Browsing by Author "Lira, Maria Jesus"

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    Concomitant Factors Associated With Tillaux-Chaput Fractures in Adults: A Case-Control Study
    (2024) Massri-Pugin, Jafet; Matamoros, Gabriel; Morales, Sergio; Urrutia, Tomas; Lira, Maria Jesus; Filippi, Jorge
    Background: Tillaux-Chaput fractures (TCFs) consist of fractures of the anterolateral distal tibia. They rarely occur in isolation in adults. When TCFs are missed, there is a risk of chronic pain, instability, and ankle osteoarthritis. This study aimed to identify which factors are related to the presence of TCFs in ankle injuries. Methods: A retrospective review of 1134 ankle fractures evaluated between 2013 and 2023 at a level 1 trauma center was performed. Inclusion criteria were patients aged >= 18 years, ankle radiographs and computed tomographic (CT) scan evaluation, and the presence of a TCF confirmed by CT scan. Exclusion criteria were prior ankle surgery, pilon, or distal tibial fractures. A musculoskeletal radiologist and a foot and ankle-trained orthopaedic surgeon classified the TCFs into type 1, an extraarticular avulsion; type 2, a fracture involving the incisura fibularis; and type 3, a fracture with impaction of the anterolateral tibial plafond. A matching control group of ankle fractures without TCF was created with a 1:2 ratio. The following variables were collected: sex, age (<50 vs >50 years), ankle dislocation or subluxation, Weber classification, Maisonneuve fracture, type of medial and posterior malleolar fracture, Lauge-Hansen classification, malleoli involved, and osteochondral lesion of the talus. Multivariate logistic regression was performed to detect which variables had an association with the TCF and their subtypes. P value <.05 was considered significant. Results: A total of 481 ankle fractures had radiographs and CT scans available for evaluation, of which 83 (17.3%) had a TCF. Of these, 44.6% were type 1, 44.6% type 2, and 9.6% type 3. The mean age was 52.2 years; 66.3% were women. Six patients (7.2%) had an isolated TCF. Fifty-eight (69.9%), 50 (60.2%), and 62 (74.7%) ankles had involvement of the lateral, medial, and posterior malleolus, respectively. Age >= 50 years (OR 2.73, 95% CI 1.45-5.14) and pronation external rotation injuries (OR 2.94, 95% CI 1.43-6.06) had a significant association with TCF. Moreover, ankle dislocation or subluxation (OR 3.16, 95% CI 1.11-8.96) and the absence of posterior malleolar fracture (OR 5.97, 95% CI 1.65-21.6) were significantly associated with TCF type 2 and 3. Conclusion: In this study, age >= 50 years and pronation external rotation injuries were the unique independent risk factors for TCF. Furthermore, ankle dislocation or subluxation and the absence of posterior malleolar fractures increased the odds of having a more severe TCF. This study provides insights into the factors associated with TCF and its subtypes during adulthood.
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    CpG Single-Site Methylation Regulates TLR2 Expression in Proinflammatory PBMCs From Apical Periodontitis Individuals
    (FRONTIERS MEDIA SA, 2022) Bordagaray, Maria Jose; Fernandez, Alejandra; Astorga, Jessica; Garrido, Mauricio; Hernandez, Patricia; Chaparro, Alejandra; Lira, Maria Jesus; Gebicke-Haerter, Peter; Hernandez, Marcela
    IntroductionApical periodontitis (AP) is a common oral disease caused by the inflammatory destruction of the periapical tissues due to the infection of the root canal system of the tooth. It also contributes to systemic bacterial translocation, where peripheric mononuclear blood cells (PBMCs) can act as carriers. Toll-like receptor (TLR) 2 mediates the response to infection and activates inflammatory responses. DNA methylation can be induced by bacteria and contributes to the modulation of this response. Despite the evidence that supports the participation of PBMCs in immune-inflammatory disorders, the inflammatory profile and epigenetic regulatory mechanisms of PBMCs in AP individuals are unknown. AimTo determine TLR2 gene methylation and inflammatory profiles of PBMCs in AP. MethodsCross-sectional exploratory study. Otherwise, healthy individuals with AP (n=27) and controls (n=30) were included. PMBCs were isolated by a Ficoll gradient, cultured for 24 hours, and both RNA and DNA were extracted. DNA was bisulfite-treated, and specific sites at the promoter region of the TLR2 gene were amplified by qPCR using validated primers. To verify its amplification, agarose gels were performed. Then, the PCR product was sequenced. mRNA expression of TLR2 was determined by qPCR. The soluble levels of 105 inflammatory mediators were first explored with Proteome Profiler Human Cytokine Array Kit. Consequently, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, IL-6R alpha, IL-1 beta, and IL-12p70 levels were measured by Multiplex assay. ResultsPBMCs from individuals with AP demonstrated a proinflammatory profile showing higher soluble levels of TNF-alpha, IL-6, and IL-1 beta compared to controls (p<0.05). Higher TLR2 expression and higher global methylation pattern of the promoter region of the gene were found in AP compared to controls (p<0.05). The CpGs single-sites at positions -166 and -146 were completely methylated, while the site -102 was totally unmethylated, independently of the presence of AP. DNA methylation of CpG single-sites in positions -77 and +24 was positively associated with TLR2 expression. ConclusionsPBMCs from AP subjects show a hyperinflammatory phenotype and TLR2 upregulation in association with single CpG-sites' methylation from the TLR2 gene promoter, thereby contributing to a sustained systemic inflammatory load in individuals with periapical endodontic diseases.
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    Disruptive behavior in the operating room: Systemic over individual determinants
    (ELSEVIER SCI LTD, 2022) Campos, Mauricio; Lira, Maria Jesus; Mery, Pamela; Calderon, Maribel; Sepulveda, Macarena; Pimentel, Fernando; Zuniga, Denisse
    Background: The operating room (OR) environment presents specific conditions that put stress on work dynamics. Disruptive behavior among members of the health team is recognized to affect work dynamics and patient outcomes. As surgeons have been syndicated as frequent disruptors, the objective was to explore their perceptions about OR working dynamics and the occurrence of disruptive behavior. Study design: Qualitative exploratory study, based on semi-structured individual interviews. Twenty participants were sampled until data saturation. For better context, we also included in the sample anesthesiologists, nurses, and technicians, among others. Using grounded theory framework, investigators extracted data from verbatim transcriptions with qualitative software. Results: Problems of infrastructure, interpersonal relationships, and organizational failures had most density of citations and trigger the most disruptive behavior narrated events. Although personality traits were noted to promote some disruptive behavior occurrence, systemic determinants were critical, such as poorly defined working roles and a plethora of personal ways to cope or avoid disruptive behavior. Conclusion: Our results suggest that disruptive behavior events are not just a matter of a surgeon's personality traits but also substantiated by systemic normalization, informal communication strategies, and undefined roles, making teams less resilient to unexpected events.
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    High prevalence of deep vein thrombosis in elderly hip fracture patients with delayed hospital admission
    (2020) Bengoa, Francisco; Vicencio, Gerardo; Schweitzer, Daniel; Lira, Maria Jesus; Zamora, Tomas; Klaber, Ianiv
    Purpose Deep vein thrombosis (DVT) is a common complication in hip fracture patients, associated with significant morbidity and mortality. Research has focused on postoperative DVT, with scant reports on preoperative prevalence. The aim of this study was to describe the prevalence of preoperative DVT in patients accessing medical care >= 48 h after a hip fracture. Methods We included elderly patients admitted >= 48 h after sustaining a hip fracture, between September 2015 and October 2017. Patients with a previous episode of DVT, undergoing anticoagulation therapy, with pathologic fractures or undergoing cancer treatment were excluded. Of 273 patients, 59 were admitted at least 48 h after the fracture. DVT screening by Doppler ultrasound of both lower extremities was carried upon hospital admission. We recorded age, sex, Charlson comorbidity index and ASA score, fracture type, time since injury, time from admission to surgery and total length of hospital stay. Results We studied 41 patients, 79 (+/- 10.34) years old. The delay from injury to admission was 120 h (48-696 h). Seven patients (17.1%) had a DVT upon admission. There were no significant differences between patients with and without DVT, regarding time from admission to surgery or the total length of the hospital stay. Conclusions The prevalence of DVT in patients admitted >= 48 h after a hip fracture was 17.1%. The diagnosis and management of DVT did not increase time to surgery or hospital stay. Our results suggest routine screening for DVT in patients consulting emergency services >= 48 h after injury.
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    Tibial Cut Accuracy in Mechanically Aligned Total Knee Arthroplasty Using Extensor Hallucis Longus Tendon to Determine Extramedullary Tibial Guide Position
    (2022) Besa, Pablo; Vega, Rafael; Ledermann, Gerardo; Calvo, Claudio; Angulo, Manuela; Lira, Maria Jesus; Vidal, Catalina; Orrego, Mario; Irribarra, Luis; Espinosa, Julio; Vial, Raimundo; Irarrazaval, Sebastian
    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.