Autocuidado digital en el manejo de los trastornos musculoesqueléticos de columna: revisión sistemática y metanálisis / Digital self-care in the management of spine musculoskeletal disorders: A systematic review and meta-analysis / Autocuidado digital no manejo de distúrbios musculoesqueléticos de coluna: revisão sistemática e metanálise

Objetivo: analizar la efectividad del autocuidado digital en el manejo del dolor y la discapacidad funcional en personas con trastornos musculoesqueléticos espinales. Método: revisión sistemática de la literatura, desarrollada con la checklist PRISMA, de ensayos clínicos aleatorizados sobre personas con trastornos musculoesqueléticos de columna e intervenciones digitales a las que se accede por computadora, smartphones u otro dispositivo portátil. Bases de datos consultadas: National Library of Medicine, Excerpta Médica dataBASE, SciVerse Scopus, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, Science Citation Indexes, Cummulative Index to Nursing and Allied Health Literature y Physiotherapy Evidence Database. Síntesis de resultados descriptiva y por metanálisis (modelo de efectos fijos) realizada con el software Review Manager. Calidad metodológica evaluada mediante la escala Physiotherapy Evidence Database. Resultados: se seleccionaron 25 ensayos (5142 participantes) que mostraron mejoras estadísticamente significativas (p<0,05) del 54% (12/22) en los niveles de dolor y del 47% (10/21) en la discapacidad funcional en el grupo intervención. Los metanálisis mostraron efectos moderados sobre la intensidad del dolor y efectos pequeños sobre la discapacidad funcional. Predominaron los estudios de calidad media. Conclusión: las intervenciones de atención digital demostraron resultados beneficiosos para la intensidad del dolor y la discapacidad funcional, principalmente para el dolor lumbar crónico. Se ha demostrado que la atención digital es promisoria para favorecer el automanejo de las afecciones musculoesqueléticas de columna. Registro PROSPERO CRD42021282102.

Objective: to analyze the effectiveness of digital self-care in the management of pain and functional disability among people with spine musculoskeletal disorders. Method: a systematic literature review, developed with the PRISMA checklist, of randomized clinical trials of people with spine musculoskeletal disorders and digital interventions accessed by means of computers, smartphones or other portable devices. Databases researched: National Library of Medicine, Excerpta Médica dataBASE, SciVerse Scopus, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Science Citation Indexes, Cumulative Index to Nursing and Allied Health Literature and Physiotherapy Evidence Database. The descriptive synthesis of the results and by means of meta-analyses (fixed-effects model) was performed with the Review Manager software. The methodological quality was evaluated with the Physiotherapy Evidence Database scale. Results: a total of 25 trials were selected (5,142 participants), which showed statistically significant improvements (p <0.05) in 54% (12/22) in the pain levels and 47% (10/21) in functional disability in the Intervention Group. The meta-analyses showed moderate effects on pain intensity and small effects on functional disability. There was a predominance of medium quality studies. Conclusion: the digital care interventions showed a beneficial result in pain intensity and in functional disability, mainly for chronic low back pain. Digital care emerges as promising to support self-management of the spine musculoskeletal conditions. PROSPERO registry number CRD42021282102.

Objetivo: analisar a efetividade do autocuidado digital no manejo da dor e incapacidade funcional em pessoas com distúrbios musculoesqueléticos de coluna. Método: revisão sistemática da literatura, desenvolvida com o checklist PRISMA, de ensaios clínicos randomizados de pessoas com distúrbios musculoesqueléticos de coluna e intervenções digitais acessadas por computador, smartphones ou outro dispositivo portátil. Bases pesquisadas: National Library of Medicine, Excerpta Médica dataBASE, SciVerse Scopus, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Science Citation Indexes, Cummulative Index to Nursing and Allied Health Literature e Physiotherapy Evidence Database. Síntese dos resultados descritiva e por metanálises (modelo de efeitos fixos) com o software Review Manager. Qualidade metodológica avaliada pela escala Physiotherapy Evidence Database. Resultados: selecionaram-se 25 ensaios (5142 participantes) que revelaram melhoras estatisticamente significativas (p<0,05) em 54% (12/22) nos níveis de dor e 47% (10/21) na incapacidade funcional no grupo intervenção. As metanálises mostraram efeitos moderados na intensidade da dor e pequenos na incapacidade funcional. Houve predominância de estudos de média qualidade. Conclusão: intervenções de cuidados digitais mostraram resultado benéfico na intensidade da dor e na incapacidade funcional principalmente para dor lombar crônica. Evidenciam-se os cuidados digitais como promissores para apoiar o autogerenciamento das condições musculoesqueléticas de coluna. Registro PROSPERO CRD42021282102.

Anestesia local en pacientes reumáticos. Avances y perspectivas / Local anesthesia in rheumatic patients. Progress and perspectives

Introducción: las enfermedades reumáticas y muscoloesqueléticas se manifiestan por alteraciones en el aparato locomotor, aunque detrás de ellas puede haber un trastorno de la respuesta inmunológica que conlleva a que la atención de estos pacientes no se deba centrar solo en los aspectos locales, sino también en su valoración sistémica por la afectación de órganos y sistemas de órganos como el cardiovascular, respiratorio, renal y digestivo. Objetivo: revisar los avances y tendencias actuales del uso de la anestesia local en pacientes con enfermedades reumáticas. Desarrollo: el tratamiento de estas enfermedades está constituido fundamentalmente por glucocorticoides los antinflamatorios no esteroideos y los fármacos modificadores de enfermedad, además de que cada vez más están disponibles medicamentos antirreumáticos, aunque algunos aún requieren de mayor evidencia para su utilización generalizada. Conclusiones: la anestesia local es una de las alternativas terapéuticas que generalmente, por vía intra articular, se emplea en los pacientes reumáticos, al igual que otros medicamentos. En la búsqueda de nuevas sustancias que induzcan mayores períodos de analgesia se ha incursionado en el empleo de adyuvantes o aditivos, que son medicamentos que se asocian de manera de sinérgica con los anestésicos locales y prolongan la duración del bloqueo sensorio-motor, atenuando la sensación dolorosa y esto permite restringir la dosis acumulativa requerida de anestésicos locales. Se reportan importantes avances en este sentido y se amplían las perspectivas por los resultados de las investigaciones(AU)

Introduction: rheumatic diseases and musculoskeletal diseases are manifested by alterations in the locomotors system, although behind them there may be a disorder of the immune response that leads to the attention of these patients should not focus only on the local aspects, but also in its systemic assessment for the involvement of organs and organ systems such as cardiovascular, respiratory, renal and digestive. Objective: To review current advances and trends in the use of local anesthesia in patients with rheumatic diseases. Development: The treatment of these diseases consists mainly of glucocorticoids, non-steroidal antiinflammatory drugs and disease modifying drugs, in addition to which antirheumatic drugs are increasingly available, although some still require more evidence for its widespread use. Conclusions: Local anesthesia is one of the therapeutic alternatives that is generally used intraarticularly in rheumatic patients, as well as other medications. In the search for new substances that induce longer periods of analgesia has been intruded into the use of adjuvants or additives, which are drugs that are associated in a synergistic manner with local anesthetics and prolong the duration of sensorimotor block, attenuating the sensation painful and this allows to restrict the required cumulative dose of local anesthetics. Important advances are reported in this regard and perspectives are broadened by the results of the investigations(AU)

The role of anatomy education in facilitating multidisciplinary collaboration in the treatment of musculoskeletal conditions ­ an example from Australia / El papel de la educación de la anatomía en la facilitación de la colaboración multidisciplinaria en el tratamiento de las afecciones musculoesqueléticas ­ un ejemplo de Australia

Emerging changes to the healthcare system are promoting the adoption of an integrative medicine and a more patient-centred approach to healthcare. A multidisciplinary approach to the management of musculoskeletal conditions has a potential to ease the pressure off the emergency public health care system. Interprofessional collaboration in health care is paramount for this synergism to occur. It is crucial that treatment options be consistent and transparent across different health professions in order for optimum patient centred care. Using the Australian educational and health setting as an example, it is argued in this paper that anatomy education could play an important role in facilitating this consistency and transparency. The first decisive step in this process would be to review the alignment of anatomy syllabi across the academic programs of different health professions. The review and comparison of anatomy content taught across the different health professional curricula should expedite the acceptance of one profession by another. This alignment of anatomy teaching would aid interprofessional relations and ultimately collaboration, beginning from education of students through to professional practice and encompassing accreditation guidelines.

Los cambios emergentes en el sistema de salud están promoviendo la adopción de una medicina integradora y un enfoque más centrado en el paciente en la atención sanitaria. Un enfoque multidisciplinario para el manejo de las afecciones musculoesqueléticas tiene el potencial para aliviar la presión del sistema de salud pública de emergencia. La colaboración interprofesional en el cuidado de la salud es primordial para que este sinergismo ocurra. Es crucial que las opciones de tratamiento sean coherentes y transparentes en las diferentes profesiones de la salud con el fin de que la atención centrada en el paciente sea óptima. Utilizando el marco educativo y de salud australiano como ejemplo, se argumenta en este trabajo que la educación en anatomía podría desempeñar un papel importante para facilitar esta consistencia y transparencia. El primer paso decisivo en este proceso sería revisar la alineación de los programas de anatomía a través de los programas académicos de diferentes profesiones de la salud. La revisión y comparación del contenido de la anatomía enseñada en los diferentes currículos de profesionales de la salud debería acelerar la aceptación de una profesión por otra. Esta alineación de la enseñanza de la anatomía ayudaría a las relaciones interprofesionales y, en última instancia, la colaboración, desde la educación de los estudiantes hasta la práctica profesional y las directrices de acreditación.

Morphometric and fractal analysis of injured skeletal muscle tissue subjected to a combination of treatments; cryotherapy and therapeutic ultrasound / Análisis de la morfometría y de la dimensión fractal en la lesión del tejido muscular esquelético expuesto en la combinación de los tratamientos de crioterapia y ultrasonido

The aim of this study was to analyze the effects of an association of cryotherapy and therapeutic ultrasound on the treatment of muscle injured by impact. Fifty-five Wistar rats were divided into five groups (n = 11), Acute Injury (AI), Injury (I), Cryotherapy (CR), Therapeutic Ultrasound (TU) and Association of Cryotherapy and Therapeutic Ultrasound (CRTU). The CR and CRTU groups received applications of Cryotherapy three times (immediately, 24 and 48 h after injury) of 20 minutes duration. The TU and CRTU groups received applications of Therapeutic Ultrasound for seven days, for five minutes, in pulsed mode, 0.5 w/cm intensity, frequency 1 MHz. Body mass and gastrocnemius mass were analyzed. In addition to histological slides stained with hematoxylin and eosin used for morphometric analysis, picrosirius dye was used for quantification of collagen by Fractal Dimension (FD). The results of the intra-group analysis showed lower body mass and gastrocnemius in the CRTU group in relation to the AI (p = 0.001), I (p = 0.001), CR (p = 0.001) and TU groups (p = 0.001), and lower values of FD to quantify collagen in the CRTU group in relation to the AI (p = 0.007) and CR groups (p = 0.014). In summary, the present study showed that the association of Cryotherapy with Therapeutic Ultrasound promoted better results in the aspects analyzed compared to application of the therapies in isolation.

El objetivo del estudio fue evaluar los efectos de la asociación de las técnicas de crioterapia y ultrasonido terapéutico en el tratamiento de la lesión muscular por impacto. Fueron utilizadas 55 ratas Wistar, expuestas a lesión y separadas en grupos (n = 11): Lesión aguda (LA), Lesión (L), Crioterapia (CR), Ultrasonido Terapéutico (UT) y Crioterapia + Ultrasonido Terapéutico (CRUT). Los grupos CR y CRUT recibieron la aplicación, durante 20 minutos, en tres momentos (inmediatamente, 24 y 48 horas, después de la lesión). Los grupos UT y CRUT, recibieron UT por siete días, con una duración de cinco minutos, en modo pulsado, con una intensidad de 0,5 W/cm2 y frecuencia de 1 MHz. Fueran medidos el peso corporal y el peso de los músculos gastrocnemios y se realizaron cortes histológicos del músculo gastrocnemio, los cuales fueron teñidos con hematoxilina-eosina (HE) para el análisis morfométrico y con picrosirius para el análisis del colágeno por dimensión fractal (DF). Los resultados de los análisis intragrupo demostraron una menor disminución de la masa coporal y muscular en el grupo CRUT. Además, fue observado un valor inferior en la morfometría en el grupo CRUT en comparación a los grupos LA (p = 0,001), L (p = 0,001), CR (p = 0,001) y UT (p = 0,001), y un menor valor de la DF con respecto al colágeno en el grupo CRUT en comparación a los grupos LA (p = 0,007) y CR (p = 0,014). En síntesis, el presente estudio demostró que el protocolo de asociación de las técnicas de CR y UT causaron mayores respuestas benéficas en los aspectos analizados en comparación a los protocolos con los tratamientos aplicados de forma aislada.

Toe thumb: A musculoskeletal disorder related to transesophageal echocardiography.

The musculoskeletal disorders (MSD) are common in healthcare providers and those who are doing sonography are also affected. There are reports of MSD in healthcare providers who do transthoracic echocardiography. Transesophageal echocardiography (TEE) is being regularly used in peri‑operative setting. We describe MSD of hand in a cardiovascular and thoracic anesthesiologist who has been performing TEE scanning for 10% of his work‑time in operating room and critical care area for the last 8 years. As the role of TEE is increasing and many doctors are doing it on a routine basis, the knowledge of association of MSD with TEE and measures to prevent it is important.

Efetividade e segurança do ultrassom terapêutico nas afecções musculoesqueléticas: overview de revisões sistemáticas Cochrane / Effectiveness and safety of therapeutic ultrasound in musculoskeletal disorders: overview of Cochrane systematic reviews

O Ultrassom terapêutico (UST) é um recurso frequentemente utilizado na prática clinica do fisioterapeuta. Entretanto, não há consenso na literatura em relação à efetividade desse recurso. Objetivo: Os objetivos do presente estudo foram verificar e sintetizar as informações contidas nas revisões sistemáticas Cochrane relacionadas ao tratamento das afecções musculoesqueléticas com o UST. Método: Foi realizada uma busca na base de dados ?Cochrane Library? e selecionadas as revisões sistemáticas que abordavam o UST como modalidade de tratamento. Resultados: Foram incluídas seis revisões sistemáticas Cochrane que analisaram a efetividade do UST em diferentes afecções musculoesqueléticas demonstrando redução significativa da dor apenas na osteartrite de joelho; não há relatos de eventos adversos decorrentes do UST em todas as revisões incluídas, sendo considerado um tratamento seguro. Conclusão: Os resultados apresentados nesse estudo devem ser analisados com cautela, pois a baixa qualidade metodológica e a heterogeneidade dos ensaios clínicos randomizados (ECRs) incluídos nas revisões sistemáticas são fatores limitantes para a confiabilidade dos dados apresentados.

Ultrasound therapy (UST) is a feature often used in clinical practice of the physiotherapist. However, there is no consensus in the literature regarding the effectiveness of this feature. Objective: The purpose of this article was to assess and synthesize the information contained in systematic reviews Cochrane related to the treatment of musculoskeletal disorders with UST. Method: We performed a search in the database ?Cochrane Library? and selected the RS that addressed the UST as a treatment modality. Results: Were included six RS Cochrane who analyzed the effectiveness of UST in different musculoskeletal demonstrating significant reduction of pain in osteoarthritis of the knee only, there are no reports of adverse events resulting from UST in all revisions included, is considered a safe treatment. Conclusion: The results presented in this study should be treated with caution because of the low methodological quality and heterogeneity of randomized controlled trials (RCTs) included in RS are limiting factors for the reliability of the data presented.

Medición de factores de crecimiento derivado de plaquetas (PDGF) por metodología ELISA en plasma de donantes y pacientes del Banco de Sangre del Hospital General de Accidentes "Ceibal" del Instituto Guatemalteco de Seguridad Social / Measurement of platelet derived growth factor (PDGF) by ELISA technique in plasma donors and patients of Blood Bank of Trauma

El factor de crecimiento derivado de plaquetas, mejor conocidos por sus siglas en inglés PDGF (Platelet Derived Growth Factor) es solamente uno de los tantos factores de crecimiento, o proteínas cuya función es la regulación, el crecimiento y la división celular. Su particularidad radica en la amplia capacidad de actuar en células óseas, fibroblastos, neurológicas, musculares, etc. Actualmente su uso terapéutico es ante lesiones crónicas tendinopatías, artrosis, pubalgias, codo de tenista, degenaración de cartílago, etc.). El objetivo del presente estudio fue deteminar la relación directa entre el recuento plaquetario basal de donante/paciente y la cantidad de factores que libera en plasma para poder estandarizar mejor el procedimiento usando tanto plasma basal o pobre en plaquetas (PPP) como plasma rico en plaquetas (PRP). Se determinó la cantidad que se recupera de factores en PPP y PRP para determinar si hay significancia clínica en usar plasma pobre ya que en la actualidad se utiliza solamente PRP esperando valores promedio, en este último de 2500 a 3500 pg/mL y así poder establecer la mejor opción que dará mejores resultados en la regeneración de tejidos y formación de osteoblastos para ser usado en pacientes ulcerados y/o quirúrgicos.

The growth factors derived from platelets (PDGF) is only one of many growth factors, or proteins whose function is to regulate the growth and cell division. Its uniqueness lies in their wide ability to act in bone cells, fibroblasts, neurological, muscules, etc. Currently its therapeutic use is varied and uses this therapy tendinopathy, osteoarthritis, pubalgia, tennis elbow, cartilage degeneration, etc. The objective of this study was to determine the direct relationship between the baseline platelet count of the donor/patient and the amount of factors released into plasma, in order to standardize the procedure using both basal plasma of platelet poor (PPP) and platelet-rich plasma (PRP). Determined the count of recovered factor in PRP and PPP to determine if clinical significance of using poor plasma as currently waiting PRP is used only average values, the latter of 2500 to 3500 pg/mL and thus establish the best option that will give better results in regenerating tissues and osteoblast formation for use in patients with sores and/or surgery.

Variation in the Numbers of Red Blood Cell Units Transfused at Different Medical Institution Types from 2006 to 2010 in Korea

BACKGROUND: This study aimed at assessing the number of red blood cell (RBC) units transfused at different types of medical institution and examining the characteristics of transfusion recipients. METHODS: We calculated and compared the number of transfusion recipients, total RBC units transfused, and RBC units transfused per recipient. Study data were extracted from insurance benefits reimbursement claims for RBC units at the Health Insurance Review & Assessment Service from 2006 to 2010. RESULTS: Between 2006 and 2010, the number of recipients of RBC units increased from 298,049 to 376,445, the number of RBC units transfused increased from 1,460,799 to 1,841,695, and the number of RBC units transfused per recipient changed from 4.90 to 4.89. The number of recipients aged > or =65 yr increased from 133,833 (44.9%) in 2006 to 196,127 (52.1%) in 2010. The highest number of RBC units was transfused to patients with neoplastic diseases (31.9%) and diseases of the musculoskeletal system and connective tissue (14.4%). More than 80% of the total number of RBC units were transfused at tertiary and general hospitals. However, this composition rate was slightly decreasing, with the composition rate for hospitals increasing from 12.6% to 16.3%. CONCLUSIONS: This study revealed an increase in the number of RBC units transfused over a 5-yr period due to an increase in the number of transfused recipients, especially recipients aged > or =65 yr; moreover, the number of RBC units transfused differed based on medical institution type. These results provide fundamental data on RBC transfusions required for future research.

Manifestações musculoesqueléticas em diabetes mellitus / Musculoskeletal disorders in diabetes mellitus

O diabetes mellitus está associado a uma grande variedade de manifestações musculoesqueléticas. Muitas delas são subclínicas e correlacionadas com tempo de evolução e controle inadequado da doença, e devem ser reconhecidas e adequadamente tratadas, pois sua abordagem melhora a qualidade de vida desses pacientes. Nesta revisão são discutidas as principais manifestações musculoesqueléticas encontradas em diabetes mellitus.

Diabetes mellitus is associated with a great variety of musculoskeletal manifestations, many of which are subclinical and correlated with disease duration and its inadequate control. They should be recognized and treated properly, because their management improves the patients' quality of life. This review discusses the major musculoskeletal manifestations found in diabetes mellitus.

Comparison of behavior, morphology and morphometry of equine and canine adipose derived mesenchymal stem cells in culture / Comparación del comportamiento, morfología y morfometría del tejido adiposo equino y canino derivado de células madre mesenquimales en cultivo

Recent studies revealed multipotent properties of fat tissue isolated mesenchymal stem cells. These cells are successfully used as therapeutic factor for many locomotive disorders, being even more effective than stem cells from bone marrow. Isolated and cultured, AD-MSCs were observed, photographed and measured to compare cells from two different species.

Estudios recientes han revelado propiedades pluripotentes del tejido graso aislado de células madre mesenquimales. Estas células se utilizan con éxito como factor terapéutico para muchos trastornos locomotores, siendo aún más eficaz que las células madre de médula ósea. Aisladas y cultivadas, AD-MSC se observaron, fotografiaron y midieron comparar células de dos especies diferentes.

[Evaluation of biochemical effects of a pharmaceutical formulation [cream] based essential oils extracted from Marrubium vulgaris cons. against osteoarticular disorders, rheumatoid arthritis and musculoskeletal disorders [MSDs]]

In many cases medical therapy [prescription anti-inflammatory drugs and corticosteroids] does not provide solutions to serious suffering of patients caused by the various joint diseases, or it has side effects exacerbating the situation. It is granted that medicinal plants are able to treat simple illnesses such as cold, or to avert more important as the ulcer. In this work, we study the effect of therapy on the natural articular deficits. We develop an approach that uses medicinal creams [dosage formulation] enriched concentration plant extracts [essential oils]. The concentrated active ingredients have been applied at the joint through the skin. In this study we are interested in a plant called Marrubium bulgaris. We studied the biochemical effects of essential oils in subjects with osteoarticular disorders: Rheumatoid arthritis [65 +/- 5 years, n10], TMS: musicians [35 +/- 6 years, n=10], as an cream of olive oil 3 xj and for 3 weeks with a placebo group that receives a cream without active ingredients. Our results indicate the corrective effects of the essential oils of bone resorption and cartilage. The application of these treatments was inversely associated with risk of osteoarticular, subjects applying these creams have marked the values of pyridinoline in its various forms, and alkaline phosphatase, CRP less important than before the treatment compared to placebo group [0.60 <4<0.90 p<0.05]. Through the power of the tested active ingredients that contain essential oils of this plant, we found that our treatments are effective where other drugs and surgery have failed

Análise das limitações, estratégias e perspectivas dos trabalhadores com LER/DORT, participantes do grupo PROFIT-LER: um estudo de caso / Analysis of the limitations, strategies and perspectives of the workers with RSI/WRMD, participants of the PROFIT-LER Group: a case study

Este estudo teve como finalidade analisar as limitações, estratégias e perspectivas dos trabalhadores com LER/DORT, participantes do grupo PROFIT-LER, da Universidade Federal da Paraíba. Para tanto, foram realizadas entrevistas individuais, utilizando um gravador e um formulário, que abrangeu questões relacionadas com dor, limitação funcional, fatores motivacionais, estratégias, expectativas em relação ao tratamento fisioterapêutico, perspectiva de vida após o tratamento e grau de conhecimentos acerca da afecção. Mediante os dados obtidos através do formulário e analisados à luz da literatura utilizada selecionada, foi possível constatar que os pesquisados apresentaram dores e limitações funcionais; que o programa PROFIT-LER ofereceu um maior conhecimento para os participantes acerca da patologia; que a estratégia mais utilizada foi a cinesioterapia; e que, quanto às perspectivas, os pesquisados pretendem continuar a praticar o que aprenderam com o grupo, assim como procurar outras formas de tratamento, uma vez que este tratamento permitiu socialização entre os trabalhadores e um maior conhecimento sobre a afecção. Desta forma, o estudo obteve êxito por alcançar o objetivo proposto e por esclarecer que o ser humano está exposto a fatores que podem alterar seu equilíbrio físico e mental, desencadeando processos patológicos.

This study had as aim to analyze the limitations, strategies and perspectives of the workers with RSI/WRMD, participants of the PROFIT - LER group, of the Universidade Federal da Paraíba. So, individual interviews were realized, using a recorder and a form, that involved questions related to the pain, functional limitation, motivational factors, strategies, expectations about the physical therapeutic treatment, life's perspective after the treatment and knowledge level about the pathology. By collecting information through a form and analyzing it based on the literature, it was possible to know that the participants have pain and functional limitations; that the PROFIT-LER program offered more information to the participants about the pathology; that kinesiotherapy was the strategy most practiced. Regarding the perspectives, the participants intended to continue to practice what they learnt in the group, and also look for another treatment options, because this treatment allowed socialization between the workers and more knowledge about the pathology. So, the study had success as it reached the proposed objective and to make clear that the human is exposed to factors that can change its physical and mental equilibrium, unchaining pathologic process.

Da legitimação a (res)significação: o itinerário terapêutico de trabalhadores com LER/DORT / From legitimation to (re-)signification: the therapeutic itinerary of workers with RSIs/WMSDs

No Brasil, as LER/DORT representam um importante problema de saúde pública. Seu modo de adoecimento, a multideterminação de sua origem e a conturbada assistência prestada aos lesionados parecem expor as próprias contradições do modo de produção capitalista. Neste artigo, buscou-se compreender os processos macrossociais identificados nos percursos de cura feito por trabalhadores com LER/DORT, atentando para os processos de negociação e (res)significação operados nessas trajetórias. Entrevistas em profundidade com trabalhadores sob regime de benefício pela previdência social brasileira passaram por "análise temática" sob a luz dos "modelos explanatórios" e da noção de "itinerário terapêutico" para abarcar o domínio socioeconômico e político. Sobressaiu o excesso e a culpabilização, ligados à etiologia; dor, cansaço e estresse iniciando os sintomas e, no curso da doença, somam-se a perícia médica, as reabilitações e o prognóstico tal como (res)significado pelos trabalhadores na tentativa de forjar um "tipo ideal" de trabalhador que, apesar da lesão, se mantém produtivo. Recomenda-se pensar políticas de saúde que sejam também responsivas aos processos mais amplos das organizações e das relações de poder e classe envolvidos na assistência às LER/DORT.

Repetitive Strain Injuries (RSIs)/Work-Related Musculoskeletal Disorders (WMSDs) are a major issue in Brazilian public health. The way such sickness is produced, its multidetermined origin and the troubled care provided to sufferers point to the very contradictions of the capitalist production system. This work aims at understanding the macrosocial processes surfaced in the workers' search for cure of RSIs/WMSDs, paying close attention to the negotiation and (re-)signification processes present in those trajectories. By drawing on "explanatory models" and the concept of "therapeutic itinerary", "thematic analysis" of in-depth interviews with Brazilian workers receiving Social Security compensation was used to approach the socioeconomic and political realms. Culpability and excess were reported in connection with etiology whereas pain, tiredness and stress were shown to be related to symptom initiation. Legal medical assessment, rehabilitation programs and prognosis were all along (re-) signified by the interviewees in an attempt to create an "ideal type" of productive worker despite the injury. It is then urged that public health policies responsive to the wider organization and processes of power and class related to the care of RSIs/WMSDs are devised.

Evidencia científica de los efectos terapéuticos atribuidos al deslizamiento lateral cervical / Scientific evidence of the therapeutic effects attributed to the cervical lateral glide

El deslizamiento Lateral Cervical es una técnica de Terapia Manual Ortopédica muy usada para el manejo del dolor y la disfunción vertebral de origen cervical, aunque existen estudios experimentales acerca de los fundamentos neurofisiológicos sobre los cuales ejerce su acción; se realizará una síntesis de la evidencia relativa a los efectos clínicos de la técnica de deslizamiento lateral cervical, a través de una Revisión Sistemática de Ensayos Clínicos Aleatorizados. Objetivo: Determinar si existe evidencia científica que avale los efectos terapéuticos atribuidos a la técnica de deslizamiento lateral cervical usado por los kinesiólogos para el manejo clínico de diversas condiciones músculo esqueléticas; Estrategia de búsqueda; sólo se incluyeron en la búsqueda de Ensayos Clínicos Aleatorizados (ECAs), las bases de datos usadas fueron : MEDLINE (Pubmed/PMC), OVID, Cochrane, PEDro y EMBASE (Science-Direct); Resultados; se seleccionaron 4 ECAs que cumplían con los criterios de elegibilidad; Conclusiones; Existe Moderada Evidencia que el deslizamiento lateral cervical produce Hipoalgesia inmediata en pacientes con Dolor Cervicobraquial Neurogénico de tipo Sub agudo, Epicondilalgia unilateral crónica y dolor de hombro unilateral con mala respuesta al tratamiento tradicional.

The Cervical Lateral Glide is a technique of Therapy Manual Orthopedic very used to the pain management and vertebral dysfunction of origin cervical, althought there esperimental studies about the basics neurophysiological on which exercises its action, There will be a synthesis of the evidence concerning the effects of clinical the technique of the cervical lateral glide, side through a systematic review of randomized controlled trials; Objective; Determine if there es evidence that scientific endorse the therapeutics effects attributed to the technique of cervical lateral glide used by the Physical Therapies for clinics handling of various conditions muscle skeletal; Strategy of Search; Only were included in the search Randomized Controlled Trials (ECAs), the databases used were: MEDLINE (Pubmed/PMC), Cochrane, OVID, PEDro and EMBASE (ScienceDirect); Results; Only 4 ECAs with their eligibility criteria of our review; Conclusions; There moderate evidence that cervical lateral glide producesinmediate hypoalgesia in patients with subacute Neurogenic Cérvicobrachial Pain, chronic lateral epicondylalgia and unilateral shoulder pain with bad responses to traditional treatment.

[Joint cartilage importance in the anatomical classification of bones with pits consequences teaching and therapeutic management of skeletor disorders]

Joint and bone are visible structures when we I alive bone. It covers extremities of long bones and faces of slier bones. It is absent from shaft of long bones and from faces of plate bones. Could introduction of joint as parameters in the staging of skeleton bones [bone with or without cartilage] improve mw comprehension of skeleton system? We reviewed 588 references during 14 years. When these is disagreement between authors, we compared data of medical literature to own data in the archives of Aziza Othmana hospital En Tunis. If disagreement is nut resolved we performed an experimental study such as "shaft fractures of long bones study" A new staging, called "classification C.VO. of Carthage" helped us to better understand the anatomical architecture of limbs. its relationship with embryology, joint biomechanics. diseases and therapeutic strategies. For each group "bone with or without cartilage" we identified 11 chapters which had as common skill the concept of" vessels for shaft structures and joint cartilage for epiphysis structures". This new classification provides probably there advantages:-Better medical teaching and comprehension of skeleton system-Improve knowledge and comprehension of disease and its management-Creation new ways in research on alive osseous structures

Desenlaces clínicos en artritis reumatoidea tratada con Infliximab: Hospital de San José, 2007 - 2008 / Clinical outcomes in rheumatoid arthritis treated with Infliximab: San Jose Hospital, 2007 - 2008

Objetivo: describir los resultados clínicos obtenidos en los pacientes con artritis reumatoidea que recibieron infliximab durante el período enero de 2007 a octubre de 2008. Pacientes y métodos: se revisaron 240 historias clínicas de enfermos con AR atendidos en el lapso correspondiente, de las cuales 73 tenían información disponible que cumpliera los criterios de inclusión y exclusión. Se analizaron las características clínicas y sociodemográficas, el comportamiento de la respuesta terapéutica si la hubo y el tiempo de aparición, el uso de medicamentos coadyuvantes y el desarrollo de eventos adversos. Resultados: se describieron 73 pacientes, de los cuales el 89,04% fueron mujeres con edad promedio de 49.7 años y evolución de la AR de 12.0 (± 8.8) años, quienes recibieron 3 mg/k de infliximab con un número promedio de dosis de 9.1. Se obtuvo respuesta terapéutica en 52,05% a las 24.15 (±19.5) semanas de tratamiento. En contraste, los pacientes restantes que aun no tenían mejoría y continuaban con el tratamiento, llevaban con el medicamento un promedio de 26.65 (±22.5) semanas. La terapia fue suspendida en 29 pacientes: 11 (15,06%) de manera temporal y 18 (24,65%) permanente. Conclusiones: el infliximab redujo la actividad inflamatoria en más de la mitad de los enfermos del presente estudio con una baja frecuencia de efectos adversos. Dicha respuesta se documentó con el control en las articulaciones dolorosas e inflamadas. No hubo relación positiva con los marcadores inflamatorios, aclarando el bajo reporte de los mismos en las historias clínicas revisadas...(AU)

Goal To describe the clinical outcomes of patients with rheumatoid arthritis who received infliximab from January of 2007 to October of 2008 by showing: Patients and methods A total of 240 medical records of patients with rheumatoid arthritis treated during this period were reviewed. 73 of this records met the inclusion and exclusion criteria. Information about clinical and socio-demographic, characteristics as well as the behaviour of therapeutic response, if it occurred, and the time of appearance of it, the use of adjuvant medicines and the occurrence of adverse events were extracted. Results: 73 patients were described, of which 89.04% were female with an average age of 49.7 years old with 12.0 (±8.8) years of RA progression who received 3 mg per kilo of infliximab with an average number of doses of 9.1. Therapeutic response was seen in 52,05% of patients between the 24.15 (±19.5) weeks of treatment. In contrast the remaining subjects who still had no therapeutic response and were still receiving infliximab was notice that the treatment lasted ± 26.65 weeks. Treatment was discontinued in 29 patients: 11(15,06%) temporarily and it was suspended permanently in 18 patients. Conclusions: Treatment with infliximab decreased inflammatory activity in more than half the patients that were observed in this study showing few side effects. This response was measured by monitoring painful and swollen joints which had no direct relation with acute phase reactants despite the lack of information in most of the clinical reports reviewed...(AU)

Experiencia del bloqueo paravertebral en sensibilización espinal segmentaria / Paraspinous block experience in spinal segmental sensitization

La Sensibilización Espinal Segmentaria (SES) corresponde a un estado hiperactivo de un segmento espinal en reacción a un foco irritativo, el cual bombardea constantemente el ganglio sensorial con estímulos. Esto se traduce en dolor espontáneo, hiperalgesia y adolinia. El Bloqueo Paraespinoso (BPE) ayudaría a la desensibilización gradual del segmento espinal comprometido. Objetivo: Mostrar manifestaciones de la SES y los efectos de Bloqueo Paraespinal en pacientes con dolor crónico de extremidad superior atendidos en el Servicio de Medicina Física y Rehabilitación del HCUCH entre abril - agosto 2008. Material y Métodos: Estudio descriptivo - retrospectivo de pacientes que consultan por dolor crónico de extremidad superior, que presentaron signos de SES en atención ambulatoria del Servicio de Medicina Física y Rehabilitación del HCUCH. Se evaluó características demográficas y clínicas, y respuestas tras BPE. Resultados: Once pacientes presentaron signos de SES. El 100 por ciento fue de sexo femenino, con una mediana edad de 44 años. El 63,6 por ciento presentó Epicondilitis como diagnóstico inicial, seguido de Lesión de MAnguito Rotator (36 por ciento) y el 36 por ciento presentó mas de una patología. El EVA inicial fue en promedio de 8,9. El territorio afectado más frecuente fue C6 - C7 (36 por ciento). Tras el BPE, el dolor en reposo disminuye a un EVA promedio de 2,8 (diminución de un 68,3 por ciento). Incidentalmente, se observó ganancia en los rangos articulares de los segmentos comprometidos. Discusión: La búsqueda y tratamiento de la SES mediante el BPE puede ser una herramienta útil en el manejo de pacientes con dolor crónico musculoesquelético.

Introduction: Spinal Segmental Sensitization (SSS) relates to an hyperactive state of one spinal segment reacting to a source of irritation that is constantly stimulating the dorsal ganglion. This translates into spontaneous pain, hyperalgesia and allodinia. The Paraspinus Block (PB) technique would prove useful to desensitize the reacting segment. Objetive: To show SSS manifestations and the effects of Paraspinus Block in patients with chronic pain in upper limbs treated at Hospital Clinico Universidad de Chile Physical and Rehab Med Center from April through August 2008. Materials and Method: Descriptive and retrospective study of Physical and Rehab Med Center outpatients with upper limb chronic pain showing signs of SSS. Demographic and clinical information was evaluated as well as response to PB treatment. Results: Eleven patients showed signs of SSS of which 100 percent were female in their mid forties. 63.6 percent were initially diagnosed with Epycondilitis while 36 percent with Rotator Cuff Tear and 36 percent with more than one disease. The initial average VAS was 8.9. The most affected area was C6 - C7 (36 percent). After PBE pain while resting is reduced to an average VAS of 2.8 (a 68.3 percent reduction). We also observed a gain in irritated segments. Discussion: The search and treatment of SSS using PBE could be a useful tool for pain management in patients with musculoskeletal chronic pain.

Tratamiento de afecciones músculo-esqueléticas con ondas de choque extracorpóreas / Extracorporeal shock wave therapy for musculoskeletal disorders

Extracorporeal shock waves are pressure waves used to treat certain musculoskeletal conditions. Focused wavetherapy, the same that is used in lithotripsy, but actingthrough a different mechanism, is used to treat pseudoarthritis and delayed consolidation, avascular necrosis of large joints, osteochondritis dissecans, calcific tendonitis and enthesopathies. We study its use in myocardial infarction. Results are positive, and this constitutes a non invasive alternative to surgery. It must be applied with anesthesia or analgesics and presents the same risks as lithotripsy. Radial wave therapy has shown good results in pathologies that do not respond well to conventional treatments, such as calcific tendonitis of the shoulder, frozen shoulder, plantar fasciitis (with or without calcaneal spurs), epicondilitis, trocanterous bursitis, patellar tendonitis,Achilles tendonitis, Morton’s neuroma, trigger points; and less favorable results in medial epicondylitis, andmore recently in diabetic foot. This therapy constitutes a non invasive alternative to surgery, practically riskfree. It is ambulatory and requires neither anesthesianor significant analgesics. It does not require sick leave. Shock waves act through the so called biological effect, producing analgesia and inducing osteogenesis, repairing tendons and other soft tissue damage, as well as reabsorbing calcium deposits. Results using shock waves are comparable to surgery, without the risks of complications associated to the later, with lower costs and less days of physical invalidity.