RESUMO
Ankle fracture is the third most prevalent fracture in older adults. Wound dehiscence is the most frequent complication. Our objective is to determine the operative wound complication rate in patients with unstable ankle fracture in whom a prophylactic simple fasciocutaneous advancement was used. METHODS: Prospective registry of patients with unstable ankle fracture, in whom a prophylactic fasciocutaneous advancement was performed between August 2020 and July 2021. Demographic variables, time spent in performing the flap, cost of osteosynthesis, minor and major complications of the surgical wound, readmission or reoperation were registered. RESULTS: 42 older adults with ankle fracture were included. Median age 69 (60-94). 31% diabetics and 21.5% active smokers. A 40% trimalleolar fracture pattern. There were 7% of superficial complications of the surgical wound. No major complications, no reoperations. CONCLUSIONS: Prophylactic fasciocutaneous advancement at the beginning of traumatological surgery is technically simple, reproducible, cheap and with low complications. LEVEL OF EVIDENCE: Level IV, cross-sectional study.
Assuntos
Fraturas do Tornozelo , Ferida Cirúrgica , Humanos , Idoso , Fraturas do Tornozelo/cirurgia , Fraturas do Tornozelo/complicações , Estudos Transversais , Tornozelo , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Systemic Lupus Erythematosus (SLE) is an autoimmune disease in which genetic factors play a role in the susceptibility to develop it. Genes related to the synthesis of interferons such as TLR7 and genetics factors such as single nucleotide polymorphisms (SNPs) or copies number variation (CNV) in the gene have been involved with the development of the disease. The genetic differences between the populations contribute to the complexity of LES. Mexico has a mestizo population with a genetic load of at least three origins: Amerindian, Caucasian, and African. The mestizo of Yucatán is the only group whose contribution Amerindian is mainly Mayan, geographically distant from other Mexican Amerindians. We analyzed the CNV and the frequency of SNP rs179008 of the TLR7 as genetic risk factors in developing the disease in patients from Yucatán and Central Mexico. Results show that 14% of the cases of the Yucatecan population showed significantly >2 CNV and a higher risk of developing the disease (OR: 34.364), concerning 4% of those coming from Central Mexico (OR: 10.855). T allele and the A/T and T/T risk genotypes of rs179008 were more frequent in patients of Central Mexico than in those of Yucatán (50% vs. 30%, 93% vs. 30%, 4% vs. 1%), and association with susceptibility to develop SLE was observed (OR: 1.5 vs. 0.58, 9.54 vs. 0.66, 12 vs. 0.14). Data support the genetic differences between and within Mexican mestizo populations and the role of the TLR7 in the pathogenesis of SLE.
Assuntos
Genótipo , Lúpus Eritematoso Sistêmico/genética , Receptor 7 Toll-Like/genética , Adulto , Alelos , Variações do Número de Cópias de DNA , Frequência do Gene , Predisposição Genética para Doença , Haplótipos , Humanos , Masculino , México , Polimorfismo de Nucleotídeo Único , População BrancaRESUMO
Objetivo: Identificar la relación entre el trabajo y la salud mental de las profesoras de preescolar de la zona metropolitana de Guadalajara (ZMG). Materiales y métodos:Se realizó un estudio transversal analítico en profesoras de nivel preescolar. Los datos se obtuvieron con un formulario de datos sociolaborales y el Cuestionario General de Salud de Goldberg (GHQ 30) punto de corte 7/8 considerado con trastorno o "si caso". Para identificar la asociación se utilizó el chi cuadrado y el OR con una significancia < 0.05. Resultados: Participaron en el estudio 286 profesoras, con una media de edad de 38.30 años (± 8.298). En promedio tenían 15 años (±9.1) como educadoras. El 25 % de las profesoras fueron consideradas como "si caso"; según los resultados de la prueba GQH-30, 45.5% presentó perturbación del sueño y 43.0 % síntomas somáticos. Se observó asociación y riesgo cuando se percibe que el trabajo tiene que ver con problemas de salud y faltar al trabajo por estos problemas, cuando se tiene más edad y más antigüedad como educadora p<0.05. Conclusión: Al haber identificado 1 de cada 4 profesoras como "si caso" y los trastornos del sueño y los síntomas somáticos como los más prevalentes, nos orientan a considerar esta población con sufrimiento psíquico, que requiere atención especial y evaluaciones periódicas con instrumentos psicométricos adecuados para favorecer la detección oportuna de casos y la prevención de enfermedades mentales.
Objectives: To identify the relationship between work and mental health of preschool teachers in the metropolitan area of Guadalajara (ZMG). Subjects and methods: An analytic cross sectional study in pre-school teachers was performed, data were obtained with a socio-labor and the Goldberg's Health Questionnaire (GHQ 30), cut point 7/8 considerate disorder or case. To identify the association, chi square and OR were used. Significance was <0.05. Results: The study involved 286female teachers with a mean age of38.30 years (± 8.298). On average they were 15 years (± 9.1) as educators. The 25 % of the teachers were considered as a case, according to test results GQH-30. 45.5 % had sleep disturbances, and 43.0% somatic symptoms. Association and risk was observed when work has to do with health problems and miss work because of these problems, when one is older and have more years as an educator p <0.05. Conclusion: By identifying 1 in 4 teachers like case and sleep disorders and somatic symptoms as the most prevalent, guide us to consider this population with psychological distress, which requires special attention and regular assessments with appropriate psychometric instruments to promote timely detection of cases and prevention of mental illness.
RESUMO
La incidencia de fractura de cadera ha aumentado, por envejecimiento de la población e incremento de su prevalencia en áreas urbanas. Cuando se presenta en pacientes centenarios, resulta un desafío quirúrgico del cual poco se ha reportado. El objetivo del presente trabajo es estudiar una pequeña casuística de ellos. Pacientes y método: se definió como paciente centenario, quien al presentar fractura de cadera tuviera 99 años cumplidos. Ellos fueron operados si su daño orgánico cerebral era leve, si no estaban postrados y no portaban patologías limitantes de su rehabilitación o sobrevida a 1año. Se revisó retrospectivamente la casuística del Servicio de Traumatología, entre 01/04/1999 y 3 1/03/2006. Se comparó sobrevida con datos estadísticos de población centenaria general en periodo estudiado. Resultados: se efectuaron 8 operaciones a seis pacientes, todas mujeres, edad promedio 100.2 años (rango 99-102). La comorbilidad más frecuente fue hipertensión arterial (3 de 6 casos) e infección urinaria ( 3/6). No hubo diabetes mellitus. En todos se usó anestesia raquídea, la cirugía consistió en reducción más inserción de tornillo dinámico de cadera en 5 casos, placa de compresióndinámica en 2 y prótesis parcial en una paciente. El promedio de hospitalización postoperatoria total fue 13,1 días (rango 5- 25), 2 presentaron complicaciones, no hubo mortalidad hospitalaria. La sobrevida fue similar a población general de igual edad sin fractura. Los resultados obtenidos permiten concluir que es posible abordar en nuestro medio, el desafío ético que significa tratar quirúrgicamente fracturas de caderas en pacientes centenarios.
The incidence of hip fracture has increased, due to population aging and augmentation of prevalence in urban areas. Centenarian patients suffering from hip fracture are a surgical challenge, with limited reporting in medical literature. The purpose of this paper is to communicate the results of small groupof them. Patients and method: all patients older than 99 year old were considered as centenarians.They were operated only if they did not suffer from dementia, prostration or limiting severe diseases that could diminish one year survival or full rehabilitation. Their record and chinical folder were studied retrospectively from 01/04/1999 until 31/03/2006 and survival compared with general centenarian population during the same period. Results: six patients underwent 8 operations, all were female, mean age 100,2 years (range 99-102). Three of 6 suffered from hipertensión, 3/6 from urinary infection. No diabetes was found. Surgery was done under regional anaesthesia, in 5 operations a dynamic hip screw was implanted, dynamic compression plate in 2 and parcial prosthesis was used in other. The average total postoperative time in the hospital was 13,1 days (range 5-25), 2 patients suffered from postoperative complications. There were no intrahospital mortality and survival was similar to the general centenarian population with no hip fractures. In view of this results, it is nowadays reasonable to face the ethical challenge to operate hip fractures in centenarian patients.