Computed tomography changes diagnosis, management and surgical planning of ankle fractures.

PURPOSE: To demonstrate how the use of adjunctive Computed Tomography (CT) can modify diagnosis, treatment options, and operative planning of ankle fractures in comparison with conventional radiographs (CR) in isolation. MATERIALS AND METHODS: A total of 53 patients diagnosed with an ankle fracture between 2011 and 2016, were assessed with CT and CR. Evaluations of the fractures using CR in isolation and CR combined with CT were compared using different readers. Fractures were assessed in terms of type, displacement, size, associated injuries, treatment, patient position and surgical planning. RESULTS: The medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, size, posteromedial or posterolateral segment) (ps < 0.042), syndesmosis injury (p < 0.001), and the absence of deltoid ligament lesion (p < 0.001), were more evident with the combination of CT and radiographs. There was an increase in operative indication (p = 0.007), prone positioning (p = 0.002), posterior malleolus surgical treatment (p < 0.001), posterolateral approach for the lateral malleolus (p = 0.003), and syndesmosis fixation (p = 0.020) with the association of CT and CR, among all groups of expertise, with a high interobserver reliability (> 0.75). CONCLUSIONS: The CR may fail to demonstrate subtle lesions, such as posterior malleolus fractures and syndesmotic injuries. The CT evaluation increases the diagnostic precision and improves the quality of information the surgeon receives, what might positively affect patient care. LEVEL OF EVIDENCE III: Retrospective Comparative Study.

Subsistence swine farming: seroprevalence and risk factors associated with Lawsonia intracellularis infection in the state of Minas Gerais Brazil in 2016.

Although it is considered an economically relevant and prevalent disease, little information is available on the epidemiology and risk factors of porcine proliferative enteropathy (PPE) in commercial pigs, and no publication is available on subsistence pig farming. The objectives of this study were to estimate the seroprevalence of L. intracellularis and identify associated risk factors in backyard pigs in the 12 mesoregions of the state of Minas Gerais, Brazil. Blood from pigs between 2 months and 6 years of age were sampled; an epidemiological questionnaire was applied to 288 properties investigated in 2016. Serum samples were tested for the presence of anti-L. intracellularis antibodies using an immunoperoxidase monolayer assay. The seroprevalence of L. intracellularis was 97.7% (CI 95%: 96.7-98.4), and there was no statistical difference among the prevalence of the sampled mesoregions. Only 3 of the 12 risk factors were significant when samples were analyzed from strongly seropositive animals (≥ 1:120) in a Poisson multivariate regression model. There was an interaction between properties in peri-urban areas and extensive production systems. This interaction demonstrated an increase in prevalence rates by 3.7 times (95%CI: 2.4-5.8). Properties close to dumps demonstrated an increase in prevalence rates by 2.2 times (95%CI: 0.99-4.8). In conclusion, anti-L. intracellularis antibodies were widely dispersed in subsistence pig farming's in Minas Gerais, indicating a wide circulation of the agent in this type of production system. The interactions of animals raised close to peri-urban areas, extensively, and close to landfills are risk factors for spread of PPE.

Green does not always mean go: A sulfated galactan from Codium isthmocladum green seaweed reduces melanoma metastasis through direct regulation of malignancy features.

Melanoma is the most lethal form of skin cancer, with a worldwide increase in incidence. Despite the increased overall survival of metastatic melanoma patients given recent advances in targeted and immunotherapy, it still has a poor prognosis and available treatment options carry diverse severe side effects. Polysaccharides from seaweed have been shown to exert antitumor activities. Here we show in vitro and in vivo antitumor activities of a sulfated homogalactan (named 3G4S) from Codium isthmocladum seaweed in the B16-F10 murine melanoma cell line. 3G4S did not induce cytotoxicity or proliferation changes; however, it was able to reduce solid tumor growth and metastasis, while not inducing side effects in mice. B16-F10 cells traits related to the metastatic cascade were also impaired by 3G4S, reducing cell invasion, colony-forming capacity and membrane glycoconjugates. Therefore, 3G4S shows promising antitumor activities without the commonly associated drawbacks of cancer treatments and can be further explored.

Non-Cytotoxic Sulfated Heterorhamnan from Gayralia brasiliensis Green Seaweed Reduces Driver Features of Melanoma Metastatic Progression.

Melanoma is a form of skin cancer with high mortality owing to its fast progression and metastatic capacity. The treatments available nowadays are only palliative in advanced stages of the disease. Thus, alternative therapies for cancer treatment are in demand, and molecules from natural sources, such as polysaccharides, could represent new possible therapeutic approaches. Polysaccharides of freshwater and marine algae with biological activities, such as antitumor properties, are greatly reported in the scientific literature. In the present study, a sulfated heterorhamnan obtained from the green seaweed Gayralia brasiliensis (Gb1 fraction) was chemically characterized and its biological activities in the B16-F10 murine melanoma cell line were evaluated. The Gb1 polysaccharidic fraction tested concentrations presented low or absence of cytotoxicity to B16-F10 cells and neither cell proliferation nor cell cycle were altered. Interestingly, Gb1 treatment decreased B16-F10 cells migration and invasion capabilities and CD44 labeling, showing to be a promising compound for further in vitro and in vivo antitumor studies.

Safe therapeutics of murine melanoma model using a novel antineoplasic, the partially methylated mannogalactan from Pleurotus eryngii.

A heteropolysaccharide was isolated by cold aqueous extraction from edible mushroom Pleurotus eryngii ("King Oyster") basidiocarps and its biological properties were evaluated. Structural assignments were carried out using mono- and bidimensional NMR spectroscopy, monosaccharide composition, and methylation analyses. A mannogalactan having a main chain of (1→6)-linked α-d-galactopyranosyl and 3-O-methyl-α-d-galactopyranosyl residues, both partially substituted at OH-2 by ß-d-Manp (MG-Pe) single-unit was found. Biological effects of mannogalactan from P. eryngii (MG-Pe) were tested against murine melanoma cells. MG-Pe was non-cytotoxic, but reduced in vitro melanoma cells invasion. Also, 50mg/kg MG-Pe administration to melanoma-bearing C57BL/6 mice up to 10days decreased in 60% the tumor volume compared to control. Additionally, no changes were observed when biochemical profile, complete blood cells count (CBC), organs, and body weight were analyzed. Mg-Pe was shown to be a promising anti-melanoma molecule capable of switching melanoma cells to a non-invasive phenotype with no toxicity to melanoma-bearing mice.

Religious and spiritual interventions in mental health care: a systematic review and meta-analysis of randomized controlled clinical trials.

BACKGROUND: Despite the extensive literature assessing associations between religiosity/spirituality and health, few studies have investigated the clinical applicability of this evidence. The purpose of this paper was to assess the impact of religious/spiritual interventions (RSI) through randomized clinical trials (RCTs). METHOD: A systematic review was performed in the following databases: PubMed, Scopus, Web of Science, PsycINFO, Cochrane Collaboration, Embase and SciELO. Through the use of a Boolean expression, articles were included if they: (i) investigated mental health outcomes; (ii) had a design consistent with RCTs. We excluded protocols involving intercessory prayer or distance healing. The study was conducted in two phases by reading: (1) title and abstracts; (2) full papers and assessing their methodological quality. Then, a meta-analysis was carried out. RESULTS: Through this method, 4751 papers were obtained, of which 23 remained included. The meta-analysis showed significant effects of RSI on anxiety general symptoms (p < 0.001) and in subgroups: meditation (p < 0.001); psychotherapy (p = 0.02); 1 month of follow-up (p < 0.001); and comparison groups with interventions (p < 0.001). Two significant differences were found in depressive symptoms: between 1 and 6 months and comparison groups with interventions (p = 0.05). In general, studies have shown that RSI decreased stress, alcoholism and depression. CONCLUSIONS: RCTs on RSI showed additional benefits including reduction of clinical symptoms (mainly anxiety). The diversity of protocols and outcomes associated with a lack of standardization of interventions point to the need for further studies evaluating the use of religiosity/spirituality as a complementary treatment in health care.

Trânsito de suídeos em Minas Gerais, Brasil / Swine industry animal network in Minas Gerais, Brazil

Minas Gerais ocupa a quarta posição entre os estados brasileiros com maior produção de suídeos. A suinocultura envolve intenso trânsito de animal e, consequentemente, forma complexas redes de fluxo. Com a movimentação, esses animais podem carrear agentes patogênicos que podem ser disseminados por meio dessa rede de contatos. Diante disso, este estudo tem como objetivo descrever e analisar o trânsito de suídeos em Minas Gerais para compreender os caminhos mais prováveis para a disseminação de possíveis surtos. Os dados foram fornecidos pelo Instituto Mineiro de Agropecuária, originados das 56.823 Guias de Trânsito Animal emitidas no ano de 2009. A movimentação dos 5.354.735 suídeos foi analisada segundo a sua finalidade. O trânsito mais intenso ocorreu com a finalidade de abate (79,95%), seguida pelas finalidades de engorda (10,64%) e de reprodução (9,38%). A movimentação de animais para exposições e leilões representou apenas 0.03% dos transportes realizados. O trânsito em Minas Gerais é heterogêneo e concentra-se, principalmente, nas regiões do Triângulo Mineiro, Alto Paranaíba e Zona da Mata. As características do fluxo de animais tornam a utilização da estratégia das redes ideal para a elaboração das medidas de vigilância e controle das doenças dos suídeos em Minas Gerais.

Minas Gerais is the fourth largest Brazilian state in swine production. This activity involves the intense animal movement producing a complex network. In this context animals can carry on infectious agents and transmit them among the population. The aim of this study is to describe and analyze the movement of swine in Minas Gerais and to understand the most likely paths to spread possible outbreaks. Data were provided by the Instituto Mineiro de Agropecuária, derived from 56.823 Transit Animal Guides issued in 2009. The movement of 5.354.735 swine was analyzed according to its purpose. The traffic was more intense for slaughter (79.95%) followed by finishing (10.64%) and reproduction purposes (9.38%). The fairs and auction purposes represented only 0.03%. Movement of animals in Minas Gerais is heterogeneous and is mainly concentrated in same regions such as Alto Paranaíba and Zona da Mata. It also occurs in the Central and South regions. The network approach, based on graph theory, can be used more efficiently for the development of swine disease control programs and crisis management in Minas Gerais.

Cross-sectional and longitudinal associations between serum uric acid and metabolic syndrome.

Research on the importance of serum uric acid (SUA) as a contributing metabolic factor to cardiovascular diseases has conducted to conflicting results, with most studies assuming a cross-sectional design. The aim of this study was to evaluate the association of SUA and metabolic syndrome (MetS) and its features. A representative sample of 2,485 individuals aged ≥18 years was randomly selected from the non-institutionalized resident population of Porto, Portugal. A total of 1,054 eligible subjects were included for the longitudinal analyses. Hyperuricemia was defined as SUA ≥70 mg/L in men and ≥60 mg/L in women. MetS was defined according the Joint Interim (2009) criteria. Associations were estimated using Poison regression and binomial models. In the cross-sectional analysis, subjects with hyperuricemia had a 2.10-fold increased risk of MetS as compared with normouricemic subjects (PR = 2.10, 95% CI: 1.68-2.63). Among MetS features, high triglycerides presented the strongest association with hyperuricemia (PR = 2.32, 95% CI: 1.84-2.91). The MetS crude incidence rate was 4.5/100 person-year (95% CI: 3.9-5.2) in normal uricemic and 13.0/100 person-year (95% CI: 8.5-20.0) in hyperuricemic participants. Using a multivariate longitudinal approach, hyperuricemia was positively associated with MetS incidence rate ratios (IRR = 1.73, 95% CI: 1.08-2.76). One standard deviation increase of SUA concentration was associated with a 1.22-fold increase in MetS risk (IRR = 1.22, 95% CI: 1.05-1.42). Elevated SUA presented the strongest association with high-triglycerides concentration (IRR = 1.44, 95%: 1.22-1.71) and waist circumference (IRR = 1.25, 95%: 1.05-1.49). The independent positive association between SUA and MetS suggested by this longitudinal study supports that SUA might be a risk factor for MetS.

Quantity and quality of information desired by Portuguese cancer patients.

Disclosure of the diagnosis of cancer to the patients affected has always been a controversial issue in the doctor-patient relationship. Undoubtedly this is so not only because of differences between countries and cultures, but also because there have been changes of opinion over the years. The aim of this study was to evaluate the quality and quantity of information desired by Portuguese cancer patients, and how and from whom they want to hear this information. Our sample comprised a total of 193 cancer patients, 87 men and 106 women. We found that 68.9% knew what their diagnosis was. In our sample, 74% wanted "as much information as possible, good or bad"; 85% said they wanted to know if their disease was cancer; 95% wanted to know the best or worst likely outcome of their disease; and 96.4% wanted to know the chances of getting cured. Most patients said they would prefer to be informed by physicians (92.7%) and have access to a telephone help-line, books and television. In conclusion, most patients wanted to know as much as possible about their illness and treatment, and the majority preferred to be involved in treatment decisions.