Prediction of reparability of meniscal tears in athletes using magnetic resonance.

Meniscal tears account for approximately 15% of all knee injuries and almost 25% of them require surgical procedures. Magnetic Resonance Imaging (MRI) is widely used for noninvasive assessment of the knee joint and is considered reliable and a powerful tool for the detection of soft tissue injuries of the knee. The aim of the study was to evaluate the sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI) to predict the meniscal tears repair in sports practitioners. 104 incoming consecutive patients who underwent knee joint ligament reconstruction and/or arthroscopy for the treatment of meniscal injury at knee joint were imaged using a 1.5-T MRI scanner prior to arthroscopy. MRI images were evaluated for anterior cruciate ligament (ACL), articular cartilage, and meniscal injury. Images were correlated with arthroscopic findings, used as the gold standard. The sensitivity, specificity, and accuracy of MRI in predicting meniscal repair were 61.1%, 65.94%, and 64.58%, respectively. The agreement between MRI and arthroscopy yielded a kappa index of 0.236, indicating fair agreement. When the menisci were evaluated separately, 65.85% sensitivity, 45.45% specificity, and 54.16% accuracy were found for the medial meniscus, while 46.15%, 79.51%, and 75.0% for the lateral meniscus, respectively. The accuracy was 62.09% in whose patients that arthroscopy was performed up to 3 months after MRI and 67.18% in those that this time frame was more than 3 months before surgery. The 54 meniscal injuries occurred more frequently in the posterior horn; most injuries had a longitudinal pattern and were located in the red-red (vascular) zone. We suggest that magnetic resonance imaging is only moderately accurate for the prediction of meniscus reparability.

Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study.

Objective The objective of this study was to compare demographic data, clinical/laboratorial features and disease activity at diagnosis in three different groups with distinct time intervals between onset of signs/symptoms and disease diagnosis. Methods A multicenter study was performed in 1555 childhood-onset systemic lupus erythematosus (American College of Rheumatology criteria) patients from 27 pediatric rheumatology services. Patients were divided into three childhood-onset systemic lupus erythematosus groups: A: short time interval to diagnosis (<1 month); B: intermediate time interval (≥1 and <3 months); and C: long time interval (≥3 months). An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2 K were evaluated. Results The number of patients in each group was: A = 60 (4%); B = 522 (33.5%); and C = 973 (62.5%). The median age at diagnosis (11.1 (4.2-17) vs. 12 (1.9-17.7) vs. 12.5 (3-18) years, P = 0.025) was significantly lower in group A compared with groups B and C. The median number of diagnostic criteria according to SLICC (7 (4-12) vs. 6 (4-13) vs. 6 (4-12), P < 0.0001) and SLEDAI-2 K (18 (6-57) vs. 16 (2-63) vs. 13 (1-49), P < 0.0001) were significantly higher in group A than the other two groups. The frequency of oral ulcers in the palate (25% vs. 15% vs. 11%, P = 0.003), pleuritis (25% vs. 24% vs. 14%, P < 0.0001), nephritis (52% vs. 47% vs. 40%, P = 0.009), neuropsychiatric manifestations (22% vs. 13% vs. 10%, P = 0.008), thrombocytopenia (32% vs. 18% vs. 19%, P = 0.037), leucopenia/lymphopenia (65% vs. 46% vs. 40%, P < 0.0001) and anti-dsDNA antibodies (79% vs. 66% vs. 61%, P = 0.01) were significantly higher in group A compared with the other groups. In contrast, group C had a less severe disease characterized by higher frequencies of synovitis (61% vs. 66% vs. 71%, P = 0.032) and lower frequencies of serositis (37% vs. 33% vs. 25%, P = 0.002), proteinuria >500 mg/day (48% vs. 45% vs. 36%, P = 0.002) and low complement levels (81% vs. 81% vs. 71%, P < 0.0001) compared with groups A or B. Conclusions Our large Brazilian multicenter study demonstrated that for most childhood-onset systemic lupus erythematosus patients, diagnosis is delayed probably due to mild disease onset. Conversely, the minority has a very short time interval to diagnosis and a presentation with a more severe and active multisystemic condition.

Reproductive parameters of Santa Inês ewes submitted to short-term treatment with re-used progesterone devices / Características reprodutivas de ovelhas Santa Inês que receberam dispositivos de progesterona reutilizados

The aim of this study was to verify the efficacy of reusing intravaginal progesterone (P4) devices on the reproductive parameters in Santa Inês ewes. Females received intravaginal P4 devices for their first, second or third use for five days plus 300 IU eCG IM and 5mg dinoprost laterovulvar 24h before device removal. Blood was collected at different moments. Transrectal ultrasonography was performed from device removal to ovulation. Part of the ewes were submitted to artificial insemination by laparoscopy (IAL - n=55) with fresh semen, whereas the rest were bred by fertile rams (n=41). On the initial 18 h, ewes that received devices for the first time showed higher P4 concentrations (5.1±1.8 vs 3.5±1.4 vs 2.4±1.1 - P<0.05). However, after the first 48h no difference was observed among all treatments and P4 supraluteal concentrations were detected in all ewes upon device removal. Estrous response, interval from device removal to estrus, rate of ovulating animals, number of ovulations, time from device removal to ovulation and average conception rates after IAL or natural mating were similar among all 3 groups. Intravaginal progesterone devices can be used up to three times without altering reproductive parameters in Santa Inês ewes.

Avaliou-se a eficácia da reutilização de dispositivos intravaginais de progesterona (P4) sobre características reprodutivas em ovelhas Santa Inês. As fêmeas receberam dispositivos intravaginais contendo P4 para o seu primeiro, segundo ou terceiro uso por cinco dias, associado a 300 UI eCG IM e 5mg dinoprost laterovulvar 24h antes da remoção dos dispositivos. Ultrassonografia transretal foi realizada da remoção dos dispositivos até a ovulação. Parte das ovelhas foi submetida à inseminação artificial laparoscópica (IAL- n=55) com sêmen a fresco, enquanto outra parte foi acasalada por machos férteis (n=41). Nas 18 h iniciais, as ovelhas que receberam dispositivos pela primeira vez apresentaram maior concentração de P4 (5.1±1.8 vs 3.5±1.4 vs 2.4±1.1 - P<0.05). Entretanto, após as primeiras 48h nenhuma diferença foi observada entre os tratamentos quanto as concentrações circulantes de progesterona. Foram encontradas concentrações de progesterona supraluteais em todas as ovelhas na retirada dos dispositivos. Estro, intervalo da retirada ao estro, taxa de animais que ovularam, número de ovulações, momento da retirada à ovulação e taxa média de concepção após IAL ou monta natural foram similares entre os tratamentos. Dispositivos intravaginais de progesterona podem ser usados até três vezes sem alterar as características reprodutivas de ovelhas Santa Inês.

Seroprevalência da infecçäo pelo HIV-1 em gestantes atendidas no IMIP, Recife - Brasil / Seroprevalence of HIV infection among pregnant women attending in the IMIP, Recife-Brasil

The number of HIV infected heterosexual has been steadily increasing in Brazil. This fact was followed by a decline on the ratio of male/female HIV infection every year. We have examined the seroprevalence of HIV infection among pregnant women attending an antenatal clinic in the Instituto Materno Infantil de Pernambuco (IMIP) at Recife, North-eastern Brazil. This study was performae as an anonymous sentinel surveillance. The collected blood samples were tested for HIV infection by two different types of ELISA, and if positive, further analysis by IIA was submitted. The subjects were arranged in four age groups with the respective proportion: group l (<15 years)-0.9 per cent, group II (15 to 20 years)-31.6 per cent, group III (21 to 34 years)-61.7 per cent and group IV (>35 years)- 5,8 per cent. It was found an HIV-1 seroprevalence of 0.1 per cent (95 per cent confidence interval, -0.l to + 0,3) This percentage represents one single HIV positive woman included in age group III. his low HIV infection seroprevalence is suitable with a low risk population (pregnant women) in a low prevalence area. However, we became concerned with the great propottion of pregnant woman under 21 years (32,5 per cent) and with the implications of how to reinforce effectively HIV preventions of how to reinforce effectively HIV prevention strategies to this population