Valoración del equilibrio postural en bipedestación-sedestación en sujetos sanos mediante acelerometría. Estudio piloto / Assessment by accelerometer of postural balance in standing-sitting position in healthy subjects-A pilot study

Introducción: La valoración del control postural y el equilibrio es de relevancia para orientar las intervenciones terapéuticas, al ser los aspectos más afectados que limitan a las personas con alteraciones en la marcha, las postura, y las actividades de la vida diaria. Se ha demostrado que la acelerometría es de utilidad para la valoración del equilibrio postural. Objetivos: Determinar, en un estudio preliminar en sujetos sanos, indicadores basados en la acelerometría eficaces para valorar la sedestación y la bipedestación en situaciones de estabilidad e inestabilidad, con y sin control visual. Metodología: Se valoró a 26 sujetos sanos mediante la colocación de acelerómetros triaxiales y realizando diferentes pruebas en sedestación y bipedestación. Resultados: La energía necesaria para la búsqueda del equilibrio ante situaciones de inestabilidad se vieron en una banda de frecuencias de 1,5-3 Hz. Conclusiones: Los indicadores para valorar el control postural y el equilibrio que podrían ser de utilidad para los terapeutas son: root mean square, densidad espectral de la energía y espectro de frecuencias

Introduction: Assessment of postural control and balance is very important to guide therapeutic interventions, these being the most affected aspects that limit people with alterations in gait, posture, and activities of daily life. It has been shown that the accelerometry is useful for assessment of postural balance. Objectives: To determine efficient indicators based on accelerometry to assess sitting and standing in stability and instability situations, with and without visual control in a preliminary study in healthy subjects. Methodology: Twenty-six healthy subjects were evaluated by placing triaxal accelerometers and performing different tests in sitting and standing positions. Results: The energy required to find a balance in instability situations was seen in a frequency band of 1.5-3 Hz. Conclusions: The indicators that could be useful for the therapists to assess postural control and balance are: root mean square, energy spectral density and frequency spectrum

Efectos de la hipoterapia en la estabilidad postural en parálisis cerebral infantil: a propósito de un caso clínico / Effects of hippotherapy on postural stability in cerebral palsy: report of a case

Antecedentes y objetivos: La falta de control postural es a menudo el factor limitante para participar en actividades de la vida diaria, identificándose como la mayor limitación para el desarrollo motor de los niños con parálisis cerebral. Es por ello de especial importancia la valoración del control postural y del equilibrio en la parálisis cerebral, para la orientación del tratamiento en la práctica clínica. El objetivo de este estudio es mostrar la evolución de la estabilidad postural en una niña con parálisis cerebral que recibe hipoterapia. Descripción del caso: Se presenta el caso de una niña de 8 años con hemiparesia derecha como resultado de una parálisis cerebral. Intervención: Se han realizado 14 sesiones de hipoterapia llevadas a cabo una vez por semana y con duración de 45 min cada sesión. La valoración de la estabilidad postural se ha analizado con una plataforma de presión, realizando 2 tipos de medición: estática y posturológica, con ojos abiertos y cerrados. Resultados: Tras la intervención, existen modificaciones positivas en la distribución de la huella plantar, la ubicación del centro de gravedad y la estabilidad postural en sentido antero-posterior, siendo el eje medio-lateral el que ha manifestado menos variabilidad de mejora. Además, los mejores porcentajes de cambio se han producido con los ojos cerrados. Discusión: La literatura nos muestra que se produce una mejoría significativa de la estabilidad postural después de haber llevado a cabo un tratamiento de hipoterapia. Realizando una valoración exhaustiva y con la utilización de una plataforma barométrica podemos observar las modificaciones producidas por la intervención terapéutica

Background and objectives: The lack of postural control is often the limiting factor to participate in activities of daily life. It has been identified as the major limitation for motor development of children with cerebral palsy. Therefore, assessment of postural control and balance in cerebral palsy is especially important for orienting the treatment in clinical practice. This study has aimed to show the evolution of postural stability in a child with cerebral palsy who receives hippotherapy. Case description: We present the case of an 8-year old girl suffering right-hemiparesis as a result of a cerebral palsy. Intervention Fourteen 14 hippotherapy sessions were performed, each of them once a week with 45 minute duration. Postural stability was evaluated with a pressure platform, performing two measurement types: static and posturological, with open and closed eyes. Results: The results indicate that there were positive changes after the intervention of the distribution of footprint, location of the center of gravity and postural stability in anteroposterior direction. The average lateral axis expressed the less improvement. Furthermore, the best exchange rates occurred with closed eyes. Discussion The literature shows a significant improvement in postural stability after having conducted hippotherapy treatment. The changes produced by therapeutic intervention can be seen when performing a comprehensive assessment and the use of a barometric platform

Chronic antigenic stimuli as a possible explanation for the immunodepression caused by liver cirrhosis.

The objectives of this work were the analysis of the functional characteristics of circulating monocytes and T lymphocytes in patients with liver cirrhosis, and evaluation of the relationship with an increased exposure to antigens due to bacterial translocation. Forty patients with liver cirrhosis (20 with compensated cirrhosis and 20 with ascitic decompensation) and 20 healthy control subjects were studied. Bacterial translocation was evaluated by serum levels of lipopolysaccharide binding protein (LBP). Macrophage activation was studied by CD40 antigen expression. T lymphocytes were analysed for activation (CD25(+), CD122(+)), effector function (CD8(+)CD45RO(+)CD57(+)), apoptosis (CD95(+)) and regulatory abilities, either by analysis of the membrane expression of co-stimulatory molecules CD80, CD86 and CD28, or by quantification of regulatory T cells CD4(+)CD25(high)forkhead box P3 (FoxP3). The percentage of activated monocytes and T lymphocytes in patients was increased significantly. The proportions of effector senescent cells and of those near to apoptosis were also significantly higher. With respect to these proportions, there were no significant differences between patients in function of the presence or absence of decompensation or in function of the increased or normal values of LBP. Conversely, those patients with elevated levels of LBP presented a significantly higher frequency of regulatory T cells than those with normal levels. In conclusion, patients with liver cirrhosis showed an intensive activation state with a higher percentage of cells committed to activation-induced death, even in non-advanced stages. It is possible that bacterial permeability and endotoxaemia contribute to the expansion of those lymphocyte populations implicated in the prevention of a more severe antigen-induced immunopathology.

T cell receptor excision circles (TRECs), CD4+, CD8+, and their CD45RO+, and CD45RA+, subpopulations in hepatitis C virus (HCV)-HIV-co-infected patients during treatment with interferon alpha plus ribavirin: analysis in a population on effective antiretroviral therapy.

Interferon (IFN)-alpha induced CD4(+) T lymphopenia is a toxic effect of the treatment of chronic hepatitis C virus (HCV) in human immunodeficiency virus (HIV)-co-infected patients. To increase the knowledge about this secondary effect, we performed an analysis of the evolution of the T cell receptor excision circles (TRECs), CD4(+) and CD8(+) T cells and of their CD45RO(+) and CD45RA(+) subpopulations during the treatment of chronic hepatitis HCV with peginterferon alpha (pegIFN-alpha) + ribavirin. Twenty HCV/HIV-co-infected patients, with undetectable HIV load after highly active antiretroviral therapy (HAART), were treated with pegIFN-alpha + ribavirin. TRECs were determined using real-time polymerase chain reaction. CD4(+) and CD8(+) T cells and their CD45RO(+) and CD45RA(+) subpopulations were analysed by two-colour flow cytometry. Median baseline CD4(+) and CD8(+) T cells were 592 mm(3) and 874 mm(3), respectively. Median baseline CD45RO(+) subpopulation was 48% for CD4(+) T and 57% for CD8(+) T lymphocytes. A progressive decrease in both T cell populations, as well as of their CD45RO(+) and CD45RA(+) subpopulations, was detected, with a difference between the baseline and nadir levels approaching 50%. The evolution of T cell populations and TRECs was independent of the response to the treatment. T lymphocytes and their subpopulations returned to baseline levels at 24 weeks after the end of treatment, with the exception of the T CD4(+) CD45RA(+) subpopulation. The ratio of CD4(+) CD45RO(+)/CD4(+) CD45RA(+) increased from 0.89 (baseline) to 1.44 (24 weeks after the end of the therapy). TRECs/ml did not return to the basal values. In conclusion, a significant reduction of CD4(+) and CD8(+) T cells, and of their CD45RA(+) and CD45RO(+) subpopulations, in HIV/HCV co-infected patients treated with pegIFN-alpha was observed. Both subpopulations increased after the suppression of treatment, but the CD4(+) CD45RA subpopulation did not reach the basal levels as a consequence, at least in part, of a decrease in thymic production.

Adhesion molecules as a prognostic marker of liver cirrhosis.

OBJECTIVE: Endothelial activation plays an active role in modifications of the circulatory status of cirrhotic patients. Soluble endothelial adhesion molecules, induced by pro-inflammatory cytokines, could be considered markers of endothelial activation. Their role in the natural history of cirrhosis and portal hypertension has not been reported. Our objective was to analyze the prognostic value of soluble adhesion molecules in cirrhotic patients. MATERIAL AND METHODS: Serum concentrations of soluble CD14, soluble receptors of tumor necrosis factor alpha and adhesion molecules ICAM-1 (intercellular adhesion molecule-1) and VCAM-1 (vascular cell adhesion molecule 1) as well as mean blood pressure, plasma renin activity, aldosterone, vasopressin and norepinephrine concentrations were determined in 64 cirrhotic patients (Child-Pugh class: A 48.4%, B 34.4%, C 17.2%), without any evidence of infection, and in 25 healthy controls. Patients were followed-up for a mean of 36.4 (range 6-60) months. RESULTS: Increased concentrations of soluble CD14, tumor necrosis factor receptors and ICAM-1 and VCAM-1 were detected in cirrhotic patients when compared with healthy controls. Tumor necrosis factor receptors and adhesion molecule concentrations were both significantly higher in advanced phases of cirrhosis (Child Pugh class C and B versus A). Fifteen patients died as a related consequence of liver cirrhosis. Multivariate analysis demonstrated that Child-Pugh score and serum levels of tumor necrosis factor receptor I and ICAM-1 were associated with mortality. CONCLUSIONS: In addition to the classic factor implicated in mortality (Child-Pugh class), alterations in inflammation-related components and soluble adhesion molecules, as representatives of hemodynamic alterations, are of prognostic significance in cirrhotic patients.

Modifications of haematological series in patients co-infected with human immunodeficiency virus and hepatitis C virus during treatment with interferon and ribavirin: differences between pegylated and standard interferon.

Therapy with interferon and ribavirin for hepatitis C virus (HCV) infection induces a decrease in several haematological population counts. It is unclear whether haematological toxicity is more severe in patients co-infected with HCV and human immunodeficiency virus (HIV). This study analysed the evolution of haematological population counts during and after interferon and ribavirin therapy for chronic HCV infection. Eleven patients co-infected with HIV and HCV and treated with pegylated interferon plus ribavirin, and ten treated with standard interferon plus ribavirin, were analysed. With reference to baseline values, neutrophil counts decreased by an average of 45% (range 18-67%), total lymphocytes by 50% (16-63%), CD4 lymphocytes by 54% (16-61%), haemoglobin by 9% (5-16%) and platelets by 31% (16-45%). The nadir of the decrease was reached in the first weeks of therapy and was maintained while patients were receiving treatment. The reduction in all series was higher with pegylated interferon. Patients recovered their baseline counts after finishing the treatment. No cases of haemorrhage or outstanding infection were detected during follow-up.

Pneumonia in HIV-infected patients in the HAART era: incidence, risk, and impact of the pneumococcal vaccination.

The objective of this study was to assess the factors implicated in an increased or decreased risk of pneumonia, with particular attention to the response to highly active antiretroviral therapy (HAART) and the effect of the polysaccharide 23-valent pneumococcal vaccination in 300 human immunodeficiency virus (HIV)-infected adults followed-up for a median of 35.6 months. Pneumococcal pneumonia occurred in 12 patients and all bacterial pneumonia (pneumonia caused by Streptococcus pneumoniae or other bacteria, as well as those with negative cultures but presumably bacterial in origin) in 40 patients. In the univariate analysis, immunodepressed patients (defined as those with less than 200 CD4+ T cell/microl), those without immunological response to HAART (defined as an increase of 25% of CD4+ T lymphocyte count), patients with previous admissions to hospital and those with cotrimoxazole or Mycobacterium avium intracellulare prophylaxis showed a higher incidence of both pneumococcal and all bacterial pneumonia. Multivariate analysis demonstrated that the presence of pneumococcal pneumonia was associated with a CD4+ lymphocyte count at the time of HIV diagnosis <200 cells/microl. The multivariate model that was more valid for prediction of all bacterial pneumonia included a CD4+ T cell count <200 cells/microl and absence of immunological response to HAART. Only in patients with a baseline CD4+ T cell count lower than 200/microl and immunological response to HAART, a near significant lower incidence of all bacterial pneumonia was observed after vaccination. Thus, these results do not support an important additional protective effect of 23-valent pneumococcal vaccine in HIV-patients with immunological response to HAART.

Factors related to the chronicity and evolution of hepatitis C infection in patients co-infected by the human immunodeficiency virus.

OBJECTIVES: This work analyses the influence of immune status, serum human immunodeficiency virus (HIV) load and hepatitis C virus (HCV) genotypes on the probability of resolution of HCV infection in HIV-co-infected patients, as well as the evolution of HCV viremia after antiretroviral therapy. PATIENTS AND METHODS: Forty-five patients with anti-HIV and anti-HCV antibodies were classified into two groups as a function of the positivity or persistent negativity of HCV RNA detection (active or recovered HCV infection, respectively). They were treated with highly active antiretroviral therapy (HAART). Serum HCV RNA was quantified by the reverse transcription-polymerase chain reaction. HCV genotypes were detected by line probe assay or by detection of type-specific antibodies. RESULTS: HCV RNA was detectable in 30 (66.6%) out of 45 HIV-infected patients. CD4+ T-cell counts, HIV viremia, or HCV genotypes were similar in patients with active or recovered HCV infection. Patients with active HCV infection had a non-significant decrease of HCV viremia during a follow-up of 12 months (from 6.15 +/- 6.32 to 5.96 +/- 6.05 log copies/mL). This was not influenced by baseline HCV or HIV viral load, HCV genotype, or CD4+ T-cell count. The non-significant decrease was present in patients with or without an immunological response to HAART. CONCLUSION: HCV genotypes, immune status, or serum HIV load did not influence the resolution or chronicity of HCV infection in HIV-co-infected individuals. A non-significant decrease of HCV viremia in these patients treated with combinations including antiproteases could be expected.

Las nuevas tecnologías de la información y las comunicaciones en salud / The new information and communication technologies in the health field

Se describe el impacto de las Nuevas Tecnologías de la Información y las Comunicaciones en el sector de la Salud, haciendo énfasis en aquellas áreas relacionadas con el desempeño de todos los profesionales y técnicos del sector. Entre otras cosas, se hace referencia a las noticias de Salud, la telemedicina, la Universidad Virtual de Salud, la Biblioteca Virtual de Salud, los descriptores en Ciencias de la Salud, la Clínica Virtual, la vigilancia en Salud, la telecirugía, las investigaciones en Salud y la cooperación internacional en Salud. Se señalan aspectos novedosos de estas tecnologías así como consejos prácticos para incorporarlas al trabajo cotidiano en instituciones académicas o asistenciales del sector. Por su naturaleza, el trabajo sirve para elevar los conocimientos y el nivel cultural de cualquier lector

The impact of the New Information and Communications Technologies on the health sector is described, making emphasis in those areas related to the performance of all the professionals and technicians of this sector. Reference is made, among other things, to health news, telemedicine, Virtual Health University, Virtual Health Library, Health Sciences Subject Headings, Virtual Clinic, health surveillance, telesurgery, health research, and international cooperation in the health field. The novel aspects of these technologies are stressed as well as practical advices to incorporate them to the daily work of academic or health assistance institutions. Due to its nature, this paper serves to improve the knowledge and the cultural level of any reader

Las nuevas tecnologías de la información y las comunicaciones en salud / The new information and communication technologies in the health field

Se describe el impacto de las Nuevas Tecnologías de la Información y las Comunicaciones en el sector de la Salud, haciendo énfasis en aquellas áreas relacionadas con el desempeño de todos los profesionales y técnicos del sector. Entre otras cosas, se hace referencia a las noticias de Salud, la telemedicina, la Universidad Virtual de Salud, la Biblioteca Virtual de Salud, los descriptores en Ciencias de la Salud, la Clínica Virtual, la vigilancia en Salud, la telecirugía, las investigaciones en Salud y la cooperación internacional en Salud. Se señalan aspectos novedosos de estas tecnologías así como consejos prácticos para incorporarlas al trabajo cotidiano en instituciones académicas o asistenciales del sector. Por su naturaleza, el trabajo sirve para elevar los conocimientos y el nivel cultural de cualquier lector(AU)

Effect of patient adherence to antiretroviral therapy on CD4+ cell count, HIV-1 RNA, and serum concentrations of tumor necrosis factor and its soluble receptors.

A 1-year prospective analysis of patient adherence to antiretroviral therapy (zidovudine plus zalcitabine [55 patients] or zidovudine plus zalcitabine plus saquinavir [32 patients]) was performed in human immunodeficiency virus (HIV)-infected patients attended at a tertiary care hospital. Adherence to therapy was measured jointly by pharmacy records, patients' self-recording, and an increase in mean corpuscular volume. Likewise, the effects of therapy on clinical parameters, HIV load, CD4+ cell count, and serum levels of tumor necrosis factor alpha (TNF-alpha) and its soluble receptors were analyzed. Twenty-seven patients of those on a double-agent regimen and 12 of those on a triple-agent regimen adhered to the treatment. Ten opportunistic events occurred in noncompliant patients versus none in compliant individuals. A significant increase in CD4+ cell count and a decrease in HIV viral load were observed only in patients who adhered to therapy. TNF and its soluble receptors remained elevated at the end of follow-up, even in patients in whom the HIV viral load decreased to < 400 copies/ml. In conclusion, adherence to therapy must be considered a major factor influencing the results of antiretroviral therapy. Although these treatments have been demonstrated to be efficacious, they are not able to normalize the immune activation markers. These data suggest a suboptimal effect of antiretroviral therapy on the eradication of HIV-1.

Relationship of hepatitis C viremia to HIV state and to infection by specific hepatitis C genotypes.

AIMS/BACKGROUND: This study was undertaken to examine the relationship of hepatitis C (HCV) viremia to human immunodeficiency virus (HIV) infection and to investigate the evidence of infection by specific hepatitis C genotypes. PATIENTS AND METHODS: The analysis of HCV viremia was performed by reverse transcription-polymerase chain reaction in serum samples from 186 patients' selected by their positivity for anti-HCV antibodies. All samples were tested for HIV infection. In those patients with sera positivity for HCV RNA, isolates were genotyped by line probe assay. In those patients whose sera were negative for HCV RNA, antibodies specific for genotypes implicated in past HCV infection were detected by ELISA. RESULTS: HCV RNA was detected in 117 patients with anti-HCV antibodies (62.9%). There was no statistically significant association between HCV RNA and HIV positivity (Odds ratio, O.R.: 1.75, Confidence interval 95%, C.I.: 0.92-3.33, p = 0.095). A positive association was demonstrated between infection by HCV genotype 3 and HCV viremia (O.R.: 10.67, C.I.: 1.51-458.05, p = 0.015) in HIV-infected patients, as well as between infection by HCV genotype 1 and HCV viremia (O.R.: 4.71, C.I.: 1.65-13.75, p = 0.002) in HIV-non infected individuals. In both groups, a negative association was observed between past HCV infection by multiple genotypes and HCV viremia (HIV-infected patients, O.R.: 0.10, C.I.: 0.00-1.11, p = 0.033. HIV-non infected patients, O.R.: 0.05, C.I.: 0.00-0.41, p = 0.001). CONCLUSIONS: Infection by specific HCV genotypes (type 3 in HIV-infected patients and by type 1 in HIV-non infected ones) implies a higher risk of HCV viremia, whereas multiple HCV types infection is negatively associated with this probability. HIV coinfection does not influence the probability of HCV viremia.

Pleural effusion in patients infected with the human immunodeficiency virus.

In order to analyze the etiology, cytological and biochemical characteristics, and outcome of pleural disease in patients infected with HIV, the medical records of 86 HIV-positive patients with pleural effusion were reviewed. Controls were 106 HIV-negative patients with parapneumonic or tuberculous effusion. Most HIV-positive patients were intravenous drug abusers (95.3%). Pleural effusions in HIV-positive patients were caused by infections in 76 (89.4%) cases. Parapneumonic effusion was diagnosed in 59 patients and tuberculous pleuritis in 15 patients. Staphylococcus aureus was the most frequently isolated bacteria. Parameters for differentiating complicated cases of parapneumonic exudate from uncomplicated cases, such as pleural fluid pH < 7.20 (sensitivity 80% vs. 84.3%), pleural fluid glucose < 35 mg/dl (sensitivity 45% vs. 56.25%) pleural fluid LDH > 1600 UI/l (sensitivity 85% vs. 62.50%), showed similar sensitivity in HIV-positive and HIV-negative patients. Monocytes in pleural fluid were significantly decreased in tuberculous pleuritis in HIV-positive patients (506 +/- 425 vs. 1014 +/- 1196 monocytes/ml, p < 0.05). No significant differences were detected in the outcome of HIV-positive and HIV-negative patients with pleural disease. It can be concluded that the pleural effusion was of predominantly infectious etiology in HIV-positive patients from populations with a high prevalence of intravenous drug abuse. Neither the biochemical parameters in pleural fluid nor the outcome differed significantly between HIV-positive and HIV-negative patients.

[Transient work disability throughout a year in the IV Area of Asturias]. / Estudio de la incapacidad laboral transitoria durante un año en el Area IV de Asturias.

OBJECTIVE: We try to determinate the epidemiological distribution of the different pathologies which produce laboral absenteeism. DESIGN: Descriptive study. SETTING: IV Health Area, Asturias. PARTICIPANTS: Parts of discharge laboral transitory incapacity P9. INTERVENTION AND MAIN RESULTS: The gross rate of laboral transitory incapacity is 16.8%. Sex: 67.3% male, 32.7% female. The mean days for episode is 37.42 (DE = 60.47). Female average duration is 10 days more than male. For each year the mean duration increased 1.3 days (r = 0.25; p < 0.05). The 50% episodes has a duration less than two weeks. The three main illness groups are the breathing diseases (VIII), locomotor diseases (XIII) and accidents and traumatism (XVII). Many pathologies are associated with sex and age. Many pathologies have a stational distribution: VIII (p < 0.001), digestive diseases (p < 0.001), mental diseases (p < 0.05) and XVII (p < 0.05). CONCLUSIONS: 1) Is interesting the exploration of the information contents in P9 parts. 2) The aged is relationed with during of absenteeism. 3) Many pathologies were associated with the sex and aged of patients. 4) Many pathologies have a stational distribution.

Evaluation of Urea-motility-indole medium for recognition and differentiation of Salmonella and Shigella species in stool cultures.

A semisolid urea-motility-indole medium designed for detection in Enterobacteriaceae of urease activity, motility, and indole production in one tube was prepared and evaluated. The formulation of the medium was similar to that of Christensen urea agar, but the agar concentration was 0.2%, and 1% tryptone was added. Results with 687 strains of Enterobacteriaceae were the same as those obtained with standard test media (98% overall agreement). The urea-motility-indole medium was also used in combination with Kligler iron agar for the recognition and differentiation of Salmonella and Shigella species from colonies picked from plating media in fecal cultures. This combination was compared with the combination of Kligler iron agar and lysine iron agar with 507 strains of non-lactose-fermenting Enterobacteriaceae. Although both combinations enabled the presumptive recognition and differentiation of Salmonella and Shigella species, an analysis of data indicated that the combination of Kligler iron agar and urea-motility-indole medium performed better than the combination of Kligler iron agar and lysine iron agar in detecting Salmonella and Shigella species.