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SUMMARYA total of 73 isolates (57 Enterobacter cloacae and 16 Enterobacter agglomerans), recovered during an outbreak of bacteremia in the Campinas area, São Paulo, Brazil, were studied. Of these isolates, 61 were from parenteral nutrition solutions, 9 from blood cultures, 2 from a sealed bottle of parenteral nutrition solution, and one was of unknown origin. Of the 57 E. cloacae isolates, 54 were biotype 26, two were biotype 66 and one was non-typable. Of 39 E. cloacae isolates submitted to ribotyping, 87.2% showed the same banding pattern after cleavage with EcoRI and BamHI. No important differences were observed in the antimicrobial susceptibility patterns among E. cloacae isolates exhibiting the same biotype, serotype and ribotype. All E. agglomerans isolates, irrespective of their origin, showed same patterns when cleaved with EcoRI and BamHI. The results of this investigation suggest an intrinsic contamination of parenteral nutrition solutions and incriminate these products as a vehicle of infection in this outbreak.

OBJECTIVE: To evaluate the association between the height of the medial longitudinal arch of the foot and non-contact injuries of the anterior cruciate ligament. METHODS: One hundred and five patients were included in this case-control study. The case group consisted of 52 patients with non-contact injury of the anterior cruciate ligament. Fifty-three individuals with no history of symptoms regarding to feet or knees comprised the control group. An anthropometric assessment of the bony arch index was performed, which consisted of measuring the ratio of the height between the navicular bone to the ground and the distance from the most posterior support point of the calcaneus to the first metatarsal-phalangeal joint. Gender, height, weight, body mass index and the frequency of sports practice were also evaluated. RESULTS: Subjects in the case group had significantly higher medial longitudinal arches than individuals in the control group. CONCLUSION: Individuals with rupture of the anterior cruciate ligament had higher arches than the corresponding controls, suggesting an association between a high medial longitudinal arch of the foot and injury of the anterior cruciate ligament. Level of Evidence III, Case-Control Study

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Introduction: The role of first ray sagittal mobility (FRSM) in the etiology and treatment of hallux valgus (HV) remains controversial. The manual clinical test of FRSM performed during the physical examination of HV is completely subjective. Our objective was to compare individuals with and without HV using a previously described manual device validated to evaluate FRSM and to assess the correlation between FRSM and HV severity and between FRSM and the degree of foot flatness. Methods: Thirty-seven feet with HV and 35 control feet were compared using a Eulji Medical Center (EMC)-like manual device. The HV grade was measured using the HV angle (HVA), and the degree of foot flatness was measured using Meary’s angle. Results: FRSM in controls: 6.31 mm; in cases: 8.97 mm, p<0.001, with a difference between controls and cases of 2.66 mm. HVA in controls: 8.75°; in cases: 23.74°, p<0.001. Correlation between FRSM and HVA in controls: r=-0.09, p=0.63; in cases: r=-0.08, p=0.63. Correlation between FRSM and Meary’s angle in controls: r=-0.04, p=0.83; in cases: r=-0.02, p=0.89. The 90th percentile in controls was 8 mm. Conclusion: The individuals with HV had greater FRSM than the controls, and the mean difference was 2.66 mm; a previous study using a Klaue device showed a similar difference of 3.62 mm. There was no correlation between HV severity and FRSM; that is, the more severe cases of HV did not show greater mobility. Therefore, more severe cases will not have a greater likelihood of tarsometatarsal arthrodesis based on the FRSM. There was no correlation between FRSM and foot flatness (Meary’s angle); that is, the FRSM did not increase with foot flatness. The 90th percentile in controls was 8 mm; in other words, 10% of individuals without HV have mobility equal to or greater than 8 mm.