[Critical shoulder angle as a predictor of severity in rotator cuff injuries]. / Ángulo crítico del hombro como predictor de severidad en las lesiones del manguito rotador.

INTRODUCTION: the connection between a critical shoulder angle (CSA) greater than 35° and the presence rotator cuff tears (RCT) is well known. However, it remains unidentified if there is an association between a higher CSA value and the presence of more severity RCT. MATERIAL AND METHODS: cross-sectional, descriptive, observational, prospective and analytical study in which patients with RCT had their CSA evaluated by imaging and the degree of the RCT by arthroscopy. Four groups were formed (without lesion; partial lesion; complete lesion; massive lesion) and were compared using ANOVA parametric statistics. The association between RCT and CSA was studied by rho Spearman coefficient. RESULTS: 71 patients were studied, 15 without RCT (CSA of 34.13 ± 0.98), 17 with partial lesion (CSA of 36.00 ± 1.15), 22 with complete lesion (CSA of 40.77 ± 0.69) and 17 with massive lesion (CSA of 41.53 ± 0.68). No significant statistical difference was found between the CSA of the groups without lesion and partial lesion (p = 0.486; 35°) but there was a difference between the groups with complete and massive lesion (p = 0.000 and p = 0.001; 35°). A significant positive association was found between CSA and RCT (rho = 0.605, p = 0.000). CONCLUSIONS: an CSA above 35° is associated to complete and massive RCT and it works as a predictor of severity for these lesions.

INTRODUCCIÓN: es bien conocida la conexión existente entre un ángulo crítico del hombro (ACH) mayor a 35° y las lesiones del manguito rotador (LMR). Sin embargo, se desconoce si existe una asociación entre los valores más elevados de ACH y la presencia de LMR de mayor severidad. MATERIAL Y MÉTODOS: estudio de corte transversal, descriptivo, observacional, prospectivo y analítico, en el que a los pacientes con LMR se les evaluó por imagen el ACH y mediante artroscopía el grado de lesión. Se formaron cuatro grupos (sin lesión; lesión parcial; lesión completa; lesión masiva) y se compararon mediante la estadística paramétrica ANOVA. Se estudió la asociación entre LMR y ACH por medio del coeficiente rho de Spearman. RESULTADOS: se estudiaron 71 pacientes, 15 sin LMR (ACH de 34.13 ± 0.98), 17 con lesión parcial (ACH de 36.00 ± 1.15), 22 con lesión completa (ACH de 40.77 ± 0.69) y 17 con lesión masiva (ACH de 41.53 ± 0.68). No se encontró diferencia significativa entre el ACH de los grupos sin lesión y lesión parcial (p = 0.486; 35°), pero sí existió diferencia entre los grupos de lesión completa y lesión masiva (p = 0.000 y p = 0.001; 35°). Se encontró una asociación positiva significativa entre ACH y LMR (rho = 0.605, p = 0.000). CONCLUSIONES: un ACH por arriba de 35° se asocia con LMR de tipo completas y masivas y funciona como factor predictivo de severidad para estas lesiones.

Diseño de una prueba de equilibrio con características contextuales para adultos mayores / Design and validation of a balance test with context characteristics for older adults

Antecedentes La pérdida de equilibrio en los adultos mayores es multifactorial y aumenta el riesgo de caídas en esta población. Existen pruebas para evaluar el equilibrio, sin embargo, se centran en la evaluación de una sola tarea, en entornos estáticos, sin considerar las demandas del control postural en situaciones de la vida cotidiana, como la interacción de la persona con el contexto y las actividades multitarea. Objetivo Diseñar y validar una prueba de equilibrio para adultos mayores con características contextuales. Materiales y método Se desarrolló una metodología de recolección de datos mixta, con un diseño metodológico exploratorio secuencial DEXPLOX derivativo de un diseño de triangulación concurrente DITRIAC. Resultados Los resultados hallados en las primeras 3fases permitieron construir los ítems de la prueba de evaluación de equilibrio, luego se realizó la primera validación de expertos, con un coeficiente kappa de Fleiss de 0,4 y una validez de contenido de Lawshe de 0,95. La segunda validación por expertos dio como resultado en la validez facial una fuerza de concordancia interevaluadores excelente y una validez de contenido de Lawshe en relevancia de 0,95 y en pertinencia de 0,97. Conclusiones La prueba diseñada ha demostrado características de validez fuertes y puede ser aplicada en adultos mayores, pues se incluyen ítems que exigen respuestas somatosensoriales, como las que se realizan en las actividades de la vida diaria e ítems con actividades de doble tarea cognitivas en el contexto real (AU)

Background Balance impairment is multifactorial in older adults and increases risk of falls in this population. There are tests to evaluate balance; nevertheless, they are focused on the evaluation of a single task, in static environments, without representing postural control demands in everyday life situations, such as person interaction-context and multi-tasking activities. Objectives Design and validate a balance test with ecological validity for older adults. Materials and methods A mixed data collection methodology was developed, with an exploratory sequential DEXPLOX methodological design derived from a DITRIAC concurrent triangulation design. Results The results from the first 3phases permitted constructing the items of the balance assessment test to, then, conduct the first validation by experts, determining a Fleiss’ kappa of 0.4 and a Lawshe content validity ratio of 0.95. The second validation by experts yielded as a result in face validity an excellent strength of inter-rater agreement and a Lawshe content validity ratio of 0.95 in relevance and 0.97 in pertinence. Conclusions The test designed showed strong characteristics of ecological validity and can be applied to older adults, given that it includes items requiring somatosensory responses, like those performed in activities of daily living and items with cognitive dual task activities used in daily routines (AU)

Pharmacological approaches to induce follicular growth and ovulation for fixed-time artificial insemination treatment regimens in ewes.

In Experiment I, during the non-breeding season, after intravaginal devices containing progesterone (P4) were withdrawn (n = 28), estrous rates were greater with treatment with 400 IU eCG (P < 0.05) than with FSH (10 and 15 mg) and no treatment. During the breeding season (n = 147), estrous and pregnancy rates after fixed-time artificial inseminations (FTAI) were similar among groups: 300 IU eCG; 10 mg FSH; and control (P > 0.05). In Experiment II (non-breeding season), ewes of one group were treated with 300 IU eCG (n = 8) and of two groups were treated with 10 mg FSH. In one FSH group, 250 µg estradiol benzoate (EB) were administered after 24 h (n = 9); in the other, 4 µg GnRH were administered after 36 h (n = 10). Serum P4 concentrations were greater in eCG-treated ewes (P < 0.05). Estrous rates were similar for the eCG- and FSH plus EB-treated ewes (P > 0.05). In Experiment III (breeding season), the treatments were: 300 IU eCG; 250 µg estradiol cypionate; 250 µg EB; or control (n = 22). Follicular growth was greater for eCG-treated ewes within 0-24 h and for control ewes within 48-72 h (P = 0.001). Although estrous and ovulation rates did not differ (P > 0.05), all eCG-treated ewes had ovulations. During the non-breeding season, FSH treatment promoted follicular growth but did not induce ovulations. For FTAI regimens, eCG was more effective than FSH plus GnRH and estradiol esters in inducing estrus and ovulation.

[Design and validation of a balance test with context characteristics for older adults]. / Diseño de una prueba de equilibrio con características contextuales para adultos mayores.

BACKGROUND: Balance impairment is multifactorial in older adults and increases risk of falls in this population. There are tests to evaluate balance; nevertheless, they are focused on the evaluation of a single task, in static environments, without representing postural control demands in everyday life situations, such as person interaction-context and multi-tasking activities. OBJECTIVES: Design and validate a balance test with ecological validity for older adults. MATERIALS AND METHODS: A mixed data collection methodology was developed, with an exploratory sequential DEXPLOX methodological design derived from a DITRIAC concurrent triangulation design. RESULTS: The results from the first 3phases permitted constructing the items of the balance assessment test to, then, conduct the first validation by experts, determining a Fleiss' kappa of 0.4 and a Lawshe content validity ratio of 0.95. The second validation by experts yielded as a result in face validity an excellent strength of inter-rater agreement and a Lawshe content validity ratio of 0.95 in relevance and 0.97 in pertinence. CONCLUSIONS: The test designed showed strong characteristics of ecological validity and can be applied to older adults, given that it includes items requiring somatosensory responses, like those performed in activities of daily living and items with cognitive dual task activities used in daily routines.

Treatment with eCG and hCG to induce onset of estrous cycles in ewes during the non-breeding season: Effects on follicular development and fertility.

Although combining of eCG and hCG administrations is known to enhance LH-like actions, there have been few studies where there was comparison of the effects of treatment of anestrous ewes with eCG and hCG and eCG alone. In Experiment 1, 18 ewes in seasonal anestrus were administered an intravaginal device (IVD) containing medroxyprogesterone acetate for 12 days, and at the time of IVD removal (D0), were allocated into the following groups (n = 6/group): no further treatment (control); 400 IU eCG (eCG); or 400 IU eCG and 200 IU hCG (eCG + hCG). There was greater ovarian follicular growth in the groups treated with gonadotropins, compared to the control, and there were greater progesterone concentrations in the eCG + hCG group on D9 (P < 0.05). In Experiment 2, 66 ewe lambs were assigned to the same treatment groups described for Experiment 1, and subsequently there was natural mating with rams. There was a greater rate of behavioral estrous manifestation in the eCG (88.5 %; 23/26) and eCG+hCG (85.2 %; 23/27), than control (30.8 %; 4/13; P < 0.05) group. Pregnancy rate was also greater in the eCG (34.6 %; 9/26) and eCG+hCG (18.6 %; 5/27) than control (0 %; 0/13; P < 0.05) group, whereas conception rate, considering only ewe lambs that were mated, was only greater in the eCG group. Although there were greater progesterone concentrations 9 days after treatment in the eCG+hCG group, there was no difference in follicular growth in anestrous ewes, nor was there an effect on estrous behavior manifestation and pregnancy rates in ewe lambs, compared to treatment with only eCG.

[Effectiveness of intra-articular anesthesia in knee arthroscopy]. / Efectividad de la anestesia intraarticular en artroscopía de rodilla.

INDRODUCTION: Knee arthroscopy is one of the most commonly performed procedures. General anesthesia and spinal blockage are the most common forms of anesthesia. We consider that this surgery can be managed with intra-articular local anesthesia, thus avoiding prolonged stays in recovery, with effective pain management and optimization of presurgical, intrasurgical and post-surgical times. MATERIAL AND METHODS: Prospective, quasi-experimental, longitudinal study to compare two anesthetic procedures: intraarticular anesthesia (lidocaine with epinephrine, bupivacaine and fentanyl) without the use of ischemia (group A); spinal blockage and use of ischemia (group B) by assessing age, surgery time, pain during surgery and 24 hour post-op VA scale, time spent in recovery, need to administer general anesthesia or anesthetic rescue doses, 24-hour range of motion. Student t-test, significance level was used: p 0.05 for nonparametric variables and 2 parametric variables. RESULTS: 38 patients were included per group. The surgical time (45 min vs 39 min, p = 0.03), recovery time (1.9 vs 3 hours, p = 0.0004) were lower in group A, while pain during surgery was greater (17 vs 3%, p = 0.09), without requiring general anesthesia. CONCLUSION: The advantages in favor of intraarticular anesthesia were: shortened hospital stays, less pain at 24 hours, safety in its application. Its disadvantage is the possibility of pain during surgery and sedation is sufficient as adjuvant.

INTRODUCCIÓN: La artroscopía de rodilla es uno de los procedimientos que más comúnmente se realizan para tratar esta articulación. La anestesia general y el bloqueo espinal son las modalidades de anestesia más comunes para este procedimiento. Consideramos que esta cirugía se puede manejar con anestesia local intraarticular, con lo que se evitan estancias en recuperación más prolongadas; tiene un mejor manejo efectivo del dolor y optimización de tiempos prequirúrgicos, intraquirúrgicos y postquirúrgicos. MATERIAL Y MÉTODOS: Estudio prospectivo, cuasiexperimental y longitudinal, realizado para comparar dos procedimientos anestésicos: la anestesia intraarticular (lidocaína con epinefrina, bupivacaína y fentanil) sin uso de isquemia (grupo A) y el bloqueo espinal y uso de manguito de isquemia (grupo B). Ambos procedimientos se calcularon mediante la evaluación de la edad, el tiempo de cirugía, el dolor transquirúrgico y a las 24 horas mediante escala EVA, el tiempo de estancia en recuperación, la necesidad de administrar anestesia general o dosis anestésica de rescate y los grados de flexión a las 24 horas en el postquirúrgico. Se utilizó prueba t de Student con un nivel de significación p 0.05 para variables no paramétricas y 2 para variables paramétricas. RESULTADOS: Se incluyeron 38 pacientes por cada grupo. El tiempo quirúrgico fue de 45 contra 39 minutos (p = 0.03); el tiempo en recuperación: 1.9 contra 3 horas (p = 0.0004), el cual fue menor en el grupo A, mientras que el dolor transquirúrgico fue mayor (17 contra 3% [p = 0.09]), sin requerir anestesia general. CONCLUSIONES: Las ventajas a favor de la anestesia intraarticular fueron: estadías hospitalarias cortas, menor dolor a las 24 horas y seguridad en su aplicación. Su desventaja es la probabilidad de dolor transquirúrgico, siendo suficiente la sedación.