Possible role of ALDH1 and CD44 in lip carcinogenesis

Abstract Lip squamous cell carcinoma (LSCC) accounts for 12% of all head and neck cancers. It is caused by chronic exposure to ultraviolet light solar radiation and related to previous actinic cheilitis (AC). This study aimed to investigate the immunostaining of the putative cancer stem cells (CSC) markers ALDH1 and CD44 in AC (n=30) and LSCC (n=20). ALDH1 positivity was found to be statistically higher in LSCC than in AC lesions (p=0.0045), whilst CD44 expression was statistically higher in AC than in LSCC lesions (p=0.0155). ALDH1+ cells in AC lesions were associated with specific clinical features: a younger age (<60 years old), the female gender, white skin, not smoking or consuming alcohol, and a fast evolution, and not associated with the chronic exposure to UV radiation (p<0.0001). CD44 positivity was associated with patients who were male, feoderm, smoked, consumed alcohol, underwent occupational exposure to UV-radiation, and demonstrated lesions with log-time evolution (p<0.0001). ALDH1 + cells were associated with mild dysplasia using a system from the World Health Organization (WHO), and with a low risk of malignant transformation, according to the binary system (p<0.0001). CD44+ cells were also associated with moderated dysplasia, according to the WHO system. In LSCC, ALDH1 + cells were positively associated with patients who were older (≥ 60 years old), smokers, and with those who consumed alcohol (p<0.0001). CD44 + cells in LSCC were associated with older (≥ 60 years old) patients as well, but also with female patients, white skin, non-smokers, and individuals who did not consume alcohol (p<0.0001), all of whom showed distinct patterns in pre- and malignant lesions of both markers. Additionally, in LSCC, both ALDH1 and CD44 staining were associated with smaller tumor sizes (T1/T2; p<0.0001). In summary, although both ALDH1 and CD44 were associated with the presence of dysplasia in AC lesions, the present findings suggest that ALDH1 and CD44 may be activated by different etiopathogenic pathways, predominantly in distinct steps of oral carcinogenesis. CD44 would thus be more significantly related to the potentially malignant lesion, while ALDH1 would be closely linked to malignancy.

Mentorship in Medical Residency in Orthopedics: Evaluation of a Program by Mentors and Mentees / Mentoria na residência médica em Ortopedia: Avaliação de um programa por mentores e mentorados

Abstract Objective To demonstrate the degree of recommendation of mentors and mentees regarding a mentorship program, to assess the degree of satisfaction of the participants, and to describes the main characteristics of the meetings in pairs. Materials and Methods A primary, retrospective, analytical study based on answers to the annual evaluation questionnaires of the institutional mentorship program in pairs of the Orthopedics and Traumatology residency from December 2017 to February 2021. Results We compiled 52 responses from 26 mentorship preceptors and 26 mentored residents. The mentees and mentors had average ages of 27 (±1.5) years and 45 (±8.2) years respectively. A total of 96% of the participants recommend the program, and 89% of the mentees reported that the mentors contributed to their personal and professional decision-making process. Conclusion The mentorship program proved to be a highly recommended strategy in medical residency in Orthopedics. Data show that mentors contributed to the mentees' personal and professional decision-making process.

Resumo Objetivo Demonstrar o grau de recomendação de mentores e mentorados quanto à participação em um programa de mentoria, avaliar o grau de satisfação dos participantes, e descrever as principais características das reuniões em dupla. Materiais e Métodos Estudo primário, retrospectivo, analítico, com análise das respostas dos questionários de avaliação anual do programa de mentoria em dupla da residência de Ortopedia e Traumatologia da instituição de dezembro de 2017 a fevereiro de 2021. Resultados Foram obtidas 52 respostas de 26 preceptores mentores e 26 residentes mentorados. A média de idade dos mentorados foi de 27 anos (±1,5 ano), ao passo que a média de idade dos mentores foi de 45 anos (±8,2 anos). O grau de recomendação do programa pelos participantes foi de 96%, e 89% dos mentorados consideraram que os mentores contribuíram para a tomada de decisões pessoais e profissionais. Conclusão O programa de mentoria se mostrou uma estratégia com alto grau de recomendação na residência médica em Ortopedia. Os dados mostram que os mentores contribuíram para a tomada de decisões pessoais e profissionais dos mentorados.

Construction and Validation of a Questionnaire to Assess the Physician-Patient Relationship and its Association with Bioethical Principles / Construcción y validación de un cuestionario para evaluar la relación médico-paciente y su asociación con los principios bioéticos / Construção e validação de um questionário para avaliar a relação médico-paciente e sua associação com os princípios bioéticos

Abstract Physician-patient relationship (PPR) is a professional-interpersonal relationship that serves as the basis for health management. We aimed to develop an instrument for patients to assess the medical attention received in the outpatient clinic. A 21 question instrument was administered to evaluate its reliability and consistency. The intraclass correlation coefficient was 0.81 (p < 0.05); to fulfill the bioethical principles, the intraclass correlation coefficient was 0.740 (p < 0.05), allowing us to get familiar with the perception of patients who attended the Nephrology Service. The survey showed autonomy as the most reported principle (69 %), followed by dignity (67 %) and justice (60 %). Courtesy, punctuality, and respect make the disease and its treatment more bearable, in addition to promoting the ethics of third parties.

Resumen La relación médico-paciente (RMP) es una relación profesional-interpersonal base para la gestión de la salud. Nuestro objetivo fue desarrollar un instrumento que permitiera evaluar la presencia de los principios bioéticos en la atención médica recibida en la consulta externa de una institución hospitalaria. El instrumento quedó constituido por 21 reactivos para evaluar su confiabilidad y consistencia. El coeficiente de correlación intraclase fue de 0,81 (p < 0,05); para el cumplimiento de los principios bioéticos, fue de 0,740 (p < 0,05). El cuestionario mostró que la autonomía fue el principio más reportado (69 %), después la dignidad (67 %) y justicia (60 %). La presencia de los principios de la bioética ampliados hace más llevadera la enfermedad.

Resumo A relação médico-paciente é uma relação profissional interpessoal, base para a gestão da saúde. Nosso objetivo foi desenvolver um instrumento que permitisse avaliar a presença dos princípios bioéticos na atenção médica recebida na consulta de uma instituição hospitalar. O instrumento foi constituído de 21 reativos para avaliar sua confiabilidade e consistência. O coeficiente de correlação intraclasse foi de 0,81 (p < 0,05); para o cumprimento dos princípios bioéticos, foi de 0,740 (p < 0,05). O questionário mostrou que a autonomia foi o princípio mais relatado (69%), depois da dignidade (67%) e da justiça (60%). A presença dos princípios da bioética ampliados torna a doença mais suportável.

Weightbearing Forefoot Axial Radiography - Technical Description and Reproducibility Evaluation / Radiografia axial do antepé com carga - Descrição da técnica e avaliação da reprodutibilidade

Abstract Objective The present study aims to describe a new weightbearing radiographic method to visualize the heads of the five metatarsals on the coronal plane, evaluating their accuracy through intraclass correlation coefficients. Methods The subjects were evaluated, with weightbearing, with the ankle at 20 degrees of plantar flexion and the metatarsophalangeal joints at 10 degrees of extension, positioned on a wooden device. Two independent foot and ankle surgeons evaluated the radiography, with one of them doing it twice, at different moments, achieving an inter and intraobserver correlation, with intraclass correlation coefficients. Results We radiographed 63 feet, achieving an interobserver correlation coefficient of the radiographic method for the metatarsal heads heights in the coronal plane of the 1st, 2nd, 3rd, 4th, and 5th metatarsals of, respectively, 0.90, 0.85, 0.86, 0.83, 0.89. The intraobserver correlation coefficient were, respectively, 0.95, 0.93, 0.93, 0.86, 0.92. Conclusion Those correlations demonstrate that the method is accurate and can be used to investigate metatarsal head misalignments in this plane.

Resumo Objetivo Este estudo tem como objetivo descrever um novo método radiográfico com carga fisiológica para visualizar as cabeças dos cinco metatarsos no plano coronal. Métodos Os indivíduos foram radiograficamente avaliados com carga, com o tornozelo a 20º de flexão plantar e as articulações metatarsofalângicas a 10º de extensão, posicionadas em um dispositivo de madeira. As medidas foram aferidas por dois avaliadores independentes, sendo que um deles mediu em dois momentos distintos, obtendo a correlação inter e intraobservador, com o coeficiente de correlação intraclasses. Resultados Examinamos 63 pés, obtendo um coeficiente de correlação interobservador do método radiográfico para as alturas das cabeças dos metatarsos no plano coronal do 1º, 2º, 3º, 4º e 5º metatarsos de, respectivamente, 0,90, 0,85, 0,86, 0,83, 0,89. O coeficiente de correlação intraobservador foi, respectivamente, 0,95, 0,93, 0,93, 0,86, 0,92. Conclusão Essas correlações demonstram que o método é preciso e pode ser usado para investigar os desalinhamentos de cabeça dos metatarsos nesse plano.

Accuracy of magnetic resonance imaging for diagnosing hallux valgus / Acurácia da ressonância magnética para o diagnóstico de hálux valgo

Abstract Objective: To assess the accuracy of magnetic resonance imaging (MRI) for the diagnosis of hallux valgus using radiography during weight bearing as the gold standard. Materials and Methods: This was a retrospective analysis of all patients undergoing MRI of the foot and radiography of the foot during weight bearing at our institution between January and June of 2015. The hallux valgus angle (HVA) was measured on MRI and radiography. The Wilcoxon signed-rank test and simple linear regression were used in order to compare measurements. Patients were divided into two groups according to the HVA determined on radiography: > 15° (hallux valgus) and ≤ 15° (control). Qualitative and quantitative assessments of MRI scans were performed. For quantitative assessment, receiver operating characteristic curves were used in order to determine the HVA cutoff with the highest accuracy. Results: A total of 66 MRI scans were included, 22 in the hallux valgus group and 44 in the control group. Wilcoxon signed-rank tests indicated a significant difference between the radiography and MRI measurements. Simple linear regression showed a nonlinear relationship between the measurements and values did not present a strong correlation. In comparison with the radiography measurements, MRI with an HVA cutoff of 16.4° exhibited the highest accuracy (86%). The accuracy of the subjective (qualitative) assessment was inferior to the objective assessment (measurement of the HVA). Conclusion: Hallux valgus can be diagnosed by measuring the HVA on MRI, satisfactory accuracy being achieved with an HVA cutoff of 16.4°.

Resumo Objetivo: Avaliar a acurácia da ressonância magnética (RM) para o diagnóstico de hálux valgo usando radiografias com carga como padrão ouro. Materiais e Métodos: Análise retrospectiva de pacientes que realizaram RM do antepé e radiografias com carga, de janeiro a junho de 2015. O ângulo metatarsofalangiano (AMF) foi medido nas RMs e nas radiografias. O teste de Wilcoxon e regressão linear foram utilizados para comparar as mensurações. Pacientes foram divididos de acordo com os valores do AMF nas radiografias: > 15° (hálux valgo) e ≤ 15° (grupo controle). Avaliações qualitativa e quantitativa foram realizadas por RM. Para análise quantitativa, uma curva ROC foi utilizada para definir o ponto de corte com maior acurácia. Resultados: Foram incluídas 66 RMs, 22 no grupo com hálux valgo e 44 no grupo controle. O teste de Wilcoxon indicou diferença significativa entre os métodos. Avaliação de regressão demonstrou relação não linear entre as medidas e e os valores não apresentaram boa correlação. Considerando os grupos hálux valgo e controle, um valor de corte 16,4° na RM demonstrou maior acurácia (86%). A avaliação subjetiva foi inferior à avaliação objetiva. Conclusão: A medida do AMF na RM pode ser utilizada para diagnóstico de hálux valgo, com um valor de corte de 16,4°.

Cardiometabolic risk factors associated with renal function in apparently healthy young students: a cross-sectional study

ABSTRACT Background: Cardiometabolic risk factors (CMRFs) appear decades before developing chronic kidney disease (CKD) in adulthood. Objective: The objective of the study was to identify the prevalence and association between CMRFs and kidney function in apparently healthy young adults (18-25 years old). Methods: We included 5531 freshman year students. Data collected on CMRFs included central obesity, high body mass index (hBMI >25), blood pressure, glycemia, lipids, uric acid (UA >6.8 mg/dL), and insulin. Glomerular filtration rate (GFR) was estimated by CKD-Epidemiology Collaboration formula. We used logistic regression and a log linear for odds ratio (OR) (95% confidence level) and probabilities. Results: The presence of any CMRF was observed in 78% (4312) of individuals; GFR ≥120/130 mL/min/1.73 m2sc was found in 33%, GFR <90 mL/min/1.73 m2sc in 3%, and proteinuria in 3%. Factors associated with high GFR were hBMI (OR 1.3 [1.14, 1.47]), UA (OR 0.2 [0.15, 0.26]), high-density lipoprotein (HDL) (OR 1.4 [1.2, 1.6]), and insulin resistance (OR 1.3 [1.05, 1.7]). CMRF associated with low GFR was UA (OR 1.8 [1.3, 2.6]), low-density lipoprotein cholesterol (OR 1.66 [1.05, 2.6]), and proteinuria (OR 3.4 [2.07, 5.7]). Proteinuria was associated with high UA (OR 1.59 [1.01, 2.5]) and hypercholesterolemia (OR 1.8 [1.03, 3.18]). The sole presence of hBMI+UA predicted low GFR with p = 0.6 and hBMI+UA+low HDL predicted proteinuria with p = 0.55. Conclusions: CMRFs were highly prevalent among this freshman student population and were associated with proteinuria and GFR abnormalities. Future studies should focus on public health programs to prevent or delay the development of CKD.

Plantas medicinales utilizadas para enfermedades del sistema digestivo en Tetela del Volcán, Estado de Morelos, México / Medicinal plants used for diseases of the digestive system in Tetela del Volcan, State of Morelos, Mexico

The medicinal plants has been used since Prehispanic times by Mexican people to treat digestive diseases. Nowadays their use is a common practice in the poor communities. This work describes the traditional use of medicinal plants to cure these type of ailment in the community of Tetela del Volcán. Guided collect of botanical material and a total of 92 semi-structured interviews to 58 people were carried out. A total of 78 species, 70 genus and 36 families were registered. The families Asteracea and Lamiaceae predominanted culturally. Most of the species were cultivated and branches were preferably utilized. Of the total of 24 diseases, stomach pain and diarrhea were the most important. The species Matricaria chamomilla L., Mentha x piperita L., Artemisia absinthium L. y Psidium guajava L had the highest modified Friedman Fidelity Indexes. This biocultural heritage contributes to health, thus to the well-bearing of inhabitants of Tetela del Volcán.

Los mexicanos han utilizado las plantas medicinales para las enfermedades del sistema digestivo desde la época prehispánica, actualmente son particularmente empleadas en las comunidades pobres. Se describe el uso de las plantas medicinales para curar dicho tipo de padecimientos en la comunidad de Tetela del Volcán. Se realizaron colectas guiadas de material botánico y 92 entrevistas semi- estructuradas a 59 informantes. Se registraron 78 especies pertenecientes a 70 géneros y 36 familias. Las familias Asteracea y Lamiaceae dominan culturalmente. La mayoría de las especies son cultivadas y se usan preferentemente las ramas. De 24 enfermedades, el dolor de estómago y la diarrea fueron las más importantes. Las especies Matricaria chamomilla L., Mentha x piperita L., Artemisia absinthium L. y Psidium guajava L. tuvieron los mayores Índices de Fidelidad de Friedman modificados. Este patrimonio biocultural contribuye en la salud y, por lo tanto, al bienestar de los habitantes de Tetela del Volcán.

Epidemiological, clinical, and laboratory factors associated with chronic kidney disease in Mexican HIV-infected patients / Fatores epidemiológicos, clínicos e laboratoriais associados à doença renal crônica em pacientes mexicanos infectados pelo HIV

ABSTRACT Aim: To determine the prevalence of chronic kidney disease (CKD) and the epidemiological, clinical, and laboratory factors associated with CKD in Mexican HIV-infected patients. Methods: Cross-sectional study. We included 274 patients with HIV/AIDS. CKD was defined by the estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m2 assessed by CKD-EPI) and albuminuria criteria from KDIGO guidelines. Clinical, epidemiological, and laboratory characteristics were compared between patients with and without CKD. The factors associated with CKD were assessed by logistic regression analysis. Results: The mean age was 41±11 years, and 72.3% of the patients were men. The global prevalence of CKD was 11.7% (n = 32); 7.2% (n = 20) were defined by eGFR criterion; 7.6% (n = 21), by the albuminuria criterion; and 3.2% (n = 9), by both CKD criteria. The most frequently observed stages of CKD were KDIGO G3A1 stage with 4.7% (n = 13), KDIGO G1A2 stage with 3.6% (n = 10) and KDIGO G3A2 stage with 1.7% (n = 5). The factors associated with CKD were use of abacavir/lamivudine (OR 3.2; 95% CI 1.1-8.9; p = 0.03), a CD4 lymphocyte count < 400 cells/µL (OR 2.6; 95% 1.03-6.4, p = 0.04), age (OR 1.1; 95% CI 1.04-1.2, p = 0.001) and albuminuria (OR 19.98; 95% CI: 5.5-72.2; p < 0.001). Conclusions: CKD was a frequent complication in HIV-infected patients. These findings confirm the importance of screening and the early detection of CKD, as well as the importance of identifying and treating traditional and non-traditional risk factors associated with CKD.

RESUMO Objetivo: Determinar a prevalência de doença renal crônica (DRC) e os fatores epidemiológicos, clínicos e laboratoriais associados à DRC em pacientes mexicanos infectados pelo HIV. Métodos: Estudo transversal. Incluímos 274 pacientes com HIV/AIDS. A DRC foi definida pela taxa de filtração glomerular estimada (TFGe < 60 mL/min/1,73 m2, avaliada pelo CKD-EPI) e pelos critérios de albuminúria das diretrizes do KDIGO. As características clínicas, epidemiológicas e laboratoriais foram comparadas entre pacientes com e sem DRC. Os fatores associados à DRC foram avaliados por análise de regressão logística. Resultados: A média da idade foi de 41 ± 11 anos e 72,3% dos pacientes eram homens. A prevalência global de DRC foi de 11,7% (n = 32); 7,2% (n = 20) foram definidos pelo critério TFGe; 7,6% (n = 21), pelo critério da albuminúria; e 3,2% (n = 9), pelos dois critérios para DRC. Os estágios mais frequentemente observados da DRC foram o estágio KDIGO G3A1 com 4,7% (n = 13); estágio KDIGO G1A2 com 3,6% (n = 10) e estágio KDIGO G3A2 com 1,7% (n = 5). Os fatores associados à DRC foram o uso de abacavir/lamivudina (OR 3,2; IC95% 1,1-8,9; p = 0,03), contagem de linfócitos CD4 < 400 células/µL (OR 2,6; 95% 1,03-6,4, p = 0,04), idade (OR 1,1; IC95% 1,04-1,2, p = 0,001) e albuminúria (OR 19,98; IC95%: 5,5-72,2; p < 0,001). Conclusões: A DRC foi uma complicação frequente em pacientes infectados pelo HIV. Esses achados confirmam a importância do rastreamento e da detecção precoce da DRC, bem como a importância de identificar e tratar os fatores de risco tradicionais e não tradicionais associados à DRC.

Vitamina D y su relación con factores de riesgo metabólicos para enfermedad cardiovascular en mujeres adultas / Vitamin D and relationship with metabolic risk factors for cardiovascular disease in adult women

Introducción. La deficiencia de vitamina D es considerada como un problema de salud pública en otros países. Se ha reportado que esta deficiencia se relaciona con el riesgo a desarrollar enfermedades metabólicas Métodos. Estudio descriptivo, transversal, en 110 mujeres adultas de Lima Metropolitana. Se calculó el índice de masa corporal (IMC) para definir el estado nutricional. Se determinó niveles de insulina, glucosa, perfil lipídico y 25(OH)-D (vitamina D). Se calculó el Homeostatic Model of Assesment Index (HOMA-I). Para definir resistencia a la insulina (RI) se consideró un HOMA-I ≥ 2,7. Para la deficiencia de la 25 (OH)-D el punto de corte fue 30 ng/ mL. Para la ingesta de vitamina D se usó la frecuencia de consumo. La identificación de dislipidemias se hizo con lo recomendado por el Third Report of the National Cholesterol Education Program. Resultados. En las pacientes con déficit de vitamina D, los promedios de edad, IMC, insulina, glucosa, HOMA-I, colesterol total, colesterol HDL, colesterol LDL, y trigliceridos fueron superiores respecto a las pacientes con dosaje de vitamina D normal, encontrándose diferencia estadísticamente significativa para el IMC (p<0,03), niveles de insulina (p<0,01), HOMA-I (p<0,01), y trigliceridos (p<0,01). Además, se determinó déficit de vitamina D en pacientes con resistencia a la insulina con la presencia de obesidad y sobrepeso así como en las pacientes con hipertrigliceridemia (p<0,05); el riesgo de tener déficit de esta vitamina estuvo asociado a resistencia a la insulina (OR:3,28; IC:1,3-8,3) y con hipertrigliceridemia (OR:4,07; IC:1,8-9,3). Conclusiones. La deficiencia de vitamina D mostró asociación con dos variables que identifican el riesgo metabólico: la resistencia a la insulina y la hipertrigliceridemia, en la población estudiada, lo que podría explicar la posible relación de esta vitamina con enfermedades cardiovasculares.

Introduction. Vitamin D deficiency is considered a public health problem in other countries. Has been reported that this deficiency is related to the risk of developing metabolic diseases. Methods. Study descriptive, cross-sectional design in 110 adult women of Lima Metropolitana. The Body Mass Index (MBI) was calculated to define the nutritional status. Blood levels of insulin, glucose, lipid profile and 25 (OH) D (vitamin D) were determined. It was calculated Homeostatic Model of Assessment Index (HOMA-I). Was calculated and to define insulin resistance (IR) a HOMA-I ≥ 2,7. For the deficiency of 25 (OH)-D, the cut-off point was 30 ng/mL for the intake of vitamin D a frequency of consumption was used. The identification of dyslipidemias was made as recommended by the Third Report of the National Cholesterol Education Program Results. In patients with vitamin D deficiency, the average age, BMI, insulin, glucose, HOMA-I, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides were higher compared to patients with normal vitamin D dosage, finding difference statistically significant for BMI (p<0,03), insulin levels (p<0,01), HOMA-I (p<0,01), and triglycerides (p<0,01). In addition, vitamin D deficiency was determined in patients with insulin resistance with the presence of obesity and overweight as well as in patients with hypertriglyceridemia (p<0,05); the risk of having vitamin D deficiency was associated with insulin resistance (OR: 3,28, CI:1,3-8,3) and with hypertriglyceridemia (OR: 4,07, CI:1,8-9,3). Conclusions. The deficiency of vitamin D showed association with two variables that identify metabolic risk: insulin resistance and hypertriglyceridemia, in the study population, which could explain the possible relationship of this vitamin with cardiovascular diseases.

Presencia de bacilos negro pigmentantés en bolsas periodontales de pacientes diabéticos tipo 2 y su relación con el control glicémico / Presence of bacilli black pigments in periodontal pockets of patients with type 2 diabetes and its relationship with the glycemic level

Objetivos: El estudio tuvo como objetivo identificar la presencia de bacilos negro pigmentantés (BNP) en bolsas periodontales de pacientes diabéticos tipo 2 y determinar una relación con su control glicémico. Material y métodos: Se evaluó un número total de 46 pacientes que cumplían con los criterio de inclusión en el estudio, de los cuales quedaron 20 por haber concluido con todas las pruebas realizadas en el estudio, como el estudio microbiológico de sus muestras de placa subgingival y las pruebas de hemoglobina glicosilada que se realizó en forma periódica en los 3 meses que se evaluó a los pacientes. Resultados: De los 20 pacientes evaluados que completaron todas sus pruebas, 14 eran mujeres y 6 varones, con un rango de edad de 40 a 68 años, pudiéndose identificar estos bacilos negro pigmentantés (BNP) en el 20 % de casos con diagnóstico de periodontitis moderada a severa (periodontitis moderada: bolsa periodontal de 6 a 7 mm y Periodontitis severa: bolsa periodontal mayor de 7 mm), presentando estos pacientes un control glicémico de condición bueno a moderado (control bueno: = 6.9 % HbAc1y control moderado: 7 a 7.9 % HbAc1). La prueba estadística realizada para valorar la relación presencia BNP y el control glicémico fue de Chi cuadrado el cual no determino significancia de la relación (P > 5 %). Conclusiones: Se identificó la presencia de BNP en pacientes diabéticos tipo 2 pero más relacionado a pacientes con cuadros de periodontitis moderada a severa y con un control glicémico de bueno a moderado, no presentando significancia estadística.

Objectives: The study aimed to identify the presence of bacilli black pigments in periodontal pockets of type 2 diabetic patients and determine a relationship with glycemic control. Material and methods: A total of 46 patients who met the criteria for inclusion in the study, of which were 20 for having completed all tests in the study, such as microbiological analysis of samples of subgingival plaque and evaluated glycosylated hemoglobin tests held periodically in the 3 months patients were assessed. Results: Of the 20 patients evaluated, 14 were women and 6 men, with an age range of 40 to 68 years, being able to identify these black bacilli pigments (BNP) in 20% of cases diagnosed with moderate to severe periodontitis (periodontitis. moderate: periodontal pocket of 6 to 7 mm and severe periodontitis: greater periodontal pocket of 7 mm), presenting these patients glycemic control in good condition to moderate (good control: = 6,9 % HbAc1 and moderate control: 7 to 7,9 % HbAc1) . The statistical test performed to assess the presence relationship BNP and glycemic control was Chi square which does not determine significance of the relationship (P> 5%). Conclusions: It was possible to identify the presence of BNP in patients with type 2 diabetes but more related to patients with moderate to severe pictures periodontitis and with good glycemic control to moderate, showing no statistical significance.

Iphone app use to Cobb angle in adolescent idiopathic scoliosis: Does this apply? / Uso de aplicativo de iphone para ângulo de Cobb na escoliose idiopática do adolescente: É aplicável? / Uso de aplicaciones móviles para Iphone para el ángulo de Cobb en la escoliosis idiopática del adolescente: ¿es aplicable?

To validate a new method of measuring the Cobb angle for scoliosis from the mobile app CobbMeter to facilitate the evaluation and measurement in clinical practice.

Validar um novo método de medida do ângulo de Cobb para escoliose a partir do aplicativo para aparelho telefônico celular CobbMeter para facilitar a avaliação e medição na prática clínica.

Validar un nuevo método de medición del ángulo de Cobb para la escoliosis a partir de la aplicación móvil CobbMeter, para facilitar la evaluación y la medición en la práctica clínica.

Epidemiologia da leishmaniose visceral em Bauru, São Paulo, no período de 2004 a 2012: um estudo descritivo* / Epidemiology of visceral leishmaniasis in Bauru, São Paulo, Brazil, 2004-2012: a descriptive study

Descrever as características epidemiológicas dos casos de leishmaniose visceral (LV) notificados no município de Bauru, estado de São Paulo, Brasil, no período de 2004 a 2012. Métodos: estudo descritivo, com dados obtidos do Sistema de Informação de Agravos de Notificação (Sinan), gerido pela Secretaria Municipal de Saúde. Resultados: no período estudado, foram notificados 381 casos de LV, distribuídos em 100 (28,6 por cento) bairros da cidade; 61,7 por cento dos casos pertenciam ao sexo masculino; 43,8 por cento eram crianças com idade ≤10 anos; 98,4 por cento eram moradores da zona urbana; a taxa de coinfecção LV/HIV encontrada foi de 9,2 por cento; e 8,1 por cento dos casos evoluíram para óbito. Conclusão: entre os casos, predominaram homens, residentes na área urbana, em bairros da periferia e com baixa escolaridade; a diversificação dessas características aponta para a necessidade de otimizar as ações de vigilância e controle da doença...

To describe the epidemiological aspects of visceral leishmaniasis (VL) cases reported in the municipality of Bauru, state of São Paulo, Brazil, 2004-2012. Methods: this was a descriptive study using data from the Notifiable Diseases Information System (SINAN) managed by the Municipal Health Department. Results: 381 cases of VL were reported in the period and were distributed over 100 of the city’s districts (28.6 per cent); 61.7 per cent of the studied cases were male; 43.8 per cent were children aged ≤10 years; 98.4 per cent lived in urban areas; VL/HIV co-infection rate was 9.2 per cent; 8.1 per cent of cases died. Conclusion: there were more cases among men and those living in the city’s urban area, in low-income neighborhoods and those with low education; the diversification of these characteristics point to the need to optimize disease surveillance and control...

Charcot neuroarthropathy: realignment of diabetic foot by means of osteosynthesis using intramedullary screws – case report

Diabetes mellitus is a serious disease that affects a large portion of the population. Charcot neuroarthropathy is one of its major complications and can lead to osteoarticular deformities, functional incapacity, ulcers and ankle and foot infections. Realignment of the foot by means of arthrodesis presents a high rate of implant failure due to weight-bearing on an insensitive foot. The aim of this report was to describe successful use of intramedullary osteosynthesis with compression screws to stabilize the deformed foot, in a diabetic patient with neuroarthropathy...

O diabetes mellitus é uma doença grave que afeta uma grande parcela da população. A neu-roartropatia de Charcot é uma das grandes complicações que podem levar a deformidades osteoarticulares, incapacidade funcional, úlceras e infecção no tornozelo e no pé. O realinhamento do pé por meio de artrodeses apresenta elevado índice de falha do implante por causa da descarga de peso em um pé insensível. O objetivo deste relato de caso é descrever o uso bem-sucedido de osteossíntese intramedular com parafusos de compressão para estabilização do pé com deformidade em paciente diabético com neuroartropatia...

Epidemiological study on talus fractures

Objective: To analyze the characteristics of patients with talus fractures and the injuries that they present. Methods: Retrospective analysis on patients hospitalized in the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine of the University of São Paulo, between 2006 and 2011, with talus fractures. Patient profile parameters, risk factors, fracture characteristics, treatment data and acute complications were analyzed. Results: Analysis on 23 cases showed that men were more affected than women, with a ratio of 4.8:1. The most frequent trauma mechanism was traffic accidents, followed by falls from a height. The most frequent type of fracture was at the neck of the talus, with 17 cases. Among the 23 cases, seven had peritalar dislocation at the time of presentation, four had exposed fractures and 11 presented other associated fractures. The mean length of time between the trauma and the definitive treatment was six days, while the mean length of hospital stay was 11 days. Three patients presented acute postoperative complications. Conclusion: Talus fractures occurred most commonly in the region of the talar neck and most frequently in young males who suffered high-energy trauma. In almost half of the cases, there were other associated fractures. The length of hospital stay was 11 days...

Objetivo: Analisar as características dos indivíduos e das lesões encontradas em pacientes com fraturas de tálus. Métodos: Análise retrospectiva dos pacientes internados no Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo de 2006 a 2011 com fratura de tálus. Foram estudados parâmetros associados ao perfil do paciente e fatores de risco, características da fratura, dados do tratamento e complicações agudas. Resultados: A análise dos 23 casos mostrou que os homens foram mais afetados do que as mulheres, com uma relação de 4,8:1. O mecanismo de trauma mais frequente foram os acidentes de trânsito, seguido pelas quedas de altura. O tipo de fratura mais frequente foi a do colo do tálus, com 17 casos. Dos 23 casos, sete apresentavam luxação peritalar no momento da apresentação, quatro tinham fratura exposta e 11 apresentavam outras fraturas associadas. O tempo médio entre o trauma e o tratamento definitivo foi de seis dias, enquanto o tempo médio de permanência hospitalar foi de 11 dias. Houve três pacientes que apresentaram complicações pós-operatórias agudas. Conclusão: A fratura do tálus foi mais comum na região do colo e mais frequente em jovens do gênero masculino que sofreram traumatismos de alta energia. Em quase metade dos casos houve fraturas associadas e o tempo de permanência hospitalar foi de 11 dias...

Flexor hallux tendon transfer: comparative study through double or single approach

OBJECTIVE: To quantify the FHL length difference obtained through a single approach and by a double combined approach. METHODS: 16 fresh cadavers, a total of 32 feet, were used to measure the FHL graft length. With the cadaver positioned in ventral decubitus, a posteromedial incision in the ankle and a second incision in the plantar cavus were performed. RESULTS: The average gain of tendon's length (GTL) was of 42.43 mm, the lowest value being 32 mm and the largest 48 mm. The comparative analysis of the GTL on the right and left sides through the paired "t" Test does not show statistical differences, with a p-value = 0.463 and a statistical power of 0.1443. The height analysis of the sample and the right and left GTL performed through linear regression do not show statistically significant differences, with a p-value of 0.38311 and 0.82640, respectively. CONCLUSION: Harvesting the FHL graft using a double combined approach yields a 42.43 mm length gain in comparison to harvesting using the single approach. Level of Evidence III, Case Control Study. .

Hállux Rígidus: estudo prospectivo da substituição articular com hemiartroplastia / Hállux Rígidus: prospective study of joint replacement with hemiarthroplasty

Objetivo: Relatar os resultados com médio prazo de seguimento após a implantação de Arthrosurface-HemiCap em pacientes com diagnóstico de hállux rígidus (HR). Método: Onze pacientes foram submetidos à artroplastia parcial da primeira metatarso-falangeana. Seis mulheres e cinco homens com idade média de 51,9 anos (46 a 58 anos) e média de seguimento pós-operatório de 3,73 anos (3-4 anos); foram classificados através do sistema de Kravitz e avaliados pelas escalas da american orthopaedic foot and ankle society (AOFAS) para hállux, visual analog scale (VAS) – analógico funcional de dor - e pela amplitude de movimento da primeira articulação metatarsofalangeana no periodo pré-operatório, pós-operatório de seis meses e pós-operatório atual. Resultados: Os resultados revelam melhora significativa dos três parâmetros analisados no estudo, tanto para análise global como para comparações pré e pós-operatórias individuais. A análise comparativa de cada variável nos períodos pós--operatórios de seis meses e atual não mostram diferença estatística o que indica manutenção dos parâmetros durante esse intervalo. Conclusão: A hemiartroplastia da primeira metatarsofalangeana é opção reprodutível e segura para o tratamento cirúrgico do hállux rígidus II e III, com significativa melhora dos parâmetros avaliados para a população estudada. Nível de Evidência IV, Série de casos.

Objective: To report the results of medium-term follow-up after deploying arthrosurface-Hemicap in patients with diagnosis of hállux rígidus (HR). method: eleven patients underwent partial arthroplasty of the first metatarsal-phalangeal joint. six women and five men with an average age 51.9 years (46 to 58 years) and average postoperative follow-up of 3.73 years (3-4 years); were classified through the Kravitz system and evaluated by the american orthopaedic foot and ankle society (aofas) scales for hallux, visual analogical scale (vas) – analog functional pain - and motion range in the first metatarsal joint in preoperative, postoperative after six months and present post-operative. Results: the results show significant improvement of the three analyzed parameters, both for overall analysis and for pre and post-operative comparisons individually. the comparative analysis of each variable in the six months and the current postoperative periods do not show statistically significant differences, indicating maintenance of parameters during this interval. conclusion: hemiarthroplasty of first metatarsophalangeal joint is a reproducible and safe option for the surgical treatment of hállux rígidus II and III, with significant improvement of the evaluated parameters for the studied population. Level of Evidence IV, Case Series.

Physical profile of counterfeit tablets Viagra® and Cialis®

The profile of tablets containing an active pharmacological ingredient can be obtained using different sets of properties, including physical and chemical aspects. The first measurements carried out on tablets are the physical characteristics also called post-tabletting batch (post-TB) characteristics. These data may be valuable to assist in the detection of pharmaceutical product forgery and may also be used in a forensic intelligence perspective when inserted into databases. This work is focused on the physical characteristics of Cialis® and Viagra® tablets seized by the Brazilian Federal Police in the Rio Grande do Sul state. Using the F-test (ANOVA), all samples of counterfeit Viagra® (n = 28) and Cialis® (n = 40) were well distinguished from authentic samples by the following post-TB characteristics: length (major and minor), thickness, and mass. Using the exploratory statistical technique of Hierarchical Cluster Analysis (HCA), tablets with similar physical profiles were grouped. This result may indicate a common illicit production. We observed the validity of using post-TB properties to generate - in a fast and reliable manner and with no sample preparation - a technological profile that joins itself to the other analytical methods assisting in routine forensic detection of counterfeit Viagra® and Cialis®.

Perfil para medicamentos na forma farmacêutica comprimidos contendo uma substância ativa pode ser obtido usando diferentes conjuntos de propriedades, incluindo aspectos físicos e químicos. As primeiras medições realizadas em comprimidos são de características físicas, também chamadas características pós-compressão. Tais dados podem ser valiosos para auxiliar na detecção de falsificações de medicamentos e ser utilizados em uma perspectiva de inteligência forense, quando inseridos em bancos de dados. Este trabalho está focado nas características físicas dos comprimidos de Cialis® e Viagra® apreendidos pela Polícia Federal no Estado brasileiro do Rio Grande do Sul. Com o emprego do Teste de Fisher (ANOVA), todas as amostras falsificadas de Viagra® (n = 28) e de Cialis® (n = 40) foram diferenciadas das amostras autênticas pelas seguintes características pós-compressão: comprimento (maior e menor), espessura e massa. Utilizando-se a Análise Hierárquica de Cluster (AHC), os comprimidos com perfis físicos semelhantes foram agrupados, o que pode indicar uma produção ilícita em comum. Observou-se a validade da utilização das características pós-compressão para gerar, de um modo rápido, confiável e sem preparo de amostra, um perfil tecnológico que se una aos demais métodos analíticos utilizados na rotina forense de detecção de falsificações de Cialis® e de Viagra®.

Fatores preditivos da marcha em pacientes diabéticos neuropático e não neuropáticos / Predictive factors of gait in neuropathic and non-neurophatic diabetic patients

OBJETIVO: Analisar a amplitude de movimento do tornozelo e as forças de reação vertical do solo envolvidas na marcha de pacientes portadores de diabetes com e sem neuropatia periférica. CASUÍSTICA E MÉTODO: 36 indivíduos divididos em três grupos: Controle - GC: 10 indivíduos sem diabetes, Diabetes - GD: 10 indivíduos portadores de diabetes sem neuropatia periférica e Neuropatia - GDN: 16 indivíduos portadores de diabetes e neuropatia diabética periférica. Foi realizada análise da marcha - AMTI® OR6/6, e da amplitude de movimento articular tíbio-társica - Sistema Vicom 640® - de todos os participantes. RESULTADOS: O primeiro e segundo pico de força vertical de reação do solo são maiores no grupo Neuropatia e a amplitude de movimento articular do tornozelo é menor nos grupos Diabetes e Neuropatia. CONCLUSÃO: A amplitude de movimento da articulação tíbio-társica está diminuida nos diabetéticos, independente da presença ou ausência de neuropatia periférica, e os diabéticos com neuropatia periférica, apresentaram aumento no primeiro e no segundo pico da força de reação vertical do solo durante a marcha.

OBJECTIVE: The purpose of this study was to analyze the range of movement of the ankle and the vertical ground reaction force involved in gait among diabetic patients with and without peripheral neuropathy. SAMPLE AND METHOD: 36 individuals were divided into three groups: Control group - CG: 10 individuals without diabetes, Diabetic group - DG: 10 individuals with diabetes without peripheral neuropathy and Neuropathy, and Diabetic neuropathic group - DNG: 16 individuals with diabetes and peripheral diabetic neuropathy. Gait - AMTI® OR6/6m and range of tibiotarsal joint movement - System Vicom 640® was carried out in all the participants. RESULTS: The first and second vertical ground reaction force peaks were statistically higher in the neuropathy group, and the range of ankle motion was lower in the Diabetes and Neuropathy groups. CONCLUSION: The range of movement of the tibiotarsal joint is lower in diabetics, regardless of the presence or absence of peripheral neuropathy, and diabetics with peripheral neuropathy show an increase in the first and second vertical ground reaction force peaks during walking.

Artroplastia total de tornozelo: experiência brasileira com a prótese HINTEGRA / Total ankle replacement: Brazilian experience with the HINTEGRA prosthesis

A artrose do tornozelo vem se tornando mais comum a cada dia. A busca por soluções que preservem a função articular fez surgir uma nova geração de próteses com três componentes e maior liberdade de movimento. Neste trabalho, apresentam-se os resultados obtidos em 10 pacientes tratados com a prótese HINTEGRA (Integra, New Deal), em ação conjunta dos Grupos do Tornozelo e Pé do DOT da Unifesp-Escola Paulista de Medicina e IOT da Faculdade de Medicina da USP-Universidade de São Paulo. Os 10 pacientes (seis mulheres e quatro homens), com idade variando de 29 a 66 anos, foram submetidos ao tratamento cirúrgico segundo a técnica de Hinterman entre janeiro e junho de 2005. Foram avaliados em intervalos predeterminados e os dados foram submetidos à análise estatística. A mobilidade do tornozelo apresentou melhora significante com a cirurgia realizada. Radiologicamente, não foram detectados sinais de soltura ou falhas nos componentes prostéticos de nenhum dos pacientes estudados. A taxa de complicações nessa amostra foi alta, mas equivalente às de outros autores e representa diretamente a curva de aprendizado relacionada com esse tipo de procedimento. Ao final de quatro anos, observaram-se significativa redução da dor e melhora do padrão funcional dos pacientes com os escores da AOFAS e de Hinterman, apontando para 20 por cento de excelentes, 70 por cento de bons e 10 por cento de maus resultados. O tratamento da artrose do tornozelo através da artroplastia total com o modelo HINTEGRA, foi capaz de oferecer bons resultados no tempo médio de observação de quatro anos.

Ankle arthritis is becoming more and more common. The search for solutions that preserve joint function has led to a new generation of prosthesis with three components and more degrees of freedom. This paper presents the results achieved in ten patients treated with the HINTEGRA Prosthesis (Integra, New Deal), a joint action of the Foot and Ankle Teams of DOT of Unifesp - Escola Paulista de Medicina and the School of Medicine of USP - Universidade de São Paulo. The ten patients (six women and four men), aged between 29 and 66 years, underwent a surgical procedure according to Hinterman's technique, from January to June 2005. They were evaluated at pre-arranged intervals, and the data were submitted to statistical analysis. The surgery led to a significant improvement in ankle mobility. Radiological studies showed no signs of loosening or failure in the prosthetic components in any of the patients studied. Although the rate of complications in our sample was high, it was equivalent to those of other authors, and directly represents the long, steep learning curve associate with this kind of procedure. At the end of four years, there was a significant reduction in the pain, and an improvement in functional pattern of the patients, with AOFAS and Hinterman scores indicating 20 percent excellent, 70 percent good, and 10 percent poor results. Despite the drawbacks, treatment of ankle arthritis through total arthroplasty with the HINTEGRA prosthesis proved to be capable of giving good results over an average observation period of four years.