ABSTRACT
El dolor lumbar corresponde a uno de los síntomas más prevalentes en la humanidad, siendo la segunda causa más frecuente de atención médica a nivel mundial. Existen diversos enfoques de diagnóstico y tratamiento para dolor lumbar, entre ellos la temporalidad del síntoma, el trabajo de diagnóstico sindromático, los síntomas de alarma, también llamados "banderas rojas", que pueden hacer sospechar patologías de mayor gravedad o urgencia. El estudio etiológico puede ser necesario en casos agudos con estas banderas rojas y en casos crónicos. Este estudio se realiza principalmente con imágenes (radiografías, tomografía computada, resonancia magnética, SPECT/CT) y ocasionalmente con exámenes de laboratorio. La mayor parte de los tratamientos están enfocados en el manejo conservador, principalmente el ejercicio físico guiado y asociado a fármacos analgésicos. Existen terapias alternativas tales como la acupuntura, el tai-chi, entre otros, algunas de ellas han mostrado ser un buen complemento al manejo del dolor lumbar. El enfoque multidisciplinario es la tendencia más actual de manejo, esto incluye el trabajo e intervención de diversos profesionales abordando el problema de forma integral, incluyendo el manejo psicoterapéutico. Intervenciones como las infiltraciones de columna han demostrado reducir el dolor por tiempos cortos, siendo útiles como puente para realizar un tratamiento apropiado. La cirugía solo se reserva para casos refractarios, siendo controversiales los resultados existentes en la literatura.
Low back pain is one of the most prevalent symptoms in humanity, being the second most common cause of medical attention worldwide. There are various approaches to diagnosis and treatment for low back pain, including the temporality of the symptom, the work of syndromatic diagnosis, the alarm symptoms, also called "red flags", that can make suspect pathologies of greater severity or emergency. The etiological study may be necessary in acute cases with these "red flags" and in chronic cases. This study is mainly done with images (X-rays, CT scan, MRI, SPECT/CT) and occasionally with laboratory tests. Most of the treatments are focused on conservative management, mainly guided physical exercise associated with analgesic drugs. There are alternative therapies such as acupuncture, tai-chi, among others, some of them have proven to be a good complement to the management of low back pain. The multidisciplinary approach is the most current management trend, this includes the work and intervention of various professionals addressing the problem in an integral way, including psychotherapeutic management. Interventions such as spinal infiltrations have been shown to reduce pain for short times, being useful as a bridge for proper treatment. Surgery is only reserved for refractory cases, the results existing in the literature being controversial.
Subject(s)
Humans , Low Back Pain/therapy , Low Back Pain/diagnostic imaging , Low Back Pain/physiopathology , Evidence-Based MedicineABSTRACT
Background: Self-efficacy is a psychological variable closely related to healthy behaviors. One of the most widely used instruments to measure this variable is the general self-efficacy scale (GSES). In Chile, the only psychometric study of this scale has important analytical limitations. Aim: To assess reliability and validity of GSES in a large Chilean sample. Material and Methods: The GSES and a self-esteem scale were applied to 2995 participants aged 11 to 76 years (60% women). Results: The scale showed optimal levels of homogeneity and internal consistency. The exploratory factor analysis and the parallel analysis suggested a one-dimensional internal structure. However, this model showed a mediocre fit in the confirmatory factor analysis due to the residual correlation between a pair of items with high semantic similarity. A one-dimensional model specifying this residual correlation attained an acceptable fit in a new confirmatory factor analysis. The new model reached strict invariance according to sex, and partial strict invariance according to age. The latent factor of the GSES showed a positive association with the latent factor of a self-esteem scale. Conclusions: The GSES is an adequate scale to measure general self-efficacy in the Chilean population and allows unbiased comparisons based on sex or age.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Self Efficacy , Psychometrics , Chile , Surveys and Questionnaires , Reproducibility of Results , Factor Analysis, StatisticalABSTRACT
INTRODUCTION: Traumatic spinal cord injury is one of the most disabling conditions occurring in man and thus stimulates a strong interest in its histopathological, biochemical, and functional changes, primarily as we search for preventive and therapeutic methods. PURPOSE: To develop an experimental model for transplantation of cells from the fetal rat central nervous system to the site of an injured spinal cord of an adult rat in which the transplanted cells survive and become integrated. This experimental model will facilitate investigations of factors that promote regeneration and functional recovery after spinal cord trauma. MATERIAL AND METHODS: Fifteen adult Wistar rats underwent laminectomy, and an spinal cord lesion was made with microdissection. Fetal spinal cord tissue was then transplanted to the site of the injury. The rats were monitored over a 48-hour period, and then their vertebral column was completely removed for histological analysis. RESULTS: In 60 percent of transplanted rats, the fetal tissue at the injured site remained viable in the site of the lesion
Subject(s)
Animals , Male , Female , Rats , Fetal Tissue Transplantation , Spinal Cord , Spinal Cord Injuries , Stem Cell Transplantation , Disease Models, Animal , Nerve Tissue , Rats, Wistar , Spinal CordABSTRACT
Dada a relevancia que o tromboembolismo pulmonar (TEP) vem adquirindo nos ultimos tempos, realizamos um estudo epidemiologico retrospectivo (caso-controle) embasado na analise de 1290 laudos de necropsias consecutivas realizadas em 1993 e 1994, no HCFMUSP, com posterior analise estatistica dos dados obtidos atraves dos programas Multlr e SPSS for Windows. Notamos que a incidencia de TEP foi de 12 por cento e que alguns fatores de risco como TVP (O.R.=13,98), trombose mural (O.R.=10,23), cirurgia ortopedica (O.R.=2,71), cirurgia neurologica (O.R.=4,16), doenca arterial obstrutiva periferica (O.R.=3,12) e ICC (O.R.=2,43) contribuem para o seu desenvolvimento. A insuficiencia hepatica apareceu como fator protetor (O.R.=0,77). Desta forma, achamos que a profilaxia nestes casos e necessaria para prevenir o TEP