High Rate of Hypothyroidism in Multidrug-Resistant Tuberculosis Patients Co-Infected with HIV in Mumbai, India.

Adverse events (AEs) among HIV-infected patients with multidrug-resistant tuberculosis (MDR-TB) receiving anti-TB and antiretroviral treatments (ART) are under-researched and underreported. Hypothyroidism is a common AE associated with ethionamide, p-aminosalicylic acid (PAS), and stavudine. The aim of this study was to determine the frequency of and risk factors associated with hypothyroidism in HIV/MDR-TB co-infected patients

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts’ review

Introduction: A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares the different percutaneous distractional approaches for intra-articular calcaneal fractures. The history, technique, anatomical and fracture considerations, limitations and the results of different distractional approaches reported in the literature are reviewed. Method: Literature review on different percutaneous distractional approaches for displaced intra-articular calcaneal fractures. Results: Eight studies in which application of a distraction technique was used for the treatment of calcaneal fractures were identified. Because of the use of different classification, techniques, and outcome scoring systems, a meta-analysis was not possible. A literature review reveals overall fair to poor result in 10-29% of patients. Ten up to 26% of patients are unable to return to work after percutaneous treatment of their fracture. A secondary arthrodesis has to be performed in 2-15% of the cases. Infectious complications occur in 2-15%. Some loss of reduction is reported in 4-67%. Conclusion: Percutaneous distractional reduction and fixation appears to be a safe technique with overall good results and an acceptable complication rate, compared with other treatment modalities for displaced intra-articular calcaneal fractures. A meta-analysis, based on Cochrane Library criteria is not possible, because of a lack of level 1 and 2 trials on this subject

SMOLDERING MULTIPLE MYELOMA IN LATIN AMERICA

Introduction: Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder with a prevalence of 0.5% in the > 40 yrs population. Effort has been made to characterize these patients in the real world. There is scarce data about SMM in Latin America (LA) and we aimed to characterize SMM in this region. Methods: A consortium between the Brazilian and Latin America myeloma study groups (GBRAM-GELAMM) were stablished to conduct a retrospective cohort study of SMM cases diagnosed from 2015 to 2023. Data collected included demographics, diagnostic and prognostic tools. We also captured data of progression to MM and SMM management. Progression-free survival (PFS) and overall survival (OS) were calculated. Results: A total of 247 pts had been included, from 35 different institutions belonging to eight different countries. Ninety-five (38.5%) of pts were followed in the public health sector (PS). The median age at diagnosis was 64 (34-90) yrs and 158 (64%) patients were female. The immunoglobulin isotype were IgG, IgA and light chains in 158 (64%), 70 (28.3%) and 14 (5.7%), respectively. Regarding exams availability, 210 (85%) pts had FLC analysis, 111 (44.9%) pts had a total body MRI or PET-CT and 106 (42.9%) pts had low radiation total body CT. A total of 191 (77.3%) pts had all the 20-2-20 criteria available from whom 74 (38.7) were low risk, 61 (32.9%) were intermediate risk, 56 (29.3) were higk risk. From the total of patients included 59 (23.9%) progressed, from whom 10 (4%), 14 (5,7%),18 (7.3%) and 17 (28.9%) were low, intermediate, high risk and unknow data, respectively. Median time to progression was 34 (3-136) months, and 11 patients had progressed over 12 months from diagnosis. Chance to progression considering the risk factors from 20-2-20 criteria was identified but not significant (p = 0.08). Thirteen (5%) pts died or lost follow-up. The median follow-up was 42.2 months. Discussion/Conclusion: This is the first cohort with representation of patients with SMM in LA. Although the majority of MM patients in LA are followed in the public sector, only 40% of the SMM cases in the present study belong to this sector, reveling the access difficult to diagnosis tools for SMM cases in the public sector. The majority of pts did have access to CT, MRI, PET, FLC assay and bone marrow study, which we interpret as a correct identification of SMM criteria in our cases. The 20-2-20 criteria works for the study population stratification although no statistical difference was observed, possibly due to the number of cases and/or shot follow-up