Interactions between marine megafauna and plastic pollution in Southeast Asia.

Southeast (SE) Asia is a highly biodiverse region, yet it is also estimated to cumulatively contribute a third of the total global marine plastic pollution. This threat is known to have adverse impacts on marine megafauna, however, understanding of its impacts has recently been highlighted as a priority for research in the region. To address this knowledge gap, a structured literature review was conducted for species of cartilaginous fishes, marine mammals, marine reptiles, and seabirds present in SE Asia, collating cases on a global scale to allow for comparison, coupled with a regional expert elicitation to gather additional published and grey literature cases which would have been omitted during the structured literature review. Of the 380 marine megafauna species present in SE Asia, but also studied elsewhere, we found that 9.1 % and 4.5 % of all publications documenting plastic entanglement (n = 55) and ingestion (n = 291) were conducted in SE Asian countries. At the species level, published cases of entanglement from SE Asian countries were available for 10 % or less of species within each taxonomic group. Additionally, published ingestion cases were available primarily for marine mammals and were lacking entirely for seabirds in the region. The regional expert elicitation led to entanglement and ingestion cases from SE Asian countries being documented in 10 and 15 additional species respectively, highlighting the utility of a broader approach to data synthesis. While the scale of the plastic pollution in SE Asia is of particular concern for marine ecosystems, knowledge of its interactions and impacts on marine megafauna lags behind other areas of the world, even after the inclusion of a regional expert elicitation. Additional funding to help collate baseline data are critically needed to inform policy and solutions towards limiting the interactions of marine megafauna and plastic pollution in SE Asia.

Current and future interventions for glenohumeral subluxation in hemiplegia secondary to stroke.

Poststroke shoulder pain is a common issue and can be caused by glenohumeral subluxation. This entity hinders function and quality of life and is caused by changes in tone and loss of fi ne control of the shoulder joints' supporting structures after a stroke. Current treatments are limited in number and effectiveness and have significant problems and limitations to their use. Furthermore, prior to percutaneous implantable neuromuscular electrical stimulation, there was no evidence for any treatment to provide relief for chronic hemiplegic shoulder pain from glenohumeral subluxation. This clinical review provides a comprehensive review of the anatomy, pathogenesis, clinical features, management, and clinical efficacy of current treatment modalities.

Influence of playing position and laterality in centripetal force and changes of direction in elite soccer players.

The purpose of the present study was to: (a) assess centripetal force (CentF) and changes of direction (COD) in elite soccer players according to playing position (central defender, CD; lateral defender, LD; central midfielder, CM; lateral midfielder, LM; forward, FW), laterality (right-footed vs. left-footed) and field zone (central vs. lateral), and (b) analyze the relationship between anthropometric characteristics (age, weight, height, body mass and fat mass) and non-linear locomotion workload. Thirty professional soccer players (age: 26.57±5.56 years) were tracked during the 2017-2018 season during friendly, national and international matches (38 total games) using inertial measurement devices. CentF and COD were the variables extracted for analysis. A one-way ANOVA was used for playing position comparison, a t-test for laterality and field zone, and Pearson's correlation coefficient to analyze relationships between anthropometric characteristics and dependent variables. There were differences by playing position in COD (556.33-to-412.18), R20COD (484.36-to-354.81) and R60COD (48.38-to-38.61) (p < .01; ωp2 = 0.03-to-0.05; CD>CM>LD>LM = FW); in CODHIA (49.75-to-37.11), R20CODHIA (16.04-to-9.11) and R60CODHIA (10.64-to-9.11) (p < .01; ωp2 = 0.03-to-0.07; CM>FW>LM>CD = LD); in CODSPRINT (14.56-to-8.40) and R20CODSPRINT (3.29-to-1.40) (p < .01; ωp2 = 0.03-to-0.04; FW = LM = CM>CD = LD); and in CentFMAX both in clockwise (992.04-to-902.09N) and counterclockwise (999.24-to-872.61N) directions (p < .02; ωp2 = 0.02-to-0.07; FW = CD>CM = LM = LD). The highest values of counterclockwise CentF were performed by left-footed players in the central zone (p < .001; d = 0.71-to-1.44) and clockwise CentF by right-footed players (p < .001; d = 0.04-to-0.55) in the lateral field zone. Moderate correlations were found between age, body mass and high intensity/sprints COD and repeated COD ability (p < .05; r = 0.235-to-0.383). Therefore, team staff should consider anthropometric characteristics, playing position, laterality and field zone to individualize training workload related to non-linear locomotion in soccer.

Porcine Breed, Sex, and Production Stage Influence the Levels of Health Status Biomarkers in Saliva Samples.

In this study, the influence of several factors such as breed, sex, and production stage over the normal range values of salivary biomarkers of health status was evaluated in pigs. A total of 409 pigs of 2 different breeds (conventional Large White × Duroc and Iberian pigs) were included in the study. Animals were divided into different groups according to their sex (male or female) and the stage of the production cycle they were in (post-weaning, nursery, fattening, and finishing). The levels of an inflammatory marker, adenosine deaminase (ADA), and two acute phase proteins, C-reactive protein (CRP) and haptoglobin (Hp) were measured in saliva samples. Moreover, the total antioxidant capacity level (TAC) was quantified for the first time in porcine saliva; therefore, an analytical validation and stability analysis during storage at -80°C were also performed. Differences according to breed were observed for all the markers studied; thus, the influence of age and sex on the normal range values were studied separately for conventional and Iberian pigs. In Large White × Duroc pigs the overall median values of ADA, CRP, Hp and TAC were 282 U/L, 10.49 ng/mL, 0.88 µg/mL, and 21.73 µM Trolox equivalents, respectively. However, higher values of inflammatory marker and acute phase proteins were observed in males at the initial stages of the production cycle, while females presented higher values when they had reached sexual maturity. In Iberian pigs the overall median values observed were 585 U/L, 4.81 ng/mL, 0.63 µg/mL, and 21.21 µM Trolox equivalents for ADA, CRP, Hp, and TAC respectively with slight differences in the influence of the studied factors. Sex differences were not observed in the levels of acute phase proteins in Iberian pigs, probably due to the castration of males during the first days of life; however, ADA levels were found to be higher in male pigs at the end of the production cycle. It could be concluded that breed, sex, and production stage influence the range values of salivary markers of health status in pigs and should be taken into account to further establish reference intervals.

Special Considerations and Assessment in Patients with Multiple Sclerosis.

Multiple sclerosis is a progressive autoimmune neurologic disorder that may affect any region of the central nervous system. Spasticity in patients with multiple sclerosis can be debilitating and detrimental to the function and quality of life of patients. Treatment options include oral medications, chemodenervation, physical therapy, and modalities. Cannabinoids in the form of a delta-9-tetrahydrocannabinol/cannabidiol oro-mucosal spray has been shown to be effective in addressing spasticity in multiple sclerosis. Successful treatment of spasticity will be integrated, multimodal, and individualized.

Ocular Dysfunctions Presenting in Tacrolimus-Induced Posterior Reversible Encephalopathy Syndrome: A Case Presentation.

The constellation of ocular symptoms known as Balint syndrome is a rare disorder seen in bilateral parieto-occipital lesions and is most frequently due to arterial occlusive disease or acute hypertension. Here we present the case of a patient with tacrolimus-induced posterior reversible encephalopathy syndrome (PRES) who presented with optic ataxia, simultanagnosia, and ocular apraxia. These ocular findings, consistent with Balint syndrome, are rarely the initial presentation of PRES. This case highlights the importance of early recognition of this unusual phenomenon, as well as the importance of an individualized rehabilitation plan to maximize functional independence in these patients. LEVEL OF EVIDENCE: V.

Safety Considerations in Prescription of NSAIDs for Musculoskeletal Pain: A Narrative Review.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed for the treatment of painful musculoskeletal conditions. When prescribing oral NSAIDs, clinicians must consider coexisting cardiovascular, cerebrovascular, gastrointestinal, and renal disease because oral NSAIDs are associated with a broad spectrum of adverse effects on these systems. The different safety profiles of NSAIDs can be attributed to differences in the extent to which the drug inhibits cyclo-oxygenase-1 vs -2 and their potential for drug-drug interactions. This narrative review intends to guide the clinician in prescribing oral NSAIDs while taking into consideration these comorbid conditions and drug interactions. LEVEL OF EVIDENCE: III.

A Review of Lung Transplantation and Its Implications for the Acute Inpatient Rehabilitation Team.

Since the late 1980s, lung transplantation has become an option for some individuals (in 2014, 4000 lung transplantations were performed) with end-stage lung disease aimed to help these individuals restore function and improve survival and quality of life. Individuals living with end-stage lung disease already are deconditioned, with poor endurance and limited exercise capacity. There are additional post-transplantation factors that can contribute to poor endurance and decreased exercise capacity. Although pulmonary rehabilitation in the pretransplantation phase is a crucial component for positive functional outcomes after lung transplantation, the incidence of post-transplantation complications, coupled with the need for immunosuppression, often warrants close monitoring by medical professionals. The acute inpatient rehabilitation unit offers an ideal setting for such patients to receive therapies to improve functional status while allowing for monitoring and medical management with a comprehensive team approach, including both the rehabilitation and the transplantation teams. In this article, we review the medical issues, physiologic changes, common complications after lung transplantation, and potential side effects of immunosuppressant therapy, as well as address rehabilitation specific concerns, outcomes, and goals of the patient undergoing lung transplantation in the acute inpatient rehabilitation unit. LEVEL OF EVIDENCE: V.

Habituation Training Improves Locomotor Performance in a Forced Running Wheel System in Rats.

Increasing evidence supports that physical activity promotes mental health; and regular exercise may confer positive effects in neurological disorders. There is growing number of reports that requires the analysis of the impact of physical activity in animal models. Exercise in rodents can be performed under voluntary or forced conditions. The former presents the disadvantage that the volume and intensity of exercise varies from subject to subject. On the other hand, a major challenge of the forced training protocol is the low level of performance typically achieved within a given session. Thus, the aim of the present study was to evaluate the effectiveness of gradual increasing of the volume and intensity (training habituation protocol) to improve the locomotor performance in a forced running-wheel system in rats. Sprague-Dawley rats were randomly assigned to either a group that received an exercise training habituation protocol, or a control group. The locomotor performance during forced running was assessed by an incremental exercise test. The experimental results reveal that the total running time and the distance covered by habituated rats was significantly higher than in control ones. We conclude that the exercise habituation protocol improves the locomotor performance in forced running wheels.

Generalized Weakness in a Transplant Patient: A Case Presentation.

Generalized weakness in transplant patients is a major complaint in tertiary rehabilitation hospitals. The diagnosis and management of generalized weakness in this population pose challenges for physicians. We present the case of a transplant patient with generalized weakness who was eventually diagnosed with calciphylaxis using a multidisciplinary diagnostic approach of electrodiagnostics, vascular study, and skin biopsy. Calciphylaxis is a rare cutaneous disorder that mimics other collagen vascular diseases in its presentation and fulminant course. Physiatrists should be cognizant of calciphylaxis, as it signals a poor prognosis if not correctly diagnosed and treated in a timely manner, with high incidence of sepsis, wound pain, and disability. LEVEL OF EVIDENCE: V.

Pharmacological Treatment of Presbyopia by Novel Binocularly Instilled Eye Drops: A Pilot Study.

PURPOSE: The feasibility, in terms of safety and potential efficacy, of a new drug combination for binocular use as a noninvasive pharmacological solution for treating presbyopia was examined. METHODS: Fourteen emmetropic presbyopic subjects (28 eyes) were given one drop of the preparation under study in each eye. For each patient, the uncorrected distance visual acuity, uncorrected near visual acuity, near and far refraction, best corrected visual acuity, best corrected far-near visual acuity, photopic and scotopic pupil size, Schirmer's test, endothelial cell count, intraocular pressure, keratometry, pachymetry, and anterior chamber depth were all performed or assessed prior to the administration of the eye drops and then 0.5, 1, 2, 3, 4, and 5 h, 1 week, and 1 month post-administration prospectively in each eye and binocularly. RESULTS: The results showed that near uncorrected visual acuity improved by about 2-3 lines from baseline in each eye and binocularly. There was no degradation in uncorrected far vision in each eye and binocularly in any patient. Refractive measurements performed in this study showed there was a maximum myopic shift of just 0.5 D that progressively reduced and disappeared at 4 h. CONCLUSION: The new topical drug treatment analyzed herein significantly improved near vision without affecting far vision. This binocular pharmacologic treatment of presbyopia has the potential to ameliorate the reading vision of presbyopes and possesses the advantages of a nonmonovision therapy. A randomized, controlled, double-masked clinical trial with a twice-a-day treatment schedule is ongoing at our institution. FUNDING: This study was supported in part by the Spanish Ministry of Health, Instituto Carlos III, Red Temática de Investigación Oftalmológica (OFTALRED), and Fundación Oftalmológica Vejarano (Popayán, Colombia).

Phantom limb pain from spinal sarcoma: a case report.

Phantom limb pain is a frequent sequela of amputation. A high prevalence of residual limb pain and back pain also exists among amputees. We present a case of a new-onset severe phantom limb pain resulting from a metastatic spinal mass in an 81-year-old patient with a history of malignant sarcoma and an old hip disarticulation amputation. The metastatic lesion, upon imaging, was found to involve the L3 vertebra and caused moderate compression of the thecal sac on the right and severe right lateral recess stenosis. After the mass was resected, the patient's phantom limb pain resolved. Our case report demonstrates that spinal metastatic pathologies may be a cause of phantom limb pain and should be included in the differential diagnosis of new-onset phantom limb pain or a change in phantom limb pain.

Early Diagnosis of Invasive Aspergillosis in Neutropenic Patients. Comparison between Serum Galactomannan and Polymerase Chain Reaction.

BACKGROUND: Invasive aspergillosis (IA) is a major cause of morbidity and mortality in profoundly neutropenic patients, so early diagnosis is mandatory. AIM: Consecutive patients with hematological malignancies undergoing intensive chemotherapy were screened for IA with two different methods which were compared. METHODS: From October 2000 to August 2003 we tested 1311 serum samples from 172 consecutive patients with a polymerase chain reaction assay and between April 2005 and April 2008 we tested 806 serum samples from 169 consecutive patients with a Galactomannan (GM) test. Bronchoalveolar (BAL) samples were obtained whenever the patient's condition allowed and tested with either method. RESULTS: The serum PCR assay had a sensitivity of 75.0% and a specificity of 91.9% and the serum GM assay had a sensitivity of 87.5% and a specificity of 93.1%, (P > 0.05). The presence of two or more consecutive positive serum samples was predictive of IA for both assays. BAL GM/PCR was positive in some patients without serum positivity and in patients with 2 or more positive serum GM/PCR. CONCLUSIONS: No significant differences between the 2 serum tests were found. The GM assay has the advantage of being standardized among several laboratories and is incorporated in the criteria established by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG), however is much more expensive. BAL GM and PCR sampling aids in IA diagnosis but needs further validation studies to differentiate between colonization and true infection in cases where serum GM or PCR are negative.

Calidad de la evaluación estatal en estomatología / Quality of the state assessment in stomatology

Introducción: la ampliación de matrícula ha constituido un reto en la educación médica y con el ejercicio del examen estatal se certifica la competencia de los egresados, por eso se hace necesario analizar la calidad de los resultados. Objetivo: evaluar la calidad obtenida en los exámenes estatales en la Facultad de Estomatología de Camagüey durante el quinquenio 2007-2012. Métodos: se realizó una investigación descriptiva del examen estatal de 384 estudiantes presentados en el periodo 2007-2012. Se utilizó el método porcentual, la media aritmética y mediana de las calificaciones. El examen teórico estatal del curso 2011-2012 se relacionó con el índice académico de los estudiantes. Resultados: de 36 estudiantes en el curso 2007-2008 se incrementó a 146 en el curso 2011-2012. En el quinquenio, el 53,6 por ciento de los estudiantes obtuvo notas de excelente, el 40,9 por ciento notas de bien, el 3,9 por ciento notas de aprobado y el 1,6 por ciento de desaprobados correspondieron a los dos cursos más numerosos. Conclusiones: la calidad de excelente de la evaluación estatal se mantiene durante el quinquenio, con una inclinación a disminuir la mediana y la media de las calificaciones finales relacionadas con el mayor número de estudiantes(AU)

Introduction: the enlargement of enrollment is a challenge in medical education, and the state owned test certifies the competition of the graduate that's why to analyze the quality of the results obtained in these stages becomes necessary. Objective: Assess the quality in the state-owned evaluation during the five year period 2007-2012 in Camaguey's Faculty of Dentistry. Method: adescriptive research of the state-owned exam of 384 students in the period 2007-2012 was done. The percentage method, arithmetical mean and median were utilized. The results of the theoretic state-owned exam of the latter course were related with the academic index of every student. Results: student's number increase from 36 in the course 2007-2008 up to 146 in the course 2011-2012. In the five year period, the 53,6 percent of the students achieved excellent marks, 40,9 percent achieved good marks , 3,9 percent achieved pass mark and the 1,6 percent achieved a disapproved mark and corresponded to the two more numerous courses. Conclusions: the quality of Excellent is maintained in he five years period, but the arithmetical mean and median in more numerous students' groups tails off(AU)

Caracterización del examen estatal escrito de Estomatología de la Universidad Médica de Camagüey / Characterization of the written State examination in the Stomatology Faculty at the Medical University of Camag-ey

Introducción: El examen estatal escrito evalúa la competencia del egresado y debe cumplir los requisitos de su confección y de su análisis informar las deficiencias en el proceso docente educativo para su perfeccionamiento. Objetivo: Caracterizar el examen estatal ordinario escrito y los resultados obtenidos en la Facultad de Estomatología. Camagüey durante el período 2011-2012. Métodos: Se realizó un estudio descriptivo del examen estatal ordinario escrito aplicado a 146 estudiantes. Se elaboró una base de datos con las calificaciones obtenidas, índice académico y una guía con las variables tipo de examen, de preguntas, nivel de asimilación, claridad de formulación, correspondencia con los objetivos de la carrera, clave de calificación y cumplimiento de los criterios de Guilbert, analizados por grupo de expertos. Resultados: En los resultados se aproximó la nota de los excelentes (27,4 %) con el índice académico de los altos rendimientos (28,1 %). La mediana general fue de 86,3. Los temas más explorados fueron Endodoncia (18,8 %), Prótesis y Odontopediatría (10,4 %). Las preguntas con más valor fueron de temas curativos. El nivel de asimilación fue reproductivo y el 35,4 % de preguntas tipo selección múltiple complemento agrupado. Existieron dificultades de diseño del examen y autopreparación de los estudiantes. Conclusiones: Los resultados se aproximaron a los rendimientos académicos. No hubo equidad entre el número, valor de las preguntas por temas y nivel de asimilación. Los errores se asociaron en frecuencia al diseño y redacción de algunas preguntas, insuficiente estudio y en menor grado a la falta de sistematicidad en el proceso docente, que permitieron determinar las deficiencias para su intervención.

Introduction: The State written exam evaluates the competence of seniors and must meet the requirements of its preparation and analysis in order to report deficiencies in the educational teaching process for its further development. Objective: To characterize the written regular state exam and the results obtained at the Faculty of Stomatology. Camaguey during the period of 2011-2012. Methods: A descriptive study of the written regular state exam was conducted to 146 students. A data base was developed with the grades obtained, academic index and a guide with the exam- type variables, questions, level of assimilation, clarity of formulation, correspondence with the objectives of the career, key qualification and compliance with the criteria of Guilbert, all analyzed by groups of experts. Results: In the results the excellent notes (27.4%) approached to the academic index of high yield (28.1%). The general average was 86,3. The most explored themes were Endodontics (18.8%), Prosthesis and Pediatric Odontology (10.4%). healing topics were the questions with more value. The level of assimilation was reproductive and 35.4% of multiple choice type questions complement clustered. There were difficulties according to the test design and the students' self study. Conclusions: The results were close to academic performance. There was no equality between the number, value of the questions by topic and level of assimilation. Errors were often associated with the design and wording of some questions, insufficient study and in a lesser extent to the lack of systematic fashion in the teaching process, which allowed to determine deficiencies for its intervention.

Relationship between health-related fitness and educational and income levels in Spanish women.

OBJECTIVES: The aim of this study was to determine whether a relationship exists between health-related fitness, taken as an indicator of regular physical activity, and educational and income levels in adult Spanish women. STUDY DESIGN: Descriptive, correlation, cross-sectional study. METHODS: A stepwise stratification procedure according to population size, age and level of physical activity according to a previous epidemiological survey was used for sampling. Two thousand and thirty-eight women gave their written consent to participate (62.8% of those invited). The final sample consisted of 1709 healthy women (aged 18-88 years). Subjects were categorized into high, medium and low level groups for education and income. All participants were assessed for morphological and physical health-related fitness. Three-way MANCOVA (age as covariate) and Bonferroni's post hoc test were used to determine the differences between groups. RESULTS: No significant relationships were found between age-adjusted educational and income levels. The lowest values for health-related fitness were found in the lowest educational and income groups (P<0.001). The higher the level of education and income, the better the values for all fitness variables (P<0.001), except anterior trunk flexibility. CONCLUSIONS: A positive relationship was found between health-related fitness and educational and income levels, which appeared to be most evident in the lowest educational and income groups. This implies that health-related promotion policies in Spain should stress the importance of regular physical activity in social classes with low levels of education and income.

Comportamiento del programa de detección precoz del cáncer bucal en la clínica estomatológica docente provincial. 1995-1999 / Behavior of the oral cancer Early detection Pragram in the provincial Teaching Dental Clinic

Se realizó un estudio estadístico descriptivo con los pacientes examinados y remitidos según el Programa de Detección de Cáncer Bucal durante el período de 1995-1999 con el objetivo de analizar este programa con un enfoque sistémico en su implementación. Se recepcionaron 102 pacientes quedando por criterios de exclusión 70 de los mismos. Se determinó que durante los años objeto de estudio excepto en1999 el porcentaje de pacientes remitidos sobre los examinados sobrepasa el 0.3% que plantea el programa nacional, así como que el mayor número de pacientes remitidos se encontraba en el grupo etáreo de 35 a 59 años de edad. El estudio reveló un 55.71% de concordancia entre los diagnósticos presuntivos y finales y que el 87.14% de los pacientes acudieron a la Consulta de cirugía máxilofacial en el segundo nivel de atención. Se determinó que el 88.57% fue objeto de algún tipo de seguimiento luego de su remisión.

A descriptive study was performed with the examined and remitted patients according to the oral cancer Early Detectión Program during the period 1995-1999 with the aim of analyzing this programan with a systemic apporach in its implementition. 102 patients were admitted, 70 out of them were excluded. It was determined that during the study years except in 1999, the percentage of remitted patients over the examined surpasses 0,3% staded in the national program d lso the greater number of remitted patients was in they age group of 35 to 59 years old. The study revealed 55.71% of coincidence among presuntive and final diagnosis and that 87.14% of patients assisted to the maxillofacial Surgery Consultation in the second level of Care Concludin, 88.57% was object of some type of follow-up after remission.