Intervencionismo guiado por ultrasonido para extremidad superior en dolor postoperatorio / Ultrasound-guided intervention for upper limb in postoperative pain

Resumen: El uso de la ecografía es una técnica de creciente interés en la anestesia regional, ya que ha permitido la visualización directa de los nervios, la aguja, las estructuras adyacentes y, principalmente, el control de la distribución del anestésico local en tiempo real. La anestesia regional guiada por ultrasonido es totalmente dependiente del operador, se requiere de conocimiento anatómico, manejo de la técnica, prevención de las complicaciones del abordaje y la solución de ellas en caso de que aparezcan. En esta revisión nos enfocaremos a la revisión de bloqueos de plexo braquial comúnmente utilizados para la anestesia y la analgesia peroperatoria, con un recuento de abordajes clásicos y abordajes de reciente publicación, los beneficios de su utilización, las complicaciones, la reducción significativa del volumen, la latencia y la practicidad en la técnica. Incluye imágenes descriptivas, cuadros comparativos con dosis, duración de analgesia postoperatoria (para ver el artículo completo y videos visite http://www.painoutmexico.com).

Abstract: The use of ultrasound is a technique of growing interest in regional anesthesia, since it has allowed the direct visualization of the nerves, the needle, the adjacent structures and mainly the control of the local anesthetic distribution in real time. The regional anesthesia guided by ultrasound is totally dependent on the operator, it requires anatomical knowledge, management of the technique, prevention of the complications of the approach and the solution of them in case they appear. In this review we will focus on the revision of brachial plexus blocks commonly used for anesthesia and perioperative analgesia, with a count of classic approaches and recently published approaches, the benefits of its use, complications, significant volume reduction, latency and practicality in the technique. It includes descriptive images, comparative Tables with doses, duration of postoperative analgesia (full version and videos visit http://www.painoutmexico.com).

Abordajes guiados por ultrasonido para miembro inferior en dolor agudo / Ultrasound-guided approaches for the lower limb in acute pain

Resumen: En la última década, el avance de los abordajes guiados por ultrasonido en analgesia y anestesia regional de miembro inferior ha sido vertiginoso. En años recientes se han multiplicado de forma considerable los estudios anatómicos que dan base al desarrollo de estas técnicas, y que permiten ofrecer al clínico abordajes para anestesia regional exclusiva y bloqueos analgésicos sensitivos de la región para permitir una movilidad temprana, importante en los nuevos protocolos de manejo perioperatorio y para evitar complicaciones relacionadas a la inmovilidad. Sin duda, el estudio sistemático de cada abordaje y los fundamentos anatómicos y farmacológicos nos permiten brindar de forma segura y eficiente una herramienta terapéutica en cada escenario clínico, en esta revisión hacemos un breve repaso sobre las técnicas más utilizadas actualmente y los nuevos abordajes propuestos en analgesia y anestesia regional de miembro inferior (para ver el artículo completo y videos visite http://www.painoutmexico.com).

Abstract: In the last decade, the advances in ultrasound-guided approaches for regional analgesia and anesthesia of the lower limb have been vertiginous. In recent years, the anatomical studies that give rise to the development of these techniques have multiplied considerably and allow the clinician to offer approaches for exclusive regional anesthesia and sensitive analgesic blocks in the region to allow early mobility, important in the new peri-operative management protocols and to avoid complications related to immobility. Undoubtedly, the systematic study of each approach and the anatomical and pharmacological foundations allow us to safely and efficiently provide a therapeutic tool in each clinical scenario. In this review, we briefly look over the most commonly used techniques and the new approaches proposed in regional analgesia and anesthesia of the lower limb (full version and videos visit http://www.painoutmexico.com).

Depressed mood and speech in Chilean mothers of 5½-year-old children.

Previous research on maternal speech and depression has focused almost exclusively on how depressed mothers talk to their infants and toddlers in the U.S. and U.K., two English-speaking countries. This study considered how depressed Spanish-speaking mothers from a Latin American country talk about their preschool-age children. Five-minute speech samples were provided by 178 Chilean mothers who were asked to talk about their 5½-year-old children to a project psychologist. Maternal depressive symptomatology was measured by the Spanish-language version of the Center for Epidemiologic Studies Depression Scale (CES-D). In multivariate analysis of covariance (MANCOVA), higher maternal depressed mood showed statistically significant associations with the following maternal speech characteristics: more criticisms, less laughter, fewer medium pauses, less positive satisfaction with the child's behavior or characteristics, a rating of a negative overall relationship with the child, and more crying (suggestive trend). A structural equation model confirmed these findings and found an indirect effect between laughter and criticisms: mothers with higher depressed mood who laughed less criticized their children less. The findings illustrate that depressed mood adversely affects how a group of Chilean mothers speak about their children.

[New therapeutic alternatives in migraine prophylaxis using histamine H3 receptor agonists]. / Nueva alternativa terapéutica en profilaxis de migraña con histamina como agonista de receptores H3.

BACKGROUND: Subcutaneous histamine at low concentrations interacts with H3-receptors and may constitute a new therapeutic drug in migraine prophylaxis. It acts by limiting the excessive inflammatory response involved in migraine pathophysiology. OBJECTIVE: Describe the results of a 15-year trial administering histamine at low concentrations. METHODS: Different study designs were used with subcutaneous histamine (10 microg/ml in Evan's solution) twice weekly, with an initial administration of microg (0.1 ml) and gradually increasing the dose to 10 microg (1.0 ml) over a 12-week period together with placebo, sodium valproate and topiramate. A Friedman-type rank ANOVA test was used to assess the difference between basal values and different design outcomes. RESULTS: Data recorded during the 12-week period showed a significant reduction in variables from both treatment groups (histamine) compared with basaline stage results (p < 0.001). The histamine group reported a reduction of headache frequency (50%), decrease in pain intensity (51%), length of migraine attacks (45%) and painkiller use (52%). CONCLUSIONS: The present study provides evidence on the safety and efficiency of subcutaneous histamine administered at a dose of 1-10 microg twice weekly. This treatment constitutes a new therapeutic alternative, and provides a clinical and pharmacological basis for the use of H3 histaminergic agonists in migraine prophylaxis.

Nueva alternativa terapéutica en profilaxis de migraña con histamina como agonista de receptores H3 / New therapeutic alternatives in migraine prophylaxis using histamine H3 receptor agonists

Antecedentes: La histamina subcutánea a bajas concentraciones puede ser una alternativa terapéutica en la profilaxis de la migraña al interactuar con receptores H3 y limitar la excesiva respuesta inflamatoria. Objetivo: Presentar los resultados de la administración de histamina bajas dosis en la profilaxis de la migraña, colectados durante 15 años. Métodos: Se aplicaron diferentes diseños de administración de histamina subcutánea (10 μg/ml en solución de Evans) dos veces a la semana, con una administración inicial de 1μg (0.1 ml) e incremento gradual hasta 10 μg (1.0 ml) durante 12 semanas. Se realizaron estudios comparativos con placebo, valproato sódico y topiramato. Se utilizó la prueba de Anova de rangos de Friedman para evaluar las diferencias entre los resultados. Resultados: Los datos registrados durante las 12 semanas de tratamiento revelaron que en el grupo con histamina las variables estudiadas tuvieron una disminución significativa comparada con el control (p<0.001), con una reducción de la frecuencia de cefalea (50%), intensidad del dolor (51%), duración de ataques de migraña (45%), así como en el consumo de analgésicos (52%). Conclusiones: El estudio aporta evidencia sobre la seguridad y eficacia de la histamina aplicada por vía subcutánea a dosis de 1 a 10 μg dos veces a la semana. Representa una nueva alternativa terapéutica y proporciona las bases clínicas y farmacológicas para el uso de agonista H3 histaminérgicos en la profilaxis de la migraña.

BACKGROUND: Subcutaneous histamine at low concentrations interacts with H3-receptors and may constitute a new therapeutic drug in migraine prophylaxis. It acts by limiting the excessive inflammatory response involved in migraine pathophysiology. OBJECTIVE: Describe the results of a 15-year trial administering histamine at low concentrations. METHODS: Different study designs were used with subcutaneous histamine (10 microg/ml in Evan's solution) twice weekly, with an initial administration of microg (0.1 ml) and gradually increasing the dose to 10 microg (1.0 ml) over a 12-week period together with placebo, sodium valproate and topiramate. A Friedman-type rank ANOVA test was used to assess the difference between basal values and different design outcomes. RESULTS: Data recorded during the 12-week period showed a significant reduction in variables from both treatment groups (histamine) compared with basaline stage results (p < 0.001). The histamine group reported a reduction of headache frequency (50%), decrease in pain intensity (51%), length of migraine attacks (45%) and painkiller use (52%). CONCLUSIONS: The present study provides evidence on the safety and efficiency of subcutaneous histamine administered at a dose of 1-10 microg twice weekly. This treatment constitutes a new therapeutic alternative, and provides a clinical and pharmacological basis for the use of H3 histaminergic agonists in migraine prophylaxis.

[Physical abuse of women]. / Maltrato físico en mujeres.

OBJECTIVE: Our aim was determine prevalence of intrafamily violence of the type physical-abuse, toward female claimants aged 18 years and older at the HGZ MF No. 1 in Colima. MATERIAL AND METHOD: A transversal study was conducted in 288 females aged 18 years and older who were seen at the Family Medicine Unit for external consultation. RESULTS: Average age was 33.86 years (+/- 11.6), the highest level of schooling was primary for 33% of subjects and secondary for 26%, 75% of our female claimants were divorced, 53.5% of monthly family incomes in each household was between 1,000 and 3,000 thousand Mexican pesos, and 27.8% of physical abuse consisted of shoving. CONCLUSIONS: Our research revealed that there is indeed physical violence toward 63.45% of female claimants at our hospital, especially toward those with low level of schooling, low socioeconomic status, and monthly income below minimum wage. These conditions only contribute toward making women fall prey to physical violence. Our study is only a first step for better understanding of domestic violence. Risk factors associated with physical abuse need to be controlled to decrease rate of interfamily violence against our claimants.

Maltrato físico en mujeres / Physical Abuse of Women

Objetivo: determinar la prevalencia de la violencia intrafamiliar en mujeres derechohabientes mayores de 18 años del HGZMF No. 1 Colima. Material y métodos: se realizó un estudio transversal en 288 mujeres mayores de 18 años que acudieron a la consulta externa de Medicina Familiar. Resultados: se estudiaron 288 mujeres, la edad media fue de 33 años (± 11.6), la escolaridad que predominó fue primaria en 33%; secundaria en 26%. El estado civil más frecuente fue separación en 75%. El ingreso mensual en 53% de las mujeres fue de mil a 3 mil pesos. En 27.8% de ellas, el maltrato físico más frecuente consistió en ser aventadas. Conclusiones: nuestro estudio identificó que la violencia física es frecuente en nuestro hospital y se presenta en 63.54% de las mujeres derechohabientes; con escolaridad y nivel socio-económico bajos, y con un salario mensual menor del mínimo; condiciones todas ellas que favorecen que la mujer sea presa fácil del maltrato físico. Este trabajo es un paso inicial dentro del estudio de violencia familiar, necesitamos modificar estos factores de riesgo para lograr reducir la violencia familiar de nuestros derechohabiente.

Objective: Our aim was determine prevalence of intrafamily violence of the type physical-abuse, toward female claimants aged 18 years and older at the HGZ MF No. 1 in Colima. Material and Method: A transversal study was conducted in 288 females aged 18 years and older who were seen at the Family Medicine Unit for external consultation. Results: Average age was 33.86 years (+/- 11.6), the highest level of schooling was primary for 33% of subjects and secondary for 26%, 75% of our female claimants were divorced, 53.5% of monthly family in comes in each household was between $1,000 and $3,000 thousand Mexican pesos, and 27.8% of physical abuse consisted of shoving. Conclusions: Our research revealed that there is indeed physical violence toward 63.45% of female claimants at our hospital, especially toward those with low level of schooling, low socioeconomic status, and monthly income below minimum wage. These conditions only contribute toward making women fall prey to physical violence. Our study is only a first step for better understanding of domestic violence. Risk factors associated with physical abuse need to be controlled to decrease rate of interfamily violence against our claimants.