Shock séptico: complicación atípica de duplicación del tracto alimentario / Septic shock: an atypical complication of alimentary tract duplication

Las duplicaciones del tracto alimentario son un conjunto heterogéneo de anomalías congénitas del tubo digestivo. Su forma de presentación es variada, y pueden desarrollar distintas complicaciones libradas a su evolución natural. La infección es una complicación poco frecuente, pero que no puede desconocerse por la gravedad que implica. Se presenta el caso de una paciente de 2 años de edad, previamente sana, con una complicación atípica de una duplicación del tracto alimentario: un shock séptico. Consultó inicialmente por distensión y dolor abdominal asociado a una masa abdominal palpable. Los estudios imagenológicos evidenciaron una formación líquida parcialmente tabicada en el hemiabdomen derecho. Durante la internación, se presentó una infección intratumoral, que evolucionó al shock séptico. Respondió favorablemente al tratamiento médico del shock, y se realizó la exéresis quirúrgica posteriormente. La anatomía patológica confirmó la duplicación del tracto alimentario.

Alimentary tract duplications are heterogenous congenital anomalies of the digestive tract. Their form of presentation is varied, and they may lead to different complications, depending on their natural course. Infection is a rare complication, but it cannot be ignored because of its severity. Here we describe the case of an otherwise healthy 2-year-old girl with an atypical complication of alimentary tract duplication: septic shock. She initially consulted due to abdominal distension and pain associated with a palpable abdominal mass. The imaging studies showed a partial fluid septation in the right side of the abdomen. During hospitalization, an intratumoral infection developed, which progressed to septic shock. The patient responded favorably to medical treatment for shock, and surgical resection was subsequently performed. The pathology report confirmed the presence of alimentary tract duplication.

Fatores de risco para interrupção do aleitamento materno exclusivo no primeiro mês de vida / Risk factors for discontinuing exclusive breastfeeding in the first month of life / Factores de riesgo para suspender la lactania materna exclusiva en el primer mes de vida

Objetivo: investigar os fatores de risco para a interrupção do aleitamento materno exclusivo antes de um mês de vida. Método:estudo de coorte prospectivo com 358 binômios assistidos em cinco maternidades, entre julho e novembro de 2020. Foram realizadas entrevistasutilizando questionário estruturado e escalas validadas. Foi realizado teste de qui-quadrado e análise de Poison. Resultados: aos 30 dias de vida, 1/3 dos bebês não se encontravam em aleitamento exclusivo e 1/4 das puérperas apontaram como causaa dor/lesão. Seis variáveis aumentaram o risco para interrupção: renda abaixo de cincosalários, falta de orientação no pré-natal, inexperiência com amamentação anterior, desmame anterior antes de um mês, baixa autoeficácia e dor com intensidade moderada/forte. Conclusão: estes fatores podem tornar-se indicadores de vulnerabilidades na amamentação. A autoeficácia, presença de dor e a falta de orientações são fatores modificáveis pouco abordados sistematicamente no ensino, na prática e na educação no Brasil.

Objective:to investigate the risk factors for stopping exclusive breastfeeding before one month of life. Method: prospective cohort study with 358 binomials cared for in five maternity hospitals, between July and November 2020. Interviews were carried out using a structured questionnaire and validated scales. Chi-square test and Poison analysis were performed. Results: at 30 days of life, 1/3 of the babies were not exclusively breastfed and 1/4 of the postpartum women reported pain/injury as the cause. Sixvariables increased the risk for interruption: income below fivewages, lack of prenatal guidance, inexperience with previous breastfeeding, previous weaning before one month, low self-efficacy and pain of moderate/severe intensity. Conclusion:these factors can become indicators of vulnerabilities in breastfeeding. Self-efficacy, presence of pain and lack of guidance are modifiable factors that are rarely addressed systematically in teaching, practice and education in Brazil.

Objetivo:investigar los factores de riesgo para suspender la lactancia materna exclusiva antes del mes de vida. Método:estudio de cohorte prospectivo con 358 binomios atendidos entre julio y noviembre de 2020. Las entrevistas se realizaron mediante cuestionario estructurado y escalas validadas. Realizadas pruebas de chi-cuadrado y análisis de Poison. Resultados:a los 30 días de vida, 1/3 de los bebés no eran amamantados exclusivamente y 1/4 de las puérperas refirieron dolor/lesión como causa. Seis variables aumentaron el riesgo de interrupción: ingresos inferiores a cinco salarios, falta de orientación prenatal,inexperiencia con la lactancia materna previa, destete previo antes del mes, baja autoeficacia y dolor de intensidad moderada/severa. Conclusión:estos factores pueden convertirse en indicadores de vulnerabilidades en lactancia. La autoeficacia, la presencia de dolor y la falta de orientación son factores modificables que rara vez se abordan sistemáticamente en la enseñanza, la práctica y la educación en Brasil.

Rotura do tendão semimembranoso ­ Relato de caso de uma rara rotura tendínea / Semimembranous tendon rupture ­ Case report of a rare tendon rupture

Contexto: A rotura da inserção distal do tendão semimembranoso é uma lesão ocasionada no tendão de um dos músculos do grupo isquiotibiais, acarretando dor no joelho. Para o diagnóstico da lesão do tendão semimembranoso, a ressonância magnética é a principal modalidade de imagem. Descrição do caso: Homem de 63 anos acusa dor no joelho esquerdo há 1 semana. Apresenta melhora da dor com repouso e medicação. Ao exame físico, apresenta teste de Waldron positivo e testes de McMurray e Appley negativos, com edema articular, sem hematomas, apresentando limitação à movimentação devido à dor. A ressonância magnética apresenta a rotura do semimembranoso, e o tratamento foi realizado com medicação analgésica e anti-inflamatória. Discussão: Essa rotura é rara, e surge de uma força em valgo em uma perna hiperextendida externamente. O uso de esteroides anabolizantes pode aumentar o risco de rotura do tendão. Contudo, a ultrassonografia é um método de fácil acesso e é cada vez mais utilizada. O diagnóstico é realizado por meio de ressonância magnética. Seu tratamento pode ser realizado com anti-inflamatórios ou reparo cirúrgico. Conclusão: Relatamos um caso de rotura do tendão semimembranoso, composta por uma sintomatologia como dor no joelho, que pode ser tratada com anti-inflamatório ou reparo cirúrgico.

Pain Patterns of the Temporomandibular Joint Dysfunction and Implications of Stress-Related Behaviors: A Pilot Study / Patrones de Dolor de la Disfunción de la Articulación Temporomandibular e Implicaciones de los Comportamientos Relacionados con el Estrés: Un Estudio Piloto

SUMMARY: Temporomandibular joint dysfunction interferes with the quality of life and activities of daily living among patients. The symptoms of temporomandibular dysfunction, including pain and clicking and popping sounds, are worsened during stressful events, and patients report increased pain around the temporomandibular joint. Stress-related behaviors, such as teeth clenching and teeth grinding, are commonly reported as increasing during stress. The prevalence of temporomandibular dysfunction and stress-related behaviors is reported differently in the literature. Stress in higher education is common. The purpose of this pilot study was to investigate the prevalence of temporomandibular joint dysfunction and stress-related behaviors among staff members at a local University. The study also sought to explore pain patterns described by people experiencing temporomandibular joint dysfunction and the relationship between stress-related behaviors and pain symptoms experienced. Further, the impact of stress on symptoms experienced by people with temporomandibular dysfunction was investigated in this pilot study.

La disfunción de la articulación temporomandibular interfiere con la calidad de vida y las actividades de la vida diaria entre los pacientes. Los síntomas de la disfunción temporomandibular, incluidos el dolor y los chasquidos, empeoran durante los eventos estresantes, y los pacientes informan un aumento del dolor alrededor de la articulación temporomandibular. Los comportamientos relacionados con el estrés, como apretar y rechinar los dientes, suelen aumentar durante el estrés. La prevalencia de la disfunción temporomandibular y los comportamientos relacionados con el estrés se informa de manera diferente en la literatura. El estrés en la educación superior es común. El propósito de este estudio piloto fue investigar la prevalencia de la disfunción de la articulación temporomandibular y los comportamientos relacionados con el estrés entre los miembros del personal de una universidad local. El objetivo del estudio además fue explorar los patrones de dolor descritos por personas que experimentan disfunción de la articulación temporomandibular y la relación entre los comportamientos relacionados con el estrés y los síntomas de dolor experimentados. Además, en este estudio piloto se investigó el impacto del estrés en los síntomas que experimentan las personas con disfunción temporomandibular.

Enfermedad de Caffey: reporte de un caso clínico / Caffey's disease: report of a clinical case / Doença de Caffey: relato de um caso clínico

Introducción: La enfermedad de Caffey es una patología ósea inflamatoria, rara, autolimitada, casi exclusiva de lactantes. Objetivos: Jerarquizar el abordaje diagnóstico de una patología poco frecuente. Caso clínico: 4 meses 22 días, varón, consulta por irritabilidad y edema de miembro inferior izquierdo de 4 días de evolución. Sin traumatismos ni fiebre. Examen físico: edema indurado en tercio medio e inferior de pierna izquierda, no rubor ni calor local. Dolor a la palpación de cara anterior y lateral de tibia y peroné. Limitación funcional, no resaltos óseos. Radiografía: engrosamiento del periostio en tibia y peroné a nivel diafisario. Hemograma: Glóbulos blancos 15.380 KU/L, Hemoglobina 10,8 g/dL, Plaquetas 816.400 10/ul, proteína C reactiva 13,90 mg/dl. Con planteo de probable infección osteoarticular se inicia clindamicina ( gentamicina e ingresa a cuidados moderados. Dada la persistencia de edema e irritabilidad, al quinto día se solicita resonancia magnética: hallazgos sugerentes de un probable proceso inflamatorio- infeccioso de partes blandas con compromiso óseo. Completa 14 días de clindamicina y 7 días de gentamicina intravenosa, hemocultivo negativo. Persiste con edema, irritabilidad y dolor. A los 21 días, se revalora la presentación clínica-imagenológica, se plantea enfermedad de Caffey. Se inicia anti-inflamatorio con buena evolución. Conclusiones: La enfermedad de Caffey es una colagenopatía rara, que afecta lactantes. El diagnóstico es clínico - radiológico (irritabilidad, tumefacción de partes blandas y alteraciones radiológicas). El pronóstico a largo plazo suele ser favorable. Es importante considerar el diagnóstico en lactantes que se presentan con esta sintomatología para evitar retrasos diagnósticos e instauración de tratamientos innecesarios.

Introduction: Caffey's disease is a rare disease that is reported almost exclusively in infants. Objective: Describe the case of a rare pathology, prioritizing the diagnostic approach. Clinical case: 4 month -old, healthy male. Consultation due to irritability and edema of the left lower limb for 4 days. No trauma or fever. Physical examination: indurated edema in the left leg, no redness or local heat. Pain on palpation of the anterior and lateral aspect of the tibia and fibula. Functional limitation, no bony protusions. Leg x-ray: thickening of the periosteum in the tibia and fibula at the diaphyseal level. Hemogram: White Blood Cells 15,380 KU/L Hemoglobin: 10.8 g/dL. Platelets: 816,400 10/ul, C-reactive protein: 13.90 mg/dl. He was admitted with a suggestion of probable osteoarticular infection. Clindamycin ( gentamicin is started. Given the persistence of edema and irritability despite treatment, on the fifth day an MRI was requested: findings suggestive of a probable inflammatory-infectious process of soft tissues with bone involvement. Completed 14 days of clindamycin and 7 days of intravenous gentamicin, blood culture negative. It persists with edema, irritability and pain. After 21 days, the clinical-imaging presentation was reassessed and Caffey's disease was considered. Anti-inflammatory begins with good evolution. Conclusions: Caffey's disease is a rare collagenopathy, that affects infants. The diagnosis is clinical - radiological (irritability, soft tissue swelling and radiological alterations). The long-term prognosis is usually favorable. It is important to consider the diagnosis in infants who present with these symptoms to avoid diagnostic delays and initiation of unnecessary treatments.

Introdução: A doença de Caffey é uma patologia óssea inflamatória rara, autolimitada, quase exclusiva de lactentes. Objetivos: Priorizar a abordagem diagnóstica de uma patologia rara. Caso clínico: 4 meses 22 dias, sexo masculino, consulta por irritabilidade e edema do membro inferior esquerdo de 4 dias de evolução. Sem trauma ou febre. Exame físico: edema endurecido em terço médio e inferior da perna esquerda, sem vermelhidão ou calor local. Dor à palpação das faces anterior e lateral da tíbia e fíbula. Limitação funcional, sem saliências ósseas. Radiografia: espessamento do periósteo na tíbia e fíbula ao nível diafisário. Hemograma: Glóbulos brancos 15.380 KU/L, Hemoglobina 10,8 g/dL, Plaquetas 816.400 10/ul, Proteína C reativa 13,90 mg/dl. Com sugestão de provável infecção osteoarticular, foi iniciada clindamicina + gentamicina e internado em cuidados moderados. Dada a persistência do edema e da irritabilidade, no quinto dia foi solicitada ressonância magnética: achados sugestivos de provável processo inflamatório-infeccioso de partes moles com envolvimento ósseo. Completou 14 dias de clindamicina e 7 dias de gentamicina intravenosa, hemocultura negativa. Persiste com edema, irritabilidade e dor. Após 21 dias, o quadro clínico-imagem foi reavaliado e considerada doença de Caffey. O antiinflamatório começa com uma boa evolução. Conclusões: A doença de Caffey é uma colagenopatia rara que afeta lactentes. O diagnóstico é clínico-radiológico (irritabilidade, edema de partes moles e alterações radiológicas). O prognóstico a longo prazo é geralmente favorável. É importante considerar o diagnóstico em lactentes que apresentam esses sintomas para evitar atrasos no diagnóstico e início de tratamentos desnecessários.

Could scalp pain be a type of unclassified headache? / A dor no couro cabeludo poderia ser um tipo de dor de cabeça não classificada?

The scalp is the structure that covers the skull. It is commonly affected by painful processes resulting from infestations, infectious or inflammatory diseases. This pain located in the scalp does not have well-defined clinical characteristics and is not yet included in the ICHD-3 diagnostic criteria. The authors suggest including this pain in the next classification of headaches as a headache attributed to a scalp disorder.

O couro cabeludo é a estrutura que cobre o crânio. É comumente acometida por processos dolorosos decorrentes de infestações, doenças infecciosas ou inflamatórias. Essa dor localizada no couro cabeludo não possui características clínicas bem definidas e ainda não está incluída nos critérios diagnósticos da ICHD-3. Os autores sugerem incluir esta dor na próxima classificação de dores de cabeça como dor de cabeça atribuída a um distúrbio do couro cabeludo.

Câncer materno: a compreensão da criança e suas representações / Maternal cancer: the child's understanding and its representations / Cáncer materno: comprensión del niño y sus representaciones

O câncer é uma doença crônico-degenerativa, que tem como uma de suas principais características a capacidade de invadir tecidos e órgãos do corpo, favorecendo o crescimento desordenado de células. É uma doença que impacta fortemente a pessoa enferma e todos à sua volta, incluindo sua família e seus amigos. A partir desse cenário, este trabalho visou compreender a visão da criança e o impacto emocional sofrido diante do diagnóstico de câncer da mãe. Buscou-se avaliar, a partir de ferramentas lúdicas e do desenho-estória, o entendimento da criança em relação ao processo de adoecimento materno, tomando como base o referencial psicanalítico para reconhecer como ela lidou com a situação. Participaram desta pesquisa uma mulher de 39 anos com diagnóstico de câncer em remissão e seu filho de 9 anos. Os resultados demonstraram que o adoecimento materno causou impactos emocionais significativos e assustadores para o infante, gerando fantasias irreais relacionadas ao câncer e a si próprio. Dessa forma, considera-se de fundamental importância o cuidado estendido aos familiares do indivíduo doente, a fim de que se tenha um olhar a todos que sofrem diante desse contexto.(AU)

Cancer is a chronic-degenerative disease that has as one of its main characteristics the ability to invade tissues and organs of the body, favoring the disordered cell growth. It is a disease that strongly impacts the sick person and everyone around them, including their family and friends. Based on this scenario, this work aimed to understand the child's view and the emotional impact suffered in the face of the mother's cancer diagnosis. It sought to evaluate, with ludic tools and drawing history, the child's understanding about the mother's illness process, based on the psychoanalytic framework to recognize how they deal with the situation. A 39-year-old woman diagnosed with cancer, in remission, and her 9-year-old son participated in this research. The results showed that the maternal illness caused significant and frightening emotional impacts for the infant, creating unrealistic fantasies related to cancer and to himself. Thus, the care extended to the sick individual's family and to the relatives is considered of fundamental importance, to give a complete care for all those who suffer in this context.(AU)

El cáncer es una enfermedad crónico-degenerativa, que tiene como una de sus principales características la capacidad de invadir tejidos y órganos, favoreciendo un crecimiento desordenado de las células. Enfermedades como esta impactan fuertemente a la persona que está enferma y a todos los que la rodean, incluidos familiares y amigos. Considerando esta situación, este estudio tuvo como objetivo comprender la percepción de un niño y el impacto emocional que sufrió ante el diagnóstico del cáncer vivido por su madre. Se pretendió evaluar, utilizando herramientas lúdicas y de dibujo-cuento, la comprensión del niño al proceso de enfermedad materna, buscando reconocer cómo el niño manejó este proceso a partir del referencial teórico psicoanalítico. En esta investigación participaron una mujer de 39 años diagnosticada de cáncer en remisión y su hijo de 9 años. Los resultados mostraron que los impactos emocionales de la enfermedad materna fueron significativos y aterradores para el infante, generando fantasías irreales relacionadas con el cáncer y él mismo. De esta forma, el cuidado extendido a la familia del individuo que está enfrentando esta enfermedad es importante para promover una atención integral a quienes la padecen en este contexto.(AU)

Factors and Their Impact on Treatment Effect of Acupuncture in Different Outcomes: A Meta-Regression of Acupuncture Randomized Controlled Trials / 中国结合医学杂志

BACKGROUND@#The effects of acupuncture have varied in different randomized controlled trials (RCTs), and there are many factors that influence treatment effect of acupuncture in different outcomes, with conflicting results.@*OBJECTIVE@#To identify factors and their impact on the treatment effect of acupuncture in different outcomes.@*METHODS@#Acupuncture RCTs were searched from 7 databases including Medline (PubMed), Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc between January 1st, 2015 and December 31st, 2019. Eligible studies must compare acupuncture to no acupuncture, sham acupuncture, or waiting lists, and report at least 1 patient-important outcome. A multi-level meta-regression was conducted using a 3-level robust mixed model and univariate analyses were performed for all independent variables, even those excluded from the multivariable model due to collinearities. We used thresholds of 0.2 and 0.4 for the difference of standardized mean differences (SMDs), categorising them as small (<0.2), moderate (0.2-0.4), or large (>0.4) effects.@*RESULTS@#The pain construct analysis involved 211 effect estimates from 153 studies and 14 independent variables. High-frequency acupuncture treatment sessions produced larger effects compared to low-frequency sessions [large magnitude, the difference of adjusted SMDs 0.46, 95% confidence interval (CI) 0.07 to 0.84; P=0.02]. The non-pain symptoms construct analysis comprised 323 effect estimates from 231 studies and 15 independent variables. Penetrating acupuncture showed moderately larger effects when compared to non-penetrating acupuncture (0.30, 95% CI 0.06 to 0.53; P=0.01). The function construct analysis included 495 effect estimates from 274 studies and 14 independent variables. Penetrating acupuncture and the flexible acupuncture regimen showed moderately larger effects, compared to non-penetrating acupuncture and fixed regimen, respectively (0.40, 95% CI 0 to 0.80; P=0.05; 0.29, 95% CI 0.06 to 0.53; P=0.01).@*CONCLUSIONS@#High-frequency acupuncture sessions appear to be a more effective approach to managing painful symptoms. Penetrating acupuncture demonstrated greater effect in relieving non-painful symptoms. Both penetrating acupuncture type and flexible acupuncture regimen were linked to significant treatment effects in function outcomes. Future studies should consider the factors that are significantly associated with the effects of acupuncture in patient-important outcomes.

Effectiveness of Acupoint Application in Patients with Pharyngeal Pain: Evidence from CHUNBO, A Prospective Real-World Study / 中国结合医学杂志

OBJECTIVE@#To assess the outcomes after acupoint application in patients with pharyngeal pain in a real-world settings, and analyze the characteristics of effective population and prescription characteristics of acupoint application.@*METHODS@#Based on CHUNBO platform, patients with pharyngeal pain who were candidates for acupoint application on the basis of physician-evaluation, were enrolled in a nationwide, prospective, 69-week multicenter observational study from August 2020 to February 2022. Propensity score matching (PSM) was used to match the confounding factors and the association rules were used to analyze the characteristics of effective population and prescription characteristics of acupoint application. Outcome assessments included the disappearance rate of pharyngeal pain (within 3, 7, and 14 days), disappearance time of pharyngeal pain, as well as adverse events.@*RESULTS@#Of 7,699 enrolled participants, 6,693 (86.9%) received acupoint application and 1,450 (21.7%) with non-acupoint application. After PSM, there were 1,004 patients each in the application group (AG) and non-application group (NAG). The disappearance rate of pharyngeal pain in the AG at 3, 7, and 14 days were all higher than those in the NAG (P<0.05). The disappearance time of pharyngeal pain in the AG were shorter than that in the NAG (logrank P<0.001, hazard ratio=1.51, 95% confidence interval: 1.41-1.63). The median age of effective cases was 4 years, mainly 3-6 years old (40.21%). The disappearance rate of pharyngeal pain in the application group with tonsil diseases was 2.19 times higher than that in the NAG (P<0.05). The commonly used acupoints for the effective cases were Tiantu (RN 22), Shenque (RN 8) and Dazhui (DU 14). The commonly used herbs for the effective cases were Natrii sulfas, Radix et Rhizoma Rhei, and Herba Ephedrae. Among them, Natrii sulfas was applied to RN 8 most frequently (support 84.39%). A total of 1,324 (17.2%) patients experienced AEs, and mainly occurred in the AG, with significant difference in the incidence of AEs between goups (P<0.05). All AEs reported were the first grade, and the average regression days of AEs was 2.8 days.@*CONCLUSIONS@#Acupoint application in patients with pharyngeal pain resulted in improved effective rate and shortened duration, especially children aged 3-6 years old, and those with tonsil diseases. Acupoint of RN 22, RN 8 and DU 14, Natrii sulfas, Radix et Rhizoma Rhei, and Herba Ephedrae were the most commonly used herbs in the treatment of pharyngeal pain.

Temporal Unfolding of Racial Ingroup Bias in Neural Responses to Perceived Dynamic Pain in Others / 神经科学通报·英文版

In this study, we investigated how empathic neural responses unfold over time in different empathy networks when viewing same-race and other-race individuals in dynamic painful conditions. We recorded magnetoencephalography signals from Chinese adults when viewing video clips showing a dynamic painful (or non-painful) stimulation to Asian and White models' faces to trigger painful (or neutral) expressions. We found that perceived dynamic pain in Asian models modulated neural activities in the visual cortex at 100 ms-200 ms, in the orbitofrontal and subgenual anterior cingulate cortices at 150 ms-200 ms, in the anterior cingulate cortex around 250 ms-350 ms, and in the temporoparietal junction and middle temporal gyrus around 600 ms after video onset. Perceived dynamic pain in White models modulated activities in the visual, anterior cingulate, and primary sensory cortices after 500 ms. Our findings unraveled earlier dynamic activities in multiple neural circuits in response to same-race (vs other-race) individuals in dynamic painful situations.

Nueva herramienta semiológica para el diagnóstico de la tendinitis de De Quervain: prueba de sinergia del primer compartimento / A new physical diagnostic tool for the diagnosis of De Quervain's tenosynovitis. First compartment synergy test

Introducción: Existen dos maniobras de provocación principales que pueden ayudar a identificar una tenosinovitis de De Quervain, más reconocidas como prueba de Finkelstein y prueba de Eichhoff. Ambas maniobras son pasivas buscando la elongación de los tendones comprometidos. Siguiendo el principio de sinergia muscular, decidimos describir una nueva maniobra activa que permita diagnosticar la tendinitis de De Quervain y así incorporar una nueva herramienta semiológica para llegar a un diagnóstico más preciso. Materiales y Métodos: Se realizó un estudio prospectivo que evaluó a todos los pacientes esqueléticamente maduros que acudieron con dolor mecánico en el borde radial de la muñeca entre abril y julio de 2023. Se les realizaron las maniobras para tendinitis de De Quervain, así como para otros cuadros del borde radial, y se solicitaron estudios diagnósticos por imágenes para confirmar la enfermedad. Se determinó la especificidad y sensibilidad de las pruebas semiológicas. Resultados: Se incluyó a 38 pacientes (43 muñecas), 29 mujeres y 9 hombres. El promedio de edad era de 47 años. La sensibilidad y especificidad de la prueba de sinergia fueron del 94,87% y 100%, respectivamente, con un valor predictivo positivo del 100%. Conclusiones: Los resultados obtenidos demuestran que las maniobras activas son superiores a las pasivas para llegar al diagnóstico correcto; en este caso, la prueba de sinergia propuesta fue la más específica. Esta maniobra no debería reemplazar a las existentes. Nivel de Evidencia: II

Introduction: There are two main provocative tests that can help us identify De Quervain's tenosynovitis. These are better known as the Finkelstein and Eichhoff tests. Both maneuvers are passive and attempt to elongate the affected tendons. Following the notion of muscle synergy, we decided to describe a new active maneuver for diagnosing De Quervain's tenosynovitis, thus incorporating a new physical diagnostic tool for a more precise diagnosis. Materials and Methods: A prospective study was conducted, evaluating all skeletally mature patients who presented with mechanical pain on the radial border of the wrist between April and July 2023. Tests for De Quervain's tenosynovitis were performed, as well as assessments for other radial border diseases. Diagnostic imaging studies were requested to confirm the diagnosis. The specificity and sensitivity of the physical tests were determined. Results: A total of 38 patients were included, and 43 wrists were evaluated (29 females, 9 males). The average age was 47 years. The sensitivity and specificity of the synergy test were 94.87% and 100%, respectively, with a positive predictive value of 100%. Conclusion: The findings reveal that active maneuvers outperform passive maneuvers for reaching the correct diagnosis; in this case, the proposed synergy test is the most specific. However, this maneuver should not replace existing ones. Level of Evidence: II

Effect of nerve growth factor on elderly degenerative knee osteoarthritis pain / 中国骨伤

OBJECTIVE@#To explore effect of nerve growth factor (NGF) antibody on knee osteoarthritis (KOA) pain model was evaluated by in vitro model.@*METHODS@#Thirty male SPF rats aged 28-week-old were divided into blank group (10 rats with anesthesia only). The other 20 rats were with monoiodoacetate (MIA) on the right knee joint to establish pain model of OA, and were randomly divided into control group (injected intraperitoneal injection of normal saline) and treatment group (injected anti-NGF) intraperitoneal after successful modeling, and 10 rats in each group. All rats were received retrograde injection of fluorogold (FG) into the right knee joint. Gait was assessed using catwalk gait analysis system before treatment, 1 and 2 weeks after treatment. Three weeks after treatment, right dorsal root ganglia (DRG) were excised on L4-L6 level, immunostained for calcitonin gene-related peptide (CGRP), and the number of DRGS was counted.@*RESULTS@#In terms of gait analysis using cat track system, duty cycle, swing speed and print area ratio in control and treatment group were significantly reduced compared with blank group (P<0.05). Compared with control group, duty cycle and swing speed of treatment group were significantly improved (P<0.05), and there was no significant difference in print area ratio between treatment group and blank group (P>0.05). The number of FG-labeled DRG neurons in control group was significantly higher than that in treatment group and blank group (P<0.05). The expression of CGRP in control group was up-regulated, and differences were statistically significant compared with treatment group (P<0.05).@*CONCLUSION@#Intraperitoneal injection of anti-NGF antibody inhibited gait injury and upregulation of CGRP in DRG neurons. The results suggest that anti-nerve growth factor therapy may be of value in treating knee pain. NGF may be an important target for the treatment of knee OA pain.

Prevention of drug diversion and substance use disorders among anesthesiologists: a narrative review

Abstract Diversion of substances from the care of the intended patient is a significant problem in healthcare. Patients are harmed by the undertreatment of pain and suffering, transmission of disease, as well as the risk associated with impaired vigilance. Healthcare providers may be harmed by the physical and mental impact of their addictions. Healthcare systems are placed in jeopardy by the legal impact associated with illegal routes of drug release including sanction and financial liability and loss of public trust. Healthcare institutions have implemented many measures to reduce diversion from the perioperative area. These efforts include education, medical record surveillance, automated medication dispensing systems, urine drug testing, substance waste management systems, and drug diversion prevention teams. This narrative review evaluates strengths, weaknesses, and effectiveness of these systems and provides recommendations for leaders and care providers.

Efficacy of ultrasound-guided infiltration with levobupivacaine and triamcinolone for myofascial pain syndrome of the quadratus lumborum: a retrospective observational study

Abstract Introduction and objectives: Myofascial Pain Syndrome (MPS) of the Quadratus Lumborum muscle (QL) is a frequent cause of chronic low back pain. With this study, we aimed to assess the efficacy of ultrasound-guided infiltration with 0.25% levobupivacaine and 40 mg triamcinolone for MPS of the QL. Methods: Observational and retrospective study of participants submitted to ultrasound-guided infiltration of the QL muscle from January 1, 2015 to June 31, 2019. Pain intensity was assessed using the five-point pain Numeric Rating Scale (NRS): pre-intervention, at 72 hours, 1 month, 3 months and 6 months post-intervention. Additional data collected were demographic characteristics, opioid consumption, and adverse effects. Results: We assessed 90 participants with mean age of 55.2 years. Sixty-eight percent of participants were female. Compared to the pre-intervention assessment, there was an improvement in pain at 72 hours (Mean Difference [MD = 3.085]; 95% CI: 2.200-3.970, p < 0.05), at the 1st month (MD = 2.644; 95% CI: 1.667-3.621, p < 0.05), at the 3rdmonth (MD = 2.017; 95% CI: 0.202-2.729, p < 0.05) and at the 6th month (MD = 1.339; 95% CI 0.378-2.300, p < 0.05), post-intervention. No statistically significant differences in opioid consumption were observed. No adverse effects associated with the technique were reported. Conclusions: Ultrasound-guided infiltration of the QL muscle is a safe and effective procedure for the treatment of pain in the QL MPS within 6 months post-intervention.

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Abstract Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO Registration: CRD42021291707.

Construção de um aplicativo: promoção à saúde do idoso com incapacidade e dor lombar / Building an app: promoting the health of elderly people with disabilities and low back pain

Introdução: A incapacidade funcional e o desempenho físico são definidos pela dificuldade ou necessidade de ajuda para o indivíduo executar tarefas diárias, podendo repercutir na capacidade adaptativa das atividades diárias, tanto nas suas capacidades físicas quanto mentais. O processo de envelhecimento acarreta incapacidade funcional, comprometendo a qualidade de vida. Objetivo geral: Construir um aplicativo em saúde com foco na saúde do idoso com incapacidade na lombar. Métodos: Trata-se de um estudo do tipo construção de um aplicativo, desenvolvido durante o período de agosto de 2021 a maio de 2022 em Fortaleza-CE, na página https://fabricadeaplicativos.com.br e será disponibilizado com um instrumento composto pelo índice de Oswestry 2.0 de Incapacidade. Resultados: Telas explicativas para download e acesso ao aplicativo desenvolvido para facilitar o alcance de informações relevantes aos idosos que sofrem limitações no seu dia a dia, provenientes do processo de envelhecimento. Conclusão: Tendo visto que existem poucos estudos e aplicativos sobre esse assunto, se faz necessário a criação de um aplicativo voltado ao tema.(AU)

Introduction: Functional disability and physical performance are defined by the difficulty or need for help for the individual to perform daily tasks. It can have repercussions on the adaptive capacity of daily activities, both in their physical and mental capacities. The aging process causes functional disability, thus compromising quality of life. General objective: To build a health application focused on the health of the elderly with disabilities in the lumbar. Methods: This is a study of the type of construction of an application, developed during the period from August 2021 to May 2022 in Fortaleza-Ceará, on page https://fabricadeaplicativos.com.br and will be made available with an instrument composed of the Oswestry 2.0 Disability Index. Results: Explanatory screens for download and access to the application that was developed to facilitate the reach of relevant information to the elderly who suffer limitations in their day-to-day coming from the aging process. Conclusion: Having seen that there are few studies and applications on this subject, it is necessary to create an application focused on the subject.(AU)

Introducción: La discapacidad funcional y el rendimiento físico se definen por la dificultad o necesidad de ayuda del individuo para realizar las tareas diarias, lo que puede repercutir en la capacidad adaptativa de las actividades diarias, tanto en sus capacidades físicas como mentales. El proceso de envejecimiento conduce a una discapacidad funcional, comprometiendo la calidad de vida. Objetivo general: Construir una aplicación de salud centrada en la salud de personas mayores con discapacidad lumbar. Métodos: Se trata de un estudio del tipo constructivo de una aplicación, desarrollado durante el período de agosto de 2021 a mayo de 2022 en Fortaleza-CE, en la página https://fabricadeaplicativos.com.br y estará disponible con un instrumento compuesto. por el Índice de Discapacidad Oswestry 2.0. Resultados: Pantallas explicativas de descarga y acceso a la aplicación desarrollada para facilitar el acceso a información relevante a personas mayores que sufren limitaciones en su vida diaria, derivadas del proceso de envejecimiento. Conclusión: Dado que existen pocos estudios y aplicaciones sobre este tema, es necesario crear una aplicación enfocada en el tema.(AU)

Intervenções não farmacológicas para redução da dor relacionada à vacinação em lactentes: revisão integrativa / Non-pharmacological interventions to reduce vaccination-related pain in infants: an integrative review

Objetivo: Identificar evidências científicas relacionadas às intervenções não farmacológicas utilizadas para redução da dor relacionada à vacinação em lactentes. Métodos: Revisão integrativa, realizada com emprego da estratégia PICo nas bases de dados IBECS, MEDLINE e Scopus, no período de fevereiro a junho de 2022, que visou responder ao seguinte questionamento: quais as evidências científicas em relação às intervenções não farmacológicas utilizadas para redução da dor associada à vacinação em lactentes? Os descritores combinados com os booleanos OR e AND foram lactente, vacinação, dor, infant, vaccination e pain. Foram incluídos artigos no recorte temporal de 2011 a 2021, publicados nos idiomas português, inglês ou espanhol. Resultados: A amostra final foi composta por 32 estudos. As medidas de intervenção não farmacológicas propostas para o alívio da dor em lactentes submetidos à vacinação foram: aleitamento materno e soluções orais de açúcar; assistência profissional em sala de vacina; e medidas de estimulação sensorial. Conclusão: A utilização dessas estratégias evidenciadas na literatura científica é capaz de favorecer o manejo mais adequado da dor relacionada à administração de vacinas e, por conseguinte, aumentar o conforto e bem-estar do lactente, além de favorecer a adesão das famílias à vacinação. Descritores: Dor; Vacinação; Lactente; Intervenções Não Farmacológicas

Objective: To identify scientific evidence related to non-pharmacological interventions used to reduce vaccination-related pain in infants. Methods: This is an integrative review carried out using the PICo strategy, in the IBECS, MEDLINE and Scopus databases, from February to June 2022, which aimed to answer the following question: what is the scientific evidence regarding non-pharmacological interventions used to reduce pain associated with vaccination in infants? The descriptors combined with the OR and AND Booleans were infant, vaccination, pain. Articles from 2011 to 2021 and published in Portuguese, English or Spanish were included. Results:The final sample consisted of 32 studies. Non-pharmacological intervention measures proposed for pain relief in infants submitted to vaccination were: breastfeeding and oral sugar solutions; professional assistance in the vaccine room; and sensory stimulation measures. Conclusion: Using these strategies evidenced in the scientific literature is able to favor the most adequate management of pain related to vaccine administration and, therefore, increase infants' comfort and well-being, in addition to favoring families' compliance with vaccination. Descriptors: Pain; Vaccination; Infant; Non-Pharmacological Interventions

Análise da eficácia do agulhamento seco e da massagem facial no tratamento de disfunções temporomandibulares com base em relato de caso clínico / Analysis of the effectiveness of dry needing and facial massage in the treatment of temporomandibular disorders based on a clinical case report

O objetivo do presente trabalho é apresentar um relato de caso de Disfunção Temporomandibular (DTM) dolorosa de origem muscular, tratado por meio de Agulhamento Seco (AS) e Massagem Facial (MF). Paciente do sexo feminino, M.R.B.A., de 47 anos, com diagnóstico de dor miofascial com referência do lado esquerdo e deslocamento de disco com redução do lado esquerdo, de acordo com os Critérios de Diagnóstico e Tratamento das Disfunções Temporomandibulares (DC/TMD). A paciente foi submetida a cinco sessões de AS e MF, executadas por fisioterapeuta experiente. Na primeira consulta, foi realizada a anamnese e exame físico para a obtenção de informações sobre qualidade, frequência, duração e intensidade da dor, bem como fatores de melhora, fatores de piora, fatores acompanhantes, fatores desencadeantes e tratamentos prévios. A intensidade da dor foi avaliada através de escala visual analógica e as intervenções com agulhamento seco foram iniciadas a partir da segunda consulta. Ao final das sessões, a paciente foi orientada quanto à continuidade de exercícios de relaxamento muscular e ao uso de placa interoclusal. Com base na escala adotada, o quadro doloroso geral da paciente teve evolução positiva de 6 a 0 após o tratamento, com destaque observado em seus pontos gatilhos de 10 e 8 para 6 e 3, para os lados esquerdo e direito respectivamente. Concluise que, após a aplicação da terapia proposta, a paciente obteve melhora com redução significativa em sua sintomatologia dolorosa em ambos os lados(AU)

The objective of this work is to present a case report of Dysfunction Painful temporomandibular joint (DTM) of muscular origin, treated with needling Dry (AS) and Facial Massage (MF). Female patient, M.R.B.A., 47 years old, with a diagnosis of myofascial pain with reference on the left side and displacement of disc with reduction on the left side, according to the Diagnostic and Treatment of Temporomandibular Disorders (DC/TMD). The patient underwent five sessions of AS and MF, performed by an experienced physiotherapist. At the first consultation, anamnesis and physical examination were carried out to obtain information on quality, frequency, duration and intensity of pain, as well as improvement factors, worsening factors, accompanying factors, triggering factors and previous treatments. The intensity of pain was assessed using a visual analogue scale and interventions with needling dry were started from the second consultation. At the end of the sessions, the patient was guided regarding the continuation of muscle relaxation exercises and the use of interocclusal splint. Based on the adopted scale, the patient's general painful condition was positive evolution of 6 to 0 after treatment, with emphasis on its points triggers from 10 and 8 to 6 and 3, for the left and right sides respectively. It is concluded that, after applying the proposed therapy, the patient improved with reduction significant in its painful symptoms on both sides

Clínica, auxología y calidad de vida en cincuenta niños, niñas y adolescentes con síndromes de sobrecrecimiento corporal segmentario de un único centro / Clinical and auxological characteristics and quality of life of 50 children and adolescents with segmental overgrowth syndromes at a single center

Introducción. Los síndromes de sobrecrecimiento corporal segmentario son un grupo de enfermedades poco frecuentes caracterizadas por exceso de crecimiento en una o más partes del cuerpo relacionadas, en su mayoría, con mutaciones en mosaico en la vía de señalización AKT/PI3K/mTOR y RAS-MAPK. Nuestro objetivo fue analizar las características clínicas y auxológicas, y la calidad de vida relacionada a salud (CVRS) en este grupo de pacientes en un hospital de tercer nivel de atención. Población y métodos. Estudio transversal de una cohorte en seguimiento. Se analizaron edad, sexo, datos sociodemográficos, mediciones antropométricas del segmento afectado y del contralateral, complicaciones, tratamiento, calidad de vida (PedsQL4.0) y dolor. Se calcularon medidas centrales y de dispersión. Se realizó análisis univariado entre calidad de vida y variables incluidas. Resultados. Se incluyeron 50 pacientes, 29 varones. Mediana de edad 9,95 (r 1,44-17,81) años. El diagnóstico más frecuente fue síndrome de sobrecrecimiento relacionado a PIK3CA (PROS) (37/50). Mediana de número de segmentos afectados 2 (r: 1-7) por niño. Cuarenta casos presentaron malformación vascular; 20, capilar. El dolor (24/50) fue la complicación más frecuente. Treinta y un pacientes mostraron asimetría de longitud de miembros inferiores, < 5 cm. La estatura se ubicó entre los centilos 50 y 97 en la mayoría de los niños. Menor CVRS se observó en mujeres, en pacientes con malformación vascular compleja y necesidades básicas insatisfechas (NBI). Conclusiones. PROS fue el diagnóstico más frecuente. El dolor fue una complicación frecuente. La CVRS fue menor en mujeres, pacientes con malformación vascular combinada y NBI.

Introduction. Segmental overgrowth syndromes are a group of rare diseases characterized by overgrowth in one or more parts of the body, mostly related to mosaic mutations in the AKT/PI3K/mTOR and RASMAPK signaling pathway. Our objective was to analyze the clinical and auxological characteristics and health-related quality of life (HRQoL) in this group of patients at a tertiary care hospital. Population and methods. Cross-sectional study of a follow-up cohort. Age, sex, sociodemographic data, anthropometric measurements of the affected and contralateral segments, complications, treatment, quality of life (PedsQL 4.0), and pain were analyzed. Central and dispersion measures were estimated. A univariate analysis between the quality of life and study variables was done. Results. A total of 50 patients were included; 29 were males. Median age: 9.95 (r: 1.44­17.81) years. The most common diagnosis was PIK3CA-related overgrowth spectrum (PROS) (37/50). The median number of affected segments was 2 (r: 1­7) per patient. Vascular malformations were observed in 40, and capillary malformations, in 20 patients. Pain was the most common complication (24/50). An asymmetry of the lower extremities of < 5 cm was observed in 31 patients. In most children, height was between the 50th and 97th percentiles. A lower HRQoL was observed among girls, patients with complex vascular malformations, and those with unmet basic needs (UBNs). Conclusions. PROS was the most common diagnosis. Pain was the most common complication. HRQoL was lower among girls, patients with combined vascular malformations, and those with UBNs.

Correlation between Anatomopathological Aspects and Pelvic Pain in Women with Deep Infiltrating Endometriosis / Correlação entre aspectos anatomopatológicos e dor pélvica em mulheres com endometriose profunda

Abstract Objective To correlate the morphological aspects with pelvic pain in women with deep infiltrating endometriosis. Methods A retrospective study with 67 women with deep endometriosis who underwent surgical treatment in a tertiary hospital from 2007 to 2017. The following variables were considered: age, parity, body mass index, site of involvement, hormonal treatment before surgery, pelvic pain, and morphometric analysis. The histological slides of the surgical specimens were revised and, using the ImageJ software for morphometric study, the percentages of stromal/glandular tissues were calculated in the histological sections. Results The mean age of the women was 38.9 ± 6.5 years. The mean pain score was 8.8 ± 1.9 and the mean time of symptomatology was 4.7 ± 3.5 years, with 87% of the patients undergoing hormone treatment prior to surgery. The average expression of CD10, CK7, and S100 markers was 19.5 ± 11.8%, 9.4 ± 5.9%, and 7.9 ± 5.8% respectively. It was found that the greater the expression of CD10, the greater the level of pain (p = 0.02). No correlation was observed between the expression of CD10, CK7, and S100 markers and age and duration of symptoms. Conclusion Women with deep infiltrating endometriosis have a positive association between the level of pain and the fibrosis component in the endometrial tissue's histological composition.

Resumo Objetivo Correlacionar os aspectos morfológicos com a dor pélvica em mulheres com endometriose profunda. Métodos Estudo retrospectivo com 67 mulheres com endometriose profunda submetidas a tratamento cirúrgico em hospital terciário de 2007 a 2017. As seguintes variáveis foram consideradas: idade, paridade, índice de massa corporal, local do acometimento, tratamento hormonal antes da cirurgia, dor pélvica e análise morfométrica. As lâminas histológicas das peças cirúrgicas foram revisadas e, por meio do software ImageJ para estudo morfométrico, foram calculadas as porcentagens de tecidos estromais/glandulares nos cortes histológicos. Resultados A média etária das mulheres foi de 38,9 ± 6,5 anos. O escore de dor médio foi de 8,8 ± 1,9 e o tempo médio de sintomatologia foi de 4,7 ± 3,5 anos, sendo que 87% das pacientes realizavam tratamento hormonal antes da cirurgia. A expressão média dos marcadores CD10, CK7 e S100 foi de 19,5 ± 11,8%, 9,4 ± 5,9% e 7,9 ± 5,8%, respectivamente. Verificou-se que quanto maior a expressão de CD10, maior o nível de dor (p = 0,02). Não foi observada correlação entre a expressão dos marcadores CD10, CK7 e S100 com a idade e duração dos sintomas. Conclusão Mulheres com endometriose profunda apresentam associação positiva entre o nível de dor e o componente de fibrose na composição histológica do tecido endometrial.