Background: Frailty screening using the Clinical Frailty Scale (CFS) has been proposed to guide resource allocation in acute care settings during the pandemic. However, the association between frailty and coronavirus disease 2019 (COVID-19) prognosis remains unclear.Objectives: To investigate the association between frailty and mortality over 6 months in middle-aged and older patients hospitalized with COVID-19 and the association between acute morbidity severity and mortality across frailty strata.Design: Observational cohort study. Setting: Large academic medical center in Brazil.Participants: A total of 1830 patients aged ≥50 years hospitalized with COVID-19 (March-July 2020).Measurements: We screened baseline frailty using the CFS (1-9) and classified patients as fit to managing well (1-3), vulnerable (4), mildly (5), moderately (6), or severely frail to terminally ill (7)(8)(9). We also computed a frailty index (0-1; frail >0.25), a well-known frailty measure. We used Cox A complete list of investigators in the COVID HCFMUSP Study Group is provided in Data S1.

A formação em Medicina é densa e com grandes responsabilidades. Contato com a morte, ambiente competitivo, privação de lazer e sensação de insegurança técnica funcionam como um retrato da formação. Objetiva-se descrever os diferentes processos que interferem no sofrimento psíquico discente em todas as escolas médicas do Ceará. O estudo acompanhou, do segundo ao sexto ano, 40 alunos da Universidade Estadual do Ceará (Uece) e 20% dos demais estudantes com ingresso comum em todas as outras escolas cearenses. Utilizou-se o Self-Report Questionnaire-20 para avaliar transtornos mentais leves (TML) . A maior prevalência de suspeitos de portar TML foi de 53,3% na Uece, com 20% dos alunos procurando ajuda psicológica. Nas outras escolas, 48,5% foram suspeitos e 18,2% procuraram ajuda. Depressão, insônia, problema pessoal, privação de lazer e insegurança técnica atuaram sobre o sofrimento. A formação médica representa um período de dúvidas, receios e tensões. Os currículos p recisam considerar como os estudantes lidam com a formação. As escolas devem tornar seus serviços de apoio mais integrados à execução dos currículos, focando os dois últimos anos, oferecendo suporte às tensões pessoais e familiares.

The bone mineral density (BMD) of the proximal femur, spine and radius shaft was determined in 75 women with atraumatic fractures of the proximal femur (FXf) (average age: 70.1 +/- 9.6 years) and 51 controls of similar age. Fractures were classified as either cervical (n = 36) or trochanteric (n = 39) on the basis of radiographic and surgical finding. The BMD of spine and proximal femur was determined by dual-photon absorptiometry (Lunar DP3) and the BMD of the radius shaft by single photon absorptiometry. The BMD of patients with FXf was significantly decreased over all skeletal sites compared to controls of similar age. No significant correlation was found between age and the BMD of the femoral neck in patients with FXf. Patients with trochanteric FXf were older and thinner (average: age, 72.9 +/- 9.4 years; weight, 53.1 +/- 7.8 kg) compared with patients with cervical fractures (age, 67.2 +/- 8.9 years; weight, 59.3 +/- 8.3 kg). Likewise the BMD of trochanteric FXf was lower at all measured sites: femoral neck, 0.548 +/- 0.066 g/cm2 vs 0.624 +/- 0.055 g/cm2 (P less than 0.001); L2-L4, 0.799 +/- 0.115 g/cm2 vs 0.925 +/- 0.106 g/cm2 (P less than 0.001); radius shaft, 0.454 +/- 0.057 g/cm2 vs 0.502 +/- 0.083 g/cm2 (P less than 0.05). Of the patients with trochanteric fractures 66% had concomitant vertebral fractures, while this occurred in only 28% of the patients with cervical fractures (P (Fisher) = 0.0007). In summary, females with trochanteric FXf are older, thinner, have less bone mass in all measured sites and suffer with a significantly greater frequency of vertebral fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

In this opinion article, we would like to draw attention to the fact that COVID-19 has a significant impact not only on immune-mediated arthritis but also on osteoarthritis (OA), the most common rheumatic disease. We suggest herein strategies for pain relief and symptom prevention in patients with OA during COVID-19 pandemic.

Improved understanding and treatment of posterior medial and lateral meniscus root tears have attracted increasing interest. These lesions significantly compromise meniscal function, which can result in an outcome resembling total meniscectomy, and are also a potential cause of knee instability. Despite facilitating repair procedures and reducing the operative time for these lesions, all-inside meniscal repair devices are not available in all circumstances or registered for use in all countries worldwide. Furthermore, all-inside arthroscopic devices can be expensive. Therefore, low-cost alternatives for the treatment of these lesions must be identified. We present 2 efficient and safe techniques: an outside-in technique for repairing medial meniscus root tears and a technique using a simple needle inserted through the transtibial tunnel for lateral meniscal root repairs, neither of which requires the use of specific instruments, thus enabling appropriate treatment of posterior medial and lateral meniscus root tears.

Objective: To evaluate the rate of deviation in the lateral radiographic incidence in patients with femoral neck fracture classified as non-diverted in the anteroposterior view (Garden I and II). Methods: Nineteen selected patients with femoral neck fractures classified as Garden I and II were retrospectively evaluated, estimating the degree of deviation in the lateral view. Results: Fifteen cases (79%) presented deviations in lateral view, with a mean of 18.6 degrees (±15.5). Conclusion: Most fractures of the femoral neck classified as Garden I and II present some degree of posterior deviation in the X-ray lateral view. Level of Evidence III, Retrospective Comparative Study.

Objective: To evaluate the profile of blood loss and blood transfusions after the introduction of Tranexamic acid (TXA) in a tertiary university hospital in Brazil. Methods: 173 patients were retrospectively divided into two groups: the ones who received TXA and the control group. Hemoglobin levels (Hb), drain output, transfusion rates, and thromboembolic events were measured. Results: Among the patients included in this study, 82 cases received TXA. Blood transfusion occurred in 3 cases of the TXA group (3.7%), and in 27 control group cases (29.7%; p < 0.001). The average Hb decrease was 2.7 g/dl (± 1.39) and the median drain output was 270 mL in the TXA group. In the control group, the values were 3.41 g/dl (± 1.34; p < 0.001) and 460 mL (p < 0.001), respectively. Thromboembolic events occurred in 2 TXA group cases (2.4%) and in 3 control group cases (3.3%; p > 0.999). Conclusion: TXA was effective in reducing blood transfusion rates, Hb decrease, and drain output on the 1st postoperative day without increasing thromboembolic events. Level of evidence III, Retrospective comparative study.

Objective: To analyse the distances between the femoral insertions of the popliteus tendon (PT) and the lateral collateral ligament (LCL) through dissections of cadaveric specimens in a mixed population. Methods: Fresh cadavers were dissected, and the anthropometric data of all specimens were recorded. The distances from the origin of the PT to the LCL in the femoral region and the diameter of each structure were measured using a digital calliper. Results: In total, 11 unpaired knees were dissected, eight men and three women, with an average age of 71.5 ± 15.2 years, weight of 57.2 ± 15.6 kg, and a mean height of 170.5 ± 8.2 cm. The distance from the center of the femoral footprint of the LCL to the PT was 10.0 ± 2.4 mm. The distances between the edges closest to each other and those more distant from each other were 3.1 ± 1.1 mm and 16.3 ± 2.4 mm, respectively. Conclusion: The distance between the midpoints of the PT and the LCL in our mixed population is smaller than the distances often reported in the literature. PLC reconstruction with separate tunnels for the LCL and PT may not be technically possible for individuals of any population. Level of Evidence III, Diagnostic studies.