Análisis del efecto de la fisioterapia temprana en la recuperación funcional de pacientes con quemaduras en miembros inferiores / Analysis of the effect of early physiotherapy on the functional recovery of patients with burns on lower limbs

Introducción: La recuperación de las actividades de la vida diaria de los pacientes quemados depende de una atención oportuna y eficaz, incluyendo la rehabilitación física. Objetivo: Evaluar la efectividad funcional de la rehabilitación temprana en pacientes con quemaduras en miembros inferiores. Métodos: Este es un estudio retrospectivo, longitudinal, observacional y analítico en el cual se evaluó la asociación que existe entre el número de sesiones de fisioterapia y diferentes variables de desenlace relacionadas con la funcionalidad del paciente quemado de miembros inferiores. Se realizaron de manera secuencial análisis uni-, bi- y multivariados para conocer las características de distribución en el primero, y la significación estadística en el segundo y tercero. Resultados: La información derivada de 32 pacientes que cumplieron con los criterios del estudio reveló una asociación simple entre la recuperación de los arcos de movilidad, sedestación, bipedestación y marcha con el número de sesiones de fisioterapia, sin que se favorezca la fuerza muscular. El análisis multivariado evidenció una correlación positiva entre el número de sesiones de fisioterapia y la sedestación, pero negativa cuando se asoció la ventilación mecánica con la bipedestación/marcha asistida. Conclusión: La aplicación de fisioterapia temprana contribuye directamente con la recuperación funcional del paciente quemado; sin embargo, es indispensable considerar que el estado catabólico de los individuos entorpece el progreso motriz

Introduction: Recovery of activities of daily living in burn patients depend on timely and effective care, including physical rehabilitation. Aim: To evaluate functional activity in lower limb burn patients after early rehabilitation. Methods: A retrospective, longitudinal, and analytic trial was conducted in order to assess the association between the number of physiotherapy sessions and the functional outcome in lower limb burn patients. Uni-, bi-, and multivariate analyses were performed in order to determine the distribution characteristics of the sample, and any significant association between variables. Results: After a review of data from 32 patients that fulfilled trial enrolment criteria, a simple association was shown between complete joint motion, sitting position, standing and walking vs. the number of physiotherapy sessions, but failed to maintain or improve muscle strength. Multivariate analysis demonstrated a positive correlation between the number of physiotherapy sessions and sitting position, but a negative one when mechanical ventilation was related to standing/walking. Conclusion: The early administration of physiotherapy helps in the functional recovery of burn patients; nevertheless it is critical to consider that catabolic processes impair motion

Adaptación al español para la población mexicana con radiculopatía lumbar de la Escala de Evaluación Estandarizada del Dolor (StEP) / Adaptation in Spanish for the Mexican population with lumbar radiculopathy of the Standardized Evaluation of Pain

Introducción: La evaluación clínica de dolor radicular asocia síntomas y signos del fenotipo doloroso con el mecanismo de base. La escala de evaluación estandarizada del dolor (StEP) diferencia dolor lumbar axial del radicular mediante interrogatorio (3 preguntas) y examen físico (8 pruebas). Objetivo: Adaptar la escala StEP al español. Metodología: Selección de escala, traducción-retraducción, ajustes ítems y utilidad, prueba piloto, análisis de validez y confiabilidad. Inclusión: Cualquier género, mayor de 18 años, dolor lumbar con o sin irradiación, que firmen consentimiento informado. Exclusión: Neuropatías, polineuropatías, miopatías, enfermedad neurológica, miofascial, venosa, siquiátrica, cardiovascular, postoperados. Muestra: 21 pacientes. Resultados: Evaluación en 2 ocasiones por paciente, intervalo de una semana, 2 evaluadores. 21 pacientes, 9 femeninos (42.9%) y 12 masculinos (57.1%); edad: 22 a 58 años (media 38). Diagnósticos: lumbalgia 7 (33.3%), lumbociática 6 (28.6%), hernia discal 5 (23.8%), espondilolistesis 2 (9.5%), radiculopatía 1 (4.8%). Evaluador 1: axial 18 (85.7%), radicular 3 (14.3%). Evaluador 2: axial 14 (66.7%), radicular 7 (33.3%). Resultados de validez adecuados. Consistencia interna (alpha de Cronbach) 0.7. Tiempo prueba/reprueba: 15 a 10 minutos. Confiabilidad inter-evaluador (índice Kappa) 0.5. Conclusión: La escala presenta variabilidad en la identificación del dolor radicular en comparación a lo reportado inicialmente por su autor; sin embargo, se considera de utilidad en la identificación clínica de la radiculopatía.

Introduction: The clinical assessment of radicular pain associates the signs and symptoms of the painful phenotype with the underlying mechanism. The Standardized Evaluation of Pain (StEP) distinguishes between axial and radicular lumbar pain by means of a questionnaire (3 questions) and a physical exam (8 tests). Objective: To adapt the StEP scale to Spanish. Methodology: Selection of the scale, translation-back translation, adjustments, items and utility, pilot test, validity and reliability tests. Inclusion criteria: Any sex, over age 18, lumbar pain with or without irradiation, signing of the informed consent. Exclusion criteria: Neuropathies, polyneuropathies, myopathies, neurologic, myofascial, venous, psychiatric, cardiovascular disease, postoperative status. Sample: 21 patients. Results: Patients were assessed twice with a one-week interval with the help of 2 evaluators. There were 21 patients, 9 females (42.9%) and 12 males (57.1%); ages 22-58 years (mean 38). Diagnoses: low back pain, 7 (33.3%); lumbosciatica, 6 (28.6%); disc herniation, 5 (23.8%); spondylolisthesis, 2 (9.5%); radiculopathy, 1 (4.8%). Evaluator 1: axial, 18 (85.7%); radicular, 3 (14.3%). Evaluator 2: axial, 14 (66.7%); radicular, 7 (33.3%). Validity results were appropriate. Internal consistency (Cornbach's alpha), 0.7. Test/re-test time: 10-15 minutes. Inter-evaluator reliability (Kappa index), 0.5. Conclusion: The scale showed variability in identifying radicular pain compared to what its author reported initially. However, it is considered as a useful tool to clinically identify radiculopathy.

Tratamiento postquirúrgico de hernia discal lumbar en rehabilitación: Revisión sistemática / Postoperative treatment for lumbar disc herniation during rehabilitation: Systematic review

Existen diversos programas e intervenciones para la rehabilitación de pacientes postoperados por hernia discal lumbar (HDL) sintomática. Para determinar el valor de las diferentes intervenciones de rehabilitación dentro del tratamiento postoperatorio de pacientes con HDL sintomática. Material y métodos: Revisión Sistemática. Búsqueda en bases de datos electrónicas desde Enero del 2000 hasta Octubre del 2012. Dos revisores independientes certificados para el uso de la escala PEDro evaluaron los ensayos clínicos incluidos en la revisión final; se incluyeron únicamente aquéllos con alta calidad metodológica; un tercer evaluador fungió de árbitro en caso de discrepancia entre los revisores. Hubo cegamiento de autores, instituciones y revistas para mejorar la precisión de calificaciones y validez interevaluador. Resultados: Se consideraron 15 ensayos clínicos para ser revisados por los evaluadores; 8 (53.3%) se consideraron de alta calidad metodológica (promedio 7.7 de 10 puntos). Se aleatorizaron 1099 participantes a diferentes grupos de tratamiento. No fue posible realizar un metaanálisis con los datos de los ensayos debido a las múltiples intervenciones y variables de desenlace utilizadas. Conclusiones: Se recomienda un programa de rehabilitación inmediata en pacientes postoperados por primera vez de microdisectomía. La intervención cognitiva con reforzamiento positivo aunado al ejercicio es un tratamiento eficaz; incluso se considera alternativo a la fusión vertebral en pacientes postoperados por HDL con recurrencia de síntomas posterior a una primera intervención. Los resultados de la actividad postquirúrgica temprana son generalmente excelentes y sin complicaciones. Se requiere aumentar el número y calidad metodológica de ensayos clínicos enfocados al tema para sustentar la utilidad de estas intervenciones en la práctica clínica diaria.

Various programs and interventions are available for the rehabilitation of patients who have undergone surgery for symptomatic lumbar disc herniation (LDH). Our aim is to determine the value of the different rehabilitation interventions included in the postoperative treatment of patients with symptomatic LDH. Material and methods: Systematic review. Search in electronic data bases from January 2000 to October 2012. Two independent reviewers certified in the use of the PEDro (Physiotherapy Evidence Data Base) scale assessed the clinical trials included in the final version; only those with high methodological quality were included. A third reviewer acted as arbitrator in case of discrepancy between reviewers. The reviewers were blinded to the authors, institutions and journals to increase the precision of their ratings and the inter-reviewer validity. Results: Fifteen clinical trials were reviewed by the reviewers; 8 (53.3%) were considered as having a high methodological quality (average of 7.7/10). Were randomized 1099 participants to different treatment groups. It was not possible to conduct a meta-analysis with the clinical trial data due to the multiple interventions and outcome measures used. Conclusions: An immediate rehabilitation program is recommended in patients undergoing micro-diskectomy for the first time. Cognitive intervention with positive reinforcement together with exercise is an effective treatment. It is even considered as an alternative to vertebral fusion in patients who underwent LDH surgery with symptom recurrence after the first surgery. The results of early postoperative activity are usually excellent and involve no complications. The number and the methodological quality of the clinical trials on this topic need to be increased to justify the usefulness of these interventions in the daily clinical practice.

[Adaptation in Spanish for the Mexican population with lumbar radiculopathy of the Standardized Evaluation of Pain]. / Adaptación al español para la población mexicana con radiculopatía lumbar de la Escala de Evaluación Estandarizada del Dolor (StEP).

INTRODUCTION: The clinical assessment of radicular pain associates the signs and symptoms of the painful phenotype with the underlying mechanism. The Standardized Evaluation of Pain (StEP) distinguishes between axial and radicular lumbar pain by means of a questionnaire (3 questions) and a physical exam (8 tests). OBJECTIVE: To adapt the StEP scale to Spanish. METHODOLOGY: Selection of the scale, translation-back translation, adjustments, items and utility, pilot test, validity and reliability tests. Inclusion criteria: Any sex, over age 18, lumbar pain with or without irradiation, signing of the informed consent. Exclusion criteria: Neuropathies, polyneuropathies, myopathies, neurologic, myofascial, venous, psychiatric, cardiovascular disease, postoperative status. Sample: 21 patients. RESULTS: Patients were assessed twice with a one-week interval with the help of 2 evaluators. There were 21 patients, 9 females (42.9%) and 12 males (57.1%); ages 22-58 years (mean 38). Diagnoses: low back pain, 7 (33.3%); lumbosciatica, 6 (28.6%); disc herniation, 5 (23.8%); spondylolisthesis, 2 (9.5%); radiculopathy, 1 (4.8%). Evaluator 1: axial, 18 (85.7%); radicular, 3 (14.3%). Evaluator 2: axial, 14 (66.7%); radicular, 7 (33.3%). Validity results were appropriate. Internal consistency (Cornbach's alpha), 0.7. Test/ re-test time: 10-15 minutes. Inter-evaluator reliability (Kappa index), 0.5. CONCLUSION: The scale showed variability in identifying radicular pain compared to what its author reported initially. However, it is considered as a useful tool to clinically identify radiculopathy.

[Postoperative treatment for lumbar disc herniation during rehabilitation. Systematic review]. / Tratamiento postquirúrgico de hernia discal lumbar en rehabilitación. Revisión sistemática.

UNLABELLED: Various programs and interventions are available for the rehabilitation of patients who have undergone surgery for symptomatic lumbar disc herniation (LDH). Our aim is to determine the value of the different rehabilitation interventions included in the postoperative treatment of patients with symptomatic LDH. MATERIAL AND METHODS: Systematic review. Search in electronic data bases--from January 2000 to October 2012. Two independent reviewers certified in the use of the PEDro (Physiotherapy Evidence Data Base) scale assessed the clinical trials included in the final version; only those with high methodological quality were included. A third reviewer acted as arbitrator in case of discrepancy between reviewers. The reviewers were blinded to the authors, institutions and journals to increase the precision of their ratings and the inter-reviewer validity. RESULTS: Fifteen clinical trials were reviewed by the reviewers; 8 (53.3%) were considered as having a high methodological quality (average of 7.7/10). Were randomized 1099 participants to different treatment groups. It was not possible to conduct a meta-analysis with the clinical trial data due to the multiple interventions and outcome measures used. CONCLUSIONS: An immediate rehabilitation program is recommended in patients undergoing microiskectomy for the first time. Cognitive intervention with positive reinforcement together with exercise is an effective treatment. It is even considered as an alternative to vertebral fusion in patients who underwent LDH surgery with symptom recurrence after the first surgery. The results of early postoperative activity are usually excellent and involve no complications. The number and the methodological quality of the clinical trials on this topic need to be increased to justify the usefulness of these interventions in the daily clinical practice.

A study of caronamide as a penicillin booster

This study on caronamide as a penicillin booster with 500 determinations of penicillin blood levels in well-controlled cases, enables us to conclude as follows: 1) That caronamide is a non-toxic drug producing a reversible elevation of penicillin plasma level, in most cases to the magnitude of 2-7 times. Occasionally a maximum elevation of 30 times is obtained. This effect permits attainment of high penicillin plasma concentration which may widen the anti-biotic range of penicillin. With the use caronamide, penicillin may be given in 1/2-1/7 of the usual dose and still attain a minimum therapeutic level thus allowing economy in its use; 2) That it prolongs penicillin stay in the blood thereby permitting a reduction in the number of injections; 3) The penicillin and caronamide together did not prove an effective therapeutic combination in the two cases of malaria studied. (Conclusion)

Simple standardized enzyme-linked immunosorbent assay for human antibodies to Entamoeba histolytica.

A simple solid-phase enzyme-linked immunosorbent assay procedure for the detection of human antibodies to Entamoeba histolytica was developed which showed a high degree of correlation with the agar gel diffusion, counterelectrophoresis, and indirect hemagglutination methods, as well as with clinical data. The enzyme-linked immunosorbent assay is rapid (1 h 15 min, total incubation time), and the reported values are referenced to a positive control so that they correlate with levels of antibody sufficient to be detected by the gel diffusion methods. The enzyme-linked immunosorbent assay is highly reproducible, specific, and sensitive; it can be used qualitatively or quantitatively.

Leukopenia, hypoxia, and complement function with different hemodialysis membranes.

Complement activation during exposure of plasma to cuprophan has been postulated to cause leukopenia and hypoxia in hemodialysis patients. To determine if hypoxia is related to leukopenia and if complement activation leads to a depletion of functional complement components, we dialyzed four patients three times sequentially against each of four types of membranes: cuprophan, regenerated cellulose, cellulose acetate, and polyacrilonitrile. Within 20 min there was a marked leukopenia with cuprophan from 5541 +/- 376 to 1216 +/- 94 (P less than 0.001) and with regenerated cellulose from 5541 +/- 411 to 1533 +/- 203 (P less than 0.001). With cellulose acetate, the change from 5558 +/- 400 to 3783 +/- 341 (P less than 0.001) was less dramatic, and with polyacrilonitrile the fall from 5591 +/- 381 to 464 +/- 401 (P less than 0.02) was minimal. After 2 and 4 hours of dialysis, a rebound leukocytosis was seen with cuprophan, regenerated cellulose, and cellulose acetate, but not with polyacrilonitrile. Transient thrombocytopenia occurred with cuprophan and regenerated cellulose. In spite of the variable degree of leukopenia, all membranes induced a similar and significant hypoxia, which was progressive throughout dialysis, even during the rebound leukocytosis. After 4 hours, the mean PO2 ranged from 91 to 93 mm Hg with all membranes. Functional hemolytic titers of whole complement, C3, C5, and C4 were normal prior to hemodialysis and failed to decrease after 4 hours with any membrane. It is concluded that hemodialysis leukopenia is membrane-dependent and is not the cause of hypoxia. In addition, hemodialysis complement activation does not lead to functional complement depletion and is of no clinical significance.

Abnormalities of complement and its components in patients with acute leukemia, Hodgkin's disease, and sarcoma.

Whole complement and component titers were measured in patients with acute leukemia, Hodgkin's disease, and sarcoma. Serum samples were obtained from 42 consecutive patients and 11 healthy control subjects. Sera were frozen and maintained at -70 degrees until analyzed by hemolytic assay. Titers were normalized using a titer obtained from a single source of pooled human serum analyzed simultaneously with each patient sample to correct for day-to-day variation inherent in the assay technique. Significant elevations (p less than or equal to 0.05) of whole complement and C5, C8, and C9 were observed for each patient category, compared to controls. Forty-one of 42 patients had C9 titers greater than or equal to 2 S.D. above the mean titer for controls. Mean C3 and C7 titers were not elevated or depressed in any group. No clinical factors that correlated with abnormal complement or component titers were identified.

Serum Bacteriostasis of Staphylococcus aureus.

Serum bacteriostasis of Staphylococcus aureus was characterized quantitatively and quantitatively. Bacteriostasis was proportional to the concentration of serum. Reproducibility was good; freezing and thawing did not materially affect the end point. Four of six different strains, including the propagating S. aureus strain for phage 73 which does not produce coagulase, were susceptible to serum bacteriostasis in similar titers; two were not susceptible at all. All six strains were effective inhibitors of bacteriostasis. Active and inactive coagulase were also inhibitors. In contrast to sensitive S. aureus, S. epidermidis and Streptococcus salivarius were not uniformly susceptible to bacteriostasis by different serums. Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, Salmonella montevideo, S. zymogenes, and Diplococcus pneumoniae were not susceptible. Among gram-positive bacteria, only D. pneumoniae inhibited S. aureus bacteriostasis. Agglutinins of S. aureus and nonspecific substances such as lysozyme, beta-lysin, C-reactive protein, and transferrin were not responsible for S. aureus serum bacteriostasis. After diethylaminoethyl column fractionation of serum, the bacteriostatic principle was eluted in proximity to blood group antibody; immunoglobulins A, G, and M appeared to be present in bacteriostatic fractions. It is suggested that S. aureus bacteriostasis by serum is due to natural antibody and that inhibitory reactions with pneumococci and coagulase are due to common antigens.