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INTRODUCTION: Fracture nonunion remains a devastating complication and may occur for several reasons, though the microbial contribution remains poorly estimated. Next-generation sequencing (NGS) techniques, including 16S rRNA gene profiling, are capable of rapid bacterial detection within clinical specimens. Nonunion cases may harbor microbes that escape detection by conventional culture methods that contribute to persistence. Our aim was to investigate the application of NGS pathogen detection to nonunion diagnosis. METHODS: In this prospective multicenter study, samples were collected from 54 patients undergoing open surgical intervention for preexisting long-bone nonunion (n = 37) and control patients undergoing fixation of an acute fracture (n = 17). Intraoperative specimens were sent for dual culture and 16S rRNA gene-based microbial profiling. Patients were followed for evidence of fracture healing, whereas patients not healed at follow-up were considered persistent nonunion. Comparative analyses aimed to determine whether microbial NGS diagnostics could discriminate between nounions that healed during follow-up versus persistent nonunion. RESULTS: Positive NGS detection was significantly correlated with persistent nonunion, positive in 77% more cases than traditional culture. Nonunion cases were observed to have significantly increased diversity and altered bacterial profiles from control cases. DISCUSSION: NGS seems to be a useful adjunct in identification of organisms that may contribute to nonunion. Our findings suggest that the fracture-associated microbiome may be a significant risk factor for persistent nonunion. Ongoing work aims to determine the clinical implications of isolated organisms detected by sequencing and to identify robust microbial predictors of nonunion outcomes. LEVEL OF EVIDENCE: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Fraturas não Consolidadas , Microbiota , Consolidação da Fratura , Fraturas não Consolidadas/cirurgia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Microbiota/genética , Estudos Prospectivos , RNA Ribossômico 16S/genética , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: This study was conducted to evaluate the effects of the provision of a protein-rich supplement on productive performance, and metabolic profile on grazing suckling female beef calves in tropical conditions during 150 d of experimentation. METHODS: Fifty-six Nellore suckling female calves, and their respective dams were distributed in a completely randomised design and made to undergo two treatments as follows: UNS (without supplementation), and SUP (supplementation with 5 g/kg body weight [BW] of a protein supplement). Throughout the experiment, animal performance and metabolic profile were evaluated. Also, ureagenesis and gluconeogenesis were assessed for gene expression. RESULTS: SUP female calves showed a higher voluntary intake (p≤0.03) of the diet components evaluated, digestibility of organic matter (p≤0.02) and microbial nitrogen production (MICN; p≤0.02) compared to UNS female calves. In its turn, serum urea nitrogen (p≤0.01) and insulin-like growth factor-1 (p≤0.03) levels and ureagenesis (p≤0.04) increased in SUP female calves compared to UNS female calves. Blood glucose and triglyceride levels were not affected by supplementation. The average daily gain (ADG) from SUP female calves was higher (p≤0.02) compared with UNS female calves. However, supplementation did not affect the body measures of the animals. CONCLUSION: In summary, provision of a protein-rich supplement improves the intake and nutrients digestibility, ADG and final BW and increases metabolic indicators of the protein status in grazing suckling female beef calves in tropical conditions.
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BACKGROUND: Multiple sclerosis (MS) is a neurological chronic disease that causes a number of physical, cognitive and emotional symptoms. The identification of these factors will allow mitigating unemployment and improve quality of life of patients. The Buffalo Vocational Monitoring Survey (BVMS) is a tool to characterize Work-Challenged patients. OBJECTIVE: To describe and analyze BVMS data in people with multiple sclerosis (PwMS) from Argentina. To study the association with physical, cognitive and psychiatric morbidity in employed patients, comparing the performance of MS Work-Challenged and MS Work-Stable patients, with and without accommodations. METHODS: 119 MS patients were administered the Argentina adaptation of the BVMS, and completed measures of physical disability, fatigue, depression, cognitive processing speed, memory and verbal fluency. RESULTS: 65.54% of the patients were employed and 19.32% were unemployed, the remaining having roles of housewife, students and disability retirees. Within the employed subgroup, 60.26% were working as employees and 39.74% were self-employed. Cognitive and clinical variables differentiate patients with and without negative events and accommodations (pâ> â0.05). CONCLUSIONS: This Spanish version BVMS is considered a new tool to monitor employment difficulties in Spanish-speaking MS patients. MS Work-Challenged had a higher depression, fatigue and worse performance in cognitive variables.
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Esclerose Múltipla , Países em Desenvolvimento , Emprego , Fadiga , Humanos , Esclerose Múltipla/complicações , Qualidade de Vida , DesempregoRESUMO
INTRODUCTION: To end the tuberculosis (TB) epidemic, efficient diagnostic tools are needed. In a previous calibration study, a portable 'point of care' electronic nose device (AeonoseTM ) proved to be a promising tool in a hospital setting. We evaluated this technology to detect TB in an indigenous population in Paraguay. METHODS: A total of 131 participants were enrolled. eNose results were compared with anamnesis, physical examinations, chest radiography and mycobacterial cultures in individuals with signs and symptoms compatible with TB. The eNose analysis was performed in two stages: first, the training with a combination of a previous study population plus 47 participants from the new cohort (total n = 153), and second, the 'blind prediction' of 84 participants. RESULTS: 21% of all participants (n = 131) showed symptoms and/or chest radiography abnormalities suspicious of TB. No sputum samples resulted culture positive for Mycobacterium tuberculosis complex. Only one patient had a positive smell print analysis. In the training model, the specificity was 92% (95% confidence interval (CI): 85%-96%) and the negative predictive value (NPV) was 95%. In the blind prediction model, the specificity and the NPV were 99% (95% CI: 93%-99%) and 100%, respectively. Although the sensitivity and positive predictive value of the eNose could not be assessed in this cohort due to the small sample size, no active TB cases were found during a one year of follow-up period. CONCLUSION: The eNose showed promising specificity and negative predictive value and might therefore be developed as a rule-out test for TB in vulnerable populations.
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Nariz Eletrônico , Sistemas Automatizados de Assistência Junto ao Leito , Grupos Populacionais , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/etnologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraguai , Projetos Piloto , Sensibilidade e Especificidade , Adulto JovemRESUMO
The aim is to determine the prevalence of active infection by herpes simplex virus type 2 (HSV-2) among Mexican women with high-risk human papillomavirus (HR-HPV) cervical infection, recruited from public gynecology and colposcopy services. In a cross-sectional study, HSV-2 antibodies, HSV-2 DNA, and HR-HPV DNA were quantified. Significant differences in HSV-2 seroprevalence and HSV-2 active infection rates were found between negative and positive HR-HPV cases. HSV-2 seroprevalence was 28.15% and 16.1% (P = .0001), while HSV-2 active infection rates were 6.83% and 0.62% (P = .001) for positive and negative HR-HPV groups, respectively. The risk of HSV-2 seropositivity was 1.7 times greater for HR-HPV-positive cases (P = .02). Similarly, HR-HPV-positive cases were nine times more likely to have an HSV-2 active infection than HR-HPV-negative cases (P = .03). High HSV-2/h-HPV coinfection rates were observed among women recruited from public gynecology and colposcopy services. The main factors related to an HSV-2 active infection are a history of risky sexual behavior and HR-HPV infection. The prevalence of HSV-2 active infection among positive HR-HPV subjects indicate that these infections constitute an important group of STIs in Mexico.
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Anticorpos Antivirais/sangue , Herpes Genital/epidemiologia , Infecções por Papillomavirus/virologia , Adulto , Colo do Útero/virologia , Coinfecção/epidemiologia , Coinfecção/virologia , Estudos Transversais , Feminino , Herpes Genital/virologia , Herpesvirus Humano 2/imunologia , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Prevalência , Estudos Soroepidemiológicos , Comportamento SexualRESUMO
To describe the prevalence and distribution of clinical and ultrasound (US) pathological findings at ankle level and to compare them, in patients with rheumatoid arthritis (RA). This is a descriptive, cross-sectional study assessing patients diagnosed with RA according to the 2010 ACR criteria, who were recruited consecutively and independently of disease status or treatment and of the presence of pain at ankle level. Clinical and US findings were acquired by two independent rheumatologists. US assessments were performed according to the EULAR and OMERACT indications. A total of 224 ankles of 112 RA patients were examined. One hundred (89.3%) patients were women and 12 (10.7%) were men, with a mean age of 51 years. RA mean disease duration was 72 months. Ankle spontaneous pain was found in 56.2% of the patients. In 65.2% of the patients, US found at least one pathologic sign indicative of joint and/or tendon pathology. Using grayscale US, joint involvement was more frequently found than tendon pathology (37.5% vs 22.3%). Conversely, no substantial difference was found between the prevalence of power Doppler signal at joint and tendon level. There was a significant correlation between clinical findings and US findings indicative of tibiotalar joint synovitis and peroneal tenosynovitis. In the present study, pain and US pathologic findings at ankle level were described and compared in a cohort of RA patients. Spontaneous pain was found in more than half of the patients and US found joint involvement more prevalent than tendon pathology.
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Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/fisiopatologia , Dor/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prevalência , Reumatologia , Sinovite/diagnóstico por imagem , Sinovite/fisiopatologia , Tendões/diagnóstico por imagem , Tenossinovite/complicações , Ultrassonografia Doppler , Adulto JovemRESUMO
BACKGROUND: Cervical cancer (CC) is caused by a persistent infection of high-risk human papillomavirus (HR-HPV). While most HPV infections are transient, persistent HPV infections are a significant health problem in Mexico. With an estimated HPV prevalence of 10% among women in reproductive age, approximately 25% of these women present at least a positive result in triage test, which according to previous studies is expected to be confirmed as positive CIN-2/3. The immune system has a key role in the natural history of HPV infection; alterations in the cellular immune response are responsible for the failure to eliminate HPV. The objective of this project is to assess the prognostic value of detecting immune markers (IL-10, IL-4, TGFß1, IFNγ, IL-6, and TNFα), the expression of HPV-HR E6/E7 proteins, and the viral load at the cervical level with respect to the persistence or clearance of HR-HPV infection, and the regression or progression of a cervical premalignant lesion. METHODS: A dynamic cohort study is being conducted in women with colposcopic, cytological, and histopathological results negative for squamous intraepithelial lesion (SIL) in the cervix and a positive HPV test; the subjects will be followed-up for 5 years, period from which 3 years have already elapsed, with yearly studies (colposcopy, cytology, and histopathology diagnosis, along with molecular HPV test, quantification of viral load and of IL-10, IL-4, TGFß1, INFγ, IL-6, and TNFα levels, along with the expression of the HR-HPV E6/E7 proteins in the cervix as a viral marker. The outcome will be categorized as viral persistence or clearance; and as SIL persistence, progression, or regression. Binomial and/or multinomial regression models adjusted for potential confounders will be used, associating the relative risk of the outcome with the immune and viral markers evaluated. DISCUSSION: This research will generate knowledge about immune markers with predictive value for the persistence and clearance of HPV, which will improve the triage of positive HPV women and thus reduce the economic burden for the Mexican health system imposed by the management of high-grade SIL and CC cases, which are still detected in late stages.
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Citocinas/sangue , Imunossupressores/sangue , Infecções por Papillomavirus/sangue , Lesões Intraepiteliais Escamosas Cervicais/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/genética , Papillomaviridae/imunologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Prognóstico , Estudos Prospectivos , Fatores de Risco , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/patologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Neoplasias do Colo do Útero/sangue , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Carga Viral , Displasia do Colo do Útero/sangue , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologiaRESUMO
El propósito de esta investigación fue conocer las características del dolor de origen dental (DOD) urgente en un Servicio de Urgencias de Atención Primaria, las preferencias terapéuticas de los médicos de Urgencias y su eficacia clínica. Para ello se realizó un cuestionario a 114 médicos de Urgencias, analizando la frecuencia y alternativas analgésicas más usadas en el DOD. Se seleccionaron las cuatro más prevalentes: Metamizol, Diclofenaco, Metamizol+Diclofenaco y Metilprednisolona, y fueron las que recibieron, en ensayo simple ciego, los cuatro grupos formados aleatoriamente de una muestra de 300 pacientes. Registramos mediante Escala Visual Numérica (EVN) la intensidad del dolor inicial, dolor percibido a las 12 y 24 h tras tratamiento, grado de mejoría, tiempo de mejora percibida y analgesia de rescate. Los cuatro grupos se compararon estadísticamente utilizando el test de Chi Cuadrado y el test ANOVA. Entre otros datos, hemos conocido las características del DOD urgente en la población seleccionada, hayando resultados estadísticamente significativos en las valoraciones medias en la EVN tras el tatamiento, más bajos en los tratados con Metilprednisolona y más altos con Diclofenaco. De igual forma, se observó un mayor porcentaje de mejoría clínica notable en el grupo tratado con Metilprednisolona, seguido de Metamizol+Diclofenaco, y en el extremo opuesto, un porcentaje mayor sin mejoría con Diclofenaco, que además fue el de mayor uso de analgesia de rescate.
The purpose of this research was to know the characteristics of dental origin pain (DOP) in an Emergency Department of Primary Care, the therapeutic preferences of emergency physicians and clinical efficacy. A questionnaire was submitted to 114 emergency physicians by reporting the frequency and analgesic alternatives most used in the DOP. We selected the four most prevalent: Metamizole, Diclofenac, Diclofenac and Metamizole + Methylprednisolone, received in a single-blind trial. The four groups were selected randomly from a sample of 300 patients. We recorded by Visual Numeric Scale (VNS) the initial pain intensity, perceived pain at 12 and 24 h after treatment, the degree of improvement, the time improvement was perceived, and the analgesia relief. The four groups were compared statistically using the chi-square test and ANOVA test. Among other data, the characteristics of the urgent DOP were studied in the selected population, noting statistically significant results in average ratings on VNS following treatment, lower in those treated with methylprednisolone and higher with diclofenac. Similarly, a higher percentage of significant clinical improvements was recorded in the group treated with methylprednisolone group, followed by Metamizole + Diclofenac, and at the opposite end, a higher percentage without improvement with diclofenac, in which the highest use of analgesia relief was also observed.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Atenção Primária à Saúde , Odontalgia/tratamento farmacológico , Serviços Médicos de Emergência/estatística & dados numéricos , Analgésicos/uso terapêutico , Distribuição de Qui-Quadrado , Método Simples-Cego , Estudos Prospectivos , Inquéritos e Questionários , Análise de Variância , Resultado do Tratamento , Quimioterapia Combinada , Escala Visual AnalógicaRESUMO
This study aimed to assess the content validity of a catalog of 76 judo exercises. Two groups of raters comprising 16 judo experts evaluated the following content validity indicators: Clarity of Language, Practical Pertinence, Theoretical Relevance, and the Dimension of each exercise. The results confirmed the content validity of the judo training catalog with indicators showing scores greater than 0.80. These findings suggest that all 76 judo exercises are pertinent, representative of judo training and understandable for judo coaches. Thus, this catalog of judo exercises may help judo coaches in the selection and recording of exercises.
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Artes Marciais/educação , Artes Marciais/fisiologia , Instruções Programadas como Assunto/normas , Livros de Texto como Assunto/normas , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Cervical cancer (CC) is responsible for >260,000 deaths worldwide each year. Efforts are being focused on identifying genetic susceptibility factors, especially in genes related to the immune response. Akna has been proposed to be one of them, but data regarding its functional role in the disease is scarce. Supporting the notion of akna as a CC susceptibility gene, we found two polymorphisms associated with squamous intraepithelial lesion (SIL) and CC; moreover, we identified an association between high akna expression levels and CC and SIL, but its direction differs in each disease stage. To show the potential existence of a cis-acting polymorphism, we assessed akna allelic expression imbalance for the alleles of the -1372C>A polymorphism. We found that, regardless of the study group, the number of transcripts derived from the A allele was significantly higher than those from the C allele. Our results support the hypothesis that akna is a CC susceptibility genetic factor and suggest that akna transcriptional regulation has a role in the disease. We anticipate our study to be a starting point for in vitro evaluation of akna transcriptional regulation and for the identification of transcription factors and cis-elements regulating AKNA function that are involved in carcinogenesis.