Clinical and pulmonary function analysis in long-COVID revealed that long-term pulmonary dysfunction is associated with vascular inflammation pathways and metabolic syndrome.

Introduction: Long-term pulmonary dysfunction (L-TPD) is one of the most critical manifestations of long-COVID. This lung affection has been associated with disease severity during the acute phase and the presence of previous comorbidities, however, the clinical manifestations, the concomitant consequences and the molecular pathways supporting this clinical condition remain unknown. The aim of this study was to identify and characterize L-TPD in patients with long-COVID and elucidate the main pathways and long-term consequences attributed to this condition by analyzing clinical parameters and functional tests supported by machine learning and serum proteome profiling. Methods: Patients with L-TPD were classified according to the results of their computer-tomography (CT) scan and diffusing capacity of the lungs for carbon monoxide adjusted for hemoglobin (DLCOc) tests at 4 and 12-months post-infection. Results: Regarding the acute phase, our data showed that L-TPD was favored in elderly patients with hypertension or insulin resistance, supported by pathways associated with vascular inflammation and chemotaxis of phagocytes, according to computer proteomics. Then, at 4-months post-infection, clinical and functional tests revealed that L-TPD patients exhibited a restrictive lung condition, impaired aerobic capacity and reduced muscular strength. At this time point, high circulating levels of platelets and CXCL9, and an inhibited FCgamma-receptor-mediated-phagocytosis due to reduced FcγRIII (CD16) expression in CD14+ monocytes was observed in patients with L-TPD. Finally, 1-year post infection, patients with L-TPD worsened metabolic syndrome and augmented body mass index in comparison with other patient groups. Discussion: Overall, our data demonstrated that CT scan and DLCOc identified patients with L-TPD after COVID-19. This condition was associated with vascular inflammation and impair phagocytosis of virus-antibody immune complexes by reduced FcγRIII expression. In addition, we conclude that COVID-19 survivors required a personalized follow-up and adequate intervention to reduce long-term sequelae and the appearance of further metabolic diseases.

Effectiveness of adding pain neuroscience education to telerehabilitation in patients with carpal tunnel syndrome: A randomized controlled trial.

BACKGROUND: Previous studies have shown positive results of pain neuroscience education (PNE) combined with exercise in patients with chronic musculoskeletal disorders. However, the effects of this intervention in patients with carpal tunnel syndrome (CTS) admitted to a telerehabilitation program remain unexplored. OBJECTIVE: To compare the effectiveness of a 6-week telerehabilitation program based on PNE + exercise versus exercise alone on patient-reported outcomes after treatment and at 6-weeks post-treatment follow-up in patients with CTS awaiting surgery. DESIGN: Randomized controlled trial. METHODS: Thirty participants were randomly assigned to the PNE + exercise or exercise-only group. Outcome measures included pain intensity, pain catastrophizing, kinesiophobia, symptom severity, function, symptoms of anxiety and depression, quality of life, self-perception of improvement. Inferential analyses of the data were performed using a two-factor mixed analysis of variance. RESULTS: Twenty-five participants completed the study. A significant time × group interaction with a large effect size was observed for kinesiophobia (F = 6.67, p = 0.005, ηp2 = 0.225) and symptom severity (F = 4.82, p = 0.013, ηp2 = 0.173). No significant interaction was observed for the other variables (p > 0.05). A significant difference in self-perceived improvement was observed in favor of the PNE + exercise group after treatment (p < 0.05). Although there were significant and clinically relevant improvements within the PNE + exercise group in pain intensity and catastrophizing, there were no significant differences between the groups. CONCLUSIONS: The addition of PNE to a telerehabilitation exercise program showed short-term improvements in kinesiophobia and symptom severity and greater self-perceived improvement in patients with CTS awaiting surgery. This study highlighted the benefits of including PNE in telerehabilitation interventions for patients with CTS.

Gender differences on effects of forearm rotation on compressive stiffness of flexor carpi ulnaris during submaximal handgrip contractions.

Little is known about gender differences in stiffness of forearm muscles during voluntary actions. This study aimed to investigate the effect of forearm rotation on flexor carpi ulnaris (FCU) stiffness in men and women during submaximal handgrip contractions. During a single session, measurements were made on 20 young participants (9 females). Two positions of the forearm were compared in random order with the elbow flexed 90 degrees: (i) neutral position and (ii) maximal supination. In each position, participants performed two submaximal handgrip contractions at 25% and 50% of maximal voluntary contraction, while compressive stiffness was collected using a hand myometer (MyotonPRO). A mixed repeated measurement ANOVA was applied to assess the interaction between gender, forearm position, and contraction intensity. The FCU stiffness is affected by handgrip contraction intensity (p < 0.001), gender (p < 0.001), BMI (p = 0.009), and forearm rotation (p = 0.007). Only the gender factor was found to have significant interaction with forearm rotation (p = 0.037). Men's FCU was stiffer than women's in both positions and contraction intensities (p < 0.05). Only in men a significant increase in FCU stiffness was observed when comparing contraction intensities at both forearm positions (p < 0.05), as well as when the forearm was rotated from neutral to supine at both intensities (p < 0.05). In conclusion, FCU stiffness during handgrip contraction differed significantly between men and women. Women have fewer stiffness changes in FCU when performing different levels of handgrip contraction. We also observed that only men increased FCU stiffness by changing the forearm position from neutral to supine position for both handgrip intensities.

Social determinants of health and physical activity are related to pain intensity and mental health in patients with carpal tunnel syndrome.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy of the upper limb and a frequent cause of disability. OBJECTIVE: To analyze the association between social determinants of health (SDH) and physical activity with pain intensity and mental health in patients with CTS. DESIGN: A cross-sectional study was conducted in patients with CTS awaiting surgery in two public hospitals in Chile. METHODS: The SDH collected included: employment status, educational level and monetary income. The level of physical activity was defined according to compliance with WHO recommendations. Outcome measures included: Pain intensity (Visual Analog Scale), Symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), and catastrophic thinking (Pain Catastrophizing Scale). The adjusted regression coefficient (ß) for the association between SDH and physical activity with each outcome was obtained using multivariable linear regression models controlling for age, sex, body mass index and symptom duration. RESULTS: Eighty-six participants were included (mean age 50.9 ± 10 years, 94% women). A high level of physical activity was associated with a 12.41 mm decrease in pain intensity (ß = -12.41, 95%CI: -23.87 to -0.95) and a 3.29 point decrease in depressive symptoms (ß = -3.29, 95%CI: -5.52 to -1.06). In addition, being employed was associated with a 2.30 point decrease in anxiety symptoms (ß = -2.30; 95%CI: -4.41 to -0.19) and a high educational level was associated with a 7.71 point decrease in catastrophizing (ß = -7.71; 95%CI: -14.06 to -1.36). CONCLUSION: Multidisciplinary care teams should be aware of the association between SDH and physical activity with physical and mental health.

Postural performance assessment in aging people with diabetes and diabetic peripheral neuropathy using a Wii balance board.

PURPOSE: To determine the effect of sensory perturbations on static postural control in older people with type 2 diabetes mellitus by comparing postural outcomes of people with and without diabetic neuropathy using a Wii Balance Board (WBB). MATERIALS AND METHODS: Static postural balance assessments were performed in 31 participants: nine with type 2 diabetes mellitus; 12 with diabetic neuropathy; and 10 non-diabetic controls. Participants stood on the WBB under sensory perturbations (visual and proprioceptive). Body balance was analysed using centre of pressure ellipse area, mean velocity, and sample entropy. The effects of within-participant factors, sensory perturbations and the between-participants factor 'group' on outcomes were analysed using a multivariate analysis of variance model. RESULTS: Type 2 diabetes mellitus participants with and without neuropathy showed altered postural performance under sensory perturbations compared to non-diabetic participants. Moreover, participants with diabetic neuropathy showed impaired postural performance when one perceptual system was disturbed. Finally, participants with type 2 diabetes mellitus without neuropathy decreased their postural performance when both sensory disturbances were present. CONCLUSIONS: The Wii Balance Board can be a useful alternative for balance impairment screening related to diabetic neuropathy and contribute as an affordable source of insight in early interventions in integral diabetes care.Implications to rehabilitationOlder people with diabetic peripheral neuropathy depend on visual and somatosensory cues to keep their static postural balance.Static balance assessment using the Wii Balance Board allows the identification of alterations in postural performance in participants with diabetes.This low-cost method used can be considered as a complement to integral diabetes care.

Detection of intermuscular coordination based on the causality of empirical mode decomposition.

Considering the stochastic nature of electromyographic (EMG) signals, nonlinear methods may be a more accurate approach to study intermuscular coordination than the linear approach. The aims of this study were to assess the coordination between two ankle plantar flexors using EMG by applying the causal decomposition approach and assessing whether the intermuscular coordination is affected by the slope of the treadmill. The medial gastrocnemius (MG) and soleus muscles (SOL) were analyzed during the treadmill walking at inclinations of 0°, 5°, and 10°. The coordination was evaluated using ensemble empirical mode decomposition, and the causal interaction was encoded by the instantaneous phase dependence of time series bi-directional causality. To estimate the mutual predictability between MG and SOL, the cross-approximate entropy (XApEn) was assessed. The maximal causal interaction was observed between 40 and 75 Hz independent of inclination. XApEn showed a significant decrease between 0° and 5° (p = 0.028), between 5° and 10° (p = 0.038), and between 0° and 10° (p = 0.014), indicating an increase in coordination. Thus, causal decomposition is an appropriate methodology to study intermuscular coordination. These results indicate that the variation of loading through the change in treadmill inclination increases the interaction of the shared input between MG and SOL, suggesting increased intermuscular coordination.

Variability in Normalization Methods of Surface Electromyography Signals in Eccentric Hamstring Contraction.

CONTEXT: In human movement analysis, normalization of a surface electromyography signal is a crucial step; therefore, parameter selection for this procedure must be adequately justified. The aim of this research was to determine the variability of electromyography signals in eccentric hamstring contraction under different normalization parameters. DESIGN: Cross-sectional study. METHODS: Nine university rugby players (age 21.50 [3.61] y; body mass index 21.50 [4.95]) and no history of recent hamstring injury. Values from maximum voluntary isometric contraction protocol and task related (ie, Nordic hamstring exercise) were used for surface electromyography signal normalization. Intersubject and intrasubject variation coefficients were used for normalization method variability and for signal reproducibility, respectively. RESULTS: Intrasubject variation coefficient value indicates acceptable reproducibility of surface electromyography (less than 12%) for all normalization procedures. Lower values of intersubject variation coefficient value were achieved for normalization procedures using task-related values. CONCLUSION: Parameters extracted from task execution provided less variability for surface electromyography amplitude normalization in eccentric hamstring muscle contractions.

Contribución de la priorización curricular de educación física y salud en la formación académica de los estudiantes / Contribution of the curricular prioritization of physical education and health in the academic training of students / Contribuição da priorização curricular de educação física e saúde na formação académica dos estudantes

RESUMEN Los procesos educativos han sufrido muchos cambios debido a la pandemia de Covid-19 intentando mantener la continuidad de los mismos a través de clases virtuales, para facilitar esta labor, el Ministerio de Educación de Chile establece la Priorización Curricular que tiene como propósito responder a las diversas dificultades y problemas del ámbito educativo que emergen debido a la paralización de las clases presenciales causado por la crisis sanitaria. El objetivo de este estudio fue conocer si la priorización curricular en Educación Física y Salud es una contribución para la formación académica de los estudiantes, para ello, se utilizó una metodología con enfoque cuantitativo, no experimental, a través de la cual se recogió información que permitió conocer la percepción de los profesores en ejercicio. Los resultados indican que su principal contribución es en el ámbito conceptual, sin embargo, presenta carencias en cuanto a algunos aspectos relevantes para un buen desarrollo del aprendizaje. Se concluye que esta organización de objetivos ha sido medianamente bien recibida por los profesores, aunque representa en su aplicación una contribución al proceso formativo.

ABSTRACT The educational processes have undergone many changes due to the Covid-19 pandemic, trying to maintain their continuity through virtual classes, to facilitate this work, the Ministry of Education of Chile establishes the Curricular Prioritization that aims to respond to the various difficulties and problems in the educational environment that emerge due to the paralysis of face-to-face classes caused by the health crisis. The objective of this study was to know if the curricular prioritization in Physical Education and Health is a contribution to the academic training of students, for this, a methodology with a quantitative, non-experimental approach was used, through which information was collected that allowed to know the perception of practicing teachers. The main results indicate that its main contribution is in the conceptual field; however, it presents deficiencies in terms of some relevant aspects for a good development of learning. It is concluded that this organization of objectives has been fairly well received by teachers, although in its application it represents a contribution to the training process.

RESUMO Os processos educacionais sofreram muitas mudanças devido à pandemia de Covid-19, tentando manter sua continuidade por meio de aulas virtuais. Para facilitar este trabalho, o Ministério da Educação do Chile estabelece a Priorização Curricular que visa responder às várias dificuldades e problemas no campo educacional que surgem devido à paralisação das aulas presenciais causadas pela crise da saúde. O objetivo deste estudo foi saber se a priorização curricular em Educação Física e Saúde é uma contribuição para a formação acadêmica dos alunos, para isso, foi utilizada uma metodologia com abordagem quantitativa, não experimental, por meio da qual foram coletadas informações que permitiu conhecer a percepção dos professores atuantes. Os resultados indicam que sua principal contribuição está no campo conceitual, porém, apresenta deficiências em alguns aspectos relevantes para um bom desenvolvimento da aprendizagem. Conclui-se que esta organização de objetivos tem sido moderadamente bem recebida pelos docentes, embora represente um contributo para o processo de formação na sua aplicação.

Effects of Cognitive and Mental Health Factors on the Outcomes Following Carpal Tunnel Release: A Systematic Review and Meta-analysis.

OBJECTIVE: To determine the effects of the cognitive and mental health factors on the outcomes after carpal tunnel release (CTR). DATA SOURCES: Embase, PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials databases from inception to August 14, 2021. STUDY SELECTION: Randomized controlled trials and observational studies of patients with CTR were included. The included studies aimed to determine the effect of the cognitive (catastrophic thinking, kinesiophobia, self-efficacy) or mental health factors (symptoms of anxiety and depression) on the outcomes at least 3 months post CTR. DATA EXTRACTION: Two independent reviewers performed data extraction and assessed the risk of bias. Data were extracted using a standardized protocol and reporting forms. The risk of bias of the included studies was assessed using the Quality in Prognosis Studies risk-of-bias tool. Random-effects models were used for meta-analysis. DATA SYNTHESIS: A total of 15 studies involving 2599 patients were included in this systematic review. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes after CTR. Quantitative analysis showed a moderate association of symptoms of depression on symptom severity (n=531; r=0.347; 95% CI, 0.205-0.475; P≤.0001), function (n=386; r=0.307; 95% CI, 0.132-0.464; P=.0008), and pain (n=344; r=0.431; 95% CI, 0.286-0.558; P≤.0001). In general, the risk of bias in the included studies was low. CONCLUSIONS: This systematic review and meta-analysis showed that symptoms of depression have a moderate association with symptom severity, function, and pain after CTR. Symptoms of anxiety, catastrophic thinking, and self-efficacy are also important indicators of poor postsurgery outcomes. Physicians, physical therapists, and occupational therapists should consider evaluating these variables in patients undergoing CTR.

Qualitative ultrasonography scale of the intensity of local twitch response during dry needling and its association with modified joint range of motion: a cross-sectional study.

BACKGROUND: The relevance of local twitch response (LTR) during dry needling technique (DNT) is controversial, and it is questioned whether LTR is necessary for successful outcomes. Furthermore, because the LTR during the deep DNT may be evoked with different intensities, it is unknown whether the magnitude of LTR intensity is associated with optimal clinical results, especially concerning to the effects of joint maximal range of motion (ROM). This study aimed to (i) determine whether visual inspections can quantify the LTR intensity during the DNT through a qualitative ultrasonography scale of LTR intensity (US-LTR scale), and (ii) assess the differences of US-LTR scale associated with changes in the maximal joint ROM. METHODS: Using a cross-sectional design, seven asymptomatic individuals were treated with DNT in the latent myofascial trigger point in both medial gastrocnemius muscles. During DNT, three consecutive LTRs were collected. The US-LTR scale was used to classify the LTRs into strong, medium, and weak intensities. The categories of US-LTR were differentiated by the velocity of LTRs using the optical flow algorithm. ROM changes in ankle dorsiflexion and knee extension were assessed before and immediately after DNT. RESULTS: The US-LTR scale showed the third LTR was significantly smaller than the first one (p < 0.05). A significant difference in velocity was observed between US-LTR categories (p < 0.001). A significant difference in the ROM was observed between the strong and weak-medium intensity (p < 0.05). CONCLUSIONS: The present findings suggest that the LTR intensity can be assessed using a qualitative US-LTR scale, and the effects of DNT on joint maximal ROM is maximized with higher LTR intensity. This study reports a novel qualitative method for LTR analysis with potential applications in research and clinical settings. However, further research is needed to achieve a broader application.

Impact of Visual Biofeedback of Trunk Sway Smoothness on Motor Learning during Unipedal Stance.

The assessment of trunk sway smoothness using an accelerometer sensor embedded in a smartphone could be a biomarker for tracking motor learning. This study aimed to determine the reliability of trunk sway smoothness and the effect of visual biofeedback of sway smoothness on motor learning in healthy people during unipedal stance training using an iPhone 5 measurement system. In the first experiment, trunk sway smoothness in the reliability group (n = 11) was assessed on two days, separated by one week. In the second, the biofeedback group (n = 12) and no-biofeedback group (n = 12) were compared during 7 days of unipedal stance test training and one more day of retention (without biofeedback). The intraclass correlation coefficient score 0.98 (0.93-0.99) showed that this method has excellent test-retest reliability. Based on the power law of practice, the biofeedback group showed greater improvement during training days (p = 0.003). Two-way mixed analysis of variance indicates a significant difference between groups (p < 0.001) and between days (p < 0.001), as well as significant interaction (p < 0.001). Post hoc analysis shows better performance in the biofeedback group from training days 2 and 7, as well as on the retention day (p < 0.001). Motor learning objectification through visual biofeedback of trunk sway smoothness enhances postural control learning and is useful and reliable for assessing motor learning.

Effects of dual-task demands on the complexity and task performance of submaximal isometric handgrip force control.

PURPOSE: To determine the effect of cognitive-motor dual-task load on temporal structure irregularity (complexity) of motor output and task performance of submaximal isometric contractions. METHODS: Twelve young, sedentary subjects performed handgrip isometric contractions until failure at 50% of maximal voluntary contraction under mathematical self-regulated dual-task (own pace; SDT), regulated dual-task (imposed pace; RDT), and control. Force signal complexity was calculated by sample entropy at the initial, middle, and final thirds. Task performance was assessed by muscle fatigue (time to failure and rate of median frequency of the radial flexor of the carpus), force and math task error, and self-perceived difficulty. RESULTS: Only RDT decreased complexity with respect to control (17.4% ± 12.6%, p = 0.005), all conditions decreased complexity by the final third (Control: 52.8% ± 18.7%, p < 0.001; SDT: 41.1% ± 32.1%, p = 0.003; RDT: 19.1% ± 21.9%, p = 0.035). Conditions did not affect time to failure, and only RDT decreased the rate of median frequency (0.1%/s ± 0.1%/s, p = 0.020). Inferior force error rate was increased by conditions (SDT: 1.5% ± 0.8%, p < 0.001; RDT: 2% ± 1.5%, p = 0.002). Math error was only augmented by RDT (from 9.9 ± 6.7 to 51.7 ± 18.8, p < 0.001), categorized as "very hard" in 85.7% of participants (p = 0.015). CONCLUSION: Only the RDT condition reduced complexity and neuromuscular fatigue while increasing force error rate of the handgrip's motor output, without affecting time to failure. A highly demanding dual-task may become a strategy to modify the organization of the hand force motor output, which may contribute to its motor adaptations.

Dry needling technique decreases spasticity and improves general functioning in incomplete spinal cord injury: A case report.

Context: Spasticity in neurological disorders (i.e. stroke patients and cerebral palsy) is positively improved by dry needling. However, reports are scarce regarding the potential effects of dry needling in reducing spasticity and improving functionality in patients with an incomplete spinal cord injury. The aim of this case report was to study the immediate, short-term effects of dry needling treatment (10 weeks) on spasticity, dynamic stability, walking velocity, self-independence, and pain in a single patient with an incomplete spinal cord injury.Findings: The dry needling treatment resulted in immediate, short-time effects on basal spasticity in the upper (reduction from 2 to 0 point median) and lower (reduction from 2 to 0 point median) limbs, as measured by the modified Ashworth Scale. Dynamic-stability, assessed by trunk accelerometry, improved more than 50% (Root Mean Squared of acceleration, Root Mean Squared of Jerk and step variability), and gait speed improved by 24.7 s (i.e. time to walk 20 m). Self-independence and pain were respectively scored by the Spinal Cord Independence Measure (21 points improvement) and visual analog scale (4 points improvement).Conclusions: This case report demonstrates that dry needling treatment can have positive effects on spasticity, dynamic stability, walking velocity, self-independence, and pain in patients with incomplete spinal cord injury. Further research is needed in a larger patient population to deeply understand the mechanism(s) associated with the obtained results and regarding the clinical significances of dry needling treatment for incomplete spinal cord injury.

Accidentes de tránsito relacionados con el trabajo: una prioridad en salud laboral y pública para Ecuador / Work-related traffic accidents: a priority for occupational and public health in Ecuador

Introducción: En Ecuador, los accidentes de tránsito relacionados con el trabajo han experimentado un incremento en los últimos años y han sido poco estudiados en seguridad y salud en el trabajo. Objetivo: Estimar el riesgo relativo de sufrir accidentes in-itínere en comparación con los accidentes ocurridos en el lugar de trabajo mediante el análisis de fuentes oficiales de información secundaria en el período de 2014 a 2016. Material y métodos: Estudio descriptivo de los accidentes de trabajo relacionados con el trabajo recopilados a través de fuentes oficiales de información secundaria. Para el análisis se utilizaron estadísticos descriptivos, cálculo del riesgo relativo (R.R.-IC95%) y la prueba chicuadrado de Pearson. Resultados: Las mujeres presentan mayor prevalencia y riesgo (R.R. = 1,86; IC95%: 1,80-1,92) de sufrir accidentes in-itínere. Asimismo, los trabajadores del sector industrial y servicios con edades entre los 18 a 35 años (R.R. = 1,16; IC95%: 1,12-1,20) muestran mayor probabilidad que el resto de actividades económicas y grupos etarios. Se observa una tendencia al aumento y probabilidad de fallecer por accidentes in-itínere (R.R. = 1,66; IC95%: 1,43-1,92) que en lugar de trabajo. Conclusiones: Los resultados del presente estudio conllevan a plantearse esta problemática como prioritaria en salud laboral y pública debido al incremento de este tipo de accidentes de trabajo. Surge la necesidad de continuar con futuras investigaciones y atención a este tipo de riesgos laborales por parte de los organismos públicos y empresas del Ecuador(AU)

Background: In Ecuador, work-related traffic accidents have experienced an increase in recent years, but are understudied from the perspective of occupational safety and health. Objective: To estimate the relative risk of suffering accidents initínere compared to workplace accidents by analyzing official sources of secondary information in Ecuador for the period from 2014 to 2016. Material and methods: Descriptive study of work-related accidents collected through official secondary information sources. For the analysis, descriptive statistics, relative risk calculation (R.R. and 95% confidence intervals, -95%CI) and the Pearson chi-square test were used. Results: Women presented a higher prevalence and risk (R.R. = 1.86, 95%CI: 1.80-1.92) of suffering traffic-related accidents. Likewise, industrial sector workers in the 18 to 35 year age group (R.R. = 1.16, 95%CI: 1.12-1.20) are at greater risk oftraffic-related accidents than other economic activity sectors and age groups. There is a trend toward an increased likelihood of dying from a traffic-related accident (R.R. = 1.66, 95%CI: 1.43-1.92) than from an accident at the workplace. Conclusions: Our results identify traffic-related occupational accidents as a priority in occupational and public health. There is a need for more research and increased awareness of these accidents on the part of public authorities and employers in Ecuador(AU)

Consenso chileno de técnicas de kinesiología respiratoria en pediatría / Chilean consensus about pediatric chest physioterapy

Chest physiotherapy is currently an outstanding therapeutic tool for the management of pediatric respiratory patients. Many and varied techniques, manual and assisted, have been developed, some requiring patient collaboration. The development of knowledge and the pathophysiological understanding of respiratory diseases in recent years has generated the need to agree on the terminology, the fundamentals and the application of each of the kinesthetic techniques of respiratory treatment in the pediatric field. The objective of this document was to compile the available literature related to the physiological mechanisms, indications, procedural aspects and most frequently used techniques in our country, with the purpose of being a guideline for the clinical practice of professionals and students. The following techniques were included: prolonged slow expiration, slow expiration with glottis opened, autogenic drainage, assisted autogenic drainage, active cycle, compression/decompression, airway clearance, forced expiration techniques, cough and respiratory exercises.

La kinesiología respiratoria es actualmente una herramienta terapéutica destacada para el manejo de los pacientes respiratorios pediátricos. Se han desarrollado muchas y variadas técnicas, manuales y asistidas, algunas requiriendo colaboración del paciente. El desarrollo del conocimiento y la comprensión fisiopatológica de las enfermedades respiratorias en los últimos años ha generado la necesidad de consensuar la terminología, los fundamentos y la aplicación de cada una de las técnicas kinésicas de tratamiento respiratorio en el ámbito pediátrico. El objetivo de este documento fue recopilar la literatura disponible relacionada con los mecanismos fisiológicos, indicaciones, aspectos procedimentales y técnicas más utilizadas en nuestro país, con el propósito de ser una directriz que oriente la práctica clínica de profesionales y estudiantes en formación. Se incluyeron así las siguientes técnicas: espiración lenta prolongada, espiración lenta con glotis abierta, drenaje autógeno, drenaje autógeno asistido, ciclo activo, presión/descompresión, bloqueos torácicos, técnicas de espiración forzada, tos y ejercicios respiratorios.

The importance of cutaneous feedback on neural activation during maximal voluntary contraction.

PURPOSE: The purpose of this study was to investigate the importance of cutaneous feedback on neural activation during maximal voluntary contraction (MVC) of the ankle plantar flexors. METHODS: The effects of cutaneous plantar anaesthesia were assessed in 15 subjects and compared to 15 controls, using a one-day pre/post-repeated measures design. Cutaneous plantar anaesthesia was induced by lidocaine injection at the centre of forefoot, lateral midfoot, and heel. Each subject performed isometric MVCs of the ankle plantar flexors. During each isometric ramp contraction, the following variables were assessed: maximal isometric torque; surface electromyography (EMG) activity of the medial gastrocnemius (MG) and tibialis anterior (TA) muscles; and co-contraction index (CCI) between the MG and TA. RESULTS: For ankle torque, two-way ANOVA showed no significant interaction between the pre/post-measurements × group (p = 0.166). However, MG activity presented significant interactions between the pre/post-measurements × group (p = 0.014). Post hoc comparisons indicated a decrease of MG activity in the experimental group, from 85.9 ± 11.9 to 62.7 ± 30.8% (p = 0.016). Additionally, the post-anaesthesia MG activity of the experimental group differed statistically with pre- and post-MG activity of the control group (p = 0.027 and p = 0.008, respectively). For TA activity and CCI, two-way ANOVA detected no significant interactions between the pre/post-measurements × group (p = 0.605 and p = 0.332, respectively). CONCLUSION: Our results indicate that during MVC, cutaneous feedback modulates neural activity to MG muscle, without changing the extent of MG-TA co-contraction.

Utilización de aprendizaje basado en equipos, como metodología activa de enseñanza de farmacología para estudiantes de Enfermería / The use of equipment-based learning as an active methodology teaching for pharmacology to Nursing studen

Introducción: el cambio de la sociedad desde una economía basada en la industria a una sustentada en el conocimiento, genera un cambio de paradigma en educación. Esto lleva a las universidades a modificar sus modelos educativos y formar profesionales capaces de responder a las necesidades del entorno. Esta propuesta exige cambiar las estrategias tradicionales de enseñanza-aprendizaje a metodologías activas e innovadoras. Team based learning es un alternativa innovadora que mezcla aspectos de docencia tradicional con los beneficios del trabajo en grupos pequeños dentro de cursos numerosos. Objetivo: dar a conocer la experiencia del uso de Team based learning como metodología activa de aprendizaje en la asignatura de farmacología para estudiantes de enfermería. Métodos: se utilizó un diseño de estudio experimental en una población de 96 estudiantes de enfermería, los cuales fueron divididos en tres grupos de 32 estudiantes cada uno. Se consideró dos grupos control y un grupo experimental. El análisis del efecto del uso de Team based learning se evaluó de forma cuantitativa y cualitativa. Resultados: los estudiantes que realizaron Team based learning obtuvieron mejores calificaciones al ser comparados con los estudiantes que utilizaron metodología tradicional. Los estudiantes, del grupo experimental, manifestaron su alto grado de satisfacción por el uso de Team based learning, ya que estimuló su aprendizaje y además, favoreció el trabajo en equipo. Conclusiones: Team based learning es una metodología de enseñanza aprendizaje que promueve el autoaprendizaje y el trabajo en equipo, ello se traduce en mejores resultados académicos, es una herramienta bien aceptada por los alumnos y considerada una forma divertida y dinámica de aprender(AU)

Introduction: The change of society from an industry-based to a knowledge-based economy generates a paradigm shift in education. This leads universities to modify their educational models and train professionals able to respond to the needs of the environment. This proposal requires changing traditional teaching-learning strategies to active and innovative methodologies. Team based learning is an innovative alternative that mixes aspects of traditional teaching with the benefits of working in small groups within numerous courses. Objective: To present the experience of the use of Team based learning as an active learning methodology in the subject of pharmacology for nursing students. Methods: An experimental study design was used in a population of 96 nursing students, who were divided into three groups of 32 students each. Two control groups and one experimental group were considered. The analysis of the effect of using Team based learning was quantitatively and qualitatively assessed. Results: The students who performed Team based learning obtained better marks when compared to students who used the traditional methodology. The students of the experimental group expressed their high satisfaction with the use of Team based learning, since it stimulated their learning and also favored teamwork. Conclusions: Team based learning is a teaching-learning methodology that promotes self-learning and teamwork, which is translated into better academic outcomes, is a tool well accepted by students and considered a fun and dynamic way to learn(AU)

Utilización de aprendizaje basado en equipos, como metodología activa de enseñanza de farmacología para estudiantes de Enfermería / The use of equipment-based learning as an active methodology teaching for pharmacology to Nursing studen

Introducción: el cambio de la sociedad desde una economía basada en la industria a una sustentada en el conocimiento, genera un cambio de paradigma en educación. Esto lleva a las universidades a modificar sus modelos educativos y formar profesionales capaces de responder a las necesidades del entorno. Esta propuesta exige cambiar las estrategias tradicionales de enseñanza-aprendizaje a metodologías activas e innovadoras. Team based learning es un alternativa innovadora que mezcla aspectos de docencia tradicional con los beneficios del trabajo en grupos pequeños dentro de cursos numerosos. Objetivo: dar a conocer la experiencia del uso de Team based learning como metodología activa de aprendizaje en la asignatura de farmacología para estudiantes de enfermería. Métodos: se utilizó un diseño de estudio experimental en una población de 96 estudiantes de enfermería, los cuales fueron divididos en tres grupos de 32 estudiantes cada uno. Se consideró dos grupos control y un grupo experimental. El análisis del efecto del uso de Team based learning se evaluó de forma cuantitativa y cualitativa. Resultados: los estudiantes que realizaron Team based learning obtuvieron mejores calificaciones al ser comparados con los estudiantes que utilizaron metodología tradicional. Los estudiantes, del grupo experimental, manifestaron su alto grado de satisfacción por el uso de Team based learning, ya que estimuló su aprendizaje y además, favoreció el trabajo en equipo. Conclusiones: Team based learning es una metodología de enseñanza aprendizaje que promueve el autoaprendizaje y el trabajo en equipo, ello se traduce en mejores resultados académicos, es una herramienta bien aceptada por los alumnos y considerada una forma divertida y dinámica de aprender(AU)

Introduction: The change of society from an industry-based to a knowledge-based economy generates a paradigm shift in education. This leads universities to modify their educational models and train professionals able to respond to the needs of the environment. This proposal requires changing traditional teaching-learning strategies to active and innovative methodologies. Team based learning is an innovative alternative that mixes aspects of traditional teaching with the benefits of working in small groups within numerous courses. Objective: To present the experience of the use of Team based learning as an active learning methodology in the subject of pharmacology for nursing students. Methods: An experimental study design was used in a population of 96 nursing students, who were divided into three groups of 32 students each. Two control groups and one experimental group were considered. The analysis of the effect of using Team based learning was quantitatively and qualitatively assessed. Results: The students who performed Team based learning obtained better marks when compared to students who used the traditional methodology. The students of the experimental group expressed their high satisfaction with the use of Team based learning, since it stimulated their learning and also favored teamwork. Conclusions: Team based learning is a teaching-learning methodology that promotes self-learning and teamwork, which is translated into better academic outcomes, is a tool well accepted by students and considered a fun and dynamic way to learn(AU)

[Effects of vitamin C administration on cholesterol gallstone formation]. / Efecto de la ingesta de vitamina C en el proceso de formación de cálculos biliares de colesterol.

BACKGROUND: Biliary cholesterol is transported by vesicles and micelles. Cholesterol microcrystals are derived from thermodynamically unstable vesicles. In experimental animals vitamin C deficiency leads to a super-saturation of biliary cholesterol and to the formation of gallstones. AIM: To search for a possible relationship between serum levels of vitamin C and the formation of cholesterol gallstones in patients with cholelithiasis. MATERIAL AND METHODS: Thirteen patients with cholelithiasis and a programmed surgical intervention were treated with 2 g/day of vitamin C per os for two weeks before surgery. Forty nine patients subjected to a cholecystectomy not supplemented with vitamin C were studied as controls. Plasma concentrations of vitamin C and lipid profiles were measured. The cholesterol saturation index, crystallization time, cholesterol and phospholipid content in vesicles and micelles, separated by gel filtration chromatography, were studied in bile samples obtained from the gallbladder. RESULTS: Vitamin C supplementation did not change significantly plasma lipids and bile lipid concentrations. However, in supplemented patients, significant reductions in vesicular cholesterol content (6.5 ± 4.8% compared to 17.9 ± 14.0% in the control group; p < 0.05) and vesicular cholesterol/phospholipid ratio (0.71 ± 0.53 compared to 1.36 ± 1.15 in controls; p < 0.05), were observed. CONCLUSIONS: Vitamin C administration may modify bile cholesterol crystallization process, the first step in cholesterol gallstone formation.