Efectividad del bloqueo de nervios cluneales para tratamiento de dolor lumbar crónico / Effectiveness of cluneal nerve block for the treatment of chronic low back pain

Introducción: El dolor lumbar representa una problemática de salud pública ante la discapacidad que genera, sea motora o sensitiva de etiología multifactorial, en la cual el atrapamiento de los nervios cluneales cumple un papel importante, encontrando como una alternativa al dolor por esta patología el manejo intervencionista. El objetivo principal del estudio fue establecer la efectividad del bloqueo de nervios cluneales en dolor lumbar crónico en pacientes mayores de 18 años de dos hospitales de Bogotá.Métodos: Estudio de tipo observacional, retrospectivo, realizado en pacientes diagnosticados con dolor lumbar crónico y signos y síntomas de atrapamiento de nervios cluneales o clunealgía llevados a bloqueo de nervios cluneales en quienes que se evaluó la intensidad del dolor y duración del efecto analgésico en cuatro momentos.Resultados: Se identificaron 45 pacientes; de estos, 11 no presentaban datos de seguimiento. El 93 % (n = 35) de los pacientes presentaron una EVA (escala visual análoga del dolor) mayor a 7 previo al procedimiento, el 28 % (n = 11) presentaron postbloqueo inmediato mejoría del dolor con una EVA menor a 6, en el primer control el 57 % (n = 22) conservaron la mejoría alcanzada, y el 10 % (n = 4) retornó a su estado basal de dolor. En el segundo, el 10 % (n = 4) de los pacientes no presentaron cambios en la intensidad, y el 78,9 % (n = 30) conservaba mejoría en la intensidad del dolor.Conclusiones: El bloqueo de los nervios cluneales es una alternativa vanguardista de manejo transitorio del dolor lumbar crónico que permitirá seleccionar con mayor objetividad los pacientes candidatos a intervencionismo guiado por fluoroscopia. Se propone la realización de estudios mediante estudios tipo III como los ensayos aleatorizados con grupos donde se administre placebo versus mezclas analgésicas en pacientes con clunealgia.(AU)

Introduction: Low back pain represents a public health problem due to the disability it generates, whether motor or sensory, of multifactorial etiology, in which cluneal nerve entrapment plays an important role, finding an alternative to pain from this pathology. interventional management. The main objective of the study was to establish the efficacy of cluneal nerve block in chronic low back pain in patients older than 18 years from two hospitals in Bogotá.Methods: Observational, retrospective study, carried out in patients diagnosed with chronic low back pain and signs and symptoms of cluneal nerve entrapment or clunealgia leading to cluneal nerve block in whom pain intensity and duration of the analgesic effect were evaluated in four moments.Results: 45 patients were identified; of these, 11 did not present follow-up data. 93 % (n = 35) of the patients presented a VAS (visual analogue pain scale) greater than 7 prior to the procedure, 28 % (n = 11) presented immediate post-block pain improvement with a VAS less than 6, 57 % at the first control (n = 22) maintained the improvement achieved, and 10 % (n = 4) returned to their baseline state of pain. In the second, 10 % (n = 4) of the patients did not show changes in intensity, and 78.9 % (n = 30) maintained improvement in pain intensity.Conclusions: Cluneal nerve blocks are an avant-garde alternative for the temporary management of chronic low back pain that will make it possible to more objectively select patients who are candidates for fluoroscopy-guided intervention. Studies are proposed using type III studies such as randomized trials with groups where placebo is administered versus analgesic mixtures in patients with clunealgia.(AU)

Planetary ball-mill as a versatile tool to controlled potato starch modification to broaden its industrial applications.

Pure potato starch has been modified by high-energy-ball-milling as a function of energy supplied, aiming to obtain products for different possibilities of industrial application. Burgios's equation has been used to calculate the energy supplied. The effect of the milling has been followed by a characterization of the starch morphology, crystallinity, solubility, swelling, retrogradation, viscosity, apparent viscosity, functional groups, and reducing sugar concentration. The high-energy-ball-milling not only changes the physical properties but also induces the mechanolysis of potato starch, breaking the glycosidic linkages of the starch molecules. A representation of the possible mechanism of starch mechanolysis is proposed. Three stages of the transformation of potato starch through high-energy ball-milling can be identified. Each of these stages generates starch with properties that can be used in different industrial applications.

Intrathecal administration of autologous bone marrow stromal cells improves neuropathic pain in patients with spinal cord injury.

Neuropathic pain (NP) is highly disabling, responds poorly to pharmacological treatment, and represents a significant cause of decreased quality of life in patients suffering from spinal cord injury (SCI). In recent years, cell therapy with autologous mesenchymal stromal cells (MSCs) has been considered as a potential therapeutic weapon in this entity. Ten patients suffering chronic SCI received 100 million MSCs into subarachnoid space by lumbar puncture (month 1 of the study) and this procedure was repeated at months 4 and 7 until reaching a total doses of 300 million MSCs. Intensity of NP was measured by standard numerical rating scale (VAS) from 0 to 10, recording scores previous to the first MSCs administration and monthly, until month 10 of follow-up. Months 1, 4, 7 and 10 of the study were selected as time points in order to a statistical analysis by the nonparametric Wilcoxon rank test. Our results showed significant and progressive improvement in NP intensity after the first administration of MSCs (p: 0.003). This study supports the benefit of intrathecal administration of autologous MSCs for the treatment of NP in patients with SCI.

Diabetes susceptibility in Mayas: Evidence for the involvement of polymorphisms in HHEX, HNF4α, KCNJ11, PPARγ, CDKN2A/2B, SLC30A8, CDC123/CAMK1D, TCF7L2, ABCA1 and SLC16A11 genes.

Association of type 2 diabetes (T2D) with common variants in HHEX, HNF4α, KCNJ11, PPARγ, CDKN2A/2B, SLC30A8, CDC123/CAMK1D, TCF7L2, ABCA1 and SLC16A11 genes have been reported, mainly in populations of European and Asian ancestry and to a lesser extent in Latin Americans. Thus, we aimed to investigate the contribution of rs1111875 (HHEX), rs1800961 (HNF4α), rs5219 (KCNJ11), rs1801282 (PPARγ), rs10811661 (CDKN2A/2B), rs13266634 (SLC30A8), rs12779790 (CDC123/CAMK1D), rs7903146 (TCF7L2), rs9282541 (ABCA1) and rs13342692 (SLC16A11) polymorphisms in the genetic background of Maya population to associate their susceptibility to develop T2D. This is one of the first studies designed specifically to investigate the inherited component of T2D in the indigenous population of Mexico. SNPs were genotyped by allelic discrimination method in 575 unrelated Maya individuals. Two SNPs rs10811661 and rs928254 were significantly associated with T2D after adjusting for BMI; rs10811661 in a recessive and rs9282541 in a dominant model. Additionally, we found phenotypical alterations associated with genetic variants: HDL to rs9282541 and insulin to rs13342692. In conclusion, these findings support an association of genetic polymorphisms to develop T2D in Maya population.

Discapacidad grave tras daño cerebral traumático: posibilidades terapéuticas de la administración subaracnoidea de células estromales / Severe disability after traumatic brain injury: therapeutic posibilities of subarachnoid administration of stromal cells

Objetivo: Estudiar el efecto terapéutico de la administración de células madre mesenquimales (CMM) para tratar secuelas neurológicas crónicas producidas tras una lesión cerebral. Material y método: En 20 ratas Wistar adultas y dos meses después de una lesión cerebral traumática, se realizó la administración subaracnoidea de CMM o suero. Se valoró la respuesta funcional de los animales y se hizo un análisis histológico del tejido cerebral. Resultados: No se obtuvieron mejoras significativas en la respuesta funcional de animales con CMM. Se localizaron CMM dentro del tejido cerebral, obteniéndose diferencias estadísticamente significativas en el tamaño de la lesión pero no en la expresión de marcadores neurales. Conclusión: El tratamiento subaracnoideo con CMM no tiene efecto en la respuesta neurológica de animales lesionados, aunque las células migraron y se integraron en el tejido cerebral, afectando a la morfología del mismo (AU)

Objective: To study the therapeutic effect of administration of mesenchymal stem cells (MSCs) to treat chronic neurological sequelae produced after traumatic brain injury (TBI). Material and method: In 20 adult Wistar rats and two months after TBI, subarachnoid administration of CMM or saline were performed. Functional response of the animals was assessed and a histological analysis of brain tissue was conducted. Results: There was no significant improvement in the functional response in animals with MSCs. MSCs were located within the brain tissue obtained statistically significant difference in lesion size but not in the expression of neural markers. Conclusion: Subarachnoid treatment with MSCs has no effect on neurological response of injured animals, although the cells migrated and integrated into the brain tissue affecting their morphology (AU)

Influencia del grado de lesión neurológica sobre la eficacia de la terapia celular en un modelo de traumatismo craneoencefálico grave / Influence of the level of neurological deficit on the efficacy of cell therapy in a model of severe traumatic brain injury

Objetivo: Determinar si el nivel de déficit neurológico influye en la eficacia de la terapia celular con células madre mesenquimales (CMM) de la médula ósea en un modelo experimental crónico de lesión cerebral traumática. Material y métodos: Se sometió a ratas Wistar adultas a un modelo de lesión cerebral traumática. Dos meses después, se clasificaron en función de su nivel de déficit neurológico mediante dos tests funcionales: Escala de valoración sensitivo-motora y Tiempo de permanencia en la zona interior (Video-Tracking-Box test, VTB test). Se inyectó suero salino solo o CMM en suero salino en el tejido cerebral dañado de los animales que obtuvieron la clasificación neurológica de lesión moderada o grave según el nivel permanente de su déficit funcional. Todos los animales se evaluaron durante los dos meses siguientes para determinar la posible eficacia de la administración de las CMM. Al finalizar el estudio, los animales se eutanasiaron y se estudiaron sus cerebros. Resultados: Se constata una recuperación funcional significativa en los animales con lesión moderada que recibieron las CMM, pero no en los animales con lesión grave cuando se compara con los controles. Conclusiones: Las conclusiones obtenidas sugieren que la gravedad de la lesión neurológica puede influir en la potencial eficacia de la terapia celular cuando es aplicada en una lesión cerebral traumática crónica (AU)

bjective: To study if the level of neurological deficit influences the efficacy of cell therapy with bone marrow stromal cells (BMSC), in an experimental model of chronic traumatic brain injury (TBI). Material and methods: Adult Wistar rats were subjected to a model of traumatic brain injury. Two months later they were classified according to their level of neurological deficit. For that, two functional tests: Scale of sensory- motor assessment and time spent in the inner zone in the Video-Tracking-Box test, were used. Saline alone or BMSC in saline was injected into the damaged brain tissue of animals suffering a permanent level of functional deficit classified as moderate or severe. All experimental groups were evaluated during the next two months to determine the potential effectiveness of the intracerebral administration of BMSC. At the end of the study animals were euthanized and their brains were studied. Results: The results show a significant functional recovery in animals with moderate injury who received BMSC, but there was no significant recovery in animals with severe traumatic brain injury when compared with controls. Conclusion: The severity of neurologic injury may influence the potential efficacy of cell therapy applied to chronic TBI (AU)

Neurogénesis endógena tras el daño cerebral traumático y su modulación mediante terapia celular / Endogenous neurogenesis after traumatic brain injury and its modulation by cell therapy

Objetivo: Estudiar la neurogénesis inducida por una lesión traumática cerebral y su modulación mediante terapia celular. Material y métodos: Se realizó un modelo de lesión cerebral traumática en ratas Wistar adultas causando un daño cerebral grave. Transcurridos dos meses de la lesión, se administraron intralesionalmente células madre estromales (CME) alogénicas obtenidas de médula ósea, o suero fisiológico. Se estudió histológicamente la zona subventricular (ZSV) de cada animal al objeto de valorar la neurogénesis endógena espontánea tras la lesión y su posible modificación por la administración intracerebral de CME. Igualmente, se valoró la modificación de los déficit funcionales tras el tratamiento. Resultados: Se detectó un aumento en la neurogénesis endógena en el grupo tratado con CME respecto del control. Este hallazgo estuvo asociado a una progresiva mejoría en la respuesta motora y sensorial en el grupo de animales que recibieron CME comparado con el grupo de animales control. Conclusiones: La eficacia de la terapia celular para revertir los déficit funcionales secundarios a una lesión traumática cerebral parece correlacionarse con un incremento de la neurogénesis endógena a nivel de la SVZ (AU)

Objective: To study the neurogenesis induced by traumatic brain injury and its modulation by cell therapy. Material and methods: We performed a model of traumatic brain injury in adult Wistar rats, causing severe brain damage. After 2 months of injury, allogeneic bone marrow stromal cells (BMSC) or saline were administered intralesionally. We studied histologically the subventricular zone (SVZ) of each animal, in order to assess endogenous neurogenesis after traumatic brain injury and its possible modulation by intracerebral administration of BMSC. Furthermore, we studied the modification of neurological deficits after BMSC administration. Results: We detected a rise in endogenous neurogenesis in the group treated with BMSC with respect to the control. This finding was associated with a progressive improvement in motor and sensory response in the group of animals that received BMSC compared with control animals. Conclusion: The efficacy of cell therapy using BMSC appears to correlate with an increase of endogenous neurogenesis at SVZ level (AU)

Endogenous neurogenesis after intracerebral hemorrhage.

Currently, it is accepted that brain injury promotes endogenous neurogenesis in mammals, primarily in the subventricular zone (SVZ), and newborn cells can migrate to the injured area. We examined the pattern of endogenous neurogenesis in adult rats after intracerebral hemorrhage (ICH) that was caused by intrastrial administration of collagenase type IV. Our results showed that ICH induced strong endogenous neurogenesis between 72 hours and 7 days after injury, but that the majority of newborn cells did not survive longer than 3 weeks due to apoptosis-mediated cell death. Furthermore, endogenous neurogenesis remained into a small extent at least 1 year after ICH. Because of the growing interest in new strategies for brain regeneration, these data suggest endogenous neurogenesis and inhibiting apoptosis of newborn neuroblasts as potential strategies to improve the consequences of hemorrhagic stroke in humans.

[Study of oxidative stress in advanced kidney disease]. / Estudio del estrés oxidativo en enfermedad renal avanzada.

INTRODUCTION: Introduction Patients with Chronic renal Disease (CRD) often have cardiovascular disease that is the main cause of morbidity and mortality. Oxidative stress and a subclinical inflammation are crucial factors in its development. The aim of this study was to asses the oxidation of the main molecular lines in patients with advanced renal disease without dialysis and to determinate the best biomarker to asses this stress. PATIENTS AND METHODS: We performed an observational study to measure the most important oxidative biomarkers in 32 patients with stage 4 CRD (MDRD = 22.1 +/- 1.08 ml/min) compared with the values obtained in a control group. In peripheral lymphocytes we measured, the lipid peroxidation by Malondialdehyde (MDA) and F2 Isoprostanes in plasma; protein oxidation by glutathione oxidized/reduced ratio (GSSG/GSH) in peripheral lymphocytes and protein carbonyls in plasma and the oxidative damage in genetic material by modified nucleotide base 8-deoxiguanosina oxo -(8-oxo-dG), after isolating nuclear and mitochondrial DNA. We also studied the antioxidant defenses with superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GSR) and catalase (CAT) in peripheral lymphocytes. We studied the correlation between oxidative stress and the renal function and oxidative stress and co-morbidity factors. RESULTS: All biomarkers showed important differences in comparison with the control subjects. 821.89 +/- 300.47 ng/ml vs. 270 (95.66) * ng/ml (p < 0.000), MDA 0.11 (0.11) * vs. 0.7 +/- 0.31 nmol/mg prot (p <0.000). GSSG / GSH: 6.89 +/- 1.91 vs. 1.39 +/- 0.75 (p <0.000), protein carbonyls: 7.41 +/- 0.84 vs. 3.63 (1.12) *. Nuclear 8-oxo-dG 7.88 (2.32) vs. 2.96 (1.78) * mitochondrial 8-oxo-dG: 15.73 +/- 2.28 vs. 13.85 +/- 1.44 (p <0.05). The Antioxidant enzymes also showed differences. Nuclear 8-oxo-dG demonstrated an important relationship with the rest of biomarkers, homocysteine (r = 0.305, p <0.05), lipoprotein (a) (r = 0.375, p <0.01), mitochondrial 8-oxo-dG (r = 0.411, p <0.05), GSSH/GSH (r = 0.595, p <0.001) and protein carbonyls (r = 0.489, p <0.05). There was an inverse correlation with total protein (r = -0.247, p <0.01), GSH (r = -0.648, p <0.000), GSR (r = -0.563, p <0.001) and SOD (r = -0.497, p <0.000). We did not find any correlation between these parameters and renal function. The presence of diabetes or the treatment with statins did not showed significant differences. * Median (Interquartile range). CONCLUSION: There is an important oxidative stress in patients with advanced renal disease, probably established during early stages of disease. Of the studied parameters, the nuclear 8-oxo-dG is the best marker for oxidative stress in CRD.

[Hypokalemic metabolic alkalosis: apropos of a case of Gitelman's syndrome]. / Alcalosis metabólica hipopotasémica: a propósito de un síndrome de Gitelman.

We present a case of Gitelman's Syndrome in a 20 year-old woman who came to our service with weakness, asthenia, leg cramps and tetany. Laboratory studies revealed metabolic alkalosis with hypokalemia, hypomagnesemia and low calcium in a 24-hour urine test. The diagnosis of this syndrome is made in some cases during adult life because this syndrome is asymptomatic over several years. Gitelman's Syndrome is autosomal recessive as is Bartter's Syndrome. The gene is located in chromosome 16q, which encodes the cotransporter Na/Cl sensitive to thiazide in the distal convoluted tubule. The defect of cotransporter produces an alteration of sodium reabsorption that causes electrolytic disorders typical of this Syndrome and different from Bartter's Syndrome. The typical electrolytic alterations are hypocalciuria and hypomagnesemia secondary to high urinary magnesium excretion. The prognosis of this syndrome is excellent and treatment consists in correction of serum electrolytes with oral administration of magnesium and potassium. In spite of this treatment, in some cases it is very difficult to reach normal serum levels of magnesium because of the high doses of oral magnesium, which produce common crises of diarrhea that increase magnesium gastrointestinal losses.

Extended follow-up of anti-HBe-positive patients with chronic hepatitis B retreated with ribavirin and interferon-alpha.

In a pilot study of combination therapy with ribavirin and IFN alpha conducted in anti-HBe-positive individuals with chronic hepatitis B, 21% of patients achieved a sustained ALT normalization and clearance of hepatitis B virus (HBV) DNA as measured by PCR. The present work has assessed whether these sustained responses are lasting long-term. In addition, IFN gamma levels were tested serially in serum as a measure of the immune system activation during treatment. By extending the post-treatment follow-up period 2 years the occurrence of delayed HBV DNA relapses was observed. A low serum level of IFN gamma was detected during and after treatment. IFN gamma demonstrated a multiphasic time-course: the amount of IFN gamma increased in parallel with reductions in HBV DNA but also with ALT flare-ups. In conclusion, the extended follow-up study of anti-HBe-positive patients after combined treatment with ribavirin and IFN alpha has shown that sustained responses are lasting in 17% patients but also that a late onset HBV DNA relapse may occur.

Hepatitis B virus-specific T-cell proliferation and cytokine secretion in chronic hepatitis B e antibody-positive patients treated with ribavirin and interferon alpha.

Immune elimination of hepatitis B virus (HBV) during antiviral therapy depends on the activation of T-cell responses, which are generally impaired in chronic hepatitis B. HBV-specific T helper (Th)-cell reactivity has been assessed post-treatment in liver and peripheral blood of 18 anti-HBe-positive patients with chronic hepatitis B administered combined ribavirin/interferon alfa (IFN-alpha) therapy. The results showed that patients with undetectable HBV DNA by quantitative polymerase chain reaction under combination therapy were able to mount an HBV-specific CD4(+) Th-cell proliferative response and such T-cell reactivity is detectable 1 year after HBV DNA clearance. Hepatitis B virus core (HBcAg) and e (HBeAg) antigen-specific Th-cell proliferation was found more frequently in the liver and peripheral blood in those patients who sustained the alanine aminotransferase (ALT) normalization together with HBV DNA loss. However, HBV-specific IFN-gamma production in vitro in peripheral blood mononuclear cells augmented in 4 of 5 sustained responders and all 13 nonresponders, interleukin 10 (IL-10) production decreased in all 5 sustained responders but increased in 7 of 13 nonresponders. Furthermore, intrahepatic HBcAg plus HBeAg-specific Th-cell proliferation only occurred in sustained responders (2 of 3, 67%, vs. 0 of 9; P =.045) whose cells showed in vitro significantly increased productions in HBcAg/HBeAg-specific IFN-gamma and IL-12 compared with nonresponders in whom IFN-gamma and IL-12 productions decreased together with increased IL-10 secretion. In conclusion this study indicates that combined therapy with ribavirin and IFN-alpha for chronic hepatitis B not only significantly reduces viremia levels but also induces lasting CD4(+) T-cell proliferation and Th1 cytokine release at the site of infection, which may lead to sustained eradication of the HBV.

Evaluación de tramadol como un opioide alternativo a la codeína en el segundo peldaño de la escalera analgésica de la oms / Assessment of tramadol as an alter native opioid instead of codeine at the second step of the W H O analgesic scale

Objetivos: Evaluar la equivalencia clínica entre tramadol y codeína ( f á rmaco de re f e rencia del segundo peldaño de la escala del dolor de la OMS) en relación a eficacia, seguridad y preferencia de los pacientes.Materiales y método: Estudio cruzado randomizado y doble ciego. Se incluyeron 60 pacientes portadores de dolor oncológico. Se administró codeína (Co) y tramadol (Tra) en dosis equivalentes (tituladas individualmente). La eficacia analgésica se midió por EVA y la seguridad por la incidencia de náusea, vómito, trastornos del sueño, constipación y cambios de ánimo.Por último se evaluó la pre f e rencia de los pacientes por una de las drogas. Se utilizaron la pruebas de Wilcoxon y Chi cuadrado para los datos no paramétricos y la prueba t de Student para los datos paramétricos.Resultados: Se analizaron un total de 44 pacientes (23 secuencia Tra-Co y 21 secuencia Co-Tra). Las características basales de ambos grupos eran comparables. La intensidad inicial del dolor (EVA) en el grupo Tra-Co fue de 6,2ñ2,6 y en el grupo Co-Tra fue de 6,6ñ2,5. Las dosis medias máximas utilizadas de tramadol fueron 68,25ñ24,2 mg y de codeína 48,8+15,5 mg cada 6 horas. Ambas drogas tuvieron una efectividad similar en el control del dolor en ambos periodos: 1.º Tra 4,1ñ2,5 y Co 3,4ñ2,2; 2.º Tra 2,3ñ2,9 y Co 2,3ñ1,8. La incidencia de efectos adversos y el uso de laxantes y antieméticos no fue estadísticamente diferente en ambos grupos, La pre f e rencia de los pacientes fue igual para ambas drogas .Conclusiones: Tramadol y codeína resultaron igualmente eficaces en el control del dolor oncológico sin diferencias en los eventos adversos, siendo ambas drogas igualmente preferidas por los pacientes. Este resultado apoya la equivalencia clínica entre tramadol y codeína en el segundo peldano de la escala del dolor de la OMS para el manejo del dolor oncológico (AU)