Therapeutic tools for oral candidiasis: Current and new antifungal drugs.

BACKGROUND: Candidiasis is one of the most common opportunistic oral infections that presents different acute and chronic clinical presentations with diverse diagnostic and therapeutic approaches. The present study carries out a bibliographic review on the therapeutic tools available against oral candidiasis and their usefulness in each clinical situation. MATERIAL AND METHODS: Recent studies on treatment of oral candidiasis were retrieved from PubMed and Cochrane Library. RESULTS: Nystatin and miconazole are the most commonly used topical antifungal drugs. Both antifungal drugs are very effective but need a long time of use to eradicate the infection. The pharmacological presentations of miconazole are more comfortable for patients but this drug may interact with other drugs and this fact should be assessed before use. Other topical alternatives for oral candidiasis, such as amphotericin B or clotrimazole, are not available in many countries. Oral fluconazole is effective in treating oral candidiasis that does not respond to topical treatment. Other systemic treatment alternatives, oral or intravenous, less used are itraconazole, voriconazole or posaconazole. Available novelties include echinocandins (anidulafungin, caspofungin) and isavuconazole. Echinocandins can only be used intravenously. Isavuconazole is available for oral and intravenous use. Other hopeful alternatives are new drugs, such as ibrexafungerp, or the use of antibodies, cytokines and antimicrobial peptides. CONCLUSIONS: Nystatin, miconazole, and fluconazole are very effective for treating oral candidiasis. There are systemic alternatives for treating recalcitrant infections, such as the new triazoles, echinocandins, or lipidic presentations of amphotericin B.

Efectividad del masaje funcional en el síndrome de impingement subacromial / Functional massage effectiveness in subacromial impingement syndrome

Objetivo: En nuestra práctica clínica, el masaje funcional ofrece buenos resultados en el tratamiento de pacientes diagnosticados de síndrome subacromial y presencia de puntos gatillo en el músculo redondo mayor. Nuestro objetivo es comprobar los resultados del masaje funcional del músculo redondo mayor sobre el dolor, la función y la movilidad, en pacientes diagnosticados de síndrome subacromial. Material y métodos: Estudio experimental de serie de casos, aleatorizado, simple ciego, multicéntrico (dos centros), con 38 participantes distribuidos aleatoriamente en dos grupos. Un fisioterapeuta de cada centro proporcionó a todos los participantes un tratamiento protocolizado en sesiones diarias durante tres semanas y, adicionalmente, los asignados al Grupo Masaje Funcional recibieron diariamente cinco minutos de masaje funcional del redondo mayor, y los asignados al Grupo Movilización Pasiva recibieron diariamente cinco minutos de movilización pasiva en dirección del estiramiento muscular. Resultados: El Grupo Masaje Funcional consiguió una mejoría estadísticamente significativa en todas las variables de resultados. El Grupo Movilización Pasiva consiguió mejoría estadísticamente significativa en todas las variables a excepción de los movimientos de extensión y rotación externa. En la comparación entre grupos, la mayor mejoría del Grupo Masaje Funcional en extensión alcanza significación estadística, y la mayor mejoría en abducción, extensión y rotación externa alcanza significación clínica de pequeña a moderada. Los sujetos asignados al Grupo Masaje Funcional mostraban una mejor satisfacción con los resultados. Conclusiones: En este estudio, el masaje funcional de los puntos gatillo del músculo redondo mayor proporciona mejores resultados clínicos que la movilización pasiva en dirección del estiramiento muscular

Objective: In our clinical practice, functional massage offers good results in the treatment of patients diagnosed of subacromial impingement syndrome and presence of teres major muscle trigger points. Our aim is to check the teres major functional massage results on pain, function and mobility in patients diagnosed of subacromial impingement syndrome. Material and methods: Experimental multicentre (two centers) randomized study of single-blind case series. A total of 38 participants were randomly divided into two groups. One physiotherapist in each center provided all the participants a protocolized treatment in daily sessions for three weeks and those assigned to Functional Massage Group also received five minutes of Functional Massage of the teres major muscle daily. Those assigned to the Passive Mobilization Group received five minutes of passive mobilization towards muscle stretch daily. Results: The Functional Massage Group achieved a statistically significant improvement in all outcome variables. The Passive Mobilization Group achieved statistically significant improvement in all variables except for the movements of extension and external rotation. The comparison between the groups, the best improvement of the Functional Massage Group reached statistical significance, and the best improvement in abduction, extension and external rotation reached small to moderate clinical significance. Subjects in the Functional Massage Group showed better satisfaction with the results. Conclusions In this study, Functional Massage of trigger points in teres major muscle provides better clinical outcomes than passive mobilization towards the muscle stretch