Forearm bone mineral density and fracture incidence in postmenopausal women with osteoporosis: results from the ACTIVExtend phase 3 trial.

Abaloparatide increased ultradistal radius bone mineral density (BMD) in the Abaloparatide Comparator Trial in Vertebral Endpoints (ACTIVE) trial. Over the subsequent 24 months in ACTIVExtend, ultradistal radius BMD gains were maintained with alendronate. Conversely, 1/3 radius BMD remained stable during ALN treatment in ACTIVExtend after decreasing during ACTIVE. INTRODUCTION: Abaloparatide (ABL) increased femoral neck, total hip, and lumbar spine bone mineral density (BMD) in postmenopausal women with osteoporosis and decreased the risk of vertebral and nonvertebral fractures in ACTIVE. Effects on fracture risk and BMD were maintained subsequently with alendronate (ALN) in ACTIVExtend. In a prespecified subanalysis of ACTIVE, ABL also increased BMD at the ultradistal radius. Our objective was to determine the efficacy of ABL followed by ALN vs placebo (PBO) followed by ALN on forearm BMD and fracture risk over 43 months in ACTIVExtend. METHODS: Ultradistal and 1/3 radius BMD (ACTIVE baseline to month 43) were measured (ABL/ALN, n = 213; PBO/ALN, n = 233). Wrist fracture rates were estimated for the ACTIVExtend intent-to-treat population (ABL/ALN, n = 558; PBO/ALN, n = 581) by Kaplan-Meier (KM) method. RESULTS: At cumulative month 25, mean increase from ACTIVE baseline in ultradistal radius BMD was 1.1% (standard error, 0.49%) with ABL/ALN vs - 0.8% (0.43%) with PBO/ALN (P < 0.01). BMD increases with ABL were maintained with ALN through month 43 in ACTIVExtend. BMD decreases at the 1/3 radius in ACTIVE (similar with ABL and PBO) were maintained through 24 months of ALN treatment in ACTIVExtend. Wrist fractures over 43 months occurred in 15 women with ABL/ALN (KM estimate, 2.8%) and 20 with PBO/ALN (KM estimate, 3.6%) (HR = 0.77, 95% CI 0.39, 1.50; P = not significant). CONCLUSION: Ultradistal radius BMD gains following treatment with ABL in ACTIVE were maintained over 24 months of ALN treatment in ACTIVExtend. Conversely, 1/3 radius BMD remained stable during ALN treatment in ACTIVExtend after decreasing during ACTIVE. TRIAL REGISTRATION: ClinicalTrials.gov : NCT01657162 submitted July 31, 2012.

COL1A1, CCDC170, and ESR1 single nucleotide polymorphisms associated with distal radius fracture in postmenopausal Mexican women.

Objective: The aim of this study was to analyze the genetic association of five ESR1 single nucleotide polymorphisms (SNPs) (rs3020331, rs851982, rs1999805, rs2234693, rs3020404), four COL1A1 SNPs (rs1800012, rs2075555, rs2412298, rs1107946), and two SNPs on the CCDC170 gene (rs9479055, rs4870044) with distal radius fracture (DRF) in a group of postmenopausal Mexican women.Methods: A case-control study was conducted. Cases (n = 182) were women above the age of 38 years with low-energy DRF, and controls (n = 201) were women without. Analysis was done through real-time polymerase chain reaction. Frequencies and Hardy-Weinberg equilibrium were calculated. A multivariate analysis including bone mass index, age, menarche, and menopause as covariables was carried out. Finally, haplotype and linkage disequilibrium (LD) analyses were performed.Results:COL1A1 rs1107946 was strongly associated with DRF. Both CCDC170 SNPs showed strong association with DRF. For the ESR1 gene, four SNPs (rs2234693, 3020404, rs3020331, and rs851982) showed very strong association with DRF. Additionally, the region between the latter two showed strong LD.Conclusions: A strong association of DRF with variants in these genes was found, including haplotypes and a region with strong LD on ESR1. The results suggest that these SNPs could be useful to detect the population at risk of presenting DRF among Mexican perimenopausal women.

Gender Disparities in Financial Relationships Between Industry and Orthopaedic Surgeons.

BACKGROUND: Recent studies in a number of surgical subspecialties have demonstrated that financial relationships with industry differ between men and women. This study aimed to determine if gender disparities exist in industry relationships with orthopaedic surgeons. METHODS: This retrospective study utilized publicly available data from the Centers for Medicare & Medicaid Services (CMS) at OpenPayments.cms.gov. Data were extracted for payments made to orthopaedic surgeons from industry for royalties, licensing, or consulting fees from 2016 to 2017. A physician's profile was used to determine name, gender, practice location, and subspecialty. Years of experience were recorded from publicly available websites. Total number of payments and amounts were compared among men and women, subspecialties, and locations. Multivariable linear regression models were used to determine predictors of total payments and number of payments. RESULTS: Royalties and consulting fees were paid to 3,418 individual physicians (11% of 29,996 physicians in the American Academy of Orthopaedic Surgeons [AAOS] census) and accounted for 88% of total payments. The majority of the total payment amount (99.6%) was made to men, while only 0.4% went to women. Male gender was a predictor of total number of payments (ß = 5.17, p < 0.001), as were years of experience (ß = 0.15 [95% confidence interval (CI): 0.10 to 0.20], p < 0.001), Mountain region (ß = 2.77 [95% CI: 0.37 to 5.17], p = 0.02), and adult reconstructive subspecialty (ß = 4.07 [95% CI: 1.89 to 6.25], p < 0.001). Years of experience (ß = 0.046 [95% CI: 0.039 to 0.052], p < 0.001), male gender (ß = 1.09 [95% CI: 0.67 to 1.51], p < 0.001), Mountain region (ß = 0.35 [95% CI: 0.020 to 0.68], p = 0.04), and adult reconstructive subspecialty (ß = 0.33 [95% CI: 0.030 to 0.63], p = 0.03) were associated with higher payments. CONCLUSIONS: Male gender, years of experience, Mountain region, and adult reconstructive subspecialty are independent predictors of a higher number of industry payments and payment amount. These disparities in industry payments may contribute to continued inequities in scholarship, academic rank, and leadership opportunities.

Identification of Arthropods By Polymerase Chain Reaction As Probes For Infectious Disease Studies In Experimental Coprolites.

The study of arthropods is still scarce in paleoparasitology, especially their molecular identification. In this experimental study, we amplify DNA using a polymerase chain reaction from 2 ectoparasite species, Rhipicephalus sanguineus and Pediculus humanus capitis, in experimentally desiccated feces. This study shows perspectives for the study of the identification of arthropods in coprolites when taxonomic identification is not possible.

Microorganisms in the ticks Amblyomma dissimile Koch 1844 and Amblyomma rotundatum Koch 1844 collected from snakes in Brazil.

Knowledge about ticks (Acari) and screening of ticks parasitizing various hosts are necessary to understand the epidemiology of tick-borne pathogens. The objective of this study was to investigate tick infestations on snakes (Reptilia: Squamata: Serpentes) arriving at the serpentarium at the Institute Vital Brazil, Rio de Janeiro. Some of the identified ticks were individually tested for the presence of bacteria of the genera Rickettsia (Rickettsiales: Rickettsiaceae), Borrelia (Spirochaetales: Spirochaetaceae), Coxiella (Legionellales: Coxiellaceae), Bartonella (Rhizobiales: Bartonellaceae), Ehrlichia (Rickettsiales: Anaplasmataceae), Anaplasma (Rickettsiales: Anaplasmataceae), and Apicomplexa protozoa of the genera Babesia (Piroplasmida: Babesiidae) and Hepatozoon (Eucoccidiorida: Hepatozoidae). A total of 115 hard ticks (Ixodida: Ixodidae) were collected from 17 host individuals obtained from four Brazilian states. Two species of tick were identified: Amblyomma dissimile Koch 1844 (four larvae, 16 nymphs, 40 adults), and Amblyomma rotundatum Koch 1844 (12 nymphs, 43 adults). Rickettsia bellii was found in A. rotundatum and A. dissimile ticks and Rickettsia sp. strain Colombianensi, Anaplasma-like and Hepatozoon sp. in A. dissimile ticks. Among the tested ticks, no DNA of Borrelia, Bartonella, Coxiella or Babesia was found. The present findings extend the geographic range of Rickettsia sp. strain Colombianensi in Brazil and provide novel tick-host associations.

Characterization of trabecular bone microstructure in premenopausal women with distal radius fractures.

Individual trabecular segmentation was utilized to identify differences in trabecular bone structure in premenopausal women with wrist fractures and non-fracture controls. Fracture subjects had reduced trabecular plate volume, number, thickness, and connectivity. Identifying altered trabecular microarchitecture in young women offers opportunities for counseling and lifestyle modifications to reduce fracture risk. INTRODUCTION: Premenopausal women with distal radius fractures (DRF) have worse trabecular bone microarchitecture than non-fracture controls (CONT), yet the characteristics of their trabecular bone structure are unknown. METHODS: Premenopausal women with DRF (n = 40) and CONT (n = 80) were recruited. Primary outcome variables included trabecular structure at the distal radius and tibia, assessed by volumetric decomposition of individual trabecular plates and rods from high-resolution peripheral quantitative CT images. Trabecular morphology included plate and rod number, volume, thickness, and connectivity. Areal bone mineral density (aBMD) of the femoral neck (FN aBMD), and ultradistal radius (UDR aBMD) were measured by DXA. RESULTS: Trabecular morphology differed between DRF and CONT at the radius and tibia (OR per SD decline 1.58-2.7). At the radius, associations remained significant when adjusting for age and FN aBMD (ORs = 1.76-3.26) and age and UDR aBMD (ORs = 1.72-3.97). Plate volume fraction, number and axially aligned trabeculae remained associated with DRF after adjustment for trabecular density (ORs = 2.55-2.85). Area under the curve (AUC) for discriminating DRF was 0.74 for the proportion of axially aligned trabeculae, compared with 0.60 for FN aBMD, 0.65 for UDR aBMD, and 0.69 for trabecular density. Plate number, plate-plate junction, and axial bone volume fraction remained associated with DRF at the tibia (ORs = 2.14-2.77) after adjusting for age, FN aBMD, or UDR aBMD. AUCP.P.Junc.D was 0.72 versus 0.61 for FNaBMD, 0.66 for UDRaBMD, and 0.70 for trabecular density. CONCLUSION: Premenopausal women with DRF have lower trabecular plate volume, number, thickness, and connectivity than CONT. Identification of young women with altered microarchitecture offers opportunities for lifestyle modifications to reduce fracture risk.

Correction to: Characterization of trabecular bone microstructure in premenopausal women with distal radius fractures.

Owing to an oversight by the corresponding author, the name of the third author of this article was rendered wrongly. His correct name is Kempland C. Walley.

A cluster of Rickettsia rickettsii infection at an animal shelter in an urban area of Brazil.

Rickettsia rickettsii infection is being increasingly recognized as an important cause of fatal acute illness in Brazil, where this tick-borne disease is designated Brazilian spotted fever (BSF). In this study we report five fatal cases of BSF in employees of an animal shelter in an urban area in the municipality of Rio de Janeiro in southeast Brazil after a natural disaster on 11 January 2011. Four of the cases occurred from 27 January to 11 April 2011, while the fifth fatal case was identified in April 2012. Three cases were confirmed by molecular analysis and two by epidemiological linkage. An investigation of BSF was performed in the animal shelter, and blood samples were collected from 115 employees and 117 randomly selected dogs. The presence of high levels (1024-4096) of antibodies against spotted fever group rickettsiae was found in three (2·6%) employees and 114 (97·5%) dogs. These findings emphasize the need to consider BSF as a possible cause of undifferentiated febrile illness, especially dengue and leptospirosis, in patients occupationally exposed to dogs heavily infested by ticks, mainly working at kennels and animal shelters that have inadequate space for the animals housed and frequently providing an environment conducive to exposure to pathogens such as R. rickettsii.

Bartonella native valve endocarditis: the first brazilian case alive and well

Bartonella is an important cause of blood culture-negative endocarditis in recent studies. Seroprevalence studies in the States of Minas Gerais and Rio de Janeiro have shown Bartonella IgG positivity around 14 percent in healthy adults and 40 percent in HIV seropositive adults, respectively. A case report of a 46-year-old white male with moderate aortic regurgitation (AR) due to rheumatic heart disease (RHD), admitted due to worsening heart failure, is presented. Clinical features were apyrexia, anemia, polyclonal hypergammaglobulinemia, hematuria and splenomegaly. He was submitted to surgery due to worsening AR. Histopathology of the excised valve showed active bacterial endocarditis and underlying RHD. Routine blood cultures were negative. Indirect immunofluorescence (IFI) assays for Coxiella burnetii were non-reactive. Bartonella henselae IgG titer was 1:4096 prior to antibiotics and 1:512 14 months after treatment. History of close contact with a young cat during the months preceding his admission was elicited.

Bartonella native valve endocarditis: the first Brazilian case alive and well.

Bartonella is an important cause of blood culture-negative endocarditis in recent studies. Seroprevalence studies in the States of Minas Gerais and Rio de Janeiro have shown Bartonella IgG positivity around 14% in healthy adults and 40% in HIV seropositive adults, respectively. A case report of a 46-year-old white male with moderate aortic regurgitation (AR) due to rheumatic heart disease (RHD), admitted due to worsening heart failure, is presented. Clinical features were apyrexia, anemia, polyclonal hypergammaglobulinemia, hematuria and splenomegaly. He was submitted to surgery due to worsening AR. Histopathology of the excised valve showed active bacterial endocarditis and underlying RHD. Routine blood cultures were negative. Indirect immunofluorescence (IFI) assays for Coxiella burnetii were non-reactive. Bartonella henselae IgG titer was 1:4096 prior to antibiotics and 1:512 14 months after treatment. History of close contact with a young cat during the months preceding his admission was elicited.

Study of hantavirus infection in captive breed colonies of wild rodents.

Wild sigmondontine rodents are known to be the reservoir of several serotypes of New World hantaviruses. The mechanism of viral transmission is by aerosol inhalation of the excreta from infected rodents. Considering that the captive breed colonies of various wild mammals may present a potential risk for hantaviral transmission, we examined 85 specimens of Thrichomys spp. (Echimyidae) and 17 speciemens of Nectomys squamipes (Sigmodontinae) from our colony for the presence of hantavirus infections. Blood samples were assayed for the presence of antibodies to Andes nucleocapsid antigen using enzyme-linked immunosorbent assay (ELISA). Additionally, serum samples from workers previously exposed to wild rodents, in the laboratories where the study was conducted, were also tested by ELISA to investigate prevalence of anti-hantavirus IgG antibodies. All blood samples were negative for hantavirus antibodies. Although these results suggest that those rodent's colonies are hantavirus free, the work emphasizes the need for hantavirus serological monitoring in wild colonized rodents and secure handling potentially infected rodents as important biosafety measures.

Study of hantavirus infection in captive breed colonies of wild rodents

Wild sigmondontine rodents are known to be the reservoir of several serotypes of New World hantaviruses. The mechanism of viral transmission is by aerosol inhalation of the excreta from infected rodents. Considering that the captive breed colonies of various wild mammals may present a potencial risk for hantaviral transmission, we examined 85 speciemens of Thrichomys spp. (Echimyidae) and 17 speciemens of Nectomys squamipes (Sigmodontinae) from our colony for the presence of hantavirus infections. Blood samples were assayed for the presence of antibodies to Andes nucleocapsid antigen using enzyme-linked immunosorbent assay (ELISA). Additionally, serum samples from workers previously exposed to wild rodents, in the laboratories where the study was conducted, were also tested by ELISA to investigate prevalence of anti-hantavirus IgG antibodies. All blood samples were negative for hantavirus antibodies. Although these results suggest that those rodent's colonies are hantavirus free, the work emphasizes the need for hantavirus serological monitoring in wild colonized rodents and secure handling potentially infected rodents as important biosafety measures.

The Internet as a communication tool for academic orthopaedic surgery departments in the United States.

BACKGROUND: The Internet's appeal as an affordable, accessible medium for information transfer makes it a potentially useful tool for practicing physicians. In the past several years, Internet-based health-care companies have proliferated, and many medical centers have established individual web sites. The purpose of the present study was to evaluate academic orthopaedic surgery departments in the United States with respect to Internet visibility and content. METHODS: We reviewed existing web sites for the 154 departments or divisions of orthopaedic surgery currently accredited for resident education by the Accreditation Council for Graduate Medical Education. The study sample consisted of the 113 departments that had a web page listed in the FREIDA (Fellowship and Residency Electronic Interactive Database) database. Each web site was assessed with regard to its informational value in the categories of clinical services, resident education, and physician recruitment. In addition, three commonly employed browsing engines were used to search for individual web sites and to determine their ease of accessibility. RESULTS: In the category of clinical services, sixty-five (57.5%) of the 113 sites provided faculty listings and forty-nine (43.4%) provided office telephone numbers and locations. Only thirteen sites provided information on common orthopaedic conditions, and five had links to other patient-education sites. In the category of resident education, twenty-four sites (21.2%) had online academic schedules, but only two provided access to complete conferences or teaching files. In the category of physician recruitment, ninety-one provided a description of their residency program and fifty-four had information on the application process, but only twenty-six web pages offered detailed departmental statistics. In terms of accessibility, fifty-three programs (46.9%) were identified by one of three popular search engines, seventeen (15%) were identified by more than one search engine, and two (1.8%) were identified by all three. CONCLUSIONS: Academic orthopaedic surgery departments in the United States underutilize the Internet as a source of clinical and educational services. In addition, existing orthopaedic web sites are difficult to access with use of popular search engines. Thus, academic orthopaedic surgery departments in the United States are missing a valuable opportunity to promote awareness of their institutions and to become educational resources for the community.

Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture.

A classification system for disruption patterns of the sigmoid notch of the radius associated with distal radius fractures has not been established. Using plain x-rays and corresponding computed tomography (CT) scans we characterized and quantified the types of sigmoid notch involvement in 20 consecutive distal radius fractures with radiocarpal joint extension. Plain radiographs revealed fracture extension into the sigmoid notch in only 7 cases (35%) and the CT scans demonstrated fracture extension into the sigmoid notch in 13 cases (65%). Of the 13 fractures with sigmoid notch involvement, 9 (69%) were displaced and 4 (31%) were nondisplaced. Sigmoid notch articular step-off (n = 7) and gapping (n = 9) were detectable on the CT scans but not on the x-rays. Plain x-rays appear to underestimate sigmoid notch involvement following distal radius fractures. In addition, CT appears to be a superior diagnostic modality for quantifying sigmoid notch fracture step-off and articular gapping.

Detection of poxvirus in cattle associated with human cases in the State of Rio de Janeiro: preliminary report.

This preliminary report describes human and cow cases of poxvirus that recently occurred in the State of Rio de Janeiro. The electron microscopic findings were consistent with parapoxviral and orthopoxviral infection. Orthopoxvirus strains were isolated from human and cow cases. Detailed viral characterization by means of genetical techniques is under investigation. Based on these informations, poxviral diseases should be also considered an emerging viral zoonosis that can affect human beings.

Intra- and interobserver reliability of sensibility testing in asymptomatic individuals.

Threshold and innervation density tests are common clinical tools used in the evaluation of peripheral nerve injuries and compression syndromes. The purpose of this study is to determine the inter- and intraobserver reliability of Semmes-Weinstein monofilaments and static and moving two-point discrimination in 48 volunteers. Kappa coefficients of inter- and intraexaminer agreement were generated for each test and investigator. The interexaminer reliability for the Semmes-Weinstein monofilaments ranged from fair to moderate in the ulnar and median nerve distributions, and slight to moderate in static and moving two-point discrimination testing. Intraobserver reliability for Semmes-Weinstein monofilaments and static and moving two-point discrimination was slight to fair for both examiners. Our data indicate that Semmes-Weinstein monofilaments and two-point discrimination tests yield unreliable measurements in asymptomatic individuals. Although useful in monitoring neurological function in pathological states, threshold and innervation density measurements from an unaffected digit or extremity may not represent a reliable standard for comparison of abnormal values.

Sexual behaviour and infection rates for HIV, blood-borne and sexually transmitted infections among patients attending drug treatment centres in Rio de Janeiro, Brazil.

A survey was carried out in 2 drug use treatment centres (TCs) in Rio de Janeiro, Brazil, to assess risk behaviours, HIV infection and other sexually transmitted infections/blood-borne infections (STIs/BBIs). Two hundred and twenty-five drug users (195 males and 30 females) were interviewed and clinically examined, and their blood and urine were tested for STIs/BBIs. Prevalences (%) for these infections were as follows--HIV: 0.9, hepatitis B virus (HBV): 14.7, hepatitis C virus (HCV): 5.8, syphilis: 5.3, gonorrhoea/chlamydia (CT/NG): 4.7. In bivariate analyses CT/NG infection was associated with younger age (P=0.003); current genitourinary symptoms (odds ratio [OR]=6.2) and a mainly illegal source of income (OR=9.1). Hepatitis C infection was associated with a history of ever having injected any drug (OR=19.6), and with each one of the injected drugs. After multiple logistic regression, lower educational level (adjusted odds ratio [AOR]=3.70) and 'ever having injected drugs' (AOR=3.69) remained as independent risk factors for hepatitis B infection. In conclusion, TCs must implement programmes directed towards the prevention of STIs/BBIs.

Intra-articular corticosteroids: an updated overview.

Intra-articular corticosteroids are widely used in the management of arthritic conditions. In the present article, literature concerning intraarticular corticosteroid preparations, administration, effects in different clinical uses, and adverse reactions is reviewed to identify areas of potential future study. There is little consensus in the literature on the appropriate technique of administration, and no clinical studies have been performed comparing various preparations for safety and effectiveness. The small number of reported complications, however, suggests that low intermittent doses pose little risk of significant adverse effects.