Anestesia general y desarrollo cerebral en niños / General anesthesia and pediatric brain development

Enero 3, 2018. No. 2952

La anestesia general de larga duración influye en la inteligencia de los niños en edad escolar. Long-duration general anesthesia influences the intelligence of school age children. Zhang Q1, Peng Y1, Wang Y2. Author information BMC Anesthesiol. 2017 Dec 19;17(1):170. doi: 10.1186/s12871-017-0462-8. Abstract BACKGROUND: General anesthesia has been linked to impaired brain development in immature animals and young children. In this study the influence of orthopedic surgery under general anesthesia on the intelligence of school age children has been evaluated.  CONCLUSIONS: More than 3 h general anesthesia influenced the IQ of school age children for up to 3 months after orthopedic surgery. Beside extended exposure time to anesthetics additional factors for post-operative IQ reduction were younger children age, mothers with low educational levels and premature birth. TRIAL REGISTRATION: Chinese Clinical Trial Registry with registration number ChiCTR-OOC-17013497  retrospectively registered on 11/23/2017. KEYWORDS: Children; Cognition; General anesthesia; Intelligence; Orthopedic surgery PDF Efectos de la anestesia en el cerebro en desarrollo. Infantes y fetos Effect of Anesthesia on the Developing Brain: Infant and Fetus. Andropoulos DB1. Author information Fetal Diagn Ther. 2017 Jun 7. doi: 10.1159/000475928. [Epub ahead of print] Abstract The potential for commonly used anesthetics and sedatives to cause neuroapoptosis and other neurodegenerative changes in the developing mammalian brain has become evident in animal studies over the past 15 years. This concern has led to a number of retrospective studies in human infants and young children, and some of these studies observed an association between exposure to general anesthesia as an infant, and later neurobehavioral problems in childhood. This association is particularly evident for prolonged or repeated exposures. Because of the significant growth of fetal interventions requiring sedation and analgesia for the fetus, or because of maternal anesthetic effects, this concern about anesthetic neurotoxicity is relevant for the fetus. The potential for anesthetic neurotoxicity is the most important clinical and research problem in the field of pediatric anesthesiology. This review will first briefly summarize the rapid brain growth and development in the fetus and neonate. Next, animal model data of anesthetic neurotoxicity in the fetus and neonate will be presented, followed by a review of recent human clinical anesthetic neurotoxicity trials. Finally, the rationale for studying dexmedetomidine as a potential neuroprotectant agent in anesthetic neurotoxicity will be reviewed along with study design for two human clinical trials involving dexmedetomidine. KEYWORDS: Anesthetic neurotoxicity; Dexmedetomidine; Fetus; Isoflurane; Neonate; Sevoflurane PDF Efectos de la anestesia sobre el desarrollo cerebral de los niños Effects of Anesthesia on Children's Brain Development Hernández-Cortez Enrique J Anesth Crit Care Open Access 2015, 2(6): 00079 Summary Nowadays, the administration of most of the anesthetics is being questioned. The quality of reversibility of these medications is being questioned, especially when administered to children under 3 years old. The administration of isoflurane elevates intracellular calcium levels which are critical for cell damage resulting in apoptosis. The NMDA and GABA receptors are indirectly involved in the effect of immature brains. The immaturity of the central nervous system associated to the administration of anesthetic agents such as inhaled anesthetics, ketamine, midazolam, nitrous oxide, and others, produces important changes in the brain that have an impact in the child's later life. There are two important elements in the neurotoxicity of anesthetics, dosage and time administration. Repeating anesthetics produces more brain changes. These modifications have resulted in serious behavioral and memory changes in experiments in animals. It is suspected that a similar situation may arise in children who manifest learning disabilities in later stages.  Keywords: Apoptosis; Anesthetics; Children PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Reconstrucción del complejo posterolateral de la rodilla

http://www.clinicadeartroscopia.com.mx/academia/reconstruccion-del-complejo-posterolateral-de-la-rodilla/


Reconstrucción del complejo posterolateral de la rodilla con técnica de Laprade más exploración neurológica del nervio ciático poplíteo externo con epineurólisis feliz Año Nuevo 2018 !! 🎉🎊del cirujano Dr. Hinojosa de lesiones complejas de rodilla



Reconstruction of the posterolateral complex of the knee with Laprade technique plus neurological exploration of the external popliteal sciatic nerve with epineurolysis happy New Year 2018 !! 🎉🎊from Dr. Hinojosa surgeon of complex knee injuries

El efecto del inserto humeral constriñido de polietileno en la biomecánica de la artroplastia de hombro reversa

http://www.lesionesdeportivas.com.mx/academia/el-efecto-del-inserto-humeral-constrinido-de-polietileno-en-la-biomecanica-de-la-artroplastia-de-hombro-reversa/



By admin in academia

The effect of humeral polyethylene insert constraint on reverse shoulder arthroplasty biomechanics.



Fuente

Este artículo es originalmente publicado en:


https://www.ncbi.nlm.nih.gov/pubmed/29276534
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734524/
http://journals.sagepub.com/doi/10.1177/1758573217701065



De:


Abdulla I1, Langohr DG1, Giles JW1, Johnson JA1, Athwal GS1.
Shoulder Elbow. 2018 Jan;10(1):25-31. doi: 10.1177/1758573217701065. Epub 2017 Apr 5.





Abstract

Background:

There is little information on the effects of altering reverse shoulder arthroplasty (RSA) polyethylene constraint on joint load, load angle and deltoid force. The present biomechanical study aimed to investigate the effects of changing RSA polyethylene constraint on joint load, load angle, deltoid force and range of motion.


Conclusions:

Altering polyethylene cup constraint in RSA to enhance stability does not significantly alter resultant joint loads and deltoid forces. Surprisingly, terminal abduction range of motion was also not significantly different with varying cup constraint, indicating that terminal impingement may be tuberosity related rather than polyethylene.

KEYWORDS:

complication; constraint; instability; polyethylene; reverse total shoulder arthroplasty; rotator cuff tear arthropathy




Resumen


Antecedentes:

Hay poca información sobre los efectos de la alteración de la restricción de polietileno de la artroplastia de hombro inversa (RSA) en la carga articular, el ángulo de carga y la fuerza del deltoides. El presente estudio biomecánico tuvo como objetivo investigar los efectos del cambio de la restricción de polietileno RSA sobre la carga articular, el ángulo de carga, la fuerza deltoide y el rango de movimiento.


Conclusiones

La alteración de la restricción de la copa de polietileno en el RSA para mejorar la estabilidad no altera significativamente las cargas conjuntas resultantes y las fuerzas deltoides. Sorprendentemente, el rango de movimiento de abducción terminal tampoco fue significativamente diferente con la restricción variable de la copa, lo que indica que la incidencia del terminal puede estar relacionada con la tuberosidad en lugar del polietileno.


PALABRAS CLAVE:

complicación; restricción; inestabilidad; polietileno; artroplastia total de hombro invertida; artropatía del desgarro del manguito de los rotadores


PMID: 29276534 PMCID: PMC5734524 [Available on 2019-01-01]DOI: 10.1177/1758573217701065

Factores asociados con la pobre elevación anterior activa después de la artroplastia total de hombro reversa

http://www.lesionesdeportivas.com.mx/academia/factores-asociados-con-la-pobre-elevacion-anterior-activa-despues-de-la-artroplastia-total-de-hombro-reversa/


By admin in academia

Factors associated with poor active anterior elevation after reverse total shoulder arthroplasty


Fuente

Este artículo es publicado originalmente en:

https://www.ncbi.nlm.nih.gov/pubmed/29275846
http://www.jshoulderelbow.org/article/S1058-2746(17)30687-0/fulltext



De:


Jeon YS1, Rhee YG2.
J Shoulder Elbow Surg. 2017 Dec 21. pii: S1058-2746(17)30687-0. doi: 10.1016/j.jse.2017.10.027. [Epub ahead of print]



Todos los derechos reservados para:


Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.



Abstract

BACKGROUND:

Although reverse total shoulder arthroplasty (RTSA) has been shown to reduce pain and to improve function in most patients, some still suffer from functional limitations. This study aimed to investigate the incidence of poor motion recovery after RTSA and to identify factors that may cause poor outcomes.


CONCLUSION:

Satisfactory improvement of active anterior elevation was achieved in three-quarters of patients who underwent RTSA using a prosthesis designed to be medialized. Of the factors we investigated, only postoperative LHO was found to be a significant risk factor for poor postoperative active anterior elevation. Therefore, surgeons should attempt to avoid increasing postoperative LHO when performing RTSA using an implant designed to be medialized.



KEYWORDS:

Shoulder; lateral humeral offset; medialized prosthesis; poor anterior elevation; reverse total shoulder arthroplasty; risk factors














Resumen


ANTECEDENTES:

Aunque la artroplastia total de hombro invertida (RTSA) ha demostrado reducir el dolor y mejorar la función en la mayoría de los pacientes, algunos todavía sufren limitaciones funcionales. Este estudio tuvo como objetivo investigar la incidencia de la recuperación de movimiento pobre después de RTSA e identificar los factores que pueden causar resultados pobres.




CONCLUSIÓN:

Se logró una mejora satisfactoria de la elevación anterior activa en tres cuartas partes de los pacientes sometidos a RTSA utilizando una prótesis diseñada para medializar.De los factores que investigamos, solo el LHO postoperatorio se encontró como un factor de riesgo significativo para la elevación anterior activa posoperatoria deficiente.Por lo tanto, los cirujanos deben intentar evitar el aumento de la LHO postoperatoria cuando realicen RTSA usando un implante diseñado para ser medializado.




PALABRAS CLAVE:

Hombro; desplazamiento lateral del húmero; prótesis medializada; mala elevación anterior; artroplastia total de hombro reversa; factores de riesgo

PMID: 29275846 DOI: 10.1016/j.jse.2017.10.027



Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Regresar a los deportes después de la artroplastia de hombro reversa: la perspectiva suiza

http://www.lesionesdeportivas.com.mx/academia/regresar-a-los-deportes-despues-de-la-artroplastia-de-hombro-reversa-la-perspectiva-suiza/


Return to sports after reverse shoulder arthroplasty-the Swiss perspective


Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29273836
https://link.springer.com/article/10.1007%2Fs00264-017-3715-8



De:

Kolling C1,2, Borovac M3,4, Audigé L5,3, Mueller AM4, Schwyzer HK5.
Int Orthop. 2017 Dec 22. doi: 10.1007/s00264-017-3715-8. [Epub ahead of print]



Todos los derechos reservados para:


Copyright information
© SICOT aisbl 2017


Abstract

PURPOSE:

This patient survey evaluated the return to previous sports activities in Swiss patients up to five years after reverse shoulder arthroplasty (RSA).
CONCLUSIONS:

Returning to previous sports activities is an important expectation of RSA patients, and the majority do. Patient expectations of post-operative sports activity need to be addressed when planning RSA.

KEYWORDS:

Patient expectations; Reverse shoulder arthroplasty; Sports; Survey




Resumen
PROPÓSITO:

Esta encuesta de pacientes evaluó el regreso a actividades deportivas previas en pacientes suizos hasta cinco años después de la artroplastia de hombro invertida (RSA).


CONCLUSIONES:

Volver a las actividades deportivas anteriores es una expectativa importante de los pacientes RSA, y la mayoría lo hace. Las expectativas del paciente de la actividad deportiva postoperatoria deben abordarse al planificar RSA.


PALABRAS CLAVE:

Expectativas del paciente; Artroplastia de hombro reversa; Deportes; Encuesta
PMID: 29273836 DOI: 10.1007/s00264-017-3715-8

Evaluación de la posición de la glenosfera: abordaje superior versus deltopectoral para artroplastia reversa de hombro

http://www.lesionesdeportivas.com.mx/academia/evaluacion-de-la-posicion-de-la-glenosfera-abordaje-superior-versus-deltopectoral-para-artroplastia-reversa-de-hombro/


By admin in academia


Assessing glenosphere position: superior approach versus deltopectoral for reverse shoulder arthroplasty


Fuente:

Este artículo es originalmente publicado en:
https://www.ncbi.nlm.nih.gov/pubmed/29273388
http://www.jshoulderelbow.org/article/S1058-2746(17)30673-0/fulltext



De:
Aibinder WR1, Clark NJ1, Schoch BS2, Steinmann SP3.
J Shoulder Elbow Surg. 2017 Dec 19. pii: S1058-2746(17)30673-0. doi: 10.1016/j.jse.2017.10.013. [Epub ahead of print]



Todos los derechos reservados para:


Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.



Abstract

BACKGROUND:

The anterosuperior (AS) approach for reverse total shoulder arthroplasty (RTSA) has been reported as a risk factor for baseplate malposition because of potential difficulty in glenoid exposure. The objective of this study was to compare glenoid baseplate position between the AS and deltopectoral (DP) approaches in relation to the surgeon’s experience and to evaluate the effect of placement on clinical outcomes.


DISCUSSION AND CONCLUSION:

Both approaches produce similar baseplate position, clinical outcomes, and rates of scapular notching when they are used for RTSA. Attempts to inferiorize the glenoid baseplate through the AS approach may increase the risk of superior inclination.



KEYWORDS:

Shoulder arthroplasty; cuff tear arthropathy; deltopectoral; malposition; notching; reverse; superior approach


Resumen
ANTECEDENTES:

El abordaje anterosuperior (AS) para la artroplastia total de hombro reversa (RTSA) se ha informado como un factor de riesgo para la mala posición de la placa base debido a la posible dificultad en la exposición glenoidea. El objetivo de este estudio fue comparar la posición de la placa base glenoidea entre los abordajes AS y deltopectoral (DP) en relación con la experiencia del cirujano y evaluar el efecto de la colocación en los resultados clínicos.


DISCUSIÓN Y CONCLUSIÓN:

Ambos abordajes producen una posición similar de la placa de base, resultados clínicos y tasas de muescas escapulares cuando se usan para RTSA. Los intentos de inferiorizar la placa base glenoidea a través del abordaje AS pueden aumentar el riesgo de una inclinación superior.

PALABRAS CLAVE:
Artroplastia de hombro; artropatía por desgarro del manguito; deltopectoral; malposición; muesca; reversa; abordaje superior

PMID: 29273388 DOI: 10.1016/j.jse.2017.10.013 Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

SIRA / ARDS

Diciembre 21, 2017. No. 2939

Conceptos actuales de síndrome de dificultad respiratoria aguda: una revisión narrativa Current Concepts of ARDS: A Narrative Review. Umbrello M1, Formenti P2, Bolgiaghi L3, Chiumello D4,5. Author information Int J Mol Sci. 2016 Dec 29;18(1). pii: E64. doi: 10.3390/ijms18010064. Abstract Acute respiratory distress syndrome (ARDS) is characterized by the acute onset of pulmonary edema of non-cardiogenic origin, along with bilateral pulmonary infiltrates and reduction in respiratory system compliance. The hallmark of the syndrome is refractory hypoxemia. Despite its first description dates back in the late 1970s, a new definition has recently been proposed. However, the definition remains based on clinical characteristic. In the present review, the diagnostic workup and the pathophysiology of the syndrome will be presented. Therapeutic approaches to ARDS, including lung protective ventilation, prone positioning, neuromuscular blockade, inhaled vasodilators, corticosteroids and recruitment manoeuvres will be reviewed. We will underline how a holistic framework of respiratory and hemodynamic support should be provided to patients with ARDS, aiming to ensure adequate gas exchange by promoting lung recruitment while minimizing the risk of ventilator-induced lung injury. To do so, lung recruitability should be considered, as well as the avoidance of lung overstress by monitoring transpulmonary pressure or airway driving pressure. In the most severe cases, neuromuscular blockade, prone positioning, and extra-corporeal life support (alone or in combination) should be taken into account. KEYWORDS: acute respiratory distress syndrome; critically ill patients; lung-protective ventilation; positive end-expiratory pressure PDF Manejo del síndrome de dificultad respiratoria aguda con posición prona Treatment of ARDS With Prone Positioning. Scholten EL1, Beitler JR2, Prisk GK3, Malhotra A2. Author information Chest. 2017 Jan;151(1):215-224. doi: 10.1016/j.chest.2016.06.032. Epub 2016 Jul 8. Abstract Prone positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. This work elucidated the physiological mechanisms underlying changes in gas exchange and respiratory mechanics with prone ventilation. However, translating physiological improvements into a clinical benefit has proved challenging; several contemporary trials showed no major clinical benefits with prone positioning. By optimizing patient selection and treatment protocols, the recent Proning Severe ARDS Patients (PROSEVA) trial demonstrated a significant mortality benefit with prone ventilation. This trial, and subsequent meta-analyses, support the role of prone positioning as an effective therapy to reduce mortality in severe ARDS, particularly when applied early with other lung-protective strategies. This review discusses the physiological principles, clinical evidence, and practical application of prone ventilation in ARDS. KEYWORDS: ARDS; critical care; hypoxemia; lung injury; ventilation PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Obstetricia / Obstetrics

Diciembre 22, 2017. No. 2940

Libro de Obstetricia Obstetrics Edited by Hassan Salah Abduljabbar, ISBN 978-953-51-3704-7, Print ISBN 978-953-51-3703-0, 198 pages, Publisher: InTech, Chapters published December 20, 2017 under CC BY 3.0 license DOI: 10.5772/66054 Edited VolumeObstetrics is the field that deals with the well-being of the pregnant women as well as the labor and delivery of a healthy baby. Obstetricians work closely as neonatologists who deal with the care of the newborn baby to reduce chances of morbidity and mortality. The objective of obstetrics is to deal with diagnosis and treatment of pregnancy, antenatal care, and prevention of complication, collaborating with midwives to monitor pregnant women in labor, facilitating delivery and performing assisted procedures if needed as episiotomy, forceps delivery, vacuum extraction, and Cesarean section if indicated. Libro / Book Prevención de nausea y vomito en mujeres con anestesia regional en cesárea. Retos y soluciones Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions. Jelting Y1, Klein C1, Harlander T1, Eberhart L2, Roewer N1, Kranke P1. Author information Local Reg Anesth. 2017 Aug 9;10:83-90. doi: 10.2147/LRA.S111459. eCollection 2017. Abstract BACKGROUND: Intraoperative nausea and vomiting (IONV) or postoperative nausea and vomiting (PONV) affecting women undergoing regional anesthesia for cesarean section is an important clinical problem since these techniques are used widely. There are burdens of literature about IONV/PONV and several in parturient and cesarean. However, it needs more attention. The underlying mechanisms of IONV and PONV in the obstetrical setting mainly include hypotension due to sympathicolysis during neuraxial anesthesia, bradycardia owing to an increased vagal tone, the visceral stimulation via the surgical procedure and intravenously administered opioids. METHODS: Given the high and even increasing rate of cesarean sections and the sparse information on the etiology, incidence and severity of nausea and vomiting and the impact of prophylactic measures on the incidence of PONV/IONV, this article aims to review the available information and provide pragmatic suggestions on how to prevent nausea and vomiting in this patient cohort. Current literature and guidelines were identified by electronic database searching (MEDLINE via PubMed and Cochrane database of systematic reviews) up to present, searching through reference lists of included literature and personal contact with experts. DISCUSSION AND CONCLUSION: Taking into account the current guidelines and literature as well as everyday clinical experience, the first step for decreasing the incidence of IONV and PONV is a comprehensive management of circulatory parameters. This management includes liberal perioperative fluid administration and the application of vasopressors as the circumstances require. By using low-dose local anesthetics, an additional application of intrathecal or spinal opioids or hyperbaric solutions for a sufficient controllability of neuraxial distribution, maternal hypotension might be reduced. Performing a combined spinal-epidural anesthesia or epidural anesthesia may be considered as an alternative to spinal anesthesia. Antiemetic drugs may be administered restrainedly due to off-label use in pregnant women for IONV or PONV prophylaxis and may be reserved for treatment. KEYWORDS: PONV; antiemetics; hypotension; neuraxial anesthesia; obstetrics PDF Comparación de fenilefrina y efedrina en el manejo de la hipotensión inducida por raquia en embarazo de alto riesgo. Revisión narrativa Comparison of Phenylephrine and Ephedrine in Treatment of Spinal-Induced Hypotension in High-Risk Pregnancies: A Narrative Review. Dusitkasem S1, Herndon BH2, Somjit M3, Stahl DL2, Bitticker E4, Coffman JC2. Author information Front Med (Lausanne). 2017 Jan 20;4:2. doi: 10.3389/fmed.2017.00002. eCollection 2017. Abstract PURPOSE: To compare maternal and fetal effects of intravenous phenylephrine and ephedrine administration during spinal anesthesia for cesarean delivery in high-risk pregnancies. SOURCE: An extensive literature search was conducted using the US National Library of Medicine, MEDLINE search engine, Cochrane review, and Google Scholar using search terms "ephedrine and phenylephrine," "preterm and term and spinal hypotension," "preeclampsia and healthy parturients," or "multiple and singleton gestation and vasopressor." PRINCIPLE FINDINGS: Both phenylephrine and ephedrine can be safely used to counteract hypotension after spinal anesthesia in patients with uteroplacental insufficiency, pregnancy-induced hypertension, and in non-elective cesarean deliveries. Vasopressor requirements before delivery in high-risk cesarean sections are reduced compared to healthy parturients. Among the articles reviewed, there were no statistically significant differences in umbilical arterial pH, umbilical venous pH, incidence of fetal acidosis, Apgar scores, or maternal hypotension when comparing maternal phenylephrine and ephedrine use. CONCLUSION: From the limited existing data, phenylephrine and ephedrine are both appropriate selections for treating or preventing hypotension induced by neuraxial blockade in high-risk pregnancies. There is no clear evidence that either medication is more effective at maintaining maternal blood pressure or has a superior safety profile in this setting. Further investigations are required to determine the efficacy, ideal dosing regimens, and overall safety of phenylephrine and ephedrine administration in high-risk obstetric patients, especially in the presence uteroplacental insufficiency. KEYWORDS: ephedrine; fetal compromise; hypotension; phenylephrine; preeclampsia; uteroplacental insufficiency PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Congreso IberoLatinoamericano de Cirugía de Mano, del 12 al 14 de abril del 2018 Hotel Barceló Maya Caribe

http://www.clinicademano.com.mx/academia/congreso-iberolatinoamericano-de-cirugia-de-mano/

Una masa muscular tonificada preserva la función articular en rodillas y caderas con artrosis

http://www.cirugiarticular.com.mx/academia/una-masa-muscular-tonificada-preserva-la-funcion-articular-en-rodillas-y-caderas-con-artrosis/

Body composition and clinical symptoms in patients with hip or knee osteoarthritis: Results from the KHOALA cohort.

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/29224976
http://www.semarthritisrheumatism.com/article/S0049-0172(17)30138-5/fulltext



De:


Jeanmaire C1, Mazières B2, Verrouil E2, Bernard L3, Guillemin F4, Rat AC5.
Semin Arthritis Rheum. 2017 Oct 18. pii: S0049-0172(17)30138-5. doi: 10.1016/j.semarthrit.2017.10.012. [Epub ahead of print]



Todos los derechos reservados para:


Copyright © 2017 Elsevier Inc. All rights reserved.



Abstract

OBJECTIVE:

To analyze the associations between body composition, notably low lean mass, and clinicalsymptoms [pain, physical function, quality of life (QoL)] in patients with symptomatic hip and/or knee OA.
METHODS:

Cross-sectional study using data from the 3-year follow-up visit of the Knee and HipOsteoArthritis Long-term assessment (KHOALA) cohort. Skeletal muscle and fat mass were measured by dual X-ray absorptiometry (DXA). Fat mass index (FMI) was defined as total fat mass/height2. Appendicular lean mass was adjusted on body mass index (ALM/BMI), and low lean mass was defined according to the definition of FNIH Sarcopenia Project recommendations. Pain and function were measured by the WOMAC index and QoL by the SF-36.
RESULTS:

In total, 358 patients underwent DXA (67% women, mean [SD] age 63.4 [8.4] years, mean BMI 29.5 [5.6]kg/m2). The visual analog scale (0-100) pain score was 38.0 [24.7] and 25.4% had hipand 74.6% knee OA. Low lean mass and ALM/BMI were associated with impaired QoL and WOMAC scores on bivariate analysis (all p ≤ 0.001) but not on multivariate analysis after adjustment for FMI. For patients with normal BMI, mean [SD] WOMAC scores were higher (greater impairment) with low lean mass than normal body composition (WOMAC function 33.4 [23.3] and 24.0 [17.4], p = 0.02), and mean SF-36 physical component score was lower (greater impairment) 40.3 [10.2] and (44.3 [8.4], p = 0.04). Among patients with obesity, low lean mass had no additional effect.
CONCLUSION:

For patients with OA and normal BMI, QoL and function were more impaired for those with than without low lean mass. Conserving muscle mass in people with OA could have functional and antalgic benefits especially for those with normal BMI.

Copyright © 2017 Elsevier Inc. All rights reserved.

KEYWORDS:

Body composition; Dual X-ray absorptiometry; Knee osteoarthritis; Low lean mass






Resumen

OBJETIVO:

Analizar las asociaciones entre la composición corporal, notablemente la baja masa magra y los síntomas clínicos [dolor, función física, calidad de vida (CdV)] en pacientes con OA de cadera y / o rodilla sintomática.


MÉTODOS:

Estudio transversal con datos de la visita de seguimiento de 3 años de la cohorte de evaluación de la rodilla y la osteoartritis de la cadera a largo plazo (KHOALA). El músculo esquelético y la masa de grasa se midieron mediante absorciometría doble de rayos X (DXA). El índice de masa grasa (FMI) se definió como la masa grasa total / altura2. La masa magra apendicular se ajustó en el índice de masa corporal (ALM / IMC), y la baja masa magra se definió de acuerdo con la definición de las recomendaciones del Proyecto de Sarcopenia FNIH. El dolor y la función se midieron mediante el índice WOMAC y la CdV por el SF-36.


RESULTADOS:

En total, 358 pacientes se sometieron a DXA (67% mujeres, media [DE] edad 63,4 [8,4] años, IMC medio 29,5 [5,6] kg / m2). La escala de la escala analógica visual (0-100) fue de 38.0 [24.7] y el 25.4% tenía cadera y el 74.6% de rodilla OA. La baja masa magra y la ALM / IMC se asociaron con puntuaciones de QoL y WOMAC dañadas en el análisis bivariado (todos p ≤ 0.001) pero no en el análisis multivariado después del ajuste para FMI. Para pacientes con IMC normal, las puntuaciones medias [SD] WOMAC fueron más altas (mayor deterioro) con baja masa magra que la composición corporal normal (función WOMAC 33.4 [23.3] y 24.0 [17.4], p = 0.02) y media SF-36 física el puntaje del componente fue menor (mayor deterioro) 40.3 [10.2] y (44.3 [8.4], p = 0.04). Entre los pacientes con obesidad, la baja masa magra no tuvo ningún efecto adicional.


CONCLUSIÓN:

Para los pacientes con OA y el IMC normal, la CdV y la función fueron más perjudicadas para los que tenían una masa magra baja. La conservación de la masa muscular en personas con OA podría tener beneficios funcionales y antálgicos especialmente para aquellos con un IMC normal.



Copyright © 2017 Elsevier Inc. Todos los derechos reservados.


PALABRAS CLAVE:

Composición corporal; Absorciometría dual de rayos X, Osteoartritis de rodilla; Baja masa magra
PMID: 29224976 DOI: 10.1016/j.semarthrit.2017.10.012