Nothing is impossible if you have the right tools and techniques to support

Background: Zonular weakness is a known complication that a surgeon can encounter during cataract surgery. Purpose: The purpose of this video is to make surgeons aware about the different tools and techniques available to handle zonulopathy. Synopsis: This video describes the various causes of zonular weakness and different tools available to manage zonular weakness intraoperatively. The surgical technique of using the tools is also demonstrated in the video. Highlights: Causes of zonular weakness and surgical techniques to handle it intraoperatively.

The Prevalence and Associated Risk Factors of Carpal Tunnel Syndrome among Private Dentists in Klang Valley, Malaysia: A Cross-sectional Study

@#Carpal Tunnel Syndrome (CTS) is a progressive entrapment neuropathy that is commonly associated with dentists. If left untreated, permanent nerve and muscle damage may occur. The purpose of this study is to determine prevalence of CTS among private dentists in Klang Valley, Malaysia and to further identify the associated risk factors for CTS symptoms. In-person interviews of 78 subjects obtained using the convenience sampling method were carried out. The Boston Carpal Tunnel Questionnaire (BCTQ) and clinical tests of Phalen and Tinel were used to examine signs and functional impact of CTS. The overall prevalence of CTS-related symptoms is 37.2%. Using BCTQ alone, 6.4% showed mild CTS symptoms through the level of functional state scoring (FSS) while 10.3% showed mild to moderate symptoms in the scale of the severity of symptoms (SSS). There is a significant correlation between the age of dentists and CTS symptoms (p = 0.007). The prevalence of CTS was more common in older dentists. Increasing age and working hours per week further enhance the risk of CTS. Findings from this study will serve as a useful baseline to establish further study in Klang Valley. Future work should examine the accounts underlying these risk factors for preventive measures.

Diagnostic Value of Median Sensory-Ulnar Motor Latency Difference in Mild Carpal Tunnel Syndrome and it’s Comparison with Difference in Sensory and Motor Latencies of Median and Ulnar Nerves

Introduction: Diagnosis of carpal tunnel syndrome (CTS)is based on clinical symptoms, examination findings, andelectrodiagnostic studies. Recent studies have shown theefficacy of median sensory-ulnar motor latency differencewas devised as another way to improve diagnostic accuracyfor mild carpal tunnel syndrome. Current research aimed tostudy diagnostic value of Median sensory ulnar motor latencydifference (MSUMLD) in mild carpal tunnel syndromeand compare it with median-ulnar (MU) sensory and motorlatency differences.Material and methods: 100 hands of CTS were studied andafter a detailed history and physical examination, routine testsand nerve conduction study was done .In mild CTS cases notdetected by routine NCS, MSUMLD was calculated and itssensitivity was compared with MU sensory and motor latencydifference.Results: It was found that Median Ulnar sensory latencydifference had the highest sensitivity.Conclusion: MSUMLD can be added as a new diagnosticparameter in detecting mild CTS with no additional testingalthough it’s sensitivity is less than Median-Ulnar sensorylatency difference

Application of the calculated electrophysiological parameters in early diagnosis of carpal tunnel syndrome

@#Objective: To investigate the application of the calculated electrophysiological parameters in early diagnosis of carpal tunnel syndrome (CTS). Methods: 44 patients (60 hands) with a diagnosis of CTS and 31 healthy volunteers (44 hands) were enrolled. Acquired indicators include median nerve distal motor latency (DML), complex muscle action potential (CMAP) amplitude, conduction velocity (MCV), median nerve sensory nerve action potential (SNAP) amplitude, and conduction velocity (SCV). Then the terminal latency index (TLI), the residual latency (RL), and the difference in peak sensory latencies between the median and ulnar nerves (ΔPSL) were calculated. Results: The two groups were matched in age and gender distribution. The CTS group showed significant difference in SCV, DML, SNAP, and CMAP compared with the control group. The sensitivity, specificity, cutoff value, Youden index, and area under the curve of each indicator are respectively as follows: TLI (0.733, 0.932, 0.622, 0.629, and 0.877), RL (0.750, 0.977, 1.334, 0.727, and 0.907), ΔPSL (0.950, 0.841, 0.150, 0.791, and 0.942), SCV (0.950, 0.796, 56.5, 0.746, and 0.946), DML (0.867, 0.932, 3.55, 0.799, and 0.930), SNAP (0.683, 0.932, 21.68, 0.615, and 0.844), and CMAP (0.683, 0.773, 8.76, 0.456, and 0.758). Conclusion: The calculated electrophysiological parameters have higher sensitivities and specificities relative to a single electrophysiological parameter, which could greatly improve the accuracy of early diagnosis of CTS.

Abordagem CTS diante das interpelações da afrocentricidade: a saúde da população negra / Enfoque CTS ante las interpelaciones de la afrocentricidad: la salud de la población negra / CTS approach to afrocentricity interpellations: the health of the black population

Resumo: Este artigo trata do exercício de pesquisadores negros para interpelar, a partir da tríade Psicologia - Abordagem CTS - Afrocentricidade, as práticas e os saberes instituídos diante da saúde da população negra. Trata-se da aposta em uma produção de psicologia, na qual esta ciência é questionada a partir da vivência social da população negra e da subjetividade afrodescendente.

Resumen: Este artículo trata del ejercicio de investigadores negros para interpelar, a partir de la tríada Psicología - Enfoque CTS - Afrocentricidad, las prácticas y los saberes instituidos ante la salud de la población negra. Se trata de la apuesta en una producción de psicología, en la cual esta ciencia es cuestionada a partir de la vivencia social de la población negra y de la subjetividad afrodescendiente.

Abstract: This article deals with the practice of black researchers to question, from the triad Psychology - Approach CTS - Afrocentricity, the practices and knowledge instituted regarding the health of the black population. It is the bet in a production of psychology, in which this science is questioned from the social experience of the black population and the Afrodescendent subjectivity.

Clinical Correlation Between Nerve Conduction Studies And Neurosonography In Peripheral Neuropathies

BACKGROUND - Peripheral neuropathies are the most common neuromuscular disorder seen by neurologists. Nerve ultrasonography is a recently emerging tool for visualizing the structure, architecture and vascularity of peripheral nerves. OBJECTIVES -To study the Clinical correlation between Nerve conduction studies and Neurosonography in peripheral neuropathies. METHODOLOGY - All patients with peripheral neuropathy were included in the study from February 2016 to January 2018. RESULTS -The most common aetiologies for peripheral neuropathy were diabetes and leprosy. Nerve ultrasound showed corresponding changes in the above conditions. CONCLUSION – Nerve ultrasound is useful in peripheral neuropathy and can complement other diagnostic investigations.

Comunidades Terapêuticas: uma invenção institucional para o tratamento da toxicomania / Therapeutic Communities: an institutional invention for drug addiction treatment / Communeautés thérapeutiques: une invention institutionelle pour le traitement de la toxicomanie

O texto aborda questões relativas ao tratamento da toxicomania, com foco na atualidade em que se pode encontrar Comunidades Terapêuticas (CTs) orientadas pelo modelo genérico de George De Leon, especialista internacionalmente reconhecido quando o assunto é tratamento do abuso de substâncias químicas. Essas CTs são invenções institucionais que podem ser consideradas resposta à falta de significantes mestres, ordenadores da civilização deixada aos desvarios do gozo. E, como se espera, elas contam com conjunto de regras estabelecido visando controle, formas de refrear os excessos vistos na toxicomania. A psicanálise, e a possibilidade de trabalho de praticantes implicados com a psicanálise, nestes espaços, são abordadas no intuito de reflexão crítica sobre o assunto, bem como para assinalar a possibilidade da inserção desse campo discursivo em meio a outros saberes...

This paper addresses some issues related to the treatment of drug addiction, focusing on today’s reality where one can find Therapeutic Communities (TC) guided by the generic model of George De Leon, internationally recognized expert in the field of treatment of substance abuse. These TCs are institutions that may be considered as a response to the lack of master signifiers, rulers of civilization that has been abandoned to the ravings of jouissance. And, as expected, they have established a set of rules aiming to control, to curb the excesses seen in drug addiction. Psychoanalysis, and the possibility of work of practitioners involved with psychoanalysis, in these areas, are addressed in this paper in order to reflect critically on the subject and to point out the possibility of inserting this discursive field among other knowledges...

Ce texte fait une analyse de questions concernant le traitement de toxicomanies, spécialement par rapport à l’actualité ou l’on trouve les Communeautés Thérapeutiques (CTs) orientées par le modèle crée par George de Leon, expert de renommée internationale dans le traitement des abus de substances chimiques. Ces CTs sont des inventions institutionelles qui peuvent être considérées comme une réponse au manque de signifiants maîtres, organisateurs de la civilisation abandonée aux égarements de la jouissance. Telles institutions comptent, comme prévu, avec un assortiment de règles établies visant controler, freiner les excès constatés dans la toxicomanie. La psychanalyse et la possibilité de son introduction dans ces espaces sont examinees pour obtenir une réflexion critique sur ce sujet autant que pour signaler la possibilité d’insertion de ce champ du discours parmi d’autres savoirs...

Pessoas idosas e a busca por informações em saúde por meio da internet / The elderly and the search for health information through the internet

O presente estudo analisa como as pessoas idosas, participantes de um programa de inclusão digital, fazem buscas sobre saúde utilizando a internet, e como essas informações relacionam as doenças autorreferidas. Fundamenta-se em aportes teóricos da Gerontologia e do campo Ciência, Tecnologia e Sociedade (CTS). Desenvolvido em cinco etapas, adotando procedimentos plurimetodológicos, foram investigados aspectos sobre a natureza e o acesso à informação em saúde por meio da internet, junto a 19 pessoas idosas. Os resultados apontam algumas das práticas cotidianas de acesso a informações via internet, e a importância destas na promoção da saúde.

The present study analyses how the elderly participants of a digital inclusion program do searches about health using the internet and how these information are related to their self-reported diseases. This study is grounded on theoretical studies of Gerontology and the Science, Technology and Society – STS field. The aspects of the nature and access to health information through the internet of 19 elderly were investigated, in three steps and adopting multi-methodological procedures. The results show some of the everyday practices of information access through the internet and the importance of these practices in the health promotion.

La transparencia como principio necesario en la bioética y su relación con los mundos de la ciencia, la tecnología y sociedad

Las diversas y cada vez nuevas prácticas profesionales, científicas, tecnocientíficas y biotecnológicas nos retan a pensar sobre la suficiencia de los principios de la bioética. En este ensayo se recoge, además de los cuatro principios tradicionales, los propuestos por pensadores como Jonas y Kauffmann y se propone, además, el de la transparencia que como complemento de la justicia puede asegurar prácticas limpias que propendan por la calidad, conservación, preservación y propagación de la vida.

The diverse and new professional, scientific, techno-scientific and bio technological practices challenge us to think about the sufficiency of the bioethical principles. This essay gathers, beyond the four traditional principles, the proposals of thinkers such as Jonas and Kauffmann, and also proposes transparency as a complement to justice, which could assure clean practices to provide life quality, conservation, preservation and propagation.

As diversas e cada vez novas práticas profissionais, cientistas, tecno-científicas e biotecnológicas nos reptam a pensar sobre a suficiência dos princípios da bioética. Neste ensaio se recolhe, além dos quatro princípios tradicionais, os propostos por pensadores como Jonas e Kauffmann e se propõe, ademais, o da transparência que como complemento da justiça pode assegurar práticas limpas que propendam pela qualidade, conservação, preservação e propagação da vida.

Obesity Affects Median Nerve Conduction - A Study in Armed Forces Individuals.

Background: Obesity, a growing public health concern, is associated with various disorders. Studies have suggested obesity as an independent risk factor that influences the prevalence of carpal tunnel syndrome (CTS) among active workers. The present study is an attempt to establish relationship between median nerve conduction velocity and obesity in people who do not have any other contributory factor for CTS other than obesity. CTS is the commonest entrapment neuropathy where the median nerve is compressed. Methods: The study was conducted in 15 obese subjects with Body Mass Index (BMI)>30 (group III) and 15 overweight subjects with BMI between 25&29.9 (group II) and 15 control subjects with BMI <25 (group I). The subjects were personnel from armed forces. Their body density was estimated using hydro-densitometry and the body fat percentage was calculated from density. The distal motor latency (DML) and the sensory conduction velocity (SCV) across the wrist on stimulation of median nerve at wrist 3cm proximal to distal crease were assessed in all subjects. Results: The mean values of DML in group I, II, and III were 3.52±0.25 ms, 3.50±0.30 ms and 3.65±0.20 ms respectively. Mean value of SCV among these groups were 48.99±3.23 m/s, 49.32±3.35 m/s and 48.69±4.00 m/s. Conclusion: No relationship could be established between BMI and DML as well as BMI and SCV. The relationship between percentage body fat and DML and SCV also found to be statistically insignificant. However, there was a correlation between BMI and body fat percentage. Carpal tunnel syndrome is uncommon even in obese armed forces personnel, which might be due to their regular body and hand exercise thereby having increased tone in hand muscles.

Cracked Tooth Syndrome (CTS) - A Roller Coaster Ride A Review.

Cracked Tooth Syndrome (CTS) is both a transient and progressive condition. CTS is a frequent reason that patients change clinician. Patient reports pain, and often the dentist relies on a periapical radiograph to determine the origin of the pain. Because the CTS is a vital pulp condition, the periapical radiograph is of limited value as a diagnostic test for CTS. As a result, lack of treatment, or inappropriate treatment, will not resolve the symptoms, often causing the patient to seek help from another clinician. Diagnosis of CTS can be difficult, appropriate treatment is necessary to prevent further damage to the tooth, and the failure to diagnose this condition can result in the eventual loss of the affected tooth. This article will present a classification system for CTS and discuss how to accurately diagnose and treat this clinical condition.

Manufacture of the Serially Sectioned Images of the Whole Body (Fourth Report: Methods for Selection and Treatment of the Cadaver and for Scanning of the MRIs and CTs) / 대한해부학회지

Visible Human Project dataset made in the United States has some problems which were caused by the cadaver selection, cadaver treatment, MRI (magnetic resonance image) scanning, and CT (computerized tomograph) scanning. Therefore, in this study, we intended to make better serially sectioned images, namely Visible Korean Human, which overcome the problems of Visible Human Project dataset. The better serially sectioned images will be the basis of better three dimensional images of the whole body, which are helpful in medical education An appropriate Korean male cadaver was selected for this study. Without injecting fixative, the cadaver's posture and direction were adjusted and fixed in an immobilizing box. Horizontal MRIs and CTs of the cadaver's whole body were scanned at 1 mm intervals. In addition, coronal and sagittal MRIs and CTs as well as movies of the MRIs and CTs were made. Age of the selected cadaver was young (32 years old), body size was Korean average (height 1,640 mm, weight 55 kg), and pathological findings were few. 1,718 couples of corresponding MRIs and CTs, in which anatomical structures appear clearly (pixel size 1 mm), were acquired. 276 couples of coronal MRIs and CTs as well as 505 couples of sagittal MRIs and CTs were acquired. Movies of all MRIs and CTs were acquired as well. The serially sectioned images acquired in this study will be helpful either in studying MRIs and CTs by referring to corresponding anatomical images or in studying anatomy and medicine by reconstructing MRIs, CTs, and anatomical images into three dimensional images.

Experimental Study on Carpal Tunnel Syndrome as a Cumulative Trauma Disorder

OBJECTIVE: To study the reaction of tissues in the carpal tunnel after repeated flexion of wrist in order to verify the pathophysiology and pathomechanism of the carpal tunnel syndrome as a cumulative trauma disorder. METHOD: Six groups of adult rabbits (5 rabbits were allocated to each groups) were exposed to repeated contractions of the wrist flexors by the median nerve stimulation at the elbow level for different durations; 2 days, 1 week, 2 weeks, 3 weeks, 4 weeks, and 5 weeks. Histological evaluation, morphometric analysis, and electrophysiological studies were carried out after the stimulation. RESULTS: There were no typical nor consistent findings in the tissues in the carpal tunnel except the median nerve. Inflammatory cell infiltration and edematous changes were noted in the epineurial tissue of median nerve. Decrease of large myelinated fibers and changes of fiber shape were observed in the median nerve. On the morphometric analysis, fiber diameter was smaller in groups of longer exposure duration. Changes were most prominent in 5 weeks group and in the periphery of the nerve fascicle in all the groups. Significant reduction of amplitude and increase of duration of compound muscle action potential were noted on electrophysiological study of the median nerve. CONCLUSION: The authors concluded that repeated experimental wrist flexion could give rise to an injury of the median nerve in the carpal tunnel. Accumulation of microtrauma of median nerve by epineurial edema and direct mechanical compression seems to be the pathomechanism of the carpal tunnel syndrome as a cumulative trauma disorder.

Usefulness of Wrist Crease Stimulation Method in Diagnosis of Carpal Tunnel Syndrome

OBJECTIVE: The previously established method of carpal tunnel syndrome (CTS) diagnosis is relatively troublesome and risk of misleading due to uncertainty of exact distance measurement for stimulation. If we use the wrist crease, an anatomical landmark, there might not be error in length measurement for stimulation at any wrist position. This study was performed to evaluate the wrist stimulation method in the diagnosis of CTS for it's convenience and reducing the errors. METHOD: Seventy healthy adults and sixty-five patients with clinical and electrophysiologic evidence of CTS were studied. Sensory nerve action potentials (SNAPs) in second and fifth digit were recorded antidromically with stimulation at a distance of 14 cm from recording electrode and stimulation at wrist crease. The ratio and difference of distal latency and ratio of amplitude between median and ulnar SNAPs were assessed. RESULTS: The ratio and difference of distal latency and ratio of amplitude in the 14 cm stimulation method were 1.52+/-0.28, 1.59+/-0.91 msec, 1.26+/-0.27 in the right, 1.43+/-0.14, 1.29+/-0.42 msec, 1.18+/-0.20 in the left, respectively in the men patients, and those of women patients were 1.48+/-0.35, 1.43+/-1.04 msec, 1.18+/-0.30 in the right, 1.53+/-0.30, 1.46 0.80 msec, 0.75+/-0.36 in the left. In wrist crease stimulation, those of men patients were 1.72+/-0.39, 1.74+/-0.98 msec, 1.22+/-0.24 in the right, 1.53+/-0.21, 1.31+/-0.46 msec, 1.25+/-0.29 in the left, and those of women patients were 1.67+/-0.46, 1.56+/-1.01 msec, 0.63+/-0.32 in the right, 1.68+/-0.37, 1.56+/-0.82 msec, 0.68+/-0.30 in the left. These results showed a significant positive correlation between the patients group and the control group in two stimulation methods (p<0.001). CONCLUSION: Based on the result of this study, wrist crease stimulation method is a quick and easy procedure, which would be recommended in the early diagnosis of CTS.

Influence of cuspal inclination on the stress distribution in maxillary first molar / 实用口腔医学杂志

Objective:To evaluate the bio-mechanics of the cracked molars. Methods: A three dimensional finite element(3D-FEM) model of an upper first molar was constructed by Ansys 8.0 software. The model's cuspal inclination was shaped according to the mean value of the cuspal inclination in the cracked maxillary first molars and the intact ones respectively. The influence of cuspal inclination on the stress distribution was evaluated under different loads:Load of 600 N vertically applied to the occlusal surface of the model, or load of 200 N applied from three directions (vertically, at a 45?angle, horizontally). Results:For the model with the cuspal inclination of the cracked maxillary first molars, its maximum tensile stress, compressive stress and Von Mises stress were higher than those of the control models. The tensile stress and Von Mises stress increased with the increase of force direction and became to the highest under horizontal loads. The tensile stress was mainly distributed at the mediolingual cusp, centre groove and the palatal side of the cervical region. Conclusions: Under equivalent loads, the molar with bigger cuspal inclination suffers more unfavorable stress, which will magnify the occurrence of cracked tooth syndrome (CTS), and horizontal bite force may be a critical factor.