The immediate effect of plantar stimulation on dynamic and static balance: A randomized controlled trial.

OBJECTIVE: To examine the immediate effect on dynamic and static balance of a manual protocol of plantar stimulation in healthy subjects. MATERIALS AND METHOD: Of the 144 healthy and physically active volunteers recruited, 98 subjects participated. Subjects were randomly assigned and allocated to the experimental group (EG) (n= 50), in which a 10-min manual protocol of plantar stimulation was applied on the right foot, or to the control group (CG) (n= 48). The change scores of the modified Star Excursion Balance Test (mSEBT) and the Unipedal Stance Test (UPST) were used to assess the immediate effect of the protocol on dynamic and static balance, respectively. RESULTS: In the dynamic balance, a group effect was found in the anterior direction, posteromedial direction and composite scores of the mSEBT when groups were compared by limb. Changes in the posteromedial direction of both limbs (right limb: p= 0.002, left limb: p= 0.05) and composite score of the right limb (p= 0.009) were significantly greater in the EG versus the CG. Non-significant results were found in the static balance (UPST time). CONCLUSIONS: The application of a 10-minute manual stimulation protocol without joint mobilization, addressed to stimulate the plantar cutaneous mechanoreceptors, could elicit benefits on dynamic balance. This improvement was observed bilaterally even though only one plantar surface was stimulated. As balance deficits may impair functional movements and regular training in sports, this intervention aims to ameliorate dynamic balancing ability could improve the functional recovery of sport gestures.

[Drawing of blood and anemia of the critical patient]. / Extracciones de sangre y anemia del paciente crítico.

UNLABELLED: OBJECTIVE. To determine the hemoglobin level variations in non-bleeding patients, its possible relationship with the blood volume drawn and number of extractions. METHODS: An observational, prospective study conducted from April to August 2007. Hemoglobin values during the ICU stay, blood volume drawn in each phlebotomy, fluid balance, APACHE II and other demographic variables were determined. RESULTS: One hundred and twenty four patients were studied. Of these, 59.7% experienced a mild decrease of hemoglobin levels (< 2g/dl) whereas 21.8% presented a more severe reduction (> 2g/dl). These decreases were correlated with the blood volume withdrawn and number of phlebotomies performed (r= 0.557, p < 0.000). There was no significant relationship between fluid balance and decrease in hemoglobin. CONCLUSION. Anemia in critical ill patient seems to be related to blood volume drawn and number of phlebotomies.

[Plasma cortisol and adrenal response to ACTH stimulation in diabetes mellitus with moderate decompensation]. / Cortisol plasmático y respuesta suprarrenal al estímulo con ACTH en la diabetes mellitus con descompensación moderada.

No significant difference was found between the mean plasma cortisol levels in 2 groups of diabetic patients (10 with non-severe metabolic decompensation and 10 well compensated). Likewise, there was not statistical difference on considering the diurnal Cortisol/nocturnal Cortisol quotients in both groups; these quotients besides showed the persistence of the circadian rythm. No valuable difference was seen in the adrenal response to ACTH stimulus. It was found direct correlation between glycemic levels and cortisol increments after stimulus in the total series of 20 patients (r = 0.44; p < 0.05). There were also significant correlations between diurnal and nocturnal Cortisol (r = 0.63; p < 0.01) and between Cortisol levels before and after stimulus (r = 0.68; p < 0.01). No differences were found in Cortisol levels on estimating the incidence of diabetic complications (retinopathy or nephropathy). All these data suggest the tendency to adrenal hyperactivity due to the diabetic decompensation through the action of the hypothalamic-pituitary axis.

[Digestive hemorrhage caused by duodenal ectopic pancreas and diffuse angiodysplasia of the colon]. / Hemorragia digestiva por páncreas ectópico duodenal y angiodisplasia difusa de colon.

We present the case of a 79-years-old male with episodes of digestive bleeding in the form of melenas in which two pathological findings were observed as potential causes: ectopic pancreas in subpyloric position and diffuse colon angiodysplasia. The difficult management of the digestive bleeding when two lesions are associated as potential causes is stressed.

[Polyglobulia and bronchopneumopathies: correlations of ferritin and other ferric parameters with various erythrocytic indexes]. / Poliglobulia y bronconeumopatías: correlaciones de la ferritina y otros parámetros férricos con diversos índices eritrocíticos.

In 15 patients with chronic bronchopneumopathy (7 with polyglobulia and 8 without it), we observed that polyglobulic patients had higher average levels of sideremia and basal saturation of transferrin and lower levels of HCM, CHCM and VCM. No significant differences were observed in the average levels of ferritin between both groups. Overall, in this series of 15 patients, a significant inverse correlation was observed between sideremia and HCM (r = -0.52; p < 0.05) and between sideremia and CHCM (r = -0.55, p < 0.5), as well as a trend towards a direct correlation between sideremia and the red blood cells count (r = 0.45, N.S.). There was also a direct correlation between serum ferritin and the sedimentation rate (r = 0.72, p < 0.01) and trends towards inverse correlations although not significant, between ferritin and sideremia (r = -0.25, N.S.). These data reflect a hyperconsumption of iron in the respiratory polyglobulia, with some relative deficit, suggesting as well that serum ferritin is not a good enough criteria in these cases for the evaluation of iron deposits, because it behaves like the sedimentation rate with respect to acute phase reactants when there is inflammation.

[Thyroid response to exogenous TSH stimulation in diabetic patients]. / Respuesta del tiroides al estímulo con TSH exógena en pacientes diabéticos.

Complicated diabetic patients have a marked decrease of plasmatic level of T3 and a less important decrease of T4. They are caused by the alteration of the extra-thyroid T3 formation from T4 and lower TSH release. 11 patients with a different metabolic state had a basal determination of T3 and T4 and 6 hours after the administration of 5 Units of TSH intramuscular in order to see whether those changes described previously existed in any other intrinsic thyroid alteration secondary to complicated diabetes. The median increases observed were between normal limits (T3: 96%; T4: 45%) and in accordance with this, a direct correlation between glycemia and its respective rate of hormonal increase were observed as well, without any statistical significance (r = 0.56 in T4; r = 0.36 in T3). These results allow us to confirm that there is not an eventual thyroid function alteration during complicated diabetes as opposed to the afore-mentioned increase of the extra-thyroid factors.

[Decompensated diabetes mellitus and circadian rhythm of plasma TSH]. / Diabetes mellitus descompensada y ritmo circadiano de la TSH plasmática.

The plasmatic levels of TSH in 2 group of diabetic patients (7 decompensated and 8 decompensated, but in treatment) were measured at 9:30 and 23:30 hours. The mean glycemia levels were of 280 +/- 45 and 150 +/- 30 mg/dl (p less than 0.0005). There was no significant difference between daily TSH and nocturnal TSH in any of the groups, but there was a tendency for the nocturnal TSH to be higher in decompensated patients. There was no difference when comparing the TSH of the first group to the TSH of the 2nd group. The mean TSH N/TSH D was superior by 1 (1.36 in decompensated and 1,095 in treated patients). The correlation between glycemia and TSH D was negligible in all groups. The data suggests the tendency that the circadian rhythm of TSH in maintained in diabetes decompensation with shorter rhythm registered in treated patients. This shows a certain normality in the suprahypophysary area in charge of the rhythm and is similar to the minor liberation of TSH after TRH stimulus that other authors have described as happening in the decompensation of diabetes mellitus.

[Secondary polycythemia and gasometric changes in chronic bronchopneumopathies with respiratory insufficiency]. / Poliglobulia secundaria y alteraciones gasométricas en bronconeumópatas crónicos con insuficiencia respiratoria.

42 patients with chronic bronchopneumopathy were divided into 2 groups: one with polyemia (15 patients) and the other without polyemia (27 patients). There was no statistical significant differences in median age, clinical evolution nor basal medium arterial PO2 value (43 +/- 12 and 48 +/- 11 mm Hg); while there was an increase of median basal PCO2 in patients with polyemia (54 +/- 8.4 and 48 +/- 9.3; P < 0.025). There was direct correlation between PCO2 and Hb levels in the whole series (r = 0.42; P < 0.01) and equal correlation in the limit of statistical signification between PCO2 and red cells (r = 0.29; P = 0.05). The correlation between these hematic values and the PO2 values of the whole series was not significant, this taking into account the logical inverse relation between them, because of the important role of hypoxia in developing polyemia. The correlation between PO2 and PCO2 was inverse and significant (r = -0.33; P < 0.05). These findings show the apparent influence of CO2 retention to produce polyemia, apart from the effects of hypoxia, being the opposite of the results in experimental studies which showed a stoppage of the erythropoietin production by CO2 effects. The probable explanation is that patients with more PCO2 had more intense respiratory malfunction than lower PCO2 patients, producing night episodes of more basal hypoxia, this being a major stimulus of polyemia.