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1.
Article in Chinese | WPRIM | ID: wpr-928298

ABSTRACT

OBJECTIVE@#To investigate the diagnostic value of 6 conventional physical examination tests for the diagnosis of supraspinatus tendon tears, and how well they could tell the difference between partial-and full-thickness tears.@*METHODS@#A total of 91 patients with different shoulder symptoms who received shoulder arthroscopic procedure were enrolled in the study from June 2017 to September 2020. The intraoperative findings were compared with the results of the preoperative physical examination of 6 clinical tests, including the Hug-up test, the Jobe test, the 0°abduction test, the drop arm test, the Neer test, and the Hawkins test, to determine the sensitivity, specificity, positive and negative predictive value, accuracy, positive and negative likelihood ratio of each test.@*RESULTS@#By arthroscopy, a total of 44 full-thickness tears, 34 partial-thickness tears, and 13 intact supraspinatus tendons were found in all 91 cases. The Hug-up and the Jobe tests significantly correlated with the intraoperative findings. The sensitivity of the Hug-up test, the Jobe test, the 0° abduction test, the drop arm test, the Neer test, and the Hawkins test was 0.90, 0.79, 0.64, 0.42, 0.49, 0.24 respectively;the specificity was 0.61, 0.69, 0.54, 0.38, 0.31, 0.77;the positive predictive value was 0.93, 0.94, 0.89, 0.80, 0.81, 0.86;the negative predictive value was 0.50, 0.36, 0.20, 0.10, 0.09, 0.14;the accuracy was 0.86, 0.78, 0.63, 0.42, 0.46, 0.32;the positive likelihood ratio was 2.30, 2.58, 1.39, 0.69, 0.71, 1.06;and the negative likelihood ratio was 0.16, 0.30, 0.67, 1.50, 1.65, 0.98.@*CONCLUSION@#The Jobe test and the Hug-up test are both effective at accurately diagnosing supraspinatus tendon tears, the Hug-up test detects supraspinatus tears with a high sensitivity, and similar specificity. The tests assessed in this study are not capable of distinguish between partial-and full thickness supraspinatus tendon tears.


Subject(s)
Arthroscopy , Humans , Physical Examination/methods , Rotator Cuff , Rotator Cuff Injuries/surgery , Tendons
2.
Arch. argent. pediatr ; 119(4): S159-S170, agosto 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281029

ABSTRACT

La displasia del desarrollo de la cadera (DDC) es una anomalía de la articulación coxofemoral caracterizada por una laxitud o posicionamiento anormal de la cabeza femoral con respecto al acetábulo. Es la patología ósea perinatal más frecuente, e incluye alteraciones que van desde el aplanamiento o la displasia acetabular hasta una luxación completa de la cabeza femoral fuera de la articulación, que puede comprometer el desarrollo y la estabilidad articular. Nuestro objetivo es transmitir una sistemática de estudio en la valoración de la cadera del recién nacido, haciendo énfasis en un examen físico correcto como pilar fundamental en la detección de la DDC, y orientar al pediatra en la selección adecuada del método diagnóstico complementario acorde a edad del paciente, con el fin de optimizar la detección y reducir el número de caderas luxadas en etapas tempranas y tardías, y así disminuir la incidencia de patologías asociadas desarrolladas a partir de este trastorno


Developmental dysplasia of the hip (DDH) is a hip joint anomaly that is characterized by a laxity or abnormal positioning of the femoral head with respect to the acetabulum. It is the most common perinatal pathology of the skeleton and includes a spectrum of alterations ranging from flattening or acetabular dysplasia, to a complete dislocation of the femoral head outside the joint that can compromise joint development and stability. The purpose of this presentation is to transmit a systematic study in the evaluation of the newborn's hip, emphasizing a correct physical examination as primordial in the detection of DDH. Also, guide the pediatriciain the proper selection of the complementary diagnostic method to be used according to the age of the patient, in order to optimize detection and reduce the number of dislocated hips in early and late stages as well as the incidence of related pathologies.


Subject(s)
Humans , Male , Female , Infant, Newborn , Developmental Dysplasia of the Hip/diagnosis , Physical Examination/methods , Risk Factors , Early Diagnosis , Developmental Dysplasia of the Hip/etiology , Hip Dislocation, Congenital/diagnosis , Hip Dislocation, Congenital/etiology
3.
Asian Journal of Andrology ; (6): 611-615, 2021.
Article in English | WPRIM | ID: wpr-922366

ABSTRACT

Subclinical varicocele represents an abnormality of veins of the pampiniform plexus on scrotal ultrasound (US) without a clinically palpable varicocele. Its significance remains unclear. While guidelines do not recommend surgical intervention, clinical management is variable. As there is limited information on long-term outcome of subclinical varicoceles due to challenges in diagnosis and management, we performed a single-institution, retrospective review of patients from October 1999 to October 2014 with subclinical varicocele and with available US studies reviewed by a single radiologist. Subclinical varicocele was defined as dilation of the pampiniform venous plexus on US involving ≥2 vessels with diameter >2.5 mm, without clinical varicocele on physical examination or prior inguinal surgery. Thirty-six of 98 patients identified were confirmed as having a subclinical varicocele and analyzed. The mean age at initial visit was 15.5 years, with a mean follow-up of 26.5 months. The majority were right-sided (69.4%, n = 25), usually with a contralateral clinical varicocele. Testicular asymmetry (>20% volume difference of the affected side by testicular atrophy index formula) was assessed in 9 patients with unilateral subclinical varicocele without contralateral clinical or subclinical varicocele and observed in 1 patient. Of 17 patients with follow-up, 3 (17.6%) progressed to clinical varicocele without asymmetric testicular volume, as most remained subclinical or resolved without surgery. In our experience, subclinical varicoceles appeared unlikely to progress to clinical varicoceles, to affect testicular volume, or to lead to surgery. Although our study is limited in numbers and follow-up, this information may aid clinical management strategies and guide future prospective studies.


Subject(s)
Adolescent , Boston , Child , Humans , Male , Physical Examination/methods , Prospective Studies , Retrospective Studies , Treatment Outcome , Varicocele/therapy , Young Adult
5.
Acta Paul. Enferm. (Online) ; 34: eAPE00232, 2021. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1248524

ABSTRACT

Resumo Objetivo: Mapear as evidências de pesquisa disponíveis para avaliação clínica da maturação da fístula arteriovenosa. Métodos: Estudo do tipo Scoping review, com busca realizada entre outubro a novembro de 2019 nas bases de dados JBI, Cochrane, Biblioteca Virtual em Saúde, PubMed, e CINAHL, sendo incluídos estudos com pacientes maiores de 18 anos, com doença renal crônica pré-dialítica ou já em hemodiálise, submetidos à cirurgia da fístula arteriovenosa; texto disponível; e idiomas inglês, espanhol ou português. Foram excluídos estudos relacionados a fase pós-operatória ou relacionados a cuidados com próteses/enxertos arteriovenosos. Resultados: Foram identificadas 1954 publicações elegíveis, dos quais 38 compuseram a amostra final. O estudo compreendeu publicações entre 1998 e 2018, com abrangência internacional do tema (94,7%). O profissional executor da avaliação foi predominantemente o enfermeiro ou equipe de enfermagem (47,4%), e a avaliação teve início no pós-cirúrgico imediato, até meses após a cirurgia. Dentre as técnicas de avaliação clínica, 23 estudos (60,5%) recomendaram o exame físico e 15 (39,5%) a combinação anamnese e exame físico. Conclusão: A presente revisão apresentou o mapeamento de evidências, nas quais a avaliação clínica da fístula arteriovenosa deve incluir anamnese e exame físico, sendo apresentados vários elementos ligados a permeabilidade e respostas vasculares do acesso. Houve a predominância do profissional enfermeiro como avaliador, sendo ressaltada a necessidade do treinamento para execução da avaliação, além de uma avaliação mais abrangente, com aplicação do Processo e Teorias de Enfermagem, e Linguagens Padronizadas, o que pode propiciar um novo campo de investigação e desenvolvimento na área.


Resumen Objetivo: Mapear las evidencias de investigación disponibles para evaluación clínica de la maduración de la fístula arteriovenosa. Métodos: Estudio tipo scoping review, cuya búsqueda fue realizada entre octubre y noviembre de 2019 en las bases de datos JBI, Cochrane, Biblioteca Virtual em Saúde, PubMed y CINAHL. Se incluyeron estudios con pacientes mayores de 18 años, con enfermedad renal crónica predialítica o ya en hemodiálisis, sometidos a cirugía de fístula arteriovenosa y textos disponibles en inglés, español o portugués. Se excluyeron estudios relacionados con la fase posoperatoria o relacionados con cuidados de prótesis/injertos. Resultados: Se identificaron 1.954 publicaciones elegibles, de las cuales 38 formaron parte de la muestra final. El estudio comprendió publicaciones entre 1998 y 2018, con alcance internacional del tema (94,7 %). El profesional que ejecutó la evaluación fue predominantemente el enfermero o el equipo de enfermería (47,4 %) y la evaluación comenzó en el posoperatorio inmediato, hasta meses después de la cirugía. Entre las técnicas de evaluación clínica, 23 estudios (60,5 %) recomendaron el examen físico y 15 (39,5 %) la combinación entre anamnesis y examen físico. Conclusión: La revisión presentó el mapeo de evidencias, en las cuales la evaluación clínica de la fístula arteriovenosa debe incluir anamnesis y examen físico. También se presentaron varios elementos relacionados con la permeabilidad y respuestas vasculares del acceso. Hubo una predominancia del profesional enfermero como evaluador y se destaca la necesidad de entrenamiento para llevar a cabo la evaluación, además de una evaluación más abarcadora, con aplicación del proceso y teorías de enfermería y un lenguaje estandarizado, lo que puede proporcionar un nuevo campo de investigación y desarrollo del área.


Abstract Objective: To map the available research evidence for arteriovenous fistula maturation clinical assessment. Methods: A scoping review, with a search conducted between October and November 2019 at JBI, Cochrane, Virtual Health Library, PubMed, and CINAHL. Studies with patients over 18 years old, with pre-dialysis chronic kidney disease or already under hemodialysis, who underwent arteriovenous fistula surgery were included; available text; and in English, Spanish, and Brazilian Portuguese. Studies related to the postoperative phase or related to care with prostheses/arteriovenous grafts were excluded. Results: One thousand nine hundred and fifty-four eligible studies were identified; 38 made up the final sample. The study comprised studies between 1998 and 2018, with an international scope of the theme (94.7%). The professional who performed the assessment was predominantly the nurse or nursing team (47.4%), and assessment started in the immediate post-surgical period, even months after surgery. Among the clinical assessment techniques, 23 studies (60.5%) recommended physical examination and 15 (39.5%) the combination of medical history and physical examination. Conclusion: This review presented the mapping of evidence, in which arteriovenous fistula clinical assessment must include medical history and physical examination. Several elements related to the permeability and vascular responses of the access were presented. There was a predominance of professional nurses as evaluators. There was need for training to carry out the assessment, in addition to a more comprehensive assessment, with the application of the Nursing Theory and Standardized Languages and Process, which may provide with a new field of research and development in the area.


Subject(s)
Humans , Male , Female , Adult , Arteriovenous Fistula/surgery , Renal Dialysis , Renal Insufficiency, Chronic , Physical Examination/methods , Postoperative Care , Nursing Care
6.
Rev. chil. pediatr ; 91(5): 800-808, oct. 2020. tab
Article in Spanish | LILACS | ID: biblio-1144281

ABSTRACT

Los trastornos de la conducta alimentaria (TCA) han adquirido relevancia en la pediatría chilena. Su tratamiento debe ser realizado, de preferencia, por equipos multidisciplinarios especializados o con alto grado de capacitación en la problemática. Sin embargo, los pediatras generales tienen un rol fundamental tanto en la prevención como en la pesquisa temprana de estas patologías. El objetivo de esta publicación es proporcionarles recomendaciones prácticas sobre las intervenciones que pueden llevar a cabo durante la atención de adolescentes, para la prevención de los TCA, la pesquisa precoz y evaluación de quienes ya los presentan, y su derivación oportuna a tratamiento especializado.


Eating disorders (ED) have become relevant in Chilean pediatrics. Their treatment must be prefe rably carried out by multidisciplinary teams with specialty or a high degree of training in the pro blem. However, general pediatricians have a fundamental role both in the prevention and in the early detection of these pathologies. The purpose of this publication is to provide them with practical recommendations on interventions that can be carried out during adolescent care for the prevention of ED, the early detection and evaluation of those who already have them, and their timely referral to specialized treatment.


Subject(s)
Humans , Adolescent , Pediatrics/methods , Pediatrics/standards , Physician's Role/psychology , Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/etiology , Feeding and Eating Disorders/psychology , Feeding and Eating Disorders/therapy , Pediatricians/standards , Pediatricians/psychology , Patient Care Team , Physical Examination/methods , Physical Examination/standards , Physician-Patient Relations , Primary Prevention/methods , Primary Prevention/standards , Referral and Consultation , Chile , Risk Factors , Early Diagnosis , Diagnosis, Differential , Medical History Taking/methods , Medical History Taking/standards
7.
Rev. chil. pediatr ; 91(4): 579-583, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138674

ABSTRACT

INTRODUCCIÓN: El himen imperforado es la malformación congénita más frecuente del tracto genital femenino. La mayoría de los casos no se pesquisan en la infancia, debido a un examen genital insuficiente. Su diagnóstico y resolución deben ser precoces y definitivas para evitar complicaciones posteriores. OBJETIVO: Presentar el caso de una lactante portadora de himen imperforado, y actualizar la información sobre las técnicas de examen genital para detectar esta patología en forma precoz y su tratamiento. CASO CLÍNICO: Lactante de 3 meses, consultó por aumento de volumen protruyente en la zona del introito. En el examen físico se realizó maniobra de valsalva que dio salida a una masa homogénea, nacarada de superficie lisa, entre los labios mayores, sugerente himen imperforado. Se complementó el estudio con ultrasonido ginecológico, el que demostró la presencia de hidrocolpos, descartando otras anomalías. Se realizó una himenotomía, que dio salida a abundante material seroso, sin mal olor, y luego se completó la himenectomía mediante la resección de la membrana himeneal. En control al 4to mes posterior a la intervención se constató un himen ampliamente permeable. CONCLUSIÓN: Los equipos de atención neonatal, requieren capacitación acerca de la técnica correcta del examen genital externo de la recién nacida y lactante. La himenectomía es la técnica que permite resolver definitiva mente el cuadro evitando complicaciones.


INTRODUCTION: Imperforated hymen is the most frequent congenital malformation of the female genital tract. Most cases are not investigated in childhood, due to an insufficient genital examination. Its diagnosis and resolution must be early and definitive to avoid subsequent complications. OBJECTIVE: A clinical case of an infant with imperforated himen is presented. To update on genital examination technique necessary to detect this pathology in the newborn and infants, and the proper treatment. CLINICAL CASE: 3-months-old infant that consulted due to an increase in bulging volume in the introitus area. In the physical examination, the Valsalva's maneuver was performed allowed the ex pulsion of a homogeneous pearly mass with a smooth surface, between the labia majora, suggesting imperforate hymen. The study was complemented with gynecological ultrasound, which demons trated the presence of hydrocolpos, ruling out other anomalies. A hymenotomy was performed, which allowed for the evacuation of abundant serous material, with no bad smell, and then the hymenectomy was completed by resection of the hymenal membrane. In follow-up monitoring 4 months after the intervention, a widely permeable hymen was found. CONCLUSION: Neonatal care teams require training on the correct technique of external genital examination of the newborn and infant. Hymenectomy is the technique that allows definitely resolving the condition, avoiding complications.


Subject(s)
Humans , Female , Infant , Congenital Abnormalities/surgery , Congenital Abnormalities/diagnosis , Hymen/abnormalities , Physical Examination/methods , Hymen/surgery
8.
J. coloproctol. (Rio J., Impr.) ; 40(2): 163-167, Apr.-Jun. 2020. graf
Article in English | LILACS | ID: biblio-1134975

ABSTRACT

ABSTRACT Purpose Pelvic floor dysfunction has a high prevalence in the adult population. The Dynamic and Multiplanar Evaluation of the Pelvic Floor (DMRIPF) represents an ideal tool for multidisciplinary management. The purpose of this analysis is to evaluate the added value of the Dynamic and Multiplanar Evaluation of the Pelvic Floor in patients with suspected pelvic floor disorders. Methods Retrospective analysis of a consecutive series of patients who underwent a DMRIPF due to suspected pelvic floor disorders between April 2005 and July 2019. Results 359 patients were included. The average number of diagnoses achieved by physical examination was 1.2 vs. 2.5 by the Dynamic and Multiplanar Evaluation of the Pelvic Floor (p < 0.001). Physical examination found a single pathology in 80.8 % of cases. Anterior rectocele (AR) was the most frequent isolated diagnosis on physical examination (68 %). On the Dynamic and Multiplanar Evaluation of the Pelvic Floor, anterior rectocele was diagnosed as an isolated condition in 10.9 %. In 231 cases, anterior rectocele was associated with up to 5 other pelvic floor disorders. The number of individuals with associated pathologies of the posterior and anterior compartments tripled. It modified physical examination findings in 17 % of individuals and, in 63.5 %, allowed the identification of additional pelvic floor pathologies that were missed by physical examination. The Dynamic and Multiplanar Evaluation of the Pelvic Floor had greater added value in patients with anterior rectocele (59.6 % vs. 20.9 %; p < 0.001). Female gender was also associated with a greater diagnostic yield (p < 0.001). Conclusion The Dynamic and Multiplanar Evaluation of the Pelvic Floor allows the detection of multi-compartment defects that could otherwise go undetected, or even alter the initial clinical diagnosis, representing an ideal tool for multidisciplinary approach of pelvic floor dislocations, allowing a comprehensive therapeutic planning.


RESUMO Objetivo A disfunção do assoalho pélvico tem alta prevalência na população adulta. A avaliação dinâmica e multiplanar do assoalho pélvico (DMRIPF) representa uma ferramenta ideal para o gerenciamento multidisciplinar. O objetivo desta análise é avaliar o valor agregado da avaliação dinâmica e multiplanar do assoalho pélvico em pacientes com suspeita de distúrbios do assoalho pélvico. Métodos Análise retrospectiva de uma série consecutiva de pacientes submetidos à avaliação dinâmica e multiplanar do assoalho pélvico por suspeita de distúrbios do assoalho pélvico entre Abril de 2005 e Julho de 2019. Resultados 359 pacientes foram incluídos. O número médio de diagnósticos alcançados pelo exame físico foi de 1,2vs. 2,5 pela avaliação dinâmica e multiplanar do assoalho pélvico p < 0,001. O exame físico encontrou uma única patologia em 80.8 % dos casos. A retocele anterior (RA) foi o diagnóstico isolado mais frequente no exame físico (68 %). Na avaliação dinâmica e multiplanar do assoalho pélvico, a retocele anterior foi diagnosticada como uma condição isolada em 10.9 %. Em 231 casos, a retocele anterior foi associada a até 5 outros distúrbios do assoalho pélvico. O número de indivíduos com patologias associadas dos compartimentos posterior e anterior triplicou. Modificou os achados do exame físico em 17 % dos indivíduos e em 63.5 %; permitiu a identificação de outras patologias do assoalho pélvico que foram esquecidas pelo exame físico. A avaliação dinâmica e multiplanar do assoalho pélvico teve maior valor agregado em pacientes com retocele anterior (59.6 % vs.20.9 %; p < 0,001. O sexo feminino também foi associado a um maior rendimento diagnóstico p < 0,001. Conclusão A avaliação dinâmica e multiplanar do assoalho pélvico permite a detecção de defeitos multicompartimentários que, de outra forma, poderiam não ser detectados, ou mesmo alterar o diagnóstico clínico inicial, representando uma ferramenta ideal para a abordagem multidisciplinar das luxações do assoalho pélvico, permitindo um planejamento terapêutico abrangente.


Subject(s)
Humans , Male , Female , Magnetic Resonance Imaging/methods , Pelvic Floor Disorders/diagnosis , Physical Examination/methods , Pelvic Floor/pathology , Rectocele/diagnosis
10.
Article in English | LILACS | ID: biblio-1057226

ABSTRACT

ABSTRACT Objective: For every 100 random children diagnosed with autism, at least 20 have morphological abnormalities, often associated with syndromes. Brazil does not have a standardized and validated instrument for morphological physical examination. This study aimed to translate into Brazilian Portuguese and culturally adapt the clinical signs described in the Autism Dysmorphology Measure, as well as validate the instrument in a sample of children with autism. Methods: The original instrument was translated, culturally adapted, and published in full, following traditional procedures for translation, back-translation, and terminology adaptation according to the Nomina Anatomica. The sample included 62 children from a published multicenter study, with intelligence quotient between 50-69, of both genders, with chronological age between 3-6 years. Two clinical geneticists performed the morphological physical examination, which consisted of investigating 82 characteristics assessing 12 body areas. We used Cohen's Kappa coefficient to evaluate the agreement between the two observers. Results: The final version of the instrument - translated into Brazilian Portuguese and culturally adapted - showed high agreement between the two observers. Conclusions: The translated instrument meets all international criteria, and minor anomalies and their clinical descriptions were standardized and are recognizable for physicians not specialized in genetics.


RESUMO Objetivo: Entre 100 crianças, não selecionadas, com diagnóstico de autismo, pelo menos 20 apresentam anomalias morfológicas, quase sempre associadas a síndromes. Não há no Brasil instrumento de exame físico morfológico padronizado e validado. O objetivo foi traduzir para o português do Brasil e adaptar culturalmente os sinais clínicos descritos no Autism Dysmorphology Measure, assim como procurar evidências de validade quando aplicado a uma amostra de crianças com autismo. Métodos: Foram feitas a tradução e a adaptação cultural do instrumento original, publicado na íntegra. Foram adotados os procedimentos tradicionais de tradução, retrotradução e adaptação da terminologia segundo a Nomina Anatomica. Foram incluídas na amostra 62 crianças com quociente de inteligência entre 50 e 69, de ambos os sexos, com idade cronológica entre três e seis anos, provenientes de estudo multicêntrico com os procedimentos metodológicos já publicados. O exame físico morfológico foi realizado por dois médicos geneticistas e consistiu na pesquisa de 82 características que avaliam 12 áreas corporais. Para avaliar a concordância entre os dois observadores foi utilizado o coeficiente Kappa de Cohen. Resultados: A versão final do instrumento traduzido e adaptado culturalmente ao português do Brasil mostrou alta concordância entre os dois observadores. Conclusões: O instrumento traduzido preenche todos os critérios propostos internacionalmente e o reconhecimento das anomalias menores e sua descrição clínica estão padronizados e são de fácil reconhecimento aos médicos não especialistas em genética.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Physical Examination/methods , Congenital Abnormalities/diagnosis , Congenital Abnormalities/genetics , Adaptation, Psychological/physiology , Autism Spectrum Disorder/psychology , Translations , Brazil/epidemiology , Surveys and Questionnaires , Reproducibility of Results , Cultural Characteristics , Body Dysmorphic Disorders/psychology , Autism Spectrum Disorder/diagnosis , Autism Spectrum Disorder/genetics
12.
Rev. cuba. endocrinol ; 30(3): e213, sept.-dic. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126443

ABSTRACT

RESUMEN Introducción: El hipogonadismo masculino puede provocar una reducción importante de la calidad de vida. La determinación de testosterona total constituye la opción inicial para el diagnóstico bioquímico del hipogonadismo. Objetivo: Determinar el intervalo de referencia de testosterona total para la población masculina en edad reproductiva del municipio Plaza de la Revolución. Métodos: Se realizó un estudio transversal y descriptivo, en una muestra representativa (n= 143) de la población masculina entre 20 y 40 años de edad, del municipio Plaza de la Revolución. Para el reclutamiento de la muestra se utilizó un método directo. El intervalo de referencia se estableció mediante un método no paramétrico. Se realizó interrogatorio, examen físico, complementarios bioquímicos (glucemia, colesterol, triglicéridos, HDL-c, LDL-c), y hormonales (testosterona total, PRL, FSH y LH). Resultados: El promedio de edad fue de 29,7 años. El índice de masa corporal osciló entre 18,95 y 29,88 kg/m2 (valor medio 24,15). Las medias de las circunferencias de cintura y cadera fueron de 86,62 cm y 99,77 cm respectivamente. El intervalo de referencia de testosterona total calculado para la población masculina del municipio Plaza de la Revolución, fue de 7,69 a 40,52 nmol/L. La mediana para la testosterona total fue de 19,10 nmol/L. Conclusiones: El intervalo de referencia de testosterona total calculado para la población masculina adulta (20 - 40 años) del municipio Plaza de la Revolución difiere del reportado por el fabricante del kit diagnóstico y puede resultar de utilidad en la práctica clínica(AU)


ABSTRACT Introduction: Male hypogonadism may cause a significant reduction in the quality of life. The determination of total testosterone constitutes the initial option for the biochemical diagnosis of hypogonadism. Objective: To determine the reference interval of total testosterone for the male population in reproductive age of Plaza de la Revolución municipality. Methods: It was conducted a cross-sectional and descriptive study in a representative sample (n=143) of the male population from 20 to 40 years old of Plaza de la Revolución municipality. For the recruitment of the sample it was used a direct method. The reference interval was established through a non-parametric method. There were conducted interrogations, physical examination, complementary biochemical (blood glucose, cholesterol, triglycerides, HDL-c, LDL-c), and hormonal tests (total testosterone, PRL, FSH and LH). Results: The average age was 29.7 years. The body mass index ranged between 18.95 and 29.88 kg/m2 (mean value of 24.15). The means of the waist and hip circumferences were 86.62 and 99.77 cm, respectively. The reference interval of total testosterone calculated for the male population of Plaza de la Revolución municipality was of 7.69 to 40.52 nmol/L. The mean for total testosterone was 19.10 nmol/L. Conclusions: The reference interval of total testosterone calculated for the adult male population (20 - 40 years old) of Plaza de la Revolución municipality differs from that reported by the manufacturer of the diagnostic kit and it can be useful in clinical practice(AU)


Subject(s)
Humans , Male , Adult , Physical Examination/methods , Testosterone/adverse effects , Hypogonadism/diagnosis , Quality of Life , Reference Values , Body Mass Index , Epidemiology, Descriptive , Cross-Sectional Studies
13.
Rev. cuba. endocrinol ; 30(3): e212, sept.-dic. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126438

ABSTRACT

RESUMEN Introducción: En Cuba, no existe consenso acerca de qué valor del índice cintura/cadera debe ser considerado de riesgo para identificar disglucemias. Objetivos: Determinar el punto de corte del índice cintura/cadera como predictor de disglucemias para ambos sexos, en personas con sospecha de padecer diabetes mellitus. Métodos: Estudio descriptivo transversal con 975 personas, de ellas 523 mujeres y 452 hombres. La muestra no fue obtenida de población general y no fue aleatoria. A los sujetos se les realizó interrogatorio, examen físico y estudios complementarios. Se determinaron distribuciones de frecuencia de las variables cualitativas y cuantitativas. Se utilizó para el procesamiento estadístico el coeficiente de correlación de Pearson, análisis de regresión logística y el análisis de curvas Receiver Operator Characteristic. Se empleó la prueba Chi Cuadrado para evaluar la significación estadística. Resultados: En ambos sexos observamos una correlación directamente proporcional y significativa entre el índice cintura/cadera y las diferentes variables estudiadas, entre ellas: glucemia en ayunas y a las 2h, insulinemia en ayunas, triglicéridos, ácido úrico y el índice de resistencia a la insulina (HOMA-IR). El colesterol se comportó de la misma forma en los hombres, pero en las mujeres se verificó una correlación débil y no significativa. El punto de corte óptimo del índice cintura/cadera, como predictor independiente de disglucemias, fue de 0,85 en las mujeres y 0,93 en los hombres. El índice cintura/cadera presentó un buen poder predictivo para identificar a sujetos con y sin disglucemias para ambos sexos y superior al de la edad. Conclusiones: El punto de corte óptimo del índice cintura/cadera, como predictor independiente de disglucemias, es de 0,85 en las mujeres y 0,93 en los hombres. Su poder predictor de disglucemias fue bueno(AU)


ABSTRACT Introduction: In Cuba, there is no consensus about what value of the waist-hip ratio must be considered as a risk to identify dysglycemia. Objectives: To determine the cut-off point of the waist-hip ratio as a predictor of dysglycemias for both sexes, in people suspected of suffering from diabetes mellitus. Methods: Descriptive cross-sectional study with 975 people, including 523 women and 452 men. The sample was not obtained from general population and it was not random. The subjects underwent interrogation, physical examination and complementary studies. There were identified frequency distributions of qualitative and quantitative variables. It was used for the statistical processing the Pearson's correlation coefficient, logistic regression analysis and the curves analysis called Receiver Operator Characteristic. It was used the chi-square test to assess the statistical significance. Results: In both sexes, it was observed a directly proportional and significant correlation between the waist-hip ratio and the different variables studied, including: fasting and after 2 hours glycemia, fasting insulinemia, triglycerides, uric acid and the insulin resistance index (HOMA-IR). Cholesterol behaved the same way in men, but in women there was a weak and not significant correlation. The optimal cut-point of the waist-hip ratio, as an independent predictor of dysglycemia, was 0.85 in women and 0.93 in men. The waist-hip ratio presented a good predictive power to identify subjects with and without dysglycemia for both sexes and it was higher than that of the age. Conclusions: The optimal cut-point of the waist-hip ratio, as an independent predictor of dysglycemia, was 0.85 in women and 0.93 in men. Its power as predictor of dysglycemia was good(AU)


Subject(s)
Humans , Male , Female , Prediabetic State/epidemiology , Body Weights and Measures/methods , Waist-Hip Ratio , Obesity/diagnosis , Physical Examination/methods , Insulin Resistance , Epidemiology, Descriptive , Cross-Sectional Studies
14.
Rev. cuba. enferm ; 35(4): e2806, oct.-dic. 2019.
Article in Portuguese | LILACS, BDENF, CUMED | ID: biblio-1251691

ABSTRACT

Introdução: Para garantir a confiabilidade na assistência de enfermagem a pacientes com distúrbios hematológicos, por meio de procedimentos seguros, baseados em ações as mais científicas possíveis, é imprescindível a realização de um exame físico de qualidade, com foco nos principais distúrbios acometidos por esses pacientes. Objetivo: Identificar a percepção dos enfermeiros durante a realização do exame físico em pacientes hospitalizados com distúrbios hematológicos. Métodos: Pesquisa qualitativa com dez enfermeiros atuantes no cuidado a pacientes hematológicos em um hospital referência de doenças hematológicas do estado do Rio de Janeiro. Os dados foram coletados mediante entrevista semi estruturada e analisados através de análise temática. Resultados: Identificamos que 100 porcento participantes responderam que realizam o exame físico na sua prática profissional. Em relação à pergunta que abordava o principal componente que deve ser identificado pelo enfermeiro durante a execução do exame físico do cliente hematológico, encontramos que o sangramento foi à resposta mais verbalizada pelos participantes. Observou-se uma preocupação na identificação dos problemas psicoemocionais decorrentes de uma patologia hematológica. Conclusão: A identificação correta dos problemas apresentados pelos pacientes hematológicos, através de uma avaliação clínica cuidadosa, torna-se fundamental para o desenvolvimento de ações que favoreçam uma melhora na qualidade da assistência a saúde(AU)


Introducción: Para garantizar la confiabilidad en la asistencia de enfermería a pacientes con disturbios hematológicos, por medio de procedimientos seguros, basados en acciones las más científicas posibles, es imprescindible la realización de un examen físico de calidad, con foco en los principales disturbios acometidos por esos pacientes. Objetivo: Identificar las percepciones de las enfermeras durante el examen físico en pacientes hospitalizados con trastornos hematológicos. Métodos: Investigación cualitativa con diez enfermeros actuantes en el cuidado a pacientes hematológicos, en un hospital referencia de enfermedades hematológicas del estado de Río de Janeiro. Los datos fueron recolectados mediante entrevista semiestructurada y analizados a través de análisis temático. Resultados: Todos los participantes respondieron que realizaban el examen físico en su práctica profesional. En relación a la pregunta que abordaba el principal componente que debe ser identificado por el enfermero durante la ejecución del examen físico del cliente hematológico, el sangrado fue a la respuesta más verbalizada por los participantes. Se observó una preocupación en la identificación de los problemas psicoemocionales derivados de una patología hematológica. Conclusión: La identificación correcta de los problemas presentados por los pacientes hematológicos, a través de una evaluación clínica cuidadosa, se vuelve fundamental para el desarrollo de acciones que favorezcan una mejora en la calidad de la asistencia a la salud(AU)


Introduction: To guarantee nursing care reliability to patients with hematological disorders, through safe procedures, based on the most possible scientific actions, it is essential to perform a quality physical examination, with a focus on the main disturbances undertaken by those patients Objective: To identify the perceptions of nurses during the physical examination in hospitalized patients with hematological disorders. Methods: Qualitative research with ten nurses participating in the care of hematological patients, in a reference hospital for hematological diseases in Rio de Janeiro State. The data were collected through semi-structured interviews and analyzed through thematic analysis. Results: All participants responded that they performed the physical examination in their professional practice. Regarding the question about the main component that should be identified by the nurse during the execution of the physical examination of the hematological client, bleeding was the response most verbalized by the participants. Concern was observed in the identification of psychoemotional problems derived from a hematological condition. Conclusion: The correct identification of the problems presented by hematological patients, through careful clinical evaluation, becomes fundamental for the development of actions that favor an improvement in the quality of health care(AU)


Subject(s)
Humans , Physical Examination/methods , Professional Practice , Quality of Health Care , Hematologic Diseases/etiology , Nursing Care/methods , Qualitative Research
16.
Rev. bras. ter. intensiva ; 31(1): 27-33, jan.-mar. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1003627

ABSTRACT

RESUMO Objetivo: Avaliar a segurança e as propriedades clinimétricas do Teste de Sentar-Levantar Cinco Vezes em pacientes mais velhos internados em unidade de terapia intensiva. Métodos: A segurança do teste foi avaliada segundo a incidência de eventos adversos e pela análise dos dados hemodinâmicos e respiratórios. Além disto, a confiabilidade de suas propriedades foi investigada por meio de avaliação de coeficientes de correlação intraclasses, mensuração do erro padrão da média, porcentagem de alteração do erro padrão da média, gráficos de Altman-Bland e de concordância-sobrevivência. Resultados: A adequabilidade do Teste de Sentar-Levantar Cinco Vezes foi identificada como baixa, já que apenas 29,8% dos potenciais participantes cumpriam os critérios de inclusão. Apenas 44% dos pacientes hospitalizados que cumpriam os critérios de inclusão realizaram o teste, sem necessidade de cessação para qualquer dos pacientes. A frequência cardíaca (79,7 ± 10,2bpm/86,6 ± 9,7bpm; p = 0,001) e a pressão arterial sistólica (118 ± 21,4mmHg/129 ± 21,5mmHg; p = 0,031) foram as únicas variáveis com aumento estatisticamente significante, sem evidência de resposta exacerbada ao teste. Além disto, não se relataram eventos adversos, e a confiabilidade tanto entre teste e reteste quanto entre avaliadores foi elevada (coeficiente de correlação entre classes ≥ 0,99). Conclusão: O Teste de Sentar-Levantar Cinco Vezes se comprovou seguro e com excelente confiabilidade. Seu uso clínico no ambiente hospitalar, contudo, pode ser restrito a pacientes adultos mais velhos com elevada funcionalidade.


ABSTRACT Objective: Assess the Five Times Sit-to-Stand Test safety and clinimetric properties in older patients hospitalized in an intensive care unit. Methods: Test safety was assessed according to the incidence of adverse events and through hemodynamic and respiratory data. Additionally, reliability properties were investigated using the intraclass correlation coefficients, standard error of measurement, standard error percentage change, Altman-Bland plot and a survival agreement plot. Results: The overall suitability of the Five Times Sit-to-Stand Test was found to be low, with 29.8% meeting the inclusion criteria. Only 44% of the hospitalized patients who met the inclusion criteria performed the test, with no need for discontinuation in any patient. Heart rate (79.7 ± 10.2bpm/86.6 ± 9.7bpm; p = 0.001) and systolic blood pressure (118 ± 21.4mmHg/129 ± 21.5mmHg; p = 0.031) were the only variables that presented a significant statistical increase, with no evidence of exacerbated response to the test. Additionally, no adverse events were reported from participating and both test-retest and interrater reliability were high (intraclass correlation coefficient ≥ 0.99). Conclusion: The Five Times Sit-to-Stand Test was proven to be safe and to have excellent reliability. Its clinical use, however, may be restricted to high-functioning older adults in hospital settings.


Subject(s)
Humans , Male , Female , Patient Discharge , Physical Examination/methods , Intensive Care Units , Movement/physiology , Cross-Sectional Studies , Reproducibility of Results , Postural Balance/physiology , Heart Rate/physiology , Middle Aged
18.
Rev. Assoc. Med. Bras. (1992) ; 64(5): 474-480, May 2018. graf
Article in English | LILACS | ID: biblio-956469

ABSTRACT

SUMMARY Point-of-care ultrasonography, which is performed at the bedside by physicians who are not specialists in imaging, has become possible thanks to recent technological advances that have allowed for a device with greater portability while maintaining image quality. The increasing use of point-of-care ultrasonography in different specialties has made it possible to expand physical examinations, make timely decisions about the patients and allows the performance of safer medical procedures. In this review, three cases from our experience are presented that highlight the use of point-of-care ultrasonography by clinicians. Bedside ultrasonography is a convenient modality used in a clinical setting to aid in early diagnosis of several common conditions. It is suggested that a hybrid approach of physical examination and point-of-care ultrasonography in the everyday clinical practice is an inevitable change of paradigm that is improving quality of care in a variety of clinical settings.


Subject(s)
Humans , Male , Female , Adult , Aged , Physical Examination/methods , Ultrasonography/methods , Point-of-Care Systems , Emergency Medical Services , Aortic Aneurysm, Abdominal/diagnostic imaging , Middle Aged , Nephrotic Syndrome/diagnostic imaging
19.
ABC., imagem cardiovasc ; 30(2): f:39-l:45, abr.-jun. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-833434

ABSTRACT

Fundamento: O ecocardiograma é uma ferramenta diagnóstica utilizada para avaliar anomalias cardíacas e esclarecer dúvidas quanto ao caráter benigno de certos achados do exame clínico cardiovascular. Objetivos: Identificar os principais motivos da solicitação do ecocardiograma pelo pediatra e avaliar o grau de ansiedade dos familiares gerado por essa conduta. Métodos: Foram incluídos pacientes com idade inferior a 18 anos, sem diagnóstico prévio de cardiopatia e encaminhados para o primeiro exame de ecocardiograma. Os familiares responsáveis pelos pacientes responderam a um questionário para avaliar o grau de ansiedade deles desde o pedido até a realização do ecocardiograma, com pontuação entre 0 e 19. Os dados foram analisados através de porcentagens, desvio padrão e teste T de Student. Resultados: Estudados 30 pacientes com idade média de 4,45 anos. O motivo de encaminhamento mais prevalente foi sopro cardíaco (23 casos), dos quais 70% não tiveram a hipótese de cardiopatia congênita confirmada após o ecocardiograma. A pontuação média no questionário de ansiedade foi 11 ± 6, sendo relacionado significativamente à presença de cardiopatia, com média de 13,0 ± 5,3 vs. 9,3 ± 5,2 no grupo sem a hipótese da mesma (p = 0,007). Conclusão: O achado de sopro foi o principal motivo para solicitação de ecocardiograma pelo pediatra. A confirmação de cardiopatia foi maior nos menores de 1 ano e com achado de sopro. Apesar do grau de ansiedade ter sido maior no grupo dos pacientes que tiveram o diagnóstico de cardiopatia congênita, este não foi desprezível nos familiares no grupo dos pacientes sem cardiopatia


Background: Echocardiography is a diagnostic tool used to evaluate cardiac anomalies and clarify doubts about the benign nature of certain findings of cardiovascular clinical examination. Objectives: To identify the main reasons for the request of echocardiography by pediatrician and evaluate the degree of anxiety of the family generated by this conduct. Methods: We included patients younger than 18 years without previous diagnosis of heart disease and referred for the first echocardiogram. Family members responsible for the patients answered a questionnaire to assess the degree of their anxiety from order to the performance of the echocardiogram, with scores between 0 and 19. Data were analyzed using percentages, standard deviation and Student's t test. Results: Studied 30 patients with a mean age of 4.45 years. The most prevalent reason for referral was heart murmur (23 cases), of which 70% patients had no congenital heart disease hypothesis confirmed, after echocardiography. The average score on the anxiety questionnaire was 11 ± 6 significantly associated with the presence of heart disease, with a mean of 13.0 ± 5.3 vs. 9.3 ± 5.2 in the group without the possibility of it (p = 0.007). Conclusion: The murmurs findings was the main reason for echocardiography request by the pediatrician. Confirmation of heart disease was higher in children under 1 year and with murmurs findings. Despite the anxiety level was higher in the group of patients who were diagnosed with congenital heart disease, this was not negligible in the family in the group of patients without heart disease


Subject(s)
Humans , Male , Female , Child , Adolescent , Adolescent , Cardiovascular Abnormalities/complications , Cardiovascular Abnormalities/diagnosis , Child , Echocardiography/methods , Heart Murmurs/diagnosis , Pediatrics , Anxiety , Diagnostic Techniques and Procedures , Medical History Taking/methods , Observational Study , Physical Examination/methods , Data Interpretation, Statistical , Surveys and Questionnaires
20.
Clinics ; 72(1): 17-22, Jan. 2017. tab, graf
Article in English | LILACS | ID: biblio-840032

ABSTRACT

OBJECTIVES: To analyze the motor development of late preterm newborn infants (LPI) from birth to term-corrected age using the Test of Infant Motor Performance (TIMP) and to compare the obtained results with those of term infants at birth. METHODS: Prospective cohort study, 29 late preterm newborn infants were evaluated by the TIMP at birth and every two weeks until term-corrected age. The TIMP was administered to 88 term infants at birth. RESULTS: The mean TIMP score of late preterm newborn infants was 51.9±5.8 at 34–35 weeks and 62.6±5.2 at 40 weeks. There was a significant increase at 38–39 weeks in the LPI group (p<0.05). There were no significant differences in the motor evaluations between term infants at birth and LPI at the equivalent age. CONCLUSION: The LPI presented a gradual progression of motor development until the term-corrected age, but differences with term infants at birth were not detected.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Infant, Premature/physiology , Child Development/physiology , Motor Skills/physiology , Physical Examination/methods , Prospective Studies , Gestational Age , Term Birth
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