Infections after spine instrumentation: effectiveness of short antibiotic treatment in a large multicentre cohort.

BACKGROUND AND OBJECTIVES: Available information about infection after spine instrumentation (IASI) and its management are scarce. We aimed to analyse DAIR (debridement, antibiotics and implant retention) prognosis and evaluate effectiveness of short antibiotic courses on early forms. METHODS: Multicentre retrospective study of patients with IASI managed surgically (January 2010-December 2016). Risk factors for failure were analysed by multivariate Cox regression and differences between short and long antibiotic treatment were evaluated with a propensity score-matched analysis. RESULTS: Of the 411 IASI cases, 300 (73%) presented in the first month after surgery, 48 in the second month, 22 in the third and 41 thereafter. Infections within the first 2 months (early cases) occurred mainly to older patients, with local inflammatory signs and predominance of Enterobacteriaceae, unlike those in the later periods. When managed with DAIR, prognosis of early cases was better than later ones (failure rate 10.4% versus 26.1%, respectively; P = 0.02). Risk factors for DAIR failure in early cases were female sex, Charlson Score, large fusions (>6 levels) and polymicrobial infections (adjusted HRs of 2.4, 1.3, 2.6 and 2.26, respectively). Propensity score matching proved shorter courses of antibiotics (4-6 weeks) as effective as longer courses (failure rates 11.4% and 10.5%, respectively; P = 0.870). CONCLUSIONS: IASIs within the first 2 months could be managed effectively with DAIR and shorter antibiotic courses. Clinicians should be cautious when faced with patients with comorbidities, large fusions and/or polymicrobial infections.

Borrelia hispanica como causa de fiebre recurrente / Borrelia hispanica as a cause of recurrent fever

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Estudio de una nueva técnica psicoterapéutica grupal en esquizofrenia basada en el cine de ficción: efectos sobre síntomas positivos y negativos / Study of a new group psychotherapy technique in schizophrenia based on fictional cinema: effects on positive and negative symptoms

Introducción: La esquizofrenia es uno de los trastornos mentales que mayor discapacidad humana genera en todo el mundo. Hasta el momento, el tratamiento de síntomas negativos en esquizofrenia dista de estar resuelto de un modo satisfactorio. La singular capacidad del cine para activar la atención, la imaginación y la memoria, así como de activar procesos mentales complejos en los espectadores, permite pensar que puede ser una herramienta terapéutica eficaz para el tratamiento de determinados trastornos mentales. Objetivos: Evaluar el eficacia de una nueva técnica psicoterapéutica (diseñada ad hoc) basada en el análisis fílmico por secuencias y el doble visionado utilizando cine de ficción en pacientes con diagnóstico de trastornos del espectro de la esquizofrenia y otros trastornos psicóticos. Metodología: Se realizó un ensayo clínico multicéntrico, aleatorizado y en grupos paralelos en el que participaron 48 pacientes con diagnóstico de trastornos psicóticos del espectro de la esquizofrenia. Se compararon los efectos de la aplicación de una técnica psicoterapéutica grupal, basada en el uso de cine de ficción como soporte y cuya técnica estaba inspirada en el análisis fílmico, frente a un grupo control que también trabajaba con una técnica más inespecífica sobre el mismo soporte. Para el desarrollo de la nueva técnica psicoterapéutica grupal -objeto de este estudio- se seleccionaron 3 técnicas del análisis fílmico en las que los investigadores en su práctica clínica observaron un potencial terapéutico: 1) la segmentación del material fílmico en secuencias; 2) el análisis por secuencias de los contenidos de la película, y 3) el doble visionado del material cinematográfico. La intervención constaba de 26 sesiones, que implicaban la doble visión de los 13 episodios de la primera temporada de la serie de televisión Los Soprano. Las medidas primarias de resultado fueron los cambios obtenidos en las subescalas de la Escala de Síndromes Positivo y Negativo de la Esquizofrenia, según el modelo pentafactorial de Wallwork, entre la situación basal y final tras el tratamiento. Como medidas de resultado cognitivas se utilizaron los cambios en las escalas de cognición incluidas en la MATRICS Consensus Cognitive Battery y en escalas de cognición social (MSCEIT, FEIT, FBS) antes y después del tratamiento. Resultados: Los resultados mostraron una mejoría estadísticamente significativa en el grupo experimental frente al grupo control en los síntomas, positivos (p=0,01; d=0,82 [IC del 95%, 0,2-1,43]), negativos (p=0,005; d=0,89 [IC del 95%, 0,26-1,51]) y desorganizados (p=0,013; d=0,49 [IC del 95%, 0,11-1,09]). En el análisis post-hoc del factor negativo se encontró mejorías estadísticamente significativas en las variables: embotamiento afectivo (p=0,041; d=0,64 [IC del 95%, 0,03-1,24]), retraimiento emocional (p=0,012; d=0,80 [IC del 95%, 0,18-1,41]), contacto pobre (p=0,000; d=1,18 [IC del 95%, 0,52-1,82]) y enlentecimiento motor (p=0,003; d=0,96 [IC del 95%, 0,33-1,58]). En el análisis post-hoc del factor positivo se encontró mejoría significativa en el subdominio delirios (p=0,01; d=0,82 [IC del 95%, 0,2-1,4]). No se encontraron diferencias significativas entre ambos grupos en síntomas afectivos ni en ninguno de los dominios cognitivos estudiados. Conclusiones: La nueva técnica psicoterapéutica propuesta es aplicable y bien aceptada por los pacientes con esquizofrenia y otros trastornos psicóticos. El uso de esta nueva técnica psicoterapéutica inspirada en el uso del análisis fílmico puede servir para mejorar los síntomas positivos, negativos y desorganizados en pacientes con esquizofrenia

Introduction: Schizophrenia is one of the mental disorders that generate the greatest human disability in the world. The treatment of negative symptoms in schizophrenia is still far from being resolved satisfactorily. The unique ability of cinema to activate attention, imagination and memory, as well as to activate complex mental processes in viewers leads one to think that it can be an effective therapeutic tool for the treatment of certain mental disorders. Objective: To evaluate the efficacy of a new psychotherapeutic technique (designed ad hoc) based on the analysis of film sequences and double viewed using fiction films in patients diagnosed with spectrum disorders of schizophrenia and other psychotic disorders. Methods: A multicentre, randomised and parallel group clinical trial was conducted on 48 patients with a diagnosis of psychotic disorders of the schizophrenia spectrum. The effects of the application of a psychotherapeutic group therapy technique, based on the use of fiction films, were compared to a control group that also worked with fiction films, but using a non-specific technique. Three film analysis techniques with potential therapeutic properties were selected for the development of the new group psychotherapy technique: 1) the segmentation of the cinematic material into sequences, 2) the analysis by sequences of the contents of the film, 3) the double viewing of the cinematographic material. The intervention consisted of 26 sessions, which involved the double viewing of the 13 episodes of the first season of the television series Los Soprano. The primary outcome measures were the changes obtained in the Positive and Negative Syndrome Scale (PANSS) subscales, according to Wallwork's five-factor model, between the baseline and final situation after treatment. Cognitive outcome measurements included changes in the cognition scales included in the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB) and in social cognition scales, like MSCEIT, FEIT, and FBS (Mayer-Salovey-Caruso Emotional Intelligence Test, Facial Emotion Identification Test, and Frankfurt self-assessment scale for persons with schizophrenia, respectively), before and after treatment. Results: The results showed a statistically significant improvement in the experimental group versus the control group in the positive [P=.01; d=0.82 (95% CI; 0.2-1.43)], negative [P=.005; d=0.89 (95% CI; 0.26-1.51)] and disorganised symptoms [P=.013; d=0.49 (95% CI; 0.11-1.09)]. In the "post-hoc" analysis of the negative factor, statistically significant improvements were found in the following variables: blunted effect (P=.041, d=0.64 (95% CI; 0.03-1.24)], emotional withdrawal (P=.012, d=0.80 (95% CI; 0.18-1.41)], poor contact (P=.000, d=1.18 (95% CI; 0.52-1.82)], and motor retardation (P=.003, d=0.96 (95% CI; 0.33-1.58).] In the "post-hoc" analysis of the positive factor there was a significant improvement in the delusions subdomain [P=.01; d=0.82 (95% CI; 0.2-1.4).] No significant differences were found between groups in affective symptoms or in any of the cognitive domains. Conclusions: The proposed new psychotherapy technique is applicable and well accepted by patients with schizophrenia and other psychotic disorders. The use of this new psychotherapy technique inspired in film analysis is effective in leading to improvements in the positive, negative, and disorganised symptoms in patients with schizophrenia

Effectiveness of a cognitive behavioral intervention in patients with medically unexplained symptoms: cluster randomized trial.

BACKGROUND: Medically unexplained symptoms are an important mental health problem in primary care and generate a high cost in health services.Cognitive behavioral therapy and psychodynamic therapy have proven effective in these patients. However, there are few studies on the effectiveness of psychosocial interventions by primary health care. The project aims to determine whether a cognitive-behavioral group intervention in patients with medically unexplained symptoms, is more effective than routine clinical practice to improve the quality of life measured by the SF-12 questionary at 12 month. METHODS/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Madrid (Spain). The number of patients required is 242 (121 in each arm), all between 18 and 65 of age with medically unexplained symptoms that had seeked medical attention in primary care at least 10 times during the previous year. The main outcome variable is the quality of life measured by the SF-12 questionnaire on Mental Healthcare. Secondary outcome variables include number of consultations, number of drug (prescriptions) and number of days of sick leave together with other prognosis and descriptive variables. Main effectiveness will be analyzed by comparing the percentage of patients that improve at least 4 points on the SF-12 questionnaire between intervention and control groups at 12 months. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: This study aims to provide more insight to address medically unexplained symptoms, highly prevalent in primary care, from a quantitative methodology. It involves intervention group conducted by previously trained nursing staff to diminish the progression to the chronicity of the symptoms, improve quality of life, and reduce frequency of medical consultations. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01484223 [http://ClinicalTrials.gov].

Ritmos biológicos, sueño y depresión: agomelatina en el tratamiento de la depresión / Biological rhythms, sleep and depression: agomelatine as the treatment for depression

La depresión y la alteración de ritmos circadianos (y, más en concreto, el ritmo de sueño-vigilia) mantienen entre sí una relación cuyo conocimiento ha crecido ampliamente en la última década. El sistema melatoninérgico es un excelente sensor biológico de esta relación. Los antidepresivos tienen una acción sobre el sueño que deriva de su acción monoaminérgica cerebral y que varía en cada caso en función del perfil receptorial de los fármacos. La agomelatina tiene un efecto antidepresivo melatoninérgico y antagonista 5-HT2C y ha mostrado eficacia en todos los ensayos clínicos controlados en trastornos depresivos publicados hasta la fecha, incluidos los estudios a gran escala de fase II y en los pacientes más graves. La agomelatina es elúnico antidepresivo conocido con efecto beneficioso sobre el sistema circadiano a través de la resincronización de los patrones de ritmos circadianos alterados. La mejoría de las quejas asociadas al ritmo sueño-vigilia de los pacientes deprimidos se mejoran sin sedación diurna. El perfil de tolerabilidad general de la agomelatina parece excelente y no tiene repercusiones sobre los parámetros de laboratorio. La ausencia de afinidad de la agomelatina por los transportadores de monoaminas y la falta de acción sobre los receptores 5-HT1A, muscarínicos e histamínicos evita los efectos adversos asociados a estos receptores (sedación, sobrepeso, boca seca, disfunción sexual, síntomas gastrointestinales, cardiovasculares o del SNC). El perfil antidepresivo de la agomelatina asociado con su efecto terapéutico sobre los ritmos circadianos, más en concreto sobre la cantidad y la estructura del sueño, y su ausencia de efectos sedativos, representa un avance selectivo en el tratamiento de la depresión humana (AU)

Depression and altered circadian rhythms (more specifically, the sleep-wake rhythm) hold a relationship whose subtleties have been extensively unravelled over the last decade. The melatonergic system is an excellent biological sensor of this relationship. The antidepressant effect on sleep depends on the specific monoaminergic action which varies according to their specific receptor profile. Agomelatine, an antidepressant with melatonergic and 5-HT2C antagonist effect, has shown to be effective in all of the controlled clinical trials for depressive disorders published so far, including large-scale studies in phase II and studies with severely affected patients. Agomelatine is the only known antidepressant with a positive effect on circadian system based on the resynchronization altered cyrcadian patterns. Complaints associated with sleeping disorders in depressed patients taking agomelatine improve without associated daytime sedation. The general tolerability of agomelatine is excellent and has shown no impact on laboratory parameters. Its lack of affinity towards monoamine transporters, as well as towards 5-HT1A, muscarine and histamine receptors avoids related side effects (sedation, weight gain, dry mouth and sexual dysfunction, as well as gastrointestinal, cardiovascular and neurological symptoms). The antidepressant profile of agomelatine represents a selective breakthrough in the treatment for depression due to its positive effect on circadian rhythms, most notably on the amount and structure of sleep, and the absence of daytime sedation (AU)