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Several total ankle arthroplasty systems rely on an extramedullary cutting guide that must be placed precisely to gauge the amount of distal tibia excised. While each technique guide offers granular instruction to ensure an accurate assessment of the distal tibia bone cut, it is not typically clear whether the Angel Wing should be placed medially or laterally with respect to the ankle and/or the X-ray beam. We found that placing the Angel Wing guide ipsilateral to the X-ray beam leads to added magnification of the guide with respect to the tibia. This magnification may result in a larger than intended resection of bone and subsequent placement of the implant in a more proximal position. A more proximal position of the distal tibial cutting guide leads to the implant interfacing with softer bone and an increased risk for implant subsidence. Given this risk and the possible effect of increased magnification on the extramedullary cutting guide, we strongly advise the surgeon to place the guide contralateral to the X-ray beam with respect to the tibia during total ankle arthroplasty.Methotrexate is an antimetabolite drug that works as a folic acid analogue to inhibit DNA synthesis. This drug is commonly used for treating conditions such as psoriasis, rheumatoid arthritis, atopic dermatitis, and collagen disease. Although methotrexate may have common adverse effects such as bone marrow suppression and liver abnormalities, less commonly encountered side effects include lower extremity cutaneous blistering and skin necrosis. To our knowledge, there have been no case reports that have described methotrexate toxicity to the foot and ankle. this website This case report highlights a case of a 61-year-old patient who initially presented to our hospital with a 2-day history of worsening pain, swelling, and blistering of his feet. The patient's initial diagnosis was secondary to burns; however, with thorough investigation, imaging, and a punch biopsy, the final diagnosis was secondary to methotrexate toxicity. This case emphasizes the importance of a thorough history and physical examination for proper diagnosis and treatment of the adverse effect of methotrexate toxicity.Hallux limitus is among the most common arthritides of the foot and ankle, with increasing incidence in the aging population. Despite its prevalence and disease burden, treatment of the condition remains poorly understood. Many patients will fail initial conservative management, whereas controversy exists surrounding indications for and outcomes of surgery. The present study sought to examine the impact of a novel forefoot orthosis on foot function, pain, and plantar pressure distributions in patients with symptomatic hallux limitus. Nineteen adult patients completed a questionnaire consisting of the 23-item Foot Function Index and a 10-point visual analogue scale measuring pain. Standing pedobarographic maps were generated using a foot scanning system. Participants were instructed to wear the orthosis in athletic shoes for 4 weeks. Eighteen participants (94.7%) experienced improvements in foot function and pain, with 12 (63.2%) reporting complete resolution of pain at the end of the 4-week trial. Mean Foot Function Index scores improved significantly from 43.0% at baseline to 11.0% with the orthosis (p less then .001). Similarly, mean visual analogue scale pain scores decreased significantly from 4.87 to 1.18 (p less then .001). Pedobarographic analysis while wearing the orthosis demonstrated increased ability of participants to bear weight on the arthritic hallux metatarsophalangeal joint and restoration of physiologic stance. Compared to existing products, the device was well tolerated and did not require footwear modifications or impede normal gait. Overall, the orthosis offers an appealing solution to patients dissatisfied with existing treatment options as well as those who may be averse to or ineligible for surgery.The aim of the current review was to assess whether there was an association between obesity and higher levels of hospitalization, poor outcomes and mortality due to the disease of novel coronavirus (COVID-19).
A systematic review of articles on the novel coronavirus, containing information on obesity and its association with COVID-19 morbidity and mortality. In the bibliographic research, four databases were used, with the terms ['COVID-19'] AND ['hospitalization'] AND ['obesity'] AND ['mortality']. Studies published from 12/01/2019 until 05/01/2020 were included. The research contains inclusive criteria targeting studies of humans adults infected by Sars-Cov-2, with or without comorbidities. This research was selected from publications in Spanish and English languages.

96 articles were identified, 15 being presented in two databases. Twenty articles were included, with a population total estimated from 1 to 7671 patients, with a prevalence of obesity ranging from 13.3% to 68.6%. The association of obesitsented an unfavorable factor for infection of novel coronavirus, where the higher the BMI the worse the outcomes. This occurred by worsening the infection itself, as well as increasing the prevalence of hospitalizations, worst outcomes and greater lethality; especially when co-occurring with other chronic conditions and in the elderly as well. Given this evidence, greater attention is suggested to the obese and overweight population in the face of the current pandemic.The use of constructed wetlands for wastewater treatment is rapidly increasing worldwide due to their advantages of low operating and maintenance costs. Denitrification in constructed wetlands is dependent on the presence of organic carbon sources, and the shortage of organic carbon is the primary hurdle for nitrate removal. Therefore, the use of inorganic electronic donors has emerged as an alternative. This paper provides a comprehensive review of nitrate removal pathways using various inorganic electron donors and the performance and development of autotrophic denitrification in constructed wetlands. The main environmental parameters and operating conditions for nitrate removal in wetlands are discussed, and the challenges currently faced in the application of enhanced autotrophic denitrification wetlands are emphasized. Overall, this review illustrates the need for a deep understanding of the complex interrelationships among environmental and operational parameters and wetland substrates for improving the wastewater treatment performance of constructed wetlands.
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