Bloqueo ecoguiado del nervio supraescapular en la capsulitis adhesiva de hombro / Ultrasound-guided suprascapular nerve block in adhesive capsulitis of the shoulder

Introducción. Lo prioritario en la capsulitis adhesiva es controlar el dolor para mejorar la evolución y secuelas. Nuestro objetivo es valorar la efectividad del bloqueo ecoguiado en fases 1 y 2 y como tratamiento precoz. Material y métodos. Estudio cuasiexperimental de 41 pacientes con capsulitis y bloqueo ecoguiado del nervio supraescapular entre septiembre de 2012 y diciembre de 2013. Evaluamos Escala Visual Analógica, balance articular y QuickDash inicial, 1, 2 y 3 meses. Resultados. Trece hombres y 28 mujeres, edad media de 56,6 años, con capsulitis unilateral en el 85,4%. Los antecedentes más frecuentes son diabetes mellitus (43,9%) con una evolución más lenta estadísticamente significativa e hipertensión arterial (36,6%). Los tratamientos previos fueron analgesia oral (90,2%), cinesiterapia (78%) e infiltraciones (36,5%). Tras bloqueo el 41,5% fue alta, el 17,1% derivado a traumatología y un 31, 7% continúan en tratamiento con cinesiterapia (60,9%) e infiltración (14,63%). Solo un 9,7% fue derivado a la clínica del dolor por mala evolución. Encontramos una relación significativa entre el bloqueo precoz y evolución más rápida (r = 0,588). Existe mejoría estadísticamente significativa respecto a la Escala Visual Analógica inicial (P50 9) tanto en primer bloqueo (7,5) como en segundo (5); en QuickDASH con 73,3 inicial, 65,9 en primero y 63,6 en segundo; y balance articular en los cuatro rangos de movimiento. Conclusiones. Tanto dolor, funcionalidad como balance articular mejoran tras el bloqueo. Por lo que podemos plantearlo como opción inicial en el tratamiento de capsulitis. No obstante, aconsejamos la realización de nuevos estudios de mayor calidad con guía ecográfica para corroborar nuestros resultados (AU)

Introduction. The main goal in adhesive capsulitis is to control pain in order to iad recovery and minimize sequels. Our aim was to assess the effectiveness of ultrasound-guided nerve block in phases 1 and 2 and as early treatment of this condition. Material and methods. A non-randomized clinical trial was conducted in 41 patients with adhesive capsulitis and ultrasound-guided suprascapular nerve block between September 2012 and December 2013. We analyzed our results according to the visual analogue scale, articular range of motion, and QuickDASH at baseline and at 1, 2, and 3 months. Results. The study group comprised 13 men and 28 women, with a mean age of 56.6 years; 85.4% of them had unilateral capsulitis. The most common antecedents were diabetes mellitus (43.9%), which was statistically significantly associated with slower recovery, and hypertension (36.6%). Previous treatments were oral analgesia (90.2%), kinesitherapy (78%) and infiltration (36.5%). After the blockade, 41.5% recovered, 17.1% underwent surgery, and 31.7% continued kinesitherapy (60.9%) or infiltration (14.63%). Only 9.7% were referred to the pain clinic due to poor recovery. We found statistically significant differences between early nerve block and faster recovery (r = 0.588), and between the initial visual analogue scale (P509) and after the second nerve block (visual analogue scale = 5). The QuickDASH decreased from 73.3 at baseline, to 65.9 at the first block and 63.6 at the second. The four ranges of motion also showed significant differences. Conclusions. Pain, functionality and articular range of motion improved after nerve block, which could therefore be a suitable treatment for adhesive capsulitis. However, further and better-quality ultrasound-guided studies are needed to confirm our results (AU)

Análisis de las fracturas mandibulares causadas por accidentes laborales: estudio descriptivo retrospectivo / Analysis of mandibular fractures caused by work related accidents: retrospective descriptive study

El objetivo de este estudio fue evaluar la tendencia de los pacientes con fracturas mandibulares asociados a accidentes laborales. Se realizó un estudio descriptivo retrospectivo en todos los casos de fracturas mandibulares que asistieron al servicio de cirugía maxilofacial del Hospital Clínico Mutual de Seguridad C.Ch.C., Santiago de Chile en un periodo de 4 años (enero 2009 - diciembre 2012). Todas las fracturas mandibulares fueron consignadas. La información fue recopilada a través de revisión de fichas clínicas electrónicas. Entre los años 2009 al 2012 se presentaron un total de 74 pacientes incluidos en el estudio con 102 rasgos de fracturas mandibulares. La fractura más común fue la de cóndilo mandibular (35 pacientes). Se observó una tasa de complicaciones del 8%. Los resultados mostrados en este estudio están en línea con la literatura y el análisis de este reporte provee información para el diseño de planes de prevención de riesgos, especialmente para desarrollar medidas de protección facial. Nivel de Evidencia: Tipo II. Estudio descriptivo.

The objective of this study was to evaluate the tendency of patients with mandibular fractures associated with working accidents. A retrospective descriptive study was performed in all cases of mandibular fractures who attended the maxillofacial surgery service at the Clinical Hospital Mutual Seguridad C.CH.C. Santiago de Chile, in a 4-year period (January 2009 - December 2012). All mandibular fractures were recorded. The information was collected through review of electronic medical records. Between 2009 and 2012, 74 patients were included in the study with 102 lines of mandibular fractures. The most common fracture was the mandibular condyle (35 patients). The complication rate was 8%. The results shown in this study are in line with the literature and the analysis of this report provides information for the design of risk prevention plans, especially in developing measures of facial protection.

Prevalence of Toxoplasma gondii in dogs from Colombia, South America and genetic characterization of T. gondii isolates.

The prevalence of Toxoplasma gondii in 309 unwanted dogs from Bogotá, Colombia, South America was determined. Antibodies to T. gondii were assayed by the modified agglutination test (MAT) and found in 52 (16.8%) of 309 dogs with titers of 1:20 in 20, 1:40 in six, 1:80 in 17, 1:160 in three, 1:320 in three, 1:1280 or higher in three. Some organs obtained after necropsy of dogs (hearts, tongues and brains, either separately or pooled) were used in bioassays carried out in mice (37 samples, of which 20 were assayed with separate organs and 17 were assayed with pooled organs), cats (pooled organs from six) and pooled organs of two dogs both in mice and cat. Mice receiving dog tissues were examined for T. gondii infection. Feces of cats that received dog tissues were examined for oocyst shedding. In total, T. gondii was isolated from tissues of 20 dogs (16 by bioassays in mice, 3 by bioassay in cats and 1 by bioassay in mice and cat). All infected mice from 7 of 17 isolates bioassayed in this host died of toxoplasmosis during primary infection. Only 10 of the 20 dogs whose tissues were bioassayed separately induced infections in mice. Interestingly, dog organs varied in their capacity to induce T. gondii infection in mice, hearts and tongues producing more positive results than the brain. The 20 T. gondii isolates obtained from seropositive dogs were PCR-RFLP genotyped using polymorphisms at 10 nuclear markers including SAG1, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, a new SAG2 and an apicoplast marker Apico. Ten genotypes were revealed. These genotypes are different from the three predominant Types I, II and III lineages that are widely spread in North America and Europe. A new allele denoted u-3 at PK1 locus was identified in three isolates. This result supports previous findings that T. gondii population is highly diverse in Colombia.

Prevalence of Toxoplasma gondii in cats from Colombia, South America and genetic characterization of T. gondii isolates.

Cats are important in the epidemiology of Toxoplasma gondii infection because they are the only hosts that can excrete the environmentally-resistant oocysts. In the present study, prevalence of T. gondii was determined in serum, feces, and tissues of 170 unwanted cats from Colombia, South America. Antibodies to T. gondii were assayed by the modified agglutination test and found in 77 of 170 (45.2%) cats with titers of <1:5 in 93, 1:5 in eight, 1:10 in 17, 1:20 in 10, 1:40 in seven, 1:80 in four, 1:160 in eight, 1:320 in six, and 1:640 or higher in 17 cats. T. gondii oocysts were not found in feces of any cat as ascertained by bioassay in mice. Tissues (brain, heart, tongue) of 116 cats were bioassayed in mice or cats. T. gondii was isolated from tissues of 15 of the 42 cats with titers of 1:40 or higher and not from any of the 90 cats titers of 1:20 or lower. Of the 29 cats whose tissues were bioassayed individually, T. gondii was isolated from the tongues of nine, hearts of eight, and brains of five. Mice inoculated with tissues of 12 of 15 infected cats died of toxoplasmosis; with nine T. gondii isolates all infected mice died. Overall, 65 of 92 (70%) of T. gondii-infected mice died of toxoplasmosis. Genotyping of these 15 isolates using polymorphisms at the SAG1, SAG2, SAG3, BTUB, and GRA6 loci revealed that three isolates (TgCtCo1, 2, and 7) had Type I alleles and one isolate (TgCtCo8) had Type II allele at all five loci. Eleven isolates contained the combination of Type I and III alleles and were divided into three genotypes, with TgCtCo3,5,6,9,12,13 and 15 had alleles I, I, III, I and III, TgCtCo4,10,11 had alleles I, III, III, I and I, and TgCtCo14 had alleles I, III, III, III, and III, at loci SAG1, SAG2, SAG3, BTUB and GRA6, respectively. All infected mice from each group had identical genotype except one mouse infected with TgCtCo5 had a Type III allele at locus BTUB and a unique allele (u-1) at locus SAG1 indicating mixed infection for TgCtCo5, whereas the rest seven mice had a Type I alleles at both loci.