Flatfoot is often asymptomatic but sometimes presents with symptoms, even in children. This thesis aimed to discover if there was a difference between children with and without symptoms, in the hope that this might aid treatment decisions. Firstly, an audit was performed to discover the prevalence and type of symptoms, as well as current treatment protocols. Secondly, 107 volunteers from the general population and 20 patients were assessed in more detail. The participants were divided into groups and ANOVA tests were used to find the significant differences. Pain and parental concern were frequently reported in the audit population. The majority of this population had moderate bilateral flexible flatfoot with an active Windlass mechanism and static heel valgus. Treatment was dependent on department. The symptomatic group displayed reduced passive ankle dorsiflexion indicating tightness of the tendo-Achilles, as well as increased frequency of severe knee hyperextension and knee valgus upon clinical examination. During static stance, three differences were found between symptomatic and asymptomatic groups, two differences between flat feet and neutral feet. During dynamic trials, the symptomatic group showed reduced stride length and percentage time spent in swing. The ground reaction profiles showed differences in early and late stance. Further investigation supported the idea that decreased late stance vertical ground reaction force peak was evidence of instability in the symptomatic group. Four kinematic parameters demonstrated significant differences at foot strike, five at midstance, and seven at foot off. In terms of kinetics, after controlling for relative stride length, four differences were found, but none between the asymptomatic and symptomatic flat feet. Plantar pressure was successfully used to estimate truncated foot length. The flat feet did not display increased peak midfoot pressure; it was actually lower in flat footed groups. Arch Index and Modified Arch Index were successfully used for instantaneous and continuous assessment of foot posture over stance. The differences found between symptomatic and asymptomatic flat feet (particularly at foot off) shed some light upon the potential causes of symptoms.

In energy harvesting communications, the transmitters have to adapt transmission to the availability of energy harvested during communication. The performance of the transmission depends on the channel conditions which vary randomly due to mobility and environmental changes. During this work, we consider the problem of power allocation taking into account the energy arrivals over time and the quality of channel state information (CSI) available at the transmitter, in order to maximize the throughput. Differently from previous work, the CSI at the transmitter is not perfect and may include estimation errors. We solve this problem with respect to the energy harvesting constraints. Assuming a perfect knowledge of the CSI at the receiver, we determine the optimal power policy for different models of the energy arrival process (offline and online model). Indeed, we obtain the power allocation scheme when the transmitter has either perfect CSI or no CSI. We also investigate of utmost interest the case of fading channels with imperfect CSI. Moreover, a study of the asymptotic behavior of the communication system is proposed. Specifically, we analyze of the average throughput in a system where the average recharge rate goes asymptotically to zero and when it is very high.

Bakgrund: Fotleden används dagligen och en nedsatt fotledsrörlighet kan orsaka många problem för personer i vardagen. Knäböj är en rörelse som används både i vardagen samt i träningssammanhang och kräver en god dorsalflexion i fotleden. Det är därför värdefullt att som fysioterapeut veta vilken metod som ökar dorsalflexion inför ett rehabiliteringsprogram där knäböj ingår. Syfte: Sammanställa litteraturen gällande akuta effekter av dynamisk och statisk stretching samt posterior talocrural glide på dorsalflexion i talocruralleden hos friska individer, definierat som personer utan fysiologisk sjukdom eller trauma med eventuell påverkan på fotleden. Studien syftar även till att värdera graden av evidens för behandlingarna. Metod: Litteratursökning utfördes i databasen PubMed. Slutligen inkluderades åtta studier med sammanlagt 141 deltagare. Samtliga studier kvalitetsgranskades enligt PEDro scale, därefter användes SBU:s GRADE för evidensbedömning. Resultat: Statistisk signifikant ökning på dorsalflexion för samtliga metoder med liknande utslag på rörlighet, med liten fördel för statisk stretch. Kvalitetsgranskning enligt PEDro scale visar på att fem studier anses vara av måttlig till hög kvalitet och tre anses vara av låg kvalitet. Otillräckligt vetenskapligt underlag för posterior talocrural glide, statisk och dynamisk stretch på dorsalflexion. Konklusion: Statisk stretch, dynamisk stretch och posterior talocrural glide ökar dorsalflexionen efter minst två minuters behandling. Evidensen talar för att samtliga metoder ger liknande utfall på dorsalflexionen med en liten fördel för statisk stretch, men fler studier behövs för att bekräfta resultatet. / Background: Demands are put on the ankle daily. Limited ankle range of motion can present problems during daily activities. The squat is a movement performed both in everyday life as well as in the context of training and requires ample dorsiflexion of the ankle. Therefore, it is of value to physiotherapists to know which method should be used to increase dorsiflexion in a rehabilitation protocol where the squat is included. Objective: To provide an overview of the acute effects of static and dynamic stretching as well as posterior talocrural glide in healthy individuals without physiological diseases or trauma relating to the ankle. The study will also assess the level of evidence surrounding each of these methods. Method: The database PubMed was used to search for the included studies. A total of eight studies was included in this review, with a total of 141 participants. Study quality was judged using PEDro scale, after which SBU’s GRADE was used to determine the level of evidence for each method. Result: A statistically significant increases present for each of the methods, with similar outcomes on the dorsiflexion. Assessing the quality of the included studies with PEDro scale resulted in five studies of moderate to high quality and three of low quality. Evidence supporting posterior talocrural glide, static and dynamic stretching is deemed insufficient according to SBU’s GRADE. Conclusion: Dorsiflexion is increased after two minutes of static and dynamic stretching as well as posterior talocrural glide. The evidence suggests that similar increases are present with each method, with static stretch showing a slightly higher result. However further research is required to confirm the result.

Background: The burden of Sexually transmitted infections (STIs) is high globally. The World Health Organisation (WHO) recommends syndromic management of these STIs, based on presentation with signs and symptoms, in resource-limited countries. Due to this syndromic approach, there is little current data on STI prevalence, including asymptomatic STIs, in high risk populations. Methods: We reviewed secondary data collected as part of the screening procedures of 6 clinical trials between 2012 and 2017 in Cape Town, South Africa. These trials recruited populations of different sexual orientation and gender, mostly key populations at risk of HIV and STI acquisition. Routine screening for STI symptoms and testing for Chlamydia, Gonorrhoea, Trichomonas, Syphilis and HIV was performed for all of the studies at screening/enrollment. Results: A total of 639 participants were screened; 411 (64.3%) self-identifying as female, 198 (31%) males, 29 (4.5%) transgender women and 01 (0.2%) transvestite. Median age was 20 years (IQR: 18-24), with the 15-24-year age category contributing 77% to the cohort. Laboratory testing diagnosed 239 (37.4%) people with STI infections in this cohort; only 28 (11.7%) people were symptomatic. 119 (88.8%) of Chlamydial, 64 (82.1%) of Gonorrhoeal, 23 (92%) of Trichomonal and 31(79.5%) of Syphilis infections elicited no signs and/or symptoms. Conclusion: A vast majority of STIs in this high-risk population were asymptomatic. Laboratory testing of causal organism was more reliable in diagnosing STIs than the use of signs and/or symptoms as recommended by WHO.

No description available.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18175号 / 医博第3895号 / 新制||医||1003(附属図書館) / 31033 / 京都大学大学院医学研究科医学専攻 / (主査)教授 上本 伸二, 教授 武藤 学, 教授 森田 智視 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第18907号 / 社医博第65号 / 新制||社医||9(附属図書館) / 31858 / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 富樫 かおり, 教授 武藤 学 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24541号 / 人健博第112号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 青山 朋樹, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

This study demonstrates the first case report in which an NK Cell deficiency initially presented as an asymptomatic disseminated herpes simplex viremia (HSV). A pre-term 13- day- old patient presented with disseminated HSV after investigation because his twin brother was found to have HSV vesicular lesions. The patient remained asymptomatic throughout the entire hospital course. While 40% of neonates never exhibit vesicular lesions, most of the infants will be symptomatic with DIC and/or respiratory and/or hepatic failure. The HSV development in his twin brother prompted immediate multiple HSV PCR testing even though he was asymptomatic. The results were positive for HSV in both plasma & nasopharynx. He received intravenous acyclovir treatment for 21 days. Both CSF & brain MRI studies demonstrated no CNS involvement. He was discharged home with oral acyclovir for one year. Two months after being off acyclovir he developed herpetic vesicles which resolved with acyclovir treatment. Currently, he is on chronic acyclovir treatment. Lymphocyte enumeration tests demonstrated NK cell deficiency. Typically, HSV is a virulent symptomatic infection especially when it presents with viremia. Here we have a case of asymptomatic HSV viremia. Likewise, HSV infection does not usually recur after 1 year of acyclovir treatment. Here, we have a child presenting with what seems to be recurrent congenital HSV infection even with adequate treatment. These atypical HSV presentations may have been due to NK cell deficiency. We, therefore, propose that clinicians should consider NK cell deficiency as possible etiology when HSV presents in an atypical manner as described in our case.

Orientador: Luis Cuadrado Martin / Resumo: Fundamentação: É crescente o número de trabalhos revelando a associação de hiperuricemia assintomática com hipertensão, síndrome metabólica, doenças cardiovasculares e doença renal crônica. Alguns estudos revelam que o tratamento da hiperuricemia assintomática reduz o número de desfechos renais e cardiovasculares. Tal premissa, no entanto, ainda não foi avaliada em uma subpopulação brasileira. Objetivos: Avaliar a associação entre tratamento com alopurinol e ocorrência de desfechos definitivos em portadores de doença renal crônica com hiperuricemia assintomática. Materiais e métodos: Foram avaliados, de forma retrospectiva, pacientes hiperuricêmicos e portadores de doença renal crônica não dialítica, em tratamento no HC-FMB – UNESP, os quais iniciaram acompanhamento no ambulatório de Insuficiência Renal Crônica ou de Nefrologia Geral do HC-UNESP desde janeiro 2002 a dezembro 2017. Com o intuito de avaliar a associação do uso do alopurinol sobre desfechos definitivos (entrada em terapia renal substitutiva, duplicação da creatinina ou morte). Resultados: Foram avaliados 109 pacientes sendo 53 do sexo feminino, cuja média de idade foi de 68 ± 11 anos. Destes, 95 eram brancos, 13 afrodescendentes e um asiático. Vinte e seis pacientes apresentaram o desfecho estudado no período; entre todos os 36 pacientes que iniciaram o uso de alopurinol no primeiro ano seguimento, ocorreram oito desfechos (22%). A proteinúria em 24 h associou-se aos desfechos avaliados Hazzard Ratio de 1,301 (I... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Rationale: There is increasing number of studies revealing an association of hyperuricemia with hypertension, metabolic syndrome, cardiovascular diseases and chronic kidney disease. Some studies have shown that treatment of asymptomatic hyperuricemia reduces the number of renal and cardiovascular outcomes. This premise, however, has not yet been evaluated in a Brazilian subpopulation. Objectives: To evaluate the association between treatment with allopurinol and the occurrence of definitive outcomes in patients with chronic kidney disease with asymptomatic hyperuricemia. Materials and methods: Hyperuricemic patients with chronic non-dialytic kidney disease under treatment at HC-FMB - UNESP who began follow-up at the Chronic Kidney Insufficiency or General Nephrology outpatient clinic at HC-UNESP, were retrospectively evaluated, from January 2002 to December 2017. In order to evaluate the association of the use of allopurinol on definitive outcomes (renal replacement therapy, creatinine doubling or death). Results: A total of 109 patients were evaluated, of which 53 were females, whose mean age was 68 ± 11 years. Of these, 95 were white, 13 Afro-descendants and one Asian. Twenty-six patients presented the outcome studied in the period; among all 36 patients who started using allopurinol in the first year of follow-up, eight outcomes (22%) occurred. Proteinuria at 24 h was associated with the Hazzard Ratio of 1.301 (95% CI: 1.122 -1.508), p: 0.011. In univariate analysis, phosp... (Complete abstract click electronic access below) / Mestre