Efectividad de la entrevista motivacional en la atención fisioterápica de los trastornos musculoesqueléticos de la espalda / Effectiveness of the motivational interview in the physiotherapy care of musculoskeletal disorders of the back: A quasi-experimental study

Objetivo: Evaluar la efectividad de la entrevista motivacional (EM) junto al tratamiento fisioterapéutico habitual en pacientes con trastornos musculoesqueléticos (TME) de la espalda en atención primaria (AP). Métodos: Estudio cuasiexperimental en pacientes que iniciaron su tratamiento en el año 2020 en una unidad de fisioterapia tras diagnóstico médico de TME en la espalda, con seguimiento prospectivo de 2grupos con actuación terapéutica: grupo experimental (GE) y grupo de control (GC). Se empleó la EM solo en el GE. A ambos grupos se les entrevistó telefónicamente a los 3y 6meses de finalizar el tratamiento fisioterápico, preguntando por el cumplimiento de pautas domiciliarias y por la percepción subjetiva del estado de salud (escala de Barthel). Se ajustaron modelos de regresión lineales (coeficiente de regresión, IC del 95%) y logísticos (OR, IC del 95%). Resultados: La población de estudio fue de 154 personas (76,6% mujeres). La salud percibida fue significativamente mejor (p<0,001) en el GE que en el GC, tanto a los 3meses de seguimiento (7,4 versus 5,0, respectivamente) como a los 6(7,1 versus 4,6, respectivamente). Hubo una fuerte asociación entre percepción de salud y cumplimiento (coeficiente de regresión 3,0 [IC del 95%=2,5-3,4]). La asociación entre la EM y el cumplimiento terapéutico se mantuvo tras ajustes multivariados (OR a 6meses=383,6 [IC del 95% = 31,0-4.742,4]). Conclusiones: la incorporación de la EM como complemento de los tratamientos de fisioterapia es una herramienta factible y efectiva para mejorar el cumplimiento de las pautas domiciliarias y la percepción subjetiva de salud. (AU)

Objective: To evaluate the effectiveness of motivational interviewing (MI) combined with the usual physiotherapy treatment in patients with back musculoskeletal disorders (MSD) in primary care (PC). Methods: Quasi-experimental study with 2groups with therapeutic action (control group and experimental group) and prospective follow-up, in a physiotherapy unit in PC, in patients who began their treatment in 2020, with a medical diagnosis of MSD in the back. MI was used only in the face-to-face visits of the experimental group. Both groups were interviewed by telephone about 3and 6months after finishing the physiotherapy treatment. For this purpose, the Barthel scale was used for the subjective perception of the state of health, and the scale of compliance with home guidelines. Linear (regression coefficient, 95% CI) and logistic (OR, 95% CI) regression models were fitted. Results: The study population was 154 people (76.6% women). Perceived health was significantly better (P<.001) in the experimental group than in the control group, both at 3(7.4 versus 5.0, respectively) and at 6months of follow-up (7.1 versus 4.6, respectively). There was a strong association between perceived health and compliance (regression coefficient 3.0 [95% CI=2.5–3.4]). The strong association between MI and treatment adherence was maintained after multivariate adjustments (6-month OR=383.6 [95% CI 31.0–4742.4]). Conclusions: MI is a feasible and effective complement to physiotherapy treatments to improve compliance with home recommendations and subjective perception of health. (AU)

Selective local anesthesia versus corticosteroid infiltration on low back pain: a randomized clinical trial. / Anestesia local selectiva frente a infiltración de corticosteroides en el dolor lumbar: ensayo clínico aleatorizado.

ANTECEDENTS AND OBJECTIVE: Local infiltrations are second line therapy in the treatment of chronic low back pain, although their use is controversial in the literature. Our objective was to compare the effectiveness of 2 types of infiltration at the paravertebral lumbar level in two groups of patients diagnosed with low back pain: corticosteroids, and selective local anaesthetic administered using segmental neural therapy (SNT). MATERIAL AND METHODS: Double-blind clinical trial in 55 patients diagnosed with low back pain in the neurosurgery department of the Hospital Central de la Defensa Gómez Ulla. Patients were randomised to 2 treatment groups to receive either paravertebral injections of corticosteroids or SNT. Outcomes were measured using a visual analogue scale, the Oswestry Disability Index, the Short Form-36, and patient satisfaction at the start of treatment (baseline) and at 3 and 12 months post intervention. RESULTS: The combined treatment group showed a statistically significant improvement in Oswestry Disability Index at 3 months. The SNT group showed a statistically significant improvement in baseline visual analogue scale vs. visual analogue scale at 3 (1.398cm, p=0.001) and 12 months (0.791cm, p=0.007). No differences were observed in the remaining variables measured. The percentage of patients that would repeat the treatment was 81% and 83%, respectively. CONCLUSIONS: Significant pain relief was achieved with SNT, and disability improved with the combined treatment. Although clinical improvement was limited, patients were satisfied. Local infiltrations should be considered as an alternative treatment for chronic low back pain. CLINICAL TRIAL REGISTRATION: This clinical trial was registered at the European Union Clinical Trials Register with EUDRA-CT number 2015-001146-29.

The prognostic role of catatonia, hallucinations, and symptoms of schizophrenia in acute and transient psychosis.

OBJECTIVES: To examine the prospective temporal stability of acute and transient psychotic disorders (ATPDs) and analyze whether there are clinical, psychopathological, or sociodemographic characteristics that predict ATPD diagnostic stability. METHOD: We conducted a prospective, 2-year, observational study of patients presenting a first-episode ATPD. A multivariate logistic regression model was developed to identify independent variables associated with ATPD diagnostic stability. Well-established predictive factors of diagnostic stability, as well as all the psychopathological features included in the ICD-10 Diagnostic Criteria for Research (DCR) descriptions of ATPD, were analyzed. RESULTS: Sixty-eight patients with a first episode of ATPD completed the study with a diagnostic stability rate as high as 55.9% (n = 38) at the end of the follow-up period. Multivariate analysis revealed that diagnostic stability was independently significantly associated with the baseline presence of motility disturbances (OR = 6.86, 95% CI = 1.10-42.62; P = 0.039), the absence of hallucinations (OR = 5.75, 95% CI = 1.51-21.98; P = 0.010), and the absence of schizophrenic features (OR = 7.13, 95% CI = 1.38-36.90; P = 0.019). CONCLUSION: A symptom checklist assessing these psychopathological features would enable early identification of those subjects whose initial ATPD diagnosis will remain stable over time.

Economic and environmental review of Waste-to-Energy systems for municipal solid waste management in medium and small municipalities.

The application of Directive 2008/98/CE on Municipal Solid Waste (MSW) implies the need to introduce technologies to generate energy from waste. Incineration, the most widely used method, is difficult to implement in low populated areas because it requires a large amount of waste to be viable (100,000 tons per year). This paper analyses the economic and environmental costs of different MSW-to-Energy technologies (WtE) in an area comprising of 13 municipalities in southern Spain. We analyse anaerobic digestion (Biomethanization), the production of solid recovered fuel (SRF) and gasification, and compare these approaches to the present Biological Mechanical Treatment (BMT) with elimination of the reject in landfill, and incineration with energy recovery. From an economic standpoint the implementation of WtE systems reduces the cost of running present BMT systems and incineration; gasification presents the lowest value. From the environmental standpoint, Life Cycle Assessment shows that any WtE alternatives, including incineration, present important advantages for the environment when compared to BMT. Finally, in order to select the best alternative, a multi-criteria method is applied, showing that anaerobic digestion is the optimal solution for the area studied.

Tratamiento multidisciplinar del traumatismo cervical con fractura de apófisis odontoides en militar, a propósito de un caso / Multidisciplinary treatment for cervical trauma with odontoid apophysis fracture in military member, a case report

La fractura de apófisis odontoides de la segunda vértebra cervical representa entre el 10 y el 15% de todas las fracturas cervicales. En el medio militar, esta lesión puede ser originada por la práctica de deportes, actividades de especial riesgo como el paracaidismo y armas de fuego o artefacto explosivo. Un diagnóstico precoz y un adecuado tratamiento multidisciplinar pueden colaborar para el correcto manejo integral de una baja. Se ha realizado una revisión de la literatura en la base de datos del PUBMED, utilizado la palabra clave «fractura odontoides», «sedación», «Halo-Jacket»

Odontoid fracture of the second cervical vertebra represents between 10 and 15% of all cervical fractures. In a military environment, this injury may be caused by the practice of sports, special risk such as skydiving and firearms or explosive device. Early diagnosis and appropriate multidisciplinary treatment can work for the proper management of a casualty. A literature review has been carried out in PUBMED database, using the keywords «fractura odontoides», «sedación», «Halo-Jacket»

Comentario / Commentary

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Fracturas de la cabeza radial. Tratamiento quirúrgico conservador. Dos casos de supervivencia de la cabeza del radio. Comentario / Fractures of the radial head. Conservative surgical treatment. Two cases of survival of the radial head. Comment

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Las complicaciones nerviosas en las luxaciones del hombro. Comentario / Neurological complicatons in shoulder dislocation. Comment

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Infecciones de la mano / Hand infections

Presentamos una revisión de 45 pacientes ingresados por uno de los siguientes tipos de infección en la mano: celulitis (24), absceso (13), paroniquia (3), panadizo (2), tenosinovitis (2) y tularemia (1). La causa más frecuente fue una herida traumática (54 por ciento) y el tiempo medio de ingreso de 8 días. Se realizó cultivo en el 62 por ciento de los casos, encontrándose S. Aureus como gérmen más frecuente en el 44 por ciento. El antibiótico más empleado fue una combinación de Amoxicilina/ac. clavulánico en el 85 por ciento de los pacientes. En el 47 por ciento de los casos se realizó tratamiento quirúrgico para drenaje y/o desbridamiento, destacando 2 complicaciones importantes: una necrosis del 3º dedo de la mano derecha, que precisó amputación a nivel de la articulación metacarpofalángica y una necrosis en el dorso del pulgar derecho, que se cubrió con un colgajo en isla (colgajo en cometa) (AU)

Terfenadine induces toxicity in cultured cerebellar neurons: a role for glutamate receptors.

Exposure of cultured cerebellar neurons to the histamine H1 receptor antagonist terfenadine resulted in neuronal degeneration and death. Terfenadine neurotoxicity was dependent upon concentration and time of exposure. After 2 h exposure, 20 microM terfenadine reduced the number of surviving neurons by 75%, and as low as 10 nM terfenadine induced significant neurotoxicity after 5 days of exposure. Neuronal sensitivity to terfenadine changed with age in culture, and at 25 days in culture neurons appeared to be much less sensitive than at 5 or 9-17 days in culture. Neurotoxicity by terfenadine could not be prevented by high concentrations of histamine (5 mM), but it was significantly delayed by blocking NMDA or non-NMDA glutamate receptors with MK-801 or CNQX respectively, suggesting the involvement of excitatory transmission mediated by glutamate in the neurotoxicity induced by terfenadine in these neurons. We also found that the presence of terfenadine (5 microM) unveiled the potential excitotoxity of the non-NMDA receptor agonist AMPA (100 microM), and reduced the concentration of glutamate necessary to induce excitotoxicity, compared to untreated cultures. These results suggest a role for terfenadine in the modulation of the excitotoxic response mediated in cerebellar neurons through ionotropic glutamate receptors.

Rheumatoid arthritis and hydroxyapatite-coated hip prostheses: five-year results. International ABG Study Group.

Medium- and long-term results from cemented total hip arthroplasty (THA) in patients with rheumatoid arthritis (RA) show a higher incidence of infection and aseptic loosening when compared to other diagnoses. Early results using uncemented prostheses are variable. Hydroxyapatite (HA) coatings are thought to improve early osseointegration in uncemented THA. In a prospective, international, multicenter clinical study, 32 RA patients who received 33 uncemented HA-coated prostheses were followed up for a minimum of 5 years. Medium-term clinical results are excellent. No infection or aseptic loosening has been recorded. Excellent osseointegration was observed radiographically. Bone remodeling was consistent with mainly proximal to midstem stress transfer. We conclude that uncemented, proximally HA-coated prostheses are a promising alternative to cemented prostheses for RA patients.

Cementless total hip arthroplasty with a threaded acetabular cup.

Eighty cementless total hip arthroplasties, using smooth threaded cups (Lord universal model), were carried out between 1985 and 1988. Sixty of these patients were available for clinical and radiological study with a mean follow up of 6 years. Five cups were revised for aseptic loosening and another 6 are awaiting revision, so 18% of the cups have failed. Fixation was classified as stable, fibrous-stable and unstable on radiographs. Twenty-six (43%) had fibrous-stable fixation and most were satisfactory clinically. This type of fixation must be carefully watched for signs of osteolysis, especially around the threads, as this precedes failure. Smooth threaded cups have good short term results, but deteriorate because of deficient osteointegration and later from wear debris. This type of cup does is not a good alternative to cemented cups.

Obturator dislocation in developmental dislocation of the hip: a complication during treatment.

A baby girl with developmental dislocation of the hip (DDH) who was treated previously with closed reduction, spica cast, and Pavlik harness had an obturator dislocation. Hyperflexion of the hip was evident during Pavlik harness treatment, but extreme laxity is considered the main factor in the complication.

False aneurysm of the femoral artery as a late complication of an intertrochanteric fracture. A case report.

False aneurysms of the femoral vessels are an important, but rare, complication after an intertrochanteric fracture of the femur. The diagnosis is usually delayed, because pain, a haematoma and unexplained anaemia are the nonspecific clinical signs. Early diagnosis by duplex and colour Doppler ultrasound is a good alternative to arteriography or magnetic resonance imaging.

Beta-protein deposition: a pathogenetic link between Alzheimer's disease and cerebral amyloid angiopathies.

Cerebral amyloid angiopathy (CAA) refers to a group of hereditary (hereditary cerebral hemorrhage with amyloidosis, HCHWA and sporadic (SCAA) disorders characterized by amyloid fibril deposition restricted to the leptomeningeal and cortical vasculature leading to recurrent hemorrhagic and/or ischemic accidents. On clinical and biochemical grounds, two forms of HCHWA can be distinguished. The amyloid subunit of the HCHWA of Icelandic origin is related to Cystatin C, while amyloid from patients of Dutch origin (HCHWA-D) is related to the beta-protein (or A4), the main component of vascular and plaque core amyloid in Alzheimer's disease (AD) and Down's syndrome (DS) [corrected]. SCAA is an increasingly recognized cause of stroke in normotensive individual amounting to 5-10% of all cerebrovascular accidents. We now report the isolation and partial amino acid sequence of the amyloid subunit from a case of SCAA and a new case of HCHWA-D. The recognition that a heterogeneous group of diseases are linked by similar pathological and chemical features suggests that diversity of etiological factors may promote a common pathogenetic mechanism leading to amyloid-beta (A beta) deposition, and open new ways of research in AD and CAA as they are related to dementia and stroke.