RESUMEN
Sport climbing is increasingly popular and consultations by climbers in hand surgery departments are on the increase. The pathologies related to this sport concern essentially the pulley system, tendons being rarely affected. We report the case of a male climber who presented an atypical rupture of the flexor superficialis tendon in his left middle finger sustained when using an atypical climbing grip technique: the "hook grip". This consists in extension of the metacarpophalangeal joints and maximal flexion of the proximal interphalangeal joints with force exerted only on middle phalanx of the middle finger. A biomechanical analysis using finger musculoskeletal modeling was performed to compare the hook grip to other grips, and the patient's recovery performance was assessed. Adapted functional treatment with physiotherapy seems to have been a good option for the treatment of this atypical lesion since the patient recovered normal use of his finger in daily life. He recovered maximal force in climbing holds. The biomechanical analysis confirmed that the atypical "hook grip" was likely at the origin of the rupture, since flexor digitorum superficialis tendon force for this grip is greater than in other climbing grip techniques. The "hook grip" seems to be dangerous and should be used cautiously by climbers to prevent similar pathology. Additionally, the patient should henceforth be careful when climbing, since the biomechanical model showed that the remaining flexor digitorum profundus tendon was overused.
Asunto(s)
Traumatismos de los Tendones , Dedos , Humanos , Masculino , Rango del Movimiento Articular , Rotura , Traumatismos de los Tendones/cirugía , Tendones/cirugíaRESUMEN
Our objective was to evaluate the efficacy of a vaccine against staphylococcal mastitis in 5 dairy sheep farms, with 316 ewes in the vaccinated (V) group and 307 in the control (C) group studied throughout a lactation period. Two administrations of the vaccine were performed during the last stage of gestation of ewes. Starting 15 d after lambing and at monthly intervals thereafter, up to 9 milk samplings were performed for bacteriological and cytological examinations. Staphylococcal isolates recovered were examined for biofilm formation. Blood samples were collected for measurement of IgG poly-N-acetylglucosamine-specific antibodies. The most frequently isolated bacteria were staphylococci: 56.4 and 76.1%, respectively, of total isolates recovered from ewes of group V and C, respectively; staphylococci as causal agents of mastitis were isolated less frequently from V (5.3%) than in ewes in C (10.3%). Among mastitis-associated staphylococcal isolates recovered from V ewes, a smaller proportion was biofilm-forming than among ones from C: 53.2% versus 74.9% of isolates; biofilm-forming staphylococci as causal agents of mastitis were isolated less frequently from ewes in group V (2.3%) than in ewes in group C (6.0%). Anti-poly-N-acetylglucosamine-specific antibody values increased in V ewes and were higher than in C; a greater proportion of ewes with low antibody titers developed staphylococcal mastitis (41.4%) than of V ewes with high antibody titers (17.0%). Incidence risk of mastitis, staphylococcal mastitis, and biofilm-associated staphylococcal mastitis was smaller in V than in C: 36.7, 17.1, and 8.0% versus 44.3, 30.9, and 18.9%, respectively. The first case of staphylococcal mastitis occurred later in V than in C: third versus second sampling point. Overall, efficacy of the vaccine was 44.6% for staphylococcal mastitis, 57.7% for biofilm-associated staphylococcal mastitis, 33.1% for staphylococcal intramammary infection, and 51.5% for biofilm-associated staphylococcal intramammary infection. Nevertheless, vaccination should not be the only means for controlling mastitis; other udder health management measures should be included therein to improve control of the infection.
Asunto(s)
Vacunas Bacterianas/administración & dosificación , Biopelículas , Mastitis/veterinaria , Enfermedades de las Ovejas/prevención & control , Infecciones Estafilocócicas/veterinaria , Animales , Femenino , Incidencia , Lactancia , Glándulas Mamarias Animales/microbiología , Mastitis/prevención & control , Leche/microbiología , Distribución Aleatoria , Ovinos , Enfermedades de las Ovejas/microbiología , Infecciones Estafilocócicas/prevención & controlRESUMEN
The objectives of this work were (1) to investigate prevalence of subclinical mastitis, (2) to identify etiological agents involved, and (3) to study factors potentially predisposing ewes to subclinical mastitis. Milk samples were collected from 2,198 ewes in 111 farms with a total population of 35,925 ewes, in all 13 administrative regions of Greece, for bacteriological and cytological examination. Prevalence of subclinical mastitis was 0.260. Main etiological agents were staphylococci (Staphylococcus aureus and coagulase-negative species), which accounted for 0.699 of all isolates recovered; prevalence of staphylococcal mastitis was 0.191. In a multivariable mixed-effects analysis, the primary factor found to be associated with increased prevalence of subclinical mastitis was the management system practiced in flocks (flocks under a semi-intensive system had the highest prevalence). Other factors that were included in the multivariable model were the stage of lactation period (ewes in the 2nd month postpartum showed the highest prevalence) and application of postmilking teat dipping. In contrast, measures taken at the end of a lactation period (e.g., intramammary administration of antimicrobial agents) were not found to have an effect on prevalence of subclinical mastitis. The results confirmed the significance of subclinical mastitis as a frequent problem of ewes, with staphylococci as the primary etiological agent. The findings confirm the multifactorial nature of subclinical mastitis and indicate that its control should rely on many approaches.
Asunto(s)
Mastitis/veterinaria , Leche/microbiología , Enfermedades de las Ovejas/diagnóstico , Infecciones Estafilocócicas/veterinaria , Animales , Femenino , Grecia/epidemiología , Mastitis/diagnóstico , Mastitis/epidemiología , Ovinos , Enfermedades de las Ovejas/epidemiología , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/epidemiología , StaphylococcusRESUMEN
BACKGROUND: Acute dyspnea is a common symptom in the ED. The standard approach to dyspnea often relies on radiologic and laboratory results, causing excessive delay before adequate therapy is started. Use of an integrated point-of-care ultrasonography (PoCUS) approach can shorten the time needed to formulate a diagnosis, while maintaining an acceptable safety profile. METHODS: Consecutive adult patients presenting with dyspnea and admitted after ED evaluation were prospectively enrolled. The gold standard was the final diagnosis assessed by two expert reviewers. Two physicians independently evaluated the patient; a sonographer performed an ultrasound evaluation of the lung, heart, and inferior vena cava, while the treating physician requested traditional tests as needed. Time needed to formulate the ultrasound and the ED diagnoses was recorded and compared. Accuracy and concordance of the ultrasound and the ED diagnoses were calculated. RESULTS: A total of 2,683 patients were enrolled. The average time needed to formulate the ultrasound diagnosis was significantly lower than that required for ED diagnosis (24 ± 10 min vs 186 ± 72 min; P = .025). The ultrasound and the ED diagnoses showed good overall concordance (κ = 0.71). There were no statistically significant differences in the accuracy of PoCUS and the standard ED evaluation for the diagnosis of acute coronary syndrome, pneumonia, pleural effusion, pericardial effusion, pneumothorax, and dyspnea from other causes. PoCUS was significantly more sensitive for the diagnosis of heart failure, whereas a standard ED evaluation performed better in the diagnosis of COPD/asthma and pulmonary embolism. CONCLUSIONS: PoCUS represents a feasible and reliable diagnostic approach to the patient with dyspnea, allowing a reduction in time to diagnosis. This protocol could help to stratify patients who should undergo a more detailed evaluation.
Asunto(s)
Disnea/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Corazón/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Vena Cava Inferior/diagnóstico por imagen , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Asma/complicaciones , Asma/diagnóstico por imagen , Disnea/etiología , Servicio de Urgencia en Hospital , Femenino , Cardiopatías/complicaciones , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico por imagen , Humanos , Enfermedades Pulmonares/complicaciones , Masculino , Persona de Mediana Edad , Derrame Pericárdico/complicaciones , Derrame Pericárdico/diagnóstico por imagen , Derrame Pleural/complicaciones , Derrame Pleural/diagnóstico por imagen , Neumonía/complicaciones , Neumonía/diagnóstico por imagen , Neumotórax/complicaciones , Neumotórax/diagnóstico por imagen , Sistemas de Atención de Punto , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico por imagen , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico por imagen , Tiempo , UltrasonografíaAsunto(s)
Hemorragia Posparto , Trastornos de la Coagulación Sanguínea/epidemiología , Transfusión Sanguínea/estadística & datos numéricos , Países Desarrollados , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Incidencia , Italia/epidemiología , Mortalidad Materna , Hemorragia Posparto/epidemiología , Hemorragia Posparto/etiología , Hemorragia Posparto/terapia , Embarazo , Complicaciones Hematológicas del Embarazo/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVES: To compare the effect of a soy rich diet and hormone replacement therapy (HRT) on the main biomarkers of bone turnover and bone mineral density (BMD) at postmenopausal age. METHODS: 187 healthy asymptomatic postmenopausal women, aged 39-60, were recruited and randomized into a soy rich diet group, a HRT group, and a control group. Bone biomarkers and BMD were evaluated at baseline and after 6 months at the end of the study. RESULTS: Diet is not as effective as HRT in reducing the postmenopausal turnover; however diet stimulates bone osteoblastic activity, as evidenced by significant increase in osteocalcin concentrations. BMD decreases significantly only in the control group, but not in the intervention groups. CONCLUSIONS: Our data suggest that soy products could be effective in reducing the risk of osteoporosis in asymptomatic postmenopausal women, but our findings should be confirmed before recommending the diet as a valid alternative to HRT.
Asunto(s)
Estrógenos no Esteroides/uso terapéutico , Glycine max , Osteoporosis Posmenopáusica/prevención & control , Fitoterapia , Adulto , Biomarcadores/análisis , Densidad Ósea/efectos de los fármacos , Remodelación Ósea/efectos de los fármacos , Colágeno/análisis , Colágeno Tipo I , Terapia de Reemplazo de Estrógeno , Femenino , Humanos , Hidroxiprolina/análisis , Isoflavonas/uso terapéutico , Persona de Mediana Edad , Osteocalcina/análisis , Osteoporosis Posmenopáusica/diagnóstico , Osteoporosis Posmenopáusica/dietoterapia , Péptidos/análisis , Fitoestrógenos , Preparaciones de PlantasRESUMEN
Individualizing risk factors is the most important tool to prevent late consequences of menopause. Celiac disease is a predisposing condition not very considered for some postmenopausal diseases, such as postmenopausal osteoporosis. In this review the authors examine climacteric conditions that could be heightened by a celiac status especially if disregarded and untreated.
Asunto(s)
Enfermedad Celíaca/complicaciones , Osteoporosis Posmenopáusica/etiología , Femenino , HumanosRESUMEN
BACKGROUND: To value the level of acceptance of the Memphis Study, (a random clinical study suggested verifying the efficacy of a diet enriched with phytoestrogens to prevent menopausal problems), and underlining the reasons which induce the acceptance or refusal of the study. STUDY DESIGN: Prospective study. METHODS: Meeting groups have been held with 82 women needing Day Hospital treatment for Menopause at III Department of Obstetrics and Gynecology of the University of Bari. The features of women and the reasons that induce these++ acceptance or refusal of the study were valued by an anonymous questionnaire with a precoded reply. RESULTS: 92.9% of the women accepted participation in the study. The main reasons for acceptance were: 1) believing that the study was drawn up for women; 2) it was done by expert physicians; 3) it was not done for financial gain. The random standard was the main reason for refusal. CONCLUSIONS: With this method we had a very high acceptance, talking over the goals and problems that study aimed to address and to resolve. The chance offered to judge the reliability and competence of physicians is important.
Asunto(s)
Selección de Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Adulto , Femenino , Humanos , Persona de Mediana Edad , Cooperación del Paciente , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
BACKGROUND: To verify the availability of foods containing phytoestrogens, the quality of available products, the degree of knowledge of these foods by dealers, the willingness of dealers to give cooperation in preparation of the MENFIS study, a study assessing the efficacy of a phytoestrogen rich diet on the long term effects of menopause. METHODS: Perspective research by questionnaires carried out in the herbalist's shops of Bari. RESULTS: For the aims of the study the herbalist's shops resulted in being the most suitable, because they were the most supplied with these products and with natural foods, with a high degree of knowledge of these foods and a helpfulness towards the users, perhaps because of the strong motivation towards this type of diet. CONCLUSIONS: The easy availability of these products, the good preparation of managers of the herbalist's shops and their good experience is a sound basis for those intending to start dietary programs with phytoestrogen rich foods.
Asunto(s)
Estrógenos no Esteroides/análisis , Análisis de los Alimentos , Isoflavonas , Dieta , Conducta Alimentaria , Femenino , Humanos , Menopausia , Fitoestrógenos , Preparaciones de PlantasRESUMEN
Food phytestrogens and prevention of postmenopausal osteoporotic and cardiovascular disease. Phytestrogens are diphenolic compounds, widely found in plants and foods, with structural and biological estrogen-like similarities. Their anti-estrogenic effects are well known and studied due to the possibility to prevent some tumors such as breast and prostate cancer. In menopause they have an estrogenic-like action on lipidic and bone metabolism. Phytestrogens rich foods can positively affect the postmenopausal osteoporotic and cardiovascular pathology.