Análise da influência estrogênica na etiologia da hipospádia

-Introdução: Hipospádia é definida como uma malformação geniturinária na qual ocorre uma fusão incompleta das pregas uretrais. Como resultado, obtém-se um meato uretral de localização anômala, em uma posição mais proximal na face ventral do pênis, em algum ponto entre a glande e o períneo. Trata-se da mais freqüente anomalia da genitália externa masculina, com uma incidência de 1 para cada 125 nascidos vivos masculinos. O presente trabalho tem por objetivo avaliar o perfil clínico e epidemiológico de crianças portadoras de hipospádia atendidas no HU/CAS da UFJF. Resultados: Realizou-se um estudo prospectivo por meio de acompanhamento ambulatorial de 30 crianças portadoras de hipospádia, entre oito meses e 12 anos de idade, 16 das quais já foram submetidas à cirurgia corretora. A média de idade das crianças participantes foi de 5,5 anos. História familiar positiva foi encontrada em 33,3% dos casos. Crianças primogênitas portadoras de hipospádia foram encontradas em 39,3% dos atendidos. As médias de peso ao nascimento e idade gestacional foram de, respectivamente, 3.119 gramas e 37 semanas. Das mães de crianças hipospádicas participantes da pesquisa, 35,7% fizeram uso de alguma medicação durante a gestação. Entretanto, em nenhum dos casos foi percebido algum tratamento hormonal durante a gestação, como fármacos anorexígenos, reposição hormonal ou terapêutica para engravidar. Conclusões: Antecedente familiar de hipospádia corrobora a teoria de que tal alteração urológica apresenta alguma herança genética. A apresentação de hipospádia está associada a um número considerável de crianças primogênitas. Entretanto, tal anomalia não se mostrou relacionada a baixo peso ao nascimento e prematuridade. Os responsáveis pelos pacientes portadores de hipospádia procuram ajuda médica numa fase tardia, o que implica em maior surgimento de alterações psicológicas conseqüentes a um pênis malformado e insatisfatório funcionalmente

How to Handle Concomitant Asymptomatic Prosthetic Joints During an Episode of Hematogenous Periprosthetic Joint Infection, a Multicenter Analysis

[Background] Prosthetic joints are at risk of becoming infected during an episode of bacteremia, especially during Staphylocococcus aureus bacteremia. However, it is unclear how often asymptomatic periprosthetic joint infection (PJI) occurs, and whether additional diagnostics should be considered.[Methods] In this multicenter study, we retrospectively analyzed a cohort of patients with a late acute (hematogenous) PJI between 2005–2015 who had concomitant prosthetic joints in situ. Patients without at least 1 year of follow-up were excluded.[Results] We included 91 patients with a hematogenous PJI and 108 concomitant prosthetic joints. The incident PJI was most frequently caused by Staphylococcus aureus (43%), followed by streptococci (26%) and Gram-negative rods (18%). Of 108 concomitant prosthetic joints, 13 were symptomatic, of which 10 were subsequently diagnosed as a second PJI. Of the 95 asymptomatic prosthetic joints, 1 PJI developed during the follow-up period and was classified as a “missed” PJI at the time of bacteremia with S. aureus (1.1%). Infected prosthetic joints were younger than the noninfected ones in 67% of cases, and prosthetic knees were affected more often than prosthetic hips (78%).[Conclusions] During an episode of hematogenous PJI, concomitant asymptomatic prosthetic joints have a very low risk of being infected, and additional diagnostic work-up for these joints is not necessary.Peer reviewe

Is an isolated positive sonication fluid culture in revision arthroplasties clinically relevant?

Objectives: The aim of this study was to investigate the clinical relevance of an isolated positive sonication fluid culture (SFC) in patients who underwent revision surgery of a prosthetic joint. We hypothesized that cases with a positive SFC have a higher rate of infection during follow-up compared with controls with a negative SFC.Methods: This retrospective multicentre observational study was performed within the European Study Group of Implant-Associated Infections. All patients who underwent revision surgery of a prosthetic joint between 2013 and 2019 and had a minimum follow-up of 1 year were included. Patients with positive tissue cultures or synovial fluid cultures were excluded from the study.Results: A total of 95 cases (positive SFC) and 201 controls (negative SFC) were included. Infection during follow-up occurred in 12 of 95 cases (12.6%) versus 14 of 201 controls (7.0%) (p = 0.125). In all, 79.8% of cases were with treated with antibiotics (76/95). Of the non-treated cases, 89% (17/19) had a positive SFC with a low virulent microorganism. When solely analysing patients who were not treated with antibiotics, 16% of the cases (3/19) had an infection during follow-up versus 5% of the controls (9/173) (p = 0.08).Discussion: Although not statistically significant, infections were almost twice as frequent in patients with an isolated positive SFC. These findings require further exploration in larger trials and to conclude about the potential benefit of antibiotic treatment in these cases.</p

The efficacy of suppressive antibiotic treatment in patients managed non-operatively for periprosthetic joint infection and a draining sinus

Objectives: Patients with prosthetic joint infections (PJIs) not suitable for curative surgery may benefit from suppressive antibiotic therapy (SAT). However, the usefulness of SAT in cases with a draining sinus has never been investigated. Methods: A multicentre, retrospective observational cohort study was performed in which patients with a PJI and a sinus tract were eligible for inclusion if managed conservatively and if sufficient follow-up data were available (i.e. at least 2 years). SAT was defined as a period of > 6 months of oral antibiotic therapy. Results: SAT was initiated in 63 of 72 (87.5 %) included patients. Implant retention during follow-up was the same in patients receiving SAT vs. no SAT (79.4 % vs. 88.9 %; pCombining double low line0.68). In total, 27 % of patients using SAT experienced side effects. In addition, the occurrence of prosthetic loosening in initially fixed implants, the need for surgical debridement, or the occurrence of bacteremia during follow-up could not be fully prevented with the use of SAT, which still occurred in 42 %, 6.3 %, and 3.2 % of cases, respectively. However, the sinus tract tended to close more often (42 % vs. 13 %; pCombining double low line0.14), and a higher resolution of pain was observed (35 % vs. 14 %; pCombining double low line0.22) in patients receiving SAT. Conclusions: SAT is not able to fully prevent complications in patients with a draining sinus. However, it may be beneficial in a subset of patients, particularly in those with pain or the hindrance of a draining sinus. A future prospective study, including a higher number of patients not receiving SAT, is needed

Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study

Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been poorly studied to date. Methods: A prospective multicentre observational study was conducted on behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections). Factors associated with remission of the infection were evaluated by multivariate and Cox regression analysis for a 24-month follow-up period. Results: Patients (n=57) had a history of trauma (87.7 %), tumour resection (7 %) and other bone lesions (5.3 %). Pathogens included Escherichia coli (n=16), Pseudomonas aeruginosa (n=14; XDR 50 %), Klebsiella spp. (n=7), Enterobacter spp. (n=9), Acinetobacter spp. (n=5), Proteus mirabilis (n=3), Serratia marcescens (n=2) and Stenotrophomonas maltophilia (n=1). The prevalence of ESBL (extended-spectrum β-lactamase), fluoroquinolone and carbapenem resistance were 71.9 %, 59.6 % and 17.5 % respectively. Most patients (n=37; 64.9 %) were treated with a combination including carbapenems (n=32) and colistin (n=11) for a mean of 63.3 d. Implant retention with debridement occurred in early OAI (66.7 %), whereas the infected device was removed in late OAI (70.4 %) (p=0.008). OAI remission was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial resistance and duration of treatment did not significantly influence the outcome. Independent predictors of the failure to eradicate OAI were age &gt;60 years (hazard ratio, HR, of 3.875; 95 % confidence interval, CI95 %, of 1.540–9.752; p=0.004) and multiple surgeries for OAI (HR of 2.822; CI95 % of 1.144–6.963; p=0.024). Conclusions: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and surgery had a successful outcome. Advanced age and multiple surgeries hampered the eradication of OAI. Optimal therapeutic options remain a challenge.</p

Marine biotechnology in Brazil : recent developments and its potential for innovation

Marine biotechnology is an emerging field in Brazil and includes the exploration of marine microbial products, aquaculture, omics, isolation of biologically active compounds, identification of biosynthetic gene clusters from symbiotic microorganisms, investigation of invertebrate diseases caused by potentially pathogenic marine microbes, and development of antifouling compounds. Furthermore, the field also encompasses description of new biological niches, current threats, preservation strategies as well as its biotechnological potential. Finally, it is important to depict some of the major approaches and tools being employed to such end. To address the challenges of marine biotechnology, the Brazilian government, through the Ministry of Science, Technology, Innovation, and Communication, has established the National Research Network in Marine Biotechnology (BiotecMar) (www.biotecmar.sage.coppe.ufrj.br). Its main objective is to harness marine biodiversity and develop the marine bioeconomy through innovative research