Comparison of effectiveness between different interventions in postconcussive symptoms in adolescents and young people: a literature review.

INTRODUCTION: Currently, concussion considers a problem of great magnitude, adolescents and young people being the population at risk, since it is in the process of maturation. Our goal has been to compare the effectiveness of different interventions (exercise therapy, vestibular rehabilitation and rest) in adolescents and young people with concussion. DEVELOPMENT: A bibliographic search was carried out in the main databases. Once the inclusion/exclusion criteria and the PEDro methodological scale were applied, 6 articles were reviewed. The results support the use of exercise and vestibular rehabilitation in the initial stages to reduce post-concussion symptoms. According to most authors, therapeutic physical exercise and vestibular rehabilitation report greater benefits, although a protocol that unifies assessment scales, study variables and analysis parameters would be needed to be able to make the inference in the target population. CONCLUSIóN: From the moment of hospital discharge, the combined application of exercise and vestibular rehabilitation could be the best option to reduce post-concussion symptoms.

Sulfur Interaction and Regeneration of CaMn0.775Ti0.125Mg0.1O2.9-δ Perovskite as Oxygen Carrier during Combustion of Sour Gas in a 500 Wth Chemical Looping Combustion Unit.

In the present study, the performance of a CaMn0.775Ti0.125Mg0.1O2.9-δ perovskite used as an oxygen carrier to burn sour gas with different H2S concentrations (up to 3000 vppm) in a continuous 500 Wth chemical looping combustion (CLC) prototype was investigated. After 29 h of sour gas combustion, the combustion efficiency had dropped by 18% in comparison with the reference test without sulfur addition. The characterization of the used particles of the perovskite confirmed that the presence of sulfur in the fuel gas had a poisonous effect through the formation of undesired compounds, such as CaSO4. The reactivity with CH4 and oxygen uncoupling capacity decreased, which could explain the decrease in the combustion efficiency. Two regeneration processes, one at high temperature (1273 K) and another one at low temperature (773-873 K), were carried out in a batch fluidized bed reactor to remove the amount of sulfur accumulated in the oxygen carrier particles. The detection of appreciable amounts of gaseous sulfur-based compounds (SO2 and H2S) during the experimentation and the postcharacterization results obtained through different techniques such as X-ray diffraction, ultimate analysis, and thermogravimetric analysis confirmed the effectiveness of both processes. Finally, the feasibility of implementation of the regeneration processes in a commercial CLC unit was thoroughly analyzed.

Over-production of exopolysaccharide by Lacticaseibacillus rhamnosus CNCM I-3690 strain cutbacks its beneficial effect on the host.

Most lactobacilli produce extracellular polysaccharides that are considered to contribute to the probiotic effect of many strains. Lacticaseibacillus rhamnosus CNCM I-3690 is an anti-inflammatory strain able to counterbalance gut barrier dysfunction. In this study ten spontaneous variants of CNCM I-3690 with different EPS-production were generated and characterized by their ropy phenotype, the quantification of the secreted EPS and genetic analysis. Amongst them, two were further analysed in vitro and in vivo: an EPS over-producer (7292) and a low-producer derivative of 7292 (7358, with similar EPS levels than the wild type (WT) strain). Our results showed that 7292 does not have anti-inflammatory profile in vitro, and lost the capacity to adhere to the colonic epithelial cells as well as the protective effect on the permeability. Finally, 7292 lost the protective effects of the WT strain in a murine model of gut dysfunction. Notably, strain 7292 was unable to stimulate goblet cell mucus production and colonic IL-10 production, all key features for the beneficial effect of the WT strain. Furthermore, transcriptome analysis of colonic samples from 7292-treated mice showed a down-regulation of anti-inflammatory genes. Altogether, our results point out that the increase of EPS production in CNCM I-3690 impairs its protective effects and highlight the importance of the correct EPS synthesis for the beneficial effects of this strain.

Vitamin B12: For more than just the treatment of megaloblastic anemia?

Vitamin B12, or cobalamin, belongs to the group of water-soluble vitamins and is ingested through food of animal origin such as eggs, milk, red meat and poultry, fish, and shellfish. Its clinical indication is the treatment of hypovitaminosis B12 administered orally or intramuscularly in the form of hydroxocobalamin. Hypovitaminosis B12 is mainly caused by deficient dietary intake (individuals with malnutrition, vegetarians or vegans, older adults, pregnant people, individuals with alcohol use disorder); when intestinal absorption is reduced (atrophic gastritis, malabsorption syndrome, gastrointestinal surgery); and for causes associated with the intake of drugs (antacids, metformin). Hypervitaminosis B12 has been associated with renal failure; liver diseases such as cirrhosis and acute-phase hepatitis; alcohol use disorder with or without liver involvement; solid tumors of the lung, liver, esophagus, pancreas, and colorectum; and in hematological malignancies such as leukemia and bone marrow dysplasia.

Attitudes of the police towards individuals with a known psychiatric diagnosis.

BACKGROUND: Police officers are increasingly required to respond to incidents involving psychiatric patients. However, few studies have assessed whether the attitude of police officers depends on prior knowledge of their specific psychiatric diagnosis. Our aim was to analyze the effects of psychiatric diagnosis on the behavior of police officers. METHODS: We utilized the Attribution Questionnaire adapted to the police context to examine the attitudes of 927 officers of the Spanish National Police Force towards persons diagnosed with either schizophrenia or depressive disorder playing the role of somebody in need of assistance, a victim of a crime, a witness, or a suspect in a criminal case. Different socio-demographic variables were also collected. RESULTS: Compared to attitudes to individuals with a known psychiatric diagnosis, police officers expressed increased willingness to help psychiatric patients and increased sympathy and attributing to them less responsibility for their actions. They also showed increased feelings of avoidance, reported a greater perception of danger and a greater need for isolation and involuntary treatment. This was especially so in the case of schizophrenia. Stigmatizing attitudes were less apparent when the person was a woman, a veteran officer, or someone with a history of work experience. CONCLUSIONS: Police officers may hold certain stigmatizing attitudes towards persons with mental illness, particularly schizophrenia, that require special attention, as they may negatively affect police action. We found several factors associated with the persistence of these stigmatizing attitudes among police officers that may guide us when implementing training programs for promoting attitude change, especially at the beginning of an officer's professional career.

Evaluation of a heart failure knowledge questionnaire and its use in guiding the educational intervention.

INTRODUCTION AND OBJECTIVE: Patient education by nurses is a cornerstone of any heart failure (HF) program, but the models are widely heterogeneous and few specific instruments exist. Our objective is to evaluate our own questionnaire and its utility as a guide for educational intervention. METHODS: This work is a prospective cohort study of patients followed-up on in a specialized unit after diagnosis of HF. The intervention group received educational sessions guided according to their knowledge using the questionnaire and was compared to a group which received standard education. The validity and reliability of the questionnaire was evaluated. The utility of the educational model was determined by the primary composite endpoint of death and/or hospital admission or emergency care for HF. RESULTS: A total of 152 patients were included, 88 which received guided education and 64 which received standard education, with a mean follow-up time of 16±4 months. In the guided education group, the evaluation questionnaire score (qs) rose from 59% to 78.5% (p=0.018), which was associated with greater self-care (28.5-0.6*qs, p=0.04), a tendency toward better quality of life (51.1-1.1*qs, p=0.09), and adherence (5.02+0.04*qs, p=0.06), with acceptable reliability (Cronbach's alpha 0.75). The primary composite endpoint was met in 12 patients (13.6%) in the intervention group compared to 19 (29.7%) in the control group (hazard ratio: 0.46; 95% confidence interval: 0.24-0.88; p=0.019). Only educational level, age, NT-proBNP, and atrial fibrillation were predictors in the multivariate analysis. CONCLUSION: The HF knowledge questionnaire proposed is a valid, reliable tool and allows for quantifying learning. Its utility in guiding education requires a certain degree of skill from the patient that determines a group with better prognosis.

Benefica chirurgia. A global surgery project focusing on hernia surgery.

BACKGROUND: The aim of international health cooperation projects is to alleviate the deficiencies in the area of health in low resource settings. Hernia surgery is a procedure that is well suited to these missions, due to its low morbidity, the fact that it can be performed on an outpatient basis, and the improvement in quality of life that it provides. OBJECTIVE: To describe the results of Benefica Chirurgia (BC), a Spanish non-profit humanitarian association in hernia pathology. METHODS: Five one-week surgical campaigns were carried out in Ecuador between 2015 and 2019, involving anesthetists, general and pediatric surgeons. Surgical and medical equipment was provided and transported by BC. ASA I/II patients underwent surgery. RESULTS: Surgery was performed on 240 patients with hernia pathology on 27 days. Sixty-three per cent of patients were male and the mean age was 48.2 years (range: 1-83). Hernia location was inguinal in 113 patients, umbilical in 101, and other in 26. The anesthetic technique used was spinal in 185 patients (77.1%), local plus intravenous sedation in 31 (12.9%), and general in 24 (10%). The surgical technique used was hernioplasty in 191 patients, herniorrhaphy in 31, incisional hernia repair in 15 and herniotomy in three. Surgery was performed on an outpatient basis in 98.4% of cases. Morbidity was 2%. Long-term postoperative evaluation is very complex. CONCLUSION: These campaigns make a significant contribution to health in low resource settings and provide great personal satisfaction for those involved. Standards achieved in the immediate postoperative period were similar to those obtained at the surgeons' centers in Europe. However, it is difficult to establish the rates of recurrence and chronic pain.

[Analysis of the effect of cognitive stimulation program in older adults with normal cognition: randomized clinical trial].

BACKGROUND: Cognitive stimulation programs in older adults seek cognitive and emotional improvements. The literature makes no reference to programs adapted according to cognitive and occupational levels in older adults with no cognitive impairment. The objective of this study was to analyze the effectiveness of level-adapted cognitive stimulation intervention in older adults in terms of cognition and mood. METHODS: Randomized clinical trial (CONSORT) at a health center, which included 201 participants =?65 years (101 intervention and 100 control) evaluated immediately after the intervention, then at six months and finally at one year. The assessment instruments were the cognitive mini-exam (CME), the abbreviated Goldberg anxiety scale and the Yesavage geriatric depression scale (GDS-15). The intervention was carried out through a cognitive stimulation program with two cognitive levels according to CME (high: 32-35; low: 28-31) with ten sessions of 45 minutes. Statistical analysis was performed by Student's t-test. RESULTS: The difference observed in the averages between control and intervention groups was statistically significant in the three assessments; these differences were observed regardless of gender, age, cognitive level, and mood. One year after the intervention, CME score reached an increase of 1.48 points in the in the high level group and 2.03 points in the low level. However, no significant differences in CME score were observed in any of the assessments for anxiety or depression. CONCLUSION: A cognitive stimulation program, cognitive level-adapted, has shown cognitive benefits in older adults without cognitive impairment living in the community, regardless of sex, age and educational level.

Efficacy of Bifidobacterium breve CECT7263 for infantile colic treatment: an open-label, parallel, randomised, controlled trial.

Infantile colic is a prevalent condition characterised by excessive crying with no effective treatment available. We aimed to evaluate the efficacy of Bifidobacterium breve CECT7263 and a combination of this and Lactobacillus fermentum CECT5716 versus simethicone in reducing the daily time spent crying in colicky infants. A multicentre randomised, open-label, parallel, controlled trial of 28 days was performed in 150 infants who were diagnosed with colic according to the Rome III criteria and who randomly received simethicone (80 mg/day; Simethicone group), B. breve CECT7263 (2×108 cfu/day, Bb group), or a combination of L. fermentum CECT5716 and B. breve CECT7263 (1×108 cfu/day per strain, Bb+Lf group). The main outcomes were minutes of crying per day and the percentage of reduction in daily crying from baseline. Data were analysed per intention to treat. All treatments significantly decreased the daily crying time at the end of the intervention (P-time <0.001). However, the infants in the Bb group had significantly decreased crying time from the first week of the study (P<0.05), whereas the Bb+Lf group and the simethicone group had significantly decreased crying time from the second week (P<0.05). The percentage of reduction in the minutes of crying from baseline in the Bb group was significantly higher than that in the Simethicone group every week of the intervention (-40.3 vs -27.6% at 1-week; -59.2 vs -43.2% at 2-weeks; -64.5 vs -53.5% at 3-week and -68.5 vs -59.5% at 4-weeks, P<0.05). Additionally, in the Bb group, infants had better night sleep, and parents reported a more positive mood at the end of the intervention. All the products used in the study were safe and well tolerated. In conclusion, the breastmilk-isolated probiotic strain B. breve CECT7263 is a safe and effective treatment for infantile colic, presenting an earlier and more robust effect than the reference prescribed drug, simethicone.

Antiretroviral treatment outcomes among late HIV presenters initiating treatment with integrase inhibitors or protease inhibitors.

OBJECTIVES: The aim of the study was to investigate the efficacy and safety of first-line antiretroviral therapy (ART) with integrase inhibitor (INI) or protease inhibitor (PI)-based regimens in patients with low CD4 cell counts and/or an AIDS-defining disease. METHODS: We conducted a retrospective, multicentre analysis to investigate discontinuation proportions and virological response in patients with CD4 cell counts < 200 cells/µL and/or AIDS-defining disease when starting first-line ART. Proportions of those discontinuing ART were compared using univariate analysis. Virological response was analysed using the Food & Drug Administration (FDA) snapshot analysis (HIV-1 RNA < 50 HIV-1 RNA copies/mL at week 48). RESULTS: Two hundred and eighteen late presenters were included in the study: 13.8% were women and 23.8% were of non-European ethnicity, and the mean baseline CD4 count was 91 cells/µL (standard deviation 112 cells/µL). A total of 131 late presenters started on INI- and 87 on PI-based treatment. It was found that 86.1% of patients treated with INIs and 81.1% of patients treated with PIs had a viral load < 50 copies/mL at week 48; proportions of discontinuation because of adverse events were 6.1% in the INI group and 11.5% in the PI group. No significant differences in discontinuation proportions were observed at week 12 or 48 between INI- and PI-based regimens (P = 0.76 and 0.52, respectively). Virological response was equally good in those receiving INIs and those receiving PIs (86.1% vs. 81.1%, respectively; P = 0.36). CONCLUSIONS: In a European cohort of late presenters starting first-line INI or PI-based ART regimens, there were no significant differences in discontinuation proportions or virological response at week 48.

ACTN3 R577X polymorphism related to sarcopenia and physical fitness in active older women.

BACKGROUND: As the population is getting older, physical activity promotion becomes a good strategy to increase quality of life in the elderly; but genetic condition also plays an important role. The purpose of this study was to examine the association of the ACTN3 R577X polymorphism with physical fitness and muscle mass in physically active older women. METHODS: A cross-sectional study was performed with two groups of older women who practiced physical exercise regularly. The first cohort comprised 164 women (age 69.7 ± 3.2 years) and the second cohort 131 women (age 78.5 ± 3.0 years). The main outcome measures were anthropometric measures with assessment of sarcopenia and sarcopenic obesity, self-reported physical activity EXERNET questionnaire (EEPAQ), evaluation of physical fitness (muscle strength and flexibility test), and ACTN3 genotyping. RESULTS: Women above 75 years old with allele R presented a higher risk of experiencing sarcopenia compared to ACTNR XX homozygous women (odds ratio 0.356, 95% confidence interval 0.139-0.915, p = 0.026). Furthermore, statistically significant differences were found in the chair stand test (p = 0.04), as well as in the sit and reach test (p = 0.01), with better results for women below 75 years old with the ACTN3 XX genotype. CONCLUSIONS: Sarcopenia and physical fitness show differences based on the ACTN3 R577X genotype in active older women.

Conocimiento sobre dengue en dos ciudades de alto y bajo riesgo del Departamento Central, Paraguay 2016 / Dengue awareness in two high and low risk cities of the Central Department, Paraguay 2016

Introducción: El conocimiento sobre el dengue incluye la presentación clínica, modo de transmisión vectorial, medidas de prevención y fuente de la información. Objetivo: Determinar el conocimiento sobre el dengue en dos ciudades de alto y bajo riesgo según endemicidad, Paraguay 2016 Metodología: Observacional, analítico, de corte transversal. La Dirección de Vigilancia de la Salud construye escenarios epidemiológicos regionales clasificándolas en endémica y no endémica según la endemicidad. Las zonas endémicas se reclasifican según umbrales epidémicos en alto riesgo, riesgo medio y bajo riesgo. Se seleccionaron dos distritos, San Lorenzo, de alto riesgo (AR) e Itauguá de bajo riesgo (BR); se realizó muestreo aleatorio simple trietápico (manzanas, casas, personas). Se analizó el conocimiento sobre el dengue según síntomas clínicos, modo de transmisión, medidas preventivas y fuentes de información. Se consideró alto conocimiento haber alcanzado un nivel del 80% o más. Se utilizaron frecuencias y porcentajes para la estadística descriptiva; se estimó la relación entre variables cualitativas con Chi cuadrado, OR con IC 95%, valor de p < 0,05, utilizando Epi Info 7. Resultados: Se entrevistaron 201 personas de ambos distritos; el 80% en AR y 73% en BR eran de sexo femenino. En ambos distritos describen fiebre, cefalea y dolor como los síntomas más conocidos (95%, 85%, 69% AR - 93%, 80%, 43%, BR). Picadura del mosquito citado como modo de trasmisión (73% AR - 68% BR. En cuanto a las medidas de prevención 84% (BR) y 80% (AR) consideran, la eliminación de criadero como la más importante; 80% (BR) y 90% (AR) que es responsabilidad de los miembros del hogar. Los medios masivos de comunicación fueron la fuente de información (85% AR - 59% BR), Se encontró que, al vivir en una zona de alta endemicidad, existe una oportunidad de 2,6 veces más de conocer los síntomas de la enfermedad OR=2,6 (IC 1,35 - 5,1). Conclusión: Se ha encontrado un alto nivel de conocimiento sobre los síntomas, el modo de transmisión y las medidas de prevención. Vivir en una comunidad de alto riesgo facilita el reconocimiento de los síntomas.

Introduction: Knowledge about dengue includes clinical presentation, vector transmission mode, prevention measures and source of information. Objective: To determine the knowledge about dengue in two cities with high and low risk according to endemicity, Paraguay 2016 Methodology: Observational, analytical, cross-sectional. The Health Surveillance Directorate builds regional epidemiological scenarios, classifying them as endemic and non-endemic according to endemicity. Endemic areas are reclassified according to epidemic thresholds in high risk, medium risk and low risk. Two districts were selected, San Lorenzo, high risk (AR) and Itauguá low risk (BR); Simple three-stage random sampling was carried out (blocks, houses, people). Knowledge about dengue was analyzed according to clinical symptoms, mode of transmission, preventive measures and sources of information. High knowledge was considered to have reached a level of 80% or more. Frequencies and percentages were used for descriptive statistics; The relationship between qualitative variables was estimated with Chi square, OR with 95% CI, p <0.05, using Epi Info 7. Results: 201 people from both districts were interviewed; 80% in RA and 73% in BR were female. In both districts they describe fever, headache and pain as the best known symptoms (95%, 85%, 69% AR - 93%, 80%, 43%, BR). Mosquito bite cited as mode of transmission (73% AR - 68% BR. Regarding prevention measures, 84% (BR) and 80% (AR) consider the elimination of the breeding site as the most important; 80% (BR ) and 90% (AR) which is the responsibility of the household members. The mass media were the source of information (85% AR - 59% BR), It was found that, living in an area of ​​high endemic burden, there is a 2.6 times more chance of knowing the symptoms of the disease OR = 2.6 (CI 1.35 - 5.1). Conclusion: A high level of knowledge about symptoms, mode of transmission and prevention measures has been found. Living in a high-risk community makes it easier to recognize symptoms.

Associations between Physical Fitness, Bone Mass, and Structure in Older People.

The main aim was to analyse the associations between several physical fitness variables and bone parameters in a sample of elderly people. 129 participants (94 females and 35 males, 76.2 ± 5.4 y) from the EXERNET cohort of Zaragoza (Spain) were included in the study. Physical fitness was assessed using the Senior Fitness Test Battery. Peripheral quantitative computed tomography (pQCT) at the tibia and dual-energy X-ray absorptiometry (DXA) at the hip and lumbar spine were used to assess bone and muscle parameters. Partial correlations were used to describe the associations between fitness and bone parameters. A stepwise regression analysis was used to determine the influence of fitness variables on bone parameters. In males, significant correlations were found between lower body strength and agility with bone total mineral density (Tt.BMD) (r = 0.41 and -0.50) and cortical thickness (r = 0.40 and -0.50, respectively) and walking speed with total and cortical density (r = -0.41 and -0.40, respectively), all measured at tibia (all p < 0.05). Regarding DXA, neck areal bone mineral density (aBMD) correlated with flexibility (r = -0.37) and walking speed (r = 0.39) and Ward's triangle with walking speed (r = 0.39). Agility predicted Tt.BMD and cortical thickness (r 2 change = 24.8% and 23.0%), while walking speed predicted cortical bone mineral density (r 2 change = 19.5%) (all p < 0.05). Females showed correlations between balance and total hip aBMD (r = 0.27) and trochanter aBMD (r = 0.25). Balance predicted trochanter (r 2 change = 4.2%) and total hip aBMD (r 2 change = 4.9%) (both p < 0.05). In conclusion, bone mass in elderly males seems to be more influenced by physical fitness than in females, being agility and walking speed the variables showing greater associations. Other variables should be taken into account in females for future research.

Terapias adyuvantes a la terapia antifibrótica en la fibrosis pulmonar idiopática: importancia del manejo multidisciplinario / Adjuvant therapies to antifibrotic therapy in IPF: importance of multidisciplinary management

La fibrosis pulmonar idiopática (FPI) se caracteriza por presentar una capacidad funcional reducida, disnea e hipoxia inducida por el ejercicio, lo que disminuye su tolerancia al esfuerzo y limita su capacidad de realizar actividades diarias. Las comorbilidades son frecuentes y su presencia contribuyen al empeoramiento de la calidad de vida y aumento de la mortalidad. Por lo anterior, es que además de las terapias antifibróticas, los pacientes con FPI se benefician de un enfoque integral de la atención que puede incluir: pesquisa, diagnóstico y tratamiento de comorbilidades, ingreso a protocolos de investigación, manejo sintomático, cuidados paliativos, oxígeno suplementario, rehabilitación pulmonar, educación y apoyo por un equipo multidisciplinario.

Idiopathic pulmonary fibrosis (IPF) is characterized by reduced functional capacity, dyspnea and exercise-induced hypoxia, which decreases tolerance to exertion and limits the ability to perform daily activities. Comorbidities are frequent and their presence contribute to worsening quality of life and increased mortality. Therefore, in addition to antifibrotic therapies, patients with IPF benefit of a comprehensive approach to care that may include: screening, diagnosis and treatment of comorbidities, admission to research protocols, symptomatic management, palliative care, supplementary oxygen, pulmonary rehabilitation, education and support by a multidisciplinary team.