Mental health and vitality predict spinal pain in healthcare workers.

BACKGROUND: Despite extensive investigation of ergonomic risk factors for spinal pain in healthcare workers, limited knowledge of psychological risk factors exists. AIMS: To assess the prospective association of mental health and vitality with development of spinal pain in healthcare workers. METHODS: A prospective cohort study was carried out involving 1950 healthcare workers from 19 hospitals in Denmark. Assessments were done at baseline and at 1-year follow-up. Mental health and vitality were measured using the Short Form-36 Health Survey, while spinal pain intensity was measured using a 0-10 scale in the low-back, upper-back and neck, respectively. Cumulative logistic regressions adjusted for several confounding factors were applied, reporting risk estimates as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Using good mental health as reference, moderate (but not poor) mental health at baseline was associated with increased pain intensity in the low-back (OR: 1.41 [95% CI: 1.21-1.77]), upper-back (OR: 1.63 [95% CI: 1.31-2.02]) and neck (OR: 1.31 [95% CI: 1.07-1.61]) at 1-year follow-up. Likewise, using high vitality as reference, both moderate and low vitality at baseline were associated with increased pain intensity in the low-back (OR: 1.54 [95% CI: 1.22-1.94] and OR: 2.34 [95% CI: 1.75-3.12], respectively), upper-back (OR: 1.72 [95% CI: 1.34-2.23] and OR: 2.46 [95% CI: 1.86-3.25], respectively) and neck (OR: 1.66 [95% CI: 1.34-2.06] and OR: 2.06 [95% CI: 1.61-2.63], respectively) at 1-year follow-up. CONCLUSIONS: Compared to healthcare workers with good mental health and high vitality, those with moderate mental health and low/moderate vitality, respectively, were more likely to increase spinal pain intensity at 1-year follow-up. These components should also be considered in the prevention of spinal pain in healthcare workers.

Outcome measures used in trials on gait rehabilitation in multiple sclerosis: A systematic literature review.

BACKGROUND: Multiple Sclerosis (MS) is associated with impaired gait and a growing number of clinical trials have investigated efficacy of various interventions. Choice of outcome measures is crucial in determining efficiency of interventions. However, it remains unclear whether there is consensus on which outcome measures to use in gait intervention studies in MS. OBJECTIVE: We aimed to identify the commonly selected outcome measures in randomized controlled trials (RCTs) on gait rehabilitation interventions in people with MS. Additional aims were to identify which of the domains of the International Classification of Functioning, Disability and Health (ICF) are the most studied and to characterize how outcome measures are combined and adapted to MS severity. METHODS: Pubmed, Cochrane Central, Embase and Scopus databases were searched for RCT studies on gait interventions in people living with MS according to PRISMA guidelines. RESULTS: In 46 RCTs, we identified 69 different outcome measures. The most used outcome measures were 6-minute walking test and the Timed Up and Go test, used in 37% of the analyzed studies. They were followed by gait spatiotemporal parameters (35%) most often used to inform on gait speed, cadence, and step length. Fatigue was measured in 39% of studies. Participation was assessed in 50% of studies, albeit with a wide variety of scales. Only 39% of studies included measures covering all ICF levels, and Participation measures were rarely combined with gait spatiotemporal parameters (only two studies). CONCLUSIONS: Selection of outcome measures remains heterogenous in RCTs on gait rehabilitation interventions in MS. However, there is a growing consensus on the need for quantitative gait spatiotemporal parameter measures combined with clinical assessments of gait, balance, and mobility in RCTs on gait interventions in MS. Future RCTs should incorporate measures of fatigue and measures from Participation domain of ICF to provide comprehensive evaluation of trial efficacy across all levels of functioning.

Serum adiponectin is associated with body composition and cognitive and psychological status in older adults living in long-term nursing homes.

Frailty is a geriatric syndrome characterized by decreasing functional reserves and increasing vulnerability to falls, injuries and declining health, leading to dependence upon caregivers. Frailty is associated not only with physical decline, but also with cognitive and psychological impairments in aging people. Higher serum adiponectin concentration has been linked to better performance on frailty measures but also to worse cognitive status. Nonetheless, several studies have proposed adiponectin as a frailty biomarker. To further delineate the relationship between adiponectin serum levels and frailty-related parameters, we studied a population of 112 long-term nursing home residents (aged 84.9 ±â€¯6.7) and analyzed their serum adiponectin levels in conjunction with frailty-related parameters including body composition, physical fitness, cognitive function, psychological parameters and quality of life. Frailty was assessed following the Fried Frailty Criteria, the Clinical Frailty Scale and the Tilburg Frailty Indicator. In women, higher serum adiponectin levels were associated with lower body weight, body mass index, body fat mass, fat mass/height2, lean mass, lean mass/height2 and smaller waist circumference and hip circumference (p < 0.05). In men, the association was positive (p < 0.05) between serum adiponectin and percentage of fat mass and negative between serum adiponectin and percentage of lean mass. Interestingly, in men, better cognitive function was inversely related to adiponectin (p < 0.05) while decreased anxiety was linked to a higher concentration of adiponectin in women (p < 0.05). According to the Tilburg Frailty Indicator, frail men had lower levels of adiponectin than those who were not frail (p < 0.05). Variables that predicted adiponectin concentration in multiple regression models were different for women and men. In women, lean mass and anxiety were independent negative predictors of blood adiponectin (ß = -0.363, p = 0.002; ß = -0.204, p = 0.067, respectively). In men, the Montreal Cognitive Assessment (MOCA) test was the only parameter to remain significant in the regression model (ß = -439, p = 0.015). The results of our study show that adiponectin is linked to body composition, cognitive function and anxiety in long-term nursing home residents with differential relationships by sex. Further studies should be conducted to determine whether adiponectin is a valid and reliable frailty biomarker.

Efectos de la posición de Trendelenburg sobre el estado hemodinámico: una revisión sistemática / Does the Trendelenburg position affect hemodynamics? A systematic review

El presente artículo es una revisión sistemática de la literatura existente referida al uso de la posición de Trendelenburg o sus variantes en el manejo del paciente hipotenso, secundario o no, en shock hipovolémico. Para ello se elaboró un protocolo de búsqueda para extraer de las bases de datos bibliográficas los artículos más relevantes. Paralelamente se consultaron los textos más representativos en materia de urgencias y emergencias sanitarias. Ello permitió seleccionar 22 artículos, de calidad razonable. La bibliografía en general es escasa y muestra importantes limitaciones metodológicas. Catorce estudios cuestionan el efecto beneficioso de la posición de Trendelenburg. La revisión de textos y manuales reveló gran diversidad de indicaciones terapéuticas. Se puede concluir que la evidencia generada hasta el momento carece de la suficiente consistencia como para afirmar que la posición de Trendelenburg ofrezca beneficios en el paciente con compromiso hemodinámico (AU)

To review the literature on use of the Trendelenburg position or variations of it to determine whether this position has an impact on hemodynamic status. A search strategy to locate the most relevant indexed articles was developed. Representative textbooks and manuals on emergency medicine were also consulted. Twenty-two articles of reasonable quality were selected. The literature on this subject is scant and studies have considerable design limitations. Fourteen studies question the benefit of the Trendelenburg position. The review of textbooks and manuals showed great diversity of therapeutic indications. Current evidence is too inconsistent to allow us to state that the Trendelenburg position is beneficial in hemodynamically compromised patients (AU)

Critical assessment of the current guidelines for the management and treatment of morbidly obese patients.

An interdisciplinary panel of specialists met in Mallorca in the first European Symposium on Morbid Obesity entitled; "Morbid Obesity, an Interdisciplinary Approach". During the two and half days of the meeting, the participants discussed several aspects related to pathogenesis, evaluation, and treatment of morbid obesity. The expert panel included basic research scientists, dietitians and nutritionists, exercise physiologists, endocrinologists, psychiatrists, cardiologists, pneumonologists, anesthesiologists, and bariatric surgeons with expertise in the different weight loss surgeries. The symposium was sponsored by the Balearic Islands Health Department; however, this statement is an independent report of the panel and is not a policy statement of any of the sponsors or endorsers of the Symposium. The prevalence of morbid obesity, the most severe state of the disease, has become epidemic. The current recommendations for the therapy of the morbidly obese comes as a result of a National Institutes of Health (NIH) Consensus Conference held in 1991 and subsequently reviewed in 2004 by the American Society for Bariatric Surgery. This document reviews the work-up evaluation of the morbidly obese patient, the current status of the indications for bariatric surgery and which type of procedure should be recommended; it also brings up for discussion some important real-life clinical practice issues, which should be taken into consideration when evaluating and treating morbidly obese patients. Finally, it also goes through current scientific evidence supporting the potential effectiveness of medical therapy as treatment of patients with morbid obesity.

Evolución del hemitiroides residual tras hemitiroidectomía por nódulo único / Follow-up of remnant thyroid tissue after hemithyroidectomy for solitary nodules

La evolución del hemitiroides residual y la recidiva del bocio tras la realización de una hemitiroidectomía por bocio nodular único es un aspecto controvertido y no resuelto. Con el fin de intentar analizar el problema se ha realizado una revisión bibliográfica, y se aportan los resultados preliminares de 2 estudios prospectivos a largo plazo sobre la evolución de la hiperplasia del lóbulo residual y el efecto del tratamiento supresor con tiroxina. Tras una hemitiroidectomía por bocio nodular único, folicular o coloide, sin datos de sospecha de enfermedad autoinmunitaria, el 47,7% de los pacientes presentan signos ecográficos de hiperplasia, generalmente micronodular. Las formas macronodulares presentan una mayor tendencia a la progresión, que ocurre en el 72,7% de los casos y es dependiente del tipo de bocio operado, pues en los casos de adenoma folicular se observa progresión en el 17,6% y en los nódulos coloide en el 57,1% de los casos. El 54% de los pacientes operados requieren tratamiento con hormona tiroidea, en el 27,7% por hipotiroidismo subclínico, que es más frecuente tras cirugía por nódulo coloide (45,8%) que por adenoma folicular (17%). El tratamiento supresor con hormona tiroidea realizado a partir de los 6 meses del diagnóstico de la hiperplasia controla la evolución en el 86% de los casos operados por adenoma folicular frente a tan sólo el 38,5% de los operados por nódulos coloides; su utilización debe valorarse de acuerdo con el criterio riesgo/beneficio especialmente en pacientes mayores de 60 años. Por todo ello, la hemitiroidectomía por nódulo único debe diseñarse de acuerdo con una correcta valoración preoperatoria de los datos clínicos, hormonales, ecográficos y citológicos, y no debe plantearse en todos los casos como una intervención estándar; en las revisiones clínicas debe incluirse siempre, además de los estudios hormonales, una ecografía con determinación de volumen del hemitiroides residual (AU)

The follow-up of residual thyroid tissue and goiter recurrence after hemithyroidectomy for solitary nodular goiter is a controversial issue that has not been resolved. To analyze the problem, we performed a literature review. The preliminary results of two long-term prospective studies on the evolution of hyperplasia of the residual lobe and the effect of thyroxine suppression therapy are reported. After hemithyroidectomy for solitary nodular goiter, whether follicular or colloid, 47.7% of patients without suspected autoimmune disease show ultrasonographic signs of hyperplasia, usually micronodular. These forms have a greater tendency to progress, which occurs in 72.7%. Progression depends on the type of goiter resected since it occurs in 17.6% of follicular adenomas and in 57.1% of colloid nodules. Fifty-four percent of patients who undergo surgery require thyroid hormone treatment. This therapy is required for subclinical hypothyroidism in 27.7%, which is more frequent after surgery for colloid nodules (45.8%) than follicular adenomas (17%). Thyroid hormone suppression therapy starting 6 months after diagnosis of hyperplasia controls progression in 86% of patients who undergo surgery for follicular adenoma compared with only 38.5% of those who undergo surgery for colloid nodules. The risk/benefit ratio of this therapy should be evaluated, especially in patients aged more than 60 years. In view of the above, hemithyroidectomy for solitary nodules should be performed after careful preoperative evaluation of clinical, hormonal, ultrasonographic and cytological data. It should not be performed in all patients as a standard procedure and, in addition to hormone studies, follow-up should always include ultrasonography with determination of residual thyroid volume (AU)

Utilidad clínica de los estudios moleculares en el carcinoma medular de tiroides familiar / Clinical use of molecular studies in familiar medullary thyroid carcinoma

El carcinoma medular de tiroides es un tumor maligno secretor de calcitonina, derivado de las células parafoliculares tiroideas. Representa del 5 al 10 por ciento de todos los carcinomas de tiroides, de los cuales el 20 por ciento se originan por mutaciones de la línea germinal. El carcinoma medular de tiroides y el feocromocitoma son los tumores malignos que forman parte de la entidad conocida como neoplasia endocrina múltiple tipo 2A (MEN 2A) y presentan una mutación en el protooncogén RET. Todos los pacientes con MEN 2A desarrollarán en el 100 por ciento un carcinoma medular de tiroides. Sólo es necesaria la mutación de un solo gen para que se desarrolle el tumor; de ahí, la herencia dominante con una penetrancia prácticamente completa en este tipo de tumores. Se han identificado varias mutaciones en el oncogén RET en casos de carcinoma medular de tiroides familiar, la mayoría en los exones 10 y 11. Los resultados comunicados en el International RET Mutation Consortium han demostrado que el 85 por ciento de las familias con síndrome MEN 2A tienen una mutación en el codón 634. El tratamiento de elección en los casos de MEN 2A con la detección de la mutación para desarrollar carcinoma medular de tiroides familiar es la tirodectomía total antes de los 5 años de edad, en prevención a la aparición de un carcinoma. En los casos en que la tirodectomía se realice de forma inadecuada o incompleta todos los pacientes desarrollarán cáncer (AU)

Comentario / Commentary

No disponible

Endocrine and immune response to injury after open and laparoscopic cholecystectomy.

BACKGROUND: There is clinical evidence that the surgical insult experienced by patients who undergo laparoscopic cholecystectomy (LC) differs significantly from that experienced by those undergoing open cholecystectomy (OC). LC is accompanied by less pain, better ventilatory function and almost total absence of secondary paralytic ileus. The aim of the present study was to investigate the endocrine and immune response to the injury induced by both types of surgery. To this end, the relationship between levels of hormones of the hypothalamus-hypophysis-adrenal axis (indicators of stress) and cytokine levels was analyzed. METHODS: Blood samples from subjects undergoing either OC (n = 14) or LC (n = 14) were obtained 24 h before surgery and 24 h and 7 days after surgery. Serum concentrations of interleukin-6 (IL-6), interleukin-1 (IL-1), interleukin-10 (IL-10) and prolactin were determined using enzyme-linked immunosorbent assay. Cortisol and GH concentrations were determined by radioimmunoassay. RESULTS: Twenty-four hours after surgery, prolactin, GH and cortisol levels were higher than preoperative values in both OC and LC groups. Seven days after surgery, cortisol and GH levels had normalized but prolactin levels were maintained. No significant differences in hormone levels were detected between OC and LC groups. IL-6 levels were significantly higher in the OC group 7 days after intervention. Correlation analysis between levels of cytokines and hormones indicated that prolactin, at concentrations exceeding physiological values, regulates levels of IL-1 (p 0.3271, p < 0.05) and IL-6 (p = 0.3765, p < 0.01). Although levels were similar in both groups, cortisol was shown to exert weak but significant, linear control on IL-6 levels (r = 0.4569, p < 0.001). CONCLUSIONS: A similar hormonal response to surgical insult was produced in patients subjected to OC and LC. IL-6 levels seem to be the most indicative of injury. Prolactin is the main hormone involved in the regulation of cytokines produced in response to this type of stress and is thought to exert control over the production of IL-6.

Cytokine levels after open and laparoscopic cholecystectomy.

A prospective study of serum cytokine levels was performed in patients randomly assigned to undergo either laparoscopic cholecystectomy (LC) or open cholecystectomy (OC). The kinetics of serum interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10), and cortisol were studied in both groups of patients. Cytokine and cortisol levels were measured in serum samples from patients who underwent either LC (n = 14) or OC (n = 14) using enzyme-linked immunosorbent assay and radioimmunoassay, respectively. Serum samples were obtained 24 h before surgery and 24 h and 7 days after surgery. IL-6 levels differed significantly (p < 0.05) between the LC and OC groups. IL-1 beta, IL-10, TNF-alpha and cortisol levels showed no significant differences (p > 0.05). Kinetic studies of IL-6, IL-1 beta and TNF-alpha levels revealed them to behave similarly, 24 h after surgery the levels of these cytokines were higher than those 24 h before surgery. These levels normalized by 7 days after surgery. Cytokine concentrations were always higher in the OC group than in the LC group. IL-1 beta and IL-10 levels were the most stable in both groups, though cortisol levels were also fairly stable.

Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula.

Somatostatin and octreotide both enhance closure of gastrointestinal fistulas. The present trial was undertaken to test whether early combined treatment with parenteral nutrition and octreotide 100 micrograms every 8 h by subcutaneous injection had a beneficial effect compared with parenteral nutrition plus placebo. Thirty-one patients with post-operative gastrointestinal or pancreatic fistula were randomly assigned to receive parenteral nutrition plus octreotide (14 patients) or placebo (17) within 8 days of fistula onset. The percentage reduction in output and rate of spontaneous closure within 20 days were analysed. Mean(s.d.) reduction in output was similar after octreotide and placebo at 24 h (66(43) versus 68(47) per cent, P = 0.9), 48 h (60(46) versus 57(43) per cent, P = 0.8) and 72 h (62(50) versus 66(49) per cent, P = 0.9) after starting the combined treatment. Closure within 20 days was observed in eight of 14 fistulas in patients given octreotide and in six of 17 in those receiving placebo (P = 0.4). Administration of octreotide, within 8 days of fistula onset, associated with parenteral nutrition does not significantly increase the spontaneous fistula closure rate compared with parenteral nutrition plus placebo.

Hemangiopericytoma in a male breast. Report of a case with cytologic, histologic and immunochemical studies.

A hemangiopericytoma in a male breast was studied by fine needle aspiration (FNA) biopsy. The FNA smears contained tissue clumps showing knob-like formations of atypical cells, spindle-shaped cells and fragments of capillaries lined by normal endothelial cells. Immunocytochemical study showed a positive reaction for vimentin, but a negative reaction for desmin and keratin. Staining for Factor VIII was positive only in the capillaries and endothelial cells. The cytodiagnosis was "mesenchymal tumor." Histopathologic study of the mastectomy specimen made the final diagnosis of hemangiopericytoma. While FNA cytology and immunocytochemistry cannot make a definitive diagnosis of this rare vascular tumor, they can be decisive in planning the surgical treatment, as in the present case.

Esophageal lymphangioma: case report and review of the literature.

We report a 66-year-old patient with an esophageal lymphangioma. Five other cases have been reported previously. Clinical features, diagnosis, and therapy are discussed.