MRI of Pediatric Foot and Ankle Conditions.

The increase in competitive sports practice among children and lack of ionizing radiation have resulted in a higher demand for MRI examinations. MRI of the children skeleton has some particularities that can lead orthopedists, pediatricians, and radiologists to diagnostic errors. The foot and ankle have several bones with abundant radiolucent and high signal intensity cartilage in several ossification centers, apophysis and physis, that can make this interpretation even harder. The present revision aims to show, how to differentiate between normal developmental findings and anatomic variants from pathologic conditions, whether mechanical, inflammatory, infectious, or neoplastic.

Genome-wide association and functional genomic analyses for various hoof health traits in North American Holstein cattle.

Hoof diseases are a major welfare and economic issue in the global dairy cattle production industry, which can be minimized through improved management and breeding practices. Optimal genetic improvement of hoof health could benefit from a deep understanding of the genetic background and biological underpinning of indicators of hoof health. Therefore, the primary objectives of this study were to perform genome-wide association studies, using imputed high-density genetic markers data from North American Holstein cattle, for 8 hoof-related traits: digital dermatitis, sole ulcer, sole hemorrhage, white line lesion, heel horn erosion, interdigital dermatitis, interdigital hyperplasia, and toe ulcer, and a hoof health index. De-regressed estimated breeding values from 25,580 Holstein animals were used as pseudo-phenotypes for the association analyses. The genomic quality control, genotype phasing, and genotype imputation were performed using the PLINK (version 1.9), Eagle (version 2.4.1), and Minimac4 software, respectively. The functional genomic analyses were performed using the GALLO R package and the DAVID platform. We identified 22, 34, 14, 22, 28, 33, 24, 43, and 15 significant markers for digital dermatitis, heel horn erosion, interdigital dermatitis, interdigital hyperplasia, sole hemorrhage, sole ulcer, toe ulcer, white line lesion disease, and the hoof health index, respectively. The significant markers were located across all autosomes, except BTA10, BTA12, BTA20, BTA26, BTA27, and BTA28. Moreover, the genomic regions identified overlap with various previously reported quantitative trait loci for exterior, health, meat and carcass, milk, production, and reproduction traits. The enrichment analyses identified 44 significant gene ontology terms. These enriched genomic regions harbor various candidate genes previously associated with bone development, metabolism, and infectious and immunological diseases. These findings indicate that hoof health traits are highly polygenic and influenced by a wide range of biological processes.

Clinical and Diagnostic Characteristics of Calcaneal Apophysitis: A Systematic Review and Thematic Analysis.

BACKGROUND: Calcaneal apophysitis is an overuse injury in pediatric patients that causes heel pain and reduction in function. The aim of this study is to explore this condition and offer medical insight into its presentation and symptomatology, along with current treatment options. METHODS: We explored PubMed/Medline for studies involving calcaneal apophysitis in pediatric patients. The search included all articles published from database inception until June 1, 2021. We only included articles published in English. Clinical information and demographics extracted from the reported studies were analyzed and assessed. RESULTS: Only 28 studies met our criteria, with a total of 1,362 cases. Of the cases reported, 973 affected boys (71.4%). Presentation was bilateral in 589 cases (43.2%) and unilateral in 433 cases (31.8%). Radiographic imaging was used for the diagnosis of 358 cases (26.3%). All reported treatment modalities were conservative, and these included physical therapy and rest, kinesiotherapy and taping, and orthotic devices. A total of 733 cases (53.7%) reported improved outcomes,32 cases (2.3%) reported no improvement, and the remainder of cases did not report prognostic outcomes (44%). CONCLUSIONS: Calcaneal apophysitis is an overuse disease commonly found in the pediatric population. Educating parents and coaches with regard to its symptomatology, etiology, and treatment is essential to diagnose the condition earlier and provide better outcomes.

Continuous digital hypothermia for prevention and treatment of equine acute laminitis: A practical review.

Laminitis is a severely debilitating and life-threatening condition that occurs as a consequence of different primary triggering factors. Continuous digital hypothermia (CDH) is recommended in horses at risk of, or diagnosed with, acute laminitis due to its several physiological and biochemical alterations that may be positive for the prevention and early treatment of the condition, representing a low risk of adverse effects. Modulation of the inflammatory response, profound vasoconstriction, and prevention of tissue damage are the most notable protective effects of cryotherapy on the lamellae. This practical review aims to summarize the published literature evaluating CDH efficacy in the prevention and early treatment of acute laminitis in horses, highlighting the most important clinical findings and discussing the best methods to provide cryotherapy. Nineteen publications evaluated different CDH methods, including the use of commercially available ice boots or fluid bags filled with iced water or crushed ice, as well as alternatives to immersion in ice, e.g., frozen gel packs and a perfused cuff prototype. Although some techniques were effective for cooling and maintaining the hooves below the optimal temperature of 10 °C, relevant limitations such as labor intensiveness, reliance on an ice source and price make its use impractical in some clinical situations. Twelve experimental studies assessed the efficacy of CDH on the prevention or early treatment of laminitis, finding multiple positive effects in terms of clinical improvement, immunological and inflammatory modulation, and histological protection. After the analysis of the literature, the clinical importance of CDH in different stages of laminitis remains clear. However, it also highlights the need for a safer, more user-friendly, and more effective method of cryotherapy that can be used both in a hospital and an ambulatory setting.

Müller-Weiss disease: a functional and quality of life assessment.

PURPOSE: Evaluate the functional health status and quality of life of patients diagnosed with Müller-Weiss disease and, secondarily, determine the influence of factors such as gender, social status, race, body mass index, and surgical and non-surgical treatment in patient outcome. METHODS: This study included 30 affected feet (18 patients) with follow-up from 2002 to 2016. Five patients were excluded from reassessment, resulting in 20 feet (13 patients). Questionnaires for functional and quality of life assessments were administered, and statistical analysis was performed. RESULTS: Patients with obesity had poor functional results and low quality of life rates. Regarding quality of life, mainly in the mental health domain, there was a significant difference (p < 0.001) that was not observed in other domains investigated, except for surgical treatment, which was superior to non-surgical treatment in terms of the physical domain (p = 0.024). Bilateral treatment was also superior to unilateral treatment in Coughlin's classification (71.4% versus 66.7%). CONCLUSIONS: Müller-Weiss disease evolved with poor functional results and low quality of life rates in patients with obesity, with no method of treatment influence on patient outcome, except for the SF-12 physical domain, where surgical treatment showed better results than conservative treatment.

Plantar vein thrombosis: an uncommon cause of plantar foot pain / Trombose venosa plantar: uma causa incomum de dor em região plantar

INTRODUCTION: Plantar vein thrombosis is a rare condition that can lead to pain, edema, and walking difficulties. It presents a series of predisposing factors, such as recent surgeries, the use of oral contraceptives, and local trauma, among others. Imaging tests are essential for the right diagnosis, and ultrasonography is the modality of choice. As for treatment, there is no consensus in the literature. REPORT: Case of a 30-year-old patient who sought emergency medical care complaining of sudden severe pain in the plantar region of her right foot with walking difficulties. On physical examination, hyperalgesia was observed in the plantar region, irradiating to the calf, associated with swelling. Color Doppler imaging identified an acute thrombus in the medial plantar vein. Rivaroxaban was initially prescribed and replaced by acetylsalicylic acid after three months. The treatment was effective, and the patient was discharged after 11 months. CONCLUSION: Plantar vein thrombosis is a rare condition and has a wide range of differential diagnoses so physicians must maintain a high level of clinical suspicion. To improve diagnosis and treatment, it would be necessary to include plantar veins in the investigation protocols of patients suspected of having Deep Venous Thrombosis, besides additional clinical research for improving treatment.

INTRODUÇÃO: A trombose de veias plantares é uma condição rara que pode cursar com dor, edema e dificuldade na deambulação. Apresenta uma série de fatores predisponentes, como cirurgias recentes, uso de anticoncepcional oral, trauma local, entre outros. A realização de exame de imagem é essencial para o diagnóstico, sendo a ultrassonografia a modalidade de escolha. Quanto ao tratamento, não há consenso na literatura. RELATO: Relatamos o caso de uma paciente de 30 anos que procurou atendimento médico de urgência com queixa de dor de forte intensidade, súbita, em região plantar do pé direito com dificuldade de deambulação. Ao exame físico, observou-se hiperalgesia em região plantar com irradiação para panturrilha, associada a empastamento da mesma. O ecodoppler colorido identificou trombo agudo em veia plantar medial. Optou-se pela prescrição de rivaroxabana, a qual foi substituída por ácido acetilsalicílico após três meses. A paciente evoluiu bem e recebeu alta do tratamento após 11 meses. CONCLUSÃO: A trombose de veias plantares é rara e tem uma alta gama de diagnósticos diferenciais, de forma que o profissional médico deve manter um alto nível de suspeição clínica. Para aperfeiçoar seu diagnóstico e tratamento, seria necessária a inclusão das veias plantares aos protocolos de investigação de pacientes com suspeita de Trombose Venosa Profunda, e pesquisas clínicas que elucidassem os melhores métodos terapêuticos.

Relato de caso: tratamento de ferida perfurante no dígito de equino / Case report: treatment of a perforating wound in the equine digit / Caso clínico: tratamiento de una herida perforante en el dedo equino

Apesar dos avanços na medicina equina, certas condições de claudicação ainda representam um desafio significativo para os clínicos veterinários, especialmente quando se trata de afecções distais, como feridas perfurantes no casco do equino. Essas lesões podem afetar estruturas vitais, incluindo a articulação interfalângica distal, o osso navicular, a bolsa do osso navicular, o tendão flexor digital profundo, a bainha sinovial e a terceira falange. O presente estudo tem como objetivo esclarecer que um diagnóstico mais rápido e preciso das estruturas afetadas e do grau de lesões resultantes leva a um tratamento mais eficaz. Além disso, foi demonstrado que o tratamento convencional com antibióticos e anti-inflamatórios não esteroides sistêmicos -AINEs,em combinação com terapias alternativas, como campo magnético pulsado, laser classe III e Ozonioterapia, apresentou um efeito sinérgico com resultados excelentes.(AU)

Despite advances in equine medicine, certain claudication conditions still pose a significant challenge to veterinary clinicians, especially when it comes to distal affections such as puncture wounds on the equine hoof. These injuries can affect vital structures, including the distal interphalangeal joint, navicular bone, navicular bone pouch, deep digital flexor tendon, synovial sheath, and third phalanx. The present study aims to clarify that a more rapid and accurate diagnosis of the affected structures and the resulting degree of injury leads to more effective treatment. Furthermore, it was shown that conventional treatment with antibiotics and systemic non-steroidal anti-inflammatory drugs -NSAIDs, in combination with alternative therapies, such as pulsed magnetic field, class III laser and ozone therapy, presented a synergistic effect with excellent results.(AU)

A pesar de los avances en medicina equina, ciertas afecciones claudicantes siguen planteando un reto importante a los clínicos veterinarios, especialmente cuando se trata de afecciones distales como las heridas perforantes en el casco equino. Estas lesiones pueden afectar a estructuras vitales, como la articulación interfalángica distal, el hueso navicular, la bolsa del hueso navicular, el tendón flexor digital profundo, la vaina sinovial y la tercera falange. El presente estudio pretende aclarar que un diagnóstico más rápido y preciso de las estructuras afectadas y del grado de lesión resultante conduce a un tratamiento más eficaz. Además, se demostró que el tratamiento convencional con antibióticos y antiinflamatorios no esteroideos sistémicos -AINE, en combinación con terapias alternativas, como el campo magnético pulsado, el láser de clase III y la ozonoterapia, presentaban un efecto sinérgico con excelentes resultados.(AU)

Occurrence of clinical laminitis after adaptation to confinement: effects on morphology, density, and mineral composition of the hoof of Nellore cattle after finishing / Ocorrência de laminite clínica após adaptação ao confinamento: efeitos na morfologia, densidade e composição mineral do casco de bovinos Nelore após terminação

Laminitis is a disease that affects the dermis and epidermis of the bovine hoof, generating changes in the hoof capsule. This study evaluated the effects of clinical laminitis diagnosed after the adaptation phase to confinement on the morphology, density, and mineral composition of the hoof of Nellore cattle after finishing. The animals were separated in the first weeks of confinement into a sick group (SG), with clinical laminitis, and a healthy group (HG). SG animals had higher heel length, dorsal wall length, toe height, and diagonal hoof length (p<0.05) than healthy animals. The dermal laminae had similar measurements for thickness, length, and spacing between them between SG and HG. Animals with laminitis showed congestion, hemorrhage, and basement membrane irregularities on histology. Computed microtomography (µCT) revealed that the hoof density of sick animals is lower than healthy ones. According to the mineral composition by energy-dispersive X-ray fluorescence (ED-XRF) spectrometry, the hooves of animals with laminitis (SG) and healthy ones (HG) were not biochemically different. Therefore, the occurrence of clinical laminitis in Nellore cattle in the first weeks of confinement causes an increase in the morphometric parameters of the hoof capsule and a reduction in the density of the abaxial hoof wall evaluated after the finishing period. This disease does not promote changes in the histomorphometric parameters of the dermal laminae and the percentage of minerals in the abaxial hoof wall.

A laminite é uma doença que afeta a derme e epiderme do casco de bovinos gerando alterações no estojo córneo. O estudo avaliou os efeitos da laminite clínica diagnosticada após a fase de adaptação ao confinamento na morfologia, densidade e composição mineral do casco de bovinos da raça Nelore após terminação. Nas primeiras semanas de confinamento, os animais foram separados em um grupo doente (GD) com laminite clínica e em um grupo saudável (GS). Os animais do GD apresentaram maior comprimento de talão, comprimento da parede dorsal, altura da pinça e comprimento diagonal do casco (p<0,05) do que os saudáveis. As lâminas dérmicas tiveram medidas semelhantes para espessura, comprimento e espaçamento entre elas entre GD e GS. Animais doentes apresentaram congestão, hemorragia e irregularidades da membrana basal na histologia. A microtomografia computadorizada (µCT) revelou que a densidade do casco de animais doentes é menor do que o saudável. Para a composição mineral por meio da espectrometria de fluorescência de raio-X por dispersão de energia (ED-XRF), o casco dos animais doentes (GD) e dos saudáveis (GS), não se mostraram diferentes bioquimicamente. Conclui-se que a ocorrência de laminite clínica em bovinos da raça Nelore nas primeiras semanas de confinamento ocasiona aumento de parâmetros morfométricos do estojo córneo e redução da densidade da parede abaxial do casco, avaliados após o período de terminação. Essa enfermidade não promove modificações nos parâmetros histomorfométricos das lâminas dérmicas e na porcentagem de minerais da parede abaxial do casco.

Quiste óseo aneurismático en el cuboides de un niño de 13 años. Presentación de un caso clínico / Aneurysmal bone cyst of the cuboid. Case report and review of the literature

Se presenta un caso clínico poco frecuente de un quiste óseo aneurismático localizado en el cuboides de un niño de 13 años. Se llegó al diagnóstico mediante la tríada de síntomas, estudios por imágenes (radiografía, resonancia magnética) y anatomía patológica. El tratamiento consistió en el abordaje y curetaje minuciosos dentro de la lesión, el fresado de alta velocidad, la electrocauterización y el relleno con aloinjerto óseo liofilizado con chips cortico-esponjosos. Pese al diagnóstico tardío, la evolución clínica fue favorable con remisión completa de los síntomas y retorno a las actividades deportivas, sin recidiva local. Nivel de Evidencia: IV

A rare clinical case of an aneurysmal bone cyst located at the level of the cuboid in a 13-year-old boy is presented. The diagnosis was reached through clinical evaluation, imaging studies (radiograph-MRI), and a pathological anatomy analysis. Its treatment consisted of thorough intralesional curettage, high speed burring, electrocautery, and filling with lyophilized bone allograft with cortical/cancellous chips. Despite the late diagnosis, we would like to highlight the favorable clinical evolution of the patient, with ad integrum remission of the symptoms and return to his sport activities, without elements of local recurrence. Level of Evidence: IV

Could an Internet-Based Foot-Ankle Therapeutic Exercise Program Modify Clinical Outcomes and Gait Biomechanics in People with Diabetic Neuropathy? A Clinical Proof-of-Concept Study.

Previous studies have shown the efficacy of foot-ankle exercises in people with diabetic peripheral neuropathy (DPN), but the quality of evidence is still low. This proof-of-concept study pursues preliminary evidence for potential clinical and gait biomechanical benefits from an internet-based foot-ankle therapeutic exercise program for people with DPN. We randomized 30 individuals with DPN (IWGDF risk category 1 or 2) into either the control group (CG) receiving the usual care or the intervention group (IG) receiving the usual care plus an internet-based foot-ankle exercise program, fully guided by the Sistema de Orientação ao Pé Diabético (SOPeD; translation: Diabetic Foot Guidance System) three times per week for 12 weeks. We assessed face-to-face clinical and biomechanical outcomes at baseline, 12 weeks, and 24 weeks (follow up). Participants had good adherence to the proposed intervention and it led to only mild adverse events. The IG showed improvements in the ankle and first metatarsophalangeal joint motion after 12 and 24 weeks, changed forefoot load absorption during foot rollover during gait after 24 weeks, reduced foot pain after 12 weeks, and improved foot function after 24 weeks. A 12-week internet-based foot-ankle exercise program using the SOPeD software (version 1.0) has the potential to reduce foot pain, improve foot function, and modify some important foot-ankle kinematic outcomes in people with DPN.

Effects of insoles adapted in flip-flop sandals for persistent heel pain: a protocol for a sham-controlled randomised trial.

INTRODUCTION: Persistent heel pain is a prevalent complaint affecting up to 10% of the population. Insoles adapted in flip-flop sandals are an alternative treatment for pain and function of individuals with persistent heel pain, showing improvement within 12 weeks of treatment. Most studies considered foot posture and biomechanics to prescribe insoles for persistent heel pain, but few verified the effects of a 12-week treatment on pain catastrophising. This study will investigate the effects of insoles adapted in flip-flop sandals on pain intensity, function, functional walking capacity and pain catastrophising of individuals with persistent heel pain. METHODS AND ANALYSIS: This is a protocol for a sham-controlled randomised trial. Eighty individuals with persistent heel pain will be assessed and randomised into two intervention groups: insoles adapted in flip-flop sandals and flip-flop sandals with sham (ie, flat) insoles. Assessments will be conducted at baseline (T0), after 6 weeks (T6), 12 weeks postintervention (T12) and after a 4-week follow-up (T16). The primary outcome will be the pain intensity, and secondary outcomes will be foot function, functional walking capacity and pain catastrophising. Analysis of variance with mixed design (if normal distribution) or Friedman's test (if not normal distribution) will verify intergroup and intragroup differences. Bonferroni post hoc tests will be performed in case of significant group or time interaction. Intent-to-treat analysis will be used, and a significance level of 5% and 95% CIs will be considered. ETHICS AND DISSEMINATION: This study was approved by the research ethics committee of the Federal University of Rio Grande do Norte (registry no. 4,018,821). Results will be disseminated to individuals, submitted to a peer-reviewed journal and disclosed in scientific meetings. TRIAL REGISTRATION NUMBER: NCT04784598.

From Mendel laws to whole genetic association study to decipher the swine mulefoot phenotype.

The swine mulefoot (SM) is a rare condition characterized by a non-cloven hoof due to the partial or total fusion of the phalanges. No comprehensive study has been conducted to identify associated markers with this phenotype until now. We aimed to characterize the association between SNP and the mulefoot phenotype using a Genome-Wide Association Study (GWAS). An experimental population was produced using a half-sib mating where the male had the mulefoot phenotype and the females (n = 6) had cloven hoofs. The cross resulted in 27 (47%) animals with the mulefoot characteristic and 30 (53%) normal animals, indicating the possible dominant gene action. Animals were further genotyped using the Illumina PorcineSNP50k BeadChip, and SNPs were tested for associations. Twenty-nine SNPs located on the SSC15, SSC4, and SSCX were associated with the mulefoot phenotype (p-value <5 × 10-5). Six markers were found in the intronic regions of VWC2L, CATIP, PDK3, PCYT1B, and POLA1 genes. The marker rs81277626, on SSC15:116,886,110 bp, is located in the Von Willebrand Factor C Domain (VWC2L), a possible functional candidate gene. The VWC2L is part of a biological process involved with the bone morphogenetic protein (BMP) signaling pathway, previously associated with syndactyly in other species. In conclusion, the identified markers suggest the involvement of the VWC2L gene in the SM phenotype in this population.

Laminite crônica em equino - tratamento com uso de ferradura com travessa horizontal e massa epóxi / Chronic laminitis in a horse - treatment with use of horseshoe with horizontal cross and epoxy putty

Background: Laminitis is characterized by an inflammation of the laminar structures of the hoof, which results in lamellar degradation of the suspensory apparatus of the distal phalanx. Despite being a common disease in the equine clinic, it is a medical emergency, which can lead the affected animals not return to sports activities. Due to the severity of laminitis and the poor prognosis, the objective was to report the case of a horse with chronic laminitis with sole perforation in all limbs treated with therapeutic shoeing using a type of horseshoe that has a horizontal crossbar and is filled with mass. Fast-drying epoxy, which has its use little described in the literature Case: A 4-year-old Crioula horse, weighing 325 kg, used in long noose competitions, was referred to the Veterinary Hospital of UFPR with chronic laminitis. The animal had reluctance to move, walk on a trestle position, grade V lameness and phalanx rotation of all limbs. The treatment of laminitis was carried out in the field, for two months, which consisted of trimming and shoeing with a horseshoe in the shape of a heart, and due to the failure of the treatment instituted, the patient presented clinical worsening. The treatment in the HV consisted of cleaning the perforated region of the sole with hydrogen peroxide and 10% iodine and dressing with cotton boots with EVA rubber on the sole to provide comfort. Corrective trimming was performed in order to remove excess forceps, lower the heel, and align the distal phalanx with the hoof wall, using a rasp. Orthopedic shoeing was performed with a normal horseshoe with a horizontal crossbar in the central region. The sole was filled with a quick-drying epoxy putty (Poxilina®), with the aim of preventing sole movement, blocking the rotation of the phalanges and improving the concavity of the hoof. Discussion: In chronic laminitis, the signs observed are claudication and deformation of the hoof, flat sole, enlargement of the white line, uneven growth of the hoof wall, hemorrhage in the abaxial white line, cracks in the hoof wall, which are observed parallel to the coronary band, in addition to phalanx rotation; in this clinical case, all these signs were observed. The trimming of horses with laminitis consists of removing the heels and decreasing the dorsal wall of the hoof, in this case, the trimming performed improved the clinical improvement of the animal five days after the procedure. The horseshoe used in the treatment of this animal has the objective of creating a weight-bearing surface on the middle of the sole, close to the tip of the frog, in this way the weight is not on the supporting edge of the clamp and, in this way, it reduces the pressure. over the most affected area. Despite the scarcity of reports on the use of this type of horseshoe, in this case it played a fundamental role in the treatment of laminitis. In this way, it is an alternative that must be taken into account when choosing the treatment, in view of its effectiveness and lower cost when compared to other methods. This case demonstrates the severity of laminitis in all limbs, especially as it presents a perforation of the sole. It is important to highlight that trimming and shoeing performed at the recommended interval (30-45 days) contributes a lot to the success of the treatment and the return of the animal to sports practice. The horseshoe with a horizontal crossbar was effective in the treatment of chronic laminitis of the forelimbs and pelvic limbs in the reported animal, with progressive improvement of the patient who returned to normal daily activities, without the presence of signs of pain or signs of laminitis after treatment.

Occurrence of foot diseases in cattle attended at the Clínica de Bovinos de Garanhuns: Epidemiological, clinical, therapeutic and economic aspects / Ocorrência de afecções podais em bovinos atendidos pela Clínica de Bovinos de Garanhuns: aspectos epidemiológicos, clínicos, terapêuticos e econômicos

The objective was to study the occurrence of foot disorders in cattle treated at the Clínica de Bovinos de Garanhuns, campus of the Universidade Federal Rural de Pernambuco from 1999 to 2021. A retrospective study of the medical records was carried out, with a total of 334 cases, in which 613 lesions were diagnosed. A frequency distribution, with simple mean and standard deviation was performed to evaluate the data. Interdigital dermatitis was more frequent in 12.4% (76/613), double sole in 9.79% (60/613), chronic laminitis in 8.81% (54/613), sole ulcer in 7.83% (48 /613), and interdigital hyperplasia in 7.24% (45/613). Laminitis and its consequences accounted for 45% of the total injuries identified, followed by 36% of injuries of secondary or uncertain cause, and 19% from infectious diseases. The distribution of lesions between the limbs was 68% in the pelvic and 32% in the thoracic limbs. Females, raised in a semi-intensive system, Holstein, with a body score of III, and large size were more affected. Lameness was present in 78% (260/334), while 10% (33/334) did not present lameness. The case fatality and recovery rates were 9% (31/334) and 73% (243/334), respectively. In total, 51% of cases occurred in the rainy season and 49% in the dry season. The main cities of origin were Bom Conselho 22.75% (76/334), Garanhuns 18.86% (63/334), and Brejão 12.57% (42/334). The estimated cost of treatment was US$ 150.13/case. Diseases are probably directly linked to management failure on the property due to the nature of the diagnosed diseases, in addition to the significant cost of the treatment of these animals, with the need for prophylactic measures in order to avoid the economic losses associated with foot diseases.

Objetivou-se estudar a ocorrência das afecções podais em bovinos atendidos na Clínica de Bovinos de Garanhuns, Campus da Universidade Federal Rural de Pernambuco, no intervalo de 1999 a 2021. Realizou-se estudo retrospectivo dos prontuários, com total 334 casos, dos quais foram diagnosticadas 613 lesões digitais. Foi realizada a distribuição de frequência, média simples e desvio padrão para avaliação dos dados. A dermatite interdigital foi a mais frequente, sendo observada em 12,4% (76/613) dos casos, seguida por sola dupla 9,79% (60/613), laminite crônica 8,81% (54/613), úlcera de sola 7,83% (48/613) e a hiperplasia interdigital 7,24% (45/613). A laminite e suas consequências representaram 45% do total de lesões identificadas, acompanhadas por 36% das injúrias de causa secundárias ou incertas e de doenças infecciosas com 19%. A distribuição das lesões entre os membros foi de 68% nos pélvicos e 32% nos torácicos. As fêmeas criadas em sistema semi-intensivo, holandesas, com escore corporal III e porte grande eram mais acometidas. A claudicação estava presente em 78% dos animais, enquanto 10% não claudicavam. As taxas de letalidade e recuperação foram de 9% (31/334) e 73 % (243/334), respectivamente. No período chuvoso foram 51% dos casos e 49% na época seca. Os principais municípios de origem foram Bom Conselho 22,75% (76/334), Garanhuns 18, 86% (63/334) e Brejão 12,57% (42/334). O custo estimado com tratamento foi de US$ 150,13/caso. Provavelmente falhas de manejo nas propriedades foram importantes fatores de risco para as doenças. Sugere-se a implementação de medidas profiláticas para evitar as perdas econômicas associadas às enfermidades podais.

Metabolic imbalances, hoof injuries, and metabolic profile of high-producing Holstein × Gir cowsshowing lameness / Desequilíbrios metabólicos, lesões nos cascos e perfil metabólico de vacas Holandesa × Gir de alta produção apresentando claudicação

This study attempted to determine the associations between metabolic imbalances and lameness or hoof injuries in high-producing Holstein × Gir cows, and to determine whether the metabolic profile affects the occurrence of lameness. Eighty cows were followed from -60 to 60 days relative to calving and hoof injuries were reported on days -60, 7 and 60. Locomotion score (LS), body condition score (BCS), the concentrations of non-esterified fatty acids, ß-hydroxybutyrate, glucose, cholesterol, albumin, total protein, blood urea nitrogen (BUN), calcium, phosphorus, and magnesium, and the activity of aspartate aminotransferase were determined at days -42, -21, -7, 0, 7, 21 and 42. The McNemar and Chi-square tests were used to compare frequencies of lameness and hoof injuries over time and to verify the associations between lameness, BCS, hoof injuries, and metabolic disorders. Two-way repeated measures ANOVA was used considering groups (non-lame × lame cows) and variations of BCS and metabolites over time. Lameness and hoof injuries increased between days -60 (20% and 66.3%) and 60 (44.7% and 98.6%). Excessive postpartum loss of BCS (P=0.017) and subclinical hypocalcemia (P=0.012) were associated with lameness on day 60. In general, the metabolic profile did not differ between lame and non-lame cows but cholesterol, albumin, BUN and magnesium concentrations were higher in non-lame cows. The postpartum decrease in BCS can affect the occurrence of lameness, and the metabolic profile of lame cows shows little difference from that of non-lame cows.

Este estudo objetivou verificar as associações entre desequilíbrios metabólicos e claudicação ou lesões nos cascos em vacas mestiças Holandesa × Gir de alta produção e determinar se o perfil metabólico afeta a ocorrência de claudicação. Oitenta vacas foram acompanhadas de -60 a 60 dias em relação ao parto e as lesões nos cascos foram avaliadas nos dias -60, 7 e 60. O escore de locomoção (EL), o escore de condição corporal (ECC), as concentrações de ácidos graxos não esterificados, ß-hidroxibutirato, glicose, colesterol, albumina, proteína total, nitrogênio ureico no sangue (BUN), cálcio, fósforo e magnésio e a atividade da aspartato aminotransferase foram determinados nos dias -42, -21, -7, 0, 7, 21 e 42. Os testes de McNemar e de Qui-quadrado foram empregados para comparar as frequências de claudicação e de lesões nos cascos ao longo do tempo e para verificar as associações entre claudicação, ECC, lesões nos cascos e distúrbios metabólicos. A análise de variâncias de medidas repetidas bifatorial foi usada considerando-se grupos (vacas com claudicação × vacas sem claudicação) e variações de BCS e de metabólitos ao longo do tempo. A claudicação e as lesões nos cascos aumentaram entre os dias -60 (20% e 66,3%) e 60 (44,7% e 98,6%). A perda excessiva de ECC no pós-parto (P=0,017) e a hipocalcemia subclínica ao parto (P=0,012) foram associadas com claudicação no dia 60. Em geral, o perfil metabólico não diferiu entre vacas com e sem claudicação, mas as concentrações de colesterol, albumina, BUN e magnésio foram maiores em vacas sem claudicação. A redução do ECC no periodo pós-parto pode afetar a ocorrência de claudicação, e o perfil metabólico das vacas claudicantes apresenta pouca diferença em relação ao das vacas não claudicantes.

Characterization and frequency of foot injuries and foot-related lameness in a sheep herd with prophylactic measures for foot-related diseases / Caracterização e frequência de lesões podais e da claudicação em rebanho ovino com medidas profiláticas de doenças podais

Foot lesions in sheep herds are responsible for great economic losses, because pain during locomotion interferes with feeding and behavior, leading productivity losses. The objective of this work was to describe the main foot disease found in sheep herd that uses prophylactic measures against foot diseases. A total of 346 ewes of different ages, with or without lameness, were assessed for the presence of foot lesions in all limbs, digits and adjacent structures. Among all the 2768 digits evaluated, 103 (29.76%) had lesions, representing 1.04 lesion per animal. 41.75% (43/103) had only one lesion, 39.81% (41/103) had two lesions, 16 (15.53%) had three lesions, and only 2.91% (3/103) had four or more lesions. Hind limbs were the most affected and the most frequent diseases were white line disease (40.05%), interdigital dermatitis (33.70%) and footrot (12.15%). It was concluded that foot disease in sheep is frequent and constitute a health problem for herds, even on farms that use strategies to prevent it. Therefore, it is essential to classify the lesions, as well as the adoption of effective prophylactic and therapeutic measures.

Lesões podais em ovinos são responsáveis por grandes perdas econômicas, pois a dor durante a locomoção interfere na alimentação e no comportamento, levando à perda de produtividade. O objetivo deste trabalho foi descrever as principais doenças podais encontradas em rebanho ovino, que utiliza medidas profiláticas contra as doenças podais. Foram examinadas 346 ovelhas quanto à presença de lesões podais em todos os membros, dígitos e estruturas adjacentes. Entre os 2.768 dígitos avaliados, 103 (29,76%) apresentavam lesões, representando 1,04 lesões por animal. 41,75% (43/103) apresentavam apenas uma lesão, 39,81% (41/103) tinham duas lesões, 16 (15,53%) tinham três lesões, e apenas três animais apresentavam quatro ou mais lesões. Os membros posteriores foram os mais afetados e as doenças mais frequentes foram a doença da linha branca (40,05%), dermatite interdigital (33,70%) e footrot (12,15%). Pode-se concluir que as lesões podais em ovinos são frequentes e constituem um problema sanitário para os rebanhos, mesmo em propriedade que realiza medidas profiláticas. Portanto, é fundamental classificar as lesões, assim como adotar as medidas profiláticas e terapêuticas eficazes.

Dermoscopy of skin infestations and infections (entomodermoscopy) - Part II: viral, fungal and other infections,

Abstract In addition to the infestations and bacterial infections reported in part I, the study of entomodermoscopy also involves descriptions of dermoscopic findings of a growing number of viral and fungal infections, among others. In this article, the main clinical situations in viral infections where dermoscopy can be useful will be described, that is in the evaluation of viral warts, molluscum contagiosum, and even in recent scenarios such as the COVID-19 pandemic. As for fungal infections, dermoscopy is particularly important, not only in the evaluation of the skin surface, but also of skin annexes, such as hairs and nails. The differential diagnosis with skin tumors, especially melanomas, can be facilitated by dermoscopy, especially in the evaluation of cases of verruca plantaris, onychomycosis and tinea nigra.

Epithelioma cuniculatum of the sole of the foot mimicking an infection.

Epithelioma cuniculatum is characterized as a slow growing lesion on the sole of the foot. A diagnosis is usually delayed by a low clinical suspicion and misdirection due to its similarity to an infection. This tumor rarely metastasize but a local invasion of adjacent soft tissues is common, requiring ample surgical resection or even amputation in advanced cases. We report a case a 76-year-old patient with a 5-year-old lesion on the sole of the foot, which was originally treated as a wart without improvement while the lesion slowly evolved. The patient was referred to our center with a diagnosis of chronic osteomyelitis. An excisional biopsy revealed an invasive keratinizing squamous carcinoma. In this advanced phase of the disease the only possible treatment was a Syme amputation.

El epitelioma cuniculatum se caracteriza por una lesión de crecimiento lento en la planta del pie cuyo diagnóstico suele retrasarse por la baja sospecha clínica y por su similitud con una infección. Este tumor raramente metastatiza, pero es común que produzca una invasión local a los tejidos blandos adyacentes, requiriendo una amplia resección quirúrgica o incluso una amputación en casos avanzados. Presentamos un caso de un paciente de 76 años con una lesión de 5 años de edad en la planta del pie, que originalmente fue tratada como una verruga plantar común sin mejoría, mientras que la lesión evolucionó lentamente. El paciente fue remitido a nuestro centro con un diagnóstico de osteomielitis crónica. Una biopsia excisional reveló un carcinoma escamoso queratinizante invasivo. En esta fase avanzada de la enfermedad el único tratamiento posible fue una amputación de Syme.

Dermoscopy of skin infestations and infections (entomodermoscopy) - Part II: viral, fungal and other infections.

In addition to the infestations and bacterial infections reported in part I, the study of entomodermoscopy also involves descriptions of dermoscopic findings of a growing number of viral and fungal infections, among others. In this article, the main clinical situations in viral infections where dermoscopy can be useful will be described, that is in the evaluation of viral warts, molluscum contagiosum, and even in recent scenarios such as the COVID-19 pandemic. As for fungal infections, dermoscopy is particularly important, not only in the evaluation of the skin surface, but also of skin annexes, such as hairs and nails. The differential diagnosis with skin tumors, especially melanomas, can be facilitated by dermoscopy, especially in the evaluation of cases of verruca plantaris, onychomycosis and tinea nigra.

Rabdomiosarcoma alveolar con metástasis cardíaca en un paciente pediátrico / Alveolar rhabdomyosarcoma with cardiac metastasis in a pediatric patient

El rabdomiosarcoma es el tumor maligno de partes blandas más frecuente en la edad pediátrica. Puede afectar cualquier localización anatómica. El subtipo histológico alveolar suele causar lesiones en las extremidades en niños de mayor edad. Los sitios metástasicos más frecuentes son el pulmón, la médula ósea, el hueso y los ganglios linfáticos. Describimos el caso de un paciente con rabdomiosarcoma alveolar (RA) con metástasis cardíaca, una presentación poco frecuente de la patología.

Rhabdomyosarcoma is the most common malignant soft tissue tumor in pediatric age. It can affect any anatomical location. Alveolar histological subtype usually presents lesions on the extremities in older children. The most common metastatic sites are the lung, bone marrow, bone and lymph node. We describe a case of alveolar rhabdomyosarcoma with cardiac metastasis in a pediatric patient, a rare presentation of the pathology.