Training in cataract surgery in Spain: analysis of the results of a survey of the European Board of Ophthalmology in a Spanish cohort.

INTRODUCTION: A survey conducted by the European Board of Ophthalmology (EBO) revealed significant differences in the surgical training of the ophthalmology residents in Europe, including a disparity between the sexes and a variation in the experience on cataract surgery (CC) between them. This study is about the Spanish sub-cohort of the survey, and its objective is to present and analyse the peculiarities of ophthalmology training in Spain within the European context, as well as discussing ways to harmonise and improve that training throughout the EU. METHODS: We analyse data of the Spanish participants in the EBO exams, defining subgroups by the Autonomous Communities existing in Spain. RESULTS: 93 of 135 requested participants (68.9%) responded. A 60.2% passed the EBO exam between 2021 and 2022, being mostly women (65.59%) aged 31 years old on average. The 91.4% were right-handed, coming from 13 of the 17 Spanish autonomous communities, although mostly from the Community of Valencia, Madrid and Catalonia. Respectively, 16.1%, 3.2% and 8.7% of the respondents said they have completed 10 or more training sessions on animal eyes, synthetic eyes and through the virtual reality simulator. This training was correlated with greater self-confidence in the management of a posterior capsular tear during surgery (p .025). All respondents manifested to have already performed stages of the CC. The average number of operations reported was 181.6 with regional disparities. A significant difference is observed between the sexes against women (-28.3%, p 0.03). DISCUSSION: Ophthalmologists in Spain, much more than other European countries, have greater opportunities for surgical training, with surgical procedures during the residency, that nearly triples those made by the others. Spanish women refer, like their European colleagues, to be in disadvantage in learning opportunities about cataract surgery. The Simulation Based Medical Education (SBME) allows to respond to the training deficit and complements the training on the patient. Although we demonstrate a significant correlation between the number of procedures carried out and self-confidence to operate simple cases, the SBME would be a complementary tool in self-confidence in front of a complication like capsular rupture. CONCLUSION: Spain massively adopts the model named by us "surgery for all", despite the underrepresentation of women in this area, emphasising a need for cultural change that the SBME could facilitate.

A combination of non-invasive tests for the detection of significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease is not superior to magnetic resonance elastography alone.

OBJECTIVES: The aims of the present study were to investigate a combination of magnetic resonance elastography (MRE) and vibration-controlled transient elastography (VCTE) or MRE and fibrosis score 4 (FIB-4) in the detection of significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: Between November 5, 2021, and March 4, 2022, a total of 119 consecutive patients with MASLD were included. Liver stiffness was measured using liver biopsy, MRE, VCTE, and FIB-4. Data were collected from outpatient visit charts. Significant fibrosis was defined as ≥ stage 2 fibrosis. RESULTS: All 119 MASLD patients were Caucasian, and their median age was 55 years. MRE, VCTE, and FIB-4 demonstrated significant accuracy in the detection of significant fibrosis with an area under the ROC curve (AUC) of 0.848 ± 0.036 (p < 0.001), 0.632 ± 0.052 (p = 0.012), and 0.664 ± 0.051 (p = 0.001), respectively. However, the diagnostic performance of MRE was superior compared to that of VCTE (AUC difference: 0.216 ± 0.053, p < 0.001) and FIB-4 (AUC difference: 0.184 ± 0.058, p = 0.001). With logistic regression analysis, it was determined that when compared to MRE alone, a combination of MRE and TE (p = 0.880) or MRE and FIB-4 (p = 0.455) were not superior for detecting significant fibrosis. CONCLUSIONS: MRE alone is an accurate and non-invasive method for the identification of MASLD patients with significant fibrosis. CLINICAL RELEVANCE STATEMENT: Magnetic resonance elastography alone accurately detects significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease. KEY POINTS: • In routine clinical practice, several non-invasive biochemical-based biomarkers and imaging methods are widely used to assess liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease. • Magnetic resonance elastography (MRE) is more accurate than vibration-controlled transient elastography (VCTE) or fibrosis score 4 (FIB-4) for assessing liver fibrosis and identifying significant fibrosis in patients with metabolic dysfunction-associated steatotic liver disease. • The combination of MRE and VCTE or MRE and FIB-4 was not superior to MRE alone.

Did radiation exposure increase with chest computed tomography use among different ages during the COVID-19 pandemic? A multi-center study with 42028 chest computed tomography scans

PURPOSE: To determine whether radiation exposure increased among different ages with chest computed tomography (CT) use during the coronavirus disease-2019 (COVID-19) pandemic. METHODS: Patients with chest CT scans in an 8-month period of the pandemic between March 15, 2020, and November 15, 2020, and the same period of the preceding year were included in the study. Indications of chest CT scans were obtained from the clinical notes and categorized as infectious diseases, neoplastic disorders, trauma, and other diseases. Chest CT scans for infectious diseases during the pandemic were compared with those with the same indications in 2019. The dose-length product values were obtained from the protocol screen individually. RESULTS: The total number of chest CT scans with an indication of infectious disease was 21746 in 2020 and 4318 in 2019. Total radiation exposure increased by 573% with the use of chest CT for infectious indications but decreased by 19% for neoplasia, 12% for trauma, and 43% for other reasons. The mean age of the patients scanned in 2019 was significantly higher than those scanned during the pandemic (64.6 vs. 50.3 years). A striking increase was seen in the 10-59 age group during the pandemic (P < 0.001). The highest increase was seen in the 20-29 age group, being 18.6 fold. One death was recorded per 58 chest CT scans during the pandemic. Chest CT use was substantially higher at the beginning of the pandemic. CONCLUSION: Chest CT was excessively used during the COVID-19 pandemic. Young and middle-aged people were exposed more than others. The impact of COVID-19-pandemic-related radiation exposure on public health should be followed carefully in future years.

Evaluation of Magnetic Resonance Elastography and Transient Elastography for Liver Fibrosis and Steatosis Assessments in the Liver Transplant Setting.

BACKGROUND: Liver graft fibrosis affects long-term graft and patient survival in liver transplant recipients. Transient elastography and magnetic resonance elastography are widely used for the assessment of liver fibrosis in routine clinical practice, but are limited in liver transplant settings. The aims of the present study were to evaluate the accuracy of magnetic resonance elastography and transient elastograph in the assessment of liver fibrosis in liver transplant recipients, and to determine the recurrence rates of post-transplant hepatic steatosis and liver fibrosis. METHODS: A total of 126 consecutive liver transplant recipients were included. Magnetic resonance elastography and transient elastography were performed for to measure liver stiffness. RESULTS: The most common cause of liver transplantation was hepatitis B virus-induced cirrhosis (50%). The mean liver stiffness value with transient elastography was 6.1 ± 3.0 kPa, and the mean magnetic resonance elastography value was 2.7 ± 1.0 kPa. A significant positive correlation was found between magnetic resonance elastography and transient elastography in terms of liver stiffness measurement (r = 0.61, P < .001). Obesity and the underlying etiology of liver diseases did not have any significant negative effect on magnetic resonance elastography and transient elastography measurements. During the follow-up, the post-transplant recurrence rates of hepatic steatosis and hepatic fibrosis were 26% and 37%, respectively. The recurrence rates of post-transplant hepatic steatosis and liver fibrosis were slightly higher in recipients with non-alcoholic fatty liver disease-related cirrhosis than those with viral hepatitisrelated etiologies (44% vs 27%, P = .43; 44% vs 30%, P = .45, respectively). CONCLUSION: Magnetic resonance elastography and transient elastography are accurate in assessing liver fibrosis in the liver transplant setting. Obesity and the underlying etiology of primary liver disease do not influence the measurements.

Use and detailed metric properties of patient-reported outcome measures for rheumatoid arthritis: a systematic review covering two decades.

INTRODUCTION: The importance of patient-reported outcome measures (PROMs) for rheumatoid arthritis (RA) clinical studies has been recognised for many years. The current study aims to describe the RA PROMs used over the past 20 years, and their performance metrics, to underpin appropriate tool selection. METHODS: The study included a systematic search for PROMs that have been in use over the period 2000-2019, with detailed documentation of their psychometric properties, and a user-friendly presentation of the extensive evidence base. RESULTS: 125 PROMs were identified with psychometric evidence available. The domains of pain, fatigue, emotional functions, mobility, physical functioning and work dominated, with self-efficacy and coping as personal factors. Domains such as stiffness and sleep were poorly served. The most frequently used PROMs included the Health Assessment Questionnaire Disability Index (HAQ), the Short Form 36 (SF-36), the EuroQoL and the Modified HAQ which, between them, appeared in more than 3500 papers. Strong psychometric evidence was found for the HAQ, and the SF-36 Physical Functioning and Vitality (fatigue) domains. Otherwise, all domains except stiffness, sleep, education and health utility, had at least one PROM with moderate level of psychometric evidence. CONCLUSION: There is a broad range of PROMs for measuring RA outcomes, but the quality of psychometric evidence varies widely. This work identifies gaps in key RA domains according to the biopsychosocial model.

Zoonotic bacteria research and analysis of antimicrobial resistance levels in parrot isolates from pet shops in the city of Fortaleza, Brazil / Pesquisa de bactérias zoonóticas e análise dos níveis de resistência antimicrobiana em isolados de psitacídeos de pet shops da cidade de Fortaleza, Brasil

The Psittaciformes are among the most popular pets due to their intelligence, ability, and ease of maintenance in small environments. However, the absence of adequate environmental stimuli generated by confinement can predispose these animals to characteristic stress conditions, leaving them susceptible to the triggering of various diseases, among which those of bacterial origin stand out. The objective of this study was to carry out a survey of enterobacteria and evaluate the antimicrobial sensitivity profile of bacteria isolated from parrots from a pet shop in the city of Fortaleza, Ceará. Ninety-six samples were collected from four pet shops (which were classified as A, B, C and D), eight samples of local swabs from budgerigar (Melopsittacus undulatus), were collected from each establishment eight from cockatiels (Nymphicus hollandicus) and eight from lovebirds (Agapornis sp.). Isolation of enterobacteria is under the methodology used by Lopes et al. (2015) with modifications. The method used to study bacterial resistance was the Kirby-Bauer method, following the standards stipulated by the Clinical and Laboratory Standards Institute. Sixty-eight enterobacteria strains from ten different species, Proteus mirabilis, Citrobacter diversus, Pantoea agglomerans, Escherichia coli, Providencia stuartii, Hafnia alvei, Proteus vulgaris, Serratia liquefaciens, Enterobacter sakasakii and Citrobacter amalonaticus, were isolated. P. agglomerans was the bacterium with the highest frequency of isolates from pet shop parrots, making up 23.5% of the isolates; the second-most isolated strain was P. mirabilis with 17.7%. In this study, 79% of the isolated strains were resistant to at least one class of antimicrobials tested. Tetracycline proved to be the most resistant antimicrobial (44%), followed by polymyxin B (38%) and nalidixic acid (25%). Among the 68 strains, 19% did not show resistance to any of the classes of antimicrobials tested. The condition of multidrug resistance - resistance to ≥3 classes of antimicrobials - was observed in 18% of the isolated strains.(AU)

Os psittaciformes estão entre os animais de estimação mais populares devido sua inteligência, habilidade, além da facilidade de manutenção da espécie em pequenos ambientes. Contudo, a ausência de estímulos ambientais adequados gerados pelo confinamento, podem predispor esses animais a quadros característicos de estresse, deixando-os susceptíveis ao desencadeamento de várias doenças dentre elas se destacam as de origem bacteriana. O objetivo desse trabalho foi realizar uma pesquisa de enterobactérias e avaliar o perfil de sensibilidade antimicrobiana de bactérias isoladas de psitacídeos de pet shop da cidade de Fortaleza, Ceará. Foram coletadas 96 amostras de quatro pet shops (os quais foram classificados em A, B, C e D), sendo coletados de cada estabelecimento oito amostras de suabes clocais oriundos de periquitos australianos (Melopsittacus undulatus), oito de calopsitas (Nymphicus hollandicus) e oito de agapornis (Agapornis sp.). O isolamento de enterobactérias está de acordo com a metodologia utilizada por Lopes et al. (2015) com modificações. O método utilizado para o estudo de resistência bacteriana foi o de Kirby-Bauer, seguindo os padrões estipulados pela Clinical and Laboratory Standards Institute. Foi isolado um total de 68 cepas de enterobactérias, de dez espécies diferentes, Proteus mirabilis, Citrobacter diversus, Pantoea agglomerans, Escherichia coli, Providencia stuartii, Hafnia alvei, Proteus vulgaris, Serratia liquefaciens, Enterobacter sakasakii e Citrobacter amalonaticus. Pantoea agglomerans foi a bactéria com maior percentagem de frequência dos isolados de psitacídeos de pet shop, perfazendo um total de 23,5% dos isolados, a segunda cepa mais isolada foi Proteus mirabilis com 17,7%. Neste estudo 79% das cepas isoladas foram resistentes a pelo menos uma classe de antimicrobianos testados, tetraciclina demonstrou ser o antimicrobiano com maior resistência (44%), seguido da polimixina B (38%) e do ácido nalidíxico (25%). Dentre as 68 cepas isoladas, 19% não apresentaram resistência a qualquer uma das classes de antimicrobianos testadas. A condição de multirresistência, ou seja, resistência a ≥3 classes de antimicrobianos foi observado em 18% das cepas isoladas.(AU)

Zoonotic bacteria research and analysis of antimicrobial resistance levels in parrot isolates from pet shops in the city of Fortaleza, Brazil

ABSTRACT: The Psittaciformes are among the most popular pets due to their intelligence, ability, and ease of maintenance in small environments. However, the absence of adequate environmental stimuli generated by confinement can predispose these animals to characteristic stress conditions, leaving them susceptible to the triggering of various diseases, among which those of bacterial origin stand out. The objective of this study was to carry out a survey of enterobacteria and evaluate the antimicrobial sensitivity profile of bacteria isolated from parrots from a pet shop in the city of Fortaleza, Ceará. Ninety-six samples were collected from four pet shops (which were classified as A, B, C and D), eight samples of local swabs from budgerigar (Melopsittacus undulatus), were collected from each establishment eight from cockatiels (Nymphicus hollandicus) and eight from lovebirds (Agapornis sp.). Isolation of enterobacteria is under the methodology used by Lopes et al. (2015) with modifications. The method used to study bacterial resistance was the Kirby-Bauer method, following the standards stipulated by the Clinical and Laboratory Standards Institute. Sixty-eight enterobacteria strains from ten different species, Proteus mirabilis, Citrobacter diversus, Pantoea agglomerans, Escherichia coli, Providencia stuartii, Hafnia alvei, Proteus vulgaris, Serratia liquefaciens, Enterobacter sakasakii and Citrobacter amalonaticus, were isolated. P. agglomerans was the bacterium with the highest frequency of isolates from pet shop parrots, making up 23.5% of the isolates; the second-most isolated strain was P. mirabilis with 17.7%. In this study, 79% of the isolated strains were resistant to at least one class of antimicrobials tested. Tetracycline proved to be the most resistant antimicrobial (44%), followed by polymyxin B (38%) and nalidixic acid (25%). Among the 68 strains, 19% did not show resistance to any of the classes of antimicrobials tested. The condition of multidrug resistance - resistance to 3 classes of antimicrobials - was observed in 18% of the isolated strains.

RESUMO: Os psittaciformes estão entre os animais de estimação mais populares devido sua inteligência, habilidade, além da facilidade de manutenção da espécie em pequenos ambientes. Contudo, a ausência de estímulos ambientais adequados gerados pelo confinamento, podem predispor esses animais a quadros característicos de estresse, deixando-os susceptíveis ao desencadeamento de várias doenças dentre elas se destacam as de origem bacteriana. O objetivo desse trabalho foi realizar uma pesquisa de enterobactérias e avaliar o perfil de sensibilidade antimicrobiana de bactérias isoladas de psitacídeos de pet shop da cidade de Fortaleza, Ceará. Foram coletadas 96 amostras de quatro pet shops (os quais foram classificados em A, B, C e D), sendo coletados de cada estabelecimento oito amostras de suabes clocais oriundos de periquitos australianos (Melopsittacus undulatus), oito de calopsitas (Nymphicus hollandicus) e oito de agapornis (Agapornis sp.). O isolamento de enterobactérias está de acordo com a metodologia utilizada por Lopes et al. (2015) com modificações. O método utilizado para o estudo de resistência bacteriana foi o de Kirby-Bauer, seguindo os padrões estipulados pela Clinical and Laboratory Standards Institute. Foi isolado um total de 68 cepas de enterobactérias, de dez espécies diferentes, Proteus mirabilis, Citrobacter diversus, Pantoea agglomerans, Escherichia coli, Providencia stuartii, Hafnia alvei, Proteus vulgaris, Serratia liquefaciens, Enterobacter sakasakii e Citrobacter amalonaticus. Pantoea agglomerans foi a bactéria com maior percentagem de frequência dos isolados de psitacídeos de pet shop, perfazendo um total de 23,5% dos isolados, a segunda cepa mais isolada foi Proteus mirabilis com 17,7%. Neste estudo 79% das cepas isoladas foram resistentes a pelo menos uma classe de antimicrobianos testados, tetraciclina demonstrou ser o antimicrobiano com maior resistência (44%), seguido da polimixina B (38%) e do ácido nalidíxico (25%). Dentre as 68 cepas isoladas, 19% não apresentaram resistência a qualquer uma das classes de antimicrobianos testadas. A condição de multirresistência, ou seja, resistência a 3 classes de antimicrobianos foi observado em 18% das cepas isoladas.

Cross-diagnostic scale-banking using rasch analysis: Developing a common reference metric for generic and health condition-specific scales in people with rheumatoid arthritis and stroke.

OBJECTIVES: To develop a common reference metric of functioning, incorporating generic and health condition-specific disability instruments, and to test whether this reference metric is invariant across 2 health conditions. DESIGN: Psychometric study using secondary data analysis. Firstly, the International Classification of Functioning, Disability and Health (ICF) Linking Rules were used to examine the concept equivalence between the World Health Organization Disability Assessment Schedule (WHODAS 2.0), Health Assessment Questionnaire (HAQ) and Functional Independence Measure (FIMTM). Secondly, a scale-bank was developed using a reference metric approach to test-equating, based on the Rasch measurement model. PARTICIPANTS: Secondary analysis was performed on data from 487 people; 61.4% with rheumatoid arthritis and 38.6% with stroke. RESULTS: Three sub-domains of the WHODAS 2.0 and all items of the HAQ and FIMTM motor mapped on to the ICF chapters d4 Mobility, d5 Self-care and d6 Domestic life. Test-equating of these scales resulted in good model fit, indicating that a scale bank and associated reference metric across these 3 instruments could be created. CONCLUSION: This study provides a transformation table to enable direct comparisons among instruments measuring physical functioning commonly used in rheumatoid arthritis (HAQ) and stroke (FIMTM motor scale), as well as in people with disability in general (WHODAS 2.0).

Características clínicas y evolución del reflujo vesicoureteral en la infancia / Clinical characteristics and outcome of childhood vesicoureteral reflux

Introducción. El objetivo fue evaluar las características clínicas y la evolución del reflujo vesicoureteral (RVU) según el sexo y grado de RVU.Población y métodos. Se incluyeron pacientes con RVU vistos durante el seguimiento de rutina entre enero de 2014 y enero de 2015. Se registraron las características demográficas, la evolución, los laboratorios y las imágenes.Resultados. Se seleccionó a 220 pacientes, cuya media de edad del diagnóstico era 3,17 ± 3,08 años; en ese momento, los varones eran menores que las niñas (2,00 ± 2,59 vs. 3,81 ± 3,15, p < 0,001). La infección urinaria fue la presentación más frecuente, seguida de hidronefrosis prenatal (HNP). El 22 % de los pacientes tuvo reflujo de grado 1-2; el 51 %, de grado 3; y el 27 %, de grado 4-5. En el reflujo de grado 4-5, las ecografías y gammagrafías con ácido dimercaptosuccínico (DMSA) marcado con 99mTc presentaron más anomalías, y se realizaron más cirugías (p < 0,001). En los varones, fueron más comunes el reflujo de grado 4-5 (43,6 % vs. 18,3 %) y las anomalías ecográficas (77 % vs. 54 %) y en la DMSA (77 % vs. 59 %) (p < 0,05). En las niñas, hubo mayores tasas de infección urinaria, disfunción de las vías urinarias inferiores y resolución espontánea (p < 0,05).Conclusiones. A pesar de la menor edad al momento del diagnóstico, la resolución espontánea fue menor en los varones, y estos presentaron HNP, reflujo grave y anomalías radiológicas más frecuentemente.

Introduction. The aim of the study was to assess the clinical features and outcome parameters of children with vesicoureteral reflux (VUR) based on gender and VUR grade.Population and methods. Patients with VUR who were seen during routine follow-up visits at Ankara University Children's Hospital between January 2014-January 2015 were included in this retrospective study. Patient demographics, clinical course, laboratory investigations, imaging were noted.Results. Two hundred and twenty patients were recruited. Mean age at the time of diagnosis was 3,17 ± 3,08 years. Boys were diagnosed at younger ages as compared to girls (2.00 ± 2,59 vs. 3,81 ± 3.15, p < 0.001). Urinary tract infection (UTI) was the most common presentation. The second presentation form was antenatal hydronephrosis (AHN) which was more common in males (25.6 %, p < 0.001). Twenty-two percent of the patients had grade 1-2, 51 % grade 3 and 27 % grade 4-5 reflux. Patients with grade 4-5 reflux had more abnormal ultrasound (US) and Tech 99m dimercaptosuccinic acid scintigraphy (DMSA) findings and surgery was performed more frequently in this group (p < 0.001). In males, grade 4-5 reflux (43.6 % vs. 18.3 %), abnormal US (77 % vs. 54 %) and DMSA (77 % vs. 59 %) findings were more frequent (p < 0.05). In girls higher rates of UTIs, lower urinary tract dysfunction (LUTD) and spontaneous reflux resolution were seen (p < 0.05).Conclusions: Despite younger age at diagnosis, spontaneous resolution was found lower in boys and they had more frequent AHN, more severe reflux, and radiological abnormalities.

Clinical characteristics and outcome of childhood vesicoureteral reflux. / Características clínicas y evolución del reflujo vesicoureteral en la infancia.

INTRODUCTION: The aim of the study was to assess the clinical features and outcome parameters of children with vesicoureteral reflux (VUR) based on gender and VUR grade. POPULATION AND METHODS: Patients with VUR who were seen during routine follow-up visits at Ankara University Children's Hospital between January 2014-January 2015 were included in this retrospective study. Patient demographics, clinical course, laboratory investigations, imaging were noted. RESULTS: Two hundred and twenty patients were recruited. Mean age at the time of diagnosis was 3,17 ± 3,08 years. Boys were diagnosed at younger ages as compared to girls (2.00 ± 2,59 vs. 3,81 ± 3.15, p < 0.001). Urinary tract infection (UTI) was the most common presentation. The second presentation form was antenatal hydronephrosis (AHN) which was more common in males (25.6 %, p < 0.001). Twenty-two percent of the patients had grade 1-2, 51 % grade 3 and 27 % grade 4-5 reflux. Patients with grade 4-5 reflux had more abnormal ultrasound (US) and Tech 99m dimercaptosuccinic acid scintigraphy (DMSA) findings and surgery was performed more frequently in this group (p < 0.001). In males, grade 4-5 reflux (43.6 % vs. 18.3 %), abnormal US (77 % vs. 54 %) and DMSA (77 % vs. 59 %) findings were more frequent (p < 0.05). In girls higher rates of UTIs, lower urinary tract dysfunction (LUTD) and spontaneous reflux resolution were seen (p < 0.05). CONCLUSIONS: Despite younger age at diagnosis, spontaneous resolution was found lower in boys and they had more frequent AHN, more severe reflux, and radiological abnormalities.

Introducción: El objetivo fue evaluar las características clínicas y la evolución del reflujo vesicoureteral (RVU) según el sexo y grado de RVU. Población y métodos: Se incluyeron pacientes con RVU vistos durante el seguimiento de rutina entre enero de 2014 y enero de 2015. Se registraron las características demográficas, la evolución, los laboratorios y las imágenes. Resultados: Se seleccionó a 220 pacientes, cuya media de edad del diagnóstico era 3,17 ± 3,08 años; en ese momento, los varones eran menores que las niñas (2,00 ± 2,59 vs. 3,81 ± 3,15, p < 0,001). La infección urinaria fue la presentación más frecuente, seguida de hidronefrosis prenatal (HNP). El 22 % de los pacientes tuvo reflujo de grado 1-2; el 51 %, de grado 3; y el 27 %, de grado 4-5. En el reflujo de grado 4-5, las ecografías y gammagrafías con ácido dimercaptosuccínico (DMSA) marcado con 99mTc presentaron más anomalías, y se realizaron más cirugías (p < 0,001). En los varones, fueron más comunes el reflujo de grado 4-5 (43,6 % vs. 18,3 %) y las anomalías ecográficas (77 % vs. 54 %) y en la DMSA (77 % vs. 59 %) (p < 0,05). En las niñas, hubo mayores tasas de infección urinaria, disfunción de las vías urinarias inferiores y resolución espontánea (p < 0,05). Conclusiones: A pesar de la menor edad al momento del diagnóstico, la resolución espontánea fue menor en los varones, y estos presentaron HNP, reflujo grave y anomalías radiológicas más frecuentemente.

Unusual Cause of Lateral Elbow Pain: A Case Report of Anconeus Muscle Contusion.

The anconeus muscle is a small and minor functioning muscle located at the posterolateral elbow region. It helps forearm extension and tightening of the joint capsule. Despite its limited functions, pathologies of the anconeus muscle can mimic other abnormalities of the elbow joint. Here, we report a rare case of a traumatic anconeus muscle contusion in a 15-year-old boy due to falling during dance. MRI showed contusion in the anconeus muscle, as well as strain in the ulnar collateral ligament and edema in the coronoid process of the ulna. To our knowledge, this is the first described case of traumatic anconeus muscle contusion in the literature. The presence of long-lasting lateral elbow pain in trauma cases without fracture should alert clinicians to consider anconeus muscle abnormalities. MRI is the best modality for diagnosis in these cases.

Clinical features and disease severity of Turkish FMF children carrying E148Q mutation.

BACKGROUND: Familial Mediterranean fever (FMF) is the most common hereditary monogenic autoinflammatory disease caused by mutations in the MEFV gene. It is controversial whether E148Q alteration is an insignificant variant or a disease-causing mutation. The aim of this study was to evaluate the clinical features and disease severity of FMF patients carrying E148Q mutation. METHODS: Files of FMF patients were retrospectively evaluated. Patients with at least one E148Q mutation were included to the study. The clinical characteristics and disease severity of the patients who were carrying only E148Q mutation were compared with the patients who were compound heterozygous for E148Q and homozygous for M694V mutation. RESULTS: The study group comprised 33 patients who were homozygous or heterozygous for E148Q; 34 with compound heterozygous E148Q mutations and 86 patients who had homozygous M694V mutation. Patients who had only E148Q mutation were found to have the oldest mean age of disease onset and lowest mean disease severity score. Attack frequency and colchicine doses were lower in patients with only E148Q mutation as compared with the other two groups. The frequency of clinical findings such as fever, abdominal pain, arthralgia, and arthritis among the three groups was similar. CONCLUSION: Familial Mediterranean fever patients with only E148Q mutation are presenting with late-onset and milder disease course despite having similar clinical findings as compared with patients who had other mutations. Finally, we imply that E148Q is a mutation and colchicine treatment should be given.

Diabetic hip arthropathy is associated with a higher prevalence of femoral head chondromalacia: a case-controlled study.

INTRODUCTION: No previous studies have characterised hip joint disease in diabetic patients undergoing hip arthroscopy. The purpose of our study was to evaluate intra-articular hip pathology and surgical variables in patients with diabetes compared to matched, non-diabetic controls. We hypothesised that diabetic patients would demonstrate a higher prevalence and severity of hip chondral pathology. METHODS: We retrospectively reviewed 795 consecutive hip arthroscopies performed by a single surgeon between 2010 and 2015. Patients ⩾18 years of age without a history of diabetes served as controls and were matched based on age, sex, body mass index, duration of symptoms, and operative side. Clinical symptoms, preoperative physical examination, and radiologic and intraoperative findings were assessed. The primary outcomes were the acetabular and femoral head chondromalacia index (CMI), calculated as the product of the Outerbridge chondromalacia grade and surface area (mm2*severity). RESULTS: 15 diabetic patients were matched to 137 non-diabetic controls. Diabetic patients demonstrated a higher prevalence of femoral head chondromalacia compared to controls both on magnetic resonance imaging (45.5% vs. 7.5%, p = 0.002) and during arthroscopy (100% vs. 75.9%, p = 0.042). Femoral head chondromalacia in diabetic patients had higher Outerbridge grade (2.4 vs. 2.0, p = 0.030) but similar CMI (513.0 vs. 416.4, p = 0.298) compared to controls. DISCUSSION: Femoral head chondral pathology was more prevalent and of higher severity grade in diabetic patients. The prevalence, size, and severity of acetabular chondral disease were similar between diabetic and non-diabetic patients. Multivariate analysis demonstrated that diabetic status was independently associated with the presence of femoral head chondromalacia.

Fatigue in pediatric patients with familial Mediterranean fever.

OBJECTIVES: Familial Mediterranean fever (FMF) is characterized by recurrent, self-limited attacks of fever with serositis involving the peritoneum, pleura and joints. Fatigue is a common problem in many pediatric rheumatic diseases; however, has not been evaluated systematically in FMF patients. Accordingly, the aim of this study was to evaluate fatigue and its possible allied factors in patients with FMF. METHODS: Patients with FMF, aged between 10 and 21 years, were assessed by completed validated fatigue questionnaire (Checklist Individual Strength-20). As a control group, patients with chronic rheumatic diseases and healthy children without any chronic disease were included. RESULTS: The study group comprised 111 patients with FMF, 54 with other chronic rheumatic diseases and 79 healthy subjects. While the CIS-20 total score and subscale scores (including subjective experience of fatigue) were similar between patients with FMF and those with other chronic rheumatic diseases (p > .05); both groups had significantly higher scores when compared with healthy subjects (p < .05). FMF patients with musculoskeletal complaints had significantly higher scores of subjective experiences of fatigue when compared to those without those complaints. CONCLUSIONS: Fatigue is a common but unrecognized complaint in patients with FMF. Familial Mediterranean fever seems to be a chronic disease with inter attack ongoing complaints.

Patient-reported outcome measures in osteoarthritis: a systematic search and review of their use and psychometric properties.

INTRODUCTION: Patient-reported outcome measures (PROM) or self-completed questionnaires have been used to report outcomes in osteoarthritis (OA) for over 35 years. Choices will always need to be made about what should be measured and, if relevant, what would be the most appropriate PROM to use. The current study aims to describe the available PROMs used in OA and their performance quality, so that informed choices can be made about the most appropriate PROM for a particular task. METHODS: The study included a systematic search for PROMs that have been in use over 17 years (period 2000-2016), and to catalogue their psychometric properties, and to present the evidence in a user-friendly fashion. RESULTS: 78 PROMs were identified with psychometric evidence available. The domains of pain, self-care, mobility and work dominated, whereas domains such as cleaning and laundry and leisure, together with psychological and contextual factors, were poorly served. The most frequently used PROMs included the Western Ontario McMaster Osteoarthritis Index, the Short Form 36 and the Knee Disability and Osteoarthritis Outcome Score which, between them, appeared in more than 4000 papers. Most domains had at least one PROM with the highest level of psychometric evidence. CONCLUSION: A broad range of PROMs are available for measuring OA outcomes. Some have good psychometric evidence, others not so. Some important psychological areas such as self-efficacy were poorly served. The study provides a current baseline for what is available, and identifies the shortfall in key domains if the full biopsychosocial model is to be explored.

Arthroscopic Microfracture of Hip Chondral Lesions.

Microfracture of hip chondral lesions has been performed for more than a decade with modified treatment principles and techniques from knee arthroscopy. This note and accompanying video review the pertinent techniques, pearls, and pitfalls of the microfracture procedure in the treatment of hip chondral lesions. After debridement of damaged chondral tissue, the size of the lesion is approximated to determine the number of microfracture holes to create. The working portal may be adjusted based on the site of the lesion. Microfracture picks of different angles are used to ensure perpendicular advancement to a depth of 3 to 4 mm in the subchondral bone. The holes are placed at a gap of approximately 3 to 4 mm. The debris is washed out to obtain open holes connecting the marrow with the articular surface. The microfracture procedure should be performed near the end of the overall procedure to secure the bleeding bone marrow within the joint and prevent washout.

Late-onset disease is associated with a mild phenotype in children with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is an autosomal recessive disease, characterised by recurrent, self-limited attacks of fever with serositis. Recently, it was shown that patients with early disease onset during childhood period had more severe disease. The aim of this study was to describe the demographic, clinical and genetic features of FMF patients who had late-onset disease during childhood period and to compare them to those with earlier onset patients. Files of patients who had been seen in our department between January 2013 and January 2014 were retrospectively evaluated. Patients were divided into two groups according to age of disease onset (group I, ≤8 years; group II, >8 years), and clinical findings were compared between the two groups. The study group comprised 317 FMF patients. There were 267 patients in group I and 50 patients in Group II. Median attack frequency was 24/year in group I and 12/year in group II (p < 0.05). Fever and M694V homozygosity were less frequently detected in group II (p = 0.003 and p = 0.022). Median delay in diagnosis was 24 months in group I and 12 months in group II (p = 0.002). Disease severity scores and final colchicine dosages were lower in group II (p < 0.001 and p = 0.003). Only a small number of FMF patients had disease onset at older ages in childhood period. It seems that FMF patients with late-onset disease have milder illness. However, more readily expression of their clinical findings in older ages yields earlier diagnosis in this group.

Vesicoureteral Reflux and Renal Scarring Risk in Children after the First Febrile Urinary Tract Infection.

BACKGROUND/AIMS: There are many controversies regarding the best approach for evaluating children after their first febrile urinary tract infection (UTI). The aim of this study was to define the clinical, laboratory, and radiological features of patients with their first febrile UTI and to investigate the factors that might predict the presence of vesicoureteral reflux (VUR) and renal scarring. METHODS: The files of patients who were followed due to their first febrile UTI between 2008 and 2013 were retrospectively reviewed (n = 300). Patients were divided into groups based on their age, the resistance state of microorganisms, the presence of VUR, and scarring on Tc99m dimercaptosuccinic acid scintigraphy. The chi-square test and Mann-Whitney U test were used for analysis. RESULTS: The median age at the first febrile UTI was 11 months and girls constituted 77% of the patient population. VUR and renal scarring were detected in 30.9 and 19.4% of the patients, respectively. C-reactive protein levels and the presence of renal scarring were significantly higher in patients with VUR (p < 0.05). Abnormal ultrasonography findings, VUR and recurrent UTIs were significantly higher in patients with renal scars (p < 0.001). In multivariate analysis, we did not detect any factor that might predict the presence of VUR and renal scarring. CONCLUSION: A majority of children had their first febrile UTI at a young age. Although we could not find any factor that might predict the VUR and scar risk in patients with their first febrile UTI, an abnormal renal scan at 6 months after infection was closely related with the presence of VUR and recurrent UTIs.

Identification and antimicrobial resistance of members from the Enterobacteriaceae family isolated from canaries (Serinus canaria) / Identificação e resistência antimicrobiana de membros da família Enterobacteriaceae isolados de canários (Serinus canaria)

The Enterobacteriaceae family contains potentially zoonotic bacteria, and their presence in canaries is often reported, though the current status of these in bird flocks is unknown. Therefore, this study aimed to identify the most common genera of enterobacteria from canaries (Serinus canaria) and their antimicrobial resistance profiles. From February to June of 2013, a total of 387 cloacal swab samples from eight domiciliary breeding locations of Fortaleza city, Brazil, were collected and 58 necropsies were performed in canaries, which belonged to the Laboratory of Ornithological Studies. The samples were submitted to microbiological procedure using buffered peptone water and MacConkey agar. Colonies were selected according to their morphological characteristics on selective agar and submitted for biochemical identification and antimicrobial susceptibility. A total of 61 isolates were obtained, of which 42 were from cloacal swabs and 19 from necropsies. The most isolated bacteria was Escherichia coli with twenty five strains, followed by fourteen Klebsiellaspp., twelve Enterobacterspp., seven Pantoea agglomerans, two Serratiaspp. and one Proteus mirabilis. The antimicrobial to which the strains presented most resistance was sulfonamides with 55.7%, followed by ampicillin with 54.1% and tetracycline with 39.3%. The total of multidrug-resistant bacteria (MDR) was 34 (55.7%). In conclusion, canaries harbor members of the Enterobacteriaceae family and common strains present a high antimicrobial resistance rate, with a high frequency of MDR bacteria.

A família Enterobacteriaceae possui bactérias com potencial zoonótico e a presença destas bactérias em canários é relatada na literatura, porém a realidade dos plantéis de criadores de canários é desconhecida. Portanto, este trabalho teve como objetivo isolar enterobactérias de canários belga (Serinus canarius) com o intuito de conhecer os gêneros mais comuns nestas aves e suas respectivas resistências a antimicrobianos. De fevereiro a junho de 2013 foram coletadas 387 amostras de swabs cloacais de canários de oito propriedades da cidade de Fortaleza, Brasil e de 58 necropsias de aves do acervo próprio do Laboratório de Estudos Ornitológicos. As amostras foram submetidas a isolamento microbiológico utilizando-se água peptonada e ágar MacConkey. As colônias foram selecionadas de acordo com suas características morfológicas nas placas, submetidas à tipificação bioquímica para identificação e ao teste de sensibilidade a antimicrobianos. Foram isoladas 61 cepas, sendo 42 de suabes cloacais e 19 de necropsias. A bactéria mais isolada foi Escherichia coli com vinte e cinco cepas, seguida por catorze Klebsiella spp., doze Enterobacter spp., sete Pantoea agglomerans, duas Serratiaspp. e uma cepa de Proteus mirabilis. As cepas apresentaram maior resistência a sulfonamidas com 55,7%, seguidas por ampicilina com 54,1% e tetraciclina com 39,3%. Além disso, o total de cepas resistentes a múltiplas drogas (RMD) foi 34 (55,7%). Portanto, conclui-se que os canários albergam enterobactérias e que as cepas apresentam alto índice de resistência a antimicrobianos, com alta frequência de cepas RMD.

Adaptation and validation of the Ankylosing Spondylitis Work Instability Scale (AS-WIS) for use in Turkey.

The Ankylosing Spondylitis Work Instability Scale (AS-WIS) is a recently developed 20-item measure to assess work instability in AS. This study aimed to adapt the AS-WIS to Turkish and to test its reliability and validity. After the translation process, 132 AS patients were assessed by the AS-WIS, Bath AS Disease Activity Index, Bath AS Functional Index and the AS Quality of Life Questionnaire. Reliability was tested by internal consistency, person separation index (PSI) and intra-class correlation coefficient (ICC); internal construct validity by Rasch analysis; external construct validity by associations with comparator scales and cross-cultural validity by comparison with the original UK data. Reliability of the Turkish AS-WIS was good with Cronbach's α and PSI of 0.88 and test-retest ICC of 0.91. Data showed good fit to Rasch model [mean item fit: -0.477 (SD 1.047), Chi-square interaction: 60.9 (df = 40, p = 0.018)]. There was no differential item functioning by age, gender, disease duration or work type. The scale was strictly unidimensional. 51 % of the patients were at moderate risk, and 9 % were at high risk of having to give up their work. External construct validity was confirmed by expected correlations with comparator scales, and a clear gradient of disease activity and functional status across increasing levels of risk. Cross-cultural validity showed some differences in item locations, but this cancelled out at the test level. Turkish version of the AS-WIS is reliable, valid and available for use in routine clinical setting to identify patients who are at risk of having to give up their current job.