Sensibilidad de la respuesta simpática cutánea y de la gammagrafía en el diagnóstico del síndrome dolor regional complejo / Sensitivity of the sympathetic skin response and scintigraphy in the diagnosis of complex regional pain syndrome

Objetivo: Evaluar la sensibilidad de la respuesta simpática cutánea (RSC) y compararla con la gammagrafía en pacientes con síndrome de dolor regional complejo diagnosticados según criterios de Budapest. Material y métodos: Se evaluó prospectivamente a 22 pacientes con síndrome de dolor regional complejo que acudieron al Servicio de Rehabilitación y Medicina Física entre enero-2018 y mayo-2022. La gammagrafía se consideró positiva si en la 1.a-2.a fase se apreció leve captación asimétrica y difusa, o cuando en la 3.a fase se apreció marcada captación periarticular del radioisótopo. La RSC era anormal si se observaba: a) ausencia de respuesta tras 20 estímulos; b) falta de habituación con permanencia de los estímulos mayor al 67,2%. Resultados: Edad 55,4±8,57 años. Síndrome de dolor regional complejo más frecuente en mujeres (90,9%), más común en miembros superiores (68,2%) que en inferiores (31,8%). En la RSC hemos observado respuesta normal (<67,2%) en 2 pacientes (11,1%), falta de RSC en 2 pacientes (11,1%) y falta de habituación (>67,2%) en 14 pacientes (77,8%). En total, 16 pacientes presentaron respuestas anormales o ausentes (88,8%). La sensibilidad diagnóstica de la gammagrafía es similar a la de la RSC (89,5 vs. 88,8%), sin diferencia estadística (p=0,6721). Conclusión: La Gammagrafía ha demostrado una sensibilidad similar a la RSC, aunque la simpleza, el bajo coste y la no invasividad de esta última técnica sugieren que podría ser más coste/efectiva y segura (no ionizante). La falta de habituación y la ausencia de respuesta podrían identificar patrones de respuesta y localizar la afectación en las vías aferente, central, eferente o post ganglionar.(AU)

Objective: To evaluate the sensitivity of sympathetic skin response (SSR) and compare it with scintigraphy in patients with complex regional pain syndrome diagnosed according to the Budapest criteria. Material and methods: Twenty-two patients with complex regional pain syndrome who attended the Rehabilitation and Physical Medicine Department between January-2018 and May-2022 have been prospectively evaluated. The scintigraphy was considered positive if in the 1st-2nd phase slight asymmetric and diffuse uptake was observed, or when in the 3rd phase marked periarticular radioisotope uptake was observed. SSR was abnormal if: a) no response after 20 stimuli; b) lack of habituation with permanence of the stimuli greater than 67.2%. Results: Age 55.4±8.57 years. Complex regional pain syndrome was more frequent in women (90.9%), more common in upper limbs (68.2%) than lower limbs (31.8%). In SSR, we have observed normal response (<67.2%) in 2 patients (11.1%), lack of SSR in 2 patients (11.1%) and lack of habituation (>67.2%) in 14 patients (77.8%). In total, 16 patients presented abnormal or absent responses (88.8%). The diagnostic sensitivity of scintigraphy is similar to that of SSR (89.5% vs 88.8%), with no statistical difference (P=.6721). Conclusion: Scintigraphy has shown similar sensitivity to SSR, although the simplicity, security, low cost, non-ionizing and non-invasiveness of the latter technique suggest that it could be more cost-effective. The lack of habituation and the absence of response could identify response patterns and localize the involvement in the afferent, central, efferent or post-ganglionic pathways.(AU)

Numerical study of the scattering of acoustic waves by an elliptic vortex.

The scattering of the acoustic waves generated by a monopolar source propagating through a two-dimensional elliptic vortex, fixed or convected by a uniform flow, is studied by solving the Linearized Euler Equations in Cartesian coordinates using the Discontinuous Galerkin Method. For a fixed vortex position, the number, amplitudes, and angular spreads of the acoustic interference beams resulting from the sound scattering are found to significantly depend on the orientation of the vortex major axis with respect to the direction of the incident waves and on the vortex maximum tangential velocity. In particular, additional interference beams are obtained at large observation angles for a more elliptical vortex. For a convected elliptic vortex, the interference beams are curved as the angle between the incident acoustic wave and the vortex major axis varies when the vortex travels in the downstream direction. As expected, the scattering of the acoustic waves leads to spectral broadening in this case. Moreover, the widths and the frequencies of the lateral lobes obtained in the spectra on both sides of the peak at the source frequency are different for elliptic and round vortices.

[Sensitivity of the sympathetic skin response and scintigraphy in the diagnosis of complex regional pain syndrome]. / Sensibilidad de la respuesta simpática cutánea y de la gammagrafía en el diagnóstico del síndrome dolor regional complejo.

OBJECTIVE: To evaluate the sensitivity of sympathetic skin response (SSR) and compare it with scintigraphy in patients with complex regional pain syndrome diagnosed according to the Budapest criteria. MATERIAL AND METHODS: Twenty-two patients with complex regional pain syndrome who attended the Rehabilitation and Physical Medicine Department between January-2018 and May-2022 have been prospectively evaluated. The scintigraphy was considered positive if in the 1st-2nd phase slight asymmetric and diffuse uptake was observed, or when in the 3rd phase marked periarticular radioisotope uptake was observed. SSR was abnormal if: a) no response after 20 stimuli; b) lack of habituation with permanence of the stimuli greater than 67.2%. RESULTS: Age 55.4±8.57 years. Complex regional pain syndrome was more frequent in women (90.9%), more common in upper limbs (68.2%) than lower limbs (31.8%). In SSR, we have observed normal response (<67.2%) in 2 patients (11.1%), lack of SSR in 2 patients (11.1%) and lack of habituation (>67.2%) in 14 patients (77.8%). In total, 16 patients presented abnormal or absent responses (88.8%). The diagnostic sensitivity of scintigraphy is similar to that of SSR (89.5% vs 88.8%), with no statistical difference (P=.6721). CONCLUSION: Scintigraphy has shown similar sensitivity to SSR, although the simplicity, security, low cost, non-ionizing and non-invasiveness of the latter technique suggest that it could be more cost-effective. The lack of habituation and the absence of response could identify response patterns and localize the involvement in the afferent, central, efferent or post-ganglionic pathways.

La estimulación transcutánea del nervio tibial posterior modifica la respuesta simpática cutánea y mejora el síndrome de vejiga hiperactiva: serie de casos y posible prueba diagnóstica / Transcutaneous stimulation of the posterior tibial nerve modifies the sympathetic skin response and improves overactive bladder syndrome: Case series and possible diagnostic test

Objetivo: a) Valorar el efecto de la neuromodulación transcutánea del nervio tibial posterior (NTTP) más biofeedback sobre la respuesta simpática cutánea (RSC). b) Evaluar su efecto sobre la sintomatología clínica. c) Considerar la RSC como una probable prueba neurofisiológica útil tanto para el diagnóstico como para el seguimiento en pacientes con vejiga hiperactiva (VH). d) Evaluar su coste comparado con otras técnicas. Material y métodos: Estudio prospectivo cuasi-experimental antes y después a 10 pacientes con VH. Variables de resultado: frecuencia miccional diurna (FMD) y nocturna (FMN), fuerza de los músculos del suelo pélvico medidos por manometría (presión máxima y media) y RSC. Resultados: La FMD mejoró de 10,3±5,45 a 5,9±2,42 episodios (p=0,0050). La FMN mejoró de 2,4±1,5 a 0,6±0,69 episodios (p=0,0012). La presión máxima varió de 34,7±16,51 a 39,7±3,65mmHg (p=0,0195). La presión media de los músculos de suelo pélvico mejoró de 6,6±3,65 a 9,3±5,43mmHg (p=0,0333). La RSC se modificó de una hiperexcitabilidad del 100% previo a tratamiento a un 50±14,14% (p=0,0000). Conclusión: La NTTP más biofeedback podrían modificar la RSC y mejorar la clínica y la manometría en una serie de pacientes con VH. Se reporta por primera vez la probable utilidad diagnóstica y pronóstica de esta prueba neurofisiológica en VH e hiperactividad del detrusor. Es necesario realizar un estudio con una muestra más amplia para poder confirmar los prometedores hallazgos observados en este estudio preliminar.(AU)

Objective: (a) To assess the effect of transcutaneous neuromodulation (TNM) of the posterior tibial nerve plus biofeedback on the sympathetic skin response (SSR). (b) Evaluate its effect on clinical symptoms. (c) Consider SSR as a probable neurophysiological test useful both for diagnosis and for follow-up in patients with overactive bladder (OAB). (d) Evaluate its cost compared to other techniques. Material and methods: A prospective quasi-experimental before and after study in 10 OAB patients. Outcome variables: daytime (DUF) and nighttime (NUF) urinary frequency, strength of the pelvic floor muscles measured by manometry (maximum and mean pressure) and sympathetic skin response (SSR). Results: DUF improved from 10.3±5.45 to 5.9±2.42 episodes (P=.0050). The NUF improved from 2.4±1.5 to 0.6±0.69 episodes (P=.0012). The maximum pressure ranged from 34.7±16.51 to 39.7±3.65mmHg (P=.0195). The mean pressure of the pelvic floor muscles improved from 6.6±3.65 to 9.3±5.43mmHg (P=.0333). SSR changed from 100% hyperexcitability prior to treatment to 50±14.14% (P=.0000). Conclusion: TNM plus biofeedback could modify SSR and improve clinical and manometry variables in a series of patients with OAB. The probable diagnostic and prognostic utility of this neurophysiological test in OAB and detrusor hyperactivity is reported for the first time. A larger sample study is needed to confirm the promising findings seen in this preliminary study.(AU)

[Transcutaneous stimulation of the posterior tibial nerve modifies the sympathetic skin response and improves overactive bladder syndrome: Case series and possible diagnostic test]. / La estimulación transcutánea del nervio tibial posterior modifica la respuesta simpática cutánea y mejora el síndrome de vejiga hiperactiva: serie de casos y posible prueba diagnóstica.

OBJECTIVE: (a) To assess the effect of transcutaneous neuromodulation (TNM) of the posterior tibial nerve plus biofeedback on the sympathetic skin response (SSR). (b) Evaluate its effect on clinical symptoms. (c) Consider SSR as a probable neurophysiological test useful both for diagnosis and for follow-up in patients with overactive bladder (OAB). (d) Evaluate its cost compared to other techniques. MATERIAL AND METHODS: A prospective quasi-experimental before and after study in 10 OAB patients. OUTCOME VARIABLES: daytime (DUF) and nighttime (NUF) urinary frequency, strength of the pelvic floor muscles measured by manometry (maximum and mean pressure) and sympathetic skin response (SSR). RESULTS: DUF improved from 10.3±5.45 to 5.9±2.42 episodes (P=.0050). The NUF improved from 2.4±1.5 to 0.6±0.69 episodes (P=.0012). The maximum pressure ranged from 34.7±16.51 to 39.7±3.65mmHg (P=.0195). The mean pressure of the pelvic floor muscles improved from 6.6±3.65 to 9.3±5.43mmHg (P=.0333). SSR changed from 100% hyperexcitability prior to treatment to 50±14.14% (P=.0000). CONCLUSION: TNM plus biofeedback could modify SSR and improve clinical and manometry variables in a series of patients with OAB. The probable diagnostic and prognostic utility of this neurophysiological test in OAB and detrusor hyperactivity is reported for the first time. A larger sample study is needed to confirm the promising findings seen in this preliminary study.

[Tarlov cyst and faecal incontinence: A case report and literature review]. / Quiste de Tarlov e incontinencia fecal: caso clínico y revisión de la literatura.

Tarlov, or perineural cysts, are lesions of the nerve root usually located at the sacral level of the spine. Their cause is unclear. These cysts are generally identified as an incidental finding and are usually asymptomatic. Symptomatic cysts are infrequent, with symptoms usually consisting of pain, radiculopathy and, less frequently, bladder, bowel and sexual dysfunction. We report the case of a 70-year-old woman with Tarlov cyst, provoking faecal incontinence, and review the aetiology, pathophysiology and management of this particular case.

Myofascial pain, widespread pressure hypersensitivity, and hyperalgesia in the face, neck, and shoulder regions, in survivors of head and neck cancer.

PURPOSE: Medical treatment for head and neck cancer may induce the presence of inflammation, pain, and dysfunction. The purpose of the current study was to assess the presence of myofascial trigger points (TrPs) and their relationship with widespread pressure hypersensitivity and hyperalgesia in survivors of head and neck cancer (sHNC). METHODS: TrPs and pressure-pain thresholds (PPTs) were quantified in different muscles/joints in the head and neck of 30 sHNC (59.45 ± 13.13 years) and 28 age- and sex-matched controls (58.11 ± 12.67 years). RESULTS: The sHNC had more TrPs in all muscles on the affected side (p < 0.05) than did the healthy controls, and in the temporalis, masseter, and suboccipitalis muscles on the unaffected side (p < 0.05). They also had lower PPTs in all places (p < 0.05) except for the temporalis muscle (p = 0.114) and C5-C6 joint (p = 0.977). The intensity of cervical pain correlated positively with the presence of upper trapezius TrPs. CONCLUSIONS: sHNC suffering cervical and/or temporomandibular joint pain have multiple active TrPs and experience widespread pressure hypersensitivity and hyperalgesia, suggestive of peripheral and central sensitization.

An open randomized active-controlled clinical trial with low-dose SKA cytokines versus DMARDs evaluating low disease activity maintenance in patients with rheumatoid arthritis.

BACKGROUND: Biologic agents are currently the strongest immunosuppressive drugs able to induce remission in rheumatoid arthritis (RA). One of the objectives of the medical scientific community now is how to maintain remission or low disease activity (LDA). The aim of this trial is to evaluate the contribution of low-dose sequential kinetic activation (SKA) IL-4, IL-10, and anti-IL-1 antibodies (10 fg/mL) in patients affected by RA in maintaining LDA or remission obtained after biological therapy. METHOD: This is a randomized, open, active-controlled, prospective, Phase IV trial. Disease activity score (DAS28), clinical disease activity index, simplified disease activity index, erythrocyte sedimentation rate and C-reactive protein levels, global health assessment, and pain visual analog scale were evaluated at baseline visit and then every 3 months together with an assessment of side effects till 12 months. Thirty-nine RA patients were enrolled and randomized to continue disease-modifying antirheumatic drugs (DMARDs) therapy or to receive a combination of SKA low-dose cytokines formulated in concentration of 10 fg/mL orally administered at a dose of 20 drops/d for 12 consecutive months. RESULTS: The rate of maintenance of LDA at 12 months was superior in the group treated with low-dose cytokines compared with patients treated with DMARDs, 66.7% and 42.1%, respectively; however, the difference between the groups was not statistically significant. No side effects were reported in both groups. CONCLUSION: This is the first study using a combination of three low-dose cytokines in RA, after data published on psoriasis. These data suggest that the use of a combination of low-dose SKA cytokines may be an opportunity to explore in the management of RA.

Somatostatin receptor scintigraphy in patients with rheumatoid arthritis and secondary Sjögren's syndrome treated with Infliximab: a pilot study.

BACKGROUND: Human T lymphocytes infiltrating tissues in autoimmune diseases are known to express somatostatin receptors amongst other activation markers. In this study, we evaluated whether somatostatin receptor scintigraphy (SRS) using a radiolabelled somatostatin analogue ((99m)Tc-EDDA/tricine-HYNIC-tyr(3)-octreotide ((99m)Tc-EDDA/HYNIC-TOC)) is able to detect the presence of immune-mediated processes in patients with rheumatoid arthritis and secondary Sjögren's syndrome. We also aimed to evaluate whether positivity to SRS was predictive of therapeutic response and if SRS could be used for monitoring the efficacy of immunomodulatory treatment. METHODS: Eighteen patients with rheumatoid arthritis and secondary Sjögren's syndrome not responding to conventional treatment were recruited for treatment with infliximab, a monoclonal antibody against TNF-α. All patients had complete blood cell count, renal and liver function tests, measurements of ESR, CRP, ANA, ENA, and anti-dsDNA antibodies, functional salivary gland scintigraphy, labial biopsy, and ophthalmologic assessment with Schirmer's test and tear film break-up time (BUT). Diagnosis was made according to the revised criteria of the American-European Consensus Group. All patients underwent SRS at baseline and after 3-6 months of therapy with infliximab. Eleven out of 18 had repeat SRS images. Images of the salivary glands and major joints were acquired 3 h after injection of 370 MBq of (99m)Tc-EDDA/HYNIC-TOC. Image analysis was performed semi-quantitatively. RESULTS: All patients showed uptake of (99m)Tc-EDDA/HYNIC-TOC in the joints. Salivary glands also showed variable radiopharmaceutical uptake in 12 out of 18 patients, but all patients showed presence of lymphocytic infiltration at labial salivary gland biopsy. All patients, who repeated the study after treatment, showed significant reduction of somatostatin uptake in the joints but not in the salivary glands. CONCLUSIONS: SRS using (99m)Tc-EDDA/HYNIC-TOC may be a useful imaging tool to assess disease activity and extent in patients with rheumatoid arthritis and may help to detect secondary Sjögren's syndrome. It may also aid therapy decision-making with anti-TNFα antibodies in the joints but not in salivary glands.

Do Patient Profiles Influence the Effects of Massage? A Controlled Clinical Trial.

Considerable scientific evidence has been published on the effectiveness of massage in different conditions, but it remains unclear whether this effectiveness is modulated by the profile of patients. The aim of this study was to compare the effects of a 21-min myofascial therapy protocol on stress responders and nonresponders stressed in the laboratory with a cold pressor test. Dependent variables included heart rate variability (HRV), blood pressure, and salivary markers such as flow rate, cortisol, immunoglobulin A (IgA), and α-amylase activity. A controlled, repeated measures, single-blind trial was conducted in 30 Caucasian students with a mean (SD) age of 20.70 (4.50) years. We found no significant between-group differences in descriptive characteristics or in any preintervention outcome measure. Analysis of covariance revealed significant increases in HRV index (F = 0.18, p = .01), salivary flow rate (F = 0.16, p = .02), and salivary IgA concentration (F = 4.36, p = .04) and significant decreases in the low-frequency domain (F = 0.18, p = .04) and LF-high-frequency ratio (F = 0.18, p = .01) in the stress responder group in comparison to the nonresponder group. In conclusion, a better response to massage was observed in stress responders than in nonresponders across various HRV parameters and salivary measures.

Calcificaciones serpiginosas en la filariasis mamaria: un descriptor no incluido en el sistema BI-RADS / Serpiginous calcifications in breast filariasis: A descriptor not included in the BI-RADS classification system

La filariasis es una enfermedad parasitaria causada por nemátodos, de curso benigno, endémica en algunas regiones tropicales, aunque las corrientes migratorias hacen que cada vez se vean más pacientes en nuestros centros. La muerte de los parásitos puede originar calcificaciones visibles en las mamografías con características específicas que no hay que confundir con otras enfermedades. Sin embargo, su aspecto no se recoge en los sistemas de clasificación de calcificaciones mamográficas más habituales (BI-RADS), lo que puede generar confusión. En este artículo planteamos la necesidad de actualizar estos sistemas de descripción, así como advertir del aspecto de estas calcificaciones para poder diagnosticarlas y no confundirlas con otras enfermedades (AU)

Filariasis is a parasitic disease with a benign course caused by nematodes. Filariasis is endemic in some tropical regions, and immigration has made it increasingly common in some centers in Spain. The death of the parasites can lead to calcifications that are visible in mammograms; these calcifications have specific characteristics and should not be confused with those arising in other diseases. However, the appearance of calcifications due to filariasis is not included in the most common systems used for the classification of calcifications on mammograms (BI-RADS), and this can lead to confusion. In this article, we discuss the need to update classification systems and warn radiologists about the appearance of these calcifications to ensure their correct diagnosis and avoid confusion with other diseases (AU)

[Serpiginous calcifications in breast filariasis: A descriptor not included in the BI-RADS classification system]. / Calcificaciones serpiginosas en la filariasis mamaria: un descriptor no incluido en el sistema BI-RADS.

Filariasis is a parasitic disease with a benign course caused by nematodes. Filariasis is endemic in some tropical regions, and immigration has made it increasingly common in some centers in Spain. The death of the parasites can lead to calcifications that are visible in mammograms; these calcifications have specific characteristics and should not be confused with those arising in other diseases. However, the appearance of calcifications due to filariasis is not included in the most common systems used for the classification of calcifications on mammograms (BI-RADS), and this can lead to confusion. In this article, we discuss the need to update classification systems and warn radiologists about the appearance of these calcifications to ensure their correct diagnosis and avoid confusion with other diseases.

Testosterone replacement therapy in hypogonadal men is associated with increased expression of LAMP-2 (CD107b) by circulating monocytes and dendritic cells.

BACKGROUND: Accumulated experimental data indicates that androgen therapy has effects on inflammation and protects from autoimmune disorders. Despite this, the in vivo effects of testosterone replacement therapy on human antigen-presenting cells-for example, monocytes and dendritic cells- remain unknown. OBJECTIVE, DESIGN AND PATIENTS: We monitored the effects of testosterone replacement therapy on the number and the functionality -as assessed by the expression of CD107b (lysosome-associated membrane protein 2, LAMP-2)- of resting and in vitro-stimulated peripheral blood (classical and nonclassical) monocytes and dendritic cells (myeloid and plasmacytoid) from hypogonadal men. RESULTS: Our results show that testosterone replacement therapy induces overexpression of CD107b by circulating monocytes and dendritic cells from hypogonadal men, both under resting (i.e. nonstimulated) conditions and after in vitro stimulation. CD107b overexpression mostly involved monocytes and in vitro stimulation with CpG oligodeoxynucleotides. Of note, a strong correlation was found between CD107b expression on monocytes and serum gonadotrophins levels. CONCLUSION: These results support the existence of an effect of testosterone therapy, and potentially also of gonadotrophins, on circulating antigen-presenting cells.

The influence of body mass index on the functional prognosis of patients with hip fracture.

BACKGROUNDS AND AIMS: To examine the contribution of patient body mass index to functional status, physical independence and emotional distress in various age groups (third and fourth age) of female hip-fracture patients. METHODS: A sample of 123 older females (>65 years) admitted in a major regional hospital with a diagnosis of hip fracture participated in this cross-sectional study. The outcome measures used in this study were body mass index (BMI), the Modified Barthel Index, the Goldberg General Health Questionnaire, the Tinetti Mobility Test and a survey collecting data from participants 24-72 h after admission. For our analysis, patients were divided into two groups according to their age: <80 years (third age) and >81 years (fourth age). In addition, three groups were made according to patients' body mass index <24 h prior to surgery: a normal weight group, an overweight group and an obese group. An ANCOVA was performed with age group as a between-subjects variable (third age, fourth age) and gender, educational level, marital status, type of fracture, type of surgery, presence of other fractures and BMI as covariates. RESULTS: Patients in the third-age group obtained significantly higher values in the Barthel Index (P = 0.040) and the Tinetti Mobility Test (P = 0.001) and lower values in the Goldberg General Health Questionnaire (P = 0.035) compared to the fourth-age group. When BMI was considered, significance was maintained only in the Tinetti Mobility Test. CONCLUSIONS: The BMI could be a relevant mediator of the relationship between functional decline and the aging process in the transition between third to fourth age in females.

[Risk factors for metabolic syndrome in a population with sleep apnea; evaluation in a population of Granada; the Granada study]. / Factores de riesgo para el síndrome metabólico en una población con apnea del sueño; evaluación en un grupo de pacientes de Granada y provincia; estudio GRANADA.

INTRODUCTION: The Metabolic Syndrome is one of the first health problems in the public health of the century. It's consider that the beginning of the syndrome is determined by numerous factors that developed two main metabolic disturbances: the insulin resistance and the central obesity. This relationship is concentrating the scientific world. As the cause-effect relationship has to be answered, the epidemiologic research has focused on without results. MATERIAL AND METHODS: 1,016 subjects were recruited in the sleep disorders laboratory in San Cecilio Hospital with sleep apnea suspicion. RESULTS: Significant correlation (p < 0,001) was found between sleep apnea severity and nocturnal saturation values and the different metabolic disturbances related to the metabolic syndrome (Hypertension, Diabetes and obesity). By the contrary, we doesn't found significant differences between No-Sleep apnea group and moderate sleep apnea group in the majority of the variables. CONCLUSIONS: Subjects with sleep apnea have significantly more possibilities to develop metabolic syndrome, and cardiovascular pathology. These subjects had to be evaluated in this sense to reduce the impact associated to this pathology.

Factores de riesgo para el síndrome metabólico en una población con apnea del sueño; evaluación en un grupo de pacientes de Granada y provincia; estudio GRANADA / Risk factors for metabolic syndrome in a population with sleep apnea; evaluation in a population of Granada; the Granada study

Introducción: El síndrome metabólico se está convirtiendo en uno de los principales problemas de salud pública del siglo XXI. Se considera que la aparición del síndrome metabólico está determinada por la interacción de factores genéticos, ambientales y nerviosos centrales (disfunción de los centros hipotalámicos de hambre y saciedad) que generan dos alteraciones metabólicas importantes: la resistencia a la acción de la insulina y la obesidad visceral. La relación de este síndrome, que concentra en la actualidad al mundo científico, con las alteraciones del sueño sigue siendo un punto sin esclarecer. Aunque se ha teorizado sobre la relación causa efecto, se desconoce aún su interrelación convirtiéndose su estudio en un objetivo primario de la investigación epidemiológica. Muestra y métodos: Se reclutaron 1016 sujetos que acudieron al servicio de Fisiología Respiratoria del Hospital Universitario "San Cecilio" de Granada (España) por sospecha de Apnea de Sueño. Resultados: Se encontró una correlación significativa (p < 0,001) entre los valores de apneas hipopneas y los valores de saturación de Oxigeno nocturna con las diferentes alteraciones metabólicas asociadas al síndrome metabólico (Hipertensión, Diabetes y Obesidad). Por el contrario, no se encontraron diferencias estadísticamente significativas test (t-Student) en la mayoría de las variables entre el grupo NO-Apnea y el grupo Apnea moderada. Conclusiones: Los sujetos con apnea de sueño poseen significativamente más riesgo de desarrollar síndrome metabólico, y por lo tanto de presentar patología cardiovascular. Estos sujetos deben ser evaluados en este sentido para reducir la morbimortalidad asociada a estas patologías (AU)

Introduction: The Metabolic Syndrome is one of the first health problems in the public health of the century. It's consider that the beginning of the syndrome is determined by numerous factors that developed two main metabolic disturbances: the insulin resistance and the central obesity. This relationship is concentrating the scientific world. As the cause-effect relationship has to be answered, the epidemiologic research has focused on without results. Material and methods: 1,016 subjects were recruited in the sleep disorders laboratory in San Cecilio Hospital with sleep apnea suspicion. Results: Significant correlation (p < 0,001) was found between sleep apnea severity and nocturnal saturation values and the different metabolic disturbances related to the metabolic syndrome (Hypertension, Diabetes and obesity). By the contrary, we doesn't found significant differences between No-Sleep apnea group and moderate sleep apnea group in the majority of the variables. Conclusions: Subjects with sleep apnea have significantly more possibilities to develop metabolic syndrome, and cardiovascular pathology. These subjects had to be evaluated in this sense to reduce the impact associated to this pathology (AU)

Progresión de la obesidad infantil en Tenerife / Children obesity progression in Tenerife Island

Introducción: En nuestra práctica asistencial hemos observado recientemente un aumento de la obesidad en la población infantil y un adelanto en su edad de aparición. Nuestro objetivo es comprobar estos fenómenos, identificando la edad de mayor riesgo de inicio de obesidad infantil y estudiar su asociación a otros factores, como el sexo y el peso al nacimiento. Material, pacientes y métodos: Se analizan las historias clínicas de todos los niños (n= 660), pertenecientes a tres cohortes, según el año de nacimiento (1989, 1997 y 2000), en tres centros de salud del área de Tenerife. El peso al nacimiento se expresó como z-score, se calculó el índice de masa corporal(IMC) anualmente a partir del año de edad y hasta los 8 años. La progresión del IMC se representa gráficamente con su valor medio anual, por sexos y cohortes. Las diferencias de evolución del IMC por sexos, intra/intercohortes, se obtienen mediante un modelo lineal general multivariante para medidas repetidas, usándose modelos ANOVA para diferenciar la edad a laque se separan las diferentes cohortes en relación con el IMC. El poder predictivo independiente del año de nacimiento, elz-score del peso al nacer y el sexo del recién nacido sobre el IMC a los 8 años de edad se valora con modelos de regresión lineal múltiple. El riesgo de estos tres factores en relación con la aparición de la obesidad a los 8 años de edad se evalúa mediante modelos de regresión logística binaria multivariable. Resultados: El año de nacimiento, el z-score del peso al nacer y el sexo muestran un poder predictivo sobre el IMC a los 8 años de edad, y el primero es el factor de mayor significación y el que supone un riesgo significativo para presentar obesidad a esta edad. La edad más probable de inicio de obesidad infantiles a los 4 años. Conclusiones: a) la edad de inicio de la obesidad se ha adelantado en nuestra población infantil; b) la obesidad se inicia, como promedio, a la edad de 4 años, aunque es mayor en los varones, y c) al menos hasta los 8 años de edad, un mayor peso al nacer se asocia a un aumento del IMC (AU)

Introduction and aim: We have perceived an increased frequency and earlier onset of child overweight and obesity. Our objetive is to prove this hypothesis by identifying the age of higher risk of child obesity onset and by studying its association to gender and birth weight. Material and methods: Birth weight was expressed as zscore and yearly Body Mass Index (BMI) from the first year to the age of eight were collected from all clinical records of 660children of three Primary Health Centers of Tenerife. Data were classified into three cohorts by their birth year (1989, 1997 and 2000). BMI progression plots were done by gender and cohort.BMI evolution by gender, so intra as among cohorts, has been tested using a multivariate generalized linear model for iterated measurements. ANOVA test was used to estimate at which age the cohorts show a different BMI. The independent predictive power of birth year, birth weight z-score and gender on BMI at the age of eight was evaluated using multiple linear regression models, whereas the influence of these variables on the risk of obesity at eight years old was evaluated using binary multivariable logistic regression models. Results: Birth year, birth weight z-score and gender show predictive power on BMI at eight years of age, being the former which implies as significant risk of obesity at that age. Obesity onset is more frequent at the age of four years. Conclusions: a) obesity onset occur at earlier age in our children; b) obesity begins at four years of age in average and is more frequent in boys, and c) a higher birth weight is associated with an increased BMI, at least until the age of eight(AU)

La función pulmonar, factores físicos que la determinan y su importancia para el fisioterapeuta / Pulmonary function. the physical factors that determine it and its importance for the physiotherapist

Introducción. El fisioterapeuta emplea, dentro de sus herramientas de valoración, aquellas destinadas a la medición de la función pulmonar. Todos los factores que afectan la función pulmonar deben ser conocidos de manera exhaustiva por el fisioterapeuta. Este trabajo pretende esclarecer aquellos factores, de carácter físico, que condicionan la función pulmonar. Objetivo. Revisar la bibliografía disponible que relacione los factores físicos que influyen en la función pulmonar. Estrategia de búsqueda. Revisión bibliográfica sistemática en las bases de datos: CINAHL, ScienceDirect, Ovid, Scopus y PubMed. Con antigüedad inferior a 25 años. Síntesis de resultados. Se obtuvo un número total de 90 artículos. Los autores han reconocido que entre los factores físicos de la función pulmonar se encuentran la edad, el sexo, la talla, el peso y el grupo étnico. A estos factores se han sumado en los últimos años, gracias a numerosos autores, los musculoesqueléticos, como la morfología de la caja torácica y el desarrollo muscular. Conclusiones. Los diferentes estudios asocian la edad, el sexo, la raza, el peso y la altura, y los factores musculoesqueléticos torácicos a la función pulmonar. Sin embargo, son necesarios más estudios que expliquen esta influencia (AU)

Introduction: Within their assessment tools, the physical therapist uses those designated for the measurement of lung function. Having extensive knowledge about the physical factors affecting normal lung function is important for the physical therapist. This paper aims to clarify those physical factors that condition pulmonary function. Aims: To review the bibliography available that relate the physical factors having an influence on pulmonary function. Search strategy: The search was made with the following databases: CINAHL, Ovid, Scopus, ScienceDirect and PubMed, with time antiquity limited to the last 25 years. Synthesis of results: A total of 90 articles were obtained from the search. The authors have stated that physical factors of pulmonary function include age, sex, height, weight and ethnic group. In recent year, many authors have also added musculoskeletal factors, morphology of the thoracic cavity and muscle development. Conclusions: The different studies associate age, sex, race, height and weight and thoracic musculoskeletal factors to pulmonary function. However, more studies are needed to explain this influence (AU)