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.

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.

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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.

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.