Etiology and antimicrobial resistance patterns in chronic osteomyelitis of the tibia: an 11-year clinical experience.

PURPOSE: To analyze changes in tendency of etiology and of antimicrobial resistance patterns to most common local and systemic antibiotics in chronic osteomyelitis of the tibia (COM-T) in a Level I trauma center over an 11-year period. METHODS: A retrospective review including all patients with COM-T who were surgically treated from January 2009 to December 2019. Patients were divided into two period groups: 2009-2014 and 2015-2019. Microbiologic etiology was analyzed. Bacterial resistance patterns evaluation was based on the Magiorakos et al. classification, including proportions of multidrug-resistant organisms (MDROs, acquired non-susceptibility to at least one agent in three or more antimicrobial categories), extensively drug-resistant (XDR) and pan drug-resistant (PDR) organisms encountered. RESULTS: A total of 173 episodes of COM-T were identified. Monomicrobial infections represented 47.4% of all cases, while 28.3% had polymicrobial infections. Negative deep-bone cultures were identified in 24.3% of the patients. The most commonly isolated microorganisms were coagulase-negative Staphylococci (24.5%) and S. aureus (20.5%). No differences were found when comparing Gram-positive infections between periods (58.3% for 2009-2014 vs. 46.7% for 2015-2019; p = 0.10). Findings were similar for Gram-negative infections (37% vs. 33.7%; p = 0.62), although more polymicrobial infections were detected (24.7% vs. 33.3%, respectively; p = 0.359). MDROs were involved in 15% of the cases, with an upward trend when comparing both periods (12.8% vs. 23.6%; p = 0.07). The most-used combination of local antibiotics-glycopeptide (vancomycin) plus aminoglycoside (gentamicin or tobramycin)-was met with low rates of resistance in the most frequently isolated microorganisms. CONCLUSION: According to the results of the present study, rates of Gram-positive and Gram-negative infections remained consistent during the two study periods, but with an upward trend in MDRO and polymicrobial infections detected. The local combination of a glycopeptide plus an aminoglycoside was effective in treating the most frequently isolated microorganisms.

Aplicação da estimulação elétrica nervosa transcutânea em indivíduos com disfunção temporomandibular: ensaio clínico randomizado / Application of transcutaneous nervous electric stimulation in individuals with temporomandibular dysfunction: randomized clinical trial

INTRODUÇÃO: A fisioterapia dispõe de vários recursos para o tratamento da disfunção temporomandibular, como a estimulação elétrica nervosa transcutânea (TENS), mas com muitas variações nos protocolos e parâmetros dosimétricos. OBJETIVO: Analisar a eficácia da estimulação elétrica nervosa transcutânea (TENS), com duração de fase e frequência fixas, na analgesia e funcionalidade de disfunções temporomandibulares. MÉTODOS: A amostra foi composta por 20 indivíduos, separados em grupo tratado e placebo, ao longo de 2 semanas de tratamento, avaliados pelo Questionário de Sintomas Mandibulares e Hábitos Orais, analisando dor e função articular. RESULTADOS: Ambos os grupos apresentaram redução na dor e escore geral, comparados ao momento préintervenção, para a função, apenas o TENS apresentou redução dos valores, mas, não houve diferenças entre os grupos. CONCLUSÃO: TENS não foi diferente do placebo no controle da dor porém, promoveu a melhora funcional nos voluntários.

INTRODUCTION: Physiotherapy has several resources for the treatment of temporomandibular dysfunction, such as transcutaneous electrical nerve stimulation (TENS), but with many variations in protocols and dosimetric parameters. OBJECTIVE: To analyze the efficacy of transcutaneous electrical nerve stimulation (TENS), with fixed phase duration and frequency, in the analgesia and functionality of temporomandibular disorders. METHODS: The sample consisted of 20 individuals, separated in a treated group and placebo, during 2 weeks of treatment, evaluated by Questionnaire on Mandibular Symptoms and Oral Habits, analyzing pain and joint function. RESULTS: Both groups presented reduction in pain and general score, compared to the pre-intervention moment, for the function, only the TENS showed a reduction of the values, but there were no differences between the groups. CONCLUSION: TENS was not different from placebo in pain control, however, it promoted functional improvement in volunteers.