Lateral wedge insoles and their use in ankle instability.

The aim of the present study is to assess the immediate effects of applying lateral wedge insoles of different heights (0.00, 0.3, 0.4, and 0.6 cm) in patients with chronic ankle instability (CAI) in normal and supinated feet during a Star Excursion Balance Test (SEBT) and in the reflex response of Peroneus Longus (PL), Peroneus Brevis (PB), and Tibialis Anterior (TA) over a 30° inversion of the feet. The effects of the height of the wedges were assessed using a double-blind, crossover design. In total, 25 participants were allocated into two groups, depending on the foot posture (Normal = 12, Supinated = 13) and performed the tests in a random fashion. Reaction time (RT) of stabilizing muscles of the ankle was measured using superficial electromyography (EMG) and postural balance with the SEBT. Foot posture did not show any significant effects on the analyzed variables. Nonetheless, the use of a 0.3 cm external rearfoot wedge (PB p = 0.002; PL p = 0.066 and TA p = 0.006) and 0.6 cm (PB p = 0.043; PL p = 0.058 and TA p = 0.071) reduces RT in stabilizing muscles of the ankle and improves results in SEBT, except for the anterolateral direction, in subjects with CAI. Therefore, our results suggest that the use of lateral wedge insoles could reduce RT and improve dynamic balance in chronic ankle instability.

Safety Aspects of Perinatal Ultrasound.

Ultrasound safety is of particular importance in fetal and neonatal scanning. Fetal tissues are vulnerable and often still developing, the scanning depth may be low, and potential biological effects have been insufficiently investigated. On the other hand, the clinical benefit may be considerable. The perinatal period is probably less vulnerable than the first and second trimesters of pregnancy, and ultrasound is often a safer alternative to other diagnostic imaging modalities. Here we present step-by-step procedures for obtaining clinically relevant images while maintaining ultrasound safety. We briefly discuss the current status of the field of ultrasound safety, with special attention to the safety of novel modalities, safety considerations when ultrasound is employed for research and education, and ultrasound of particularly vulnerable tissues, such as the neonatal lung. This CME is prepared by ECMUS, the safety committee of EFSUMB, with contributions from OB/GYN clinicians with a special interest in ultrasound safety.

EFSUMB Clinical Safety Statement for Diagnostic Ultrasound - (2019 revision).

This document is the updated 2019 revision of the EFSUMB Clinically Safety Statement. A Safety Statement has been published by EFSUMB annually since 1994 by the Safety Committee (ECMUS) of the federation. The text is deliberately brief and gives a concise overview of safety in the use of diagnostic ultrasound.

Miocardiopatía no compactada asociada a síndrome 1P36 / Non-compaction cardiomyopathy associated to 1P36 syndrome

La miocardiopatía no compa da (MNC) es una enf medad congénita caracterizada por la ausencia de compaqctación del miocardio ventricular. Tiene una gran variabilidad genética, clinica, evolutiva y pronóstica. Presentamos a una recién nacida pretérmino (34 semanas) con restrición del crecimiento intrauterino, fenotipo peculiar, hipotonia generalizada y distrés respiratono. La ecocardiografía objetiva ausencia de compactación del ventrículo izquierdo y disfunción sistólica leve, que se trata con captopril y ácido acetilsalicílico. Desarrolla crisis convulsivas parciales resistentes al tratamiento y se evidencia ausencia de respuesta en potenciales auditivo-visuales del tronco del encéfalo. El cariotipo convencional es normal pero el estudio de microarrays revela deleción 1p36.33-p36.23. El estudio carddiológico y genético de los progenitores es normal. El conocimiento de esta cardiopatía permite un diagnóstico precoz. Debe realizarse despistaje a familiares de primer grado. Dada la frecuente asociación entre MNC y síndrome 1p36 recomendamos incluir estudio genético mediante microarrays en pacientes con sospecha de asociación sindrómica y normalidad en el cariotipo convencional, como en el caso que presentamos (AU)

The non-compaction cardiomypathy (MNC) is a congenital disorder characterized by the absence of the compaction ventricular myocardium. It presents a high variability, genetic, clinical, evolutionary and prognostic. We report a preterm newborn (34 weeks) with intrauterine growth restriction particular phenotype, generalized hypotonia and respiratory distress. Echocardiography objective absence of compaction left ventricular myocardium and mild sistolic dysfunction, treated with captopril and acetylsalicylic acid. Develops resistant treatment partial seizurcs and lack response evident in visual-auditory evoked potentials brainstem. The conventional kariotype is normal but the microarray study revealed 1p.36-p36.23 deletion. Cardiological and genetic study of the parents are normal. Thebest knowledge of the MNC allows earlier diagnosis. Have to perform screening for first-degree relatives. Given the frequent association between MNC and lp36 syndrome, we recommend using microarray genetic study in patients with suspected syndromic association and normality in the conventional as in the case presented (AU)

The effects of intermittent hypoxia training on hematological and aerobic performance in triathletes.

The aim of the present research was to analyze modifications on hematological and aerobic performance parameters after a 7-week intermittent hypoxia training (IHT) program. Eighteen male trained triathletes were divided in two groups: an intermittent hypoxia training group (IHTG: n: 9; 26.0 ± 6.7 years; 173.3 ± 5.9 cm; 66.4 ± 5.9 kg; VO2max: 59.5 ± 5.0 ml/kg/min) that conducted a normoxic training plus an IHT and a control group (CG: n: 9; 29.3 ± 6.8 years; 174.9 ± 4.6 cm; 59.7 ± 6.8 kg; VO2max: 58.9 ± 4.5 ml/kg/min) that performed only a normoxic training. Training process was standardized across the two groups. The IHT program consisted of two 60-min sessions per week at intensities over the anaerobic threshold and atmospheric conditions between 14.5 and 15% FiO2. Before and after the 7-week training, aerobic performance in an incremental running test and hematological parameters were analyzed. After this training program, the IHTG showed higher hemoglobin and erythrocytes (p < 0.05) values than in the CG. In terms of physiological and performance variables, between the two groups no changes were found. The addition of an IHT program to normoxic training caused an improvement in hematological parameters but aerobic performance and physiological variables compared to similar training under normoxic conditions did not increase.

Effect of 6 weeks of whole body vibration training on total and segmental body composition in healthy young adults.

The applied use of new technologies to enhance performance and improve health has been increasing. Initially, whole body vibration training (WBVT) was used as system to improve elite athlete performance. However, this is also used to improve body composition, especially there is a great attention on the effectiveness of WBVT to reduce fat and body weight, with a potential increase in muscle tissue. The aim of this study was to investigate the effects of a 6-week vibration-training program on total and segmental body composition in a group of physically healthy participants. The final study sample included 64 healthy young adults. Subjects were randomly allocated into the control group (CG: n = 26; 16 males and 10 females) and the experimental group (EGWBVT: n = 38; 19 males and 19 females). The program lasted six weeks with a frequency of three sessions per week and each session varied in intensity. There were not found statistically significant differences in any of the body composition variables analysed. This study suggests that a six-week vibration-training program with an increasing intensity (7.2 g-32.6 g) in healthy young adults that are not overweight did not alter total and segmental body composition.

Adiponectin and graft vascular disease after cardiac transplantation.

Graft vascular disease (GVD) is a form of accelerated atherosclerosis that involves the transplanted heart, affecting more than 40% of patients after follow-up of 5 years. According to some authors, adiponectin concentration is a prognostic factor for progression of coronary atherosclerosis. Following this line of research, the objective of the present study was to analyze the relationship between adiponectin concentration and development of GVD in 52 cardiac transplant recipients. Patients were divided into 2 groups according to findings at intravascular ultrasound: group 1 with 21 patients without GVD, and group 2 with 31 patients with GVD. Patients with GVD were further divided into 2 additional groups according to results of coronary angiography: group 3 with 35 patients without GVD, and group 4 with 17 patients with any degree of GVD. No significant differences (P=.50) were observed insofar as adiponectin concentration between groups 1 and 2, and groups 3 and 4. Significant differences in adiponectin concentration were observed when the sex of the patient was considered (P=.002), with higher concentrations detected in women. Serious cardiac events were more common in patients with GVD (P=.001). Mean time between transplantation and diagnosis of GVD was 67 months in group 1, 107 months in group 2, 71 months in group 3, and 101 months in group 4. Significant differences were observed between groups 1 and 2 (P=.030).

Preliminary experience with conversion from calcineurin inhibitors to everolimus in cardiac transplantation maintenance therapy.

INTRODUCTION: Everolimus has been prescribed both for initial and maintenance therapy after cardiac transplantation. Herein, we present our initial experience with everolimus as maintenance therapy after cardiac transplantation. METHODS: We retrospectively included all of our patients in whom therapy was changed from calcineurin inhibitors to everolimus between September 2006 and October 2007. We analyzed their baseline clinical characteristics, indications for conversion to everolimus therapy, and beneficial vs adverse effects of the maneuver. RESULTS: In 16 heart transplant recipients, therapy was changed to everolimus because of allograft vasculopathy (n = 8), renal failure (n = 4), or sirolimus toxicity (n = 4). Treatment with everolimus was initiated at a mean (SD) of 79.8 (52.7) months (range, 10-163 mo) after transplantation. The initial dose was 1.4 (0.2) mg (range, 1.0-1.5 mg), and the maintenance dose was 1 (0.31) mg (range, 0.5-1.5 mg). Follow-up was 7.28 (3.22) months (range, 0.5-13 mo). Observed side effects included hypertriglyceridemia, hypertension, and edema. Only 1 of 4 patients included because of sirolimus intolerance did not tolerate everolimus; renal dysfunction did not worsen in any of these 4 patients. No allograft vasculopathy was observed. CONCLUSIONS: Renal function seem to stabilize after conversion to everolimus therapy in patients with previous progressive dysfunction. The safety profile was proved in all patients, although conclusions cannot be established about the evolution of allograft vasculopathy.

Marcadores analíticos de enfermedad vascular del injerto en el trasplante cardiaco / Laboratory test markers of graft vascular disease in heart transplant patients

La enfermedad vascular del injerto (EVI) afecta a más del 40% de los pacientes trasplantados cardiacos a los 5 años de seguimiento y es la primera causa de muerte después del primer año postraplante cardiaco. El objetivo es demostrar la relación entre las concentraciones de adiponectina y otras citocinas con el desarrollo de EVI y sus distintos grados de severidad. Material y metodología: incluimos 21 pacientes a los que se realiza coronariografía-IVUS (ecografía intracoronaria) para el diagnóstico de EVI y determinamos las cifras de adiponectina. Tenían EVI por coronariografía 10 pacientes y por IVUS 14 pacientes. Resultados: No se encontraron diferencias estadísticamente significativas en los niveles de adiponectina en función de la existencia de EVI diagnosticada por coronariografía ni en función del grado de severidad de la EVI por IVUS. Se encontraron asociaciones estadísticamente significativas entre la existencia de EVI diagnosticada por IVUS y las concentraciones de IL-6 (p=0,025) con mayores concentraciones de IL6 en los que no tenían EVI o era de grado leve y entre la existencia de EVI por coronariografía y los niveles de BNP (p=0,014) con niveles más elevados de BNP en los que tenían EVI. Se encontró una relación entre el sexo y los niveles de adiponectina (p=0,025) con niveles superiores en las mujeres. Había una relación estadísticamente significativa entre la aparición de eventos cardiacos mayores (MACE) y la existencia de EVI diagnosticada por coronariografía (p=0,012) (AU)

Graft vascular disease (GVD) affects over 40% of all heart transplant patients after 5 years of follow-up, and is the first cause of death after the first post-transplantation year. A study is made of the relationship between the concentrations of adiponectin and other cytokines and the development of GVD and its different degrees of severity. Material and methods: The study included 21 patients subjected to coronariography-intravascular ultrasound (IVUS) for the diagnosis of GVD, with the determination of adiponectin levels. GVD was identified by coronariography in 10 patients and by IVUS in 14 patients. Results: There were no statistically significant differences in adiponectin levels according to the existence of GVD diagnosed by coronariography, or according to the severity of GVD as determined by IVUS. Statistically significant correlations were recorded between the presence of GVD diagnosed by IVUS and the concentrations of IL-6 (p=0.025), with higher IL-6 levels in those without GVD or with only mild GVD; and between the presence of GVD determined by coronariography and the levels of BNP (p=0.014) – higher levels of this protein being found in the patients with GVD. A relationship was observed between patient gender and adiponectin levels (p=0.025), with higher concentrations in women. A statistically significant relationship was seen between the appearance of major adverse cardiac events (MACEs) and the existence of GVD as diagnosed by coronariography (p=0.012) (AU)

La consulta médica auxiliada y los 10 minutos por paciente: la segunda reforma de la atención primaria en los últimos 20 años

No disponible

Movimiento versus ayudas técnicas en el anciano / Movement versus technique helps in the old man

No disponible

Dependencia en el anciano artrósico e intervención enfermera / Dependency in the arthrosic elderly and nursing intervention

La artrosis como enfermedad degenerativa osteoarticular incide de forma directa en la capacidad de independencia del individuo, sobre todo en el anciano. En este último se complejiza enormemente la respuesta ante la necesidad de desplazarse o de moverse condicionada, no ya solamente por factores orgánicos y fisiológicos, sino que, además, se intercalan aspectos de carácter psicológico, económico, social, cultural, etc. que convierten, no ya la necesidad sino incluso el placer del movimiento, en una verdadera tortura para el anciano amén de restar, considerablemente, su capacidad de independencia. Realizamos en el presente trabajo una valoración de dichos condicionantes en pacientes ancianos tributarios de tratamiento protésico en las articulaciones de la cadera y la rodilla, al tiempo que comprobamos la necesidad de implementar actuaciones enfermeras, en este tipo de pacientes, que rentabilicen mejor los recursos terapéuticos a través de una adecuada educación para la salud. (AU)

Validación clínico-estadística de cuantificación de superficies en úlceras por presión / Clinical-statistical validation of the quantification of bedsore surface

En el campo de los cuidados de enfermería dispensados a los pacientes portadores de úlceras por presión es necesario destacar los que inciden en el control y evolución de dichas lesiones mediante la medición y cuantificación de las superficies cutáneas que se ven incursas en la situación mencionada. En la bibliografía se recogen diversas alternativas para dar satisfacción a dicho requerimiento. Nosotros planteamos en este trabajo un estudio comparativo de diversos métodos de medición de las superficies cutáneas, en los pacientes afectos de úlceras por presión, que nos ha permitido descartar alguno de ellos tras el análisis estadístico correspondiente de las diversas variables. Por el contrario, con respecto a otros métodos de medición de superficies ulcerativas hemos comprobado su validación estadística aunque alguno de los utilizados ha mostrado menos exactitud que otro propuesto por nosotros concluyendo, finalmente, que es necesario aplicar un método que permita al profesional de enfermería alcanzar objetivos de rapidez, eficacia y fiabilidad así como la posibilidad del registro protocolizado (AU)

[Fibrous pseudotumor of the testis: description of a case]. / Pseudotumor fibroso de testículo: descripción de un caso.

A case of testicular fibrous pseudotumor is reported with special reference to the site of implantation, in testicular adnexa and tunica albuginea.