Satisfaction analysis of overground gait exoskeletons in people with neurological pathology. a systematic review.

BACKGROUND: People diagnosed with neurological pathology may experience gait disorders that affect their quality of life. In recent years, research has been carried out on a variety of exoskeletons in this population. However, the satisfaction perceived by the users of these devices is not known. Therefore, the objective of the present study is to evaluate the satisfaction perceived by users with neurological pathology (patients and professionals) after the use of overground exoskeletons. METHODS: A systematic search of five electronic databases was conducted. In order to be included in this review for further analysis, the studies had to meet the following criteria: [1] the study population was people diagnosed with neurological pathology; [2] the exoskeletons had to be overground and attachable to the lower limbs; and [3]: the studies were to include measures assessing either patient or therapist satisfaction with the exoskeletons. RESULTS: Twenty-three articles were selected, of which nineteen were considered clinical trials. Participants diagnosed with stroke (n = 165), spinal cord injury (SCI) (n = 102) and multiple sclerosis (MS) (n = 68). Fourteen different overground exoskeleton models were analysed. Fourteen different methods of assessing patient satisfaction with the devices were found, and three ways to evaluate it in therapists. CONCLUSION: Users' satisfaction with gait overground exoskeletons in stroke, SCI and MS seems to show positive results in safety, efficacy and comfort of the devices. However, the worst rated aspects and therefore those that should be optimized from the users' point of view are ease of adjustment, size and weight, and ease of use.

Effects of ATLAS 2030 gait exoskeleton on strength and range of motion in children with spinal muscular atrophy II: a case series.

BACKGROUND: Children with spinal muscular atrophy (SMA) present muscle weakness and atrophy that results in a number of complications affecting their mobility, hindering their independence and the development of activities of daily living. Walking has well-recognized physiological and functional benefits. The ATLAS 2030 exoskeleton is a paediatric device that allows gait rehabilitation in children with either neurological or neuromuscular pathologies with gait disorders. The purpose is to assess the effects in range of motion (ROM) and maximal isometric strength in hips, knees and ankles of children with SMA type II after the use of ATLAS 2030 exoskeleton. METHODS: Three children (mean age 5.7 ± 0.6) received nine sessions bi-weekly of 60 min with ATLAS 2030. ROM was assessed by goniometry and strength by hand-held dynamometer. All modes of use of the exoskeleton were tested: stand up and sit down, forward and backward walking, and gait in automatic and active-assisted modes. In addition, different activities were performed during the gait session. A descriptive analysis of all variables was carried out. RESULTS: The average time of use was 53.5 ± 12.0 min in all sessions, and all participants were able to carry out all the proposed activities as well as to complete the study. Regarding isometric strength, all the measurements increased compared to the initial state, obtaining the greatest improvements for the hip flexors (60.2%) and extensors muscles (48.0%). The ROM increased 12.6% in hip and 34.1% in the ankle after the study, while knee ROM remained stable after the study. CONCLUSION: Improvements were showed in ROM and maximal isometric strength in hips, knees and ankles after using ATLAS 2030 paediatric gait exoskeleton in all three children. This research could serve as a preliminary support for future clinical integration of ATLAS 2030 as a part of a long-term rehabilitation of children with SMA. TRIAL REGISTRATION: The approval was obtained (reference 47/370329.9/19) by Comunidad de Madrid Regional Research Ethics Committee with Medical Products and the clinical trial has been registered on Clinical Trials.gov: NCT04837157.

Systematic review of surveillance systems and methods for early detection of exotic, new and re-emerging diseases in animal populations.

In this globalized world, the spread of new, exotic and re-emerging diseases has become one of the most important threats to animal production and public health. This systematic review analyses conventional and novel early detection methods applied to surveillance. In all, 125 scientific documents were considered for this study. Exotic (n = 49) and re-emerging (n = 27) diseases constituted the most frequently represented health threats. In addition, the majority of studies were related to zoonoses (n = 66). The approaches found in the review could be divided in surveillance modalities, both active (n = 23) and passive (n = 5); and tools and methodologies that support surveillance activities (n = 57). Combinations of surveillance modalities and tools (n = 40) were also found. Risk-based approaches were very common (n = 60), especially in the papers describing tools and methodologies (n = 50). The main applications, benefits and limitations of each approach were extracted from the papers. This information will be very useful for informing the development of tools to facilitate the design of cost-effective surveillance strategies. Thus, the current literature review provides key information about the advantages, disadvantages, limitations and potential application of methodologies for the early detection of new, exotic and re-emerging diseases.

Acute predictors for mortality after severe TBI in Spain: Gender differences and clinical data.

OBJECTIVE: The main objective of this study is to determine whether gender affects global mortality and functional outcome after severe traumatic brain injury (TBI). METHODS: This retrospective cohort study included 629 patients with severe TBI (14.9% female) admitted to the ICU of a university hospital. Patients were split into gender groups to study potential differences in global mortality and functional outcome at ICU discharge and 6 months post-trauma using the GOS. The following variables were analysed: age, intracranial injury, injury mechanism, injury severity, factors contributing to secondary brain injury, monitoring level, treatment, complications, length of stay in the ICU and cause of death. RESULTS: No differences were found between gender groups in neuromonitoring level or surgical procedures. Women had higher APACHE II scores, a higher incidence of pre-hospital hypotension, anaemia and transfusion and higher mortality rates in the ICU (OR = 1.74; 95% CI = 1.09-2.77) and 6 months post-trauma (OR = 1.65; 95% CI = 1.02-2.67). There were no significant differences in functional outcome at ICU discharge or 6 months post-injury. The multivariate analysis did not show gender as an independent predictive factor in mortality after severe TBI. CONCLUSION: In this study, gender was not found to be an independent predictor for poorer outcome after severe TBI.

Safety and usability of the MAK exoskeleton in patients with stroke.

BACKGROUND AND PURPOSE: Stroke is one of the leading causes of disability in adults worldwide, and one of the main objectives in the rehabilitation of these patients is to recover the gait. New technologies have emerged to cope with this issue, complementing conventional therapy with the use of devices such as exoskeletons. The Marsi Active Knee (MAK) exoskeleton (Marsi Bionics SL, Madrid, Spain) has already been tested, but an updated version was improved to allow the patients to perform functional exercises. The aim of this study was to assess the safety and usability of the MAK in the stroke population as well as its potential clinical effects. METHODS: A single-group open label intervention trial was conducted. The device was used twice a week for 5 weeks during 1 h per visit. During the visits, sit-to-stand transitions, walking, stair climbing, trunk rotations, and weight-transfer exercises were performed using the device. Adverse events were collected from participants and therapists to assess safety. The Quebec User Evaluation of the Satisfaction with assistive Technology (QUEST 2.0) was used by both therapists and participants to assess usability. To evaluate its clinical effects, active range of motion (ROM) and muscle strength were assessed in the lower limb. RESULTS: Six participants with stroke were recruited. The device was shown to be safe since no serious adverse events were reported neither by patients nor by therapists. Every proposed exercise was performed. Regarding clinical effects, overall muscle strength showed an increase after the treatment, although ROM measurements did not show any difference. DISCUSSION: Our results suggest that the MAK device is safe for stroke patients. Nevertheless, further changes to enhance usability are recommended, such as an improvement of the attachment system and an adaptation for the drop foot. Beneficial effects regarding increases in muscle strength were obtained. Further trials with a larger sample size, longer intervention periods, and a control group are needed to verify these results. Also, future research should focus on the usability of the MAK as an assistive technology.

Is it in their eyes? Correlation between microorganisms isolated from bronchial aspirates and conjunctival swabs in a Pediatric Intensive Care Unit.

OBJECTIVE: Our observational, retrospective study aimed to determine the correlation between bacteria isolated from bronchial aspirates of pediatric ICU patients (PICU) with respiratory infections and those obtained from conjunctival swabs of the same patients exhibiting clinical conjunctivitis. METHODS: Throughout the period from 2015 to 2022, we reviewed all clinically significant bronchial aspirates (≥105 CFU/mL) and positive conjunctival swabs obtained from PICU patients. These records were retrieved from the microbiology database, cross-referencing the data to identify patients who tested positive for both during the same clinical episode. RESULTS: The median age of the patients was 5 months (interquartile range: 1-7). Among the cohort, twenty-one patients exhibited positivity in both bronchial aspirate and conjunctival swab samples, showcasing a microbial match in 85.71% of cases (18 out of 21). The most frequently isolated microorganisms were Haemophilus influenzae (55.6%), followed by Pseudomonas aeruginosa (14.3%), Klebsiella aerogenes (9.5%), and Escherichia coli, Stenotrophomonas maltophilia, and Enterobacter cloacae, each accounting for 4.8% of the isolates. CONCLUSIONS: Our study demonstrates a strong concordance between the isolated microorganisms from both samples in patients presenting clear symptoms of clinical conjunctivitis. These findings provide a basis for future prospective studies that may leverage conjunctival swabs as a predictive tool for identifying microorganisms involved in respiratory infections.

A colorimetric method for determination of γ-glutamyl-S-ethenyl-cysteine in narbon vetch (Vicia narbonensis L.) seeds.

A new colorimetric method based on the bleaching of the iodoplatinate ion has been developed for fast and easy determination of γ-glutamyl-S-ethenyl-cysteine (GEC) in narbon vetch (Vicia narbonensis L.) seeds. The calibration curve showed a good correlation (r(2)=0.9959) between absorbance and GEC amounts from 5.5 to 33 µg (10-59.78 µmol/L). The limits of detection and quantification were 1.16 and 3.55 µmol/L, respectively, and no significant interferences from other sulfur-containing compounds were observed. The method showed excellent repeatability (relative standard deviation [RSD]=0.28%), reproducibility (RSD=4.4%), and accuracy (94%). Determination of GEC in 20 narbon vetch accessions yielded values that were in agreement with those reported previously using capillary electrophoresis and high-performance liquid chromatography methods. The method could be especially valuable for determination of GEC during the process of production of new low-GEC narbon vetch varieties.

Bottlenose dolphins (Tursiops truncatus) aggressive behavior towards other cetacean species in the western Mediterranean.

Aggressive behavior of bottlenose dolphins (Tursiops truncatus) towards conspecifics is widely described, but they have also often been reported attacking and killing harbour porpoises (Phocoena phocoena) around the world. However, very few reports exist of aggressive interactions between bottlenose dolphins and other cetacean species. Here, we provide the first evidence that bottlenose dolphins in the western Mediterranean exhibit aggressive behavior towards both striped dolphins (Stenella coeruleoalba) and Risso's dolphins (Grampus griseus). Necropsies and visual examination of stranded striped (14) and Risso's (2) dolphins showed numerous lesions (external rake marks and different bone fractures or internal organ damage by blunt trauma). Indicatively, these lessons matched the inter-tooth distance and features of bottlenose dolphins. In all instances, these traumatic interactions were presumed to be the leading cause of the death. We discuss how habitat changes, dietary shifts, and/or human colonization of marine areas may be promoting these interactions.

Hostility and helper T-cells in patients with bulimia nervosa.

OBJECTIVE: The study aimed to analyze the correlation between lymphocyte counts and several psychopathological variables associated with psychological instability (depression, hostility, impulsivity, self-defeating personality traits, and borderline personality symptoms) in patients with bulimia nervosa (BN). METHOD: Sixty BN patients were assessed, using specific scales for eating pathology, general psychopathology, impulsivity, depression, and borderline personality features. Lymphocyte and lymphocyte subset counts were performed. Plasma cortisol at 8:00, before and after administration of 1 mg of dexamethasone at 23:00, was determined. The influence of body weight, and the use of tobacco, alcohol, and caffeine was controlled. The relationship between each isolated variable and the number of immune cells was analyzed. In a second step, supplementary post-hoc analysis of the variables was introduced to confirm the accuracy of the psychopathological assessment. RESULTS: Hostility was negatively correlated with the number of helper T-cells (CD4+). Patients with high hostility had lower CD4+ cell counts and lower CD4+/CD8+ ratios. In the post-hoc control study, hostility was significantly related with other "interpersonal" items. CONCLUSIONS: These results support the idea that hostility, as an expression of disturbed interpersonal relationships, could play a role as a modulator of immune activity in patients with BN.

Inactivation of Escherichia coli in fresh water with advanced oxidation processes based on the combination of O3, H2O2, and TiO2. Kinetic modeling.

The purpose of this work was to study the efficiency of different treatments, based on the combination of O3, H2O2, and TiO2, on fresh surface water samples fortified with wild strains of Escherichia coli. Moreover, an exhaustive assessment of the influence of the different agents involved in the treatment has been carried out by kinetic modeling of E. coli inactivation results. The treatments studied were (i) ozonation (O3), (ii) the peroxone system (O3/0.04 mM H2O2), (iii) catalytic ozonation (O3/1 g/L TiO2), and (iv) a combined treatment of O3/1 g/L TiO2/0.04 mM H2O2. It was observed that the peroxone system achieved the highest levels of inactivation of E. coli, around 6.80 log after 10 min of contact time. Catalytic ozonation also obtained high levels of inactivation in a short period of time, reaching 6.22 log in 10 min. Both treatments, the peroxone system (O3/H2O2) and catalytic ozonation (O3/TiO2), produced a higher inactivation rate of E. coli than ozonation (4.97 log after 10 min). While the combination of ozone with hydrogen peroxide or titanium dioxide thus produces an increase in the inactivation yield of E. coli regarding ozonation, the O3/TiO2/H2O2 combination did not enhance the inactivation results. The fitting of experimental values to the corresponding equations through non-linear regression techniques was carried out with Microsoft® Excel GInaFiT software. The inactivation results of E. coli did not respond to linear functions, and it was necessary to use mathematical models able to describe certain deviations in the bacterial inactivation processes. In this case, the inactivation results fit with mathematical models based on the hypothesis that the bacteria population is divided into two different subgroups with different degrees of resistance to treatments, for instance biphasic and biphasic with shoulder models. Graphical abstract ᅟ.

[Failure mode and effects analysis on computerized drug prescriptions]. / Análisis modal de fallos y efectos en las prescripciones farmacológicas informatizadas.

OBJECTIVE: To identify and analyze errors in drug prescriptions of patients treated in a "high resolution" hospital by applying a Failure mode and effects analysis (FMEA).Material and methods A multidisciplinary group of medical specialties and nursing analyzed medical records where drug prescriptions were held in free text format. An FMEA was developed in which the risk priority index (RPI) was obtained from a cross-sectional observational study using an audit of the medical records, carried out in 2 phases: 1) Pre-intervention testing, and (2) evaluation of improvement actions after the first analysis. An audit sample size of 679 medical records from a total of 2,096 patients was calculated using stratified sampling and random selection of clinical events. RESULTS: Prescription errors decreased by 22.2% in the second phase. FMEA showed a greater RPI in "unspecified route of administration" and "dosage unspecified", with no significant decreases observed in the second phase, although it did detect, "incorrect dosing time", "contraindication due to drug allergy", "wrong patient" or "duplicate prescription", which resulted in the improvement of prescriptions. CONCLUSIONS: Drug prescription errors have been identified and analyzed by FMEA methodology, improving the clinical safety of these prescriptions. This tool allows updates of electronic prescribing to be monitored. To avoid such errors would require the mandatory completion of all sections of a prescription.

Lymphoscintigraphic study in a case of rheumatoid arthritis-related lymphoedema.

Lymphoedema of the upper limbs is a rare extraarticular manifestation of rheumatoid arthritis (RA). Herein we report a patient with RA who presented two episodes of lymphoedema in the hands and forearms coinciding with flares of polyarthritis. Lymphoscintigraphy showed lymphatic-ectasia. The oedema improved with slow-acting drug treatment.

L-dopa malabsorption in a parkinsonian patient with Strongyloides stercoralis duodenitis.

We report a parkinsonian patient initially responding to L-dopa who developed a severe loss of drug efficacy due to Strongyloides stercoralis duodenitis. The patient was put on mebendazole and metronidazole, and the parasitosis abated, allowing L-dopa reduction by 33%. Our patient illustrates the advisability of searching for Strongyloides stercoralis when L-dopa malabsorption is suspected in Parkinson's disease.

Comparative incidence of upper gastrointestinal bleeding associated with individual non-steroidal anti-inflammatory drugs.

OBJECTIVE: The existence of two isoforms of cyclo-oxygenase (COX), COX-1 and COX-2, is now well established. Because inhibition of COX-1 by nonsteroidal anti-inflammatory drugs (NSAIDs) is linked to gastrointestinal (GI) damage, agents with a better COX-2/COX-1 inhibition ratio may have less GI toxicity. The aim of this study was to compare the incidence of upper gastrointestinal bleeding (UGIB) in association with specific NSAIDs including the new "COX-2 preferential" inhibitors. PATIENTS Y METHOD: Individual incidence of NSAID-related UGIB in a health-authority area was estimated, based on cases of UGIB, sales of non-aspirin NSAIDs, and data of used doses in community subjects, during a four-year period. Comparisons were made by calculating individual rate-ratio (RR) and 95% confidence interval (CI) taking as a reference the specific NSAID with the lowest incidence of UGIB. RESULTS: The incidence of UGIB associated with thirteen specific NSAIDs included in the study varied greatly, from 1.7 per 1,000 person-years for aceclofenac to 25.8 per 1,000 person-years for ketorolac. The use of "COX-1 preferential" inhibitors versus "COX-2 preferential" inhibitors was associated with a RR of 5.3 (95% CI, 2.78-10.04), and between NSAIDs with "COX-1-COX-2 mixed" inhibition RR was 2.2 (95% CI, 1.13-4.28). CONCLUSIONS: Our results show that there are differences in GI toxicity according to specific NSAIDs. A substantial reduction in number of cases of UGIB could result from the use of NSAIDs with a "COX-2 preferential" inhibition.

Pre-endoscopic prognostic factors in non-varicose upper gastrointestinal bleeding. Development of a predictive algorithm.

OBJECTIVE: Upper gastrointestinal or digestive bleeding (UDB) is a common problem requiring hospitalization and implying important morbidity-mortality. The aim of the present study is to identify clinical and laboratory factors predictive of a serious course of non-varicose UDB, based on the development of a simple algorithm for application in the clinical setting. METHODS: A longitudinal study was made of 803 hospitalized patients with non-varicose UDB. Clinical and laboratory parameters were recorded in the Emergency Service before endoscopy. A first non-conditional logistic regression model was developed, including those variables exhibiting a greater capacity for predicting a serious outcome. This model was posteriorly simplified to facilitate clinical application. The prognostic performance was estimated by calculating the area under the ROC curve. RESULTS: The initial predictive model included 11 variables, with an area under the ROC curve of 0.74 (95%CI: 0.71-0.77), while in the second model these same variables were dichotomized, exhibiting an area under the ROC curve of 0.74 (95%CI: 0.70-0.77). Based on the corresponding regression coefficients, the prognostic variables were classified as either major (shock, liver disease, anticoagulant therapy, urea/creatinine ratio > 62) or minor (hematocrit < 33%, renal failure, presentation as hematemesis and melenas, systolic arterial pressure < 110 mmHg, regular alcohol consumption, a history of UDB, and a patient age of > 75 years). UDB was predicted to take an unfavorable course in the presence of one major factor or two minor factors. CONCLUSIONS: The proposed algorithm includes pre-endoscopy clinical and laboratory variables, and allows early classification of patients with non-varicose UDB in terms of their possible clinical course.

Epidemiologic aspects on nonvariceal upper gastrointestinal bleeding in a mediterranean region: incidence and sociogeographic and temporal fluctuations.

AIM: The objectives of this study were to know the incidence of acute nonvariceal upper gastrointestinal bleeding (UGIB) in a Mediterranean region, and to analyze variations due to sociodemographic (age, gender and Primary Care district) and time factors (trend and seasonality). MATERIAL AND METHODS: Longitudinal study during 4 years (April 1995 to March 1999) including all cases of nonvariceal UGIB admitted to the reference hospital of a Health authority area of the Valencian Community, divided into 17 Primary Care districts. Incidence was modeled by Poisson regression. RESULTS: Incidence for the whole period was 108 cases per 100,000 persons-year (95% CI: 100-115). Almost half of the cases (44.9%) were associated to the previous use of nonsteroidal anti-inflammatory drugs (NSAIDs). Incidence was significantly higher for males and older people. Variations of incidence by Primary Care Districts were only significant for NSAID-related UGIB. In the time series analysis, we found a negative trend and a clear seasonality with higher incidence in autumn and winter compared with spring and summer. When relating the seasonality with UGIB, a significant seasonal pattern was only found for UGIB caused by duodenal ulcer, and disappeared in subjects with previous use of NSAIDs. CONCLUSIONS: In our region, nonvariceal UGIB has a significant incidence, but slightly below that reported by other studies carried out in our country. The highest incidence of UGIB was observed in males, and increased sharply with age. In the time series analysis, a negative trend and a clear seasonal pattern that is absent in cases of previous use of NSAIDs, were found.

Influence of nonsteroidal anti-inflammatory drugs on clinical course in upper gastrointestinal tract bleeding.

UNLABELLED: To establish the influence of nonsteroidal anti-inflammatory drugs (NSAIDs) on the clinical course of upper gastrointestinal bleeding (UGIB), we designed a longitudinal cohort study to assess the effect of prior use of these drugs on several outcome variables in patients with UGIB. RESULTS: 164 (46.6%) of 352 patients with UGIB consumed NSAIDs in the week previous to the onset of bleeding. This group had significantly fewer previous episodes of peptic ulcer and UGIB (p < 0.01), more associated comorbidity, and increased use of steroids (p < 0.05). On endoscopic examination, gastric ulcer was the most frequent lesion in patients with NSAIDs as compared to duodenal ulcer in patients without NSAID use (p < 0.0001). There were no differences in the multivariate analysis between groups regarding lowest hemoglobin level, need for transfusion, stability of bleeding, surgical or endoscopic management, depth of lesions and hospital stay. CONCLUSIONS: a relevant proportion of patients admitted for UGIB had used NSAIDs during the previous week. The most frequent lesion in this group was gastric ulcer. In our study the clinical course of NSAID-associated UGIB was similar to that in other nonvariceal types of bleeding.

[Adjunctive treatment with hyperbaric oxygen in a patient with rhino-sinuso-orbital mucormycosis]. / Tratamiento adyuvante con oxígeno hiperbárico en un paciente con mucormicosis rino-sinuso-orbitaria.

Mucormycosis (phycomycosis) is an acute and often fatal infection, mostly seen in diabetics and immunocompromised patients, and seldom in healthy people. Therapy includes aggressive surgical debridement, amphotericin B and control of underlying predisposing condition (diabetes, immunosuppression or immunodeficiency). The rhino-sinuso-orbital presentation is typically observed in insulin-dependent diabetes mellitus with ketoacidosis. This metabolic condition may impair the polymorphonuclear function in a reversible way and this may favour infection by a mucoral. These spores germinate into hyphae, which invade local arteries and arterioles, causing thrombosis, vascular insufficiency and tissue hypoxia and acidosis, conditions which further enhance fungal growth. Hyperbaric oxygen has theoretical value in treating mucormycosis, since it reduces tissue hypoxia caused by the vascular insufficiency. We report an insulin-dependent diabetic patient with rhino-sinuso-orbital mucormycosis, who after being treated with amphotericin B and surgical debridement on two occasions, maintained clinical and tomographic evidence of active infection, and mucoral persistence in the lesion. An aggressive surgical debridement, using microsurgical techniques, was performed. Amphotericin B was increased up to a total dose of 3900 mg. (he had previously received 2900 mg) and hyperbaric oxygen was added as adjunctive treatment. The outcome was successful. There was no evidence of relapse after a 16-month follow-up. This observation would confirm the usefulness of hyperbaric oxygen as adjunctive therapy in mucormycosis.

[Malignant peritoneal mesothelioma. An infrequent cause of prolonged fever syndrome and leucocytosis in a young adult]. / Mesotelioma maligno de peritoneo. Causa infrecuente de síndrome febril prolongado y leucocitosis en un adulto joven.

Peritoneal mesothelioma is a rare neoplasia usually associated with exposure to asbestos. The incidence in the population not in contact with asbestos is of one per million per year. The disease is most common in males over the age of 40, with signs and symptoms of neoplasic disease together with abdominal pain and ascitis with or without a palpable abdominal mass. We report the case of a young male without a history of exposure to asbestos who presented with prolonged fever, leukocytosis and a septated peritoneal exudate. With a presumptive diagnosis of peritoneal tuberculosis, the patient received empirical antituberculosis treatment. Because the clinical picture persisted and microbiological studies remained negative, a second exploratory laparotomy was performed which demonstrated the presence of a malignant epithelial peritoneal mesothelioma.