Bilateral Tibial Tuberosity Periosteal Sleeve Fracture in an Adolescent: A Case Report

@#Tibial tuberosity avulsion fracture is a rare injury, and bilateral occurrence is more uncommon. Periosteal sleeve fracture is a unique fracture pattern which was first described in the lower pole of patella in children. We are reporting a rare case of bilateral tibial tuberosity sleeve fracture in a teenage boy which occurred while sprinting. The patient underwent open reduction, pull through suture fixation of the bilateral tibial tuberosity and screw fixation of left tibial tuberosity. Post-operative rehabilitation included gradual increment of range of motion with hinged brace and quadriceps muscle strengthening. Close follow-up was done to monitor the progression of his recovery. At six months follow-up, the patient recovered well. Both knees had full range of motion with an intact extensor mechanism.

Emergency Care Capacity in Pediatric Hospitals, Khartoum, Sudan

@#Introduction: Critical pediatric patients have specific needs, which require special skills, training, equipment, supplies, personnel, and medications. While the knowledge related to enhance survival rate of newborn and children has improved over the past few decades. This study conducted to assess the emergency care capacity in pediatric hospitals at Khartoum state, Sudan. Methods: This is a descriptive cross-sectional hospital-based study, it was conducted in three hospitals at Khartoum, Sudan 2017-2018, to assess emergency care capacity in pediatric hospitals. Data was collected using open-ended questionnaire, and observational checklist. The data scored using dichotomous indicators (absent or present). Results: The study showed that there is shortage in human resources necessary to provide emergency care. However, much essential equipment for emergency care of children was absent in most hospitals, moreover, only 33% of hospitals had Triage system staffed by a trained person. Further, the clinical practice protocols for managing dehydration, neonatal sepsis, and neonatal resuscitation were not traced at the three hospitals. There are a limited laboratory services in one hospital. Conclusion: It is concluded that pediatric specialized hospitals, in Khartoum state, Sudan, have low capacity to provide emergency care for children. Further efforts are needed to improve the emergency care capacity in Khartoum hospitals.

A semi-automated microscopic image analysis method for scoring Ki-67 nuclear immunostaining

Nuclear proliferation marker MIB-1 (Ki-67) immunohistochemistry (IHC) is used to examine tumor cell proliferation. However, the diagnostic or prognostic value of the Ki-67 nuclear staining intensity and location, defined as nuclear gradient (NG), has not been assessed. This study examined the potential association between Ki-67 NG and cell cycle phases and its effect on the prognosis of pulmonary typical carcinoid (PTC) tumors. We propose a method for classifying the NG of Ki-67 during the cell cycle and compare the results between PTC, pulmonary adenocarcinoma (PAD), and breast ductal carcinoma (BDC). A literature review and objective analysis of IHC-stained paraffin sections were used to determine the Ki-67 labeling index and composed a stratification of the NG into NG1, NG2, and NG3/4 categories. A semi-automated image analysis protocol was established to determine the Ki-67 NG in PTC, PAD, and BDC. High intraobserver consistency and moderate interobserver agreement were achieved in the determination of Ki-67 NG in tumor specimens. NG1 and NG2 were lower in PTC than in PAD and BDC. Cox multivariate analysis of PTC after adjusting for age and number of metastatic lymph nodes showed that Ki-67 NG1 and NG2 significantly predicted clinical outcomes. The semi-automated method for quantification of Ki-67 nuclear immunostaining proposed in this study could become a valuable diagnostic and prognostic tool in PTC.

Dietary phytate induces subclinical mechanical allodynia in mice

Neuropathic pain is a condition with varying origins, including reduced dietary micronutrient intake. Phytate is a polyphosphate found in seeds and grains that can act as an antinutrient due to the ability of sequester essential divalent metals. Here we tested whether moderate dietary phytate intake could alter nociceptive pain. We subjected weaning mice to a chow supplemented with 1% phytate for eight weeks. Body weight gain, glycemic responses, food ingestion, water ingestion, and liver and adipose tissue weights were not altered compared to controls. We observed a decreased mechanical allodynia threshold in the intervention group, although there were no changes in heat- or cold-induced pain. Animals consuming phytate showed reduced spinal cord tumor necrosis factor (TNF), indicating altered inflammatory process. These data provide evidence for a subclinical induction of mechanical allodynia that is independent of phytate consumption in animals with otherwise normal phenotypic pattern.

Cotransplantation of marginal mass allogeneic islets with 3D culture-derived adult human skin cells improves glycemia in diabetic mice

Islet transplantation represents a therapeutic option for type 1 diabetes (T1D). Long-term viability of transplanted islets requires improvement. Mesenchymal stromal cells (MSCs) have been proposed as adjuvants for islet transplantation facilitating grafting and functionality. Stem cell aggregation provides physiological interactions between cells and enhances the in situ concentration of modulators of inflammation and immunity. We established a hanging-drop culture of adult human skin fibroblast-like cells as spheroids, and skin spheroid-derived cells (SphCs) were characterized. We assessed the potential of SphCs in improving islet functionality by cotransplantation with a marginal mass of allogeneic islets in an experimental diabetic mouse model and characterized the secretome of SphCs by mass spectrometry-based proteomics. SphCs were characterized as multipotent progenitors and their coculture with anti-CD3 stimulated mouse splenocytes decreased CD4+ T cell proliferation with skewed cytokine secretion through an increase in the Th2/Th1 ratio profile. SphCs-conditioned media attenuated apoptosis of islets induced by cytokine challenge in vitro and importantly, intratesticular SphCs administration did not show tumorigenicity in immune-deficient mice. Moreover, SphCs improved glycemic control when cotransplanted with a marginal mass of allogeneic islets in a diabetic mouse model without pharmacological immunosuppression. SphCs' protein secretome differed from its paired skin fibroblast-like counterpart in containing 70% of up- and downregulated proteins and biological processes that overall positively influenced islets such as cytoprotection, cellular stress, metabolism, and survival. In summary, SphCs improved the performance of transplanted allogeneic islets in an experimental T1D model, without pharmacological immunosuppression. Future research is warranted to identify SphCs-secreted factors responsible for islets' endurance.

Comparison of clinical characteristics of wild-type SARS-CoV-2 and Omicron

SUMMARY OBJECTIVE: This study aimed to investigate the effect of mutations by comparing wild-type SARS-CoV-2 and Omicron regarding clinical features in patients with COVID-19. It also aimed to assess whether SARS-CoV-2 cycle threshold value could predict COVID-19 severity. METHODS: A total of 960 wild-type and 411 Omicron variant patients with positive results in SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction test from oropharyngeal and/or nasopharyngeal samples during their hospital admissions were included in this retrospective study. The reference symptoms of the patients were obtained from the hospital database. The correlation between chest computed tomography findings and the "cycle threshold" of patients with wild-type SARS-CoV-2 was assessed. RESULTS: Cough, fever, shortness of breath, loss of taste and smell, and diarrhea were found to be statistically significantly higher (p=0.001; 0.001; 0.001; 0.001; and 0.006; respectively) in the wild-type cohort, while in the Omicron cohort, sore throat and headache were found to be statistically significantly higher (p=0.001 and 0.003, respectively). An inverse relationship was found between chest computed tomography findings and viral load. CONCLUSION: This study revealed that the Omicron variant tended to infect predominantly the upper respiratory tract and showed decreased lung infectivity, and the disease progressed with a milder clinical course. Therefore, the study showed that the tropism of the virus was changed and the viral phenotype was affected. It was also found that SARS-CoV-2 viral load did not predict COVID-19 severity in patients with wild-type SARS-CoV-2.

Physical Activity and Dermatology Quality of Life: A Study During COVID-19 Pandemic in Surakarta, Indonesia

Context/Background: Earlier studies have shown a possible correlation between skin health and physi-cal activity. Moreover, the COVID-19 pandemic has impacted physical activity levels due to many rea-sons. Aims/Objectives: This study aims to analyze the correlation between physical activity and dermatology quality of life during the COVID-19 pandemic. Methodology: A cross-sectional study was conducted in Surakarta, Central Java, Indonesia. This study used Dermatology Life Quality Index(DLQI) and International Physical Activity Questionnaire Short Form (IPAQ-SF) in Bahasa Indonesia to measure dermatology quality of life and physical activity. Results: A total of 207 adults participated in this study. Our study showed that females are at risk for developing a DLQI score >10 (PR: 1.23, 95% CI: 3.05-4.97). There is no significant relationship between physical activity measured in IPAQ-SF with skin-related quality of life measured by DLQI. Conclusions: A significant relationship was observed between the female sex and comorbidity with a skin condition that impairs life quality. However, this study found no significant relationship between physical activity measured in IPAQ-SF with skin-related quality of life measured in DLQI.

Hemorragia del tracto digestivo superior, enfoque para el médico general / Upper digestive tract bleeding, approach for the general Practitioner / Hemorragia do trato digestivo superior, enfoque para o médico geral

La hemorragia del tracto digestivo superior (HTDS) es el sangrado originado por encima del ángulo de Treitz. A pesar del aumento en las estrategias de prevención, del incremento en los tratamientos con Inhibidor de bomba de protones (IBP) y de la intervención endoscópica temprana, esta patología sigue siendo una causa frecuente de consulta a urgencias, con una morbimortalidad no despreciable y alta carga para el sistema de salud. Esta revisión se enfoca en la HTDS de causa diferente a las varices. La principal causante de esta entidad es la enfermedad ácido-péptica, que es consecuencia del gran consumo de antiinflamatorios no esteroideos (AINES) y de la infección por Helicobacter Pylori. Otras causas son el síndrome de Mallory Weiss, la esofagitis erosiva, las malformaciones arteriovenosas y la malignidad.

Upper gastrointestinal bleeding (UGIB) refers to any bleeding originating above the angle of Treitz. Despite an increase in prevention strategies, proton pump inhibitor (PPI) therapy and early endoscopic intervention, this pathology continues to be an important cause of admission to the emergency department for gastrointestinal causes, having a pretty high morbidity and mortality in addition to a high burden on the health system. This review focuses on non-variceal UGIB. The main cause of this entity being peptic acid disease, due to great consumption of NSAIDs and Helicobacter Pylori infection. Other causes are Mallory Weiss syndrome, erosive esophagitis, arteriovenous malformations, and malignancy.

A hemorragia do trato digestivo superior (HTDS) é o sangrado originado acima do ângulo de Treitz. Apesar do aumento nas estratégias de prevenção, do incremento nos tratamentos com Inibidor da bomba de prótons (IBP) e da intervenção endoscópica precoce, esta patologia segue sendo uma causa frequente de consulta a urgências, com uma morbimortalidade não depreciável e alta carga para o sistema de saúde. Esta revisão se enfoca na HTDS de causa diferente às varizes. A principal causante desta entidade é a doença ácido-péptica, que é consequência do grande consumo de anti-inflamatórios não esteróideos (AINES) e da infecção por HelicobacterPylori. Outras causas são a síndrome de Mallory Weiss, a esofagites erosiva, as malformações arteriovenosas e a malignidade. Palavras-chave: hemorragia gastrointestinal; úlcera péptica; endoscopia gastrointestinal; inibidores da bomba de prótons; medicina geral.

An Overlooked Entity in Diagnosing Hip Pain with Neuropathy in an Athletic Young Adult: A Case Report

@#Hip pain is frequently encountered in the athletic community. Femoro-acetabular impingement (FAI) is a common cause of hip pain in young adults. However, it is important to appreciate the uncommon diagnosis and the role of imaging for unexplained hip pain. The pathology behind a posterior hip pain is often misdiagnosed as the cause of hip pain is non-specific, extensive and elusive. We managed to detect the pathology through magnetic resonance arthrography (MRA) of hip with gadolinium enhancement after a series of inconclusive history, physical examination and imaging findings were completed. This particular case vignettes an overlooked osteoid osteoma that leads to the delay in diagnosis and increase morbidity.

Rotational alignment of the tibial component in total knee arthroplasty:a narrative review / 中华外科杂志

Component malrotation is one of the major causes of failure in total knee arthroplasty.Based on previous researches,Insall line has excessive external rotation tendency.Although Akagi line is the most recognized anatomical axis at present,it still has a certain tendency of internal rotation.The tibial posterior condylar axis is not suitable for symmetrical component and yet the Curve-on-Curve technique is not suitable for anatomic component.In addition,reference to any fixed anatomical markers cannot ensure the rotation consistency of tibiofemoral component in extension position.Although range of motion technique is beneficial to tibiofemoral rotation synchronization,its clinical effect seems to be unstable.Nevertheless,Patients can obtain good postoperative results with all major techniques.Before the recognized "gold standard" is defined,orthopedic surgeons can determine the rotation alignment of tibial component according to their most accustomed surgical method.With a deeper understanding of knee anatomy,biomechanics and kinematics,digital assistive technology may be expected to become a breakthrough in the tibial rotational alignment.

Cognition enhancing effect of rosemary (Rosmarinus officinalis L.) in lab animal studies: a systematic review and meta-analysis

Patients with mild cognitive impairment eventually progress to Alzheimer's disease (AD) causing a strong impact on public health. Rosmarinus officinalis has long been known as the herb of remembrance and can be a potential cognition enhancer for AD. The aim of this review was to summarize the qualitative and quantitative aspects of R. officinalis and its active constituents in enhancing cognition. A structured search was conducted on Google Scholar and PubMed to find relevant studies that assessed the effect of R. officinalis extract or any of its active constituents on cognitive performance in animals. The following information was extracted from each study: 1) article information; 2) characteristics of study animals; 3) type of intervention: type, dose, duration, and frequency of administration of R. officinalis; and 4) type of outcome measure. Data were analyzed using Review Manager and meta-analysis was performed by computing the standardized mean difference. Twenty-three studies were selected for qualitative analysis and fifteen for meta-analysis. From the fifteen included papers, 22 with 35 comparisons were meta-analyzed. Effect sizes for intact and cognitively impaired animals were 1.19 (0.74, 1.64) and 0.57 (0.19, 0.96), indicating a positive effect on both groups. The subgroup analyses showed substantial unexplained heterogeneity among studies. Overall, R. officinalis improved cognitive outcomes in normal and impaired animals, and results were robust across species, type of extract, treatment duration, and type of memory. However, studies had a considerable amount of heterogeneity, and subgroup analyses failed to find any heterogeneity moderator.

The protective effect of melatonin supplementation against taxol-induced testicular cytotoxicity in adult rats

The aim of the present investigation was to study the toxic influences of taxol (TXL) on the testes of rats and the protective impact of melatonin (MLT) against such effects. Rats were classified into control, sham, TXL, MLT, and MLT+TXL-treated groups. Histological and ultrastructural changes were observed in testicular tissues of TXL-intoxicated rats including thickening of tunica albuginea and degenerative alterations in spermatogenic, Sertoli, and Leydig cells. A significant increase (P≤0.05) was found in the thickness of tunica albuginea and numbers of tubules without sperm, apoptotic germinal epithelia, and apoptotic Leydig cells, whereas the diameter of tubules and height of germinal epithelia displayed a significant decrease (P≤0.05) compared with the control, sham, and MLT-treated groups. Immunohistochemically, a marked decrease (P≤0.05) in Bcl-2 immunoreactivity and significant elevation (P≤0.05) in P53 and caspase-3 immunoreactivities were recorded. Co-treatment of MLT and TXL modulated such histological, histomorphometrical, and ultrastructural changes induced by TXL. Also, MLT had a protective effect against testicular apoptosis induced by TXL, as shown by the elevated expression of Bcl-2 and decreased expression of P53 and caspase-3. In conclusion, the current investigation proved that MLT had a protective role against TXL-induced testicular cytotoxicity, which may be a result of inhibition of testicular apoptosis.

Cellular consequences of small supernumerary marker chromosome derived from chromosome 12: mosaicism in daughter and father

Constitutional genomic imbalances are known to cause malformations, disabilities, neurodevelopmental delay, and dysmorphia and can lead to dysfunctions in the cell cycle. In extremely rare genetic conditions such as small supernumerary marker chromosomes (sSMC), it is important to understand the cellular consequences of this extra marker, as well the factors that contribute to their maintenance or elimination through successive cell cycles and phenotypic impact. The study of chromosomal mosaicism provides a natural model to characterize the effect of aneuploidy on genome stability and compare cells with the same genetic background and environment exposure, but differing in the presence of sSMC. Here, we report the functional characterization of different cell lines from two familial patients with mosaic sSMC derived from chromosome 12. We performed studies of proliferation dynamics, stability, and variability of these cells using fluorescent in situ hybridization (FISH), sister chromatid exchanges (SCE), and conventional staining. We also quantified the telomere-related genomic instability of sSMC cells using 3D telomeric profile analysis by quantitative-FISH. sSMC cells exhibited differences in the cell cycle dynamics compared to normal cells. First, the sSMC cells exhibited lower proliferation index and higher frequency of SCE than normal cells, associated with a higher level of chromosomal instability. Second, sSMC cells exhibited more telomeric-related genomic instability. Lastly, the differences of sSMC cells distribution among tissues could explain different phenotypic repercussions observed in patients. These results will help in our understanding of the sSMC stability, maintenance during cell cycle, and the cell cycle variables involved in the different phenotypic manifestations.

Evaluación funcional del manejo de rupturas masivas del manguito de los rotadores con el uso del balón subacromial / Functional evaluation of the management of massive rotator cuff ruptures with the use of the subacromial balloo

Resumen: Introducción: Las rupturas del manguito de los rotadores (MR) se presentan en más de 50% de los pacientes mayores de 60 años y pueden causar cambios en la biomecánica normal del hombro que pueden desencadenar una artropatía por desgarro del MR. Actualmente, no existe un consenso sobre el tratamiento para el desgarro masivo del MR. Objetivo: Evaluar los resultados clínicos y radiográficos de la colocación del balón subacromial en estas lesiones. Material y métodos: Estudio analítico, longitudinal y retrospectivo de 10 pacientes consecutivos tratados con el uso del balón subacromial. Se utilizaron escalas de Constant (CS) y ASES prequirúrgicas, a los seis y 12 meses de seguimiento postquirúrgico. Los resultados radiográficos fueron valorados por medio del intervalo acromio-humeral (IAH) en una radiografía anteroposterior (AP) verdadera de hombro. Resultados: La mejoría promedio en la CS fue de 41.7 ± 8.93 a los 12 meses de seguimiento, la escala de ASES mostró una mejoría promedio de 64.6 ± 4.9 a los 12 meses de seguimiento. El IAH prequirúrgico fue de 6.1 ± 1.10 y la media a los 12 meses de seguimiento fue de 7.1 ± 0.9. Se observó una mejoría clínica y radiográfica en todas las escalas; sin embargo, no se encontraron resultados estadísticamente significativos. Conclusión: El balón subacromial previene el ascenso de la cabeza humeral en los primeros 12 meses de colocado; suponemos que podría restaurar la cinemática glenohumeral normal mejorando movilidad y disminuyendo dolor.

Abstract: Introduction: Rotator cuff (MR) ruptures occur in more than 50% of patients over the age of 60, and can cause changes in normal shoulder biomechanics that can trigger rotator cuff tear arthropathy. There is currently no consensus on treatment for massive rotator cuff tears. Objective: To evaluate the clinical and radiographic outcomes of subacromial balloon placement in these lesions. Material and methods: Analytical, longitudinal and retrospective study of 10 consecutive patients treated with the use of the subacromial balloon. Constant (CS) and ASES scales were used preoperatively and at 6, 12 months of post-surgical follow-up. Radiographic results were assessed using the Acromio-humeral Interval (AHI) on a true AP shoulder X-ray. Results: The average improvement in CS was 41.7 ± 8.93 at 12 months of follow-up, the ASES scale showed an average improvement of 64.6 ± 4.9 at 12 months of follow-up. The presurgical AHI was 6.1 ± 1.10 and the mean at 12 months of follow-up was 7.1 ± 0.9. Clinical and radiographic improvement was observed at all scales, however no statistically significant results were found. Conclusion: The subacromial balloon prevents the ascent of the humeral head in the first 12 months of placement; we assume that it could restore normal glenohumeral kinematics by improving mobility and decreasing pain.

Do the Different Types of Pulmonary Hypertension Cause the Same Effect on Right Heart and Serum Asymmetrical Dimethylarginine Levels in Female Patients?

ABSTRACT Objective: Right-heart function is a major determinant of clinical outcome in patients with elevated pulmonary artery pressure due to pulmonary venous hypertension (PVH) and pulmonary arterial hypertension (PAH). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. This study aimed to evaluate if different types of pulmonary hypertension (PH) would cause the same effect on right-heart functions and serum ADMA levels in female patients. Methods: This study included patients with PAH as group I, patients with PVH due to mitral stenosis (mitral valve area ≤ 1.5 cm2, without any additional valve or left-heart disease and systolic pulmonary artery pressure ≥ 50 mmHg in transthoracic echocardiography) as group II, and healthy control subjects as group III. Transthorasic echocardiographic evaluations for right-heart functions were performed according to the guidelines of the American Society of Echocardiography. Venous blood samples were collected, and the serum ADMA concentrations were obtained with the ELISA kit (DRG® International Inc., Springfield, NJ, USA). Results: Patients in groups I and II had higher ADMA levels than healthy control subjects. Right-atrium area and dimensions, right-ventricular (RV) volumes, grade of tricuspid regurgitation, systolic pulmonary arterial pressure, RV wall thickness, and RV outflow tract diameters were significantly higher in group I patients than in group II patients. Right-ventricular myocardial performance index was lower, and RV fractional area change and tricuspid valve systolic tissue Doppler velocity were higher in group II patients than in group I patients. Conclusion: This study demonstrated that both PAH and PVH caused increase in right-heart dimensions and impairment in right-heart functions.

Angular Deformities of the Knee in Children Treated with Guided Growth

@#Introduction: The guided growth technique is an alternative to corrective osteotomy for treating angular deformities of the extremities. It has the advantage of being minimally invasive and is effective in a growing child. This study reports on the outcome of guided growth technique using a plate in correcting knee angular deformities. Materials and methods: We conducted a retrospective study of children with angular deformity of the knee treated by the guided growth technique from January 2010 to December 2015 in a tertiary centre. The guided growth technique was done using either the flexible titanium plate (8-plate) or the 2- hole reconstruction plate. Correction of deformity was assessed on radiographs by evaluating the mechanical axis deviation and tibiofemoral angle. The implants were removed once deformity correction was achieved. Results: A total of 17 patients (27 knees) were evaluated. Twenty-two knees (81.5%) achieved complete correction of the deformity. The median age was 4.0 (interquartile range 3.0-6.0) years and the median Body Mass Index (BMI) was 26.0 (25.0-28.0). There were 7 unilateral and 10 bilateral deformities with different pathologies (14 tibia vara, 3 genu valgus). The median rate of correction was 0.71° per month. One patient (1 knee) had screw pull-out and two patients (4 knees) had broken screws in the proximal tibia. Three patients (5 knees) failed to achieve complete correction and were subsequently treated with corrective osteotomies. Out of five patients (8 knees) who were followed-up for at least 12 months after removal of hardware, two had rebound deformities. No permanent growth retardation occurred in our patients. Conclusion: Our outcome for guided growth to correct knee angular deformity was similar to other studies. Guided growth is safe to perform in children below 12 years old and has good outcome in idiopathic genu valgus and Langeskiold II for tibia vara. Patients should be observed for recurrence until skeletal maturity following implant removal.

Clinical and post mortem examination of white worm lizards (Amphisbaena alba) in the State of Paraíba, Northeastern Brazil: morphological, pathological and radiographic findings of a secretive species

ABSTRACT: Amphisbenians are limbless reptiles that belong to the order Squamata. Due to their fossorial and secrevie habits, little is known about their morphology, ecology and pathological conditions that may affect them. In this manuscript, we present a brief guide for identification of normal structures as well as traumatic injuries on radiography and necropsy of Amphisbaena alba. From April to September 2019, three cases of A. alba with suspected trauma were referred to the Veterinary Hospital of the Federal University of Paraíba (UFPB). In the clinical evaluation, traumatic injuries were observed, and support therapy was instituted, but they did not resist and died shortly after. Bone fractures and organ ruptures, in addition to specific structures of this species were identified on radiography. A systematic necropsy was performed of all amphisbaenians in order to evaluate external and internal structures, not only to identify lesions but also to investigate the morphological aspects of amphisbenids. Macroscopically, multiple organ fractures and ruptures observed in radiographs were confirmed, in addition to the presence of the cestodes Semenoviella amphisbaenae in the large intestine. Histologically, it was possible to identify normal characteristics and microscopic lesions in the tissues. This is the first study to incorporate morphological, clinical, and pathological aspects of A. alba. This manuscript brings essential information for wildlife veterinarians and pathologists who may have to treat or perform a necropsy on these unique reptiles.

RESUMO: Anfisbenas são répteis desprovidos de membros que pertencem a ordem Squamata. Devido a seus hábitos fossoriais e reclusos, pouco se conhece sobre sua morfologia, ecologia e condições patológicas que possam afetá-las. Neste artigo, um guia sucinto para a necropsia, identificação de tecidos e órgãos e lesões encontradas em Amphisbaena alba, é apresentado. Durante março e dezembro de 2019, três casos de A. alba com suspeita de trauma foram encaminhados ao Hospital Veterinário da Universidade Federal da Paraíba. Na avaliação clínica foram observadas lesões traumáticas e instituído um suporte terapêutico, porém não resistiram e morreram em seguida. Foram realizadas projeções radiográficas onde identificaram fraturas e ruptura de órgãos, além de identificar estruturas específicas dessa espécie. Uma avaliação completa de estruturas externas e internas foi conduzida para investigar aspectos morfológicos dos anfisbenídeos. Macroscopicamente foram confirmadas múltiplas fraturas e rupturas de órgãos observadas anteriormente nas radiografias, além disso evidenciou no intestino grosso presença de parasitos anoplocéfalos denominados Semenoviella amphisbaenae. Na histologia foi possível identificar características normais e lesões microscópicas nos tecidos. Esse é o primeiro estudo a incorporar aspectos morfológicos, clínicos e patológicos de A. alba. Esse manuscrito traz informações essenciais para clínicos e patologistas de animais selvagens que podem se deparar com casos clínicos ou de necropsia de Amphisbaena alba.

Biomechanical comparison of conventional double-row repair versus double row repair with the parachute configuration / Comparación biomecánica de la reparación convencional de doble fila frente a la reparación de doble fila con la configuración del paracaídas

Abstract: Introduction: The rotator cuff tears are a very frequent condition. The rotator cuff repair is a procedure often perform by the orthopedic surgeon. There are multiple techniques and suture configurations for this type of repairs. The double row configuration is one of the most used and consider very effective for mid-size and large size rotator cuff tears. The parachute configuration for this repair is a novel technique that may be useful for mid-size and large size tears, for this repair two medial double row anchors are used and one knotless lateral anchor. Our porpoise was to compare biomechanical performance and footprint coverage of a conventional suture-bridge double-row rotator cuff repair configuration versus a double-row-parachute. Methods: This paper shows the biomechanical behavior on a cadaver model of the parachute configuration, and also compares this conformation with a double row in a suture-bridge fashion. Our hipothesis was that the Parachute configuration's biomechanical performance is equivalent to the suture-bridging double-row technique. Results: The parachute configuration advantages show the advantage of using less anchors, which will decrease the surgical time and also the risks of using multiple hardware in the humeral head.

Resumen: Introducción: La lesión del manguito rotador es una patología común cuya reparación es un procedimiento realizado por los cirujanos ortopedistas. Existen muchas técnicas de reparación, así como múltiples configuraciones de anclas y suturas para realizar estos procedimientos. La técnica de doble fila es una de las más usadas para rupturas de tamaño mediano y grande con buenos resultados. La configuración en «paracaídas¼ para la reparación del manguito rotador puede llegar a ser útil para éstas, en este tipo de configuración se utilizan dos anclas mediales y un ancla sin nudos lateral. Nuestro objetivo fue la comparación de la eficiencia biomecánica y cobertura de la huella de una configuración convencional de doble fila «suture bridge¼ frente a una configuración en «paracaídas¼. Métodos: Este trabajo revisó el comportamiento biomecánico, en piezas cadavéricas, de la configuración de paracaídas y se comparó con la configuración de doble fila tipo «suture-bridge¼. Nuestra hipótesis era que el rendimiento biomecánico de la configuración de Parachute es equivalente a la técnica de doble fila «suture bridge¼. Resultados: Las posibles ventajas de la configuración de paracaídas son el uso de menos anclas, disminuyendo el tiempo quirúrgico y los riesgos de tener múltiples implantes en la cabeza humeral.

Percepción de los gerentes y directivos de las IPS públicas del Área Metropolitana del Valle de Aburrá sobre los convenios docencia - servicio en salud / Perception that managers and executives from the public IPS in the Metropolitan Area of Aburrá Valley have of health service - teaching agreements / Percepção dos gerentes e diretivos das IPS públicas da Área Metropolitana do Valle de Aburrá sobre os convênios docência - serviço em saúde

Objetivo: conocer la percepción de gerentes y profesionales con cargos administrativos de hospitales públicos o empresas sociales del Estado de segundo y tercer nivel de complejidad del Área Metropolitana del Valle de Aburrá, en los que hay convenios docencia - servicio, pero que no se encuentran categorizados como hospitales universitarios, acerca del proceso de rotación de estudiantes de medicina, con el fin de indagar sobre el compromiso que las instituciones tienen con estos procesos formativos, qué tan informados están con respecto a la metodología de los mismos y cuáles son los beneficios o limitantes que de ellos se desprenden. Metodología: se realizó una investigación cualitativa con enfoque hermenéutico. Se entrevistaron 14 gerentes y profesionales con cargos administrativos de 6 hospitales públicos del Área Metropolitana del Valle de Aburrá. Resultados: las prácticas de los estudiantes de medicina de primeros semestres se enmarcan en asuntos básicos porque al estar iniciando su formación les es permitida poca práctica, tienen nula relación o intervención directa con los pacientes y les es denegado el acceso a la historia clínica. Conclusiones: los estudiantes de medicina de primeros semestres desarrollan rotaciones básicas y requieren acompañamiento y supervisión por parte de los docentes. Las ventajas que obtienen las IPS a razón del desarrollo de las prácticas son menores en comparación con las limitaciones que este proceso suscita.

Objective: To find out the perception of the personnel with administrative responsibilities from second and third complexity-level public hospitals or State social enterprises in the Aburrá Valley (which have teaching agreements, but that are not considered teaching hospitals), about medicine students' rotation. The aim was to ascertain the institutional commitment to the formative processes, their knowledge of their methodology, as well as benefits or limitations that result from such processes. Methodology: A qualitative hermeneutical study in which 14 managers and professionals with administrative charges from six public hospitals of the Metropolitan Area of the Aburrá Valley were interviewed. Results: the first-semester medical students' practices are framed in basic matters because when they are starting their training, they are allowed little practice, have little or no direct relationship or intervention with patients and are denied access to their clinical history. Conclusions: first-semester Medicine students are framed in basic rotations. They require permanent accompaniment and supervision from teachers. The advantages that IPS obtain due to the development of students' practices are few compared to the limitations that this process causes.

Objetivo: conhecer a percepção de gerentes e profissionais com cargos administrativos de hospitais públicos ou empresas sociais do Estado de segundo e terceiro nível de complexidade da Área Metropolitana do Valle de Aburrá, nos que há convênios docência - serviço, mas que não se encontram categorizados como hospitais universitários, sobre o processo de rodízio de estudantes de medicina, com o fim de indagar sobre o compromisso que as instituições têm com estes processos formativos, que tão informados estão com respeito à metodologia dos mesmos e quais são os benefícios ou limitantes que deles se desprendem. Metodologia: se realizou uma investigação qualitativa com enfoque hermenêutico. Se entrevistaram 14 gerentes e profissionais com cargos administrativos de 6 hospitais públicos da Área Metropolitana do Valle de Aburrá. Resultados: os estágios dos estudantes de medicina de primeiros semestres se quadram em assuntos básicos porque ao estar iniciando sua formação lhes é permitida pouca prática, têm nula relação ou intervenção direta com os pacientes e lhes é denegado o acesso à história clínica. Conclusões: os estudantes de medicina de primeiros semestres desenvolvem rotações básicas e requerem acompanhamento e supervisão por parte dos docentes. As vantagens que obtém as IPS a razão do desenvolvimento dos estágios é menor em comparação com as limitações que este processo suscita.

Intoxicación por fósforo blanco durante fiestas decembrinas: a propósito de un caso / Intoxication by white phosphorus during Christmas Holidays: a case / Intoxicação por fósforo branco durante festas de dezembro: a propósito de um caso

El fósforo blanco es la forma más común del fósforo disponible. Es altamente reactivo y está presente en distintos productos químicos. En Colombia es utilizado en productos pirotécnicos. Cuando ocurre ingesta accidental o voluntaria, el principal riesgo es el hepático y renal, además de lesiones por quemaduras en piel y compromiso hemodinámico. Se describe el caso de una paciente de 10 meses, con ingesta accidental de "totes" de pólvora que no alcanzó a desarrollar falla hepática. Se utilizó N-Acetilcisteína para aumentar la síntesis de glutatión y evitar la progresión clínica.

White is the most common form of the available phosphorus. It is highly reactive and is present in different chemical products. In Colombia, it is used for the preparation of pyrotechnic products. When accidental or voluntary intake occurs, the main risks are hepatic and renal, in addition to injuries from skin burns and hemodynamic compromise. The article describes a case report of a 10-month-old patient who inadvertently ingested pyrotechnic powder, but failed to develop liver failure. N-Acetylcysteine (NAC) was used to increase Glutathione synthesis and prevent clinical progression.

O fósforo branco é a forma mais comum do fósforo disponível. É altamente reativo e está presente em diferentes produtos químicos. Na Colômbia é utilizado em produtos pirotécnicos. Quando ocorre ingesta acidental ou voluntária, o principal risco é o hepático e renal, ademais de lesões por queimaduras na pele e compromisso hemodinâmico. Se descreve o caso de uma paciente de 10 meses, com ingesta acidental de "bolsas" de pólvora que não alcançou a desenvolver falha hepática. Se utilizou N-Acetilcisteína para aumentar a síntese de glutationa e evitar a progressão clínica.