Efectos de la aplicación de un protocolo de entrenamiento de fuerza previo, a la cirugía de artroplastía total de rodilla en pacientes mayores de 60 años con artrosis de rodilla

La indicación mas frecuente para implantar una prótesis total de rodilla es eliminar el dolor y restaurar la movilidad causada por una gran destrucción articular en el cartílago, como ocurre con la osteoartritis. La cirugía de reemplazo de articulaciones es una intervención eficaz utilizada cada vez más para osteoartritis de cadera y de rodilla. Los pacientes diagnosticados de osteoartritis primaria avanzada que son susceptibles de recibir una prótesis total de rodilla, debido al dolor y la rigidez articular evitan utilizar la articulación durante las actividades de la vida diaria, como caminar y subir escaleras, de forma que adoptan una actitud sedentaria, afectando a la musculatura implicada en la rodilla, contribuyendo de esta forma a dificultar la movilidad de la misma. Esta situación de sedentarismo hace que el paciente afronte la cirugía con unas peores condiciones físicas que cuando fue diagnosticado e incluido en lista de espera para prótesis total de rodilla. Esta situación repercutirá en el proceso de postrehabilitación siendo este más duradero y costoso. Actualmente existen programas para mejorar los resultados físicos después de la cirugía y por otro lado aparecen otros diseñados para mejorar la función física y minimizar la ansiedad del paciente antes de la cirugía. Este tipo de actuaciones previas a la cirugía son conocidos como programas de prehabilitación. La mayoría de estos programas emplean una metodología con bastantes carencias metodológicas que hacer entender la escasa evidencia por la falta de resultados obtenidos. El objetivo principal de este trabajo es analizar los efectos que produce en el periodo postoperatorio, el entrenamiento de fuerza empleando altas intensidades sobre pacientes con gonartrosis severa que están en lista de espera para la cirugía de prótesis total de rodilla. De forma más concreta se pretende conocer que efectos produce este tipo de entrenamiento en diversas variables al mes y a los tres meses tras la cirugía. Las variables estudiadas son dolor, rango de movilidad, fuerza isométrica máxima, equilibrio, circumetría del muslo, percepción subjetiva de calidad, test timed up and go y test de la escalera, así como conocer el grado de satisfacción percibido por los pacientes tras el programa propuesto. En el siguiente estudio participaron un total de 50 pacientes mayores de 60 años con gonartrosis severa y en lista de espera quirúrgica para ATR, el 80% de los sujetos fueron mujeres. Esta muestra se dividió en dos grupos de 25 sujetos y de forma aleatorizada se asignó a cada uno de ellos. Un grupo control (GC) y un grupo prehabilitación (GPH), que realizó el entrenamiento de fuerza durante 8 semanas, con una frecuencia de 3 días a la semana supervisado por un fisioterapeuta. Tras una semana de familiarización, se llevo a cabo el entrenamiento de fuerza con una intensidad de 10RM sobre la musculatura abductora de cadera, extensora y flexora de rodilla, junto con un trabajo de equilibrio en diferentes apoyos. Los resultados obtenidos mostraron una mejoría significativa en todas las variables pre y postoperatorias. También se registró que el GPH tras el programa de fortalecimiento mostró un alto grado de satisfacción. Este trabajo concluye afirmando que el programa de fuerza empleando altas intensidades, es un método adecuado para mejorar la fuerza preoperatoria de sujetos mayores de 60 años que están en lista de espera, repercutiendo positivamente en la mejora de la capacidad funcional postoperatoria

Effect of a common exercise programme with an individualised progression criterion based on the measurement of neuromuscular capacity versus current best practice for lower limb Tendinopathies (malaga trial) : a protocol for a randomised clinical trial

High-load resistance training has shown positive effects in pain and function in lower limb tendinopathies. However, some authors suggest that current exercise programmes produce an increase in tolerance to load and exercise in general but without fixing some existing issues in tendinopathy. This may indicate the need to include training aspects not currently taken into account in the current programmes. The main objective of this study will be to compare the effect of a common exercise protocol for the three predominant lower limb tendinopathies (Achilles, patellar and gluteal), based on an individualised control of the dose and training of specific aspects of the neuromuscular system versus the current best practice for each location

Validation of the International Consultation on Incontinence Questionnaire‑Pediatric Lower Urinary Tract Symptoms (ICIQ‑CLUTS) for Spanish‑speaking children

The International Consultation on Incontinence Questionnaire-Pediatric Lower Urinary Tract Symptoms (ICIQ-CLUTS) is a 12-item self-administered tool to screen lower urinary tract symptoms (LUTS) in children. The aim of this study is to translate and validate the ICIQ-CLUTS into Spanish (ICIQ-CLUTS-Sp) and to study its psychometric properties. The cross-cultural adaptation of the ICIQ-CLUTS was performed following international recommendations. The psychometric analysis of the ICIQ-CLUTS-Sp was carried out to determine the reliability, validity, and diagnostic accuracy in a sample of 155 children and parents who completed the Spanish version ICIQ-CLUTS. The reliability indicators for the ICIQ-CLUTS-Sp were excellent (Cronbach's alpha was > 0.8 and ICC > 0.9 both for children's and parents' versions). There was a high Pearson r > 0.6 and a high agreement level between children's and parents' answers (ICC > 0.6), except in 4 items. For parents, the standard error of measurement (SEm) was 0.41, and the minimal detectable change (MDC) was 1.14 points. In children, these results were 0.42 and 1.16 points, respectively. Cut-off points greater than 15 points in the parent version or 16 points in the children version have the highest sensitivity and specificity for detecting LUTS. Conclusion: The Spanish version of the ICIQ-CLUTS questionnaire is a valid, reliable, and diagnostically accurate instrument to identify cases of children with LUTS. Therefore, it can be used to screen for lower urinary tract symptoms in Spanish speaking children and/or parents, as well as to monitor the effects of interventions. What is Known: • Lower urinary tract symptoms in children should be assessed multimodally using minimally invasive diagnostic procedures. One way to do this is to use the questionnaire to differentiate these cases in paediatric patients. • A cross-cultural adaptation of the ICIQ-CLUTS questionnaire to Spanish has not yet been done. What is New: • Based on a comprehensive validation methodology, this study highlights that the ICIQ-CLUTSSp questionnaire has good psychometric properties

Effect of a gamified education intervention with Kahoot on the levels of absenteeism from the degree in physiotherapy

Introduction: High levels of absenteeism have become one of the main problems in university education, due to the difficulty it causes in the implementation of basic active strategies such as self-guided learning. The gamified education tool Kahoot has become one of the most popular methods of gamification in the classroom environment. The aim of this study was to compare the levels of absenteeism obtained with the introduction of a gamified education methodology using Kahoot versus the traditional methodology of individual or group written tasks. Methodology: The Kahoot tool was used as a gamified education strategy on the Kinesitherapy subject of the Degree in Physiotherapy of the University of Valencia, with a total of 100 students enrolled. All the sessions included a presentation of contents. In addition, half of the ten sessions included the use of a gamification intervention, answering ten questions at the end of the session using Kahoot. Class attendance was assessed using the number of students who attended each class. The effectiveness of both options was evaluated by comparing means between the number of students attending the classes in which the Kahoot tool was used versus the number of students in the classes in which a traditional methodology was applied. Results: The analysis of the mean differences in class attendance revealed a statistically significant increase (p = .004) in the number of students present in the sessions with Kahoot (mean 70.8 (25.3)) with respect to the sessions without gamification (mean 52.6 (21.2)). In terms of percentage, there was a significant reduction in absenteeism in classes with Kahoot (mean 29.2%) compared to classes with a traditional approach (mean 47.4%). Conclusions: Based on the results in class attendance, Kahoot can be used as a gamified education tool to improve the participation and reducing the absenteeism in university studies of Physiotherapy.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Search for Mutations in a Segment of the Exon 28 of the Human Von Willebrand Factor Gene. New Mutations, R1315C and R1341W, Associated with Type 2M and 2B Variants

[EN] von Willebrand Disease (vWD) is the most frequently inherited bleeding disorder in humans, and is caused by a qualitative and/or quantitative abnormality of the von Willebrand factor (vWF), A large number of defects that cause qualitative variants have been located in the Al domain of the vWF, which contains sites for interaction with platelet glycoprotein Ib (GPIb). We have developed a new approach to detect mutations based on Ddel digestion and single-strand conformation polymorphism analysis. A segment of 487 nucleotides, extending from intron 27 to codon 1368 of the pre-pro vWF was amplified from genomic DNA, The cleavage with Ddel yields two fragments of appropriate size for this kind of analysis and confirms that the gene, rather than the pseudogene, is being investigated, Six families with type 2B vWD: one type 2M vWD family, and one another type 2A vWD family were studied. After sequencing the fragments with an altered electrophoretic pattern, we found four mutations previously described-R1308C, V1316M, P1337L, and R1306W-in patients with 2B vWD, The last one arose de novo in the patient. In addition, two new candidate mutations were observed: R1315C and R1341W. The first one was associated to type 2M vWD, whereas the one second cosegregated with type 2B vWD. The fact that these new mutations were not found in 100 normal alleles screened further supports their causal relationship with the disease, These mutations, which induce either a gain or a loss of function, further show an important regulatory role of this region in the binding of vWF to GPIb and its implications in causing disease.We wish to thank J.M. Montoro for performing multimeric assays and R. Curats for his technical assistance.Casaña, P.; Martínez, F.; Espinós-Armero, CÁ.; Haya, S.; Lorenzo, JI.; Aznar, JA. (1998). Search for Mutations in a Segment of the Exon 28 of the Human Von Willebrand Factor Gene. New Mutations, R1315C and R1341W, Associated with Type 2M and 2B Variants. American Journal of Hematology. 59(1):57-63. https://doi.org/10.1002/(sici)1096-8652(199809)59:13.0.co;2-z576359

Risk profile and mode of transmission of monkeypox: A rapid review and individual patient data meta-analysis of case studies

Since May 2022, an outbreak of monkeypox in non-endemic countries has become a potential public health threat. The objective of this rapid review was to examine the risk profile and modes of transmission of monkeypox. PubMed, Web of Science, and Scopus were searched from inception through July 30 to collect case reports/series on patients with monkeypox infection. For meta-analysis, data on the total number of participants and deaths by binary categories of exposure (age, sex, country, other co-infections or existing conditions, and mode of contagion) were used. A total of 62 studies (4659 cases) were included. Most cases came from Africa (84.3%), followed by Europe (13.9%). In 63.6% of the cases, the mode of contagion was human contact, while 22.8% of the cases were by animal contact, and 13.5% were unknown or not reported. The mortality rate was 6.5% throughout these studies. The risk of mortality was higher in the younger age group (risk difference: 0.19; 95% CI: 0.02–0.36), in cases with other co-infections or current chronic conditions (risk difference: 0.03; 95% CI: 0.01–0.05) and in the category of low- and middle-income countries (risk difference: 0.06; 95% CI: 0.05–0.08). There were no significant differences with respect to sex or mode of contagion. These results help to understand the major infection pathways and mortality risk profiles of monkeypox and underscores the importance of preventing outbreaks in specific settings, especially in settings densely populated by children, such as day care centres and schools

Q1311X: a novel nonsense mutation of putative ancient origin in the von Willebrand factor gene

[EN] Type 3 von Willebrand disease, a recessive autosomally inherited bleeding disorder, refers to complete deficiency of von Willebrand factor (VWF). The novel Q1311X mutation was detected in the homozygous state in four Spanish patients from two apparently unrelated families of gypsy origin. The lack of specific amplification of platelet VWF cDNA from two of the patients indicates reduced levels of mutated gene expression. The similar haplotype linked to mutated alleles suggests a common origin. On the basis of the two instabilities observed and the estimated mutation rate of the microsatellites of intron 40 of the VWF gene, we can estimate that this mutation could have arisen about 2300 years ago.We wish to thank J.M. Montoro and R. Curats for their technical assistance. This work was supported in part by F1S 99/0633.Casaña, P.; Martínez, F.; Haya, S.; Lorenzo, JI.; Espinós-Armero, CÁ.; Aznar, JA. (2000). Q1311X: a novel nonsense mutation of putative ancient origin in the von Willebrand factor gene. British Journal of Haematology. 111(2):552-555. https://doi.org/10.1046/j.1365-2141.2000.02410.x552555111

Handgrip strength and work limitations:A prospective cohort study of 70,820 adults aged 50 and older

The purpose of the study was to investigate the association between handgrip strength and the incidence of work limitations in European adults aged 50 and older. We conducted a prospective cohort study among adults aged 50 and older from 27 European countries and Israel. Data were collected from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 1, 2, 4, 5, 6, and 7. Handgrip strength was measured using a hand dynamometer (Smedley, S Dynamometer, TTM) and participants replied to questions about work limitations. Cox regression was conducted for statistical analyses. A total of 70,820 older adults (mean age 61 ± 7.7 years; 54.3 % women) were followed during a mean of 3.8 ± 2.9 years. The fully adjusted model showed that participants with low handgrip strength (<16 kg in women and <27 kg in men) had a significantly higher risk of work limitations compared with participants with normal values of handgrip strength (hazard ratio: 1.36; 95 % confidence interval: 1.28–1.44). Kaplan-Meier trajectories revealed that the survival probability to experience work limitations in the normal handgrip category was 20 % lower than in the low handgrip category in most of the follow-up period. We identified low level of handgrip strength as a risk factor for work limitations in adults aged 50 years or older. This could be used as an accessible measure to screen workers at risk of developing work limitations

Significant linkage and non-linkage of type 1 von Willebrand Disease to the von Willebrand factor gene

[EN] Significant linkage of types 2A and 2B von Willebrand disease (VWD) to the von Willebrand factor (VWF) gene have been reported, as well as mutations in the VWF gene. However, data for the partial quantitative variant are less consistent. An inconsistency of association between the type 1 VWD phenotype and genotype has been reported recently. We undertook linkage analysis of 12 families with definite or possible type 1 VWD patients. One family with classic type 1 VWD had a high lod score (Z = 5.28, theta = 0.00). A total lod score of 10.68 was obtained for the four families with fully penetrant disease. In two families linkage was rejected, while three families did not show conclusive evidence of linkage. This study corroborates ABO blood group influence, especially in patients with mild deficiencies and/or incomplete penetrance, Indirect genetic analysis may be an option for diagnosing asymptomatic or presymptomatic type 1 VWD carriers, particularly in families showing higher penetrance. The study indicates defects of the VWF locus are to be expected in more than half of the families studied. However, as defects at different loci may be the cause of this phenotype, the results of the segregation analyses should be interpreted with caution, especially in studies involving small families, or mild expressions of the disorder or incomplete penetrance.This work was partly supported by F1S grant # 99/0633 (Spain). We wish to thank J. M. Montoro for the multimeric structure analyses, R. Curats for his help in the segregation analyses, all the staff of the `Unidad de CoagulopatõÂas CongeÂnitas de la Comunidad 5alenciana' for their technical and clinical assistance, and Mr Peter Blair for the linguistic advice given in writing this paper.Casaña-Gargallo, MP.; Martínez, F.; Haya, S.; Espinós-Armero, CÁ.; Aznar, JA. (2001). Significant linkage and non-linkage of type 1 von Willebrand Disease to the von Willebrand factor gene. British Journal of Haematology. 115(3):692-700. https://doi.org/10.1046/j.1365-2141.2001.03132.x692700115