Which patients with renal colic should be referred?

Around 1-2 people per thousand present with an acute episode of pain caused by renal stones each year. Renal colic is classically sudden in onset, unilateral, and radiates from loin to groin. Renal pelvic or upper ureteric stones usually cause more flank pain and tenderness while lower ureteric stones cause pain radiating towards the ipsilateral testicle or labia. Other common symptoms include nausea and vomiting, haematuria and irritative LUTS. A febrile patient with renal colic requires immediate hospital admission. Symptoms suggestive of renal colic along with a positive dipstick for haematuria have a reported sensitivity of 84% and specificity of 99% but it is important to consider other differential diagnoses. An NSAID is preferred over an opiate drug as an initial analgesic choice as the NSAID can help reduce ureteric spasm. Diclofenac has the best evidence base for this class of analgesic. About 90% of stones will pass spontaneously and thus it is often appropriate to manage renal colic at home. Patients with signs of peritonitis, systemic infection, septic shock as well as those whose diagnosis is unclear should be referred urgently to hospital. Patients who are systemically unwell with renal stones are more likely to have an infected and obstructed urinary tract system that needs urgent imaging and possible drainage. All patients who are managed at home should have renal tract imaging within a week by fast track referral to radiology or as an urgent urology outpatient referral as per local guidelines to rule out an obstructed urinary system. Patients with recurrent stones should be advised to maintain a copious fluid intake (>2 L/day) to reduce the concentration of the urine. A reduction in salt intake (ideally

Correlacion clinica-patologica de corioamnionitis en pacientes que ingresan al servicio ginecologia en el año 2009 en el Hospital Universitario Clinica San Rafael

Este trabajo tuvo como utilidad básica determinar cuál es la correlación del diagnóstico clínico con los criterios de Gibss y con el Gold estándar que es la patología en las paciente con corioamnionitis para así poder establecer si el diagnostico se realizó en forma adecuada y cuáles son los criterios más relevantes para su diagnóstico. Dicha investigación se realizó de la siguiente manera: 1. Se Identificaron las pacientes que ingresaron al servicio de urgencias o al servicio de ginecología de la Clínica san Rafael con diagnóstico de Corioamnionitis (teniendo en cuenta los criterios de Gibbs), pacientes que desarrollaron la entidad durante el trabajo de parto o a las cuales se les hizo el diagnostico durante el mismo parto se establecieron los criterios de Gibss para cada una como parte del diagnóstico clínico de corioamnionitis 2. se revisaron los estudios anatomo-patologico realizado a las placentas culminado el proceso de trabajo de parto ya fuera por vía vaginal o cesárea y se realizó un estudio de asociación entre el resultado patológico de corioamnionitis y el diagnóstico clínico. Con esta investigación se estableció el diagnóstico clínico se correlaciono con la patología en el 54% de los casos 1. la asociación de los criterios de Gibbs con el diagnostico patológico, encontrando que individualmente los criterios que se asocian con el diagnóstico definitivo de corioamnionitis fueron: la taquicardia materna OR (8,53), taquicardia fetal OR (7,7), y leucocitosis OR (2,86), la descarga vaginal fétida y la hipersensibilidad uterina tuvieron menor significancia con OR de 1,24 y 1,1 respectivamente. e En la regresión logística se encontró que los criterios de Gibbs fueron estadísticamente significativos en donde para la taquicardia materna OR (7,29), taquicardia fetal OR (4,107), hipersensibilidad uterina OR (2,96), leucocitosis OR (4,93) y descarga vaginal OR (2,65)

Sensibilidad del cuestionario anamnésico de síntomas de miembro superior y columna desarrollado por la unidad de investigación de ergonómica de postura y movimiento (EPM) desde la perspectiva de la fisioterapia en Colombia

El propósito de este estudio es evaluar la sensibilidad, especificidad y valores predictivos del Cuestionario Anamnésico de Síntomas de Miembro Superior y Columna (CASMSC) desarrollado por la Unidad de Investigación de Ergonomía de Postura y Movimiento (EPM). Se realizó un estudio descriptivo de tipo correlacional, mediante el análisis de datos secundarios de una base de datos con registros de trabajadores de la industria de alimentos (n=401) en el año 2013, a quienes se les había aplicado el CASMSC, así como una evaluación clínica fisioterapéutica enfocada en los mismos segmentos corporales; esta última utilizada como prueba de oro. Para analizar si existían diferencias estadísticas por edad, antigüedad y género se aplicó el análisis de varianza de una vía. La sensibilidad, especificidad y valores predictivos del CASMSC se informan con sus respectivos intervalos de confianza (95%). La prevalencia de umbral positivo para sospecha de Desorden Músculo Esquelético (DME) tanto de miembro superior como de columna se encontró muy por encima de la media nacional para el sector. La sensibilidad del CASMSC para miembro superior estuvo en el rango de un 80% a 94,57% y para columna cervical y lumbar fue de 36,4% y 43,4%, respectivamente. Para la región dorsal fue casi del doble de las otras dos regiones (85,7%). El CASMSC es recomendable en su apartado para miembro superior dado a su alto nivel de sensibilidad.

Vitamin E supplementation, cereal feed type and consumer sensory perceptions of poultry meat quality

Lipid oxidation leads to meat spoilage and has been reported to cause adverse changes in the flavour and texture of poultry meat. Vitamin E has been found to be effective in delaying lipid oxidation. The aim of this study was to determine whether the vitamin E supplementation of chicken feed influences the consumers' perception of the quality of chicken meat under normal display and storage conditions. Untrained consumers (n 32) evaluated cooked breast meat from chickens (both corn fed and wheat fed) supplemented with 75 250 or 500 mg/kg vitamin E and after storage at 4° C for 4 and 7 d. Factorial analysis found an interaction between vitamin E treatment and storage day upon the perceived juiciness (P = 0.023) and tenderness (P = 0.041) of the chicken meat. Perceptions of quality relative to vitamin E level were more evident on day 4 than day 7. When the two cereal types were compared, the time-related subgroup effects were observed only in meat from corn-fed chickens supplemented with either 75 or 250 mg/kg, which was perceived to be juicier (P = 0.018) and more tender (P = 0.020) than that supplemented at the 500 mg/kg level. These results imply that the two lower concentrations of vitamin E have some advantages over 500 mg/kg, but for optimal consumer acceptance of corn-fed chicken meat, we suggest that 250 mg/kg vitamin E should be added to corn-fed poultry feed. There was no evidence to suggest any advantages in changing the current amount of vitamin E (75 mg/kg) used to rear wheat-fed birds.

Production systems - An example from Brazil

Important information about the Brazilian agribusiness, population and economy are presented in this paper, as well as details of beef production, market, industry and production system, to inform people involved in meat industry about details on demography, production, economy and production systems of a country that is the largest player in beef exports in the world and that uses, mostly, Bos indicus based bovine population, reared under pasture conditions, for meat production purposes. Herd size, genetic evaluation programs, quantity of beef produced and market is informed, with figures about the global and major players` production. Some discussion related to environmental concerns, methane emission and carbon fixation is also presented, as well as meat quality. Meat quality of fed animals is also compared with beef from animals that are raised in pasture conditions. (c) 2009 Elsevier Ltd. All rights reserved.

Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy

Background: Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset. Hypothesis: The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy (lambda = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm(2) and a total dose of 5.4 J per session. Results: The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P =.007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group. Conclusion: Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.

Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players

Background—Palpation is an important clinical test for jumper's knee.

Objectives—To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality.

Methods—In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively.

Results—Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36–38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (p<0.001). Tender and symptomatic tendons were more likely to have ultrasound abnormality than tenderness alone (p<0.01).

Conclusions—In this age group, palpation is a reliable test but it is not cost effective in detecting patellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.

Painful nipples in nursing mothers: fungal or staphylococcal?

Painful nipples, or ‘breast thrush’, in nursing mothers is a well recognised condition. It is a clinical diagnosis characterised by intense nipple pain often radiating into the breast, especially during breastfeeding. Between feeds it may cause a burning sensation and tenderness; breastfeeding may be abandoned because of it.

Effects of dietary lipid type on muscle fatty acid composition, carcass leanness, and meat toughness in lambs.

Isonitrogenous amounts of two protein sources differing in rumen degradation rate and in lipid composition were fed to sheep with or without a rapidly fermentable cereal grain. The effects on intake, carcass leanness, and muscle fatty acid (FA) composition were examined. Thirty-eight crossbred wether lambs (9 mo, 35 to 48 kg) were allocated by stratified randomization to six treatment groups: 1) basal diet of alfalfa hay:oat hay (20:80) ad libitum = basal; 2) basal + lupin (358 g DM/d) = lupin; 3) basal + fish meal (168 g DM/d) = fish meal; 4) basal + barley (358 g DM/d) = barley; 5) basal + barley + lupin (179 + 179 g DM/d) = barley/lupin; or 6) basal + barley + fish meal (179 + 84 g DM/d) = barley/ fish meal. Lambs were fed individually. Dietary treatments were imposed for 8 wk, and the supplements were offered at 2-d intervals. Daily feed intake and weekly BW of lambs were recorded. At the end of the feeding period lambs were slaughtered after an overnight fast. Hot carcass weight (HCW) and fat depth (GR; total fat and muscle tissue depth at 12th rib, 110 mm from midline) were recorded. At 24 h postmortem samples of longissimus thoracis (LT) and longissimus lumborum (LL) muscles were taken from chilled (4 deg C) carcasses for the assessment of FA composition and meat tenderness, respectively. Lambs fed lupin or fish meal with or without barley had heavier slaughter weights (P < 0.004) and HCW (P < 0.001) than lambs fed basal or barley when initial BW was included as a covariate. The lupin diet also resulted in heavier carcasses (P < 0.05) than the fish meal or barley/fish meal diets. With GR as an indicator, fish meal and barley/ fish meal diets produced leaner carcasses (P < 0.01) than lupin and barley/lupin lambs. Long-chain n-3 FA content [20:5n-3 (P < 0.001), 22:5n-3 (P < 0.003), and 22:6n-3 (P < 0.001)] in the LT muscle were substantially higher with the fish meal and barley/fish meal diets, whereas muscle total n-6 FA was increased (P < 0.003) by lupin and barley/lupin compared with all other diets. Thus, increased muscle long-chain n-3 FA content occurred without an increase in fatness measured as GR, whereas increased muscle n-6 FA content was associated with an increase in carcass fatness. Under these circumstances, a reduction in carcass fatness had no effect on meat tenderness measured as Warner-Bratzler shear force.

Skin hunger

Performed dusk till dawn, Friday 26 October 2007
"Skin Hunger is an improvised movement performance that invites the audience to engage directly with the performer. The performer is accompanied by a sign that invites the audience to 'touch me and see what happens'. He then uses the tactile information as a stimulus to generate movement and motivation for what he does. Small moments of relationship emerge from the initiations offered by the audience and the performer's ability to be responsive to the moment of touch.

The sign reads:

Touch me.
Touch me and see what happens.

Perhaps I will dance
Or I may do something else.

If you hit me I will bruise I do not enjoy physical pain.

Tenderness is rare.

Brush, scratch, rub, pat, prod, punch, bump, jiggle, stroke, push, nudge, tickle, hug, squeeze, caress, feel, grope, fondle, graze, tap, fiddle with, handle, slap, knead, cuff, spank, thump, shake, jerk, clout, graze, chafe, tap, poke, jab, dig, skim, shove, pet, cuddle, embrace, finger, maul, paw, manipulate, pump, support. "
cf. Melbourne International Arts Festival. Musicircus artists
(http://www.melbournefestival.com.au/musicircus_artists)

The use of auricular examination for screening heaptic disorders

Researches on auricular acupuncture (AA) have examined mainly its treatment effects. This study aimed to investigate the accuracy and precision of using auricular examination (AE) as a complementary diagnostic tool for screening hepatic disorders. Twenty patients suffering from liver dysfunction and 25 controls aged 18–60 years were recruited from an acute hospital. Participants were examined using three AE methods including visual inspection, electrical skin resistance measurement, and tenderness testing on the liver AA zone of both ears. Significant differences were found in visual inspection and electrical skin resistance on the AA zones between the two groups. Patients suffering from liver dysfunction tended to have at least one abnormality in skin color, appearance, presence of papules, abundance of capillary and desquamation on the ear (Relative Risk—Right ear: RR = 2.9, 95% confidence interval (CI) 1.4, 6.2; Left: RR = 1.8, 95% CI, 1.01, 3.1). The sensitivity for visual inspection was 0.7 for both ears; specificity was 0.76 for the (R) and 0.6 for the (L) ear. The mean difference in electrical skin resistance was 4.3 MΩ (95% CI, 1.7, 6.9) for the (L) ear; 4.5 MΩ (95% CI, 1.5, 7.6) for the (R) ear. Our results suggest that malfunction of the liver appeared to be reflected by the presence of morphological changes on the liver AA zone. Visual inspection and electrical skin resistance on the liver AA zone are potentially sensitive to screen hepatic disorders.

Devious intimacy

Devious Intimacy combines a sly, playful wit with a melancholic tenderness to navigate the complex terrain of difficult feelings. Vickery’s poems move effortlessly between the private world of love and sexuality to wider forms of connection, teasing out how past histories and literature underscore contemporary human bonds and how we imagine ourselves in light of neighbours, nationhood, and the environment. From Abstract Expressionism to Test Cricket, Vickery’s poetry delves into that which delights and intrigues us, both celebrating and critiquing our everyday routines and aesthetic modes of reception. Wry, smart, and bristling with acute observation, Devious Intimacy is a beguiling mix of charm and charge.

Weathering, fibre strength and colour properties of processed white cashmere

Weathering refers to the degradation of wool fibres that occur during growth from exposure of the fleece to sunlight, water and air. Weathering damage to Merino wool reduces quantities of fibre that are harvested, reduces length in both raw and processed wools, reduces spinning performance and dyeing outcomes. This work aimed to aimed to quantify if and to what extent weathering occurred in 38 lots of commercial dehaired white cashmere and cashmere top sourced from traditional and new origins of production and the extent of any association between weathering and tensile strength properties of the dehaired cashmere and cashmere top. The cashmere was tested for physical properties, bundle tenacity and extension, tristimulus values brightness (Y) and yellowness (Y-Z) and reflectance. Dye uptake was used as an index of weathering. Linear models, relating to weathering, bundle tenacity and Y-Z were fitted to origin and other objective measurements. Mean attributes (range) were: mean fibre diameter, 17.0 μm (13.5–21.3 μm); bundle tenacity of tops, 10.3 cN/tex (8.3–12.9 cN/tex), for dehaired fibre, 10.1 cN/tex (9.1–11.4 cN/tex). Stain uptake varied from 0.92 to 6.34 mg/g fibre indicating a six-fold variation in the extent of weathering. Both the extent of weathering and the bundle tenacity of commercial lots of cashmere were affected by the origin of the cashmere. Increased weathering reduced bundle tenacity, bundle extension, increased the yellowness and reduced reflectance of white cashmere. Bundle tenacity of cashmere declined as fibre diameter variability increased from 20 to 22.5%. For the samples tested, the cashmere from China, Mongolia, Afghanistan and Iran showed more weathering than cashmere from Australia, New Zealand and the USA. The differences in the extent of weathering and of bundle tenacity between cashmere from different origins were of commercial significance.

Características fisico-químicas e sensoriais da carne de bubalinos Murrah abatidos em diferentes períodos de confinamento

Objetivou-se avaliar as características físicas, químicas e sensoriais da carne de búfalos abatidos em diferentes períodos de confinamento. Foram utilizados 20 bubalinos da raça Murrah, castrados, descornados, com idade média inicial de 15 meses, abatidos aos 75, 100, 125 ou 150 dias de confinamento. Após o abate, as carcaças foram identificadas e resfriadas por 24 horas. Durante a desossa, foram colhidas amostras do contrafilé entre a 10ª e 11ª costelas para análise das características sensoriais e das perdas por cocção; entre a 11ª e 12ª costelas para avaliação da composição centesimal, do valor calórico, do pH e do índice de fragmentação miofibrilar (IFM); e entre a 12ª e 13ª costelas para a avaliação do escore de marmorização e da força de cisalhamento. A composição centesimal, o pH, a força de cisalhamento, o valor calórico, as perdas por cocção e o IFM não diferiram estatisticamente entre os períodos de confinamento. O grau de marmorização diferiu entre as idades de abate, uma vez os animais abatidos aos 75 dias de confinamento apresentaram escore de 1,25; os abatidos aos 100 e 125 dias, escore 2; e aqueles abatidos aos 150 dias de confinamento, escore 2,2. em todos os períodos de confinamento, a carne bubalina foi classificada como macia (média 3,94 kgf) e apresentou com características que não diferiram pelo painel sensorial entre os 75 e 150 dias de confinamento. O abate de bubalinos aos 75 e 150 dias de confinamento não influencia as características sensoriais sabor, aroma e cor da carne bubalina.