Francisco José Berral

A MUFA-Rich Diet Improves Posprandial Glucose, Lipid and GLP-1 Responses in Insulin-Resistant Subjects

Objective: To study the effects of three weight-maintenance diets with different macronutrient composition on carbohydrate, lipid metabolism, insulin and incretin levels in insulin-resistant subjects. Methods: A prospective study was performed in eleven (7 W, 4 M) offspring of obese and type 2 diabetes patients. Subjects had a BMI > 25 Kg/m2, waist circumference (men/women) > 102/88, HBA1c < 6.5% and were regarded as insulin-resistant after an OGTT (Matsuda ISIm <4). They were randomly divided into three groups and underwent three dietary periods each of 28 days in a crossover design: a) diet high in saturated fat (SAT), b) diet rich in monounsaturated fat (MUFA; Mediterranean diet) and c) diet rich in carbohydrate (CHO). Results: Body weight and resting energy expenditure did not changed during the three dietary periods. Fasting serum glucose concentrations fell during MUFA-rich and CHO-rich diets compared with high-SAT diets (5.02 ± 0.1, 5.03 ± 0.1, 5.50 ± 0.2 mmol/L, respectively. Anova < 0.05). The MUFA-rich diet improved insulin sensitivity, as indicated by lower homeostasis model analysis-insulin resistance (HOMA-ir), compared with CHO-rich and high-SAT diets (2.32 ± 0.3, 2.52 ± 0.4, 2.72 ± 0.4, respectively, Anova < 0.01). After a MUFA-rich and high-SAT breakfasts (443 kcal) the postprandial integrated area under curve (AUC) of glucose and insulin were lowered compared with isocaloric CHO-rich breakfast (7.8 ± 1.3, 5.84 ± 1.2, 11.9 ± 2.7 mmol · 180 min/L, Anova < 0.05; and 1004 ± 147, 1253 ± 140, 2667 ± 329 pmol · 180 min/L, Anova <0.01, respectively); while the integrated glucagon-like peptide-1 response increased with MUFA and SAT breakfasts compared with isocaloric CHO-rich meals (4.22 ± 0.7, 4.34 ± 1.1, 1.85 ± 1.1, respectively, Anova < 0.05). Fasting and postprandial HDL cholesterol concentrations rose with MUFA-rich diets, and the AUCs of triacylglycerol fell with the CHO-rich diet. Similarly fasting proinsulin (PI) concentration fell, while stimulated ratio PI/I was not changed by MUFA-rich diet. Conclusions: Weight maintenance with a MUFA-rich diet improves HOMA-ir and fasting proinsulin levels in insulin-resistant subjects. Ingestion of a virgin olive oil-based breakfast decreased postprandial glucose and insulin concentrations, and increased HDL-C and GLP-1 concentrations as compared with CHO-rich diet.

Arthroscopic treatment of the snapping iliopsoas tendon through the central compartment of the hip: A PILOT STUDY

We undertook a prospective pilot study to determine whether arthroscopic surgery through the central compartment of the hip was effective in the management of a snapping iliopsoas tendon. Seven patients were assessed pre-operatively and at three, six, 12 and 24 months after operation. This included the assessment of pain on a visual analogue scale (VAS) and function using the modified Harris hip score. All the patients had resolution of snapping post-operatively and this persisted at follow-up at two years. The mean VAS score for pain fell from 7.7 (6 to 10) pre-operatively to 4.3 (0 to 10) by three months (p = 0.051), and to 3.6 (1 to 8) (p = 0.015), 2.4 (0 to 8) (p = 0.011) and 2.4 (0 to 8) (p = 0.011) by six, 12 and 24 months, respectively. The mean modified Harris hip score increased from 56.1 (13.2 to 84.7) pre-operatively to 88.4 (57.2 to 100) at one year (p = 0.018) and to 87.9 (49.5 to 100) at two years (p = 0.02). There were no complications and no weakness occurred in the musculature around the hip. Our findings suggest that this treatment is effective and would support the undertaking of a larger study comparing this procedure with other methods of treatment.

Delayed diagnosis of fatigue fractures in the elderly

A retrospective study was made of 30 stress fractures in elderly patients engaged in noncompetitive sporting activities, mostly marching and running. Fractures were located exclusively in the lower limbs. In many cases the diagnosis was delayed and in several cases was incorrect because the stress fracture was mis taken for other conditions. Given that the number of senior citizens engaged in active life and sporting ac tivities is constantly growing, physicians should be aware of this type of fracture to ensure early diagnosis and appropriate treatment.

Composição corporal de pacientes acamados por fraturas do quadril

As fraturas do quadril sao a maior causa de hospitalizacao da terceira idade, e constituem um consideravel encargo economico e social. A taxa de mortalidade atual apos um ano de fratura e acima de 33%, e o risco de morte e maior do quarto ao sexto mes apos a fratura. O objetivo deste estudo foi de avaliar alteracoes na composicao corporal de pacientes idosos, durante sua hospitalizacao por fraturas femur proximal, atraves de metodos antropometricos e analise dos valores fisiologicos de gasto energetico. Foi realizado um estudo prospectivo utilizando-se 45 pacientes consecutivos com diagnostico de fratura do quadril. Em todos os casos, foram obtidas medidas diretas e avaliacoes antropometricas indiretas baseadas em estimativas, nas primeiras 24 horas e repetidas apos uma semana de admissao hospitalar. Apos uma semana de internacao houve diminuicao da media do perimetro do braco (0,73 cm, p=0.0052) e da espessura da prega tricipital (1.41 mm, p=0.0181), sem haver modificacao das outras variaveis estudadas. A avaliacao antropometrica como um meio de se fazer um mapa da composicao corporal, em conjunto com as estimativas indiretas sugeridas neste estudo, podem ajudar a determinar o estado nutricional e necessidades caloricas de pacientes idosos.

Postural control and low back pain in elite athletes comparison of static balance in elite athletes with and without low back pain.

Although current research findings suggest that postural control or static balance is impaired in subjects with low back pain, few studies have specifically addressed the effect of low back pain on static balance in elite athletes. Forty-four athletes belonging to Chilean national teams took part in this study; 20 had low back pain and the remaining 24 were healthy controls. Displacement of the centre of pressure was analyzed by computerized platform posturography, using a standardized protocol; subjects were required to stand upright on both feet, with eyes first open then closed. The results showed that, athletes with low back pain used significantly more energy (p< 0.0182) and had a greater displacement of the centre of pressure (p< 0.005) with open eyes to control posture than healthy athletes. It may be concluded that static balance is impaired in elite athletes with low back pain and that analysis of two-footed stance provides a sensitive assessment of static balance in athletes.

Complicações em artroscopia de quadril

OBJETIVOS: Determinar a prevalencia de complicacoes ocorridas em uma serie de casos consecutivos de artroscopia de quadril; avaliar a evolucao da casuistica atraves de uma curva de aprendizado; reconhecer as causas das complicacoes nas cirurgias do quadril por via artroscopica. METODOS: Foram avaliados 150 casos consecutivos submetidos a artroscopia de quadril no periodo de maio de 2004 a dezembro de 2008. As complicacoes encontradas foram classificadas sob tres aspectos: sistema orgânico acometido, gravidade, grupos de 50 casos de acordo com a ordem de realizacao do procedimento. Utilizaram-se para a analise dos dados obtidos a estatistica descritiva e o teste exato de Fisher. RESULTADOS: Observaram-se 15 complicacoes (10%) neste estudo. Dez foram complicacoes neurologicas, duas osteoarticulares, uma vasculo-isquemica e duas cutâneas. Na classificacao de gravidade, tres foram classificadas como maiores, 12 intermediarias e nenhuma considerada menor. A incidencia das complicacoes ao longo da curva de aprendizado nao apresentou diferenca estatistica significativa (p = 0,16). CONCLUSOES:A artroscopia de quadril e um procedimento cirurgico de baixa morbidade, que cursa, em alguns casos, com complicacoes. Essas sao, frequentemente, neurologicas e transitorias. Elas ocorrem, principalmente, devido a tracao articular. A taxa de complicacoes nao diminuiu com o evoluir da casuistica.

BIOMECHANICS AND HISTOLOGICAL ANALYSIS IN RABBIT FLEXOR TENDONS REPAIRED USING THREE SUTURE TECHNIQUES (FOUR AND SIX STRANDS) WITH EARLY ACTIVE MOBILIZATION

Objective: Analyzing suture time, biomechanics (deformity between the stumps) and the histology of three groups of tendinous surgical repair: Brazil-2 (4-strands) which the end knot (core) is located outside the tendon, Indiana (4-strands) and Tsai (6-strands) with sutures technique which the end knot (core) is inner of the tendon, associated with early active mobilization. Methods: The right calcaneal tendons (plantar flexor of the hind paw) of 36 rabbits of the New Zealand breed (Oryctolagus cuniculus) were used in the analysis. This sample presents similar size to human flexor tendon that has approximately 4.5 mm (varying from 2mm). The selected sample showed the same mass (2.5 to 3kg) and were male or female adults (from 8 ½ months). For the flexor tendons of the hind paws, sterile and driven techniques were used in accordance to the Committee on Animal Research and Ethics (CETEA) of the University of the State of Santa Catarina (UDESC), municipality of Lages, in Brazil (protocol # 1.33.09). Results: In the biomechanical analysis (deformity) carried out between tendinous stumps, there was no statistically significant difference (p>0.01). There was no statistical difference in relation to surgical time in all three suture techniques with a mean of 6.0 minutes for Tsai (6- strands), 5.7 minutes for Indiana (4-strands) and 5.6 minutes for Brazil (4-strands) (p>0.01). With the early active mobility, there was qualitative and quantitative evidence of thickening of collagen in 38.9% on the 15th day and in 66.7% on the 30th day, making the biological tissue stronger and more resistant (p=0.095). Conclusion: This study demonstrated that there was no histological difference between the results achieved with an inside or outside end knot with respect to the repaired tendon and the number of strands did not affect healing, vascularization or sliding of the tendon in the osteofibrous tunnel, which are associated with early active mobility, with the repair techniques applied.

Complications in hip arthroscopy

Objectives: To determine the prevalence of complications in a series of consecutive cases of hip arthroscopy; to assess the progression of the sample through a learning curve; and to recognize the causes of complications in arthroscopic hip operations. Method: 150 consecutive cases that underwent hip arthroscopy between May 2004 and December 2008 were evaluated. The complications encountered were classified in three ways: organic system affected, severity and groups of 50 consecutive cases. The data were analyzed by means of descriptive statistics and Fishers exact test. Results: We observed 15 complications in this study (10%): ten were neurological, two were osteoarticular, one was vascular-ischemic and two were cutaneous. In the classification of severity, three were classified as major, 12 as intermediate and none as minor. The incidence of complications over the course of the learning curve did not present any statistically significant difference (p = 0.16). Conclusions: Hip arthroscopy is a surgical procedure that involves low morbidity, but which presents complications in some cases. These complications are frequently neurological and transitory, and mainly occur because of joint traction. The complication rate did not decrease with progression of our sample.

INTRA ARTICULAR CALCANEAL FRACTURES: A CLINICAL AND BIOMECHANICAL ANALYSIS.

Objective: Verify the variables of plantar pressure distribution of patients submitted to surgical procedure for calcaneal fracture, and correlate them with two different surgical approaches. Method: The authors studied 15 patients between 20 and 53 years of age (average 40.06 yrs.) who had intra-joint calcaneal fractures, submitted to surgical treatment by means of two different approaches: the lateral and the sinus tarsi. The authors checked the plantar pressure distribution by correlating these variables with the two different surgical approaches. The plantar pressure distribution was assessed using the Pedar System (Novel, Gmbh, Munich, Germany), by checking the maximum peak of the hindfoot and forefoot pressure on the affected and the normal sides. Results: the mean maximum pressure of the hindfoot plantigram in both approaches showed no statistical difference (t=0.11; p=0.91), as well as the mean maximum pressure of the forefoot plantigram (t=-0,48; p=0,64). Conclusion: The authors have concluded that there were no significant statistical differences between the average maximum peak of the hindfoot and forefoot pressure on the affected side as compared to the normal side, and these variables have showed no differences when compared to the surgical approach used.