Early Debridement, antibiotics and implant retention (DAIR) in patients with suspected acute infection after hip or knee arthroplasty - safe, effective and without negative functional impact

Introduction: Debridement, antibiotics and implant retention (DAIR) is known to be effective in treating acute periprosthetic joint infection (PJI). However, deciding to perform additional surgery in the early postoperative period may be challenging as there is the concern of adding morbidity and clinical presentation is often subtle. We mean to assess the impact of early DAIR on final functional outcome. Methods: A case-control comparison was performed between patients that underwent DAIR for suspected PJI between 2010-2016 and controls randomly selected (1:2 ratio) from a list of primary joint replacements. Patients were matched for anatomic site, age, gender, American Society of Anesthesiologists (ASA) classification, body mass index and follow-up time. The outcome of surgical treatment and complications were assessed and Hip disability and Osteoarthritis Outcome Score (HOOS) or Knee injury and Osteoarthritis Outcome Score (KOOS) were performed. Results: Thirty-eight cases were included at a mean follow-up of 42 months. Infection was not confirmed in one patient. There was one infection related-death and three other cases of treatment failure that required a two-stage revision. Overall success rate was 89.2%. There were no significant patient reported differences regarding final functional outcome between both groups: pain 91±6 vs. 87±13; other symptoms 90±8 vs. 90±9; activities of day living 86±8 vs. 85±14; sport 63±13 vs. 57±16; quality of life 78±17 vs. 76±16. Discussion: These findings support that DAIR for suspected acute PJI is safe, effective and causes no impact on final functional results. Thus, a low threshold for assuming infection and subsequent DAIR may safely be adopted in the early postoperative period.info:eu-repo/semantics/publishedVersio

Reproductive output, foraging destinations, and isotopic niche of olive ridley and loggerhead sea turtles, and their hybrids, in Brazil

Hybridization is a fundamental evolutionary and ecological process with significant conservation ramifications. Sea turtle hybridization occurs at unusually high frequencies along the northeastern coast of Brazil. To better understand the process, we studied the reproductive output, migration patterns (through satellite telemetry), and isotopic niches of loggerhead turtles Caretta caretta and olive ridley turtles Lepidochelys olivacea and their hybrids. We classified 154 nesting females as loggerhead (n = 91), olive ridley (n = 38), or hybrid (n = 25) based on mitochondrial and nuclear DNA. Further, we compared nesting female morphological data and reproductive parameters (clutch size, emergence success, hatchling production, incubation period) of 405 nests among hybrids and parental species. We found no significant differences among the 3 groups when hatchling production was corrected for female body size, indicating that hybrids and parental species produce similar numbers of hatchlings per clutch. Satellite tracking of 8 post-nesting hybrid females revealed shared foraging grounds with both parental species, as well as neritic migrations between foraging and nesting areas similar to those previously reported for loggerheads and olive ridleys. Analyses of 13C and 15N isotope values (n = 69) further confirmed this pattern, as hybrid isotopic niches overlapped extensively with both parental species. Thus, given the similarities presented between hybrids and their parental species in reproductive, ecological, and behavioral characteristics, we conclude that these hybrids may persist along with other sea turtle nesting populations in the area, with research and conservation implications. © The authors 2021. Open Access under Creative Commons by Attribution Licence. Use, distribution and reproduction are unrestricted. Authors and original publication must be credited

Resolving the ancestry of Austronesian-speaking populations

There are two very different interpretations of the prehistory of Island Southeast Asia (ISEA), with genetic evidence invoked in support of both. The “out-of-Taiwan” model proposes a major Late Holocene expansion of Neolithic Austronesian speakers from Taiwan. An alternative, proposing that Late Glacial/postglacial sea-level rises triggered largely autochthonous dispersals, accounts for some otherwise enigmatic genetic patterns, but fails to explain the Austronesian language dispersal. Combining mitochondrial DNA (mtDNA), Y-chromosome and genome-wide data, we performed the most comprehensive analysis of the region to date, obtaining highly consistent results across all three systems and allowing us to reconcile the models. We infer a primarily common ancestry for Taiwan/ISEA populations established before the Neolithic, but also detected clear signals of two minor Late Holocene migrations, probably representing Neolithic input from both Mainland Southeast Asia and South China, via Taiwan. This latter may therefore have mediated the Austronesian language dispersal, implying small-scale migration and language shift rather than large-scale expansion

Subclinical thyroid dysfunction and cognitive decline in old age

<p>Background: Subclinical thyroid dysfunction has been implicated as a risk factor for cognitive decline in old age, but results are inconsistent. We investigated the association between subclinical thyroid dysfunction and cognitive decline in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER).</p> <p>Methods: Prospective longitudinal study of men and women aged 70–82 years with pre-existing vascular disease or more than one risk factor to develop this condition (N = 5,154). Participants taking antithyroid medications, thyroid hormone supplementation and/or amiodarone were excluded. Thyroid function was measured at baseline: subclinical hyper- and hypothyroidism were defined as thyroid stimulating hormones (TSH) <0.45 mU/L or >4.50 mU/L respectively, with normal levels of free thyroxine (FT4). Cognitive performance was tested at baseline and at four subsequent time points during a mean follow-up of 3 years, using five neuropsychological performance tests.</p> <p>Results: Subclinical hyperthyroidism and hypothyroidism were found in 65 and 161 participants, respectively. We found no consistent association of subclinical hyper- or hypothyroidism with altered cognitive performance compared to euthyroid participants on the individual cognitive tests. Similarly, there was no association with rate of cognitive decline during follow-up.</p> <p>Conclusion: We found no consistent evidence that subclinical hyper- or hypothyroidism contribute to cognitive impairment or decline in old age. Although our data are not in support of treatment of subclinical thyroid dysfunction to prevent cognitive dysfunction in later life, only large randomized controlled trials can provide definitive evidence.</p&gt

Subclinical thyroid dysfunction and cognitive decline in old age

<p>Background: Subclinical thyroid dysfunction has been implicated as a risk factor for cognitive decline in old age, but results are inconsistent. We investigated the association between subclinical thyroid dysfunction and cognitive decline in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER).</p> <p>Methods: Prospective longitudinal study of men and women aged 70–82 years with pre-existing vascular disease or more than one risk factor to develop this condition (N = 5,154). Participants taking antithyroid medications, thyroid hormone supplementation and/or amiodarone were excluded. Thyroid function was measured at baseline: subclinical hyper- and hypothyroidism were defined as thyroid stimulating hormones (TSH) <0.45 mU/L or >4.50 mU/L respectively, with normal levels of free thyroxine (FT4). Cognitive performance was tested at baseline and at four subsequent time points during a mean follow-up of 3 years, using five neuropsychological performance tests.</p> <p>Results: Subclinical hyperthyroidism and hypothyroidism were found in 65 and 161 participants, respectively. We found no consistent association of subclinical hyper- or hypothyroidism with altered cognitive performance compared to euthyroid participants on the individual cognitive tests. Similarly, there was no association with rate of cognitive decline during follow-up.</p> <p>Conclusion: We found no consistent evidence that subclinical hyper- or hypothyroidism contribute to cognitive impairment or decline in old age. Although our data are not in support of treatment of subclinical thyroid dysfunction to prevent cognitive dysfunction in later life, only large randomized controlled trials can provide definitive evidence.</p&gt

State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis

The 5th International Porto Congress of Multiple Sclerosis took place between the 14th and 16th of February 2019 in Porto, Portugal. Its intensive programme covered a wide-range of themes—including many of the hot topics, challenges, pitfalls and yet unmet needs in the field of multiple sclerosis (MS)—led by a number of well-acknowledged world experts. This meeting review summarizes the talks that took place during the congress, which focussed on issues in MS as diverse as the development and challenges of progressive MS, epidemiology, differential diagnosis, medical management, molecular research and imaging tools

Polimorfismo e esteroides androgênicos anabólicos: uma revisão integrativa / Polymorphism and anabolic androgenic steroids: an integrative review

Esteroides androgênicos anabólicos (EAAs) são substâncias relacionadas a testosterona que estimularão o crescimento dos tecidos corporais e aumento da performance em exercícios. O uso desses esteroides por frequentadores de academia e fisiculturistas tem se tornado um problema de saúde pública. Determinados polimorfismos genéticos (SNPs), causam alterações no metabolismo destas substâncias podendo agravar os efeitos colaterais. Diante do exposto, o objetivo desta pesquisa é descrever a influência dos SNPs bem como a potencialização dos efeitos colaterais após uso contínuo de EAAs. Este estudo consiste em uma revisão narrativa realizada entre os meses de março e abril de 2019 utilizando-se artigos publicados entre os anos de 2008 e 2019 obtidos a partir do banco de dados PubMed utilizando os descritores obtidos através do DeCs: “Polymorphism” AND “Anabolic Agents”. Foram incluídos artigos que fizessem relação direta com o tema proposto e apresentasse resultados em humanos. Artigos que não abordavam a temática central desta pesquisa foram excluídos. Foram encontrados 29 artigos, após leitura prévia apenas 11 foram selecionados. Dentre os resultados obtidos, o polimorfismo no gene UGT2B17 foi o mais citado, o mesmo causa uma diminuição da excreção de testosterona pela urina, permitindo uma maior concentração no sangue podendo assim agravar os efeitos colaterais. Além deste, polimorfismos nos genes ATP8B1/ABCB11, CYP17 e receptores ?-adrenérgicos também foram citados como responsáveis por alterações metabólicas destas substâncias. Diante do exposto, este estudo possibilitou identificar quais são os polimorfismos relatados com maior frequência na literatura quando associado a EAAs. De toda forma, faz-se necessário novos estudos com o intuito de elucidar de forma clara quais prejuízos o uso indiscriminado destas substâncias pode trazer ao indivíduo em longo praz