objetivo: Informar un caso clínico de una amputación traumática parcial de una extremidad superior con recuperación funcional después de 13 años de seguimiento. Caso clínico: Paciente masculino de ocho años con traumatismo grave en la extremidad superior izquierda, desprendimiento de los músculos bíceps y tríceps y una fractura diafisaria oblicua del húmero distal. La fractura se fijó de manera transitoria con alambres de Kirschner de 2.0 mm, seguido de inmovilización con aparato de Sarmiento y al final se realizó reducción abierta y fijación interna con placa de compresión dinámica de 3.5 mm. La integridad muscular y neurovascular permitió la reparación microquirúrgica del nervio radial y la rehabilitación neuromuscular. Conclusiones: Este informe clínico representa un caso de una recuperación funcional excelente atestiguada a través de un periodo de seguimiento de 13 años.

Introduction: There are just a few reports that deal with long-term outcomes of a partial amputation surgical repair. Long-term studies have reported similar rates of disability among patients with amputations and those that have been undergoing reconstructive surgery. Objective: The purpose of this report is describing a clinical case of a patient with partial traumatic amputation of an upper limb with an excellent functional recovery after 13 years of follow-up. Clinical case: The case of an 8 year old male patient with severe trauma to the upper left limb is described. The lesions included an oblique diaphyseal open fracture of the distal region of the humerus, along with detachment of the biceps and triceps muscles. The fracture was fixed transiently with 2.0 mm Kirschner's wire followed by immobilization with Sarmiento's brace, and finally, open reduction and internal fixation with a 3.5 mm dynamic compression plate were performed. The muscular and neurovascular integrity allowed microsurgical repair of the radial nerve and neuromuscular rehabilitation. Conclusion: This clinical report represents a case with an excellent functional recovery witnessed through a 13-year follow-up period.

[Combination of noise plus weight-bearing accelerates consolidation time in tibial shaft fractures: A preliminary report]. / La combinación de ruido más carga de peso acelera la consolidación en las fracturas de la diáfisis tibial: Un informe preliminar.

Introduction: Long bones fractures are responsible for prolonged periods of incapacity and economic losses. New therapies for shortening the time of consolidation are needed. Thus, the purpose of this clinical study was to evaluate the efficacy of noise plus weight-bearing over the bone consolidation of tibial shaft fractures. Methods: In this clinical trial, 12 patients with tibial shaft fractures were recruited during a 24-month period. Participants were treated with intramedullary nails and randomized to two groups: an experimental group and a control group. Both groups underwent a rehabilitation program consisting of two daily walking sessions with progressive weight-bearing. Simultaneously, the experimental group received a noise stimulus on the fracture site with intensities of 0.1-0.6 N and frequencies of 0.1-50 Hz. Radiographic consolidation was evaluated by Radiographic Unión Scale of Tibia. Results: X-ray consolidation was achieved at 18.6 ± 3.6 weeks and 27.2 ± 6.9 weeks, for experimental and control group, respectively (p < 0.05). Recovery of mobility ranges in the knee and ankle was faster in the experimental group than in the control group. Conclusions: This new method to stimulate fracture consolidation has the following advantages: it is effective, portable, easy to use, and inexpensive.

Introducción: Las fracturas de huesos largos son causa de períodos prolongados de incapacidad y pérdidas económicas. Se necesitan nuevas terapias para acortar el tiempo de consolidación. Por lo tanto, el objetivo de este estudio clínico fue evaluar la eficacia del ruido más el soporte de peso sobre la consolidación ósea de las fracturas de la diáfisis tibial. Método: En este ensayo clínico, 12 pacientes con fracturas de la diáfisis tibial fueron reclutados durante un período de 24 meses. Los participantes fueron tratados con clavos intramedulares y luego aleatorizados a dos grupos: un grupo experimental y un grupo control. Ambos grupos se sometieron a un programa de rehabilitación que consta de dos sesiones diarias de caminata con soporte progresivo de peso. Simultáneamente, el grupo experimental recibió un estímulo de ruido en el sitio de la fractura con intensidades de 0.1-0.6 N y frecuencias de 0.1-50 Hz. La consolidación radiográfica se evaluó mediante la escala RUST. Resultados: La consolidación radiográfica se logró a las 18.6 ± 3.6 semanas en el grupo experimental y a las 27.2 ± 6.9 semanas en el grupo control (p < 0.05). La recuperación de los rangos de movilidad en la rodilla y el tobillo fue más rápida en el grupo experimental que en el grupo control. Conclusiones: Este nuevo método para estimular la consolidación de fracturas tiene las siguientes ventajas: es eficaz, portátil, fácil de usar y económico.

Osteocalcin Serum Levels in Gestational Diabetes Mellitus and Their Intrinsic and Extrinsic Determinants: Systematic Review and Meta-Analysis.

BACKGROUND: Undercarboxylated osteocalcin (ucOC) increases insulin release and insulin resistance in mice. In humans, evidence is scarce but a correlation of ucOC and total osteocalcin (tOC) with glycemic status markers has been demonstrated. The relationship of ucOC and tOC with gestational diabetes mellitus (GDM) has been even less characterized. OBJECTIVE: To assess the mean difference of tOC and ucOC serum concentrations among nondiabetic pregnant women and women diagnosed as GDM in the second trimester of pregnancy and to determine the possible intrinsic and extrinsic contributors to this difference. METHODS: A systematic search was performed to identify relevant studies published in English and Spanish using PubMed, SCOPUS, ISI Web of Knowledge, and PROSPERO database for meta-analysis. Observational studies measuring mean serum levels of osteocalcin among GDM, with at least 10 subjects analyzed in each group were selected. Mean difference (MD) by random effects model was used. Heterogeneity between studies was assessed using Cochran's Q, H, and I 2 statistics. RESULTS: From 38 selected studies, 5 were retained for analysis for a total of 1119 pregnant women. Serum concentrations of tOC were not significantly different among women with GDM and nondiabetic pregnant controls (MD: 1.56; 95% CI: -0.70 to 3.82; p = 0.175). Meanwhile, ucOC serum levels were significantly higher among women with GDM (MD: 1.17; 95% CI: 0.24 to 2.11; p = 0.013). The only factor influencing tOC was the UV index, showing a reduction in mean difference between GDM and controls when exposed to higher concentrations of UV rays. CONCLUSIONS: This meta-analysis provides evidence to support the use of ucOC as a potential marker for GDM rather than tOC, yielding very little variability among studies and no difference among methods or brands used for its analysis.

The +49A>G CTLA-4 polymorphism is associated with rheumatoid arthritis in Mexican population.

BACKGROUND: The Cytotoxic T lymphocyte antigen (CTLA-4) is one of the major susceptibility genes associated with autoimmune diseases. Susceptibility to rheumatoid arthritis (RA) is determined by both environmental and genetic factors. The genetic contribution approaches 50-60%. The association between RA with the +49A>G CTLA-4 polymorphism in the Mexican population was investigated. METHODS: The polymerase chain reaction-restriction fragment was used to amplify the +49A>G CTLA-4 polymorphism in RA patients and healthy subjects (HS). RESULTS: We analyzed the association between the +49A>G CTLA-4 polymorphism and RA. The G allele frequency was higher in RA patients than HS (46.8 vs 37.7%, OR=1.45, p=0.01). RA patients carrying the A/G genotype were significantly more likely to be positive to CRP and RF. There was no evidence of an association between SNP genotypes and the clinical characteristics of rheumatoid arthritis. CONCLUSIONS: The +49A>G CTLA-4 polymorphism is a genetic marker of susceptibility for RA in western Mexican population.