Efficacy of Deep Dry Needling versus Percutaneous Electrolysis in Ultrasound-Guided Treatment of Active Myofascial Trigger Points of the Levator Scapulae in Short-Term: A Randomized Controlled Trial.

Deep dry needling (DDN) and percutaneous electrolysis (PE) provide the benefit of the mechanical effect of the needle, and PE adds the potential advantages of the galvanic current it incorporates in myofascial trigger points (MTrPs) therapy. The aim of this study was to compare the short-term efficacy between PE and DDN on active MTrPs of the levator scapulae by considering pain intensity. A simple-blind randomized controlled trial was carried out, recruiting patients suffering from non-specific neck pain lasting more than 3 months and with active MTrPs in the levator scapulae muscle (n = 52). Patients were divided into intervention (PE; n = 26) and control (DDN; n = 26) groups and received one treatment session on the active MTrPs of the levator scapulae. Patients were assessed for pain intensity, pressure pain threshold (PPT), cervical range of motion (CROM), neck disability and post-needling soreness, immediately after treatment, at 72 h and at 14 days. In addition, pain during treatment was recorded after the procedure. There were no significant differences for pain intensity, post-needling soreness and PPT. We found significant differences in CROM, immediately after treatment (p = 0.043), and at 72 h (p = 0.045), in favor of the PE group. Significant differences were found for neck disability (p < 0.047), immediately post-treatment, in favor of the DDN group. Moreover, there were significant differences for pain during the intervention (p < 0.002), in favor of the DDN group (4.54 ± 2.21) versus the PE group (6.54 ± 2.27). PE and DDN appear to have similar short-term effects. PE proved to be a more painful treatment than DDN. Clinical trial registry: NCT04157426.

Exploring Knowledge about Fang Traditional Medicine: An Informal Health Seeking Behaviour for Medical or Cultural Afflictions in Equatorial Guinea.

This study explores a range of informal health-seeking behaviors, including the use of Fang Traditional Medicine (FTM) for medical or cultural afflictions in Equatorial Guinea (EQ), the therapeutic methods used, the health problems handled, the learning process, traditional medicine user profiles and the social images of Fang Traditional Healers (FTHs). Ethnography was employed as a qualitative strategy using emic-etic approaches. Semi-structured interviews were conducted with 45 individuals, including 6 community leaders, 19 tribal elders, 7 healthcare professionals, 11 FTHs and 2 relatives of traditional healers in 5 districts of EQ. FTM offers a cure for malaria and treatments for reproductive health issues, bone fractures and cultural illnesses. Several methods used to learn FTM are based on empirical observation, and without the need for traditional schooling, unlike with Western medical professionals: for example, watching a family member, or the spirits or ancestors, can reveal healing knowledge. Materials from forests, including tree barks and plants, and rituals are used to keep Fang populations healthy; in addition, two rituals known as "osuiñ" and "etoak" (infusions of tree barks with the blood of sacrificed animals) are the most commonly used treatments. In addition, elders and women are the most active consumers of FTM. FTM plays a relevant role in curing medical and cultural afflictions in Fang communities. The informal health-seeking behavior among the Fang community is conditioned by the explanation model of illness.

Dry needling of the flexor digitorum brevis muscle reduces postural control in standing: A pre-post stabilometric study.

There are studies that show the better balance after dry needling in lumbar pain. However, the postural control effects after foot dry needling are unknown. Our objective was to check if dry needling reduces postural control. Eighteen subjects with flexor digitorum brevis (FDB) muscle Myofascial trigger point were evaluated pre- and post-deep dry needling. We measured stabilometric variables in a pre-post study. We have found significant differences in three stabilometric variables: surface with eyes closed (29.36-53.21 mm2 ) (p = 0.000), medium speed of the laterolateral displacement with eyes closed (1.42-1.64 mm/s) (p = 0.004), and medium speed of the anteroposterior displacement with eyes closed (1.30-1.53 mm/s) (p = 0.025). Dry needling therapy application in FDB muscle reduces standing postural control with eyes closed.

Holistic nursing care for people diagnosed with an eating disorder: A qualitative study based on patients and nursing professionals' experience.

PURPOSE: To analyze eating disorder patients and nursing professionals' views and experience of the relationship-based care established. DESIGN AND METHODS: A qualitative study that employs an interpretative phenomenological analysis. Nineteen patients and 19 nurses participated in the research through interviews and narrations. FINDINGS: Nurses' help is both unexpected and relevant during the patients' recovery process. They provide care not focusing just on nutritional aspects, other factors such as mutual help, the psychological, emotional, social, and personal aspects are highlighted. PRACTICE IMPLICATIONS: This study provides a deep understanding of the relationship-based care established that makes it possible to expand knowledge and to individualize the care provided.

Biomarkers and Nutrients in Musculoskeletal Disorders.

Worldwide, the burden of musculoskeletal disorders is increasing with great variations between-countries, which makes it difficult for policymakers to provide resources and adequate interventions in order to provide for their appropriate management [...].

Flexor Digitorum Brevis Muscle Dry Needling Changes Surface and Plantar Pressures: A Pre-Post Study.

BACKGROUND: The effects of the dry needling technique and pain reduction have been demonstrated in numerous quality studies. However, the mechanical effects of dry needling are largely unknown. METHODS: A total of 18 subjects with flexor digitorum brevis muscle myofascial trigger point were evaluated pre- and post-deep dry needling. We measured static footprint variables in a pre-post study. MAIN FINDINGS: We found differences in rearfoot maximum pressure (119.22-111.63 KPa; p = 0.025), midfoot maximum pressure (13.68-17.26 KPa; p = 0.077), midfoot medium pressure (4.75-6.24 KPa; p = 0.035) and forefoot surface (86.58-81.75 cm2; p = 0.020). All variables with significant differences decrease, with the exception of forefoot surface which showed an increase. CONCLUSIONS: After flexor digitorum brevis muscle dry needling, midfoot plantar pressures (maximum and medium) and forefoot surface were increased, and rearfoot maximum pressure was decreased.

Pressure and Traction Technique Improves Postural Control More Than Tactile Stimulation in Foot Plantar Fascia: A Randomized Single-Blind Trial.

OBJECTIVE: To check the acute effects of manual pressure and traction technique on balance and plantar footprint variables. DESIGN: A single-blind clinical study with 2 groups. SETTING: Private practice. PARTICIPANTS: Healthy participants (N=40; 28 female and 12 male) were recruited to carry out a single-blind study. INTERVENTIONS: Experimental group performed a bilateral plantar fascia manual pressure and traction technique. Control group performed a tactile stimulation. The position of the participant, the therapist, and the time of application of the techniques (5min) were the same for both interventions. MAIN OUTCOME MEASURES: We measured stabilometry variables and static footprint. The footprint variables were divided in rear, middle, and front foot areas. RESULTS: Significant differences were found in stabilometry variables. There was an improvement in experimental group at X displacement with eyes open (P=.014) and surface eyes closed (P=.046) variables. CONCLUSIONS: After technique the experimental group improved the stabilometry variables, specifically surface with eyes closed and X displacement with eyes open. The static footprint variables have not shown differences after the technique compared with the control group.

Acute effects of myofascial induction technique in plantar fascia complex in patients with myofascial pain syndrome on postural sway and plantar pressures: A quasi-experimental study.

OBJECTIVES: The prevalence of myofascial pain syndrome varies from 21% 93%. Several studies have shown that myofascial induction is effective in treating myofascial pain syndrome. Although these techniques have shown some effectiveness in clinical practice, there have been little study into their effects, and have deep effects. The purpose of this study was to investigate if the application of a single myofascial induction technique for each foot, targeted to the plantar fascia resulted in changes in balance and footprint variables. DESIGN: A quasi-experimental study. SETTING: An outpatient clinic. SUBJECTS: 20 healthy participants (12 females and 8 males) were evaluated pre and post Myofascial induction technique for each foot in plantar fascia during 5 min. METHODS: We measured static footprint and stabilometry variables in asymptomatic subjects. The footprint surface area was divided: bilateral rear foot, bilateral midfoot, bilateral fore foot. RESULTS: We found differences in the footprint variables: maximun pressure in forefoot (p = 0.025), surface in forefoot (p = 0.03). The myofascial induction has no effects on stabilometry variables. CONCLUSIONS: The immediate effects of the longitudinal technique of myofascial induction of the plantar fascia are the increase of surface and maximum pressure in fore foot.

Immediate Effects of Intermittent Bilateral Ankle Plantar Flexors Static Stretching on Balance and Plantar Pressures.

OBJECTIVE: The purpose of this study was to analyze the immediate effects of an intermittent plantar flexion static-stretching protocol on balance and plantar pressures. METHODS: The study included a sample size of 24 healthy participants (21 female and 3 male). Participants were 32.20 ± 8.08 years, 166.20 ± 8.43 cm, and 62.77 ± 9.52 kg. All participants performed an intermittent plantar flexion static-stretching protocol. Five sets (60 seconds intermittent stretch; 15 seconds for the rest time) of a passive plantar flexor stretching (70% to 90% of the point of discomfort) were performed. Static footprint analysis and a stabilometry analysis were performed before and after stretching. A P value < .05 with a CI of 95% was considered statistically significant for all tests. RESULTS: Intermittent ankle plantar static stretching resulted in a significantly greater forefoot surface contact area and lower rear foot medium and maximum plantar pressures. In addition, static stretching caused a lower displacement of the center of pressure for both eyes open and eyes closed conditions. CONCLUSION: An intermittent plantar flexor static-stretching protocol improved balance and reduced rear foot plantar pressures (maximum and medium pressures).

Effectiveness of Deep Dry Needling vs Ischemic Compression in the Latent Myofascial Trigger Points of the Shortened Triceps Surae from Triathletes on Ankle Dorsiflexion, Dynamic, and Static Plantar Pressure Distribution: A Clinical Trial.

OBJECTIVE: To determine the immediate efficacy of a single session of deep dry needling (DDN) vs ischemic compression (ICT) in a latent myofascial trigger point (MTrP) of the shortened triceps surae from triathletes for ankle dorsiflexion and redistribution of plantar pressures and stability. DESIGN: A randomized simple blind clinical trial (NCT03273985). SETTING: An outpatient clinic. SUBJECTS: Thirty-four triathletes with a latent MTrP in the shortened gastrocnemius. METHODS: Triathletes were randomized to receive a single session of DDN (N = 17) or ICT (N = 17) in a latent MTrP of the shortened triceps surae. The primary outcome was ankle dorsiflexion range of motion (ROM) by a universal goniometer. Secondary objectives were distribution of dynamic and static plantar pressures by T-Plate platform pressure, with measurements both before and after five, 10, 15, 20, and 25 minutes of treatment. RESULTS: There were no statistically significant differences (P > 0.05) for ankle dorsiflexion ROM or dynamic and static plantar pressures between the experimental group treated with DDN and the control group treated with ICT before and after treatment. CONCLUSIONS: DDN vs ICT carried out in latent MTrPs of the shortened gastrocnemius of triathletes did not present differences in terms of dorsiflexion ROM of the tibiofibular-talar joint or in static and dynamic plantar pressure changes before and immediately after treatment.

Effectiveness between Dry Needling and Ischemic Compression in the Triceps Surae Latent Myofascial Trigger Points of Triathletes on Pressure Pain Threshold and Thermography: A Single Blinded Randomized Clinical Trial.

BACKGROUND: Deep dry needling (DDN) and ischemic compression technic (ICT) may be considered as interventions used for the treatment of Myofascial Pain Syndrome (MPS) in latent myofascial trigger points (MTrPs). The immediate effectiveness of both DDN and ICT on pressure pain threshold (PPT) and skin temperature of the latent MTrPs of the triceps surae has not yet been determined, especially in athletes due to their treatment requirements during training and competition. OBJECTIVE: To compare the immediate efficacy between DDN and ICT in the latent MTrPs of triathletes considering PPT and thermography measurements. METHOD: A total sample of 34 triathletes was divided into two groups: DDN and ICT. The triathletes only received a treatment session of DDN (n = 17) or ICT (n = 17). PPT and skin temperature of the selected latent MTrPs were assessed before and after treatment. RESULTS: Statistically significant differences between both groups were shown after treatment, showing a PPT reduction (p < 0.05) in the DDN group, while PPT values were maintained in the ICT group. There were not statistically significant differences (p > 0.05) for thermographic values before and treatment for both interventions. CONCLUSIONS: Findings of this study suggested that ICT could be more advisable than DDN regarding latent MTrPs local mechanosensitivity immediately after treatment due to the requirements of training and competition in athletes' population. Nevertheless, further studies comparing both interventions in the long term should be carried out in this specific population due to the possible influence of delayed onset muscle soreness and muscle damage on PPT and thermography values secondary to the high level of training and competition.

Exploring the knowledge, explanatory models of illness, and patterns of healthcare-seeking behaviour of Fang culture-bound syndromes in Equatorial Guinea.

In 1994, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) included "culture-bound syndromes" in its classification of psychiatric disorders and associated them with disease processes that manifest in behavioural or thought disorders that develop within a given cultural context. This study examines the definitions, explanatory models, signs and symptoms, and healthcare-seeking behaviours common to Fang culture-bound syndromes (i.e., kong, eluma, witchcraft, mibili, mikug, and nsamadalu). The Fang ethnic group is the majority ethnic group in Equatorial Guinea. From September 2012 to January 2013, 45 key Fang informants were selected, including community leaders, tribal elders, healthcare workers, traditional healers, and non-Catholic pastors in 39 of 724 Fang tribal villages in 6 of 13 districts in the mainland region of Equatorial Guinea. An ethnographic approach with an emic-etic perspective was employed. Data were collected using semi-structured interviews, participant observation and a questionnaire that included DHS6 key indicators. Interviews were designed based on the Cultural Formulation form in the DSM-5 and explored the definition of Fang cultural syndromes, symptoms, cultural perceptions of cause, and current help-seeking. Participants defined "Fang culture-bound syndromes" as those diseases that cannot be cured, treated, or diagnosed by science. Such syndromes present with the same signs and symptoms as diseases identified by Western medicine. However, they arise because of the actions of enemies, because of the actions of spirits or ancestors, as punishments for disregarding the law of God, because of the violation of sexual or dietary taboos, or because of the violation of a Fang rite of passage, the dzas, which is celebrated at birth. Six Fang culture-bound syndromes were included in the study: 1) Eluma, a disease that is targeted at the victim out of envy and starts out with sharp, intense, focussed pain and aggressiveness; 2) Witchcraft, characterized by isolation from the outside, socially maladaptive behaviour, and the use of hallucinogenic substances; 3) Kong, which is common among the wealthy class and manifests as a disconnection from the environment and a lack of vital energy; 4) Mibili, a possession by evil spirits that manifests through visual and auditory hallucinations; 5) Mikug, which appears after a person has had contact with human bones in a ritual; and 6) Nsamadalu, which emerges after a traumatic process caused by violating traditions through having sexual relations with one's sister or brother. The therapeutic resources of choice for addressing Fang culture-bound syndromes were traditional Fang medicine and the religious practices of the Bethany and Pentecostal churches, among others. Among African ethnic groups, symbolism, the weight of tradition, and the principle of chance in health and disease are underlying factors in the presentation of certain diseases, which in ethno-psychiatry are now referred to as culture-bound syndromes. In this study, traditional healers, elders, healthcare professionals, religious figures, and leaders of the Fang community in Equatorial Guinea referred to six such cultural syndromes: eluma, witchcraft, kong, mibili, mikug, and nsamadalu. In the absence of a multidisciplinary approach to mental illness in the country, the Fang ethnic group seeks healthcare for culture-bound syndromes from traditional healing and religious rites in the Evangelical faiths.

A rare case of Meleney’s Ulcer after partial chemical matricectomy

Antecedentes. La úlcera de Meleney es una infección poco frecuente, pero potencialmente grave que ocurre a menudo en el postoperatorio. Este tipo de úlcera no ha sido anteriormente descrita en el pie tras la realización de una matricectomía parcial con fenol. Caso Clínico. Una paciente fue intervenida mediante fenolización parcial de la matriz ungueal medial del dedo gordo del pie, y transcurridos 2 meses tuvo una recidiva de la deformidad ungueal que causó las úlceras de Meleney. Resultados. Las úlceras se mantuvieron sin cicatrizar aún pautando un régimen de tratamiento con antibióticos, por lo que se requirió de una nueva intervención quirúrgica para eliminar completamente la infección. Conclusión. Este caso presenta una úlcera de Meleney destacando una presentación inicial aparentemente benigna de la fascitis necrotizante en el hallux tras la realización de una matricectomía química parcial mediante abordaje quirúrgico utilizando fenol(AU)

Background. Meleney’s ulcer is a rare, but potentially deadly infection that often occurs in post-surgical sites. This type of ulcer has not previously been reported in the toenail after phenol matricectomy. Patient Case. A female patient underwent partial phenolization of the medial nail matrix of the hallux, but after 2 months had a recurrent spicula that caused Meleney’s ulcers. Results. The ulcers remained after treatment with antibiotics, and further surgery was required to fully clear the infection. Conclusion. This case and review of Meleney’s ulcer highlights the deceptively benign initial presentation of necrotizing fasciitis at the hallux after partial chemical matricectomy surgery using a phenol-based approach(AU)

Cuestiones relativas a la historia clínica

El presente articulo tiene por objeto establecer los documentos que constituyen el registro de actividades clínicas y se dirige a establecer los contenidos mínimos que deben de constar en la historia clínica, así como a establecer un modelo de la misma orientado al ámbito de las Ciencias Podológicas. (AU)