Scapholunate and lunotriquetral joint dynamic stabilizers and their role in wrist neuromuscular control and proprioception.

BACKGROUND: Recent research interest has grown in exploring the role of muscles, isometric contraction, proprioception, and neuromuscular control in addressing dynamic scapholunate and lunotriquetral joint instability, marking a shift in the understanding of wrist stability. PURPOSE: To present a comprehensive review of the carpal ligaments anatomy and wrist biomechanics, with a particular focus on the role of proprioception in dynamic carpal stability and their role in managing scapholunate (SL) and lunotriquetral (LTq) dynamic instabilities. STUDY DESIGN: We conducted a systematic search of the literature and review of the most relevant papers published and indexed in pubmed, related to wrist biomechanics, proprioception and its contribution to carpal dynamic stability. METHODS: The study involved a comprehensive review of neuromuscular mechanisms in dynamic stabilization of the carpus, based on cadaver studies. The 3D position of the scaphoid, triquetrum, and capitate was monitored before and after tendon loading. RESULTS: The extensor carpi ulnaris (ECU) and the flexor carpi radialis (FCR) are identified as the primary pronators of the midcarpal joint. The ECU's pronation effect can potentially strain the scapholunate ligament, while the supinator muscles, the abductor pollicis longus (APL), the extensor carpi radialis longus (ECRL), and the flexor carpi ulnaris (FCU), have a protective role, particularly in cases of scapholunate ligament dysfunctions. The FCR, despite being a pronator of the distal row, has a beneficial effect as it provokes supination of the scaphoid. CONCLUSIONS: Comprehending carpal dysfunctions and instabilities hinges on understanding carpal anatomy and normal biomechanics. Proprioception, encompassing joint position sensation and neuromuscular control, is pivotal for stability. Biomechanical research informs tailored muscle strengthening for specific carpal issues. Supinator muscles should be strengthened for SL injuries, and ECU-focused strengthening and proprioceptive training are key for dynamic LTq instabilities. Ongoing research should delve into the intricate relationship between carpal ligaments, muscles, and proprioception to enhance wrist stability.

Modelo de gestión del cuidado de enfermería en servicios hospitalario / Nursing care management model in hospital services

RESUMEN Objetivo: Describir el modelo de gestión del cuidado de enfermería en servicios hospitalarios. Metodología: La metodología desarrollada en este estudio se basó en la perspectiva cuantitativa, utilizando tipologías documental-bibliográficas que ayudan a establecer el análisis del objeto de investigación. El material abordado se conformó por tesis de grado, investigaciones científicas, trabajos arbitrados y, con ello, descubrir características y relaciones entre los elementos. En conclusión: El rol de enfermería en el desarrollo de los modelos de gestión del cuidado en los servicios hospitalarios, es de gran importancia ya que establecen los mecanismos de comunicación para su implementación en conjunto con el resto del equipo de salud, que hace vida en los centros hospitalarios.

ABSTRACT Objective: To describe the nursing care management model in hospital services. Methodology: The methodology developed in this study is based on the quantitative perspective using documentary-bibliographic typologies that help to establish the analysis of the research object. The material approached consisted of degree theses, scientific research, refereed works and thus discovering characteristics and relationships between the elements. In conclusion: The role of nursing in the development of care management models in hospital services is of great importance since it is necessary to establish the communication mechanisms for its implementation together with the rest of the health team that works in the hospital centers.

Kienböck's disease: preventing disease progression in early-stage disease.

Currently Kienböck's disease remains an 'unsolved' problem in hand surgery. Different factors have been associated with the avascular necrosis of the lunate. Mechanical, vascular and biological factors, alone or in combination, may have an influence in the aetiopathogenesis and determine the progress of the disease and even the results of the treatment. This is especially relevant in the early stages, in which conservative or surgical treatment may modify the natural history of the disease, maintaining the lunate structure and thus preserving the joint surfaces. There are multiple surgical treatments for Kienböck's disease in the early stages, before lunate collapse; each one is based on one of the possible factors that can cause avascular necrosis of the lunate. The objective is not only to treat symptoms but to prevent progression. This article is a review of the most frequent treatments used in the early stages and a personal view of the authors.Level of evidence: V.

Seasonality Modulates the Cellular Antioxidant Activity and Antiproliferative Effect of Sonoran Desert Propolis.

The main chemical composition and pharmacological potential of propolis from arid and semi-arid regions of the Sonoran Desert have been previously reported. Caborca propolis (CP), from an arid zone of the Sonoran Desert, has shown a polyphenolic profile that suggests a mixed plant origin, presenting poplar-type markers, as well as a 6-methoxylated flavonoid, xanthomicrol, characteristic of Asteraceae plants. In addition, CP has shown significant antioxidant properties and antiproliferative activity on cancer cells. In this study, we analyzed the influence of collection time on the chemical constitution, antiproliferative activity and protective capacity of CP against reactive oxygen species (ROS), by using HPLC-UV-diode array detection (DAD) analysis, 3-(4,5-dimethylthiazol-2-yl)-2,5-Dimethyltetrazoliumbromide (MTT) and 2,2-diphenyl-1-picryl-hydrazyl (DPPH) assays, as well as cellular antioxidant activity (CAA) assay on murine B-cell lymphoma M12.C3.F6 cells. HPLC-UV-DAD analyses of seasonally collected CP (one-year period) revealed quantitative differences among the most abundant CP constituents: pinocembrin, galangin, chrysin and pinobanksin-3-O-acetate. Though all seasonal samples of CP induced an antiproliferative effect in M12.C3.F6 cells, CP from autumn showed the highest inhibitory activity (IC50: 5.9 ± 0.6 µg/mL). The DPPH assay pointed out that CP collected in autumn presented the highest antioxidant potential (IC50: 58.8 ± 6.7 µg/mL), followed by winter (65.7 ± 12.2 µg/mL) and spring (67.0 ± 7.5 µg/mL); meanwhile, the summer sample showed a lesser antioxidant capacity (IC50: 98.7 ± 2.5 µg/mL). The CAA assay demonstrated that CP induced a significant protective effect against ROS production elicited by H2O2 in M12.C3.F6 cells. Pretreatment of M12.C3.F6 cells with CP from spring and autumn (25 and 50 µg/mL for 1 h) showed the highest reduction in intracellular ROS induced by H2O2 (1 and 5 mM). These results indicate that the antiproliferative effect and cellular antioxidant activity of CP are modulated by quantitative fluctuations in its polyphenolic profile due to its collection time.

Management of metacarpal fractures.

The metacarpal fractures are common fractures which are treated by orthopaedic surgeons, plastic surgeons and hand surgeons equally. These are seen in young adults who have active life style. These have a major impact in life style of the patients if these are not treated adequately. The management of the fractures vary among surgeons to surgeons; two surgeons in the same centre can have a different treatment plan for a fracture. There are no standard guidelines for the treatment and it ranges from conservative management, Kirschner's wire (K-wires), plates and screws. This review article is about the management of metacarpal fractures where the commonly done procedures are reviewed.

Abundance and distribution of benthic foraminifera as indicators of the quality of the sedimentary environment in a subtropical lagoon, Gulf of California.

Abundance and spatial distribution of benthic foraminifera were used to evaluate the impacts of anthropogenic activities on sediment quality in a coastal lagoon in the Gulf of California. In 1985 and 2013, 27 samples of superficial sediments were collected. The foraminifera genera Ammonia, Cribroelphidium, Quinqueloculina and Peneroplis were dominant in both years. The abundance of Ammonia increased from 41% to 60%, while Peneroplis abundance decreased from a maximum of 50% in 1985 to 7% in 2013. The greater abundance of Ammonia and the greater spatial coverage of Ammonia and Cribroelphidium suggest a marked environmental deterioration in the quality of the sedimentary environment, which contrasts with studies of trace elements in the sediment of this lagoon. The Foram Stress Index indicates that sediment quality has deteriorated over time, likely due to the effects of anthropogenic activities around the lagoon.

Clinical translation of a mesenchymal stromal cell-based therapy developed in a large animal model and two case studies of the treatment of atrophic pseudoarthrosis.

Pseudoarthrosis is a relatively frequent complication of fractures, in which the lack of mechanical stability and biological stimuli results in the failure of bone union, most frequently in humerus and tibia. Treatment of recalcitrant pseudoarthrosis relies on the achievement of satisfactory mechanical stability combined with adequate local biology. Herein we present two cases of atrophic pseudoarthrosis that received a tissue-engineering product (TEP) composed of autologous bone marrow-derived mesenchymal stromal cells (BM-MSC) combined with deantigenized trabecular bone particles from a tissue bank. The feasibility of the treatment and osteogenic potential of the cell-based medicine was first demonstrated in an ovine model of critical size segmental tibial defect. Clinical-grade autologous BM-MSC were produced following a good manufacturing practice-compliant bioprocess. Results were successful in one case, with pseudoarthrosis resolution, and inconclusive in the other one. The first patient presented atrophic pseudoarthrosis of the humeral diaphysis and was treated with osteosynthesis and TEP resulting in satisfactory consolidation at month 6. The second case presented a recalcitrant pseudoarthrosis of the proximal tibia and the Masquelet technique was followed before filling the defect with the TEP. This patient presented a neuropathic pain syndrome unrelated to the treatment that forced the amputation of the extremity 3 months later. In this case, the histological analysis of the tissue formed at the defect site provided evidence of neovascularization but no overt bone remodelling activity. It is concluded that the use of expanded autologous BM-MSC to treat pseudoarthrosis was demonstrated to be feasible and safe, provided that no clinical complications were reported, and early signs of effectiveness were observed. Copyright © 2016 John Wiley & Sons, Ltd.

Modelos de calidad del software, un estado del arte

Existen diferentes modelos de calidad del software que permiten un proceso de mejora continua con su implementación. En el presente escrito se exponen características de los modelos investigados a través de una revisión de información, se realiza una clasificación de los mismos de acuerdo con el nivel de proceso o de producto; cada modelo cuenta con unas características y una estructura la cual se enuncia brevemente en el escrito. Las diferentes empresas, con el fin de verse inmersas en una mejora continua de sus procesos, han identificado la importancia de hacerse a la implementación de modelos que permitan certificar y garantizar la calidad de sus productos y procesos, se encontraron algunos casos de éxito de la implementación de los modelos estudiados, los cuales permitieron a las empresas posicionarse o destacarse por mejorar los procesos de su negocio.

There are many software quality models that allows a process of continuous improvement with its implementation. In this paper some characteristics of the investigated models are exposed, through an information revision, a classification of these models is performed according to the level of the process or product; each model count with some characteristics and a structure that is briefly stated in the written. The different enterprises in order to be immersed on a continuous improvement of their processes have identified the importance of getting the implementation of models that allows to certify an guarantee the quality of their processes and products, some success cases were found for the implementation of the studied models, which allowed the enterprises to position or stand by the improvement of their business process.

Existem diferentes modelos de qualidade de software que permitem processo de melhoria contínua com a sua implementação. Neste escrita características dos modelos investigados através de uma revisão das informações forem definidos, a mesma classificados de acordo com o nível de processo ou produto é feito; cada modelo tem características e uma estrutura que brevemente indicado na carta. Diferentes empresas, a fim de ser imerso em um processo contínuo de melhoria identificaram a importância de começar a implementação de modelos para certificar e garantir a qualidade de seus produtos e processos, alguns casos de sucesso foram encontrados implementação dos modelos estudados, o que permitiu que as empresas a posicionar ou ficar para melhorar seus processos de negócios.

Apoptotic induction by pinobanksin and some of its ester derivatives from Sonoran propolis in a B-cell lymphoma cell line.

Propolis is a resinous substance produced by honeybees (Apis mellifera) from the selective collection of exudates and bud secretions from several plants. In previous works, we reported the antiproliferative activity of Sonoran propolis (SP) on cancer cells; in addition we suggested the induction of apoptosis after treatment with SP due to the presence of morphological changes and a characteristic DNA fragmentation pattern. Herein, in this study we demonstrated that the antiproliferative effect of SP is induced through apoptosis in a B-cell lymphoma cancer cell line, M12.C3.F6, by an annexin V-FITC/Propidium iodide double labeling. This apoptotic effect of SP resulted to be mediated by modulations in the loss of mitochondrial membrane potential (ΔΨm) and through activation of caspases signaling pathway (3, 8 and 9). Afterward, in order to characterize the chemical constituents of SP that induce apoptosis in cancer cells, an HPLC-PDA-ESI-MS/MS method followed by a preparative isolation procedure and NMR spectroscopy analysis have been used. Eighteen flavonoids, commonly described in propolis from temperate regions, were characterized. Chrysin, pinocembrin, pinobanksin and its ester derivatives are the main constituents of SP and some of them have never been reported in SP. In addition, two esters of pinobanksin (8 and 13) are described by first time in propolis samples in general. The antiproliferative activity on M12.C3.F6 cells through apoptosis induction was exhibited by pinobanksin (4), pinobanksin-3-O-propanoate (14), pinobanksin-3-O-butyrate (16), pinobanksin-3-O-pentanoate (17), and the already reported galangin (11), chrysin (9) and CAPE. To our knowledge this is the first report of bioactivity of pinobanksin and some of its ester derivatives as apoptosis inducers. Further studies are needed to advance in the understanding of the molecular basis of apoptosis induction by SP and its constituents, as well as the structure-activity relationship of them.

Opinión de los médicos residentes de los hospitales catalanes sobre la formación en urgencias / Resident physicians' opinions of their emergency medicine training in Catalan hospitals

Objetivo: Conocer la opinión de los médicos internos residentes (MIR) de Cataluña acerca de la necesidad y utilidad de la formación recibida en los servicios de urgencias. Métodos: Se envió un cuestionario electrónico a los MIR de Cataluña mediante la colaboración de sus jefes de estudio. El cuestionario contenía variables sociodemográficas, preguntas sobre la predisposición del residente hacia las urgencias, y variables relacionadas con la formación: valoración de la necesidad de una estancia en urgencias, y conocimientos y aptitudes adquiridos durante la rotación (historia clínica, relación con los familiares, trabajo en equipo, toma de decisiones, identificación y manejo de pacientes críticos y aprendizaje de técnicas diagnóstico-terapéuticas). Se hicieron análisis descriptivos y se compararon los resultados entre distintas especialidades. Resultados: Se envió el cuestionario a 1.431 residentes de 21 hospitales y unidades docentes. Respondieron 427 residentes (29,8%). Tanto la valoración sobre la necesidad de realizar una formación en urgencias como sobre los conocimientos adquiridos fueron elevadas [8,9 (1,7) y 8,2 (1,9) puntos, respectivamente, en una escala de 1 a 10]. Los aspectos en los cuales habían adquirido mayor conocimiento fueron la toma de decisiones y el manejo de pacientes críticos. Los residentes de Medicina Familiar y Comunitaria mostraron mayor predisposición a escoger la especialidad de urgencias (33,7% frente a 6,1%, p < 0,001). Su valoración acerca de la necesidad de formarse en urgencias también fue superior [9,2 (1,5) frente a 8,7 (1,8), p = 0,006]. Conclusiones: Los MIR de Cataluña opinan que una estancia en urgencias durante su residencia es necesaria y útil para su formación. Los residentes de Medicina Familiar y Comunitaria son los que más valoran esta formación (AU)

Objective: To know the opinion of medical residents in hospitals in Catalonia about the need for and usefulness of the training they receive in the emergency department. Methods: We sent an electronic questionnaire to all residents in Catalonia, through their cooperating supervisors. The questionnaire contained items to collect information on sociodemographic variables and attitudes toward emergency medicine. Items related to training covered the residents’ assessment of the need for a rotation in the emergency department and the knowledge and skills acquired during the rotation (case history writing, relations with patients’ relatives, teamwork, decision-making, identifying and managing critical patients, acquisition of diagnostic and therapeutic techniques). We compiled descriptive statistics and compared the results for residents from different specialties. Results: Questionnaires were sent to 1431 residents in 21 hospitals and other training facilities. Responses were received from 427 (29.8%). Mean (SD) scores expressed on a scale of 1 to 10 were high for both the need for training in emergency medicine (8.9 [1.7]) and knowledge acquired during the rotation (8.2 [1.9]). The residents reported that they had acquired more knowledge in the areas of decision-making and management of critical patients. Family medicine residents expressed greater interest in choosing the specialty of emergency medicine (33.7% vs 6.1% for other residents, P<.001), and their opinion of the need for training in emergency medicine was also higher than other residents’ (9.2 [1.5] vs 8.7 [1.8], P=.006). Conclusions: Medical residents in Catalonia believe that a rotation in the emergency department provides necessary and useful training. Family medicine residents are the ones who value emergency training most highly (AU)

[Resident physicians' opinions of their emergency medicine training in Catalan hospitals]. / Opinión de los médicos residentes de los hospitales catalanes sobre la formación en urgencias.

OBJECTIVES: To know the opinion of medical residents in hospitals in Catalonia about the need for and usefulness of the training they receive in the emergency department. MATERIAL AND METHODS: We sent an electronic questionnaire to all residents in Catalonia, through their cooperating supervisors. The questionnaire contained items to collect information on sociodemographic variables and attitudes toward emergency medicine. Items related to training covered the residents' assessment of the need for a rotation in the emergency department and the knowledge and skills acquired during the rotation (case history writing, relations with patients' relatives, teamwork, decision-making, identifying and managing critical patients, acquisition of diagnostic and therapeutic techniques). We compiled descriptive statistics and compared the results for residents from different specialties. RESULTS: Questionnaires were sent to 1431 residents in 21 hospitals and other training facilities. Responses were received from 427 (29.8%). Mean (SD) scores expressed on a scale of 1 to 10 were high for both the need for training in emergency medicine (8.9 [1.7]) and knowledge acquired during the rotation (8.2 [1.9]). The residents reported that they had acquired more knowledge in the areas of decision-making and management of critical patients. Family medicine residents expressed greater interest in choosing the specialty of emergency medicine (33.7% vs 6.1% for other residents, P<.001), and their opinion of the need for training in emergency medicine was also higher than other residents' (9.2 [1.5] vs 8.7 [1.8], P=.006). CONCLUSION: Medical residents in Catalonia believe that a rotation in the emergency department provides necessary and useful training. Family medicine residents are the ones who value emergency training most highly.

OBJETIVO: Conocer la opinión de los médicos internos residentes (MIR) de Cataluña acerca de la necesidad y utilidad de la formación recibida en los servicios de urgencias. METODO: Se envió un cuestionario electrónico a los MIR de Cataluña mediante la colaboración de sus jefes de estudio. El cuestionario contenía variables sociodemográficas, preguntas sobre la predisposición del residente hacia las urgencias, y variables relacionadas con la formación: valoración de la necesidad de una estancia en urgencias, y conocimientos y aptitudes adquiridos durante la rotación (historia clínica, relación con los familiares, trabajo en equipo, toma de decisiones, identificación y manejo de pacientes críticos y aprendizaje de técnicas diagnóstico-terapéuticas). Se hicieron análisis descriptivos y se compararon los resultados entre distintas especialidades. RESULTADOS: Se envió el cuestionario a 1.431 residentes de 21 hospitales y unidades docentes. Respondieron 427 residentes (29,8%). Tanto la valoración sobre la necesidad de realizar una formación en urgencias como sobre los conocimientos adquiridos fueron elevadas [8,9 (1,7) y 8,2 (1,9) puntos, respectivamente, en una escala de 1 a 10]. Los aspectos en los cuales habían adquirido mayor conocimiento fueron la toma de decisiones y el manejo de pacientes críticos. Los residentes de Medicina Familiar y Comunitaria mostraron mayor predisposición a escoger la especialidad de urgencias (33,7% frente a 6,1%, p < 0,001). Su valoración acerca de la necesidad de formarse en urgencias también fue superior [9,2 (1,5) frente a 8,7 (1,8), p = 0,006]. CONCLUSIONES: Los MIR de Cataluña opinan que una estancia en urgencias durante su residencia es necesaria y útil para su formación. Los residentes de Medicina Familiar y Comunitaria son los que más valoran esta formación.

Syndrome in question

Costello syndrome (CS) is a rare genetic disorder, first described by Costello in 1971, caused by mutations in the HRAS proto-oncogene. Clinical findings include facial dysmorphism, skin disorders, cognitive impairment, cardiac and musculoskeletal defects. There is an increased risk of malignancies in these patients, due to the proto-oncogene mutation, and also sudden death secondary to heart disease. We report a case with characteristic phenotype, highlighting the peculiar skin changes.

Syndrome in question. Costello syndrome.

Costello syndrome (CS) is a rare genetic disorder, first described by Costello in 1971, caused by mutations in the HRAS proto-oncogene. Clinical findings include facial dysmorphism, skin disorders, cognitive impairment, cardiac and musculoskeletal defects. There is an increased risk of malignancies in these patients, due to the proto-oncogene mutation, and also sudden death secondary to heart disease. We report a case with characteristic phenotype, highlighting the peculiar skin changes.

Nail apparatus melanoma: a diagnostic opportunity.

Malignant Melanoma is a high mortality neoplasm. The involvement of the nail apparatus is rare, with only 2 out of 3 patients seeking medical attention as the result of recent nail melanocytic lesions. This results in late diagnosis and a prognosis worse than cutaneous melanoma. We report a female, presenting with ulcerative lesions with clinical and laboratory features compatible with leishmaniasis. On return after treatment initiation a longitudinal melanonychia was observed on her first right finger. Biopsy of the nail matrix was performed. Histopathology was compatible with melanoma in situ. Longitudinal melanonychia is not a specific sign for melanoma and it is important that the dermatologist should identify the suspect lesions correctly. The incidental diagnosis of nail melanoma in situ in our case significantly impacted the patient's survival.

Nail apparatus melanoma: a diagnostic opportunity / Melanoma do aparelho ungueal: uma oportunidade diagnóstica

Malignant Melanoma is a high mortality neoplasm. The involvement of the nail apparatus is rare, with only 2 out of 3 patients seeking medical attention as the result of recent nail melanocytic lesions. This results in late diagnosis and a prognosis worse than cutaneous melanoma. We report a female, presenting with ulcerative lesions with clinical and laboratory features compatible with leishmaniasis. On return after treatment initiation a longitudinal melanonychia was observed on her first right finger. Biopsy of the nail matrix was performed. Histopathology was compatible with melanoma in situ. Longitudinal melanonychia is not a specific sign for melanoma and it is important that the dermatologist should identify the suspect lesions correctly. The incidental diagnosis of nail melanoma in situ in our case significantly impacted the patient's survival.

Melanoma Maligno é uma neoplasia de alta mortalidade, sendo raro o acometimento do aparelho ungueal. Apenas 2/3 dos pacientes procuram atendimento médico devido lesão melanocítica ungueal recente, tornando o diagnóstico tardio e com prognóstico pior que do melanoma cutâneo. Descreve-se um caso de paciente sexo feminino, apresentando lesões ulceradas com características clínico-laboratoriais compatíveis com leishmaniose tegumentar americana. No retorno após início do tratamento foi observada melanoníquia longitudinal no primeiro quirodáctilo direito. Realizada biópsia da matriz ungueal com histopatológico compatível com melanoma in situ. Melanoníquia longitudinal não é sinal específico de melanoma. A identificação das lesões suspeitas é importante tarefa dos dermatologistas. O diagnóstico incidental de melanoma ungueal in situ do caso relatado resultou em grande impacto na sobrevida da paciente.

Less invasive fixation of an interthrocanteric fracture in an ankylosed hip with cannulated screws: a case report.

A 68-year-old woman presented following a road accident with an undisplaced intertrochanteric fracture affecting an ankylosed hip and an ipsilateral calcaneal fracture. The interthrocanteric fracture was fixed with four 7.0 mm cannulated screws. The calcaneal fracture was fixed with K wires and immobilized in a plaster. Because of this combination of injuries, although she was allowed to mobilize non weight bearing from the first week, sitting and progressive weight bearing were not permitted for six weeks. Radiographs taken at the one year showed consolidation of the hip fracture without complications. Final functional indices showed an EQ-5D VAS score of 40, EQ-5D health state index adapted to Spanish value sets of 0.493 and an Oxford Hip Score of 31. Screw fixation of an undisplaced intertrochanteric fracture in an ankylosed hip may be sufficient in some instances provided the patient remains non weight bearing for long enough.

[Evaluation of the use of repellent against mosquito bite by military personnel in the Amazon Basin]. / Avaliação do uso de repelentes contra picada de mosquitos em militares na Bacia Amazônica.

BACKGROUND: In Brazil, diseases caused by insect bites are frequent. Therefore, it is extremely important that prophylatic measures are adequately carried out, especially in endemic areas such as the Amazon which receives a great number of visitors, for both business and tourism purposes.. OBJECTIVES: To evaluate the use of insect repellents available in the market by military personnel who often go in missions in the middle of the jungle, in the Amazon region. METHODOLOGY: Fifty - one militaries in the Amazon region were selected and they answered a questionnaire in June/2008. RESULTS: 63,7% of the militaries used products that contained Deet in the maximum concentration of only 15% that has minimum repellent action; 36% reported to combine these products with sun protective products which increased the risk of intoxication; 36,4% used a natural repellent during their missions; two of the militaries participants used vitamin B and considered their repellent action ineffective. CONCLUSION: The repellents that contain Deet and which were used by the group present concentrations that are lower than the concentrations considered safe for using in the jungle. It was frequent the combination of Deet with sun protective products ,which is a potentially toxic association. Natural repellents that have "andiroba" and" copaíba" as components presented a higher perception of protection from the participants.

Avaliação do uso de repelentes contra picada de mosquitos em militares na Bacia Amazônica / Evaluation of the use of repellent against mosquito bite by military personnel in the Amazon Basin

FUNDAMENTOS: No Brasil, doenças provocadas por picadas de insetos são frequentes, o que torna extremamente importante a execução de medidas profiláticas de forma adequada, sobretudo, em áreas endêmicas como a Amazônia, que recebe um grande contingente de visitantes, a trabalho ou turismo. OBJETIVOS: Avaliar o uso dos repelentes de insetos disponíveis no mercado por militares que costumam realizar missões em ambiente de selva, na região amazônica. MÉTODOS: Foram selecionados cinquenta e um militares da região amazônica que responderam um questionário em junho/2008. RESULTADOS: 63,7 por cento dos militares usaram produtos contendo Deet na concentração máxima de apenas 15 por cento, que possui mínima ação de repelência; 36 por cento relataram usar protetor solar associado, o que levou a um risco maior de intoxicação; 36,4 por cento fizeram uso de um repelente natural em suas missões; dois militares usaram vitamina B e consideraram a sua ação de repelência ineficaz. CONCLUSÕES: Os repelentes à base de Deet utilizados pelo grupo estudado apresentam concentrações inferiores às consideradas seguras para uso em ambiente de selva. Foi frequente a associação do Deet com protetor solar, que é uma combinação potencialmente tóxica. Os repelentes naturais à base de andiroba e copaíba apresentaram o maior grau de percepção de proteção.

BACKGROUND: In Brazil, diseases caused by insect bites are frequent. Therefore, it is extremely important that prophylatic measures are adequately carried out, especially in endemic areas such as the Amazon which receives a great number of visitors, for both business and tourism purposes.. OBJECTIVES: To evaluate the use of insect repellents available in the market by military personnel who often go in missions in the middle of the jungle, in the Amazon region. METHODOLOGY: Fifty - one militaries in the Amazon region were selected and they answered a questionnaire in June/2008. RESULTS: 63,7 percent of the militaries used products that contained Deet in the maximun concentration of only 15 percent that has minimum repellent action; 36 percent reported to combine these products with sun protective products which increased the risk of intoxication; 36,4 percent used a natural repellent during their missions; two of the militaries participants used vitamin B and considered their repellent action ineffective. CONCLUSION: The repellents that contain Deet and which were used by the group present concentrations that are lower than the concentrations considered safe for using in the jungle. It was frequent the combination of Deet with sun protective products ,which is a potentially toxic association. Natural repellents that have "andiroba" and" copaíba" as components presented a higher perception of protection from the participants.

The Spaso technique: a prospective study of 34 dislocations.

BACKGROUND: The Spaso technique has been recently described as a new, simple, and effective manoeuvre for reducing anterior shoulder dislocation. However, there is a lack of series in the English literature. The aim of the study was to evaluate the results obtained with the introduction of this technique in an emergency department. METHODS: An observational prospective study at the Hospital Clínic of Barcelona Orthopaedic Emergency Department was done from January 2007 to May 2007. In this period, the Spaso technique was applied in 36 anterior shoulder dislocations. Two of the patients were excluded due to a presentation later than 24 hours after the dislocation, leaving a total of 34 dislocations in 33 patients. They occurred in 22 male and 12 female shoulders. The patients' ages ranged from 21 to 80 years (average, 51 years). The success of the attempt, complications, and other data were collected. RESULTS: The Spaso technique was successful in 23 (67.6%) of the 34 anterior shoulder dislocations. If just those patients with previous shoulder dislocations were taken into account, the success rate increased to 83%. No complications were observed. CONCLUSION: Based on the results of the present study, we consider the Spaso technique as a safe and effective manoeuvre for the reduction of anterior shoulder dislocations, with an acceptable success rate similar to the classical techniques previously described.