Unraveling Hermansky-Pudlak syndrome type 7: a case report and comprehensive literature review on the identification of DTNBP1 variants.

PURPOSE: We report a case of Hermansky-Pudlak Syndrome type 7 (HPS-7) caused by a homozygous variant in the dystrobrevin-binding protein 1 gene (DTNBP1) and highlight the genetic challenges associated with this rare disorder. METHODS: Case report. Literature review was performed by searching PubMed on May 2023, without language or date restriction, using the following terms: Hermansky-Pudlak syndrome, Hermansky-Pudlak syndrome type 7, and dystrobrevin-binding protein 1 gene. RESULTS: We report a case of a 69-year-old Portuguese female who presented for ophthalmic evaluation with long-standing severe visual impairment, pronounced photophobia, right-eye esotropia, and bilateral pendular nystagmus. Anterior segment examination revealed iris transillumination defects, while the ocular fundus showed hypopigmentation and the absence of the foveal reflex. The patient had a history of oculocutaneous albinism (OCA) and recurrent epistaxis. Her family history was positive for first-degree consanguineous parents and a deceased sister at young age who also exhibited OCA and recurrent epistaxis. Genetic testing identified a homozygous pathogenic nonsense variant in the DTNBP1, c.307C>T p.(Gln103*). The patient's clinical features and genetic testing support the diagnosis of HPS-7. The identified variant has been previously reported in the literature, in adult patients of Portuguese descent. CONCLUSION: This work highlights the genetic complexity of HPS-7 and emphasizes the importance of genetic testing in the diagnosis of this rare disorder. The identification of a rare pathogenic variant expands our understanding of HPS-7 genetics and suggests a possible founder effect in the Portuguese population.

Beliefs and Self-Perceptions of Spanish Mental Health Professionals about Physical Therapy in Mental Health: An Observational Survey Study.

OBJECTIVE: The aim of this study is to understand the image, perception, and beliefs regarding the role of the physiotherapist in the field of mental health physiotherapy, both among the professional community and other multidisciplinary teams. METHODS: An observational phenomenological qualitative study through the administration of an ad hoc survey comprising both categorical and open-ended as well as quantitative questions was conducted. RESULTS: A total of 368 responses were analysed. The participants comprised 78.4% women with a mean age of 37.5, an average professional experience of 14.33 years, and 88.3% practicing physical therapists. From the qualitative analysis conducted, three categories emerged in relation to the obtained responses: (a) functions with codes of "improving quality of life" and "intervening in physical pathologies"; (b) objectives with codes of "Improving quality of life", "Intervening in physical pathologies", "Functional rehabilitation", "Health promotion", and "Intervening in mental disorders"; and (c) image with codes "unfamiliarity", "holistic vision", "necessity", and "importance". Regarding the tools, the findings highlight a strong focus on physical exercise interventions due to their well-established benefits. Cognitive strategies like therapeutic relationships and cognitive-behavioural techniques were also prominent. Additionally, embodiment techniques involving movement, relaxation, breathing, and voice usage were notable. Lastly, manual therapy and physical agents formed another distinct category. CONCLUSIONS: The vision and role of this professional profile were unknown to the respondents. Despite being perceived as having a holistic view of the patient and being considered an essential need, the actual image remains vague. However, there is significant interest, indicating a promising future, although the lack of specialized training is noted. Therefore, the need for specialized education and awareness campaigns among professionals in the mental health field is highlighted.

Mapping the field of physical therapy and identification of the leading active producers. A bibliometric analysis of the period 2000- 2018.

OBJECTIVES: The objectives of the study were: 1) Describe the thematic structure and evolution of the field of physical therapy; 2) identify the main research producers (i.e. countries and institutions); and 3) compare their research output and citation impact. METHODS: Papers related to physical therapy indexed in Web of Science (2000-2018) were identified to delineate the field, using keywords, journals, and citation networks. VOSviewer software, advanced bibliometric text mining, and visualization techniques were used to evaluate the thematic structure. We collected data about the country and institutional affiliation of all the authors and calculated production and citation impact indicators. RESULTS: 85,697 papers were analyzed. Eleven thematic clusters were identified: 1) "health care and education"; 2) "biomechanics"; 3) "psychosocial, chronic pain and quality of life outcomes"; 4) "evidence-based physical therapy research methods"; 5) "traumatology and orthopedics"; 6) "neurological rehabilitation"; 7) "psychometrics and cross-cultural adaptation"; 8) "gait-balance analysis and Parkinson's disease"; 9) "exercise"; 10) "respiratory physical therapy"; and 11) "back pain." The United States, the United Kingdom, and Australia were the most productive countries. Netherlands, Norway, and Sweden had the highest citation impact. CONCLUSIONS: Our bibliometric visualization approach makes it possible to comprehensively study the thematic structure of physical therapy. The ranking of producers has evolved and now includes China and Brazil. High research production does not imply a high citation impact.

Evolution of the thematic structure and main producers of physical therapy interventions research: A bibliometric analysis (1986 to 2017).

BACKGROUND: Bibliometric studies are used to analyse and map scientific areas, and study the scientific output and impact of institutes and countries. OBJECTIVES: Describe the thematic structure and evolution of the field of physical therapy interventions using articles indexed in Physiotherapy Evidence Database (PEDro). Also, identify and compare the main producers (countries, institutions) over time (research output, citation impact). METHODS: Eligible articles were those indexed in PEDro (1986-2017) and matched to Web of Science. VOSviewer software, bibliometric text mining, and visualisation techniques were used to evaluate the thematic structure of the included articles. We collected data about authors' country and institutional affiliation, and calculated bibliometric indicators (production, citation impact). RESULTS: A total of 29 090 articles were analysed. Eight topics were identified: "neurological rehabilitation"; "methods"; "exercise for prevention and rehabilitation of lifestyle diseases"; "assessment and treatment of musculoskeletal pain"; "physical activity", "health promotion and behaviour change"; "respiratory physical therapy"; "hospital, primary care and health economics"; "cancer and complementary therapies". The most productive countries were United States, United Kingdom, Australia, and Canada. The most impactful countries were United States, France, Finland, and Canada. The most productive institutions were University of Sydney, VU University of Amsterdam, University of Queensland, and University of Toronto. CONCLUSIONS: The thematic structure of physical therapy interventions has evolved over time with "neurological rehabilitation", "methods", "exercise related to lifestyle diseases", and "physical activity" becoming increasingly important. Main producers of this research were traditionally located in North America and Europe but now include countries like China and Brazil.

THE EDUCATIONAL ENVIRONMENT THROUGH THE LENSES OF A PEER MENTORING GROUP FOR MEDICAL STUDENTS / EL ENTORNO EDUCATIVO A TRAVÉS DE LOS LENTES DE UN GRUPO DE TUTORÍA DE PARES PARA ESTUDIANTES DE MÉDICA / O AMBIENTE EDUCACIONAL PELAS LENTES DE UM GRUPO DE MENTORIA ENTRE PARES PARA ESTUDANTES DE MEDICINA

The perception of the learning process is shaped by individual experiences and related to the academic environment. This article aimed to evaluate the perception of the educational environment of medical students linked to the peer-mentoring group GEDAAM (Study Group on Didactics Applied to Medical Learning) at the Federal University of Minas Gerais. The data come from a cross-sectional study with 129 members of GEDAAM. The Dundee Ready Education Environment Measure (DREEM) scale was used to assess the perception of the educational environment. Descriptive and comparative analysis were performed (Chi-square test). For almost all assessed domains, the students' perception was more positive than negative (Global score = 108.41). The longer the length of stay at GEDAAM, the worse the Global perception of the educational environment. It is suggested that participating in GEDAAM contributes to a more critical view of the medical teaching environment. 

La percepción del proceso de aprendizaje está conformada por experiencias individuales y relacionada con el entorno académico. Este artículo tuvo como objetivo evaluar la percepción del entorno educativo de los estudiantes de medicina vinculados al grupo de mentoría entre pares GEDAAM (Grupo de Estudio de Didáctica Aplicada al Aprendizaje de la Medicina) de la Universidad Federal de Minas Gerais. Los datos provienen de un estudio transversal con 129 miembros de GEDAAM. Se utilizó la escala Dundee Ready Education Environment Measure (DREEM) para evaluar la percepción del entorno educativo. Se realizaron análisis descriptivos y comparativos (prueba de Chi-cuadrado). Para casi todos los dominios evaluados, la percepción de los estudiantes fue más positiva que negativa (puntuación global = 108,41). Cuanto más tiempo se pasa en GEDAAM, peor es la percepción global del entorno educativo. Se sugiere que la participación en el GEDAAM contribuya a una visión más crítica del entorno de la enseñanza médica.

A percepção do processo de aprendizagem é moldada por experiências individuais e relacionadas ao meio acadêmico. Este artigo objetivou avaliar a percepção do ambiente educacional de estudantes de medicina ligados ao grupo de mentoria entre pares GEDAAM (Grupo de Estudos em Didática Aplicada ao Aprendizado da Medicina) da Universidade Federal de Minas Gerais. Os dados são provenientes de estudo transversal com 129 membros do GEDAAM. A escala Dundee Ready Education Environment Measure (DREEM) foi utilizada para avaliar a percepção do ambiente educacional. Foram realizadas análises descritivas e comparativas (Teste Qui-quadrado). Para quase todos os Domínios avaliados a percepção dos estudantes foi mais positiva do que negativa (escore Global=108,41). Quanto maior o tempo de permanência no GEDAAM, pior a percepção Global do ambiente educacional. Sugere-se que participar do GEDAAM contribua para uma visão mais crítica do ambiente de ensino de medicina.

Aggressive Neuroblastoma in a Pediatric Patient with Severe Hemophilia A.

Despite the extensive information regarding hemophilia's hemorrhagic complications, the literature on cancer in hemophilia is scarce, especially in pediatric patients. Many uncertainties remain concerning diagnosis and workup. We report a rare case of two severe diseases (neuroblastoma and hemophilia A (HA)) concomitantly present in the same pediatric patient. We highlight that the diagnosis of severe HA did not have a negative impact on the patient's oncologic course. This case also illustrates the significance of the cooperation among different specialties and hospitals when caring for the same patient.

Acute hypobaric hypoxia and cardiac energetic response in prepubertal rats: Role of nitric oxide.

NEW FINDINGS: What is the central question of this study? In adult rat hearts, exposure to hypobaric hypoxia increases tolerance to hypoxia-reoxygenation, termed endogenous cardioprotection. The mechanism involves the nitric oxide system and modulation of mitochondrial oxygen consumption. What is the cardiac energetic response in prepubertal rats exposed to hypobaric hypoxia? What is the main finding and its importance? Prepubertal rats, unlike adult rats, did not increase tolerance to hypoxia-reoxygenation in response acute exposure to hypobaric hypoxia, which impaired cardiac contractile economy. This finding could be related to a failure to increase nitric oxide synthase expression, hence modulation of mitochondrial oxygen consumption and ATP production. ABSTRACT: Studies in our laboratory showed that exposure of rats to hypobaric hypoxia (HH) increased the tolerance of the heart to hypoxia-reoxygenation (H/R), involving mitochondrial and cytosolic nitric oxide synthase (NOS) systems. The objective of the present study was to evaluate how the degree of somatic maturation could alter this healthy response. Prepubertal male rats were exposed for 48 h to a simulated altitude of 4400 m in a hypobaric chamber. The mechanical energetic activity in perfused hearts and the contractile functional capacity of NOS in isolated left ventricular papillary muscles were evaluated during H/R. Cytosolic nitric oxide (NO), production of nitrites/nitrates (Nx), expression of NOS isoforms, mitochondrial O2 consumption and ATP production were also evaluated. The left ventricular pressure during H/R was not improved by HH. However, the energetic activity was increased. Thus, the contractile economy (left ventricular pressure/energetic activity) decreased in HH. Nitric oxide did not modify papillary muscle contractility after H/R. Cytosolic p-eNOS-Ser1177 and inducible NOS expression were decreased by HH, but no changes were observed in NO production. Interestingly, HH increased Nx levels, but O2  consumption and ATP production in mitochondria were not affected by HH. Prepubertal rats exposed to HH preserved cardiac contractile function, but with a high energetic cost, modifying contractile economy. Although this could be related to the decreased NOS expression detected, cytosolic NO production was preserved, maybe through the Nx metabolic pathway, without modification of mitochondrial ATP production and O2  consumption. In this scenario, the treatment was unable to increase tolerance to H/R as observed in adult animals.

Are musculoskeletal conditions neglected in national health surveys?

OBJECTIVE: To describe the proportion of national health surveys that contain questions on the prevalence and consequences of musculoskeletal conditions. METHODS: We used a comprehensive search strategy to obtain national health surveys from the 218 countries listed by the World Bank. Two authors independently extracted information from each national health survey. Outcomes were the proportion of surveys that contained questions on the prevalence of musculoskeletal conditions using the Global Burden of Disease categorization of RA, OA, low back pain, neck pain, gout and other and contained condition-specific questions about activity limitation, severity of pain and work absence. We also measured how frequently the prevalence of low back pain was measured using a consensus-based standard definition for low back pain prevalence studies. RESULTS: We identified national health surveys from 170 countries. Sixty-two (36.4%), the majority from high-income countries (n = 43), measured the prevalence of at least one musculoskeletal condition. OA [53 (85.4%)], low back pain [39 (62.9%)] and neck pain [37 (59.7%)] were most commonly measured, while RA and gout prevalence were only measured in 10 (5.9%) and 3 (1.8%) surveys, respectively. A minority of surveys assessed condition-specific activity limitations [6 (3.6%)], pain severity [5 (2.9%)] and work absence [1 (0.6%)]. Only one survey used the consensus-based standard definition for low back pain. CONCLUSION: Musculoskeletal conditions are neglected in the majority of national health surveys. Monitoring musculoskeletal conditions through ongoing surveys is crucial for the development and evaluation of health policies to reduce their burden.

Production Trends, Collaboration, and Main Topics of the Integrative and Complementary Oncology Research Area: A Bibliometric Analysis.

BACKGROUND: The prevalence of cancer has increased over time worldwide. Nevertheless, the number of deaths has been reduced during the past 2 decades. Thus, one-third of the cancer patients are users of complementary and alternative therapies, looking for other types of interventions. The main aim of the present study is to understand the current status of the research in integrative and complementary oncology. Three different aspects were analyzed: production trends, country collaboration, and leading research topics. METHODS: The dataset was obtained from the documents indexed under the Integrative and Complementary Medicine category of the Web of Science database from 1976 to 2017. VOSviewer and SciMAT software were employed to perform the bibliometric analysis. RESULTS: The Journal of Ethnopharmacology, China Medical University and the People's Republic of China are the leading producers in the field. Regarding the collaboration, the United States and China present a close connection. The scientific community is focused on the following topics: apoptosis, breast cancer, oxidative stress, chemotherapy, and nuclear factor-Kappa-B (NF-Kappa-B). CONCLUSIONS: The present article shows potentially important information that allows understanding of the past, present, and future of research in integrative and complementary oncology. It is a useful evidence-based framework on which to base future research actions and academic directions.

Topic platelet gel application in chronic diabetic foot ulcers.

In this observational study performed during 45 months we evaluated patients with chronic and recalcitrant diabetic ulcers who were treated with homologous platelet gel. METHODS: platelet gels were obtained from homologous platelet concentrates that were aliquoted and freezed, being then activated with calcium gluconate and applied in the ulcer after cleaning and debridement. We evaluated patient's comorbidities, wound characteristics (size, tissue, inflammatory signs, pain), number and time of treatment as well as outcome (classified as complete epithelialization; partial improvement- 50% reduction in wound size or pain relief; no evolution). RESULTS: Fifty-two patients (42 males, 10 females), with a median age of 65 years (range 43-85) were proposed for platelet gel. The following associated comorbidities were observed: hypertension (n = 41), dyslipidemia (n = 29), polyneuropathy (n = 30), peripheral arteriopathy (n = 32), retinopathy (n = 21), nephropathy (n = 15), cardiac ischemic disease (n = 14), obesity (n = 9). Thirty-eight patients presented with 3 or more associated comorbidities. The more frequent ulcer locations were sole of the foot (n = 13) and heel (n = 10). The median number of applications was 16, during 8.5 weeks. Nineteen patients (44%) achieved complete healing, 3 patients (7%) had a partial response and 21 (49%) had no progression. We did not observe a statistically significant relationship between patient age and response nor between number of comorbidities and response. We observed a more favorable evolution in patients with good compliance and good glycemic control. CONCLUSION: Platelet gel is an effective therapeutic alternative, provided compliance and effective metabolic control are ensured.

A Therapeutic Exercise Program Improves Pain and Physical Dimension of Health-Related Quality of Life in Young Adults: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to evaluate the effects of an exercise therapy program on pain and physical dimension of health-related quality of life for young adults with musculoskeletal pain. DESIGN: This is a randomized controlled single-blind trial. Fifty-seven subjects (58% women) were randomly assigned to experimental [n = 28, 21.4 (2.9) yrs] and control [n = 29, 21.0 (4.2) yrs] groups. The experimental group participated in a 9-wk stabilization exercise therapy program, 60 mins/wk, whereas the control group did not exercise, with a preintervention and postintervention assessment. Primary outcome was Physical Component Summary of SF-36. Secondary outcomes were Nordic Musculoskeletal Questionnaire, Visual Analogue Scale, Oswestry Disability Index, Neck Disability Index, and Trunk Flexor Endurance Test. The Shapiro-Wilk, independent t test or Mann-Whitney U test, X, or Fisher's exact test were used for statistical analysis. RESULTS: After intervention, the experimental group improved by 3.2 (4.5) points on the Physical Component Summary (P = 0.01), decreased prevalence of low back pain in the last month (P = 0.02) and cervical disability (P = 0.02), and increased flexor trunk endurance (P = 0.005). CONCLUSIONS: This study confirmed that a 9-wk progressive exercise therapy program can improve physical health and reduce the prevalence of cervical disability and low back pain in the last month in young adults with musculoskeletal pain.

Cardioprotection after acute exposure to simulated high altitude in rats. Role of nitric oxide.

AIM: In previous studies, upregulation of NOS during acclimatization of rats to sustained hypobaric hypoxia was associated to cardioprotection, evaluated as an increased tolerance of myocardium to hypoxia/reoxygenation. The objective of the present work was to investigate the effect of acute hypobaric hypoxia and the role of endogenous NO concerning cardiac tolerance to hypoxia/reoxygenation under ß-adrenergic stimulation. METHODS: Rats were submitted to 58.7 kPa in a hypopressure chamber for 48 h whereas their normoxic controls remained at 101.3 kPa. By adding NOS substrate L-arg, or blocker L-NNA, isometric mechanical activity of papillary muscles isolated from left ventricle was evaluated at maximal or minimal production of NO, respectively, under ß-adrenergic stimulation by isoproterenol, followed by 60/30 min of hypoxia/reoxygenation. Activities of NOS and cytochrome oxidase were evaluated by spectrophotometric methods and expression of HIF1-α and NOS isoforms by western blot. Eosin and hematoxiline staining were used for histological studies. RESULTS: Cytosolic expression of HIF1-α, nNOS and eNOS, and NO production were higher in left ventricle of hypoxic rats. Mitochondrial cytochrome oxidase activity was decreased by hypobaric hypoxia and this effect was reversed by L-NNA. After H/R, recovery of developed tension in papillary muscles from normoxic rats was 51-60% (regardless NO modulation) while in hypobaric hypoxia was 70% ±â€¯3 (L-arg) and 54% ±â€¯1 (L-NNA). Other mechanical parameters showed similar results. Preserved histological architecture was observed only in L-arg papillary muscles of hypoxic rats. CONCLUSION: Exposure of rats to hypobaric hypoxia for only 2 days increased NO synthesis leading to cardioprotection.

[Importance of nutritional treatment in the inflammatory process of rheumatoid arthritis patients; a review]. / Importancia de los aspectos nutricionales en el proceso inflamatorio de pacientes con artritis reumatoide; una revisión.

INTRODUCTION: Clinical characteristics of rheumatoid arthritis (AR) justify its multidisciplinary approach, within which nutritional intervention is included. Certain nutritional components influence the cellular metabolism and interfere in the pathological inflammatory process, so that they may act as coadjutant in the treatment of many inflammatory diseases, among which AR is in - cluded. AIM: To analyze the evidence related to the therapeutical effects of the polyunsaturated fatty acids, mediterranean diet, olive oil and certain antioxidant nutrients, on chronic inflammation and AR symptomatology. METHODS: Non-Systematic revision in Cochrane, Pubmed, Scopus, Sportdiscus and Amed, from 2003 to March 2013, and subsequent applications of inclusion and exclusion criteria. RESULTS: Evidence on polyunsaturated fatty acids suggests that they produce clinical improvement and inhibitory effects over the AR inflammatory response. As regards the mediterranean diet, evidence points out that it decreases both pain and disease activity. In the case of the olive oil, although there are not enough studies, some effects are observed such as inflammatory markers reduction and oxidative stress inhibition. Finally, limited and contradictory evidence is found regarding the effectiveness of antioxidants. CONCLUSION: There exist studies which suggest that some dietetic elements (polyunsaturated fatty acids, mediterranean diet and antioxidants) have anti-inflammatory effects and decrease AR disease activity. More studies are required to empower the results on those aspects where evidence is still non conclusive.

Introducción: Las características clínicas de la artritis reumatoide (AR) justifican su abordaje multidisciplinar, dentro del cual se incluye la intervención nutricional. Ciertos componentes nutricionales tienen implicaciones en el metabolismo celular e interfieren en el proceso inflamatorio patológico por lo que pueden actuar como coadyuvantes en el tratamiento de numerosas enfermedades inflamatorias, entre las que se incluye la AR. Objetivos: Analizar la evidencia sobre los efectos terapéuticos de los ácidos grasos poliinsaturados, de la dieta mediterránea, del aceite de oliva y de ciertos nutrientes antioxidantes en el estado inflamatorio crónico y en la sintomatología de la AR. Métodos: Revisión no sistemática en Cochrane, Pubmed, Scopus, Sportdiscus y Amed, del 2003 a marzo de 2013, y posterior aplicación de los criterios de inclusión y exclusión. Resultados: La evidencia sobre los ácidos grasos poliinsaturados sugiere que éstos producen mejoría clínica y efectos inhibidores sobre la respuesta inflamatoria en la AR. Sobre la dieta mediterránea, la evidencia apunta a que ésta produce una disminución del dolor y de la actividad de la enfermedad. Para el aceite de oliva, aunque no hay estudios suficientes, se aprecian efectos tales como la reducción de marcadores inflamatorios y la inhibición del estrés oxidativo. Sobre la eficacia de los antioxidantes todavía existe evidencia limitada y contradictoria. Conclusiones: Hay estudios que sugieren que algunos componentes dietéticos (ácidos grasos poliinsaturados, dieta mediterránea y antioxidantes) tienen efectos antiinflamatorios y disminuyen la actividad de la AR. Se requieren más estudios para afianzar los resultados en aquellos aspectos donde la evidencia todavía es inconclusa.

Importancia de los aspectos nutricionales en el proceso inflamatorio de pacientes con artritis reumatoide; una revisión / Importance of nutritional treatment in the inflammatory process of rheumatoid arthritis patients; A review

Introducción: Las características clínicas de la artritis reumatoide (AR) justifican su abordaje multidisciplinar, dentro del cual se incluye la intervención nutricional. Ciertos componentes nutricionales tienen implicaciones en el metabolismo celular e interfieren en el proceso inflamatorio patológico por lo que pueden actuar como coadyuvantes en el tratamiento de numerosas enfermedades inflamatorias, entre las que se incluye la AR. Objetivos: Analizar la evidencia sobre los efectos terapéuticos de los ácidos grasos poliinsaturados, de la dieta mediterránea, del aceite de oliva y de ciertos nutrientes antioxidantes en el estado inflamatorio crónico y en la sintomatología de la AR. Métodos: Revisión no sistemática en Cochrane, Pubmed, Scopus, Sportdiscus y Amed, del 2003 a marzo de 2013, y posterior aplicación de los criterios de inclusión y exclusión. Resultados: La evidencia sobre los ácidos grasos poliinsaturados sugiere que éstos producen mejoría clínica y efectos inhibidores sobre la respuesta inflamatoria en la AR. Sobre la dieta mediterránea, la evidencia apunta a que ésta produce una disminución del dolor y de la actividad de la enfermedad. Para el aceite de oliva, aunque no hay estudios suficientes, se aprecian efectos tales como la reducción de marcadores inflamatorios y la inhibición del estrés oxidativo. Sobre la eficacia de los antioxidantes todavía existe evidencia limitada y contradictoria. Conclusiones: Hay estudios que sugieren que algunos componentes dietéticos (ácidos grasos poliinsaturados, dieta mediterránea y antioxidantes) tienen efectos antiinflamatorios y disminuyen la actividad de la AR. Se requieren más estudios para afianzar los resultados en aquellos aspectos donde la evidencia todavía es inconclusa (AU)

Introduction: Clinical characteristics of rheumatoid arthritis (AR) justify its multidisciplinary approach, within which nutritional intervention is included. Certain nutritional components influence the cellular metabolism and interfere in the pathological inflammatory process, so that they may act as coadjutant in the treatment of many inflammatory diseases, among which AR is included. Aim: To analyze the evidence related to the therapeutical effects of the polyunsaturated fatty acids, mediterranean diet, olive oil and certain antioxidant nutrients, on chronic inflammation and AR symptomatology. Methods: Non-Systematic revision in Cochrane, Pubmed, Scopus, Sportdiscus and Amed, from 2003 to March 2013, and subsequent applications of inclusion and exclusion criteria. Results: Evidence on polyunsaturated fatty acids suggests that they produce clinical improvement and inhibitory effects over the AR inflammatory response. As regards the mediterranean diet, evidence points out that it decreases both pain and disease activity. In the case of the olive oil, although there are not enough studies, some effects are observed such as inflammatory markers reduction and oxidative stress inhibition. Finally, limited and contradictory evidence is found regarding the effectiveness of antioxidants. Conclusion: There exist studies which suggest that some dietetic elements (polyunsaturated fatty acids, mediterranean diet and antioxidants) have anti-inflammatory effects and decrease AR disease activity. More studies are required to empower the results on those aspects where evidence is still non conclusive (AU)

Impact of physical and psychosocial factors on disability caused by lumbar pain amongst fishing sector workers.

Functional disability due to lumbar pain should be considered from the biopsychosocial model. There is inconclusive evidence as to whether the key determining factors in this form of disability are psychosocial or physical. Our aim is to identify variables that cause functional disability due to lumbar pain amongst shellfish gatherers in Galicia by means of a cross-sectional survey. Participants (N = 929) completed a self-administered, paper-based questionnaire including sociodemographic and lifestyle issues, as well as the nature of the lumbar pain, the presence of musculoskeletal pain in other regions of the body, the Roland-Morris Disability Questionnaire (RMDQ) and SF-36. Univariate examination, ROC curve and logistic regression analyses were performed. Most of these workers are women (98.7 %), with a mean age of 50.6 years. The point-prevalence of lumbar pain stands at 65.5 %. The RMDQ mean was 4.9 (SD = 4.7). In the logistic regression analysis, the variables associated with disability (RMDQ > median) were age (OR = 1.04), physical exercise (OR = 0.57), pain intensity (OR = 1.16), the number of regions of musculoskeletal pain (OR = 1.24) and mental health (SF-36) (OR = -0.95). Functional disability is determined by the physical nature of the pain and mental health attributes, although the former has a greater impact. In decreasing order of importance, functional disability is attributable to the presence of lower back pain, the number of regions of musculoskeletal pain, the intensity of that pain and age. Regular physical exercise and better mental health have a protective effect on disability.

Padronização da nomenclatura dos linfonodos axilares baseada em critérios anatômicos / Anatomical criteria based padronization on the axilary lymph nodes nomenclature

Os linfonodos axilares recolhem a linfa de todo membro superior e de parte da parede torácica. A glândula mamária drena 80% de sua linfa para estes linfonodos. O conhecimento da drenagem de cada quadrante mamário para os respectivos grupos axilares é de suma importância para o cirurgião que vai realizar o esvaziamento axilar, bem como para o radioterapeuta na instituição do tratamento complementar. As literaturas anatômica, cirúrgica e oncológica denominam os linfonodos axilares em grupos com diferentes números de componentes e com as mais diversas nomenclaturas, fato este que causa confusão na difusão dos conhecimentos a respeito das patologias malignas nesta área. Visando esclarecer estas dúvidas, realizou-se uma revisão bibliográfica, bem como a efetuação de dissecações, no sentido de padronizar o número e a nomenclatura dos diferentes grupos de linfonodos dentro da axila. Foram dissecadas seis axilas de cadáveres adultos, não fixados, de ambos os sexos e de variados grupos éticos. Na literatura mundial encontram-se 21 diferentes denominações para estes linfonodos. Segundo os achados, a melhor nomenclatura a ser seguida é a que classifica os linfonodos axilares em cinco grupos: apicais, centrais, laterais, torácicos laterais e subescapulares.

Mechanism of action of novel naphthofuranquinones on rat liver microsomal peroxidation.

In order to elucidate the effect on mammal systems of new derivatives from 2-hydroxy-3-allyl-naphthoquinone, alpha-iodinated naphthofuranquinone (NPPN-3223), beta-iodinated naphthofuranquinone (NPPN-3222) and beta-methyl naphthofuranquinone (NPPN-3226) synthesized as possible trypanocidal agents, their effect on rat liver microsomal lipid peroxidation was investigated. They (a) inhibited NADPH-dependent, iron-catalyzed microsomal rat liver lipid peroxidation; (b) did not inhibit the tert-butyl hydroperoxide-dependent lipid peroxidation; (c) did not inhibit ascorbate-lipid peroxidation with the exception of NPPN-3226 which did inhibit it; (d) stimulated NADPH oxidation and microsomal oxygen uptake; (e) increased superoxide anion formation by NADPH-supplemented microsomes and (f) stimulated ascorbate oxidation. The three drugs were reduced to their seminaphthofuranquinone radical by the liver NADPH-P450 reductase system, as detected by ESR measurements. These results support the hypothesis that naphthofuranquinones reduction by microsomal NADPH-P450 reductase and semiquinone oxidation by molecular oxygen diverts electrons, preventing microsomal lipid peroxidation. In addition, hydroquinones and/or semiquinones formed by naphthofuranquinones reduction would be capable of lipid peroxidation inhibition and on interacting with the lipid peroxide radicals can lead to an antioxidant effect as we suggested for NPPN-3226 in close agreement to the inhibition of ascorbate-lipid peroxidation. Due to the properties of these molecules and their incoming structure developments, naphthofuranquinones would be considered as potentially promising therapeutic agents, mainly against Chagas disease.

Informe breve: evaluación del lavado de manos en un equipo de salud / Brief report: evaluating hand/washing in a health - caring group

El lavado de manos previo y posterior a la atención de cada paciente es el mejor método para prevenir la transmisión de microorganismos de un paciente a otro y así disminuir la infección hospitalaria. Se evaluó el conocimiento de la norma de lavado de manos y se observó el cumplimiento de la misma al iniciar la investigación y luego la intervención (concientización). La muestra estuvo integrada por el personal de salud de una sala del sector de Clínica II del Hospital de Niños de La Plata. Se realizó el cultivo de los pulpejos de los dedos sobre agar sangre antes y después de lavarse las manos a todo el personal que se presto voluntariamente; con estos cultivos se realizaron talleres de mostración. El porcentaje de conocimiento de la norma fue alta, el cumplimiento de lavado de mano pasó de 38,7% a 61,3% luego de la intervención. La educación continua es la manera de mejorar el cumplimiento de la norma del lavado de manos y así contribuir a disminuir la infección hospitalaria.