Electromyography assisted application of botulinum toxin in pterygoid musculature for the treatment of masticatory myofascial pain / Aplicación de toxina botulínica en musculatura pterigoidea asistida con electromiografía para tratamiento del dolor miofascial

AIM: To evaluate the efficacy of botulinum toxin A injection (BTA) in the lateral pterygoid muscles assisted by electromyography (EMG) for the treatment of masticatory myofascial pain (MMP). MATERIAL AND METHODS: We conducted a retrospective study of 31 patients diagnosed of MMP who were treated by infiltration of botulinum toxin A in 1, 2 or 3 times, in the lateral and medial pterygoid muscles by electromyographic control of the puncture site. We assessed the treatment effectiveness in pain intensity decrease by numerical scales (NS) and categorical scales (CS). The impact of pathology on its quality of life, the decrease of demand for analgesic drugs, and the duration of BTA effect and its side effects were also valued. RESULTS: The mean decrease in pain after treatment was 4.9 +/- 2.9 points in NS. A statistical decrease of the pain (p = 0.01) can be shown after treatment. There is no statistical relationship between greater improvement after the administration of a greater number of injections. However, there is a significant improvement in the decrease of the pain in CS (p = 0.028) after the administration of several injections. There is also a significant decrease (p = 0.012) of the use of analgesic medication post-treatment. CONCLUSIONS: EMG assisted pterygoid muscles infiltration of BTA is effective in the treatment of MMP; it improves quality of life and decreases the consumption of health resources

OBJETIVO: Evaluar la eficacia de la inyección de toxina botulínica A (TBA) en los músculos pterigoideos guiada por electromiografía (EMG) para el tratamiento del dolor miofascial masticatorio. MATERIAL Y MÉTODOS: Realizamos un estudio retrospectivo de 31 pacientes diagnosticados de dolor miofascial de origen masticatorio a los que se le administró TBA en los músculos pterigoideos laterales y mediales guiada por EMG. Se evaluó la efectividad por disminución de intensidad del dolor mediante escalas numéricas (EN) y escalas categóricas (EC). Además, se determinó el impacto de esta patología en su calidad de vida, la duración del tratamiento y la disminución de la demanda de analgésicos. RESULTADOS: La disminución media del dolor en la EN tras tratamiento fue de 4,9 +/- 2,9 puntos. Se observó una disminución estadística del dolor (p < 0,01) después del tratamiento. No existe una relación estadística entre una mejoría mayor después de la administración de un mayor número de inyecciones. Sin embargo, hay una mejora significativa en la disminución del dolor en la CS (p = 0,028) después de la administración de varias inyecciones; así como una disminución significativa del uso de medicación analgésica posttratamiento (p = 0,012). CONCLUSIONES: La administración de TBA guiada por EMG en los músculos pterigoideos es eficaz en el tratamiento del dolor miofascial masticatorio, mejor la calidad de vida y se consigue una disminución del consumo de analgésicos postratamiento

Usefulness of Doppler ultrasound-obtained resistance index in thyroid nodules with ultrasonographic malignant characteristics. / Utilidad del índice de resistencia obtenido por ultrasonido Doppler en nódulos tiroideos de características ecográficas malignas.

Introduction: Thyroid nodular disease is highly prevalent in the general population. Its diagnosis has increased with Doppler ultrasound, by means of which features suggestive of malignancy can be detected, such as resistance and pulsatility indices elevation. Objective: To assess the correlation of a high resistance index and histopathological findings in patients with ultrasonographic suspicion of malignant thyroid nodules. Method: Prospective, cross-sectional, analytic, observational study of diagnostic tests carried out at Specialty Hospital 25, in Monterrey, Nuevo León. Patients with thyroid nodules of ultrasonographic malignant characteristics were included; the resistance index of the nodules was obtained and compared with histopathological findings. Results: Forty-eight patients with ultrasonographic diagnosis of malignant nodules were included. The correlation of elevated resistance indices with malignant thyroid nodule histopathologic diagnosis was significant (p = 0.001). Sensitivity was 73.3% and specificity 78.7%; positive predictive value was 61.1% and negative predictive value was 86.6%. Conclusion: The resistance index determination is increasingly being used, but its sensitivity and specificity are low, and it is not a reliable method, and other complementary methods are therefore still required.

Introducción: La patología nodular tiroidea tiene alta prevalencia en la población general. Su diagnóstico se ha incrementado con el Doppler, con el cual se pueden detectar características sugerentes de malignidad, como elevación de los índices de resistencia y pulsatilidad. Objetivo: Evaluar la correlación de un índice de resistencia alto y los hallazgos histopatológicos en pacientes con sospecha ecográfica de nódulos tiroideos malignos. Método: Estudio prospectivo, observacional, transversal y analítico de pruebas diagnósticas, en el Hospital de Especialidades 25, Monterrey, Nuevo León. Se incluyó a pacientes con nódulos tiroideos de características ecográficas malignas; se obtuvo el índice de resistencia de los nódulos, que se comparó con los hallazgos histopatológicos. Resultados: Se incluyeron 48 pacientes con diagnóstico ecográfico de nódulo tiroideo maligno. La correlación de índices de resistencia elevados y diagnóstico histopatológico de nódulos tiroideos malignos fue significativa (p = 0.001). La sensibilidad fue de 73.3 %, y la especificidad de 78.7 %; valor predictivo positivo de 61.1 % y valor predictivo positivo negativo de 86.6 %. Conclusión: La determinación del índice de resistencia cada vez es más empleada, pero la sensibilidad y especificidad es baja y no es un método confiable, por lo que aún se requieren otros métodos complementarios.

Infant botulism in Andalusia (Southern Spain).

BACKGROUND: Infant botulism (IB) is caused by the intestinal colonization by Clostridium botulinum in the first year of life and its subsequent production of neurotoxins. Traditionally, IB has been associated to honey consumption. IB cases tend to cluster in geographic regions. In Europe, IB is a rare disorder. From 1976 through 2006, 65 cases were identified in 13 European countries. In Spain, in the last 15 years, most of the cases have been reported in one region, Andalusia (Southern Spain). A specific treatment for IB type A and type B (BabyBIG) is available outside of the United States since 2005. METHODS: and aims: We performed a retrospective review of IB cases detected in Andalusia since 1997 and compare them with the cases of IB reported in Europe. RESULTS: We identified 11 confirmed cases of IB in Andalusia since 1997, and 14 cases in Spain. Nine out of 11 cases were detected since 2007; none of these infants had been exposed to honey consumption. One case in 1997 and another in 2000 were associated to honey. Two cases were treated with BabyBIG in 2007. In the period 2006-2012 the cases of IB reported in Europe were 54. CONCLUSIONS: We identified a considerable increase in the incidence of IB since 2006. A tendency to a reduction in the number of cases of IB linked to honey consumption has also been identified. An increase in the exposure to these bacteria from the environment could be presumed. Clinicians should maintain a high index of suspicion for this treatable disorder.