Adaptación transcultural, validación y valoración de las propiedades psicométricas, de la versión española del cuestionario Western Ontario Shoulder Instability Index / Transcultural adaptation, validation and assessment of the psychometric properties of the spanish version of the Western Ontario Shoulder Instability Index questionnaire

Objetivo. El propósito del presente trabajo es presentar la adaptación transcultural y validación realizada del cuestionario Western Ontario Shoulder Instability Index (WOSI) al idioma español (España), así como la evaluación de sus propiedades psicométricas. Material y métodos. La adaptación transcultural se realizó mediante la técnica de traducción y retrotraducción. Posteriormente se realizó una prueba piloto y se ponderaron las propiedades psicométricas. Se evaluaron 79 pacientes que cumplimentaron el cuestionario Western Ontario Shoulder Instability Index dos veces, en el periodo de 2 meses y se estratificaron estadísticamente en 3 grupos diferentes (cohortes). Resultados. • Validez estructural: ofreció un resultado válido, aunque dispar de la estructura de 4 dominios del cuestionario original. • Validez de criterio: Coeficiente de Correlación de Pearson: 0,745 (ROWE) y 0,471 (EQ-5D-5L). • Consistencia interna: alfa de Cronbach: 0,96, test-retest (ICC): 0,949. • Sensibilidad al cambio: t-Student: 42,38; respuesta promedio estandarizada (SRM): 2,69; tamaño del efecto (ES): 2,61; error estándar de medición (SEM): 23%; mínimo cambio detectable (SDC): 76%. No se halló efecto suelo o techo. Conclusiones. La versión española del cuestionario Western Ontario Shoulder Instability Index ofrece una herramienta válida, confiable y con una alta sensibilidad al cambio para la valoración de pacientes afectos de inestabilidad de hombro (AU)

Objective. The aim of the present study is to present a transcultural adaptation and validation of the Western Ontario Shoulder Instability Index questionnaire into Spanish (Spain), and to assess its psychometric properties. Material and methods. The transcultural adaptation was conducted according to sequential forward and backward translation approach. A pilot study was subsequently performed to ensure acceptable psychometric properties. The Western Ontario Shoulder Instability Index questionnaire was administered to 79 patients twice within a period of 2 months, and patients were stratified into 3 groups (cohorts). Results. • Structural validation: valid, though uneven results were obtained regarding the structure of the 4 domains of the original questionnaire. • Criterion validity: Pearson's correlation coefficient: ROWE:0.74; EQ-5D-5L:0.471. • Internal consistency: Cronbach's alpha: 0.96; coefficient of intraclass correlation: 0.949. • Sensitivity to change: t-Student- t: 42.38; standard response means: 2.69; effect size: 2.61; standard error of measurement: 23%; Minimal detectable change: 76%. No floor or ceiling effects were detected. Conclusions. The Spanish version of the Western Ontario Shoulder Instability Index questionnaire is a valid, reliable tool, and highly sensitive to change to assess patients with shoulder instability (AU)

Transcultural adaptation, validation and assessment of the psychometric properties of the spanish version of the Western Ontario Shoulder Instability Index questionnaire. / Adaptación transcultural, validación y valoración de las propiedades psicométricas, de la versión española del cuestionario Western Ontario Shoulder Instability Index.

OBJECTIVE: The aim of the present study is to present a transcultural adaptation and validation of the Western Ontario Shoulder Instability Index questionnaire into Spanish (Spain), and to assess its psychometric properties. MATERIAL AND METHODS: The transcultural adaptation was conducted according to sequential forward and backward translation approach. A pilot study was subsequently performed to ensure acceptable psychometric properties. The Western Ontario Shoulder Instability Index questionnaire was administered to 79 patients twice within a period of 2 months, and patients were stratified into 3 groups (cohorts). RESULTS: CONCLUSIONS: The Spanish version of the Western Ontario Shoulder Instability Index questionnaire is a valid, reliable tool, and highly sensitive to change to assess patients with shoulder instability.

Giant cell arteritis and polymyalgia rheumatica: usefulness of vascular magnetic resonance imaging studies in the diagnosis of aortitis.

OBJECTIVES: One of the unresolved challenges posed in giant cell (temporal) arteritis (GCA) is the detection and monitoring of large-artery complications, particularly aortitis. Recent investigations support vascular magnetic resonance imaging (MRI) studies in this issue. We report our preliminary experience with this imaging technique in the study of the aorta and its proximal branches in patients with GCA and/or polymyalgia rheumatica (PMR). METHODS: Between 2000 and 2003, six patients with GCA and/or PMR seen in our department were diagnosed with aortitis using vascular MRI studies. In all cases, the study was performed according to a specifically designed protocol that included MRI and MR angiography (MRA). RESULTS: MRI was a hepful non-invasive method for diagnosis of aortitis in all cases, providing accurate information about its extent. In particular, MRI had a higher ability to detect earlier stages of vasculitis disclosing subclinical aortitis in five of the six patients. The main signs of early vascular inflammation observed were vessel wall thickness and oedema (six cases) and increased mural enhancement on postcontrast T1-weighted images (four cases). MRA disclosed lumen changes (stenosis) in two patients. On follow-up studies, whereas vascular stenosis and vessel wall thickness remained invariable, vascular wall oedema and contrast enhancement improved significantly when disease activity decreased. CONCLUSION: MRI may be a useful technique for diagnosing patients with occult major artery involvement in GCA, whether presenting with classic symptoms of temporal arteritis or PMR. Its utility for monitoring the course of the disease and response to treatment requires further confirmation.

Capilaroscopia en las unidades de reumatología. Usos y aplicaciones / Capillaroscopy in rheumatology units. Uses and applications

La capilaroscopia es una técnica sencilla, inocua y barata que debería incluirse en el protocolo de estudio de cualquier paciente que explica una clínica compatible con un fenómeno de Raynaud. Es de utilidad también en pacientes con esclerodermia sistémica progresiva para conocer su probable evolución y en pacientes con otras enfermedades sistémicas como la dermatomiositis, el lupus eritematoso sistémico o la artritis reumatoide. Se puede considerar como una valiosa técnica para detectar de forma precoz la afectación de la microcirculación en la esclerodermia sistémica progresiva y para distinguir entre los pacientes con fenómeno de Raynaud primario y aquellos en los que este trastorno constituye la manifestación inicial de otras enfermedades autoimnunes. La capilaroscopia debería formar parte de las exploraciones complementarias específicas de la reumatología que permitan una mayor diferenciación con otras especialidades (AU)

Usefulness of different techniques in the study of the epidemiology of salmonellosis.

Our objective was to evaluate the usefulness of serotyping, phagotyping, antibiotyping and RAPD (random amplified polymorphic DNA) in the study of the epidemiology of salmonellosis in Elche (Spain). We examined 1232 clinical isolates of non-typhoid Salmonella serotypes. Serotyping adequately differentiates 12.3% of the isolates and phagotyping raises this percentage to 37%. Antibiotyping is a suitable complement in certain circumstances, such as in the case of specific outbreaks. RAPD is a fast and simple technique which is within the reach of most laboratories, complementing the results obtained by antibiotyping and serotyping, in order to be able to control outbreaks of salmonellosis in everyday practice.

Characterisation of Salmonella spp. mutants produced by exposure to various fluoroquinolones.

We repeatedly exposed six Salmonella spp. strains of different serotypes (three susceptible to nalidixic acid and three resistant) to constant low concentrations of various fluoroquinolones with the aim of characterising the mutations that produce the first decrease in susceptibility to these agents. The fluoroquinolone-susceptibility of all the strains was reduced after repeated exposure to these agents. However, gyrA mutants were not always produced. Furthermore, the type of mutation produced and the time taken for it to appear varied depending on the initial resistance to nalidixic acid, the antibiotic used and the serotype involved. Therefore, we believe that the initial decrease in quinolone-susceptibility is due to various mechanisms and, in many cases, is not caused by mutations in the gyrA gene

Serotipos y sensibilidad antibiótica del género Salmonella en Elche / Serotypes and antibiotic susceptibility of the genus Salmonella in Elche, Spain

Las salmonelosis son uno de los principales problemas de salud pública de nuestro medio. Salmonella enteritidis es el serotipo más frecuente, seguido de S. typhimurium, S. hadar y S. virchow. La sensibilidad antibiótica es distinta en cada serotipo, pero en general se observa un incremento del número de aislamientos resistentes a los antibióticos, sobre todo al ácido nalidíxico en S. hadar, aunque no hemos aislado ninguna cepa resistente al ciprofloxacino. Nuestro estudio aporta datos que contribuyen a controlar estas infecciones y alerta sobre el aumento de la resistencia a algunos antibióticos, lo cual debe motivar la instauración de medidas de salud pública y de control en el uso de antibióticos, sobre todo en animales (AU)

[Serotypes and antibiotic susceptibility of the genus Salmonella in Elche, Spain]. / Serotipos y sensibilidad antibiótica del género Salmonella en Elche.

Salmonellosis is one of the main public health problems in developed countries. The most common serotype is Salmonella enteritidis, followed by S. typhimurium, S. hadar and S. virchow. Each serotype's sensitivity to antibiotics is different, but in general, there has been an increase in the number of isolates resistant to antibiotics. This is especially true for S. hadar and nalidixic acid, although we have not isolated any strains resistant to ciprofloxacin. Our study provides data that may help to control these infections and draws attention to the increase in resistance to certain antibiotics. This should give rise to the implementation of measures to protect public health and control the use of antibiotics, especially in animals.

[Evolution of resistance to quinolones in Salmonella enterica in our setting]. / Evolución de la resistencia a las quinolonas en Salmonella enterica en nuestro medio.

Salmonella enterica is mainly associated with acute gastroenteritis; however, it is also associated with other more severe disease processes, for which quinolones are the treatment of choice. We retrospectively studied the evolution of resistance to nalidixic acid and ciprofloxacin of all the clinical isolates of S. enterica from 1992 to 1998 in our hospital environment. A total of 848 strains from feces, blood and other locations were studied. We detected an increase in the resistance to nalidixic acid from 12% in 1992 to 21.3% in 1998, especially in the Enteritidis and Hadar serotypes. We did not detect resistance to ciprofloxacin, but there was in increase in the MIC in the nalidixic acid-resistant strains. Although this is interpreted as sensitive according the the NCCLS criteria, if we apply the cutoff points established by MENSURA, 89.46% of the strains do not fit into this category (S <0.12 mg/l). This puts into question the utility of quinolones in the long-term treatment of severe disease processes produced by this type of strain.

[Evolution of resistance to quinolonesin Salmonella enterica in our environment] / Evolución de la resistencia a las quinolonas en Salmonella enterica en nuestro medio.

Salmonella enterica is mainly associated with acute gastroenteritis; however, it is also associated with other more severe disease processes, for which quinolones are the treatment of choice. We retrospectively studied the evolution of resistance to nalidixic acid and ciprofloxacin of all the clinical isolates of S. enterica from 1992 to 1998 in our hospital environment. A total of 848 strains from feces, blood and other locations were studied. We detected an increase in the resistance to nalidixic acid from 12% in 1992 to 21.3% in 1998, especially in the Enteritidis and Hadar serotypes. We did not detect resistance to ciprofloxacin, but there was in increase in the MIC in the nalidixic acid-resistant strains. Although this is interpreted as sensitive according the the NCCLS criteria, if we apply the cutoff points established by MENSURA, 89.46% of the strains do not fit into this category (S <0.12 mg/l). This puts into question the utility of quinolones in the long-term treatment of severe disease processes produced by this type of strain.