Applications of EMG in Clinical and Sports Medicine

This second of two volumes on EMG (Electromyography) covers a wide range of clinical applications, as a complement to the methods discussed in volume 1. Topics range from gait and vibration analysis, through posture and falls prevention, to biofeedback in the treatment of neurologic swallowing impairment. The volume includes sections on back care, sports and performance medicine, gynecology/urology and orofacial function. Authors describe the procedures for their experimental studies with detailed and clear illustrations and references to the literature. The limitations of SEMG measures and methods for careful analysis are discussed. This broad compilation of articles discussing the use of EMG in both clinical and research applications demonstrates the utility of the method as a tool in a wide variety of disciplines and clinical fields

The role of chronic and recurrent infection in the generation of overactive bladder symptoms in multiple sclerosis

This thesis provides original evidence that patients with multiple sclerosis may harbour undisclosed urinary infection that generates urothelial inflammation and overactive bladder symptoms. The studies within this thesis examine the performance of recommended diagnostic tests for urinary tract infection, and explore the bacterial ecology of urinary infection and its associated urothelial inflammatory response. The association between lower urinary tract inflammation, bacterial colonisation and the generation of overactive bladder symptoms is explored. A novel therapy with proposed immunomodulatory effects was tested as a candidate treatment for overactive bladder symptoms. The urinary dipstick is the recommended diagnostic test for urinary infection in patients with multiple sclerosis. In patients with chronic lower urinary tract symptoms, the dipstick failed to identify culture-positive bacterial infection in more than half of cases. This failure is compounded by the poor performance of current culture-based diagnosis that employs erroneous quantitative diagnostic thresholds. When a sensitive culture method was deployed and quantitative thresholds rejected, controlled data demonstrated that bacterial urinary infection was evident in sixty percent of patients. Quantitative and qualitative differences in the bacterial ecology of infecting isolates were evident amongst patients and controls. This was associated with increased urothelial inflammation amongst patients. Prospective, controlled data demonstrated that escalating urothelial inflammation, characterised by the expression of pyuria, was associated with increased bacterial load in the lower urinary tract. Pyuria predicted the severity of overactive bladder symptoms and indices of bladder function. Am immunomodulatory treatment for overactive bladder symptoms was tested as part of this work but no therapeutic effects were identified

Clinical Management of Complicated Urinary Tract Infection

Complicated urinary tract infections (cUTIs) are a major cause of hospital admissions and are associated with significant morbidity and health care costs. Knowledge of baseline risk of urinary tract infection can help clinicians make informed diagnostic and therapeutic decisions. Prevalence rates of UTI vary by age, gender, race, and other predisposing risk factors. In this regard, this book provides comprehensive information on etiology, epidemiology, immunology, pathology, pathogenic mechanisms, symptomatology, investigation and management of urinary tract infection. Chapters cover common problems in urinary tract infection and put emphasis on the importance of making a correct clinical decision and choosing the appropriate therapeutic approach. Topics are organized to address all of the major complicated conditions frequently seen in urinary tract infection. The authors have paid particular attention to urological problems like the outcome of patients with vesicoureteric reflux, the factors affecting renal scarring, obstructive uropathy, voiding dysfunction and catheter associated problems. This book will be indispensable for all professionals involved in the medical care of patients with urinary tract infection

Modelo explicativo de deficiência em população com transtornos mentais graves atendida em uma instituição especializada da cidade de Cali (Colômbia)

Introducción: en Colombia, según la Encuesta Nacional de Salud Mental realizada en 2015, la prevalencia de vida de depresión mayor, trastorno afectivo bipolar y esquizofrenia es del 9,1 %, 1,3 % y 1 %, respectivamente. Estos trastornos mentales graves se caracterizan por ser asumidos desde una postura nosográfica que no incorpora la interacción entre el contexto y la persona. La discapacidad es una dimensión de los trastornos mentales graves, y requiere ser investigada desde herramientas como la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud. Conocer su frecuencia y los factores personales y ambientales que la explican puede facilitar la implementación de estrategias para mejorar la calidad de vida de esta población. Materiales y métodos: se llevó a cabo un estudio exploratorio, observacional, de corte transversal, para determinar la prevalencia y describir el aporte de variables sociodemográficas, clínicas y psicosociales en un modelo explicativo de discapacidad en personas con trastornos mentales graves que asisten a servicios de salud mental y psiquiatría de una institución especializada de Cali (Colombia). Resultados: el 65,9 % de la muestra presenta algún grado de discapacidad; el 46,2 %, discapacidad moderada; el 19,4 %, discapacidad severa; y el 0,4 %, discapacidad extrema. El modelo explicativo incluye el aporte de variables sociodemográficas, clínicas y psicosociales. Conclusión: este estudio demuestra que la frecuencia de discapacidad en la población con TMG es recurrente, y al parecer poco estudiada, vinculando el desempeño desde cada dominio que hace parte de la vida diaria. Los resultados de la investigación permiten identificar el aporte de factores personales y ambientales en la discapacidad experimentada por esta población en Cali.Introduction: In Colombia, according to the National Mental Health Survey conducted in 2015, the lifetime prevalence of major depression, bipolar affective disorder, and schizophrenia is 9.1 %, 1.3 %, and 1 %, respectively. These severe mental disorders (SMD) are characterized by being assumed from a nosographic stance that does not incorporate the interaction between the context and the person. Disability is a dimension of severe mental disorders, and it needs to be investigated using tools such as the International Classification of the Functioning of Disability and Health. Knowing their frequency and personal and environmental factors that explain them can facilitate the implementation of strategies to improve the quality of life of this population. Materials and methods: An exploratory, observational, cross-sectional study was conducted to determine the prevalence and to describe the contribution of socio-demographic, clinical, and psychosocial variables in an explanatory model of disability in people with severe mental disorders, attended in the mental health and psychiatry services of a specialized institution in Cali, Colombia. Results: From the sample, 65.9 % showed some degree of disability; 46.2 %, moderate disability; 19.4%, severe disability, and 0.4 %, extreme disability. The explanatory model includes the contribution of socio-demographic, clinical, and psychosocial variables. Conclusion: This study shows that the frequency of disability in the population with SMD is recurrent, and little studied linking performance from each domain that is part of daily life. The results of the investigation allow identifying the contribution of personal and environmental factors in the disability experienced by this population in Cali.Introdução: na Colômbia, segundo o Inquérito Nacional de Saúde Mental realizado em 2015, a prevalência de vida de depressão maior, transtorno afetivo bipolar e esquizofrenia são de 9,1 %, 1,3 %, e 1 %, respetivamente. Estes transtornos mentais graves se caracterizam por serem assumidos desde uma postura nosográfica que não incorpora a interação entre o contexto e a pessoa. A deficiência é uma dimensão dos transtornos mentais graves, e requere ser pesquisada desde ferramentas como a Classificação Internacional do Funcionamento da Deficiência e da Saúde. Conhecer sua frequência e os fatores pessoais e ambientais que a explicam, pode facilitar a implementação de estratégias para melhorar a qualidade de vida desta população. Materiais e métodos: se realizou um estudo exploratório, observacional, de corte transversal, para determinar a prevalência e descrever o aporte de variáveis sociodemográficas, clínicas e psicossociais em um modelo explicativo de deficiência em pessoas com transtornos mentais graves que assistem a serviços de Saúde Mental e Psiquiatria de uma instituição especializada de Cali, Colômbia. Resultados: o 65,9 % da amostra apresenta algum grau de deficiência. O 46,2 % deficiência moderada, o 19,4 % deficiência severa, e o 0,4 % deficiência extrema. O modelo explicativo inclui o aporte de variáveis sociodemográficas, clínicas e psicossociais. Conclusão: este estudo demostra que a frequência de deficiência na população com tmg é recorrente, e aparentemente pouco estudada, vinculando o desempenho desde cada domínio que faz parte da vida diária. Os resultados da pesquisa permitem identificar o aporte de fatores pessoais e ambientais na deficiência experimentada por esta população em Cali

Hysterectomy

This book is intended for the general and family practitioners, as well as for gynecologists, specialists in gynecological surgery, general surgeons, urologists and all other surgical specialists that perform procedures in or around the female pelvis, in addition to intensives and all other specialities and health care professionals who care for women before, during or after hysterectomy. The aim of this book is to review the recent achievements of the research community regarding the field of gynecologic surgery and hysterectomy as well as highlight future directions and where this field is heading. While no single volume can adequately cover the diversity of issues and facets in relation to such a common and important procedure such as hysterectomy, this book will attempt to address the pivotal topics especially in regards to safety, risk management as well as pre- and post-operative care