Abstract Background Hand osteoarthritis (HOA) is a highly prevalent disease that may be impacted by social inequalities. Few studies in HOA are from underdeveloped regions. We intend to contribute to fill this gap presenting clinical characteristics of our low-income HOA cohort (LIHOA). Methods Data from 119 patients with a HOA diagnosis fulfilling ACR criteria seen between August 2019 and May 2023 in Fortaleza/Brazil. Evaluations included pain (VAS, visual analogue scale), X-ray (KL, Kellgren-Lawrence), grip and pinch strength (KgF), Cochin hand functional scale (CHFS), FIHOA, and SF-12 scores. Social data included monthly (<1, 1≥/<3, ≥3 MW) minimum wage earnings, occupation, and literacy [</≥ 9 school-years (SY)]. Results 107 out of the 119 patients were included. Mean age was 61.9 (±10.3) years with 94 (92%) women. Systemic arterial hypertension (48%), metabolic syndrome (42.8%), dyslipidemia (28.4%), and obesity (25%) were the most common comorbidities. Mean disease duration was 7.5 ± 7.1 years. Median VAS values at rest and activity were 3 (3–5) and 8 (5–9), respectively (p < 0.001). Fifty-seven (56.4%) patients had ≥4 symptomatic joints with a median of 4 (2–8) painful joints at activity. The 2nd distal interphalangeal (IF), joint was the most symptomatic (21; 23.3%) and most had >4 IF nodes. OA in other joints: 37 (36.2%) spine, 28 (29.4%) knee, 21 (20.5%) bunions. Functional impairment was mild [8 (5–14) median FIHOA]. Median serum CRP was 0.2 mg/dL (0.1–0.4) with 14 (20%) patients above reference value. Mean total KL score was 27.6 ± 13.6 with 21 (23%), 38 (41.7%), and 33 (36.2%) KL2, KL3, and KL4, respectively; 51 (54.8%) and 42 (45.2%) patients declared </≥3 MW earnings, respectively. Most declared >9SY including 37.2% with a university degree. Individuals earning <3 MW had lower pinch (p < 0.004) and grip strength (p < 0.01), and higher FIHOA scores (p < 0.007), as compared to ≥3 MW earning group. Literacy or occupation did not impact outcome. SYSADOA were used by 13 (12.7%), 6 used oral and 3 topical anti-inflammatory drugs and 2 used 5 mg/d prednisone. Conclusion Clinical characteristics in our LIHOA cohort mirror those reported in affluent regions. Socioeconomic disparities influenced functional outcome in LIHOA cohort. (HOA inequalities regions lowincome low income LIHOA. . (LIHOA) 11 201 202 FortalezaBrazil Fortaleza Brazil Fortaleza/Brazil VAS, (VAS scale, , scale) Xray X ray KL, (KL KellgrenLawrence, KellgrenLawrence Kellgren Lawrence Kellgren-Lawrence) KgF, KgF (KgF) CHFS, CHFS (CHFS) SF12 SF 12 SF-1 <1, 1 (<1 1≥/<3 ≥ earnings </≥ [</ schoolyears school SY. SY (SY)] 10 619 61 61. ±10.3 103 (±10.3 92% 92 (92% women 48%, 48 48% (48%) 42.8%, 428 42.8% (42.8%) 28.4%, 284 28.4% (28.4%) 25% 25 (25% comorbidities 75 7 7. 71 3–5 35 (3–5 5–9, 59 5–9 (5–9) p 0.001. 0001 0.001 0 001 0.001) Fiftyseven Fifty seven 56.4% 564 56 (56.4% 2–8 (2–8 nd IF, (IF) (21 23.3% 233 23 > nodes 36.2% 362 36 (36.2% spine 29.4% 294 29 (29.4% knee 20.5% 205 20 (20.5% bunions [ 5–14 514 (5–14 FIHOA. FIHOA] 02 0. mgdL mg dL 0.1–0.4 0104 (0.1–0.4 20% (20% value 276 27 27. 136 13. 23%, 23% (23%) 41.7%, 417 41.7% 41 (41.7%) KL2 KL3 KL4 54.8% 548 54 (54.8% 45.2% 452 45 (45.2% 9SY 372 37.2 degree 0.004 0004 004 0.01, 0.01 01 0.01) 0.007, 0007 0.007 007 0.007) group 12.7%, 127 12.7% (12.7%) antiinflammatory anti inflammatory mgd d prednisone (LIHOA Kellgren-Lawrence (KgF (CHFS SF1 SF- <1 (< 1≥/< </ [< (SY) ±10. (±10. (92 (48% 42.8 (42.8% 28.4 (28.4% (25 3– (3– 5– (5–9 000 0.00 00 56.4 (56.4 2– (2– (IF (2 23.3 36.2 (36.2 29.4 (29.4 20.5 (20.5 5–1 (5–1 0.1–0. 010 (0.1–0. (20 (23% 41.7 (41.7% 54.8 (54.8 45.2 (45.2 37. 0.0 12.7 (12.7% ( 1≥/ (SY ±10 (±10 (9 (48 42. (42.8 28. (28.4 (3 (5– 56. (56. 23. 36. (36. 29. (29. 20. (20. 0.1–0 (0.1–0 (23 41. (41.7 54. (54. 45. (45. 12. (12.7 1≥ ±1 (±1 (4 (42. (28. (5 (56 (36 (29 0.1– (0.1– (41. (54 (45 (12. (± (42 (28 0.1 (0.1 (41 (12 (0. (1 (0

Paciente de 69 anos, com história de traumas repetitivos no punho, simulando clinicamente tenossinovite, sendo feitas ultrassonografia com doppler e ressonância nuclear magnética, que evidenciaram trombose da artéria ulnar. O diagnóstico preciso da doença do martelo hipotenar por meio desses exames possibilita uma intervenção precoce e melhora o prognóstico dos pacientes acometidos por essa rara afecção.

Case report of a 69 year-old patient, with history of repetitive trauma events in the wrist, clinically simulating tenosynovitis, being held with Doppler Ultrasound and Magnetic Nuclear Resonance, which showed ulnar artery thrombosis. The accurate diagnosis of the hammer hypothenar disease through those tests enable an early intervention, improving the prognosis of patients affected by this rare disease.

Os autores relatam um caso de condrossarcoma em uma paciente de 14 anos portadora de osteocondromatose múltipla, que procurou assistência médica com a queixa de tumoração na coxa esquerda. Cortes tomográficos do membro afetado evidenciaram lesão osteodestrutiva no terço superior do fêmur esquerdo. O diagnóstico foi feito através da revisão da lâmina do serviço de origem da paciente, confirmando o achado de condrossarcoma grau I em lesão condromatosa. Foi realizada desarticulação do colo femoral devido ao extenso comprometimento de grupos musculares, de tecido celular subcutâneo e de pele. A literatura mostra ampla variação nas taxas de transformação maligna das exostoses em pacientes portadores desta doença, sendo esta uma importante complicação nestes pacientes.

The authors report a case of chondrosarcoma in a 14-year-old female patient with multiple osteochondromatosis who has sought medical assistance complaining of a tumor on the left coxa. CT images of the affected limb have demonstrated osteodestructive lesion on the superior third of the left femur. The diagnosis has been made through a review of the biopsy slide from the service of origin of the patient, confirming the finding of a grade I chondrosarcoma in a chondromatous lesion. Disarticulation of the femoral neck was made because of the large extent of the lesion in muscular groups, subcutaneous cellular tissue and skin. The literature shows a wide variation in rates of malignant transformation of exostosis in patients with this disease, and this is a significant complication in patients affected by this disease.

Os autores descrevem dois casos em que se utilizou a ultra-sonografia intra-operatória como método auxiliar à ressecção cirúrgica de insulinomas pancreáticos. Ressaltamos a importância desta técnica, principalmente nos casos em que estes tumores não foram localizados adequadamente por outros métodos no estudo pré-operatório, evitando-se ressecções amplas desnecessárias e reduzindo as complicações pós-operatórias.

The authors describe two cases of utilization of intraoperative ultrasound as an auxiliary method for surgical resection of pancreatic insulinomas. We emphasize the importance of this procedure, particularly in patients whose tumors could not be well delimited using other preoperative methods, thus avoiding unnecessary ample resections and reducing postoperative complications.