Background Non-alcoholic fatty liver disease is a liver condition that is increasing worldwide and expected to become the number one cause of cirrhosis and hepatocellular carcinoma in the next 5 years. Currently there are no successful or approved pharmacological treatments. Weight loss is the first-line therapy as a 7 to 10% reduction improves steatosis, inflammation, hepatocyte ballooning, and fibrosis. To achieve this, lifestyle interventions including daily exercise and diet must be encouraged. We aimed to assess the effects of diet, exercise, or a combination of both compared to conventional treatment in patients with non-alcoholic fatty liver disease. Methods and finding A literature search was performed in CENTRAL, EMBASE, and PubMed. Randomized controlled trials comparing lifestyle changes with conventional treatment were included, without date restriction. Two authors searched studies according to eligibility criteria, extracted data, and assessed study quality. Subgroup analysis was made by type of intervention, duration of intervention and supervision. We calculated mean differences between the intervention and the control group with their corresponding 95% confidence intervals. Quality of the evidence was assessed using the Cochrane Risk of bias tool. This study is registered in PROSPERO, number CRD42020184241, and checked with the PRISMA checklist. 30 RCTs met the inclusion criteria. Compared to conventional treatment, combined exercise with diet seems to elicit greater reductions in ALT (MD: -13.27 CI 95% -21.39, -5.16), AST (MD: -7.02 CI 95% -11.26, -2.78) and HOMA-IR (MD: -2.07 CI 95% -2.61, -1.46) than diet (ALT MD: -4.48 CI 95% -1.01, -0.21; HOMA-IR MD: -0.61 CI 95% -1.01, -0.21) and exercise (ALT and AST non-significant; HOMA-IR MD = -0.46 CI 95% -0.8, -0.12) alone. Additionally, exercise improved quality of life, cardiorespiratory fitness, and weight (MD: -2.64 CI 95% -5.18, -0.09). Conclusion Lifestyle changes are effective in the treatment of NAFLD. Diet and exercise combined are superior to these interventions alone in improving liver enzymes and HOMA-IR.
Background The rotator cuff surgery (RCS) incidence is rising rapidly in North America, Europe, Asia, and Australia. Despite this, multiple factors limit patients’ access to surgery. In Latin America, barriers to orthopedic surgery have been largely ignored. The purpose of this study was to calculate the rate of RCS in Chile between 2008 and 2018, investigating possible associated factors to access such as age, sex, and the health insurance. Methods An ecological study was carried out with nationwide data obtained from the Database of Hospital Discharges of the Department of Statistics. All Chilean inhabitants aged 25 years or more were included. We used the ICD-10 codes M751, M754, and S460. The annual incidence rate of surgeries and the incidence rate for the period studied per 100,000 inhabitants were calculated. Data were analyzed stratified by age, sex, year of study, and the health insurance. Negative binomial regression was used to compare rates. Statistical analyzes were performed with Stata v.14 software. Results 39,366 RCSs were performed, with a total rate for the period of 32.36 per 100,000 inhabitants. The annual rate of surgeries from 2008 to 2018 increased from 24.55 to 49.11 per 100,000/year. When adjusting for year, an annual increase in surgery rates of 8.19% (95% CI 6.7–9.6) and 101% growth between 2008 and 2018 (95% CI 90–109%, p < 0.001) was observed. When comparing the global rates according to the health insurance, the public system corresponds to 21.3 per 100,000 and the private system to 72 per 100,000, the latter being 3.4-times higher (95% CI 2.7–4.4; p < 0.001). Conclusion RCS rates are increasing in Chile concordantly with previous reports of other western countries. The most important factor associated with RCS rate found was the patients’ health insurance, with higher rates observed for the private sector.
Introduction Knee arthrocentesis is frequently performed as a diagnostic or therapeutic procedure.Although considered a key competency for medical doctors, most students never execute the procedure during their training. We aimed to assess technical and nontechnical skills for knee arthrocentesis through high-delity hybrid simulation Methods Medical students and general physicians were recruited for training; orthopedic surgeons were recruited as experts. Trainees received educational documentation prior to training. Trainees took a medical history and obtained informed consent from a patient-actor, then encountered a simulated knee to execute the procedure. We adapted a direct observation scale to assess technical and nontechnical skill performance. Personalized feedback was received after each session. Performance among trainees (learning curves) and between trainees and experts was compared using a mixed-effects model. ResultsTrainees signi cantly improved from the rst session to the second and third. The third session was the learning curve plateau. Performance obtained in the third and fourth sessions were similar to expert performance. The assessment tool evaluated technical and nontechnical skills with high internal consistency and showed high interobserver reliability.Discussion Learning curve analysis showed that high-delity simulation allowed trainees to become pro cient in technical and nontechnical skills required to perform a safe knee arthrocentesis.
This study aimed to determine the tibial cut (TC) accuracy using extensor hallucis longus (EHL) tendon as an anatomical landmark to position the total knee arthroplasty (TKA) extramedullary tibial guide (EMTG), and its impact on the TKA mechanical alignment (MA). We retrospectively studied 96 TKA, performed by a single surgeon, using a femoral tailored intramedullary guide technique. Seventeen were prior to the use of the EHL and 79 used the EHL tendon to position the EMTG. We analyzed preoperative and postoperative standing total lower extremity radiographs to determine the tibial component angle (TCA) and the correction in MA, comparing pre-EHL use and post-EHL technique incorporation. Mean TCA was 88.89 degrees and postoperative MA was neutral in 81% of patients. Pre- and postoperative MAs were not correlated. As a conclusion of this study, using the EHL provides a safe and easy way to determine the position of EMTG.
ResumenEn los últimos años, ha habido un aumento en la aplicación de cuestionarios diseñados para la medición de resultados (o desenlaces) clínicos en la práctica médica. Para aplicar un cuestionario en una población distinta a la cual fue originalmente creado y diseñado, es necesario llevar a cabo un proceso riguroso de adaptación, con una determinada metodología. El objetivo de esta guía metodológica es describir el proceso de traducción, adaptación transcultural y validación de medidas de resultados informados por los pacientes (MRIPs) en Ortopedia y Traumatología.Nivel de evidencia: IV
Background The rotator cuff surgery (RCS) incidence is rising rapidly in North America, Europe, Asia, and Australia. Despite this, multiple factors limit patients’ access to surgery. In Latin America, barriers to orthopedic surgery have been largely ignored. The purpose of this study was to calculate the rate of RCS in Chile between 2008 and 2018, investigating possible associated factors to access such as age, sex, and the healthcare system.Methods An ecological study was carried out with nationwide data obtained from the Database of Hospital Discharges of the Department of Statistics. All Chilean inhabitants aged 25 years or more were included. We used the ICD-10 codes M751, M754, and S460. The annual incidence rate of surgeries and the incidence rate for the period studied per 100,000 inhabitants were calculated. Data were analyzed stratified by age, sex, year of study, and the healthcare system. Negative binomial regression was used to compare. Statistical analyzes were performed with Stata v.14 software.Results 39,366 RCSs were performed, with a total rate for the period of 32.36 per 105 inhabitants. The annual rate of surgeries from 2008 to 2018 increased from 24.55 to 49.11 per 105/year. When adjusting for year, an annual increase in surgery rates of 8.19% (95% CI 6.7–9.6) and 101% growth between 2008 and 2018 (95% CI 90–109%, p < 0.001) was observed. When comparing the global rates according to the healthcare system, the public system corresponds to 21.3 per 105 and the private system to 72 per 105, the latter being 3.4-times higher (95% CI 2.7–4.4; p < 0.001).Conclusion RCS rates are increasing in Chile concordantly with previous reports of other western countries. The most important factor associated with RCS rate found was the patients’ healthcare system, with higher rates observed for the private sector.
Purpose To describe the reverse shoulder arthroplasty angle (RSA angle) in magnetic resonance imaging (MRI) and compare the angle formed using bony landmarks (Bony RSA angle or B-RSA angle) with another angle formed using the cartilage margin as reference (Cartilage RSA angle or C-RSA angle). Methods Adult patients with a shoulder MRI obtained in our hospital between July 2020 and July 2021 were included. The C-RSA angle and B-RSA angle were measured. All images were independently assessed by 4 evaluators. Intraclass correlation coefficient (ICC) was determined for the B-RSA and C-RSA to evaluate interobserver agreement. Results A total of 61 patients were included with a median age of 59 years (17-77). C-RSA angle was significantly higher than B-RSA (25.4° ± 0.7 vs 19.5° ± 0.7, respectively) with a P-value <.001. The overall agreement was considered “good” for C-RSA (ICC = 0.74 [95% CI 0.61-0.83]) and “excellent” for B-RSA angle (ICC = 0.76 [95% CI 0.65-0.85]). Conclusions C-RSA angle is significantly higher than B-RSA angle. In cases without significant glenoid wear neglecting to account for the remaining articular cartilage at the inferior glenoid margin may result in superior inclination of standard surgical guides.
Resumen Objetivo Describir el uso de los cuestionarios reportados por pacientes (patient-reported outcome measures, PROMs, en inglés) en cirugía de tobillo y pie en Chile. Materiales y métodos Estudio descriptivo, transversal, en el que se diseñó y se aplicó una encuesta para conocer el uso de PROMs en Chile. Se invitó a participar a los traumatólogos cuya actividad principal fuese la cirugía de tobillo y pie. Resultados En total, 73 de 110 traumatólogos contestaron la encuesta. El 75% de los encuestados ha utilizado PROMs al menos una vez, y el 50% los utiliza de manera regular. La finalidad con la que se utilizan es principalmente de investigación (83%), y su aplicación es realizada la mayoría de las veces por los médicos del equipo (94%). Se identificaron 15 cuestionarios distintos aplicados en nuestro medio, siendo los más utilizados la Escala Visual Análoga (EVA), la Escala de Tobillo y Retropié de la American Orthopaedic Foot and Ankle Society (AOFAS), el 36-item Short Form Health Survey (SF-36), y la Escala de Resultados de Pie y Tobillo (Foot and Ankle Outcome Score, FAOS, en inglés). Los encuestados que no han utilizado estos cuestionarios señalaron como principales limitantes la falta de información, de tiempo y de personal capacitado. Conclusión El 75% de los traumatólogos dedicados a la cirugía de tobillo y pie encuestados ha utilizado PROMs en su práctica clínica. Existe una amplia variedad de cuestionarios aplicados, y el presente estudio constituye la primera aproximación de su aplicación en nuestro medio. Nivel de evidencia: 4.
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