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Background: Hemarthrosis is a typical clinical manifestation in patients with hemophilia. Its recurrence causes hemophilic arthropathy, characterized by chronic joint pain. Watching movement recorded from a first-person perspective and immersively can be effective in the management of chronic pain. The objective of this study was to evaluate the effectiveness of an immersive virtual reality intervention in improving the pain intensity, joint condition, muscle strength and range of motion in patients with hemophilic knee arthropathy. (2) Methods: Thirteen patients with hemophilic knee arthropathy were recruited. The patients wore virtual reality glasses and watched a flexion–extension movement of the knee on an immersive 180° video, recorded from a first-person perspective over a 28-day period. The primary variable was the pain intensity (visual analog scale). The secondary variables were the joint status (Hemophilia Joint Health Score), quadriceps and hamstring strength (dynamometry), and range of motion (goniometry). (3) Results: After the intervention period, statistically significant differences were observed in the intensity of the joint pain (Standard error [SE] = 19.31; 95% interval confidence [95%CI] = −1.05; −0.26), joint condition (SE = 18.68; 95%CI = −1.16; −0.52) and quadriceps strength (SE = 35.00; 95%CI = 2.53; 17.47). We found that 38.46% and 23.07% of the patients exhibited an improvement in their quadriceps muscle strength and joint condition above the minimum detectable change for both variables (8.21% and 1.79%, respectively). (4) Conclusions: One hundred and eighty degree immersive VR motion visualization can improve the intensity of joint pain in patients with hemophilic knee arthropathy. An intervention using immersive virtual reality can be an effective complementary approach to improve the joint condition and quadriceps strength in these patients. Sin financiación 4.964 JCR (2021) Q2, 55/172 Medicine, General & Internal 1.040 SJR (2021) Q1, 438/2489 Medicine (miscellaneous) No data IDR 2021 UEM

To implement one analysis method of the ankle bone contour that could make a more precise ankle arthrodesis.Twenty tomographies were submitted to 3D reconstruction. Seven points of anatomic interest for ankle arthrodesis with the three screws technique were marked with a triplannar marker. The median of the position of markers was estimated, and the union of the seven median points allow the construction of one median ankle for that population. Using this median ankle, sizes and angles for the screws position were determined.Two median ankles were reconstructed, left and right. The position of the screw passage were determined considering the anatomical parameters. In the right ankle the lateral to medial screw should enter 4.56 cm and 0.79 above and posterior to lateral malleolus, with one inclination of 17.34° in relation to tibial longitudinal axis; and 0° in relation to tibial axial plane. The position for the other two screws is also described.Our article is the first to presents one precise guide for ankle arthrodesis based on a populational assessment.Implementar método de análise do contorno e alinhamento ósseos no tornozelo de uma população normal, possibilitando uma artrodese tibiotársica mais precisa.Tomografias de vinte tornozelos foram submetidas à reconstrução 3D. Nesses exames, 7 pontos anatômicos de interesse para a técnica de fixação com 3 parafusos foram identificados e marcados com indicadores da posição triplanar. As médias das localizações de cada ponto foram calculadas. A união dessas médias permitiu a reconstrução de um tornozelo padrão daquela população. Nesses tornozelos médios estudou-se os comprimentos e ângulos para a passagem dos parafusos.Dois tornozelos, direito e esquerdo, foram reconstruídos. A posição para a passagem dos parafusos em relação a parâmetros anatômicos foi determinada. Para o tornozelo direito, a passagem do parafuso de lateral para medial deve ocorrer com o ponto de entrada 4,56 cm acima e 0,79 cm posterior à ponta do maléolo lateral, com inclinação de 17,34° em relação ao eixo longitudinal e 0° em relação ao eixo axial da tíbia. As posições dos outros dois parafusos também estão descritas.Esse é o primeiro trabalho que apresenta um guia preciso para realização da artrodese do tornozelo, baseado em um estudo populacional. Nível de evidência II, Estudos Diagnósticos.

En el presente trabajo se expone el estudio antropológico y paleopatológico rea- lizado en tres individuos fallecidos durante la Guerra Civil Española, y exhuma- dos en la localidad leonesa de Canseco. Previo al estudio antropológico, para la facilitación de su análisis, los restos fue- ron dispuestos en conexión anatómica. Los tres individuos eran de sexo masculi- no, de mediana edad y de una estatura en torno a los 165 cm. Una vez finalizado dicho estudio, se llevó a cabo el análisis paleopatológico, de- tectándose hernias discales, nódulos de Schrmöl y entesopatías, así como caries, hipoplasias y alteraciones para-masticatorias. Se destaca la presencia de espina bífida oculta en dos de los individuos; por su ca- rácter genético, pudiendo estar relacionada con procesos de endogamia. Se exponen las posibles patologías causantes de la muerte de estos individuos, todas ellas ocasionadas por armas de fuego y metralla.

Objetivo: Avaliar o perfil clínico-terapêutico e a resposta à profilaxia em pacientes hemofílicos A e B em um centro de referência no Ceará. Métodos: Estudo de coorte retrospectivo, com dados de 133 hemofílicos A e B, em profilaxia entre 2016 e 2021, por meio de prontuários médicos e sistema Web Coagulopatias. Resultados: Os pacientes todos do sexo masculino em sua maioria foram hemofílicos A (93,2%), na forma grave, residentes em Fortaleza, com maior prevalência do município de Guaiúba. A maioria fazia uso de Fator VIII recombinante e em profilaxia secundária, em relação ao comprometimento articular a maioria não apresentou relato de hemartroses (66,9%), articulação-alvo (87,9%) ou artropatia (54,9%), porém os hemofílicos em profilaxia terciária apresentaram um maior comprometimento articular em relação a profilaxia primária e secundária. Verificou-se uma correlação negativa entre o tempo de profilaxia e a dose de fator utilizada, demonstrando que quanto maior o tempo de profilaxia menor a dose do fator utilizada. Um total de 13 hemofílicos A grave desenvolveram inibidor de fator VIII realizando imunotolerância (ITI) com sucesso total em 84,6%. Por meio da curva ROC, foi verificado uma associação entre a necessidade de ITI e a dose de fator de coagulação, com acurácia de 67,7% de que o uso de doses maiores de fator predispõe ao desenvolvimento de inibidores. Conclusão: Os dados do estudo permitem inferir que quanto mais precoce o tratamento de profilaxia menor é comprometimento articular, dose do fator utilizada e menor predisposição de desenvolver inibidores dos fatores da coagulação.

Introduction: Epidemiological studies on hemophilia in the Brazilian population are historically scarce. Despite the continuous effort made by the National Program of Inherited Bleeding Disorders to map this condition, little information is available, especially on the period prior to program conception. Therefore, the present study aims to assess the epidemiological, serological, and clinical characteristics of patients with hemophilia in the state of Rio Grande do Sul, Brazil. Methods: A total of 455 patients had their medical records reviewed from January 1, 2003 to December 31, 2007. Results: We observed a remarkable prevalence of hepatitis C virus (HCV) infection in patients with both hemophilia A and B, and this prevalence significantly increased along with age (p < 0.001). No positive anti-HCV results were observed among children younger than 5 years old. There was a significant correlation between the severity of hemophilia and the number of arthropathies in all age categories. Considering the presence of inhibitors, a significant difference was observed between age groups, as older patients had higher inhibitor titers. There was a significant correlation between mean coagulation factor consumption and the number of arthropathies in patients over 5 years old. Conclusions: This profile analysis of patients with hemophilia reflects a gradual improvement in treatment safety and efficiency, as well as the need for continued investment in this population.

Orientador : Fausto Berzin Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba Resumo: Os ruídos articulares do joelho esquerdo normal de 43 indivíduos jovens de ambos os sexos, sendo 20 do sexo masculino e 23 do sexo feminino, foram analisados através da técnica artrosonográfica. As gravações destes ruídos obtidas em uma sala acústica, onde buscamos diminuir e foram evitar os possiveis ruidos extrinsecos as gravaçoes. Estes ruidos foram transportados posteriormente para um gravador de rolo acoplado a um eletromiógrafo, de onde obtivemos a análise dos ruídos articulares, tanto as suas características sonoras quanto as suas características visuais, observadas na tela do eletromiógrafo. O parâmetro de medida utilizado na classificação dos ruídos articulares foi a intensidade sonora que reproduziu-se na tela do.eletromiógrafo de três maneiras distintas: 1) curvas de fraca intensidade para os joelhos do tipo suave; 2) curvas de média intensidade para os joelhos do tipo moderado e 3) curvas de forte intensidade para os jolhos do tipo intenso. Os ruídos articulares comuns aos três tipos articulares classificados, caracterizaram-se na forma de chiados, rangidos, creptações, estalos e estalidos Abstract: The joint sounds of normal left knee of 43 young persons of both sex being 20 male and 23 female were analyzed through the ar~hrophonographic technique. The recording of these sounds were taken in a acoustic room where we tried to decrease and avoid any outside noises. These sounds, later were transfered to a tape record attached.to:a electromyograph from were we took the analysis of the joínt sounds as in theirs characteristic sounds as in their visual characteristics observed from the screen of the electromyograph. The paraxreter of measure used to classify the joint sounds wasthesonorous intensity that reproduced in the screen of theelectromyograph in three'distinct 'ways: 1) waves of weak intensity for knees type smooth; 2) waves of medium intensity for knees type moderate and 3) waves of strong intensity for knees , t;ype intense. The cornrnonjoint sounds to the threetype classifled are presented in the form of creaking, grinding, grating, crackling and claping Mestrado Biologia e Patologia Buco-Dental Mestre em Odontologia

A artrose e a artrite reumatóide (AR) são doenças articulares caracterizadas por mecanismos fisiopatológicos diferentes, porém com sintomas clínicos bem parecidos, o que inclui dor articular, comprometimento da função da articulação afetada além de danos estruturais que são caracterizados por osteófitos na artrose e erosões ósseas na AR. Os principais tratamentos da AR incluem medicamentos conhecidos por provocarem efeitos colaterais diversos como osteoporose, susceptibilidade à infecções, efeitos metabólicos, alto índice de toxicidade, além do alto custo geral do tratamento. Com isso, o laser de baixa potência (LBP) surge como uma opção terapêutica que pode auxiliar na redução e resolução do processo inflamatório, diminuindo o tempo de utilização de medicamentos, custos e melhorando a qualidade de vida dos pacientes. Diante disso, o objetivo deste trabalho foi avaliar a ação do LBP na resolução do processo inflamatório induzido por zymosan em modelo experimental animal. Foram avaliados os efeitos do LBP infravermelho (830nm, 10mW, modo contínuo de emissão da luz), compranado duas fluências (3J/cm2 e 30J/cm2 ) e tempos de tratamento (24h, 48h e 72h) na resolução do processo inflamatório. Camundongos C57BL/6 foram distribuídos nos seguintes grupos: ZY- Artrite induzida; ZY + Dexa– artrite induzida e tratada com dexametasona; ZY + 3 J/cm2 artrite induzida e tratada com laser 3 J/cm2 ; e ZY + 30 J/cm2 artrite induzida e tratada com laser 30 J/cm2 . Para cada grupo descrito, 3 tempos de tratamentos foram utilizados: 24h, 48h e 72h, ou seja, 1, 2 ou 3 sessões de LBP ou dexametasona, respectivamente. O número de animais por subgrupo foi de 5, totalizando 60 animais. O zymosan foi aplicado próximo a região talo crural e subtalar de ambos membros posteriores dos camundongos. Os resultados revelaram grande influxo de células inflamatórias, predominantemente de polimorfonucleares no tecido conjuntivo adjacente a articulação após 24h do primeiro tratamento, fato esse que persistiu ainda nos grupos com duas sessões de tratamento (48h). Uma redução no infiltrado inflamatório foi observada nos grupos que foram tratados por 3 dias consecutivos (72h), em especial aqueles tratados com fluência 30 J/cm2 e dexametasona. Observou-se que os grupos tratados com dexametasona e LBP na fluência de 30J/cm2 apresentaram uma tendência de redução da inflamação em todos os tempos testados (24h, 48h e 72h) quando comparado aos seus respectivos grupos ZY, apesar de nenhuma diferença estatística ser encontrada (p>0,05). Já o grupo 3J/cm2 apresentou uma leve redução na sua área inflamatória, somente a partir do tempo 48h e não apresentou também diferenças estatísticas quando comparados ao grupo não tratado (ZY) (p>0,05). Adicionalmente, após 48h, o grupo ZY aumentou sua área de inflamação, podendo indicar que nesse tempo ocorra o ápice do processo inflamatório nesse modelo experimental. Nossos resultados demonstram que a terapia com LBP tende a reduzir o processo inflamatório a partir de 48h de tratamento na maior fluência (30 J/cm2 ), enquanto na menor fluência (3 J/cm2 ) o efeito anti-inflamatória é mais lento. A fluência de 30 J/cm2 apresenta comportamento anti-inflamatório semelhante a medicamentos utilizados em patologias inflamatórias, como por exemplo a dexametasona. Arthrosis and rheumatoid arthritis (RA) are joint diseases characterized by different pathophysiological mechanisms. However, they may present remarkably similar clinical symptoms, including pain and function loss of joint and structural damage, characterized by osteophytes in arthrosis and bone erosion in RA. The main treatments for RA include drugs which cause several side effects such as osteoporosis, susceptibility to infections, metabolic effects, and high toxicity. In general terms, such treatments can represent high cost to governments. Therewith, the low-level laser therapy (LLLT) appears as therapeutic option which may be helpful in inflammatory process resolution, reducing medication use time, costs and quality of life improving. Therefore, the aim was to evaluate LLLT inflammatory process resolution zymosan induced. Infrared laser parameters were: 830nm, 10mW, continuous light emission mode, purchased two energy densities (3J/cm2 and 30J/cm2 ) and treatment times (24h, 48h and 72h). C57BL/6 mice were distributed into groups: ZY- arthritis induced; ZY + Dexa – arthritis induced and treated with dexamethasone; ZY + 3 J/cm2 – arthritis induced and treated with LLLT at 3 J/cm2 ; and ZY + 30 J/cm2 - arthritis induced and treated with LLLT at 30 J/cm2 . For each group described, 3 treatment times were used: 24h, 48h and 72h (1, 2 or 3 LLLT sessions or dexamethasone, respectively). The number of animals per subgroup was 5, totalling 60 animals. The zymosan was injected in crural and subtalar regions, both mice hind limbs. The results demonstrated inflammatory cells influx, predominantly polymorphonuclear in connective tissue adjacent after 24 hours, persisting after two treatment sessions both LLLT and dexamethasone groups (48 hours). Decrease of inflammatory infiltrate was observed in groups treated for 3 consecutive days (72h), especially with LLLT at 30 J/cm2 and dexamethasone. It was observed that dexamethasone and LLLT at 30J/cm2 treatments showed tendency to reduce inflammation at all times tested (24h, 48h and 72h) when compared with untreated group (ZY), although no statistical differences were observed (p>0.05). On the other hand, LLLT at 3J/cm2 showed slight reduction in inflammatory area, only from 48h and it did also not present statistical differences when compared with untreated group (ZY) (p>0.05). Additionally, after 48 hours, ZY group increased its inflammation area. This finding may indicate the inflammatory process peak for this experimental model. Our results demonstrate that LLLT tends to reduce the inflammatory process after 48 hours at the highest energy density (30 J/cm2 ), while at the lowest energy density (3 J/cm2 ) the anti-inflammatory effect was slower. LLLT at 30J/cm2 presents anti-inflammatory behaviour similar to drugs used in inflammatory pathologies, such as dexamethasone.

Orientador: Manoel Barros Bértolo Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: Objetivo: Avaliar sinovite pelo ultrassom (US) articular em pacientes com artrite reumatóide (AR) inicial e correlacionar com os dados clínicos, radiográficos e laboratoriais. Pacientes e Métodos: Este estudo avaliou 832 articulações de 32 pacientes (24 mulheres e 8 homens) com AR inicial selecionados no período de 2008 a 2010 do ambulatório de artrite da Universidade Estadual de Campinas, caracterizado por 20 (62.5%) caucasóides e 12 (37.5%) não caucasóides; um tempo médio de doença de 13 meses, com média de idade de 42 anos. Nesta amostra foram detectadas, pelas escalas semiquantitativas cinza (SG) e pelo power Doppler (PD), 173 articulações com sinovite de grau 0 a 3. Foi usado um ultrassom GE LOGIQ XP-linear de alta frequência (8-10 MHz). Todas as mãos foram radiografadas e analisadas pelo score de Larsen com variação de grau entre 0 a V. Resultados: Este estudo evidenciou correlações significativas e positivas entre os dados ultrassonográficos, clínicos e laboratoriais: SGUS e PDUS do punho D e PCR (r=0.41 a 0.42), SGUS do 3ªMTF D, 4ªMTF D com o HAQ - DI (r=0.37 a 0.38), SGUS do 4ªMTF E e o PCR (r=0.42), SGUS do 2ªMTF D e o FR (r=0.40), SGUS-Score 7mod com o DAS28 (PCR) (r=0.38) e o PDUS-Score 7mod com o PCR (r=0.39). Houve correlações significativas negativas com o SGUS 2ªMTCF D com a dose e o tempo de uso MTX (r=-0.36 a -0.37). O PCR nesta amostra pode ser considerado um indicador de atividade inflamatória quando existe sinovite detectada pelo US. Conclusão: A utilização do US mostrou ser uma importante ferramenta na avaliação de AR inicial e dá um suporte mais seguro no diagnóstico para iniciativas terapêuticas mais precisas e seletivas Abstract: This study evaluated 832 joints of 32 patients (24 women and 8 men) with early RA enrolled for the period 2008 to 2010 of the arthritis clinic of the Universidade Estadual de Campinas (UNICAMP), characterized by 20 (62.5%) Caucasians, 12 (37.5%) non-Caucasians, an average disease was 13 months, with a mean age of 42 years. This sample was detected by semi-quantitative gray scale (GS) and power Doppler (PD) 173 joints with synovitis of degree 0 to 3. It was used a GE LOGIQ XP-linear ultrasound and high frequency (8-10 MHz) transducer. All hands were X-rayed and analyzed by the Larsen score, with grades ranging from 0 to V. This study showed positive and significant correlation between sonographic, clinical and laboratory data: GSUS/PDUS of right wrist and CRP (r = 0.41 to 0.42), GSUS of the right 3ºMTP, GSUS of the right 4ºMTP and HAQ - DI (r = 0.37 to 0.38), GSUS of the left 4ºMTP and CRP (r = 0.42), GSUS of the right 2ºMTP and FR (r = 0.40), GSUS 7mod-score with the DAS28 (CRP) (r = 0.38) and PDUS 7mod-Score to CRP (r = 0.39). There was a significant negative correlation with the right 2ºMCP with dose and duration of MTX use (r = -0.36 to -0.37). The CRP in this sample can be considered an indicator of inflammatory activity, when analyzed separately or with all the joints committed. Using the US was an important tool in the evaluation of RA and gives a more secure support for initiatives in the diagnosis and treatment more precise and selective Doutorado Clínica Médica Doutor em Clínica Médica

Background Recurrent hemarthrosis that begin in childhood lead to progressive joint deterioration. Patients with haemophilia have chronic pain, functional disability and a reduced perception of health-related quality of life. Purpose To analyse the perceived quality of life of adult patients with haemophilic arthropathy and its relationship with pain, joint condition, kinesiophobia and catastrophism. Methods Eighty-three adult patients with haemophilia were included in this multicentre, cross-sectional, descriptive study. Perceived quality of life (36-Item Short Form Health Survey), perceived usual and maximum pain (visual analogue scale), joint condition (Haemophilia Joint Health Score), kinesiophobia (Tampa Scale of Kinesiophobia) and catastrophism (Pain Catastrophizing Scale) were assessed. Sociodemographic, clinical and therapeutic variables and drug consumption for pain control were collected. Descriptive statistics used means and standard deviations. The correlation of quality of life with the dependent variables was calculated with the Pearson correlation test. The differences in quality of life as a function of the binomial variables were calculated with Student’s t-test for independent samples. Results Physical component of quality of life perceived by patients with hemophilia is lower than Spanish population (30.51 VS 48.85). Regarding the mental component, patients with hemophilia showed higher values (56.07 VS 49.97). Catastrophism correlated (p p r = -.18; p > .05). Habitual and maximal joint pain correlated with all items except to role-emotional (r = − .19 and r = − .09, respectively) and mental component score (r = − .16 and r = − .07, respectively). Catastrophism and weekly drug intake were inversely correlated with quality of life. Age was positively correlated with perceived quality of life. There were differences in quality of life as a function of the severity of haemophilia and the intake of drugs for pain control. Conclusions The perceived quality of life of adult patients with haemophilia is worse than that of the Spanish population. Pain, kinesiophobia, catastrophism, haemophilia severity and the intake of pain-control medication influence the quality of life of these patients.

Background: Chronic joint injury of the elbow joint is common in patients with hemophilia. Myofascial release is used for the management of pain and functionality in patients with chronic restrictions. Objective: To evaluate the effectiveness of myofascial release in patients with hemophilic elbow arthropathy. Methods: Sixty-nine patients with hemophilia took part in this randomized controlled trial. They were recruited from 10 hemophilia patient Associations. They were randomly allocated to experimental (n = 35) or control group (n = 34). The intervention consisted of three 50-min sessions of fascial therapy over a 3-week period. The intervention included 11 bilaterally administered maneuvers in both upper limbs (from shoulder girdle to forearm). The study variables were frequency of elbow bleeding (self-report), joint status (Hemophilia Joint Health Score), and joint pain (visual analog scale) at baseline, after the intervention, and at the 3-month follow-up. Results: There were significant changes (P < .001) in the repeated measures factor in the frequency of hemarthrosis (F = 20.64), joint status (F = 31.45), and perceived joint pain (F = 30.08). We found group interaction with the (P < .001) in the frequency of hemarthrosis (F = 21.57), joint status (F = 99.98), and perceived joint pain (F = 44.26). There were changes (P < .01) in the pairwise comparison analysis between the pretreatment assessment and the posttreatment and follow-up assessments. Conclusions: Myofascial release decreases frequency of elbow bleedings, and improved joint status and perception of elbow pain in patients with hemophilic elbow arthropathy. Myofascial release may be recommended to improve joint status and joint pain in patients with hemophilic elbow arthropathy. Sin financiación 1.889 JCR (2020) Q3, 99/167 Medicine, General & Internal 0.590 SJR (2020) Q2, 1149/2448 Medicine (miscellaneous) No data IDR 2020 UEM

Background Hemophilic arthropathy is characterized by loss of function and chronic pain. Fascial therapy mobilizes the connective tissue, intervening in the state of the injured fascial complex and the surrounding tissues. Objectives The aim of this study is to evaluate the safety of a physiotherapy program through fascial therapy in adult patients with hemophilic ankle arthropathy. Design Prospective cohort study. Methods Twenty-three adult patients with hemophilia from 26 to 65 years of age were recruited. The intervention consisted of three sessions of 45-minute fascial therapy for three consecutive weeks. An evaluation was carried out before as well as after treatment. The study variables were joint status (assessed with Hemophilia Joint Health Score), joint pain (using visual analogue scale), ankle range of motion (with a universal goniometer) and bleeding frequency (administering self-registration of bleeding). The mean difference was calculated using the Student's t-test for paired samples and using the Cohen formula we calculated the effect size of the dependent variables. Results None of the patients developed muscular or articular bleeding during the treatment period. After treatment, significant improvements (p

Introduction: Numerous measuring instruments for the evaluation of hemophilic arthropathy have been developed. One of the most used systems is the Hemophilia Joint Health Score (HJHS) given its sensitivity to clinical changes appearing in the joints because of recurrent hemarthrosis. Objective: Assessing the interrater reliability, using the Spanish version of the HJHS (version 2.1) in children with hemophilia. Design: Reliability study to assess the interrater reliability of the Spanish version of HJHS. Methods: A sample of 36 children aged 7–13 years diagnosed with hemophilia A or B was used. Two physiotherapists performed physical assessments with the Spanish version of the HJHS. Descriptive statistics (range, mean, standard deviation) and the analysis of interrater reliability were calculated. Results: The interrater reliability was heterogeneous since the Kappa coefficient range (ĸ), although significant (p < 0.001), ranged 0.31–1.00 in the variables of HJHS (swelling, duration of swelling, muscle atrophy, crepitus on motion, flexion loss, extension loss, joint pain, strength, and global gait). In assessing the bias of observers with the Bland and Altman method, the observer 1 scored 0.41 (CI [−0.67, 1.49]) units above observer 2, and the difference between the two was significant (t(36) = 4.48), p < 0.001). Conclusions: The interrater reliability of the Spanish population version of the HJHS is high. This scale should be used generically in evaluating musculoskeletal pediatric patients with hemophilia. Sin financiación 1.624 JCR (2019) Q2, 39/68 Rehabilitation 0.601 SJR (2019) Q2, 67/213 Physical Therapy, Sports Therapy and Rehabilitation No data IDR 2019 UEM

To compare quality of life (according to the SF-12) in patients with rotator cuff arthropathy with controls paired by sex and age. Secondary objectives are to compare the groups according to the ASES and VAS scales.This cross-sectional study with controls paired by sex and age compared patients with rotator cuff arthropathy with surgical indication for reverse shoulder arthroplasty. The groups were compared according to the SF-12, ASES, and VAS scales.The groups consisted of 38 individuals, 28 women. The SF-12 demonstrated a significant difference in the physical component, with the cases scoring 31.61 ± 6.15 and the controls 49.39 ± 6.37 (p0.001). For the mental component, the difference was not significant, with the cases scoring 44.82 ± 13.18 and the controls 48.96 ± 8.65 (p=0.109). The cases scored 7.34 ± 2.11 on the VAS and 31.26 ± 15.12 on the ASES, while the controls scored 0.55 ± 1.31 and 97.53 ± 6.22, respectively (p0.001).Patients with rotator cuff arthropathy had poorer results for the physical component of the SF-12 than the controls. They also had poorer functional results according to the ASES scale, and more pain according to the VAS.Comparar a qualidade de vida, de acordo com o SF-12, entre pacientes com artropatia do manguito rotador e controles pareados por sexo e idade. É objetivo secundário a comparação dos grupos de acordo com as escalas ASES e EVA.Estudo transversal com controles pareados por sexo e idade, que comparou pacientes com artropatia do manguito rotador e indicação de artroplastia reversa do ombro com indivíduos sadios. Os grupos foram comparados quanto às escalas SF-12, ASES e EVA.Os grupos foram formados por 38 indivíduos, sendo 28 do sexo feminino. O SF-12 apresentou diferença significativa no componente físico, tendo os casos registrado 31,61 ± 6,15 e os controles 49,39 ± 6,37 (p0,001). Para o componente mental, a diferença não foi significativa, tendo os casos apresentado 44,82 ± 13,18 e os controles 48,96 ± 8,65 (p=0.109). Os casos apresentaram EVA de 7,34 ± 2,11 e ASES de 31,26 ± 15,12, enquanto os controles apresentaram 0,55 ± 1,31 e 97,53 ± 6,22, respectivamente (p0,001).Os pacientes com artropatia do manguito rotador apresentam piores resultados no componente físico do SF-12 quando comparados aos controles. Têm, ainda, piores resultados funcionais pela escala da ASES e mais dor pela EVA.

ResumoObjetivoAvaliar os resultados clínicos e radiológicos e o impacto na qualidade de vida da artroplastia reversa do ombro.MétodosSérie de casos retrospectiva que avaliou 13 pacientes submetidos à artroplastia reversa do ombro com seguimento clínico mínimo de dois anos. Foi feita avaliação clínica antes e após a cirurgia com as escalas da American Shoulder and Elbow Surgeons (ASES) e escala visual analógica (EVA) e as manobras funcionais mão‐boca, mão‐nuca e mão‐cabeça. A qualidade de vida foi aferida com o questionário 12‐Item Short‐Form Health Survey (SF‐12). Registramos o índice de complicações e o aspecto radiográfico pós‐operatório.ResultadosOs pacientes evoluíram de 23,1±15 para 82,7±15 pela escala da ASES (p < 0,001). O componente físico do SF‐12 passou de 31,7±6,9 para 47,1±8,6 (p

Objective To compare screw fixation strength for subtalar arthrodesis. Methods Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP Group), and the other foot, plantar to dorsal orientation (PD Group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix ® 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD Groups using Student’s t test, with p=0.05 used to determine statistical significance. Results Statistical analysis demonstrated that the mean torque to failure slightly favored the DP Group (37.3Nm) to the PD Group (32.2Nm). However, the difference between the two groups was not statistically significant (p=0.55). Conclusion In subtalar arthrodesis, there is no significant difference in construct strength between dorsal-to-plantar and plantar-to-dorsal screw orientation. The approach chosen by the surgeon should be based on factors other than the biomechanical strength of the screw orientation. RESUMO Objetivo Comparar a força de fixação dos parafusos para artrodese subtalar. Métodos Oito pares de pés de cadáveres frescos foram submetidos à artrodese da articulação subtalar com dois parafusos canulados de 7,3mm. A randomização foi usada para atribuir a orientação do parafuso, de modo que um pé em cada par foi designado com orientação de dorsal para plantar (Grupo DP), e o outro pé com orientação de plantar para dorsal (Grupo PD). Técnica cirúrgica padrão com radioscopia foi usada para os procedimentos. Após a fixação, cada amostra foi testada até a falha com um dispositivo Bionix®858 MTS, aplicando força axial descendente a uma distância para criar torque. O torque de falha foi comparado entre os Grupos DP e PD, usando o teste t de Student, com p=0,05 usado para determinar significância estatística. Resultados A análise estatística demonstrou que a média do torque até a falha favoreceu ligeiramente o Grupo DP (37,3Nm) em relação ao PD (32,2Nm). No entanto, a diferença entre os dois grupos não foi estatisticamente significativa (p=0,55). Conclusão Na artrodese subtalar, não há diferença significativa na força de compressão entre as orientações dos parafusos dorsal-plantar e plantar-dorsal. A abordagem escolhida pelo cirurgião deve ser baseada em outros fatores, sem preocupação com a força biomecânica da orientação dos parafusos.

ResumoObjetivoDescrever a ocorrência de artrite séptica glenoumeral em pacientes com artropatia do manguito rotador, bem como destacar a importância do correto diagnóstico e procedimento cirúrgico.MetologiaForam feitas oito drenagens cirúrgicas em sete pacientes com pioartriteglenoumeral. Todos os pacientes apresentavam artropatia do manguito rotador (quatro do sexo masculino e três do feminino). Seis pacientes apresentavam pioartrite no ombro dominante, a idade variou de 53 a 93 anos (média de 74 anos). A duração media dos sintomas antes da lavagem cirúrgica foi de seis semanas. Seis pacientes foram submetidos ao tratamento com a combinação de irrigação artroscópica e desbridamento, um paciente foi tratado por artrotomia aberta. Todos os pacientes receberam antibioticoterapia sistêmica de acordo com a sensibilidade bacteriana.ResultadosOs sete pacientes obtiveram resultados satisfatórios, se levarmos em consideração principalmente a melhoria da dor e a satisfação dos pacientes. A avaliação funcional foi feita por meio da escala da Universidade da Califórnia em Los Angeles (UCLA). Apenas um paciente precisou passar por um novo procedimento artroscópico, em quatro culturas foi isolado o Staphylococcus aureus, em uma cultura a Escherichia coli e em duas situações, nas quais os pacientes usavam antibioticoterapia empírica, essas culturas tiveram resultado negativo. Entre os procedimentos associados fez‐se quatro tenotomias do bíceps, uma ressecção do 1/3 lateral da clavícula devido àosteomielite e uma artrotomia do joelho.ConclusãoO tratamento cirúrgico foi eficaz nos casos de artrite associada a artropatia do manguito rotador. Sempre suspeitar, em pacientes com artropatia do manguito rotador com sinais subclínicos e laboratoriais alterados, da possibilidade de uma pioartrite.AbstractObjectiveTo describe occurrences of septic glenohumeral arthritis among patients with arthropathy of the rotator cuff, and to highlight the importance of correct diagnosis and surgical procedures.MethodologyEight surgical drains were installed in seven patients with glenohumeral pyoarthritis. All the patients presented arthropathy of the rotator cuff (four males and three females). Six patients presented pyoarthritis in the dominant shoulder. The age range was from 53 to 93 years (mean: 74 years). The mean duration of the symptoms before the surgical lavage was six weeks. Six patients underwent treatment consisting of a combination of arthroscopic irrigation and debridement, and one patient was treated by means of open arthrotomy. All the patients received systemic antibiotic therapy in accordance with their bacterial sensitivity.ResultsAll seven patients achieved satisfactory results, taking into consideration especially the improvement of pain and the patients’ satisfaction. The functional assessment was performed using the University of California Los Angeles (UCLA) scale. Only one patient needed to go through another arthroscopic procedure. Staphylococcus aureus was isolated from four cultures and Escherichia coli from one culture. There were two situations in which the patients used empirical antibiotic therapy and the cultures showed negative results. Among the associated procedures, tenotomy of the biceps was performed in four cases, resection of the lateral third of the clavicle due to osteomyelitis in one case and arthrotomy of the knee in one case.ConclusionSurgical treatment was effective in the cases of arthritis associated with arthropathy of the rotator cuff. In patients with arthropathy of the rotator cuff and subclinically altered laboratory signs, the possibility of pyoarthritis should always be suspected.

Se presenta el caso clínico de una paciente de 38 años que padece una úlcera neuropática infectada en pie derecho (Charcot). Tras 6 semanas de tratamiento combinando antibiote-rapia, cura en ambiente húmedo y descarga con bota óptima, se logra la epitelización y resolu-ción definitiva de la lesión. The clinical case of a 38-year-old patient who has an infected neuropathic ulcer right foot (Charcot), is presented. After 6 weeks of treat-ment combining antibiotic therapy, cure in a humid environment and discharge with optimal boot, epithelialization and definitive resolution of the lesion is achieved. Enfermería

Background: The primary clinical manifestations of hemophilia are muscle and joint bleeding. Recurrent bleeding leads to a degenerative process known as hemophilic arthropathy. Fascial therapy is one of the most used physiotherapy techniques today to improve joint dysfunctions and chronic pain. Objective: To assess the safety and efficacy of fascial therapy treatment in patients with hemophilic arthropathy of ankle and knee. Design: Non-randomized, controlled clinical trial. Intervention: Sixteen patients with hemophilia were allocated to an experimental group or to a control group. The physiotherapy intervention was performed through three sessions (one per week), for 60 min per session. Patients received a physiotherapy treatment using a fascial therapy protocol for patients with hemophilia. Main outcome measures: The joint status was evaluated using the Hemophilia Joint Health Score; pain was assessed with the Visual Analogue Scale; the range of movement was evaluated using a universal goniometer; the flexibility of the hamstring muscles was assessed with the fingertip-to-floor, and the lumbar mobility through the Schöber test. Results: We observed significant differences in the experimental group for both quality of life and illness behavior. There was no significant improvement in the joint status; however, an improvement was noted in terms of perception of pain in the ankle. Conclusions: A physiotherapy program based on fascial therapy is safe in patients with hemophilia. Fascial therapy may improve joint status, pain, and mobility in patients with hemophiliac arthropathy of the knee and ankle. Sin financiación 1.158 JCR (2018) Q4, 49/65 Rehabilitation 0.536 SJR (2018) Q2, 80/209 Physical Therapy, Sports Therapy and Rehabilitation No data IDR 2018 UEM

Background: The main clinical manifestations of hemophilia are muscle and joint bleeding. Recurrent bleeding leads to a degenerative process known as hemophilic arthropathy. The development of inhibitors (antibodies against FVIII/FIX concentrates) is the main complication in the treatment of hemophilia. The objective was to assess the safety and efficacy of manual therapy treatment in a patient with hemophilia and inhibitor. Case presentation: A 26-year-old patient with hemophilia B and inhibitor received physiotherapy treatment based on manual therapy for 3 months, with a frequency of 2 sessions per week. The joint status was evaluated using the Hemophilia Joint Health Score; pain was assessed with the Visual Analog Scale; and the range of movement was evaluated using a universal goniometer. The patient developed no joint bleeding in the knees or ankles as a result of the physiotherapy treatment. Following treatment, improvements were noted in the range of movement of knees and ankles, the perception of pain in both knees, and ankle functionality. Conclusions: Until now, manual therapy using joint traction was contraindicated in patients with hemophilia and inhibitor, as it was feared to cause possible joint bleeding. This is the first case study to address the safety and efficacy of manual therapy in a patient with hemophilia and an inhibitor. The results of this study may help to establish which manual therapy treatments are indicated in patients with hemophilic arthropathy and inhibitors. Thus, a physiotherapy program based on manual therapy may be safe in patients with hemophilia and inhibitor and such therapy may improve joint condition, pain, and joint range of motion in patients with hemophilia and inhibitor. Randomized clinical trials are needed to confirm the results of this case study. Sin financiación 2.002 JCR (2018) Q2, 34/76 Orthopedics 0.880 SJR (2018) Q2, 73/289 Orthopedics and Sports Medicine No data IDR 2018 UEM

Objective To verify the safety and effectiveness of manual therapy intervention using fascial therapy in adult patients with haemophilic elbow arthropathy. Methods Prospective cohort study. A total of 28 patients with haemophilic elbow arthropathy was recruited in 3 cities in Spain. Patients received one-fascial therapy session per week for 3 weeks. The dependent variables were: frequency of joint bleeding, joint pain (visual analogue score) and joint status (Hemophilia Joint Health Score). Outcomes were measured at baseline (T0), post-treatment (T1) and after 3 months’ follow-up (T2). Using Student’s t-test, the means obtained in the evaluations were compared. The analysis of variance (ANOVA) test of repeated measures provided the intra-subject effect. The chosen level of significance was p < 0.05. Results A total of 28 patients were recruited according to the selection criteria. No joint bleeding occurred during or after the intervention. The primary outcome, frequency of bleeding, improved after intervention (p

OBJECTIVE: to present a retrospective analysis on the clinical-functional results and complications among patients with rotator cuff arthropathy (RCA) who underwent reverse arthroplasty of the shoulder.METHODS: patients with a diagnosis of RCA associated with pseudoparalysis of anterior elevation who underwent reverse arthroplasty of the shoulder with a minimum follow-up of one year were selected.RESULTS: preoperative information was gathered from our shoulder and elbow arthroplasty register, comprising age, sex, laterality, history of previous procedures, Constant's functional scores and the preoperative range of motion as described in the protocol of the American Academy of Shoulder and Elbow Surgery (ASES). After a mean follow-up of 44 months, 17 patients (94%) were satisfied with the result from the procedure.CONCLUSION: reverse arthroplasty for treating RCA in patients with pseudoparalysis of the shoulder was shown to be effective in achieving a statistically significant improvement in range of motion regarding anterior flexion and abduction. However, in this series, there was no improvement in range of motion regarding external and internal rotation. Reverse arthroplasty is a procedure that reestablishes shoulder joint function in patients who previously did not present any therapeutic possibilities. OBJETIVO: apresentar uma análise retrospectiva dos resultados clínico-funcionais e das complicações dos pacientes com artropatia do manguito rotador (AMR) submetidos à artroplastia reversa do ombro.MÉTODOS: foram selecionados pacientes com diagnóstico de AMR associada à pseudoparalisia da elevação anterior submetidos à artroplastia reversa do ombro com seguimento mínimo de um ano.RESULTADOS: foram coletadas informações pré-operatórias, por meio do nosso Registro de Artroplastias do Ombro e Cotovelo, que consistiam em idade, sexo, lateralidade, história de procedimentos prévios, escores funcionais de Constant, além da amplitude de movimentos pré-operatórios, conforme protocolo da American Academy of Shoulder and Elbow Surgery (Ases). Com seguimento médio de 44 meses, 17 pacientes (94%) estavam satisfeitos com o resultado do procedimento.CONCLUSÃO: a artroplastia reversa no tratamento da AMR em pacientes com pseudoparalisia do ombro demonstrou-se efetiva na melhoria, com significância estatística, da amplitude de movimentos de flexão anterior e abdução. Porém, nesta série não houve melhoria da amplitude dos movimentos de rotação externa e interna. A artroplastia reversa é um procedimento que restabelece a função da articulação do ombro em pacientes que previamente não apresentavam possibilidades terapêuticas.

ResumoObjetivoapresentar uma análise retrospectiva dos resultados clínico‐funcionais e das complicações dos pacientes com artropatia do manguito rotador (AMR) submetidos à artroplastia reversa do ombro.Métodosforam selecionados pacientes com diagnóstico de AMR associada à pseudoparalisia da elevação anterior submetidos à artroplastia reversa do ombro com seguimento mínimo de um ano.Resultadosforam coletadas informações pré‐operatórias, por meio do nosso Registro de Artroplastias do Ombro e Cotovelo, que consistiam em idade, sexo, lateralidade, história de procedimentos prévios, escores funcionais de Constant, além da amplitude de movimentos pré‐operatórios, conforme protocolo da American Academy of Shoulder and Elbow Surgery (Ases). Com seguimento médio de 44 meses, 17 pacientes (94%) estavam satisfeitos com o resultado do procedimento.Conclusãoa artroplastia reversa no tratamento da AMR em pacientes com pseudoparalisia do ombro demonstrou‐se efetiva na melhoria, com significância estatística, da amplitude de movimentos de flexão anterior e abdução. Porém, nesta série não houve melhoria da amplitude dos movimentos de rotação externa e interna. A artroplastia reversa é um procedimento que restabelece a função da articulação do ombro em pacientes que previamente não apresentavam possibilidades terapêuticas.AbstractObjectiveto present a retrospective analysis on the clinical‐functional results and complications among patients with rotator cuff arthropathy (RCA) who underwent reverse arthroplasty of the shoulder.Methodspatients with a diagnosis of RCA associated with pseudoparalysis of anterior elevation who underwent reverse arthroplasty of the shoulder with a minimum follow‐up of one year were selected.Resultspreoperative information was gathered from our shoulder and elbow arthroplasty register, comprising age, sex, laterality, history of previous procedures, Constant's functional scores and the preoperative range of motion as described in the protocol of the American Academy of Shoulder and Elbow Surgery (ASES). After a mean follow‐up of 44 months, 17 patients (94%) were satisfied with the result from the procedure.Conclusionreverse arthroplasty for treating RCA in patients with pseudoparalysis of the shoulder was shown to be effective in achieving a statistically significant improvement in range of motion regarding anterior flexion and abduction. However, in this series, there was no improvement in range of motion regarding external and internal rotation. Reverse arthroplasty is a procedure that reestablishes shoulder joint function in patients who previously did not present any therapeutic possibilities.

Objetivo: Revisar las bases del tratamiento de las enfermedades reumáticas (artritis reumática, artritis psoriásica y espondiloartritis) con medicamentos biológicos, las estrategias de optimización basadas en la reducción de dosis/ampliación del intervalo posológico en pacientes con buen control y evaluar el nivel de implementación de esta estrategia en pacientes del Hospital Universitario Virgen del Rocío (HUVR), y los resultados obtenidos. Determinar el impacto económico que supone la implementación de la estrategia. Materiales y métodos: Estudio observacional retrospectivo de 840 pacientes con enfermedades reumáticas que estuvieran en tratamiento con fármacos biológicos en el HUVR de Sevilla durante el año 2016. Se recogieron las variables necesarias para caracterizar a los pacientes y su tratamiento a través de Diraya® y APD® (Athos Pharma) en el servicio de farmacia hospitalaria del hospital. Resultados: Se incluyeron 840 pacientes. El 46,5% presentaba optimización de dosis. Optimización según diagnóstico: artritis reumatoide (46%), artritis psoriásica (55,4%) y espondiloartritis (39,8%). Optimización según fármaco: Etanercept (66,1%), Adalimumab (37,1%), Golimumab (36,8%), Tocilizumab (72,2%), Certolizumab pegol (24,4%), Abatacept (16,7%), Secukinumab (0%), Infliximab (8,5%). Las pautas más empleadas fueron 25mg de Etanercept una vez por semana y 40 mg de Adalimumab cada 3 semanas. El impacto económico de la estrategia generó un ahorro de 1.568.086€ durante el año 2016. Conclusiones: La optimización terapéutica fue llevada a cabo en el 46,5% de los pacientes, hecho que supera a otros estudios similares con los que se compararon resultados. Se consiguió una alta efectividad en la estrategia ya que el 82,2% de los pacientes optimizados continuaron con la terapia con éxito. Además del beneficio económico para la sostenibilidad el sistema sanitario, dicha reducción posológica genera una mejor adherencia al tratamiento por parte de los pacientes e incrementa en ellos una mejor calidad de vida. Universidad de Sevilla. Grado en Farmacia

[Objetivo] Desarrollar criterios para determinar las indicaciones apropiadas de la prótesis invertida de hombro en artropatías por lesión del manguito rotador y las variables determinantes de este proceso., [Método] Se utilizó un panel de expertos mediante metodología RAND/UCLA con 9 expertos en Traumatología, 2 en Rehabilitación y 1 en Reumatología, que evaluaron 192 casos hipotéticos. Cada experto puntuó mediante una escala del 1 (extremadamente inadecuado) al 9 (extremadamente apropiado)., [Resultados] 22 casos hipotéticos fueron considerados adecuados. El dolor, limitación funcional, necesidad funcional, defecto glenoideo, edad, artrosis y posibilidad de reparación del manguito rotador son variables determinantes para indicar la implantación de una prótesis invertida de hombro., [Conclusiones] El método RAND/UCLA es útil para el estudio de las indicaciones de procedimientos como la prótesis invertida de hombro, y proporciona una lista de las indicaciones adecuadas. Las variables requieren ser validadas mediante estudios prospectivos o revisión de historias clínicas., [Objective] Develop criteria to determine the appropriate indications of inverted shoulder prosthesis in arthropathies due to rotator cuff injury and the variables that determine this process., [Method] A panel of experts assessed 192 hypothetical cases using RAND/UCLA methodology. Nine Traumatology experts, two Rehabilitation experts and one Rheumatology expert comprised this panel. Each expert scored on a scale from 1 (extremely unsuitable) to 9 (extremely appropriate)., [Results] 22 hypothetical cases were considered adequate. Pain, functional limitation, functional need, glenoid defect, age, osteoarthritis and possibility of rotator cuff repair are determining as variables to indicate the implantation of an inverted shoulder prosthesis., [Conclusions] The RAND/UCLA method is useful for the study of procedure indications such as the inverted shoulder prosthesis, and it provides a list of suitable indications. Prospective studies or medical record reviews should validate these variables., [Objectif] Proposer les critères définissant l’indication appropriée de prothèse d’épaule inversée dans les arthropathies pour lésion de la coiffe des rotateurs, et les variables déterminant ce processus., [Méthodes] Un panel d’experts, compris par 9 traumatologues, 2 kinésithérapeutes et 1 rhumatologue, a été utilisé pour évaluer 192 cas hypothétiques par la méthode RAND/UCLA. Chaque expert a fait son évaluation sur une échelle de 1 (extrêmement inapproprié) à 9 (extrêmement approprié)., [Résultats] Vingt-deux cas hypothétiques ont été considérés comme appropriés. Des variables telles que la douleur, la limitation fonctionnelle, la nécessité fonctionnelle, le défaut glénoïdien, l’âge, l’arthrose et la possibilité de correction de la coiffe des rotateurs, ont déterminé l’indication de prothèse d’épaule inversée., [Conclusions] La méthode RAND-UCLA est utile pour l’étude des indications de procédés, tels que la prothèse d’épaule inversée, et procure une liste des indications appropriées. Il faut valider les variables avec des études prospectives ou une révision des dossiers médicaux., Este trabajo ha sido financiado por el Ministerio de Sanidad, Servicios Sociales e Igualdad a través del plan de calidad para el Sistema Nacional de Salud.

OBJETIVO: Avaliar os resultados da artroplastia parcial de ombro tipo CTA® para o tratamento da artropatia degenerativa do manguito. MÉTODOS: De dezembro de 2006 a junho de 2009, 23 ombros de 23 pacientes foram submetidos à artroplastia parcial tipo CTA® para o tratamento de artropatia por lesão do manguito rotador. O tempo de seguimento pós-operatório variou de seis a 35 meses. A idade média foi de 74,1 anos. Houve predomínio do sexo feminino em 78,3% dos casos. O membro direito foi acometido em 18 pacientes. Todos os pacientes foram submetidos, sem melhora dos sintomas, ao tratamento fisioterápico prévio por pelo menos seis meses e foram submetidos à cirurgia pela mesma equipe cirúrgica. Nenhum dos pacientes havia realizado cirurgia prévia no ombro afetado. A avaliação dos pacientes no seguimento pós-operatório seguiu os critérios do escore da UCLA. RESULTADOS: Verificou-se melhora da dor em todos pacientes após a artroplastia. Pelo escore da UCLA, a média de pontos em relação à dor foi de 9,22 (variando de 10 a oito). Quanto à função, a média foi de seis (10 a dois). Encontramos nesses pacientes média de 2,39 na flexão frontal ativa (quatro a zero). Na força de flexão frontal a média foi de 4,09 com máxima de cinco e mínima de três. A média de pontos do escore da UCLA foi de 26,52. Noventa e cinco porcento dos pacientes ficaram satisfeitos com a cirurgia. CONCLUSÃO: A artroplastia parcial de ombro tipo CTA® tem resultados satisfatórios no tratamento da artropatia degenerativa do manguito rotador e apresenta baixa taxa de complicação.

OBJETIVO: Avaliar os resultados obtidos com a artroplastia parcial de ombro para o tratamento da artropatia por lesão do manguito rotador. MÉTODOS: No período de junho de 1989 a março de 2004, 11 ombros de 11 pacientes foram submetidos a artroplastia parcial de ombro para o tratamento de artropatia por LMR. O tempo de seguimento variou de 27 a 183 meses, com média de 69 meses. A idade média foi de 69,1 anos, variando de 44 a 78 anos. Houve predomínio do sexo feminino em 90,9% dos casos (10 pacientes). O membro dominante foi acometido em 10 pacientes. Os métodos escolhidos para avaliação dos pacientes, no seguimento pós-operatório, basearam-se nos critérios da UCLA; no índice de satisfação dos pacientes em relação ao alívio da dor; e no método de avaliação de objetivos limitados, proposto por Neer et al. RESULTADOS: O índice de satisfação dos pacientes em relação ao alívio da dor foi de 81,8%. Com o método de avaliação da UCLA, observamos média de 22,7 pontos. Por meio do método de avaliação de objetivos limitados, proposto por Neer et al, obtivemos seis pacientes com resultados satisfatórios e cinco insatisfatórios. CONCLUSÃO: A artroplastia parcial de ombro para o tratamento da artropatia por lesão do manguito rotador promove alívio do quadro doloroso e permite alguma melhora na função do membro para realização das atividades diárias; entretanto, é uma técnica que leva a altos índices de resultados insatisfatórios. OBJECTIVE: To evaluate the results achieved with partial arthroplasty of the shoulder to treat arthropathy due to rotator cuff lesion. METHODS: From June 1989 to March 2004, 11 shoulders of 11 patients were submitted to partial arthroplasty of the shoulder to treat an arthropathy due to rotator cuff lesion. Follow-up time varied from 27 to 182 months, with a mean of 69 months. Mean age was 69.1 years, ranging from 44 to 78 years. There was a predominance of the female gender, in 90.9% of the cases (10 patients). The dominant member was involved in 10 patients. The methods chosen to evaluate the patients in follow-up were based on UCLA criteria; on patient satisfaction indices regarding pain relief; and on limited objective evaluation method proposed by Neer et al. RESULTS: The patient satisfaction index regarding pain relief was 81.8%. With the UCLA evaluation method, the authors observed a mean score of 22.7 points. With the limited objective evaluation method proposed by Neer et al, they had six patients with satisfactory results and five with unsatisfactory results. CONCLUSION: Partial arthroplasty of the shoulder to treat an arthropathy due to rotator cuff lesion brings pain relief and allows for some improvement in limb function for daily activities, however, the technique has high indices of unsatisfactory results.

OBJECTIVE: To describe occurrences of septic glenohumeral arthritis among patients with arthropathy of the rotator cuff, and to highlight the importance of correct diagnosis and surgical procedures. METHODOLOGy: Eight surgical drains were installed in seven patients with glenohumeral pyoarthritis. All the patients presented arthropathy of the rotator cuff (four males and three females). Six patients presented pyoarthritis in the dominant shoulder. The age range was from 53 to 93 years (mean: 74 years). The mean duration of the symptoms before the surgical lavage was six weeks. Six patients underwent treatment consisting of a combination of arthroscopic irrigation and debridement, and one patient was treated by means of open arthrotomy. All the patients received systemic antibiotic therapy in accordance with their bacterial sensitivity. RESULTS: All seven patients achieved satisfactory results, taking into consideration especially the improvement of pain and the patients' satisfaction. The functional assessment was performed using the University of California Los Angeles (UCLA) scale. Only one patient needed to go through another arthroscopic procedure. Staphylococcus aureus was isolated from four cultures and Escherichia coli from one culture. There were two situations in which the patients used empirical antibiotic therapy and the cultures showed negative results. Among the associated procedures, tenotomy of the biceps was performed in four cases, resection of the lateral third of the clavicle due to osteomyelitis in one case and arthrotomy of the knee in one case. CONCLUSION: Surgical treatment was effective in the cases of arthritis associated with arthropathy of the rotator cuff. In patients with arthropathy of the rotator cuff and subclinically altered laboratory signs, the possibility of pyoarthritis should always be suspected. RESUMO OBJETIVO: Descrever a ocorrência de artrite séptica glenoumeral em pacientes com artropatia do manguito rotador, bem como destacar a importância do correto diagnóstico e procedimento cirúrgico. METOLOGIA: Foram feitas oito drenagens cirúrgicas em sete pacientes com pioartriteglenoumeral. Todos os pacientes apresentavam artropatia do manguito rotador (quatro do sexo masculino e três do feminino). Seis pacientes apresentavam pioartrite no ombro dominante, a idade variou de 53 a 93 anos (média de 74 anos). A duração media dos sintomas antes da lavagem cirúrgica foi de seis semanas. Seis pacientes foram submetidos ao tratamento com a combinação de irrigação artroscópica e desbridamento, um paciente foi tratado por artrotomia aberta. Todos os pacientes receberam antibioticoterapia sistêmica de acordo com a sensibilidade bacteriana. RESULTADOS: Os sete pacientes obtiveram resultados satisfatórios, se levarmos em consideração principalmente a melhoria da dor e a satisfação dos pacientes. A avaliação funcional foi feita por meio da escala da Universidade da Califórnia em Los Angeles (UCLA). Apenas um paciente precisou passar por um novo procedimento artroscópico, em quatro culturas foi isolado o Staphylococcus aureus, em uma cultura a Escherichia coli e em duas situações, nas quais os pacientes usavam antibioticoterapia empírica, essas culturas tiveram resultado negativo. Entre os procedimentos associados fez-se quatro tenotomias do bíceps, uma ressecção do 1/3 lateral da clavícula devido àosteomielite e uma artrotomia do joelho. CONCLUSÃO: O tratamento cirúrgico foi eficaz nos casos de artrite associada a artropatia do manguito rotador. Sempre suspeitar, em pacientes com artropatia do manguito rotador com sinais subclínicos e laboratoriais alterados, da possibilidade de uma pioartrite.

RESUMEN: La artritis reumatoide (AR) disminuye la actividad física, afecta la funcionalidad social e incrementa el estrés psicológico, con el subsecuente deterioro de la calidad de vida. Objetivo: caracterizar las publicaciones sobre calidad de vida en pacientes con AR. Materiales y métodos: revisión sistemática de la literatura, en cuatro bases multidisciplinarias de datos, a partir de un protocolo exhaustivo y reproducible; los análisis se basaron en frecuencias. Resultados: se caracterizaron 244 investigaciones; 55,3% hechas en Europa y 25,4%, en América, de las cuales el 60% fueron en Estados Unidos; 59% fueron evaluaciones de la calidad de vida como desenlace primario; 29,1%, estudios de intervención con medición de la calidad de vida como desenlace secundario; y 11,9%, estudios de validación de escalas. Los principales instrumentos de medición fueron Medical Outcome Study Short-Form 36 (51,6%) y Stanford Health Assessment Questionnaire (39,7%). Alrededor de la mitad de los estudios no hicieron clasificación clínica de los pacientes con AR. Conclusión: los resultados evidencian el interés creciente por investigar la calidad de vida de pacientes con AR, la disponibilidad de múltiples escalas genéricas y específicas para su estudio y la concentración de las publicaciones en Europa y Norteamérica. ABSTRACT: Rheumatoid arthritis (RA) decreases physical activity, affects functionality, and increases social and psychological stress, with subsequent deterioration in the quality of life. Objective: To characterize the literature on quality of life in patients with RA. Methods: Systematic review of the literature in four multidisciplinary databases, using a comprehensive and reproducible protocol; analyses were based on frequencies. Results: 244 studies were characterized, out of them 55.3% were done in Europe and 25.4%, in America, of which 60% were form the United States; 59% corresponded to assessments of quality of life as the primary outcome; 29.1% were intervention studies that measured quality of life as secondary outcome, and 11.9% were scale validation studies. The primary measurement tools were Medical Outcome Study Short - Form 36 (51.6%) and Stanford Health Assessment Questionnaire (39.7%). About half of the studies did not do clinical staging of patients with RA. Conclusion: Our results demonstrate the interest to investigate the quality of life in patients with RA, the availability of multiples generic and specific scales for such purpose, and the concentration of publications in Europe and North America. Key words: Health; Quality of Life; Rheumatoid Arthritis; Systematic Review. RESUMEN: La artritis reumatoide (AR) disminuye la actividad física, afecta la funcionalidad social e incrementa el estrés psicológico, con el subsecuente deterioro de la calidad de vida. Objetivo: caracterizar las publicaciones sobre calidad de vida en pacientes con AR. Materiales y métodos: revisión sistemática de la literatura, en cuatro bases multidisciplinarias de datos, a partir de un protocolo exhaustivo y reproducible; los análisis se basaron en frecuencias. Resultados: se caracterizaron 244 investigaciones; 55,3% hechas en Europa y 25,4%, en América, de las cuales el 60% fueron en Estados Unidos; 59% fueron evaluaciones de la calidad de vida como desenlace primario; 29,1%, estudios de intervención con medición de la calidad de vida como desenlace secundario; y 11,9%, estudios de validación de escalas. Los principales instrumentos de medición fueron Medical Outcome Study Short-Form 36 (51,6%) y Stanford Health Assessment Questionnaire (39,7%). Alrededor de la mitad de los estudios no hicieron clasificación clínica de los pacientes con AR. Conclusión: los resultados evidencian el interés creciente por investigar la calidad de vida de pacientes con AR, la disponibilidad de múltiples escalas genéricas y específicas para su estudio y la concentración de las publicaciones en Europa y Norteamérica. COL0088881

Patellofemoral pain syndrome (PFPS) is a prevalent clinical condition and it affects gait behavior. Braking and propulsive impulses are important biomechanical parameters obtained from ground reaction forces (GRF), which combine the amount of force applied over a period of time. The aim of this study was to evaluate these impulses while walking up and down stairs in healthy controls and PFPS individuals. The results did not reveal significant differences in braking and propulsive impulses between groups during these activities. Thus, the painful condition on a simple functional activity was insufficient to change the motor strategy to walking up or down the stairs. "Análise dos impulsos de frenagem e de propulsão em indivíduos com síndrome da dor femoropatelar durante subida e descida de degraus." A síndrome da dor femoropatelar (SDFP) é uma condição clínica prevalente e que afeta o comportamento da marcha. Impulsos de frenagem e propulsão são importantes parâmetros biomecânicos obtidos a partir da força de reação do solo que combinam a quantidade de força aplicada sobre um período de tempo. O objetivo deste estudo foi avaliar esses impulsos durante a subida e descida de degraus em indivíduos controle saudáveis e com SDFP. Os resultados não revelaram diferenças significativas nos impulsos de frenagem e propulsão entre os grupos durante essas atividades. Assim, a condição dolorosa em uma atividade funcional simples foi insuficiente para modificar a estratégia motora de descer ou subir degraus. "Análisis de los impulsos de frenado y propulsión en la personas con síndrome de dolor patelofemoral durante la actividad de subir y bajar un escalón." El Síndrome de dolor patelofemoral (SDPF) es una condición médica prevalente que afecta al comportamiento de la marcha. Impulso de propulsión y de frenado son parámetros biomecánicos importantes obtenidos a partir de la fuerza de reacción del suelo que combinan la cantidad de fuerza aplicada durante un período de tiempo. El objetivo del estudio fue evaluar estos impulsos durante las actividades de subir y bajar un escalón en sujetos sanos y con SDP. Los resultados no mostraron diferencias significativas en los impulsos de frenado y propulsion entre los grupos durante las actividades. Por lo tanto, Por lo tanto, la condición dolorosa en una actividad funcional simple, no fue suficiente para cambiar la estratégia de subir y bajar un escalón.

Sin financiación 3.590 JCR (2018) Q2, 23/73 Hematology 1.163 SJR (2018) Q1, 32/135 Hematology No data IDR 2018 UEM

Sin financiación 3.590 JCR (2018) Q2, 23/73 Hematology 1.163 SJR (2018) Q1, 32/135 Hematology No data IDR 2018 UEM

Systemic lupus erythematosus is a disease that affects women predominantly, with variable manifestations. This is a case report on a young male patient that debuts with lupus arthropathy, variety Jaccoud’s arthropathy. We review the clinical characteristics of lupus in males and the differences with the disease in females. El lupus eritematoso sistémico es una enfermedad que afecta predominantemente a mujeres, presentándose con manifestaciones variables. Esta comunicación de caso trata sobre un paciente varón joven, que debuta con artropatía lúpica, variedad artropatía de Jaccoud. Se realiza una revisión de la literatura acerca de las características clínicas del lupus en el varón y sus diferencias con el cuadro clínico en la mujer.

Sin financiación 2.990 JCR (2019) Q2, 32/76 Hematology 1.151 SJR (2019) Q1, 29/134 Hematology No data IDR 2019 UEM

Se realizó un estudio descriptivo-retrospectivo de los pacientes con diagnóstico de síndrome de Reiter tratados en el Servicio Nacional de Reumatología en un período de 2 años; el grupo inicial estuvo formado por 23 pacientes, del que se excluyeron 6 por no resultar útiles o concluyentes. Se estudiaron los elementos generales de esta artropatía, los signos clínicos más frecuentes del síndrome, las alteraciones de laboratorio y las radiológicas presentes durante el ingreso, la forma de evolución de la enfermedad y la terapéutica empleada. Se comprobó que todos los pacientes fueron hombres con una edad promedio de 22,7 años, la forma posdisentérica fue la más frecuente y la rodilla, la localización inflamatoria predominante. El antígeno mayor de histocompatibilidad HLA B 27 estuvo presente en 11 de los 14 pacientes en que se indicó. Se resaltó la respuesta satisfactoria con el uso de la indometacina.A descriptive and retrospective study of the patients with diagnosis of Reiter´s syndrome treated at the National Service of Rheumatology during 2 years was conducted. The initial group was composed of 23 patients, of whom 6 were excluded since they were not useful or concluding. The general elements of this arthropathy, the most frequent clinical signs of the syndrome, the laboratory and radiological alterations observed during admission, the evolution of the disease and the therapeutic used were studied. It was found that all patients were males with an average age of 22.7 % yearse old. The postdysenteryc form was the commonest and the knee was the predominant inflammatory localization. The greatest HLA B 27 histocompatibility antigen was present in 11 of the 14 patients that received it. The satisfactory response obtained with the use of indomethacin was stressed.