ABSTRACT
OBJECTIVES: To evaluate the association between low back pain (LBP) and painful temporomandibular disorders (TMDs). METHODS: Systematic review of observational studies. Searches were conducted using OVID MEDLINE, CINHAL, Web of Science and PUBMED databases up to 21 October 2022. Qualitative and quantitative analyses were performed. Risk of bias (RoB) was assessed using the Quality in Prognosis Studies tool (QUIPS). RESULTS: Eight studies were included in the present review with meta-analysis. The first onset of TMDs was more likely in patients with previous chronic LBP (hazard ratio (HR) 1.53 [95% confidence interval (CI): 1.28; 1.83, p < .00001]). In addition, patients with chronic LBP had 3.25 times the odds (OR) [95% CI: 1.94; 5.43, p < .00001] of having chronic TMDs than those who did not have chronic LBP. In addition, the higher the exposure to chronic LBP, the higher the risk of developing a first onset of TMDs. CONCLUSIONS: Chronic LBP can be considered a risk/contributing factor for painful TMDs. Although there is a high certainty in the evidence linking chronic LBP with the risk of a first onset of TMDs, there are insufficient studies to draw definitive conclusions. Furthermore, while an association between chronic LBP and chronic TMDs and a dose-effect was observed between these two conditions, a limited number of studies and evidence exist to support these findings. Future studies are needed to increase the body of evidence.
Subject(s)
Low Back Pain , Temporomandibular Joint Disorders , Humans , Chronic Disease , Low Back Pain/complications , Prognosis , Temporomandibular Joint Disorders/complications , Temporomandibular Joint Disorders/epidemiology , Observational Studies as TopicABSTRACT
The first clinical guidelines on hepatic encephalopathy were published in 2009. Almost 14 years since that first publication, numerous advances in the field of diagnosis, treatment, and special condition care have been made. Therefore, as an initiative of the Asociación Mexicana de Gastroenterología A.C., we present a current view of those aspects. The manuscript described herein was formulated by 24 experts that participated in six working groups, analyzing, discussing, and summarizing the following topics: Definition of hepatic encephalopathy; recommended classifications; epidemiologic panorama, worldwide and in Mexico; diagnostic tools; conditions that merit a differential diagnosis; treatment; and primary and secondary prophylaxis. Likewise, these guidelines emphasize the management of certain special conditions, such as hepatic encephalopathy in acute liver failure and acute-on-chronic liver failure, as well as specific care in patients with hepatic encephalopathy, such as the use of medications and types of sedation, describing those that are permitted or recommended, and those that are not.
Subject(s)
Hepatic Encephalopathy , Lactulose , Rifaximin , Hepatic Encephalopathy/diagnosis , Hepatic Encephalopathy/drug therapy , Rifaximin/therapeutic use , Lactulose/therapeutic useABSTRACT
Introducción: La parálisis cerebral espástica unilateral afecta a la función de la extremidad superior. Las terapias en espejo y de observación de la acción domiciliaria pueden ser útiles en su tratamiento. El objetivo ha sido evaluar la viabilidad de programas de terapia de observación de la acción y terapia en espejo combinada con observación de la acción domiciliaria en niños con parálisis cerebral espástica unilateral. Sujetos y métodos: El estudio de viabilidad incluyó a niños (6-12 años), asignados aleatoriamente a dos grupos: terapia de observación de la acción y terapia en espejo y observación de la acción. Se realizaron 20 sesiones domiciliarias de una hora, y se incluyeron actividades unimanuales y bimanuales. Se evaluó la viabilidad de las intervenciones y procedimientos, y el uso espontáneo (escala Assisting Hand Assessment) y la funcionalidad (Jebsen Taylor Hand Function Test) de la extremidad superior. Resultados: Se reclutaron 25 familias, y 17 cumplieron los criterios de inclusión. Doce niños (8,75 ± 2,38 años) participaron en el estudio. Todas las familias completaron las intervenciones y no existieron efectos adversos. La dosis total de intervención fue superior al 96%. Tras la intervención, se hallaron cambios clínicamente relevantes en ambos grupos en el uso espontáneo de la extremidad superior, así como en la funcionalidad en el grupo de terapia de observación de la acción. Conclusiones: La terapia de observación de la acción y la terapia en espejo combinada con terapia de observación de la acción se consideran viables para aplicarse en el hogar y dirigidas a niños con parálisis cerebral espástica unilateral.(AU)
Introduction: Unilateral spastic cerebral palsy affects upper extremity function. Mirror and home-based action observation therapies may be useful in its treatment. The aim has been to evaluate the feasibility of action observation therapy and mirror therapy programmes combined with home action observation in children with unilateral spastic cerebral palsy. Subjects and methods: The feasibility study included children (6-12 years old), randomly assigned to two groups: action observation therapy and mirror therapy and action observation. Twenty-hour home sessions were conducted, including unimanual and bimanual activities. Feasibility of interventions and procedures, and spontaneous use (Assisting Hand Assessment scale) and functionality (Jebsen Taylor Hand Function Test) of the upper extremity were assessed. Results: Twenty-five families were recruited, with 17 meeting the inclusion criteria. Twelve children (8.75 ± 2.38 years) participated in the study. All families completed the interventions, with no adverse effects. The total intervention dose was above 96%. After the intervention, clinically relevant changes were found in both groups in spontaneous use of the upper extremity, as well as in functionality in the action observation therapy group. Conclusions: Action observation therapy and mirror therapy combined with action observation therapy are considered feasible to be applied at home and aimed at children with unilateral spastic cerebral palsy.(AU)
Subject(s)
Humans , Child , Cerebral Palsy , Upper Extremity , Hemiplegia , Mirror Neurons , Therapeutics , Feasibility Studies , Neurology , Nervous System DiseasesABSTRACT
INTRODUCTION: Unilateral spastic cerebral palsy affects upper extremity function. Mirror and home-based action observation therapies may be useful in its treatment. The aim has been to evaluate the feasibility of action observation therapy and mirror therapy programmes combined with home action observation in children with unilateral spastic cerebral palsy. SUBJECTS AND METHODS: The feasibility study included children (6-12 years old), randomly assigned to two groups: action observation therapy and mirror therapy and action observation. Twenty-hour home sessions were conducted, including unimanual and bimanual activities. Feasibility of interventions and procedures, and spontaneous use (Assisting Hand Assessment scale) and functionality (Jebsen Taylor Hand Function Test) of the upper extremity were assessed. RESULTS: Twenty-five families were recruited, with 17 meeting the inclusion criteria. Twelve children (8.75 ± 2.38 years) participated in the study. All families completed the interventions, with no adverse effects. The total intervention dose was above 96%. After the intervention, clinically relevant changes were found in both groups in spontaneous use of the upper extremity, as well as in functionality in the action observation therapy group. CONCLUSIONS: Action observation therapy and mirror therapy combined with action observation therapy are considered feasible to be applied at home and aimed at children with unilateral spastic cerebral palsy.
TITLE: Terapia en espejo y de observación de la acción en niños con parálisis cerebral espástica unilateral: estudio de viabilidad.Introducción. La parálisis cerebral espástica unilateral afecta a la función de la extremidad superior. Las terapias en espejo y de observación de la acción domiciliaria pueden ser útiles en su tratamiento. El objetivo ha sido evaluar la viabilidad de programas de terapia de observación de la acción y terapia en espejo combinada con observación de la acción domiciliaria en niños con parálisis cerebral espástica unilateral. Sujetos y métodos. El estudio de viabilidad incluyó a niños (6-12 años), asignados aleatoriamente a dos grupos: terapia de observación de la acción y terapia en espejo y observación de la acción. Se realizaron 20 sesiones domiciliarias de una hora, y se incluyeron actividades unimanuales y bimanuales. Se evaluó la viabilidad de las intervenciones y procedimientos, y el uso espontáneo (escala Assisting Hand Assessment) y la funcionalidad (Jebsen Taylor Hand Function Test) de la extremidad superior. Resultados. Se reclutaron 25 familias, y 17 cumplieron los criterios de inclusión. Doce niños (8,75 ± 2,38 años) participaron en el estudio. Todas las familias completaron las intervenciones y no existieron efectos adversos. La dosis total de intervención fue superior al 96%. Tras la intervención, se hallaron cambios clínicamente relevantes en ambos grupos en el uso espontáneo de la extremidad superior, así como en la funcionalidad en el grupo de terapia de observación de la acción. Conclusiones. La terapia de observación de la acción y la terapia en espejo combinada con terapia de observación de la acción se consideran viables para aplicarse en el hogar y dirigidas a niños con parálisis cerebral espástica unilateral.
Subject(s)
Cerebral Palsy , Child , Humans , Cerebral Palsy/therapy , Feasibility Studies , Hand , Upper ExtremityABSTRACT
INTRODUCTION: Approximately 30% of patients with mesial temporal lobe epilepsy (MTLE) will develop drug resistance, which requires early surgical treatment. The success of the surgical procedure largely depends on the correct lateralisation of the epileptogenic zone, which can only be determined in 70% of patients with such conventional diagnostic tools as video electroencephalography and volumetric structural magnetic resonance imaging. We evaluated the performance of a memory functional magnetic resonance imaging (fMRI) paradigm in lateralising the epileptogenic zone in patients with drug-resistant MTLE. METHODS: We included 18 patients with MTLE attended at the Instituto Neurológico Colombiano in Medellin (Colombia) between 2018 and 2019. The volume of functional activation in both temporal lobes was determined with a memory fMRI paradigm. A concordance analysis was performed to compare the performance of fMRI against that of conventional tests. RESULTS: In patients with left MTLE, lower total activation was found in the hemisphere ipsilateral to the epileptogenic zone as compared to the contralateral hemisphere (121.15 ± 16.48 voxels vs 170.23 ± 17.8 voxels [P < .001]), showing substantial concordance with conventional tests. Patients with right MTLE displayed lower hippocampal activation ipsilateral to the epileptogenic zone (18.5 ± 3.38 voxels vs 27.8 ± 3.77 voxels in the contralateral hippocampus [P = .048]), showing moderate concordance with conventional tests. CONCLUSIONS: These findings suggest that lower functional activation as determined by a memory fMRI paradigm has a high level of concordance with conventional tests for lateralising the epileptogenic zone in patients with drug-resistant MTLE.
ABSTRACT
We designed and built a homemade computed tomography imaging spectrometer (CTIS) of 250×250pixels of spatial resolution and 2 nm spectral resolution. The optical design considers a CTIS optical array coupled to a digital reflex camera. We reconstructed the intensity spectra of a fluorescent source, the diffuse reflectance of a ColorChecker, and samples of Capsicum annuum of three different colors, using the expectation-maximization sequential algorithm, optimized utilizing an array of indices to reduce the reconstruction time. The results obtained with a ColorChecker indicate a high positive correlation of 0.9745 with an average residual difference of 1.31% concerning the spectra obtained with a commercial integrating sphere spectrometer. The feasibility of the proposed CTIS system shows how to detect and evaluate the physiological changes resulting from the decomposition of the green fruit of the Capsicum annuum in a range from 500 to 650 nm.
Subject(s)
Algorithms , Motivation , Tomography, X-Ray Computed/methodsABSTRACT
Objetivo: el dolor se define como "una experiencia sensorial y emocional desagradable asociada o similar a la asociada con daño tisular real o potencial". El objetivo de este estudio es describir la prevalencia, evaluación y manejo del dolor, en pacientes hospitalizados en una institución de alta complejidad. Metodología: estudio observacional descriptivo longitudinal. Se incluyeron adultos hospitalizados en una institución de alta complejidad durante tres meses; excluyendo pacientes con <48h de hospitalización, alteración del estado de conciencia, diálisis extrainstitucional o historias clínicas incompletas para cumplir los objetivos. El análisis de la información se realizó aplicando métodos descriptivos. Los análisis fueron llevados a cabo en el paquete estadístico SPSSv.26(Inc, Chicago, IL). Resultados: se incluyeron 655 pacientes hospitalizados que cumplieron criterios de elegibilidad, con una edad promedio de 53.9 años. La mediana de días de estancia hospitalaria fue de 5 (RIQ 28). El número de tomas del dolor en relación con el número de tomas de signos vitales es de 1:4. Los pacientes recibieron entre 2 y 6 medicamentos diferentes para el control del dolor, siendo la dipirona, con el 68.5%, la más utilizada. Al egreso casi la totalidad de los pacientes presentó un adecuado control del dolor. Conclusiones: persiste una deficiencia en las tomas de la eva cada vez que se toman los signos vitales del paciente hospitalizado. La implementación de la política institucional "clínica que alivia el dolor" busca que se logre un adecuado control del dolor durante la hospitalización.
Objective: pain is defined as "an unpleasant sensory and emotional experience associated or similar to that associated with actual or potential tissue damage." The aim was to describe the prevalence, evaluation, and management of pain in patients hospitalized in a high complexity institution. Methodology: longitudinal descriptive observational study. Adults hospitalized from an overly complex institution for three months were included; excluding patients with <48h of hospitalization, altered state of consciousness, extra-institutional dialysis or incomplete medical records to meet the objectives. The information analysis was conducted by applying descriptive methods. The analyzes were carried out in the statistical package SPSSv.26 (Inc, Chicago, IL). Results: 655 hospitalized patients who met eligibility criteria were included, with a mean age of 53.9 years. The median days of hospital stay was 5 (IQR, 28). The number of shots of pain in relation to the number of vital signs shots is 1: 4. The patients received between 2 and 6 different medications for pain control, with dipyrone being the most widely used (68.5%). At discharge, almost all of the patients had adequate pain control. Conclusions: a deficiency persists in the VAS measurements each time the vital signs of the hospitalized patient are taken. The implementation of the institutional policy "clinic that relieves pain" seeks to achieve adequate pain control during hospitalization.
Objetivo: A dor é definida como "uma experiência sensorial e emocional desagradável associada ou semelhante àquela associada a dano tecidual real ou potencial". O objetivo deste estudo é descrever a prevalência, avaliação e manejo da dor em pacientes internados em uma instituição de alta complexidade. Metodologia:estudo observacional descritivo longitudinal. Foram incluídos adultos internados em instituição de alta complexidade por três meses; excluindo pacientes com menos de 48h de internação, estado alterado de consciência, diálise extrainstitucional ou prontuários incompletos para atender aos objetivos. A análise das informações foi realizada por meio de métodos descritivos. As análises foram realizadas no pacote estatístico SPSSv.26( Inc , Chicago, IL).Resultados: Foram incluídos 655 pacientes internados que preencheram os critérios de elegibilidade, com média de idade de 53,9 anos. O número médio de dias de internação foi de 5 (IQR 2-8). O número de injeções de dor em relação ao número de injeções de sinais vitais é 1:4. Os pacientes receberam entre 2 e 6 medicamentos diferentes para controle da dor, sendo a dipirona , com 68,5%, a mais utilizada. Na alta, quase todos os pacientes apresentavam controle adequado da dor. Conclusões: persiste uma deficiência nas medidasvas toda vez que se mede os sinais vitais do paciente hospitalizado. A implantação da política institucional "clínica que alivia a dor" busca alcançar o controle adequado da dor durante a internação.
Subject(s)
Humans , Pain , Vital Signs , Pain Management , HospitalizationABSTRACT
Hyperglycemia enhancing the intracellular levels of reactive oxygen species (ROS) contributes to dysfunction and progressive loss of beta cells and thereby to diabetes mellitus. The oxidation sensitive calcium/calmodulin dependent phosphatase calcineurin promotes pancreatic beta cell function and survival whereas the dual leucine zipper kinase (DLK) induces apoptosis. Therefore, it was studied whether calcineurin interferes with DLK action. In a beta cell line similar concentrations of H2O2 decreased calcineurin activity and activated DLK. DLK interacted via its φLxVP motif (aa 362-365) with the interface of the calcineurin subunits A and B. Mutation of the Val prevented this protein protein interaction, hinting at a distinct φLxVP motif. Indeed, mutational analysis revealed an ordered structure of DLK's φLxVP motif whereby Val mediates the interaction with calcineurin and Leu maintains an enzymatically active conformation. Overexpression of DLK wild-type but not the DLK mutant unable to bind calcineurin diminished calcineurin-induced nuclear localisation of the nuclear factor of activated T-cells (NFAT), suggesting that both, DLK and NFAT compete for the substrate binding site of calcineurin. The calcineurin binding-deficient DLK mutant exhibited increased DLK activity measured as phosphorylation of the downstream c-Jun N-terminal kinase, inhibition of CRE-dependent gene transcription and induction of apoptosis. These findings show that calcineurin interacts with DLK; and inhibition of calcineurin increases DLK activity. Hence, this study demonstrates a novel mechanism regulating DLK action. These findings suggest that ROS through inhibition of calcineurin enhance DLK activity and thereby lead to beta cell dysfunction and loss and ultimately diabetes mellitus.
Subject(s)
Calcineurin/metabolism , Insulin-Secreting Cells , MAP Kinase Kinase Kinases/metabolism , Reactive Oxygen Species/metabolism , Animals , Apoptosis , Cell Line , Cricetinae , Insulin-Secreting Cells/cytology , Insulin-Secreting Cells/metabolism , Protein BindingABSTRACT
Attenuation of host IL-10 activity during Eimeria infection may elicit a robust Th1 response to eliminate the parasite from the gut epithelium. An experiment was conducted to study the effects of feeding IL-10 neutralizing antibody delivered via a dried egg product (DEP) on growth performance, immune responsivity, and gut health outcomes during a severe challenge with either Eimeria acervulina (study 1) or Eimeria tenella (study 2) following FDA CVM #217 protocol to test anticoccidial products. A total of 720 male Ross 308 chicks were used in each study, with 15 replicate cages of 12 birds and the following 4 treatments: sham-inoculated (uninfected) control diet (UCON), Eimeria-infected control diet (ICON), and Eimeria-infected control diet supplemented with DEP at 2 levels (165 [I-165] or 287 [I-287] U/tonne in study 1 and 143 [I-143] or 287 [I-287] U/tonne in study 2). Individual birds assigned to infected treatment groups received a single oral dose of either 200,000 E. acervulina (study 1) or 80,000 E. tenella (study 2) oocysts at 12 d of age (i.e., d post inoculation [DPI] 0), whereas uninfected birds were sham-inoculated with tap water. A one-way ANOVA was performed on outcomes including growth performance, hematology, serum chemistry profiles, immunophenotyping profiles, and intestinal lesion scores. In both studies, DPI 0 to 7 weight gain, feed intake, and feed conversion ratio were worse (P < 0.05) in all infected groups compared with the UCON group. Compared with ICON, DEP supplementation elicited no differences on overall growth performance. Histopathology and lesion scores revealed severe damage to the gut epithelium owing to the Eimeria challenge, yet DEP supplementation did not improve these outcomes or oocyst shedding, hematological measurements, or serum chemistry. However, DEP supplementation improved (P < 0.05) the percentage of circulating CD3+ cells at 6 DPI in study 2. These results indicate that DEP does not appear to elicit a coccidiostatic effect during a severe infection with E. acervulina or E. tenella.
Subject(s)
Coccidiosis , Dietary Supplements , Interleukin-10 , Poultry Diseases , Animals , Antibodies/administration & dosage , Antibodies/pharmacology , Chickens , Coccidiosis/veterinary , Eimeria , Interleukin-10/immunology , Male , Poultry Diseases/therapyABSTRACT
The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.
El objetivo de este trabajo es valorar la eficacia del tratamiento conservador con plantillas ortopédicas en la enfermedad de Müller-Weiss (EMW). El soporte plantar tiene como objetivo pronar el retropié e inmovilizar las articulaciones talonavicular y naviculocuneiforme o ambas a la vez como alternativa a la osteotomía valguizante de calcáneo y las artrodesis. Se analizan las características clínicas y radiológicas de 10 casos de EMW en ocho pacientes objeto del estudio y se valoran los resultados obtenidos. Se comenta el proceso de fabricación de los soportes plantares así como los materiales empleados. El tamaño de la muestra no es significativo; sin embargo, de manera preliminar, el tratamiento conservador es posible en determinados casos de la EMW para aliviar el dolor, mejorar la dinámica de la marcha y limitar la progresión de la enfermedad en el corto plazo.
Subject(s)
Calcaneus , Foot Diseases , Tarsal Bones , Arthrodesis , Foot Diseases/surgery , Humans , Osteotomy , Treatment OutcomeABSTRACT
Muscle fatigue is an important field of study in sports medicine and occupational health. Several studies in the literature have proposed methods for predicting muscle fatigue in isometric con-tractions using three states of muscular fatigue: Non-Fatigue, Transition-to-Fatigue, and Fatigue. For this, several features in time, spectral and time-frequency domains have been used, with good performance results; however, when they are applied to dynamic contractions the performance decreases. In this paper, we propose an approach for analyzing muscle fatigue during dynamic contractions based on time and spectral domain features, Permutation Entropy (PE) and biomechanical features. We established a protocol for fatiguing the deltoid muscle and acquiring surface electromiography (sEMG) and biomechanical signals. Subsequently, we segmented the sEMG and biomechanical signals of every contraction. In order to label the contraction, we computed some features from biomechanical signals and evaluated their correlation with fatigue progression, and the most correlated variables were used to label the contraction using hierarchical clustering with Ward's linkage. Finally, we analyzed the discriminant capacity of sEMG features using ANOVA and ROC analysis. Our results show that the biomechanical features obtained from angle and angular velocity are related to fatigue progression, the analysis of sEMG signals shows that PE could distinguish Non-Fatigue, Transition-to-Fatigue and Fatigue more effectively than classical sEMG features of muscle fatigue such as Median Frequency.
Subject(s)
Muscle Fatigue , Muscle, Skeletal , Cluster Analysis , Electromyography , EntropyABSTRACT
Resumen: El objetivo de este trabajo es valorar la eficacia del tratamiento conservador con plantillas ortopédicas en la enfermedad de Müller-Weiss (EMW). El soporte plantar tiene como objetivo pronar el retropié e inmovilizar las articulaciones talonavicular y naviculocuneiforme o ambas a la vez como alternativa a la osteotomía valguizante de calcáneo y las artrodesis. Se analizan las características clínicas y radiológicas de 10 casos de EMW en ocho pacientes objeto del estudio y se valoran los resultados obtenidos. Se comenta el proceso de fabricación de los soportes plantares así como los materiales empleados. El tamaño de la muestra no es significativo; sin embargo, de manera preliminar, el tratamiento conservador es posible en determinados casos de la EMW para aliviar el dolor, mejorar la dinámica de la marcha y limitar la progresión de la enfermedad en el corto plazo.
Abstract: The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.
Subject(s)
Calcaneus , Tarsal Bones , Foot Diseases/surgery , Osteotomy , Arthrodesis , Treatment OutcomeSubject(s)
C-Reactive Protein/metabolism , Infections/diagnosis , Lupus Erythematosus, Systemic/complications , Serum Amyloid P-Component/metabolism , Adult , Biomarkers/blood , Female , Humans , Infections/blood , Infections/complications , Lupus Erythematosus, Systemic/blood , Male , Middle Aged , Symptom Flare Up , Young AdultABSTRACT
OBJECTIVES: The revised European consensus on sarcopenia definition and diagnosis (EWGSOP2) includes the SARC-F questionnaire, the most valid and consistent sarcopenia screening tool, as the mandatory first step. Our aim was the translation, cross-cultural adaptation, and validation of the SARC-F questionnaire as a culturally-responsive Spanish-language version for the European population. STUDY DESIGN: Cross-sectional descriptive study, applying the two-step WHO methodology for translation and cross-cultural adaptation of health questionnaires, and harmonization with the Mexican-Spanish version. European Union Geriatric Medicine Society recommendations for SARC-F validation in European languages were considered. PARTICIPANTS: Outpatient clinics of a university hospital. INCLUSION CRITERIA: stable, ambulatory (including aids), community-dwelling population ≥65 years old. MAIN OUTCOME MEASURES: The self-reported 5-item SARC-F questionnaire was administered; scores ≥4 indicated sarcopenia. Sensitivity, specificity, accuracy-likelihood ratios, predictive values, and kappa statistics were calculated and consecutively compared with European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2 criteria. RESULTS: This Spanish version, administered in an average 70s, has adequate internal consistency (Cronbach alpha=0.779). For the validation study, 90 (43.3%) of 208 potentially eligible subjects (81.4 ± 5.9 years old, 75.6% women) were included. SARC-F identified 51 (56.7%) subjects with sarcopenia and 39 (43.3%) without the disease. Prevalence was 17.8% per EWGSOP and 25.6% per EWGSOP2 (58% accuracy and fair agreement: sensitivity, 78.3%; specificity, 50.8%). CONCLUSIONS: SARC-F is a feasible tool, suitable for bedside assessment in community-dwelling older patients. Wide diffusion of this culturally-responsible SARC-F Spanish version is expected as EWGSOP2 is adopted and sarcopenia assessment is broadly implemented in Spain.
Subject(s)
Geriatric Assessment/methods , Sarcopenia/diagnosis , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Independent Living , Language , Male , Surveys and QuestionnairesABSTRACT
OBJECTIVES: To evaluate the impact of false-positive IgM immunoblots on Lyme disease treatment and case reporting in a large healthcare system. METHODS: We obtained the results of all Lyme disease serological tests ordered at U.S. Air Force healthcare facilities in the USA between January 2013 and December 2017. We conducted chart reviews to adjudicate positive IgM immunoblots (from two-tier and independent testing) as true positives or false positives using established criteria, and we assessed whether these cases were reported to the U.S. Department of Defense surveillance system. RESULTS: Of the 18 410 serum tests (17 058 immunoassays and 1352 immunoblots) performed on 15 928 unique individuals, 249/1352 (18.4%) IgM immunoblots were positive. After excluding repeat tests, insufficiently documented cases, and participants with a history of Lyme disease, 212 positive IgM immunoblot cases were assessed. A total of 113/212 (53.3%) were determined to be false positives. Antibiotics were prescribed for Lyme disease for 97/99 (98.0%) participants with a true-positive test and 91/113 (80.5%) participants with a false-positive test. The number of false-positive cases reported to the surveillance system was identical to the number of unreported true-positive cases (n = 44). CONCLUSIONS: Lyme disease serological tests were overused in a large healthcare system, and positive results were frequently misinterpreted, leading to misdiagnosis and widespread antibiotic misuse. Underreporting of true-positive cases was offset by overreporting of false-positive cases, suggesting that the discrepancy between the reported incidence and true incidence of Lyme disease may not be as significant as previously assumed.
Subject(s)
Lyme Disease/diagnosis , Lyme Disease/epidemiology , Medical Overuse/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Bacterial/blood , Child , Child, Preschool , False Positive Reactions , Female , Humans , Immunoblotting/methods , Immunoglobulin M/blood , Incidence , Infant , Male , Middle Aged , Military Personnel , Retrospective Studies , Serologic Tests/methods , United States/epidemiology , Young AdultABSTRACT
In the search of nanomaterials to be used in drug delivery applications, Density Functional Theory calculations were implemented to study the interaction between graphene (G) and hexagonal boron nitride nanosheet (hBNN) with octahedral B12N12 fullerenes. These B12N12 fullerenes were considered in two cases: pristine and the modified one with boron-boron, nitrogen-nitrogen (tetragon) and boron-boron-boron (hexagon) homo-nuclear bonds. The whole systems were analyzed in the gas and aqueous phases. The results reveal for all these systems that the interaction is in the range of physisorption (Eadsâ¯=â¯from -0.03 to -0.37â¯eV) for both phases, limiting its functions as a vehicle. However, for the nano-composite: B12N12 fullerene modified and hBNNs, the values of average chemical reactivity and HOMO-LUMO gap decreased whereas the polarity was improved, thereby this combination of quantum descriptors lead them to be considered as potential vehicle for drug delivery.
Subject(s)
Boron Compounds/chemistry , Fullerenes/chemistry , Graphite/chemistry , Nanostructures/chemistry , Density Functional Theory , Models, Molecular , Molecular Conformation , Spectrum AnalysisABSTRACT
The growth plate is a cartilaginous layer present from the gestation period until the end of puberty where it ossifies joining diaphysis and epiphysis. During this period several endocrine, autocrine, and paracrine processes within the growth plate are carried out by chondrocytes; therefore, a disruption in cellular functions may lead to pathologies affecting bone development. It is known that electric fields impact the growth plate; however, parameters such as stimulation time and electric field intensity are not well documented. Accordingly, this study presents a histomorphometrical framework to assess the effect of electric fields on chondroepiphysis explants. Bones were stimulated with 3.5 and 7â¯mV/cm, and for each electric field two exposure times were tested for 30â¯days (30â¯min and 1â¯h). Results evidenced that electric fields increased the hypertrophic zones compared with controls. In addition, a stimulation of 3.5â¯mV/cm applied for 1â¯h preserved the columnar cell density and its orientation. Moreover, a pre-hypertrophy differentiation in the center of the chondroepiphysis was observed when explants were stimulated during 1â¯h with both electric fields. These findings allow the understanding of the effect of electrical stimulation over growth plate organization and how the stimulation modifies chondrocytes morphophysiology.
Subject(s)
Chondrocytes/cytology , Electric Stimulation , Growth Plate/growth & development , Animals , Cell Proliferation , Cells, Cultured , Chondrocytes/pathology , Chondrocytes/ultrastructure , Electric Stimulation/instrumentation , Equipment Design , Femur/cytology , Femur/growth & development , Femur/pathology , Femur/ultrastructure , Growth Plate/cytology , Growth Plate/pathology , Growth Plate/ultrastructure , Humerus/cytology , Humerus/growth & development , Humerus/pathology , Humerus/ultrastructure , Hypertrophy , Osteogenesis , Rats , Rats, WistarABSTRACT
OBJECTIVE: Our purpose was to review senior author results of TKA in patients with extra-articular angular deformities (correction of mechanical axis was performed without an additional procedure for osteotomy). METHODS: Results of TKA in nine knees with osteoarthritis and associated extra-articular angular deformity of femur were reviewed retrospectively. This group was compare with a with a control group of 20 patients diagnosed with osteoarthritis that underwent TKA without extra-articular deformity. Angulation of deformity in patients was 19° in coronal plane (range 15°-25°) and 12° in sagittal plane (range 8°-5°). Knee Score (KS) and Functional Score (FS) were measured pre and post-surgery, likewise arc flexion was reported. Results in KS and FS were correlationed with extra-articular angulation. RESULTS: Duration of follow-up averaged 55 months (range, 48-63 months). KS Average and FS increased from 50.5 and 38.4 points, preoperatively, to 96.5 and 84.4 points, respectively, at time of following-up. No statistically significant differences in any postoperative parameters were found between the postoperative group of extra-articular deformities and the control group were found. Positive correlation was obtained between deformity degrees and KS. Arc of motion averaged 86° preoperatively and 118° at time of following-up. No total knee arthroplasty was revised. CONCLUSION: In our opinion, best management for extra-articular deformities associated to osteoarthritis is to carry out a knee replacement without corrective osteotomy on condition that planification allow to us avoid ligaments insertions, using an extensive soft-tissue balancing in conjunction with a minimally constrained TKA.
ABSTRACT
Objetivo. De entre los muchos instrumentos propuestos para medir la calidad de vida de los pacientes con adicción a opiáceos tratados con metadona el WHOQOL-BREF, propuesto por la World Health Organization, es el que más se utiliza en la actualidad. Este trabajo pretende estudiar la fiabilidad y la validez de constructo de la prueba, aplicada a una muestra amplia y representativa de pacientes, y comparar los resultados con los datos disponibles para población general en España. Se reclutó una muestra de 523 sujetos que se encontraban en tratamiento con metadona, en Madrid y Extremadura. Se efectuó un análisis factorial confirmatorio para probar la estructura teóricamente propuesta y, seguidamente, un análisis paralelo optimizado para conocer el número más adecuado de componentes de la prueba. Los resultados muestran que la prueba presenta sólidos valores de consistencia interna, tanto a nivel del ítem como de las escalas. La estructura tetradimensional teórica se confirma en la muestra con adecuados indicadores de ajuste, aunque también se obtienen serios argumentos para considerar su unidimensionalidad. Se estudió la relación estructural entre los cuatro dominios. El WHOQOL-BREF se muestra como una prueba fiable y válida para su uso en pacientes tratados con metadona, proporcionando una medida multidimensional de la calidad de vida percibida, que incluye factores sociales y ambientales ausentes en otros instrumentos, que son de enorme importancia en el tratamiento de los problemas adictivos
The most commonly instrument used to measure quality of life in patients with addictive behaviors is the WHOQOL-BREF, developed by the World Health Organization. No studies have been found to explore the psychometric properties in Spanish clinical samples. This paper aims to study their reliability as well as the construct validity in a representative sample of patients and comparing the results to the data available for the general population in Spain. A sample was recruited comprised of 523 subjects who were undergoing treatment with methadone in Madrid and Extremadura. A confirmatory factor analysis was completed to test the theoretically proposed structure and then an optimized-parallel analysis was done to establish the most adequate number of components. The result offers solid values for internal consistency both as concerns the items and the scales. The theoretical tetra-dimensional structure is confirmed in the sample although serious arguments are also found for considering its onedimensionality. The structural relationship between the four domains was studied. The WHOQOL-BREF proves to be a reliable and valid test for use on patients treated with methadone, providing a multi-dimensional measure of perceived quality of life that includes social and environmental factors of great importance in treating addiction problems
Subject(s)
Humans , Opioid-Related Disorders/drug therapy , Methadone/therapeutic use , Opiate Substitution Treatment/methods , Quality of Life , Sickness Impact Profile , Psychometrics/instrumentation , Reproducibility of ResultsABSTRACT
Background/Objective Differentiating systemic lupus erythematosus (SLE) activity from infections in febrile patients is difficult because of similar initial clinical presentation. The aim of this study is to evaluate the usefulness of a number of biomarkers for differentiating infections from activity in SLE patients admitted with systemic inflammatory response (SIRS). Methods Patients with SLE and SIRS admitted to the emergency room were included in this study. Measurements of different markers including procalcitonin, neutrophil CD64 expression and presepsin, were performed. Infection was considered present when positive cultures and/or polymerase chain reaction were obtained. Sensitivity and specificity were calculated for all biomarkers. Results Twenty-seven patients were admitted, 23 women (82.5%), mean age 33.2 years. An infectious disease was confirmed in 12 cases. Markers for SLE activity including anti-DNA titers by IIF ( p = 0.041) and enzyme-linked immunosorbent assay ( p = 0.009) were used for differentiating SLE flares from infection. On the contrary, increased procalcitonin ( p = 0.047), neutrophil CD64 expression by flow cytometry ( p = 0.037) and presepsin ( p = 0.037) levels were observed in infected SLE patients. Conclusions High neutrophil CD64 expression, presepsin and procalcitonin levels are useful to differentiate infections from activity in SLE patients. In most cases, a positive bioscore that includes these three markers demonstrate the presence of an infectious disease.
