Distance Education for children with a disability and/or from vulnerable families.

Different reasons may hinder the right to education of children with a disability and/or from vulnerable families; for example, living in rural areas where they do not have access to public transport, restriction of opportunities to access schools, precarious economic situations, lack of minimum services that meet the needs of hygiene and personal care, among other reasons. This has made it necessary to implement changes in traditional education systems. For this reason, the objective of this study is to build a theoretical base that facilitates the understanding of the requirements of these children in terms of distance education. To do this, the authors interviewed primary education teachers who work with children with a disability and/or from vulnerable families. A qualitative research methodology was used with the focus group as a technique for collecting information. Ten primary school teachers participated in an interview made up of a set of open-ended questions that facilitated their narratives regarding education strategies used for students with a disability and/or those living in vulnerable families, which were later grouped into categories. As a result of this research, the following strategies used by the participating teachers were collected: recreating the feeling of the physical classroom in the virtual classroom, fostering friendship and companionship among students, designing engagement strategies, and considering the socio-cultural variables that influence learning. The teachers assured that distance education is a perfectly viable alternative for children with a disability and/or from vulnerable families.

Esophageal stricture as an initial manifestation of Crohn's disease.

Crohn's disease located in the esophagus is rare, being exceptional as the initial manifestation of the disease. Erosive ulcerative esophagitis, stricture and fistula are forms of presentation, as in other esophageal pathologies, so the differential diagnosis is broad. The histologic features of esophageal Crohn's disease can be nonspecific and increase the diagnostic challenge. Esophageal Crohn's disease should be included in the differential diagnosis of esophageal strictures and may require esophagectomy if medical-endoscopic treatment is not effective.

[Consensus of the ambulatory surgery commite section of the Spanish Association of Surgeons on the role of ambulatory surgery in the SARS-CoV-2 pandemic]. / Consenso de la sección de cirugía mayor ambulatoria de la Asociación Española de Cirujanos sobre el papel de la cirugía mayor ambulatoria en la pandemia SARS-CoV-2.

The current situation of the SARS-CoV-2 pandemic has paralyzed non-urgent and/or oncological surgery in many hospitals in our country with what it means for the health of citizens who are awaiting a surgical procedure. Outpatient Surgery can afford more than 85% of the surgical procedures that are performed in a surgical department and is presented as a feasible and safe alternative at the present time since it does not require admission and decreases clearly the risk of infection. In addition, it is the tool that should be generalized to solve the accumulation of patients on the waiting list that the pandemic is generating, so it seems appropriate that the Ambulatory Surgery section of the Spanish Association of Surgeons present a series of recommendations for the implementation of outpatient surgery in these exceptional circumstances that we have to live.

[Influence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomy]. / Influencia del confinamiento por COVID-19 en los resultados ponderales durante el primer año tras la gastrectomía vertical.

INTRODUCTION: COVID-19 pandemic has lead to lockdown of population in many countries. In Spain, the state of alarm was established from March 15 to June 20, 2020. Usually this fact decreased people's mobility and physical activity, in addition to producing or exacerbating psychological disorders. Our aim was to determine the influence that this condition had over the short-term ponderal results of patients undergoing laparoscopic vertical gastrectomy from May 2019 to May 2020. METHODS: Case-control study for comparing the percentage of excess weight lost (%EWL) and the percentage of total weight lost (%TWL) of patients that underwent a VG during the last year, so they were affected by lockdown in April and part of March 2020 (group 1), to the %EWL and %TWL of a control group (group 2), obtained from our previous series. RESULTS: The mean %EWL in group 1 is 47,37 ± 18,59 and in group 2 is 51,13 ± 17,59, being p = 0,438. Meanwhile, the mean %TWL in group 1 is 21,14 ± 8,17 and in group 2 is 24,67 ± 8,01, with p = 0,115. CONCLUSIONS: Population lockdown by COVID-19 did not get worse short-term results of vertical gastrectomy. More studies with a larger number of patients are necessary to draw firm conclusions.

Barrett's esophagus is a controversial condition.

We wish to respond to the comments provided by José Miguel Esteban López-Jamar and Ravishankar Asokkumar (1) about our report in this Journal (2). Some of the comments were perhaps prompted by inadequately explained or understood concepts, since they mention aspects that we never even considered or stated.

Effect of the vaginal microbiome on the pregnancy rate in women receiving assisted reproductive treatment.

PURPOSE: To investigate if the vaginal microbiome influences the IVF outcome. METHODS: Thirty-one patients undergoing assisted reproductive treatment (ART) with own or donated gametes and with cryotransfer of a single euploid blastocyst were recruited for this cohort study. Two vaginal samples were taken during the embryo transfer procedure, just before transferring the embryo. The V3 V4 region of 16S rRNA was used to analyze the vaginal microbiome, and the bioinformatic analysis was performed using QIIME2, Bioconductor Phyloseq, and MicrobiomeAnalyst packages. Alpha diversity was compared between groups according to the result of the pregnancy test. RESULTS: Fourteen (45.2%) patients did not and seventeen (54.8 %) did achieve pregnancy under ART. A greater index of alpha diversity was found in patients who did not achieve pregnancy comparing to those who did, although this difference was not significant (p = 0.088). In the analysis of beta diversity, no statistically significant differences were observed between groups established as per the pregnancy status. Samples from women who achieved pregnancy showed a greater presence of Lactobacillus spp. The cluster analysis identified two main clusters: the first encompassed the genera Lactobacillus, Gardnerella, Clostridium, Staphylococcus, and Dialister, and the second included all other genera. Women who achieved pregnancy were mainly detected microorganisms from the first cluster. CONCLUSIONS: The vaginal microbiome can influence the results of ART. The profiles dominated by Lactobacillus were associated with the achievement of pregnancy, and there was a relationship between the stability of the vaginal microbiome and the achievement of pregnancy.

Barrett's esophagus: "All diseases are divine and all are human".

Barrett's esophagus (BE) is a controversial condition. The significance of this condition lies in its premalignant potential, so it is important that clinically applicable biomarkers be identified for early detection and targeted prevention. Dysplasia is currently used as main biomarker, but others most recently surveyed in cancer also include microRNAs. Classically, BE was considered to be an acquired disease related to pathological gastroesophageal acid and bile reflux. However, some cases are associated with genetic predisposition, representing an inherited, familial form of BE. The actual gene, or genes, involved in this condition have not yet been identified. Main therapeutic options include medical treatment and antireflux surgery. Both types of treatment are equally efficient in controlling symptoms and neither is able to cause the metaplastic segment to disappear, which is why the risk of malignancy remains. However, we may use endoscopic radiofrequency to eradicate BE and replace it by the typical squamous epithelium of the esophagus. The currently accepted indications of radiofrequency in BE include low- and high-grade dysplasia, but not Barrett's esophagus without dysplasia. In conclusion, BE may have two different presentations: environmental ("human", reflux) or sporadic BE, which is the most common form, and genetic ("divine", inherited) or familiar BE, less common but with a greater risk for malignancy. As they might be two different diseases, surveillance programs and treatments should also be different.

Is prophylactic gastrectomy indicated for healthy carriers of CDH1 gene mutations associated with hereditary diffuse gastric cancer?

INTRODUCTION: hereditary diffuse gastric cancer (HDGC) is a recently reported hereditary cancer syndrome. Patients with suspected HDGC must be under surveillance via endoscopy and multiple biopsies. As an alternative, some studies suggest prophylactic gastrectomy (PG) for disease carriers. The goal of this article was to report our experience with a CDH1 mutation positive family who underwent PG. PATIENTS AND METHODS: the index case was a 34-year-old female diagnosed with diffuse gastric adenocarcinoma and massive carcinomatosis. There was a family history of gastric adenocarcinoma in seven family members. A genetic study identified the c.1577G>A mutation, in exon 11 of the CDH1 gene via sequencing analysis. RESULTS: this mutation was also present in other six family members, who subsequently underwent prophylactic gastrectomy. The pathology study of resected gastric segments revealed multiple microscopic foci of adenocarcinoma in five of these individuals. These foci were not detected in the multiple endoscopies performed before surgery. CONCLUSIONS: we recommend prophylactic gastrectomy for CDH1 mutation carriers even in the absence of lesions during endoscopic screening.

Evolution of gastroesophageal reflux after laparoscopic vertical gastrectomy. A radiographic, manometric and pH-metric study.

INTRODUCTION: the relationship between laparoscopic vertical gastrectomy (LVG) and gastroesophageal reflux (GER) is still controversial. Therefore, its study is of great interest in order to obtain definitive conclusions. The goal of the study was to establish whether LVG modifies pH-metric GER in obese patients and to analyze the associated factors. PATIENTS AND METHODS: the first 26 patients who underwent LVG in our institution were enrolled in the study. A barium swallow, 24-hour ambulatory pH-metry and four-channel intraluminal esophageal manometry (IEM) were all performed before and one year after surgery. RESULTS: among the pH-metric data, there was a significant increase in the DeMeester index after the procedure (p = 0.028), while other parameters remained unchanged. Furthermore, 50% of patients with preoperative pH-metric GER had normal values at one year after surgery. IEM showed a decrease in lower esophageal sphincter (LES) pressure and in the mean wave amplitude at the distal third of the esophagus (p = 0.007 and p = 0.025, respectively). The rate of newly-developed hiatal hernias in the radiographic study was 36.4%. CONCLUSION: LVG mildly increases GER, which is likely related to the development of hiatal hernias and a decrease in LES pressure and esophageal sweep. However, LVG should not be contraindicated for patients with preoperative pH-metric GER, as this may clear after the procedure.

Contribution of the virtual colonoscopy in a case of intestinal intussusception.

The present paper describes a case of ileocecal intussusception detected by ultrasound and confirmed by CT, including the imaging characteristics allowing its diagnosis. The patient was referred for colonoscopy, which could not be completed, to assess the cause of intussusception. Then it was decided to resort to Virtual colonoscopy, which allowed to identify and characterize a cecal neoplasm serving as a lead point for the intussusception.

Sweat sodium loss influences serum sodium concentration in a marathon.

The aim of this investigation was to determine the influence of sweat electrolyte concentration on body water and electrolyte homeostasis during a marathon. Fifty-one runners completed a marathon race in a warm and dry environment (24.4 ± 3.6 °C). Runners were classified as low-salt sweaters (n = 21; <30 mmol/L of sweat Na+ concentration), typical sweaters (n = 20; ≥30 and <60 mmol/L of sweat Na+ concentration), and salty sweaters (n = 10; ≥60 mmol/L of sweat Na+ concentration). Before and after the race, body mass and a sample of venous blood were obtained. During the race, sweat samples were collected by using sweat patches, and fluid and electrolyte intake were recorded by using self-reported questionnaires. Low-salt, typical and salty sweaters presented similar sweat rates (0.93 ± 0.2, 0.92 ± 0.29, 0.99 ± 0.21 L/h, respectively), body mass changes (-3.0 ± 1.0, -3.3 ± 1.0, -3.2 ± 0.8%), total Na+ intake (12.7 ± 8.1, 11.5 ± 9.7, 14.5 ± 16.6 mmol), and fluid intake (1.3 ± 0.8, 1.2 ± 0.8, 1.2 ± 0.6 L) during the race. However, salty sweaters presented lower post-race serum Na+ concentration (140.8 ± 1.3 vs 142.5 ± 1.1, 142.4 ± 1.4 mmol/L; P < 0.01) and serum osmolality (297 ± 6 vs 299 ± 5, 301 ± 6 mOsm/kg; P < 0.05) than low-salt and typical sweaters. Sweat electrolyte concentration could influence post-race serum electrolyte concentration in the marathon. However, even the saltiest sweaters did not develop exercise-associated hyponatremia or associated symptoms.

ACTN3 genotype influences exercise-induced muscle damage during a marathon competition.

PURPOSE: Exercise-induced muscle damage has been identified as one of the main causes of the progressive decrease in running and muscular performance in marathoners. The aim of this investigation was to determine the influence of the ACTN3 genotype on exercise-induced muscle damage produced during a marathon. METHODS: Seventy-one experienced runners competed in a marathon race. Before and after the race, a sample of venous blood was obtained and maximal voluntary leg muscle power was measured during a countermovement jump. In the blood samples, the ACTN3 genotype (R577X) and the changes in serum creatine kinase and myoglobin concentrations were measured. Data from RX heterozygotes and XX mutant homozygotes were grouped as X allele carriers and compared to RR homozygotes. RESULTS: At the end of the race, X allele carriers presented higher serum myoglobin (774 ± 852 vs 487 ± 367 U L-1; P = 0.02) and creatine kinase concentrations (508 ± 346 vs 359 ± 170 ng mL-1; P = 0.04) than RR homozygotes. Pre-to-post-race maximal voluntary leg muscle power reduction was more pronounced in X allele carriers than RR homozygotes (-34.4 ± 16.1 vs -27.3 ± 15.4%; P = 0.05). X allele carriers self-reported higher levels of lower limb muscle pain (7 ± 2 vs 6 ± 2 cm; P = 0.02) than RR homozygotes at the end of the race. CONCLUSIONS: In comparison to RR homozygotes, X allele carriers for the R577X polymorphism of the ACTN3 gene presented higher values for typical markers of exercise-induced muscle damage during a competitive marathon. Thus, the absence of a functional α-actinin-3 produced by the X allele might induce higher levels of muscle breakdown during prolonged running events.

Physiological Demands of Elite Cross-Country Skiing During a Real Competition.

The aim of this study was to assess different physiological variables before and after a 5-km (women) and 10-km (men) cross-country skiing competition to determine potential mechanisms of fatigue. Fourteen elite-level skiers competed in an official cross-country skiing competition using the classical style (9 men and 5 women). Instantaneous skiing velocity was measured during the race by means of 15-Hz global positioning system devices. Before and after the race, a sample of venous blood was obtained to assess changes in blood lactate and serum electrolyte and myoglobin concentrations. Prerace to postrace changes in blood oxygen saturation, forced vital capacity during a spirometry test, jump height during a countermovement jump, and handgrip force were also measured. Mean race speed was 15.8 ± 2.5 and 15.4 ± 1.5 km·h, whereas mean heart rate was 171 ± 6 and 177 ± 3 b·min for men and women, respectively. There were no significant prerace to postrace changes in jump height, handgrip force, and forced vital capacity in men and women. Blood oxygen saturation was reduced from prerace to postrace in men (95.9 ± 2.1% to 93.1 ± 2.3%, p = 0.02) and women (97.8 ± 1.1% to 92.4 ± 2.1%, p < 0.01), whereas blood lactate concentration increased at the end of the race in men (1.4 ± 0.5 to 4.9 ± 2.1 mmol·L, p < 0.01) and women (1.9 ± 0.1 to 6.9 ± 3.2 mmol·L, p < 0.01). After the race, blood markers of muscle damage were at low concentrations, whereas serum electrolytes remained unchanged. Fatigue in 5- and 10-km cross-country skiing competitions was related to a reduced blood oxygen carrying capacity and presumably increased muscle and blood acidosis, whereas the influence of exercise-induced muscle damage on fatigue was minor.

Effects of oral salt supplementation on physical performance during a half-ironman: A randomized controlled trial.

The aim of this study was to investigate the effectiveness of oral salt supplementation to improve exercise performance during a half-ironman triathlon. Twenty-six experienced triathletes were matched for age, anthropometric data, and training status, and randomly placed into the salt group (113 mmol Na(+) and 112 mmol Cl(-)) or the control group (cellulose). The experimental treatments were ingested before and during a real half-ironman triathlon competition. Pre- and post-race body mass, maximal force during a whole-body isometric strength test, maximal height during a countermovement jump, were measured, and blood samples were obtained. Sweat samples were obtained during the running section. Total race time was lower in the salt group than in the control group (P = 0.04). After the race, whole-body isometric strength (P = 0.17) and jump height (P = 0.49) were similarly reduced in both groups. Sweat loss (P = 0.98) and sweat Na(+) concentration (P = 0.72) were similar between groups. However, body mass tended to be less reduced in the salt group than in the control group (P = 0.09) while post-race serum Na(+) (P = 0.03) and Cl(-) (P = 0.03) concentrations were higher in the salt group than in the control group. Oral salt supplementation was effective to lessen body mass loss and increase serum electrolyte concentration during a real half-ironman.

CFTR genotype-related body water and electrolyte balance during a marathon.

The aim of this investigation was to determine the influence of CFTR genotype on body water and electrolyte balance during a marathon. Fifty-one experienced runners completed a marathon race. Before and after the race, body mass and a sample of venous blood were obtained. During the race, sweat samples were collected using sweat patches, and fluid and electrolyte intake were obtained using self-reported questionnaires. Thirty-eight participants (74.5% of the total) were 7T/7T homozygotes, 11 (21.6%) were 7T/9T heterozygotes, and one participant presented the rare genotype 5T/7T. Another participant with 9T/9T presented the mutation p.L206W. Participants with 7T/7T showed higher sweat sodium concentrations (42.2 ± 21.6 mmol/L) than 7T/9T (29.0 ± 24.7 mmol/L; P = 0.04). The runner with the 5T/7T genotype (10.2 mmol/L) and the participant with the p.L206W mutation (20.5 mmol/L) exhibited low-range sweat sodium concentrations. However, post-race serum sodium concentration was similar in 7T/7T and 7T/9T (142.1 ± 1.3 and 142.4 ± 1.6 mmol/L, respectively; P = 0.27) and did not show abnormalities in participants with the 5T/7T genotype (140.0 mmol/L) and the p.L206W mutation (143.0 mmol/L). Runners with the CFTR-7T/7T genotype exhibited increased sweat sodium concentrations during a marathon. However, this phenotype was not related with increased likelihood of suffering body water and electrolyte imbalances during real competitions.

Influence of endurance running on calcaneal bone stiffness in male and female runners.

PURPOSE: The aim of this investigation was to determine the influence of endurance running on calcaneus bone stiffness in male and female runners. METHODS: A total of 122 marathoners (longer distance runners, men = 101; women = 21) and 81 half-marathon and 10-km runners (shorter distance runners; men = 48; women = 33), competing in an international running event, underwent an ultrasonographic assessment of the right and left calcaneus. Calcaneus bone stiffness was estimated using the measurements of the speed of sound (SOS) and broadband ultrasound attenuation (BUA). Seventy-five age-matched sedentary people served as the control group. RESULTS: Male and female longer distance runners and shorter distance runners presented higher values than sedentary counterparts in SOS (P < 0.05), and calcaneus stiffness (P < 0.05). Although there were no significant differences between longer distance and shorter distance runners in the ultrasonographic variables, longer distance runners presented greater effects size in SOS (1.00 vs. 0.93 males; 1.10 vs. 0.77 females), BUA (0.62 vs. 0.25 males; 0.89 vs. 0.20 females) and calcaneus stiffness (0.88 vs. 0.66 males; 1.20 vs. 0.60 females) than shorter distance endurance runners. CONCLUSION: Calcaneus bone stiffness was higher in all endurance runners compared to a sedentary control population. The volume of ground reaction forces which occur during endurance running might induce the adaptation of the calcaneus bone.

Muscle damage produced during a simulated badminton match in competitive male players.

The purpose of the study was to assess the occurrence of muscle damage after a simulated badminton match and its influence on physical and haematological parameters. Sixteen competitive male badminton players participated in the study. Before and just after a 45-min simulated badminton match, maximal isometric force and badminton-specific running/movement velocity were measured to assess muscle fatigue. Blood samples were also obtained before and after the match. The badminton match did not affect maximal isometric force or badminton-specific velocity. Blood volume and plasma volume were significantly reduced during the match and consequently haematite, leucocyte, and platelet counts significantly increased. Blood myoglobin and creatine kinase concentrations increased from 26.5 ± 11.6 to 197.3 ± 70.2 µg·L(-1) and from 258.6 ± 192.2 to 466.0 ± 296.5 U·L(-1), respectively. In conclusion, a simulated badminton match modified haematological parameters of whole blood and serum blood that indicate the occurrence of muscle fibre damage. However, the level of muscle damage did not produce decreased muscle performance.

Acute consumption of a caffeinated energy drink enhances aspects of performance in sprint swimmers.

This study investigated the effect of a caffeinated energy drink on various aspects of performance in sprint swimmers. In a randomised and counterbalanced order, fourteen male sprint swimmers performed two acute experimental trials after the ingestion of a caffeinated energy drink (3 mg/kg) or after the ingestion of the same energy drink without caffeine (0 mg/kg; placebo). After 60 min of ingestion of the beverages, the swimmers performed a countermovement jump, a maximal handgrip test, a 50 m simulated competition and a 45 s swim at maximal intensity in a swim ergometer. A blood sample was withdrawn 1 min after the completion of the ergometer test. In comparison with the placebo drink, the intake of the caffeinated energy drink increased the height in the countermovement jump (49.4 (SD 5.3) v. 50.9 (SD 5.2) cm, respectively; P<0.05) and maximal force during the handgrip test with the right hand (481 (SD 49) v. 498 (SD 43) N; P<0.05). Furthermore, the caffeinated energy drink reduced the time needed to complete the 50 m simulated swimming competition (27.8 (SD 3.4) v. 27.5 (SD 3.2) s; P<0.05), and it increased peak power (273 (SD 55) v. 303 (SD 49) W; P <0.05) and blood lactate concentration (11.0 (SD 2.0) v. 11.7 (SD 2.1) mM; P<0.05) during the ergometer test. The caffeinated energy drink did not modify the prevalence of insomnia (7 v. 7%), muscle pain (36 v. 36%) or headache (0 v. 7%) during the hours following its ingestion (P>0.05). A caffeinated energy drink increased some aspects of swimming performance in competitive sprinters, whereas the side effects derived from the intake of this beverage were marginal at this dosage.

The ingestion of a caffeinated energy drink improves jump performance and activity patterns in elite badminton players.

The aim of this study was to investigate the effectiveness of a caffeine-containing energy drink to enhance physical and match performance in elite badminton players. Sixteen male and elite badminton players (25.4 ± 7.3 year; 71.8 ± 7.9 kg) participated in a double-blind, placebo-controlled and randomised experiment. On two different sessions, badminton players ingested 3 mg of caffeine per kg of body mass in the form of an energy drink or the same drink without caffeine (placebo). After 60 min, participants performed the following tests: handgrip maximal force production, smash jump without and with shuttlecock, squat jump, countermovement jump and the agility T-test. Later, a 45-min simulated badminton match was played. Players' number of impacts and heart rate was measured during the match. The ingestion of the caffeinated energy drink increased squat jump height (34.5 ± 4.7 vs. 36.4 ± 4.3 cm; P < 0.05), squat jump peak power (P < 0.05), countermovement jump height (37.7 ± 4.5 vs. 39.5 ± 5.1 cm; P < 0.05) and countermovement jump peak power (P < 0.05). In addition, an increased number of total impacts was found during the badminton match (7395 ± 1594 vs. 7707 ± 2033 impacts; P < 0.05). In conclusion, the results show that the use of caffeine-containing energy drink may be an effective nutritional aid to increase jump performance and activity patterns during game in elite badminton players.