Prevalencia de enfermedad osteomioarticular lumbosacras y miembros inferiores en auxiliares de enfermería / Prevalence of lumbosacral and lower limb osteomyoarticular pathologies in nursing assistants / Prevalência de doença osteomioarticular lombossacral e de membros inferiores em auxiliares de enfermagem

RESUMEN Introducción: Los trabajadores de la salud se enfrentan permanentemente a labores complejas que afectan la región lumbar y miembros inferiores. Objetivo: Identificar la prevalencia de enfermedad osteomioarticular lumbosacras y miembros inferiores en auxiliares de enfermería Método: Se realizó un estudio epidemiológico, descriptivo y transversal en una muestra de 46 auxiliares del Distrito 18D04 de salud de Tungurahua, Ecuador. El instrumento aplicado fue un cuestionario para indagar variables sociodemográficas, antigüedad en el sector, horarios, tipos y tiempo de exposición a las labores habituales. Se utilizó la prueba estadística Chi-cuadrado, la paramétrica de correlación de Pearson y la prueba t de Student. Resultados: El 85 % de los estudiados presentó enfermedades lumbosacras y miembros inferiores durante el tiempo de trabajo, se apreció que el 39 % ha tenido una baja temporal al trabajo entre 1-3 días. Se identificó que la carga de peso es realizada por un 37 % y caminatas prolongadas en un 33 %. El 67 % tenía entre 11 y 40 años de trabajo y el resto menos de 10 años en el sector. El 54 % padeció enfermedades pertenecientes a miembros inferiores y un 46 % a lumbosacras. Conclusiones: El padecimiento de enfermedad osteomioarticular lumbosacras y miembros inferiores está relacionado con la edad y con padecerlas en los últimos doce meses, estas han provocado ausentismo laboral. No se comprobó una relación estadísticamente significativa con el padecimiento de enfermedad osteomioarticular con la antigüedad en el sector, las jornadas de trabajo y las actividades que más desarrollan.

ABSTRACT Introduction: Health care workers are constantly confronted with complex tasks that affect the lumbar region and lower limbs. Objective: To identify the prevalence of lumbosacral and lower limb osteomyoarticular pathologies in nursing assistants. Method: An epidemiological, descriptive and cross-sectional study was carried out in the 18D04 health district of Tungurahua, Ecuador. A total of 46 nursing assistants were selected in this study. We aimed a questionnaire to assess the sociodemographic variables, seniority in the health sector, time schedules, modes and time of exposure to the usual work. Chi-square test, Pearson's parametric correlation test, and the Student's t-test were used. Results: Most nursing assistants, the 85%, were diagnosed with lumbosacral and lower limb pathologies, and 39% took a temporary absence from work between 1-3 days. It was found that 37 % performed the heavy load work and 33% performed prolonged walks. The 67% had between 11 and 40 years of work and the rest had less than 10 years in the health sector. Fifty-four percent suffered from lower limb pathologies and 46% from lumbosacral pathologies. Conclusions: Lumbosacral and lower limb osteomyoarticular pathology is related to age, and their suffering in the last 12 months has led to a level of absenteeism in the workplace. There was no an important relationship, statistically, between osteomyoarticular pathology and seniority in the sector, working hours and the activities most frequently performed.

RESUMO Introdução: Os trabalhadores da saúde enfrentam constantemente tarefas complexas que afetam a região lombar e membros inferiores. Objetivo: Identificar a prevalência de doenças osteomioarticulares lombossacrais e de membros inferiores em auxiliares de enfermagem. Método: Estudo epidemiológico, descritivo e transversal em uma amostra de 46 auxiliares do Distrito Sanitário 18D04 de Tungurahua, Equador. O instrumento aplicado foi um questionário para investigar variáveis sociodemográficas, antiguidade no setor, horário, tipos e tempo de exposição a tarefas normais. Foram utilizados o teste estatístico Qui-quadrado, correlação paramétrica de Pearson e teste t de Student. Resultados: 85% dos estudados apresentaram doenças lombossacrais e de membros inferiores durante o tempo de trabalho, observou-se que 39% tiveram afastamento temporário do trabalho entre 1-3 dias. Identificou-se que a descarga de peso é realizada por 37% e as caminhadas prolongadas por 33%. 67% tinham entre 11 e 40 anos de trabalho e o restante menos de 10 anos no setor. 54% sofreram doenças pertencentes aos membros inferiores e 46% lombossacral. Conclusões: O sofrimento da doença osteomioarticular lombossacral e de membros inferiores está relacionado à idade e com o sofrimento nos últimos doze meses, estes têm causado absenteísmo ao trabalho. Não foi verificada relação estatisticamente significativa entre o sofrimento de doença osteomioarticular e o tempo de permanência no setor, a jornada de trabalho e as atividades que mais desenvolvem.

Evaluation of Cases of Abdominal Wall Endometriosis at Universidade Estadual de Campinas in a period of 10 Years / Avaliação dos casos de endometriose de parede abdominal na Universidade Estadual de Campinas em um período de 10 anos

Abstract Purpose To determine the clinical and epidemiological characteristics of abdominal wall endometriosis (AWE), as well as the rate and recurrence factors for the disease. Methods A retrospective study of 52 women with AWE was performed at Universidade Estadual de Campinas from 2004 to 2014. Of the 231 surgeries performed for the diagnosis of endometriosis, 52 women were found to have abdominal wall endometriosis (AWE). The frequencies, means and standard deviations of the clinical characteristics of these women were calculated, as well as the recurrence rate of AWE. To determine the risk factors for disease recurrence, Fisher's exact test was used. Results The mean age of the patients was 30.71 ± 5.91 years. The main clinical manifestations were pain (98%) and sensation of a mass (36.5%).We observed that 94% of these women had undergone at least 1 cesarean section, and 73% had used medication for the postoperative control of endometriosis. The lesion was most commonly located in the cesarean section scar (65%). The recurrence rate of the disease was of 26.9%. All 14 women who had relapsed had surgical margins compromised in the previous surgery. There was no correlation between recurrent AWE and a previous cesarean section (p = 0.18), previous laparotomy (p = 0.11), previous laparoscopy (p = 0.12) and postoperative hormone therapy (p = 0.51). Conclusion Women with previous cesarean sections with local pain or lumps should be investigated for AWE. The recurrence of AWE is high, especially when the first surgery is not appropriate and leaves compromised surgical margins.

Resumo Objetivos Determinar as características clínicas e epidemiológicas da endometriose de parede, bem como sua taxa de recorrência e os fatores que levam a ela. Métodos Estudo retrospectivo, em que se avaliaram 52 mulheres com endometriose de parede na Universidade Estadual de Campinas no período de 2004 a 2014. Entre as 231 cirurgias para diagnosticar endometriose, foram encontradas 52 mulheres que apresentavam endometriose de parede. Foram calculadas as frequências, a média e o desvio padrão das características clínicas destas mulheres, bem como a taxa de recorrência da endometriose de parede. Para determinar os fatores de risco de recorrência, foi utilizado o teste exato de Fisher. Resultados A idade média das mulheres foi de 30.71 ± 5,91 anos. As principais manifestações clínicas foram dor (98%) e sensação do nódulo (36,5%). Foi observado que 94% dessas mulheres tinham pelo menos uma cesárea, e 73% destas fizeram uso de medicação para controle da endometriose no pós-operatório. A localizaçãomais frequente da lesão foi na cicatriz da cesárea (65%). A taxa de recorrência da doença foi de 26,9%. Todas as 14mulheres que tiveramrecidiva tinhammargens cirúrgicas comprometidas na cirurgia prévia. Não houve correlação entre a endometriose de parede recorrente e a cesariana prévia (p = 0,18), a laparotomia prévia (p = 0,11), a laparoscopia prévia (p = 0,12) e receber terapia hormonal no pós-operatório (p = 0,51). Conclusão Mulheres com antecedente de cesárea anterior com dor local ou nódulo devem ser investigadas com relação à endometriose de parede. A recorrência do endometrioma de parede é alta, principalmente quando a primeira cirurgia não é adequada, e deixa margens cirúrgicas comprometidas.

Factores de riesgo biomecánicos y psicosociales presentes en la industria venezolana de la carne / Biomechanical and psychosocial risk factors in the Venezuelan meat processing industry

INTRODUCCIÓN: la identificación y evaluación de factores de riesgo relacionados a trastornos musculoesqueléticos (TME) representa la base para una efectiva adaptación de las condiciones de trabajo. OBJETIVO: evaluar los principales factores de riesgo biomecánico y psicosocial a los que se exponen trabajadores de la industria cárnica. Método: el estudio es descriptivo, transversal, basado en observación directa, encuestas y análisis de videos, para la aplicación de las metodologías RULA, OCRA, ecuación de NIOSH, ERGO y CoPsoQ-ISTAS21, sobre 71 tareas. RESULTADOS: el mayor riesgo postural recae en tareas de embutido y empaque, alcanzándose puntajes RULA de 7. En cuanto a repetitividad destaca el empaque de productos cocidos con 60% de sus tareas en nivel medio. Los mayores riesgos por levantamiento de cargas se ubicaron en las áreas de embutido, con índices inaceptables entre 25% y 50% de sus tareas. En empujes y arrastres de cargas, cinco de las seis áreas presentaron niveles inaceptables de riesgo. Los factores psicosociales de inseguridad, doble presencia, estima y exigencias psicológicas fueron percibidos negativamente por más del 50% de los trabajadores. DISCUSIÓN: entre las principales causantes de los altos niveles de riesgo destacan: levantamiento de productos por encima de hombros, realización de actividades manuales de pre-empaque y el empuje manual de contenedores pesados. CONCLUSIONES: el sector analizado reúne niveles de riesgo biomecánico y psicosocial que lo hace vulnerable a la aparición de TME.

INTRODUCTION: the identification and assessment of risk factors related to Musculoskeletal Disorders (MSD) is the basis for an effective adaptation of working conditions. OBJECTIVE: the aim is to evaluate the main biomechanical and psychosocial risk factors in workers of a meat processing industry. METHOD: the study is descriptive, transversal, based on direct observation, surveys and analysis of videos, for the application of the methodologies RULA, OCRA, NIOSH's equation, ERGO and CoPsoQ-ISTAS21, about 71 tasks. RESULTS: the greater postural risk is in task of inlay and packaging, which reach RULA's scores of 7. In terms of repeatability, the packaging of products cooked stand out with 60% of its tasks at moderate level. The greatest risks by lifting were located in the inlay areas, with unacceptable rates between 25% and 50% of its tasks. Five of the six areas showed unacceptable levels of risk in push and drag. The psychosocial factors: insecurity, double presence, esteem and psychological demands were perceived negatively by more than 50% of the workers. DISCUSSION: the main causes of the high levels of risk include: lifting of products above shoulders, manual activities of pre-packaging and the manual pushing of heavy containers. CONCLUSIONS: the meat industry has biomechanical and psychosocial risk levels that make it vulnerable to MSD.

Statin-Induced myopathy: a clinical perspective

Statins are at the forefront of treatments for hyperlipidemia, coronary artery disease and stroke. Patients may not adhere to Statins therapy due to hepatic or neuromuscular side effects that include neuropathy and myopathy. The latter include myalgia, lassitude, fatigue, proximal muscle weakness with or without elevated creatine kinase [CK] or myoglobinuria. Studies suggest that these symptoms are under reported and may occur in as much as 5% or more. This article reviews the definition, incidence, possible mechanisms, risk factors, clinical presentation and suggested management of Statin-induced myopathy

Síndrome hipotónico del recién nacido / Hypotonic syndrome in the newborn

Background: The Newborn Hypotonic Syndrome (NHS) is a clinical entity that presents up to 28 days after birth. The main symptom is a significant decrease in muscular tone, but its severity is determined by the lack of muscular strength. NHS is a relatively frequent entity, so it becomes an important diagnosis problem. There is few information in literature regarding its incidence. Method: Retrospective study performed between May 2000 - April 2006, including patients with diagnosis of NHS in a Neonatal Intesive Care Unit. Results: 2 158 newborns, of which 113 (5.2 percent) had NHS. 83 percent of cases were attributed to central causes, such as hipoxic-isquemic encephalopathy (49 percent) and genetic disorders (15 percent). 17 percent of cases corresponded to peripheral causes, including hypermagnesemia (68 percent) and myopathic diseases (21 percent). Conclusions: 1) NHS is a relatively frequent clinical entity; 2) Central causes are the most prevalent; 3) It is possible to study the etiology of NHS with a systematic approach.

Introducción: El síndrome hipotónico del recién nacido (SHRN) es un cuadro clínico que se presenta hasta los 28 días de vida extrauterina. Su síntoma definitorio es la disminución significativa en tono muscular, pero su gravedad se relaciona a asociación a falta de fuerzas. Es un cuadro aparentemente poco frecuente en este grupo etáreo, pero que plantea un problema diagnóstico importante. Existe escasa información en la literatura respecto a su frecuencia real. Objetivo: Evaluar la incidencia de SHRN, su etiología y aprobación diagnóstica. Método: Estudio retrospectivo con revisión de fichas clínicas, desde mayo 2000 a abril 2006, incluyendo pacientes ingresados con diagnóstico de SHRN a unidad de intermedio-intensivo de servicio de recién-nacidos de un hospital universitario (SRNU). Resultados: El número total de RN ingresados a SRNU fue 2158, en 5,2 por ciento (113) el motivo de ingreso, principal o secundario, correspondió a SHRN. Del total de SHRN, 83 por ciento correspondió a causas centrales, destacando encefalopatía hipóxico-isquemica (ehi) (49 por ciento) y genetopatía (15 por ciento). Las causas periféricas correspondieron a 17 por ciento, destacando hipermagnesemia (68 por ciento) y miopatías (21 por ciento). Conclusiones: Con los datos obtenidos, es posible concluir para este estudio: 1) El SHRN es una entidad clínica relativamente frecuente; 2) Las causas centrales son las más frecuentes; 3) Es posible estudio escalonado orientado a encontrar etiología específica del SHRN.

Recurrent annual outbreaks of a hepato-myo-encephalopathy syndrome in children in western Uttar Pradesh, India.

BACKGROUND & OBJECTIVE: Outbreaks of an acute encephalopathy syndrome affecting children, with high case-fatality, have been reported in western Uttar Pradesh, India for the last many years.We investigated these cases in Bijnor district and present our findings. METHODS: Fifty five children aged 2-10 yr hospitalized from 2003 to 2005 in Bijnor, Uttar Pradesh, with features of acute encephalopathy were selected by defined clinical criteria. Various laboratory investigations were performed. RESULTS: The disease had peak incidence in early winter months. Previously healthy, 2-4 yr old rural children (mean age-3.78 yr) of very low socio-economic background were most vulnerable. Almost all had vomiting preceding unconsciousness and a majority had mild fever and abnormal behaviour/agitation. Abnormal posture of trunk and limbs were distinctive features. Fluctuation of blood pressure was seen in three-quarter cases. Serum aminotransferases, creatine phosphokinase and lactic dehydrogenase levels were found markedly raised virtually in all cases in whom the tests were performed. Serum glucose was found low (<50 mg/dl) in 47.3 per cent cases at presentation. Cerebrospinal fluid (CSF) was under normal or low pressure and without pleocytosis in all cases. No microorganism could be isolated from serum, CSF, urine and visceral specimens. Neuroimaging performed in two cases was also normal. Liver biopsy performed in 21 cases showed acute hepatotoxic injury in all with marked hydropic change and perivenular necrosis. Tibial muscle biopsy done in 8 cases showed focal necrosis while brain biopsy taken in 2 cases had mild spongiosis with focal gliosis. Forty two children succumbed to their illness (case fatality 76.4%), most within 72 h of presentation. Survivors did not show any neurological deficit. INTERPRETATION & CONCLUSION: Our findings showed that the outbreaks were due to a multi-system disease with toxic injury to liver, muscles and brain (hepato-myo-encephalopathy) and not due to viral encephalitis as believed so far. The cause remains unknown but several features suggest the possibility of phytotoxin-induced pathology.

Epidemiologia e saúde: prevalência das lesões musculares esqueléticas (LME) esportivas em instituições cíveis e militares (Exército Brasileiro) da cidade de João Pessoa / Epidemiology and health: prevalence of the sporting skeletal muscular lesions (SML) in civil and military institutions (Brazilian Army) of João Pessoa City

O objetivo deste estudo é analisar a prevalência de lesões musculares esqueléticas (LME) a partir do relato médico. Realizou-se um estudo descritivo, não-probabilístico, amostra de 10 médicos cíveis e militares que atendem em média 03 clínicas. A coleta de dados iniciou-se pela visita às clínicas e aplicação do instrumento que foi um questionário. A análise estatística utilizou pacote SPSS, para média, desvio padrão, percentual relativo e acumulativo. Os resultados encontraram: 40,0% ortopedistas traumatologistas; 40,0% dos atendidos entre 19 a 24 e 40,0%, 25 a 30 anos; desporto de maior nº de atendimentos: 100% futebol, 70,0% voleibol; tipo de LME: 30,0% entorses do tornozelo e 30,0% fratura; segmento mais acometido: tornozelo 60,0% e joelho 40,0%; afastamento para o tratamento: 50,0% 3 semanas; afastamento definitivo da prática: 90,0% se afasta 10%; 30,0% das LME são provocadas por falta de estrutura física para o tipo de esforço; 50,0% das LME acontecem na quadra descoberta. O coeficiente médio da prevalência encontrou 185,88 casos para LME esportivas de acordo com um mês de investigação. O futebol é o desporto que mais destina praticantes às clínicas e o tornozelo é o segmento mais afetado, sendo a entorse uma das LME mais freqüentes, ocorrendo nas quadras externas.

The objective of this study is to analyze the prevalence of skeletal muscular lesions (SML) starting from the medical report. It has been carried out a descriptive, nonprobabilistic, sample of 10 civil and military doctors that assist 03 clinics on the average. The collection of data began by visiting the clinics the application of the instrument, a questionnaire. The statistical analysis used SPSS package, for average, standard deviation, relative and accumulative percentile. The results found 40.0% of traumathologist orthopeadist; 40.0% of those assisted are between 19 to 24 and 40.0% 25 to 30 years-old; sports of larger no. of attendances: 100.0% soccer; 70.0% volleyball; type of SML: 30.0% ankle sprains, 30.0% fracture; I segment attacked: ankle 60,0% and knee 40,0%; average of removal for treatment: 50.0% 3 weeks; 90.0% stand back 10%; 30,0% of SML are provoked by lack of physical structure for the type of effort; 50.0% mention that SML happens on uncovered court. The medium coefficient of the prevalence found a of 185.88 cases for sporting SML in agreement with a month of investigation. Soccer is the sport that more it destines apprentices to the clinics and the ankle is the most affected segment, being the strain one of most frequent SML, happening in the external blocks.

Review of sarcocystosis in Malaysia.

Sarcocystis is a tissue coccidian with an obligatory two-host life cycle. The sexual generations of gametogony and sporogony occur in the lamina propria of the small intestine of definitive hosts which shed infective sporocysts in their stools and present with intestinal sarcocystosis. Asexual multiplication occurs in the skeletal and cardiac muscles of intermediate hosts which harbor Sarcocystis cysts in their muscles and present with muscular sarcocystosis. In Malaysia, Sarcocystis cysts have been reported from many domestic and wild animals, including domestic and field rats, moonrats, bandicoots, slow loris, buffalo, and monkey, and man. The known definitive hosts for some species of Sarcocystis are the domestic cat, dog and the reticulated python. Human muscular sarcocystosis in Malaysia is a zoonotic infection acquired by contamination of food or drink with sporocysts shed by definitive hosts. The cysts reported in human muscle resembled those seen in the moonrat, Echinosorex gymnurus, and the long-tailed monkey, Macaca fascicularis. While human intestinal sarcocystosis has not been reported in Malaysia so far, it can be assumed that such cases may not be infrequent in view of the occurrence of Sarcocystis cysts in meat animals, such as buffalo. The overall seroprevalence of 19.8% reported among the main racial groups in Malaysia indicates that sarcocystosis (both the intestinal and muscular forms) may be emerging as a significant food-borne zoonotic infection in the country.

Cisticercose musculo-cutanea e visceral: doenca rara? / Musculocutaneous and visceral cysticercosis: a rare disease?

O presente trabalho teve como objetivos estimar a frequencia das formas musculo-cutanea e visceral da cisticercose em exames anatomo-patologicos e necropsias realizados em Brasilia, Distrito Federal (estudo retrospectivo) e diagnosticar a cisticercose musculo-cutanea em pacientes residentes na mesma regiao geografica (estudo prospectivo). Em 64.911 protocolos de exames anatomo-patologicos, o diagnostico de cisticercose foi observado em 30 (0,05 por cento), sendo que em 27 (90,0 por cento) os cistos estavam nos tecidos musculo-cutaneo-mucoso, em 1 (3,3 por cento) em ganglio e em 2 (6,7 por cento) no sistema nervoso central. Entre aqueles com cistos nos tecidos musculo-cutaneo-mucoso 2 (7,4 por cento) tinham cisticercos em lingua. Em 1520 protocolos de necropsia, encontraram-se 25 (1,6 por cento) com diagnostico de cisticercose, sendo: 24 (96,0 por cento) com neurocisticercose, seja isolada ou associada a outras formas da doenca; e 2 (8,0 por cento) com cisticercos em coracao, 2 (8,0 por cento) em musculo esqueletico e 1 (4,0 por cento) em figado, seja isolados ou associados a outras localizacoes do parasito. Foram tambem examinados 1122 individuos, realizando-se em todos eles as reacoes sorologicas de imunofluorescencia indireta e ELISA para cisticercose e a investigacao radiologica de partes mole do cranio...

Triquinosis esporádica / Sporadic trichnosis

En el presente trabajo se analizan retrospectivamente las características clínicas y de laboratorio detectadas en 13 casos de triquinosis aguda esporádica, estudiados en el Instituto Nacional de Nutrición "Salvador Zubirán" (INNSZ) de 1977 a 1986. El número de casos por año fue de uno a dos con aumento a cinco en 1986; ningún paciente mostró correlación entre el tipo de dieta o sitio específico en la ciudad. La sintomatología fue similar a la descrita para la forma epidémica; en 69.1 por ciento de los casos se sospechó el diagnóstico en base clínicas y el 84.6 por ciento mostró eosinofilia. El motivo de la biópsia muscular fueron los síntomas musculares (92.3%) y corroboró la parasitosis en el 100 por ciento de los pacientes. El tratamiento fue tiabendazol y/o prednisona con mejoría en la mayoría de los pacientes durante su seguimiento (x: 7 meses). Se discute la utilidad de la biopsia muscular, las posibilidades de tratamiento y se enfatiza en los síntomas, signos y hallazgos de laboratorio de la triquinosis esporádica para sospechar dicha zoonosis ante un cuadro clínico de enfermedad inflamatoria multisistémica con síntomas musculares predominantes