Associations between respiratory function, balance, postural control, and fatigue in persons with multiple sclerosis: an observational study.

Introduction: Fatigue, postural control impairments, and reduced respiratory capacities are common symptoms in persons diagnosed with Multiple Sclerosis (MS). However, there is a paucity of evidence establishing correlations among these factors. The aim of this study is to analyze respiratory function in persons with MS compared to the control group as well as to analyze the relationship between fatigue, respiratory function and postural control in persons with MS. Materials and methods: A total of 17 persons with MS and 17 healthy individuals were enrolled for this cross-sectional study. The evaluated parameters included fatigue assessed using the Visual Analog Scale-fatigue (VAS-F) and the Borg Dyspnea Scale, postural control assessed through the Mini Balance Evaluation System Test (Mini-BESTest), Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Trunk Impairment Scale (TIS); and respiratory capacities measured by Maximum Inspiratory Pressure (MIP), Maximum Expiratory Pressure (MEP), Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), FEV1/FVC ratio, Diaphragmatic excursion and diaphragmatic thickness. Results: A very high correlation was observed between the Borg Dyspnoea Scale and the BBS (r = -0.768), TUG (0.867), and Mini-BESTest (r = -0.775). The VAS-F exhibited an almost perfect correlation solely with the TUG (0.927). However, none of the variables related to fatigue exhibited any correlation with the respiratory variables under study. Balance-related variables such as BBS and Mini-BESTest demonstrated a very high and high correlation. Respectively, with respiratory function variables MEP (r = 0.783; r = 0.686), FVC (r = 0.709; r = 0.596), FEV1 (r = 0.615; r = 0.518). BBS exhibited a high correlation with diaphragmatic excursion (r = 0.591). Statistically significant differences were noted between the persons with MS group and the control group in all respiratory and ultrasound parameters except for diaphragmatic thickness. Conclusion: The findings suggest that decreased postural control and balance are associated with both respiratory capacity impairments and the presence of fatigue in persons with MS. However, it is important to note that the alterations in respiratory capacities and fatigue are not mutually related, as indicated by the data obtained in this study. Discrepancies were identified in abdominal wall thickness, diaphragmatic excursion, and respiratory capacities between persons with MS and their healthy counterparts.

Effectiveness of Invasive Techniques in Patients with Fibromyalgia: Systematic Review and Meta-Analysis.

OBJECTIVE: To attain a synthesis of the evidence on the effectiveness of invasive techniques in patients with fibromyalgia, through systematic review and meta-analysis and by assessing the methodological quality of the studies considered. METHODS: A systematic review and meta-analysis were carried out as defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The bibliographic research was carried out in the PEDro, Cochrane, PubMed, Science Direct, Web of Science, Google Academics, Dialnet, and Scielo databases from September through December of 2018. RESULTS: Results show that invasive techniques produce a significant decrease in the pain, the impact of fibromyalgia and in the pain pressure threshold (standardized mean difference [95% confidence interval]: -0.94 [-1.44, -0.44], P of global effect= 0.0002; -0.99 [-1.69, -0.29], P of global effect= 0.006; and 0.31 [0.02, 0.61], P of global effect = 0.04, respectively). Lastly, a significant increase was observed in the quality-of-life variable after intervention (0.84 [0.30, 1.38], P of global effect = 0.002). CONCLUSIONS: Invasive techniques are considered effective for pain relief, as well as for producing a short-term increase in the pain pressure threshold, an improvement in quality of life, and a decrease in the impact of fibromyalgia.

Blunted Expansion of Regulatory T Lymphocytes Is Associated With Increased Bacterial Translocation in Patients With Major Depressive Disorder.

Background: Major Depressive Disorder (MDD) is associated with both proinflammatory and adaptive immune response abnormalities. Regulatory T lymphocytes (Tregs), a subtype of CD4+ T cells, are relevant for maintaining immune-inflammatory system homeostasis and control of inflammation such as the kind potentially induced by the interactions between the intestinal microbiome and gut mucosa. We investigated the Treg population and its distribution along their stages of differentiation/activation, as well as its function in MDD patients without concomitant diseases. We also studied the potential association between Treg alterations, intestinal barrier damage, and bacterial translocation. Methods: 30 MDD patients and 20 healthy controls were studied. The levels of circulating CD25FoxP3+ Tregs and their distribution on the naïve (TN), effector (TE), central (TCM), and effector memory(TEM) differentiation/activation stages were analyzed using polychromatic flow cytometry. Chemokine receptors (CCR) 2, 5, and 6, and the intracytoplasmic IL-10 expression by the Tregs were also analyzed. The serum IL-10 was measured using Luminex. The serum levels of zonulin and the intestinal fatty acid-binding protein (I-FABP), both markers of gut barrier function, and the LPS-binding protein (LBP), a marker of bacterial translocation, were measured using an enzyme-linked immunosorbent assay. Results: MDD patients had increased number of circulating Tregs cells with enhanced number of Tregs at the TN, TE, TCM, and TEM stages. The percentage of Tregs cells at TN stage was significantly higher in MDD patients. The percentage of Tregs that expressed CCR2 and CCR6 was increased as well as those expressing IL-10. MDD patients had significantly increased levels of circulating I-FABP and LBP. MDD patients with high LBP levels had a significant reduction in the number of circulating Tregs compared to normal-LBP MDD patients. Conclusions: MDD patients showed an expansion of circulating Tregs and their CD25highFoxP3+ and CD25lowFoxP3+ subsets throughout the different stages of CD4+ T lymphocyte differentiation/activation. Tregs also showed an increased frequency of cells expressing CCR6 and CCR2. IL-10 Treg production was also enhanced in MDD patients that concurrently had increased serum IL-10 levels. However, this Treg expansion was blunted in MDD patients with gut barrier damage and increased bacterial translocation.

Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

OBJECTIVE: The aim of this study was to summarize evidence on the effectiveness of therapeutic exercise in Fibromyalgia Syndrome. DESIGN: Studies retrieved from the Cochrane Plus, PEDro, and Pubmed databases were systematically reviewed. Randomized controlled trials and meta-analyses involving adults with fibromyalgia were included. The primary outcomes considered in this systematic review were pain, global well-being, symptoms of depression, and health-related quality of life. RESULTS: Effects were summarized using standardized mean differences with 95% confidence intervals using a random effects model. This study provides strong evidence that physical exercise reduces pain (-1.11 [95% CI] -1.52; -0.71; overall effect p < 0.001), global well-being (-0.67 [95% CI] -0.89, -0.45; p < 0.001), and symptoms of depression (-0.40 [95% CI] -0.55, -0.24; p < 0.001) and that it improves both components of health-related quality of life (physical: 0.77 [95% CI] 0.47; 1.08; p < 0.001; mental: 0.49 [95% CI] 0.27; 0.71; p < 0.001). CONCLUSIONS: This study concludes that aerobic and muscle strengthening exercises are the most effective way of reducing pain and improving global well-being in people with fibromyalgia and that stretching and aerobic exercises increase health-related quality of life. In addition, combined exercise produces the biggest beneficial effect on symptoms of depression.

Gestión de coberturas de personal en atención primaria. Automatización del cálculo / Management of needed health care workers in primary care. Automating the calculation

El Servicio de Atención Primaria de Santa Coloma de Gramenet ha diseñado un sistema que estandariza y automatiza la planificación de coberturas de personal sanitario. Está dividido en dos partes: una calculadora que en función de parámetros de actividad y presión asistencial orienta sobre el riesgo previsible derivado de nuestra planificación, y otra con indicadores centinela; el principal es el «nivel básico asistencial», definido como el porcentaje de usuarios atendidos a 2, 3 y 7 días naturales, y valora su repercusión en la asistencia a la población. Los resultados en el verano de 2010 muestran un aumento de la eficiencia al disminuir la plantilla presencial respecto al año 2009, conseguir una mejor distribución de ésta en el periodo acorde con la actividad realizada y mejorar la gestión presupuestaria. Puesto que los datos necesarios están disponibles y su cálculo es sencillo, puede ser exportable a todo nuestro ámbito (AU)

The Santa Coloma de Gramenet Primary Care Service has designed a new tool to standardize and automate the process of planning the number of needed health care workers. The tool is divided in two parts: a calculator, which gives guidance on the foreseeable risk depending on the activity and the health care workers’ workload, and sentinel indicators; the main is the “welfare basic level”, that is the percentage structure of visited patients and their delay at 2, 3 and 7 calendar days, assessing the impact on the care of the population. The results of its use in the summer of 2010 have demonstrated its efficiency by lowering the needed workers with respect to 2009, achieving a better distribution according to the workload and improving the economic management. Given that the necessary data are accessible through computerized databases and its simple use, we believe it to be exportable to other fields (AU)

[Management of needed health care workers in primary care. Automating the calculation]. / Gestión de coberturas de personal en atención primaria. Automatización del cálculo.

The Santa Coloma de Gramenet Primary Care Service has designed a new tool to standardize and automate the process of planning the number of needed health care workers. The tool is divided in two parts: a calculator, which gives guidance on the foreseeable risk depending on the activity and the health care workers' workload, and sentinel indicators; the main is the "welfare basic level", that is the percentage structure of visited patients and their delay at 2, 3 and 7 calendar days, assessing the impact on the care of the population. The results of its use in the summer of 2010 have demonstrated its efficiency by lowering the needed workers with respect to 2009, achieving a better distribution according to the workload and improving the economic management. Given that the necessary data are accessible through computerized databases and its simple use, we believe it to be exportable to other fields.

[Prevalence of diabetes mellitus in young Asian Indian immigrants in Santa Coloma de Gramenet (Spain)]. / Prevalencia de diabetes mellitus en inmigrantes indostánicos jóvenes en Santa Coloma de Gramenet, España.

BACKGROUND AND OBJECTIVE: There is a general agreement to consider Asian Indian subjects, specially those who immigrated to Western countries, as a high-risk population to develop type 2 diabetes mellitus (DM2). This could be mainly explained by reasons based on the immigration changes, particularly the metabolic impact of a westernized diet (environmental hypothesis) or reasons based in the presence of tissue resistance to insulin (genetic hypothesis). The aim of the study was to estimate the prevalence of DM2 in 3 populations of Asian Indian immigrants, non-Asian Indian immigrants and autochthonous subjects. POPULATION AND METHOD: An observational multicenter study was performed in 3 primary care centers from Santa Coloma de Gramenet (Barcelona, Spain). Subjects from Asian Indian, non-Asian Indian and autochthonous origin born between 1948-73 were compared. Their DM2 prevalence as well as sociodemographic and clinical data among diabetic patients were analyzed. RESULTS: The overall prevalence of DM2 was 4.6 %. The prevalence of DM2 was higher among Asian Indian immigrants (20.9%, 95% CI, 12.1-29.1) compared with autochthonous (3.6%; 95% CI, 2.9-9.3; p < 0.001) and non-Asian Indian immigrants (9.7%; 95% CI, 5.3-14.1; p = 0.013). Nevertheless, differences between autochthonous and non-Asian Indian immigrants were found (p < 0.001). Asian Indians subjects had an earlier diagnosis age, especially those younger than 44 years, than those of non-Asian Indian immigrants and autochthonous groups (p < 0.002 and p < 0.006, respectively). CONCLUSIONS: Taken together, these results suggest that young immigrant populations have a higher prevalence of DM2 compared with autochthonous ones. Indeed, the prevalence of DM2 among immigrant Asian Indians represents the highest reported in the European Union so far and shows differences with non-Asian Indian immigrants. In spite of this, these differences are not totally conclusive in statistical terms; further studies are needed to compare both populations.

Prevalencia de diabetes mellitus en inmigrantes indostánicos jóvenes en Santa Coloma de Gramenet, España / Prevalence of diabetes mellitus in young Asian Indian immigrants in Santa Coloma de Gramenet (Spain)

Fundamento y objetivo: Hay un acuerdo general en considerar que la población de origen indostánico, sobre todo los inmigrantes de países occidentales, tiene un riesgo especialmente elevado a desarrollar diabetes mellitus tipo 2 (DM2). Para explicarlo se han defendido argumentos basados en el impacto de los cambios debidos a la inmigración, especialmente el atribuible a la adopción de una dieta occidental (hipótesis ambiental) o debidos a la presencia de resistencia tisular a la insulina (hipótesis genética). El objetivo principal del estudio es valorar la prevalencia de DM2 en tres poblaciones de inmigrantes: indostánicos, inmigrantes no indostánicos y autóctonos. Población y método: Estudio transversal y multicéntrico realizado en 3 centros de atención primaria de Santa Coloma de Gramenet (Barcelona, España). Se estudiaron tres poblaciones nacidas entre 1948 y 1973 según su origen: indostánico, no indostánico y autóctono. Se analizó la prevalencia de DM2 y la relación de variables sociodemográficas y de comorbilidad entre los pacientes diabéticos. Resultados: Se estudió a 2.690 individuos de los que un 4,6% tenía DM2. La prevalencia de DM2 fue superior en el grupo de indostánicos (20,9%, intervalo de confianza [IC] del 95%, 12,1-29,1) en relación con el grupo de autóctonos (3,6%, IC del 95%, 2,9-4,3; p < 0,001) y a la de inmigrantes no indostánicos (9,7%, IC del 95%, 5,3-14,1; p = 0,013). No obstante, la prevalencia de los inmigrantes no indostánicos también fue estadísticamente significativa respecto a los autóctonos (p < 0,001). Los indostánicos presentaron una edad de diagnóstico más temprana (por debajo de los 44 años) comparado con la de los inmigrantes no indostánicos y los autóctonos (p < 0,002 y p < 0,006, respectivamente). Conclusiones: Se observa una mayor prevalencia de DM2 en población inmigrante joven en relación con la población autóctona. La prevalencia de DM2 en inmigrantes indostánicos es la más alta de las registradas en la Unión Europea y superior a la de los inmigrantes no indostánicos, después son necesarios subsiguientes estudios que comparen ambas poblaciones

Bakground and objective: There is a general agreement to consider Asian Indian subjects, specially those who immigrated to Western countries, as a high-risk population to develop type 2 diabetes mellitus (DM2). This could be mainly explained by reasons based on the immigration changes, particularly the metabolic impact of a westernized diet (environmental hypothesis) or reasons based in the presence of tissue resistance to insulin (genetic hypothesis). The aim of the study was to estimate the prevalence of DM2 in 3 populations of Asian Indian immigrants, non-Asian Indian immigrants and autochtonous subjects. Population and method: An observational multicenter study was performed in 3 primary care centers from Santa Coloma de Gramenet (Barcelona, Spain). Subjects from Asian Indian, non-Asian Indian and autochtonous origin born between 1948-73 were compared. Their DM2 prevalence as well as sociodemographic and clinical data among diabetic patients were analyzed. Results: The overall prevalence of DM2 was 4.6 %. The prevalence of DM2 was higher among Asian Indian immigrants (20.9%, 95% CI, 12.1-29.1) compared with autochtonous (3.6%; 95% CI, 2.9-9.3; p < 0.001) and non-Asian Indian immigrants (9.7%; 95% CI, 5.3-14.1; p = 0.013). Nevertheless, differences between autochtonous and non-Asian Indian immigrants were found (p < 0.001). Asian Indians subjects had an earlier diagnosis age, especially those younger than 44 years, than those of non-Asian Indian immigrants and autochthonous groups (p < 0.002 and p < 0.006, respectively). Conclusions: Taken together, these results suggest that young immigrant populations have a higher prevalence of DM2 compared with autochtonous ones. Indeed, the prevalence of DM2 among immigrant Asian Indians represents the highest reported in the European Union so far and shows differences with non-Asian Indian immigrants. In spite of this, these differences are not totally conclusive in statistical terms; further studies are needed to compare both populations

Valor del ecocardiograma-doppler en el pronóstico y en el seguimiento de la miocardiopatía hipertrófica / Value of Doppler-Echo for the Prognosis and Follow Up of Hypertrophic Cardiomyopathy

Introducción y objetivos. El objetivo del presente estudio fue analizar el valor pronóstico y la evolución del ecocardiograma-Doppler en una población hospitalaria adulta con miocardiopatía hipertrófica (MH).Métodos. Se estudiaron 119 pacientes consecutivos diagnosticados de MH (52 ñ 12 años, 60 mujeres) durante un seguimiento medio de 9,7 ñ 6,7 años. La evolución ecocardiográfica se analizó en los 104 pacientes (67 con obstrucción dinámica) en quienes se disponía al menos de 2 ecocardiogramas con un intervalo de 3,7 ñ 3 años (uno a 7 años) entre ambas exploraciones. Resultados. Durante el seguimiento 7 pacientes fallecieron y 31 presentaron complicaciones severas (siete fallecimientos, 15, síncope, cuatro, angina grado IV, tres, disnea grado IV y dos, infarto). La presencia de insuficiencia mitral (p = 0,001) y un gradiente dinámico superior a 50 mmHg (p = 0,02) fueron predictores de mortalidad, y un índice de aurícula izquierda superior a 25 mm/m2 (p = 0,028), de complicaciones severas. En un 15 por ciento de los pacientes con MH no obstructiva en el primer registro ésta pasó a ser obstructiva en el último registro. También se observó un incremento del número de pacientes con insuficiencia mitral (el 80 frente al 66 por ciento; p = 0,01) y en su severidad (p = 0,038) durante el seguimiento. Conclusiones. La presencia de insuficiencia mitral, de gradiente dinámico superior a 50 mmHg, y un índice de aurícula izquierda superior a 25 mm/m2 son variables de mal pronóstico en los pacientes adultos con MH. Durante el seguimiento se observa la evolución a formas obstructivas en un 15 por ciento de las MH no obstructivas y una tendencia a la progresión de la insuficiencia mitral (AU)