"Penumbra sign" in knee pain: a case of distal femur osteomyelitis

"Penumbra sign" is a characteristic finding in magnetic resonance imaging (MRI) of Brodie's abscess, a rare variant of subacute osteomyelitis. We aimed to discuss the imaging finding penumbra sign that will help in the diagnosis of osteomyelitis and may be useful to clinicians in differential diagnosis. A 26-year-old male patient presented to the emergency department with complaints of pain and limping in the right knee that did not go away. He had a history of arthroscopic debridement and percutaneous fixation surgery due to osteochondral fragment 3 years ago. There were no additional findings in the patient's vital parameters, physical examination, and medical history. X-ray imaging revealed two screws in the distal femur and a well-defined sclerotic rim surrounding a radiolucent lesion anterior to the screws. MRI revealed a lesion in the distal femoral metaphysis with low-density fluid and hyperintense granulation tissue surrounding it. After surgical abscess drainage and local debridement, bone cement was placed in the resulting cavity. Teicoplanin treatment was started. The patient was discharged and complete recovery was achieved in the second month. The diagnosis of osteomyelitis is often missed or confused with bone tumors in non-traumatic cases presenting with persistent bone pain. MRI imaging is frequently used in differential diagnosis, and detection of characteristic imaging signs such as the penumbra sign accelerates the diagnosis. In this context, emergency department clinicians, in particular, should be cautious and not forget that early treatment can be started by recognizing these signs.

Obstrucción intestinal secundario a vólvulo de sigmoides en un paciente joven Reporte de un caso / Intestinal Obstruction Secondary to Sigmoid Volvulus in a Young Patient. Case report

Resumen El vólvulo de sigmoides ocurre como resultado de una torsión del eje mesentérico colónico, cuenta con una etiología multifactorial y controvertida, de fisiopatología no clara aún. Presenta un cuadro clínico de inicio inespecífico y posteriores signos y síntomas de oclusión intestinal; su diagnóstico se establece mediante tomografía computarizada, con una sensibilidad y especificidad mayor al 90%. El manejo dependerá de la condición clínica del paciente. Caso clínico: Hombre de 29 años con antecedente de síndrome de Asperger. Refirió que desde 7 días previos a su ingreso presentó dolor tipo cólico difuso, asociado a distensión abdominal e intolerancia a la vía oral. Acudió a valoración hospitalaria donde se realizóa tomografía computarizada con niveles hidroaéreos, torsión de arteria mesentérica inferior de aspecto de torbellino. Se realizó laparotomía exploradora a través de la cual se encontró sigmoides dilatado y volvulado, con perforación en la unión rectosigmoidea; se realizó sigmoidectomía con colorectoanastomosis. Al quinto día presentó datos de respuesta inflamatoria con abdomen agudo, por lo que ingresó a laparotomía exploradora donde se encontró dehiscencia de anastomosis; se realizó procedimiento de Hartmann. El paciente presentó choque séptico y falleció a las 24 horas del postquirúrgico. Discusión: La presentación de vólvulo sigmoides generalmente se presenta en personas mayores de 70 años, pocos casos se describen en personas jóvenes y están relacionados con enfermedad de dismotilidad intestinal. El paciente no contaba con factores predisponentes, el diagnóstico se estableció con imágenes características de la enfermedad, como la imagen en torbellino, se decidió manejo quirúrgico con la realización de resección con colorectoanastomosis. Conclusión: La oclusión intestinal por vólvulo sigmoides es una patología infrecuente en jóvenes y de clínica inespecífica. Ante un paciente que presente datos de oclusión intestinal deberá ser abordado de manera apropiada, sobre todo en pacientes en quienes hayan debutado con una clínica insidiosa y persistente de dolor abdominal secundario a oclusión intestinal, sean jóvenes con o sin factores de riesgo.

Abstract Sigmoid volvulus occurs due to a torsion of the colonic mesenteric axis, it has a multifactorial and controversial etiology, and its pathophysiology is not yet clear. Presenting a clinical picture of non-specific onset and later signs and symptoms of intestinal occlusion, its diagnosis is established with computed tomography with a sensitivity and specificity greater than 90%. Management will depend on the clinical condition of the patient. Clinical case: A 29-year-old man with a history of Asperger syndrome. He referred 7 days prior to admission with diffuse cramping pain, associated with abdominal distension and oral intolerance. He went to the hospital for evaluation where a computed tomography was performed with air-fluid levels, torsion of the inferior mesenteric artery with a whirlwind appearance. Exploratory laparotomy was performed, finding a dilated and volvulated sigmoid with perforation at the rectosigmoid junction. A sigmoidectomy with colorectal anastomosis was performed. On the fifth day, he presented data of inflammatory response with acute abdomen, entering exploratory laparotomy finding anastomosis dehiscence, Hartmann procedure was performed. The patient presented septic shock, died 24 hours after surgery. Discussion: The presentation of sigmoid volvulus generally occurs in people older than 70 years, few cases are described in young people and are related to intestinal dysmotility disease, the patient did not have predisposing factors, the diagnosis is established with characteristic images of the disease such as whirlwind image, surgical management is decided by performing resection with colorectal anastomosis. Conclusion: Intestinal occlusion due to sigmoid volvulus is an infrequent pathology in young people and with non-specific symptoms. When faced with a patient presenting evidence of intestinal occlusion, this should be appropriately addressed, especially in patients who have debuted with insidious and persistent symptoms of abdominal pain secondary to intestinal occlusion, whether they are young with or without risk factors.

El estudio de los efectos de la modalidad lingüística en el léxico mental / The study of the effects of linguistic modality on the mental lexicon

Resumen El estudio se cuestiona sobre un abordaje fructífero en el estudio de los efectos de la modalidad lingüística (de señas versus oral) en la organización de la memoria semántica. Para responder la pregunta de investigación, un aspecto central es definir criterios y procedimientos capaces de distinguir entre los factores transportados por la modalidad lingüística de los que le son propios. Entre los primeros, se encuentran la edad de exposición a la lengua natural y su distribución funcional, etaria o geográfica. Entre los aspectos propios de la modalidad se incluyen la iconicidad y el grado de concreción/abstracción de las piezas léxicas. Se sugiere centrarse en el uso de dicho gradiente para evocar dominios conceptuales. Si lo concreto/abstracto es un continuo, entonces hay que preguntarse qué forma de organización es predominante en el léxico mental de las poblaciones señantes u oyentes y qué factores modulan el perfil de esa organización.

Abstract The efforts to understand the relationship of the meaning of a lexical piece to the object to which it refers, the relationship between the lexical pieces and the concepts, and the understanding of the meanings shared between two speakers who use the same lexical pieces have all constituted major problems for the semantic memory models. According to contemporary literature, perceptual-motor, linguistic, and social information have different weights in the formation of concepts, whether concrete or abstract, stored in the aforementioned memory. Regardless of the models developed so far, it is interesting to note that semantic knowledge is represented by various ways of relating the concepts and the types of relationships between them. In this context, studies in sign languages and comparative studies between spoken and sign languages are scarce. Thus, little is known about the effect of linguistic modality on the semantic networks. After all, the theory on semantic networks and norms for the production of features has been grounded on theories of language and its processing adjusted to spoken languages. As the incorporation of the sign language and the Deaf population has shown in other psycholinguistic and linguistic topics, the importance of including these languages and populations, and comparatives with spoken languages, might increase the explanatory power of the theory to account for the universal and contextual aspects of language and its processing. In this effort, there is a latent risk: the linguistic modality can be only a vehicle for more well-known or studied cross-modal variables (e. g., age of acquisition, functional distribution of language, size of the available lexicon, etc.). If it is considered that languages are not stored together, but similar processes can occur in them, it is essential to find out what may be a singular feature of each modality (spoken versus sign) that might ground differentiated processes. Considering the high iconicity of the sign languages and the possibility of a high concreteness of the lexical pieces in the sign language as distinctive features -not collapsible into well-known variables such as the aforementioned-, this article suggests a careful approach to avoid the aforementioned risk in the study of the effects of the linguistic modality (sign versus oral) in the organization of semantic memory. Since perceptual-motor and social information are the main sources of iconicity, a balanced instrument is necessary in the evocation of perceptual-motor, social, and linguistic information. Repeated free word association tasks seem like an appropriate paradigm for a suggested approach. The reasons for this are that, by not censoring the types of response, then free association tasks allow capturing all kinds of concepts (concrete or abstract), all kinds of semantic relationships/organization (paradigmatic versus thematic) and all kinds of processes (comparison versus interaction). This type of task therefore makes it possible to collect meanings related to linguistic information and non-linguistic experience because affective and experiential information is accessible by doing the task in different repetitions. The approach and the tool are exemplified by an ongoing comparative study between Deaf signing and hearing populations. The partial findings of this study also serve to focus on the expected effects of the difference in iconicity and the level of concreteness/abstractness of the lexical pieces of each linguistic modality; namely, the differences between an abstract and a concrete conceptualization of the conceptual domains. Taxonomic and introspective labels might appear as indicative of paradigmatic relationships, of a taxonomic organization, and of underlying comparison processes. On the other hand, the situational and entity labels, indicative of syntagmatic relationships, of a thematic organization and of underlying interaction processes, might suggest a predominantly concrete organization.

Assessing the validity of flap motility sign in predicting the extent of anterior capsular tears in phacoemulsification

Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.

THE ‘FEEDING BRONCHUS SIGN‘ IN CAVITARY LUNG LESIONS, ITS EVALUATION WITH COMPUTED TOMOGRAPHY AND A GUARDED OPINION REGARDING PHYSIOTHERAPY

BACKGROUND Bronchiectasis and cavitation are key features of acute and chronic pulmonary infections. Cavitary lesions may carry unfavourable prognosis with regard to complete restoration of pulmonary function in few patients. OBJECTIVES To evaluate type and site of bronchiectasis, its relation with cavity formation on computed tomography and providing an insight to sorting out subjects suited for physiotherapy. A radiological sign-“Feeding bronchus sign” has been discussed with reference to bronchiectasis, its origin, natural course and a suggestion of guarded future management and rehabilitation. METHODS Total 150 chest CT scans with presence of cavity and bronchiectasis were retrospectively reviewed and followed up for type, site of bronchiectasis, signs of active infection, site of cavity and presence of “feeding bronchus sign”. Final diagnosis was confirmed by sputum sample, acid-fast bacillus test or culture or polymerase chain reaction. RESULTS Out of 150 cases, 70 (46%) had chronic and 80 (53%) had active infection. 33 (22%) had solitary and 117 (78%) had multiple cavities. 37 (34.6 %) patients had cylindrical, 11 (7.3 %) had varicose, 27 (18%) had cystic bronchiectasis, 23 (15.3%) had cylindrical and varicose, 19 (12.6%) had cylindrical and cystic and 33 (22%) had all three types. “Feeding bronchus sign” was observed in 102 (68%) patients. Radiological evidence of disease progression was seen in 21 patients, improvement in 19 and no change in 17 on follow-up CT. CONCLUSION Patients with positive “Feeding bronchus sign” are at risk for increased disease transmission and secondary opportunistic infections. Improvement and maintenance of quality of life is ultimate goal of management. Apart from antibiotics, pulmonary rehabilitation also plays an important role in cavitary lung disease

Estratégias de comunicação dos profissionais de saúde com pessoas com deficiência auditiva: revisão integrativa / Communication strategies employed by health professionals with hearing impaired people: an integrative review / Estrategias de comunicación de los profesionales de la salud con las personas con discapacidad auditiva: revisión integradora

RESUMO Objetivo: identificar estudos na literatura científica sobre a comunicação dos profissionais de saúde entre pessoas com deficiência auditiva na prestação do cuidado. Método: revisão integrativa realizada em fevereiro/2021, em 14 bases de dados e busca manual, sem recorte temporal, nos idiomas português, inglês, espanhol, através dos descritores Pessoas com Deficiência Auditiva e Profissionais de Saúde e suas variações, sem delimitação de contexto. A análise dos resultados deu-se pela organização em grupos temáticos conforme sua frequência. Resultados: 16 estudos foram selecionados, destacando-se os resultados: uso da escrita e mímica como principais estratégias de comunicação; falta de qualificação dos profissionais para uma comunicação efetiva, sendo o uso de LIBRAS a forma menos utilizada; e, sentimento de insegurança, bloqueio, incapacidade que profissionais vivenciam na comunicação com pessoas com deficiência auditiva. Conclusão: é necessário investir na qualificação dos profissionais de saúde em LIBRAS tornando a comunicação mais eficaz, contribuindo para a melhoria da prática assistencial.

ABSTRACT Objective: to identify studies in the scientific literature on the communication between health professionals and hearing impaired people during care provision. Method: an integrative review carried out in February 2021 in 14 databases and with manual search, without time frame, in Portuguese, English, Spanish and through the Hearing Impaired People and Health Professionals descriptors and their variations, without context delimitation. The results were analyzed by organizing them into thematic groups according to their frequency. Results: a total of 16 studies were selected, with the following results standing out: use of writing and mimicry as main communication strategies; non-qualification of the professionals for effective communication, with the use of LIBRAS as the least used means; and feelings of insecurity, blockage and disability experienced by the professionals in communicating with hearing impaired people. Conclusion: it is necessary to invest in health professionals' qualification in LIBRAS, making communication more effective and contributing to improvements in the care practice.

RESUMEN Objetivo: identificar estudios en la literatura científica sobre la comunicación entre los profesionales de la salud y las personas con deficiencia auditiva en la prestación de cuidados. Método: revisión integradora realizada en febrero de 2021, en 14 bases de datos y búsqueda manual, sin recorte temporal, en portugués, inglés y español, a través de los descriptores Personas con discapacidad auditiva y Profesionales de la Salud y sus variantes, sin delimitación de contexto. El análisis de los resultados se realizó organizándolos en grupos temáticos en función de la frecuencia. Resultados: Se seleccionaron 16 estudios, se destacaron los resultados: uso de la escritura y la mímica como principales estrategias de comunicación; falta de cualificación de los profesionales para lograr una comunicación efectiva, el LIBRAS es la forma menos utilizada; y, sentimiento de inseguridad, bloqueo, incapacidad que experimentan los profesionales en la comunicación con personas con deficiencia auditiva. Conclusión: es necesario invertir en la capacitación de los profesionales de la salud en LIBRAS para que haya una comunicación más efectiva que contribuya a mejorar la práctica asistencial.

Pulmonary Hydatid without Liver Involvement: A Case Series

Pulmonary hydatid is not a rare disease. But raising a suspicion for its diagnosis is limited. There are limited approaches for the diagnosis and treatment of the same. We present here four cases of pulmonary hydatid, without liver involvement, with emphasis on how it was misdiagnosed and received multiple treatment and landed into complications. Most of our cases presented with cough, sputum and hemoptysis. For these nonspecific signs and symptoms, patient is generally treated on a different line of diagnosis. Two of the cases were already treated for abscess and fungal infection. One of the patients was on antitubercular treatment. One of our cases was secondarily infected with aspergilloma. One of the cases was referred to oncologist to start chemotherapy. Interestingly, to raise a suspicion, none of our cases had liver involvement. A detailed history revealed expectoration of white salty material in sputum, living with sheep and dog and expectorating grape-like vesicles in sputum. History helped us to put hydatid as one of our differentials. Echinococcal serology was positive in three cases. Only three cases had on-table appearance of hydatid cyst. All four cases underwent surgical management for complete cure. There is need for strong suspicion and a detailed history and proper set of investigations help in timely diagnosis and management of pulmonary hydatid disease.

Effectiveness of educational video on deaf people's knowledge and skills for cardiopulmonary resuscitation: a randomized controlled trial / Efectividad de video educativo sobre conocimiento y habilidad de personas sordas para reanimación cardiopulmonar: ensayo controlado aleatorizado / Efetividade de vídeo educativo no conhecimento e habilidade de surdos para ressuscitação cardiopulmonar: ensaio randomizado controlado

ABSTRACT Objective: To analyze the effectiveness of an educational video on deaf people's knowledge and skills about cardiopulmonary resuscitation. Method: A randomized trial, carried out at three schools with 113 deaf people (control group = 57 and intervention group = 56). After the pre-test, the control group was exposed to the lecture, while the intervention group was exposed to the video. The post-test occurred immediately after the intervention and was repeated after 15 days. A validated instrument was used, with 11 questions, presented in video/Libras (to enable understanding by deaf people) and in written/printed form (to record the answers). Results: In the analysis of knowledge, the median of correct answers in the pre-test was similar between the groups (p = 0.635), while the intervention group had a higher accuracy in the immediate post-test (p = 0.035) and after 15 days (p = 0.026). In the skill analysis, the median of correct answers in the pre-test was higher in the control group (p = 0.031). There was no difference in the immediate post-test (p = 0.770), and there was a higher accuracy in the intervention group in the post-test after 15 days (p = 0.014). Conclusion: The video proved to be effective in increasing deaf people's knowledge and skills about cardiopulmonary resuscitation. Brazilian Registry of Clinical Trials: RBR-5npmgj.

RESUMEN Objetivo: Analizar la efectividad de un video educativo sobre el conocimiento y la habilidad de las personas sordas acerca de la reanimación cardiopulmonar. Método: Ensayo aleatorizado, realizado en tres escuelas con 113 personas sordas (grupo control = 57 y grupo intervención = 56). Después de la prueba previa, el grupo de control fue expuesto a la conferencia, mientras que el grupo de intervención fue expuesto al video. La posprueba se realizó inmediatamente después de la intervención, y se repitió a los 15 días. Se utilizó un instrumento validado, con 11 preguntas presentadas en video/Libras (para que los sordos comprendan) y en forma escrita/impresa (para registrar las respuestas). Resultados: En el análisis de conocimientos, la mediana de aciertos en la preprueba fue similar entre los grupos (p = 0,635), mientras que el grupo intervención tuvo mayor acierto en la posprueba inmediato (p = 0,035) y después 15 días (p = 0,026). En el análisis de habilidades, la mediana de aciertos en la preprueba fue mayor en el grupo control (p = 0,031). No hubo diferencia en la posprueba inmediato (p = 0,770), y el grupo intervención tuvo más éxito en la posprueba a los 15 días (p = 0,014). Conclusión: El video demostró ser efectivo para aumentar el conocimiento y las habilidades de las personas sordas sobre la reanimación cardiopulmonar. Registro Brasileño de Ensayos Clínicos: RBR-5npmgj.

RESUMO Objetivo: Analisar a efetividade de vídeo educativo no conhecimento e habilidade de surdos acerca da ressuscitação cardiopulmonar. Método: Ensaio randomizado, realizado em três escolas com 113 surdos (grupo controle = 57 e grupo intervenção = 56). Após o pré-teste, o grupo controle foi exposto à aula expositiva, enquanto o grupo intervenção foi exposto ao vídeo. O pós-teste ocorreu imediatamente depois da intervenção, e foi repetido após 15 dias. Foi utilizado instrumento validado, com 11 questões apresentadas em vídeo/libras (para viabilizar compreensão dos surdos) e de forma escrita/impressa (para registro das respostas). Resultados: Na análise do conhecimento, a mediana dos acertos do pré-teste foi semelhante entre os grupos (p = 0,635), enquanto houve maior acerto do grupo intervenção no pós-teste imediato (p = 0,035) e após 15 dias (p = 0,026). Na análise da habilidade, a mediana dos acertos do pré-teste foi maior no grupo controle (p = 0,031). Não houve diferença no pós-teste imediato (p = 0,770), e houve maior acerto do grupo intervenção no pós-teste após 15 dias (p = 0,014). Conclusão: O vídeo mostrou-se efetivo no aumento do conhecimento e habilidade de surdos acerca da ressuscitação cardiopulmonar. Registro Brasileiro de Ensaios Clínicos: RBR-5npmgj.

Descripción del nivel de conocimiento de los signos y síntomas de alarma obstétrica en mujeres embarazadas / Description of the level of knowledge about the signs and symptoms of obstetric alarm in pregnant women

Resumen OBJETIVO: Describir el nivel de conocimiento de los signos y síntomas de alarma obstétrica en mujeres embarazadas. MATERIALES Y MÉTODOS: Estudio de serie de casos prolectivo y descriptivo efectuado en la Unidad de Medicina Familiar 16, Instituto Mexicano del Seguro Social, Mexicali, Baja California, entre los meses de enero a junio de 2022. Variables de estudio: edad, sexo, escolaridad y nivel de conocimiento de signos y síntomas de alarma a través de una encuesta elaborada conforme a los criterios de la guía de práctica clínica. Se utilizó estadística descriptiva con el programa SPSSv24. RESULTADOS: Se estudiaron 150 pacientes embarazadas. El bajo nivel de conocimiento de los signos y síntomas de alarma se observó en 15 casos, el nivel medio en 47 casos y el nivel alto en 88 casos (58.7%). En cuanto a las características de la población, los límites de edad fueron 20 y 34 años, la escolaridad secundaria ocupó el 47.3% seguido de la preparatoria con el 35.3% y en cuanto a la ocupación el 80.7% refirió ser empleada. El 34% cursaba el primer trimestre del embarazo y el 48.7% el segundo trimestre. CONCLUSIONES: El nivel de conocimiento de las pacientes embarazadas atendidas en la unidad es alto y medio porque pueden reconocer los signos y síntomas de alarma durante el embarazo, sobre todo quienes cursan el segundo embarazo, en coincidencia con estudios nacionales e internacionales. El grupo predominante fue el de 20 a 34 años, con escolaridad media y superior.

Abstract OBJECTIVE: To describe the level of knowledge of obstetric alarm signs and symptoms in pregnant women. MATERIALS AND METHODS: Selective and descriptive case series study carried out in the Family Medicine Unit 16, Mexican Institute of Social Security, Mexicali, Baja California, between January and June 2022. Study variables: age, sex, education and level of knowledge of warning signs and symptoms through a survey prepared according to the criteria of the Clinical Practice Guide. Descriptive statistics were performed using SPSSv24. RESULTS: 150 pregnant patients were screened. A low level of knowledge of warning signs and symptoms was observed in 15 cases, a medium level in 47 cases and a high level in 88 cases (58.7%). Regarding the characteristics of the population, the age range was 20-34 years, 47.3% had secondary education, followed by high school with 35.3%, and 80.7% reported being employed. Thirty-four per cent were in the first trimester of pregnancy and 48.7 per cent in the second trimester. CONCLUSIONS: The level of knowledge of pregnant patients attending the unit is high and medium in terms of being able to recognize the warning signs and symptoms of pregnancy, particularly in the second trimester, in line with national and international studies. The predominant age group was 20-34 years, with secondary and higher education.

Percepção de sintomas osteomusculares e sua repercussão nas atividades de vida diária em intérpretes de língua de sinais / Musculoskeletal symptoms perception and its impact on language interpreters' daily lives

Resumo Objetivo: analisar a percepção de sintomas osteomusculares e sua repercussão nas atividades de vida diária referidas por intérpretes da língua brasileira de sinais (libras). Métodos: pesquisa qualitativa de natureza descritiva-analítica, utilizando a análise de conteúdo categorial temática. Foi aplicado questionário sociodemográfico e realizada entrevista semiestruturada com 12 profissionais intérpretes de libras, atuantes nas redes de ensino nos níveis fundamental, médio e superior do município de Goiânia, convidados via redes sociais, no primeiro semestre de 2021. Resultados: foram identificadas três categorias temáticas: percepção álgica, percepção de cansaço e atividades de vida diária. Os profissionais estavam trabalhando remotamente devido à pandemia da doença COVID-19, cujo regime permitiu uma flexibilização do processo de trabalho com aulas on-line, eventos, palestras e congressos a partir do domicílio do trabalhador. Houve um aumento expressivo da demanda física e psicológica, devido ao aumento das atividades a serem cumpridas e por estarem ausentes os limites entre ambiente de "trabalho" e "casa". Conclusão: os participantes apresentaram percepções negativas em todos os aspectos avaliados, evidenciando a existência de sobrecarga na atuação como intérprete de língua de sinais.

Abstract Objective: to analyze the perception of musculoskeletal symptoms and their repercussion in the activities of daily living reported by professional Brazilian sign language interpreters (LIBRAS). Methods: descritive-analytical qualitative research, using thematic categorical content analysis. We used a sociodemographic questionnaire and a semi-structured interview with 12 professional LIBRAS interpreters, working in the primary, secondary, and superior education in the municipality of Goiânia. They were invited via social media, in the first half of 2021. Results: we identified three thematic categories: pain perception, perception of tiredness, and activities of daily living. The professionals were working remotely due to the COVID-19 pandemic. This allowed flexibility in the work schedule, with online classes, events, lectures, and congresses participation from the worker's home. Conclusion: the participants had negative perceptions in all aspects evaluated, evidencing an overload in acting as a sign language interpreter in educational activities.

Instrumento de evaluación de la percepción de los contrastes mínimos en Lengua de Señas Chilena - evidencias de confiabilidad / Instrument to evaluate the perception of minimal contrasts in Chilean Sign Language - reliability evidence

RESUMEN Objetivo Obtener evidencias de confiabilidad de la prueba para evaluar la percepción de los contrastes mínimos en Lengua de Señas Chilena (LSCh). Método Participaron 10 niños y adolescentes Sordos con edades entre los 7 y 14 años, que fueron evaluados con la prueba de percepción de los contrastes mínimos en LSCh. En un primer momento se les aplicó la prueba, y entre 11 y 14 días después se les reaplicó nuevamente (confiabilidad test - retest). Para analizar los datos, fue realizada la correlación Rho de Spearman. Durante la primera aplicación se solicitó autorización a los padres de los niños y adolescentes para grabar las respuestas de los participantes para que otro evaluador pudiese repuntuar los protocolos, con el fin de obtener la confiabilidad interevaluador. Para el análisis de los datos se utilizó el cálculo estadístico first-order agreement coefficient (AC1) de Gwet. Resultados En la confiabilidad test - retest se obtuvo una correlación fuerte y significativa (Rho= 0,741; p=0,014). En la confiabilidad interevaluador, los valores de concordancia obtenidos varían entre 0,962 a 1 (p<0,001), indicando que la prueba presenta concordancia casi perfecta. Conclusión La prueba de percepción de pares de mínimos en LSCh presenta confiabilidad test - retest e interevaluador satisfactoria.

ABSTRACT Purpose Obtain evidence of the test reliability to evaluate the perception of minimum contrasts in Chilean Sign Language (LSCh). Methods Ten deaf children and adolescents aged between 7 and 14 years participated in this study. They were evaluated with the test of perception of minimal contrasts in LSCh. The test was reapplied 11 and 14 days after the first application (test-retest reliability). Spearman's Rho correlation was performed. During the first application, authorization was requested from the parents of the children and adolescents to record the responses of the participants so that another evaluator could re-score the protocols, in order to obtain inter-rater reliability. First-order agreement coefficient (AC1) Gwet's was used for data analysis. Results Test-retest obtained a strong and significant correlation (Rho= 0.741; p=0.014). The concordance values obtained inter-rater vary between 0.962 and 1 (p<0.001), indicating that the test presents almost perfect concordance. Conclusion The minimum pairs perception test in LSCh presents satisfactory test-retest and inter-rater reliability.

DC-SIGN receptor is expressed by cells from cutaneous leishmaniasis lesions and differentially binds to Leishmania (Viannia) braziliensis and L. (Leishmania) amazonensis promastigotes

BACKGROUND Dendritic cells (DCs) specific intercellular adhesion molecule (ICAM)-3-grabbing non integrin receptor (DC-SIGN) binds to subgenera Leishmania promastigotes mediating its interaction with DC and neutrophils, potentially influencing the infection outcome. OBJECTIVES In this work, we investigated whether DC-SIGN receptor is expressed in cells from cutaneous leishmaniasis (CL) lesions as well as the in vitro binding pattern of Leishmania (Viannia) braziliensis (Lb) and L. (L.) amazonensis (La) promastigotes. METHODS DC-SIGN receptor was labeled by immunohistochemistry in cryopreserved CL tissue fragments. In vitro binding assay with CFSE-labeled Lb or La promastigotes and RAJI-transfecting cells expressing DC-SIGN (DC-SIGNPOS) or mock-transfected (DC-SIGNNEG) were monitored by flow cytometry at 2 h, 24 h and 48 h in co-culture. RESULTS In CL lesion infiltrate, DC-SIGNPOS cells were present in the dermis and near the epidermis. Both Lb and La bind to DC-SIGNPOS cells, while binding to DC-SIGNNEG was low. La showed precocious and higher affinity to DC-SIGNhi population than to DC-SIGNlow, while Lb binding was similar in these populations. CONCLUSION Our results demonstrate that DC-SIGN receptor is present in L. braziliensis CL lesions and interact with Lb promastigotes. Moreover, the differences in the binding pattern to Lb and La suggest DC-SIGN can influence in a difference way the intake of the parasites at the first hours after Leishmania infection. These results raise the hypothesis that DC-SIGN receptor could participate in the immunopathogenesis of American tegumentary leishmaniasis accounting for the differences in the outcome of the Leishmania spp. infection.

Awareness of Stroke among University Employees in Kigali, Rwanda: A Cross Sectional Study

Background Awareness of stroke is important for appropriate and timely stroke prevention and management. Objective To assess the level of awareness about the risk factors, signs, and appropriate responses for stroke among university employees in Rwanda. Methods We employed a quantitative descriptive cross-sectional approach. We involved 92 participants, and a self-administered questionnaire to collect data. We computed descriptive statistics and used the Chi-Square test to assess any differences in stroke awareness. Results We found that 12% and 15.2% of the participants were not aware of any risk factor and warning sign of stroke respectively. Regarding the reaction in case a warning sign of stroke was noticed, 9.8% of the participants indicated that they would do nothing or advise the victim to take rest at home. The limited awareness was significantly higher in the administrative than academic employees for both risk factors (p=0.002) and warning signs (p=0.006), but not for the appropriate responses to stroke (p=0.426). Conclusion A significant proportion of the participants were not aware of any stroke risk factor, warning sign and appropriate responses. It is important to conduct further similar studies and implement stroke education interventions in university communities

Urticaria pigmentosa in a 9‐month‐old male: case report

@#Urticaria pigmentosa (UP) is the most common form of cutaneous mastocytosis in children. It can be diagnosed clinically, based on the appearance of numerous brownish macules and papules that are symmetrically distributed, mostly on the trunk and the extremities. Skin biopsy is helpful in establishing the diagnosis. Treatment options generally include antihistamines and/or topical corticosteroids. In most cases, pediatric UP tends to disappear spontaneously before puberty. We present the case of a 9-month-old male with a history of multiple brownish patches and plaques, which started when he was four months old. He was diagnosed with UP based on clinical and histopathologic findings, and was prescribed oral antihistamines and emollients for symptomatic treatment.

Tinker, tailor, soldier, cell: the role of C-type lectins in the defense and promotion of disease

C-type lectins (CTLs) represent a large family of soluble and membrane-bound proteins which bind calcium dependently via carbohydrate recognition domains (CRDs) to glycan residues presented on the surface of a variety of pathogens. The deconvolution of a cell's glycan code by CTLs underpins several important physiological processes in mammals such as pathogen neutralization and opsonization, leukocyte trafficking, and the inflammatory response. However, as our knowledge of CTLs has developed it has become apparent that the role of this innate immune family of proteins can be double-edged, where some pathogens have developed approaches to subvert and exploit CTL interactions to promote infection and sustain the pathological state. Equally, CTL interactions with host glycoproteins can contribute to inflammatory diseases such as arthritis and cancer whereby, in certain contexts, they exacerbate inflammation and drive malignant progression. This review discusses the 'dual agent' roles of some of the major mammalian CTLs in both resolving and promoting infection, inflammation and inflammatory disease and highlights opportunities and emerging approaches for their therapeutic modulation.

Step-by-step instructions for detecting whirlpool sign in adnexal torsion / Journal of Rural Medicine

Objective: Adnexal torsion is a common gynecological emergency whose prompt diagnosis is essential because a delay may lead to ovarian dysfunction. Although the whirlpool sign is reliable for diagnosing ovarian cyst torsion, technical difficulties hinder its use by sonographers. Here we developed a systematic approach to visualizing this sign by focusing on the fact that torsion arises from the space between the uterus and the pelvic wall. One must determine the origin of the torsion via transverse imaging of the uterus and follow the twisted ligaments to the ovarian cyst.Patients and Methods: Two women aged 56 (Case 1) and 28 years (Case 2) visited our hospital with lower abdominal pain. Transvaginal ultrasonography showed a 7-cm right ovarian cyst in Case 1 and a 5-cm cyst in the Douglas pouch in Case 2; normal bilateral ovaries and the whirlpool sign were detected in both cases. Under laparoscopic guidance in Cases 1 and 2, an ovarian cyst and a paraovarian cyst were confirmed and removed.Results: Our step-by-step method allowed us to identify the whirlpool sign and confirm adnexal torsion, leading to prompt surgery in both cases.Conclusion: Using a systematic procedure helps less experienced practitioners detect the whirlpool sign.

Effectiveness analysis of percutaneous parallel screw fixation via posterolateral "safe zone" for Hawkins type Ⅰ- Ⅲ talar neck fractures / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral "safe zone" for Hawkins type Ⅰ-Ⅲ talar neck fractures.@*METHODS@#A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral "safe zone" parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups ( P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale.@*RESULTS@#The operation time in the study group was significantly shorter than that in the control group ( P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant ( P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups ( P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups ( P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients' satisfaction in the study group were significantly better than those in the control group ( P<0.05).@*CONCLUSION@#The treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral "safe zone" can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.

The Role of Non-Contrast CT in the Diagnosis of a Rare Cause of Small Bowel Obstruction Due to Bezoar

@#Contrast Enhanced CT Abdomen is usually used to investigate the source of the small bowel obstruction. A 13-year old girl presented with signs of small bowel obstruction and was complicated with acute renal injury. Non-contrast CT Abdomen showed findings consistent with bezoar, and the findings are similar to the features seen in a contrast study. This case shows that both the plain and the contrast CT abdomen give similar findings of bezoar, one not inferior to the other.

Consistency between iodine-unstained area and tumor pathological size of endoscopic submucosal dissection specimen in superficial esophageal cancer / 中华消化内镜杂志

Objective:To investigate the consistency between the iodine-unstained area and the pathological size of endoscopic submucosal dissection (ESD) specimens of superficial esophageal cancer.Methods:A retrospective study was performed on data of 32 patients with superficial esophageal cancer who accepted ESD from May 2019 to April 2020 in the First Affiliated Hospital, Zhejiang University School of Medicine. The maximum transverse diameter and maximum longitudinal diameter of the iodine-unstained area were compared with the tumor pathological area. A size difference no more than 0.5 cm was considered as conformity, any difference between 0.5 and 1.0 cm was considered as non-conformity, and any difference no less than 1.0 cm was considered as serious non-conformity. At the same time, pink sign after spraying Lugo solution and the consistency of pink sign area with the iodine free area were observed.Results:A total of 32 patients with 33 lesions were enrolled in this study, including 23 males and 9 females and the age of the patients was 59.5±7.3 years. There were 19 (57.6%) lesions whose size of iodine-unstained area was consistent with the tumor pathological area. These 19 lesions were all positive for the pink sign, and the pink sign area overlapped with the iodine-unstained area. In addition, 4 (12.1%) iodine-unstained areas of the lesions did not match the size of the pathological area, and 10 (30.3%) iodine-unstained areas of the lesions were seriously inconsistent with the size of the pathological area. These 14 (42.4%) lesions were all positive for pink sign, and the pink sign area was significantly smaller than the iodine-unstained area. Among the 14 discordant lesions, 2 lesions underwent ESD according to the iodine-unstained area, which resulted in excessive resection and postoperative stenosis.Conclusion:Determining the extent of superficial esophageal cancer by iodine-unstained areas before ESD may lead to excessive resection of the lesions, which is related to the fact that the iodine-unstained areas of the lesions are sometimes significantly larger than the pink sign areas. Therefore, in order to achieve precise treatment, endoscopists can choose the iodine-unstained area with positive pink sign as the first choice for resection.

Research progress of ultra-high field strength 7.0 T magnetic resonance imaging in multiple sclerosis / 中华神经科杂志

Multiple sclerosis (MS) is one of the demyelinating diseases of the central nervous system, and its pathogenesis is still unclear. Magnetic resonance imaging (MRI) is an effective tool for the diagnosis and monitoring of MS, and the identification of MS lesions is increasingly updated with the development of technology. In recent years, 7.0 T ultra-high field MRI has been widely used in MS. This review will make an overview of the research progress of 7.0 T ultra-high field MRI in MS in recent years.