Muscle quality an evolving concept.

Muscle quality concept can be analyzed from a morphological and functional perspectives that include relation between these properties. Morphological muscle quality considers muscle composition, architectural and structural properties. Functional muscle quality has been defined as a ratio between muscle strength or power per unit of muscle mass or area. Biological and adaptative changes to ageing must be considered when interpretation of muscle quality assessment is done in a clinical or research context. One of the conditions that requires an adequate homologation in terminology is sarcopenia, to establish definition and cut-off points.

Implication of myddosome complex genetic variants in outcome severity of COVID-19 patients.

BACKGROUND/PURPOSE(S): During a viral infection, the immune response is mediated by the toll-like receptors and myeloid differentiation Factor 88 (MyD88) that play an important role sensing infections such as SARS-CoV-2 which has claimed the lives of more than 6.8 million people around the world. METHODS: We carried out a cross-sectional with a population of 618 SARS-CoV-2-positive unvaccinated subjects and further classified based on severity: 22% were mild, 34% were severe, 26% were critical, and 18% were deceased. Toll Like Receptor 7 (TLR7) single-nucleotide polymorphisms (rs3853839, rs179008, rs179009, and rs2302267) and MyD88 (rs7744) were genotyped using TaqMan OpenArray. The association of polymorphisms with disease outcomes was performed by logistic regression analysis adjusted by covariates. RESULTS: A significant association of rs3853839 and rs7744 of the TLR7 and MyD88 genes, respectively, was found with COVID-19 severity. The G/G genotype of the rs3853839 TLR7 was associated with the critical outcome showing an Odd Ratio = 1.98 (95% IC = 1.04-3.77). The results highlighted an association of the G allele of MyD88 gene with severe, critical and deceased outcomes. Furthermore, in the dominant model (AG + GG vs. AA), we observed an Odd Ratio = 1.70 (95% CI = 1.02-2.86) with severe, Odd Ratio = 1.82 (95% CI = 1.04-3.21) with critical, and Odd Ratio = 2.44 (95% CI = 1.21-4.9) with deceased outcomes. CONCLUSION: To our knowledge this work represents an innovative report that highlights the significant association of TLR7 and MyD88 gene polymorphisms with COVID-19 outcomes and the possible implication of the MyD88 variant with D-dimer and IFN-α concentrations.

ACE and ACE2 Gene Variants Are Associated With Severe Outcomes of COVID-19 in Men.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the current coronavirus disease 2019 (COVID-19) pandemic, affecting more than 219 countries and causing the death of more than 5 million people worldwide. The genetic background represents a factor that predisposes the way the host responds to SARS-CoV-2 infection. In this sense, genetic variants of ACE and ACE2 could explain the observed interindividual variability to COVID-19 outcomes. In order to improve the understanding of how genetic variants of ACE and ACE2 are involved in the severity of COVID-19, we included a total of 481 individuals who showed clinical manifestations of COVID-19 and were diagnosed by reverse transcription PCR (RT-PCR). Genomic DNA was extracted from peripheral blood and saliva samples. ACE insertion/deletion polymorphism was evaluated by the high-resolution melting method; ACE single-nucleotide polymorphism (SNP) (rs4344) and ACE2 SNPs (rs2285666 and rs2074192) were genotyped using TaqMan probes. We assessed the association of ACE and ACE2 polymorphisms with disease severity using logistic regression analysis adjusted by age, sex, hypertension, type 2 diabetes, and obesity. The severity of the illness in our study population was divided as 31% mild, 26% severe, and 43% critical illness; additionally, 18% of individuals died, of whom 54% were male. Our results showed in the codominant model a contribution of ACE2 gene rs2285666 T/T genotype to critical outcome [odds ratio (OR) = 1.83; 95%CI = 1.01-3.29; p = 0.04] and to require oxygen supplementation (OR = 1.76; 95%CI = 1.01-3.04; p = 0.04), in addition to a strong association of the T allele of this variant to develop critical illness in male individuals (OR = 1.81; 95%CI = 1.10-2.98; p = 0.02). We suggest that the T allele of rs2285666 represents a risk factor for severe and critical outcomes of COVID-19, especially for men, regardless of age, hypertension, obesity, and type 2 diabetes.

The yawning gap between osteoporosis diagnosis and treatment after a fragility fracture in Mexico.

This study shows a diagnostic and therapeutic gap for osteoporosis in patients with fragility fractures of the hip, distal radius, and vertebrae. Patients with fragility fractures treated in Mexico fail to receive an osteoporosis diagnosis, referral, and follow-up treatment. The therapeutic gap is higher than reported in other countries. INTRODUCTION: Osteoporosis is a highly prevalent and disabling disease. While there is typically a gap between osteoporosis diagnosis and treatment after a fragility fracture, this gap has not been measured in Mexico. The study aimed to describe and quantify the gap between osteoporosis diagnosis and treatment after an incident fragility fracture. MATERIALS AND METHODS: A descriptive and 3-year retrospective chart review study was conducted on patients over the age of 50 with a diagnosis of an incident acute low-energy fracture of either the hip, distal radius, or vertebrae. RESULTS: We included 838 patients with a mean age of 76.3 ± 12.2 years. The sample was mostly women (665 participants, 79.4%); 589 (70.3%) had a hip fracture, 173 (20.6%) had a distal radius fracture, and 76 (9.1%) had a vertebral fracture. Only 28 (3.3%) had a previous diagnosis and were taking a pharmacological treatment for osteoporosis; 11 (1.3%) received their diagnosis while hospitalized. Immediately after the fracture, and 1 and 3 years later, 144 (17.1%), 71 (8.4%), and 96 (11.4%) respectively received a pharmacological treatment, 195 (23.2%), 65 (7.7%), and 45 (5.3%) supplementation, and 16 (1.9%), 16 (1.9%), and 21 (2.5%) a non-pharmacologic treatment. No significant differences in treatment prescriptions were found after a second or third fracture. CONCLUSION: The study quantifies the too high frequency of failure to diagnose and treat osteoporosis in patients with fragility fractures. Measures should be established to reduce the yawning gap between osteoporosis diagnosis and treatment after a fragility fracture.

Adaptation of clinical practice guidelines for osteoporosis in a Mexican context. Experience using methodologies ADAPTE, GRADE-ADOLOPMENT, and RAND/UCLA.

High quality guidelines are required to enhance clinical practice, but its development is time consuming and a complex process. Adaptation might shorten development time and prevent double effort adjusting recommendations for a local context. BACKGROUND AND OBJECTIVE: The aim of this article is to present our experience in a process in which we combined two methodologies for the adaptation of high quality osteoporosis CPGs for a primary health care context, with the inclusion of a formal consensus. METHODS: We began an adaptation process with ADAPTE, and required to migrate to GRADE-ADOLOPMENT methodology, based on GIN-McMaster Guideline Development Checklist. To identify high quality clinical practice guidelines, we performed a systematic review as per the PRISMA-statement methodology (PROSPERO: CRD42019138548, August 19th, 2019); methodological quality was assessed using the Appraisal of Guidelines for Research & Evaluation version II system. We developed a RAND/UCLA consensus to support the inclusion of good practice statements and feasibility of selected recommendations. RESULTS: Thirteen clinical questions were integrated, and fracture risk was selected as the main outcome for intervention recommendations analysis. Six high quality guidelines were selected. We prepared final recommendations from selected guides in an evidence synthesis framework. After the consensus, we integrated 50 recommendations. CONCLUSION: By starting the adaptation process with ADAPTE, we experienced a time consuming process, which we could overcome when migrating to GRADE-Adolopment in combination with a consensus panel.

Nonpharmacological interventions for osteoporosis treatment: Systematic review of clinical practice guidelines.

OBJECTIVES: The aim of this study was to perform a systematic review of clinical practice guidelines to identify nonpharmacologic recommendations for osteoporosis treatment. METHODS: A systematic review of literature following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-statement methodology for clinical practice guidelines was conducted; PROSPERO CRD42019138548. Assessment of selected clinical practice guidelines with the AGREE (Appraisal of Guidelines for Research & Evaluation)-II methodological quality instrument was performed, and those graded over 60 points were selected for recommendations extraction and evidence analysis. RESULTS: Only 6 clinical practice guidelines fulfilled criteria, 69 nonpharmacological recommendations were extracted: 13 from American Association of Clinical Endocrinologists and American College of Endocrinology guideline, 16 from Malaysian Osteoporosis Society guideline, 15 from the Ministry of Health in Mexico guideline, 14 from Royal Australian College of General Practitioners guideline, 7 from Sociedad Española de Investigación Ósea y del Metabolismo Mineral guideline, and 7 from National Osteoporosis Guideline Group guideline. Percentage by theme showed that the highest number of recommendations were 12 (17.1%) for vitamin D, 11 (15.7%) for a combination of calcium and vitamin D, and 11 (15.7%) for exercise. CONCLUSIONS: These recommendations address integrating interventions to modify lifestyle, mainly calcium and vitamin D intake, and exercise. Other recommendations include maintaining adequate protein intake, identification and treatment of risk factors for falls, and limiting the consumption of coffee, alcohol and tobacco. Considerations on prescription must be taken.

[Asociación de la composición corporal total con la fuerza del tronco, el dolor y la discapacidad en pacientes con espondiloartrosis lumbar]. / The association of total body composition with trunk strength, pain and disability in patients with lumbar osteoarthritis.

INTRODUCCIÓN: Las alteraciones en la composición corporal total podrían influir sobre la fuerza, el dolor y la discapacidad en pacientes con espondiloartrosis lumbar. OBJETIVO: Analizar la asociación de la composición corporal total con la fuerza muscular del tronco, el dolor y la discapacidad en pacientes con espondiloartrosis lumbar. MÉTODO: Estudio piloto en mayores de 50 años con dolor crónico de espalda baja y espondiloartrosis lumbar. Se excluyeron pacientes con diabetes mellitus, depresión, ansiedad, artropatías inflamatorias, fracturas vertebrales, escoliosis, cirugías de columna, cardiopatías, hipertensión arterial, radiculopatía o claudicación neurogénica. Se recolectaron datos sobre tiempo de evolución, composición corporal (masa grasa y muscular total), fuerza del tronco (isocinesia), dolor (escala numérica verbal) y discapacidad (Roland Morris). Análisis estadístico con U de Mann-Whitney y correlaciones de Spearman. RESULTADOS: 27 pacientes (18 mujeres y 9 hombres) con edad de 58.59 ± 6.98 años. La masa muscular total se asoció con el dolor (rho: -0.63, p = 0.001) y con la fuerza del tronco (flexores rho: -0.42, p = 0.02; extensores rho: -0.50, p = 0.007), sin correlación con la discapacidad. No se encontró correlación de la masa grasa con ninguna de las variables. CONCLUSIÓN: La disminución de la masa muscular se asocia con el dolor, pero no con la discapacidad, en pacientes con espondiloartrosis lumbar. BACKGROUND: Variations in body composition among patients with lumbar osteoarthritis may influence pain and disability and muscle strength. OBJECTIVE: To analyze the relationship between body composition with pain, disability and muscle strength, in patients with lumbar osteoarthritis. METHODS: Pilot study in patients older than 50 years of age, with chronic low back pain and lumbar osteoarthritis, who agreed to participate through informed consent. We excluded patients with diabetes mellitus, depression, anxiety, inflammatory arthropathies, vertebral fractures, idiopathic scoliosis, spinal surgery, heart disease or hypertension, radiculopathy or neurogenic claudication. Data on evolution time, body composition (total body fat and muscle mass), trunk strength, pain (numerical rating scale), and disability (Roland Morris questionnaire) were collected. Mann-Whitney U-test and Spearman correlations were performed. RESULTS: 27 patients (18 women and 9 men) aged 58.59 ± 6.98 years. Negative correlations between muscle mass with pain (rho: −0.63, p = 0.001) and strength (flexors rho: −0.42, p = 0.02; extensors rho: −0.50, p = 0.007) were found, without correlation with disability. No correlations of fat mass with pain or disability were found. CONCLUSION: Decreased of muscle mass were associated with higher pain scores without influencing the disability in patients with lumbar osteoarthritis..

Fear-avoidance beliefs increase perception of pain and disability in Mexicans with chronic low back pain / Crenças de medo e evitação aumentam a percepção de dor e incapacidade em mexicanos com lombalgia crônica

ABSTRACT Background: Fear-avoidance beliefs are related to the prognosis of chronicity in low back pain in subacute stages, however in chronic pain, is no clear the influence of these factors; it has been suggested that the study population can determine the magnitude of influence on disability and pain of those suffering from back pain. Currently, information does not exist in the Mexican population. Objective: To analyze the relationship between fear-avoidance beliefs with pain and disability in Mexicans with chronic low back pain; analyze potentials differences between subgroups according to the time of evolution. Methods: Cross-sectional study in Mexicans with chronic LBP aged between 18 and 45. Data were collected on general socio demographic characteristics, time of evolution, body mass index, pain, disability and fear-avoidance beliefs. Results: 33 men and 47 women, with an average age of 34.19 ± 7.65 years. Higher scores of fear-avoidance beliefs were obtained in women (47.2 ± 20.99 versus 38.5 ± 9.7; p = 0.05) and single participants (p = 0.04). A positive correlation was found between disability (r = 0.603, p < 0.001) and pain (r = 0.234, p = 0.03) with high scores of fear-avoidance beliefs. Through generalized linear models for disability, total score of the fear avoidance beliefs questionnaire showed a standardized beta coefficient of 0.603, p < 0.001 (R 2 of 0.656); for pain showed a standardized beta coefficient of 0.29, p = 0.01 (R 2 of 0.721). Conclusion: The present study suggests that there is a strong relationship between pain severity, FABQ scores, and functional disability in Mexicans with chronic LBP.

RESUMO Introdução: As crenças de medo e evitação estão relacionadas com o prognóstico da cronicidade da lombalgia nas fases subagudas; contudo, na dor crônica, não é clara a influência desses fatores. Sugeriu-se que um estudo populacional pode determinar a magnitude da influência da lombalgia sobre a incapacidade e a dor. Atualmente não há informação a esse respeito na população mexicana. Objetivo: Analisar a relação entre as crenças de medo e evitação com a dor e incapacidade em mexicanos com lombalgia crônica; analisar potenciais diferenças entre subgrupos determinados pelo tempo de evolução. Métodos: Estudo transversal em mexicanos com lombalgia crônica entre 18 e 45 anos. Coletaram-se dados sobre características sociodemográficas gerais, tempo de evolução, índice de massa corporal, dor, incapacidade e crenças de medo e evitação. Resultados: Foram estudados 33 homens e 47 mulheres com média de 34,19 ± 7,65 anos. Obtiveram-se escores de crenças de medo e evitação mais elevados em participantes do sexo feminino (47,2 ± 20,99 versus 38,5 ± 9,7; p = 0,05) e solteiros (p = 0,04). Encontrou-se uma correlação positiva entre a incapacidade (r = 0,603, p < 0,001) e a dor (r = 0,234, p = 0,03), com altas pontuações de crenças de medo e evitação. Por meio de modelos lineares generalizados para incapacidade, a pontuação total no questionário de crenças de medo e evitação mostrou um coeficiente beta padronizado de 0,603, p < 0,001 (R2 de 0,656); para a dor, mostrou um coeficiente beta padronizado de 0,29, p = 0,01 (R2 de 0,721). Conclusão: O presente estudo sugere que há uma forte relação entre a intensidade da dor, os escores no FABQ e a incapacidade funcional em mexicanos com lombalgia crônica.

Fear-avoidance beliefs increase perception of pain and disability in Mexicans with chronic low back pain.

BACKGROUND: Fear-avoidance beliefs are related to the prognosis of chronicity in low back pain in subacute stages, however in chronic pain, is no clear the influence of these factors; it has been suggested that the study population can determine the magnitude of influence on disability and pain of those suffering from back pain. Currently, information does not exist in the Mexican population. OBJECTIVE: To analyze the relationship between fear-avoidance beliefs with pain and disability in Mexicans with chronic low back pain; analyze potentials differences between subgroups according to the time of evolution. METHODS: Cross-sectional study in Mexicans with chronic LBP aged between 18 and 45. Data were collected on general socio demographic characteristics, time of evolution, body mass index, pain, disability and fear-avoidance beliefs. RESULTS: 33 men and 47 women, with an average age of 34.19±7.65 years. Higher scores of fear-avoidance beliefs were obtained in women (47.2±20.99 versus 38.5±9.7; p=0.05) and single participants (p=0.04). A positive correlation was found between disability (r=0.603, p<0.001) and pain (r=0.234, p=0.03) with high scores of fear-avoidance beliefs. Through generalized linear models for disability, total score of the fear avoidance beliefs questionnaire showed a standardized beta coefficient of 0.603, p<0.001 (R2 of 0.656); for pain showed a standardized beta coefficient of 0.29, p=0.01 (R2 of 0.721). CONCLUSION: The present study suggests that there is a strong relationship between pain severity, FABQ scores, and functional disability in Mexicans with chronic LBP.

Glenohumeral osteoarthritis: overview, therapy, and rehabilitation.

PURPOSE: Glenohumeral osteoarthritis (GHOA) is a common cause of pain and functional disability of the shoulder. Despite the limited evidence, there are several options for the treatment of this pathology. The aim of this article is to provide current information on the characteristics of the disease and the pathophysiology, evidence based on medical and surgical treatments with emphasis on the rehabilitation process. METHODS: It was performed with an extensive literature review, mainly clinical practice guidelines, randomized controlled trials, reviews, focusing on the rehabilitation management. RESULTS: There are few clinical practice guidelines that address GHOA as a pathology with unique characteristics. Evidence based treatment recommendations are mostly supported by low-quality evidence and experts' opinions, with few high levels of evidence studies guiding treatment decisions. CONCLUSIONS: Despite the lack of good quality evidence, rehabilitation programs have proven to be efficient and reliable, and this revision provides information and recommendations in this field. Implication of Rehabilitation Glenohumeral osteoarthritis is a common cause of pain and functional disability of the shoulder There are few clinical practice guidelines that address Glenohumeral Osteoarthritis as a pathology with unique characteristics, and recommendations for rehabilitation and therapeutic exercise are poor The paper provides current information on the characteristics of the disease, its rehabilitation process, and could be of interest for rehabilitation professionals to direct their practices in this field.

Proposal and Evaluation of a Telerehabilitation Platform Designed for Patients With Partial Rotator Cuff Tears: A Preliminary Study.

OBJECTIVE: To propose and evaluate the effectiveness of a telerehabilitation platform designed for patients with rotator cuff (RC) tears. METHODS: During the first study phase, a virtual service platform that included information on RC tear pathology, joint care, and a series of instructions regarding therapeutic exercise was designed and created. Subsequently, in the clinical phase, a quasi-experimental study was performed. The platform was tested on patients and evaluated at baseline and at 1, 2, 3, and 6 months with respect to their pain levels and functionality on the Constant-Murley (CM) scale. RESULTS: Eleven patients were included, 5 women and 6 men, with a median age of 55 years (range, 42-68 years). Pain diminished from a baseline value of 64 mm (range, 40-80 mm) to 16 mm (range, 0-30 mm) at 6 months (p<0.001). Points on the CM scale rose from a baseline value of 54 points (range, 51-66 points) to 85 points (range, 70-100 points) at 6 months (p=0.001). Functionality in daily living and work activities, movement, and strength exhibited significant changes at 6 months (p<0.05). CONCLUSION: Significant changes were observed in pain and functionality in this group of participants who used a telerehabilitation platform. To the best of our knowledge, this is the first study that included a specific program for RC tears.

Knee muscle strength correlates with joint cartilage T2 relaxation time in young participants with risk factors for osteoarthritis.

The objective of this study is to correlate T2 relaxation time (T2RT), measured by magnetic resonance imaging (MRI) with quadriceps and hamstring strength in young participants with risk factors for knee osteoarthritis (OA). A descriptive cross-sectional study was conducted with participants between 20 and 40 years of age, without diagnosis of knee OA. Their T2 relaxation time was measured through MRI, and their muscle strength (MS) was measured with an isokinetic dynamometer. Seventy-one participants were recruited, with an average age of 28.3 ± 5.5 years; 39 (55 %) were females. Negative correlations were found between T2RT and quadriceps peak torque (QPT) in males in the femur r = -0.46 (p = 0.01), tibia r = -0.49 (p = 0.02), and patella r = -0.44 (p = 0.01). In women, correlations were found among the femur r = -0.43 (p = 0.01), tibia r = -0.61 (p = 0.01), and patella r = -0.32 (p = 0.05) and among hamstring peak torque (HPT), in the femur r = -0.46 (p = 0.01), hamstring total work (HTW) r = -0.42 (p = 0.03), and tibia r = -0.33 (p = 0.04). Linear regression models showed good capacity to predict T2RT through QPT in both genders. The present study shows that early changes in femoral, tibial, and patellar cartilage are significantly correlated with MS, mainly QPT, and that these early changes might be explained by MS, which could play an important role in pre-clinical phases of the disease.

Water-based Tai Chi: theoretical benefits in musculoskeletal diseases. Current evidence.

Tai Chi is a low-impact and moderate intensity exercise that has shown positive effects in patients with musculoskeletal disorders. Recently have been developed clinical studies on the benefits of Tai Chi techniques combined with hydrotherapy. Both types of treatment include physical training of balance, mobility, strength, coordination and sensory input that could complement each other. This report aims to present the current evidence about the benefits of the combination of water based Tai Chi in musculoskeletal diseases in order to establish whether the combined intervention is better than Tai Chi or hydrotherapy alone.

Percutaneous Vertebroplasty Versus Conservative Treatment and Rehabilitation in Women with Vertebral Fractures due to Osteoporosis: A Prospective Comparative Study.

BACKGROUND: Percutaneous vertebroplasty is commonly used in the management of osteoporosis-related vertebral fractures, although there is controversy on its superiority over conservative treatment. Here we compare pain and function in women with vertebral osteoporotic fractures who underwent percutaneous vertebroplasty versus conservative treatment with a protocolized rehabilitation program. METHODS: A longitudinal and comparative prospective study was conducted. Women ≥ 60 years of age with a diagnosis of osteoporosis who had at least one vertebral thoracic or lumbar compression fracture were included and divided into two groups, conservative treatment or vertebroplasty. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were used to assess pain and function, respectively, as the outcome measures. RESULTS: We included 31 patients, 13 (42%) treated with percutaneous vertebroplasty and 18 (58%) with conservative treatment. Baseline clinical characteristics, bone densitometry and fracture data were similar in both groups. At baseline, VAS was 73.1 ± 28.36 in the vertebroplasty group and 68.6 ± 36.1 mm in the conservative treatment group (p = 0.632); at three months it was 33.11 ± 10.1 vs. 42 ± 22.21 mm (p = 0.111); and at 12 months, 32.3 ± 11.21 vs. 36.1 ± 12.36 mm (p = 0.821). The ODI at baseline was 83% in the vertebroplasty group vs. 85% for conservative management (p = 0.34); at three months, 36 vs. 39% (p = 0.36); and at 12 months, 29.38 vs. 28.33% (p = 0.66). CONCLUSIONS: Treatment with percutaneous vertebroplasty had no advantages over conservative treatment for pain and function in this group of women ≥ 60 years of age with osteoporosis.

Association of strength, muscle balance, and atrophy with pain and function in patients with degenerative spondylolisthesis.

PURPOSE: To analyze the relationship of strength, muscular balance, and atrophy with pain and function in patients with degenerative spondylolisthesis. STUDY DESIGN: Transversal, descriptive, and observational. PATIENTS AND METHODS: Institutional review board approval was obtained for this study. Twenty six patients ages 50 years and older, with degenerative spondylolisthesis at L4-L5. Measurements included Pain Visual Analogue Scale scores (VAS), Oswestry Disability Index scores (ODI), and isokinetic trunk testing; assessment of multifidus atrophy and spinal stenosis was performed by Magnetic Resonance Imaging (MRI). STATISTICS: Statistical analysis was performed using SPSS version 17.0 software for Windows. Pearson's correlation was used to ascertain the correlation between variables. ANOVA with analysis of covariance was used to determine the correlation between the remainder variables. Significance was set at p < 0.05. RESULTS: Of the 26 patients studied, with an average age of 60.23 ± 7.6 years, 20 had grade I spondylolisthesis and 6 were grade II. Correlation between the ODI scores and spondylolisthesis grading was significant (r=0.576, p=0.005); correlation between agonist/antagonist ratio in the isokinetic test (predominant extensor muscles over flexors) with the ODI scores was also significant (r=0.446, p=0.02), regardless of spinal stenosis. No correlation was found between functionality and pain with strength or multifidus atrophy. CONCLUSION: Muscle trunk imbalance with predominance of extensor over flexor muscles is associated with functional disability. Rehabilitation programs should be designed to improve muscle balance rather than muscle strength alone.

Effects of a stabilization exercise program in functionality and pain in patients with degenerative spondylolisthesis.

OBJECTIVE: To determine the effects of stabilization exercises on pain and function in patients with degenerative spondylolisthesis. STUDY DESIGN: Nonrandomized clinical trial, with 6 months of follow up. METHODS: Twenty patients over 50 years of age with degenerative spondylolisthesis underwent a 6-month, home-based training program of stabilization exercises. We applied functional and pain scales (Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), and conducted an isokinetic trunk test. Statistical analysis included a T test for quantitative variables, a chi-squared test for qualitative data, and Pearson correlations. The significance alfa level was 0.05. RESULTS: Both pain and Oswestry Index scores were significantly decreased. Initial and final VAS "back pain" results were 63.50 ± 18.05 mm and 43.4 ± 22.09 (p=0.007) respectively. Initial and final VAS "sciatic pain" results were 53.65 ± 29.03 mm and 36.65 ± 27.21 (p=0.035) respectively. Oswestry Index at the beginning of the study was 30.35 ± 15.6%, decreasing to a final 20.15 ± 13.6% (p=0.007). The results of VAS and ODI scores correlated significantly with improvement in the isokinetic test. CONCLUSION: Lumbar stabilization exercises could be an effective treatment option in controlling pain and improving function in patients with degenerative spondylolisthesis. Further investigation with randomized controlled trials is necessary to obtain confirmation of these results.

Effectiveness of calcitonin in intermittent claudication treatment of patients with lumbar spinal stenosis: a systematic review.

STUDY DESIGN: Systematic review. OBJECTIVE: Analyze the level of evidence in the effectiveness of calcitonin on the treatment of neurogenic claudication in patients with lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: One of the most disabling features of lumbar spinal stenosis is neurogenic claudication. There have been proposed different drug therapies for it. The recommendation for calcitonin use in these patients has been sustained on autocontrolled clinical trial (Streifler et al, Neurol Neurosurg Psychiatry 1989;52:543-4), which only included 6 patients. MATERIAL AND METHOD: We performed a search on electronic databases that included Medline and Embase; we recovered 10 original articles, of which only 4 fulfilled the RCT criteria. These articles were reviewed independent and blinded way by 6 previously capacitated reviewers to extract data and score a quality of them by the criteria of Cochrane Handbook (1996) with maximum score of 1.00 and minimum score of 0.33. RESULTS: Score quality vary in the 4 articles: Porter and Millar, Spine 1988;13:1061-4 (score, 0.68), Eskola et al, Calcif Tissue Int 1992;50:400-3 (score, 0.88), Podichetty et al, Spine 2004;29:2343-9 (score, 0.88), and Tafazal et al, Eur Spine J 2007;16:207-12 (score, 0.92). Due to the great heterogenicity observed (sample sizes, selection criteria, doses, frequency, and duration of calcitonin, and outcome measurements), we were unable to perform a meta-analysis. Only one of these studies (Porter and Millar, Spine 1988;13:1061-4; score, 0.68) found favorable results for the use of calcitonin compared with placebo; of the 3 remaining trials none found significative evidence between drug therapy and placebo. CONCLUSION: The present data suggest that calcitonin administration in the treatment for neurogenic claudication has no benefit in patients with lumbar spinal stenosis.

[Neurological effects by occlusion of the carotid artery and induced hypoxia in newborn rats]. / Efectos neurológicos de la ligadura de la carótida común izquierda e hipoxia inducida en ratas neonatas.

BACKGROUND: Hypoxic-ischemic encephalopathy is a cause of disability in the infant population. One of the most used animal models in the hypoxic-ischemic encephalopathy in immature brain is the preparation of Levine applied by Rice in newborn rats and consists of the bond of the left common carotid artery followed by induced hypoxia. The objective of this investigation was to study the neurological effects of the bond of the left common carotid and induced hypoxia in newborn rats. METHODS: Five control rats, five sham rats and five rats with hypoxic-ischemic lesion by means of the application of Levine's preparation at 7 days of age were used. On day 42, all rats were evaluated by time of grasping, posterior reflex test and analysis of the spontaneous locomotor activity (number of bipedal movements, number of stepped stalls, grooming time). RESULTS: The lesioned group presented less grasping time, lower number of positive responses to the posterior reflex and lower number of stepped stalls (p = 0.024, 0.002 and 0.0001, respectively). There were no statistically significant differences in grooming time or number of bipedal movements. CONCLUSIONS: Newborn rats in whom Levine preparation was applied presented clinical alterations that may resemble some of the signs that accompany infantile cerebral palsy (grasp problems, wrong response to postural reflexes and alteration in locomotion).

Efectos neurológicos de la ligadura de la carótida común izquierda e hipoxia inducida en ratas neonatas / Neurological effects by occlusion of the carotid artery and induced hypoxia in newborn rats

BACKGROUND: Hypoxic-ischemic encephalopathy is a cause of disability in the infant population. One of the most used animal models in the hypoxic-ischemic encephalopathy in immature brain is the preparation of Levine applied by Rice in newborn rats and consists of the bond of the left common carotid artery followed by induced hypoxia. The objective of this investigation was to study the neurological effects of the bond of the left common carotid and induced hypoxia in newborn rats. METHODS: Five control rats, five sham rats and five rats with hypoxic-ischemic lesion by means of the application of Levine's preparation at 7 days of age were used. On day 42, all rats were evaluated by time of grasping, posterior reflex test and analysis of the spontaneous locomotor activity (number of bipedal movements, number of stepped stalls, grooming time). RESULTS: The lesioned group presented less grasping time, lower number of positive responses to the posterior reflex and lower number of stepped stalls (p = 0.024, 0.002 and 0.0001, respectively). There were no statistically significant differences in grooming time or number of bipedal movements. CONCLUSIONS: Newborn rats in whom Levine preparation was applied presented clinical alterations that may resemble some of the signs that accompany infantile cerebral palsy (grasp problems, wrong response to postural reflexes and alteration in locomotion).