Eficacia del tratamiento de rehabilitación para el síndrome del túnel carpiano: un ensayo clínico controlado aleatorizado / Efficacy of rehabilitation treatment for carpal tunnel syndrome: A randomized controlled clinical trial

Introducción y objetivo El síndrome del túnel carpiano es la neuropatía del nervio mediano más frecuente. Existen múltiples tratamientos invasivos y no invasivos, incluyen férulas, ultrasonido terapéutico (UST) e infiltraciones con esteroides (IE) que han demostrado una mejora en los estudios de conducción nerviosa (ECN), sin embargo, se desconoce el efecto de los tratamientos conservadores combinados. El objetivo fue determinar la eficacia del tratamiento conservador para mejorar los ECN y las manifestaciones clínicas en pacientes con síndrome del túnel carpiano. Métodos Pacientes con diagnóstico de síndrome del túnel carpiano mediante ECN, sin enfermedades que afecten al nervio periférico. Todos firmaron consentimiento informado y fueron aleatorizados en 3 grupos de tratamiento (G1: férula+UST; G2: férula+IE; G3; férula+UST+IE). Participaron 3 médicos especialistas en rehabilitación (médico 1: realizó los ECN; médico 2: realizó evaluaciones clínicas; médico 3: realizó la IE). Tratamientos: UST (10 sesiones continuas de lunes a viernes durante dos semanas, 3MHz, 0,8W/cm2, 8min) aplicado por el mismo fisioterapeuta. Infiltración: dosis única, 1ml de metilprednisolona (40mg/ml) mezclado con 1ml de (0,5%) bupivacaína. Férula: férulas neutras volares hechas a la medida, de fibra de vidrio para uso nocturno. Resultados Se incluyeron 30 pacientes y 30 manos, con una edad de 50,5±7,5 años, todas ellas mujeres. Los grupos no tenían diferencias en las variables electrofisiológicas y clínicas al inicio del estudio. Tras la intervención (4 semanas) los grupos 2 y 3 mostraron mejoría en el ECN (p<0,05) siendo mayor en el grupo 3. En la evaluación final (8 semanas) todos los grupos mostraron una mejoría en las variables electrofisiológicas y clínicas. Conclusiones El tratamiento combinado de férula+UST+IE presenta resultados significativos en el ECN a las 4 semanas de seguimiento, en comparación a los otros dos grupos (AU)

Introduction and objective Carpal tunnel syndrome is the most common median nerve mononeuropathy. There are multiple conservative treatments, invasive (corticoid injections [CI]) and non-invasive (splinting, therapeutic ultrasound [TUS], laser, exercise). However, the treatment choice is controversial. The aim was to determine the efficacy of conservative treatment to improve the clinical and electrophysiological evaluations. Methods Outpatients referred whit carpal tunnel syndrome clinical diagnosis to perform nerve conduction study (NCS) were included, without chronic or metabolic diseases that affect the peripheral nerves, without carpal tunnel syndrome treatment and with mild or moderate axonotmesis or neuropraxia in NCS baseline. Patients who signed informed consent forms were randomized in three treatment groups (Group 1: TUS+splint; Group 2: CI+splint and Group 3: TUS+CI+splint) were referred for clinical evaluations. The NCS was performed in each patient at baseline, fourth and eighth weeks by the same physiatrist and the clinical evaluations were performed at baseline and the final follow-up. Results Thirty patients were included; mean age was 50.7±7.5 years and all of them females, without differences in NCS or clinical variables in the baseline evaluations. All groups exhibited improvement in some clinical and electrophysiological variables in the final evaluation, though only group 3 showed improvement on median/ulnar nerves sensory peak latency difference (1.2±0.4 vs. 0.4±0.4; p=0.001) starting in week four. Conclusions The conservative treatment in patients with CTS improves NCS and clinical variables, including the most sensitive electrophysiological test (medial/ulnar difference), though if we combined three treatments (splint+TUS+CI), the improvement was found to be faster and remarkable (AU)

First Record of Stephanostomum Sp. Looss, 1899 (Digenea: Acanthocolpidae) Metacercariae Parasitising the Pleasure Oyster Crassostrea Corteziensis (Hertlein) from the Mexican Pacific Coast.

The aim of this investigation was to identify the parasites present in the largely understudied pleasure oyster Crassostrea corteziensis in Sinaloa state in the northwestern Mexican Pacific coast. Inspection of twenty-eight oysters collected on "Ceuta" lagoon revealed the presence of the digenean Stephanostomum sp. (Digenea: Acanthocolpidae) cysts. Metacercariae were found encapsulated and embedded in the digestive gland and mantle tissue of oysters. The prevalence of infection revealed that 84.6 % were infected, the abundance was 13.62, with a mean intensity of 16.09 per host. The members of this genus are characterized by a double crown of spines in the cephalic region surrounding the buccal opening of the worm. Significantly, we report the first incidence of the digenean Stephanostomum sp of the family Acanthocolpidae parasitizing Crassostrea corteziensis. Further we report that this bivalve is now considered a new intermediate host, and the northwestern Mexican Pacific coast is a new geographical distribution area for this digenean. The findings contribute to our understanding of the biology, biodiversity and host preference of these parasites, with implications for health risks posed by human consumption of the pleasure oyster.

Treatment of inhalant-induced psychotic disorder with carbamazepine versus haloperidol.

OBJECTIVE: The efficacy and adverse effects of carbamazepine and haloperidol were compared in the treatment of inhalant-induced psychotic disorder. METHODS: Forty male patients admitted to an acute psychiatric unit for treatment of inhalant dependence and inhalant-induced organic mental disorder, as diagnosed by DSM-III-R, were randomly assigned to receive five weeks of treatment with carbamazepine or haloperidol in identical-appearing capsules. The Brief Psychiatric Rating Scale and the DiMascio Extrapyramidal Symptoms Scale were administered weekly. RESULTS: Both treatment groups improved significantly over time. A reduction of symptom severity of 48.3 percent in the carbamazepine group and 52.7 percent in the haloperidol group was observed. Approximately half the patients in each group were considered treatment responders at the end of the study. Adverse effects were significantly more common and more severe in the haloperidol group. CONCLUSIONS: Carbamazepine appears to have comparable efficacy but fewer adverse effects than haloperidol for the treatment of inhalant-induced psychotic disorder.