INTRODUCTION.Prevention measures are highly important to poor communities because surveillance and access to health care may be limited.OBJECTIVES We aimed establish measures to contain and suppress the spread of COVID-19, associating education, active case tracking, and humanitarian aid in two needy communities in Brazil. The adherence to the measures and evolution of the number of cases were verified during the project.MATERIALS AND METHODS.The target population consisted of approximately 1300 participants(350 families). A collection of epidemiological data was performed in family members registered for the project. Rapid tests were performed on people who had symptoms and their contacts. Scientific information through audio-visual materials,educational pamphlets written in colloquial language, food parcels,masks,hygiene and cleaning materials were provided directly to family nuclei. RESULTS The common needs faced by families were food inputs and/or ready-to-eat food, mentioned by 91.4% (233) of the people, and hygienic and cleaning materials, mentioned by 30.6% (78) of the people. Only 34.9% (84) of families had 70% rubbing alcohol or hand sanitizer gel at home.The most frequently cited sources of information on COVID-19 were television [cited by 82.4% (210) of the people]; social media [25.5% (65)]; friends, neighbours, or family members [13.7% (35)]; and radio [11.4% (29)] .A total of 83.7% (175) stated that the actions helped them to avoid leaving the community.CONCLUSIONS Community isolation may be the best way to contain the spread of pandemics in fragile populations with low socio-economic status.Educational actions combined with rapid testing and humanitarian aid were objective forms to promote community isolation.

Objectives Prompt diagnosis of septic arthritis (SA) in acute native hot joints is essential to reduce unnecessary antibiotics and hospital admissions. We evaluated the utility of SF and serum tests in differentiating causes of acute hot joints. Methods We performed a systematic literature review of diagnostic testing for in acute hot joints. Articles were included if studying ≥1 serum or SF test(s) for an acute hot joint, compared with clinical assessment and SF microscopy and culture. English-language articles only were included, without date restriction. The following were recorded for each test, threshold and diagnosis: sensitivity, specificity, positive/negative predictive values and likelihood ratios. For directly comparable tests (i.e. identical fluid, test and threshold), bivariate random-effects meta-analysis was used to pool sensitivity, specificity and areas under curve (AUC). Results 8443 articles were identified, 49 ultimately included. Information on 28 distinct markers in SF and serum, differentiating septic from non-septic joints, was extracted. Most had been tested at multiple diagnostic thresholds, yielding a total of 27 serum markers and 156 SF markers. Due to heterogeneity of study design, outcomes and thresholds, meta-analysis was possible for only eight SF tests, all differentiating septic from non-septic joints. Of these, leukocyte esterase had the highest pooled sensitivity (0.94 [0.70, 0.99]) with good pooled specificity (0.74 [0.67, 0.81]). Conclusion Our review demonstrates many single tests, individually with diagnostic utility but suboptimal accuracy for exclusion of native joint infection. A combination of several tests +/- stratification score is required to optimise rapid assessment of the hot joint.

Background/Aims  Prompt diagnosis of septic arthritis in acute native hot joint presentations is essential to guide management. Patients are frequently admitted and treated with antibiotics whilst awaiting synovial fluid (SF) culture results, which may take 48hours. A rapid test to exclude septic arthritis would reduce unnecessary antibiotics and hospital admissions. Aim: To evaluate the utility of SF and serum tests in differentiating septic from non-septic causes of acute hot joints. Methods  We performed a systematic literature review of diagnostic testing for diagnosis/exclusion of septic arthritis in acute hot joints. Medline, Scopus and Cochrane Library were searched by two researchers. Search strategy included MeSH terms for: causes of a hot or swollen joint or effusion; diagnostic marker or test; SF or serum. Inclusion criteria were: ≥1 serum or SF test(s) to differentiate septic from non-septic causes of acute hot native joints, compared with clinical assessment and SF microscopy and culture. English-language articles only were included, without date restriction. In addition to patient demographics, diagnoses and comparator diagnoses, the following was recorded for each test and threshold (where applicable): sensitivity, specificity, positive/negative predictive values and likelihood ratios, of septic arthritis. For directly comparable tests (i.e. identical fluid, test and threshold), bivariate random-effects meta-analysis was used to pool sensitivity, specificity and areas under curve (AUC). Results  8,443 articles were identified, with 54 eligible for inclusion. Information on 28 distinct markers in SF and serum, differentiating septic from non-septic joints, was extracted. Most markers had been tested at multiple potential diagnostic thresholds, yielding a total of 27 serum markers and 156 SF markers. Due to heterogeneity of study design, outcomes and diagnostic thresholds, meta-analysis was possible for only eight tests differentiating septic from non-septic joints (Table 1). P103 Table 1:Sensitivity, specificity and AUCs for SF tests included in the meta-analysis.Synovial fluid testNumber of articles in meta- analysisSensitivity (95% CI)Specificity (95% CI)AUCGlucose (40mg/dL)20.59 (0.48, 0.69)0.86 (0.75, 0.92)0.593Lactate (≥5mmol/L)20.56 (0.32, 0.78)0.77 (0.67, 0.84)0.768Lactate (≥10mmol/L)20.36 (0.22, 0.53)0.99 (0.96, 1.00)0.852Leukocyte esterase ( ++ or +++)40.94 (0.70, 0.99)0.74 (0.67, 0.81)0.784Polymorphonuclear cells (>90%)20.69 (0.41, 0.88)0.65 (0.53, 0.75)0.665Pro-calcitonin (0.5μg/L)20.67 (0.26, 0.92)0.93 (0.84, 0.97)0.931Tumour necrosis factor α (36pg/mL)20.86 (0.49, 0.97)0.88 (0.54, 0.98)0.931White blood cells (50,000/mm3)50.56 (0.42, 0.69)0.90 (0.87, 0.92)0.895A test was eligible for meta-analysis if > 1 study used the same marker, threshold and fluid. Studies testing markers at other thresholds and/or in serum were not eligible for meta-analysis if not replicated in a second study. Conclusion  Our review demonstrates many single tests with some evidence for diagnostic utility but individually with suboptimal accuracy, for exclusion of native joint infection. A far greater number of SF than serum tests were identified. A combination of several tests +/- stratification score is potentially required to optimise diagnostic accuracy. Further work is therefore indicated on the use of rapid and cost-effective biomarkers for the acute hot joint. Disclosure  M. Dey: None. M. Al-Attar: None. L. Peruffo: None. S.S. Zhao: None. S. Duffield: None. N.J. Goodson: None.

Background:The acute hot joint presentation is a common clinical emergency, often the result of crystal arthritis or trauma. However, all diagnoses can mimic septic arthritis, which should be excluded promptly due to the potential for rapid joint destruction and significant morbidity. The gold-standard test for septic arthritis is synovial fluid culture, which can take several days to perform. Meanwhile, patients are often admitted and given antimicrobials. Other specialties have made use of rapid biomarkers to exclude infection, for example, exclusion of empyema using pleural fluid pH and glucose [1]. Such biomarkers could reduce the need for lengthy hospital admissions and inappropriate antibiotic use in the acute hot joint presentation.Objectives:1.Evaluate research interest over time, on the use of diagnostic biomarkers in the acute hot joint presentation.2.Compare research interest in the use of diagnostic biomarkers in acute hot native versus acute hot prosthetic joints.Methods:We performed a review of the number of publications reporting the use and diagnostic accuracy of biomarkers to exclude infection in the acute hot joint presentations. The database,Scopus, was searched for English-language studies (1946-2018) using search terms relating to septic arthritis, crystal arthritis, and diagnostic markers derived from synovial fluid/aspirate. The number of papers published per year on prosthetic joints only was also calculated. Therefore, the following were recorded for each year 1946-2018: total number of studies; prosthetic joints only; native joints only. Values were plotted, with polynomial trend-lines and R2calculated.Results:Our search yielded 2279 relevant studies in total (561 on prosthetic joints), published 1946-2018. Only 1 study was identified for the year 1946; the next recorded publication was in 1960. Therefore, this single study was excluded as an outlier. Results are presented in Figure 1. The number of studies on diagnostic biomarkers for acute hot joints continued to increase after 1960. From 2016, the number of studies conducted in prosthetic joints outnumbered those done in native joints. Polynomial trend-lines applied to the results showed studies on native acute hot joints are predicted to decline, while those in prosthetic joints will continue to increase.Conclusion:Reasons for an increasing number of studies on prosthetic compared to native acute hot joints include a narrower differential diagnosis in prosthetic joints, i.e. septic vs aseptic. In contrast, native acute hot joints may be the result of various causes including crystal arthritis, inflammatory arthritis, and trauma. Having a narrower differential diagnosis may facilitate diagnostic research in prosthetic joint presentations. Furthermore, incidence of prosthetic joint infection is also greater than that of native joint infection [2]. Nonetheless, the incidence of native joint infection is increasing [3]. This, and the lack of methods by which to rapidly distinguish native joint septic arthritis from non-infective causes, indicates that more research is required in this area.References:[1]Heffner JE et al. Pleural fluid chemical analysis in parapneumonic effusions. A meta-analysis. Am J Respir Crit Care Med. 1995 Jun;151(6):1700–8.[2]Roerdink RL et al. The difference between native septic arthritis and prosthetic joint infections: A review of literature. J Orthop Surg (Hong Kong).[3]Rutherford AI et al. A population study of the reported incidence of native joint septic arthritis in the United Kingdom between 1998 and 2013. Rheumatol (United Kingdom). 2016;55(12):2176–80.Disclosure of Interests:None declared

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RESUMOIntrodução: Os schwannomas intracranianos representam 8% dos tumores do compartimento craniano. Habitualmente se originam dos nervos vestibular, trigeminal ou facial. Os schwannomas do nervo troclear são entidades raras, com menos de 100 casos na literatura, e 33% com confirmação histológica. Relato de Caso: Mulher de 32 anos, com história de três meses de parestesias dimidiadas à esquerda, sem diplopia ou outras queixas visuais. A ressonância magnética evidenciou lesão sólidocística ocupando a cisterna ambiens e do ângulo pontocerebelar à direita. Foi submetida a ressecção microcirúrgica da lesão, confirmada histopatológicamente como schwannoma, e com identificação da origem na porção cisternal do nervo troclear. Após cirurgia, a paciente apresentou melhora completa dos sintomas pré-operatórios, sem novos déficits. Revisão da Literatura: Foram usadas as bases de dados on-line PubMed, MEDLINE e Web of Science, resultando em 94 pacientes com 95 schwannomas encontrados na literatura. Do total, 33% tinham confirmação histológica. 42% foram submetidos a cirurgia, 16% a radiocirurgia, e 42% não foram tratados. Ressecção completa da lesão foi obtida em 58% dos pacientes tratados cirurgicamente. Conclusão: Os schwannomas de nervo troclear são lesões raras que devem fazer parte do diagnóstico diferencial das lesões tumorais, que ocupam a cisterna do ângulo pontocerebelar.ABSTRACT Introduction: Intracranial schwannomas represent 8% of tumors of the cranial compartment. They mostly origin in the vestibular, trigeminal and facial nerves. Trochlear nerve schwannomas are a rare entity, with less than 100 cases in literature, and only 33% with histological confirmation. Case Report: 32 year-old woman, with a 3-month history of left-sided paroxysmal paresthesis, without diplopia or other visual complaints, although she had ambliopia of the ipsilateral eye. Magnetic resonance imaging (MRI) showed a solid-cystic lesion occupying the right ambiens and cerebello-pontine angle cisterns. She underwent microsurgical resection of the lesion, histologically confirmed as schwannoma, and whose origin was found in the cisternal part of the trochlear nerve. After surgery, pre-operative symptoms improved, without new deficits. Literature Review: Pubmed, MEDLINE and Web of Science databases were used, resulting in 94 patients with 95 schwannomas found in literature. From total, 33% had histological confirmation. 42% of the cases underwent surgery, 16% underwent radiosurgery, and 42% were not treated. Gross total resection was obtained 58% of surgically treated patients. Conclusion: Trochlear nerve schwannomas are rare lesions, which should be part of the differential diagnosis of lesion occupying the cerebellopontine cistern.

<p class="PargrafoABNT"><strong>Objetivos:</strong> Óleo de peixe, rico em ácido eicosapentaenoico (EPA), mostrou benefícios renoprotetores em modelos animais de doenças crônicas. O objetivo deste trabalho foi avaliar os efeitos da suplementação com óleo de peixe três vezes mais concentrado em EPA (EPA 3X) na função renal de ratos e a eficiência desta suplementação por um curto período de tempo.</p><p><strong>Metodologia:</strong> Ratos Wistar (n=16) foram divididos em dois grupos, controle (C) e suplementado (CO) por 14 dias com óleo de peixe (EPA 3X). Foram determinados os seguintes parâmetros: ganho de peso, ingesta de água e ração, fluxo urinário, proteinemia, trigliceridemia, osmolaridade, clearance de creatinina e fração de excreção de sódio.</p><p><strong>Resultados</strong>: Os ratos suplementados tiveram níveis de triglicerídeos no plasma 58,4% menores que os ratos controle (p=0,0239), entretanto os restantes dos parâmetros sistemicos avaliados não apresentaram alterações. A suplementação com óleo de peixe não alterou o fluxo urinário. Entretanto, no grupo CO identificou-se um aumento na filtração glomerular, com um incremento em média de 67,8% no clearance de creatinina em relação ao grupo C (<em>p</em>=0,054). A excreção média de proteínas totais na urina e a fração de excreção de sódio foram semelhantes entre os grupos.</p><p><strong>Conclusão</strong>: A suplementação com óleo de peixe três vezes mais concentrado em EPA por um período curto de tempo (quinze dias) provocou alterações significativas tanto em parâmetros sistêmicos (redução significativa na trigliceridemia<strong>)</strong> quanto na função renal de ratos controle (incremento na filtração glomerular) indicando a eficiência desta suplementação. </p>