Inter-and Intra-Examiner Reliability of Supraspinatus Muscle Tendon Palpation: A Cross-Sectional Study by Ultrasonography.

BACKGROUND AND OBJECTIVES: Palpation is an inherent and basic skill of health professionals-particularly manual therapists who base their diagnosis and treatment in a clinical environment. Many authors have previously described multiple palpation positions for supraspinatus muscle tendon (SMT); however, there are no current studies that evaluate palpation concordance reliability for the SMT in this particular position. This study aimed to investigate the intra- and inter-rater reliabilities of supraspinatus muscle tendon (SMT) palpation. MATERIALS AND METHODS: Thirty-six healthy participants (14 females; aged 22-35 years) were recruited. Musculoskeletal ultrasound was used to measure the SMT localization after two physiotherapists performed the SMT palpation at two different times. The distance between the two marked points was used to analyze the analysis of true agreement between examiners. Finally, we analyzed if the demographic variables influenced the palpation procedure. RESULTS: The intra-examiner reliability showed a high percentage of concordance for examiner 1 (E.1) (first palpation procedure (P.1) = 91.7%: second palpation procedure (P.2) = 95.8%) and examiner 2 (E.2) (P.1 = 91.6%; P.2 = 97.2%) and high percentage of inter-palpation agreement for E.1 (87.5%) and E.2 (88.9%). The inter-examiner reliability showed a high total concordance for the right shoulder (E.1 = 94.4%; E.2 = 95.8%) and left shoulder (E.1 = 93.05%; E.2 = 95.05%). The agreement (%) according to both examiners was 93.05% for the right shoulder and 94.4% for the left shoulder. The agreement between both examiners and the ultrasound (% of true agreement) was 92.9% for the right shoulder and 92.8% for the left shoulder. A statistically significant association (p = 0.02) was found for weight regarding concordance reliability; this was not seen for dominant arm, age, gender, body mass index, height, and tendon depth (p > 0.05). CONCLUSIONS: The SMT palpation technique showed a high level of concordance and reproducibility.

Análisis del control del paciente diabético en el área de atención primaria Mancha-Centro de Castilla-La Mancha. Barómetro de la diabetes / Analysis of diabetic patient control in the Primary Care Area of La Mancha-Centro, in the Castile-La Mancha region. Diabetes barometer

OBJETIVOS: Evaluar el control del paciente con diabetes mellitus (DM) en atención primaria(AP), analizando el sistema de registro informático del Sevicio de Salud de Castilla-La Mancha(SESCAM). MATERIAL Y MÉTODOS: Muestra de 938 pacientes con diagnóstico de DM sobre 14.733 individuos incluidos en el año 2009 en el registro informático del SESCAM del área Mancha Centro (Turriano), que comprende 25 centros de AP. Se analizaron distintos parámetros clínicos y analíticos: hemoglobina glicosilada (HbA1c), colesterol total (CT), presión arterial (PA) e índice de masa corporal(IMC), así como el número de procesos por paciente/año: análisis de HbA1c y lípidos, controles de PA, monitorizaciones de pie diabético y revisiones oculares. RESULTADOS: La prevalencia de diabetes conocida fue del 6,36% en la población general. El 54%de los pacientes presentaron una HbA1c < 7%, y el 24,1%, > 8%. El 79% asociaban sobrepeso u obesidad. El 38% eran hipertensos. No se realizó control de CT en el 16% de los individuos, obteniendo valores por debajo de 200 mg/dl en el 45%. Se registró menos de una revisión de pie al año, ninguna revisión ocular, ni control de microalbuminuria. CONCLUSIONES: El sistema «Turriano» es eficaz en el registro de pacientes con diabetes. La mayoría de los pacientes de nuestro estudio presentan un buen control metabólico y de los factores de riesgo cardiovascular

AIMS: To determine the clinical control of patients with diabetes in Primary Care in the a Mancha Centro area (Castile-La Mancha region).MATERIAL AND METHODS: The computerised records system of the Regional Health Service in Castile-La Mancha (Turriano) included 14,733 patients in 2009, in which 938 patients with diabetes were identified in the 25 centres belonging to La Mancha Centro area. Several parameters were collected: HbA1c, total cholesterol, blood pressure, and body mass index (BMI). The number of process per patient/year also were also collected, including number of: HbA1c, total cholesterol, blood pressure controls, feet controls, and eyes controls. RESULTS: Diabetes prevalence was 6.36% of the general population. The HbA1c was measured on average once a year. An HbA1c under 7 mg/dL was found in 54% of patients, and greater than 8 mg/dL in 24.1% of them. The large majority (79%) of patients with diabetes were overweight or obese. Hypertension was found in 40% of the patients. Total cholesterol was not controlled in 16% of patients; 45% had a total cholesterol under 200 mg/dL. Less than one check-up of the feet was done, and no eye control nor microalbuminuria were registered. CONCLUSIONS: The Turriano system is effective for recording the diabetic population. Most patients in our study showed good metabolic control as well as of cardiovascular risk factors

Neutralización heteróloga e interacción de amanitinas con venenos de Bothropsy Crotalus y de abeja / Heterologous neutralization and interaction of toxic amanitins with Bothrops and Crotalus venoms, and honey bee venom / Neutralização heteróloga e interação das amanitinas tóxicas com veneno de Bothrops e Crotalus e veneno de abelha

En el presente trabajo se examinó la interacción de las amanitinas de Amanita phalloides (Basidiomycetes) con los venenos de las serpientes Bothrops neuwiedi diporus ("yarará pequeña"), B. alternatus ("yarará grande"), Crotalus durissus terrificus ("serpiente de cascabel") y de la abeja mielera Apis mellifera. Se aplicaron las técnicas de Ouchterlony, inmunotransferencia, electroforesis rocket y electroforesis en gel de poliacrilamida a los anti-venenos y anti-toxinas obtenidos por inmunización en caballos y/o en conejos. Los anti­sueros de serpientes y las amanitinas reaccionaron en forma cruzada, así como el veneno de abeja y las amanitinas. Cuando los venenos de Bothrops neuwiedii diporus y Crotalus durissus terrificus se preincubaron con las amanitinas y se analizaron por electroforesis en gel de poliacrilamida-dodecilsulfato de sodio (dodecylsulfate-polyacrylamide gel electrophoresis: SDS-PAGE), algunas bandas de proteínas desaparecieron y otras se redujeron notablemente. Estos resultados revelan por primera vez la interacción y la degradación de las proteínas de los venenos de serpientes por las amanitinas. Por otra parte, la modificación del tiempo de coagulación de la sangre humana, debida a los venenos, se corrigió con los ciclopéptidos de Amanita. Estos resultados también se informan por primera vez en este trabajo. La presencia de polipéptidos tóxicos en los venenos de serpientes y abejas, así como en A. phalloides y la reactividad cruzada demostradas en este trabajo, sugieren la existencia de epítopos comunes a todos ellos. Teniendo en cuenta estas reacciones, el uso de anti-venenos heterólogos parece ser de utilidad en el tratamiento del envenenamiento.

In the present work, the interaction of the amanitins of Amanita phalloides (Basidiomycetes) with the venoms of Bothrops neuwiedi diporus ("small yarará snake"), B. alternatus ("big yarará"), Crotalus durissus terrificus ("rattlesnake"), and honey bee Apis mellifera was examined. Ouchterlony, immunotransfer, rocket-electrophoresis, and polyacrylamide gel electrophoresis techniques were applied to anti-venoms and anti-toxins obtained by immunization in horses and/or in rabbits. Snake antisera and amanitins cross-reacted as well as bee venom and amanitins. When venoms of Bothrops neuwiedii diporus and Crotalus durissus terrificus were preincubated with amanitins and analysed by sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE), some protein bands disappeared and others were significantly reduced. These results reveal for the first time the interaction and degradation of proteins in snake venoms by amanitins. Moreover, the modification of the human blood clotting time due to snake venoms was corrected by the Amanita cyclopeptides. These results are also reported for the first time in this work. The occurrence of toxic polypeptides in the snake and bee venoms as well as in A. phalloides, and the cross-reactivity demostrated herein, suggest the occurrence of epitopes common to all of them. Taking into account these reactions,the use of heterologous anti-venoms seems to be of value in envenomation treatment.

No presente trabalho foi examinada a interação das amanitinas de Amanita phalloides (Basidiomy­cetes) com os venenos das serpentes Bothrops neuwiedi diporus ("jararaca-cruzeira"), B. alternatus ("urutu"), Crotalus durissus terrificus ("serpente cascavel") e da abelha-europeia Apis mellifera. Foram aplicadas as técnicas de Ouchterlony, imunotransferência, eletroforese rocket e eletroforese em gel de poliacrilamida aos anti-venenos e anti-toxinas obtidos por imunização em cavalos e/ou em coelhos. Os anti-soros de serpentes e as amanitinas reagiram em forma cruzada, bem como o veneno de abelha e as amanitinas. Quando os venenos de Bothrops neuwiedii diporus e Crotalus durissus terrificus foram incubados previamente com as amanitinas e foram analisados por eletroforese em gel de poliacrilamida-dodecilsulfato de sódio (dodecylsulfate-polyacrylamide gel electrophoresis: SDS-PAGE), algumas faixas de proteínas desapareceram e outras se reduziram notavelmente. Estes resultados revelam por primeira vez a interação e a degradação das proteínas dos venenos de serpentes pelas amanitinas. Por outra parte, a modificação do tempo de coagulação do sangue humano, devido aos venenos, se corrigiu com os ciclopeptídeos de Amanita. Estes resultados também se informam por primeira vez neste trabalho. A presença de polipeptídeos tóxicos nos venenos de serpentes e abelhas, bem como em A. phalloides e a reatividade cruzada demonstradas neste trabalho, sugerem a existência de epítopos comuns a todos eles. Levando em consideração estas reações, o uso de anti-venenos heterólogos parece ser de utilidade no tratamento do envenenamento.

Neutralización heteróloga e interacción de amanitinas con venenos de Bothropsy Crotalus y de abeja / Heterologous neutralization and interaction of toxic amanitins with Bothrops and Crotalus venoms, and honey bee venom / NeutralizaþÒo heteróloga e interaþÒo das amanitinas tóxicas com veneno de Bothrops e Crotalus e veneno de abelha

En el presente trabajo se examinó la interacción de las amanitinas de Amanita phalloides (Basidiomycetes) con los venenos de las serpientes Bothrops neuwiedi diporus ("yarará pequeña"), B. alternatus ("yarará grande"), Crotalus durissus terrificus ("serpiente de cascabel") y de la abeja mielera Apis mellifera. Se aplicaron las técnicas de Ouchterlony, inmunotransferencia, electroforesis rocket y electroforesis en gel de poliacrilamida a los anti-venenos y anti-toxinas obtenidos por inmunización en caballos y/o en conejos. Los anti¡sueros de serpientes y las amanitinas reaccionaron en forma cruzada, así como el veneno de abeja y las amanitinas. Cuando los venenos de Bothrops neuwiedii diporus y Crotalus durissus terrificus se preincubaron con las amanitinas y se analizaron por electroforesis en gel de poliacrilamida-dodecilsulfato de sodio (dodecylsulfate-polyacrylamide gel electrophoresis: SDS-PAGE), algunas bandas de proteínas desaparecieron y otras se redujeron notablemente. Estos resultados revelan por primera vez la interacción y la degradación de las proteínas de los venenos de serpientes por las amanitinas. Por otra parte, la modificación del tiempo de coagulación de la sangre humana, debida a los venenos, se corrigió con los ciclopéptidos de Amanita. Estos resultados también se informan por primera vez en este trabajo. La presencia de polipéptidos tóxicos en los venenos de serpientes y abejas, así como en A. phalloides y la reactividad cruzada demostradas en este trabajo, sugieren la existencia de epítopos comunes a todos ellos. Teniendo en cuenta estas reacciones, el uso de anti-venenos heterólogos parece ser de utilidad en el tratamiento del envenenamiento.(AU)

In the present work, the interaction of the amanitins of Amanita phalloides (Basidiomycetes) with the venoms of Bothrops neuwiedi diporus ("small yarará snake"), B. alternatus ("big yarará"), Crotalus durissus terrificus ("rattlesnake"), and honey bee Apis mellifera was examined. Ouchterlony, immunotransfer, rocket-electrophoresis, and polyacrylamide gel electrophoresis techniques were applied to anti-venoms and anti-toxins obtained by immunization in horses and/or in rabbits. Snake antisera and amanitins cross-reacted as well as bee venom and amanitins. When venoms of Bothrops neuwiedii diporus and Crotalus durissus terrificus were preincubated with amanitins and analysed by sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE), some protein bands disappeared and others were significantly reduced. These results reveal for the first time the interaction and degradation of proteins in snake venoms by amanitins. Moreover, the modification of the human blood clotting time due to snake venoms was corrected by the Amanita cyclopeptides. These results are also reported for the first time in this work. The occurrence of toxic polypeptides in the snake and bee venoms as well as in A. phalloides, and the cross-reactivity demostrated herein, suggest the occurrence of epitopes common to all of them. Taking into account these reactions,the use of heterologous anti-venoms seems to be of value in envenomation treatment.(AU)

No presente trabalho foi examinada a interaþÒo das amanitinas de Amanita phalloides (Basidiomy¡cetes) com os venenos das serpentes Bothrops neuwiedi diporus ("jararaca-cruzeira"), B. alternatus ("urutu"), Crotalus durissus terrificus ("serpente cascavel") e da abelha-europeia Apis mellifera. Foram aplicadas as técnicas de Ouchterlony, imunotransferÛncia, eletroforese rocket e eletroforese em gel de poliacrilamida aos anti-venenos e anti-toxinas obtidos por imunizaþÒo em cavalos e/ou em coelhos. Os anti-soros de serpentes e as amanitinas reagiram em forma cruzada, bem como o veneno de abelha e as amanitinas. Quando os venenos de Bothrops neuwiedii diporus e Crotalus durissus terrificus foram incubados previamente com as amanitinas e foram analisados por eletroforese em gel de poliacrilamida-dodecilsulfato de sódio (dodecylsulfate-polyacrylamide gel electrophoresis: SDS-PAGE), algumas faixas de proteínas desapareceram e outras se reduziram notavelmente. Estes resultados revelam por primeira vez a interaþÒo e a degradaþÒo das proteínas dos venenos de serpentes pelas amanitinas. Por outra parte, a modificaþÒo do tempo de coagulaþÒo do sangue humano, devido aos venenos, se corrigiu com os ciclopeptídeos de Amanita. Estes resultados também se informam por primeira vez neste trabalho. A presenþa de polipeptídeos tóxicos nos venenos de serpentes e abelhas, bem como em A. phalloides e a reatividade cruzada demonstradas neste trabalho, sugerem a existÛncia de epítopos comuns a todos eles. Levando em consideraþÒo estas reaþ§es, o uso de anti-venenos heterólogos parece ser de utilidade no tratamento do envenenamento.(AU)