Trastornos somatomorfos y rasgos de personalidad en pacientes hospitalizados por lumbalgia crónica en El Salvador / Somatoform Disorders and Personality Traits in Hospitalized Patients with Chronic Back Pain in El Salvador

Introducción. El trastorno somatomorfo se caracteriza por la presentación de múltiples síntomas físicos que no pueden ser atribuidos a otra enfermedad física, mental o al uso de sustancias, teniendo como comorbilidad más prevalente a los trastornos de personalidad. Objetivo. Determinar la frecuencia de trastorno somatomorfo, sus características principales y diferentes rasgos de personalidad entre pacientes con lumbalgia crónica. Metodología. Estudio descriptivo transversal realizado con pacientes ingresados en el servicio de neurocirugía del Hospital General del Instituto Salvadoreño del Seguro Social. La recolección de datos se realizó a través de la escala Screening for Somatoform Symptoms 2 y la escala InternationalPersonality Disorder Examination. Las variables cualitativas fueron analizadas a través de frecuencias absolutas. Las variables cuantitativas fueron analizadas a través de medidas de tendencia central y de dispersión. Los análisis estadísticos fueron realizados en el programa Statistical Package for the Social Sicience, versión 26. Resultados. Se incluyeron 60 pacientes, 40 de ellos mujeres, 31 entre los 41 y 60 años. Veintiocho pacientes presentaron ocho o más síntomas, excluyéndose dolor lumbar. Cuarenta y cinco pacientes reportaron sintomatología por más de un año. Cincuenta y tres pacientes presentaron trastorno somatomorfo. Los trastornos de personalidad más frecuentes fueron obsesivo-compulsivos (31), límites (21) y paranoides (21). Conclusión. Los pacientes con dolor lumbar crónico que requieren ingreso hospitalario presentan una alta frecuencia de trastornos somatomorfos, con dolor en piernas o brazos como síntoma principal; además, estos pacientes se caracterizan por presentar en su mayoría rasgos de personalidad obsesivo-compulsivos.

Introduction. The somatoform symptoms disorder is characterized by multiple psychical symptoms that can't be attributed to another physical or mental health diagnosis or drug abuse, having personality disorders as the most common comorbidity. Objective. To determine the frequency of somatoform disorders, it's most important characteristics and different personality traits among patients with chronic back pain. Methodology. Cross-sectional descriptive study carried out with patients admitted to the neurosurgery department of the General Hospital of the Salvadoran Social Security Institute. Data collection was carried out using the Screening for Somatoform Symptoms 2 scale and the International Personality Disorder Examination scale. The qualitative variables were analyzed through absolute frequencies. The quantitative variables were analyzed through measures of central tendency and dispersion. The statistical analyzes were carried out using the Statistical Package for the Social Sciences version 26. Results. The study included 60 patients, 40 of them women, 31 between 41 and 60 years old. Twenty-eight patients presented eight or more symptoms, excluding low back pain. Forty-five patients reported symptoms for more than one year. Fifty-three patients presented somatoform disorder. The most frequent personality disorders were obsessive-compulsive (31), borderline (21) and paranoid (21). Conclusion. Patients with chronic lower back pain who require hospital admission have a high frequency of somatoform disorders, with the main symptom being pain in the legs or arms; furthermore, these patients are characterized by mostly presenting obsessive-compulsive personality traits

Lumbar Core Muscle Stability Training Combined with Kinesiology Taping Technique in Rehabilitation Treatment of Lumbar Disc Herniation / 中山大学学报(医学科学版)

ObjectiveTo investigate the clinical efficacy of lumbar core muscle stability training combined with kinesiology taping technique in the rehabilitation treatment of lumbar disc herniation （LDH）. MethodsA total of 99 LDH patients treated in Ningbo Yinzhou No. 2 Hospital from January 2018 to January 2020 were selected and divided into control group （n=49） and observation group （n=50）. Kinesiology taping technique was applied to patients in the control group and patients in the observation group were treated with lumbar core muscle stability training combined with kinesiology taping technique， then we compared the therapeutic effect， lumbar function and pain degree， surface electromyography of lumbar extensor muscles， lumbar range of motion， LDH recurrence and skin allergies before and after the treatment between the two groups. ResultsAfter 4 weeks of treatment， compared with those in the control group， in the observation group， the visual analogue scale （VAS） and Oswestry disability index （ODI） scores were significantly lower （P<0.05）； the Japanese Orthopaedic Association （JOA） score， mean power frequency of lumbar extensor muscles， integral electromyography value and lumbar function score were significantly higher （P<0.05）. During the treatment， there was no significant difference in the incidence of complications between two groups （P>0.05）. After 4 weeks of treatment， the observation group had a significantly lower LDH recurrence rate than the control group （P<0.05）. ConclusionLumbar core muscle stability training combined with kinesiology taping technique achieves a significantly better therapeutic effect than kinesiology taping technique in the rehabilitation treatment of LDH and can effectively relieve muscle fatigue， help alleviate lumbar spine pain and improve the function of lumbar spine.

Effect of core muscles training based on spinal fine-tuning manipulation on lumbar spine function and quality of life in patients with lumbar facet joint disorders / 中国康复理论与实践

ObjectiveTo explore the effect of core muscles training based on spinal fine-tuning manipulation on lumbar facet joint disorders. MethodsFrom February, 2021 to February, 2022, 80 patients with lumbar facet joint disorders in Huadong Hospital Affiliated to Fudan University were randomly divided into control group (n = 40) and observation group (n = 40) randomly. Both groups received routine treatment and spinal fine-tuning manipulation, while the observation group received core muscles training in addition, for six weeks. They were assessed with Japanese Orthopaedic Association (JOA) scores, Short-Form of McGill Pain Questionnaire and World Health Organization Quality of Life-BREF before and after treatment. The recurrence rate was observed after three months follow-up. ResultsThe scores of all the scales improved after treatment (t > 5.751, P < 0.001), and improved more in the observation group than in the control group (t > 2.051, P < 0.05). After three months follow-up, the recurrence rate was 7.89% (3/38) in the observation group, less than 28.13% (9/32) in the control group (χ2 = 5.005, P = 0.025). ConclusionCombination of core muscles training may improve lumbar function, reduce lumbar pain, reduce recurrence and improve quality of life for patients with lumbar facet joint disorders.

Safety of preoperative branch embolization in patients undergoing evar / Segurança da embolização pré-operatória do ramo em pacientes submetidos a evar

Abstract The purpose of this systematic review is to evaluate the safety of pre-endovascular abdominal aortic aneurysm repair (EVAR) embolization of aortic side branches - the inferior mesenteric artery and lumbar arteries. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. A search of MEDLINE and DIMENSION databases identified 9 studies published from 2011 to 2021 that satisfied the inclusion and exclusion criteria. These studies were analyzed to detect the incidence of embolization-related complications. A total of 482 patients underwent preoperative aortic side branch embolization, 30 (6.2%) of whom suffered some kind of minor complication. The only major complication observed was ischemic colitis in 4 (0.82%) patients, two (0.41%) of whom died after bowel resection surgery. Regarding these findings, aortic side branch embolization seems to be a safe procedure, with very low percentages of both minor and major complications.

Resumo O objetivo desta revisão sistemática foi avaliar a segurança da embolização de artéria mesentérica inferior (AMI) e artérias lombares (ALs) pré-correção endovascular de aneurisma da aorta abdominal. Foram realizadas pesquisas nas bases de dados MEDLINE e Dimensions. Foram encontrados 9 estudos publicados de 2011 a 2021 que atendiam aos critérios de inclusão e exclusão. Os estudos foram analisados ​​para definir a incidência de complicações relacionadas à embolização. No total, 482 pacientes foram submetidos a embolização de AMI e/ou ALs, dos quais 30 (6,2%) sofreram algum tipo de complicação menor. A única complicação importante observada foi colite isquêmica em 4 (0,82%) pacientes. Dois (0,41%) desses pacientes morreram após cirurgia de ressecção intestinal. Em relação a esses achados, a embolização de AMI e ALs parece ser um procedimento seguro, com um percentual muito baixo de complicações menores e importantes.

The squat exercise recruits core muscles as much as localized exercises / O exercício de agachamento recruta músculos do tronco tanto quanto exercícios localizados

Abstract Introduction In the context of resistance training, which encompasses both strengthening and rehabilitation, the incorporation of global range exercises demands intense activation of the trunk muscle groups, which play a primary role in body stabilization. The squat, notorious for its complexity and effectiveness in activating stabilizers during execution, raises a central question: whether this exercise recruits the muscles more significantly compared to localized exercises, such as push-ups and trunk exten-sions. Objective To identify the degree of activation of the trunk muscles during squats and compare it with localized exercises for the trunk muscles: lumbar and abdominal. Methods Using surface electromyography, the activation of the iliocostalis, multifidus, internal oblique, external oblique and rectus abdominis muscles was evaluated. The sample included 16 physically active volunteers of both sexes. A repeated measures t-test (α < 0.05) was used as an analysis method. Results The iliocostalis, multifidus and internal oblique muscles showed similar levels of activation both in the squat and in their respective isolated exercises, while the rectus abdominis and external oblique muscles showed greater activity during trunk flexion. Conclusion It is possible to infer that squats are an effective exercise for training the iliocostalis, multifidus and internal oblique muscles, while localized exercises are more suitable for strengthening the external oblique and rectus abdominis muscles. Such conclusion can contribute to optimizing the planning of exercise sessions by replacing isolated trunk exercises with squats.

Resumo Introdução No contexto do treinamento resistido, que engloba tanto o fortalecimento quanto a reabilitação, a incorporação de exercícios de alcance global demanda uma intensa ativação dos grupos musculares do tronco, os quais desempenham um papel primordial na estabilização corporal. O agachamento, notório por sua complexidade e eficácia na ativação dos estabilizadores durante a execução, suscita uma questão central: se o agachamento recruta de forma mais acentuada a musculatura do tronco comparativamente a exercícios localizados, tais como flexões e extensões do tronco. Objetivo Identificar o grau de ativação dos músculos do tronco durante o agachamento e confrontá-lo com exercícios localizados para a musculatura do tronco: lombar e abdominal. Métodos Através da aplicação da eletromiografia de superfície, avaliou-se a ativação dos músculos iliocostal, multífido, oblíquo interno, oblíquo externo e reto abdominal. A amostra englobou 16 voluntários de ambos os gêneros, fisicamente ativos. Empregou-se um teste t de medidas repetidas (α < 0,05) como método de análise. Resultados Os músculos iliocostal, multífido e oblíquo interno manifestaram níveis semelhantes de ativação tanto no agachamento quanto em seus respectivos exercícios isolados, enquanto os músculos reto abdominal e oblíquo externo apresentaram maior atividade durante a flexão do tronco. Conclusão É possível inferir que o agachamento se configura como um exercício eficaz para o treinamento do iliocostal, multífido e oblíquo interno, enquanto os exercícios localizados se revelam mais indicados para o fortalecimento do oblíquo externo e dos músculos reto abdominais. Tais conclusões podem contribuir para a otimização do planejamento de sessões de exercícios, mediante a substituição de exercícios isolados de tronco pelo agachamento.

Traumatic lumbar hernia: A systematic review of the literature / 中华创伤杂志(英文版)

PURPOSE@#Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases.@*METHODS@#A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology guidelines. The English literature from 1990 until 2021 was reviewed, using PubMed, EMBASE and Google Scholar bibliographic databases, to identify case reports and case series with patients that were diagnosed with TLH. For each eligible study, demographics, clinical presentation, hernia characteristics, preoperative imaging investigations, operation details, and postoperative data were extracted for assessment. Statistical analysis was performed on SPSS, version 20.0.@*RESULTS@#A total of 62 studies were included for review, with 164 patients with TLH. Mean age was (42.6 ± 14.3) years (47.6% males, 31.1% females, gender not specified in 35 cases). Mean diameter of hernia neck was (6.3 ± 3.1) cm, while the triangles of Petit and Grynfeltt were affected in 74.5% and 14.6%, respectively. Patients diagnosed in the emergency setting account for 54.2%, with CT scan establishing diagnosis in all but one case (97.7%). A delayed diagnosis was made in 45.8%, at a mean 1 year following trauma. Flank bulging (82.8%) and chronic back pain (34.3%) were the most frequent symptoms. In both delayed and acute group, open surgery (63.6% and 92.3%, respectively) was the preferred surgical approach. Postoperative complications were reported in 11.4% of acute and 15.0% of delayed patients. Hernia recurrence was 7%.@*CONCLUSIONS@#TLH is uncommon with 164 cases described since 1990. CT scan is the gold standard in diagnosis. Open surgery is generally the preferred approach, particularly in the emergency setting. Acute TLH can be treated either by primary suture repair or mesh, depending on the local conditions, whereas delayed cases usually require a mesh.

Analysis of the causes of cage subsidence after oblique lateral lumbar interbody fusion / 中国骨伤

OBJECTIVE@#To observe the cage subsidence after oblique lateral interbody fusion (OLIF) for lumbar spondylosis, summarize the characteristics of the cage subsidence, analyze causes, and propose preventive measures.@*METHODS@#The data of 144 patients of lumbar spine lesions admitted to our hospital from October 2015 to December 2018 were retrospectively analyzed. There were 43 males and 101 females, and the age ranged from 20 to 81 years old, with an average of (60.90±10.06) years old. Disease types:17 patients of lumbar intervertebral disc degenerative disease, 12 patients of giant lumbar disc herniation, 5 patients of discogenic low back pain, 33 patients of lumbar spinal stenosis, 26 patients of lumbar degenerative spondylolisthesis, 28 patients of lumbar spondylolisthesis with spondylolisthesis, 11 patients of adjacent vertebral disease after lumbar internal fixation, 7 patients of primary spondylitis in the inflammatory outcome stage, and 5 patients of lumbar degenerative scoliosis. Preoperative dual-energy X-ray bone mineral density examination showed 57 patients of osteopenia or osteoporosis, and 87 patients of normal bone density. The number of fusion segments:124 patients of single-segment, 11 patients of two-segment, 8 patients of three-segment, four-segment 1 patient. There were 40 patients treated by stand-alone OLIF, and 104 patients by OLIF combined with posterior pedicle screw. Observed the occurrence of fusion cage settlement after operation, conducted monofactor analysis on possible risk factors, and observed the influence of fusion cage settlement on clinical results.@*RESULTS@#All operations were successfully completed, the median operation time was 99 min, and the median intraoperative blood loss was 106 ml. Intraoperative endplate injury occurred in 30 patients and vertebral fracture occurred in 5 patients. The mean follow-up was (14.57±7.14) months from 6 to 30 months. During the follow-up, except for the patients of primary lumbar interstitial inflammation and some patients of lumbar spondylolisthesis with spondylolisthesis, the others all had different degrees of cage subsidence. Cage subsidence classification:119 patients were normal subsidence, and 25 patients were abnormal subsidence (23 patients were gradeⅠ, and 2 patients were gradeⅡ). There was no loosening or rupture of the pedicle screw system. The height of the intervertebral space recovered from the preoperative average (9.48±1.84) mm to the postoperative average (12.65±2.03) mm, and the average (10.51±1.81) mm at the last follow-up. There were statistical differences between postoperative and preoperative, and between the last follow-up and postoperative. The interbody fusion rate was 94.4%. The low back pain VAS decreased from the preoperative average (6.55±2.2 9) to the last follow-up (1.40±0.82), and there was statistically significant different. The leg pain VAS decreased from the preoperative average (4.72±1.49) to the final follow-up (0.60±0.03), and the difference was statistically significant (t=9.13, P<0.000 1). The ODI index recovered from the preoperative average (38.50±6.98)% to the latest follow-up (11.30±3.27)%, and there was statistically significant different. The complication rate was 31.3%(45/144), and the reoperation rate was 9.72%(14/144). Among them, 8 patients were reoperated due to fusion cage subsidence or displacement, accounting for 57.14%(8/14) of reoperation. The fusion cage subsidence in this group had obvious characteristics. The monofactor analysis showed that the number of abnormal subsidence patients in the osteopenia or osteoporosis group, Stand-alone OLIF group, 2 or more segments fusion group, and endplate injury group was higher than that in the normal bone mass group, OLIF combined with pedicle screw fixation group, single segment fusion group, and no endplate injury group, and the comparison had statistical differences.@*CONCLUSION@#Cage subsidence is a common phenomenon after OLIF surgery. Preoperative osteopenia or osteoporosis, Stand-alone OLIF, 2 or more segments of fusion and intraoperative endplate injury may be important factors for postoperative fusion cage subsidence. Although there is no significant correlation between the degree of cage subsidence and clinical symptoms, there is a risk of cage migration, and prevention needs to be strengthened to reduce serious complications caused by fusion of cage subsidence, including reoperation.

Imaging study on thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis / 中国骨伤

OBJECTIVE@#To observe the alteration of thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis(AIS) and the difference of physiological curvature between different types of scoliosis.@*METHODS@#A retrospective analysis was conducted on 305 adolescent patients taken full spine X-ray in our hospital from January 2017 to December 2021. The patients were divided into normal group and scoliosis group. The normal group was composed of 179 patients, 79 males and 100 females, aged 10 to 18 years old with an average of (12.84±2.10) years old, with cobb agle less than 10 degrees. The scoliosis group was composed of 126 patients, 33 males and 93 females, aged 10 to 18 years old with an average of (13.92±2.20) years old. The gender, age, Risser sign, thoracic kyphosis(TK) and lumbar lordosis(LL) in 2 groups were compared, and the TK and LL were also compared between different genders, different degrees of scoliosis and different segments of scoliosis.@*RESULTS@#The female ratio(P=0.001) and age (P<0.001) in scoliosis group were higher than them in normal group; the ratio of low-grade ossification was higher in normal group than in scoliosis group(P=0.038). TK was significantly smaller in scoliosis group than in normal group(P<0.001), but there was no significant difference in LL between the 2 groups(P=0.147). There were no significant difference in TK and LL between male and female. The TK was significantly bigger in mild AIS patients than in moderate AIS patients(P<0.05), but there was no significant difference in LL between mild and moderate patients(P>0.05). The TK and LL in different segments scoliosis were not found significant difference.@*CONCLUSION@#The physiological curvature of thoracic and lumbar spine is independent of gender. The thoracic physiological curvature becomes smaller in AIS patients, but lumbar curvature remains unchanged. The thoracic physiological curvature in mild AIS patients is greater than that in moderate AIS patients, but the lumbar curvature is almost unchanged between mild and moderate scoliosis and is similar with that in normal adolescent. The alteration of thoracic and lumbar physiological curvature in AIS patients may be related to relative anterior spinal overgrowth, and the specific detailed mechanism needs to be further studied.

Clinical study of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of thoracolumbar osteoporotic compression fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures.@*METHODS@#From February 2020 to October 2021, 92 patients with thoracolumbar osteoporotic compression fracture were treated by percutaneous vertebroplasty. According to different treatment methods, they were divided into the observation group and the control group. The observation group was treated with modified suspension reduction and then percutaneous vertebroplasty, while the control group was treated with percutaneous vertebroplasty alone. The observation group (47 cases), including 20 males and 27 females, the age ranged from 59 to 76 years old with an average of (69.74±4.50) years old, fractured vertebral bodies:T10(2 cases), T11(7 cases), T12(19 cases), L1(14 cases), L2(5 cases);the control group(45 cases), including 21 males and 24 females, the age ranged from 61 to 78 years old with an average of (71.02±3.58) years old, fractured vertebral bodies:T10(3 cases), T11(8 cases), T12(17 cases), L1(12 cases), L2(5 cases);The leakage of bone cement were observed, the visual analogue scale (VAS), Oswestry lumbar dysfunction index (ODI), anterior vertebrae height (AVH), Cobb angle of kyphosis and the amount of bone cement injected before and after operation were recorded and compared between the two groups.@*RESULTS@#All patients were followed up, ranged from 6 to10 with an average of (8.45±1.73) months. Two patients ocurred bone cement leakage in observation group and 3 patients in control group. AVH of observation group increased (P<0.05) and Cobb angle of injured vertebrae decreased (P<0.05). Cobb angle of injured vertebrae and AVH of the control group were not significantly changed (P>0.05). Cobb angle of injured vertebrae of the observation group was lower than that of control group (P<0.05) and AVH was higher than that of the control group (P<0.05). In the observation group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.32±1.05) scores, (3.56±1.18) scores, (1.83±0.67) scores, (1.27±0.34) scores, and ODI were(40.12±14.69) scores, (23.76±10.19) scores, (20.15±6.39) scores, (13.45±3.46) scores. In the control group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.11±5.26) scores, (3.82±0.68) scores, (1.94±0.88) scores, (1.36±0.52) scores, and ODI were(41.38±10.23) scores, (25.13±14.22) scores , (20.61±5.82) scores, (14.55±5.27) scores . The scores of VAS and ODI after operation were lower than those before operation (P<0.05), but there was no significant difference between the two groups (P<0.05).@*CONCLUSION@#Modified suspension reduction method combined with PVP surgery for osteoporotic thoracolumbar compression fractures has achieved good clinical results, which can effectively relieve lumbar back pain, restore vertebral height, correct kyphosis, improve lumbar function and patients' quality of life.

Application value of bone cement containing rhbFGF and RHBMP-2 in PKP treatment of osteoporotic lumbar compression fracture / 中国骨伤

OBJECTIVE@#To investigate the effect of bone cement containing recombinant human basic fibroblast growth factor (rhbFGF) and recombinant human bone morphogenetic protein-2 (rhBMP-2) in percutaneous kyphoplasty(PKP)treatment of osteoporotic vertebral compression fracture(OVCF).@*METHODS@#A total of 103 OVCF patients who underwent PKP from January 2018 to January 2021 were retrospectively analyzed, including 40 males and 63 females, aged from 61 to 78 years old with an average of (65.72±3.29) years old. The injury mechanism included slipping 33 patients, falling 42 patients, and lifting injury 28 patients. The patients were divided into three groups according to the filling of bone cement. Calcium phosphate consisted of 34 patients, aged(65.1±3.3) years old, 14 males and 20 females, who were filled with calcium phosphate bone cement. rhBMP-2 consisted of 34 patients, aged (64.8±3.2) years old, 12 males and 22 females, who were filled with bone cement containing rhBMP-2. And rhbFGF+rhBMP-2 consisted of 35 patients, aged (65.1±3.6) years old, 14 males and 21 females, who were filled with bone cement containing rhbFGF and rhBMP-2. Oswestry disability index (ODI), bone mineral density, anterior edge loss height, anterior edge compression rate of injured vertebra, visual analog scale (VAS) of pain, and the incidence of refracture were compared between groups.@*RESULTS@#All patients were followed for 12 months. Postoperative ODI and VAS score of the three groups decreased (P<0.001), while bone mineral density increased (P<0.001), anterior edge loss height, anterior edge compression rate of injured vertebra decreased first and then slowly increased (P<0.001). ODI and VAS of group calcium phosphate after 1 months, 6 months, 12 months were lower than that of rhBMP-2 and group rhbFGF+rhBMP-2(P<0.05), bone mineral density after 6 months, 12 months was higher than that of rhBMP-2 and group calcium phosphate(P<0.05), and anterior edge loss height, anterior edge compression rate of injured vertebra of group rhbFGF+rhBMP-2 after 6 months and 12 months were lower than that of group rhBMP-2 and group calcium phosphate(P<0.05). There was no statistical difference in the incidence of re-fracture among the three groups (P>0.05).@*CONCLUSION@#Bone cement containing rhbFGF and rhBMP-2 could more effectively increase bone mineral density in patients with OVCF, obtain satisfactory clinical and radiological effects after operation, and significantly improve clinical symptoms.

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.

Morphometrics of T11-L5 Vertebrae in Jordanian Population: CT Scan-Based Study / Morfometría de las Vértebras T11-L5 en una Población Jordana: Estudio Basado en Tomografía Computarizada

SUMMARY: The study will provide information on the morphometrics of the vertebrae, which can be used to guide clinicians on the appropriate size of transpedicular screws to use in spine interventions among the Jordanian population and for comparative studies with other races. A retrospective analysis of normal CT scans of the lumbar and thoracolumbar areas was done. Linear and angular measurements of 336 vertebrae were collected for 25 males and 23 females. The results were compared between right and left and between both sexes. The L5 has the longest AVBH and the shortest PVBH in both sexes, it also, had the shortest and widest pedicle in both males and females. ratio of the AVBH to PVBH showed progressive increase in both sexes from T11 to L5. Similarly, the VBW increased progressively from the top to the bottom in both sexes, but it was significantly different between both sexes. The L1 was the most cranially oriented vertebrae in males while the L2 showed the most cranial orientation in females. Both sexes L5 was the most caudally oriented vertebrae. This study provides a database for vertebral morphometrics in the Jordanian population, there are slight differences between the right and left side in the upper studied vertebrae (T11-L2) and some measurement showed significant differences between males and females. These findings need to be taken into consideration when inserting pedicle screws.

Este estudio proporciona información sobre la morfometría de las vértebras, la cual puede ser utilizada por los médicos oara determinar el tamaño adecuado de los tornillos transpediculares a utilizar en intervenciones de columna en la población jordana y para estudios comparativos con otras grupos. Se realizó un análisis retrospectivo de tomografías computarizadas normales de las áreas lumbar y toracolumbar. Se recogieron medidas lineales y angulares de 336 vértebras de 25 hombres y 23 mujeres. Los resultados se compararon entre vértebras derechas e izquierdas y entre ambos sexos. La L5 tiene el AVBH más largo y el PVBH más corto en ambos sexos, también tenía el pedículo más corto y más ancho tanto en hombres como en mujeres. La relación de AVBH a PVBH mostró un aumento progresivo en ambos sexos de T11 a L5. De manera similar, el VBW aumentó progresivamente de arriba hacia abajo en ambos sexos, pero fue significativamente diferente entre ambos sexos. La L1 fue la vértebra más orientada cranealmente en los hombres, mientras que la L2 mostró la orientación más craneal en las mujeres. En ambos sexos L5 fue la vértebra más orientada caudalmente. Este estudio proporciona una base de datos para la morfometría vertebral en la población jordana, donde existen ligeras diferencias entre el lado derecho e izquierdo en las vértebras superiores estudiadas (T11-L2). Algunas mediciones mostraron diferencias significativas entre hombres y mujeres. Estos hallazgos deben tenerse en cuenta al insertar tornillos pediculares.

Bloqueos Nerviosos. Bases Anatómicas del Dolor Somático Abdomino-Pélvico / Nerve Blocks. Anatomy of the Somatic Innervation of the Abdomino-Pelvic Cavity

El dolor abdominal es una de las sintomatologías que afectan con frecuencia la cavidad abdomino-pélvica. Dicha cavidad posee una inervación somática en la que intervienen del séptimo a doceavo nervios intercostales, ramos colaterales y terminales del plexo lumbar y el nervio pudendo; siendo objetivo de este trabajo la descripción anatómica del dolor abdominopélvico a través del plexo lumbar, nervios intercostales y nervio pudendo, sus diferentes patrones y variaciones de conformación, y las implicancias de éstas últimas en las distintas maniobras clínico-quirúrgicas. Se realizó un estudio descriptivo, observacional y morfométrico de la inervación somática de la cavidad abdomino-pélvica, en 50 preparaciones cadavéricas, fijadas en solución de formaldehído, de la Tercera Cátedra de Anatomía, Facultad de Medicina, Universidad de Buenos Aires, entre Agosto/2017-Diciembre/2019. La descripción clásica del plexo lumbar se encontró en 35 casos; la presencia del nervio femoral accesorio en ningún caso; así como también la ausencia del nervio iliohipogástrico en ningún caso; el nervio obturador accesorio se halló en 2 casos; el nervio genitofemoral dividiéndose dentro de la masa muscular del psoas mayor en 6 casos; el nervio cutáneo femoral lateral emergiendo únicamente de la segunda raíz lumbar en 6 casos y por último se encontró la presencia de un ramo del nervio obturador uniéndose al tronco lumbosacro en un caso. Los nervios intercostales y el nervio pudendo presentaron una disposición clásica en todos los casos analizados. Es esencial un adecuado conocimiento y descripción del plexo lumbar, nervios intercostales y nervio pudendo para un adecuado abordaje de la cavidad abdomino-pélvica en los bloqueos nerviosos.

SUMMARY: Abdominal pain is one of the symptoms that affect the abdominal-pelvic cavity. The abdominal-pelvic cavity has a somatic innervation involving the seventh to twelfth intercostal nerves, collateral and terminal branches of the lumbar plexus and the pudendal nerve. The objective of this work is the description of the lumbar plexus, intercostal nerves and pudendal nerve, its different patterns and structure variations, as well as its implications during pain management in patients. A descriptive, observational, and morphometric study of patterns and structure variations of the lumbar plexus, intercostal nerves and pudendal nerve was conducted in 50 formalin-fixed cadaveric dissections of the Third Chair of Anatomy at the School of Medicine in the Universidad de Buenos Aires from August 2017 to December/2019. The standard description of the lumbar plexus was found in 35 cases; accessory femoral nerve was not present in any of the cases; absence of the iliohipogastric nerve was also not found in any case, while the accessory obturating nerve was found in 2 cases; genitofemoral nerve dividing within the muscle mass of psoas in 6 cases; lateral femoral cutaneous nerve emerging only from the second lumbar root in 6 cases and finally, presence of a branch of the obturating nerve was found joining the lumbosacral trunk in one case. The pudendal and intercostal nerve patterns presented a typical pathway in all cases. Adequate knowledge and description of the lumbar plexus, intercostal nerves and pudendal nerve is essential for an adequate approach of the abdominal-pelvic cavity in nerve blocks.

Hemofilia A adquirida en el posparto: reporte de caso / Postpartum-acquired hemophilia A: case report

RESUMEN La hemofilia A adquirida es un trastorno hemorrágico poco frecuente a nivel mundial, y se caracteriza por la presencia de autoanticuerpos inhibidores dirigidos hacia un factor de la coagulación, en la mayoría de ocasiones el factor VIII. Las etiologías son variadas, entre las que se encuentra el posparto. Se presenta el caso de una paciente de 34 años con dolor lumbar, hematuria y hematoma en región glútea derecha, sin antecedentes previos de sangrado. Por extensión de las manifestaciones hemorrágicas es transferida al servicio de emergencia. Los exámenes auxiliares de perfil de coagulación, prueba de mezclas y medición de los títulos de inhibidores del factor VIII permitieron confirmar el diagnóstico. El caso resalta la importancia de considerar esta patología en una paciente puérpera con persistencia de sangrado por herida operatoria, hematoma extenso y sin historia de sangrado previo.

ABSTRACT Acquired hemophilia A is a rare bleeding disorder worldwide, characterized by the presence of inhibitory autoantibodies directed against a coagulation factor, most often factor VIII. There are several possible causes, and it can occur during the postpartum period. We present the case of a 34-year-old female patient with back pain, hematuria and a right gluteal hematoma, with no previous history of bleeding. She was transferred to the emergency department due to the extension of the hemorrhagic manifestations. Diagnosis was confirmed with the coagulation profile, mixing test and the assessment of factor VIII inhibitor tier. The case highlights the importance of considering this condition in a postpartum patient with persistent postoperative bleeding, extensive hematoma and no history of previous bleeding.

Factors Associated with Low Back Pain in Coffee Pickers from Chinchiná and Palestina (Colombia)

Objective. The objective of the study was to determine the prevalence of low back pain and associated risk factors among coffee pickers. Methods. The participants completed a survey and underwent tests to determine flexibility and V̇O2max. Results. Among 98 coffee pickers with an average age of 44.7 (±13.7), 58.2% had experienced low back pain. The average duration and intensity of low back pain in the patients were 6.0 ± 6.5 years and 47.1 ± 21.0 mm/100 mm respectively. The average values of body fat and V̇O2max were 13.2 ± 2.8% y 32.5 ± 8.6 ml.kg-1.min-1 respectively. Regression analysis showed that for a higher V̇O2max value decreased the probability of experiencing low back pain, while a higher body fat content increased the probability of suffering from low back pain. Conclusions. There is a high prevalence of low back pain among coffee pickers from Chinchiná and Palestina. Higher body fat content increases the likelihood of experiencing lumbar pain, while elevated levels of V̇O2max decrease it.

Objetivo. El estudio tuvo como objetivo determinar la prevalencia del dolor lumbar y los factores de riesgo asociados entre los recolectores de café. Métodos. Los participantes respondieron a una encuesta y se sometieron a pruebas para determinar la flexibilidad y el V̇O2max. Resultados. Entre 98 recolectores de café de 44,7 años (±13,7), el 58,2% había experimentado dolor lumbar. La duración e intensidad promedio del dolor lumbar en los pacientes fue de 6,0 ± 6,5 años y 47,1 ± 21,0 mm/100 mm, respectivamente. Los valores promedio de grasa corporal y V̇O2max fueron 13.2 ± 2.8% y 32.5 ± 8.6 ml.kg-1.min-1 respectivamente. El análisis de regresión demostró que para un valor alto de V̇O2max la probabilidad de padecer dolor lumbar es menor mientras que para un valor alto de contenido de grasa corporal la probabilidad de sufrir dolor lumbar es mayor. Conclusiones. Existe una alta prevalencia de dolor lumbar entre los recolectores de café de Chinchiná y Palestina. Un mayor contenido de grasa corporal incrementa la probabilidad de padecer lumbalgia, mientras que niveles elevados de V̇O2max la disminuye.

Objetivo. O estudo teve como objetivo determinar a prevalência da dor lombar e fatores de risco associados entre os catadores de café. Métodos. Os participantes responderam a uma enquete e foram submetidos a testes para determinar flexibilidade e V̇O2max. Resultados. Entre 98 catadores de café com 44,7 anos (±13,7), 58,2% apresentavam dor lombar. A duração média e intensidade da dor lombar nos pacientes foi de 6,0 ± 6,5 anos e 47,1 ± 21,0 mm/100 mm, respectivamente. Os valores médios de gordura corporal e V̇O2max foram 13,2 ± 2,8% e 32,5 ± 8,6 ml.kg-1.min-1 respectivamente. A análise de regressão amostrou que para um alto valor de V̇O2max a probabilidade de sofrer lombalgia é menor enquanto que para um alto índice de gordura corporal a probabilidade de sofrer lombalgia é maior. Conclusões. Tem uma alta prevalência da dor lombar entre os catadores de café de Chinchiná e Palestina. Um valor mais alto de V̇O2max diminui a probabilidade de sofrer lombalgia, enquanto um valor alto de gordura corporal a aumenta.

A Morphometric Study of Typical and Atypical Lumbar Vertebrae in South Indian Population

Introduction:The lumbar vertebrae are affected in conditions such as congenital defects, degenerative diseases, accidents, and cancer metastasis. A thorough knowledge of the morphometry of typical and atypical lumbar vertebrae in adults of South Indian population is needed for lumbar spine surgeries. MaterialsandMethods: Adescriptive study was done on 200 dry lumbar vertebrae, of which 100 were typical and 100 were atypical lumbar vertebrae. The following dimensions of both typical and atypical lumbar vertebrae were measured with digital vernier calipers: anteroposterior and transverse diameters of the body; anterior and posterior body heights; anteroposterior and transverse diameters of vertebral foramen; height, breadth, and width of the laminae; length, height, and width of the pedicles; transverse processes and spinous process; distance between the two superior articular processes; and the distance between the two inferior articular processes. All the measurements were tabulated. The mean and standard deviation were calculated for each of the parameters and the results were statistically analyzed. Results: The anteroposterior and transverse diameters of the body, the height of the laminae on both sides, the length and height of the spinous process, and the distance between the superior articular facets were significantly longer in atypical lumbar vertebrae than that of typical lumbar vertebrae (P < 0.05). There was no significant difference in measurements between both sides. Conclusion: The dimensions of vertebral foramen, transverse processes, spinous processes, and distance between articular processes were different from the dimensions of previous studies. The morphometric data obtained will be useful for orthopedic procedures on the lumbar vertebrae in South Indian population

Lumbar Facet Syndrome and the Use of Radiofrequency Ablation Technique as an Alternative Therapy: A Systematic Review / Síndrome facetária lombar e a utilização da técnica de ablação por radiofrequência como terapia alternativa: uma revisão sistemática

Abstract Lumbar facet syndrome stands out as a significant cause for the increasing prevalence of back pain complaints. Alternatives such as radiofrequency (RF) ablation may be a therapeutic option to relieve the chronic pain associated with this condition. It is critical to analyze the effectiveness of lumbar facet syndrome treatment using the traditional RF ablation technique and the relief generated by it in chronic low back pain (CLBP). This study is a systematic review using the following inclusion criteria: title, observational studies, clinical trials, controlled clinical trials, clinical studies, and publications over the last 17 years (from 2005 to 2022). The exclusion criteria included papers addressing other themes and review articles. The databases used for data collection included the Medical Literature Analysis and Retrieval System Online (Medline), PubMed, Scientific Electronic Library Online (SciELO), Lilacs, and Biblioteca Virtual em Saúde (Virtual Health Library in Portuguese). The query used the following terms: facet, pain, lumbar, and radiofrequency. The application of these filters yielded 142 studies, and 12 were included in this review. Most studies indicated that the traditional RF ablation technique was beneficial in relieving CLBP refractory to conservative treatment.

Resumo Em um contexto de aumento da prevalência de queixas de dores na coluna, a síndrome facetária se destaca como um importante causador. Alternativas como a ablação por radiofrequência (RF) podem ser uma opção de terapia para alívio da dor crônica que essa patologia pode causar. É necessário analisar a eficácia do tratamento da síndrome facetária pela técnica de ablação por radiofrequência tradicional e o alívio gerado nas dores lombares crônicas (DLC). O presente estudo trata-se de uma revisão sistemática cujo os critérios de inclusão para análise foram: título; estudos observacionais; ensaios clínicos; ensaio clínico controlado; estudos clínicos e publicação nos últimos dezessete anos (2005-2022). Já os critérios de exclusão foram: artigos que abordavam outras temáticas e artigos de revisão. As bases utilizadas para coleta de dados incluíram Medical Literature Analysis and Retrieval System online (Medline), Pubmed, Scientific Electronic Library Online (SciELO), Lilacs, Biblioteca Virtual em Saúde. Os termos utilizados para a pesquisa foram: facet; pain; lumbar; radiofrequency. Aplicando-se os filtros foram encontrados 142 estudos, 12 foram incluídos. Os estudos em sua maioria apontaram ser benéfica a técnica de ablação por radiofrequência tradicional no alívio das dores lombares crônicas refratárias ao tratamento conservador.

Fidel Pagés, el auténtico descubridor de la anestesia epidural, en el centenario de su publicación Anestesia metamérica (1921-2021) / Fidel Pagés, the true discoverer of epidural anesthesia, on the centenary of his publication Anestesia metamérica (1921-2021)

Resumen: Pocas han sido las Figuras españolas que han aportado alguna interesante novedad al mundo de la anestesia, pero ninguna tan injustamente tratada y olvidada como la de Pagés, verdadero pionero de la anestesia epidural, que él denominaría «anestesia metamérica¼ en su artículo publicado en el mes de marzo de 1921 en la Revista Española de Cirugía, fundada por él mismo. Años después, en 1931, Dogliotti, profesor de Cirugía de Módena publicó sus experiencias sobre la anestesia epidural, a la que llamó «anestesia peridural segmentaria¼, ignorando el trabajo de Pagés publicado 10 años antes. El trabajo de Dogliotti fue rápidamente reconocido, asumiendo todos los méritos de la paternidad de la técnica epidural, quedando Pagés relegado a un olvido injusto que con este trabajo tratamos de reparar. La idea central de este texto versará sobre el reconocimiento de Pagés como verdadero promotor del abordaje epidural con fines quirúrgicos. Destacar sus ideas innovadoras sobre el bienestar del paciente y la minimización de los efectos adversos de las técnicas anestésicas y quirúrgicas, así como valorar una obra que, aunque corta, bien podría incluirse entre los mejores cirujanos españoles de principio del siglo XX, un cirujano con alma de anestesiólogo.

Abstract: Few Spanish Figures have contributed any interesting novelty to the world of anesthesia. But none so unjustly treated and forgotten such as Pagés, a true pioneer of epidural anesthesia, which he would call «metameric anesthesia¼ in his article published in March 1921 in the Spanish Journal of Surgery, founded by himself. Later, in 1931, Dogliotti, Modena Professor of Surgery published his experiences on epidural anesthesia, which he called «segmental peridural anesthesia¼, ignoring Pagés work published 10 years earlier. Dogliotti's work was quickly recognized, assuming all the merits of the paternity of the epidural technique, leaving Pagés relegated to an unjust oblivion that with this work we try to repair. The central idea of this text will focus on the recognition of Pagés as a true promoter of the epidural approach for surgical purposes. Highlight his innovative ideas about patient well-being and minimizing the adverse effects of anesthetic and surgical techniques. As well as assessing a work that, although short, could well be included among the best Spanish surgeons of the early twentieth century, a surgeon with the soul of an anesthesiologist.

[Errata] Estudo piloto sobre diâmetro do canal lombar e distância percorrida em pacientes com estenose espinhal lombar: um modelo de predição multivariado / [Erratum] Pilot study on lumbar canal diameter and walking distance in patients with lumbar spinal stenosis: a multivariate prediction model

INTRODUCTION: Neurogenic claudication (NC) is the classic clinical presentation of patients with Lumbar Spinal Stenosis (LSS). These patients may or may not present with symptoms of leg pain and difficulty walking. These symptoms are exacerbated while walking and standing and are eased by sitting or bending forward. METHOD: Patients with LSS, having a lumbar canal diameter of ≤12mm, were recruited from a recognized Tertiary care hospital. Each subject's demographic characteristics and anthropometrics were noted, and the testing procedure was explained. The canal diameter was documented with the help of an MRI report. A self-paced walking test was used to assess the walking distance. STATISTICAL ANALYSIS: Depending on the normality of the data, the Pearson correlation coefficient (r) was used to find the correlation between canal diameter at different lumbar levels and walking distance in patients with LSS. RESULT: Pearson correlation coefficient (r) determined a fair positive correlation (r = 0.29) between lumbar canal diameter and walking distance. Stepwise multiple regression analysis was done, and a prediction equation was found for different levels of canal stenosis. CONCLUSION: Findings of our present study suggest a fair positive correlation between walking distance and canal diameter at L5-S1. This study may also be useful in predicting the approximate canal diameter by estimating the walking distance of the patient with symptoms of LSS and vice-versa.

INTRODUÇÃO: A claudicação neurogênica (CN) é a apresentação clínica clássica de pacientes com Estenose Espinhal Lombar (EEL). Esses pacientes podem ou não apresentar sintomas de dor nas pernas e dificuldade para caminhar. Esses sintomas são exacerbados ao caminhar e ficar em pé e são aliviados ao sentar ou inclinar-se para a frente. MÉTODO: Pacientes com EEL, com diâmetro do canal lombar ≤12mm, foram recrutados em um hospital terciário reconhecido. As características demográficas e antropométricas de cada sujeito foram anotadas e o procedimento do teste foi explicado. O diâmetro do canal foi documentado com a ajuda de um relatório de ressonância magnética. Um teste de caminhada individualizado foi usado para avaliar a distância percorrida. ANÁLISE ESTATÍSTICA: Dependendo da normalidade dos dados, o coeficiente de correlação de Pearson (r) foi usado para encontrar a correlação entre o diâmetro do canal em diferentes níveis lombares e a distância percorrida em pacientes com EEL. RESULTADO: O coeficiente de correlação de Pearson (r) determinou uma correlação positiva razoável (r = 0,29) entre o diâmetro do canal lombar e a distância percorrida. Análise de regressão múltipla stepwise foi feita, e uma equação de predição foi encontrada para diferentes níveis de estenose do canal. CONCLUSÃO: Os achados de nosso estudo sugerem uma correlação positiva razoável entre a distância percorrida e o diâmetro do canal em L5-S1. Este estudo também pode ser útil para prever o diâmetro aproximado do canal, estimando a distância percorrida pelo paciente com sintomas de EEL e vice-versa.

Lumbar puncture for neurosyphilis investigation in asymptomatic patients with HIV-syphilis coinfection: a cross-sectional study among infectious disease specialists

ABSTRACT BACKGROUND: Syphilis is a major public health issue worldwide. In people living with human immunodeficiency virus (PLHIV), there are higher incidences of both syphilis and neurosyphilis. The criteria for referring PLHIV with syphilis for lumbar puncture is controversial, and the diagnosis of neurosyphilis is challenging. OBJECTIVE: To describe the knowledge, attitudes, and practices of infectious disease specialists and residents in the context of care for asymptomatic HIV-syphilis coinfection using close-ended questions and case vignettes. DESIGN AND SETTING: Cross-sectional study conducted in three public health institutions in São Paulo (SP), Brazil. METHODS: In this cross-sectional study, we invited infectious disease specialists and residents at three academic healthcare institutions to answer a self-completion questionnaire available online or in paper form. RESULTS: Of 98 participants, only 23.5% provided answers that were in line with the current Brazilian recommendation. Most participants believed that the criteria for lumbar puncture should be extended for people living with HIV with low CD4+ cell counts (52.0%); in addition, participants also believed that late latent syphilis (29.6%) and Venereal Disease Research Laboratory (VDRL) titers ≥ 1:32 (22.4%) should be conditions for lumbar puncture in PLHIV with no neurologic symptoms. CONCLUSION: This study highlights heterogeneities in the clinical management of HIV-syphilis coinfection. Most infectious disease specialists still consider syphilis stage, VDRL titers and CD4+ cell counts as important parameters when deciding which patients need lumbar puncture for investigating neurosyphilis.