GPS Suitability for Physical Frailty Assessment.

The ageing of the population needs the automation of patient monitoring. The objective of this is twofold: to improve care and reduce costs. Frailty, as a state of increased vulnerability resulting from several diseases, can be seen as a pandemic for older people. One of the most common detection tests is gait speed. This article compares the gait speed measured outdoors using smartphones with that measured using manual tests conducted in medical centres. In the experiments, the walking speed was measured over a straight path of 80 m. Additionally, the speed was measured over 2.4 m in the middle of the path, given that this is the minimum distance used in medical frailty tests. To eliminate external factors, the participants were healthy individuals, the weather was good, and the path was flat and free of obstacles. The results obtained are promising. The measurements taken with common smartphones over a straight path of 80 m are within the same order of error as those observed in the manual tests conducted by practitioners.

Emplacement and associated sedimentary record of the Jurassic submarine salt allochthon of the Wurzeralm (Eastern Alps, Austria).

A fossil salt sheet emplaced in the Jurassic in submarine conditions is described in the Eastern Alps of Austria, providing unique insights into the emplacement of similar submarine structures and their potential control on depositional systems. The salt sheet is a plug-fed extrusion emplaced due to squeezing of a salt diapir under compression. The preserved mylonitic shear fabric in the evaporites indicates radial, south-directed emplacement of the salt sheet. Tectono-sedimentary relationships record the evolution of the salt structure, from initial diapiric growth, to salt sheet extrusion and posterior collapse. Syn-extrusion sediments record the variable bathymetry of the extruding salt sheet, with reefal carbonates building up on the crestal bulge while their deeper water equivalents accumulated on the extruding salt lobe. This is the first description of a salt allochthon still linked to its source diapir in the Eastern Alps.

Salt-rich versus salt-poor structural scenarios in the central Northern Calcareous Alps: implications for the Hallstatt facies and early Alpine tectonic evolution (Eastern Alps, Austria).

One of the most remarkable features of the central Northern Calcareous Alps (Eastern Alps, Austria) is the widespread presence of Upper Triassic deep-water carbonates (the Hallstatt facies) and Permo-Triassic evaporites resting on deep-water Middle Jurassic strata and their underlying Upper Triassic shallow-water carbonate platform successions. The Hallstatt facies and accompanying evaporites have been classically interpreted to originate either from a location south of the time-equivalent carbonate platforms, or to have been deposited in deeper water seaways within the broad platform domain. To date, this dispute has been addressed mostly through the analysis of Triassic and Jurassic facies distribution in map view, which, however, is subject to some degree of ambiguity and subjectivity. In this contribution we present, for the first time, sequentially restored regional cross-sections through the central Northern Calcareous Alps to understand the implications of the contrasting paleogeographic models. We present (a) an interpretation based on a highly allochthonous origin of the Triassic deep-water units and (b) an interpretation based on their relative autochthony in which we incorporate the potential influence of salt tectonics in the central NCA. The restored cross-sections provide a framework within which the alternative scenarios and their paleogeographic implications can be better understood. Through this analysis we propose that salt tectonics in the central NCA can provide a valid explanation for apparent inconsistencies in the relative autochthony scenario and thus constitutes a reasonable alternative to the currently accepted allochthony scenario.

Association between human leukocyte antigen class II-DR-DQ and narcolepsy: a case control study.

STUDY OBJECTIVES: Narcolepsy is a neurologic disorder characterized by irresistible sleep attacks. Although its etiology is unknown, it is strongly associated with genetic variances in the human leukocyte antigen (HLA) complex. We investigated the association of HLA class II-DR-DQ alleles in a sample of patients with narcolepsy-cataplexy (narcolepsy type 1; NT1) and patients with narcolepsy without cataplexy (narcolepsy type 2; NT2) with a control group. Additionally, we compared demographic, clinical, and laboratory characteristics of patients with narcolepsy with or without the DQB1*06:02 allele. METHODS: This case control study included 21 patients with NT1 (56.8%), 16 patients with NT2 (43.2%), and 100 controls. Sequence-based typing identified HLA-DRB1 alleles, and HLA-DQB1 typing was done using PCR-Sequence-Specific Oligonucleotide. Allele and haplotype frequencies were calculated by direct counting. Nocturnal polysomnography and Multiple Sleep Latency Test were performed in all participants. RESULTS: In the NT1 group, only one allele had a significantly higher frequency than in the NT2 group: DQB1*06:02 (61.9% vs. 18.8%;). Compared to controls, DQB1*06:02 (61.9% vs. 18.0% in controls) and DRB1*15:01(47.6% vs. 8.0%), had higher frequencies in patients with NT1. Multiple analyses showed that patients with NT1 had an increased chance of being HLA-DQB1*06:02 positive. HLA-DRB1*15:01-DQA1*01:02-DQB1*06:02 haplotype is associated with NT1 in our Brazilian patients. PSG was identified in DQB1*06:02 positive subgroup REM sleep latency (REML) ≤ 15 minutes, and all patients had two or more sleep-onset REM periods (SOREMPs) at MSLT. CONCLUSIONS: This study showed a strong association between HLA DQB1*06:02 and the haplotype HLA-DRB1*15:01-DQA1*01:02-DQB1*06:02 in patients with NT1. Patients with DQB1*0602 allele showed shorter REMLs at PSG. These results reinforce the suggestion of DQB1 genotyping as relevant to narcolepsy screening.

Identification of a Potential Entry-Fusion Complex Based on Sequence Homology of African Swine Fever and Vaccinia Virus.

African swine fever virus (ASFV) belongs to the family of Asfarviridae, part of the group of nucleocytoplasmic large DNA viruses (NCLDV). Little is known about the internalization of ASFV in the host cell and the fusion membrane events that take place at early stages of the infection. Poxviruses, also members of the NCLDV and represented by vaccinia virus (VACV), are large, enveloped, double-stranded DNA viruses. Poxviruses were considered unique in having an elaborate entry-fusion complex (EFC) composed of 11 highly conserved proteins integrated into the membrane of mature virions. Recent advances in methodological techniques have again revealed several connections between VACV EFC proteins. In this study, we explored the possibility of an analogous ASFV EFC by identifying ten candidate proteins exhibiting structural similarities with VACV EFC proteins. This could reveal key functions of these ASFV proteins, drawing attention to shared features between the two virus families, suggesting the potential existence of an ASFV entry-fusion complex.

Managing multiple sclerosis in individuals aged 55 and above: a comprehensive review.

Multiple Sclerosis (MS) management in individuals aged 55 and above presents unique challenges due to the complex interaction between aging, comorbidities, immunosenescence, and MS pathophysiology. This comprehensive review explores the evolving landscape of MS in older adults, including the increased incidence and prevalence of MS in this age group, the shift in disease phenotypes from relapsing-remitting to progressive forms, and the presence of multimorbidity and polypharmacy. We aim to provide an updated review of the available evidence of disease-modifying treatments (DMTs) in older patients, including the efficacy and safety of existing therapies, emerging treatments such as Bruton tyrosine kinase (BTKs) inhibitors and those targeting remyelination and neuroprotection, and the critical decisions surrounding the initiation, de-escalation, and discontinuation of DMTs. Non-pharmacologic approaches, including physical therapy, neuromodulation therapies, cognitive rehabilitation, and psychotherapy, are also examined for their role in holistic care. The importance of MS Care Units and advance care planning are explored as a cornerstone in providing patient-centric care, ensuring alignment with patient preferences in the disease trajectory. Finally, the review emphasizes the need for personalized management and continuous monitoring of MS patients, alongside advocating for inclusive study designs in clinical research to improve the management of this growing patient demographic.

Arrhythmias and cardiac MRI associations in patients with established cardiac dystrophinopathy.

AIMS: Some patients with cardiac dystrophinopathy die suddenly. Whether such deaths are preventable by specific antiarrhythmic management or simply indicate heart failure overwhelming medical therapies is uncertain. The aim of this prospective, cohort study was to describe the occurrence and nature of cardiac arrhythmias recorded during prolonged continuous ECG rhythm surveillance in patients with established cardiac dystrophinopathy and relate them to abnormalities on cardiac MRI. METHODS AND RESULTS: A cohort of 10 patients (36.3 years; 3 female) with LVEF<40% due to Duchenne (3) or Becker muscular (4) dystrophy or Duchenne muscular dystrophy-gene carrying effects in females (3) were recruited, had cardiac MRI, ECG signal-averaging and ECG loop-recorder implants. All were on standard of care heart medications and none had prior history of arrhythmias.No deaths or brady arrhythmias occurred during median follow-up 30 months (range 13-35). Self-limiting episodes of asymptomatic tachyarrhythmia (range 1-29) were confirmed in 8 (80%) patients (ventricular only 2; ventricular and atrial 6). Higher ventricular arrhythmia burden correlated with extent of myocardial fibrosis (extracellular volume%, p=0.029; native T1, p=0.49; late gadolinium enhancement, p=0.49), but not with LVEF% (p=1.0) on MRI and atrial arrhythmias with left atrial dilatation. Features of VT episodes suggested various underlying arrhythmia mechanisms. CONCLUSIONS: The overall prevalence of arrhythmias was low. Even in such a small sample size, higher arrhythmia counts occurred in those with larger scar burden and greater ventricular volume, suggesting key roles for myocardial stretch as well as disease progression in arrhythmogenesis. These features overlap with the stage of left ventricular dysfunction when heart failure also becomes overt. The findings of this pilot study should help inform the design of a definitive study of specific antiarrhythmic management in dystrophinopathy. TRIAL REGISTRATION NUMBER: ISRCTN15622536.

Case report and presentation of a new classification system for hip acetabular and periacetabular ossifications and calcifications.

This report describes a rare case in which double calcifications of the acetabular labrum and rectus femoris occurred concomitantly in a middle-aged female patient who was treated successfully with surgical intervention via hip arthroscopy. Contribution: This case highlights the existence of various types of calcifications around the acetabulum, with a proposed new classification system for acetabular and periacetabular rim ossifications.

Practical tool to identify Spasticity-Plus Syndrome amongst patients with multiple sclerosis. Algorithm development based on a conjoint analysis.

Introduction: The Spasticity-Plus Syndrome (SPS) in multiple sclerosis (MS) refers to a combination of spasticity and other signs/symptoms such as spasms, cramps, bladder dysfunction, tremor, sleep disorder, pain, and fatigue. The main purpose is to develop a user-friendly tool that could help neurologists to detect SPS in MS patients as soon as possible. Methods: A survey research based on a conjoint analysis approach was used. An orthogonal factorial design was employed to form 12 patient profiles combining, at random, the eight principal SPS signs/symptoms. Expert neurologists evaluated in a survey and a logistic regression model determined the weight of each SPS sign/symptom, classifying profiles as SPS or not. Results: 72 neurologists participated in the survey answering the conjoint exercise. Logistic regression results of the survey showed the relative contribution of each sign/symptom to the classification as SPS. Spasticity was the most influential sign, followed by spasms, tremor, cramps, and bladder dysfunction. The goodness of fit of the model was appropriate (AUC = 0.816). Concordance between the experts' evaluation vs. model estimation showed strong Pearson's (r = 0.936) and Spearman's (r = 0.893) correlation coefficients. The application of the algorithm provides with a probability of showing SPS and the following ranges are proposed to interpret the results: high (> 60%), moderate (30-60%), or low (< 30%) probability of SPS. Discussion: This study offers an algorithmic tool to help healthcare professionals to identify SPS in MS patients. The use of this tool could simplify the management of SPS, reducing side effects related with polypharmacotherapy.

Dynamic Contrast-Enhanced Magnetic Resonance Lymphangiography for Diagnosis and Treatment of Chylopericardium After Cardiac Transplantation.

Chylopericardium is a rare complication after cardiac transplantation. We report a case of a 69-year-old woman with persistent chylopericardium after a heart transplantation due to Chagas disease. Failure of conservative treatment led to dynamic contrast-enhanced magnetic resonance lymphangiography and percutaneous radiologic intervention of the lymphatic leakage and symptoms resolution.

Caracterización de la composición corporal y el grado de actividad física del personal del servicio de medicina física y rehabilitación de un hospital de Bogotá, Colombia / Characterization of body composition and physical activity level of the staff of the physical medicine and rehabilitation service of a hospital in Bogota, Colombia

Introducción. La Organización Mundial de la Salud (OMS) define la salud como un estado de completo bienestar físico, mental y social, y establece que los hábitos de vida saludable son acciones que modifican los factores de riesgo cardiovascular. Hacer actividad física disminuye el riesgo cardiovascular y puede modificar el peso y la composición corporal, por lo que analizar la composición corporal y el nivel de actividad física de las personas es de gran importancia. Objetivo. Caracterizar la composición corporal y el grado de actividad física del personal asistencial del Servicio de Medicina Física y Rehabilitación del Hospital Militar Central (HOMIL) de Bogotá, Colombia, durante el año 2020. Métodos. Estudio transversal realizado con 46 trabajadores del Servicio de Medicina Física y Rehabilitación del HOMIL. Resultados. La mayoría de participantes eran mujeres (65%) pertenecientes a diferentes dependencias, principal-mente a terapia física (37%), y tenían un índice de masa corporal (IMC) normal (58,7%); el 34,8% presentó sobrepeso y el 6,5%, obesidad. En la medición de la composición corporal por bioimpedancia eléctrica se observó que la mayoría de participantes (69,6%) tenía una proporción normal de masa grasa normal y que el volumen de grasa visceral fue elevado en la mitad de la población y normal en la otra mitad. La actividad física en la mayoría de la población fue moderada (47,8%), lo que pudo estar asociado a que el 70,6% de los trabajado- res dedicaba cuatro o más horas a realizar actividades sedentarias. Conclusión. La mayoría del personal de salud perteneciente al Servicio de Medicina Física y Rehabilitación del HOMIL presenta IMC normal; sin embargo, una gran proporción tiene sobrepeso y obesidad y solo la mitad presenta un nivel de actividad física moderada, dejando en evidencia la presencia de condiciones con necesidad de corregir para evitar complicaciones cardiovasculares.

Introduction. The World Health Organization (WHO) defines health as a state of complete physical, mental and social well-being, and establishes that healthy lifestyle habits are actions that modify cardiovascular risk factors. Physical activity decreases cardiovascular risk and can modify weight and body composition, so analyzing body composition and the level of physical activity of individuals is of great importance. Objective. To characterize the body composition and the degree of physical activity of the assisting personnel of the Physical Medicine and Rehabilitation Service of the Central Military Hospital (HOMIL) of Bogota, Colombia, during the year 2020. Methods. Cross-sectional study conducted with 46 workers of the Physical Medicine and Rehabilitation Service of the HOMIL. Results. The majority of participants were women (65%) belonging to different units, mainly physical therapy (37%), and had a normal body mass index (BMI) (58.7%); 34.8% were overweight and 6.5% obese. The measurement of body composition by electrical bioimpedance showed that the majority of participants (69.6%) had a normal proportion of normal fat mass and that the volume of visceral fat was elevated in half of the population and normal in the other half. Physical activity in the majority of the population was moderate (47.8%), which could be associated with the fact that 70.6% of the workers dedicated four or more hours to physical activity. Conclusion. Most of the health personnel belonging to the Physical Medicine and Rehabilitation Service of the HOMIL present normal BMI; however, a large proportion are overweight and obese and only half present a moderate level of physical activity, leaving in evidence the presence of conditions that need to be corrected to avoid cardiovascular complications.

Cambios en la composición corporal en pacientes con enfermedad isquémica en fase II de rehabilitación cardíaca / Changes in body composition in patients with ischemic disease undergoing phase II cardiac rehabilitation

Introducción. La enfermedad isquémica cardíaca es la principal causa de mortalidad en Colombia, por lo que los servicios de rehabilitación cardíaca juegan un papel fundamental en la prevención secundaria. El sobrepeso y la obesidad son factores intervenidos mediante composición corporal a través de bioimpedancia eléctrica para discriminar el agua corporal total, el agua extracelular, la masa magra, la masa grasa y la grasa visceral, siendo este último parámetro uno de los predictores de nuevos eventos cardiovasculares. Objetivo. analizar los cambios en la composición corporal en pacientes con enfermedad isquémica. Materiales y métodos. Estudio analítico retrospectivo realizado en 34 pacientes con diagnóstico de cardiopatía isquémica que entre el 3 de agosto de 2020 y el 4 de agosto de 2021 asistieron a rehabilitación cardíaca fase II de forma presencial en el Hospital Militar Central de Bogotá, Colombia. Se aplicó un muestreo probabilístico. Resultados. La mediana de la edad de los participantes fue de 58 años y la mayoría fueron hombres (88,2%). Con respecto a las medidas antropométricas, la mediana del peso inicial fue 69,3 kg y la final, 68,7 kg (p=0,025); la mediana inicial del índice de masa corporal (IMC) fue 26,3 kg/m2 y la final, 26,1 kg/m2 (p=0,003); la mediana del perímetro abdominal inicial fue 91,5 cm y la final, 89,5 cm (p=0.000), y la mediana del perímetro de cadera inicial fue 98,5 cm y la final, 94 cm (p=0.000). En la composición corporal se encontró que la masa grasa disminuyo: la mediana pasó de 7,3 kg/m2 a 6,0 kg/m2 (p=0,002), al igual que la grasa visceral, cuya mediana pasó de 3,4 L a 3,1 L (p=0,003). La mediana de la capacidad física aumentó pasando de 7,2 MET a 10,4 MET (p=0.000). Conclusión. Los pacientes con diagnóstico de cardiopatía isquémica que asistieron a rehabilitación cardíaca al Hospital Militar Central presentaron cambios estadísticamente significativos entre el ingreso y el final del programa en peso, IMC, perímetro abdominal y de cadera, masa grasa, grasa visceral y capacidad física.

Introduction. Ischemic heart disease is the main cause of mortality in Colombia, so cardiac rehabilitation services play a fundamental role in secondary prevention. Overweight and obesity are factors intervened by means of body composition through electrical bioimpedance to discriminate total body water, extracellular water, lean mass, fat mass and visceral fat, the latter parameter being one of the predictors of new cardiovascular events. Objective. to analyze changes in body composition in patients with ischemic disease. Materials and Methods. Retrospective analytical study conducted in 34 patients with a diagnosis of ischemic heart disease who between August 3, 2020 and August 4, 2021 attended phase II cardiac rehabilitation in person at the Hospital Militar Central de Bogotá, Colombia. Probabilistic sampling was applied. Results. The median age of the participants was 58 years and the majority were men (88.2%). Regarding anthropometric measurements, the median initial weight was 69.3 kg and the final weight was 68.7 kg (p=0.025); the median initial body mass index (BMI) was 26.3 kg/m2 and the final weight was 26.1 kg/m2 (p=0.003); the median initial abdominal perimeter was 91.5 cm and the final perimeter was 89.5 cm (p=0.000), and the median initial hip perimeter was 98.5 cm and the final hip perimeter was 94 cm (p=0.000). In body composition, fat mass decreased: the median went from 7.3 kg/m2 to 6.0 kg/m2 (p=0.002), as did visceral fat, whose median went from 3.4 L to 3.1 L (p=0.003). Median physical capacity increased from 7.2 MET to 10.4 MET (p=0.000). Conclusion. Patients with a diagnosis of ischemic heart disease who attended cardiac rehabilitation at the Central Military Hospital presented statistically significant changes between admission and the end of the program in weight, BMI, abdominal and hip circumference, fat mass, visceral fat and physical capacity.

Relato de Caso: paralisia unilateral de prega vocal por tuberculose mediastinal / Case report: unilateral vocal fold paralysis by mediastinal tuberculosis

Introdução: A tuberculose (TB) acomete especialmente os pulmões, no entanto, também se tem conhecimento das formas extrapulmonares. Dentre essas, buscamos relatar um caso raro de TB mediastinal localizada em trajeto de nervo laríngeo recorrente (NLR), a qual se manifestou com paralisia de prega vocal (PPV). Relato de Caso: Paciente masculino, 58 anos, apresentando quadro de disfonia. Histórico de exérese de testículo esquerdo e anatomopatológico evidenciando orquiepididimite crônica granulomatosa sugestiva de etiologia tuberculosa. Ex-tabagista e ex-etilista. Realizou, há 15 anos, um tratamento por 6 meses para TB pulmonar. Contactante de paciente bacilífero há três anos. A videolaringoscopia identificou PPV esquerda paramediana. A tomografia computadorizada (TC) de pescoço evidenciou linfonodos calcificados no mediastino superior, fossas supraclaviculares e espessamento de corda vocal à direita. A TC de Tórax apresentou conglomerados sequelares linfonodais calcificados no mediastino e sequela de processo granulomatoso crônico tipo TB em ápices pulmonares. Sorologia de HIV não reagente. Baciloscopia negativa, com amostra insuficiente. Cultura de escarro negativa. Discussão: A PPV esquerda encontrada na videolaringoscopia e TC de pescoço e os achados de TB mediastinal indicaram acometimento do NLR esquerdo pelo processo granulomatoso em seu trajeto, sendo esse, uma reativação de TB ganglionar mediastinal. Fora realizado esquema básico de tratamento para TB, com posterior resolução do quadro de disfonia. Embora a TB torácica seja uma condição comum, a rouquidão devido à PPV é uma complicação raramente associada. Conclusão: Salientamos a importância de estender a investigação ao mediastino na vigência de PPV unilateral, uma vez que a disfunção do NLR pode justificar o quadro.

Introduction: tuberculosis (TB) affects most commonly the lungs; nevertheless, extrapulmonary forms are also known. With that in mind, we intend to report a rare case of mediastinal TB located on the path of the recurrent laryngeal nerve (RLN), manifesting itself with vocal fold paralysis (VFP). Case report: male patient, 58 years old, presenting dysphonia. History of exeresis of the left testicle and anatomopathological showing chronic granulomatous orchiepididimitis, suggestive of tuberculous etiology. Former smoker, ex-alcoholic. Previous treatment for six months due to pulmonary TB, 15 years ago. Bacilli patient contactant for three years. Videolaryngoscopy identified paramedian left VFP. Computed tomography (CT) of the neck showed calcified lymph nodes in the upper mediastinum, supraclavicular fossa, and thickening on the right vocal cord. Chest CT showed calcified lymph node sequels in the mediastinal and Chronic Granulomatous TB-type sequel in pulmonary apices. Non-reactive HIV serology. Negative baciloscopy, insufficient sample. Negative sputum culture. Discussion: the finding of left VFP in videolaryngoscopy and neck CT, associated with the findings of mediastinal TB, indicated that the left RLN's involvement occurred due to the granulomatous process in its path, meaning a reactivation of mediastinal ganglionic TB. A simple treatment schedule for TB had been conducted, with subsequent resolution of the dysphonia. Even though thoracic TB is a common condition, hoarseness due to VFP is a rarely associated complication. Conclusion: we stress the importance of extending the investigation to the mediastinum in case of unilateral VFP since a dysfunction of the RLN is a possible justification of the case.

Manifestaciones cardiacas de la infección por Covid-19 y su enfoque rehabilitador. Revisión narrativa / Cardiac manifestations of Covid-19 infection and its rehabilitative approach. Narrative review

La infección por el nuevo coronavirus (Covid-19), descrita desde diciembre de 2019, ha ocasionado una pandemia de gran magnitud con consecuencias devastadoras a nivel mundial e implicaciones en la salud de las personas que la padecen y presentan síntomas, lo cual genera complicaciones a corto y a largo plazo, éstas últimas aún desconocidas en su totalidad. Se han descrito complicaciones cardiovasculares secundarias a la infección por Covid -19 entre las que se cuenta la aparición de arritmias, infarto agudo del miocardio, miocarditis y eventos trombótico. Sin embargo, las complicaciones a largo plazo aún no se dilucidan en su totalidad teniendo en cuenta el corto periodo de evolución de la enfermedad. A pesar de esto, es clara la asociación que existe entre las enfermedades cardiovasculares previas y la coinfección por Covid-19, lo cual favorece la aparición de enfermedades severas y peores desenlaces en las personas que las presentan. Teniendo en cuenta esta asociación, es importante crear o fortalecer programas de rehabilitación cardiaca que utilicen herramientas tecnológicas para favorecer la telerrehablitación y así mejorar la calidad de vida de las personas, favoreciendo su independencia.

The infection by the new coronavirus (Covid-19), described since December 2019, has caused a pandemic of great magnitude with devastating consequences worldwide and implications in the health of people who suffer from it and present symptoms, which generates short and long term complications, the latter still unknown in its entirety. Cardiovascular complications secondary to Covid-19 infection have been described, including arrhythmias, acute myocardial infarction, myocarditis and thrombotic events. However, long-term complications are not yet fully elucidated considering the short evolution period of the disease. Despite this, there is a clear association between previous cardiovascular disease and Covid-19 coinfection, which favors the onset of severe disease and worse outcomes in those who present it. Taking this association into account, it is important to create or strengthen cardiac rehabilitation programs that use technological tools to favor telerehablitation and thus improve the quality of life of people, favoring their independence.

Concordancia entre ecoscopia realizada por médicos no cardiólogos y ecocardiografía convencional / Agreement between "echoscopy" performed by non-cardiologist physicians and conventional cardiac ultrasound

Resumen Introducción: el ultrasonido cardiaco enfocado ha sido propuesto como una aproximación útil para mejorar la toma de decisiones clínicas, permitiendo identificar rápidamente signos ultrasonográficos de una lista específica de diagnósticos potenciales. Objetivo: evaluar un programa de entrenamiento para médicos sin experiencia en ecocardiografía a fin de realizar ultrasonido cardiaco enfocado por medio de un dispositivo portátil (ecoscopio). Materiales y métodos: se compararon los resultados obtenidos mediante ecoscopia realizada por los médicos que recibieron el entrenamiento, con los obtenidos mediante ecocardiografía convencional realizada por cardiólogos expertos. Métodos: un total de 5 médicos no cardiólogos incluyendo un estudiante de Medicina de último año, 2 residentes de Medicina Interna y 2 Intensivistas participaron en un curso de entrenamiento de cuatro semanas, dirigido por un Cardiólogo experto de nivel III así: Primera semana: teoría y bases de ecocardiografía (3 horas diarias) Segunda semana: teoría de la adquisición de imágenes. Hallazgos normales y anormales (50 estudios). Tercera semana: manejo del ecoscopio (50 estudios). Cuarta semana: recolección de datos. Se incluyeron pacientes programados para ecocardiografía convencional en el Laboratorio de métodos no invasivos. A cada paciente se le realizaron dos exámenes. El primero consistió en una ecoscopia hecha por médico que recibió el entrenamiento y el segundo consistió en un ecocardiograma realizado por un cardiólogo experto. Los parámetros ecocardiográficos evaluados fueron: fracción de eyección del ventrículo izquierdo, disfunción ventricular derecha, crecimiento auricular izquierdo, hipertensión pulmonar, enfermedad valvular cardiaca y derrame pericárdico. Por medio de análisis de concordancia (índice Kappa) se compararon los resultados encontrados en ecoscopia versus ecocardiografía. Resultados: de 221 estudios se obtuvo concordancia moderada en fracción de eyección del ventrículo izquierdo (к =0,541, p<0,000), función ventricular derecha (к =0,403, p<0,001), dilatación de la aurícula izquierda (к =0,413, p<0,001), valvulopatía mitral (к =0,466, p<0,001) y tricuspídea (к =0,437, p<0,001). La valvulopatía aórtica mostró un acuerdo débil. El derrame pericárdico y la hipertensión pulmonar tuvieron concordancia pobre y débil, respectivamente. Conclusiones: con un tiempo limitado de formación, los participantes sin experiencia previa en técnicas de ultrasonido y utilizando ecoscopia, alcanzaron un acuerdo moderado en la mayoría de las mediciones cuando se comparó con ecocardiografía convencional practicada por ecocardiografistas expertos. Es necesario un estudio con mayor número de participantes que determine el tiempo de formación ideal para obtener resultados comparables con ecocardiografía.

Abstract Introduction: Focused cardiac ultrasound has been proposed as a useful approach for improving clinical decision making, as well as to be able to rapidly identify the ultrasound signs of a specific list of potential diagnoses. Objective: To evaluate a training program for physicians with no experience in cardiac ultrasound with the aim performing focused cardiac ultrasound using a portable device (echoscopy). Materials and methods: The results obtained from echoscopy performed by the physicians that received training were compared with those obtained with conventional cardiac ultrasound carried out by expert cardiologists. A total of 5 non-cardiologist doctors, including 1 medical student, 2 Internal Medicine residents, and 2 from Intensive Medicine, took part in a four-week training course given by a Level III Cardiology specialist. The course included: First week: Theory and basis of cardiac ultrasound (3 hours daily) Second week: Theory of acquiring images. Normal and abnormal findings (50 studies). Third week: handling of the echoscope (50 studies). Fourth week: Data collection. The study included patients scheduled for conventional cardiac ultrasound in the Non-Invasive Methods Laboratory. Two examinations were carried out on each patient. The first consisted of an echoscopy performed by a doctor that had received the training, and the second consisted of a cardiac ultrasound carried out by an expert cardiologist. The ultrasound parameters evaluated were: left ventricular ejection fraction, right ventricular dysfunction, left atrial enlargement, pulmonary hypertension, cardiac valve disease, and pericardial effusion. The results found in echoscopy versus cardiac ultrasound were compared using concordance analysis (Kappa Index). Results: The following results were obtained on the 221 studies performed: moderate agreement in left ventricular ejection fraction (к =0.541, P<.000), right ventricular function (к =0.403, P<.001), left atrial enlargement (к =0.413, P<.001), mitral valve and tricuspid valve disease (к =0.437, P<.001 and (к =0.466, P<.001, respectively). There was weak agreement with aortic valve disease. Pericardiac effusion and the presence of pulmonary hypertension had a poor and week agreement, respectively. Conclusions: With a limited training period, the participants with no previous experience in ultrasound techniques and using echoscopy achieved a moderate agreement in the majority of measurements when compared with conventional cardiac ultrasound performed by experts in the technique. A study with a larger number of participants is required in order to determine the ideal training period to obtain results comparable with cardiac ultrasound.

Guía de Práctica Clínica para el Diagnóstico y Tratamiento de Esclerosis Múltiple en Adultos / Clinical Practice Guidelines: Diagnostic and Treatment of Multiple Sclerosis in Adults

La Esclerosis Múltiple (EM) es una enfermedad crónica del sistema nervioso central, para la cual aún no hay una cura definitiva; sin embargo, existe una diversa variedad de terapias con el objetivo de modificar el curso natural de la enfermedad, que promueve la inclusión constante de nuevas estrategias terapéuticas. Objetivo: La Sociedad Peruana de Neurología, por encargo del Ministerio de Salud, convocó a un comité de expertos con el objetivo de elaborar una guía de práctica clínica para el diagnóstico y tratamiento de EM. Método: Se realizó una búsqueda y evaluación de guías de práctica clínica bajo la metodología AGREE II, escogiendo como modelo la Guía de Práctica Clínica Catalana. Las preguntas clínicas no concernientes al tratamiento fueron resueltas a través de revisión sistemática. Las preguntas clínicas de tratamiento se diseñaron bajo el formato PICO y se resolvieron con un meta-análisis de ensayos clínicos disponibles hasta agosto del 2017, tomando en consideración las terapias aprobadas por DIGEMID hasta enero del 2017. Las recomendaciones finales fueron elaboradas mediante el método Delphi modificado con un consenso de al menos 80% de los miembros de su comité. Finalmente se realizó una revisión externa del manuscrito por expertos internacionales en EM. Resultados: Se formularon 18 preguntas clínicas y 21 recomendaciones para el manejo, incluyendo algoritmos terapéuticos.

Multiple Sclerosis (MS) is a chronic disease of the central nervous system, for which there is still no definitive cure; but there is a diverse variety of therapies with the objective of modifying the course of the disease, which promotes the constant inclusion of new therapeutic strategies. Objective: The Peruvian Society of Neurology, as requested by the Peruvian Health Ministry, convened a committee of experts with the purpose of elaborating a clinical practice guideline for the diagnosis and treatment of MS. Method: Clinical practice guidelines were searched and evaluated according to the AGREE II methodology, choosing the Catalan Clinical Practice Guide as a model. The clinical questions not related to treatment were solved through a systematic review. The clinical treatment questions were assessed under the PICO format and were solved with a meta-analysis of clinical trials available until August 2017, considering the therapies approved by DIGEMID until January 2017. The final recommendations were elaborated using the modified Delphi method with a consensus of at least 80% of the members of its committee. Finally, an external revision of the manuscript was made by international experts in MS. Results: Eighteen clinical questions and twenty-one recommendations for management were developed, including therapeutic algorithms.

Evaluation of enemas containing sucralfate in tissue content of muc-2 protein in experimental model of diversion colitis / Avaliação de enemas com sucralfato no conteúdo tecidual da proteina muc-2 em colite de exclusão experimental

ABSTRACT Background: The effects of topical application of sucralfate (SCF) on the tissue content of MUC-2 protein have not yet been evaluated in experimental models of diversion colitis. Aim: To measure the tissue content of MUC-2 protein in the colonic mucosa diverted from fecal stream submitted to the SCF intervention. Methods: Thirty-six rats underwent derivation of intestinal transit through proximal colostomy and distal mucous fistula. The animals were divided into three groups which were submitted application of enemas with saline, SCF 1 g/kg/day and SCF 2 g/kg/day. Each group was divided into two subgroups, according to euthanasia was done after two or four weeks. The colitis diagnosis was established by histopathological study and the inflammatory intensity was evaluated by previously validated scale. The MUC-2 protein was identified by immunohistochemistry and the tissue content was measured computerized morphometry). Results: The application of enemas with SCF in the concentration of 2 g/kg/day reduced inflammatory score of the segments that were diverted from fecal stream. The content of MUC-2 in diverted colon of the animals submitted to the intervention with SCF, independently of intervention period and the used concentration, was significantly greater than animals submitted to the application of enemas containing saline (p< 0.01). The content of MUC-2 after the intervention with SCF in the concentration of 2 g/kg/day was significantly higher when compared to the animals submitted to the application containing SCF at concentration of 1.0 g/kg/day (p<0.01). The tissue content of MUC-2 reached the highest values after intervention with SCF in the concentration of 2 g/kg/day for four weeks (p<0.01). Conclusion: The preventive application of enemas containing SCF reduces the inflammatory score and avoids the reduction of tissue content of MUC-2, suggesting that the substance is a valid therapeutic strategy to preserve the mucus layer that covers the intestinal epithelium.

RESUMO Racional: Os efeitos da aplicação tópica de sucralfato (SCF) no conteúdo tecidual da proteína mucina-2 (MUC-2) ainda não foram avaliados em modelos experimentais de colite de exclusão. Objetivo: Mensurar o conteúdo tecidual da proteína MUC-2 na mucosa cólica sem trânsito intestinal submetida à intervenção com SCF. Método: Trinta e seis ratos foram submetidos à derivação intestinal por colostomia proximal terminal e fístula mucosa distal. Foram divididos em três grupos segundo recebessem clisteres contendo solução fisiológica (SF), SCF 1 g/kg/dia e SCF 2 g/kg/dia. Cada grupo foi dividido em dois subgrupos, segundo a eutanásia ser realizada após duas ou quatro semanas. O diagnóstico de colite foi estabelecido por estudo histopatológico e a intensidade inflamatória foi avaliada por escala validada. A expressão tecidual da MUC-2 foi identificada por imunoistoquímica e seu conteúdo mensurado por morfometria computadorizada. Resultados: A aplicação de clisteres com SCF na concentração de 2 g/kg/dia reduziu a intensidade inflamatória no cólon sem trânsito fecal. O conteúdo tecidual de MUC-2 no cólon sem trânsito dos animais submetidos à intervenção com SCF, independente do tempo de intervenção e da concentração utilizada, foi maior quando comparado aos animais tratados com SF (p<0,01). O conteúdo de MUC-2 após a intervenção com SCF na concentração de 2 g/kg/dia foi maior quando comparado aos animais submetidos à intervenção com concentração menor (p<0,01). O conteúdo de MUC-2 foi maior após intervenção com SCF na concentração de 2 g/kg/dia por quatro semanas (p<0,01). Conclusão: A aplicação preventiva de clisteres com SCF reduz o grau de inflamação e preserva o conteúdo tecidual de MUC-2, em segmentos desprovidos de trânsito intestinal, mostrando-se uma estratégia terapêutica válida para preservar a camada de muco que recobre o epitélio intestinal.

[retracted article]: evaluation of enemas containing sucralfate in tissue content of muc-2 protein in experimental model of diversion colitis / [artigo retratado]: avaliação de enemas com sucralfato no conteúdo tecidual da proteina muc-2 em colite de exclusão experimental

ABSTRACT Background: The effects of topical application of sucralfate (SCF) on the tissue content of MUC-2 protein have not yet been evaluated in experimental models of diversion colitis. Aim: To measure the tissue content of MUC-2 protein in the colonic mucosa diverted from fecal stream submitted to the SCF intervention. Methods: Thirty-six rats underwent derivation of intestinal transit through proximal colostomy and distal mucous fistula. The animals were divided into three groups which were submitted application of enemas with saline, SCF 1 g/kg/day and SCF 2 g/kg/day. Each group was divided into two subgroups, according to euthanasia was done after two or four weeks. The colitis diagnosis was established by histopathological study and the inflammatory intensity was evaluated by previously validated scale. The MUC-2 protein was identified by immunohistochemistry and the tissue content was measured computerized morphometry). Results: The application of enemas with SCF in the concentration of 2 g/kg/day reduced inflammatory score of the segments that were diverted from fecal stream. The content of MUC-2 in diverted colon of the animals submitted to the intervention with SCF, independently of intervention period and the used concentration, was significantly greater than animals submitted to the application of enemas containing saline (p< 0.01). The content of MUC-2 after the intervention with SCF in the concentration of 2 g/kg/day was significantly higher when compared to the animals submitted to the application containing SCF at concentration of 1.0 g/kg/day (p<0.01). The tissue content of MUC-2 reached the highest values after intervention with SCF in the concentration of 2 g/kg/day for four weeks (p<0.01). Conclusion: The preventive application of enemas containing SCF reduces the inflammatory score and avoids the reduction of tissue content of MUC-2, suggesting that the substance is a valid therapeutic strategy to preserve the mucus layer that covers the intestinal epithelium.

RESUMO Racional: Os efeitos da aplicação tópica de sucralfato (SCF) no conteúdo tecidual da proteína mucina-2 (MUC-2) ainda não foram avaliados em modelos experimentais de colite de exclusão. Objetivo: Mensurar o conteúdo tecidual da proteína MUC-2 na mucosa cólica sem trânsito intestinal submetida à intervenção com SCF. Método: Trinta e seis ratos foram submetidos à derivação intestinal por colostomia proximal terminal e fístula mucosa distal. Foram divididos em três grupos segundo recebessem clisteres contendo solução fisiológica (SF), SCF 1 g/kg/dia e SCF 2 g/kg/dia. Cada grupo foi dividido em dois subgrupos, segundo a eutanásia ser realizada após duas ou quatro semanas. O diagnóstico de colite foi estabelecido por estudo histopatológico e a intensidade inflamatória foi avaliada por escala validada. A expressão tecidual da MUC-2 foi identificada por imunoistoquímica e seu conteúdo mensurado por morfometria computadorizada. Resultados: A aplicação de clisteres com SCF na concentração de 2 g/kg/dia reduziu a intensidade inflamatória no cólon sem trânsito fecal. O conteúdo tecidual de MUC-2 no cólon sem trânsito dos animais submetidos à intervenção com SCF, independente do tempo de intervenção e da concentração utilizada, foi maior quando comparado aos animais tratados com SF (p<0,01). O conteúdo de MUC-2 após a intervenção com SCF na concentração de 2 g/kg/dia foi maior quando comparado aos animais submetidos à intervenção com concentração menor (p<0,01). O conteúdo de MUC-2 foi maior após intervenção com SCF na concentração de 2 g/kg/dia por quatro semanas (p<0,01). Conclusão: A aplicação preventiva de clisteres com SCF reduz o grau de inflamação e preserva o conteúdo tecidual de MUC-2, em segmentos desprovidos de trânsito intestinal, mostrando-se uma estratégia terapêutica válida para preservar a camada de muco que recobre o epitélio intestinal.

Influence of the application of enemas with oily extract of curcumin (Curcuma longa) on the tissue content of neutral and acidic mucins in the colonic mucosa without fecal stream / Influência da aplicação de clisteres contendo extrato oleoso de curcumina (Curcuma longa) no conteúdo tecidual de mucinas neutras e ácidas na mucosa cólica sem trânsito intestinal

ABSTRACT Purpose: To verify if the application of enemas containing oily extracts of curcumin preserves the tissue content of mucins in the glands of the colonic mucosa without fecal stream. Method: Thirty-six Wistar rats were submitted to diversion of the fecal stream by proximal colostomy and distal mucous fistula. The animals were subdivided into three groups, and accordingly received enemas with saline and oily extract of curcumin at concentrations of 50 mg/kg/day or 200 mg/kg/day. After two or four weeks of intervention, the irrigated colic segments were removed. Neutral and acidic mucins were identified by Periodic-acid Schiff and Alcian-Blue techniques, respectively. The content of both mucin subtypes was measured by computerized morphometry. Mann-Whitney test was used to analyze the results, adopting a significance level of 5% (p ≤ 0.05). Results: There was an increase in the tissue content of neutral mucins in animals treated with curcumin at a concentration of 50 mg/kg/day for four weeks, whereas in the group treated with 200 mg/kg/day there was an increase independent of the time of intervention. The content of acidic mucins increased in animals treated with 200 mg/kg/day regardless of the intervention time, whereas in those treated with 50 mg/kg/day an increase was observed only after four weeks. Conclusion: Enemas with curcumin preserve the content of neutral and acidic mucins in the colonic epithelium without fecal stream.

RESUMO Objetivo: Verificar se a aplicação de clisteres com extrato oleoso de curcumina preserva o conteúdo de mucinas nas glândulas da mucosa cólica sem trânsito intestinal. Método: Trinta e seis ratos Wistar foram submetidos à derivação intestinal por colostomia proximal e fístula mucosa distal. Os animais foram subdivididos em três grupos, segundo receberem clisteres com soro fisiológico 0,9%, extrato oleoso de curcumina nas concentrações de 50 mg/kg/dia ou 200 mg/kg/dia. Após duas ou quatro semanas de intervenção foram removidos os segmentos cólicos irrigados. As mucinas neutras e ácidas foram identificadas pelas técnicas do PAS e Alcian-Blue, respectivamente. O conteúdo tecidual de ambos os subtipos de mucinas foi mensurado por morfometria computadorizada. Utilizou-se teste de Mann-Whitney para análise dos resultados adotando-se nível de significância de 5% (p ≤ 0,05). Resultados: Houve aumento no conteúdo de mucinas neutras nos animais tratados com curcumina na concentração de 50 mg/kg/dia por quatro semanas, enquanto nos tratados com 200 mg/kg/dia houve aumento independente do tempo de intervenção. O conteúdo de mucinas ácidas aumentou nos animais tratados com 200 mg/kg/dia independente do tempo de intervenção, enquanto nos tratados com 50 mg/kg/dia encontrou-se aumento apenas após quatro semanas. Conclusão: Clisteres com curcumina preservam o conteúdo de mucinas neutras e ácidas no epitélio cólico sem trânsito intestinal.