Trends in HIV post-exposure prophylaxis following sexual exposure in Brazil (2011-2019).

We examined trends in the prevalence of post-exposure prophylaxis following sexual exposure (PEPSE) per million population (2011-2019) and the proportion of repeated PEPSE within 365 days of the first PEPSE dispensing (2011-2018) in Brazil. We also compared the prevalence of repeated PEPSE according to patient and health services characteristics in 2018. The prevalence of PEPSE increased 55.5% from 2011 to 2019. Repeated PEPSE increased 11.8%, reaching 8.4% among people with their first dispensing in 2018. The prevalence of repeated PEPSE was higher in cis men or trans women (versus cisgender women); homosexuals (versus heterosexuals); and people aged 25-29 years (versus other age groups). We also observed greater prevalence of repeated PEPSE in HIV services in populous cities or services with elevated caseloads. Our findings highlight the need for strategies to reduce repeated PEPSE and promote other HIV-prevention technologies, particularly among young adults, cisgender men, transgender women, and homosexuals.

RESUMEN: Examinamos las tendencias de la prevalencia de uso de la profilaxis posterior a la exposición sexual (PEPSE) por millón de población (2011­2019) y la proporción de PEPSE repetida dentro de los 365 días de la primera dispensación de PEPSE (2011­2018) en Brasil. También comparamos la prevalencia de PEPSE repetida según las características del paciente y de los servicios de salud en 2018. La prevalencia de PEPSE aumentó un 55,5% de 2011 a 2019. La PEPSE repetida aumentó un 11,8%, alcanzando el 8,4% entre las personas con su primera dispensación en 2018. La prevalencia de PEPSE repetida fue mayor en hombres cis o mujeres trans (versus mujeres cisgénero); homosexuales (versus heterosexuales); y personas de 25 a 29 años (versus otros grupos de edad). También observamos una mayor prevalencia de repetición en los servicios de VIH de las ciudades más pobladas o con un elevado número de clientes. Nuestros hallazgos ponen de manifiesto la necesidad de estrategias para reducir la repetición de la PEPSE y promover otras tecnologías de prevención del VIH entre los adultos jóvenes, especialmente los hombres, las trans y los homosexuales.

Inter-sectoral prioritization of climate technologies: insights from a Technology Needs Assessment for mitigation in Brazil.

Technological development is key for national strategies to cope with the Paris Agreement's goals. Technology Needs Assessments (TNAs) aim to identify, prioritize, and diffuse climate change mitigation and/or adaptation technologies in developing countries. Their methodology includes a multi-criteria decision analysis (MCDA) framework but, although many countries already conducted a TNA, literature lacks discussions on country-specific processes for a TNA, as it usually follows a one-size-fits-all approach. This paper provides empirical evidence on the importance of country-driven processes that help shaping international programmes into country-specific needs and capabilities. It presents lessons learned from a tailored process for identification, prioritization, and selection of mitigation technologies in the scope of a TNA project for Brazil, an exceptional case of a developing country with strong capacity in integrated assessment modelling (IAM) scenarios for guiding its climate strategies. A previous IAM scenario result allowed pre-selecting technologies in six key economic sectors, while other TNAs prioritized no more than three. This allowed the elaboration of an overall ranking from the MCDA, in contrast to sectoral rankings that are mostly employed in other countries' TNAs. The overall ranking serves not only as a basis for the selection of priority technologies but also provides information on the integrated innovations framework for climate technologies in the country. Further specific findings of the tailored Brazilian TNA approach are discussed in the paper in order to call for the importance that a technology transfer project should not only be country-driven but also conducted through a country-specific process. Supplementary Information: The online version contains supplementary material available at 10.1007/s11027-022-10025-6.

The mgΔlpn mouse model for Marfan syndrome recapitulates the ocular phenotypes of the disease.

PURPOSE: Fibrillin-1 and -2 are major components of tissue microfibrils that compose the ciliary zonule and cornea. While mutations in human fibrillin-1 lead to ectopia lentis, a major manifestation of Marfan syndrome (MFS), in mice fibrillin-2 can compensate for reduced/lack of fibrillin-1 and maintain the integrity of ocular structures. Here we examine the consequences of a heterozygous dominant-negative mutation in the Fbn1 gene in the ocular system of the mgΔlpn mouse model for MFS. METHODS: Eyes from mgΔlpn and wild-type mice at 3 and 6 months of age were analyzed by histology. The ciliary zonule was analyzed by scanning electron microscopy (SEM) and immunofluorescence. RESULTS: Mutant mice presented a significantly larger distance of the ciliary body to the lens at 3 and 6 months of age when compared to wild-type, and ectopia lentis. Immunofluorescence and SEM corroborated those findings in MFS mice, revealing a disorganized mesh of microfibrils on the floor of the ciliary body. Moreover, mutant mice also had a larger volume of the anterior chamber, possibly due to excess aqueous humor. Finally, losartan treatment had limited efficacy in improving ocular phenotypes. CONCLUSIONS: In contrast with null or hypomorphic mutations, expression of a dominant-negative form of fibrillin-1 leads to disruption of microfibrils in the zonule of mice. This in turn causes lens dislocation and enlargement of the anterior chamber. Therefore, heterozygous mgΔlpn mice recapitulate the major ocular phenotypes of MFS and can be instrumental in understanding the development of the disease.

Kinematics approach with neural networks for early detection of sepsis (KANNEDS).

BACKGROUND: Sepsis is a severe illness that affects millions of people worldwide, and its early detection is critical for effective treatment outcomes. In recent years, researchers have used models to classify positive patients or identify the probability for sepsis using vital signs and other time-series variables as input. METHODS: In our study, we analyzed patients' conditions by their kinematics position, velocity, and acceleration, in a six-dimensional space defined by six vital signs. The patient is affected by the disease after a period if the position gets "near" to a calculated sepsis position in space. We imputed these kinematics features as explanatory variables of long short-term memory (LSTM), convolutional neural network (CNN) and linear neural network (LNN) and compared the prediction accuracies with only the vital signs as input. The dataset used contained information of approximately 4800 patients, each with 48 hourly registers. RESULTS: We demonstrated that the kinematics features models had an improved performance compared with vital signs models. The kinematics features model of LSTM achieved the best accuracy, 0.803, which was nine points higher than the vital signs model. Although with lesser accuracies, the kinematics features models of the CNN and LNN showed better performances than vital signs models. CONCLUSION: Applying our novel approach for early detection of sepsis using neural networks will prove to be an invaluable, more accurate method than considering only simple vital signs as input variables. We expect that other researchers with similar objectives can use the model presented in this innovative approach to improve their results.

Does switching from multiple to single-tablet regimen containing the same antiretroviral drugs improve adherence? A group-based trajectory modeling analysis.

Combination Antiretroviral Therapy (cART) in single-tablet regimens (STR) is a simplification strategy that can potentially improve medication adherence and clinical outcomes. We conducted a retrospective cohort study of 1206 patients using efavirenz, tenofovir and lamivudine in multiple-tablet regimen who switched to the STR containing the same active ingredients in a southeast metropolis in Brazil. We measured adherence using the proportion of days covered (PDC≥95%) and evaluated this outcome before and after the switch using paired non-parametric statistics. Additionally, we used group-based trajectory modeling to identify adherence patterns to cART for each period and evaluate the migration behavior of patients between the trajectory groups. We observed a 14% increase in the proportion of adherent patients after switching to STR and a 6.2% increase in the proportion of patients with CD4 count>500 cells/µl (p < 0.001), without changes in viral load outcomes. We identified four adherence trajectories in each period. Most patients (60%, n = 722) migrated towards a group with better adherence trajectory or remained in the trajectory group with the highest probability of adherence after the switch. Our findings suggest that the implementation of the STR had a positive impact on adherence and CD4 count. This may potentially improve virologic outcomes later on treatment.

Using OPC and HL7 Standards to Incorporate an Industrial Big Data Historian in a Health IT Environment.

Health Level Seven (HL7) is one of the standards most used to centralize data from different vital sign monitoring systems. This solution significantly limits the data available for historical analysis, because it typically uses databases that are not effective in storing large volumes of data. In industry, a specific Big Data Historian, known as a Process Information Management System (PIMS), solves this problem. This work proposes the same solution to overcome the restriction on storing vital sign data. The PIMS needs a compatible communication standard to allow storing, and the one most commonly used is the OLE for Process Control (OPC). This paper presents a HL7-OPC Server that permits communication between vital sign monitoring systems with PIMS, thus allowing the storage of long historical series of vital signs. In addition, it carries out a review about local and cloud-based Big Medical Data researches, followed by an analysis of the PIMS in a Health IT Environment. Then it shows the architecture of HL7 and OPC Standards. Finally, it shows the HL7-OPC Server and a sequence of tests that proved its full operation and performance.

Renal vein thrombosis in the course of non-operative treatment of kidney trauma: A rare case report.

INTRODUCTION: Venous thromboembolism is widely recognized as a life-threatening complication in trauma, yet renal vein thrombosis (RVT) following trauma is particularly rare. PRESENTATION OF CASE: We report a case of a 67-year-old man who was brought to the emergency department after falling down a 14-step staircase at home which presented right kidney trauma (parenchyma laceration with a perirenal hematoma) on computed tomography, and hematuria. Considering the patient's hemodynamic stability, a non-operative treatment was initiated, and the patient was referred to the intensive care unit for close observation. On post-trauma day 3, a repeated CT revealed right renal vein thrombosis. After evaluation, it was decided to maintain prophylactic anticoagulation doses of enoxaparin (40 mg/day) due to the elevated risk of bleeding in high-grade renal trauma and planned an inferior vena cava (IVC) filter placement. In the following days, the hematuria resolved spontaneously and an IVC filter was placed. The patient progressed with no complaints, spontaneous diuresis, improvement in laboratory parameters, and cardiovascular stability, which led to his discharge on day 12 with rivaroxaban 10 mg/day. The patient was successfully treated with a non-operative approach, and the RVT disappeared after 35 days. DISCUSSION: Post-traumatic renal vein thrombosis is a rare occurrence, and due to the infrequent nature of these events, specific management guidelines are not fully established, particularly when thrombosis is confirmed in an acutely injured patient. CONCLUSION: Conservative therapy seems to play a meaningful role in trauma-related renal vein thrombosis treatment.

FRACTURE-DISLOCATIONS OF THE ELBOW: CAN THEY INFLUENCE THE PATTERN FRACTURE OF RADIAL HEAD?

Introduction: Radial head fractures are consistently part of a terrible triad of the elbow and can occur in association with Monteggia fracture-dislocations, transolecranon fractures, and their variations. Understanding the degree of comminution of the radial head fracture and the location of fragments determines the course of action to be taken. Objectives: To correlate fracture-dislocations with the pattern of radial head fracture (number of fragments) and involvement in the proximal radioulnar region. Materials and Methods: A retrospective study (level II) of patients undergoing surgery for radial head fractures associated with fracture-dislocations. Patients had radiographs in anteroposterior and lateral views, as well as tomography. The number of radial head fracture fragments and the presence of fractures in the proximal radioulnar region were correlated with the type of fracture-dislocation and demographic variables. Conclusion: Elbow fracture-dislocation types could not predict the number of fragments and the location of radial head fractures. However, most injuries presented three or more fragments in the radial head, and many had involvement of the proximal radioulnar region, suggesting high-energy trauma. Level of Evidence II; Retrospective Study.

Introdução: As fraturas da cabeça do rádio estão sempre presentes em uma tríade terrível do cotovelo e podem ocorrer associadas a uma fratura-luxação de Monteggia, fratura transolecraniana e suas variações. Conhecer o grau de cominuição da fratura da cabeça do rádio e a localização dos fragmentos determinam a conduta a ser tomada. Objetivos: Correlacionar as fraturas-luxações com o padrão da fratura da cabeça do rádio (número de fragmentos) e o acometimento na região radioulnar proximal. Material e Métodos: Estudo retrospectivo (nível II) de pacientes submetidos a cirurgia devido fraturas de cabeça de rádio associadas às fraturas-luxações. Os pacientes possuíam radiografia nas incidências anteroposterior e perfil e tomografia. O número de fragmentos da fratura da cabeça do rádio e a presença de fratura na região radioulnar proximal foram correlacionadas com o tipo de fratura-luxação e as varáveis demográficas. Conclusão: Os tipos de fratura-luxação do cotovelo não foram capazes de predizer o número de fragmentos e a localização da fratura da cabeça do rádio. Entretanto, a maioria das lesões apresentaram três ou mais fragmentos na cabeça do rádio e muitos apresentaram acometimento da região da radioulnar proximal sugerindo traumas de alta energia. Nível de Evidência II; Estudo Retrospectivo.

The Hertel classification can't predict the risk of humeral head osteonecrosis after osteosynthesis using an anterolateral approach.

BACKGROUND: Proximal humeral fractures can progress to osteonecrosis of the humeral head. Hertel developed a binary classification system (12 subtypes) and demonstrated that some patterns have more risk to develop osteonecrosis. Hertel described the prevalence and the risk factors for Humeral head osteonecrosis after osteosynthesis using a Deltopectoral approach. Few studies have evaluated the prevalence and the capacity of Hertel's classification to predict Humeral Head osteonecrosis following osteosynthesis of proximal Humeral fractures through the anterolateral approach. The objectives of this study were to correlate osteonecrosis predictors established by the Hertel classification with the risk of developing osteonecrosis and its prevalence after osteosynthesis using the anterolateral approach. METHODS: This was a retrospective study of patients who underwent osteosynthesis of proximal humerus fractures using an anterolateral approach. Patients were divided into two groups: high risk for necrosis (group 1) and low risk for necrosis (group 2) according to Hertel's criteria. The overall prevalence of osteonecrosis and the prevalence in each group were calculated. A radiological examination was performed in the true anteroposterior (Grashey), scapular, and axillary views, before and after the operation (minimum 1 year after surgery). A Kaplan-Meier curve was used to assess the pattern of the temporal evolution of osteonecrosis. The groups were compared using the Chi-square test or Fisher's exact test. The unpaired t-test (parametric variables - age) and the Mann-Whitney test (non-parametric time between trauma and surgery) were used. RESULTS: In total, 39 patients were evaluated. The postoperative follow-up time was 14.5 ± 3.3 months. The time to onset of necrosis was 14.1 ± 3.9 months. Sex, age, and time between trauma and surgery did not influence the risk of necrosis. Type 2, 9, 10, 11, and 12, or fractures with posteromedial head extension less than or equal to 8 mm, or diaphysis deviation greater than 2 mm, as well as grouping did not influence the risk for osteonecrosis. CONCLUSIONS: Hertel's criteria were not able to predict the development of osteonecrosis after osteosynthesis of proximal humerus fractures performed through the anterolateral approach. The total prevalence of osteonecrosis was 17.9% with a tendency toward an increased incidence after 1 year of surgical treatment.

Functional Shoulder Evaluation after Osteosynthesis of Greater Tuberosity Fracture: Is There any Influence of Glenohumeral Dislocation?

Objective To evaluate the postoperative functional and radiographic outcomes of the shoulder of patients submitted to transosseous suturing of a greater tuberosity fracture (GTF) through an anterolateral route and the influence of the glenohumeral dislocation on these outcomes. Methods We conducted a retrospective study and functional assessment using the Constant-Murley score. The distance between the greater tuberosity and the joint surface of the proximal humerus (in true anteroposterior radiographs) after the union was calculated. We used the Fisher exact test for the categorical independent variables, and the Student t or Mann-Whitney test for the non-categorical variables. Results In total, 26 patients met the inclusion criteria, and 38% of the sample presented an association between glenohumeral dislocation and GTF. The mean Constant-Murley score was of 82.5 + 8.02 points. The presence of an associated dislocation did not alter the functional outcome. The mean distance between the greater tuberosity of the humerus and the joint surface of the humeral head after the union was of 9 ± 4.3 mm below the articular line of the humeral head. The dislocation led to a lower level of reduction, but this did not influence the Constant-Murley score. Conclusion The cases of GTF submitted to surgical treatment with transosseous sutures had good functional outcomes. The presence of dislocation made the anatomical reduction of the greater tuberosity difficult. However, it did not influence the Constant-Murley score.

MORTALITY AFTER SURGICAL TREATMENT OF PROXIMAL HUMERUS FRACTURES IN OLDER PATIENTS.

Mortality of patients after osteosynthesis of proximal humeral fractures (PHF) has been poorly studied in contrast to fractures of the proximal femur. OBJECTIVE: To evaluate the mortality of older patients with PHF undergoing surgical treatment. METHODS: Retrospective study of patients undergoing surgical treatment PHF between 2009-2019. Demographic data, Neer classification, and mortality of this cohort of patients were evaluated. Non-categorical variables were tested using the Kolmogorov-Smirnov test. The unpaired t-test (parametric variables) was used. Categorical variables were tested by Fisher's exact test. A Kaplan-Meier mortality curve was constructed. RESULTS: 59 patients were evaluated. There was a predominance of females in the sixth decade of life. The most prevalent fractures were Neer's type III. The highest mortality occurred in the first 4 years after surgery (4.1 + 3.2 years). The only comorbidity capable of changing the survival curve was DM (p = 0.03) Conclusion: Overall mortality was 11.3%. The highest mortality occurred in the first 4 years of follow-up. Diabetic patients evolve with earlier mortality and have 7 times more chance of death. Level of Evidence III, Retrospective Study.

A mortalidade de pacientes após osteossíntese de fratura de úmero proximal (FUP) é pouco estudada em comparação com as fraturas do fêmur proximal. Objetivo: Avaliar a mortalidade de pacientes idosos com FUP submetidos a tratamento cirúrgico. Métodos: Estudo retrospectivo de pacientes submetidos ao tratamento cirúrgico FUP entre 2009 e 2019. Foram avaliados dados demográficos, classificação de Neer e a mortalidade dessa coorte de pacientes. As variáveis não categóricas foram testadas pelo teste de Kolmogorov-Smirnov. Utilizou-se o teste t não pareado para variáveis paramétricas. As variáveis categóricas foram testadas pelo teste exato de Fisher. Construiu-se a curva de mortalidade pelo método de Kaplan-Meier. Resultados: Foram avaliados 59 pacientes, havendo predomínio do sexo feminino na faixa dos 60 anos. As fraturas mais prevalentes foram as do tipo III de Neer. A maior mortalidade ocorreu nos quatro primeiros anos pós-operatórios (4,1 + 3,2 anos). A única comorbidade capaz de mudar a curva de sobrevida foi o diabetes mellitus (p = 0,03). Conclusão: A mortalidade geral foi de 11,3%. A maior mortalidade ocorreu nos primeiros quatro anos de seguimento. Pacientes diabéticos evoluem com mortalidade mais precoce e possuem sete vezes mais chance de óbito. Nível de Evidência III, Estudo Retrospectivo.

EPIDEMIOLOGICAL STUDY OF SURGICALLY TREATED HUMERAL SHAFT FRACTURES - A 10-YEAR REVIEW.

Most epidemiological studies do not exclusively address fractures treated surgically but include those with conservative treatment. In Brazil, few epidemiological studies address fractures prevalence undergoing surgical treatment. Objective: To assess the prevalence, demographics, and associated injuries of surgically treated humeral shaft fractures. Methods: A retrospective study between 2009 and 2019 with patients undergoing osteosynthesis of humeral shaft fracture. Categorical variables were assessed using Fisher's chi-square or exact test, and non-categorical variables were assessed using the unpaired t-test. A significance level of 5% was adopted. Results: A total of 115 patients were evaluated. Mean age was 37.9 ± 15.6 years, with a male predominance (66.9%) due to car accidents. The most prevalent fracture type was 12 A3. Open fracture prevalence was 11.3%. Radial nerve damage prevalence was 33% and low-energy trauma was twice as likely. Conclusion: Surgically treated humeral shaft fractures were more prevalent in men, young, and related to high-energy trauma, with a transverse line pattern. Fractures secondary to low-energy trauma had a greater association with radial nerve injury. Level of Evidence III, Epidemiological, Retrospective Study.

A maior parcela dos estudos epidemiológicos não aborda exclusivamente as fraturas tratadas cirurgicamente, mas engloba as de tratamento conservador. No Brasil existem poucos estudos epidemiológicos que versam sobre a prevalência das fraturas submetidas ao tratamento cirúrgico. Objetivo: Avaliar a prevalência, os dados demográficos e as lesões associadas das fraturas da diáfise do úmero tratadas cirurgicamente. Métodos: Estudo retrospectivo conduzido entre 2009 e 2019, com pacientes submetidos a osteossíntese de fratura diafisária do úmero. As variáveis categóricas foram testadas pelo teste qui-quadrado ou teste exato de Fisher, enquanto as não categóricas foram medidas pelo teste t não pareado. Adotou-se nível de significância de 5%. Resultados: Foram avaliados 115 pacientes. A média de idade foi de 37,9 ± 15,6 anos, com uma predominância de pacientes do sexo masculino (66,9%) devido a acidentes automobilísticos. A fratura tipo 12 A3 foi a mais prevalente. A prevalência de fratura exposta foi de 11,3%. A lesão nervo radial ocorreu em 33%, principalmente em traumas de baixa energia. Conclusão: As fraturas diafisárias do úmero tratadas cirurgicamente foram mais prevalentes em homens jovens e relacionadas a traumas de alta energia, com padrão de traço transverso. Fraturas secundárias e traumas de baixa energia tiveram maior associação com lesão do nervo radial. Nível de Evidência III, Estudo Epidemiológico, Retrospectivo.

Prevalence and risk factors for pseudarthrosis in humeral shaft fractures treated by minimally invasive plate osteosynthesis: A 10-year review.

Introduction: Fractures of the humeral shaft account for about 3% to 5% of all fractures. Although conservative treatment remains the first choice, there are a number of surgical indications. Minimally invasive plate osteosynthesis shows good functional results. However, complications have been reported, such as non-union. Objective: To assess the prevalence and risk factors for non-union after treatment of humeral shaft fractures using minimally invasive plate osteosynthesis. Materials and methods: This retrospective study was carried out in patients treated by minimally invasive plate osteosynthesis between 2009 and 2019. Demographic data and variables related to the fracture that could influence bone healing were analysed. The unpaired t-test and Mann-Whitney test were used for the statistical analyses. Categorical variables were analysed using the chi-square test or Fisher's exact test. Results: The study population showed a male predominance (53 of 75, 70.7%). The average time for fracture healing was 19.8 ± 15.3 weeks. Seven patients developed non-union. Only the presence of an open fracture increased the likelihood of non-union. Conclusions: The prevalence of non-union in patients treated by minimally invasive plate osteosynthesis was 9.3%. Patients with open fractures were six times more likely to progress to non-union. Fracture characteristics (Arbeitsgemeinschaft für Osteosynthesefragen classification, fracture location and plate working length) did not influence progression to non-union.

The role of platelet-rich plasma in the mild and severe stages of atherosclerotic disease in mice.

Background: Platelet-rich plasma (PRP) has a high concentration of growth factors (GFs), which present a therapeutic wound healing effect. Despite having been correlated with an immunomodulatory function, the administration of PRP has not yet been investigated in atherosclerosis models. Aim: Evaluate the effect of lyophilized PRP on atherosclerosis in mice models through serum analysis. Methods: Animals received a high-fat diet for disease induction and a weekly PRP retro-orbital application. Effectiveness was evaluated by measuring inflammatory markers in plasma following the treatment of mice with either PRP or saline solution. Results: PRP was well characterized for platelet and GF concentrations; the atherosclerotic profile was established. Cytokine concentrations were altered after PRP applications. Conclusion: PRP could modulate the inflammatory pattern in the early stages of atherosclerosis.

Platelet-rich plasma (PRP) contains growth factors, which stimulate normal wound healing. This product seems to be a good modulator of white blood cells and has not been investigated in atherosclerosis. This study aimed to evaluate PRP in atherosclerosis using mice models. The PRP was produced from animals and preserved using the lyophilization technique; the product was then applied weekly in the vein. For atherosclerosis induction, genetically modified animals were fed a high-fat diet. The effectiveness was evaluated by measuring plasma inflammatory markers after treatment, and PRP seemed to alter cell-signaling molecules (cytokines). This study concluded that PRP was capable of modulating the inflammatory pattern during the early stages of atherosclerosis.

Prediabetes Induces More Severe Acute COVID-19 Associated With IL-6 Production Without Worsening Long-Term Symptoms.

Aims: Pre-existing conditions, such as age, hypertension, obesity, and diabetes, constitute known risk factors for severe COVID-19. However, the impact of prediabetes mellitus (PDM) on COVID-19 severity is less clear. This study aimed to evaluate the influence of PDM in the acute and long-term phases of COVID-19. Materials and methods: We compared inflammatory mediators, laboratory and clinical parameters and symptoms in COVID-19 patients with prediabetes (PDM) and without diabetes (NDM) during the acute phase of infection and at three months post-hospitalization. Results: Patients with PDM had longer hospital stays and required intensive care unit admission more frequently than NDM. Upon hospitalization, PDM patients exhibited higher serum levels of interleukin 6 (IL-6), which is related to reduced partial pressure of oxygen (PaO2) in arterial blood, oxygen saturation (SpO2) and increased COVID-19 severity. However, at three months after discharge, those with PDM did not exhibit significant alterations in laboratory parameters or residual symptoms; however, PDM was observed to influence the profile of reported symptoms. Conclusions: PDM seems to be associated with increased risk of severe COVID-19, as well as higher serum levels of IL-6, which may constitute a potential biomarker of severe COVID-19 risk in affected patients. Furthermore, while PDM correlated with more severe acute-phase COVID-19, no long-term worsening of sequelae was observed.

LTB4-Driven Inflammation and Increased Expression of ALOX5/ACE2 During Severe COVID-19 in Individuals With Diabetes.

Diabetes is a known risk factor for severe coronavirus disease 2019 (COVID-19), the disease caused by the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, there is a lack of knowledge about the mechanisms involved in the evolution of COVID-19 in individuals with diabetes. We aimed to evaluate whether the chronic low-grade inflammation of diabetes could play a role in the development of severe COVID-19. We collected clinical data and blood samples of patients with and without diabetes hospitalized for COVID-19. Plasma samples were used to measure inflammatory mediators and peripheral blood mononuclear cells, for gene expression analysis of the SARS-CoV-2 main receptor system (ACE2/TMPRSS2), and for the main molecule of the leukotriene B4 (LTB4) pathway (ALOX5). We found that diabetes activates the LTB4 pathway and that during COVID-19 it increases ACE2/TMPRSS2 as well as ALOX5 expression. Diabetes was also associated with COVID-19-related disorders, such as reduced oxygen saturation as measured by pulse oximetry/fraction of inspired oxygen (FiO2) and arterial partial pressure of oxygen/FiO2 levels, and increased disease duration. In addition, the expressions of ACE2 and ALOX5 are positively correlated, with increased expression in patients with diabetes and COVID-19 requiring intensive care assistance. We confirmed these molecular results at the protein level, where plasma LTB4 is significantly increased in individuals with diabetes. In addition, IL-6 serum levels are increased only in individuals with diabetes requiring intensive care assistance. Together, these results indicate that LTB4 and IL-6 systemic levels, as well as ACE2/ALOX5 blood expression, could be early markers of severe COVID-19 in individuals with diabetes.

Periodontal surgery associated with odontoplasty in the esthetic functional rehabilitation of a fractured anterior tooth.

Anterior dental fractures often require a multidisciplinary approach. This article presents a case in which an extensive fracture with palatal biological width invasion was treated successfully through clinical crown lengthening with odontoplasty. This procedure was a simple direct technique that restored the tooth without damaging the dental esthetics, the gingival contour, or the papillae.

Online exports and the skilled-unskilled wage gap.

The development of the Internet is often seen as a source of demand for skilled workers and therefore a potential driver of the wage gap between skilled and unskilled workers. This paper focuses on the impact that international trade in online platforms has on the skilled-unskilled wage gap. Because online trade allows smaller firms with relatively more unskilled workers to access world markets, one can expect an expansion of online exports to reduce the wage gap. After correcting for potential endogeneity bias in a sample of 22 developing countries for which online trade and wage gap data can be matched, we find that a 1 percent increase in the share of online exports over GDP leads to a 0.01 percent decline in the skilled-unskilled wage gap.

ANTEROLATERAL APPROACHES FOR PROXIMAL HUMERAL OSTEOSYNTHESIS: A SYSTEMATIC REVIEW.

OBJECTIVE: Anterolateral approaches for proximal humerus osteosynthesis have great advantages because they allow direct exposure of the lateral aspect of the humerus without the muscular retraction seen in the deltopectoral approach. However, much resistance is found among surgeons due to the potential risk of iatrogenic injury to the axillary nerve. To identify the incidence of axillary nerve iatrogenic lesions and evaluate the functional results of proximal humerus osteosynthesis with locking plates using anterolateral approaches. METHODS: The literature review followed the PRISMA protocol. RESULTS: A total of 23 articles were selected from 786 patients submitted to anterolateral approaches. Three cases (0.38%) of iatrogenic axillary nerve lesions were confirmed. The results of the functional tests were similar to those of the deltopectoral approach. CONCLUSION: Anterolateral approaches are a viable and safe alternative for proximal humerus osteosynthesis with locking plate. Subacromial impingement was the most frequent complication. Level of Evidence II, Systematic Review.

OBJETIVO: As vias de acesso anterolaterais para a osteossíntese do úmero proximal permitem a exposição direta do aspecto lateral do úmero sem necessitar das retrações musculares da via deltopeitoral. Contudo, há grande preocupação com a possibilidade de lesão iatrogênica do nervo axilar e consequente piora no resultado funcional pós-operatório. Identificar a incidência de lesões iatrogênicas do nervo axilar e avaliar os resultados funcionais da osteossíntese do úmero proximal com placas bloqueadas, utilizando as vias anterolaterais. MÉTODOS: Revisão da literatura seguindo o protocolo PRISMA. RESULTADOS: Foram selecionados 23 artigos do total de 786 indivíduos submetidos às vias de acesso anterolaterais. Foram confirmados 3 casos (0,38%) de lesões iatrogênicas do nervo axilar. Os resultados dos testes funcionais foram semelhantes aos da via deltopeitoral. CONCLUSÃO: As vias de acesso anterolaterais são uma alternativa viável e segura para a osteossíntese do úmero proximal com placas bloqueadas. Nível de Evidência II, Revisão Sistemática.

DOES SURGEON SPECIALIZATION CHANGE THE PROXIMAL HUMERAL OSTEO-SYNTHESIS APPROACH?

OBJECTIVE: To evaluate the choice of surgical approach among Brazilian orthopedists and whether shoulder surgery specialty training or duration of experience influences the decision-making. METHODS: A questionnaire on the preferred approach and complications was administered to orthopedic surgeons with and without shoulder specialization training. The chi-square test or Fisher's exact test was applied. RESULTS: We interviewed 114 orthopedists, 49 (43.0%) traumatologists, 36 (31.5%) specialist surgeons, and 29 (25%) shoulder surgery specialist residents. In cases of fracture without dislocation, specialized training and duration of experience did not influence the approach used (primarily deltopectoral). In cases of fracture/dislocation, 97.2% of the specialists versus 82.1% of the traumatologists opted for the deltopectoral approach (p = 0.034). In cases of fractures/dislocation, 92.5% of surgeons with more than 5 years of experience and 78.7% with less than 5 years of experience opted for the deltopectoral approach (p = 0.032). CONCLUSION: Specialization in shoulder surgery did not influence surgeons' approaches to manage fractures without dislocation. In cases of fracture/dislocation, shoulder surgery specialization training and duration of experience were associated with selection of the deltopectoral approach. Level of Evidence V, Expert opinion.

OBJETIVO: Avaliar a via de acesso de escolha entre os ortopedistas brasileiros e se a formação de especialista em cirurgia do ombro e/ou tempo de experiência influenciam nessa decisão. MÉTODOS: Realizou-se questionário entre ortopedistas, com e sem especialização em ombro, sobre qual a via de acesso preferida e as complicações observadas. Aplicou-se o teste do qui-quadrado ou o teste exato de Fisher. RESULTADOS: Foram entrevistados 114 ortopedistas, 49 (43,0 %) traumatologistas, 36 (31,5 %) cirurgiões especialistas e 29 (25 %) residentes de especialização em cirurgia do ombro. Nas fraturas sem luxação a formação especializada e o tempo de experiência não influenciaram na escolha (maioria deltopeitoral). Na fratura/luxação, 97,2% dos especialistas optaram pela deltopeitoral, comparado com 82,1% dos traumatologistas (p=0,034). Nas fraturas/luxação, cirurgiões com experiência superior a 5 anos optaram pela deltopeitoral (92,5%) e aqueles com menos de 5 anos optaram pela via deltopeitoral (78,7%) (p=0,032). A diminuição do arco de movimento (ADM) foi a complicação mais relatada. CONCLUSÃO: A especialização em cirurgia do ombro não influenciou na escolha nas fraturas sem luxação. Na fratura/luxação, a especialização e o tempo de experiência associaram-se à escolha da via deltopeitoral. A complicação mais frequente foi a diminuição do ADM, principalmente entre os cirurgiões do Ombro. Nível de Evidência V, Opinião de especialistas.