Cost-effectiveness of two dry needling interventions for plantar heel pain: A secondary analysis of an rct

Plantar heel pain is a common cause of foot pain that affects patients’ quality of life and represents a significant cost for the healthcare system. Dry needling and percutaneous needle electrolysis are two minimally invasive treatments that were shown to be effective for the management of plantar heel pain. The aim of our study was to compare these two treatments in terms of health and economic consequences based on the results of a published randomized controlled trial. For this, we evaluated the costs from the point of view of the hospital and we carried out a cost-effectiveness study using quality of life as the main variable according to the Eq-5D-5L questionnaire. The cost of the complete treatment with dry needling (DN) was €178.86, while the percutaneous needle electrolysis (PNE) was €200.90. The quality of life of patients improved and was translated into +0.615 quality-adjusted life years (QALYs) for DN and +0.669 for PNE. PNE presented an average incremental cost-effectiveness ratio (ICER) of €411.34/QALY against DN. These results indicate that PNE had a better cost-effectiveness ratio for the treatment of plantar heel pain than DN

Cost-effectiveness of upper extremity dry needling in the rehabilitation of patients with stroke

Introduction: Dry needling (DN) has been shown to be effective for the treatment of upper extremity hypertonia in patients with stroke. Purpose: To evaluate the cost-effectiveness of DN in patients with stroke. Methods: A cost-effectiveness analysis was performed in a research study conducted at a Spanish public hospital where patients were classified into two groups with or without DN. Hypertonia was measured using the Modified Modified Ashworth Scale (MMAS), and quality of life (QOL) was assessed using the EuroQoL 5-dimension questionnaire. Data regarding the effects and costs of physiotherapy were presented by calculating the mean and 95% confidence interval. The health outcomes were evaluated considering the rate of responders to the treatment based on the MMAS. Spanish preference weights were used to estimate quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were calculated to determine the economic value of DN. Results: Eighty patients with stroke in the subacute stage of recovery were selected to participate in this study. Based on the rate of responders, the ICER of the DN group was very low. Despite the sensitivity analysis performed, the results of the ICUR were not encouraging. Discussion: Cost-effectiveness with responder rate results were favourable for the DN group and were confirmed by the sensitivity analysis according to levels of care. In addition, our findings revealed that 4 weeks of treatment could be more cost-effective than 8 weeks. DN treatment of the upper extremity appears to be cost-effective based on the rate of responders measured using the MMAS scale. © The Author(s) 2021

Differential shotgun analysis of mesenchymal stem cells from osteoarthritis patients

Comunicaciones a congreso

Utilización inadecuada de un servicio de urgencias hospitalario. Una evaluación con criterios explícitos

ResumenFundamentoExiste un crecimiento del número de visitas en los servicios de urgencias hospitalarios (SUH) con una elevada proporción de utilización inapropiada. Los métodos empleados para identificar el uso inadecuado basados en criterios implícitos limitan las comparaciones entre hospitales. El objetivo de este estudio es conocer la proporción de visitas inadecuadas en un SUH y sus factores asociados, utilizando un método objetivo.Material y métodoSe utilizó un instrumento basado en criterios explícitos e independientes del diagnóstico para identificar las visitas inapropiadas en una muestra aleatoria de 1.845 pacientes mayores de 14 años que acudieron a los servicios médicos de un SUH, y se analizaron los factores asociados a la demanda inadecuada.ResultadosLa proporción de urgencias inadecuadas fue del 26,8% (495/1.845). En el análisis bivariante la menor edad, la ausencia de patología asociada, las visitas espontáneas y determinados grupos diagnósticos (enfermedades de la piel, músculo-esqueléticas, mentales y sintamos mal definidos) se asociaron a una mayor proporción de uso inadecuado del SUH. Al ajustar las variables mediante regresión logística, la edad, la patología asociada, las consultas espontáneas y los grupos diagnósticos, mantuvieron la asociación con el uso inadecuado, pero otras variables como el ser mujer y la llegada al SUH fuera del turno de noche también se asociaron a una mayor utilización inadecuada.ConclusionesAl menos la cuarta parte de las visitas realizadas en los servicios médicos de los SUH no requieren atención urgente. La inadecuación de las visitas se asocia a características del paciente y el proceso asistido.SummaryBackgroundSeveral studies have shown a growth in the number of visits to accident and emergency (A&E) hospital departments with a high proportion of inappropriate utilization. Methods to identify improper use based on implicit criteria limit the comparisons between hospitals. The aim of this study is to know the proportion of inappropriate attendance's in an A&E department and their associated factors, using a method with objective criteria.MethodsAn instrument based on diagnosis-independent explicit criteria was used to identify inappropriate visits in a random sample of 1845 14-year-old greater patients attended to A&E medical services, and the factors associated with improper demand were analysed.ResultsThe proportion of inappropriate attendance's was of the 26,8% (495/1.845). The unadjusted analysis show that the smaller age, absence of comorbidity, spontaneous visit and some diagnostic groups (diseases of the skin, muscle-skeletal, mental, and bad defined symptoms) were associated to a greater proportion of improper use. Upon adjusting the variables through logistics regression, the age, associated pathology, the spontaneous attendance's and diagnostic groups, maintained the association with improper use, but other variables as woman gender, and night hours were also associated to inappropriate utilization.ConclusionsAt least the fourth part of the attendance's in the A&E medical services do not require urgent attention. Inappropriate utilization is associated to characteristic of the patient and the attended process

The antitumor drug vinblastine induces the phosphorylation of annexin A2

Comunicaciones a congreso

Study of two bovine bone blocks (sintered and non-sintered) used for bone grafts: physico-chemical characterization and in vitro bioactivity and cellular analysis

High-temperature compression and electron backscatter diffraction (EBSD) techniques were used in a systematic investigation of the dynamic recrystallization (DRX) behavior and texture evolution of the Inconel625 alloy. The true stress–true strain curves and the constitutive equation of Inconel625 were obtained at temperatures ranging from 900 to 1200 °C and strain rates of 10, 1, 0.1, and 0.01 s−1. The adiabatic heating effect was observed during the hot compression process. At a high strain rate, as the temperature increased, the grains initially refined and then grew, and the proportion of high-angle grain boundaries increased. The volume fraction of the dynamic recrystallization increased. Most of the grains were randomly distributed and the proportion of recrystallized texture components first increased and then decreased. Complete dynamic recrystallization occurred at 1100 °C, where the recrystallized volume fraction and the random distribution ratios of grains reached a maximum. This study indicated that the dynamic recrystallization mechanism of the Inconel625 alloy at a high strain rate included continuous dynamic recrystallization with subgrain merging and rotation, and discontinuous dynamic recrystallization with bulging grain boundary induced by twinning. The latter mechanism was less dominan

A rabbit model of Acanthamoeba keratitis: Use of infected soft contact lenses after corneal epithelium debridement with a diamond burr

PURPOSE. To develop a rabbit model of Acanthamoeba keratitis (AK) as the best method to reproduce the natural course of this disease. METHODS. To induce AK, infected contact lenses (1000 amoebae/mm2, 90% trophozoites) were placed over the previously debrided corneal surface, in combination with a temporary tarsorrhaphy. Environmental and clinical strains of Acanthamoeba spp. (genotype T4) were used. Three groups (1L, n = 32; 2L–21d, n = 5; 2L–3d, n = 23) were established according to the number of contact lenses used (1L, 1 lens; 2L–21d and 2L–3d, 2 lenses) and the placement day of these (1L, day 1; 2L–21d, days 1 and 21; 2L–3d, days 1 and 3). The infection was quantified by a clinical score system and confirmed using corneal cytology and culture, polymerase chain reaction and histopathologic analysis. RESULTS. The infection rate obtained was high (1L, 87.5%; 2L–21d, 100%; 2L–3d, 82.6%), although no clinical signs were observed in the 50% of the infected animals in group 1L. Among groups, group 2L–3d showed more cases of moderate and severe infection. Among strains, no statistically significant differences were found in the infection rate. In the control eyes, cross infection was confirmed when a sterile contact lens was placed in the previously debrided corneas but not if the eye remained intact. CONCLUSIONS. The combination of two infected contact lenses after corneal debridement seems to be an alternative model, clinically and histopathologically similar to its human counterpart, to induce the different AK stages and reproduce the course of the disease in rabbits

The Effects of 6 Weeks of Tribulus terrestris L. Supplementation on Body Composition, Hormonal Response, Perceived Exertion, and CrossFit® Performance: A Randomized, Single-Blind, Placebo-Controlled Study

[EN] Tribulus terrestris L. (TT) supplementation have been shown to enhance sports performance in many but not all studies. Moreover, data regarding the potential impact of TT supplementation on CrossFit® endurance is limited. This study aimed to determine whether TT supplementation improve body composition, hormonal response, and performance among CrossFit® athletes. In a randomized, single-blind, placebo-controlled trial, a total of 30 healthy CrossFit®-trained males were randomly allocated to receive either 770 mg of TT supplementation or a placebo daily for 6 weeks. Body mass, fat mass, fat composition, testosterone and cortisol levels, and CrossFit® performance (5 common Workouts of the Day: back squat, bench press, dead lift, Grace, and CrossFit® Total) were assessed before and after intervention. There were no significant group x time interactions for the outcomes of the study except for testosterone levels and bench press performance (p < 0.05). TT supplementation did not impact enhance performance or body composition in CrossFit® male athletes. However, TT supplementation may act as a testosterone booster helping the recovery after physical loads and mitigating fatigueS

Recensiones

RESEÑA de : Martínez Buján, Carlos. "Derecho penal económico". Valencia : Tirant lo Blanch, 2002. RESEÑA de : Pérez Galdós, Benito. "El crimen de la calle de Fuencarral" (ed. y pról. de Reig, Rafael). Madrid : Lengua de Trapo, 2002. RESEÑA de : Gil Gil, Alicia. "La ausencia del elemento subjetivo de justificación". Granada : Editorial Comares, 2002. RESEÑA de : Silva Sánchez, Jesús María." La expansión del Derecho penal". Madrid : Civitas, 200

The effects of 6 weeks of Tribulus terrestris L. supplementation on body composition, hormonal response, perceived exertion, and CrossFit® performance: A randomized, single-blind, placebo-controlled study

Producción CientíficaTribulus terrestris L. (TT) supplementation have been shown to enhance sports performance in many but not all studies. Moreover, data regarding the potential impact of TT supplementation on CrossFit® endurance is limited. This study aimed to determine whether TT supplementation improve body composition, hormonal response, and performance among CrossFit® athletes. In a randomized, single-blind, placebo-controlled trial, a total of 30 healthy CrossFit®-trained males were randomly allocated to receive either 770 mg of TT supplementation or a placebo daily for 6 weeks. Body mass, fat mass, fat composition, testosterone and cortisol levels, and CrossFit® performance (5 common Workouts of the Day: back squat, bench press, dead lift, Grace, and CrossFit® Total) were assessed before and after intervention. There were no significant group x time interactions for the outcomes of the study except for testosterone levels and bench press performance (p < 0.05). TT supplementation did not impact enhance performance or body composition in CrossFit® male athletes. However, TT supplementation may act as a testosterone booster helping the recovery after physical loads and mitigating fatigue