Cultural adaptation and validation of a peninsular Spanish version of the MSTCQ© (Multiple Sclerosis Treatment Concerns Questionnaire). / Adaptación cultural y validación al español de España del MSTCQ© (Multiple Sclerosis Treatment Concerns Questionnaire).

INTRODUCTION: Although subcutaneous treatments for multiple sclerosis (MS) have been shown to be effective, adverse reactions and pain may adversely affect treatment satisfaction and adherence. This study presents an adapted and validated Spanish version of the Multiple Sclerosis Treatment Concerns Questionnaire© (MSTCQ), which evaluates satisfaction with the injection device (ID) across 4 domains: injection system (A), side effects (B) (flu-like symptoms, reactions, and satisfaction), experience with treatment (C) and benefits (D). METHODS: Two study phases: 1) Cultural adaptation process with input from experts (n=6) and patients (n=30). 2) Validation obtained by means of an observational, cross-sectional, multi-centre study evaluating 143 adult MS patients using an ID. Tools employed: MSTCQ©, Patient-Reported Indices for Multiple Sclerosis (PRIMUS©), and Treatment Satisfaction Questionnaire for Medication (TSQM©). Psychometric properties: Feasibility (percentage of valid cases and floor/ceiling effects); Reliability (Cronbach α) and test-retest correlation (n=41, intraclass correlation coefficient, ICC); and construct validity (factor analysis of domains A and B) and convergent validity (Spearman rank-order correlation for MSTCQ© vs TSQM©). RESULTS: Mean age (SD) was 41.94 (10.47) years, 63% of the group were women, and 88.11% presented relapsing-remitting MS. Mean (SD) EDSS score was 2.68 (1.82) points. MSTCQ© completion was high (0%-2.80% missing data). Internal consistency was high at α=0.89 for the total score (A+B) and α=0.76, 0.89, and 0.92 for domains A, B, and C, respectively. The version demonstrated excellent test-retest reliability for the total (ICC=0.98) and for domains A, B, and C: ICC=0.82, 0.97, and 0.89, respectively. Factor analysis corroborated the internal structure of the original questionnaire. The association between total and domain scores on both the MSTCQ© and the TSQM© was moderately strong (Rho=0.42-0.74) and significant (P<.05 and P<.01). CONCLUSION: The Spanish version of MSTCQ© demonstrates appropriate psychometric properties.

Prevalence and risk factors of multidrug-resistant tuberculosis in Cubal, Angola: a prospective cohort study.

BACKGROUND: Although the Republic of Angola is one of the 14 countries figuring in the three high tuberculosis (TB) burden country lists, the true multidrug-resistant TB (MDR-TB) situation is unknown. MATERIAL AND METHODS: Patients aged 16 years with a diagnosis of pulmonary TB were prospectively enrolled from June 2014 to July 2015. Sputum samples were collected for culture and drug susceptibility testing in all patients, and for Xpert® MTB/RIF testing in all previously treated patients and in new patients whose sputum remained smear-positive after 2 months of treatment. RESULTS: A total of 422 patients were included; Mycobacterium tuberculosis was isolated in 308 sputum samples. The prevalence of MDR-TB was 8.0% (18/225) in new patients and 71.1% (59/83) in previously treated patients. Male sex (OR 2.95, 95%CI 1.35-6.44, P = 0.007), previous anti-tuberculosis treatment (OR 20.86, 95%CI 9.53-45.67, P < 0.001), presence of pleural thickening (OR 7.68, 95%CI 1.57-37.43, P = 0.012) and duration of illness >4 months (OR 3.34, 95%CI 1.45-7.69, P = 0.005) were independent risk factors for MDR-TB. CONCLUSIONS: The prevalence of MDR-TB in Cubal, Angola, was higher than estimated by the World Health Organization for Angola and one of the highest worldwide. Facilities to diagnose and treat MDR-TB are urgently needed in Angola.

[Effectiveness of pre-emptive hemodialysis with high-flux membranes for the treatment of life-threatening alcohol poisoning]. / Eficacia de la hemodiálisis precoz con membranas de alto flujo en el tratamiento de las intoxicaciones graves por alcoholes.

Alcohol intoxication (methanol, ethanol and ethylene glycol) may result in metabolic acidosis with increased anion gap, increased serum osmolal gap, and neurologic abnormalities ranging from drunkenness to coma, and death. The mortality and morbidity rates remain very high despite intensive care therapy. The toxicity of methanol and ethylene glycol is clearly correlated to the degree of metabolic acidosis. The established treatment of severe methanol and ethylene glycol intoxication is ethanol administration and hemodialysis (HD). By inhibiting the main metabolic pathway of methanol and ethylene glycol (alcohol dehydrogenase), ethanol prevents the formation of major toxic metabolites (formic acid, glycolic acid and oxalic acid). Conventional HD can reduce serum methanol, ethanol and ethylene glycol and its metabolites rapidly, but high-flux membranes should be capable of removing more toxic per hour of HD. In this report, we describe 14 cases of life-threatening alcohol intoxication (11 methanol, 1 ethanol, and 2 ethylene glycol) who were treated successfully with supportive care, ethanol infusion (methanol and ethylene glycol), and early HD with a high-flux dialyser. The median pH was 7.04 +/- 0.06 (range 6.60-7.33), median bicarbonate 9.9 +/- 1.9 mmol/l (range 1.4-25), and median base deficit 18.4 +/- 2.6 mmol/l (range 2-33). The median anion gap was 29.1 +/- 2.3 mmol/l (range 16-45) and the median osmolal gap was 119 +/- 47 mOsm/l (range 16-402). On admission there was an excellent linear correlation between the serum toxic alcohol concentrations and the osmolal gaps (R2 = 0.98, p = 0.0006). In all cases early HD corrected metabolic acidosis and osmolal abnormalities. The mortality was 7 % (1 from 14). We conclude that pre-emptive HD should be performed in severe intoxications to remove both the parent compound and its metabolites. The HD prescription should include a large surface area dialyser with high-flux membrane, a blood flow rate in excess of 250 ml/min, a modified bicarbonate bath enriched with phosphorus and potassium, and a long time session. The phosphorus and potassium-enriched bicarbonate-based dialysis solution used in patients with normal phosphorus and potassium serum levels avoided HD-induced hypophosphatemia and hypopotassemia. HD as implemented in these cases is a safe and very effective approach to the management of alcohol poisoning.

Manual motor speed dysfunction as a neurocognitive endophenotype in euthymic bipolar disorder patients and their healthy relatives. Evidence from a 5-year follow-up study.

BACKGROUND: Few studies have examined Manual Motor Speed (MMS) in bipolar disorder (BD). The aim of this longitudinal, family study was to explore whether dysfunctional MMS represents a neurocognitive endophenotype of BD. METHODS: A sample of 291 subjects, including 131 BD patients, 77 healthy first-degree relatives (BD-Rel), and 83 genetically-unrelated healthy controls (HC), was assessed with the Finger-Tapping Test (FTT) on three occasions over a 5-year period. Dependence of FTT on participants´ age was removed by means of a lineal model of HC samples, while correcting simultaneously the time and learning effect. Differences between groups were evaluated with an ANOVA test. RESULTS: The patients' performance was significantly worse than that of HC over time (p≤0.006), and these deficits remained when non-euthymic BD patients (n=9) were excluded from analysis. Some significant differences between BD patients and BD-Rel (p≤0.037) and between BD-Rel and HC (p≤0.033) were found, but they tended to disappear as time progressed (p≥0.057). Performance of the BD-Rel group was intermediate to that of BD and HC. Most sociodemographic and clinical variables did not affect these results in patients. (p≥0.1). However, treatment with carbamazepine and benzodiazepines may exert a iatrogenic effect on MMS performance (p≤0.006). LIMITATIONS: Only right-handed subjects were included in this study. Substantial attrition over time was detected. CONCLUSIONS: There were significant differences between the patients´ MMS performance and that of healthy relatives and controls, regardless of most clinical and sociodemographic variables. Dysfunctional MMS could be considered an endophenotype of BD. Further studies are needed to rule out possible iatrogenic effects of some psychopharmacological treatments.

[Nephropathia caused by hantavirus puumala: a case report]. / Nefropatía por hantavirus puumala: a propósito de un caso.

We present a patient from Germany with Hantavirus infection, admitted in the Emergency room of our hospital, with fever, thrombocytopenia, acute renal failure, oliguria, mild proteinuria and hematuria. Percutaneous renal biopsy revealed an acute interstitial nephritis without medulla haemorrhages. The virus infection confirmation was made by detection of IgM against Hantavirus Puumala. This infection should be considered in patients with thrombocytopenia, fever and acute renal failure, over all if they are from North and Central Europe.

[Cerebral haemorrhage in patients treated with oral anticoagulation]. / Hemorragia cerebral en pacientes en tratamiento con anticoagulantes orales.

INTRODUCTION: Intracranial haemorrhage (ICH) during dicumarinic treatment is a complication related to anticoagulation intensity with a high level of mortality. The aim of our study is to analize etiology, location and outcome of intracerebral haemorrhages related with anticoagulant therapy. PATIENTS AND METHODS: Over 401 spontaneous intracranial haemorrhages consecutively admitted in the neurological ward, we analyzed the acenocumarol ICH by location, anticoagulation range and factors that conditioned the outcome. RESULTS: We identified 26 patients, 6.5% of total ICH. Mean age was 75.2 +/- 7.9 years-old, over the rest of ICH. International Normalized Ratio (INR) was less than 2 in 10 patients, between 2 and 3 in six and greater than 3 in ten patients. 8 patients (31%) died, three of them had multiple ICH, but none of them had a INR greater than 2. Dicumarinic haemorrhages were of lobar location in 14 cases (three of them multiples) and deep in 12 cases. CONCLUSIONS: In our study, dicumarinic ICH are responsible of 6.5% total intracranial haemorrhages and they are not in clear relation with excessive anticoagulation. Mortality is slightly greater than the other ICH. Relatively benignity of these patients, the age and lobar location suggest that the etiology of these haemorrhages can be related to a subjacent amyloid angiopathy.

Use of the Pannell-Milstein roller bottle apparatus to produce high concentrations of the CSF-1, the mouse macrophage growth factor.

A simple roller bottle apparatus for growing B cell hybridomas in dialysis tubing yields high concentrations of monoclonal antibodies (Pannell and Milstein, J. Immunol. Methods (1992) 146, 43-48). Here we describe an adaptation of this apparatus for the simple production of high concentrations of the mouse macrophage specific growth factor, CSF-1. This apparatus appears to have general applicability for the production of other secreted cytokines.

Mouse microglial cell lines differing in constitutive and interferon-gamma-inducible antigen-presenting activities for naive and memory CD4+ and CD8+ T cells.

We developed a panel of non-virus transformed cell lines derived from individual microglial precursors residing in the brains of normal mice. These colony stimulating factor-1-dependent cell lines are B7-1+ (CD80), Mac-1+, Mac-2+, Mac-3+, CD45+, MHC class I+, colony stimulating factor-1 receptor+, and they ingest antibody-coated particles. However, the cell lines differ in their expression of B7-2 (CD86), F4/80, Ly-6C and MHC class II molecules. They also differ in their ability to constitutively process and present antigens to naive CD4+ and CD8+ T cells, memory CD4+ and CD8+, and in the manner by which interferon gamma modulates their antigen-presenting activities. These cell lines should be valuable as models for studies on the immunobiology of the microglia.

Reduction of methemerythrin-anion adducts by dithionite ion.

The reduction by dithionite ion (in excess) of methemerythrin-anion adducts, Hr+X-, to deoxyhemerythrin, Hr degree, has been examined at 25 degrees and pH 6.3 and 8.2. The results accord with the scheme: S2O42- in equilibrium 2SO2- rapid Hr+X- in equilibrium Hr++X- k-1, k1 Hr++SO2- leads to PRODUCT k2 with X- = Br-, HCO2-, CNO-, and F-, k2[SO2-] greater than k1[X-], and the pseudo first-order rate constant, kobs (= k-1), is independent of [X-] and [S2O42-]. Only with X- = NCS- is k2[SO2-] approximately k1[X-] and kobs = a[S2O42-]1/2 (b[NCS-] + [S2OR2-]1/2)-1. Values at pH 6.3 of k-1 (sec-1) and k1 (M-1 sec-1), obtained by anation and anion displacement reactions, are 2.3 x 10(-3), 1.6 x 10(-2) (Br-); 1.5 x 10(-3), 1.2 x 10(-2) (HCO2-); 1.3 x 10(-4), 0.52 (CNO-) and approximately 2 x 10(-4), 3.3 x 10(-3) (CN-, pH 7.0). Values of k-1 from reduction and displacement methods are in good agreement with each other. The value of k2 (1.6 x 10(5) M-1 sec-1, pH 6.3) in somewhat smaller than that for reduction of the met form of hemoproteins. There is only a small effect of pH on rates. Direct reduction of Hr+CN- does not occur, in contrast with Mb+CN-.

Application of adaptive signal processing for determining the limits of P and T waves in an ECG.

A new algorithm for the determination of the limits of P and T waves is proposed, and its foundations are mathematically analyzed. The algorithm performs an adaptive filtering so that the searched point corresponds to a minimum. Crucial properties of its performance are discussed, i.e., immunity to base line drifts and full adaptation to any cardiological criteria. A series of tests are made involving real registers with different morphologies for P and T-waves.

A low-complexity fuzzy activation function for artificial neural networks.

A novel fuzzy-based activation function for artificial neural networks is proposed. This approach provides easy hardware implementation and straightforward interpretability in the basis of IF-THEN rules. Backpropagation learning with the new activation function also has low computational complexity. Several application examples ( XOR gate, chaotic time-series prediction, channel equalization, and independent component analysis) support the potential of the proposed scheme.

[The automatic, beat-to-beat determination of the QT interval and analysis of its spontaneous variability under basal conditions]. / Determinación automática, latido a latido, del intervalo QT y análisis de su variabilidad espontánea en condiciones basales.

OBJECTIVES: An analysis is made of the automatic beat-by-beat measurement of QT and other intervals related to ventricular repolarization. The variability pattern of these intervals is investigated in normal subjects at rest, along with their relation to RR cycle variability. MATERIAL AND METHODS: The electrocardiographic signals (LII) from 11 normal subjects (mean age 31 +/- 10 years) were recorded over 5 min and processed by applying specific algorithms to determine beat-by-beat the RR, QT, RT, QTm and RTm intervals (Tm = peak of T wave). An analysis was made of the variability of these intervals in the time (standard deviation, variation coefficient, difference between maximum and minimum values) and frequency domains (spectral analysis applying the Fourier transform). RESULTS: The differences between the automatic measurements and those performed by two observers (n = 110) were respectively -1.3 +/- 6.4 and -3.7 +/- 6.5 ms for QT, - 1.0 +/- 1.4 and -1.0 +/- 2.3 ms for QTm, -0.3 +/- 1.4 and -0.2 +/- 1.8 ms for RTm, and 0.7 +/- 6.5 and -2.8 +/- 10.3 ms for RT. The QT and RT intervals exhibited greater variability (SD = 6 +/- 1 ms) than QTm and RTm (SD = 3 +/- 1 ms, p < 0.0001). These differences persisted on comparing the corresponding variation coefficients. The differences between the maximum and minimum measurements were 45 +/- 24 ms for QT and RT, the values being significantly less in the case of QTm (21 +/- 26 ms, p < 0.05) and RTm (20 +/- 27 ms, p < 0.05). In the frequency domain, the high- (HF) and low-frequency (LF) band energies were low in the series formed by the ventricular repolarization intervals, and the LF band normalized amplitude was significantly lower than in the RR series. There were no significant differences in the frequencies of the maximum values of the LF and HF bands of the RR series with respect to the QT series. The correlations between the RR intervals and the subsequent repolarization intervals obtained in each subject were not significant in 7 of the 11 subjects studied. CONCLUSIONS: The automatic beat-by-beat determination of the ventricular repolarization intervals is precise, particularly when considering the intervals defined by the T wave peak. Repolarization variability during the sinus rhythm at rest is small, and is not linearly related to modifications of the previous RR interval. Neurovegetative and humoral influences are postulated to explain QT variations. The neurovegetative and humoral influences that regulate cardiac cycle and ventricular repolarization variability at rest, are found to be quantitatively different.

[Influence of early or late referral to nephrologist over morbidity and mortality in hemodialysis]. / Referencia precoz y tardía al nefrólogo, su influencia en la morbi-mortalidad en hemodiálisis.

OBJECTIVE: We studied the influence of early vs late referral to nephrologist of patients with chronic renal failure over clinical situation at the onset of hemodialysis and outcome. SUBJECTS AND METHODS: From january 1994 to december 1998, 139 patients started hemodialysis for end-stage renal disease at the Hospital General de Albacete, all of them included in the study and clinical follow-up concluded in december 2001. Patients with rapidly progressive glomerulonephritis were excluded. Early (ER) and late referral (LR) were defined by the time of first nephrology encounter greater than or less than 6 months respectively, before iniciation of hemodialysis. RESULTS: 106 patients (76.25%) were referred early; mean follow-up time 6.3 +/- 4.5 years. 33 patients (23.74%) had late referral, follow-up time was less then six months, 18 patients were followed during less than 4 weeks. There were no differences in demographic data and comorbid conditions between LR and ER patients (age, cardiac and vascular disease, diabetes, neoplasia...). Mean plasma concentration of creatinine and urea was significantly greater, whereas hematocrit and albumin were less in the LRA than the ER group. Emergency dialysis through central vein catheterisation was more frequent in the LR group. Number of admissions and duration of hospital stay were higher in the LR group. No significant differences in nutrition, dialysis doses or anemia were found between the two groups after 6 and 12 months of hemodialysis. Long term outcome was similar in both groups: no significant differences were found in percentage of patients transplanted or deceased after 3 years of treatment. Survival analysis failed to show a difference between ER and LR groups (mean survival time was 73.6 +/- 4.3 months and 73.0 +/- 6 months respectively). CONCLUSION: Late referral to the nephrologist is associated with increased early morbidity vs early referral, although long term outcome is not worse if predialysis comorbid conditions are comparable and dialysis care achieve equal results in dialysis doses, nutrition and anemia in both groups in the first months of treatment. Improvement of outcome of patients referred early to the nephrologist will depend on the adoption of preventive measures over comorbidity factors that should be applied in early stages of renal disease.

[Hypermineralcorticism syndrome secondary to topical application of 9-alpha-fluoroprednisolone (author's transl)]. / Síndrome de hipermineralcorticismo por aplicaciíon tópica de 9-alfa-fluorprednisolona.

A patient is reported who presented with severe arterial hypertension and pronounced hypokalemic metabolic alkalosis along with suppression of 17-hydroxicorticoids, plasma renin activity and urinary aldosterone excretion, in relation to topical application of 9-alpha-fluoroprednisolone, 300 mg weekly. The clinical picture changed after discontinuation of the steroid preparation. Whenever topical steroids are prescribed for extensive chronic skin the development of systemic side-effects must be watched. Depending on the type of steroid employed, Cushing's syndrome or a hypermineralcorticism state may appear. The differential diagnosis of a hypermineralcorticism syndrome without aldosteronism should include the possible topical application of fluorated steroids.

[Monitoring dermatomal somatosensory evoked potentials at the ERB point, the cervical spinal cord and the cerebral cortex in the diagnosis of cervical radiculopathy]. / Registro de potenciales evocados somatosensoriales dermatómicos en punto de Erb, médula cervical y corteza cerebral en el diagnóstico de la radiculopatía cervical.

INTRODUCTION: Recording at various levels of the somatosensory pathway is often used in somatosensory evoked potentials to mixed nerve stimulation (SEP), but not in dermatomal somatosensory evoked potentials (DSEP) in which only the cortical potential is usually recorded. The aim of our study was to compare the recordings of upper limb DSEP at Erb point, cervical cord, and subcortical and cortical levels with SEP recordings in healthy subjects and patients with cervical radiculopathy. PATIENTS AND METHODS: 17 patients with clinical history, MRI and electromyography consistent with cervical radiculopathy and 17 healthy subjects were included. Median and ulnar nerves were stimulated at the wrist; and C6, C7 and C8 dermatomes at the 1st, 3rd and 5th fingers respectively. All the potentials obtained with SEP and DSEP were compared between controls and patients by t test for independent samples. We also used Pearson s correlation for height/latencies, weight/amplitude and age/peripheral nerve conduction velocity (PNCV). RESULTS: DSEP potentials were of similar morphology of those observed in SEP but had longer latencies and smaller amplitudes. We found a positive correlation between height and latencies, and a negative association of weight with amplitude of peripheral potential, and age/PNCV. No difference between controls and the neurological intact segments of patients was found. 13 patient had DSEP altered while only 5 of them had altered SEP recorded. The most common finding was prolongation of the conduction time of the segment N9 N13 on DSEP recordings. CONCLUSION: We found that it is possible to record and to identify all the potentials in DSEP as observed in the SEP. On cervical radiculopathy, DSEP with the present technique increase the sensitivity and give some additional and useful information regarding the extension and localization of the pathology. Besides, DSEP recording is a non invasive technique, non traumatic and well tolerated for our patients.

[Ovarian cancer. An anatomicopathological study]. / Cáncer ovárico. Estudio anatomoclínico.

We studied 118 patients with primary ovarian cancer at the Civil Hospital of Guadalajara over a ten-years period; to evaluate incidence, risk factors, clinical aspects, pathology and treatment. Twenty per cent of the patients were classified as stage I, 14 cases (11.8%) stage II, 37 (31%) were stage III and 43 (36%), stage IV. First-stage disease was confirmed by laparotomy; average age was fifty years old, commonly found in patients with invasive carcinoma. Seventy-seven patients received postoperative chemotherapy with cisplatin plus adriamycin and ciclophosphamide or vincrystin, and twelve radiotherapy. Thirteen were evaluated by second look laparotomy, 12 of whom were without clinical residual disease; in 6 we found macroscopic residual tumor. Follow-up was done in 89 patients, and there wasn't clinic disease through 12 to 48 months, with 21 months average. The clinicopathologic study showed predominance of serous and cystic surface epithelium tumours. The aspects of the gross anatomy of the malignant tumours are important from the viewpoint of the benign tumours differentiation.

Adaptación cultural y validación al español de España del MSTCQ© (Multiple Sclerosis Treatment Concerns Questionnaire) / Cultural adaptation and validation of a peninsular Spanish version of the MSTCQ© (Multiple Sclerosis Treatment Concerns Questionnaire)

Introducción: A pesar de la efectividad de los tratamientos inyectables para la esclerosis múltiple (EM), las reacciones adversas y el dolor pueden implicar problemas de satisfacción y adherencia. Se presenta la validación de la versión española del Multiple Sclerosis Treatment Concerns Questionnaire (MSTCQ)©, que evalúa la satisfacción con el dispositivo de autoinyección (DA), 4 dimensiones: sistema de inyección (A), efectos secundarios (B) (síntomas pseudogripales, reacciones, satisfacción), experiencia con el tratamiento (C) y beneficios (D). Métodos: Dos fases de estudio: 1) Adaptación cultural con expertos (n = 6) y pacientes (n = 27). 2) Estudio observacional, transversal y multicéntrico de validación. Se evaluaron 143 pacientes adultos con EM que utilizaban el DA Extavijec(TM) 30G. Cuestionarios: MSTCQ©; Patient-Reported Indices for Multiple Sclerosis (PRIMUS©), y Treatment Satisfaction Questionnaire for Medication (TSQM©). Propiedades psicométricas: factibilidad (% casos válidos y distribución de puntuaciones); fiabilidad (α-Cronbach) y test-retest (n = 41, coeficiente correlación intraclase [CCI]), y validez de constructo (análisis factorial A y B, [AF]) y convergente (Spearman-rho MSTCQ© versus TSQM©). Resultados. Edad media (DT) 41,94 (10,47) años, 63% mujeres, 88,11% con EM remitente-recurrente, media (DT) EDSS 2,68 (1,82) puntos. Alta cumplimentación del MSTCQ© (perdidos 0-2,80%). Alta consistencia interna: puntuación total (A + B) α = 0,89, por dimensiones (A, B y C) α = 0,76, 0,89 y 0,92, respectivamente. Excelente concordancia test-retest en las puntuación total (CC I= 0,98), por dimensiones (A, B y C) CCI = 0,82, 0,97 y 0,89, respectivamente. El AF corroboró la estructura interna del cuestionario original. Correlación moderada (Rho = 0,42-0,74) y significativa (p < 0,05 y p < 0,01) entre las puntuación total y por dimensiones del MSTCQ© y el TSQM©. Conclusiones. Se constatan adecuadas propiedades psicométricas de la versión española del MSTCQ

Introduction: Although subcutaneous treatments for multiple sclerosis (MS) have been shown to be effective, adverse reactions and pain may adversely affect treatment satisfaction and adherence. This study presents an adapted and validated Spanish version of the Multiple Sclerosis Treatment Concerns Questionnaire© (MSTCQ), which evaluates satisfaction with the injection device (ID) across 4 domains: injection system (A), side effects (B) (flu-like symptoms, reactions, and satisfaction), experience with treatment (C) and benefits (D). Methods: Two study phases: 1) Cultural adaptation process with input from experts (n = 6) and patients (n = 30). 2) Validation obtained by means of an observational, cross-sectional, multi-centre study evaluating 143 adult MS patients using an ID. Tools employed: MSTCQ©, Patient-Reported Indices for Multiple Sclerosis (PRIMUS©), and Treatment Satisfaction Questionnaire for Medication (TSQM©). Psychometric properties: Feasibility (percentage of valid cases and floor/ceiling effects); Reliability (Cronbach α) and test-retest correlation (n = 41, intraclass correlation coefficient, ICC); and construct validity (factor analysis of domains A and B) and convergent validity (Spearman rank-order correlation for MSTCQ© vs TSQM©). Results: Mean age (SD) was 41.94 (10.47) years, 63% of the group were women, and 88.11% presented relapsing-remitting MS. Mean (SD) EDSS score was 2.68 (1.82) points. MSTCQ© completion was high (0%-2.80% missing data). Internal consistency was high at α=0.89 for the total score (A+B) and α = 0.76, 0.89, and 0.92 for domains A, B, and C, respectively. The version demonstrated excellent test-retest reliability for the total (ICC = 0.98) and for domains A, B, and C: ICC = 0.82, 0.97, and 0.89, respectively. Factor analysis corroborated the internal structure of the original questionnaire. The association between total and domain scores on both the MSTCQ© and the TSQM© was moderately strong (Rho = 0.42-0.74) and significant (P < .05 and P < .01). Conclusion: The Spanish version of MSTCQ© demonstrates appropriate psychometric properties

[Reversible "man-in-the-barrel" syndrome caused by hypoxic-ischemic encephalopathy]. / Síndrome del "hombre en barril" reversible causado por encefalopatía hipóxico-isquémica.

INTRODUCTION: Hypoxic-ischemic encephalopathy can lead to different clinical presentations, such as bilateral cortical borderzone infarctions due to cerebral hypoperfusion (especially after cardiopulmonary arrest), which would cause a "man-in-the-barrel" syndrome if the anterior circulation is affected. This syndrome has multiple etiologies, both central (bilateral frontal and/or pyramidal decussation lesions and cervical spinal cord lesions) as well as peripheral ones such as multifocal motor neuropathy. CASE REPORT: We report the case of a 19-year-old man who developed a "man-in-the-barrel" syndrome with bilateral and proximal upper limb brachial diplegia after bilateral watershed infarctions involving distal fields of the middle and the anterior cerebral artery due to cerebral hypoperfusion in a comatose patient without internal carotid obstruction. CONCLUSIONS: The rate of death in this syndrome is higher than 90% and it predicts a worse outcome in comatose patients. Nevertheless, our patient has had complete clinical improvement.