Descripción electrofisiològica del síndrome de túnel carpiano según edad en pacientes adultos / Electrophysiological severity of carpal tunnel syndrome according to age in adult patients

Background: Carpal tunnel syndrome (CTS) represents 90% of entrapment neuropathies. Severity may be greater in older patients. Aim: To describe the electrophysiological findings in adult patients with CTS and determine if severity is related to age. Material and Methods: Descriptive and retrospective study of electrophysiological findings in patients over 18 years of age with clinical suspicion of CTS, studied between January 2011 and December 2015. Neurophysiological severity was classified in 3 grades, comparing them by age, gender and laterality. Results: Of 1156 patients subjected to electrophysiological studies due to a clinical suspicion of CTS, 690 (60%) had electrophysiological features of the disease. In 274 patients (24%) the compromise was mild, in 162 (14%) it was moderate and in 254 (22%) it was severe. There was a positive association between age and CTS severity (p < 0.01). Severity was significantly greater in males than females (p < 0.01). Bilateral CTS was present in 471 patients (68%), which was associated with increased age and severity (p < 0.01). Conclusions: Electrophysiological severity in CTS increases with age. Other factors associated with higher severity are male gender and bilateral disease.

Cuestionario de actividades de la vida diaria (T-ADLQ): utilidad en pacientes con accidente cerebrovascular menor / Usefulness of the activities of daily living questionnaire (T-ADLQ) in patients with minor stroke

Background: The inability to carry out activities of daily living (ADL) is prevalent in elderly people and it is associated with hypertension and stroke. Aim: To evaluate ADLs using the T-ADLQ in hypertensive patients with minor stroke. Subjects and Methods: T-ADLQ, Cognitive tests (Minimental and Addenbrooke), and Hamilton depression test were applied to 100 hypertensive ambulatory patients (55 without symptomatic stroke and 45 with ischemic stroke, Rankin ≤ 2). Results: In stroke patients the ability to perform ADL was significantly reduced compared with hypertensive patients without stroke. Cognitive dysfunction and depressive symptoms were associated with a lower ADL performance. Conclusions: The T-ADLQ is useful to evaluate ADL in hypertensive ambulatory patients with ischemic stroke.

Carotid body Thermoreceptors, sympathetic neural activation, and cardiometabolic disease

The carotid body (CB) is the main peripheral chemoreceptor that senses the arterial PO2, PCO2 and pH. In response to hypoxemia, hypercapnia and acidosis, carotid chemosensory discharge elicits reflex respiratory, autonomic and cardiovascular adjustments. The classical construct considers the CB as the main peripheral oxygen sensor, triggering reflex physiological responses to acute hypoxemia and facilitating the ventilatory acclimation to chronic hypoxemia at high altitude. However, a growing body of experimental evidence supports the novel concept that an abnormally enhanced CB chemosensory input to the brainstem contributes to overactivation of the sympathetic nervous system, and consequent pathology. Indeed, the CB has been implicated in several diseases associated with increases in central sympathetic outflow. These include hypertension, heart failure, sleep apnea, chronic obstructive pulmonary disease and metabolic syndrome. Indeed, ablation of the CB has been proposed for the treatment of severe and resistant hypertension in humans. In this review, we will analyze and discuss new evidence supporting an important role for the CB chemoreceptor in the progression of autonomic and cardiorespiratory alterations induced by heart failure, obstructive sleep apnea, chronic obstructive pulmonary disease and metabolic syndrome.

Túnel del carpo: una revisión de tres años en neurofisiología clínica / Carpal tunnel syndrome: a three years neurophysiological review

Se presenta la experiencia de un laboratorio regional de electrofisiología en el diagnóstico de Sídrome del túnel del carpo, durante un período de 3 años. 116 pacientes fueron diagnosticados, incluyendo 107 mujeres y 9 varones, con una edad promedio de 51,3 años. El STC se diagnosticó en 163 ocasiones, representando el 85 por ciento de las mononeuropatías diagnosticadas en el período. Se registraron 86 STC derechos y 77 izquierdos (47 pacientes con alteración bilateral). La latencia motora distal en el nervio mediano presentó una sensibilidad de 84 por ciento, mientras que la latencia sensitiva palma-muñeca alcanzó un 98 por ciento

Consentimiento informado: variables que lo modifican / Informed consent: variables that modified it

El consentimiento informado ha pasado desde el plano de la discusión informal a ser una exigencia en diferentes ámbitos del quehacer médico. En el presente trabajo se pretende establecer la factibilidad de la solicitud del consentimiento informado y, las variables que influyen en la aceptación por parte del paciente. Para esto se diseñó un experimento ficticio en el cual se sometería al paciente a una nueva droga para tratar su patología, evaluando los beneficios terapéuticos y posibles efectos adversos. Se solicitó a los pacientes su participación voluntaria exponiendo previamente los riesgos y beneficios a los cuales se exponía. Según los resultados obtenidos en este trabajo, la solicitud del consentimiento informado es factible de realizar en nuestro país, pero está dificultada por la falta de un lugar físico adecuado y la poca disponibilidad de tiempo de los médicos. Respecto de las variables estudiadas tanto el nivel socio-económico, edad, sexo y educación de los pacientes, no modularían la respuesta del encuestado: excepto la condición de médico tratante del encuestador, que obtuvo un porcentaje significativamente superior de aceptación. Los motivos de rechazos más frecuentes fueron: temor a reacciones adversas, el deseo de consultar a terceros y sentirse bien con su tratamiento