[Early clinical and radiological basic detection of congenital hip dysplasia at primary health care units]. / Detección temprana clínica y radiológica básica de la displasia congénita de cadera en unidades médicas del primer nivel de atención.

DISCUSSION: The number of cases of late congenital hip dysplasia has increased, together with its sequelae, disability and absence of early diagnosis. The problem is that there is a difference between the sensitivity and the clinical exam, and the physicians knowledge of this topic is poor. We evaluated the quality of the training provided to the primary health care staff on congenital hip dysplasia. A prospective cohort study was undertaken to study 228 physicians for 3 years. A workshop was delivered and the physicians took a pre-workshop and a post-workshop exam. Then pelvic X-rays of infants under 6 months of age were taken and the X-ray references and measurements were assessed. The statistical analysis assesses the change in the pre-workshop and post-workshop grades in both the group that participated in the workshop and the group that did not. The statistical variables used included means, standard deviation, minimum and maximum grades, and the score differences. Students t test was used to prove the statistical significance of the differences, with n-1 degrees of freedom. Thirty-one pathological hips were detected in infants under 6 months of age in the group that took the workshop. The group that received the training shows that the latter may have a positive impact since an improvement in the grades (p 0.0001) was seen after the theoretical and practical course and after the X-ray measurements. A low knowledge level was observed. The training raised the awareness of the health care staff and a progressive increase was seen in the number of infants under 6 months of age who received a timely detection.

Hay un aumento en el número de casos de displasia de cadera congénita tardía, secuelas, discapacidad y falta de diagnóstico temprano. La problemática observada es que difieren la sensibilidad y exploración clínica y los conocimientos del tema en médicos son deficientes. Se evaluó la calidad de la capacitación en displasia congénita de cadera al personal del primer nivel de la atención médica. Se realizó un estudio de cohorte prospectiva estudiando a 228 médicos por tres años; se les aplicó un examen pre- y postcurso, se dio un taller. Posteriormente, se inició la toma de radiografías de pelvis en menores de seis meses, se evaluó la referencia y la medición radiográfica. El análisis estadístico valoró el cambio de calificación obtenida en las mediciones antes y después del taller, tanto en el grupo que lo recibió como en el que no lo llevó. Se utilizaron promedios, desviación estándar, mínimo y máximo para describir las calificaciones, así como para las diferencias de puntajes. Para probar la significancia en las diferencias, se utilizó «t¼ de Student, con n-1 grados de libertad. Se detectaron 31 caderas patológicas en menores de seis meses de vida con el taller. El grupo capacitado reflejó que el curso podría tener impacto positivo al mejorar significativamente la calificación (p 0.0001) posterior al curso tanto teórico como práctico y la medición radiográfica. Se evidenció un bajo conocimiento. La capacitación con el taller sensibilizó al personal médico y se observó un número progresivo de pacientes menores de seis meses con una detección oportuna.

Detección temprana clínica y radiológica básica de la displasia congénita de cadera en unidades médicas del primer nivel de atención / Early clinical and radiological basic detection of congenital hip dysplasia at primary health care units

Resumen: Hay un aumento en el número de casos de displasia de cadera congénita tardía, secuelas, discapacidad y falta de diagnóstico temprano. La problemática observada es que difieren la sensibilidad y exploración clínica y los conocimientos del tema en médicos son deficientes. Se evaluó la calidad de la capacitación en displasia congénita de cadera al personal del primer nivel de la atención médica. Se realizó un estudio de cohorte prospectiva estudiando a 228 médicos por tres años; se les aplicó un examen pre- y postcurso, se dio un taller. Posteriormente, se inició la toma de radiografías de pelvis en menores de seis meses, se evaluó la referencia y la medición radiográfica. El análisis estadístico valoró el cambio de calificación obtenida en las mediciones antes y después del taller, tanto en el grupo que lo recibió como en el que no lo llevó. Se utilizaron promedios, desviación estándar, mínimo y máximo para describir las calificaciones, así como para las diferencias de puntajes. Para probar la significancia en las diferencias, se utilizó "t" de Student, con n-1 grados de libertad. Se detectaron 31 caderas patológicas en menores de seis meses de vida con el taller. Discusión: El grupo capacitado reflejó que el curso podría tener impacto positivo al mejorar significativamente la calificación (p < 0.0001) posterior al curso tanto teórico como práctico y la medición radiográfica. Se evidenció un bajo conocimiento. La capacitación con el taller sensibilizó al personal médico y se observó un número progresivo de pacientes menores de seis meses con una detección oportuna.

Abstract: The number of cases of late congenital hip dysplasia has increased, together with its sequelae, disability and absence of early diagnosis. The problem is that there is a difference between the sensitivity and the clinical exam, and the physicians' knowledge of this topic is poor. We evaluated the quality of the training provided to the primary health care staff on congenital hip dysplasia. A prospective cohort study was undertaken to study 228 physicians for 3 years. A workshop was delivered and the physicians took a pre-workshop and a post-workshop exam. Then pelvic X-rays of infants under 6 months of age were taken and the X-ray references and measurements were assessed. The statistical analysis assesses the change in the pre-workshop and post-workshop grades in both the group that participated in the workshop and the group that did not. The statistical variables used included means, standard deviation, minimum and maximum grades, and the score differences. Student's t test was used to prove the statistical significance of the differences, with n-1 degrees of freedom. Thirty-one pathological hips were detected in infants under 6 months of age in the group that took the workshop. Discussion: The group that received the training shows that the latter may have a positive impact since an improvement in the grades (p < 0.0001) was seen after the theoretical and practical course and after the X-ray measurements. A low knowledge level was observed. The training raised the awareness of the health care staff and a progressive increase was seen in the number of infants under 6 months of age who received a timely detection.

[Evaluation of the functional results in the treatment of pelvic limbs with multiple level surgery in spastic ICP patients]. / Evaluación de resultados funcionales en el tratamiento de miembros pélvicos con cirugía multinivel en pacientes espásticos con parálisis cerebral infantil.

UNLABELLED: The purpose of this study is to assess the effects of multiple level surgery of the pelvic limbs in patients with spastic infantile cerebral palsy seen at the National Rehabilitation Institute and show that their clinical improvement is comparable to the reports in the national and international literature. MATERIAL AND METHODS: This is a longitudinal, prospective, descriptive, self-controlled, before-and-after clinical trial that included patients with spastic infantile cerebral palsy who underwent multiple-level single-stage surgery from January 2007 to August 2008. The inclusion criteria were as follows: both genders, ages 4 to 16 years, with a complete clinical file, with preoperative and 8-12 month postoperative rehabilitation. Elimination criterion: any event not related with multiple-level surgery. Exclusion criterion: any surgeries prior to admission. A descriptive statistical analysis was used, together with the Student t-test and the chi-square test. RESULTS: 81 patients with a mean age of 7 +/- 3.2, an age range of 4-16 years; 60.5% males and 39.5% females. The subtypes of spastic infantile cerebral palsy were as follows: biparesis 64.2%, quadriparesis 22.2%, hemiparesis 8.6%, double hemiparesis 4.9%. The clinical-surgical classification (14) changed as a result of improvement and according to the number of surgical procedures: 6 patients (7.4%) had significant improvement (p = 0.13) with one procedure; 44 patients (54.3%) had significant improvement (p = 0.002) with two procedures; 28 patients (34.6%) had significant improvement (p = 0.04) with three procedures, and 3 patients (3.7%) had significant improvement (p = 0.19) with four procedures. On the other hand, when the number of surgical procedures was related with the diagnostic subtype of spastic infantile cerebral palsy, in those undergoing one procedure the clinical-surgical classification did not change in the cases of biparesis (p = 0.26), hemiparesis (p = 0.18), and double hemiparesis (p = 0.50). In those undergoing two surgical procedures the significant changes occurred for the cases of biparesis (p = 0.20), quadriparesis (p = 0.007), and double hemiparesis (p = 0.16). In those undergoing four procedures no changes occurred in the cases of biparesis (p = 0.26) and hemiparesis (p = 0.50). DISCUSSION: An improvement in the clinical-surgical classification was observed (p = 0.0001) based on the results of Gazi Zorer, as well as a significant improvement (p < 0.001) and an improvement reported by the gait analysis by the following authors: Ugur Sayli, Gouth, MA Khan.

[Effect of naloxone on somatosensory evoked potentials in congenital insensitivity to pain]. / Efecto de naloxona sobre los potenciales evocados somatosensoriales en la insensibilidad congénita al dolor.

The somatosensory evoked potentials were recorded (SEP) in a child 11 years old with congenital insensitivity to pain. The records were made before and after naloxone administration (160 mg i.m.) and they were compared with the SEPs from normal children. The place where records were taken was the somatosensory area of the scalp and the site of the stimulation was the contralateral medial nerve of the wrist. The results show that naloxone provokes higher waves of the patient's SEP that before administration of naloxone. On the other hand lower SEPs were observed in the patient with congenital insensitivity to pain than in those from normal children. The results suggest that congenital insensitivity to pain could be related to abnormal activities of morphine-like substances of endogenous production.

Efecto de naloxona sobre los potenciales evocados somatosensoriales en la insensibilidad congenita al dolor. / Effect of naxolone on the somatosensory evoked potentials in congenital insensibility to pain

Se hizo registro de los potenciales evocados somatosensoriales(PES) en un nino de 11 anos con insensibilidad congenita al dolor antes y despues de la administracion de naloxona (160 mg.i.m.) y se compararon con los PES de ninos aparentemente sanos.Los resultados parecen indicar que la naloxona produce un aumento en la amplitud de los componentes de los PES registrados en el area somatosensorial del cuero cabelludo, contralateral al sitio de estimulacion en el nervio mediano a nivel de la muneca, por otra parte, hay una clara disminucion en la amplitud de los componentes de los PES registrados en el paciente con insensibilidad congenita al dolor con respecto a los obtenidos en un nino normal.Los resultados apoyan la suposicion de que los pacientes con insensibilidad congenita al dolor existe un aumento en las sustancias de produccion endogena parecidas a la morfina (endorfinas)

[Congenital pain insensitivity]. / Insensibilidad congénita al dolor.

A case showing multiple lesions that make it very illustrative is reported. Differential diagnosis is made with some other diseases that are similar in some isolated facts. Mention is also made on the pathophysiology of the disease as well as on the necessity of the intercourse of several medicosurgical specialties in the management of these patients. A brief review of the literature is made.