Differences in physical examination findings between those who present with or without headache soon after a whiplash injury: a cross-sectional study.

AIM: To determine differences in physical examination findings between people with acute whiplash-associated disorders (WAD) with and without headache. METHODS: In this cross-sectional study, participants with acute WAD were evaluated to assess differences in the presence of physical impairments. The following were assessed: pain intensity on manual palpation the over spinous process of C1-C3, zygapophyseal joints of C0-C4, and trapezius, sternocleidomastoid, suboccipitalis, masseter and temporalis muscles; cervical range of motion (ROM); flexion-rotation test (FRT); forward head posture; cranio-cervical flexion test (CCFT); neck flexor and extensor endurance; pressure-pain thresholds (PPT) over neural structures and upper limb neural tests (ULNT) in addition to median UNLT + CCF. Correlation analyses were performed to assess the association between examination findings and headache intensity. Logistic regression and discriminant analyses were also performed. RESULTS: Forty-seven participants (26 men and 21 women; mean age = 38.9 years old) were included in the study. 60% of the participants presented with headache. Several examination findings were significantly different between groups. A group of examination findings composed of neck endurance, manual palpation over cervical and muscular structures, PPT, CCFT, ROM and FRT could discriminate between groups with a sensitivity of 86.7% and specificity of 90%. CONCLUSIONS: Several neuromusculoskeletal features are different between people with acute WAD with or without headache. A combination of features could distinguish between groups with high levels of sensitivity and specificity.

Headache production during physical examination in patients with and without headache attributed to a whiplash injury: A case-control study.

BACKGROUND: Provocation of headache on physical examination of the neck may reflect a role of cervical structures in the presence of acute whiplash-associated headache (WAH). OBJECTIVE: To determine differences in headache provocation during physical tests in people with and without WAH after a whiplash injury. DESIGN: Case-control study. METHODS: Forty-seven people with acute whiplash-associated disorders participated, 28 with WAH. Passive accessory intervertebral movement over the tubercle of C1, the spinous processes of C2-C3 and facet joints of C0-C4, the flexion-rotation test (FRT), manual palpation of cranio-cervical muscles and the upper limb neurodynamic test + cranio-cervical flexion were assessed bilaterally twice by a blinded examiner; headache provocation was determined. Cohen's kappa and Chi-squared were determined to evaluate the intra-rater reliability of test results and differences between groups, respectively. A logistic regression model was also performed. RESULTS: Intra-rater reliability of headache provocation was good or excellent for most tests. Significant differences between groups were found with higher positive tests in WAH for the assessment of C2 (68%), the most painful side of C0-C1 (57%), C1-C2 (75%) and C2-C3 (53%), most (79%) and least (25%) restricted sides of the FRT, and manual palpation of the most painful side for the trapezius (53%), masseter (50%) and temporalis (46%) muscles. Provocation of headache during the assessment of C2 and C1-C2 on the most painful side demonstrated the highest association with WAH. CONCLUSION: Mechanical provocation of headache is more frequent in people with WAH than in those without headache soon after a whiplash injury.

Headache features in people with whiplash associated disorders: A scoping review.

BACKGROUND: Whiplash-associated headache (WAH) is one of the most common symptoms after a whiplash injury, leading to high disability. Nevertheless, the clinical characteristics of WAH have not been well described. OBJECTIVE: To synthesise the existing literature on the clinical characteristics of WAH. DESIGN: Scoping review. METHODS: The protocol for this scoping review was registered in Open Science Framework and the PRISMA extension for Scoping Reviews tool was used to ensure methodological and reporting quality. A systematic search was conducted in PubMed, EMBASE, CINAHL, Web of Science and Scopus. The search was performed by one author and the screening of articles was conducted by two authors independently. RESULTS: A total of 11363 articles were initially identified and finally 26 studies were included in the review. Headache intensity was the most commonly reported feature. Headache duration, frequency and location were also reported in at least four studies. Few studies reported physical impairments that may be related to the presence of WAH. A differentiation with concussion characteristics was only performed in eight studies. CONCLUSION: WAH appears to be of mild to moderate intensity, typically with episodes of short duration which is commonly experienced in the occipital region amongst other regions, and with a tendency to reduce in intensity over time.

Physical testing in patients with acute whiplash-associated disorders: A within session test-retest reliability study.

BACKGROUND: People with whiplash-associated disorders (WAD) commonly present with a variety of physical impairments. However, the reliability of physical tests has not been established for patients with acute WAD. OBJECTIVE: To assess test-retest reliability of different physical tests in acute WAD. DESIGN: Intra-rater test-retest reliability. METHODS: Patients with acute WAD were recruited. Physical tests were used to evaluate articular, muscular and neural systems in two blocks of measurements separated by 10 min. Bland-Altman plots were performed to assess intrarater agreement, which included calculation of the mean difference (d) between rates, the 95% CI for d, the standard deviation of the differences and the 95% limits of agreement. Reliability was calculated via the standard error of measurement, the minimal detectable change, percent of agreement, the intraclass-correlation coefficient, and kappa coefficient. RESULTS: 47 patients participated. Test-retest reliability was excellent or good for almost all measures, except for extension ROM, ULTT for the radial nerve, and active cervical extension and upper cervical rotation performed in 4-point kneeling, which presented moderate reliability. Systematic bias was found in cervical ROM in flexion, left and right lateral-flexion, left and right rotation; left ULTT for radial nerve; right trapezius, suboccipitalis and temporalis muscles, left temporalis; C3, both sides of C1-C2, left C3-C4. CONCLUSION: The majority of physical tests achieved good or excellent test-retest intra-rater reliability when tested in patients with acute WAD. Findings must be considered with caution for those tests which demonstrated systematic bias. Additional research is warranted to evaluate inter-rater reliability.

Differentiating migraine, cervicogenic headache and asymptomatic individuals based on physical examination findings: a systematic review and meta-analysis.

BACKGROUND: Migraine and cervicogenic headache (CGH) are common headache disorders, although the large overlap of symptoms between them makes differential diagnosis challenging. To strengthen differential diagnosis, physical testing has been used to examine for the presence of musculoskeletal impairments in both conditions. This review aimed to systematically evaluate differences in physical examination findings between people with migraine, CGH and asymptomatic individuals. METHODS: The databases MEDLINE, PubMed, CINAHL, Web of Science, Scopus, EMBASE were searched from inception until January 2020. Risk of bias was assessed with the Downs and Black Scale for non-randomized controlled trials, and with the Quality Assessment of Diagnostic Accuracy Studies tool for diagnostic accuracy studies. When possible, meta-analyses with random effect models was performed. RESULTS: From 19,682 articles, 62 studies were included in this review and 41 were included in the meta-analyses. The results revealed: a) decreased range of motion [°] (ROM) on the flexion-rotation test (FRT) (17.67, 95%CI:13.69,21.65) and reduced neck flexion strength [N] (23.81, 95%CI:8.78,38.85) in CGH compared to migraine; b) compared to controls, migraineurs exhibit reduced flexion ROM [°] (- 2.85, 95%CI:-5.12,-0.58), lateral flexion ROM [°] (- 2.17, 95% CI:-3.75,-0.59) and FRT [°] (- 8.96, 95%CI:-13.22,-4.69), reduced cervical lordosis angle [°] (- 0.89, 95%CI:-1.72,-0.07), reduced pressure pain thresholds over the cranio-cervical region [kg/cm2], reduced neck extension strength [N] (- 11.13, 95%CI:-16.66,-5.6) and increased activity [%] of the trapezius (6.18, 95%CI:2.65,9.71) and anterior scalene muscles (2.87, 95%CI:0.81,4.94) during performance of the cranio-cervical flexion test; c) compared to controls, CGH patients exhibit decreased neck flexion (- 33.70, 95%CI:-47.23,-20.16) and extension (- 55.78, 95%CI:-77.56,-34.00) strength [N]. CONCLUSION: The FRT and neck flexion strength could support the differential diagnosis of CGH from migraine. Several physical tests were found to differentiate both headache types from asymptomatic individuals. Nevertheless, additional high-quality studies are required to corroborate these findings. STUDY REGISTRATION: Following indications of Prisma-P guidelines, this protocol was registered in PROSPERO on 21/05/2019 with the number CRD42019135269 . All amendments performed during the review were registered in PROSPERO, indicating the date and what and why was changed.

Novel T9 loop conformation of filamenting temperature-sensitive mutant Z from Mycobacterium tuberculosis.

As of 2017, tuberculosis had infected 1.7 billion people (23% of the population of the world) and caused ten million deaths. Mycobacterium tuberculosis (Mtb) is quickly evolving, and new strains are classified as multidrug resistant. Thus, the identification of novel druggable targets is essential to combat the proliferation of these drug-resistant strains. Filamenting temperature-sensitive mutant Z (FtsZ) is a key protein involved in cytokinesis, an important process for Mtb proliferation and viability. FtsZ is required for bacterial cell division because it polymerizes into a structure called the Z-ring, which recruits accessory division proteins to the septum. Here, the crystal structure of the MtbFtsZ protein has been determined to 3.46 Šresolution and is described as a dimer of trimers, with an inter-subunit interface between protomers AB and DE. In this work, a novel conformation of MtbFtsZ is revealed involving the T9 loop and the nucleotide-binding pocket of protomers BC and EF.

An Update on the Treatment and Management of Cellulitis. / Actualización en el abordaje y manejo de celulitis.

Cellulitis and erysipelas are local soft tissue infections that occur following the entry of bacteria through a disrupted skin barrier. These infections are relatively common and early diagnosis is essential to treatment success. As dermatologists, we need to be familiar with the clinical presentation, diagnosis, and treatment of these infections. In this article, we provide a review of the literature and update on clinical manifestations, predisposing factors, microbiology, diagnosis, treatment, and complications. We also review the current situation in Chile.

Implementation of the integrated approach in different types of exposure scenarios.

The International Commission on Radiological Protection (ICRP) recognises three types of exposure situations: planned, existing, and emergency. In all three situations, the release of radionuclides into the natural environment leads to exposures of non-human biota, as well as the potential for exposures of the public. This paper describes how the key principles of the ICRP system of radiological protection apply to non-human biota and members of the public in each of these exposure situations. Current work in this area within ICRP Task Group 105 is highlighted. For example, how simplified numeric criteria may be used in planned exposure situations that are protective of both the public and non-human biota. In emergency exposure situations, the initial response will always be focused on human protection; however, understanding the potential impacts of radionuclide releases on non-human biota will likely become important in terms of communication as governments and the public seek to understand the exposures that are occurring. For existing exposure situations, there is a need to better understand the potential impacts of radionuclides on animals and plants, especially when deciding on protective actions. Understanding the comparative impacts from radiological, non-radiological, and physical aspects is often important in managing the remediation of legacy sites. Task Group 105 is making use of case studies of how exposure situations have been managed in the past to provide additional guidance and advice for the protection of non-human biota.

ICRP Publication 124: Protection of the Environment under Different Exposure Situations.

In this report, the Commission describes its framework for protection of the environment and how it should be applied within the Commission's system of protection. The report expands upon its objectives in relation to protection of the environment, in so far as it relates to the protection of animals and plants (biota) in their natural environment, and how these can be met by the use of Reference Animals and Plants (RAPs); their Derived Consideration Reference Levels (DCRLs), which relate radiation effects to doses over and above their normal local background natural radiation levels; and different potential pathways of exposure. The report explains the different types of exposure situations to which its recommendations apply; the key principles that are relevant to protection of the environment; and hence how reference values based on the use of DCRLs can be used to inform on the appropriate level of effort relevant to different exposure situations. Further recommendations are made with regard to how the Commission's recommendations can be implemented to satisfy different forms of environmental protection objectives, which may require the use of representative organisms specific to a site, and how these may be compared with the reference values. Additional information is also given with regard to, in particular, communication with other interested parties and stakeholders. Issues that may arise in relation to compliance are also discussed, and the final chapter discusses the overall implications of the Commission's work in this area to date. Appendices A and B provide some numerical information relating to the RAPs. Annex C considers various existing types of environmental protection legislation currently in place in relation to large industrial sites and practices, and the various ways in which wildlife are protected from various threats arising from such sites.

ICRP Publication 125: Radiological Protection in Security Screening.

The use of technologies to provide security screening for individuals and objects has been increasing rapidly, in keeping with the significant increase in security concerns worldwide. Within the spectrum of technologies, the use of ionizing radiation to provide backscatter and transmission screening capabilities has also increased. The Commission has previously made a number of statements related to the general topic of deliberate exposures of individuals in non-medical settings. This report provides advice on how the radiological protection principles recommended by the Commission should be applied within the context of security screening. More specifically, the principles of justification, optimisation of protection, and dose limitation for planned exposure situations are directly applicable to the use of ionising radiation in security screening. In addition, several specific topics are considered in this report, including the situation in which individuals may be exposed because they are concealed ('stowaways') in a cargo container or conveyance that may be subject to screening. The Commission continues to recommend that careful justification of screening should be considered before decisions are made to employ the technology. If a decision is made that its use is justified, the framework for protection as a planned exposure situation should be employed, including optimization of protection with the use of dose constraints and the appropriate provisions for authorisation and inspection.

[Cranial hemophilic pseudotumor]. / Pseudotumor hemofílico craneal. Caso clínico.

The haemophilic pseudotumor is defined as an encased hematoma that increases of volume progressively by episodes of recurrent hemorrhage. It is a rare complication of haemophilia occurring in 1-2% of patients with moderate or severe factor VIII or IX deficiency. Its more frequent location is in the long bones of low extremities and pelvis. We report a case of a 21-year-old man with moderate deficiency of factor VIII (19% of normal factor VIII activity) that developed a pseudotumor in the cranium. To our knowledge, this is the third case of the cranial hemophilic pseudotumor in medical literature.

Determination of uranium and thorium concentrations in unprocessed soil samples.

An assay technique that directly determines the amount of 238U and 232Th in unprocessed, bulk soil samples has been developed. In this technique, a sample consisting of a 125-mL plastic bottle full of contaminated, moist, unprocessed soil is irradiated with gamma rays from 57Co. Induced U and Th K alpha fluorescent x rays are detected using a high-purity intrinsic germanium planar detector. Because of sample irradiation geometry, the fluorescent x-ray peaks lie on top of a large Compton backscatter peak. Spectral data are first fit to a combination polynomial and ERFc-step-function background that is subtracted from the peak data. The remaining peak data are fit to a Voigt Profile to properly determine peak area. The Voigt Profile, which is the convolution of the Gaussian response of the detector system and the Lorentzian energy distribution of x rays, describes the spectral peak better than a simple Gaussian distribution. A mathematical point-node model of the source-target-detector system, which includes fluorescent x-ray production by singly scattered Compton gamma s, calculates the predicted x-ray peak area per Bq cm-3 of target contamination. Soil attenuation coefficients, which are measured for each sample, are used by the model to properly transport gamma s and x rays through the soil sample. The sample 238U and 232Th concentrations are then calculated by dividing the measured peak areas by the model-predicted peak areas per Bq cm-3. No "soil standards," no assumptions about progeny equilibrium, and no sample preparation are required for this technique.

Desarrollo morfológico de la articulación temporomandibular en fetos humanos / Morphological development of the temporomandibular joint in human fetus

Se estudió el desarrollo de la articulación Témporomandibular en 26 fetos de 2,3 meses de edad a fetos de término. Se disecaron articulaciones con el objeto de conocer las características morfológicas de los componentes de esta articulación. Se constató que el primer esbozo de las estructuras de la articulación temporomandibular es el proceso condíleo de la mandíbula, que se aprecia a los 2,3 meses de edad fetal y que se presenta en estadio cartilaginoso y aplanado en ambos sentidos. alrededor de los 3,5 meses de edad aproximadamente, se observan el disco y la cápsula articular, teniendo el primero el aspecto de una membrana delgada y blanquecina, así como la segunda, el de una envoltura de forma cilíndrica y alargada en sentido vertical. La fosa mandibular comienza a esbozarse como tal a los 3,5 meses de edad y ya a los 4,8 meses, lo hace el tubérculo articular. En este estadio, las estructuras de la articulación témporomandibular se encuentra totalmente esbozadas, siendo sus cambios posteriores solamente referidos a sus dimensiones, forma, disposición y consistencia. Estas estructuras van aumentando de tamaño de acuerdo al grado de crecimiento fetal, teniendo un mayor incremento de su magnitud en los 2 últimos meses de vida intrauterina. Se hace una descripción detallada de las características morfológicas de las estructuras de la articulación temporomandibular durante la vida fetal, que difieren en cierta medida a las descripciones encontradas en la vida extrauterina