Level of Physical Activity and Knowledge about the Physical Activity Guidelines in a Group of Medical Residents from Puerto Rico.

OBJECTIVE: Physicians who know about physical activity guidelines (PAG) and those who adhere to the PAG themselves may have a greater tendency to recommend physical activity (PA) to their patients. This study was aimed at evaluating the level of PA in a group of medical residents from Puerto Rico and to assess their knowledge regarding the PAG for adults. METHODS: A total of 104 medical residents from Puerto Rico completed a selfadministered questionnaire designed to obtain standardized estimates of their PA and to determine their level of knowledge regarding the PAG. RESULTS: Results: Most of the medical residents (66.3%) declared that they did not have any knowledge of the existence of the PAG and that their residency programs had not provided any educational activities about the PAG (96.2%). The level of inactivity among medical residents was high; 41.35% reported not engaging in any PA during their leisure time. CONCLUSION: Most of the medical residents in this group from Puerto Rico did not know about the PAG and many of them did not engage in PA. As a means of improving patient care, medical residents from Puerto Rico might benefit if their programs implemented educational activities aimed at increasing knowledge of both PA and the PAG.

Severe systemic inflammatory response syndrome immediately after spinal surgery in a patient with axial gout.

We report a 55-year-old man with gouty arthritis who developed a 3-month history of low back pain, gradual lower extremities weakness and urinary incontinence. Lumbar MRI showed an exophytic lesion at L3-L4. Immediately after spinal decompression surgery, he developed fever, disorientation, polyarthritis, acute kidney injury and leucocytosis. He was treated with multiple antimicrobial agents for presumed spinal abscess but did not improve. Multiple body site cultures were negative. Aspiration of the sacroiliac joint revealed the presence of monosodium uric acid crystals. A diagnosis of acute gout was done, and he was treated with high-dose intravenous methylprednisolone and colchicine. Within 48 hours, he had a remarkable clinical improvement. At discharge, neurological and laboratory abnormalities had resolved. Awareness of risk factors for axial gout and a high degree of suspicion are important to establish a prompt diagnosis and treatment to prevent severe complications as seen in this case.

Right upper quadrant abdominal pain as the initial presentation of polyarteritis nodosa.

Polyarteritis nodosa (PAN) is a necrotising vasculitis that involves medium and small vessels. PAN generally presents with constitutional, cutaneous, neurological, renal and gastrointestinal manifestations. However, PAN initially involving a single organ/system is uncommon. Here, we present a 42-year-old man who was hospitalised because of severe right upper quadrant abdominal pain that started 2 months before. Physical examination was remarkable for right upper quadrant abdominal tenderness. Abdominopelvic CT showed lymphadenopathy but no hepatic, gallbladder, pancreatic, intestinal or renal abnormalities. Abdominal angiography showed multiple small aneurysms located in the jejunal and hepatic arteries characteristic of PAN. He had a prompt and remarkable response to high-dose corticosteroids and oral cyclophosphamide. Our case, together with other reports, suggests that PAN should be considered in patients presenting with right upper abdominal pain. Timely diagnosis and treatment reduce the overall morbidity and mortality of the disease.

Rheumatology practice profiles in teaching and community settings in Puerto Rico: implications to subspecialty training.

BACKGROUND: University-based fellowship training programs may not always provide the required experience to manage common and less complex medical conditions usually seen at the community setting. Few studies have addressed this concern. OBJECTIVE: The purpose of this study was to compare the demographic features, diagnoses, and rheumatologic procedures in patients seen at the University of Puerto Rico Medical Sciences Campus Adult Rheumatology Training Program practice and 3 community-based rheumatology practices in Puerto Rico. METHODS: Claim forms submitted to health care insurance companies in 2007 from the university and community practices were evaluated. Demographic parameters, primary diagnoses (per International Classification of Diseases, Ninth Revision), medical visits, and rheumatologic procedures (per Current Procedural Terminology 4) were examined. Variables were analyzed by χ and Student t tests. RESULTS: A total of 11,373 claim forms were reviewed: 1952 from the university setting and 9421 from the community-based practices. Younger age and female sex were more common in visits from the university-based setting. Autoimmune diseases were reported more commonly at the university setting (65.3% vs 37.6%, P < 0.001). Conversely, osteoarthritis (24.4% vs 9.8%, P < 0.001), fibromyalgia syndrome (7.4% vs 1.9, P < 0.001), and regional rheumatic pain syndromes (7.2% vs 1.4%, P < 0.001) were seen more frequently at community practices. Hospital/emergency room visits (11.8% vs 0.3%, P < 0.001) were more frequent at the university setting, whereas joint (13.3% vs 2.9%, P < 0.001) and periarticular injections (6.2% vs 1.7%, P < 0.001) were performed more frequently at the community practices. CONCLUSIONS: Several differences were found in the profile of demographic parameters, diagnoses, medical visits, and rheumatologic procedures between patients seen at the University of Puerto Rico Medical Sciences Campus rheumatology practice and 3 community-based practices. Efforts may be required to diversify and increase the exposure of rheumatology fellows to patients with conditions commonly seen at the community setting.

Evaluation of maximal inspiratory pressure, tracheal airway occlusion pressure, and its ratio in the weaning outcome.

PURPOSE: The objective of this study is to evaluate the predictive performance of maximal inspiratory pressure (Pimax), airway occlusion pressure (P 0.1), and its ratio (P 0.1/Pimax) in the weaning outcome. MATERIALS AND METHODS: Seventy patients on mechanical ventilation for more than 24 hours, who fulfilled weaning criteria, were prospectively evaluated. Pimax less than -25 cm H(2)O, P 0.1 less than 4.2 cm H(2)O, and P 0.1/Pimax less than 0.14 were evaluated in all patients before spontaneous breathing trials. The receiver operating characteristic (ROC) curve was calculated to evaluate the predictive performance of each index. RESULTS: Pimax presented the area under the ROC curves smaller than those for P 0.1 and P 0.1/Pimax (0.52 x 0.76 and 0.52 x 0.78; P = .004 and P = .0006, respectively), being the criteria of worst performance. P 0.1/Pimax presented excellent predictive performance in weaned patients, with sensitivity of 98.08, but with the area under the ROC curves only slightly larger than those for P 0.1 (0.78 x 0.76, respectively; P = .69). CONCLUSION: In our study, P 0.1 and P 0.1/Pimax ratio were moderately accurate, whereas Pimax was less accurate in predicting the weaning outcome.

Efeitos da fisioterapia respiratória e da mobilização passiva sobre a pressão intracraniana / Effects of respiratory physical therapy and passive mobilization on intracranial pressure

Os efeitos da fisioterapia sobre a pressão intracraniana (PIC) não são totalmente esclarecidos. O objetivo deste estudo é avaliar os efeitos da fisioterapia respiratória e movimentação passiva sobre a PIC. Foram avaliados 70 pacientes com traumatismo cranioencefálico e acidente vascular cerebral com Escala de Coma de Glasgow ≤ 8. A cabeceira foi mantida em 30 graus durante o estudo. A PIC foi monitorizada durante as seguintes condutas: compressão torácica, vibração associada à compressão torácica, compressão torácica contínua unilateral, aspiração traqueal com circuito aberto e com circuito fechado, movimentação passiva de membros superiores e inferiores, rotação do quadril, mobilização escapular e flexão lateral do tronco inferior. A variação da PIC durante as condutas foi avaliada pelo teste de Wilcoxon. A PIC inicial foi de 14 ± 6,4 mm Hg. Quatro condutas alteraram a PIC de forma significativa: Flexão lateral do tronco inferior (19,1 ± 6,52 mmHg; p < 0,0001), compressão torácica unilateral contínua (19,09 ± 6,43 mmHg; p < 0,0001), aspiração traqueal com circuito aberto (19,06 ± 6,46 mmHg; p < 0,0001) e com circuito fechado (18,2 ± 7,61 mmHg; p < 0,0001). Compressão torácica unilateral contínua e flexão lateral do tronco inferior devem ser evitadas em pacientes com hipertensão intracraniana. A aspiração traqueal é inevitável, mas deve ser cautelosa.

The effects of physical therapy on intracranial pressure (ICP) are not totally clear. The aim of this study was to evaluate the effects of respiratory physical therapy and passive mobilization on ICP. Seventy patients with traumatic brain injury (TBI) and stroke with Glasgow Coma Scale (GCS) ≤ 8 were evaluated. Thirty degree head-up position was used during the study. ICP was monitored during the following procedures: chest compression, vibration associated to chest compression, unilateral continuous chest compression, tracheal suction with open circuit and closed circuit, passive mobilization of arms and legs, hip rotation, scapular mobilization and lateral flexion of the lower trunk. Wilcoxon test was used to evaluate changes on ICP during the procedures. Initial ICP was 14 ± 6.4 mmHg. Four procedures changed ICP expressively: lateral flexion of the lower trunk (19.1 ± 6.52 mmHg; p < 0.0001), unilateral continuous chest compression (19.09 ± 6.43 mmHg; p < 0.0001), tracheal suction with open circuit (19.06 ± 6.46 mmHg; p < 0.0001) and with closed circuit (18.2 ± 7.61 mmHg; p < 0.0001). Unilateral continuous chest compression and lateral flexion of the lower trunk should be avoided in patients with intracranial hypertension. Tracheal suction is unavoidable, but should be done carefully.