Radiofrecuencia pulsada del nervio supraescapular en el tratamiento del hombro doloroso / Pulsed radiofrequency of the supraescapular nerve in the treatment of painful shoulder

El hombro doloroso no es diagnóstico específico, pues abarca disímiles diagnósticos cuyos límites son poco exactos y pueden solaparse. Es una patología de bastante frecuencia en la población en general. El tratamiento con radiofrecuencia pulsada se ha vuelto cada vez más popular en la terapia del hombro doloroso crónico, debido a su duradero efecto y a la ausencia de daños. Específicamente, la radiofrecuencia del nervio supraescapular se emplea en el tratamiento del hombro doloroso crónico para varias patologías. Este trabajo de fin de máster pretende abordar la importancia del uso de la radiofrecuencia pulsada del nervio supraescapular para tratamiento del hombro doloroso. Para ello se realizó una revisión sistemática, a partir de una selección crítica de la literatura científica sobre esta temática, disponible desde 2000 hasta la fecha, utilizando como fuentes bibliográficas las plataformas Google Scholar, Web of Science, PubMed y Scopus. Fueron examinados de manera crítica 47 trabajos, seleccionados después de filtrar los registros iniciales siguiendo los criterios de inclusión y exclusión. Los estudios consultados demuestran la eficacia de la técnica en el tratamiento del dolor crónico de hombro, especialmente con la guía de la ecografía. Por lo general los estudios incluyen tres tipos de valoraciones: la valoración clínica del dolor, la valoración funcional, y la valoración de la respuesta al tratamiento. Se observan mejoras en cuanto al dolor, la flexión, abducción y rotación del hombro, las cuales se mantienen hasta los seis meses. Varios estudios combinan la técnica con otros tratamientos, lo que puede resultar prometedor para el futuro.(AU)

Shoulder pain is not a specific diagnosis, since it encompasses dissimilar diagnoses, whose limits are imprecise and may overlap. It is a fairly common pathology in the general population. Pulsed radiofrequency treatment has become increasingly popular in chronic painful shoulder therapy due to its long-lasting effect and absence of damage. Specifically, the radiofrequency of the suprascapular nerve is used in the treatment of chronic painful shoulder, for various pathologies. This Master’s Project aims to address the importance of the use of pulsed radiofrequency of the suprascapular nerve for the treatment of painful shoulder. For them, a systematic review was carried out, based on a critical selection of the scientific literature on this subject, available from 2000 to date, using the Google Scholar, Web of Science, PubMed and Scopus platforms as bibliographic sources. Forty-seven works were critically examined, selected after filtering the initial records following the inclusion and exclusion criteria. The studies consulted demonstrate the efficacy of the technique in the treatment of chronic shoulder pain, especially with ultrasound guidance. Studies generally include three types of assessments: clinical pain assessment, functional assessment, and treatment response assessment. Improvements in pain, flexion, abduction and rotation of the shoulder are observed, which are maintained up to six months. Several studies combine the technique with other treatments, which may be promising for the future. Among the main limitations to the use of the technique are that there are currently limited data on the use of pulsed radiofrequency for chronic pediatric pain, the feasibility of patient follow-up, and questions about the ideal parameters (time, voltage, frequency, pulse duration), to achieve the improvement of radiofrequency treatments.(AU)

Development of Anxiolytic and Depression-like Behavior in Mice Infected with Mycobacterium lepraemurium.

Murine leprosy is a systemic infectious disease of mice caused by Mycobacterium lepraemurium (MLM) in which the central nervous system (CNS) is not infected; nevertheless, diseased animals show measurable cognitive alterations. For this reason, in this study, we explored the neurobehavioral changes in mice chronically infected with MLM. BALB/c mice were infected with MLM, and 120 days later, the alterations in mice were evaluated based on immunologic, histologic, endocrine, neurochemical, and behavioral traits. We found increases in the levels of IL-4 and IL-10 associated with high bacillary loads. We also found increase in the serum levels of corticosterone, epinephrine, and norepinephrine in the adrenal gland, suggesting neuroendocrine deregulation. Mice exhibited depression-like behavior in the tail suspension and forced swimming tests and anxiolytic behavior in the open field and elevated plus maze tests. The neurobehavioral alterations of mice were correlated with the histologic damage in the prefrontal cortex, ventral hippocampus, and amygdala, as well as with a blood-brain barrier disruption in the hippocampus. These results reveal an interrelated response of the neuroimmune--endocrinological axis in unresolved chronic infections that result in neurocognitive deterioration.

Influencia de la modalidad de respuesta, edad y nivel de educación en el cuestionario internacional de síntomas prostáticos (IPSS) / Influence of the response modality, age and level of education in the international prostate symptoms questionnaire (IPSS)

OBJETIVOS: evaluar la influencia de la modalidad de respuesta (paciente vs. asistido por urólogo) en el cuestionario IPSS (International Prostate Symptom Score) y su relación con la edad y nivel de educación. MATERIALES Y MÉTODOS: Análisis prospectivo de 74 pacientes que acudieron a la consulta de urología por síntomas de Hiperplasia Prostática Benigna (HPB) con o sin tratamiento para su patología y que no hayan completado anteriormente el cuestionario internacional de síntomas prostáticos (IPSS). Los cuestionarios fueron completados en la misma consulta urológica, primero por el paciente y luego con ayuda del urólogo. Se categorizó por edad y nivel de educación. Se evaluó la diferencia entre los puntajes de IPSS obtenidos con la forma autocompletada y con asistencia del urólogo y si esta diferencia estaba relacionada con la edad y con el nivel de educación. Los datos fueron analizados utilizando test no paramétrico para datos apareados de Wilcoxon. RESULTADOS: no se encontró diferencia estadísticamente significativa entre el cuestionario completado por el paciente y el asistido por el urólogo. La media del score total fue de 13,66, y 13,67, respectivamente (p: 0.86). Al analizar los subgrupos, con respecto a la edad y al nivel de educación, tampoco se encontraron diferencias estadísticamente significativas. CONCLUSIÓN: en nuestra población de estudio, el cuestionario IPSS no fue influenciado por la modalidad de administración, tampoco por la edad ni por el nivel de educación.

OBJECTIVES: to evaluate the influence of the response modality (patient vs. urologist-assisted) in the IPSS questionnaire (international prostate symptom score) and its relationship with age and education level. MATERIALS AND METHODS: Prospective analysis of 74 patients who came to the urology clinic for symptoms of Benign Prostatic Hyperplasia (BPH) with or without treatment for their pathology and who have not previously completed the international prostate symptoms questionnaire (IPSS). The questionnaires were completed in the same urological consultation, first by the patient and then with the help of the urologist. It was categorized by age and education level. The difference between the IPSS scores obtained with the self-completed form and with the assistance of the urologist and whether this difference was related to age and level of education was evaluated. The data were analyzed using non-parametric test for paired Wilcoxon data. RESULTS: no statistically significant difference was found between the questionnaire completed by the patient and the one assisted by the urologist. The average of the total score was 13.66, and 13.67, respectively (p: 0.86). When analyzing the subgroups, regarding age and level of education, no statistically significant differences were found. CONCLUSION: In our study population, the IPSS questionnaire was not influenced by the modality of administration, neither by age nor by level of education.

New technologies and advances in weight loss therapy. / Nuevas tecnologías y avances en terapias para la pérdida de peso.

Bariatric surgery is the most effective treatment for obesity and its comorbidities but there are barriers that prevent its general acceptance. The growing obesity epidemic has resulted in the need for the creation of new, less invasive treatments, with a wide margin of safety and effectiveness for conditioning weight loss, at least greater than that resulting from treatment based on diet and exercise. Emerging therapies include devices that are endoscopically placed and removed, classified as: space-occupying devices, restrictive or anatomic-remodeling procedures, endoluminal bypass, and duodenal mucosal resurfacing. Percutaneous techniques and less invasive surgeries are also included. In general, results have shown improvement in glucose metabolism in diabetic patients. With respect to weight loss, results do not surpass those of bariatric surgery, but are better than results with conservative treatment (diet and exercise) and have a low rate of adverse events. Clinical use of a new technique should be carried out within a multidisciplinary management program that includes nutritional, psychologic, physical activity, and medical support. It must be understood that novel therapies are not being created to substitute bariatric surgery, but rather to increase treatment options in the general population, with greater reach and impact. The aim of the present study was to provide an up-to-date literature review on emerging technologies for the treatment of obesity.

An appraisal of the taxonomy and nomenclature of trypanosomatids presently classified as Leishmania and Endotrypanum.

We propose a taxonomic revision of the dixenous trypanosomatids currently classified as Endotrypanum and Leishmania, including parasites that do not fall within the subgenera L. (Leishmania) and L. (Viannia) related to human leishmaniasis or L. (Sauroleishmania) formed by leishmanias of lizards: L. colombiensis, L. equatorensis, L. herreri, L. hertigi, L. deanei, L. enriettii and L. martiniquensis. The comparison of these species with newly characterized isolates from sloths, porcupines and phlebotomines from central and South America unveiled new genera and subgenera supported by past (RNA PolII gene) and present (V7V8 SSU rRNA, Hsp70 and gGAPDH) phylogenetic analyses of the organisms. The genus Endotrypanum is restricted to Central and South America, comprising isolates from sloths and transmitted by phlebotomines that sporadically infect humans. This genus is the closest to the new genus Porcisia proposed to accommodate the Neotropical porcupine parasites originally described as L. hertigi and L. deanei. A new subgenus Leishmania (Mundinia) is created for the L. enriettii complex that includes L. martiniquensis. The new genus Zelonia harbours trypanosomatids from Neotropical hemipterans placed at the edge of the Leishmania-Endotrypanum-Porcisia clade. Finally, attention is drawn to the status of L. siamensis and L. australiensis as nomem nudums.

Successive Intramuscular Boosting with IFN-Alpha Protects Mycobacterium bovis BCG-Vaccinated Mice against M. lepraemurium Infection.

Leprosy caused by Mycobacterium leprae primarily affects the skin and peripheral nerves. As a human infectious disease, it is still a significant health and economic burden on developing countries. Although multidrug therapy is reducing the number of active cases to approximately 0.5 million, the number of cases per year is not declining. Therefore, alternative host-directed strategies should be addressed to improve treatment efficacy and outcome. In this work, using murine leprosy as a model, a very similar granulomatous skin lesion to human leprosy, we have found that successive IFN-alpha boosting protects BCG-vaccinated mice against M. lepraemurium infection. No difference in the seric isotype and all IgG subclasses measured, neither in the TH1 nor in the TH2 type cytokine production, was seen. However, an enhanced iNOS/NO production in BCG-vaccinated/i.m. IFN-alpha boosted mice was observed. The data provided in this study suggest a promising use for IFN-alpha boosting as a new prophylactic alternative to be explored in human leprosy by targeting host innate cell response.

Adjuvant treatment with a dialyzable leukocytes extract contributes to maintain HPV-infected women free of low-grade cervical lesions.

PURPOSE OF INVESTIGATION: To investigate if adjuvant treatment with a dialyzable extract of leukocytes (DLE), may help HPV-infected patients with low-grade intraepithelial squamous cervical lesions (LIS) to get free of HPV infection and cervical lesions. MATERIALS AND METHODS: Patients with untreated, low-grade cervical lesions were treated either with surgery (Group A) or with DLE (Group B). Pa- tients with low-grade but recurrent cervical lesions were newly treated with surgery plus DLE (Group C). RESULTS: A decreased or ab- sent cervical lesion correlated with a diminished or absent HPV viral load at one year of treatment (r = 0.6,p <0.05). Seventy-nine percent of Group B but only 50 % of Group C and 38 % of Group A patients were free of cervical lesion after 24 months of treatment (p < 0.05). CONCLUSION: The present data support the benefit of adding DLE as adjuvant for treating HPV-infected women with LIS.

Dengue virus serotype-2 impairs proliferation of healthy donors' T lymphocytes.

OBJECTIVES: T lymphocytes are not infected by dengue virus (DENV), nevertheless it is possible that exposure to DENV may affect their function. T lymphocytes from DENV-infected individuals are impaired in their proliferative capacity, although this effect has been attributed to altered function of antigen-presenting cells rather than to an intrinsic defect on T lymphocytes. Here we analyzed whether T lymphocytes from healthy donors became impaired in their proliferative capacity following in vitro exposure to DENV serotype-2 (DENV-2), as well as the possible mechanisms for this. METHODS: Isolated CD4+ and CD8+ T lymphocytes from healthy donors were in vitro exposed to DENV-2, before polyclonal activation, cell proliferation, IL-2 synthesis. IL-2Rα expression, nuclear translocation of NF-AT and NF-κB, and intracellular calcium flux were assessed. RESULTS: In vitro exposure of both CD4+ and CD8+ T lymphocytes from healthy donors to DENV-2 impairs cell proliferation, IL-2 synthesis, and IL-2Rα (CD25) cell membrane expression. Signalling wise, exposure to DENV-2 impairs the nuclear translocation of NF-AT, downstream of intracellular calcium mobilization, as well as that of NF-κB. CONCLUSION: In the course of a dengue infection, direct exposure of T lymphocytes to DENV could affect cell-mediated immune responses.

Síndrome de Cushing secundario a secreción ectópica: un desafío diagnóstico / Cushing syndrome secondary to ectopic: diagnostic challenge

The diagnosis of Cushing Syndrome secondary to Ectopic ACTH secretion constitutes a challenge to the endocrinologist. The goal is to make a differential diagnosis of Cushing’s disease and localize the ACTH-secreting tumor, to achieve quick and effective management of a disease that can be fatal. The mainly diffuculties are the limited data due to their low prevalence and the wide variety of the origin tumors. Therefore, a comprehensive and multidisciplinary study is needed, analyzing each particular case. This article reviews the diagnostic alternatives, their strengths and weaknesses, proposing an algorithm that contributes to our clinical practice...

Hipocalcemia asociada a hiperfosfemia y PTH elevada: caso clínico / Hypocalcemia, vitamin D deficiency and elevated PTH levels in a patient with celiac disease: report of one case

We report a 56 years old woman that presented a severe hypocalcemia, with a serum calcium of 4.7 mg/dl, after the intake of bisphosphonates. Laboratory examination showed elevated PTH levels (167 pg/ml), hyperphosphatemia, hypomagnesemia and normal phosphate tubular reabsorption. Therefore, the diagnosis of pseudohypoparathyroidism was considered (PHP). However, further studies showed low levels of 25 OH Vitamin D (13.6 ng /ml), osteoporosis, positive anti endomysium antibodies and an endoscopic biopsy, that confirmed the presence of a celiac disease.

[Anal intraepithelial neoplasia (NIA) and infection with human papillomavirus (HPV) in anoreceptive patients]. / La neoplasia intraepitelial anal y la infección por virus del papiloma humano en pacientes anorreceptivos.

BACKGROUND: An association between human papilloma virus (HPV) infection and progression to anal intraepithelial neoplasia (AIN) and epidermoid cancer has been established. OBJECTIVE: To know the prevalence of low and high grade AIN, as well as HPV infection in an anoreceptive patients group, infected or not, by human immunodeficiency virus (HIV). MATERIAL AND METHODS: All patients with anoreceptive sexual relations were considered in this study. Patients who accepted anal citology and high definition anoscopy and biopsies with a follow-up not minor of 3 months were included. RESULTS: Forty-four patients were included: 40 male (90.9%) with average age of 31 years. Anal cytology showed inflammatory alterations in 21 patients (28%), low grade intraepithelial lesion in 23 (52%); there were not patients with high grade epithelial lesion. According to the high definition anoscopy, there were low grade intraepithelial lesion in 42 patients (95%) and high grade in 2 (5%). Biopsy showed low grade intraepithelial in 26 patients (59%), high grade in 4 (9%) and inflammatory alterations in 14 (32%). The prevalence of AIN and HPV infection was 68% in both diseases. The HIV infection was associated with the presence of high grade AIN (p=0.002, OR 47.7) CONCLUSIONS: There is a high prevalence of AIN and HPV infection between patients with anoreceptive sexual relations. The HIV infection is a risk factor for the development of high grade AIN.

[Epidemiological characteristics of colorectal cancer in the General Hospital of Mexico. A 20 years analysis: 1988-2007]. / Comportamiento epidemiológico del cáncer de colon y recto en el Hospital General de México. Análisis de 20 años: 1988-2007.

INTRODUCTION: Distribution of colon and rectal tumors has been studied by many authors, which have considered that distal colon and rectum are more affected. However, its frequency and distribution have changed in recent years. OBJECTIVE: A descriptive analysis of colorectal cancer in the General Hospital of Mexico during the last 20 years (1988-2007). MATERIAL AND METHODS: This is a transversal comparative study between decades from the database of the Pathology Service of the General Hospital of Mexico, of cases of cancer diagnosed from January 1988 to December 2007. Variables included age, gender, anatomic site of the tumor,grade of differentiation, stadification and type of surgery. RESULTS: There were 222 cases from 1988 to 1997 and 400 cases from 1998 to 2007. 115 (52%) were female in the firs decade and 210 (53%) in the second. We found a prevalence of 71 cases (32%) for the proximal colon, 24 (11%) for the distal colon and 127 (57%) for the rectum in the first decade; in second decade there were 182 (45%) cases for the proximal colon, 50 (13%) for the distal colon and 168 (42%) for the rectum. CONCLUSIONS: The number of colorectal cancerduring the last decade almost doubled in our hospital (80%); we also found an increase in the number of proximal tumors and a decreasein the number of rectal tumors.

Análisis de los Comités de Ética de Investigación Clínica (CEIC) en la provincia de Sancti Spíritus.

Se realizó un estudio descriptivo transversal sobre la estructuración, funcionamiento y capacitación de los (CEIC). Se aplicó una encuesta nacional diseñada por (CENCEC) a 16 miembros de dichos comités, con los objetivos de: describir su estructura cualitativa-cuantitativa, funcionamiento general y particular, así como la capacitación de sus miembros. Se recomendó preparar y ejecutar un programa de capacitación y reestructuración de estos órganos en las diferentes unidades.

Angioplastía coronaria en pacientes octogenarios / Coronary angioplasty in octogenarians patients

Introduction: According to international literature, the percutaneus coronary angioplasty (PTCA) can be performed in octogenarian with a high rate of success and favorable long term prognosis. There are no Chilean publications about PTCA in octogenarian patients. Objective: To show our experience in octogenarian patients who underwent PTCA. Material and method: From a serial prospective registration of patients who underwent coronary angiography studies between 1992and 2005, all the octogenarian patients subjected to PTCA were evaluated, being described their pre and in-hospital variables, with emphasis in the results of the PTCA Results: Of a total of 7262 patients, 77 octogenarian patients underwent PTCA (1percent). The average age was 83.2 +/- 3.4 years, 54.5 percent male. They were studied mainly by myocardial infraction (MI) (55.8 percent) and unstable angina (29.8 percent). 59.7 percent were hypertensive and 19.4 percent had diabetes. The angiographic study showed mainly single vessel (37.6 percent) and two vessel disease in 32.4 percent. The PTCA was elective in 57.1 percent, the rest were emergency procedures. The PTCA was successful in 88.3 percent. There were no intra procedure complications, and 7 patients presented smaller post procedure complications. 11 patients (14.3 percent) died; 10 because of MI. 66 were discharged without complications. Conclusion: The PTCA is a feasible procedure to perform in octogenarian patients, with good immediate results.

The line blot assay: problems with titrating first and second antibodies for Western blot and immunohistochemistry assays?

We describe a technique designed to assess the optimal dilution of primary and secondary antibodies, to be used in Western blot, dot blot, the multi-antigen print immunoassay (MAPIA) and immunohistochemistry assays. The method that we call "line blot" is not an alternative but a practical, complementary tool for the above techniques that assures definitive results are obtained from single assays, so there is no need to repeat the assay. As with most immunoenzymatic assays, the line blot assay is very sensitive, allowing the detection of absolute amounts of antigen as low as 2.5 ng in the 0.5 cm-long segment line (see Results), depending on the strength of the secondary, enzyme-labelled antibody.

Palsy of the rear limbs in Mycobacterium lepraemurium-infected mice results from bone damage and not from nerve involvement.

A small but relatively constant proportion (3-5%) of mice chronically infected with Mycobacterium lepraemurium (MLM) develops bilateral paralysis of the rear limbs. The aim of the study was to investigate whether or not the bilateral leg palsy results from nerve involvement. Direct bacterial nerve infection or acute/delayed inflammation might possibly affect the nerves. Therefore, palsied animals were investigated for the presence of: (a) histopathological changes in the leg tissues including nerves, bones and annexes, and (b) serum antibodies to M. lepraemurium and M. leprae lipids, including phenolic glycolipid I from M. leprae. Histopathological study of the palsied legs revealed that the paralysis was not the result of direct involvement of the limb nerves, as neither bacilli nor inflammatory cells were observed in the nerve branches studied. Antibodies to brain lipids and cardiolipin were not detected in the serum of the palsied animals, thus ruling out an immune response to self-lipids as the basis for the paralysis. Although high levels of antibodies to MLM lipids were detected in the serum of palsied animals they were not related to limb paralysis, as the nerves of the palsied legs showed no evidence of inflammatory damage. In fact, nerves showed no evidence of damage. Paralysis resulted from severe damage of the leg bones. Within the bones the bone marrow became replaced by extended bacilli-laden granulomas that frequently eroded the bone wall, altering the normal architecture of the bone and its annexes, namely muscle, tendons and connective tissue. Although this study rules out definitively the infectious or inflammatory damage of nerves in murine leprosy, it opens a new avenue of research into the factors that participate in the involvement or the sparing of nerves in human and murine leprosy, respectively.

Expression of a lymphatic endothelial cell marker in benign and malignant vascular tumors.

Tumors of endothelial cell origin are relatively common. Soft tissue tumors and numerous subtypes of benign and malignant vascular tumors have been described; the histogenesis of many of these tumors is uncertain, and distinguishing between benign and malignant vascular tumors, some of which express lymphatic endothelial cell markers, can be problematic. In the present study, immunophenotypic expression of a novel hyaluronan receptor (LYVE-1), which is expressed by endothelial cells of normal lymphatic vessels but not blood vessels, was determined in benign and malignant vascular tumors. It was found that, except in lymphangiomas, intramuscular hemangiomas, and Masson's hemangiomas, endothelial cells in benign blood vessel tumors (including capillary and cavernous hemangiomas, glomus tumors, pyogenic granulomas, and epithelioid hemangiomas) were negative for LYVE-1, and that all angiosarcomas and Kaposi's sarcomas were positive for LYVE-1. Expression of LYVE-1 and other lymphatic endothelial cell markers in relatively few vascular neoplasms has implications for the histogenesis of these lesions, and may prove useful in distinguishing angiosarcoma and Kaposi's sarcoma from most common benign vascular tumors.