Musculoskeletal involvement in neglected tropical diseases: a comprehensive review.

Neglected tropical diseases (NTDs) encompass a group of diseases predominantly found in tropical regions, with origins dating back to their inclusion in the United Nations Millennium Development Goals in 2000. This initiative aimed to raise awareness and global funding to combat these diseases, which thrive in areas with limited sanitation, healthcare, and education. NTDs are caused by various pathogens such as bacteria, fungi, parasites, and viruses and affect over two billion individuals in resource-poor communities, leading to preventable deaths and devastating consequences. While the musculoskeletal system is only occasionally affected, the resulting chronic disabilities prevent individuals from working, posing a significant socioeconomic burden in this region of the world. Some NTDs exhibit distinct imaging features, and radiologists need to be aware of these characteristics to facilitate early treatment. In this review, we delve into musculoskeletal NTDs, focusing on clinical features and imaging findings, differential diagnosis, and clinical management.

MRI findings of closed hand injuries in adolescent goalkeepers: a case-based review.

Soccer-related injuries in youth goalkeepers are underrepresented in epidemiological studies, despite goalkeepers experiencing distinct types of upper limb injuries and training loads compared to outfield players. Digit injuries are particularly prevalent, with up to five times more upper extremity injuries reported in this position. Such injuries can lead to interphalangeal joint instability and an increased risk of reinjury. Mechanisms of injury include falls, axial loading of digits, and rotational force due to grasping activities. The proximal interphalangeal joint is the most frequently injured in sports, followed by the metacarpophalangeal joint of the thumb. Achieving precise diagnosis can be challenging due to the complex soft-tissue anatomy of the hand. Radiologists play a crucial role in accurate diagnosis through imaging studies, enabling timely treatment. This article focuses on closed traumatic finger and thumb injuries in adolescent goalkeepers, describing injury mechanisms and outlining relevant MRI features to facilitate proper clinical approaches for diagnosis based on imaging findings.

Upper extremity infection: imaging features with focus on magnetic resonance imaging.

Upper extremity infections are frequently seen, especially in individuals with weakened immune system, posttraumatic events, and after surgery procedures. If not properly treated, such conditions can lead to serious consequences, such as movement impairment, amputation, and even mortality. These infections have the potential to spread extensively from their initial site of entry, traversing interconnected spaces either intra or extra-compartmental. Understanding the relevant anatomy is crucial to assess location and stage of infection, since surgical intervention and intravenous antibiotics are usually required. In this article, the authors provide a comprehensive review of the imaging findings of upper extremity infection, focusing on magnetic resonance imaging (MRI). Furthermore, this article sheds light on the pivotal role of radiology in managing hand, elbow, and shoulder infections offering an overview of available treatment options. KEY FINDINGS: Various types of infections affecting the upper extremity will be discussed, including infectious tenosynovitis, deep space infections, septic arthritis, and osteomyelitis. Authors also highlight anatomical spaces, common pathogens, spread routes, and key radiological features of these conditions.

Service organization protocol for coping with undergraduate students' psychological distress: a collective construction.

OBJECTIVE: to report on the experience of the elaboration process of a service organization protocol for coping with public undergraduate students' psychological distress in the countryside of São Paulo. METHOD: experience report on protocol production, an action research product, carried out according to the health care and service organization protocol model, made possible by remote meetings with 33 professionals linked to the management and services of the university's health and social assistance departments. RESULTS: collective protocol production provided an opportunity for an institutional agreement on educational, therapeutic and support actions, to be developed in groups or individually with students, with provision for permanent education with civil servants. FINAL CONSIDERATIONS: this experience made it possible to list specific actions to face undergraduate students' psychological distress, bringing health professionals closer to those in management, promoting the exchange of concepts and practices to re-signify and transform the work developed.

Outcomes of imaging-guided corticosteroid injections in hip and knee osteoarthritis patients: a systematic review.

PURPOSE: The purpose of this systematic review is to evaluate the current literature on the use of image-guided corticosteroid injections in the treatment of patients with knee and hip OA. EVIDENCE ACQUISITION: We conducted a comprehensive literature search through June 30, 2022. Publication type, study design, imaging guidance modality, osteoarthritis severity, number of injections, steroid type and dose, anesthetic type and dose, the total number of patients, follow-up intervals, and measured outcomes were extracted from the included studies. EVIDENCE SYNTHESIS: There were 23 included studies (10 hips, 12 knees, 1 both hip and knee). Hip injections were found to be effective in treating short- and long-term pain and more effective than hyaluronic acid, Mepivacaine, NSAIDs, and normal saline in terms of improvement in pain and/or function. There was less impact on QoL. Knee injections were found either to have little or no impact or were similar or inferior to comparison injections (intra-articular hyaluronic acid, PRP, NSAIDs, normal saline, adductor canal blocks). Study data could not be aggregated because the corticosteroid types and doses, methods of outcome assessment, and follow-up time points varied widely. CONCLUSION: Our systematic review found generally positive outcomes for the hip, but overall negative outcomes for the knee, although hip injections may carry a risk of serious adverse outcomes. A larger trial with uniform methodology is warranted. Specific studies on the adverse effects of corticosteroid injections are also warranted.

Service organization protocol for coping with undergraduate students' psychological distress: a collective construction / Protocolo de organización de servicios para el enfrentamiento del malestar psicológico de estudiantes universitarios: una construcción colectiva / Protocolo de organização de serviço para enfrentamento do sofrimento psíquico de universitários: uma construção coletiva

ABSTRACT Objective: to report on the experience of the elaboration process of a service organization protocol for coping with public undergraduate students' psychological distress in the countryside of São Paulo. Method: experience report on protocol production, an action research product, carried out according to the health care and service organization protocol model, made possible by remote meetings with 33 professionals linked to the management and services of the university's health and social assistance departments. Results: collective protocol production provided an opportunity for an institutional agreement on educational, therapeutic and support actions, to be developed in groups or individually with students, with provision for permanent education with civil servants. Final considerations: this experience made it possible to list specific actions to face undergraduate students' psychological distress, bringing health professionals closer to those in management, promoting the exchange of concepts and practices to re-signify and transform the work developed.

RESUMEN Objetivo: relatar la experiencia del proceso de elaboración colectiva de un protocolo de organización de servicios para el enfrentamiento del malestar psicológico de estudiantes de una universidad pública del interior de São Paulo. Método: relato de experiencia sobre la elaboración del protocolo, producto de investigación-acción, realizado según el modelo de protocolo de organización asistencial y de servicios de salud, posibilitado por encuentros a distancia con 33 profesionales vinculados a la gestión y servicios de los departamentos de salud y asistencia sociales universitarios. Resultados: la producción colectiva del protocolo brindó oportunidad para un acuerdo institucional sobre acciones educativas, terapéuticas y de apoyo, a ser desarrolladas en grupo o individualmente con los estudiantes, con previsión de educación permanente con los servidores públicos. Consideraciones finales: esta experiencia permitió enumerar acciones específicas para enfrentar el sufrimiento psíquico de estudiantes universitarios, acercando a los profesionales de la salud a los profesionales de la gestión, promoviendo el intercambio de conceptos y prácticas para resignificar y transformar el trabajo desarrollado.

RESUMO Objetivo: relatar experiência sobre o processo de elaboração coletiva de protocolo de organização de serviço para enfrentamento do sofrimento psíquico de estudantes de universidade pública do interior paulista. Método: relato de experiência da produção do protocolo, produto de pesquisa-ação, realizada conforme modelo de protocolo de cuidado à saúde e de organização de serviço, viabilizada por encontros remotos com 33 profissionais vinculados à gestão e aos serviços dos departamentos de saúde e assistência social da universidade. Resultados: a produção coletiva do protocolo oportunizou a pactuação institucional de ações educativas, terapêuticas e de apoio, para serem desenvolvidas em grupo ou individualmente com os estudantes, sendo previstas as de educação permanente com os servidores. Considerações finais: esta experiência possibilitou elencar ações específicas para o enfrentamento do sofrimento psíquico de estudantes universitários, aproximando profissionais da assistência aos da gestão, promovendo intercâmbio de concepções e práticas para ressignificar e transformar o trabalho desenvolvido.

Efficacy of the Video Modeling Technique as a Facilitator of Non-invasive Dental Care in Autistic Children: Randomized Clinical Trial.

This study aims to evaluate the video modeling technique during the dental appointment. A blinded randomized clinical trial was composed of 2 groups, consisting of 20 autistic children (4 to 12 years) in each group: control (did not watch the video before the consultation) and intervention (watched the video before the consultation). The primary outcome was the mean number of visits to perform a dental appointment. The number of consultations was analyzed by T-test or Mann-Whitney test. The results showed that the mean number of consultations in the intervention group was 1.5 (± 1.53) and in the control group 2 (± 1.77) (p ≤ 0.05). The video modeling technique can be effective in minimizing the number of dental consultations in autistic children.

Roles of Calcium Signaling in Gene Expression and Photosynthetic Acclimatization of Solanum lycopersicum Micro-Tom (MT) after Mechanical Damage.

A momentary increase in cytoplasmic Ca2+ generates an oscillation responsible for the activation of proteins, such as calmodulin and kinases, which interact with reactive oxygen species (ROS) for the transmission of a stress signal. This study investigated the influence of variations in calcium concentrations on plant defense signaling and photosynthetic acclimatization after mechanical damage. Solanum lycopersicum Micro-Tom was grown with 0, 2 and 4 mM Ca2+, with and without mechanical damage. The expression of stress genes was evaluated, along with levels of antioxidant enzymes, hydrogen peroxide, lipid peroxidation, histochemistry, photosynthesis and dry mass of organs. The ROS production generated by mechanical damage was further enhanced by calcium-free conditions due to the inactivation of the oxygen evolution complex, contributing to an increase in reactive species. The results indicated that ROS affected mechanical damage signaling because calcium-free plants exhibited high levels of H2O2 and enhanced expression of kinase and RBOH1 genes, necessary conditions for an efficient response to stress. We conclude that the plants without calcium supply recognized mechanical damage but did not survive. The highest expression of the RBOH1 gene and the accumulation of H2O2 in these plants signaled cell death. Plants grown in the presence of calcium showed higher expression of SlCaM2 and control of H2O2 concentration, thus overcoming the stress caused by mechanical damage, with photosynthetic acclimatization and without damage to dry mass production.

Imaging findings of lower limb involvement following COVID-19.

Coronavirus disease 2019 (COVID-19) is known mainly by the severe acute respiratory syndrome, with myalgia as a common clinical symptom. Recent reports described musculoskeletal complications related to COVID-19 such as myositis, neuropathy and arthropathy. Radiologists and ordering physicians should be aware of lower limb complications following severe COVID-19 for optimal patient care.

Bilateral upper extremity myositis after COVID-19 vaccination.

Vaccination adverse reactions are common and usually are represented by transitory pain and edema. We present a case of bilateral muscle edema involving shoulders and arms due to myositis following COVID-19 vaccination, and focus on the imaging findings to differentiate with other diagnosis such as infection and tumors.

Postoperative Imaging of the Rotator Cuff: A Systematic Review and Meta-Analysis.

BACKGROUND. It is unclear which, MRI or ultrasound (US), is the most useful imaging tool to diagnose rotator cuff retears. OBJECTIVE. The objective of this study was to evaluate MRI and US in terms of diagnosing retear of a repaired rotator cuff tendon using a systematic review and meta-analysis. EVIDENCE ACQUISITION. A comprehensive literature search was performed on the main concepts of MRI (including noncontrast MRI and MR arthrography), US, and rotator cuff repairs. Inclusion criteria consisted of original research studies that assessed the diagnostic accuracy of MRI and US (index tests) for the diagnosis of rotator cuff tendon retear after prior rotator cuff repair using surgical findings as the reference standard. QUADAS-2 was used to assess methodologic quality. Meta-analyses were performed to compare MRI and US studies in the diagnosis of all retears and of full-thickness retears. Study variation was analyzed using the Cochran Q test and I2 statistic. EVIDENCE SYNTHESIS. Eight studies (MRI, n = 6; US, n = 2) satisfied inclusion and exclusion criteria, consisting of 304 total patients (MRI, n = 221; US, n = 83) and 309 shoulders (MRI, n = 226; US, n = 83). Years of publication ranged from 1993 to 2006 for the MRI studies and from 2003 to 2018 for the US studies. Two studies had high risk of bias in terms of applicability to clinical practice because of patient selection. Five studies had potential risk of bias in two categories, whereas two had potential risk of bias in three categories. For all retears, mean sensitivity and specificity for MRI were 81.4% (95% CI, 73.3-87.5%) and 82.6% (95% CI, 76.3-87.5%) and 83.7% (95% CI, 67.4-92.7%) and 90.7% (95% CI, 73.6-97.1%) for US. For full-thickness retears, mean sensitivity and specificity for MRI were 85.9% (95% CI, 80.2-90.2%) and 89.1% (95% CI, 84.6-92.4%) and 89.7% (95% CI, 75.6-96.1%) and 91.0% (95% CI, 75.5-97.1%) for US. There was no significant difference in terms of sensitivity or specificity for either comparison (p = .28-.76). CONCLUSION. Our analyses revealed no significant difference between US and MRI for the diagnosis of rotator cuff tendon tears after prior cuff repair. CLINICAL IMPACT. Either MRI or US can be considered a first-line imaging option to assess suspected rotator cuff retear after prior repair.

Automatic MRI segmentation of pectoralis major muscle using deep learning.

To develop and validate a deep convolutional neural network (CNN) method capable of selecting the greatest Pectoralis Major Cross-Sectional Area (PMM-CSA) and automatically segmenting PMM on an axial Magnetic Resonance Imaging (MRI). We hypothesized a CNN technique can accurately perform both tasks compared with manual reference standards. Our method is based on two steps: (A) segmentation model, (B) PMM-CSA selection. In step A, we manually segmented the PMM on 134 axial T1-weighted PM MRIs. The segmentation model was trained from scratch (MONAI/Pytorch SegResNet, 4 mini-batch, 1000 epochs, dropout 0.20, Adam, learning rate 0.0005, cosine annealing, softmax). Mean-dice score determined the segmentation score on 8 internal axial T1-weighted PM MRIs. In step B, we used the OpenCV2 (version 4.5.1, https://opencv.org ) framework to calculate the PMM-CSA of the model predictions and ground truth. Then, we selected the top-3 slices with the largest cross-sectional area and compared them with the ground truth. If one of the selected was in the top-3 from the ground truth, then we considered it to be a success. A top-3 accuracy evaluated this method on 8 axial T1-weighted PM MRIs internal test cases. The segmentation model (Step A) produced an accurate pectoralis muscle segmentation with a Mean Dice score of 0.94 ± 0.01. The results of Step B showed top-3 accuracy > 98% to select an appropriate axial image with the greatest PMM-CSA. Our results show an overall accurate selection of PMM-CSA and automated PM muscle segmentation using a combination of deep CNN algorithms.

Bilateral pectoralis major MRI in weightlifters: findings of the non-injured side versus age-matched asymptomatic athletes.

OBJECTIVE: To evaluate magnetic resonance imaging (MRI) features of the contralateral side in weightlifting athletes with pectoralis major (PM) tears. We hypothesized that MRI of the non-injured side may present increased pectoralis major tendon (PMT) length and thickness and greater pectoralis major muscle (PMM) volume and cross-sectional area when compared with the control group. METHODS: We retrospectively identified MRI cases with unilateral PM injury and reviewed imaging findings of the contralateral side. Also, we evaluated MRI from ten asymptomatic control weightlifting athletes, with PM imaging from both sides. Two musculoskeletal radiologists independently reviewed MRI and measured PMT length, PMT thickness, PMM volume (PMM-vol) and PMM cross-sectional area (PMM-CSA), as well as humeral shaft cross-sectional area (Hum-CSA) and the ratio between PMM-CSA and Hum-CSA (PMM-CSA/Hum-CSA). Data were compared between the non-injured side and controls. The MRI protocol from both groups was the same and included T1 FSE and T2 FATSAT axial, coronal, and sagittal images, one side at a time. RESULTS: We identified 36 male subjects with unilateral PM injury with mean age 35.7 ± 8 years and 10 age- and gender-matched controls (p = 0.45). A total of 36 PM MRI with non-injured PM and 20 PM MRI studies were included in this study. PMT length and PMT thickness were significantly higher in contralateral PM injury versus control subjects (both P < 0.001). Also, PM-CSA and Hum-CSA were greater in the contralateral PM injury group (P = 0.032 and P < 0.001, respectively). PMT thickness > 2.95 mm had 80.6% sensitivity and 90.0% specificity to differentiate the non-injured PM group from controls. CONCLUSION: Non-injured side MR imaging of patients with previous contralateral PM lesion demonstrates greater PMT thickness and length as well as PM-CSA and Hum-CSA than controls.

Genotoxicity assessment in two Amazonian estuaries using the Plagioscion squamosissimus as a biomonitor.

Genotoxicity studies in coastal ecosystems have been a priority in Environmental Risk Assessment (ERA). This research aimed to study the genotoxicity by the micronucleus test and comet assay in two Brazilian Amazon estuaries (anthropized and control) using Plagioscion squamosissimus as a biomonitor. Blood samples were collected from 54 specimens. No significant genotoxic effects were detected in the cells analyzed, although the highest occurrence (MN and DNA damages) was observed in anthropized site. The percentage of genomic damage differed between the sites studied, being always higher in anthropizes site as well. Of the nucleoids analyzed in this site, on average, 28 ± 14.42% of the cells were classified in the highest damage class. The fish analyzed in the present study are direct influenced of xenobiont agents capable of producing damage to the genetic material of aquatic organisms in both sites and, consequently, may bring consequences still little reported in studies of morphophysiological alterations in humans.

Cell wall thickenings and tylosoid: developmental morphology reveals novelties for secretory canals in Protium ovatum (Burseraceae).

We investigated the structure, histochemistry, and ultrastructure of the secretory canals in the vegetative axis of Protium ovatum from a developmental perspective. Samples of roots, stems, and leaves were analyzed using light and transmission electron microscopy. Secretory canals composed of a uniseriate epithelium and a wide lumen occurred in the phloem of all analyzed organs. Schizogenesis and lysigenesis were merging processes involved in the origin, growth, ramification, and fusion of the secretory canals, forming an anastomosed secretory net. Essential oils, polysaccharides, and proteins were detected in the epithelial cells, as well as plastids with poorly developed thylakoids, dictyosomes, rough endoplasmic reticulum, polysomes, and oil drops, showing the mixed nature of the secretion. Epithelial cells exhibited pectin-cellulosic thickenings in the anticlinal and radial walls. These thickenings may act in directing the secretion flux toward the lumen, protecting the neighboring tissues from the toxicity of secreted metabolites. Structural irregularities observed in the mitochondria cristae in epithelial cells may be associated with processes induced by toxic substances. Epithelial cells protruded into the lumen and became lignified in the outer portion of the secondary phloem, obliterating the non-functional secretory canals. We propose that this phenomenon presents a physiological significance similar to that of tylose, preserving the secretion flow inside the active portions of the secretory system. To our knowledge, epithelial cells with wall thickenings, mitochondria with structural abnormalities, and obliteration of non-functional canals are features reported for the first time for Burseraceae. These features have important functional significance for Burseraceae secretory system and contribute to a deeper knowledge of P. ovatum, a medically and economically important plant.

Transgeracionalidade e violência: um estudo com mulheres vítimas de relações conjugais violentas / Transgenerationality and violence: a study with women victims of violent marital relationships / Transgeneracionalidad y violencia: un estudio con mujeres víctimas de relaciones conyugales violentas

O estudo teve como objetivo compreender as experiências familiares e conjugais de mulheres em situação de violência conjugal. Trata-se de um estudo de casos múltiplos, com três mulheres em situação de violência conjugal. Os instrumentos incluíram uma entrevista sobre as relações familiares e o genograma familiar. A investigação das relações transgeracionais apontou que as mulheres haviam vivenciado padrões violentos em suas próprias famílias de origem na infância e/ou adolescência, presenciado violência entre os pais, ou como vítimas de violência parental. Tais vivências podem ter favorecido a manutenção das mulheres nas relações violentas. Os resultados encontrados apontam para a importância da ampliação do olhar sobre a violência conjugal, considerando, também, vivências na família de origem, tanto em relação a intervenções junto às mulheres, quanto em termos preventivos, visando favorecer o desenvolvimento de práticas educativas não coercitivas nas famílias. Abstract

The study aimed to understand the family and conjugal experiences of women in situations of conjugal violence. This is a multiple case study, with three women in situations of conjugal violence. The instruments included an interview on family relationships and the family genogram. The investigation of transgenerational relationships pointed out that the women had experienced violent patterns in their own families of origin during childhood and/or adolescence, witnessed violence between parents, or were victims of parental violence. Such experiences may have favored the maintenance of the women in violent relationships. The results found point to the importance of expanding the view on conjugal violence, considering also experiences in the family of origin, both in relation to interventions with women and in preventive terms, aiming to favor the development of non-coercive educational practices in families.

El estudio tuvo como objetivo comprender las vivencias familiares y conyugales de las mujeres en situación de violencia conyugal. Es un estudio de casos múltiples, con tres mujeres en situación de violencia conyugal. Los instrumentos incluyeron una entrevista sobre relaciones familiares y el genograma familiar. La investigación de las relaciones transgeneracionales mostró que las mujeres habían experimentado patrones violentos en sus familias de origen en la infancia y/o adolescencia, siendo testigos de violencia entre los padres, o como víctimas de violencia parental. Tales experiencias pueden haber favorecido el mantenimiento de las mujeres en las relaciones violentas. Los resultados encontrados señalan la importancia de ampliar la mirada sobre la violencia conyugal, considerando también las experiencias en la familia de origen, tanto en relación a intervenciones con mujeres, como en términos preventivos, con el objetivo de favorecer el desarrollo de prácticas educativas no coercitivas en las familias.

Apoplasmic barrier in the extrafloral nectary of Citharexylum myrianthum (Verbenaceae).

MAIN CONCLUSION: The cytological changes underlying the formation of an apoplasmic barrier in the multi-layered extrafloral nectaries of Citharexylum myrianthum are compatible with the synthesis, transport and deposition of suberin. In terms of ontogenesis and function, the intermediate layers of these nectaries are homologous with the stalks of nectar-secreting trichomes. Anticlinal cell wall impregnations are common in trichomatic nectaries and their functions as endodermis-like barriers have been discussed because of possible direct effects on the nectary physiology, mainly in the nectar secretion and resorption. However, the cytological events linked to nectary wall impregnations remain little explored. This study documents the ontogenesis and the fine structure of the EFN cells, and cytological events linked to the wall impregnations of multi-layered extrafloral nectaries (EFNs) in Citharexylum myrianthum Cham. (Verbenaceae). EFNs are patelliform, and differentiated into (a) a multicellular foot, which is compound in structure and vascularised with phloem strands, (b) a bi-layered intermediate region with thickened cell walls and (c) a single-layered secretory region with palisade-like cells. EFNs are protodermal in origin, starting with a single protodermal cell and ending with the complex, multi-layered structure. The cell wall impregnations first appear in the very young EFN and increase towards maturity. Lipid patches (assumed to be suberin) are deposited on the inner faces of the primary walls, first along the anticlinal walls and then extend to the periclinal walls. On both walls, plasmodesmata remain apparently intact during the maturation of the EFNs. In the peripheral cytoplasm there are abundant polymorphic plastids, well-developed Golgi bodies often close to rough endoplasmic reticulum profiles, mitochondria and polyribosomes. Cytological events linked to the wall impregnations are consistent with suberin synthesis, transport and deposition. Our findings offer new insights into the structure-properties of specialised nectary cell walls and so should contribute to our knowledge of the physiological and protective roles of this structure in nectar glands.