Satisfaction of patients with mechanical neck disorders attended to by primary care physical therapists

Objective To describe the satisfaction and expectations of the patients with neck pain with relation to the physical therapy received and to analyse the relationship between the patient's characteristics and his degree of satisfaction and expectation. Design This study is performed in the setting of a random clinical trial. Participants Subjects between 18 and 60 years of age with subacute mechanical neck disorders. Main variables Patient's expectations and satisfaction with the received treatment (scale similar to Likert's Scale). Other variables Pain intensity, episodes of previous neck pain, depression and anxiety symptoms (Goldberg Scale), age and gender, physical disability, general state of health, duration of the present episode of neck pain, regular exercise and regular consumption of medicines. Results and conclusions A total of 90 patients were studied. The mean age was 40.1 years and 88.9% were female. Thirteen per cent of the subjects expected partial relief, 60% expected good recovery and 27% expected complete recovery. Those patients who have not suffered previous episodes of neck pain and those who have a higher score on the Goldberg Scale have a higher expectation of recovering after the treatment. About patients' satisfaction after the intervention, 2% totally unsatisfied, 1% very unsatisfied, 2% somewhat unsatisfied, 2% indifferent, 17% somewhat satisfied, 42% very satisfied and 30% totally satisfied. Those patients who experienced a greater decrease in pain were more satisfied. It would be interesting to study in depth the measurement of patients' satisfaction with the received physical therapy and to extend it to other pathologies.     

Intravenous cyclophosphamide monthly pulses in refractory myasthenia gravis

Journal of Neurology - Refractory myasthenia gravis (MG) is defined as a failure to respond adequately to conventional therapies, the inability to reduce immunosuppressive therapy without clinical...     

Effectiveness of the KiVa Antibullying Program with and without the Online Game in Chile: a Three-Arm Cluster Randomized Controlled Trial

Bullying is a major health problem. The KiVa antibullying program has been evaluated in Finland and other European countries, showing preventive effects on self-reported bullying victimization and perpetration. No evaluations of this program have been conducted in Latin America. A cluster randomized controlled trial was conducted at socially vulnerable schools in Santiago, Chile, to assess the effectiveness of the KiVa antibullying program in grades 5 and 6 (aged 10–12 years). Schools were randomly assigned (1:1:1) to three groups: the full KiVa group (including the online game), the partial KiVa group (did not include the online game), and the control group in which the regular school curriculum was implemented. The primary outcome was self-reported bullying victimization, assessed before the intervention (baseline) at the end of the academic year (November 2016) and post-intervention, 12 months after the baseline assessment (November 2017). This trial is registered with ClinicalTrials.gov, number NCT02898324. A total of 39 schools (13 in each group) were included; no schools withdrew. The baseline survey included 5923 participants, and the endpoint survey included 3968 participants. Participants in the partial KiVa group had lower bullying victimization at the endpoint survey than those in the control group (OBVQ-R adjusted mean difference???0.14; 95% CI,???0.26 to???0.01; effect size???0.13, 95% CI???0.24 to???0.01, p?=?0.035). There was no effect of the full KiVa group for bullying victimization compared with the control and partial KiVa groups. Compared to the control group, participants in the partial KiVa group had lower witnessing bullying at school (adjusted mean difference?=???0.25; 95% CI???0.45 to???0.05; effect size???0.18, 95% CI,???0.32 to???0.04, p?=?0.013). No effects were found for other secondary outcomes, including bullying perpetration in any comparisons between arms. The implementation of the KiVa antibullying program had mixed results in Chile. There was only a small effect on bullying victimization and witnessing when KiVa was delivered without the online game.

     

Impaired bone microarchitecture and strength in patients with tumor-induced osteomalacia

Some studies based on bone biopsy have demonstrated that in patients with tumor-induced osteomalacia (TIO) the mineralization process of the bone matrix is profoundly disturbed. However, the interrelationship between clinical and biochemical features and bone microarchitecture in this disease needs further analysis. With this purpose in mind, we set out three objectives: (i) to determine bone microarchitecture and estimated bone strength in a group of patients with tumor-induced osteomalacia using high-resolution peripheral quantitative computed tomography (HR-pQCT) and finite element analysis (FEA), (ii) to investigate correlations between duration of disease, biochemical features, bone density, HR-pQCT and FEA parameters, and (iii) to compare HR-pQCT and FEA parameters with a healthy control group. Ten patients with TIO were included. All patients had non-resolved disease. At the distal radius, all bone microarchitecture parameters were significantly affected in patients with TIO in comparison with healthy controls. At the distal tibia, all parameters were significantly impaired, except for trabecular thickness. All the parameters were more affected in the distal tibia than in the distal radius. Women with TIO (n = 7) had significantly lower bone strength parameters than healthy controls. In men (n = 3), bone strength parameters were significantly lower than in the control group at the distal tibia. Alkaline phosphatase levels exhibited a negative correlation with microarchitecture parameters, failure load, and stiffness. Higher levels of parathyroid hormone correlated with poorer microarchitecture parameters. We believe that in TIO, hormonal disturbances and the lack of mechanical stimulus specially converge to generate an extremely harmful combination for bone health. © 2021 American Society for Bone and Mineral Research (ASBMR).     

Hiperfrecuentadores en urgencias. ¿Quiénes son? ¿Por qué consultan?

Objective

To determine the prevalence of frequent Paediatric Emergency Departments users and to analyse their characteristics, comparing initial consultations and re-consultations.

Liver toxicity mechanisms of herbs commonly used in Latin America

Mexico owns approximately 4500 medicinal plants species, a great diversity that position it at the second place after China. According to the Mexican health department, 90% of common population consumes them to treat various diseases. Additionally, herbal remedies in Latin America (LA) are considered a common practice, but the frequency of use and the liver damage related to its consumption is still unknown. Despite the high prevalence and indiscriminate herbal consumption, the exact mechanism of hepatotoxicity and adverse effects is not fully clarified and is still questioned. Some herb products associated with herb induced liver injury (HILI) are characterized by presenting a different chemical composition that may vary from batch to batch, also the biological activity of many medicinal plants and other natural products are directly related to their most active component and its concentration. There are two main biological components that are associated with liver damage, alkaloids, and flavonoids, which are frequent constituents of commonly used herbs. The interaction with the different cytochrome P-450 isoforms, inflammatory, and oxidative activities seem to be the main damage pathway involved in the liver. It is important to know the herbal adverse effects and mechanisms involved; therefore, this article is focused on the beneficial and deleterious effects as well as the possible toxicity mechanisms and interactions of the herbs that are frequently used in LA, since the herb–host interaction may not always be the expected or desired depending on the clinical context in which it is administered.     

Benign paroxysmal positional vertigo simultaneously affecting several canals: a 46-patient series

Although it is uncommon for benign paroxysmal positional vertigo (BPPV) to affect more than one canal simultaneously, it is not exceptional. We attempt to determine whether these patients present differences relative to “single-canal” cases. A prospective study was done in patients with BPPV, divided into three groups: single-canal BPPV, multi-canal BPPV in one ear and multi-canal BPPV in both ears. Diagnosis was by Dix and Hallpike, supine roll and cephalic hyperextension tests. Treatment was according to the affected canals, by Semont, Epley, Lempert and Yacovino manoeuvres. Aetiology, sex, age, response to treatment, recurrence and final status in each of the three groups was evaluated. Five hundred and eighty-three patients were diagnosed with BPPV: 537 single-canal (92 %) and 46 multi-canal (8 %); of the latter, 36 bilateral and 10 unilateral cases. Basic differences between groups were: greater percentage of idiopathic cases in single-canal (p < 0.0001, Chi-square), greater percentage of post-traumatic cases in bilateral multi-canals (p = 0.006, Chi-square) and prior history of BPPV was more common in unilateral multi-canal (p = 0.006, Chi-square). No differences between groups in response to treatment, recurrence and final status were detected. There are aetiological differences between patients with single-canal BPPV, unilateral multi-canal BPPV and bilateral multi-canal BPPV. Response to therapeutic manoeuvres, however, shows that over 90 % of the patients in all the groups are cured.