Affected Body Regions Research Articles

The use of high-frequency skin ultrasound in the diagnosis of lipodermatosclerosis.

IntroductionLipodermatosclerosis is a symptom of severe venous insufficiency, the diagnosis of which is based on the clinical picture. Although the histopathology of the skin and the subcutaneous tissue allows for the most reliable diagnosis, it is not recommended due to healing disorders.AimThe aim of this study was to assess the usefulness of high-frequency ultrasound in the diagnosis of lipodermatosclerosis.Materials and methodsThe study included 10 patients with lipodermatosclerosis who underwent Duplex Doppler ultrasound of lower limb veins, high-frequency ultrasound of the tibial skin, and radiography of the lower leg, all of which were analyzed in correlation with clinical symptoms.ResultsThe study group included 9 women and 1 man aged 39–81 years. Manifestations of lipodermatosclerosis were detected in 14 limbs. High-frequency ultrasound showed that the mean dermis thickness at the affected sites was 2.63 mm, and was significantly thicker compared to healthy skin (1.45 mm) (p = 0.00002). Higher echogenicity was detected in the affected body regions in 85.7% of cases for the skin and 92.9% of cases for the subcutaneous tissue. Subcutaneous and vascular wall calcifications were detected in 92.9% and 78.6% of cases, respectively. Fibrosis was observed in all limbs, and compression sonoelastography showed that the compliance of the subcutaneous tissue was lower than that of muscles. The border between the skin and the subcutaneous tissue was blurred in 57.1% of cases. Radiography revealed thickening of the affected skin regions in all limbs, with calcifications detected in 85.7% of cases. A blurred border between the skin and the subcutaneous tissue was observed in 35.7% of limbs.ConclusionHigh-frequency ultrasonography of the skin and the subcutaneous tissue in the lower legs supported with radiological findings is highly useful in the diagnosis of lipodermatosclerosis.

Clinical Characteristics of and Services Provided for Patients with Lymphedema Referred to a Physiotherapy Program During the Years 2009 Through 2019.

Background: Lymphedema is a chronic and progressive disease whose diagnosis involves determination of clinical and demographic characteristics. The aim of this retrospective study was to analyze the clinical characteristics of patients with lymphedema and their various diagnoses. We studied patients who were referred for physiotherapy services at any point during the years 2009 through 2019. Methods: Retrospective data were collected from the files of 430 lymphedema patients. The type, cause, localization, stage, and severity of lymphedema and physiotherapy needs were analyzed and reported. Results: Primary and secondary lymphedema were observed in 18 (4.2%) and 412 (95.8%) patients, respectively. The patients' mean body mass index score was 30.66 kg/m2. The data indicated that the most common cause of secondary lymphedema was breast cancer and its treatments (n = 196, 47.6%). Other causes were chronic venous insufficiency (CVI) (n = 140, 34%), lipolymphedema (n = 11, 2.7%), and other types of cancers (n = 65, 15.7%). According to the affected body regions, 416 patients had unilateral/bilateral upper and lower extremity lymphedema and 14 had head and neck lymphedema. The patients were followed with a home-based physiotherapy program (n = 353, 82.1%) or they underwent treatments through an outpatient program (n = 77, 17.9%). Conclusions: Most patients admitted to the clinic had a diagnosis of breast cancer and CVI. The severity and stages of lymphedema were variable. The data indicated that most patients were followed through a home-based physiotherapy program. These results may set a frame for understanding the treatment and care needs of patients with lymphedema.

Prevalence of Musculoskeletal Disorders among Dentists and Dental Students in Germany.

Background: Dentists are at a higher risk of suffering from musculoskeletal disorders (MSD) than the general population. However, the latest study investigating MSD in the dental profession in Germany was published about 20 years ago. Therefore, the aim of this study was to reveal the current prevalence of MSD in dentists and dental students in Germany. Methods: The final study size contained 450 (287 f/163 m) subjects of different areas of specialization. The age of the participants ranged from 23 to 75 years. The questionnaire consisted of a modified version of the Nordic Questionnaire, work-related questions from the latest questionnaire of German dentists, typical medical conditions and self-developed questions. Results: The overall prevalence showed that dentists suffered frequently from MSD (seven days: 65.6%, twelve months: 92%, lifetime: 95.8%). The most affected body regions included the neck (42.7%–70.9%–78.4%), shoulders (29.8%–55.6%–66.2%) and lower back (22.9%–45.8%–58.7%). Overall, female participants stated that they suffered from pain significantly more frequently, especially in the neck, shoulders and upper back. Conclusion: The prevalence of MSD among dentists, especially in the neck, shoulder and back area, was significantly higher than in the general population. In addition, women suffered more frequently from MSD than men in almost all body regions.

Child transport injuries and deaths in Lebanon: a multicentre retrospective study

IntroductionRoad traffic injury (RTI) constitutes the leading cause of deaths and disabilities for individuals aged 5–29 years globally. Lebanon suffers from a high toll of transport mortality and morbidity, though...

Body mapping of regional sweat distribution in young and older males

PurposeGiven the pressing impact of global warming and its detrimental effect on the health of older populations, understanding age-related changes in thermoregulatory function is essential. Age differences in regional sweat distribution have been observed previously, but given the typically small measurement areas assessed, the development of whole body sweat maps for older individuals is required. Therefore, this study investigated age-related differences in regional sweat distribution in a hot environment (32 °C/50%RH) in young and older adults, using a body mapping approach.MethodsTechnical absorbent pads were applied to the skin of 14 young (age 24 ± 2 years) and 14 older (68 ± 5 years) males to measure regional sweat rate (RSR) at rest (30 min) and during exercise (30 min), at a fixed heat production (200 W m−2). Gastrointestinal (Tgi) and skin temperature (Tsk), heart rate, thermal sensation, and thermal comfort were also measured.ResultsWhole body sweat maps showed that despite equal heat production, healthy older males had significantly lower gross sweat loss (GSL) than the young and significantly lower RSR at almost all body regions at rest and at the hands, legs, ankles, and feet during exercise. The lower sweat loss in the older group coincided with a greater increase in Tgi and a consistently higher Tsk at the legs, despite subjectively feeling slightly cooler than younger individuals.ConclusionThese findings support the evidence of age-related deterioration in both autonomic and subjective responses in the heat and highlight the lower extremities as the most affected body region.

Clinical profile of confirmed scorpion stings in a referral center in Manaus, Western Brazilian Amazon

Scorpion envenomations are a major public health problem in Brazil, and most medically important cases are attributable to the Tityus genus. The objective of this study is to describe the clinical and epidemiological aspects of a series of 151 cases of confirmed scorpion stings, which were treated at the hospitals of two cities in the Western Brazilian Amazon, between June 2014 and December 2019. This study shows that the genus Tityus was the most prevalent. Tityus (Atreus) metuendus (Pocock, 1897) was responsible for the greatest number of cases (68.2%), followed by Tityus (Archaeotityus) silvestris (Pocock, 1897) (14.6%). Most of the envenomations involved males (53.6%), and analysis showed a slight predominance in the group from 40 to 49 years (22.5%). The most affected body regions were feet (49.0%) and hands (31.8%). The time elapsed between the accident and medical care was ≤6 h in 92.1% of cases. Regarding clinical severity, classes I (80.8%) and II (15.9%) predominated. However, there were five (3.3%) class III cases; four for T. metuendus and one for T. silvestris. The most frequent local and systemic manifestations were, respectively, pain (84.1%), paresthesia (34.4%) and mild edema (25.8%), and nausea (9.3%) and myoclonia (8.6%). The clinical manifestations were similar among the patients stung by the different species of scorpions. There were no differences between the manifestations of envenomation caused by T. metuendus, T. silvestris and T. raquelae. For victims of T. apiacas, a higher frequency of piloerection and myoclonia was observed, and was described by the affected patients as a ‘sensation of receiving an electric shock’ throughout the body. No deaths were registered. The species of greatest epidemiological importance in Manaus is T. metuendus, a species that leads to clinical pictures that do not differ substantially from those observed in other Brazilian regions. T. apiacas causes neurological manifestations that differed from other Tityus species. Our findings suggest that the available antivenoms have little effectiveness when used in the treatment of envenomations by some Amazonian scorpions.

Perfil de pacientes vítimas de fraturas internados em um hospital universitário: estudo transversal

OBJETIVO: Descrever o perfil clínico epidemiológico dose pacientes vítimas de fraturas internados em um hospital universitário do Maranhão. MÉTODOS: Trata-se de um E estudo descritivo transversal, retrospectivo e de abordagem quantitativa, realizado a partir da análise de prontuários destes pacientes no Hospital Universitário da Universidade Federal do Maranhão (HU-UFMA) no setor de traumato-ortopedia. RESULTADOS: Foram analisados 251 prontuários, em que no qual houve predomínio do sexo masculino (52,59%), cor parda (64,1%), residentes em São Luís (57%), solteiros (51%), baixa escolaridade, apresentando maior índice de ensino fundamental incompleto (35,3%) e a média de idade foi de 45,4 anos. O tipo de trauma que mais causou fraturas foram as quedas, com 127 vítimas (50,6%), seguido dos acidentes de trânsito com (27,8%) de acidentes motociclísticos, (3,98%) de acidentes automobilísticos, (3,98%) de atropelamentos. Quanto às regiões corpóreas mais acometidas, observou-se com maior frequência as lesões nos membros inferiores (MMII), sendo 33,47% fraturas de fêmur, 23,11% de tíbia e 11,95% de tornozelo. O tipo de cirurgia mais realizado foi a osteossíntese, para a estabilização do seguimento, com 82,87% de prevalência. Desses pacientes 98,8% obtiveram alta hospitalar após procedimento cirúrgico com mediana de 3 dias de internação e 1,2% evoluíram para óbito. CONCLUSÃO: Houve maior prevalência de fraturas entre os indivíduos do sexo masculino, solteiros, compreendidos na faixa etária de 13 a 38 anos, o mecanismo de trauma com maiores números de casos foram quedas e acidentes de trânsito, com maior acometimento dose membros inferiores.

Abstract B60: Exposure assessment among an adult population on radiation therapy, chemotherapy, and other cancer therapies in childhood

Abstract Childhood cancer therapies are known risk factors for the development of second primary cancers. They are also suggested risk factors for late adverse health effects. Until now, there is no established questionnaire to retrospectively assess exposure to cancer therapies in childhood among adults. Therefore, we aim to validate a new self-administered questionnaire. The study population consists of 438 former childhood cancer patients of the KiKme study. Participants are asked whether they had received cancer therapies and how often and with which dose they were treated. Used medications and affected body regions are inquired. Questionnaire data are used to compute cytotoxic drugs dose of chemotherapy, taking patients’ weight and height into account, and to reconstruct individual organ doses. For validation, self-reports are compared to data of cancer therapies of 178 patients from hospitals and clinical studies. Quality assessment for binary variables are performed by measuring sensitivity and specificity. AUC and ROC curve are used for graphical comparison. The validity is analyzed by the positive (PPV) and negative predictive value (NPV). Cohen’s Kappa (κ) is used to measure the concordance between the two assessments. Continuous variables are tested for validity by the intraclass correlation coefficient. A Bland-Altman plot is used to consider the patterns of disagreement between the measurements. Influencing factors (e.g., number of neoplasms, sex, sociodemographic factors, comorbidities, time since cancer treatment) on the dichotomous outcome variable “degree of agreement” are analyzed using logistic regression. If the questionnaire is reliable, logistic regression and mixed models will be used to estimate possible risk associations with cancer therapies. A perfect agreement between questionnaire and therapy data was found on whether a chemotherapy was received (κ = 1.00). The agreement for exposure to radiotherapy was lower, but in the upper substantial area (κ = 0.77). For radiotherapy, sensitivity (94%) and PPV (96%) of the questionnaire were at a very high level. Specificity (85%) and NPV (80%) were less precise. The agreement for exposure to radiotherapy was higher in participants with one cancer (κ = 0.82) compared to participants with more than one diagnosis (κ = 0.62). The odds ratios for agreement were 0.5 (0.1; 1.8) for participants with two vs. one diagnosis, 1.3 (0.3; 4.9) for men vs. women, 10.9 (1.7; 71.9) for age over 36.4 years (median) vs. younger participants, 2.2 (0.6; 9.0) for high vs. low education, 0.3 (0.1; 1.4) for over 26.5 years of follow-up (median) vs. less, 2.4 (0.6; 9.5) for existing vs. nonexisting comorbidities. In conclusion, the new developed questionnaire seems to be reliable for the retrospective assessment of binary exposure to cancer therapies in childhood, especially for chemotherapy. However, for radiotherapy older participants showed a significant higher agreement. All other tested variables showed no significant influence. Citation Format: Lara Kim Brackmann, Caine Lucas Grandt, Heike Schwarz, Irene Schmidtmann, Thomas Hankeln, Danuta Galetzka, Sebastian Zahnreich, Peter Scholz-Kreisel, Maria Blettner, Heinz Schmidberger, Manuela Marron. Exposure assessment among an adult population on radiation therapy, chemotherapy, and other cancer therapies in childhood [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr B60.

Characteristics and Injury Patterns in Electric-Scooter Related Accidents-A Prospective Two-Center Report from Germany.

Since the introduction of rental E-scooters in Germany in mid-June 2019, the safety of this new means of transport has been the subject of extensive public debate. However, valid data on injuries and usage habits are not yet available. This retrospective two-center study included a total of 76 patients who presented to the emergency department following E-scooter-related accidents. The mean age was 34.3 ± 12.4 years and 69.7% of the patients were male. About half of the patients were admitted by ambulance (42.1%). Fractures were found in 48.6% of patients, and 27.6% required surgical treatment due to a fracture. The upper extremities were the most commonly affected body region, followed by injuries to the lower extremity and to the head and face. Only one patient had worn a helmet. In-hospital treatment was necessary for 26.3% of the cases. Patients presented to the emergency department mainly during the weekend and on-call times. This is the first report on E-scooter-related injuries in Germany. Accidents with E-scooters can cause serious injuries and, therefore, represent a further burden to emergency departments. The use of E-scooters appears to be mostly recreational, and the rate of use of protective gear is low.

Work-related musculoskeletal pain and characteristics of brewery workers in southwest Nigeria - a pilot study

BACKGROUND: Work-related musculoskeletal pain (WMSP) is a common symptom associated with work-related musculoskeletal disorders. It is aggravated by poor lifting techniques, inappropriate ergonomics, repetitive movements and awkward posture during the course of performing one’s duties. Variables such as age, marital status, work experience, alcohol, smoking and exercise habits have been found to play major roles in WMSP prevalence among different categories of workers. OBJECTIVES: This study focused on the lifetime, 12-month and point prevalence of WMSP in association with the socio-demographics, lifestyle and work-related characteristics of brewery workers in Osun state, Southwest, Nigeria. METHOD: A descriptive research design was utilized, and a total of eighty-nine (89) participants were recruited with strict adherence to the inclusion criteria. A 28-item questionnaire was developed to obtain specific information on the prevalence and pattern of WMSP, while anthropometric measurements (weight and height) of each participant were measured. Collected data were organized and analyzed using descriptive statistics and Chi square test. RESULTS: The lifetime, 12-month and point prevalence of WMSP among the participants were 96.6%, 93.3%, and 57.3% respectively. The low back was the mostly affected body region. Significant associations exist between each of the lifetime, 12-month and point prevalence of WMSP and participants' marital status. Furthermore, a significant association exists between the point prevalence of WMSP and participants’ age. CONCLUSION: It was concluded that there was a high prevalence of WMSP among brewery workers in Osun state, Southwest, Nigeria.

Shotgun Wounds: Nationwide Trends in Epidemiology, Injury Patterns, and Outcomes from US Trauma Centers.

Shotguns represent a distinct form of ballistic injury because of projectile scatter and variable penetration. Due in part to their rarity, existing literature on shotgun injuries is scarce. This study defined the epidemiology, injury patterns, and outcomes after shotgun wounds at a national level. Patients with shotgun injury were identified from the National Trauma Data Bank (2007-2014). Transferred patients and those with missing procedure data were excluded. Demographics, injury data, and outcomes were collected and analyzed. Categorical variables are presented as number (percentage) and continuous variables as median (interquartile range). Shotgun wounds comprised 9% of all firearm injuries. After exclusions, 11,292 patients with shotgun injury were included. The median age was 29years (21-43) and most were male (n=9887, 88%). Most injuries occurred in the South (n=4092, 36%) and among white patients (n=4945, 44%). The median Injury Severity Score was 9 (3-16). Overall in-hospital mortality was 14% (n=1341), with 669 patients (7%) dying in the emergency department. Assault was the most common injury intent (n=6762, 60%), followed by accidental (n=2081, 19%) and self-inflicted (n=1954, 17%). The lower and upper extremities were the most commonly affected body regions (n=4071, 36% and n=3422, 30%, respectively), while the head was the most severely injured (median Abbreviated Injury Scale score 4 [2-5]). In the United States, shotgun wounds are an infrequent mechanism of injury. Shotgun wounds as a result of interpersonal violence far outweigh self-inflicted and accidental injuries. White men in their 20s in the southern parts of the country are most commonly affected and thereby delineate the high-risk patient population for injury by this mechanism at a national level.

The Prevalence of Musculoskeletal Problems in Architects

Aim: Architects are required to work on a computer for several hours a day which mainly requires sittingin prolonged static postures, along with bending and flexing the neck which might put strain on the back,cervical and wrist area.[1]The purpose of the study was to identify the prevalence of common musculoskeletalproblems in Architects.Methodology: A community based cross-sectional survey was conducted on 106 architects workingfor more than 2 years by administering the Extended Nordic Musculoskeletal Questionnaire to quantifythe musculoskeletal pain and activity limitations in 9 body regions. A Self-Designed Questionnaire wasadministered aiming at getting information regarding the various musculoskeletal problems faced byarchitects, various postured attained and activities performed throughout the day.Results: Out of total architects investigated, 80% architects experienced musculoskeletal pain. Neck, lowerback and shoulders were the most commonly affected body regions. The results showed that the work-relatedrisk factors like arms below shoulder activities (77.4%), frequent bending (41.5%), arms above shoulderactivities (25.5%), twisting (17.9%) and awkward postures were highly associated with musculoskeletaldisorders.Conclusion: The study concluded that there was 80% prevalence of musculoskeletal problems in Architects.Neck was the most commonly affected body region followed by low-back, shoulder and upper back. Majorityof architects required to work on computer in continuous sitting and also required to perform arm activitybelow shoulder level and bending constantly which may have contributed to the high prevalence of workrelated musculoskeletal disorders in this population. The study also concluded that the implementation ofergonomic intervention strategies at the workplace may eliminate ergonomic hazards and minimize the riskof work-related musculoskeletal disorders

Ankara bombing: distribution of injury patterns with radiological imaging.

PurposeTo describe and explain the blast injuries and imaging findings in the Ankara terrorist explosion that took place on October 10, 2015.Material and methodsA total of 77 patients who underwent radiologic imaging were classified as primary, secondary, tertiary, and quaternary, according to the injury type. The patients were evaluated based on body regions, such as head and neck, thorax, abdomen, lower extremity, and upper extremity.ResultsBlast lung injury was identified in one patient and tympanic membrane perforation in seven patients, as the primary injury. Sixty-two of 77 patients had secondary blast injuries caused by shrapnel. The blast injuries were observed in the head and neck (16/77, 20.7%), thorax (11/77, 14.2%), abdomen (16/77, 20.7%), lower extremity (48/77, 62.3%), and upper extremity (5/77, 6.4%). Vascular injuries were seen in eight cases, of which seven were in the lower extremities.ConclusionsThe most common blast injury pattern was of a secondary type in the current study. Lower extremities were the significantly more affected body region, probably due to the bomb exploding at ground level. In mass casualty events, radiologic imaging is located at the centre of patient management.

Comparative study of work-related musculoskeletal disorders among mechanized and manual stone miners

Background: Workers in the mining industry are prone to multiple health problems including musculoskeletal disorder. Very few studies are available assessing the occurrence of work-related musculoskeletal disorder (WMSD) among manual and mechanized mine workers due to unergonomic working conditions. Aims: The aim of this study is to establish and compare the prevalence of WMSD due to unergonomic working conditions among the manual and mechanized miners with age and work exposure and also to identify the most commonly affected body region. Materials and Methods: A questionnaire-based survey of about 889 manual and mechanized miners was conducted in different states of India. Results: It was also observed that vibration exposure was relatively higher among manual miners (62%) as compared to mechanized workers (45%) and also manual lifting of heavy loads is common practice in manual miners with 73% miners engaged in it as compared to only 23% mechanized miners. WMSDs were significantly higher in manual miners (61%) as compared to mechanized miners (36%). Odds ratio of WMSDs in relation to the age group of 18–40, 41–50, and 51–60 years was 2.56, 2.25, and 2.76, respectively, and in relation to work exposure of 0–10, 11–20, and >20 years was 3.38, 2.17, and 2.59, respectively, indicating that manual workers are much more prone for WMSDs. Conclusion: Our study showed that due to unergonomic working conditions, manual mine workers are more prone for WMSDs as compare to mechanized mine workers and work exposure is more relevant factor than age to study WMSDs.

Risk of spread in adult-onset isolated focal dystonia: a prospective international cohort study

ObjectiveIsolated focal dystonia can spread to muscles beyond the initially affected body region, but risk of spread has not been evaluated in a prospective manner. Furthermore, body regions at risk...

Prevalence of musculoskeletal symptoms in blue-collar workers: association with individual and lifestyle-related factors

This study aimed to investigate the 12-month and 7-day prevalence of musculoskeletal symptoms in different body regions and its association with individual (age, gender and BMI) and lifestyle-related (physical activity level and sitting time) factors among blue-collar workers of a Portuguese manufacturing company. One hundred and thirty-six blue-collar workers participated in the study. Musculoskeletal symptoms were assessed with the Nordic Musculoskeletal Questionnaire, and physical activity level and sitting time were assessed with IPAQ-Short Version. The 12-month prevalence was higher in the low back (56.6%), followed by the wrist/hand (50%), the shoulder (45.6%) and the neck (44.9%). In the last 7 days, the four most affected body regions were: the low back region (25%), the shoulders (20.6%) and the neck and wrist/hands (19.9%). Regarding individual factors, significant associations were found between age and the prevalence of musculoskeletal symptoms in the shoulder (p=0.034), elbow (p=0.033), wrist/hand (p=0.030), thigh/hip (p=0.008), neck (p=0.010) and the low back region (p=0.045), with the older workers reporting higher prevalence of musculoskeletal symptoms. Also, women reported a significant higher prevalence of musculoskeletal symptoms in the neck than men (p=0.025). Overweight and obese workers had a significantly higher prevalence of symptoms in the shoulder (p=0.003), wrist/hands (p=0.030) and neck (p=0.033). Regarding lifestyle-related factors, no significant associations were found between physical activity level or sitting time (p>0.05) and the prevalence of musculoskeletal symptoms in any of the body regions. To conclude, blue-collar workers have a high prevalence of musculoskeletal symptoms. Individual factors like age, gender and BMI seem to influence the prevalence of musculoskeletal symptoms in different body regions, but lifestyle-related factors such as the physical activity level and sitting time seem not to be associated with the prevalence of musculoskeletal symptoms in studied sample. The results emphasize the need of workplace interventions to prevent musculoskeletal symptoms in this population.

The Importance of Primary Reconstruction in the Treatment of Blast Related Hand Injuries During Childhood.

Blast injuries are common during wartime but are also related to various holiday festivals worldwide. Despite strict legislations, these devices still cause serious injuries leaving permanent disabilities. Children are affected in numerous cases with the hand being the most affected body region. The aim of our study was to profile the blast related hand injuries and to review treatment modalities that we used. A retrospective study of patients treated for blast-devices related hand injuries between 2006 and 2015 was performed. 112 patient with blast related hand injuries were treated in our department during the 10-year period. Most of the patients were male. The dominant hand was injured in 83.9% of the patients. Associated injuries were observed in 14.3% of patients. 90 children were treated on an out-patient basis, mostly due to hand burns (86.7%) or uncomplicated blast injuries (13.3%). 22 children required hospitalization due to severe blast and crush injuries and amputations. Surgery was carried out as the urgent procedure and involved debridement with primary repair. In the case of amputations debridement and sufficient skin ensuring complete wound coverage was the procedure of choice. Blast related injuries of the hand during childhood are frequent and can cause different and complex defects. Besides prevention of these injuries, primary reconstruction of the affected hand is of outmost importance in preventing long-term consequences.

Regional motor cortex dysfunction in amyotrophic lateral sclerosis.

ObjectiveThe pathophysiological processes underlying amyotrophic lateral sclerosis (ALS) need to be better understood, although cortical dysfunction has been implicated. Previous transcranial magnetic stimulation (TMS) studies have assessed cortical dysfunction from the hand. The aim of the present study was to determine whether cortical dysfunction was evident across representations of three body regions, and to relate these changes to clinical features of ALS.MethodsIn this cross‐sectional study, threshold tracking TMS was undertaken in 60 sporadic ALS patients, with motor evoked potential (MEP) responses recorded over the hand (abductor pollicis brevis), lower limb (tibialis anterior), and bulbar (trapezius) regions. The cross‐sectional findings were compared to 28 age‐ and gender‐matched controls.ResultsCortical dysfunction was evident across the representation of the three body regions, although the degree and nature of the dysfunction varied. Cortical hyperexcitability, as heralded by reduced short interval intracortical inhibition (SICI), was evident in all cortical regions (hand, P < 0.01; leg, P < 0.05; bulbar, P < 0.05) in ALS patients when compared with healthy control subjects. Importantly, features of cortical hyperexcitability seemed more prominent in clinically affected body regions and correlated with functional disability and muscle weakness. Cortical inexcitability was more prominent in the leg (P < 0.001) and bulbar regions (P < 0.01) when compared with controls.InterpretationThe nature of cortical dysfunction varied across the body regions in ALS, with cortical hyperexcitability being more prominent in the upper limbs while cortical inexcitability was more evident in the lower limbs and bulbar regions. The findings suggest a heterogeneity of cortical pathophysiological processes in ALS.

Characteristics and Consequences of Work-Related Musculoskeletal Pain among Cardiac Sonographers Compared with Peer Employees: A Multisite Cross-Sectional Study

Work-related musculoskeletal pain (WRMSP) among cardiac sonographers has been incompletely studied. The aim of this study was to compare the frequency, magnitude, and impact of WRMSP among cardiac sonographers with those of a control group of peer employees. An electronic survey was sent to cardiac sonographers and peer employees assigned to different occupational exposures within the Department of Cardiovascular Medicine at 10 Mayo Clinic facilities in four states. A total of 416 subjects completed the survey: 111 sonographers (27%) and 305 peer-employee control subjects (73%). The mean age was 43±11years, and 307 subjects (74%) were women. The sonographers' response rate was 86%. WRMSP was experienced by a large majority of sonographers (95 [86%] vs 140 [46%] for control subjects, P<.001). This association persisted after multivariate adjustment (odds ratio, 8.18; 95% confidence interval, 4.33-15.46; P<.001). Compared with coworkers, sonographers' pain was perceived as more severe (pain score>5 on a 10-point scale; 62% vs 29%, P<.001) and as getting worse (14% vs 2%, P<.001). The neck (58% vs 25%), shoulder (51% vs 11%), lower back (44% vs 26%), and hand (42% vs 9%) were the most frequently affected body regions (P<.001 for each). The presence of WRMSP in sonographers was more often associated with interference in performance of daily (37% vs 12%, P<.001) and work-related (42% vs 11%, P<.001) activities. Because of pain, sonographers more often sought medical evaluation (27% vs 12%, P<.001), missed work (13% vs 4%, P<.001), had work restrictions (5% vs 0.6%, P=.005), and were considering changing employment (9% vs 0.5%, P<.001) compared with control subjects. WRMSP in cardiac sonographers is much more prevalent and severe compared with peer employees. WRMSP in sonographers affects daily and work-related activities, as well as future employment plans. Further studies assessing the potential role of preventive interventions are needed.

Perfil epidemiológico de vítimas de violência atendidos em hospital de emergência

Objetivo: O objetivo do estudo visa analisar o perfil epidemiológico de vítimas de projetil de arma de fogo, arma branca e agressões corporais atendidas em hospital geral do estado de uma capital do nordeste brasileiro no período de 2011 a 2015. Método: Trata-se de um estudo ecológico e retrospectivo, por meio de análise dos prontuários dos pacientes atendidos no hospital. As variáveis estudadas foram: hora, local, dia e mês da ocorrência, locomoção até o hospital, idade, sexo, raça/etnia, escolaridade, escala de coma de Glasgow, conduta adotada, região corporal afetada e evolução do paciente. Resultados: Foram avaliados 5035, sendo 2984 prontuários de projetil de arma de fogo, 1276 de arma branca e 775 de agressões corporais. A faixa etária mais acometida foi de 20 a 39 anos, predominância no sexo masculino. A região corporal mais lesada foi o abdome, com projetil de arma de fogo e arma branca, 24,0% e 28,1% respectivamente. Receberam abordagem cirúrgica 84,7% e a taxa de letalidade foi 5,8%, para arma branca. Conclusão: Esse estudo permitiu identificar a existência de risco no período noturno, além de evidenciar altas taxas de letalidade. Torna-se visível a importância do debate sobre a temática na busca de minimização dos agravos.