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1.
Parasit Vectors ; 13(1): 138, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32178706

RESUMO

BACKGROUND: Schistosomiasis and infection by soil-transmitted helminths are some of the world's most prevalent neglected tropical diseases. Infection by more than one parasite (co-infection) is common and can contribute to clinical morbidity in children. Geostatistical analyses of parasite infection data are key for developing mass drug administration strategies, yet most methods ignore co-infections when estimating risk. Infection status for multiple parasites can act as a useful proxy for data-poor individual-level or environmental risk factors while avoiding regression dilution bias. Conditional random fields (CRF) is a multivariate graphical network method that opens new doors in parasite risk mapping by (i) predicting co-infections with high accuracy; (ii) isolating associations among parasites; and (iii) quantifying how these associations change across landscapes. METHODS: We built a spatial CRF to estimate infection risks for Ascaris lumbricoides, Trichuris trichiura, hookworms (Ancylostoma duodenale and Necator americanus) and Schistosoma mansoni using data from a national survey of Rwandan schoolchildren. We used an ensemble learning approach to generate spatial predictions by simulating from the CRF's posterior distribution with a multivariate boosted regression tree that captured non-linear relationships between predictors and covariance in infection risks. This CRF ensemble was compared against single parasite gradient boosted machines to assess each model's performance and prediction uncertainty. RESULTS: Parasite co-infections were common, with 19.57% of children infected with at least two parasites. The CRF ensemble achieved higher predictive power than single-parasite models by improving estimates of co-infection prevalence at the individual level and classifying schools into World Health Organization treatment categories with greater accuracy. The CRF uncovered important environmental and demographic predictors of parasite infection probabilities. Yet even after capturing demographic and environmental risk factors, the presences or absences of other parasites were strong predictors of individual-level infection risk. Spatial predictions delineated high-risk regions in need of anthelminthic treatment interventions, including areas with higher than expected co-infection prevalence. CONCLUSIONS: Monitoring studies routinely screen for multiple parasites, yet statistical models generally ignore this multivariate data when assessing risk factors and designing treatment guidelines. Multivariate approaches can be instrumental in the global effort to reduce and eventually eliminate neglected helminth infections in developing countries.

2.
J Arthroplasty ; 35(3): 855-858, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31708294

RESUMO

BACKGROUND: Resection arthroplasty of the hip is considered a viable option after multiple failed attempts to eradicate a prosthetic joint infection (PJI). However, much less information about resection arthroplasty of the knee is available. The goals of this study were to determine the success of infection eradication with a resection arthroplasty of the knee and subsequent functional outcomes in this group. METHODS: We retrospectively identified 25 knees (23 patients) treated with resection arthroplasty of the knee for PJI performed at a single institution between 1974 and 2016. The mean age at resection arthroplasty was 65 years. The mean body mass index was 37 kg/m2, and the mean Charleston Comorbidity Index was 5. Patients had a mean of 5 operations on the knee (mean of 3 operations for infection) before the resection arthroplasty. Failure to eradicate the infection was defined as any reoperation for infection. Clinical outcomes were assessed via ambulatory status, use of gait aids, and ongoing pain. The mean follow-up was 4 years. RESULTS: At most recent follow-up, 84% (21 of 25) of knees were free of infection. Three patients had recurrent infection within the first year, and 1 patient had a late infection at 4 years postoperatively. However, only 1 patient required a subsequent amputation. Forty-five percent were community ambulators, 35% were household ambulators, and 20% were only able to transfer. All patients required knee bracing and assistive devices. Fifteen percent of patients were using long-term narcotics. CONCLUSION: This large series demonstrates the results of selected use of resection arthroplasty as a treatment for recalcitrant periprosthetic knee infections that have failed multiple attempts to eradicate an ongoing PJI. The resection definitively solved the infection in 84% of patients. Functional results were variable but surprisingly good in some. All patients required bracing and assistive devices.

3.
J Anim Ecol ; 89(2): 423-435, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31571223

RESUMO

Geographic variation in environmental conditions as well as host traits that promote parasite transmission may impact infection rates and community assembly of vector-transmitted parasites. Identifying the ecological, environmental and historical determinants of parasite distributions and diversity is therefore necessary to understand disease outbreaks under changing environments. Here, we identified the predictors and contributions of infection probability and phylogenetic diversity of Leucocytozoon (an avian blood parasite) at site and species levels across the New World. To explore spatial patterns in infection probability and lineage diversity for Leucocytozoon parasites, we surveyed 69 bird communities from Alaska to Patagonia. Using phylogenetic Bayesian hierarchical models and high-resolution satellite remote-sensing data, we determined the relative influence of climate, landscape, geography and host phylogeny on regional parasite community assembly. Infection rates and parasite diversity exhibited considerable variation across regions in the Americas. In opposition to the latitudinal gradient hypothesis, both the diversity and prevalence of Leucocytozoon parasites decreased towards the equator. Host relatedness and traits known to promote vector exposure neither predicted infection probability nor parasite diversity. Instead, the probability of a bird being infected with Leucocytozoon increased with increasing vegetation cover (NDVI) and moisture levels (NDWI), whereas the diversity of parasite lineages decreased with increasing NDVI. Infection rates and parasite diversity also tended to be higher in cooler regions and higher latitudes. Whereas temperature partially constrains Leucocytozoon diversity and infection rates, landscape features, such as vegetation cover and water body availability, play a significant role in modulating the probability of a bird being infected. This suggests that, for Leucocytozoon, the barriers to host shifting and parasite host range expansion are jointly determined by environmental filtering and landscape, but not by host phylogeny. Our results show that integrating host traits, host ancestry, bioclimatic data and microhabitat characteristics that are important for vector reproduction are imperative to understand and predict infection prevalence and diversity of vector-transmitted parasites. Unlike other vector-transmitted diseases, our results show that Leucocytozoon diversity and prevalence will likely decrease with warming temperatures.

4.
Bone Joint J ; 101-B(12): 1520-1525, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31787000

RESUMO

AIMS: Reverse shoulder arthroplasty (RSA) reliably improves shoulder pain and function for a variety of indications. However, the safety and efficacy of RSA in elderly patients is largely unknown. The purpose of this study was to report the mortality, morbidity, complications, reoperations, and outcomes of primary RSA in patients aged > 80 years. PATIENTS AND METHODS: Between 2004 and 2013, 242 consecutive primary RSAs were performed in patients aged > 80 years (mean 83.3 years (sd 3.1)). Of these, 53 were lost to follow-up before two years and ten had died within two years of surgery, leaving 179 for analysis of survivorship, pain, motion, and strength at a minimum of two years or until revision surgery. All 242 patients were considered for the analysis of 90-day, one-year, and overall mortality, medical complications (90-day and overall), surgical complications, and reoperations. The indications for surgery included rotator cuff arthropathy, osteoarthritis, fracture, the sequela of trauma, avascular necrosis, and rheumatoid arthritis. A retrospective review of the medical records was performed to collect all variables. Survivorship free of revision surgery was calculated at two and five years. RESULTS: One patient (0.4%) died within the first 90 days. A total of 45 patients (19%) were known to have died at the time of the final follow-up, with a median time to death of 67.7 months (interquartile range 40.4 to 94.7) postoperatively. Medical complications occurred in six patients (3%) and surgical complications occurred in 21/179 patients (12%). Survivorship free from revision was 98.9% at two years and 98.3% at five years; survivorship free from loosening was 99.5% at final follow-up. The presence of peripheral vascular disease correlated with a higher complication rate. CONCLUSION: Primary RSA was safe and effective in patients aged > 80 years, with a relatively low rate of medical and surgical complications. Thus, age alone should not be a contraindication to primary RSA in patients aged > 80 years. However, a careful evaluation of comorbidities is required in this age group when considering primary RSA. Cite this article: Bone Joint J 2019;101-B:1520-1525.


Assuntos
Artroplastia do Ombro , Dor de Ombro/cirurgia , Fatores Etários , Idoso de 80 Anos ou mais , Artroplastia do Ombro/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Dor de Ombro/etiologia , Dor de Ombro/mortalidade , Dor de Ombro/fisiopatologia , Resultado do Tratamento
5.
J Anim Ecol ; 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31782152

RESUMO

Microbial communities are increasingly recognized as crucial for animal health. However, our understanding of how microbial communities are structured across wildlife populations is poor. Mechanisms such as interspecific associations are important in structuring free-living communities, but we still lack an understanding of how important interspecific associations are in structuring gut microbial communities in comparison with other factors such as host characteristics or spatial proximity of hosts. Here, we ask how gut microbial communities are structured in a population of North American moose Alces alces. We identify key microbial interspecific associations within the moose gut and quantify how important they are relative to key host characteristics, such as body condition, for predicting microbial community composition. We sampled gut microbial communities from 55 moose in a population experiencing decline due to a myriad of factors, including pathogens and malnutrition. We examined microbial community dynamics in this population utilizing novel graphical network models that can explicitly incorporate spatial information. We found that interspecific associations were the most important mechanism structuring gut microbial communities in moose and detected both positive and negative associations. Models only accounting for associations between microbes had higher predictive value compared to models including moose sex, evidence of previous pathogen exposure or body condition. Adding spatial information on moose location further strengthened our model and allowed us to predict microbe occurrences with ~90% accuracy. Collectively, our results suggest that microbial interspecific associations coupled with host spatial proximity are vital in shaping gut microbial communities in a large herbivore. In this case, previous pathogen exposure and moose body condition were not as important in predicting gut microbial community composition. The approach applied here can be used to quantify interspecific associations and gain a more nuanced understanding of the spatial and host factors shaping microbial communities in non-model hosts.

6.
PLoS Negl Trop Dis ; 13(9): e0007723, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31568504

RESUMO

BACKGROUND: Schistosomiasis is a neglected tropical disease caused by Schistosoma parasites. Intervention relies on identifying high-risk regions, yet rapid Schistosoma diagnostics (Kato-Katz stool assays (KK) and circulating cathodic antigen urine assays (CCA)) yield different prevalence estimates. We mapped S. mansoni prevalence and delineated at-risk regions using a survey of schoolchildren in Rwanda, where S. mansoni is an endemic parasite. We asked if different diagnostics resulted in disparities in projected infection risk. METHODS: Infection data was obtained from a 2014 Rwandan school-based survey that used KK and CCA diagnostics. Across 386 schools screened by CCA (N = 19,217). To allow for uncertainty when interpreting ambiguous CCA trace readings, which accounted for 28.8% of total test results, we generated two presence-absence datasets: CCA trace as positive and CCA trace as negative. Samples (N = 9,175) from 185 schools were also screened by KK. We included land surface temperature (LST) and the Normalized Difference Vegetation and Normalized Difference Water Indices (NDVI, NDWI) as predictors in geostatistical regressions. FINDINGS: Across 8,647 children tested by both methods, prevalence was 35.93% for CCA trace as positive, 7.21% for CCA trace as negative and 1.95% for KK. LST was identified as a risk factor using KK, whereas NDVI was a risk factor for CCA models. Models predicted high endemicity in Northern and Western regions of Rwanda, though the CCA trace as positive model identified additional high-risk areas that were overlooked by the other methods. Estimates of current burden for children at highest risk (boys aged 5-9 years) varied by an order of magnitude, with 671,856 boys projected to be infected by CCA trace as positive and only 60,453 projected by CCA trace as negative results. CONCLUSIONS: Our findings show that people in Rwanda's Northern, Western and capital regions are at high risk of S. mansoni infection. However, variation in identification of environmental risk factors and delineation of at-risk regions using different diagnostics likely provides confusing messages to disease intervention managers. Further research and statistical analyses, such as latent class analysis, can be used to improve CCA result classification and assess its use in guiding treatment regimes.


Assuntos
Antígenos de Helmintos/urina , Fezes/parasitologia , Esquistossomose mansoni/diagnóstico , Esquistossomose mansoni/epidemiologia , Adolescente , Animais , Criança , Pré-Escolar , Clima , Doenças Endêmicas , Feminino , Geografia , Humanos , Masculino , Doenças Negligenciadas , Prevalência , Fatores de Risco , Ruanda/epidemiologia , Schistosoma mansoni/imunologia , Esquistossomose mansoni/imunologia , Esquistossomose mansoni/parasitologia
7.
J Hand Surg Eur Vol ; 44(10): 1036-1040, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31550978

RESUMO

Ninety-six wrists (56 right and 40 left) in 96 patients (36 males and 60 females, mean age 38, range 15-77 years) underwent repair of ulnotriquetral ligament split tears between 2007 and 2016. Mayo wrist scores, visual analogue scale pain scores, and objective measures including grip strength and range of motion were obtained. Patients were assessed after a mean follow-up of 21 months (range 6-112 months). Ulnotriquetral split tear repair resulted in substantial improvements in pain and function. The mean Mayo wrist score improved from 57 preoperatively to 81 postoperatively, with 84% of patients achieving a good or excellent outcome. Pain scores decreased from 5.8 to 1.2. Grip improved from 25 kg to 29 kg. There was no significant change in range of motion of the wrist. Complications were noted in eight patients, with three experiencing continued pain, four with dysaesthesia of the dorsal sensory ulnar nerve, and one superficial infection. Arthroscopic ulnotriquetral split tear repair significantly reduced pain and improved Mayo wrist scores. Level of evidence: IV.

8.
JBJS Case Connect ; 9(3): e0294, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274646

RESUMO

CASE: We report 3 patients with classic trigeminal neuropathy (TN) findings, which were due to compressive cervical radiculopathy, and provide a brief anatomic explanation for this association. In each case, left-sided disk herniation between the C5 and C7 levels caused TN and classic (dermatome appropriate) cervical radicular findings, all of which resolved with anterior cervical decompression and fusion (ACDF). CONCLUSIONS: To our knowledge, this is the first report of TN caused by radicular compression in the caudal subaxial (C5-C7) cervical spine, which resolved after ACDF.

9.
Trop Med Infect Dis ; 4(2)2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31207897

RESUMO

Soil-transmitted helminth (STH) infections are globally distributed intestinal parasite infections caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms (Ancylostoma duodenale and Necator americanus). STH infection constitutes a major public health threat, with heavy burdens observed in many of the world's tropical and subtropical regions. Mass drug administration and sanitation improvements can drastically reduce STH prevalence and associated morbidity. However, identifying targeted areas in need of treatment is hampered by a lack of knowledge on geographical and population-level risk factors. In this study, we applied Bayesian geostatistical modelling to data from a national school-based STH infection survey in Rwanda to (1) identify ecological and population-level risk factors and (2) provide comprehensive precision maps of infection burdens. Our results indicated that STH infections were heterogeneously distributed across the country and showed signatures of spatial clustering, though the magnitude of clustering varied among parasites. The highest rates of endemic clustering were attributed to A. lumbricoides infection. Concordant infection patterns among the three parasite groups highlighted populations currently most at-risk of morbidity. Population-dense areas in the Western and North-Western regions of Rwanda represent areas that have continued to exhibit high STH burden across two surveys and are likely in need of targeted interventions. Our maps support the need for an updated evaluation of STH endemicity in western Rwanda to evaluate progress in MDA efforts and identify communities that need further local interventions to further reduce morbidity caused by STH infections.

10.
Trends Parasitol ; 35(6): 452-465, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047808

RESUMO

Host specificity encompasses the range and diversity of host species that a parasite is capable of infecting and is considered a crucial measure of a parasite's potential to shift hosts and trigger disease emergence. Yet empirical studies rarely consider that regional observations only reflect a parasite's 'realized' host range under particular conditions: the true 'fundamental' range of host specificity is typically not approached. We provide an overview of challenges and directions in modelling host specificity under variable environmental conditions. Combining tractable modelling frameworks with multiple data sources that account for the strong interplay between a parasite's evolutionary history, transmission mode, and environmental filters that shape host-parasite interactions will improve efforts to quantify emerging disease risk in times of global change.

11.
J Hand Surg Eur Vol ; 44(9): 957-962, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31117865

RESUMO

Our study aimed to report the short-term outcomes of patients who underwent partial ulnar head replacement and distal radial ulnar joint interposition arthroplasty. From 2012 to 2016, nine patients underwent this procedure with mean follow-up of 27 months (range 12-55). Seven of the nine patients had previously undergone surgical intervention on the ipsilateral wrist. The procedure resulted in substantial improvements in pain and function. Mayo Wrist Score improved from 37 preoperatively to 73 postoperatively, and six patients achieved a good or excellent outcome. Visual analogue pain scores decreased from 7 preoperatively to 1 postoperatively. Grip improved from 20 kg preoperatively to 30 kg postoperatively. There was no significant change in wrist range of motion. Two patients underwent revision surgery to improve wrist motion. We conclude that over short-term follow-up the procedure provides a feasible option for distal radial ulnar joint arthritis. Level of evidence: IV.

12.
Int J Parasitol ; 49(5): 321-336, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30858050

RESUMO

The cat flea (Ctenocephalides felis) is the most common parasite of domestic cats and dogs worldwide. Due to the morphological ambiguity of C. felis and a lack of - particularly largescale - phylogenetic data, we do not know whether global C. felis populations are morphologically and genetically conserved, or whether human-mediated migration of domestic cats and dogs has resulted in homogenous global populations. To determine the ancestral origin of the species and to understand the level of global pervasion of the cat flea and related taxa, our study aimed to document the distribution and phylogenetic relationships of Ctenocephalides fleas found on cats and dogs worldwide. We investigated the potential drivers behind the establishment of regional cat flea populations using a global collection of fleas from cats and dogs across six continents. We morphologically and molecularly evaluated six out of the 14 known taxa comprising genus Ctenocephalides, including the four original C. felis subspecies (Ctenocephalides felis felis, Ctenocephalides felis strongylus, Ctenocephalides felis orientis and Ctenocephalides felis damarensis), the cosmopolitan species Ctenocephalides canis and the African species Ctenocephalides connatus. We confirm the ubiquity of the cat flea, representing 85% of all fleas collected (4357/5123). Using a multigene approach combining two mitochondrial (cox1 and cox2) and two nuclear (Histone H3 and EF-1α) gene markers, as well as a cox1 survey of 516 fleas across 56 countries, we demonstrate out-of-Africa origins for the genus Ctenocephalides and high levels of genetic diversity within C. felis. We define four bioclimatically limited C. felis clusters (Temperate, Tropical I, Tropical II and African) using maximum entropy modelling. This study defines the global distribution, African origin and phylogenetic relationships of global Ctenocephalides fleas, whilst resolving the taxonomy of the C. felis subspecies and related taxa. We show that humans have inadvertently precipitated the expansion of C. felis throughout the world, promoting diverse population structure and bioclimatic plasticity. By demonstrating the link between the global cat flea communities and their affinity for specific bioclimatic niches, we reveal the drivers behind the establishment and success of the cat flea as a global parasite.


Assuntos
Doenças do Gato/parasitologia , Ctenocephalides/classificação , Doenças do Cão/parasitologia , Infestações por Pulgas/parasitologia , Infestações por Pulgas/veterinária , África , Animais , Gatos , Ctenocephalides/genética , Ctenocephalides/crescimento & desenvolvimento , Cães , Feminino , Marcadores Genéticos , Humanos , Masculino , Filogenia
13.
Ecol Lett ; 22(3): 547-557, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30637890

RESUMO

Parasites with low host specificity (e.g. infecting a large diversity of host species) are of special interest in disease ecology, as they are likely more capable of circumventing ecological or evolutionary barriers to infect new hosts than are specialist parasites. Yet for many parasites, host specificity is not fixed and can vary in response to environmental conditions. Using data on host associations for avian malaria parasites (Apicomplexa: Haemosporida), we develop a hierarchical model that quantifies this environmental dependency by partitioning host specificity variation into region- and parasite-level effects. Parasites were generally phylogenetic host specialists, infecting phylogenetically clustered subsets of available avian hosts. However, the magnitude of this specialisation varied biogeographically, with parasites exhibiting higher host specificity in regions with more pronounced rainfall seasonality and wetter dry seasons. Recognising the environmental dependency of parasite specialisation can provide useful leverage for improving predictions of infection risk in response to global climate change.


Assuntos
Malária Aviária , Parasitos , Animais , Aves/parasitologia , Especificidade de Hospedeiro , Interações Hospedeiro-Parasita , Filogenia , Especificidade da Espécie
14.
BMC Infect Dis ; 18(1): 218, 2018 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-29764368

RESUMO

BACKGROUND: Q fever is a zoonotic disease caused by Coxiella burnetii. This bacterium survives harsh conditions and attaches to dust, suggesting environmental dispersal is a risk factor for outbreaks. Spatial epidemiology studies collating evidence on Q fever geographical contamination gradients are needed, as human cases without occupational exposure are increasing worldwide. METHODS: We used a systematic literature search to assess the role of distance from ruminant holdings as a risk factor for human Q fever outbreaks. We also collated evidence for other putative drivers of C. burnetii geographical dispersal. RESULTS: In all documented outbreaks, infective sheep or goats, not cattle, was the likely source. Evidence suggests a prominent role of airborne dispersal; Coxiella burnetii travels up to 18 km on gale force winds. In rural areas, highest infection risk occurs within 5 km of sources. Urban outbreaks generally occur over smaller distances, though evidence on attack rate gradients is limited. Wind speed / direction, spreading of animal products, and stocking density may all contribute to C. burnetii environmental gradients. CONCLUSIONS: Q fever environmental gradients depend on urbanization level, ruminant species, stocking density and wind speed. While more research is needed, evidence suggests that residential exclusion zones around holdings may be inadequate to contain this zoonotic disease, and should be species-specific.


Assuntos
Febre Q/transmissão , Febre Q/veterinária , Microbiologia do Ar , Animais , Coxiella burnetii/patogenicidade , Surtos de Doenças , Feminino , Cabras , Abrigo para Animais , Humanos , Incidência , Gado/microbiologia , Febre Q/epidemiologia , Ovinos , Doenças dos Ovinos/epidemiologia , Doenças dos Ovinos/transmissão , Vento , Zoonoses/epidemiologia , Zoonoses/transmissão
15.
Ecology ; 99(6): 1277-1283, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29768661

RESUMO

Inferring interactions between co-occurring species is key to identify processes governing community assembly. Incorporating interspecific interactions in predictive models is common in ecology, yet most methods do not adequately account for indirect interactions (where an interaction between two species is masked by their shared interactions with a third) and assume interactions do not vary along environmental gradients. Markov random fields (MRF) overcome these limitations by estimating interspecific interactions, while controlling for indirect interactions, from multispecies occurrence data. We illustrate the utility of MRFs for ecologists interested in interspecific interactions, and demonstrate how covariates can be included (a set of models known as Conditional Random Fields, CRF) to infer how interactions vary along environmental gradients. We apply CRFs to two data sets of presence-absence data. The first illustrates how blood parasite (Haemoproteus, Plasmodium, and nematode microfilaria spp.) co-infection probabilities covary with relative abundance of their avian hosts. The second shows that co-occurrences between mosquito larvae and predatory insects vary along water temperature gradients. Other applications are discussed, including the potential to identify replacement or shifting impacts of highly connected species along climate or land-use gradients. We provide tools for building CRFs and plotting/interpreting results as an R package.


Assuntos
Nematoides , Parasitos , Animais , Aves , Clima , Ecologia
16.
Curr Rev Musculoskelet Med ; 11(1): 141-149, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29411320

RESUMO

PURPOSE OF REVIEW: This review aims to describe the tendon transfer options for treating irreparable rotator cuff tears (RCTs). Options for transfer include latissimus dorsi and lower trapezius transfers for posterior-superior RCTs and pectoralis major and latissimus dorsi transfer for anterior-superior RCTs. RECENT FINDINGS: While the latissimus dorsi tendon transfer has historically been performed for posterosuperior RCTs, the lower trapezius transfer is a more anatomic option and has demonstrated promising results in recent studies. Similarly, the pectoralis major transfer has historically been the tendon transfer of choice for anterosuperior RCTs. However, the latissimus dorsi tendon transfer has recently been shown to be a safe and anatomic tendon transfer for subscapularis insufficiency. The treatment of irreparable RCTs involves complex decision making. Tendon transfer procedures can restore the glenohumeral joint force couples, allowing restoration of near-normal shoulder kinematics. Benefits include reliable pain relief, increased function, and increased strength. Proper selection of donor tendon is crucial, and the principles of tendon transfer procedures must be adhered to for maximal benefit.

17.
Glob Chang Biol ; 24(7): 3254-3265, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29436086

RESUMO

Changes in species distributions open novel parasite transmission routes at the human-wildlife interface, yet the strength of biotic and biogeographical factors that prevent or facilitate parasite host shifting are not well understood. We investigated global patterns of helminth parasite (Nematoda, Cestoda, Trematoda) sharing between mammalian wildlife species and domestic mammal hosts (including humans) using >24,000 unique country-level records of host-parasite associations. We used hierarchical modelling and species trait data to determine possible drivers of the level of parasite sharing between wildlife species and either humans or domestic animal hosts. We found the diet of wildlife species to be a strong predictor of levels of helminth parasite sharing with humans and domestic animals, followed by a moderate effect of zoogeographical region and minor effects of species' habitat and climatic niches. Combining model predictions with the distribution and ecological profile data of wildlife species, we projected global risk maps that uncovered strikingly similar patterns of wildlife parasite sharing across geographical areas for the different domestic host species (including humans). These similarities are largely explained by the fact that widespread parasites are commonly recorded infecting several domestic species. If the dietary profile and position in the trophic chain of a wildlife species largely drives its level of helminth parasite sharing with humans/domestic animals, future range shifts of host species that result in novel trophic interactions may likely increase parasite host shifting and have important ramifications for human and animal health.


Assuntos
Animais Domésticos/parasitologia , Animais Selvagens/parasitologia , Ecologia/estatística & dados numéricos , Helmintíase/epidemiologia , Helmintos/fisiologia , Interações Hospedeiro-Parasita/fisiologia , Animais , Dieta , Ecossistema , Helmintíase/transmissão , Helmintos/classificação , Humanos , Modelos Estatísticos
18.
Parasit Vectors ; 11(1): 8, 2018 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-29307305

RESUMO

BACKGROUND: Spillover of parasites at the domestic animal - wildlife interface is a pervasive threat to animal health. Cat and dog fleas (Ctenocephalides felis and C. canis) are among the world's most invasive and economically important ectoparasites. Although both species are presumed to infest a diversity of host species across the globe, knowledge on their distributions in wildlife is poor. We built a global dataset of wild mammal host associations for cat and dog fleas, and used Bayesian hierarchical models to identify traits that predict wildlife infestation probability. We complemented this by calculating functional-phylogenetic host specificity to assess whether fleas are restricted to hosts with similar evolutionary histories, diet or habitat niches. RESULTS: Over 130 wildlife species have been found to harbour cat fleas, representing nearly 20% of all mammal species sampled for fleas. Phylogenetic models indicate cat fleas are capable of infesting a broad diversity of wild mammal species through ecological fitting. Those that use anthropogenic habitats are at highest risk. Dog fleas, by contrast, have been recorded in 31 mammal species that are primarily restricted to certain phylogenetic clades, including canids, felids and murids. Both flea species are commonly reported infesting mammals that are feral (free-roaming cats and dogs) or introduced (red foxes, black rats and brown rats), suggesting the breakdown of barriers between wildlife and invasive reservoir species will increase spillover at the domestic animal - wildlife interface. CONCLUSIONS: Our empirical evidence shows that cat fleas are incredibly host-generalist, likely exhibiting a host range that is among the broadest of all ectoparasites. Reducing wild species' contact rates with domestic animals across natural and anthropogenic habitats, together with mitigating impacts of invasive reservoir hosts, will be crucial for reducing invasive flea infestations in wild mammals.


Assuntos
Animais Domésticos , Animais Selvagens , Ctenocephalides/classificação , Ctenocephalides/crescimento & desenvolvimento , Transmissão de Doença Infecciosa , Ectoparasitoses/veterinária , Animais , Canidae , Ctenocephalides/genética , Ectoparasitoses/transmissão , Felidae , Muridae , Filogenia
19.
Curr Rev Musculoskelet Med ; 11(1): 48-54, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29335854

RESUMO

PURPOSE OF REVIEW: This review aims to describe the nonreconstructive options for treating ulnar collateral ligament (UCL) injuries ranging from nonoperative measures, including physical therapy and biologic injections, to ligament repair with and without augmentation. RECENT FINDINGS: Nonoperative options for UCL injuries include guided physical therapy and biologic augmentation with platelet-rich plasma (PRP). In some patients, repair of the UCL has shown promising return to sport rates by using modern suture and suture anchor techniques. Proximal avulsion injuries have shown the best results after repair. Currently, there is growing interest in augmentation of UCL repair with an internal brace. The treatment of UCL injuries involves complex decision making. UCL reconstruction remains the gold standard for attritional injuries and complete tears, which occur commonly in professional athletes. However, nonreconstructive options have shown promising results for simple avulsion or partial thickness UCL injuries. Future research comparing reconstructive versus nonreconstructive options is necessary.

20.
J Shoulder Elbow Surg ; 27(3): 455-462, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29273388

RESUMO

BACKGROUND: The anterosuperior (AS) approach for reverse total shoulder arthroplasty (RTSA) has been reported as a risk factor for baseplate malposition because of potential difficulty in glenoid exposure. The objective of this study was to compare glenoid baseplate position between the AS and deltopectoral (DP) approaches in relation to the surgeon's experience and to evaluate the effect of placement on clinical outcomes. METHODS: There were 109 shoulders that underwent RTSA for cuff tear arthropathy or osteoarthritis with cuff tearing by a single surgeon. The AS approach was used in 87 shoulders. Clinical, radiographic, and functional outcomes were assessed for all patients with a minimum of 2 years of follow-up. Initial postoperative radiographs of all 109 shoulders were assessed for baseplate positioning. RESULTS: The mean change in glenoid inclination was 3.0° inferior with the AS approach and 2.5° inferior with the DP approach (P = .68). Pain scores (P = .14), range of motion, and American Shoulder and Elbow Surgeons scores (P = .16) improved in both groups, without a difference between approach. Scapular notching was noted in 68.5% of AS shoulders and 72.4% of DP shoulders (P = .78). Over time, there was a trend to place the glenoid baseplate more caudal with less inferior tilt. DISCUSSION AND CONCLUSION: Both approaches produce similar baseplate position, clinical outcomes, and rates of scapular notching when they are used for RTSA. Attempts to inferiorize the glenoid baseplate through the AS approach may increase the risk of superior inclination.


Assuntos
Artroplastia do Ombro/métodos , Previsões , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Prótese de Ombro , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Osteoartrite/fisiopatologia , Radiografia , Amplitude de Movimento Articular , Fatores de Risco , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Resultado do Tratamento
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