Maximal aerobic power in patients with chronic low back pain: a comparison with healthy subjects.

The objective of the study was to compare the maximal aerobic capacity of patients with chronic low back pain with healthy asymptomatic controls matched for age, gender and level of physical activity at work and during sports activities. Reported data in the literature with respect to aerobic capacity in patients with chronic low back pain are not conclusive. Nevertheless, based on the assumption that chronic low back pain leads to deconditioning, physical training programs are widely used as a treatment. A total of 70 patients with chronic low back pain and 70 healthy asymptomatic subjects completed questionnaires regarding demographics and performed a graded maximal exercise test until exhaustion on a cycle ergometer. The maximal aerobic power was measured by indirect calorimetry. Heart rate, respiratory exchange ratio and blood lactate levels were also measured. The test was considered maximal when VO2max achievement criteria were obtained. VO2max values were compared among groups. The absolute and normalized for weight values of VO2max measured in patients with chronic low back pain were significantly lower than that of the control group. Independent comparison between men and women showed that absolute values of VO2max are also significantly lower in men and women with chronic low back pain. Women reached absolute and normalized for weight VO2max values significantly lower than those of men, both in chronic low back pain and control group. In conclusion, chronic low back pain patients, especially women, seem to have a reduced aerobic capacity compared to healthy asymptomatic subjects.

A new non exercise-based VO2max prediction equation for patients with chronic low back pain.

UNLABELLED: INTRODUCTION The measurement of the maximal oxygen uptake as a parameter of cardiorespiratory fitness is useful in exercise prescription in functional restoration programs but this measurement requires the subject's maximal exertion which is not always possible in patients with chronic low back pain. The purpose of this study was to develop a regression equation to predict maximal oxygen uptake based on non-exercise data in adult patients with chronic low back pain. METHODS: Cross sectional study in which 70 participants completed a maximal graded exercise test in cycle ergometer to assess maximal oxygen uptake. RESULTS: Patients achieved a mean +/- SD value of VO(2)max of 30.8 (+/-7.7) ml kg(-1) min(-1). The regression model included as data of non-exercise the patient's gender, body mass index and the intensity of physical activity during leisure time. Multiple linear regression analysis generated the following formula (R (2) = 38.3, SEE = 6.08 ml kg(-1) min(-1)): VO(2)max (ml kg(-1) min(-1)) = 35.3377 - 0.475411 x BMI + 0.155232 x PALT + 7.97682 x gender; where BMI = body mass index, PALT = physical activity during leisure time, women = 0, men = 1. The Durbin Watson statistic showed no problems with serial autocorrelation (D-W = 1.86). The Kolmogorov-Smirnov normality test demonstrated that the errors are distributed normally. CONCLUSIONS: This study provides a new and relatively precise non-exercise regression model to predict VO(2)max in patients with chronic low back pain.

Prevalencia del síndrome de Burnout en residentes de especialidades médicas / Prevalence of Burnout syndrome in medical residents / Prevalência do síndrome de Burnout em residentes de especialidades médicas

Resumen Introducción La alta carga de actividades académico asistenciales durante la residencia de medicina, pueden generar un estado de desgaste de tipo ocupacional por causa del estrés psicológico y emocional. Objetivo Determinar la prevalencia del síndrome de Burnout en residentes de especialidades médicas de una universidad pública en el departamento del Cauca- Colombia. Materiales y Métodos Estudio descriptivo de corte transversal, realizado en 40 estudiantes de residencia médica, en quienes se estableció la presencia de agotamiento emocional, despersonalización y realización personal, dominios evaluados por el Test Maslach Burnout Inventory Human Services Survey, instrumento que evalúa la prevalencia de síndrome de Burnout. Resultados En una población de residentes de medicina compuesta por hombres en un 55%, se encontró que la razón de prevalencia del síndrome de Burnout fue del 0,9 y estuvo presente en el 47,5% de los participantes, El 42,5% presentaban cansancio emocional, el 55% presentaron baja despersonalización y solo la mitad reportaron estar en un alto nivel de realización personal, Discusión La presencia de altos niveles de agotamiento emocional tiene un valor decisorio para la presencia del síndrome de Burnout en la población de residentes médicos similar a lo reportado en diferentes estudios en médicos y especialistas. Conclusiones Existe una alta prevalencia de síndrome de Burnout en residentes de medicina con mayor compromiso en el sexo femenino y la edad menor de 35 años.

Abstract Introduction Due to the high load of academic-assistance demands during medical residency, a burnout state of occupational nature might be generated because of psychological and emotional stress. Purpose To determine the prevalence of burnout syndrome in medical residents of a public university in the department of Cauca - Colombia. Materials and Methods A descriptive cross-sectional study was conducted in 40 students of medical residency who presented emotional exhaustion, depersonalization and reduced personal accomplishment, dimensions evaluated by the Maslach Burnout Inventory - Human Services Survey Test, an instrument that assesses the prevalence of burnout syndrome. Results In a population of medical residents composed of men in 55%, the burnout prevalence rate was 0.9%, being present in 47.5% of the participants. While emotional exhaustion was reported in 42,5% and lower degrees of depersonalization in 55%, high levels of personal accomplishment were reported by just half of them. Discussion The presence of high levels of emotional exhaustion has a decisive value for the prevalence of burnout syndrome in the population of medical residents, similar to that reported in different studies in doctors and medical specialists. Conclusions There is a high prevalence of burnout syndrome in medical residents, being more often in females under 35 years old.

Resumo Introdução A alta carga de atividades acadêmico-assistenciais durante a residência de medicina podem gerar uma situação de desgaste de tipo ocupacional por conta do estresse psicológico e emocional. Objetivo Determinar a prevalência do síndrome de Burnout em residentes de especialidades médicas de uma universidade pública no departamento de Cauca - Colômbia. Materiais e Métodos Estudo descritivo de corte transversal, realizado em 40 estudantes de residência médica, visando estabelecer a ocorrência de exaustão emocional, despersonalização e realização pessoal, domínios avaliados pelo Teste Maslach Burnout Inventory Human Services Survey, instrumento que avalia a prevalência do síndrome de Burnout. Resultados Em uma população de residentes de medicina conformada por homens em um 55%, encontrou-se que a razão de prevalência do síndrome de Burnout foi de 0,9 e esteve presente em 47,5% dos participantes. 42,5% apresentava esgotamento emocional, 55% apresentava baixa despersonalização e apenas a metade relatou estar em um alto nível de realização pessoal. Discussão A existência de altos níveis de exaustão emocional tem um valor decisivo na presença do síndrome de Burnout na população de residentes médicos semelhante ao nível estimado em diferentes estudos em médicos e especialistas. Conclusões Existe uma alta prevalência do síndrome de Burnout em residentes de medicina com maior acometimento no sexo feminino e em pessoas menores de 35 anos.

Intervención educativa sobre embarazo en la adolescencia. Consejo Popular San Francisco. Venezuela / Educational intervention on pregnancy in adolescence. "San Francisco" Consejo Popular. Venezuela

Fundamento: los estudios realizados en el ámbito mundial sobre el embarazo en la adolescencia demuestran la necesidad de una atención integral, lo que ayudaría a la familia en la educación de los jóvenes. Objetivo: implementar un programa de intervención educativa que contribuya a modificar los conocimientos de los jóvenes sobre el embarazo en la adolescencia. Métodos: estudio de intervención educativa en adolescentes de la comunidad San Francisco, pertenecientes al Consultorio San Francisco del Municipio Agua Blanca, Estado Portuguesa, durante el período comprendido desde julio 2012 hasta julio 2013. Se trabajó con la totalidad del universo, constituido por 30 adolescentes pertenecientes a la zona. Se aplicó una encuesta inicial antes de la intervención. Se impartió un ciclo de clases en las que se abordaron diferentes tópicos relacionados con el embarazo en la adolescencia, tales como: complicaciones del embarazo, edad óptima, conocimientos de anticoncepción, complicaciones del aborto. Finalizada la intervención se aplicó el mismo instrumento para la evaluación de los conocimientos. Resultados: se logró un aumento del nivel de conocimientos; el 96,6 % adquirió conocimientos sobre el uso de anticonceptivos, el 80 % sobre las complicaciones del embarazo, más del 70 % sobre las complicaciones del aborto, y más del 90 % se evaluó de adecuado en el conocimiento sobre la edad óptima para el embarazo.Conclusiones: la intervención educativa resultó efectiva para aumentar los conocimientos de los adolescentes sobre las consecuencias del embarazo en la adolescencia, pero su principal beneficio sería que modificara conductas.

Background:The studies accomplished in the worldwide space on pregnancy in adolescence demonstrate the need of an integral attention that would help the family in young people’s education.Objective: to implement a program of educational intervention that contribute to modify young people’s knowledges on pregnancy in adolescence.Methods: Study of educational intervention in teens of San Francisco community, belonging to the Municipality of Agua Blanca, San Francisco clinic, Portuguesa State, during the period from July 2012 to July 2013. It was worked up with the totality of the universe constituted for 30 teenagers from this zone. An initial opinion poll before the intervention was applied. A cycle of clasees were taught where different topics related to the theme of pregnancy in adolescence such as: complications of pregnancy, optimal age, knowledges of contraception, complications of abortion. Once finished the intervention the same instrument for the evaluation of knowledges was applied.Results:An increasement of the level of knowledge was achieved; The 96.6 % acquired knowledge on the use of contraceptives, the 80 % on the complications of pregnancy, over the 70 % on the complications of abortion, and over the 90 % was evaluated as suitable on the optimal age for pregnancy.Conclusions: Educational intervention proved to be effective to increase the knowledge of teens on the consequences of pregnancy in adolescence, but its principal benefit would be to modify conducts.

Physical deconditioning in chronic low back pain.

OBJECTIVE: To establish the level of cardiorespiratory fitness and the rate of decrease in maximal aerobic capacity according to age in patients with chronic low back pain and compare these with normative data. DESIGN: Prospective case series with historical controls. SUBJECTS/PATIENTS: Seventy patients with chronic low back pain. METHODS: A maximal cycle ergometer protocol was used to measure VO2max, heart rate, respiratory exchange ratio and blood lactate levels. RESULTS: Seventy patients achieved absolute and normalized for weight VO2max values of 2.17 (standard deviation (SD) 0.65) l/min and 30.79 (SD 7.77) ml/kg/min, respectively. Absolute VO2max was poorly related to age in both men and women with chronic low back pain (r = -0.22 and r = -0.28, respectively). VO2max normalized for weight was also inversely related to age in both men and women (r = -0.36 and r = -0.42, respectively). The rate of VO2max decline between 20 and 59 years was -3.3 ml/kg/min/decade for the entire population and -1.2 and -5.4 ml/kg/min/decade in men and women, respectively. CONCLUSION: The level of physical fitness of patients with chronic low back pain is comparable to the physical fitness of healthy, but poorly conditioned subjects. Patients with chronic low back pain show a VO2max decline with ageing that is slower than of active subjects.

Aerobic fitness and limiting factors of maximal performance in chronic low back pain patients.

BACKGROUND: Studies of measurement of maximal aerobic uptake in patients with chronic low back pain have shown inconsistent results and none has focused on clinical endpoints of ergometry tests. OBJECTIVE: To determine the level of cardiorespiratory fitness and to establish factors limiting the maximal effort during the ergometry. METHODS: Patients with chronic low back pain performed a graded maximal exercise test. Clinical endpoints of the test were determined and grouped as "maximal effort" and "symptom-limited effort" endpoints. RESULTS: 101 patients aged 29.8 +/- 7.5 achieved a VO2 max value of 30.0 (+/- 7.27) ml.kg(-1).min(-1). In men and women independently, a linear regression analysis demonstrated that VO2 max was inversely and weakly related to age. When compared to normative categories of VO2 max, men and women were situated in the fair category. Quadriceps/leg fatigue was reported by 47.5% of patients and was the most frequent limiting factor of the tests. "Symptom limited effort" endpoints were reported by 54.4% of the subjects. CONCLUSIONS: Clinical limiting factors of maximal exertion interfere the achievement of maximal oxygen uptake in patients with low back pain during ergometry. Further, there exists an association among the clinical endpoints of the tests and the VO2 value achieved. CLBP patients have a lower level of aerobic fitness than healthy controls.

Exposición a pantallas, sobrepeso y desacondicionamiento físico en niños y niñas / Exposure to screens, being overweight and physical deconditioning in children

Antecedentes. El sobrepeso y la obesidad infantil son un problema grave de salud. La actividad física determina la capacidad cardiorespiratoria. Los datos relacionados con el sobrepeso, obesidad y exposición a pantallas no son concluyentes.Métodos. Encuestamos a niños y niñas de edades entre 10 y 12 años acerca del tiempo frente a pantallas. Adicionalmente realizamos mediciones antropométricas y funcionales.Resultados. Estudiamos a 325 niños y niñas. El tiempo promedio frente a pantallas fue de 4.96 horas/día, permaneciendo los hombres más tiempo frente a pantallas. La prevalencia de sobrepeso fue de 22.8% y de obesidad 2.8%. El estudio no demostró diferencias antropométricas entre los sujetos con permanencias superiores e inferiores a 2 horas/día frente a pantallas.Conclusiones. Es elevado el número de horas de exposición frente a pantallas.

Análisis de ligamento genético de la diabetes mellitus tipo 1, a marcadores de los cromosomas 2 y 11 en familias antioqueñas / Genetic linkage analysis of type 1 diabetes mellitus to markers on chromosomes 2 and 11 in families from Antioquia, Colombia

La Diabetes Mellitus (DM) comprende un grupo heterogéneo de desordenes hiperglucémicos clasificados en subgrupos de acuerdo a su fisiopatología y etiología, entre los cuales se destacan la Diabetes Mellitus tipo1 (DM1) y la diabetes mellitus tipo 2 (DM2). La DM1 es de aparición temprana y una absoluta escasez de insulina hace que los pacientes sean insulino dependientes desde el inicio de los síntomas y la (DM2) que se manifiesta en la edad adulta y no todos los pacientes que la sufren son insulino dependientes

Diabetes mellitus (DM) comprises e heterogeneous group of hypoglycemic disorders, that are grouped according to their physiopathology and etiology; the most notorious ones are type 1 DM (DM1) and type 2 DM (DM2); DM1 is characterized by early onset and absolute lack of insulin; therefore, patients suffering from it depend on insulin since the beginning of their symptoms; in contrast, DM2 manifests during adult life and not all patients depend on insulin

Malaria: estudio de 55 casos / Malaria: a 55 cases study

Mediante el analisis retrospectivo de 55 historias clinicas con diagnostico de malaria, se realizo un estudio descriptivo a cerca del comportamiento de esta enfermedad. Como hallazgos importantes tuvimos: en 28% de los pacientes, la parasitemia fue mixta (P.Vivax y P. Falciparum); hubo dos casos de malaria post transfusional y dos de malaria adquirida en Medellin. De tres casos con malaria cerebral, en uno se hallo P.Vivax tal vez por haber confundido el tipo de Plasmodium por que era parasitemia mixta que no se evidencio en la placa de hemoparasitos. Existio recurrencia de la enfermedad en 18.2

Transplante simultaneo de rinon y pancreas con pancreaticoduodenocistostomia / Simultaneous transplant of kidney and pancreas with pancreaticduodenalcystostomy

Se presenta el primer caso de un transplate simultaneo renal y pancreatico realizado en Colombia el 26 de Marzo de 1988 en un paciente de 36 anos, que desde los 17 sufria una diabetes mellitus tipo 1 y quien en los ultimos tiempos tenia una insuficiencia renal terminal por sindrome nefrotico. Habia presentado varios episodios de coma diabetico. Una vez realizado el transplante se observo desde un comienzo como el rinon transplantado no funcionaba, lo que dificulto su tratamiento. Permanecio practicamente insulino independiente por mas de tres semanas. Como el pancreas se coloco en situacion extraperitoneal, se presento necrosis de los musculos de esta zona debido a la formacion de un hematoma y se produjo pancreatitis superficial. Hacia la 4 semana hubo compromiso severo de el estado general e inconciencia, y fue necesario extraerle el pancreas transplatado. Fallecio el 21 de abril de 1988, 26 dias despues de la cirugia.