The impact of allergies on patient-reported outcomes after total hip and knee arthroplasty: a systematic review and meta-analysis.

INTRODUCTION: Metal hypersensitivity has been associated with persistent symptoms after total hip arthroplasty (THA) and total knee arthroplasty (TKA), despite successful joint replacement. Allergies frequently co-occur and have been linked to psychiatric disturbances such as anxiety. There is a knowledge gap regarding the effect of allergies, including metal hypersensitivity, on patient-reported outcome measures (PROMs) after THA and TKA. This study aimed to evaluate the influence of allergies including metal hypersensitivity on PROMs in patients undergoing THA and TKA. MATERIAL AND METHODS: A systematic search PROSPERO (CRD42023475972) was conducted using PubMed, EMBASE, Scopus, and Cochrane databases. Studies that compared allergic and non-allergic adults undergoing primary THA or TKA and reported PROMs were included. Methodological quality was assessed using the MINORS criteria. The mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. Eight studies, involving 33,808 patients, were included. RESULTS: For functional outcomes assessed using SF-12, SF-36, KOOS JR, and HOOS JR, allergic patients demonstrated significantly worse scores (SMD - 0.23, 95% CI -0.36 to -0.09). The WOMAC functional scale also demonstrated poorer results in allergic patients (MD 2.49, 95% CI 0.64 4.35). For pain assessed using the WOMAC pain scale, allergic patients reported significantly greater pain (MD 1.04, 95% CI 0.46 1.62). Changes in mental status assessed using the SF-12 and SF-36 did not show significant differences between the groups (MD -0.46, 95% CI -1.40 to 0.47). In subgroup analysis, patients in the THA subgroup showed significantly worse outcomes (MD -7.20, 95% CI -12.97 - -1.43). CONCLUSION: This meta-analysis found that patients with allergies, including metal hypersensitivity, generally had worse functional outcomes after THA and TKA than patients without allergies. Further research is required to confirm these findings. Preoperative allergy screening can identify individuals at risk of treatment optimization.

Impact of prior spinal fusion surgery on complications and functional outcomes following total hip arthroplasty: an updated systematic review and meta-analysis.

PURPOSE: This study aimed to compare the complication rates and functional outcomes between patients with and without a history of spinal fusion undergoing THA. METHODS: A systematic search was conducted across PubMed, EMBASE, Scopus, and Cochrane databases. Studies that compared adults with and without a history of spinal fusion after primary THA were included. The methodological quality of the studies was evaluated using MINORS criteria. Meta-analyses were performed utilizing mean differences (MD), standardized mean differences (SMD), and odds ratios (OR), along with 95% confidence intervals (CI). RESULTS: Seventeen studies involving 1,789,356 patients (31,786 in the SF group and 1,757,570 in the Non-SF group) were analyzed. The spinal fusion group exhibited significantly higher rates of dislocation (OR 2.50, 95% CI 1.78-3.52), periprosthetic fracture (OR 1.96, 95% CI 1.39-2.77), overall complications (OR 1.73, 95% CI 1.10-2.71), and revision rates (OR 1.86, 95% CI 1.74-1.99). Furthermore, within the first three months, there was an increased risk of dislocation (OR 4.38, 95% CI 1.36-14.14) and revisions (OR 3.87, 95% CI 1.63-9.18). Longer spinal fusions were significantly associated with a higher risk of dislocations (OR 0.62, 95% CI 0.53-0.71). Additionally, prior spinal fusion was linked to higher levels of pain (SMD 0.11, 95% CI 0.02-0.19) and poorer functional outcomes (MD - 0.09, 95% CI - 0.18 to - 0.00). CONCLUSIONS: Patients with a history of spinal fusion undergoing THA exhibit increased complication rates, higher levels of pain, and greater functional limitations than those without prior fusion. These findings have significant clinical implications for optimizing perioperative care in high-risk patient populations.

Biomarker responses and lethal dietary doses of tau-fluvalinate and coumaphos in honey bees: Implications for chronic acaricide toxicity.

Evidence suggests that acaricide residues, such as tau-fluvalinate and coumaphos, are very prevalent in honey bee colonies worldwide. However, the endpoints and effects of chronic oral exposure to these compounds remain poorly understood. In this study, we calculated LC50 and LDD50 endpoints for coumaphos and tau-fluvalinate, and then evaluated in vivo and in vitro effects on honey bees using different biomarkers. The LDD50 values for coumaphos were 0.539, and for tau-fluvalinate, they were 12.742 in the spring trial and 8.844 in the autumn trial. Chronic exposure to tau-fluvalinate and coumaphos resulted in significant changes in key biomarkers, indicating potential neurotoxicity, xenobiotic biotransformation, and oxidative stress. The Integrated Biomarker Response was stronger for coumaphos than for tau-fluvalinate, supporting their relative lethality. This study highlights the chronic toxicity of these acaricides and presents the first LDD50 values for tau-fluvalinate and coumaphos in honey bees, providing insights into the risks faced by colonies.

Biochemical Effects of Heavy Metals and Organochlorine Compounds Accumulated in Different Tissues of Yellow-Legged Gulls (Larus Michahellis).

In the present study, livers, kidneys and adipose tissue of Yellow-legged Gull (Larus michahellis) were collected. Samples were used to determine relationships between heavy metals/metalloids in liver and kidneys (Hg, Cd, Pb, Se and As) or persistent organic pollutants in adipose tissue (7 PCBs and 11 organochlorine pesticides) with biomarkers of oxidative stress (CAT, GPx, GR, GSH, GST, MDA) analysed in both internal organs. Three possible influencing variables have been studied: age, sex and sampling area. As a result, statistically significant differences (P < 0.05, P < 0.01) were only found according to the sampling area, with differences among the three studied areas found in both organs. Significant positive correlations (P < 0.01) were found in liver (Hg vs. GST; Se vs. MDA) and in kidney (As vs. GR; As vs. GPx; PCB52 vs. CAT; PCB138 vs. CAT). The scarcity in correlations suggests that the levels of pollutants found in animals were not high enough to trigger an effect at the oxidative level.

Evaluating the chronic effect of two varroacides using multiple biomarkers and an integrated biological response index.

There is mounting evidence that acaricides are among the most prevalent medicinal compounds in honey bee hive matrices worldwide. According to OCDE guideline No. 245 chronic lethal concentration of tau-fluvalinate (at concentrations ranging from 77.5 to 523.18 ppm), coumaphos (59.8 ppm) and dimethoate (0.7 ppm) were determined. The activity of the biomarkers acetylcholinesterase (AChE), carboxylesterase (CbE), glutathione S-transferase (GST), catalase (CAT) and malondialdehyde (MDA) was analysed and as they are implicated in neurotoxicity, biotransformation and antioxidant defences, these values were combined into an integrated biomarker response (IBR). There was enhanced AChE, CAT and GST activity in honey bees exposed to tau-fluvalinate, while dimethoate inhibited AChE activity. Both dimethoate and coumaphos inhibited CbE activity but they enhanced CAT activity and MDA formation. Our results highlight how these biomarkers may serve to reveal honey bee exposure to commonly used acaricides.

Heavy metals and metalloid levels in the tissues of yellow-legged gulls (Larus michahellis) from Spain: sex, age, and geographical location differences.

In the present study, mercury (Hg), cadmium (Cd), lead (Pb), selenium (Se), and arsenic (As) were measured in liver, kidney, and feathers of adult, juvenile, and chick seagulls (Larus michahellis) collected from the northwest of Spain. Age, sex, and the geographical location of samples were considered variables that can influence metal bioaccumulation, for which concentrations were determined by means of ICP-MS. The mean concentrations (dry weight) found in seagulls were 7.01 ± 0.37 mg Hg/kg, 22.82 ± 2.83 mg Cd/kg, 7.36 ± 1.36 mg Pb/kg, 18.64 ± 0.63 mg Se/kg, and 10.64 ± 0.59 mg As/kg. Regarding the different factors analyzed, Hg was the only metal showing sex-related differences, being significantly higher (p < 0.05) the concentrations found in feathers of males (1.26 ± 0.12 mg/kg) than those in females (0.99 ± 0.11 mg/kg). A highly significant (p < 0.01) increase in levels of some metals was found in liver related to the increase of age: Hg (adults (A) 3.33 ± 0.22 mg/kg vs chicks (C) 1.76 ± 0.28 mg/kg), Cd (A 4.74 ± 0.62 mg/kg vs C 1.79 ± 0.2), Pb (A 0.65 ± 0.12 mg/kg vs juveniles 0.4 ± 0.11 mg/kg), and Se (A 7.56 ± 0.43 mg/kg vs C 5.24 ± 0.53 mg/kg). Positive correlations between Cd-Hg and Se-Hg were found in liver (p < 0.001), kidney (p < 0.001), and feathers (p < 0.05 and p < 0.001, respectively). The associations found may reflect antagonistic interactions between Se and Cd on Hg toxicity. The results suggest that L. michahellis can reveal local contamination around the foraging and breeding sites and can be a very useful monitoring instrument for assessing heavy metal contamination and sentinel species of environmental health.

Current options and investigational drugs for the treatment of eosinophilic esophagitis.

INTRODUCTION: Current treatments of eosinophilic esophagitis (EoE) induce symptomatic and histological remission in a proportion of patients. However, they do not fully meet patients' needs and limitations should be acknowledged. The growing epidemiology of EoE has generated a great interest for research into novel therapeutic approaches. AREAS COVERED: This article discusses current therapies available for EoE, those under investigation and presents potential additional ones. Established anti-inflammatory treatments for EoE include dietary therapy, proton pump inhibitors, and swallowed topical corticosteroids, which are combined with endoscopic dilation in cases of strictures. Refractoriness, recurrence after treatment-cessation, and need for long-term therapies have encouraged investigation of novel, esophageal-targeted formulas of topical corticosteroids and of new therapeutic approaches directed at blocking the molecular pathways that lead to inflammation in EoE. These include monoclonal antibodies (including mepolizumab, reslizumab, benralizumab, dectrekumab, cendakimab, and dupilumab), JAK-STAT blockers, and S1PR agonists, among others. Some have provided evidence of effectiveness and safeness in the short-term use. EXPERT OPINION: Therapies under investigation potentially can target multiple Th2-associated diseases that converge in EoE patients. Therapeutic strategies require a personalized and patient-centered approach to reduce the burden of the disease, and cost-effectiveness analysis to position their use in a complex therapeutic landscape.

Surgical treatment of cocaine-induced palatal perforations: Report of three cases and literature review.

Destruction of the osteocartilaginous framework of the nose and sinuses is a well-known side effect of inhaled cocaine. Palate involvement is, however, a very uncommon event that may lead to oronasal communication with the subsequent food and liquids reflux and nasal speech. Given the addictive character of this etiologic agent, the management of cocaine-induced palatal perforations tends to be conservative by means of a prosthetic obturator. In this paper three cases with surgically treated cocaine-induced palatal perforations are reported and a review of the literature is made focusing on the management of this process. Despite the usual reluctancy, surgical palatal reconstruction should be considered in selected committed patients as a definitive solution for the annoying rhinolalia and solid-liquid reflux to the nose, thus improving their quality of life and social relationships. Key words:Cocaine, oral fistula, palate, palatal perforation, oronasal communication.

Effectiveness of Three Scalpel Debridement Techniques on Painful Callus in Older People.

BACKGROUND: Plantar hyperkeratotic lesions are prevalent foot problems in the older population, affecting 30% to 65% of people older than 65 years. Their onset is a common cause of foot pain due to the release of inflammatory mediators. Because of its simplicity, scalpel debridement is the most common treatment. We assessed how the degree of plantar hyperkeratosis debridement affects self-perception of pain in older people. METHODS: Three hundred older participants (mean ± SD age, 76.3 ± 7.4 years) were randomly allocated to receive full debridement (FD) of plantar hyperkeratoses, partial debridement (PD) of plantar hyperkeratoses, or debridement simulation (control group). Plantar hyperkeratotic pain was measured on a visual analog scale before treatment, just after treatment, 24 hours after treatment, and 7 days after treatment. RESULTS: Both FD and PD of plantar hyperkeratoses of the forefoot generate similar levels of self-perception of pain just after treatment (P = .32), 24 hours after treatment (P = .15), and 7 days after treatment (P = .22). Significant differences were found between the groups treated using a scalpel (FD and PD) and the control group just after treatment (P = .04 for FD; P = .05 for PD), 24 hours after treatment (P = .03 for FD; P = .04 for PD), and 7 days after treatment (P = .04 for FD and PD). CONCLUSIONS: The results of this trial suggest that there are no significant differences in pain reduction between PD and FD of forefoot plantar hyperkeratoses in older people.

Documenting a cultural landscape using point-cloud 3d models obtained with geomatic integration techniques. The case of the El Encín atomic garden, Madrid (Spain).

A country's cultural landscapes are an important part of its heritage. The growing need to identify, catalogue and preserve these resources has led to a rapid change in the management and inventorying of heritage in general and of cultural landscapes in particular. The main aim of this work is to develop and apply an updated and integrated methodology for capturing and processing geo-information for the digital documentation of cultural heritage. The proposed case study is the atomic garden in the Finca El Encín (Madrid), a singular space with unique biogeographical features created over 60 years ago. The results of the case study validate the method, consisting of an unmanned aerial platform equipped with sensors to obtain point clouds and aerial images in conjunction with point clouds and images captured with a terrestrial laser scanner.

Lead content in soils and native plants near an abandoned mine in a protected area of south-western Spain: an approach to determining the environmental risk to wildlife and livestock.

A study of the impact of an abandoned lead (Pb) mine ("Las Musas"), located in SW Spain, on the contamination of the surface soil and pastures in its vicinity revealed the presence of widely distributed, high levels of Pb contamination. The total Pb concentrations in soils sampled at distances from 3 to 998 m from the mine ranged between 129 and 1053 mg/kg, when it has been reported that non-polluted soils have concentrations of 29-40 mg/kg. These exceed the maximum tolerable levels in agricultural soils for the protection of environmental and human health as established in international and regional regulations. While the concentrations of potentially bioavailable Pb in the soils also surpassed the regulatory levels, the effective bioavailable fractions were low. The Pb concentrations measured in native plants ranged from 1.70 to 129 mg/kg dry weight, with Cynosurus echinatus, Philadelphus coronarius, and Fraxinus angustifolia being the species that bioaccumulated the greatest concentrations of this metal. Estimation of the environmental risk to wildlife and livestock grazing in the studied area showed no potential toxicity for these animals.

Metal content in the liver, kidney, and feathers of Northern gannets, Morus bassanus, sampled on the Spanish coast.

The value of birds as bioindicators for monitoring the environmental inorganic elements has been globally recognized. In this context, due to its well-known ecology and population stability, the Northern gannet (Morus bassanus) could be particularly useful. Dead Northern gannets (n = 30) were collected and samples from the liver, kidney, and feathers were taken, dried, mineralized, and finally analyzed via ICP-MS. Metals and metalloids, namely As, Cd, Hg, Pb, and Zn, associated with environmental pollution and toxicity on living organisms, were evaluated. The mean highest concentrations of As, Hg, and Zn were found in the liver (0.916, 7.026, and 89.81 mg/kg dry weight, respectively). For Cd, the kidney showed the highest mean concentration (17.51 mg/kg dry weight), whereas for Pb, this value corresponded to the feathers (0.399 mg/kg dry weight). Significant differences were found between the age classes in terms of contaminant concentrations, with the adults exhibiting higher metal levels. This difference was significantly relevant for Pb and Hg, where the effect of age was observed for all the considered tissues. When considering the effect of gender, no significant differences were observed, in agreement with similar studies performed in other geographical regions. Finally, positive correlations between the concentrations of Hg and Pb in the feathers and in the liver (r = 0.688, p < 0.001 and r = 0.566, p < 0.001, respectively) were observed, as well as between the feather and kidney concentrations (r = 0.685, p < 0.001) indicating the possibility to use feathers, a non-invasive biomonitoring tissue, for better understanding Hg and Pb exposure in seabirds.

Fatal Streptoccocus canis Necrotizing Fasciitis and Myositis in a Free-Ranging Iberian Lynx (Lynx pardinus).

A free-ranging Iberian lynx (Lynx pardinus) was found dead after 16 mo of being reintroduced. On gross necropsy, necrotic areas in the left biceps femoris and intercostal muscles were identified. Streptococcus canis was isolated from both groups of muscles and was confirmed by PCR, corroborating a necrotizing myositis diagnostic.

Do plantar hyperkeratoses affect balance in people older than 65 years old?

Tactile information picked up by plantar receptors provides afferent sensory information that is fundamental for controlling body balance. Plantar hyperkeratoses may alter the quality and quantity of such information, thereby modifying balance. AIM: Analyse how plantar hyperkeratosis debridement affects static body balance in subjects of 65 years of age or older. METHODS: In order to analyse the impact of hyperkeratoses on balance, 50 older people took part in this study. Pain caused by plantar hyperkeratoses was measured on a visual analogue scale. Static balance was assessed on a pressure sensitive platform. The treatment was scalpel debridement of hyperkeratoses. RESULTS: Pain decreased significantly (p=0.03). Regarding the variables analysed, significant differences were found between pre- and post-treatment values in anteroposterior length (Length, mm) (p=0.032) and anteroposterior amplitude (Amp, mm) (p=0.044) of the centre of plantar pressure with eyes open. CONCLUSIONS: Plantar hyperkeratosis debridement is capable of interfering favourably with sensory afferent inputs, thereby improving control of stability and modifying stabilometric readings in the AP component when a subject balance with eyes open.

Influence of sex on biomarkers of oxidative stress in the kidney, lungs, and liver of rabbits after exposure to diazinon.

The present study evaluated the effect of two oral doses of the pesticide diazinon (25 and 125 mg/kg bw) on four biochemical parameters (malondialdehyde and glutathione levels, and catalase and glutathione S-transferase enzymatic activities) in the kidney, lungs, and liver of rabbit after 10 days of exposure. Malondialdehyde levels were significantly greater in exposed animals compared to controls, especially in the animals exposed to the higher dose of the pesticide. This result was reflected in the glutathione levels, which were significantly lower at that same higher dose. Catalase activity was also inhibited by the higher dose of the pesticide in all three organs analysed, whereas inhibition of glutathione S-transferase activity was only significant for the kidney and lungs. There were some slight differences between the sexes: taking the results for all three organs, the higher dose of diazinon resulted in a clearly significant inhibitory effect on the catalase activity and glutathione levels in males, and a significant enhancing effect on the malondialdehyde levels in females. These results help to confirm the interest of considering such endogenous factors in future ecotoxicological studies, and that the four biomarkers considered are suitable for reflecting the toxic effects of diazinon on rabbits, especially the effects related to oxidative stress. Graphical abstract.

Effect of debridement of plantar hyperkeratoses on gait in older people - An exploratory trial.

Hyperkeratoses are a common cause of foot pain due to the release of inflammatory mediators, which can have an impact on the mobility and independence of people suffering from them. However, the repercussions that hyperkeratoses have on gait parameters remain uncertain. AIM: The aim of this study is to analyze the repercussions that plantar hyperkeratosis debridement has on several kinematic and kinetic variables of gait in a group of older participants. METHODS: 98 older participants (75.1 ±â€¯6.7 years) were randomly assigned to two groups: Group A, Scalpel debridement of plantar hyperkeratoses; and Group B, Control group (Simulated debridement). Plantar hyperkeratotic pain was measured before and after treatment on a visual analog scale. Several kinematic and kinetic variables of gait were measured before and after treatment using a Win-Track pressure sensitive walkway. RESULTS: A significant difference was found in the level of pain between the treated group and the control group (p < 0.01 [8.55-18.15; 95% confidence interval]). Regarding the gait parameters, statistically significant reductions were found in peak pressures (p < 0.05; Cohen's d = 2.688) and maximum force (p < 0.04; d = 0.262). CONCLUSIONS: Data suggests that debridement of plantar hyperkeratosis may lead to a reduction in pain and appear to reduce peak maximum force and peak plantar pressure. No significant changes were observed in the kinematic variables analyzed. The duration of the benefits remain unknown.

Reference intervals for B-esterases in gull, Larus michahellis (Nauman, 1840) from Northwest Spain: influence of age, gender, and tissue.

Over the last years, cholinesterase (ChE) and carboxylesterase (CbE) activities have been increasingly used in environmental biomonitoring to detect the exposure to anticholinesterase insecticides such as organophosphorates (OPs) and carbamates (CBs). The aim of this study was to determine ChE and CbE enzymatic activities present in liver and muscle of yellow-legged gulls (Larus michahellis), a seabird species considered suitable to monitor environmental pollution. In order to provide reference data for further biomonitoring studies, the influence of different factors, such as gender, age, sampling mode, and tissue, was considered in the present study. Our data report a statistically significant difference in CbE enzymatic activity comparing liver and muscle samples (P < 0.05) along with an age-related CbE activity in liver samples (P < 0.05). Moreover, according to our results, capture method might influence CbE and ChE activity in both liver and muscle samples (P < 0.05). These findings underline the importance to assess basal levels of ChE and CbE activity considering, among other factors, gender-, age- and organ-related differences and confirm the suitability of Larus michahellis as a sentinel species especially within an urban environment.

Levels of perfluorinated acids (PFCAs) in different tissues of Lepidochelys olivacea sea turtles from the Escobilla beach (Oaxaca, Mexico).

Lepidochelys olivacea is the most abundant and globally distributed sea turtle species in the world and thus, monitoring this species for persistent organic pollutants, such as perfluorinated chemicals, is fundamental for their protection. This study was the first to evaluate the occurrence of five PFCAs (PFOA, PFNA, PFDA, PFUnA, PFDoA) in liver and blood samples of Olive Ridley turtle population from the Escobilla beach (Oaxaca, Mexico). PFDA and PFUnA were the predominant PFCs in blood samples (detected in 93% and 84% of samples, respectively) and were also present in the highest concentrations. Liver samples showed higher PFCA concentrations than whole blood samples, with PFNA and PFDA the most abundant PFCs congeners in liver samples, detected in 65% and 47% of the samples, respectively. The measured levels of contaminants in the blood samples of Lepidochelys olivacea sea turtles were compared to the levels reported in the literature for other turtle species. While linear significant correlations between PFNA, PFDA and PFUnA concentrations in blood samples and curved carapace lengths were determined, no correlation was found for PFOA, supporting the hypothesis that sea turtles could have a higher ability to eliminate this perfluorinated chemical from their blood than other PFCAs. However, we do not know if the concentrations are species or sampling areas dependent.

Uncommon cause of life-threatening retroperitoneal hemorrhage in a healthy young Hispanic patient: splenic artery aneurysm rupture.

Splenic artery aneurysms (SAA) are a rare life threatening clinical diagnosis. We present a case of a young Hispanic woman with an aneurysm of the middle branch of the splenic artery and active leakage. The defect was embolized with complete resolution of the retroperitoneal bleeding. Physicians should be aware of this rare entity especially when female patients presents complainiing of severe epigastric pain with associated hypovolemic shock.