Muscle Injury: Pathophysiology, Diagnosis, and Treatment / Lesão muscular: Fisiopatologia, diagnóstico e tratamento

Abstract Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides these injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by ultrasound, which is dynamic and cheap, but examiner dependent; and magnetic resonance imaging (MRI), which provides better anatomical definition. The initial phase of the treatment consists in protection, rest, optimal use of the affected limb, and cryotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in the clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement.

Resumo O tecido muscular esquelético possui a maior massa do corpo humano, correspondendo a 45% do peso total. As lesões musculares podem ser causadas por contusões, estiramentos ou lacerações. A atual classificação separa as lesões entre leves, moderadas e graves. Os sinais e sintomas das lesões grau I são edema e desconforto; grau II, perda de função, gap e equimose eventual; grau III, rotura completa, dor intensa e hematoma extenso. O diagnóstico pode ser confirmado por ultrassom (dinâmico e barato, porém examinador-dependente); e ressonância magnética (RM) (maior definição anatômica). A fase inicial do tratamento se resume à proteção, ao repouso, ao uso otimizado do membro afetado e crioterapia. Anti-inflamatórios não hormonais (AINHs), ultrassom terapêutico, fortalecimento e alongamento após a fase inicial e amplitudes de movimento sem dor são utilizados no tratamento clínico. Já o cirúrgico possui indicações precisas: drenagem do hematoma, reinserção e reforço musculotendíneos.

Effect of one-time high load exercise on skeletal muscle injury in rats of different genders: oxidative stress and mitochondrial responses

Purpose: To evaluate the impact of one-time high load exercise on skeletal muscle injury and analysis its mechanism in different genders. Methods: Twenty-four male and 24 female rats were divided randomly into four groups respectively: control, 0 h, 6 h, and 24 h after exercise. The activities of creatine kinase (CK), lactate dehydrogenase (LDH), and myohemoglobin (MYO) in serum, the expression level of oxidative stress markers, mitochondrial respiratory chain complex enzyme, and the apoptosis related protein in quadriceps were detected. Results: The results showed that the activities of CK, LDH and MYO in serum increased immediately after exercise and restored faster in female rats. More obvious structural disorder and apoptosis in male rats were showed. Malondialdehyde (MDA) and superoxide dismutase (SOD) were increased while catalase (CAT) and glutathione (GSH) were decreased in male rats. SOD, CAT and GSH were increased in female rats. Mitochondrial complex enzyme activity was decreased in males and increased in females. Conclusions: The skeletal muscle injury in both genders of rat could be induced by one-time high load exercise due to the mitochondrial respiratory enzyme dysfunction and oxidative stress, which was relatively mild and recovered quicker in female rats.

Musculoskeletal injuries in taekwondo athletes: a nationwide study in Portugal

SUMMARY BACKGROUND Taekwondo is a martial art that emphasizes blows using the feet and fists, and it is characterized by direct and continuous body contact, which subjects their practitioners to a higher number of injuries. This study aimed to determine the incidence of musculoskeletal injuries in Portuguese taekwondo athletes and analyze its associated factors. METHODS The sample included 341 taekwondo athletes, aged between 4 and 62 years (18.77±12.77 years), 237 (69.5%) were male, and 104 (30.5%) female. A questionnaire was administered at a national level in taekwondo training and competitions via interview. RESULTS One hundred and thirty-two (38.7%) taekwondo athletes reported having suffered an injury since they began their practice, totaling 294 injuries. Seventy-six (22.3%) athletes had an injury in the previous 12-months period, with a total of 112 injuries. There were 2.15 injuries per 1,000 hours of taekwondo training. The most common of all injuries was muscle injury (strain, contusion) (58.6%), in the foot and fingers (18.9%). The attack technique (28.8%) was the most prevalent injury mechanism. Adult athletes presented a higher risk of sustaining taekwondo-related injuries than adolescents (odds ratio = 3.91; 95%CI: 1.13-13.55; p=0.032), and athletes who trained more than 1 hour had a risk 4.20 times greater (95%CI: 1.44-12.29; p=0.009) than those who trained up to 1 hour per session. CONCLUSIONS Injuries were frequent among Portuguese taekwondo athletes, with specific body areas affected, mainly caused by the attack technique. It is necessary to create injury prevention strategies, including specific training and the use of protective equipment.

RESUMO INTRODUÇÃO O Taekwondo consiste numa arte marcial que enfatiza os golpes com os pés e punhos, sendo caracterizada pelo contato corporal direto e contínuo, fatores que podem ocasionar lesões. O objetivo do estudo foi determinar a incidência de lesões musculoesqueléticas em atletas portugueses de taekwondo e analisar os fatores associados. MÉTODOS A amostra foi constituída por 341 atletas de taekwondo, com idades entre 4 e 62 anos (18,77±12,77), sendo 237 (69,5%) do sexo masculino. O instrumento de medida consistiu num questionário, aplicado sob a forma de entrevista, em nível nacional. RESULTADOS Cento e trinta e dois (38,7%) atletas relataram terem sofrido lesões desde que iniciaram a prática, totalizando 294 lesões. Setenta e seis (22,3%) atletas referiram presença de lesões no período de 12 meses, totalizando 112 lesões. Foram registradas 2,15 lesões por 1.000 horas de treinamento de taekwondo. O tipo de lesão mais frequente foi a lesão muscular (57,7%) e as localizadas no pé e dedos (18,9%). A técnica de ataque (28,8%) foi o mecanismo de lesão mais prevalente. Os adultos apresentaram maior risco de sofrer lesões comparados aos adolescentes (odds ratio = 3,91; IC 95%: 1,13-13,55; p=0,032), e os atletas que treinaram mais de uma hora tiveram um risco de 4,20 (IC 95%: 1,44-12,29; p=0,009) do que aqueles que treinaram até uma hora por sessão. CONCLUSÕES Os dados do estudo revelaram que as lesões foram frequentes em atletas portugueses de taekwondo, com áreas corporais específicas afetadas, e causadas principalmente pela técnica de ataque. Torna-se necessário elaborar estratégias de prevenção de lesões, incluindo treinamentos específicos e uso de material de proteção.

Associated factors and profile of injuries in professional ballroom dancers in Brazil: a cross-sectional study

Abstract Aims: Ballroom dance consists of a modality characterized by fast and dynamic movements performed in pairs, aiming at technical and artistic excellence. Objective: To analyze the prevalence, characteristics, and factors associated with injuries in professional ballroom dancers, considering possible differences between sexes. Method: 320 professional dancers of both sexes with a mean age of 31.48±8.63 years, who were in professional companies and/or dance schools from five regions of Brazil. The measurement was performed through an online self-administered questionnaire about general information and injuries. Results: A high frequency of musculoskeletal injuries (80.0%) was observed, especially osteoarticular ones (52.4%). In women, the lower limbs were the anatomical location most reported (31.1%) and the knee in male dancers (28.7%). Overweight men, with more than 11 years of dance practice, who danced in companies and also performed other physical activities, were more likely to have injuries. However, women were less likely to have injuries when they were overweight and more likely when they practiced other dance modalities besides ballroom dancing. Conclusions: Approximately 64.1% of ballroom dancers suffered an injury throughout their professional careers. For men, being overweight as well as the search for complementary activities to the physical training routine for both sexes, seem to influence the occurrence of injuries. Identification of the factors associated with injuries in ballroom dancers contributes both to preventive actions and to rehabilitation processes, favoring a healthy and safe career for professionals involved in this practice.

Firearm-Related Musculoskeletal Injuries in Brazilian Children and Teenagers / Lesões musculoesqueléticas por armas de fogo em crianças e adolescentes brasileiros

Abstract Objective To evaluate and describe musculoskeletal injuries by firearms in children and adolescents attended in a major trauma center. Methods This was a retrospective study that evaluated the medical records of < 18 years old patients who were victims of injuries by firearms and who presented to the emergency department of our hospital, from January 2014 to December 2016. A total of 51 patients were excluded for not showing musculoskeletal injures or for other reasons, while 126 were included. The collected data were: gender; age; way of admission; body site hit; fractures; complications and sequelae; associated injures; hospitalization time; surgeries; deaths. Results Out of 126 patients included, 107 were male (84.9%) and 19 were female (15.1%). The mean age was 15 years and 5 months old (range: 2y + 8 months to 17y + 11 months years old). A total of 70 patients were hospitalized (55.6%), with a mean hospital stay of 9.6 days, and 21 patients were hospitalized in the intensive care unit (ICU) for a mean of 14.7 days. A total of 37 patients needed orthopedic surgery (29.4%). There were 6 deaths (4.8%). The thigh was the most hit region, in 43 injuries (24.7%). Six patients had spinal cord sequelae, and eight patients had peripheral nerves injuries. A total of 58 patients (46%) had 71 fractures, and the femur was the most hit (15.5%). A total of 52 (41.3%) patients presented with associated injuries. In the 71 fractures, the treatment was conservative in 45 (63.4%), surgical in 23 (32.4%). Three injuries resulted in death (4.2%). Conclusion Adolescents and males are at-risk groups for firearms injuries, and the lesions are mainly on the lower limbs. Less than half of the patients had fractures, but many had complex lesions with potential for severe sequelae.

Resumo Objetivo Avaliar e descrever lesões musculoesqueléticas por armas de fogo em crianças e adolescentes atendidas em um pronto-socorro de grande porte. Métodos Estudo retrospectivo avaliando os prontuários de pacientes, vítimas de armas de fogo e menores de 18 anos de idade que deram entrada ao pronto socorro do nosso hospital, de janeiro de 2014 a dezembro de 2016. Um total de 51 pacientes foi excluído por não apresentar lesões musculoesqueléticas ou outras razões, enquanto 126 foram incluídos. Os dados colhidos foram: sexo; idade; via de entrada; tipo de lesão; balas alojadas e removidas; local do corpo atingido; fraturas; complicações e sequelas; lesões associadas; tempo de internamento e de UTI; cirurgias; e óbitos. Resultados Dos 177 pacientes menores de 18 anos que deram entrada no pronto socorro por ferimento por armas de fogo, 126 pacientes (71,2%) atenderam aos critérios de inclusão. Foram excluídos 51 (43 por não apresentaram lesões musculoesqueléticas). Cento e sete (84,9%) eram do sexo masculino e 19 (15,1%) do feminino. A média de idade foi 15,5 anos (limites, 2 anos + 8 meses a 17 anos + 11 meses). Setenta pacientes foram internados por tempo médio de 9,6 dias, e 21 pacientes foram hospitalizados na unidade de tratamento intensivo (UTI) por 14,7 dias em média. Um total de 37 pacientes (29,4%) foi submetido a cirurgias ortopédicas. Houve um total de 6 óbitos (4,8%). A coxa foi a principal região atingida, em um total de 43 vezes (24,7%). Seis pacientes tiveram lesões da medula espinhal, e oito pacientes tiveram lesões de nervos periféricos. Um total de 58 pacientes (46%) teve 71 fraturas, e o fêmur foi o principal osso fraturado (11 pacientes; 15,5%). Um total de 52 pacientes (41,3%) tiveram lesões associadas. Das 71 fraturas, o tratamento foi conservador em 45 (63,4%) e cirúrgico em 23 (32,4%). Três evoluíram para óbito (4,2%). Conclusão Os adolescentes e o sexo masculino são grupo de risco para lesões de armas de fogo, e as lesões são principalmente em membros inferiores. Menos da metade dos pacientes apresentaram fraturas, mas muitos apresentaram lesões complexas com potencial de graves sequelas.

Prevalencia de lesiones osteomusculares en patinadores de carreras de Villavicencio, Colombia / Prevalence of musculoskeletal injuries in racing skaters in Villavicencio, Colombia

RESUMEN Objetivo Determinar la prevalência de lesiones osteomusculares y su relación con las diferentes variables de presentación en la práctica del patinaje de carreras, en atletas por categorías de edad entre los 8 y los 23 años de edad, de la ciudad de Villavicencio, Colombia. Métodos Se desarrolló un estudio observacional analítico de corte transversal o de prevalencia, por medio de la aplicación de un instrumento de recolección de información que fue diseñado y validado cualitativa y cuantitativamente. El instrumento incluyó las variables asociadas a la presentación de lesiones organizadas en cinco dominios. La información recolectada se analizó con estadística descriptiva. Resultados El 66,7 % de la población estudiada pertenecía al sexo femenino, el 39 % de los patinadores tenía entre cinco y seis años de vida deportiva y se ubicó en la categoría de transición; nueve de cada diez atletas realizaron entrenamiento más de cinco días a la semana; la misma proporción realizó de tres a cinco horas de entrenamiento diario. La prevalencia de lesiones osteomusculares fue del 53,7 % del total de la población estudiada; el 29,6 % presentaron entre una y dos lesiones y el 5,6 % de patinadores lesionados tuvo entre nueve y diez lesiones. Conclusiones La mayoría de lesiones osteomusculares se relacionaron con las categorías de menor edad, en periodos precompetitivo y de preparación específica; afectaron miembros inferiores y fueron, en mayor proporción, lesiones óseas y musculares.(AU)

Abstract Objective To determine the prevalence of musculoskeletal injuries and their relation to different presentation variables in inline speed skaters by age categories, between 8 and 23 years of age, from Villavicencio, Colombia. Methods An observational cross-sectional or prevalence analytical study was developed by applying an information collection instrument that was designed and validated qualitatively and quantitatively. The instrument included variables associated with the presentation of lesions organized in five domains. The information collected was analyzed with descriptive statistics. Results 66.7 % of the population studied were females, 39 % of skaters had between five and six years of sporting experience, and were in the transition category. Nine out of ten athletes trained more than five days a week, and the same proportion did three to five hours of daily training. The prevalence of musculoskeletal injuries was 53.7 % in the total population studied; 29.6 % had between one and two injuries, and 5.6% of injured skaters had between nine and ten injuries. Conclusions Most of musculoskeletal injuries were related to the younger age categories, in precompetitive and specific preparation periods. The lower limbs were the most affected, to a greater extent, by bony and muscular lesions.(AU)

Efeito da cinesioterapia em crianças queimadas: revisão bibliográfica / Effect of kinesiotherapy in buried children: bibliographic review / Efecto de la cinesioterapia en los niños quemados: revisión de la literatura

OBJETIVOS: Analisar na revisão de literatura o efeito da cinesioterapia em crianças que sofreram queimaduras. MÉTODO: Nesse artigo foi realizada uma pesquisa de caráter bibliográfico, descritivo e documental. Foram utilizadas as seguintes bases de dados para a revisão bibliográfica: Literatura Internacional em Ciências da Saúde (MEDLINE), Scientific Eletronic Library Online (SCIELO) e Google Acadêmico. RESULTADOS: A cinesioterapia deve ser uma intervenção central na maioria dos planos de tratamento fisioterapêutico, principalmente nas disfunções do sistema musculoesquelético, pretendendo eliminar ou reduzir a limitação funcional e a incapacidade. CONCLUSÃO: Conforme verificado com esse estudo, a cinesioterapia deve ser uma intervenção central, preservando as disfunções do sistema musculoesquelético.

OBJECTIVES: To analyze in literature review the effect of kinesiotherapy in children who suffered burns. METHOD: In this article a bibliographic, descriptive and documentary research was carried out. The following databases were used for the bibliographic review: International Literature in Health Sciences (MEDLINE), Scientific Electronic Library Online (SCIELO) and Google Scholar. RESULTS: Kinesiotherapy should be a central intervention in most physiotherapeutic treatment plans, especially in musculoskeletal system dysfunctions, aiming to eliminate or reduce functional limitation and disability. CONCLUSION: As verified with this study, kinesiotherapy should be a central intervention preserving dysfunctions of the musculoskeletal system.

Utilidad de la resonancia magnética en el diagnóstico de lesiones musculares de localización atípica / Usefulness of magnetic resonance imaging in the diagnosis of atypical location muscle lesions

En el presente los desgarros musculares son una causa muy frecuente de lesión en la práctica deportiva. Según los estudios actuales, un 30% de las lesiones en atletas afecta los músculos, siendo particularmente comunes a nivel de los isquiotibiales, el recto anterior de los cuádriceps, los gemelos y los aductores. El diagnóstico se realiza en forma sencilla mediante un estudio ecográfico. Sin embargo, existe un número importante de lesiones musculares de localización profunda e infrecuente, que pueden pasar inadvertidas en la ecografía y que causan largos períodos de inactividad para el deportista. La resonancia magnética (RM), por su resolución anatómica y capacidad multiplanar, es el método de elección para el estudio de este tipo de afecciones, ya que permite descartar otras patologías de similar presentación clínica y realizar un diagnóstico específico. En este artículo describimos los desgarros musculares de localización inusual, particularmente los de localización pelviana, evaluando también la pared torácica, abdominal y miembros superiores e inferiores. En todos los casos, se usaron equipos de alto campo 1.5 y 3 Tesla.

Muscle injuries are currently particularly frequent among people who participate in sports. Current studies show that 30% of injuries in athletes affect muscles, with hamstrings, quadriceps, gastrocnemius, and adductors being particularly prevalent. The diagnosis is easily made with an ultrasound study. However, there are a significant number of muscle injuries, considered uncommon, that may be not be detected by ultrasound, mainly because of their depth, and could be responsible for long periods of inactivity for the sportsman. Magnetic resonance imaging (MRI), with a better anatomical resolution and multiplanar capability, is the method of choice for detecting the precise location and severity of the injury and can establish their severity. The aim of this article is to review muscle tears of unusual location, particularly in the pelvic area, but also evaluating the chest wall, abdomen, and upper and lower limbs. All patients were evaluated by 3 and 1.5 Tesla MRI units.

O papel dos anti-inflamatórios não hormonais no tratamento da dor musculoesquelética / The role of non-steroid anti-inflammatory in the treatment of musculoskeletal pain

Os anti-inflamatórios não esteroides (AINEs) estão entre os medicamentos mais comumente prescritos em todo o mundo e são responsáveis por cerca de um quarto de todas as notificações de reações adversas. Têm sido amplamente indicados em pacientes com doença reumática e outras doenças musculoesqueléticas - população de maior risco de graves complicações gastrintestinais (GI). Os AINEs tópicos são administrados para o tratamento de diversas condições: lesões musculoesqueléticas, dor pós-operatória, neuralgia pós-herpética, periodontite, úlceras aftosas e ceratoses actínicas. Dados mostram que metade dos AINEs é indicada para osteoartrite (OA). Sua administração tópica oferece como benefício menor incidência de efeitos adversos sistêmicos, como úlcera péptica e hemorragia GI, na metabolização do medicamento nos tecidos afetados...

Nonsteroidal anti-inflammatory are among the drugs more usually prescribed in all over the world which is responsible for about a fourth of all notifications of adverse reactions. It has been widely indicated in patients with rheumatic disease and others musculoskeletal disease - high risk population of severe gastrointestinal complications (GI). The topic AINEs are managed for the treatment of many conditions: musculoskeletal injury, postoperative pain, postherpetic neuralgy, periodontic, mouth ulcer and actinic keratosis. Data show that half of AINEs are indicated for osteoarthritis (OA). Its topic administration provides benefits like less incidence of systemic adverse effects like peptic ulcer and GI bleeding in drug-metabolizing in affected tissues...

An Integrative Model of Workplace Self-protective Behavior for Korean Nurses

PURPOSE: This study was conducted to develop and test a hypothetical stage model of workplace self-protective behaviors with respect to blood transmitted infections and musculoskeletal injuries for Korean nurses. METHODS: A nonexperimental, cross-sectional study designwas adopted. The study participants were 320 nurses at two Korean university hospitals. Perceived sensitivity, severity, barriers, benefits, self-efficacy, social support, and safety climate were assessed. RESULTS: Overall, fit indicators showed a good fit for the hypothetical model of self-protective behaviors against blood transmitted infections and musculoskeletal injuries. The significant factors of self-protective behaviors against blood transmitted infections were perceived barriers and social support. The significant factors of self-protective behaviors against musculoskeletal injuries were perceived benefits, barriers, and self-efficacy. CONCLUSION: Our findings suggest that the significant psychosocial constructs of stages of self-protective behavior are dependent on health problem type. Accordingly, we advise that characteristics of behavior and types of disease and health problem should be given priority when developing intervention programs for particular self-protective health behaviors.

Trauma de extremidades: avaliação e manejo inicial das lesões graves e ameaçadoras da vida / Trauma of limbs: evaluation and initial management of severe, life-threatening injuries

Este artigo versará sobre as lesões musculoesqueléticas graves que podem trazer risco à vida, na importância do seu reconhecimento precoce e manejo inicial dessas lesões, que deverão ser realizadas pelo médico no departamento de emergência.

This article discusses the severe musculoskeletal injuries that can bring serious risk to life, the initial evaluation and management of these injuries that must be performed by the physician in the emergency department.

Perfil das características do treinamento e associação com lesões musculoesqueléticas prévias em corredores recreacionais: um estudo transversal / A description of training characteristics and its association with previous musculoskeletal injuries in recreational runners: a cross-sectional study

CONTEXTUALIZAÇÃO: A corrida é uma das atividades físicas mais populares do mundo, sendo que o número de praticantes vem crescendo nos últimos 40 anos. Uma das consequências do aumento da popularidade da prática de corrida é o aumento das lesões musculoesqueléticas. OBJETIVOS: Descrever os hábitos, as características de treinamento e o histórico de lesões de corredores recreacionais, além de verificar possíveis associações entre os hábitos e as características de treinamento com lesões musculoesqueléticas prévias relacionadas à corrida. MÉTODOS: Duzentos corredores preencheram um formulário contendo questões sobre dados pessoais, histórico da prática de corrida, características do treinamento, tipo de tênis, tipo de pisada e histórico de lesões nos últimos 12 meses. Os dados foram analisados pela estatística descritiva e modelos de regressão logística. RESULTADOS: A maioria dos corredores eram homens, com idade média de 43 (DP=10,5) anos, índice de massa corporal de 24,2 (IQ=4,3) kg/m², volume de treino de 35 km semanais (IQ=28), e 55% dos corredores relataram apresentar alguma lesão musculoesquelética nos últimos 12 meses. As principais lesões encontradas foram as tendinopatias e as lesões musculares. A variável que apresentou associação com lesão musculoesquelética prévia relacionada à corrida foi a experiência de corrida entre cinco e 15 anos (Odds Ratio (OR)=0,2; IC95%=0,1 a 0,9). CONCLUSÕES: A prevalência de lesões musculoesqueléticas relacionadas à corrida nos últimos 12 meses foi de 55%, e a variável experiência de corrida foi associada com a ausência de lesões musculoesqueléticas prévias relacionadas à corrida.

BACKGROUND: Running is one of the most popular physical activities in the world and the number of runners has increased over the past 40 years. One of the consequences of the growing running popularity is the increase of musculoskeletal injuries. OBJECTIVES: To describe the routines, training characteristics and history of injury in recreational runners and to evaluate possible associations between the routines and training characteristics with previous musculoskeletal running-related injuries. METHODS: A total of 200 runners participated in this study. The participants completed an electronic form containing questions about personal characteristics, running experience, training characteristics, type of running shoes, foot type and previous injuries history over the last 12 months. The data were analyzed descriptively as well as by using logistic regression models. RESULTS: The majority of the runners was male, aged 43.0 (SD=10.5) years-old, have a body mass index of 24.2 (IQR=4.3) kg/m², and had training volume of 35.0 (IQR=28.0) kilometers per week. Fifty-five percent of runners had injuries over the last 12 months. The most prevalent injuries observed were tendinopathies and muscle injuries. The variable that showed an association with previous running-related injuries was running experience from 5 to 15 years (Odds Ratio (OR)=0.2; 95%CI=0.1 to 0.9). CONCLUSIONS: The prevalence of running-related injuries over the last 12 months was 55%. The variable running experience was associated with the absence of previous musculoskeletal running-related injuries.

Stem cell therapy: A novel & futuristic treatment modality for disaster injuries.

Stem cell therapy hold the potential to meet the demand for transplant cells/tissues needed for treating damages resulting from both natural and man-made disasters. Pluripotency makes embryonic stem cells and induced pluripotent stem cells ideal for use, but their teratogenic character is a major hindrance. Therapeutic benefits of bone marrow transplantation are well known but characterizing the potentialities of haematopoietic and mesenchymal cells is essential. Haematopoietic stem cells (HSCs) have been used for treating both haematopoietic and non-haematopoietic disorders. Ease of isolation, in vitro expansion, and hypoimmunogenecity have brought mesenchymal stem cells (MSCs) into limelight. Though differentiation of MSCs into tissue-specific cells has been reported, differentiation-independent mechanisms seem to play a more significant role in tissue repair which need to be addressed further. The safety and feasibility of MSCs have been demonstrated in clinical trials, and their use in combination with HSC for radiation injury treatment seems to have extended benefit. Therefore, using stem cells for treatment of disaster injuries along with the conventional medical practice would likely accelerate the repair process and improve the quality of life of the victim.

Caracterización de adultos mayores hospitalizados con lesiones traumáticas osteomioarticulares / Characterization of aged adults hospitalized due to osteomioarticular traumatic injuries

Se realizó un estudio descriptivo y transversal de los 109 ancianos ingresados a causa de lesiones traumáticas osteomioarticulares en el Servicio de Ortopedia y Traumatología del Hospital Clinicoquirúrgico Docente Dr Ambrosio Grillo Portuondo de Santiago de Cuba, durante el primer semestre de 2009. Las variables de interés para la investigación incluyeron: edad, sexo, antecedentes patológicos, escala geriátrica de evaluación funcional, tipo de lesión, tratamiento y complicaciones. Se encontró que los pacientes más afectados por tales traumatismos resultaron ser las mujeres y los mayores de 70 años, que la fractura de cadera fue la lesión más común y que a pesar de que solí­an presentar enfermedades asociadas, eran activos y experimentaban escasas complicaciones.

A descriptive and cross-sectional study of 109 elderly hospitalized at Orthopedics and Traumatology Service from Dr Ambrosio Grillo Portuondo Teaching Clinical-Surgical Hospital in Santiago de Cuba due to osteomioarticular traumatic injuries was carried out during the first semester of 2009. Interest variables for the research included: age, sex, medical history, geriatric scale of functional assessment, injury type, treatment, and complications. It was found that the patients most affected by such trauma were women and those aged persons over 70 years old. Hip fracture was the most common injury. In spite of having associated diseases, they were active people and barely experienced complications.

Lesão muscular nos atletas / Muscle injuries in athletes

Este artigo tem por objetivo demonstrar a fisiologia, o diagnóstico e o tratamento das lesões musculares com foque nos atletas, suas demandas e expectativas. As lesões musculares estão entre as queixas mais comuns no atendimento ortopédico, ocorrendo tanto em atletas como em não atletas. Estas lesões caracterizam um desafio para os especialistas, haja vista a lenta recuperação que afasta o atleta dos treinamentos e competições, as frequentes sequelas e a recorrência das lesões. A maior parte das lesões musculares ocorre durante atividade desportiva, correspondendo de 10 a 55 por cento de todas as lesões. Os músculos mais comumente afetados são os isquiotibiais, quadríceps e gastrocnêmios. Músculos estes biarticulares que estão mais sujeitos a forças de aceleração e desaceleração. O tratamento da lesão muscular varia desde o tratamento conservador até o tratamento cirúrgico. Novos procedimentos estão sendo utilizados, como a câmara hiperbárica e o uso de fatores de crescimento. No entanto, ainda é grande o número de recidivas de lesões. A lesão muscular continua sendo um tema com várias controvérsias. Novos tratamentos estão sendo pesquisados e desenvolvidos. A prevenção com fortalecimento muscular, o alongamento e o equilíbrio muscular continuam sendo o melhor "tratamento".

This article had the aim of demonstrating the physiology, diagnosis and treatment of muscle injuries, focusing on athletes and their demands and expectations. Muscle injuries are among the most common complaints in orthopedic practice, occurring both among athletes and among non-athletes. These injuries present a challenge for specialists, due to the slow recovery, during which time athletes are unable to take part in training and competitions, and due to frequent sequelae and recurrences of the injuries. Most muscle injuries (between 10 percent and 55 percent of all injuries) occur during sports activities. The muscles most commonly affected are the ischiotibial, quadriceps and gastrocnemius. These muscles go across two joints and are more subject to acceleration and deceleration forces. The treatment for muscle injuries varies from conservative treatment to surgery. New procedures are being used, like the hyperbaric chamber and the use of growth factors. However, there is still a high rate of injury recurrence. Muscle injury continues to be a topic of much controversy. New treatments are being researched and developed, but prevention through muscle strengthening, stretching exercises and muscle balance continues to be the best "treatment".

Aproximaciones complementarias y alternativas al cuidado de la salud en el Instituto Nacional de Cancerología: estudio de prevalencia / Alternative and complementary medicine at the National Cancer Institute of Colombia: a prevalence survey

Objetivo: Determinar la prevalencia de uso de medicinas alternativas y complementarias en los pacientes oncológicos del Instituto Nacional de Cancerología (INC) de Colombia. Métodos: Estudio transversal con un componente cualitativo (grupos focales), a partir del cual se diseñó una encuesta para caracterizar y determinar la frecuencia del uso de terapias alternativas en pacientes del INC. Resultados: Se aplicaron 359 encuestas en pacientes con distintos tipos de cánceres (ginecológicos, de mama, de piel, de cabeza y cuello, del sistema osteomuscular y gastrointestinales). Se reportaron 38 intervenciones diferentes. La mediana de tratamientos utilizados por paciente fue de 2. El 73,5% de los entrevistados (264 pacientes, IC95%: 68,7%-78%) usaron métodos terapéuticos de medicina complementaria y alternativa; especialmente, del grupo de terapias herbales. La principal fuente de acceso a estas terapias fue a través de familiares o conocidos (68%). Los médicos sólo recomendaron su uso en 8% de los pacientes encuestados. Conclusiones: Se encontró una reiterada utilización de terapias complementarias y alternativas; el grupo de terapias herbales basadas en plantas fue el más reportado en dicho grupo de pacientes. El acceso a éstas no se hace a través de los sistemas de salud oficiales. En nuestro país se requiere mayor investigación en el área.

Objective: To determine use prevalence for alternative and complementary medicines at the National Cancer Institute of Colombia. Methods: A cross-sectional study was carried out. Focus groups were used for designing the survey. Results: 359 surveys were carried out corresponding to patients with different types of cancer. In total 38 types of complementary medicines were reported and the median number of therapies per patient was 2. Some 73.5% (95%CI 68.7%-78.0%) used complementary and alternative therapies, being the group of herbal medicine the most commonly used. Doctors recommended their use in 8% of cases. The family and nearby persons were the main source for accessing this type of therapies. Conclusions: There is a high-frequency utilization of complementary and alternative therapies. The group of herbal medicine is the most common. The findings contradict the lack of access to this type of therapies within the health system. In our country, additional research is needed in this area.

Bailarinos profissionais e saúde: uma revisão da literatura / Professional dancers and health: a literature review

O bailarino é um artista com demandas físicas comparáveis às de um atleta de alta performance e a um profissional de dedicação integral, com um longo período de formação. A saúde do bailarino apresenta especificidades, ainda pouco investigadas. As lesões musculoesqueléticas são o maior enfoque da literatura, em virtude das altas incidências. Muitos são os fatores de risco de lesão descritos entre bailarinos. Citam-se idade, gênero, tempo de prática, índice de massa corpórea, treino suplementar, fatores ambientais e biomecânicos. Mais recentemente, foram descritos fatores psicológicos. O tratamento das lesões muitas vezes é postergado em virtude dos compromissos profissionais e do medo do afastamento. Há evidências de que as estratégias de tratamento e prevenção podem diminuir a incidência de futuras lesões. A literatura é recente e heterogênea, o que limita conclusões mais consistentes. Nota-se que fatores relativos à dinâmica e ao processo de trabalho ou a aspectos organizacionais são raramente pesquisados. Uma nova forma de aproximação é necessária para melhor compreensão do processo saúde/doença do bailarino profissional.

The dancer is an artist with high physical demands who can be compared with an athlete of a high performance and a professional of integral devotion, with a long period of formation. Dancer’s health has specific features that are still little investigated so far. Musculoskeletal injuries are the most frequent focus of the studies, due to their high incidence. There are many risk factors described in dancers, like: individual’s characteristics as age, gender and time of practice, body mass index (BMI), supplementary training, environmental factors, biomechanical factors, and more recently, psychological factors have been more focused in the studies. Also, the treatment of injuries is usually delayed because of professional commitments, aggravated by the fear of missing show sessions. Preliminary evidences suggest that appropriate strategies of treatment and prevention could avoid the development of further injuries. The literature on this issue is young and very heterogeneous, limiting more consistent conclusions. It is also observed that factors related to work process and dynamics, as well as work organization, are poorly approached, so far. So, new approaches are required in order to improve the understanding on the health disease process in professional dancers.

[Changes in soldiers' aerobic fitness and muscle endurance during initial basic training of Iran military]

Amount of physical activity during basic training period [BTP] should provide a suitable level of physical fitness at the end of this period and also be matched to soldiers' physical fitness baseline [PFB] in order to decrease the occurrence of musculoskeletal injuries [MSI] during BTP. The aim of this study was to determine the changes in soldiers' aerobic fitness and muscle endurance during BTP and also to determine the relationship between soldiers' PFB and occurrence of MSI during IBT. In this semi-experimental study, 150 soldiers of Iran military randomly selected as sample group. We evaluated them at the beginning and the end of BTP by means of Army Physical Fitness TEST. To examine the relationship between incidence of MSI during BTP and PFB frequency of the MSI in the sample were recorded. The finding show that at the end of the BTP, physical fitness, aerobic fitness, upper body endurance and abdominal endurance increased significantly, but only in case of upper body endurance, standard level was not implemented. There was a significant negative relationship between incidence of MDI with physical fitness, aerobic fitness and upper body endurance. In accordance with the results, although current program of BTP has positive effects on soldiers' physical fitness, it doesn't bring about all aspects of physical fitness needed to successful military operations. By categorizing and training the soldiers based on the PFB. It may be possible to decrease the incidence of MSI