Functional status, physical activity level, and exercise regularity in patients with fibromyalgia after Multidisciplinary treatment: retrospective analysis of a randomized controlled trial.

Multidisciplinary treatments have shown to be effective for fibromyalgia. We report detailed functional outcomes of patients with fibromyalgia who attended a 3-month Multidisciplinary treatment program. The hypothesis was that patients would have increased functional status, physical activity level, and exercise regularity after attending this program. We performed a retrospective analysis of a randomized, simple blinded clinical trial. The inclusion criteria consisted of female sex, a diagnosis of fibromyalgia, age 18-60  and 3-8 years of schooling. Measures from the Fibromyalgia Impact Questionnaire (FIQ) and the COOP/WONCA Functional Health Assessment Charts (WONCA) were obtained before and at the end of the treatment and at 3-, 6-, and 12-month follow-ups. Patients recorded their number of steps per day with pedometers. They performed the six-minute walk test (6 MW) before and after treatment. In total, 155 women participated in the study. Their median (interquartile interval) FIQ score was 68.0 (53.0-77.0) at the beginning of the treatment, and the difference between the Multidisciplinary and Control groups was statistically and clinically significant in all of the measures (except the 6-month follow-up). The WONCA charts showed significant clinical improvements in the Multidisciplinary group, with physical fitness in the normal range across almost all values. In that group, steps/day showed more regularity, and the 6 MW results showed improvement of -33.00 (-59.8 to -8.25) m, and the differences from the Control group were statistically significant. The patients who underwent the Multidisciplinary treatment had improved functional status, physical activity level, and exercise regularity. The functional improvements were maintained 1 year after treatment completion.

Fisiopatología de la rigidez articular: bases para su prevención / Physiopathology of articular stiffness: preventive bases

El objetivo del presente trabajo es realizar una revisión bibliográfica de la fisiopatología de la rigidez articular y de sus repercusiones en el enfoque preventivo de la fisioterapia. La falta de movimiento y de tensiones aplicadas sobre las articulaciones da como resultado rigidez articular. El desconocimiento del origen de la rigidez puede llevar consigo una recurrencia del problema. El conocimiento de las causas y sus cambios histológicos permitirá aplicar las técnicas más oportunas obteniendo mejores resultados. Método: Revisión bibliográfica de textos clásicos y Bases de Datos específicas. Resultados: La rigidez articular se da como resultado de la falta de movimiento y de fuerzas aplicadas sobre las articulaciones. La falta de estrés altera las características morfológicas, bioquímicas y biomecánicas de los tejidos. La inmovilización produce proliferación del tejido conectivo y desorganización del colágeno de los distintos tejidos. La prevención de la rigidez se basa en minimizar los efectos nocivos de la inmovilización y pasa por un completo tratamiento de fisioterapia, iniciado en fase de inmovilización. Las medidas preventivas se resumen en medidas antiedema, movilización pasiva y activa, isométricos, inicio temprano del tratamiento y Movilización Pasiva Continua combinada con fisioterapia

This article takes a look at the scientific basis of articular stiffness throughout a bibliographic review of the physiopathology and its repercussions in physical therapy. Lack of movement and joint stress lead to articular stiffness. If the origin of the restriction is unknown, recurrence of the problem may occur. The causes knowledge and histological changes let us apply appropriate techniques to get better results. Methodology: bibliographic review of classic works and specific Databases. Results: articular stiffness is the consequence of lack of movement and joint stress deprivation. Stress deprivation alters the morphologic, biochemical and biomechanical characteristics of tissues. Proliferation of connective tissue and collagen disorganization appear as a result of immobilization. Stiffness prevention is based in minimizing dangerous effects of immobilization and goes through a complete physical therapy treatment, initiated during immobilization phase. Preventive measures are edema's treatment, active and passive mobilization, isometrics, early beginning of the treatment and Passive Continuous Motion (combined with physical therapy)

Validación de la versión española del Fibromyalgia Impact Questionnaire / Validation of the Spanish version of the Fibromyalgia Impact Questionnaire

Objetivo: Traducir, validar y adaptar el Fibromyalgia Impact Questionnaire (FIQ) al castellano para poder utilizarlo en España. Material y métodos: La traducción del FIQ original a la lengua castellana fue realizada por un traductor oficial (nativo español). El documento resultante fue de nuevo traducido al inglés por otro traductor independiente (nativo inglés). Se compararon los 2 documentos y se elaboró un documento en castellano consensuado por el grupo de investigadores y los traductores, así se obtuvo el Spanish FIQ (S-FIQ). Participaron 41 mujeres afectadas del síndrome de fibromialgia (SFM). Se explora la validez del S-FIQ. Para comparar el S-FIQ con otro test ya validado en español se administra el S-FIQ y el Cuestionario de Salud SF-36. Para analizar la reproducibilidad, se pidió a los pacientes que cumplimentaran el S-FIQ 7 días más tarde. Resultados: Se realizaron algunas adaptaciones culturales para obtener el S-FIQ final. El valor del coeficiente de correlación intraclase del S-FIQ total fue de 0,81. Las puntuaciones S-FIQ se correlacionaban con las del SF-36. Conclusión: El S-FIQ mantuvo las propiedades metodológicas de la versión original y se puede usar como herramienta de medida en pacientes españoles con SFM (AU)

[Class I and II histocompatibility antigens and severity of the alcoholic liver lesion]. / Antígenos de histocompatibilidad de clases I y II y gravedad de la lesión hepática alcohólica.

The association between the class I and class II histocompatibility antigens (HLA) and the severity of alcoholic liver disease was studied in 102 alcoholic patients (64 males and 38 females) with liver disease. According to histologic diagnosis 41 patients had a mild hepatic lesion (12 with minimum changes, 15 with steatosis and 14 with fibrosis) and 61 patients had severe hepatic lesion (13 with alcoholic hepatitis, 35 with cirrhosis and 13 with cirrhosis and alcoholic hepatitis). No differences were found between the two groups in regards to sex, quantity and length of alcohol consumption, although the patients with mild hepatic lesion were younger than those with severe hepatic lesion (41.2 +/- 8.2 and 47.8 +/- 11.6 years, respectively). The prevalence of the A30, B16, B47, Bw56, Cw1, Cw5 and Cw7 antigens was higher in the alcoholics than in the controls, although only the A30 (12.7% vs. 4.4%, p < 0.04) and the Bw56 antigens (3.9% vs 0.1%, p < 0.001) remained significant when the p value was corrected by the number of antigens studied. These differences were due to a greater prevalence of the A30 antigens (17.0% vs. 4.4%, p < 0.001), B16 (24.3% vs. 7.5%, p < 0.01) and Bw56 (7.3% vs 0.1%, p < 0.001) in patients with mild hepatic lesion versus the controls. In contrast, these antigens were present in similar numbers in patients with severe hepatic lesion and in the controls. On the other hand, no differences were observed regarding the prevalence of the class II HLA antigens between the alcoholics and the controls, or between the two alcoholic groups. These data suggest that the alcoholics with A30, B16 and Bw56 antigens are less susceptible to developing severe liver disease.

[Carbon monoxide poisoning: a pending subject for physicians and users]. / Intoxicación por monóxido de carbono: una asignatura pendiente para médicos y usuarios.

OBJECTIVE: To assess the incidence of cases of carbon monoxide poisoning diagnosed at a General Hospital's Casualty Department, to evaluate its clinical features and diagnostic difficulties, to find data on how much information the patients had on the risk of poisoning, what measures were adopted for a technician to check the apparatus which caused the poisoning, and on re-use. DESIGN: An observational descriptive study. SETTING: Casualty Department of a County Hospital with a catchment area of 80,000 people. PARTICIPANTS: Included in the survey were the 27 clinical histories for the cases of poisoning attended in Casualty at Igualada General Hospital in 1993. RESULTS: 27 poisoning cases were diagnosed (0.5/1,000 emergencies attended). Symptoms were non-specific in most cases, being mainly migraine, nausea/vomiting and feeling sick. CONCLUSIONS: Carbon monoxide poisoning is still an important cause of morbidity and mortality. Focus on the possible diagnosis during the winter months would enable new, potentially serious cases to be treated or avoided. Campaigns to warn the community and to check apparatuses causing poisoning are needed.

[The characteristics of arterial hypertension in the population of a preventive medicine service]. / Características de la hipertensión arterial en la población de un servicio de medicina preventiva.

Of 2,115 persons who were submitted to a voluntary check-up, we found 10.6% suffering from hypertension and 16.2% with borderline hypertension, the latter group having been followed and the condition subsequently confirmed in 45.9% of the case. The prevalence increases with age. There were no prevailing differences found between rural and city populations. The prevalence is greater in self-employed persons that in salary workers and we would bring to the fore the higher prevalence in housewives (p less than 0.0005). 74.8% of the hypertensive patients knew of their situation but only 15.6% of them showed normal blood pressure at the following-up. Rarely 0.85% had severe hypertension and 3% had moderate hypertension.

Alcoholic foamy degeneration in Spain. Prevalence and clinico-pathological features.

Among 389 consecutive chronic alcoholics in whom a liver biopsy was performed for diagnostic purposes, nine patients (2.3%) had histological changes of "alcoholic foamy degeneration" (AFD), characterized by numerous small fat droplets in the swollen hepatocytes of the centrilobular area. In five cases, there were non-specific clinical features, while the other four cases presented acute hepatic decompensation with jaundice and a reduced prothrombin activity. Seven patients had high serum lipid concentrations including hypertriglyceridemia and hypercholesterolemia, which improved after withdrawal of alcohol intake. In conclusion, AFD has a broad clinicopathological spectrum including asymptomatic patients and other cases with severe liver decompensation manifested by jaundice and reduced prothrombin activity. AFD is usually associated with hyperlipemia.