ABSTRACT BACKGROUND AND OBJECTIVES: Spine diseases have a high annual prevalence and are the main causes of years lived with disability and chronic pain. Among the postoperative analgesic control options, patient-controlled analgesia (PCA) and multimodal analgesia (MMA) have shown good clinical results. This meta-analysis seeks new evidence to help in the treatment of acute postoperative pain in patients undergoing spinal surgery. CONTENTS: The following databases were used: Cochrane Central Register of Controlled Trials, Medline and Embase. Studies that compared two post-surgical analgesic interventions were included; MMA and PCA. The parameters evaluated were: analgesic effect; opioid consumption; length of hospital stay; and adverse effects. Registration of the systematic review protocol: (PROSPERO CRD42023446627). There was no statistical difference when assessing analgesic improvement comparing MMA to PCA (MD -0.12 [-0.41, 0.17] 95%CI with p=0.69). There was a statistical difference, with lower opioid consumption in MMA compared to PCA (MD -3.04 [-3.69, -2.39] 95%CI with p=0.0002). Statistically significant difference regarding length of hospital stay in favor of MMA (MD -13.17 [-16.98, -9.36] 95%CI with p=0.00001), and significantly lower incidence of nausea and vomiting in patients undergoing MMA in compared to PCA (OR 0.26 [0.11, -0.64] 95%CI with p=0.003). CONCLUSION: MMA was equivalent to PCA in the treatment of acute postoperative spinal pain, with the significant clinical advantage and safety of lower amounts of infused opioids, shorter hospital stay and lower incidence of adverse effects.

RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças da coluna apresentam alta prevalência anual e são as principais causas de anos vividos com incapacidade e de cronificação da dor. Dentre as opções de controle analgésico pós-operatória, a analgesia controlada pelo paciente (ACP) e a analgesia multimodal (AMM) apresentam bons resultados clínicos. O objetivo deste estudo foi buscar novas evidências que auxiliem no tratamento da dor aguda no pós-operatório do paciente submetido à cirurgia da coluna. CONTEÚDO: As bases de dados utilizadas: Cochrane Central Register of Controlled Trials, Medline e Embase. Foram incluídos estudos que compararam duas intervenções analgésicas pós-cirúrgicas; AMM e ACP. Os parâmetros avaliados foram: efeito analgésico; consumo de opioide; tempo de internação hospitalar e efeitos adversos. Registro do protocolo de revisão sistemática: (PROSPERO CRD42023446627). Não houve diferença estatística quando avaliadas a melhora analgésica comparando a AMM à ACP (MD -0,12 [-0,41, 0,17] 95%CI com p=0,69). Houve diferença estatística, com menor consumo de opioide na AMM em comparação à ACP (MD -3,04 [-3,69, -2,39] 95%IC com p=0,0002). Diferença estatística significativa com relação ao tempo de permanência hospitalar a favor da AMM (MD -13,17 [-16,98, -9,36] 95%IC com p=0,00001), e incidência significativamente menor de náuseas e vômitos nos pacientes submetidos a AMM em comparação a ACP (OR 0,26 [0,11, -0,64] 95%IC com p=0,003). CONCLUSÃO: A AMM foi equivalente à ACP no tratamento da dor aguda pós-operatória da coluna, com a significativa vantagem clínica e a segurança de menores quantidades de opioides infundidos, menor tempo de internação hospitalar e menor incidência de efeitos adversos.

Abstract Objectives: To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: 1) Diagnosis – audiologic and radiologic; 2) Treatment – hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI). Conclusions: The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.

Abstract Objective The present study aims to analyze the use of shoulder imbalance as a parameter for scoliosis screening as well as its relationship with other parameters of physical examination. Methods This study assesses a smartphone application that analyzes several parameters of the physical examination in adolescent idiopathic scoliosis. Medical and non-medical examiners applied the screening tool in students in a public school and in a private sports club. After data collection, interobserver correlation was done to verify shoulder imbalance and to compare shoulder imbalance with Adam's bending test and with trunk rotation. Results Eighty-nine participants were examined, 18 of whom were women and 71 of whom were men. Two subjects were excluded from the analysis. The mean age of subjects from the public school was 11.30 years and, for those from the sports club, it was 11.92 years. The examiners had poor-to-slight interobserver concordance on shoulder asymmetry in the anterior and posterior view. No significant statistical correlation was found between shoulder asymmetry and positive Adam's forward bending test. Conclusion Our preliminary study shows that the shoulder asymmetry has a poor correlation with the Adam's forward bending test and measuring trunk rotation using a scoliometer. Therefore, the use of shoulder imbalance might not be useful for idiopathic scoliosis screening. Level of Evidence III; Diagnostic Study

Resumo Objetivo O objetivo deste estudo é analisar o uso da assimetria de ombros como parâmetro para a triagem de escoliose e sua relação a outros parâmetros do exame físico. Métodos Este estudo avalia um aplicativo para smartphone que analisa diversos parâmetros do exame físico de adolescentes com escoliose idiopática. Examinadores médicos e não médicos utilizaram o instrumento de triagem em alunos de uma escola pública e de um clube esportivo privado. Após a coleta de dados, a correlação interobservador foi determinada para verificar a assimetria de ombros e compará-la ao teste de inclinação de Adam e à medição da rotação do tronco. Resultados Oitenta e nove participantes foram examinados, sendo 18 do sexo feminino e 71 do sexo masculino. Dois indivíduos foram excluídos da análise. A média de idade dos participantes da escola pública foi de 11,30 anos e do clube esportivo, 11,92 anos. Os examinadores apresentaram concordância interobservador baixa a branda quanto à assimetria de ombros em incidência anterior e posterior. Não houve correlação estatística significativa entre a assimetria de ombros e o resultado positivo no teste de inclinação do tronco de Adam. Conclusão Nosso estudo preliminar mostra que a assimetria de ombros tem baixa correlação com o teste de inclinação de Adam e assim como com a medição de rotação do tronco com escoliômetro. Portanto, o uso da assimetria de ombros pode não ser útil na triagem da escoliose idiopática. Nível de Evidência III; Estudo Diagnóstico

Abstract This meta-analysis aimed to investigate the effects of propolis on the severity of coronavirus disease symptoms by reducing periodontal disease. PubMed, EMBASE, SciELO, Web of Science, and SCOPUS databases were systematically searched. Studies have been conducted analyzing propolis’s effects on COVID-19 and periodontitis. The study was conducted according to the PRISMA statement and registered in PROSPERO. Risk of Bias (RoB) assessment and meta-analysis of clinical studies were performed (Review Manager 5, Cochrane). The certainty of the evidence was assessed using GradePro (GDT). Studies have shown propolis flavonoids inhibit viral replication in several DNA and RNA viruses, including coronaviruses. Propolis components have an aminopeptidase inhibitor activity that can inhibit the main proteases of SARS viruses and seem to inhibit protein spikes, which are sites of most mutations in SARS-CoV strains. The meta-analysis showed favorable results with the use of propolis on probing depth (95%CI: 0.92; p < 0.001), clinical attachment level (95%CI: 1.48; p < 0.001), gingival index (95%CI: 0.14; p = 0.03), plaque index (95%CI: 0.11; p = 0.23), and blending on probing (95%CI: 0.39; p < 0.001). The antibacterial activity of propolis could be mediated through its direct action on microorganisms or the stimulation of the immune system, activating natural defenses. Thus, propolis inhibits the replication of SARS-CoV-2 as well as its bacterial activity. Treatment with propolis improves general health and facilitates the activation of the immune system against coronavirus.

Abstract Objective: To review the literature on the diagnosis and treatment of vestibular schwannoma. Methods: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on vestibular schwannoma were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results: The topics were divided into 2 parts: (1) Diagnosis – audiologic, electrophysiologic tests, and imaging; (2) Treatment – wait and scan protocols, surgery, radiosurgery/radiotherapy, and systemic therapy. Conclusions: Decision making in VS treatment has become more challenging. MRI can diagnose increasingly smaller tumors, which has disastrous consequences for the patients and their families. It is important to develop an individualized approach for each case, which highly depends on the experience of each surgical team.

RESUMO Objetivo Avaliar a capacidade de correção imediata do colete Wood-Chêneau-Rigo (WCR), produzido com recursos tecnológicos digitais e de engenharia robótica, em curvas primárias e secundárias de escoliose idiopática do adolescente (EIA). Métodos Realizou-se um estudo retrospectivo com 138 pacientes com diagnóstico de EIA que adquiriram o colete WCR entre 2019 e 2021 em um laboratório de produção de órteses e próteses ortopédicas. Esses indivíduos foram submetidos à análise independente dos parâmetros radiográficos por um único pesquisador, tendo como desfecho principal a medida padronizada das curvas principal e secundária pelo método de Cobb. As radiografias analisadas foram realizadas em ortostase antes e imediatamente depois da adaptação do colete no paciente. A capacidade de correção foi calculada pela razão entre a diferença das curvas pré e pós-colete e a curva pré-colete. Resultados A média de correção da curva primária com o WCR foi de 48,4% e a da curva secundária foi de 41,0%. O nível de correção da curva primária foi significativamente maior nos pacientes com curva principal com ápice da convexidade na região toracolombar (p = 0,004), principalmente toracolombar à esquerda (p = 0,010); curvas com magnitude entre 10º e 24,9º (p < 0,001) e curvas do tipo simples (p < 0,001). Conclusões O colete WCR, produzido com modernos recursos tecnológicos, foi eficaz na correção imediata da EIA. São necessários estudos a longo prazo sobre essa nova modalidade de tratamento conservador da escoliose. Nível de Evidência III; Estudo retrospectivo.

ABSTRACT Objective To evaluate the immediate correction capacity of the Wood-Chêneau-Rigo brace (WCR), produced using digital technological resources and robotic engineering, in primary and secondary curves of adolescent idiopathic scoliosis (AIS). Methods A retrospective study was conducted of 138 patients with a diagnosis of AIS and who received a WCR brace from a laboratory that makes orthoses and orthopedic prostheses between 2019 and 2021. These individuals were submitted to an independent analysis of the radiographic parameters by a single researcher, the main outcome of which was the standardized measurement of the main and secondary curves using the Cobb method. The radiographs analyzed were performed in orthostasis before and immediately after the adaptation of the brace on the patient. The correction capacity was calculated as the ratio of the difference between the pre- and post-brace curves to the pre-brace curve. Results The mean correction with the WCR was 48.4% for the main curve and 41.0% for the secondary curve. The level of correction of the main curve was significantly higher in patients with a main curve with the apex of convexity in the thoracolumbar region (p = 0.004), especially in the left thoracolumbar region (p = 0.010); curves of magnitude between 10º and 24.9º (p <0.001); and curves classified as simple (p <0.001). Conclusion The use of the WCR, which is produced using modern technological resources, was effective in the immediate correction of AIS. Long-term studies on this new modality of conservative scoliosis treatment are necessary. Level of evidence III; Retrospective study.

RESUMEN Objetivo Evaluar la capacidad de corrección inmediata del corsé de Wood-Chêneau-Rigo (WCR), producido con recursos tecnológicos digitales e ingeniería robótica, en curvas primarias y secundarias de la escoliosis idiopática del adolescente (EIA). Métodos Se realizó un estudio retrospectivo de 138 pacientes con diagnóstico de EIA que adquirieron el corsé WCR entre 2019 y 2021 en un laboratorio de producción de ortesis y prótesis ortopédicas. Estos individuos fueron sometidos a un análisis independiente de los parámetros radiográficos por un solo investigador, siendo el resultado principal la medición estandarizada de las curvas principal y secundaria por el método de Cobb. Las radiografías analizadas se tomaron en bipedestación antes e inmediatamente después de la adaptación del corsé al paciente. La capacidad de corrección se calculó por la razón entre la diferencia entre las curvas de antes y de después del uso del corsé y la curva de antes del corsé. Resultados La corrección promedio de la curva primaria con el WCR fue del 48,4% y de la curva secundaria fue del 41,0%. El nivel de corrección de la curva primaria fue significativamente más grande en pacientes con una curva principal con vértice de la convexidad en la región toracolumbar (p = 0,004), principalmente toracolumbar a la izquierda (p = 0,010); curvas con magnitud entre 10º y 24,9º (p < 0,001) y curvas simples (p < 0,001). Conclusiones El uso corsé WCR, producido con modernos recursos tecnológicos, fue efectivo en la corrección inmediata de la EIA. Se necesitan estudios a largo plazo sobre esta nueva modalidad de tratamiento conservador de la escoliosis. Nivel de evidencia III; Estudio retrospectivo.

RESUMO Objetivo O objetivo desse trabalho foi determinar a prevalência dos pacientes submetidos a procedimentos eletivos de coluna com mucosa nasal colonizada por Staphylococcus aureus Meticilina Resistente (MRSA). Métodos Foi realizado estudo retrospectivo dos prontuários de todos os pacientes submetidos a procedimentos eletivos, totalizando 125, entre 2015 e 2017, por dois cirurgiões de coluna do serviço de Ortopedia e Traumatologia do Hospital Mater Dei, de Belo Horizonte, Minas Gerais. A investigação pré-operatória para MRSA consistiu em swab nasal submetido à cultura microbiológica. Resultados Dos 125 pacientes avaliados, três (2,4%) apresentaram resultado positivo para colonização nasal por MRSA. Essa prevalência está de acordo com a literatura estrangeira, que varia de 1,5 a 5,9%. Desses pacientes, nenhum apresentou infecção da ferida operatória, provavelmente devido às medidas de profilaxia instituídas. Conclusão Apesar das limitações do estudo, constatamos que a população estudada apresenta prevalência de carreamento nasal de MRSA similar às populações estrangeiras. Nível de evidência III; Estudo Retrospectivo.

ABSTRACT Objective The objective of this study was to determine the prevalence of patients with colonization of methicillin-resistant Staphylococcus aureus (MRSA) in the nasal mucosa, who underwent elective spinal procedures. Methods Retrospective study of the medical records of all patients submitted to elective procedures, totaling 125 individuals in the period of 2015 and 2017, performed by two spinal surgeons of the Orthopedics and Traumatology Service of Hospital Mater Dei, Belo Horizonte, Minas Gerais. The pre-operative investigation of MRSA consisted of the collection of a nasal swab for microbiological culture. Results Of the 125 patients evaluated, three (2.4%) showed positive results for MRSA nasal colonization. This prevalence is consistent with the international literature, that ranges from 1.5 to 5.9%. Of these patients none had infection of the surgical wound, probably due to the preoperative prophylactic measures. Conclusions Despite the limitations of the study, we found that the prevalence of carriers of this nasal MRSA population is similar to that of populations worldwide . Level of evidence III; Retrospective Study.

RESUMEN El objetivo de este estudio fue determinar la prevalencia de pacientes con colonización de Staphylococcus aureus resistente a la meticilina (SARM) en la mucosa nasal que se sometieron a procedimientos electivos de columna vertebral. Métodos Estudio retrospectivo de los registros médicos de todos los pacientes sometidos a procedimientos electivos, con un total de 125 individuos en el período de 2015 a 2017, realizado por dos cirujanos de columna vertebral del Servicio de Ortopedia y Traumatología del Hospital Mater Dei, de Belo Horizonte, Minas Gerais. La investigación preoperatoria de SARM consistió en la recolección de un hisopo nasal para cultivo microbiológico. Resultados De los 125 pacientes evaluados, tres (2,4%) tuvieron resultados positivos para la colonización nasal por SARM. Esta prevalencia está de acuerdo con la literatura internacional, que varía de 1,5% a 5,9%. De estos pacientes, ninguno tuvo infección de la herida quirúrgica, probablemente debido a las medidas profilácticas preoperatorias. Conclusiones A pesar de las limitaciones del estudio, encontramos que la prevalencia de portadores de SARM nasal de esta población es similar a la de poblaciones de todo el mundo. Nivel de Evidencia III; Estudio retrospectivo.

RESUMO Este consenso de recomendações para a radioterapia (RT) hipofracionada de toda a mama foi organizado pela Sociedade Brasileira de Radioterapia (SBRT) considerando o cenário ideal para indicação e segurança na tecnologia aplicada. Questões de controvérsias e contraindicações (RT hipofracionada em pacientes submetidas à quimioterapia [QT], RT hipofracionada nas drenagens linfáticas, RT hipofracionada após mastectomia com ou sem reconstrução imediata, a realização de reforço de dose em leito cirúrgico [ou boost], RT hipofracionada em pacientes com idade menor que 50 anos, RT hipofracionada em mamas volumosas, RT hipofracionada em histologia de carcinoma in situ [CDIS]) foram discutidas em encontro presencial, sendo o consenso atingido quando existisse concordância de pelo menos 75% dos panelistas. O grau de recomendação foi também sugerido de acordo com o nível de evidência científico disponível, qualificado entre fraco, médio ou forte. Assim, este consenso deverá servir para auxiliar os especialistas da radioterapia brasileira em relação às indicações e particularidades dessa técnica, como uma alternativa segura e viável para a realidade nacional.

SUMMARY This recommendation consensus for hypofractionated whole-breast radiotherapy (RT) was organized by the Brazilian Society of Radiotherapy (SBRT) considering the optimal scenario for indication and safety in the technology applied. All controversies and contraindication matters (hypofractionated RT in patients who underwent chemotherapy [CT], hypofractionated RT in lymphatic drainage, hypofractionated RT after mastectomy with or without immediate reconstruction, boost during surgery, hypofractionated RT in patients under 50 years old, hypofractionated RT in large breasts, hypofractionated RT in histology of carcinoma in situ [DCIS]) was discussed during a meeting in person, and a consensus was reached when there was an agreement of at least 75% among panel members. The grade for recommendation was also suggested according to the level of scientific evidence available, qualified as weak, medium, or strong. Thus, this consensus will aid Brazilian radiotherapy experts regarding indications and particularities of this technique as a viable and safe alternative for the national reality.

Abstract Purpose: To compare the influence of two metallic implants in the diagnosis of periprosthetic infection using 99m technetium-labeled ceftizoxime. Methods: Twenty rats were randomly divided into four groups, which received sterile and contaminated titanium and stainless steel implants. After 3 weeks, scintilographic images were obtained using a gamma chamber. Radioactivity counts were obtained for the region of interest (ROI) on the operated and non-operated paws. Results: Groups A, B, and C showed homogenous distribution of the radiopharmaceutical. Hyper uptake was observed in the operated paw from group D. The ROI target count was higher in the two groups with stainless steel implants. Among the control groups, the count was higher in the stainless steel group. Furthermore, among the contaminated groups, the uptake was higher in the stainless steel group, with a significant difference. The target: non-target ratio was significantly lower in the control and contaminated groups with both titanium and stainless steel, but the comparison between control groups and contaminated groups was only significant in the former. The cpm/g observed after a decay of 48h showed statistically significant differences between groups. Conclusion: Different biomaterials used in implants have an influence on the results of scintigraphy with 99mTc-CFT.

RESUMO Objetivo: Estudo retrospectivo do resultado funcional de pacientes com hérnia de disco lombar submetidos à discotomia totalmente endoscópica. Métodos: Quinze pacientes consecutivos, 10 homens e cinco mulheres, com média de idade de 34,2 anos, foram avaliados após 15, 30, 90 e 180 dias do pós-operatório por meio do questionário Oswestry Disability Index (ODI) e da Escala Analógica Visual (EVA) para dor axial e nos membros inferiores. Resultados: Houve significativa melhora funcional na avaliação do ODI dos pacientes comparando-se os resultados pré-operatórios com o terceiro e sexto mês de pós-operatório (p < 0,05), bem como da EVA para dor axial pré-operatória com relação a 15, 30 e 90 dias (p < 0,05) de pós-operatório, e da EVA para dor em membro inferior pré-operatória com relação a 15, 90 e 180 dias de pós-operatório (p < 0,05). Conclusão: A discotomia totalmente endoscópica é um procedimento eficaz que deve ser considerado como uma das alternativas à discotomia convencional.

ABSTRACT Objective: Retrospective study of the functional outcome of patients with lumbar disc herniation who underwent full-endoscopic discectomy. Methods: Fifteen consecutive patients, 10 men and 5 women, mean age of 34.2 years, were evaluated at 15, 30, 90 and 180 days after surgery through the Oswestry Disability Index (ODI) questionnaire and the Visual Analogue Scale (VAS) of axial and lower limbs pain. Results: There was a significant improvement in ODI evaluation of patients when comparing the preoperative results with the third and sixth postoperative month (p<0.05), as well as the VAS for preoperative axial pain with respect to 15, 30 and 90 days (p<0.05) after surgery, and VAS for preoperative pain in the lower limbs with respect to 15, 90 and 180 days postoperatively (p<0.05). Conclusion: The full-endoscopic discectomy is an effective procedure which should be considered as an alternative to conventional discectomy.

RESUMEN Objetivo: Estudio retrospectivo de los resultados funcionales en pacientes con hernia de disco lumbar sometidos a la discectomía totalmente endoscópica. Métodos: Quince pacientes consecutivos, 10 hombres y 5 mujeres, con edad promedio de 34,2 años, fueron evaluados después de 15, 30, 90 y 180 días de la cirugía y respondieron el cuestionario Oswestry Disability Index (ODI) y la Escala Visual Analógica (EVA) para el dolor axial y de las extremidades inferiores. Resultados: Hubo una mejora significativa en la evaluación funcional del ODI de los pacientes al comparar los resultados preoperatorios con el tercer y sexto mes después de la cirugía (p < 0,05), así como la EVA para el dolor axial preoperatorio con respecto a 15, 30 y 90 días (p < 0,05) después de la cirugía y EVA para el dolor en el miembro inferior con respecto al preoperatorio y 15, 90 y 180 días después de la intervención (p < 0,05). Conclusión: La discectomía totalmente endoscópica es un procedimiento eficaz que debe ser considerado como una alternativa a la discectomía convencional.