Manual therapy in adults with tension-type headache: A systematic review.

INTRODUCTION: Tension-type headache is the most common primary headache, with a high prevalence and a considerable socioeconomic impact. Manual physical therapy techniques are widely used in the clinical field to treat the symptoms associated with tension-type headache. This systematic review aims to determine the effectiveness of manual and non-invasive therapies in the treatment of patients with tension-type headache. DEVELOPMENT: We conducted a systematic review of randomised controlled trials in the following databases: Brain, PubMed, Web of Science, PEDro, Scopus, CINAHL, and Science Direct. Ten randomised controlled trials were included for analysis. According to these studies, manual therapy improves symptoms, increasing patients' well-being and improving the outcome measures analysed. CONCLUSIONS: Manual therapy has positive effects on pain intensity, pain frequency, disability, overall impact, quality of life, and craniocervical range of motion in adults with tension-type headache. None of the techniques was found to be superior to the others; combining different techniques seems to be the most effective approach.

[Treadmill training with partial body weight support in subjects with incomplete spinal cord injury: a systematic review]. / Entrenamiento en cinta rodante con soporte parcial del peso corporal en pacientes con lesión medular incompleta: revisión sistemática.

INTRODUCTION: The partial body weight supported treadmill training is a common therapeutic strategy in rehabilitation of people with spinal cord injuries. AIM: To analyze its effects on gait, balance and muscle strength in people with incomplete spinal cord injury compared to conventional treatment or overground gait training. PATIENTS AND METHODS: A compilation of clinical trials from 2007 to 2019 was carried out. We included articles that evaluate the effects of body weight supported treadmill training on gait, balance and muscle strength in subjects with incomplete spinal cord injury. RESULTS: A total of six articles were analyzed. The walking cadence, speed and resistance improved in the participants that received the intervention compared to those that were treated with conventional training. The functionality, balance and strength improved in most studies, but there were not differences between them. CONCLUSIONS: Body weight supported treadmill training improves the spatiotemporal parameters of walking and resistance in subjects with incomplete spinal cord injury, but in most variables analyzed (balance, functionality and strength) the changes are not superior to those observed after conventional training.

TITLE: Entrenamiento en cinta rodante con soporte parcial del peso corporal en pacientes con lesión medular incompleta: revisión sistemática.Introducción. El entrenamiento de la marcha sobre pasarela rodante con soporte parcial del peso corporal es una estrategia terapéutica frecuente en la rehabilitación de personas con lesión medular. Objetivo. Analizar los efectos de esta intervención en la marcha, el equilibrio y la fuerza muscular en personas con lesión medular incompleta en comparación con un tratamiento de fisioterapia convencional o con un entrenamiento de la marcha sobre suelo. Pacientes y métodos. Se realizó una recopilación de ensayos clínicos desde 2007 hasta 2019. Se incluyeron trabajos que evaluasen el entrenamiento de la marcha con soporte parcial del peso corporal en cinta rodante en pacientes con lesión medular incompleta y que analizasen la marcha, el equilibrio y la fuerza muscular. Resultados. Se analizaron seis artículos. Según los resultados de los estudios incluidos, la cadencia, la velocidad y la resistencia de marcha mejoraron en los participantes que recibieron entrenamiento sobre pasarela rodante con soporte parcial del peso corporal respecto al grupo de control. Las variables de funcionalidad, equilibrio y fuerza mejoraron en ambos los grupos de intervención. Conclusiones. El entrenamiento de la marcha con soporte parcial del peso corporal sobre cinta rodante mejora los parámetros espaciotemporales de la marcha y la resistencia de los pacientes con lesión medular incompleta, pero, en la mayoría de las variables analizadas, los cambios no son superiores a los observados tras un entrenamiento convencional.

[Observational gait scale for persons with lower extremity amputation. Design and content validity]. / Escala observacional de la marcha del sujeto con amputación de la extremidad inferior: diseño y validez de contenido.

INTRODUCTION: Gait pattern is altered in persons with lower extremity amputation. To assess gait pattern, it is important to use observational gait scales with a good content validity. OBJECTIVES: To design an observational gait scale and to analyze its content validity. MATERIAL AND METHODS: An expert committee was formed to obtain a version of the scale. The same committee was responsible for evaluating the scale. The content validity index (CVI) was calculated, both for each item and for the global scale. RESULTS: The main kinematic and spatiotemporal alterations were selected to design the items. The scale consists of 2sections and 25 items, with a maximum score of 35 points. An overall CVI score of 0.90 was obtained, and an index of validity for most items with values higher than 0.78. CONCLUSION: The Observational gait scale for persons with amputation of the lower extremity showed excellent content validity according to the CVI obtained. Future studies should evaluate its reliability and construct validity.

Daylight photodynamic therapy is an option for the treatment of actinic keratosis in patients with xeroderma pigmentosum in Africa.

BACKGROUND: Xeroderma pigmentosum (XP) is a very rare and severe genetic disorder with a DNA repair defect of ultraviolet (UV)-induced damage. Photodynamic therapy (PDT) has been successfully used in XP patients to treat actinic keratosis (AK) and daylight PDT (DL-PDT) has demonstrated similar efficacy to conventional PDT (C-PDT) for AK. OBJECTIVES: To assess DL-PDT for the treatment of AK in patients with XP. METHODS: Patients with XP were evaluated by a group of Spanish and African dermatologists. Clinical characteristics of the patients were assessed and divided in mild, severe or moderate affectation of AK in the face. A topical photosensitizer was extended on the patients' faces and after two hours of indoor light exposure, fluorescence was assessed and the cream was removed. Patients were examined two and seven days later to assess the reaction to PDT and followed up three months later. RESULTS: A total of 13 patients were treated on the whole face. Three were classified as severe AK, six as moderate AK and four as mild AK. Fluorescence assessment showed a soft yellow-green colour and a pink-color delineating the AK. Two days after treatment patients presented a scaly reaction. After one week the reaction healed, there was improvement and after three months no adverse events were noticed. CONCLUSIONS: PDT is an option for treatment of AK in patients with XP.

[Top-down and bottom-up approaches for the treatment of unilateral spatial neglect in stroke patients: A systematic review]. / Enfoques top-down y bottom-up para el tratamiento de la heminegligencia espacial en sujetos con ictus: revisión sistemática.

OBJECTIVE: To evaluate the effectiveness of top-down and bottom-up approaches in the rehabilitation of unilateral spatial neglect in stroke patients. METHODOLOGY: We carried out a systematic review of randomized controlled trials from January of 2013 to March of 2017. The following databases were searched: Scopus, Science Direct, Web of Science, Pubmed and CINHAL. The methodological quality, level of scientific evidence and the strength of recommendation were evaluated. RESULTS: We included 13 studies (294 subjects): nine studies (188 patients) carried out therapies with a bottom-up approach such us eye patching, virtual reality, optokinetic stimulation, transcranial magnetic stimulation and prism adaption; three studies (94 patients) evaluated therapies with a top-down approach such us visual scanning, sensory feedback and mental practice; one study incorporated both approaches. Nine of these studies showed improvements in spatial neglect scales; five of these used bottom-up approaches, another three used top-down approaches and the remaining study combined both approaches. Disability was evaluated by nine studies, and only three reported improvements. Three studies reported significant improvements in motor function in the intervention groups. CONCLUSIONS: Top-down and bottom-up approaches could improve unilateral spatial neglect, disability and motor function in patients with stroke.

Prescribing Habits for Androgenic Alopecia Among Dermatologists in Spain in 2017: A Cross-Sectional Study. / Estudio transversal acerca de los hábitos de prescripción en alopecia androgénica de los dermatólogos en España en 2017.

BACKGROUND: Topical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA). MATERIAL AND METHODS: Descriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain. RESULTS: The responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%). A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy. CONCLUSIONS: The most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA.

[Usability and acceptability of portable exoskeletons for gait training in subjects with spinal cord injury: a systematic review]. / Usabilidad y aceptabilidad de los exoesqueletos portables para el entrenamiento de la marcha en sujetos con lesion medular: revision sistematica.

INTRODUCTION: Spinal cord injury limits severely life expectancy and it causes in a restriction in the activities of the daily life of the subjects who suffer it. Training the gait with portable exoskeletons in subjects with spinal cord injury is a new approach to rehabilitation. AIM: To examine the usability and acceptability of these devices for gait training in subjects with spinal cord injury. PATIENTS AND METHODS: A literature search was conducted until February 2017 in the databases: Medline (PubMed, EBSCO), PEDro, Scopus and Web of Science. The methodological quality, the level of scientific evidence and the strength of recommendation were evaluated. RESULTS: Finally, eight studies were considered recruiting a total of 45 patients. The training programs had an average of 35 sessions and a duration 60 minutes approximately. In general, no adverse events and no relevant increases in pain, blood pressure, heart rate or fatigue were reported. In addition, the satisfaction with the intervention and the perception of quality of life of the participants were quite high. CONCLUSIONS: The rehabilitation of the gait with portable exoskeletons seems to be a safe intervention that generates acceptance and satisfaction among patients with spinal cord injury.

TITLE: Usabilidad y aceptabilidad de los exoesqueletos portables para el entrenamiento de la marcha en sujetos con lesion medular: revision sistematica.Introduccion. La lesion medular limita gravemente la esperanza de vida y produce una restriccion en las actividades de la vida diaria de los sujetos que la padecen. El entrenamiento de la marcha con exoesqueletos portables en sujetos que han sufrido una lesion medular supone un nuevo enfoque en su rehabilitacion. Objetivo. Examinar la usabilidad y aceptabilidad de estos dispositivos para el entrenamiento de la marcha en sujetos con lesion medular. Pacientes y metodos. Se realizo una busqueda bibliografica hasta febrero de 2017 en las bases de datos Medline (PubMed, EBSCO), PEDro, Scopus y Web of Science. Se evaluaron la calidad metodologica, el nivel de evidencia cientifica y la fuerza de recomendacion. Resultados. Finalmente, se consideraron ocho trabajos, que seleccionaron a un total de 45 pacientes. Los programas de entrenamiento tuvieron una media de 35 sesiones y una duracion aproximada de 60 minutos. En general, no se describieron efectos adversos importantes ni incrementos relevantes del dolor, la presion arterial, la frecuencia cardiaca o la fatiga. Ademas, la satisfaccion con la intervencion y la percepcion de la calidad de vida de los participantes fueron altas. Conclusiones. La rehabilitacion de la marcha con exoesqueletos portables genera aceptacion y satisfaccion entre los pacientes con lesion medular.

[Training cortical signals by means of a BMI-EEG system, its evolution and intervention. A case report]. / Entrenamiento de las señales corticales a traves de un sistema BMI-EEG, evolucion e intervencion. A proposito de un caso.

INTRODUCTION: In the last years, new technologies such as the brain-machine interfaces (BMI) have been incorporated in the rehabilitation process of subjects with stroke. These systems are able to detect motion intention, analyzing the cortical signals using different techniques such as the electroencephalography (EEG). This information could guide different interfaces such as robotic devices, electrical stimulation or virtual reality. CASE REPORT: A 40 years-old man with stroke with two months from the injury participated in this study. We used a BMI based on EEG. The subject's motion intention was analyzed calculating the event-related desynchronization. The upper limb motor function was evaluated with the Fugl-Meyer Assessment and the participant's satisfaction was evaluated using the QUEST 2.0. The intervention using a physical therapist as an interface was carried out without difficulty. CONCLUSIONS: The BMI systems detect cortical changes in a subacute stroke subject. These changes are coherent with the evolution observed using the Fugl-Meyer Assessment.

TITLE: Entrenamiento de las señales corticales a traves de un sistema BMI-EEG, evolucion e intervencion. A proposito de un caso.Introduccion. En los ultimos años estan incorporandose nuevas tecnologias en el tratamiento fisioterapeutico de pacientes con ictus, como las interfaces cerebro-maquina ­brain-machine interface (BMI)­, capaces de detectar la intencion de movimiento analizando las señales corticales por medio de diferentes tecnicas, como la electroencefalografia (EEG). Estas señales se traducen en comandos con el fin de realizar una funcion. Caso clinico. Varon de 40 años con ictus de dos meses de evolucion, en el cual se empleo un dispositivo BMI-EEG. La intencion de movimiento del sujeto se analizo calculando la desincronizacion relacionada con el evento. La funcion motora del miembro superior fue evaluada con la escala de Fugl-Meyer, y el nivel de satisfaccion del paciente, mediante el cuestionario QUEST 2.0. La intervencion se llevo a cabo sin dificultad siendo el fisioterapeuta la interfaz. Conclusiones. Los sistemas BMI-EEG detectan cambios corticales en un sujeto con ictus subagudo. Estos cambios son coherentes con los cambios observados en escalas clinicas.

[Instrumental gait analysis in stroke patients]. / Analisis instrumental de la marcha en pacientes con ictus.

INTRODUCTION: The motor control deficits after stroke affect the gait pattern. There is a significant variability between subjects. AIMS: To analyse, by using a capture motion system, the gait pattern in stroke patients with different levels of motor function, and to establish, despite the participants heterogeneity, what alterations in the gait pattern are usual in each participant. SUBJECTS AND METHODS: Nine stroke subjects with independent gait and ten control subjects participated in this study. Motion capture was performed using the VICON Motion System ®. The motion of the pelvis, hip, knee and ankle were analyzed in the sagittal plane. Also, the spatio-temporal parameters of gait were observed. RESULTS: The motor function evaluated using the Flug-Meyer Assessment (lower limb section) varied between 15 and 33 points. Participants had alterations in the kinematic pattern which were common between each of them. In stroke patients it was observed: an increment of the pelvis range of motion in both sides; at the hip joint, a decrease of the maximum peak of extension during the stance phase in the affected side and a greater flexion during the stance and the swing periods in the non-affected side; at the knee, a major knee flexion during the initial contact; and at the ankle joint, an slight ankle plantar flexion during the initial contact on the affected side. CONCLUSIONS: There are several landmarks in stroke gait that the clinicians should keep attention during the walking observation.

TITLE: Analisis instrumental de la marcha en pacientes con ictus.Introduccion. Las alteraciones en el control motor consecuentes al ictus afectan al patron de marcha, existiendo una importante variabilidad intersujeto. Objetivos. Valorar, a traves de un sistema de captura del movimiento, el patron cinematico de la marcha en sujetos con ictus y establecer que alteraciones del patron de la marcha son comunes entre los participantes. Sujetos y metodos. Participaron nueve pacientes con ictus con capacidad de marcha y diez sujetos controles. Para la captura del movimiento se empleo el sistema VICON Motion System ®. Se analizaron los movimientos articulares de pelvis, cadera, rodilla y tobillo en el plano sagital, y los parametros espaciotemporales de la marcha. Resultados. La funcion motora de los participantes, valorada mediante la escala Fugl-Meyer (seccion del miebro inferior), oscilo entre 15 y 33 puntos. Los participantes presentaron alteraciones en la cinematica comunes entre ellos. En los pacientes con ictus se registro: aumento de la amplitud de movimiento de la pelvis en ambos hemicuerpos (lado afecto y no afecto frente a control, p < 0,01); en la cadera, disminucion de la maxima extension durante la fase de apoyo en el lado afecto (p < 0,01) e incremento de la flexion en las fases de apoyo y oscilacion en el no afecto (p = 0,025); en la rodilla, mayor flexion durante la fase de contacto inicial (lado afecto frente a control, p < 0,01; lado no afecto frente a control, p = 0,02); y en el tobillo, ligera flexion plantar durante la fase de contacto inicial en el lado afecto. Conclusiones. A pesar de la variabilidad clinica, existen alteraciones especificas comunes de la marcha en sujetos con ictus.

[Influence of diet in idiopathic hypercalciuria]. / Influencia de la dieta en la hipercalciuria idiopática.

OBJECTIVES: To find out if differences in diet may justify the presence of idiopathic hypercalciuria (IH) and to verify if the calcium-restricted diet, often recommended for treatment of IH, is nutritionally appropriate. PATIENTS AND METHODS: Dietary intake and mineral and electrolyte urinary excretion were studied twice in 10 children diagnosed of IH and in 9 controls. First, while being on a free diet. Second, after a week of suppression of milk and dairy products. RESULTS: Intakes of calories, proteins, carbohydrates, fats, and minerals were similar in IH patients and controls. Withdrawal of dairy products of diet resulted in an important reduction in the intakes of calcium (71.1%), phosphorus (63.5%) and fats (30.1%), although only calcium intake was remarkably below international recommendations (33.6 +/- 10.4%). CONCLUSIONS: Spontaneous diet of this group of hypercalciuric children was no different from that of control children. Suppression of milk and dairy products causes a nutritionally inappropriate diet.