Good tolerance and benefits should make early exercises a routine in patients with acute brain injury / Boa tolerância e benefícios de exercícios precoces devem fazer parte da rotina em pacientes com lesão cerebral aguda

Abstract Introduction: The negative impact of prolonged immobilization results a physical decline during hospitalization in patients with acute brain injury. Objective: To investigate the benefits of early exercises on the mobility of patients with acute brain injury assisted at an Intensive Care Unit (ICU). Methods: This is a prospective, single-blind, controlled clinical trial. A total of 303 patients were assessed. Due to eligibility criteria, exercise protocol was applied in 58 participants, 32 with brain injury caused by traumatic event and 26 with brain injury caused by cerebrovascular event. Exercise began 24 hours after patients' admission at the ICU. Participants were submitted to passive and active mobilization protocols, performed according to level of sedation, consciousness and collaboration. Statistical analysis was conducted with repeated measures analysis of variance. Significance was set at 5%. Results: The group of patients with traumatic brain injuries was younger (p = 0.001) and with more men (p = 0.025) than the group of patients with clinical events. Most exercise sessions were performed in sedated patients. By the end of the protocol, participants with traumatic and clinical brain injury were able to do sitting and standing exercises. Both groups were similar on ICU discharge (p = 0.290). The clinical group presented better improvement on level of consciousness than the traumatic group (p = 0.005). Conclusion: Participants with an acute brain injury presented at the time of discharge from the ICU good mobility and improvement in the level of consciousness.

Resumo Introdução: O impacto negativo da imobilização prolongada resulta em declínio funcional durante a hospitalização em pacientes com lesão cerebral aguda. Objetivo: Investigar os benefícios dos exercícios precoces na mobilidade dos pacientes com lesão cerebral aguda atendidos em uma Unidade de Terapia Intensiva (UTI). Métodos: Trata-se de um estudo clínico prospectivo, controlado e cego. Foram avaliados 303 pacientes. Devido aos critérios de elegibilidade, o protocolo de exercício foi aplicado em 58 participantes, 32 com lesão cerebral causada por evento traumático e 26 com lesão cerebral causada por evento cerebrovascular. O exercício começou 24 horas após a admissão dos pacientes na UTI. Os participantes foram submetidos a protocolos de mobilização passiva e ativa, realizados de acordo com o nível de sedação, consciência e colaboração. A análise estatística foi realizada com análise de medidas repetidas de variância. A significância foi estabelecida em 5%. Resultados: O grupo de pacientes com lesão cerebral traumática foi mais jovem (p = 0,001) e com mais homens (p = 0,025) do que o grupo de pacientes com eventos clínicos. A maioria das sessões de exercícios foi realizada em pacientes sedados. Ao final do protocolo, os participantes com lesão cerebral traumática e clínica foram capazes de fazer exercícios de sentar e ficar em pé. Ambos os grupos foram semelhantes na alta da UTI (p = 0,290). O grupo clínico apresentou melhor ganho no nível de consciência do que o grupo traumático (p = 0,005). Conclusão: Os participantes com lesão cerebral aguda apresentaram no momento da alta da UTI boa mobilidade e melhora do nível de consciência.

Anatomía del cuerpo calloso en ratas sometidas a estrés prenatal crónico / Anatomy of corpus callosum in rats submitted to chronic prenatal stress

RESUMEN: El cuerpo calloso (CC), es la mayor comisura de sustancia blanca del encéfalo de los mamíferos placentados, constituida por numerosos haces de fibras transversales que conectan áreas corticales de ambos hemisferios cerebrales. Por otro lado, el estrés se define como una respuesta general del organismo ante demandas externas o internas, inicialmente amenazantes, que consiste en movilizar recursos fisiológicos y psicológicos para poderlas afrontar. Dada la importancia del cuerpo calloso en las conexiones cortico-corticales, el objetivo del presente estudio, fue evaluar el efecto en ratas, de un estrés prenatal crónico por inmovilización, sobre la anatomía macroscópica del CC. Se utilizaron seis ratas preñadas de la cepa Wistar de 250 g, de las cuales tres fueron sometidas, a partir del octavo día postconcepción, a una restricción de movimiento por diez días (2h/día). Posteriormente, las madres prosiguieron su gestación, parto y lactancia. Al nacimiento, las camadas fueron ajustadas a seis crías machos por madre (n=36), destetadas a los 21 días y sacrificadas a los 45-52 días de edad. Los encéfalos fueron seccionados a través de la cisura interhemisférica y ambos hemisferios fotografiados por su cara medial. Las imágenes fueron digitalizadas y analizadas mediante el programa Scion Image®, para la medición del área total, parciales (tercio anterior, medio, posterior y quinto posterior) y perímetro callosal. Es así como, el estrés prenatal por inmovilización, afectó significativamente (p<0,01), la morfología macroscópica del cuerpo calloso. Evidenciándose una disminución del área total, áreas parciales y perímetro callosal, en los animales sometidos a restricción prenatal. Estableciendo una relación directa entre número de axones y área callosal e inversa entre diámetro y densidad axonal; lo observado podría tener incidencia en la transferencia interhemisférica.

SUMMARY: The Corpus Callosum (CC) is the largest white matter commissure in the brain of placental mammals, consisting of numerous transverse fiber bundles that connect cortical areas of both cerebral hemispheres. On the other hand, stress is defined as a general response of the organism to external or internal demands, initially threatening, which consists of mobilizing physiological and psychological resources to be able to face them. Given the importance of CC in cortico-cortical connections, the aim of the present study, was to evaluate the effect of chronic pre-natal immobilization stress on the macroscopic anatomy of CC in rats. Six 250g pregnant rats of the Wistar strain were used, of which three were subjected, starting on the eighth post-conception day, to movement restriction for ten days (2h/day). Subsequently, the mothers continued their gestation, delivery and lactation. At birth, litters were adjusted to six male offspring per mother (n=36), which were weaned at 21 days and slaughtered at 45-52 days of age. The brains were fixed, and later sectioned through the interhemispheric fissure and both hemispheres photographed by their medial aspect. The images were digitized and analyzed using the Scion Image® program, for the measurement of the total area, partial area (ante- rior, middle and posterior thirds, as well as posterior fifth) and callosal perimeter. Thus, prenatal stress due to immobilization significantly affected (p<0.01), the macroscopic morphology of the CC. Evidence shows a decrease in the total area, partial areas and callosal perimeter in the animals subjected to prenatal restraint, as compared to normal animals. Establishing a direct relationship between number of axons and callosal area and an inverse relationship between diameter and axonal density, what was observed may have an impact on interhemispheric transfer.

PRO-Trauma: Protocolo para promoção do conforto às vítimas de trauma imobilizadas / Pro-trauma: protocol to promoting comfort in immobilised trauma victims / Pro-trauma: protocolo para promover la comodidad en las víctimas de traumas inmovilizados

Objetivo: Apresentar o protocolo de um estudo que procura desenvolver uma escala para avaliação do desconforto provocado pela imobilização nas vítimas de trauma e um modelo de maca eficaz na imobilização da vítima de trauma em desenvolvimento. Método: Realizar-se-ão quatro estudos sequenciais: Estudo descritivo, exploratório de abordagem quantitativa para avaliar o grau de desconforto provocado pela imobilização na maca de vácuo e/ou plano duro; Estudo psicométrico para construir e validar um instrumento que permita avaliar o desconforto provocado pela imobilização na maca de vácuo e plano duro; Construção da ImoConfort Mattress para imobilização e transporte de vítimas; e Ensaio clínico randomizado para avaliar a eficácia da ImoConfort Mattress quanto ao conforto, imobilização, aquecimento e controlo da trepidação/vibração provocada pelo transporte. Considerações finais: A criação de um instrumento que monitorize o desconforto durante o socorro e transporte com imobilização, contribuirá para melhorar o tratamento implementado às vítimas de trauma. Espera-se que a ImoConfort Mattress contribua para a melhoria da qualidade da assistência clínica durante o socorro extra-hospitalar. (AU)

Objective: To present the protocol of a study that seeks to develop a scale to assess the discomfort caused by immobilisation in trauma victims and an effective mattress model for immobilization of trauma victims, in desenvolviment. Methods: Four sequential studies will be carried out: Descriptive, exploratory quantitative approach study to assess the degree of discomfort caused by the vacuum mattress splint and/or spine board; Psychometric study to construct and validate an instrument to assess the discomfort caused by immobilization on vacuum mattress splint and/or spine board; Construction of the ImoConfort Mattress for immobilization and transportation of victims; Randomized clinical trial to assess the effectiveness of the mattress in terms of comfort, immobilization, rewarming and control of trepidation/vibration caused by transportation. Final considerations: The creation of an instrument to monitor discomfort during rescue and transport with immobilisation will help to improve all the treatment implemented for trauma victims. The construction of ImoConfort Mattress will improve the quality of clinical care during out-of-hospital rescue. (AU)

Objetivo: Presentar el protocolo de un estudio que pretende desarrollar una escala para evaluar las molestias causadas por la inmovilización en las víctimas de trauma y un modelo de una camilla efectiva para la inmovilización de la víctima de trauma en desenvolvimiento. Métodos: Se llevarán a cabo cuatro estudios secuenciales: Estudio descriptivo y exploratorio del enfoque cuantitativo para evaluar el grado de incomodidad causado por la camilla de vacío y/o plano duro; Estudio psicométrico para construir y validar un instrumento para evaluar la incomodidad causada por la inmovilización; Construcción del ImoConfort Mattress para la inmovilización y el transporte de las víctimas; Ensayo clínico aleatorio para evaluar la eficacia de la camilla respecto a la comodidad, la inmovilización, el calentamiento y el control de las trepidaciones/vibraciones causadas por el transporte. Consideraciones finales: La creación de un instrumento para monitorizar la incomodidad durante el rescate y el transporte con inmovilización contribuirá a mejorar todo el tratamiento aplicado a las víctimas de trauma. La construcción del ImoConfort Mattress mejorará la calidad de la atención clínica durante la ayuda extrahospitalaria. (AU)

Nail disorders associated with cast immobilization of the forearm and wrist: report of two cases and review of the literature

Abstract Cast immobilization is used in the management of various injuries of joints and/or limbs. A variety of nail disorders have been reported in association with cast immobilization of the forearm and wrist among a limited number of patients so far. The mechanism was not clearly identified in some of these cases. Here, the authors report two patients with nail disorders appeared after the removal of immobilization cast of forearm and wrist and review the literature.

Artrogripose Múltipla Congênita: Relato de dois casos / Arthrogryposis Multiplex Congenita: Report of two cases

RESUMO: A Artrogripose Múltipla Congênita (AMC) é uma síndrome rara, que representa um grupo de condições congênitas caracterizado por contraturas articulares em duas ou mais articulações, não progressivas, geralmente simétricas, de etiologia desconhecida e que pode estar associada a outras malformações, como viscerais e neurológicas. Apresenta-mos dois casos isolados com achados característicos de AMC, atendidos em ambulatório de pediatria de alto risco de uma cidade do Oeste do Paraná. Caso 1: lactente, sexo feminino, 14 dias de vida, com redução dos movimentos fetais referidos pela mãe, apresentando malformações envolvendo somente os membros, visualizadas logo após o nasci-mento. Caso 2: lactente, sexo masculino, quatro meses de vida, com diagnóstico de hipocinesia fetal ao ultrassom obstétrico de 23 semanas, ao nascimento apresenta contraturas dos membros e disfunção do sistema nervoso cen-tral. O diagnóstico da artrogripose é complexo e essencialmente clínico, sendo necessária uma anamnese meticulosa, contemplando uma avaliação da gestação, via de parto, história familiar e um exame físico minucioso, classificando quais os tipos de contraturas, membros envolvidos, presença de musculatura alterada e de alterações neurológicas, a fim de diferenciar a AMC das outras síndromes que também cursam com contraturas articulares. O seguimento e tratamento dos lactentes com artrogripose devem ocorrer em acompanhamento multidisciplinar devido às variadas manifestações que a doença pode apresentar e à característica de recidiva ao longo dos anos. (AU)

ABSTRACTArthrogryposis Multiple Congenita (AMC) is a rare syndrome that represents a group of congenital conditions character-ized by joint contractures in two or more joints, non-progressive, usually symmetrical, of unknown etiology and which may be associated with other malformations, such as visceral and neurological. We present two isolated cases with characteristic features of AMC, seen in a high-risk pediatrics outpatient clinic in a city in western Paraná. Case 1: infant, female, 14 days old, with reduced fetal movements reported by the mother, presenting malformations involving only the limbs, seen immediately after birth. Case 2: infant, male, four months old, diagnosed with fetal hypokinesia on 23-week obstetric ultrasound, at birth, presents limb contractures and central nervous system dysfunction. The diagnosis of ar-throgryposis is complex and essentially clinical, requiring a meticulous anamnesis, including an assessment of pregnan-cy, delivery, family history and a thorough physical examination, classifying what types of contractures, involved limbs, presence of altered musculature and neurological changes to differentiate AMC from other syndromes that also have joint contractures. The aftercare and treatment of infants with arthrogryposis must occur in multidisciplinary follow-up due to the varied manifestations that the disease may present and the characteristic of recurrence over the years. (AU)

Percepção da equipe multiprofissional sobre a contenção mecânica de idosos: paradoxos do cuidado / Perception of a multidisciplinary team on physical restraint use on older adults: care paradoxes

OBJETIVO: Descrever a percepção da equipe multiprofissional sobre o uso da contenção mecânica em idosos. METODOLOGIA: Pesquisa qualitativa realizada com 58 profissionais da área da saúde em duas Instituições de Longa Permanência para Idosos localizadas no estado do Rio de Janeiro, Brasil. Utilizou-se entrevista semiestruturada, com análise temática do conteúdo. O período de coleta de dados foi de novembro de 2017 a junho de 2018. RESULTADOS: Foram identificadas 21 unidades de registro, organizadas em três categorias: percepção da equipe sobre as consequências e riscos do uso da contenção mecânica: o paradoxo da segurança do paciente; implicações na decisão da contenção mecânica de idosos; e estratégias para conter e não conter. CONCLUSÕES: Os achados refletem a necessidade de capacitação dos profissionais no que tange às estratégias de cuidado alternativas, livres de contenção, como parte da promoção de uma cultura de cuidado que respeite o direito à liberdade e a dignidade das pessoas, especialmente as mais vulneráveis.

OBJECTIVE: To describe the perception of a multidisciplinary team on the use of physical restraint in older adults. METHODS: Qualitative research conducted with 58 health professionals in two long term care facilities for older adults located in the state of Rio de Janeiro, Brazil. Semi-structured interviews were further analyzed using thematic content analysis. The data was collected from November 2017 to June 2018. RESULTS: Twenty-one initial codes were identified and organized in three categories: team perception of the consequences and risks of a physical restraint (the patient's safety paradox); implications of the decision of physical restraint of the older adults; and strategies to restrain and not restrain. CONCLUSIONS: The results reinforce the need for training of professionals on restraint-free alternatives of care, as part promoting a culture of care that respects the right to freedom and the dignity of people ­ especially the most vulnerable ones.

Decreto Supremo que prorroga el Estado de Emergencia Nacional por las graves circunstancias que afectan la vida de la Nación a consecuencia del COVID-19 / Supreme Decree that extends the State National Emergency for the serious circumstances affecting the life of the Nation as a result of COVID-19

El Decreto contiene las acciones diferenciadas en relación a las medidas de inmovilización en algunos departamentos y provincias de nuestro país, en razón a los altos índices de contagio y propagación del COVID-19.

Prevalência de cuidados paliativos em pacientes com síndrome de imobilidade em um serviço de atenção domiciliar / Prevalence of palliative care in patients with immobility syndrome in a home care attention service

Introdução: a síndrome de imobilidade (SI) é definida por critérios clínicos específicos, a saber, presença dos dois critérios maiores, declínio cognitivo e múltiplas contraturas e pelo menos dois dos menores, disfagia, afasia, lesão por pressão e dupla incontinência, tendo indicação de cuidados paliativos desde o momento de sua identificação. Objetivo: determinar a prevalência da SI em pacientes em atendimento domiciliar e verificar a inclusão destes em cuidados paliativos. Métodos: estudo documental, descritivo-exploratório e retrospectivo, coletados do prontuário dos pacientes do Serviço de Atendimento Domiciliar de Curitiba, no período de 1 a 31 de julho de 2018, totalizando 566 pacientes. Critérios de inclusão: idade igual ou superior a 18 anos, estar em atendimento domiciliar, apresentar critérios para SI. Critérios de exclusão: dados incompletos que impeçam a caracterização da SI. Foi utilizado o teste de associação de qui-quadrado e o teste da ANOVA. Considerou-se o p ≤ 0,05 com significância estatística. Resultados: 56 (9,9%) apresentaram critérios para SI. A ocorrência da SI no sexo feminino foi de 13,1% e no masculino 6,1%, com significância estatística (p=0,0218). A média de idade de 72,43. Quanto aos critérios menores, n=56 (100%) tinham dupla incontinência, n=48 (83,9%) disfagia, n=41 (73,2%) afasia e n=31 (55,4%) lesões por pressão. Dos pacientes com SI, 44,46% estavam em cuidados paliativos. Conclusão: a SI foi associada ao sexo feminino, a média de idade foi 72,43 anos. A prevalência foi de 9,9%, dos quais somente 44,46% estavam em cuidados paliativos, o que nos aponta que o atendimento domiciliar não está ofertando aos seus pacientes o melhor atendimento possível. Palavras-chave: Imobilização. Cuidados paliativos. Serviços de assistência domiciliar.(AU)

Introduction: the immobility syndrome (IS) is defined by specific clinical criteria, namely, presence of the two major criteria, cognitive decline and multiple contractures and at least two of the smallest, dysphagia, aphasia, pressure injury and double incontinence and indicates palliative care from the moment of its identification. Objective: to determine the prevalence of IS in patients in home care and to verify their inclusion in palliative care. Methods: this is a documentary, descriptiveexploratory and retrospective study, collected from patients' records of the Home Care Service of Curitiba, from 1 to 31 July 2018, totaling 566 patients. Inclusion criteria: age equal to or greater than 18 years, being in home care, presenting criteria for IS. Exclusion criteria: incomplete data that prevent the characterization of the IS. The chi-square association test and the ANOVA test were used. The p ≤ 0.05 was considered statistically significant. Results: n=56 (9.9%) presented criteria for IS. The occurrence of IS in the female sex was 13.1% and in the male, 6.1%, with statistical significance (p=0.0218). The mean age was 72.43. Regarding the minor criteria n=56 (100%) had double incontinence, n=48 (83.9%) dysphagia, n=41 (73.2%) aphasia, and n=31 (55.4%) pressure injuries. Of the patients with IS 44.46% were in palliative care. Conclusion: IS was associated with females, mean age was 72.43 years. The prevalence was 9.9%, of which only 44.46% were in palliative care, which indicates that home care is not offering its patients the best care possible. Keywords: Immobilization. Palliative care. Home care services.(AU)

Severe Osteoarthritis of the Elbow after a Non- Displaced Radial Head Fracture: Case Report / Osteoartrite global do cotovelo após uma fratura não deslocada da cabeça radial: Relato de caso

Abstract Fractures of the radial head account for over 50% of all fractures of the forearm. Broberg and Morrey (modification of the Mason classification) classify them in four types. Type 1 fractures are non-displaced or minimally displaced, considered stable and without mechanical joint blockage. In this type of fracture, a non-operative management with a short period of immobilization leads to a good clinical result without adverse outcomes. Clinically relevant associated lesions are not common. Because of this, arthritis of the radiocapitellar and ulnohumeral joint after the non-displaced radial head fracture is uncommon. This case report presents a young patient diagnosed with isolated non-displaced radial head fracture, that evolved 8 months later, to global arthritis of the elbow.

Resumo As fraturas da cabeça radial representam mais de 50% de todas as fraturas do antebraço. Broberg e Morrey (modificação da classificação de Mason) as classificam em quatro tipos. As fraturas do tipo 1 são aquelas não deslocadas ou minimamente deslocadas, consideradas estáveis e sem bloqueio mecânico das articulações. Nesse tipo de fratura, um manejo não operatório com um curto período de imobilização permite bom resultado clínico sem desfechos adversos. Lesões associadas clinicamente relevantes não são comuns. Por esse motivo, a artrite da articulação radiocapitelar e ulnoumeral após a fratura da cabeça do rádio não deslocada é incomum. Este relato de caso apresenta um paciente jovem com diagnóstico de fratura isolada da cabeça radial não deslocada que evoluiu, 8 meses depois, para artrite global do cotovelo.

Triple open dislocation in the index finger of the hand without a high-energy trauma / Triple luxación abierta del segundo dedo de la mano tras traumatismo de baja energía

A simultaneous double dislocation (both proximal [PIP] and distal [DIP] interphalangeal joints) of a triphalangeal finger is a rare entity. The most common hand affected is the right hand. In the case of a closed triple dislocation (metacarpophalangeal [MCP], PIP and DIP joints); there are only two cases in the literature revised. In this case, we report an open triple dislocation in the index finger of the left-hand of a 54-year-old man treated by closed reduction and 3 weeks of immobilization followed by active mobilization with satisfactory results.

La luxación simultánea de las articulaciones interfalángicas proximal (IFP) y distal (IFD) de un dedo de tres articulaciones es una rara entidad. La mano que es afectada con más frecuencia es la derecha. Con relación a una triple luxación cerrada (articulación metacarpofalángica [MCF], IFP e IFD), sólo hay descritos dos casos en la literatura revisada. En este caso, describimos una triple luxación abierta del segundo dedo de la mano en un varón de 54 años de edad tratada mediante reducción cerrada,e inmovilización durante 3 semanas seguida de movilización activa supervisada, con resultado final satisfactorio.

Updates on the Diagnosis and Treatment of Restless Legs Syndrome / 신경정신의학

Restless legs syndrome (RLS) is a neurological sleep disorder characterized by an urge to move the legs or arms and is associated with discomfort and paresthesia in the legs. RLS is diagnosed based on the clinical symptoms, and polysomnography is performed to quantify the periodic limb movements during sleep or in patients who undergo the suggested immobilization test. Determining the cause of RLS is important for accurately diagnosing and evaluating this condition. The treatment of RLS varies according to the etiology, severity, and frequency of the patients' symptoms. Accurate identification and treatment of the cause of RLS are important in patients with secondary RLS. Iron supplementation could be useful in patients with uremia, iron deficiency, and for RLS during pregnancy. Dopamine agonists have been used as the first-line treatment for primary RLS. On the other hand, augmentation is a known adverse effect associated with the long-term use of dopamine agonists. Therefore, recent treatment guidelines recommend the administration of anticonvulsants, such as pregabalin and gabapentin, to treat RLS. Iron, opioids, or benzodiazepines may be useful in patients refractory to anticonvulsants or dopamine agonists. RLS is a chronic condition. Therefore, it is essential to establish a long-term treatment plan, considering both the efficacy and adverse effects of therapeutic agents used in patients.

Síndrome de inmovilidad en adultos mayores del Policlínico Bernardo Posse del municipio San Miguel del Padrón / Immobilization syndrome in elderly people in "Bernardo Posse" Policlinic in San Miguel del Padron

RESUMEN Fundamento: Dentro de los grandes síndromes geriátricos, la inmovilidad es una de las más graves consecuencias de las enfermedades que puede sufrir el anciano. Objetivo: Caracterizar el comportamiento del síndrome de inmovilidad en los adultos mayores del Grupo Básico de Trabajo n.o 1 del policlínico Bernardo Posse de San Miguel del Padrón. Metodología: Se realizó un estudio descriptivo, retrospectivo, en 145 pacientes con síndrome de inmovilidad, de una población de 160 ancianos desde enero de 2015 a diciembre del 2017. Se determinó el tipo de inmovilidad, y las causas principales, así como las complicaciones. Resultados: El síndrome predominó en pacientes femeninos en edades altas de la vida. El tipo de inmovilidad más frecuente fue la larvada y las causas más frecuentes fueron las enfermedades osteomioarticulares, las infecciones, el cáncer y el síndrome del cuidador. Las complicaciones que predominaron fueron a nivel de los sistemas digestivo, respiratorio, cardiovascular y la piel. Conclusiones: El riesgo de presentar algún tipo de inmovilidad aumenta con la edad y el sexo femenino es más susceptible a este. La inmovilidad es una entidad sindromática que deteriora de manera significativa la calidad de vida de los adultos mayores ya que el anciano inmovilizado es un paciente de alto riesgo para la aparición de complicaciones.

ABSTRACT Background: Within the great geriatric syndromes, immobility is one of the most serious consequences of the diseases that the elderly can suffer. Objective: To characterize the behavior of the immobility syndrome in the elderly from the Basic Working Group No. 1 at Bernardo Posse polyclinic in San Miguel del Padrón. Methodology: A retrospective descriptive study was carried out in 145 patients with immobility syndrome, from a population of 160 elderly people, from January 2015 to December 2017. The type of immobility was determined, as well as the main causes, as well as complications. Results: The syndrome predominated in female patients at high ages of life. The most frequent type of immobility was larvae and the most frequent causes were osteomyoarticular diseases, infections, and cancer also the caregiver syndrome. The predominated complications were at the level of the digestive, respiratory, cardiovascular and skin systems. Conclusions: The risk of presenting some type of immobility increases with age, and the female sex is more susceptible to it. Immobility is a syndromic disease that significantly deteriorates the quality of life of elderly, since the immobilized elderly person is a high-risk patient for complications.

Luxación de la articulación temporomandibular: apropósito de un caso y su diagnóstico diferencial / Luxation of the temporomandibular joint: about a case report and its differential diagnosis

Resumen La luxación temporomandibular es infrecuente, pero genera gran repercusión en el esqueleto facial. En ocasiones el cuadro clínico inicial es inespecífico y puede confundirse con otras patologías si no se tiene un adecuado conocimiento del tema, o se realiza una anamnesis incorrecta. Este artículo presenta el caso de una paciente que consultó al servicio de urgencias por disartria y desviación de la comisura labial hacia la izquierda, asociado a dolor severo y parestesia en hemicara derecha. No obstante, al ingreso la paciente refirió síntomas ambiguos, que para el médico evaluador sugirieron una causa neurológica. Durante la observación se solicitó valoración por servicio de cirugía plástica, se logró orientación de la anamnesis y examen físico, obteniendo una impresión diagnóstica de luxación de articulación temporomandibular derecha, confirmada por imagenología, y por ende un tratamiento oportuno con reducción e inmovilización en el servicio de urgencias. MÉD.UIS.2019;32(3):49-54

Abstract The temporomandibular joint dislocation is uncommon, but it causes a great repercussion on the facial skeleton. Occasionally, the initial symptoms can be unspecific and confuse with other pathologies if there are not an adequate knowledge of the topic and the anamnesis is incorrect. This article presents a clinical case of a patient with dysarthria and left deviation of the labial commissure, associated with severe pain and paresthesia in the right side of the face. Nevertheless, the patient initially referred ambiguous symptoms, suggesting a neurological cause. During observation in the emergency room, plastic surgery service valorated the patient, with subsequent orientation of the anamnesis and physical examination, achieving a satisfactory management of the acute dislocation. MÉD.UIS.2019;32(3):49-54

An efficient method of Yarrowia lipolytica immobilization using oil- and emulsion-modified bacterial cellulose carriers

Background: Yarrowia lipolytica is a nonconventional, dimorphic yeast with multiple biotechnological applications. Considering the size of Y. lipolytica cells and a plethora of its morphological forms (spherical cells or hyphae and pseudohyphae), it is highly difficult to select a suitable carrier for this useful microorganism. Bacterial cellulose (BC) is currently considered one of the most promising immobilization carriers. In the current study, the usefulness of oil- and emulsion-modified BCs as a carrier for Y. lipolytica immobilization was investigated. Static and agitated cultures were conducted in media supplemented with oil or emulsion to improve carrier porosity. Results: It was found that the application of oil- and emulsion-modified BCs correlated with significantly higher efficiency of Y. lipolytica immobilization and hence higher yield than the yield achieved with an unmodified carrier. Increased efficiency of immobilization correlated with BC porosity-related parameters, which, in turn, depended on the size of oil droplets introduced into the culture medium. Moreover, changes in porosity-related parameters caused by the addition of oil or emulsion to the medium were observed when the cultures were conducted only under static conditions and not under agitated conditions. Conclusion: The application of oil- and emulsion-modified BCs as carriers significantly increased the efficiency of Y. lipolytica immobilization as compared to unmodified BC. The addition of oil or emulsion to the culture medium can be a simple but effective method to modify the porosity of BC-based carriers.

Antagonistic activity of Microbial Association of Kefir Grains and the areas of its usage

One of the newest areas of using the potential of a microbial association of kefir grains is obtaining a biodegradable film. The research was aimed at creating a packaging material with new properties of suppressing the development of concomitant microflora in dried berries and fruits.

Glutamine Supplementation Ameliorates Chronic Stress-induced Reductions in Glutamate and Glutamine Transporters in the Mouse Prefrontal Cortex

Chronic immobilization stress (CIS) induces low levels of glutamate (Glu) and glutamine (Gln) and hypoactive glutamatergic signaling in the mouse prefrontal cortex (PFC), which is closely related to the Glu-Gln cycle. A Gln-supplemented diet ameliorates CIS-induced deleterious changes. Here, we investigated the effects of CIS and Gln supplementation on Glu-Gln cycle-related proteins to characterize the underlying mechanisms. Using the CIS-induced depression mouse model, we examined the expression of 11 proteins involved in the Glu-Gln cycle in the PFC. CIS decreased levels of glutamate transporter 1 (GLT1) and sodium-coupled neutral amino acid transporter (SNAT) 1, SANT2, SNAT3, and SNAT5. Gln supplementation did not affect the non-stressed group but significantly increased GLT1 and SNATs of the stressed group. By immunohistochemical analysis, we confirmed that SNAT1 and SNAT2 were decreased in neurons and GLT1, SNAT3, and SNAT5 were decreased in astrocytes in the medial PFC of the stressed group, but Gln-supplemented diet ameliorated these decrements. Collectively, these results suggest that CIS may cause depressive-like behaviors by decreasing Glu and Gln transportation in the PFC and that a Gln-supplemented diet could prevent the deleterious effects of CIS.

Peripheral Neuropathies in Patients with Rhabdomyolysis: Clinical Characteristics and Electrodiagnostic Findings in the Acute/Subacute Stage

BACKGROUND: Rhabdomyolysis is a syndrome caused by injury to skeletal muscle and characterized by myalgia and swelling of the affected muscles. Peripheral nerve injury rarely occurs in patients with rhabdomyolysis. METHODS: We reviewed the medical records of 8 consecutive patients with peripheral neuropathies associated with rhabdomyolysis. We assessed the clinical characteristics and electrodiagnostic findings of eight patients. RESULTS: In seven patients, rhabdomyolysis occurred after prolonged immobilization. In one patient, blunt trauma was a cause of rhabdomyolysis. All patients presented with weakness and paresthesia in lower extremities and electrodiagnostic tests showed peripheral nerve injury suggesting sciatic neuropathy or lumbosacral plexopathy. Although rhabdomyolysis itself recovered completely in all patients, neurologic deficits from neuropathy recovered partially and slowly. CONCLUSIONS: Sciatic nerve or lumbosacral plexus was injured in all eight patients. Among the various causes of rhabdomyolysis, prolonged immobilization is associated with development of peripheral neuropathy.

Frameless Fractionated Gamma Knife Radiosurgery with ICON™ for Large Metastatic Brain Tumors

BACKGROUND: Recently, a new generation of gamma knife radiosurgery (GKRS) equipped with a frameless immobilization system has encouraged the use of fractionated GKRS as an increasingly favorable treatment option. We investigated the preliminary outcome of efficacy and toxicity associated with frameless fractionated gamma knife radiosurgery (FF GKRS) for the treatment of large metastatic brain tumors. METHODS: Fifteen patients with 17 lesions were treated using FF GKRS and included in this study, because of the large tumor size of more than 10 cm3. FF GKRS was performed based on a thermoplastic mask system for 3 to 5 consecutive days. RESULTS: The mean duration of clinical follow-up was 12 months (range, 4–24), and the local control rate was 100%. Tumor volume decreased in 13 lesions (76.5%), and remained stable in 4 lesions (23.5%). One patient was classified as new lesion development because of the occurrence of leptomeningeal seeding regardless of the tumor volume change. Compared with the initial volume at the time of FF GKRS, tumor volume change at the last follow-up was 62.32% ± 29.80%. Cumulative survival rate at 12 months was 93.3% ± 6.4%. One patient died during the follow-up period because of the progression of the primary disease. No patient showed radiation necrosis on the follow-up images. CONCLUSION: Daily FF GKRS by gamma knife ICON™ revealed satisfactory tumor control rate and low morbidity, despite the short follow-up period. Further prospective studies and a longer follow-up of a large cohort of patients diagnosed with brain metastases are required to elucidate the effect of FF GKRS in brain metastases.

Early Rehabilitation after Total Mastectomy and Immediate Reconstruction with Tissue Expander Insertion in Breast Cancer Patients: A Retrospective Case-control Study / 한국유방암학회지

PURPOSE: To prevent surgical site complications, many plastic surgeons use the so-called “conventional protocol,” which immobilizes the shoulder and upper arm for 1 month after reconstruction. In an effort to improve the shoulder mobility of patients who received immediate breast reconstruction with tissue expander insertion (TEI), we introduced an early rehabilitation protocol with a short-term immobilization period of 2 weeks. This study aims to compare this early rehabilitation exercise program with the conventional protocol and to determine factors affecting shoulder mobility and quality of life of patients after immediate breast reconstruction. METHODS: A total of 115 patients with breast cancer who underwent reconstructive surgery were retrospectively reviewed. For patients who underwent reconstruction before January 2017, the conventional protocol was followed with immobilization of their shoulder for over 4 weeks. Patients who underwent reconstruction after January 2017 were educated to undergo a self-exercise program after a short-term immobilization period of 2 weeks. We compared shoulder mobility, pain, quality of life, and complications at postoperative 1 and 2 months between the groups. RESULTS: Patients who received early rehabilitation showed greater shoulder flexion and abduction range at postoperative 1 month than those who received the conventional protocol. This increased shoulder abduction range continued until postoperative 2 months. There were no significant surgical site problems in both groups during the 2 months of follow-up. CONCLUSION: To enhance the recovery of shoulder mobility, early rehabilitation with a shorter immobilization period should be recommended to patients with breast cancer undergoing reconstruction surgery with TEI. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03541161

Use of the cross-leg distally based sural artery flap for the reconstruction of complex lower extremity defects

Cross-leg flaps are a useful reconstructive option for complex lower limb defects when free flaps cannot be performed owing to vessel damage. We describe the use of the extended distally based sural artery flap in a cross-leg fashion for lower extremity coverage in three patients. To maximise the viability of these extended flaps, a delay was performed by raising them in a bipedicled fashion before gradual division of the tip over 5 to 7 days for cross-leg transfer. Rigid coupling of the lower limbs with external fixators was critical in preventing flap avulsion and to promote neovascular takeover. The pedicle was gradually divided over the ensuing 7 to 14 days before full flap inset and removal of the external fixators. In all three patients, the flaps survived with no complications and successful coverage of the critical defect was achieved. One patient developed a grade 2 pressure injury on his heel that resolved with conservative dressings. The donor sites and external fixator pin wounds healed well, with no functional morbidity. The cross-leg extended distally based sural artery flap is a reliable reconstructive option in challenging scenarios. Adequate flap delay, manoeuvres to reduce congestion, and postoperative rigid immobilization are key to a successful outcome.