Effect of muscle length on maximum evoked torque, discomfort, contraction fatigue, and strength adaptations during electrical stimulation in adult populations: A systematic review.

Neuromuscular electrical stimulation (NMES) can improve physical function in different populations. NMES-related outcomes may be influenced by muscle length (i.e., joint angle), a modulator of the force generation capacity of muscle fibers. Nevertheless, to date, there is no comprehensive synthesis of the available scientific evidence regarding the optimal joint angle for maximizing the effectiveness of NMES. We performed a systematic review to investigate the effect of muscle length on NMES-induced torque, discomfort, contraction fatigue, and strength training adaptations in healthy and clinical adult populations (PROSPERO: CRD42022332965). We conducted searches across seven electronic databases: PUBMED, Web of Science, EMBASE, PEDro, BIREME, SCIELO, and Cochrane, over the period from June 2022 to October 2023, without restricting the publication year. We included cross-sectional and longitudinal studies that used NMES as an intervention or assessment tool for comparing muscle lengths in adult populations. We excluded studies on vocalization, respiratory, or pelvic floor muscles. Data extraction was performed via a standardized form to gather information on participants, interventions, and outcomes. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for cross-over trials and the Physiotherapy Evidence Database scale. Out of the 1185 articles retrieved through our search strategy, we included 36 studies in our analysis, that included 448 healthy young participants (age: 19-40 years) in order to investigate maximum evoked torque (n = 268), contraction fatigability (n = 87), discomfort (n = 82), and muscle strengthening (n = 22), as well as six participants with spinal cord injuries, and 15 healthy older participants. Meta-analyses were possible for comparing maximal evoked torque according to quadriceps muscle length through knee joint angle. At optimal muscle length 50° - 70° of knee flexion, where 0° is full extension), there was greater evoked torque during nerve stimulation compared to very short (0 - 30°) (p<0.001, CI 95%: -2.03, -1.15 for muscle belly stimulation, and -3.54, -1.16 for femoral nerve stimulation), short (31° - 49°) (p = 0.007, CI 95%: -1.58, -0.25), and long (71° - 90°) (p<0.001, CI 95%: 0.29, 1.02) muscle lengths. At long muscle lengths, NMES evoked greater torque than very short (p<0.001, CI 95%: -2.50, -0.67) and short (p = 0.04, CI 95%: -2.22, -0.06) lengths. The shortest quadriceps length generated the highest perceived discomfort for a given current amplitude. The amount of contraction fatigability was greater when muscle length allowed greater torque generation in the pre-fatigue condition. Strength gains were greater for a protocol at the optimal muscle length than for short muscle length. The quality of evidence was very high for most comparisons for evoked torque. However, further studies are necessary to achieve certainty for the other outcomes. Optimal muscle length should be considered the primary choice during NMES interventions, as it promotes higher levels of force production and may facilitate the preservation/gain in muscle force and mass, with reduced discomfort. However, a longer than optimal muscle length may also be used, due to possible muscle lengthening at high evoked tension. Thorough understanding of these physiological principles is imperative for the appropriate prescription of NMES for healthy and clinical populations.

Longitudinal impact of leisure-time physical activity on pain intensity and daily activity limitation in people with low back pain. Findings from the PAMPA cohort.

OBJECTIVE: We aimed to prospectively evaluate the association between leisure-time physical activity and outcomes related to low back pain (LBP), such as pain intensity and daily activity limitation. METHODS: We analyzed data from the PAMPA (Prospective Study about Mental and Physical Health) cohort, a longitudinal study with adults residing in Southern Brazil. Participants answered an online-based, self-administered questionnaire. Physical activity was assessed as minutes per week, and those who reported engaging in 150 min/week or more were considered active. We also assessed the types of activities participants engaged. Pain intensity was assessed with a numeric pain rating scale (from 0 to 10), and participants reported whether their pain restricted their daily activities. Generalized linear models were used to investigate the association between physical activity and LBP outcomes. RESULTS: Data from 991 individuals (82.7% women) aged 38.9 ± 13.9 were analyzed. Pain intensity was higher in those inactive in waves one (ß: 0.54; 95 % CI 0.23, 0.86), three (ß: 0.38; 95% CI 0.02, 0.75), and four (ß: 0.48; 95% CI 0.06, 0.90). Also, being physically inactive at wave one was associated with a higher probability of daily activity limitation at waves two (IRR 1.77; 95% CI 1.27; 2.46), three (IRR 1.63; 95% CI 1.17, 2.29), and four (IRR 1.73; 95% CI 1.20, 2.50). CONCLUSION: Not practicing at least 150 min/week of physical activity resulted in higher levels of pain and an increased risk of daily activity limitation in individuals with LBP. Moreover, various forms of activities have shown to be advantageous in alleviating pain among this group.

Drug Cost Avoidance Resulting from Participation in Clinical Trials: A 10-Year Retrospective Analysis of Cancer Patients with Solid Tumors.

The objective of this single-center retrospective study was to describe the clinical characteristics of adult patients with solid tumors enrolled in cancer clinical trials over a 10-year period (2010-2019) and to assess drug cost avoidance (DCA) associated with sponsors' contributions. The sponsors' contribution to pharmaceutical expenditure was calculated according to the actual price (for each year) of pharmaceutical specialties that the Vall d'Hebron University Hospital (HUVH) would have had to bear in the absence of sponsorship. A total of 2930 clinical trials were conducted with 10,488 participants. There were 140 trials in 2010 and 459 in 2019 (228% increase). Clinical trials of high complexity phase I and basket trials accounted for 34.3% of all trials. There has been a large variation in the pattern of clinical research over the study period, whereas, in 2010, targeted therapy accounted for 79.4% of expenditure and cytotoxic drugs for 20.6%; in 2019, immunotherapy accounted for 68.4%, targeted therapy for 24.4%, and cytotoxic drugs for only 7.1%. A total of four hundred twenty-one different antineoplastic agents were used, the variability of which increased from forty-seven agents in 2010, with only seven of them accounting for 92.8% of the overall pharmaceutical expenditure) to three hundred seventeen different antineoplastic agents in 2019, with thirty-three of them accounting for 90.6% of the overall expenditure. The overall expenditure on antineoplastic drugs in clinical care patients not included in clinical trials was EUR 120,396,096. The total cost of antineoplastic drugs supplied by sponsors in a clinical trial setting was EUR 107,306,084, with a potential DCA of EUR 92,662,609. Overall, clinical trials provide not only the best context for the progress of clinical research and healthcare but also create opportunities for reducing cancer care costs.

Prevalence and factors associated with long COVID in adults from Southern Brazil: findings from the PAMPA cohort.

Most COVID-19 survivors have reported experiencing persistent symptoms after the infection - these types of cases are known as long COVID. Since Brazil was an epicenter of the COVID-19 pandemic, a high burden of long COVID is expected. This study aimed to identify the prevalence and factors associated with long COVID in adults in Southern Brazil, analyzing data from the PAMPA cohort. Participants filled out a self-reported online questionnaire in June 2022. This study only included subjects who tested positive for COVID-19. Long COVID was defined by any symptoms that persisted for at least three months after the SARS-CoV-2 infection. Poisson's regression models with robust variance were used to identify factors associated with long COVID; and results were reported as prevalence ratios (PR) and respective 95% confidence intervals (95%CI). A total of 1,001 participants (77.4% women, mean age [SD] = 38.3 [11.9] years) were analyzed. The prevalence of long COVID among these patients was 77.4% (95%CI: 74.7; 79.9). The likelihood of long COVID was higher in unvaccinated participants (PR = 1.23, 95%CI: 1.06; 1.42), in those with chronic conditions (PR = 1.13, 95%CI: 1.04; 1.24), and in those who were hospitalized due to the COVID-19 infection (PR = 1.24, 95%CI: 1.16; 1.32). This prevalence was also higher in women (PR = 1.21, 95%CI: 1.09; 1.33) than in men. Physical activity was associated with a reduced likelihood of fatigue, neurological complications, coughing, and headaches as persistent symptoms after a COVID-19 infection. It was found that three out of four adults in Southern Brazil experienced long COVID. Public policies aiming to reduce the burden of long COVID must be prioritized, especially in groups that are at higher risk of developing this harmful condition.

British Society for Paediatric and Adolescent Dermatology assessment and support of mental health in children and young people with skin conditions: a multidisciplinary expert consensus statement and recommendations.

BACKGROUND: Psychological and mental health difficulties are common in children and young people (CYP) living with skin conditions and can have a profound impact on wellbeing. There is limited guidance on how best to assess and support the mental health of this population, who are at risk of poor health outcomes. OBJECTIVES: To provide consensus-based recommendations on the assessment and monitoring of and support for mental health difficulties in CYP with skin conditions (affecting the skin, hair and nails); to address practical clinical implementation questions relating to consensus guidance; and to provide audit and research recommendations. METHODS: This set of recommendations was developed with reference to the AGREE II instrument. A systematic review and literature appraisal was carried out. A multidisciplinary consensus group was convened, with two virtual panel meetings held: an initial meeting to discuss the scope of the study, to review the current evidence and to identify areas for development; and a second meeting to agree on the content and wording of the recommendations. Recommendations were then circulated to stakeholders, following which amendments were made and agreed by email. RESULTS: The expert panel achieved consensus on 11 recommendations for healthcare workers managing CYP with skin conditions. A new patient-completed history-taking aid ('You and Your Skin') was developed and is being piloted. CONCLUSIONS: The recommendations focus on improved mental health assessments for CYP presenting with a skin condition, with clinical guidance and suggested screening measures included. Information on accessing psychological support for CYP, when required, is given, and recommendations for staff training in mental health and neurodiversity provided. Embedding a psychosocial approach within services treating CYP with skin disease should ensure that CYP with psychological needs are able to be identified, listened to, supported and treated. This is likely to improve health outcomes.

Draft Genome Sequence of the Plant Growth Promoter and Biocontrol Agent Bacillus velezensis Strain BIB0110.

Here, we report the draft genome sequence of Bacillus velezensis strain BIB0110, a broad-range biocontrol agent isolated from cultivated eucalyptus in Brazil. The genome has a size of 4.19 Mbp, with a GC content of 45.87%, and it was assembled into 32 scaffolds.

Kilohertz Frequency Alternating Current Induces Less Evoked Torque and Less Neuromuscular Efficiency Than Pulsed Current in Healthy People: A Randomized Crossover Trial.

CONTEXT: Pulsed current and kilohertz frequency alternating current are 2 types of neuromuscular electrical stimulation (NMES) currents often used by clinicians during rehabilitation. However, the low methodological quality and the different NMES parameters and protocols used in several studies might explain their inconclusive results in terms of their effects in the evoked torque and the discomfort level. In addition, the neuromuscular efficiency (ie, the NMES current type that evokes the highest torque with the lowest current intensity) has not been established yet. Therefore, our objective was to compare the evoked torque, current intensity, neuromuscular efficiency (evoked torque/current intensity ratio), and discomfort between pulsed current and kilohertz frequency alternating current in healthy people. DESIGN: A double-blind, randomized crossover trial. METHODS: Thirty healthy men (23.2 [4.5] y) participated in the study. Each participant was randomized to 4 current settings: 2 kilohertz frequency alternating currents with 2.5 kHz of carrier frequency and similar pulse duration (0.4 ms) and burst frequency (100 Hz) but with different burst duty cycles (20% and 50%) and burst durations (2 and 5 ms); and 2 pulsed currents with similar pulse frequency (100 Hz) and different pulse duration (2 and 0.4 ms). The evoked torque, current intensity at the maximal tolerated intensity, neuromuscular efficiency, and discomfort level were evaluated. RESULTS: Both pulsed currents generated higher evoked torque than the kilohertz frequency alternating currents, despite the similar between-currents discomfort levels. The 2 ms pulsed current showed lower current intensity and higher neuromuscular efficiency compared with both alternated currents and with the 0.4 ms pulsed current. CONCLUSIONS: The higher evoked torque, higher neuromuscular efficiency, and similar discomfort of the 2 ms pulsed current compared with 2.5-kHz frequency alternating current suggests this current as the best choice for clinicians to use in NMES-based protocols.

Differentiating Multiple Sclerosis From AQP4-Neuromyelitis Optica Spectrum Disorder and MOG-Antibody Disease With Imaging.

BACKGROUND AND OBJECTIVES: Relapsing-remitting multiple sclerosis (RRMS), aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) may have overlapping clinical features. There is an unmet need for imaging markers that differentiate between them when serologic testing is unavailable or ambiguous. We assessed whether imaging characteristics typical of MS discriminate RRMS from AQP4-NMOSD and MOGAD, alone and in combination. METHODS: Adult, nonacute patients with RRMS, APQ4-NMOSD, and MOGAD and healthy controls were prospectively recruited at the National Hospital for Neurology and Neurosurgery (London, United Kingdom) and the Walton Centre (Liverpool, United Kingdom) between 2014 and 2019. They underwent conventional and advanced brain, cord, and optic nerve MRI and optical coherence tomography (OCT). RESULTS: A total of 91 consecutive patients (31 RRMS, 30 APQ4-NMOSD, and 30 MOGAD) and 34 healthy controls were recruited. The most accurate measures differentiating RRMS from AQP4-NMOSD were the proportion of lesions with the central vein sign (CVS) (84% vs 33%, accuracy/specificity/sensitivity: 91/88/93%, p < 0.001), followed by cortical lesions (median: 2 [range: 1-14] vs 1 [0-1], accuracy/specificity/sensitivity: 84/90/77%, p = 0.002) and white matter lesions (mean: 39.07 [±25.8] vs 9.5 [±14], accuracy/specificity/sensitivity: 78/84/73%, p = 0.001). The combination of higher proportion of CVS, cortical lesions, and optic nerve magnetization transfer ratio reached the highest accuracy in distinguishing RRMS from AQP4-NMOSD (accuracy/specificity/sensitivity: 95/92/97%, p < 0.001). The most accurate measures favoring RRMS over MOGAD were white matter lesions (39.07 [±25.8] vs 1 [±2.3], accuracy/specificity/sensitivity: 94/94/93%, p = 0.006), followed by cortical lesions (2 [1-14] vs 1 [0-1], accuracy/specificity/sensitivity: 84/97/71%, p = 0.004), and retinal nerve fiber layer thickness (RNFL) (mean: 87.54 [±13.83] vs 75.54 [±20.33], accuracy/specificity/sensitivity: 80/79/81%, p = 0.009). Higher cortical lesion number combined with higher RNFL thickness best differentiated RRMS from MOGAD (accuracy/specificity/sensitivity: 84/92/77%, p < 0.001). DISCUSSION: Cortical lesions, CVS, and optic nerve markers achieve a high accuracy in distinguishing RRMS from APQ4-NMOSD and MOGAD. This information may be useful in clinical practice, especially outside the acute phase and when serologic testing is ambiguous or not promptly available. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that selected conventional and advanced brain, cord, and optic nerve MRI and OCT markers distinguish adult patients with RRMS from AQP4-NMOSD and MOGAD.

Prevalence and factors associated with long COVID in adults from Southern Brazil: findings from the PAMPA cohort / Prevalência e fatores associados à COVID longa em adultos do Sul do Brasil: achados da coorte PAMPA / Prevalencia y factores asociados con el COVID largo en adultos del Sur de Brasil: hallazgos de la cohorte PAMPA

Abstract: Most COVID-19 survivors have reported experiencing persistent symptoms after the infection - these types of cases are known as long COVID. Since Brazil was an epicenter of the COVID-19 pandemic, a high burden of long COVID is expected. This study aimed to identify the prevalence and factors associated with long COVID in adults in Southern Brazil, analyzing data from the PAMPA cohort. Participants filled out a self-reported online questionnaire in June 2022. This study only included subjects who tested positive for COVID-19. Long COVID was defined by any symptoms that persisted for at least three months after the SARS-CoV-2 infection. Poisson's regression models with robust variance were used to identify factors associated with long COVID; and results were reported as prevalence ratios (PR) and respective 95% confidence intervals (95%CI). A total of 1,001 participants (77.4% women, mean age [SD] = 38.3 [11.9] years) were analyzed. The prevalence of long COVID among these patients was 77.4% (95%CI: 74.7; 79.9). The likelihood of long COVID was higher in unvaccinated participants (PR = 1.23, 95%CI: 1.06; 1.42), in those with chronic conditions (PR = 1.13, 95%CI: 1.04; 1.24), and in those who were hospitalized due to the COVID-19 infection (PR = 1.24, 95%CI: 1.16; 1.32). This prevalence was also higher in women (PR = 1.21, 95%CI: 1.09; 1.33) than in men. Physical activity was associated with a reduced likelihood of fatigue, neurological complications, coughing, and headaches as persistent symptoms after a COVID-19 infection. It was found that three out of four adults in Southern Brazil experienced long COVID. Public policies aiming to reduce the burden of long COVID must be prioritized, especially in groups that are at higher risk of developing this harmful condition.

Resumo: A maior parte dos sobreviventes da COVID-19 relatou sintomas persistentes após a infecção, também conhecida como COVID longa. O Brasil foi um epicentro da pandemia de COVID-19, logo, espera-se uma alta carga de COVID longa. Este estudo teve como objetivo identificar a prevalência e os fatores associados à COVID longa em adultos no Sul do Brasil. Foram analisados dados da coorte PAMPA. Os participantes preencheram um questionário online autoaplicável em junho de 2022. Foram incluídos apenas os participantes que testaram positivo para COVID-19. A COVID longa foi definida como qualquer sintoma que persistiu por pelo menos três meses após a infecção do SARS-CoV-2. Os modelos de regressão de Poisson com variância robusta foram usados para identificar fatores associados à COVID longa; os resultados foram relatados como razão de prevalência (RP) e seus respectivos intervalos de 95% de confiança (IC95%). Ao todo, 1.001 participantes (77,4% mulheres, idade média [DP] = 38,3 [11,9] anos) foram analisados. A prevalência da COVID longa foi de 77,4% (IC95%: 74,7; 79,9). A probabilidade da COVID longa foi maior em participantes não vacinados (RP = 1,23, IC95%: 1,06; 1,42), pessoas com condições crônicas (RP = 1,13, IC95%: 1,04; 1,24), e pacientes hospitalizados devido à infecção por COVID-19 (RP = 1,24, IC95%: 1,16; 1,32) em comparação com as contrapartes. A prevalência foi maior em mulheres (RP = 1,21, IC95%: 1,09; 1,33) do que em homens. A atividade física foi associada à probabilidade reduzida de fadiga, complicações neurológicas, tosse e dor de cabeça como sintomas persistentes após a infecção por COVID-19. Três em cada quatro adultos no Sul do Brasil tiveram COVID longa. Políticas públicas que visem reduzir a carga da covid longa devem ser priorizadas, especialmente nos grupos de maior risco desta condição.

Resumen: La mayoría de los supervivientes de la COVID-19 relató síntomas persistentes tras la infección, también conocida como COVID largo. Brasil fue un epicentro de la pandemia de COVID-19, así, se espera una alta carga de COVID largo. El objetivo de este estudio fue identificar la prevalencia y los factores asociados con la COVID largo en adultos en el Sur de Brasil. Se analizaron datos de la cohorte PAMPA. Los participantes rellenaron un cuestionario en línea autoadministrado en junio de 2022. Solo se incluyeron los participantes que dieron positivo para COVID-19. La COVID largo fue definida como cualquier síntoma que persistió durante al menos tres meses tras la infección del SARS-CoV-2. Se utilizaron los modelos de regresión de Poisson con varianza robusta para identificar factores asociados con el COVID largo; se relataron los resultados como razón de prevalencia (RP) y sus respectivos intervalos de 95% confianza de 95% (IC95%). En total, se analizaron 1.001 participantes (el 77,4% mujeres, edad media [DP] = 38,3 [11,9] años). La prevalencia del COVID largo fue del 77,4% (IC95%: 74,7; 79,9). La probabilidad del COVID largo fue más alta en participantes no vacunados (RP = 1,23, IC95%: 1,06; 1,42), personas con condiciones crónicas (RP = 1,13, IC95%: 1,04; 1,24) y pacientes hospitalizados debido a la infección por COVID-19 (RP = 1,24, IC95%: 1,16; 1,32) en comparación con sus contrapartes. La prevalencia fue más alta en mujeres (RP = 1,21, IC95%: 1,09; 1,33) que en hombres. La actividad física se asoció con la probabilidad reducida de fatiga, complicaciones neurológicas, tos y dolor de cabeza como síntomas persistentes tras la infección por COVID-19. Tres de cada cuatro adultos en el Sur de Brasil han tenido COVID largo. Se deben priorizar las políticas públicas destinadas a reducir la carga del COVID largo, sobre todo en los grupos de mayor riesgo para esta condición.

A comparison between carbon footprint of water production facilities in the Canary Islands: groundwater resources vs. seawater desalination.

The Canary Islands have a water culture tied to the exploitation of their groundwater by means of wells and water galleries. However, the growth of tourism, the increase in the local population and the development of agriculture have led to the emergence of new ways of obtaining water, such as the desalination of seawater. The presence of these desalination plants covers the entire archipelago except for the island of La Palma, and sometimes they function as a complement to water needs, while in other cases they are the only source of drinking water available. To study the environmental impact of the production of drinking water through the exploitation of the aquifer and the desalination of seawater, the carbon footprint methodology was used following the guidelines of the GHG Protocol. The result has shown that seawater installations have the largest carbon footprint, mainly due to the high electricity consumption in the islands and the electricity mix of the archipelago which, as it does not rely entirely on renewable energy sources, increases CO2 emissions into the atmosphere due to the production of drinking water in the islands.

Hip abduction machine is better than free weights to target the gluteus medius while minimizing tensor fascia latae activation.

INTRODUCTION: Changes in the lower extremities' biomechanics are associated with gluteus medius (GMed) weakness and increased tensor fascia latae (TFL) activation. OBJECTIVE: To determine which exercises produce greater GMed activity while minimizing TFL activation during the concentric and eccentric phases of three single-joint strengthening exercises. DESIGN: Controlled laboratory study. SETTING: Laboratory. PARTICIPANTS: Eleven males (age: 29.18 ± 4.51 years; body mass: 84.01 ± 14.48 kg; height: 1.74 ± 0.07 m; body fat: 16.34 ± 3.33%). MAIN OUTCOME MEASURES: GMed and TFL activation and activation ratio while performing ten maximal repetitions of three exercises: side-lying hip abduction (SLHA); clamshell (CLAM) and hip abductor machine (HAM). RESULTS: GMed activation was greater than TFL in all exercises in both concentric and eccentric phases. There were no differences in GMed activation between the three exercises in both phases. TFL activation was greater in SLHA compared to HAM and CLAM during both phases. In both concentric and eccentric phases, GMed:TFL ratio was greater in HAM compared to CLAM and SLHA. CONCLUSIONS: GMed had increased activation compared to TFL in all analyzed exercises. Considering GMed:TFL ratio, if the goal is to preferentially activate GMed while minimizing TFL activation, the hip abductor machine seems to be the best exercise.

Reliability of knee extensor neuromuscular structure and function and functional tests' performance.

INTRODUCTION: The aim of this study was to evaluate the intra and inter-rater and inter-analyzer reliability of neuromuscular variables and functional tests. METHODS: Cross-sectional crossover design. Two independent raters and analyzers evaluated twenty-two healthy subjects. Knee-extensor strength was assessed from three maximal voluntary isometric contractions. Muscle activation was obtained from the vastus lateralis (VL), rectus femoris (RF), and vastus medialis (VM) muscles. VL and RF muscles' architecture [fascicle length (FL), pennation angle (PA), muscle thickness (MT)] was obtained at rest by ultrasound. The time from five sit-to-stand (STS) trials, and the distance from the 6-min walk test (6MWT) were obtained. Intraclass correlation coefficient was determined and classified as strong (r = 0.75-1.00), moderate (r = 0.40-0.74), and weak (r < 0.40). RESULTS: Strong intra-rater reliability values were observed for strength (r = 0.97), muscle activation [VL (r = 0.91); RF (r = 0.92); VM (r = 0.80)], VL [FL (r = 0.90); PA (r = 0.94); MT (r = 0.99)] and RF [MT (r = 0.85)] muscle architecture, STS (r = 0.95), and 6MWT (r = 0.98). Inter-rater reliability also presented strong values for strength (r = 0.97), muscle activation [VL (r = 0.94); RF (r = 0.79); VM (r = 0.78)], muscle architecture VL [PA (r = 0.81) and MT (r = 0.88)] and RF [MT (r = 0.80)], STS (r = 0.93), and 6MWT (r = 0.98). A moderate correlation VL muscle architecture [FL (r = 0.69)]. Inter-analyzer muscle architecture reliability presented strong VL [FL (r = 0.77); PA (r = 0.76); MT (r = 0.91)] and RF [MT (r = 0.99)]. CONCLUSION: The high intra and inter-rater and inter-analyzer reliability values for most variables is evidence that they can be used for clinical evaluation. Muscle architecture might need a longer training period by different raters and analyzers to increase reliability.

Páncreas ectópico, una posible y rara causa de hipoglucemia postprandial / Ectopic pancreas, a possible rare cause of postprandial hypoglycemia

Introducción: El páncreas ectópico es la segunda anomalía congénita pancreática más frecuente después del páncreas divisum. Fue descrito por primera vez en 1729 por Schultz y se define como la presencia de tejido pancreático que carece de comunicación anatómica o vascular con el cuerpo principal del páncreas. La localización más frecuente es en el estómago (25 - 38 por ciento), seguido de duodeno, yeyuno e íleon. El 40 por ciento de los casos son sintomáticos y es más frecuente su presentación en varones en torno a la 5ª y 6ª década de la vida. Objetivo: Presentar un caso de páncreas ectópico diagnosticado a través de un estudio histológico tras realizada la cirugía. Presentación de caso: Presentamos el caso de una paciente compatible con hipoglucemia y cuyo estudio definitivo mostró la presencia de tejido pancreático ectópico en estómago, con resolución completa de los síntomas tras tratamiento quirúrgico. La anatomía patológica mostró una lesión nodular tumoral benigna (2,5 cm), constituida por tejido pancreático heterotópico, con presencia de páncreas exocrino con acinos. Páncreas endocrino con presencia de islotes de Langerhans y componente epitelial con ductos. Afectación desde la submucosa hasta la subserosa, con una pared muscular propia con hiperplasia muscular en relación a la heterotopía pancreática. La mucosa gástrica mostraba inflamación crónica leve con escasos folículos linfoides. Conclusiones: La presencia de páncreas ectópico es una entidad poco frecuente, pero a tener en cuenta en pacientes con clínica de hipoglucemia, una vez descartadas otras causas. No existe consenso con respecto a indicaciones en el manejo de lesiones pequeñas y asintomáticas, por lo que se recomienda individualizar cada caso teniendo en cuenta el tamaño, la localización y el tipo histológico(AU)

Introduction: Ectopic pancreas is the second most frequent congenital anomaly after pancreas divisum. It was described for the first time in 1729 by Schultz and it is defined as the presence of pancreatic tissue with no anatomical or vascular communication with the main body of pancreas. The most common location is in the stomach (25-38 percent), followed by the duodenum, jejunum and ileum ones. 40 percent of the cases are symptomatic and is more frequent their presentation in males in the fifth or sixth decade of life. Objective: To present a case of ectopic pancreas diagnosed through a histological study after surgery. Case presentation: Case of a patient with clinical features compatible with hypoglycemia that after being studied showed the presence of ectopic pancreatic tissue in the stomach, with a complete solution of the symptoms after surgical treatment. The pathological anatomy showed a benign tumor nodular lesion (2.5 cm), made up of heterotopic pancreatic tissue, with the presence of exocrine pancreas with acini. Endocrine pancreas with the presence of islets of Langerhans and epithelial component with ducts. Involvement from the submucosa to the subserosa, with a proper muscular wall with muscular hyperplasia in relation to pancreatic heterotopia. The gastric mucosa showed mild chronic inflammation with few lymphoid follicles. Conclusions: The presence of ectopic pancreas is a rare condition, but it should be taken into account in patients with clinical features of hypoglycemia once ruled out other causes. There is no consensus in regards to the indications for the management of small and asymptomatic lesions, so, it is recommended to individualize each case taking into account the size, location and histological type(AU)

Access to treatment for chronic kidney disease by children and adolescents in Brazil.

BACKGROUND: This study aimed to identify main factors associated with child and adolescent access to chronic kidney disease (CKD) treatment in Brazil. METHODS: Multi-center cross-sectional study conducted in eight pediatric nephrology centers across all Brazilian geographic regions. Information was collected on characteristics associated with referral and treatment of patients with CKD. The following outcomes were analyzed as follows: (1) age at first consultation, and (2) time elapsed between referral and treatment at the specialized service. RESULTS: Three hundred thirty-five children were assessed. Variables associated with age at first consultation were as follows: CAKUT (HR=1.7; 95%CI 1.3-2.2, p<0.01); private health plan (HR=1.54; 95%CI 1.06-2.23, p=0.02); modified Medical Outcomes Study Social Support Survey mMOS-SS score (HR=1.02; 95%CI 1.00-1.03, p=0.024); maternal age (HR=0.96; 95%CI 0.95-0.97, p<0.01); and number of siblings in the household (HR=0.86; 95%CI 0.79-0.83, p<0.01). Significant variables associated with time elapsed between referral and treatment at the specialized service were as follows: each additional occupant sharing the household (HR=0.94; 95%CI:0.89-0.99, p=0.02), residing in the Northeast (HR=0.81; 95%CI:0.67-0.98, p=0.03) and having someone to take them to the physician (HR=1.36; 95%CI 1.07-1.74, p=0.01). The median time interval between patient referral and treatment by the service was 11 days (IQR 10-31). CONCLUSION: There are potentially modifiable factors hampering access of children with CKD to specialized treatment. The importance of the role of social support for the two outcomes should serve as an alert for health managers and professionals to consider this aspect throughout all steps of the care process of children with CKD.

Alternating Current Is More Fatigable Than Pulsed Current in People Who Are Healthy: A Double-Blind, Randomized Crossover Trial.

OBJECTIVE: Tolerance level and rapid fatigue onset are limitations in the use of neuromuscular electrical stimulation (NMES) as an electrotherapeutic resource in rehabilitation and training protocols; however, it is unclear if pulsed current (PC) and alternating current (AC) produce different fatigue levels when applied at submaximal contraction level. The purpose of this study was to compare fatigue and discomfort levels between PC and AC during a submaximal contraction protocol in people who are healthy. METHODS: In this double-blind, randomized crossover trial conducted in a laboratory setting, 30 male volunteers [23.23 years of age (SD = 4.59)] performed 2 submaximal fatigue protocols (with a 7-day interval) in a randomized order: PC (pulse duration = 2 milliseconds, pulse frequency = 100 Hz) and AC (2.5 kHz, pulse duration = 0.4 milliseconds, burst frequency = 100 Hz). NMES currents were applied to the knee extensor motor point of the dominant limb. The NMES protocol consisted of 80 evoked contractions (time on:off = 5:10 seconds) and lasted 20 minutes. The current was maintained at a constant intensity throughout the NMES protocol. The primary outcome measures were maximal voluntary isometric contraction, fatigue index (evoked torque decline), fatigability (number of contractions for a 50% drop in evoked-torque from the protocol start), total evoked torque-time integral (TTI), decline in TTI, and discomfort level. RESULTS: AC at 2.5 kHz demonstrated higher maximal voluntary isometric contraction decline post-fatigue, higher fatigue index, higher fatigability (ie, fewer contractions to reach the 50% evoked torque decline from the protocol start), smaller total TTI, and higher TTI decline compared with PC. No between-currents difference was observed in discomfort level. CONCLUSION: PC is less fatigable than AC at 2.5 kHz. IMPACT: Based on this study, PC is the preferred current choice when the NMES goal is to generate higher muscle work, higher mechanical load, and smaller fatigability during training both for athletes who are healthy and for rehabilitation programs for people with disease or injury.

Integrated care to address child and adolescent health in the 21st century: A clinical review.

Background: Increasing specialisation and technical sophistication of medical tools across the 21st century have contributed to dramatic improvements in the life-expectancy of children and adolescents with complex physical health problems. Concurrently, there is growing appreciation within the community of the extent that children and adolescents experience mental disorders, which are more prevalent in those with complex chronic, serious or life-limiting health conditions. In this context, there are compelling reasons for paediatric services to move to a model of care that promotes greater integration of child psychiatry within the medical, somatic teams that care for children and adolescents in children's hospitals. Aims: In this article, we discuss the range of medical disorders managed by contemporary paediatrics. Materials and Methods: We conducted a broad review of the literature and existing services, and use individual accounts to illustrate adolescents' healthcare preferences in the context of the challenges they experience around their mental health. Results: Relevant disorders include life-limiting disorders, such as cancer; disorders involving the brain, such as epilepsy; common chronic disorders, such as asthma and diabetes; psychiatric emergencies, such as deliberate self-harm; and conditions that most commonly present to paediatric services, but where psychiatric input is required, such as severe eating disorders, somatic symptom disorders and gender dysphoria. The persisting legacy of the historical separation of physical and mental health services is described. Yet there are many models of service integration that can promote more collaborative care between psychiatrists and medical specialists, including some which have been taken to scale. Discussion: In essence, clinical teams in children's hospitals require more collaborative approaches that facilitate early recognition and treatment of the psychological aspects of illness as an integral part of patient-centred, family-focussed paediatric care, rather than as something that is bolted on when things go wrong. Conclusion: Whilst trust and goodwill between services and providers will be required for novel models of care to be implemented, evaluation of these new models and incorporation of young people's healthcare preferences is needed.

Effectiveness of lanreotide autogel 120 mg at extended dosing intervals for acromegaly.

PURPOSE: Recent data indicate that extended dosing intervals (EDIs) with lanreotide autogel 120 mg are effective and well-received among patients with acromegaly who have achieved biochemical control with monthly injections of long-acting somatostatin analogues (SSAs). We further evaluated the effectiveness of lanreotide autogel 120 mg delivered at EDIs (>4 weeks) in routine clinical practice. METHODS: Cross-sectional, multicentre, observational study conducted to determine the effectiveness-measured by control of serum insulin-like growth factor 1 (IGF-1)-of lanreotide autogel 120 mg at dosing intervals >4 weeks for ≥6 months in selected patients with acromegaly treated in routine clinical practice (NCT02807233). Secondary assessments included control of growth hormone (GH) levels, treatment adherence, patient satisfaction, and quality of life (QoL) using validated questionnaires (EQ-5D, AcroQoL, and TSQM-9). Patients who received radiotherapy within the last 6 months were excluded. RESULTS: Among 109 patients evaluated, mean (SD) age was 59.1 (13.2) years. IGF-1 values were normal (mean [SD]: 175.0 [74.5], 95% CI: 160.8 -189.1) in 91.7% of cases and normal in 91.4% of patients without previous radiotherapy treatment (n = 81). GH levels were ≤2.5 and ≤1 ng/mL, respectively, in 80.6% and 58.3%. Most patients were treated either every 5-6 (57.8%) or 7-8 weeks (38.5%), with 2.8% treated greater than every 8 weeks. The mean AcroQoL score was 63.0 (20.1). The mean global treatment satisfaction score (TSQM-9) was 75.1 (16.6). Treatment adherence (defined as no missed injections) was 94.5%. CONCLUSION: Lanreotide autogel 120 mg at intervals of >4 weeks provided IGF-1 control in more than 90% of patients with acromegaly. Treatment satisfaction and adherence were good. These findings support use of extended dosing intervals in patients who have achieved good biochemical control with long-acting SSAs.

Implication of gestational diabetes treatment on maternal weight gain and low neonatal weight: a large retrospective cohort study / Implicación del tratamiento de la diabetes gestacional en el aumento de peso materno y bajo peso neonatal: gran estudio de cohorte retrospectivo

Objective: the treatment for gestational diabetes is based on diet, and this may modify maternal weight gain. The limited maternal weight gain is related to newborns with small weight for their gestational age (SGA), and many studies have found an increase of SGA in women with gestational diabetes (GD), but the reason for this is not clear. The objective of this study is to evaluate the effects of gestational diabetes treatment on maternal weight gain and neonatal weight. Methods: a retrospective cohort study of 1,765 patients with GD, according to the National Diabetes Data Group (NDDG) criteria. We assessed: pre-pregnancy BMI, total maternal weight gain (MWG), weight gain during the third trimester, gestational week of starting the treatment, and treatment modality (diet or diet plus insulin). Birth weight was adjusted by gestational age and gender: SGA (= 10th) and large for gestational age (LGA) ( > 90th). Results: the percentage of newborns with weight percentile = 10 was 14.8%. The diet and the time of initiation of the treatment were related to maternal weight gain (MWG) in the third trimester. For every 1 kcal/kg of variation in the diet (increase or decrease), a MWG variation of 0.03 (0.001-0.06) kg occurred (p < 0.01). For each week before the beginning of treatment, the mother did not gain 0.13 ± [(-0.15) - (-0.11)] kg in the third trimester (p < 0.01). The SGA was related to the lowest MWG in total gestation: 7.0 (IQR 3.0-10.4) kg vs. 8.4 (IQR 5.0-11.6) kg (p < 0.01), and in the third trimester: 0.3 (IQR -0.9-1.5) kg vs. 0.9 (IQR -0.3-2.2) kg (p < 0.01). Conclusion: the dietary treatment for gestational diabetes leads to a lower maternal weight gain and induces an impact on neonatal weight

Objetivo: el tratamiento para la diabetes gestacional se basa en la dieta y esto puede modificar el aumento de peso materno. Un aumento de peso materno limitado está relacionado con recién nacidos con bajo peso para su edad gestacional (SGA). Muchos estudios han encontrado un aumento de niños con bajo peso en mujeres con diabetes gestacional, pero la razón de esto no está clara. El objetivo de este estudio es evaluar los efectos del tratamiento de la diabetes gestacional sobre el aumento de peso materno y el peso neonatal. Métodos: estudio de cohortes retrospectivo en 1765 pacientes con diabetes gestacional, según los criterios de los National Diabetes Data Groups (NDDG). Evaluamos: IMC antes del embarazo, aumento de peso materno total (MWG), aumento de peso durante el tercer trimestre, semana gestacional de inicio del tratamiento y modalidad de tratamiento (dieta o dieta más insulina). El peso al nacer se ajustó por edad gestacional y género: SGA (percentil de = 10) y grande para la edad gestacional (LGA) (percentil de > 90). Resultados: el porcentaje de recién nacidos con peso percentil de = 10 fue del 14,8%. La dieta y el momento de inicio del tratamiento se relacionaron con el aumento de peso materno en el tercer trimestre. Por cada 1 kcal/kg de variación en la dieta (aumento o disminución) se produjo una variación de aumento del peso materno de 0,03 (0,001-0.06) kg (p < 0,01). Por cada semana antes de inicio del tratamiento, la madre dejó de ganar 0,13 ± [(- 0,15) - (- 0,11)] kg en el tercer trimestre (p < 0,01). El SGA se relacionó con un aumento de peso materno más bajo en el total de la gestación: 7,0 (IQR 3,0-10,4) kg vs. 8,4 (IQR 5,0-11,6) kg (p < 0,01), y en el tercer trimestre: 0,3 (IQR -0,9-1,5) kg vs. 0,9 (IQR -0,3-2,2) kg (p < 0,01). Conclusión: el tratamiento dietético para la diabetes gestacional puede conducir a un menor aumento de peso materno y a su vez inducir un impacto en el peso neonatal

Implication of gestational diabetes treatment on maternal weight gain and low neonatal weight: a large retrospective cohort study.

INTRODUCTION: Objective: the treatment for gestational diabetes is based on diet, and this may modify maternal weight gain. The limited maternal weight gain is related to newborns with small weight for their gestational age (SGA), and many studies have found an increase of SGA in women with gestational diabetes (GD), but the reason for this is not clear. The objective of this study is to evaluate the effects of gestational diabetes treatment on maternal weight gain and neonatal weight. Methods: a retrospective cohort study of 1,765 patients with GD, according to the National Diabetes Data Group (NDDG) criteria. We assessed: pre-pregnancy BMI, total maternal weight gain (MWG), weight gain during the third trimester, gestational week of starting the treatment, and treatment modality (diet or diet plus insulin). Birth weight was adjusted by gestational age and gender: SGA (≤ 10th) and large for gestational age (LGA) (> 90th). Results: the percentage of newborns with weight ≤ 10 was 14.8 %. The diet and the time of initiation of the treatment were related to maternal weight gain (MWG) in the third trimester. For every 1 kcal/kg of variation in the diet (increase or decrease), a MWG variation of 0.03 (0.001-0.06) kg occurred (p < 0.01). For each week before the beginning of treatment, the mother did not gain 0.13 ± [(-0.15) - (-0.11)] kg in the third trimester (p < 0.01). The SGA was related to the lowest MWG in total gestation: 7.0 (IQR 3.0-10.4) kg vs 8.4 (IQR 5.0-11.6) kg (p < 0.01), and in the third trimester: 0.3 (IQR -0.9-1.5) kg vs. 0.9 (IQR -0.3-2.2) kg (p < 0.01). Conclusion: the dietary treatment for gestational diabetes leads to a lower maternal weight gain and induces an impact on neonatal weight.

INTRODUCCIÓN: Objetivo: el tratamiento para la diabetes gestacional se basa en la dieta y esto puede modificar el aumento de peso materno. Un aumento de peso materno limitado está relacionado con recién nacidos con bajo peso para su edad gestacional (SGA). Muchos estudios han encontrado un aumento de niños con bajo peso en mujeres con diabetes gestacional, pero la razón no está clara. El objetivo es evaluar los efectos del tratamiento de la diabetes gestacional sobre el aumento de peso materno y el peso neonatal. Métodos: estudio de cohortes retrospectivo en 1765 pacientes con diabetes gestacional. Evaluamos: IMC antes del embarazo, aumento de peso materno total, aumento de peso durante tercer trimestre, semana gestacional de inicio y modalidad de tratamiento (dieta o dieta más insulina). El peso al nacer se ajustó por edad gestacional y género: SGA (≤ 10) y grande para la edad gestacional (> 90). Resultados: el porcentaje de recién nacidos con peso ≤ 10 fue 14,8%. La dieta y el momento de inicio del tratamiento se relacionaron con aumento de peso materno en el tercer trimestre. Por cada 1 kcal/kg de variación en dieta (aumento o disminución) se produjo una variación de aumento del peso materno de 0,03 (0,001-0,06) kg (p < 0,01). Por cada semana antes de inicio del tratamiento la madre dejó de ganar 0,13 ± [(- 0,15)-(- 0,11)] kg en el tercer trimestre (p < 0,01). El SGA se relacionó con un aumento de peso materno más bajo en el total de la gestación: 7,0 (IQR 3,0-10,4) kg versus 8,4 (IQR 5,0-11,6) kg (p < 0,01), y en el tercer trimestre: 0,3 (IQR -0,9-1,5) kg vs. 0,9 (IQR -0,3-2,2) kg (p < 0,01). Conclusión: el tratamiento dietético para la diabetes gestacional puede conducir a un menor aumento de peso materno y a su influir en el peso neonatal.

Development of a risk score for earlier diagnosis of chronic kidney disease in children.

OBJECTIVE: To develop a clinical score for the early identification of chronic kidney disease (CKD) in children and adolescents. The early diagnosis of CKD in childhood allows the adoption of measures to slow the progression of the disease, thereby reducing morbidity and mortality. Nevertheless, the diagnosis is often made too late for proper patient management. STUDY DESIGN: We preformed a case-control study of a multicenter Brazilian sample of 752 pediatric patients; the study cases (n = 376) were CKD patients with a median estimated GFR of 37 (IQR = 22 to 57) ml/min/1.73 m2. The control group (n = 376) comprised age-, gender- and center-matched children who were followed for nonrenal diseases. Potential risk factors were investigated through a standard questionnaire that included symptoms, medical history, and a clinical examination. Two multivariable models (A and B) were fitted to assess predictors of the diagnosis of CKD. RESULTS: In model A, 9 variables were associated with CKD diagnosis: antenatal ultrasound with urinary malformation, recurrent urinary tract infection, polyuria, abnormal urine stream, nocturia, growth curve flattening, history of hypertension, foamy urine and edema (c-statistic = 0.938). Model B had the same variables as model A, except for the addition of the history of admission during the neonatal period and the exclusion of antenatal ultrasound variables (c-statistic = 0.927). CONCLUSIONS: The present scores may serve as a warning sign for CKD diagnosis in children among professionals working in the primary care setting where the symptoms associated with a risk of CKD may be overlooked.