A Novel Uni- and Biplanar External Fixator for Initial and Definitive Complex Foot Trauma.

Background: Evidence concerning the complex foot trauma, especially its definitive management, is scarce. Soft tissue envelope sequalae are the primary parameters that delay or make internal fixation implausible. Stability conferred by external fixators makes them a reasonable initial treatment choice. Although AO or circular fixators can be applied around the foot, this can involve a learning curve and substantial costs, especially for the circular fixator. There is little evidence as to how well external fixators work as a definite method of fixation in patients where progression to internal fixation cannot be made. Methods: We prospectively evaluated 10 adult patients with severe and complex foot trauma who were consecutively treated at our clinic. Initial reduction and stabilization were performed with an external fixator that was initially conceived for distal radius fractures, applied during the initial procedure and mantained throughout the treatment. Results: Fracture healing was obtained in all 10 cases, and both internal and external column length was restored. One of the patients developed chronic osteomyelitis. At the 1-year follow-up visit, these patients averaged 45.6 points in the physical and 44.8 points on the mental status sections of the 12-Item Short Form Health Survey (SF-12). The Foot Function Index findings for pain, disability, and daily activities limitations were 33.3, 39, and 41.5, respectively, which suggest moderate residual impairment. Conclusion: In this relatively small case series of complex foot trauma, we found that the use of simple external fixation as definitive treatment worked reasonably well. Level of Evidence: Level III, prospective cohort study.

Limb salvage versus amputation: Experience of a young patient at a university hospital.

Decision-making regarding limb amputation represents a significant clinical challenge, especially when the initial evaluation does not coincide with the criteria established in scales used worldwide, as is the case of the MESS scale. This article presents the case of a 24-year-old female patient who was transferred to a university hospital after a road traffic accident with severe and large lesions in the left lower limb. Despite a poor initial prognosis and in-hospital complications, including multiple surgical procedures and foot drop, a favorable recovery was achieved with complete anatomical salvage of the limb at risk. The multidisciplinary approach and intensive rehabilitation were instrumental in achieving a satisfactory functional recovery. This case highlights the importance of considering factors beyond amputation scale scores, as well as the need for comprehensive care to improve outcomes in patients with complex extremity injuries.

Factors associated with the quality of corneas retrieved for transplantation by Eye Banks: a scoping review protocol.

INTRODUCTION: The cornea is an avascular and transparent layer of connective tissue crucial to retinal image quality. Diseases can impair its quality, affecting vision. Keratoplasty is the only therapy capable of restoring vision quality in severe corneal involvement. Despite the established practice of transplantation, access to corneal tissue is limited in many places, and the quality of retrieved corneas is not always adequate, resulting in disqualification. Not all factors affecting tissue quality are fully understood due to the multifactorial nature of processes and variations in procedures globally. OBJECTIVE: The objective is to map the global literature to establish the factors associated with the clinical and sociodemographic conditions of donors, and the conditions inherent in the processing of corneas that can influence the quality of this tissue for transplantation purposes. METHODS AND ANALYSIS: A scoping review will be developed based on the methodological framework of the Joanna Briggs Institute. The scientific report will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension checklist for Scoping Reviews. Searches will be conducted in 30 indexed and 12 grey literature databases, without time or location restrictions. The selection of studies will be carried out in three distinct phases: screening, eligibility and inclusion. After defining the sample, data from the selected studies will be systematically extracted into an electronic spreadsheet. The results will be presented descriptively through tables and graphs of absolute and relative frequency. In addition, the PRISMA Scoping Review flow chart will be presented to present the process of searching, including and excluding articles and documents. ETHICS AND DISSEMINATION: This scoping review study does not require prior ethical approval as it uses publicly available and already published studies. The research protocol is registered in the Open Science Framework (osf.io/bw6r7). The findings will be submitted for publication in peer-reviewed scientific journals and presented at ophthalmology and/or transplantation conferences through oral presentations or posters.

Impact of Early- and High-Dose Caffeine on the Cerebellum Development in Newborn Rats.

INTRODUCTION: Preterm newborns struggle with maintaining an adequate respiratory pattern; early caffeine administration is suggested to stimulate respiration and reduce bronchopulmonary dysplasia, however, its consequences on the immature cerebellum remains unknown. This study aimed to assess the impact of early caffeine administration, at standard and high doses, accompanied by supplemental oxygen on cerebellar development in an experimental model. METHODS: Five groups of Wistar pups were formed (n = 8 offspring/group): (a) negative control: no intervention; (b) placebo: pups remaining from birth until the 7th day of life (DOL) exposed to fractional inspired oxygen (FiO2) 45%, resembling preterm infant condition and as a placebo, 0.2 mL oral 5% dextrose, from the first DOL until the 14th DOL; (c) caffeine group: oral caffeine, 1st DOL 20 mg/kg, and from 2nd to 14th DOL, 5 mg/kg (standard dose); (d) caffeine at the standard dose, plus O2: during the first 7 DOLs (FiO2: 45%); (e) caffeine: 40 mg/kg in the first DOL, 10 mg/kg the next 14 DOLs, plus O2 in the first 7 DOLs (FiO2: 45%). Subjects were sacrificed on their 15th DOL; measurements were taken from the cerebellum, specifically the external granular layer (EGL) and molecular layer (ML), with quantification of cell migration. RESULTS: Caffeine administration in pups resulted in a delay in cerebellum development based on persistent transitional EGL cells; this finding was exacerbated in groups exposed to caffeine plus O2, as evident from the thicker EGL. The negative control group showed near-complete cell migration with a thicker ML and a significantly smaller EGL. CONCLUSIONS: Early caffeine administration in newborn rats disrupts cerebellar cortex cell processes and connectivity pathways, with exacerbated effects in groups receiving caffeine plus O2.

NEWS2, S/F-ratio and ROX-index at emergency department for the prediction of adverse outcomes in COVID-19 patients: An external validation study.

BACKGROUND: In the context of the COVID-19 pandemic, the early and accurate identification of patients at risk of deterioration was crucial in overcrowded and resource-limited emergency departments. This study conducts an external validation for the evaluation of the performance of the National Early Warning Score 2 (NEWS2), the S/F ratio, and the ROX index at ED admission in a large cohort of COVID-19 patients from Colombia, South America, assessing the net clinical benefit with decision curve analysis. METHODS: A prospective cohort study was conducted on 6907 adult patients with confirmed COVID-19 admitted to a tertiary care ED in Colombia. The study evaluated the diagnostic performance of NEWS2, S/F ratio, and ROX index scores at ED admission using the area under the receiver operating characteristic curve (AUROC) for discrimination, calibration, and decision curve analysis for the prediction of intensive care unit admission, invasive mechanical ventilation, and in-hospital mortality. RESULTS: We included 6907 patients who presented to the ED with confirmed SARS-CoV-2 infection from March 2020 to November 2021. Mean age was 51 (35-65) years and 50.4% of patients were males. The rate of intensive care unit admission was 28%, and in-hospital death was 9.8%. All three scores have good discriminatory performance for the three outcomes based on the AUROC. S/F ratio showed miscalibration at low predicted probabilities and decision curve analysis indicated that the NEWS2 score provided a greater net benefit compared to other scores across at a 10% threshold to decide ED admission at a high-level of care facility. CONCLUSIONS: The NEWS2, S/F ratio, and ROX index at ED admission have good discriminatory performances in COVID-19 patients for the prediction of adverse outcomes, but the NEWS2 score has a higher net benefit underscoring its clinical utility in optimizing patient management and resource allocation in emergency settings.

Systematic review on the implementation of metrological assurance systems for medical devices in Latin America.

Background: Metrology plays a crucial role in small healthcare service businesses to ensure the quality of products and services. While legal metrology in healthcare exists in some regions, it lacks harmonization. In other countries, there is limited presence of metrology in medical and biomedical engineering. We aimed to evaluate the implementation of metrological assurance systems for medical devices in Latin America. Methods: A systematic review was conducted following PRISMA 2020 guidelines and registered with PROSPERO (CRD42022359284). Searches were performed across 13 databases from October 30th to November 3rd, 2022. The search equation was "(((quality assurance) AND (metrology)) AND (medical devices))." A total of 7,789 documents were identified, of which only 16 met the inclusion criteria. Results: The majority of studies (75%) were conducted in Colombia, with a significant portion being undergraduate theses. The primary normative references used in the analyzed studies were ISO 10012 and ISO 17025, with the majority (68.75%) relying on national legislation for their approach. One study in Colombia referenced eight standards, and one in Brazil analyzed user involvement in medical device management. Among the included studies, 56.25% were conducted in healthcare institutions, mainly clinics. Most studies provided implementation guidelines, with ISO 10012 being prominent, alongside ISO 17025, which implicitly addresses ISO 9001 elements. Global bias was low across all studies. Conclusion: Our results underscore the importance of metrological assurance in managing medical devices in Latin America. The utilization of international standards and national legislation illustrates the diverse approaches adopted by different institutions. Future research should focus on optimizing metrological practices to enhance quality and safety in healthcare.

How does external debt and governance quality impact renewable energy consumption: novel policy insights from BRICS countries.

Amidst global environmental reforms, the role of energy systems is under scrutiny to promote ecological welfare through low-carbon alternatives. Amongst the solutions, the role of renewable energy as a clean source has become popular to mitigate climate change. However, the impact of debt on renewable energy consumption remains limited in the economic literature. The debt initiatives provide funding for environmental initiatives primarily, while it is also credited as a barrier to limiting the growth of clean energy programs. Within such discussion, the current study extended the dialogue by examining how external debt impacts energy transition in Brazil, Russia, India, China, and South Africa (BRICS) economies in the presence of institutional quality, education expenditures, and banking development. Using the novel CS-ARDL, AMG, and CCEMG tests, the study results showed that external debt decreases renewable energy consumption, while institutional quality, educational expenditures, banking developments, and economic growth are essential elements of green energy developments. Based on these conclusions, this study provides novel policy guidelines to align BRICS energy and economic agendas.

Sex differences in entrapment in a multinational sample: a network analysis perspective.

Background: The concept of entrapment has been highlighted as a transdiagnostic element that manifests itself in disorders such as depression, anxiety, and suicidal ideation. Although research has been conducted in different contexts independently, a comprehensive multi-country study to assess gender differences in entrapment through network analysis has not yet been carried out. The objective of this study was to evaluate the entrapment network in men and women at the multinational level. Methods: A sample of 2,949 participants, ranging in age from 18 to 73 years from six countries (Germany, Iran, Spain, Slovakia, El Salvador, and Peru), was considered. They completed the entrapment scale. A network analysis was performed for both men and women to identify the connectivity between indicators and the formation of clusters and domains, in addition to the centrality assessment in both sex groups. Results: The study findings revealed the presence of a third domain focused on external interpersonal entrapment in the network of men and women. However, in relation to the interconnectivity between domains, variations were evidenced in both networks, as well as in centrality, it was reported that men present a greater generalized entrapment in various aspects of life, while women tend to experience a more focused entrapment in expressions of intense emotional charge. Conclusion: The multinational study identified variations in the structure of entrapment between genders, with three domains (internal, external, and external-interpersonal) and differences in the interaction of indicators and groupings, as well as discrepancies in centrality.

Out of hospital cardiac arrest, first steps to know and follow in Mexico to have cardioprotected territories. A point of view of a group of experts / Paro cardiaco extrahospitalario, primeros pasos que se deben conocer y hacer en México para tener espacios cardioprotegidos. Punto de vista de un grupo de expertos

Abstract Sudden cardiac death is a common occurrence. Out-of-hospital cardiac arrest is a global public health problem suffered by ≈3.8 million people annually. Progress has been made in the knowledge of this disease, its prevention, and treatment; however, most events occur in people without a previous diagnosis of heart disease. Due to its multifactorial and complex nature, it represents a challenge in public health, so it led us to work in a consensus to achieve the implementation of cardioprotected areas in Mexico as a priority mechanism to treat these events. Public access cardiopulmonary resuscitation (CPR) and early defibrillation require training of non-medical personnel, who are usually the first responders in the chain of survival. They should be able to establish a basic and efficient CPR and use of the automatic external defibrillator (AED) until the emergency services arrive at the scene of the incident. Some of the current problems in Mexico and alternative solutions for them are addressed in the present work.

Resumen La muerte súbita cardíaca (SCD) es un acontecimiento común. El paro cardiaco extrahospitalario (OHCA) es un problema de salud pública mundial que sufren ≈3.8 millones de personas al año. Se ha avanzado en el conocimiento de esta enfermedad, su prevención y tratamiento, sin embargo, la mayoría de los eventos se producen en personas sin diagnóstico previo de cardiopatía. Debido a su carácter multifactorial y complejo, representa un reto en salud pública, lo que obliga a trabajar en un consenso para lograr la implementación de "Espacios Cardio protegidos" en México, como mecanismo prioritario de atención a estos eventos. La reanimación cardiopulmonar básica (RCPB) y la desfibrilación temprana de acceso público requieren de entrenamiento al personal no médico, que suelen ser los primeros respondientes para iniciar la cadena de la supervivencia. Ellos deberían instaurar una RCPB eficiente y el uso del desfibrilador automático externo (AED) hasta que lleguen al lugar del incidente los servicios de emergencias. El presente trabajo menciona algunos de los problemas actuales en México y algunas opciones de solución para los mismos.

Ventriculitis due to multidrug-resistant gram-negative bacilli associated with external ventricular drain: evolution, treatment, and outcomes.

Introduction: Nosocomial infectious ventriculitis caused by multidrug-resistant (MDR) Gram-negative bacilli associated with external ventricular drainage (EVD) placement poses a significant mortality burden and hospital costs. Objectives: This study aims to analyze the characteristics, ventriculitis evolution, treatment, and outcomes of patients with ventriculitis due to MDR Gram-negative bacilli associated with EVD placement. Methods: A retrospective cohort study focusing on patients with nosocomial infection caused by MDR Gram-negative bacilli while on EVD was conducted from 2019 to 2022. Medical, laboratory, and microbiological records were collected. The antibiotic resistance of the Gram-negative bacilli isolated in the cerebrospinal fluid (CSF) of patients was analyzed. The risk factors were identified using univariate risk models and were analyzed using survival curves (Cox regression). An adjusted Cox proportional hazards model was also constructed. Results: Among 530 patients with suspected EVD-associated ventriculitis, 64 patients with isolation of Gram-negative bacilli in CSF were included. The estimated mortality was 78.12%. Hemorrhages (intracranial, subarachnoid, and intraventricular) were observed in 69.8% of patients. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most frequently isolated bacilli. In the univariate analysis, significant risk factors for mortality included arterial hypertension, a Glasgow Coma Scale (GCS) score of ≤ 8, invasive mechanical ventilation (IMV) upon hospital admission and during hospitalization, septic shock, and ineffective treatment. The adjusted Cox proportional hazards model revealed that septic shock (HR = 3.3, 95% CI = 1.5-7.2; p = 0.003) and ineffective treatment (HR = 3.2, 1.6-6.5, 0.001) were significant predictors. A high resistance to carbapenems was found for A. baumannii (91.3%) and P. aeruginosa (80.0%). Low resistance to colistin was found for A. baumannii (4.8%) and P. aeruginosa (12.5%). Conclusion: Ineffective treatment was an independent hazard factor for death in patients with ventriculitis caused by MDR Gram-negative bacilli associated with EVD.

The Applicability of Dynamic External Fixator in a Prospective Evaluation of Open Tibial Fracture Treatment.

Aim: This prospective study assessed the clinical and radiological outcomes of open tibia fractures treated with a dynamic external fixator. Materials and methods: Twenty-five patients underwent surgical debridement and stabilisation with a dynamic external fixator between November 2016 and April 2022. Regular follow-up evaluated bone healing progression. Results: Favourable outcomes were demonstrated in 20 patients. However, there were three cases of non-union, two of which subsequently deformed, and two cases of pin site-related infection. There were no fracture site infections. Conclusion: This study demonstrates the use of dynamic external fixation in the treatment of open tibia fractures. The low incidence of complications suggests its effectiveness and potential. How to cite this article: Bezerra BS, Araujo TA, Cardonia GG, et al. The Applicability of Dynamic External Fixator in a Prospective Evaluation of Open Tibial Fracture Treatment. Strategies Trauma Limb Reconstr 2024;19(1):36-39.

External validation of the ARCH score in patients undergoing aortic arch reconstruction under circulatory arrest.

BACKGROUND: Aortic arch surgery with hypothermic circulatory arrest (HCA) carries a higher risk of morbidity and mortality compared to routine cardiac surgical procedures. The newly developed ARCH (arch reconstruction under circulatory arrest with hypothermia) score has not been externally validated. We sought to externally validate this score in our local population. METHODS: All consecutive open aortic arch surgeries with HCA performed between 2014 and 2023 were included. Univariable and multivariable analyses were performed. Model discrimination was assessed by the C-statistic with 95% confidence intervals as part of the receiver operating characteristic (ROC) curve analysis. Model performance was visualized by a calibration plot and quantified by the Brier score. RESULTS: A total of 760 patients (38.3% females) were included. The mean age was 61 (±13.6) years, with 56.4% of patients' age >60 years. The procedures were carried out mostly emergently or urgently (59.6%). Total arch replacement was performed in 32.5% of the patients, and aortic root procedures were carried out in 74.6%. In-hospital death occurred in 64 patients (8.4%), and stroke occurred in 5.4%. The C-statistic revealed a low discriminatory ability for predicting in-hospital mortality (area under the ROC curve, 0.62; 95% confidence interval, 0.54-0.69; P = .002); however, model calibration was found to be excellent (Brier score of 0.07). CONCLUSIONS: The ARCH score for in-hospital mortality showed low discriminatory ability in our local population, although with excellent ability for prediction of mortality.

"Supratip Cross Flap: Reshaping the Nasal Tip and Improving the Nasal Vault Function."

The authors propose a novel flap for rhinoplasty: the supratip cross flap (SCF). It is a simple and effective method for avoiding and correcting alar contour deformities and external nasal valve (ENV) issues in rhinoplasty without grafts. In addition to its benefit for supratip break, the flap also allows a smooth and natural transition between the nasal dorsum and the nasal tip complex.

3D printing feasibility of a controlled dynamization device for external circular fixation.

AIM: to assess the small-scale 3D printing feasibility and cost estimation of a device for controlled dynamization. MATERIALS AND METHOD: The two-part device previously developed by our research group was printed with a carbon fiber-reinforced nylon filament (Gen3 CarbonX™ PA6+CF, 3DXTECH Additive Manufacturing) by a professional 3D printer (FUNMAT HT, Intamsys). Electricity, material, and labor costs for production in a Brazilian city in the Santa Catarina state were calculated. RESULTS: The devices for controlled dynamization were successfully printed in accordance with the planned design and dimensions. Six out of 38 printed devices presented defects in the bolt hole and were discarded. The average printing time per device was 1.9 h. The average electricity, material, and labor costs per printed device were respectively US$0.71, US$13.55, and US$3.04. The total production cost per device reaches approximately US$20 by adding the average cost of defective devices (15 %). CONCLUSION: 3D printing of the controlled dynamization device is feasible and its cost seems affordable to most healthcare services, which could optimize the consolidation of diaphyseal fractures and reduce treatment time for patients.

Comparison of quality of life after radical treatment in prostate cancer: radical prostatectomy versus external radiotherapy.

OBJECTIVE: To assess and compare the functional and quality of life results in patients treated with curative intent for localized prostate cancer during 2015 in our hospital. METHOD: 77 patients treated by radical prostatectomy or external radiotherapy with androgen deprivation were prospective enrolled. Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) questionnaire at 3-year follow-up and Spanish Questionnaire on Quality of Life in Patients with Prostate Cancer (CAVIPRES-30) at diagnosis and at 3-year follow-up were registered. RESULTS: 68 patients were included, 39 patients treated by radical prostatectomy and 29 received external radiotherapy with androgen deprivation. Among the operated patients, 61.5% were dry and 17.9% use three or more daily pads, compared to 72.4% and 6.8%, respectively, in the radiotherapy group. 48.7% of prostatectomized patients reported very poor or no capacity to have a sufficiently rigid erection, compared to 69% of the radiated group. After surgery, 43.6% considered bad or very bad quality-of-life, compared to 68.9% in the radiotherapy group. In the comparison of the data of the pre- and post-treatment questionnaire can be seen that the patients had a superior perception before the procedure. CONCLUSIONS: Patients treated by surgery have a better perception of quality-of-life compared to those treated by radiotherapy.

OBJETIVO: Determinar y comparar los resultados funcionales y de calidad de vida de pacientes con cáncer de próstata tratados con intención curativa durante el año 2015 en nuestro centro. MÉTODO: Se incluyeron 77 pacientes sometidos a prostatectomía radical (PR) o radioterapia externa con terapia de deprivación androgénica (TDA). Se realizaron el Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) tras 3 años de seguimiento y el Cuestionario Español de Calidad de Vida en Pacientes con Cáncer de Próstata (CAVIPRES-30) al diagnóstico y a los 3 años. RESULTADOS: Se incluyeron 68 pacientes, 39 con PR y 29 con radioterapia más TDA. De los pacientes intervenidos, el 61.5% están secos y el 17.9% usan tres o más compresas, diarias frente al 72.4% y el 6.8%, respectivamente, en el grupo de radioterapia. El 48.7% de los prostatectomizados refieren erecciones muy malas o ninguna, frente al 69% de los radiados. Tras la cirugía, el 43.6% refieren mala o muy mala calidad de vida, frente al 68.9% de los radiados. En la comparación de los datos del cuestionario pre- y postratamiento, los pacientes tenían una percepción superior antes del procedimiento. CONCLUSIONES: Los pacientes tratados mediante cirugía tienen una mejor percepción de su calidad de vida relacionada con la salud que los radiados.

Absent right common carotid artery with associated anterior communicating aneurysm: embryology and imaging correlation.

PURPOSE: To report an unusual absent right common carotid artery with embryological and clinical emphasis. METHODS: A 63-year-old female with a multilobulated anterior communicating artery saccular aneurysm was referred to our center for definite treatment. An analysis of her carotid system on CTA and DSA with 3D modeling was performed to assess the embryology of an absent right common carotid and its association with aneurysm development. RESULTS: Cerebral angiogram demonstrated an absent right common carotid artery and separate origin of the internal and external right carotid arteries arising from the brachiocephalic trunk. CONCLUSION: Absence of the common carotid artery is an uncommon anatomical variant, usually asymptomatic and commonly associated with other vascular abnormalities. It is important to be familiar with the association between this anatomical variant given its hemodynamic stress, high risk of stroke, and aneurysm formation.

Clinical and radiographic characterization of external root resorption. / Características clínicas y radiográficas de reabsorciones radiculares externas.

Introduction: The following bibliographic review was carried out with the purpose of recognizing the clinical and radiographic characteristics that must be considered in the diagnosis of external root resorption, including treatments. Methods: A bibliographic search was carried out in PubMed/Medline, Cochrane Library and Google Scholar databases under the term "external root resorption", from 2010 to 2022 in Spanish and English. Experimental studies and bibliographic reviews were selected, and finally 17 articles were included. Results: The results obtained indicated that each type of resorption presents specific clinical characteristics that differentiate them, these are: for external inflammatory resorption a negative pulp vitality; for replacement external resorption the absence of mobility and metallic percussion; for cervical external resorption a pink coloration of the crown; superficial external resorption does not present any type of clinical symptoms and transient apical collapse presents a transient change in color. Conclusion: External root resorptions require accurate and early diagnosis. A clinical examination should be performed with emphasis on the following: probing, coloration, mobility, and vitality tests.

Introducción: La siguiente revisión bibliográfica se realizó con el propósito de reconocer las características clínicas y radiográficas que deben ser evaluadas para el diagnóstico de las reabsorciones radiculares externas incluyendo también sus tratamientos. Metodología: Se llevó a cabo una búsqueda en las bases de datos MEDLINE/PubMed, Cochrane Library y Google Scholar bajo el término , incluyendo estudios experimentales y revisiones bibliográficas desde 2010 a 2022 en español e inglés, incluyendo finalmente 17 artículos. Resultados: Los resultados obtenidos señalaron que cada tipo de reabsorción radicular externa presenta características clínicas específicas que las diferencian. Estas diferencias son: para la reabsorción externa inflamatoria la vitalidad pulpar negativa; para la reabsorción externa de reemplazo la ausencia de movilidad y percusión metálica; para la reabsorción externa cervical una coloración rosada de la corona; la reabsorción externa superficial no presenta ningún tipo de sintomatología clínica y la reabsorción de colapso apical transitorio presenta un cambio de coloración transitorio. Conclusión: Las reabsorciones radiculares externas requieren un diagnóstico preciso y temprano. Se debe realizar un examen clínico con énfasis en sondaje, coloración, movilidad y pruebas de vitalidad.

Exploring clinical variability in gelsolin amyloidosis: Brazilian family case study with confocal microscopy.

INTRODUCTION: Genetic mutations or inflammatory, degenerative, or neoplastic conditions can trigger amyloidosis. Hereditary gelsolin amyloidosis is a genetic disorder primarily marked by amyloid fibrils composed of misfolded gelsolin fragments. CASE REPORT: We present three sisters with AGel amyloidosis, illustrating its clinical diversity. Patient 1, a 51-year-old, had bilateral ptosis, ocular discomfort, and dry eye syndrome due to cranial nerve involvement. Patient 2, a 53-year-old, experienced progressive bilateral visual impairment. Patient 3, a 50-year-old, exhibited right eye ectropion. Genetic analysis, with the identical mutation, heterozygous c.640G > A (p.Asp214Asn) mutation, confirmed AGel amyloidosis diagnoses, with common findings including lattice corneal amyloidosis, reduced corneal sensitivity, and recurrent corneal erosions. Neurological manifestations included ataxia and peripheral neuropathy, with skin abnormalities observed in patient 1. Ocular involvement severity and distribution varied among patients. DISCUSSION: Common ocular and neurological manifestations validated AGel amyloidosis diagnoses, reinforcing its hereditary basis. Neurological symptoms highlighted the disorder's impact on various organ systems, while skin abnormalities contributed to ocular discomfort. Variable ocular involvement emphasized the disorder's heterogeneity. These patients emphasize hereditary gelsolin amyloidosis's clinical diversity and suggest potential environmental influences on disease expression. Genetic confirmation and confocal microscopy findings reaffirm the genetic basis while raising questions about assessing systemic disease severity, necessitating further investigation in larger cohorts. Ophthalmologists' specialized care is crucial for managing ocular symptoms, given the absence of a universal cure.

Influence of contextual factors on match running performance of starters and non-starters in elite youth male soccer players.

This study investigated the effects of match location, quality of opposition (classified into: strong [1st to 4th position]; intermediate [5th to 15th position]; weak [16th to 20th position]), and match outcome on the match running performance of starters and non-starters from a top elite Brazilian soccer team. Absolute measures were calculated using total distance, high-speed (19.8-25.2 km·h-1), sprinting (≥ 25.2 km·h-1), total distance high-acceleration (> 2m·s2), and deceleration (< -2m·s2) were recorded by GPS units from a sample of young soccer players (N = 25) in a total of 17 matches. Relative measures were calculated by dividing absolute measures by the total duration of the matches. Non-starters covered greater total distance (p = 0.02), sprinting (p = 0.02), high-acceleration and deceleration (p = 0.04), sprinting distance relative per minute played (p = 0.005), and high-acceleration and deceleration relative per minute played (p < 0.001) when the team plays at home, strong opponents, and wins the matches. Starters covered greater total distance in high-speed running (p = 0.04), high-acceleration and deceleration (p = 0.03), and high-speed running relative per minute played (p = 0.04) when the team plays strong opponents and wins the matches. These findings highlight the impact of contextual factors during matches on the locomotor performance of young soccer players.

Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods.

Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences ( p > 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.