Alunos canhotos de odontologia da cidade de Uberlândia: perfil, ergonomia e dores osteomusculares / Left-handed dentistry students in the city of Uberlândia: profile, ergonomics and muscular pain

Os dentistas são um grupo de alto risco para o desenvolvimento de doenças de desordens musculoesqueléticas e tendo em vista que o sistema de produção industrial desenvolve produtos que atendem a maioria da população destra, os estudantes canhotos precisam se adequar a uma formação acadêmica, usando instrumentais, cadeiras odontológicas eoutros objetos projetados para destros. O presente trabalho teve como objetivo a coletade informações sobre os canhotos nos cursos de Odontologia da cidade de Uberlândia ­Minas Gerais. Foram incluídos todos os alunos canhotos matriculados no ano de 2022 e que estavam cursando ou já cursaram disciplinas com atividades laboratoriais ou clínicas. Questionários foram aplicados para identificação do perfil, das dificuldades, da ergonomia e das dores osteomusculares dos alunos canhotos em suas atividades. Os dados foram em seguida tabulados e passaram por análise estatística. Da quantidade total de alunos das três instituições (n=1.578), foram entrevistados 45 (2,8%) alunos canhotos, sendo a maioria feminina (80%), na qual identificou-se um posicionamento inadequado do operador canhoto quando comparado ao preconizado pela ISO-FDI, além da limitação de movimento na presença de auxiliar (82,2%). Os locais com maior frequência de dor/desconforto foram: pescoço (79%), costas superior esquerda (63%) e inferior esquerda (61%) e punhos/ mãos esquerda (56%). A intensidade da dor variou entre alguma, moderada e bastante. O impedimento de realizar atividades diárias foi relatado por 17% dos alunos (n=7) e destes somente 1 buscou atendimento médico. Não houve diferença estatística na comparação entre instituição pública e privada. Diante dos resultados, concluiu-se que os canhotos representam minoria dos alunos de Odontologia e apresentam várias regiões de dor/ desconforto devido às adaptações e posturas erradas durante os atendimentos. Apesar de grande parte apresentar dor, poucos tiveram impedimento de atividades rotineiras ou procuraram ajuda médica(AU)

Dentists are a high risk group for the development of musculoskeletal disorders and considering that the industrial production system develops products that serve the majority of the right-handed population, lefthanded students need to adapt to an academic training, using instruments, dental chairs and other objects designed for right-handers. This study aimed to collect information about left-handers in Dentistry courses in the city of Uberlândia - Minas Gerais. All left- handed students enrolled in the year 2022 and who were taking or had taken courses with laboratory or clinical activities were included. Questionnaires were applied to identify the profile, difficulties, ergonomics and musculoskeletal pain of left-handed students in their activities. The data were tabulated and then undergo statistical analysis. Of the total number of students from the three institutions (n=1,578), 45 (2.8%) left-handed students were interviewed, the majority being female (80%), in which an inadequate positioning of the left-handed operator was identified when compared to the recommended one by ISO-FDI, in addition to limitation of movement in the presence of an assistant (82.2%). The places with the highest frequency of pain/discomfort were: neck (79%), upper left back (63%) and lower left back (61%) and left wrists/hands (56%). The intensity of pain varied between some, moderate and a lot. The impediment to carrying out daily activities was reported by 17% of the students (n=7) and of these, only 1 sought medical attention. There was no statistical difference when comparing public and private institutions. In view of the results, it was concluded that left-handers represent a minority of dentistry students and have several regions of pain/discomfort due to adaptations and wrong postures during consultations. Although most of them had pain, few were prevented from performing routine activities or sought medical help(AU)

Efectividad de la entrevista motivacional en la atención fisioterápica de los trastornos musculoesqueléticos de la espalda / Effectiveness of the motivational interview in the physiotherapy care of musculoskeletal disorders of the back: A quasi-experimental study

Objetivo: Evaluar la efectividad de la entrevista motivacional (EM) junto al tratamiento fisioterapéutico habitual en pacientes con trastornos musculoesqueléticos (TME) de la espalda en atención primaria (AP). Métodos: Estudio cuasiexperimental en pacientes que iniciaron su tratamiento en el año 2020 en una unidad de fisioterapia tras diagnóstico médico de TME en la espalda, con seguimiento prospectivo de 2grupos con actuación terapéutica: grupo experimental (GE) y grupo de control (GC). Se empleó la EM solo en el GE. A ambos grupos se les entrevistó telefónicamente a los 3y 6meses de finalizar el tratamiento fisioterápico, preguntando por el cumplimiento de pautas domiciliarias y por la percepción subjetiva del estado de salud (escala de Barthel). Se ajustaron modelos de regresión lineales (coeficiente de regresión, IC del 95%) y logísticos (OR, IC del 95%). Resultados: La población de estudio fue de 154 personas (76,6% mujeres). La salud percibida fue significativamente mejor (p<0,001) en el GE que en el GC, tanto a los 3meses de seguimiento (7,4 versus 5,0, respectivamente) como a los 6(7,1 versus 4,6, respectivamente). Hubo una fuerte asociación entre percepción de salud y cumplimiento (coeficiente de regresión 3,0 [IC del 95%=2,5-3,4]). La asociación entre la EM y el cumplimiento terapéutico se mantuvo tras ajustes multivariados (OR a 6meses=383,6 [IC del 95% = 31,0-4.742,4]). Conclusiones: la incorporación de la EM como complemento de los tratamientos de fisioterapia es una herramienta factible y efectiva para mejorar el cumplimiento de las pautas domiciliarias y la percepción subjetiva de salud. (AU)

Objective: To evaluate the effectiveness of motivational interviewing (MI) combined with the usual physiotherapy treatment in patients with back musculoskeletal disorders (MSD) in primary care (PC). Methods: Quasi-experimental study with 2groups with therapeutic action (control group and experimental group) and prospective follow-up, in a physiotherapy unit in PC, in patients who began their treatment in 2020, with a medical diagnosis of MSD in the back. MI was used only in the face-to-face visits of the experimental group. Both groups were interviewed by telephone about 3and 6months after finishing the physiotherapy treatment. For this purpose, the Barthel scale was used for the subjective perception of the state of health, and the scale of compliance with home guidelines. Linear (regression coefficient, 95% CI) and logistic (OR, 95% CI) regression models were fitted. Results: The study population was 154 people (76.6% women). Perceived health was significantly better (P<.001) in the experimental group than in the control group, both at 3(7.4 versus 5.0, respectively) and at 6months of follow-up (7.1 versus 4.6, respectively). There was a strong association between perceived health and compliance (regression coefficient 3.0 [95% CI=2.5–3.4]). The strong association between MI and treatment adherence was maintained after multivariate adjustments (6-month OR=383.6 [95% CI 31.0–4742.4]). Conclusions: MI is a feasible and effective complement to physiotherapy treatments to improve compliance with home recommendations and subjective perception of health. (AU)

High α-diversity of skin microbiome and mycobiome in Japanese patients with vitiligo.

BACKGROUND: Vitiligo is an acquired pigmentary disorder characterized by depigmented patches on the skin that majorly impact patients' quality of life. Although its etiology involves genetic and environmental factors, the role of microorganisms as environmental factors in vitiligo pathology remains under-researched. OBJECTIVES: Our study explored the presence of characteristic bacterial and fungal flora in vitiligo-affected skin and investigated their potential roles in vitiligo pathogenesis. METHODS: We sequenced bacterial 16S rRNA and the fungal ITS1 region from skin swabs collected at frequently affected sites, namely the forehead and back, of patients with vitiligo. We analyzed bacterial and fungal flora in lesional and non-lesional areas of patients with vitiligo compared with corresponding sites in age- and sex-matched healthy subjects. RESULTS: Our findings revealed elevated α-diversity in both bacterial and fungal flora within vitiligo lesions compared with healthy controls. Notably, bacterial flora exhibited a distinctive composition in patients with vitiligo, and the proportional representation of Enterococcus was inversely correlated with the degree of vitiligo progression. Gammaproteobacteria, Staphylococcus spp., and Corynebacterium spp. were more abundant in vitiligo patients, with notable Staphylococcus spp. prevalence during the stable phase on the forehead. Conversely, the proportion of Malassezia sympodialis was lower and that of Malassezia globosa was higher in the progressive phase on the back of vitiligo patients. CONCLUSION: Our study identified some characteristic bacterial and fungal groups associated with vitiligo activity and prognosis, highlighting the potential roles of microorganisms in pathogenesis and offering insights into personalized disease-management approaches.

Vibration reduction of human body biodynamic response in sitting posture under vibration environment by seat backrest support.

Four-degree-of-freedom (4-DOF) human-chair coupling models are constructed to characterize the different contact modes between the head, chest back, waist back and backrest. The seat-to-head transfer ratio (STHT) is used as an evaluation metric for vibration reduction effectiveness. The simulated vibration reduction ratio of the model is close to the experimental results, which proves the validity of the model. The peak STHT is obviously reduced (P < 0.05, T-test) with seat-backrest support. The experiments show that supporting the head ( a 1 , P < 0.05, Wilcoxon matched-pairs signed ranks) has the best vibration reduction effect (21%), supporting the chest back ( a 2 , P < 0.05) has a reduced effect (11%), and supporting the waist back ( a 3 , P < 0.05) has the weakest effect (4%). When the upper torso is in full contact with the backrest, the peak STHT curve and resonance frequency are positively correlated with the contact stiffness of the seat surface and negatively correlated with the contact damping. In order to reduce the seat-to-head transfer ratio, the lowest STHT peak and lowest total energy judgments were proposed as the selection methods for the selection of the contact stiffness and damping of the backrest in two environments (periodic and non-periodic excitation), respectively.

The effect of lower back and lower-extremity kinesiology taping on static balance and physical function performance in people with multiple sclerosis: A pilot study.

INTRODUCTION: Multiple sclerosis (MS) can lead to numerous deficits in body functions, including balance and mobility impairment. This study examined the effect of lower back and lower extremity kinesiology tape (KT) application on static balance and physical functioning performance in people with MS (pwMS) and compared that to a non-elastic tape. METHODS: This pilot randomized study recruited and enrolled 10 participants with MS that were allocated into two groups: kinesio (n = 6) and non-elastic (n = 4) tape. Participants were assessed with and without the respective tape on static balance with eyes open and closed and various physical function tests. RESULTS: Effect sizes for the Kinesio tape intervention were found to be small, while effect sizes for the sham tape/place condition varied from small to high. For both groups, the tendency was to reduce or maintain performance on the tests comparing tape and no tape. A subsequent, mixed-factor ANOVA revealed no significant difference between KT or sham tape/placebo. CONCLUSION: Our findings suggest that KT applied on lower back and lower extremity muscles does not seem to improve static balance and physical function performance in pwMS.

Comparison and Evaluation of the Accuracy for Thoracic and Lumbar Pedicle Screw Fixation in Early-Onset Congenital Scoliosis Children.

BACKGROUND: Compared to adult scoliosis, correcting scoliosis in children often presents greater challenges. This is attributed to two key factors. Firstly, it involves accounting for the growth potential of children. Secondly, the thinner pedicles in children can complicate screw insertion, particularly when dealing with existing deformities. The utilization of intraoperative navigation technology offers a modest improvement in the precision of screw placement but does come with the drawback of increased radiation exposure. The aim of this study is to investigate and assess the accuracy of manually inserting pedicle screws in the thoracic and lumbar spine to rectify deformities in children with early-onset congenital scoliosis. METHODS: In this retrospective study, 26 hospitalized patients diagnosed with early-onset congenital scoliosis between December 2014 and December 2019 were selected. The cohort comprised 16 boys and 10 girls, aged between 2 and 10 years, with an average age of 4.68 ± 2.42 years. Pedicle screw fixation was applied in the segment spanning from T1 to L5. Pedicle screws were inserted manually, guided by the positioning of the C-arm and anatomical markers. The assessment of pedicle screw placement was based on the distance of penetration into the medial, lateral, or anterior bone cortex of the vertebral body, including the pedicle, categorized into three grades: Grade 1 (placement <2 mm), Grade 2 (placement between 2-4 mm), and Grade 3 (placement >4 mm). Grade 1 indicates accurate pedicle screw placement, while Grades 2 and 3 signify abnormal pedicle screw placement. Complications related to pedicle screw insertion were also recorded, both during and after the surgical procedure. RESULTS: A total of 173 pedicle screws were inserted in this study, with an average of 6.65 screws per patient. Accurate screw placement was achieved in 143 cases (82.7%), while 30 pedicle screws were found to be abnormal. Among the abnormal screws, 24 were categorized as Grade 2 (13.9%), and 6 as Grade 3 (3.5%). Grade 2 abnormalities were distributed across 20 thoracic vertebrae and 4 lumbar vertebrae, while Grade 3 abnormalities affected 5 thoracic vertebrae and 1 lumbar vertebra. When comparing the lumbar and thoracic vertebral regions, a significant difference in the rate of abnormal screw placement was observed (χ2 = 5.801, p < 0.05). The rate of abnormal screw placement was higher in the thoracic vertebral region with abnormal vertebral bodies than in the lumbar vertebral regions. Furthermore, a statistically significant difference in the rate of abnormal screw placement was found between the concave and convex sides (χ2 = 23.047, p < 0.05). The concave side of the abnormal vertebral body had a higher rate of abnormal screw placement (55.6%, 15/27) compared to the convex side (20.1%, 7/34), and this difference was statistically significant (p < 0.05). Throughout the intraoperative and postoperative follow-up period, spanning from 12 to 56 months, only one patient experienced issues with wound healing, and no complications related to pedicle screw placement occurred, such as hemopneumothorax, pedicle fracture, nerve root injury, aortic injury, screw loosening, pullout or breakage, or spinal cord injury. CONCLUSIONS: In children under 10 years of age with early-onset congenital scoliosis, the freehand placement of thoracic and lumbar pedicle screws demonstrates a high level of accuracy. Moreover, complications associated with pedicle screw insertion are infrequent following surgery. It is advisable to exercise caution when placing pedicle screws in thoracic vertebral bodies and morphologically abnormal vertebral bodies, with particular attention to the concave side when screw placement is required in these regions.

Effect of taping on posture of thoracic region in patients with thoracic kyphosis using acceleration.

BACKGROUND: In the working environment of modern society, a poor sitting posture for a prolonged time may lead to abnormal spinal alignment such as thoracic kyphosis (TK). OBJECTIVE: This study aimed to evaluate the efficacy of taping for posture correction of patients with TK, providing theoretical and empirical guidance for clinicians attempting to rectify TK posture. METHODS: The study included 15 subjects aged 30-60 years, all with a TK angle of ⩾ 40∘. Subjects were required to ascend and descend a set of three steps (a low step, high step, and second low step) under three different conditions: without tape assistance, with taping assistance using 20% elongation, and with taping assistance using 40% elongation. A triaxial accelerometer was employed to measure and compare the anterior-posterior (AP), vertical (VT), and medial-lateral (MIL) movements of the thoracic vertebrae in the different conditions. RESULTS: There were no significant differences in the MIL (P= 0.903) or AP (P= 0.114) movements between the no tape assistance and 20% elongation taping conditions. However, a significant difference was found in the VT movement (P= 0.017). Comparing the no assistance condition to the 40% elongation taping condition, no significant changes were noted in the MIL movement (P= 0.650), but significant differences were detected in both the VT (P= 0.003) and AP movements (P= 0.016). No significant differences were found in any of the three measurements between 20% and 40% elongation taping. CONCLUSION: Taping serves as an effective method for immediately improving kyphotic posture. It corrects the position of the scapula and cervicothoracic line and exerts passive retraction on the relevant muscles, thus mitigating trunk imbalance.

Water depth and speed may have an opposite effect on the trunk vertical displacement in horses trotting on a water treadmill.

OBJECTIVE: To measure the trunk vertical displacement (VD) in horses trotting on a water treadmill (WT) at different water depths (WDs) and speeds. ANIMALS: 6 sound Standardbred horses (median age 12 years [IQR:10.5-12]). METHODS: The horses were trotted on a WT at 2 speeds (3.5 m/s and 5 m/s) and during 4 conditions: dry treadmill (DT), WD at mid-cannon (WD-CAN), mid-radius (WD-RAD), and shoulder (WD-SHOUL). The dorsoventral movement was obtained with accelerometers placed over the withers, thoracolumbar junction (T18), tuber sacrale (TS), and sacrum (S5). The VD was defined with the median value of the upward (Up) and downward (Down) amplitudes of the vertical excursion during each stride. The difference of VD at each sensor location was compared between the DT and the 3 WDs, and between the 2 trotting speeds for the same condition. RESULTS: The VD amplitudes were significantly increased at any sensor location when trotting in water at WD-CAN and WD-RAD compared to DT (P < .05 for all), with the highest increase at WD-RAD and T18. When the speed increased from 3.5 to 5 m/s, the VD amplitudes were significantly decreased at T18 at each water level (P = .03), and at WD-RAD only for the withers and TS (P = .03). CLINICAL RELEVANCE: Both water depth and speed affect the trunk VD in horses at trot on a WT with an opposite effect. The VD increases when increasing the WD up to mid-radius, while the VD decreases when increasing the trotting speed, with the main effects observed at the thoracolumbar junction.

Conjoined thoracodorsal perforator-supercharged dorsal intercostal artery perforator propeller flap for reconstruction of a complex upper back defect: Case report and review of the literature on supercharged pedicled perforator flaps.

The reported complications' rate of perforator propeller flaps is variably high, but the etiology of distal flap necrosis, potentially linked to vascular insufficiency, is yet to be clarified. Vascular augmentation procedures have been previously described involving an extra anastomosis of a superficial vein, while a perforator-to-perforator supercharging approach has been only sporadically documented in literature. We present a case of perforator-to-perforator vascular supercharging of an extended dorsal intercostal artery perforator (DICAP) propeller flap to provide a salvage option for pedicled flap complicated by venous congestion. A 71-year-old male patient underwent Dermatofibrosarcoma Protuberans resection in the upper back, leading to a 17 × 17 cm defect with bone exposure. A 30 × 9 cm DICAP propeller flap was planned, with the distal third of the flap designed over the adjacent Thoracodorsal artery perforasome, in a conjoined fashion. Considering the small DICAP pedicle caliber and the flap lateral extension, a thoracodorsal artery perforator vein was dissected and included in the distal flap. Once the flap was raised on its main pedicle, the skin paddle turned blue, showing signs of venous insufficiency. Indocyanine green angiography (ICG) showed a viable proximal half of the flap. Hence, after rotating the skin paddle to reach the upper margin of the defect, an additional anastomosis between the perforating thoracodorsal vein and the perforating vein of the dorsal scapular pedicle was performed according to the perforator-to-perforator approach. Doing so, both clinical and ICG examinations showed a well perfused flap, with normal capillary refill. The postoperative course was uneventful, and the patient obtained a good oncological and reconstructive result 4 months postoperatively. The second Vasconez law ("all of the flap will survive except the part that you need") is often encountered in propeller flaps surgery. Our case shows that it is possible to prevent or overcome this problem by planning appropriate vascular augmentation procedures according to the perforator-to-perforator approach, being guided by advanced vascular imaging tools like ICG.