Reference Values for Human Posture Measurements Based on Computerized Photogrammetry: A Systematic Review.

OBJECTIVE: The main objective of this study was to review the literature to identify reference values for angles and distances of body segments related to upright posture in healthy adult women with the Postural Assessment Software (PAS/SAPO). METHODS: Electronic databases (BVS, PubMed, SciELO and Scopus) were assessed using the following descriptors: evaluation, posture, photogrammetry, physical therapy, postural alignment, postural assessment, and physiotherapy. Studies that performed postural evaluation in healthy adult women with PAS/SAPO and were published in English, Portuguese and Spanish, between the years 2005 and 2014 were included. RESULTS: Four studies met the inclusion criteria. Data from the included studies were grouped to establish the statistical descriptors (mean, variance, and standard deviation) of the body angles and distances. A total of 29 variables were assessed (10 in the anterior views, 16 in the lateral right and left views, and 3 in the posterior views), and its respective mean and standard deviation were calculated. Reference values for the anterior and posterior views showed no symmetry between the right and left sides of the body in the frontal plane. There were also small differences in the calculated reference values for the lateral view. CONCLUSION: The proposed reference values for quantitative evaluation of the upright posture in healthy adult women estimated in the present study using PAS/SAPO could guide future studies and help clinical practice.

Estrategias terapéuticas para el tratamiento de la prostatitis crónica/síndrome de dolor pélvico crónico / Therapeutic strategies for the treatment of chronic prostatitis / chronic pelvic pain syndrome

La prostatitis crónica/síndrome de dolor pélvico crónico es una enfermedad con una repercusión sobre la calidad de vida que en ocasiones es equiparable a la de los pacientes con infarto de miocardio, diabetes mellitus, etc. Durante años, la terapia médica estándar se ha realizado con antiinflamatorios no esteroideos, alfa-bloqueantes y antibióticos. Con el objetivo de analizar las alternativas terapéuticas existentes en la actualidad se ha llevado a cabo una búsqueda bibliográfica en PubMed de los artículos publicados hasta marzo del 2014, encontrando diversas terapias para el tratamiento de la prostatitis crónica/síndrome de dolor pélvico crónico como modificaciones en los estilos de vida, fitoterapia, extractos bacterianos orales inmunoestimulantes, acupuntura, terapia miofascial y biofeedback, terapias neuromoduladoras, ondas de choque extracorpóreas, fármacos con efecto sobre el sistema nervioso central y periférico, terapias cognitivo-conductuales y terapias térmicas. Aunque muchos de estos estudios muestran a priori unos resultados satisfactorios, son necesarios ensayos clínicos controlados y aleatorizados con el objetivo de determinar la efectividad real así como la durabilidad de estos tratamientos en el tiempo (AU)

The chronic prostatitis/chronic pelvic pain syndrome is a disease with an impact on quality of life which is sometimes comparable to that of patients with myocardial infarction, diabetes mellitus, etc. For years, the standard medical therapy was performed with non steroidal anti-inflammatory, alpha-blockers and antibiotics. In order to analyze existing therapeutic alternatives at the moment, a comprehensive literature search in PubMed database was conducted for articles published up to March 2014 data, founding several therapies for the treatment of chronic prostatitis/chronic pelvic pain syndrome as changes in lifestyle, herbal medicine, oral immunostimulant bacterial extracts, acupuncture, myofascial therapy and biofeedback, neuromodulatory therapies, extracorporeal shockwave, medications known to affect the central and peripheral nervous system, cognitive-behavioral therapies and thermal therapies. Although many of these studies show a priori satisfactory results, controlled randomized clinical trials are necessary to determine the actual effectiveness and durability of these treatments over time (AU)

SimTCM: A human patient simulator with application to diagnostic accuracy studies of Chinese medicine.

OBJECTIVE: The aim of this work is to develop and implement the SimTCM, an advanced computational model that incorporates relevant aspects from traditional Chinese medicine (TCM) theory as well as advanced statistical and epidemiological techniques for simulation and analysis of human patients. METHODS: SimTCM presents five major attributes for simulation: representation of true and false profiles for any single pattern; variable count of manifestations for each manifestation profile; empirical distributions of patterns and manifestations in a disease-specific population; incorporation of uncertainty in clinical data; and the combination of the four examinations. The proposed model is strengthened by following international standards for reporting diagnostic accuracy studies, and incorporates these standards in its treatment of study population, sample size calculation, data collection of manifestation profiles, exclusion criteria and missing data handling, reference standards, randomization and blinding, and test reproducibility. RESULTS: Simulations using data from patients diagnosed with hypertension and post-stroke sensory-motor impairments yielded no significant differences between expected and simulated frequencies of patterns (P=0.22 or higher). Time for convergence of simulations varied from 9.90 s (9.80, 10.27) to 28.31 s (26.33, 29.52). The ratio iteration profile necessary for convergence varied between 1:1 and 5:1. CONCLUSION: This model is directly connected to forthcoming models in a large project to design and implement the SuiteTCM: ProntTCM, SciTCM, DiagTCM, StudentTCM, ResearchTCM, HerbsTCM, AcuTCM, and DataTCM. It is expected that the continuity of the SuiteTCM project enhances the evidence-based practice of Chinese medicine. The software is freely available for download at: http://suitetcm.unisuam.edu.br.

SimTCM: A human patient simulator with application to diagnostic accuracy studies of Chinese medicine / 中西医结合学报

The aim of this work is to develop and implement the SimTCM, an advanced computational model that incorporates relevant aspects from traditional Chinese medicine (TCM) theory as well as advanced statistical and epidemiological techniques for simulation and analysis of human patients.

In Vivo Antiprotozoal Activity of the Chloroform Extract from Carica papaya Seeds against Amastigote Stage of Trypanosoma cruzi during Indeterminate and Chronic Phase of Infection.

In order to evaluate the antiprotozoal activity of the chloroform extract of Carica papaya seeds during the subacute and chronic phase of infection of Trypanosoma cruzi, doses of 50 and 75 mg/kg were evaluated during the subacute phase, including a mixture of their main components (oleic, palmitic, and stearic acids). Subsequently, doses of 50 and 75 mg/kg in mice during the chronic phase of infection (100 dpi) were also evaluated. It was found that chloroform extract was able to reduce the amastigote nests numbers during the subacute phase in 55.5 and 69.7% (P > 0.05) as well as in 56.45% in animals treated with the mixture of fatty acids. Moreover, the experimental groups treated with 50 and 75 mg/kg during the chronic phase of the infection showed a significant reduction of 46.8 and 53.13% respectively (P < 0.05). It is recommended to carry out more studies to determine if higher doses of chloroformic extract or its administration in combination with other antichagasic drugs allows a better response over the intracellular stage of T. cruzi in infected animal models and determine if the chloroform extract of C. papaya could be considered as an alternative for treatment during the indeterminate and chronic phase of the infection.

A systematic review of the angular values obtained by computerized photogrammetry in sagittal plane: a proposal for reference values.

OBJECTIVE: Reference values for postural alignment in the coronal plane, as measured by computerized photogrammetry, have been established but not for the sagittal plane. The objective of this study is to propose reference values for angular measurements used for postural analysis in the sagittal plane for healthy adults. METHODS: Electronic databases (PubMed, BVS, Cochrane, Scielo, and Science Direct) were searched using the following key words: evaluation, posture, photogrammetry, and software. Articles published between 2006 and 2012 that used the PAS/SAPO (postural assessment software) were selected. Another inclusion criterion was the presentation of, at least, one of the following measurements: head horizontal alignment, pelvic horizontal alignment, hip angle, vertical alignment of the body, thoracic kyphosis, and lumbar lordosis. Angle samples of the selected articles were grouped 2 by 2 in relation to an overall average, which made possible total average, variance, and SD calculations. RESULTS: Six articles were included, and the following average angular values were found: 51.42° ± 4.87° (head horizontal alignment), -12.26° ± 5.81° (pelvic horizontal alignment), -6.40° ± 3.86° (hip angle), and 1.73° ± 0.94° (vertical alignment of the body). None of the articles contained the measurements for thoracic kyphosis and lumbar lordosis. CONCLUSION: The reference values can be adopted as reference for postural assessment in future researches if the same anatomical points are considered.

Assessment of the anti-protozoal activity of crude Carica papaya seed extract against Trypanosoma cruzi.

In order to determine the in vivo activity against the protozoan Trypanosoma cruzi, two doses (50 and 75 mg/kg) of a chloroform extract of Carica papaya seeds were evaluated compared with a control group of allopurinol. The activity of a mixture of the three main compounds (oleic, palmitic and stearic acids in a proportion of 45.9% of oleic acid, 24.1% of palmitic and 8.52% of stearic acid previously identified in the crude extract of C. papaya was evaluated at doses of 100, 200 and 300 mg/kg. Both doses of the extracts were orally administered for 28 days. A significant reduction (p < 0.05) in the number of blood trypomastigotes was observed in animals treated with the evaluated doses of the C. papaya extract in comparison with the positive control group (allopurinol 8.5 mg/kg). Parasitemia in animals treated with the fatty acids mixture was also significantly reduced (p < 0.05), compared to negative control animals. These results demonstrate that the fatty acids identified in the seed extracts of C. papaya (from ripe fruit) are able to reduce the number of parasites from both parasite stages, blood trypomastigote and amastigote (intracellular stage).

Butyrate activates the monocarboxylate transporter MCT4 expression in breast cancer cells and enhances the antitumor activity of 3-bromopyruvate.

Most malignant tumors exhibit the Warburg effect, which consists in increased glycolysis rates with production of lactate, even in the presence of oxygen. Monocarboxylate transporters (MCTs), maintain these glycolytic rates, by mediating the influx and/or efflux of lactate and are overexpressed in several cancer cell types. The lactate and pyruvate analogue 3-bromopyruvate (3-BP) is an inhibitor of the energy metabolism, which has been proposed as a specific antitumor agent. In the present study, we aimed at determining the effect of 3-BP in breast cancer cells and evaluated the putative role of MCTs on this effect. Our results showed that the three breast cancer cell lines used presented different sensitivities to 3-BP: ZR-75-1 ER (+)>MCF-7 ER (+)>SK-BR-3 ER (-). We also demonstrated that 3-BP reduced lactate production, induced cell morphological alterations and increased apoptosis. The effect of 3-BP appears to be cytotoxic rather than cytostatic, as a continued decrease in cell viability was observed after removal of 3-BP. We showed that pre-incubation with butyrate enhanced significantly 3-BP cytotoxicity, especially in the most resistant breast cancer cell line, SK-BR-3. We observed that butyrate treatment induced localization of MCT1 in the plasma membrane as well as overexpression of MCT4 and its chaperone CD147. Our results thus indicate that butyrate pre-treatment potentiates the effect of 3-BP, most probably by increasing the rates of 3-BP transport through MCT1/4. This study supports the potential use of butyrate as adjuvant of 3-BP in the treatment of breast cancer resistant cells, namely ER (-).

Effects of papaya seeds extract on the sperm characteristics of dogs.

The effect of chloroform extracts from seeds of the papaya plant (Carica papaya) on the spermatic characteristics of dogs was evaluated at doses of 50, 100 and 150 mg/kg, Groups 1, 2, and 3, respectively. Structural and ultrastructural changes in sperm cells and testicular parenchyma were also evaluated, and possible side effects were noted. Significant reductions in sperm concentration and motility were observed starting from Days 60 and 75, respectively, in all treated groups (P<0.05), but no azoospermia was noted. A mild osmotic diarrhea occurred in dogs from Group 3 (150 mg/kg), although blood variables were within the normal range of a clinically healthy dog. Arrested spermatogenesis was observed in the seminiferous tubules of all treated groups, and vacuolization and signs of Sertoli cell degeneration were detected in all treated groups, particularly in Group 3 (150 mg/kg). Selective damage to Sertoli cells induced by the extract occurred in all treated groups independently of the extract concentration. Alteration of the epididymal environment may reduce the motility of sperm cells, considering that their structure was normal. Sperm characteristics in treated animals were considered to be similar to those of sub-fertile dogs. However, these effects may be temporary, and dogs may recover normal sperm characteristics when the extract is withdrawn.

The implementation of isoniazid preventive therapy in HIV clinics: the experience from the TB/HIV in Rio (THRio) study.

OBJECTIVE: The TB/HIV in Rio (THRio) study was launched in September 2005 to assess the impact of integrated tuberculosis (TB) and HIV treatment strategies in 29 HIV clinics in Rio de Janeiro, Brazil. DESIGN: THRio is a cluster-randomized trial (CRT) to determine whether routine screening for and treatment of latent TB in HIV clinic patients with access to antiretroviral therapy will reduce TB incidence at the clinic level. THRio is part of the Consortium to Respond Effectively to AIDS/TB Epidemic that is implementing research studies to assess the impact of bold, new public health paradigms for controlling the AIDS/TB epidemic. METHODS: Twenty-nine public primary HIV clinics were randomly assigned a date to begin implementing TB screening procedures and provision of isoniazid preventive therapy (IPT) for TB/HIV coinfected patients. Final analysis of the CRT is expected in 2011. RESULTS: Starting at date of tuberculin skin test (TST)/IPT implementation at each clinic through August 2010, 1670 HIV-infected patients initiated IPT, of which 215 are still receiving treatment. Of the remaining 1455 patients, 1230 (85%) completed therapy and only 20 (1.2%) patients initiating IPT reported adverse reactions leading to discontinuation of therapy. IPT completion was higher among HIV-infected patients receiving HAART (87%) than those not yet receiving HAART (79%, P < 0.01). Times to TST and IPT have markedly decreased postintervention, but remain considerably long. The richness of the THRio database has resulted in several analyses of this expansive cohort of HIV-infected patients that are reviewed here. CONCLUSIONS: The national implementation of TST and IPT for HIV-positive patients in Brazil has been invigorated partly due to THRio's baseline results. Expanded use of IPT in HIV patients in Rio de Janeiro is achievable with high adherence and low adverse events, although this effort requires a package of activities including training, advocacy and reorganization of services.

Indicación actual de la cirugía abierta en el tratamiento de la litiasis renal. Ureterocalicostomía como tratamiento definitivo de litiasis en mujer con patología renal / Current indications of open surgery for the treatment of renal lithiasis. Ureterocalycostomy as definitive treatment for lithiasis in a female with recurrent dis

OBJETIVO: Presentamos un caso de litiasis recidivante asociado a alteración anatómica de la pelvis renal secundaria a cirugía.MÉTODOS/RESULTADOS: La paciente presenta un episodio de infección urinaria complicada con pionefrosis y septicemia. En la urografía intravenosa se observa litiasis radiodensa infecciosa, pielolocalicial múltiple compleja, sobre riñón con hidronefrosis grado III-IV por importante esclerosis piélica secundaria a cirugía previa sobre dicha unidad renal. Se realiza nefrectomía polar inferior con nefrolitotomía y reconstrucción de la vía urinaria superior mediante uréterocalicostomía. Dos años y medio después de la cirugía la urografía de control refleja ausencia de litiasis y leve retraso de la función renal.CONCLUSIONES: La ureterocalicostomía está indicada en casos de obstrucción de la unión ureteropiélica asociada a una pelvis intrarrenal por alteraciones de la fusión, rotación o localización renal, y en casos de fibrosis peripiélica severa secundaria a una pieloplastía fallida o cirugía renal previa. En el caso presentado además del componente infeccioso de las litiasis, una alteración anatómica, probablemente secundaria a la cirugía previa, provocaba una perpetuación de la clínica litiásica. Ante tal sospecha se impuso una solución de tipo quirúrgico que solucionara en un tiempo tanto la eliminación de la litiasis como una correcta derivación de la zona funcionante del riñón para evitar recidivas posteriores(AU)

OBJECTIVE: We describe one case of recurrent lithiasis associated with anatomical alteration of the renal pelvis related to previous surgery.METHODS/RESULTS: The patient presented a urinary tract infection episode, complicated with pyonephrosis and septi-cemia. In the intravenous urography, infectious radiopaque pyelocaliceal multiple and complex lithiasis can be seen, as well as kidney hydronephrosis grade III-IV. Important pyelic sclerosis secondary to previous surgery on the renal unit was seen. Nephrectomy was performed with lower pole nephro-lithotomy and reconstruction of the upper urinary tract through ureterocalicostomy. Two and a half years after surgery, control urogram shows absence of urolithiasis and a slight delay of renal function.CONCLUSIONS: Ureterocalicostomy is indicated in cases of ureteropelvic junction obstruction associated with intrare-nal pelvis caused by alterations of fusion, rotation or location of kidney. It is also indicated in cases of severe peripyelic fibrosis secondary to previous pyeloplasty failure or renal sur-gery. In our case, in addition to the infectious component of lithiasis, an anatomical alteration, probably secondary to previous surgery, caused the chronification of lithiasis. Fa-cing such suspicion a surgical management was undertaken to eliminate the lithiasis and get a correct derivation of the working area of the kidney, in order to prevent further recu-rrences(AU)

Criterios clínicos y radiológicos en la decisión terapéutica del reflujo vesicoureteral. Un análisis retrospectivo de nuestra experiencia / Clinical and radiological criteria for the therapeutic decision for vesicoureteral reflux. Retrospective analysis of our experience

Objetivo: Establecer, en base a nuestra experiencia, unos esquemas terapéuticos del reflujo vesicoureteral en el niño, apoyándonos en resultados clínicos y radiológicos, observando cómo han ido evolucionando las indicaciones y tiempos de tratamiento con el advenimiento de las técnicas endoscópicas. Métodos: Se han analizado los pacientes con reflujo vesicoureteral tratados en dos periodos de similar duración: el primero (106 pacientes), entre 1995 y marzo 2001 (fecha en que se introdujeron las técnicas endoscópicas); el segundo, (138 pacientes), desde esa fecha hasta marzo de 2007. En todos los pacientes se estudiaron variables clínicas, diagnósticas y terapéuticas, así como el resultado obtenido. Resultados: El número de pacientes tratados aumentó en el segundo período, en él disminuyó ostensiblemente (de 24 a 7) el número de pacientes que requirieron reimplantación vesicoureteral. La proporción de éxitos del tratamiento endoscópico ascendió al 94,9%, no apreciándose diferencias significativas en función de la edad o el grado de reflujo, aunque se observa un mayor porcentaje de fracasos en niños menores de 3 años y en reflujos de alto grado. La presencia de malformaciones asociadas no se relacionó con una peor evolución tras el tratamiento. Conclusiones: En aquellos reflujos donde el tratamiento médico no ha sido eficaz, persistiendo o empeorando el mismo, y como alternativa a la cirugía abierta (con buenos resultados pero con una morbilidad no desdeñable), el tratamiento endoscópico se convierte en una alternativa de eficacia similar y mínimamente agresiva. Proponemos un esquema orientativo para establecer las indicaciones de cada estrategia terapéutica en función del grado de reflujo y su evolución clínica (AU)

Objectives: According to our experience, we present a proposal for the treatment of vesicoureteral reflux, based on both clinical and radiological evidences. We also describe how the introduction of endoscopic procedures has influenced the evolution of treatment indications as well as the time intervals for treatment. Methods: We have analysed all cases of vesicoureteral reflux treated in our Department in two periods of similar length: The first one (106 patients) comprised from 1995 to March 2001 (when endoscopic procedures were introduced). The second one (138 patients), comprised from March, 2001 to March 2007. Clinical, diagnostic, therapeutic and outcome-related variables were studied for all cases. Results: The number of patients was higher in the se-cond period. In this period the number of cases requiring ureteral reimplantation decreased with respect to the first one (from 24 to 7). The success rate with endoscopic treatment reached 94,9%, with no significant differences regarding age or grade of reflux, although higher rates of failures were observed in children aged less than 3 years old and in high-grade reflux. The association of reflux with other malformations was not related with a worse evolution after treatment. Conclusions: Endoscopic treatment, due to its similar efficacy and low aggressiveness, should be considered a valid alternative to open surgery (which offers good results but non-negligible comorbidity) for persistent reflux in which medical treatment has not been useful. We propose a tentative therapeutic scheme to establish the indications for each type of treatment depending on the grade of reflux and its clinical evolution (AU)

Granuloma inflamatorio secundario a la ingestion de espina de pescado: presentación de un caso y revisión de la literatura / Inflammatory granuloma following a fish bone swallowing

La ingestión de objetos extraños ocurre ocasionalmente en los adultos, especialmente en aquéllos que utilizan prótesis dentales. La mayoría de esos objetos transitan por el tracto gastrointestinal sin causar síntomas, aunque algunas veces se pueden presentar complicaciones como perforación, absceso, obstrucción, tumoración, peritonitis localizada o generalizada. Se informa el caso de una paciente que desarrolló una tumoración abdominal dependiente de intestino secundaria a la perforación de éste, como consecuencia de la ingestión de una espina de pescado. Se comunican los síntomas presentados y la dificultad diagnóstica, pues fue valorada por diferentes especialista sin logara llega a un diagnóstico de certeza. Cabe hacer notar la importancia del aspecto macroscópico de la tumoración, que sugería un proceso tumoral de características malignas, y que histopatológicamanete fue señalado como un granuloma inflamatorio libre de células malignas secundario a cuerpo extraño (espina de pescado), caso raro de acuerdo a la bibliografía revisada.