Dietoterapia en artritis reumatoide: Revisión de la evidencia

La artritis reumatoide (RA), es una enfermedad crónica reumática, caracterizada por un daño articular progresivo y manifestaciones extraarticulares, que pueden desencadenar una discapacidad. La etiología de las patologías autoinmunes, incluyendo la RA, es compleja, abarcando factores de tipo genético, hormonal, dietarios y ambientales. Sin embargo, los mecanismos fisiológicos por los que estos agentes contribuyen a la patogenia aún no están definidos completamente. Estudios sugieren un impacto de la disbiosis del microbioma intestinal en la patogénesis de la artritis reumatoide sugiriendo también la alteración de la permeabilidad intestinal como una posible causa. Esta se puede relacionar con patrones dietarios influyentes en la prevención de esta patología así como una propuesta de tratamiento complementario al manejo farmacológico tradicional, considerando el riesgo aumentado de estos pacientes de desarrollar síndrome metabólico y "caquexia reumatoide", una acumulación de tejido adiposo acompañado de una disminución de tejido muscular debido a los cambios catabólicos debido a la inflamación crónica e inactividad física a consecuencia de las dificultades motoras. Ante evidencia reciente que propone patrones de alimentación e intervenciones dietarias como tratamiento complementario a la terapia farmacológica en el manejo de la RA, la siguiente revisión narrativa cualitativa se propone revisar la efectividad de intervenciones propuestas en términos de dolor y actividad de enfermedad, encontrando dentro de la amplia heterogeneidad de intervenciones propuestas, aquellos patrones dietéticos con efecto modulador de la microbiota intestinal como la dieta mediterránea y sus variaciones en contexto de la promoción de un estilo de vida serían positivas como terapia complementaria a esta patología.

Rheumatoid arthritis (RA) is a chronic rheumatic disease characterised by progressive joint damage and extra-articular manifestations that can lead to disability. The aetiology of autoimmune diseases, including RA, is complex, involving genetic, hormonal, dietary, and environmental factors. However, the physiological mechanisms by which these agents contribute to pathogenesis have not yet been fully defined. More recent studies suggest an impact of gut microbiome dysbiosis on the pathogenesis of autoimmune diseases in both animal and human models, including rheumatoid arthritis, also suggesting altered intestinal permeability as a possible cause. This modification of the gut microbiome may be related to influential diet patterns in the prevention of this pathology, as well as a proposed complementary treatment to traditional pharmacological treatment, also considering the increased risk for these patients of developing metabolic syndrome and "rheumatoid cachexia", an accumulation of adipose tissue accompanied by a decrease in muscle tissue due to catabolic changes due to chronic inflammation and physical inactivity as a consequence of motor difficulties in RA. With the emergence of recent evidence proposing dietary interventions and eating patterns as adjunctive treatment to drug therapy in the management of RA, the following narrative qualitative review proposes reviewing recent evidence on the effectiveness of various proposed dietary interventions in the treatment of rheumatoid arthritis in terms of pain and disease activity, finding between a high heterogeneity of proposed interventions, those dietary patterns with modulating effect on the gut microbiome as Mediterranean diet and its variations in the context of promoting a healthy lifestyle would be positive as a complementary therapy for this disease.

Impact of two methods of pulmonary re-expansion in patients undergoing bariatric surgery by videolaparoscopy / Impacto de dois métodos de reexpansão pulmonar em pacientes submetidos a cirurgia bariátrica por videolaparoscopia

Evaluating the impact of lung re-expansion methods on the postoperative pulmonary function and respiratory complications such as atelectasis, pneumonia and hypoxemia in videolaparoscopy-based bariatric surgery. Prospective clinical study conducted with 105 patients randomly divided into three groups: control (conventional postoperative physical therapy), recruitment (intraoperative alveolar recruitment) and decompression (postoperative chest compression and decompression maneuver). Spirometry, respiratory and hemodynamic variables were analyzed. All groups have presented worsened values in spirometry measurements within the postoperative period (p < 0.00) and there was significant decrease in respiratory rates in comparison to the immediate preoperative period (p = 0,01). Mean end-expiratory carbon dioxide pressure in the recruitment group was higher than in the control in all assessed time intervals (p = 0.03). Chest compression and decompression maneuver and alveolar recruitment were beneficial to pulmonary function recovery. There were no differences in postoperative pulmonary complications and function in the three assessed groups, except for significant decrease in respiratory rates and in the end-expiratory carbon dioxide pressure level in the recruitment group. (AU)

Avaliar o impacto de métodos de re-expansão pulmonar na função pulmonar e incidência de complicações respiratórias como as atelectasias, pneumonias e hipoxemia no pós-operatório de cirurgia bariátrica por videolaparoscopia. Estudo clínico, prospectivo realizado com 105 pacientes, randomizado em três grupos: grupo controle (fisioterapia convencional no pós-operatório), grupo recrutamento (recrutamento alveolar no intraoperatório) e grupo descompressão (manobra de compressão e descompressão torácica no pós-operatório). Foram analisadas variáveis espirométricas, respiratórias e hemodinâmicas. No pós-operatório todos os grupos apresentaram piora nas medidas espirométricas (p < 0,00) e redução significativa da frequência respiratória quando comparado o período pré e pós-operatório imediato em todos os grupos (p = 0,01). As médias de pressão expiratória final de gás carbônico no grupo recrutamento foram maiores que no grupo controle em todos os intervalos de tempos avaliados (p = 0,03). A manobra de compressão e descompressão torácica e o recrutamento alveolar foram benéficos para a recuperação da função pulmonar. Nos três grupos avaliados não houve diferença nas complicações e função pulmonar no pós-operatório, exceto redução significativa da frequência respiratória e da pressão expiratória final de dióxido de carbono no grupo recrutamento alveolar. (AU)

Mechanism of Sini Powder on protecting liver based on network pharmacology / 中草药

Objective: To explore the material basis and hepatoprotective mechanism of Sini Powder in the treatment of chronic hepatitis, fatty liver and liver cancer based on network pharmacology, and reveal the molecular mechanism of Sini Powder in the treatment of liver diseases "treating different diseases with same treatment". Methods: The effective chemical constituents and targets of Sini Powder and the disease targets of chronic hepatitis, fatty liver and liver cancer were searched by TCMSP, CTD, Genecards, Omim and related literatures. The potential targets of hepatoprotective effect of Sini Powder were obtained by TBtools software, the interaction network of "effective chemical composition-target" and potential target proteins was constructed by Cytoscape 3.7.2 software, and the potential targets were annotated by Uniprot database. David database was used to analyze GO biological function and KEGG pathway enrichment of potential targets. Results: A total of 137 effective chemical constituents, 223 targets, 478 targets for chronic hepatitis, 17277 targets for fatty liver, 16930 targets for liver cancer, and 30 potential targets for hepatoprotection were obtained. GO biological function and KEGG pathway enrichment analysis showed that a total of 178 biological processes and 51 pathways were involved in potential targets. Among the top 20 pathways, nine pathways were related to liver disease. Conclusion: Sini Powder may play a protective role in liver by regulating potential targets such as IL-6, VEGFA, EGFR, PPARG, CASP3 and HIF-1, TNF, PI3K-Akt and other related signaling pathways to exert the functions of anti-inflammation, anti-oxidative stress and inhibition of apoptosis in order to protect liver.

Apical periodontitis in relation to radiographic quality of endodontic treatment in a selected adult Turkish population: a cross-sectional study / Periodontite apical em relação à qualidade radiográfica do tratamento endodôntico em uma amostra da população adulta turca: um estudo transversal

Objective: The aim of this study was to examine the quality of root canal fillings and their relationship with apical periodontitis (AP) in a selected Turkish population. Material and Methods: The cases in this study was formed of patients attending routine dental treatment at the Faculty of Dentistry, University of Birun. 1024 patients were examined with panoramic radiographs and 1780 endodontically treated teeth with present periapical radiographs. Endodontic treatment quality was evaluated by obturation length, density, taper quality and iatrogenic errors. Presence of AP was analysed according to Ørstavik's periapical index (PAI). The chi-square test was used for statistical analyses. Results: Statistically significant relationship was found between both the tooth type and location with obturation quality (p: 0.000; p < 0.05). Obturation quality of maxillary and mandibular molars are significantly less than the other tooth types in the same location. Apical periodontitis were noticed in 740 teeth (41.6%). Inadequate obturation quality was found to be significantly effective on the periapical status of tooth types both in maxilla and mandible (p < 0.05). Conclusion: The frequency of inadequate root canal obturations of endodontically treated teeth of the selected Turkish population was high, especially in molar teeth and women. Even though radiographic obturation quality is not the only success criteria in endodontic treatment, it is still one of the most important criteria regarding the positive correlation of "inadequate" obturations with AP(AU)

Objetivo: O objetivo deste estudo foi examinar a qualidade dos preenchimentos do canal radicular e sua relação com a periodontite apical (PA) em uma amostra da população turca. Material e Métodos: Os casos deste estudo foram formados por pacientes em tratamento odontológico de rotina na Faculdade de Odontologia da Universidade de Birun. Mil e vinte e quatro pacientes foram examinados com radiografias panorâmicas e 1780 dentes tratados endodonticamente com radiografias periapicais presentes. A qualidade do tratamento endodôntico foi avaliada pelo comprimento da obturação, densidade, qualidade do cone e erros iatrogênicos. A presença de PA foi analisada de acordo com o índice periapical de Ørstavik (IPA). O teste do qui-quadrado foi utilizado para análises estatísticas. Resultados: Foi encontrada relação estatisticamente significante entre o tipo e a localização do dente com a qualidade da obturação (p: 0,000; p < 0,05). A qualidade da obturação dos molares superiores e inferiores é significativamente menor que os outros tipos de dentes no mesmo local. Periodontite apical foi observada em 740 dentes (41,6%). A qualidade inadequada da obturação mostrou ser significativamente eficaz no estado periapical dos tipos de dentes, tanto na maxila quanto na mandíbula (p < 0,05). Conclusão: A frequência de obturação inadequada do canal radicular de dentes tratados endodonticamente na população turca selecionada foi alta, principalmente em dentes molares e mulheres. Embora a qualidade da obturação radiográfica não seja o único critério de sucesso no tratamento endodôntico, ainda é um dos critérios mais importantes em relação à correlação positiva das obturações "inadequadas" com a PA.(AU)

Cirugía herniaria electiva en pacientes portadores de tratamiento anticoagulante / Elective hernia surgery in patients with anticoagulant treatment

Resumen Introducción: Diversas patologías requieren de tratamiento anticoagulante oral (TACO). Algunos de estos pacientes requieren resolución quirúrgica. El manejo perioperatorio de estos pacientes es variable dependiendo del centro. Objetivos: Evaluar la morbilidad y mortalidad del protocolo de manejo de patología herniaria en TACO, atendidos en nuestro hospital. Material y Métodos: Estudio descriptivo prospectivo de 37 pacientes sometidos a cirugía herniaria en TACO entre 2008-2016. Los datos fueron obtenidos de la base de datos computacional del Equipo de Hernias, con un seguimiento mínimo de 1 mes. Se evaluaron las características clínicas, quirúrgicas y la morbimortalidad postoperatoria. El traslape consistió en hospitalizar al paciente tres días previos a la cirugía, suspendiéndose el TACO e iniciando heparina de bajo peso molecular (HBPM) en dosis terapéuticas, que se suspende 24 h previas a la cirugía. Se reinicia la HPBM a las 12 a 24 h postoperatorias, y se inicia el traslape a TACO a las 24-48 h. Los datos fueron analizados con Stata v14. Resultados: De los 37 pacientes estudiados, veintiséis pacientes fueron hombres (70,2%), la media de edad fue de 67,3 años. El 48,7% tenían fibrilación auricular. El 100% consumía acenocumarol como TACO. La media en el inicio del traslape a la anticoagulación oral fue de 1,4 días. El promedio de INR al momento del alta fue de 2,04. Dos pacientes fueron dados de alta con dalteparina. Un paciente (2,7%), presentó dolor en el postoperatorio inmediato y uno (2,7%), equimosis del sitio quirúrgico. Conclusiones: El protocolo de trabajo utilizado, demostró ser seguro, con una mínima morbilidad postoperatoria.

Introduction: Various pathologies require oral anticoagulant treatment (TACO). Some of these patients present pathologies of surgical resolution. The perioperative management of these patients is variable depending on the center. Aim: To evaluate the morbidity and mortality of patients attended with hernia pathology and TACO, assisted in our hospital. Materials and Method: Prospective, descriptive study of 37 patients submmited to hernia surgery in TACO between 2008-2016. The data was obtained from the computer database of the Hernia Team, with a minimum follow-up of 1 month. Clinical, surgical characteristics and postoperative morbidity and mortality were evaluated. The treatment overlap from TACO to Low Molecular Weight Heparin (LMWH) in therapeutic doses, was initiated three days before surgery. LMWH was suspended 24 hours prior to surgery, and reinitiated 12 to 24 hours post operation. 48 to 72 hours TACO was resumed. The data was analyzed with Stata v14. Results: Twenty-six patients were men, the mean age was 67.3 years. 48.7% had atrial fibrillation. 100% consumed acenocoumarol as TACO. The mean time for resuming TACO after surgery was 1.4 days. The average INR at the time of discharge was 2.04. Two patients were discharged with dalteparin. One patient (2.7%) presented pain in the immediate postoperative period and one showed ecchymosis of the surgical site (2.7%). Conclusions: The work protocol used, proved to be safe, with minimal postoperative morbidity.

Focos Terapéuticos en un Caso de Abandono Temprano: Perspectivas del Terapeuta y de Jueces Externos / Therapeutic Foci in an Early Dropout Case: Therapist's and External Judges' Perspectives

Introducción: es necesario mayor estudio de la experiencia de abandono terapéutico temprano. Indagar sistemáticamente casos únicos puede conformar una respuesta orgánica a este desafío. Objetivos y métodos: se analizó y comparó la evolución de focos terapéuticos, planteados por el terapeuta tratante y por dos juezas externas, para un caso de abandono temprano de psicoterapia psicodinámica focalizada de un trastorno emocional. Ciegos a la codificación de la contraparte, terapeuta y juezas utilizaron el Diagnóstico Psicodinámico Operacionalizado-2 (OPD-2) para generar un perfil psicodinámico y establecer focos de tratamiento. Para cada foco, aplicaron la Escala de Presencia de Foco y la Escala de Cambio Estructural de Heidelberg. Resultados y discusión: se observaron puntos de convergencia y divergencia entre las perspectivas de terapeuta y juezas externas. Se discute la utilidad de dichos puntos para la comprensión del abandono temprano del paciente, así como las implicancias del OPD-2 como herramienta de investigación orientada a la práctica

Introduction: more study on the experience of therapeutic early dropout is needed. The systematic study of psychodynamic single cases can conform an organic response to this challenge. Aims & Methods: therapeutic foci's evolution, proposed by both treating therapist and two external judges, for the same early dropout case of a focused psychodynamic psychotherapy for an emotional disorder, were analyzed and compared. Blind to the counterpart's rating process, therapist and judges employed Operationalized Psychodynamic Diagnosis (OPD-2) in order to generate a psychodynamic profile and establish therapeutic foci. For each focus, they applied the Focus Presence Scale and the Heidelberg Structural Change Scale. Results & Discussion: specific convergences' and discrepancies' points between therapist's and judges' perspectives were observed. Such points' usefulness for the understanding of patient's early dropout, together with OPD-2' implications as a practice-oriented research tool, are discussed

Conhecimento dos acadêmicos de fisioterapia sobre o manejo da dor / Knowledge of physical therapy students on pain management

Introdução: Estudos indicam que acadêmicos de vários semestres da fisioterapia apresentam limitações no conhecimento relacionado à dor e suas terapêuticas. Contudo, essa temática ainda é pouco explorada em acadêmicos no último ano da graduação em fisioterapia. Objetivo: Descrever o conhecimento sobre dor por parte dos acadêmicos do último ano de uma instituição privada de ensino superior. Métodos: Estudo descritivo transversal com 59 acadêmicos de ambos os sexos, matriculados no estágio curricular supervisionado, do último ano do curso de fisioterapia de uma instituição privada de ensino superior. Todos os participantes foram submetidos a um questionário validado contendo questões relacionadas à fisiopatologia, subjetividade, avaliação e terapêuticas não farmacológicas da dor. Resultados: Cinquenta e seis voluntários compuseram a amostra final deste estudo. 88% deles indicaram não existir uma disciplina ou um professor especialista sobre dor. 58% dos acadêmicos não reconhecem a dor como um sinal vital. Houve conhecimento satisfatório sobre conceitos básicos relacionados à fisiopatologia, avaliação e tratamento da dor. Contudo, falhas que comprometem o manejo da dor foram detectadas. Conclusão: Existe inconsistência no conhecimento de acadêmicos do último ano do curso de fisioterapia sobre aspectos ligados a avaliação e tratamento de pacientes com dor. (AU)

Introduction: Studies indicate that academics from several semesters of physical therapy have limitations in knowledge related to pain and its therapeutics. However, this subject is still little explored in academics in the last year of graduation in physical therapy. Objective: To describe the knowledge about pain on the part of the academics of the last year of a private institution of higher education. Methods: Descriptive cross-sectional study with 59 male and female students, enrolled in the supervised curricular traineeship, of the last year of the physical therapy course of a private institution of higher education. All participants were submitted to a validated questionnaire containing questions related to pathophysiology, subjectivity, evaluation and nonpharmacological pain therapy. Results: Fifty-six volunteers composed the final sample of this study. 88% of them indicate that there is no discipline or specialist pain teacher. 58% of academics do not recognize pain as a vital sign. There was satisfactory knowledge about basic concepts related to pathophysiology, evaluation and treatment of pain. However, failures that compromise the management of pain were detected. Conclusion: There is inconsistency in the knowledge of academics of the last year of the physical therapy course on aspects related to the evaluation and treatment of patients with pain. (AU)

Elderly people living alone / Pessoas idosas que vivem em domicílios unipessoais

Introduction: In the last decades, a social phenomenon has emerged: the number of elderly people residing in single-person households, that is, living alone. Among these individuals are those who accumulate losses in health, social and personal life during their lifespan. Objective: To integrate scientific knowledge about elderly people living alone. Methods: It is an integrative review performed on four international databases. The theoretical reference of the Quality of Life was chosen to categorize the results. Results: After critical reading and analysis of 16 selected articles, two main themes and four subthemes emerged. The first main theme was named by "Contextualization of the Elderly that Lives Alone"; the second main theme was called "The role of family in the life of the elderly living alone". Conclusion: This age group needs a support network to maintain their quality of life; this network must encompass family members, friends, neighbors and health professionals and these must aid the elderly living alone in daily activities, travels and healthcare, among others; since the elderly living alone usually present chronic conditions, cognitive/motor deficit and higher risk of social isolation. (AU)

Introdução: Nas últimas décadas um fenômeno social vem emergindo: o número de pessoas que residem em domicílios unipessoais, isto é, que moram sós. Dentre esses indivíduos destacamse aqueles idosos que acumulam perdas na saúde, na vida social e pessoal durante o seu ciclo vital. Objetivo: Integrar o conhecimento científico sobre as pessoas idosas que moram sós. Métodos: Revisão Integrativa de literatura realizada em quatro bases de dados internacionais. O referencial teórico da Qualidade de Vida foi escolhido à categorização dos resultados. Resultados: Após a análise e leitura crítica das 16 referências selecionadas, emergiram dois temas principais "Contextualização da pessoa idosa que vive só", que foi subdividida em quatro subtemas. O segundo tema foi nomeado como "O papel da família na vida da pessoa idosa que vive só". Conclusão: Esse grupo etário necessita de uma rede de apoio para manutenção de sua qualidade de vida; tal rede pode ser formada por familiares, amigos, vizinhos e profissionais de saúde e esses devem auxiliar a pessoa idosa que reside só em suas atividades diárias, viagens, cuidados de saúde e outros; pois o idoso que mora sozinho geralmente apresenta condições crônicas de saúde, déficit cognitivo e/ou motor, com risco ao isolamento social. (AU)

Perda significativa de peso em pacientes com esquizofrenia na dieta hipocalórica de longo prazo: estudo piloto / Significant weight loss in patients with schizophrenia in long-term hypocaloric diet: a pilot study

Objetivo: A esquizofrenia está associada ao aumento da obesidade e morbidade por doença cardiovascular. O objetivo do presente estudo foi avaliar alterações no peso e índice de massa corporal (IMC) de pacientes com esquizofrenia após tratamento nutricional de longo prazo. Método: Estudo piloto retrospectivo envolvendo 42 indivíduos com esquizofrenia em tratamento nutricional entre 2004 e 2010. Os prontuários médicos foram revisados após aprovação institucional e coleta de dados para peso, índice de massa corporal (IMC), idade, gênero e dieta. O peso e o IMC foram avaliados no início do tratamento nutricional, após seis meses, após 12 meses e no momento da coleta de dados. Resultados: Houve perda significativa de peso e diminuição significativa do IMC quando comparados a cada grupo com o valor basal (p<0,001). Conclusões: Demonstramos que as intervenções nutricionais podem promover uma significativa perda de peso na esquizofrenia. Estes resultados suportam a importância da intervenção nutricional na esquizofrenia e trazem evidências de que a perda de peso permanece ao longo do tempo.(AU)

Objective: Schizophrenia is associated with increased obesity and morbidity from cardiovascular disease. The aim of the present study was to evaluate changes in weight and body mass index (BMI) of patients with schizophrenia following a long-term nutritional treatment. Methods: Retrospective pilot study involving 42 individuals with schizophrenia on nutritional treatment from 2004 to 2010. Medical charts were reviewed after institutional approval and data collection was conducted for weight, body mass index (BMI), age, gender and diet prescription. Weight and BMI were evaluated at baseline of nutrition treatment, after six months, after 12 months and at the time of data collection. Results: There was a significant weight loss and significant decreased in BMI when compared each group to baseline (p<0.001). Conclusions: We demonstrate that nutritional interventions can promote a significant weight loss in schizophrenia. These results support the importance of nutritional intervention in schizophrenia and bring evidences that weight loss remains along the time.(AU)

Obtención combinada de parámetros para la planificación dosimétrica 2D y 3D de tratamientos con en Hipertiroidismo / Combined parameters estimation for dosimetry treatment planning in Hyperthyroidism using 2D and 3D

La planificación, optimización y verificación de los tratamientos-paciente específico con fuentes abiertas de es objeto de investigación constante desde el punto de vista médico y de protección radiológica. El objetivo de este estudio fue verificar el uso combinado de varios equipos médico-nucleares para la estimación de los parámetros de biodistribución y farmacocinética necesarios para la planificación y verificación del tratamiento-paciente específico del hipertiroidismo. Para ello se estudiaron las respuestas de tres equipos médico-nucleares (Captor de Yodo, Cámara Gamma Philips Forte con colimador de pinhole, Cámara Mediso Nucline con colimadores de alta energía y propósitos generales para estudios planares y SPECT) empleando el maniquí de tiroides. Se comprobó la linealidad de la respuesta a la actividad en condiciones clínicas y se obtuvieron índices de correlación del ajuste superiores a 0,99 para actividades diagnósticas y terapéuticas. Se evaluó la concordancia de los parámetros calculados por los diferentes equipos y se encontró una discrepancia menor del 6 % para los índices de captación en actividades terapéuticas y del 1,1 % para las diagnósticas. Se estableció y verificó un protocolo que permite, con una sola administración de , desarrollar la cuantificación dosimétrica 2D y 3D para pacientes hipertiroideos, con un uso optimizado de los equipos imagenológicos

Optimization and verification of Specific Patient Treatment Planning with unsealed sources in hyperthyroidism diseases is a desirable goal from medical and radiation protection viewpoints. In order to verify the estimation of patient’s specific treatment dose and his/her related parameters, a combination of 3 different apparatus or pieces of equipment used in nuclear medicine were studied - the Iodine Probe, a Philips Forte Camera with pin-hole collimators and a Mediso Nucline with HEGP for planar and SPECT techniques- by using the typical neck phantom and sources simulating diagnosis and treatment procedure. The linear behavior on diagnostic and therapeutic activity range was verified, showing a linear correlation fitting factor > 0,99. The differences between thyroid uptake determinations in all equipment were less than 6 % for therapeutic activities and less than 1,1 % in the diagnostic range. The combined protocol to calculate all the necessary parameters for the patient treatment dose planning using 2D or 3D approach was established and verified, avoiding wasting time with gamma cameras and with only one administration of

Observation of the Curative Effects of Acupuncture Combined with Blood-letting Therapy on Postherpetic Neuralgia / 浙江中医药大学学报

[Objective] To observe the different effects of acupuncture combined with blood-letting theraphy and conventional western medicine for postherpetic neuralgia.[Methods] Choose 80 cases patients with neuralgia after herpes zoster from our hospital 's clinic and wards and then divide them randomly into two groups—the acupuncture bleeding group and the medicine group. The patients in the acupuncture bleeding group were treated mainly by local multiple-superficial needling. They were acupunctured with Ashi points in herpes zoster local as the centre using disaposable acupuncture needles five times a week. The needle point aimed at the lesion and the inserted body skin shallowly along superficial fascia. Meanwhile, pricking pain part with skin needles combined with blood letting and cupping were performed on the patients twice a week. In the medicine group, the patients took Tetrandrine three times a day with 40mg at a time. After four weeks, observe and evaluate the curative effects.[Result] In the acupuncture bleeding group, 8 patients were cured, 22 markedly improved,10 effective, 0 ineffective and the apparent recovey rate was 75%. In the medical group, 2 patients were cured, 10 markedly improved,20 effective, 8 ineffective and the apparent effective rate was 30%. There was a signifcant difference in curative effects between two groups with statistical significance( P<0.05). [Conclusion] Acupuncture bleeding method is an effective treatment for postherpetic neuralgia, which is superior to conventional western medicine treatment.

Nefropatía por IgA. revisión y conducta terapéutica a propósito de un caso clínico / Therapeutic management of an IgA nephropathy case and disease review

La Nefropatía por Inmunoglobulina A (NIgA), también conocida como enfermedad de Berger, fue descrita por primera vez en 1968 por Berger e Hinglais. Se trata de una enfermedad heterogénea, tanto desde el punto de vista clínico, como histológico, caracterizada por la presencia de depósitos mesangiales de IgA. La clínica de presentación es extremadamente variable, pudiendo manifestarse desde microhematuria aislada hasta un deterioro agudo de la función renal por una glomerulonefritis extracapilar superpuesta. Inicialmente se la consideraba una entidad de buen pronóstico, pero con el paso del tiempo y a partir de un mayor conocimiento de la NIgA, se constató que la realidad era otra y que del 20 al 30% de los pacientes a los 20 años evolucionaban a la insuficiencia renal crónica (IRC) terminal y otro 20% mostraba una pérdida significativa de la función renal. En el presente artículo se describe un caso clínico de un paciente en el que se detectan casualmente marcadores de daño renal en la orina, y en quien los hallazgos histológicos observados en la biopsia renal modificaron su pronóstico y la conducta terapéutica. A partir de este caso clínico se realiza una actualización sobre la Nefropatía por IgA

Inmunoglobulin A (NIgA) Nephropathy also known as Berger disease, was described for the first time in 1968 by Berger and Hinglais. It is a heterogeneous disease, not only from clinical point of view but also from the histologicalone. Characterized by the presence of IgA mesangials deposits. Clinical presentation is extremely variable and can vary from isolated microhematuria up to a severe damage of renal function due to superimposed extracapillary glomerulonephritis. Initially it was considered an entity with good prognosis, but over time and more knowledge about IgAN, it was shown that 20 to 30% of 20 years old patients evolved to end stage renal failure and other 20% had important renal function loss. In the present article we describe a case of a patient in whom we detected by chance renal damage markers in the urine, and then the histologic findings observed in renal biopsy, modified the prognosis and therapeutic procedure. From this clinical case, we performed an update on IgA Nephropathy

Therapeutic effect of integrated traditional Chinese and western medicine therapy on reynolds syndrome / 中国基层医药

Objective To explore therapeutic effect of integrated traditional Chinese and western medicine therapy on reynolds syndrome,and to provide effective and reliable operation method for treatment of the disease. Methods 104 cases with reynolds syndrome were randomly divided into observation group (59 cases)and control group (45 cases)by random number table method.The observation group was treated with aspirin,nifedipine combined with traditional Chinese medicine dialectical therapy,the control group was treated with aspirin and nifedipine. The cold water test ,fist test results and hemorheology indexes of the two groups were measured before and after a period of treatment.The therapeutic effects were evaluated after one course.Results After treatment,the fist test, cold water test positive rates of observation group were 32.2%,23.7%,which were lower than 75.6%,57.8% of the control group (χ2 =19.199,12.504,all P 0.05 ). Conclusion In the treatment of reynolds syndrome,the integrated traditional Chinese and western medicine therapy has better curative effect and low drug adverse reaction rate,with good clinical application value.

Fonoaudiología y estética facial: experiencia de Brasil en la atención primaria de salud / speech therapy and facial esthetic: experience of Brazil in primary health care

La fonoaudiología es una disciplina relativamente nueva en Chile por lo cual se encuentra en pleno proceso de crecimiento y desarrollo. En este contexto, en el área de Motricidad Orofacial ha surgido hace algunos años una subespecialidad denominada “estética facial” que aborda la musculatura facial y sus alteraciones, ya sean secundarias al proceso natural de envejecimiento y/o a factores externos. Brasil, país pionero en esta práctica, ha desarrollado diversos planes de intervención en salud. A través de la creación de Núcleos de Apoyo a la Salud de la Familia, se ha incluido la estética facial en el contexto de atención primaria de salud. Es así que en la ciudad de Sete Lagoas, Minas Gerais se ha desarrollado un programa de estética facial con el objetivo de fomentar la integración del cuidado físico y mental de los usuarios. La evidencia científica muestra los resultados de la fonoaudiología estética, relajando la musculatura facial, disminuyendo arrugas y líneas de expresión y mejorando la sensación de bienestar de las personas. Se plantea la importancia de ampliar el conocimiento del profesional fonoaudiólogo chileno y desarrollar nuevas áreas de desempeño para contribuir en el beneficio de la población...

Speech Therapy is relatively new discipline in Chile, therefore, it is in the process of growth and development. As part of the orofacial motricity area, a new specialty has began to develop: Facial esthetic. This new area deals with facial muscles and their alterations caused by natural aging processes and/or external factors. Brazil, a pioneer country in this practice, has developed several health intervention plans. In this respect, facial esthetic has been included in the context of primary health care, through the creation of Family Health Support Centers. For instance, a program of facial esthetic has been implemented in the city of Sete Lagoas, Minas Gerais. This program aims to promote the integration of physical and mental care. Scientific evidence shows that esthetic’s speech therapy produce relaxation of facial muscles, reducing wrinkles and fine lines and improving the people’s sense of well-being. Therefore, increasing the knowledge about this area in Chilean speech therapists and developing new areas of professional performance would be important issues to address...

DialysisNet: Application for Integrating and Management Data Sources of Hemodialysis Information by Continuity of Care Record / 대한의료정보학회지

OBJECTIVES: Health Avatar Beans was for the management of chronic kidney disease and end-stage renal disease (ESRD). This article is about the DialysisNet system in Health Avatar Beans for the seamless management of ESRD based on the personal health record. METHODS: For hemodialysis data modeling, we identified common data elements for hemodialysis information (CDEHI). We used ASTM continuity of care record (CCR) and ISO/IEC 11179 for the compliance method with a standard model for the CDEHI. According to the contents of the ASTM CCR, we mapped the CDHEI to the contents and created the metadata from that. It was transformed and parsed into the database and verified according to the ASTM CCR/XML schema definition (XSD). DialysisNet was created as an iPad application. The contents of the CDEHI were categorized for effective management. For the evaluation of information transfer, we used CarePlatform, which was developed for data access. The metadata of CDEHI in DialysisNet was exchanged by the CarePlatform with semantic interoperability. RESULTS: The CDEHI was separated into a content list for individual patient data, a contents list for hemodialysis center data, consultation and transfer form, and clinical decision support data. After matching to the CCR, the CDEHI was transformed to metadata, and it was transformed to XML and proven according to the ASTM CCR/XSD. DialysisNet has specific consideration of visualization, graphics, images, statistics, and database. CONCLUSIONS: We created the DialysisNet application, which can integrate and manage data sources for hemodialysis information based on CCR standards.

Revisión bibliográfica del uso de láser de baja potencia como tratamiento en alteraciones del nervio alveolar inferior en osteotomía sagital de rama / Literature review of the use of low power laser therapy for treating inferior alveolar nerve disorder in sagittal ramus osteotomy

Una de las principales complicaciones al realizar la osteotomía sagital de rama, es la presencia de alteraciones sensitivas que se producen a nivel del nervio alveolar inferior. La parestesia luego de esta técnica reporta una incidencia entre el 85-87 por ciento, de los cuales entre el 0-24 por ciento queda con parestesia permanente. Dentro de los tratamientos utilizados para recuperar las alteraciones sensitivas se encuentra el uso de láser de baja frecuencia; el cual se utiliza para acelerar la recuperación sensitiva y la reparación neuronal, disminuir el dolor y restaurar el funcionamiento normal del nervio injuriado. Los objetivos de esta investigación fueron realizar una revisión bibliográfica sobre los resultados obtenidos en pacientes sometidos a osteotomía sagital de rama que presentaron alteraciones sensitivas y en cuyo tratamiento se utilizó el láser, y crear un protocolo de tratamiento con láser en pacientes sometidos a osteotomía sagital de rama madibular. Se realizó una revisión de artículos entre los años 1990-2010, utilizando buscadores como: EBSCO, Cochcrane, TripDataBase, Medline, Lilacs, Pubmed y Decs, además de una búsqueda en revistas científicas. Los resultados de los artículos seleccionados señalan el efecto beneficioso que conlleva el uso del láser, demostrando su eficacia en la recuperación precoz de la sensibilidad postoperatoria. El uso del láser de baja frecuencia es una alternativa favorable para pacientes con alteraciones sensitivas que fueron sometidos a cirugía sagital de rama, debido a su pronta, mejor y mayor recuperación de la sensibilidad...

A major complication that occurs at the sagittal ramus osteotomy, is the presence of damage occurring at the inferior alveolar nerve. An incidence of paresthesia after this technique reported at 85-87 percent, of which between 0-24 percent are left with permanent paresthesia. Among the treatments used to restore sensitivity is the use of low level laser therapy, which is used to speed recovery and repair sensitive neurons, reduce pain, and restore normal functioning to injured nerve. The aims were to undertake a literature review of empiric research on the results obtained in patients under going sagittal ramus osteotomy, who has sensory disturbances and in wich laser treatment was used, and create a laser treatment protocol in patients undergoing sagittal ramus osteotomy. A review of articles between the years 1990-2010, using search engines such as EBSCO, Cochcrane, Tripdatabase, Medline, Lilacs, Pubmed and Decs. The review also included a search in scientific journals. The results of the reviewed literature showed the beneficial effect of the use of laser, demonstrating its effectiveness in the early recovery of postoperative sensitivity. The use of low level laser therapy is a favorable alternative for patients with sensory impairment who underwent sagittal ramus osteotomy due to its rapid and greater sensitivity recovery...

Influência da dança na força muscular de membros inferiores de idosos / The dance’s influence on muscle strength of lower limbson the elderly

Objetiva-se avaliar a influência da dança na força muscular de membros inferiores de idosos. A pesquisa tem caráter quali-quantitativo, tendo como sujeitos dez idosos de ambos os sexos, que praticaram aulas de dança de salão durante doze semanas. A avaliação foi realizada antes e após esse período, e composta por questionário com dados pessoais e anamnese, teste de levantar e sentar em 30 segundos e entrevista semi-estruturada com pergunta norteadora em relação à percepção de força muscular do idoso. Na análise quantitativa, foi utilizado o teste estatístico T Pareado, com nível de significância de p<0,05%. Na análise da parte qualitativa da pesquisa foram utilizados direcionamentos propostos por Minayo (1994). A força muscular mensurada através do teste de sentar e levantar em 30 segundos, demonstra que 4 participantes tiveram diminuição e 6 tiveram aumento no número de movimentos completos executados no teste, mas não houve diferença significativa estatisticamente entre os valores antes e após a intervenção (P=0,1934). O discurso dos participantes demonstrou, porém, que houve melhora perceptiva do idoso quanto à força muscular e também da mobilidade, jovialidade e auto-estima. Sugere-se que o efeito da dança, praticada na frequência utilizada neste estudo, causa maior efeito no bem-estar e na esfera psicossocial do indivíduo do que na força muscular mensurável Atividade lúdica emfisioterapia, realizada através de exercícios em grupo, traz benefícios; porém, não deve ser uma atividade isolada, mas sim associada a um treino específico para ganho de força muscular voltado às necessidades de idosos...

The aim of this study was to evaluate the influence of dance in the lower limb muscle strength on the elderly. This research has a qualitative-quantitative aproach. The sample was composed by ten elderly of both sexes, who practiced ballroom dancing classes during twelve weeks. The evaluation was performed before and after the classes and it was composed by a questionnaire with personal data and medical history, “test stand and sit in 30 seconds” and a semi-structured interview with a guiding question regarding the perception of muscular strength of the elderly. The quantitative analysis was performed using the Student’s t-test with a significance level of p<0,05%. The qualitative analysis was made according directions proposed by Minayo (1994). The evaluation of muscle strength measured by the test of sitting and standing up, showed that four participants had a decreased and six had an increase in the number of movements executed, but not existed a significant statistical difference between the values before and after intervention (p=0,1934). However, the speech of the participants showed an improvement on the perception in relation muscle strength, mobility, joviality and self-esteem. It suggests that the effect of the dance, performed in the frequency used in this study, has an effect on the well-being and psychosocial sphere of the elderly. Playful activities in physical therapy performed by groups, bringing benefits, however, it should not be an isolated activity, it should be associated with a specific training to improve muscle strength related to the needs of each elderly...

Alterações hematológicas em pacientes infectados pelo vírus da imunodeficência humana submetidos à terapia antirretroviral com e sem inibidor de protease / Hematological abnormalities in patients infected with human immunodeficiency virus on antiretroviral therapy with and without protease inhibitors

A anemia é uma anormalidade hematológica comumente encontrada em pacientes infectados pelo vírus da imunodeficiência humana (HIV) e sua prevalência estimada entre 63 por cento a 95 por cento. O objetivo deste estudo foi avaliar as alterações hematológicas e o Índice de Massa Corporal (IMC) de pacientes HIV soropositivos com ou sem uso de terapia antirretroviral com e sem inibidor de protease. Os pacientes HIV soropositivos foram diagnosticados pelo teste de enzimaimunoensaio (ELISA) e confirmados por imunofluorescência. As alterações hematológicas foram determinadas por aparelho de automação Coulter Maxim Autoloader®, contagem de células CD4+ e CD8+ por citometria de fluxo FACSCount® e carga viral por amplificação baseada na sequência do ácido nucleico - Nucleic Acid Sequence Based Amplification (NASBA®). A avaliação dos dados hematológicos demonstrou níveis diminuídos no número de leucócitos e hemoglobina no grupo de estudo que fazia uso de terapia antirretrovial, quando comparado ao grupo controle sem uso desta terapia; resultado semelhante verificou-se também para o IMC dos pacientes HIV soropositivos (p<0,0001, p=0,006 e p<0,0001) respectivamente. Não houve diferença significativa entre os grupos que faziam uso de terapia antirretrovial com e sem inibidores de protease (IP). A avaliação dos dados hematológicos associada à contagem de células CD4+ e quantificação da carga viral pode contribuir para o monitoramento da infecção e auxiliar na tomada de decisão a respeito da intervenção clínica mais adequada nestes pacientes. Rev. Bras. Hematol. Hemoter.

Anemia is the most commonly encountered hematologic abnormality in from 63 percent to 95 percent of human immunodeficiency virus (HIV)-positive patients. This study intends to evaluate hematological alterations and changes in the body mass index of HIV-positive patients on antiretroviral therapy with or without protease inhibitors and those who are not on antiretroviral therapy. The HIV-positive patients were diagnosed by the ELISA test and confirmed by immunofluorescence. The hematological alterations were determined using a Coulter Maxim Autoloader®, CD4+ and CD8+ cell counts by FACSCount® Flux cytometry and viral load by Nucleic Acid Sequence Based Amplification (NASBA®). The evaluation of hematological alterations showed smaller numbers of leukocytes and hemoglobin in the study group who used antiretroviral therapy compared to the control group (not on antiretroviral therapy); similar results were found for the body mass index of HIV-positive patients (p<0.0001, p=0.006 and p<0.0001), respectively. There were no significant differences identified between the groups on antiretroviral therapy with or without protease inhibitors. An evaluation of the hematological alterations associated with CD4+ cell counts and measurement of the viral load may contribute to monitor HIV infection and assist in the decision of the most appropriate clinical intervention in these patients. Rev. Bras. Hematol. Hemoter.

On the therapeutic effect of the traditional Chinese medicine periodic treatment after the artifitial abortion / 国际中医中药杂志

Objective This paper aims at the therapeutic effect aft er the artifitial abortion by employing the TCM periodic treatment with respect to shortening the vaginal bleeding time and accelerating the uterine lining recovery. Methods Sampling 280 cases of artifitial abortion in early pregnancy, the author divides them at random the testing and control groups with each of the membership of 140 cases. Given the Nifuratel perorally same as the control group, the testing group is additionally under the TCM periodic treatment, that is, dosing Chinese medicine with the purpose of eliminating blood stasis,promoting tissue regeneration as well as invigorating the vital energy and nourishing the blood during the 1 to 3 days'postoperation period, giving Chinese medicine with a view of strenthening liver and kidney together with activating vital energy during the 4 to 14 days' postoperation period, instructing Chinese medicine in order to nourish the spleen and kidney as well as regulate Chong and Ren Vessels during the 15 to 25 days' postoperation period perorally and respectivelly. In contrast, the control group is given Xuefuzhuyu Capsules after the whole postoperation period. Results In terms of the time of vaginal bleeding, menstrual recovery and the regenerating condition of the uterine lining, the result (except for 3 cases in testing group and 2 cases in control group quiting the experiment) shows that after treatment (9 days after the abortion) the testing group achieves the effect superior to that of control group (P＜0.01). Conclusion The conclusion is that the TCM periodic therapy is effective in the aspect of shortening the vaginal bleeding time, accelerating the uterine lining recovery and regulating the menstrual circle.

Treatment of varicose vein

High venous pressure in leg from walking in erect position can lead the development of defective valves and reflux, and superficial veins may become elongated and tortuous. Women are more prone to varicose vein due to hormonal influences and pregnancy. Besides long standing occupation and female gender, there are other risk factors including age, family history, obesity, and prior deep vein thrombosis. Recently developed health related quality of life has contributed to concern more about varicose vein and develop the treatment modalities of varicose vein. Because of the chronicity of the development of varicose vein, most patients are usually accustomed to high venous pressure of their leg and feel minor or no discomfort. Among the reasons to seek for the treatment of varicose vein, cosmetic purpose is the most common. Most patients prefer non-surgical treatment including sclerotheraphy to surgical intervention. High ligation and stripping of varicose vein has remained as the standard treatment of varicose vein with excellent long term results. Minimal invasive non-surgical treatments including radiofrequency ablation and endovenous laser treatment have shown less scars and earlier mobility. Newer treatment modalities have to prove comparable long term results, not merely better cosmetic and short term results. We reviewed about the development of varicose vein and the treatment modalities including preventive measures. Correct comprehension of the patient and proper application of the treatment modality are essential for the good result without recurrence after the treatment of varicose vein.