RESUMO
Lateral wedges were originally proposed to manage medial compartment osteoarthritis of the knee but recent reviews suggest that lateral wedges do not affect disease progression. We performed a systematic review to analyse the recent literature and define how effective, if at all, lateral wedges are in the management of medial compartment osteoarthritis of the knee. The inclusion criteria were defined as any study published within the last decade, using a sample size of at least twenty patients, and investigating the effect of insoles or wedges on either unilateral or bilateral knee varus osteoarthritis. The standardised keyword term 'lateral*wedge*OR insole*OR orthotic* OR medial compartment OR varus OR osteoarthri* OR knee*' was used. We identified 10 studies that fitted our inclusion criteria. Although there is not enough evidence in the literature to prove that lateral wedge orthotics are an effective treatment for varus osteoarthritis of the knee, there is some evidence to suggest that they do have some symptomatic effect. Patients with early osteoarthritis and higher BMI may benefit to a greater extent than those with a greater extent of degenerative changes and lower BMI. The literature is unclear as to what the optimal duration for the use of lateral wedges is, but does support the prolonged use of the wedges as the benefits at one month are maintained at one year. Future studies should be randomised controlled trials with a large sample size with long follow-up, and use objective clinical, biomechanical and radiological outcome measures.
RESUMO
Renewed interest in the use of Metarhizium anisopliae and its toxins for insect control prompted the following safety assessment. A neutral extract (methylene chloride, pH 7.2), derived from M. anisopliae cultures, was evaluated for toxicity and mutagenicity using aquatic animal bioassays and the Ames test. The average LC50 of the neutral extract obtained in static, acute 96-h tests conducted with 0.05) mortalities or malformations.
