Complete Distal Rupture of the Rectus Femoris in an Elite Football Player: A Non-operative Treatment.

Although muscle injuries represent the most frequent injury in professional football, isolated complete distal ruptures of the rectus femoris (RF) muscle are rare, and there is no consensus on their treatment and return to play (RTP). In this article, we report a clinical case of successful non-surgical management of an RF grade 4c muscle injury in a professional football player, in which the athlete was able to RTP 21 weeks after the injury, had no re-injury >1 year after RTP, and is playing at an elite level in the Portuguese Football First League.

Estrés académico en estudiantes de un programa de Enfermería - Montería 2019 / Estresse acadêmico em estudantes de enfermagem em Montería, Colômbia (2019) / Academic Stress in Undergraduate Nursing Students in Montería, Colombia (2019)

Introducción: Los estudiantes de programas de la salud, como enfermería, pueden experimentar cambios psicológicos, sociales, físicos, emocionales, entre otros; por la alta carga que genera el desarrollo de las labores académicas, y más aún, cuando son combinadas con actividades de tipo asistencial; estos cambios pueden generar estrés, el cual puede afectar el cumplimiento normal del rol de profesionales en formación. El objetivo de este estudio fue determinar el estrés académico durante las prácticas formativas en estudiantes de un programa de enfermería de la Ciudad de Montería, Colombia. Materiales y Métodos: Estudio con enfoque cuantitativo, diseño descriptivo de corte transversal, la muestra fue de 245 estudiantes, calculada mediante un muestreo intencional, se aplicaron los instrumentos SISCO SV ­ 21 y una encuesta sociodemográfica Resultados: La muestra estuvo conformada en su mayoría por mujeres, con edad promedio de 21 años, procedentes de la zona urbana y pertenecientes al nivel socioeconómico dos, el 96.32% de los participantes presentaron estrés y lo clasificaron como moderado (66.94%), con un nivel de intensidad de medio (47.04%). El agente estresor más frecuente fue la forma de evaluación de los profesores, lo que generó sentimientos de depresión y tristeza y la estrategia mayormente utilizada fue el control sobre las emociones. Discusión: Un alto porcentaje de estudiantes, manifestaron sentirse estresados durante el desarrollo de sus prácticas formativas, lo cual concuerda con hallazgos disponibles en la literatura. Conclusiones: Es necesario, que se establezcan programas de intervención dentro de las universidades, enfocados a la prevención y manejo del estrés.

Introduction: Students in health sciences degrees such as nursing may experience psychological, social, physical and emotional changes, among others, due to the high burden generated by academic tasks and even more so when they are combined with nursing practicum. These changes may generate stress affecting the normal fulfillment of the professionals-in-training role. Objective: To determine academic stress in undergraduate nursing students during their nursing practicum in Montería, Colombia. Materials and Methods: A quantitative descriptive cross-sectional study was conducted with a sample of 245 students calculated through purposive sampling. SISCO SV-21 inventory and a socio-demographic survey were applied. Results: The sample was mostly composed of women at an average age of 21 years old from urban areas classified as socioeconomic stratum 2. 96.32% of participants experienced stress, classifying it as moderate stress (66.94%) and average intensity level (47.04%). The most frequent stress agent was the method of evaluation used by teachers, which generated feelings of depression and sadness. The most common strategy used was control over emotions. Discussion: A high percentage of students reported feeling stressed during their nursing practicum, which is in line with the findings available in the literature. Conclusions: It is necessary to establish intervention programs at universities focused on stress prevention and management.

Introdução: Os estudantes de ciências da saúde, como enfermagem, podem experimentar mudanças psicológicas, sociais, físicas e emocionais, entre outras, devido à alta carga gerada pelas atividades acadêmicas e ainda mais quando são combinadas com a prática de enfermagem. Estas mudanças podem gerar estresse que afeta o cumprimento normal da função de profissional em treinamento. Objetivo: Determinar o estresse acadêmico em estudantes de enfermagem durante sua prática de enfermagem em Montería, Colômbia. Materiais e Métodos: Um estudo descritivo quantitativo transversal foi realizado com uma amostra de 245 estudantes calculada através de amostragem proposital. O inventário SISCO SV-21 e um levantamento sócio-demográfico foram aplicados. Resultados: A amostra foi composta principalmente de mulheres com idade média de 21 anos, provenientes de áreas urbanas classificadas como estrato sócio-econômico 2. 96,32% dos participantes experimentaram estresse, classificando-o como estresse moderado (66,94%) e nível médio de intensidade (47,04%). O agente de estresse mais freqüente foi o método de avaliação utilizado pelos professores, o que gerou sentimentos de depressão e tristeza. A estratégia mais comum foi o controle das emoções. Discussão: Uma alta porcentagem de estudantes informou sentir-se estressado durante a prática de enfermagem, o que está de acordo com as pesquisas disponíveis na literatura. Conclusões: É necessário estabelecer programas de intervenção nas universidades com foco na prevenção e gestão do estresse.

Perfusion Magnetic Resonance as a Biomarker for Sorafenib-Treated Advanced Hepatocellular Carcinoma: A Pilot Study.

BACKGROUND: Sorafenib is the currently recommended therapy in patients with advanced hepatocellular carcinoma (HCC). Among the several biomarkers available for the evaluation of the therapeutic response and prognosis, there is perfusion magnetic resonance imaging (p-MRI) that, through measurement of the vascular permeability unit (ktrans), may retrieve useful information regarding the microvascular properties of focal liver lesions. The aim of this study was to evaluate the impact of sorafenib therapy in patients with advanced HCC using the p-MRI technique. MATERIALS AND METHODS: In this retrospective study, 27 patients with the diagnosis of advanced HCC were included for palliative therapy using sorafenib. MRI of the liver was performed before the beginning of the oral therapy (T0), after 3 (T3), and after 6 months (T6). Dynamic acquisitions of the tumor (n = 50, during the first 2 min after contrast injection) were obtained in the coronal plane and were used to compute the parametric perfusion maps, acquiring the ktrans value using the extended Tofts pharmacokinetic model. RESULTS: The value of ktrans obtained at T0 was significantly different from the value of ktrans obtained at T6 (p = 0.028). There were no significant differences between T0 and T3 (p = 0.115) or a correlation between ktrans at T0 and the size of the lesion (p = 0.376). The ktrans value at T0 in patients with progression-free survival (PFS) > 6 months was not significantly different from the ktrans value in patients with PFS ≤6 months (p = 0.113). The ktrans value at T0 was not significantly different between patients who were previously submitted to chemoembolization and those who were not submitted (p = 0.587). CONCLUSION: In this pilot study, the ktrans value may serve as a biomarker of tumor response to antiangiogenic therapy, but only 6 months after its initiation. Clinical outcomes such as PFS were not predicted before the initiation of treatment.

INTRODUÇÃO: O sorafenib é a terapêutica atualmente recomendada em doentes com carcinoma hepatocelular avançado. Entre os vários biomarcadores disponíveis para a avaliação da resposta terapêutica e do prognóstico, existe a perfusão por Ressonância Magnética na qual, através da unidade de permeabilidade vascular (ktrans), se obtém informação relativa às propriedades microvasculares das lesões tumorais. O objetivo deste estudo foi avaliar o impacto da terapêutica com sorafenib em doentes com carcinoma hepatocelular avançado, através da técnica de perfusão por Ressonância Magnética (p-RM). MATERIAIS E MÉTODOS: Neste estudo observacional retrospetivo, foram incluídos 27 doentes, com diagnóstico de carcinoma hepatocelular avançado com indicação para terapêutica paliativa com sorafenib. Foi realizado estudo de Ressonância Magnética hepática antes do início da terapêutica com sorafenib (T0), aos 3 (T3) e aos 6 meses (T6) após o seu início. As imagens adquiridas no plano coronal (n = 50, durante os primeiros 2 minutos após a injeção de contraste paramagnético) foram utilizadas para fusão dos mapas paramétricos de perfusão, obtendo-se o valor de ktrans, usando o modelo farmacocinético de Tofts. RESULTADOS: O valor de ktrans obtido em T0 foi significativamente diferente do valor de ktrans obtido em T6 (p = 0.028). Não existiram diferenças significativas entre T0 e T3 (p = 0.115) ou correlação entre o valor de ktrans em T0 e a dimensão da lesão (p = 0.376). Associadamente, o valor de ktrans em T0 nos doentes com sobrevivência livre de progressão superior a 6 meses não foi significativamente diferente do valor de ktrans nos doentes com sobrevivência livre de progressão inferior ou igual a 6 meses (p = 0.113). O valor de ktrans em doentes com ou sem tratamento prévio por quimioembolização não mostrou diferença estatisticamente significativa (p = 0.587). CONCLUSÃO: Neste estudo inicial, o valor de ktrans pode servir como biomarcador da perfusão tumoral na resposta à terapêutica anti-angiogénica, 6 meses após o seu início. O seu valor antes do inicio do tratamento não permitiu predizer o desfecho clinico em termos de sobrevivência livre de doença nos pacientes submetidos ou não a prévia quimioembolização.© 2019 Sociedade Portugueasa de Gastrenterologia.

Efectividad de la implementación de la estrategia AIEPI comunitario en Montería, Colombia / Effectiveness of the implementation of community IMCI strategy in Monteria Colombia

Objetivo: Describir los alcances que ha tenido la Estrategia Atención Integral de las Enfermedades Prevalentes de la Infancia sobre la morbilidad y mortalidad en menores de cinco años residentes en el sector sur del municipio de Montería (Córdoba, Colombia). Metodología: Estudio descriptivo, de enfoque social, cuantitativo. Se realizó entrevista a 145 cuidadores de niños y niñas para evaluar conocimientos, aplicabilidad de las 18 prácticas claves y morbilidad sentida de las enfermedades sujeto de la estrategia en 87 familias con viviendas ubicadas en estrato 1 y 2. La información oficial sobre las tasas de mortalidad infantil (2005-2015) del municipio se utilizó para analizar la tendencia de este indicador. Resultados: Las prácticas claves más utilizadas son las relativas a las competencias para control de las enfermedades sujetos de la estrategia (80% a 99,3%), sin embargo, un alto porcentaje (66,9%) no reconoce los signos de alarma; las prácticas claves menos utilizadas se relacionan con la promoción de la salud y prevención de las enfermedades prevalentes (23%-57,9%). La movilización social con enfoque etno-cultural tiene un nivel intermedio de frecuencias de uso (60% a 79%). Predominan las diarreas y neumonías, los aprendizajes más permanentes se relacionan con las prácticas clave 11,12 y 17; las menos aplicadas son las prácticas 3, 7, 8, 9 y 10. Después de la implementación de la estrategia se observó un descenso sostenido de la mortalidad infantil. Conclusiones: Los padres y cuidadores de niños y niñas dan importancia y aplicabilidad diferencial para el control de las enfermedades, no a su prevención

Objective: Describe the scope that has been the strategy Integrated management in childhood Illness (IMCI) on morbidity and mortality in children under five years living in the South of the municipality of Monteria (Cordoba, Colombia). Methodology: Descriptive study, social, quantitative approach. It was interview with 145 caregivers of children to assess knowledge, applicability of the 18 key practices, and felt morbidity of diseases subject of strategy in 87 families with homes in strata 1 and 2. The official information on the rates of infant mortality (2005-2015) of the municipality was used to analyze the trend of this indicator.Results: The most used practices are those relating to competences for disease control subject of the strategy (80% to 99.3%), however, a high percentage (66.9%) does not recognize the warning signs; lesser used practices related to the promotion of health and prevention of diseases prevalent (23%-57,9%). Social mobilization with ethno-cultural approach has an intermediate level of frequency of use (60% to 79%). Diarrhea and pneumonia predominate, more permanent learning relate to key practices 11, 12 and 17; the less applied are key practices 3, 7, 8, 9 and 10. Lower sustained mortality was observed after the implementation of the strategy IMCI. Conclusions: The parents and caregivers of children give more importance and differential applicability for the control of diseases than for their prevention

Imaging Findings of Metaplastic Carcinoma of the Breast with Pathologic Correlation.

OBJECTIVES: To review the imaging findings of a series of cases of metaplastic carcinoma of the breast, a rare and aggressive form of breast cancer with variable imaging features. MATERIALS AND METHODS: Retrospective review of multimodality imaging features of eleven cases of metaplastic carcinoma of the breast retrieved from a single hospital institution database. Clinical and pathologic data were also documented. RESULTS: The median age of presentation was 65 years. Four cases had axillary lymphadenopathies, and two had distant metastases. An oval mass was the most common sonographic finding (7/11; 64%). Lesions displayed circumscribed/partially circumscribed margins (6/11; 55%) or non-circumscribed margins (5/11; 45%). Most lesions had a heterogeneous echo structure (9/11; 82%) and posterior acoustic enhancement (6/11; 55%). In nine patients, mammographies were available. An oval dense mass was the most common mammographic finding (5/9; 56%). The majority of cases had non-circumscribed margins (6/9; 67%), and nearly half displayed calcifications (4/9; 44%). CONCLUSIONS: Mammographic findings were not different from the usual features of more prevalent types of breast cancer, though the majority of metaplastic carcinoma of the breast showed possible distinctive sonographic features, such as circumscribed margins or complex echogenicity, reflecting the histologic background.

Liver MRI: From basic protocol to advanced techniques.

Liver MR is a well-established modality with multiparametric capabilities. However, to take advantage of its full capacity, it is mandatory to master the technique and optimize imaging protocols, apply advanced imaging concepts and understand the use of different contrast media. Physiologic artefacts although inherent to upper abdominal studies can be minimized using triggering techniques and new strategies for motion control. For standardization, the liver MR protocol should include motion-resistant T2-w sequences, in-op phase GRE T1 and T2-w fast spin echo sequences with fat suppression. Diffusion-weighted imaging (DWI) is mandatory, especially for detection of sub-centimetre metastases. Contrast-enhanced MR is the cornerstone of liver MR, especially for lesion characterization. Although extracellular agents are the most extensively used contrast agents, hepatobiliary contrast media can provide an extra-layer of functional diagnostic information adding to the diagnostic value of liver MR. The use of high field strength (3T) increases SNR but is more challenging especially concerning artefact control. Quantitative MR belongs to the new and evolving field of radiomics where the use of emerging biomarkers such as perfusion or DWI can derive new information regarding disease detection, prognostication and evaluation of tumour response. This information can overcome some of the limitations of current tests, especially when using vascular disruptive agents for oncologic treatment assessment. MR is, today, a robust, mature, multiparametric imaging modality where clinical applications have greatly expanded from morphology to advanced imaging. This new concept should be acknowledged by all those involved in producing high quality, high-end liver MR studies.

Factores socioeconómicos, demográficos, institucionales y familiares asociados con exceso de peso en niños de 2 a 5 años asistentes a los jardines infantiles de Envigado-Colombia, 2014-2015 / Socioeconomic, demographic, institutional and familial factors associated with excess weight in children 2 to 5 years of age attending daycares in Envigado-Colombia, 2014-2015

RESUMEN Introducción: el sobrepeso y la obesidad afectan la salud pública a nivel mundial y su aumento responde a múltiples factores. Objetivo: determinar factores socioeconómicos, demográficos, familiares e institucionales asociados a exceso de peso en niños de 2 a 5 años escolarizados en Envigado- Antioquia durante 2014-2015, para fortalecer estrategias de prevención de sobrepeso y obesidad infantil. Materiales y métodos: estudio observacional, descriptivo transversal, con una muestra de 278 menores seleccionados mediante muestreo probabilístico. Se hizo evaluación antropométrica y se aplicaron encuestas a padres y docentes. Se realizó análisis estadístico bivariado y multivariado en SPSS. Resultados: el 28,8% presentó exceso de peso (9,7% obesidad y 19,1% sobrepeso); 48,6% correspondía a niños de 5 años y 47,8% eran mujeres. Los factores asociados con exceso de peso fueron: no asistencia al programa de crecimiento y desarrollo (RP 4,1; IC:1,2-14,1) preferencia por ver televisión y uso de videojuegos en tiempo libre (RP 4,4; IC:1,10-17,7), no consumir cereales y tubérculos en la lonchera (RP 5,5; IC:1,2-26,1), y antecedente de obesidad o sobrepeso en familiar o cuidador (RP 3,8; IC:1,1-13,3). Conclusión: los factores que mejor explican el exceso de peso infantil corresponden a antecedentes familiares y las prácticas de cuidado en el hogar.

ABSTRACT Introduction: Overweight and obesity affect public health on a global level and its increase is due to multiple factors. Objective: To determine socioeconomic, demographic, familial, and institutional factors associated with excess weight in daycare children aged 2-5 years in Envigado, Colombia from 2014-2015 in order to strengthen childhood overweight and obesity prevention strategies. Materials and methods: An observational, descriptive, cross-sectional study with a sample of 278 children, selected by probability sampling. Anthropometric evaluation was conducted along with parental and teacher surveys. Bi-variate and multivariate statistical analyses were completed using SPSS. Results: 28.8% presented with excess weight (9.7% obesity and 19.1% overweight); 48.6% were aged 5 years, and 47.8% were female. Factors associated with excess weight included: not attending the growth and development program (OR 4.1; CI;1.2-14.1), preference for television watching and use of video games during free time (OR 4.4; CI:1.10-17.7), not eating whole grains and root vegetables for snack (OR 5.5; CI:1.2-26.1), and incidence of overweight or obesity in the family or direct caregiver (OR 3.8; CI:1.1-13.3). Conclusion: Factors that most influence excess weight in children are familiar factors such as incidence of overweight and obesity and caregiving practices in the family.

Metallosis: A diagnosis not only in patients with metal-on-metal prostheses.

Although the real actual incidence of metallosis is unknown, it is described as a rare diagnosis with a 5% estimated incidence in the hip prosthetic replacements. The adoption of non-metallic articular prosthetic devices, made of polyethylene and ceramic, is the main reason to the diminishing number of reported cases. We present a case of metallosis with a clinical systemic presentation in a patient with a non-metallic hip prosthesis, which occurred due to a fracture of the acetabular liner component, leading to abnormal metal-metal contact. The metallic debris leads to a massive local and systemic release of cytokines. Revision is necessary whenever osteolysis and loosening of the prosthesis occur. Imaging evaluation, especially CT, has a central role in diagnosis and planning the surgical treatment.