Smoking-attributable mortality by sex in the 27 Brazilian federal units: 2019.

OBJECTIVES: The aim of this study was to estimate smoking-attributable mortality (SAM) in the population aged 35 years and over in Brazil's 27 federal units by sex, in 2019. STUDY DESIGN: This is an attributable mortality analysis. METHODS: We applied a method dependent on the prevalence of smoking, based on the population attributable fractions. Data on mortality due to causes causally related to smoking were derived from Brazil's Death Registry, data on prevalence of smoking from a survey conducted in Brazil in 2019, and data on relative risks from five US cohorts. Crude and age-adjusted SAM rates were calculated by sex. Estimates of SAM were calculated by specific causes of death and major mortality groups for each federal unit by sex. RESULTS: In 2019, smoking caused 480 deaths per day in Brazil. Although the SAM varied among the federal units, the pattern is not clear, with the greatest difference being between Rio Grande do Sul (crude rate: 248.8/100,000 inhabitants) and Amazonas (106.0/100,000). When the rates were adjusted by age, the greatest differences were observed between Acre (271.1/100,000) and Distrito Federal (131.1/100,000). SAM was higher in males; however, while the main specific cause of SAM in men was ischemic heart disease, in women it was chronic obstructive pulmonary disease. The major mortality group having the greatest impact on SAM across all federal units was the cardiometabolic diseases. CONCLUSIONS: The variability in the burden of SAM in the different regions of Brazil reaffirms the need for SAM data disaggregated at the geographic level.

Arthroscopic rotator cuff repair using a single or double row technique: A meta-analysis of randomized clinical trial. / Reparación artroscópica del manguito rotador mediante una técnica de hilera simple o doble hilera: un metaanálisis de los ensayos clínicos aleatorizados.

PURPOSE: To compare the double row technique versus the single row technique for arthroscopic rotator cuff repair, in order to assess whether there are clinical differences. METHODS: Systematic review of randomized clinical trials comparing the clinical results of the double-row technique versus the single-row technique in arthroscopic rotator cuff repair. Demographic, clinical, and surgical variables were analyzed, including functional scores, tendon healing rate, and re-tear rate. RESULTS: Thirteen randomized clinical trials were selected. 437 patients in the single row group (50.7%) and 424 patients in the double row group (49.3%) were analyzed. No significant differences were found between the two groups in terms of age (P=.84), sex (P=.23) and loss to follow-up (P=.52). Significant differences were found for the better results of the double row technique at the UCLA level (P=.01). No significant differences were found on the Constant-Murley scale (P=.87) or on the ASES scale (P=.56). Similarly, there was a higher healing rate (P=.006) and less risk of rotator cuff re-tears with the double row technique (P=.006). CONCLUSIONS: In rotator cuff repair, the double row technique was found to be superior to the single row technique in terms of better UCLA score, better tendon healing rate, and lower re-tear rate. No clinically significant differences were found on the Constant-Murley scale or on the ASES scale.

Frequency of fatal and non-fatal overdoses and response to grief and loss among people who inject drugs: An unexplored dimension of the opioid overdose crisis.

BACKGROUND: We investigated the relationship between overdose events and grief and loss responses among people who inject drugs. METHODS: We conducted a cross-sectional, tablet-based survey with a convenience sample of people who inject drugs (n = 249) from four community-based harm reduction programs in Toronto in 2019. We examined the association between frequency and types of overdose events (own, witnessed, death of significant person) in the last 6 months with grief and loss responses, identified using latent class analysis. RESULTS: Among respondents, 70 (48.6 %) reported 2 or more personal overdoses, 173 (79.5 %) witnessed 2 or more overdoses, and 69 (41.4 %) experienced overdose deaths of 2 or more significant persons in the last 6 months. We identified 2 latent classes with probability of membership of 38.6 % (95 % confidence interval [CI]=31.0, 46.7) for medium/low intensity of responses to grief/loss and 61.4 % (95 % CI= 53.3, 69.0) for severe responses to grief/loss. In adjusted Poisson regression models with robust standard error estimators, severe responses to grief/loss were associated with exposure to two or more own overdoses (prevalence ratio [PR] = 1.44; 95 % CI=1.12, 1.84, p-value=0.004), and having witnessed one (PR=2.09; 95 % CI=1.05, 4.15, p-value=0.04) or witnessed two or more overdoses (PR=2.25; 95 % CI=1.24, 4.09, p-value=0.008). Severe grief/loss responses were also more common in individuals exposed to all three types of overdose events (PR=2.42; 95 % CI=1.08, 5.41, p-value=0.03). CONCLUSIONS: Cumulative overdose events were associated with severe responses to grief and loss. Bereavement interventions should consider the complex nature of grief and loss following overdoses.

Antimicrobial effect of Moringa oleifera seed powder against Vibrio cholerae isolated from the rearing water of shrimp (Penaeus vannamei) postlarvae.

Shrimp farming has experienced rising costs as a result of disease outbreaks associated with Vibrio spp. Suitable strategies for disease prevention and control are therefore urgently needed. This study aimed to evaluate the antimicrobial effect of Moringa oleifera seed powder against Vibrio cholerae in the rearing water of Pacific white shrimp (Penaeus vannamei) postlarvae. In vitro assays included the determination of minimum inhibitory concentration (MIC) of M. oleifera seed powder against V. cholerae, whereas in vivo assays included the effect of M. oleifera seed powder on bacterial load and water quality parameters in the rearing tanks, as well as its effect on shrimp postlarvae survival. M. oleifera seed powder inhibited the growth of V. cholerae with MIC values of 62·5 µg ml-1 . Moreover, seawater pH of treated tanks (8·66) was significantly lower (P < 0·01) than pH of the control tanks (9·02), whereas the visibility of treated tanks (37·08 cm) was significantly higher (P < 0·01) as compared to control tanks (35·37 cm). Likewise, V. cholerae load was significantly reduced (P < 0·01) from 4·7 × 104 to 3·1 × 103  CFU per ml in tanks treated with M. oleifera seed powder. Altogether, this study demonstrates the antimicrobial activity of M. oleifera against V. cholerae in shrimp culture.

Nevertheless, She Resisted - Role of the Environment on Listeria monocytogenes Sensitivity to Nisin Treatment in a Laboratory Cheese Model.

The growth of Listeria monocytogenes on refrigerated, ready-to-eat food products is a major health and economic concern. The natural antimicrobial nisin targets the bacterial cell wall and can be used to inhibit L. monocytogenes growth on cheese. Cell wall composition and structure, and therefore the efficacy of cell wall acting control strategies, can be severely affected by environmental and stress conditions. The goal of this study was to determine the effect of a range of pH and temperatures on the efficacy of nisin against several strains of L. monocytogenes in a lab-scale, cheese model. Cheese was made with or without the addition of nisin at different pH and then inoculated with L. monocytogenes; L. monocytogenes numbers were quantified after 1, 7, and 14 days of incubation at 6, 14, or 22°C. While our data show that nisin treatment is able to reduce L. monocytogenes numbers, at least initially, growth of this pathogen can occur even in the presence of nisin, especially when cheese is stored at higher temperatures. Several environmental factors were found to affect nisin efficacy against L. monocytogenes. For example, nisin is more effective when cheese is stored at lower temperatures. Nisin is also more effective when cheese is made at higher pH (6 and 6.5), compared to cheese made at pH 5.5, and this effect is at least partially due to the activity of cell envelope modification genes dltA and mprF. Serotype was also found to affect nisin efficacy against L. monocytogenes; serotype 4b strains showed lower susceptibility to nisin treatment compared to serotype 1/2 strains. Overall, our results highlight the importance of considering environmental conditions specific to a food matrix when developing and applying nisin-based intervention strategies against L. monocytogenes.

Poblaciones silvestres y domiciliadas de Triatoma Infestans en comunidades del municipio de Mecapaca próximas a la ciudad de La Paz / Wild and domiciled populations of Triatoma Infestans in communities of the municipality of Mecapaca next to the city of La Paz

OBJETIVO: determinar la presencia de Triatoma infestans y las características de sus poblaciones en algunas comunidades del Municipio de Mecapaca cercanas a la cuidad de La Paz. MÉTODOS: la búsqueda entomológica de Triatoma infestans con trampas cebo ratón en sitios silvestres y peridomiciliares o manuales dentro de domicilios, fue realizada en 11 zonas de 8 comunidades del Municipio de Mecapaca, determinando la altura sobre el nivel del mar y la ubicación geográfica de las mismas. Mediante claves dicotómicas según Lent y Wygodzinski se ha realizado la identificación morfológica de los especímenes capturados. Con la observación directa en microscopio óptico de las deyecciones de los especímenes y análisis molecular por PCR Multiplex se ha determinado la infección por Trypanosoma cruzi y las DTUs (Unidades Discretas de Tipificación). RESULTADOS: se encontraron sitios positivos para la presencia de T. infestan, siendo el Indice de Dispersión Entomológica de 50%. Del total de los especímenes capturados (N=103), 91 especímenes (88%) fueron individuos en fase ninfal y 12 individuos (12%) fueron adultos. Se caracterizó T. cruzi TcI y el índice tripano triatominico fue de 50% en individuos capturados en zona silvestre de Huayhuasi y de 16% en individuos capturados en zona peridomiciliar de Huajchilla distante solo a 20 km desde la ciudad de La Paz. CONCLUSIONES: los resultados han constatado presencia de poblaciones silvestres y domiciliadas de T. infestans en sitios silvestres y domiciliares de comunidades del Municipio de Mecapaca cercanas a la ciudad de La Paz. El hallazgo determinaría nuevos esquemas de distribución geográfica de poblaciones de T. infestans e infestación de hábitat humano.

OBJECTIVE: to determine the presence of Triatoma infestans and the characteristics of their populations in some communities of the Municipality of Mecapaca next to the city of La Paz. METHODS: The entomological search of Triatoma infestans with mouse bait traps in wild and peridomiciliary or manual sites within homes, was carried out in 11 areas of 8 communities of the Municipality of Mecapaca, determining the altitude above sea level and their geographical location. By means of dichotomous keys according to Lent and Wygodzinski, the morphological identification of the captured specimens has been carried out. With direct microscopic observation of specimen dejections and molecular analysis by Multiplex PCR, Trypanosoma cruzi infection and DTUs (Discrete Typification Units) have been determined. RESULTS: positive sites were found for the presence of T. infestan, with the Entomological Dispersion Index being 50%. Of the total of the specimens captured (N = 103), 91 specimens (88%) were individuals in the nymphal phase and 12 individuals (12%) were adults. T. cruzi TcI was characterized and the triatominic trypan index was 50% in individuals captured in the wild zone of Huayhuasi and 16% in individuals captured in the peridomiciliary area of Huajchilla, only 20 km away from the city of La Paz. CONCLUSIONS: the results have confirmed the presence of wild and domiciled populations of T. infestans in wild and domiciliary sites of communities of the Municipality of Mecapaca near the city of La Paz. The finding would determine new geographical distribution schemes of T. infestans populations and human habitat infestation.

Ceguera por catarata, un desafío nacional inadvertido: a propósito de una experiencia / Cataract blindness, a national overlooked challenge: About an experience

Antecedente: Debido a que la catarata es la principal causa de ceguera y discapacidad visual, organismos internacionales y los gobiernos han adoptado políticas y planes que dan prioridad a esta patología ocular (Iniciativa VISIÓN 20/20 de Organización Mundial de la Salud y Asociación Internacional para la Prevención de la Ceguera), acogidas por los países miembros, incluyendo el plan «Salud ocular universal 2014-2019¼, que prioriza la cirugía de catarata para reducción de la ceguera prevenible sobre todo en los países en desarrollo. Objetivo: Describir la experiencia del Centro de Salud Integral Zoé en el establecimiento de un programa de prevención de ceguera por catarata, período 2010-2017. Metodología: CSI-Zoé es una organización no gubernamental con servicios de salud generales y oftalmológicos altamente subsidiados o de costos reducidos. Se hizo una recopilación de información y análisis de las atenciones por problemas visuales en el periodo 2010-2017, con enfoque al problema de cataratas. Resultados: En 2017 hubo 174 jornadas de captación de 16,426 personas con problemas visuales, en las áreas más pobres a nivel nacional, especialmente adultos mayores de 50 años con necesidad de cirugía, atendidos localmente o referidos a la clínica en Tegucigalpa. De 2010 a 2017 se practicaron 12,352 cirugías por catarata, con un promedio anual de 1,500 (rango 746 a 2,254). Discusión: CSI-Zoé ha establecido un programa exitoso que le ha permitido estar a la delantera en la realización de cirugías de catarata, convirtiéndolo en el centro con mayor presteza en la respuesta nacional para prevención de ceguera por catarata...(AU)

Evisceración intestinal a través de vagina / Transvaginal small bowell evisceration

Objetivos: Descripción de una complicación posquirúrgica infrecuente, la evisceración intestinal vaginal, y revisión de los factores predisponentes, diagnóstico y su tratamiento quirúrgico corrector definitivo, las vías de abordaje y las posibles técnicas quirúrgicas, basándonos en la literatura científica disponible. Material y métodos: Se presenta el caso clínico de una paciente de 46 años con la complicación referida, su evaluación inicial, manejo quirúrgico y seguimiento. Se realiza laparotomía para evaluación de la viabilidad de las asas intestinales herniadas, reparación del defecto existente en la cúpula vaginal y técnica quirúrgica correctora en el mismo tiempo quirúrgico, la colposacropexia con malla con buen resultado a corto y medio plazo. Conclusiones: La evisceración vaginal en una complicación infrecuente que requiere una valoración rápida y una actitud quirúrgica urgente, debido a la alta morbimortalidad a la que se asocia

Objectives: We describe an uncommon postoperative complication, vaginal evisceration of the intestine, and review the predisposing factors, diagnosis and definitive corrective surgery, the surgical approaches and possible surgical techniques, based on the available scientific literature. Material and methods: We report the case of a 46-year-old patient with the aforementioned complication, initial evaluation, surgical management and monitoring. We performed a laparotomy to assess the viability of the herniated intestinal loops, repair the defect in the vaginal vault and perform a surgical correction in one procedure. We used a colposacropexy mesh with good short- and medium-term results. Conclusions: Vaginal evisceration is a rare complication that requires rapid assessment and urgent surgical treatment due to the high morbidity and mortality with which it is associated

Metal-ligand pair anisotropy in a series of mononuclear Er-COT complexes.

Synthetic control of the crystal field has elevated lanthanides to the forefront of single-molecule magnet (SMM) research, yet the resultant strong, predictable single-ion anisotropy has thus far not translated into equally impressive molecule-based magnets of higher dimensionality. This roadblock arises from the dual demands made of the crystal field: generate anisotropy and facilitate magnetic coupling. Here we demonstrate that particular metal-ligand pairs can dominate the single-ion electronic structure so fully that the remaining coordination sphere plays a minimal role in the magnitude and orientation of the magnetic anisotropy. This Metal-Ligand Pair Anisotropy (MLPA) effectively separates the crystal field into discrete components dedicated to anisotropy and magnetic coupling. To demonstrate an MLPA building unit, we synthesized four new mononuclear complexes that challenge the electronic structure of the iconic lanthanocene ([Ln(COT)2]+; COT2- = cyclooctatetraene dianion) complex which is known to generate strong anisotropy with Ln = Er3+. Variation in symmetry and coordination strength for Er(COT)I(THF)2 (THF = tetrahydrofuran) (1), Er(COT)I(Py)2 (Py = pyridine) (2), Er(COT)I(MeCN)2 (MeCN = acetonitrile) (3), and Er(COT)(Tp*) (Tp* = tris(3,5-dimethyl-1-pyrazolyl)borate) (4) shows that the Er-COT unit stabilizes anisotropy despite deliberate de-optimization. All four half-sandwich complexes display SMM behavior with effective energy barriers of U eff = 95.6(9), 102.9(3.1), 107.1(1.3), and 133.6(2.2) cm-1 for 1-4 by a multi-relaxation-process fitting. More importantly, the basic state splittings remain intact and the anisotropy axes are within several degrees of normal to the COT2- ring according to complete active space self-consistent field (CASSCF) calculations. Further investigation of the MLPA conceptual framework is warranted as it can provide building units with well-defined magnetic orientation and strength. We envision that the through-barrier processes observed herein, such as quantum tunneling, can be mitigated by formation of larger clusters and molecule-based materials.

Canine rabies elimination: governance principles.

Rabies is still one of the deadliest diseases known to exist in the 21st century, and yet it remains irresponsibly neglected and underestimated. In light of this, this paper discusses the principles of governance as they relate to rabies control, using examples of global intersectoral coordination programmes for the control of canine rabies and for the elimination of human rabies transmitted by dogs. The first of these programmes was the Meeting of Rabies Program Directors of the Americas (REDIPRA), which has served as a model of intersectoral success for rabies elimination in other regions. Examples of intersectoral cooperation on several continents, mainly between the health and agriculture sectors, are detailed to discuss various methods of achieving better technical cooperation. These cooperation programmes follow the 'coalition model' set by REDIPRA. They bring together various actors, such as governments, non-governmental organisations, the private sector, the science and research community, international cooperation agencies and donors, under a common umbrella for advocacy and for the implementation of local projects for the elimination of human rabies transmitted by dogs. Networking is the main intersectoral governance mechanism presented in this review.

Bien qu'elle soit connue pour être l'une des maladies faisant le plus de victimes au xxie siècle, la rage demeure fortement négligée et sous-estimée, traduisant un déficit de responsabilité en la matière. À la lumière de cet état de fait, les auteurs examinent les principes de gouvernance applicables à la lutte contre la rage, en prenant pour exemples les programmes mondiaux destinés à assurer la coordination intersectorielle de la lutte contre la rage canine et de l'élimination de la rage humaine transmise par les chiens. Le premier des programmes examinés est celui mis en oeuvre par les Réunions des Directeurs des Programmes nationaux de contrôle de la rage en Amérique latine (REDIPRA), qui a servi de modèle dans d'autres régions du monde en tant qu'exemple de coopération intersectorielle réussie pour l'élimination de la rage. Les auteurs examinent en détail quelques exemples de coopération intersectorielle dans différents continents et portant pour la plupart sur les secteurs de la santé et de l'agriculture, ce qui les conduit à mettre en avant les méthodes permettant d'améliorer la qualité de la coopération technique. Ces programmes de coopération s'inspirent du « modèle de coalition ¼ inauguré par les REDIPRA. Ils réunissent plusieurs acteurs tels que les gouvernements, les organisations non gouvernementales, le secteur privé, la communauté des chercheurs et des scientifiques, les agences de coopération internationale et les donateurs, autour d'un objectif commun axé sur la promotion et la mise en oeuvre des projets locaux d'élimination de la rage humaine transmise par les chiens. Le travail en réseaux est le principal mécanisme de gouvernance intersectorielle présenté dans cette analyse.

La rabia es todavía una de las enfermedades más mortíferas que se conocen y aún subsisten en el siglo XXI, pese a lo cual sigue estando, de forma harto irresponsable, desatendida y subestimada. Ante tal realidad, los autores exponen los principios de la gobernanza en relación con la lucha antirrábica, ofreciendo ejemplos de programas de coordinación intersectorial a escala mundial para combatir la rabia canina y eliminar la rabia humana transmitida por perros. El primero de tales programas fue la «Reunión de directores de programas contra la rabia de las Américas¼ (REDIPRA), que después ha servido de modelo de labor intersectorial eficaz para la eliminación de la rabia en otras regiones. Tras describir en detalle ejemplos de cooperación intersectorial en varios continentes, básicamente entre los sectores de la agricultura y la salud, los autores examinan varios métodos para dotar de más eficacia a la cooperación técnica. Estos programas de cooperación siguen el «modelo de coalición¼ establecido por la REDIPRA: se trata de federar a distintos interlocutores (gobiernos, organizaciones no gubernamentales, entidades del sector privado, círculos científicos y de investigación, organismos de cooperación internacional, donantes, etc.) en torno a un designio común de sensibilización y aplicación de proyectos locales para eliminar la rabia humana transmitida por perros. El trabajo en red es el principal mecanismo de gobernanza intersectorial que presentan los autores en estas líneas.

Ferromagnetic coupling in a chloride-bridged erbium single-molecule magnet.

We present the first ferromagnetically-coupled Er3+ complex with linked, high-anisotropy Er-COT (COT2- = cyclooctatetraene dianion) subunits. The dinuclear complex, [Er(µ2-Cl)(COT)(THF)]2, demonstrates single-molecule magnetism with a single, zero-field magnetization relaxation barrier of Ueff = 113 cm-1. This system offers evidence that anisotropy can be preserved in the presence of ferromagnetic linking of the Er-COT subunits, providing a rational means to build strong molecular magnets of tunable dimensionality.

Controversia acerca del tiempo de ayuno preoperatorio de chicles y caramelos / Controversy on chewing gum and sweets during the preoperative fasting period

No disponible

A rare case of large cell neuroendocrine carcinoma of the urinary bladder evaluated by 18F-FDG-PET/CT / Un caso raro de carcinoma neuroendocrino de células grandes de la vejiga evaluado con 18F-FDG-PET/TC

No disponible

Infección por adenovirus en hospital de niños con enfermedades respiratorias crónicas / Adenovirus infection in a children's hospital with chronic pulmonary diseases

Introducción: Las infecciones por adenovirus se diseminan rápidamente en recintos cerrados causando brotes asociados a gran morbimortalidad. Objetivos: Identificar tasa de ataque (TA) de infección por adenovirus en hospital de niños con enfermedades respiratorias crónicas (ERC) y evaluar factores asociados que faciliten la infección. Pacientes y Método: Entre junio y octubre de 2010 se evaluaron 50 niños con ERC del Hospital Josefina Martínez. Ellos estuvieron expuestos durante el invierno a pacientes con infección respiratoria aguda baja. A los pacientes con ERC sintomáticos (fiebre y cambio en su signología respiratoria basal) se les realizó Inmunofluorescencia Directa (IFD) Viral. "Caso" fue definido como "paciente sintomático e IFD positiva para Adenovirus". Se evaluaron TA primaria, secundaria y global. Variables como género, edad, traqueostomía y gastrostomía fueron analizadas buscando asociación con los casos. Resultados: El 44 por ciento de los pacientes eran lactantes. El 68 por ciento tenía traqueostomía y 54 por ciento gastrostomía. El primer paciente con Adenovirus ingresó en junio y el caso primario apareció dos semanas después. Hubo 25 casos secundarios que representaron TA secundaria de 51 por ciento. La TA global fue 52 por ciento. No hubo fallecidos. Los lactantes tuvieron un riesgo tres veces mayor que los niños mayores de contraer la infección (OR 3,31 [IC95 por ciento 1,02-10,72; p = 0,046]). No hubo asociación significativa con traqueostomía, gastrostomía ni género. Conclusiones: La alta diseminación de la infección por adenovirus en recintos cerrados obliga a extremar las medidas de prevención de IAAS especialmente en lactantes.

Introduction: Intrahospital adenovirus infections spread rapidly in closed environments causing outbreaks associated with high morbidity and mortality. Objectives: To identify the attack rate (AR) of adenovirus in a hospital treating children with Chronic Respiratory Diseases (CRD) and to evaluate associated factors that facilitate infection. Patients and Methods: Fifty children with CRD were evaluated between June 2010 and October 2010 at Josefina Martinez Hospital. They were exposed to patients with acute lower respiratory infection during winter. Patients with CRD symptoms (fever and change in basal nasal mucus) underwent Viral Direct Immunofluorescence (DIF). The case was defined as "symptomatic patient with positive DIF for Adenovirus". Primary, secondary and global ARs were evaluated. Variables such as gender, age, tracheostomy and gastrostomy were analyzed looking for associations with the cases. Results: 44 percent of patients were infants; 68 percent of children had tracheostomy and 54 percent had gastrostomy. The first patient with Adenovirus was admitted in June and the primary case was reported two weeks later. 25 cases presented secondary AR corresponding to 51percent Global AR was 52 percent overall. No mortality was reported. The risk was three times higher in infants than older children (OR 3.31 [IC95 percent 1.02-10.72; p = 0.046]). No significant associations with tracheostomy, gastrostomy and gender were found. Conclusions: The rapid spread of adenovirus infection in closed environments requires extreme prevention measures especially regarding infants.

Concentración de metales séricos (titanio, cromo y cobalto) en el seguimiento de las artroplastias totales de cadera / Serum metal (titanium, chromium and cobalt) concentrations in the follow-up of total hip arthroplasty

Objetivo: Analizar la degradación de los productos metálicos que constituyen las aleaciones de las prótesis de cadera. Pacientes y método: Se midió, mediante absorción atómica, el titanio, el cromo y el cobalto en la sangre de 58 pacientes con prótesis totales de cadera, compuestas por aleaciones de cromo y cobalto y de titanio, con o sin cementar. Se analizó la evolución de las concentraciones séricas preoperatorias, a los seis y a los 12 meses. Resultados: Encontramos una elevación significativa tras el inicio de la movilización de la articulación, pero sin afectación clínica. Los percentiles 95 de la distribución de concentraciones fueron para el Ti 27 mg/L, Cr 1 mg/L y Co 1,7 mg/L. Conclusión: La elevación de estas concentraciones podría ser indicativa de mal funcionamiento del implante o de desgaste excesivo que podría conducir a toxicidades locales o remotas (AU)

Objective: To analyze the degradation of the metal products contained in hip prosthesis alloys. Patients and method: Atomic absorption measurements were made of the titanium, chromium and cobalt concentrations in the blood of 58 patients with total hip replacement implants made of titanium, chromium and cobalt alloys with or without cementing. The evolution of the serum metal concentrations was assessed based on measurements obtained preoperatively and 6 and 12 months after surgery. Results: A significant increase in serum levels was noted after the start of joint mobilization, though without clinical repercussions. The percentile 95 values of the metal concentration distributions were 27 mg/l for titanium, 1 mg/l in the case of chromium, and 1.7 mg/l for cobalt. Conclusion: The rise in serum metal concentrations could be indicative of poor implant function or excessive wear that in turn could lead to local or disseminated toxicity (AU)

Ruminant brucellosis in Upper Egypt (2005-2008).

Brucellosis is endemic among humans and ruminant in Egypt and recent reports suggest that its incidence may be increasing. In this study we describe the frequency of brucellosis among different ruminant species in Upper Egypt and its spatial distribution using the data generated by a large-scale control campaign undertaken between 2005 and 2008. A total of 120,090 individual animals of different ruminant species were tested during the campaign. The true proportions of brucellosis were estimated as 0.79% (CI: 0.71%-0.87%), 0.13% (CI: 0.08%-0.18%), 1.16% (1.05%-1.27%) and 0.44% (0.34%-0.54%) among cattle, buffaloes, sheep and goats respectively. We estimated that 0.2% (CI: 0.16%-0.23%) of households in the study area keep at least one seropositive animal. Spatial autocorrelation of the proportions of seropositive households and seropositive animals was assessed using Global Univariate Moran's I and Local Univariate LISA. These analyses showed that the distribution of seropositive animals has considerable spatial heterogeneity with clustering in the northern governorates of the study area. Our results show that brucellosis is widespread and heterogeneously distributed in Upper Egypt. At the current level of available resources it is very unlikely that test and slaughter could be implemented with the intensity needed to be effective and other control measures that could replace or complement the test and slaughter policy in place should be considered. Also, this study illustrates some of the challenges faced by bilateral projects that have to accommodate an externally funded intervention with an ongoing national official disease control program.

Osteoporosis transitoria del embarazo complicada con fractura subcapital de cadera: caso clínico y revisión de la literatura / Transient osteoporosis complicated by a subcapital hip fracture in pregnancy: a clinical case and a literature review

La osteoporosis transitoria de la cadera es una dolencia poco frecuente caracterizada por dolor y acusada osteopenia en la cabeza y cuello femorales que puede aparecer en el tercer trimestre de embarazo. Describimos el caso de una gestante de 36 semanas con fractura subcapital de cadera en la que se realiza reducción cerrada y fijación interna (AU)

Transient osteoporosis of the hip is a rare condition characterized by pain and marked osteopenia in the femoral head and neck that can occur in the third trimester of pregnancy. We describe the case of a 36weeks pregnant with a subcapital hip fracture treated by closed reduction and internal fixation (AU)