Acute liver failure: Management update and prognosis.

Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. Its pathophysiology and clinical course vary, depending on the cause of the primary liver injury, and can lead to high morbidity and mortality or the need for liver transplantation, despite available therapies. This syndrome involves excessive activation of the immune system, with damage in other organs, contributing to its high mortality rate. The most accepted definition includes liver injury with hepatic encephalopathy and coagulopathy within the past 26 weeks in a patient with no previous liver disease. The main causes are paracetamol poisoning, viral hepatitis, and drug-induced liver injury, among others. Identifying the cause is crucial, given that it influences prognosis and treatment. Survival has improved with supportive measures, intensive therapy, complication prevention, and the use of medications, such as N-acetylcysteine. Liver transplantation is a curative option for nonresponders to medical treatment, but adequate evaluation of transplantation timing is vital for improving results. Factors such as patient age, underlying cause, and severity of organ failure influence the post-transplant outcomes and survival.

[Heart autotransplantation for the treatment of a rhabdomyosarcoma of the left ventricle. Report of one case]. / Autotrasplante cardiaco en el tratamiento quirúrgico de tumores cardiacos primarios. Caso clínico.

Heart autotransplantation is an exceptional surgical technique used in the treatment of uncontrolled cardiac arrhythmias and primary unresectable cardiac tumors. We report a 28-year-old male with a rhabdomyosarcoma of the left ventricle, localized in the lateral and posterior wall, which involved the mitral valve and circumflex artery. After a complete study ruling out dissemination of the tumor, the patient was operated. Surgical exploration determined the unresectability of the tumor with the heart in situ. Therefore, the heart was explanted, preserving the right atrium and coronary sinus for re-implantation. Fifty percent of the mitral valve and the circumflex artery from its origin, were resected due to tumor infiltration. The heart was reconstructed with bovine pericardium and a mechanical valve was implanted in the mitral position. Afterward, the heart was implanted again following the same sequence as in bicaval transplantation, followed by a double bypass grafting to the distal circumflex territory. The patient had no significant complications and after nine months of follow up, there was no evidence of local recurrence. In the fourth postoperative month, a subcutaneous mass in the left thigh that was considered a metastasis without histological confirmation appeared. The lesion disappeared with radio and chemotherapy.

Actin protein inside DMPC GUVs and its mechanical response to AC electric fields.

Cells are dynamic systems with complex mechanical properties, regulated by the presence of different species of proteins capable to assemble (and disassemble) into filamentous forms as required by different cells functions. Giant unilamellar vesicles (GUVs) of DMPC (1,2-dimyristoyl-sn-glycero-3-phosphocholine) are systems frequently used as a simplified model of cells because they offer the possibility of assaying separately different stimuli, which is no possible in living cells. Here we present a study of the effect of acting protein on mechanical properties of GUVs, when the protein is inside the vesicles in either monomeric G-actin or filamentous F-actin. For this, rabbit skeletal muscle G-actin is introduced inside GUVs by the electroformation method. Protein polymerization inside the GUVs is promoted by adding to the solution MgCl2 and the ion carrier A23187 to allow the transport of Mg+2 ions into the GUVs. To determine how the presence of actin changes the mechanical properties of GUVs, the vesicles are deformed by the application of an AC electric field in both cases with G-actin and with polymerized F-actin. The changes in shape of the vesicles are characterized by optical microscopy and from them the bending stiffness of the membrane are determined. It is found that G-actin has no appreciable effect on the bending stiffness of DMPC GUVs, but the polymerized actin makes the vesicles more rigid and therefore more resistant to deformations. This result is supported by evidence that actin filaments tend to accumulate near the membrane.

Functional outcomes after physiotherapy program in patients with massive and irreparable rotator cuff tear.

OBJECTIVE: To evaluate the short term and 1-year follow-up functional effects of a physiotherapy programme in patients over 60 years of age with massive and irreparable Rotator Cuff (RC) tear. METHODS: A total of 96 patients with massive and irreparable RC tear were prospectively recruited. All patients were treated with a 12-week physiotherapy programme. Three evaluations were performed, at the beginning, at the end of the treatment and at one year of follow-up. The Constant-Murley questionnaire was used to assess shoulder function, the DASH questionnaire for upper limb function, and the Visual Analogue Scale (VAS) for pain intensity. RESULTS: At the end of the treatment, all the variables showed a clinically and statistically significant difference (p<.05). At one year of follow-up, the Constant-Murley showed an increase of 26.5 points (Cohen's d=1.7; 95% CI: 23.5-29.5; p<.001), DASH showed a decrease of 31.4 points (Cohen's d=2.2; 95% CI: 28.5-34.3; p<.001), and the VAS showed a decrease of 3.9cm (Cohen's d=3.6; 95% CI: 3.6-4.1; p<.001). CONCLUSION: In the short term and 1-year follow-up, a physiotherapy programme showed clinically and statistically significant results in all functional variables in patients older than 60 years with massive and irreparable RC tear.

Effectiveness of early versus delayed motion in patients with distal radius fracture treated with volar locking plate: A systematic review and meta-analysis.

The aim of this study was to determine the effectiveness of early versus delayed motion on the functional outcomes in patients with distal radius fracture (DRF) treated with a volar locking plate. A systematic review and meta-analysis of randomized clinical trials was performed. An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria included randomized clinical trials that compared the effect of early versus delayed motion on wrist and/or upper limb function, pain, grip strength, and wrist range of motion in subjects older than 18 years with DRF treated with a volar locking plate. Five clinical trials were included that met the eligibility criteria for the quantitative synthesis. At 6 weeks, the PRWE questionnaire showed a mean difference (MD) of -10.6 points (p < 0.001), the MD was -11.1 points for the DASH questionnaire (p < 0.001), -0.56 cm for pain on VAS (p = 0.01), 5.0 kg for grip strength (p = 0.01), 12.5 degrees for wrist flexion (p = 0.07), and 12.8 degrees for wrist extension (p = 0.05). All differences favored the early motion treatment. At 3 months of follow-up, only the DASH, pain on VAS, and grip strength showed significant differences in favor of early motion. At 1 year of follow-up, none of the variables studied were different between groups. In the short term, there was moderate to high evidence of clinically and statistically significant differences in the functional outcomes in favor of early versus delayed motion in patients with DRF treated with a volar locking plate. But these differences were not observed at 1 year of follow-up. PROSPERO registration no.: CRD42020158706.

Effectiveness of omega-3 fatty acid supplementation in patients with Alzheimer disease: A systematic review and meta-analysis. / Efectividad de la suplementación de ácidos grasos omega-3 en pacientes con enfermedad de Alzheimer: revisión sistemática con metaanálisis.

INTRODUCTION: Alzheimer disease (AD) is a neurodegenerative disease characterised by progressive dementia associated with global cognitive dysfunction. METHODS: We conducted a systematic review and meta-analysis of clinical trials evaluating omega-3 supplementation in patients with AD. OBJECTIVE: To determine if there is scientific evidence of the effectiveness of omega-3 supplementation in improving cognitive function in patients with AD. SEARCH STRATEGY: We included only randomised controlled trials (RCTs) from the following databases: Medline, Cochrane Central, Cinahl, and LILACS. An electronic search was also conducted using Google Scholar. STUDY SELECTION: Six articles met the eligibility criteria. The risk of bias was assessed following the Cochrane method. CONCLUSION: There is no consistent evidence to support the effectiveness of omega-3 supplementation in improving cognitive function in AD patients in the short and medium term.

The effect of atorvastatin on haemostatic parameters in apparently healthy dogs.

OBJECTIVE: To determine the effect of atorvastatin on haemostatic parameters as measured by prothrombin time, activated partial thromboplastin time and thromboelastography in apparently healthy dogs administered 2 mg/kg orally once daily for 1 week. MATERIALS AND METHODS: Prospective study of 20 apparently healthy client-owned dogs at a small animal specialty hospital. Dogs had a baseline complete blood count, serum chemistry profile, fibrinogen, platelet count, prothrombin time, activated partial thromboplastin time and thromboelastography performed. Each dog was then administered approximately 2 mg/kg of atorvastatin orally once daily for 1 week, and the laboratory tests were repeated. Adverse effects attributed to atorvastatin were recorded. RESULTS: All 20 enrolled dogs completed the study. Dogs received a median dose of 2.06 mg/kg (range 1.94 to 2.44 mg/kg) atorvastatin once daily, which was associated with a significant increase in pulse rate, mean corpuscular haemoglobin concentration, albumin and a significant decrease in mean corpuscular volume, cholesterol and lipase values compared with baseline. On thromboelastography, there was a significant increase in maximum amplitude, G, coagulation index, amplitude at 30 minutes, amplitude at 60 minutes and significant decrease in percentage of clot lysed at 30 minutes and percentage of clot lysed at 60 minutes values compared with baseline. Six dogs had a noticeable increase in appetite. CLINICAL SIGNIFICANCE: The results of this study suggest that atorvastatin may produce a procoagulant effect in dogs, although the clinical significance is unclear. Polyphagia was the most commonly reported adverse effect.

Práctica basada en evidencia en la rehabilitación post-COVID-19: una mirada desde la Fisioterapia / Evidence-based practice in post-COVID-19 rehabilitation: A physical therapy point of view

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Relation between COVID-19 and Guillain-Barre syndrome in adults. Systematic review / Relación entre COVID-10 y sindrome Guillain-Barre en adultos. Revisión sistemática

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Efectividad de la suplementación de ácidos grasos omega-3 en pacientes con enfermedad de Alzheimer: revisión sistemática con metaanálisis / Effectiveness of omega-3 fatty acid supplementation in patients with Alzheimer disease: A systematic review and meta-analysis

INTRODUCCIÓN: La enfermedad de Alzheimer (EA) es una patología neurodegenerativa caracterizada por demencia de carácter progresivo asociada a una perdida global de funciones cognitivas. MÉTODOS: Se realizó una síntesis de evidencia a través de una revisión sistemática con metaanálisis de ensayos clínicos que hayan evaluado la suplementación de omega-3 en pacientes con EA. OBJETIVO: Determinar si existe evidencia científica que avale la efectividad de la suplementación omega-3 en la mejoría de la función cognitiva de pacientes con EA. Estrategia de búsqueda: La estrategia de búsqueda incluyó solo ensayos clínicos aleatorizados (ECA). Las bases de datos usadas fueron: Medline, Cochrane Central, Cinahl y Lilacs. Además, se realizó una búsqueda electrónica en Google Scholar. Selección de estudios: Se obtuvieron 6 artículos que cumplían con nuestros criterios de elegibilidad. Se evaluó el riesgo de sesgo según el método Cochrane. CONCLUSIÓN: No hay evidencia consistente que avale la suplementación de omega-3 versus placebo en la mejoría de la función cognitiva de pacientes con EA a corto y mediano plazo

INTRODUCTION: Alzheimer disease (AD) is a neurodegenerative disease characterised by progressive dementia associated with global cognitive dysfunction. METHODS: We conducted a systematic review and meta-analysis of clinical trials evaluating omega-3 supplementation in patients with AD. OBJECTIVE: To determine if there is scientific evidence of the effectiveness of omega-3 supplementation in improving cognitive function in patients with AD. Search strategy: We included only randomised controlled trials (RCTs) from the following databases: Medline, Cochrane Central, Cinahl, and LILACS. An electronic search was also conducted using Google Scholar. Study selection: Six articles met the eligibility criteria. The risk of bias was assessed following the Cochrane method. CONCLUSION: There is no consistent evidence to support the effectiveness of omega-3 supplementation in improving cognitive function in AD patients in the short and medium term

Subclavian artery stenosis: hemodynamic aspects and surgical outcome.

Ninety seven patients (mean age: 58 years) with lesions involving the subclavian artery were studied to determine the relationship between clinical symptoms, angiographic lesions and Doppler-detected hemodynamic disorders. Ninety patients had vertebro-basilar insufficiency (VBI) and 7 had hemispheric manifestations or upper limb ischemia. Of the 105 lesions of the subclavian artery, we observed 76 stenoses greater than 50% and 29 complete occlusions. Thirty seven patients presented a unilateral subclavian lesion and 63 multiple lesions. Doppler examination of the vertebral artery including an upper limb hyperaemic test allowed classification of the patients into three stages: stage 1 "pre-subclavian steal" (35 patients): sudden decrease in the systolic vertebral flow with complete interruption during hyperaemia; stage 2 "intermittent subclavian steal" (18 patients): transient inversion of vertebral during systole with permanent inversion for 1 or 2 minutes after hyperaemia; stage 3 "permanent subclavian steal" (33 patients): complete inversion of the vertebral flow without diastolic flow and increase of flow during hyperaemia. The clinical, hemodynamic and angiographic findings were compared. In stage 1, 65.7% of the patients presented severe VBI (at least two signs) and 66% had a 50 to 70% stenosis of the subclavian artery. In stage 2, 66.6% of the patients presented severe VBI and 78% had a 75 to 95% stenosis. In stage 3, 72.7% of the patients had severe VBI and 73% had either subtotal or complete occlusion of the subclavian artery. There was no correlation between the severity of VBI and the hemodynamic stages but a strong correlation between the hemodynamic grades and the anatomical lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of antral and duodenal bleeding ulcers by Guevara's catheter.

The catheter is based on the principle of compression and tamponage, assuring and guaranteeing hemostasis at the base of the ulcer. This method is suitable for permanently controlling an acute hemorrhage in the event medical treatment fails and surgery is contraindicated. Emergency surgery is changed to elective surgery with all its advantages.

[Procedures in critical ischemia of the legs in non-emergency situations]. / Conduite à tenir dans les ischémies critiques des membres inférieurs en dehors de l'urgence.

Our experience with 91 operated cases in 84 patients (47 men, 37 women) relates essentially to arterial diseases resulting from overloading and diabetic arteriopathy. Diagnosis of critical ischemia is easy in clinical conditions, but it is advisable to rely on universally recognized hemodynamic standards to define this condition. Ankle pressure should be less than 400 mmHg and the Doppler trace flat or barely perceptible. Patients in our series had a mean ankle pressure of 32.4 mmHg. Local examination can determine the extent of gangrene, whereas general examination detects numerous, often associated defects diabetes, coronary artery disease, rhythm disorders, arterial hypertension, etc. As far as possible, these defects are to be corrected before surgery. X-ray examination (M. Kasbarian) is frequently done in conjunction with conventional aorto-arteriography and digital angiography. The later technique allows arteries to be visualized which are not seen with the conventional technique. The x-ray examination will indicate whether revascularization is feasible, although it cannot show whether it will be efficient. In our series, opacification of the plantar arches was predictive neither of success nor failure. But do tests exist which can predict the success of a revascularization attempt? It would be necessary to be able to estimate ankle pressure after the operation, and several methods have tried to do this. TcPO2 would seem to be a good examination. The possibilities of nuclear magnetic resonance are being studied, and the results thus far are promising. Preoperative explorations are carried out in a different situation. Arteriography performed in the operating room is a simple act which can reveal a usable downstream bed not indicated in preoperative X-rays, although it provides no hemodynamic data. Measurement of peripheral resistances would appear to be a very good predictive examination. Flow measurements by infusion or electronic flowmeter also seem to be predictive for bypass results. Unfortunately, these measurements are at present not widely performed and the critical threshold is assessed differently. Given the difficulty of correctly estimating the value of these numerous methods, many surgeons, ourselves included, have chosen to revascularize patients whenever the upstream bed as evaluated by X-ray indicates the presence of at least one viable artery.

Efectos del tratamiento multimodal en pacientes con síndrome de dolor regional complejo tipo 1 con, al menos, seis meses de evolución: un estudio descriptivo / Effects of multimodal treatment in patients with complex regional pain syndrome type 1 with, at least, 6 months of evolution: a descriptive study

Objetivos: El objetivo principal del presente trabajo es describir los cambios en el dolor posterior a esquema de tratamiento multimodal en pacientes con síndrome de dolor regional complejo tipo 1 (SDRC 1), con más de seis meses de evolución, que ingresan a control en Servicio de Medicina Física y Rehabilitación del Hospital Clínico San Borja Arriarán. Material y método: Series de casos de pacientes con sospecha o diagnóstico de SDRC 1 que ingresan para manejo a la Unidad de Dolor Crónico no Oncológico (UCDNO), a los se les realizaron evaluaciones de dolor a través de la Escala Visual Analógica (EVA) y del Cuestionario para la Graduación del Dolor Crónico, funcionalidad de la extremidad superior (EESS) con Quick DASH y la Escala Funcional de la Extremidad Inferior (Lower Extremity Functional Scale [LEFS]) para extremidades inferiores (EEII), al momento del ingreso y en seguimiento a los dos meses de manejo multimodal por equipo interdisciplinario. Resultados: La muestra se compuso de 14 pacientes: 6 tuvieron compromiso de EESS y 8 de EEII, en mayor porcentaje fue de mujeres, con un tiempo promedio para el diagnóstico de 14,6 meses y tiempo promedio de evolución al momento del ingreso de 19,8 meses. Posterior al tratamiento la EVA mostró una disminución estadística y clínicamente significativa (2,2 cm con una DS de 2,1 [p = 0,0018]). La variable Quick DASH mostró una reducción de 20,5 puntos con una DS de 20,2 (p = 0,0558) y la variable LEFS un incremento de 13,9 puntos con una DS de 20,8 (p = 0,1008), ambas diferencias no son estadísticamente significativas pero ambas con diferencias clínicas mínimamente importantes relevantes. Se demostró correlación moderada pero que no es estadísticamente significativa entre el tiempo de evolución y la intensidad del dolor que presentan los pacientes al momento de la primera evaluación. Conclusiones: Las intervenciones multimodales guiadas por Fisiatra en un equipo interdisciplinario en el manejo del SDRC permitieron demostrar, después de un periodo de seguimiento, cambios clínicamente significativos en disminución del dolor y mejoría en funcionalidad, con disminución también en aspectos de discapacidad asociada

Objectives: The main objective of this work is to describe the changes in pain after a multimodal treatment scheme in patients with Complex Regional Pain Syndrome type 1 (CRPS 1), with more than 6 months of evolution, who enter treatment at the Physical Medicine and Rehabilitation Service of the San Borja Arriarán Clinical Hospital. Material and method: Series of cases of patients with suspicion or diagnosis of CRPS 1 who were admitted for management to the Non-Oncological Chronic Pain Unit, who underwent pain assessments through the Visual Analogue Scale (VAS) and the Chronic Pain Grade Questionnaire, functionality of the upper extremity (UE) with Quick DASH and the Lower Extremity Functional Scale Functional Scale for lower extremities (LE), at the time of admission and in follow-up after two months of multimodal management by an interdisciplinary team. Results: The sample consisted of 14 patients, 6 had a compromise of UE and 8 of LE, in a greater percentage of women, with an average time for the diagnosis of 14.6 months and average time of evolution at the time of admission of 19.8 months. After the treatment, the VAS showed a statistically and clinically significant decrease (2.2 cm with a DS of 2.1 [p = 0.0018]). The variable Quick DASH showed a reduction of 20.5 points with a DS of 20.2 (p = 0.0558) and the variable LEFS an increase of 13.9 points with a DS of 20.8 (p = 0.1008), both differences are not statistically significant but both with Minimal Clinically Important Difference relevant. Moderate correlation was demonstrated but it is not statistically significant between the time of evolution and the intensity of the pain presented by the patients prior to the start of the multimodal treatment. Conclusions: The multimodal interventions guided by Physiatrist in an interdisciplinary team in the management of the CRPS allowed to demonstrate, after a period of follow-up, clinically significant changes in pain reduction and improvement in functionality, with a decrease also in aspects of associated disability

¿Sirve el taping patelar en pacientes con dolor crónico de rodilla? / Does the patellar taping in patients with chronic pain knee?

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Efectividad de la movilización neurodinámica en el dolor y funcionalidad en sujetos con síndrome del túnel carpiano: revisión sistemática / Effectiveness of neurodynamic mobilization in pain and functionality in subjects with carpiano tunnel syndrome: systematic review

El síndrome del túnel del carpo (STC) es la neuropatía periférica más común y de mayor porcentaje, afectando principalmente más a mujeres que a hombres. La técnica de movilización neural es una intervención que está dirigida a las estructuras neurales mediante el posicionamiento y el movimiento de múltiples articulaciones, para descomprimir la zona y liberar la presión del nervio afectado. Se realizará una síntesis de la evidencia a través de una revisión sistemática de ensayos clínicos aleatorizados que hayan comparado la técnica de movilización neural por sí sola con otros tipos de intervenciones. Nuestro objetivo es determinar si existe evidencia científica que avale la efectividad de la técnica de movilización neurodinámica en pacientes diagnosticados con síndrome del túnel carpiano. La estrategia de búsqueda incluyó ensayos clínicos aleatorizados y ensayos clínicos controlados. Las bases de datos usadas fueron: Medline, LILACS, Central, CINAHL, SPORTDiscus y PEDro. Se obtuvieron cuatro artículos que cumplían con los criterios de elegibilidad. Se concluye que existe moderada evidencia, que la técnica de movilización neural en comparación con placebo, cuidados estándar y agentes físicos podría ayudar a disminuir el dolor y mejorar la funcionalidad a sujetos con síndrome del túnel del carpo. La decisión de aplicar este tipo de tratamientos también debe basarse en costos, preferencias y seguridad del tratamiento (AU)

Carpal Tunnel Syndrome (STC) is the most common peripheral neuropathy with a higher percentage, affecting mainly women than men. The technique of neural mobilization is an intervention that is directed at neural structures by positioning and moving multiple joints, to decompress the area and release the pressure of the affected nerve. A synthesis of the evidence was done through a systematic review of randomized clinical trials that was compared with the technique of neural mobilization with other types of interventions. Our objective is to determine if there is scientific evidence to support the effectiveness of the neurodynamic mobilization technique in patients diagnosed with carpal tunnel syndrome. The search strategy included randomized clinical trials and controlled clinical trials. The databases used were: Medline, LILACS, Central, CINAHL, SPORTDiscus and PEDro. Four items were obtained that met the eligibility criteria. We conclude that there is moderate evidence that the neural mobilization technique compared with placebo, standard care and physical agents, could help decrease pain and improve the functionality of subjects with carpal tunnel syndrome. The decision to apply this type of treatment should also be based on costs, preferences and treatment safety (AU)

¿En qué basamos nuestras decisiones clínicas como profesionales de salud?. Segunda parte: la pregunta clínica / How base our clinical decisions making in health professionals?. Second part: clinical question

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Efectividad de las técnicas de movilización articular sobre el rango de movimiento de pacientes adultos con capsulitis adhesiva primaria de hombro: revisión sistemática y metanálisis / The effectiveness of joint mobilization techniques for range of motion in adult patients with primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis

Resumen OBJETIVO: Determinar la efectividad de las técnicas de movilización articular en el rango de movimiento en pacientes adultos con capsulitis adhesiva primaria de hombro. MÉTODO: Revisión sistemática con metanálisis. La búsqueda fue realizada en las bases de datos MEDLINE/PubMed, PEDro, CENTRAL, LILACS, EMBASE, CINAHL, Scopus y Web of Science. Los criterios de elegibilidad fueron estudios que utilizaran una técnica de movilización articular oscilatoria y/o mantenida aplicada, sola o adicionada, a un programa de tratamiento en pacientes con capsulitis adhesiva primaria, en cualquier estadio. La selección de estudios y la extracción de datos fueron realizadas por dos autores de forma independiente. El riesgo de sesgo se evaluó según la herramienta propuesta por Cochrane. RESULTADOS: Se incluyeron 14 estudios con variados riesgos de sesgo. La movilización posterior versus otra técnica articular no presenta diferencia de media significativa (- 0,95 grados; intervalo de confianza de 95%; - 5,93 a 4,02), mientras que comparada con un grupo control la diferencia es de 26,80 grados (intervalo de confianza 95%; 22,71 a 30,89), además cuando se aplica un conjunto de técnicas articulares versus un grupo control, para la abducción la diferencia es de 20,14 grados (intervalo de confianza 95%; 10,22 a 30,05). En ambos casos, los resultados son estadísticamente significativos y se aprecia un tamaño de efecto moderado. CONCLUSIONES: La evidencia científica no es concluyente acerca de la efectividad de la movilización articular, dada la heterogeneidad en la metodología y sesgo de los artículos incluidos en esta revisión. Al compararla con tratamientos que no incluyen terapia manual, parecieran favorecer la mejoría del rango de movimiento y reducción del dolor, en pacientes con capsulitis adhesiva primaria de hombro.

Abstract OBJECTIVE: To determine the effectiveness of joint mobilization techniques in the range of motion in adult patients with primary adhesive shoulder capsulitis. METHODS: Systematic review with meta-analysis. The search was performed in the MEDLINE/PubMed, PEDro, CENTRAL, LILACS, EMBASE, CINAHL, Scopus and Web of Science databases. The eligibility criteria were studies that used an oscillatory and/or maintained joint mobilization technique applied alone or added-on to a treatment program in patients with primary adhesive capsulitis at any stage. Two authors carried out the selection of studies and the extraction of data, independently. Risk of bias was evaluated according to the tool proposed by Cochrane. RESULTS: We included 14 studies with variable risk of bias. Posterior mobilization compared to any other technique was not significantly different (0.95 degrees; 95% CI: - 5.93 to 4.02), whereas compared to a control group, the difference is 26.80 degrees (CI 95%: 22.71 to 30.89). When applying a set of joint techniques versus a control group, for abduction the difference is 20.14 degrees (95% CI: 10.22 to 30.05). In both cases, the results are statistically significant, and the effect size is moderate. CONCLUSIONS: The evidence is not conclusive about the effectiveness of joint mobilization. When compared with treatments that do not include manual therapy, joint mobilization seems to have a favorable effect on the range of motion and pain reduction in patients with primary adhesive shoulder capsulitis.

Terapia de juicio de lateralidad e imaginería de movimiento y ejercicios de activación muscular selectiva glenohumerales en sujetos con ruptura masiva del manguito rotador: serie de casos / Therapy of judgment of laterality and imagenery of movement and exercises of selective muscular activation glenohumeral in subjects with massive rupture of the rotating sleeve: case series

Introducción: El desgarro masivo del maguito rotador (DMMR) es una condición clínica degenerativa que corresponde a una ruptura de 5 cm, o una que compromete a dos o más tendones del manguito rotador (MR), generando pérdida de funcionalidad y dolor incapacitante. Objetivo: Describir los cambios en el dolor y función de hombro posterior a un programa de 6 semanas de terapia de juicio de lateralidad e imaginería de movimiento y ejercicios de activación selectiva glenohumerales en sujetos con rotura masiva del manguito rotador. Métodos: Este estudio es una investigación descriptiva y diseño serie de casos, con una muestra de 50 participantes con diagnóstico de ruptura masiva de manguito rotador. Los pacientes realizaron un programa de ejercicios selectivos glenohumerales más terapia de juicio de lateralidad e imaginería de movimiento durante 6 semanas. Se midieron las variables de función, dolor, ROM de abducción y flexión de hombro, a la sexta semana y al sexto mes de evolución. Resultados: Existen diferencias significativas en la intensidad del dolor, función de hombro, AROM de flexión y AROM de abducción de hombro, posterior a la intervención (p < 0,05). Existen diferencias estadísticamente significativas para todas las medidas de resultados entre la intervención y el sexto mes de seguimiento (p < 0,05). Solo el dolor presentó diferencias estadísticamente significativas entre la sexta semana y el sexto mes de seguimiento (p = 0,01). Conclusión: La aplicación de la terapia de juicio de lateralidad e imaginería de movimiento adicionada a un programa de ejercicios selectivos estabilizadores glenohumerales durante 6 semanas podría mejorar la función de hombro, disminuir el dolor y aumentar los AROM de flexión y abducción de hombro en pacientes con ruptura masiva del manguito rotador

Introduction: Massive tear of the rotator cuff (DMMR) is a degenerative clinical condition, which corresponds to a 5 cm rupture, or one that compromises two or more tendons of the rotator cuff (MR), generating loss of functionality and disabling pain. Objective: To describe changes in pain and shoulder function following a 6-week program of lateral-imaging and motion imaging therapy and selective glenohumeral activation exercises in subjects with massive rotator cuff tears. Methods: This study is a descriptive research and design of a series of cases, with a sample of 50 participants with diagnosis of rotator cuff mastication. Patients underwent a glenohumeral selective exercise program plus laterality and motion imaging therapy for 6 weeks. The variables of function, pain, abduction ROM and shoulder flexion were measured at sixth week and sixth month of evolution. Results: There were significant differences in pain intensity, shoulder function, AROM flexion and shoulder abduction AROM, after the intervention (p > 0.05). Statistically significant differences were found for all outcome measures between the intervention and the sixth follow-up month (p < 0.05). Only the pain of the statistically significant differences between the sixth week and the sixth month of follow-up (p = 0.01). Conclusion: The application of laterality trial therapy and motion imaging added to a program of selective exercises stabilizadores glenohumerales during 6 weeks, could improve shoulder function, decrease pain and increase AROM flexion and shoulder abduction in patients with massive rupture of the rotator cuff