[Effects of virtual reality on balance and gait in stroke: a systematic review and meta-analysis]. / Efectos de la realidad virtual sobre el equilibrio y la marcha en el ictus: revision sistematica y metaanalisis.

INTRODUCTION: Stroke is the leading cause of disability in adulthood. Recently the improvement of virtual reality technologies has been used in the rehabilitation of stroke patients. AIM: To review published research literature on the effects of the virtual reality interventions vs conventional therapy on balance and gait in stroke. PATIENTS AND METHODS: A systematic and a meta-analysis of randomized controlled trials was performed during March 2018 in the databases: PubMed, PEDro, Web of Science, Scopus, Cochrane Library and Medline at EBSCO. The selection criteria were: randomized controlled trials published in English or Spanish during the past ten years. The PEDro scale evaluated the quality of the methods used in the studies. A total of 14 clinical trials were included in the systemic review, of which 10 contributed information to the meta-analysis. RESULTS: Favourable results were found on balance (Berg Balance Scale: standardized mean difference, SMD = -1.89; 95% CI: -2.72 to -1.07; Timed Up and Go, SMD: 1.42; 95% CI: 1.03-1.81), and gait (GaitRite platform: cadence, SMD: -1.51, 95% CI: -2.05 to -0.97; step length, SMD: -1.63, 95% CI: -2.18 to -1.08; stride length, SMD: -1.63, 95% CI: -2.18 to -1.08; velocity, SMD: -1.58, 95% CI: -2.97 to -0.18). CONCLUSION: The results show the potential benefit of virtual reality interventions to recover balance and gait after stroke.

TITLE: Efectos de la realidad virtual sobre el equilibrio y la marcha en el ictus: revision sistematica y metaanalisis.Introduccion. El ictus es la mayor causa de discapacidad en los adultos. En los ultimos años, la mejora en las tecnologias de realidad virtual ha propiciado su uso para la rehabilitacion de pacientes de ictus. Objetivo. Analizar las evidencias cientificas existentes sobre la efectividad del uso de realidad virtual frente a la terapia convencional en la mejora de la marcha y el equilibrio de pacientes que han sufrido un ictus. Pacientes y metodos. Se ha realizado una revision sistematica y un metaanalisis durante marzo de 2018 en las siguientes bases de datos: PubMed, PEDro, Web of Science, Scopus, Cochrane Library y Medline via EBSCO. Los principales criterios de seleccion fueron ensayos clinicos controlados aleatorizados, publicados en ingles o español, durante los ultimos diez años (2008-2018). La calidad metodologica de los estudios se evaluo mediante la escala PEDro. Se incluyo un total de 14 ensayos clinicos aleatorizados con intervenciones de realidad virtual en la revision sistematica, 10 de ellos en el metaanalisis. Resultados. Se han obtenido resultados favorables de las intervenciones de realidad virtual sobre el equilibrio (Berg Balance Scale: diferencia de medias estandarizada, DME: ­1,89; intervalo de confianza al 95%, IC 95%: ­2,72 a ­1,07; Timed Up and Go: DME: 1,42; IC 95%: 1,03 a 1,81) y la marcha (GaitRite: cadencia, DME: ­1,51, IC 95%: ­2,05 a ­0,97; longitud del paso, DME: ­1,63, IC 95%: ­2,18 a ­1,08; longitud de la zancada, DME: ­1,63, IC 95%: ­2,18 a ­1,08; velocidad, DME: ­1,58, IC 95%: ­2,97 a ­0,18). Conclusion. Los resultados obtenidos muestran el beneficio potencial de la realidad virtual sobre la recuperacion de la marcha y equilibrio en sujetos que han sufrido ictus.

Hospitalisation by tick-borne diseases in the last 10 years in two hospitals in South Spain: analysis of tick exposure data collected in the Emergency Department.

Tick-borne diseases (TBDs) can sometimes cause severe symptoms and lead to hospitalisation, but they often go unnoticed in the Emergency Department (ED). The aim of this study was twofold: (i) to describe the profile of patients hospitalised by TBDs; and (ii) to evaluate the data collected in the medical records from the ED in order to analyse their potential clinical consequences. A total of 84 cases that included all TBD diagnoses registered in the ED records were identified and analysed. These corresponded to all the hospitalisations by TBDs in the last 10 years (2009-2019) in two tertiary hospitals in Granada, Spain. Statistical analyses were made using RStudio. Coinciding with the absence of patient's report of exposure to ticks, 64.3% of TBDs were not suspected in the ED. Intensive care unit admission was required in 8.3% of cases, and the mortality rate was 2.4%. Non-suspected cases showed longer hospital stay (P < 0.001), treatment duration (P = 0.02) and delay in the initiation of antibiotic treatment (P < 0.001). Our findings indicate that symptoms associated with TBDs are highly non-specific. In the absence of explicit information related to potential tick exposure, TBDs are not initially suspected. As a consequence, elective treatment administration is delayed and hospitalisation time is prolonged. In conclusion, our results highlight the importance of addressing potential exposure to ticks during the ED contact with patients presenting with febrile syndrome.