Abstract Aim The bifid mandibular condyle is a morphological alteration of the temporomandibular joint in which the condyle has a groove on its upper surface that generates two condylar heads. This alteration can be unilateral or bilateral. Most bifid mandibular condyles are detected by panoramic radiographs, however, Cone Beam computed tomography of the temporomandibular joint is considered the test of choice for the diagnosis of this alteration. The purpose of this work is to present a case of bilateral bifid mandibular condyle, incidentally detected by Cone Beam computed tomography requested for a presumptive diagnosis of osteoarthritis. Clinical case A 22-year old female patient with no history of craniofacial trauma requests a Cone Beam computed tomography of the temporomandibular joints due to a presumptive diagnosis of osteoarthritis. In the volume exploration, bifid mandibular condyles were found with two condylar heads, medial and lateral bilaterally, being more accentuated in the right condyle.

Resumen Objetivo El cóndilo mandibular bífido es una alteración morfológica de la articulación temporomandibular en la que el cóndilo presenta un surco en la superficie superior que genera dos cabezas condilares. Esta alteración puede ser unilateral o bilateral. La mayoría de los cóndilos mandibulares bífidos se detectan mediante radiografías panorámicas, sin embargo, la tomografía computarizada Cone Beam de articulación temporomandibular es considerado el examen de elección para el diagnóstico de esta alteración. El propósito de este trabajo es presentar un caso de cóndilo mandibular bífido bilateral detectado incidentalmente mediante una tomografía computarizada Cone Beam solicitada por un diagnóstico presuntivo de osteoartritis. Caso clínico Una paciente de 22 años sin antecedentes de traumatismos cráneo faciales solicita una tomografía computarizada Cone Beam de articulaciones temporomandibulares por diagnóstico presuntivo de osteoartritis. En la exploración del volumen se encontraron cóndilos mandibulares bífidos con dos cabezas condilares, medial y lateral de forma bilateral, siendo más acentuado en el cóndilo derecho.

RESUMEN: El objetivo del estudio fue medir la fuerza del músculo cuádriceps femoral después de la artroplastia total de cadera (THA, por sus siglas en inglés) y el tratamiento kinésico, para determinar su impacto en la recuperación funcional de pacientes con osteoartritis de cadera. En el estudio participaron 79 pacientes con THA (25 hombres y 54 mujeres). Se excluyeron quienes tuvieron tratamiento Kinésico previo fuera del hospital, operación por fractura de cadera y no completar el tratamiento. Las principales medidas tomadas fueron: Fuerza Máxima Isométrica (MIS), Time UP and GO (TUG), Puntuación Modificada de Harris de Cadera. Hubo un aumento significativo en la MIS de la extensión de rodilla del lado operado después del tratamiento tanto en hombres (p<0,0001, EE=0,43) como en mujeres (p<0,0001, EE=1,22). En el TUG, el tiempo de ejecución fue significativamente menor después del tratamiento en hombres (p<0,0001, EE=0,77) y mujeres (p<0,0001, EE=0,94). La puntuación final de Harris aumentó significativamente después del tratamiento en hombres (p<0,0001, EE=2,90) y mujeres (p<0,0001, EE=1,96). En cuanto a la asociación entre MIS y la puntuación de Harris, se observó que por cada aumento de 1 kg en esta medida en comparación con la evaluación inicial, la puntuación de Harris aumentó en 0,179 puntos después de 12 semanas de tratamiento (β=0,179; p=0,050). En conclusión se observó un aumento en la MIS de la extensión de rodilla del lado operado después del tratamiento en ambos sexos. Al mismo tiempo, la funcionalidad aumentó después del tratamiento tanto en hombres como en mujeres.

SUMMARY: The objective was measure quadricep strength after Total Hip Arthroplasty (THA) and kinetic treatment and then determine its impact on the functional recovery of patients with hip osteoarthritis. A total of 79 (25 were male and 54 were female) patients with THA. Exclusion criteria were previous extra-system kinetic treatment, operated on for hip fracture, not completing the treatment. Maximum Isometric Strength (MIS), Time Up and Go (TUG), Modified Harris Hip Score. There was a significant increase in the MIS of the post-treatment operated knee extension in both men and women (p < 0.0001 SE = 0.43; p < 0.0001 SE = 1.22, respectively). In the TUG, the execution time was significantly lower post-treatment in both men and women (p < 0.0001 SE = 0.77; p < 0.0001 SE = 0.94, respectively). The final Harris score increased significantly post-treatment in male and female (p < 0.0001 SE = 2.90; p < 0.0001 SE = 1.96, respectively). the association between MIS and the Harris score, it was noted that, for a 1 kg increase in this measure compared to the initial assessment, the Harris score, after 12 weeks of treatment, increased by 0.179 points (β = 0.179; p = 0.050). The conclusions were Indicate an increase in knee extension MIS of the operated hip after treatment in both sexes. At the same time, functionality increased post-treatment in both male and female.

Abstract: Introduction: The increasing acceptance of cannabinoids for therapeutic purposes has been linked to changes in legislation, high prevalence and ineffective control of chronic pain with conventional analgesics. Objective: Determine the prevalence of chronic pain, the analgesic treatment modality with herbal therapies (cannabis) in adults in southeastern Mexico. Material and methods: A cross-sectional and ethnographic study was carried out on 267 people with chronic pain and regular use of herbal medicine for analgesic purposes. Hypothesis tests were carried out to evaluate differences between average values, age and pain intensity, comparing the use of cannabis with the type of pain, gender, algological diagnoses and comorbidities. Results: An association was observed between chronic pain: diabetes, hypertension, neoplasms in women, in older adults. 46% of the participants suffered from osteoarthritis and 20.9% had other diagnoses. The preferred modality for the topical administration of cannabis was tinctures in Mezcal or alcohol and to a lesser extent macerated in oils and inhalation. Conclusions: The findings do not allow cannabis to be considered as monotherapy for chronic pain in patients with chronic pain. However, they offer a promising field in the search for analgesic alternatives that avoid the chronic consumption of opiates or non-steroidal anti-inflammatory drugs (NSAIDs).

Resumen: Introducción: La creciente aceptación de los cannabinoides con fines terapéuticos se ha vinculado a cambios en la legislación, alta prevalencia y control ineficaz de dolor crónico con analgésicos convencionales. Objetivo: Determinar la prevalencia del dolor crónico, la modalidad de tratamiento analgésico con terapias herbales (cannabis) en adultos del sureste de México. Material y métodos: Se efectuó un estudio transversal y etnográfico en 267 personas con dolor crónico y empleo regular de la herbolaria con fines analgésicos. Se efectuaron pruebas de hipótesis para evaluar diferencias entre valores promedio, edad e intensidad del dolor, comparándose el empleo de cannabis con el tipo de dolor, género, diagnósticos algológicos y comorbilidades. Resultados: Se observó asociación entre dolor crónico con: diabetes, hipertensión, neoplasias en mujeres, adultos mayores. El 46% de los participantes padecía osteoartritis y 20.9% presentaba otros diagnósticos. Las modalidades preferidas para la administración tópica de cannabis fueron tinturas en mezcal o en alcohol y, en menor proporción, macerados en aceites e inhalación. Conclusiones: Los hallazgos no permiten considerar a la cannabis como monoterapia para pacientes con dolor crónico. Sin embargo, ofrecen un campo promisorio en la búsqueda de alternativas analgésicas que eviten el consumo crónico de opiáceos o antiinflamatorios no esteroideos (AINE).

Abstract Knee osteoarthritis (OA) is an inflammatory and degenerative condition resulting in articular cartilage destruction and functional loss. Its prevalence has grown considerably due to increased life expectancy and obesity, and its diagnosis relies on evaluation, medical examination, and confirmation by supplementary radiographic images. Knee OA is multifactorial and influenced by several local, systemic, and external aspects. In addition, its progress and therapeutic responses highly depend on the characteristics of each subject. The initial recommendation is drug treatment and alternative therapies to improve quality of life. However, if these treatments are unsuccessful, one must consider surgical treatment. Surgical options include arthroscopies, osteotomies, and partial and total arthroplasties, while non-surgical treatments include medications and alternative therapies such as infiltrations, acupuncture, and physical exercise. It is worth highlighting that biomarkers can be a significant strategy for early disease detection, assessment of disease activity, prediction of prognosis, and monitoring a better response to therapy. Nevertheless, this topic must be the focus of further research to confirm its findings. (OA loss obesity evaluation examination images local systemic aspects addition subject However unsuccessful arthroscopies osteotomies arthroplasties nonsurgical non infiltrations acupuncture exercise detection activity prognosis therapy Nevertheless findings

Resumo A osteoartrite (OA) do joelho é uma doença inflamatória e degenerativa que ocasiona a destruição da cartilagem articular e leva à perda de funções. Sua prevalência vem crescendo consideravelmente devido ao aumento da expectativa de vida e da obesidade, e o diagnóstico pode ser feito por meio de avaliação e exames médicos, e é confirmado em imagens radiográficas complementares. Uma condição multifatorial, a OA do joelho pode ser influenciada por diversos aspectos locais, sistêmicos e externos; além disso, a sua evolução e as respostas aos tratamentos dependem muito das características de cada indivíduo. Inicialmente, recomenda-se proceder a um tratamento medicamentoso e a terapias alternativas que melhorem a qualidade de vida do paciente; mas, a partir do momento em que se verifica que tais terapias não estão proporcionando resultados satisfatórios, um tratamento cirúrgico deve ser considerado. Entre os tratamentos cirúrgicos, as artroscopias, as osteotomias e as artroplastias parciais e totais são destacadas; os métodos não cirúrgicos incluem o uso de medicamentos e de terapias alternativas, como infiltrações, acupuntura e prática de exercícios físicos. Vale ressaltar ainda que a utilização de biomarcadores pode ser uma importante estratégia para detectar precocemente a doença, avaliar sua atividade, prever um prognóstico e monitorar uma melhor resposta à terapia; porém, esse tema ainda deve ser foco de mais estudos para que os seus resultados sejam comprovados. (OA funções obesidade médicos complementares multifatorial locais externos disso indivíduo Inicialmente recomendase recomenda paciente mas satisfatórios considerado artroscopias destacadas infiltrações físicos atividade terapia porém comprovados

Abstract Osteoarthritis (OA) can incapacitate the individual to perform their activities of daily living due to pain. This is an important public health issue that worsens worldwide and in Brazil, since the population goes through an aging process, and has caused increased public spending on the monitoring and maintenance of treatments that can last for years and still not be resolutive. Thus, the search for innovative and effective therapies that can reduce costs becomes necessary. In this context, the present study reports the first application of cell therapy with adipose-derived stem cells in the treatment of cases of OA that are refractory to the conservative treatment, performed in the Brazilian Unified Health System (Sistema Único de Saúde, SUS). The evaluation was performed with the application of the Visual Analog Scale (VAS), the Short Form Health Survey (SF-36) and the Western Ontario and McMaster Universities (WOMAC), specifics for OA evaluation, and also an analysis of the synovial fluid (inflammatory cytokines). The cell therapy improved the scores on the WOMAC, SF-36 and EVA, and reduced the inflammatory process. We observed a decrease of 0.73x in the TNF, of 0,71x in IL-1b, of 0,68x in IL-8, and of 0,70x in IL-10. For IL-6, an increase of 1,48x was observed. Therefore, this cell therapy can be considered promising in aiding the management of this disease, since it improved the patient's pain, decrease inflammatory markers, and enabled the return to activities of daily living, which resulted in an improvement in their quality of life. (OA pain Brazil process resolutive Thus necessary context adiposederived adipose derived Sistema Saúde SUS. SUS . SUS) VAS, VAS , (VAS) SF36 SF 36 (SF-36 WOMAC (WOMAC) cytokines. cytokines cytokines) SF-3 EVA 073x x 0 73x TNF 071x 71x IL1b, IL1b ILb IL 1b, 1b b IL-1b 068x 68x IL8, IL8 8, 8 IL-8 070x 70x IL10. IL10 10. 10 IL-10 IL6, IL6 6, 6 IL-6 148x 1 48x Therefore disease patients patient s markers life (VAS SF3 3 (SF-3 (WOMAC SF- IL- IL1 IL-1 (SF- (SF

Resumo A osteoartrite (OA) pode deixar o indivíduo incapacitado para realizar suas atividades da vida diária devido ao quadro álgico. Essa é uma importante questão de saúde pública que se agrava no mundo inteiro e no Brasil, uma vez que a população passa pelo processo de envelhecimento, e isso causa um aumento nos gastos públicos com o acompanhamento e manutenção dos tratamentos que podem perdurar por anos e mesmo assim não serem resolutivos. Assim, torna-se necessária a busca por terapias inovadoras e eficazes que possam reduzir esses custos. Nesse contexto, o presente estudo relata a primeira aplicação de terapia celular com células-tronco mesenquimais do tecido adiposo no tratamento de OA refratária ao tratamento conservador realizada no Sistema Único de Saúde (SUS). Na avaliação, foram usados os instrumentos Escala Visual Analógica (EVA), os questionários de qualidade de vida Short Form Health Survey (SF-36) e Western Ontario and McMaster Universities (WOMAC), específicos para avaliação da OA, e fez-se uma análise do líquido sinovial (citocinas inflamatórias). A terapia celular melhorou as pontuações no WOMAC, SF-36, e EVA, e reduziu o processo inflamatório. Observou-se redução de 0,73 × do TNF, de 0,71 × da IL-1b, de 0,68 × da IL-8, e de 0,70 × da IL-10. Já para a IL-6, observou-se aumento de 1,48 ×. Portanto, considera-se este tipo de terapia celular promissora no auxílio do manejo desta doença, pois melhorou o quadro álgico do paciente, reduziu os marcadores inflamatórios, e possibilitou o retorno às atividades da vida diária, o que resultou em uma melhora de sua qualidade de vida. (OA Brasil envelhecimento resolutivos Assim tornase torna custos contexto célulastronco células tronco SUS. SUS . (SUS) EVA , (EVA) SF36 SF 36 (SF-36 WOMAC (WOMAC) fezse fez citocinas inflamatórias. inflamatórias inflamatórias) SF36, 36, SF-36 inflamatório Observouse Observou 073 0 73 0,7 TNF 071 71 IL1b, IL1b ILb IL 1b, 1b b IL-1b 068 68 0,6 IL8, IL8 8, 8 IL-8 070 70 IL10. IL10 10. 10 IL-10 IL6, IL6 6, 6 IL-6 observouse observou 148 1 48 1,4 Portanto considerase considera doença paciente inflamatórios (SUS (EVA SF3 3 (SF-3 (WOMAC SF-3 07 7 0, 06 IL- IL1 IL-1 14 4 1, (SF- SF- (SF

Abstract Background: Aging, urbanization, and lifestyle changes have fueled the non-communicable diseases (NCDs) epidemic. Objective: Assess mortality, disability, risk factors and life expectancy in people aged ≥60 years (LE-60) in Mexico from 1990-2022 using estimates from the Global Burden of Diseases, Injuries and Risk factors study. Material and methods: Health loss/gain in terms of disability-adjusted life years, risk factors, LE-60 and healthy life expectancy (HALE-60) by sex and state were analyzed. Results: NCDs and metabolic risk factors were the main contributors of health loss, noting a high prevalence of non-lethal conditions related to functional decline (vision and hearing loss), oral conditions, and chronic pain (back pain and osteoarthritis). All-cause mortality and disability rates decreased among men and women while LE-60 and HALE-60 increased from 1990-2022, with state-level variations. States with greater development and healthcare had higher LE-60 and HALE-60. Conclusions: LE-60 increases were not accompanied by reductions in disability due to functional decline, highlighting the need for healthcare strategies to enhance healthy aging.

Resumen Antecedentes: El envejecimiento, la urbanización y cambios en los factores de riesgo han intensificado la epidemia de enfermedades crónicas no transmisibles (ECNT). Objetivo: Evaluar mortalidad, discapacidad, factores de riesgo y esperanza de vida en personas ≥ 60 años (EV-60) en México de 1990-2022, conforme a estimaciones del estudio de la Carga Global de Enfermedades, Lesiones y Factores de Riesgo. Material y métodos: Se analizaron las pérdidas/ganancias en salud en términos de años de vida saludable perdidos, factores de riesgo, EV-60 y esperanza de vida saludable (EVS-60) por sexo y estado de la República Mexicana. Resultados: La carga se centró en riesgos metabólicos y ECNT. Se observó una alta prevalencia de condiciones no letales relacionadas con el deterioro funcional de los órganos de los sentidos, padecimientos orales y asociados con dolor crónico (lumbalgia y osteoartritis). Las tasas de mortalidad y discapacidad disminuyeron en hombres y mujeres mientras que EV-60 y EVS-60 se incrementaron en el período 1990-2022, con variaciones estatales. Las entidades federativas con mayor desarrollo y mejor atención médica tuvieron mejor EV-60 y EVS-60. Conclusiones: El aumento en EV-60 no se acompañó de una reducción de la discapacidad por deterioro funcional, lo que resalta la necesidad de estrategias para promover un envejecimiento saludable.

Abstract Diabetes mellitus is a systemic condition potentially related to an increased risk of progression of various infections such as chronic osteomyelitis by accelerating the inflammatory process with bone tissue necrosis and suppuration. Therefore, if there is no proper management of these infections, they can be life-threatening as they spread to deeper spaces in the head and neck. We describe the case of a 52-year-old male patient with a history of diabetes mellitus and grade III osteoarthritis who was diagnosed with chronic suppurative osteomyelitis of the mandible. He underwent a multidisciplinary surgical intervention in which he underwent a hemimandibulectomy with immediate mandibular reconstruction. The present case highlights the importance of early and radical treatment of patients with chronic suppurative osteomyelitis of the mandible and systemic comorbidities. In addition, this case presents a review of diabetes mellitus and the risk of developing odontogenic infections and complications when invading deeper spaces in the head and neck. Therefore, in this population, careful planning is required for early surgical and pharmacological treatment.

Resumen La diabetes mellitus es una condición sistémica potencialmente relacionada con un mayor riesgo de progresión de diversas infecciones como la osteomielitis crónica al acelerar el proceso inflamatorio con necrosis del tejido óseo y supuración. Por lo tanto, si no hay un manejo adecuado de estas infecciones pueden ser potencialmente mortales al llegar a propagarse a espacios más profundos de la cabeza y cuello. Describimos el caso de un paciente varón de 52 años con antecedentes de diabetes mellitus y osteoartrosis grado III a quien se le diagnosticó de osteomielitis crónica supurativa mandibular. Se le realizó una intervención quirúrgica multidisciplinaria en la cual se le realizó una hemimandibulectomía con reconstrucción mandibular inmediata. El presente caso destaca la importancia del tratamiento temprano y radical de los pacientes con osteomielitis mandibular crónica supurativa y comorbilidades sistémicas. Además, en este caso se presenta una revisión sobre la diabetes mellitus y el riesgo de desarrollar infecciones odontogénicas y complicaciones al invadir espacios más profundos de la cabeza y cuello. Por lo tanto, en esta población se requiere de una planificación cuidadosa para realizar un tratamiento quirúrgico y farmacológico temprano.

Resumen Introducción: La artrodesis tibioastragalina es una opción para tratar la artrosis de tobillo en pacientes que no responden a las medidas conservadoras. Su principal desventaja es el compromiso a mediano y largo plazo de las articulaciones vecinas. Objetivo: Determinar el compromiso de las articulaciones vecinas a mediano y largo plazo, y su impacto sobre los resultados funcionales en los pacientes con artrodesis de tobillo. Materiales y Métodos: Se evaluó a una serie de 11 pacientes (6 mujeres y 5 hombres). El diagnóstico inicial era artrosis postraumática (9 casos), artritis séptica (1 caso) y lesión osteocondral de astrágalo (1 caso). El promedio de edad al operarse era de 50 años. La media de seguimiento fue de 9 años. Se evaluó el compromiso radiográfico de las articulaciones vecinas. La función se valoró mediante la escala analógica visual para dolor, la escala de la AOFAS y un cuestionario simple de satisfacción. Resultados: Diez pacientes (91%) tenían artrosis en alguna de las articulaciones vecinas. El puntaje medio en la escala analógica visual fue de 2,6 y el de la escala de la AOFAS, de 71. Nueve refirieron estar muy satisfechos; uno, medianamente satisfecho y otro se manifestó insatisfecho. Conclusión: El compromiso de las articulaciones vecinas es muy frecuente a largo plazo, pero esto no repercute directamente en los resultados funcionales.

Abstract Introduction: Tibiotalar arthrodesis is an option in the treatment of ankle osteoarthritis in patients who do not respond to conservative measures. Its main disadvantage is the compromise of adjacent joints in the medium and long term. Objective: To determine the involvement of adjacent joints in the medium and long term and its impact on functional outcomes in patients with ankle arthrodesis. Materials and Methods: We evaluated a series of 11 patients, 6 females and 5 males. The initial diagnosis was post-traumatic osteoarthritis (9 cases), septic arthritis (1 case), and osteochondral lesion of the talus (1 case). The mean age at the time of surgery was 50 years. The mean follow-up was 9 years. The radiographic compromise of the adjacent joints was evaluated. The patients were functionally evaluated using the Visual Analog Pain Scale (VAS), the AOFAS scale (American Orthopedic Foot and Ankle Score), and a simple satisfaction questionnaire. Results: 10 patients (91%) presented with osteoarthritis of one of the adjacent joints. The average score on the VAS was 2.6, while on the AOFAS scale, it was 71. Nine patients reported being very satisfied, one was moderately satisfied, and one was dissatisfied. Conclusion: The involvement of adjacent joints is very frequent in the long term, but this does not have a direct impact on the patient’s functional outcomes.

Resumen Introducción: Las osteotomías supramaleolares son una opción de tratamiento para la artrosis asimétrica de tobillo. El objetivo de este artículo es describir los resultados clínicos, radiográficos y subjetivos obtenidos en pacientes con artrosis de tobillo que fueron sometidos a una osteotomía supramaleolar. Materiales y Métodos: Estudio observacional descriptivo retrospectivo de pacientes sometidos a una osteotomía supramaleolar por artrosis de tobillo entre enero de 2010 y julio de 2017. Se analizaron las historias clínicas para recabar datos clínicos y radiográficos preoperatorios y posoperatorios. Resultados: Se incluyó a 13 pacientes que se habían sometido a una osteotomía supramaleolar de tobillo: 8 con una desalineación del tobillo y retropié en valgo (61,5%) y 5 (38,5%) en varo. El puntaje medio posoperatorio de la escala analógica visual de los pacientes con deformidad en varo disminuyó de 9 ± 0,45 a 3 ± 1 (p <0,05) y de una media de 7,88 ± 0,35 a 2,15 ± 1,64 (p <0,05) en aquellos con deformidad en valgo. El puntaje medio de la escala de la AOFAS se modificó de 32,8 ± 16,2 antes de la cirugía a 82,1 ± 13,6 en el posoperatorio, en el grupo con deformidad en varo (p <0,05) y de 31 ± 17,3 a 93,1 ± 6,20, respectivamente, en aquellos con deformidad en valgo (p <0,05). Se constató la consolidación radiográfica en 12 pacientes (92,3%), en un tiempo promedio de 10.4 semanas. Conclusión: La osteotomía supramaleolar como tratamiento de la artrosis asimétrica de tobillo es una técnica predecible, con muy buenos resultados clínicos y radiográficos a corto y mediano plazo.

Abstract Introduction: Supramalleolar osteotomies are a treatment option for asymmetric ankle osteoarthritis. Our work aims to describe the clinical, radiographic, and subjective outcomes obtained in patients with ankle osteoarthritis who underwent a supramalleolar osteotomy (SMOT). Materials and Methods: Retrospective, observational, and descriptive study on patients who underwent SMOT for ankle osteoarthritis between January 2010 and July 2017. The patients’ clinical records were analyzed. Results: We included 13 patients who underwent SMOT, 8 patients with valgus (61.5%) and 5 (38.5%) with varus rearfoot and ankle misalignment. The mean varus VAS score decreased from 9 ± 0.45 to 3 ± 1 postoperatively (p <0.05) and, in valgus deformities, from a mean 7.88 ± 0.35 to 2.15 ±1.64 postoperatively (p <0.05). The mean AOFAS score changed from 32.8 ± 16.2 to 82.1 ± 13.6 postoperatively in the varus deformity group (p <0.05) and from 31 ± 17.3 preoperatively to 93.1 ± 6.20 postoperatively in the valgus deformity group (p <0.05). Twelve patients (92.3%) achieved radiographic union in an average time of 10.4 weeks. Conclusion: Supramalleolar osteotomy as a treatment for asymmetric ankle osteoarthritis is a predictable technique with very good clinical and radiological outcomes in the short and medium term.

Abstract Psoriatic arthritis (PA) usually presents as oligoarthritis or monoarthritis and can be a diagnostic challenge in the absence of psoriasis background. We report the case of a 57-year-old patient who presented to the Family Physician (FF) after one year of inflammatory signs and onycholysis of the 3rd finger of the right hand. Initial exams showed signs of inflammation from the periungueal tissues to the distal interphalangeal joint, and negative analytical inflammatory parameters. The condition was interpreted in an infectious context and, later, as osteoarthritis, without improvement with the instituted treatments. The disease and the diagnosis delay had significant psychological and professional impact on the patient. This case reports a rare presentation of PA, that could increase the diagnostic suspicion of this entity in Primary Health Care and highlights the role of the FF in the holistic follow-up and management of patient expectations, besides articulation with other specialties.

Resumo A artrite psoriática (AP) apresenta-se, habitualmente, como uma oligoartrite ou monoartrite, e pode constituir um desafio diagnóstico na ausência de história de psoríase. Relata-se o caso de um paciente de 57 anos que recorreu ao Médico de Família (MF) após um ano de evolução de sinais inflamatórios e onicólise do 3º dedo da mão direita. Os exames iniciais mostravam sinais inflamatórios dos tecidos peri-ungueais até à articulação interfalângica distal, e parâmetros inflamatórios analíticos negativos. O quadro foi interpretado em contexto infecioso e, posteriormente, como osteoartrose, não tendo existido melhoria com os tratamentos instituídos. A doença e o atraso no diagnóstico tiveram significativo impacto psicológico e profissional no paciente. Este caso relata uma apresentação rara de AP, podendo aumentar a suspeição diagnóstica desta entidade nos Cuidados de Saúde Primários, e evidencia o papel do MF no acompanhamento holístico e gestão das expectativas do paciente, além da articulação com as outras especialidades.

Resumen La articulación sinovial de la rodilla puede verse afectada por enfermedades, como artritis o artrosis, siendo generalmente el reemplazo de rodilla la solución clínica seleccionada en casos irreversibles. Este trabajo se orienta a investigar el mecanismo de lubricación por aplastamiento en rodillas sanas y artrósicas, con la finalidad de lograr conocimientos que puedan utilizarse para retrasar el reemplazo de rodilla. Se analiza un único cóndilo adoptando el modelo geométrico equivalente de elipsoide rígido sobre plano deformable, donde se considera que el fluido sinovial es Newtoniano y que el cartílago articular es un material elástico lineal. Se realizaron estudios variando el módulo de elasticidad del cartílago, su espesor y la viscosidad del fluido sinovial, adoptando valores correspondientes a articulaciones naturales sanas y osteoartríticas, con el fin de evaluar su influencia en el desempeño del proceso de lubricación por aplastamiento (squeeze film lubrication). En comparación con lo obtenido para una articulación sana, la disminución patológica del módulo de elasticidad no tendría una influencia significativa en el mínimo espesor de película lubricante, mientras que la disminución patológica del espesor del cartílago incrementaría dicho espesor. La disminución patológica de la viscosidad disminuye en un 65 % el espesor mínimo de película lubricante, por lo que la viscosuplementación (y consiguiente aumento de la viscosidad) sería deseable porque prevendría el desgaste de las superficies articulares. La disminución del espesor o en el módulo elástico del cartílago produciría una disminución de las tensiones en el tejido. Por otra parte, una disminución de la viscosidad produce un aumento de estas tensiones. En la articulación artrósica (donde la viscosidad del fluido, el espesor y el módulo elástico del cartílago se encuentran disminuidos), para una carga de 800 N, la altura mínima del canal de lubricación, las presión máxima y la tensión de Von Mises en el cartílago obtenidas son 66%, 22% y 28% menores que aquellas obtenidas para una articulación sana.

Abstrac The synovial joint of the knee can be affected by diseases, such as arthritis or osteoarthritis, being a knee replacement the selected clinical solution in irreversible cases. This work is aimed at investigating lubricated contact in healthy and pathological knees, with the aim of achieving knowledge that can be used to delay knee replacement. The equivalent geometric model of a rigid ellipsoid on a deformable plane is adopted, where the synovial fluid is considered to be Newtonian and the articular cartilage is a linear elastic material. Studies were carried out varying the modulus of elasticity E of the cartilage, its thickness e and the viscosity of the synovial fluid , adopting values corresponding to healthy and osteoarthritic natural joints, in order to evaluate their influence on the functioning of the joint considering squeeze film lubrication. Compared to what was obtained for a healthy joint, the decrease in the elastic modulus E would not have a signifi-cant influence on the minimum lubricant film thickness, while the decrease in cartilage thickness would improve said thickness. The decrease in viscosity decreases the minimum thickness of the lubricating film by 65%, so viscosup-plementation would increase the viscosity, which would also increase said thickness and prevent wear of the articular surfaces. A decrease in cartilage thickness or in cartilage module would produce a decrease of the cartilage tensions. On the other hand, a decrease of viscosity produces an increase of these tensions. In a pathological joint (where the fluid viscosity and the cartilage thickness and elastic module are diminished), and considering a load of 800 N, the minimum film height, the maximum pressure and the maximum Von Mises tension obtained are 66 %, 22% and 28 % respectively lower than those observed for a healthy articulation.

ABSTRACT Background: Osteoarthritis is a frequent rheumatic disease. Some single-nucleotide polymorphisms of the gene associated with fat mass and obesity are associated with increased body mass index and knee osteoarthritis. Objective: The objective of this study was to analyze the association of single nucleotide polymorphism rs1477196 of the fat mass and obesity gene with primary knee osteoarthritis. Methods: This observational and cross-sectional study included 347 Mexican participants. We performed the genotypification analysis with TaqMan® probe C_2031262_10 for rs1477196 (Thermo Fisher Scientific). Multivariate analysis included covariables such as age, type 2 diabetes, obesity, and postmenopause. Results: Type 2 diabetes, obesity, and postmenopause were associated with primary knee osteoarthritis in female participants. We did not find an association between rs1477196 and obesity. In the codominant and dominant genetic models, rs1477196 was significantly associated with primary knee osteoarthritis only in the female group, including in the model adjusted by other covariables (odds ratio = 2.517; 1.035-6.123; p = 0.042 and odds ratio = 2.387; 1.054-5.407; p = 0.037, respectively). The interaction between rs1477196 and obesity was significantly associated with primary knee osteoarthritis in female participants (p = 0.039 and p = 0.043). Conclusions: Our findings suggest that the rs1477196 variant of the fat and obesity mass gene may be associated with the risk of primary knee osteoarthritis in women.

SUMMARY OBJECTIVE: Knee osteoarthritis is a common and disabling disease. We aimed to examine the effect of low-level laser therapy in addition to routine physical therapy modalities (transcutaneous electrical stimulation, superficial heating modality of infrared, ultrasound, and exercise) on the functional status and pain in knee osteoarthritis. METHODS: Patients with knee osteoarthritis (n=71) who underwent physical therapy (transcutaneous electrical stimulation, infrared, ultrasound, exercise therapy, and low-level laser therapy) were retrospectively screened. Patients who received low-level laser therapy on acupuncture points, transcutaneous electrical stimulation, infrared, ultrasound, and exercise were included in the low-level laser therapy (+) (n=35), and patients who received only transcutaneous electrical stimulation, ultrasound, infrared, and exercise were included in the low-level laser therapy (–) group (n=36). The Visual Analog Scale for activity pain, Lysholm Knee Scoring Scale, and walking and stair climbing tests were used before and after treatment obtained from patient files. RESULTS: The post-treatment Visual Analog Scale activity score and walking and stair climbing test results were statistically significantly lower in the low-level laser therapy (+) group than in the low-level laser therapy (–) group. There was no significant difference in post-treatment Lysholm Knee Scoring Scale scores between the two groups. In both groups, the Visual Analog Scale activity, Lysholm Knee Scoring Scale, and walking and stair climbing test scores statistically significantly decreased after treatment. CONCLUSION: Knee osteoarthritis increases with aging and creates significant functional limitations. low-level laser therapy with routine physiotherapy contributed to the improvement in the pain and functional status of the patients with knee osteoarthritis. Low-level laser therapy can be recommended in osteoarthritis treatment guidelines with the support of further studies, which is an easy-to-apply, effective, and reliable method.

ABSTRACT: This study assessed the efficacy of an intra-articular injection of allogeneic adipose tissue-derived from mesenchymal stem cells (AD-MSCs) for the treatment of hip dysplasia in dogs. The study group included 12 otherwise healthy dogs of different breeds, ages, weights, and degrees of hip dysplasia diagnosed using radiography. An orthopedic assessment was performed on all dogs before and at 30, 60, and 90 days after infusion of AD-MSCs(2 × 106cells). On the same days, each dog’s owner answered a questionnaire based on theHelsinkiChronic Pain Index. The data were converted to ordinal data based on the score for each variable, and the Friedman test for multiple comparisons was used to verify the results. Compared with the corresponding values on day 0, orthopedic and gait assessments and owners’ reported pain indexes improved over the 90-day observation period. These results suggested that treatment with allogeneic AD-MSCs significantly reduced the clinical signs associated with hip dysplasia during the study period. However, long-term studies are needed to determine the optimal therapeutic protocol for routine clinical use of AD-MSCs in hip dysplasia. ABSTRACT intraarticular intra articular tissuederived tissue derived ADMSCs AD MSCs (AD-MSCs 1 breeds ages weights radiography 30 60 9 ADMSCs2 2 AD-MSCs( 106cells. 106cells . 106cells) dog s Index variable 0 owners 90day period However longterm long term 3 6

RESUMO: O objetivo deste estudo foi avaliar a eficácia clínica da aplicação intra-articular de células-tronco mesenquimais alógenas derivadas do tecido adiposo (AD-CTM) no tratamento de cães portadores de osteoartrite secundária a displasia do coxofemoral (DCF). Doze cães de ambos os sexos, diferentes raças, idades e peso, portadores de graus variados de DCF comprovada em radiografia e livres de quaisquer outras alterações clínicas ou ortopédicas, foram utilizados no estudo. Todos os cães foram submetidos a avaliação ortopédica nos dias 0, 30, 60 e 90 após aplicação de AD-CTM na dose de 2 x 106. Além disso, os tutores preencheram a um questionário, baseado no Índice de dor crônica de Helsinque (IDCH) nos mesmos intervalos. Em comparação com o dia 0, observou-se melhora significativa na avalição em locomoção e físico-ortopédica assim como na avaliação dos tutores pelo IDCH ao longo dos 90 dias. Os resultados permitem inferir que as AD-CTM alógenas contribuíram significativamente para a redução dos sinais clínicos comumente associados a DCF durante o período de estudo. Entretanto, há necessidade de estudos de longo prazo para melhor determinação de protocolos terapêuticos baseados no uso de AD-CTM na rotina clínica. RESUMO intraarticular intra articular célulastronco células tronco ADCTM AD CTM (AD-CTM DCF. . (DCF) sexos raças peso ortopédicas 0 30 6 9 106 disso questionário (IDCH intervalos observouse observou se físicoortopédica físico Entretanto (DCF 3 10 1

RESUMEN Introducción: La artrosis (OA) es una enfermedad inflamatoria degenerativa crónica, caracterizada por la degeneración progresiva del cartílago articular, que afecta principalmente a la articulación de la rodilla. La población anciana es la más afectada, intensificándose el proceso de envejecimiento. La concentración de tejido adiposo intramuscular en los músculos del muslo y la OA de rodilla a diferentes edades sigue siendo objeto de investigación. Objetivo: Investigar el área transversal de los músculos del muslo a diferentes edades con la relación de la presencia de grasa intramuscular y la OA de rodilla. Métodos: Se emparejó a 80 participantes en 4 grupos: Grupo de jóvenes con osteoartritis y Grupo de mayores con osteoartritis, ambos sedentarios y con diagnóstico de OA de rodilla II o III; Grupo de jóvenes sanos y Grupo de mayores sanos, ambos sanos y sedentarios. Los grupos fueron emparejados según sexo e índice de masa corporal, sometidos a evaluación fisioterapéutica, cuestionario WOMAC, exámenes radiográficos de las rodillas y tomografía computarizada del muslo. El análisis morfométrico se realizó manualmente con el software ITK-SNAP (versión 3.6), por un único evaluador. En el análisis estadístico se utilizó la prueba ANOVA unidireccional seguida del post-hoc de Bonferroni para las variables dependientes (p≤0,05). Resultados: La comparación del área transversal de los músculos recto femoral, vasto lateral, semitendinoso, sartorio y gracilis entre los grupos no indicó diferencias significativas (p>0,05). El estudio de la atenuación para el tejido adiposo muscular no indicó diferencias significativas en los valores de entre los grupos OA-Young y Aged-S para todos los músculos evaluados. Conclusión: Individuos jóvenes con OA de rodilla presentan características morfológicas musculares similares a las encontradas durante el proceso de envejecimiento, caracterizando el envejecimiento precoz de los músculos del muslo. Nivel de Evidencia III; Estudio transversal y observacional retrospectivo. Introducción (OA crónica articular afectada investigación Objetivo Métodos 8 III corporal fisioterapéutica WOMAC ITKSNAP ITK SNAP versión 3.6, 36 3.6 , 3 6 3.6) evaluador posthoc post hoc p≤0,05. p005 p p≤0,05 . 0 05 (p≤0,05) Resultados femoral lateral semitendinoso p>0,05. p>0,05 (p>0,05) OAYoung Young AgedS Aged S evaluados Conclusión retrospectivo 3. p00 p≤0,0 (p≤0,05 p>0,0 (p>0,05 p0 p≤0, (p≤0,0 p>0, (p>0,0 p≤0 (p≤0, p>0 (p>0, p≤ (p≤0 p> (p>0 (p≤ (p> (p

ABSTRACT Introduction: Osteoarthritis (OA) is a chronic inflammatory degenerative disease, characterized by progressive degeneration of the articular cartilage, affecting mostly the knee joint. The elderly population is the most affected, intensifying the aging process. The concentration of intramuscular adipose tissue in the thigh muscles and knee OA at different ages remains under investigation. Objective: Investigate the cross-sectional area of thigh muscles at different ages with the relationship of the presence of intramuscular fat and knee OA. Methods: 80 participants were paired into 4 groups: Young Osteoarthritis Group and Old Osteoarthritis Group, both sedentary with knee OA diagnosis II or III; Healthy Young Group and Healthy Old Group, both healthy and sedentary. The groups were paired according to gender and body mass index, submitted to physiotherapeutic evaluation, WOMAC questionnaire, knee X-ray and thigh CT scans. Morphometric analysis was performed manually with ITK-SNAP software (version 3.6), by a single evaluator. Statistical analysis used the one-way ANOVA test followed by Bonferroni post-hoc for dependent variables (p≤0.05). Results: Comparison of the cross-sectional area of the rectus femoris, vastus lateralis, semitendinosus, sartorius and gracilis muscles between the groups indicated no significant differences (p>0.05). The study of attenuation for muscle adipose tissue indicated no significant difference in the values of between the OA-Young and Aged-S groups for all the muscles evaluated. Conclusion: Young individuals with knee OA present muscle morphological characteristics similar to those found during the aging process, characterizing early aging of the thigh muscles. Level of Evidence III; Retrospective cross-sectional and observational study. Introduction (OA disease cartilage joint affected process investigation Objective crosssectional cross sectional Methods 8 III index evaluation questionnaire Xray X ray scans ITKSNAP ITK SNAP version 3.6, 36 3.6 , 3 6 3.6) evaluator oneway one way posthoc post hoc p≤0.05. p005 p p≤0.05 . 0 05 (p≤0.05) Results femoris lateralis semitendinosus p>0.05. p>0.05 (p>0.05) OAYoung AgedS Aged S evaluated Conclusion 3. p00 p≤0.0 (p≤0.05 p>0.0 (p>0.05 p0 p≤0. (p≤0.0 p>0. (p>0.0 p≤0 (p≤0. p>0 (p>0. p≤ (p≤0 p> (p>0 (p≤ (p> (p

RESUMO Introdução: A osteoartrite (OA) é uma doença inflamatória crônico-degenerativa, caracterizada pela degeneração progressiva da cartilagem articular, acometendo em maior parte a articulação do joelho. A população idosa é a mais atingida, intensificando o processo de envelhecimento. A concentração de tecido adiposo intramuscular nos músculos da coxa e a OA de joelho em diferentes idades permanece em investigação. Objetivo: Investigar a área de secção transversa dos músculos da coxa em diferentes idades com a relação da presença de gordura intramuscular e OA de joelho. Métodos: 80 participantes foram pareados em 4 grupos: Grupo Osteoartrite Jovem e Grupo Osteoartrite Idoso, ambos sedentários com diagnóstico de OA de joelho II ou III; Grupo Jovem Saudável e Grupo Idoso Saudável, ambos saudáveis e sedentários. Os grupos foram pareados de acordo com sexo e índice de massa corporal, submetidos à avaliação fisioterapêutica, questionário WOMAC, exames de raio-x dos joelhos e tomografia computadorizada da coxa. A análise morfométrica foi realizada manualmente com software ITK-SNAP (versão 3.6), por um único avaliador. Análise estatística utilizou o teste ANOVA one-way seguido pelo post-hoc de Bonferroni, para variáveis dependentes (p≤0,05). Resultados: A comparação da área de secção transversa dos músculos reto femoral, vasto lateral, semitendinoso, sartório e grácil, entre os grupos, não indicou diferenças significativas (p>0,05). O estudo da atenuação para o tecido adiposo muscular não indicou diferença significativa nos valores de entre os grupos OA-Jovem e Idoso-S para todos os músculos avaliados. Conclusão: Indivíduos jovens com OA de joelho apresentam características morfológicas musculares semelhantes às encontradas durante o processo de envelhecimento, caracterizando um envelhecimento precoce dos músculos da coxa.Nível de Evidência III; Estudo retrospectivo transversal e observacional. Introdução (OA crônicodegenerativa, crônicodegenerativa crônico degenerativa, degenerativa crônico-degenerativa articular atingida investigação Objetivo Métodos 8 III corporal fisioterapêutica WOMAC raiox raio x ITKSNAP ITK SNAP versão 3.6, 36 3.6 , 3 6 3.6) avaliador oneway one way posthoc post hoc Bonferroni p≤0,05. p005 p p≤0,05 . 0 05 (p≤0,05) Resultados femoral lateral semitendinoso grácil p>0,05. p>0,05 (p>0,05) OAJovem IdosoS S avaliados Conclusão coxaNível Nível observacional 3. p00 p≤0,0 (p≤0,05 p>0,0 (p>0,05 p0 p≤0, (p≤0,0 p>0, (p>0,0 p≤0 (p≤0, p>0 (p>0, p≤ (p≤0 p> (p>0 (p≤ (p> (p