Chronic osteomyelitis: what the surgeon needs to know

Chronic osteomyelitis represents a progressive inflammatory process caused by pathogens, resulting in bone destruction and sequestrum formation. It may present with periods of quiescence of variable duration, whereas its occurrence, type, severity and prognosis is multifactorial. The ‘gold standard’ for the diagnosis of chronic osteomyelitis is the presence of positive bone cultures and histopathologic examination of the bone. Its management remains challenging to the treating physician, with a multidisciplinary approach involving radiologists, microbiologists with expertise in infectious diseases, orthopaedic surgeons and plastic surgeons. Treatment should be tailored to each patient according the severity and duration of symptoms, as well as to the clinical and radiological response to treatment. A combined antimicrobial and surgical treatment should be considered in all cases, including appropriate dead space management and subsequent reconstruction. Relapse can occur, even following an apparently successful treatment, which has a major impact on the quality of life of patients and is a substantial financial burden to any healthcare system

O modal cicloviário na cidade de Pato Branco – PR: análise do atual sistema cicloviário e das vias do anel central

Visando o desenvolvimento sustentável das cidades, este trabalho tem por objetivo avaliar a infraestrutura cicloviária existente na cidade de Pato Branco – PR, bem como, analisar uma área delimitada dentro da região central da cidade com foco na implantação de uma rota cicloviária. Para a avaliação da infraestrutura cicloviária existente, utilizou-se de forma parcial a ferramenta IMUS – Índice de Mobilidade Urbana Sustentável. Já para a análise das vias, fez-se uso das ferramentas: Nível de Stress de Sorton e Walsh e Índice de Condição das Vias (ICV) de Epperson-Davis. Cruzando os resultados obtidos pelas ferramentas e a avaliação subjetiva realizada em campo, apresentou-se a classificação final das vias em um mapa síntese. Concluiu-se, a respeito do sistema cicloviário atual, que este não está sendo pensado de forma integrada. Em relação à área delimitada na região central, verificou-se que a maior parte das vias possui grande potencial em comportar rotas cicloviárias.Aiming at the sustainable development of cities, this study aims to evaluate the existing bicycle infrastructure in the city of Pato Branco - PR, as well as to analyze a delimited area within the central region of the city focusing on the implementation of a cycleway route. For the evaluation of the existing bicycle infrastructure, the IMUS - Urban Sustainable Mobility Index tool was used in a partial way. For the analysis of the routes, the following tools were used: Sorton and Walsh Stress Level and Epperson-Davis Road Conditions Index (ICV). Crossing the results obtained by the tools and the subjective evaluation performed in the field, the final classification of the pathways was presented in a synthesis map. It was concluded, regarding the current cycle system, that this is not being thought in an integrated way. In relation to the area delimited in the central region, it was verified that most of the roads have great potential in behaving cycleway routes

Produção e validação de tecnologia educativa

Anais do II Seminário Seminário Estadual PIBID do Paraná: tecendo saberes / organizado por Dulcyene Maria Ribeiro e Catarina Costa Fernandes — Foz do Iguaçu: Unioeste; Unila, 2014As ações educativas em saúde requerem planejamento, organização e sistematização. Nem sempre o processo educativo conta com materiais adequados para sua efetivação. Objetiva-se expor, a partir de referencial bibliográfico, o processo de produção e validação de tecnologias educativas que envolvem seis etapas. Na primeira realiza-se a produção da tecnologia educativa; na segunda a elaboração de um projeto e encaminhamento ao Comitê de Ética em Pesquisa; na terceira selecionam- se os juízes para avaliar se a tecnologia produzida está ou não adequada às suas finalidades; na quarta etapa, a tecnologia deve submeter-se à avaliação do grupo alvo; na quinta, o profissional realiza a análise das sugestões e procede a discussão; na sexta etapa ocorre a produção final da tecnologia. Este movimento permite qualificar a produção e validação de tecnologias disponibilizando material adequado as ações educativa

Retos de economía política en los servicios de agua potable: El proceso de reforma en Perú

El presente documento analiza la organización del sistema de Agua Potable y Desagüe en el Perú, en el marco de los términos de referencia proporcionados por la Red de Centros de Investigación del Banco Interamericano de Desarrollo. El sistema de Agua Potable y Desagüe en el Perú atraviesa desde 1990 por un proceso de transición de una estructura centralizada a otra de carácter descentralizada para la mayoría de localidades donde las Municipalidades Provinciales tienen la responsabilidad de prestar dicho servicio, mientras el mercado más importante, Lima Metropolitana (la capital del país) depende del Gobierno Central. Dicho proceso de transición está asociado a dos gobiernos sucesivos y de orientaciones económicas contrapuestas. El propósito de este documento es analizar el comportamiento del sector durante la transición, con especial énfasis en los elementos que inciden en el menor avance del proceso de reforma del sector de saneamiento en comparación con los que se ejecutan en otras áreas de la economía. Parte del proceso de reforma contempla el aporte al sector de organismos multilaterales, como los del Banco Mundial para la empresa SEDAPAL, que abastece a Lima Metropolitana, y recursos del Banco Interamericano de Desarrollo, destinados a empresas municipales. En ambos casos, se prevé que en los próximos años, los organismos multilaterales continúen financiando la rehabilitación del sector.

Assessment of clinical trial quality and its impact on meta-analyses

OBJECTIVE: To evaluate whether different quality assessment tools applied to a group of clinical trials could be correlated, and what would be their impact on meta-analysis results. METHODS: Thirty-eight randomized controlled clinical trials were analyzed. These had been selected for a systematic review of the therapeutic efficacy of alpha interferon for treating chronic hepatitis B. The following tools were utilized: Maastricht (M), Delphi (D), Jadad (J) and the Cochrane Collaboration (CC) method (gold standard). The Spearman correlation coefficient was used to compare the results from the three methods. The Kappa test was used to assess the concordance between the reviewers in applying the tools, and the weighted Kappa test was applied to compare the quality ranking determined by the tools. The outcomes assessed in the meta-analyses were clearance of HBV-DNA and HBeAg. RESULTS: The studies presented regular to low quality. The concordance between reviewers varied according to the instrument utilized: D=0.12; J=0.29; M=0.33; and CC=0.53. The correlation was moderate and homogeneous (D/J=0.51; D/M=0.53; and J/M=0.52). Thje meta-analysis result relating to HBV-DNA ranged from RR=0.71 (95% CI: 0.66-0.77) to RR=0.67 (95% CI: 0.58-0.79). For HBeAg, the results ranged from RR=0.85 (95% CI: 0.80-0.90) to RR=0.85 ( 95% CI: 0.77-0.93). These results depended on the quality of the studies included. CONCLUSIONS: The quality assessment tools presented good correlation. In systematic reviews with the same direction of effect, the quality assessment may not significantly change the results. The Cochrane Collaboration method was the most reproducible method and easiest to apply.OBJETIVO: Analisar se diferentes instrumentos de avaliação de qualidade, aplicados a um grupo de estudos clínicos que se correlacionam e qual seu impacto no resultado na metanálise. MÉTODOS: Foram analisados 38 estudos clínicos randomizados e controlados, selecionados para a revisão sistemática sobre a eficácia terapêutica do Interferon Alfa no tratamento da hepatite crônica pelo vírus B. Utilizaram-se os seguintes instrumentos: Maastricht (M), Delphi (D) e Jadad (J) e o método da Colaboração Cochrane (CC), considerado padrão-ouro. Os resultados definidos pelos três instrumentos foram comparados pelo teste de Correlação de Spearman. O teste de Kappa (K) avaliou a concordância entre os revisores na aplicação dos instrumentos e o teste de Kappa ponderado analisou o ordenamento de qualidade definido pelos instrumentos. O clareamento do HBV-DNA e HbeAg foi o desfecho avaliado na metanálise. RESULTADOS: Os estudos foram de regular e baixa qualidade. A concordância entre os revisores foi, de acordo com o instrumento: D=0.12, J=0.29 e M=0.33 e CC= 0,53. A correlação foi moderada e homogênea (D/J=0,51; D/M=0,53 e J/M=0,52). Os resultados da metanálise (HBV-DNA), variaram de RR=0,71; IC 95%: 0,66-0,77 a RR=0,67; IC 95%: 0,58-0,79 e (HbeAg) de RR=0,85; IC 95%: 0,80-0,90 a RR=0,85; IC 95%:0,77-0,93, dependendo da qualidade dos estudos incluídos. CONCLUSÕES: Os instrumentos de avaliação de qualidade têm boa correlação. Nas revisões sistemáticas que apontem à mesma direção do efeito, a avaliação pode não alterar significantemente seu resultado. O método da Colaboração Cochrane é o mais reprodutível e de simples aplicação.Faculdade Estadual de Medicina de MaríliaUniversidade Federal do Rio Grande do NorteUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Effects of commercial apple varieties on human gut microbiota composition and metabolic output using an in vitro colonic model

Apples are a rich source of polyphenols and fiber. A major proportion of apple polyphenols escape absorption in the small intestine and together with non-digestible polysaccharides reach the colon, where they can serve as substrates for bacterial fermentation. Animal studies suggest a synergistic interaction between apple polyphenols and the soluble fiber pectin; however, the effects of whole apples on human gut microbiota are less extensively studied. Three commercial apple varieties-Renetta Canada, Golden Delicious and Pink Lady-were digested and fermented in vitro using a batch culture colonic model (pH 5.5-6.0, 37 °C) inoculated with feces from three healthy donors. Inulin and cellulose were used as a readily and a poorly fermentable plant fiber, respectively. Fecal microbiota composition was measured by 16S rRNA gene Illumina MiSeq sequencing (V3-V4 region) and Fluorescence in Situ Hybridization. Short chain fatty acids (SCFAs) and polyphenol microbial metabolites were determined. The three apple varieties significantly changed bacterial diversity, increased Actinobacteria relative abundance, acetate, propionate and total SCFAs (p < 0.05). Renetta Canada and Golden Delicious significantly decreased Bacteroidetes abundance and increased Proteobacteria proportion and bifidobacteria population (p < 0.05). Renetta Canada also increased Faecalibacterium prausnitzii, butyrate levels and polyphenol microbial metabolites (p < 0.05). Together, these data suggest that apples, particularly Renetta Canada, can induce substantial changes in microbiota composition and metabolic activity in vitro, which could be associated with potential benefits to human health. Human intervention studies are necessary to confirm these data and potential beneficial effects

Intercultural exchange in late antique historiography

Late Antiquity is the land of plenty for scholars interested in intercultural exchange, and yet the subject still lacks systematical investigation. The study of late antique historiography allows for a particularly rewarding approach. Late antique historiographical texts testify to contemporary attitudes towards contacts between different cultures, religions, languages; but they were also impacted on by intercultural exchange, mostly in the form of translation or adaptation of sources imported from other cultural areas. The six contributions gathered in this volume present case studies focused on the Mediterranean region and Western Asia, crossing religious, linguistic and political borders in a chronological framework that goes from the fourth to the eleventh centuries. Besides showcasing the results that can be harvested with such a twofold analytical approach to late antique historiography, they also pinpoint the methodological challenges researchers are likely to meet when venturing in the mainly uncharted field of intercultural exchange in Late Antiquity

Impact of ageing and a synbiotic on the immune response to seasonal influenza vaccination; a randomised controlled trial

Background & Aims Ageing increases risk of respiratory infections and impairs the response to influenza vaccination. Pre- and probiotics offer an opportunity to modulate anti-viral defenses and the response to vaccination via alteration of the gut microbiota. This study investigated the effect of a novel probiotic, Bifidobacterium longum bv. infantis CCUG 52486, combined with a prebiotic, gluco-oligosaccharide, on the B and T cell response to seasonal influenza vaccination in young and older subjects. Methods In a double-blind, randomized controlled trial, 58 young (18-35y) and 54 older (60-85y) subjects were supplemented with the synbiotic for 8 weeks. At 4 weeks they were administered with a seasonal influenza vaccine. B and T cell phenotype and responsiveness to in vitro re-stimulation with the vaccine were assessed at baseline, 4, 6 and 8 weeks. Results B and T cell profiles differed markedly between young and older subjects. Vaccination increased numbers of memory, IgA+ memory, IgG+ memory and total IgG+ B cells in young subjects, but failed to do so in older subjects and did not significantly alter T cell subsets. Seroconversion to the H1N1 subunit in the older subjects was associated with higher post-vaccination numbers of plasma B cells, but seroconversion was less consistently associated with T cell phenotype. B and T cell subsets from both young and older subjects demonstrated a strong antigen-specific recall challenge, and although not influenced by age, responsiveness to the recall challenge was associated with seroconversion. In older subjects, CMV seropositivity was associated with a significantly lower recall response to the vaccine, but the synbiotic did not affect the responsiveness of B or T cells to re-stimulation with influenza vaccine. Conclusions Antigen-specific B and T cell activation following an in vitro recall challenge with the influenza vaccine was influenced by CMV seropositivity, but not by a synbiotic

Gobernanza territorial y acciones de desarrollo local en el valle de Río Chico (Río Chico, Argentina) (2004-2014)

El territorio de estudio fue el valle de Río Chico. Ubicado en Suroeste de la Región Sur de la Provincia de Río Negro. Por medio de la revisión teórica y la sistematización de las experiencias de intervención como agente de desarrollo de la AER INTA Ingeniero Jacobacci, se logró ajustar el procedimiento de investigación pertinente para este espacio micro-local. La tesis se concentró en los comportamientos e interacciones entre la Comisión de Fomento, la Cooperativa Agrícola Ganadera Nuevo Río y la “Mesa Técnica” de Río Chico. Fueron elegidas por ser las instituciones que orientan el desarrollo local del Paraje y estar transitando procesos de transformación internas y de sus formas de articulación con el medio (translimites). La Comisión de Fomento se democratiza, la Mesa técnica refuerza su conocimiento sobre el área y la Cooperativa se constituye como una organización formal. El eje de análisis la investigación fueron el estudio de las acciones territoriales que evidencian las representaciones y las estrategias de los actores que interactúan en el Territorio. Los conceptos desarrollados fueron las Acciones Territoriales (Bustos Cara, 2008), la Identidad Colectiva (Melucci, 1999) y la conformación de un Sistema de Acción Público (Beslay et al, 1998). Las perspectivas de la Gobernanza Territorial (Bustos Cara, 2008; Farinó Fasí, 2008) y de la Sociología de las Organizaciones (Crozier y Frieberg, 1990) fueron centrales para entender la distribución de poder a nivel micro-local y en las relaciones regionales en un contexto de la Nueva Ruralidad (Echeverri y Perico, 2002). Las hipótesis centrales de la investigación fueron: 1- “Las interacciones entre la Comisión de Fomento, la Cooperativa Agrícola Ganadera Río Chico Lda. y la Mesa Técnica, conforman la Gobernanza Territorial como la forma de mediar entre las demandas de los pobladores y la Acción Política de todas las escalas territoriales. 2-"El campo de relaciones de poder conforma un Sistema de Acción Pública”. 3- "La trayectoria de la Gobernanza Local aporta a la comprensión de la complejidad de las Acciones Territoriales que contribuyen a la conformación de la Cohesión Territorial”. Para guiar al proceso de investigación, nos propusimos como objetivo: “Analizar los procesos socio-organizativos en su relación con la construcción de un Sistema de Acción Pública Local a partir de la constitución de una Comisión de Fomento con capacidad política territorial y autonomía relativa”. Y de la misma manera: “Observar el desarrollo y las formas de articulación entre la esfera socio-económica (COOPERATIVA), la dimensión política (Comisión de Fomento) y la dimensión técnica (Mesa técnica)”. La construcción del Territorio de Río Chico sobre la base de nuevas reglas en la relación de la sociedad con el Estado y con actores orientados hacia el Desarrollo Local se da en un ambiente donde la inestabilidad es una constante y coexisten relaciones de rivalidad y cooperación. En el campo de relaciones de poder interaccionan con la presentación de oportunidades y las posibilidades de solucionar problemas. Las reflexiones en torno al caso, brindaron elementos para comprender la gobernanza democrática local, y los Sistemas de Acción Pública Local. Además se obtuvieron elementos para analizar la Cohesión Territorial local a través de las Acciones Territoriales. Los fenómenos meteorológicos adversos re dinamizan al Sistema de Acción Pública local. Las políticas de riego y sobre el equipamiento de la COOPERATIVA; como así sobre la construcción de cobertizos, fueron experiencias basadas en la necesidad de superar las crisis agropecuarias. El segundo ejemplo, tiene el ingrediente extra de evidenciar la fuerza centrípeta que genera el patrimonio local del equipo agro mecánico por la convergencia de intereses sociales, técnicos y políticos. En la tesis se emplea la figura de “aparecer en la FOTO” para graficar el proceder mencionado. Otro aporte pretendido es de carácter teórico. Pudimos distinguir del concepto de Territorio dos dimensiones. La primera corresponde a la distinción de la teoría de desarrollo territorial como una visión más o menos compartida. Por otra parte, se encuentra la dimensión sobre la forma de intervención en el mismo y como ámbito de las políticas públicas (Bustos Cara 2014). La primera acepción permite un análisis integral (Bustos Cara 2014). La segunda interpreta cómo enfrentar las diversas dificultades en el entramado social. Donde la distribución del poder es un fenómeno complejo. La trayectoria de las estrategias de los actores podría permitir acercarse a la lógica del proceso. La reestructuración del Estado y la fragmentación institucional, legitima la centralidad de la acción, “todo tiende a resolverse en la acción” (Bustos Cara, 2008, pág. 50).Facultad de Ciencias Agrarias y Forestale

La “descrizione dei tempi” all’alba dell’espansione islamica

The 7-8th centuries are commonly believed tohave beena stagnant phase of Byzantine historiography. This book investigates the writing of history in Greek and Syriacduring this period through the study of four later chronicles which used lost 7-8th-century sources. The materials shared by these texts shed light on the sources themselves and on the practice of "memory keeping" among Christians in such a crucial age