Novedades en las guías de práctica clínica respecto al tratamiento de la artrosis de cadera, rodilla y manos / News in the clinical practice guidelines regarding the treatment of the hip, knee and hands osteoarthritis

La información contenida en las guías de práctica clínica (GPC) representa una fuente de importantes contenidos que el clínico puede trasladar a su práctica cotidiana. La combinación de la evidencia científica disponible con el criterio del comité de expertos que participan en su desarrollo y elaboración ofrecen un documento consistente en sus recomendaciones, a la vez que reflejan aquellas intervenciones a desterrar de nuestro proceder habitual. En este artículo se reflejan las novedades relacionadas con el tratamiento de la artrosis que han sido incluidas en las principales GPC publicadas en los tres últimos años (2018-2020). Paradójicamente se hace énfasis en la individualización del abordaje, cuya piedra angular continúa siendo el ejercicio terapéutico (aeróbico y de potenciación), así como en el adiestramiento en autocuidado. Asimismo, se presentan numerosas puntualizaciones relacionadas con el abordaje no quirúrgico.(AU)

Information included in the clinical practice guidelines (CPG) represents a source of important content that clinician can transfer to their clinical practice. Combination of the scientific evidence available with the criteria of the expert´s committee who participate in development and preparation offers a document with the best recommendations and reflecting those interventions to get out from our usual procedure. This article reflects the novelties related to the treatment of osteoarthritis that have been included in the main CPGs published in the last three years (2018-2020). Paradoxically, emphasis is placed on the individualization of the approach whose cornerstone continues to be therapeutic exercise (aerobic and potentiation) as well as self-care training. Likewise, numerous topics related to the non-surgical approach are presented.(AU)

How reliable is the Spanish bodily harm assessment scale?

The use of scales to quantify or qualify bodily harm resulting from an unintentional car accident has been mandatory in Spain since 1995 and compensation for personal injuries resulting from a traffic accident is calculated according to a legal ruling established by Royal Decree 8/2004 (RDL). This present study assesses the reliability of the scale. Agreement between the evaluations for the same patient by 24 qualified observers following the Royal Decree 8/2004 was measured using the Kappa index. The variables assessed were the days of hospitalization, impeditive days, non impeditive days and the functional and aesthetic sequelae. The application of the Fleiss Kappa index obtained a result of 0.37, indicating a "fair agreement" according to the rating scale proposed by Landis and Koch. This study demonstrates the unreliability of the Spanish medical scale for the assessment of injury as described in the RDL 8/2004. The scale should adopt the measurement systems and clinical classifications of outcomes such as the ASIA, SCI scale or the Daniels scale of neurological injury and allow scientific discussion of the findings of the report. The resulting quantitative value should operate as a reliable indicator of a specific quality of the damage.

High Prevalence of Neuropathic Pain Features in Patients with Knee Osteoarthritis: A Cross-Sectional Study.

OBJECTIVE: The present epidemiological research evaluated the prevalence of neuropathic pain characteristics in patients with painful knee osteoarthritis (OA) and the plausibility that such neuropathic features were specific of OA. METHODS: Outpatients with chronic pain associated with knee OA who attended orthopedic surgery or rehabilitation clinics were systematically screened for neuropathic pain with the Douleur Neuropathique in 4 questions (DN4) questionnaire. Data from medical files and those obtained during a single structured clinical interview were correlated with the DN4 scores. Information on potential confounders of neuropathic-like qualities of knee pain was collected to evaluate as much as possible only the symptoms attributable to OA. RESULTS: Of 2,776 patients recruited, 2,167 patients provided valid data from 2,992 knees. The DN4 was scored positively (≥ 4) in 1,125 patients (51.9%) and 1,459 knees (48.8%). When patients with potential confounders were excluded, the respective prevalences were 33.3% and 29.4%. Patients who scored positively in the DN4 had more severe pain, greater structural damage, and more potential confounders of neuropathic pain. Three potential confounders conveyed much of the variability explained by regression analyses. However, latent class analyses revealed that the concourse of other factors is required to explain the neuropathic pain qualities. CONCLUSIONS: A relevant proportion of patients with chronic pain associated with knee OA featured neuropathic pain qualities that were not explained by other conditions. The present research has provided reasonable epidemiological grounds to attempt their definite diagnosis and classification.

Estimating adult stature from radiographically determined metatarsal length in a Spanish population.

The ability to determine height in adult life can be crucial in the identification of skeletal remains. Very often, the small bones found among such remains are not only the most numerous, but also the best preserved, a fact which calls for more research into developing methods to estimate height from metatarsals. The aim of this paper is to verify the use of the dimensions of the metatarsals as estimators of adult height in a Spanish population using radiologically determined metatarsal lengths and to propose regression equations and test the formulae for determining adult stature. The present research is based on a study of 228 healthy Caucasoid adults from Galicia (NW Spain). The first and second metatarsals of the left foot were measured by a dorso-plantar X-ray using a digital medical image viewer. The best correlation obtained was with the maximum length of the 1st metatarsal for males. The corresponding regression equation is as follows: S=819.88+12.79 M1. A comparison of our statistical results with those of neighbouring population groups indicates that ours is more accurate. This must be due to the so-called specificity of regression equations in relation to the series on the base from which they were developed.

Characterization of lesions in hanging deaths.

Hanging is a common method of committing suicide and a routine task in medico-legal autopsies. The hanging mark is the most relevant external sign and its characteristics are well known, but, for unknown reasons, there are major differences in reports on internal findings. We retrospectively studied 228 consecutive cases of hanging deaths. A complete standard autopsy was performed for every case. We investigated the association between the characteristics of the hanging mark and the frequency of bone, cartilage, soft tissue, and vascular injuries with the mode of suspension. Most cases (75.3%) presented some kind of bone or cartilage fracture, but these were unrelated to any of the variables studied. Vascular lesions are clearly more infrequent: intimal injuries were found in the carotid artery (9.1%), the jugular vein (2.2%), and ruptures of the carotid adventitial layer (21.7%). These could be partially associated with the use of a hard fixed noose and body weight.

Improved estimation of postmortem interval based on differential behaviour of vitreous potassium and hypoxantine in death by hanging.

Many formulae are available to estimate the relation between the potassium ([K+]) and hypoxantine ([Hx]) concentration in the vitreous humour and the postmortem interval (PMI). Typically these have been based on a correlation test and linear regression using the postmortal interval as the independent variable and [K+] or [Hx] as the dependent variable in order to estimate the confidence interval. However, a recent study has shown that a more precise measurement of PMI can be obtained if [K+] is used as the independent variable. The regression lines obtained from the most recent deceased subjects with forensic relevance received for autopsy in the Institute of Legal Medicine are [K+] = 5.589 + 0.174PMI and [Hx] = 26.459 + 3.017PMI, by changing the variables, we obtain PMI=3.967[K+] - 19.186 (R2 = 0.688, P < 0.001) and PMI = 0.172 [Hx] + 0.170 (R2 = 0.518, P < 0.001). In this paper we propose the cause of death as an extra factor which modifies the relationship and gives even greater precision in estimating PMI. In cases of death by hanging the results are considerably improved with [K+] = 5.224 + 0.225PMI and [Hx] = 15.161+4.957PMI, respectively, and consequently, PMI = 3.631[K+] - 17.334 (R2 = 0.818, P< 0.001) and PMI = 0.153[Hx] - 0.368 (R2 = 0.757, P < 0.001): the slope is less and the precision is obviously enhanced.