Stroke - shoulder pain and upper limb function

Introduction: Stroke causes disability and pain, especially shoulder pain. Often, shoulder pain, has a not completely known mechanism and evolution.1,2 Objectives: Assess shoulder pain and its impact in upper limb function, in patients who had suffered a stroke within 6 months. Methods: Observational study. Included patients at discharge from an inpatient rehabilitation centre, from November 2019 until February 2020. Assessment was done using validated Portuguese versions of the Brief Pain Inventory (BPI) and Fugl Meyer Assessment Scale (FMAS). Results: Of 32 patients screened, 26 fulfilled the inclusion criteria, 7 were females (26,9 %), with mean age of 60,7±10 years. Mean values of BPI Severity and Interference were 3,2±1,6 and 2,4±1,8, respectively. The mean values of the FMAS Motor Function and Passive Articular Movement were 38,8±23,2 and 20,3±2,3, respectively. Analysing the association between both subscales of BPI and both Subscales of FMAS negative correlations were found to be statistically significant with a confidence interval of 95% but there was no correlation between BPI Severity and FMAS motor function. Six patients (23%) received a local injection for shoulder pain. Analysing both groups, BPI Severity and both subscales of FMAS showed a statistically significant difference (p values of 0,0083, 0,0031 and 0,0056, respectively) for a Wilcoxon/Kruskal-Wallis test with a confidence interval of 95%. Discussion/Conclusions: Patients with voluntary upper limb movements after a stroke tend to have less shoulder pain. Local injection was an effective intervention for shoulder pain. The greatest limitation of this study is the small sample size.

Right VI palsy revealing nasopharyngeal cancer (UCNT)

VI paralysis is a frequent and classic pathology in the clinical consultation of ophthalmology. The main difficulty is the diagnostic process (for the etiology). In young adults, be aware of the possibility of a tumor with the correlation of rapid imaging. UCNT is frequent in Morocco, its neurological symptoms are misleading because we do not always think of examining the nasopharynx properly in the event of damage to the cranial pairs. Improving the prognosis for this cancer requires early diagnosis.

Rehabilitation of spinal cord injury with autogenous stromal vascular fraction in dogs

Background: Spinal cord injury (SCI) is an unexpected, traumatic event, its consequences often persist for the rest of life. The neurological deficit caused by spinal cord (SC) injury is permanent, and conservative treatment can not completely restore neurological functions in animals. Repeated autogenous adipose-derived stromal vascular fraction (SVF) has been used to deliver MSCs, growth factors such as brain-derived neurotrophic factor, nerve growth factor, and neurotrophin-3 at the site of injury. Methods: In the present study, six dogs presented with SCI, were routinely examined based on standard neurological examination protocol and subjected to the survey radiography. Treatment plans differed as per the presentation of the case. Stable and physically responsive patients were selected for repeated autogenous SVF therapy for rehabilitation. Results: After conservative treatment in SCI, from the second week onwards, when patient supports or able to move affected area in relation to forequarter, the patients were administered repeated autogenous SVF therapy, which restored motor function in the form of intermittent weight-bearing on fetlock and/or posture change. Significance: Spinal cord damage either partial or complete is always an ailment related to neurological deficit of the affected body parts. The repeated administration of autogenous stromal vascular fraction therapy in combination of physiotherapy significantly reverse, the effects of neurological deficit and progressively restore posture and weight bearing on the affected hind quarter in dogs.

Reduction of drug-drug interaction and inappropriate prescription in polymedicated elderly who consult in the ambulatory

Introduction: Older adults or elderly people over 64 years of age are patients more vulnerable to suffering adverse events related to medication, and this can generate states of both physical and psychological discomfort, loss of autonomy, mental disorders, etc. Objectives: To analyze the drug-drug interaction and inappropriate prescription of drugs in the outpatient setting in the elderly and implement barriers to reduce this problem. Materials and methods: Quasi-experimental study, of the before after type. The Beers 2019 criteria were used to assess inappropriate drug prescribing. The Uptodate definition of drug-drug interactions and their classification were used. Results: 203 polypathological, sarcopenic elderly patients were studied. These patients attended the outpatient consultation during the 2016-2018 period. 99 patients participated in the pre-intervention and 104 in the post-intervention. The distribution by sex was: 110 (54.2%) women and 93 (45.8%) men. The mean age was 77.3 + 13.3 years. In the total sample analyzed before the intervention, 33 (33.3%) showed inappropriate prescription of drugs criteria. Drug interactions in the pre-intervention were present in 51 patients (51.5%). After the intervention that consisted of training doctors with the Beers criteria and editing a list with clinically relevant interactions in the elderly, which can cause adverse events, inappropriate prescription was reduced to 26 patients (25%), p = 0.05, and clinically relevant interactions were reduced from 51 (51.51%) to 12 (11.53%), p = 0.003. The association between inappropriate prescription and clinically relevant interactions is OR: 3.23 (95% CI 1.91-3.88). Conclusions: The proportion of patients with inappropriate prescription is within the ranges published by various authors as well as drug interactions, the intervention was good to reduce the two problems in this sample of patients.

Acupuncture and cupping alternative therapy in patients with acute low back pain

Introduction: acupuncture and cupping constitute an alternative therapy to alleviate different conditions, especially acute low back pain, which improves the level of satisfaction and impacts on the quality of life of patients who suffer from it. Objective: to evaluate the efficacy of treatment with acupuncture and cupping in patients with acute low back pain. Methods: a randomized phase III therapeutic clinical trial was carried out in patients who attended the Natural and Traditional Medicine service of the rehabilitation room of the Juan Manuel Páez Inchauthi Polyclinic, in the municipality of Moa, Holguín province, Cuba, in the period of July to December of the year 2017. The study universe consisted of 80 patients who attended the consultation; The sample was randomly selected and consisted of 60 patients in two study groups, group I, who received acupuncture treatment, and group II, with cupping, made up of 30 patients each. Both were diagnosed with post Bi syndrome. Results: men predominated in the study, with 63.3%, and study group II, with 66.7%. The age group from 40 to 49 years was the most affected. In both, the exogenous wind factor predominated. It was observed that the Bi wind syndrome is the most benefited with acupuncture therapy, as when the suction cup was applied. Conclusion: in both groups there was 100% effectiveness of acupuncture therapy and the cupping, in the improvement or cure of acute low back pain.

Latest perspectives of resistance training (RT) on muscle and fat in the physical medicine

For rehabilitation and sports medicine, resistance training (RT) has been known to increase muscle strength. Several latest reports showed the changes in muscle and fat tissues by RT and endurance training (ET). Systematic review and meta-analysis from 58 papers included about 3000 subjects, 45-60min session, 2.7 times a week and 5 months. As a result, RT group showed 1.46% reduction in body fat, which is equivalent to 0.55kg of fat mass. When one emphasizes the weight result by the scale, clinical effect of RT cannot be evaluated correctly, because RT brings increased muscle mass and decreased fat mass.

When age becomes a plus: Seniors and Cognitive Reserve

Cognitive Reserve alludes to gain, resistance, plasticity and is the functional correlative of neuroplasticity and a potential protection factor, which could explain why some patients may show the same pathology but quite different clinical manifestations. Among the activities considered as promoters are studies, work, physical and social activities. Although there are surveys or tables that seek to measure these factors and reflect this reserve in an index, this can be a quite reductionist strategy. Given the increasing ageing of the population, added to the active elders paradigm, programs addressed to seniors are carried out; it is important to consider that gains are accumulative and dynamism must be promoted from earlier ages. The sample for this work consisted of 30 seniors (60–87years) from the Region of Valparaíso, Chile. The CRIq was applied to the participants to measure the CR index and no differences were found between men and women. The purpose of this work is to describe the activities that promote reserve, carried out from 18 years onwards by 30 autonomous and cognitively competent seniors. It is held that it is not the type of activity that matters, but rather the frequency and the length of the execution period that turns into advantages for the persons. The data submitted reveal that seniors never failed to frequently execute some of the activities. That is, they had the habit of being active along their whole lives. This mechanism could be considered as a kind of dynamo where the greater input of promoting activities would make possible better conditions of the nervous system, but it does not have an easy storage as it is in continuous use. For this reason, gains depend on the active habit of execution, its early start, diversity of activities and permanence during the whole life span.