Pilot therapeutic education program in multiple system atrophy: Safety, quality of life and satisfaction from a national registry based longitudinal study.

BACKGROUND: Therapeutic education programs are effective in several chronic conditions. However, evidence is lacking in multiple system atrophy (MSA). We aimed to assess efficacy and safety of a comprehensive therapeutic education program in people with MSA (PwMSA) and their caregivers. METHODS: In this prospective longitudinal study we included 16 PwMSA and their main caregivers in 4 groups of 4 dyads each. The program consisted of eight 60-min interdisciplinary sessions: introduction, orthostatic hypotension, speech therapy, gait and respiratory physiotherapy, psychological support, urinary dysfunction, occupational therapy/social work. UMSARS, NMSS, PDQ39, EQ5 and Zarit scales were administered at baseline and 6 months later. After each session participants filled-out a modified EduPark satisfaction questionnaire and a Likert scale. Educational material was generated for each session after suggestions by participants. RESULTS: At baseline PwMSA and caregivers were comparable in age and sex, with significant correlation between UMSARS-IV (disability) and PDQ39 (quality of life). Adherence to sessions was of 94,92 %. Total modified EduPark scores and Likert scales did not differ in PwMSA vs. caregivers, mild-moderate vs. severe-advanced cases or between genders. The significant difference in satisfaction across sessions (p = 0.03) was driven by higher scores in speech, respiratory and occupational therapy sessions. Longitudinally there was no significant worsening in any scale, nor a significant increase post-vs. pre-program in the number of consultations. CONCLUSIONS: The healthcare education program in MSA was feasible, satisfactory, and safe for patients and caregivers. The educational material of the program is being forwarded to incident MSA cases attending our clinic.

Combined CSF α-SYN RT-QuIC, CSF NFL and midbrain-pons planimetry in degenerative parkinsonisms: From bedside to bench, and back again.

INTRODUCTION: Differential diagnosis between Parkinson's disease (PD) and atypical parkinsonisms (APs: multiple system atrophy[MSA], progressive supranuclear palsy[PSP], corticobasal degeneration[CBD]) remains challenging. Lately, cerebrospinal fluid (CSF) studies of neurofilament light-chain (NFL) and RT-QuIC of alpha-synuclein (α-SYN) have shown promise, but data on their combination with MRI measures is lacking. OBJECTIVE: (1) to assess the combined diagnostic ability of CSF RT-QuIC α-SYN, CSF NFL and midbrain/pons MRI planimetry in degenerative parkinsonisms; (2) to evaluate if biomarker-signatures relate to clinical diagnoses and whether or not unexpected findings can guide diagnostic revision. METHODS: We collected demographic and clinical data and set up α-SYN RT-QuIC at our lab in a cross-sectional cohort of 112 participants: 19 control subjects (CSs), 20PD, 37MSA, 23PSP, and 13CBD cases. We also determined CSF NFL by ELISA and, in 74 participants (10CSs, 9PD, 26MSA, 19PSP, 10CBD), automatized planimetric midbrain/pons areas from 3T-MRI. RESULTS: Sensitivity of α-SYN RT-QuIC for PD was 75% increasing to 81% after revisiting clinical diagnoses with aid of biomarkers. Sensitivity for MSA was 12% but decreased to 9% with diagnostic revision. Specificities were 100% against CSs, and 89% against tauopathies raising to 91% with diagnostic revision. CSF NFL was significantly higher in APs. The combination of biomarkers yielded high diagnostic accuracy (PD vs. non-PD AUC = 0.983; MSA vs. non-MSA AUC = 0.933; tauopathies vs. non-tauopathies AUC = 0.924). Biomarkers-signatures fitted in most cases with clinical classification. CONCLUSIONS: The combination of CSF NFL, CSF RT-QuIC α-SYN and midbrain/pons MRI measures showed high discriminant ability across all groups. Results opposite to expected can assist diagnostic reclassification.

Validation in Spanish of the Ottawa scale for non-technical skills in health personnel in crisis situations.

INTRODUCTION: Non-technical skills are related to morbi-mortality in medicine; it has been proposed that 46% of fatal outcomes are explained to limitations in non-technical skills and only 5% to technical skills deficiencies, however, there is no validated instrument or scale in spanish that allows its evaluation in the management of medical crisis. OBJECTIVE: To evaluate the psychometric properties of a Spanish-adapted version of the "Ottawa crisis resource management (CRM) global rating scale (GRS)" in medical staff involved in critical decision-making based in high-fidelity simulation, which could be beneficial to impact patient safety and improve clinical outcomes. METHODS: Transversal cultural instrument validation and adaptation study, included 91 participants who simulated a medical crisis between 2018 and 2019, and to whom the Spanish version of the CRM-GRS was applied in order to evaluate its psychometric properties. RESULTS: A cultural adaptation with translation into Spanish of the CRM-GRS was made. Subsequently, the scale was applied to 91 participants. An internal consistency (Cronbach's alpha) greater than 0.9 was found in each dimension. The level of inter-rater reliability, evaluated by the interclass coefficient was 0.59 to 0.69, and test-retest reliability with an interclass coefficient greater than 0.7. The validity of the convergent construct was moderate (interclass coefficient between 0.6 and 0.7 for all domains) and the validity of the divergent construct between 0.4 and 0.5 was found adequate. CONCLUSION: The translated and adapted Spanish version of the CRM-GRS in crisis had adequate internal consistency, reliability, and construct validity.

Validation in spanish of the Ottawa scale for non-techical skills in health personnel in crisis situations. / Validación en castellano de la escala de Ottawa para habilidades no técnicas en personal de salud en situación de crisis.

INTRODUCTION: Non-technical skills are related to morbi-mortality in medicine; it has been proposed that 46% of fatal outcomes are explained to limitations in non-technical skills and only 5% to technical skills deficiencies, however, there is no validated instrument or scale in spanish that allows its evaluation in the management of medical crisis. OBJECTIVE: To evaluate the psychometric properties of a Spanish-adapted version of the "Ottawa crisis resource management (CRM) global rating scale (GRS)" in medical staff involved in critical decision-making based in high-fidelity simulation, which could be beneficial to impact patient safety and improve clinical outcomes. METHODS: Transversal cultural instrument validation and adaptation study, included 91 participants who simulated a medical crisis between 2018 and 2019, and to whom the Spanish version of the CRM-GRS was applied in order to evaluate its psychometric properties. RESULTS: A cultural adaptation with translation into Spanish of the CRM-GRS was made. Subsequently, the scale was applied to 91 participants. An internal consistency (Cronbach's alpha) greater than 0.9 was found in each dimension. The level of inter-rater reliability, evaluated by the interclass coefficient was 0.59 to 0.69, and test-retest reliability with an interclass coefficient greater than 0.7. The validity of the convergent construct was moderate (interclass coefficient between 0.6 and 0.7 for all domains) and the validity of the divergent construct between 0.4 and 0.5 was found adequate. CONCLUSION: The translated and adapted Spanish version of the CRM-GRS in crisis had adequate internal consistency, reliability, and construct validity.

Réplica del artículo: Aportes de la tomografía de coherencia óptica Visante(R) y la ecografía ocular en el diagnóstico y seguimiento del síndrome de efusión ciliocoroideo bilateral secundario a topiramato / Reply of the article: Contribution of the Visante(R) OCT and B-scan ultrasonography in the diagnosis and follow up of a bilateral ciliochoroidal effusion syndrome induced by topiramate

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High-order dispersion mapping of an optical fiber.

We report on measurements of high-order dispersion maps of an optical fiber, showing how the ratio between the third and fourth-order dispersion (ß3/ß4) and the zero-dispersion wavelength (λ0) vary along the length of the fiber. Our method is based on Four-Wave Mixing between short pulses derived from an incoherent pump and a weak laser. We find that the variations in the ratio ß3/ß4 are correlated to those in λ0. We present also numerical calculations to illustrate the limits on the spatial resolution of the method. Due to the good accuracy in measuring λ0 and ß3/ß4 (10 -3% and 5% relative error, respectively), and its simplicity, the method can be used to identify fiber segments of good uniformity, suitable to build nonlinear optical devices such as parametric amplifiers and frequency comb generators.

Aportes de la tomografía de coherencia óptica Visante(R) y la ecografía ocular en el diagnóstico y seguimiento del síndrome de efusión ciliocoroideo bilateral secundario a topiramato / Contribution of the Visante(R) OCT and B-scan ultrasound in the diagnosis and follow up of a topiramate-induced bilateral ciliochoroidal effusion syndrome

Se trata de un hombre de 45 años con cierre angular y miopía aguda bilateral tras inicio de tratamiento con topiramato por dependencia al alcohol y la heroína. La tomografía de coherencia óptica Visante(R) y la ecografía ocular muestran efusión ciliocoroidea bilateral como mecanismo fisiopatológico. El tratamiento consistió en la retirada del topiramato, y la utilización de hipotensores oculares, ciclopléjico y corticoides tópicos, con lo cual se resolvió el síndrome de efusión ciliocoroidea. La tomografía de coherencia óptica Visante(R) y la ecografía ocular son herramientas útiles en el diagnóstico y seguimiento de los pacientes con cierre angular y miopía en el contexto del síndrome de efusión ciliocoroidea secundario a topiramato. Debido al amplio espectro de indicaciones de esta medicación, tanto el personal sanitario que lo indica como los oftalmólogos, deben conocer las posibles manifestaciones oculares atribuidas a este medicamento

A 45 year-old man with bilateral acute angle-closure and myopia after starting treatment with topiramate, secondary to alcohol and heroin dependence. Using Visante(R) OCT (Optical Coherence Tomography) and B-scan Ultrasound he was diagnosed with bilateral ciliochoroidal effusion as the pathophysiological mechanism. Topiramate was stopped and ocular hypotensive therapy with a topical cycloplegic and corticosteroids were started, resolving ciliochoroidal effusion syndrome. Visante(R) OCT and B-scan Ultrasound are useful tools for the diagnosis and follow-up of patients with acute angle-closure and myopia due to topiramate. As a result of broad spectrum of indications for topiramate, physicians and ophthalmologists should be aware of the possible ophthalmological manifestations attributable to this drug

Contribution of the Visante® OCT and B-scan ultrasound in the diagnosis and follow up of a topiramate-induced bilateral ciliochoroidal effusion syndrome. / Aportes de la tomografía de coherencia óptica Visante® y la ecografía ocular en el diagnóstico y seguimiento del síndrome de efusión ciliocoroideo bilateral secundario a topiramato.

A 45 year-old man with bilateral acute angle-closure and myopia after starting treatment with topiramate, secondary to alcohol and heroin dependence. Using Visante® OCT (Optical Coherence Tomography) and B-scan Ultrasound he was diagnosed with bilateral ciliochoroidal effusion as the pathophysiological mechanism. Topiramate was stopped and ocular hypotensive therapy with a topical cycloplegic and corticosteroids were started, resolving ciliochoroidal effusion syndrome. Visante® OCT and B-scan Ultrasound are useful tools for the diagnosis and follow-up of patients with acute angle-closure and myopia due to topiramate. As a result of broad spectrum of indications for topiramate, physicians and ophthalmologists should be aware of the possible ophthalmological manifestations attributable to this drug.

Defecto pupilar eferente, ¿preganglionar o posganglionar? Diagnóstico clínico vs. neuroimagen / Preganglionic or postganglionic efferent pupillary defect? Clinical versus neuroimaging diagnosis

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Tissue-type plasminogen activator induces synaptic vesicle endocytosis in cerebral cortical neurons.

The release of the serine proteinase tissue-type plasminogen activator (tPA) from the presynaptic terminal of cerebral cortical neurons plays a central role in the development of synaptic plasticity, adaptation to metabolic stress and neuronal survival. Our earlier studies indicate that by inducing the recruitment of the cytoskeletal protein ßII-spectrin and voltage-gated calcium channels to the active zone, tPA promotes Ca(2+)-dependent translocation of synaptic vesicles (SVs) to the synaptic release site where they release their load of neurotransmitters into the synaptic cleft. Here we used a combination of in vivo and in vitro experiments to investigate whether this effect leads to depletion of SVs in the presynaptic terminal. Our data indicate that tPA promotes SV endocytosis via a mechanism that does not require the conversion of plasminogen into plasmin. Instead, we show that tPA induces calcineurin-mediated dynamin I dephosphorylation, which is followed by dynamin I-induced recruitment of the actin-binding protein profilin II to the presynaptic membrane, and profilin II-induced F-actin formation. We report that this tPA-induced sequence of events leads to the association of newly formed SVs with F-actin clusters in the endocytic zone. In summary, the data presented here indicate that following the exocytotic release of neurotransmitters tPA activates the mechanism whereby SVs are retrieved from the presynaptic membrane and endocytosed to replenish the pool of vesicles available for a new cycle of exocytosis. Together, these results indicate that in murine cerebral cortical neurons tPA plays a central role coupling SVs exocytosis and endocytosis.

Horse chestnut (Aesculus hippocastanum L.) starch: Basic physico-chemical characteristics and use as thermoplastic material.

Starch isolated from non-edible Aesculus hippocastanum seeds was characterized and used for preparing starch-based materials. The apparent amylose content of the isolated starch was 33.1%. The size of starch granules ranged from 0.7 to 35 µm, and correlated with the shape of granules (spherical, oval and irregular). The chain length distribution profile of amylopectin showed two peaks, at polymerization degree (DP) of 12 and 41-43. Around 53% of branch unit chains had DP in the range of 11-20. A. hippocastanum starch displayed a typical C-type pattern and the maximum decomposition temperature was 317 °C. Thermoplastic starch (TPS) prepared from A. hippocastanum with glycerol and processed by melt blending exhibited adequate mechanical and thermal properties. In contrast, plasticized TPS with glycerol:malic acid (1:1) showed lower thermal stability and a pasty and sticky behavior, indicating that malic acid accelerates degradation of starch during processing.

Retraso del alta hospitalaria por motivos no médicos / Impact of delayed discharge for nonmedical reasons in a tertiary hospital internal medicine department

Antecedentes. Un alta diferida es la que se produce cuando, desde el punto de vista clínico, un paciente es dado de alta del hospital, pero continúa ocupando la cama por un problema no médico. Esta circunstancia sobrecarga el sistema sanitario, pero la frecuencia real de la misma y la pérdida de días útiles de hospitalización que ocasiona no han sido evaluadas en nuestro país hasta la fecha. Objetivo. Analizar la demora del alta efectiva por razones no médicas en un Servicio de Medicina Interna de un hospital de tercer nivel y determinar los factores clínicos y sociofamiliares asociados a esta situación. Pacientes y métodos. Estudio observacional y prospectivo, que analizó las características de los pacientes cuya alta se demoró por motivos no médicos durante 12 meses. Resultados. De las 4.850 altas que se produjeron en el Servicio de Medicina Interna, 170 (3,5%) se demoraron por problemas no médicos. Ello supuso una pérdida de 1.603 días útiles para hospitalización de otros enfermos. La mediana de demora fue de 5 días (rango: 3-12 días). Los pacientes con altas diferidas tenían una edad más avanzada, mayor prevalencia de enfermedad cerebrovascular aguda y problemas relacionados con el consumo de alcohol o benzodiacepinas. Los motivos principales aducidos para no irse de alta fueron: la sobrecarga y/o incapacidad de los familiares para el cuidado del enfermo por imposibilidad de conciliar los cuidados que requería con la vida laboral (51,8%), y la carencia de familiares o red de apoyo social (21,8%). Conclusiones. Las altas diferidas por motivos no médicos son frecuentes y están motivadas principalmente por dificultades sociofamiliares para hacerse cargo de los pacientes tras el ingreso hospitalario. Suponen una gran sobrecarga para los hospitales(AU)

Background. Delayed discharge occurs from a clinical point of view when a patient is considered medically fit for discharge but continues occupying a bed due to a nonmedical problem. This circumstance overloads the care system, however, its real frequency and loss of useful days of hospitalization have not being evaluated in Spain up to date. Objective. To analyze the frequency of hospital delayed discharges due to non-medical reasons in a tertiary hospital Internal Medicine Department and to determine the clinical and socio-familial factors related to this situation. Patients and methods. An observational and prospective study was performed to analyze the characteristics of the patients whose discharge was delayed for nonmedical reason over a 12-month period. Results. There were 4850 discharges in the Internal Medicine Department, 170 (3.5%) of which were delayed because of nonmedical problems. This accounted for a loss of 1603 useful days of hospitalization for other patients within one year. The median delay was 5 days (range: 3-12). Patients with delayed discharges were elder and had a higher prevalence of acute cerebrovascular disease as well as alcohol or benzodiazepines use related problems. The main causes were the overload or inability of the family to care for the patient and the impossibility to combine patient care with the family's working life (51.8%), and lack of family or social support network (21.8%). Conclusions. Delayed discharges for nonmedical reasons are frequent and mainly motivated by social-familiar problem to take charge of the patients after their hospitalization. This accounts for a significant overload for the hospitals(AU)

[Impact of delayed discharge for nonmedical reasons in a tertiary hospital internal medicine department]. / Retraso del alta hospitalaria por motivos no médicos.

BACKGROUND: Delayed discharge occurs from a clinical point of view when a patient is considered medically fit for discharge but continues occupying a bed due to a nonmedical problem. This circumstance overloads the care system, however, its real frequency and loss of useful days of hospitalization have not being evaluated in Spain up to date. OBJECTIVE: To analyze the frequency of hospital delayed discharges due to non-medical reasons in a tertiary hospital Internal Medicine Department and to determine the clinical and socio-familial factors related to this situation. PATIENTS AND METHODS: An observational and prospective study was performed to analyze the characteristics of the patients whose discharge was delayed for nonmedical reason over a 12-month period. RESULTS: There were 4850 discharges in the Internal Medicine Department, 170 (3.5%) of which were delayed because of nonmedical problems. This accounted for a loss of 1603 useful days of hospitalization for other patients within one year. The median delay was 5 days (range: 3-12). Patients with delayed discharges were elder and had a higher prevalence of acute cerebrovascular disease as well as alcohol or benzodiazepines use related problems. The main causes were the overload or inability of the family to care for the patient and the impossibility to combine patient care with the family's working life (51.8%), and lack of family or social support network (21.8%). CONCLUSIONS: Delayed discharges for nonmedical reasons are frequent and mainly motivated by social-familiar problem to take charge of the patients after their hospitalization. This accounts for a significant overload for the hospitals.

Clindamycin and quinolone therapy for Bacillus anthracis Sterne infection in 60Co-gamma-photon-irradiated and sham-irradiated mice.

OBJECTIVES: Sublethal ionizing doses of radiation increase the susceptibility of mice to Bacillus anthracis Sterne infection. In this study, we investigated the efficacy of clindamycin in 60Co-gamma-photon-irradiated and sham-irradiated mice after intratracheal challenge with B. anthracis Sterne spores. Clindamycin has in vitro activity against B. anthracis and inhibits the production of toxin from other species, although no direct evidence exists that production of B. anthracis toxin is inhibited. METHODS: Ten-week-old B6D2F1/J female mice were either sham-irradiated or given a sublethal 7 Gy dose of 60Co-gamma-photon radiation 4 days prior to an intratracheal challenge with toxigenic B. anthracis Sterne spores. Mice were treated twice daily with 200 mg/kg clindamycin (subcutaneous or oral), 100 mg/kg moxifloxacin (oral), 50 mg/kg ciprofloxacin (subcutaneous) or a combination therapy (clindamycin + ciprofloxacin). Bacteria were isolated and identified from lung, liver and heart blood at five timed intervals after irradiation. Survival was recorded twice daily following intratracheal challenge. RESULTS: The use of clindamycin increased survival in gamma-irradiated and sham-irradiated animals challenged with B. anthracis Sterne in comparison with control mice (P < 0.001). Ciprofloxacin-treated animals had higher survival compared with clindamycin-treated animals in two experiments, and less survival in a third experiment, although differences were not statistically significant. Moxifloxacin was just as effective as clindamycin. Combination therapy did not improve survival of sham-irradiated animals and significantly decreased survival among gamma-irradiated animals (P = 0.01) in comparison with clindamycin-treated animals. B. anthracis Sterne was isolated from lung, liver and heart blood, irrespective of the antimicrobial treatment. CONCLUSIONS: Treatment with clindamycin, ciprofloxacin or moxifloxacin increased survival in sham-irradiated and gamma-irradiated animals challenged intratracheally with B. anthracis Sterne spores. However, the combination of clindamycin and ciprofloxacin increased mortality associated with B. anthracis Sterne infection, particularly in gamma-irradiated animals.