Revisión del tratamiento rehabilitador en la distonía cervical: una puesta al día / Review of rehabilitation treatment for cervical dystonia: an update

Objetivo. El objetivo de este trabajo es realizar una actualización sobre el tratamiento rehabilitador de la distonía cervical (DC), tanto de su eficacia como de las estrategias utilizadas. Búsqueda y selección de estudios. Se identificaron 21 estudios mediante la búsqueda en bases de datos electrónicas de los artículos científicos publicados tanto en inglés como en castellano entre enero de 2000 y febrero de 2016, con las palabras clave: distonía cervical, tratamiento, rehabilitación, fisioterapia, tortícolis espasmódica. Los criterios de inclusión fueron: ensayos clínicos con pacientes diagnosticados de DC en tratamiento rehabilitador y con una calidad metodológica aceptable según la escala de Jadad. Resultados y conclusiones. Se han seleccionado 5 estudios. En líneas generales se aconseja: ejercicios de relajación, estiramientos, reeducación motora, equilibrio, coordinación y propiocepción. Los ejercicios deben ser inicialmente tutelados y una vez aprendidos deben realizarse en sesiones cortas y frecuentes de autorrehabilitación con el objetivo de inducir neuroplasticidad. Parece claro que la asociación de un programa fisioterápico al tratamiento con toxina botulínica es beneficioso (AU)

Objective. The aim of this study was to provide an update on rehabilitation treatment for cervical dystonia (CD), in terms of both its effectiveness and the strategies used. Study search and selection strategy. A total of 21 studies were identified by a search in electronic database for scientific articles published in English or Spanish from January 2000 to February 2016, with the keywords: cervical dystonia, treatment, rehabilitation, physiotherapy, and spasmodic torticollis. Inclusion criteria were: clinical trials of patients diagnosed with CD receiving rehabilitation treatment and with an adequate methodological quality according to the Jadad scale. Results and conclusions. Five studies were selected. In general, we recommend: relaxation exercises, stretching, motor re-education, balance, coordination and proprioception. The exercises should initially be supervised and, once learned, should be made in short and frequent self-rehabilitation sessions in order to induce neuroplasticity. It seems clear that the combination of a physiotherapeutic program and botulinum toxin treatment is beneficial (AU)

Spatial variability of cadmium and lead in natural soils of a humid Mediterranean environment: La Rioja, Spain.

The concentration levels of cadmium and lead in 250 horizon samples from 125 different soil profiles of undisturbed soils of La Rioja, Spain, were determined. Knowledge of regional contents as well as the variability and background values of trace elements in soils is of critical importance to assess human impact on the soil environment and to determine baseline values and quality standards. Heavy-metal horizontal distribution was mainly affected by the nature of the bedrock and, to a smaller extent, anthropogenic activity. Vertical distributions were mainly of a natural origin depending first on the bedrock and second on the result of soil processes.

Reorientación de la actividad asistencial en un servicio de Medicina Física y Rehabilitación: análisis de costes. Evidencia y medicina coste-efectiva / Assistance activity reorientation in a physical medicine and rehabilitation service: costs analyses. Evidence and cost-efectiveness medicine

Introducción: El continuo aumento del gasto sanitario, en un medio con recursos limitados, obliga a potenciar la función gestora de los servicios utilizando criterios de efectividad y eficiencia. Material y métodos: Realizamos una revisión de todas las patologías atendidas en fisioterapia en el hospital durante el año 2007, analizando las prescripciones de tratamiento más habituales. Solicitamos a Control de Gestión información de los costes del área terapéutica del mismo año, realizando un cálculo aproximado del coste que supuso la patología dolorosa osteoarticular y el programa de rehabilitación cardiaca. Revisamos información de medicina basada en la evidencia (MBE) en rehabilitación y consultamos la base de datos Centre for Reviews and Dissemination, buscando información coste-efectividad de las patologías revisadas. Resultados: Del total de patologías atendidas en el área terapéutica del hospital el 42% correspondieron a algias de origen osteoarticular, que fueron tratadas de forma individual, con prescripciones terapéuticas de dudosa eficacia, según la revisión de la MBE y con un coste similar, en el caso de la cervicalgias y lumbalgias al coste por paciente del grupo de rehabilitación cardiaca, siendo este programa, en nuestro departamento, de desarrollo hospitalario y avalado por la MBE y la medicina coste-efectiva. Conclusiones: El desarrollo de la función gestora del servicio precisa reorientar nuestra actividad asistencial: descentralizar la patología dolorosa osteoarticular, modificar nuestras prescripciones terapéuticas con pautas más acordes a la MBE, teniendo en cuenta los costes de los procedimientos empleados y mejorar la atención de la patología más compleja a nivel hospitalario (AU)

Introduction: The continuous increase of health expense in an enviroment of scant resources makes necessary the reinforcement of the services management function using efficiency and effectiveness criteria. Material and methods: We carried out a revision of each pathology attended in physiotherapy at our hospital in 2007, analyzing the most habitual treatment prescriptions. We asked Management Control for information about therapeutic area costs during the same year in order to make an estimate calculation of the cost of osteoarticular painful pathology and the cardiac rehabilitation programme. Information about medicine based on evidence (MBE) in rehabilitation is revised and the Centre for Reviews and Dissemination data base is consulted looking for information on cost-effectiveness in the pathologies revised. Results: From the total of the pathologies attended in the hospital therapeutic area, 42% correspond to pain with an osteoarticular origin. These were treated in an individual way, with therapeutic prescriptions of questionable effectiveness, according to the MBE revision and with a similar cost, in the case of neck and back pain, to the cost per patient in the heart rehabilitation group, this programme being, in our department, developed in hospital and guaranteed by the MBE and the cost-effective medicine. Conclusion: The development of the services management function needs to reorientate assistance activity by decentralizing osteoarticular painful pathology, by modifying our therapeutic prescriptions with patterns more in agreement with the MBE, taking into account the cost of the procedures used, and finally by improving the treatment of more complex pathologies at hospital level (AU)

Rehabilitación del ictus: modelo asistencial. Recomendaciones de la Sociedad Española de Rehabilitación y Medicina Física, 2009 / Stroke rehabilitation: Care model. Recommendations of the Spanish Society of Physical Medicine and Rehabilitation, 2009

Objetivos: La Sociedad Española de Medicina Física y Rehabilitación elabora un documento de recomendaciones de buena práctica clínica sobre el modelo asistencial en la rehabilitación (RHB) del ictus basadas en la experiencia clínica y el consenso de los autores y las guías de práctica clínica de referencia. Estrategia de búsqueda: La búsqueda se centra en guías de práctica clínica y artículos relevantes sobre el modelo asistencial en la RHB del ictus en las bases de datos MEDLINE, Embase y Cochrane Databases desde enero de 2004 hasta enero de 2009.Selección de estudios: Se seleccionan ensayos clínicos aleatorizados, metaanálisis, revisiones sistemáticas y artículos de revisión sobre el modelo asistencial en la RHB del ictus. Síntesis de resultados: El programa rehabilitador del ictus es un proceso complejo que requiere un abordaje multidisciplinario, siendo elementos claves el inicio precoz, la intensidad adecuada, la evaluación periódica y la participación activa de pacientes y cuidadores. Conclusiones: En todos los niveles de atención sanitaria y sociosanitaria, hospitalaria o comunitaria se debe asegurar la atención de RHB a cargo de un equipo multidisciplinario, coordinada por un médico especialista en RHB con adecuados niveles de organización y experiencia de los profesionales (AU)

Objectives: The Spanish Society of Physical Medicine and Rehabilitation has elaborated a document of good clinical practice recommendations on the care model in stroke rehabilitation based on the clinical experience and consensus of the authors and reference clinical practice guides. Search strategy: The search was focused on clinical practice guides and articles related with the care model in stroke rehabilitation in the MEDLINE, EMBASE and COCHRANE DATABASES from January 2004 to January 2009.Selection of studies Randomized clinical trials, meta-analyses, systematic reviews and review articles on the care model in stroke rehabilitation were selected. Synthesis of results: The stroke rehabilitation program is a complex procedure that requires a multidisciplinary approach. Its key elements are early initiation, adequate intensity, periodic evaluation and active participation of the patients and caregivers. Conclusions: Rehabilitation care under the responsibility of a multidisciplinary team, coordinated by a medical specialist in rehabilitation with adequate levels of organization and experience of the professionals should be assured on all health a and socio-health care, hospital or community levels (AU)

A molecular microbial ecology approach to studying hemodialysis water and fluid.

Bacteria, or bacteria-derived products, might be responsible for deleterious effects in hemodialysis patients. Most microorganisms in hemodialysis water, including potential pathogens, are difficult to isolate and might subsist in a 'viable but not culturable' state or may need specific culture media. A molecular culture-independent approach based on the analysis of the 16S rDNA obtained from total DNA has been used to better know the diversity of bacteria inhabiting hemodialysis water and fluid, and to address the possible health effects associated with their presence. Four clone libraries from 16S rDNA (274 clones) were analyzed to characterize the species or groups of bacteria present, to assess their distribution in the water circuit, and to compare the results with those previously obtained in culture-dependent analysis. One hundred and ninety-seven clones of four gene libraries were analyzed by sequencing, and were identified phylogenetically. Clones affiliated to the Alphaproteobacteria group led the diversity. The presence in several samples of Alpha-4-proteobacteria, recognized as sphingolipids producers, was to be noted. The most abundant clones were affiliated to the Betaproteobacteria branch, closely related to the genus Herbaspirillum. As known, Alphaproteobacteria and Betaproteobacteria genomes might present a manifest excess in CpG sequences and most of them show a lipopolysaccharide-rich outer membrane, both described as inducers of innate immunity responses. Another abundant group, belonging to the Cyanobacteria class, a possible source of cyanotoxins, was not related to any previously cultured bacterium. Possible risk implications for hemodialysis patients of the bacterial community detected are discussed.

Reflex sympathetic dystrophy syndrome of the lower limbs in a renal transplant patient treated with tacrolimus.

BACKGROUND: Recently, a previously unrecognized posttransplant syndrome known as reflex sympathetic dystrophy syndrome of the lower limbs has emerged in patients receiving cyclosporine as immunosuppression. We describe herein this complication observed in a patient treated with tacrolimus after kidney transplantation. METHODS: A 49-year-old man received a kidney transplant from a cadaver donor and was treated with tacrolimus. Three months later, the patient complained of severe pain in the lower limbs that affected both knees and ankles. Bone scintigraphy and magnetic resonance were consistent with reflex sympathetic dystrophy syndrome. RESULTS: Laboratory tests that included creatinine, glomerular filtration rate, calcium, phosphate, urate, alkaline phosphatase, and parathormone were normal or near normal. Tacrolimus levels were around 13 microg/ml. Clinical improvement appeared slowly and spontaneously during the following 3 months, without appreciable changes in the tacrolimus level. CONCLUSIONS: In kidney transplant patients, tacrolimus could be a risk factor for the development of a reflex sympathetic dystrophy syndrome.

[Pseudoneurologic conversion and factitious disorders: differential diagnosis in 2 clinical cases]. / Trastornos seudoneurológicos de conversión y facticios: diagnóstico diferencial a través de dos casos clínicos.

The recognition and differentiation of conversion and factitious disorders could be difficult when they coexist with physical problems and their psychopathology is not evident. We present two illustrative cases of patients who share the existence of neurological disorders and present a similar psychiatric semiology, which is phenomenologically different related with their physical deficits. The psychopathological assessment was made by means of a standardized instrument for diagnosis (SCAN) and suitable paraclinical techniques for each case. The test MMPI (Minnesota Multiphasic Personality Inventory) was used in both cases, and an exploration with Thiopental was carried out in one of them. The pertinent differential diagnosis, the advantages of coordinated interdisciplinary interventions in order to elucidate these mental disorders, and the convenience of using appropriated psychometric instruments and exploratory methods are expounded in the present paper.

Chronic pain in the spinal cord injured: statistical approach and pharmacological treatment.

We include in this article the results of a postal inquiry into chronic pain in SCI patients in Valencia (Spain), and our experience with their management. A mailed questionnaire including lesion and chronic pain data was sent to all of the 380 SCI patients who live in the region of Valencia. We received 202 answers, with 145 questionnaires being accurately answered and these were analysed for this study. The results show that chronic pain (that is, lasting more than 6 months) is very common (65.5%). The most frequent type was deafferentation pain (phantom pain), described as burning or a painful numbness. Since 1988 we have been treating a sample of 33 patients suffering from resistant pain according to the following therapies: 1 amitriptyline + clonazepam+NSAID (nonsteroidal antiinflammatory drugs); 2 amitriptyline + clonazepam + 5-OH-tryptophane + TENS (transcutaneous electrical nerve stimulation); 3 amitriptyline + clonazepam + SCS (spinal cord stimulation); 4 morphine, by continuous intrathecal infusion. After almost 4 years using these therapies we can affirm that the results regarding analgesia reached 80% in all cases, and that morphine used by intrathecal route is very safe and useful in selected patients.