Prevalencia y factores de riesgo de dolor pélvico / Prevalence and risk factors of pelvic pain

Objetivos: Determinar la prevalencia de síntomas de dolor pélvico crónico (DPC) en Málaga y provincia y detectar los factores de riesgo asociados. Método: Estudio transversal entre habitantes de Málaga y provincia con edades comprendidas entre los 18 y 65 años; muestreo no probabilístico por cuotas (n = 887; 414 mujeres y 473 hombres), estratificado por sexo, edad y comarcas. Todos cumplimentaron el CDPC-M, herramienta validada por su capacidad discriminativa entre sujetos con DPC y sujetos que no lo padecen. Resultados: la prevalencia de síntomas de DPC en sujetos entre 18-65 años fue de 22,8% en la población en general (30,9%: mujeres y 15,6%: hombres) (RR = 1.974 mujeres frente a hombres, IC 95%: 1,53-2,55, p < 0,001). Tras corregirse por sexo y edad, los individuos que practican actividad física presentan una menor puntuación en CDPC-M que los que no la hacen (diferencia de medias −0,65 ± 0,27). Los siguientes factores se asocian significativamente a mayor puntuación en la escala: levantar y/o mover carga en actividades de la vida diaria (1,34 ± 0,33), la ingesta de laxantes y/o dieta rica en fibra (2,09 ± 0,48), haber sufrido en el pasado enfermedad infecciosa urogenital -vulvovaginitis, cistitis y prostatitis- (1,77 ± 0,55), hemorroides/fisura anal (1,31 ± 0,40) o traumatismo pélvico (1,21 ± 0,61) respectivamente. En relación con los hábitos posturales solo las horas que el sujeto pasa en bipedestación muestran tendencia a presentar mayores puntuaciones en CDPC-M (coeficiente de regresión ajustado por sexo y edad de 0,078 puntos/hora; EE = 0,04; p < 0,068). Conclusiones: Alta prevalencia de síntomas de DPC en Málaga (22,8%), relacionada significativamente con diversos factores de riesgo

Objectives: To determine the prevalence of chronic pelvic pain (CPP) symptoms in Malaga and its province and to identify associated risk factors. Method: A cross-sectional study was carried out in Malaga and its province, involving subjects aged 18-65 years throughout a non-probability sampling by quotas (n = 887), stratified by sex, age and counties. All participants completed the QCPP-M, a self-administered questionnaire, validated tool due to its ability to discriminate patients with and without CPP. Results: Prevalence of symptoms of CPP in subjects aged between 18 and 65 years was 22.8% in general population (30.9% women and 15.6% men) (RR = 1.974 for women versus men, 95% CI 1.53-2.55, P < 0.001). After correction by sex and age individuals who practice physical activity had a lower score in QCPP-M than others who did not (mean difference −0.65 ± 0.27). They were significantly associated with higher scores in the following factors: lifting and/or moving weights in activities of daily life (1.34 ± 0.33), laxatives intake and/or high-fiber diet (2.09 ± 0.48), and having suffered from urogenital infectious disease in the past: vulvovaginitis, cystitis and prostatitis (1.77 ± 0.55), hemorrhoids/anal fissure (1.31 ± 0.40) or pelvic trauma (1.21 ± 0.61) respectively. Individuals who spend more time standing had a tendency to have higher scores on QCPP-M (coefficient of regression adjusted for sex and age of 0.078 points/h, SE = 0.04, P < 0.068). Conclusions: High prevalence of CPP symptoms in Málaga (22.8%); this is related to several significant risk factors

Prevalence and risk factors of pelvic pain.

OBJECTIVES: To determine the prevalence of Chronic Pelvic Pain (CPP) symptoms in Malaga and its province and to identify risk factors associated. METHOD: a cross-sectional study was carried out in Malaga and its province, 18-65 years-old throughout a non-probability sampling by quotas (n = 887), stratified by sex, age and counties. All participants completed the QCPP-M, a self-administered questionnaire, validated tool due to its ability to discriminate patients with and without CPP. RESULTS: prevalence of symptoms of CPP in subjects between 18-65 years-old was 22.8% in general population (30.9% women and 15.6% men) (RR = 1.974 for women versus men, 95% CI 1.53-2.55, P < .001). After correction by sex and age individuals who practice physical activity had a lower score in QCPP-M that others who do not not (mean difference -0.65 ± 0.27). They were significantly associated with higher scores in the following factors: lifting and/or moving weights in activities of daily life (1.34 ± 0.33), laxatives intake and/or high-fiber diet (2.09 ± 0.48), having suffered from urogenital infectious disease in the past: vulvovaginitis, cystitis and prostatitis (1.77 ± 0.55), hemorrhoids/anal fissure (1.31 ± 0.40) or pelvic trauma (1.21 ± 0, 61) respectively. Individuals who spend more time standing had a tendency to have higher scores on QCPP-M (coefficient of regression adjusted for sex and age of 0.078 points/hour, SE = 0.04, P < .068). CONCLUSIONS: High prevalence of CPP symptoms in Málaga (22.8%), this is related with significantly several risk factors.

Participación de la inervación pudenda en la hiperactividad del detrusor y el síndrome de vejiga hiperactiva / Participation of the Pudendal Innervation in the Detrusor Overactivity of the Detrusor and in the Overactive Bladder Syndrome

Objetivos: La presencia de los síntomas funcionales de la fase de llenado y la hiperactividad del detrusor son dos disfunciones del tracto urinario inferior relacionadas entre sí. Pretendemos estudiar la participación de la lesión del nervio pudendo en ambas disfunciones urinarias. Material y métodos: Se realizó un estudio transversal de corte en una serie de 108 mujeres. El estudio consistió en un interrogatorio sobre la presencia de síntomas funcionales del tracto urinario inferior, cistomanometría y determinación del tiempo de latencia periférico del nervio pudendo, electromiografía selectiva del esfínter anal externo y determinación del tiempo de latencia del reflejo sacro. Resultados: Se observó una tendencia hacia la significación entre la presencia de polaquiuria y la amplitud de los potenciales de unidad motora (mayores en presencia de polaquiuria)y de la presencia de urgencia-incontinencia y el tiempo de latencia sacro (mayor en presenciade urgencia incontinencia), y una relación significativa entre la puntuación del King’s Health Questionnaire y el tiempo de latencia periférico del nervio pudendo. Respecto de la hiperactividad del detrusor se observó un mayor tiempo de latencia sacro en pacientes con hiperactividad con tendencia hacia la significación. Conclusiones: Existe una relación entre las alteraciones de la inervación pudenda y la presencia de síntomas de la fase de llenado e hiperactividad del detrusor. Esta relación explicaría la acción terapéutica de la rehabilitación perineal sobre estas disfunciones (AU)

Objectives: The functional symptoms of the filling phase and detrusor over activity are two inter-related dysfunctions of the lower urinary tract. We have aimed to study the participation of the lesion of the pudendal nerve in both urinary dysfunctions. Material and methods: A cross-sectional cutoff study in a series of 108 women was carried out. The study consisted in the questioning on the presence of functional symptoms of the lower urinary tract, cystomanometry and determination of peripheral pudendal nerve latency time, selective electromyography of the external anal sphincter and determination of the sacral reflexlatency time. Results: A tendency was observed towards significance between the presence of pollakiuria amplitude of motor unit potentials (greater in presence of pollakiuria) and the presence of urgency-incontinence and time of sacral latency (greater in the presence of urge incontinence) and a significant relation between the score on the King’s Health Questionnaire and peripheral pudendal nerve latency time. Regarding detrusor hyperactivity, greater sacral latency time was observed in patients with over activity with tendency towards significance. Conclusions: There is a relation between pudendal innervation alterations and presence of symptoms in the filling phase and detrusor over activity. This relation would explain the therapeutic action of the perineal rehabilitation on these dysfunctions (AU)

[Participation of the pudendal innervation in the detrusor overactivity of the detrusor and in the overactive bladder syndrome]. / Participación de la inervación pudenda en la hiperactividad del detrusor y el síndrome de vejiga hiperactiva.

OBJECTIVES: The functional symptoms of the filling phase and detrusor overactivity are two inter-related dysfunctions of the lower urinary tract. We have aimed to study the participation of the lesion of the pudendal nerve in both urinary dysfunctions. MATERIAL AND METHODS: A cross-sectional cutoff study in a series of 108 women was carried out. The study consisted in the questioning on the presence of functional symptoms of the lower urinary tract, cystomanometry and determination of peripheral pudendal nerve latency time, selective electromyography of the external anal sphincter and determination of the sacral reflex latency time. RESULTS: A tendency was observed towards significance between the presence of pollakiuria amplitude of motor unit potentials (greater in presence of pollakiuria) and the presence of urgency-incontinence and time of sacral latency (greater in the presence of urge incontinence) and a significant relation between the score on the King's Health Questionnaire and peripheral pudendal nerve latency time. Regarding detrusor hyperactivity, greater sacral latency time was observed in patients with overactivity with tendency towards significance. CONCLUSIONS: There is a relation between pudendal innervation alterations and presence of symptoms in the filling phase and detrusor overactivity. This relation would explain the therapeutic action of the perineal rehabilitation on these dysfunctions.

[Mismatch negativity and conscience level in severe traumatic brain injury]. / Mismatch negativity y nivel de conciencia en el traumatismo craneoencefálico grave.

INTRODUCTION: The mismatch negativity (MMN) is a component of the long-latency auditory evoked potentials, that are used to check the functionality of automatic attentional processes of attentive information processing. Vegetative state diagnosis is frequent following severe traumatic brain injury (TBI). Eventually, some patients improve their condition to another one called minimal conscientious state. AIM: To evaluate the diagnostic usefulness of MMN in severe TBI patients during the subacute phase after leaving the neurological intensive care unit. PATIENTS AND METHODS: We gathered MMN results from 19 patients (12 males and 7 females; 8 vegetative state and 11 minimal conscientious state) with ages between 17 and 59 years (mean: 27.3 years). The delay between TBI onset and MMN recordings were greater than 2 months (mean: 181 days). During the recording session, patients were evaluated by means of the Multisociety Task Force on Persistent Vegetative State scale. RESULTS: All the minimal conscientious state patients (100%) showed MMN potential. In seven of the vegetative state patients (87.5%) the MMN was not found. The remaining MMN potential positive vegetative state patient improved to MCS 16 days after testing. CONCLUSIONS: MMN is a valid tool for differentiating vegetative state from MCS during the subacute phase of severe TBI. Hence it is a useful aid to the clinical evaluation. This would diminish the impact of a possible diagnostic error and its prognosis on therapeutical management, family and health costs. It can also be used for evaluating other brain disorders with altered consciousness.

Mismatch negativity y nivel de conciencia en el traumatismo craneoencefálico grave / Mismatch negativity and conscience level in severe traumatic brain injury

Introducción. El componente mismatch negativity (MMN) es un potencial evocado de larga latencia que refleja el funcionamiento de un mecanismo automático y preatencional del procesamiento de estímulos. El estado vegetativo es un diagnóstico muy frecuente tras un traumatismo craneoencefálico (TCE) grave que, en ocasiones, evoluciona hacia un nivel de conciencia superior denominado estado de respuesta mínima. Objetivo. Evaluar la utilidad diagnóstica de la MMN en pacientes que han sufrido un TCE grave en fase subaguda tras la salida de la Unidad de Cuidados Intensivos. Pacientes y métodos. Se ha realizado MMN auditiva a 19 pacientes (12 hombres y 7 mujeres), con edades comprendidas entre 17 y 59 años (media: 27,3 años), que sufrieron TCE grave hacía más de dos meses (media: 181 días). En el momento de la prueba, ocho se encontraban en estado vegetativo, y 11, en estado de respuesta mínima. Resultados. El 100% (11/11) de los pacientes en estado de respuesta mínima presentaron potencial MMN. En siete de los pacientes en estado vegetativo no se recogió el potencial (87,5%). El paciente vegetativo en el que se obtuvo MMN pasó a estado de respuesta mínima a los 16 días. Conclusiones. La MMN es una herramienta de gran utilidad en la fase subaguda de un TCE grave para el diagnóstico diferencial entre estado vegetativo y estado de respuesta mínima, refrendando el juicio clínico y minimizando las consecuencias familiares, sanitarias, sociales y económicas derivadas de un posible error, y abriendo la posibilidad de ser aplicada a otras patologías cerebrales adquiridas

Introduction. The mismatch negativity (MMN) is a component of the long-latency auditory evoked potentials, that are used to check the functionality of automatic attentional processes of attentive information processing. Vegetative state diagnosis is frequent following severe traumatic brain injury (TBI). Eventually, some patients improve their condition to another one called minimal conscientious state. Aim. To evaluate the diagnostic usefulness of MMN in severe TBI patients during the subacute phase after leaving the neurological intensive care unit. Patients and methods. We gathered MMN results from 19 patients (12 males and 7 females; 8 vegetative state and 11 minimal conscientious state) with ages between 17 and 59 years (mean: 27.3 years). The delay between TBI onset and MMN recordings were greater than 2 months (mean: 181 days). During the recording session, patients were evaluated by means of the Multisociety Task Force on Persistent Vegetative State scale. Results. All the minimal conscientious state patients (100%) showed MMN potential. In seven of the vegetative state patients (87.5%) the MMN was not found. The remaining MMN potential positive vegetative state patient improved to MCS 16 days after testing. Conclusions. MMN is a valid tool for differentiating vegetative state from MCS during the subacute phase of severe TBI. Hence it is a useful aid to the clinical evaluation. This would diminish the impact of a possible diagnostic error and its prognosis on therapeutical management, family and health costs. It can also be used for evaluating other brain disorders with altered consciousness