Dual plating in the metastatic distal humerus: Benefits may outweigh the risks.

Background: Impending and complete pathologic fractures of the distal humerus are rare complications of metastatic cancer. Surgical treatment aims to quickly restore function and minimize pain. Plate and screw fixation (PSF) is a common method for addressing these lesions, but unlike in orthopaedic trauma, there are no clear guidelines for best management. While dual PSF theoretically provides better support and reduces the chance of reoperation due to tumor progression, single PSF is currently the more common choice. Materials and methods: Between March 2008 and September 2021, 35 consecutive patients who underwent PSF for distal humerus metastasis or multiple myeloma were retrospectively reviewed. The proportion of patients who developed various postoperative complications, including infection, nonunion, deep vein thrombosis, tumor progression, and radial nerve palsy, as well as those requiring reoperation, was calculated. Mann-Whitney U test, Pearson's chi-squared, and Fisher's exact test were used to investigate differences between the single and dual PSF groups with statistical significance defined as p ≤ 0.05. Results: There was no significant difference (p = 0.259) in revision rate, although 3 of 21 (14.3 %) single PSF patients required reoperation compared to 0 of 14 (0.0 %) dual PSF patients. The revisions were performed in one patient due to refracture and in two patients due to tumor progression. Although not statistically significant, a larger percentage of single PSF patients developed a postoperative complication compared to dual PSF patients [odds ratio 0.42 (95 % confidence interval 0.071 to 2.5); p = 0.431]. Single PSF did lead to shorter operative time compared to dual PSF [p < 0.001]. Conclusion: Dual PSF is non-inferior to single PSF and potentially results in fewer reoperations and postoperative complications in distal humerus pathologic lesions, although it leads to longer operative time. The current study is limited by small sample size due to the rarity of distal humerus metastatic lesions.

Contraception in women with diabetes: adequacy of medical files registration and prescription - a cross-section study.

OBJECTIVE: To describe the adequacy of diabetes mellitus (DM) patient's files registry regarding contraception method (CM), factors associated with lack of registry, and if prescription is in accordance with World Health Organization (WHO) eligibility criteria. RESEARCH DESIGN AND METHODS: This cross-sectional study was developed in two phases: (1) electronic medical records of women with DM who attended the outpatient clinic of a university hospital were reviewed to identify women in reproductive age and to look for CM registration and (2) interviews regarding contraception use, comorbidities and chronic DM complications. RESULTS: Among 1069 files analyzed, 313 women with DM in childbearing age were identified. Out of those, 55.3% had a CM registered. Age >40 years, non-white skin color, and ≤11 years of education were associated with no registration. Of the 270 women interviewed, 201 (74.4%) were using CM. Out of the 69 patients not on CM, 51 fertile patients were at risk of an unplanned pregnancy (18.8% of the sample). The most frequently used method was oral hormonal (combined: 34.3%; progestin-only: 17.9%), and 67 (33.3%) were using an inadequate method (WHO eligibility category 3/4). CONCLUSION: One third of women with DM are in childbearing age. Older age, non-white skin color, and lower education level were associated with lack of CM registration. One-third of respondents were using CM inappropriate for their clinical condition and one-fifth were at risk for an unplanned pregnancy. So, improvements in family planning for women with DM should be instituted.

Sclerodermiform Dermatitis After Coronary Artery Bypass Graft With an Internal Thoracic Artery Conduit.

Coronary artery bypass grafting is a common surgical procedure that often uses the saphenous vein, internal thoracic artery, or radial artery as a conduit to improve blood circulation to the heart. When a blockage or impediment to arterial flow is noted, this procedure is undertaken to ensure the myocardium receives the blood it needs to function optimally. Infrequently, dermatoses overlying the conduit site may be observed, notably with the saphenous vein harvest site. Here we report the first case of sclerodermiform dermatitis occurring at the internal thoracic artery donor graft site. This unique case is important for providers to be aware of when evaluating a patient post-operatively who presents with new-onset dermatologic changes at the site of previous donor harvesting to ensure optimal treatment and management.

Assessing the Diagnostic Accuracy of Teledermatology Consultations at a Local Veterans Affairs Dermatology Clinic.

With the advances in health information technology and the need for increased access to specialized health care, the advent of telemedicine was designed to bring care to individuals at a distance. Telemedicine decreases barriers to health care and brings medical specialists to underserved areas and populations. We have seen a tremendous increase in the need and utilization of telemedicine during the COVID-19 pandemic due to the lockdowns and social distancing efforts. Virtual care continues to be extended to patients to maintain their health care needs when in-person clinic appointments are not feasible or ideal such as seen during a pandemic. Telemedicine is an additional tool that has proven vital to our healthcare system. To provide optimal care, a strong technological infrastructure must be in place. Once in practice, positive outcomes have been noted for patients and healthcare providers as diagnosis, treatment, and appropriate triage can be made virtually and at the patients' convenience. To ensure high-quality care is provided through the Veterans Affairs teledermatology consultation service, we investigated the concordance of teledermatology diagnoses with clinical examination findings through a retrospective chart review covering a one-year time period. Our study found a concordance of 75.3% between the teledermatology diagnoses and the in-person clinical diagnoses. The main limitation we found to virtual examination is the inability to perform total body skin examinations. We found that 60.2% of patients had additional diagnoses when examined in person, with 8.4% of patients having an additional malignant diagnosis. These findings highlight the need for in-person examinations when feasible to ensure that no other diagnoses go undiscovered if not captured on the submitted images for teledermatology consultation. Despite the limitations posed by photographic examination, teledermatology can be used as a reliable method for diagnosis when a conventional in-person examination is not readily available or ideal, such as during a pandemic, and can serve as a powerful triaging tool.

Intrapelvic melanocytic schwannoma resection with computer-assisted navigation.

Melanocytic schwannoma is a rare nerve tumor characterized by melanin-producing neoplastic Schwann cells. Wide surgical resection is the management of choice for this tumor; however, anatomical location and proximity to nerve roots can make locating this tumor and the surgical resection challenging. Here we describe the case of 49-year-old male with a melanocytic schwannoma in the presacral area adjacent to the second sacral nerve root that was managed by wide resection aided by computer-assisted navigation due to the difficulty in identifying its location intraoperatively. The utilization of computer-assisted navigation improves accuracy and precision through the creation of a virtual continuous tridimensional map, particularly useful when oftentimes tumor margins may seem equivocal and further resection would compromise the patient's functionality. The value of computer-assisted navigation for soft tissue tumor resections in orthopedic oncology is still in its infancy, though, in certain scenarios it may advance the technique for some soft tissue resections.

A universidade inserida na comunidade: conhecimentos, atitudes e comportamentos de adolescentes de uma escola pública frente a doenças sexualmente transmissíveis / The university in the community: knowledge, attitudes and behavior of adolescents from a public school regarding sexually transmitted diseases

Introdução: As doenças sexualmente transmissíveis (DSTs) são infecções disseminadas principalmente através do contato sexual. A maioria dos casos ocorre em adolescentes e adultos jovens. O presente estudo visa avaliar conhecimento, atitudes, comportamento e transmissão das DSTs em adolescentes de uma escola pública, após a inserção da Universidade na comunidade através de trabalhos desenvolvidos pelos alunos de Medicina da ULBRA. Métodos: Estudo descritivo, tipo inquérito epidemiológico, de caráter quantitativo, com alunos de 7ª e 8 ª séries de uma escola municipal de Canoas, RS. Resultados: Participaram do estudo 185 alunos com média de idade de 15,3 anos. Quando questionados se conheciam DSTs, 91,4% responderam positivamente, sendo a síndrome da imunodeficiência adquirida a doença mais citada. A maioria recebe informações acerca desse assunto na escola. A média de idade de início das atividades sexuais foi de 13,9 anos. Quanto às relações sexuais, 44,9% já a iniciaram e 92,8% destes fazem uso do preservativo, sendo a prevenção da gravidez o motivo mais apontado. Apenas dois alunos referiram ocorrência de infecção no passado. Conclusão: A idade de início das relações sexuais é precoce. Um número considerável de jovens mostra-se consciente e faz uso de preservativo, embora não seja com o intuito de prevenir doenças, mas de evitar gestações indesejadas. A maioria dos jovens apresenta bom nível de conhecimento sobre o assunto. Sendo assim, é de grande valia a intervenção da Universidade nas escolas, uma vez que esses são os locais onde os adolescentes afirmam receber a maioria das informações acerca das DSTs.

Introduction: Sexually transmitted diseases (STDs) are infections spread mainly through sexual contact. Most cases occur in adolescents and young adults. The present study aims to assess the knowledge, attitudes, behavior and transmission of STDs in adolescents from a public school after University intervention in the community through educational work done by medical students of ULBRA. Methods: A descriptive, epidemiological investigation with a quantitative approach, with 7th and 8th graders of a municipal school of Canoas, RS. Results: The study included 185 students with a mean age of 15.3 years. When asked if they knew STDs, 91.4% answered “yes”, with acquired immunodeficiency syndrome being the most cited disease. Most students receive information about this subject at school. The mean age of sexual initiation was 13.9 years. Regarding sex intercourse, 44.9% had already started it and 92.8% of these reported using condoms, pregnancy prevention being the most frequently reason for doing so. Only two students reported occurrence of infection in the past. Conclusion: The age of onset of sexual activity is early. A considerable number of young people is aware and uses condoms, although not with the intention of preventing diseases, but to avoid unwanted pregnancies. Most young people are fairly knowledgeable about the subject. Therefore, the University’s intervention in schools is highly valuable, since these are the places where teens claim to receive most information about STDs.

Dificuldades na coleta do exame preventivo do câncer do colo uterino: qual a percepção das usuárias?

Este trabalho apresenta um estudo qualitativo descritivo-exploratório, desenvolvido com mulheres entre 25 e 59 anos que possuem prontuário e que realizam avaliação ginecológica na Unidade de Saúde Jardim Leopoldina, na cidade de Porto Alegre. Investiga o conhecimento, a atitude e o comportamento dessas mulheres em relação a adesão ao teste de rastreamento (citopatológico de colo uterino) utilizado para a prevenção do câncer do colo uterino.

Doenças Sexualmente Transmissíveis: conhecimento, atitudes e comportamento entre os adolescentes de uma escola pública / Sexually Transmissible Diseases: knowledge, attitudes and behavior among the teenagers of a public school

O objetivo do trabalho foi avaliar o conhecimento de doenças sexualmente transmissíveis (DSTs) em adolescentes de uma escola pública, no município de Canoas, Rio Grande do Sul, comparando as diferenças e semelhanças entre os gêneros. A metodologia utilizada foi estudo descritivo, transversal, de caráter quantitativo, do tipo inquérito. A amostra foi de 221 alunos. Na análise, foram utilizados os testes o teste t-Student, qui-quadrado de Pearson ou Exato de Fisher. As análises foram realizadas no programa SPSS (Statistical Package for the Social Sciences) versão 10.0. Foram estudados 221 alunos de 7a e 8a séries. Não houve predomínio de gênero (de meninos e meninas). A média de idade foi de 14,4 ± 1,39 anos. Quanto ao conhecimento dos adolescentes sobre DSTs, 77,4% responderam que conhecem alguma DST, 20,8% não o tinham e 1,8% não responderam; as mais citadas foram Acquired Immunodeficiency Syndrome (Aids), com 91,3%, 66,7%, sífilis, e 64,3%, gonorréia. Quase totalidade da amostra (93,7%) respondeu que sabe o significado de DST, e 6,3% não sabiam. Pode-se evidenciar que a grande maioria recebe informações na escola, com 77,8%, por intermédio de agentes comunitários, com 35,1%, e por meio da televisão, com 31%. Quanto ao uso de preservativo masculino, 90,9% da amostra faz uso deste e 4,5%, não; 1,5% nunca usou. Pode-se concluir, a partir deste trabalho, que a grande maioria dos adolescentes demonstrou conhecimento adequado sobre DSTs. As meninas mostraram ter mais consciência do uso do preservativo, apontando que os meninos têm maior resistência ao seu uso. Isso mostra que há a necessidade de maior conscientização dos meninos, em relação ao uso da camisinha, o que representa, talvez, uma questão sociocultural.

The aim of this study was to evaluate the knowledge about sexually transmitted diseases (STD) among the teenagers of a public school in the city of Canoas, Rio Grande do Sul, comparing the differences/similarities between the gender. The methodology used was that of a descriptive cross-sectional study of quantitative character, type survey. The sample consisted of 221 students. The data were analyzed using Student.s t-test, Pearson.s chi-square test or Fisher.s Exact Test. The analyses were performed in the SPSS (Statistical Package for the Social Sciences) software, version 10.0. Two hundred and twenty one students from the 7th and 8th grades were evaluated. None of the gender was predominating. The average age was of 14.4 ± 1.39 years. As refers to the knowledge of the teenagers about STDs, 77.4% declared that they did know something about STD, 20.8% did not have any information and 1.8% did not answer; the most cited STDs were Acquired Immunodeficiency Syndrome (AIDS) with 91.3%, syphilis (66.7%) and gonorrhea (64.3%). Almost the entire sample (93.7%) declared to know the meaning of STD, only 6.3% did not. It may be concluded that the great majority receives information at school (77.8%), from health agents (35.1%) and through TV (31%). With respect to male condom use, 90.9% of the sample uses the condom, 4.5% do not and 1.5% had never used it. This study allows concluding that the great majority of the teenagers have appropriate knowledge about STDs. The girls showed more conscious of the importance of using a condom, mentioning that the boys tended to resist to its use. This might be indicative of a sociocultural question and of the need to raise the awareness of the boys with regard to condom use.