The immediate effect of plantar stimulation on dynamic and static balance: A randomized controlled trial.

OBJECTIVE: To examine the immediate effect on dynamic and static balance of a manual protocol of plantar stimulation in healthy subjects. MATERIALS AND METHOD: Of the 144 healthy and physically active volunteers recruited, 98 subjects participated. Subjects were randomly assigned and allocated to the experimental group (EG) (n= 50), in which a 10-min manual protocol of plantar stimulation was applied on the right foot, or to the control group (CG) (n= 48). The change scores of the modified Star Excursion Balance Test (mSEBT) and the Unipedal Stance Test (UPST) were used to assess the immediate effect of the protocol on dynamic and static balance, respectively. RESULTS: In the dynamic balance, a group effect was found in the anterior direction, posteromedial direction and composite scores of the mSEBT when groups were compared by limb. Changes in the posteromedial direction of both limbs (right limb: p= 0.002, left limb: p= 0.05) and composite score of the right limb (p= 0.009) were significantly greater in the EG versus the CG. Non-significant results were found in the static balance (UPST time). CONCLUSIONS: The application of a 10-minute manual stimulation protocol without joint mobilization, addressed to stimulate the plantar cutaneous mechanoreceptors, could elicit benefits on dynamic balance. This improvement was observed bilaterally even though only one plantar surface was stimulated. As balance deficits may impair functional movements and regular training in sports, this intervention aims to ameliorate dynamic balancing ability could improve the functional recovery of sport gestures.

Idarucizumab in High-risk Thoracic Surgery.

Direct oral anticoagulants have suggested a favorable profile compared with vitamin K antagonists. However, the lack of treatment to reverse the effect of direct oral anticoagulants has limited its use in some patients who require rapid reversal of anticoagulation, as those included in the transplant waiting list. Idarucizumab is a recently approved drug to reverse the anticoagulant effect of dabigatran. However, the clinical experience when using this drug is scarce. Herein, we present a clinical case on anticoagulation reversal with idarucizumab to perform heart and lung transplantation in a patient with Eisenmenger syndrome.

Elaboración y validación del «Cuestionario de actitudes hacia la ética profesional en Fisioterapia» / Elaboration and validation of the «Attitudes questionnaire towards professional ethics in Physiotherapy»

Objetivo: En el contexto universitario resulta necesaria la elaboración y validación de cuestionarios para ser aplicados en la valoración de nuevos modelos formativos que garanticen la adquisición de la competencia ética. El objetivo de este estudio es presentar la elaboración, evaluación de la fiabilidad y unidimensionalidad del «Cuestionario de actitudes hacia la ética profesional en Fisioterapia» (CAEPFIS). Material y método: Se procedió a la elaboración de un cuestionario que analizara las actitudes hacia la ética profesional en estudiantes de Fisioterapia (CAEPFIS) mediante un estudio piloto con estudiantes de Fisioterapia de último curso (n=100). Se llevó a cabo un análisis de consistencia interna (alfa de Cronbach) y se detectaron y eliminaron los ítems indiferenciadores. Posteriormente, se analizó la unidimensionalidad del cuestionario (análisis factorial de componentes principales, prueba de esfericidad de Barlett y medida de adecuación muestral de Kaiser-Meyer-OIkin [KMO]). Finalmente, el cuestionario constó de 33 ítems. Se empleó Predictive Analytics Software (PASW) 18.0 (SPSS Inc., Chicago, IL, EE. UU.). Resultados: El CAEPFIS presenta una elevada consistencia interna (coeficiente alfa de Cronbach=0,898). Los ítems del CAEPFIS se acercan a la unidimensionalidad deseada (análisis factorial de componentes principales: KMO=0,762; χ2=1.871,874; df=528; p<0,001). El primer factor muestra una buena proporción de la varianza total, explica el 25,8% de la misma y todos los ítems presentan pesos por encima de 0,3. Conclusiones: El CAEPFIS muestra fiabilidad y unidimensionalidad para ser empleado como instrumento de recogida de datos para analizar las actitudes hacia la ética profesional en estudiantes de Fisioterapia

Purpose: In the university context the creation and validation of questionnaires to be applied in assessment of new teaching models that guarantee the acquisition of ethical competence is necessary. This study aims at presenting the creation, assessment of internal consistence and unidimensionality of the ‘Attitudes questionnaire towards professional ethics in Physiotherapy’ (CAEPFIS). Material and method: A questionnaire analyzing attitudes towards professional ethics in Physiotherapy students (CAEPFIS) was created by means of a study carried out with physiotherapy students in the last year of their degree (n=100). An analysis of internal consistency (Cronbach's Alpha) was carried out, whilst differentiator elements were detected and deleted. Afterwards, unidimensionality of the questionnaire was analyzed (factorial analysis of principal components, Barlett's test of sphericity and Kaiser-Meyer-OIkin KMO). Finally, the questionnaire comprised 33 items. Predictive Analytics Software (PASW) 18.0 (SPSS Inc., Chicago, IL, USA) was used. Results: CAEPFIS shows a high internal consistency (Cronbach's Alfa=0.898). Items of CAEPFIS are close to the desired unidimensionality (Factorial Analysis of Principal Components: KMO=0.762; χ2=1,871.874; df=528; p<0.001). The first factor shows a good proportion of total variance, explains the 25.8% of it and all items present weights higher than 0.3. Conclusions: CAEPFIS shows internal consistency and unidimensionality to be used as a tool of data collection to analyze attitudes towards professional ethics in physiotherapy students

Incidence of development of obesity after heart transplantation according to the calcineurin inhibitor.

BACKGROUND: Development of obesity after heart transplantation (HT) is a common complication, largely attributed to immunosuppressive therapy. The objective of this study is to compare the incidence of development of obesity after HT, according to the calcineurin inhibitor (CNI) used (cyclosporine [CsA] vs tacrolimus [Tac]). METHODS: We studied 101 consecutive HT patients from November 2006 to December 2010. A diagnosis of overweight-obesity was made by a body mass index of ≥25 kg/m(2), which was assessed before HT and at 1 year after HT. Patients were randomly assigned to the administration of CsA or Tac by a simple randomization method using a computer program (56% received CsA and 44% Tac). RESULTS: Of the 101 patients, 77% were men, and ischemic heart disease was the most common indication for HT. At baseline, there were no differences in weight between groups treated with CsA or Tac. The mean weight for each group was 71.5 ± 12 and 75 ± 14 kg, respectively (P = .2). The weight increase was greater among CsA patients: after HT, the weight gain was 6.9 ± 11 kg in the CsA group, whereas a minimal weight loss of 0.03 ± 14 kg (P = .008) was experienced in the group treated with Tac. The multivariate analysis showed that only CsA treatment was an independent predictor of development of obesity 1 year after HT (odds ratio, 3.84; 95% CI, 1.04-14.21; P = .01). CONCLUSION: Weight gain after HT may be related to the CNI used and CsA seems to be the CNI that produces the greatest increase.

Rehabilitación cardiaca postinfarto mediante programa Euroaction / Euroaction cardiac rehabilitation program after infarction

Introducción. Los programas de prevención o rehabilitación secundaria de las enfermedades cardiovasculares son efectivos si asocian al tratamiento farmacológico cambio del estilo de vida y, particularmente, intervenciones en la dieta, cese del consumo de tabaco y práctica regular de actividad física. El programa Euroaction ha permitido modificaciones del estilo de vida y efecto beneficioso sobre los factores de riesgo cardiovascular en pacientes que han sufrido síndrome coronario agudo. Material y métodos. Con un programa de fácil implementación (8 sesiones semanales), se estudia su efectividad sobre 401 pacientes, en su mayoría de riesgo moderado (51,5%). Resultados. El programa logra a los 6 meses los objetivos de prevención secundaria, con disminución del perímetro abdominal (p < 0,05), índice de masa corporal (p < 0,05), colesterol total (p < 0,005), triglicéridos y lipoproteínas de baja densidad (p < 0,001), con ascenso de las lipoproteínas de alta densidad (p < 0,001). También se produjo descenso significativo de la glucemia en pacientes con cifras basales > 126 mg/dl (p < 0,001) y de la presión arterial sistólica en pacientes con valores > 140 mmHg (< 0,001) y diastólica > 90 mmHg (p < 0,001). Se redujo la proporción de pacientes sedentarios que pasó del 50,9 al 7,5% a los 6 meses, realizando el 73% de ellos un ejercicio físico regular moderado, mejorando su capacidad aerobia. Solo se consiguió abandono del hábito tabáquico en el 50% de los pacientes. Conclusiones. El programa Euroaction se mostró efectivo para control de los factores de riesgo tras evento coronario, obteniendo resultados similares a otros programas de mayor complejidad. Los pacientes consiguen un aumento de su capacidad aerobia(AU)

Introduction. Rehabilitation or secondary prevention programs of cardiovascular disease are effective if associated with drug treatment, life style changes and especially dietary interventions, smoking cessation and regular practice of physical activity. The Euroaction program has allowed lifestyle modifications and beneficial effect on the risk factors in patients who have suffered acute coronary syndrome. Material and methods. Using an easy to implement program having 8 weekly sessions, we studied its effectiveness on 401 patients, most of whom had moderate risk (51.5%). Results. At 6 months, the program achieved the secondary prevention goals, with reduction in abdominal perimeter (P < .05), body mass index (P < .05), total cholesterol (P < .005), triglycerides and low density lipoprotein (P < .001) and elevation of high density lipoproteins (P < .001). There was a significant decrease of glycemia in patients with baseline levels > 126 mg/dl (P < .001) and systolic blood pressure in patients with > 140 mmHg (<.001) and diastolic > 90 mmHg (P < .001). The proportion of sedentary patients decreased from 50.9 to 7.5% of the patients at 6 months, 73% of them doing moderate regular exercise, with improvement in their aerobic capacity. Smoking cessation was only achieved in half of the patients. Conclusions. The Euroaction program was effective for the control of risk factors after myocardial infarct. It obtained similar results to other more complex programs. The patients achieved increased aerobic capacity(AU)