Autonomous Patient-Controlled Mobilization Protocol After Flexor Tendon Repair: A Case Series.

BACKGROUND: Despite many publications on rehabilitation after repair of flexor tendon injuries of the hand, there is no consensus as to which method is superior. It is clear that nonadherence to postoperative therapy adversely affects the outcome after flexor tendon surgery. In the context of a developing country, the most important factor associated with poor outcome is late onset of rehabilitation therapy. An autonomous rehabilitation program is proposed, with the use of a low-cost splint and based on an online illustrative video with the expectation to improve adherence and patient compliance, thus ensuring satisfactory outcome. METHODS: Twenty-two consecutive digits of 14 patients after flexor tendon repair in zone II were included. Autonomous early passive mobilization physical therapy and splinting started shortly after surgery, supported by an online available video depicting prescribed exercises; follow-up was continued until postoperative week 20. Patients were evaluated regarding range of motion, grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) disability scale. RESULTS: Range of motion after 20 weeks according to the scoring system of the American Society of Surgery of Hand was excellent in 4, good in 11, and fair in 4 fingers. The mean total active motion score was 86% (95% confidence interval, 78%-93%). The mean grip strength at final follow-up was 86% of the contralateral hand. The mean QuickDASH score was 12.5 (2.3-31.8). CONCLUSION: This protocol achieves good results in range of motion and early return of function of the hand. We propose this simple, nonexpensive method to developing countries with less than optimal availability of health care.

Unraveling the ecological processes modulating the population structure of Escherichia coli in a highly polluted urban stream network.

Escherichia coli dynamics in urban watersheds are affected by a complex balance among external inputs, niche modulation and genetic variability. To explore the ecological processes influencing E. coli spatial patterns, we analyzed its abundance and phylogenetic structure in water samples from a stream network with heterogeneous urban infrastructure and environmental conditions. Our results showed that environmental and infrastructure variables, such as macrophyte coverage, DIN and sewerage density, mostly explained E. coli abundance. Moreover, main generalist phylogroups A and B1 were found in high proportion, which, together with an observed negative relationship between E. coli abundance and phylogroup diversity, suggests that their dominance might be due to competitive exclusion. Lower frequency phylogroups were associated with sites of higher ecological disturbance, mainly involving simplified habitats, higher drainage infrastructure and septic tank density. In addition to the strong negative relationship between phylogroup diversity and dominance, the occurrence of these phylogroups would be associated with increased facilitated dispersal. Nutrients also contributed to explaining phylogroup distribution. Our study proposes the differential contribution of distinct ecological processes to the patterns of E. coli in an urban watershed, which is useful for the monitoring and management of fecal pollution.

Acute Pannexin 1 Blockade Mitigates Early Synaptic Plasticity Defects in a Mouse Model of Alzheimer's Disease.

Synaptic loss induced by soluble oligomeric forms of the amyloid ß peptide (sAßos) is one of the earliest events in Alzheimer's disease (AD) and is thought to be the major cause of the cognitive deficits. These abnormalities rely on defects in synaptic plasticity, a series of events manifested as activity-dependent modifications in synaptic structure and function. It has been reported that pannexin 1 (Panx1), a nonselective channel implicated in cell communication and intracellular signaling, modulates the induction of excitatory synaptic plasticity under physiological contexts and contributes to neuronal death under inflammatory conditions. Here, we decided to study the involvement of Panx1 in functional and structural defects observed in excitatory synapses of the amyloid precursor protein (APP)/presenilin 1 (PS1) transgenic (Tg) mice, an animal model of AD. We found an age-dependent increase in the Panx1 expression that correlates with increased Aß levels in hippocampal tissue from Tg mice. Congruently, we also observed an exacerbated Panx1 activity upon basal conditions and in response to glutamate receptor activation. The acute inhibition of Panx1 activity with the drug probenecid (PBN) did not change neurodegenerative parameters such as amyloid deposition or astrogliosis, but it significantly reduced excitatory synaptic defects in the AD model by normalizing long-term potentiation (LTP) and depression and improving dendritic arborization and spine density in hippocampal neurons of the Tg mice. These results suggest a major contribution of Panx1 in the early mechanisms leading to the synaptopathy in AD. Indeed, PBN induced a reduction in the activation of p38 mitogen-activated protein kinase (MAPK), a kinase widely implicated in the early neurotoxic signaling in AD. Our data strongly suggest that an enhanced expression and activation of Panx1 channels contribute to the Aß-induced cascades leading to synaptic dysfunction in AD.

El proceso de enfermar de los médicos y sus consecuencias en el profesionalismo / The process of physicians falling ill and consequences for their professionalism / O processo de adoecimento dos médicos e as suas consequências acerca do profissionalismo

Resumen: La idiosincrasia de la profesión médica, los rasgos de personalidad característicos del médico y la falta de formación específica para reconocer y tratar adecuadamente la propia vulnerabilidad, predisponen a este colectivo a padecer más patología mental y, probablemente, un deficiente tratamiento de otras enfermedades. La mayoría de los estudios realizados hasta el momento se centran en la patología mental y adictiva del médico, desde el punto de vista del riesgo para la mala praxis y la seguridad de sus pacientes. La revisión narrativa de la literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) ha mostrado que, en el entorno hispanoparlante, apenas disponemos de información actualizada sobre el médico como paciente, a pesar de ser un tema de indudable relevancia desde el punto de vista de la seguridad asistencial, del profesionalismo y del propio bienestar de los profesionales. La situación del médico que enferma es compleja y poco conocida, con conflicto de roles y con repercusiones en la ética profesional y la calidad asistencial.

Abstract: The idiosyncrasy of the medical profession, the characteristic personality traits of the physician and the lack of specific training to properly recognize and treat one's own vulnerability dispose this group to suffer more mental pathology and probably worse control of other medical diseases. Most of the studies promoted so far focus on the psychiatric and addictive concerns of the physician, from the point of view of the sick doctor as being at risk for malpractice and to guarantee the safety of their patients. The narrative review of scientific literature (MEDLINE, EMBASE and IME 1985-2016) has shown that we do not have in the Spanish-speaking environment updated information about the doctor as a patient, despite being a topic of incipient media repercussion and undoubtedly relevant from the point of view of patient safety, professionalism and medical ethics and as well as the welfare of professionals. The characteristic of a sick doctor are more complex than the rest of patients with a conflict of roles and repercussions on professional ethics and the quality of care.

Resumo: A idiossincrasia da profissão médica, as características de personalidade característica do médico e a falta de formação específica para reconhecer e, corretamente, tratar a própria vulnerabilidade, predispõem esse grupo a sofrer mais patologias mentais, e provavelmente tratamento deficiente de outras doenças. A maioria dos estudos realizados até agora tem como foco a patologia mental e o comportamento aditivo do médico, do ponto de vista do risco por negligência e segurança de seus pacientes. A revisão narrativa da literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) tem mostrado que no ambiente de idioma hispânico temos apenas informações atualizadas sobre o médico como paciente, apesar de ser uma questão de relevância inquestionável do ponto de vista da segurança assistencial, do profissionalismo e do próprio bem-estar dos profissionais. A situação do médico enfermo é complexa e pouco conhecida, com conflito de papéis e impacto sobre a ética profissional e a qualidade dos cuidados médicos. São necessários mais estudos, tanto quantitativos como qualitativos, que permitam compreender o processo do adoecimento dos médicos em cada um dos seus estágios profissionais (desde a graduação até a aposentadoria) para ser capaz de considerar estratégias para a melhoria na atenção da saúde desses profissionais.

Resonancia magnética de imágenes Giroimag-01: diagnóstico de lesiones del Sistema Nervioso Central / Giroimag-01 magnetic resonance imaging: diagnosis of injuries of the central nervous system

Se realizó un estudio comparativo sobre la positividad de la resonancia magnética de imágenes respecto a otros medios de diagnósticos imagenológicos y neurofisiológicos en lesiones del sistema nervioso central, con el objetivo de determinar la sensibilidad, la especificidad, la fuerza y el error de la prueba con el tomógrafo cubano Giroimag-01 en el diagnóstico de estas lesiones. Se seleccionó una muestra intencional de 398 pacientes y se utilizó como criterio de selección que se les hubieran practicado tomografía axial computadorizada, electroencefalograma o potenciales evocados multimodales o ambos, reflejados estos en las solicitudes de estudios. Entre los diagnósticos efectuados las lesiones más representativas fueron las enfermedades degenerativas, los tumores cerebrales y cerebelosos, los accidentes vasculares encefálicos, las enfermedades desmielinizantes y las hidrocefalias. Quedó demostrado que este tomógrafo posee una elevada sensibilidad y especificidad para la detección de lesiones del sistema nervioso central

Frecuencia fenotípica y génica del antígeno kell en la región central de Cuba (Villa Clara) / Genic and phenotypic frecuency of kell antigen in the central region of Cuba (Villa Clara)

Se presenta la frecuencia fenotípica y génica del antígeno Kell en una muestra de la población de la región central Cuba que representa la primera investigación sobre el sistema sanguíneo Kell realizada en la población cubana. Sobre la base de los resultados obtenidos se determinó la fecuencia génica del alelo K1 (Kell) y de su antitético esperado K2 (CELLANO); se encontró que su distribución en los principals grupos raciales de nuestra población es heterogénea: blancos (0,030 ; 0,970), negros (0,009 ; 0,991) y mulatos (0,016 ; 0,984)