Despite achieving sufficiency in vitamin D concentrations from ≥3000 IU supplementation, physical performance did not significantly improve. Between-study heterogeneity was large, and well-designed RCTs examining the effect of vitamin D supplementation on serum 25(OH)D concentrations, physical performance, and injuries in different sports, latitudes, ethnicities, and vitamin D status are needed.
ImportanceInjuries to hyaline cartilage have poor healing potential. Microfracture is often used to treat these lesions; yet, significant variation exists in postoperative rehabilitation protocols.ObjectiveTo systematically examine the evidence on the effects of postoperative weight-bearing status after microfracture surgery. We aimed to ascertain the surgical outcomes and complications associated with patients undergoing microfracture surgery for chondral lesions of the hip, knee or ankle assessing for any difference in outcome between early versus delayed weight-bearing postoperatively.Evidence reviewA literature search was performed through five databases (CINHAL, MEDLINE, EMBASE, PubMed and Web of Science) identifying studies addressing weight-bearing following microfracture surgery published between 1990 and March 2015. 2 reviewers conducted a full-text review of eligible studies and the references of these included studies. Inclusion criteria included studies conducted on human subjects who underwent microfracture with a described postoperative weight-bearing protocol; had outcomes data reported and were published in English. Exclusion criteria included review articles, non-surgical studies, technique papers and non-English language studies. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria were used to evaluate the quality of the evidence among all included studies and data were abstracted and separated by joint—hip, knee and ankle. Descriptive statistics are presented.FindingsWe identified and included 46 studies (5 hip studies, 22 knee studies and 19 ankle studies) of very low methodological quality. No included hip studies examined early weight-bearing or any functional protocol assessment. With respect to knee microfracture studies, only 20 of a total of 900 patients followed an early weight-bearing protocol. Given the discrepancy between early and delayed weight-bearing sample sizes available, comparative analyses of outcome scores and complications/reoperations were not pursued. With respect to ankle microfracture studies, there were no differences in functional scores and the rate of complications or reoperations between early and delayed weight-bearing groups.Conclusions and relevanceThere is insufficient evidence to draw any meaningful conclusions with respect to differences in functional scores between early versus delayed weight-bearing following microfracture surgery for the treatment of chondral lesions in the hip, knee and ankle.
Résumé :(traduction)Le virus du papillome humain (VPH) est une des infections sexuellement transmissibles les plus répandues. Il existe quatre types de VPH : 6, 11, 16, et 18. Les types 6 et 11 causent les condylomes acuminés alors que les types 16 et 18 sont asymptomatiques chez les hommes, mais peuvent évoluer en cancer du col utérin chez les femmes. Bien que ce soit rare, un faible pourcentage d'hommes et de femmes ont reçu le diagnostic du VPH malgré l'absence de contact sexuel anté-rieur. Dans cette étude, nous discutons le cas d'un jeune homme de 15 ans de l'Asie du Sud qui a contracté un type inconnu de VPH à faible risque sans avoir eu de contact sexuel. Le VPH est extrêmement contagieux, mais en général, le système immunitaire est capable de contrôler l'infection et de prévenir l'apparition de condylomes acuminés. Dans ce cas, il est important d'empêcher la propagation d'infections virales. Plusieurs déterminants de la santé affectent la transmission du VPH, notamment le revenu, le statut social, le réseau de soutien social, l'éducation et l'alphabétisme, la culture, les environnements sociaux et physiques, ainsi que les services de santé. Pour contribuer à la prévention du VPH, l'éducation sexuelle devrait être enseignée dans les écoles dès un jeune âge et le vaccin Gardasil® devrait être administré aux femmes ainsi qu'aux hommes dès le bas âge afin de réduire le fardeau de la maladie et l'incidence du VPH. Mots-clés :VPH, non sexuel, mâle, Gardasil® Abstract:Human papillomavirus (HPV) is one of the most common sexually transmitted infections. There are four common HPV strains: 6, 11, 16, and 18. Strains 6 and 11 cause genital warts, while strains 16 and 18 are asymptomatic in males and may progress to cervical cancer in females. Although uncommon, a small percentage of males and females have been diagnosed with HPV without previous sexual contact. In this case report, we discuss a case conducted on a 15-year-old South Asian male who contracted an unknown low-risk strain of HPV with no history of sexual contact. HPV is highly infectious, however in the majority of cases the immune system is able to clear the infection, preventing the appearance of genital warts. In cases such as these, it is important to help control the spread of viral infections. Several determinants of health are involved in and affect the transmission of HPV, including income and social status, social support networks, education and literacy, culture, social and physical environments, and health services. To aid in the prevention of HPV, sexual education should be taught at early ages within schools and the Gardasil® vaccine should be administered to both females and males at an early age to reduce the burden of disease and the incidence of HPV.
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