Human communication, the internet, medicine and its addictions

Communication amongst human beings is vital for the development and support of the human race. It is impressive how we have gone from smoke signals, carrier pigeons, ‘‘foot’’ or ‘‘horse’’ messengers, to land and air mail, fax, and telephones. However, nothing is as interesting and as incredible as communication through the internet and its derivations, like ‘‘social networks’’ and the use of the smartphone. This device allows the user to be connected with practically everybody, it even allows audio and video recording and to make commercial transactions. The question is, how does this impact health, science and medicine? The answer is not that simple, and we approach this topic in this issue of Medicina Universitari

Plantar Fasciitis—A Comparison of Treatment with Intralesional Steroids versus Platelet-Rich Plasma

Background: Many treatment options for plantar fasciitis currently exist, some with great success in pain relief. The objective of our study was to compare the use of intralesional steroids with platelet-rich plasma (PRP), using pain scales and functional evaluation, in patients with plantar fasciitis who did not respond to conservative treatment. Methods: A controlled, randomized, blinded clinical assay was performed. Patients were assigned to one of the two groups by selecting a sealed envelope. The steroid treatment group received 8 mg of dexamethasone plus 2 mL of lidocaine as a local anesthetic. The PRP treatment group received 3 mL of PRP activated with 0.45 mL of 10% calcium gluconate. All of the patients were evaluated at the beginning of the study, and at 2, 4, 8, 12, and 16 weeks post-treatment with the Visual Analog Scale (VAS), Foot and Ankle Disability Index (FADI), and American Orthopedic Foot and Ankle Society (AOFAS) scale. Results: The right foot was the most frequently affected foot (63%). The average age of the patients was 44.8 years (range, 24–61 years). All scales used (VAS, FADI and AOFAS) showed that the difference was not statistically significant between the two groups. Conclusions: We can conclude that the use of PRP is an effective treatment method for patients with plantar fasciitis who do not respond to conservative treatment because PRP demonstrates an efficacy equal to that of steroids. However, the cost and the time for preparation the PRP are two of the disadvantages of this treatment. (J Am Podiatr Med Assoc 107(6): 490-496, 2017

Evaluación de pacientes con fractura de radio distal tratados con fijación percutánea

En fracturas del radio distal existe una tendencia hacia la reducción abierta y fijación interna, sin embargo, el tratamiento mediante reducción cerrada y enclavamiento percutáneo continúa ofreciendo buenos resultados pero es necesaria una terapia física y rehabilitación temprana y adecuada. Material y métodos: Evaluamos a pacientes con fractura de radio distal tratados mediante reducción por maniobras y enclavamiento percutáneo, utilizamos escalas clínicas funcionales como la escala de DASH, la escala de muñeca de la Clínica Mayo y Escala Visual Análoga para valorar dolor. Los resultados de los pacientes fueron comparados a las 12 y 24 semanas. Así mismo comparamos a pacientes con o sin rehabilitación. Resultados: se evaluó a 60 pacientes con la escala DASH, en pacientes con rehabilitación obtuvieron 4.3 puntos, mientras que sin rehabilitación fue de 10.5 puntos (p = 0.00001), en la escala de la Clínica Mayo con rehabilitación tuvieron 86.7 puntos y sin rehabilitación tuvieron 77.8 puntos (p = 0.00001). El EVA no fue significativo. Conclusión: Todos los pacientes mostraron mejoría en sus escalas de evaluación clínica. Sin embargo, al comparar a pacientes con rehabilitación y sin rehabilitación la diferencia fue mayor en la escala de la Clínica Mayo y en la escala de DAS

A Comparison of Botulinum Toxin A and Intralesional Steroids for the Treatment of Plantar Fasciitis: A Randomized, Double- Blinded Study

Plantar fasciitis is the most frequent cause of chronic heel pain. This pathology generally presents in patients who are 40 years of age or older, overweight, sedentary, or engage in intense physical activity. 14,32 Because of its anatomic orientation and its tensile strength, the plantar fascia functions to prevent foot collapse. It is a piece of thick connective tissue that originates at the base of the calcaneus and extends distally to the phalanges. Stretching of the plantar fascia prevents the displacement of the calcaneus and the metatarsals and helps to maintain the medial longitudinal arch. The plantar fascia simulates a cable between the calcaneus and the metatarsophalangeal joints. The windlass mechanism described by Hicks 13 for the action of the plantar fascia explains that during dorsiflexion of the toes, the length of the plantar fascia is effectively shortened, causing an elevation of the arch. Extension of the toes increases the arc of tension with the metatarsophalangeal joints, similar to an axis or anchor point. Shortening of the plantar fascia that results from dorsiflexion of the hallux is the essence of the reel mechanism. When a complete fasciotomy is performed, this mechanism is lost, decreasing the stability of the arch and interfering with stability during the terminal stance phase. Methods: The patients were randomly divided into 2 groups according to the treatment received. The patients were evaluated over 6 months. The evaluation scores included the Visual Analog Scale (VAS), Maryland Foot and Ankle, Foot and Ankle Disability Index (FADI), and American Orthopaedic Foot and Ankle Society (AOFAS) score. Moreover, patients were instructed to perform plantar fascia stretching exercises over the course of the study. The final number of patients was 36, of whom 19 received BTX-A (10 men and 9 women) and 17 (6 men and 11 women) received steroids. Results: When compared to patients who received steroids, the patients who received BTX-A exhibited more rapid and sustained improvement over the duration of the study. Conclusion: A combination of BTX-A and plantar fascia stretching exercises yielded better results for the treatment of plantar fasciitis than intralesional steroids. Level of Evidence: Level I, therapeutic studies

Correlation between obesity and severity of distal radius fractures

Introduction: The incidence of obesity has increased significantly worldwide. Our hypothesis was that patients with obesity have a more severe distal radius fracture and we realized a study to evaluate this correlation between obesity and severity of distal radius fractures caused by low-energy injuries. Materials and methods: A total of 114 patients with distal radius fracture were examined in

The effect of intra-articular injection of autologous bone marrow stem cells on pain and knee function in patients with osteoarthritis

Abstract Aim: Management of osteoarthritis (OA) is basically symptomatic. Recently, stem cells (SC) have been used in the search for an optimum treatment. We decided to conduct a controlled clinical trial to determine if a single intra-articular injection of in vivo stimulated bone marrow SC could lead to an improvement in pain management and quality of life in patients with knee OA. Method: This was a prospective, open-label, phase I/II clinical trial to assess the safety and efficacy of a single intra-articular injection of autologous stimulated bone marrow stem cells (BM-SC) in patients with knee OA. Individuals of both genders older than 30 years with confirmed diagnosis of OA who signed informed consent were included in two groups: SC group received in vivo BM stimulation with subcutaneous administration of granulocyte colony stimulating factor (G-CSF). SC were obtained by BM aspiration and administered in a single intra-articular injection. The control group received exclusively oral acetaminophen. Visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were performed at 1 week, 1 month and 6 months in both groups. This trial was registered in ClinialTrials.gov NCT01485198. Results: A total of 61 patients were included. Socio-demographic characteristics, OA grades and initial scores were similar in both groups. The BM-SC group showed significant improvement in knee pain and quality of life during the 6-month follow-up. Conclusion: The study demonstrates feasibility and supports efficacy of a completely ambulatory procedure in treatment of knee OA. Key words: bone marrow, knee osteoarthritis, stem cells