Functional outcomes and complications of patients contaminated with Cutibacterium acnes during primary reverse shoulder arthroplasty: study at two- and five-years of follow-up.

PURPOSE: The objective of the study was to compare the functional outcomes and the complication rate of the patients with C. acnes contamination at the end of the primary reverse shoulder arthroplasty (RSA) surgery to those patients without C. acnes contamination. METHOD: A total of 162 patients were included. In all cases, skin and deep tissue cultures were obtained. A molecular typing characterization of the C. acnes strains was performed. Functional outcomes were assessed with the Constant score at the two and five year follow-up and all complications were also recorded. RESULTS: A total of 1380 cultures were obtained from the 162 primary RSA surgeries. Of those, 96 turned out to be positive for C. acnes. There were 25 patients with positive cultures for C. acnes. The overall postoperative Constant score was not significantly different between those patients having C. acnes-positive cultures and those with negative cultures at the two and five year follow-up (59.2 vs. 59.6 at two years, p 0.870, and 59.5 vs. 62.4 at five years, p 0.360). Patients with positive cultures presented a higher complication rate (p 0.001) with two infections, one revision surgery, and one dislocation. CONCLUSION: Patients ending up with C. acnes-positive cultures after primary shoulder arthroplasty surgery do not have worse clinical outcomes when compared to patients having negative cultures, but a greater number of complications were found in those patients with C. acnes-positive cultures.

Cutibacterium acnes in primary reverse shoulder arthroplasty: from skin to deep layers.

BACKGROUND: The aim of this study was to determine the presence of Cutibacterium acnes (formerly Propionibacterium acnes) on the skin and in deep tissue in a real clinical scenario of primary reverse shoulder arthroplasty. METHODS: This prospective study included 90 primary reverse shoulder arthroplasties, and 12 cultures were obtained from each patient. Each sample was homogenized and used to inoculate PolyVitex (bioMérieux, Marcy-l'Etoile, France) agar and Schaedler (bioMérieux) agar plates. The same procedure was also followed with a thioglycolate broth. Culture was considered positive for C acnes when 2 or more colonies were observed. Total DNA from C acnes isolates was extracted using the InstaGene Matrix (Bio-Rad Laboratories, Hercules, CA, USA) method. The phylotype was determined, and single-locus sequence typing was done on all isolates. RESULTS: We obtained 1080 tissue cultures from the 90 patients included, and 62 of those tissue cultures (5.7%) were positive for C acnes. There were 22 C acnes-positive tissue cultures before prosthesis implantation and 40 after implantation. C acnes was isolated in 17 patients (18.8%). We sent 38 positive samples for blinded phylotyping, single-locus sequence typing, and multi-locus sequence typing type determination. Many of the clusters isolated belonged to phylotype IB and clonal complex (CC) 36 or phylotype II and CC53. DISCUSSION: In the real scenario of patients undergoing primary reverse shoulder arthroplasty using antibiotic prophylaxis and standard preoperative skin preparation with chlorhexidine, C acnes was isolated in the deep layers of 18.8% of the patients. The C acnes K1 and K2 subtypes (belonging to phylotype II and CC53), reported to be commonly involved in prosthetic joint infection, were usually isolated.

The impact of body mass index on metatarsalgia surgical outcomes.

INTRODUCTION: Several studies have suggested that an increased body mass index (BMI) is a negative factor for forefoot plantar pain but its influence in the surgical correction of metatarsalgia is unknown. The purpose of the present study is to evaluate the influence of the BMI on the surgical outcomes of metatarsalgia. It has been hypothesized that the higher the BMI, the worse the functional outcomes after metatarsalgia surgical treatment at one year follow-up. MATERIAL AND METHODS: A prospective cohort study that included all patients operated on for third rocker metatarsalgia was conducted. Weil's osteotomy was performed on all the patients operated on. The patients' pre-operative height, weight, and BMI were recorded. The patients were subsequently divided into three groups based on their BMI. There was group 1 or the normal group (18.5 > BMI ≤ 25 kg/m2), group 2 or the overweight group (25 > BMI ≤ 30 kg/m2), and group 3 or the obese group (BMI > 30 kg/m2). Pre-operative, post-operative, and differential AOFAS were used to evaluate and compare the groups. The post-operative VAS was also measured to assess pain. The correlation between the BMI and those variables was also analyzed. RESULTS: After the exclusion criteria were applied, 107 patients were finally assessed. There were 22 patients (20.6%) in group 1, 52 patients (48.6%) in group 2, and 33 patients (30.8%) in group 3. No correlation was observed between the BMI and AOFAS (p > 0.05). Neither were any differences found when the three groups were compared (p > 0.05). Moreover, no correlation between the BMI and the VAS score was observed (p = 0.690). CONCLUSION: Obesity does not negatively influence functional outcomes after surgery for metatarsalgia in short to medium term. Regardless of their BMI, patients with propulsive metatarsalgia improve in functionality after surgical treatment.

3D reconstruction does not improve agreement and results in an increase in surgical indications in proximal humeral fractures.

The objective of this study is to analyze the effect of different imaging modalities in treatment decision making in proximal humeral fractures. After evaluation of 116 consecutive proximal humeral fractures, observers were asked to give treatment recommendation (conservative vs. surgery). If surgery was proposed, they were told to select surgery of choice. When 3D imaging was added, complexity of fractures significantly increased (p < 0.001), number of surgeries significantly increased (p < 0.000) and number of ORIF treatments significantly increased (p < 0.0004). Addition of 3D imaging of proximal humeral fractures significantly increases number of surgical decisions when compared to radiographs alone or together with CT.

Serum C-reactive protein in patients undergoing elective shoulder arthroplasty. Prospective study.

BACKGROUND: The objective of the study was to determine the normalization curve of the serum C-reactive protein (CRP) in elective shoulder arthroplasty. METHODS: A prospective study including 58 consecutive patients who had undergone elective shoulder arthroplasty. Forty-one patients had received a Reverse Shoulder Arthroplasty, 13 a Total Shoulder Arthroplasty and 4 a Hemiarthroplasty. Based on a pilot study, blood samples to determine CRP values were obtained at baseline (1 h before surgery), on the 1st, 2nd, 6th, 8th and 14th postoperative days. All the patients included presented no postoperative complications during inpatient stay or any re-admission during the three months after surgery. RESULTS: Mean CRP values showed a rapid increase on the 1st postoperative day (7-fold higher than the baseline in cuff tear arthropathy, 11-fold higher in primary osteoarthritis, 1-fold higher in acute fracture) and reached a peak on the 2nd postoperative day (14-fold higher than the baseline in cuff tear arthropathy, 24-fold higher in primary osteoarthritis and 2-fold higher in acute fracture). After the 2nd postoperative day CRP values began to slowly decrease reaching the normal range in the 14th postoperative day. CONCLUSIONS: Serum CRP levels after elective shoulder arthroplasty rapidly increase to reach a maximum peak after the 2nd surgery day and then slowly decrease to return to normality on the 14th day. Knowing the normalization curve of CRP can be a helpful tool to help in the diagnosis of acute infections in elective shoulder arthroplasty.

Non-surgical periodontal therapy for the treatment of chronicperiodontitis / Terapia periodontal não-cirúrgica no tratamento da periodontite crônica

Objective: The aim of this split-mouth controlled study was to compare the clinical benefits of administering subgingival 10% Doxycycline (test group) with a placebo gel (control group), as an adjunct to mechanical therapy in the treatment of chronic periodontitis. Methods: Fifteen patients with moderate to severe chronic periodontitis, with at least 2 pairs of comparable contralateral defects (pocket depth ?6 mm), were selected. The subjects were submitted to initial periodontal treatment, which included oral hygiene advice and supra-gingival ultrasonic instrumentation at least one month before starting the experiments. Clinical attachment level (CAL), probing depth (PD) and gingival margin level (GML) were assessed at baseline, and after 3 and 6 months, using a manual probe (PCP-15, Hu Friedy). Plaque index was less than 20% throughout the study period. Results: Comparison between groups indicated a PD reduction and CAL gain greater in the test group than in the control group at 3 and 6 months; however, no significant difference was shown (p>0,05). Conclusion: The findings suggest that 10% Doxycycline hyclate applied subgingivally as an adjunct to conventional periodontal treatment, did not promote additional benefit when compared to scaling and root planing with a placebo gel in patients with moderate to severe chronic periodontitis.

Objetivo: Comparar os benefícios clínicos da administração de gel composto de hiclato de doxiciclina a 10% (grupo teste) em relação ao gel placebo (grupo controle) associado à terapia mecânica no tratamento da periodontite crônica. Métodos: Foram selecionados 15 pacientes com periodontite crônica moderada a severa, e um mínimo de 2 pares de defeitos contralaterais comparáveis (profundidade de sondagem ? 6mm). Os pacientes foram submetidos ao tratamento periodontal inicial, que incluiu instrução de higiene oral, instrumentação ultra-sônica pelo menos um mês antes do início do experimento. Os parâmetros clínicos: nível clínico de inserção (NCI), profundidade de sondagem (PS), e nível da margem gengival (NG) foram aferidos no início, após 3 e 6 meses utilizando uma sonda periodontal manual (PCP-15, Hu Friedy). O índice de placa se manteve inferior a 20% durante todo o estudo. Resultados: As comparações entre os grupos indicaram que redução na PS e ganho no NCI foi maior no grupo teste do que no grupo controle aos 3 e 6 meses, porém, não houve diferença estatisticamente significante (p>0,05). Conclusão: Esses achados sugerem que a aplicação subgengival de hiclato de doxiciclina gel a 10%, como adjunto ao tratamento periodontal convencional não promoveu benefício adicional ao tratamento com raspagem e alisamento radicular com aplicação de gel placebo, em pacientes com periodontite crônica moderada a severa.

Problemas emocionais em um adulto com dislexia: um estudo de caso / Emotional problems in an adult with dyslexia: a case study

Este trabalho visa abordar os diversos tipos de sentimentos causados pela dislexia, baseando-se em um relato real, obtido por meio de uma entrevista em que o sujeito relatou suas experiências e frustrações do início da sua vida escolar até a fase adulta. Com isto focou-se na análise do discurso do sujeito, selecionando os recortes mais significativos e interpretados à luz da literatura. Desse modo, procurou-se salientar os prejuízos emocionais causados pela baixa-estima, agressividade, ansiedade, depressão, ou pelo medo de errar ou de ser descoberto, entre outros sentimentos apontados nesta pesquisa e comumente encontrados em indivíduos com dislexia que podem se estender, afetando tanto o plano social quanto o profissional. Porém, esses sentimentos podem ser superados por meio de um diagnóstico correto, possibilitando assim um tratamento eficaz, mas a principal causa de superação pode estar ligada à habilidade desenvolvida em superar, estrategicamente, as dificuldades(AU)

Problemas emocionais em um adulto com dislexia: um estudo de caso / Emotional problems in an adult with dyslexia: a case study

Este trabalho visa abordar os diversos tipos de sentimentos causados pela dislexia, baseando-se em um relato real, obtido por meio de uma entrevista em que o sujeito relatou suas experiências e frustrações do início da sua vida escolar até a fase adulta. Com isto focou-se na análise do discurso do sujeito, selecionando os recortes mais significativos e interpretados à luz da literatura. Desse modo, procurou-se salientar os prejuízos emocionais causados pela baixa-estima, agressividade, ansiedade, depressão, ou pelo medo de errar ou de ser descoberto, entre outros sentimentos apontados nesta pesquisa e comumente encontrados em indivíduos com dislexia que podem se estender, afetando tanto o plano social quanto o profissional. Porém, esses sentimentos podem ser superados por meio de um diagnóstico correto, possibilitando assim um tratamento eficaz, mas a principal causa de superação pode estar ligada à habilidade desenvolvida em superar, estrategicamente, as dificuldades.

Estudio de un brote debido a aislados de Klebsiella pneumoniae productores de betalactamasas de espectro extendido en un centro asistencial de Rosario - Argentina / An outbreak of extended spectrum beta-lactamase Klebsiella pneumoniae producers in a health care center from Rosario - Argentina

En América Latina (AL) son trascendentes los productores de betalactamasas de espectro extendido (BLEE) en infecciones hospitalarias. Los datos de API y SENTRY revelan una incidencia del 22 a 55. En AL y frecuentemente en el Cono Sur predominan las BLEE de la familia CTX-M contrariamente a EUA y Europa donde prevalecen las derivadas de TEM. Las CTX-M afectan cefotaxima, ceftriaxona y cefepima con más frecuencia que ceftacidima. El tratamiento depende del empleo de carbapenemes con el riesgo de seleccionar resistencia en bacilos gram negativos no fermentadores. El uso de otros betalactámicos particularmente cefepima no es aconsejable por las frecuentes fallas observadas en nuestro medio debido al efecto inóculo por aislados productores de CTX-M-2. Describimos un brote por Klebsiella pneumoniae (Kp) ocurrido entre junio-julio 2004. En el período previo, sólo un paciente presentó una infección debida a Kp productora de BLEE y en el posterior, lo presentaron dos pacientes Se determinó la CIM por microdilución en agar. El fenotipo BLEE se sospechó por ensayo del efecto del clavulanato unido a cefalosporinas de 3ª generación (C3G). Se determinó el punto isoeléctrico (pI) y la detección por PCR del tipo molecular por métodos convencionales. Se comprobaron dos bandas pI 5.4 y 8.2 con ampicilina y ceftriaxona en todas las cepas excepto en dos. Todas las cepas revelaron producción de CTX-M-2 excepto en dos cepas que se identificaron como productoras de SHV-5. Los estudios clonales se correspondieron con los moleculares identificándose dos clones. El brote se resolvió usando dos importantes medidas: 1) lavado de manos y otras medidas de barrera y 2) restringiendo el uso de C3G y ciprofloxacina

Um desafio para o cirurgião-dentista: a valorização da saúde / A challenge for the surgeon-dentist: the valuation of health

A saúde, como reflexo da melhoria na qualidade de vida, tem sido a meta dos países em desenvolvimento, mas há que se reconhecer às barreiras que dificultam tal processo. O trabalho realizado em dois bairros de Santa Cruz do Sul, RS busca conhecer quais os serviços odontológicos mais procurados por essa população, considerando a renda per capita mensal, freqüência e em que circunstâncias os moradores procuram o Serviço Único de Saúde (SUS). Uma entrevista domiciliar e a revisão de literatura fornecem subsídios para melhor compreender tais barreiras a partir de vivências locais. Vê-se necessidade de mudanças e, nesse sentido, a inserção da equipe odontológica no Programa de Saúde da Família (PSF) se apresenta como um desafio na prática e no pensar do cirurgião-dentista

Efecto modulador de antibióticos sobre la adherencia bacteriana a biomateriales / Antibiotics modulation of bacterial adherence to medical biomaterials

La colonización de polímeros origina un foco de infección de difícil erradicación, debido a que las bacterias adheridas a materiales inertes presentaban propiedades fisiológicas especiales. Las infecciones urinarias complicadas debidas a sondas vesicales son las responsables del 40 por ciento de las infecciones urinarias hospitalarias. Se analizó el efecto modular de cefotaxima y ciprofloxacina en concentraciones subinhibitorias, sobre la adherencia a sondas vesicales de cepas uropatógenas de Escherichia coli. Este estudio se efectuó con cepas con bajo y elevado grado de hidrofobicidad determinados por agregación salina. Los experimentos de adherencia a sondas vesicales, en ausencia y presencia de ambos antibióticos, se realizaron a la hora y a las 24 h de contacto con los antibacterianos mencionados. El número de UFC/ml adheridas, se determinó por espectrofotometría y recuento de colonias. Se demostró que en la mayoría de las cepas con elevado grado de hidrofobicidad, aumentó el número de UFC/ml que se adhirieron a la sonda vesical, con alguno de los tratamientos. En forma inversa se comportaron las cepas con bajo grado de hidrofobicidad. El comportamiento diferente de las cepas, tratadas en las mismas condiciones, no permite generalizar el efecto de los antibióticos en concentraciones subinhibitorias, sobre la colonización bacteriana de sondas vesicales

Efecto modulador de antibióticos sobre la adherencia bacteriana a biomateriales / Antibiotics modulation of bacterial adherence to medical biomaterials

La colonización de polímeros origina un foco de infección de difícil erradicación, debido a que las bacterias adheridas a materiales inertes presentaban propiedades fisiológicas especiales. Las infecciones urinarias complicadas debidas a sondas vesicales son las responsables del 40 por ciento de las infecciones urinarias hospitalarias. Se analizó el efecto modular de cefotaxima y ciprofloxacina en concentraciones subinhibitorias, sobre la adherencia a sondas vesicales de cepas uropatógenas de Escherichia coli. Este estudio se efectuó con cepas con bajo y elevado grado de hidrofobicidad determinados por agregación salina. Los experimentos de adherencia a sondas vesicales, en ausencia y presencia de ambos antibióticos, se realizaron a la hora y a las 24 h de contacto con los antibacterianos mencionados. El número de UFC/ml adheridas, se determinó por espectrofotometría y recuento de colonias. Se demostró que en la mayoría de las cepas con elevado grado de hidrofobicidad, aumentó el número de UFC/ml que se adhirieron a la sonda vesical, con alguno de los tratamientos. En forma inversa se comportaron las cepas con bajo grado de hidrofobicidad. El comportamiento diferente de las cepas, tratadas en las mismas condiciones, no permite generalizar el efecto de los antibióticos en concentraciones subinhibitorias, sobre la colonización bacteriana de sondas vesicales (AU)