Background:Failed shoulder instability surgery is mostly considered to be the recurrence of shoulder dislocation but subluxation, painful or non-reliable shoulder are also reasons for patient dissatisfaction and should be considered in the notion.Methods:The authors performed a revision of the literature and online contents on evaluation and management of failed shoulder instability surgery.Results: When we look at the reasons for failure of shoulder instability surgery we point the finger at poor patient selection, technical error and an additional traumatic event. More than 80% of surgical failures, for shoulder instability, are associated with bone loss. Quantification of glenoid bone loss and investigation of an engaging Hill-Sachs lesion are determining facts. Adequate imaging studies are determinant to assess labrum and capsular lesions and to rule out associated pathology as rotator cuff tears. CT-scan is the method of choice to diagnose and quantify bone loss. Arthroscopic soft tissue procedures are indicated in patients with minimal bone loss and no contact sports. Open soft tissue procedures should be performed in patients with small bone defects, with hiperlaxity and practicing contact sports. Soft tissue techniques, as postero-inferior capsular plication and remplissage, may be used in patients with less than 25% of glenoid bone loss and Hill-Sachs lesions. Bone block procedures should be used for glenoid larger bone defects in the presence of an engaging Hill-Sachs lesion or in the presence of poor soft tissue quality. A tricortical iliac crest graft may be used as a primary procedure or as a salvage procedure after failure of a Bristow or a Latarjet procedure. Less frequently, the surgeon has to address the Hill-Sachs lesion. When a 30% loss of humeral head circumference is present a filling graft should be used.Conclusion:Reasons for failure are multifactorial. In order to address this entity, surgeons must correctly identify the causes and tailor the right solution.

RESUMOIntrodução: O objetivo deste estudo, é o de analisar a evidência atual no que respeita ao tratamento cirúrgico de roturas da coifa dos rotadores, em doentes com mais de 65 anos de idade. A hipótese proposta foi que o tratamento cirúrgico de roturas da coifa dos rotadores, em doentes com 65 anos ou mais, acarreta bons resultados funcionais. Não existe, na literatura atual, uma revisão sistemática com os mesmos parâmetros que esta. Material e Métodos: Recorremos à Medline ® , PubMed, Scopus, e Cochrane Register of Controlled Trials, na procura de estudos entre janeiro de 1999 e dezembro de 2015, independentemente da língua, que incluíssem as palavras: 'rotator cuff' e '65 years' ou '70 years'. Como critérios de inclusão estipulámos, estudos (nível I a IV) que reportassem os resultados funcionais de doentes com 65 anos ou mais, submetidos à reparação cirúrgica de uma rotura da coifa dos rotadores sintomática. Foram incluídas técnicas artroscópicas, mini-invasivas e abertas. Os critérios de exclusão estipulados foram, estudos que incluíssem doentes com menos de 65 anos, estudos que não recorressem a escalas de avaliação funcional validadas, como ferramenta de aferição primária, e aqueles com tempo de seguimento inferior a um ano. Este trabalho seguiu as orientações da Preferred Reporting Items for Systematic Reviews and Meta-Analyses -PRISMA. A informação colhida incluiu dados demográficos, padrões de rotura, procedimentos cirúrgicos realizados e resultados, clínicos e das reparações efectuadas. Os resultados funcionais foram convertidos em percentagens, permitindo a comparação de dados entre os estudos. Resultados: Quatorze estudos cumpriram os critérios de inclusão: 11 estudos nível IV, um estudo nível III e dois estudos nível II. Sete estudos reportaram melhorias com significado estatístico entra as avaliações funcionais pré e pós operatórias. Todos os estudos reportaram resultados funcionais bons ou excelentes. Discussão: É provável que seriam obtidos resultados mais consistentes, se todos os estudos incluídos tivessem critérios de selecção mais homogéneos e rigorosos. Apesar de tal não se ter verificado, os resultados clínicos foram, todavia, favoráveis. Isto traduziu-se numa melhoria dos resultados funcionais, com significado estatístico, em todos os estudos prospectivos incluídos. Conclusão: Com base na literatura atual, a reparação de roturas da coifa dos rotadores em doentes com 65 anos ou mais, está associada à melhoria dos resultados funcionais e a um bom grau de satisfação com o procedimento. Palavras-chave: Artroscopia; Idoso; Revisão Sistemática; Rotura da Coifa dos Rotadores ABSTRACTIntroduction: The objective of this study was to analyze current evidence regarding surgical management of rotator cuff tears in patients of 65 years of age and above. Our hypothesis was that surgical repair of rotator cuff tears, in patients older than 65 years, conveys good outcome scores. We have not found a similar systematic review in current literature. Material and Methods: Medline ® , PubMed, Scopus, and the ...

Stroke treatment has dramatically improved in recent decades. However, although new treatments have reduced its mortality and the severity of its physical and cognitive sequelae, many people still have incapacitating disabilities following a stroke. Depression is the most common psychiatric disorder following stroke; it is important to recognise and treat as it limits motor and cognitive rehabilitation. Antidepressant medication is an effective treatment and can improve adherence to clinically recommended physical and cognitive tasks, thereby enhancing functional remodelling of neuronal pathways and improving rehabilitation outcomes.

IntroductionIn late 2019, an epidemic outbreak emerges in China caused by a new coronavirus with high transmission and human infection potential which in March 2020, was characterized by WHO as a pandemic. The lockdown has repercussions on the population’s well-being, reflected in their food choices. There is a tendency to increase the consumption of energy dense food, rich in fat and carbohydrates, which are related to an increased risk of depression.ObjectivesThe main goal of this non-systematic literature review was to understand the impact of the Mediterranean Diet on Mental Health promotion in SARSCoV-2 pandemic.MethodsLiterature from Pubmed database were searched, with the following keywords: COVID-19, Depression, Anxiety, Mental Health and Mediterranean Diet.ResultsStudies indicate that a diet based on the Mediterranean Diet is associated with a decreased risk of developing depressive symptoms, especially when there is moderate to high adherence to this dietary pattern. High consumption of plant and fish foods, reduced consumption of sugary products, processed and red meats and the use of olive oil as a fat source, are principles of the Mediterranean diet, associated with an improvement in endothelial function, increased levels of eicosanoids and serotonin synthesis and regulation of serotonin which seem to explain this protective effect.ConclusionsIn addition to decreasing the risk of obesity, diabetes, and hypertension, comorbidities associated with the most serious disease of COVID-19, the Mediterranean Diet seems to play an important role in promoting mental health, with a decreased risk of developing depressive symptoms.DisclosureNo significant relationships.

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