Utilidad del campo magnético en la cervicobraquialgia crónica / No disponible

La medicina física y rehabilitación consta con un arsenal terapéutico amplio para tratar afecciones crónicas, utilizando esencialmente agentes físicos naturales y artificiales. El tratamiento casi siempre es conservador y puede utilizarse la aplicación local de las corrientes eléctricas y el campo magnético como medidas de fisioterapia. Teniendo en cuenta los efectos biológicos de la terapia con campo magnéticoregional, se investigó su utilidad en la cervicobraquialgia crónica, que representa una de las formas más frecuentes de incapacidad que acuden a nuestras consultas. Objetivos: evaluar la eficacia del campo magnético regional en la cervico-braquialgia crónica con respecto a la corriente interferencial. Material y métodos: el estudio prospectivo y descriptivo se realizó en el Servicio de Fisiatría de la Clínica Central Cira García, en el periodo comprendido entre diciembre del 2008 a diciembre del 2009. El universo estuvo compuesto por 60 pacientes y la muestra por dos grupos de pacientes (30 cada uno) que cumplieron los requisitos de inclusión para la entidad. Se les aplicó la escala analógico visual y el test de McGill para la evaluación del dolor y la escala de incapacidad de Lee y Stanford en la consulta inicial y finalizado el tratamiento. Un grupo realizó tratamiento con corriente interferencial, y otro grupo recibió tratamiento con magnetoterapia regional. La información se procesó por paquete estadístico SPSS versión 11.5. Resultados y conclusiones: la evolución del dolor y la incapacidad entre los grupos no tuvieron diferencias significativas, para una p menor a 0,05; ambas terapias son efectivas en el abordaje de esta entidad. La Corriente Interferencial fue más efectiva para el alivio del dolor cuando se comparó con la Magnetoterapia regional. Solo se presentaron escasas reacciones adversas con la corriente interferencial (AU)

The Physical Medicine and Rehabilitation consists with a wide therapeutic arsenal to treat chronic affections, using natural and artificial physical agents essentially. The treatment is almost always conservative and it can be used the local application of the electric currents and the magnetic field as physiotherapy measures. Keeping in mind the biological effects of the therapy with regional magnetic field, their utility was investigated in the chronic cervical pain that represents one in the most frequent ways in inability that go to our consultations. Objectives: to evaluate the effectiveness of the regional magnetic field in the chronic cervical pain with regard to the application of interferential current. Material and methods: the prospective and descriptive study was carried out in the Service of Rehabilitation of the Central Clinic "Cira García", in the period understood among December 2008 to December 2009. The universe was compound for 60 patients and the sample for two groups of patient (30 each one) that completed the insertion requirements for the entity. They were applied the visual analogical scale and McGill's test for the evaluation of the pain and the scale of inability of Lee and Stanford in the initial and concluded consultation the treatment. A group carried out treatment with interferential current, and another group received treatment with regional magneto therapy. The information was processed by statistical package SPSS version 11.5. Results and conclusions: the evolution of the pain and the inability among the groups didn't have significant differences, or p less than 0.05; both therapies are effective in the boarding of this entity. The interferential current was more effective for the relief of the pain when it was compared with the regional magnetotherapy. Scarce adverse reactions were only presented with the interferential current (AU)

Histological and molecular features of lipomatous and nonlipomatous adipose tissue in familial partial lipodystrophy caused by LMNA mutations.

OBJECTIVES: Type 2 familial partial lipodystrophy (FPLD2) is a rare adipose tissue (AT) disease caused by mutations in LMNA, in which lipomas appear occasionally. In this study, we aimed to histologically characterize FPLD2-associated lipomatosis and study the expression of genes and proteins involved in cell cycle control, mitochondrial function, inflammation and adipogenesis. DESIGN AND PATIENTS: One lipoma and perilipoma fat from each of four subjects with FPLD2 and 10 control subjects were analysed by optical microscopy. The presence of inflammatory cells was evaluated by immunohistochemistry. Real-time RT-PCR and Western blot were used to evaluate gene and protein levels. RESULTS: Adipocytes from lipodystrophic patients were significantly larger than those of controls, in both the lipomas and perilipoma fat. Lipodystrophic AT exhibited CD68(+) macrophages and CD3(+) lymphocytes infiltration. TP53 expression was reduced in all types of lipomas. At protein level, C/EBPß, p53 and pRb were severely disturbed in both lipodystrophic lipomas and perilipoma fat coming from lipoatrophic areas, whereas the expression of CEBPα was normal. Mitochondrial function genes were less expressed in lipoatrophic fat. In both lipomas and perilipoma fat from lipoatrophic areas, the expression of adipogenes was lower than controls. CONCLUSIONS: Even in lipomas, the adipogenic machinery is impaired in lipodystrophic fat coming from lipoatrophic regions in FPLD2, although the histological phenotype is near-normal, exhibiting low-grade inflammatory features. Our results suggest that the p53 pathway and some adipogenic proteins, such as CEBPα, could contribute to the maintenance of this near normal phenotype in the remnant AT present in these patients.

Reduced adipogenic gene expression in fibroblasts from a patient with type 2 congenital generalized lipodystrophy.

AIMS: Beradinelli-Seip congenital generalized lipodystrophy is a rare autosomal recessive disorder characterized by near-complete absence of adipose tissue, Herculean appearance, insulin resistance, hypoleptinaemia and diabetes mellitus. The aim of this study was to investigate the in vitro effects of pioglitazone on the expression of genes involved in adipogenesis in fibroblasts from a patient with this condition due to a seipin mutation. METHODS: Primary cultures of fibroblasts from the skin of the patient were obtained. Fibroblasts were treated with classic adipose differentiation medium, with and without pioglitazone. Several adipogenes were evaluated by real-time reverse transcriptase-polymerase chain reaction and western blotting. Intracellular localization of prelamin A was studied by immunofluorescence microscopy. RESULTS: The expression of the adipogenic genes PPARG, LPL, LEP and SLC2A4 was reduced in lipodystrophic fibroblasts, while treatment with pioglitazone increased the expression of these genes. Moreover, and unexpectedly, we found an accumulation of farnesylated prelamin A in lipodystrophic fibroblasts. CONCLUSIONS: The process of adipocyte differentiation is compromised in patients with Beradinelli-Seip congenital lipodystrophy owing to diminished expression of the regulatory genes involved, which pioglitazone treatment partially rescues. Prelamin A accumulation establishes a link with other types of familial lipodystrophies, as familial partial lipodystrophy.

Láser infrarrojo frente a acupuntura en el tratamiento del espolón calcáneo / Infrared laser vs. acupuncture in the treatment of heel spurs

Introducción: La Medicina Física y Rehabilitación y la Medicina Natural y Tradicional son especialidades médicas que desarrollan medidas de promoción de la salud, prevención, diagnóstico y tratamiento, utilizando como terapéutica agentes físicos y naturales, ayudándose con la acupuntura y el láser terapéutico. El espolón calcáneo es un osteofito que crece en la parte anterior de la tuberosidad plantar del calcáneo secundario a procesos inflamatorios de causa degenerativa o a procesos inflamatorios locales de origen inmunológico asociados a las espondiloartropatías. Para diagnosticarlo, la mayoría de las veces es suficiente el examen clínico, o puede acompañarse de estudios de imagen, como la radiografía y el ultrasonido. El síntoma más importante es el dolor y el tratamiento casi siempre es conservador, aunque pueden emplearse otros agentes terapéuticos. Objetivos: Investigamos el efecto analgésico obtenido mediante la aplicación de la radiación láser infrarrojo, en pacientes portadores de espolón calcáneo. Material y métodos: La investigación consistió en un estudio prospectivo, descriptivo y comparativo. De un universo de 62 pacientes que acudieron al Servicio de Medicina Natural y Tradicional del Policlínico Universitario 30 de Noviembre, en el período de enero de 2005 a enero de 2008; se conformó una muestra de 52 pacientes, divididos en 2 grupos de 26 cada uno. Un grupo llevó tratamiento con laserterapia y otro, con acupuntura. Se incluyó a pacientes de ambos sexos, cualquier raza y edades de 20-80 años; se excluyó a mujeres gestantes y pacientes neoplásicos. A todos se les midió el grado de intensidad del dolor según escala visual analógica al inicio, durante y al final del tratamiento. Resultados y conclusiones: Predominó el grupo etáreo de 51-60 años y del sexo femenino en ambos grupos. Se logró el alivio del dolor a partir de la segunda sesión de tratamiento en el grupo de laserterapia, y se curó al 61,5% de los pacientes. En acupuntura el comienzo de la mejoría se produjo a partir de la cuarta sesión, y se curó a un 42,3%. En el grupo de laserterapia, se demuestra la efectividad de este método, debido a que la desviación promedio de laserterapia (0,683) se aparta menos de la media que la desviación promedio de acupuntura (0,882). Recomendamos el uso de láser de baja potencia, como tratamiento de primera línea para el manejo de condiciones álgicas e inflamatorias asociadas al espolón calcáneo (AU)

Introduction: Physical Medicine and Rehabilitation and Traditional and Natural Medicine are medical specialties that develop measures for the promotion of health, prevention, diagnosis and treatment, using physiotherapy and natural agents, along with acupuncture and therapeutic laser. The heel spur is an osteophyte that grows in the front part of the plantar tuberosity of the heel bone secondary to inflammatory processes of a degenerative cause or of immune origin associated with the spondyloarthropathies. It is mainly diagnosed by clinical examination, x-ray studies and ultrasound. The most important symptom is the pain and the treatment is almost always conservative, although other therapeutic agents can be employed. Objective: We studied the analgesic effect obtained by the application of an infrared laser radiation in patient suffering from heel spur. Methods: The investigation consisted of a comparative, descriptive, and prospective study. Of a total of 62 patients who attended the Department of Traditional and Natural Medicine of the November 30th University Polyclinic, in the period of January 2005 to January 2008, 52 patients were formed into 2 groups of 26. One group had lasertherapy and the other acupuncture treatment. Patients of both sexes and of any race were included, and ages ranged from 20 to 80 years. We excluded pregnant women and patients with cancer. The pain intensity was measured in all of them using the visual analog scale (VAS), before, during and at the end of treatment. Results and conclusions: The majority were in the 51 to 60 years age group and the female sex in both groups. Pain relief was achieved in the laser treatment group in the second session, curing 61.5% of the patients. In acupuncture they had to wait until the fourth session before there was improvement, curing 42.3%. The effectiveness of this method is shown in the laser therapy group, with an average deviation (0.683) which was significantly less than the average of the acupuncture average deviation (0.882). We recommend the use of low-power laser as first line treatment of pain and inflammation associated with heel spur (AU)

Láser de baja potencia en el tratamiento de las calcificaciones de hombro / Low power laser in the treatment of shoulder calcifications

Introducción: La artropatía o enfermedad por depósito de cristales es la entidad en la que el factor desencadenante de la respuesta inflamatoria es la presencia de microcristales en las estructuras articulares, pudiendo conducir con el tiempo a la lesión articular. No necesariamente se asocia a manifestaciones clínicas, y frecuentemente es un hallazgo radiológico casual. Objetivos: Se evaluó la eficacia del láser de baja potencia en pacientes con calcificaciones periarticulares de hombro con respecto al tratamiento convencional con iontoforesis. Material y métodos: Se llevó a cabo un estudio longitudinal, prospectivo y explicativo, de corte experimental, donde se aplicaron 2 tipos de tratamientos, el convencional con iontoforesis y el láser de baja potencia utilizando las técnicas de la ser puntura y la serterapia, para lo cual se emplearon equipos de fabricación cubana. La muestra estuvo conformada por 46 pacientes con síndrome doloroso agudo localizado en hombro, que asistieron a la consulta de ortopedia y recibieron tratamiento en el Servicio de Rehabilitación de la Clínica Central Cira García. Para medir el grado de eficacia de la terapéutica utilizada en ambos grupos de trabajo se empleó el test de Constant. Resultados y conclusiones: Predominó el sexo masculino y el grupo de edad más afectado estuvo entre 38 y 57 años de edad. El uso del láser fue efectivo para el tratamiento del hombro doloroso por calcificaciones articulares, lo cual se evidencia en la disminución del dolor, el aumento de la movilidad y de la potencia muscular. Los pacientes tratados con láser notaron la mejoría inicial entre la primera y tercera sesiones de tratamiento. No aparecieron reacciones adversas con el uso del láser de baja potencia. En ambos tratamientos se logró curación, pero fue significativamente más evidente en el tratamiento con laser (AU)

Introduction: Arthropathy, or crystal deposition disease, is an entity in which the factor triggering the inflammatory response is the presence of microcrystals in the joint structures, which can eventually lead to joint lesions. Associated clinical manifestations are not always present and this disease is often identified as an incidental radiological finding. Objective: We evaluated the effectiveness of low power laser therapy in patients with calcifications of the shoulder joints compared with conventional treatment with iontophoresis. Material and methods: We performed a longitudinal, experimental, prospective, explanatory y study, in which two types of treatments were applied: conventional treatment with iontophoresis and low power laser using the laser puncture techniques and laser therapy, with devices manufactured in Cuba. The sample was composed of 46 patients with acute painful syndrome located in the shoulder attending the outpatient orthopedic clinic and receiving treatment in the Rehabilitation Service of the Cira Garcia Central Clinic. To measure the degree of effectiveness of the therapy used in the two groups, the Constant test was used. Results and conclusions: There was a predominance of male sex and the most frequently affected age group was between 38 and 57 years. The use of the laser was effective in the treatment of painful shoulder due to joint calcifications, demonstrated by decreased pain, and increased mobility and muscular power. Patients treated with laser noticed an initial improvement between the first and third treatment sessions. There were no adverse reactions with the use of low power laser therapy. Cure was achieved by both treatments but was significantly more evident with the laser treatment (AU)

Site-dependent differences in both prelamin A and adipogenic genes in subcutaneous adipose tissue of patients with type 2 familial partial lipodystrophy.

BACKGROUND: Type 2 familial partial lipodystrophy (FPLD2) is characterised by loss of fat in the limbs and buttocks and results from mutations in the LMNA gene. AIM: To evaluate the role of several genes involved in adipogenesis in order to better understand the underlying mechanisms of regional loss of subcutaneous adipose tissue (scAT) in patients with FPLD2. METHODS: In total, 7 patients with FPLD2 and 10 healthy control participants were studied. A minimal model was used to calculate the insulin sensitivity (IS). scAT was obtained from abdomen and thigh by biopsy. Relative gene expression was quantified by real-time reverse transcription PCR in a thermal cycler. Prelamin A western blot analysis was carried out on scAT and prelamin A nuclear localisation was determined using immunofluorescence. Adipocyte nuclei were examined by electron microscopy. RESULTS: Patients with FPLD2 were found to have significantly lower IS. The expression of LMNA was similar in both groups. The expression of PPARG2, RB1, CCND3 and LPL in thigh but not in abdomen scAT was significantly reduced (67%, 25%, 38% and 66% respectively) in patients with FPLD2. Significantly higher levels of prelamin A were found in peripheral scAT of patients with FPLD2. Defects in the peripheral heterochromatin and a nuclear fibrous dense lamina were present in the adipocytes of patients with FPLD2. CONCLUSIONS: In FPLD2 participants, prelamin A accumulation in peripheral scAT is associated with a reduced expression of several genes involved in adipogenesis, which could perturb the balance between proliferation and differentiation in adipocytes, leading to less efficient tissue regeneration.