Percutaneous tracheostomy in COVID patients. Experience in our hospital center after one year of pandemic and review of the literature.

BACKGROUND: The pandemic caused by SARS-COV-2 has caused an increase in the need of tracheostomies in patients affected with respiratory distress syndrome. In this article we report our experience during a year of pandemic, we develop our surgical technique to perform percutaneous tracheostomy with the patient in apnea and we compare our results with those of other centers through a bibliographic review. MATERIAL AND METHODS: A one-year retrospective clinical study was carried out on tracheotomies performed on patients admitted to the intensive care unit with severe SARS-CoV-2, with difficulty for ventilation or weaning. The technique performed was percutaneous, with fibroscopic control through the endotracheal tube, keeping the patient under apnea during the opening of the airway, reducing by this method the risk of exposure to the virus. RESULTS: From 35 percutaneous tracheotomies performed, 31% of the patients died from respiratory complications due to SARS-COV-2, but none due to the surgical procedure. The most frequent complication (8.5% of patients) was bleeding around the tracheostoma, resolved with local measures. No healthcare provider involved in the performance of the technique had symptoms or was diagnosed with COVID-19. CONCLUSIONS: Our technique of performing percutaneous tracheostomy maintaining apnea during the procedure, under fibroscopic control, has proven to be safe for all those involved in the procedure, and for the patient.

Manejo de pacientes en cirugía oral y maxilofacial durante el periodo de crisis y de control posterior de la pandemia de COVID-19 / Management of patients in oral and maxillofacial surgery during the stage of crisis and subsequent control of COVID-19 pandemic

La pandemia por la nueva infección respiratoria conocida como enfermedad coronavirus 2019 (COVID-19), causada por el virus SARS-CoV-2, ha desencadenado una perturbación sin precedentes en la actividad habitual de los servicios de cirugía oral y maxilofacial en España, retrasando la atención rutinaria de pacientes e intervenciones quirúrgicas programadas. Los cirujanos orales y maxilofaciales son uno de los colectivos sanitarios con mayor riesgo de infección nosocomial por el estrecho contacto que se produce con los pacientes asintomáticos y sintomáticos con infección por SARS-CoV-2 a través de la cavidad oral y orofaringe. El propósito del presente documento ha sido actualizar la evidencia disponible para el manejo y tratamiento seguro y efectivo en consulta, cirugías ambulatorias, programadas y urgentes y hospitalización, minimizando al mismo tiempo, tanto como sea posible, el riesgo de contagio para el cirujano oral y maxilofacial, personal sanitario y pacientes. Este documento pretende esclarecer los aspectos más significativos y crear un protocolo común de manejo de pacientes con COVID-19 en cirugía oral y maxilofacial durante la fase aguda de propagación y de control posterior de la pandemia en nuestro país

The pandemic due to the new respiratory infection known as coronavirus 2019 disease (COVID-19), caused by the SARS-CoV-2 virus, has triggered an unprecedented disruption in the normal activity of oral and maxillofacial surgery departments in Spain, delaying routine patient care and elective surgical interventions. Oral and maxillofacial surgeons are one of the healthcare groups with the highest risk of nosocomial infection because of the close contact that occurs with asymptomatic and symptomatic patients with SARS-CoV-2 infection through the oral cavity and oropharynx. The purpose of this document has been to update the available evidence for the safe and effective management and treatment in outpatient clinic, ambulatory, elective and emergency surgeries, and hospitalization, while minimizing as much as possible the risk of infection for the oral and maxillofacial surgeon, health workers and patients. This document aims to clarify the most significant aspects and create a common protocol for the management of patients with COVID-19 in oral and maxillofacial surgery during the acute stage of spread and subsequent control of the pandemic in our country

Dolor de espalda en estudiantes de entre 12 y 17 años: aproximación multifactorial basada en árboles de decisión / Back pain in students of 12-17 years old: Multifactorial approach based in decision trees

Objetivo: El objetivo de este estudio se centrará en la elaboración de un árbol de decisión como una técnica de análisis de datos que permita establecer combinaciones de factores de riesgo que puedan predisponer a padecer dolor de espalda en esta población. Material y métodos: La muestra del estudio estuvo formada por 337 jóvenes con una edad de entre 12 y 17 años de un centro escolar de Castellón. Los sujetos cumplimentaron el Adolescent Sedentary Activity Questionnaire y el cuestionario Nórdico de Kuorinka. Además, se realizó una valoración del índice de masa corporal, del porcentaje de grasa corporal, de las características de la mochila escolar y del tiempo de transporte de esta y de la actividad física habitual (esta última mediante acelerometría). Estos factores se utilizaron como variables de entrada en un árbol de decisión, con el objetivo de clasificar a los adolescentes en función de si habían tenido o no algún episodio de dolor de espalda. Resultados: El árbol mostró una exactitud del 78,39% en la clasificación de los estudiantes. La sensibilidad de la clasificación fue del 90,77% mientras que la especificidad fue del 63,21%. Conclusiones: El árbol de decisión es una técnica de análisis que ha permitido encontrar combinaciones de factores de riesgo que están relacionados con la aparición de dolor de espalda en adolescentes. Los resultados hallados indican que la práctica de actividad física, el índice de masa corporal, el porcentaje de grasa, el tiempo de transporte de la mochila a la escuela, los minutos de actividades sedentarias realizados a la semana y los antecedentes familiares de dolor de espalda son factores relacionados con el dolor de espalda en la adolescencia

Objective: The aim of this study was to use a decision tree as a data analysis technique in order to establish combinations of risk factors that may predispose schoolchildren to suffer back pain. Material and methods: The study sample consisted of 337 young people between 12 and 17 years of age from a high school in Castellon, Spain. The subjects completed the Adolescent Sedentary Activity Questionnaire and the Kuorinka Nordic questionnaire. The study also included an assessment of the body mass index, body fat percentage, the characteristics of the school backpack, the time of transportation of the backpack, and habitual physical activity (latter by means of accelerometers). These factors were used as input variables in a decision tree, with the objective of classifying adolescents according to whether they had or had not a back pain episode. Results: The tree showed an accuracy of 78.39% in student classification. The sensitivity of the classification was 90.77%, while the specificity was 63.21%. Conclusions: The decision tree is a useful analysis technique that has allowed finding combinations of risk factors associated with low back pain in adolescents. The findings suggest that practicing physical activity, the body mass index, body fat percentage, time of transportation of the backpack, minutes of sedentary activities, and family history of back pain are factors related to back pain in adolescents

Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis.

BACKGROUND: Temporal artery biopsy (TAB) is a surgical procedure with a low positive yield. The purpose of this study is to determine which variables are the most important in the giant cell arteritis (GCA) diagnosis. The objective of this evaluation is to improve the percentage of positive temporal artery biopsy and if possible, avoid the biopsy in some cases. MATERIAL AND METHODS: A retrospective clinical study consisted of 90 patients who had undergone TAB at the Río Hortega Hospital (Spain) from January 2009 to December 2016. Clinical findings, erythrocyte sedimentation rates (ESR) and other laboratory parameters, American College of Rheumatology (ACR) criteria for GCA score and biopsy results were recorded. RESULTS: Nineteen (21.1%) biopsies were positive for GCA. The mean age in positive TAB was 78.6 years old (SD 7.93), and 73.7% were female. Presence of temporal headache (p = 0.003), jaw claudication (p = 0.001), abnormal artery exploration (p = 0.023), elevated erythrocyte sedimentation rate (p = 0.035), CRP (p = 0.018) and platelets (p = 0.042), were significantly associated with GCA. Multivariate logistic regression revealed that the best predictors for the diagnosis of GCA are headache and jaw claudication, adjusted by sex, age, and temporal exploration. CONCLUSIONS: TAB has benefit only for patients who score a 2 or 3 on the ACR criteria for GCA without biopsy. These findings highlight the need for a better diagnostic strategy for patients with suspected temporal arteritis.

Comorbidity and physical activity in people with paraplegia: a descriptive cross-sectional study.

STUDY DESIGN: Descriptive cross-sectional study. SETTING: The study was conducted in the Spinal Cord Injury Unit of the University Vall d'Hebron Hospital and in the Physical Education and Sports Department of the University of Valencia. OBJECTIVES: The aim of this study was to quantify the presence of comorbidities in spinal cord injury (SCI) subjects who did or did not perform regular physical activity (PA) and to identify the relationship between PA and the level of comorbidity. METHODS: The sample consisted of patients with complete motor SCI (T2-T12), who were fitted with an accelerometer attached to the non-dominant wrist for a period of 1 week. The clinical and blood analytic variables were selected by an expert panel. RESULTS: In the exploratory analysis, we have found differences in the total number of pathologies between active and inactive patients, with fewer total pathologies in the active patient group. An association was found between the PA level and diabetes mellitus (; P=0.047; φ=0.25). We also observed an association between the cardioprotector level of high-density lipoprotein (HDL)-cholesterol and PA level (; P=0.057; Φ0.24). CONCLUSIONS: Our results suggest that patients considered active showed lower total comorbidity than inactive patients and higher protection levels against developing cardiovascular comorbidity.

Comparison of conventional hamstring/quadriceps ratio between genders in level-matched soccer players / Comparación del ratio de fuerza convencional isquiotibial/cuádriceps entre jugadores de fútbol de niveles similares de ambos sexos / Comparação da relação de força convencional entre isquiotibiais/quadríceps entre jogadores de futebol com níveis semelhantes, de ambos os sexos

Objectives. The main goal of our study is to compare the hamstring/quadriceps (H/Q) ratio at different knee angles between level-matched male and female soccer players and to determine whether differences in the H/Q ratio exist between the dominant and the non-dominant leg. Methods. A cross-sectional study design was used to compare an isometric H/Q ratio and functional isokinetic ratio (between hamstring in eccentric contraction and quadriceps in concentric contraction) between males (n=14) and females (n=14). These ratios were studied at two different speeds of movement (60°s−1 and 180°s−1) and in five different positions (40°, 50°, 60°, 70° and 80° degrees of knee flexion). Results. Our results showed no differences in the H/Q ratio between genders. The ratio in the dominant leg showed an average of 9% higher values. The ratios were an average of 53.4% lower in positions near flexion than in positions near extension. Conclusions. For both men and women, the results showed lower ratios in the non-dominant leg compared to the dominant leg. At higher velocities, the force ratios were higher, while in more knee-flexed positions, the ratios were lower. Finally, we did not find differences in ratios between men and women (AU)

Objetivos. El objetivo principal del estudio es comparar el ratio de fuerza isquiotibial/cuádriceps (ratio H/Q) en diferentes ángulos de rodilla entre jugadores de fútbol de niveles similares y determinar si existen diferencias en dicho ratio entre la pierna dominante y la no dominante. Métodos. Se utilizó un diseño transversal para comparar el ratio isométrico H/Q y el ratio funcional isocinético (ratio entre la fuerza durante una contracción excéntrica de isquiotibial y la fuerza durante una contracción concéntrica de cuádriceps) entre hombres (n=14) y mujeres (n=14). Estos ratios se estudiaron en dos velocidades (60° s−1 y 180° s−1) y en 5 posiciones diferentes (40, 50, 60, 70 y 80 grados de flexión de rodilla). Resultados. Nuestros resultados no mostraron diferencias significativas en el ratio H/Q entre sexos. El ratio en la pierna dominante mostró valores un 9% más altos que en la pierna no dominante. Los ratios fueron de media un 53.4% más bajos en posiciones cercanas a la flexión que en posiciones cercanas a la extensión. Conclusiones. Para ambos sexos los resultados mostraron ratios más bajos en la pierna no dominante comparado con la pierna dominante. A velocidades superiores, los ratios de fuerza fueron mayores, mientras que en posiciones de mayor flexión de rodilla los ratios fueron menores. Por último, no se encontraron diferencias significativas en los ratios entre hombres y mujeres (AU)

Objetivos. O principal objetivo do nosso estudo é comparar a relação de força entre Isquiotibiais/Quadríceps (H/Q) em diferentes ângulos do joelho entre jogadores de futebol (masculino e feminino) de níveis semelhantes para determinar se existem diferenças na relação entre H/Q entre o membro dominante e a não-dominante. Método. U estudo de delineamento transversal foi utilizado para comparar a relação isométrica entre H/Q e isocinética funcional (razão entre a força dos isquiotibiais em contração excêntrica e do quadríceps em contração concêntrica, durante a extensão do joelho) entre homens (n=14) e mulheres (n=14). Estas razões foram estudadas em duas velocidades diferentes de movimento (60°/s e 180°/s) e em cinco posições diferentes (por exemplo 40, 50, 60, 70, e 80 graus de flexão do joelho). Resultados. Os resultados não mostraram diferenças significativas na relação H/Q entre os sexos. A relação da perna dominante mostrou valores médios de 9% mais elevados em relação a perna não dominante. As proporções foram, em média, 53,4% menor em posições próximas a flexão do que em posições perto da extensão. Conclusões. Para ambos os sexos, os resultados mostram razões mais baixas no membro não dominante em comparação com a dominante. À velocidade mais elevadas, as relações de força foram superiores, enquanto que em maiores flexões de joelho as relações foram menores. Finalmente, não foram encontradas diferenças significativas nas proporções entre homens e mulheres (AU)

Osteoma frontoetmoidal con extensión intraorbitaria. A propósito de un caso / Frontoethmoidal osteoma with orbital extension. A case report

CASO CLÍNICO: Presentamos el caso de un osteoma frontoetmoidal derecho con invasión intraorbitaria en un varón de 43 años que comenzó como un cuadro de dolor retroocular con proptosis, inflamación peripalpebral y diplopía binocular por limitación del recorrido muscular. Se realizó cirugía abierta mediante abordaje subcraneal anterior, con extirpación de varios fragmentos de osteoma, cuyo análisis histológico confirmó el diagnóstico. DISCUSIÓN: Los osteomas son tumores benignos formadores de hueso de crecimiento lento. Habitualmente son asintomáticos, hasta que producen complicaciones por efecto masa en el cerebro o en la órbita, o a nivel local, hasta que obstruyen el drenaje del seno donde asientan, generando mucoceles

CASE REPORT: A case is presented of a right frontoethmoidal osteoma with intraorbital invasion in a 43-year-old male, who was seen in the clinic with a proptosis, retro-orbital pain, peri-palpebral inflammation, and binocular diplopia due to muscular route limitation. Open surgery was performed using a subcranial approach, with removal of several fragments of osteoma. Histological analysis confirmed the diagnosis. DISCUSSION: Osteomas are benign bone-forming tumours with slow growth. They are usually asymptomatic until mass effect complications occur in the brain or in the orbit, or locally, generating mucoceles due to sinus drainage obstruction

Prevalencia y características clínico-patológicas del tumor de células gigantes / Prevalence and Clinicopathological Characteristics of Giant Cell Tumors

Resumen: La frecuencia del tumor de células gigantes reportada en la literatura es muy variable. Tomando en cuenta que nuestra población presenta características propias, diferentes a las poblaciones anglosajona y asiática, consideramos que tanto la frecuencia como las cualidades clínicas del tumor de células gigantes en nuestro país son distintas. El objetivo principal de este trabajo fue determinar la frecuencia y las características clínico-patológicas del tumor de células gigantes de hueso. Se realizó un estudio transversal y descriptivo de los casos diagnosticados en el servicio como tumor de células gigantes de hueso durante el período comprendido de Enero a Diciembre de 2013. En cada caso seleccionado, se revisó el expediente clínico electrónico, el expediente radiológico, así como también las laminillas. Los tumores de células gigantes comprendieron 17% de los tumores óseos en general y 28% de los tumores óseos benignos. Hubo 13 mujeres y 18 hombres. Los lugares de presentación más frecuentes del tumor de células gigantes fueron: tibia proximal, nueve casos (29%) y fémur distal, seis casos (19%). Cuarenta y cinco por ciento de los tumores de células gigantes se encontraron asociados con quiste óseo aneurismático (14 casos) y un caso (3%) fue maligno. En esta serie, el tumor de células gigantes presentó una frecuencia intermedia; es decir, una frecuencia mayor a la reportada en países anglosajones (con frecuencia baja), aunque sin llegar a ser igual a la de los países asiáticos (frecuencia alta).

Abstract: The frequency of giant cell tumors reported in the literature is very variable. Considering that our population has its own features, which distinguish it from the Anglo-Saxon and Asian populations, we think that both the frequency and the clinical characteristics of giant cell tumors in our population are different. The major aim of this paper was to determine the frequency and clinicopathological characteristics of giant cell tumors of the bone. A cross-sectional descriptive study was conducted of the cases diagnosed at our service as giant cell tumors of the bone from January to December 2013. The electronic clinical records, radiologic records and histologic slides from each case were reviewed. Giant cell tumors represented 17% of total bone tumors and 28% of benign tumors. Patients included 13 females and 18 males. The most frequent locations of giant cell tumors were: the proximal tibia, 9 cases (29%), and the distal femur, 6 cases (19%). Forty-five percent of giant cell tumors were associated with aneurysmal bone cyst (ABC) (14 cases) and one case (3%) was malignant. The frequency of giant cell tumors in this case series was intermediate, that is, higher than the one reported in Anglo-Saxon countries (usually low), but without reaching the frequency rates reported in Asian countries (high).

Neural network for estimating energy expenditure in paraplegics from heart rate.

The aim of the present study is to obtain models for estimating energy expenditure based on the heart rates of people with spinal cord injury without requiring individual calibration. A cohort of 20 persons with spinal cord injury performed a routine of 10 activities while their breath-by-breath oxygen consumption and heart rates were monitored. The minute-by-minute oxygen consumption collected from minute 4 to minute 7 was used as the dependent variable. A total of 7 features extracted from the heart rate signals were used as independent variables. 2 mathematical models were used to estimate the oxygen consumption using the heart rate: a multiple linear model and artificial neural networks. We determined that the artificial neural network model provided a better estimation (r=0.88, MSE=4.4 ml · kg(-1) · min(-1)) than the multiple linear model (r=0.78; MSE=7.63 ml · kg(-1) · min(-1)).The goodness of fit with the artificial neural network was similar to previous reported linear models involving individual calibration. In conclusion, we have validated the use of the heart rate to estimate oxygen consumption in paraplegic persons without individual calibration and, under this constraint, we have shown that the artificial neural network is the mathematical tool that provides the better estimation.

Tratamiento y reconstrucción en tumores óseos del húmero con prótesis no convencional tipo RIMAG / Treatment and reconstruction of bone tumors of the with a rimag unconventional prosthesis

Introducción: La cirugía conservadora y de reconstrucción con prótesis no convencional en tumores del húmero sin compromiso neurovascular está indicada ayudando a conservar las funciones del hombro, del codo y la mano. El húmero es el tercer sitio más frecuentemente afectado por los tumores benignos, agresivos, malignos y metastásicos provocando limitación funcional o pérdida de la extremidad. Material: Pacientes con tumor óseo en el húmero sin invasión neurovascular, que cumplan con los criterios de selección. Prótesis no convencional tipo RIMAG, no cementada, con ajuste diafisario y bloqueo con pernos. Métodos: Entre Junio de 1995 y Diciembre de 2011, fueron tratados 39 pacientes con tumores intraarticulares tipo I según las clasificaciones de Malawer y Enneking, con resección tumoral y reconstrucción con prótesis no convencional y partes blandas. Resultados: Se estudiaron 18 mujeres y 21 hombres entre 12-72 años, con tumores como: tumores de células gigantes (14), osteosarcomas (7), metástasis (7), condrosarcomas (6), sarcomas de Ewing (2), condroblastoma (2), y quiste óseo aneurismático (1). Doce pacientes murieron por enfermedad sistémica, el resto de la serie sobreviven. Los márgenes quirúrgicos fueron amplios con resección humeral entre los 100 a 230 mm. Los resultados funcionales fueron evaluados de acuerdo a la Sociedad de Tumores Musculoesqueléticos; 13 excelentes, 16 buenos, 5 fallas, 5 pobres. Discusión: El nivel de la resección no restringe la colocación de esta prótesis que permite realizar revisiones a futuro. El resultado satisfactorio depende del tamaño de la resección y musculatura del hombro conservada y no es limitado por el tamaño de la resección mejorando la discapacidad del paciente.

Introduction: Conservative surgery and reconstruction with an unconventional prosthesis are indicated for tumors of the humerus without neurovascular compromise, as they help preserve shoulder, elbow and hand function. The humerus is the third most frequent site of benign, aggressive, malignant and metastatic tumors that cause functional limitation or limb loss. Material: Patients with a bone tumor of the humerus without neurovascular involvement that met the inclusion criteria. Unconventional, uncemented RIMAG prosthesis with diaphyseal fit and locking bolts. Methods: 39 patients with intraarticular type I tumors according to the Malawer and Enneking classification were treated with tumor resection and reconstruction with an unconventional prosthesis and soft tissues. Results: Patients enrolled included 18 females and 21 males ages 12-72 years with tumors such as: giant cell tumors (14), osteosarcomas (7), metastasis (7), chondrosarcomas (6), Ewing's sarcomas (2), chondroblastoma (2) and aneurysmatic bone cyst (1). Twelve patients died due to systemic disease and the remaining patients survived. Surgical margins were broad, with humeral resection between 100 and 230 mm. Functional results were assessed according to the Muscoloskeletal Tumor Society score as 13 excellent, 16 good, 5 failures and 5 poor. Discussion: The resection level does not restrict the placement of this prosthesis, which permits future revisions. An appropriate result depends on the resection size and the preserved shoulder musculature and it is not limited by the size of resection, thus improving patients' disability.

Effects of resistance training on strength, pain and shoulder functionality in paraplegics.

STUDY DESIGN: Time series design. OBJECTIVES: To determine the effects of a shoulder resistance training programme on isokinetic and isometric strength, body composition, pain and functionality in paraplegic subjects. SETTING: University of Valencia, Valencia, Spain. METHODS: A total of 15 subjects with thoracic spinal cord injury (SCI) performed three testing sessions with an 8-week period between the sessions. Subjects were not disturbed between the first and the second testing sessions. Subjects performed an 8-week resistance training programme after the second testing session. Variations in isometric and isokinetic shoulder muscle strength, body composition, reported pain and shoulder functionality were evaluated. RESULTS: The training programme produced a significant increase (P<0.05) in the isometric and isokinetic strength of several shoulder movements as well as an increase (P<0.05) in arm fat-free mass and a decrease in arm fat mass (FM). Furthermore, reported pain was decreased, (P<0.05) and upper-limb functionality was increased (P<0.05). CONCLUSION: Implementing resistance training programmes as physical therapy in SCI subjects effectively increases strength, muscle mass and upper-limb functionality, whereas decreasing FM and pain perception.

Force normalization in paraplegics.

The principal aim of our study was the determination of the effectiveness of a standardized ratio, allometric scaling model and a gamma function model in normalizing the isometric torque data of spinal cord patients and healthy subjects. For this purpose we studied a sample of 21 healthy males and 23 spinal cord injury males. The experiment consisted of the measurement of the force of the upper limb movement executed by all the subjects. We also determined anthropometric variables with dual-energy x-ray absorptiometry. The experimental data were analyzed with 3 force normalization methods. Our results indicate that the most important confounding variable was the fat free mass of the dominant upper limb (r>0.36, p<0.05). With the standardization by body mass and allometric scaling model, the normalized torque was influenced by body size variables. However, the normalized torque by the gamma function model was independent of body size measures. Paraplegics were weaker (p<0.05) in extension movements when the data were normalized by the gamma function model. In summary, this study shows that the gamma function model with fat free mass of the dominant upper limb was more effective than the standardized ratio in removing the influence of body size variables.

Effect of maternal obesity on lactation: systematic review / Efecto de la obesidad materna sobre la lactancia: revisión sistemática

Objective: The short duration or lack of breastfeeding has been associated with maternal obesity. The purpose of this study was to systematically review prospective studies that assessed the effect of maternal obesity on lactation. Methods: A search of studies was conducted in Pubmed, these included prospective studies on maternal obesity and initiation, intention and duration of breastfeeding: 653 articles were found, only seven were prospective studies. After adding other studies found by hand, a total of nine studies were analyzed. Results: Three out of four papers observed a higher risk for delay lactogenesis among obese mothers, oddsratio ranging from 1.02 to 1.10. The study assessing the initiation of lactation showed that non-obese mothers initiated lactation sooner, OR: 0.39 (95% CI: 0.25-0.62). The overall risk for cessation of breastfeeding showed that obese mothers had higher risks of early cessation, HR:1.50 (CI 95% 1.11-2.04). In one study it was observed that obese mothers were not more likely to never breastfeed, OR = 1.56 (95% CI: 0.97-1.50). Conclusions: This review shows that in prospective studies, obese mothers are more likely to have delayed lactogenesis and reduced lactation. Therefore, weight control and breastfeeding promotion should be reinforced before and during pregnancy. In overweight and obese mothers, breastfeeding should be closely monitored after birth (AU)

Objetivo: La falta de lactancia o su corta duración has ido asociada con la obesidad materna. El propósito de este estudio fue realizar una revisión sistemática de estudios prospectivos que estudiaron el efecto de la obesidad materna sobre la lactancia. Métodos: Se realizó una búsqueda en Pubmed, se incluyeron estudios prospectivos del efecto de la obesidad materna sobre la iniciación, la intención y la duración dela lactancia: se encontraron 653 artículos, y siete fueron estudios prospectivos. Después de agregar otros estudios seleccionados a mano, se analizaron nueve estudios. Resultados: Tres de cuatro estudios observaron un mayor riesgo de retraso de la lactogénesis en madres obesas, OR:1,02 a 1,10. El estudio que analizó la iniciación de la lactancia describió que las madres no obesas iniciaron la lactancia más temprano, OR: 0,39 (95% CI: 0,25-0,62). El riesgo determinación temprana de la lactancia fue mayor en madres obesas, HR: 1,50 (CI 95% 1,11-2,04). En un estudio se observó que las madres obesas no tenían más probabilidades de no lactar, OR = 1,56 (95% CI: 0,97-1,50). Conclusiones: Esta revisión realizada en estudios prospectivos indica que, es más probable que las madres obesas tengan lactogénesis atrasada o un periodo corto de lactancia. Por lo tanto, el control de peso y la promoción de la lactancia deben reforzarse antes y durante el embarazo. Enmadres con sobrepeso y obesidad, la lactancia debe de ser promovida y supervisada después de nacimiento (AU)

Effects of low carbohydrate diets on weight and glycemic control among type 2 diabetes individuals: a systemic review of RCT greater than 12 weeks / Efectos de las dietas bajas en carbohidratos sobre el peso y el control glicémico en individuos con diabetes tipo 2: revisión sistemática de estudios aleatorizados de más de 12 semanas

Introduction: Low carbohydrate diets (LCD) have shown beneficial effects on short-term weight reduction programs for obese individuals without diabetes, but the long-term evidence of efficacy on individuals with type 2diabetes is not conclusive. Objective: To evaluate, the effectiveness of 12 or more weeks of LCD compared to Low Fat Diet (LFD), Usual Care Diet (UCD) or Low Glycemic Index Diet (LGID) on weight reduction and AIC on type 2 diabetes individuals. Methods: A systematic review was conducted on randomized trials registered in PubMed, Cochrane and EBSCO host from January 1st2000 to January 1st2010including those with an intervention program with LCD in type 2 diabetes subjects and a follow-up 12 weeks. Available data on study design; carbohydrate composition of diet; duration of diet; and the outcomes of weight, lipid levels (total, low density lipoprotein and high-density lipoprotein cholesterol, and triglycerides), hemoglobin A1C percent and/or fasting glucose were extracted. Results: Five studies showed greater weight reduction with LCD, of which four demonstrated no significant difference. The longest trial intervention studies did not show a difference in weight change. Only two studies showed greater reduction of A1C with LCD, including the longest intervention trial with a low carbohydrate Mediterranean diet. Conclusions: This review shows that there are no consistent differences in weight and A1C changes over the long-term treatment with LCD and LFD, UCD or LGID (AU)

Introducción: Las dietas bajas en carbohidratos han demostrado, a corto plazo, efectos benéficos sobre la pérdida de peso en individuos obesos sin diabetes, sin embargo la evidencia sobre su efectividad a largo plazo en individuos con diabetes tipo 2 no es concluyente. Objetivo: Evaluar el efecto de dietas bajas en carbohidratos (DBC) en intervenciones mayores a 12 semanas comparadas con dietas bajas en grasas (DBG), dietas de cuidado común (DCC) o dietas con bajo índice glicémico (DBIG), sobre la pérdida de peso y la hemoglobina glucosilada (A1C) en individuos con diabetes tipo 2.Métodos: Se realizó una revisión sistemática de estudios aleatorizados publicados en PubMed, Cochrane y EBSCO host del 1º de Enero del 2000 al 1º de Enero del2010. Se extrajeron datos sobre el diseño del estudio, la composición de carbohidratos de la dieta, la duración de la dieta y resultados de cambios en peso, en porcentaje deA1C, glucosa en ayuno y lípidos sanguíneos. Resultados: Cinco estudios mostraron mayor reducción de peso con DBC, de los cuales cuatro no demostraron diferencia estadística. El estudio de mayor tiempo de intervención no mostró diferencia en la pérdida de peso. Únicamente dos estudios mostraron mayor reducción en el porcentaje de A1C con DBC, incluyendo el estudio de mayor tiempo de intervención. Conclusiones: Esta revisión muestra la falta de consistencia en las diferencias sobre los cambios en el peso y laA1C en intervenciones con seguimiento mayor de 12semanas con DBC comparadas con DBG, DCC o DBIG (AU)

Transdermal nitroglycerine treatment of shoulder tendinopathies in patients with spinal cord injuries.

STUDY DESIGN: A clinical blind study was conducted to determine the efficacy of transdermal nitroglycerine treatment on the awareness of shoulder pain. OBJECTIVE: This study aims to determine the effects of transdermal nitroglycerine on shoulder pain and on functional shoulder movement in patients with spinal cord injuries and shoulder tendinopathies. A second aim is to establish the side effects of the treatment. SETTING: Hospital "La Fe" in Valencia, Spain. METHODS: A total of 45 spinal cord injury patients, all of whom are wheelchair users with shoulder tendinopathy, were randomly divided into two groups: placebo (n=12) and experimental (n=33). The experimental group (EG) received transdermal treatment for 6 months in the form of a 1.25 mg nitroglycerine (NT) patch on the greater tubercle. A placebo patch was used with the placebo subjects. Functional shoulder movements were assessed by articular range of motion and pain, using a visual analogical scale. RESULTS: NT treatment reduced the awareness of shoulder pain and increased the functional movement and range of articular motion in the shoulders of the EG members (P<0.05). CONCLUSIONS: We conclude that transdermal NT is an efficient method for treating shoulder tendinopathies in wheelchair users with spinal cord injuries.

Time and frequency analysis of the static balance in young adults with Down syndrome.

The main objective of this study is to understand the differences in equilibrium control between normal subjects and those with Down syndrome. A total of 54 subjects participated voluntarily, divided into control group and Down syndrome group. The equilibrium of the subjects was tested under two conditions: bipedal support with eyes open and closed. The signals were analyzed in a time and frequency domain. The statistical parameters selected (i.e., RMS distance, mean velocity, mean frequency and sway area) to analyze the behavior of the center of pressures (CoP) are calculated employing the result of the combination of the time series data in both directions (i.e. resultant distance). In order to calculate the frequency bands produced by the displacements of the CoP, a Fast Fourier Transform of the data was performed. The group with Down syndrome showed poorer static equilibrium control than the control group in the time domain. In the frequency domain, we found differences between the groups in the distribution of energy in the frequency bands analyzed. In addition, we observed the existence of an interaction effect of the group and the condition tested (p<0.001). These findings show that in the absence of visual information, the control group increases the energy at low frequencies, while the group with Down syndrome decreases it. Additionally, the lower amount of energy observed in this band under the 'eyes closed' condition may serve to identify abnormalities in the functioning of the vestibular apparatus of individuals with Down syndrome and/or difficulties experienced by these individuals in extracting relevant information from this route.

Two-leg squat jumps in water: an effective alternative to dry land jumps.

The current study was designed to quantify and compare the kinetic parameters of two-leg squat jumps carried out on dry land, in water and in water using area devices that increase drag force. Twelve junior female handball players who had been competing at national level for the previous two years volunteered to participate in the study. Intensity of the two-leg squat jump was examined using a force plate (9 253-B11, Kistler Instrument AG, Winterthur, Switzerland) in three different conditions: on dry land, in water and in water using devices. An ANOVA with repeated measurements (condition) was applied to establish differences between the three jumps. The results show that peak impact force and impact force rate for the water jumps was lower than for the dry land jumps (p<0.05), while peak concentric force was higher for the water jumps than the dry land jumps (p<0.05). In addition, no statistically significant differences were found between water jumps for these variables (p>0.05). These results indicate that water provides an ideal environment for carrying out jumps, as the variables associated with the exercise intensity are boosted, while those related to the impact force are reduced and this fact could be less harmful.

Force fluctuations during the Maximum Isometric Voluntary Contraction of the quadriceps femoris in haemophilic patients.

In the general population, the degenerative processes in joints are directly related to adult age, and osteoarthrosis represents the most frequent musculoskeletal alteration. In the haemophilic patient, the degenerative processes in the joint begin at very early ages, and are directly related to musculoskeletal bleeding episodes, which are occasionally subclinical and constitute haemophilic arthropathy. In the haemophilic patient, arthropathy constitutes the most frequent, severe and disabling pathology, and its assessment includes muscular force-related parameters. We have studied the value of Maximum Isometric Voluntary Contraction in the quadriceps femoris of 46 subjects, 28 haemophiliacs (16 severe, eight moderate and four mild) and 18 healthy individuals with a view to establishing appropriate values of force and to restoring physical therapy recommendations. The maximum force values were significantly greater (P < 0.001) in the healthy individuals group. The mild haemophiliacs group also presented significant differences of force (P < 0.05) in relation to the severe and moderate haemophilic patient groups. The mild and severe haemophilia patients presented greater fluctuations of force (P < 0.001) than the control group, the haemophilia group have a minor skill to produce constant force. The seriousness of the arthropathy in the knee is directly related to diminished values of maximum force. Our work evidences that patients with severe haemophilia present a greater degree of arthropathy in relation to moderate and mild haemophilia patients. Haemophilic arthropathy is associated with muscular atrophy and strength deficit. In haemophilic patients, the deficit of maximum force and the presence of fluctuations may suggest an increased risk of bleeding during physical activities and the need to programme specific physical therapy guidelines which increase muscular power through resistance training.

Surface electrical stimulation of the quadriceps femoris in patients affected by haemophilia A.

Eighteen sessions of surface electrical stimulation was applied to the quadriceps femoris of the left leg of ten male subjects affected by severe haemophilia A, while ten healthy subjects constituted the control group. The isometric strength, the electromyographic activity and the diameter of the rectus femoris were measured in both legs before and after a six-week treatment period. After the treatment, the people affected by haemophilia showed a gain in strength by 13.8% in the stimulated leg and by 17.1% in the non-stimulated one. No changes were detected in the electromyographic activity. On the contrary, the diameter of the rectus femoris of the stimulated leg increased in 24.34%, while no significant change was found in the nonelectrically stimulated leg. These results show for the first time that the application of electrical stimulation in haemophilic patients contributes to the gain and development of strength and trophism. The results also show that the surface electrical stimulation does not represent a threat to the patients' health, and that can be used for therapeutic purposes.

La turalemia en el diagnóstico diferencial de las adenopatías cervicales. A proposito de un brote tularémico en Castilla-León / Tularemia in the differential diagnosis of cervical lymph node enlargernent. An outbreak of tularemia in Castilla-León, Spain

La presencia de adenopatías cervicales plantea un reto diagnóstico en la patología de cabeza y cuello. Estas pueden ser secundarias a procesos infecciosos locales o generales, a enfermedades sistémicas no infecciosas o deberse a la diseminación metastásica linfática de procesos tumorales. Entre los múltiples cuadros infecciosos que pueden desarrollar adenopatías cervicales se encuentra el de la Tularemia. Esta enfermedad, rara en nuestro medio, se ha presentado con inusitada incidencia en Castilla-León en los últimos meses de 1997, alcanzando los 136 casos diagnosticados en nuestro Hospital, de los cuales 13 desarrollaron adenopatías en la región de cabeza y cuello. El propósito de este artículo es presentar a la Turalemia como una enfermedad a tener en cuenta en el diagnóstico diferencial de las adenopatías cervicales en nuestro medio (AU)

The presence of enlarged cervical lymph nodes is a diagnostic challenge in disease of the head and neck. Lymph node enlargement may be secondary to local or general infectious disease, to non-infectious systemic disease, or to lymphatic metastasis of tumoral processes. Among the many infectious processes that originate cervical lymph nodes is tularemia. This disease is uncommon in Spain, but was unusually frequent in Castilla-León in the last months of 1997, with 136 cases diagnosed in our hospital, 13 accompanied by lymph node enlargement of the head and neck. This article shows that tularemia should be considered in the differential diagnosis of cervical lymph node enlargement in our region (AU)