Bone Marrow Aspirate Concentrate Improves Outcomes in Adults With Osteochondral Dissecans of the Talus and Achilles Rupture.

PURPOSE: The objective of this systematic literature review was to investigate the effects of the clinical application of bone marrow aspirate (BMA) and/or bone marrow aspirate concentrate (BMAC) in tendon and cartilage injuries in the foot and ankle. METHODS: A search of the Embase, MEDLINE/PubMed, CINAHL, and Cochrane databases was performed in January 2021. The risk of bias of the studies was assessed using the tool "A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies." The outcomes analyzed included pain reduction and functional improvement with the use of BMA/BMAC in patients with tendon and cartilage injuries in the foot and ankle. RESULTS: Eleven studies met the inclusion criteria for analysis, involving a total of 527 subjects with osteochondral lesions (OCLs) of the talus, cartilage lesions of the talus, and acute Achilles tendon rupture. BMAC was applied alone in 4 studies, and in 7 studies, it was compared with other techniques such as matrix-induced autologous chondrocyte implantation, particulate juvenile articular cartilage, or microfracture. Interventions demonstrated improved function and reduced foot and ankle pain and showed no serious adverse effects. CONCLUSIONS: Evidence indicates that BMAC provides good clinical results, with improved function and reduced pain in adults with OCL and cartilage lesions of the talus and acute Achilles tendon rupture. LEVEL OF EVIDENCE: Level IV, systematic review of level II to IV studies.

Validade das informaçöes ocupaçäo e causa básica em declaraçöes de óbito de Botucatu, Säo Paulo / Validity of information on occupation and principal cause on death certificates in Botucatu, Säo Paulo

Estuda a validade das informaçöes sobre ocupaçäo habitual e causa básica em declaraçöes de óbito (DO) de moradores de Botucatu falecidos nesta cidade. Analisou-se a concordância dessas informaçöes com seus padröes-ouro, estabelecidos por intermédio de entrevistas com familiares de 552 falecidos em 1997 e análise de documentaçäo médica. O coeficiente Kappa para a concordância entre a informaçäo sobre ocupaçäo e o padräo-ouro foi 0,31 (IC 95 por cento 0,29-0,34). Para a concordância entre causa básica declarada e o padräo-ouro, o coeficiente Kappa foi de 0,76 (IC 95 por cento 0,75-0,77). Conclui-se que, embor a validade da informaçäo sobre a causa básica do óbito seja boa, a validade da informaçäo sobre a ocupaçäo habitual é bastante precária. Isto impossibilita a utilizaçäo dessas informaçöes em estudos epidemiológicos locais. Tal constataçäo alerta para a necessidade de previamente verificar a fidedignidade de informaçöes ocupacionais provenientes de declaraçöes de óbito em estudos de saúde do trabalhador. Outra implicaçäo desse achado é enfatizar a necessidade de investir-se n melhoria da qualidade dessas informaçöes.