Efficacy of the use of video games on mood, anxiety and depression in stroke patients: preliminary findings of a randomised controlled trial.

BACKGROUND: In the different published studies, there is no consensus on the efficacy of virtual reality as an adjuvant treatment of mood states. AIM: The aim of this study is to evaluate the impact of no immersive virtual reality with the Nintendo Switch device in rehabilitation treatment on mood, anxiety and depression in stroke patients admitted to neurorehabilitation units. METHODS: Fifty-eight patients admitted to neurorehabilitation units underwent a 1:3 multicentre randomised clinical trial. The intervention group consisted of 17 patients and the control group of 41 patients. The intervention group performed 6 virtual reality sessions together with the conventional treatment, and the control group performed only the conventional rehabilitation sessions. Primary and secondary clinical outcomes were measured before and six weeks after the intervention. RESULTS: Comparing the intervention group and control group, the anxiety levels of the intervention group decreased compared to the results observed in the control group (p = 0.01), as did the dependence of the intervention group (0.015). On the other hand, the results obtained after the intervention by the control group for anxiety (0.479) and depression (0.292) were not statistically significant. CONCLUSION: Rehabilitation VR used as an adjuvant treatment to conventional treatment has a beneficial impact on the neurological status and state of anxiety of stroke patients admitted to neurorehabilitation units. TRIAL REGISTRATION: Registered in the https://clinicaltrials.gov/ repository (NTC NCT05143385). Protocol registration date 7 October 2021, retrospectively registered.

Impact of virtual reality-based therapy on post-stroke depression: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Post-stroke depression is the most common neuropsychiatric consequence and reduces rehabilitation effectiveness. However, the efficacy of virtual reality (VR) on mental health treatment for patients after a stroke is uncertain. AIMS: The aim of this study was to evaluate the efficacy of VR as a co-adjuvant form of treatment to reduce depression in stroke patients admitted to neurorehabilitation units. METHODS: We systematically searched medical databases including PubMed, CINAHL, PsycINFO, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov from inception to November 16, 2023. Clinical trials comparing the use of VR as an adjuvant form of treatment in stroke patients' rehabilitation with the usual treatment were included. Pooled standardized mean differences were calculated using a random-effects model. Subgroup analyses were performed according to type of stroke, VR characteristics, and the scale used to measure depression. Meta-regression analysis was performed for intervention duration and to determine the mean age of the participants. RESULTS: Eight studies and 388 stroke patients were included. The VR interventions were associated with a lower risk of depression in patients (ES = -0.69; 95% CI [-1.05, -0.33]; I2 = 57.6%; p ≤ .02). The estimates were not affected by the type of stroke, the type of VR used, the blinding process, the type of scale used to detect depression, the duration of the intervention (weeks and minutes), and the total number of sessions. Meta-regression shows that younger samples (p = .00; 95% CI [0.01, 0.08) and longer interventions (p = < .05; 95% CI [-0.00, -0.00) lead to a greater reduction in depression. LINKING EVIDENCE TO ACTION: This review provides an important basis for treating depression in patients after a stroke. Professionals working in stroke neurorehabilitation units should consider VR as a form of co-adjuvant treatment for depression in patients. SYSTEMATIC REVIEW REGISTRATION: CRD42022303968.

Efficacy of the therapeutic use of video games on the depressive state of stroke patients: Protocol for systematic review and meta-analysis.

AIM: To assess the effects of virtual reality (VR) on the depressive state of patients with stroke admitted to neuro-rehabilitation units. Design: Systematic review and meta-analysis protocol. METHODS: Randomized Controlled Trials (RCTs) focusing on the effects of virtual reality on depressive state as a primary outcome will be included. Grey literature and the following databases will be consulted: PubMed, Cinahl, PsycInfo, Scopus, Embase, Cochrane Library and Web of Science. The recently revised Cochrane risk of bias tool will be used to assess the quality of included studies. Data will be extracted and meta-analyses will be performed within the specific condition of the emotional state of stroke patients admitted to neurorehabilitation units. Meta-regression and subgroup analyses will be used to identify effective modes and patterns of therapy delivery. The approach of assessment, development and evaluation of recommendations will be applied to reach a convincing conclusion. DISCUSSION: An accurate, transparent and standardized review process is expected to provide recommendations on the use of VR technology in the healthcare of stroke patients. IMPACT: Emotional difficulties are common after stroke and have an impact on rehabilitation outcome. VR seems to have an important role in the treatment and depression in neurological patients, as it is able to improve levels of well-being, coping strategies and social relationships. The systematic review may contribute to a more convincing and specific conclusion compared to existing studies of this type. TRIAL REGISTRATION: Systematic review registration: CRD42022303968.

Effectiveness and Safety of Ustekinumab in Ulcerative Colitis: Real-world Evidence from the ENEIDA Registry.

BACKGROUND AND AIMS: The development programm UNIFI has shown promising results of ustekinumab in ulcerative colitis [UC] treatment which should be confirmed in clinical practice. We aimed to evaluate the durability, effectiveness, and safety of ustekinumab in UC in real life. METHODS: Patients included in the prospectively maintained ENEIDA registry, who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score [PMS]>2], were included. Clinical activity and effectiveness were defined based on PMS. Short-term response was assessed at Week 16. RESULTS: A total of 95 patients were included. At Week 16, 53% of patients had response [including 35% of patients in remission]. In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with lower likelihood of achieving remission. Remission was achieved in 39% and 33% of patients at Weeks 24 and 52, respectively; 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at Week 16, 63% at Week 56, and 59% at Week 72; primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. CONCLUSIONS: Ustekinumab is effective in both the short and the long term in real life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.

Management of Helicobacter pylori infection at the primary care level. The implementation of specific counseling improves eradication rates.

BACKGROUND: Management of Helicobacter pylori infection has been expanded from the gastroenterology specialist (GS) to primary care physicians (PCPs), with a large increase in requests for urea breath tests (UBT). Due to the lack of evidence at this level, we evaluated the appropriateness of UBT indications and treatment for H pylori infections between PCPs and GSs and the effect of introducing specific counseling to PCPs. MATERIALS AND METHODS: This was a quasi-experimental study. Phase I included 650 consecutive UBT requested by PCPs (400) and GSs (250). Indications and treatments were classified as appropriate or inappropriate based on national guidelines. Data on eradication rates were also collected. In phase II, 240 UBT and patients' treatment outcomes were analyzed after individually counseling PCPs on both aspects. RESULTS: Of 1049 UBT, inappropriate indications in phase I were significantly higher in tests requested by PCP compared with GS (35.9% vs 7.2%; P < 0.001). Inappropriate treatment regimens were significantly higher for PCPs in phase I (65.8% vs 26.4%; P < 0.001). Consequently, eradication rates were significantly lower in patients treated by PCPs compared with those treated by GS (63.7% vs 81.4%; P = 0.004). A significant increase in adherence to appropriate treatment regimens (75.8% vs 34.2%; P < 0.001) and eradication rates (79.2% vs 63.7%; P = 0.002) were observed in the PCP group after counseling; however, the appropriateness of indications did not improve. CONCLUSIONS: Patients infected with H pylori managed at the primary care level had poorer outcomes. The introduction of specific counseling for PCPs significantly improved treatment management, but not indications.

[Infliximab therapy in ulcerative colitis: initial experience in two referral centers]. / Tratamiento con infliximab en la colitis ulcerosa: experiencia inicial en dos centros de referencia.

OBJECTIVE: To perform a descriptive analysis of our experience with infliximab in the treatment of ulcerative colitis (UC). MATERIAL AND METHODS: We performed a retrospective, observational study of all patients with UC treated with infliximab and with criteria of corticosteroid resistance or dependence in two referral hospitals. The medical records of all patients treated with infliximab to December 2006 were reviewed, following the GETECCU Guidelines. Lennard-Jones and Montreal criteria were used for diagnosis and classification, respectively. Activity was defined according to Truelove-Witts criteria. Response was evaluated at 8 weeks, although most of the patients were followed-up for more than 30 weeks. RESULTS: Nineteen patients (15 steroid-dependent and four severe, steroid-resistant) were included. Of the 15 steroid-dependent patients, response to infliximab was observed in 13 (86%; 95% IC, 56-98) and complete remission was achieved in nine (60%; 32-83.7); colectomy was performed in one patient. Remission was achieved in two out of four severe, steroid-resistant patients and the remaining two patients were colectomized. Only one serious adverse event (Pseudomonas aeruginosa cavitary pneumonia) was observed in one patient, who was also receiving azathioprine and prednisone. DISCUSSION: This short-term experience suggests that infliximab can be useful in some UC patients. However, the therapeutic role of this drug should be defined more precisely in further studies.

Tratamiento con infliximab en la colitis ulcerosa: experiencia inicial en dos centros de referencia / Infliximab therapy in ulcerative colitis: initial experience in two referral centers

Objetivo: Describir nuestra experiencia con infliximab en el tratamiento de la colitis ulcerosa (CU). Material y métodos: Estudio observacional y retrospectivo de pacientes tratados con infliximab por CU, con criterios de corticorresistencia o corticodependencia en dos hospitales de referencia. Se revisan las historias clínicas de todos los pacientes tratados con infliximab, según la Guía de GETECCU, hasta diciembre de 2006, utilizando los criterios de Lennard-Jones, la clasificación de Montreal y los criterios de Truelove-Witts. Se evalúa la respuesta a las 8 semanas, aunque en la mayoría de los casos hay un seguimiento mayor de 30 semanas. Resultados: Se evalúan 19 pacientes (15 corticodependientes y 4 corticorresistentes). El fármaco obtuvo respuesta en 13 de 15 corticodependientes (87%; intervalo de confianza [IC] del 95%, 56-98) y remisión en 9 de 15 (60%; IC del 95%, 32-83,7). En 2 pacientes no hubo respuesta con una colectomía. Se observó remisión en 2 (50%) de los 4 corticorresistentes, y los otros 2 pacientes fueron sometidos a colectomía. Se observó sólo un efecto adverso grave: una neunomíaa cavitada por Pseudomonas aeruginosa en un paciente tratado simultáneamente con azatioprina y prednisona. Discusión: Esta experiencia sugiere que infliximab es un fármaco activo en la CU refractaria, aunque su posición en el esquema terapéutico debe definirse con nuevos estudios

Objective: To perform a descriptive analysis of our experience with infliximab in the treatment of ulcerative colitis (UC). Material and methods: We performed a retrospective, observational study of all patients with UC treated with infliximab and with criteria of corticosteroid resistance or dependence in two referral hospitals. The medical records of all patients treated with infliximab to December 2006 were reviewed, following the GETECCU Guidelines. Lennard-Jones and Montreal criteria were used for diagnosis and classification, respectively. Activity was defined according to Truelove-Witts criteria. Response was evaluated at 8 weeks, although most of the patients were followed-up for more than 30 weeks. Results: Nineteen patients (15 steroid-dependent and four severe, steroid-resistant) were included. Of the 15 steroid-dependent patients, response to infliximab was observed in 13 (86%; 95% IC, 56-98) and complete remission was achieved in nine (60%; 32-83.7); colectomy was performed in one patient. Remission was achieved in two out of four severe, steroid-resistant patients and the remaining two patients were colectomized. Only one serious adverse event (Pseudomonas aeruginosa cavitary pneumonia) was observed in one patient, who was also receiving azathioprine and prednisone. Discussion: This short-term experience suggests that infliximab can be useful in some UC patients. However, the therapeutic role of this drug should be defined more precisely in further studies

Evaluación de las actividades de detección y seguimiento del cáncer cervicouterino en población bajo cobertura de la Secretaría de Salud. México, 1992 / Evaluation of the activities of screening and follow-up of cervical uterine carcinoma from the population under coverage of the Ministry of Health in Mexico, 1992

Se presentan los resultados del programa de Detección Oportuna del Cáncer Cervicouterino para el año de 1992 que se conduce en las unidades de la Secretaría de Salud (SSA) basados en los informes anuales de Papanicolau de las unidades aplicativas y los laboratorios de diagnóstico en todo el país. En éstas se tomaron en total 1'022,862 Papanicolaus que representaron el 59.7 por ciento de logro con respecto a la meta programada. Existe un rango de la cobertura alcanzada de laminillas tomadas/usuarias, que va de 7.9 por ciento a 42.89 por ciento en las entidades. Las metas propuests sólo estaban estimando cubrir al 21 por ciento de la población bajo cobertura de la SSA. La incidencia determinada para displasia fue de 218.08 casos por cada 100,000 mujeres del grupo de edad de 15 a 69 años bajo cobertura de la SSA, y de cáncer cervicouterino fue de 64 casos por cada 100,000 mujeres del grupo de edad de 15 a 69 años bajo cobertura de la SSA. Se presentan estos resultados para que sirvan como marco de referencia a las estrategias del programa de Detección Oportuna de Cáncer Cervicouterino