Charcot Foot Beaming with Subsequent Titanium Allergy: A Case Report.

[Formula: see text].

Perioperative Opioid Analgesics and Hallux Valgus Correction Surgery: Trends, Risk Factors for Prolonged Use and Complications.

In the setting of an opioid epidemic, this study aims to provide evidence on opioid use trends, risk factors for prolonged use, and complications from perioperative opioid consumption in hallux valgus surgery. A national database was queried for patients who underwent hallux valgus correction. Regression analysis identified: (1) risk factors for prolonged postoperative narcotic use; and (2) association between preoperative/prolonged postoperative narcotic use and postoperative complications. A linear regression analysis was used to determine trends. About 20,749 patients were included, of which 3464 patients were prescribed narcotics preoperatively and 4339 were identified as prolonged postoperative narcotic prescription users. Preoperative prescriptions were identified as risk factors for prolonged use. Perioperative narcotic use was observed to be a risk factor for poor outcomes. About 21% of patients were identified as prolonged postoperative narcotic prescription users. Patients undergoing hallux valgus corrective surgery should be counseled regarding their increased risk of complications when using narcotics.

Perioperative Opioid Analgesics and Hip Arthroscopy: Trends, Risk Factors for Prolonged Use, and Complications.

PURPOSE: The purpose of this article is to (1) examine trends in preoperative and prolonged postoperative opioid analgesic use in patient undergoing hip arthroscopy, (2) characterize risk factors for prolonged opioid analgesic use following hip arthroscopy, and (3) explore preoperative and prolonged postoperative opioid analgesic use as independent risk factors for complications following hip arthroscopy. METHODS: A private insurance database was queried for patients undergoing hip arthroscopy from 2007 to 2015 with a minimum of 6 months of follow-up. Independent risk factors for prolonged opioid analgesic use were determined. Preoperative and prolonged opioid analgesic use as risk factors for complications were examined. RESULTS: There was a significantly decreasing trend in preoperative (P = .002) and prolonged postoperative (P = .009) opioid analgesic use. The most significant risk factor for prolonged postoperative opioid analgesic use was preoperative use (odds ratio [OR], 3.61; P < .0001). Other preoperative prescriptions, including muscle relaxants (OR, 1.5; P < .0001) and anxiolytics (OR, 2.0; P < .0001), were also significant risk factors. Preoperative opioid analgesic use was a significant risk factor for postoperative complications, including emergency room visits (OR, 2.1; P < .0001) and conversion to total hip arthroplasty (THA) (OR, 1.6; P < .0001). Prolonged postoperative opioid analgesic use was associated with a higher risk of revision hip arthroscopy (OR, 1.4; P = .0004) and conversion to THA (OR, 1.8; P < .0001). CONCLUSIONS: More than a quarter of patients undergoing hip arthroscopy continue to receive opioid analgesic prescriptions more than 3 months postoperatively. The most significant risk factor for prolonged opioid analgesic use is preoperative opioid analgesic use. Additionally, anxiolytics, substance use or abuse, morbid obesity, and back pain were among the more notable risk factors for prolonged postoperative opioid analgesic use. Preoperative and prolonged postoperative opioid analgesic use was associated with a higher likelihood of several adverse effects/complications. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Risk Factors for Repeat Debridement, Spacer Retention, Amputation, Arthrodesis, and Mortality After Removal of an Infected Total Knee Arthroplasty With Spacer Placement.

BACKGROUND: Chronic periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is most commonly addressed with a 2-stage exchange procedure. The purpose of this study is to examine the natural history of patients who have undergone prosthesis removal and spacer placement and evaluate risk factors for outcomes other than reimplantation. METHODS: Patients who underwent removal of an infected TKA and placement of an antibiotic spacer for PJI were identified in a Medicare database. Patients with a study outcome within 1 year were then identified: (1) in hospital mortality, (2) knee arthrodesis, (3) amputation, (4) repeat debridement procedure without reimplantation, and (5) reimplantation. Independent risk factors for these outcomes were evaluated with a multivariate logistic regression analysis. RESULTS: A total of 18,533 patients were included. Within 1 year postoperatively, 691 patients (3.7%) died in a hospital setting, 852 patients (4.5%) underwent a knee arthrodesis, 574 patients (3.1%) underwent an amputation, 2683 patients (14.5%) underwent a repeat debridement procedure without being reimplanted, 2323 patients (12.5%) retained their spacer, and 11,420 patients (61.6%) underwent spacer removal and reimplantation within 1 year. Numerous independent patient-related risk factors for these outcomes were identified. CONCLUSION: A large number of patients (38.4%) do not undergo reimplantation within 1 year of prosthesis removal and spacer placement. Outcomes after prosthesis removal and antibiotic spacer placement are variable, and there are several independent risk factors for such outcomes that may be used to develop and improve existing treatment strategies for patients presenting with chronic PJI after TKA.

Novel PI3Kγ mutation in a 44-year-old man with chronic infections and chronic pelvic pain.

A 44-year-old man is presented here with 14 years of chronic purulent sinusitis, a chronic fungal rash of the scrotum, and chronic pelvic pain. Treatment with antifungal therapy resulted in symptom improvement, however he was unable to establish an effective long-term treatment regimen, resulting in debilitating symptoms. He had undergone extensive work-up without identifying a clear underlying etiology, although Candida species were cultured from the prostatic fluid. 100 genes involved in the cellular immune response were sequenced and a missense mutation was identified in the Ras-binding domain of PI3Kγ. PI3Kγ is a crucial signaling element in leukotaxis and other leukocyte functions. We hypothesize that his mutation led to his chronic infections and pelvic pain.

Targeting the OB-Folds of Replication Protein A with Small Molecules.

Replication protein A (RPA) is the main eukaryotic single-strand (ss) DNA-binding protein involved in DNA replication and repair. We have identified and developed two classes of small molecule inhibitors (SMIs) that show in vitro inhibition of the RPA-DNA interaction. We present further characterization of these SMIs with respect to their target binding, mechanism of action, and specificity. Both reversible and irreversible modes of inhibition are observed for the different classes of SMIs with one class found to specifically interact with DNA-binding domains A and B (DBD-A/B) of RPA. In comparison with other oligonucleotide/oligosaccharide binding-fold (OB-fold) containing ssDNA-binding proteins, one class of SMIs displayed specificity for the RPA protein. Together these data demonstrate that the specific targeting of a protein-DNA interaction can be exploited towards interrogating the cellular activity of RPA as well as increasing the efficacy of DNA-damaging chemotherapeutics used in cancer treatment.

[Zinc levels in prostatic fluid of patients with prostate pathologies]. / Niveles de zinc en líquido prostático de pacientes con patologías de próstata.

The prostate is a gland that surrounds the posterior urethra in man and, along with seminal vesicles, produces prostatic and seminal fluids. Prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer are the most frequent pathologies of this gland. Zinc is an important element in the makeup of prostatic fluid and plays an important role in the immunology of the infectious and neoplastic pathologies of the prostate. The aim of this study was to determine zinc concentrations in prostatic fluid of patients with prostate pathologies and to use this measurement as a diagnostic parameter. Thirty patients with prostatic pathologies and ten healthy controls were studied. Prostatic fluid samples were collected using prostatic massage. Zinc concentration was determined using electrothermal atomizeratomic absorption spectrometry (ETA-AAS). The mean zinc concentrations obtained in the studied population were as follows: 11 patients with BPH: 15.087,78 micromol/dL, 10 patients with prostatis: 863,33 micromol/dL, 9 patients with prostate cancer: 1.027,60 micromol/dL and 10 healthy subjects: 7.467,52 micromol/dL. The low zinc concentrations obtained in patients with prostatitis and prostate cancer, in contrast to the control group, led us to consider the possibility of recommending zinc supplements as a coadjuvant therapy in patients with prostatitis and also, to use zinc measurements as another diagnostic tool, for cases in which it is necessary to differentiate benign prostatic hyperplasia from prostate cancer.

Niveles de zinc en líquido prostático de pacientes con patologías de próstata / Zinc levels in prostatic fluid of patients with prostate pathologies

La próstata es una glándula que rodea la uretra posterior en el hombre, junto a las vesículas seminales, produce los líquidos prostático y seminal. La prostatitis, la hiperplasia benigna y el cáqncer de próstata son las patologías más frecuentes que la afectan. El zinc es un elemento importante en la composición química del líquido prostático y juega un papel fundamental en la inmunología de los fenómenos infecciosos y neoplásicos. El objetivo de la presente investigación fue determinar las concentraciones de zinc en líquido prostático de pacientes con patología de dicha glándula a fin de que sirva como parámetro para su diagnóstico y fundamento para una nueva forma terapéutica. Se estudiaron 30 pacientes con patología de próstata y 10 sujetos sanos, de quienes se obtuvo una muestra de líquido prostático mediante masaje prostático para luego determinar la concentración de zinc a través de espectrometría de absorción atómica con atomización electrónica (ETA-AAS). En los 11 pacientes con hiperplasia de próstata se encontró una concentración promedio de zinc de 15.087,78 µmol/dL, los 10 pacientes con prostatitis tuvieron una concentración de 863,33 µmol/dL y los 9 pacientes con diagnóstico de cáncer de próstata presentaron una concentración de zinc de 1.027,60 µmol/dL. La concentración promedio de zinc en el grupo control (10 personas) fue de 7.467,52 µmol/dL. En conclusión, la concentración baja de zinc en los pacientes con prostatitis y cáncer de próstata, con respecto al grupo control, permite plantear la posibilidad de utilizar suplementos de zinc como terapia complementaria en los pacientes con prostatitis, y la determinación de zinc, junto al antígeno prostático, representa un nuevo elemento para los casos en que exista dudas sobre el diagnóstico de cáncer de próstata y de hiperplasia prostática benigna.

[Serum levels of Zn in children with different degress of nutritional deficiency]. / Concentraciones séricas de zinc en niños con diferentes grados de déficit nutricional.

The importance of Zinc (Zn) as a necessary oligoclement for human nutrition begins in the first three decades of life. At the moment, the role that Zn plays in the infantile nutrition is very well-known, acquiring a special connotation in children with proteic-energetics malnutrition (PEM). In this study the daily ingestion and the serum measuremets of Zn were determined in 64 undernourished children (light, mild and severe) and in 25 eutrophic children with ages between 1 to 5 years, belonging to families of the strata IV and V according to the Graffar scale corrected by age. The results of the serum values of Zn were for the light undernourished of 39.73 +/- 14.97 microg/dL (30.38 microg/dL-44.56 microg/dL), for the mild undernourished of 35.07 +/- 28.13 microg/dL (27.76 microg/dL-65.80 microg/dL) and for the severe undernourished of 15.48 +/- 10.44 microg/dL (5.57 microg/dL-28.56 microg/dL), which were diminished in relation with the control group, 76.71 +/- 33.29 microg/dL (45.75 microg/dL - 78.27 microg/dL) with p < 0.0001. Equally, there were significant differences (p < 0.001) among the group of severe undernourished with the light undernourished and normal subjects. In relation with the daily ingestion of Zn, a statistically significant difference was observed only (p < 0.001) in the severe undernourished, 1.87 +/- 0.54 mg/día (1.20 mg/día-2.87 mg/día) when comparing them with the light undernourished, 5.48 +/- 0.98 mg/día (3.50 mg/día-7.87 mg/día), the mild undernourished, 4.99 +/- 1.24 mg/día (4.10 mg/día-11.42 mg/día) ) and the normal subjects, 6.22 +/- 0.98 mg/día (4.8 mg/día-8.02 mg/día). There was a positive correlation between ingestion and seric values of Zn when the 3 undernourished groups were studied. These results allow to conclude that both the seric values of Zn and its ingestion show modifications in relation with the degree of nutritional deficiency.

Concentraciones séricas de zinc en niños con diferentes grados de déficit nutricional / Serum levels of Zn in children with different degress of nutritional deficiency

La importancia del zinc (Zn) como oligoelemento necesario para la nutrición humana data de más de tres décadas. Actualmente el papel que desempeña el Zn en la nutrición infantil es bien conocido, adquiriendo especial connotación en los niños con desnutrición proteico-energética (DPE). En el presente estudio se determinaron las ingestas diarias y las concentraciones séricas de Zn en 64 niños desnutridos (leves, moderados y graves) y en 25 niños eutróficos en edades comprendidas entre 1 y 5 años, pertenecientes a familias de los estratos IV y V según Graffar modificado. Los resultados de las concentraciones séricas de Zn fueron en los desnutridos leves en 39,73 ± 14,97µg/dL (30,38 µg/dL-44.56 µg/dL), en los desnutridos moderados 35,07 ± 28,13 µg/dL (27,76 µg/dL-65,80 µg/dL) y en los desnutridos graves 15,48 ± 10,44 µg/dL (5,57 µg/dL-28,56 µg/dL), valores que estuvieron disminuidos en relación con el grupo control, 76,71 ± 33,29 µg/dL (45,75 µg/dL-78,27 µg/dL) con p < 0,0001. Igualmente se encontraron diferencias significativas (p < 0,001) entre el grupo de desnutridos graves y los desnutridos leves y moderados. En relación con la ingesta diaria de Zn sólo se observó diferencia estadísticamente significativa (p < 0,001) en los desnutridos graves, 1,87 ± 0,54 mg/día (1,20 mg/día-2,87 mg/día) al compararlos con los desnutridos leves, 5,48 ± 0,98 mg/día (3,50 mg/día-7,87 mg/día), los desnutridos moderados, 4,99 ±1,24 mg/día (4,10 mg/día-11,42 mg/día) y los eutróficos, 6,22 ± 0,98 mg/día (4,8 mg/día-8,02 mg/día). Se encontró una correlación positiva (r = 0,5146; p < 00,1) entre ingesta y concentración sérica de Zn cuando se estudiaron los 3 grupos de desnutridos. Estos resultados permiten concluir que tanto las concentraciones séricas de Zn como la ingesta se ven modificadas en relación con el grado de déficit nutricional

[Diminished zinc plasma concentrations and alterations in the number of lymphocyte subpopulations in Down's syndrome patients]. / Disminución de las concentraciones plasmáticas de cinc y alteraciones numéricas de subpoblaciones de linfocitos en pacientes con síndrome de down.

Alterations of plasma levels of zinc and in the immune system in Down's syndrome (DS) have been reported. These alterations have been associated with a high rate of infectious diseases, which represent the main cause of mortality in affected individuals. The objectives of this study were to determine plasma zinc levels and to evaluate the immune system in DS patients. Peripheral blood samples were obtained from 43 DS patients examined at the Unidad de Genética Médica, Universidad del Zulia in Maracaibo, Venezuela. Their mean age (+/- SD) was 2.3 +/- 2.0 years. As control group, 40 healthy children were studied (mean +/- SD 2.3 +/- 2.0 years). Karyotypes by a standard technique, the determination of plasma levels of zinc by atomic absorption spectrophotometry and the evaluation of the immune system by flow cytometry were carried out in the study groups. All DS patients had free trisomy 21. Significantly disminished zinc plasma levels, helper T lymphocyte (CD4) percentage, helper/cytotoxic (CD4/CD8) ratio and B-cells (CD19) were found in DS patients by matching with control group. An increase in CD8 was also found. No significative difference in the lymphocyte subpopulations between DS patients with disminished plasma levels of zinc and DS patients with normal zinc were found. These findings suggest that zinc deficiency is not the sole etiology involved in the disorders of immune system seen in DS patients. Other factors, such as thymic alterations and molecular abnormalities due to gene overexpression of loci located on chromosome 21 could be involved. Although, zinc supplementation is recommended in these patients with zinc deficiency, further studies with a double-blind, placebo versus zinc design are needed to evaluate the potentially beneficial effects of zinc treatment in DS patients.

Disminución de las concentraciones plasmáticas de cinc y alteraciones numéricas de subpoblaciones de linfocitos en pacientes con síndrome de Down / Disminished zinc plasma concentrations and alterations in the number of lymphocyte subpopulations in down´s syndrome patients

Se ha reportado alteración de los niveles plasmáticos de cinc y trastornos del sistema inmunitario en los pacientes con síndrome de Down (SD), lo que se ha asociado con alta tasa de enfermedades infecciosas, las cuales representan una de las principales causas de mortalidad en los individuos afectados. El objetivo de este trabajo fue determinar las concentraciones plasmáticas de cinc y evaluar el sistema inmunitario en pacientes con SD. Para esto se tomaron muestras de sangre periférica de 43 pacientes con SD con promedio de edad ± DE, de 2,3 ± 2 años; que asistieron a la Unidad de Genética Medica de la Universidad del Zulia en Maracaibo, Venezuela. Como controles se estudiaron 40 niños aparentemente sanos con promedio de edad de 2,5 ± 2,2 años. A todos los pacientes se les realizó el cariotipo según la técnica convencional, determinación de cinc por espectrofotometría de absorción atómica y citometría de flujo para evaluar el sistema inmunitario. Todos los pacientes presentaban trisomía libre del cromosoma 21. Se observó una disminución significativa de los niveles de cinc; del porcentaje de linfocitos T cooperadores (CD4), de la relación entre éstos y los linfocitos T citotóxicos (CD4/CD8) así como también, del porcentaje de células B (CD19) al compararlos con los controles. También se observó un aumento en CD8. Al comprar las subpoblaciones linfocitarias en los pacientes con SD que presentaron valores normales de cinc con aquellos que tenían valores disminuidos no se encontró diferencia estadísticamente significativa. Los resultados obtenidos en esta investigación sugieren que probablemente no sólo la deficiencia de cinc está involucrada en las alteraciones del sistema inmunitario observada en los pacientes con SD; otros factores previamente descritos, tales como las alteraciones tímicas y las anormalidades moleculares debidas a la sobreexpresión de genes localizados en el cromosoma 21, podrían estar involucrados. Aunque se recomienda la suplementación de cinc en estos pacientes con deficiencia de este oligoelemento , se necesitan estudios con diseño a doble ciego de placevo versus cinc para evaluar los potenciales efectos beneficiosos del tratamiento con cinc en pacientes con SD

Niveles de mercurio en cabello de individuos expuestos ocupacionalmente en el área odontológica / Mercury levels in the hair of occupationally exposed individuals in the dental area

En este estudio se establecieron los niveles de mercurio (Hg) en cabello de individuos profesionalmente expuestos en el área odontológica y se contrastaron con las concentraciones mercuriales de un grupo control no expuesto ocupacionalmente al Hg. Las muestras de cabello fueron recolectadas de 15 individuos expuestos y 15 no expuestos, residentes de la ciudad de Maracaibo y zonas circunvencians. Los individuos fueron interrogados a través de una encuesta en relación a datos personales, dirección de habitación, ocupación, alimentación, hábitos, salud, tratamiento médicos, número de restauraciones de amalgama, tratamientos cosméticos en el cabello, etc. Se tomaron 2 cm de cabello distal en la zona occipital del cuero cabelludo de cada individuos, las cuales se almacenaron en bolsas plásticas de cierre hermético a 4§C. Previo al análisis espectrométrico, las muestras se levaron y se desmineralizaron usando microondas. La determinacion exacta, precisa y libre de interferencias de Hg se realizó empleando la espectrometría de absorción atómica por vapor frío. La concentración media de Hg (+- 1 DE obtenida para el grupo expuesto (E) fue 2,07 +- 2,23 (ca. intervalo experimental: 0,13 - 7,91 mg Hg/g) y para el grupo control (C) fue 2,65 +- 2,06 (ca. intervalo experimental): 0,75 - 6,75 mg Hg/g). No se observaron diferencias estadísticamente significativas (p>0,05) entre los niveles de mercurio para los grupos E y C; por lo tanto, el vapor de Hg absorbido en la clínica dental no influyó en el nivel de Hg en cabello del grupo expuesto, debido posiblemente al uso de sistemas de aire acondicionado y buena ventilación que presentaron las clínicas. Los resultados obtenidos en este estudio revelaron que el manejo y uso apropiado de la amalgama dental no altera el nivel de mercurio presente en el cabello del personal que labora en la clínica dental

Graphite furnace atomic absorption spectrometric determination of blood lead with palladium modification

In this work we present a graphite furnace atomic absorption spectrometric method for blood lead using palladium as a chemical modifier. Whole blood was diluted 10- fold with a 0.1% v/v triton X-100 solution; 10*L of this solution and 10*L of the palladium-based modifier (2mg Pd/L, 2% w/v citric acid and 0.01 M nitric acid) were injercted onto the l'vov platform by using the alternate volume mode. The following furnace operating parameters were used: (a) drying steps, 120-C for 10s and 250-C for 30s; (b) pyrolisis steps, 800-C for 45s (with oxygen) and 1100-C for 25s; (c) atomization, 1600-C for 3s; (d) clean out, 2700-C for 4s. Accuracy was tested by using (i) a NIST standard (SRM-909) and the Behring Control Blood for Metal 1 (OSSD 21) with lead concentrations of 23.7 ñ 0.7 *g/L) and 413 ñ 51 *g/L (found: 407 ñ 6 *g/L) respectively; (ii) recovery studies (ca. 100 ñ 1%), and (iii) a reported method (meadf relative error: 5.1%). Approximate standard deviations of 0.3 (within-run) and 0.7 (between-runs) *g Pb/L were found in the precision study. The detection limit (3*) and the characteristic mass (for a 10- *L injection volume) were 0.1 *g Pb/L and 15 pg/0.0044A*s, respectively. The proposed method was used to establish the lead levels of patients with renal insuficiency; a mean concentration (ñ SD) of 59 ñ 39 *g Pb/L (range: 12 - 160 *g Pb/L) was found. The method was interference-free, reliable and reproducible

Niveles plúmbicos en la población infantil de la Ciudad de Maracaibo / Lead levels in the infant population in Maracaibo City

Se estudiaron las concentraciones plúmbicas sanguíneas de la población infantil de la ciudad de Maracaibo. Se seleccionaron 152 niños, con edades comprendidas entre 1 y 12 años (Mediana = 7 años; 97 del sexo masculino y 55 de sexo femenino). Estos sujetos recibían diversos tratamientos clínicos en el Servicio de Pediatría del Hospital Dr. Adolfo Pons. Las muestras de sangre completa se colocaron en tubos de polipropileno que contenían heparina sódica y se mantuvieron a - 20§C hasta el momento de análisis espectroquímico. Las muestras de sangre completa fueron diluídas con triton X-100 (0.1 % V/V). Las determinaciones del plomo se realizaron mediante la técnica de la espectrometría de absorción atómica con atomización electrotérmica (horno de grafito). La concentración promedio de plomo en sangre completa de la muestra poblaciónal infantil estudiada fue 14.2 ñ 3.6 *g Pb/dL (rango: 4.0 - 22.0 *g Pb/dL). Se observó un aumento no significativo en la concentración promedio de los valores (ca. 14.2 ñ 3.3 *g Pb/dL) respecto a los valores encontrados en las hembras (ca. 13.1 ñ 3.9 *g Pb/dL). La exposición ambiental fue el factor responsable de las relativamente altas concentraciones plúmbicas exhibidas por los infantes marabinos. Los niveles plúmbicos encontrados fueron inferiores al valor máximo establecido por los organismos internacionales de salud (ca. 25 *g Pb/dL). Sin embargo, estas concentraciones fueron relativamente altas, en comparación con la media plúbica manifestada por los adultos marabinos (ca. 18.9 ñ 0.4 *g Pb/dL). Por tal motivo, se recomienda el establecimiento de programas de supervisión y monitoreo de este metal..