Search

On April 7, 2020, at 10h00 a living nest of White-eyed Buzzard was found in Sardarshar, Churu, Rajasthan. On April 27, 2020, at 14:00 successful hatching of all four nestlings was reported. After 20 days we examined the nest again and found only 3 nestlings in the nest.

From year 2011 to 2017 more than 1203 birds died at Jorbeer Carcass dump, Bikaner. In 2012, necroscopy examination revealed the presence of extensive visceral gout in the carcasses of Steppe Eagles. The synovial membrane of the knee joints also showed uric acid crystals, which were formed into numerous large discs with needle-thin peripheral radiations, and occasional inflammatory mononuclear cell foci (Sharma et al., 2012). Now, with unequivocal evidence that this veterinary drug can cause a much wider impact on Eurasia’s biodiversity, it is time for action – it is necessary to remove the diclofenac from market including multidose vials and find other cause of mortality.

Biological activity of water can be apparently judged by the colonization of bacteria (microbes). In order to find out the extent of pollution and the relationship between inorganic matters and microbiota, a quantitative and qualitative analysis of bacteria in various types of sewage waters, namely sewage water by the residential colonies (group I), industrial waste water (group II), sewage treatment hub (group III), unorganized collected waste water (group IV) and old residential waste collection center (group V), of Bikaner city (Rajasthan, India) was carried out from February, 2010 to May, 2010. Water samples were taken from surface only owing to low depth and investigated for various abiotic factors (viz. transparency, pH, carbonate, bicarbonate, total alkalinity, total hardness, salinity, chloride, calcium, magnesium, sulphate, nitrate, silica, and inorganic phosphorous) and biotic factors (viz. number and diversity of bacteria). The domestic sewage water causes major water borne diseases basing upon Total Bacterial Count (TBC) and coliform Count (CC). The coliform count in the present study ranged from 2.5 to 5.12 MPN/mL. Comparision of microbial population in sewage water from all different Groups was done and the higher values of TBC and CC were recorded only in Sewage treatement hub (Group III).

Objective  To validate the low-cost model for arthroscopy training and analyze the acceptance and usefulness of the developed simulator in medical teaching and training. Method  Ten medical students, ten third-year orthopedic residents, and ten shoulder surgeons performed predetermined tasks on a shoulder simulator twice. The parameters used were time to complete the tasks, number of looks at the hands, GOALS score (Global Operative Assessment of Laparoscopic Skills) and comparison between groups and within groups. An adapted Likert scale was applied addressing the individuals' impressions about the simulator and its applicability. Results  In the intergroup comparison, the shoulder surgeons had better scores and times than the other groups. When the tasks were repeated, the group of surgeons had a 59% improvement in time (p < 0.05), as did the group of medical students. In the GOALS score, shoulder surgeons had consistently better scores than the other groups. And when we evaluated the evolution from the first to the second test, the group of surgeons and the group of academics had a statistically significant improvement (p < 0.05). In terms of lookdowns, there was a decrease in all groups. There was consensus that the simulator is useful in training. Conclusion  The simulator developed allowed the differentiation between individuals with different levels of training in arthroscopic surgery. It was accepted by 100% of the participants as a useful tool in arthroscopic shoulder surgical training., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective  This study aimed to perform an imaging evaluation to prove the existence or not of symmetry between the clavicles of healthy subjects from Curitiba, Paraná, Brazil, and identify potential factors influencing the clavicular length. Method  The study analyzed chest computed tomography (CT) scans of 211 patients with no clavicular fracture or malformations (100 women and 111 men). We measured the greatest clavicular diagonal on both sides, and the software automatically generated the maximum distance in millimeters. Relative and absolute frequencies described qualitative variables and mean values; quantitative variables used a 95% confidence interval. Value comparisons employed the student's t-test, and correlations determinations used Pearson's correlation coefficient. The significance level adopted was 5%. Results  There was a significant difference between the clavicular length (right clavicle, 143.58 mm; left clavicle, 145.72 mm; p = 0.037), indicating asymmetry. On average, the left clavicle was 3.71 mm larger. Asymmetry was significant for both men and women (p < 0.001). The average difference was 4.13 mm for men and 3.23 mm for women. Seventy-three percent of the sample had < 5 mm of asymmetry, 23.7% had 5 to 10 mm, and 3.3% had > 10 mm of asymmetry. Conclusion  The studied population did not present clavicular symmetry. On average, the left clavicle was longer than the right clavicle, with differences of 3.71 mm in the general sample, 3.23 mm in women, and 4.13 mm in men. The only significant factor was gender since men presented longer clavicles and higher differences than women., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Owing to condensed development processes, expanding evidence and differences in healthcare system characteristics, many COVID-19 guidelines differ in their quality and treatment recommendations, which has consequences for clinical practice. This review aimed to identify COVID-19 treatment guidelines, assess their quality and summarise their recommendations. Guidelines were identified for five therapies most commonly used among inpatients with COVID-19 (remdesivir, dexamethasone, tocilizumab, baricitinib and casirivimab/imdevimab) from 11 countries. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Full details of recommendations and supporting evidence were analysed for high-quality guidelines, defined as those scoring ≥50% in Domain 3 (Rigour of Development) of AGREE-II. Overall, guidelines differed substantially in their quality and, even among high-quality guidelines using the same evidence, recommendations regarding specific therapeutics varied. Potential reasons for this heterogeneity, including the availability and consistency of clinical data, visibility of trial end-points and context-specific factors, are discussed., Competing Interests: Conflict of interet: D.A. Wohl reports research funding from Gilead Sciences, Merck & Co. and Eli Lily to his university; and honoraria for consulting, advisory boards and educational events from Gilead Sciences. A.A. Espineuva, L. Dau, C-Y. Wang, A. Lachmann and R.A. Bam are employees of Gilead Sciences Inc., Foster City, CA, USA. A. Rawal is an employee of Costello Medical Inc., Boston, MA, USA. K. Chappell-Smith is an employee of Costello Medical Consulting Ltd., Cambridge, UK. J.K. Rockstroh reports consulting fees from Gilead Sciences, Janssen Merck, and ViiV Healthcare Limited; payment for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Gilead Sciences, Janssen, Merck, Theratechnologies and ViiV Healthcare Limited; and participation on a data safety monitoring or advisory board for Abivax, Galapagos, Gilead Sciences, Merck and ViiV Healthcare Limited., (Copyright ©The authors 2022.)

Growing evidence suggests that ABO blood group may play a role in the immunopathogenesis of SARS-CoV-2 infection, with group O individuals less likely to test positive and group A conferring a higher susceptibility to infection and propensity to severe disease. The level of evidence supporting an association between ABO type and SARS-CoV-2/COVID-19 ranges from small observational studies, to genome-wide-association-analyses and country-level meta-regression analyses. ABO blood group antigens are oligosaccharides expressed on red cells and other tissues (notably endothelium). There are several hypotheses to explain the differences in SARS-CoV-2 infection by ABO type. For example, anti-A and/or anti-B antibodies (e.g. present in group O individuals) could bind to corresponding antigens on the viral envelope and contribute to viral neutralization, thereby preventing target cell infection. The SARS-CoV-2 virus and SARS-CoV spike (S) proteins may be bound by anti-A isoagglutinins (e.g. present in group O and group B individuals), which may block interactions between virus and angiotensin-converting-enzyme-2-receptor, thereby preventing entry into lung epithelial cells. ABO type-associated variations in angiotensin-converting enzyme-1 activity and levels of von Willebrand factor (VWF) and factor VIII could also influence adverse outcomes, notably in group A individuals who express high VWF levels. In conclusion, group O may be associated with a lower risk of SARS-CoV-2 infection and group A may be associated with a higher risk of SARS-CoV-2 infection along with severe disease. However, prospective and mechanistic studies are needed to verify several of the proposed associations. Based on the strength of available studies, there are insufficient data for guiding policy in this regard., (© 2021 International Society of Blood Transfusion.)

Objective: to validate a lumbar spine endoscopic flavectomy simulator using the construct method and to assess the acceptability of the simulator in medical education., Methods: thirty medical students and ten video-assisted surgery experienced orthopedists performed an endoscopic flavectomy procedure in the simulator. Time, look-downs, lost instruments, respect for the stipulated edge of the ligamentum flavum, regularity of the incision, GOALS checklist (Global Operative Assessment of Laparoscopic Skills), and responses to the Likert Scale adapted for this study were analyzed., Results: all variables differed between groups. Procedure time was shorter in the physician group (p < 0.001). Look-downs and instrument losses were seven times greater among students than physicians. Half of the students respected the designated incision limits, compared to 80% of the physicians. In the student group, about 30% of the incisions were regular, compared to 100% in the physician group (p < 0.001). The physicians performed better in all GOALS checklist domains. All the physicians and more than 96% of the students considered the activity enjoyable, and approximately 90% believed that the model was realistic and could contribute to medical education., Conclusions: the simulator could differentiate the groups' experience level, indicating construct validity, and both groups reported high acceptability.

The present study created a cheap (below US$ 100) shoulder arthroscopy training model, affordable for the practical education of medical students and residents. The model was created using a polyvinyl chloride (PVC) knee joint pipe (150 mm in diameter and 90 degrees in inclination) and a synthetic shoulder model. The parts were arranged to simulate a lateral recumbency with the upper limb in traction, which is the frequent positioning during arthroscopies. Colored dots on the glenoid and a partial rotator cuff model on the upper portion of the scapula were placed to assist training. This inexpensive, easy-to-make model for shoulder arthroscopy can aid surgical training., Competing Interests: Conflito de Interesses Os autores declaram não haver conflito de interesses., (Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: To validate an affordable and easily reproducible arthroscopic knee surgery simulator made from simple, low-cost materials by demonstrating its ability to distinguish experienced from novice arthroscopists (i.e., construct validity). Additionally, acceptance and usefulness of the simulator in medical training and education were assessed., Design: The simulator was used to perform a partial meniscectomy in both menisci. External and intra-articular images obtained during the procedures were used to assess objective visual parameters. The Arthroscopic Surgical Skill Evaluation Tool and a Likert scale addressing individual perceptions about the simulator and its applicability in medical education were also used., Setting: The study was conducted at Hospital de Clínicas da Universidade Federal do Paraná, a teaching hospital in southern Brazil., Participants: Thirty sixth-year medical students were recruited, as well as 10 orthopedic surgeons who had knee arthroscopy expertise and were members of a sports traumatology and knee arthroscopy group., Results: There were statistically significant differences between the groups in all objective parameters. The mean time to perform the procedure was 60% higher among students compared to surgeons. Students needed 72.5% more time on average to perform triangulations and obtained an error rate approximately twice higher in the assessment of the area removed from the menisci. Regarding Arthroscopic Surgical Skill Evaluation Tool scores, statistically significant differences were found between surgeons and students in all 8 domains and in the total score. The simulator was well accepted, as over 90% of participants found it useful for education and training, believed it contributed to teaching and assessing specific surgical steps and procedures, and reported that the task was enjoyable., Conclusions: The arthroscopic knee surgery simulator was largely accepted and had good applicability in objective measurement of surgical skills, distinguishing medical students from orthopedic surgeons and thus demonstrating construct validity., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Case: A 69-year-old man fell from a height, resulting in direct axial loading while both shoulders were fully abducted. He was referred to the surgical ward, and both shoulders were reduced by closed reduction using the traction-countertraction maneuver. After little improvement of complaints of pain in the right shoulder over 45 days, magnetic resonance demonstrated traumatic rupture of the supraspinatus., Conclusion: Inferior dislocation (luxation erecta) is an uncommon event, with bilateral dislocation being even rarer. Treatment should be initiated urgently via closed reduction or, if this is not possible, through open reduction. The long-term prognosis is favorable after appropriate treatment.

Objective: The use of images in 3D reconstruction is an instrument that facilitates the interpretation of the fracture, observations of deviations, rotations and articular surface., Objective: To evaluate the inter-observer and intra-observer reliability of the Neer x AO proximal humerus fracture classification on radiographs versus computed tomography with three-dimensional reconstruction (3D)., Methods: We evaluated the digital radiographs (anteroposterior and profile) and computerized tomography with 3D reconstruction of patients presenting with a proximal humerus fracture, surgically treated at an Orthopedics and Traumatology Service. All radiographs and computed tomography were classified (Neer and AO) by eight (8) orthopedic surgeons, specialists in the upper limb and sent, following the pre-established numeration by the author, in a spreadsheet to the author of the study., Results: The Neer and AO scores were more reproducible when determined by computed tomography with 3D reconstruction, mainly in fractures of greater complexity (Neer 4 parts and AO group C). However, in absolute values, inter and intra-observer reproducibility and concordance still remain low., Conclusion: Computed tomography with 3D reconstruction allows a better analysis of fractures of group C and Neer 4 parts. However, the inter and intra-observer agreement does not increase significantly in comparison to the radiographs. Level of evidence III, Study of non-consecutive patients, without gold standard, applied uniformly. , Competing Interests: All authors declare no potential conflict of interest related to this article.

Objective: The objective of this study is to analyze the surgical results of humeral shaft fracture treatment and describe its epidemiology., Methods: Retrospective study that identified all patients treated with surgical fixation of humeral shaft fractures between December of 2014 and June of 2016 in a trauma reference center. All medical records were reviewed in search of epidemiological data referent to the trauma and post-operative results, including radiographic healing of the fracture and related complications., Results: Fifty-one patients were included, mostly male (78.4%), with an average age of 35.02 years. The most common trauma mechanism was a traffic accident (56.9%) followed by same-level falls (17.6%). No statistically significant difference was found between healing time comparing surgical fixation techniques, including open reduction and internal fixation, minimally invasive technique, intramedullary nailing, and external fixation., Conclusion: Although each technique has inherent advantages and disadvantages, all fixation methods proved to be adequate options for the surgical treatment of humeral shaft fractures with high rates of healing and low rates of post-operative complications.

Introduction: Cobicistat, a component of stribild (STB), is known to inhibit renal creatinine secretion. A detailed analysis of the renal safety profile of STB in two Phase 3b switch studies of virologically-suppressed individuals on stable therapy: STRATEGY(S)-PI (STB vs a RTV-boosted protease inhibitor [PI] with emtricitabine and tenofovir DF [FTC/TDF]); and STRATEGY(S)-NNRTI (STB versus a non-nucleoside reverse transcriptase inhibitor [NNRTI] with FTC/TDF) is herein described., Materials and Methods: Baseline eGFR ≥70 mL/min was an inclusion criterion. The renal safety profile of STB was examined by baseline eGFR through week 48 (i.e., changes in eGFR, renal tubular laboratory abnormalities, investigator-reported renal adverse events leading to discontinuation and unreported subclinical proximal renal tubulopathy [PRT]). Subclinical PRT was defined as a confirmed serum-creatinine increase ≥0.4 mg/dL and two or three markers of renal tubular dysfunction (hypophosphatemia, normoglycemic glycosuria, proteinuria) occurring at the same visit at least once and with no alternative etiologies., Results: In S-PI, 433 subjects (STB 293; PI 140) and in S-NNRTI, 434 subjects (STB 291; NNRTI 143) were randomized and treated. Most (>85%) STB subjects had a baseline eGFR ≥90 mL/min. STB subjects with baseline eGFR <90 mL/min had smaller declines in eGFR compared to those with baseline eGFR ≥90 mL/min and similar occurrences of renal tubular laboratory abnormalities (Table 1). Rate of renal adverse events leading to study drug discontinuation were similar for the STB group (one PRT in a subject with baseline tubular laboratory abnormalities consistent with underlying PRT and one isolated increase in serum creatinine) and PI group (one isolated decrease in eGFR); none in the NNRTI group. The case of PRT improved after study drug discontinuation. There were no cases of unreported subclinical PRT in any group., Conclusions: In this virologically suppressed patient population, the renal safety of STB did not differ by baseline eGFR. The renal discontinuation rate was low in the STB group, similar to the RTV-boosted PI group, and consistent with published historical rates.

Objective: to compare healing strength of the infraspinatus tendon of rats with corticoid inoculation, regarding maximum tension, maximum force and rupture force, after injury and experimental repair., Methods: a total of 60 Wistar rats were subjected to tenotomy of the infraspinatus tendon, which was then sutured. Before the surgery, they were divided into a control group (C) inoculated with serum and a study group (S) inoculated with corticoids over the tendon. After repair, the rats were sacrificed in groups of 10 individuals in the control group and 10 in the study group at the times of one week (C1 and S1), three weeks (C3 and S3) and five weeks (C5 and S5). The rats were dissected, separating out the infraspinatus tendon with the humerus. The study specimens were subjected to a traction test, with evaluation of the maximum tension (kgf/cm(2)), maximum force (kgf) and rupture force (kgf), comparing the study group with the respective control groups., Results: among the rats sacrificed one week after the procedure, we observed greater maximum tension in group C1 than in group S1. The variables of maximum force (kgf) and rupture force did not differ statistically between the groups investigated. In the same way, among the rats sacrificed three weeks after the procedure, group C3 only showed greater maximum tension than group S3 (p = 0.007), and the other variables did not present differences. Among the rats sacrificed five weeks after the procedure (C5 and S5), none of the parameters studied presented statistical differences., Conclusion: we concluded that corticoid diminished the resistance to maximum tension in the groups sacrificed one and three weeks after the procedure, in comparison with the respective control groups. The other parameters did not show differences between the study and control groups.