Statistical model based 3D shape prediction of postoperative trunks for non-invasive scoliosis surgery planning

One of the major concerns of scoliosis patients undergoing surgical treatment is the aesthetic aspect of the surgery outcome. It would be useful to predict the postoperative appearance of the patient trunk in the course of a surgery planning process in order to take into account the expectations of the patient. In this paper, we propose to use least squares support vector regression for the prediction of the postoperative trunk 3D shape after spine surgery for adolescent idiopathic scoliosis. Five dimensionality reduction techniques used in conjunction with the support vector machine are compared. The methods are evaluated in terms of their accuracy, based on the leave-one-out cross-validation performed on a database of 141 cases. The results indicate that the 3D shape predictions using a dimensionality reduction obtained by simultaneous decomposition of the predictors and response variables have the best accuracy.

Multimodal image fusion of anatomical structures for diagnosis, therapy planning and assistance

This paper provides an overview of work done in recent years by our research group to fuse multimodal images of the trunk of patients with Adolescent Idiopathic Scoliosis (AIS) treated at Sainte-Justine University Hospital Center (CHU). We first describe our surface acquisition system and introduce a set of clinical measurements (indices) based on the trunk's external shape, to quantify its degree of asymmetry. We then describe our 3D reconstruction system of the spine and rib cage from biplanar radiographs and present our methodology for multimodal fusion of MRI, X-ray and external surface images of the trunk We finally present a physical model of the human trunk including bone and soft tissue for the simulation of the surgical outcome on the external trunk shape in AIS.

Reliability of a quantitative clinical posture assessment tool among persons with idiopathic scoliosis

Objective To determine overall, test–retest and inter-rater reliability of posture indices among persons with idiopathic scoliosis. Design A reliability study using two raters and two test sessions. Setting Tertiary care paediatric centre. Participants Seventy participants aged between 10 and 20 years with different types of idiopathic scoliosis (Cobb angle 15 to 60°) were recruited from the scoliosis clinic. Main outcome measures Based on the XY co-ordinates of natural reference points (e.g. eyes) as well as markers placed on several anatomical landmarks, 32 angular and linear posture indices taken from digital photographs in the standing position were calculated from a specially developed software program. Generalisability theory served to estimate the reliability and standard error of measurement (SEM) for the overall, test–retest and inter-rater designs. Bland and Altman's method was also used to document agreement between sessions and raters. Results In the random design, dependability coefficients demonstrated a moderate level of reliability for six posture indices (ϕ = 0.51 to 0.72) and a good level of reliability for 26 posture indices out of 32 (ϕ ≥ 0.79). Error attributable to marker placement was negligible for most indices. Limits of agreement and SEM values were larger for shoulder protraction, trunk list, Q angle, cervical lordosis and scoliosis angles. The most reproducible indices were waist angles and knee valgus and varus. Conclusions Posture can be assessed in a global fashion from photographs in persons with idiopathic scoliosis. Despite the good reliability of marker placement, other studies are needed to minimise measurement errors in order to provide a suitable tool for monitoring change in posture over time.

Differences in Standing and Sitting Postures of Youth with Idiopathic Scoliosis from Quantitative Analysis of Digital Photographs

The objective of this study was to explore whether differences in standing and sitting postures of youth with idiopathic scoliosis could be detected from quantitative analysis of digital photographs. Standing and sitting postures of 50 participants aged 10–20-years-old with idiopathic scoliosis (Cobb angle: 15° to 60°) were assessed from digital photographs using a posture evaluation software program. Based on the XY coordinates of markers, 13 angular and linear posture indices were calculated in both positions. Paired t-tests were used to compare values of standing and sitting posture indices. Significant differences between standing and sitting positions (p < 0.05) were found for head protraction, shoulder elevation, scapula asymmetry, trunk list, scoliosis angle, waist angles, and frontal and sagittal plane pelvic tilt. Quantitative analysis of digital photographs is a clinically feasible method to measure standing and sitting postures among youth with scoliosis and to assist in decisions on therapeutic interventions.

Is Breast Asymmetry Present in Girls with Adolescent Idiopathic Scoliosis?

Study Design Cross-sectional descriptive study. Objectives To characterize breast asymmetry (BA), as defined by breast volume difference, in girls with significant adolescent idiopathic scoliosis (AIS), using magnetic resonance imaging (MRI). Summary and Background BA is a frequent concern among girls with AIS. It is commonly believed that this results from chest wall deformity. Although many women exhibit physiological BA, the prevalence is not known in adolescents and it remains unclear if it is more frequent in AIS. Breasts vary in shape and size and many ways of measuring them have been explored. MRI shows the highest precision at defining breast tissue. Methods Thirty patients were enrolled on the basis of their thoracic curvature, skeletal and breast maturity, without regard to their perception on their BA. MRI acquisitions were performed in prone with a 1.5-Tesla system using a 16-channel breast coil. Segmentation was achieved using the ITK-SNAP 2.4.0 software and subsequently manually refined. Results The mean left breast volume (528.32 ± 205.96 cc) was greater compared with the mean right breast volume (495.18 ± 170.16 cc) with a significant difference between them. The mean BA was found to be 8.32% ± 6.43% (p < .0001). A weak positive correlation was observed between BA and thoracic Cobb angle (0.177, p = .349) as well as thoracic gibbosity angle (0.289, p = .122). The left breast was consistently larger in 65.5% of the patients. Twenty patients (66.7%) displayed BA ≥5%. Conclusions We have described BA in patients with significant AIS using MRI. This method is feasible, objective, and very precise. The majority of patients had a larger left breast, which could compound the apparent BA secondary to trunk rotation. In many cases, BA is present independently of thoracic deformity. This knowledge will assist in counseling AIS patients in regards to their concerns with BA.

Towards Non Invasive Diagnosis of Scoliosis Using Semi-supervised Learning Approach

In this paper, a new methodology for the prediction of scoliosis curve types from non invasive acquisitions of the back surface of the trunk is proposed. One hundred and fifty-nine scoliosis patients had their back surface acquired in 3D using an optical digitizer. Each surface is then characterized by 45 local measurements of the back surface rotation. Using a semi-supervised algorithm, the classifier is trained with only 32 labeled and 58 unlabeled data. Tested on 69 new samples, the classifier succeeded in classifying correctly 87.0% of the data. After reducing the number of labeled training samples to 12, the behavior of the resulting classifier tends to be similar to the reference case where the classifier is trained only with the maximum number of available labeled data. Moreover, the addition of unlabeled data guided the classifier towards more generalizable boundaries between the classes. Those results provide a proof of feasibility for using a semi-supervised learning algorithm to train a classifier for the prediction of a scoliosis curve type, when only a few training data are labeled. This constitutes a promising clinical finding since it will allow the diagnosis and the follow-up of scoliotic deformities without exposing the patient to X-ray radiations.

A Novel Method for the 3-D Reconstruction of Scoliotic Ribs From Frontal and Lateral Radiographs

Among the external manifestations of scoliosis, the rib hump, which is associated with the ribs' deformities and rotations, constitutes the most disturbing aspect of the scoliotic deformity for patients. A personalized 3-D model of the rib cage is important for a better evaluation of the deformity, and hence, a better treatment planning. A novel method for the 3-D reconstruction of the rib cage, based only on two standard radiographs, is proposed in this paper. For each rib, two points are extrapolated from the reconstructed spine, and three points are reconstructed by stereo radiography. The reconstruction is then refined using a surface approximation. The method was evaluated using clinical data of 13 patients with scoliosis. A comparison was conducted between the reconstructions obtained with the proposed method and those obtained by using a previous reconstruction method based on two frontal radiographs. A first comparison criterion was the distances between the reconstructed ribs and the surface topography of the trunk, considered as the reference modality. The correlation between ribs axial rotation and back surface rotation was also evaluated. The proposed method successfully reconstructed the ribs of the 6th-12th thoracic levels. The evaluation results showed that the 3-D configuration of the new rib reconstructions is more consistent with the surface topography and provides more accurate measurements of ribs axial rotation.

Non-invasive quantitative assessment of scoliosis spinal surgery outcome

Improving the appearance of the trunk is an important goal of scoliosis surgical treatment, mainly in patients' eyes. Unfortunately, existing methods for assessing postoperative trunk appearance are rather subjective as they rely on a qualitative evaluation of the trunk shape. In this paper, an objective method is proposed to quantify the changes in trunk shape after surgery. Using a non-invasive optical system, the whole trunk surface is acquired and reconstructed in 3D. Trunk shape is described by two functional measurements spanning the trunk length: the lateral deviation and the axial rotation. To measure the pre and postoperative differences, a correction rate is computed for both measurements. On a cohort of 36 scoliosis patients with the same spinal curve type who underwent the same surgical approach, surgery achieved a very good correction of the lateral trunk deviation (median correction of 76%) and a poor to moderate correction of the back axial rotation (median correction of 19%). These results demonstrate that after surgery, patients are still confronted with residual trunk deformity, mainly a persisting hump on the back. That can be explained by the fact that current scoliosis assessment and treatment planning are based solely on radiographic measures of the spinal deformity and do not take trunk deformity into consideration. It is believed that with our novel quantitative trunk shape descriptor, clinicians and surgeons can now objectively assess trunk deformity and postoperative shape and propose new treatment strategies that could better address patients' concern about their appearance. © (2013) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.

Not the outside but the inside matters : functional analysis of Capricious and Tartan during Drosophila tracheal morphogenesis

The tubular structures, which transport essential gases, liquids, or cells from one site to another, are shared among various divergent organisms. These highly organized tubular networks include lung, kidney, vasculature and mammary gland in mammals as well as trachea and salivary gland in Drosophila melanogaster. Many questions regarding the tubular morphogenesis cannot be addressed sufficiently by investigating the mammalian organs because their structures are extremely complex and therefore, systematic analyses of genetic and cellular programs guiding the development is not possible. In contrast, the Drosophila tracheal development provides an excellent model system since many molecular markers and powerful tools for genetic manipulations are available. Two mechanisms were shown to be important for the outgrowth of tracheal cells: the FGF signaling pathway and the interaction between the tracheal cells and the surrounding mesodermal cells. The Drosophila FGF ligand encoded by branchless (bnl) is localized in groups of cells near tracheal metameres. The tracheal cells expressing the FGF receptor breathless (btl) respond to these sources of FGF ligand and extend towards them. However, this FGF signaling pathway is not sufficient for the formation of continuous dorsal trunk, the only muticellular tube in tracheal system. Recently, it was found out that single mesodermal cells called bridge-cells are essential for the formation of continuous dorsal trunk as they direct the outgrowth of dorsal trunk cells towards the correct targets. The results in this PhD thesis demonstrate that a cell adhesion molecule Capricious (Caps), which is specifically localized on the surface of bridge-cells, plays an essential role in guiding the outgrowing dorsal trunk cells towards their correct targets. When caps is lacking, some bridge-cells cannot stretch properly towards the adjacent posterior tracheal metameres and thus fail to interconnect the juxtaposing dorsal trunk cells. Consequently, discontinuous dorsal trunks containing interruptions at several positions are formed. On the other hand, when caps is ectopically expressed in the mesodermal cells through a twi-GAL4 driver, these mesodermal cells acquire a guidance function through ectopic caps and misguide the outgrowing dorsal trunk cells in abnormal directions. As a result, disconnected dorsal trunks are formed. These loss- and gain-of-function studies suggest that Caps presumably establishes the cell-to-cell contact between the bridge-cells and the tracheal cells and thereby mediates directly the guidance function of bridge-cells. The most similar protein known to Caps is another cell adhesion molecule called Tartan (Trn). Interestingly, trn is expressed in the mesodermal cells but not in the bridge-cells. When trn is lacking, the outgrowth of not only the dorsal trunks but also the lateral trunks are disrupted. However, in contrast to the ectopic expression of caps, the misexpression of trn does not affect tracheal development. Whereas Trn requires only its extracellular domain to mediate the matrix function, Caps requires both its extracellular and intracellular domains to function as a guidance molecule in the bridge-cells. These observations suggest that Trn functions differently from Caps during tracheal morphogenesis. Presumably, Trn mediates a matrix function of mesodermal cells, which support the tracheal cells to extend efficiently through the surrounding mesodermal tissue. In order to determine which domains dictate the functional specificity of Caps, two hybrid proteins CapsEdTrnId, which contains the Caps extracellular domain and the Trn intracellular domain, and TrnEdCapsId, which consists of the Trn extracellular domain and the Caps intracellular domain, were constructed. Gain of function and rescue experiments with these hybrid proteins suggest on one hand that the extracellular domains of Caps and Trn are functionally redundant and on the other hand that the intracellular domain dictates the functional specificity of Caps. In order to identify putative interactors of Caps, yeast two-hybrid screening was performed. An in vivo interaction assay in yeast suggests that Ras64B interacts specifically with the Caps intracellular domain. In addition, an in vitro binding assay reveals a direct interaction between an inactive form of Ras64B and the Caps intracellular domain. ras64B, which encodes a small GTPase, is expressed in the mesodermal cells concurrently as caps. Finally, a gain-of-function study with the constitutively active Ras64B suggests that Ras64B presumably functions downstream of Caps. All these results suggest consistently that the small GTPase Ras64B binds specifically to the Caps intracellular domain and may thereby mediate the guidance function of Caps.

Spechte als ökologische Indikatoren in Natur- und Wirtschaftswäldern im Bialowiera-Wald (Ostpolen)

Die vorliegende Untersuchung analysiert die Eignung der "Spechtgemeinschaft" als ökologische Indikatorengruppe und formuliert vor dem Hintergrund der Ergebnisse Forderungen und Empfehlungen für einen "spechtgerechten" Umgang mit Wäldern. Die Habitatnutzung von sieben Spechtarten beim Nahrungserwerb wurde über einen Zeitraum von zwei Jahren in urwaldartigen und forstlich genutzten Beständen verschiedener Waldgesellschaften systematisch beobachtet. Das Untersuchungsgebiet ist der Bialowieza-Wald im äußersten Osten Polens, wo in enger räumlicher Nachbarschaft Natur- und Wirtschaftswaldflächen bearbeitet werden konnten. Die Beobachtungen erfolgten zwischen Anfang März 1999 und Ende Februar 2001 und wurden zu allen Jahreszeiten durchgeführt. Vier der insgesamt sechs Probeflächen repräsentieren die wichtigste Laubwaldgesellschaft des Gebietes, das Tilio-Carpinetum, die übrigen zwei die wichtigste Nadelwaldgesellschaft, das Peucedano-Pinetum. Die Hälfte der zwischen 42 und 54 ha großen Probeflächen lag im streng geschützten Urwaldreservat des Bialowieza-Nationalparkes, die übrigen in forstlich genutzten Waldbeständen. Zusätzlich wurde ein 2,5 km langes Transekt durch bewirtschafteten Erlen-Eschen-Auenwald und sehr naturnahen Erlenbruch bearbeitet. Die Probeflächen wurden in ein Raster aus 50x50m großen Quadranten unterteilt. Zur Beobachtung der Spechte beim Nahrungserwerb erfolgten 21 Begehungen je Probefläche bzw. Transekt. Die Probeflächen wurden dazu auf parallelen Linien mit Abständen von je 100m begangen, Startpunkt und Startrichtung wurden variiert. Zur Charakterisierung der Vegetation und Bestandesstruktur erfolgten Erhebungen zur Baumartenzusammensetzung, Größenklassenverteilung der Bäume, Totholzanteil und Krautvegetation. 1332 Beobachtungen von Spechten beim Nahrungserwerb konnten ausgewertet werden. Der Buntspecht wurde in allen Flächen am häufigsten gesehen. Mittel-, Weißrücken- und Kleinspecht wurden überwiegend in den Tilio-Carpineten beobachtet, in den Naturwäldern häufiger als in den bewirtschafteten Beständen. Der Dreizehenspecht wurde im Nadelwald und stärker mit Fichten durchmischtem Laubwald angetroffen. Bei Schwarz- und Grauspecht konnte keine klare Vorliebe für bestimmte Waldgesellschaften ermittelt werden. Der Buntspecht ernährte sich vor allem im Herbst und Winter überwiegend von fetthaltigen Samen und wurde dann meist beim Bearbeiten von Fichten- oder Kiefernzapfen in Schmieden beobachtet. Der Mittelspecht suchte als "Sammelspecht" seine Nahrung vor allem an den Oberflächen der Stämme und Äste. Klein-, Weißrücken-, Dreizehen- und Schwarzspecht traten als Hackspechte in Erscheinung. Die wenigen Daten zum Grauspecht reichen nicht zur Ermittlung der bevorzugten Nahrungserwerbstechnik aus. Bei Bunt-, Mittel- und Weißrückenspecht konnte eine deutliche Vorliebe für die Stieleiche als Nahrungsbaum nachgewiesen werden. Der Dreizehenspecht ist jedoch die einzige der beobachteten Arten mit einer weitgehenden Spezialisierung auf eine bestimmte Baumart, er nutzte in allen Waldgesellschaften meist die Fichte. Insgesamt bevorzugten die Spechte Bäume mit großen Stammdurchmessern, beim Kleinspecht ist diese Vorliebe allerdings nur schwach ausgeprägt. Totholz wurde von Weißrücken-, Dreizehen- und Kleinspecht bei der Nahrungssuche bevorzugt, vom Mittelspecht jedoch nur gelegentlich genutzt. Beim Buntspecht zeigte der Totholz-Nutzungsanteil erhebliche Unterschiede zwischen verschiedenen Baumarten. Liegendes Totholz spielte in den Tilio-Carpineten im Vergleich zu stehendem Totholz und toten Teilen lebender Bäume nur eine geringe Rolle für Nahrung suchende Spechte.

Diversity and nutritional properties of Pakistani dates: implications for sustainable value chain and decent living perspectives of rural households

Date palm (Phoenix dactylifera L.) occupies almost three percent of the total worldwide cultivated area, with an annual production of seven million tonnes (t). Pakistan is an ideal place for the cultivation of date palm due to its sandy loam soil and semi-arid climate. In 2012, Pakistan produced 600,000 t of dates, on an area of 95,000 ha. Baluchistan province is the country’s top date producer, followed by Sindh, Punjab and Khyber Pakhtunkhwa (KPK) provinces. More than 300 date varieties are known to exist in Pakistan and some commercially important cultivars are: Karbalaen, Aseel, Muzawati, Fasli, Begum Jhangi, Hillawi, Dashtiari, Sabzo, Koharaba, Jaan Swore, Rabai and Dhakki. Six districts from the four provinces of Pakistan (Jhang, Muzaffargarh and Bahawalpur (Punjab), Dera Ismail Khan (KPK), Khairpur (Sindh) and Panjgur (Baluchistan)) with largest area under date palm cultivation were selected to conduct socio-economic surveys including the income sources of date palm growers. A structured questionnaire with open-ended and closed questions was used for face-to-face interviews of 170 date palm growers. At each location after selection of a first farmer through a local guide, the former was requested to provide names and addresses of three other date growers in his area. From these three names, one was randomly selected for the next sampling. Additionally, date palm fronds and fruits of all available cultivars were collected for morphological and nutritional analyses. Soil samples were collected from the groves for subsequent chemical and physical analyses. Almost all farmers used dates as a food item for their families and some were using low quality dates as a feed for their livestock. Apart from dates, other date palm components (trunk, spadix, frond, inflorescence and seed) were used by date palm growers as a raw material for making many by-products for their families. Date palm had a major contribution in the income of households, 24% received 91-100% of their income from date palms. More than half of the surveyed farmers had date palm groves, but scattered plantations, home gardens and intercropping systems with cereal and other fruits were also present. Dhakki, Muzawati, Aseel, and Karbalaen were the most important commercial cultivars grown in the provinces of KPK, Baluchistan, and Sindh. Aseel, Karoch, Haleni, Karbalaen, and Muzawati cultivars had the most firm fruit and good total soluble sugar, calcium and magnesium contents. The amount of magnesium found in dates of studied cultivars ranged from 0.143 to 0.876 mg g-1. A great variation in frond morphology was recorded among the cultivars. Fruit length and fruit weight was highest in Dhakki date, making it visually more attractive for customers in addition to its good nutritional properties. The seed weight of the studied cultivars ranged from 0.7-2.0 g, while Desi dates had largest seed, making them less attractive for marketing. However, in terms of nutritional value and fruit size, most of the investigated varieties can compete with globally important commercial dates.

Analysis of Pleistocene paleodrainage evolution in the Po Basin (Italy) by multivariate statistical techniques

In order to obtain a high-resolution Pleistocene stratigraphy, eleven continuously cored boreholes, 100 to 220m deep were drilled in the northern part of the Po Plain by Regione Lombardia in the last five years. Quantitative provenance analysis (QPA, Weltje and von Eynatten, 2004) of Pleistocene sands was carried out by using multivariate statistical analysis (principal component analysis, PCA, and similarity analysis) on an integrated data set, including high-resolution bulk petrography and heavy-mineral analyses on Pleistocene sands and of 250 major and minor modern rivers draining the southern flank of the Alps from West to East (Garzanti et al, 2004; 2006). Prior to the onset of major Alpine glaciations, metamorphic and quartzofeldspathic detritus from the Western and Central Alps was carried from the axial belt to the Po basin longitudinally parallel to the SouthAlpine belt by a trunk river (Vezzoli and Garzanti, 2008). This scenario rapidly changed during the marine isotope stage 22 (0.87 Ma), with the onset of the first major Pleistocene glaciation in the Alps (Muttoni et al, 2003). PCA and similarity analysis from core samples show that the longitudinal trunk river at this time was shifted southward by the rapid southward and westward progradation of transverse alluvial river systems fed from the Central and Southern Alps. Sediments were transported southward by braided river systems as well as glacial sediments transported by Alpine valley glaciers invaded the alluvial plain. Kew words: Detrital modes; Modern sands; Provenance; Principal Components Analysis; Similarity, Canberra Distance; palaeodrainage

Seguimiento de áreas cruentas cubiertas con queratinocitos autólogos cultivados en suero autólogo: Estudio multicéntrico en Bogotá

En 2009 se presento la estandarización de cultivos de queratinocitos autólogos cultivados en suero autólogo. En este estudio los autores describen la efectividad de estos parches de regeneración de piel, para la cobertura de áreas cruentas con indicación de injerto de piel parcial. El porcentaje de epitelización del área cruenta fue el punto principal. Métodos: 47 pacientes fueron incluidos consecutivamente, equivalentes a 78 áreas cruentas. Las áreas fueron estratificadas según la profundidad: grupo 1:IIA (n=8) grupo 2: IIB (n=39); grupo 3,III (n=24) y grupo 4, etiología diferente: Otras (n=7). Todas las áreas fueron tratadas con injertos de queratinocitos autólogos cultivados en suero autólogo y se realizo registro fotográfico y del porcentaje de epitelización al día 5, 7, 15 y 30. Resultados: La efectividad de los injertos de queratinocitos autólogos es de 53.16% ± 46.46%. El porcentaje de epitelización es mayor para el grupo 1 (100%) y grupo 2 (62.79%) que para el grupo 3 (27.57%) y el grupo 4 (33.86%). Se encontró relación entre la interacción de las medianas del porcentaje de epitelización entre área corporal y grado de quemadura (p<0.001 KW) siendo mayor para el grupo 1 en todas las áreas, grupo 2 en cara, grupo 3 en tronco y grupo 4 en cara; y el menor porcentaje de epitelización en el grupo 3 y grupo 4 de las áreas ubicadas tronco. Conclusión: Los injertos de queratinocitos autólogos cultivados en suero autólogo son un método de cobertura eficaz para áreas cruentas producidas por quemaduras IIA y IIB independientemente del tamaño y la localización , y para las áreas cruentas pequeñas (<9cm2) de etiología diferente o grado III de profundidad. Palabras Clave: Cultivo queratinocitos, cobertura áreas cruentas, efectividad.

Examen neurológico

Se realizó un capítulo sobre la descripción del examen neurológico como herramienta principal en el abordaje del paciente con patología neurológica.

Morbilidad laboral en el sector agrícola en trabajadores afiliados a una administradora de riesgos laborales (ARL) de Colombia, durante el periodo 2011-2012.

Este estudio muestra la prevalencia por enfermedad laboral de un grupo de trabajadores afiliados a una ARL en Colombia. Compara la morbilidad laboral entre dos grupo de trabajadores expuestos y no expuestos al trabajo agrícola y al interior del grupo de trabajadores agrícolas agrupados en las actividades de corte de caña, cultivo de banano y flores. Se realizó un estudio descriptivo de tipo transversal durante el periodo 2011-2012, mediante la revisión de una base de datos de morbilidad laboral. Se realizó un análisis uni-variado y Bi-variado y se comparó la morbilidad con datos sociodemográficos, grupos de trabajadores agrícolas y no agrícolas, y actividad productiva del sector agrícola. Se revisaron 3129 diagnósticos de enfermedad profesional durante el periodo de estudio, 433 diagnósticos fueron trabajadores agrícolas y 2696 pertenecieron a otros grupos de trabajadores. Los desórdenes Osteomusculares fueron los diagnósticos más prevalentes en el grupo Agro 92% y No Agro 86% y en las actividades de corte de caña, cultivo de banano y flores. Entre el grupo Agrícola y no agrícola se encontraron diferencias significativas en los siguientes diagnósticos: Síndrome del túnel del carpo, Síndrome de manguito rotador, Otras sinovitis y tenosinovitis, Lumbago no Especificado, Hipoacusia Neurosensorial Bilateral y epicondilitis lateral; de igual manera se encontraron diferencias entre las actividades de corte de caña y cultivo de banano y flores en los diagnósticos de: Epicondilitis, Sinovitis, Síndrome del túnel del Carpo y Trastorno lumbar. El factor de riesgo más prevalente en el grupo agrícola fue el Ergonómico con el 92.8% de los casos