The Influence of Mental Health Diagnoses on Patient Experiences and Outcomes in Patients Undergoing WALANT Hand Surgery.

Purpose: The purpose of this study was to gauge whether patients with preexisting mental health conditions have desirable outcomes when undergoing wide-awake local anesthesia with no tourniquet (WALANT) hand surgery. Methods: A retrospective review of 133 patients who underwent WALANT surgery by 2 senior authors from August 2019 to October 2020 was performed. Patients were administered a 10-question postoperative survey detailing perioperative pain, experience, and satisfaction concerning their procedure. Analysis was performed for patient responses to the questionnaire, demographics, comorbidities, and patient-reported outcomes using the Single Assessment Numeric Evaluation (SANE). Results: There were 61 patients identified as having a preexisting psychiatric diagnosis compared to 70 patients without who underwent WALANT surgery. Comparing psychiatric diagnosis and nonpsychiatric diagnosis cohorts, there was no significant difference in preoperative anxiety (3.75 vs 3.30), pain during procedure (0.67 vs 0.56), or pain after surgery (4.89 vs 4.26). There was a significantly higher pain score with preoperative injection in the psychiatric diagnosis cohort (4.07 vs 2.93). When asked if they would have a WALANT procedure again, 95.1% of patients in the psychiatric diagnosis cohort and 98.6% of patients in the nonpsychiatric diagnosis group said they would. There was no significant difference in average preoperative SANE scores (59.67 [no psych diagnosis] vs 61.70 [psych diagnosis]) or postoperative SANE scores (82.82 [no psych diagnosis] vs 81.06 [psych diagnosis]) between the two cohorts. Conclusions: WALANT surgery was nearly as well tolerated in patients with a preexisting mental health diagnosis when compared to those without a preexisting diagnosis. Clinical Relevance: Surgeons who are currently or potentially performing WALANT surgery should not rule out patients as eligible candidates because of a prior diagnosis of a mental health condition.

Plate vs. intramedullary screw fixation of chevron olecranon osteotomies: a biomechanical study.

Background: Intra-articular distal humerus fractures frequently require olecranon osteotomies for adequate exposure, but fixation of olecranon osteotomies is associated with high rates of hardware-related complications requiring subsequent reoperation for removal. Intramedullary screw fixation is an attractive option to attempt to minimize hardware prominence. The purpose of this biomechanical study is to directly compare intramedullary screw fixation (IMSF) with plate fixation (PF) of chevron olecranon osteotomies. It was hypothesized that PF would be biomechanically superior to IMSF. Methods: Chevron olecranon osteotomies of 12 matched pairs of fresh-frozen human cadaveric elbows were repaired with either precontoured proximal ulna locking plates or cannulated screws with a washer. Displacement and amplitude of displacement at the dorsal and medial aspects of the osteotomies under cyclic loading conditions were measured. Finally, the specimens were loaded to failure. Results: The IMSF group had significantly greater medial displacement (P = .034) and dorsal amplitude (P = .029) than the PF group. Medial displacement was negatively correlated with bone mineral density in the IMSF group (r = -0.66, P = .035) but not in the PF group (r = .160, P = .64). Mean load to failure between groups, however, was not statistically significant (P = .183). Conclusions: While there was no statistically significant difference in the load to failure between the two groups, IMSF repair resulted in significantly greater displacement of the medial osteotomy site during cyclic loading and greater amplitude of displacement dorsally with loading force. Decreased bone mineral density was associated with an increased displacement of the medial repair site. These results suggest that IMSF of olecranon osteotomies may result in increased fracture site displacement when compared to PF; this displacement may be greater in patients with poor bone quality.

WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release.

BACKGROUND: This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. METHODS: Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. RESULTS: Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, P = .007) and WALANT groups (53.5 ± 15.8, P = .008), F(2, 153) = 6.465, P = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), F(2, 153) = 5.732, P = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, F(2, 153) = 101.1, P < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, F(2, 153) =171.1, P < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, F(2, 153) = 109.3, P < .001). There were no differences in complication rates. CONCLUSIONS: Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.

Wide Awake Local Anesthesia No Tourniquet Technique in Hand Surgery: The Patient Experience.

BACKGROUND: We attempted to evaluate patient satisfaction and overall experience during wide awake, local anesthesia, with no tourniquet (WALANT) hand surgery and quantify surgery-related outcomes. METHODS: We conducted a retrospective analysis of patient demographics, comorbidities, and patient reported outcomes via Single Assessment Numeric Evaluation (SANE) scores collected pre- and postoperatively of patients undergoing WALANT surgery by the 2 participating senior authors. A solution of 1% lidocaine with 1:100,000 epinephrine was used by 1 surgeon, while the other used a 1:1 ratio of 1% lidocaine with 1:100,000 epinephrine and 0.5% bupivacaine for local anesthetic injection. Patients were administered a postoperative survey to assess patient experience, including anxiety and pain levels, and overall satisfaction in the perioperative period. RESULTS: Overall, 97.7% of patients indicated that they would undergo a WALANT-style surgery if indicated in the future, 70.5% ate the day of surgery, and a total of 39.1% of patients reported driving to and from surgery. Postoperative SANE scores increased as compared with preoperative scores across all patients. The use of combination 1% lidocaine with 1:100,000 epinephrine and 0.5% bupivacaine was associated with lower intraoperative and postoperative visual analog scale pain scores. CONCLUSIONS: WALANT hand surgery was generally well tolerated with excellent surgical outcomes. Patients reported ease of preparation for surgery, faster recovery, and lack of anesthetic side effects as the main benefits of wide-awake surgery. Combination use of lidocaine and bupivacaine may be better than lidocaine alone with respect to pain control in the initial recovery period.

The multigenerational effects of clothianidin on Chironomus xanthus: Larvae exposed to this acetylcholine super agonist show no clear resistance.

Clothianidin (CLO) is an insecticide belonging to the second-generation class of neonicotinoids. In this study, we evaluated how CLO affects the survival and the complete life cycle of the tropical insect Chironomus xanthus, a non-target species, considering the Parental (P) and Filial (F1) generations. We found a 48 h-lethal concentration (LC50) of CLO of 3.78 µg/L. The lowest observed effect concentrations (LOECs) were: i) for body growth and head capsule width in P generation = 47.3 ng/L CLO; ii) for body growth and head capsule width in F1 generation larvae = 80 and 36.4 ng/L CLO, respectively; iii) for cumulative emergence it was 80 ng/L CLO in the P generation, while there was no significant difference in the F1 generation; iv) for total developmental time for males and females = 61.53 ng/L in P generation; v) in the F1 generation, the LOEC was determined to be 36.4 ng/L for males and 80 ng/L for females; vi) The number of total hatched eggs and total hatched eggs/female had LOECs of 36.4 ng/L CLO for both generations. Our study reveals that environmentally relevant concentrations of the CLO-based insecticide are highly toxic to C. xanthus. It also shows that the F1 generation, resulting from parents exposed to CLO was not clearly resistant to the insecticide. This fact might be explained by the different effects observed for males and females of F1 generation. Understanding the sub-types of acetylcholine receptors present on target and non-target insect species and toxicological effects of neonicotinoids seems to be desirable for the insecticide industry to deal with insect pests and the environmental protection of non-target organisms.

Suture Tape Augmentation for the Repair of Index Finger Radial Collateral Ligament Injury: A Biomechanical Study.

PURPOSE: Despite their clinical importance in maintaining the stability of the pinch mechanism, injuries of the radial collateral ligament (RCL) of the index finger may be underrecognized and underreported. The purpose of this biomechanical study was to compare the repair of index finger RCL tears with either a standard suture anchor or suture tape augmentation. METHODS: The index fingers from 24 fresh-frozen human cadavers underwent repair of torn RCLs using either a standard suture anchor or suture tape augmentation. Following the repairs, the initial displacement of the repair with a 3-N ulnar deviating load was evaluated. Next, the change in displacement (cyclic deformation) of the repair after 1,000 cycles of 3 N of ulnar deviating force was calculated (displacement of the 1000th cycle - displacement of the first cycle). Finally, the amount of force required to cause clinical failure (30° ulnar deviation) of the repair was determined. RESULTS: Suture tape augmentation repairs displayed significantly less cyclic deformation (0.8 ± 0.5 mm) after cyclic loading than suture anchor repairs (1.8 ± 0.7 mm). There was no significant difference in the force required to cause the clinical failure of the repairs between the suture tape (35.1 ± 18.1 N) and suture anchor (24.5 ± 9.2 N) repairs. CONCLUSIONS: Index finger RCL repair with suture tape augmentation results in decreased deformation with repetitive motion compared with RCL repair alone. CLINICAL RELEVANCE: Suture tape augmentation may allow for early mobilization following index finger RCL repair by acting as a brace that protects the repaired ligament from deforming forces.

The sexual reproduction of the nontarget planarian Girardia tigrina is affected by ecologically relevant concentrations of difenoconazole: new sensitive tools in ecotoxicology.

The fungicide difenoconazole, widely used to reduce the negative impacts of fungi diseases on areas with intensive farming, can reach freshwater systems causing deleterious effects on nontarget organisms. The acute and chronic toxicity of a commercial formulation containing 250 g L-1 of difenoconazole (Prisma®) as the active ingredient was assessed in the freshwater planarian Girardia tigrina. The endpoints evaluated were feeding rate, locomotion, regeneration, and sexual reproduction of planarians. The estimated 48 h LC50 of the commercial formulation on planarians expressed as the concentration of the active ingredient difenoconazole was 47.5 mg a.i.L-1. A significant decrease of locomotion (LOEC = 18.56 mg a.i.L-1), delayed regeneration (LOEC = 9.28 mg a.i.L-1), and sexual reproduction impairment, i.e., decreased fecundity and fertility rates (LOEC ≤ 1.16 mg a.i.L-1) were observed on planarians exposed to sublethal concentrations of the formulation. This study demonstrated the importance of using reproductive, physiological, and behavioral parameters as more sensitive and complementary tools to assess the deleterious effects induced by a commercial formulation of difenoconazole on a nontarget freshwater organism. The added value and importance of our research work, namely, the impairment of sexual reproduction of planarians, contributes to the development of useful tools for ecotoxicology and highlights the fact that those tools should be developed as guidelines for testing of chemicals. Our results showed that the use of reproductive parameters of Girardia tigrina would help to complement and achieve a better assessment of the risk posed by triazole fungicides to freshwater ecosystems.

Reabilitação funcional para pacientes acometidos por covid-19 / Functional rehabilitation for patients affected by covid-19

O vírus SARS-CoV-2 foi detectado na cidade de Wuhan, na China, no final de 20191. Desde então, a alta transmissibilidade deste novo coronavirus e a elevada morbimortalidade relacionada à COVID-19, a infecção viral causada pelo SARS-CoV-2, cresceu exponencialmente em todo o planeta, culminando, primeiramente, em uma emergência de saúde pública de importância internacional e, logo em seguida, em uma grave pandemia2,3. A transmissão do vírus ocorre tanto por vias respiratórias quanto extrarrespiratórias e durante o período de desenvolvimento da COVID-19 no organismo humano a apresentação clínica inclui sintomas relacionados a alterações no olfato, paladar e complicações gastrointestinais, além do acometimento de forma mais acentuada do sistema respiratório.4 Em consequência dos sintomas da COVID-19, muitos pacientes precisam ser internados e, em alguns casos, são submetidos a procedimentos invasivos para garantir a condição fisiológica básica para a manutenção da vida. Durante o período de internação os pacientes desenvolvem condição clínica com debilitação fisiológica e a aptidão física geral reduz sensivelmente.5 Ao receber alta hospitalar, muitos desses pacientes precisam de tratamentos voltados à recuperação da condição física debilitada pela ação da doença.6 A Secretaria Municipal de Saúde Pública (SESAU) de Campo Grande/MS, na Região Centro-Oeste do Brasil, se mostrou atenta a esta demanda. O Serviço de Doenças Crônicas Não Transmissíveis (DANT), juntamente com a Coordenadoria de Atenção Especializada, estruturou no Sistema Único de Saúde (SUS) um serviço de reabilitação funcional destinado às pessoas com doenças crônicas não transmissíveis, que estiveram internadas por infecção pelo SARS-CoV-2 e precisam de atenção especializada para restabelecer a capacidade de trabalho e de realização das atividades da vida diária. O atendimento é realizado na Unidade Especializada de Reabilitação e Diagnóstico (UERD), que faz parte da Rede Municipal de Saúde (REMUS). Um projeto de reabilitação funcional foi elaborado pela equipe técnica da SESAU, para ser desenvolvido por meio de uma equipe multiprofissional formada por fisioterapeuta, profissional de educação física, nutricionista e psicólogo. As intervenções são realizadas com o uso de Projetos Terapêuticos Singulares (PTS), seguindo critérios de inclusão e exclusão pré-estabelecidos7, para pacientes com doenças crônicas não transmissíveis, em condição de pós-internação decorrente de COVID-19. O encaminhamento dos pacientes, vindos dos demais pontos da REMUS, é realizado por médicos dos três níveis de atenção à saúde (primária, secundário e terciário), via Sistema de Regulação (SISREG). Foi estabelecido um fluxo para as intervenções, sendo que no primeiro atendimento cada paciente passa por um acolhimento dado pela equipe multiprofissional (fisioterapeuta, profissional de educação física, nutricionista e psicólogo) em uma consulta compartilhada. Nesta etapa a equipe faz uma triagem e identifica a condição clínica da pessoa atendida. Posteriormente, os profissionais constroem, de forma coletiva, um PTS. Nos dias subsequentes, o paciente é contatado para iniciar o tratamento de reabilitação, por meio de agendamento nos dias e horários em que haja compatibilidade entre as vagas ofertadas e a disponibilidade do paciente. O protocolo do PTS consiste de intervenções com frequência de duas vezes por semana, com alternância entre os profissionais que desenvolvem as atividades. Os pacientes são atendidos, inicialmente, com um total de 10 sessões de 40 a 60 minutos cada, durante cinco semanas. Se a equipe identificar que há indicação de continuidade do tratamento, o paciente pode ser mantido no programa por mais sessões, com avaliação caso a caso. O processo de alta do paciente ocorre quando são finalizadas as sessões do PTS. Esse processo é caracterizado pelas orientações ao paciente e sua família/cuidador, com encaminhamento profissional para a contrarreferência da unidade de saúde à qual o paciente está vinculado na atenção primária, por meio de relatório de alta, com informações referentes ao tratamento e orientações, visando a integralidade do cuidado. Com isso, a atenção primária dará prosseguimento do cuidado em saúde ao usuário em seu território de abrangência. O programa de reabilitação funcional prevê uma abordagem multiprofissional, com longitudinalidade do cuidado e respeito às singularidades de cada paciente. Os propósitos são aliviar os efeitos das disfunções musculares e respiratórias, mitigar os danos do imobilismo após longo período de internação hospitalar, além de atenuar as sequelas psicológicas e necessidades nutricionais. Para obter a almejada melhora da saúde geral e da qualidade de vida das pessoas atendidas, cada área profissional envolvida no PTS intervém da seguinte forma: A Fisioterapia atua em duas vertentes: a) fisioterapia respiratória, com o objetivo de aumentar a capacidade pulmonar e recuperar disfunções referentes ao processo de respiração; b) fisioterapia motora, com o objetivo de corrigir e restabelecer as condições físicas do paciente. A abordagem do profissional de Educação Física é voltada à melhora dos componentes cardiorrespiratório e neuromuscular, visando a promoção da autonomia funcional, o controle dos fatores de risco para comorbidades, correção postural e manutenção do peso ideal. O atendimento inclui o treinamento aeróbio, o treinamento resistido, ações de educação em saúde, além de incentivo à continuidade da prática de atividades físicas após o término das sessões do PTS, para manutenção e ampliação dos ganhos obtidos. A Nutrição atua com o propósito de manutenção do bom estado do sistema imunológico dos pacientes e, para isso, realiza avaliação nutricional e orientações ligadas à promoção de uma alimentação saudável. A Psicologia disponibiliza suporte psicológico, com oferecimento de um espaço para que o paciente compartilhe seus sentimentos e necessidades, buscando a auto segurança. Com isso, objetiva-se minimizar o trauma psicológico decorrentes do período de internação, que pode ter gerado reações emocionais como medo, angústia, ansiedade e tristeza. O conjunto de intervenções propostas representa uma readequação do serviço de saúde, em função da demanda oriunda da pandemia de COVID-19. Para isso, são necessárias estratégias capazes de proporcionar recuperação físico-funcional e reintegração social dos indivíduos infectados pelo vírus SARS-CoV-2, uma vez que essa infecção pode prejudicar a capacidade de realizar atividades da vida diária e a funcionalidade dos indivíduos que passaram por internação hospitalar, além de alterar o desempenho profissional e dificultar a interação social, com possibilidade de aumento de fatores de risco para doenças crônicas não transmissíveis.8 Nesse sentido, o PTS realizado por uma equipe multiprofissional, como no programa relatado, é um dispositivo de cuidado que visa a resolutividade dos casos complexos por meio da corresponsabilização e utilização dos recursos de todos os envolvidos, por meio do desenvolvimento de ações terapêuticas a partir de uma reflexão sistematizada. Para isso, o PTS deve ser abordado em duas perspectivas, uma delas centrada na clínica ampliada e outra na recuperação da autonomia da vida afetiva do sujeito, tal como preconizado no SUS.9 Em ambas as perspectivas sempre são considerados o sujeito, as equipes de saúde, o território e a família onde o PTS é desenvolvido.10 A utilização do PTS no âmbito da saúde pública melhora não só o processo de trabalho como o vínculo entre todos os envolvidos ­ profissionais de saúde e pacientes, potencializando assim a assistência integral à saúde na produção do cuidado, em função da troca de saberes no âmbito multiprofissional.11-13 Nota-se, portanto, que o processo de tratamento dos pacientes com COVID-19 é fundamental não apenas durante a fase hospitalar, mas também após alta melhorada. Dentre as estratégias disponíveis para atender os pacientes na rede pública de saúde, o desenvolvimento de programas de reabilitação funcional, por meio de PTS e intervenções multiprofissionais, pode garantir a continuidade do acompanhamento, promovendo a recuperação de implicações provocadas pela doença, proporcionando mais qualidade de vida às pessoas no período pós-internação.

Comportamento sedentário de adultos e idosos durante a pandemia de COVID-19 / Sedentary behavior of adults and elderly people during COVID-19 pandemic

Objetivo: avaliar a associação entre indicadores de comportamento sedentário e variáveis sociodemográficas em adultos e idosos de Campo Grande/MS, durante o período de vigência das medidas de distanciamento social para conter a pandemia de COVID-19 no ano de 2020. Métodos: a coleta de dados ocorreu com uso de formulário online distribuído via aplicativo de mensagem aos adultos e idosos, de ambos os sexos, cadastrados no programa de promoção de atividades físicas da Fundação Municipal de Esportes do Município de Campo Grande-MS. Utilizou-se amostragem não probabilística por julgamento, com distribuição e recebimento do formulário online entre os dias 7 e 14 de abril de 2020. Resultados: foram obtidos 1907 formulários com respostas válidas. A maioria dos participantes excedeu o valor considerado adequado à saúde para o tempo de tela (86,7%), mas, simultaneamente, a maioria do grupo se manteve com valores recomendados para o tempo sentado (61,4%). Os idosos diferiram dos adultos (p<0,01), com menor frequência de tempo de tela e maior proporção de tempo sentado. Conclusões: durante o período de distanciamento social, o tempo de tela foi o comportamento sedentário com frequência mais elevada na população geral, mas os idosos foram mais expostos ao excessivo tempo sentado.

Objective: to analyse the association between sedentary behaviour parameters and sociodemographic variables in adults and elderly of Campo Grande/MS, Brazil, during the social distancing period due to the COVID-19 pandemic in the year 2020. Methods: For data collection, an online form was applied through a messaging app for adults and elderly registered in the promotion of the physical activity program of the Municipal Sports Foundation of the City of Campo Grande/MS. A non-probabilistic sampling was used in the present study, in which the data collection was performed between April 7th and 14th, 2020. Results: 1907 forms were answered. The majority of participants presented excessive screen time (86.7%), however, a high proportion of participants had adequate values for sitting time (61.4%). The difference was observed between elderly and adults (p<0.01), in which low and high proportions of the screen and sitting time were observed for the elderly, respectively. Conclusion: During the social distancing period, the screen time was the sedentary behaviour more frequent, but for the elderly, the sitting time was the main sedentary behaviour.

Effects of lethal and sublethal concentrations of peracetic acid and active chlorine of calcium hypochlorite on Chironomus xanthus.

Freshwater ecosystems are vulnerable to residual concentrations of chemical agents from anthropogenic activities, and the real impacts of such compounds can only be evaluated accurately using ecotoxicological tests. The assessment of ecotoxicological effects of peracetic acid (PAA) and the active chlorine of calcium hypochlorite (Ca(ClO)2) on the insect Chironomus xanthus Meigen (Diptera: Chironomidae) is highly relevant as there are few reports on its effects in fresh water ecosystems. To our best knowledge, this is the first study to assess the chronic toxicity of the compounds to C. xanthus. The toxicity bioassays for C. xanthus included the acute effect (CL50) and the chronic effects based on body length, head width, and cumulative emergence. The results obtained in the acute effect tests indicated that the active chlorine of Ca(ClO)2 is 14 fold more toxic than PAA to C. xanthus. In sublethal evaluations, the active chlorine of Ca(ClO)2 presented higher toxicity than PAA in terms of percentage emergence, body development, and head width. In general, the results showed lower PAA toxicity relative to the active chlorine of Ca(ClO)2, demonstrating that PAA is a promising substitute for chlorinated disinfectants. In addition, the study facilitates the establishment of reference values for the safe release of effluents treated with PAA into water bodies.

Comparative ecotoxicological evaluation of peracetic acid and the active chlorine of calcium hypochlorite: Use of Dugesia tigrina as a bioindicator of environmental pollution.

Chlorine plays a primary role in the disinfection of drinking water and wastewater due to its effectiveness as a biocide; however, there is evidence of the formation of toxic byproducts from its application, and this has promoted the search for alternatives. Alternative disinfectants can be effective in the inactivation of pathogenic microorganisms and are less damaging to human health and aquatic ecosystems. However, more information is needed on the effect of residual concentrations on the environment. This work compares the ecotoxicological effects of PAA disinfectants and the active chlorine of calcium hypochlorite in relation to the organism Dugesia tigrina (planaria), in terms of the acute effects: LC50, and chronic effects: feeding, locomotion, regeneration, reproduction and fertility. The results indicated that the active chlorine was more toxic than PAA, with LC50 (96 h) of 2.63 mg.L-1 and 3.16 mg.L-1, respectively. Sub-lethal exposure to active chlorine was more toxic when compared to PAA, and there was evidence of significantly reduced feeding and locomotion, causing a greater delay in regeneration and impairment in reproduction and fertility. The results allowed the comparison of the two disinfectants using half-life constants of the compounds and the lowest observed effect level (LOEC) of the oxidants. Chlorine represents a greater risk to the ecosystem for a longer period. The results obtained in this study can help in the establishment of discharge limits for PAA in water bodies.

Proximal Interphalangeal Joint Silicone Arthroplasty for Osteoarthritis: Midterm Outcomes.

Background: Osteoarthritis of the proximal interphalangeal (PIP) joint affects a large percentage of the population and can lead to significant functional disability. The purpose of this study is to evaluate the midterm clinical effectiveness of PIP joint arthroplasty for nonrheumatic arthritis. Methods: A single-center retrospective cohort study evaluating preoperative and postoperative objective and subjective measures was conducted. Range of motion (ROM), Disabilities of the Arm, Shoulder and Hand scores, key pinch strength, grip strength, and satisfaction with respect to pain, deformity, function, and strength were measured. Results: Forty-five fingers in 25 patients were followed up for a mean period of 42 months. Preoperative and postoperative mean ROM was equivalent at 59.1° and 59.2°, respectively. Postoperative grip and key pinch strength showed significant improvement and near normalization compared with contralateral extremity. Complication rate was 37% with 20% requiring revision surgery. Patients with diabetes mellitus had higher odds of requiring revision surgery. Pain scores improved from 7.4 to 1.9 on a visual analog scale. Overall satisfaction was high at 84%, and 91% of patients would have the surgery performed again. Conclusions: Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. Our study presents midterm follow-up data that support significant pain relief, increased grip and key pinch strength, and high satisfaction associated with this implant.

Educação permanente em saúde no contexto da atenção primária: estudo descritivo de uma região de saúde em Mato Grosso do Sul / Continual education in health in the context of primary health: a descriptive study of a health region in Mato Grosso do Sul

A organização do sistema de saúde do Brasil se dá por meio de políticas e programas implementados gradativamente e, entre esses, tem-se a Política Nacional de Atenção Básica (PNAB) e a Política Nacional de Educação Permanente em Saúde (PNEPS). Objetivo:Conhecer o desenvolvimento institucional da PNAB e PNEPS na região de saúde de Dourados-MS, no período de 2008 a 2013, com o objetivo de identificar as ações de educação permanente em saúde efetivadas e sua relação com a atenção primária à saúde (APS). Materiais e Métodos:Foi realizado um estudo descritivo, por meio de consultas a bancos de dados de sistemas de informações de base nacional e documentos oficiais relativos às comissões que subsidiam as tomadas de decisões gestoras referentes às políticas de saúde naquela região. Resultados:No período de 2008 a 2013 houve recebimento de recursos federais no valor de R$ 1.497.165,75 e foram realizados 14 projetos de educação permanente na região estudada, dos quais 40% foram destinados aos profissionais da APS. Simultaneamente, notou-se incremento no número de equipes, no número de profissionais e no percentual de cobertura da Estratégia Saúde da Família no mesmo período e localidade. Conclusão:Apesar do progresso numérico da Estratégia Saúde da Família na localidade estudada, os investimentos de projetos de educação permanente em saúde na APS representaram menos da metade das ações realizadas no período de 2008 a 2013.

The organization of Brazil's health system happens through gradually implemented programs and policies and, among those, there is the National Policy of Basic Care (PNAB) and the National Policy of Continual Education in Health (PNEPS). Objective:To analyze the institutional development of the PNAB and the PNEPS in the health region of Dourados-MS, in the period between 2008 and 2013, aiming to identify the accomplished actions on continual education in health and their relation to the primary health care(APS). Materials and methods:A descriptive study was carried out by means of consultations to databases of information systems of national bases and official documents related to the commissions which subsidize the managing decision making referring to the region's health policies. Results:In the period between 2008 and 2013 federal resources worth R$1,497,165.75 were received and 14 permanent education projects were carried out in the region, of which 40% were destined to APS professionals. Simultaneously, it was noticed an increase in the number of teams, in the number of professionals, and on the percentage of coverage of the Family Health Strategy in the same period and location. Conclusion:In spite of the numerical progress of the Family Health Strategy in the studied location, the investments of projects on continual education in health in the APS represented less than half of the actions performed in the period between 2008 and 2013.

Biomechanical differences between left- and right-handed baseball pitchers.

Left-handed baseball pitchers are thought to have a number of theoretical advantages compared to right-handed pitchers; however, there is limited scientific research detailing differences in the pitching mechanics of right- and left-handed pitchers. Therefore, this study sought to understand whether any kinematic and kinetic differences existed between right- and left-handed baseball pitchers. A total of 52 collegiate pitchers were included in this study; 26 left-handed pitchers were compared to 26 age-, height-, weight- and ball velocity-matched right-handed pitchers. Demographic information, passive shoulder range of motion and kinematic and kinetic data were obtained for each pitcher participating in the study. Results indicated that left-handed pitchers did not have a glenohumeral internal rotation deficit as compared to right-handed pitchers. Kinematic analysis indicated that elbow flexion, horizontal glenohumeral abduction and wrist coronal plane motion were significantly different between the two study cohorts. It was also noted that left-handed pitchers had increased elbow varus moments. The findings of this study suggest that pitching coaches should be aware that there are biomechanical differences between left- and right-handed pitchers.

Dynamics of a haemodynamic headache: A case report and literature review of headache secondary to flow inversion of the internal jugular vein.

BACKGROUND: Haemodialysis arteriovenous fistulas have common local and regional complications, but are rarely associated with neurological symptoms. CASE REPORT: A 43-year-old woman presented with short acute episodes of unilateral, non-throbbing, severe headache, vertigo and left lateropulsion. She had undergone renal transplantation and had a still-functioning left brachial arteriovenous fistula. No abnormality was detected on neurological examination or on brain parenchymal imaging. Colour Doppler ultrasonography showed a subclavian steal syndrome of the left vertebral artery and reversed flow in the left internal jugular vein. Ligation of the arteriovenous fistula had to be delayed as a result of renal graft dysfunction. Six months later she developed a headache attributed to intracranial hypertension. All symptoms subsided after ligation of the arteriovenous fistula. LITERATURE REVIEW: We identified 16 case reports of central neurological complications attributed to haemodialysis brachial fistulas. Headache descriptions were scarce and were not fully detailed. CONCLUSIONS: The case of our patient suggests that unilateral, episodic, non-throbbing, non-postural headache with transient neurological symptoms can be caused by combined arterial and venous flow abnormalities secondary to a high-flow arteriovenous brachial fistula. In this setting, this pattern of headache may precede overt signs of intracranial hypertension and may be used as a warning sign of cerebral venous congestion.

A formação de sanitaristas como potencializadora da prática profissional no sistema único de saúde / The graduation of sanitarians as an improvement of professional practice in the unified health system

A formação em nível da especialização (pós-graduação lato sensu) tem por finalidade aprofundar conhecimentos em determinada área; assim a especialização em saúde pública/coletiva se caracteriza como uma estratégia de fortalecimento da formação de profissionais de saúde para o trabalho no Sistema Único de Saúde (SUS). Objetivo: conhecer a percepção dos egressos dos Cursos de Especialização em Saúde Pública realizados pela Escola de Saúde Pública de Mato Grosso do Sul, no período 2008-2011, sobre a sua contribuição para a melhoria da prática profissional no SUS. Materiais e Métodos: pesquisa qualitativa para a qual se utilizou de questionário para a obtenção de dados, fundamentada em Minayo (1992) e na análise de conteúdo (Bardin, 1979). A pesquisa foi realizada com 13 egressos. Resultados: verificou-se unanimidade na afirmação quanto à contribuição do curso para a melhoria da prática profissional, sobretudo no entendimento de que o trabalho no SUS se caracteriza por atuação em equipe, com atenção integral e caráter multiprofissional. A epidemiologia e a vigilância em saúde são apresentadas como técnicas de apoio à gestão, e o planejamento como principal instrumento da função gestora que se revelou como a maior potência do curso. A humanização da atenção e a promoção da saúde se revelaram como as maiores fragilidades do curso, na percepção dos participantes. Conclusão: o processo de formação por meio do curso de especialização é uma estratégia para a melhoria da prática profissional no SUS.

The educational degree of specialization (post graduation lato sensu) aims to deepen knowledge in a particular area. Therefore, a specialization in public/community health is characterized as a strengthening strategy to train healthcare professionals to work at the Unified Health System (SUS). Objective: To know the perception of graduates from public specialization courses held by the School of Public Health of Mato Grosso do Sul, from 2008 to 2011, about their contribution to the improvement of professional practice at SUS. Materials and Methods: Qualitative research using a questionnaire in order to obtain data, which was grounded on the content analysis (Bardin, 1979 end Minayo, 1992) to interpret the answers collected from 13 graduates of specialization courses in public health, that characterized the study sample. Results: The course contribution to improve professional practice, especially on the understanding that working at SUS is characterized by team work with integral care and multidisciplinary character, was unanimously stated. Epidemiology and health surveillance are presented as techniques of management support and, planning is the main instrument of the management function, which has proved to be the greater potency in the course. Humanizing care and health promotion were revealed as the largest weaknesses of the course, as perceived by the participants. Conclusion: The course is strategic to improve professional practice at SUS.

Influência da prática de atividade física sobre a qualidade de vida de usuários do SUS / The influence of the practice of physical activity on the quality of life of SUS's patients

O estudo objetivou verificar a influência da atividade física sobre a qualidade de vida de participantes e não participantes de um Programa de Atividade Física, atendidos nas Unidades Básicas de Saúde da Família, no município de Campo Grande (MS). A população foi constituída de 90 indivíduos com mais de 40 anos, de ambos os sexos, os quais responderam ao questionário SF-36. Os resultados demonstraram diferença estatisticamente significativa entre os grupos, com valores melhores a favor da população praticante de atividade física. Foi possível concluir que tal prática pode contribuir para a melhora da qualidade de vida em programas de promoção da saúde, como o Estratégia Saúde da Família.

The study aimed to investigate the influence of physical activity on the quality of life of participants and not participants of a Physical Activity Program attended in the Family Health Basic Units, in the municipality of Campo Grande-MS. The population was composed of 90 individuals over 40 years, of both sexes, who replied to the questionnaire SF-36. Results showed statistically significant differences between groups, with better values for the physical activity practitioner population. It was possible to conclude that such practice can contribute to the improvement of the quality of life in health promotion programs, such as the Family Health Strategy.

Management of complications relating to complex traumatic hand injuries.

Complex hand injuries result in local trauma to osseous, neurovascular, and soft tissue structures. The large amount of energy imparted to these tissues may result in complex regional pain syndrome, stiffness, or infection. Unfortunately, a good outcome may not only depend on the technical aspects of the procedure but on the expectations, occupation, age, and other factors that are out of the surgeon's control. The best treatment for these complications is prevention; however, this review offers strategies to combat the complications once they arise.