Clinical and functional outcome of total knee arthroplasty in osteoarthritic patients at a tertiary care center in Kerala: a prospective study

Background:Osteoarthritis affects the knee joint more frequently than any other joint. Osteoarthritis is a chronic joint disease that affects the older age group, women more frequently, and is associated in 90% of cases with a varus deformity of the knee. The following study was conducted to evaluate the functional outcome of total knee arthroplasty in osteoarthritis using the knee society score.Methods:The study was conductedin patients treated for osteoarthritis of the knee joint at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala during the period from December 2019 to March 2022. Thirty patients diagnosed with osteoarthritis of the knee joint were taken into the study, all were undergone total knee arthroplasty. Patients were followed up at 4 weeks, 12 weeks, and 24 weeks.Results:The sample consisted of thirty osteoarthritic patients with 8 males and 22 were females. The patients' ages ranged from45-75 years. Among these 30 patients, 14 involved the right side, and 16 involved the left knee joint. The mean pre-operative knee clinical score was 36.93 which was improved to post-operative 84.70 following total knee arthroplasty. The mean pre-operative knee functional score was 16.83 which was improved to post-operative 71.17 following total knee arthroplasty.The outcome was rated as per knee society score. We got excellent results in 25 cases (83%), good in 3(10%), and fair in 2 patients (7%) according to knee clinical score whereas 8 excellent (27%), 16 good (53%), 5 fair (17%) and 1 poor(3%) results were found according to knee functional score.Conclusions:Total knee arthroplasty shows drastic improvement in the functional ability of the patient and the ability of the patient to get back to a pre-disease state, which is mainly because of pain-free joint movements, reflected by the improvement in the post-operative knee clinical score and knee functional score.

Recursos y vulnerabilidades de comunidades migrantes en Chile para enfrentar la pandemia SARS-CoV-2

Objetivo Conocer, en contexto de la pandemia por SARS-CoV-2, las vulnerabilidades psicosociales y socioeconómicas de la población migrante internacional en Chile y los recursos y capitales sociales reportados desde la propia comunidad. Métodos Estudio cualitativo descriptivo. Se realizaron 40 entrevistas semiestructuradas a migrantes (N=30) e informantes claves (N=10), ejecutadas virtualmente durante el 2020. El material fue analizado mediante análisis temático. El proyecto fue aprobado por el Comité de Ética Científico de la Facultad de Medicina de la Universidad del Desarrollo. Resultados Como principales vulnerabilidades enfrentadas por parte de personas migrantes en pandemia se identifican: hacinamiento, precariedad laboral y necesidades económicas, uso del transporte público, desinformación y creencias en torno al COVID-19, discriminación, falta de redes de apoyo, y estatus migratorio. Como recursos se reconocen: contar con redes de apoyo, posibilidad de teletrabajo o salir a trabajar, acceso a información y a la red asistencial y municipal, apoyo gubernamental y de la sociedad civil. Adicionalmente, se reportan experiencias de diagnóstico de COVID-19, identificando dificultades en acceso a PCR y adaptaciones familiares y laborales como cambios en los hábitos de vida dentro y fuera del hogar. Discusión El estudio entrega información relevante e inédita para la construcción de políticas en salud para migrantes internacionales con foco en crisis sanitarias. Se destaca la necesidad de fortalecer adecuaciones interculturales en las estrategias de prevención del contagio y de promoción de la salud y aumentar la disponibilidad de respuesta en el acceso a salud en el marco de la pandemia, mitigando así la vulnerabilidad social en migrantes y potenciando sus recursos de afrontamiento.

Objective To know, in the context of the SARS-CoV-2 pandemic, the psychosocial and socioeconomic vulnerabilities experienced by the international migrant population in Chile, as well as the resources and social capital reported from the community itself and its support networks, and to analyze the reception and implementation of the measures recommended by the health authorities in the different stages of the pandemic in the country. Methods Descriptive qualitative study. The information was collected through 40 semi-structured individual interviews with migrants (N=30) and key informants (N=10), carried out through online communication platforms during 2020. A thematic analysis of the material was carried out. The project was approved by the Scientific Ethics Committee of the Faculty of Medicine of the Universidad del Desarrollo. Results The main vulnerabilities experienced by migrants in the context of the pandemic include overcrowding, job insecurity and economic needs, use of public transport, misinformation and beliefs about COVID-19, experiences of discrimination and xenophobia, lack of support networks, and migratory status. The main resources are support networks, the possibility of working remotely or going out to work, access to information, access to the assistance and municipal network, and government support and civil society. In addition, experiences of diagnosis of COVID-19 are reported, identifying difficulties in accessing PCR testing, and family and work adaptations such as changes in lifestyle habits inside and outside the home. Discussion The study provides relevant and unpublished information for the construction of health policies for international migrants with a focus on sanitary crises. It highlights the need to strengthen cross-cultural strategies for the prevention of infection and health promotion, and to improve access to health in the context of the pandemic and beyond, thereby mitigating the social vulnerability experienced by migrants and enhancing their coping resources.

Diagnóstico de la Tricomonas vaginalis en la mujer / Diagnosis of Trichomonas vaginalis in women

OBJETIVO: revisar los diferentes métodos de diagnóstico de la tricomoniasis vaginal disponibles hasta el presente. MATERIALES Y MÉTODOS: se revisó la bibliografía latinoamericano e internacional a través de los sitios electrónicos de Pub-Med y Scielo. RESULTADOS: la Tricomonas vaginalis es considera como la enfermedad de transmisión sexual no viral, curable más frecuente y prevalente en el mundo. Se revisan los diferentes de métodos para diagnosticar la presencia de la tricomonas vaginalis en pacientes femeninos con síntomas y signos de la infección producida por el protozoario flagelado. CONCLUSIONES: se revisaron los diferentes métodos de diagnostico de la infección producida por la Tricomonas vaginalis en pacientes femeninas, desde los clásicos hasta los más actuales que emplean alta tecnología.

OBJECTIVE: to review the different diagnostic methods of Trichomonas vaginal available at the present time. MATERIAL AND METHOD: it was reviewed the Latin-American and international bibliography using the Pub-Med and Scielo web sites. RESULTS: Trichomonas vaginalis is considered the most common and prevalent sexual transmitted disease curable and non-viral worldwide. It was reviewed the different methods to diagnose the presence of Trichomonas vaginalis in female patients with symptoms and signs of infection produces by the flagellate protozoa. CONCLUSION: Different methods of diagnosis of the infection produced by Trichomonas vaginalis, since the classics to the most current methods that use high technology, were reviewed.

Prevalencia y caracterización genotípica de cepas de Staphylococcus aureus resistente a meticilina aisladas en un hospital regional mexicano / Prevalence and genotypic characterization of methicillin-resistant strains of Staphylococcus aureus isolated in a Mexican regional hospital

Resumen Introducción: Staphylococcus aureus es uno de los patógenos con mayor prevalencia en el mundo, asociado a una alta tasa de mortalidad y un rápido desarrollo de resistencia a los antimicrobianos. A pesar de su patogenicidad, su seguimiento epidemiológico en México es escaso. Objetivo: Analizar la epidemiología molecular local y determinar el origen clonal de cepas resistentes a meticilina (RM) aisladas de pacientes internados en el Hospital Central "Dr. Ignacio Morones Prieto". Métodos: Se llevó a cabo un estudio prospectivo de corte transversal, de julio a diciembre de 2016. La caracterización de las cepas se realizó mediante genotipificación Spa, la determinación por RPC punto final de la frecuencia de genes de virulencia específicos y su antibiograma. Resultados: A partir de estos datos, se obtuvo que la prevalencia de S. aureus RM fue de 25,7%, destacando la presencia del tipo Spa t895 en 76% de las cepas resistentes y un patrón similar de susceptibilidad a antimicrobianos. Conclusión: Los resultados de este estudio indican que la prevalencia regional de SARM no se ha modificado en los últimos 10 años y proporcionan información valiosa del origen clonal y los factores de virulencia de las cepas de S. aureus aisladas en la región.

Abstract Background: Staphylococcus aureus is one of most prevalent pathogens in the world associated with a high mortality rate and a rapid development of resistance to antibiotics. Despite its pathogenicity, epidemiological monitoring in Mexico is scarce. Aim: To analyze the local molecular epidemiology and determine the clonal origin of methicillin-resistant (MR) strains isolated from patients admitted to Hospital "Dr. Ignacio Morones Prieto". Methods: A cross-sectional prospective study was carried out from July to December 2016. The characterization of the strains was carried out by Spa genotyping, frequency of specific virulence genes by PCR and antibiogram. Results: The prevalence of MRSA was 25.7%, highlighting the presence of the Spa type t895 in 76% of the resistant strains and a similar pattern of susceptibility to antibiotics. Conclusion: The results of this study indicate that the regional prevalence of MRSA has not changed in the last 10 years and provide valuable information on the clonal origin and the virulence factors of the strains of S. aureus isolated in the region.

Comparison of MRI-ultrasound fusion–guided and transrectal ultrasound–guided prostate biopsy for the detection of prostate cancer in biopsy-naive men

OBJECTIVE@#Transrectal ultrasound-guided prostate biopsy (TRUSPBx) is the recommended method for the histopathologic confirmation of prostate cancer. However, the overall cancer detection rate is low; hence, patients are potentially exposed to multiple biopsies and their attendant morbidity. Multiparametric MRI of the prostate followed by MRI-Ultrasound fusion-guided prostate biopsy (FBx) is an emerging diagnostic pathway that has been established and recommended in men with a persistently elevated PSA despite a previous negative biopsy. However, evidence regarding its value in the biopsy-naïve setting is scarce. The objective is to compare the diagnostic accuracy of MRI fusion-guided prostate biopsy against TRUSPBx in biopsy-naïve men. @*METHODS@#This is a retrospective cohort study involving biopsy-naïve men with a PSA of 3 to 20 ng/ml. Primary outcomes of the study include overall cancer detection rate (CDR) and detection of clinically-significant prostate cancer (csPCa). Subgroup analyses were performed based on PSA level and prostate volume. Independent t-test, Mann Whitney U test and Chi square test were used in the statistical analysis.@*RESULTS@#A total of 185 biopsy-naïve men with a PSA level of 3 – 20 ng/mL were included in the study. Median pre-biopsy PSA level was 7.07 ng/mL (5.06 – 11.0) and 9.02 ng/mL (5.8 – 13.8) in the FBx arm and TRUS-guided biopsy arm, respectively. Ninety-nine (n=99; 53%) underwent MP-MRI of the prostate followed by MRI fusion-guided prostate biopsy and eighty-six (n=86; 46%) underwent the standard TRUS-guided prostate biopsy. Compared to TRUSPBx, FBx significantly detected more prostate cancer (CDR: 68% vs 30%, p<0.0001) and csPCa (46% vs 22%, p=0.001). The diagnostic yield of FBx was distinctly superior in the subgroup of men with a PSA of 4 – 10 ng/mL (CDR: 64% vs 7%, p<0.0001; csPCa: 43% vs 2%, p<0.0001) and a prostate volume of <40grams (CDR: 82% vs 36%, p<0.0001; csPCa: 53% vs 21%, p=0.006).@*CONCLUSION@#Compared to the current standard, the diagnostic yield of MRI fusion-guided prostate biopsy is significantly better in biopsy-naïve men. FBx detected more men with prostate cancer, with a higher proportion of men having clinically-significant disease. This advantage is strongly evident in men with a PSA level of 4 – 10 ng/mL and an average prostate volume of 40 grams. Hence, Multiparametric MRI of the prostate followed by MRI fusion-guided prostate biopsy is an effective first-line diagnostic modality for prostate cancer in men presenting with elevated PSA levels.

Validation of chromogenic in situ hybridization reactions for DNA and RNA detection in formalin-fixed paraffin-embedded tissue / Validação das reações de hibridização in situ cromogênica para detecção de DNA e RNA em tecidos fixados em formalina e incluídos em parafina

ABSTRACT Introduction: Chromogenic in situ hybridization (CISH) is used alternatively to the traditional immunohistochemical methods for the diagnosis of infectious diseases in formalin-fixed paraffin-embedded samples, since it presents high sensitivity and specificity. This type of sample undergoes several chemical modifications during histological processing, and both poor and excessive fixation can impair sample quality, making it difficult to obtain good results. In CISH, it is common to use positive samples as quality control for the reactions; however, this practice does not provide any information regarding the preservation of the genetic material, nor does it avoid false-negative results. Objective: The objective of this study was to validate the deoxyribonucleic acid (DNA) (+) and (-), and ribonucleic acid (RNA) (+) and (-) control probes to be used as quality control for the samples, evaluating preservation of the genetic material. Materials and methods: Twelve histological sections were used (in quadruplicate, n = 48), prepared from a pool of tissues without microscopic changes related to infectious and/or inflammatory processes. The CISH protocol was conducted according to the manufacturer's instructions, standardized under the conditions of our laboratory, using commercial DNA and RNA probes chemically linked to digoxigenin. Results and conclusion: Our results were very satisfactory, showing high reproducibility, accuracy, sensitivity and analytical specificity, high predictive values for positive and negative assays and with zero ratio of false-positive and false-negative results, allowing the validation of this reaction.

RESUMEN Introducción: La hibridación in situ cromogénica (CISH) es una alternativa a los métodos tradicionales inmunohistoquímicos para el diagnóstico de enfermedades infecciosas en muestras fijadas en formoly embebidas enparafina, puesto que tiene alta sensibilidad y especificidad. Este tipo de muestra sufre diversas modificaciones químicas durante elprocesamiento histológico, y tanto la mala fijación cuanto la fijación excessiva pueden perjudicar la calidad de las muestras, impidiendo buenos resultados. En la CISH, es común el empleo de muestras positivas para control de calidad de reacciones; sin embargo, esta práctica no proporciona ninguna información acerca de la preservación del material genético. Objetivo: El propósito de este estudio ha sido realizar la validación de las sondas comerciales para ácido desoxirribonucleico (ADN) (+) y (-) y ácido ribonucleico (ARN) (+) y (-), para que sean utilizadas como control de calidad, evaluando la preservación del material genético en las muestras testadas. Material y métodos: Se incluyen en el estudio 12 cortes histológicos (en cuadruplicado, n = 48), confeccionados a partir de un pool de tejidos sin alteraciones microscópicas relacionadas con procesos infecciosos y/o inflamatorios. El protocolo de CISH se desarrolló de acuerdo a las instrucciones del fabricante y bajo las condiciones del nuestro laboratorio, haciendo uso de sondas comerciales de ADN y ARN quimicamente ligadas a digoxigenina. Resultados y conclusión: Nuestros resultados han sido muy satisfactorios, demostrando alta reproducibilidad, exactitud, sensibilidad, y especificidad analítica, así como altos valores predictivos para ensayos positivos y negativos, y con proporción nula de falsos negativos y falsos positivos, lo que ha permitido la validación de esa reacción.

RESUMO Introdução: A hibridização in situ cromogênica (CISH) é uma alternativa aos métodos tradicionais imuno-histoquímicospara diagnóstico de doenças infecciosas em amostras fixadas em formalina e incluídas em parafina, visto que apresenta grande sensibilidade e especificidade. Esse tipo de amostra sofre diversas modificações químicas durante o processamento histológico, e tanto a má fixação quanto a fixação em excesso podem prejudicar a qualidade das amostras, inviabilizando bons resultados. Na CISH, é comum a utilização de amostras positivas como controle de qualidade das reações; entretanto essa prática não fornece nenhuma informação a respeito da preservação do material genético, nem evita resultados falso-negativos nas amostras testadas. Objetivo: O objetivo deste estudo foi realizar a validação das sondas comerciais para ácido desoxirribonucleico (DNA) (+) e (-) e ácido ribonucleico (RNA) (+) e (-), para serem utilizadas como controle de qualidade, avaliando apreservação do material genético nas amostras testadas. Materiais e métodos: Foram utilizados 12 cortes histológicos (em quadruplicata, n = 48), confeccionados a partir de um pool de tecidos sem alterações microscópicas relacionadas com processos infecciosos e/ou inflamatórios. O protocolo de CISH foi conduzido de acordo com as instruções do fabricante e padronizado conforme as condições do nosso laboratório, utilizando sondas comerciais de DNA e RNA quimicamente ligadas à digoxigenina. Resultados e conclusão: Nossos resultados foram muito satisfatórios, demonstrando alta reprodutibilidade, acurácia, sensibilidade e especificidade analítica, bem como altos valores preditivos para ensaios positivos e negativos e com proporção nula de resultados falso-negativos e falso-positivos, o que possibilitou a validação dessa reação.

The gait-dependent intermittent pneumatic compression ambulatory boot device: Preliminary reports on calf pressure and venous hemodynamics

RATIONALE@#Compression therapy has been demonstrated to be beneficial in a number of vascular conditions including chronic arterial ischemia, venous insufficiency and primary and secondary lymphedema. Its effectivity however is limited and questioned by the nature of the treatment procedure which requires that the patient be in a sitting or recumbent position while it is being administered.@*METHODS@#The author describes the development of a boot device which provides gait-dependent intermittent compression to the ankle and calf@*RESULTS@#In volunteer studies, the device produced a cycle of pressure changes from 15-40 mmHg at the interface. Simulated calf compression resulted in augmentation of venous flow recorded by duplex sonography at the superficial femoral vein area, indicating an improvement in venous hemodynamics with the use of the device.@*CONCLUSION@#These findings demonstrate the potential for an attractive ambulatory alternative to the commonly employed nonambulant therapies for venous insufficiency.

A comparison of distal endoluminal graft fixation methods: Healing characteristics of metallic stents and the endoluminal suture technique

RATIONALE@#Endoluminal grafts (EG) are a promising alternative to conventional open surgical approaches in the treatment of aneurysmal and occlusive arterial diseases. These devices generally employ metallic stents to secure the proximal and distal EG extents. However, the problem of intimal hyperplasia at the distal EG anastomotic ends similarly affect long-term outcomes as in conventional interposition grafting methods. A technique of distal EG anastomosis using handsewn endoluminal sutures is described and its effects on subsequent development of intimal hyperplasia compared with that of metallic endoluminal stents@*METHODS@#Ten adult mongrel dogs underwent bilateral common iliac artery endoluminal grafting procedures. On one side, the distal EG anastomosis was anchored with metallic stents while on the contralateral side the distal EG was secured with endoluminal sutures. The grafts were harvested after one month and the intimal characteristics were observed using histopathological methods.@*RESULTS@#Distal EG metallic stents and endoluminal sutures resulted in similar patency rates of 90%. The average time to deploy distal EG metallic stents was 56 seconds, while the average time to secure the distal EG anastomosis using endoluminal sutures was 3 minutes 42 seconds. Metallic stents induced the development of intimal hyperplasia to a degree greater than endoluminal sutures (316 ± 12 μm vs. 245 ± 30 μm, p<0.05), but did not affect patency.@*CONCLUSION@#Hand sewn endoluminal suture technique results in a lesser degree of intimal hyperplasia compared with that produced by endoluminal metallic stents, while the patency rates are comparable.

Antifungal activity of crude glycolated extracts of Solanum tuberosum L. (white potato) peelings against Candida and Aspergillus species

@#<p style="text-align: justify;"><strong>Background:</strong> A rise in the number of immunocompromised patients has increased the risk of opportunistic fungal infections. Identifying novel sources of antifungal agents from commonly discarded materials (i.e. potato peelings) can provide a cheaper alternative for antifungal drugs.</p><p style="text-align: justify;"><strong>Objectives:</strong> The aim of the study was to determine the antifungal activity of crude glycoalkaloid extract from Solanum tuberosum L. (white potato) peelings against opportunistic fungi Candida albicans, Candida glabrata, Aspergillus niger, Aspergillus fumigatus, and Aspergillus flavus.</p><p style="text-align: justify;"><strong>Methods:</strong> The glycoalkaloid content from dried potato peelings were extracted using ethanol and confirmed using colorimetric tests.The extract had a concentration 833.33 microgram/mL. Determination of the minimum inhibitory concentrations (MICs) of the extract via two-fold broth dilution was performed for the five fungi with amphotericin B and fluconazole as the reference antifungal drugs.</p><p style="text-align: justify;"><strong>Results:</strong> MICs of the crude extract for C. albicans, C. glabrata, A. fumigatus, and A. niger were not found within the concentration range of the studies and would thus need further experiments using a broader range of glycoalkaloid concentrations. The extract was found to have a MIC of 104.17microgram/mL for A. flavus, thereby verifying the antifungal effect of glycoalkaloid against A. flavus at said concentration.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Glycoalkaloids from Solanum tuberosum are a potential source of antifungals against certain opportunistic fungi.</p>

The effect of local application of neutralizing antibody to interleukin-1B on the development of vein graft intimal hyperplasia

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Intimal hyperplasia (IH) remains one of the major obstacles to long term vein graft patency. IL-1B has been demonstrated to be one of the first inflammatory cytokines expressed in the rat vein graft model of IH and may be an important initiator of the sequence of events leading to the development of IH. This study was designed to establish the role of IL-1B by demonstrating the outcome of inhibiting its effects by the use of neutralizing antibodies on the development of IH in this model.</p><p style="text-align: justify;"><strong>METHODS:</strong> Rat epigastric vein to femoral artery interposition grafts were treated with neutralizing antibody to IL-1B suspended in pluronic gel and harvested at the end of one week and two weeks. The amount of intimal hyperplasia was measured at the anastomotic and midgraft regions.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The amount of IH was less at the anastomotic and midgraft regions of the treated grafts at the end of one week (p<0.05), but did not differ significantly with the untreated group at the end of two weeks.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Neutralizing antibody to IL-1B delivered locally retarded but did not prevent the occurrence of IH in vein grafts. The initiation of the cascade of events in the development of IH is affected in a major way , but not singularly by IL-1B</p>

Microvascular in-vivo analysis of retrograde venous arterialization of ischemic skeletal muscle

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Nearly 20% of patients with critical limb ischemia will not be suitable for arterial bypass due to distal small vessel occlusion, and venous arterialization of the distal venous bed might be a valuable surgical option. This study demonstrates the in-vivo microcirculatory effects of this type of intervention.</p><p style="text-align: justify;"><strong>METHODS:</strong> Using intravital video microscopy, the authors studied the distal skeletal microcirculatory characteristics following venous arterialization of critical hindlimb ischemia in the rat. 25 Wistar rats underwent proximal ligation of the femoral arteries followed by venous arterialization carried out by anastomosing the saphenous vein to the femoral artery using microsurgery techniques. Microcirculatory hemodynamic conditions of the soleus muscle were observed under normal, ischemic, and arterialized conditions. Fluorescein-labeled red cells were used to measure red cell velocities (Vrbc) at the capillaries, and acridine orange injections used to stain endothelial cell nuclei to measure microcirculatory diameters, and leukocyte nuclei to measure leukocyte adhesion. Laser Doppler Perfusion (LDP) units at the distal limb were measured continuously throughout the procedure.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Proximal femoral arterial ligation resulted in drastic reductions in LDP and Vrbc. Following distal venous arterialization, LDP returned to an average of 41% of baseline. Vrbc returned to near baseline values in 70% of the capillaries. Flow at the capillary and venular system showed frequent reversals and great variations in velocities. Venules and venu-venular anastomoses diameters increased by 50%. There was immediate macromolecular tracer leakage and leukocyte activation was significantly increased in both ischemic and arterialized groups (15 cells vs 156 and 178 cells respectively).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Venous arterialization may provide an improvement in microcirculatory velocities but is accompanied by microcirculatory injury and dysfunction in the acute phase. These results suggest that mechanisms besides microcirculatory hemodynamics play a role in the overall picture of clinical effectivity of the procedure</p>

Depression, sexuality and fibromyalgia syndrome: clinical findings and correlation to hematological parameters / Depressão e sexualidade na síndrome fibromiálgica: achados clínicos e correlação com parâmetros hematológicos

ABSTRACT Fibromyalgia (FM) is characterized by chronic pain and comorbidities. Objective To investigate sexuality and depression in women with FM compared with controls and to correlate the findings with hematological parameters. Methods 33 women with FM and 19 healthy women were included and evaluated with the following instruments: Female Sexual Function Index, Beck Inventory, Visual Analogue Scale, medical history and laboratory exams. Results The prevalence of sexual dysfunction (P = 0.007) and depression (P < 0.001) were higher in the study group than in the control group; they were positively correlated (P = 0.023). The study group showed lower serum concentrations of testosterone, free T4, antinuclear factor, and lower blood hemoglobin and hematocrit. Conclusions FM was associated with high scores of sexual dysfunction and depression, and there were correlations with hematological parameters. We suggest the involvement of immune-inflammatory mediators and FM, which need further investigation to understand their role in FM syndrome and its comorbidities.

RESUMO Fibromialgia (FS) é caracterizada por dor e comorbidades. Objetivo investigar depressão e sexualidade em mulheres com FS comparadas a controles, e correlacionar os achados com parâmetros hematológicos. Métodos 33 mulheres com FS e 19 controles saudáveis foram incluídas e avaliadas através dos seguintes instrumentos: Índice de Função Feminina Sexual, Inventário de Beck, escala visual analógica, história médica e exames laboratoriais. Resultados A prevalência de disfunção sexual (P = 0,007) e depressão (P < 0,001) foram maiores no grupo de estudo do que nos controles; também houve correlação positiva (P = 0,023). O grupo de estudo apresentou menor concentração sérica de testosterona, T4 livre, fator antinuclear e menos concentração de hemoglobina e hematócrito. Conclusões A FS associou-se com altos índices de disfunção sexual e depressão, e houve correlação com os parâmetros hematológicos estudados. Sugere-se o envolvimento de mediadores imuno-inflamatórios na FS, que necessita de maior investigação para a compreensão dos mecanismos tanto na FS e quanto em suas comorbidades.

Determinação de valores de referência séricos para os eletrólitos magnésio, cloretos, cálcio e fósforo em ovinos das raças Dorper e Santa Inês / Determination of magnesium, chloride, calcium and phosphorus serum reference values for Dorper and Santa Inês sheep breeds

A ovinocultura no Brasil é uma atividade em grande expansão e, com o aumento da demanda mundial por carne ovina, aumentou-se o interesse no monitoramento da sanidade do rebanho, utilizando diversas ferramentas como auxiliares no diagnóstico clínico, tais como os intervalos de referência séricos. Os elementos minerais constituem 2 a 5,5% do corpo dos vertebrados, exercendo diversas funções no organismo. O objetivo deste trabalho foi obter intervalos de referência para os eletrólitos magnésio, fósforo, cloreto e cálcio para ovinos das raças Dorper e Santa Inês. Foram coletados soros de 487 animais clinicamente sadios, sendo 146 da raça Dorper e 341 da raça Santa Inês. Os eletrólitos foram mensurados utilizando-se kits comerciais. Os dados foram analisados quanto à raça, sexo e idade, e os intervalos de referência determinados. Os resultados revelaram diferenças significativas nos intervalos de referência obtidos para os eletrólitos cálcio e magnésio na variável raça, e para o eletrólito fósforo na variável faixa etária e, quando confrontados com valores de referência já publicados, comprovou-se a existência de diferença estatística significativa entre os mesmos em todos os analitos estudados.

The sheep industry in Brazil is an important economic activity, and with the increasing global demand for sheep meat there is a great interest in the monitoring of the herd health, and serum reference ranges are basic tools for veterinary clinical pathology assays. Mineral elements correspond to 2-5.5% of the body of vertebrates, holding different functions in their physiology. The objective of this study was to obtain reference intervals of the electrolytes magnesium, phosphorus, chloride and calcium for the Dorper and Saint Ines sheep breeds. Sera samples were collected from 487 clinically healthy sheep, 146 from Dorper and 341 from Santa Ines breed. Electrolytes were measured using commercial kits. Data were analyzed taking the race, sex and age variables in account, and reference ranges were established. The results revealed significant statistical differences in reference ranges obtained for the electrolytes calcium and magnesium concerning the variable race, and for the electrolyte phosphorus in the variable age and, when compared with reference values already published, proved the existence of significant differences.

Aging and health: Self-efficacy for Self-direction in Health Scale / Envelhecimento e saúde: Escala de Autoeficácia para a Autodireção na Saúde

ABSTRACT OBJECTIVE To validate the Escala de Autoeficácia para a Autodireção na Saúde (EAAS - Self-efficacy for Self-direction in Health Scale). METHODS Non-experimental quantitative study of EAAS validation, by confirmatory factorial analyses, evaluating a sample of 508 older adults from the north and the center of Portugal with mean age of 71.67 (from 51 to 96 years), to whom the Self-efficacy for Self-direction in Health Scale, the Rosenberg Self-esteem Scale, the Positive and Negative Affect Schedule, the Satisfaction with Life Scale, and the Instrumental Activities of Daily Living Scale were applied. The EAAS was developed from the theoretical constructs of self-efficacy and from self-directed learning within the PALADIN European project framework, aiming to develop an instrument able to assess the extent to which older adults take good care of their health. RESULTS The internal consistency was 0.87 (Cronbach's alpha) and confirmatory factorial analyses enabled to find a model near the one theoretically proposed, indicating a structure consisting of four dimensions: physical exercise, healthy diet, engaging in health-related learning, and visits to health professionals. From the psychometric point of view, the model in four factors showed quite satisfactory fit indicators. CONCLUSIONS The Self-efficacy for Self-direction in Health Scale, with 16 items, is adequate to evaluate to what extent older adults have confidence in their ability to take care of their own health, with high degree of autonomy.

RESUMO OBJETIVO Validar a Escala de Autoeficácia para a Autodireção no domínio da Saúde (EAAS). MÉTODOS Estudo quantitativo não experimental de validação da EAAS, por meio de análises fatoriais confirmatórias, avaliando amostra de 508 seniores e idosos provenientes das regiões Norte e Centro de Portugal com média etária de 71.67 (51 a 96 anos), a quem foram aplicadas a Escala de Autoeficácia para a Autodireção na Saúde, a Escala de Autoestima de Rosenberg, a Escala de Afeto Positivo e Afeto Negativo, a Escala de Satisfação Com a Vida e a escala de Atividades Instrumentais da Vida Diária. A EAAS foi desenvolvida a partir dos construtos teóricos da autoeficácia e da aprendizagem autodirigida no âmbito do projeto europeu PALADIN, visando constituir um instrumento apto a avaliar até que ponto os seniores cuidam bem da sua saúde. RESULTADOS A consistência interna encontrada foi de 0.87 (alfa de Cronbach) e as análises fatoriais confirmatórias permitiram encontrar um modelo próximo ao proposto teoricamente, indicando uma estrutura constituída por quatro dimensões: exercício físico, alimentação saudável, envolvimento em aprendizagens relativas à saúde e visitas a profissionais de saúde. Do ponto de vista psicométrico, o modelo em quatro fatores mostrou indicadores de ajustamento bastante satisfatórios. CONCLUSÕES A Escala de Autoeficácia para a Autodireção na Saúde, com 16 itens, é adequada para avaliar em que medida os seniores têm confiança na sua capacidade para tomar conta da própria saúde, com elevado grau de autonomia.

Agressive central giant cell granuloma of the mandible: case report / Agressivo granuloma central de células gigantes de mandíbula: relato de caso

Granulomas de células gigantes (GCCG) são lesões benignas intra-ósseas proliferativas. Estas lesões podem aparecer na região anterior da maxila ou da mandíbula, porém mais frequentemente encontradas na mandíbula. A etiopatogenia permanece desconhecida, no entanto, alguns autores consideram como uma resposta reparadora, ao invés de uma condição neoplásica. Clinicamente, o CGCG é assintomático, podendo causar expansão com desvio ou a proliferação da cortical óssea. Esta condição é geralmente unifocal. A remoção cirúrgica é, na maioria dos casos, o tratamento de escolha. Embora, os métodos de tratamento não-cirúrgicos, tais como injeções intralesionais de corticoesteróides, administração sistêmica de calcitonina e interferon foram relatados. Este artigo descreve as características radiográficas de um CGCG extenso na região anterior mandibular em um paciente de 09 anos de idade. O tratamento incluiu ressecção óssea com substituição por tíbia e aplicação de fatores de crescimento ósseo.

Central giant cell granulomas (CGCG) are benign intraosseous proliferative lesions. Usually located are at the anterior region of the maxilla ormandible, although are more frequently found in the mandible. Etiopathogenesis of these lesions has remained unknown, however, some consider them as reparative response rather than neoplastic condition. Clinically CGCG present as asymptomatic, with expansive swelling causing deviation or proliferation of cortical bone. This condition is usually unifocal. Surgical removal is often the preferred treatment. Although nonsurgical treatment methods, such as intralesional corticosteroid injections, systemic calcitonin and interferon have been reported. This article describes the radiographic features of a large CGCG in the anterior mandibular region seen in a9 year-old patient. Treatment of this lesion included resection of the anterior region of the mandible and replacement by tibia with bone growth factors.

Toxoplasmosis aguda en embarazadas asintomáticas de Rio de Janeiro, Brasil / Acute toxoplasmosis among asymptomatic pregnant women in Rio de Janeiro, Brazil

Objetivos: Determinar la frecuencia de toxoplasmosis aguda en mujeres embarazadas en la ciudad de Rio de Janeiro, Brasil. Material y métodos: Se incluyeron 2 673 mujeres embarazadas, asintomáticas para toxoplasmosis, durante el 2007. Se determinó IgM anti T. gondii en suero mediante inmunofluorescencia indirecta como diagnóstico de sensibilidad y la confirmación de los casos positivos por medio de ELISA. Se determinó el coeficiente de prevalencia. Resultados: Once (0,41%) tenían anticuerpos IgM anti-Toxoplasma gondii, con títulos iguales o mayores a 1:16. Conclusiones: La prevalencia de toxoplasmosis aguda en gestantes asintomáticas de la ciudad del Rio de Janeiro es baja, menor del promedio nacional de Brasil. (AU)

Objectives: To determine the frequency of acute toxoplasmosis among pregnant women in the city of Rio de Janeiro, Brazil. Methods: A total of 2673 asymptomatic pregnant women were included during 2007. IgM anti T. gondii was detected by indirect immunofluorescence, positive samples were confirmed by ELISA. Results: 11 (0,41%) pregnant women were IgM positive with titers of at least 1:16. Conclusions: Prevalence of acute toxoplasmosis among asymptomatic pregnant women in the city of Rio de Janeiro is low, lower that the overall prevalence in Brazil. (AU)

Doença periodontal em doenças reumáticas pediátricas / Periodontal disease in pediatric rheumatic diseases

Gengivite e periodontite são doenças periodontais imunoinflamatórias caracterizadas por infecções localizadas crônicas geralmente associadas a uma inflamação insidiosa. Essa revisão narrativa discute doenças periodontais e mecanismos que influenciam a resposta imune e a autoimunidade na área das doenças reumáticas pediátricas (DRP), particularmente a artrite idiopática juvenil (AIJ), lúpus eritematoso sistêmico juvenil (LESJ) e dermatomiosite juvenil (DMJ). Foi notada maior frequência de gengivite nessas doenças em comparação com controles sadios, enquanto casos de periodontite foram achados raros. Em pacientes com AIJ, a gengivite e a periodontite estavam relacionadas a fatores mecânicos, artrite crônica com incapacitação funcional, desregulação da resposta imunoinflamatória, dieta e medicamentos, principalmente corticosteroides e ciclosporina. Em pacientes com LESJ, a gengivite estava associada a períodos mais longos da doença, doses elevadas de corticosteroides, hiperativação dos linfócitos B e elevação da imunoglobulina G. São escassos os dados sobre doenças periodontais na população com DMJ; nos pacientes ativos, foi observado um padrão gengival singular, caracterizado por eritema gengival, dilatação dos capilares e formação arbustiforme. Em conclusão, gengivite foi a doença periodontal mais comum em pacientes com DRP. A associação observada com a atividade da doença reforça a necessidade de futuros estudos, com o intuito de determinar se a resolução dessa complicação irá influenciar o curso ou a gravidade da doença.

Gingivitis and periodontitis are immunoinflammatory periodontal diseases characterized by chronic localized infections usually associated with insidious inflammation. This narrative review discusses periodontal diseases and mechanisms influencing the immune response and autoimmunity in pediatric rheumatic diseases (PRD), particularly juvenile idiopathic arthritis (JIA), childhood-onset systemic lupus erythematosus (C-SLE) and juvenile dermatomyositis (JDM). Gingivitis was more frequently observed in these diseases compared to health controls, whereas periodontitis was a rare finding. In JIA patients, gingivitis and periodontitis were related to mechanical factors, chronic arthritis with functional disability, dysregulation of the immunoinflammatory response, diet and drugs, mainly corticosteroids and cyclosporine. In C-SLE, gingivitis was associated with longer disease period, high doses of corticosteroids, B-cell hyperactivation and immunoglobulin G elevation. There are scarce data on periodontal diseases in JDM population, and a unique gingival pattern, characterized by gingival erythema, capillary dilation and bush-loop formation, was observed in active patients. In conclusion, gingivitis was the most common periodontal disease in PRD. The observed association with disease activity reinforces the need for future studies to determine if resolution of this complication will influence disease course or severity.

Is hypoxia a stressor to American bullfrog tadpoles? / A hipóxia é um estressor para girinos de rã-touro?

The aim of this study was to evaluate alterations to the physiological profile of cortisol in pro-metamorphose phase tadpoles of Lithobates catesbeianus exposed to hypoxia stressor in a capture experiment and in a crowding experiment. The capture study was performed by the treatments: stress due to individual capture with a hand net, stress due to batch capture with a hand net and stress due to capture by emptying. Three simultaneous replicates was done witch 12 animals were sampled (6 normoxia - immediately blood collection) and 6 hypoxia - blood collection after 15 min of air exposition) in two collection times with 5 days by intervals. The crowding study was performed by the treatments 1 tadpole L-1, 5 tadpoles L-1 and 10 tadpoles L-1. Three simultaneous replicates was done witch 8 animals (4 normoxia and 4 hypoxia) were sampled in the zero moment (ZM) - blood collection before the experiment, 6 animals/treatment (3 normoxia and 3 hypoxia) to 4 and 8 days and 18 animals/treatment (9 normoxia and 9 hypoxia) to 12 days. The average values to plasmatic cortisol varying from 1.7 to 5.1ng mL-1 (capture study) and 1.0 to 4.2ng mL-1 (crowding study). It concludes that the biomarker tested (cortisol) showed no alterations front of the stressor used. Alternatively, a larger response pattern to these stimuli may have been expressed in another level of an unmeasured hormone (corticosterone). And the bullfrog has great ability to adapt to different management compared to other aquatic organisms, which demonstrates the plasticity of these animals.

Avaliou-se o cortisol em girinos de rã-touro (Lithobates catesbeianus), no estágio de pró-metamorfose ao mecanismo estressor de hipóxia juntamente com captura (1º experimento) e adensamento (2º experimento). O experimento de captura foi composto pelos tratamentos: Captura individual com puçá, Captura em massa com puçá e Captura por escoamento, com 3 réplicas simultâneas onde 12 organismos foram amostrados (6 normoxia - coleta imediata de sangue e 6 hipoxia - coleta de sangue após 15 min de exposição ao ar) em 2 tempos de coleta com intervalo de 5 dias. O experimento de densidade foi composto pelos tratamentos: 1 girino L-1, 5 girinos L-1 e 10 girinos L-1, com 3 réplicas simultâneas onde 8 animais (4 normoxia e 4 hipoxia) foram amostrados no momento zero (MZ) - coleta de sangue anterior ao experimento, 6 animais/tratamento (3 normoxia e 3 hipoxia) para 4 e 8 dias e 18 animais/tratamento (9 normoxia e 9 hipoxia) para 12 dias. Os valores médios para o cortisol plasmático foram de 1,7 a 5,1ng mL-1 (Experimento de Captura); e 1,0 a 4,2ng mL-1 (Experimento de Densidade). Conclui-se que o marcador biologico de estresse utilizado (cortisol) não foi alterado pelo agente extressor. Alternativamente a resposta a este estímulo pode ser expressa em outro nível hormonal (corticosterona). E a rã-touro apresenta ótima capacidade de se adaptar aos diferentes manejos se comparados a outros organismos aquáticos, o que demonstra a plasticidade destes animais.

Fibroma osificante juvenil, presentación de un caso clínico y revisión de la literatura / Juvenil ossifying fibroma, case report and review of the literature

Se presenta el caso de una paciente de seis años, de sexo femenino sin antecedentes mórbidos ni familiares de importancia, quien consulta por proptosis izquierda en abril de 2011. Se realiza resonancia magnética de cerebro evidenciándose un tumor de seno etmoidal con compromiso de órbita izquierda que ocasiona exoftalmo. La biopsia endoscópica nasal fue compatible con fibroma osificante juvenil. Posteriormente se realiza antrostomía con etmoidectomía en dos tiempos, con resultados satisfactorios para la paciente. Aunque el fibroma osificante juvenil es un tipo de lesión benigna poco frecuente, puede llegar a ser muy agresiva y con una alta tasa de recidiva en ciertas ocasiones, por lo que se debe tener en cuenta para realizar un diagnóstico y tratamiento precoz, con un seguimiento programado a largo plazo.

This paper presents the case of a patient of six years old female without background or important morbidly in her family, who consults for left-sided proptosis in April of 2011. It performs brain magnetic resonancebeing demonstrated a tumor of theethmoid sinus with commitment to the left orbit that causes exophthalmus. Nasal endoscopic biopsy was compatible with juvenile ossifying fibroma. It was subsequently performed ananthrostomy whitethmoidectomy in two times, with satisfactory results for the patient. Although the Juvenile ossifying fibroma is a rare type of benign lesion, can be very aggressive and have a high recurrence rate in certain occasions, by what should be taken into account to make an early diagnosis and treatment, with a scheduled follow up in the long term.

Atresia de coanas, revisión y una mirada desde la evidencia / Choanal atresia, review and a look from the evidence

La atresia de coanas es la anomalía congénita nasal más común. Cuando es bilateral, se presenta con dificultad respiratoria desde el nacimiento. La atresia unilateral se manifiesta con insuficiencia ventilatoria y rinorrea unilateral, pudiendo pasar inadvertida. El diagnóstico se sospecha ante la ausencia de paso de aire en las fosas nasales y la imposibilidad de hacer progresar una sonda nasogástrica. Se confirma mediante examen endoscópico y tomografía computarizada. El tratamiento definitivo es quirúrgico, existiendo diferentes técnicas y vías de abordaje. Se presenta una revisión de la literatura, con especial énfasis en el tratamiento pos-quirúrgico con stents y mitomicina-C a través de una mirada desde la evidencia.

Choanal atresia is the most common congenital nasal anomaly. When bilateral, it presents with respiratory distress at birth. Unilateral atresia is manifested by respiratory failure and unilateral rhinorrhea, and may go along unnoticed. Diagnosis is suspected in the absence of airflow in the nasal cavity and for the inability to advance a nasogastric tube. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and there are different techniques and surgical approaches. A review of the literatureis presented, with special emphasis onthepost-surgical treatmentwithstents and Mitomycin-Cview from the evidence.