Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections.

BACKGROUND: The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. METHODS: We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P<0.05. RESULTS: The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00-1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05-2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80-0.95; P=0.003). CONCLUSIONS: There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.

Platelet-rich plasma outcomes do not correlate with patient satisfaction or perceived cost-effectiveness.

BACKGROUND: As platelet-rich plasma injection for knee osteoarthritis (OA) has increased in popularity, it has become more important to assess its effectiveness and satisfaction with its use in the context of its high cost. The purpose of this study was to determine satisfaction, commercial appeal, and effectiveness of platelet-rich plasma (PRP) for the treatment of knee OA. METHODS: A retrospective review of patients who underwent PRP injection in the knee from 2016 to 2019 was performed. Various patient-reported outcomes were collected, including: satisfaction with the PRP injection (out of 100), whether the patient would want to undergo PRP injection again, whether they would recommend the injection and whether they felt that the injection was worth the cost was collected. VAS pain scores were collected and measured out of 100. Demographics and radiographical information were obtained via chart review. Statistical analyses were conducted including descriptive statistics and binary logistic and linear regressions. RESULTS: Overall, 114 patients were included. The mean pre-injectionpain score was 70.4, and the mean pain level decreased after injection to 36.8. Patients rated their satisfaction on average as neutral along the aforementioned continuous scale (49.2), , 50.9% stated that they would get the PRP injection again, 60.5% would recommend to a friend, and 50.9% felt the injection was worth the cost. Younger age and improved post-injection pain correlated with increasing likelihood of desiring further PRP injection. CONCLUSIONS: Patients on average rated satisfaction slightly below average, indicating net neutrality in terms of satisfaction with their injection. Furthermore, only half of the patients indicated that it was worth the cost and that they would receive it again. Younger age and post-injection pain relief increased desire for further injection, but pain-relief did not correlate with patients saying that the injection was worth the cost.

A retrospective study of clinical and epidemiological characteristics of snakebite in Napo Province, Ecuadorian Amazon.

BACKGROUND: Snakebite envenoming remains a relevant public health problem in tropical and subtropical countries. In Ecuador, this is particularly true in an area of great diversity like the Amazon region. Nevertheless, there is scarce information about epidemiological and clinical characteristics of these accidents in this area. METHODS: This was a descriptive and retrospective study of snakebite cases treated at a tertiary hospital in the Napo Province, Ecuadorian Amazon, from 2015 to 2019. We collected sociodemographic and snakebite-related information, clinical aspects and the use of antivenom and antibiotics from medical records. RESULTS: Information from 133 snakebite accidents was reviewed in this time period. Reports of snakebite envenoming decreased over the years. In total, 67% of those bitten were from nearby indigenous communities, which were the most affected groups. When a species was identified, Bothrops atrox was responsible for the highest number of cases registered. Local clinical manifestations were more frequent than systemic signs, in keeping with the typical effects produced by bothropic venoms. Additionally, data showed that more antivenom vials were given than those suggested by the protocol of the Ecuadorian Ministry of Health, in proportion to the grade of severity. Finally, we identified a low incidence of adverse reactions with antivenom administration, as well as a frequent use of antibiotics. CONCLUSIONS: The profile of snakebite accidents in the Napo Province is very similar to that described for other localities in the Amazon region of Ecuador and neighboring countries, with its challenges and limitations. Such aspects underlie the importance of establishing a robust and science-based public health program to respond to this frequent, but neglected, tropical disease.

Posterior tibial tubercle measured by the sagittal TT-TG distance correlates with increased risk for patellofemoral chondral lesions.

PURPOSE: To evaluate the variation in tibial tubercle sagittal alignment in patients with and without patellofemoral (PF) cartilage wear. METHODS: This was a single-centre, retrospective review of patients that underwent a cartilage restoration procedure for isolated PF cartilage wear from 2014 to 2020. Patients were matched in a 1:2 ratio for age, sex and BMI to partial meniscectomy patients as controls. The sagittal TT-TG (sTT-TG) distance was measured on preoperative axial T2 magnetic resonance imaging (MRI) and was defined as the distance between a point at the nadir of the trochlear cartilage and the most anterior point of the tibial tubercle. RESULTS: One hundred and forty patients (47 cartilage restoration, 94 meniscectomy) were included. Mean age, BMI, and height for the total cohort were 34.01 ± 8.7, 26.6 ± 6.4, and 173.0 ± 17.7 respectively, with 78 males (55%) and 63 females (45%). There were no significant differences between groups for age, BMI or sex (n.s). The cartilage restoration group (- 2.5 mm ± 5.9) was found to have a significantly more posterior (negative) sTT-TG compared to the meniscectomy group (1.72 mm ± 6.7) (p < 0.001). Interrater reliability was excellent (ICC = 0.931, p < 0.001). Patients with less than - 3.4 mm sTT-TG were 2.74 times more likely to have a cartilage restoration procedure compared to those with greater than - 3.4 mm (OR 2.7, 95% CI 1.3-5.85). Patients with < - 10 mm posterior translation were 13.7× (CI 1.6-111.1) more likely to have a cartilage restoration procedure. CONCLUSION: Patients that underwent isolated cartilage restoration procedures had a significantly more posterior tibial tubercle than partial meniscectomy controls based on the sagittal TT-TG. The more posterior the tubercle, the more likely the patient had a cartilage restoration procedure. Surgeons should consider the sTT-TG measurement in patients presenting with anterior knee pain, particularly patellofemoral lesions. LEVEL OF EVIDENCE: III.

La asociación entre Fusobacterium nucleatum y el cáncer colorrectal: una revisión sistemática y metaanálisis / The association between Fusobacterium nucleatum and cancer colorectal: a systematic review and meta-analysis

IntroducciónSe desconocen los factores etiológicos exactos del cáncer colorrectal (CCR), aunque se ha intentado relacionar con factores genéticos y ambientales. La posible asociación con Fusobacterium nucleatum podría abrir posibilidades en el diagnóstico precoz.ObjetivoRevisar los estudios que analizan la asociación entre F. nucleatum y el CCR.MétodosSe utilizaron las publicaciones disponibles en la base de datos MEDLINE PubMed hasta el día 1 de enero de 2020, que incluían los términos «cáncer colorrectal» y «Fusobacterium nucleatum». Se realizó un metaanálisis con el software Stata.ResultadosUn total de 57 artículos fueron incluidos en la revisión sistemática. El metaanálisis indicó una mayor presencia de F. nucleatum en muestras de tejido tumoral de CCR, con respecto a muestras control de tejido sano, con una odds ratio de 4,558 (IC 95%: 3,312-6,272), y cuando se utilizaron muestras control de adenomas colorrectales, con una odds ratio de 3,244 (IC 95%: 2,359-4,462).ConclusiónHay una mayor presencia de F. nucleatum en el CCR. Sin embargo, se necesitan estudios que demuestren esta relación.

IntroductionThe etiological factors of colorectal cancer (CRC) are not precisely known, although genetic and environmental factors have been implicated. A possible association with Fusobacterium nucleatum may provide opportunities for an early diagnosis.ObjectiveTo review studies that address the association between F. nucleatum and CRC.MethodsThe MEDLINE PubMed database was searched using the terms «colorectal cancer» and «Fusobacterium nucleatum», retrieving publications published up to January 1 2020. Stata software was used for a meta-analysis.ResultsThe systematic review included 57 articles. Meta-analysis results indicated a more frequent presence of F. nucleatum in CRC tumor tissue samples in comparison to control samples of healthy tissue, with an odds ratio of 4.558 (95% CI: 3.312-6.272), and in comparison, to control samples of colorectal adenomas, with an odds ratio of 3.244 (95% CI: 2.359-4.462).ConclusionThere is a more frequent presence of F. nucleatum in the CRC. However, further studies are needed to verify this relationship.

The association between Fusobacterium nucleatum and cancer colorectal: A systematic review and meta-analysis.

INTRODUCTION: The etiological factors of colorectal cancer (CRC) are not precisely known, although genetic and environmental factors have been implicated. A possible association with Fusobacterium nucleatum may provide opportunities for an early diagnosis. OBJECTIVE: To review studies that address the association between F. nucleatum and CRC. METHODS: The MEDLINE PubMed database was searched using the terms «colorectal cancer¼ and "Fusobacterium nucleatum", retrieving publications published up to January 1 2020. Stata software was used for a meta-analysis. RESULTS: The systematic review included 57 articles. Meta-analysis results indicated a more frequent presence of F. nucleatum in CRC tumour tissue samples in comparison to control samples of healthy tissue, with an odds ratio of 4.558 (95% CI: 3.312-6.272), and in comparison, to control samples of colorectal adenomas, with an odds ratio of 3.244 (95 % CI: 2.359-4.462). CONCLUSION: There is a more frequent resence of F. nucleatum in the CRC. However, further studies are needed to verify this relationship.

New Insights into the Methylation of Mycobacterium tuberculosis Heparin Binding Hemagglutinin Adhesin Expressed in Rhodococcus erythropolis.

In recent years, knowledge of the role that protein methylation is playing on the physiopathogenesis of bacteria has grown. In Mycobacterium tuberculosis, methylation of the heparin binding hemagglutinin adhesin modulates the immune response, making this protein a subunit vaccine candidate. Through its C-terminal lysine-rich domain, this surface antigen interacts with heparan sulfate proteoglycans present in non-phagocytic cells, leading to extrapulmonary dissemination of the pathogen. In this study, the adhesin was expressed as a recombinant methylated protein in Rhodococcus erythropolis L88 and it was found associated to lipid droplets when bacteria were grown under nitrogen limitation. In order to delve into the role methylation could have in host-pathogen interactions, a comparative analysis was carried out between methylated and unmethylated protein produced in Escherichia coli. We found that methylation had an impact on lowering protein isoelectric point, but no differences between the proteins were found in their capacity to interact with heparin and A549 epithelial cells. An important finding was that HbhA is a Fatty Acid Binding Protein and differences in the conformational stability of the protein in complex with the fatty acid were observed between methylated and unmethylated protein. Together, these results suggest that the described role for this mycobacteria protein in lipid bodies formation could be related to its capacity to transport fatty acids. Obtained results also provide new clues about the role HbhA methylation could have in tuberculosis and point out the importance of having heterologous expression systems to obtain modified proteins.

Professional continuous glucose monitoring and endocrinology eConsult for adults with type 2 diabetes in primary care: Results of a clinical pilot program.

BACKGROUND: Limitations in access to specialty diabetes care exist. Endocrinology eConsult that integrates professional continuous glucose monitoring (CGM-enhanced eConsult) may improve healthcare delivery, but has yet to be evaluated. We implemented a pilot program for patients with type 2 diabetes (T2DM) managed by primary care clinical pharmacists using CGM-enhanced eConsult and evaluated the acceptability and clinical outcomes in comparison to routine in-person endocrinology consultation. METHODS: Seventy-four adult patients with established T2DM (age 18-65) were included. Twenty-nine were seen in-person by endocrinology and 45 were seen by pharmacists in primary care. Thirteen patients were referred for CGM-enhanced eConsult. Acceptability was assessed with pre/post clinician acceptability questionnaires and patient assessment of perceived burden. Clinical outcomes included time to first specialty appointment, baseline and 3-month follow-up HbA1c, and antihyperglycemic medication use. RESULTS: There were no differences in patient acceptability of the CGM-enhanced eConsult as compared to endocrinology referral or pharmacy care. At baseline, all patients referred for eConsult were prescribed insulin. Three-month glycemic outcomes were comparable, with HbA1c reduction 1% + 2% in endocrinology, 1.5% + 1.1% with CGM-enhanced eConsult, and 1.6% + 1.8% in clinical pharmacy (p = 0.19). Time to an initial diabetes visit with a pharmacist was significantly shorter than with endocrinology, 20 days (IQR 26) for pharmacy vs. 45 days (IQR 54) for endocrinology, (p = 0.0001). CONCLUSIONS: CGM-enhanced eConsult resulted in more timely access to endocrinology expertise, was acceptable to patients, and resulted in similar short-term glycemic outcomes compared to in-person consultation. Effectiveness of CGM-enhanced eConsults should be further explored.

The association between Fusobacterium nucleatum and cancer colorectal: a systematic review and meta-analysis. / La asociación entre Fusobacterium nucleatum y el cáncer colorrectal: una revisión sistemática y metaanálisis.

INTRODUCTION: The etiological factors of colorectal cancer (CRC) are not precisely known, although genetic and environmental factors have been implicated. A possible association with Fusobacterium nucleatum may provide opportunities for an early diagnosis. OBJECTIVE: To review studies that address the association between F. nucleatum and CRC. METHODS: The MEDLINE PubMed database was searched using the terms «colorectal cancer¼ and «Fusobacterium nucleatum¼, retrieving publications published up to January 1 2020. Stata software was used for a meta-analysis. RESULTS: The systematic review included 57 articles. Meta-analysis results indicated a more frequent presence of F. nucleatum in CRC tumor tissue samples in comparison to control samples of healthy tissue, with an odds ratio of 4.558 (95% CI: 3.312-6.272), and in comparison, to control samples of colorectal adenomas, with an odds ratio of 3.244 (95% CI: 2.359-4.462). CONCLUSION: There is a more frequent presence of F. nucleatum in the CRC. However, further studies are needed to verify this relationship.

Decisión Making, Stress Assessed by Physiological Response and Virtual Reality Stimuli / Toma de Decisiones, Estrés Valorado mediante la Respuesta Fisiológica y Estímulos en Realidad Virtual

Abstract Many decisions must be made under stress; therefore, stress and decision-making are intrinsically related not only at the behavioral level but also at the neural level. Additionally, virtual reality tools have been proposed as a method to induce stress in the laboratory. This review focuses on answering the following research question: Does stress assessed by physiological variables of a subject under virtual reality stimuli increase the chances of error in decision-making? The reviewed studies were consulted in the following databases: PubMed, IEEE Xplore, and Science Direct. The analysis of the consulted literature indicates that the stress induced in the laboratory using virtual reality tools and the physiological response of the central and autonomous nervous system are complementary subjects and allow the design of training and support systems for the decision-making process.

Resumen Muchas decisiones deben tomarse bajo estrés, por lo tanto, el estrés y la toma de decisiones están intrínsecamente relacionados, no solo a nivel conductual sino también a nivel neural. Además, las herramientas de realidad virtual se han propuesto como un método para inducir estrés en el laboratorio. El presente trabajo de revisión temática se centra en responder la siguiente pregunta de investigación: ¿El estrés evaluado mediante variables fisiológicas de un sujeto bajo estímulos de realidad virtual aumenta las posibilidades de error en la toma de decisiones? Los estudios revisados fueron consultados en las siguientes bases de datos: PubMed, IEEE Xplore y Science Direct. El análisis de la literatura consultada indica que el estrés inducido en el laboratorio, por medio de herramientas de realidad virtual, y la respuesta fisiológica del sistema nervioso central y autónomo son temas que se complementan y permiten el diseño de sistemas de soporte y entrenamiento para el proceso de toma de decisiones.

Selection of a Single Domain Antibody, Specific for an HLA-Bound Epitope of the Mycobacterial Ag85B Antigen.

T cells recognizing epitopes on the surface of mycobacteria-infected macrophages can impart protection, but with associated risk for reactivation to lung pathology. We aimed to identify antibodies specific to such epitopes, which carry potentials for development toward novel therapeutic constructs. Since epitopes presented in the context of major histocompatibility complex alleles are rarely recognized by naturally produced antibodies, we used a phage display library for the identification of monoclonal human single domain antibody producing clones. The selected 2C clone displayed T cell receptor-like recognition of an HLA-A*0201 bound 199KLVANNTRL207 peptide from the Ag85B antigen, which is known to be an immunodominant epitope for human T cells. The specificity of the selected domain antibody was demonstrated by solid phase immunoassay and by immunofluorescent surface staining of peptide loaded cells of the T2 cell line. The antibody affinity binding was determined by biolayer interferometry. Our results validated the used technologies as suitable for the generation of antibodies against epitopes on the surface of Mycobacterium tuberculosis infected cells. The potential approaches forward the development of antibody in immunotherapy of tuberculosis have been outlined in the discussion.

Lesión traumática de la arteria carótida por impacto contra un cable atravesado en el camino / Traumatic injury of the carotid artery by impact with a wire across the road

Las lesiones contusas de la arteria carótida tienen el potencial de provocar graves complicaciones neurológicas debido a eventos cerebrovasculares isquémicos. Presentación del caso Un paciente masculino de 41 años sufrió un trauma en el cuello, luego de impactar contra un cable atravesado en la vía pública, mientras conducía una motocicleta. El paciente desarrolló un hematoma expansivo en el cuello pero no presentó alteraciones neurológicas. La puntuación de la escala de coma de Glasgow fue 15/15. Ante la sospecha de una lesión de la arteria carótida se realizó angiotomografía contrastada que demostró una lesión de la íntima carotidea. El manejo quirúrgico incluyó trombectomía in-situ y arteriorrafa. Conclusión La lesión traumática de la arteria carótida es una condición poco común que requiere una alta sospecha clínica para su diagnóstico. El manejo comprende resolución quirúrgica y anticoagulación para prevenir complicaciones de orden neurológico.

Blunt carotid arterial injuries have the potential for cause severe neurological complications due to stroke Case Report A 41 year old male patient suffered a neck trauma by an impact with a wire across the road, while he was driving a motorcycle. The patient developed an expansive hematoma in the neck but do not showed neurological disorders. The score of the Glasgow coma scale was 15/15. Suspecting an injury in the carotid artery a CT angiography with contrast was performed which showed a carotid damage. Surgical management included thrombectomy and suture of the artery. Conclusion Traumatic injury to the carotid artery is a rare condition that requires a high clinical suspicion for diagnosis. Treatment consists in an adequate surgical procedure and anticoagulation to prevent neurological complications.