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)

Nano-dimensional CeO2 nanorods for high Ni loading catalysts: H2 production by autothermal steam reforming of methanol reaction.

CeO2 nanorods were synthesized by a hydrothermal method and used as the support for preparing a series of Ni/CeO2 nanorod catalysts. The surface area of the catalysts decreased when the Ni percent over the CeO2 nanorods was increased. SEM results showed that the CeO2 is formed by nanorods approximately 1 µm in length. TEM and HREM revealed that the width of the nanorods is about 8 nm and it grew along the [1 1 1¯] axis. The catalytic activity of the catalysts was improved as the Ni was loaded onto CeO2 nanorods. The exposed planes of the CeO2 nanorod structure along the zone axis [0 1 1] for Ni impregnation were (1¯ 1¯ 1), (1 1 1¯), (1 1¯ 1), (1¯ 1 1¯), (2 0 0) and (2¯ 0 0) and they were more reactive for methanol conversion than (2¯ 2¯ 0), (2¯ 0 2¯), (0 2 2¯), (0 2¯ 2), (2 0 2) and (2 2 0) planes from the [1 1 1¯] axis (growth direction of the nanorod). This finding is mainly ascribed to the synergistic effect of the CeO2 nanorods and the Ni.

Effects of haptoglobin polymorphisms and deficiency on susceptibility to inflammatory bowel disease and on severity of murine colitis.

BACKGROUND: Haptoglobin (Hp) is a haemoglobin-binding protein with immunomodulatory properties. Its gene (16q22) harbours a common polymorphism with two different alleles: Hp1 and Hp2. Genotype Hp22 has been shown to be over-represented in different immune diseases. Results in Crohn's disease (CD) are contradictory. AIMS: To determine whether Hp plays a role in inflammatory bowel disease, both genetically and functionally. METHODS: 1061 patients with CD, 755 with ulcerative colitis (UC) and 152 with primary sclerosing cholangitis, as well as 452 healthy controls, were genotyped using touch-down PCR. To confirm association results, 464 CD trios and 151 UC trios were genotyped. Serum Hp concentrations were determined in 62 individuals of different genotype. Colitis was induced in mice with dextran sulphate sodium (DSS) and oxazolone (Oxa). Cytokine production was evaluated by mRNA quantification in colonic tissue and ELISA on supernatants of mesenteric lymph node cells. RESULTS: Prevalence of Hp2 was higher in CD and UC than in controls. In the confirmatory cohorts, Hp2 was over-transmitted to the affected offspring. Serum Hp concentrations were higher in individuals with genotypes Hp11 and Hp21 than in those with Hp22 (1.38 vs 0.89 g/l). DSS- and Oxa-induced colitis were more severe in Hp-deficient mice than in control mice and accompanied by higher concentrations (although not statistically significantly different) of tissue mRNA for cytokines. Interleukin-17 production was significantly higher in the presence of Hp-deficient serum compared with wild-type serum. CONCLUSIONS: The Hp gene may play a role in susceptibility to inflammatory bowel disease. Its implication in other immune diseases underscores the common pathways between these diseases. Experimental models of colitis showed that Hp has a protective role in inflammatory colitis, most likely by inhibiting the production of Th1 and Th17 cytokines.

A novel synthesis method to produce silver-doped CeO2 nanotubes based on Ag nanowire templates.

Silver nanowires were used as templates to synthesize silver-doped CeO(2) (Ag-CeO(2)) nanotubes by the precipitation method. The precipitated solid was dried at 100 °C for 24 h and calcined at 500 °C for 5 h. A TEM, HRTEM, LV-SEM and XRD study was carried out to determine the micro and nanostructural characteristics of the samples. LV-SEM analysis allowed us to observe microtubular empty structures constituted by Ce, O and Ag as indicated by EDS. These tubular structures, with an external diameter from 120 to 280 nm and an internal diameter from 40 to 80 nm, were mainly composed of 11 nm ceria nanoparticles. This kind of structures was obtained when CeO(2) nanoparticles covered the Ag nanowires during the synthesis. Due to the presence of ammonium hydroxide used during the synthesis, a fraction of the silver nanowire reacts and Ag atoms begin to migrate outside the ceria microtube. When the sintering process is applied, the Kirkendall effect can occur. So, out-diffusion of the remnant Ag through the interface is faster than the in-diffusion of the shell material (CeO(2)), which eventually results in a coaxial nanotube on completion of the non-equilibrium interdiffusion, leaving the central core completely empty, driving the formation of hollow tubular Ag-CeO(2) structures as a result.

Tiroides ectópico asociado con Graves-Basedow / Ectopic thyroids associated with Graves-Basedow Disease

Se presenta un caso de tiroides ectópico sublingual asociado a enfermedad de Graves-Basedow en un niño de 16 años con antecedentes personales de diabetes mellitus tipo 1 desde los 11 años. La verdadera incidencia de tiroides ectópico es desconocida por cursar la mayor parte de ellos de forma asintomática; en caso de presentar clínica, suele ser hipotiroidismo, siendo excepcional su asociación a hipertiroidismo (AU)

A case is presented of sublingual ectopic thyroid associated to Graves-Basedow disease in a 16 year-old male child with personal background of Diabetes Mellitus 1 from 11 years of age. The true incidence of ectopic thyroid is unknown as it mostly occurs symptomatically. If there are symptoms, they are generally hypothyroidism, its association to hyperthyroidism being very rare (AU)

Coalescence phenomena in 1D silver nanostructures.

Different coalescence processes on 1D silver nanostructures synthesized by a PVP assisted reaction in ethylene glycol at 160 °C were studied experimentally and theoretically. Analysis by TEM and HRTEM shows different defects found on the body of these materials, suggesting that they were induced by previous coalescence processes in the synthesis stage. TEM observations showed that irradiation with the electron beam eliminates the boundaries formed near the edges of the structures, suggesting that this process can be carried out by the application of other means of energy (i.e. thermal). These results were also confirmed by theoretical calculations by Monte Carlo simulations using a Sutton-Chen potential. A theoretical study by molecular dynamics simulation of the different coalescence processes on 1D silver nanostructures is presented, showing a surface energy driven sequence followed to form the final coalesced structure. Calculations were made at 1000-1300 K, which is near the melting temperature of silver (1234 K). Based on these results, it is proposed that 1D nanostructures can grow through a secondary mechanism based on coalescence, without losing their dimensionality.

[Bacteraemia due to Leuconostoc spp. in a patient without immunological disorders]. / Bacteriemia por Leuconostoc spp. en paciente sin factores de riesgo.

Leuconostoc spp are gram-positive coccobacilli, catalase and oxidase negative, vancomycin resistant. Causes of infection have been reported previously but it has not been described confirmed bacteremia due to Leuconostoc spp in patient without other immunological disorders. We describe a case of bacteremia in a 64-years-old man with a prosthetic valve 7 months before to begin fever of unknown origin. We confirmed bacteremia due Leuconostoc spp and the treatment with respective antibiotics permits the cure. Leuconostoc spp should be considered as a potential cause of bacteraemia, but we would be observant to the bacteremias due vancomycin resistant germs, because in most cases the laboratory do not find the sensitivity to this antibiotic.

Bacteriemia por Leuconostoc spp. en paciente sin factores de riesgo / Bacteriemia due to Leuconostoc spp. in a patient without inmunological disorders

Los microorganismos del género Leuconostoc son coco-bacilos gram-positivos, catalasa-negativos y oxidasa-negativos, que se caracterizan por ser intrínsecamente resistentes a Vancomicina. Se han descrito procesos infecciosos causados por estos microorganismos, pero no se han descrito casos de bacteriemia confirmada por Leuconostoc spp. en pacientes sin alteraciones inmunológicas. Describimos un caso de bacteriemia en un hombre de 64 años con bioprótesis 7 meses antes de iniciar cuadro de fiebre de origen desconocido. Confirmamos bacteriemia por Leuconostoc spp. y el tratamiento antibiótico correspondiente permitió la curación del cuadro. Aunque Leuconostoc spp. deba ser considerado una causa excepcional de bacteriemia, debemos estar atentos a las infecciones por gérmenes vancomicín-resistentes ya que muchos laboratorios no determinan de forma rutinaria la sensibilidad a esta antimicrobiano

Leuconostoc spp are gram-positive coccobacilli, catalasa and oxidase negative, vancomycin resistant. Causes of infection have been reported previously but it has not been described confirmed bacteremia due to Leuconostoc spp in patient without other immunological disorders. We describe a case of bacteremia in a 64-years-old man with a prosthetic valve 7 months before to begin fever of unknown origin. We confirmed bacteremia due Leuconostoc spp and the treatment with respectives antibiotics permits the cure. Leuconostoc spp should be considered as a potencial cause of bacteriemia, but we would be observant to the bacteremias due vancomicin resitant germs, because in most cases the laboratory do not find the sensitivity to this antibiotic

TEM and molecular simulation studies on the hydroxylapatite structure with Si and Mg impurities.

Transmission electron microscopy (TEM) and molecular simulation studies of traces of chemical elements such as Mg, Si, and OH in the hydroxylapatite (CaHAP) crystal structure obtained from the sand dollar were carried out. Two different types of CaHAP crystal morphologies in the samples synthesized by the hydrothermal method used were observed. Reflections with regular intensity in the experimental electron diffraction patterns obtained from these morphologies were observed. However, when these results were compared with a simulated electron diffraction pattern (which was obtained using the crystalline structure proposed for the hydroxylapatite) some forbidden reflections in the experimental pattern were observed. Then, in order to reproduce the experimental patterns Si and Mg atoms in the crystalline lattice were introduced. These elements in the elemental chemical analysis carried out by X-ray energy dispersive spectroscopy (EDS) in the typical CaHAP morphologies were detected. The positions of these atoms in the asymmetric unit were obtained using molecular simulation and during the relaxation process, the structure did not show changes in the lattice parameters. Subsequently, the crystalline structure was reproduced and matched the electron diffraction patterns simulated resulting in the experimental electron diffraction pattern. Experimental and simulated X-ray diffraction spectra were also matched.

Ataxias hereditarias / Hereditary ataxias

La ataxia constituye una manifestación clínica relacionada con una disfunción del cerebelo (ataxia cerebelosa) o debida a una insuficiente información sensitiva (ataxia sensitiva) que, en la práctica, está presente en situaciones muy diversas. Pueden relacionarse con patología esporádica –como un tumor de cerebelo– o tener una base genética que facilita su presentación familiar. En esta aportación se analizan las ataxias con base genética o hereditaria, entre las que pueden distinguirse tres grupos principales: ataxias no progresivas, ataxias progesivas y ataxias episódicas. En el primer grupo, y entre las formas autonómicas recesivas, destaca el síndrome de Joubert, junto a otros menos habituales como el de Norman, Gillespie, etc.; entre los tipos de herencia dominante se incluye la aplasia cerebelosa vermiana o la ataxia cerebelosa con espasticidad. La ataxia cerebelosa con oftalmoplejía externa se ligada a X. Entre las ataxias progresivas, el lugar más destacado lo ocupa la ataxia de Friedreich –autosómica recesiva–. Las variantes con herencia dominante constituyen un grupo muy numeroso de situaciones pero de inicio ya en la edad adulta

[Ear, nose, and throat manifestations in patients with primary immunodeficiencies]. / Manifestaciones otorrinolaringológicas de los pacientes con immunodeficiencias primarias.

OBJECTIVE: To determine the flowgram for the timely diagnosis of the immunodeficiencies congenital primary, based on the demonstrations otorrinolaringol recurrent chronicles to difficult control, with or without associated systemic diseases. MATERIAL AND METHOD: Retrospective study, descriptive and observational that included patient with diagnostic of primary known immunodeficiency. They were checked the clinical files to know their evolution and medical treatment-surgical. RESULTS: They were found 10 patient with diagnostic of some primary immunodeficiency; this was made based on the infectious symptoms otolaryngal chronic recurrent to difficult control; they were six men and four women between the four and 36 years old. They were found the following immunodeficiencies: one of hyper-IgM, three by IgG, variable common three, a deficit with C3 of the complement, two of IgA more atopia. CONCLUSIONS: The chronicle sinusitis or recurrent and the otitis mean chronicle or recurrent can be the only demonstrations of a patient with primary immunodeficiency. The immunology evaluation must include, at least: hematic biometric completes with differential, seric levels of immunoglobulins, the same as subclass of IgG, C4 and C3 of the complement, response to immunization with proteins (diphtheria and tetanus), and polysaccharide antigens (pneumovax).