Lateral subtalar dislocation associated with a lateral malleolus and a nutcracker cuboid fracture: Case report of a rare pattern of lesion.

INTRODUCTION AND IMPORTANCE: Combined fracture of the lateral malleolus and cuboid due to a lateral subtalar dislocation is an uncommon injury. Literature is scarce on this trauma association. To the best of our knowledge, this represents a new lesion pattern. Hereby we describe its mechanism, management and outcomes. CASE PRESENTATION: We report a case of a 58-year-old woman, who fell from the stairs and presented with pain and an acute deformity of the left foot and ankle. Plain radiographs and CT scan revealed a lateral subtalar dislocation with a lateral malleolus and cuboid fractures. After a failed closed reduction, the patient underwent an open reduction and fixation of the talonavicular joint. An external fixator was applied to address the cuboid fracture. The lateral malleolus was treated conservatively with 5.5 weeks of immobilization. At 38 months of follow-up, the patient scored 87% on the AOFAS ankle-hindfoot scale and returned to normal daily activity. Radiographs demonstrate signs of posttraumatic arthritis at the subtalar and talonavicular joints. CLINICAL DISCUSSION: After reduction of the lateral subtalar dislocation, addressing the nutcracker cuboid fracture was essential, since it can contribute to a flatfoot deformity. Although the patient progressed to posttraumatic arthritis, the sequelae are usually well tolerated and a good outcome was achieved. CONCLUSION: The rarity of this pattern of lesion is related to the necessary multidirectional forces. Correct management of the associated fractures is essential. Our study demonstrates a new lesion pattern of lateral subtalar dislocations, its mechanism, management and outcomes.

Prevalence of overweight and obesity in the adult indigenous population in Brazil: A systematic review with meta-analysis.

To carry out a systematic review to identify the prevalence of overweight and obesity in the adult indigenous population in Brazil. The databases used were PubMed, Scopus, Virtual Health Library (VHL), and Science Direct, with the following search strategy: "overweight" OR "obesity" AND "indigenous" OR "tribe" AND "Brazil". For the meta-analysis, RStudio® software was used. Were 22 articles included. The combined effect of the meta-analysis studies showed a global prevalence of overweight and obesity of 45%. Approximately half (45%) of indigenous Brazilian adults have excess weight. These findings highlight the need to implement public policies for the prevention and treatment of these morbidities.

[Disrespect and abuse during childbirth and abortion in Latin America: systematic review and meta-analysisDesrespeito e maus-tratos durante o parto e o aborto na América Latina: revisão sistemática e meta-análise]. / Irrespeto y maltrato durante el parto y el aborto en América Latina: revisión sistemática y metaanálisis.

OBJECTIVE: This review synthesizes the evidence (quantitative, general, and by typological categories) of disrespect and abuse during childbirth and abortion in health facilities in Latin America and the Caribbean. METHODS: Systematic searches identified 18 primary studies. Q and I2 were calculated, meta-analyses and meta-regressions were performed, and subgroups were analyzed using a DerSimonian and Laird random-effects model grouped by inverse variance and the Freeman-Tukey double arcsine transformation. RESULTS: Studies conducted in five Latin American countries were identified. No studies from the Caribbean were found. The aggregate prevalence of disrespect and abuse during childbirth and abortion was 39%. The aggregated prevalence of the phenomenon in childbirth was 43% and 29% during abortion. The high heterogeneity made it impossible to generate aggregate measures according to typological categories. Nevertheless, the frequencies of specific forms of the phenomenon were grouped typologically. CONCLUSIONS: The evidence suggests that disrespect and abuse during childbirth and abortion care are human-rights and public-health problems that are prevalent in some countries of the Region. It is necessary to reach international consensus on the definition and operationalization of this problem and to develop standardized methods for its measurement. Doing so is essential in order to achieve the targets of the 2030 Agenda related to reducing maternal and newborn morbidity and mortality and eliminating all forms of violence and discrimination against women.

OBJETIVO: Esta revisão sintetiza as evidências quantitativas, gerais e desagregadas por categorias tipológicas do desrespeito e maus-tratos na atenção institucional ao parto e ao aborto na América Latina e Caribe. MÉTODOS: Dezoito estudos primários foram identificados por meio de buscas sistemáticas. Foi feito o cálculo de Q e I2 e realizadas meta-análises, metarregressões e análises de subgrupos com um modelo de DerSimonian e Laird de efeitos aleatórios agrupados com variância inversa e transformação de Freeman-Tukey (duplo arco-seno). RESULTADOS: Foram identificados estudos realizados em cinco países da América Latina. Não foi identificado nenhum estudo no Caribe. Observou-se uma prevalência agregada de 39% de desrespeito e maus-tratos durante o parto e o aborto. A medida agregada para este fenômeno durante o parto foi 43% e a medida agregada nos casos de aborto foi 29%. Devido à alta heterogeneidade, não foi possível gerar medidas agregadas segundo categorias tipológicas. No entanto, são descritas as frequências de formas específicas do fenômeno agrupadas tipologicamente. CONCLUSÕES: As evidências indicam que o desrespeito e os maus-tratos na atenção ao parto e ao aborto são uma questão de direitos humanos e de saúde pública prevalente em alguns países da Região. É preciso chegar a um consenso internacional sobre a definição e a operacionalização deste problema e elaborar métodos padronizados para mensurá-lo. Isso é imprescindível para o alcance das metas da Agenda 2030 relativas à redução da morbidade e mortalidade materna e perinatal e à eliminação de todas as formas de violência e discriminação contra a mulher.

A Rapid and Efficient ChIP Protocol to Profile Chromatin Binding Proteins and Epigenetic Modifications in Arabidopsis.

Chromatin immunoprecipitation (ChIP) is a widely used and very powerful procedure to identify the proteins that are associated with the DNA to regulate developmental processes. These proteins can be transcription factors, or specific histone variants and modified histones, which are all crucial for gene regulation. In order to obtain reliable results, ChIP must be carried out under highly reproducible conditions. Here, we describe a simple and fast ChIP protocol adapted for Arabidopsis seedlings, which can serve as a basis for other species, organs or more sophisticated procedures, such as the sequential ChIP. We also provide user-oriented troubleshooting to increase the chances of successful applications.

Sequential ChIP Protocol for Profiling Bivalent Epigenetic Modifications (ReChIP).

Identification of chromatin modifications, e.g., histone acetylation and methylation, among others, is widely carried out by using a chromatin immunoprecipitation (ChIP) strategy. The information obtained with these procedures is useful to gain an overall picture of modifications present in all cells of the population under study. It also serves as a basis to figure out the mechanisms of chromatin organization and gene regulation at the population level. However, the ultimate goal is to understand gene regulation at the level of single chromatin fibers. This requires the identification of chromatin modifications that occur at a given genomic location and within the same chromatin fiber. This is achieved by following a sequential ChIP strategy using two antibodies to distinguish different chromatin modifications. Here, we describe a sequential ChIP protocol (Re-ChIP), paying special attention to the controls needed and the required steps to obtain meaningful and reproducible results. The protocol is developed for young Arabidopsis seedlings but could be adapted to other plant materials.

Abuse and disrespect in childbirth process and abortion situation in Latin America and the Caribbean-systematic review protocol.

BACKGROUND: Studies show that a large number of women around the world have experienced situations of abuse, disrespect, abuse, and neglect during childbirth and/or abortion. This violence is a serious violation of the rights of women, especially because it is a period in which the woman is more physiologically, socially, and psychologically vulnerable. Although this type of violence is known, there is still no international consensus on the definition of such violence and its prevalence is not known. In this sense, this systematic review aims (1) to find quantitative data about abuse and disrespect in obstetric care (delivery and/or abortion) in Latin America and the Caribbean to estimate the average prevalence of this type of abuse and (2) to identify interventions-including programs, laws, and regulations-which have been implemented to prevent or respond to abuse and disrespect in childbirth process and abortion situation, evaluating its effectiveness on a global scale. METHODS: For this, we will use a refined and pre-established strategy to search databases such as PubMed, Embase, LILACS, and Scielo, and the studies found will pass through a selection process to complete the screening stage. DISCUSSION: Data will be extracted using standardized forms with the following information: scope of study, sample characteristics, objectives, design, data collection, methods of analysis, data source, and results. Considering the heterogeneity of the definitions of abuse, disrespect, and mistreatment of women in labor or abortion, it may not be possible to carry out the meta-analysis of the frequency of events reported in the included articles. Events reported by the original articles will be classified according to a typology of abuse, disrespect, and maltreatment in the labor or abortion process described by Bohren et al. (PLoS Med, 2015). SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016038651.

High-resolution analysis of DNA synthesis start sites and nucleosome architecture at efficient mammalian replication origins.

DNA replication origins are poorly characterized genomic regions that are essential to recruit and position the initiation complex to start DNA synthesis. Despite the lack of specific replicator sequences, initiation of replication does not occur at random sites in the mammalian genome. This has lead to the view that DNA accessibility could be a major determinant of mammalian origins. Here, we performed a high-resolution analysis of nucleosome architecture and initiation sites along several origins of different genomic location and firing efficiencies. We found that mammalian origins are highly variable in nucleosome conformation and initiation patterns. Strikingly, initiation sites at efficient CpG island-associated origins always occur at positions of high-nucleosome occupancy. Origin recognition complex (ORC) binding sites, however, occur at adjacent but distinct positions marked by labile nucleosomes. We also found that initiation profiles mirror nucleosome architecture, both at endogenous origins and at a transgene in a heterologous system. Our studies provide a unique insight into the relationship between chromatin structure and initiation sites in the mammalian genome that has direct implications for how the replication programme can be accommodated to diverse epigenetic scenarios.

The diseases we cause: Iatrogenic illness in a department of internal medicine.

BACKGROUND: The aim of this study was to estimate the incidence, main causes, and risk factors of iatrogenic disease occurring in a department of internal medicine. METHODS: Over a 1-year period, physicians systematically filled out a 2-page questionnaire for all patients admitted to the ward. A database was created and the data were statistically analyzed. Patients undergoing immunosuppressive, chemo-, or radiation therapy were excluded. Missing data were completed by reviewing the patients' charts. The patients were then divided into two groups: those with and those without iatrogenic disease. The groups were compared using several parameters including gender, age, social features, days of hospitalization, associated illness, functional status, medical impression, prognosis, associated renal or liver function impairment, drugs taken daily, and outcome. In the group with iatrogenic disease, the type, severity, and predictability were also analyzed. RESULTS: Of the 879 patients admitted to the ward, 445 completed questionnaires and were included in the study. A total of 102 patients (22.9%) developed 121 iatrogenic events. Forty-four patients (43.1%) were admitted for iatrogenic illness, 10 (9.8%) developed life-threatening events, and in 3 (6.8%) it was the cause of death. Fifty-eight patients (56.8%) registered 77 episodes of iatrogenic disease during their hospital stay, 20 (19.6%) developed life-threatening events, and 9 (11.7%) died, 4 (5.2%) of an iatrogenic cause (nosocomial infections). Significant differences were found in 20 out of 26 parameters studied (p<0.005 for all cases; 95% confidence interval). Eighteen percent of all iatrogenic disease was severe, 61.9% predictable, 54.5% avoidable, and 59% drug-related, 80% of which was due to side effects or adverse reactions. Infection and metabolic and electrolyte disorders were the most frequent effects. CONCLUSIONS: It is possible to identify risk factors for iatrogenic events. Chronically ill elderly inpatients are the main target of iatrogenic events.

Metabolic syndrome in dyslipidemia consultations.

AIMS: To evaluate the prevalence of the metabolic syndrome (MS) in dyslipidemia consultations, according to the criteria established by the National Cholesterol Education Program Adult Treatment Panel III (ATP III); to classify patients with MS according to ATP III risk categories and prevention type (primary versus secondary); and to evaluate evolution to type 2 diabetes in these patients. METHODS: A retrospective study was conducted based on analysis of the clinical records of 470 patients followed in dyslipidemia consultations at Internal Medicine II of Coimbra University Hospitals. MS was defined as the presence of three or more of the following abnormalities: waist circumference > 102/88 cm (male/female), triglyceride levels > or =150 mg/dl, HDL-cholesterol level < 40/50 mg/dl (male/female), blood pressure > or = 130/85 mmHg and fasting glucose > or = 110 mg/dl. The patients were classified into three risk categories according to the major risk factors defined by ATP III, regardless of LDL-cholesterol level. RESULTS: MS was diagnosed in 31.3% of the patients; 53.7% were male and mean age was 52.7+/-11.9 years. The most prevalent anomaly was hypertriglyceridemia (95.9%), followed by waist circumference (76.1%), HDL cholesterol (73.5%), blood pressure (69.4%) and fasting glycemia (36.7%). Based on the risk categories identified by ATP III, 30.6% of the patients had no or only one risk factor, 66.7% had multiple (2 or more) risk factors and 2.7% had coronary disease or an equivalent risk profile. 97.3% of the patients with MS were in primary prevention. 18.4% developed diabetes, the majority within 1-3 years of the first consultation. CONCLUSIONS: Our study identified a high MS prevalence in patients followed in dyslipidemia consultations, particularly in older age-groups. More than half of the MS patients had an intermediate risk profile and most of them were in primary prevention. We also found that a fifth of non-diabetic patients developed diabetes during follow-up.

The methylenetetrahydrofolate reductase (MTHFR) 677C-->T mutation and cardiovascular risk--A case of ischemic stroke and acute myocardial infarction.

The authors report the case of a 39-year-old male patient who had an ischemic stroke (complete infarction of right anterior cerebral circulation) and an acute myocardial infarction during the same year. Molecular study revealed he was homozygous for the 677C-->T mutation in the gene coding for methylenetetrahydrofolate reductase, a key enzyme of folate metabolism; deficiency of this enzyme is associated with increased cardiovascular risk and neurological lesions. Some considerations are put forward about hyperhomocysteinemia and the MTHFR 677C-->T mutation as cardiovascular risk factors.