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The study of the brain by magnetic resonance imaging (MRI) allows to obtain detailed anatomical images, useful to describe specific encephalic structures and to analyze possible variabilities. It is widely used in clinical practice and is becoming increasingly used in veterinary medicine, even in exotic animals; however, despite its potential, its use in comparative neuroanatomy studies is still incipient. It is a technology that in recent years has significantly improved anatomical resolution, together with the fact that it is non-invasive and allows for systematic comparative analysis. All this makes it particularly interesting and useful in evolutionary neuroscience studies, since it allows for the analysis and comparison of brains of rare or otherwise inaccessible species. In the present study, we have analyzed the prosencephalon of three representative sauropsid species, the turtle Trachemys scripta (order Testudine), the lizard Pogona vitticeps (order Squamata) and the snake Python regius (order Squamata) by MRI. In addition, we used MRI sections to analyze the total brain volume and ventricular system of these species, employing volumetric and chemometric analyses together. The raw MRI data of the sauropsida models analyzed in the present study are available for viewing and downloading and have allowed us to produce an atlas of the forebrain of each of the species analyzed, with the main brain regions. In addition, our volumetric data showed that the three groups presented clear differences in terms of total and ventricular brain volumes, particularly the turtles, which in all cases presented distinctive characteristics compared to the lizards and snakes.

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A 9-year-old 6-kg male castrated mixed-breed dog was admitted to the hospital as a second opinion for left-sided nephrectomy. Plain radiographs, ultrasound, excretory urography and retrograde urethrography revealed left-sided hydronephrosis and calculi in the bladder and urethra. The urethral calculi were hydropropulsed into the bladder and nephrectomy and cystotomy were performed. Three days after surgery, the patient showed preputial inflammation, pain and pollakiuria. Retrograde urethrography was repeated and extra-urethral leakage of contrast medium into the penile tissue was identified, followed by filling of the draining veins, reaching the caudal vena cava, with subsequent opacification of the right renal pelvis and ureter and opacification of a lymph node. The dog improved during hospitalisation and a retrograde urography performed 6 months after the initial surgery confirmed full recovery.

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PURPOSE: To explore the factors involved in adherence to self-care behaviors in patients with type 1 diabetes. MATERIALS AND METHODS: Patients with type 1 diabetes (age range: 14-71 years) were invited to participate at seven Spanish hospitals. They completed a dossier which recorded sociodemographic and clinical variables and also measured personality variables, emotional state, beliefs, and concerns regarding the illness, by means of questionnaires. RESULTS: A total of 428 patients with type 1 diabetes were included (58% women, age 36 (11.8) years, diabetes duration 18.3 (10.2) years, HbA1c 7.9 +/-1.3%). A total of 60.1% of patients found it difficult to follow the treatment recommendations for the care of their disease. The reasons given were mood (25.2%), lack of motivation (13.4%), work (12%), and economic difficulties (3.8%). Other personal reasons were reported by 5.7%. Motivation, training in diabetes management, importance the patient attributed to the disease, and self-efficacy were the variables that predicted adherence to self-care behaviors, together accounting for 32% of its variance. Anxiety and depression were highly prevalent in this study population (57.1% and 23.1%, respectively) and were associated with lower adherence. CONCLUSION: In the present study assessing patients with type 1 diabetes, motivation, training in diabetes management, beliefs regarding the disease, and self-efficacy were the main contributors to adherence to self-care behaviors. On the other hand, anxiety and depression were highly prevalent and associated with lower adherence. Thus, supplementing therapeutic education with strategies designed to raise levels of motivation, discussion of beliefs about the disease, and encouragement of self-efficacy might be a useful way to increase patient involvement in self-care.

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Objetivo: Conocer las vivencias de los pacientes que se encontraban al final de la vida y fueron atendidos por los servicios de urgencias, mediante los discursos de sus cuidadores familiares que acompañaban al familiar en este tránsito asistencial. Método: Estudio de enfoque cualitativo, basado en el paradigma de la fenomenología hermenéutica. En total participaron 81 cuidadores familiares. Las técnicas que se utilizaron fueron la entrevista en profundidad y el grupo de discusión, con un total de 5 grupos de discusión y 41 entrevistas. El período de recopilación de los datos se realizó entre enero del 2013 y junio del 2014. Resultados: En la red de los discursos obtenida respecto a la «Atención Urgente», todos los códigos se aglutinan respecto a una única línea argumentativa: las deficiencias en la atención urgente. Entre ellos, hemos encontrado distintas dimensiones que se establecen en función de los diferentes tiempos de la atención, o los distintos aspectos determinantes de estas deficiencias: desorganización de la atención recibida, poca experiencia de los profesionales en las urgencias, aplicación de protocolos generales, en los servicios de urgencias, inadecuada atención en el trato recibido, demoras en la atención en urgencias. Conclusiones: En general, destacamos la insatisfacción de los familiares con respecto a la atención en los servicios de urgencias. Las necesidades que precisan este tipo de situaciones no están cubiertas desde estos servicios y son de baja calidad. Por tanto, es necesario reorientar los protocolos de atención de estos pacientes

Objective: To discover the experiences of end-of-life patients attended by the emergency services, through the discourse of the family caregivers who accompanied the family member in this care transit. Method: A qualitative approach study, based on the paradigm of hermeneutical phenomenology. In total, 81 family caregivers participated. The techniques used were the in-depth interview and the discussion group, with a total of 5 discussion groups and 41 interviews. The period of data collection was carried out between January 2013 and June 2014. Results: In the network of discourses obtained with respect to "Urgent Care", all the codes were grouped in relation to a single argumentative line: deficiencies in urgent care. Among them, we found different dimensions that are established depending on the different times of care, or the different determinant aspects of these deficiencies: disorganization of the care received, lack of experience of the professionals in emergencies, application of general protocols in the emergency services, inadequate care in the treatment received, delays in emergency care. Conclusions: In general, we highlight the dissatisfaction of the family members with respect to the care received from the emergency services. The needs of these types of situation are not covered from these services and are of low quality. Therefore, it is necessary to reorient the care protocols for these patients

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OBJECTIVE: To discover the experiences of end-of-life patients attended by the emergency services, through the discourse of the family caregivers who accompanied the family member in this care transit. METHOD: A qualitative approach study, based on the paradigm of hermeneutical phenomenology. In total, 81 family caregivers participated. The techniques used were the in-depth interview and the discussion group, with a total of 5 discussion groups and 41 interviews. The period of data collection was carried out between January 2013 and June 2014. RESULTS: In the network of discourses obtained with respect to "Urgent Care", all the codes were grouped in relation to a single argumentative line: deficiencies in urgent care. Among them, we found different dimensions that are established depending on the different times of care, or the different determinant aspects of these deficiencies: disorganization of the care received, lack of experience of the professionals in emergencies, application of general protocols in the emergency services, inadequate care in the treatment received, delays in emergency care. CONCLUSIONS: In general, we highlight the dissatisfaction of the family members with respect to the care received from the emergency services. The needs of these types of situation are not covered from these services and are of low quality. Therefore, it is necessary to reorient the care protocols for these patients.

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This study describes the development of a new questionnaire to measure health-related quality of life (HRQoL) in patients with type 1 diabetes (the ViDa1 questionnaire) and provides information on its psychometric properties. For its development, open interviews with patients took place and topics relevant to patients' HRQoL were identified and items were generated. Qualitative analysis of items, expert review, and refinement of the questionnaire followed. A pilot study (N = 150) was conducted to explore the underlying structure of the 40-item ViDa1 questionnaire. A Principal Component Analysis (PCA) was performed and six of the items that did not load on any of the factors were eliminated. The results supported a four-dimensional structure for ViDa1, the dimensions being Interference of diabetes in everyday life, Self-care, Well-being, and Worry about the disease. Subsequently, the PCA was repeated in a larger sample (N = 578) with the reduced 34-item version of the questionnaire, and a Confirmatory Factor Analysis (CFA) was performed (N = 428). Overall fit indices obtained presented adequate values which supported the four-factor model initially proposed [([Formula: see text] 2601.93) (p < 0.001); Root Mean Square Error of Approximation = 0.060 (CI = 0.056 -0.064)]. As regards reliability, the four dimensions of the ViDa1 demonstrated good internal consistency, with Cronbach's alphas ranging between 0.71 and 0.86. Evidence of convergent-discriminant validity in the form of high correlations with another specific HRQoL questionnaire for diabetes and low correlations with other constructs such as self-efficacy, anxiety, and depression were presented. The ViDa1 also discriminated between different aspects of clinical interest such as type of insulin treatment, presence of chronic complications, and glycemic control, temporal stability, and sensitivity to change after an intervention. In conclusion, the ViDa1 questionnaire presents adequate psychometric properties and may represent a good alternative for the evaluation of HRQoL in type 1 diabetes.

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Objetivo: Identificar cuáles han sido las principales limitaciones y dificultades en el acceso a los recursos sociosanitarios que han vivido las personas al final de la vida, a través de las vivencias y las percepciones de los cuidadores de estos enfermos. Método: Estudio cualitativo multicéntrico con enfoque fenomenológico, mediante 5 grupos de discusión y 41 entrevistas en profundidad, en Andalucía, España. La selección de los participantes se realizó intencionadamente entre los cuidadores que habían sufrido la muerte de su familiar, entre 2 meses y 2 años después del fallecimiento. Se optó por el método de Giorgi para el análisis de la información, y como soporte informático utilizamos Atlas ti 6.0. Resultados: Se han obtenido una serie de categorías relacionadas con distintos niveles de asistencia sanitaria: el sufrimiento en los servicios de urgencias, la necesidad de intimidad, la sensación de soledad y la vivencia en el domicilio. Conclusiones: Los cuidadores han descrito una serie de obstáculos de acceso a los distintos recursos sociosanitarios, entre los que destacan la existencia de protocolos muy generales de atención que no tenían en cuenta el proceso de enfermedad de su familiar y la necesidad de una habitación individualizada, durante el ingreso hospitalario. En el domicilio se sienten protegidos por los profesionales de atención primaria, pero presentan dificultades de acceso a apoyo psicológico y a las unidades de cuidados paliativos. Por tanto, es prioritario que desde el sistema sanitario se puedan fomentar los aspectos asistenciales esenciales en la atención a estos enfermos y favorecer una muerte con dignidad.

Objective: From the perspective of their health providers, to identify the main limitations and difficulties which persons at the end of their lives have experienced in relation to their accessibility to social-sanitary resources. Method: This is a phenomenological-focused qualitative and multi-centric study which conducted 5 discussion groups and 41 in-depth interviews in Andalucia, Spain. The participant selection was limited to those health providers who had suffered the death of a family member within the past two years. The Giorgi method was chosen to analyze and back-up the data. Atlas ti 6.0 was also used. Results: From the analysis, several sanitary-assistance-level categories arose including: the suffering at the urgency services, the need of intimacy, the feelings of loneliness, and the life at home. Conclusions: The care providers described a series of barriers to the access to social-sanitary resources highlighting the very general attention protocols which did not integrally consider the illness process of the beloved, and the need to an individualized room while admission at the hospital. Although while at home, these persons feel protected under the attention of the primary care professionals, they have difficulties to having access to psychological support at the palliative care units. Therefore, it is a priority that, from the sanitary system, the essential assisting attention can be warranted, thus supporting these sick persons to go through death in dignity.

Objetivo: Identificar quais têm sido as principais limitações e dificuldades no acesso aos recursos sociosanitários que viveram as pessoas no final da vida, através das vivencias e as percepções dos cuidadores destes doentes. Método: Estudo qualitativo multicêntrico com abordagem fenomenológica, mediante 5 grupos de discussão e 41 entrevistas a profundidade, em Andaluzia, Espanha. A seleção dos participantes realizou-se intencionadamente entre aqueles cuidadores que sofreram a morte de seu familiar, entre dois meses e dois anos depois da morte. Optou-se pelo método de Giorgi par análise da informação e como suporte informático, utilizamos Atlas ti 6.0. Resultados: Obtiveram-se uma série de categorias relacionadas, com diferentes níveis de assistência sanitária: o sofrimento nos serviços de pronto socorro, a necessidade de intimidade, a sensação de solidão e a vivencia no domicílio. Conclusões: Os cuidadores, descreveram uma série de obstáculos de acesso aos diferentes recursos sociosanitários nos quais salienta, a existência de protocolos muito gerais de atenção que não tinham em conta o processo de doença de seu familiar e a necessidade de um quarto individualizado, durante o ingresso hospitalar. No domicilio sentem-se protegidos pelos profissionais de atenção primaria, mas, apresentam dificuldades de acesso ao apoio psicológico e às unidades de cuidados paliativos. Portanto, é prioritário que desde o sistema sanitário se possam promover aqueles aspectos assistenciais essenciais na atenção destes doentes e favorecer uma morte com dignidade.

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OBJETIVO: Explorar el significado de morir con dignidad desde la experiencia vivida por los testigos directos que han acompañado este proceso en personas fallecidas en Andalucía. MÉTODO: Estudio fenomenológico multicéntrico en el que se han analizado los discursos obtenidos en los grupos de discusión de 5 provincias andaluzas con la participación de 40 personas. El análisis de los datos se ha realizado a través de la propuesta de Van Manem.como herramienta informática hemos utilizado el programa Atlas Ti 7.0. RESULTADOS: El acompañamiento de los seres queridos se erige como elemento clave en la percepción de una muerte digna. También se destaca según orden de prioridad: el alivio del sufrimiento, el buen trato profesional, la capacidad de decidir y la posibilidad de expresar la dimensión espiritual. La cumplimentación de voluntades vitales anticipadas apenas es mencionada. CONCLUSIÓN: Se confirman como elementos esenciales los definidos en la Ley 2/2010, de morir con dignidad (sin sufrimiento, en compañía, respetando deseos, y posibilitando la despedida y el sentido trascendente del proceso de morir). Las personas cuidadoras en el final de la vida priorizan los aspectos psicosociales, destacando la necesidad de acompañamiento, la despedida de los seres queridos y el buen trato profesional sobre los aspectos físicos. La promoción de la Ley de Muerte Digna y Voluntades Vitales Anticipadas se encuentra aún en desarrollo

OBJECTIVE: To explore the meaning of dying with dignity from the perspective of the direct witnesses who have accompanied this process in dying people from Andalusia. METHOD: Phenomenological study conducted in different centres, which including analysing the transcriptions of the dialogues from discussion groups with 40 participants in five provinces in Southern Spain. The data was analysed using the Van Manen proposal and Atlas Ti 7.0 program was applied as a software tool. RESULTS: Being in the company of loved ones is noted as a key element in the perception of a dignified death. The following elements, according to a priority order, were also pointed out: relief of suffering, a good professional care, decision making ability, and the opportunity to consider their spiritual dimension. Achievement of their Living Wills is hardly mentioned. CONCLUSIONS: The essential elements defined in the Death with Dignity Law, 2/2010 are confirmed as being true (without suffering, with company, respecting living wills, having possibilities of the farewell, and the transcendental meaning of the death process). Caregivers, at the end of life, give priority to psychological aspects, underlying the need of company, a farewell of the loved ones, and a good professional care on the physical aspects. The promotion of the dignified Death Law and Living Wills are still being developed

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OBJECTIVE: To explore the meaning of dying with dignity from the perspective of the direct witnesses who have accompanied this process in dying people from Andalusia. METHOD: Phenomenological study conducted in different centres, which including analysing the transcriptions of the dialogues from discussion groups with 40 participants in five provinces in Southern Spain. The data was analysed using the Van Manen proposal and Atlas Ti 7.0 program was applied as a software tool. RESULTS: Being in the company of loved ones is noted as a key element in the perception of a dignified death. The following elements, according to a priority order, were also pointed out: relief of suffering, a good professional care, decision making ability, and the opportunity to consider their spiritual dimension. Achievement of their Living Wills is hardly mentioned. CONCLUSION: The essential elements defined in the Death with Dignity Law, 2/2010 are confirmed as being true (without suffering, with company, respecting living wills, having possibilities of the farewell, and the transcendental meaning of the death process). Caregivers, at the end of life, give priority to psychological aspects, underlying the need of company, a farewell of the loved ones, and a good professional care on the physical aspects. The promotion of the dignified Death Law and Living Wills are still being developed.

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Presentamos el caso clínico de un paciente varón de 46 años remitido a Rehabilitación por condropatía en la rodilla izquierda, atrofia de cuádriceps y limitación de la flexo-extensión. El paciente tenía el antecedente de cirugía abierta y artroscópica en dicha rodilla en dos ocasiones. En la primera se le realizó meniscectomía, y sinoviectomía y limpieza de adherencias en la segunda. En la primera revisión del paciente llamaba la atención, además de su dolor y limitación articular en la rodilla, una marcha patológica con espasticidad y clonus. Imposibilidad para la marcha de talones y tendencia al recurvatum de rodilla. Rehistoriando al paciente nos refirió lumbociatalgias de repetición y empeoramiento progresivo. Ante estos hallazgos se derivó a Neurología donde fue ingresado para estudio. Se le diagnosticó una mielopatía dorsal en relación a proceso ocupante de espacio D6-D8. Fue intervenido por Neurocirugía que le practicó laminectomía D5-D8 más exéresis completa de la lesión que anatomopatológicamente se etiquetó de hemangioma cavernoso dorsal

We present the clinic case of a 46-year old male patient sent to rehabilitation due to chondropathy in the left knee, quadriceps atrophy and limitation of the flexoextension. The patient had a background of open and arthroscopic surgery on that knee twice before, with out meniscectomy in the first intervention and synovectomy and cleaning of the adhesions in the second one. In the first check-up, in addition to the patient's pain and joint limitation in the knee, pathological gait with spasticity and clonus stood out. There was also impossibility to walk on the heals and tendency to knee recurvatum. When the patient's background was reviewed, he reported repetitive lumbosciatalgia and progressive deterioration. Due to these findings, the patient was referred to Neurology where he was admitted for study, and was diagnosed of dorsal myelopathy related to D6-D8 space occupying process. He was operated on in Neurosurgery, performing a D5-D8 laminectomy in addition to complete exeresis of the lesion that was labelled by pathology as a dorsal cavernous hemangioma

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Introducción. La disfunción tubárica suele determinar una hipoacusia de transmisión o barotraumas por cambios de presión no compensada por la trompa obstruida. Objetivo. Revisar la relación entre la disfunción temporomandibular y las alteraciones del oído medio. Realizar una primera valoración de la eficacia del tratamiento primario de la disfunción temporomandibular y de ejercicios específicos en pacientes con disfunción tubárica. Material y métodos. Estudio prospectivo sobre 14 pacientes bajo el criterio de inclusión de padecer una mala adaptación a los cambios de presión o una hipoacusia de conducción secundaria a una disfunción tubárica. Se estableció un protocolo de tratamiento dirigido no sólo a la disfunción temporomandibular sino también al oído medio y la trompa de Eustaquio. Resultados. Se incluyeron 14 pacientes, 10 mujeres y 4 hombres con una edad media de 37,14 años (R: 13-74). El 92,85 % presentaba un síndrome de disfunción temporomandibular, el 85,71 % hipoacusia de transmisión y el 64,28 % mala adaptación a los cambios de presión. Casi todos los pacientes empezaron el tratamiento con un timpanograma y una audiometría previos, y tras dicho tratamiento se repitieron estas pruebas, mejorando el 71,42 % de los timpanogramas y el 85,75 % de las audiometrías. Subjetivamente se encontraba mejor el 92,85 % de los pacientes. Conclusiones. La mayoría de los pacientes respondió muy bien a los ejercicios específicos, con casos espectaculares desde las primeras sesiones. Mejoraron síntomas como la hipoacusia y la mala adaptación a los cambios de presión. La rehabilitación de la disfunción tubárica es eficaz, sencilla y no necesita de gran aparataje, pero sí de una gran colaboración terapeuta-paciente

Introduction. Tubal dysfunction generally determines transmission hypoacusis or barotraumas due to uncompensated pressure changes by obstructed tube. Objective. Review the relationship between temporomandibular dysfunction and middle ear disorders. Perform a first assessment of primary treatment efficacy of the temporomandibular dysfunction and of specific exercises in patients with tubal dysfunction. Material and methods. Prospective study on 14 patients with the enrollment criterion of suffering poor adaptation to pressure changes or transmission hypoacusis secondary to tubal dysfunction. A treatment protocol aimed not only at temporomandibular dysfunction but also at the middle ear and Eustachian tube was also established. Results. Fourteen patients, 10 women and 4 men with a mean age of 37.14 years (R: 13-74) were enrolled. A total of 92.85 % had temporomandibular dysfunction syndrome, 85.71 % transmission hypoacusis and 64.28 % poor adaptation to pressure changes. Almost all the patients began treatment with a previous tympanogram and audiometry and the tests were repeated after this treatment, 71.42 % of the tympanograms and 85.75 % of the audiometries improving. A total of 92.85 % of the patients felt better subjectively. Conclusions. Most of the patients responded very well to specific exercises, with spectacular cases from the first sessions. Symptoms such as hypoacusis, poor adaptation to pressure changes, etc. improved. Rehabilitation of tubal dysfunction is effective, simple and does not need much equipment but does need great therapist-patient collaboration

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STUDY DESIGN: Prospective, open-label, comparative study, to assess the effects of sildenafil on blood pressure in a population of patients with spinal cord injury (SCI). OBJECTIVES: To determine the effect of sildenafil on blood pressure in patients with erectile dysfunction secondary to SCI by comparing changes in blood pressure in SCI patients with a neurologic level below T5 versus higher levels. To establish a relationship between the potential hypotensive effect and protective muscle spasm against blood pressure reduction. To assess the effects of age, complexity and duration of SCI on changes in blood pressure. To record any adverse effects occurring during the study. SETTING: Spinal Cord Injury Unit, Insular University Hospital of Gran Canaria, Canary Islands, Spain. SUBJECTS: In total, 22 male SCI patients aged 18 years or older with a history of SCI greater than 3 months in duration. METHODS: Patients with erectile dysfunction secondary to SCI were included in the study, without excluding patients with a neurologic level above 75 or asymptomatic low blood pressure. Patients with specific contraindications for use of the drug were excluded. A personal history was obtained, and the level of injury (ASIA/IMSOP scales of international standards), impairment grade (ASIA impairment scale), spasticity grade (modified Ashworth scale) and baseline sitting and supine blood pressure values were determined. A single dose of 50 mg of sildenafil was administered, and patients remained sitting at 45 degrees . Blood pressure was monitored every 10 min for 4 h and whenever the patient reported symptoms. Any relevant signs and symptoms manifested during the study period were also recorded. Analysis of the changes in blood pressure values was performed using a paired t-test in each group of patients according to neurologic level and spasticity grade. RESULTS: A decrease in blood pressure was observed in all patients, although patients with a level of injury at T5 or above and those with a complete SCI showed a less intense decrease (P<0.05). The spasticity grade of the patients was protective against the fall in blood pressure, as it was less significant in patients with grade 3 (P>0.1) than in those with grade 0. Adverse effects were few and transient. None were related to hypotension. CONCLUSION: Sildenafil caused a decrease in blood pressure in SCI patients with a neurologic level of injury above T5 and complete injuries (grade A), but did not have clinical implications in the patients studied. A higher spasticity grade tends to protect the patient from the fall in blood pressure. Age and duration of injury do not appear to influence this decrease.

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Uno de los motivos más frecuentes de consulta en Rehabilitación infantil es la enfermedad podológica. Las consultas sobre posibles alteraciones de los pies tienen su importancia por el alto número de éstas, por tratarse de niños con padres preocupados, y porque, en ocasiones, son alteraciones secundarias a afecciones neurológicas, infecciosas y traumáticas, entre otras. En la mayoría de los casos, sólo es necesario recomendar un calzado adecuado, sencillas normas posturales y realizar un seguimiento del paciente, por lo que consideramos fundamental el conocimiento del desarrollo evolutivo normal del pie infantil. En menos casos, será precisa la indicación de ejercicios, estiramientos, estimulación, calzados correctores y adaptaciones ortopédicas. Las indicaciones quirúrgicas quedan reducidas a un porcentaje mínimo de los pacientes. En esta revisión intentaremos familiarizarnos con el crecimiento y el desarrollo del pie normal y distinguir las alteraciones más frecuentes observadas en Rehabilitación; por último, se tratarán algunos aspectos del tratamiento de estas alteraciones (AU)

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La eficacia de las diversas estrategias terapéuticas dirigidas al tratamiento de las alteraciones funcionales de la articulación temporomandibular (ATM) sigue siendo hoy un tema muy controvertido. Esta articulación, cuya estructura básica es el disco o menisco articular, se emplea de forma permanente, es móvil, resistente, y su alteración más frecuente es la disfunción unilateral o bilateral de etiología multifactorial. El objetivo de este estudio es valorar la eficacia del método de tratamiento de la disfunción de la ATM mediante técnicas de rehabilitación. En este artículo presentamos los resultados de un estudio prospectivo donde se ha seguido durante un período de tres años a 90 pacientes tratados con una técnica de rehabilitación integral compuesta por técnicas de relajación y concienciación, cinesiterapia y electrotermoterapia específica, como tratamiento inicial o secundario al fracaso de otro tratamiento conservador basado en medios farmacológicos o férulas de descarga. Los pacientes se valoran mediante un protocolo que mide como resultado principal el restablecimiento de la funcionalidad en la ATM y el grado en que este objetivo se consigue. Los resultados muestran que tras el alta se recupera la funcionalidad de la ATM en más del 90 por ciento de los casos. El estudio apunta hacia la eficacia del tratamiento rehabilitador integral en las diversas disfunciones de la ATM. (AU)

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Mediante el presente trabajo realizamos una revisión actualizada de la enfermedad de Duchenne, dando especial relevancia al tratamiento rehabilitador. La enfermedad de Duchenne es la distrofia muscular más frecuente, con una incidencia del orden de 10 a 30 casos/100.000 habitantes. Se transmite de forma recesiva ligada al cromosoma X, y afecta a los hombres, pero es transmitida por las mujeres. La patogénesis no está clara y la sintomatología se inicia generalmente antes de los 2-3 años. Las manifestaciones clínicas más frecuentes son: la seudohipertrofia de pantorrillas, “marcha de pato” o en Trendelenburg, la dificultad para levantarse del suelo o de una silla, la hiperlordosis y el abdomen prominente, la cifoscoliosis, el desequilibrio entre grupos musculares agonistas y antagonistas, la deficiencia mental leve y las fracturas fáciles. Suele existir un retraso en el control del tronco en la bipedestación y la deambulación. Cuando el paciente logra la deambulación, lo hace con dificultad y caídas frecuentes; pierde la capacidad de deambulación a los 10-15 años, por lo que debe utilizar una silla de ruedas. Generalmente, estos pacientes fallecen antes de los 25 años por insuficiencia cardiorrespiratoria. El diagnóstico se establece después de la sospecha clínica mediante analítica, electromiografía y biopsia. El tratamiento rehabilitador es la única alternativa terapeútica para el “paciente Duchenne”, y se basa en una cinesiterapia general y específica respiratoria, balneoterapia, tratamiento ortopédico, terapia ocupacional e integración escolar (AU)

We present an update on Duchenne muscular dystrophy, focusing especially on rehabilitación therapy. This disease is the most common type of muscular dystrophy, with an incidence ranging from 10 to 30 cases per 100,000 population. It is an X-linked recessive disorder that is transmitted to male children by their mothers. The pathogenesis is unclear and the symptoms generally appear between the ages of 2 and 3 years. The most common clinical signs are calf pseudohypertrophy, duck gait or Trendelemburg, difficulty in rising from the floor or chair, hyperlordosis and prominent abdomen, kyphoscoliosis, imbalance between agonist and antagonist muscle groups, mild mental retardation and easy fractures. There is usually delayed trunk control on standing and walking. Walking, when achieved, is difficult and falls are frequent; the ability to walk is lost between the ages of 10 and 15 years, after which the child requires a wheelchair. These patients usually die before the age of 25 years due to cardiorespiratory failure. When clinically suspected, the diagnosis is established on the basis of laboratory analyses, electromyography and biopsy. Rehabilitation, the only therapeutic alternative for Duchenne patients, involves general kinesiotherapy, respiratory therapy, hydrotherapy, orthopedic treatment, occupational therapy and integration into school life (AU)

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Los cambios de la tensión arterial (TA) relacionados con la menopausia son difíciles de evaluar porque coinciden con el envejecimiento, aumento de peso, cambios en el estilo de vida y presencia de otros factores de riesgo cardiovascular. Pero, aunque aún en discusión, existen evidencias de que la deficiencia estrogénica puede inducir disfunción endotelial e hiperactividad simpática y potenciar el aumento de la presión sistólica relacionado con la edad. El tratamiento hormonal sustitutivo (THS) no aumenta la incidencia de hipertensión arterial (HTA) ni agrava la preexistente, en cambio, sí se evidencia aumento significativo de colesterol ligado a lipoproteínas de baja densidad (LDL), disminución de colesterol ligado a lipoproteínas de alta densidad (HDL), aumento de triglicéridos y disminución del fibrinógeno. En cualquier caso, no existe contraindicación para la utilización del THS en la mujer postmenopáusica con HTA. Ahora bien, es aconsejable, como afirma el Joint National Committee (JNC-VI), que a estas mujeres se les controle periódicamente la TA.Hoy por hoy, y mientras no se disponga de los resultados definitivos de estudios en marcha, el THS no está indicado para la prevención de cardiopatía isquémica en la mujer sana. Cuando se valore la decisión de instaurar o no THS a una mujer postmenopáusica, la prevención de la patología cardiovascular no ha de estar entre sus indicaciones. Las guías internacionales no diferencian en lo que respecta al tratamiento de la HTA entre sexos o estado hormonal, luego las recomendaciones son las mismas que en cualquier hipertenso. Se debe hacer especial hincapié en las medidas higiénico-dietéticas y en la restricción de sodio por la alta prevalencia de sal-sensibilidad, en la pérdida de peso en caso de coexistir obesidad, recomendar la utilización de los suplementos orales de calcio, ya que pueden tener un efecto aditivo con el tratamiento farmacológico antihipertensivo y ayudan a prevenir la osteoporosis. El ejercicio físico aeróbico colaborará a reducir el riesgo cardiovascular y a evitar la pérdida de calcio del hueso. Cualquier antihipertensivo podría ser utilizado en la mujer con THS, ya que no existen datos de que el tratamiento hormonal afecte a la eficacia o seguridad de estos medicamentos (AU)

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