Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully treated in over 2/3 of patients through rehabilitation protocols designed to reduce pain and return function to the individual. Applying preventive medicine strategies, the majority of cases of PFPS may be avoided if a pre-diagnosis can be made by clinician or certified athletic trainer testing the current researched potential risk factors during a Preparticipation Screening Evaluation (PPSE). We provide a detailed and comprehensive review of the soft tissue, arterial system, and innervation to the patellofemoral joint in order to supply the clinician with the knowledge required to assess the anatomy and make recommendations to patients identified as potentially at risk. The purpose of this article is to review knee anatomy and the literature regarding potential risk factors associated with patellofemoral pain syndrome and prehabilitation strategies. A comprehensive review of knee anatomy will present the relationships of arterial collateralization, innervations, and soft tissue alignment to the possible multifactoral mechanism involved in PFPS, while attempting to advocate future use of different treatments aimed at non-soft tissue causes of PFPS

Treatment of American tegumentary leishmaniasis in special populations : a summary of evidence

We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making

Tailored WBGT as a heat stress index to assess the direct solar radiation effect on indoor thermal comfort

Uncontrolled solar radiation and the related effects on occupant productivity can lead to considerable indoor thermal discomfort in office environments. In this paper, the Radiance Daylight Coefficient (DC) method is used to assess incoming solar radiation and consequent indoor thermal discomfort through delta mean radiant temperature (ΔMRT). The ΔMRT allows expressing an adjusted predicted mean vote (Adjusted PMV). Under the conditions of direct solar radiation, the Adjusted PMV value surpasses the applicability range of the standard PMV in terms of MRT value. To overcome this limitation, the assessment of the effect of incoming shortwave solar radiation is expressed in the heat stress index of wet bulb globe temperature (WBGT). This procedure was tested under a variety of climatic conditions (e.g., Sol-air temperature) to estimate dissatisfaction in indoor office environments located in Milan (Italy) for an occupant positioned at different distances from the fenestration (0.75 m, 1.25 m, and 1.75 m) and exposed to direct solar radiation (e.g., without shading devices). The condition with no shading device was then compared with the condition with shaded glazing to test the impact of the solar radiation on the indoor thermal stress conditions. The results reported through ΔWBGT allow the estimation of the heat stress conditions on an annual basis when ΔWBGT > 0. Finally, it is proposed that the metric of Annual Radiation Heat Stress (ARHS) should include ΔWBGT and assess the heat stress spatially due to the incoming direct solar radiation