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1.
Methods Mol Biol ; 2230: 17-37, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33197006

RESUMO

The study of postnatal skeletal repair is of immense clinical interest. Optimal repair of skeletal tissue is necessary in all varieties of elective and reparative orthopedic surgical treatments. However, the repair of fractures is unique in this context in that fractures are one of the most common traumas that humans experience and are the end-point manifestation of osteoporosis, the most common chronic disease of aging. In the first part of this introduction the basic biology of fracture healing is presented. The second part discusses the primary methodological approaches that are used to examine repair of skeletal hard tissue and specific considerations for choosing among and implementing these approaches.


Assuntos
Consolidação da Fratura , Fraturas Ósseas/terapia , Sistema Musculoesquelético/fisiopatologia , Osteoporose/terapia , Envelhecimento/patologia , Fraturas Ósseas/fisiopatologia , Humanos , Osteoporose/fisiopatologia
2.
PLoS One ; 15(8): e0237812, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817716

RESUMO

Bhutan is one of the biological hotspots in the world where humans and natural flora and fauna co-exist in close proximity. Bhutan is home to two species of bears: Sloth Bear and Himalayan Black Bear. Human conflicts with bears are reported from all over the country. This study describes the profile of the victims and the pattern of injury resulting from bear attacks and circumstances around human conflicts with bears in Bhutan between 2015 and 2019. This was a cross-sectional study with a review of hospital records of patients treated at the National Referral Hospital from 01 January 2015 till 31 December 2019. Data were extracted into a structured pro forma and entered into EpiData Entry 3.1 and analysed in STATA 13.1. There were thirty-four patients who were provided care for bear maul injuries, with an average annual caseload of 6.8 cases per year. The injury prevalence was 100% and the kill prevalence was 0%. Bear attacks were reported from fourteen of twenty districts of the country. The mean age of the victims was 49 (±13) years. Males (26, 76%) and farmers (26, 76%) were the common victims; the risk of bear attacks was 0.16 per 100,000 farmers per year. The commonest region of the body attacked was the face (29, 85%) and victims were provided emergency and rehabilitative care within and outside the country. Thirty-three victims (97%) were provided post-exposure prophylaxis for rabies. All victims received antibiotics despite the lack of national guidelines on the choice of antibiotics post-bear maul. Human-bear conflict is multi-faceted, puts a considerable strain on bear-conservation efforts and requires multi-disciplinary efforts in the prevention of human injury and socioeconomic losses.


Assuntos
Agressão/fisiologia , Comportamento Animal/fisiologia , Mordeduras e Picadas/epidemiologia , Ursidae/fisiologia , Adolescente , Adulto , Agressão/psicologia , Animais , Animais Selvagens/psicologia , Animais Selvagens/virologia , Butão/epidemiologia , Mordeduras e Picadas/fisiopatologia , Mordeduras e Picadas/cirurgia , Mordeduras e Picadas/virologia , Orelha/lesões , Orelha/fisiopatologia , Orelha/cirurgia , Serviço Hospitalar de Emergência , Fazendeiros , Feminino , Florestas , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Raiva/epidemiologia , Raiva/patologia , Raiva/virologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cirurgia Plástica/métodos , Ursidae/psicologia , Adulto Jovem
3.
J Bone Miner Metab ; 38(6): 894-902, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32656645

RESUMO

INTRODUCTION: Rapid descent in bone mineral density (BMD) and ascent in bone turnover marker (BTM) occur within the short period following denosumab (Dmab) discontinuation. In addition, the incidence of vertebral fracture also rises within the short period. The purpose of this study is to investigate the effects of sequential therapy using zoledronic acid (ZOL) on any adverse events after Dmab discontinuation. MATERIALS AND METHODS: This study was a multicenter retrospective observational study, and the subjects were osteoporosis patients who visited our institutions between 2013 and 2018. We performed sequential therapy using ZOL for 30 patients who had difficulty continuing Dmab, due to physical or social reasons, and investigated the fracture incidence and BMD/BTM changes at 4 time points (at the start of Dmab, the start of ZOL, 6 months after ZOL and 12 months after ZOL). RESULTS: No new vertebral/nonvertebral fractures were observed at each time point after switching from Dmab to ZOL in any of the 30 patients. The BMD/BTM changes were evaluated in 18 of the 30 cases, since all data of lumbar/femoral neck BMDs and TRACP-5b at 4 time points was only available in 18 cases. BMDs significantly increased at each time point compared with that at the start of Dmab. Serum TRACP-5b significantly decreased at each time point compared with that at the start of Dmab. CONCLUSION: It was suggested that sequential therapy using ZOL could suppress the decrease of BMD, and increase of BTM, if the period of Dmab administration was less than 3 years.


Assuntos
Denosumab/uso terapêutico , Suspensão de Tratamento , Ácido Zoledrônico/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/efeitos adversos , Conservadores da Densidade Óssea/uso terapêutico , Remodelação Óssea/efeitos dos fármacos , Denosumab/efeitos adversos , Feminino , Fraturas Ósseas/sangue , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/sangue , Estudos Retrospectivos , Fosfatase Ácida Resistente a Tartarato/sangue , Ácido Zoledrônico/efeitos adversos
4.
J Am Acad Orthop Surg ; 28(18): 737-741, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32618680

RESUMO

Lymphatic flow plays a notable role in the regulation of bone formation and remodeling. Chronic accumulation of the lymph fluid within tissues may lead to issues with proper bone healing after fractures, emphasizing the importance of proper management of lymphedema after trauma. Many associated risk factors place patients at risk for lymphedema, including previous surgery with nodal dissection, radiation therapy, infection, malignancy, family history of congenital lymphedema, and trauma. The benchmark imaging technique for the diagnosis of lymphedema is lymphoscintigraphy. Other modalities include duplex ultrasonography, CT, and MRI. First-line conservative treatment of lymphedema is compression. Complete decongestive therapy or complex physical therapy, also known as decongestive lymphatic therapy (DLT), has shown positive results in reducing lymphedema. Surgical interventions aim to either reconstruct and restore function of the lymphatic system or debulk and reduce tissues and fluids. Understanding the significance of lymphedema on bone healing and techniques available to recognize it are important factors in preventing delay in diagnosis and ensuring proper management of lymphedema after trauma.


Assuntos
Osso e Ossos/lesões , Fraturas Ósseas/complicações , Linfedema/etiologia , Linfedema/terapia , Osso e Ossos/fisiopatologia , Bandagens Compressivas , Tratamento Conservador/métodos , Diagnóstico por Imagem , Fraturas Ósseas/fisiopatologia , Humanos , Linfedema/diagnóstico , Linfedema/cirurgia , Procedimentos Ortopédicos/métodos , Modalidades de Fisioterapia , Cicatrização
5.
J Am Acad Orthop Surg ; 28(14): 597-605, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692097

RESUMO

INTRODUCTION: The purpose of this study is to assess the impact of Trauma Recovery Services (TRS), a program facilitating engagement and recovery on satisfaction after orthopaedic trauma. METHODS: Two hundred ninety-four patients with surgically managed extremity fractures were prospectively surveyed. Satisfaction was assessed after 12 months using a 13-question telephone survey, rated on a Likert scale from 1 to 5 (with five being excellent). TRS resource utilization during and after hospitalization was recorded. Eighty-eight patients (30%) used TRS. RESULTS: Overall satisfaction was high with a mean score of 4.32. Although no differences were observed between the control group and patients with TRS utilization in age, sex, race, insurance, smoking history, or employment status, TRS patients sustained more high-energy mechanisms (81% versus 56%) and had more associated psychiatric illness (33% versus 17%), both P < 0.01. Multivariable regression indicated general exposure to TRS to be an independent predictor of higher overall care ratings (B = 1.31; P = 0.03). DISCUSSION: Utilization of TRS was the greatest predictor of better overall care ratings. This study builds on existing evidence demonstrating the positive impact of Trauma Survivor Network programming. We conclude that a hospital-wide program supporting patient education and engagement can effectively increase patient satisfaction after traumatic injury. LEVEL OF EVIDENCE: Prognostic Level II.


Assuntos
Fraturas Ósseas/psicologia , Fraturas Ósseas/cirurgia , Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/estatística & dados numéricos , Satisfação do Paciente , Serviços Preventivos de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Eficiência Organizacional , Feminino , Previsões , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Inquéritos e Questionários , Adulto Jovem
6.
Jt Dis Relat Surg ; 31(2): 193-200, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584714

RESUMO

OBJECTIVES: This study aims to compare the early clinical, functional and radiographic outcomes of a small cohort of patients with calcaneal fractures treated with closed reduction using a dual- point distraction system and the traditional lateral approach. PATIENTS AND METHODS: We prospectively treated 40 patients with calcaneus fractures who presented to our emergency department between January 2017 and February 2018. In total, 35 patients (22 males, 13 females; median age 39.8 years; range, 19 to 57 years) were included in this study since five patients were not followed up. Fractures were classified according to the Sanders classification system using computer tomography images. Clinical outcomes including postoperative two-week visual analog scale (VAS) score, sickness absence period, operating time and complication rate were recorded. RESULTS: The mean follow-up period was 24 months. Closed reduction using dual-point distraction and percutaneous fixation (group 1) was performed in 17 patients, whereas the extended lateral approach (group 2) was used in 18 patients. There were no significant differences between both groups in age, follow- up outcomes and Sanders classification. Operating time was significantly shorter in group 1 than in group 2. At postoperative two weeks, VAS scores were significantly lower in group 1 than in group 2. The complication rate and sickness absence period were significantly lower in group 1 than in group 2. CONCLUSION: Closed reduction using dual-point distraction can be preferred owing to many advantages including considerably decreased risk of wound complications, sickness absence period and length of hospital stay as well as superior postoperative rehabilitation with a low pain score.


Assuntos
Calcâneo/cirurgia , Redução Fechada , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Redução Aberta , Adulto , Calcâneo/lesões , Feminino , Seguimentos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/fisiopatologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Licença Médica , Tomografia Computadorizada por Raios X , Adulto Jovem
7.
Ned Tijdschr Geneeskd ; 1642020 04 30.
Artigo em Holandês | MEDLINE | ID: mdl-32395953

RESUMO

A 14-year-old boy presented to the emergency department with pain in his right buttock after a breakdance move. He got injured while simultaneously hyperflexing his hip and extending his knee. Upon physical examination he had tenderness over his right ischial tuberosity and an inability to perform combined hip extension and knee flexion. Radiography and CT-imaging showed an avulsion fracture of the ischial tuberosity.


Assuntos
Nádegas , Dança/lesões , Fraturas Ósseas , Ísquio , Dor Musculoesquelética/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Dor Aguda , Adolescente , Diagnóstico Diferencial , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/etiologia , Fraturas Ósseas/fisiopatologia , Humanos , Ísquio/diagnóstico por imagem , Ísquio/lesões , Masculino , Dor Musculoesquelética/etiologia
8.
Int J Sports Med ; 41(8): 495-504, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32242332

RESUMO

The musculoskeletal system has an integral role throughout life, including structural support to the body, protection, and allowing a range of fine to complex movements for daily living to elite sporting events. At various times, injuries to the musculoskeletal system occur resulting in varying levels of impact to the person both acutely and chronically. Specifically, there is a spectrum of complexity in orthopedic injuries, with some such as common muscle strains, that while burdensome will have no impact on life-long functional ability, and others that can result in long lasting disability. Focusing on extremity injuries, this review highlights: i)the current impact of orthopedic injuries in sport and daily life; ii) the foundation of bone and skeletal muscle repair and regeneration; and iii) the disruptions in regenerative healing due to traumatic orthopedic injuries. This review seeks to maximize the broad and collective research impact on sport and traumatic orthopedic injuries in search of promoting ongoing innovation for treatment and rehabilitation approaches aimed to improve musculoskeletal health throughout life.


Assuntos
Extremidade Inferior/lesões , Extremidade Inferior/fisiopatologia , Músculo Esquelético/lesões , Músculo Esquelético/fisiopatologia , Regeneração/fisiologia , Extremidade Superior/lesões , Extremidade Superior/fisiopatologia , Atividades Cotidianas , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/reabilitação , Regeneração Óssea , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/reabilitação , Humanos , Inflamação/fisiopatologia , Modalidades de Fisioterapia , Cicatrização/fisiologia
10.
Clin Sports Med ; 39(2): 401-422, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115091

RESUMO

Metacarpal and phalangeal fractures are common injuries in athletes and occur frequently in contact and ball-handling sports. They usually result after direct hits from other players or athletic equipment. The fractures often are minimally displaced and require a short period of immobilization followed by early range of motion for expeditious return to play. Unstable or intra-articular fractures may require operative fixation. Open reduction and internal fixation afford the most stability while allowing for early rehabilitation. Athletes represent a unique population, and treatment of these fractures requires consideration of specific sport, timing of injury, and level of play.


Assuntos
Traumatismos em Atletas/terapia , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/terapia , Ossos Metacarpais/lesões , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/cirurgia , Falanges dos Dedos da Mão/anatomia & histologia , Fixação Interna de Fraturas , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/cirurgia , Humanos , Ossos Metacarpais/anatomia & histologia , Redução Aberta , Amplitude de Movimento Articular , Volta ao Esporte
11.
PLoS One ; 15(3): e0229127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32134943

RESUMO

Vibration acceleration through whole body vibration has been reported to promote fracture healing. However, the mechanism responsible for this effect remains unclear. Purpose of this study was to determine whether vibration acceleration directly affects cells around the fracture site and promotes endochondral ossification. Four-week-old female Wistar Hannover rats were divided into two groups (vibration [V group] and control [C group]). The eighth ribs on both sides were cut vertically using scissors. From postoperative day 3 to 11, vibration acceleration using Power Plate® (30 Hz, low amplitude [30-Low], 10 min/day) was applied in the V group. Mature calluses appeared earlier in the V group than in the C group by histological analysis. The GAG content in the fracture callus on day 6 was significantly higher in the V group than in the C group. The mRNA expressions of SOX-9, aggrecan, and Col-II in the fracture callus on day 6 and Col-X on day 9 were significantly higher in the V group than in the C group. For in vitro analysis, four different conditions of vibration acceleration (30 or 50 Hz with low or high amplitude [30-Low, 30-High, 50-Low, and 50-High], 10 min/day) were applied to a prechondrogenic cell (ATDC5) and an undifferentiated cell (C3H10T1/2). There was no significant difference in cell proliferation between the control and any of the four vibration conditions for both cell lines. For both cell lines, alcian blue staining was greater under 30-Low and 50-Low conditions than under control as well as 30-High and 50-High conditions on days 7 and 14. Vibration acceleration under 30-L condition upregulated chondrogenic gene expressions of SOX-9, aggrecan, Col-II, and Col-X. Low-amplitude vibration acceleration can promote endochondral ossification in the fracture healing in vivo and chondrogenic differentiation in vitro.


Assuntos
Diferenciação Celular , Condrócitos/fisiologia , Condrogênese/fisiologia , Consolidação da Fratura/fisiologia , Osteogênese/fisiologia , Vibração , Aceleração , Animais , Fenômenos Biomecânicos/fisiologia , Calo Ósseo/fisiologia , Células Cultivadas , Feminino , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/terapia , Ratos , Ratos Wistar , Vibração/uso terapêutico
12.
Am J Phys Med Rehabil ; 99(9): 789-794, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32195737

RESUMO

OBJECTIVE: Prevalence and characteristics of fractures and factors related to loss of ambulation after lower limb fractures were investigated. DESIGN: Chart review included height, weight, dual-energy x-ray absorptiometry, corticosteroid use, vitamin D, fracture history, muscle strength, range of motion, and timed performance tests (10 meter walk/run, Gowers, and four steps). Patients were grouped by fracture location and ambulation loss after fracture. RESULTS: Two hundred eighty-seven patients with Duchenne muscular dystrophy were identified, 53 of these had experienced fracture. Eighty-one percent were older than 9 yrs at first fracture and 36.4% became nonambulatory after fracture. Dorsiflexion range of motion (fracture side, P = 0.021), quadriceps strength (right side, P = 0.025), and shoulder abduction strength (right, left, and fracture side; P = 0.028, P = 0.027, and P = 0.016) were significantly different within the groups. Patients who became nonambulatory after fracture initially had less dorsiflexion (right, left, fracture side; 2.25 vs. -7.29, P = 0.004; 2.67 vs. -12, P = 0.001; and 2.41 vs. -7.42, P = 0.002) and slower 10-meter walk/run times (7.43 secs vs. 14.7 secs, P = 0.005). CONCLUSIONS: Fracture represents a significant risk in patients with Duchenne muscular dystrophy; both slower walking speed and ankle contracture confer an increased risk of ambulation loss after fracture. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Identify the main factors that are associated with ambulation loss after fracture in patients with Duchenne muscular dystrophy; (2) Identify the risk of fracture in the Duchenne muscular dystrophy population; and (3) Articulate the characteristics associated with fracture in patients with Duchenne muscular dystrophy. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Assuntos
Fraturas Ósseas/fisiopatologia , Extremidade Inferior/lesões , Limitação da Mobilidade , Distrofia Muscular de Duchenne/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Fraturas Ósseas/etiologia , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Distrofia Muscular de Duchenne/complicações , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Caminhada/fisiologia , Adulto Jovem
13.
Orthopedics ; 43(3): e125-e133, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32077970

RESUMO

Dynamization of fracture fixation constructs provides early rigidity for primary bone healing and late motion for secondary healing. A review of laboratory, animal, and clinical studies investigating the impact, and optimal timing, of dynamization is limited by lack of standardization across studies. However, in animal models, dynamization improves histologic and biomechanical properties compared with statically rigid or flexible controls. In animals, dynamization at 3 to 4 weeks showed improved histologic results. In clinical studies, it showed faster, stronger, and stiffer bone healing. Clinical success dynamizing external fixators and intramedullary nails suggests a role for late dynamization in other fixation types, such as bridge plating. [Orthopedics. 2020;43(3):e125-e133.].


Assuntos
Fixação de Fratura/métodos , Consolidação da Fratura/fisiologia , Fraturas Ósseas/cirurgia , Animais , Fenômenos Biomecânicos , Fraturas Ósseas/fisiopatologia , Humanos
14.
BMC Geriatr ; 20(1): 66, 2020 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066394

RESUMO

BACKGROUND: Early operative treatment of acetabulum fractures in geriatric patients has been suggested to reduce pain and allow for earlier mobilization. The aim of this study was to determine mortality, complications and functional outcome after operative and non-operative treatment. METHODS: Patients aged ≥60 years with operative treatment of low-energy fragility fracture of the acetabulum from 2009 to 2016 and a follow-up of at least 24 months were identified. The patients were contacted by phone and a modified Merle d'Aubigné score was obtained. If patients or their relatives were not available for follow-up, mortality data was assessed using a national social insurance database. RESULTS: One hundred seventy-six patients (mean age 78, SD 10 years; 73 female) were available for analysis of mortality data. At final follow-up (68 months, SD 26, range, 24 to 129), 99/176 patients (56.3%) had deceased. One-year-mortality was 25.0% and 2-year mortality 35.8%. Type of treatment (non-operative vs. operative) did not affect mortality at 1 and 2 years (p = .65 and p = .10). Hospital-acquired infections were observed in 31/176 cases (17.6%), thromboembolic events and delirium in 6 patients (3.4%). In-hospital mortality was 5.7%. Patients who underwent operative treatment were more likely to have an in-hospital infection (p = .02) but less likely to sustain thromboembolic events (p = .03). The mean hospital stay was 14 days (SD 10 days, range, 1 to 66). Patients with operative treatment were longer hospitalized than patients with non-operative treatment (p < .001). The rate of secondary conversions to THA was 12.4%, this was not affected by initial treatment. The mean modified Merle d'Aubigné Score of those patients available for a final follow-up (n = 47; follow-up 56 months, SD 28, range, 24 to 115) was 14/18 points, SD 3 (range 7 to 18). Functional results at final follow-up between operatively and non-operatively treated patients were without difference. CONCLUSIONS: All-cause mortality and in-hospital complications are high among geriatric patients with low-energy fractures of the acetabulum even when treated operatively. Secondary conversion rates to THA are similar to those seen in younger patients. Mid-term functional outcome in those surviving is fair.


Assuntos
Acetábulo/lesões , Acetábulo/fisiopatologia , Fraturas Ósseas/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Acetábulo/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas Ósseas/mortalidade , Fraturas Ósseas/cirurgia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
BMC Med Genet ; 21(1): 21, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005172

RESUMO

BACKGROUND: More than 95% of individuals with RTT have mutations in methyl-CpG-binding protein 2 (MECP2), whose protein product modulates gene transcription. The disorder is caused by mutations in a single gene and the disease severity in affected individuals can be quite variable. Specific MECP2 mutations may lead phenotypic variability and different degrees of disease severity. It is known that low bone mass is a frequent and early complication of subjects with Rett syndrome. As a consequence of the low bone mass Rett girls are at an increased risk of fragility fractures. This study aimed to investigate if specific MECP2 mutations may affects the degree of involvement of the bone status in Rett subjects. METHODS: In 232 women with Rett syndrome (mean age 13.8 ± 8.3 yrs) we measured bone mineral density at whole body and at femur (BMD-FN and BMD-TH) by using a DXA machine (Hologic QDR 4500). QUS parameters were assessed at phalanxes by Bone Profiler-IGEA (amplitude dependent speed of sound: AD-SoS and bone transmission time: BTT). Moreover, ambulation capacity (independent or assisted), fracture history and presence of scoliosis were assessed. We divided the subjects with the most common point mutations in two group based on genotype-phenotype severity; in particular, there has been consensus in recognising that the mutations R106T, R168X, R255X, R270X are considered more severe. RESULTS: As aspect, BMD-WB, BMD-FN and BMD-TH were lower in subjects with Rett syndrome that present the most severe mutations with respect to subjects with Rett syndrome with less severe mutations, but the difference was statistically significant only for BMD-FN and BMD-TH (p < 0.05). Also both AD-SoS and BTT values were lower in subjects that present the most severe mutations with respect to less severe mutations but the difference was not statistically significant. Moreover, subjects with Rett syndrome with more severe mutations present a higher prevalence of scoliosis (p < 0.05) and of inability to walk (p < 0.05). CONCLUSION: This study confirms that MECP2 mutation type is a strong predictor of disease severity in subjects with Rett syndrome. In particular, the subjects with more severe mutation present a greater deterioration of bone status, and a higher prevalence of scoliosis and inability to walk.


Assuntos
Doenças Ósseas/genética , Proteína 2 de Ligação a Metil-CpG/genética , Osteoporose/genética , Síndrome de Rett/genética , Adolescente , Adulto , Densidade Óssea/genética , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/fisiopatologia , Criança , Pré-Escolar , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/genética , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Mutação , Osteoporose/diagnóstico por imagem , Osteoporose/fisiopatologia , Síndrome de Rett/diagnóstico por imagem , Síndrome de Rett/fisiopatologia , Escoliose/diagnóstico por imagem , Escoliose/genética , Escoliose/fisiopatologia , Índice de Gravidade de Doença , Adulto Jovem
18.
J Pak Med Assoc ; 70(Suppl 1)(2): S10-S14, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31981328

RESUMO

OBJECTIVE: To determine the association of delay in treatment with injury-specific patient outcomes. METHODS: This was a single-center, longitudinal cohort study on orthopaedic trauma registry. Data on patients enrolled between June 2015 and June 2018 were analyzed. Data was collected from admitted consenting patients' medical records. Definitive surgical care provided after 24 hours was considered as 'delayed surgical treatment'. Outcomes of patients were serially assessed on follow-up visits up to 12 months using injury-specific scoring system. RESULTS: A total of 789 patients, were enrolled with 856 upper or lower extremity injuries altogether; in 67 cases both extremities were involved. Surgery was done in 90% while 10% were managed conservatively. A delay in the surgical procedure was experienced by 185(23%) patients. Mortality was 3.28% (6 of 185) in the delayed treatment group and 1% (6 of 603 patients) in the early treatment group (p=0.046). In proximal femur there was a nonsignificant trend towards better outcomes in the early treatment group at 3 and 12 months (p=0.06), while in Tibial shaft fractures, there was a non-significant trend towards better outcomes in the delayed treatment group at 3 and 6-months (p=0.09). There was no association between treatment delay for distal radius and proximal humerus fractures and their outcomes. CONCLUSIONS: Our trauma registry model provides outcomes data enabling identification of patient subsets who did not achieve good outcome, and suggests possible role of delay in surgical treatment beyond 24 hours in the outcomes..


Assuntos
Extremidades/lesões , Fraturas Ósseas/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Acidentes por Quedas , Acidentes de Trânsito , Adulto , Idoso , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/fisiopatologia , Cardiopatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Paquistão/epidemiologia , Sistema de Registros , Fatores de Risco , Resultado do Tratamento , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/fisiopatologia , Ferimentos e Lesões/cirurgia
19.
Public Health ; 181: 102-109, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31982636

RESUMO

OBJECTIVE: Despite growing evidence for the association between other dietary macronutrients and bone health, limited and inconsistent knowledge is available regarding carbohydrate intake. In this systematic review and meta-analysis, we purposed to clarify and synthesize the knowledge about the relation between carbohydrate intake and the risk of fracture. STUDY DESIGN: Systematic review and meta-analysis of observational studies. METHODS: In this study, PubMed and Scopus were used to conduct a comprehensive search for articles published up to September 2018. The screening was done independently by two authors. Pooled effect sizes were calculated using fixed and random effect models for the highest versus lowest intake categories. The dose-response nature of the relationship was also investigated. RESULTS: No association was observed between carbohydrate intake and the risk of fracture in high versus low intake meta-analysis (overall relative risk [RR]: 1.24; 95% confidence interval [95% CI]: 0.84-1.84; P = 0.27) with moderate heterogeneity (I2 = 57.7%, P heterogeneity = 0.05). Moreover, there was no relationship between carbohydrate intake and the risk of fracture in both linear (overall RR: 1.00; 95% CI: 0.94-1.05; P = 0.88) (I2 = 68.1%, P heterogeneity = 0.48) and nonlinear (Pnon-linearity = 0.14) models. CONCLUSION: No association was observed between carbohydrate intake and the risk of fracture.


Assuntos
Carboidratos da Dieta/administração & dosagem , Fraturas Ósseas/epidemiologia , Estudos Observacionais como Assunto , Dieta , Carboidratos da Dieta/efeitos adversos , Fraturas Ósseas/fisiopatologia , Humanos , Estado Nutricional , Medição de Risco , Fatores de Risco
20.
Am J Phys Anthropol ; 171(2): 285-297, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31702830

RESUMO

INTRODUCTION: Physiological stress is one of the various factors that can have an impact on stable isotope ratios. However, its effect on bone collagen stable isotope ratios is still not fully understood. This study aims to build on previous research on how different disease stages may affect bone collagen stable isotope ratios. MATERIALS AND METHODS: Carbon (δ13 C) and nitrogen (δ15 N) isotope ratios were assessed in 33 skeletons that retained evidence of infectious disease and healed fractures. Samples were taken from active lesions (long bones n = 14; ribs n = 4), healed lesions (long bones n = 10; ribs n = 9), or a fracture callus (long bones n = 9; ribs n = 3). Results were compared to stable isotope ratios calculated for regions on these bones that did not retain evidence of disease or fracture. RESULTS: Long bones with active lesions had a significantly higher average δ15 N (δ15 N = 11.1 ± 0.9‰) compared to those without lesions (δ15 N = 10.7 ± 0.7‰; p = .02), while fracture calluses showed the largest range for both δ15 N and δ13 C. There were no significant differences in stable isotope ratios when compared between nonlesion and lesion sites in the ribs. DISCUSSION: The increase in δ15 N seen in active lesions, when compared with δ15 N from nonlesion regions on the same long bone, may be a consequence of altered protein metabolism. The high variability of δ15 N and δ13 C in fractures may be related to different healing stages of the calluses. This study suggests that stable isotope data can contribute information about diseases in the past, as well as an individual's response to diseases in the absence of modern medicine and antibiotics.


Assuntos
Osso e Ossos/química , Consolidação da Fratura , Adulto , Idoso , Doenças Ósseas/fisiopatologia , Isótopos de Carbono/análise , Feminino , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Isótopos de Nitrogênio/análise , Portugal , Adulto Jovem
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