Uso de la balneoterapia y el ejercicio terapéutico en la mejora física y psicosocial en adolescentes con lupus y artritis juvenil: un estudio de método mixto / Use of balneotherapy and therapeutic exercise in physical and psychosocial improvement in adolescents with lupus and juvenile arthritis: A mixed method study

Antecedentes y objetivo: Evaluar los cambios a nivel físico y psicosocial de una intervención combinada de balneoterapia y ejercicio terapéutico en grupo aplicado en jóvenes con lupus eritematoso sistémico y artritis idiopática juvenil. Materiales y métodos: Estudio longitudinal prospectivo pre y postintervención y cualitativo fenomenológico descriptivo. La intervención consistió en un programa combinado de balneoterapia, ejercicio terapéutico en grupo y terapia manual e instrumental. Se evaluaron el dolor percibido (Escala Visual Analógica), el estado funcional (Health Assessment Questionnaire) y la fatiga (Escala de Evaluación Funcional de Terapia de Enfermedades Crónicas-Fatiga). Las entrevistas se analizaron mediante análisis temático. Resultados: Quince adolescentes de 14,1±2,1 años participaron en el estudio. Se observó una mejoría significativa respecto al dolor máximo (p=0,006; TE=1,1), dolor medio (p=0,029; TE=0,5) y estado funcional (p=0,013; TE=0,7). Sin embargo, a pesar de que la fatiga disminuyó, no se encontraron diferencias estadísticamente significativas (p=0,415; TE=0,3). Los temas principales surgidos tras las entrevistas fueron «una experiencia de aprendizaje» y «desventajas», que describen la vivencia de la intervención. Discusión y conclusiones: Parece que la combinación de balneoterapia y el ejercicio terapéutico en grupo es útil para reducir el dolor y mejorar la función física. Ensayos clínicos en diferentes poblaciones reportan resultados similares, hallando una disminución del dolor. Se concluye que la realización de un programa de fisioterapia combinado de balneoterapia y ejercicio terapéutico en grupo produce beneficios con relación al dolor y al estado funcional, favoreciendo además la ampliación de conocimientos y el automanejo de la enfermedad.

Background and objective: To evaluate the physical and psychosocial changes of a combined intervention of balneotherapy and therapeutic exercise applied in young people with systemic lupus erythematosus and juvenile idiopathic arthritis. Materials and methods: Pre- and post-intervention prospective longitudinal and descriptive phenomenological qualitative studies were conducted. The intervention consisted of a combined program of balneotherapy, therapeutic group exercise and physiotherapy techniques. Perceived pain (Visual Analogue Scale), functional status (Health Assessment Questionnaire), and fatigue (Chronic Disease Therapy-Fatigue Functional Assessment Scale) were assessed. The interviews were analysed using thematic analysis. Results: 15 adolescents aged 14.1±2.1 years participated in the study. A significant improvement was observed with respect to maximum pain (P=.006; ES=1.1), mean pain (P=.029; ES=0.5) and functional status (P=.013; ES=0.7). However, despite the decrease in fatigue, no statistically significant differences were found (P=.415; ES=0.3). The main themes that emerged after the interviews were “a learning experience” and “disadvantages of the intervention”. Discussion and conclusions: It seems that the combination of balneotherapy and therapeutic group exercise is effective in reducing pain and improving physical function. Randomized clinical trials performed in different populations report similar results, finding a decrease in pain. It is concluded that carrying out a physiotherapy program combined balneotherapy and therapeutic group exercise produces benefits in relation to pain and functional status, also favoring the expansion of knowledge and self-management of the disease.

Efectividad del ejercicio terapéutico y drenaje linfático manual en personas con síndrome pospoliomielitis que presentan sobrepeso y adiposidad abdominal: serie de casos / Effectiveness of exercise therapy and manual lymphatic drainage in people with post-polio syndrome who are overweight and abdominal adiposity: Case series

Antecedentes y objetivo En España casi 800.000 personas con discapacidad reconocen que no practican ejercicio, como por ejemplo, las personas que sufren un síndrome pospoliomielitis. Estas personas presentan secuelas como fatiga, debilidad y dolor muscular que, unidas a su sobrepeso y adiposidad abdominal, favorecen la presencia de alteraciones musculoesqueléticas. El objetivo de este estudio es valorar los efectos del ejercicio terapéutico y del drenaje linfático manual en una serie de casos de personas con síndrome pospoliomielitis que presentan sobrepeso y adiposidad abdominal. Descripción de los casos Ocho pacientes con síndrome pospoliomielitis, sobrepeso y adiposidad abdominal fueron incluidos. El protocolo se basó en un programa de ejercicio terapéutico progresivo, 3 veces al día, y una sesión de drenaje linfático manual según el método Vodder, una vez a la semana, durante 9 semanas. Peso e índice de masa corporal, valoración antropométrica de los pliegues cutáneos y perímetros, calidad de vida, actividad física en personas con discapacidad y cuestionario de satisfacción fueron las variables analizadas al inicio y a la finalización del programa. Resultados y discusión Los resultados muestran diferencias estadísticamente significativas respecto al peso (p=0,034) e índice de masa corporal (p=0,031), pliegues iliocrestales derecho (p=0,003) e izquierdo (p=0,007) y perímetros de cadera (p=0,005) y de cintura (p=0,024). Conclusión La combinación de ejercicio terapéutico y drenaje linfático manual en personas con síndrome pospoliomielitis podría ser útil para reducir el sobrepeso y la adiposidad a nivel abdomina (AU)

Background and objective In Spain, almost 800,000 people with disabilities do not exercise, such as, for example, people suffering post-polio syndrome. This population reports sequelae such as fatigue, weakness and muscle pain, accompanied by overweight and abdominal adiposity which play an important role in the presence of musculoskeletal disorders. The combination of exercise therapy and manual lymphatic drainage would be beneficial in these people. The objective of this study is to assess the effects of exercise therapy and manual lymphatic drainage in a case series of people with post-polio syndrome who are overweight and abdominal adiposity. Case description Eight patients with post-polio syndrome, overweight and with abdominal adiposity were included. The protocol consisted of a progressive abdominal exercise programme, three times a day and a lymphatic drainage session according to the Vodder method once a week for nine weeks. Weight and body mass index, anthropometric assessment of skin folds and perimeters, health questionnaire, physical activity in people with disabilities and satisfaction questionnaire were analysed at the baseline and after the programme. Results and discussion The results show statistically significant differences in weight (p=.034) and body mass index (p=.031), right (p=.003) and left iliac-crest skin folds (p=.007), and hip (p=.005) and waist perimeters (p=.024). A combination of exercise therapy and manual lymphatic drainage could be useful to reduce overweight and abdominal adiposity in people with post-polio syndrome (AU)

Myotonometry as a measure to detect myofascial trigger points: an inter-rater reliability study.

OBJECTIVE: Several diagnostic methods have been used in the identification of mechanical properties of skeletal muscle, including myofascial trigger points (MTrPs), however, they are not suitable for daily clinical use. Myotonometry offers an easy noninvasive alternative to assess these muscle properties. Nevertheless, previous research has not yet studied the mechanical properties of MTrPs by myotonometry. The purposes of this study were (1) to analyze the differences in the mechanical properties between latent MTrPs and their taut bands by myotonometry, (2) to investigate the inter-rater reproducibility of myotonometric measurements, and (3) to examine the association between myotonometry and passive isokinetic dynamometry. APPROACH: Fifty individuals (58% male; age 24.6 ± 7.9 years) with a latent medial MTrP of the right soleus muscle participated. The mechanical properties of this MTrP area of soleus muscle and its taut band area were measured using a myotonometer (MyotonPRO). Additionally, passive resistive torque and extensibility of triceps surae muscle were assessed using a Kin-Com dynamometer. MAIN RESULTS: Statistical analysis indicated higher values for the stiffness parameter in the taut band with respect to the MTrP (P < 0.05). The inter-rater reliability of the myotonometric measurements was good for all variables (ICC3,1 > 0.75). The standard error of measurement (SEM) and minimal detectable difference (MDD) indicated a small measurement error for frequency and stiffness variables (SEM% < 10%; MDD95% < 20%). Significant fair correlations between myotonometric parameters and passive isokinetic parameters ranged from -0.29 to 0.48 (P < 0.05). SIGNIFICANCE: The myotonometer was demonstrated to be a reliable tool and was able to quantify differences in the mechanical properties of myofascial tissues. The potential of this method for the assessment of myofascial pain syndromes requires further investigation.

Muerte materna por embolismo de líquido amniótico después de una cesárea. Patología obstétrica de alta morbilidad y mortalidad / Maternal death due to amniotic fluid embolism after cesarean section. Obstetric pathology with high morbimortality

Resumen OBJETIVO: reportar el caso de una paciente embarazada, a quien se le efectuó una cesárea por situación fetal transversa, con descompensación hemodinámica provocada por hemorragia posparto de origen desconocido y que finalizó en muerte materna. CASO CLÍNICO: gestante de 40 años, multípara, a quien se efectuó una cesárea por situación fetal transversa y posteriormente sufrió descompensación hemodinámica como consecuencia de hemorragia postparto. La paciente falleció y en la autopsia se confirmó, como causa de muerte, embolia de líquido amniótico. La embolia de líquido amniótico es una alteración extremadamente rara, asociada con el paso de componentes amnióticos y fetales a la circulación pulmonar materna. Su diagnóstico es poco frecuente, cuya confirmación se establece mediante autopsia en la mayoría de los casos.

Abstract OBJECTIVE: To report the clinical case of a pregnant patient, who underwent a cesarean section due to a transverse fetal situation, with hemodynamic decompensating caused by postpartum haemorrhage of unknown origin and ending in maternal death. CLINICAL CASE: a 40-year-old multiparous patient, who in the context of a caesarean section for fetal transverse situation, suffers hemodynamic decompensating as a result of postpartum hemorrhage. The patient died, whose autopsy later confirmed amniotic fluid embolism as the cause of death Amniotic fluid embolism is a condition of extreme gravity produced by the anaphylactic reaction and obstruction of maternal circulation, derived from the passage of amniotic fluid with cells, fetal hair, or mother fluids to the bloodstream.

Peritonectomía con quimioterapia intraperitoneal hipertérmica en el tratamiento del tumor de Krukenberg. A propósito de un caso clínico / Peritonectomy with hyperthermic intraperitoneal chemotherapy in the treatment of Krukenberg tumor. A clinical case

Resumen ANTECEDENTES: el tumor de Krukenberg es una neoplasia caracterizada por metástasis ováricas de origen digestivo. El diagnóstico se establece en estadios avanzados de la enfermedad, mediante pruebas de imagen y determinación de marcadores inmunorreactivos relacionados con enfermedades del aparato digestivo. En la mayoría de los casos existe afectación bilateral en ambos anejos. OBJETIVO: reportar el caso de una paciente con tumor de Krukenberg. CASO CLÍNICO: paciente de 41 años de edad, intervenida de cáncer de mama hacía 10 años como único antecedente ginecológico de interés. Se diagnosticó con metástasis ovárica de adenocarcinoma gástrico primario, tratada con cirugía radical y quimioterapia hipertérmica intraperitoneal, con supervivencia de casi dos años entre el diagnóstico del tumor y su fallecimiento. CONCLUSIÓN: el tratamiento de estas neoplasias es muy agresivo, incluye cirugías radicales (peritonectomía) asociadas con quimioterapia para la carcinomatosis concomitante y técnicas hipertérmicas intraperitoneales. La supervivencia varía en función de las series reportadas y, en términos generales, se considera una neoplasia de muy mal pronóstico

Abstract BACKGROUND: These tumors are defined as metastatic ovarian adenocarcinomas of usually digestive origin. The few symptoms usually occurs when the disease is in advanced stages and, in most cases, with bilateral extension to both annexes. Krukenberg tumors frequently appear in young patients. Diagnosis is based on imaging tests and on the sensitivity of these tumors to specific immunoreactive markers, especially to those related to diseases of the digestive tract. OBJECTIVE: report the case of a patient with Krukenberg tumor. CLINICAL CASE: present the case of a patient who underwent breast cancer surgery 10 years ago as the only gynecological history of interest, who was diagnosed with ovarian metastases of primary gastric adenocarcinoma, treated with radical surgery plus intraperitoneal hyperthermic chemotherapy, and with survival of almost two years between tumor diagnosis and patient exitus. CONCLUSION: These therapies include radical surgeries such as peritonectomy, chemotherapy treatments aimed at treating associated carcinomatosis, and hyperthermic intraperitoneal techniques. Survival can vary depending on the series, and it is generally considered a disease of very poor prognosis.

Is it possible to increase bioavailability but not environmental risk of PAHs in bioremediation?

The current poor predictability of end points associated with the bioremediation of polycyclic aromatic hydrocarbons (PAHs) is a large limitation when evaluating its viability for treating contaminated soils and sediments. However, we have seen a wide range of innovations in recent years, such as an the improved use of surfactants, the chemotactic mobilization of bacterial inoculants, the selective biostimulation at pollutant interfaces, rhizoremediation and electrobioremediation, which increase the bioavailability of PAHs but do not necessarily increase the risk to the environment. The integration of these strategies into practical remediation protocols would be beneficial to the bioremediation industry, as well as improve the quality of the environment.

[Musculoskeletal hydatidosis: an unusual location]. / Hidatidosis musculoesquelética: una localización atípica.

Hydatidosis is a zoonosis with a continuing high prevalence in our environment. The most commonly affected organs are the lungs and the liver, with the musculoskeletal location being considered an unusual one. We comment the case of a patient who presented a series of lesions in his left iliac crest and middle left buttock with spontaneous fistulization to the skin surface. In this case a combined treatment was given; prior to the surgical operation we administered a cycle of albendazol. Following removal of the lesion, the patient was given two further cycles of albendazol in order to minimize the risk of a recurrence of the illness. This patient is currently free of any symptoms relating to this illness.

Hidatidosis musculoesquelética: una localización atípica / Musculoskeletal hydatidosis: an unusual location

La hidatidosis es una zoonosis con una elevada prevalencia aún en nuestro medio. Generalmente afecta a hígado y pulmón, debiendo considerarse la afectación músculo-esquelética una localización atípica de la enfermedad. Presentamos el caso de un paciente con lesiones en cresta iliaca y glúteo medio izquierdos, con fistulización espontánea a través de la piel. Se realizó tratamiento combinado con un ciclo de albendazol previo a la intervención y exéresis quirúrgica de la lesión. En el postoperatorio se completaron dos ciclos más de tratamiento con albendazol en un intento de disminuir el riesgo de recurrencia de la enfermedad. El paciente se encuentra asintomático y no ha presentado ninguna complicación hasta la fecha

Hydatidosis is a zoonosis with a continuing high prevalence in our environment. The most commonly affected organs are the lungs and the liver, with the musculoskeletal location being considered an unusual one. We comment the case of a patient who presented a series of lesions in his left iliac crest and middle left buttock with spontaneous fistulization to the skin surface. In this case a combined treatment was given; prior to the surgical operation we administered a cycle of albendazol. Following removal of the lesion, the patient was given two further cycles of albendazol in order to minimize the risk of a recurrence of the illness. This patient is currently free of any symptoms relating to this illness

[Self-perception of health in non-institutionalised elderly]. / Autopercepción de salud en ancianos no institucionalizados.

OBJECTIVE: To evaluate the self-perception of health (SH) of non-institutionalised over-65s. To relate this SH to age, sex, social and economic level, and use of health services. DESIGN: Descriptive cross-sectional study on a sample stratified by age and sex. SETTING: City of Avila.Participants. 425 interviews representative of the census of the over-65s, using the SF-36 Health Questionnaire and a complementary questionnaire to gather information on social and economic levels and use of health services. MAIN RESULTS: The QWB well-being index was at 0.67 (0.69 men; 0.65 women), dropping with age (0.70 in < 70s; 0.59 in > 84 years old). The highest scores on the questionnaire were in the dimensions social function (81.1) and emotional role (79.8); and the worst in general health (51.9) and vitality (58.5), with men always having higher scores (p < 0.05, except in physical function [p = 0.05] and general health [p = 0.47]). At greater ages the scores were worse, with physical function (-50.6%) and physical role (-45.7%) more affected by age, and mental health (-12.1%), general health (-16.1%) and emotional role (-17.8%) less affected. Men perceived their health as more stable than women did (63.7% vs. 44.6%; p < 0.001). There was self-perception of better health, the higher the social and economic levels (p < 0.05 in all dimensions), the greater the educational level reached (p < 0.05 except in social function) and the less the health services were used (p < 0.05, except for mental health-hospital admission). CONCLUSIONS: The Index of Well-being of our elderly people is comparable to that recorded in other samples. Men had self-perception of better health than women and saw their health as more stable. SH gets significantly worse with age. Higher economic and social levels and less use of health services are related to better SH.

Autopercepción de salud en ancianos no institucionalizados / Self-perception of health of the non-institutionalised elderly

Objetivo. Evaluar la autopercepción de salud (AS) de los mayores de 65 años no institucionalizados. Relacionar dicha AS con edad, sexo, nivel socioeconómico (NSE) y utilización de servicios sanitarios (USS).Diseño. Descriptivo transversal sobre muestra estratificada por edad y sexo. Emplazamiento. Ciudad de Ávila. Participantes. Un total de 425 entrevistas representativas de la población censal de mayores de 65 años utilizando el Cuestionario de Salud SF-36 y un cuestionario complementario que recoge información sobre NSE y USS. Resultados principales. El índice de bienestar QWB es de 0,67 (0,69 varones; 0,65 mujeres), decreciendo con la edad (0,70 en 84 años). Las mejores puntuaciones en el cuestionario se dan en las dimensiones función social (81,1) y rol emocional (79,8) y las peores en salud general (51,9) y vitalidad (58,5), con mejores valores siempre en varones (p < 0,05 excepto en función física [p = 0,05] y salud general [p = 0,47]). A mayor edad siguen peores puntuaciones, afectándose más función física (-50,6 por ciento) y rol físico (-45,7 por ciento) y menos salud mental (-12,1 por ciento), salud general (-16,1 por ciento) y rol emocional (-17,8 por ciento). Los varones perciben más estable su salud que las mujeres (63,7 por ciento frente a 44,6 por ciento; p < 0,001). Hay mejor AS cuanto mayor es el NSE (p < 0,05 en todas las dimensiones), mayor es el nivel de estudios (p < 0,05 excepto en función social) y menor es la USS (p < 0,05 excepto en salud mental-ingreso hospitalario). Conclusiones. El índice de bienestar de nuestros ancianos es comparable al de otras poblaciones. Los varones presentan mejor AS que las mujeres y perciben que su salud se mantiene estable en mayor proporción. La AS empeora con la edad significativamente. Un mayor NSE y una menor USS se relacionan con una mejor AS (AU)

Team-teaching in an integrated classroom: perceptions of deaf and hearing teachers.

This study examined the perceptions of teams of two teachers, one deaf and one hearing, team-teaching students who are deaf and hard-of-hearing (D/HH) in co-enrolled classrooms. Five teachers who had worked in teams and their supervisor were interviewed about their team-teaching experiences and their perception of the effectiveness of this approach. Informants' responses were videotaped, transcribed, and analyzed. From the interview data, four main categories were identified: (1) philosophy of education, (2) perception of roles, (3) benefits of team-teaching, and (4) challenges. Findings revealed that team-teaching in co-enrolled classrooms gave all students access to their own and each other's cultures, languages, and social identities; deaf and hearing people were seen to have equality of status and students who are D/HH were seen to benefit from teachers' high expectations.