Ecological momentary assessment for chronic pain in fibromyalgia using a smartphone: a randomized crossover study.

BACKGROUND: Daily diaries are a useful way of measuring fluctuations in pain-related symptoms. However, traditional diaries do not assure the gathering of data in real time, not solving the problem of retrospective assessment. Ecological momentary assessment (EMA) by means of electronic diaries helps to improve repeated assessment. However, it is important to test its feasibility in specific populations in order to reach a wider number of people who could benefit from these procedures. METHODS: The present study compares the compliance and acceptability of an electronic diary running on a smartphone using a crossover design for a sample with a specific pain condition, fibromyalgia and low familiarity with technology. Forty-seven participants were randomly assigned to one of two conditions: (1) paper diary - smartphone diary and (2) smartphone diary - paper diary, using each assessment method for 1 week. RESULTS: The findings of this study showed that the smartphone diary made it possible to gather more accurate and complete ratings. Besides, this method was well accepted by a sample of patients with fibromyalgia referred by a public hospital, with an important proportion of participants with low level of education and low familiarity with technology. CONCLUSIONS: The findings of this study support the use of smartphones for EMA even in specific populations with a specific pain condition, fibromyalgia and with low familiarity with technology. These methods could help clinicians and researchers to gather more accurate ratings of relevant pain-related variables even in populations with low familiarity with technology.

Prevalence and associated factors of anterior atlantoaxial luxation in a nation-wide sample of rheumatoid arthritis patients.

OBJECTIVE: To estimate the prevalence of anterior atlantoaxial subluxation (AAS) in patients with rheumatoid arthritis (RA), and to analyse its association with disease markers. METHODS: Cross-sectional analysis of a cohort of RA patients randomly selected from the clinical registries of 34 centres. AAS, defined as an atlantoaxial displacement in cervical spine X-rays greater than 3 mm on flexion films, was actively searched for. Bivariate and multivariate analysis was performed to examine its association with clinical, functional, and treatment variables. RESULTS: AAS was found in 88 out of 736 patients with available cervical radiographs, (prevalence and 95% confidence interval [CI]: 12% [9.7-14.2]). The presence of AAS was highly associated with a Larsen score (0-150) over 50 (OR and 95% CI: 5.31 [2.68-10.55]), RA duration of more than 10 years (4.48 [2.70-7.44]), disease onset before age 50 (4.15 [2.42-7.12]), eye involvement (3.93 [1.63-9.46]), and previous RA related surgery (3.90 [2.46-6.19]). No association was found with rheumatoid factor. Multivariate analysis showed that a disease onset before the age of 50, the number of previous DMARD, and, above all, a Larsen score greater than 50 were important independent factors associated with AAS. There is a 33% increased risk for AAS every 10 units up in the Larsen score. CONCLUSION: AAS is frequent in RA patients, particularly in those with markers of erosive disease.

Effect of a moderate intensity exercise training protocol on the metabolism of macrophages and lymphocytes of tumour-bearing rats.

It is commonly accepted that moderate intensity exercise is beneficial to the immune system. We tested the influence of a moderate intensity training protocol (8 weeks) upon immune system function in Wistar tumour-bearing (TB) rats. The metabolism of glucose and glutamine in lymphocytes and macrophages was assessed, together with some functional parameters (hydrogen peroxide production and lymphocyte proliferative response). These substrates were chosen since they represent the most important energetic and synthetic metabolites for these cellular types. The training protocol caused a decrease of 17.4 per cent in the production of H(2)O(2) by macrophages, as well as a decrease in glucose consumption (25 per cent) and lactate production (47.1 per cent), and an increase in the production of labelled CO(2) from the oxidation of [U-(14)C]-glucose, in TB rats. The training protocol was also able to induce changes in the maximal activity of some key enzymes in the metabolism of glucose and glutamine, a reduction of hexokinase (68.8 per cent) activity and an increase in the activity of citrate synthase (10.1 per cent) in TB rats. The training protocol increased the proliferative response of lymphocytes cultivated in the absence of mitogens (75 per cent), of those cultivated in the presence of ConA (38.2 per cent) and in the presence of LPS (45.0 per cent). These cells also showed an increase in the maximal activity of some key enzymes of the glycolytic and glutaminolytic pathways. Our data demonstrated that the training protocol was able to induce an increase in aerobic utilisation of both substrates in lymphocytes and macrophages. The training protocol was also able to prevent several changes in glucose and glutamine metabolism that are normally present in sedentary TB rats. These changes in immune cell metabolism induced by the training protocol were able to increase TB rat survival.

Detecting anti-SSA and anti-SSB antibodies in routine analysis: a comparison between double immunodiffusion and immunoblotting.

The aim of this study was to assess the performance of a commercially available procedure for detecting anti-Sjögren's syndrome A (anti-SSA) and anti-Sjögren's syndrome B (anti-SSB) antibodies by immunoblotting (IB) and compare it with double immunodiffusion (DID). We also studied the clinical significance of these profiles in a series of unselected anti-SSA positive patients. Serum samples from 534 patients that were positive on an immunofluorescent screening test using HEp-2 cells were analysed for anti-SSA and anti-SSB antibodies by DID and IB (Biolab Anablot System II), and the results on anti-SSA antibodies were confirmed by an enzyme-linked immunosorbent assay (ELISA). Fifty-five serum samples were found to be positive for anti-SSA antibodies. Among these, 24 were anti-SSA negative by IB but positive by DID and ELISA ('non-blotter sera'), whereas only three serum samples were anti-SSA negative by DID but positive by IB and ELISA. Of the 18 anti-SSB positive serum samples, eight were negative by DID. All the serum samples that were anti-SSB positive by DID were also positive by IB. Anti-SSB antibodies showed a significant association with eye dryness and leucopenia. Anti-52 kDa SSA antibodies were associated with anti-SSB antibodies but showed no significant association with sicca symptoms, while anti-60 kDa SSA antibodies were associated with lower rates of leucopenia. The 'non-blotter' profile showed no significant association with any clinical parameter. IB is less sensitive than DID for detecting anti-SSA antibodies but more sensitive than DID for detecting anti-SSB antibodies. The determination of anti-SSA immunoblotting profiles in patients positive for anti-SSA antibodies by DID does not significantly improve the clinical usefulness of this test. As expected, anti-SSB antibodies were associated with clinical features of Sjögren's disease. Non-blotting (probably conformational) anti-SSA antibodies did not show any further association with clinical parameters and seem to have no clinical relevance.

[Electronic forum of Revista de neurología: 'Internet, Medicine and Neuroglia']. / Foro electrónico de revista de neurología: 'Internet, Medicina y Neurología'.

INTRODUCTION: In recent years Internet has drastically transformed the world of telecommunications. Questions about whether Internet and the global communication accessibility may be considered as a fundamental aspect in the medicine of today and tomorrow have been brought up. OBJECTIVE: Discuss current and future applications of Internet to the field of Medicine and Neurology. METHODS: Bibliographical review based on Medline and standard Web search engines. Forum sessions performed through Internet by means of Web-Chat. Forum coordination entirely performed by electronic mail. RESULTS: There are several opinions regarding the influence of Internet on Medicine and Neurology. Currently, the communication and collaboration between teams is improving. It allows scientific publications on-line, improves continuous remote training and facilitates information to patients. New applications like telemedicine need more development. CONCLUSIONS: Currently, Internet represents an efficient tool for collaboration, training and distribution of information in the field of Medicine and Neurology.

Validation of the medical expert system RENOIR.

RENOIR is an expert system developed to assist the diagnosis of 37 diseases of connective tissue and inflammatory arthropathies. Precise diagnosis of rheumatic diseases implies great uncertainty and there is no gold standard with which to compare the expert system output. To overcome this problem a set of clinical cases was submitted to RENOIR and its diagnoses were compared with those of clinicians. Medical records of 81 patients with rheumatic diseases were interpreted by RENOIR and by 12 clinicians at three different expertise levels in rheumatology. Distances between the likelihoods of the 37 considered diseases provided by clinicians and RENOIR were computed as a disagreement measure. Mahalanobis distance was used to correct the collinearity between the possibilities of each pair of diseases. Using the resulting matrices of distances between experts, cluster analyses were carried out to classify RENOIR among human experts. Greater differences between RENOIR and clinicians than among clinicians themselves were not found.

Asociación de los antígenos HLA-DR10,DR4 y DR1 con artritis reumatoidea / The association of the HLA-DR10,DR4 and DR1 antigens with rheumatoid arthritis

Objetivo:Establecer la relación entre los antígenos HLA de clase I y II y artritis reumatoidea. Material y métodos: Mediante un diseño de casos y controles se ha evaluado una muestra de conveniencia de 39 pacientes con artritis reumatoidea,que cumplían al menos cuatro criterios del American College of Rheumatology (ACR).Como grupo de comparación se utilizaron 264 controles sanos de la población.La tipificación de HLA se determinó serológicamente.Resultados:En el análisis se determinó por regresión logística,se detectó asociación de la enfermedad con DR10 (RR:7,7;IC 95 por ciento ,28,9-2,1),DR4 (RR:5,3;IC 95 por ciento,11,7-2,4)y DR1 (RR:3,6;IC 95 por ciento,8,0-1,6).La presencia de más de uno de estos antígenos no significaba mayor riesgo de padecer la enfermedad.No hemos observado asociación entre la presencia de estos antígenos y la gravedad de la enfermedad,manifestada por la seropositividad o afectación sistémica del proceso.Conclusiones:Nuestros resultados confirman que los antígenos HLA de clase II,DR10,DR4 y DR1, que comparten secuencias de aminoácidos en la región que contacta con el receptor del antígeno de los linfocitos T, son un factor de riesgo para el desarrollo de la artritis reumatoidea.

Asociación de los antígenos HLA-DR10,DR4 y DR1 con artritis reumatoidea / The association of the HLA-DR10,DR4 and DR1 antigens with rheumatoid arthritis

Objetivo:Establecer la relación entre los antígenos HLA de clase I y II y artritis reumatoidea. Material y métodos: Mediante un diseño de casos y controles se ha evaluado una muestra de conveniencia de 39 pacientes con artritis reumatoidea,que cumplían al menos cuatro criterios del American College of Rheumatology (ACR).Como grupo de comparación se utilizaron 264 controles sanos de la población.La tipificación de HLA se determinó serológicamente.Resultados:En el análisis se determinó por regresión logística,se detectó asociación de la enfermedad con DR10 (RR:7,7;IC 95 por ciento ,28,9-2,1),DR4 (RR:5,3;IC 95 por ciento,11,7-2,4)y DR1 (RR:3,6;IC 95 por ciento,8,0-1,6).La presencia de más de uno de estos antígenos no significaba mayor riesgo de padecer la enfermedad.No hemos observado asociación entre la presencia de estos antígenos y la gravedad de la enfermedad,manifestada por la seropositividad o afectación sistémica del proceso.Conclusiones:Nuestros resultados confirman que los antígenos HLA de clase II,DR10,DR4 y DR1, que comparten secuencias de aminoácidos en la región que contacta con el receptor del antígeno de los linfocitos T, son un factor de riesgo para el desarrollo de la artritis reumatoidea.

Avascular necrosis of bone in human immunodeficiency virus infection and antiphospholipid antibodies.

We describe 3 cases of human immunodeficiency virus (HIV) infected patients with antiphospholipid antibodies (aPL) in serum who developed avascular necrosis (AVN), an association that to our knowledge, has rarely been described. Given that the 3 patients had stopped their intravenous drug addiction 2 years before the clinical picture appeared, and none had any known risk factors for developing AVN, there may be an association, perhaps fortuitous, between HIV infection, the presence of aPL and the development of AVN.

[Diabetologic education at a general hospital in Cataluna: methodology and short-term indicators of effectiveness]. / Educación diabetológica en un hospital general de Cataluña: metodología e indicadores de efectividad a corto plazo.

In order to carry out an initial evaluation of an intrahospital diabetes education programme after its first year, the methods used are described and some previously established short term effectiveness indicators are analyzed: 1) knowledge of the theory, 2) insulinization, 3) blood glucose self testing at home, 4) metabolic control, 5) readmission in hospital, and 6) detection of chronic complications. An analysis of the previous situation was carried out resulting in a mean hospital stay of 10.8 days/patient/year during 1985, being the mean hospital stay for the general population of 8.1 days. 222 diabetic patients (63 type I and 159 type II) were included in the programme during the first year, and their cultural background, diabetes education, place of origin and participation were evaluated. 358 written tests were examined. The scores obtained after the educational sessions (75.6 +/- 17.5) were significantly higher than the initial scores (47.4 +/- 23.1; p less than 0.001). Prior the programme, 93 patients (41.9%) were on insulin. At the time of the evaluation 156 (70.2%) were on insulin treatment, of which 86 (38.7%) were on rapid insulin. Furthermore, 141 patients (66.1%) were carrying out periodic (over 10 tests/week) blood glucose determinations at home. In a 96 patient follow up group (36 type I and 60 type II) a significant improvement in baseline glucose levels (8.6 +/- 2.7 vs 12.6 +/- 4.2 mmol/l; p less than 0.001) as well as glycosylated hemoglobin levels (9.3 + 1.2% vs 11.0 + 2.0%; p greater than 0.001) was confirmed; this improvement was maintained throughout the time period considered.(ABSTRACT TRUNCATED AT 250 WORDS)