Study of validity and intra and inter-observer reliability of modified-modified Schöber test in subjects with low-back pain

In patients with low-back pain the lumbar spine range of motion (ROM) is often measured by the modified version of the modified Schöber test (MMST), but its psychometric properties have not been ascertained for clinical use. The purpose here was to verify intra and inter-observer validity and reliability of the MMST in subjects with low-back pain, and to compare obtained ROM measures to those obtained by radiography, taken as gold standard. The study involved 20 subjects with chronic low-back pain, of both sexes, employees at a university hospital. The MMST was applied twice by two examiners each. The Pearson correlation coefficient found when comparing measures obtained via MMST and radiography was r=0.14, showing a poor correlation between the tests. The intra-observer intraclass correlation coefficient (ICC) found was 0.96 (CI 95% 0.91;0.98), and the inter-observer ICC was 0.93 (IC 95% 0.84;0.97), showing high reliability; the Bland & Altman agreement test showed high agreement intra (-0.21) and inter-observer (-0.21). Although a high reliability both intra and inter-observer was found for the modified-modified Schöber test, the latter showed low validity in assessing lumbar spine range of motion, when compared to the gold standard.Em pacientes com lombalgia, mensura-se a amplitude de movimento (ADM) da coluna lombar por meio da versão modificada do teste de Schöber modificado (MTSM), mas suas propriedades psicométricas não são comprovadas para uso clínico. Este estudo verificou a validade e confiabilidade intra e interobservador do MTSM em indivíduos com lombalgia, comparando as medidas da ADM com as obtidas por meio de radiografia, método considerado padrão-ouro. Participaram 20 voluntários com lombalgia, de ambos os sexos, funcionários de um Hospital Universitário. O MTSM foi aplicado duas vezes por dois avaliadores. As medidas obtidas pelo teste e por radiografia foram comparadas usando o coeficiente de correlação de Pearson, obtendo-se r=0,14, ou seja, correlação fraca. O coeficiente de correlação intraclasse (CCI) dos MTSM intra-observador foi 0,96 (IC 95% 0,91;0,98) e interobservador 0,93 (IC 95% 0,84;0,97), indicando alta confiabilidade; o teste de Bland & Altman mostrou alta concordância intra e interobservador, com valores de -0,21 e -0,28, respectivamente. Embora tenha sido encontrada alta confiabilidade intra e interobservador na aplicação da versão modificada do teste de Schöber modificado, este apresentou baixa validade para medir a ADM da coluna lombar, quando comparado ao padrão-ouro

Occurence and Bioactivities of Funicone-Related Compounds

Studies on production of secondary metabolites by fungi have received a substantial boost lately, particularly with reference to applications of their biological properties in human medicine. Funicones represent a series of related compounds for which there is accumulating evidence supporting their possible use as pharmaceuticals. This paper provides a review on the current status of knowledge on these fungal extrolites, with special reference to aspects concerning their molecular structures and biological activities

Der Gefangene in Spanien

Aus dem Französischen des N. Massias, Offiziers der Artillerie2 Teile in einem Band mit durchgehender Seiten- und BogenzählungNebent.: Der Gefangene in Spanien oder Blicke auf die Provinzen Catalonien und GrenadaFingerprint nach Ex. der FB Gotha und der ULB Sachsen-AnhaltVorlageform des Erscheinungsvermerks: Zürich und Leipzig bey Ziegler und Söhne 1799. - Leipzig ist Messplat

Développement d’une vidéo didactique d’aide à l’exérèse initiale d’un naevus suspect en cabinet de médecine générale

The initial excision of a suspicious nevus is an achievable procedure to general practitionners (GP). In the current context, a real benefit could be brought to patients if surgery is properly performed. Here, our task aims at creating a didactic movie to assist GPs removing the skin lesion. The different steps - antisepsis, anesthesia, excision technique and haemorrhage risk management – have been thoroughly studied through narrative reviews, while - suture, anatomopathological examination and rates of medical excision - have been analysed in official references and practices. Quality criteria for an instructional video have been looking for as well. Our results enabled to establish the excision modalities. Antisepsis is performed with alcoholic chlorhexidine and anesthesia with lidocaïne and epinephrine. The excision, done with scalpel blade or punch, is performed with a 2 mm safety margin. Most of the time, antithrombotic therapy should be followed up. These results permitted to create a didactic video broadcast on a public network. Even if this study seems to promote the Hospital- General Practice link, it should not however encourage GPs to carry out procedures that should come from specialist doctors.L'exérèse d'un naevus suspect est un geste accessible pour le médecin généraliste. Dans le contexte actuel de démographie médicale, celle-ci peut apporter un réel bénéfice pour le patient, à condition d'être correctement réalisée. L'objectif de notre travail est de créer un support numérique didactique d'aide à la prise en charge initiale d'un naevus suspect en cabinet de médecine générale. Les étapes asepsie, anesthésie, repérage et technique d'exérèse et la gestion du risque hémorragique ont été étudiées à travers des revues narratives distinctes de littérature. La suture, l'examen anatomopathologique et la cotation CCAM du geste ont fait l'objet d'analyses de pratique et de recommandations officielles. Les critères de qualité d'une vidéo ont également été recherchés. Nos résultats ont permis d'établir les étapes essentielles de l'exérèse. L'asepsie se fait à l'aide de chlorhexidine alcoolique et l'anesthésie est réalisée avec de la lidocaïne adrénalinée, les marges d'exérèse retenues sont de 2 millimètres, et l'excision est réalisée à l'aide d'un bistouri ou d'un punch. La poursuite des antithrombotiques est le plus souvent recommandée. Ces résultats nous ont permis de créer une vidéo didactique diffusé sur une plateforme publique. Si ce travail semble s'inscrire dans le réseau de soins ville-hôpital, il ne doit pas cependant encourager le médecin généraliste à réaliser des actes qui relèveraient d'un avis spécialisé

Activity of fosfomycin alone or combined with temocillin in vitro and in a murine model of peritonitis due to KPC-3- or OXA-48-producing Escherichia coli

International audienceBackground - Alternative therapeutic regimens are urgently needed against carbapenemase-producing Enterobacteriaceae. Fosfomycin often remains active against KPC and OXA-48 producers, but emergence of resistance is a major limitation. Our aim was to determine whether the association of temocillin with fosfomycin might be useful to treat KPC- or OXA-48-producing Escherichia coli infections. Methods - Isogenic derivatives of E. coli CFT073 with blaKPC-3- or blaOXA-48-harbouring plasmids (named CFT073-KPC-3 and CFT073-OXA-48, respectively) were used. The addition of temocillin to fosfomycin was tested using the chequerboard method and time-kill curves as well as in a fatal peritonitis murine model. Mice were treated for 24 h with fosfomycin alone or in combination with temocillin. Bacterial loads, before and after treatment, were determined in the peritoneal fluid and fosfomycin-resistant mutants were detected. Results - Temocillin MICs were 8, 32 and 256 mg/L for CFT073 (WT), CFT073-KPC-3 and CFT073-OXA-48, respectively. Fosfomycin MIC was 0.5 mg/L for all strains. The chequerboard experiments demonstrated synergy for all three strains. In time-kill curves, combining temocillin with fosfomycin was synergistic, bactericidal and prevented emergence of resistance for CFT073-pTOPO and CFT073-KPC-3, but not CFT073-OXA-48. In vivo, for the three strains, bacterial counts were lower in peritoneal fluid with the combination compared with fosfomycin alone (P < 0.001) and inhibited growth of resistant mutants in all cases. Conclusions - The combination of fosfomycin and temocillin demonstrated a benefit in vitro and in vivo against E. coli strains producing KPC-3 or OXA-48-type carbapenemases. This combination prevented the emergence of fosfomycin resistance and proved to be more bactericidal than fosfomycin alone