Papers by Pablo Villaseñor
Tennis elbow Golfers ’ elbow
Intraarticular elbow injection Rotator cuff tendinopathy Frozen shoulder Subscapular neuropathy A... more Intraarticular elbow injection Rotator cuff tendinopathy Frozen shoulder Subscapular neuropathy Axillary neuropathy a b s t r a c t The elbow patients herein discussed feature common soft tissue conditions such as tennis elbow, golfers’ elbow and olecranon bursitis. Relevant anatomical structures for these conditions can easily be identified and demonstrated by cross examination by instructors and participants. Patients usually present rotator cuff tendinopathy, frozen shoulder, axillary neuropathy and suprascapular neuropathy. The structures involved in tendinopathy and frozen shoulder can be easily identified and demonstrated under normal conditions. The axillary and the suprascapular nerves have surface landmarks but cannot be palpated. In neuropathy however, physical findings in both neuropathies are pathognomonic and will be discussed.
Coagulopathy of the surgical patient. The new cellular model of the coagulation and its application in anesthesiology
Revista De Investigacion Clinica, 2005
Background. Causes of FUO change according to medical innovations, modifications of social circum... more Background. Causes of FUO change according to medical innovations, modifications of social circumstances, and emerging health risks. Aim. To describe the epidemiology of classical FUO, the time and procedures to achieve a definitive diagnosis, and to underline the variables useful in distinguishing FUO categories. Setting. A third-referral center in Mexico City. Methods. Patients admitted with prolonged fever were evaluated. Clinical charts of patients with classical FUO were assessed; comparisons between classical FUO categories were made. Results. 45 patients with 44.9 ± 17.2 years of age, previous fever duration of 51.2 ± 51.5 days, and 88.9% referred from other hospitals were evaluated. Nineteen patients had infectious causes; eight, neoplastic conditions; 12, inflammatory non-infectious diseases; one had another cause, and five were discharged with no etiologic diagnosis. Age, LDH levels, length of fever, and weight loss greater than 10 kg may be used to classify patients into a definite category. Conclusions. Classical FUO is an unusual presentation of frequent infectious diseases; SLE is the main cause within the inflammatory non-infectious conditions, and non-Hodgkin's lymphoma is the first cause of cancer. Some clinical and laboratory clues may be used to guide the study work up of patients with classical FUO.
![Research paper thumbnail of [Prevalence of chronic pruritus in patients of a tertiary care hospital]](https://attachments.academia-assets.com/81929627/thumbnails/1.jpg)
Revista medica del Instituto Mexicano del Seguro Social, 2014
BACKGROUND Chronic pruritus is occasionally intractable; it has different etiologies and affects ... more BACKGROUND Chronic pruritus is occasionally intractable; it has different etiologies and affects life quality. Our objective was to describe the prevalence of pruritus in newly-arrived patients at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán". METHODS A cross-sectional study was developed in newly-arrived patients. We conducted previous surveys in order to identify those patients with pruritus. With a second survey we inquired their sociodemographic traits, comorbidities, drugs being administered, the characteristics of pruritus, and the impact on the patient's quality of life. RESULTS Of 554 previous surveys, we identified 70 cases of chronic pruritus. Most of the cases were women in their middle ages (42 years). According to the classification of pruritus, 67.2 % was associated to the underlying disease, 14.8 % was related to dermatologic condition, 3.3 % to pharmacological effects, 4.9 % to other conditions, and 9.8 % was idiopathic. Life...
linical Anatomy of the Ankle and Foot
This paper emphasizes the anatomical substrate of several foot conditions that are seldom discuss... more This paper emphasizes the anatomical substrate of several foot conditions that are seldom discussed in this context. These include the insertional and non-insertional Achilles tendinopathies, plantar fasciopathy, inferior and posterior heel spurs, foot compartment syndromes, intermetatarsal bursitis and Morton’s neuroma. It is a rather superficial anatomical review of an organ that remains largely neglected by rheumatologists. It is our hope that the cases discussed and the cross examination by instructors and participants will stimulate study of the foot and the attention it deserves. © 2012 Elsevier Espana, S.L. All rights reserved. Anatomia clinica del tobillo y el pie alabras clave: rticulaciones del tobillo y el pie r e s u m e n Este articulo enfatiza las estructuras anatomicas que sirven de sustrato a entidades clinicas como la endon de Aquiles endon tibial posterior ojinete graso plantar usculos del pie ervios plantares tendinopatia no insercional e insercional del tendon de...
Coagulopatía del paciente quirúrgico. El nuevo modelo celular de la coagulación y su aplicación e... more Coagulopatía del paciente quirúrgico. El nuevo modelo celular de la coagulación y su aplicación en Anestesiología
IntroductIon: Superficial mycoses are among the most frequent causes of consult in dermatology. T... more IntroductIon: Superficial mycoses are among the most frequent causes of consult in dermatology. The comparative efficacy and roll of traditional anti-mycotic drugs needs to be assessed. objetIve: To compare head to head, the clinical and microbiological efficacy of topical bifonazole and ketoconazole in tinea pedis MaterIals and Methods: 46 patients with diagnosis of tinea pedis were studied. Diagnosis was based on clinical findings and KOH and culture. Following a randomization process, 23 patients received local bifonazole and 23 patients received ketoconazole; both drugs were applied twice daily for 2 weeks. Clinical evaluations and direct exam were performed on days 15 and 30 after initiation of therapy. results: 46 patients (27 women and 19 men) participated in this trial. Mean age, 62 years (range 23-89). Most patients had interdigital tinea (46.4%), while plantar tinea was observed in about a third of patients (37.7%); four patients (11.6%) had a mixed distribution. Eighteen ...
Eficacia autoevaluada de un taller de anatomía clínica musculoesquelética: una encuesta preliminar
Metodos Un cuestionario de autoevaluacion de competencias se envio por correo electronico a los p... more Metodos Un cuestionario de autoevaluacion de competencias se envio por correo electronico a los participantes en un taller practico de anatomia clinica musculoesqueletica 1�3 meses despues de concluido el taller. Los resultados de este cuestionario se compararon con los resultados de un examen practico tomado por un instructor, previo al taller practico. Resultados La tasa de respuesta de los participantes fue del 76,4%. La puntuacion de la competencia autoevaluada global de los temas anatomicos incluidos en el examen practico previo fue 76,9 (escala de 0 a 100) en comparacion con una puntuacion total de 48,1 obtenida en la evaluacion practica previa al taller (p<0,001). Para los temas que se abordaron en el taller, pero no incluidos en la competencia previa a la autoevaluacion, la calificacion fue de 62,9. Las diferencias en el conocimiento anatomico entre personas de diferentes paises y grupos de profesionales que se observaron en el examen practico previo ya no se vieron en el...
Comparison of bifonazole vs ketoconazole in treatment of tinea pedis: A randomized clinical trial
Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion, 2005
BACKGROUND Causes of FUO change according to medical innovations, modifications of social circums... more BACKGROUND Causes of FUO change according to medical innovations, modifications of social circumstances, and emerging health risks. Aim. To describe the epidemiology of classical FUO, the time and procedures to achieve a definitive diagnosis, and to underline the variables useful in distinguishing FUO categories. Setting. A third-referral center in Mexico City. METHODS Patients admitted with prolonged fever were evaluated. Clinical charts of patients with classical FUO were assessed; comparisons between classical FUO categories were made. RESULTS 45 patients with 44.9 +/- 17.2 years of age, previous fever duration of 51.2 +/- 51.5 days, and 88.9% referred from other hospitals were evaluated. Nineteen patients had infectious causes; eight, neoplastic conditions; 12, inflammatory non-infectious diseases; one had another cause, and five were discharged with no etiologic diagnosis. Age, LDH levels, length of fever, and weight loss greater than 10 kg may be used to classify patients into...
Classical fever of unknown origin (FUO)
Las causas de fiebre de origen indeterminado (FOI) varian de acuerdo con las innovaciones medicas... more Las causas de fiebre de origen indeterminado (FOI) varian de acuerdo con las innovaciones medicas o con modificaciones de las circunstancias sociales y riesgos para la salud. Objetivo: Describir la epidemiologia de la FOI, el tiempo y procedimientos empleados para alcanzar un diagnostico definitivo y evaluar las variables que pueden usarse para diferenciar sus categorias. Hospital: Centro de referencia de tercer nivel de la ciudad de Mexico. Metodos: Se evaluo a pacientes con fiebre prolongada; los expedientes clinicos de aquellos con FOI fueron analizados y se compararon sus principales categorias. Resultados: Fueron evaluados 45 pacientes, de 44 ± 17.2 anos de edad y duracion promedio de la fiebre de 51.2 ± 51.5 dias, de los cuales 88.9% habian sido referidos de otros hospitales. De ellos, 19 fueron diagnosticados con causas infecciosas, ocho con enfermedades neoplasicas, l2 con enfermedades inflamatorias no infecciosas, uno por alguna otra causa y cinco fueron dados de alta sin d...
End-of-life phase in the intensive care unit
RESUMEN En los Estados Unidos mueren 2.5 millones de personas al año, 60% de estas muertes son de... more RESUMEN En los Estados Unidos mueren 2.5 millones de personas al año, 60% de estas muertes son dentro de un hospital y 50% requirieron de manejo en la unidad de terapia intensiva (UTI). La etapa terminal de la vida y su abordaje ha adquirido gran importancia en los últimos años por las características de los pacientes que ingresan a la UTI y requiere de un entrenamiento formal de todos los especialistas que forman parte del equipo multidisciplinario que maneja al paciente grave, siendo el eje de éstos, el intensivista. Recientemente se ha demostrado que en la UTI no únicamente se aplican cuidados curativos, sino que los cuidados paliativos son parte fundamental del manejo. Los conceptos relacionados a la etapa terminal de la vida son: terapia de apoyo vital, suspensión del apoyo vital, negación del apoyo vital, calidad de vida, calidad de muerte, muerte apropiada, sedación terminal, destete terminal, muerte cerebral, donación de órganos, solicitud de estudio post mortem y cómo dar malas noticias. Dentro del entorno de la etapa terminal de la vida es fundamental el conocimiento de la voluntad e intereses del enfermo, del marco jurídico vigente, del grupo étnico y sus características socio-culturales-religiosas, la comunicación con la familia y con todo el grupo médico y paramédico, para llegar a la decisión consensada más correcta de qué hacer en la etapa terminal de la vida desde los puntos de vista éticos y legales. Palabras clave: Etapa terminal de la vida, cuidados paliativos, terapia de apoyo vital, suspensión del apoyo vital, muerte cerebral. SUMMARY In the United States 2.5 millions people die annually, 60% in hospitals and 50% required intensive care unit (ICU) attention. End-of-life phase and it approach has become a very important medical aspect in the last years in the ICU. It requires a formal training of every physician involved in care of critically ill under guidance of the intensivist. Recently, it's been shown that not only curative care, but palliative care are fundamental in the management of patients admitted to the ICU. The common concepts related to end-of-life phase are: life support therapy, life support withdrawal, life support with holding, quality of life, quality of death, appropriate death, terminal sedation, terminal weaning, brain death, organ donation, autopsy request and how to give bad news. In the context of end-of-life phase, the knowledge of patient's interests and will, the medico-legal framework, ethnic group and their social-cultural-religious characteristics and communication with the family and the medical and paramedical group are fundamental for a consensus about the end-of-life taking to account ethical and legal endpoints.
Prevalencia del prurito crónico en pacientes de un hospital de tercer nivel
Revista médica del Instituto Mexicano del Seguro Social, 2014
Background: Chronic pruritus is occasionally intractable; it has different etiologies and affects... more Background: Chronic pruritus is occasionally intractable; it has different etiologies and affects life quality. Our objective was to describe the prevalence ...
Blood and Genomics
Morphea is a disorder limited to the skin, characterized by a stable oval plaque with a glossy pl... more Morphea is a disorder limited to the skin, characterized by a stable oval plaque with a glossy plane surface that feels indurated on palpation. In contrast, systemic sclerosis is additionally characterized by disseminate cutaneous engrossment, sclerodactyly, the presence of Raynaud´s phenomenon, and internal organ involvement. Human leukocyte antigen (HLA)-DR4 class Ⅱ alleles are associated with morphea in Caucasians, whereas, HLA-DR4 presents as high frequency in Amerindians, besides it was associated with autoimmune disease. The aim of this study was to determine HLA-DR alleles in Mexican patients with morphea. This study recruited 24 morphea patients, whose HLA alleles frequencies were compared with HLA alleles frequencies presented in 22 systemic sclerosis patients and 99 ethnically matched healthy controls. The HLA-DRβ1 locus was genotyped based on the hybridization technique. HLA-DR4 and DR8 frequencies showed increases in morphea patients compared with healthy controls, whereas HLA-DR4 exhibited a statistical association with morphea when allele frequencies were compared with systemic sclerosis patients. Thus, HLA-DRβ1 associations varied in morphea and systemic sclerosis, suggesting the participation of different immunological molecular mechanisms.
The rheumatology physical examination: making clinical anatomy relevant
Clinical Rheumatology
To review the importance of physical examination in the diagnostic process of musculoskeletal con... more To review the importance of physical examination in the diagnostic process of musculoskeletal conditions vis-a-vis the development of sensitive and powerful technologies such as MRI and high-resolution ultrasound. Because the physical examination of the musculoskeletal system is an exercise of applied clinical anatomy, the authors tested, in one-to-one practical examinations, the basal knowledge of musculoskeletal anatomy of rheumatology trainees, rheumatologists, and other professionals of musculoskeletal medicine. The results of the authors’ surveys were disappointing, with a correct response rate of 50 to 60% depending on the locales. To correct this deficit, the authors gave many active-learning, case-centered seminars throughout the Americas and some overseas that may have fostered an interest in the study of clinical anatomy. There was an increased interaction between anatomy departments and clinicians, and that daily use of clinical anatomy would make anatomy relevant, improve clinical skills, and probably reduce the overall costs of the health care system. Key Points • Knowledge of musculoskeletal anatomy is the basic diagnostic tool in the regional pain syndromes • Knowledge of musculoskeletal anatomy helps understand the musculoskeletal involvement in the regional and systemic rheumatic disorders • An active-learning methodology was used since 2006 to review the anatomy that is relevant for rheumatology trainees and practitioners of musculoskeletal medicine • A skilled, anatomy-based physical examination and a well-thought diagnostic hypothesis could reduce the use of expensive technologies that, being too sensitive, may lead the unaware clinician astray
Clinical Rheumatology, 2016
This is a repository copy of A survey of anatomical items relevant to the practice of rheumatolog... more This is a repository copy of A survey of anatomical items relevant to the practice of rheumatology: upper extremity, head, neck, spine, and general concepts..
Teaching of clinical anatomy in rheumatology: a review of methodologies
Clinical Rheumatology, 2015
Clinical anatomy may be defined as anatomy that is applied to the care of the patient. It is the ... more Clinical anatomy may be defined as anatomy that is applied to the care of the patient. It is the foundation of a well-informed physical examination that is so important in rheumatologic practice. Unfortunately, there is both documented and observed evidence of a significant deficiency in the teaching and performance of a competent musculoskeletal examination at multiple levels of medical education including in rheumatology trainees. At the Annual Meeting of the American College of Rheumatology in Boston, MA, that took place in November 2014, a Clinical Anatomy Study Group met to share techniques of teaching clinical anatomy to rheumatology fellows, residents, and students. Techniques that were reviewed included traditional anatomic diagrams, hands-on cross-examination, cadaver study, and musculoskeletal ultrasound. The proceedings of the Study Group section are described in this review.
![Research paper thumbnail of [Prevalence of chronic pruritus in patients of a tertiary care hospital]](https://attachments.academia-assets.com/81929680/thumbnails/1.jpg)
Revista médica del Instituto Mexicano del Seguro Social
Chronic pruritus is occasionally intractable; it has different etiologies and affects life qualit... more Chronic pruritus is occasionally intractable; it has different etiologies and affects life quality. Our objective was to describe the prevalence of pruritus in newly-arrived patients at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán". A cross-sectional study was developed in newly-arrived patients. We conducted previous surveys in order to identify those patients with pruritus. With a second survey we inquired their sociodemographic traits, comorbidities, drugs being administered, the characteristics of pruritus, and the impact on the patient's quality of life. Of 554 previous surveys, we identified 70 cases of chronic pruritus. Most of the cases were women in their middle ages (42 years). According to the classification of pruritus, 67.2 % was associated to the underlying disease, 14.8 % was related to dermatologic condition, 3.3 % to pharmacological effects, 4.9 % to other conditions, and 9.8 % was idiopathic. Life quality was not affected i...
AB1408 Knowledge of clinical anatomy by rheumatology fellows and rheumatologists in latin america
Annals of the Rheumatic Diseases, 2012
ABSTRACT Background It is generally agreed that knowledge of musculoskeletal anatomy is a prerequ... more ABSTRACT Background It is generally agreed that knowledge of musculoskeletal anatomy is a prerequisite to performing an adequate rheumatologic physical examination. However, little information is available regarding the level of anatomical knowledge of rheumatology fellows (RF) and practicing rheumatologists (PR). Methods All participants in a series of musculoskeletal clinical anatomy seminars held in 5 Latin American countries under an ILAR grant in 2010 and 2011 had a one-to-one, standardized, pre-seminar evaluation in which they were asked to demonstrate or identify the structures or functions in the bodies of the participants and instructors of 20 anatomic structures. The average duration of the evaluations was 7 minutes. This exercise was accepted by the national societies, participating rheumatology services and seminar attendees. Standard summary statistics are presented. Differences between groups were tested with T test or ANOVA. Results There were 191 participants in the study. These included 113 (59.1%) RF from 15 training programs, 55 (28.7%) PR and 23 (12%) non-rheumatologist health care professionals (NRHP). PR had a median experience of 10 (range 3-46) yrs. Mean number of correct answers (out of 20 questions) was 9.04 (95CI: 8.49 to 9.53) for all participants. Of these, 37.7% answered correctly &lt;5 questions, 56.7% 5-15 questions and 5.8% &gt;15 questions. Correct answers in RF averaged 9.24 (95CI: 8.55 to 9.92), in PR 9.03 (95CI: 8.05 to 10.03) and in NRHP 7.91 (95CI: 6.47 to 9.36) (ANOVA p=0.439). When 1st year fellows we recompared with 2nd, or 2nd plus 3rd (oneprogram) year fellows, a significant difference was found favoring the latter [8.38 (95CI: 7.37 to 9.40) vs 9.91 (95CI: 8.9 to 10.7), p=0.02]. Anatomical knowledge in PR was unrelated to length of experience (Pearson’s r=0.21, p=0.11), [0-5yr 8.59 (95CI: 6.94 to 10.24), 6 -10yrs 7.67 (95CI: 5.12 to 10.21) and &gt;10yrs 9.70 (95CI: 8.2 to 11.21) (ANOVA p=0.363]. Conclusions Anatomical knowledge is far from satisfactory for most RF, PR and NRHP tested in Latin America. Although RF fared better in the 2nd plus 3rd year of training most fellows failed to correctly identify the majority of structures or functions and only 9.3% obtained &gt;15 of the 20 correct answers. For PR length of practice had no bearing on anatomical knowledge. The lowest scores were found in NRHP. Efforts should be made to improve anatomical knowledge early during rheumatology training to improve physical examination skills and understanding of the anatomic basis of regional pain syndromes. Also, clinical anatomy should be emphasized in continuing medical education activities for PR and NRHP. Improved clinical skills in anatomic diagnosis and the resulting decreased dependence on technology may ultimately result in societal cost saving. Data from other parts of the world should be obtained as the knowledge gap we perceived may not be limited to Latin America. Disclosure of Interest None Declared
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Papers by Pablo Villaseñor