[Pressure digit sign in patients with knee osteoarthritis]. / Signo de digito-presión en pacientes con osteoartritis de rodilla.

INTRODUCTION: it is estimated that 302 million people worldwide are affected by osteoarthritis, corresponding to 60% osteoarthritis (OA) of the knee, which responsible 80% of disability in older adults, hence the importance of the association of the sign with the early inflammatory process in OA. OBJECTIVE: to determine the association of digital pressure sign in patients with and without osteoarthritis of the knee. MATERIAL AND METHODS: this was an observational, comparative cross-sectional study, carried out in patients with and without a diagnosis of knee OA, to whom the digital pressure sign was determined. The sample was calculated with the formula for two proportions, obtaining a total of 40 participants per group, obtained by non-probabilistic sampling for convenience. The statistical analysis included frequencies, percentages, 2 and OR. The bioethics regulations in force were respected. RESULTS: the study included 80 participants, with a median age of 48.9 years (RQI 46-53.7), 73.1% were predominantly female sex (38), and a statistically significant association was found between patients with OA and the presence of digital pressure sign, 2 4.62 and p value = 0.41, OR of 2.65. CONCLUSIONS: the presence of digital pressure sign increases the probability of having OA 2.65 times more.

INTRODUCCIÓN: se estima que 302 millones de personas en el mundo son afectadas por osteoartritis, correspondiendo 60% a osteoartritis (OA) de rodilla, causante de 80% de discapacidad en adultos mayores, de ahí la importancia de la asociación del signo de digito-presión con el proceso inflamatorio temprano en OA. OBJETIVO: determinar la asociación del signo de digito-presión en pacientes con y sin osteoartritis de rodilla. MATERIAL Y MÉTODOS: estudio observacional, transversal comparativo, realizado en pacientes con y sin diagnóstico de OA de rodilla, a quienes se les determinó el signo de digito-presión; la muestra se calculó con la fórmula para dos proporciones que determinó un total de 40 participantes por grupo, obtenidos por muestreo no probabilístico por conveniencia; el análisis estadístico incluyó frecuencias, porcentajes, 2 y OR. Se respetó la reglamentación de bioética vigente. RESULTADOS: el estudio incluyó a 80 participantes, con una mediana de edad de 48.9 años (RIQ 46-53.7), predominó el sexo femenino en 73.1% (38). Se encontró asociación estadísticamente significativa entre pacientes con OA y la presencia del signo de digito-presión, 2 4.62 y p = 0.41, OR de 2.65. CONCLUSIONES: la presencia del signo de digito-presión aumenta 2.65 veces más la probabilidad de tener OA.

[Don Quixote de la Mancha and the description of biphasic sleep in Spanish literature]. / Don Quijote de la Mancha y la descripción del sueño bifásico en la literatura española.

INTRODUCTION: Biphasic or segmented sleep is the habit of sleeping a first and a second sleep separated by a watching. The historian A Ekirch found that this was how people slept in pre-industrial times before the powerful artificial lighting. He is based on texts in different languages, from Antiquity to the 20th century, but the absence of sources in Spanish is striking. AIM: Review the Spanish literature searching references of the biphasic sleep using the keywords 'first sleep' and 'at the first cockcrow'. DEVELOPMENT: In the Second Part of Don Quixote de la Mancha (Chapter 68), Cervantes describes biphasic sleep with remarkable success, correlating the biotypes of Quixote and Sancho with their temperaments and sleeping and eating habits. Strangely, Ekirch cites the chapter, but not biphasic sleep. In this review I reproduce eleven texts in Spanish (13th to 19th centuries), mostly classical works, which refer to it by arranging its phases in a way that coincides with the hours in which the night was divided in the pre-industrial era: 20:00-21:00 to 00:00, first sleep, 00:00 to 03:00, wakefulness; 03:00 to 06:00, second sleep. La Celestina provides significant data too. Recent studies proved that this habit is physiological, and it adapts to the lifestyle that requires it. CONCLUSIONS: References to biphasic sleep in Spanish literature are identified and cited for the first time, confirming Ekirch's hypothesis. In Don Quixote, Cervantes describes it with great breadth and sharpness.

TITLE: Don Quijote de la Mancha y la descripción del sueño bifásico en la literatura española.Introducción. El sueño bifásico o segmentado es el hábito de dormir un primer y un segundo sueño separados por una vigilia. El historiador Ekirch describe que así se dormía en los tiempos preindustriales antes de la potente iluminación artificial. Se basó en textos en diferentes idiomas, desde la Antigüedad hasta el siglo xx, pero llama la atención la ausencia de fuentes en español. Objetivo. Se revisó la literatura española en busca de referencias al sueño bifásico usando como palabras clave 'primer sueño' y 'a los primeros gallos'. Desarrollo. En la segunda parte de Don Quijote de la Mancha (capítulo 68), Cervantes describe el sueño bifásico con notable acierto, correlacionando los biotipos de Quijote y Sancho con sus temperamentos y hábitos de sueño y alimentarios. Curiosamente, Ekirch cita el capítulo, pero no el sueño bifásico. En esta revisión reproduzco 11 textos en español (siglos xiii a xix), mayormente obras clásicas, que lo refieren, disponiendo sus fases en coincidencia con las horas en que se dividía la noche en la era preindustrial: 20:00-21:00 a 00:00, primer sueño; 00:00 a 03:00, vigilia; 03:00 a 06:00, segundo sueño. La Celestina aporta datos significativos. Estudios recientes probaron que este hábito es fisiológico y se adapta al estilo de vida que lo requiere. Conclusiones. Se identifican y citan por primera vez referencias al sueño bifásico en la literatura española, confirmando la hipótesis de Ekirch. El Quijote lo describe con mayor amplitud y agudeza.

Resultados funcionales de la aplicación de toxina botulínica tipo A contra antiinflamatorios orales en la rehabilitación de síndrome de hombro doloroso por lesión del mango de los rotadores / Functional results of type a botulinum toxin versus oral antiinflammatory agents in the rehabilitation of painful shoulder syndrome caused by rotator cuff lesion

Las enfermedades del mango de los rotadores se caracterizan por signos inespecíficos, síntomas y alteraciones de la anatomía, su etiología es multifactorial y pueden abarcar desde tendinitis hasta rupturas masivas de espesor completo del tendón del manguito de los rotadores, las cuales comprometen la biomecánica normal del hombro afectado. Normalmente suceden en mayores de 40 años; sin embargo, el asociado a trauma depende del mecanismo de lesión y no tiene relación directa con la edad de aparición de los síntomas. Se han descrito factores vasculares en el daño al tendón del manguito de los rotadores, en patologías que afectan a la microcirculación; sin embargo, estudios recientes no han demostrado que el tendón bajo observación directa presente datos de hipovascularidad. La toxina botulínica tipo A realiza su acción mediante bloqueo de la liberación de acetilcolina en la placa neuromuscular; en las articulaciones provoca liberación de la tensión capsular así como la disminución de factores pro inflamatorios tales como la interleucina-1; aunque existen pocos artículos sobre su utilidad intraarticular, en los grupos musculares y tendinosos, además de tener un efecto miorrelajante existen diversas publicaciones que apoyan su utilidad en el manejo del dolor y su utilidad en la rehabilitación de este grupo de pacientes; en dosis bajas, ha sido ampliamente utilizada. Material y métodos: Se trata de un estudio prospectivo, experimental y longitudinal en el cual se realizó seguimiento a 24 pacientes con diagnóstico de síndrome de hombro doloroso demostrado por pruebas clínicas y de gabinete debido a lesiones del mango de los rotadores, sin criterios de reparación quirúrgica inmediata, o ya reparados, a los cuales a 12 pacientes se les aplicará toxina botulínica tipo A en el espacio subacromial de forma peri-tendón del tendón conjunto del manguito de los rotadores, así como en puntos de dolor y contractura muscular en hombro, con una dosis total de 200 UI de toxina botulínica tipo A, mientras que al grupo control, de 12 pacientes, se le administraron antiinflamatorios vía oral por seis semanas, tipo Cox 2, Celecoxib 100 mg cápsulas una cada 12 horas; a los dos grupos se les sometió a un programa de rehabilitación ya establecido, el cual fue supervisado cada dos semanas y hasta las seis semanas de evolución; se realizaron valoraciones subjetivas y objetivas valorando la presencia de dolor, el nivel funcional y la movilidad posible mediante la escala de valoración funcional de hombro de Constant y la escala visual análoga. Resultados: Grupo de Celecoxib Promedio de escala de Constant inicial fue de 60 puntos, el inmediato a la primera dosis se mantuvo en 60 puntos, a las dos semanas de tratamiento con Celecoxib se encontró un puntaje de Constant promedio de 66 puntos y a las seis semanas el promedio fue de 70.33 puntos, siendo el valor de la p > 0.005. Grupo de toxina botulínica 200 UI máximo en hombro afectado, 50 UI subacromial y 150 en puntos de dolor además de asociarlo a programa de ejercicios de rehabilitación supervisados en consultorio. El promedio de la escala de Constant inicial fue de 58 puntos, el inmediato a la primera dosis se elevó a 70.83 puntos, a las dos semanas posteriores a infiltración y seguimiento de ejercicios en consultorio fue de puntaje Constant promedio de 77.16 puntos y a las seis semanas el promedio fue de 78.5 puntos, siendo el valor de la p < 0.005 (p = 0.00045). En cuanto a la escala visual análoga se observó que en el grupo de Celecoxib existió una disminución de dicha escala a las seis semanas con una p < 0.005.

Rotator cuff conditions are characterized by unspecific signs, as well as anatomic alterations and symptoms. They have a multifactorial etiology and may include everything from tendinitis to massive, full thickness tears of the rotator cuff tendon that compromise the normal biomechanics of the involved shoulder. They usually occur in people over 40 years of age but lesions resulting from trauma may vary according to the mechanism of injury and are not directly related with the age at onset of symptoms. Vascular factors have been described as related with rotator cuff tendon damage in conditions affecting the microcirculation. However, recent studies have not proven that the tendon under direct observation shows hypovascularity. Type A botulinum toxin acts by blocking the release of acetylcholine in the neuromuscular plate; in the joints it releases capsular tension and reduces proinflammatory factors such as interleukin-1 (IL-1). There are only a few papers on its intraarticular benefit; in muscle and tendon groups it not only has a muscle relaxant effect, but several publications support its utility for pain management. It has been widely used in the rehabilitation of this group of patients at low doses. Material and methods: Prospective, investigational and longitudinal study involving the follow-up of 24 patients with a diagnosis of painful shoulder syndrome proven clinically and with imaging tests, and caused by rotator cuff lesions. The patients either did not meet the criteria for immediate surgical repair or had already undergone such a repair. Type A botulinum toxin was applied to 12 patients in the subacromial space around the rotator cuff conjoint tendon, as well as in the painful spots and in the muscle contracture in the shoulder. The total dose of Type A botulinum toxin was 200 IU. The control group, also composed of 12 patients, was given a COX-2 oral antiinflammatory agent for 6 weeks (Celecoxib, 100 mg BID). Both groups followed a pre-established rehabilitation program for a total of 6 weeks and were supervised every 2 weeks. Subjective and objective assessments were made including pain, performance level and possible mobility, using Constant's functional shoulder assessment and the visual analog scale (VAS). Results: Celecoxib group: Mean initial Constant scale score was 60; after the first dose it remained unchanged. After 2 weeks of treatment with Celecoxib the mean Constant score was 66; by 6 weeks it was 70.33, with p > 0.005. The botulinum toxin group received a maximum dose of 200 IU in the affected shoulder, 50 IU were administered subacromially and 150 in the painful spots. This treatment was combined with rehabilitation exercises supervised at the doctor's office. The mean initial Constant scale score was 58; immediately after the first dose it went up to 70.83. Two weeks after the injection and the supervision of rehabilitation exercises at the office, the mean Constant scale score was 77.16; at six weeks it was 78.5, with p < 0.005 (p = 0.00045). The VAS in the Celecoxib group decreased at six weeks with p < 0.005.

[Functional results of type A botulinum toxin versus oral anti-inflammatory agents in the rehabilitation of painful shoulder syndrome caused by rotator cuff lesion]. / Resultados funcionales de la aplicación de toxina botuínica tipo A contra antiinflamatorios orales en la rehabilitación de síndrome de hombro doloroso por lesión del mango de los rotadores.

UNLABELLED: Rotator cuff conditions are characterized by unspecific signs, as well as anatomic alterations and symptoms. They have a multifactorial etiology and may include everything from tendinitis to massive, full thickness tears of the rotator cuff tendon that compromise the normal biomechanics of the involved shoulder. They usually occur in people over 40 years of age but lesions resulting from trauma may vary according to the mechanism of injury and are not directly related with the age at onset of symptoms. Vascular factors have been described as related with rotator cuff tendon damage in conditions affecting the microcirculation. However, recent studies have not proven that the tendon under direct observation shows hypovascularity. Type A botulinum toxin acts by blocking the release of acetylcholine in the neuromuscular plate; in the joints it releases capsular tension and reduces proinflammatory factors such as interleukin-1 (IL-1). There are only a few papers on its intraarticular benefit; in muscle and tendon groups it not only has a muscle relaxant effect, but several publications support its utility for pain management. It has been widely used in the rehabilitation of this group of patients at low doses. Material and methods: Prospective, investigational and longitudinal study involving the follow-up of 24 patients with a diagnosis of painful shoulder syndrome proven clinically and with imaging tests, and caused by rotator cuff lesions. The patients either did not meet the criteria for immediate surgical repair or had already undergone such a repair. Type A botulinum toxin was applied to 12 patients in the subacromial space around the rotator cuff conjoint tendon, as well as in the painful spots and in the muscle contracture in the shoulder. The total dose of Type A botulinum toxin was 200 IU. The control group, also composed of 12 patients, was given a COX-2 oral antiinflammatory agent for 6 weeks (Celecoxib, 100 mg BID). Both groups followed a pre-established rehabilitation program for a total of 6 weeks and were supervised every 2 weeks. Subjective and objective assessments were made including pain, performance level and possible mobility, using Constant's functional shoulder assessment and the visual analog scale (VAS). RESULTS: Celecoxib group: Mean initial Constant scale score was 60; after the first dose it remained unchanged. After 2 weeks of treatment with Celecoxib the mean Constant score was 66; by 6 weeks it was 70.33, with p > 0.005. The botulinum toxin group received a maximum dose of 200 IU in the affected shoulder, 50 IU were administered subacromially and 150 in the painful spots. This treatment was combined with rehabilitation exercises supervised at the doc tor's office. The mean initial Constant scale score was 58; immediately after the first dose it went up to 70.83. Two weeks after the injection and the supervision of rehabilitation exercises at the office, the mean Constant scale score was 77.16; at six weeks it was 78.5, with p < 0.005 (p = 0.00045). The VAS in the Celecoxib group decreased at six weeks with p < 0.005.

[Multifocal brain haemorrhage associated with migraine and medication abuse]. / Hemorragia cerebral multifocal asociada a migraña y abuso de fármacos.

INTRODUCTION: Although ischemic stroke is a well known complication of migraine, cerebral hemorrhage has been uncommonly reported. CASE REPORT: We present the case of a 56-year-old woman with a long history of headache and abuse of ergotamine and antiinflamatory drugs who was admitted for generalized seizures, right hemiparesis and coma. An early brain CT scan showed multiple cortico-subcortical hemorrhages localized amongst others on right frontal, left parietal, and posterior left temporo parietal regions. In the previous two years she had increased the doses on medications containing 1 mg of ergotamine and 500 mg of dipirone consuming two to six tablets a day, and 500 to 1,500 mg of aspirin a day too. Although she exceeded the maximum ergot cumulative doses allowed of 10 mg per week, it cannot be considered a typical nor a pure manifestation of ergotism. When other possible causes of stroke were excluded, the association of migraine with the protracted vasoconstriction of ergotamine, able per se to damage the capillary endothelium, and an altered local hemostasis induced by aspirin remained as the most probable mechanism of brain bleeding. After discharge she had no motor sequelae and she could return to her usual work. A neuropsychological assessment done four months later showed subclinical cognitive deficits depending on an abnormal frontal functioning. CONCLUSION: This life-threatening and potentially disabling complication must stress to physicians about the risks of ergotamine plus aspirin abuse, drawing their efforts to prevent, to recognize and to control the propensity to self medication of some patients with daily headaches.