Validación de test de flexión-relajación para definir un déficit lumbar con electrodos tetrapolares / Validation of the flexion-relaxation test to define a lumbar deficit with tetrapolar electrodes

Introducción y objetivo: Obtener un nuevo punto de corte (PC) para un test de flexión-relajación (FR) lumbar efectuado con electrodos (e.) tetrapolares, desde valores ya definidos con dispositivos bipolares.Materiales y métodosLa muestra del estudio consta de 47 pacientes en situación de incapacidad temporal por dolor lumbar (DL). Fueron evaluados mediante un test de dinamometría isométrica, una prueba cinemática y una valoración del fenómeno FR.Se plantean dos experimentos con curvas ROC. El primero, con 47 pacientes que efectuaron de modo consecutivo el test FR con ambos tipos de electrodos, utilizándose como variable de clasificación el punto de corte conocido para los e. bipolares (2,49uV). En el segundo, con los datos de la EMGs registrados con e. tetrapolares en 17 pacientes, se efectúa un test de DeLong que compara las 2 curvas ROC que construimos, por un lado, al clasificar la muestra desde pruebas de dinamometría y cinemática, y por el otro, al clasificarlos con los valores de la EMGs bipolar.ResultadosUn total de 34 pacientes completaron adecuadamente las valoraciones del primer experimento y 17 pacientes el segundo. El primer estudio arroja un punto de corte de 1,2uV, con un AUC del 87,7%; sensibilidad 84,2% y especificidad 80%. El segundo muestra un PC para los e. bipolares de 1,21uV (AUC 87,5%) y para los e. tetrapolares de 1,43 (AUC 82,5%) con un test de DeLong sin diferencias significativas entre ambas curvas (p>0,4065).ConclusionesLa metodología de validación con curvas ROC ha permitido obtener un nuevo PC para la prueba FR de modo práctico, simplemente simultaneando ambos test sobre el mismo grupo de pacientes hasta obtener una muestra significativa. (AU)

Introduction and objective: To obtain a new cut-off point (CP) for a lumbar flexion-relaxation (RF) test established with tetrapolar (e.) electrodes, from values already defined with bipolar devices.Materials and methodsThe study sample consists of 47 patients in a situation of temporary disability due to low back pain (DL). They were evaluated by means of an isometric dynamometry test, a kinematic test and an assessment of the FR phenomenon.Two experiments with ROC curves are proposed. The first, with 47 patients who consecutively performed the RF test with both types of electrodes, using the cut-off point (CP) known for the e. bipolar (2.49μV). In the second, with the EMG data recorded with e. tetrapolar in 17 patients, a DeLong test was performed that compares the 2 ROC curves that were constructed on the one hand, by classifying the sample from dynamometry and kinematic tests, and on the other, by classifying them with the bipolar EMG values.ResultsA total of 34 patients adequately completed the evaluations of the first experiment and 17 patients the second. The first study shows a cut-off point of 1.2μV, with an AUC of 87.7%; Sensitivity 84.2% and Specificity 80%. The second shows a PC for e. bipolars of 1.21μV (AUC 87.5%) and for e. tetrapolar values of 1.43 (AUC 82.5%) with a DeLong test without significant differences between both curves (p>0.4065).ConclusionsThe validation methodology with ROC curves has made it possible to obtain a new PC for the RF test in a practical way, simply by simultaneously performing both tests on the same group of patients until a significant sample is obtained. (AU)

[Validation of the flexion-relaxation test to define a lumbar deficit with tetrapolar electrodes]. / Validación de test de flexión-relajación para definir un déficit lumbar con electrodos tetrapolares.

INTRODUCTION AND OBJECTIVE: To obtain a new cut-off point (CP) for a lumbar flexion-relaxation (RF) test established with tetrapolar (e.) electrodes, from values already defined with bipolar devices. MATERIALS AND METHODS: The study sample consists of 47 patients in a situation of temporary disability due to low back pain (DL). They were evaluated by means of an isometric dynamometry test, a kinematic test and an assessment of the FR phenomenon. Two experiments with ROC curves are proposed. The first, with 47 patients who consecutively performed the RF test with both types of electrodes, using the cut-off point (CP) known for the e. bipolar (2.49µV). In the second, with the EMG data recorded with e. tetrapolar in 17 patients, a DeLong test was performed that compares the 2 ROC curves that were constructed on the one hand, by classifying the sample from dynamometry and kinematic tests, and on the other, by classifying them with the bipolar EMG values. RESULTS: A total of 34 patients adequately completed the evaluations of the first experiment and 17 patients the second. The first study shows a cut-off point of 1.2µV, with an AUC of 87.7%; Sensitivity 84.2% and Specificity 80%. The second shows a PC for e. bipolars of 1.21µV (AUC 87.5%) and for e. tetrapolar values of 1.43 (AUC 82.5%) with a DeLong test without significant differences between both curves (p>0.4065). CONCLUSIONS: The validation methodology with ROC curves has made it possible to obtain a new PC for the RF test in a practical way, simply by simultaneously performing both tests on the same group of patients until a significant sample is obtained.

Anxiety towards Statistics and Its Relationship with Students' Attitudes and Learning Approach.

Many university students have difficulties when facing statistics related tasks, leading to an increase in their levels of anxiety and poor performance. Researchers have identified negative attitudes towards statistics, which have been shaped through students' secondary education experience, as a major driver for their failure. In this study we want to uncover the causal recipes of attitudes leading to high and low levels of anxiety in secondary education students, and the role that the learning approach plays in these relationships. We used fuzzy sets comparative qualitative analysis (fsQCA) in a sample of 325 students surveyed on the multifactorial scale of attitudes toward statistics (MSATS) and the revised two factor study process questionnaire (R-SPQ-2F). The results indicate that, respectively, a high or a low level of self-confidence is the most important and a sufficient condition by itself for achieving a low or a high level of anxiety, while the learning approaches and other attitudes are only present in other causal combinations that represent a small number of cases.

El fenómeno de flexión-relajación lumbar como test diagnóstico en la evaluación de un déficit lumbar. Sensibilidad y especificidad / The lumbar flexion-relaxation phenomen as a diagnostic test in assessment of lumbar impairment. Sensitivity and specificity

OBJETIVO: Definir el papel del fenómeno de flexión-relajación (FR), valorado mediante ratios (FRR), como test diagnóstico para definir una situación de déficit (impairment) en pacientes con dolor lumbar crónico (DLC). MATERIAL Y MÉTODO: La muestra del estudio consta de 180 sujetos, 16 voluntarios sanos y 164 pacientes en situación de incapacidad laboral por DLC, que fueron remitidos consecutivamente desde enero de 2012 a diciembre de 2017 para su valoración al laboratorio de biomecánica de una mutua de accidentes de trabajo. Las evaluaciones consistieron en un test de dinamometría isométrica, una prueba cinemática y una valoración del fenómeno FR. Se establecieron unos criterios mínimos en la ejecución de los test para ser aceptados como pruebas válidas para el estudio. El estado de déficit lumbar o de recuperación clínica en un paciente se definió a partir de los test de dinamometría y de cinemática. La respuesta FR se valoró con los FRR. Se tomaron un total de 4 ratios diferentes para el análisis con curvas ROC. RESULTADOS: Se obtuvieron 86 pruebas válidas (16 clasificadas como déficit lumbar y 71 como casos recuperados). La mejor ratio obtiene un área bajo la curva ROC de 0,87, una S: 0,84 y una E: 0,87 para identificarlos y un valor predictivo positivo del 97%. CONCLUSIONES: El test FR guarda con las evaluaciones de dinamometría y de cinemática una alta coherencia para objetivar una situación de déficit, siendo este una prueba de fácil ejecución por parte de los pacientes con DLC

OBJECTIVE: To define the role of the flexion-relaxation phenomenon (FRP), assessed through ratios (FRR), as a diagnostic test to define impairment in patients with chronic low back pain (CLBP). MATERIAL AND METHOD: The study sample consisted of 180 participants (16 healthy volunteers and 164 patients on work disability due to CLBP), who were consecutively referred for evaluation at the Biomechanics Laboratory of a workplace accident insurance company from January 2012 to December 2017. The evaluations consisted of an isometric dynamometry test, a kinematic test and assessment of the FRP phenomenon. Minimum criteria were established in the performance of the tests for their acceptance as valid for the study. Lumbar impairment or clinical recovery was defined on the basis of the results of the dynamometry and kinematic tests. The FRP response was assessed with FRRs. A total of 4 different ratios were taken for analysis with ROC curves. RESULTS: A total of 86 valid tests were obtained (16 classified as lumbar impairment and 71 as recovered cases). The best ratio obtained an area under the ROC curve of 0.87, with a sensitivity of 0.84, a specificity of 0.87, and a positive predictive value of 97%. CONCLUSION: The FRP test, along with dynamometry and kinematic evaluations, is effective in identifying lumbar impairment and is the easiest test for patients with CLBP to perform

[The lumbar flexion-relaxation phenomen as a diagnostic test in assessment of lumbar impairment. Sensitivity and specificity]. / El fenómeno de flexión-relajación lumbar como test diagnóstico en la evaluación de un déficit lumbar. Sensibilidad y especificidad.

OBJECTIVE: To define the role of the flexion-relaxation phenomenon (FRP), assessed through ratios (FRR), as a diagnostic test to define impairment in patients with chronic low back pain (CLBP). MATERIAL AND METHOD: The study sample consisted of 180 participants (16 healthy volunteers and 164 patients on work disability due to CLBP), who were consecutively referred for evaluation at the Biomechanics Laboratory of a workplace accident insurance company from January 2012 to December 2017. The evaluations consisted of an isometric dynamometry test, a kinematic test and assessment of the FRP phenomenon. Minimum criteria were established in the performance of the tests for their acceptance as valid for the study. Lumbar impairment or clinical recovery was defined on the basis of the results of the dynamometry and kinematic tests. The FRP response was assessed with FRRs. A total of 4 different ratios were taken for analysis with ROC curves. RESULTS: A total of 86 valid tests were obtained (16 classified as lumbar impairment and 71 as recovered cases). The best ratio obtained an area under the ROC curve of 0.87, with a sensitivity of 0.84, a specificity of 0.87, and a positive predictive value of 97%. CONCLUSIONS: The FRP test, along with dynamometry and kinematic evaluations, is effective in identifying lumbar impairment and is the easiest test for patients with CLBP to perform.

Fiabilidad del fenómeno de flexión-relajación cervical. Factores que definen el protocolo de valoración / Reliability of the cervical flexion-relaxation phenomenon. Factors defining an assessment protocol

Introducción: El fenómeno de flexión-relajación en columna cervical (FRc) no tiene la misma difusión clínica que el test lumbar. La respuesta de los músculos cervicales es menos evidente. Tanto el protocolo de evaluación como la instrumentación utilizada tienen influencia para alcanzar un valor de fiabilidad con validez clínica. Se plantea un estudio test-retest en 3 condiciones distintas, para definir un protocolo de valoración idóneo. Material y método: Se evalúan 3 grupos con 9, 11 y 10 voluntarios, respectivamente, en un test-retest efectuado con un intervalo entre 7 a 14 días. En el grupo i, se evalúa la prueba con electromiografía de superficie (EMGs) bipolar, sin control del movimiento. Para el grupo ii se usa electrodo bipolar, con control de la velocidad de ejecución y una leve ayuda para estabilizar el tronco. En el grupo iii, se controla la velocidad, se aumenta la estabilización y se usa un electrodo tetrapolar. Como variables de resultado se toman la ratio de flexión-relajación y su logaritmo neperiano. Se efectúa un test sentado con el tronco recto y otro en flexión a 45°. Resultados: Para el grupo iii las 4 variables obtienen valores en el coeficiente de correlación intraclase (ICC > 0,80). En el grupo ii, el ICC estaba comprendido entre 0,3-0,6. Para el grupo i, las 4 variables fueron muy inferiores a 0,3. Conclusión: Con una adecuada estabilización de la postura, control de la velocidad y adecuada instrumentación de la prueba, puede objetivarse una respuesta de FRc. Definir un protocolo fiable permite avanzar en el uso clínico del test

Introduction: The cervical flexion-relaxation phenomenon (FRP) is not as well-known as the lumbar test. The response of the cervical muscles is less evident. Both the ASSESSMENT protocol and the instrumentation used influence the achievement of a reliability value with clinical validity. We conducted a test-retest study in 3 different conditions, to define a suitable assessment protocol. Material and method: Three groups were evaluated with 9, 11 and 10 volunteers, respectively, in a test-retest study with an interval between 7 and 14 days. In group i, the test was assessed with a bipolar electrode of surface electromyography (EMGs) and without movement control. In group ii, we used a bipolar electrode, the speed of the movement was controlled and we introduced a slight help to stabilise the trunk. In group iii, speed was controlled, stabilisation was increased and a four-pole electrode was used. As outcome variables, we took the flexion-relaxation ratio and its neperian logarithm. A sitting test was performed with the trunk straight and another was conducted with 45° flexion. Results: In group iii, the 4 variables obtained intraclass correlation coefficient values with clinical validity (ICC > 0.80). In group ii, the ICC ranged from 0.3-0.6. In group i, the 4 variables were much lower than 0.3 Conclusion: A valid cervical FRP can be obtained with good stabilisation of posture, control of speed and suitable instrumentation of the test. Definition of a reliable protocol would increase the clinical use of the test

Evaluation of the feeding value of Dichrostachys cinerea pods for fattening pigs in Cuba.

Dichrostachys cinerea (L.) Wight & Arn. is a tropical leguminous shrub widely regarded as an invasive species in Cuba, after having invaded a significant proportion of its arable land during the past decades. Concurrently, smallholder pig producers are highly constrained by the scarcity of protein feeds. This study aimed to assess the feeding value of D. cinerea pod meal (DCPM) as an alternative protein supplement for pigs in Cuban smallholder production systems. An on-farm feeding trial was carried out with three groups (N = 10) of growing-fattening pigs over 60 days, where DCPM replaced 0, 15, and 30% in DM of a dietary commercial concentrate. Then, in an in vivo digestibility trial with eight growing pigs, apparent digestibilities of DCPM were determined for dry matter (DM), organic matter (OM) and crude protein (CP). Finally, in vitro digestibilities for OM (fecal and ileal) and CP (ileal) were determined. In the feeding trial, pig body weight gains were not affected by increased dietary substitution levels of concentrate for DCPM. Blood parameters, with a few exceptions, did not show significant differences among groups. Values for in vivo OM and CP digestibilities were 40.81 and 50.26%, and substantially higher than in vitro values. In conclusion, our results showed that at least 30% of DM in commercial concentrate could be substituted by DCPM without affecting pig growth performances under Cuban smallholder conditions. The low digestibility of DCPM is, however, not acceptable for intensive pig production systems. In vitro enzyme digestibility methods developed for commercial pig feeds are not suitable for DCPM without further calibration.

Effect of Tamarindus indica L. leaves' fluid extract on human blood cells.

Tamarind leaves are edible; however, their saponin content could be toxic to human blood cells. In this article, the effect of tamarind leaf fluid extract (TFE) on human blood cells was evaluated by using several tests. Results revealed that TFE did not cause significant haemolysis on human red blood cells even at the lowest evaluated concentration (20 mg/mL). Blood protein denaturalisation ratio was consistently lower than in control at TFE concentrations greater than 40 mg/mL. Erythrocyte membrane damage caused by the action of oxidative H2O2 displayed a steady reduction with increasing TFE concentrations. In the reactive oxygen species (ROS) measurement by using flow cytometry assay, leucocyte viability was over 95% at tested concentrations, and a high ROS inhibition was also recorded. Protective behaviour found in TFE should be attributed to its polyphenol content. Thus, tamarind leaves can be regarded as a potential source of interesting phytochemicals.

Phaeohyphomycosis fungal infections in solid organ transplant recipients: clinical presentation, pathology, and treatment.

BACKGROUND: Dematiaceous, or dark-pigmented, fungi are known to cause infections such as phaeohyphomycosis, chromoblastomycosis, and mycetoma. These fungi are becoming increasingly important opportunistic pathogens in solid organ transplant recipients (SOTR). We present a retrospective chart review of 27 SOTR who developed phaeohyphomycosis infections post transplant from 1988 to 2009. METHODS: Cases were reviewed for fungal species isolated, date and source of culture, immunosuppressive and fungal therapy used, and outcome. The majority of isolates obtained were from the skin and soft tissue, with 3 pulmonary and brain abscesses. RESULTS: The time from transplantation to onset of infection ranged from 2 months to 11 years. The species isolated were Exophiala (11), Ochroconis (3), Alternaria (2), Phoma (2), Wangiella (1), Cladosporium (1), Aureobasidium (1), Chaetomium (1), Coniothyrium (1), and non-sporulating fungi (2). An additional 4 patients had infections confirmed by pathology, but no cultures were done. Most of the affected skin lesions were surgically debrided and treated with itraconazole; 2 patients were treated with voriconazole and 2 with amphotericin D. Death from fungal disease occurred only in patients with pulmonary and brain abscesses. CONCLUSIONS: As the number of SOTR increases, so does the incidence of fungal infections in that population. Surgery, along with antifungal therapy and a reduction in immunosuppression, are the cornerstones of treatment.

Familial hypobetalipoproteinemia: analysis of three Spanish cases with two new mutations in the APOB gene.

Extremely low LDL-cholesterol concentrations are very unusual and generally related with comorbidities accompanying malnutrition. Less frequently low LDL-cholesterol levels result from mutations in the APOB, PCSK9, ANGPTL3, SAR1B and MTTP genes (primary hypobetalipoproteinemia). We investigated three patients with plasma LDL-cholesterol levels below the fifth percentile of the Spanish population. We recorded data on demographic and anthropometric characteristics, life style habits, physical examination, liver ultrasound and lipid and lipoprotein levels, in the probands and their first-degree relatives. Secondary causes of hypocholesterolemia were ruled out by clinical study, complementary tests and follow-up. The APOB, MTTP and SAR1B genes were sequenced. Patients were found to be heterozygotes for point mutations located in the exon 26 of the APOB gene. One patient, with fatty liver, carried a previously described mutation (c.7600C>T) (Arg2507X), causing the formation of truncated Apo B-55.25. The other two mutations producing truncations are new. One asymptomatic patient carried the Arg3672X (Apo B-80.93) and the other with fatty liver and steatorrhea carried the Ser2184fsVal2193X (Apo B-48.32). Our study reinforces the concept that in the heterozygous carriers of truncated Apo Bs, the clinical manifestations of FHBL are dependent on the size of the truncations.

Efficacy and safety of maribavir dosed at 100 mg orally twice daily for the prevention of cytomegalovirus disease in liver transplant recipients: a randomized, double-blind, multicenter controlled trial.

Maribavir is an oral benzimidazole riboside with potent in vitro activity against cytomegalovirus (CMV), including some CMV strains resistant to ganciclovir. In a randomized, double-blind, multicenter trial, the efficacy and safety of prophylactic oral maribavir (100 mg twice daily) for prevention of CMV disease were compared with oral ganciclovir (1000 mg three times daily) in 303 CMV-seronegative liver transplant recipients with CMV-seropositive donors (147 maribavir; 156 ganciclovir). Patients received study drug for up to 14 weeks and were monitored for CMV infection by blood surveillance tests and also for the development of CMV disease. The primary endpoint was Endpoint Committee (EC)-confirmed CMV disease within 6 months of transplantation. In a modified intent-to-treat analysis, the noninferiority of maribavir compared to oral ganciclovir for prevention of CMV disease was not established (12% with maribavir vs. 8% with ganciclovir: event rate difference of 0.041; 95% CI: -0.038, 0.119). Furthermore, significantly fewer ganciclovir patients had EC-confirmed CMV disease or CMV infection by pp65 antigenemia or CMV DNA PCR compared to maribavir patients at both 100 days (20% vs. 60%; p < 0.0001) and at 6 months (53% vs. 72%; p = 0.0053) after transplantation. Graft rejection, patient survival, and non-CMV infections were similar for maribavir and ganciclovir patients. Maribavir was well-tolerated and associated with fewer hematological adverse events than oral ganciclovir. At a dose of 100 mg twice daily, maribavir is safe but not adequate for prevention of CMV disease in liver transplant recipients at high risk for CMV disease.

Medición de resultados del tratamiento funcional de las fracturas metatarsianas mediante la escala AOFAS y la duración de la incapacidad laboral / Measurement of the results of functional treatment of metatarsal fractures using the AOFAS scale and the duration of work incapacity

Objetivo. Mostrar la efectividad del tratamiento funcional de las fracturas metatarsianas consistente en apoyo completo inmediato o precoz sin inmovilización. Material y método. Se estudian de manera prospectiva 276 individuos con fracturas metatarsianas simples o complejas tratadas con el método funcional, consistente en realizar apoyo sin inmovilización de manera inmediata (antes del tercer día de la lesión) o precoz (desde el 3.° al 21.° día de la fractura). Los criterios de inclusión fueron pacientes de 16 a 65 años, de ambos sexos, con fractura cerrada y abierta grado I de metatarsianos, aislada o múltiple, que realizaron carga efectiva en los primeros 21 días. Se analizaron los efectos de la inyección de esteroide en foco propuesta para este tratamiento, el tiempo de descarga, la rehabilitación, el tipo de trabajo desempeñado por el paciente y el número de metatarsianos fracturados. Los resultados se evaluaron mediante la escala AOFAS (American Orthopaedic Foot and Ankle Society), la duración de la incapacidad laboral y las complicaciones del tratamiento. Resultados. Se obtuvo una puntuación excelente en la escala AOFAS y un bajo grado de complicaciones. Discusión. Este método se fundamenta en la función de sostén del sistema músculo-ligamentario y el uso de un zapato con suela rígida, que permiten un apoyo precoz sin desplazamiento secundario. La carga inmediata proporciona mejor resultado que la diferida, y la infiltración de esteroide no aporta beneficios. Conclusiones. Proponemos el método funcional como tratamiento para todas las fracturas cerradas del metatarso desplazadas o no, excepto para las fracturas desplazadas de la base del quinto metatarsiano (AU)

Objective. To demonstrate the effectiveness of functional treatment for the fractures of the metatarsal, which consisted of immediate or early weight bearing without immobilisation. Material and methodology. We prospectively studied 276 patients with simple or complex fractures of the metatarsal, treated with a functional method which consisted of immediate (before the 3rd day since the fracture) or early (between 3rd and 21st day) effective weight bearing. Inclusion criteria were patients aged 16-65, both sexes, diagnosed with isolated or multiple, closed or opened type I metatarsal fractures who did weight bearing exercises during the first 21 days. We analysed the effects of the steroid injection proposed for this treatment in the focus of the fracture, the days of weight bearing, rehabilitation and number of metatarsal fractures. Results were evaluated using AOFAS (American Orthopaedic Foot and Ankle Society) scores, days of work incapacity and complications of the treatment. Results. The AOFAS score for patients treated functionally was excellent and we found few complications with it. Discussion. The functional method is based on the function of ligaments and muscles of the forefoot and the aid of a rigid-soled shoe which allows early weight-bearing to avoid secondary displacement of the fractures. The results show that immediate weight bearing provides better results than delayed bearing. Injection of steroid does not appear to have any benefit. Conclusions. We propose the functional method for all closed displaced or non-displaced metatarsal fractures, except for the displaced fractures on the base of the fifth metatarsal (AU)

[Measurement of the results of functional treatment of metatarsal fractures using the AOFAS scale and the duration of work incapacity]. / Medición de resultados del tratamiento funcional de las fracturas metatarsianas mediante la escala AOFAS y la duración de la incapacidad laboral.

OBJECTIVE: To demonstrate the effectiveness of functional treatment for the fractures of the metatarsal, which consisted of immediate or early weight bearing without immobilisation. MATERIAL AND METHODOLOGY: We prospectively studied 276 patients with simple or complex fractures of the metatarsal, treated with a functional method which consisted of immediate (before the 3(rd) day since the fracture) or early (between 3(rd) and 21(st) day) effective weight bearing. Inclusion criteria were patients aged 16-65, both sexes, diagnosed with isolated or multiple, closed or opened type I metatarsal fractures who did weight bearing exercises during the first 21 days. We analysed the effects of the steroid injection proposed for this treatment in the focus of the fracture, the days of weight bearing, rehabilitation and number of metatarsal fractures. Results were evaluated using AOFAS (American Orthopaedic Foot and Ankle Society) scores, days of work incapacity and complications of the treatment. RESULTS: The AOFAS score for patients treated functionally was excellent and we found few complications with it. DISCUSSION: The functional method is based on the function of ligaments and muscles of the forefoot and the aid of a rigid-soled shoe which allows early weight-bearing to avoid secondary displacement of the fractures. The results show that immediate weight bearing provides better results than delayed bearing. Injection of steroid does not appear to have any benefit. CONCLUSIONS: We propose the functional method for all closed displaced or non-displaced metatarsal fractures, except for the displaced fractures on the base of the fifth metatarsal.

Estudio comparativo del tratamiento clásico y funcional de las fracturas metatarsianas / A comparative study of the traditional and functional treatment of the metatarsal fractures

Objetivo: Demostrar la efectividad del tratamiento funcional de las fracturas del metatarso comparando dicho método con los tratamientos clásicos ortopédico-conservador y quirúrgico. Material y metodología: : Estudio del tratamiento de las fracturas metatarsianas aisladas o múltiples, cerradas o abiertas grado I de Gustilo en pacientes de ambos sexos y edad comprendida entre 16 y 65 años, donde 276 fueron tratados con un método funcional consistente en carga efectiva sin inmovilización de manera inmediata o precoz, y 262 con inmovilización o cirugía. Se analizó el tipo de fractura, la característica del trabajo habitual, la incapacidad temporal o baja laboral (IT) y las complicaciones de los diferentes tratamientos. Resultados: Los pacientes tratados con el método funcional permanecieron menos tiempo de baja laboral y sufrieron menos complicaciones que los que se trataron con los métodos tradicionales. Conclusión: Los buenos resultados obtenidos permiten generalizar el tratamiento funcional para las fracturas cerradas del metatarso (AU)

Objective: To demonstrate the efficacy of functional treatment of metatarsal fractures comparing this method with traditional orthopedic-conservative and surgical treatments. Material and Methods: Study on treatment of isolated or multiple, closed or open Gustilo grade I metatarsal fractures in patients of both sexes. One group consisted of 276 patients treated with a functional method, with effective loading without immediate or early immobilization, and the other was a control group of 262 patients treated with immobilization or surgery. Age ranged from 16 and 65 years. Type of fracture, usual job characteristics, duration of the temporary disability or sick leave (TD) and the complications of the different treatments were analyzed. Results: Patients treated with the functional method remained on sick leave for a shorter period and suffered fewer complications than those treated with traditional methods. Conclusion: The good results obtained allow functional treatment of closed metatarsal fractures on general basis (AU)

[Coronary calcification and subclinical myocardial dysfuncion in rheumatoid arthritis]. / Calcificación coronaria y disfunción miocárdica subclínica en la artritis reumatoide.

Rheumatoid arthritis (RA) is characterized by high cardiovascular (CV) mortality, which has been related to systemic inflammation. Our aim was to analyze coronary calcification by computed tomography and subclinical myocardial dysfunction evaluated by brain natriuretic peptide (BNP) levels and an electrocardiogram in RA patients and its relationship with disease characteristics. Seventy-three RA patients and same number of controls formed by osteoarthritis patients were studied, all without a background of cardiovascular clinical events. RA patients had a higher calcium score than the control group (19.2% vs. 11%; p=0.17)), this being associated with disease duration. BNP levels (90.0 vs. 45.4; p=0.003), corrected QT length, large QT frequency and silent myocardial infarct were higher in the RA group. In conclusion, RA patients showed more coronary calcification frequency than in general population and more biochemical and electrocardiogram myocardial subclinical dysfunction signs.

Clinical utility of a combination of tumour markers in the diagnosis of malignant pleural effusions.

BACKGROUND: The aim of the present study was to evaluate the diagnostic value of the tumour markers carcinoembryonic antigen (CEA), carbohydrate antigens CA 125, CA 15.3, CA 19.9 and tumor-associated glycoprotein 72 (TAG 72) in the pleural fluid (PF) of patients with pleural effusions of different etiologies. PATIENTS AND METHODS: One hundred and fifty-five patients with pleural effusions (40 malignant, 84 benign and 31 paraneoplastic) were studied prospectively. The concentration of the tumour markers in serum and PF were measured by magnetic particle enzyme immunoassay. The PF to serum (PF/S) concentration ratios were calculated. RESULTS: The concentrations of CEA, CA 15.3, CA 19.9 and TAG 72 in PF and the PF/serum ratios were significantly higher in effusions of malignant and paraneoplastic origin than in those of benign origin. The receiver operating characteristic (ROC) curves were calculated for each marker and the diagnostic cut-off point was selected as the value that offered a specificity of 100% (CEA: 6.5 ng/ml; CA 15.3:62.4 IU/l; TAG 72:10.9 IU/l). CEA presented the greatest sensitivity [45% in the malignant group, 38.7% in the paraneoplastic group, and 41.4% in the pooled group (combined malignant and paraneoplastic)]. TAG 72 presented the largest area under the curve (0.89 in the malignant group and 0.80 in the pooled group). The diagnostic efficacy of the PF/S ratios was not better than measurement of the tumour markers in pleural fluid. The highest diagnostic accuracy for the diagnosis of malignant pleural effusions was achieved by grouping the markers in a panel comprising CEA, CA 15.3 and TAG 72; this showed a sensitivity of 75% and a negative predictive value of 79.1% . In the subgroup of patients with negative cytology, the sensitivity was 41.2% for CEA, 35.5% for CA 15.3 and 33.3% for TAG 72. The combination of these three markers achieved a sensitivity of 84.6%. CONCLUSION: The combined measurement of CEA, CA 15.3 and TAG 72 in pleural fluid is a useful complementary test in the differential diagnosis of pleural effusions of malignant origin.

Fracturas de metatarsianos tratadas sin inmovilización y con carga inmediata / Metatarsal fractures treated with no immobilization and inmediate weight bearing

Objetivo: Evaluar el resultado del tratamiento de las fracturas de metatarsianos con carga inmediata y completa. Población y metodología: Se estudiaron 101 pacientes con fractura de uno o varios metatarsianos, con o sin desplazamiento, en un rango de edad entre 15 y 61 años, y un predominio de los varones (87 casos). Las fracturas fueron tratadas con carga completa y precoz, según la tolerancia del paciente. La carga inmediata, 2 o menos días después del accidente, se empleó en 65 pacientes (64,35%); la carga diferida, entre 2 días y 3 semanas, en 36 casos (35,64%). En 66 casos se infiltró el foco de fractura con 2 cc de corticoide (infiltración en foco: 66 pacientes (65,34%). En las restantes 35 fracturas (34,65%) se comenzó la carga sin infiltración. Para la evaluación utilizamos la escala de valoración del metatarso de Kitaoka al mes del alta considerando también la duración de la incapacidad temporal y las complicaciones. Resultados: Se reincorporaron a su trabajo habitual 95 pacientes; 5 continuaron realizando su actividad laboral desde el inicio (sin baja). Un caso con fractura en la base del 5º MTT con diástasis que requirió posterior tratamiento quirúrgico, no se ha detectado ninguna complicación. Conclusiones: el tratamiento propuesto constituye una alternativa al tratamiento ortopédico, con inmovilización enyesada y descarga, e incluso al tratamiento quirúrgico (AU)

Objetive: to evaluate the outcome of the metatarsal fractures treatment with immediate weight-bearing with neither cast nor surgery. Material and Methods: We prospectively studied 101 patients, 87 male and 14 female ranged between 15-61 years, affected on displaced/non displaced metatarsal fractures. Sixty-five patients were treated with early (less than 2 days) and complete weight bearing after injury and 36 patients with later weight-bearing, (between 2 days and 3 weeks). Sixty-sex patients received a steroid injection in the fracture focus proceeding to weight bearing as well. For the evaluation of the results we used the Kitaoka score one month after the reinsertion to their labour activities. Results: Ninty-five patients returned to the same work, 5 did not give up working and one patient with a severe displaced fracture on the base of the 5th metatarsal surgery was necessary. Conclusions: the early and complete weight-bearing treatment is an alternative for the conservative and surgical treatment of the metatarsal fractures (AU)

Phosphocalcic metabolism after biliopancreatic diversion.

BACKGROUND: Malabsorptive techniques to treat morbid obesity have been followed by alterations in phosphocalcic metabolism. Knowledge of the preoperative situation is important to assess the influence of these techniques on phosphocalcic metabolism and to consider treatments for these alterations. METHODS: 61 consecutive morbidly obese patients (50 women, 11 men, age 19 to 63 years) having had biliopancreatic diversion (BPD) were studied in a prospective manner. Preoperative and postoperative levels of calcium, phosphorus, 25-hydroxyvitamin D, tartrate resistant acid phosphate, plasma parathormone (PTH), tubular absorption of phosphate, and urinary calcium and pyridinolines were analyzed, as well as the potential risk factors for their alterations. Follow-up of all patients was a minimum of 4 years. RESULTS: Before BPD, 42.3% of patients presented an increase in PTH and 54% a decrease in the 25-OH vitamin D, but the values of calcium and plasma phosphorus maintained at normal level. 81.8% of the patients with an increase in the PTH maintained high levels after BPD, while 60% of those with a normal preoperative PTH also presented hyperparathyroidism 4 years after the intervention. A correlation between the levels of plasma PTH and body mass index was not found. CONCLUSION: Morbid obesity is accompanied by a high percentage of hyperparathyroidism. BPD produces malabsorption of vitamin D during the first years, favoring the persistence or appearance of hyperparathyroidism. It is important to recognize and treat the secondary hyperparathyroidism. The postoperative period could necessitate more energetic interventions to get more efficient control of the phosphocalcic metabolism.

Dinamometría isocinética / Isokinetic dynamometer

El método isocinético se puede definir como un sistema de evaluación que utiliza la tecnología informática y robótica para obtener y procesar en datos cuantitativos la capacidad muscular. Actualmente, es el sistema más adecuado para evaluar de forma objetiva la fuerza muscular, en términos de parámetros físicos (momento de fuerza, trabajo y potencia). Los isocinéticos no son sólo un medio de reeducación y entrenamiento muscular, sino también un sistema adecuado para la evaluación y el diagnóstico en el campo de la biomecánica. Este artículo pretende dar una visión del amplio campo que supone la utilización de los isocinéticos como herramienta objetiva para evaluar la función muscular y de sus posibilidades como herramienta clínica. Mostramos una breve referencia de su reciente historia para, posteriormente, analizar los datos que se pueden obtener, así como la interpretación de los mismos. Finalizamos con la exposición esquemática de su aplicación según las distintas articulaciones

The isokinetic method can be defined as an assessment system that uses computer and robotic technology to obtain and process muscular capacity in quantitative data. It is presently the most adequate system to objectively assess muscular force, in terms of physical parameters (force moment, work and potency). Isokinetics not only are a means for muscular reeducation and training, but also an adequate system for assessment and diagnosis in the field of biomechanics. A view of the wide field which the use of isokinetics has as an objective tool to assess muscle function and its possibilities as a clinical tool is shown. We provide a brief reference of its recent history to then analyze the data that may be obtained and the interpretation of these. We finish with the schematic presentation of its application according to the different joints

[Diagnostic efficacy of fine needle aspiration biopsy in patients with thyroid nodular disease. Analysis of 510 cases]. / Eficacia diagnóstica de la punción-aspiración con aguja fina en pacientes con patología nodular tiroidea. Análisis de 510 casos.

INTRODUCTION: The prevalence of palpable thyroid nodules in the general population is 4%-7%. Although most are benign, 5% are carcinomas. This study aimed to assess the efficacy of fine needle aspiration biopsy (FNAB) of thyroid nodules to diagnose malignancy and know the benefit of repeating the FNAB in the same nodule. PATIENTS AND METHODS: A total of 510 patients (431 women and 79 men; mean age [standard deviation]: 47.6 [14.3] years) with surgery due to thyroid nodular condition between 1989 and 2002 and who had at least one FNAB prior to the surgery were studied. RESULTS: The first FNAB was benign in 312 patients (61.2%), malignant in 38 (7.5%), suspicious or indeterminate in 97 (19%) and insufficient in 63 (12.4%). Sensitivity and specificity in the first FNAB for malignancy diagnosis was 76% and 84%, respectively. Successive FNABs had a moderate concordance and significance. However, repeating the puncture did not improve diagnostic performance, since sensitive increased (84%), but specificity worsened (79%) and the area under the ROC curve was similar. In the group with suspicious or indeterminate FNAB, histology was benign in 70% and malignant in 30%. CONCLUSIONS: FNAB sensitivity and specificity for diagnosis of malignancy in thyroid nodules are high. Repetition of puncture on the same nodule does not improve diagnostic performance of the cytology. Among patients with suspicious FNAB, there is a high proportion of malignancy, which makes surgery necessary in these cases.