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INTRODUCTION: bone defects drastically alter the patient's quality of life, and can produce serious sequelae such as dysfunctional shortening, angular deformity, joint stiffness and irreversible gait disorder. OBJECTIVE: to describe the experience of managing post-traumatic bone defects of long bones treated with the membrane induction technique. MATERIAL AND METHODS: retrospective observational study of patients with bone defects greater than 3 cm in diaphyseal pseudoarthrosis of long bones, who underwent the Masquelet technique. Period taken from January 2019 to January 2021. All patients underwent vigorous debridement and stabilization of the fracture, to then place the cement spacer. Spacer removal was at 4-6 weeks. The degree of consolidation was assessed, as well as the evolution of the treatment. RESULT: 25 patients were included in the study; the mean age was 36.8 ± 8.9 years. Diameter of bone losses was 3 to 10 cm (84%) and > 10 cm (16%). Bone consolidation occurred in patients with a defect < 10 cm (16%). 32% of patients presented some complication. CONCLUSIONS: bone union was achieved only in a few patients with defects smaller than 10 cm, requiring alternative procedures in most cases. Proper selection of patients is required.

INTRODUCCIÓN: los defectos óseos alteran drásticamente la calidad de vida del paciente y pueden producir serias secuelas como acortamiento disfuncional, deformidad angular, rigidez articular y trastorno irreversible de la marcha. OBJETIVO: describir la experiencia clínica en el manejo de defectos óseos postraumáticos de huesos largos tratados con la técnica de inducción de membrana. MATERIAL Y MÉTODOS: estudio observacional, retrospectivo, de pacientes con defectos óseos mayores de 3 cm con pseudoartrosis diafisaria de huesos largos, a los que se aplicó la técnica de Masquelet. En el período de Enero de 2019 a Enero de 2021. A todos los pacientes se les realizó desbridamiento enérgico y estabilización de la fractura, para posteriormente colocar el espaciador de cemento. El retiro del espaciador fue a las 4-6 semanas. Se valoró el grado de consolidación y la evolución del tratamiento. RESULTADOS: se incluyeron 25 pacientes, la media de edad fue de 36.8 ± 8.9 años. El diámetro de las pérdidas óseas fue de 3 a 10 cm (84%) y > 10 cm (16%). La consolidación ósea se presentó en pacientes con un defecto < 10 cm (16%). Treinta y dos por ciento de los pacientes presentó alguna complicación. CONCLUSIONES: la consolidación ósea se logró sólo en aquellos pacientes con defectos < 10 cm, requiriendo procedimientos alternativos a la técnica de inducción de membrana en la mayoría de los casos. Se requiere una selección adecuada de pacientes para lograr la consolidación ósea por medio de esta técnica.

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Aedes aegypti mosquitoes transmit several human pathogens that cause millions of deaths worldwide, mainly in Latin America. The indiscriminate use of insecticides has resulted in the development of species resistance to some such compounds. Piperidine, a natural alkaloid isolated from Piper nigrum, has been used as a hit compound due to its larvicidal activity against Aedes aegypti. In the present study, piperidine derivatives were studied through in silico methods: pharmacophoric evaluation (PharmaGist), pharmacophoric virtual screening (Pharmit), ADME/Tox prediction (Preadmet/Derek 10.0®), docking calculations (AutoDock 4.2) and molecular dynamics (MD) simulation on GROMACS-5.1.4. MP-416 and MP-073 molecules exhibiting ΔG binding (MMPBSA -265.95 ± 1.32 kJ/mol and -124.412 ± 1.08 kJ/mol, respectively) and comparable to holo (ΔG binding = -216.21 ± 0.97) and pyriproxyfen (a well-known larvicidal, ΔG binding= -435.95 ± 2.06 kJ/mol). Considering future in vivo assays, we elaborated the theoretical synthetic route and made predictions of the synthetic accessibility (SA) (SwissADME), lipophilicity and water solubility (SwissADME) of the promising compounds identified in the present study. Our in silico results show that MP-416 and MP-073 molecules could be potent insecticides against the Aedes aegypti mosquitoes.

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INTRODUCTION: The evaluation and management of acetabular bone loss in total hip arthroplasty is a challenge for orthopedic surgeons, we wish in this study to determine the inter-observer concordance in the Paprosky classification for acetabular defects. MATERIAL AND METHODS: Observational, descriptive, longitudinal, prospective study. It was performed using anteroposterior hip radiographs of patients scheduled for primary total hip arthroplasty or revision with acetabular bone defect, Sinapse local X-ray system, 20 X-rays were assessed per observer taken randomly (doctors assigned to the joint replacement service with minimum experience of five years) using the Paprosky classification spontaneously, (without previous classes) for acetabular defects, inter-observer concordance was assessed using Cohen's Kappa coefficient. RESULTS: An interobserver agreement was obtained on average for the Paprosky classification of acetabular defects using the Cohen's Kappa coefficient, the concordance analysis was done using the statistical program statistical package for the social sciences of 0.237. CONCLUSIONS: Both the null hypothesis (Kappa greater than 0.80 value considered optimal) and the alternative hypothesis (Kappa from 0.41 to 0.80 value equal to moderate to good) did not agree with our study (Kappa equal to 0.237) value equal to mild, in addition , it was shown that the greater the acetabular defect, the lower the interobserver agreement in surgeons in our institution.

INTRODUCCIÓN: La evaluación y manejo de la pérdida ósea acetabular en la artroplastía total de cadera es un desafío para los cirujanos ortopédicos, deseamos en este estudio determinar la concordancia interobservador en la clasificación de Paprosky para defectos acetabulares. MATERIAL Y MÉTODOS: Estudio observacional, descriptivo, longitudinal, prospectivo. Se realizó utilizando las radiografías anteroposteriores de cadera de pacientes programados para artroplastía total de cadera primaria o de revisión con defecto óseo acetabular, sistema de rayos X local Sinapse, se valoraron 20 radiografías por observador tomadas de manera aleatoria (médicos adscritos al servicio de reemplazos articulares con experiencia mínima de cinco años) utilizando la clasificación de Paprosky de manera espontánea (sin clases previas) de defectos acetabulares, se evaluó la concordancia interobservador mediante el coeficiente de kappa de Cohen. RESULTADOS: Se obtuvo una concordancia interobservador en promedio para la clasificación de Paprosky de defectos acetabulares utilizando el coeficiente de kappa de Cohen, el análisis de concordancia se hizo empleando el programa estadístico Statistical Package for the Social Sciences de 0.237. CONCLUSIONES: Tanto la hipótesis nula (kappa mayor de 0.80 valor considerado óptimo) como la hipótesis alternativa (kappa de 0.41 a 0.80 valor igual a moderada a buena) no concordaron con nuestro estudio (kappa igual a 0.237) valor igual a leve, además se demostró que a mayor defecto acetabular menor es la concordancia interobservador en cirujanos en nuestra institución.

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Resumen: Introducción: La evaluación y manejo de la pérdida ósea acetabular en la artroplastía total de cadera es un desafío para los cirujanos ortopédicos, deseamos en este estudio determinar la concordancia interobservador en la clasificación de Paprosky para defectos acetabulares. Material y métodos: Estudio observacional, descriptivo, longitudinal, prospectivo. Se realizó utilizando las radiografías anteroposteriores de cadera de pacientes programados para artroplastía total de cadera primaria o de revisión con defecto óseo acetabular, sistema de rayos X local Sinapse, se valoraron 20 radiografías por observador tomadas de manera aleatoria (médicos adscritos al servicio de reemplazos articulares con experiencia mínima de cinco años) utilizando la clasificación de Paprosky de manera espontánea (sin clases previas) de defectos acetabulares, se evaluó la concordancia interobservador mediante el coeficiente de kappa de Cohen. Resultados: Se obtuvo una concordancia interobservador en promedio para la clasificación de Paprosky de defectos acetabulares utilizando el coeficiente de kappa de Cohen, el análisis de concordancia se hizo empleando el programa estadístico Statistical Package for the Social Sciences de 0.237. Conclusiones: Tanto la hipótesis nula (kappa mayor de 0.80 valor considerado óptimo) como la hipótesis alternativa (kappa de 0.41 a 0.80 valor igual a moderada a buena) no concordaron con nuestro estudio (kappa igual a 0.237) valor igual a leve, además se demostró que a mayor defecto acetabular menor es la concordancia interobservador en cirujanos en nuestra institución.

Abstract: Introduction: The evaluation and management of acetabular bone loss in total hip arthroplasty is a challenge for orthopedic surgeons, we wish in this study to determine the inter-observer concordance in the Paprosky classification for acetabular defects. Material and methods: Observational, descriptive, longitudinal, prospective study. It was performed using anteroposterior hip radiographs of patients scheduled for primary total hip arthroplasty or revision with acetabular bone defect, Sinapse local X-ray system, 20 X-rays were assessed per observer taken randomly (doctors assigned to the joint replacement service with minimum experience of five years) using the Paprosky classification spontaneously, (without previous classes) for acetabular defects, inter-observer concordance was assessed using Cohen's Kappa coefficient. Results: An interobserver agreement was obtained on average for the Paprosky classification of acetabular defects using the Cohen's Kappa coefficient, the concordance analysis was done using the statistical program statistical package for the social sciences of 0.237. Conclusions: Both the null hypothesis (Kappa greater than 0.80 value considered optimal) and the alternative hypothesis (Kappa from 0.41 to 0.80 value equal to moderate to good) did not agree with our study (Kappa equal to 0.237) value equal to mild, in addition , it was shown that the greater the acetabular defect, the lower the interobserver agreement in surgeons in our institution.

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From 20th century, our views, understanding and treatment of pathogenic infections have drastically changed. Pathogenic organisms were discovered, classified and treatments were subsequently implemented. Candidiasis spp. was discovered and linked to the condition; Vulvovaginal Candidiasis (VVC), commonly known as yeast infection, which affects the female lower genital tract, vulva and vagina. Symtoms of such an infection include itching, burning, soreness and a creamy vaginal discharge. Given the nature, location and symptoms of such an infection, individuals are often self-conscious and hesitant to discus it or seek medical attention until symptoms become unbearable. VVC is one of the most common infections in reproductive age females with 75% of women experiencing infection at least once in their lives. Due to the qualitative gap in literature toward women affected by VVC in our country, this study aimed to highlight the knowledge, attitudes and practices towards VVC among reproductive age in Trinidad and Tobago.

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Non-steroidal anti-inflammatory drugs are inhibitors of cyclooxygenase-2 (COX-2) that were developed in order to avoid the side effects of non-selective inhibitors of COX-1. Thus, the present study aims to identify new selective chemical entities for the COX-2 enzyme via molecular modeling approaches. The best pharmacophore model was used to identify compounds within the ZINC database. The molecular properties were determined and selected with Pearson's correlation for the construction of quantitative structure-activity relationship (QSAR) models to predict the biological activities of the compounds obtained with virtual screening. The pharmacokinetic/toxicological profiles of the compounds were determined, as well as the binding modes through molecular docking compared to commercial compounds (rofecoxib and celecoxib). The QSAR analysis showed a fit with R = 0.9617, R2 = 0.9250, standard error of estimate (SEE) = 0.2238, and F = 46.2739, with the tetra-parametric regression model. After the analysis, only three promising inhibitors were selected, Z-964, Z-627, and Z-814, with their predicted pIC50 (-log IC50) values, Z-814 = 7.9484, Z-627 = 9.3458, and Z-964 = 9.5272. All candidates inhibitors complied with Lipinski's rule of five, which predicts a good oral availability and can be used in in vitro and in vivo tests in the zebrafish model in order to confirm the obtained in silico data.

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Models validation in QSAR, pharmacophore, docking and others can ensure the accuracy and reliability of future predictions in design and selection of molecules with biological activity. In this study, pyriproxyfen was used as a pivot/template to search the database of the Maybridge Database for potential inhibitors of the enzymes acetylcholinesterase and juvenile hormone as well. The initial virtual screening based on the 3D shape resulted in 2000 molecules with Tanimoto index ranging from 0.58 to 0.88. A new reclassification was performed on the overlapping of positive and negative charges, which resulted in 100 molecules with Tanimoto's electrostatic score ranging from 0.627 to 0.87. Using parameters related to absorption, distribution, metabolism and excretion and the pivot molecule, the molecules selected in the previous stage were evaluated regarding these criteria, and 21 were then selected. The pharmacokinetic and toxicological properties were considered and for 12 molecules, the DEREK software not fired any alert of toxicity, which were thus considered satisfactory for prediction of biological activity using the Web server PASS. In the molecular docking with insect acetylcholinesterase, the Maybridge3_002654 molecule had binding affinity of -11.1 kcal/mol, whereas in human acetylcholinesterase, the Maybridge4_001571molecule show in silico affinity of -10.2 kcal/mol, and in the juvenile hormone, the molecule MCULE-8839595892 show in silico affinity value of -11.6 kcal/mol. Subsequent long-trajectory molecular dynamics studies indicated considerable stability of the novel molecules compared to the controls.AbbreviationsQSARquantitative structure-activity relationshipsPASSprediction of activity spectra for substancesCommunicated by Ramaswamy H. Sarma.

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INTRODUCTION: Preventive analgesia in orthopedic surgery is becoming increasingly important because post-surgical pain management is more pleasant for the patient and allows them to initiate rehabilitation early. With this premise we consider the following hypothesis. The perception of post-surgical pain at two, 12 and 24 hours with local infiltration into the surgical wound with ropivacaine plus systemic analgesia will be less compared to patients who infiltrate with saline into the surgical wound plus systemic analgesia. MATERIAL AND METHODS: A randomized double-blind, prospective randomized controlled clinical trial was conducted in the period January 2018 to August 2018. RESULTS: The null hypothesis is rejected in the group valued at two hours and the null hypothesis is accepted in the groups valued at 12 and 24 hours. CONCLUSION: Ropivacaine infiltration is an effective method for managing postoperative pain for the first 2 hours in open shoulder surgery procedures.

INTRODUCCIÓN: La analgesia preventiva en cirugía ortopédica cada vez toma mayor importancia debido a que el control del dolor postquirúrgico es más grato para el paciente y le permite iniciar rehabilitación de forma temprana. Con esta premisa nos planteamos la siguiente hipótesis. La percepción del dolor postquirúrgico a las dos, 12 y 24 horas con infiltración local en la herida quirúrgica con ropivacaína más analgesia sistémica será menor en comparación con los pacientes que se infiltren con solución salina en la herida quirúrgica más analgesia sistémica. MATERIAL Y MÉTODOS: Se realizó un ensayo clínico controlado aleatorizado doble ciego, prospectivo en el período comprendido de Enero de 2018 a Agosto de 2018. RESULTADOS: Se rechazó la hipótesis nula en el grupo valorado a las dos horas y se aceptó la hipótesis nula en los grupos valorados a las 12 y 24 horas. CONCLUSIÓN: La infiltración con ropivacaína es un método efectivo para el manejo del dolor postoperatorio durante las primeras dos horas en procedimientos de cirugía abierta de hombro.

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INTRODUCTION: The education process is understood as an activity focused on developing competencies through the use of educational tools and strategies that can be evaluated. The training of the residents in traumatology and orthopedics requires you to acquire knowledge and develop skills that will affect the diagnosis, treatment and prognosis of the patient. Therefore, what will be the evaluation of the educational intervention on the theoretical and practical knowledge in this group of physicians on the technique of taking, measuring and preparation of hamstring graft for the reconstruction of anterior cruciate ligament? MATERIAL Y METHODS: A prospective, quasi-experimental study was conducted to evaluate the impact of educational intervention in 23 Traumatology and orthopaedic residents on the use of hamstring in the anterior cruciate ligament reconstruction through theoretical sessions and Practice on cadaverous knees with preand post-intervention evaluations. RESULTS: The correlation between the pre and post evaluation educational intervention, both theoretical and practical, was statistically significant (p = 0.004 and p = 0.4, respectively). CONCLUSION: The statistically significant correlation between preand post-educational intervention evaluations speaks of the value of learning strategies, in the case of this study, the intervention through a theoretical and practical session by a simulated patient promotes knowledge acquisition and development of skills.

INTRODUCCIÓN: El proceso de educación se entiende como una actividad enfocada a desarrollar competencias mediante el empleo de herramientas y estrategias educativas que pueden ser sometidas a evaluación. La formación del médico residente de Traumatología y Ortopedia le exige adquirir conocimientos y desarrollar destrezas que repercutirán en el diagnóstico, tratamiento y pronóstico del paciente. Por lo tanto, ¿cuál será la evaluación de la intervención educativa sobre los conocimientos teóricos y prácticos en residentes de la especialidad de traumatología y ortopedia sobre la técnica de toma, medición y preparación de injerto de isquiotibiales para la reconstrucción de ligamento cruzado anterior? MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo, cuasiexperimental para evaluar el impacto de la intervención educativa en 23 residentes de Traumatología y Ortopedia sobre el uso de isquiotibiales en la reconstrucción de ligamento cruzado anterior mediante sesiones teórica y práctica en rodillas cadavéricas con evaluaciones pre- y postintervención. RESULTADOS: La correlación entre la evaluación pre- y postintervención educativa, tanto teórica como práctica, fue estadísticamente significativa (p = 0.004 y p = 0.4, respectivamente). CONCLUSIONES: La correlación estadísticamente significativa entre evaluaciones pre- y postintervención educativa refiere el valor de las estrategias de aprendizaje, en el caso de este estudio, la intervención a través de una sesión teórica y práctica mediante un paciente simulado (práctica necroquirúrgica) promueve la adquisición de conocimientos y el desarrollo de habilidades y destrezas.

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Sheehan's syndrome (SHS) is a rare condition related to the risk of osteoporosis and evaluation of bone texture imaging features on panoramic radiographs would be suitable for this condition, which was the aim of the present study. Fractal dimension, lacunarity, and trabecular morphologic aspects were significantly altered in these patients. INTRODUCTION: SHS is an important public health problem particularly in developing countries. It is characterized as postpartum hypopituitarism secondary to obstetric complications-related ischemic pituitary necrosis that shows significant systemic metabolic repercussions. Thus, this study aimed to evaluate bone texture parameters in digital panoramic radiographs of patients with SHS. METHODS: A case-control study was conducted with 30 SHS patients from an Endocrinology and Diabetology Service of reference in Brazil, and 30 age- and sex-matched healthy controls. A custom computer program measured fractal dimension, lacunarity, and some morphologic features in the following mandibular regions of interest (50 × 50 pixels): below the mental foramen (F1), between the first and second molars (M1), and at the center of the mandibular ramus (R1). RESULTS: The fractal analysis showed a statistically significant difference between the studied groups in all regions of interest. The fractal dimension in F1 (p = 0.016), M1 (p = 0.043), and R1 (p = 0.028) was significantly lower in SHS group, as well as lacunarity in R1 (p = 0.008). Additionally, several morphologic features were statistically significant in the SHS group (p < 0.05). CONCLUSION: Therefore, individuals with SHS showed altered imaging texture parameters on panoramic radiographs, which reflect a smaller spatial organization of the bone trabeculae and, possibly, a state of reduced mineral bone density.

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