Unveiling the role of osteoblastic micro RNAs in the skeleton: from biological functions to therapeutic potential / Rol de los micro-ARN osteoblásticos en el esqueleto: desde las funciones biológicas al potencial terapéutico

MicroRNAs (miRNAs) are small non-coding RNA molecules that play critical roles in post-transcriptional gene regulation. They function by binding to target messenger RNA (mRNA) molecules, leading to their degradation or inhibiting their translation into proteins. In the context of skeletal diseases, such as osteoporosis, osteoarthritis, and bone metastasis, there is growing evidence osteoblastic miRNAs, are involved in the regulation of bone formation and maintenance.Osteoblasts are bone-forming cells responsible for synthesizing and depositing the extracellular matrix, which ultimately mineralizes to form bone tissue. Osteoblastic miRNAs modulate various aspects of osteoblast function, including proliferation, differentiation, mineralization, and apoptosis. Dysregulation of these miRNAs can disrupt the balance between bone formation and resorption, leading to skeletal diseases.The therapeutic implications of targeting osteoblastic miRNAs in skeletal diseases are significant. Modulating the expression levels of specific miRNAs holds promise for developing novel therapeutic strategies to enhance bone formation, prevent bone loss, and promote bone regeneration. Potential therapeutic approaches include the use of synthetic miRNA mimics to restore miRNA expression in diseases associated with miRNA downregulation or the use of anti-miRNA oligonucleotides to inhibit miRNA function in diseases associated with miRNA upregulation.miRNA-based therapies are still in the early stages of development, and further research is needed to fully understand the complexity of miRNA networks. Additionally, the delivery of miRNAs to specific target tissues and cells remains a challenge that needs to be addressed for effective clinical translation. Nonetheless, targeting osteoblastic miRNAs represents a promising avenue for future therapeutic interventions in skeletal diseases. (AU)

Los micro-ARNs (miARNss) son pequeños ARN no codificantes que desempeñan un papel fundamental en la regulación génica postranscripcional. Ejercen su función al unir-se a moléculas de ARN mensajero (ARNm), promoviendo su degradación e inhibiendo su traducción en proteínas. En el contexto de las enfermedades esqueléticas, como la osteoporosis, la osteoartritis y la metástasis ósea existe evidencia de que los miARNs osteoblásticos están involucrados en la regulación de la formación y del mantenimiento óseo. Los osteoblastos son células formadoras de hueso responsables de sintetizar y depositar la matriz extracelular, que finalmente se mineraliza para formar el hueso. Los miARNs derivados de osteoblastos modulan varios aspectos de la función de estas células, incluida la proliferación, diferenciación, mineralización y la apoptosis. La desregulación de estos miARNs puede alterar el equilibrio entre la formación y la resorción ósea, lo que lleva a enfermedades óseas. Las implicaciones terapéuticas de los miARNs osteoblásticos en enfermedades esqueléticas son significativas. La modulación de los niveles de expresión de miARNs específicos es prometedora para desarrollar nuevas estrate-gias terapéuticas a fin de mejorar la formación, prevenir la pérdida y promover la regeneración ósea. Los enfoques terapéuticos potenciales incluyen el uso de miméticos de miARNs para restaurar la expresión de miARNs o el uso de oligonucleótidos anti-miARNs para inhibir su función. Las terapias basadas en miARNs aún se encuentran en las primeras etapas de desarrollo. La administración de miARNs a las células y los tejidos específicos sigue siendo un desafío para lograr una aplicación clínica eficaz. (AU)

Colocación de implantes en paciente con antecedentes de toma de bifosfonatos / Placement of implants in a patient with a history of bisphosphonates taken

El uso de bifosfonatos es un excelente tratamiento para pacientes con artritis reumatoide y enfermedades óseas, por ejemplo, osteoporosis. Se realiza un reporte de caso de paciente femenino, quien estuvo bajo consumo de este fármaco por prescripción de su médico para la prevención de artritis reumatoide postmenopausia. La paciente acude a consulta para la colocación de implantes en zona desdentada y comenta haber terminado el tratamiento de bifosfonatos hace un año. Se tomaron pruebas de diagnóstico y se realizó la colocación de implantes sin ninguna complicación. Sus citas de control fueron más frecuentes en cuatro meses, sobre todo por el detalle de consumo de bifosfonatos, pero en ninguna cita hubo algún detalle alarmante, la cicatrización iba en forma. Se dio de alta a la paciente después de sus citas periódicas y de asegurar su buena cicatrización a un implante bien situado (AU))

The use of bisphosphonates is an excellent treatment for patients with rheumatoid arthritis and bone diseases such as osteoporosis. Here is a case report of a female patient, who was under consumption of this drug by prescription of her doctor for the prevention of post-menopausal rheumatoid arthritis. The patient went to the consultation for the placement of implants in the edentulous area and comments having finished the bisphosphonate treatment one year ago. The diagnostic tests were taken, and the implant placement was performed well without any complications. The control appointments were more frequent in four months, especially due to the detail of bisphosphonate consumption, but in no appointment, there were any alarming details, the healing was in good shape. The patient discharged after her regular appointments and to ensure that she was healing well and that implant was well placed (AU)

Effect of PKM2 on Osteogenic and Adipogenic Differentiation of Bone Marrow Mesenchymal Stem Cells in Myeloma Bone Disease / 中国实验血液学杂志

OBJECTIVE@#To investigate the expression of pyruvate kinase M2 (PKM2) in bone marrow mesenchymal stem cells (BMSCs) in myeloma bone disease (MBD) and its effect on osteogenic and adipogenic differentiation of BMSCs.@*METHODS@#BMSCs were isolated from bone marrow of five patients with multiple myeloma (MM) (MM group) and five with iron deficiency anemia (control group) for culture and identification. The expression of PKM2 protein were compared between the two groups. The differences between osteogenic and adipogenic differentiation of BMSCs were assessed by using alkaline phosphatase (ALP) and oil red O staining, and detecting marker genes of osteogenesis and adipogenesis. The effect of MM cell line (RPMI-8226) and BMSCs co-culture on the expression of PKM2 was explored. Functional analysis was performed to investigate the correlations of PKM2 expression of MM-derived BMSCs with osteogenic and adipogenic differentiation by employing PKM2 activator and inhibitor. The role of orlistat was explored in regulating PKM2 expression, osteogenic and adipogenic differentiation of MM-derived BMSCs.@*RESULTS@#Compared with control, MM-originated BMSCs possessed the ability of increased adipogenic and decreased osteogenic differentiation, and higher level of PKM2 protein. Co-culture of MM cells with BMSCs markedly up-regulated the expression of PKM2 of BMSCs. Up-regulation of PKM2 expression could promote adipogenic differentiation and inhibit osteogenic differentiation of MM-derived BMSCs, while down-regulation of PKM2 showed opposite effect. Orlistat significantly promoted osteogenic differentiation in MM-derived BMSCs via inhibiting the expression of PKM2.@*CONCLUSION@#The overexpression of PKM2 can induce the inhibition of osteogenic differentiation of BMSCs in MBD. Orlistat can promote the osteogenic differentiation of BMSCs via inhibiting the expression of PKM2, indicating a potential novel agent of anti-MBD therapy.

Influence of patellofemoral joint degeneration on clinical outcomes after medial unicompartmental knee arthroplasty / 中华医学杂志(英文版)

BACKGROUND@#Patellofemoral joint (PFJ) degeneration has traditionally been regarded as a contraindication to unicompartmental knee arthroplasty (UKA). More recently, some researchers have proposed that PFJ degeneration can be ignored in medial UKA, and others have proposed that this change should be reviewed in PFJ degenerative facets and severity. This study aimed to systematically evaluate the effect of PFJ degeneration on patient-reported outcome measures (PROMs) and revision rates after medial UKA.@*METHODS@#Electronic databases (PubMed, Embase, Web of Science, etc.) were searched for studies assessing the influence of PFJ degeneration on medial UKA. A random-effects meta-analysis was conducted for the Oxford knee score (OKS), Knee society score (KSS), and revision rates and stratified by PFJ degenerative facets (medial/lateral/trochlear/unspecified), severe PFJ degeneration (bone exposed), and bearing type (mobile/fixed). Heterogeneity was assessed by the Cochran Q test statistic and chi-squared tests with the I-squared statistic.@*RESULTS@#A total of 34 articles with 7007 knees (2267 with PFJ degeneration) were included (5762 mobile-bearing and 1145 fixed-bearing and 100 unspecified). Slight to moderate degenerative changes in the medial and trochlear facets did not decrease the OKS and KSS, and only lateral facets significantly decreased the OKS (mean difference [MD] = -2.18, P   <  0.01) and KSS (MD = -2.61, P   <  0.01). The severity degree of PFJ degeneration had no additional adverse effect on the OKS, KSS, or revision rates. For mobile-bearing UKA, only lateral PFJ degeneration significantly decreased the OKS (MD = -2.21, P  < 0.01) and KSS (MD = -2.44, P  < 0.01). For fixed-bearing UKA, no correlation was found between PROMs/revision rates and PFJ degeneration.@*CONCLUSION@#For medial mobile-bearing UKA, slight to moderate degenerative changes in the PFJ, except lateral facet, did not compromise PROMs or revision rates. For medial fixed-bearing UKA, although it might not be conclusive enough, PROMs or revision rates were not adversely affected by PFJ degeneration (regardless of the facet).

Adecuación de la terapia hidrocinética en el paciente ortopédico-traumatológico: un estudio transversal / Appropriateness of hydrokinesitherapy in the orthopedic-traumatological patient: a cross sectional surve

ABSTRACT Introduction: Hydrokinesitherapy is a rehabilitation method used for the treatment of different types of orthopedic, neurological, respiratory problems, etc. However, the existing literature presents not so much evidence regarding the greater efficacy of water treatment compared to dry treatment in patients with post-traumatic outcomes. Objective: Through the administration of a questionnaire, we tried to investigate the rehabilitation experience of hydrokinetic therapists (trained with the so-called Sequential and Preparatory Approach) in order to understand hydrokinesitherapy areas and methods of proper application based on experts' opinion. Methods: A cross-sectional study was carried out in 2020 by administering a questionnaire to physiotherapists trained in hydrokinesitherapy according to the Sequential and Preparatory Approach method, with the aim to investigate their opinion on the use of hydrokinesitherapy in patients with various orthopedic-traumatological problems. Microsoft FORMS® platform was used for the administration of the questionnaire. Results: Sixty-two users participated in the study. From their answers emerged that the use of hydrokinesitherapy is not recommended for the treatment of post-traumatic hypersensitization of peri-lesional tissues (hypersensitive scars; general hypersensitization) and neuropathic syndromes (of the upper and lower limbs). Conclusions: The data obtained from administering the questionnaire were not sufficient to create a specific path to define the appropriateness of hydrokinesitherapy for some orthopedic-traumatological problems but could be considered a good starting point on which to build future developments through further studies.

RESUMEN Introducción: La terapia hidrocinética es un método rehabilitador utilizado para el tratamiento de diferentes tipos de problemas ortopédicos, neurológicos, respiratorios, entre otros. Sin embargo, en la literatura existente no abundan evidencias en cuanto a la mayor eficacia del tratamiento con agua en comparación con el tratamiento seco en pacientes con resultados traumáticos. Objetivo: A través de un cuestionario, se intentó investigar la experiencia de rehabilitación de los terapeutas hidrocinéticos (entrenados con el llamado Enfoque Secuencial y Preparatorio) para comprender las áreas de la terapia hidrocinética y los métodos de aplicación adecuados con base en la opinión de expertos. Métodos: Se realizó un estudio transversal en el año 2020 mediante la administración de un cuestionario a fisioterapeutas formados en la terapia hidrocinética según el método de Abordaje Secuencial y Preparatorio, con el objetivo de averiguar su opinión sobre el uso de la terapia hidrocinética en pacientes con diversos problemas ortopédico-traumatológicos. Se utilizó la plataforma Microsoft FORMS® para la administración del cuestionario. Resultados: Sesenta y dos usuarios participaron en el estudio. De sus respuestas surgió que no se recomienda el uso de la terapia hidrocinética para el tratamiento de la hipersensibilización postraumática de los tejidos perilesionales (cicatrices hipersensibles; hipersensibilización general) y síndromes neuropáticos (de miembros superiores e inferiores). Conclusiones: Los datos obtenidos del cuestionario no fueron suficientes para crear una ruta específica que defina la idoneidad de la terapia hidrocinética para algunos problemas ortopédicos-traumatológicos, pero podría considerarse un buen punto de partida para construir futuros desarrollos a través de estudios adicionales.

Aggressive central giant cell granuloma of the mandible: A case report and review of literature

Mandibular aggressive central giant cell granuloma is a rare non-neoplastic giant cell tumour characterised by pain, bone destruction, tooth root resorption, jawbone cortical perforation, and high recurrence rate. This is a case of a 10-year-old boy who presented to the Dental Surgical outpatient clinic of University of Uyo Teaching Hospital with a three-year history of left jaw swelling. The clinical diagnosis was fibrous dysplasia of the left hemi-mandible. Consequently, left hemi-mandibulectomy was performed, and subsequent histopathological diagnosis was aggressive central giant cell granuloma of the mandible. This article presents this rare diagnosis and explores its classification, aetiopathogenesis, clinico-pathological features and management.

The Role of Whole Body DWI in the Evaluation of Bone Disease in Multiple Myeloma / 中国实验血液学杂志

OBJECTIVE@#To explore the characteristics of ADC value changes in DWI of newly diagnosed symptomatic MM patients and its correlation with R-ISS stage.@*METHODS@#The data of 148 newly diagnosed symptomatic MM patients treated by whole-body DWI scan at The First Affiliated Hospital of Soochow University from June 2016 to June 2019 were selected and retrospectively analyzed and 30 cases of age-matched healthy people were selected as controls. The differences of ADC values between the patients in normal control group, DWI- group and DWI+ group were compared, and the relationship between ADC values and R-ISS stage in MM patients was compared.@*RESULTS@#The plasma cell percentage of the patients in DWI+ group was higher than those in DWI- group. ADC values of vertebra, sternum, rib, pectoral girdle, pelvic girdle of the patients in DWI+ group were significantly higher than those in DWI- group and normal control group. The ADC values of each part of the patients in DWI- group were higher than those in normal control group. ADC values of sternum, rib and pectoral girdle in the patients at R-ISS stage III were higher than those at R-ISS stage I and II, while, there was no statistical difference between R-ISS stage I and II groups. And there was no significant difference in ADC values of other bone parts such as vertebra and pelvic girdle in patients at R-ISS stage Ⅰ-Ⅲ.@*CONCLUSION@#DWI+ in MM patients is related to higher tumor invasion. The ADC values of the DWI+ group are higher than those of the DWI- group; the bone ADC values of the DWI- patients are still higher than the normal ones. And there is a certain relationship between ADC value and R-ISS stage.

Application value of imaging examination in the diagnosis of Muller-Weiss disease / 中国骨伤

OBJECTIVE@#To analyze radiological characteristics of Muller-Weiss disease, evaluate the clinical value of the imaging examination in diagnosis of Muller-Weiss disease.@*METHODS@#The imaging data of 26 patients with Muller-Weiss disease were collected from September 2015 to August 2020, including 7 males and 19 females, aged 43 to 68 years old with an average of (52.7±4.6) years old. In the X-ray examination observed the shape and position of the navicular bone. The talar-first metatarsal angle(TFM) was measured on the weight-bearing anteroposterior radiograph. The arch angle and angle between mid-axis of talus and mid-axis of the first metatarsal(Meary angle) were measured on the weight-bearing lateral radiographs. The morphology, density, adjacent joint space and position of the navicular bone were evaluated by computed tomography(CT), and magnetic resonance imaging(MRI) was used to observe the shape, signal, cartilage and surrounding soft tissue changes of the navicular bone.@*RESULTS@#Among 26 patients, 21 cases were unilateral and 5 cases were bilateral;X-ray examination showed that the lateral part of navicular bone of foot was compressed and flattened, showing"comma like"or"drop like", navicular moved to the medial side, partial fragmentation of bone, peripheral articular hyperplasia, uneven density and narrowing of relationship gap. According to Meary angle and deformity degree of the affected foot on the lateral X-ray of the load-bearing foot, Maceira staging was performed. There were 0 cases in stageⅠ, 2 cases in stage Ⅱ, 11 cases in stage Ⅲ, 9 cases in stage Ⅳand 4 cases in stage Ⅴ. CT examination showed bone fragmentation, medial displacement of navicular bone and formation of the talocalcaneal joint. MRI examination showed the irregular shape and uneven signal of navicular bone, narrowing of joint space, talocalcaneal joint surface hyperplasia and cartilage destruction, tarsal joint effusion and swelling of surrounding soft tissue.@*CONCLUSION@#Muller-Weiss disease has specific imaging manifestation, and an accurate diagnosis can be made based on the patient's age, gender, and clinincal history. Preoperative imaging examination can stage the disease, help clinicians to formulate better surgical plans, and postoperative imaging examination can better evaluate the surgical effect.

Cannabis. Usos y aplicaciones en la práctica odontológica diaria: revisión de la literatura / Cannabis. Uses and applications in daily dental practice: a review of the literature

La evidencia científica presente en la literatura indica que el cannabis puede ser utilizado con fines terapéuticos para tratar distintas afecciones odontológicas. Dado el acceso sencillo a la cavidad bucal, las distintas formulaciones de cannabis pueden aplicarse de forma tópica. La aplicación local de dosis bajas de cannabis ha demostrado alta efectividad para tratar distintas afecciones bucales, constituyendo un tratamiento seguro con baja probabilidad de generar repercusiones sistémicas indeseadas. En la actualidad, está siendo incorporado a materiales convencionales de uso e higiene odontológica con la finalidad de aprovechar sus efectos terapéuticos. El cannabis tiene múltiples usos en odontología: como componen-te de enjuagues bucales y soluciones para la desinfección de conductos radiculares, en tratamientos de trastornos de ansiedad bucal, como complemento en terapias oncológicas, como analgésico para atenuar el dolor inflamatorio y el neuropático, como miorrelajante y condroprotector para tratar trastornos de articulación témporomandibular (ATM) y bruxismo, como osteomodulador para el tratamiento de patologías que comprometen la integridad ósea, como la enfermedad periodontal y la osteoporosis, y para la cicatrización ósea asociada a fracturas, extracciones dentarias e implantes, y como inmunomodulador con potencial terapéutico para tratar patologías autoinmunes como las enfermedades reumáticas. El trata-miento local con cannabis es efectivo, bien tolerado por el paciente y con pocos efectos adversos. Por lo tanto, se puede concluir que el cannabis aporta un enorme abanico de posibilidades terapéuticas para tratar distintas afecciones odontológicas, aunque aún se requiere mayor cantidad de estudios científicos que avalen su utilización en cada situación fisiopatológica particular (AU)

The scientific evidence present in the literature indicates that cannabis can be used for therapeutic purposes to treat different dental conditions. Given the easy access to the oral cavity, the different cannabis formulations can be applied topically. The local application of low doses of cannabis has shown high effectiveness in treating different oral conditions, constituting a safe treatment with a low probability of generating unwanted systemic repercussions. It is currently being incorporated into conventional materials for dental use and hygiene in order to take advantage of its therapeutic effects. Cannabis has multiple uses in dentistry: as a component of mouthwashes and solutions for disinfecting root canals, in the treatment of oral anxiety disorders, as a complement in oncological therapies, as an analgesic to reduce inflammatory and neuropathic pain, as a muscle relaxant and chondroprotective to treat temporomandibular joint disorders and bruxism, as an osteomodulator for the treatment of pathologies that compromise bone integrity, such as periodontal disease and osteoporosis, and or bone healing associated with fractures, dental extractions and implants, and as immunomodulator with therapeutic potential to treat autoimmune pathologies such as rheumatic diseases. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Therefore, it can be concluded that cannabis provides an enormous range of therapeutic possibilities to treat different dental conditions, although more scientific studies are still required to support its use in each particular pathophysiological situation (AU)

Enfermedades, lesiones y accidentes en trabajadores de la construcción en Uruguay, período 2014-2018 / Illnesses, injuries and accidents among construction workers in Uruguay, 2014-2018

El presente trabajo se realizó en el marco de las actividades de investigación y extensión del Departamento de Salud Ocupacional de la Facultad de Medicina Universidad de la República, por iniciativa de los trabajadores del sindicato único de la construcción y afines. El objetivo fue conocer el perfil de salud y enfermedad de los trabajadores del sector con el propósito de generar acciones que promuevan la salud laboral del colectivo involucrado. La investigación realizada es de carácter descriptivo a partir de fuentes secundarias. De los resultados se destacaron las enfermedades del aparato osteomioarticular, lesiones por traumatismos o envenenamiento y patologías del aparato respiratorio como principales causas de ausentismo de origen médico. La patología osteomioarticular fue la primera causa de incapacidad total y también es la primera causa de incapacidad para la tarea en el periodo estudiado. La tasa de incidencia acumulada de los accidentes en el año 2014 fue de 81,8 por 1.000 trabajadores cotizantes de la construcción, presentando una caída sostenida hasta el 2018 que alcanzó el valor de 60,2 por 1.000 trabajadores cotizantes. El tipo de accidente más frecuente observado en el periodo fueron las lesiones a esfuerzo excesivo. Con respecto a los accidentes mortales existe una caída marcada entre los años 2014 al 2016 con un ascenso progresivo en 2018. De la investigación surge como necesidad mejorar el reconocimiento de la patología profesional en el sector, profundizar las acciones en seguridad y salud con énfasis en aspectos ergonómicos de la carga física(AU)

This study was carried out under the framework of the research and outreach activities of the Department of Occupational Health of the School of Medicine of the University of the Republic, as an initiative of the workers of its single union of construction and related industries. The objective was to describe the health and disease profile of workers in the sector in order to generate actions to promote their occupational health. The study was descriptive and consisted of a secondary analysis of existing data. Musculoskeletal disorders, traumatic injuries, poisonings and respiratory illnesses were the main cause of sickness absence. Musculoskeletal disorders were the main cause of both work-related and total disability. The cumulative incidence rate of injuries in 2014 was 81.8 per 1000 dues-paying construction workers, and subsequently declined until 2018, to an incidence of 62.2 per 1000 dues-paying workers. Overexertion was the most common mechanism of injury. With respect to fatal accidents, there was a arked decline between 2014 and 2016, followed by a progressive increasein 2018. This study underscores the need to improve the recognition of occupational illness and injury in the construction and related industries sector, and to add depth to safety and health interventions, with an emphasis on ergonomic aspects of physical loads(AU)

Prevalencia de enfermedad osteomioarticular lumbosacras y miembros inferiores en auxiliares de enfermería / Prevalence of lumbosacral and lower limb osteomyoarticular pathologies in nursing assistants / Prevalência de doença osteomioarticular lombossacral e de membros inferiores em auxiliares de enfermagem

RESUMEN Introducción: Los trabajadores de la salud se enfrentan permanentemente a labores complejas que afectan la región lumbar y miembros inferiores. Objetivo: Identificar la prevalencia de enfermedad osteomioarticular lumbosacras y miembros inferiores en auxiliares de enfermería Método: Se realizó un estudio epidemiológico, descriptivo y transversal en una muestra de 46 auxiliares del Distrito 18D04 de salud de Tungurahua, Ecuador. El instrumento aplicado fue un cuestionario para indagar variables sociodemográficas, antigüedad en el sector, horarios, tipos y tiempo de exposición a las labores habituales. Se utilizó la prueba estadística Chi-cuadrado, la paramétrica de correlación de Pearson y la prueba t de Student. Resultados: El 85 % de los estudiados presentó enfermedades lumbosacras y miembros inferiores durante el tiempo de trabajo, se apreció que el 39 % ha tenido una baja temporal al trabajo entre 1-3 días. Se identificó que la carga de peso es realizada por un 37 % y caminatas prolongadas en un 33 %. El 67 % tenía entre 11 y 40 años de trabajo y el resto menos de 10 años en el sector. El 54 % padeció enfermedades pertenecientes a miembros inferiores y un 46 % a lumbosacras. Conclusiones: El padecimiento de enfermedad osteomioarticular lumbosacras y miembros inferiores está relacionado con la edad y con padecerlas en los últimos doce meses, estas han provocado ausentismo laboral. No se comprobó una relación estadísticamente significativa con el padecimiento de enfermedad osteomioarticular con la antigüedad en el sector, las jornadas de trabajo y las actividades que más desarrollan.

ABSTRACT Introduction: Health care workers are constantly confronted with complex tasks that affect the lumbar region and lower limbs. Objective: To identify the prevalence of lumbosacral and lower limb osteomyoarticular pathologies in nursing assistants. Method: An epidemiological, descriptive and cross-sectional study was carried out in the 18D04 health district of Tungurahua, Ecuador. A total of 46 nursing assistants were selected in this study. We aimed a questionnaire to assess the sociodemographic variables, seniority in the health sector, time schedules, modes and time of exposure to the usual work. Chi-square test, Pearson's parametric correlation test, and the Student's t-test were used. Results: Most nursing assistants, the 85%, were diagnosed with lumbosacral and lower limb pathologies, and 39% took a temporary absence from work between 1-3 days. It was found that 37 % performed the heavy load work and 33% performed prolonged walks. The 67% had between 11 and 40 years of work and the rest had less than 10 years in the health sector. Fifty-four percent suffered from lower limb pathologies and 46% from lumbosacral pathologies. Conclusions: Lumbosacral and lower limb osteomyoarticular pathology is related to age, and their suffering in the last 12 months has led to a level of absenteeism in the workplace. There was no an important relationship, statistically, between osteomyoarticular pathology and seniority in the sector, working hours and the activities most frequently performed.

RESUMO Introdução: Os trabalhadores da saúde enfrentam constantemente tarefas complexas que afetam a região lombar e membros inferiores. Objetivo: Identificar a prevalência de doenças osteomioarticulares lombossacrais e de membros inferiores em auxiliares de enfermagem. Método: Estudo epidemiológico, descritivo e transversal em uma amostra de 46 auxiliares do Distrito Sanitário 18D04 de Tungurahua, Equador. O instrumento aplicado foi um questionário para investigar variáveis sociodemográficas, antiguidade no setor, horário, tipos e tempo de exposição a tarefas normais. Foram utilizados o teste estatístico Qui-quadrado, correlação paramétrica de Pearson e teste t de Student. Resultados: 85% dos estudados apresentaram doenças lombossacrais e de membros inferiores durante o tempo de trabalho, observou-se que 39% tiveram afastamento temporário do trabalho entre 1-3 dias. Identificou-se que a descarga de peso é realizada por 37% e as caminhadas prolongadas por 33%. 67% tinham entre 11 e 40 anos de trabalho e o restante menos de 10 anos no setor. 54% sofreram doenças pertencentes aos membros inferiores e 46% lombossacral. Conclusões: O sofrimento da doença osteomioarticular lombossacral e de membros inferiores está relacionado à idade e com o sofrimento nos últimos doze meses, estes têm causado absenteísmo ao trabalho. Não foi verificada relação estatisticamente significativa entre o sofrimento de doença osteomioarticular e o tempo de permanência no setor, a jornada de trabalho e as atividades que mais desenvolvem.

Metabolic assessment in pure struvite stones formers: is it necessary? / Avaliação metabólica em formadores de cálculo de estruvita pura: é necessário?

Abstract Background and objective: Magnesium ammonium phosphate stones (MAP), also known as struvite stones, are associated with urinary infection and impairment of renal unit. The aim of this study is to evaluate the urinary metabolic risk factors for recurrence of renal calculi in patients submitted to nephrectomy due to MAP stones. Methods: We retrospectively reviewed the charts of patients > 18 years old submitted to total nephrectomy due to pure MAP stones and pure calcium oxalate (CaOx) stones from July 2006 to July 2016. Urinary metabolic parameters were assessed through 24-hour urine exams ≥ 3 months after nephrectomy. Urinary metabolic parameters and new event related to lithiasis were compared. Results: Twenty-eight and 39 patients were included in MAP and CaOx group, respectively. Abnormalities in 24-hour urine samples were similar between groups. Hypercalciuria occurred in 7.1 and 10.3% of patients in MAP and CaOx group, respectively (p = 0.66), whereas hypocitraturia was present in 65.2 and 59.0% of patients with MAP and CaOx group, respectively (p = 0.41). No significant difference in new events was found between MAP and CaOx groups (17.9 vs. 23.1%, respectively; p = 0.60). Conclusion: A 24-hour urine evaluation should be offered to patients submitted to nephrectomy due to pure MAP stones in order to detect metabolic risk, improve treatment, and prevent stone recurrence.

Resumo Contexto e objetivo: Cálculos de fosfato de amônio e magnésio (FAM), também conhecidos como cálculos de estruvita, estão associados à infecção urinária e ao comprometimento da unidade renal. O objetivo deste estudo é avaliar os fatores de risco metabólico-urinários para recorrência de cálculos renais em pacientes submetidos à nefrectomia devido a cálculo de FAM. Métodos: Revisamos retrospectivamente os prontuários de pacientes > 18 anos submetidos à nefrectomia total devido a cálculos de FAM puro e cálculos de oxalato de cálcio puro (OxCa) de julho de 2006 a julho de 2016. Os parâmetros metabólicos urinários foram avaliados através de exames de urina de 24 horas ≥ 3 meses após a nefrectomia. Os parâmetros metabólicos urinários e um novo evento relacionado à litíase foram comparados. Resultados: Vinte e oito e 39 pacientes foram incluídos nos grupos FAM e OxCa, respectivamente. As anormalidades em amostras de urina de 24 horas foram similares entre os grupos. A hipercalciúria ocorreu em 7,1 e 10,3% dos pacientes nos grupos FAM e OxCa, respectivamente (p = 0,66), enquanto a hipocitratúria esteve presente em 65,2 e 59,0% dos pacientes nos grupos FAM e OxCa, respectivamente (p = 0,41). Nenhuma diferença significativa em novos eventos foi encontrada entre os grupos FAM e OxCa (17,9 vs. 23,1%, respectivamente; p = 0,60). Conclusão: Uma avaliação de urina de 24 horas deve ser oferecida aos pacientes submetidos à nefrectomia devido a cálculos de FAM puro, a fim de detectar risco metabólico, melhorar o tratamento e prevenir a recorrência de cálculos.

X-linked hypophosphatemic rickets: a new mutation / Raquitismo hipofosfatêmico ligado ao X: uma nova mutação

Abstract Phosphopenic rickets may be caused by mutations in the PHEX gene (phosphate regulating endopeptidase homolog X-linked). Presently, more than 500 mutations in the PHEX gene have been found to cause hypophosphatemic rickets. The authors report a clinical case of a 4-year-old girl with unremarkable family history, who presented with failure to thrive and bowing of the legs. Laboratory tests showed hypophosphatemia, elevated alkaline phosphatase, normal calcium, mildly elevated PTH and normal levels of 25(OH)D and 1.25(OH)D. The radiological study showed bone deformities of the radius and femur. Clinical diagnosis of phosphopenic rickets was made and the genetic study detected a heterozygous likely pathogenic variant of the PHEX gene: c.767_768del (p.Thr256Serfs*7). This variant was not previously described in the literature or databases. Knowledge about new mutations can improve patient's outcome. Genetic analysis can help to establish a genotype-phenotype correlation.

Resumo O raquitismo fosfopênico pode ser causado por mutações no gene PHEX (ligado ao X do homólogo da endopeptidase que regula o fosfato). Atualmente, mais de 500 mutações no gene PHEX causam raquitismo hipofosfatêmico. Os autores relatam um caso clínico de uma menina de 4 anos com histórico familiar sem relevância, que apresentou falha no crescimento e arqueamento das pernas. Os exames laboratoriais mostraram hipofosfatemia, fosfatase alcalina elevada, cálcio normal, PTH levemente elevado e níveis normais de 25(OH)D e 1,25(OH)D. O estudo radiológico mostrou deformidades ósseas no rádio e no fêmur. O diagnóstico clínico do raquitismo fosfopênico foi realizado e o estudo genético detectou uma provável variante patogênica heterozigótica do gene PHEX: c.767_768del (p.Thr256Serfs*7). Esta variante não foi descrita anteriormente na literatura ou nas bases de dados. O conhecimento sobre novas mutações pode melhorar o desfecho de pacientes. A análise genética pode ajudar a estabelecer uma correlação genótipo-fenótipo.

The presence of hyperostosis in Atlantic moonfish, Selene setapinnis (Mitchill, 1815) in the Brazilian Coast - case report / [A presença de hiperostoses no peixe-galo-sem-penacho, Selene setapinnis (Mitchill, 1815) na costa brasileira - relato de caso]

The occurrence of hyperostotic bones is common in marine fish, especially in the Carangidae family, despite few records of this condition in fishes from Brazilian waters. The present study describes the occurrence of hyperostosis in Atlantic moonfish (Selene setapinnis) in, Rio de Janeiro State, Brazil. Radiographs of the fish specimens were taken and all of them presented hyperostosis in at least three different regions: cleithrum, pterygiophores and pleural ribs. The observed pattern is different from previously described for other species of the same genus. It is the first record for the species and a valuable contribution to the study of bone diseases in fishes from the Brazilian coast.(AU)

A ocorrência de ossos hipertostóticos é comum em peixes marinhos, especialmente na família Carangidae, apesar de poucos relatos dessa condição em peixes de águas brasileiras. O presente estudo descreve a ocorrência de hiperostose no peixe-galo-sem-penacho (Selene setapinnis) no estado do Rio de Janeiro, Brasil. Radiografias dos espécimes de peixes foram feitas e todos os exemplares apresentaram hiperostoses em pelo menos três regiões diferentes: cleithrum, pterigióforos e costelas pleurais. O padrão observado é diferente do descrito previamente para outras espécies do mesmo gênero. Este é o primeiro relato para a espécie e é uma contribuição valiosa para o estudo de doenças ósseas em peixes da costa brasileira.(AU)

Relationship of serum vitamin D with liver disease severity and bone abnormalities in cholestatic children

@#<p style="text-align: justify;"><strong>Background:</strong> Vitamin D deficiency occurs in 10% to 36% of children with cholestasis. The relationship between serum vitamin D levels, severity of liver disease and bone abnormalities in children has not been extensively investigated.</p><p style="text-align: justify;"><strong>Objective:</strong> To determine serum vitamin D levels and its association with liver disease severity and presence of radiographic rickets in children with cholestasis.</p><p style="text-align: justify;"><strong>Methods:</strong> Children aged 0-10 years with cholestasis underwent serum 25-hydroxyvitamin D levels (25-[OH]D) determination, radiographs of wrists and knees and liver function tests. Liver disease severity was evaluated using the Child-Pugh score. Radiographs were assessed using Thacher Rickets Severity Score. Data were analyzed using odds ratio and Spearman's correlation coefficient.</p><p style="text-align: justify;"><strong>Results:</strong> We included 51 children [Mean (SD) age: 5 (6) months, 63% are males], mostly with biliary atresia (51%). Forty-seven (92%) had serum 25-(OH)D deficiency and four (8%) had insufficiency. Radiologic bone abnormalities were observed in 22 (43%) cases; specifically, rickets in 16 (31%). No association was observed with vitamin D levels and liver disease severity (OR 1.27, 95% CI 0.12-13.31) nor with rickets score (OR 0.07, 95% CI 0.004-1.37).</p><p style="text-align: justify;"><strong>Conclusion:</strong> Majority of the children with cholestasis had vitamin D deficiency, with a third having radiographic findings of rickets. Serum vitamin D levels were not associated with liver disease severity or with rickets score.</p><p style="text-align: justify;"><strong>Key Words:</strong> Vitamin D, rickets, cholestasis, bone disease, bone abnormalities</p>

Osteopoiquilose: comparação entre a radiografia e a ressonância magnética / Osteopoiquilosis: comparison between radiography and magnetic resonance

A osteopoiquilose é uma displasia osteosclerótica rara que mostra uma transmissão autossômica dominante e tem características radiológicas específicas que não apresenta clínica específica; o diagnóstico é feito por achados radiológicos incidentais típicos em pacientes que procuram tratamento para outros problemas médicos. A osteopoiquilose pode ser confundida com metástases osteoblásticas, esclerose tuberosa e mastocitose óssea. Relatamos uma mulher de 37 anos queixando-se de dor e edema no punho há 20 dias. A paciente foi submetida a avaliação com ressonância magnética, apresentando ossos do carpo e regiões epifisárias do rádio e ulna, além de metacarpos e algumas falanges, com diversos focos escleróticos dispersos. Em seguida, para nova avaliação, a paciente realizou radiografias de joelhos, ombros e punhos, confirmando os focos escleróticos encontrados na ressonância magnética, confirmando o diagnóstico de osteopoiquilose

Osteopoikilosis is a rare osteosclerotic dysplasia that shows an autosomal dominant transmission and has characteristic radiological features, there are no specific clinical features; diagnosis is made by incidental typical radiological findings in patients seeking treatment for other medical problems. Osteopoikilosis can be confused with osteoblastic metastases, tuberous sclerosis, and bone mastocytosis. We report a 37-years-old woman, complaining of pain and swelling in the wrist 20 days ago. The patient submitted to MRI for evaluation, showing carpal bones and epiphyseal regions of radius and ulna, as well as metacarpal and some phalanges, presenting several scattered sclerotic foci. After that for further evaluation, the patient was referred for radiographs of the knees, shoulders, and wrists, confirming the sclerotic foci found in MRI, confirming the diagnosis of osteopoikilosis

Fundamentos de elección terapéutica: osteonecrosis maxilar asociada a drogas antirresortivas (MRONJ) / Fundamentals of therapeutic choice: anti-resorptive drug-related maxillary osteonecrosis (MRONJ)

La acción terapéutica favorable que los antirresortivos (bifosfonatos BPs, denosumab DS) y drogas antiangiogénicas ocasionan en el tejido óseo en aquellos pacientes que presentan como causa etiológica cáncer o discrasias óseas incluyen hipercalcemias malignas o ­si requieren el consumo de dicha droga a baja concentración­ como ser: osteoporosis, osteopenia, enfermedad de Paget, displasia fibrosa, Osteogénesis Imperfecta. (1) La presente actualización pretende relacionar el tratamiento odontológico con prescripción crónica y drogas antirresortivas, para lo cual American Association of Oral and Maxillofacial Surgeons AAOMS: define el concepto de Osteonecrosis Maxilar Asociada a drogas Antirresortivas (MRONJ) como: «Área ósea necrótica expuesta al medio bucal con más de ocho semanas de permanencia, en presencia de tratamiento crónico con bifosfonatos en ausencia de radioterapia en cabeza y cuello¼. La AAOMS estableció los siguientes grupos de acuerdo con sus características clínicas en 4 estadios (0, 1 ,2 y 3) de acuerdo con el aspecto clínico y radiológico de la lesión osteonecrótica. Estadío 0: lesión osteonecrótica sin evidencia de hueso necrótico en pacientes bajo consumo de drogas antirresortivas. Estadío 1: lesión osteonecrótica con signos clínicos y ausencia de sintomatología clínica. Estadío 2: lesión osteonecrótica con signo y sintomatología clínica evidente. Estadío 3: lesión osteonecrótica con signo y sintomatología evidente que compromete a estructuras nobles: fracturas patológicas, anestesia del nervio dentario inferior, comunicación buco-nasal, comunicación buco-sinusal, fístulas cutáneas (2) (AU)

It is known the favourable action which antiresorptive (Bisphosphonates BPs, Denosumab: DS) and Antiangiogenic drugs produce in bone tissue. High concentrations are primarily used as an effective treatment in the management of cancer-related disorders, including hypercalcemia of malignant. Besides, low concentrations are used for other metabolic bone diseases including Osteoporosis, Osteopenia, Paget's Disease, Fibrous Dysplasia, Imperfect Osteogenesis. (1) The update relate relationship between dentistry and chronic treatment with antiresorptive drugs. According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), MRONJ is defined as exposed or necrotic bone in the maxillofacial region that has persisted for more than 8 weeks in association with current or previous BPs or DS therapy and with a lack of head and neck radiotherapy. AAOMS divided the MRONJ into 4 stages (0,1, 2 and 3) according to the clinical and radiological aspect of the osteonecrotic lesion: Stage 0: osteonecrotic lesion without sign-pathognomonic evidence of osteonecrosis. Stage 1: osteonecrotic lesion with clinical signs and absence of clinical symptoms. Stage 2: osteonecrotic lesion with sign and evident clinical symptoms. Stage 3: osteonecrotic lesion with signs and evident symptoms that involve noble structures: pathological fractures, anaesthesia of the lower dental nerve, oral-nasal communication, oral-sinus communication, skin fistulas (2) (AU)