Reforming the workers' compensation process for occupational lung disease among miners in South Africa: an efficiency study of claims assessment.

PURPOSE: The large burden of silicosis and tuberculosis (TB) in the South African mining industry, coupled with an under-resourcing of the compensation agencies responsible for certifying occupational lung disease, have resulted in serious backlogs. This work aimed to measure the efficiency gains from triaging occupational lung disease claims using claim type, years of mining exposure and computer aided detection (CAD) to save on scarce medical adjudicators. METHODS: During 2020, the compensation authority started to triage claims for TB and those of miners with < 10 years of service to two-person panels instead of the four-person panel plus radiologist used previously. Efficiency gain was calculated in medical person-units saved and reduction in delays. Different service thresholds predictive of silicosis were simulated, as well as the impact of pre-classification of chest X-rays with CAD using different combinations of sensitivity and specificity. RESULTS: The new triage system saved 20.3% in person-time units and reduced delays by 10-20 days. Without CAD the greatest efficiency gain (28%) was projected from dispensing with a mining service threshold and routing all non-TB claims to the small panels at the outset. Simulation of four different CAD sensitivity/specificity combinations yielded efficiency gains of 18.2-36.1%, with 31.1% judged the most realistic. Use of sensitivity of close to 100% would not be feasible because of the very low resulting specificity. CONCLUSION: Pre-adjudication triage of claims at the compensation agency is capable of saving a substantial proportion of adjudicator time and reducing certification delays. Additional efficiency gains are achievable by referring all claims to small panels to begin with and improvement of CAD performance for this ex-miner population.

Evolución del dolor en pacientes con sensibilización central y artrosis tras artroplastia de rodilla / Pain evolution in patients with central sensitization and osteoarthritis after knee arthroplasty

Introducción: En pacientes con artrosis de rodilla se ha identificado un 30% de asociación de dolor de sensibilización central (DSC). El objetivo es analizar la persistencia de DSC en pacientes tras artroplastia de rodilla y su correlación con la intensidad del dolor, funcionalidad y los factores determinantes asociados, además de evaluar la exploración física como instrumento de valoración. Material y métodos: Estudio cuasiexperimental antes-después de pacientes intervenidos de artroplastia total de rodilla. Se analiza la evolución de variables subjetivas (características del dolor, cuestionarios painDETECT, WOMAC y escala visual numérica) y de exploración física (hiperalgesia térmica, alodinia, hipoestesia, algometría y goniometría), tres meses antes y tres y seis meses después de la cirugía mediante el test de ANOVA de medidas repetidas para las cuantitativas y el Q de Cochran para las cualitativas. Se utilizó la prueba de Spearman para la correlación de los cuestionarios, del PD-Q y variables de exploración y para el modelo multivariante del PD-Q con determinantes clínicos. Resultados: Sesenta y siete pacientes completaron el estudio. La evolución de las variables cuantitativas y cualitativas fue significativa, con correlación entre cuestionarios. En el modelo multivariante lineal de PD-Q se obtuvo relación significativa de antecedentes de limitación movilidad en flexión, dolor musculoesquelético crónico y la asociación de depresión y tiempo. Conclusiones: Un porcentaje significativo de pacientes con artrosis de rodilla tras artroplastia persistieron con probable DSC, correlacionándose con intensidad y funcionalidad. La limitación de movilidad y comorbilidad crónica previas podrían ser determinantes de DSC, siendo la exploración y anamnesis, herramientas útiles en consulta.(AU)

IntroductionIn patients with knee osteoarthritis, a group of 30% has been identified with central pain sensitization (CPS). The aim is to analyze the persistence of CPS in patients after knee arthroplasty and its correlation with pain intensity, functionality, determining factors and to evaluate physical examination as an assessment instrument.Material and methodsQuasi-experimental before–after study of patients operated on total knee arthroplasty. The evolution of subjective variables (pain characteristics, painDETECT questionnaire, WOMAC and Numerical Rating Scale) and physical examination (thermal hyperalgesia, allodynia, hypoesthesia, algometry and goniometry) 3 months before and 3 and 6 months after surgery are analysed using repeated measures ANOVA test for the quantitative ones and Cochran's Q for the qualitative ones. Spearmen test was used for the correlation of the questionnaires, the PD-Q and exploration variables and for the multivariate model of the PD-Q with clinical determinants. Results: Sixty-seven patients completed the study. The evolution of the quantitative and qualitative variables was significant, with a correlation between questionnaires. In the linear multivariate model of PD-Q, a significant relationship was obtained from personal history of flexion limitation, chronic musculoskeletal pain and the association between depression and time. Conclusions: A significant percentage of patients with knee osteoarthritis after arthroplasty persisted with probable CPS, correlating with intensity and functionality. The limitation of mobility and previous chronic comorbidity could be determinants of CPS, with anamnesis and exploration being useful tools in consultation.(AU)

[Pain evolution in patients with central sensitization and osteoarthritis after knee arthroplasty]. / Evolución del dolor en pacientes con sensibilización central y artrosis tras artroplastia de rodilla.

INTRODUCTION: In patients with knee osteoarthritis, a group of 30% has been identified with central pain sensitization (CPS). The aim is to analyze the persistence of CPS in patients after knee arthroplasty and its correlation with pain intensity, functionality, determining factors and to evaluate physical examination as an assessment instrument. MATERIAL AND METHODS: Quasi-experimental before-after study of patients operated on total knee arthroplasty. The evolution of subjective variables (pain characteristics, painDETECT questionnaire, WOMAC and Numerical Rating Scale) and physical examination (thermal hyperalgesia, allodynia, hypoesthesia, algometry and goniometry) 3 months before and 3 and 6 months after surgery are analysed using repeated measures ANOVA test for the quantitative ones and Cochran's Q for the qualitative ones. Spearmen test was used for the correlation of the questionnaires, the PD-Q and exploration variables and for the multivariate model of the PD-Q with clinical determinants. RESULTS: Sixty-seven patients completed the study. The evolution of the quantitative and qualitative variables was significant, with a correlation between questionnaires. In the linear multivariate model of PD-Q, a significant relationship was obtained from personal history of flexion limitation, chronic musculoskeletal pain and the association between depression and time. CONCLUSIONS: A significant percentage of patients with knee osteoarthritis after arthroplasty persisted with probable CPS, correlating with intensity and functionality. The limitation of mobility and previous chronic comorbidity could be determinants of CPS, with anamnesis and exploration being useful tools in consultation.

Menthol as an Ergogenic Aid for the Tokyo 2021 Olympic Games: An Expert-Led Consensus Statement Using the Modified Delphi Method.

INTRODUCTION: Menthol topical application and mouth rinsing are ergogenic in hot environments, improving performance and perception, with differing effects on body temperature regulation. Consequently, athletes and federations are beginning to explore the possible benefits to elite sport performance for the Tokyo 2021 Olympics, which will take place in hot (~ 31 °C), humid (70% RH) conditions. There is no clear consensus on safe and effective menthol use for athletes, practitioners, or researchers. The present study addressed this shortfall by producing expert-led consensus recommendations. METHOD: Fourteen contributors were recruited following ethical approval. A three-step modified Delphi method was used for voting on 96 statements generated following literature consultation; 192 statements total (96/96 topical application/mouth rinsing). Round 1 contributors voted to "agree" or "disagree" with statements; 80% agreement was required to accept statements. In round 2, contributors voted to "support" or "change" their round 1 unaccepted statements, with knowledge of the extant voting from round 1. Round 3 contributors met to discuss voting against key remaining statements. RESULTS: Forty-seven statements reached consensus in round 1 (30/17 topical application/rinsing); 14 proved redundant. Six statements reached consensus in round 2 (2/4 topical application/rinsing); 116 statements proved redundant. Nine further statements were agreed in round 3 (6/3 topical application/rinsing) with caveats. DISCUSSION: Consensus was reached on 62 statements in total (38/24 topical application/rinsing), enabling the development of guidance on safe menthol administration, with a view to enhancing performance and perception in the heat without impairing body temperature regulation.

Frequency, virulence factors and antifungal susceptibility of Candida parapsilosis species complex isolated from patients with candidemia in the central region of Argentina.

PURPOSE: Our objectives were to report species distribution and survival of patients with candidemia in Argentina's central region and to establish the prevalence of C.parapsilosis sensu lato species, their virulence factors and their antifungal susceptibility profiles. METHODS: Yeasts isolated from bloodstream infections in Córdoba (Argentina) (n=35) were molecularly identified. The production of lipase and acid aspartic protease (Sap), the adhesion capacity, and the isolates' ability to form biofilm were evaluated. The in vitro activity of 7 antifungal drugs was evaluated (CLSIdocument M27-4thed). RESULTS: C. albicans was the most prevalent species (48.57%) followed by C. parapsilosis sensu lato (28.57%). The 30-day survival rate for C. albicans candidemia was slightly lower than non-albicans blood infections (50.00% vs. 57.90%). C. parapsilosis sensu stricto and C. orthopsilosis account for 60% and 40% of the cryptic species. Sap production and biofilm formation capacity were higher in C. parapsilosis sensu strico than in C.orthopsilosis. All the strains were susceptible to caspofungin (CAS), anidulafungin (AFG), amphotericin B (AMB), posaconazole (POS) and voriconazole (VRC). Azoles were the most potent agent against C. parapsilosis sensu lato followed by echinocandins and AMB. There were no differences between MICs for fluconazole, VRC, POS and AMB. Contrarily, C. parapsilosis sensu stricto strains showed lower MIC than C. orthopsilopsis isolates for itraconazole and higher MIC values for echinocandins (P<0.01). CONCLUSIONS: We report a high frequency of isolation of C.orthopsilosis in candidemia patients of central region. Data on the prevalence, virulence capability and antifungal susceptibility of C. parapsilosis complex provide new epidemiological information about these cryptic species in Argentina.

Application of embryo biopsy and sex determination via polymerase chain reaction in a commercial equine embryo transfer program in Argentina.

Embryo biopsy for fetal sexing has clinical application, but few reports are available of its use within an active embryo transfer program. We evaluated results on biopsy of 459 embryos over one breeding season. There were no significant differences in pregnancy rate between biopsied and non-biopsied embryos (72% vs 73%) or for biopsied embryos recovered at the centre (73%) compared with those shipped overnight (72%). However, the pregnancy rate decreased significantly in shipped embryos biopsied ≥20h after collection. Overall, 86% of biopsies provided a sex diagnosis. The likelihood of a positive genomic (g) DNA result was significantly higher for biopsies from large blastocysts (96%) than from smaller embryos (70-85%). In total, 38% of biopsies were positive for Y chromosome DNA (Y-DNA) and were diagnosed as male. Subsequently, 95% of Y-DNA-positive embryos were confirmed as male and 78% of Y-DNA-negative embryos were confirmed as female. The accuracy of prediction of female (Y-DNA negative) was significantly higher when the biopsy sample was probed for Y-DNA only compared with probing for both gDNA and Y-DNA. We estimate that by transferring only Y-DNA-negative embryos, 3% of potential female pregnancies may have been lost, and production of male pregnancies was reduced by 72%.

Precooling does not Enhance the Effect on Performance of Midcooling with Ice-Slush/Menthol.

This study investigated whether the combination of internal precooling (PC) and internal midcooling (MC cooling during exercise) would enhance performance more than MC alone. 9 trained males completed two 30-km cycling trials in a hot and humid environment (WBGT: 29±0.7°C, 80±0.02% relative humidity). For 30 min before exercise, the subjects sat quietly and drank water at 23°C (MC) or 3°C (PC+MC). During the MC and PC+MC time trials, they drank an ice-slush/menthol beverage (i. e., 0.025% menthol). Trial time, gastrointestinal temperature (Tco ), heart rate (HR), rating of perceived exertion (RPE), thermal sensation (TS), and thermal comfort (TC) were assessed. Trial time was not significantly different (P>0.05) between MC and PC+MC (3 737±552 s and 3 815±455 s). Before exercise, Tco was lower with precooling (37.0±0.3°C; P<0.02). During exercise, no between-trial differences were noted for Tco, HR, RPE, TC or TS, but RPE was significantly lower with PC+MC in the latter stages (P<0.05). (1) Cold beverage intake before exercise did not improve the subsequent exercise performance with ice-slush/menthol beverage intake, and (2) despite no improvement in performance, RPE declined in the latter stages of exercise in the condition of PC+MC, suggesting that this combination might be beneficial for longer exercise.

Recomendaciones sobre rehabilitación en la cirugía de resección pulmonar de la Sociedad Española de Rehabilitación Cardio-Respiratoria (SORECAR) / Recommendations of the Spanish Society of Cardio-Respiratory Rehabilitation (SORECAR) on rehabilitation after lung resection surgery

La cirugía de resección pulmonar es la única opción curativa en las fases tempranas del cáncer de pulmón, pero sigue presentando una alta morbimortalidad perioperatoria. Una correcta estratificación del riesgo quirúrgico y una optimización de la situación general del paciente precirugía son elementos claves para disminuir el riesgo de complicaciones postoperatorias. Por otro lado, la cirugía junto a las posibles terapias adyuvantes impactan de manera negativa en la capacidad funcional y en la calidad de vida de muchos pacientes. Un grupo de expertos fue nombrado por la Sociedad Española de Rehabilitación Cardio-Respiratoria (SORECAR) para que realizaran una revisión de todas las evidencias disponibles sobre la evaluación funcional en la estratificación del riesgo quirúrgico y sobre la rehabilitación pre- y poscirugía de resección pulmonar y para que elaboraran un documento aplicándolas a la práctica clínica. Así se ha diseñado un protocolo de actuación en rehabilitación durante la fase pre- y poscirugía de resección pulmonar, con instrucciones o recomendaciones a modo de resumen. Con esto se pretende potenciar el papel de la rehabilitación en la cirugía de resección pulmonar y consensuar el modo de actuar en este campo (AU)

Lung resection surgery is the only curative option in the early stages of lung cancer but carries a high risk of perioperative morbidity and mortality. Proper surgical risk stratification and pre-surgical optimization of the patient's overall situation are key elements to reduce the risk of postoperative complications. Surgery, together with possible adjuvant therapies, may impact negatively on functional capacity and quality of life in many patients. Consequently, a group of experts was appointed by the Spanish Society of Cardio-Respiratory Rehabilitation (SORECAR) to review all the available evidence on functional assessment in surgical risk stratification and on pre- and postsurgery rehabilitation in order to create a document that applied their findings to clinical practice. As a result, an action plan has been defined for rehabilitation during the pre- and postsurgical stages of lung resection with instructions or recommendations presented as a checklist. The aim of creating this document was to enhance the role of rehabilitation after lung resection surgery and to agree on interventions in this area (AU)

Imposed Cold-water Ingestion during Open Water Swimming in Internationally Ranked Swimmers.

The authors explored the effects of open water swimming in a tropical environment on both core temperature (T c) and thermal perceptions of high-level swimmers during an official international 10-km race and two 5-km swimming tests. The swimmers drank neutral water (i. e., 28.0±3.0°C) ad libitum every 2,000 m during Competition, whereas the ingested volume was imposed in the 5-km tests: every 1,000 m, they drank 190 mL of cold water (CW, 1.1±0.7°C) or neutral water (NW, 28.0±3.0°C). They also self-rated their thermal comfort and sensation (TC and TS), and their T c was recorded. The study demonstrated that adequate fluid intake significantly decreased T c in swimmers swimming at race pace in hot water (i. e., 37.5±0.3°C vs. 38.3±0.4°C, in NW vs. Competition, respectively). This effect was more pronounced with cold water (i. e., 36.7±1.1°C, in CW). No significant changes were noted in mean heart rate (i. e., 145±5, 143±4 and 141±5 bpm for NW, CW and Competition, respectively). Further studies are needed to explore the effect of this cooling method on the performances of international swimmers during tropical swimming events.

[Candidemia epidemiology in Córdoba Argentina. Surveillance study of five institutions]. / Epidemiologia de candidemia en Córdoba Republica Argentina. Estudio de vigilancia de cinco instituciones.

UNLABELLED: The incidence rate of invasive infections due to Candida species has increased drastically in the last 20 years, causing a 40% mortality rate in hospitalized patients. In order to comprehend the epidemiology of Candida bloodstream infection, the study was carried out. MATERIALS AND METHODS: A retrospective study was done based on microbiology laboratory reports from five terciary care hospitals from the city of Cordoba between January 2010 and August 2012. RESULTS: 158 patients had candidemia, the average age was 55,8 years, and 54% of patients were in the intensive care unit. Candida albicans (44%), Candida parapsilosis (22%) and Candida tropicalis (12%) were the main fungi isolated. Candida parapsilosis was commonly associated with catether infections. CONCLUSIONS: The data from the city of Cordoba showed that C. albicans, C. parapsilosis y C. tropicalis were the more frequent species isolated from blood cultures. This is similar to what is seen in other series published from Argentina and Latinamerica. This study may have implications when it comes to deciding which empiric antifugal agent is best for the treatment of candidemia.

La incidencia de infecciones invasivas por Candida ha aumentado en forma dramática en los últimos 20 años, siendo causa importante de mortalidad en torno al 40% en los pacientes hospitalizados. Material y métodos: Se realizó un estudio retrospectivo, basado en reportes de laboratorio de cinco hospitales de tercer nivel de la ciudad de Córdoba entre enero de 2010 y agosto de 2012, con el objetivo de conocer la epidemiología regional. Resultados: 158 pacientes con candidemia, edad promedio de 55.8 años, el 60% internados en unidades de cuidados intensivos. Candida albicans 44%, Candida parapsilosis 22% y Candida tropicalis 12% fueron las principales especies aisladas. Candida parapsilosis estuvo comúnmente asociada a infecciones relacionadas a catéteres. Conclusiones: Esta serie local de la ciudad de Córdoba muestra que C. albicans, C. parapsilosis y C. tropicalis son las especies mas frecuentes coincidente con el perfil de las series publicadas en Argentina y Latinoamérica. Esto puede tener implicancias para decidir que agente antifúngico usar empíricamente para tratar las candidemias.

Epidemiologia de candidemia en Córdoba Republica Argentina. Estudio de vigilancia de cinco instituciones. / [Candidemia epidemiology in Córdoba Argentina. Surveillance study of five institutions].

UNLABELLED: The incidence rate of invasive infections due to Candida species has increased drastically in the last 20 years, causing a 40

mortality rate in hospitalized patients. In order to comprehend the epidemiology of Candida bloodstream infection, the study was carried out. MATERIALS AND METHODS: A retrospective study was done based on microbiology laboratory reports from five terciary care hospitals from the city of Cordoba between January 2010 and August 2012. RESULTS: 158 patients had candidemia, the average age was 55,8 years, and 54

of patients were in the intensive care unit. Candida albicans (44

), Candida parapsilosis (22

) and Candida tropicalis (12

) were the main fungi isolated. Candida parapsilosis was commonly associated with catether infections. CONCLUSIONS: The data from the city of Cordoba showed that C. albicans, C. parapsilosis y C. tropicalis were the more frequent species isolated from blood cultures. This is similar to what is seen in other series published from Argentina and Latinamerica. This study may have implications when it comes to deciding which empiric antifugal agent is best for the treatment of candidemia.

Epidemiologia de candidemia en Córdoba Republica Argentina. Estudio de vigilancia de cinco instituciones / [Candidemia epidemiology in Córdoba Argentina. Surveillance study of five institutions].

UNLABELLED: The incidence rate of invasive infections due to Candida species has increased drastically in the last 20 years, causing a 40

mortality rate in hospitalized patients. In order to comprehend the epidemiology of Candida bloodstream infection, the study was carried out. MATERIALS AND METHODS: A retrospective study was done based on microbiology laboratory reports from five terciary care hospitals from the city of Cordoba between January 2010 and August 2012. RESULTS: 158 patients had candidemia, the average age was 55,8 years, and 54

of patients were in the intensive care unit. Candida albicans (44

) and Candida tropicalis (12

) were the main fungi isolated. Candida parapsilosis was commonly associated with catether infections. CONCLUSIONS: The data from the city of Cordoba showed that C. albicans, C. parapsilosis y C. tropicalis were the more frequent species isolated from blood cultures. This is similar to what is seen in other series published from Argentina and Latinamerica. This study may have implications when it comes to deciding which empiric antifugal agent is best for the treatment of candidemia.

Successful cryopreservation of expanded equine blastocysts.

Effective cryopreservation of expanded equine blastocysts (> 300 µm in diameter) has been difficult, perhaps due to the volume of blastocoele fluid or the presence of the equine embryonic capsule. Recently, we reported normal viability of equine embryos after trophoblast biopsy, which resulted in blastocyst collapse. The present study addressed the effect of biopsy and resultant breach of the capsule and blastocyst collapse on survival of expanded equine blastocysts after vitrification. First, non-biopsied, small embryos (< 300 µm) were vitrified in fine-diameter microloader pipette tips using dimethylsulfoxide-containing medium (DM) or ethylene glycol-containing medium (EG). A third group was vitrified with EG, but was warmed using sucrose (EG/s). Embryos in the DM and EG/s treatments grew in culture after vitrification, and established pregnancies after transfer (3 of 12 and 3 of 6, respectively). Expanded blastocysts 300-730 µm in diameter were then biopsied and vitrified; rates of normal pregnancy (detection of embryonic heartbeat) after warming and transfer were 2 of 16 (13%) and 6 of 13 (46%) for DM and EG/s treatments, respectively (P = 0.05). Within the EG/s treatment, it appeared that greater loss of blastocoele fluid after biopsy was associated with higher survival. Therefore, an altered ("Central") biopsy technique was used to aspirate blastocoele fluid, followed by vitrification in EG/s. Pregnancy rates were 1 of 8 (13%) for embryos cultured after warming and 4 of 7 (57%) for embryos transferred immediately after warming (P = 0.1). Finally, expanded blastocysts 407 to 565 µm in diameter were biopsied from the periphery, and blastocoele fluid was removed with gentle suction. After vitrification with EG/s, this resulted in a rate of normal pregnancy of 5 of 7 (71%). These findings demonstrated that blastocoele collapse and vitrification in fine-diameter pipettes allowed successful cryopreservation of expanded equine blastocysts.

Viability of equine embryos after puncture of the capsule and biopsy for preimplantation genetic diagnosis.

The equine embryo possesses a capsule that is considered essential for its survival. We assessed viability after breaching the capsule of early (Day 6) and expanded (Day 7 and 8) equine blastocysts by micromanipulation. The capsule was penetrated using a Piezo drill, and trophoblast biopsy samples were obtained for genetic analysis. Pregnancy rates for Day-6 embryos, which had intact zonae pellucidae at the time of recovery, were 3/3 for those biopsied immediately after recovery and 2/3 for those biopsied after being shipped overnight under warm (∼28 °C) conditions. The pregnancy rates for encapsulated Day-7 expanded blastocysts were 5/6 for those biopsied immediately and 5/6 for those biopsied after being shipped overnight warm. Two of four encapsulated Day-8 blastocysts, 790 and 1350 µm in diameter, established normal pregnancies after biopsy. Nine mares were allowed to maintain pregnancy, and they gave birth to nine normal foals. Biopsied cells from eight embryos that produced foals were subjected to whole-genome amplification. Sex was successfully determined from amplified DNA in 8/8 embryos. Identification of disease-causing mutations matched in the analyses of 6/6 samples for the sodium channel, voltage-gated, type IV, alpha subunit (SCN4A) gene and in 6/7 samples for the peptidylprolyl isomerase B (PPIB) gene, in embryo-foal pairs. Thus, the capsule of the equine embryo can be breached without impairing viability. Further work is needed to determine whether this breach is transient or permanent. These findings are relevant to the understanding of equine embryo development and to the establishment of methods for micromanipulation and embryo cryopreservation in this species.

Differences in delta13C and delta15N stable isotopes in the pearly razorfish Xyrichtys novacula related to the sex, location and spawning period.

In the present study, Xyrichtys novacula (Labridae) were sampled at five locations around the islands of Ibiza and Formentera (western Mediterranean Sea). Isotopic signatures of delta13C, delta15N and the C:N ratio were analysed in relation to locality, sex and size differences. delta13C and delta15N partitioning was also studied in the reproductive spawning period. There were significant differences in the delta13C signature between localities for both sexes, but not for delta15N. Sex differences were also found with a mean +/-s.e. value of -17.38 +/- 0.06 per thousand delta13C and 8.36 +/- 0.05 per thousand delta(15)N for females and -17.17 +/- 0.07 per thousand delta13C and 8.80 +/- 0.06 per thousand delta15N for males. Increasing total length in both sexes was positively correlated with delta15N enrichment and a significant positive linear regression was established for both variables. During the reproductive spawning period, there were changes in delta13C fractioning with enrichment in postspawning females and males (with respect to prespawning and spawning periods) and delta(15)N impoverishment in postspawning females (with respect to prespawning and spawning periods). Xyrichtys novacula uses local food sources, as confirmed by delta(13)C and delta(15)N, and females and males use different food sources, thus avoiding intraspecific competition. This was confirmed by delta15N enrichment as size increased. Spawning leads to special requirements for gonad maturation, which is reflected in the isotopic signatures for both sexes.

Calidad de vida relacionada con la salud en receptores de un trasplante pulmonar. Su relación con variables clínicas / Health-related quality of life in lung transplantation recipients. Relationship with clinical variables

Objetivo Conocer la calidad de vida relacionada con la salud (CVRS) en trasplantados de pulmón y su relación con la disnea y la prueba de 6 min marcha. Material y método Estudio descriptivo. Participantes: pacientes trasplantados de pulmón. Mediciones: variables sociodemográficas, volumen espiratorio forzado en el primer segundo, parámetros funcionales (disnea y prueba de 6min marcha) y test genérico de calidad de vida SF-36. Prueba t de una muestra para comparar las puntuaciones medias en cada dimensión del SF-36 con los valores de referencias de la población española. Correlación de Pearson entre CVRS percibida y parámetros funcionales. Análisis multivariante para identificar variables predictivas de la CVRS. Resultados Participaron 59 personas, 36 hombres y 23 mujeres. La media de edad fue de 43,77 años (DE±15,27) y el tiempo medio postrasplante de 3,7 años (DE±2,18). Las puntuaciones obtenidas en el SF-36 para las dimensiones de función física, dolor, salud mental y vitalidad fueron superiores a las de la población de referencia (p<0,05), no encontrándose diferencias para el resto. Las dimensiones función física, rol físico y función social presentaron correlación con el grado de disnea (p=0,01), así como en el análisis multivariante (R2=0,60). Conclusiones La CVRS declarada por los pacientes trasplantados de pulmón es similar a la de la población de referencia española. El grado de disnea es el parámetro que mejor se relaciona con la calidad de vida (AU)

Objective To know the health-related quality of life (HRQL) to the in lung transplantation recipient and their relationship with the dyspnea and with the 6-min walk test. Material and method Descriptive study. Participants: Lung transplanted patients. Mensurations: socio-demografic data, FEV1, functional parameters (dyspnea and 6-min walk test), and generic test of HRQL SF-36 Health Index. A t-test to compare the mean punctuations in each dimesion the SF-36 with the reference values of the spanish population. Pearson correlation between perceived HRQL and functional parameters. Multivariate analysis to identify predicted variables of the HRQL. Results 59 people, 36 men and 23 women participated. The mean age was 43.77 years (SD±15.27) and the mean time postrasplante of 3.7 years (SD±2.18). The punctuations obtained in the lung transplanted patients for the dimensions physical function, pain, mental health and vitality they went upper to them the population reference values (p value<0.05), not being differences for the rest. The dimensions physical function, role physical and social function presented high correlations with the degree of dyspnea (p value=0.01) as well as in the multivariate analysis (R2=0.60). Conclusions The HRQL declared by the lung transplanted patients it is similar to the reference spanish population. The dyspnea it is the parameter that better is related with the quality of life (AU)

Nivel funcional y capacidad de marcha en ancianos con fractura de cadera a los seis meses de un programa de rehabilitación domiciliaria / Effects of a six months' home rehabilitation program on the functional level and walking ability of old people with hip fracture

Objetivo: Conocer el nivel funcional para las actividades básicas de la vida diaria y la capacidad de marcha en ancianos con fractura de cadera (FC) a los seis meses de un programa de rehabilitación domiciliaria (PRD). Pacientes y método: Estudio prospectivo antes-después con 136 pacientes de 70 años o mayores, residentes en la comunidad, intervenidos de FC y derivados a un PRD. Se compararon el índice de Barthel (IB) y la capacidad de marcha al inicio y a los seis meses. Se aplicaron análisis de regresión lineal y logística múltiples. Resultados: El IB a los seis meses aumentó 26,32 puntos respecto al inicial (desviación estándar: 20,60; intervalo de confianza del 95%: 22,83–29,82; p<0,001). El 59,1% de pacientes tenía capacidad de marcha a los seis meses frente al 19,9% inicial (p<0,001). Los análisis de regresión relacionaron con un mejor nivel funcional y tener capacidad de marcha a los seis meses a la ausencia de comorbilidad y de complicaciones, a tener capacidad de marcha al inicio del tratamiento y al incremento del IB al alta. Conclusiones: La rehabilitación domiciliaria mejora el nivel funcional, manteniéndose a los seis meses de finalizado el tratamiento. La mejora en la capacidad de marcha disminuye a lo largo de este tiempo (AU)

Objective: To know the functional level for the basic activities of daily living and the walking ability in old men with hip fracture to the six months a home rehabilitation program. Patients and method: A before-after prospective study on 136 patients, who were ≥ 70 years old, lived in the community, had a hip fracture operation and was later referred to a home rehabilitation program. Both their Barthel index rate and ability to walk were contrasted at the beginning, on being discharged and after six months. Logistic, multiple and lineal regression analyses were made to identify variables associated with the functional level and ability to walk. Results: After six months the values of the Barthel index increased an average of 26.32 points (SD: 20.6; 95% CI: 22.82–29.82; p <0.001). Patients walking ability after 6 months were 40% higher then just after the discharge (p <0.001). A good functional level and the ability to walk after 6 months were related (regression analysis) with the following factors: not having comorbidity and side health problems, ability to walk from the beginning of the treatment and an increasing in the values of the Barthel index at the moment of the Hospital discharge. Conclusions: Home rehabilitation improve the functional level staying to the six months the treatment it is concluded. The improvement in the walking ability it diminishes along this time (AU)

Safety of positive-pressure valve connectors in arterial catheters inserted into critically ill patients.

Needleless valve connectors were introduced to avoid needlestick injuries in healthcare workers but some concerns exist about their microbiological safety. A randomised controlled trial was performed to assess hub colonisation affecting positive-pressure valve connectors (PPVCs) compared to conventional caps used for radial arterial catheters inserted into critically ill patients. Patients were randomly assigned either to the PPVC (Smartsite Plus positive bolus valve) or to the conventional cap group. Only catheters inserted for >24h were analysed. Of 100 consecutive arterial lines, 80 were inserted for >24h (mean insertion duration 5.8 days), 41 in the PPVC group and 39 in the conventional cap group. Catheter hubs were colonised in eight cases in the control group (20.5%) and in one case in the PPVC group (2.4%). Hub colonisation was caused by coagulase-negative staphylococci in all cases. No attributable bacteraemia was observed. In multivariate analysis, PPVC (odds ratio: 0.09; 95% confidence interval: 0.1-0.79; P=0.03) and use of the line for continuous haemodynamic monitoring (0.16; 0.03-0.89; P=0.037) were independently associated with a lower incidence of hub colonisation.

EPOC: influencia sobre la disnea de un programa de ejercicio domiciliario / COPD: influence of a home exercise programme on dyspnoea

INTRODUCCIÓN: La rehabilitación respiratoria (RR) es unaterapia beneficiosa para los enfermos con enfermedad pulmonarobstructiva crónica (EPOC). Sin embargo, la aplicación de lamayoría de los programas diseñados exige un elevado consumo derecursos y pocos han demostrado su eficacia a largo plazo.OBJETIVO: Comparar en pacientes con Enfermedad PulmonarObstructiva Crónica (EPOC) la efectividad a largo plazo de unprograma de RR domiciliaria mínimamente supervisado en relacióna los cambios en la disnea y capacidad funcional.DISEÑO: Ensayo clínico prospectivo, aleatorizado, de 1 añode duración, con 2 grupos: rehabilitación y control. Se presentanlos resultados de los pacientes que han completado un periodo deinclusión de 6 meses. Se midieron pre-entrenamiento y post-entrenamientodos variables: la disnea mediante el índice de disneabasal de Mahler (IDBM) e índice transicional de disnea (ITD), y lacapacidad de ejercicio mediante la prueba de 6 minutos marcha(P6MM).PACIENTES: Individuos con EPOC moderada y grave queacuden a una consulta de Neumología y que cumplen unos criteriosestablecidos de inclusión en un programa de RR.INTERVENCIÓN: Al grupo de RR se le instruyó en un programade ejercicio domiciliario con entrenamiento de extremidadessuperiores e inferiores.RESULTADOS: Se evaluaron 19 sujetos (edad 65 ± 6 años yporcentaje de FEV1 medio de 39%), que se asignaron aleatoriamentea cada grupo de estudio: Grupo RR (n = 11) y grupo control(n = 8). El IDBM fue de 4,6 en el grupo RR y 4,75 en el grupo control.A los 6 meses el ITD fue 3,5 en el grupo RR y 0,63 en el control,con diferencias en todas las subescalas. La distancia recorridaen el 6MWT se incrementó en ambos grupos, aunque con una diferenciade 46 metros a favor del grupo de RR.CONCLUSIONES: Un programa de RR domiciliario y mínimamentesupervisado consigue una mejoría significativa en la disneay en la capacidad de esfuerzo en los pacientes con EPOC

Introduction: Respiratory rehabilitation (RR) is a beneficialtherapy for those patients with chronic obstructive pulmonary disease(COPD). However, the application of the majority of the programmesdesigned demands a high consumption of resources andfew have demonstrated their efficacy in the long term.Objective: To compare the long-term effectiveness of a programof minimally supervised home RR in relation to the changesin dyspnoea and functional capacity in patients with ChronicObstructive Pulmonary Disease (COPD).Method: Prospective randomized clinical trial of 1 year duration,with 2 groups: rehabilitation and control. The results of thepatients who have completed an inclusion period of 6 months areshown. Two pre-training and post-training variables were measured:dyspnoea by means of Mahler’s basal dyspnoea index(MBDI) and transitional dyspnoea index (TDI), and the exercisecapacity by means of the 6 minutes walk test (6MWT).Patients: Individuals with moderate and serious COPD whocame to a pneumology consultation and who fulfilled the establishedcriteria of inclusion in a programme of RR.Intervention: The RR group was instructed in a home exerciseprogram with training of the upper and lower limbs.Results: Nineteen patients were evaluated (age 65 ± 6 yearsand average FEV1 of 39%), which were randomly assigned to eachstudy group: RR group (n = 11) and control group (n = 8). TheMBDI was 4.6 in the RR group and 4.75 in the control group. At 6months the TDI was 3.5 in the RR group and 0.63 in the controlgroup, with differences in all the subscales. The distance covered inthe 6MWT increased in both groups, although with a difference of46 metres in favour of the of RR group.Conclusions: A program of minimally supervised home RRobtains a significant improvement in the dyspnoea and capacityfor effort in the patients with COPD