Neuropatía múltiple como manifestación clínica de una recidiva de leucemia / Isolated multiple neuropathy as clinical manifestation of leukemia relapse

Introducció La neuroleucemiosis es una rara enfermedad del sistema nervioso periférico producida por la infiltración por células leucémicas. Caso clínico: Presentamos el caso de una paciente de 34 años con antecedente de una leucemia mielomonoblástica aguda en remisión, que presentaba una parálisis progresiva del nervio mediano derecho, del facial bilateral y del peroneal izquierdo. El electromiograma confirmó el diagnóstico de una neuropatía múltiple. La tomografía por emisión de positrones-tomografía computarizada mostró un hipermetabolismo de ambos nervios ciáticos, facial bilateral y mediano derecho. La biopsia de médula ósea confirmó la recidiva de la leucemia, por lo que se inició un nuevo ciclo de quimioterapia con mejoría de los déficits neurológicos. Conclusión: La infiltración del sistema nervioso periférico por células leucémicas puede simular múltiples síndromes neurológicos dependiendo de las estructuras afectadas. La barrera hematonerviosa actúa como defensa de las células leucémicas contra la quimioterapia y el sistema inmunitario, por lo que el sistema nervioso periférico constituye un reservorio de las células leucémicas. Por ello, la neuroleucemia debe considerarse en pacientes con antecedentes de leucemia que presenten síntomas aislados de afectación del sistema nervioso periférico.(AU)

Introduction: Neuroleukemia is a rare disorder of the peripheral nervous system due to leukemic cell infiltration. Case report: We present the case of a 34-year-old patient with history of acute myelomonoblastic leukemia in remission that presented progressive paresis of the right median, bilateral facial, and left peroneal nerves. The electromyogram confirmed the diagnosis of multineuropathy. A PET-CT showed hypermetabolism of both sciatic, facial, and right median nerves. A bone marrow aspirate confirmed the leukemia relapse so a new round of chemotherapy was performed with improvement of the neurological deficit. Conclusion: Peripheral nervous system infiltration by leukemic cells can mimic multiple syndromes depending on the structures involved. The nerve-blood barrier acts as a defense of leukemic cells against chemotherapy and the immune system. Thus, the peripheral nervous system constitutes a reservoir of leukemic cells. Neuroleukemia should be considered in patients with history of acute leukemia who have isolated symptoms of the peripheral nerve.(AU)

Isolated multiple neuropathy as clinical manifestation of leukemia relapse. / Neuropatía múltiple como manifestación clínica de una recidiva de leucemia.

INTRODUCTION: Neuroleukemia is a rare disorder of the peripheral nervous system due to leukemic cell infiltration. CASE REPORT: We present the case of a 34-year-old patient with history of acute myelomonoblastic leukemia in remission that presented progressive paresis of the right median, bilateral facial, and left peroneal nerves. The electromyogram confirmed the diagnosis of multineuropathy. A PET-CT showed hypermetabolism of both sciatic, facial, and right median nerves. A bone marrow aspirate confirmed the leukemia relapse so a new round of chemotherapy was performed with improvement of the neurological deficit. CONCLUSION: Peripheral nervous system infiltration by leukemic cells can mimic multiple syndromes depending on the structures involved. The nerve-blood barrier acts as a defense of leukemic cells against chemotherapy and the immune system. Thus, the peripheral nervous system constitutes a reservoir of leukemic cells. Neuroleukemia should be considered in patients with history of acute leukemia who have isolated symptoms of the peripheral nerve.

TITLE: Neuropatía múltiple como manifestación clínica de una recidiva de leucemia.Introducción. La neuroleucemiosis es una rara enfermedad del sistema nervioso periférico producida por la infiltración por células leucémicas. Caso clínico. Presentamos el caso de una paciente de 34 años con antecedente de una leucemia mielomonoblástica aguda en remisión, que presentaba una parálisis progresiva del nervio mediano derecho, del facial bilateral y del peroneal izquierdo. El electromiograma confirmó el diagnóstico de una neuropatía múltiple. La tomografía por emisión de positrones-tomografía computarizada mostró un hipermetabolismo de ambos nervios ciáticos, facial bilateral y mediano derecho. La biopsia de médula ósea confirmó la recidiva de la leucemia, por lo que se inició un nuevo ciclo de quimioterapia con mejoría de los déficits neurológicos. Conclusión. La infiltración del sistema nervioso periférico por células leucémicas puede simular múltiples síndromes neurológicos dependiendo de las estructuras afectadas. La barrera hematonerviosa actúa como defensa de las células leucémicas contra la quimioterapia y el sistema inmunitario, por lo que el sistema nervioso periférico constituye un reservorio de las células leucémicas. Por ello, la neuroleucemia debe considerarse en pacientes con antecedentes de leucemia que presenten síntomas aislados de afectación del sistema nervioso periférico.

Relación entre la actividad en las redes sociales de las revistas de medicina interna y las citaciones que reciben / Relationship between internal medicine journals’ activity on social networks and the citations they receive

Antecedentes y objetivo: Las redes sociales son medios de divulgación de información científica. Se han generado métricas alternativas que evalúan el impacto de publicaciones científicas en redes sociales. Este estudio busca evaluar si existe correlación entre la actividad de las revistas de medicina interna en las redes sociales y las métricas tradicionales basadas en citaciones. Métodos: Se identificaron las revistas de medicina interna a partir de la base de datos SCImago. Se extrajo información de las métricas tradicionales y alternativas de actividad de las revistas en Facebook, Twitter, YouTube e Instagram. Se evaluó correlación mediante el coeficiente de Spearman. Resultados: De un total de 134 revistas de medicina interna, 17 contaban con presencia en las redes sociales evaluadas. El índice SJR fue más alto en revistas con red social vs. sin red social (59 vs. 18, p<0,0001), y la correlación global entre el índice SJR y el número de seguidores/año en Facebook fue muy fuerte (coeficiente de Spearman 0,95, p<0,05) y fuerte para el número de seguidores/año en Twitter (coeficiente de Spearman 0,54, p <0,05). Conclusiones: Nuestro estudio sugiere que existe una correlación muy fuerte entre las métricas de actividad de las redes sociales, comparado con las métricas tradicionales basadas en el número de citaciones en revistas de medicina interna (AU)

Background and objectives: Social networks are a means for disseminating scientific information. Alternative metrics assessing the impact of scientific publications on social networks have been created. Our study aims to assess the correlation between the activity of internal medicine journals on social networks and traditional metrics based on citations. Methods: Internal medicine journals were identified in the SCImago-Scopus database and information on traditional impact metrics was extracted. In addition, alternative metrics of activity were determined for Facebook, Twitter, YouTube, and Instagram. The correlation was assessed through Spearman's correlation coefficient. Results: Of 134 Internal Medicine journals, 17 had a presence on the social networks evaluated. The SJR index was higher in journals with a presence on social networks vs. those without (59 vs. 18, p <.0001). The overall correlation between the SJR index and the number of followers/year was very strong for Facebook (Spearman's correlation coefficient 0.95, p <.05) and strong for Twitter (Spearman's correlation coefficient 0.54 p <.05). Conclusions: Our study suggests that there is a very strong correlation between social network activity metrics (mainly Facebook and Twitter) compared to traditional metrics based on the number of citations of internal medicine journals (AU)

Relationship between internal medicine journals' activity on social networks and the citations they receive.

BACKGROUND AND OBJECTIVES: Social networks are a means for disseminating scientific information. Alternative metrics assessing the impact of scientific publications on social networks have been created. Our study aims to assess the correlation between the activity of internal medicine journals on social networks and traditional metrics based on citations. METHODS: Internal medicine journals were identified in the SCImago-Scopus database and information on traditional impact metrics was extracted. In addition, alternative metrics of activity were determined for Facebook, Twitter, YouTube, and Instagram. The correlation was assessed through Spearman's correlation coefficient. RESULTS: Of 134 Internal Medicine journals, 17 had a presence on the social networks evaluated. The SJR index was higher in journals with a presence on social networks vs. those without (59 vs. 18, p < .0001). The overall correlation between the SJR index and the number of followers/year was very strong for Facebook (Spearman's correlation coefficient 0.95, p < .05) and strong for Twitter (Spearman's correlation coefficient 0.54 p < .05). CONCLUSIONS: Our study suggests that there is a very strong correlation between social network activity metrics (mainly Facebook and Twitter) compared to traditional metrics based on the number of citations of internal medicine journals.

The Impact of Anesthesia-Influenced Process Measure Compliance on Length of Stay: Results From an Enhanced Recovery After Surgery for Colorectal Surgery Cohort.

BACKGROUND: Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort. METHODS: From January 2013 to April 2015, data from 1140 consecutive patients were collected for all patients before (pre-ERAS) and after (ERAS) implementation of an ERAS program. Compliance with 9 specific process measures directly influenced by the anesthesiologist or acute pain service was analyzed to determine the impact on hospital length of stay (LOS). RESULTS: Process measure compliance was associated with a stepwise reduction in LOS. Patients who received >4 process measures (high compliance) had a significantly shorter LOS (incident rate ratio [IRR], 0.77; 95% CI, 0.70-0.85); P < .001) compared to low compliance (0-2 process measures) counterparts. Multivariable regression suggests that utilization of multimodal nausea and vomiting prophylaxis (IRR, 0.78; 95% CI, 0.68-0.89; P < .001), scheduled postoperative nonsteroidal pain medication use (IRR, 0.76; 95% CI, 0.67-0.85; P < .001), and strict adherence to a postoperative opioid administration (IRR, 0.58; 95% CI, 0.51-0.67; P < .001) protocol for breakthrough pain were independently associated with reduced LOS. CONCLUSIONS: Our findings suggest that increased compliance with process measures directly influenced by the anesthesiologists and in concert with a formal anesthesia protocol is associated with reduced LOS. Engaging anesthesiology colleagues throughout the surgical encounter increases the overall value of perioperative care.

Leishmania infantum antigens modulate memory cell subsets of liver resident T lymphocyte.

In the recent years, the liver has been recognized as an important immune organ with major regulatory functions and immune memory, adding to the well-described vital metabolic functions. There are evidences from experimental infections performed with visceral Leishmania species that immune responses to parasite infection can be organ-specific. The liver is the compartment of acute resolving infection, with minimal tissue damage and resistance to reinfection, whereas the spleen is the compartment of parasite persistence. Control of hepatic infection in mice requires a coordinated immune response that involves the development of inflammatory granulomas. It is also described that the liver harbors populations of resident lymphocytes, which may exhibit memory characteristics. Therefore, the present study aims to address the role of the liver as an immune memory organ in the context of Leishmania infantum infection, by characterizing phenotypically resident liver T lymphocytes. The dynamics of memory T cells in L. infantum infected BALB/c mice and the effect of anti-leishmanial treatment in the differentiation of memory cell subsets were analyzed. The potential of recognition, differentiation and selection of memory lymphocytes by three L. infantum recombinant proteins were also explored. L. infantum infection generates effector and central memory T cells, but the cells did not expand when recalled, demonstrating a possible parasite silencing effect. The treatment with a leishmanicidal drug (antimoniate meglumine) increases the levels of memory and effector T cells, eliciting a more robust hepatic immune response. L. infantum parasites with a decreased sensitivity to the leishmanicidal drug favor the expansion of memory CD8+ T cell subset, but inhibit the proliferation of CD8+ T effector cells, possibly assuring their own survival. The recombinant proteins LirCyp1 and LirSOD are strongly recognized by memory cells of treated mice, indicating that these proteins might be used in a prophylactic or therapeutic vaccine formulation. Thus, L. infantum released antigens induce the development of immune memory subsets in the liver resident T cell population that specifically recognized parasite antigens, including recombinant proteins.

Beneficios del ejercicio sobre la circulación arterial periférica en pacientes diabéticos tipo 2 con claudicación intermitente: serie de casos / Benefits of exercise on the peripheral arterial circulation in diabetic type 2 patients with intermittent claudication: A series of cases

Objetivo Analizar el efecto de un programa de deambulación sobre el estado de la circulación arterial de miembros inferiores en pacientes diabéticos con enfermedad arterial periférica (estadio I de Leriche-Fontaine).Pacientes y métodosSe realiza un estudio de cohortes retrospectivo sobre 15 individuos diabéticos tipo II con enfermedad arterial periférica pertenecientes al Centro de Salud de la Zubia (Distrito Metropolitano-Granada). El cálculo del índice tobillo/brazo y la determinación de la máxima velocidad y distancia de deambulación se realizaron previa y posteriormente al desarrollo de un programa de deambulación de 90 días de duración.ResultadosLa media obtenida en el índice tobillo/brazo del miembro inferior derecho es de basal: 0.96 ± 0.122/postbasal: 1.01 ± 0.089; p<0,046. Asimismo, la media del índice de tobillo/brazo en el miembro inferior izquierdo es de basal: 0.612±0,201/postbasal: 0.837±0,281; p<0.052. También se encuentran diferencias estadísticamente significativas en la máxima distancia recorrida (basal: 22.13 [5.21]/postbasal: 25.15 [4.25]; p<0,046), así como en la máxima velocidad de deambulación (basal: 5.43 [1.03]/postbasal: 7.089 [4.35]; p<0,048).ConclusiónUn programa de deambulación de 2,5km diarios produce un aumento de la distancia de claudicación intermitente y del índice tobillo/brazo en pacientes diabéticos tipo II con enfermedad arterial periférica (estadio i de Leriche-Fontaine)(AU)

ObjectiveTo evaluate the effect of a walking program on lower limbs arterial circulation in diabetic patients with peripheral arterial disease (Leriche-Fontaine Stage I).Patients and methodsA retrospective cohort study was conducted on 15 individuals with type II diabetic peripheral arterial disease who belonged to the Zubia Health Center (Metropolitan Health Area of Granada). Ankle/brachial index and maximum walking speed and distance were measured before and after a 90-day long walking program.ResultsThe mean obtained in the right ankle/brachial index was basal: 0.96±0.122/post-baseline: 0.089±1.01; P<0.046. Mean obtained in the left ankle/brachial index was basal: 0.612±0.201/postbasal: 0.837±0.281; P<0.052. Statistically significant differences were also found in maximum walking distance (basal 22.13±5.21/postbasal: 25.15±4.25; P<0.046) as well as maximum walking speed (basal: 5.43 [1.03]/postbasal: 7,089 [4.35]; P <0.048).ConclusionA walking program of 2.5km per day produces an increase in intermittent claudication distance and ankle/brachial index in type II diabetic patients with peripheral arterial disease (Leriche-Fontaine Stage I)(AU)

Effects of pool-based exercise in fibromyalgia symptomatology and sleep quality: a prospective randomised comparison between stretching and Ai Chi.

OBJECTIVE: To evaluate the effectiveness and tolerability of two pool-based physical therapies, stretching and Ai Chi, in fibromyalgia symptomatology and sleep quality. METHODS: Eighty-one patients, randomly assigned to stretching (n=39) or Ai Chi (n=42), received 18 physiotherapy sessions and were evaluated at baseline, at treatment termination, and after 4 and 12 weeks of follow-up. Main outcome measures were the Fibromyalgia Impact Questionnaire (FIQ) and the Pittsburgh Sleep Quality Index (PSQI). Secondary outcome measures included the Beck Depression Inventory (BDI), the State and Trait Anxiety Inventory (STAI), and the SF-12 Health Survey (SF-12). Data analysis was done with repeated measures ANOVA and effect size estimation. RESULTS: No differences were found between groups but significant reduction in the FIQ and the PSQI scores were observed in Ai Chi but not in stretching group, with larger effect sizes and longer effect duration on sleep measures. BDI scores decreased in stretching but not in Ai Chi group with small effect sizes. Trait-anxiety scores decreased in both groups also with small effect sizes. The mental component summary of the SF-12 increased only in stretching group with effect sizes moderate to large. CONCLUSIONS: Although no global differences were found between groups, Ai Chi significantly improved fibromyalgia symptomatology and sleep quality, whereas stretching only improved subjects' psychological well-being.

Prevalencia del Síndrome de Burnout en Fisioterapia / Prevalence of Burnout Syndrome in Physiotherapy

El síndrome de Burnout es un tipo de estrés laboral que puede tener repercusiones psicosomáticas, conductuales, emocionales, familiares y sociales, que pueden ser motivo de bajo rendimiento laboral. El objetivo de este trabajo es conocer la prevalencia del síndrome de Burnout en los Fisioterapeutas, pertenecientes al Servicio Andaluz de Salud, que desarrollan su actividad profesional en hospitales y centros de salud de Granada (capital). Material y métodos: Se diseñó un estudio observacional transversal sobre una muestra de 46 fisioterapeutas, a los que se les administró el Maslach Burnout Inventory para medir el grado de Síndrome de Burnout. Resultados: El 37 % de los encuestados presentó un porcentaje elevado en el grado de Burnout para el cansancio emocional, el 17,40 % presentó una alta despersonalización, y un 69,50 % presentó una baja realización personal. El Síndrome de Burnout se encuentra en el 10, 87 % (n = 5) de la muestra. Conclusiones: En general, la prevalencia del síndrome de Burnout es relativamente baja, en base al siguiente criterio: elevado agotamiento emocional, baja realización personal y alta despersonalización

Burnout Syndrome refers to a kind of occupational stress that can have psychosomatic, behavioural, emotional, familial, and social repercussions; it can also cause loss of effeciancy at work. The aim of this study is to determine the prevalence of Burnout syndrome in physiotherapists, who belong to Servicio Andaluz de Salud and redeem their professional activity in hospital and health centres from Granada (city). Material and methods: A cross-sectional study was designed in a sample of 46 physiotherapists, who were given the Maslach Burnout Inventory to measure the degree of Burnout syndrome. Results: The 37 % of the staff interviewed presented a high percentage in the degree of Burnout for the emotional exhaustion, the 17.40 % presented a high depersonalization, and 69.50 % presented a low personal execution. The Burnout Syndrome is in the 10.87 % of the staff. Conclusion: In general the prevalence of Burnout syndrome is relatively low in base to following criteria elevated emotional exhaustion, low personal execution and high depersonalization

Delirium in acute stroke: a preliminary study of the role of anticholinergic medications.

The pathogenesis of delirium in acute stroke is incompletely understood. The use of medications with anticholinergic (ACH) activity is associated with an increased frequency of delirium. We hypothesized that the intake of medications with ACH activity is associated with delirium in acute stroke patients. Delirium was assessed using the DSM-IV-TR criteria and the Delirium Rating Scale, in a sample of consecutive patients with an acute (< or =4 days) cerebral infarct or intracerebral haemorrhage (ICH). We performed a gender and age matched case-control study. Twenty-two delirious stroke patients (cases) and 52 non-delirious patients (controls) were compared concerning the intake of ACH medications (i) before stroke, (ii) during hospitalization but before the assessment. The variables associated with delirium on bivariate analysis were entered in a stepwise logistic regression analysis. The final regression model (Nagelkerke R2 = 0.65) retained non-neuroleptics ACH medication during hospitalization (OR = 24.4; 95% CI = 2.18-250), medical complications (OR = 20.8; 95% CI = 3.46-125), ACH medication taken before stroke (OR = 17.5; 95% CI = 1.00-333.3) and ICH (OR = 16.9; 95% CI = 2.73-100) as independent predictors of delirium. This preliminary result indicates that drugs with subtle ACH activity play a role in the pathogeneses of delirium in acute stroke. Medication with ACH activity should be avoided in acute stroke patients.

Translaminar lumbar epidural endoscopy: technique and clinical results.

To provide baseline outcome data for a new lumbar microinvasive diskectomy done with standard arthroscopic instrumentation, we retrospectively reviewed the cases of 190 patients. All patients were assessed by a modified MacNab outcome classification with a minimum of a 2-year follow-up. All complications of this procedure were reported as well. No previous outcome data are available for this procedure, since it has been done primarily at one center, by the same surgeon, using his previously reported techniques. Results were good or excellent in 175 patients and fair or poor in 15. Complications were not severe and were easily remedied. This success rate is comparable to rates reported for other minimally invasive operations on the lumbar spine. This new technique of minimally invasive lumbar spine surgery provides minimal morbidity and a long-term outcome comparable to that of other standard procedures. The added benefits of using standard arthroscopic instrumentation are discussed.

Translaminar lumbar epidural endoscopy: anatomy, technique, and indications.

This article describes a new technique to achieve access to the epidural space via a direct posterior portal. This minimally invasive technique allows treatment of disc protrusions and extrusions with full visualization and minimal dissection of the paraspinal musculature. Hemostasis, visualization, and triangulation is performed with standard arthroscopic instrumentation. The anatomy of, indications for, and advantages of this techniques are described.

Ocular motility in Parkinson's disease.

INTRODUCTION: Parkinson's disease is associated with multiple abnormalities of both the afferent and efferent visual systems. Blepharospasm, paucity of blinking, apraxia of lid opening, visual neglect, reduced vergence, reduced upgaze, and blurred vision are reported findings in these patients. The association of these findings with the disease, and their duration, severity, and treatment have not been systematically investigated. PATIENTS AND METHODS: Patients with Parkinson's disease were prospectively examined. An age-matched control group was recruited from accompanying family members and volunteers. Data recorded included presence of visual complaint, the severity of the Parkinson's disease by Hoehn and Yahr Stage (scale = 1 to 5), duration of disease, pharmacologic therapy, visual acuity, ocular motility, accommodation, convergence amplitudes, and the near point of convergence. RESULTS: Thirty-nine patients were entered into each group, each with 21 men and 18 women. The average patient had had the disease for 8.9 years with a severity index of 2.6. Asthenopia, upgaze deficiency, and convergence insufficiency were significantly more common in the patients with Parkinson's disease than in the controls. Mean geometric visual acuity was poorer in the Parkinson's patients (20/39 compared with 20/28); P < .001). DISCUSSION: Visual complaints were significantly more common in the Parkinson's patients than in the age-matched controls. The frequency of ocular abnormalities was not related to the duration of the disease. Increasing severity seemed to be correlated with the presence of convergence insufficiency and a decline in acuity.