Nutritional evaluation of therapeutic diets for cardiovascular diseases in hospitals of General Santos City, Philippines: A comparative cross-sectional study

Objective@#This study aimed to evaluate the nutritional adequacy and compliance with cardiovascular disease (CVD) guidelines in therapeutic diets implemented in four hospitals in General Santos City, Philippines. @*Methods@#The study employed a cross-sectional study and analyzed the one-day therapeutic menus of four hospitals using the Philippine Food Composition Table and the United States Department of Agriculture nutrient database. The nutrient contents calculated in this study were compared among hospitals and benchmarked against the Philippine Dietary Reference Intakes (PDRI) and CVD-specific guidelines, the Dietary Approaches to Stop Hypertension (DASH), and Therapeutic Lifestyle Changes (TLC). The nutrient adequacy ratios (NARs) and the corresponding mean (SD) values were used to interpret the data.

Intake of Fruits and Vegetables as Self Prescribed Weight Reducing and DASH Diets among Obese-Hypertensive Individuals Attending Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria

Background: Five servings of fruits and vegetables each day, along with relatively unprocessed whole grains or legumes with each meal, are essential for reducing the risk of obesity, hypertension and other related non communicable diseases. While being low or relatively low in calories, fruits and vegetables include a large amount of dietary fiber and a range of micronutrients, antioxidants and phytochemicals which are all essential for health. Aims: To investigate the intake of fruits and vegetables as self prescribed weight reducing and DASH (Dietary Approach to Stop Hypertension) diets among obese - hypertensive individuals attending Irrua Specialist Teaching Hospital Irrua, Edo State. Methods: A descriptive cross sectional study design was used with a sample size of 440 obese hypertensive individuals (with body mass index of = or > 30Kg/m2 and blood pressure of = or > 140/90mmHg). Questionnaires, personal interviews and anthropometric measurements were used to collect data using purposive sampling technique. Data collected were analyzed using Statistical Package for the Social Sciences (IBM SPSS) 22 Version. Results: A total of 440 respondents were used in the study and data were elicited from all of this number giving a 100% response rate. A total of 242 (55.0%) and 215 (48.9%) of the respondents consumed fruits and vegetables only one to two days per week with only 36 (8.2%) and 26 (5.9%) consuming fruits and vegetables every day. Conclusion: It can be concluded based on the key findings of this study that there is statistically significant mean difference in fruits and vegetables consumption amongst obese - hypertensive individuals attending Irrua Specialist Teaching Hospital, Edo State, Nigeria (p<0.05).

Comparison of above elbow and below elbow immobilisation for conservative treatment of distal end radius fracture in adults: A systematic review and meta-analysis of randomized clinical trials / 中华创伤杂志(英文版)

PURPOSE@#The aim of this study was to analyze if any difference exists on the type of immobilisation (above elbow vs. below elbow) in the conservative treatment of distal end radius fractures in adults.@*METHODS@#The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic literature search was performed up to 1st October 2021 in Medline, Embase, Ovid and Cochrane database using the search terms, "distal end radius fractures OR fracture of distal radius", "conservative treatment OR non-surgical treatment", "above elbow immobilisation" and "below elbow immobilisation". Randomized clinical trials written in English, describing outcome of distal end radius fractures in adults by conservative or non-surgical means using above elbow immobilisation or below elbow immobilisation were included and assessed according to the risk of bias assessment (RoB2) tool by Cochrane collaboration. Non-randomized clinical trials, observational studies, retrospective studies, review articles, commentaries, editorials, conference presentations, operative techniques and articles without availability of full text were excluded from this review. The meta-analysis was performed using Review Manager version 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark).@*RESULTS@#Six randomized clinical trials were included for quantitative review. High heterogeneity (I2 > 75%) was noted among all the studies. The standard mean difference (MD) between the disability of the arm, shoulder and hand scores in both the groups was 0.52 (95% CI: -0.28 to 1.32) which was statistically non-significant. There was no statistical difference in the radial height (MD = 0.10, 95% CI: -0.91 to 1.12), radial inclination (MD = 0.5, 95% CI: -1.88 to 2.87, palmar tilt (MD =1.06, 95% CI: -0.31 to 2.43) and ulnar variance (MD = 0.05, 95% CI: -0.74 to 0.64). It was observed that shoulder pain occurred more commonly as a complication in above elbow immobilisation and the values were statistically significant (above elbow: 38/92, 41.3%; below elbow: 19/94, 20.2%).@*CONCLUSION@#This two-armed systematic review on the above elbow or below elbow immobilisation to be used for conservative treatment of the distal end radius fracture in adults resulted in non-significant differences in terms of functional and radiological scores among the 2 groups but significant increase in the complication rates in the above elbow group.

Functional outcome of displaced intra-articular fractures of the distal radius: Comparison of closed reduction percutaneous pinning with or without external fixation versus open reduction plate fixation

OBJECTIVES@#The purpose of the study was to determine the outcomes of closed reduction percutaneous pinning (CRPP) with or without external fixation (EF) with open reduction and internal fixation (ORIF) using plate and screws. @*METHODS@#Outcomes of ORIF versus CRPP, with or without external fixation for intra-articular distal radius fractures were compared through a multicenter, non-randomized, ambispective cohort study. A validated Filipino version of the DASH score (FIL-DASH) was used as primary outcome measure.@*RESULTS@#The ORIF group consisted of 13 patients and the CRPP group, eight patients. Pain scores, post-operative complications and radiographic measurements were also evaluated. Mean FIL-DASH score for the ORIF group (M=26.69, SD=4.88) was significantly higher versus the CRPP group (M=14.59, SD=10.64; t(19)=3.58, p=0.002). No significant differences in radiologic parameters, pain scores, and complications were found.@*CONCLUSION@#The study demonstrates that functional outcomes post-CRPP with or without external fixation compares favorably over ORIF for distal radius fractures at one-year post-surgery.

A Comparative Study Between Plate Fixation and Intramedullary Fixation for Displaced Mid-Shaft Clavicle Fractures in Adults

@#Introduction: Clavicle fractures are frequently encountered by orthopaedic surgeons. Though multiple treatment techniques have been described in literature, open reduction and internal fixation with plating and intramedullary nailing are preferred in adults. This study analyses the functional outcome, complications, duration of bony union of mid-shaft clavicle fractures treated with plate fixation versus intramedullary fixation. Materials and methods: A quasi- experimental study was conducted on 38 patients with mid-shaft clavicle fracture aged between 18 to 60 years at a tertiary care centre in South India. Nineteen patients were treated by plate fixation and 19 patients underwent intramedullary nail fixation. Every alternate patient with mid-shaft fracture clavicle was treated with plate osteosyntheses or nailing. Results: The average age of presentation was 42 years in plate fixation and 31 years in nail fixation group. Robinson’s classification type 2B1 was the most common type of fracture in both groups. The Visual Analogue Scale (VAS) score reduced significantly from pre-operative to postoperative day 1 in both the groups but there was no significant difference between the two groups. The Disabilities of the Arm, Shoulder and Hand (DASH) score at 6, 12 and 24 weeks reduced significantly in both the groups but showed no statistically significant difference between the two groups. However, intramedullary nail fixation group had a shorter duration of hospital stay and showed an earlier improvement in the DASH score during the first six months after surgery. Complications included implant loosening (three patients) in plating group and implant failures (two cases) in nailing group. Conclusion: There is a role for surgical intervention for certain cases of displaced and comminuted clavicle fracture in order to avoid malunion or non-union and their potential long-term sequelae. Both the surgical modalities of plating, and nailing provide good functional outcome and allow early return to occupational activities.

Dietary pattern analysis among stone formers: resemblance to a DASH-style diet / Análise do padrão alimentar de pacientes litiásicos: similaridades com o padrão de dieta DASH

Abstract Recent epidemiological studies have shown that dietary patterns may have a more persistent impact on the risk of stone formation than single nutrients of the diet. Dietary Approaches to Stop Hypertension (DASH), a low-sodium and fruits/vegetables-rich diet, has been associated with a lower risk of nephrolithiasis, due to altered urinary biochemistry. This observational study aimed to investigate whether the dietary pattern of stone formers (SF) resembled a DASH-diet and its influence on urinary lithogenic parameters. Anthropometric data, fasting serum sample, 24-h urine samples, and a 3-day food intake record under an unrestricted diet were obtained from 222 SF and compared with 136 non-SF subjects (controls). The DASH-diet food portions were determined from the food records whereas intakes of sodium chloride (NaCl) and protein (protein equivalent of nitrogen appearance, PNA) were estimated from 24-hr urinary sodium and urea. A dietary profile close to a DASH-diet was not observed in any of the groups. NaCl intake and PNA were significantly higher in SF versus non-SF (12.0 ± 5.2 v.s. 10.1 ± 3.4 g/day, p = 0.01 and 1.8 ± 0.1 v.s. 1.4 ± 0.1 g/kg/day, p = 0.03). SF exhibited a positive correlation of NaCl intake and PNA with urinary calcium, oxalate and uric acid, and of PNA with urinary sodium. SF consumed more vegetables and legumes, but less fruits and low-fat dairy items than non-SF. The present series presented a dietary profile characterized by low calcium and high salt and protein contents, not reflecting an ideal DASH-style diet pattern.

Resumo Estudos epidemiológicos recentes mostraram que os padrões alimentares podem ter um impacto mais persistente sobre o risco de formação de cálculos do que apenas os nutrientes da dieta. A dieta DASH (Dietary Approaches to Stop Hypertension), uma dieta pobre em sódio e rica em frutas/vegetais, tem sido associada a um menor risco de nefrolitíase, devido às alterações metabólicas urinárias. Este estudo observacional teve como objetivo investigar se o padrão alimentar de pacientes litiásicos (Lit) se assemelhava a uma dieta estilo DASH e sua influência nos parâmetros litogênicos urinários. Dados antropométricos, amostra de soro em jejum, amostras de urina de 24 horas e um registro de ingestão alimentar de 3 dias sob dieta irrestrita foram obtidos de 222 Lit e comparados com 136 indivíduos não-Lit (controles). As porções de alimentos do padrão de dieta DASH foram determinadas a partir dos registros alimentares, enquanto a ingestão de cloreto de sódio (NaCl) e proteína (Equivalente Protéico do Aparecimento de Nitrogênio Urinário, PNA) foram estimadas a partir da uréia e sódio urinários de 24 horas. Um perfil alimentar próximo a uma dieta estilo DASH não foi observado em nenhum dos grupos. A ingestão de NaCl e PNA foram significativamente maiores nos Lit versus não-Lit (12,0 ± 5,2 v.s. 10,1 ± 3,4 g/dia, p = 0,01 e 1,8 ± 0,1 v.s. 1,4 ± 0,1 g/kg/dia, p = 0,03). Os Lit exibiram uma correlação positiva entre a ingestão de NaCl e PNA com cálcio, oxalato e ácido urinários, e de PNA com sódio urinário. Os Lit consumiram mais vegetais e leguminosas, mas menos frutas e lácteos com teor reduzido de gordura do que os não-Lit. A presente série apresentou um padrão alimentar caracterizado por reduzido consumo de cálcio e elevado em sal e proteínas, não refletindo um padrão ideal de dieta DASH.

A descriptive study of patterns of traumatic hand injury cases in a tertiary care hospital

Background: All patients who presented to the emergency and trauma with a clinical evidence of hand injury were assessed based on the history and examination, mechanism of injury, common patterns of the injuries, management of the injuries and their functional outcome. The aim and objective were to study the mode, pattern, management and early outcome of hand injury cases attending Department of Emergency Medicine and trauma.Methods: This was a hospital based descriptive study, of patients presenting with hand injuries to the emergency department. The management plan was formulated and the outcomes of the treatment were assessed by limb function loss and Quick DASH 9 score.Results: Majority of our study population belonged to 16 to 35 years age group comprising of mostly males. Most of the incidents occurred within 50 km from our hospital. The mean duration to arrival at our hospital from site of injury was 2.71±2.61 hours. Road traffic accident in males and thermal burns in females were common. Fractures to phalanges of index and middle fingers were the most common type of injury. The average calculated Quick DASH 9 score was found to be 51.24±9.89.Conclusions: Hand injuries were found to be more prevalent in lower socioeconomic strata of the society with education status and occupation as major risk factors. Increased awareness and better implementation of traffic rules and better safety measures at workplace environment are the need of the hour to decrease the burden of hand injury.

The Effect of Dash Diet on the Blood Pressure of the Male Hypertensive Office Employees between 33-55 Years of Age

Aims:To determine the effect of the DASH Diet on the Blood Pressure of the male hypertensive office employees between 33-55 years of age. Place and Duration of Study:The study was conducted at Abhitex International Company, Panipat, Haryana, India between November 2018 to January 2019. Methodology:The Clinical blood pressure of the office employees of Abhitex International company, Panipat, between the age group of 35 to 55 years was recorded, following the international guidelines given by American Heart Association(AHA) and American College of Cardiology. Purposive sampling was done and the employees who had clinical blood pressure above 120/80 mm Hg were considered as the samples for the study. The dietary pattern of the samples was evaluated by checking the adherence to the DASH diet which was done through a questionnaire and 3 days 24-hour diet recall. Dietary adherence was assessed using a scoring scheme adoptedby Folsom and colleagues. Samples were made aware of the DASH Diet and post one month the adherence to DASH Diet was again checked and the change in the clinical blood pressure was observed.Results:There were 50 study participants. The mean age of the participants was 41.5 years. The average Systolic blood pressure of the 50 participants in the pre-test was 149.3 mm of Hg and average diastolic blood pressure was 89.58 mm of Hg. Pre Nutrition Education Program, the total mean DASH adherence score was4.3 out of 10 but post NEP and after following DASH Diet, the adherence score for the DASH Diet improved and resulted in 6.7 which indicated that the samples adhered more to the DASH Diet post NEP. There were reductions in systolic (149.30±18.98 mmHg to 146.12±14.85 mmHg) and diastolic (89.58±8.76 mmHg to86.28±4.76 mmHg) blood pressures when the subjects adhered towards the DASH Diet. A significant difference at p=0.05(p=0.039*) in the pre and post-systolic blood pressure was observed in the study. A similar trend was also noticed in the pre and post-diastolic blood pressure which showed a highly significant difference at p=0.05(p=0.002**).Conclusion:It was concluded from the study that the improvement in the DASH Diet adherence score was associated with a reduction in the Clinical blood pressure. There was a reduction in systolic (149.30±18.98 mmHg to 146.12±14.85 mmHg) and diastolic (89.58±8.76 mmHg to 86.28±4.76 mmHg) blood pressures with an improvement of DASH Adherence Score (4.3±1.27 to 6.7±1.19)

Abordagem dietética para controle da hipertensão: reflexões sobre adesão e possíveis impactos para a saúde coletiva / A dietary approach to control hypertension: reflections on adherence to and possible impacts on public health

Resumo A dieta DASH (Dietary Approach to Stop Hypertension) é considerada um padrão alimentar saudável, sendo preconizada para o controle da hipertensão arterial. O objetivo do artigo foi revisar a literatura sobre a dieta DASH e verificar sua adesão pela população brasileira. Realizou-se revisão integrativa nas bases Medline/PubMed, SciELO e LILACS, nos idiomas inglês e português. A literatura sobre dieta DASH é extensa, entretanto quatro estudos mostrando a adesão pela população brasileira foram encontrados. A dieta DASH representa uma intervenção potencialmente acessível e aplicável que poderia melhorar a saúde da população. Os estudos diferiram entre si nos métodos de avaliação utilizados e a baixa adesão evidencia a necessidade de implementação de ações no âmbito da atenção nutricional ao hipertenso. Estratégias inovadoras serão necessárias para determinar a melhor forma de minimizar as barreiras para disseminação e adesão a esse padrão alimentar saudável. Sugere-se planos alimentares e orientações flexíveis, pouco restritivas, compatíveis, com objetivos claros, direcionados para mudanças graduais, com monitoramento frequente de equipe multiprofissional de saúde.

Abstract The DASH (Dietary Approach to Stop Hypertension) diet is considered a healthy eating standard and has been recommended for the control of arterial hypertension. The scope of this article was to review the scientific literature regarding the DASH diet and to verify the adherence to this food standard by the Brazilian population. An integrative review of the literature in the Medline/PubMed, SciELO and LILACS databases was conducted in English and Portuguese. The literature on the DASH diet is extensive. However, only four studies showing adherence to the DASH diet by the Brazilian population were found. Findings from this review show that the DASH diet represents a potentially accessible and applicable intervention, which could improve the health of the population. The studies differed in the methods of evaluation. The low adherence to the diet in the Brazilian population reveals the need for nutritional actions to deal with hypertension. Innovative strategies are called for to determine how best to minimize the barriers to dissemination and greater adherence to this healthy food standard. Food plans and flexible, non-restrictive, compatible guidelines with clear objectives directed towards gradual changes with frequent monitoring by a multiprofessional health team, are suggested.

Traduccion, adaptacion cultural y validacion de una escala de funcion del miembro superior: DASH / Translation, cultural adaptation and validation of the DASH - upper extremity functional scale

Introducción El objetivo del estudio fue realizar la traducción, adaptación cultural y validación de una escala de función del miembro superior, denominada DASH, por sus siglas en inglés (discapacidad del brazo, el hombro y la mano). Materiales y métodos Se realizó un estudio metodológico de validación de escalas: traducción (constó de traducciones inglés-español, comité de expertos inicial, dos contratraducciones, un segundo comité de expertos y una traducción definitiva); evaluación de confiabilidad (pruebas de coherencia interna, test-retest y cambio mínimo detectable); respuesta al cambio (mediciones en pacientes antes y después de tratamiento), y estudio de validez (se hicieron pruebas de validez de apariencia, de constructo y de criterio). Resultados La prueba traducida fue aplicada a 338 pacientes con enfermedades de mano y hombro, 311 fueron utilizables. La consistencia interna, mediante alfa de Cronbach, se estimó > 0,96; el resultado del coeficiente de concordancia de Lin fue 0,86. El cambio mínimo detectable fue 15,88, la capacidad de respuesta al cambio mediante la prueba de la t de Student aplicada sobre la diferencia en la puntuación arrojó una p < 0,001; adicionalmente se corrió una correlación no paramétrica de Spearman entre la diferencia en la puntuación DASH y la diferencia en la escala visual analógica de cambio en estado de salud (EVA SALUD) y se obtuvo un r = 0,62 (p < 0,001). Discusión La escala DASH traducida y adaptada al español demostró una buena fiabilidad, estabilidad y capacidad de respuesta al cambio, logró discriminar entre diferentes enfermedades y tiene una validez estimada buena en cuanto a contenido, constructo y criterio.

Introduction The objective of the study was to perform translation, cultural adaptation and validation of a function scale of the upper limb, called DASH, for its acronyms in English (disability of the arm, shoulder and hand). Materials and methods A methodological study of scale validation was performed: translation (consisting of English-Spanish translations, initial expert committee, two backtranslations, a second committee of experts and a definitive translation); reliability assessment (internal consistency tests, test-retest and minimum detectable change); response to change (measurements in patients before and after treatment), and validity study (validity tests of appearance, construct and criteria were performed). Results The translated test was applied to 338 patients with hand and shoulder diseases, 311 were usable. The internal consistency, using Cronbach's alpha, was estimated to be > 0.96; The result of the Lin coefficient of agreement was 0.86. The minimum detectable change was 15.88, the ability to respond to change using the Student t test applied on the difference in score yielded a p <0.001; A nonparametric Spearman correlation was recorded between the difference in the DASH score and the difference in the visual analogue scale of change in health status (EVA HEALTH) with r = 0.62 (p <0.001). Discussion The DASH scale, translated and adapted to Spanish demonstrated good reliability, stability and responsiveness to change, managed to discriminate between different diseases and has an estimated validity in terms of content, construct and criteria.

Percutaneous Pinning For Management of Non-Comminuted Extra-Articular Distal Radial Fractures: A Prospective Study

Distal radius fractures are one of the common injuries for which orthopedic consultations are sought. These injuries make up to 10-15% of all bony injuries in adult population. High energy trauma as seen in road traffic accidents is common cause of these injuries. Noncomminuted extra-articular fractures of distal radius are common in adult males following vehicular accidents. Majority of the patients with distal radial fractures are managed by closed reduction and immobilization. Poor functional outcome and complications such as malunion has made many researchers to look for alternative methods of managing these patients. An attractive alternative for managing these cases consist of Percutaneous pinning followed by immobilization of the fracture for 3 weeks. This method is simple and affordable and reported to have excellent functional outcome.Methods:This was a prospective cohort study conducted in the department of orthopedics of a tertiary care medical college situated in an urban area. 40 adult patients with Noncomminuted extraarticular fractures of distal radius were included in this study on the basis of a predefined inclusion and exclusion criteria. All patients were treated by closed reduction followed by percutaneous pinning using K-wires. Below elbow plaster cast was given for 3 weeks after which plaster was removed and physiotherapy was started. Follow up X-rays were taken at 3 and 6 weeks. Functional outcome was assessed by Quick DASH scores. SSPE 21.0 was used for statistical analysis and p value less than 0.05 was taken as statistically significant.Results: Out of the 40 studied cases there were 34 (85%) males and 6 (15%) females a M:F ratio of 1:0.17. The most common affected age group was found to be <30 years (55%) and most common mechanism of injury was motor vehicular accidents (65%). All patients were treated by closed reduction followed by percutaneous pinning using K-wires. Excellent or good functional outcome was seen in 34 (85%) patients. 4 (10%) patients were found to have fair functional outcome and remaining 2 (5%) patients were found to have poor functional outcome as assessed by Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire.Conclusion:Percutaneous pinning followed by immobilization of the fracture is an effective treatment for Non-comminuted extra-articular fractures of distal radius having excellent functional outcome.

Hipertensión arterial en la infancia: recomendaciones para su diagnóstico y tratamiento. Parte 2 Rama de Nefrología Infantil, Sociedad Chilena de Pediatría / Blood hypertension in children: guideliness for diagnosis and treatment. Part 2 Pediatric Nephrology Branch, Chilean Pediatric Society

Resumen: La hipertensión arterial (HTA) en niños y adolescentes es una importante patología, de reservado pronóstico, asociada a factores modificables y no modificables. La prevalencia estimada es de apro ximadamente un 3,5%, la cual va aumentando progresivamente con la edad. El método ideal para su diagnóstico es la medición de la presión arterial (PA) con instrumentos auscultatorios. De acuerdo a la Academia Americana de Pediatría (AAP) la PA debe ser medida en niños mayores de 3 años una vez al año, y en niños menores de 3 años, si presentan factores de riesgo. Una vez confirmada la HTA, la evaluación debe dirigirse hacia la detección de una enfermedad causal y/o a la búsqueda de factores de riesgo asociados a una HTA primaria. El objetivo del tratamiento de la HTA primaria y secundaria en pediatría es lograr un nivel de PA que disminuya el riesgo de daño de los órganos blanco. Las opciones terapéuticas incluyen: tratamiento según etiología específica, no farmacológico y farmacológico. En esta Guia se presenta la posición de la Rama de Nefrología de la Sociedad Chile na de Pediatría con el objetivo de orientar a pediatras y nefrólogos infantiles en correcto manejo de la HTA en la infancia. En esta segunda parte se presentan las recomendaciones sobre el tratamiento antihipertensivo, haciendo énfasis en los cambios de estilo de vida.

Abstract: Hypertension (HTN) in children and adolescents is an important pathology, of, guarded prognosis, associated with modifiable and non-modifiable factors. The estimated prevalence is around 3.5% which increases progressively with age. The ideal method for its diagnosis is the measurement of blood pressure (BP) with auscultatory instruments. According to the American Academy of Pedia trics (AAP), BP should be measured in children older than three years of age once a year, and in children younger than three years of age if they present risk factors. Once the HTN is confirmed, the evaluation should be directed towards the detection of a causative disease and/or the search for risk factors associated with a primary HTN. The objective of treating primary and secondary HTN in pediatrics is to achieve a BP level that decreases the risk of target organ damage. Therapeutic op tions include treatment according to specific etiology, non-pharmacological and pharmacological one. This paper presents the position of the Chilean Society of Pediatrics Nephrology Branch with the aim of guiding pediatricians and pediatric nephrologists in the correct management of HTN in childhood. In this second part, recommendations on antihypertensive treatment are presented with an emphasis on lifestyle changes.

Rehabilitación de fracturas de mano con ortesis robóticas / Rehabilitation of hand fractures with robotic orthoses

Introducción: el presente estudio corresponde a una serie de casos clínicos que describe los resultados del tratamiento de fracturas de mano realizado por el grupo de investigación F- CIBER-HAND en Manizales, Colombia; este tratamiento integra el manejo quirúrgico de la fractura, la rehabilitación convencional y la rehabilitación con ortesis robóticas. Objetivo: generar evidencia clínica (nivel III) de que el manejo interdisciplinario especializado y el uso de ortesis robóticas disminuye la rigidez articular en los pacientes post-quirúrgicos de fracturas de la mano. Materiales y métodos: se seleccionaron 10 pacientes con fracturas de mano que presentaron signos clínicos de rigidez articular después de dos semanas del post operatorio, se les practicó terapia física y movilización pasiva con la ortesis robótica PRO-Dix. Resultados: todos los pacientes tuvieron mejoría funcional de la mano según escala DASH, disminución de la intensidad del dolor según escala visual análoga del dolor y recuperación del arco de movilidad articular según goniometría; además, retornaron a las actividades de la vida diaria que realizaban previas a la fractura. Discusión: se requieren ensayos clínicos aleatorizados para determinar las ventajas del protocolo de rehabilitación que incluye ortesis robótica versus la terapia convencional exclusivamente. Conclusiones: la movilización pasiva con ortesis robóticas complementa de forma eficaz la terapia física en pacientes post-quirúrgicos de fracturas de la mano, lo que favorece la recuperación de los arcos de movilidad articular y disminuye la rigidez articular.

Introduction: the present study corresponds to a series of clinical cases describing the results of the treatment of hand fractures carried out by the F- CIBER-HAND research group in Manizales, Colombia; this treatment integrates surgical management of the fracture, conventional rehabilitation and rehabilitation with robotic orthoses. Objective: to generate clinical evidence (level III) that specialized interdisciplinary management and the use of robotic orthoses reduces joint stiffness in post-surgical patients with hand fractures. Materials and methods: 10 patients with hand fractures who presented clinical signs of joint stiffness two weeks after surgery were selected and underwent physical therapy and passive mobilization with the PRO-Dix robotic orthosis. Results: all patients had functional improvement of the hand according to the DASH scale, reduction of pain intensity according to the visual analog pain scale and recovery of joint mobility arc according to goniometry; they also returned to their pre-fracture activities of daily living. Discussion: randomized clinical trials are required to determine the advantages of the rehabilitation protocol that includes robotic orthosis versus conventional therapy alone. Conclusions: passive mobilization with robotic orthoses effectively complements physical therapy in post-surgical patients with hand fractures, which favors the recovery of joint mobility arcs and reduces joint stiffness.

Lesiones de hombro en la tercera edad y su repercusión funcional en escala de DASH / Shoulder injuries in the elderly and their functional impact on the DASH scale

Resumen: Introducción: Los problemas discapacitantes de hombro en la tercera edad son frecuentes. Objetivo: Cuantificar los diagnósticos encontrados en 100 casos consecutivos en rehabilitación y su repercusión funcional en la escala de DASH. Material y métodos: 100 pacientes consecutivos con edad > 65 años recibidos en rehabilitación, se efectuó diagnóstico y valoración funcional en la escala de DASH. Resultados: La distribución por género con predominio del femenino (67%); la edad mostró variación de 65 a 98 años con promedio y DE 78 ± 12; los 10 diferentes diagnósticos correspondieron a ruptura del tendón supraespino (58%); artrosis glenohumeral (11%); síndrome de pinzamiento (9%); secuelas de fractura de tercio proximal de húmero (9%); artrosis acromioclavicular (7%); ruptura del tendón de la porción larga del bíceps (2%); fractura de la escápula (1%); necrosis avascular de cabeza humeral (1%); luxación escápulo-humeral recidivante inveterada (1%) y lesión del nervio circunflejo (1%). La distribución correspondió a 52% derechas, 40% izquierdas y 8% bilaterales. La escala de DASH mostró variación de 94 a 52% con promedio y DE 71 ± 22.3. Los problemas de hombro en la tercera edad se asocian siempre a discapacidad importante.

Abstract: Introduction: Disabling shoulder problems in the elderly are common. Objective: To quantify the diagnoses found in 100 consecutive shoulders cases in rehabilitation and its functional impact on the DASH scale. Material and methods: 100 consecutive patients with age > 65 years received in the Rehabilitation Department, performing diagnosis and functional assessment in the DASH scale. Results: Distribution by gender with predominance of the female (67%); the age showed variation from 65 to 98 years with average and SD 78 ± 12. Ten different diagnoses were found: supraspinatus tendon rupture (58%); gleno-humeral osteoarthritis (11%); impingement syndrome (9%); proximal humeral fracture (9%); acromio-clavicular osteoarthritis (7%); long biceps tendon rupture (2%); scapula fracture (1%); humeral head avascular necrosis (1%); neglected gleno-humeral dislocation (1%) and circumflex nerve injury (1%). The distribution corresponded to 52% right, 40% left and 8% bilateral. The DASH scale showed variation from 94 to 52% with mean and SD 71 ± 22.3. Elderly shoulder problems are associated with disability, its relation with DASH is not clear.

Complex Proximal Humeral Fracture Fixation with PHILOS Plate using Minimal Invasive Percutaneous Plate Osteosynthesis (MIPPO) Technique: A Series of 30 Patients

@#plate osteosynthesis depends on the quality of the bone,design of the fixation devices and intra-operative soft tissuedissection. This study evaluates the functional outcome ofminimally invasive percutaneous plate osteosynthesis usinglocking compression plate in proximal humerus fracturetreatment. MaterialsandMethods:The study was conducted on 30patients with complex proximal humerus fractures treated byminimally invasive percutaneous plate osteosynthesis usinglocking compression plate (PHILOS). There were 21 malesand 9 females. The average age of our study group was 58.8years. All the patients were evaluated at six weeks, threemonths, four months, six months and 12 months followingsurgery. Results:All patients had fracture union at an average of 13.2weeks. The mean DASH score at the follow-up was 8.69 (2.5to 17.16), the average range of flexion was 143.83 degrees(100 to 170 degrees) and abduction was 121.49 degrees (90to 160 degrees). We had superficial infection in three patientswhich resolved with a short course of antibiotics. There wasexcellent outcome in 26 patients, good and fair in twopatients each. Conclusion:Proximal humerus fractures treated withminimally invasive percutaneous plate osteosynthesis usinglocking compression plate with minimal soft tissuedissection, provides good functional outcome and earlyreturn of shoulder function.

Linking of Items in Two Function-related Questionnaires to the International Classification of Functioning, Disability and Health: Shoulder Pain

PURPOSE: This study was to identify international classification of functioning, disability and health (ICF) categories that could be linked conceptually to disability of arm, shoulder and hand (DASH) items and short form of health survey 36 (SF-36) items for persons with shoulder pain. METHODS: Linkage between each item in DASH and SF-36 and the categories in the ICF were assessed. The linking process was performed by ten health professionals following the linking rule. One hundred four patients with shoulder pain were enrolled from 12 private clinic outpatient departments and participated in this study. Pearson correlation coefficients were used to assess the relationships between each scale item and the linked ICF code. RESULTS: Thirty DASH items were able to be linked to 30 ICF codes, whereas the 36 items in SF-36 were only linked to 17 ICF codes. General health items included in SF-36 could not be linked to a relevant ICF concept. There was a high correlation between the two measurement tools and the linked ICF codes, DASH and its ICF code list (r=0.91), SF-36-Physical Health and its code list (r=−0.62), and SF-36-Mental Health and its code list (r=−0.72). CONCLUSION: The results suggest that concepts within each item in DASH can be linked to ICF codes for patients with shoulder pain, however, the concepts in the SF-36 items had limited linkage to ICF codes. The shoulder-specific functional tool, DASH can be expressed with ICF codes and, therefore, its use can promote data standardization and improve communication between professionals.

Rehabilitación temprana de fracturas de mano con órtesis robóticas. Reporte de caso / Early rehabilitation of hand fractures with robotic orthosis. Case report

Introducción El presente estudio de casos revela los avances tecnológicos en el tratamiento de las fracturas de mano realizados por el grupo de investigación F-CIBER-HAND en Manizales, Colombia; integra la intervención quirúrgica practicada por el cirujano ortopedista de mano, la movilización temprana indicada por Fisiatría, la rehabilitación convencional por fisioterapeuta especializada en Ortopedia y Traumatología, y la terapia de movilización pasiva mediante ortesis robóticas. Materiales y métodos Se seleccionaron cuatro pacientes: paciente con fractura intraarticular compleja de la cabeza del quinto metacarpiano de la mano derecha; paciente con fractura conminuta de la base del cuarto metacarpiano de la mano izquierda; paciente con fractura diafisiaria del quinto metacarpiano de la mano derecha, y paciente con fractura subcapital del segundo metacarpiano de la mano izquierda, los cuales fueron tratados de acuerdo con los cuatro momentos terapéuticos descritos, con seguimiento de su evolución clínica individual. Resultados En todos los pacientes se ponen de manifiesto la recuperación funcional de la mano según la Escala de Discapacidades del Hombro, el Codo y la Mano (DASH), la disminución de la intensidad del dolor según la Escala Visual Análoga del Dolor (EVA) y la recuperación del arco de movilidad articular; además, todos los pacientes retornaron a las actividades de la vida diaria y laborales. Discusión Se concluye que con el manejo quirúrgico especializado y la rehabilitación temprana complementada con ortesis robóticas, se mejoró la funcionalidad de la mano, disminuyó el dolor, hubo ganancia del arco articular y reinserción a las actividades cotidianas. El propósito del estudio es generar evidencia clínica de que el manejo interdisciplinario especializado y el uso de ortesis robóticas mejora la condición clínica de los pacientes con fracturas de la mano. Nivel de evidencia clínica nivel IV.

Background The present cases study reveals technological advances in the treatment of hand fractures performed by the F-CIBER-HAND research group in Manizales - Colombia, integrating the surgical intervention by Hand Orthopedic Surgeon, early mobilization Indicated by Physiatry, the conventional rehabilitation by Physiotherapist specialized in Orthopedics and Traumatology, and passive mobilization therapy whit robotic orthoses. Materials and methods Four patients were selected: patient with complex intra-articular fracture in the head of the 5th right metacarpal, patient with a fracture in the base of the 4th left metacarpal, patient with diaphyseal fracture of the 5th right metacarpal, and patient with subcapital fracture of the 2nd left metacarpal, who were treated according to the four therapeutic moments described, with follow-up of their individual clinical evolution. Results In all patients was evident functional recovery of the hand according to the DASH scale, decrease of pain intensity according to analogous visual scale, and recovery of the joint mobility arc. In addition, all the patients returned satisfactorily to the daily life activities and jobs. Discussion It was concluded that with specialized surgical management and early rehabilitation complemented with robotic orthoses, the functionality of the hand was improved, pain decreased, there was gain of the articular arch and reinsertion to daily activities. The purpose of the study is to generate clinical evidence that specialized interdisciplinary management and the use of robotic orthoses improve the clinical condition of patients with hand fractures. Evidence level IV.

Artisanal fisherwomen/shellfish gatherers: analyzing the impact of upper limb functioning and disability on health-related quality of life / Pescadoras artesanais/marisqueiras: análise do impacto da funcionalidade e incapacidade de membros superiores sobre a qualidade de vida relacionada com a saúde

Abstract The aim is to analyze upper limb functioning and disability, and its association with health-related quality of life among artisanal fisherwomen from Bahia, Brazil. Cross-sectional epidemiological study was conducted with a sample of 209 fisherwomen. Structured questionnaires were used for socio-demographic and comorbidity information, as well as the instruments Disabilities of the Arm, Shoulder and Hand (DASH) and Short-Form Healthy Survey (SF-36) respectively, to evaluate the upper limbs and health-related quality of life. The results demonstrated that the presence of musculoskeletal disorders in the upper limbs directly affects the values of the DASH instrument and the SF-36v01 questionnaire scores, while also generating a negative correlation between the DASH and SF-36v01. The varying functioning abilities, pain and social aspects negatively affect upper limb function, and the daily activities and work of fisherwomen. The presence of chronic disease and the absence of intervention and rehabilitation for these professionals, that could produces, in a long-term, cases of disability.

Resumo O objetivo foi analisar a incapacidade e a funcionalidade de membros superiores e verificar sua associação com a qualidade de vida relacionada com a saúde de pescadoras artesanais da Bahia, Brasil. Estudo epidemiológico, de corte transversal, envolvendo uma amostra de 209 pescadoras artesanais. Foram utilizados questionários estruturados para informações sociodemográficas e comorbidades e os instrumentos Disabilities of the Arm, Shoulder and Hand (DASH) e Medical Outcomes Study 36-Item Short-Form Healthy Survey (SF-36), para, respectivamente, avaliação dos membros superiores e qualidade de vida relacionada com a saúde. Os resultados encontrados demonstram que a presença de distúrbios musculoesqueléticos (DME) em membros superiores afeta diretamente os valores do instrumento DASH e os escores do SF-36v01, bem como a correlação negativa encontrada entre o DASH e os domínios do SF-36v01. As variáveis capacidade funcional, dor e aspectos sociais afetam negativamente a funcionalidade de membros superiores e as atividades do cotidiano e do trabalho de pescadoras artesanais. A presença de doença crônica e a ausência de intervenção e reabilitação desses profissionais geram, a longo prazo, casos de incapacidade.

Endoprosthetic Reconstruction of distal Humerus following Resection of distal Humeral Giant Cell Tumours in Six Patients in Rural India

Giant cell tumour is a commonly occurring benign bone tumour in the Indian population. The common sites of involvement in descending order of frequency are distal femur, proximal tibia, distal radius and proximal humerus. The less commonly occurring sites are distal humerus, pelvis and proximal femur. We present six cases of giant cell tumour involving the distal humerus in rural India. After obtaining a tissue diagnosis by Trucut biopsy and classifying using Enneking's classification, we proceeded to perform wide resection followed by endoprosthetic reconstruction using custom mega prosthesis. We present here six patients (M: F: 2: 4) who were managed by us between 2008-2014. They presented to us with pain around the elbow and restriction in range of movements. They were each noted radiographically to have a lytic lesion involving the distal humerus with the likely diagnosis of giant cell tumour. Closed biopsy was done in all of them to obtain a definitive diagnosis. All patients underwent wide resection and reconstruction using distal humerus custom prosthesis. All patients were followed up at 6, 12, 18 and 24 weeks and thereafter six monthly until the last review. They were assessed using the DASH scoring system. All patients were well with no evidence of recurrence with good to fair functional outcome. We conclude that careful pre-operative planning with meticulous soft tissue dissection and good implant metallurgy and design, these tumours can be treated with good long term functional results.

The Radial Bow following Square Nailing in Radius and Ulna Shaft Fractures in Adults and its Relation to Disability and Function

One of the points made against nailing in radius and ulna shaft fractures has been the loss of radial bow and its impact on function. The aims of the study were to assess the change in magnitude and location of the radial bow in radius and ulna shaft fractures treated with intramedullary square nails and to assess the impact of this change on functional outcome, patient reported disability and the range of motion of the forearm. We measured the magnitude of radial bow and its location in the operated extremity and compared it to the uninjured side in 32 adult patients treated with intramedullary square nailing for radius and ulna shaft fractures at our institute. The mean loss of magnitude of maximum radial bow was 2.18 mm which was statistically significant by both student-T test and Mann-Whitney U test with p value less than 0.01. The location of maximum radial bow shifted distally but was statistically insignificant. The magnitude of maximum radial bow had a negative correlation with DASH score that was statistically insignificant (R=- 0.22, p=0.21). It had a positive, statistically significant correlation to the extent of supination in the operated extremity (R = 0.66, p = 0.0004). A loss of up to 2mm of radial bow did not influence the functional outcome as assessed by criteria reported by Anderson et al. The magnitude of radial bow influenced the supination of the forearm but not the final disability as measured by DASH score. Intramedullary nailing did decrease the magnitude of radial bow but a reduction of up to 2mm did not influence the functional outcome.