Alteración de la marcha y poliartralgia como manifestación de escorbuto en un niño. Presentación de un caso / Gait disturbance and polyarthralgia as a manifestation of scurvy in a pediatric patient. Case report

La vitamina C o ácido ascórbico es imprescindible para el correcto funcionamiento del organismo. Los seres humanos no pueden sintetizarla; en consecuencia, dependen estrictamente de su aporte exógeno. Su déficit causa escorbuto, un cuadro que se manifiesta con fatiga, mialgias y poliartralgias, hemorragias en la piel y sangrado de las encías. Es una enfermedad infrecuente. La mayoría de los casos publicados corresponden a niños con restricciones alimentarias por trastornos del neurodesarrollo. La respuesta satisfactoria al aporte de ácido ascórbico confirma el diagnóstico. La sospecha de esta enfermedad evitaría exámenes complementarios innecesarios y el tratamiento temprano ayudaría a revertir los síntomas y prevenir complicaciones. Se presenta el caso de un varón de 13 años que consulta por dolor en ambas caderas con progresión hacia las rodillas, sumado a pérdida de la fuerza y hematomas en los miembros inferiores. El objetivo de esta presentación es resaltar la importancia de la anamnesis alimentaria completa y evitar un abordaje tardío con múltiples intervenciones. Nivel de Evidencia: IV

Vitamin C or ascorbic acid is essential for the correct functioning of the organism. As it cannot be synthesized by humans, it is obtained from external food sources. Deficiency of ascorbic acid produces scurvy, which includes symptoms as fatigue, myalgia and polyarthralgia, associated with skin hemorrhage and bleeding gums. Scurvy is a rare entity. Most of the reported cases involve children with food restrictions due to neurodevelopmental disorders. The early detection of the clinical signs of this condition would avoid unnecessary complementary tests, and early treatment would help reverse symptoms and prevent complications. Case Report: a 13-year-old male patient presented with pain in both hips radiating to the knees associated with loss of strength and hematomas in the lower limbs. Objective: to highlight the importance of a complete nutritional assessment to avoid a late approach with multiple interventions. Level of Evidence: IV

Prevalencia de alteraciones musculoesqueléticas en pacientes que asisten al Centro de Salud de la provincia del Guayas / Prevalence of musculoskeletal disorders in patients attending the Health Center of the province of Guayas / Prevalência de perturbações músculo-esqueléticas em doentes que frequentam o Centro de Saúde da província de Guayas

Los Trastornos musculoesqueléticos (TME) abarcan más de 150 patologías que pueden afectar al sistema locomotor, siendo considerado por la Organización Mundial de la Salud (OMS) en el año 2021 como el principal factor para la incapacidad laboral y de requerir rehabilitación. Estas lesiones se presentan de forma repentina y pueden llegar a ser enfermedades crónicas, las cuales pueden afectar de una manera social, económica y laboral. Objetivo. Establecer la prevalencia de las alteraciones musculoesqueléticas más frecuentes, asociadas a incapacidad laboral en pacientes que asisten al Centro de Salud en la provincia del Guayas. Materiales y métodos. Este trabajo de investigación tiene un alcance descriptivo observacional, de enfoque cuantitativo con un diseño no experimental de corte transversal, el mismo que se apoyó en una base de datos de tipo numérico. Resultados. Obteniendo como resultado una mayor prevalencia en el dolor articular con un 32,49%, seguido de lumbalgia 14,13%, patologías artrósicas 13.73% y dorsalgia 2,62%. Conclusiones. Al realizar la comparación entre varios estudios se pudo determinar que la edad más frecuente para presentar alteraciones musculoesqueléticas es de los 30 a 70 años de edad dentro de la población laboral, siendo a mayor edad, mayor prevalencia a incapacidad laboral.

Musculoskeletal disorders (MSDs) encompass more than 150 pathologies that can affect the locomotor system, being considered by the World Health Organization (WHO) in the year 2021 as the main factor for work incapacity and requiring rehabilitation. These injuries occur suddenly and can become chronic diseases, which can affect socially, economically and occupationally. Objective. To establish the prevalence of the most frequent musculoskeletal alterations associated with incapacity for work in patients attending the Health Center in the province of Guayas. Materials and methods. This research work has a descriptive observational scope, with a quantitative approach and a non-experimental cross-sectional design, which was supported by a numerical database. Results. Obtaining as a result a higher prevalence of joint pain with 32.49%, followed by low back pain 14.13%, osteoarthritic pathologies 13.73% and dorsalgia 2.62%. Conclusions. When comparing several studies, it was possible to determine that the most frequent age for presenting musculoskeletal alterations is between 30 and 70 years of age within the working population, the older the age, the higher the prevalence of incapacity for work.

As doenças musculoesqueléticas (MSDs) abrangem mais de 150 patologias que podem afetar o sistema locomotor, sendo consideradas pela Organização Mundial da Saúde (OMS) no ano 2021 como o principal fator de incapacidade de trabalho e que necessitam de reabilitação. Essas lesões ocorrem repentinamente e podem se tornar doenças crônicas, que podem afetar social, econômica e profissionalmente. Objetivo. Estabelecer a prevalência dos distúrbios musculoesqueléticos mais frequentes associados à incapacidade de trabalho em pacientes que frequentam o Centro de Saúde na província de Guayas. Materiais e métodos. Este trabalho de pesquisa tem um escopo observacional descritivo, com uma abordagem quantitativa e um projeto transversal não-experimental, que foi apoiado por um banco de dados numérico. Resultados. Obtendo como resultado uma maior prevalência de dores articulares com 32,49%, seguida de dores lombares baixas 14,13%, patologias artríticas 13,73% e dores nas costas 2,62%. Conclusões. Uma comparação entre vários estudos mostrou que a idade mais frequente para apresentar distúrbios musculoesqueléticos é entre 30 e 70 anos de idade na população trabalhadora, sendo que quanto maior a idade, maior a prevalência de incapacidade para o trabalho.

Perfil epidemiológico de pacientes com Hemofilia A e doenças associadas ao uso do fator VIII/recombinante / Epidemiological profile of patients with Hemophilia A and diseases associated with the use of factor VIII/recombinant

Introdução: o Brasil é o quarto país em casos de Hemofilia A. O tratamento é infundir o fator de coagulação ausente. Reações ao uso do fator podem incluir manifestações alérgicas, doenças virais transfusionais e aloanticorpos. Objetivo: analisar o perfil epidemiológico de pacientes com Hemofilia A, e as doenças associadas ao uso do fator VIII e fator VIII recombinante. Metodologia: estudo transversal descritivo e retrospectivo. A coleta de dados foi realizada nos prontuários de pacientes com diagnóstico de hemofilia A, preenchidos com mais de 70% das informações, na Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Brasil. Resultados: o Ministério da Saúde identificou no Estado do Amazonas, o registro de 276 indivíduos com diagnóstico de Hemofilia A. Incluídos para análise neste estudo 164 prontuários. Características sociodemográficas: homens 99,4%, adolescentes (28%) e jovens (26,8%); de cor parda 67,1%, ensino fundamental incompleto 28,6% e, exercendo a ocupação de estudante 42,7%. Condição clínica: 36,6% classificados com hemofilia A grave. Todos os pacientes tiveram diagnóstico clínico e laboratorial. O parentesco mais comum é o de irmãos com 35,3%. Sintomas predominantes: hemartrose 45,4%; dor 31,9%; edema 24% e artropatia 8,5%. O fator VIII recombinante, administrado em 34,8% dos pacientes, enquanto o fator VIII plasmático em 28,0%. Administrados doses de 2000UI a 2999UI. As complicações: artralgia 77,4% e hemorragia 77,4%. Conclusão: cuidados qualificados dos profissionais de saúde auxiliam na prevenção de complicações sérias, resultando em qualidade de vida ao hemofílico.

Introduction: Brazil is the fourth country in cases of Hemophilia A. The treatment is to infuse the missing clotting factor. Reactions to the use of the factor can include, allergic manifestations, transfusion viral diseases and alloantibodies. Objective: analyze the epidemiological profile of patients with Hemophilia A, and the diseases associated with the use of factor VIII and recombinant factor VIII. Methodology: descriptive and retrospective cross-sectional study. Data collection was carried out in the medical records of patients diagnosed with hemophilia A, filled with more than 70% of the information, at the Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas, Brazil. Results: in the Ministry of Health of Brazil, it was identified, for the State from Amazonas, the registry of 276 individuals diagnosed with Hemophilia A. Included in the analysis for this study, 164 medical records. Sociodemographic characteristics: male, 99.4%, adolescents (28%) and young people (26.8%), brown skin color, 67.1%, incomplete elementary school, 28.6%, and working as a student, 42.7%. Clinical condition: 36.6% classified with severe hemophilia A. All patients had a clinical and laboratory diagnosis. The most common kinship is that of brothers, 35.3%. Predominant symptoms: hemarthrosis 45.4%, pain 31.9%, edema 24% and arthropathy 8.5%. Recombinant factor VIII, administered in 34.8% of patients, while plasma factor VIII in 28.0%. Doses of 2000 IU to 2999 IU were administered. Complications: arthralgia 77.4% and hemorrhage 77.4%. Conclusion: qualified care by health professionals helps to prevent serious complications, resulting in quality of life for the hemophiliac.

Sinovitis transitoria de cadera en un niño como probable manifestación inicial atípica de COVID-19 / Transient synovitis of the hip in a pediatric patient as an atypical initial manifestation of COVID-19

Comunicamos el caso de un niño con sinovitis de cadera como manifestación inicial atípica de una infección por SARS-CoV-2. Varón de 7 años que consultó por dificultad en la marcha e impotencia funcional con dolor localizado en la cadera derecha. El diagnóstico presuntivo fue sinovitis transitoria de cadera, por lo que recibió tratamiento conservador. A los 12 días, continuaba con impotencia funcional y presentó decaimiento y fiebre. Ante la evolución atípica del cuadro, se decidió su internación para punción articular/drenaje. Se obtuvo un líquido articular claro de aspecto inflamatorio que no presentó desarrollo en los cultivos bacterianos. Durante la internación, se confirmó el resultado positivo de la reacción en cadena de la polimerasa para SARS-CoV-2. El paciente evolucionó favorablemente una vez resuelto el cuadro viral. En el último seguimiento, no tenía síntomas y el rango de movilidad era completo. La sinovitis transitoria de cadera puede ser una manifestación clínica inicial atípica de COVID-19. En el contexto de la pandemia, es indispensable sospechar una posible artropatía reactiva como consecuencia del virus, principalmente cuando la presentación es atípica, hay contactos familiares estrechos, fiebre u otros síntomas respiratorios asociados. Nivel de Evidencia: IV

We report the case of a pediatric patient with transient synovitis of the hip as an initial atypical manifestation of a COVID-19 infection. A 7-year-old boy presented with gait disturbance, limping, and pain in his right hip. After 12 days, the patient continued with functional limitations and had associated symptoms such as fatigue and fever. Because of the atypical course, he was admitted to the hospital for joint aspiration. Due to institutional protocols, the preoperative evaluation included a COVID-19 PCR test. The joint aspiration sample showed clear synovial fluid with inflammatory characteristics and negative bacterial culture. COVID-19 PCR test results came out positive during the patient's hospital stay. Clinical symptoms improved after the viral condition resolved. In the last follow-up, he was asymptomatic with a full hip range of motion. Transient synovitis of the hip could be an atypical initial symptom of a COVID-19 infection. Given the pandemic context of this disease, it is important to consider reactive arthritis as a consequence of this infection, especially in cases of atypical presentation, close family contact, fever, or other associated respiratory symptoms. Level of Evidence: IV

Enfrentamiento del paciente con poliartralgias y poliartritis / Patient's facing polyarthralgia and polyarthritis

El dolor articular es un motivo de consulta frecuente en la práctica clínica. La distinción del tipo de dolor, su distribución, los síntomas acompañantes, el examen físico y la evaluación de algunos exámenes de laboratorio ayudan a orientar acerca de las posibles causas y a pesquisar enfermedades graves que pueden causar destrucción articular o compromiso de otros órganos, con el fin de dar tratamiento oportuno y eficaz. En este artículo se dan algunas pautas que se pueden realizar en la consulta de Atención Primaria para distinguir cuadros de poliartralgias y poliartritis agudas y crónicas. Además, se dan nociones de algunas de las enfermedades reumatológicas más frecuentes.

Joint pain is a frequent reason for consultation in clinical practice. The distinction of the type of pain, its distribution, the accompanying symptoms, the physical examination and the evaluation of some laboratory test help to guide about the possible causes and to investigate serious diseases that can cause joint destruction or involvement other organs, in order to provide timely and effective treatment. This article gives some guidelines that can be carried out in the Primary Care consultation to distinguish acute and chronic polyarthralgia and polyarthritis. In addition, notions of some of the most frequent rheumatological diseases are given.

Síndrome DRESS por paracetamol / DRESS syndrome due to acetaminophen

A síndrome DRESS é uma entidade rara e distinta, caracterizada por acometimento cutâneo e envolvimento de órgãos internos, com risco potencial de morte. O diagnóstico e o tratamento pre- coces são de vital importância. Relatos de DRESS por paraceta- mol são raros na literatura, razão pela qual apresentamos este caso. Paciente do sexo masculino, 56 anos, com surgimento de rash maculopapular, febre, linfadenopatia e hipereosinofilia 3 semanas após suspensão de paracetamol, associados ao ante- cedente familiar de reação a fármaco. Evoluiu bem após pulso- terapia com metilprednisolona.

DRESS syndrome is a rare and distinct entity characterized by cutaneous manifestations and internal organs involvement with a potential risk of death. Early diagnosis and treatment are vi- tally important. Reported cases of DRESS syndrome due to ace- taminophen are rare in the literature, and that is the reason for this case report. A 56-year-old male patient with maculopapular rash, fever, lymphadenopathy, and hypereosinophilia three we- eks after suspension of acetaminophen, associated with a family history of drug reaction. It progressed well after pulse therapy with methylprednisolone.

Individuals requiring orthognathic surgery have more depression and pain than controls

Abstract The objective of this study was to evaluate if individuals with dentofacial deformities (DFD) who require orthognathic surgery are affected more by depression and pain. A case-control study was performed with 195 individuals. In the DFD group, 145 individuals with Class II and III malocclusion requiring orthognathic surgery were selected. The control group was composed of 50 individuals with no DFD. All patients were diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Data were analyzed with a significance level of 0.05. The DFD group more often presented severe depression (p = 0.020) and chronic pain (p = 0.017). They also presented higher prevalence of Nonspecific Physical Symptoms Including Pain (P = 0.002) and Nonspecific Physical Symptoms Excluding Pain (p = 0.002). Concerning TMD symptoms, the DFD group had more myofascial (p = 0.002) and articular pain (p = 0.041). Therefore, the results of this study suggest that depression and pain are more common in individuals with DFD requiring orthognathic surgery compared with individuals without DFD.

Psicanálise, clínica ampliada e dor física: algumas articulações / Psychoanalysis, extended clinic, and physical pain: some articulations / Psicoanálisis, clínica ampliada y dolor físico: algumas articulaciones

A Psicanálise é capaz de enriquecer a clínica ampliada e, assim, viabilizar a superação de limitações inerentes ao modelo biomédico que se revelam por meio de práticas em saúde voltadas a pacientes que padecem de dor física. O presente estudo possui um duplo objetivo. Em primeiro lugar, buscaremos traçar um breve panorama de tentativas de compreensão da dor física ao longo da história, a fim de contextualizar e problematizar o surgimento e a consolidação do modelo biomédico. Em segundo lugar, discutiremos alguns aportes psicanalíticos para a apreensão teórica da dor física que, a nosso ver, podem gerar contribuições relevantes para a clínica ampliada. Concluímos, com base em formulações freudianas e pós-freudianas, que a dor física, desde diferentes ângulos, ocupa um "lugar" fronteiriço, em contraste com o que sugere o modelo biomédico. Com isso, iluminamos aspectos subjetivos das condições dolorosas que merecem ser levados em conta pelos profissionais de saúde (AU).

Psychoanalysis is able to enrich the expanded clinic and, thus, make it possible to overcome limitations inherent to the biomedical model that are revealed through health practices aimed at patients who suffer from physical pain. The present study has a double objective. First, we will seek to outline a brief overview of attempts to understand physical pain throughout history, in order to contextualize and problematize the emergence and consolidation of the biomedical model. Second, we will discuss some psychoanalytical contributions for the theoretical understanding of physical pain that, in our view, can produce relevant contributions to the expanded clinic. We conclude, based on Freudian and Post-Freudian formulations, that physical pain, from different perspectives, occupies a "place" between borders, in contrast to what the biomedical model proposes. Thus, we illuminate subjective aspects of painful conditions that deserve to be taken into account by health professionals (AU).

El psicoanálisis es capaz de enriquecer la clínica ampliada y, de este modo, posibilitar la superación de limitaciones inherentes al modelo biomédico que se revelan mediante prácticas en salud dirigidas a pacientes que padecen de dolor físico. Este trabajo posee un doble objetivo. En primer lugar, procuraremos trazar un breve panorama de tentativas de comprensión del dolor físico a lo largo de la historia, a fin de contextualizar y problematizar el surgimiento y la consolidación del modelo biomédico. En segundo lugar, discutiremos algunos aportes psicoanalíticos para la aprehensión teórica del dolor físico que, a nuestro juicio, pueden generar contribuciones relevantes para la clínica ampliada. Concluimos, con base en formulaciones freudianas y posfreudianas, que el dolor físico, desde diferentes ángulos, ocupa un "lugar" fronterizo, en contraste con lo que sugiere el modelo biomédico. Así, iluminamos aspectos subjetivos de las condiciones dolorosas que merecen ser tenidos en cuenta por los profesionales de la salud (AU).

Estudio de trastornos temporomandibulares en pacientes parcialmente desdentados / A study of temporomandibular disorders in partially edentulous patients

El objetivo de este estudio es determinar la frecuencia y características del edentulismo parcial y patologías de la articulación temporomandibular en pacientes adultos. Se realizó un estudio observacional y descriptivo de pacientes que concurrieron al Módulo de Odontología Rehabilitadora de la Facultad de Odontología, se seleccionaron 60 pacientes que necesitaban rehabilitación protésica parcial. Las variables estudiadas fueron: edad, sexo, clase de Kennedy, dolor articular, ruidos articulares, restricción y desviación mandibulares. Los datos fueron cargados en una base de datos diseñada a tal efecto, para su análisis estadístico. Del análisis del estudio se observó ausencia parcial de piezas dentarias con mayor frecuencia en el sexo femenino (58%), el 52% correspondieron a la clase I de Kennedy: el 64% en el maxilar inferior, el 17% presentó dolor articular, 28% ruidos articulares, 68% presentó desviación mandibular (siendo lo más frecuente hacia la derecha), y el 42% presentó restricción mandibular leve y solo un n=1, grave. Las pérdidas de las piezas dentarias bilaterales posteriores del maxilar inferior son las de mayor frecuencia asociado a patologías frecuentes del ATM. Partiendo desde la prevención, evitando las pérdidas de piezas dentarias y con una correcta rehabilitación se podrá lograr una buena salud bucodental (AU)

The objective of this study is to determine the frequency and characteristics of partial edentulism and pathologies of the temporomandibular joint in adult patients. An observational and descriptive study of patients who attended the Rehabilitation Dentistry Module of the Faculty of Dentistry was carried out; 60 patients who needed partial prosthetic rehabilitation were selected. The variables studied were age, sex, Kennedy class, joint pain, joint noises, mandibular restriction, and mandibular deviation. The data were loaded into a database designed for this purpose, for statistical analysis. From the analysis of the study, partial absence of teeth was observed with greater frequency in females (58%), 52% corresponded to Kennedy Class I: 64% in the lower jaw, 17% presented joint pain, 28 % joint noises, 68% presented mandibular deviation being the most frequent to the right, 42% presented mild mandibular restriction and only one n = 1 severe. Loss of the posterior bilateral teeth of the lower jaw are the most frequent associated with frequent TMJ pathologies. Starting from prevention, avoiding the loss of teeth and with correct rehabilitation, good oral health can be achieved (AU)

Importancia de las características clínicas y de laboratorio en el diagnóstico de las infecciones concomitantes por dengue y chikungunya: reporte de un caso probable / Importance of clinical and laboratory characteristics in the diagnosis of dengue and chikungunya co-infection: Probable case report

Se presenta el caso de una mujer de 38 años que consultó inicialmente por fiebre indiferenciada. A pesar de que el cuadro clínico evolucionó con manifestaciones clínicas de dengue con signos de alarma y de que la detección de IgM antidengue en una sola muestra indicaba que se trataba de un caso probable que había podido ocurrir durante los tres meses anteriores, la paciente consultó de forma reiterada, pues no presentaba una mejoría significativa. En el décimo día del inicio de los síntomas, se observó edema simétrico en múltiples articulaciones acompañado de dolor, así como lesiones hiperpigmentadas en el surco nasogeniano. Se confirmó el diagnóstico de chikungunya por la presencia de anticuerpos IgM. Aunque puede pasar desapercibida, en los países endémicos para dengue y chikungunya existe la posibilidad de la infección concomitante, la cual puede agravar la evolución clínica de cada una de estas enfermedades. Por ello, es necesario que el médico considere las características clínicas y de laboratorio de ambas enfermedades para diagnosticar su presencia simultánea, garantizar un manejo adecuado y minimizar las complicaciones.

We report the case of a 38-year-old woman who initially consulted for an undifferentiated fever. Although her clinical condition evolved with signs and symptoms compatible with dengue with alarm signs and that the anti-dengue IgM detection in a single sample indicated it was a probable case that could have happened during the previous three months, the patient kept consulting due to little improvement. On the tenth day after the onset of symptoms, she presented with painful polyarticular symmetric edema, as well as hyperpigmented lesions in the nasolabial fold. Chikungunya diagnosis was confirmed by the presence of IgM antibodies. In endemic countries for dengue and chikungunya, the possibility of co-infection exists, but it may go unnoticed. On the other hand, the co-infection may worsen the clinical course of these diseases. Therefore, physicians should evaluate the clinical and laboratory characteristics of both infections to be able to diagnose the coinfection for adequate management and to minimize complications.

Doença de Still do adulto: um desafio diagnóstico / Adult-onset Still's disease: a diagnostic challenge

A doença de Still do adulto é uma rara condição inflamatória, cujo diagnóstico é um desafio, por se tratar de diagnóstico de exclusão, após vasta investigação. Manifesta-se com febre alta diária, amigdalite não supurativa, artrite, rash evanescente, leucocitose e hiperferritinemia. O presente caso demonstra a doença de Still do adulto e sua vasta investigação, motivando a realização de revisão bibliográfica sobre inovações na fisiopatologia, no diagnóstico e no tratamento.

Adult onset Still's disease is a rare inflammatory condition, the diagnosis of which is a challenge, because it is a diagnosis of exclusion, and demands extensive investigation. It manifests with high daily fever, nonsuppurative tonsillitis, arthritis, evanescent rash, leukocytosis, and hyperferritinemia. The present case de­monstrates adult-onset Still's disease and its extensive inves­tigation, motivating literature review on innovations of its pathophysiology, diagnosis, and treatment.

Estudo da associação entre os dados antropométricos e articulares com a dor em praticantes de balé clássico / Study of the association between anthropometric and articular data with pain in classical ballet practice

Objetivo: o estudo tem como objetivo, estudar os fatores musculoesqueléticos que podem gerar dor em bailarinas clássicas. Os movimentos do balé requerem que o desempenho seja realizado com maestria, envolvendo posições articulares em seu limite e esforços musculares que podem exceder as amplitudes normais de movimento, gerando assim, elevado estresse mecânico nos ossos e tecidos moles. Diversos fatores podem estar associados a dores intensas e a lesões musculoesqueléticas em praticantes de balé clássico. Materiais e métodos: foi realizado um estudo de caso, no qual foram avaliados os dados de três bailarinas clássicas com idade entre 15 e 17 anos, em um estúdio de balé clássico selecionado e localizado no interior de Goiás. Para coleta de dados foram utilizados dois instrumentos, sendo eles o Questionário de Avaliação da Bailarina Clássica, formulado pela própria pesquisadora e a avaliação física, onde foram coletados dados a partir de uma ficha elaborada pelos pesquisadores. Resultados: as voluntárias referiram dor, principalmente no movimento de grand plié, aumento da amplitude de abdução de quadril e fraqueza nos rotadores laterais de quadril. Conclusão: este estudo revelou uma maior incidência de episódios de dor em bailarinos clássicos causada por desequilíbrio de força muscular em membros inferiores..(AU)

Objective: this study aims to study the musculoskeletal factors that can generate pain in classical dancers. There are several types of dance and classic ballet stands out among them, because it is common to find dancers with various injuries due to physical exertion, because their practitioners suffer high mechanical stress their musculoskeletal structures. Several factors may be associated with intense pain and musculoskeletal injuries in classical ballet practitioners. Materials and methods: a case study was carried out, in which the data of three classical ballet dancers aged 15 to 17 years old were evaluated in a classical ballet studio selected and located in the interior of Goias. Two instruments were used to collect data, The Classical Dancer Evaluation Questionnaire, formulated by the researcher herself and the physical evaluation, where data were collected from a file prepared by the researchers. Results: the volunteers referred pain mainly to the large movement, with increased abduction hip range of motion and weakness in the lateral hip rotators. Conclusion: this study revealed a higher incidence of pain episodes in classical dancers caused by imbalance of muscle strength in the lower limbs..(AU)

Uso de bastones contralaterales en artrosis de rodilla / Contralateral canes for knee osteoarthritis

INTRODUCCIÓN La artrosis de rodilla es un problema de salud relevante dada su alta prevalencia y discapacidad asociada. Dentro de las alternativas de manejo no farmacológico se ha planteado el uso de bastones, sin embargo no existe consenso en la literatura respecto a su indicación. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos tres revisiones sistemáticas que en conjunto incluyeron cuatro estudios primarios, de los cuales, uno es ensayo aleatorizado. Concluimos que el uso de bastón contralateral en pacientes con artrosis de rodilla probablemente disminuye el dolor. Además, podría aumentar levemente la funcionalidad, pero la certeza de la evidencia es baja.

INTRODUCTION Knee osteoarthritis is a relevant health problem given its high prevalence and associated disability. Within the non-pharmacological management alternatives, the use of canes has been proposed, however, there is no consensus in the literature regarding its indication. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified three systematic reviews including four studies overall, of which one was randomized trials. We conclude that the use of a contralateral cane in patients with knee osteoarthritis probably reduces pain. In addition, it could slightly increase function, but the certainty of the evidence is low.

Controlled release alginate-chitosan microspheres of tolmetin sodium prepared by internal gelation technique and characterized by response surface modeling

Tolmetin sodium (TS) is a powerful non-steroidal mitigating drug for the treatment of rheumatoid joint inflammation, osteoarthritis, and adolescent rheumatoid joint pain. In addition to its gastrointestinal (GIT) problems, TS has a short biological half-life (1 hr). In a trial to overcome these side effects and control the rate of (TS) release, chitosan coated alginate microspheres are recommended. A Box-Behnken experimental design was employed to produce controlled release microspheres of TS in the sodium alginate and chitosan copolymers (Alg-Ch) by emulsification internal gelation methodology. The effect of critical formulation variables namely, drug to polymer ratio (D:P ratio), speed of rotation and span 80% on drug encapsulation efficiency (% EE), drug release at the end of 2 hours (Rel2) and drug release at the end of 8 hours (Rel8) were analyzed using response surface modeling. The parameters were assessed using the F test and mathematical models containing only the significant terms were generated for each parameter using multiple linear regression analysis. The produced microspheres were spherical in shape with extensive pores at D:P ratio 1:1 and small pores at a drug to polymer ratio (D:P ratio) 1:3. Differential scanning calorimetry (DSC) affirmed the steady character of TS in microspheres and revealed their crystalline form. All formulation variables examined exerted a significant influence on the drug release, whereas the speed emerged as a lone factor significantly influencing % EE. Increasing the D: P ratio decreases the release of the drug after two and 8 hours. The increase in speed results in an increase in drug release after two and eight hours. The drug release from the microspheres followed zero order kinetics. TS Alg-Ch microspheres exhibited a significant anti-inflammatory effect on incited rat paw edema after eight hours. These results revealed that the internal gelation technique is a promising method to control TS release and eradicate GIT side effects using Alg-Ch copolymers.

Ocorrência de dor combinada na coluna lombar, cintura pélvica e sínfise púbica entre gestantes do extremo sul do Brasil / Occurrence of combined pain in the lumbar spine, pelvic girdle and pubic symphysis among pregnant women in the extreme south of Brazil

RESUMO: Objetivos: Estimar a prevalência e caracterizar a ocorrência de dor lombar gestacional (DLG), dor na cintura pélvica posterior (DCPP) e dor na sínfise púbica (DSP) entre gestantes residentes em Rio Grande, RS. Métodos: Estudo transversal realizado com todas as puérperas com parto em 2016. Foram utilizadas duas figuras para investigar a presença de DLG, DCPP e DSP de forma isolada ou combinada. Regressão logística multinomial foi usada para avaliar os fatores associados a cada sintoma. Resultados: DLG foi referida por 42,2% das entrevistadas, DSP por 4,9%, e DCPP por 2%, enquanto DLG + DSP por 9%, DLG + DCPP por 2,8%, DCPP + DSP por 1,1% e dor nas três regiões por 3,9% delas. Quanto maior era a idade da gestante, menor foi o risco de DLG e de DLG combinada a uma das regiões da cintura pélvica e maior o risco de DCPP + DSP. Depressão na gestação aumentou o risco de todas as combinações dos sintomas. Conclusão: Este estudo realizou uma descrição mais detalhada da ocorrência dos desfechos avaliados e de seus fatores associados. Estudos como este são raros no país, sobretudo com baixas taxas de perdas e recusas. A elevada prevalência dos sintomas avaliados sugere que sua investigação seja rotineira nas consultas de pré-natal, atendo-se a idade das gestantes, sintomas depressivos e a dores combinadas e intensas.

ABSTRACT: Objectives: To estimate the prevalence and characterize the occurrence of low back pain (LBP), posterior pelvic girdle pain (PPGP) and pubic symphysis pain (PSP) among pregnant women resident in Rio Grande, RS. Methods: This was a cross-sectional study of all postpartum women who gave birth in 2016. Two pictures were used to investigate the presence of LBP, PPGP and PSP, both isolated and combined. Multinomial logistic regression was used to evaluate the factors associated with each symptom. Results: LBP was reported by 42.2%, PSP by 4.9%, and PPGP by 2%, while LBP + PSP was reported by 9%, LBP and PPGP by 2.8% and PPGP + PSP by 1.1%, and pain in all three regions was reported by 3.9% of the sample. The more advanced the age of the pregnant women, the risk for LBP and of LBP combined with one of the pelvic girdle regions was reduced, while the risk for PPGP + PSP was increased. Depression during pregnancy increased the risk for all symptom combinations. Conclusion: This study provided a detailed description of the occurrence of the evaluated outcomes and its associated factors. Studies like this are rare in Brazil, especially a census with low rates of losses and refusals. The high prevalence of the evaluated symptoms suggests that it should be investigated routinely in prenatal care, taking into account the age of the pregnant women, depressive symptoms and those experiencing combined or intense pain.

Paciente com Chikungunya evoluindo com Síndrome de Angústia Respiratória do Adulto grave / Chikungunya evolving with SRDA Chikungunya patient progressing to severe Adult Respiratory Distress Syndrome

Objetivo: Demonstrar casos de Chikungunya cujos paciente evoluíram com Síndrome da Angústia Respiratória do Adulto. Métodos: Estudo descritivo e documental cuja a amostra foi composta por pacientes internados em um hospital no município de Campos dos Goytacazes, diagnosticados com sorologia IgM positiva para febre do vírus Chikungunya, que evoluíram para Síndrome da Angústia Respiratória do Adulto. Foram feitas análises de prontuários e de imagens radiológicas, além de revisão de literatura. Resultados: Foram incluídos três pacientes no estudo, sendo que um evoluiu ao óbito e os outros dois obtiveram recuperação de suas funções após o quadro agudo da doença. Conclusão: A Chikungunya é uma doença recente em território nacional, com possível evolução para quadros graves, especialmente em sua fase aguda. Por essa razão, estudos aprofundados são necessários para maior conhecimento e entendimento da patologia e de suas factíveis complicações.

Objective: To report cases of Chikungunya that progressed with Acute Respiratory Distress Syndrome. Methods: This is a descriptive and documental study, the sample of which consisted of patients who were hospitalized, in the city of Campos dos Goytacazes, diagnosed with positive IgM serology for Chikungunya fever, which progressed to Acute Respiratory Distress Syndrome. Medical records and radiological images were analyzed, and literature reviewed. Results: Three patients were included in the study, with one of them progressing to death, and the other two having their functions recovered after acute illness. Conclusion: Chikungunya is a recent disease in the national territory, with possible progression to severe conditions, especially on its acute phase. For this reason, in-depth studies are necessary for a better knowledge and understanding of the pathology and its likely complications