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Background: Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. Methods: 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia; and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p Results: 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). Conclusions: In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.

Objective To determine the comorbidities associated with disability in patients with OA in Mexico (2013–2015). Material and methods A cross-sectional, retrospective and multicentre IMPACTAR study (n = 7703) in Mexican patients (2013–2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n = 7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables. Results Mean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000–16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%). Conclusions Programs and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability.

In this article, we report the case of a 43-year-old male patient with mononeuritis multiplex associated with antiphospholipid antibodies. The patient had no other clinical or laboratory features of other systemic or autoimmune diseases or systemic vasculitis. He was treated with oral anticoagulant and mycophenolate mofetil, and is progressing favorably.

Background Patients with RA have a two to four-fold increased risk of developing infections compared to the general population. For this reason, the administration of influenza, pneumococcal and shingles vaccines is recommended for all patients with RA, preferably prior to initiating treatment, Previous studies have demonstrated the low prevalence of vaccination as well as adherence to current recommendations by rheumatologists in other regions. Objective To determine the knowledge and adherence to the current vaccination recommendations for patients with RA by rheumatology members of the Mexican College of Rheumatology (MCR), and to identify barriers to their application in this population. Methods A cross-sectional study was conducted through a survey sent to 577 rheumatologists from Mexico in January 2017. Results We received completed surveys from 122 individuals, representing 21.14% of the 577 rheumatologists in our registry. Fifty percent responded that they recommended immunisation against influenza to 76%–100% of their patients, 36.07% recommended immunisation against pneumococcus to 76%–100% of their patients, and 69.67% of the survey responders did not recommend shingles immunisation routinely to their patients. Conclusions The data collected in this study show there is poor adherence to immunisation schedules recommended for the RA population. This data suggests there is misinformation about the effectiveness, safety and optimal timing of immunisation in patients with RA in Mexico.

In the modern world, among the different clinical presentations of osteoarthritis, gonarthrosis and coxarthrosis exhibit the highest prevalence. In this paper, the characteristics of osteoarthritis and the different scales of assessment and classification of this pathology are exposed, to provide an exhibition of current evidence generated around diagnostic algorithms and treatment of osteoarthritis, with emphasis set out in the knee and hip, as these are the most frequent; a rational procedure for monitoring patients with osteoarthritis based on characteristic symptoms and the severity of the condition is also set. Finally, reference is made to the therapeutic benefits of the recent introduction of viscosupplementation with Hylan GF-20.En el mundo moderno, de entre las distintas presentaciones clínicas de la osteoartrosis, la gonartrosis y la coxartrosis son las que exhiben las mayores prevalencias. En el presente artículo se enuncian los rasgos característicos de la osteoartrosis y las diferentes escalas de evaluación y clasificación de esta patología, para a continuación ofrecer una exposición de la evidencia actual generada en torno a los algoritmos de diagnóstico y terapéuticos de la osteoartrosis, con énfasis en la de rodilla y la de cadera por ser estas las de mayor frecuencia; también se establece un procedimiento racional para el seguimiento del paciente con osteoartrosis en función de la sintomatología característica y el grado de severidad del padecimiento. Finalmente, se alude a los beneficios terapéuticos de la reciente introducción de la viscosuplementación mediante Hilano GF-20.

There has been great renewed interest in the past few years in unicompartmental arthroplasty for medial arthrosis of the knee due to the advantages over total knee replacement.A retrospective epidemiological study was performed with 25 consecutive patients (30 knees) from January 2002 to September 2013, who underwent unicompartmental knee arthroplasty with a phase 3 Oxford prosthesis using polyethylene inserts with an ultra-congruent design. With an average follow-up of 6.1 years (1.1-11.5 years). The following demographical variables were analyzed: weight, size, body mass index and perioperative variables like hemoglobin, bleeding and surgical time; we evaluated the pre and post-operative function of patients according to clinical and functional scales. We performed a clinical and radiological evaluation of the implant to check for the presence of arthrosis changes in non-intervened compartments.We observed optimal survival of the implant. The clinical Knee Score Society improved from 61 in the pre-op to 84 at the end of the follow-up period, with 90% excellent and good results. At the end of the follow-up the average post-surgical flection was 120 degrees and full extension. Only two patients showed satisfactory results due to progression of the arthrosis in the lateral compartment and only one patient required conversion to total replacement in two surgeries due to a periprosthetic infection.Unicompartmental knee arthroplasty is a less invasive surgery with good clinical and functional results. The success of the procedure is based on the proper selection of patients.

Resume Contexte. Une augmentation de l'expression d'une glycoproteine de membrane appelee P-glycoproteine a ete mise en evidence a maintes reprises dans des cellules normales et neoplasiques. La P-glycoproteine est une molecule qui pompe les medicaments hydrophobes (comme les glucocorticoides) en dehors des cellules, reduisant ainsi leurs effets therapeutiques ou toxiques. Le gene qui code pour la P-glycoproteine est appele MDR-I (« MDR a pour multidrug resistance ) Objectif. Evaluer l'activite fonctionnelle de la P-glycoproteine dans des lymphocytes et monocytes de malades souffrant de lupus erythemateux dissemine. Methodes. Nous avons etudie 30 malades souffrant de lupus erythemateux dissemine et 20 volontaires sains. Des cellules mononucleees ont ete isolees du sang peripherique par centrifugation a gradient, puis incubees en presence de daunorubicine (un medicament fluorescent expulse par la P-glycoproteine) a 37 °C ou 4 °C, pendant 30 minutes. L'activite de la P-glycoproteine a ete mesuree par cytometrie en flux. Les resultats sont exprimes sous la forme du pourcentage de lymphocytes ou de monocytes ayant une activite P-glycoproteine elevee (cellules a faible fluorescence). Resultats. La fluorescence moyenne des lymphocytes et des monocytes etait comparable chez les malades et les sujets sains. Cependant, etant donne que la technique utilisee est capable de mesurer l'activite de pompe de la P-glycoproteine cellule par cellule, nous avons pu demontrer que le pourcentage de lymphocytes ayant une activite P-glycoproteine accrue etait plus grand chez les lupiques (11,51 ± 14,3) que chez les temoins bien portants (0,71 ± 0,57) (p Conclusions. Nos resultats laissent penser que l'activite de la P-glycoproteine influence peut-etre la dose de glucocorticoide necessaire pour le traitement du lupus erythemateux dissemine.

Resume Contexte. La multiresistance est caracterisee par une expression excessive de la P-glycoproteine, pompe membranaire qui expulse les medicaments de la cellule vers le milieu extracellulaire. Objectif. Rechercher dans la polyarthrite rhumatoide des correlations entre l'activite de la P-glycoproteine, la concentration d'ARN messager du TNF-α et l'etat clinique. Methodes. Nous avons etudie 16 malades, dont huit consideres refractaires au traitement (groupe R) et huit non refractaires (NR), ainsi que 24 sujets bien portants. L'activite de la P-glycoproteine fonctionnelle a ete mesuree par cytometrie en flux. Des cellules mononucleees du sang peripherique isolees par centrifugation a gradient ont ete incubees avec de la daunorubicine afin de permettre la detection de cellules ayant le phenotype correspondant au gene MDR-I (« MDR a pour multiple drug resistance ). Les concentrations d'ARN messager du TNF-α ont ete determinees par PCR quantitative. Resultats. Le pourcentage de lymphocytes caracterises par une forte activite P-glycoproteine etait plus eleve chez les malades que chez les sujets normaux ( p = 0,0001). Chez les malades refractaires, l'activite P-glycoproteine etait plus marquee et l'expression du gene TNF-α considerablement plus importante que chez les malades non refractaires ( p = 0,006). L'ARN messager du TNF-α n'etait pas decelable chez les sujets normaux. Conclusions. Une augmentation de l'activite P-glycoproteine semble etroitement liee a une evolution clinique defavorable et a une absence de reponse au traitement. Elle pourrait etre liee a une expression accrue de TNF-α et a l'administration au long cours de divers medicaments, notamment de glucocorticoides. Une activite accrue de la P-glycoproteine et une production excessive de TNF-α semblent liees a un mauvais pronostic dans la polyarthrite rhumatoide.

The incidence of infectious diseases increases with ageing. The enzymatic activity of leucocytes may have a relevant role in the morbidity and mortality due to infections in the elderly. In this study we have compared the activity of enzymes involved in the inflammatory response in leucocytes from young and elderly women. A total of 35 healthy females was studied, 20 volunteers aged 78–98 years (mean 89.1 years) and 15 young controls aged 19–34 years (mean 26 years). All of them were in good clinical condition, without any acute or chronic disease. Intracellular enzyme activity was analysed by flow cytometry in leucocytes from young and elderly women. The enzyme substrates employed were for oxidative burst, l-aminopeptidase, collagenase, cathepsin B, C, D and, G and dipeptidyl peptidase I. The intracellular enzyme activity assessed by flow cytometry in leucocytes from young and elderly women was similar, as far as oxidative burst, l-aminopeptidase, cathepsin B, C, D and G are concerned. An increased collagenase activity was detected in granulocytes from elders. The mean fluorescence channels for this enzyme corresponded to 86 ± 23 and 60 ± 15 in cells from elders and controls, respectively (P = 0.01224). An increased dipeptidyl peptidase I activity was detected in lymphocytes from elderly women. The corresponding values for this enzyme in elders and the young were 65.9 ± 43.3 and 17.3 ± 5, respectively (P = 0.0036). The proper functional activity of intracellular enzymes involved in inflammatory responses is likely to be determinant for successful ageing.

Biotechnological drugs (BTDs) are complex molecules whose manufacturing process precludes the ability to identically reproduce the structure of the original product, and therefore there cannot be an absolute equivalence between the original (innovative) medication and its biosimilar counterpart. BTDs have been proven useful in the treatment of several rheumatic diseases, however their high cost has prevented their use in many patients. Several BTD patents have expired or are close to expire, triggering the development of structurally similar drugs with efficacy and safety profiles comparable to the innovative compound; however, these must be evaluated through evidence based medicine. The Mexican General Health Law contemplates the registry of these biosimilar drugs for their use in our country. This document is a forethought from members of the Mexican College of Rheumatology, pharmacologists, and epidemiologists, in accordance with Mexican health authorities regarding the necessary scientific evidence required to evaluate the efficacy and safety of biosimilar drugs before and after their arrival to the Mexican market.

Venous thromboembolism (VTE) is a worldwide public health problem, with an annual incidence of 1-2 cases/1,000 individuals in the general population and a 1-5% associated mortality. Orthopedic surgery is a major surgical risk factor for VTE, but the problem is more important for patients with hip and knee joint replacement, multiple traumatisms, severe damage to the spine, or large fractures. Thromboprophylaxis is defined as the strategy and actions necessary to diminish the risk of VTE in high-risk orthopedic surgery. Antithrombotics may prevent VTE. At the end of this paper, we describe a proposal of thromboprophylaxis actions for patients requiring high-risk orthopedic surgery, based on the opinion of specialists in Orthopedics and Traumatology who work with high-risk orthopedic surgery patients. A search for evidence about this kind of surgery was performed and a 100-item inquiring instrument was done in order to know the opinions of the participants. Then, recommendations and considerations were built. In conclusion, this document reviews the problem of VTE in high-risk orthopedic surgery patients and describes the position of the Colegio Mexicano de Ortopedia y Traumatología related to VTE prevention in this setting.

Venous thromboembolic disease (VTED) is a public health problem worldwide. In the United States it causes 2 million annual cases. Its annual incidence is 1-2 cases per 1,000 individuals in the general population. It is a disease frequently associated with life threatening complications and its mortality rate is 1-5% of cases. Due to its high complication rate, its slow recovery, and the need for prolonged disability, it is considered as a high-cost disease. VTED may occur in both surgical and medical patients; the known associated risk factors include prolonged rest, active cancer, congestive heart failure, atrial fibrillation, and stroke, among the major medical conditions. Orthopedic surgery represents the main surgical risk factor for VTED, including mainly hip and knee replacements, as well as polytraumatized patients with severe spinal lesions, and major fractures. VTED may be prevented with the appropriate use of antithrombotics. The participants in this consensus defined thromboprophylaxis as the strategy and actions undertaken to reduce the risk of VTED in patients undergoing high risk orthopedic surgery. The position of the Mexican College of Orthopedics and Traumatology regarding the prevention of VTED in orthopedic surgery is described herein.

Treatment strategies in the management of rheumatoid arthritis (RA) have significantly changed in the past decade. The early use of disease-modifying antirheumatic drugs (DMARDs) is the basis of this new treatment strategy. Because these agents alter the natural disease course of RA, early aggressive intervention results in better outcomes with respect to future structural damage and disability. The arrival of the 'biologic agents' era in rheumatology has further improved the therapeutic options in patients with RA. A significant portion of individuals with this ailment are elderly, with approximately one-third of patients experiencing their first symptoms after the age of 60 years. Yet, many elderly patients with RA do not receive optimal treatment. Although the reasons for this have not been completely defined, it seems clinicians are reluctant to use DMARDs in the elderly because of uncertainty regarding their efficacy and safety in this population. The aging process is associated with important changes in drug pharmacokinetics and pharmacodynamics. It appears that the former, mainly through decreased renal clearance, is responsible for an increased incidence of adverse effects with some DMARDs. The old are also more susceptible to infection than the young, making prevention of infectious disease through vaccination of particular importance; however, healthcare professionals should be aware that some DMARDs, including biologic agents, may interfere with responses to vaccination. The available data, although limited, suggest that DMARDs, including some biologic agents, are similarly effective in the old and the young, while maintaining very good adverse effect profiles. Therefore, the elderly with RA should not be excluded from receiving optimal treatment with these medications. At the same time, clinicians must be aware of the possible increased risk of drug toxicities, recognize the need to adjust therapy to match individual patient characteristics (i.e. renal function, co-morbidities, concomitant medication use or polypharmacy), and use the lowest possible effective dosage. This review describes the special considerations to be taken into account when administering conventional (synthetic) or biologic DMARDs to elderly patients with RA.

It is well known that infections in patients with diabetes mellitus are more severe, although there is controversy for increased susceptibility to them. Non-specific immune response mechanisms could be related to defense and/or susceptibility to pathogens. The aim of this study was to investigate the activity of several enzymes involved in the primary host defense mechanisms in non-insulin dependent diabetes mellitus (NIDDM). Twenty NIDDM females with a mean HbA(1c) level of 8.19% were included. No patient had clinical evidence of infection. As controls 20 healthy females were studied. The enzymes tested were dipeptidyl-peptidase I (DPP-I), cathepsin B and D, NADPH oxidase and superoxide dismutase (oxidative burst) and collagenase. Isolated leukocytes were incubated with the specific substrates in pyrogen free conditions. The intracellular enzyme activity was analyzed by flow cytometry. Collagenase enzymatic activity was similar in the three leukocyte subpopulations studied. Oxidative burst induction in monocytes was comparable between both groups. Enzyme activity of cathepsin B and D in all cell subsets, oxidative burst in PMN cells, and DPP-I in lymphocytes and monocytes from patients, was higher than those from healthy females (P

Multidrug resistance (MDR) is characterized by overexpression of P-glycoprotein, a pump molecule that decreases intracellular drug concentrations by increasing drug efflux from cells.To look for correlations between clinical status and P-glycoprotein activity and/or TNF-alpha mRNA levels in patients with rheumatoid arthritis.Sixteen patients were studied. Based on response to therapy, eight were refractory and eight nonrefractory to treatment. Findings were compared to those in 24 healthy controls. Flow cytometry was used to evaluate P-glycoprotein activity in peripheral blood mononuclear cells isolated by gradient centrifugation and incubated with the P-glycoprotein substrate daunorubicin. TNF-alpha mRNA levels were determined using quantitative PCR.Patients with rheumatoid arthritis showed an increased number of lymphocytes with high P-glycoprotein activity (p = 0.0001) as compared to the normal controls. P-glycoprotein activity was higher in the refractory than in the non-refractory patient subgroup (p = 0.006). Also, TNF-alpha mRNA levels were markedly higher in the refractory subgroup than in the nonrefractory subgroup, and were undetectable in the normal controls.Enhanced P-glycoprotein activity may be closely related to an unfavorable clinical course and a poor response to treatment. Increased TNF-alpha expression and chronic exposure to various drugs, including glucocorticoids, may contribute to increase P-glycoprotein activity. Both high P-glycoprotein activity and excessive amounts of TNF-alpha seem associated with poor outcome in rheumatoid arthritis.