Factores relacionados con la no adherencia a la rehabilitación cardiaca en pacientes con insuficiencia cardiaca / Factors related to non-adherence to cardiac rehabilitation in patients with heart failure

Introducción En la insuficiencia cardiaca (IC) se ha recomendado la rehabilitación cardiaca como estrategia de intervención que mejora la capacidad funcional, la calidad de vida relacionada con la salud y la supervivencia. No obstante, la adherencia a dichos programas es escasa. El objetivo fue determinar los factores relacionados con la no adherencia a la rehabilitación cardiaca en pacientes con IC en Colombia. Método Estudio observacional y retrospectivo. Se vincularon pacientes con IC en una clínica de Colombia, y la adherencia a la rehabilitación cardiaca se midió con ≥80% de las sesiones programadas. Se tuvieron en cuenta variables sociodemográficas, clínicas, capacidad aeróbica funcional (Sit to Stand y test de caminata de los 6minutos), Duke Activity Status Index (DASI), calidad de vida Minnesota Living with Heart Failure Questionnaire (MLFHQ) y depresión Patient health Questionnaire9 (PHQ-9). Resultados Se vincularon 300 pacientes con IC con edad 63,16±12,87; 194 (64,7%) eran hombres. La adherencia a la rehabilitación cardiaca fue del 66,67%, hubo diferencias estadísticamente significativas entre los grupos en la hipertensión arterial, FEVI, colesterol, LDL, triglicéridos, PAS, PAD, distancia recorrida, VO2e, METs, DASI y PHQ-9, p≤0,05. El modelo de regresión logística ajustado por sexo y edad mostró OR para la no adherencia a la RC: hipertensión arterial 2,23 [1,22-4,07], LDL fuera de metas 2,15 [1,20-3,88], triglicéridos fuera de metas 2,34 [1,35-4,07], DASI<4METs 2,38 [1,04-5,45] y PHQ-9 1,06 [1,00-1,12]. Conclusión La hipertensión arterial, LDL, triglicéridos, DASI y depresión con el cuestionario PHQ-9 son factores relacionados para no presentar adherencia a la rehabilitación cardiaca en pacientes con IC. (AU)

Introduction In heart failure, cardiac rehabilitation has been recommended as an intervention strategy that improves functional capacity, health-related quality of life and survival. However, adherence to these programs is low. The objective was to determine the factors related to non-adherence to cardiac rehabilitation in patients with heart failure in Colombia. Method Observational and retrospective study. Patients with heart failure were linked in a clinic in Colombia, adherence to cardiac rehabilitation was measured with ≥80% of scheduled sessions. Sociodemographic and clinical variables, functional aerobic capacity (Sit to Stand and 6-minute walk test), Duke Activity Status Index (DASI), quality of life Minnesota Living with Heart Failure Questionnaire (MLFHQ) and depression Patient health questionnaire 9 (PHQ-9) were taken into account. Results 300 patients were linked with heart failure with age 63.16±12.87; men 194 (64.7%). Adherence to cardiac rehabilitation was 66.67%, there were statistically significant differences between the groups in arterial hypertension, LVEF, cholesterol, LDL, triglycerides, SBP, DBP, distance traveled, VO2e, METs, DASI and PHQ-9 P≤.05. The logistic regression model adjusted for sex and age showed OR for non-adherence to CR arterial hypertension 2.23 [1.22-4.07], LDL outside of goals 2.15 [1.20-3.88], triglycerides outside goals 2.34 [1.35-4.07], DASI<4METs 2.38 [1.04-5.45] and PHQ-9 1.06 [1.00-1.12]. Conclusion High blood pressure, LDL, triglycerides, DASI and depression with the PHQ-9 questionnaire are related factors for not having adherence to cardiac rehabilitation in patients with heart failure. (AU)

Factores relacionados con la no adherencia a la rehabilitación cardiaca en pacientes con insuficiencia cardiaca / Factors related to non-adherence to cardiac rehabilitation in patients with heart failure

Introducción En la insuficiencia cardiaca (IC) se ha recomendado la rehabilitación cardiaca como estrategia de intervención que mejora la capacidad funcional, la calidad de vida relacionada con la salud y la supervivencia. No obstante, la adherencia a dichos programas es escasa. El objetivo fue determinar los factores relacionados con la no adherencia a la rehabilitación cardiaca en pacientes con IC en Colombia. Método Estudio observacional y retrospectivo. Se vincularon pacientes con IC en una clínica de Colombia, y la adherencia a la rehabilitación cardiaca se midió con ≥80% de las sesiones programadas. Se tuvieron en cuenta variables sociodemográficas, clínicas, capacidad aeróbica funcional (Sit to Stand y test de caminata de los 6minutos), Duke Activity Status Index (DASI), calidad de vida Minnesota Living with Heart Failure Questionnaire (MLFHQ) y depresión Patient health Questionnaire9 (PHQ-9). Resultados Se vincularon 300 pacientes con IC con edad 63,16±12,87; 194 (64,7%) eran hombres. La adherencia a la rehabilitación cardiaca fue del 66,67%, hubo diferencias estadísticamente significativas entre los grupos en la hipertensión arterial, FEVI, colesterol, LDL, triglicéridos, PAS, PAD, distancia recorrida, VO2e, METs, DASI y PHQ-9, p≤0,05. El modelo de regresión logística ajustado por sexo y edad mostró OR para la no adherencia a la RC: hipertensión arterial 2,23 [1,22-4,07], LDL fuera de metas 2,15 [1,20-3,88], triglicéridos fuera de metas 2,34 [1,35-4,07], DASI<4METs 2,38 [1,04-5,45] y PHQ-9 1,06 [1,00-1,12]. Conclusión La hipertensión arterial, LDL, triglicéridos, DASI y depresión con el cuestionario PHQ-9 son factores relacionados para no presentar adherencia a la rehabilitación cardiaca en pacientes con IC. (AU)

Introduction In heart failure, cardiac rehabilitation has been recommended as an intervention strategy that improves functional capacity, health-related quality of life and survival. However, adherence to these programs is low. The objective was to determine the factors related to non-adherence to cardiac rehabilitation in patients with heart failure in Colombia. Method Observational and retrospective study. Patients with heart failure were linked in a clinic in Colombia, adherence to cardiac rehabilitation was measured with ≥80% of scheduled sessions. Sociodemographic and clinical variables, functional aerobic capacity (Sit to Stand and 6-minute walk test), Duke Activity Status Index (DASI), quality of life Minnesota Living with Heart Failure Questionnaire (MLFHQ) and depression Patient health questionnaire 9 (PHQ-9) were taken into account. Results 300 patients were linked with heart failure with age 63.16±12.87; men 194 (64.7%). Adherence to cardiac rehabilitation was 66.67%, there were statistically significant differences between the groups in arterial hypertension, LVEF, cholesterol, LDL, triglycerides, SBP, DBP, distance traveled, VO2e, METs, DASI and PHQ-9 P≤.05. The logistic regression model adjusted for sex and age showed OR for non-adherence to CR arterial hypertension 2.23 [1.22-4.07], LDL outside of goals 2.15 [1.20-3.88], triglycerides outside goals 2.34 [1.35-4.07], DASI<4METs 2.38 [1.04-5.45] and PHQ-9 1.06 [1.00-1.12]. Conclusion High blood pressure, LDL, triglycerides, DASI and depression with the PHQ-9 questionnaire are related factors for not having adherence to cardiac rehabilitation in patients with heart failure. (AU)

Factors related to non-adherence to cardiac rehabilitation in patients with heart failure.

INTRODUCTION: In heart failure, cardiac rehabilitation has been recommended as an intervention strategy that improves functional capacity, health-related quality of life and survival. However, adherence to these programs is low. The objective was to determine the factors related to non-adherence to cardiac rehabilitation in patients with heart failure in Colombia. METHOD: Observational and retrospective study. Patients with heart failure were linked in a clinic in Colombia, adherence to cardiac rehabilitation was measured with ≥80% of scheduled sessions. Sociodemographic and clinical variables, functional aerobic capacity (Sit to Stand and 6-minute walk test), Duke Activity Status Index (DASI), quality of life Minnesota Living with Heart Failure Questionnaire (MLFHQ) and depression Patient health questionnaire 9 (PHQ-9) were taken into account. RESULTS: 300 patients were linked with heart failure with age 63.16 ± 12.87 men 194 (64.7%). adherence to cardiac rehabilitation was 66.67%, there were statistically significant differences between the groups in arterial hypertension, LVEF, cholesterol, LDL, Triglycerides, SBP, DBP, distance traveled, VO2e, METs, DASI and PHQ-9 p-value =<0.05. The logistic regression model adjusted for sex and age showed OR for non-adherence to CR arterial hypertension 2.23[1.22-4.07], LDL outside of goals 2.15[1.20-3.88], triglycerides outside goals 2.34[1.35-4.07], DASI<4METs 2.38 [1.04-5.45] and PHQ-9 1.06[1.00-1.12]. CONCLUSION: High blood pressure, LDL, triglycerides, DASI and depression with the PHQ-9 questionnaire are related factors for not having adherence to cardiac rehabilitation in patients with heart failure.

Approach to coping in colombian elite athletes: gender, age and sport / Aproximación al afrontamiento en deportistas de élite colombianos: sexo, edad y deporte

The aim of the study was to analyse, using the Spanish version of the ACSQ-1, the use of coping strategies considering gender, age, type of sport and sport modality, as well as the correlations themselves. The sample consisted of 334 Colombian elite athletes (156 men and 178 women) with a mean age of 27 years (M = 27.10, SD = 6.57). The most commonly used strategies were emotional calming and cognitive restructuring, with mental withdrawal being the least used. Men had higher values than women for emotional calm and cognitive restructuring. Younger athletes had higher values than older athletes for mental withdrawal and seeking social support. Paralympic athletes showed higher values than Olympic athletes in emotional calmness and cognitive restructuring, and nodifferences were found depending on the sport modality. Significant correlations were found between most strategies (AU)

El objetivo del estudio fue analizar, empleando la versión española del ACSQ-1, el uso de estrategias de afrontamiento considerando sexo, edad, tipo dedeporte y modalidad deportiva, así como las propias correlaciones. La muestra estuvo compuesta por 334 deportistas de élite colombianos (156 hombres y 178 mujeres) con una media de edad de 27 años (M = 27,10, DE = 6,57). Las estrategias más empleadas fueron la calma emocional y la reestructuración cognitiva, siendo la menos usada el retraimiento mental. Los hombres presentaron mayores valores que las mujeres en calma emocional y reestructuración cognitiva. Los deportistas de menos edad presentaron mayores valores que los de más en retraimiento mental y búsqueda de apoyo social. Los deportistas de modalidades paralímpicas mostraron mayores valores que los de olímpicas en calma emocional y reestructuración cognitiva, no encontrándose diferencias en función de la modalidad deportiva. Se encontraron correlaciones significativas entre la mayor parte de estrategias (AU)

'Guess who'? An Italian multicentric study on pigmentation traits prevalence in endometriosis localizations.

OBJECTIVES: Previous evidence seems to support the more common presence of certain pigmentation types in women with endometriosis. The aim of this study was to assess the association of certain somatic phenotypes with specific localizations of the disease. The genetic makeup of those somatic traits may will help in better define the disease pathogenesis. STUDY DESIGN: Multicentric, retrospective study of women aged 18 to 45 with histologically confirmed endometriosis. 575 patients were recruited at eleven different Italian endometriosis clinics from March 2015 to January 2021. Data regarding clinical and surgical features were recorded following the self-administered endometriosis patient questionnaire and the surgical standard of reports approved by the World Endometriosis Research Foundation (WERF). Pigmentation types/somatic phenotypes frequencies among endometriosis localizations were reported. A logistic regression analysis was performed to determine somatic types independently associated with disease' localizations. RESULTS: Having green eyes increased by ∼4 folds (OR 3.7; 95% CI: 1.42-9.61; p = 0.007) the risk of having a ureteral nodule, whereas brown/black eyes decreased this risk (OR 0.34; 95% CI: 0.13-0.87; p = 0.025). Consistently, the combination of green eyes and blonde/light brown hairs increased the odds of ureteral endometriosis by more than 5 folds (OR 5.40; 95%CI: 2.02-14.49; p = 0.001), even after correction for anthropometric confounders (aOR 5.85; 95% CI: 2.13-16.09; p < 0.001). CONCLUSIONS: The association between endometriosis and pigmentary traits has been herein confirmed, with the novel finding of the possible predisposition of ureteral endometriosis in patients with green eyes and blonde/light brown hairs. Further investigation on the genetic makeup of somatic traits may provide new inroads also into the molecular aspects of endometriosis leading to a better understanding of this complex disease.

Impact of endometriosis on obstetric outcome after natural conception: a multicenter Italian study.

PURPOSE: To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy. METHODS: Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous natural pregnancies. Marginal logistic regression models were fitted to evaluate the impact of endometriosis on obstetric outcome. A post hoc analysis was performed within the endometriosis group comparing women with severe adenomyosis versus women with absent or mild adenomyosis. RESULTS: Three hundred and fifty-five pregnancies in endometriosis group and 741 pregnancies in control group were included. Women with endometriosis had a higher risk of preterm delivery < 34 weeks (6.4% vs 2.8%, OR 2.42, 95% CI 1.22-4.82), preterm delivery < 37 weeks (17.8% vs 9.7%, OR 1.98, 95% CI 1.23-3.19), and neonatal admission to Intensive Care Unit (14.1% vs 7.0%, OR 2.04, 95% CI 1.23-3.36). At post hoc analysis, women with endometriosis and severe adenomyosis had an increased risk of placenta previa (23.1% vs 1.8%, OR 16.68, 95% CI 3.49-79.71), cesarean delivery (84.6% vs 38.9%, OR 8.03, 95% CI 1.69-38.25) and preterm delivery < 34 weeks (23.1% vs 5.7%, OR 5.52, 95% CI 1.38-22.09). CONCLUSION: Women with endometriosis who conceive naturally have increased risk of preterm delivery and neonatal admission to intensive care unit. When severe adenomyosis is coexistent with endometriosis, women may be at increased risk of placenta previa and cesarean delivery. TRIAL REGISTRATION: Clinical trial registration number: NCT03354793.

Quantitative analysis of movements in facial nerve palsy with surface electromyography and kinematic analysis.

Facial nerve paralysis (FNP) has a significant effect on a person's quality of life. In individuals with FNP undergoing facial rehabilitation, methods to analyze the loss of function are useful in diagnosis, treatment and follow up. To propose a protocol with kinematic analysis coupled with sEMG to evaluate the outcomes of FNP, quantifying the excursion degrees of the facial muscles and symmetry of voluntary movements. 10 patients (Group A) were followed by diagnosis until the end of the rehabilitation program. Kinematic analysis of 20 healthy adults (group B) was performed as a starting point to have a normality range and to test intra-subject and inter- intra rater reliability. An optoelectronic system and sEMG wireless electrodes were used. In Group A, a significant improvement in the movement of frontalis muscle (P = 0.0118) after 4-week treatment from the beginning (T0) 9.8 ± 4.5 mm to the end of rehabilitation (T1) 16.3 ± 5.8 mm and orbicularis oris (P = 0.0143) from T0 14.8 ± 5.5 mm to T1 20.3 ± 3.3 mm and, a reduction of % of maximum voluntary contractions (MVC) at T1 for frontalis and orbicularis compared to T0. This protocol provides meaningful data in a simple, reliable and objective way for the functional assessment of patients with PNF.

Rehabilitation of patients post-COVID-19 infection: a literature review.

Rehabilitation is important for patients with coronavirus disease 2019 (COVID-19) infection. Given the lack of guidelines in English on the rehabilitation of these patients, we conducted a review of the most recent reports. We performed this literature review using the principal research databases and included randomized trials, recommendations, quasi-randomized or prospective controlled clinical trials, reports, guidelines, field updates, and letters to the editor. We identified 107 studies in the database search, among which 85 were excluded after screening the full text or abstract. In total, 22 studies were finally included. The complexity of the clinical setting and the speed of spread of the severe acute respiratory syndrome coronavirus 2, which leads to rapid occupation of beds in the intensive care unit, make it necessary to discharge patients with COVID-19 who have mild symptoms as soon as possible. For these reasons, it is necessary to formulate rehabilitation programs for these patients, to help them restore physical and respiratory function and to reduce anxiety and depression, particularly patients with comorbidities and those who live alone or in rural settings, to restore a good quality of life.

La adherencia al entrenamiento muscular del suelo pélvico en las mujeres con incontinencia urinaria. Revisión sistemática de la literatura / Adherence to pelvic floor muscle training in women with urinary incontinence. Systematic review of the literature

Antecedentes: La incontinencia urinaria femenina es un problema de salud de elevada prevalencia, costes sociales y económicos. El entrenamiento muscular del suelo pélvico es el tratamiento conservador más utilizado en mujeres con cualquier tipo de incontinencia urinaria, pero requiere de la adhesión a dichos programas de entrenamiento. Sin embargo, los estudios publicados hasta la fecha alertan de la falta de adherencia a estos programas, identificándose como una barrera para el proceso de recuperación. Objetivo: El objetivo de este trabajo es describir la adherencia al entrenamiento muscular del suelo pélvico en las mujeres con incontinencia urinaria. Estrategia de búsqueda y selección de estudios: Se realizó una revisión bibliográfica en las bases de datos PubMed, Medes, LILACS, CINAHL, CUIDENPlus, PsycINFO, ENFISPO, La biblioteca Cochrane Plus, Trip, ProQuest, PROSPERO, Epistemonikos, The Cochrane Library, SPORTDiscus, PEDro, IBECS, Web of Science y Scopus, completándose con una estrategia de búsqueda manual. Los artículos incluidos fueron ensayos controlados aleatorizados o análisis secundarios de los mismos, publicados entre 2007 y 2018. La evaluación de la calidad metodológica se realizó con la escala PEDro, realizándose la implementación de las normas PRISMA. Resultados: Siete artículos se incluyeron en esta revisión. Las tasas de adherencia variaron entre el 92 y el 53,55% en el corto plazo y entre el 80 y el 38,1% en el seguimiento. Los sistemas de medición se basaron en diarios, cuestionarios y datos recogidos por los fisioterapeutas. La falta de homogeneidad en los estudios supone una limitación para un metaanálisis válido. Conclusiones: Las tasas de adherencia del entrenamiento muscular del suelo pélvico en incontinencia urinaria femenina son bajas, siendo necesarias acciones que puedan homogeneizar los sistemas de medición y las estrategias de mejora de la adherencia terapéutica

Introduction: Female urinary incontinence is a health problem of high prevalence, social and economic costs. Training of the pelvic floor muscles is the most used conservative treatment in women with any type of urinary incontinence, but requires adherence to these programs. However, studies published to date warn of the lack of adherence to these programs, identifying this as a barrier to the recovery process. Objective: The objective of this work is to describe the adherence to pelvic floor muscle training in women with urinary incontinence. Search strategy and study selection: A bibliographic review was made in the databases PubMed, Medes, LILACS, CINAHL, CUIDENPlus, PsycINFO, ENFISPO, The Cochrane Plus library, Trip, ProQuest, PROSPERO, Epistemonikos, The Cochrane Library, SPORTDiscus, PEDro, IBECS, Web of Science and Scopus, completing with a manual search strategy. The articles included were randomised controlled trials, or secondary analyses of these, published between 2007 and 2018. The evaluation of the methodological quality was carried out using the PEDro scale, with the implementation of the PRISMA standards. Results: Seven articles were included in this review. Adherence rates varied between 92% and 53.55% in the short term, and between 80% and 38.1% in the follow-up. The measurement systems were based on diaries, questionnaires, and data collected by the physiotherapists. The lack of homogeneity in the studies is a limitation for a valid meta-analysis. Conclusions: The adherence rates of pelvic floor muscle training in female patients with urinary incontinence are low, and actions are needed to standardise measurement systems, as well as strategies to improve therapeutic adherence

Endometriosis: seeking optimal management in women approaching menopause.

The incidence of endometriosis in middle-aged women is not minimal compared to that in the reproductive age group. The treatment of affected women after childbearing age to the natural transition toward menopause has received considerably poor attention. Disease management is problematic for these women due to increased contraindications regarding hormonal treatment and the possibility for malignant transformation, considering the increased cancer risk in patients with a long-standing history of the disease. This state-of-the-art review aims for the first time to assess the benefits of the available therapies to help guide treatment decisions for the care of endometriosis in women approaching menopause. Progestins are proven effective in reducing pain and should be preferred in these women. According to the international guidelines that lack precise recommendations, hysterectomy with bilateral salpingo-oophorectomy should be the definitive therapy in women who have completed their reproductive arc, if medical therapy has failed. Strict surveillance or surgery with removal of affected gonads should be considered in cases of long-standing or recurrent endometriomas, especially in the presence of modifications of ultrasonographic cyst patterns. Although rare, malignant transformation of various tissues in endometriosis patients has been described, and management is herein discussed.

Propiedades psicométricas del autoinforme de barreras para la práctica del ejercicio físico (Abpef) / Psychometric properties of the barrier autoinform for the practice of the physical exercise (Abpef)

El estudio consistió en examinar las propiedades psicométricas del cuestionario de autoinforme de barreras para la práctica del ejercicio físico (ABPEF) y comprobar el efecto del género sobre dichas barreras. Se han estudiado sus propiedades psicométricas con una muestra de 342 adolescentes (media de edad: 15.02±1.86). Se realizaron análisis de confiabilidad, análisis factorial exploratorio, correlación ítem con puntaje total y análisis factorial confirmatorio. Se encuentra una buena confiabilidad interna (α = .86), adecuada correlación ítem con puntaje total, y la presencia de cuatro factores en el análisis factorial exploratorio con correlaciones significativas entre las mismas. El análisis factorial confirmatorio mostró adecuado ajuste a los datos de un modelo tetrafactorial del cuestionario (X2 /gl = 3.696; GFI=.89; AGFI=.86; RMSEA=.061). El género femenino presenta mayores barreras para la práctica del ejercicio físico. Este cuestionario es un instrumento fiable y válido y se sugiere su uso en futuras investigaciones

The objective of this study was to examine the psychometric properties of the self-report questionnaire for physical exercise (ABPEF). And to chek the effect of gender on those barriers. Their psychometric properties were studied with a sample of 342 adolescents (mean age: 15.02 ± 1.86). We performed reliability analysis, exploratory factor analysis, item correlation with total score and confirmatory factor analysis. We found a good internal reliability (α = .86), an adequate item correlation with total score, and the presence of four factors in the exploratory factor analysis with significant correlations between them. The confirmatory factor analysis showed adequate adjustment to the data of a tetrafactorial model of the questionnaire (X2 / gl = 3.696; GFI = .89; AGFI = .86; RMSEA = .061). The female gender presents greater barriers to the practice of physical exercise. This questionnaire is a reliable and valid instrument for the population under study, and its use in future research is suggested

Utilidad de los catéteres percutáneos para perfusión continua de anestésico local en el manejo del dolor postoperatorio en pacientes sometidos a artrodesis lumbar instrumentada. Estudio de cohortes prospectivas / Utility of percutaneous catheters for local anaesthetics infusion for postoperative pain control in lumbar arthrodesis. A prospective cohort study

Objetivo: Valorar si la administración asociada de levobupivacaína a través de dos catéteres percutáneos submusculares conectados a dos bombas elastoméricas en el postoperatorio de la artrodesis instrumentada lumbar es más eficaz que el uso aislado de analgesia intravenosa controlada por el paciente con cloruro mórfico y comparar sus efectos secundarios. Material y método: Estudio observacional, prospectivo, de cohortes. Se comparó la necesidad de analgesia de rescate entre ambos grupos, la valoración subjetiva del dolor mediante la escala visual analógica y la presencia de efectos adversos con una y otra técnica. Resultados: No se encontraron diferencias estadísticamente significativas en cuanto a las necesidades de analgesia de rescate. El dolor medido con la escala visual analógica fue significativamente menor (p = 0,032) en reposo a las 48h postoperatorias en el grupo tratado con catéteres. La escala visual analógica media en el resto de momentos presentó una tendencia a un menor dolor postoperatorio en el grupo tratado con catéteres, pero sin significación estadística. No hubo diferencias estadísticamente significativas en los efectos adversos, aunque en el grupo tratado con catéteres hubo 6 casos de efectos adversos frente a 11 casos del grupo tratado con analgesia convencional. Conclusiones: Se observó una tendencia en el grupo tratado con catéteres a presentar menor dolor postoperatorio con menos efectos indeseables, aunque las diferencias no fueron estadísticamente significativas

Objective: To evaluate whether postoperative continuous wound infiltration of levobupivacaine through two submuscular catheters connected to two elastomeric pumps after lumbar instrumented arthrodesis is more effective than intravenous patient-controlled analgesia. Material and methods: An observational, prospective cohorts study was carried out. The visual analogue scale, the need for additional rescue analgesia and the onset of adverse effects were recorded. Results: Pain records measured with visual analogue scale scale were significantly lower in the 48hours postoperative record at rest (p=.032). The other records of visual analogue scale showed a clear tendency to lower levels of pain in the group treated with the catheters. No statistically significant differences were found in the rescue analgesia demands of the patients. The adverse effects were lower in the catheter group (6 cases versus 11 cases) but without statistical differences. Conclusions: A trend to lower pain records was found in the group treated with catheters, although differences were not statistically significant

Utility of percutaneous catheters for local anaesthetics infusion for postoperative pain control in lumbar arthrodesis. A prospective cohort study. / Utilidad de los catéteres percutáneos para perfusión continua de anestésico local en el manejo del dolor postoperatorio en pacientes sometidos a artrodesis lumbar instrumentada. Estudio de cohortes prospectivas.

OBJECTIVE: To evaluate whether postoperative continuous wound infiltration of levobupivacaine through two submuscular catheters connected to two elastomeric pumps after lumbar instrumented arthrodesis is more effective than intravenous patient-controlled analgesia. MATERIAL AND METHODS: An observational, prospective cohorts study was carried out. The visual analogue scale, the need for additional rescue analgesia and the onset of adverse effects were recorded. RESULTS: Pain records measured with visual analogue scale scale were significantly lower in the 48hours postoperative record at rest (p=.032). The other records of visual analogue scale showed a clear tendency to lower levels of pain in the group treated with the catheters. No statistically significant differences were found in the rescue analgesia demands of the patients. The adverse effects were lower in the catheter group (6 cases versus 11 cases) but without statistical differences. CONCLUSIONS: A trend to lower pain records was found in the group treated with catheters, although differences were not statistically significant.

Incidence of tuberculosis in HIV-infected patients in Spain: the impact of treatment for LTBI.

SETTING: Twenty hospitals in Spain. OBJECTIVE: To describe the incidence of active tuberculosis (TB) and factors related to TB development after treatment for latent tuberculous infection (TLTBI) in human immunodeficiency virus-1 (HIV-1) infected patients in the highly active antiretroviral therapy era. DESIGN: In a multicentre cohort of HIV-1-infected patients, we calculated TB incidence by tuberculin skin test (TST) results and TLTBI, and factors associated with a positive TST and the development of TB after TLTBI. RESULTS: Of 7902 patients, 6.5% had a history of TB at enrolment: 168 patients developed TB during 10,889 person-years (py) of follow-up, corresponding to an incidence rate of 1.54 cases per 100 py (95%CI 1.33-1.80). TB incidence in TST-positive patients who did not receive TLTBI was three times higher (6 cases/100 py) than in those who did (1.75 cases/100 py). In patients who received TLTBI, risk of development of TB was higher among cases aged <35 years (HR 6.14, 95%CI 1.12-33.73) and in those with a nadir CD4(+) cell count of <200 cells/µl (HR 5.64, 95%CI 1.34-23.70). CONCLUSIONS: TLTBI is effective in preventing the development of TB in HIV-infected patients, particularly in those who were TST-positive.

Do thyroid cancer patients with basal undetectable Tg measured by current immunoassays require rhTSH testing?

OBJECTIVE: To evaluate the predictive value of disease free status of basal thyroglobulin (Tg) in differentiated thyroid carcinoma (DTC). DESIGN: Basal and recombinant human TSH (rhTSH) stimulated Tg measured with a commercial immunoassay (Liaison DiaSorin, Italial), neck ultrasonography (US) and fine needle aspiration cytology if required were performed in DTC patients followed prospectively for 6.8 years in a university hospital. 92 consecutive DTC patients were included. 74 patients with basal and stimulated Tg <1.0 ng/ml and Tg antibodies and US negative were considered as disease-free and persistent/recurrent disease was detected in 18 patients. In 25/74 disease-free patients rhTSH test was repeated within one year. RESULTS: 63/92 patients had undetectable basal Tg (<0.5 ng/ml), with rhTSH-Tg <0.5 ng/ml in 52, in 6 rhTSH-Tg between 0.5 and 1 ng/ml, in 2 between 1-2 ng/ml (disease-free after 3 years of follow-up) and >2.0 ng/ml (mean 4.1±2.4 ng/ml) in another 3, with US lymphatic metastasis confirmed histologically. Disease-free state was predicted with a sensitivity (S) of 66.7% and specificity (Sp) of 75.7% for basal Tg-0.5 ng/ml, and S 100% and Sp 85.1% for stimulated Tg-0.92. rhTSH test and US were repeated within one year in 25 disease-free patients with Tg<1.0 ng/ml. No further elevation below 1 ng/ml was observed. CONCLUSIONS: Low risk patients with undetectable basal Tg measured with current commercially available immunoassays should be followed with at least one rhTSH stimulated Tg and neck US because of the insufficient predictive value for recurrence/persistent disease of basal Tg.

Hydrogen dissociation on small aluminum clusters.

Transition states and reaction paths for a hydrogen molecule dissociating on small aluminum clusters have been calculated using density functional theory. The two lowest spin states have been taken into account for all the Al(n) clusters considered, with n=2-6. The aluminum dimer, which shows a (3)Π(u) electronic ground state, has also been studied at the coupled cluster and configuration interaction level for comparison and to check the accuracy of single determinant calculations in this special case, where two degenerate configurations should be taken into account. The calculated reaction barriers give an explanation of the experimentally observed reactivity of hydrogen on Al clusters of different size [Cox et al., J. Chem. Phys. 84, 4651 (1986)] and reproduce the high observed reactivity of the Al(6) cluster. The electronic structure of the Al(n)-H(2) systems was also systematically investigated in order to determine the role played by interactions of specific molecular orbitals for different nuclear arrangements. Singlet Al(n) clusters (with n even) exhibit the lowest barriers to H(2) dissociation because their highest doubly occupied molecular orbitals allow for a more favorable interaction with the antibonding σ(u) molecular orbital of H(2).

Disección carotídea en un paciente consumidor de cocaína / Carotid dissection in a cocaine-abusing patient

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