Comparing dextrose prolotherapy with other substances in knee osteoarthritis pain relief: A systematic review

Abstract The objective of this study is to compare the effectiveness of dextrose-prolotherapy with other substances for pain relief in patients with primary knee osteoarthritis. The literature screening was done in January 2021 through Medline (PubMed), EMBASE, and Database of the National Institute of Health based on the following criteria: randomized clinical trials that subjected patients with primary knee osteoarthritis who underwent treatment with dextrose-prolotherapy and other substances for pain relief. Paired reviewers independently identified 3381 articles and included 8 trials that met the eligibility criteria. According to the findings of this review, participants that underwent dextrose-prolotherapy showed improvements between baseline and posterior assessments and when compared to saline injections, but when compared to other substances, the results were not clear. Although dextrose-prolotherapy is a useful treatment method by itself, it is still not possible to clearly affirm that it is superior or inferior to its counterparts. There is an urgent need for further studies to bring more evidence to the field. HIGHLIGHTS Dextrose injections promote deposition of collagen into injured structures through growth factors and inflammatory cells. Dextrose-prolotherapy is a useful treatment method, but it is not superior or inferior to its counterparts.

Burkholderia cepacia, cystic fibrosis and outcomes following lung transplantation: experiences from a single center in Brazil

OBJECTIVES: To evaluate the impact of Burkholderia cepacia complex colonization in cystic fibrosis patients undergoing lung transplantation. METHODS: We prospectively analyzed clinical data and respiratory tract samples (sputum and bronchoalveolar lavage) collected from suppurative lung disease patients between January 2008 and November 2013. We also subtyped different Burkholderia cepacia complex genotypes via DNA sequencing using primers against the recA gene in samples collected between January 2012 and November 2013. RESULTS: From 2008 to 2013, 34 lung transplants were performed on cystic fibrosis patients at our center. Burkholderia cepacia complex was detected in 13 of the 34 (38.2%) patients. Seven of the 13 (53%) strains were subjected to genotype analysis, from which three strains of B. metallica and four strains of B. cenocepacia were identified. The mortality rate was 1/13 (7.6%), and this death was not related to B. cepacia infection. CONCLUSION: The results of our study suggest that colonization by B. cepacia complex and even B. cenocepacia in patients with cystic fibrosis should not be considered an absolute contraindication to lung transplantation in Brazilian centers.

Impact of obesity and surgical skills in laparoscopic totally extraperitoneal hernioplasty / Impacto da obesidade e habilidades cirúrgicas na hernioplastia laparoscópica totalmente extraperitoneal

ABSTRACT Background: Laparoscopic totally extraperitoneal (TEP) hernia repair is a technically demanding procedure. Recent studies have identified BMI as an independent factor for technical difficulty in the learning period. Aim: To analyze the effect of overweight and obesity on the technical difficulties of TEP. Method: Prospective study on patients who underwent a symptomatic inguinal hernia by means of the TEP technique. Were analyzed gender, BMI, previous surgery, hernia type, operative time and complications. Technical difficulty was defined by operative time, major complications and recurrence. Patients were classified into four groups: 1) underweight, if less than 18,5 kg/m²; 2) normal range if BMI between 18,5 and 24,9 kg/m²; 3) overweight if BMI between 25-29,9 kg/m²; and 4) obese if BMI≥30 kg/m². Results: The cohort had a total of 190 patients, 185 men and 5 women. BMI values ranged from 16-36 kg/m² (average 26 kg/m²). Average operating time was 55.4 min in bilateral hernia (15-150) and 37.8 min in unilateral (13-150). Time of surgery was statistically correlated with increased BMI in the first 93 patients (p=0.049). Conclusion: High BMI and prolonged operative time are undoubtedly correlated. However, this relationship may be statistically significant only in the learning period. Although several clinical features can influence surgical time, upon reaching an experienced level, surgeons appear to easily handle the challenges.

RESUMO Racional: A hernioplastia laparoscópica totalmente extraperitoneal (TEP) é procedimento tecnicamente exigente. Estudos recentes identificaram o IMC como um fator independente para a dificuldade técnica durante o período de aprendizagem. Objetivo: Analisar o efeito do sobrepeso e da obesidade sobre as dificuldades técnicas na TEP. Método: Estudo prospectivo em pacientes submetidos à hernioplastia inguinal sintomática por meio da TEP. Foram analisados gênero, IMC, operação prévia, tipo de hérnia, tempo operatório e presença de complicações. A dificuldade técnica foi definida pelo tempo operatório, complicações maiores e recorrência. Os pacientes foram classificados em quatro grupos: 1) baixo peso, se menor que 18,5 kg/m²; 2) peso normal se IMC entre 18,5 e 24,9 kg/m²; 3) sobrepeso se IMC entre 25 e 29,9 kg/m²; e 4) obesos se IMC≥30 kg/m². Resultados: A coorte incluiu 190 pacientes, 185 homens e cinco mulheres. Os valores de IMC variaram de 16-36 kg/m² (média de 26 kg/m²). O tempo médio de operação foi de 55,4 min nas hérnias bilaterais (15-150) e 37,8 min nas unilaterais (13-150). O tempo cirúrgico foi estatisticamente correlacionado com o aumento do IMC nos primeiros 93 pacientes (p=0,049). Conclusão: IMC elevado e tempo operatório prolongado estão indubitavelmente correlacionados. No entanto, esta relação pode ser estatisticamente significativa apenas no período de aprendizagem. Embora várias características clínicas possam influenciar o tempo cirúrgico, ao chegar a um nível experiente, os cirurgiões parecem lidar facilmente com os desafios.

Perioperative management of drugs commonly used in patients with rheumatic diseases: a review

Rheumatic diseases are very prevalent, affecting about 7 million people in North America; they affect the musculoskeletal system, often with systemic involvement and potential for serious consequences and limitation on quality of life. Clinical treatment is usually long-term and includes drugs that are considered either simple or complex and are occasionally unknown to many health professionals who do not know how to manage these patients in emergency units and surgical wards. Thus, it is important for clinicians, surgeons and anesthesiologists who are involved with rheumatic patients undergoing surgery to know the basic principles of therapy and perioperative management. This study aims to do a review of the perioperative management of the most commonly used drugs in rheumatologic patients. Manuscripts used in this review were identified by surveying MEDLINE, LILACS, EMBASE, and COCHRANE databases and included studies containing i) the perioperative management of commonly used drugs in patients with rheumatic diseases: and ii) rheumatic diseases. They are didactically discussed according to the mechanism of action and pharmacokinetics; and perioperative management. In total, 259 articles related to the topic were identified. Every medical professional should be aware of the types of drugs that are appropriate for continuous use and should know the various effects of these drugs before indicating surgery or assisting a rheumatic patient postoperatively. This information could prevent possible complications that could affect a wide range of patients.

Human islet xenotransplantation in rodents: A literature review of experimental model trends

Among the innovations for the treatment of type 1 diabetes, islet transplantation is a less invasive method of treatment, although it is still in development. One of the greatest barriers to this technique is the low number of pancreas donors and the low number of pancreases that are available for transplantation. Rodent models have been chosen in most studies of islet rejection and type 1 diabetes prevention to evaluate the quality and function of isolated human islets and to identify alternative solutions to the problem of islet scarcity. The purpose of this study is to conduct a review of islet xenotransplantation experiments from humans to rodents, to organize and analyze the parameters of these experiments, to describe trends in experimental modeling and to assess the viability of this procedure. In this study, we reviewed recently published research regarding islet xenotransplantation from humans to rodents, and we summarized the findings and organized the relevant data. The included studies were recent reports that involved xenotransplantation using human islets in a rodent model. We excluded the studies that related to isotransplantation, autotransplantation and allotransplantation. A total of 34 studies that related to xenotransplantation were selected for review based on their relevance and current data. Advances in the use of different graft sites may overcome autoimmunity and rejection after transplantation, which may solve the problem of the scarcity of islet donors in patients with type 1 diabetes.

Laparoscopic totally extraperitoneal (TEP) hernioplasty using two trocars: anatomical landmarks and surgical technique / Hernioplastia laparoscópica totalmente extraperitoneal (TEP) utilizando dois trocárteres: reparos anatômicos e técnica cirúrgica / Hernioplastia laparoscópica totalmente extraperitoneal (TEP) utilizando dois trocárteres: reparos anatômicos e técnica cirúrgica

BACKGROUND: Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach are widely accepted alternatives to open surgery, both providing less postoperative pain, hospital length of stay and early return to work. Classical TEP technique requires three skin incisions for placement of three trocars in the midline or in triangulation. AIM: To describe a technique using only two trocars for laparoscopic total extraperitoneal for inguinal hernia repair. METHOD: Extraperitoneal access: place two regular trocars on the midline. The 10 mm is inserted into the subcutaneous in horizontal direction after a transverse infra-umbilical incision and then elevated at 60º angle. The 5 mm trocar is inserted at the same level of the pubis with direct vision. Preperitoneal space dissection: introduction 0º optical laparoscope through the infra-umbilical incision for visualization and preperitoneal dissection; insufflation pressure must be below 12 mmHg. Dissection of some anatomical landmarks: pubic bone, arcuate line and inferior epigastric vessels. Exposure of "triangle of pain" and "triangle of doom". Insertion through the 10 mm trocar polypropylene mesh of 10x15 cm to cover the hernia sites. Peritoneal sac and the dorsal edge of the mesh are repositioned in order to avoid bending or mesh displacement. It is also important to remember that the drainage is not necessary. RESULTS: The 2-port TEP required less financial costs than usual because it is not necessary an auxiliary surgeon to perform the technique. Trocars, suturing material and wound dressing were spared in comparison to the classical technique. Besides, there were only two incisions, which provides a better plastic result and less postoperative pain. CONCLUSION: The TEP technique using two trocars is an alternative technique which improves cosmetic and financial outcomes. .

RACIONAL: Dentre as correções endoscópicas das hérnias, as abordagens totalmente extraperitoneal (TEP) e transabdominal pré-peritoneal (TAPP) são amplamente aceitas como alternativas à operação aberta, fornecendo menos dor no período pós-operatório, menor tempo de permanência hospitalar e retorno precoce ao trabalho. A técnica TEP clássica requer três incisões na pele para a colocação de três trocárteres na linha média ou em triangulação. OBJETIVO: Descrever uma técnica utilizando apenas dois trocárteres para hernioplastia laparoscópica totalmente extraperitoneal (TEP). MÉTODO: Acesso extraperitoneal: são inseridos dois trocárteres sobre a linha média; um de 10 mm é inserido no subcutâneo em direção horizontal após incisão infra-umbilical transversal e, em seguida, elevado ao ângulo de 60°; outro de 5 mm é inserido ao nível do pubis com visão direta. Tempos operatórios: 1) dissecção do espaço preperitoneal: introdução da ótica laparoscópica de 0º através da incisão infra-umbilical para visualização e dissecção pré-peritoneal; pressão de insuflação inferior a 12 mmHg; 2) Dissecção de alguns reparos anatômicos: pubis, linha arqueada e vasos epigástricos inferiores; 3) reconhecimento do "triângulo da dor" e "triângulo do desastre"; 4) Inserção através do trocáter de 10 mm de tela de polipropileno de 10x15 cm para cobrir o sitio da hérnia; 5) Reposicionamento do peritônio e da borda dorsal da tela para evitar dobras ou deslocamento da tela. Não é necessária a drenagem. RESULTADOS: Esta técnica foi utilizada em nove pacientes e apresentou bom resultado sem necessidade de um cirurgião auxiliar para executá-la, apenas dois trocáteres, menos material de sutura e de curativos. Além disso, exigiu apenas duas incisões, o que proporcionou melhor resultado estético e menor dor no período pós-operatório. CONCLUSÃO: A técnica proposta utilizando dois trocárteres é uma alternativa viável, com melhora dos resultados cosméticos e financeiros. .

Extensão Médica Acadêmica: um projeto da Faculdade de Medicina da Universidade de São Paulo para treinamento clínico e humanização do cuidado em saúde de alunos da medicina, nutrição e fisioterapia / “Extensão Médica Acadêmica”: healthcare humanization and clinical training of medicine, nutrition and physical therapy students from the School of Medicine of University of São Paulo

A Extensão Médica Acadêmica (EMA) foifundada em 1998 na FMUSP visando à formação de médicos que valorizam o exame clínico e o relacionamentohumano. É um projeto de voluntariado atualmente organizado por estudantes de medicina, fisioterapia e nutrição da USP. O EMA é sustentado por três pilares: ensino, assistência e pesquisa. O projeto é realizado aos sábados em dois bairros carentes da cidade de SãoPaulo, e tem como objetivo oferecer um atendimento ambulatorial gratuito de qualidade, que priorize cuidados em saúde e humanização na relação médico-paciente. Os pacientes são atendidos por alunos e os casos sãodiscutidos com profissionais de saúde, e durante a semana são realizadas reuniões com todos os membros doprojeto, na Faculdade de Medicina da USP, contribuindo para a consolidação e aprofundamento dos conceitos em saúde. Este modelo de ensino complementa os estudos em sala de aula, pois permite o desenvolvimento de habilidades geralmente pouco exploradas durante o início da graduação tradicional. O EMA incentiva seus alunos a valorizarem a relação médico-paciente desde o primeiroano da graduação. Assim, o projeto tem êxito em reunir pessoas dispostas a lidar com pacientes, aprender sobresaúde e ensinar outros estudantes. Como resultado, muitos de seus membros continuam a participar do projeto após o término da faculdade, tornando-se orientadores comprometidos a passar adiante o conhecimento adquirido durante sua prática profissional...

The Academic Medical Extension (EMA) is a volunteer project of the School of Medicine of University of São Paulo organized by students of Medicine, Physical Therapy and Nutrition of University of São Paulo. It was founded in 1998 in order to provide a better academic development to students who value physical examination and human relations, besides providing to students in the beginning of graduation an early contact with patients and promotingan exchange of information between those three areas of health. EMA is sustained by three pillars: assistance,education and research, thus constituting an alternative tocommunity-based education and assistance with a focus on humanization. The project is carried in two regions in the city of São Paulo and aims to offer these needy populationsa free ambulatory care with quality, promote health and prevention. On Saturdays, undergraduate students see the patients and discuss the clinical case with a health professional; once a week, they attend a meeting with their group, which includes students of the three areas of health. During this meeting, the students report the clinical case and are assisted by other students to conduct the case and teachwhat they’ve learnt about the patient, collaborating with the establishment and deepening of the concepts in health. The project seeks to encourage their students since the first yearof college to value the physician-patient relationship. Thus, it brings together people willing to work ithout the intention to earn a profit, but to learn more about health and to teachother students. As a result, members still participate in the project after graduation, as doctors committed to pass on their experience and knowledge...

Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP): descrição de um projeto musical de gestão, comunicação e relacionamento dos acadêmicos de medicina da Faculdade de Medicina da Universidade de São Paulo / “Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP)”: description of a project of music, management, communication and relationship of medical students of“Faculdade de Medicina da Universidade de São Paulo”

Recentemente tem se discutido muito sobre a formação médica dos acadêmicos das faculdades de medicina. A humanização é um aspecto que influencia a formação de um profissional médico com aptidão para lidar com seres humanos. Estudantes daFaculdade de Medicina da Universidade de São Paulo (FMUSP) com interesse em música se reuniram e formaram um grupo que realiza apresentações musicais em um recital. Assim foi criadoo Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP). Os membros do REMUSP realizam ensaios no Teatro da Faculdade de Medicina da USP de quatro a cinco horas por semana, aproximadamente, organizados através de grupos de Facebook e e-mail. No ano de 2011, durante a sua primeira apresentação, os membros do REMUSP executaram peças predominantemente do estilo clássico e popular, como: Canon In D – Johann Pachelbel, Ave Maria – Johann Sebastian Bach, Solfeggietto – C.P.E. Bach, Can You Feel The Love Tonight? – Elton John, New York, New York – Frank Sinatra, Kiss From a Rose – Seal etc. Atualmente, o REMUSP procuraestimular a cooperatividade e organização nas apresentações musicais, sendo que os ensaios são cada vez mais preenchidos por peças tocadas em conjuntos, em detrimento das individuais, visando à integração e ao aperfeiçoamento da comunicação eorganização de um grupo musical composto por futuros médicos mais humanizados...

Recently there has been an important discussion about the training of medical students from medical colleges.Humanization is an aspect that influences the formation of a medical professional with the ability to deal with human beings. Students of the Faculty of Medicine, University of SãoPaulo (USP) interested in music came together and formed a group that performs in a musical recital. Thus was created the Recital Students of Medicine, University of São Paulo(REMUSP). Members of REMUSP perform musical rehearsals at the Theatre, Faculty of Medicine, USP, four to five hours per week, approximately, organized through Facebook groupsand e-mail. In 2011, during their first presentation, members of the REMUSP performed predominantly classic style and popular as: Canon In D - Johann Pachelbel, Ave Maria - JohannSebastian Bach, Solfeggietto - CPE Bach, Can You Feel The Love Tonight? - Elton John, New York, New York - FrankSinatra, Kiss From a Rose - Seal etc. Currently, the demand REMUSP stimulate cooperatively and organization in musical performances, and musical rehearsals are increasingly filled by pieces to be played by a group, at the expense of the individual,aiming at integration and improvement of communication and organization of a musical group composed of future doctors more humanized...