Carlos Vallbona

Response of pain to static magnetic fields in postpolio patients: A double-blind pilot study

OBJECTIVE To determine if the chronic pain frequently presented by postpolio patients can be relieved by application of magnetic fields applied directly over an identified pain trigger point. DESIGN Double-blind randomized clinical trial. SETTING The postpolio clinic of a large rehabilitation hospital. PATIENTS Fifty patients with diagnosed postpolio syndrome who reported muscular or arthritic-like pain. INTERVENTION Application of active or placebo 300 to 500 Gauss magnetic devices to the affected area for 45 minutes. MAIN OUTCOME MEASURE Score on the McGill Pain Questionnaire. RESULTS Patients who received the active device experienced an average pain score decrease of 4.4 +/- 3.1 (p < .0001) on a 10-point scale. Those with the placebo devices experienced a decrease of 1.1 +/- 1.6 points (p < .005). The proportion of patients in the active-device group who reported a pain score decrease greater than the average placebo effect was 76%, compared with 19% in the placebo-device group (p < .0001). CONCLUSIONS The application of a device delivering static magnetic fields of 300 to 500 Gauss over a pain trigger point results in significant and prompt relief of pain in postpolio subjects.

Neuromuscular fatigue in prostate cancer patients undergoing radiation therapy

OBJECTIVE To determine the etiology of fatigue in prostate cancer patients undergoing radiation therapy (RT). METHODS Thirteen prescreened men (60 to 76 years in age, 58 to 130 kg in body weight) were evaluated for neuromuscular fatigue (NMF) of the tibialis anterior (TA) muscle, cardiopulmonary fatigue (CPF), and psychological-subjective fatigue (PSF) at 1 to 2 weeks before RT (Pre), at the end of 8 weeks of RT (RT), and at 5 to 6 weeks after completion of RT (Post). OUTCOME MEASURES For NMF, the TA muscle was fatigued by sustained isometric contraction at 80% of maximum voluntary contraction for 60 seconds on a force dynamometer. Neuromuscular efficiency (NME) expressed as a ratio of isometric force (in Newtons) and respective integrated electromyograms were measured. For CPF, stress testing was performed on a treadmill using the modified Bruce protocol. Piper Fatigue Scale, Beck Depression Inventory, and Epworth Sleepiness Scale were administered to evaluate PSF. DATA ANALYSIS Paired t tests, single factor analysis of variance, and nonparametric analysis. RESULTS At RT, there was a significant decline in NME of TA at the beginning (18.4%, p < .01) and the end (29.2%, p < .001) of sustained muscle contraction for 60 seconds. Post values were lower but nonsignificant in comparison with Pre values. NME recovered within 5 to 6 weeks after RT. No abnormalities were detected in CPF or PSF. No correlation was found between the decline in NME and psychological status of the patients. CONCLUSION Results provide definitive evidence of transient decline in NME in prostate cancer patients at the completion of RT. The effect seems to be specific for neuromuscular performance alone and is independent of the cardiovascular or psychological status of the patients.

Hypertension awareness and control in an inner-city African–American sample

African–Americans in the US are at high risk for hypertension-related morbidity and mortality. The majority of African–Americans live in central city areas, and lower socioeconomic status and health care utilization patterns have been hypothesized to contribute to higher blood pressure (BP) levels and poorer control of treated hypertension in this group. In order to plan an intervention to improve hypertension care for inner city African–Americans in Houston, Texas, we conducted a baseline survey of residents in 12 low-income ZIP code areas with a >70% African–American population to determine the level of hypertension awareness, treatment and control, and associated sociodemographic, health care utilization, and medication compliance variables. Subjects were recruited to attend a BP measurement and assessment of knowledge, attitudes and behaviors through random digit phone dialing in the target ZIP code areas. Of the 962 subjects examined, 433 (45%) were hypertensive (systolic BP ⩾140 mm Hg or diastolic pressure ⩾90 mm Hg or taking antihypertensive medication). Among all hypertensives, 73% were aware, 64% were on treatment, and 28% were controlled to 140/90 mm Hg. Of hypertensives on treatment, 43% were controlled to 140/90 mm Hg, but 72% were controlled using the criterion of 160/95 mm Hg, and 75% were controlled using a diastolic pressure <90 mm hg only. these results are similar to those reported for african–americans in the most recent us national health survey. males were less likely to be aware, receiving treatment and controlled than were females. although lack of awareness was associated with less frequent bp measurement, 77% of those unaware reported a measurement within the past 2 years. the majority of aware hypertensives reported frequent physician contact and high compliance with medication. we conclude that intervention to improve hypertension control in this population should focus on ensuring that health providers diagnose bp and establish treatment goals based on the current standard of 140/90 mm hg.

Resting and stimulated endocrine function in human subjects with cervical spinal cord transection.

Abstract Serial measurement of blood glucose, urinary glucocorticoids, mineralo-corticoids, catecholamines, and methylhydroxymandelic acid show that, at rest, men with a section of the cervical spinal cord, have low normal blood glucose and nearly normal adrenal-cortical and adrenal-medullary function. The chronic patients have a decreased excretion of methylhydroxymandelic acid. In these subjects, the hyperglycemia observed after surgery of deafferented parts of the body is erratic, and the expected increase in urinary corticosteroids is absent. This increase is present during exacerbation of infection. Short but stressful episodes of hypotension do not lead to an increase in urinary catecholamines or methylhydroxyandelic acid. Change from recumbent to erect position, accompanied by hypotension, or to sitting, does not lead to increased urinary aldosterone. The results of these preliminary studies show that disruption of neural connections between brain and spinal cord and dissociation of the normally integrated function of the autonomic nervous system, modify many neurohormonal responses to stimulation.

Adult Onset Diabetes Mellitus: Glycemic Control and Family Function

To test the hypothesis that family function differs in patients acording to their level of diabetes control, family function was assessed using the Family APGAR questionnaire in low-income patients with adult-onset diabetes who were under comprehensive care in five community health centers. From 3,000 active patients, a group of 385 with the following characteristics were randomly selected: mean age, 59.1 (range 25–93); M:F ratio, 1:4; and ethnic distribution (blacks: Hispanics: whites, 48%: 31%:21%). Categorizing patients by their extent of diabetes control, good family function was found in 92% of patients in good control of their diabetes mellitus, in 66% of those in fair control, and only in 50% of those in poor control (p <0.005, X2=44.1, df=2). Since these data point to the association between levels of family functioning and control of diabetes, further studies are needed to ascertain if an improvement in family functioning will lead to better diabetic control.

Human circadian circulatory rhythms during weightlessness in extraterrestrial flight or bedrest with and without exercise

Human circadian coronary circulatory rhythms during space flight weightlessness or bedrest with and without exercise

The total lung capacity and its subdivisions in respiratory poliomyelitis.

Abstract The supine total lung capacity and its subdivisions has been determined in 62 patients with respiratory muscle paralysis due to poliomyelitis. The results were contrasted with those obtained using the same methods in 50 healthy subjects matched according to age, sex, and physical characteristics. A significant reduction of the total lung capacity was found in the patients. This was accounted for by reductions or alterations in the functional residual capacity and the maximum lung volume above the resting expiratory level. The frequent reduction of functional residual capacity was more marked in the patients studied after 2 years from onset of their illness. Respiratory muscle paralysis, duration of illness, thoracic deformities, and prolonged artificial respiration were considered to be contributory to these lung compartition changes.

Advances in the community control of hypertension: from epidemiology to primary care practice

PURPOSE To review the progress in hypertension control in the United States since 1972, to examine the factors that contributed to that progress and to consider areas in which further improvement is required. METHODS A review of epidemiological, clinical and health services research related to hypertension control was conducted. We report our experience in evaluating hypertension control in a multi-ethnic community clinic population as an illustration of the challenges of hypertension management in primary care practice. SUMMARY OF FINDINGS Hypertension prevalence in the United States population has remained relatively stable, whereas actual blood pressure levels in the population have declined slightly. Most Americans (approximately 80%) have had a blood pressure check within the past year, but the rate of blood pressure control in treated hypertensives has been disappointing. The current diagnostic and therapeutic criterion of blood pressure < or = 140/90 mmHg, regardless of individual patient characteristics (e.g. age, race), should be re-evaluated.

Longitudinal analyses of daily excretory rhythms in men with tetraplegia due to cervical spinal cord transection

In a continuing investigation on the relationship of afferent neural pathways to physiological rhythmicity, 37 hospitalised human subjects were studied: 7 were healthy and 30 had a complete cervical spinal cord transection (tetraplegics). The healthy subjects, stressed on day 3 and kept supine on days 5, 6 and 7, maintained no regular activity or sleep schedules. Eight tetraplegics had been paralysed for less than 2 months (acute), 12 for 2 to 10 months (subacute), and 10 for more than 10 months (chronic). Fluid balance and urinary excretion of sodium (Na), potassium (K), aldosterone, 17 hydroxycorticosteroids (17 OHCS), epinephrine (E), norepinephrine (NE) and methoxyhydroxymandelic acid (MHMA), were determined every 6 hours for 6 or 7 days. The raw data were transformed to percentage of daily output. Evaluation of daily rhythms for each consecutive day for each group shows: (1) significant rhythms in fluid balance, Na, K and 17 OHCS excretion for the healthy group; (2) significant rhythms only in fluid balance and K excretion for the tetraplegic groups; (3) no significant rhythms in aldosterone, E, NE and MHMA excretion for any group. In previous studies evaluation of daily rhythm on similarly transformed data pooled together as 1 day for each subject shows: (1) normal and significant rhythms in Na excretion in chronic tetraplegics; (2) significant rhythms in 17 OHCS excretion for all tetraplegics although the crest occurred later than normal; (3) no aldosterone excretory rhythms in tetraplegics even after tilt table exercises but significant ones in non-hospitalised healthy subjects; (4) significant rhythms in E, NE and MHMA excretion in chronic tetraplegics although the crest occurred later than normal. Combined evaluation of data indicates that interruption of afferent neural pathways does not influence fluid balance and K excretory rhythms, modifies excretory rhythms of Na and 17 OHCS and suppresses those of aldosterone. Weak daily rhythms of excretion of E, NE and MHMA were disclosed in hospitalised chronic tetraplegics due to the regularity of their activities.

Blood pressure measurement and antihypertensive treatment in a low-income African-American population.

OBJECTIVES The purpose of this study was to describe blood pressure measurement and hypertension treatment in an inner-city African-American community. METHODS A random-digit dialing telephone survey of adults more than 18 years of age was carried out in 12 predominantly African-American zip code areas in Houston, Texas. RESULTS More than 90% of subjects reported a blood pressure measurement within the past 2 years, and 87% of known hypertensives reported current medication use. CONCLUSIONS Further improvements in hypertension control among African Americans in this country are likely to depend primarily on changes in diagnosis and management practices of health care providers and on maintaining primary care access for all socioeconomic groups.