Compressive Structures of the Median Nerve at the Elbow / Estructuras Compresivas del Nervio Mediano en el Codo

SUMMARY: The objective of this study was to analyze the potential for compression of the median nerve (MN) caused by the bicipital aponeurosis (BA), the humeral and ulnar heads of the pronator teres muscle (PTM) and the arcade of the flexor digitorum superficialis muscle (FDS) in recently deceased cadavers. In this analysis 20 forearms of 10 recently deceased adult male cadavers were dissected. Dissections were performed in the institution's autopsy room or anatomy laboratory. The short and long heads of the biceps brachii muscle, as well as the BA were identified in all upper upper limbs. The BA received contribution from the short and long heads of the biceps brachii muscle. In 12 upper limbs the BA was wide and thickened and in 8 it was supported by the MN. In 5 upper limbs, the BA was wide but not very thick, and in 3 it was narrow and not very thick. We identified the existence of the FDS muscle arcade in all dissected upper limbs. A fibrous arcade was identified in 4 forearms, a muscular arcade in 14 and a transparent arcade in 2 upper limbs. In all of them, we recorded that the arcade was in contact with the MN. We recorded the humeral and ulnar heads of the PTM in all dissected upper limbs, with the presence of fibrous beams between them along their entire length. The MN was positioned between the humeral and ulnar heads of the PTM in all upper limbs. In eight upper limbs (40 %), we identified that the BA had thickness and contact with the MN with the potential to cause its compression. Compression between the humeral and ulnar heads of the PTM by the fibrous connections has the potential to cause nerve compression in all upper limbs (100 %). We did not identify that the anatomical structure of the FDS arcade had the potential to cause compression in the MN.

El objetivo de este estudio fue analizar la potencial compresión del nervio mediano (NM) causado por la aponeurosis bicipital (AB), las cabezas humeral y cubital del músculo pronador redondo (MPR) y la arcada del músculo flexor superficial de los dedos (MFS). En este análisis se diseccionaron 20 antebrazos de 10 cadáveres masculinos de individuos adultos fallecidos recientemente. Las disecciones se realizaron en la sala de autopsias o en el laboratorio de anatomía de la Institución. En todos los miembros superiores se identificaron las cabezas corta y larga del músculo bíceps braquial, así como la AB. La AB recibió contribución de las cabezas corta y larga del músculo bíceps braquial. En 12 miembros superiores la AB era ancha y engrosada y en 8 estaba sostenida por el NM. En 5 miembros superiores la AB era ancha pero poco gruesa, y en 3 era estrecha y de menor grosor. Identificamos la existencia de la arcada muscular MFS en todos los miembros superiores disecados. Se identificó una arcada fibrosa en 4 antebrazos, una arcada muscular en 14 y una arcada delgada y transparente en 2 miembros superiores. En todos ellos registramos que la arcada estaba en contacto con el NM. Registramos las cabezas humeral y cubital del MPR en todos los miembros superiores disecados, con presencia de haces fibrosos entre ellas en toda su longitud. El NM estaba situado entre las cabezas humeral y cubital del MPR en todos los miembros superiores. En ocho miembros superiores (40 %), identificamos que la AB era gruesa y tenía contacto con el NM con potencial para causar su compresión. La compresión entre las cabezas humeral y ulnar del MPR, por las conexiones fibrosas, tiene el potencial de causar compresión nerviosa en todos los miembros superiores (100 %). No identificamos que la estructura anatómica de la arcada MFS tuviera el potencial de causar compresión del NM.

Lineamientos técnicos para la habilitación y rehabilitación de personas con alteraciones musculoesqueléticas / Technical guidelines for the rehabilitation and rehabilitation of people with musculoskeletal disorders

El presente documento desarrolla las diferentes intervenciones en salud desde la promoción de la salud para las alteraciones musculoesqueléticas, prevención de las alteraciones hasta la atención que deberá ser diferenciada, según categorías funcionales en cualquiera de los niveles de atención, incluyendo las instituciones especializadas en habilitación y rehabilitación. Además, se desarrollan las consideraciones para la atención en habilitación y rehabilitación, que los profesionales de salud del SNIS deberán ejecutar, incluyendo los cuidados paliativos necesarios, las ayudas técnicas y tecnologías de asistencia

This document develops the different health interventions from health promotion for musculoskeletal disorders, prevention of disorders to care that must be differentiated, according to functional categories at any of the levels of care, including institutions specialized in habilitation and rehabilitation. In addition, considerations are developed for habilitation and rehabilitation care, which SNIS health professionals must execute, including the necessary palliative care, technical aids and assistive technologies

Conservative Approach to Type III Ulnar Club Hand: Case Report / Abordagem conservadora da mão torta ulnar tipo III: Relato de caso

Abstract Ulnar club hand is a rare condition of the upper limbs, for which treatment depends on the degree of morphological and functional impairment, correlating with the radiographic classification of Dobyns, Wood, and Bayne. The aim of the present study is to report a case of a 6-year-old male patient, followed up for type III ulnar club hand (total ulnar dysplasia). Despite the initial difficulty of manipulating objects and performing everyday tasks, conservative physical therapy treatment provided strength gain and development of functional skills for daily life. We conclude that patients with type III deformity can be properly managed with rehabilitation although they require outpatient follow-up until skeletal maturity is reached, as dynamic deformities and new functional limitations may lead to need for corrective surgeries.

Resumo A mão torta ulnar é uma rara afecção de membros superiores, cujo tratamento depende do grau de comprometimento morfológico e funcional, que se correlaciona com a classificação radiográfica de Dobyns, Wood e Bayne. O objetivo deste estudo é relatar um caso de um paciente de 6 anos de idade, do sexo masculino, acompanhado devido a mão torta ulnar do tipo III (aplasia total da ulna). Apesar da dificuldade inicial de manipular objetos e realizar tarefas cotidianas, o tratamento conservador fisioterapêutico propiciou o ganho de força e o desenvolvimento de habilidades funcionais para a vida diária. Concluímos que pacientes com deformidade do tipo III podem ser manejados adequadamente com reabilitação embora necessitem de seguimento ambulatorial até a maturidade esquelética, pois deformidades dinâmicas e novas limitações funcionais podem levar à necessidade de cirurgias corretivas.

Caliber-persistent labial artery: report of 3 cases

Abstract The caliber-persistent labial artery is a vascular anomaly in which a primary arterial branch penetrates into the submucosal tissue without reduction in diameter. Most lesions are benign and do not require treatment, except for complications and/or on patient demands. In this way, noninvasive diagnostic tools are preferred such as high-resolution and color Doppler ultrasonography which allow direct observation of the lesion, assessing its exact location and diameter at every axis, as well as the blood flow velocity. An excisional biopsy of these lesions or even their surgical extirpation could have a fatal outcome with profuse bleeding.

Desórdenes musculoesqueléticos, estrés y calidad de vida en docentes de un centro del Servicio Nacional de Aprendizaje / Musculoskeletal disorders, stress, and life quality in professors of Servicio Nacional de Aprendizaje

Objetivo. Esta investigación se propuso establecer la relación entre los desórdenes musculoesqueléticos, el estrés y la calidad de vida de los docentes de un centro del Servicio Nacional de Aprendizaje. Materiales y Método. El estudio fue cuantitativo, no experimental, descriptivo. La muestra estuvo constituida por 55 docentes, seleccionados de forma probabilística aleatoria simple. Los instrumentos utilizados fueron el cuestionario nórdico de des-órdenes musculoesqueléticos, el cuestionario de estrés del Ministerio de la Salud y de la Protección Social y el test de calidad de vida WhoQol Bref ­ versión en español, autorizado por la Organización Mundial de la Salud. El análisis de datos se realizó en el software SPSS versión 23, a partir de estadísticos descriptivos (mediana y rango intercuartílico) y correlativos (r Pearson y Rho Spearman), teniendo en cuenta la distribución normal, la cual se calculó a partir de la prueba Kolmogorov Smirnov. Resultados. Se encontró relación positiva y asociación estadísticamente signifi-cativa entre los desórdenes musculoesqueléticos y los síntomas de estrés y el estrés general (p<0,5 y p<0,01). También se encontró correlación negativa y asociación estadística entre los desórdenes musculoesqueléticos y la mayoría de dominios de la calidad de vida y resultados similares al relacionar el estrés con la calidad de vida (p<0,5 y p<0,01). Conclusión. Se encontró que, a mayor presencia de desórdenes musculoesquelé-ticos y estrés, menor es la calidad de vida en los docentes participantes del estudio

Objective. This research aimed to stablish the relationship between musculoskeletal disorders, stress, and quality of life of professors at a Servicio Nacional de Apren-dizaje campus. Materials and methods. The study was quantitative, non-experimental, de-scriptive. The sample was constituted by 55 professors, selected by a simple random sample. The instruments used were the Nordic Musculoskeletal Questionnaire, the stress questionnaire of Colombia ́s Ministry of Health and Social Protection, and the Quality of Life Test, WhoQol Bref - Spanish version, authorized by the Word Health Organization. The data analysis was in SPSS-23, based on descriptive sta-tistics (median and interquartile range) and correlative statistics (r Pearson and Rho Spearman), considering the normal distribution, which is calculated according to the Kolmogorov-Smirnov test. Results. Positive relationship and a statistically significant association were found between musculoskeletal disorders and stress symptoms and general stress (p<0,5 and p<0,01). Negative correlation and statistical association were also found between musculoskeletal disorders and most domains of quality of life, as well as similar re-sults when stress was related to quality of life (p <0.5 and p <0.01).Conclusion. It was found that the greater the presence of musculoskeletal disorders and stress, the lower the quality of life in the teachers participating in the study

Epidemiology of Open Tibia fractures presenting to a tertiary referral center in Southern Malawi: a retrospective study

Road traffic accidents in Malawi have increased in recent years resulting in a high incidence of trauma seen in the hospitals as well as a high prevalence of musculoskeletal impairment in the community. Open fractures are a common consequence of road traffic accidents, and the tibia is the most common long bone open fracture. Objective Epidemiology of open tibia fractures at the largest tertiary level hospital in Malawi and incidence of infections of open fractures managed at the institution. Methodology This was a retrospective study of consecutive open tibia fracture patients seen and admitted to Queen Elizabeth Central Hospital's (QECH) orthopedic department from 1st January 2019 to 31st December 2019. Patients with life-threatening head, chest, or abdominal injuries were excluded as management takes priority over any limb-threatening injury. Results There were 72 open tibia fractures screened, and 60 of these met our entry criteria; 6 patients did not, while 6 patient files were missing. The median age of patients was 36 years, IQR (27-44.75) with Males making up 82%(n=49) of open fractures. Most of the open tibia fractures were caused by road traffic accidents 63%(n=38), followed by assaults 18%(n=11), falls 17%(n=10), and industrial accidents 2%(n=1). 26.7% (n=16) of open tibia fractures developed an infection. We found that patients' average length of stay was 16. 9(IQR 9.5-31.25) days. Most of the injuries (68.3%, n=41) were moderate to high energy injuries being Gustilo et al. grade II and III open tibia fractures. Conclusion This study identified that open tibia fractures were common in our hospital and that were often high energy injuries requiring an extended hospital stay to manage. The infection rate noted was higher than that reported on average in lower- and middle-income countries. There is a need to do more robust prospective studies in the area to gather more information.

Musculoskeletal disorders in operator drivers in northwestern Namibia ­ associated factors and awareness

Background: Operator drivers are responsible for driving trackless heavy-duty mining or construction vehicles such as graders, dumpers, loaders, and bulldozers. They have an increased prevalence of musculoskeletal disorders (MSDs) due to the nature of their work. There is a paucity of data on MSDs and associated factors among operator drivers in Namibia. Objective: We assessed awareness of, and factors associated with, MSDs among operator drivers in the construction and mining industries in Namibia. Methods: In this cross-sectional study, questionnaires were administered to operator drivers, and managerial staff were interviewed, using a semi-structured interview guide. Data obtained were analysed using chi-square tests and binary logistic regression modelling. Results: 182 operator drivers completed the questionnaires, and 13 operator drivers' supervisors and managers were interviewed. Factors associated with MSDs were length of service for ≥ 10 years (OR 15.3, 95% CI 6.0­39.0), alcohol consumption (OR 2.8, 95% CI 1.1­6.7), lack of physical fitness activity (OR 8.8, 95% CI 3.8­20.4), and lack of awareness of MSDs (OR 3.1, 95% CI 1.3­7.3). Managerial staff were of the opinion that the operator drivers did not suffer from MSDs. Conclusion: We found health issues that are associated with MSDs among the operator drivers, impacting their general wellness and productivity. Monitoring of health and wellness of these workers by the companies is recommended. There is need to increase MSD awareness, personal protective equipment usage, ergonomics skills training, and physical fitness exercises for operator drivers. Employers are urged to adopt policies, and to design guidelines and interventions aimed at promoting occupational health and safety in this population.

Effect of kinesio tape on scapular kinematics in subjects with scapular dyskinesis

Scapular dyskinesis is an abnormality in scapula static or dynamic position. There are several techniques for scapular dyskinesis conservative treatment, including Kinesio Tape application, which is used to promote and support scapula joint alignment, decrease pain and improve local muscle control. The study aim to investigate the effect of kinesio tape on scapular kinematics in subjects with scapular dyskinesis. Fourteen subjects with scapular dyskinesis performed flexion and scaption movements in two conditions: (1) without load and (2) holding a dumbbell. A scapular tape was applied over the lower trapezius (Y shaped) muscle with a 20% tension. Kinematic data were captured with 10 infrared cameras and analyzed based on Euler angles, peak values of upward rotation, internal rotation, and posterior tilt angles. To compare the situations with and without kinesio tape the repeated measures two-way ANOVAs (α = 0.05) was performed using SPSS software. Scapular tape increase upward rotation and posterior tilt during flexion of the shoulder. No interaction (Load x KT) was found during flexion, suggesting that KT effect in the peak values is the same, regardless the load condition. Scapular tape decreases internal rotation during scaption and a significant interaction was found between load x KT, suggesting the effect of using KT could depend the load u sed during this movement. The results suggest that kinesio tape may can be use as assistant to increase upward rotation, posterior tilt and decrease internal rotation in scapular dyskinesis subjects. (AU)

Agenesia esternal total: reconstrucción esternal con placas absorbibles y pericardio bovino en un paciente de 4 años / Total sternal cleft: sternal reconstruction with absorbable plaques and bovine pericardium in a 4-year-old patient

La agenesia esternal es una rara malformación del desarrollo embrionario del esternón, que puede estar o no relacionado con otras anomalías congénitas. Se presenta el caso de un paciente de 4 años de edad con agenesia esternal total, que fue llevado a reconstrucción de la pared torácica anterior con material protésico absorbible y pericardio bovino, logrando la adecuada estabilidad de la pared torácica y la corrección de la función de la misma, con una evolución satisfactoria después de dos años de seguimiento

Sternal cleft is a rare malformation of the embryonic development of the sternum, which may or may not be related to other congenital anomalies. We present the case of a 4-year-old patient with total sternal cleft, who underwent reconstruction of the anterior chest wall with absorbable prosthetic material and bovine pericardium, achieving adequate stability and correction of the function of the chest wall, with a satisfactory evolution after two years of follow-up

Retração de cintura escapular em recémnascidos internados em uma Unidade de Cuidados Intermediários / Scapular waist retraction in newborns admitted to an Intermediate Care Unit

INTRODUÇÃO: As unidades de cuidados neonatais dispõem de altos recursos tecnológicos que, aliados ao avanço da ciência, visam garantir a sobrevida de recém-nascidos (RNs). Entretanto, o internamento expõe os RNs a variados estímulos que, associados a assistência inadequada, podem favorecer o surgimento de alterações posturais. OBJETIVO: Investigar a frequência dos sinais sugestivos de retração de cintura escapular em RNs que necessitaram de internamento. MATERIAIS E MÉTODOS: Estudo observacional, quantitativo e longitudinal, realizado com 16 RNs, internados na Unidade de Cuidados Intermediários (UCI) de um hospital estadual, localizado na cidade de cidade de Salvador, Bahia, no ano de 2019. Os dados foram coletados por meio de medidas das escápulas, sinal do cachecol, protocolo de inspeção biomecânica e prontuários. RESULTADOS: Sete (43,7%) RNs apresentaram sinais sugestivos de retração de cintura escapular. Seis (37,5%) apresentaram sinal do cachecol positivo e apenas um (6,3%) apresentou simultaneamente os sinais de abdução de membros superiores, adução escapular, sinal do cachecol positivo e redução das medidas das escápulas em relação à coluna ao longo do internamento. A comparação entre a diferença do maior e do menor valor das medidas das escápulas, com o sinal do cachecol, não foi estatisticamente significante. Porém, aqueles que apresentaram sinal do cachecol positivo e/ou diminuição das medidas atingiram valores máximos de dias de internamento. CONCLUSÃO: Os sinais sugestivos de retração de cintura escapular estiveram presentes em quase metade da amostra. Importante salientar que esses achados traduzem as características específicas da população do estudo, considerando suas limitações.

INTRODUCTION: Neonatal care units have high technological resources that, together with the advancement of science, aim to ensure the survival of newborns (NBs). However, hospitalization exposes newborns to various stimuli that, associated with inadequate care, can favor the appearance of postural changes. OBJECTIVE: To investigate the frequency of signs suggestive of scapular waist retraction in newborns who required hospitalization. Materials and METHODS: Observational, quantitative, and longitudinal study, carried out with 16 newborns, admitted to the Intermediate Care Unit (ICU) of a state hospital, located in the city of Salvador, Bahia, in the year 2019. Data were collected through scapula measurements, scarf signs, biomechanical inspection protocol, and medical records. RESULTS: Seven (43.7%) of the newborns showed signs suggestive of scapular waist retraction. Six (37.5%) showed a positive scarf sign and only one (6.3%) simultaneously showed signs of the abduction of the upper limbs, scapular adduction, positive scarf sign, and reduced scapular measurements in relation to the spine along with hospitalization. The comparison between the difference between the highest and lowest scapular measurements, with the scarf sign, was not statistically significant. However, those who showed a positive scarf sign and/or reduced measurements reached maximum values for days of hospitalization. CONCLUSION: Signs suggestive of scapular waist retraction were present in almost half of the sample. It is important to note that these findings reflect the characteristics of the study population, considering their limitations.

Síndrome congénito de Klippel-Trenaunay-Weber: caso clínico / Congenital Klippel-Trenaunay-Weber syndrome: clinical case

RESUMEN: El síndrome de Klippel-Trenaunay-Weber (SKTW) es una enfermedad congénita poco frecuente caracterizada por hipertrofia de un miembro que afecta a los huesos y a las partes blandas, con extensos angiomas planos, várices y otras anomalías vasculares, como fístulas arteriovenosas. Su incidencia es de 1:100.000 personas. El objetivo fue describir un caso raro de SKTW bilateral, confirmado con hallazgos clínicos e imagenológicos en un niño de 9 años de edad, de sexo masculino, con antecedentes de sangrado digestivo bajo, herniorrafía inguinal izquierda y orquidopexia ipsilateral. En ambos miembros inferiores se identificaron lesiones hemangiomatosas e hipertrofia muscular y edema en miembro inferior izquierdo con ausencia de segundo y tercer dedos del pie izquierdo por antecedente quirúrgico de amputación. Adicionalmente, presentaba adenopatías cervicales e inguinales. Dentro de los hallazgos radiográficos importantes, se observó una cortical ósea delgada en el fémur del miembro inferior izquierdo. El SKTW afecta típicamente a los miembros inferiores de forma unilateral; este es un caso infrecuente de afección bilateral (con predominio izquierdo). Algunos pacientes, registran compromiso visceral con hemorragia digestiva baja, además de alteraciones genitourinarias, presentes en el 30% de los casos. La presentación de adenopatías es inusual.

SUMMARY: Klippel-Trenaunay-Weber syndrome (KTWS) is a rare congenital disease characterized by limb hypertrophy affecting bones and soft tissues, with extensive flat angiomas, varicose veins, and other vascular abnormalities, such as arteriovenous fistulas. Its incidence is 1: 100,000 people. The aim of this work was to describe a rare case of bilateral KTWS, confirmed with clinical and imaging findings in a 9-year-old male, with a history of lower gastrointestinal bleeding, left inguinal herniorrhaphy and ipsilateral orchidopexy. In both lower limbs, hemangiomatous lesions and muscle hypertrophy were identified, and in the left lower limb edema was identified with absence of the second and third toes due to a surgical history of amputation. Additionally, the patient presented cervical and inguinal lymphadenopathy. Among the important radiographic findings, in the left lower limb femur a thin bony cortex was observed. KTWS typically affects the lower limbs unilaterally; this is an infrequent case of bilateral affection (predominantly left). Some patients have visceral involvement with lower gastrointestinal bleeding, as well as genitourinary alterations, present in 30 % of cases. The presentation of lymphadenopathy is unusual.

Valorização das equipes de enfermagem mediada pela macroergonomia como complemento estratégico nas organizações de saúde / Valueing nursing teams: macroergonomy as a strategic complement in healthcare organizations / Valorización de los equipos de enfermería mediada por la macroergonomía como complemento estratégico en las organizaciones de salud

Enfermeiros, obstetrizes, técnicos e assistentes de enfermagem fazem parte da maior categoria profissional atuante no setor de saúde brasileiro: existe uma forte relação de interdependência entre esse grupo e a própria estruturação do sistema de saúde como um todo. Sugere-se na literatura que, mesmo adotando medidas de proteção, os agravos musculoesqueléticos são os mais prevalentes nessa população, o que acarreta um ciclo destrutivo autoalimentado. Neste trabalho buscou-se, por meio de uma abordagem qualitativa, propor uma discussão fundamentada e multidisciplinar acerca dos problemas ergonômicos existentes na atividade laboral desenvolvida por equipes de enfermagem durante a prestação do cuidado. Como subsídio, foram elaboradas revisões narrativas de literatura, na tentativa de delinear a intersecção entre três eixos principais: a ergonomia, o processo decisório estratégico e os instrumentos normativos em vigor no país. Um processo de formulação estratégico inclusivo e que perpassa todos os membros da organização, respeitando as suas competências, será aquele que poderá trazer melhores benefícios gerais. Nesse contexto, a macroergonomia pode ser empregada como complemento estratégico para gerar vantagem competitiva sustentável para a organização, incluir as equipes de enfermagem na tomada de decisão e reduzir os agravos musculoesqueléticos.

Nurses, midwives, technicians and nursing assistants make up the largest occupational group in Brazil's healthcare industry, which indicates a strong interdependence relation between this group and the healthcare system's structure. Specialized literature suggests that, despite the protective measures adopted, musculoskeletal disorders are the most prevalent in this population, leading to a self-inflicted destructive cycle. This literature review proposes a well-founded and multidisciplinary discussion on the ergonomic problems observed in nursing teams during care delivery, developing the topic over three main axes: Ergonomics; Strategic Decision-making Process; and Laws and Regulations. A strategic process that considers the competencies of all its members during its formulation is the one capable of bringing better benefits overall. In this scenario, macro-ergonomics can be implemented as a strategic complement to generate sustainable competitive advantage for healthcare organizations, include nursing teams in the decision-making process, and reduce their musculoskeletal disorders.

Las enfermeras, parteras, técnicos y auxiliares de enfermería son parte del grupo ocupacional más grande en el sistema de salud brasileño; y existe una fuerte relación de interdependencia entre este grupo y la propia estructura del sistema sanitario en su conjunto. La literatura especializada sugiere que los trastornos musculoesqueléticos son los más frecuentes en esta población, incluso cuando se adoptan medidas de protección, lo que lleva a un ciclo autoinfligido destructivo. Con base en un enfoque cualitativo, este trabajo propone una discusión bien fundamentada y multidisciplinaria sobre los problemas ergonómicos en los equipos de enfermería durante la prestación de atención. Para ello, se utilizó la revisión de la literatura para desarrollar el tema desde tres ejes principales: ergonomía; proceso de toma de decisiones estratégicas; leyes y reglamentos vigentes en Brasil. Un proceso de formulación estratégico inclusivo y que toma en cuenta todos los miembros de la organización, respetando sus competencias, será el que puede brindar mejores beneficios en general. En este escenario, la macroergonomía puede ser utilizada como complemento estratégico para generar una ventaja competitiva sostenible para las organizaciones de atención médica, incluir a equipos de enfermería en el proceso de toma de decisiones y reducir sus trastornos musculoesqueléticos.

Alagille Syndrome: Features and Outcome among Filipino Children

@#We report 13 children fulfilling criteria of Alagille syndrome. All had chronic cholestasis secondary to paucity of intrahepatic bile ducts and triangular facies. Eight children had associated congenital heart disease (six pulmonic stenosis, one each tetralogy of Fallot and patent ductus arteriosus), seven with butterfly vertebrae and one with posterior embryotoxon. Seven of the 13 children are alive and jaundice-free but three with concomitant hypercholesterolemia; the six other children died of liver-related complications.

Effect of horse riding equipment in activity of trunk and lower limb muscles in equine-assisted therapy

Equine-assisted therapy uses the horse in rehabilitation and/or education of people, such as Down syndrome(SD), cerebral palsy(PC)and intellectual disability(DI). In context, the rehabilitation program and horse riding equipment should be usedaccording to the specific characteristics of each individual, becoming an ally in the quest for excellence in equine-assisted therapy programs. The aim was to evaluate the effect of riding equipment used in equine-assisted therapy on the muscular activityof trunk and lower limb of individuals with SD, PC and DI. The study included 15 individuals equally assigned to each group: SD, PC and DIwith a mean age of 16.2 (±1.10), 16 (±1.22)e 16 (±0) years,respectively. The analysis of muscle activity was performed through surface electromyography, using four variations of horse riding equipment: saddle with and without feet supported on the stirrups and blanket with and without feet supported on the stirrups. Sigma Stat 3.5®software was used for statistical analysis.The Shapiro Wilk's test was used for normality of the data, the Bartlett test for homogeneity of the variances and the Kruskal-Wallis test for repeated measures with no normal distribution.Statistically significant differences were observed forp<0.05.The SDgroup presented a greater muscular activity of trunk and lower limbs with blanket equipment without the feet supported in the stirrups (H = 15.078, p = 0.002), as in the DI group (H=8.302, p = 0.040), while inPCgroup was the saddle with feet supported in the stirrups (H=11.137,p = 0.011). The choice of riding equipment used in equine-assisted therapy interferes differently in the pattern of muscular activation of the trunk and the lower limbs, according to the pathological processes of the practitioners. It should be an important aspect to consider when planninga treatment.

Síndrome de CLOVES: tratamiento con rapamicina oral: reporte de dos casos / CLOVES syndrome: treatment with oral rapamycin: report of two cases

INTRODUCCIÓN: El síndrome de CLOVES se caracteriza por sobrecrecimiento lipomatoso asociado a malformaciones vasculares, representando un desafío diagnóstico y terapéutico. La rapamicina, un inhibidor de la vía mTOR, ha demostrado ser una buena alternativa terapéutica en un grupo de anomalías vasculares. Reportamos dos casos de síndrome de CLOVES con buena respuesta al tratamiento con rapamicina oral. OBJETIVO: Reportar la experiencia del uso de rapamicina oral en el tratamiento de dos pacientes con síndrome de CLOVES. CASOS CLÍNICOS: Caso 1: preescolar femenino de tres años de edad con sín drome de CLOVES e historia de hospitalizaciones reiteradas por infección severa de malformaciones linfáticas macroquísticas y episodios trombóticos. Evoluciona con mala calidad de vida, múltiples hospitalizaciones, riesgo quirúrgico y progresión de las lesiones, por lo que se indicó rapamicina oral. A los 6 meses de tratamiento se evidenció reducción clínica y radiológica del tamaño de las masas lipomatosas y linfáticas, ausencia de linforrea cutánea y mejoría significativa de la calidad de vida, sin requerir nuevas hospitalizaciones. Caso 2: escolar femenino de diez años de edad, portadora de síndrome de CLOVES, que desarrolló escoliosis y deterioro de su capacidad motora, haciéndose dependiente del uso de silla de ruedas. Se indicó rapamicina oral, evidenciándose a los cuatro meses de tratamiento mejoría en su capacidad física, independencia y autovalencia, con desaparición de la linforrea. CONCLUSIÓN: Proponemos la rapamicina oral para el tratamiento de pacientes con sín drome de CLOVES que presenten complicaciones y deterioro de la calidad de vida producto de su enfermedad.

INTRODUCTION: CLOVES syndrome is characterized by lipomatous overgrowth associated with vascular malforma tions, representing a diagnostic and a therapeutic challenge. Rapamycin, an mTOR inhibitor, has proved to be a good therapeutic option in some vascular anomalies. In this article, we report two ca ses of CLOVES syndrome with good response to oral rapamycin treatment. OBJECTIVE: To report the outcome of two patients with CLOVES syndrome treated with oral rapamycin. CLINICAL CASES: Case 1: A three-year-old female preschooler with CLOVES syndrome and history of repeated hospita lizations due to severe infections resulting from macrocystic lymphatic malformations and due to thrombotic episodes. The patient evolved with poor quality of life, multiple hospitalizations, surgical risk and progression of the lesions, therefore, oral rapamycin was indicated. After six months of treatment, clinical and radiological reduction in the size of the lipomatous and lymphatic masses, cutaneous lymphorrhea absence and a significant improvement of her quality of life were observed, without requiring new hospitalizations. Case 2: a ten-year-old female schooler with CLOVES syndro me, who developed scoliosis and deterioration of her motor skills, becoming wheelchair-dependent. Oral rapamycin was indicated, showing improvement in her physical capacity, independence and au tonomy, and absence of lymphorrhea after four months of treatment. CONCLUSION: We propose oral rapamycin for the treatment of patients with CLOVES syndrome who present with complications and deterioration in the quality of life as a result of the disease.

Clinical aspects of congenital microcephaly syndrome by Zika virus in a rehabilitation center for patients with microcephaly

SUMMARY OBJECTIVE In this study, we intend to identify the prevalence of clinical variables in children with microcephaly. METHODS This is a cross-sectional and observational study with data collected from medical records of patients admitted to the microcephaly outpatient clinic of a referral center in Teresina-PI. Demographic (gender and age) and clinical data (presence of epilepsy, dysphagia, irritability, and associated comorbidities) were collected. The frequency of Zika virus as a probable etiology was determined from computed tomography patterns and the exclusion of other etiologies by serological tests. RESULTS A total of 67 patient records were evaluated, of which 31 were male and 36 were female, with a mean age of 1 year and 10 months. The most prevalent clinical variables were epilepsy, present in 47 children (70.2%), and irritability in 37 (55.2%). Also with a high frequency, 22 had dysphagia (32.8%), and 13 had musculoskeletal comorbidities (19.4%). Only three patients in the sample had cardiac abnormalities (4.5%), and no endocrine comorbidity was found. A total of 38 children in the sample (56.7%) presented ZIKV as a probable etiology and, in these cases, there was a higher frequency of epilepsy and dysphagia compared to other etiologies, although not statistically significant. CONCLUSION Epilepsy, irritability, dysphagia, and musculoskeletal comorbidities were the most frequent clinical variables in children with microcephaly. There was a high prevalence of congenital ZIKV microcephaly syndrome in this sample.

RESUMO OBJETIVO Pretende-se, neste estudo, identificar a prevalência de variáveis clínicas em crianças com microcefalia. MÉTODOS Trata-se de um estudo transversal e observacional com dados coletados de prontuários de pacientes admitidos no ambulatório de microcefalia de um centro de referência em Teresina (PI). Foram coletados dados demográficos (gênero Ve idade) e clínicos (presença de epilepsia, disfagia, irritabilidade e comorbidades associadas). A frequência de Zika vírus como provável etiologia foi determinada a partir de padrões da tomografia computadorizada e da exclusão de outras etiologias por exames sorológicos. RESULTADOS Foram avaliados 67 prontuários de pacientes, sendo 31 do sexo masculino e 36 do sexo feminino, com idade média de 1 ano e 10 meses. As variáveis clínicas mais prevalentes foram epilepsia, presente em 47 das crianças (70,2%), e irritabilidade, em 37 (55,2%). Também com elevada frequência, 22 possuíam quadro de disfagia (32,8%) e 13 apresentavam comorbidades osteomusculares (19,4%). Apenas três pacientes da amostra tinham quadro de alterações cardiológicas (4,5%) e nenhuma comorbidade endocrinológica foi encontrada. Trinta e oito crianças da amostra (56,7%) apresentaram ZIKV como provável etiologia e, nesses casos, houve maior frequência de epilepsia e disfagia em comparação com outras etiologias, embora não de forma significativa estatisticamente. CONCLUSÕES Epilepsia, irritabilidade, disfagia e comorbidades osteomusculares foram as variáveis clínicas mais frequentes em crianças com microcefalia. Houve uma prevalência alta de síndrome de microcefalia congênita por ZIKV nessa amostra.

Avaliação fisioterapêutica em criança com malformação congênita de membro inferior: um relato de caso / Physiotherapy evaluation in children with congenital malformation of lower members: a case study

Este trabalho teve como objetivo realizar uma avaliação fisioterapêutica em um voluntário com malformação congênita do membro inferior direito, a fim de conhecer seus aspectos motores e funcionais, devido ao fato de ser um caso peculiar com incidência de 1 a cada 100.000 nascidos vivos. Tratou-se de um relato de caso, realizado na clínica escola de fisioterapia de uma universidade do interior do Estado de São Paulo. Os procedimentos consistiram em: anamnese, exame físico, escalas e instrumentos de avaliação do controle, índice de Barthel modificado, plataforma de força e avaliação postural. Pode-se observar através da avaliação fisioterapêutica alterações posturais relevantes com assimetrias entre os hemicorpos, déficit de equilíbrio e diminuição de força muscular no membro inferior direito, o que acarreta uma alteração biomecânica importante no participante avaliado. Essas informações coletadas durante as avaliações são essenciais para conhecer as alterações físicas decorrentes da malformação congênita para promover um melhor direcionamento em seu tratamento.

A physiotherapy evaluation has been undertaken with a voluntary subject with congenital malformation of the right lower limber to understand motor and functional aspects of the issue. The fact has an occurrence of 1/100000 live births. The case study has been undertaken in a physiotherapy school at a university clinical in the interior of the state of São Paulo, Brazil. Procedures included anamnesis, physical examination, scales and instruments for control assessment, modified Barthel Index, force platform and posture evaluation. Physiotherapeutic evaluation revealed significant posture changes with asymmetry between the hemibodies, deficit in equilibrium and lessening of muscular force in the right lower member, with subsequent important biomechanical changes in the patient. Information collected during evaluations is essential to understand the physical alternations due to congenital malformation for better results through treatment.

Observational Methods for Assessing Ergonomic Risks for Work-Related Musculoskeletal Disorders. A Scoping Review / Métodos observacionales para evaluar los riesgos ergonómicos de los Desórdenes Músculo esqueléticos relacionados con el trabajo: revisión del alcance / Métodos observacionais para avaliar os riscos ergonômicos das Desordens Musculoesqueléticas relacionados com o trabalho: revisão do alcance

Abstract Introduction: Work-related musculoskeletal disorders (WRMSDS) are one of the most common causes of absence from work. Exposures in the work environment can cause or aggravate the impact of these musculoskeletal disorders and the identification of ergonomic exposures are essential in risk assessment. It is important to assess all three key indicators of these exposures (intensity, frequency and duration) for being able to estimate the risk level for the development of WRMSDS. Aim: This paper aims to give an overview of some of the observational methods that can be used for assessment of ergonomic risks at the workplace. Methods: This study was conducted as a scoping review of the medical and ergonomic literature and official governmental webpages in Sweden, U.S.A. and the Netherlands. Results: In total, 19 different observational methods were identified. We summarize our findings based on the body parts that were studied and what key indicators were assessed: 1) intensity of the work load (posture and force production), 2) frequency of the work load (e.g. repetitive movements), and 3) the duration of the work load (e.g. static work). In an appendix we include a brief presentation of these methods together with the work sheet (if available) and the source reference of the observational method. Conclusion: For ergonomists that perform risk assessments, there is a large number of observational assessment tools available and it is important to understand that different methods can be used simultaneously to be able to estimate the objective risk levels for WRMSDS.

Resumen Introducción: Los desórdenes músculo-esqueléticos relacionados con el trabajo (DME) son una de las causas más comunes de la ausencia laboral. Las exposiciones en el entorno de trabajo pueden causar o agravar el impacto de estos desórdenes músculo-esqueléticos y la identificación de exposiciones ergonómicas es esencial en la evaluación de riesgos. Es importante evaluar los tres indicadores clave de estas exposiciones (intensidad, frecuencia y duración) para poder estimar el nivel de riesgo para el desarrollo de DME. Objetivo: Este artículo tiene como objetivo proporcionar una visión general de algunos de los métodos de observación que se pueden utilizar para evaluar los riesgos ergonómicos en el lugar de trabajo. Métodos: Este estudio se realizó como una revisión del alcance de la literatura médica y ergonómica y de las páginas web gubernamentales oficiales en Suecia, EE. UU. Y los Países Bajos. Resultados: En total, se identificaron 19 métodos de observación diferentes. Resumimos nuestros hallazgos en función de las partes del cuerpo que se estudiaron y los indicadores clave evaluados: 1) la intensidad de la carga de trabajo (postura y producción de fuerza), 2) la frecuencia de la carga de trabajo (por ejemplo, movimientos repetitivos) y 3) la duración de la carga de trabajo (por ejemplo, trabajo estático). En un apéndice incluimos una breve presentación de estos métodos junto con la hoja de trabajo (si estaba disponible) y la fuente de referencia del método de observación. Conclusión: Para los ergónomos que realizan evaluaciones de riesgo hay una gran cantidad de herramientas de evaluación observacional disponibles y es importante comprender que se pueden usar diferentes métodos simultáneamente para poder estimar los niveles de riesgo objetivo para DME.

Resumo Introdução: As desordens musculoesqueléticas relacionadas com o trabalho (DME) são uma das causas mais comuns da ausência do trabalho. As exposições no entorno de trabalho podem causar ou agravar o impacto destas desordens musculoesqueléticas e a identificação de exposições ergonómicas são essenciais na avaliação de riscos. É importante avaliar os três indicadores chave destas exposições (intensidade, frequência e duração) para poder estimar o nível de risco para o desenvolvimento de DME. Objetivo: Este artigo tem como objetivo proporcionar uma visão geral de alguns dos métodos de observação que se podem utilizar para avaliar os riscos ergonômicos no lugar de trabalho. Métodos: este estudo se realizou como uma revisão do alcance da literatura médica e ergonômica e dos sites governamentais oficiais na Suécia, nos Estados Unidos e nos Países Baixos. Resultados: Em total, identificaram-se 19 métodos de observação diferentes. Resumimos os nossos achados em função das partes do corpo que se estudaram e os indicadores chave avaliados: 1) a intensidade da carga de trabalho (postura e produção de força), 2) a frequência da carga de trabalho (por exemplo, movimentos repetitivos) e 3) a duração da carga de trabalho (por exemplo, trabalho estático). Em um anexo incluímos uma breve apresentação destes métodos junto à folha de trabalho (se estava disponível) e a fonte de referência do método de observação. Conclusão: Para os ergonomistas que realizam avaliações de risco, há uma grande quantidade de ferramentas de avaliação observacional disponíveis e é importante compreender que podem-se usar diferentes métodos simultaneamente para poder estimar os níveis de risco objetivo para DME.

Paciente con asociación de síndrome uña-rótula y artrogriposis múltiple congénita. Evolución clínico-radiológica / Patient with association of nail-patella syndrome and multiple congenital arthrogryposis. Clinical radiological evolution

RESUMEN La asociación de la artrogriposis múltiple congénita con el síndrome uña -rótula es rara, porque ambas patologías son infrecuentes. Debido a la gran variedad de manifestaciones clínico-radiológica de ambos síndromes, es necesario conocer el cuadro clínico de cada una de ellas para poder identificar el origen de todas las afectaciones encontradas en el paciente, una vez alcanzada la adultez. Se presentó un paciente adulto tratado durante su infancia en el Hospital Pediátrico “Eliseo Noel Caamaño”, de Matanzas, con la asociación de ambas entidades, con el fin de observar su estado anatómico, funcional y radiológico actual. El objetivo fue estudiar la evolución clínico-radiológica del paciente a través del tiempo. Se concluyó que en este tipo de patologías se producen severas deformidades del Sistema Osteomioarticular, así como de otros sistemas, por lo que se requiere de un trabajo multidisciplinario y de un estricto seguimiento para lograr personas útiles a la sociedad a pesar de sus limitaciones físicas... (AU)

ABSTRACT The association of multiple congenital arthrogryposis with nail-patella syndrome is rare, because both pathologies are infrequent. Due to the great range of clinical radiological manifestations of both syndromes, it is necessary to know the clinical characteristics of each of them to identify the origin of these affections found in the patient after reaching the adulthood. It is presented an adult patient treated during the childhood in the Pediatric Hospital ¨Eliseo Noel Caamaño¨, of Matanzas, with the association of both entities, to observe his current anatomic, functional and radiological status. The aim was studying the patient´s clinical radiological evolution through the time. The conclusion we arrived at was that this kind of pathologies produce severe deformities of the Osteomyoarticular System and also of other systems, so it is required a multidisciplinary approach and a strict follow-up to offer the society useful persons in spite of their physical limitations...(AU)

Síndrome de Grebe: Reporte de un caso / Grebe syndrome. Case report

La condrodisplasia de Grebe es un trastorno raro autosómico recesivo que pertenece al grupo de las osteocondrodisplasias. Clínicamente se caracteriza por un severo dismorfismo con una marcada micromelia y deformidad de las extremidades inferiores y superiores. Conocer este tipo de síndrome orienta a dar mejores diagnósticos y permite el diagnóstico diferencial con patologías más comunes, como la acondroplasia. Se presenta una paciente de 35 años con diagnóstico de síndrome de Grebe desde los 10 años. El síndrome de Grebe tiene una muy baja incidencia; por este motivo, es poco conocido por el cuerpo médico en general y aun menos para los ortopedistas, quienes serán los encargados de tratar a estos pacientes. Nivel de Evidencia: IV

Grebe syndrome is a rare autosomal recessive disorder that belongs to the group of osteochondrodysplasias. Clinically, it is characterized by severe dysmorphism, marked micromelia and deformities of the lower and upper limbs. Recognition of this syndrome allows to give better diagnoses and to establish a differential diagnosis with more common pathologies, such as achondroplasia. We present a 35-year-old woman with diagnosis of Grebe syndrome at the age of 10. Grebe syndrome has a very low incidence; therefore, it is unknown by general physicians and still less by orthopedic surgeons, who will treat these patients. Level of Evidence: IV