Neuropathy of the suprascapular and axillary nerves in rotator cuff arthropathy: a prospective electrodiagnostic study.

PURPOSE: Prevalence of axillary (AN) and/or suprascapular (SSN) neuropathy in rotator cuff tear arthropathy (RCTA) is unknown. We aimed to prospectively evaluate for preoperative neurodiagnostic abnormalities in order to determine their prevalence, location, and influence on reverse shoulder arthroplasty (RSA) outcomes. METHODS: Patients who underwent RSA for RCTA were prospectively included. An electromyography and nerve conduction study were performed pre and post-surgery. Clinical situation: VAS, Relative Constant-Murley Score (rCMS) and ROM over a minimum of two years follow-up. RESULTS: Forty patients met the inclusion criteria; mean follow-up was 28.4 months (SD 4.4). Injuries in RCTA were present in 83.9% (77.4% in AN and 45.2% in SSN). There were no differences on preoperative VAS, ROM, and rCMS between patients with and without preoperative nerve injuries. Four acute postoperative neurological injuries were registered under chronic preoperative injuries. Six months after RSA, 69% of preoperative neuropathies had improved (82.14% chronic injuries and 77.7% disuse injuries). No differences in improvement between disuse and chronic injuries were found, but patients with preoperative neuropathy that had not improved at the postoperative electromyographic study at six months, scored worse on the VAS (1.44 vs 2.66; p .14) and rCMS (91.6 vs 89.04; p .27). CONCLUSIONS: The frequency of axillary and suprascapular neuropathies in RCTA is much higher than expected. Most of these injuries improve after surgery, with almost complete neurophysiological recovery and little functional impact on RSA. However, those patients with preoperative neuropathies and absence of neurophysiological improvement six months after surgery have lower functional results.

Functional results of Circumferential Capsular Release in adhesive shoulder capsulitis. Comparative study of patients over and under fifty years of age.

INTRODUCTION: The aim of our study is to evaluate the functional and mobility outcomes in patients who have undergone arthroscopic circumferential arthrolysis of the shoulder and to find out if there are differences in the results in relation to the patient's age. MATERIALS AND METHODS: This is a retrospective case series of patients with idiopathic adhesive capsulitis treated by arthroscopic 360º circumferential capsulotomy in lateral position and followed for a minimum of 2 years. Range of motion (ROM), functional outcomes using the Constant Score (CS), health-related quality of life outcomes with the EuroQol Five Dimensions tool (EQ-5D), pain using the Visual Analogue Scale (VAS). RESULTS: A total of 26 shoulders were included, 10 men (41.7%) and 14 women (58.3%), with 2 patients being bilateral. The mean age was 48.64 ± 7.5 years, and the mean follow-up was 50.2 months. Postoperative ROM improved significantly compared to preoperative ROM (p < 0.05). Shoulder forward flexion improved by 38.6° (95%CI 22.3-54.9, p < 0.01), abduction by 35.2° (95%CI 17.6-52.8, p < 0.01) and external rotation by 21.9° (95%CI 12.8-30.9, p < 0.01 p < 0.01). Median internal rotation improved from buttock to T12 (p < 0.01). The mean improvement in CS was 54.3 ± 24.4 points (p < 0.01). The EQ-5D and VAS scores at the end of follow-up were 0.73 ± 0.23 and 2.73 ± 2.55, respectively. There were no statistical differences between young patients and patients aged 50 years or older in ROM or functional results. CONCLUSIONS: Patient age did not affect outcomes significantly, with patients older than 50 years showing similar results to younger patients.

Do the humeral radiographic changes at 5-year follow-up affect the clinical outcomes of press-fit humeral stems in primary reverse shoulder arthroplasties?

INTRODUCTION: The purposes of this study were to analyze and compare the functional outcomes and radiological changes around the press-fit humeral components in two contemporary medialized reverse total shoulder arthroplasty (RTSA) systems at a minimum of 5-year follow-up. MATERIALS AND METHODS: Between December 2003 and December 2015, 249 consecutive RTSAs were performed at our hospital. Of these, 68 primary uncemented RTSA met our inclusion criteria. The Constant-Murley score (CMS), the modified Constant score, a visual analog scale (VAS) and active shoulder range of motion (ROM) were measured pre- and postoperatively. Radiological assessment was performed by plain radiographs at a minimum of 5 years postoperatively. RESULTS: At a mean follow-up of 80.2 months, there was no significant difference (p = .59) between the postoperative functional scores and range of motion of the two groups (Delta Xtend and Lima SMR). Radiological data of stress-shielding were observed in 38 patients (55.9%) being slightly more frequent in the Lima SMR group (21 patients) than in the Delta Xtend group (17 patients) (p = .62). CONCLUSIONS: Our study shows that the good functional results are similar between the two uncemented RTSA systems used and that they do not depend on the presence of radiological changes (stress-shielding) in the humeral stem at a minimum 5-year follow-up.

Oral condition of critical patients and its correlation with ventilator-associated pneumonia: a pilot study / Condição oral de pacientes críticos e sua correlação com pneumonia associada a ventilação mecânica: um estudo piloto

Introduction: Literature has reported inadequate oral hygiene conditions in Intensive Care Unit (ICU) patients and the occurrence of Ventilator-associated pneumonia in about 9%-27% of all intubated patients. Objective: The aim of this study was to evaluate ICU patient's oral conditions and correlate this with the presence of ventilator-associated pneumonia. Material and Method: Twenty-three patients were categorized in the following way: with periodontal disease and ventilator-associated pneumonia, with periodontal disease and without ventilator-associated pneumonia, without periodontal disease and with ventilator-associated pneumonia, and with neither periodontal disease nor ventilator-associated pneumonia. The periodontal disease index, plaque index, and decay-missing-filled index were used in the assessment. Result: There was no statistically significant difference in the incidence of periodontal disease with respect to ventilator-associated pneumonia, but the number of teeth and surfaces with attachment loss above 4 mm was always greater in patients with ventilator-associated pneumonia. Conclusion: The extent of periodontal disease may contribute to the onset of ventilator-associated pneumonia. However, studies with a larger sample are needed to validate this relationship.

Introdução: A literatura vem relatando condições inadequadas de higiene oral de pacientes em unidade de terapia intensiva (UTI) e a ocorrência de Pneumonia associada à ventilação mecânica em cerca de 9%-27% de todos os pacientes intubados. Objetivo: O objetivo deste estudo foi avaliar condições orais de pacientes críticos e correlacionar com a presença de pneumonia associada à ventilação mecânica. Material e Método: Vinte e três pacientes foram categorizados da seguinte maneira: com a doença periodontal e com pneumonia associada à ventilação mecânica, com doença periodontal e sem pneumonia associada à ventilação mecânica, sem doença periodontal e com pneumonia associada à ventilação mecânica e sem doença periodontal e sem pneumonia associada à ventilação mecânica. Foram utilizados na avaliação os índices de placa, de doença periodontal e índice de cariados, perdidos e obturados. Resultado: Não houve diferença estatisticamente significante na incidência da doença periodontal em relação à pneumonia associada à ventilação mecânica, mas o número de dentes e superfícies com perda de inserção acima de 4 mm sempre foi maior em pacientes com pneumonia associada à ventilação mecânica. Conclusão: A extensão da doença periodontal pode contribuir para o aparecimento de pneumonia associada à ventilação mecânica. No entanto, são necessários estudos com uma amostra maior para validar essa relação.

Disposición y enfoques de aprendizaje en estudiantes universitarios de primer año / First-year university students’ disposition and approaches to learning

La investigación del aprendizaje autorregulado ha permitido distinguir estrategias o procesos cognitivos que el estudiante selecciona y ejecuta para alcanzar sus objetivos. Al enfrentar una tarea el estudiante analiza sus características, el contexto y sus propias capacidades adoptando estrategias de planificación y gestión de sus recursos, empleando un enfoque de aprendizaje superficial o profundo. Para describir la relación entre las variables estrategias de disposición y enfoques de aprendizaje se aplicó el Cuestionario de Estrategias de Aprendizaje a 344 estudiantes de primer año de ocho carreras de una universidad chilena. Los resultados mostraron relaciones significativas (r superior a .30, p<.001) entre estrategias de disposición y utilización de enfoque de aprendizaje profundo y entre estas variables y las horas de estudio semanales.

Research on self-regulated learning has recognized cognitive processes that students select and execute to achieve their goals. When performing a task, the student analyzes the task characteristics, context and his own capacities, employing resource planning and management, adopting either deep or superficial learning approaches. To describe the relationship between “disposition to learning strategies and” and “deep and superficial learning approaches”, the “Cuestionario de Formas de Estudio” questionnaire was applied to 344 1st year students from eight study programs of a Chilean university. The results show significant correlation (r greater than 0.30, p lower than 0.001) between disposition to learning strategies and usage ofdeep learning approaches, and between the aforementioned variables and the amount of weekly study time.

Respuesta terapéutica e histológica de pacientes con gastritis crónica y helicobacter pylori / terapéutica and histológica Answer of patients with chronic gastritis and to helicobacter pylori

El propósito de esta investigación fue demostrar el efecto de la terapia para Helicobacter Pylori (HP) sobre la histología de pacientes con gastritis crónica asociada a HP, y comparar el efecto diferencial del tratamiento para erradicación del HP versus los bloqueadores H2 sobre la histología de pacientes con gastritis crónica asociada a HP. Se seleccionaron un total de 120 pacientes con gastritis crónica y HP divididos en dos grupos: un grupo de 60 pacientes que recibieron terapia convencional para erradicación de HP en base a Omeprazol, Amoxicilina y Metronidazol y otro grupo de 60 pacientes que recibieron un bloqueador H2. La edad promedio del grupo de estudio fue de 41 +- 13.4 años, siendo para el grupo I de 40.8 +- 14.6 años y para el grupo II de 42.7 +- 12.2 años (p=0.42). El tratamiento de erradicación para HP demuestra ser más efectivo que el bloqueador H2 para disminuír la congestión (p=0.03), hemorragia (p=0.0002), erosion (p=0.03). Se observó una erradicación del HP luego del tratamiento específico del 88.4 por ciento (p=0.0001).

La proteina C reactiva en el diagnóstico diferencial de la infecciones del tracto urinario altas y bajas, 1994

El,presnte estudio transversal, se realizó entre enero y mayo de 1994, en 138 pacientes hombres y mujeres de una edad comprendida entre los 16 y 86 años, que asistieron a consulta externa de Medicina Interna de los Hospitales; Eugenio Espejo de Quito,Provincial Docente de Ambato, Provincial de Latacunga y Cantonal de Sangolquí, con sintomatología sugerente de infección del tracto urinario (UTI) y a los cuales se les realizó urocultivo para confirmar la infección urinaria y otros exámenes complemetarios como Biometría hemática, Velocidad de eritrosedimentación, urea, glucosa, creatinina, elemental y mocroscópico de orina, urocultivo, antibiograma y proteina c reactiva (PCR), para realizar el diagnóstico diferencial entre infecciones urinarias altas y bajas, por la gran diferencia sobre la morbi-mortalidad de estas dos entidades. De este estudio se obtuvo como resultados: 95 pacientes con infecciones urinarias altas y 39 con infeccciones bajas, de las infecciones altas en 70 casos el PCR fue positivo y solo en 25 casos fue negativo, mientras que en las infecciones bajas 8 casos tuvieron PCR positivo y 31 fueron PCR negativas. Otro resultado de este estudio es que la E. Coli con el 77.5 por ciento es el germen más frecuentemente involucrado en la patogenía de las infecciones de tracto urinario y luego se encuentra proteus con el 8.7 por ciento. También se obtuvo como resultado que las infecciones urinarias presentaron 80 por ciento de resistencia a la ampicilina, 51,5 por ciento a las sulfas y 41.5 por ciento a las cefalosporinas de primera generación. Como conclusión podemos afirmar que le PRC relacionado con otras variables clínicas nos permite orientar el diagnóstico diferencial de las UTI, por lo cual debe ser incluido en todo algoritmo de estudio sobre las mismas, y por otro lado afirmar que todo paciente con sintomatología sugerente de UTI debe realizarse un urocultivo, para en base a ello realizar un tratamiento adecuado: