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Existen diversas problemáticas que afectan la salud y el desempeño de un cuidador. El objetivo del presente estudio fue identificar la relación entre síntomas de depresión de los cuidadores primarios informales y la dependencia que perciben en la persona cuidada. El diseño del estudio fue no experimental, transversal y correlacional. La muestra fue no probabilística, intencional, de 259 cuidadores informales. Se utilizó el Cuestionario sobre la salud del paciente, Escala de Depresión (PHQ-8) y la Escala de Barthel, empleada para medir la capacidad de la persona para realizar 10 actividades básicas de la vida diaria. La edad promedio de los cuidadores de este estudio fue de 49.6 años, con predominio del sexo femenino, con 82.6 %; en el parentesco del cuidador, en su mayoría fueron hijas (38.2 %). El porcentaje de dependencia percibida por los cuidadores se ubicó en la categoría de dependencia moderada, con el 32.4 %. Los resultados muestran una correlación pequeña pero significativa (r = - 0.159, P = 0.010) entre dependencia y síntomas de depresión. El grupo de cuidadores de personas con dependencia severa presentó mayor sintomatología depresiva que sus pares cuidadores de personas con dependencia moderada (P = 0.014). Los cuida dores primarios informales reportaron mayor sintomatología depresiva cuando percibieron más dependencia en sus familiares con enfermedades crónicas.

Subtalar arthrodesis is a surgical stabilization procedure in the isolated pathology of the subastragaline joint that does not respond to conservative treatment, its goal is to obtain a solid fusion of the joint to eliminate or improve pain and function, normalizing the distribution of foot loads and alignment of the foot. There are studied variables that interfere with the surgical outcome of patients treated with subtalar arthrodesis such as: smoking, age, sex, osteoarthritis, BMI, rehabilitation, osteosynthesis material and surgical technique.To know the prognostic factors associated with the results of subastragaline arthrodesis.Retrospective, longitudinal, descriptive study with review of files and conducting descriptive statistics of treated cases of August 2012- Jan 2016 with subtalar arthrodesis to identify predictive factors affecting the outcome.29 feet were analyzed, reporting a successful arthrodesis in 21 cases (72.4%), in 82.8% the surgical technique was adequate. The complication rate was 20.7% On the AOFAS scale 55.2% were reported as a very good result, 27.6% good and only 17.2% regular. The factors associated with good outcome were sex and postoperative rehabilitation.The subtalar arthrodesis provides improvement in pain and alignment, at our service this procedure presents a success rate of 72.4%, among the factors associated with statistical significance was rehabilitation and sex.La artrodesis subastragalina o astrágalo calcánea, es un procedimiento de estabilización quirúrgica en la patología aislada de la articulación subastragalina que no responde a tratamiento conservador, su objetivo es obtener una fusión sólida de la articulación para eliminar o aminorar el dolor y mejorar la función, normalizando la distribución de cargas del pie y su alineación. Existen variables estudiadas que interfieren en el resultado quirúrgico de los pacientes tratados con artrodesis subastragalina como son: el tabaquismo, edad, sexo, artrosis, IMC, rehabilitación, material de osteosíntesis y la técnica quirúrgica.Conocer los factores pronósticos asociados a los resultados de la artrodesis subastragalina.Estudio retrospectivo, longitudinal, descriptivo con revisión de expedientes y elaboración de estadística descriptiva de casos tratados de Agosto de 2012 a Enero de 2016 con artrodesis subastragalina para identificar factores pronósticos que afecten el resultado.Se analizaron 29 pies, reportándose una artrodesis exitosa en 21 casos (72.4%), en 82.8% la técnica quirúrgica fue adecuada. La tasa de complicaciones fue de 20.7%. En la escala de la Sociedad Ortopédica Americana de Pie y Tobillo (AOFAS) 55.2% se reportaron como resultado muy bueno, 27.6% bueno y sólo 17.2% regular, se encontraron como factores asociados el sexo y la rehabilitación postoperatoria al buen resultado.La artrodesis subastragalina brinda alivio en cuanto al dolor y mejoría en alineación, en nuestro servicio este procedimiento presenta una tasa de éxito de 72.4%, entre los factores asociados con significancia estadística fue la rehabilitación y el sexo.

Resumen Introduccion La diabetes mellitus es uno de los principales problemas de salud a nivel mundial debido a sus altos indices de incidencia, prevalencia, los costes que genera a la economia de cada pais, las complicaciones que derivan de esta y los altos indices de mortalidad. Esta enfermedad concierne a la familia, ya que los cambios en el estilo de vida del paciente demandan apoyo familiar, orientacion en la toma de decisiones y acciones necesarias para el adecuado manejo de la enfermedad. Asociado a lo anterior, algunos estudios han demostrado los beneficios de un adecuado automanejo en enfermedades cronicas, que implica: adherencia al tratamiento, reconocer sintomas de la enfermedad, habitos de alimentacion saludable, ejercicio y visitas al medico. Objetivo Analizar la relacion entre el automanejo y la percepcion de funcionalidad familiar en personas con diabetes tipo 2 que reciben atencion en los centros de salud de la Jurisdiccion n. 2 de Tampico, Tamaulipas, Mexico. Metodos Estudio transversal-correlacional, muestreo no probabilistico por conveniencia con una N = 100. Se aplicaron los instrumentos Partners in Health Scale y APGAR familiar. Resultados Los resultados muestran una correlacion significativa entre el APGAR familiar total y el indice de automanejo. Conclusiones Con base en los resultados se concluye que la relacion entre automanejo y percepcion de funcionalidad familiar debe ser explorada con mayor detalle, ya que podria ser un elemento de suma importancia en el diseno de estrategias de combate a la diabetes, no exclusivamente desde la labor de la enfermeria sino en colaboracion con el equipo multidisciplinario de salud.

Introducción: Las personas con diabetes e hipertensión experimentan con mayor frecuencia sintomatología depresiva, lo cual contribuye a un inadecuado automanejo de la enfermedad, que implica tareas como: la toma de la medicación, asistir a las consultas médicas, el conocimiento de signos y síntomas, además de la toma de decisiones. Objetivo: Por lo anterior, el objetivo de este trabajo es identificar la relación entre automanejo en general y sus dimensiones con síntomas depresivos en personas con diabetes e hipertensión. Método: Estudio transversal-correlacional con n=205 pacientes con diagnóstico de diabetes (100) e hipertensión (105). Muestreo no probabilístico por conveniencia. Se utilizó la estadística descriptiva y r de Pearson. Se aplicaron los instrumentos Partners in Health (PIH) y The Patient Health Questionnaire (PHQ-8). Resultados: Se encontró correlación estadísticamente significativa entre la sintomatología depresiva y el automanejo (r=-0.308 ρ

espanolIntroduccion: Dado el caracter prioritario de atencion a las enfermedades no transmisibles, la Organizacion Mundial de la Salud propuso el Modelo de Cuidados Cronicos. En este modelo incluye el automanejo como un elemento principal en el combate de dichas enfermedades. Objetivo: identificar las variables predictoras del comportamiento de automanejo en usuarios con Diabetes Mellitus, Hipertension Arterial y Obesidad. Metodos: La muestra no probabilistica e intencional fue de 386 usuarios de la Secretaria de Salud de Tamaulipas (Ciudad Victoria y Tampico). El diseno de estudio fue no experimental, transversal. Resultados: casi la mitad (42.2%) de los participantes con ECNT refieren sintomas de trastorno depresivo en el continuo de leve a grave, la categoria que obtuvo mayor porcentaje de IMC fue sobrepeso con 33.2% y mas de un tercio de la poblacion (36.8%) percibe algun grado de disfuncion familiar. Asi tambien se aplico un analisis de Regresion Lineal Multiple con el metodo de pasos, el modelo indica que fueron siete predictores del comportamiento de Automanejo (varianza explicada R2=.325); la variable autoeficacia fue el mas importante (β=38) y el apoyo social percibido el predictor con carga mas baja (β=.10). Conclusiones: estos predictores representan elementos importantes para ampliar el conocimiento y entender el comportamiento del automanejo, area que es promovida en el modelo de atencion a cronicos de la Organizacion Mundial de la Salud y en la actualidad es liderada por el area de enfermeria. EnglishIntroduction: Considering the priority regarding the attention of non transmissible diseases, the World Health Organization proposed the Chronic Care Model which, by encompassing self-management as one main element, is intended to address these diseases. Objective: To identify predictor variables related to behavior on self-management among patients with Diabetes Mellitus, Hypertension, and Obesity. Methods: The intentional and non probabilistic simple included 386 patients from the Health Secretariat in Tamaulipas, Mexico (Ciudad Victoria and Tampico). The study design was non experimental and transversal. Results: About half (42.2%) of the participants with Chronic Non Transmissible diseases referred having depressive disorder ranging from mild to severe. Regarding the BMI, 33.2% showed overweight. Moreover, 36.8% perceived some degree of family dysfunction. A Multiple Linear Regression was calculated. The model indicated that there were seven predictors of the behavior on self-management (explained variance R 2 =.325); being self-efficacy the most important (β=38), and perceived social support the lowest in load (β=.10). Conclusions: These predictors represent important elements to consider when building on the knowledge and understanding the behavior related to self-management, an area which is highlighted in the Chronic Care Model of the World Health Organization, particularly within nursing. portuguesIntroducao: Dado o carater prioritario de atencao as doencas nao transferiveis, a Organizacao Mundial da Saude propos o Modelo de Cuidados Cronicos. Neste modelo inclui-se o automanejo como um elemento principal no combate de tais doencas. Objetivo: identificar as variaveis preditoras do comportamento de automanejo em usuarios com Diabetes Mellitus, Hipertensao Arterial e Obesidade. Metodos: A amostra nao probabilistica e intencional foi de 386 usuarios da Secretaria de Salud de Tamaulipas (Ciudad Victoria e Tampico). O desenho de estudo foi nao experimental, transversal. Resultados: quase a metade (42.2%) dos participantes com ECNT referem sintomas de transtorno depressivo no continuo de leve a grave, a categoria que obteve maior porcentagem de IMC foi sobrepeso com 33.2% e mais de um terco da populacao (36.8%) percebe algum grau de disfuncao familiar. Assim tambem se aplicou uma analise de Regressao Linear Multipla com o metodo de passos, o modelo indica que foram sete preditores do comportamento de Automanejo (variância explicada R2=.325); a variavel autoeficacia foi a mais importante (β=38) no apoio social percebido e o preditor com carga mais baixa (β=.10). Conclusoes: estes preditores representam elementos importantes para ampliar o conhecimento e entender o comportamento de automanejo, area que e promovida no modelo de atencao a cronicos da Organizacao Mundial da Saude e na atualidade e liderada pela area de enfermagem.

Introduction In this study, we determined normal levels of dysferlin expression in CD14+ monocytes by flow cytometry (FC) as a screening tool for dysferlinopathies. Methods Monocytes from 183 healthy individuals and 29 patients were immunolabeled, run on an FACScalibur flow cytometer, and analyzed by FlowJo software. Results The relative quantity of dysferlin was expressed as mean fluorescence intensity (MFI). Performance of this diagnostic test was assessed by calculating likelihood ratios at different MFI cut-off points, which allowed definition of 4 disease classification groups in a simplified algorithm. Conclusion The MFI value may differentiate patients with dysferlinopathy from healthy individuals; it may be a useful marker for screening purposes. Muscle Nerve 54: 1064-1071, 2016.

The Partners and Health Scale Instrument has been validated in several countries, however, it has just been applied in Spanishspeaking countries to people with chronic conditions, allowing a self-management evaluation with wide clinical application and research. It is the first time it has been applied in elderly patients (60 or older) in Spanish-speaking countries. This study shows the instrument validity in this population - users of health services of the Ministry of Health in Lima-Peru. An intentional non-probabilistic sample of 152 subjects with Construction Validity was performed: 1) Factor Analysis and 2) Confirmatory with structural equations and Reliability: Cronbach’s Alpha presents construct validity in three factors with an explained variance of 0.597. From the results of the goodness of fit model measures obtained by AMOS 24.0 and FACTOR 10.10, it can be seen that 6 of the 7 measures obtained are acceptable. The reliability with the Cronbach Alpha coefficient was 0.845. Although the model may have high-quality goodness of fit, the possibility of another alternative model that meets a better fit cannot be rejected; the results allow us to conclude that this Instrument presents validity and reliability in the evaluation of self-management within three factors.

Charcot arthropathy is defined as an articular degenerative, chronic, progressive disease that affects one or more peripheral joints, develops as a result of a failure in the normal sensory perception (pain and proprioception) in the innervation of joints located in the foot and ankle, is characterized by destructive bone lesions without the presence of infection. Neuropathy is directly associated with diabetes mellitus type 1 and 2. Surgery is indicated when there is severe involvement of soft tissue, foot joints are unstable, at the presence of chronic or recurrent ulcers or when the foot and ankle can not fit to a normal shoe, and had limitation to perform activities of daily living.Charcot arthropathy is defined as an articular degenerative, chronic, progressive disease that affects one or more peripheral joints, develops as a result of a failure in the normal sensory perception (pain and proprioception) in the innervation of joints located in the foot and ankle, is characterized by destructive bone lesions without the presence of infection. Neuropathy is directly associated with diabetes mellitus type 1 and 2. Surgery is indicated when there is severe involvement of soft tissue, foot joints are unstable, at the presence of chronic or recurrent ulcers or when the foot and ankle can not fit to a normal shoe, and had limitation to perform activities of daily living.observational, prospective, transversal, descriptive.patients diagnosed with Charcot neuropathy type 3a of Brodsky. Surgically treated by ankle arthrodesis with an intramedullary blocked nail, from January 2010 to August 2015.16 patients were analyzed. Preoperative AOFAS score was 35.0 ± 5.2 points. Postoperative follow-up period of 4 years to 7 months. Postoperative AOFAS scale showed an improvement of 40 points (p = 0.0001).The proposed treatment allows bone stabilization, resulting in a full foot plantar support and decreases the occurrence of chronic ulcers that are difficult to treat, and is an alternative method that avoids lead to amputation.La artropatía de Charcot se define como un padecimiento articular degenerativo, crónico y progresivo que se caracteriza por lesiones óseas destructivas sin presencia de infección. La neuropatía está asociada directamente con la diabetes mellitus tipo 1 y 2. La cirugía está indicada cuando existe compromiso de partes blandas, inestabilidad de las articulaciones del tobillo y pie, cuando se desarrollan úlceras recurrentes o no es posible adecuar el tobillo o el pie a un calzado normal o en los pacientes que presentan deformidad severa, úlceras o dolor crónico y limitación para realizar las actividades de la vida diaria. El presente es un trabajo observacional, prospectivo, transversal y descriptivo de pacientes con diagnóstico de neuroartropatía de Charcot tipo 3a de Brodsky tratados quirúrgicamente mediante artrodesis de tobillo con clavo centromedular retrógrado bloqueado, del 1o de Enero de 2010 al 31 de Agosto de 2015. Se analizaron 16 pacientes. En el preoperatorio la media de la escala de AOFAS fue de 35.0 ± 5.2 puntos. Un seguimiento postoperatorio de cuatro años con un mínimo de siete meses. En el postoperatorio la escala de AOFAS mostró un incremento de 40 puntos hacia la mejoría (p = 0.0001). La técnica revisada logra la estabilización ósea, resultando en un pie con apoyo plantígrado que disminuye la aparición de úlceras crónicas y mejora el desarrollo en las actividades de la vida cotidiana.

Bone infection and nonunion are the main orthopedic and traumatic complications whose treatment remains a challenge because multiple factors are involved in the rate of failures when you try to correct them. Knowing these factors were the problem that caused the research through a prospective longitudinal study of 83 patients of 43.3 ± 16.1 years old. They were treated for aseptic and septic nonunion, osteomyelitis, osteitis, malunion or infected joint replacement. The cases were classified with or without postoperative complications and outcome related to systemic and local factors taken prognostic model Cierny-Mader as factors affecting immune surveillance, metabolism and local vascularization. For bivariate analysis of data Χ² it was applied or where appropriate Fishers exact test; for multivariate analysis model not conditional binary logistic regression method was applied Wald backward to select the significant prognostic factors. The alpha error was set 0.05. General complications occurred in 51.8% of cases. Local factors (lymphedema, arteritis, venous insufficiency, loss of skin) with an OR of 5.0 (95% CI 1.0-24.9, p = 0.03), septic nonunion with OR of 5.0 (95% CI 1.9-13.0, p = 0.001) and segmental fractures with an OR of 3.2 (95% CI 0.8-13.0, p = 0.07) were the prognostic factors identified in the bivariate analysis; however, the logistic regression only selected as the septic pseudoarthrosis as a significant factor. It is necessary to detect and if necessary control or eliminate those factors that can directly affect poor postoperative results.La infección ósea y la seudoartrosis son las principales complicaciones ortopédicas en cuyo tratamiento intervienen múltiples factores en la tasa de falla al tratar de corregirlas. Conocer estos factores fue el problema que originó la investigación a través de un estudio longitudinal y prospectivo de una cohorte histórica de 83 pacientes de 43.3 ± 16.1 años de edad tratados por seudoartrosis asépticas y sépticas, osteomielitis, osteítis, consolidación viciosa o prótesis infectadas, el desenlace se relacionó con los factores pronósticos sistémicos y locales tomados del modelo de Cierny-Mader como factores que afectan la vigilancia inmunológica, el metabolismo y la vascularización local. Para el análisis bivariado se aplicó Χ² o el test exacto de Fisher; para el análisis multivariado se aplicó el modelo de regresión logística binaria no condicional con método de Wald hacia atrás para seleccionar los factores pronósticos significativos. El error alfa se fijó 0.05. Las complicaciones se presentaron en 51.8% de los casos. Los factores locales (linfedema, arteritis, insuficiencia venosa y pérdida de piel) con una OR de 5.0 (IC 95% 1.0-24.9, p = 0.03), las seudoartrosis sépticas con OR de 5.0 (IC 95% 1.9-13.0, p = 0.001) y fracturas segmentarias con OR de 3.2 (IC 95% 0.8-13.0, p = 0.07) fueron los factores pronósticos identificados en el análisis bivariado; sin embargo, la regresión logística sólo seleccionó como factor significativo a las seudoartrosis sépticas. Es necesario detectar y en su caso controlar o eliminar dichos factores que pueden incidir directamente en malos resultados postquirúrgicos.

"Different methods are available to evaluate the degree of bone healing. A good choice involves employing optical techniques with infrared light to eval - uate the progress of bone consolidation. Because infrared light is absorbed in liquids and reflected in solids, it is possible to assess bone consolidation progress using an incident light source and a coupled photo sensor. We used a 940-nm light source that is capable of reaching bone to determine the degree of bone consolidation. Five New Zealand White rabbits were used according to the NOM-062-ZOO99 standard. In each animal, a fracture was generated in the left tibia, and the fragments were fixed using an external fixator constructed with Kirschner nails and dental acrylic cement. Progress in bone consolidation was evaluated at days 7, 23, and 34 after surgery. A linear dependence was observed between the days elapsed and the reflection of the infrared light."

In this study, we determined normal levels of dysferlin expression in CD14Monocytes from 183 healthy individuals and 29 patients were immunolabeled, run on an FACScalibur flow cytometer, and analyzed by FlowJo software.The relative quantity of dysferlin was expressed as mean fluorescence intensity (MFI). Performance of this diagnostic test was assessed by calculating likelihood ratios at different MFI cut-off points, which allowed definition of 4 disease classification groups in a simplified algorithm.The MFI value may differentiate patients with dysferlinopathy from healthy individuals; it may be a useful marker for screening purposes. Muscle Nerve 54: 1064-1071, 2016.

Conservative surgery and reconstruction with an unconventional prosthesis are indicated for tumors of the humerus without neurovascular compromise, as they help preserve shoulder, elbow and hand function. The humerus is the third most frequent site of benign, aggressive, malignant and metastatic tumors that cause functional limitation or limb loss.Patients with a bone tumor of the humerus without neurovascular involvement that met the inclusion criteria. Unconventional, uncemented RIMAG prosthesis with diaphyseal fit and locking bolts.39 patients with intraarticular type I tumors according to the Malawer and Enneking classification were treated with tumor resection and reconstruction with an unconventional prosthesis and soft tissues.Patients enrolled included 18 females and 21 males ages 12-72 years with tumors such as: giant cell tumors (14), osteosarcomas (7), metastasis (7), chondrosarcomas (6), Ewing's sarcomas (2), chondroblastoma (2) and aneurysmatic bone cyst (1). Twelve patients died due to systemic disease and the remaining patients survived. Surgical margins were broad, with humeral resection between 100 and 230 mm. Functional results were assessed according to the Muscoloskeletal Tumor Society score as 13 excellent, 16 good, 5 failures and 5 poor.The resection level does not restrict the placement of this prosthesis, which permits future revisions. An appropriate result depends on the resection size and the preserved shoulder musculature and it is not limited by the size of resection, thus improving patients' disability.

To assess the functional efficacy of the RIMAG unconventional hip prosthesis in cancer and non-cancer patients.Functional analysis of 38 patients with RIMAG arthroplasty, using the Musculoskeletal Tumor Society Scoring System and including the following: functionality versus histologic diagnosis (5 malignancies, 3 metastases, 14 giant cell tumors (GCT), 8 with other benign tumors, and 8 had no tumor), age (40.4 +/- 19.1 years), sex (24 females, 14 males), postoperative follow-up (34.7 +/- 31.3 months). Analysis of intraoperative, immediate and late complications, time to weight bearing, gait and work or social reintegration were also assessed.Global mean of ideal functionality was 65.6 +/- 23.2%. Age was negatively correlated with the functionality rate (r = -0.507, p = 0.001); significant difference with the histologic diagnosis: malignant tumors 54.8, metastasis 58.6, giant cell tumor 25.6, other benign tumors 34.2, non-tumor causes 56.6 (p = 0.001). When functionality means were adjusted for age with a covariance analysis, better percentages were found for benign tumors (79.2 +/- 6.8%) and giant cell tumors (76.4 +/- 6.3%), less functionality for non-tumor causes (45.7 +/- 7.6%), and intermediate percentages for malignant tumors and metastasis (p = 0.03). Intraoperative complications occurred in 4 cases (28.6%), immediate in 3 (7.8%), late in 15 (39.4%); 62.5% of patients started immediate weight bearing, 92.1% resumed their usual activities after surgery.The reconstruction of the proximal femur with RIMAG is a safe and reliable treatment option, with complication rates below the ones reported in the literature. Satisfactory results were obtained, with high functional rates for benign tumors, and low rates in older patients, malignant tumors and metastasis.

To determine the prognosis factors in Mexican patients with Bell's palsy.We designed a prospective, longitudinal, descriptive, and observational analysis. Two hundred and fifty one patients diagnosed with Bell's palsy at the National Institute of Rehabilitation were included. We studied the sociodemographic characteristics, seasonal occurrence, sidedness, symptoms, and therapeutic options to determine the prognostic factors for their recovery.Thirty-nine percent of patients had a complete recovery and 41.5% had an incomplete recovery. Marital status, gender, etiology, symptoms, sidedness, House-Brackmann grade, and treatments did not represent significant prognostic factors for recovery. Age40 years (OR = 2.4, IC 95% 1.3-4.3, p = 0.002) and lack of physical therapy (OR = 6.4, IC 95% 1.4-29.6, p = 0.006) were significant prognostic factors for incomplete recovery. Familial palsy resulted to be a protective prognostic factor against an incomplete recovery (OR = 0.54, IC 95% 0.28-1.01, p = 0.039). This protection factor was only significant in female patients (OR = 0.41, p = 0.22) but not in male patients (OR = 1.0, p = 0.61).The proportion of cases with incomplete recovery was high. The age40 years and lack of physical therapy were the only significant prognostic factors for an incomplete recovery.

The cerebral palsy has the first place of physical handicap in children (type spastic, 88%). Tizanidine imidazole derivative is centrally acting as a a2-adrenergic agonist.To demonstrate clinically the effectiveness of tizanidine in the decrease of the spasticity.We assigned randomly in a double blind study 10 children treated with tizanidine (0.05 mg/kg/day) and 30 with placebo for a 6-month period, after which they were unified in the group of tizanidine. The dependent variables were spasticity, Ashworth scale, posture tone scale, reflex scale and liver function test.The spasticity and the reflex decreased in the group of tizanidine an 78.85% in comparison with a 7.64% in the group of placebo (p = 0.0001); in the monitoring of 6 months 35 patients reduced this to 78.2% (p= 0.0001). The duration of effectiveness of tizanidine in four patients was two months and they never returned to their appraisal basal. Without reported adverse effects, the liver function test remains normal.Tizanidine produces a significant reduction of the spasticity in children without adverse effects, having a high percentage of acceptance to the prescribe dose.

Patellar complications during total knee arthroplasty (TKA) with and without prosthesis has been reported with great variability in the rates of patellar complications and has been noted by different authors. We decided to perform a meta-analysis study to find possible differences among them by measuring the effects of magnitude (EM), the rate risks (RR), and the number of patients (NP) who require this treatment. We found that in studies that include small samples, the aleatory errors are greater than those with larger samples, so the first would not be considered to estimate the effect of magnitude against control groups (without patellar prosthesis). When we carried out correct comparisons between these groups, the percentage of complications in the patellar group were reduced. We also see that the differences in patellar complications reported by different authors with a similar large number of samples are due to different levels of expertise in the surgical procedure employed. We conclude that a meta-analysis study will be necessary in Orthopedics.

Introduccion. La paralisis cerebral infantil ocupa el primer lugar de discapacidad (tipo espastico, 88%). La tizanidina es un imidazolico de accion central y agonista que actua como a2-adrenergico. Objetivo. Demostrar clinicamente la efectividad de la tizanidina en la disminucion de la espasticidad. Pacientes y metodos. Por asignacion aleatoria en estudio doble ciego, se trataron durante 6 meses 10 ninos con tizanidina (0,05 mg/kg/dia) y 30 con placebo, los cuales posteriormente se unificaron en el grupo de la tizanidina. Las variables dependientes fueron la espasticidad, la escala de Ashworth, la escala del tono postural, los reflejos y las pruebas de funcionamiento hepatico. Resultados. La espasticidad y los reflejos fueron sistematicamente menores en el grupo de la tizanidina, de manera que la espasticidad se redujo en un 78,85% frente al 7,64 % con el placebo (p = 0,0001); en el seguimiento de seis meses de los 35 pacientes se redujo un 78,2% (p = 0,0001). La duracion de la efectividad de la tizanidina en cuatro pacientes fue de dos meses y estos nunca regresaron a su valoracion basal. No se observaron efectos adversos ni la elevacion de enzimas hepaticas. Conclusiones. La tizanidina produce una reduccion significativa de la espasticidad en ninos, sin efectos adversos y con un alto porcentaje de aceptacion en las dosis prescritas.