Emerging and Novel Viruses in Passerine Birds.

There is growing interest in emerging viruses that can cause serious or lethal disease in humans and animals. The proliferation of cloacal virome studies, mainly focused on poultry and other domestic birds, reveals a wide variety of viruses, although their pathogenic significance is currently uncertain. Analysis of viruses detected in wild birds is complex and often biased towards waterfowl because of the obvious interest in avian influenza or other zoonotic viruses. Less is known about the viruses present in the order Passeriformes, which comprises approximately 60% of extant bird species. This review aims to compile the most significant contributions on the DNA/RNA viruses affecting passerines, from traditional and metagenomic studies. It highlights that most passerine species have never been sampled. Especially the RNA viruses from Flaviviridae, Orthomyxoviridae and Togaviridae are considered emerging because of increased incidence or avian mortality/morbidity, spread to new geographical areas or hosts and their zoonotic risk. Arguably poxvirus, and perhaps other virus groups, could also be considered "emerging viruses". However, many of these viruses have only recently been described in passerines using metagenomics and their role in the ecosystem is unknown. Finally, it is noteworthy that only one third of the viruses affecting passerines have been officially recognized.

Avian Leukosis: Will We Be Able to Get Rid of It?

Avian leukosis viruses (ALVs) have been virtually eradicated from commercial poultry. However, some niches remain as pockets from which this group of viruses may reemerge and induce economic losses. Such is the case of fancy, hobby, backyard chickens and indigenous or native breeds, which are not as strictly inspected as commercial poultry and which have been found to harbor ALVs. In addition, the genome of both poultry and of several gamebird species contain endogenous retroviral sequences. Circumstances that support keeping up surveillance include the detection of several ALV natural recombinants between exogenous and endogenous ALV-related sequences which, combined with the well-known ability of retroviruses to mutate, facilitate the emergence of escape mutants. The subgroup most prevalent nowadays, ALV-J, has emerged as a multi-recombinant which uses a different receptor from the previously known subgroups, greatly increasing its cell tropism and pathogenicity and making it more transmissible. In this review we describe the ALVs, their different subgroups and which receptor they use to infect the cell, their routes of transmission and their presence in different bird collectivities, and the immune response against them. We analyze the different systems to control them, from vaccination to the progress made editing the bird genome to generate mutated ALV receptors or selecting certain haplotypes.

A Novel Dependoparvovirus Identified in Cloacal Swabs of Monk Parakeet (Myiopsitta monachus) from Urban Areas of Spain.

The introduction of invasive birds into new ecosystems frequently has negative consequences for the resident populations. Accordingly, the increasing population of monk parakeets (Myiopsitta monachus) in Europe may pose a threat because we have little knowledge of the viruses they can transmit to native naïve species. In this study, we describe a new dependoparvovirus detected by metagenomic analysis of cloacal samples from 28 apparently healthy individuals captured in urban areas of Madrid, Spain. The genomic characterization revealed that the genome encoded the NS and VP proteins typical of parvoviruses and was flanked by inverted terminal repeats. No recombination signal was detected. The phylogenetic analysis showed that it was closely related to a parvovirus isolated in a wild psittacid in China. Both viruses share 80% Rep protein sequence identity and only 64% with other dependoparvoviruses identified in Passeriformes, Anseriformes, and Piciformes and are included in a highly supported clade, which could be considered a new species. The prevalence was very low, and none of the additional 73 individuals tested positive by PCR. These results highlight the importance of exploring the viral genome in invasive species to prevent the emergence of novel viral pathogenic species.

Preoperative Progressive Pneumoperitoneum in the Treatment of Hernias With Loss of Domain. Our Experience in 50 Cases.

Introduction: Surgical planning for repair of giant hernias with loss of domain needs to consider patient comorbidities, potential risks and possible postoperative complications. Some postoperative complications are related to the increase in intra-abdominal pressure caused by the reintroduction of abdominal contents into the peritoneal space. Preoperative progressive pneumoperitoneum (PPP) increases the capacity of abdominal cavity prior to hernia repair and allows for better physiological postoperative adaptation. The aim of this study is to analyze perioperative and intraoperative characteristics as well as outcomes of a cohort of patients treated with PPP prior to giant hernia repair at a single, high volume center. Methods: Prospective, descriptive, observational single-center study including 50 patients undergoing PPP prior to hernia with loss of domain repair between January 2005 and June 2022. We analysed epidemiological, surgical and safety variables. Results: Fifty patients were included: 43 incisional hernias, 6 inguinal hernias and 1 umbilical hernia. Mean age was 66 years (36-85). Median insufflation time was 12 days (4-20) and median insufflated volume of ambient air was 10,036 cc. There were complications during PPP in nine patients: 2 decompensation of chronic respiratory disease and 7 subcutaneous emphysema. PPP was prematurely suspended in patients with respiratory decompensation. All patients with incisional and umbilical hernias underwent open repair with mesh placement. Preperitoneal repair was performed in inguinal hernias. Three cases of hernia recurrence were reported during the follow up. Conclusion: PPP is a safe and effective tool in the preoperative management of patients with giant hernias. It helps to achieve the decrease or absence of abdominal wall tension and can favour the results of complex eventroplasty techniques.

Comparison of Endogenous Alpharetroviruses (ALV-like) across Galliform Species: New Distant Proviruses.

The Genus Alpharetrovirus contains viruses pathogenic mainly for chickens, forming the Avian Sarcoma and Leukosis Virus group (ASLV). Cells of most Galliform species, besides chickens, contain genetic elements (endogenous retroviruses, ERVs) that could recombine with other alpharetroviruses or express proteins, complementing defective ASLV, which may successfully replicate and cause disease. However, they are quite unknown, and only ALV-F, from ring-necked pheasants, has been partially published. Upon scrutiny of 53 genomes of different avian species, we found Alpharetrovirus-like sequences only in 12 different Galliformes, including six full-length (7.4-7.6 Kbp) and 27 partial sequences. Phylogenetic studies of the regions studied (LTR, gag, pol, and env) consistently resulted in five almost identical clades containing the same ERVs: Clade I (presently known ASLVs); Clade II (Callipepla spp. ERVs); Clade IIIa (Phasianus colchicus ERVs); Clade IIIb (Alectoris spp. ERVs); and Clade IV (Centrocercus spp. ERVs). The low pol identity scores suggested that each of these Clades may be considered a different species. ORF analysis revealed that putatively encoded proteins would be very similar in length and domains to those of other alpharetroviruses and thus potentially functional. This will undoubtedly contribute to better understanding the biology of defective viruses, especially in wild Galliformes, their evolution, and the danger they may represent for other wild species and the poultry industry.

Is pedagogical training an essential requirement for inclusive education? The case of faculty members in the area of Social and Legal Sciences in Spain.

INTRODUCTION: This study investigates the profiles of 25 faculty members of the area of Social and Legal Sciences, from seven Spanish universities, who were selected by students with disabilities. Specifically, the aim of this paper is to understand why, despite their lack of pedagogical and disability training, they are considered to be inclusive faculty members. OBJECTIVE: For this purpose, we analysed the professional characteristics of these academics, their conceptions about disability, what actions they carry out to provide an inclusive response and how they consider that the current situation of university students with disabilities could be improved. METHODS: Semi-structured individual interviews were used to collect the data. Subsequently, a progressive analysis of the data was performed, using an inductive system of categories and codes. RESULTS AND CONCLUSIONS: The results show that these faculty are responsible, involved and committed to their teaching performance. Moreover, they regard reasonable adjustments as a fundamental requirement to handle the different needs of students with disabilities. This paper-which can also be useful for faculty and researchers in other areas of knowledge-comes to the conclusion that training is relevant for becoming an inclusive faculty member. Nevertheless, good will and eagerness to do one's job properly are even more important aspects.

Unidad de Hospitalización a Domicilio del paciente quirúrgico durante la pandemia de la COVID-19 / Home Hospitalization Unit of Surgical Patients During the COVID-19 Pandemic

INTRODUCCIÓN: la pandemia de la COVID-19 ha puesto a prueba sistemas sanitarios a nivel mundial. Desde el servicio de Cirugía General y ante la disminución de camas de hospitalización surgió la necesidad de planificar y organizar una estrategia para la hospitalización y cuidado de pacientes quirúrgicos. La hospitalización a domicilio (HAD) es una modalidad asistencial eficaz en patología médica y quirúrgica donde, por un tiempo limitado, personal sanitario realiza tratamiento y seguimiento de pacientes en su domicilio. OBJETIVO: describir nuestra experiencia de HAD en el paciente quirúrgico durante la pandemia de la COVID-19. MÉTODO: estudio observacional, descriptivo, prospectivo, unicéntrico. 44 pacientes en HAD del 11 de Marzo al 10 de Mayo de 2020. Se incluyeron pacientes sometidos a cirugía urgente, programada y pacientes quirúrgicos con tratamiento conservador o intervencionismo. Se evaluaron variables epidemiológicas, motivo de ingreso, tratamiento, estancia media, tasa de reingresos, complicaciones y mortalidad. RESULTADOS: edad media 64 años ± 16,7 (23-89). 52% hombres y 49% mujeres. 23 pacientes con cirugía urgente o programada, 12 tratamiento conservador, 2 drenaje torácico, 5 drenaje percutáneo y 2 terapia de presión negativa para cura de herida quirúrgica. Estancia media 8,6 días ± 3,6 (1-19). Registradas 5 complicaciones: suboclusión, rectorragia, enfisema subcutáneo, absceso pulmonar e infección por COVID-19. 2 pacientes reingresaron. CONCLUSIONES: La HAD es un modelo seguro y eficaz para disminuir la estancia hospitalaria en pacientes quirúrgicos seleccionados. La combinación de ingreso de corta estancia e ingreso en régimen de HAD podría ser una buena opción en el postoperatorio y recuperación de pacientes quirúrgicos

INTRODUCTION: current COVID-19 pandemic is testing healthcare systems at a global level. From General Surgery Department we decided to provide a practical strategy for surgical patients' hospitalization that allowed to treat them as if they were admitted in hospital. Home Hospitalization is an effective healthcare modality in medical and surgical pathology in which, for a limited time, health practitioners provide active treatment at patient's home. The aim of this study is to describe our experience of home care hospitalization in surgical patients during the covid-19 pandemic. METHOD: Observational, descriptive, prospective, single-center study. 44 patients admitted to surgical home hospitalization unit from March 11 to May 10 2020. Patients with emergency or elective surgery and surgical patients who required conservative medical treatment or interventionism were included. Epidemiological variables, diagnosis, treatment, mean stay, readmissions rate, complications and mortality were evaluated. RESULTS: Mean age 64 years ± 16,7 (23-89). 52% men and 49% women. 23 patients underwent emergency or elective surgery, 12 patients conservative medical treatment, 2 thoracic drainage, 5 percutaneous drainage due to intra-abdominal abscesses and 2 patients with negative pressure therapy for surgical wound healing. Mean hospital stay 8,6 days ± 3,6 (1-19). Five complications were registered: subocclusion, colo-rectal bleeding, subcutaneous emphysema, lung abscess and a COVID-19 infection. Readmissions rate: 4,5%. CONCLUSIONS: Home hospitalization is an effective model to decrease or avoid hospital stay in selected patients. It also appears to be as safe as inpatient hospitalization. Combination of short-stay admission and home admission could be a good therapeutic option in surgical patients

Comparative Metagenomics of Palearctic and Neotropical Avian Cloacal Viromes Reveal Geographic Bias in Virus Discovery.

Our understanding about viruses carried by wild animals is still scarce. The viral diversity of wildlife may be best described with discovery-driven approaches to the study of viral diversity that broaden research efforts towards non-canonical hosts and remote geographic regions. Birds have been key organisms in the transmission of viruses causing important diseases, and wild birds are threatened by viral spillovers associated with human activities. However, our knowledge of the avian virome may be biased towards poultry and highly pathogenic diseases. We describe and compare the fecal virome of two passerine-dominated bird assemblages sampled in a remote Neotropical rainforest in French Guiana (Nouragues Natural Reserve) and a Mediterranean forest in central Spain (La Herrería). We used metagenomic data to quantify the degree of functional and genetic novelty of viruses recovered by examining if the similarity of the contigs we obtained to reference sequences differed between both locations. In general, contigs from Nouragues were significantly less similar to viruses in databases than contigs from La Herrería using Blastn but not for Blastx, suggesting that pristine regions harbor a yet unknown viral diversity with genetically more singular viruses than more studied areas. Additionally, we describe putative novel viruses of the families Picornaviridae, Reoviridae and Hepeviridae. These results highlight the importance of wild animals and remote regions as sources of novel viruses that substantially broaden the current knowledge of the global diversity of viruses.

Clinical and Hematological Follow-Up of Long-Term Oral Therapy with Type-I Interferon in Cats Naturally Infected with Feline Leukemia Virus or Feline Immunodeficiency Virus.

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV), two of the most important pathogens of cats, produce chronic systemic diseases with progressive death of cells involved in the immune response, ultimately leading to death. Immunostimulants is one of the few alternatives to the symptomatic treatment. In this study, 27 naturally FeLV-infected (FeLV+) and 31 naturally FIV-infected (FIV+) cats were administered orally by their owners 60 IU/day of recombinant human interferon alpha (rHuIFN-α) for four months in alternate weeks. Clinical status was evaluated and blood samples collected at four different visits or months (M): pretreatment (M0), mid-treatment (M2), end of treatment (M4), and 4-8 months after end of treatment (M10). Most cats ostensibly improved their clinical status, and many became asymptomatic. rHuIFN-α treatment improved the anemic processes observed at M0 (at least in cats with mild or moderate anemia) and leukocyte counts, including a more favorable CD4+/CD8+ ratio. An increase in the serum gammaglobulin concentration was seen in 80% of the cats. Despite observing an obvious favorable progress in the clinical, biopathological, and CD4+/CD8+ values during treatment, almost invariably all the parameters analyzed worsened after treatment discontinuation (M10), which suggests that the interferon-α protocol should be either extended or include additional cycles for a long-lasting benefit in FeLV+ and FIV+ cats.

A Novel and Divergent Gyrovirus with Unusual Genomic Features Detected in Wild Passerine Birds from a Remote Rainforest in French Guiana.

Sequence-independent amplification techniques have become important tools for virus discovery, metagenomics, and exploration of viral diversity at the global scale, especially in remote areas. Here, we describe the detection and genetic characterization of a novel gyrovirus, named GyV11, present in cloacal, oral, and blood samples from neotropical wild birds in French Guiana. The molecular epidemiology revealed the presence of GyV11 only in passerine birds from three different species at a low prevalence (0.73%). This is the first characterization and prevalence study of a gyrovirus carried out in resident wild bird populations in a remote region, and provides evidence of the fecal-oral route transmission and local circulation of the virus. The molecular phylogeny of gyroviruses reveals the existence of two distinct gyrovirus lineages in which GyV11 is phylogenetically distinct from previously reported gyroviruses. Furthermore, GyV11 is placed basal in the gyrovirus phylogeny, likely owing to its ancestral origin and marked divergence. This study also provides important insights into the ecology, epidemiology, and genomic features of gyroviruses in a remote neotropical rainforest. The pathogenesis of this virus in avian species or whether GyV11 can infect humans and/or chickens needs to be further investigated.

Frailty syndrome is associated with changes in peripheral inflammatory markers in prostate cancer patients undergoing androgen deprivation therapy.

OBJECTIVE: To evaluate the role of peripheral inflammation (leukocyte differential count, the proinflammatory cytokines IL-beta, TNF-α, IL-6, IL-8, and the inflammatory markers fibrinogen and C-reactive protein [CRP]) in frailty syndrome in patients with prostate cancer (CaP) undergoing antiandrogen therapy (ADT). METHODS: A total of 46 men between 51 and 92 years of age with CaP and receiving ADT were classified as frail, prefrail or robust according to the Fried scale. A geriatric assessment was performed, based on the Minimental State Examination for cognitive function, the Barthel index for basic activities of daily living, the Yesavage scale for geriatric depression, and the Athens insomnia scale. In addition, blood samples were collected to assess peripheral inflammation biomarkers including proinflammatory cytokines, fibrinogen, CRP and leukocyte differential count, as well as other biochemical and hematological parameters. RESULTS: A significant negative correlation between the severity of frailty syndrome and lymphocyte count was observed (P < 0.01). The concentration of IL-6 (P < 0.05), CRP (P < 0.05), and fibrinogen (P < 0.01) were significantly associated with frailty syndrome, but not of TNF-α, IL-beta, or IL-8. The severity of frailty syndrome was not dependent upon the clinical disease stage at diagnosis, the time elapsed since CaP diagnosis, the presence of metastases, or prostatectomy. CONCLUSIONS: Further research into the role of leukocyte subtypes and peripheral inflammation and the associated adverse outcomes in patients with CaP under ADT is warranted in order to tailor interventions aimed at reducing symptoms of frailty syndrome, such as loss of muscle strength and low physical activity.

Follow-Up of Viral Parameters in FeLV- or FIV-Naturally Infected Cats Treated Orally with Low Doses of Human Interferon Alpha.

Specific treatments for the long-life infections by feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are either toxic, expensive or not too effective. Interferon α (IFN-α) is an immunomodulatory molecule which has been shown in vitro to decrease the release of infective particles. The aim of this study was to follow the progress of the clinical score and viral parameters of FeLV- and FIV-naturally infected privately owned cats treated with recombinant human IFN-α (rHuIFN-α, Roferon-A). Twenty-seven FeLV-infected cats (FeLV+) and 31 FIV-infected cats (FIV+) were enrolled in the study. Owners were instructed to orally administer 1 mL/day of 60 IU rHuIFN-α/mL in alternating weeks for four months. Blood samples were taken at the beginning of the study (M0), mid-treatment (M2), end of treatment (M4), and 6-10 months later (M10). Clinical status at these time points improved notably with rHuIFN-α treatment, regardless of the initial severity of the disease, an effect which lasted throughout the study in most animals (15 of the 16 FeLV+ symptomatic cats; 20 of the 22 FIV+ symptomatic cats) improved markedly their clinical situation. In FeLV+ cats plasma antigenemia (p27CA), reverse transcriptase (RT) activity, and proviral load decreased at M2 and M4 but increased again at M10 ("rebound effect"). The level of antigenemia or RT activity was below the detection limits in FIV+ cats, and the effect on proviral load was less marked than in FeLV+ cats. Taken together, these results indicate that rHuIFN-α is a good candidate for treating FeLV+ cats, but the "rebound effect" seen when treatment was discontinued suggests that additional studies should be conducted to clarify its effect on progression of the infection in cats.

A novel group of avian astroviruses from Neotropical passerine birds broaden the diversity and host range of Astroviridae.

Metagenomics is helping to expand the known diversity of viruses, especially of those with poorly studied hosts in remote areas. The Neotropical region harbors a considerable diversity of avian species that may play a role as both host and short-distance vectors of unknown viruses. Viral metagenomics of cloacal swabs from 50 Neotropical birds collected in French Guiana revealed the presence of four complete astrovirus genomes. They constitute an early diverging novel monophyletic clade within the Avastrovirus phylogeny, representing a putative new astrovirus species (provisionally designated as Avastrovirus 5) according to the International Committee on Taxonomy of Viruses (ICTV) classification criteria. Their genomic organization shares some characteristics with Avastrovirus but also with Mamastrovirus. The pan-astrovirus RT-PCR analysis of the cloacal samples of 406 wild Neotropical birds showed a community-level prevalence of 4.9% (5.1% in passerines, the highest described so far in this order of birds). By screening birds of a remote region, we expanded the known host range of astroviruses to the avian families Cardinalidae, Conopophagidae, Furnariidae, Thamnophilidae, Turdidae and Tyrannidae. Our results provide important first insights into the unexplored viral communities, the ecology, epidemiology and features of host-pathogen interactions that shape the evolution of avastroviruses in a remote Neotropical rainforest.

Prospects in Innate Immune Responses as Potential Control Strategies against Non-Primate Lentiviruses.

Lentiviruses are infectious agents of a number of animal species, including sheep, goats, horses, monkeys, cows, and cats, in addition to humans. As in the human case, the host immune response fails to control the establishment of chronic persistent infection that finally leads to a specific disease development. Despite intensive research on the development of lentivirus vaccines, it is still not clear which immune responses can protect against infection. Viral mutations resulting in escape from T-cell or antibody-mediated responses are the basis of the immune failure to control the infection. The innate immune response provides the first line of defense against viral infections in an antigen-independent manner. Antiviral innate responses are conducted by dendritic cells, macrophages, and natural killer cells, often targeted by lentiviruses, and intrinsic antiviral mechanisms exerted by all cells. Intrinsic responses depend on the recognition of the viral pathogen-associated molecular patterns (PAMPs) by pathogen recognition receptors (PRRs), and the signaling cascades leading to an antiviral state by inducing the expression of antiviral proteins, including restriction factors. This review describes the latest advances on innate immunity related to the infection by animal lentiviruses, centered on small ruminant lentiviruses (SRLV), equine infectious anemia virus (EIAV), and feline (FIV) and bovine immunodeficiency viruses (BIV), specifically focusing on the antiviral role of the major restriction factors described thus far.

Maedi-Visna virus: current perspectives.

Maedi-Visna virus (MVV) and caprine arthritis-encephalitis virus are commonly known as small ruminant lentiviruses (SRLVs) due to their genetic, structural, and pathogenic similarities. They produce lifelong lasting infections in their hosts, which are characterized by slow progression till overt disease happens. There are four major clinical forms derived from a chronic inflammatory response due to the constant low grade production of viruses from monocyte-derived macrophages: respiratory (caused by interstitial pneumonia), mammary (which may produce a decrease in milk production due to subclinical mastitis), joint (characterized by lameness), and neurological (characterized by chronic nonpurulent meningoencephalomyelitis). There are three levels which try to eliminate the virus: cellular, body, and the flock level. However, SRLVs have ways to counteract these defenses. This review examines some of them.

Vínculos familiares e inclusión social. Variables predictoras de la conducta prosocial en la infancia / Family linkages and social inclusion. Predictors of prosocial behavior in childhood

Los objetivos de esta investigación son analizar las relaciones de la conducta prosocial con variables del entorno familiar (apego y abandono del padre y de la madre), variables personales (inestabilidad emocional, agresividad y afrontamiento ante situaciones estresantes) y variables del entorno social próximo (aceptación y rechazo por los pares); además, estudiar las variables predictoras de la conducta prosocial. La conducta prosocial constituye un factor de protección personal que fomenta relaciones positivas entre los pares y promueve comportamientos de adaptación personal y social (Mikolajewski, Chavarria, Moltisanti, Hart & Taylor, 2014). Han participado 1447 niños/as (50.4% varones y 49.6% mujeres). Tienen entre 7 y 12 años (M = 9.27; DT = 1.36). Los resultados comprueban las relaciones positivas de la conducta prosocial con apego (padre y madre), afrontamiento funcional y aceptación por los pares. Asimismo, muestran las relaciones negativas de la conducta prosocial con abandono (padre y madre), inestabilidad emocional, agresividad, afrontamiento disfuncional y rechazo por los pares. Las variables predictoras de la conducta prosocial son, en positivo, apego de la madre, afrontamiento funcional y expectativas de aceptación por los pares; y, en negativo, son inestabilidad emocional, agresividad física y verbal, y expectativas de rechazo por los pares. Se discuten las implicaciones educativas

The purpose of this study was to investigate the relationship between prosocial behavior and family environment variables (attachment to the mother and father and abandonment by the mother and father), personal variables (emotional instability, aggression, and coping strategies), and variables that relate to the immediate social environment (peer acceptance and rejection). This study also examined the predictors of prosocial behavior. Prosocial behavior is a personal protective factor that encourages positive relationships between peers and promotes personal and social adjustment behaviors (Mikolajewski, Chavarria, Moltisanti, Hart & Taylor, 2014). A study with a sample of 1,447 children (50.4% male and 49.6% female) aged between 7 and 12 years (M = 9.27; SD = 1.36) was conducted. The results confirmed the positive relationships between prosocial behavior and parental attachment, functional coping, and peer acceptance. The results also confirmed the negative relationships between prosocial behavior and abandonment by the parents, emotional instability, aggression, dysfunctional coping, and peer rejection. The positive predictor variables for prosocial behavior were attachment to the mother, functional coping, and expectations of peer acceptance. The negative predictor variables for prosocial behavior were emotional instability, physical and verbal aggression, and expectations of peer rejection. The findings have educational implications, which are discussed herein

Subjective and objective sleep quality in elderly individuals: The role of psychogeriatric evaluation.

Aging affects sleep and sleep problems are common in older individuals. However, the relationship between objective and subjective tools for analysing sleep and psycho-geriatric variables have not been tested in institutionalised older individuals. This work analyses sleep quality by using actigraphy as an objective tool and validates the Athens and Oviedo sleep questionnaires in octogenarian elderly individuals as subjective scales of sleep perception. All patients wore an actigraph device for one week and then completed the Athens and Oviedo clinical sleep-evaluation questionnaires. Morning cortisol levels in blood plasma and saliva samples were also measured to assess the association between objective and reported sleep patterns. Age, gender, and psycho-geriatric evaluations, including Barthel, Tinetti, and Mini-Mental scale measurements were analysed as variables with the potential to confound the strength of any such associations. There was a significant inverse correlation between the number of awakenings and the time spent awake during night assessed by actigraphy and the total Oviedo questionnaire score, but no significant associations for the other parameters. The blood cortisol concentration appears to be a marker of insomnia related to sleep times of less than four hours and diagnosis of insomnia based on Athens scale and thus, represents a potential marker for sleep interventions.

Sleep Alterations in Non-demented Older Individuals: The Role of Cortisol.

BACKGROUND: Sleep alterations can impair quality of life and contribute to disease progression but they, and their features and contributing factors, are rarely analysed in institutionalised older individuals. In this study, we investigated sleep alterations, the factors involved, and the role of cortisol in sleep-related problems in institutionalised individuals. METHODS: We conducted a descriptive cross-sectional study in participants living in nursing homes in Valencia (Spain); sleep alterations were determined based on two validated tools: the Athens insomnia scale and Oviedo sleep questionnaire. Plasma cortisol was measured in the morning and determined by high performance liquid chromatography-mass spectroscopy, along with other blood analytical parameters. We also analysed any confounding factors (sleep duration, morning awakening time, intake of hypnotic and psychotropic medication, and cognitive function). RESULTS: The mean age was 82.5 years (range: 65-99); approximately 80% were women and sleep alterations were present in 25-60% of the population, depending on the scale used or type of sleep disorder considered. There was no significant correlation between morning cortisol concentrations and sleep disorders, sex, age, or psychotropic drug ingestion (including hypnotic drugs). However, there was a significant correlation between cortisol and an Oviedo questionnaire subscale for evaluating insomniarelated adverse events, which remained significant after adjusting for multiple potentially confounding factors. CONCLUSION: Sleep disorders are common in institutionalised older individuals and are not related to sleep duration or decreased by ingestion of hypnotic medications. There is a significant relationship between morning cortisol levels in blood and insomnia-related sleep disorders (e.g. snoring with awakenings, nightmares, restless legs syndrome, etc.) but not directly with insomnia or hypersomnia.

Cerebral palsy: the meaning of physical therapy for mother caregivers / Paralisia cerebral: o significado da fisioterapia na visão de mães cuidadoras

Abstract Introduction: Exercise therapy, as applied by a physiotherapist, aims to improve the acquisition of functional skills by children with cerebral palsy (CP). Treatment instructions are given to mothers, but are frequently not followed. Objective: To get to know the meaning of the role of physiotherapy in the treatment of children with CP, according to their mothers' perception; and to check mothers' compliance with physiotherapists' recommendations at home. Methods: This was a qualitative study. Interviews were conducted with 11 mother caregivers. Data were collected through interviews based on a guide questions about the meaning of the role of physiotherapy in the treatment of children with CP, and about the continuity of care outside the outpatient setting. All the interviews were recorded, transcribed and analyzed using Bardin's content analysis technique. Results: These women have a positive perception of the physical therapy treatment; they value and recognize the benefits, by emphasizing that it provides for the physical, psychological and social recovery of their children. Mothers are aware of the benefits of treatment and that it is important to continue treatment at home. They show themselves willing and able to implement the recommendations given by the physical therapist, and demonstrate their constant concern for the welfare of their children. Conclusion: Physiotherapists should work more intensively with mothers who fail to adhere to home treatment programs. They should try and identify the reasons for their non-compliance, offer them guidance, advice, and assistance in order to clarify doubts and help solve difficulties faced by caregivers.

Resumo Introdução: O fisioterapeuta busca melhorar a aquisição das habilidades funcionais da criança com paralisia cerebral. São repassadas orientações importantes sobre o tratamento para as mães, que muitas vezes não são seguidas. Objetivo: Conhecer o significado do tratamento fisioterapêutico para a recuperação de crianças com diagnóstico de paralisia cerebral, partindo do olhar de suas mães; verificar se essas mulheres cumprem as orientações fisioterapêuticas no ambiente domiciliar. Métodos: Trata-se de um estudo qualitativo descritivo-exploratório. Foram realizadas entrevistas com 11 mães cuidadoras. A coleta de dados foi realizada por meio de uma entrevista semiestruturada baseada em perguntas norteadoras relacionadas ao significado da fisioterapia na vida da criança acometida sob o ponto de vista da mãe e sobre a continuidade do tratamento fora do ambiente ambulatorial. As entrevistas foram gravadas, transcritas, e analisadas com o Método da Análise do Conteúdo de Bardin. Resultados: Foi possível constatar que estas mulheres têm uma percepção positiva do tratamento fisioterapêutico na vida do filho; valorizam e reconhecem os benefícios do tratamento, enfatizando a recuperação da criança no aspecto físico, psicológico e social. Observou-se a conscientização dessas mulheres sobre o tratamento e sua continuidade domiciliar; elas se mostram disponíveis e ativas na execução das orientações passadas, demonstrando-se preocupadas em sempre oferecer auxílio em benefício do filho. Conclusão: O fisioterapeuta deve atuar de forma mais intensiva nos casos de não adesão ao tratamento domiciliar, buscando identificar a causa da não realização das atividades, orientando, aconselhando, e oferecendo suporte para sanar dúvidas e dificuldades enfrentadas por essas cuidadoras.

Dermatofibrosarcoma protuberans en pacientes pediátricos / Dermatofribosarcoma protuberans in pediatric patients

Antecedentes y Objetivos. Presentamos 3 casos de dermatofibrosarcoma protuberans (DFSP) en pacientes pediátricos para documentar la presentación clínica poco frecuente de esta patología. Pacientes y Método. Realizamos un análisis descriptivo retrospectivo de los 3 últimos casos de DFSP en nuestro centro durante los años 2010 - 2013. Resultados. Una niña de 12 años remitida desde otra institución por DFSP en parte distal del muslo, en la que ampliamos bordes quirúrgicos de resección en 3 cm y practicamos cobertura con dermis artificial e injerto autólogo; tras 1 año de observación sin recidiva, realizamos reconstrucción del defecto mediante injertos autólogos de grasa. Otra niña de 12 años diagnosticada de Síndrome de Hamartomatosis Múltiple asociado al gen PTEN, que presentó DFSP en labio mayor derecho y en mama derecha, recidivante en esta última localización. Por último, un DFSP congénito en una paciente remitida a los 3 meses de vida con tumoración gigante de pared abdominal. El diagnóstico orientativo inicial con resonancia magnética con gadolino, solo se confirmó finalmente por los hallazgos histopatológicos de la pieza de resección; ni la punción aspiración ni la biopsia cutánea lograron confirmar el diagnóstico. Conclusiones. El DFSP es un tipo de sarcoma raro de la piel del niño y del adulto, localmente agresivo y con una alta tasa de recidiva. La escisión local amplia puede provocar mutilaciones y desfigurar al paciente; por ello la cirugía micrográfica de Mohs permite reducir los márgenes quirúrgicos (AU)

Background and Objectives. We present 3 cases of dermato fibro sarcoma protuberans (DFSP) to document the unusual clinical presentation of this condition in pediatric patients. Patients and Methods. We conduct a retrospective descriptive analysis of the last 3 cases of DFSP treated in our institution during years 2010-2013. Results. A 12-year-old girl referred from another institution for DFSP in distal thigh; we practised surgical margins extended 3 cm resection and cover with artificial dermis and autologous graft; after 1 year follow up without recurrence, reconstruction of the defect was performed using autologous fat grafts. Another 12-year-old girl diagnosed of Multiple Hamartoma Syndrome associated with PTEN gene, who presented DFSP at the right labia major and at the right breast, being recurrent in this last location. Finally, a congenital DFSP in a patient referred at 3 months with giant tumour of abdominal wall. The initial diagnosis was made by MRI with gadolinium. The final diagnosis of DFSP was made based on histopathological findings of the piece following surgical resection, because percutaneous biopsy or skin biopsy couldn´t confirm the diagnostic. Conclusions. DFSP is a rare type of sarcoma of the skin in children and adults, locally aggressive, with a high rate of recurrence. Wide local excision may cause maiming and disfiguring to the patient, thereby Mohs micrographic surgery (CMM) enables to reduce surgical margins (AU)