The Effect of Muscle Fatigue on Muscle Force-Couple Activation of the Shoulder

Context: Muscle fatigue is an important concept in regard to the muscle function of the shoulder joint. Its effect on the muscle force couples of the glenohumeral joint has not been fully identified. Objective: To examine the effects of muscle fatigue on muscle force-couple activation in the normal shoulder. Design: Pretest, posttest. Patients: Ten male subjects, age 18Ð30 years, with no previous history of shoulder problems. Main Outcome Measures: EMG (area) values were assessed for the anterior and middle deltoid, subscapularis, and infraspinatus muscles during 4 dynamic stabilizing exercises before and after muscle fatigue. The exercises examined were a push-up, horizontal abduction, segmental stabilization, and rotational movement on a slide board. Results: No significant differences were observed for any of the muscles tested. Conclusions: The results of our study indicate that force-couple coactivation of the glenohumeral joint is not significantly altered after muscle fatigue

Colombian consensus on the diagnosis, treatment, and prevention of candida Spp. disease in children and adults

La Candidiasis Invasora (CI) y la candidemia, como su manifestación más frecuente, se ha convertido en la principal causa de micosis oportunista a nivel hospitalario. Este manuscrito realizado por miembros de la Asociación Colombiana de Infectología (ACIN), tuvo como objetivo proporcionar un conjunto de recomendaciones para manejo, seguimiento y prevención de la CI/candidemia y de la infección candidiásica de mucosas, en población adulta, pediátrica y neonatal, en un entorno hospitalario, incluyendo las unidades hemato-oncológicas y unidades de cuidado crítico. Todos los datos obtenidos mediante una búsqueda exhaustiva, fueron revisados y analizados de manera amplia por todos los miembros del grupo, y las recomendaciones emitidas se elaboraron luego de la evaluación de la literatura científica disponible, y el consenso de todos los especialistas involucrados, reconociendo el problema de la emergencia de las infecciones por Candida Spp. y brindando una correcta orientación a los profesionales de la salud sobre el manejo de pacientes con enfermedad candidiásica, de una forma racional y práctica, enfatizando en la evaluación del paciente, estrategias de diagnóstico, profilaxis, tratamiento empírico, tratamiento dirigido y terapia preventiva.Invasive Candidiasis (IC) and candidemia (as its most frequent manifestation) have become the main cause of opportunistic mycosis at hospital settings. This study, made by members of the Colombian Association of Infectious Diseases (ACIN), was aimed at providing a set of recommendations for the management, follow-up and prevention of IC / candidemia and mucous membrane candida infection in adult, pediatric and neonatal patients in a hospital setting, including the hemato-oncological and critical care units. All the data obtained through an exhaustive search were reviewed and analyzed in a comprehensive manner by all the members of the group, and the recommendations issued are being made after a careful review of the scientific literature available and the consensus of all specialists involved; the emergence of Candida Spp. problem is highlighted and a correct orientation to health professionals regarding the management of patients with candidiasis is provided in a rational and practical way, emphasizing patient evaluation, diagnostic strategies, prophylaxis, empirical treatment, directed treatment and preventative therap

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Atrial fibrillation genetic risk differentiates cardioembolic stroke from other stroke subtypes

AbstractObjectiveWe sought to assess whether genetic risk factors for atrial fibrillation can explain cardioembolic stroke risk.MethodsWe evaluated genetic correlations between a prior genetic study of AF and AF in the presence of cardioembolic stroke using genome-wide genotypes from the Stroke Genetics Network (N = 3,190 AF cases, 3,000 cardioembolic stroke cases, and 28,026 referents). We tested whether a previously-validated AF polygenic risk score (PRS) associated with cardioembolic and other stroke subtypes after accounting for AF clinical risk factors.ResultsWe observed strong correlation between previously reported genetic risk for AF, AF in the presence of stroke, and cardioembolic stroke (Pearson’s r=0.77 and 0.76, respectively, across SNPs with p &lt; 4.4 × 10−4 in the prior AF meta-analysis). An AF PRS, adjusted for clinical AF risk factors, was associated with cardioembolic stroke (odds ratio (OR) per standard deviation (sd) = 1.40, p = 1.45×10−48), explaining ∼20% of the heritable component of cardioembolic stroke risk. The AF PRS was also associated with stroke of undetermined cause (OR per sd = 1.07, p = 0.004), but no other primary stroke subtypes (all p &gt; 0.1).ConclusionsGenetic risk for AF is associated with cardioembolic stroke, independent of clinical risk factors. Studies are warranted to determine whether AF genetic risk can serve as a biomarker for strokes caused by AF.</jats:sec

Diseño Del Programa De Salud Ocupacional Para El Centro De Hemodinámica Del Quindío S.A.

El programa de salud ocupacional que se diseñó durante el segundo semestre del 2008, en el Centro de Hemodinamia del Quindío S.A., en donde se recolectaron una series de datos a través de visitas periódicas, que fueron de gran aporte para la elaboración del Panorama de factores de riesgo y con fundamento en este los subprogramas de medicina preventiva, medicina del trabajo, higiene y seguridad industrial.PregradoProfesional en Seguridad y Salud en el Trabaj

Identificación electroforética de &alpha;2-macroglobulina en plasma de ovino de pelo (Ovis aries) y búfalo (Bubalus bubalis) Electrophoretic identification of &alpha;2-macroglobulin in the plasma of tropical hair sheep (Ovis aries) and buffalo (Bubalus bubalis)

A través del presente estudio se analizaron plasmas sanguíneos de seis especies, incluyendo el humano tanto en estado gestante como no gestante, identificándose por primera vez en plasma, la glicoproteína &alpha;2-Macroglobulina (&alpha;2-M) de ovino de pelo (Ovis aries) y de búfalo (Bubalus bubalis). La presencia de esta proteína en el plasma sanguíneo de todas las especies en estudio se demostró mediante electroforesis en gel de poliacrilamida usando sodio dodecilsulfato como agente denaturante (SDS PAGE) al 7.5% identificándose como bandas de 180 kDa y en forma no denaturante PAGE 5% como bandas de 720 kDa. Estas últimas bandas fueron claramente intercambiables de la forma tetramérica a la forma monomérica en los ensayos electroforéticos. Como controles se usaron la &alpha;2-M (tetramérica) y la proteína de la zona de gestación (PZP) (dimérica) purificadas a un 98%; así como, las bandas de estas dos proteínas en el plasma humano. El análisis de la secuencia del dominio N-terminal de la (&alpha;2-M) de ovino de pelo, fue muy similar al de la proteína humana purificada. Tanto la &alpha;2-M humana como la bovina llegaron a ser activadas a la forma rápida por medio de la reacción con metilamina. Lo anterior demuestra diferencias en la reactividad de las &alpha;2-M animales con la amina primaria cuando se comparan los resultados con la forma rápida de la &alpha;2-M humana. Será necesario unificar los métodos de purificación de esta proteína en todas las especies, de tal manera que los dominios sensibles de las &alpha;-macroglobulinas (tio&#953;ster y región señuelo) tengan el mismo tratamiento y el mismo grado de desnaturalización para todas las preparaciones de &alpha;2-M.<br>Blood plasma from six different non pregnant and pregnant species, including human blood plasma, was analyzed for detection of &alpha;2-Macroglobulin (&alpha;2-M). The tropical hair sheep (Ovis aries) and the buffalo (Bubalus bubalis) were studied for the first time in Colombia. The presence of the &alpha;2-M in plasma of all the species was demonstrated by SDS 7.5% PAGE as bands of 180 kDa as well as by non-denaturing 5% PAGE with bands of 720 kDa. The tetrameric form &alpha;2-M (tetramérica) and the pregnancy zone protein (PZP) (dimeric) purified at 98%, as well as its corresponding bans from human plasma were used as control. The N-terminal sequence of the band of 180 kDa in Tropical hair sheep plasma was very similar to the purified human &alpha;2-M. The results indicated the presence of &alpha;2-M in blood plasma of all the species tested, while the PZP was present only in the pregnant human plasma. Both human and bovine &alpha;2-M became activated with the fast form by reacting with Methylamine. This Fac. demonstrates the differences in the reactivity of the animal&rsquo;s &alpha;2-M with primary amine as compared with the human &alpha;2-M. It could be necessary to unify purification methods into one method for all species, so that the sensitive domain of the &alpha;-macroglobulins (thiolester and bait region) receives the same treatment and grade of denaturation for all &alpha;2-M preparation