Ortoze za bolnike z revmatoidnim artritisom

Article presents reasons for use of orthoses and the most frequently used orthoses in patients with rheumatoid arthritis, basic biomechanical principles, side effects, and a review of orthoses for different body parts.V prispevku so opisani vzroki za uporabo ortoz pri bolnikih z revmatoidnim artritisom, osnovni biomehanski principi, stranski učinki in pregled ortoz po delih telesa. Ovaj članak govori o mjestu i ulozi fizikalne terapije u RA

Functioning of persons following lower limb amputation – patients’ perspective

Aim: The aim of the present study was to describe functioning of persons following lower limb amputation from their perspective by using ICF. Special emphasis was laid on detecting environmental barriers and facilitators. Methods: All subjects examined at the author’s outpatient clinic within six months who met the inclusion criteria were included into study. A student of occupational therapy prepared a list of ICF categories from all the components. She also interviewed all the subjects. Results: Forty-six subjects (36 men and 10 women), 63.5 years old on average at the time of study, amputated 21.8 years before the study on average were included into the study. They had impairments of up to 4 body functions (median 3) in addition to the amputation of one body structure; problems with 0 to 22 activities and participation (median 7); from 1to 19 barriers (median 11.5) and from 6 to 26 facilitators (median 15) in their environment. Discussion: Although all the included subjects completed comprehensive rehabilitation following lower limb amputation they still experienced several impairments, limitations and restrictions. Rehabilitation team members have to know these facts and try to decrease their impact on the functioning of persons following lower limb amputation. Conclusions: Persons following lower limb amputation who completed comprehensive rehabilitation still experience several impairments, limitations and restrictions

Measuring patterns of disability using the International Classification of Functioning, Disability and Health in the post-acute stroke rehabilitation setting.

Objective To determine whether the International Classification of Functioning, Disability and Health (ICF) model is adequate for assessing disability patterns in stroke survivors in the sub-acute rehabilitation setting in terms of potential changes in functional profiles over time. Methods Functional profiles of 197 stroke patients were assessed using the ICF Checklist and the Functional Independence Measure (FIMTM) at admission and discharge from rehabilitation hospital. The ICF Checklist was applied based on medical documentation and rehabilitation team meetings. Descriptive analyses were performed to identify changes in ICF categories and qualifiers from admission to discharge, and correlations between different improvement measures were calculated. Results Mean rehabilitation duration was 60 days; patients' mean age was 60 years, with mean FIM-score 75 at admission. Mean FIM-score improvement at discharge was 12.5. Within Body Functions, changes in at least 10% of patients were found regarding 13 categories; no categories within Body Structures, 24 within Activities and Participation, and 2 within Environmental Factors. Changes were mostly due to improvement in qualifiers, except for within Environmental Factors, where they were due to use of additional categories. Correlations between improvements in Body Functions and Activities and Participation (regarding capacity and performance), as well as between capacity and performance within Activities and Participation, were approximately 0.4. Conclusion Rating ICF categories with qualifiers enables the detection of changes in functional profiles of stroke patients who underwent an inpatient rehabilitation programme.

Sudden and unexpected deaths in an adult population, Cape Town, South Africa, 2001-2005

Background. According to the regulations of the National Health Act, all ‘sudden and unexpected’ deaths in South Africa should be referred to Forensic Pathology Services (FPS) for further investigation. Objectives. We aimed to determine the final outcomes of forensic postmortem examinations in ‘sudden and unexpected’ adult deaths referred to Tygerberg FPS between 2001 and 2005. Methods. The study was a retrospective descriptive study. Demographic and autopsy data from adult cases of ‘sudden and unexpected deaths’ referred to Tygerberg FPS were collected and analysed. Results. Some 816 adult cases of ‘sudden’ deaths were studied. The presumed manner of death was natural in 645 (79.0%) cases, unnatural in 99 (12.2%), and undetermined in 72 (8.8%). Diseases of the cardiovascular, respiratory and central nervous systems accounted for the majority of natural deaths. Infectious diseases accounted for most deaths in the youngest age group studied (18 - 29 years); however, ischaemic heart disease was the most prevalent cause of death in the total study population. Conclusions. This study highlighted the lack of useful pre-autopsy information and therefore the performance of ‘unnecessary’ medicolegal autopsies in a resource-limited country. Clinicians could ease the burden by giving useful information when referring cases to FPS. Feedback should be given to family members, especially where the cause of death may have an impact on surviving family members

Medical certification of death in South Africa – moving forward

Despite improvements to the Death Notification Form (DNF) used in South Africa (SA), the quality of cause-of-death information remains suboptimal. To address these inadequacies, the government ran a train-the-trainer programme on completion of the DNF, targeting doctors in public sector hospitals. Training materials were developed and workshops were held in all provinces. This article reflects on the lessons learnt from the training and highlights issues that need to be addressed to improve medical certification and cause-of-death data in SA. The DNF should be completed truthfully and accurately, and confidentiality of the information on the form should be maintained. The underlying cause of death should be entered on the lowest completed line in the cause-of-death section, and if appropriate, HIV should be entered here. Exclusion clauses for HIV in life insurance policies with Association of Savings and Investments South Africa companies were scrapped in 2005. Interactive workshops provide a good learning environment, but are logistically challenging. More use should be made of online training resources, particularly with continuing professional development accreditation and helpline support. In addition, training in the completion of the DNF should become part of the curriculum in all medical schools, and part of the orientation of interns and community service doctors in all facilities

Immunodiagnosis of Paracoccidioidomycosis due to Paracoccidioides brasiliensis Using a Latex Test: Detection of Specific Antibody Anti-gp43 and Specific Antigen gp43

BackgroundParacoccidioidomycosis (PCM) is a life-threatening systemic disease and is a neglected public health problem in many endemic regions of Latin America. Though several diagnostic methods are available, almost all of them present with some limitations.Method/Principle FindingsA latex immunoassay using sensitized latex particles (SLPs) with gp43 antigen, the immunodominant antigen of Paracoccidioides brasiliensis, or the monoclonal antibody mAb17c (anti-gp43) was evaluated for antibody or antigen detection in sera, cerebrospinal fluid (CSF), and bronchoalveolar lavage (BAL) from patients with PCM due to P. brasiliensis. the gp43-SLPs performed optimally to detect specific antibodies with high levels of sensitivity (98.46%, 95% CI 91.7-100.0), specificity (93.94%, 95% CI 87.3-97.7), and positive (91.4%) and negative (98.9%) predictive values. in addition, we propose the use of mAb17c-SLPs to detect circulating gp43, which would be particularly important in patients with immune deficiencies who fail to produce normal levels of immunoglobulins, achieving good levels of sensitivity (96.92%, 95% CI 89.3-99.6), specificity (88.89%, 95% CI 81.0-94.3), and positive (85.1%) and negative (97.8%) predictive values. Very good agreement between latex tests and double immune diffusion was observed for gp43-SLPs (k = 0.924) and mAb17c-SLPs (k = 0.850), which reinforces the usefulness of our tests for the rapid diagnosis of PCM in less than 10 minutes. Minor cross-reactivity occurred with sera from patients with other fungal infections. We successfully detected antigens and antibodies from CSF and BAL samples. in addition, the latex test was useful for monitoring PCM patients receiving therapy.Conclusions/SignificanceThe high diagnostic accuracy, low cost, reduced assay time, and simplicity of this new latex test offer the potential to be commercialized and makes it an attractive diagnostic assay for use not only in clinics and medical mycology laboratories, but mainly in remote locations with limited laboratory infrastructure and/or minimally trained community health workers.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Dept Microbiol Immunol & Parasitol, Div Cell Biol, São Paulo, BrazilEvandro Chagas Inst, Bacteriol & Mycol Div, Ananindeua, Para, BrazilUniv Fed Alfenas, Inst Biomed Sci, Alfenas, MG, BrazilUniversidade Federal de São Paulo, Dept Microbiol Immunol & Parasitol, Div Cell Biol, São Paulo, BrazilFAPESP: FAPESP 2011/07350-1FAPESP: 2011/01628-8FAPESP: 2009/54181-0FAPESP: 2009/54024-2Web of Scienc

Interleukin-6-dependent survival of multiple myeloma cells involves the Stat3-mediated induction of micro-RNA-21 through a highly conserved enhancer

Signal transducer and activator of transcription 3 (Stat3) is implicated in the pathogenesis of many malignancies and essential for IL-6–dependent survival and growth of multiple myeloma cells. Here, we demonstrate that the gene encoding oncogenic microRNA-21 (miR-21) is controlled by an upstream enhancer containing 2 Stat3 binding sites strictly conserved since the first observed evolutionary appearance of miR-21 and Stat3. MiR-21 induction by IL-6 was strictly Stat3 dependent. Ectopically raising miR-21 expression in myeloma cells in the absence of IL-6 significantly reduced their apoptosis levels. These data provide strong evidence that miR-21 induction contributes to the oncogenic potential of Stat3