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OBJECTIVE: The objective was to evaluate the level of evidence about the associated factors and the risk factors of osteonecrosis of femoral head (ONFH) in sickle cell individuals. METHODS: The review was based on the search and selection of studies available in the electronic databases PubMed, SCIELO, LILACS, BVS. As descriptors, the terms of Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) corresponding to “Osteonecrosis”, “Necrosis avascular” and “Aseptic necrosis” and “Femoral head” and “sickle cell disease” and “risk factor” and “predictor”. RESULTS: Among clinical and laboratorial factors the most promising risk factors were the severity of sickle cell disease and acute chest syndrome. As a result, from studies of a moderate level of quality, blood pressure, body weight, previous trauma, haemoglobin to haematocrit ratio (Hb/HCT), and number of hospitalizations can be highlighted. Others, such as genetic markers and male gender, have also been positively associated in lower quality studies. CONCLUSION: For a better clarification of what the risk factors are for the ONFH, it is necessary to study with populations of different origins, different ages, different profiles of Hb, which present greater methodological rigor and perform a multivariate analysis to control confounding factors. Further study is also needed to understand the genetic determinants of ONFH.

Efforts have been made to determine new predictors of morbidity and mortality in patients with severe burn injuries. This prospective cohort study aimed to determine the association of serum albumin concentration on admission and renal failure, pulmonary infection, sepsis, and death in patients with burn injuries. We included 141 patients, aged >18 years, who were admitted to our institution between April and August 2018. Among them, 59.1% were male and 83.8% had burns covering 2.2 g/dL (odds ratios [OR]: 18.7; 95% confidence interval [CI]: 4.9 to 70.8). Serum albumin ≤2.2 g/dL was also significantly associated with pulmonary infection (OR: 13.1, 95% CI: 3.8 to 45.7), renal failure (OR: 30.2, 95% CI: 7.4 to 122.3), and sepsis (OR: 16.9, 95% CI: 4.9 to 58.3). Serum albumin concentration cut-points and ABSIs were determined to be death predictors using areas under the receiver operating characteristic curves (AUCs). The AUCs with albumin or ABSI alone were 0.89 (95% CI: 0.79 to 0.98) and 0.92 (95% CI: 0.87 to 0.96), respectively. The AUC including both albumin and ABSI was 0.96 (95% CI: 0.90 to 0.98), indicating that the combination is a better death predictor than either measure alone. We confirmed that burn patients with a serum albumin concentration ≤2.2 g/dL on admission have substantially increased morbidity and mortality.

Bilateral shoulder septic arthritis is a rare condition in immunocompetent patients without known risk factors, therefore, it can be easily misdiagnosed. Septic arthritis is an emergency due to its potential to cause rapid destruction of cartilage and bone as well as the risk for systemic spread. Aggressive early treatment is crucial for easing pain, preventing joint collapse, and permanent loss of shoulder function. We presented a case report of a 68 years-old man, suffering from multiple comorbidities and bilateral shoulder septic arthritis. The patient underwent arthroscopic surgery in the left shoulder. Antibiotic therapy was carried out after the surgical procedure using clindamycin. The patient had a satisfactory outcome, characterized by regression of the inflammatory symptoms in both shoulders. There was an improvement in pain and fevers settled. In this case report, we have also discussed treatment options as well as possible outcomes.

ackground Chronic pain leads to functional and social disability, emotionally impacting individuals. Objective: To describe the main impairments of activities of daily living, anxious and depressive symptoms and quality of life in patients with chronic pain. Methods: Cross-sectional study with patients at the Chronic Pain Clinic attended between June / 2016 and March / 2019. Clinical and socio-demographic variables were collected, using the Hospital scale for Anxiety and Depression, Visual Numerical Scale for Pain, SF-36 scale for Quality of Life, and data analysis using the SPSS statistical program. Results: The mean age was 50.0±10 years, being (89.6%) female. There was a predominance of people with a partner, with religion, complete high school education and unemployed. Degenerative disease was the most frequent diagnosis (68.9%); pain intensity ranged from moderate to severe, score 6-8 (7). Most used drugs were analgesics (93.3%) followed by antidepressants (70.7%). Physical activity as an adjuvant treatment (41.5%), and anesthetic blocks (39.6%). When investigating daily activities, the work showed total limitation followed by movement; and, partially, leisure and home activity. The quality of life was well below the median, with the physical and emotional aspects being worse. Related to the subjects' activities, sleep is the most compromised; followed by partial difficulties with appetite and sexual activity. Most show self-esteem moderately satisfied with the treatment, even with anxious and depressive symptoms. Conclusion: Pain has a very significant impact on quality of life; compromises and limits daily activities and reveals more presence of anxious and depressive symptoms in people suffering from chronic pain.

BACKGROUND AND OBJECTIVES: Chronic pain causes functional and social disability, resulting in emotional impact. This study’s objective was to describe the main impairments of activities of daily living, anxious and depressive symptoms, and quality of life in patients with chronic pain. METHODS: Cross-sectional study with chronic pain outpatients. Analysis of clinical and sociodemographic variables, as well as activities of daily living. Assessment of pain, anxious and depressive symptoms by the Hospital Anxiety and Depression Scale, quality of life by the Medical Outcomes Study 36 - Item Short Form Health Survey questionnaire and data analysis by the SPSS statistical software. RESULTS: The study observed limitations in work, movement, leisure and home activities, quality of life below the median and worse for the physical and emotional domains. Sleep was very impaired, followed by partial difficulty with appetite and sexual activity. Although they had anxious and depressive symptoms, most participants were moderately satisfied with their treatment. CONCLUSION: Chronic pain has a very significant impact on quality of life, impairing and limiting daily activities more intensely in individuals with anxious and depressive symptoms. RESUMO JUSTIFICATIVA E OBJETIVOS: Dor crônica acarreta incapacidade funcional e social, impactando emocionalmente os indivíduos. O objetivo deste estudo foi descrever os principais comprometimentos das atividades de vida diária, sintomas ansiosos e depressivos e qualidade de vida em pacientes com dor crônica. MÉTODOS: Estudo transversal com pacientes de ambulatório de dor crônica. Análise das variáveis clínicas e sociodemográficas, assim como das atividades de vida diária. Avaliação de dor, de sintomas ansiosos e depressivos pela Hospital Anxiety and Depression Scale, de qualidade de vida pelo questionário Medical Outcomes Study 36 - Item Short Form Health Survey e a análise dos dados no programa estatístico SPSS. RESULTADOS: Foi evidenciada limitação para o trabalho, movimento, lazer e atividade domiciliar, qualidade de vida abaixo da mediana e pior para os domínios aspectos físicos e emocionais. O sono foi muito comprometido, seguido de dificuldade parcial para apetite e atividade sexual. Embora apresentassem sintomas ansiosos e depressivos, a maioria dos participantes estavam moderadamente satisfeitos com o tratamento. CONCLUSÃO: A dor crônica impacta de forma muito significativa na qualidade de vida, comprometendo e limitando as atividades diárias de modo mais intenso nos portadores de sintomas ansiosos e depressivos.

To verify the impact of avascular necrosis of the femoral head on the quality of life of children and adolescents with Perthes disease and sickle cell disease.A comparative study including 24 children between eight and 18 years old with avascular necrosis of the femoral head secondary to Perthes disease and sickle cell disease (Group with Necrosis) and 24 children considered asymptomatic (Group without Necrosis). Clinical and sociodemographic data were collected and the PedsQL 4.0 and the Charnley score for hip dysfunction were applied.There was no difference in the overall score and in any domain when comparing the Perthes group (global = 73.1) and the sickle cell disease group (global = 65.9). When comparing the groups with necrosis and without necrosis, the Perthes group had a lower overall score only for the Physical Functioning domain (87.5 versus 68.5); sickle cell disease group had a lower overall score (64.9 versus 79.4) and in the Physical Functioning (68.5 versus 87.5) and School Functioning (62.9 versus 73.7) domains.Avascular necrosis of the femoral head produces lower quality of life scores both in the global evaluation and in the domains Physical Functioning and School Functioning. Necrosis, bilateral lesion, and hip function were found to be associated with the loss of quality of life.Verificar o impacto da necrose avascular da cabeça do fémur sobre a qualidade de vida de crianças e adolescentes com doença de Perthes e anemia falciforme.Estudo comparativo com 24 crianças entre oito e 18 anos com necrose avascular da cabeça do fémur secundária à doença de Perthes e à anemia falciforme (grupo com necrose) e 24 crianças consideradas assintomáticas (grupo sem necrose). Foram coletados dados clínicos e sociodemográficos e aplicado o instrumento PedsQL 4.0 e o escore de Charnley para disfunção do quadril.Não houve diferença no escore global e em nenhum domínio comparando os grupos Perthes (global = 73,1) e anemia falciforme (global = 65,9). Quando comparados os grupos sem necrose e com necrose, nota-se que o grupo Perthes tem escore inferior apenas para o domínio Capacidade Física (87,5 versus 68,5); já o grupo anemia falciforme tem escore global inferior (64,9 versus 79,4) e também nos domínios Capacidade Física (68,5 versus 87,5) e Aspecto Escolar (62,9 versus 73,7).A necrose avascular da cabeça do fémur produz escores de qualidade de vida inferiores tanto na avaliação global, como nos domínios Capacidade Física e Aspecto Escolar. Foram identificadas presença de necrose, lesão bilateral e função do quadril como fatores associados à perda de qualidade de vida.

Diagnosis of synovitis/tenosynovitis by physical examination can be difficult. Ultrasound (US) can be an effective tool for the evaluation of joint involvement in systemic lupus erythematosus (SLE). This study will describe musculoskeletal findings by US in SLE patients and the evaluation of their correlation with physical examination. SLE patients underwent clinical/sonographic evaluation of hand/wrists. In total, 896 joints were evaluated: at least 1 change on physical examination was found in 136 joints and at least 1 US abnormality was found in 65 of 896 joints. Out of the 65 joints with US changes, only 13 had findings on physical examination. Conversely, 111 joints had tenderness on physical examination with no sonographic abnormalities. Tenosynovitis was statistically significant more frequently with joint edema (41%) (p = 0.0003). US can detect musculoskeletal changes in only a minority of symptomatic SLE patients. Clinical findings may be related to some reasons that cannot be explained using US.

Artigo original: Marcos Almeida Matos, Jandrice Carrasco, Luanne Lisle, Marilda Castelar. Avascular necrosis of the femoral head in sickle cell disease in pediatric patients suffering from hip dysfunction. Rev Salud Pública 2016; 18(6): 986-995.

Mucopolysaccharidoses (MPS) are inborn errors of metabolism caused by deficient lysosomal enzymes, leading to organomegaly, hip osteonecrosis, coarse facial features, bone deformities, joint stiffness, cardiac and pulmonary symptoms (MPS VI) or hypermobility (MPS IVA). Some patients may present with non-classical forms of the disease in which osteoarticular abnormalities are the initial symptoms of non-classical forms. As orthopedists and surgeons are the specialists most frequently consulted before the diagnosis, it is critical that MPS may be considered as a differential diagnosis for patients with bone dysplasia. Experts in Latin America reviewed medical records focusing on disease onset, first symptoms and the follow-up clinical and surgical outcomes of non-classical MPS VI and IVA patients. All patients displayed orthopedic issues, which worsened over time, followed by cardiac and ophthalmological abnormalities. Our findings enlighten the necessity of including non-classical MPS as possible diagnosis for patients who report osteoarticular abnormalities in absence of inflammation.

Objective To evaluate the association between bone changes due to vaso-occlusive events in sickle cell disease (SCD) revealed by conventional MRI sequences and the fat fraction obtained using a 6-point DIXON technique (FFdix), in an attempt to use quantitative data as a biomarker for bone complications. Methods Cross-sectional study, with 48 SCD patients, 26–homozygous (HbSS), and 22–compound heterozygous (HbSC). Forty-eight healthy individuals paired by age, weight, and sex with SCD patients. All participants underwent lumbar spine and pelvis MRI. Conventional sequences: bone complications related to vaso-occlusive events—femoral head avascular necrosis, bone infarctions, “H”-shaped vertebrae, bone marrow necrosis. Six-point DIXON technique: quantitative evaluation of the bone marrow at pre-established sites (lumbar vertebrae, sacrum, iliacs, femoral heads, greater femoral trochanters, femoral necks). Pearson's correlation, ROC curve, and binary logistic regression analysis were performed. Results The most frequent findings in the SCD group included femoral head avascular necrosis (75%), bone infarctions (58.3%), “H”-shaped vertebrae (58.3%), and typical imaging findings of bone marrow necrosis (8.3%). Cortical bone thickness in the proximal femoral diaphysis in patients with SCD was moderately negatively correlated with FFdix in lumbar vertebrae, iliacs, femoral necks, and first sacral vertebrae. The ROC curves and odds ratios demonstrated excellent performance of FFdix in all the evaluated anatomical sites and identified patients having bone complications. Conclusions FFdix could serve as a potential biomarker in SCD because of its association with bone complications secondary to vaso-occlusive events in patients with SCD, especially in femoral heads, femoral necks, and iliacs.

Background The aim of the present study was to evaluate health-related quality of life in pediatric patients with avascular necrosis of the femoral head. Material and methods A comparative study was conducted involving 32 children and adolescents in "ONFH Group" (subjects with a diagnosis of ONFH) and 44 in "Comparison Group" (asymptomatic children), both aged between 8 and 18. Clinical and sociodemographic data were obtained along with PedsQL 4.0 questionnaires to evaluate the quality of life in the age-ranges studied. Results The two groups were similar as regards sociodemographic characteristics. Comparison of the quality of life total scores demonstrated significant differences between the ONFH group and the comparison group (58.86±16.54 versus 82.08±9.51), and this also occurred in all the domains analyzed. The predictors that showed correlation with the quality of life were: presence of necrosis, age, time of diagnosis, radiographic classification, Charnley score, educational level, previous surgeries, and previous infections. Conclusion Our data confirm the hypothesis that pediatric patients with ONFH demonstrate a lower quality of life than healthy children in all the domains evaluated, especially with regard to the physical aspect.

Purpose To verify the association between functional independence (FI) and quality of life (QOL) in patients with knee osteoarthritis. Materials and Methods A cross-sectional study composed of 93 patients with knee osteoarthritis was performed. Osteoarthritis was stratified according the classification of Ahlbach. For evaluation of the patient's overall FI, the Barthel index was used. The patient's QOL was measured by means of the Medical Outcomes Study 36–Item Short Form Health Survey (SF-36) questionnaire. Results The mean age of the patients was 60 years (range, 54.0 to 69.5 years) and only 32 patients (34.3%) were found to be independent. Dependent or independent individuals presented difference in all domains of the QOL including physical function (p=0.001), role-physical (p=0.005), bodily pain (p=0.001), general health (p=0.004), vitality (p=0.009), social function (p=0.010), role-emotional (p=0.002) and mental health (p=0.001). Correlation between FI and QOL was different for all domains of the SF-36. Correlation with FI was strongest for physical function (r=0.609, p

Background. Osteoarthritis of the knee is a degenerative disease which affects the functional status and qua­lity of life of patients. The treatment of choice in advanced stages is total knee arthroplasty (TKA). Although the procedure consistently yields good results, functional limitations may persist after surgery. The aim of the study was to evaluate the impact of TKA on the practice of sport and how this relates to factors such as demographic and clinical data. Material and methods. This is a cross-sectional cohort study of operated vs. unoperated patients. A standar­diz­ed instrument for data collection was employed. Information collected comprised personal, socio-demographic and clinical data. Patients were asked about their current practice of physical exercise. We also recorded group-specific data; for the operated group, we recorded data about the surgery and, for the unoperated group, we recorded data about the disease. Results. Patients who had undergone TKA practiced sport twice as much as those who had not been opera­ted on yet (33.8% versus 15.5%). The prevalence of the practice of sports was significantly higher in older patients with lower levels of pain, p < 0.001 and p < 0.001, respectively. Conclusions. 1.The findings of our study support the conclusion that patients are significantly more active after total knee arthroplasty. 2. Low and medium intensity sports modalities were more prevalent in operated patients. 3.We also identified that active patents tend to be older, with lower level of pain, have better functional class, and a higher level of education.

Mucopolysaccharidosis (MPS) is a rare and neglected disorder. Only a few studies to date have focused on humanistic impacts of the disease, particularly health-related quality of life (HRQOL). The objective of our research is to (1) evaluate HRQOL in Brazilian patients with MPS and (2) assess the validity of the PedsQL 4.0 Generic Core Scales (PedsQL) in this specific disease. We performed an analytical cross-sectional study using the Brazilian Portuguese version of the PedsQL in 22 patients with MPS between the ages of 8 and 21. With regard to assessing the validity of the PedsQL for MPS, we evaluated internal consistency using Cronbach’s α coefficient and reliability using the Spearman–Brown estimate of agreement. The mean HRQOL score in our sample was 63.6 points. The worst score was obtained in the Psychosocial domain (61.9) on account of interference with school (56.1), while the Physical Health domain had the highest score (67.6). The total PedsQL internal consistency was .764 points. The Physical Health domain obtained the highest internal consistency (.914), whereas the Psychosocial Health domain obtained the lowest one (.754). MPS was demonstrated to decrease HRQOL, and PedsQL seems to be a valid instrument to perform this kind of analysis.

Varus supracondylar osteotomy of the femur is the established procedure for treating painful knees that present lateral arthrosis and valgus deformity. In descriptions of the conventional surgical techniques, there are divergences regarding the location, access route, correction level, fixation type and area for synthesis insertion. This is most evident in cases of severe valgus with angles greater than 30° and distal femoral deformation, in association with hypoplasia of the lateral condyle. The authors describe a new surgical technique for distal femoral osteotomy, based on anatomical and geometrical criteria, which was developed in their clinic for treating severe valgus cases, and they present one of the cases treated. In the new technique, the wedge to be surgically resected has an oblique direction and the format of an isosceles triangle. This new proposal thus seeks to resolve problems that have been presented in such cases, through enabling valgus correction without causing any new deformity of the distal femur. Good cortical bone contact is promoted, and application of a stable synthesis system is made easier. However, the age limits for such patients and the degree of knee arthrosis that might contraindicate this procedure remain unknown. Hence, a larger sample and longer follow-up for operated cases are required.

Objective. To evaluate the influence of hip dysfunction on quality of life of pediatric patients with sickle cell disease (SCD). Methods. Clinical demographic, Charnley hip score, Barthel scale and Pediatric Quality of Life Inventory (PedsQL 4.0) questionnaires were used. Results. Seventeen patients were placed into the group “with hip dysfunction,” and 54 into the group “without hip dysfunction.” The group “with hip dysfunction” had a higher average age ( P = .026), weight ( P = .029), and height ( P = .019) than the group “without hip dysfunction.” There was also a higher prevalence of hip trauma ( P = .05) and pain ( P = .00). The study demonstrated that hip dysfunction negatively influenced quality of life in the physical activity ( P = .11) and psychosocial ( P = .003) domains. Conclusion. Hip dysfunction and previous hip trauma negatively influenced quality of life, especially in the physical activity and psychosocial domains.

BACKGROUND. The objective of this study is to evaluate the response of the musculoskeletal system to enzyme replacement therapy in a group of patients with Mucopolysaccharidosis (MPS). MATERIAL AND METHODS. A retrospective study was done based on records from 22 patients with different types of MPS (I, II and VI) who were treated with enzyme replacement therapy (ERT). Patient data were evaluated after an average of 21.4 months. Data collected were: Global Motor Function Classification System (GMFCS); measured range of motion (ROM) of the knee, elbow, and shoulder joints; and an evaluation of hand function as proposed by Haddad. A comparison was done between data from the "pre-treatment" and "posttreatment" groups to evaluate the significant clinical differences between the pre and post-treatment periods. RESULTS. In the total group, 13 (59.1%) maintained or improved their motor score and 8 (36.3%) ended up with a worse score. Only ROM of the shoulders saw a statistically significant improvement. The right shoulder increased from 59.7º to 78.4º (p = 0.017), and the left one from 65.2º to 80.2º (p=0,036). CONCLUSIONS. Based on the data, it is possible to conclude that ERT was able to stabilize or improve motor function in the majority of patients and also significantly increase the range of motion of shoulder joints in patients with MPS.

Over recent years, there has been a significant increase of integrated computing devices and systems within the healthcare sector, including computerized machines which can see deep within the human body to detect illnesses previously missed, help engage the patient, provide enhanced education, and access medical data not readily accessible before. However, as new technologies, medications, treatments, and procedures are being developed rapidly, clinicians are expected to incorporate this new information into their daily practices, apply this knowledge to their patients, track each patient’s individual health status and background, while communicating quickly with patients, hospitals, and other providers. Additionally, clinicians are expected to keep up with the latest published medical data in the hopes of increasing the accuracy of diagnoses and treatments to improve patient health outcomes. However, there is a “small” problem with this expectation, there is not enough hours in a day to accomplish all of these tasks. According to a report by the Memorial Sloan-Kettering Cancer Center, it would take at least 160 hours (or four 40-hour work weeks) of reading every single week just to keep up with new medical knowledge as it’s published, let alone applying the effort to consider its relevance or to implement it practically. This places false expectations on clinicians. While they may be an experienced doctor, they still require a process which delivers functional, meaningful, efficient, and user-friendly technology to their daily work environment. Therefore, it is important to develop a methodology to support and compliment the recent strategy of health care delivery and payments.

Objective The aim of this study is to verify the prevalence of avascular necrosis (AVN) in pediatric patients with sickle cell anemia and hip dysfunction, and to evaluate the presence of associated risk factors. Method A cross-sectional study was conducted in a group of 92 patients with sickle cell disease and hip dysfunction. Clinical and sociodemographic characteristics were collected, and laboratory variables were evaluated. All the subjects underwent radiographic and clinical evaluation of the hip. The participants were divided into two groups: the "AVN Group" consisting of patients with AVN, and the "Comparison Group" without AVN. Both groups were evaluated in search of factors associated with osteonecrosis of the femoral head. Results 43 (46.7 %) out of 92 individuals presented hip dysfunction, and 13 were diagnosed with AVN (30.2 %). Comparison between groups showed significant differences in time of diagnosis, previous trauma, presence of pain, and mean values of functional scores. Higher percentage rates of fetal hemoglobin, higher platelet counts and lower rates of total hemoglobin were perceived in the Comparison Group. Conclusions Pediatric patients with sickle cell anemia with hip dysfunction present a prevalence of 39.4 % of osteonecrosis of the femoral head. This was associated with a longer time of diagnosis (97 months), previous trauma in 92 % of patients, and a mean Charnley score of 15 points. Also, an association with lower rate of fetal hemoglobin (7.2 versus 11.8) was found, which supports the hypothesis that fetal hemoglobin may function as a protective factor against avascular necrosis.

OBJECTIVE : To assess the quality of life of knee osteoarthritis patients using the SF-36 questionnaire METHODS : Cross-sec-tional study with 93 knee osteoarthritis patients. The sample was categorized according to Ahlbӓck score. All individuals were interviewed with the SF-36 questionnaire RESULTS : The main finding of the study is related to the association of edu-cation level with the functional capacity, functional limitation and pain. Patients with higher education level had better functional capacity when they were compared to patients with basic level of education CONCLUSION : Individuals with osteoarthritis have a low perception of their quality of life in functional capacity, functional limitation and pain. There is a strong association between low level of education and low perception of quality of life. Level of Evidence IV, Clinical Case Series.

Obstructive Sleep Apnea Syndrome (OSAS) is defined as recurrent episodes of complete or partial obstruction of the upper airway during sleep. The airflow can be reduced or completely stopped despite of inspiratory effort, resulting in intermittent episodes of hypoxemia and hypercapnia. OSAS may be a factor in the worsening of nocturnal hypoxemia, of the underlying disease, leading to acute chest syndrome. The aim of this work was to review data on the pathophysiology of OSAS in children and adolescents with sickle cell anemia. We revisited articles published over the last ten years linked to the Medline and Lilacs databases, as well as cross-referencing using these articles. The following keywords were used: sleep apnea, obstructive sleep apnea, sickle cell anemia, sickle cell disease. Studies suggest that OSAS may increase clinical complications, such as painful crises, delayed growth, cognitive and intelligence disorders, nocturnal arterial desaturation and strokes in children with sickle cell anemia. Studies suggest that OSAS may increase the clinical complications of children with sickle cell anemia. Rev. Bras. Hematol. Hemoter.

Sixty-one-year-old male patient with diagnosis of myelodysplastic syndrome and unstable angina was submitted to coronary angiography and implant of stent. His Blood vell count revealed 40,000 platelets/mm³. Coronary angiography with previous platelet transfusion showed obstruction of 80% of the right coronary artery (RCA). Following the administration of clopidogrel, the patient was submitted to another platelet transfusion and stent implantation in the RCA lesion. No bleeding was observed after the introducers removal. After 6 months, treadmill test was positive and new coronary aniography, in the same conditions, showed in-stent restenosis. This case report suggests that coronary stent implantation in patients with thrombocytopenia is a safe procedure, provided that prophylactic platelet transfusion is performed, although late restenosis may occur.

In order to evaluate the seroepidemiology and response to Butang vaccine in adolescents from low income families in Central Brazil, blood samples of 664 adolescents were tested for hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), and hepatitis B surface antibody (anti-HBs) markers, and multiple logistical regression analysis was carried out to determine variables associated with hepatitis B virus (HBV) infection markers. further, three 20 microg Butang vaccine doses were offered to all susceptible individuals (n = 304). Among those who accepted them (n = 182), the seroresponse was evaluated in 170 individuals by quantitative anti-HBs. an overall hbv prevalence of 5.9% was found: four adolescents were HBsAg positive, 24 were anti-HBc, anti-HBs-reactive, and 11 were anti-HBc only. The analyse of risk factors showed that age 16-19 years, place of birth outside Goias, school B and body piercing were statistically associated with HBV infection markers (p < 0.05). All 170 adolescents responded to Butang, and a geometric mean titer (gmt) of 4344 mUI/ml was obtained. these results reinforce the importance of hepatitis b vaccine in adolescents despite of the hbv regional endemicity, and suggest that three doses of 20 microg of the Butang should guarantee protective anti-hbs levels to individuals at a critical time for hepatitis b acquiring such as latter adolescence and adulthood.

The purpose of this survey was to describe the occurrence of bovine mastitis caused by Prototheca zopfii in Goiás State, Brazil. Samples of milk, environment and udder were taken from a herd of 120 Holstein cows. Sabourauds dextrose agar plates were incubated under aerobic conditions at 37 degrees C/96 h, for microbiological analysis. Somatic cell count and milk composition were also determined. Histological sections from two udders were stained with HE and PAS. Prototheca zopfii was identified in six cows whose milk had a watery appearance. They also showed a pronounced decrease in milk yield, fat and lactose. Pronounced infiltration of mononuclear cells, atrophy of alveoli and fibrosis were observed. The presence of this agent in other herds in the State is highly likely.

Histoplasmosis is a worldwide systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. The fungus lives in soil that contains large amounts of birds or bats droppings. This infection occurs through inhalation of spores of H. capsulatum and has a wide clinical spectrum, ranging from mild to disseminated forms that depend on the infecting inoculum, the immune status of the host and the virulence of the strain. The diagnosis of histoplasmosis is based on clinical, epidemiological, radiological and laboratory aspects; however, some symptoms may be confused with other diseases, such as tuberculosis and other mycoses. The reference test for the confirmation of the diagnosis of histoplasmosis is the isolation and identification of H. capsulatum in culture. However, in the absence of it, serology has been used for the presumptive diagnosis of histoplasmosis through antibody detection. The principal antigenic complex used to detect antibodies anti-H. capsulatum is the histoplasmin, consisting mainly of antigens C, H and M. These antigens, in their native forms, are glycoproteins containing specie-specific protein epitopes and non-specific glycosides. Chemical deglycosylations by sodium metaperiodate (NaIO4) have shown to increase the sensitivity and specificity of immunoenzymatic methods, such as Western blot and ELISA, reducing cross-reactivity with other fungi. The aim of this study was to validate the immunoassay method (Western blot) to detect antibodies in the diagnosis of histoplasmosis Therefore, a case-control study was conducted using 118 serum samples from patients with histoplasmosis, and 118 serum samples from individuals with clinical and epidemiological history compatible with systemic mycosis, either healthy or suffering from other mycosis or tuberculosis. These patients were residents in the state of Rio de Janeiro and the samples, collected from 2000 to 2013, were sent to the Mycology Laboratory of the Instituto Nacional de Infectologia Evandro Chagas. Diagnostic validation parameters were calculated based on the categorization of results obtained in a 2 x 2 table and analyzed using SPSS Statistics 17.0. The Western blot was shown sensitivity of 94.9%, specificity of 94.1%, accuracy of 94.5% and also almost perfect precision. Besides, the strips have been proved to be viable for use or at least five years after the sensitization with antigen HMIN-PT. These results prove the validity of the enzyme immunoassay (Western blot) for the detection of antibodies anti-H. capsulatum, using HMIN-PT as a good accuracy tool in the diagnosis of histoplasmosis and reproducible, contributing to improve the diagnosis of this mycosis, since this technique allows obtaining results in less than 24 hours which implies a breakthrough despite existing at present and will eventually be deployed and made available to other centers belonging to the Public Health System

Osteoporosis has been reported among Human T-cell Lymphotropic Virus type 1 (HTLV-1) infected aged patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) diagnosis. However, the association between osteoporosis and HTLV-1 infection remains unclear. This study aimed to evaluate the presence of bone disorders in young HTLV-1 asymptomatic individuals. A cross sectional study was carried out at the HTLV Reference Center in Salvador, Brazil. Forty-seven HTLV-1 infected asymptomatic and 108 healthy subjects aged between 20 to 45 years were included. Biochemical markers of bone metabolism were measured and bone mineral density (BMD) was determined at the femoral neck and at the lumbar spine (L1 -L4). Significant low BMD (Z-score

The objective of our study was to compare both Kite's and Ponseti's methods to evidence which one is the most efficient technique in the treatment of congenital idiopathic clubfoot, based on a meta-analysis of current scientific literature. We performed a search of the past 20 years of literature (1986 to 2006) on MEDLINE, LILACS, and EMBASE databases for clinical trials that compared both Kite's and Ponseti's methods. The search in the literature provided 4 selected papers for the meta-analysis. There was a significant difference between the groups, in which the Ponseti's group was more effective in treating congenital clubfoot, considering both primary correction (P = .001) and uncorrected plus relapsed feet (P = .014). In conclusion, our meta-analysis indicates that Ponseti's group in the clubfoot treatment was superior to Kite's group; however, the available studies have some methodological limitations such as small sample sizes and historical control.

p. 116-119 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2014-05-12T14:39:31Z No. of bitstreams: 1 1413-78522013000200009.pdf: 217489 bytes, checksum: e82a578896e2e8052709cac2c41842ef (MD5) Approved for entry into archive by Flávia Ferreira (flaviaccf@yahoo.com.br) on 2014-05-15T14:56:20Z (GMT) No. of bitstreams: 1 1413-78522013000200009.pdf: 217489 bytes, checksum: e82a578896e2e8052709cac2c41842ef (MD5) Made available in DSpace on 2014-05-15T14:56:21Z (GMT). No. of bitstreams: 1 1413-78522013000200009.pdf: 217489 bytes, checksum: e82a578896e2e8052709cac2c41842ef (MD5) Previous issue date: 2013 Objetivo: Avaliar o gasto energético na marcha em pacientes com mucopolissacaridose, utilizando uma metodologia simples e aplicável ao ambiente clínico. MÉTODOS: Realizou-se estudo transversal comparando-se o gasto energético da marcha de 19 pacientes portadores de mucopolissacaridose (Grupo MPS) com 19 indivíduos assintomáticos da comunidade (Grupo Comparação). O gasto energético foi mensurado em Cal por um relógio da marca Polar (modelo FT7) durante uma caminhada de 50 metros. Foram também avaliados idade, peso, altura, IMC, frequência cardíaca inicial, frequência cardíaca final, e tempo de marcha. RESULTADOS: O Grupo MPS teve gasto energético na marcha de 2,84 Cal(±1,01), versus 1,42 Cal(±0,51), sendo 100% maior que o Grupo Comparação; também em relação ao Grupo Comparação, o Grupo MPS teve frequência cardíaca inicial 22% maior, frequência cardíaca final 13% e tempo da caminhada 25% maiores. CONCLUSÕES: O gasto energético na marcha de pacientes com mucopolissacaridose é duas vezes mais alto em comparação com indivíduos assintomáticos e a metodologia usada para avaliação mostrou-se alternativa eficiente para o ambiente clínico convencional. Nível de Evidencia III, Estudo Transversal Comparativo.

Background Avascular necrosis of the femoral head (ANFH) has been described as a frequent outcome in patients with sickle cell disease (SCD). The objective of the current report is to present the prevalence of ANFH in patients under the age of 21 suffering from SCD as well as discuss some possible associated risk factors. Material and method A cross-sectional study was carried out in a group of 100 patients. Clinical, demographic variables and risk factors were investigated. Seventy-two patients had their data completely analyzed. Eight patients were found to be affected and comprise the study group while the other 64 patients comprised the comparison group. Results The prevalence of ANFH was 8 out of 72 (11.1%). Age (p=0.042), weight (p=0.04) and hemoglobin levels (0.048) were associated with ANFH. Correlations with time from diagnosis (p=0.14), ulcers (p=0.013), ferritin levels (p=0.07) and a family history of thrombosis were near-significant. Conclusions The attention of physicians treating SCD patients must also be drawn to the possibility of ANFH in order to prevent or avoid this disastrous complication, especially in younger patients presenting with frequent hemolytic crises.

Background HTLV-1 infection alters the immune function and increases the risk of several infectious diseases. In this meta-analysis, we assess the association between HTLV- 1/2 and active tuberculosis (TB). Methods Four databases were searched for relevant articles that describe the frequency of HTLV- 1/2 infection among TB patients and control groups of healthy individuals or patients without a history of TB. Data were analyzed using the EasyMA software. Results The search yielded two hundred and eight articles. Six met the inclusion criteria and were included in the meta-analysis. The estimated relative risk of HTLV- 1/2 infection in TB patients was 3.25 times higher than in the population based control groups. Conclusion Patients with active TB have a higher risk of HTLV- 1/2 infection. Prospective studies involving latent tuberculosis infection (LTBI) in HTLV-1-infected individuals are necessary to evaluate the potential benefit of TB chemoprophylaxis.

p. 1075-1083 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-09-24T16:24:26Z No. of bitstreams: 1 1806-37132009001100004.pdf: 296221 bytes, checksum: 594e2568fc6615333e59d31bd52ca0f3 (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2013-11-20T19:49:11Z (GMT) No. of bitstreams: 1 1806-37132009001100004.pdf: 296221 bytes, checksum: 594e2568fc6615333e59d31bd52ca0f3 (MD5) Made available in DSpace on 2013-11-20T19:49:11Z (GMT). No. of bitstreams: 1 1806-37132009001100004.pdf: 296221 bytes, checksum: 594e2568fc6615333e59d31bd52ca0f3 (MD5) Previous issue date: 2009 OBJETIVO: Estimar a prevalência da síndrome da apneia obstrutiva do sono (SAOS) em crianças e adolescentes com anemia falciforme (AF) e investigar a possível correlação entre hemoglobina anual média e tempo total de sono com SpO2 < 90% e tempo total de sono com SpO2 < 80%, assim como investigar a possível correlação entre o índice de apneia-hipopneia (IAH) e episódios de crise álgica. MÉTODOS: Participaram 85 pacientes com AF, que responderam a um questionário, foram avaliados por um pediatra e um otorrinolaringologista, e submetidos a estudo polissonográfico. O diagnóstico de SAOS foi definido como IAH > 1. RESULTADOS: A prevalência da SAOS foi 10,6%. Observou-se uma correlação negativa entre hemoglobina anual média e tempo total de sono com SpO2 < 90% (r = -0,343; p = 0,002) e tempo total de sono com SpO2 < 80% (r = -0,270; p = 0,016). Não foi observada associação entre IAH e episódios de crise álgica. CONCLUSÕES: A prevalência da SAOS nesta população foi alta (10,6%). Portanto, é importante identificar precocemente os sinais de SAOS e avaliar hemoglobina anual média, devido à correlação inversa entre essa e o tempo total de sono com SpO2 < 90% ou < 80%.

Objectives To determine the prevalence of obstructive adenotonsillar hypertrophy in children and adolescents with sickle cell anemia; to investigate possible association between the presence of more than five episodes of tonsillitis in the last 12 months and episodes of painful crises in the same period; and to compare the mean annual hemoglobin level in children and adolescents with and without obstructive adenotonsillar hypertrophy. Methods Prospective, observational, cross-sectional study involving 85 children and adolescents with sickle cell anemia. All patients answered a questionnaire and underwent a standard otolaryngology examination, including endoscopic endonasal approach. The diagnosis of obstructive adenotonsillar hypertrophy was made according to the Brodsky scale. Results The prevalence of obstructive adenotonsillar hypertrophy was 55.3%. Obstructive adenotonsillar hypertrophy was associated with history of difficulty in eating (76.7 vs. 23.5%, p = 0.003), presence of more than five episodes of tonsillitis in the last 12 months (70.6 vs. 29.4%, p = 0.021), loud snoring (73.0 vs. 27.0%, p = 0.004), and sleep apnea (71.8 vs. 28.2%, p = 0.005). Patients with obstructive adenotonsillar hypertrophy had more episodes of recurrent upper airway tract infection (62.5 vs. 37.5; p = 0.010). The presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises (median = 12 vs. 2, p = 0.017). There was no significant difference between mean annual hemoglobin levels of patients with obstructive adenotonsilar hypertrophy vs. nonobstructive adenotonsillar hypertrophy: 7.6 vs. 8.2 g/dL, p = 0.199. Conclusions The prevalence of obstructive adenotonsillar hypertrophy was 55.3% in children and adolescents with sickle cell anemia; the presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises in the same period; and there was no difference in the mean annual hemoglobin value among those with or without obstructive adenotonsillar hypertrophy.

Background: Through an experimental biomechanical study on rabbits, tendon reinsertion by means of trans-osseous suture on a spongy bone bed and suture anchor were evaluated comparatively at different phases of healing. Methods: Twenty-four New ZealandWhite rabbits wereused: 2 aspilots,4 as the controlgroup, and 18 asthe experimental group. These 18 animals underwent sectioning and reinsertion of the Achilles tendon bilaterally, using the technique of trans-osseous suture on 1 side and suture anchor on the other. All the pelvic limbs that underwenttheprocedurewerethenimmobilizedfor3weeks.Theexperimentalgroupwasdividedinto3groups that were sacrificed, respectively, 3, 6, and 12 weeks later. The tendon-bone complex was subjected to biomechanical tests to evaluate the parameters of maximum strength, stiffness, and yield strength. Results: There was no statistically significant difference between the suture anchor group and the transosseous suture group, in relation to yield strength (3 weeks, P ¼ .222; 6 weeks, P ¼ .465; and 12 weeks, P ¼ .200) or maximum strength (3 weeks, P ¼ .222; 6 weeks, P ¼ .076; and 12 weeks, P ¼ .078). In relation to stiffness, the suture anchor group showed a statistically significant difference only at 3 weeks of healing (P ¼ .032) over the trans-osseous suture group. Conclusion: The technique of suturing with an anchor was shown to be similar to the technique of trans-osseous suture for the studied parameters. Level of evidence: Basic Science Study, In-Vitro Biomechanics Study. 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.

Chronic pain is a public health problem with high impact on various population segments. There are few population studies with the aim of delineating the profile of the chronic pain patient, and generating data for actions to prevent, control and minimize the problem. The aim of this study was to estimate the prevalence of chronic pain in the population of Salvador, Bahia, Brazil and identify independent predictors associated with this morbidity. A cross-sectional study was conducted in a sample population of 2297 individuals of20 years of age, in Salvador, Brazil. A standardized questionnaire was applied at home to collect data about socio-demographic characteristics, lifestyle, chronic pain and abdominal circumference measurement. The chronic pain was defined as pain with a duration of longer than 6 months. Prevalence of pain and the OR (univariate analysis) were estimated and adjusted (logistic regression), and their ICs at 95% and p0.05 in the two analyses. The presence of chronic pain was found in 41.4% of the total study population, women being more affected (48.4% against 32.8% in men), with OR of 1.92 IC 95% 1.6-2,28 p0.001. Among the studied factors, in the gross analysis, the following were shown to be associated with chronic pain: conjugal situation, smoking, excessive alcohol consumption, presence of central obesity and age, all with p0.05. In the multivariate analysis, female sex, smoking, excessive alcohol consumption, and age were sustained as independent predictors. The presence of chronic pain was predominant in women, the elderly, smokers or ex-smokers and excessive alcohol consumers.

Acute poisoning is a frequent accident in childhood, particularly in children under 4 years of age. This was a descriptive study with data collected from standardized forms of the Poison Control Center and patient record charts. All the cases of acute poisoning in children aged 0 to 14 years during the period 2008 to 2012 were selected. The variables studied comprised characteristics of the events and toxic agents, clinical development, and outcome. A total of 657 cases of acute poisoning, with higher frequency in the age-group from 1 to 4 years (48.7%) and male sex (53.4%), were recorded. The occurrences were accidental in 92% of the cases, and 5.8% were due to suicide attempts. Among the toxic agents, medications (28.5%), venomous animals (19.3%), nonvenomous animals (10%), household cleaning products (9.0%), and raticide agents (8.7%) predominated. The majority of cases were characterized as light (73.5%) and around 18% required hospitalization, and there was low lethality (0.5%).

To the Editor; Orthosis expenditure and compliance are both extremely important issues that can affect clubfoot treatment. Poor results and relapses could be associated with noncompliance due to economic, clinical and psychosocial reasons. Therefore, the study presented by Mang’oli et al (1) is not only scientifically relevant but also very important to developing countries or even to local areas within industrialized countries that are affected by poverty. The mean age at enrollment of the patients was 24 months, and the mean duration of Steenbeek foot abduction brace (SFAB) wear was 18 months (range six to 28 months). Therefore, all of the patients used the SFAB for a period of at least six months and most for >18 months. The results of the study showed that the noncompliance rate was lower (15%) in the SFAB group compared with the traditional brace group (41%). Our group has recently published a meta-analysis demonstrating that noncompliance was the main cause of relapse in the treatment of clubfoot (2). For example, the noncompliance rate in a study by Lehman et al (3) was 28.9% within a period of approximately six months after the initial correction. Although noncompliant patients had good results in 45.5% of cases, it is clear that compliance may be a problem within the first six months after casting correction. I would like to know the opinion of the authors about the effect of time in their study and what explanation they would give for the fact that, after six months, the compliance rate was higher than expected in the traditional group. If possible, I would like to know how the authors evaluated the interference of psychosocial factors in compliance.

A instabilidade atlantoaxial (IAA) é caracterizada pelo aumento da mobilidade da articulação C1-C2 devido a frouxidão ligamentar alar, sendo freqüente em portadores da Síndrome de Down. O objetivo deste trabalho é estudar a freqüência de IAA e sua associação com hiperfrouxidão ligamentar generalizada em pacientes com Síndrome de Down. Selecionou-se 80 crianças, 34 (42,5%) masculinos e 46 (57,5%) femininos, com idades entre 5,6 e 15 anos (média de 9). Os pacientes foram avaliados por questionário e radiografia em perfil da coluna cervical em flexão. Encontrou-se sintomatologia clínica em 58%, comumente relatada como fraqueza em membros inferiores. A distância atlanto-odontoidal foi de até 4,5 mm em 77,5% , de 4,5 a 6 mm em 15% e, maior que 6 mm em 7,5% dos pacientes avaliados. Os pacientes portadores de hiperfrouxidão ligamentar generalizada (grupo 1) não apresentaram maior freqüência de IAA em relação aos não portadores de hiperfrouxidão (grupo 2). Os autores concluíram que a IAA apresenta alta freqüência na síndrome de Down, não havendo associação direta com hiperfrouxidão ligamentar generalizada.

From 1995 to 1998, twenty seven pediatric patients were included in a prospective clinical study. Their age ranging from 8.9 to 17.5 years old (mean 13.5), 20 (74%) were male and 7(26%) female, with a follow-up going from 3 to 39 months (average of 17). Osteogenic sarcoma arises in Knee (55.5%), ankle (26%), shoulder (11.1%), pelvis (3.7%) and hip (3.7%). Tumors less than 12cm were considered being small ones, while those bigger than 12cm were considered large. .All patients were submitted to clinical, radiological, histological evaluation and graded by Enneking(5) system (13 were IIB and 8 were IIIB); treated by chemotherapeutic agents, according to "Brazillian Protocol 91" and had a local surgical control. There were carried out 9 (42.9%) radical surgical interventions and 12 (57.1%) surgeries of limb preservation. According to lesion size, eight (38.1%) out of 14 (67.9%) patients with a tumor greater than 12cm died; in contrast, none out of 7 with tumor less than 12cm relapsed or died. Authors have concluded that tumor size can be a good factor for prognosis indication, being low cost, simple, easy to reproduce and specially useful for taking pre-treatmente decisions. Entre 1995 a 1998, vinte e sete pacientes foram incluídos neste estudo clínico prospectivo. A idade variou entre 8,9 e 17,5 anos (média de 13,5), 20 (74%) eram do sexo masculino e 7 (26%) do sexo feminino com seguimento entre 3 e 39 meses (média de 17). O osteossarcoma incidiu no joelho (55,5%), tornozelo (26%), ombro (11,1%0), pelve (3,7%) e quadril (3,7%). Tumores menores que 12cm eram considerados pequenos e maiores que 12cm eram considerados grandes. Os pacientes foram submetidos a avaliação clínica, radiológica e histológica e classificados pelo sistema de Enneking(5) (13 eram IIB e 8 eram IIIB); foram tratados com agentes quimioterápicos de acordo com o protocolo brasileiro 91 e pelo controle cirúrgico local. Foram realizadas 9 (42,9%) cirurgias radicais e 12 (57,1%) cirurgias de preservação do membro. De acordo com o tamanho tumoral, 8 (38,1%) dos 14 (67,9%) pacientes com tumores maiores que 12cm faleceram; ao contrário, nenhum dos 7 pacientes com tumores menores que 12cm apresentaram recidiva ou faleceram. Os autores concluem que a medida do tamanho tumoral pode vir a ser um bom fator prognóstico, sendo também de baixo custo, simples, de fácil reprodutibilidade e especialmente útil para tomada de decisões pré-tratamento.

Paragangliomas are rare neuroendocrine tumors that originate in specialized cells derived from neural crest cells, affecting the region of the carotid or jugular-tympanic artery. They are rare within the spinal canal and, when they occur, they are normally found in the extramedullary intradural compartment of the lumbosacral region. This report presents the case of a 26-year-old male patient who was diagnosed with pathological fracture of the thoracic spine (T10), secondary to paraganglioma, thus causing complete spinal cord injury. Surgical treatment was performed at the General Hospital of the State of Bahia and the complication of excessive bleeding occurred, which indicated that there had been a need for prior embolization. Because of this, the authors recommend caution when evaluating and treating this rare lesion that causes neurological deficits, with careful surgical planning in order to catastrophic complications.