Internet-based interdisciplinary therapeutic group (Grupo Interdisciplinar Online, GIO) for perinatal anxiety and depression-a randomized pilot study during COVID-19.

Early interventions may promote reductions in mothers' anxiety-depression (AD) symptoms and improvements in their offspring. This longitudinal randomized research was conducted to assess the effects of interdisciplinary online therapeutic groups (GIO) in at-risk mothers and babies during the COVID-19 pandemic in a disadvantaged neighborhood in Barcelona (Spain). A total of 135 babies were born from March 2020 to June 2021 in a primary healthcare center of Barcelona (Spain). Pregnant woman and new mothers were screened for AD symptomatology through EPDS and STAI questionnaires. Seventy-two of them met high-risk criteria for AD and were included in the study. They were randomly assigned into the two groups of the study: 40 participants were assigned to GIO, the therapeutic group (TG), while 32 of them were assigned to the control group (CG) and received treatment as usual. The course of the mothers' symptomatology was assessed, as well as the baby's development at 6 months old in a blind pediatric follow-up. No differences were found in AD between both groups before the intervention. However, we obtained a significant decrease in AD symptomatology (EPDS p < .001; STAI state p = .015 and STAI trait p < .001at 6 months of life) after the intervention in the TG compared to the CG. Pediatric follow-up at 6 months demonstrated significant differences between groups in babies' development assessment (manipulation p = .003; language p < .001; sociability p < .001). The GIO helped to ensure healthy development of the baby and reduction of the mothers' depressive-anxiety symptomatology.

A randomized phase II/III study of cabazitaxel versus vinflunine in metastatic or locally advanced transitional cell carcinoma of the urothelium (SECAVIN).

BACKGROUND: Despite the advent of immunotherapy in urothelial cancer, there is still a need to find effective cytotoxic agents beyond first and second lines. Vinflunine is the only treatment approved in this setting by the European Medicines Agency and taxanes are also widely used in second line. Cabazitaxel is a taxane with activity in docetaxel-refractory cancers. A randomized study was conducted to compare its efficacy versus vinflunine. PATIENTS AND METHODS: This is a multicenter, randomized, open-label, phase II/III study, following a Simon's optimal method with stopping rules based on an interim futility analysis and a formal efficacy analysis at the end of the phase II. ECOG Performance Status, anaemia and liver metastases were stratification factors. Primary objectives were overall response rate for the phase II and overall survival for the phase III. RESULTS: Seventy patients were included in the phase II across 19 institutions in Europe. Baseline characteristics were well balanced between the two arms. Three patients (13%) obtained a partial response on cabazitaxel (95% CI 2.7-32.4) and six patients (30%) in the vinflunine arm (95% CI 11.9-54.3). Median progression-free survival for cabazitaxel was 1.9 versus 2.9 months for vinflunine (P = 0.039). The study did not proceed to phase III since the futility analysis showed a lack of efficacy of cabazitaxel. A trend for overall survival benefit was found favouring vinflunine (median 7.6 versus 5.5 months). Grade 3- to 4-related adverse events were seen in 41% patients with no difference between the two arms. CONCLUSION: This phase II/III second line bladder study comparing cabazitaxel with vinflunine was closed when the phase II showed a lack of efficacy of the cabazitaxel arm. Vinflunine results were consistent with those known previously. TRIAL NUMBER: NCT01830231.

Hypoxia imaging with [18F]-FMISO-PET for guided dose escalation with intensity-modulated radiotherapy in head-and-neck cancers.

BACKGROUND AND PURPOSE: Positron emission tomography (PET) with [(18)F]-fluoromisonidazole ([(18)F]-FMISO) provides a non-invasive assessment of hypoxia. The aim of this study is to assess the feasibility of a dose escalation with volumetric modulated arc therapy (VMAT) guided by [(18)F]-FMISO-PET for head-and-neck cancers (HNC). PATIENTS AND METHODS: Ten patients with inoperable stages III-IV HNC underwent [(18)F]-FMISO-PET before radiotherapy. Hypoxic target volumes (HTV) were segmented automatically by using the fuzzy locally adaptive Bayesian method. Retrospectively, two VMAT plans were generated delivering 70 Gy to the gross tumour volume (GTV) defined on computed tomography simulation or 79.8 Gy to the HTV. A dosimetric comparison was performed, based on calculations of tumour control probability (TCP), normal tissue complication probability (NTCP) for the parotid glands and uncomplicated tumour control probability (UTCP). RESULTS: The mean hypoxic fraction, defined as the ratio between the HTV and the GTV, was 0.18. The mean average dose for both parotids was 22.7 Gy and 25.5 Gy without and with dose escalation respectively. FMISO-guided dose escalation led to a mean increase of TCP, NTCP for both parotids and UTCP by 18.1, 4.6 and 8% respectively. CONCLUSION: A dose escalation up to 79.8 Gy guided by [(18)F]-FMISO-PET with VMAT seems feasible with improvement of TCP and without excessive increase of NTCP for parotids.

[Chondrocalcinosis of the temporomandibular joint revealed by a hearing loss: a case report]. / Une chondrocalcinose de l'articulation temporo-mandibulaire révélée par une hypoacousie: à propos d'un cas.

INTRODUCTION: Chondrocalcinosis is a microcrystalline arthropathy that principally affects the knee. It is a rare disorder, usually asymptomatic, that occurs mainly in the elderly people. PURPOSE: To report a case of a temporomandibular joint chondrocalcinosis with ossicular contact revealed by a conductive hearing loss. CASE REPORT: We describe the case of a 57-year-old man with a right conductive sudden hearing loss of 15 dB. The CT scan revealed a lytic lesion in the right attic extended to the middle cerebral fossa in contact with the ossicles with a suspicion of lysis of the head of the malleus. MRI showed a lesion enhancing after gadolinium injection on T1 weighted images. A biopsy revealed a chondrocalcinosis of the temporomandibular joint. Due to the complexity of surgical excision and the benin character of the lesion, a medical treatment and a radiologic follow-up every six months were proposed. CONCLUSION: Chondrocalcinosis of the temporo-mandibular joint is rare especially when it is revealed by a hearing loss. We present here a review of the literature.

First-line treatment of exudative vocal fold-lesions by in-office local corticosteroid injection: A literature review.

OBJECTIVES: There are emerging reports of the effectiveness of in-office awake vocal-fold corticosteroid injection in the treatment of exudative vocal-fold lesions. The aim of this study was to review this therapy and specify indications, practical modalities and outcomes. STUDY DESIGN: Systematic review of the literature without meta-analysis. METHODS: A systematic review by PubMed search for the period January 2000 to December 2018 was carried out. RESULTS: Nine articles were included, for a total of 502 lesions: nodules (46.4%), polyps (31.7%), and Reinke's edema (21.9%). Submucosal injection of low-dose triamcinolone acetonide (0.1 to 0.3mL) was transoral, transcutaneous or transnasal via flexible endoscope with operating channel. Lesion volume was significantly reduced in more than 90% of cases, with significant vocal improvement in all studies. Relapse rates ranged between 4% and 31%, with time to relapse of 1 to 40 months. CONCLUSIONS: First-line treatment of exudative glottic lesions by submucosal corticosteroid injection provides at least transient significant reduction in lesion volume and vocal improvement. It is consensually reserved to moderate-sized mainly exudative lesions without fibrosis. In-office injection provides an immediate therapeutic response in case of vocal impairment, enabling surgery under general anesthesia to be postponed.

Use of the Ambu(®) aScope™ in 10 patients with predicted difficult intubation.

Fibreoptic intubation is the gold standard for patients with predicted difficult intubation. The Ambu(®) aScope™ is a single-use device for fibreoptic tracheal intubation. We assessed its performance in 10 patients with predicted difficult tracheal intubation. The procedure was easy and successful in nine patients. However, the limited time of use did not permit intubation in one patient who required three attempts with different size tracheal tubes. The limited image resolution that can be expected of a single-use fibreoptic system and the absence of a suction channel are other potential limitations. On the other hand, being single-use this device has the advantage of avoiding the risk of infectious disease transmission and is always ready to use.

[Ultrasound-guided single dose injection of 0.5% levobupivacaine or 0.5% ropivacaine for a popliteal fossa nerve block in unilateral hallux valgus surgery]. / Levobupivacaína 0.5% frente a ropivacaína 0.5% en el bloqueo poplíteo con dosis única de anestésico local por abordaje posterior dirigido por ecografía para cirugía de hallux valgus unilateral.

OBJECTIVE: To compare the perioperative analgesic efficacy of 0.5% levobupivacaine and 0.5% ropivacaine injected in a single dose to block the tibial and peroneal nerves for surgery using a posterior (popliteal fossa) approach. MATERIAL AND METHODS: Prospective randomized trial in patients undergoing hallux valgus surgery; anesthesia was provided by blocking nerves in the popliteal fossa with either 0.5% levobupivacaine or 0.5% ropivacaine. Variables studied were times until anesthetic block onset and reversal, need for additional sedation or peripheral block anesthetic, course of postoperative pain at 12, 24 and 48 hours and at 7 days, nighttime rest, need for additional analgesia, and patient satisfaction. RESULTS: Forty-six patients were enrolled. Times until onset of the sensory and motor blocks were similar in the 2 groups. For 57.1% of the patients, the sensory and motor block lasted 24 hours after surgery, with no between-group differences. The levobupivacaine group had less pain at rest 24 hours after surgery (mean [SD] visual analog scale score of 0.16 [0375] vs. 1.17 [1.88] in the ropivacaine group; P < .05). No patient reported severe pain or required additional analgesics. None were readmitted. More than 80% rested well at night. No between-group differences were observed. CONCLUSIONS: The use of a single dose of either levobupivacaine or ropivacaine to provide anesthesia for a popliteal approach to hallux valgus surgery is effective for controlling postoperative pain.

In vitro chemical and cellular tests applied to uranium trioxide with different hydration states.

A simple and rapid in vitro chemical solubility test applicable to industrial uranium trioxide (UO3) was developed together with two in vitro cellular tests using rat alveolar macrophages maintained either in gas phase or in alginate beads at 37 degrees C. Industrial UO3 was characterized by particle size, X-ray, and IR spectra, and chemical transformation (e.g., aging and hydration of the dust) was also studied. Solvents used for the in vitro chemical solubility study included carbonates, citrates, phosphates, water, Eagle's basal medium, and Gamble's solution (simulated lung fluid), alone, with oxygen, or with superoxide ions. Results, expressed in terms of the half-time of dissolution, according to International Commission on Radiological Protection (ICRP) classification (D,W,Y), varied for different hydration states of UO3, showing a lower solubility of hydrated UO3 in solvents compared to basic UO3 or UO3 heated at 450 degrees C. Two in vitro cellular tests on cultured rat alveolar macrophages (cells maintained in gas phase and cells immobilized in alginate beads) were used on the same UO3 samples and generally showed a lower solution transfer rate in the presence of macrophages than in the culture medium alone. The results of in vitro chemical and cellular tests were compared, with four main conclusions: a good reproducibility of the three tests in Eagle's basal medium the effect of hydration state on solubility, the classification of UO3 in terms of ICRP solubility criteria, and the ability of macrophages to decrease uranium solubility in medium.

Pleural effusion in multiple myeloma.

We report the first case of IgA-kappa multiple myeloma presenting as a myelomatous and eosinophilic pleural effusion with increased adenosine deaminase activity. In a review of the literature, 80 percent of myelomatous pleural effusions are due to IgA multiple myeloma.

Epidemiology of HTLV-I infection in Spain. HTLV Spanish Study Group.

BACKGROUND: The human T-lymphotropic virus type I (HTLV-I) has been implicated in the genesis of tropical spastic paraparesis (TSP), adult T-cell lymphoma (ATL), and some cases of uveitis, subacute arthropathies, chronic dermatitis and lymphocytic alveolitis. The virus is endemic in some areas of the Caribbean basin, Japan, subSaharan Africa, Central and South America, Middle East and Melanesia. Given that HTLV-I is transmitted through similar ways to HIV, screening in blood donors is recommended in some countries. MATERIALS AND METHODS: The clinical, epidemiological and virological characteristics of 27 patients with HTLV-I infection were identified in Spain up to September 1995. RESULTS: Eighteen cases were Spanish natives and 9 were immigrants from endemic areas. Fifteen were male and 12 were female. The majority (12/18; 66.7 percent) of subjects born in Spain had resided in endemic areas or had had sexual partners from these regions. Four patients had TSP, three had ATL and one developed lymphomatous granulomatosis and T-cell lymphoma. The remaining HTLV-I subjects were asymptomatic at the time of diagnosis. Four cases were identified from screening of blood donors. CONCLUSION: HTLV-I is present in Spain, affecting natives and, less frequently, immigrants from endemic areas. Both neurological and lymphoproliferative diseases have been recognized in a quarter of patients.

HTLV-I/II infections in Spain. The HTLV-I/II Spanish Study Group.

Antibodies to HTLV-I/II were investigated in sera from 7521 individuals living in Spain. They were classified in four major groups: a) subjects at high risk of retroviral infections e.g. parenteral drug addicts, homosexuals, prostitutes, and multiple-transfused individuals; b) patients suffering illness associated with HTLV-I in endemic regions; c) immigrants from endemic areas; and d) blood donors. Sera were collected from 1984 to December 1991. Repeatedly reactive ELISA was found in 211 samples (2.8%), but Western blot only confirmed the presence of HTLV-I/II antibodies in 23 samples (0.30%), corresponding to eight (0.25%) out of 3207 drug abusers, six (0.72%) out of 894 immigrants (five Africans and one South American), three (0.41%) out of 727 patients with HTLV-related diseases (one woman with HTLV-I associated myelopathy had received blood transfusions in an endemic area), four (0.54%) out of 793 prostitutes, one multiple-transfused native woman, and one (0.16%) out of 603 native seamen. The Western blot antibody pattern confirmed HTLV-II infection instead of HTLV-I in nine (39%) subjects. The remaining 14 (61%) HTLV-reactive samples were interpreted as HTLV-I seropositive, most of which were from immigrants. None of 857 blood donors analysed was reactive for HTLV antibody. These results suggest that both HTLV-I and HTLV-II are present in Spain, although at a low rate and mostly restricted to individuals coming from endemic areas, drug addicts, and prostitutes. Furthermore, diseases related to HTLV-I (particularly lymphoproliferative disorders, and subacute myelopathies) seem to be rarely associated with these viruses in Spain, a non-endemic area.

Autologous hemopoietic reconstitution after fetal liver infusion in patients with bone marrow failure: consequence or coincidence?

In the past 4 years we have treated four patients with a total of 19 fetal liver infusions (FLI). Two cases of refractory anemia with excess blasts in transformation (RAEB-t) were conditioned with cyclophosphamide and total body irradiation (1400 cGy) and were treated with FLI. In spite of such intensive conditioning, one patient recovered autologous hemopoiesis 3 weeks later, remaining in remission 4 years after this procedure. The second patient died with aplastic marrow on day 154, and the third suffered from severe aplastic anemia refractory to several types of conventional treatment. After FLI and without previous conditioning therapy a partial fetal engraftment was documented. This was transient and followed by autologous hemopoietic recovery and cure of the disease. The fourth patient had bone marrow failure in the setting of a severe pneumonia following autologous bone marrow transplantation. Ten days after FLI the hematological parameters dramatically improved and the pneumonia resolved. Autologous reconstitution of hemopoiesis was demonstrated. These experiences suggest that FLI might stimulate autologous hemopoiesis. This therapeutic approach may be useful to treat bone marrow failure when there is no response to first-line therapy. In hematologic malignancies with an indication for stem cell transplantation, other sources such as allogeneic or autologous bone marrow seem preferable to fetal liver cells.

Blood pressure measurement in an ambulatory setting: concordance between physician and patient self-measurement.

The aim of this study was to determine concordance between physician and patient blood pressure (BP) measurements in an ambulatory setting. A diagnostic intervention cross-sectional study using a convenience sample was employed. A total of 106 hypertensive patients were included in the study. Patients who were unable to perform their self-measurement or those with cardiac arrhythmia were excluded. BP was determined nine times in each subject in the medical office in a randomised order: BP was taken three times by the physician using a mercury sphygmomanometer (SPH-Hg), three times by the physician using a validated, automated oscillometer (Omron HEM 705 CP), and three times by the patient himself with the same device. The intraclass correlation coefficient was calculated. In all, 59 women and 47 men aged 65.7 (10) years were analysed. Mean BP measurements for the physician using the mercury sphygmomanometer, the physician using the Omron, and the patient using the same device were: 136 (15.8)/80 (11), 137 (17.9)/80 (10), and 139* (17.6)/80 (10) mmHg, respectively. BP control was 48.1, 48.1, and 36.8*% (*P < 0.05), respectively. Intraclass correlation coefficients for systolic/diastolic pressures were: 0.77/0.65 (physician-sphygmomanometer Hg, physician-Omron; P < 0.001), 0.75/0.64 (physician-sphygmomanometer Hg, patient-Omron, P < 0.001), and 0.83/0.83 (physician-Omron, patient-Omron; P < 0.001). In conclusion, the three types of measurement in the medical office were significantly concordant. Patient office self-measurement showed a tendency to increase systolic BP and worsen BP control.

[Minimal intervention in smoking in the outpatient pneumonology consultation]. / Intervención mínima sobre el trabaquismo en la consulta neumológica extrahospitalaria.

Brief intervention (BI) in smoking has been shown to be an effective way of stopping smoking in the general population. BI involves medical advice given to each smoking patient, with complementary information on the effects of smoking on the body and methods of giving up the habit. Patients who come to the clinic with respiratory disease may be especially receptive to BI since the strong link between their symptoms and smoking may increase their motivation for cessation. A BI protocol on smoking was applied in 285 smokers seen in an outpatient pneumological clinic. Two hundred eight smokers (group A) received medical advice and health care education with the offer of follow up. Seventy-seven smokers (group B) received the same BI protocol, with the offer of support treatment with nicotine gum (2 mg) and an explanation as to its use. One year after BI the patients were contacted by telephone to determine the number of non-smokers, with the result adjusted according to the truth index (71.4%) known for telephone response in this context. A total of 71 (24.9%) smokers were not located by telephone due to change of address, wrong number, exitus or lack of telephone. The estimated number of non-smokers in group A was 31.5/160 (19.7%) and 8.6/54 (15.9%) (non significant difference, chi square test). Group B's use of nicotine gum was therapeutically significant in 11.0% of the cases. We conclude that the efficacy of BI in the outpatient pneumological clinic is high.(ABSTRACT TRUNCATED AT 250 WORDS)

Illegible handwriting in medical records.

In clinical records many items are handwritten and difficult to read. We examined clinical histories in a representative sample of case notes from a Spanish general hospital. Two independent observers assigned legibility scores, and a third adjudicated in case of disagreement. Defects of legibility such that the whole was unclear were present in 18 (15%) of 117 reports, and were particularly frequent in records from surgical departments. Through poor handwriting, much information in medical records is inaccessible to auditors, to researchers, and to other clinicians involved in the patient's care. If clinicians cannot be persuaded to write legibly, the solution must be an accelerated switch to computer-based systems.

[HTLV-II infection in Spain. Analysis of 113 cases identified until November, 1994. Spanish Group for the Study of HTLV/I/II]. / Infección por HTLV-II en España. Análisis de 113 casos identificados hasta noviembre de 1994. Grupo Español para el Estudio del HTLV-I/II.

BACKGROUND: HTLV-II is a human retrovirus considered to be responsible for the genesis of some lymphoproliferative and neurologic syndromes. The virus is endemic in some Amerindian and African tribes as well amongst injecting drug addicts (IDA) in North America and Europe. METHODS: The clinical, epidemiologic and virologic characteristics of the patients with HTLV-II infection identified in Spain up to November 1994 are described. RESULTS: One hundred thirteen subjects have been identified with HTLV-II infection in Spain with 4 being African immigrants residing in Madrid and the remaining being IDA from other European countries. Most were males (94/113; 83%). All were IDA except six (5 had acquired the infection by sexual contact and one by blood transfusion). Most of the IDA infected with HTLV-II were coinfected with HIV-1 (93/113; 83%). No patient showed clinical manifestations attributable to HTLV-II infection although one drug addict male coinfected with HIV-1 and HTLV-II developed a non-inflammatory proximal myopathy. CONCLUSIONS: Infection by HTLV-II is present in Spain and affects with preference to injecting drug addicts. It has been shown to be of growing incidence with a current global prevalence of 2% in IDA.

[Severe gastrointestinal complication of Behcet's disease]. / Complicación gastrointestinal grave de la enfermedad de Behçet.

We describe a case of Behçet's syndrome with ileoceal affection of the gastrointestinal track, torpid course evolving to an intermittent febrile syndrome and associated to clinical signs of acute abdomen and latter septic complication due to a fecaloid fistula after surgery. We discuss the similarities with the inflammatory intestinal disease and the problem of the diagnosis and treatment of this particular implication of Behçet's syndrome.

[S. pneumoniae sternoclavicular arthritis in a patient with HIV infection]. / Artritis esternoclavicular por S. pneumoniae en paciente con infección por VIH.

HIV infection is a predisposing factor for pneumococcic infection. While pneumonia is the most frequent location, other locations (articular, meningeal, endocardiac, etc) have been less frequently described. Among the articular infections described in patients with HIV infection, the sternoclavicular affection is extremely rare and it usually develops in association with parenterally drug addiction, being Staphylococcus aureus and Pseudomonas aeruginosa the most frequently germs involved. We describe the first case of sternoclavicular arthritis by Streptococcus pneumoniae in a patient with HIV infection. In our case, the chronic hepatopathy associated to alcohol consumption is a predisposing factor related to the pneumococcic infection. Our case suggests the need to formally investigate the HIV infection in young patients with invasive pneumococcic infection.