Immobilization, Lymphedema, and Obesity are Predictive Factors in the Development of Adhesive Capsulitis in Breast Cancer Patients

OBJECTIVE

 Adhesive capsulitis is a condition characterized by shoulder pain and stiffness. Breast cancer treatment has been linked to the development of this condition, but its mechanisms are still little known. This study's objective was to identify predictors factors associated with the development of adhesive capsulitis in breast cancer patients.

METHODS

 A case control study was performed with women undergoing treatment for breast cancer in a single center. The sampling was nonprobabilistic and consecutive. Adhesive capsulitis was defined as constant pain associated with decreased active and passive shoulder movement in anterior elevation, external rotation at 0°/90° abduction, and internal rotation at 90° abduction. The study group consisted of patients with shoulder pain and range of motion limitations, while the control group consisted of women without any shoulder abnormalities. Sociodemographic and clinical variables were collected. A univariate logistic regression was used to assess the influence of variables on the studied outcome. For p < 0.20, a multivariate logistic regression was used. The probability of null hypothesis rejection was 5%.

RESULTS

 A total of 145 women were assessed, with 39 (26.9%) on the study group and 106 (73.1%) on the control group. The majority was under 60 years old. In the multivariate analysis, variables correlated to the outcome under study were shoulder immobilization (OR = 3.09; 95% CI: 1.33-7.18; p = 0.009), lymphedema (OR = 5.09; 95% CI: 1.81-14.35; p = 0.002), and obesity (OR = 3.91; 95% CI: 1.27-12.01; p = 0.017).

CONCLUSION

 Lymphedema, postsurgery immobilization, and obesity are predictive factors for the development of adhesive capsulitis in breast cancer patients.

Pacientes com capsulite adesiva relatam melhora da funcionalidade pela Classificação Internacional de Funcionalidade, Incapacidade e Saúde e DASH após bloqueios do nervo supraescapular

Objetivo Avaliar a funcionalidade em pacientes com capsulite adesiva submetidos a bloqueio do nervo supraescapular (BNSE).

Métodos Um estudo clínico prospectivo do tipo antes e depois foi realizado em um único centro com pacientes com capsulite adesiva secundária tratados com quatro bloqueios baseados em limites anatômicos. A amostra foi não probabilística, tendo sido obtida após consulta de rotina em ambulatório especializado. Os instrumentos utilizados para avaliação foram a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) e o questionário de Disfunções do Braço, Ombro e Mão (DASH), que foram aplicados antes da intervenção (T0), uma semana após o quarto BNSE (T4), e três após o primeiro BNSE #x0028;T12#x0029;. As médias dos itens da CIF e do DASH nos diferentes tempos (T0 x T4; T4 x T12; e T0 x T12) foram comparadas por meio do teste t pareado. A probabilidade de rejeitar a hipótese nula foi de 5%.

Resultados A amostra foi composta por 25 indivíduos com média de idade de 58,16 anos; 16 eram mulheres. A duração dos sintomas dolorosos variou de 2 a 16 meses, com média de 5,92 meses. A CIF mostrou que todos os domínios já haviam melhorado em T4, à exceção dos fatores ambientais, que só melhoraram aos 3 meses (p = 0,037). Os pacientes já relataram melhora na função do ombro em T4 e mais ainda em T12, ao final da coleta de dados (p = 0,019).

Conclusão A técnica de BNSE é eficaz em pacientes com capsulite adesiva após 4 semanas de aplicação, com melhora da funcionalidade do indivíduo e sua manutenção até 12 semanas.

Avaliação do desempenho dos residentes em ortopedia na prática clínica

Objetivo Avaliar o desempenho de residentes de ortopedia na realização de exames clínicos.

Métodos O Mini-CEX foi aplicado por três docentes em quatro momentos distintos. O instrumento foi adaptado pelos autores para uso em ortopedia, com desenvolvimento de descritores para cada habilidade avaliada. Os supervisores foram treinados pelo pesquisador principal para utilização do Mini-CEX por meio de materiais didáticos e discussões e os descritores do instrumento foram padronizados.

Resultados As pontuações médias obtidas nas quatro avaliações de cada um dos 21 residentes revelaram melhora no desempenho de todas as habilidades entre o primeiro e o quarto encontro.

Conclusões O desempenho dos residentes em ortopedia apresentou evolução satisfatória, com melhora progressiva de todas as habilidades.

Associação de sintomas ansiosos e depressivos em pacientes com capsulite adesiva

Objetivo Avaliar a associação entre sintomas ansiosos e depressivos em pacientes com capsulite adesiva.

Métodos Trata-se de um estudo transversal realizado em centro único de um hospital terciário com pacientes portadores de capsulite adesiva secundária. O grupo controle não apresentava doença do ombro, tireoidopatias e nem ansiedade e/ou depressão. O instrumento utilizado foi a escala hospitalar de ansiedade e depressão. A análise da covariância foi utilizada para comparação dos escores do Hospital Anxiety and Depression Scale (HADS, na sigla em inglês) entre os grupos. O nível de significância foi de 5%.

Resultados A amostra final foi de 17 pacientes (caso) e 27 (controle). Os dados amostrais apresentaram distribuição normal por meio do teste de Shapiro-Wilk (p > 0,05). A instrumento HADS com pontuação > 0,70 (alfa de Cronbach) se mostrou confiável e com boa consistência interna. Os pacientes com capsulite adesiva, no quesito “sintomas ansiosos” (p = 0,019), relataram sintomas no patamar de “duvidosos” (média/desvio padrão = 8,88/4,50). Eles não apresentaram “sintomas depressivos” (média/desvio padrão = 6,41/3,69), apesar do p = 0,015.

Conclusão Existe uma associação positiva “duvidosa” entre sintomas ansiosos e capsulite adesiva, mas negativa para sintomas depressivos.

Association between spirituality/religiousness and quality of life among healthy adults: a systematic review

BACKGROUND

Health-related quality of life (HRQoL) is determined by multiple factors that include components such as spirituality and religiousness (S/R). Even though various systematic reviews have investigated the association between S/R and improved health outcomes in the most different groups, healthy young individuals are seldom addressed.

OBJECTIVE

To assess the association between S/R and HRQoL among young, healthy individuals.

METHODS

Systematic review of papers published in the last ten years and indexed in four academic research databases (PubMed, Web of Science, Cochrane Library, and Scopus) and two gray literature databases. Inclusion criteria were studies assessing S/R and HRQoL using validated instruments and assessing healthy adults (i.e., non-clinical patients, not belonging to any specific group of chronic diseases), aged between 18 and 64 years old.

RESULTS

Ten out of 1,952 studies met the inclusion criteria: nine cross-sectional and one longitudinal cohort study, in which 89% of the participants were college students. Nine studies report a positive association between S/R and HRQoL, while one study did not report any significant association. The main HRQoL domains associated with S/R were the psychological, social relationships, and environment domains, while the S/R most influent facets/components were optimism, inner strength, peace, high control, hope, and happiness.

CONCLUSIONS

Higher S/R levels among healthy adult individuals were associated with higher HRQoL levels, suggesting the S/R can be an important strategy to deal with adverse environmental situations even among those without chronic diseases, enhancing the wellbeing of individuals. Registration of systematic review: PROSPERO-CRD42018104047.

Intestinal microbiota and active systemic lupus erythematosus: a systematic review

BACKGROUND

Systemic Lupus Erythematosus (SLE) is an autoimmune disease, characterized by being multi-systemic and, therefore, reaching various organs and affecting mainly young women. Its pathogenesis comprehends many factors, including the interaction between microbiota and immune system. This systematic review assessed the relationship between intestinal microbiota and SLE in activity, highlighting microbiota representative patterns regarding quantity and diversity.

METHODS

This study considered researches carried out in patients with SLE, with no restriction of age or gender, which fulfilled the classification criteria of either Systemic Lupus International Collaborating Clinic (SLICC), American College of Rheumatology (ACR) or European League Against Rheumatism (EULAR) and used the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) to classify disease in activity or remission were included. The search was carried out from October, 2020 to January, 2021 using the following databases: Medline via Pubmed, Scopus, and Embase. Five papers were included with a total of 288 participants with SLE.

RESULTS

Regarding microbiota in patients with SLE in activity, there was significant increase in the following genera: Lactobacillus, Streptococcus, Megasphaera, Fusobacterium, Veillonella, Oribacterium, Odoribacter, Blautia, and Campylobacter. On the other hand, decrease in Faecalibacterium and Roseburia genera as well as Ruminococcus gnavus species was observed in remission cases, showing differences between the microbiota profile in SLE in activity and in remission.

CONCLUSIONS

Results suggest that dysbiosis may be involved in the disease activity process.

TRIAL REGISTRATION

CRD42021229322 .

Detecção de genes de resistência em bactérias isoladas de piometra em cadelas

A piometra apresenta diversas alterações imunológicas e moleculares que são responsáveis pela inflamação uterina, e a doença pode ser infecciosa ou não. O objetivo deste estudo foi isolar e identificar bactérias no conteúdo uterino de cadelas com piometra, analisar o perfil de suscetibilidade aos antibióticos, detectar a produção de enzimas β-lactamase por testes fenotípicos e genes de resistência aos β-lactâmicos. Dezoito amostras de conteúdo uterino foram coletadas por punção aspirativa. As amostras foram inoculadas em meio bacteriológico e identificadas por testes bioquímicos. Posteriormente, foram realizados testes de antibiograma, triagem para detecção de β-lactamases e PCR em tempo real para detecção de genes de resistência. Escherichia coli, Klebsiella spp., Enterobacter aerogenes, Citrobacter spp., Staphylococcus spp. e Streptococcus spp. foram identificados nas amostras de conteúdo uterino analisadas. No teste de antibiograma, 90,5% dos isolados apresentaram resistência a pelo menos um antibiótico, e destes, 36,8% foram considerados MR, sendo três Staphylococcus spp., três E. coli e uma Klebsiella spp. Sobre a resistência bacteriana aos grupos de antibióticos testados, 38,1% dos isolados foram resistentes a pelo menos um tipo de β-lactâmico, 33,3% à tetraciclina, 19,0% aos aminoglicosídeos e 14,3% às fluorquinolonas, macrolídeos e trimetoprim-sulfametoxazol. No teste fenotípico para detecção da produção de β-lactamase, as amostras de E. coli foram negativas, e Klebsiella spp. foi positiva para a produção de AmpC, que apresentou os genes blaCMY, blaSPM e blaSIM. As bactérias resistentes aos antibióticos representam um grande desafio e, portanto, o suporte laboratorial é essencial, sem o qual o sucesso terapêutico diminui e a morte pode ser inevitável.

Magnetic resonance imaging of the spine in a pediatric population: incidental findings

Abstract Objective: To determine the prevalence of incidental findings on magnetic resonance imaging (MRI) scans of the cervical, thoracic and lumbar spine in a paediatric population. Materials and Methods: We evaluated 190 spinal MRI examinations of patients aged ≤ 18 years of age. The study included only patients for whom complete medical records were available and who underwent complete MRI examination of the cervical, thoracic or lumbar spine, including whole-spine sagittal T2-weighted sequences. Imaging findings not related to the symptom or indication for MRI were considered incidental findings. Results: Of the 190 MRI examinations evaluated, 110 were in women and 80 were in men. The mean age of the study population was 12.46 ± 3.68 years. The main clinical indications for MRI in the sample were lumbago, scoliosis, dorsalgia and cervicalgia. Incidental findings were detected in the cervical, thoracic and lumbar spine in 40 (21.05%), 26 (13.83%) and 43 (22.63%) of the patients, respectively. The most common were (in the cervical spine) reversal/correction of the normal curvature; (in the thoracic spine) intravertebral disc herniation (Schmorl’s node) and disc dehydration; and (in the lumbar spine) disc protrusion (12 cases), Schmorl’s node (5 cases) and spondylolysis (4 cases). Conclusion: Incidental findings on MRI of the spine are less common in the paediatric population than in the adult population. Nevertheless, careful clinical evaluation of paediatric patients with complaints of axial and radiating pain is necessary in order to determine the correlation between symptoms and imaging findings.

Repetitive Transcranial Magnetic Stimulation Improves Depressive Symptoms and Quality of Life of Poststroke Patients-Prospective Case Series Study

Background:

Poststroke depression (PSD) is a serious psychiatric complication often reported after a stroke. Nearly a third of stroke survivors experience depressive symptoms at some point, affecting their functional recovery and quality of life. In recent years, repetitive transcranial magnetic stimulation (rTMS) has been studied by many researchers and found to be a safe supporting tool for the treatment of PSD.

Objective:

We aim to evaluate the effects of rTMS on PSD and on the quality of life of poststroke patients.

Method:

A prospective clinical case series, performed at CRER Rehabilitation, Brazil, between June 2016 and May 2017. A nonprobabilistic sample (n = 15) was divided into 2 groups (excitatory stimulation in F3, n = 8; inhibitory stimulation in F4, n = 7) and underwent 20 sessions of rTMS. Individuals were assessed according to the 17-item Hamilton Depression Rating Scale (HAM-D17) and World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) questionnaire at 3 different moments: baseline, at the end of the treatment, and in a 1-month follow-up meeting.

Results:

Both groups presented a significant change in the score of all WHOQOL-BREF domains and in HAM-D17. In the group that received inhibitory stimulation (F4), score changes were continuous and gradual, comparing the 3 moments. In the excitatory stimulated (F3) group, however, the improvement in scores was more expressive between baseline and the second moment, without significant changes in the follow-up.

Conclusions:

The findings of this clinical study suggest that rTMS can be a promising tool, capable of relieving depressive symptoms and helping in the improvement of poststroke patients’ quality of life.

Acromion fracture and lateral angle of the scapula spine: Case report and literature review

•

Fractures of the scapula are rare, especially in the lateral angle.

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Computed tomography helps to classify fracture types.

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Fractures with risk of bipartition is indicated surgical fixation.

Introduction

Scapular fractures are uncommon and correspond to 0.5–1% of all body fractures. The study objective was to present a rare case report of a fracture (lateral acromion and angle of the scapula spine) and review of the literature on which will greatly contribute to diagnosis and treatment.

Presentation of case

A 74-year-old female patient with comminuted fracture of the acromial process and lateral angle of the spine of the scapula with subacromial space. The patient underwent surgical treatment with open reduction and use of blocked plaque, two plain Steinmann wires 2.0 and local bone graft.

Discussion

Segmental fracture of acromion and spine of the scapula needs early diagnosis for the proper treatment. In our case report, the patient presented fracture of the acromion and lateral angle of the spine of the scapula, classified as Ogawa 1 and 3; Kunt 3; and AO A1, respectively.

Conclusion

Segmental fracture of the acromion and lateral angle of the spine of the scapula with subacromial space reduction requires surgical intervention in order to avoid secondary complications. Early diagnosis favors better prognosis.

Genomics of Klebsiella pneumoniae ST16 producing NDM-1, CTX-M-15, and OXA-232

OBJECTIVES

Genomic characterization of the internationally spread sequence type (ST) 16 carbapenem-resistant Klebsiella pneumoniae.

METHODS

The complete genomes of three carbapenem producing ST16 K. pneumoniae from Italian patients were analysed by single-nucleotide polymorphism-based phylogeny, core genome multilocus sequence typing, resistance, plasmid, and virulence content and compared with ten genomes of ST16 strains isolated in other countries. Plasmids carrying bla_NDM-1 or bla_OXA-232 carbapenemase genes were assembled and sequences were analysed.

RESULTS

The internationally spread ST16 K. pneumoniae clone showed variability in terms of distribution of NDM-1 and OXA-232 type carbapenemases. In some ST16 strains, up to six plasmids can be simultaneously present in the same cell, including ColE-like plasmids carrying bla_OXA-232 and IncF plasmids carrying bla_NDM-1. The differences observed in plasmid, resistance, and virulence content and core genome suggested that there is not a unique, highly conserved ST16 clone, but instead different variants of this lineage circulate worldwide.

CONCLUSIONS

The ST16 K. pneumoniae clone has spread worldwide and may become a high-risk clone.

Patient-reported measures of quality of life and functional capacity in adhesive capsulitis

Objective:

To evaluate patient-reported measures of quality of life and functional capacity in adhesive capsulitis before and after suprascapular nerve block treatment; to analyze the influence of clinical and sociodemographic variables on both the outcome and correlation between the respective instruments.

Method:

A prospective clinical study was performed with adhesive capsulitis patients. Inclusion criteria were clinical diagnosis of adhesive capsulitis and a shoulder imaging test. The WHOQOL-BREF and DASH instruments were administered before and after treatment. A Constant test score of 55 points was used as a cutoff point for discontinuation of treatment. Mean values were compared using paired t-test and Wilcoxon. The Pearson or Spearman coefficients were used for correlation analysis. Multiple linear regression analysis was carried out using variables with p<0.20 as predictors in univariate analysis and WHOQOL domains and DASH as outcomes. The significance level was 5%.

Results:

Forty-three patients were evaluated. The comparison between WHOQOL-BREF and DASH mean values before and after the blocks, p<0.05. DASH correlated negatively with the physical, psychological and environmental WHOQOL-BREF domains. Older patients and those with higher levels of education influenced the improvement in patients' quality of life and functional capacity.

Conclusion:

The improvement of adhesive capsulitis with treatment involves an improvement in quality of life and functional capacity. The greater functional capacity of the shoulder matches a better quality of life for patients. Age and education level are the variables that most influence improvement in quality of life and functional capacity.

Quality of life and functional capacity of patients with adhesive capsulitis: identifying risk factors associated to better outcomes after treatment with nerve blocking

INTRODUCTION

The objectives of this study were to assess the quality of life and functional capacity of adhesive capsulitis patients at the beginning and end of procedure and to identify risk factors associated to better outcomes after treatment with nerve blocking.

METHODS

A prospective cohort study was performed. Inclusion criteria were clinical signs of adhesive capsulitis and disease changes on shoulder imaging exams. The short form of World Health Organization Quality of life and Disabilities of the Arm, Shoulder and Hand questionnaires were administered at the beginning and end of treatment. A score of 55 points or more on the Constant index was used for discontinuation of treatment. We used the Wilcoxon test for paired samples. Multiple regression analysis of Poisson was carried out using exposure variables with p<0.20 in the univariate analysis and the satisfactory quality of life and better functional capability as outcomes. The significance level was 5%.

RESULTS

43 patients were evaluated. For the comparison between medians values at the beginning and end of treatment (physical domain: 46.43-67.86; psychologic domain: 66.67-79.17; social domain: 66.67-75; environment domain: 62.5-68.75; DASH: 64.16-38.33), p was <0.05. Aging (physical/psychologic/DASH), higher educational level (physical/environment/DASH), less severity (only physical) and fewer nerve blocking (only psychologic) were these independent risk factors.

CONCLUSIONS

Quality of life and functional capacity of the patients improve at the end of procedure. Older patients and higher education levels are the risk factors most associated to satisfactory quality of life and better functional capacity after treatment with nerve blocking.

Association between physical activity and vitamin D: A narrative literature review

Summary This narrative review of the medical literature assessed whether outdoor and indoor physical activity would increase the plasma levels of vitamin D. Synthesis of this liposoluble vitamin is mainly mediated by sunlight on the skin, where it is activated to perform its main action, which is to control the serum levels of calcium as soon as the element is absorbed in the intestines, assisting in the regulation of bone metabolism. Physical activity is any body movement that results in energy expenditure, while outdoor physical activity refers to physical activity carried out at public parks or other open spaces, as is the case of the popular practice of taking walks. Exercising outdoors would have both the benefits of physical activity and of sun exposure, namely the synthesis of vitamin D. However, according to the studies analyzed, increased plasma concentration of vitamin D occurs with physical activity both indoors and outdoors.

Correlation between body mass index and faecal microbiota from children

Childhood obesity is an increasing problem at the global level and considered as a risk factor for obesity development and the associated co-morbidities in adult life. In this study, the occurrence of Bacteroides fragilis group, Clostridium spp., Bifidobacterium spp. and Escherichia coli in 84 faecal samples from 30 obese, 24 overweight and 30 lean children was verified by culture technique and quantitative determination by quantitative PCR. In addition, Lactobacillus spp. and Methanobrevibacter smithii were also analysed. A correlation between the body mass index (BMI) and these bacteria was sought. Bacteroides vulgatus, Clostridium perfringens and Bifidobacterium adolescentis were most prevalent in all samples evaluated by culture-method. The B. fragilis group were found at high concentrations in obese and overweight children when compared with the lean ones (p 0.015). The obese and overweight children harboured higher numbers of Lactobacillus spp. than lean children (p 0.022). The faecal concentrations of the B. fragilis group (r = 0.24; p 0.026) and Lactobacillus spp. (r = 0.44; p 0.002) were positively correlated with BMI. Bifidobacterium spp. were found in higher numbers in the lean group than the overweight and obese ones (p 0.042). Furthermore, a negative correlation between BMI and Bifidobacterium spp. copy number (r = -0.22; p 0.039) was observed. Our findings show some difference in the intestinal microbial ecosystem of obese children compared with the lean ones and a significant association between number of Lactobacillus spp. and B. fragilis group and BMI.

Arthroscopic treatment of refractory adhesive capsulitis of the shoulder

OBJECTIVE

to evaluate the results of arthroscopic treatment of refractory adhesive capsulitis of the shoulder associated as for improved range of motion after a minimum follow up of six years.

METHODS

from August 2002 to December 2004, ten patients with adhesive capsulitis of the shoulder resistant to conservative treatment underwent arthroscopic surgery. One interscalene catheter was placed for postoperative analgesia before the procedure. All were in Phase II, with a minimum follow up of two years. The mean age was 52.9 years (39-66), predominantly female (90%), six on the left shoulder. The time between onset of symptoms and surgical treatment ranged from six to 20 months. Four adhesive capsulitis were found to be primary (40%) and six secondary (60%).

RESULTS

the preoperative mean of active anterior elevation was 92°, of external rotation was 10.5° of the L5 level internal rotation; the postoperative ones were 149°, 40° and T12 level, respectively. Therefore, the average gain was 57° for the anterior elevation, 29.5° for external rotation in six spinous processes. There was a significant difference in movements' gains between the pre and post-operative periods (p<0.001). By the Constant Score (range of motion), there was an increase of 13.8 (average pre) to 32 points (average post).

CONCLUSION

the arthroscopic treatment proved effective in refractory adhesive capsulitis of the shoulder resistant to conservative treatment, improving the range of joint movements of patients evaluated after a minimum follow up of six years.

Arthroscopic treatment of adhesive capsulitis of the shoulder with minimum follow up of six years

OBJECTIVE

To evaluate the results of the arthroscopic treatment of adhesive capsulitis of the shoulder with six to nine years of follow up.

METHODS

From August 2002 to December 2004, ten patients underwent arthroscopic capsular release for adhesive capsulitis refractory to conservative treatment. An interscalene catheter was used for postoperative analgesia, before the procedure. All were in stage II, with a minimum follow up of six years. The mean age was of 52.9 years old (range, 39 to 66), with female predominance (90%) and six left shoulders. The time between the onset of symptoms and surgery varied from six to 20 months. There were four patients in the primary form (40%) and six in the secondary (60%).

RESULTS

In the preoperative evaluation, the mean active anterior elevation was 92°, 10.5° of external rotation, and internal rotation level L5. Postoperatively, the mean active elevation was 149°, 40° of external rotation and internal level T12, respectively. Thus, the average gains were 57° in forward active elevation, 29.5° in external rotation and six spinous processes, these values being statistically significant (p <0.001). According to the Constant functional score (arc of movements), the value increased from 13.8 (preoperative mean) to 32 points (postoperative mean).

CONCLUSION

Arthroscopic treatment of adhesive capsulitis of the shoulder refractory to conservative treatment allows effective gain of range of motion of this joint.

Correlation between functional disability and quality of life in patients with adhesive capsulitis

OBJECTIVE:

To determine the correlation between functional disability and quality of life of patients with adhesive capsulitis.

METHODS:

Two instruments (WHOQOL-BREF and DASH) were applied to evaluate the quality of life and functional capacity of patients with adhesive capsulitis. Inclusion criteria were age between 35 and 75 years old and achievement of shoulder imaging. Each domain of the WHOQOL-BREF was correlated with DASH. Pearson's correlation coefficient was used for parametric variables and Spearman's correlation coefficient was used when at least one variable had a non-normal distribution. The level of significance was p <0.05.

RESULTS:

Forty three patients with mean age of 54.7 years old were evaluated. The mean values found in the physical, psychological, social and environmental domains of the WHOQOL-BREF and DASH were 45.3, 63.9, 68.2, 60.2 and 61.6, respectively. A moderate negative correlation was found between DASH and the physical domain of WHOQOL-BREF (r= - 0.583, p<0.001).

CONCLUSION:

The only domain where WHOQOL-BREF correlates with DASH is the physical domain, suggesting that measures to promote the improvement of functional capacity may lead to better quality of life of patients with adhesive capsulitis.

Level of Evidence IV, Prospective Study.

Suprascapular nerve block: important procedure in clinical practice. Part II

The suprascapular nerve block is a reproducible, reliable, and extremely effective treatment method in shoulder pain control. This method has been widely used by professionals in clinical practice such as rheumatologists, orthopedists, neurologists, and pain specialists in the treatment of chronic diseases such as irreparable rotator cuff injury, rheumatoid arthritis, stroke sequelae, and adhesive capsulitis, which justifies the present review (Part II). The objective of this study was to describe the techniques and complications of the procedure described in the literature, as the first part reported the clinical indications, drugs, and volumes used in single or multiple procedures. We present in details the accesses used in the procedure: direct and indirect, anterior and posterior, lateral and medial, upper and lower. There are several options to perform suprascapular nerve block. Although rare, complications can occur. When properly indicated, this method should be considered.

Ethical standards adopted by Brazilian journals of medical specialties

OBJECTIVE

To review ethical standards contained in guidelines to authors of Brazilian scientific journals in several medical specialties and see if there is any standardization available.

METHODS

This is an exploratory study evaluating Brazilian scientific journals classified on the Portal of Journals on Health Sciences of the Virtual Health Library in all medical specialties regarding guidelines to authors submitting manuscripts and concerning ethical standards for research in humans. Data was collected and categorized for the presence of the following variables: Ethics Committee approval; Helsinki Declaration and/or Resolution 196/96, informed consent; ethical standards; uniform requirements; patients' confidentiality and no ethical references. The association among the variables was also examined.

RESULTS

Out of a total of 8,701 journals, 95 were included in the current study. The variables were investigated, with each one's frequency being verified. Eighty per cent were referred for an Ethics Committee approval; 43.15% of Helsinki Declaration; 43.15% of informed consent; 9.47% of ethical standards; 32.63% of uniform requirements and 15.78% of patients' confidentiality were referenced. In the whole sampling, 9.47% of journals do not mention any ethical reference as a guide to authors submitting manuscripts. An association among variables occurred in 61% of the sample.

CONCLUSION

Ethical aspects of submitting manuscripts were mentioned in over 90% of the guides to authors of national scientific journals and no standardization at all is available.

Fratura do acrômio associada a lesão arterial: relato de caso

A fratura do acrômio com lesão arterial é uma associação rara. O quadro clínico caracteriza-se por dor no ombro, incapacidade funcional e edema do membro acometido, com pulso e temperatura distais diminuídos. A radiografia do ombro e a arteriografia definem o diagnóstico e auxiliam na evolução pós-operatória. Os autores relatam um caso raro de fratura da base do acrômio associada a lesão da artéria ulnar ipsilateral, seu tratamento, bem como a avaliação pré e pós-operatória.

ARTHROSCOPY FOR TREATMENT OF REFRACTORY CALCIFIC TENDONITIS OF THE SHOULDER

Objective: To evaluate the results from arthroscopic treatment in patients with calcific tendonitis of the shoulder. Methods: Between September 2001 and June 2006, 55 patients with calcific tendonitis of the shoulder that was resistant to conservative treatment were evaluated, with follow-up of 12 to 70 months. The mean age was 42 years, ranging from 30 to 64 years; 44 patients were female (80%). There were 37 right shoulders, and 63.63% of the cases were on the dominant side. Pain was the main symptom, and the mean time between onset of symptoms and arthroscopy was 38 months (range: five to 120 months). The tendon affected was the supraspinatus in 42 cases, the infraspinatus in 11 cases and an association between these in two cases. Acromioplasty was carried out in 12 patients (21.82%) and subacromial bursectomy was performed in all cases. Results: According to the UCLA criteria, 46 cases were excellent and six were good, making a total of 52 satisfactory results (94.54%). Conclusion: Arthroscopic treatment of calcific tendonitis of the shoulder appears to be an effective method, with high rates of satisfactory results. Associated acromioplasty is not necessary.