[Diagnosis and pharmacological and nonpharmacological treatment of fibromyalgia. Compendium of the best evidence]. / Diagnóstico y tratamiento farmacológico y no farmacológico de la fibromialgia. Síntesis de la mejor evidencia.

Chronic generalized musculoskeletal pain is one of the most common reasons for consultation in daily medical practice, and it poses a diagnostic and therapeutic challenge. Fibromyalgia is one of the so-called central sensitization syndromes, mainly characterized by generalized pain in the musculoskeletal system. Fibromyalgia diagnosis is basically clinical, and it should be considered whenever patients complain of generalized pain. Patients with chronic inflammatory diseases may also suffer from fibromyalgia, and this condition may be the reason for the pain they complain of in medical consultations. The aim of this review paper has been to provide our readers with a summary of the best available evidence about this disease based upon an updated review of scientific literature on fibromyalgia aspects, such as its diagnostic criteria, pathophysiology, clinical profile and differential diagnosis, followed by an ample systematic review of its pharmacological and non-pharmacological aspects. This systematic review analyses the multidisciplinary aspects in which sufficient evidence was found in the two strongest types of clinical research design, 1) controlled clinical trials and 2) systematic reviews or meta-analysis. This review was developed by a group of Latin American specialists from several countries, recognized as a group of experts in fibromyalgia study.

[Digestive involvement in progressive systemic sclerosis]. / Compromiso digestivo en esclerosis sistémica progresiva.

We studied 14 patients with PSS, 12 females and 2 males with a mean age of 43.6 and a medium of 8 years disease. All of the patients were selected for this study according to updated ARA criteria and were included in a prospective protocol to investigate digestive involvement. This protocol consists of a complete medical history, physical examination, radiologic and endoscopic studies, parasitological and microbial flora investigation. The symptoms more frequently seen were: pyrosis (78%), gastroesophageal regurgitation (50%), flatulence (50%), dysphagia (42%) and chronic diarrhea (21%). The radiologic findings commonly seen were: distal esophageal aperistalsis (78%), gastroesophageal reflux (57%), dilatation of intestinal loops (35%), changes of the mucosal folds (35%). A mild esophagitis was seen endoscopically in 64% of the patients, moderate and severe in 7% respectively. The study of the microbial flora showed contaminations with enterobacteria in 5 patients (35%). After statistical analysis we concluded that the digestive compromise by PSS is frequent, being the esophagus more commonly affected (80%), at the beginning in the form of reflux esophagitis and later in esophageal stenosis, the compromise of the small intestine (40%) is manifested by chronic diarrhea or dyspeptic flatulence, which correlates well the radiologic findings and the bacterial overgrowth in this organ. The colonic compromise generally is asymptomatic, and the common finding is dilatation os the colonic loops. Finally, the bacterial overgrowth in the small intestine is a secondary involvement to the intestinal compromise of Progressive Systemic Sclerosis.

[Microflora of the upper part of the small bowel in healthy Peruvian subjects]. / Microflora de la parte alta del intestino delgado en peruanos sanos.

In 20 healthy Peruvians aerobic cultures were done of upper small bowel contents, obtained following the method of the string capsule or Enterotest, and of faringeal material, obtained doing gargles with sterilized water. In 15 (75%) of the 20 subjects cultures of small bowel contents either were sterile (in 5 subjects, or 25% of the total) or revealed only diverse aerobic germs (in 10 subjects, or 50% of the total), the germs more frequently found being: negative coagulase staphylococcus albus (in 7 subjects, or 35% of the total), alpha hemolytic streptococcus (in 4 subjects, or 20% of the total) and Neisseria catarrhalis (in 4 subjects, or 20% of the total). In 5 (25%) of the 20 subjects, coliform bacteria were found in the upper small bowel (Klebsiella pneumonia in 2, and Escherichia coli in the remaining 3). Of those 5 subjects, only 2 (10% or the total of 20) had the microorganisms exclusively in the bowel, and in both the concentration of germs was 10(4)/ml. On the contrary, the 3 remaining subjects (15% of the total) had coliforms also in the pharynx; in 2 of the 3 subjects the concentration of germs found in the bowel was 10(3)/ml, and, in the remaining one, 10/ml; only one of the 3 subjects presented germs in the pharynx in a greater concentration than in the bowel, while another presented germs in the same concentration in both localizations, and the remaining one presented germs in the bowel in a concentration lower than in the pharynx.(ABSTRACT TRUNCATED AT 250 WORDS)

Microflora de la parte alta del intestino delgado en peruanos sanos. / [Microflora of the upper part of the small bowel in healthy Peruvian subjects]

In 20 healthy Peruvians aerobic cultures were done of upper small bowel contents, obtained following the method of the string capsule or Enterotest, and of faringeal material, obtained doing gargles with sterilized water. In 15 (75

) of the 20 subjects cultures of small bowel contents either were sterile (in 5 subjects, or 25

of the total) or revealed only diverse aerobic germs (in 10 subjects, or 50

of the total), the germs more frequently found being: negative coagulase staphylococcus albus (in 7 subjects, or 35

of the total), alpha hemolytic streptococcus (in 4 subjects, or 20

of the total) and Neisseria catarrhalis (in 4 subjects, or 20

of the total). In 5 (25

) of the 20 subjects, coliform bacteria were found in the upper small bowel (Klebsiella pneumonia in 2, and Escherichia coli in the remaining 3). Of those 5 subjects, only 2 (10

or the total of 20) had the microorganisms exclusively in the bowel, and in both the concentration of germs was 10(4)/ml. On the contrary, the 3 remaining subjects (15

of the total) had coliforms also in the pharynx; in 2 of the 3 subjects the concentration of germs found in the bowel was 10(3)/ml, and, in the remaining one, 10/ml; only one of the 3 subjects presented germs in the pharynx in a greater concentration than in the bowel, while another presented germs in the same concentration in both localizations, and the remaining one presented germs in the bowel in a concentration lower than in the pharynx.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study of 2 methods of measuring intestinal transit time]. / Estudio comparativo de dos métodos de medición de la velocidad del tránsito intestinal.

In 20 healthy volunteers, intestinal transit times, obtained following a simple method, recently described, in which a small liquid-containing rubber bag is used as a marker, were compared with the times obtained following, simultaneously, another method, already universally accepted, in which small barium-impregnated pellets are used as markers. The intestinal transit determined with the rubber bag (TTI-B) (14.1 - 79.2 hours; mean +/- s.d.: 42.4 +/- 20.7 hours) were significantly shorter than the times determined with the plastic pellets (TTI) (26.4 - 88.1 hours; mean +/- s.d.: 60.2 +/- 25.5 hours (P less than 0.001). But, TTI-B and TTI correlate closely (r: + 0.86), and, furthermore, TTI-B results may be converted to TTI results with the help of a simple regression equation: TTI (in minutes) = 831 + 1.09 TTI-B (in minutes). After analyzing what has been observed in the present work and in previous works, it was concluded that the new method to measure intestinal transient time using the small rubber bag is reliable and simple, and that it may help to better understand what happens in some important gastrointestinal problems.

Estudio comparativo de dos métodos de medición de la velocidad del tránsito intestinal. / [Comparative study of 2 methods of measuring intestinal transit time]

In 20 healthy volunteers, intestinal transit times, obtained following a simple method, recently described, in which a small liquid-containing rubber bag is used as a marker, were compared with the times obtained following, simultaneously, another method, already universally accepted, in which small barium-impregnated pellets are used as markers. The intestinal transit determined with the rubber bag (TTI-B) (14.1 - 79.2 hours; mean +/- s.d.: 42.4 +/- 20.7 hours) were significantly shorter than the times determined with the plastic pellets (TTI) (26.4 - 88.1 hours; mean +/- s.d.: 60.2 +/- 25.5 hours (P less than 0.001). But, TTI-B and TTI correlate closely (r: + 0.86), and, furthermore, TTI-B results may be converted to TTI results with the help of a simple regression equation: TTI (in minutes) = 831 + 1.09 TTI-B (in minutes). After analyzing what has been observed in the present work and in previous works, it was concluded that the new method to measure intestinal transient time using the small rubber bag is reliable and simple, and that it may help to better understand what happens in some important gastrointestinal problems.

[Time of normal intestinal transit in Peruvian subjects]. / Tiempo de tránsito intestinal normal en Perú.

Intestinal transit-time (TTI) and daily steel weight (PDH) were determined in 20 Peruvian healthy volunteers, following a universally accepted technique. Mean of TTI (mean +/- s.d.: 60.2 +/- 25.5 h) was similar to the ones reported in subjects, from other world places, who consume refined diets, poor in fibre; while mean of PDH (mean +/- s.d.: 174.5 +/- 114.0 g) compared better to the ones reported in subjects who consume mixed diets, composed by refined foods and foods with a high fibre content. Contrarily to what other authors have observed, correlation between TTI and PDH was not significant (r r0.03, only). The obtained results may be explained by the coexistence of several inconstant determinant factors, among which would be a deficient ingestion of dietary fibre.