Pediatric musculoskeletal disorders: Inclusion of Manual Therapy

Sr. Editor

Nos es grato saludarle. Hemos leído con sumo interés la carta: Prevención de dolor lumbar en niños en etapa escolar,¹ ya que nos parece de vital importancia el trabajo interdisciplinario en la prevención y atención primaria de estas disfunciones, por ende las felicitaciones del caso por la propuesta y las ideas planteadas.

De tal manera creemos importante abordar esta temática ya que las disfunciones musculoesqueléticas son un problema frecuente en la salud pública, siendo uno de los principales motivos por el que se solicita asistencia sanitaria, siendo la prevalencia en niños y adolescentes comparable a la de adultos,² además de añadir que varios autores han informado que el dolor de espalda, consecuencia de estas disfunciones, en la infancia y adolescencia se asocia con dolor de espalda en un futuro.²

Por lo antes mencionado, brindamos una alternativa, que vendría a ser la Terapia Manual Ortopédica, ya que viene brindando mucha eficacia en el abordaje de estas disfunciones, además no solo en estas, sino también en disfunciones de diversos sistemas.² Esta especialidad de la Fisioterapia y/o Kinesiología, establece un parámetro básico y de suma importancia que es el razonamiento clínico, cuya principal premisa es el abordaje biopsicosocial del paciente,³ este se refiere al manejo integral de la disfunción y las causas que llevaron a esta, es decir, que no solo brinda un análisis de la zona disfuncional sino que analiza todos los factores biomecánicos implícitos en esta, analizando concienzudamente las estructuras y diseñando un plan específico para la función que realiza el paciente, siendo principalmente en esta población la relación entre la postura en sedente y el mobiliario escolar (mesa y silla).¹

Esta propuesta de abordaje en pacientes pediátricos y adolescentes, está recibiendo mayor atención en esta última década, tenemos además demonografías y comentarios, muchas ideas presentadas en publicaciones que tratan esta temática⁵ y su consecuente trabajo interdisciplinario, orientado siempre a mejorar los abordajes en pos del paciente.

Por consiguiente, el trabajo de atención primaria del Pediatra con el Fisioterapeuta de la especialidad, sería bastante benéfico para el paciente y sus implicancias a largo plazo tales como las disfunciones posturales y su consecuente dolor músculo esquelético, pudiendo lograr una educación adecuada del paciente, familiares y su entorno, fomentando la prevención de disfunciones mas complejas y degenerativas en los pacientes pediátricos, trayendo así cambios a mediano y largo en la salud pública de su país.

Fuente: Archivos argentinos de pediatría

URL: http://hdl.handle.net/10757/555444

An unidentified cluster of infection in the Peruvian Amazon region

Introduction: Bartonella bacilliformis is the etiological agent of Carrion’s disease, which is a neglected disease linked to people in low-socioeconomic populations in Andean valleys. An outbreak of B. bacilliformis was reported in a rural area of the Peruvian Amazon region. The aim of this study was to characterize this outbreak using molecular techniques. Methodology: Fifty-three blood samples from patients diagnosed with Carrion’s disease were analyzed by molecular tools, using both a Bartonella-specific polymerase chain reaction (PCR) and an universal PCR, both based on 16S rRNA gene amplification. Additional water samples from the area were also analyzed. Results: Unexpectedly, the samples were positive only when the universal PCR was used. Although environmental contamination cannot be ruled out, the results showed that Sphingomonas faeni was the possible causative agent of this outbreak, and that water was the most feasible infection source. Conclusions: Diagnosis by clinical criteria or microscopy may lead to misdiagnosis. There is a need to include molecular tools in the routine diagnosis of febrile syndromes, including Carrion’s disease.
Source: The Journal of Infection in Developing Countries
URL: http://hdl.handle.net/10757/555445

Prevalence of ideal cardiovascular health in Peru: The cronicas cohort study

Background: American Heart Association 2020 Impact Goal focuses on promotion of health and control of cardiovascular risk. We aimed to determine the prevalence of Ideal Cardiovascular Health in Peru. Methods: Ideal Cardiovascular Health is the presence of 3 ideal health factors (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/ <80 mm Hg, and untreated fasting plasma glucose <100 mg/dL) and 4 ideal health behaviors (never smoker, body mass index <25 kg/m2, high physical activity, and fruit and vegetable consumption >3 times/day). Data from the CRONICAS longitudinal study, an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings. Results: 3058 of 3618 (84.5%) of the CRONICAS cohort participants had complete information for analysis. Figure 1 shows the agestandardized prevalence estimates of ideal, intermediate and poor health metrics. No one had all 7 metrics; only 48 (15.7%) had 6 ideal health metrics and 650 (21.3%) had ≤ 1 ideal health metric. Compared to urban Lima, living in rural Puno was associated with more Ideal Cardiovascular Health (OR 2.09, 95% CI 1.49-2.91) and rural Tumbes was less ideal (OR 0.54, 95% CI 0.39-0.76) after adjusting for sex, age, education and wealth index. Conclusion: There is an alarmingly low prevalence of Ideal Cardiovascular Health in Peru and the metrics with the greatest potential for improvement are health behaviors, including diet quality, physical activity and body weight.
Source: The Journal of the American College of Cardiology
URL: http://hdl.handle.net/10757/555446

How geography influences complex cognitive ability

Evolutionary explanations for geography's influence on complex cognitive ability (CCA) imply
virtually immutable components of between-nation IQ differences. Their weight vis-à-vis the
weight of situational components was evaluated through an analysis of a 194-country data set.
Additive effects of absolute latitude (AL) and longitudinal distance from Homo sapiens' cradle
(LDC) explain Northeastern Asian higher, Sub-Saharan African lower CCAs. AL exerts cognitive
influence directly and through socioeconomic development and evolutionary genetics whereas
LDC does through evolutionary genetics; however, this occurs differently in Africa-Near East-
Europe and elsewhere. The findings are understood assuming supremacy of contemporary UVB
radiation → hormonal and climatic → socioeconomic mediators of the AL–CCA linkage whose
effects are moderated by heterogeneous genetic and cultural adaptations to radiation and climate.
Geography's cognitive effects are dynamic and public-policy actions may modify them.
Source: Intelligence
URL: http://hdl.handle.net/10757/554348

Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy.
Source: PLoS ONE
URL: http://hdl.handle.net/10757/552402