Efectividad de un programa de rehabilitación multicomponente para pacientes con daño cerebral adquirido y la influencia del tiempo transcurrido desde la lesión hasta el inicio de la intervención

Las personas con Daño Cerebral Adquirido (DCA) presentan dificultades funcionales a distintos niveles (físico, emocional,cognitivo). Los programas de rehabilitación multicomponente parecen ser efectivos en su recuperación, sin embargo son escasos los estudios que analicen su efectividad en población española. Este trabajo pretende analizar laefectividad de estos programas y el efecto del tiempo trascurrido entre la adquisición del daño y el inicio al tratamiento. Método: Participaron 50 pacientes con DCA del Sistema Nacional de Salud derivados a la clínica UNER, con una edad media de 50,34 años (DT=15,74) siendo el 40% (n=20) mujeres. Los participantes recibieron durante 6 meses cincosesiones semanales multidisciplinares de neuropsicología, terapia ocupacional, fisioterapia y logopedia. Se evaluó el nivel de funcionalidad antes y después de la intervención con la Medida de Independencia y Evaluación Funcional (Fim+Fam). Asimismo, se compararon las puntuaciones Fim+Fam entre los participantes de inicio temprano al tratamiento (≤3 meses post-daño, ≤3M) y los de inicio tardío (>3 meses post-daño, >3M). Resultados: Se hallaron diferencias significativas en las puntuaciones Fim+Fam antes (M=129,28) y después de la intervención (M=155,52; r=0,61). El grupo ≤3M presentópuntuaciones significativamente superiores (M=174,55) tras la intervención que el grupo >3M (M=142,83;r=0,39). Conclusiones: El programa multicomponente parece ser efectivo en la mejora de la funcionalidad de personas con DCA destacando el área cognitiva. Los resultados sugieren un periodo crítico de inicio al tratamiento de hasta 3 meses que podría optimizar la recuperación del DCA. Son necesarios futuros estudios experimentales con muestras más amplias que corroboren estos resultadosAcquired Brain Injury (ABI) people present diverse functional difficulties at differentlevels (physic, cognitive, emotional). Rehabilitation programs are effective improving the distinct affected areas, however, scant studies have analyze their effectivity in the Spanish population. Therefore, this research aims to study the effectivity of a multi-disciplinary rehabilitation program for ABI people and the influence of time interval from brain injury to rehabilitation start. Method: 50 ABI patients from the National Public Health System were referred to UNER clinic, of which 40% (n=20) were women, with mean age 50.34 years (SD=15.74). Participants completed a 6-month rehabilitation program composed of 5 weekly multidisciplinary sessions of neuropsychology, occupational, speech and physical therapy. Program effectivity was analyzed assessing patients’ functional level before and after intervention through the Functional Independence and Assessment Measure (FimFam). Likewise, FimFam scores were compared between patients with Early Rehabilitation Start (ERS; ≤3moths post-injury) and Late Start (LRS; >3moths post-injury). Results: Statistical significant differences were found in FimFam scores before (M=129.28) and after intervention (M=155.52; r=0.61). Moreover, ERS patients had significant superior FimFamscores after intervention (M=174.55) than LRS patients (M=142.83; r=0.39). Conclusions: This multi-disciplinary rehabilitation program seems to be effective improving ABI patients’ functioning, emphasizing cognitive factor performance. Furthermore, these results suggest a critic period of early rehabilitation start of up to 3 months that could optimized ABI recovery. Future experimental studies with larger samples are needed to corroborate these result

The mitochondrial inhibitor oligomycin induces an inflammatory response in the rat knee joint

[Abstract] Background. Recent findings support a connection between mitochondrial dysfunction and activation of inflammatory pathways in articular cells. This study investigates in vivo in an acute model whether intra-articular administration of oligomycin, an inhibitor of mitochondrial function, induces an oxidative and inflammatory response in rat knee joints. Methods. Oligomycin was injected into the rat left knee joint on days 0, 2, and 5 before joint tissues were obtained on day 6. The right knee joint served as control. Results were evaluated by macroscopy and histopathology and by measuring cellular and mitochondrial reactive oxygen species (ROS), 4-hydroxy-2-nonenal (4-HNE, a marker of lipid peroxidation), nuclear factor erythroid 2-related factor 2 (Nrf2), and CD68 (macrophages) and chemokine levels. The marker of mitochondrial mass COX-IV was also evaluated. Results. The macroscopic findings showed significantly greater swelling in oligomycin-injected knees than in control knees. Likewise, the histological score of synovial damage was also increased significantly. Immunohistochemical studies showed high expression of IL-8, coinciding with a marked infiltration of polymorphonuclears and CD68+ cells in the synovium. Mitochondrial mass was increased in the synovium of oligomycin-injected joints, as well as cellular and mitochondrial ROS production, and 4-HNE. Relatedly, expression of the oxidative stress-related transcription factor Nrf2 was also increased. As expected, no histological differences were observed in the cartilage; however, cytokine-induced neutrophil chemoattractant-1 mRNA and protein expression were up-regulated in this tissue. Conclusions. Mitochondrial failure in the joint is able to reproduce the oxidative and inflammatory status observed in arthritic joints.Instituto de Salud Carlos III; 09/02340Instituto de Salud Carlos III, RD12/0009/0018, RIERGalicia. Consellería de Innovación, Industria e Comercio; PXIB916357PRInstituto de Salud Carlos III; PI12/02771Xunta de Galicia; PS09/56Galicia. Consellería de Economía e Industria; INCITE 09E1R916139ESGalicia. Consellería de Economía e Industria; IN845B2010/176Galicia. Consellería de Economía e Industria; 10CSA916035P

The mitochondrial inhibitor oligomycin induces an inflammatory response in the rat knee joint

[Abstract] Background. Recent findings support a connection between mitochondrial dysfunction and activation of inflammatory pathways in articular cells. This study investigates in vivo in an acute model whether intra-articular administration of oligomycin, an inhibitor of mitochondrial function, induces an oxidative and inflammatory response in rat knee joints. Methods. Oligomycin was injected into the rat left knee joint on days 0, 2, and 5 before joint tissues were obtained on day 6. The right knee joint served as control. Results were evaluated by macroscopy and histopathology and by measuring cellular and mitochondrial reactive oxygen species (ROS), 4-hydroxy-2-nonenal (4-HNE, a marker of lipid peroxidation), nuclear factor erythroid 2-related factor 2 (Nrf2), and CD68 (macrophages) and chemokine levels. The marker of mitochondrial mass COX-IV was also evaluated. Results. The macroscopic findings showed significantly greater swelling in oligomycin-injected knees than in control knees. Likewise, the histological score of synovial damage was also increased significantly. Immunohistochemical studies showed high expression of IL-8, coinciding with a marked infiltration of polymorphonuclears and CD68+ cells in the synovium. Mitochondrial mass was increased in the synovium of oligomycin-injected joints, as well as cellular and mitochondrial ROS production, and 4-HNE. Relatedly, expression of the oxidative stress-related transcription factor Nrf2 was also increased. As expected, no histological differences were observed in the cartilage; however, cytokine-induced neutrophil chemoattractant-1 mRNA and protein expression were up-regulated in this tissue. Conclusions. Mitochondrial failure in the joint is able to reproduce the oxidative and inflammatory status observed in arthritic joints.Instituto de Salud Carlos III; 09/02340Instituto de Salud Carlos III, RD12/0009/0018, RIERGalicia. Consellería de Innovación, Industria e Comercio; PXIB916357PRInstituto de Salud Carlos III; PI12/02771Xunta de Galicia; PS09/56Galicia. Consellería de Economía e Industria; INCITE 09E1R916139ESGalicia. Consellería de Economía e Industria; IN845B2010/176Galicia. Consellería de Economía e Industria; 10CSA916035P

Pathogenic pathways and therapeutic approaches targeting inflammation in diabetic nephropathy

Diabetic nephropathy (DN) is associated with an increased morbidity and mortality, resulting in elevated cost for public health systems. DN is the main cause of chronic kidney disease (CKD) and its incidence increases the number of patients that develop the end-stage renal disease (ESRD). There are growing epidemiological and preclinical evidence about the close relationship between inflammatory response and the occurrence and progression of DN. Several antiinflammatory strategies targeting specific inflammatory mediators (cell adhesion molecules, chemokines and cytokines) and intracellular signaling pathways have shown beneficial effects in experimental models of DN, decreasing proteinuria and renal lesions. A number of inflammatory molecules have been shown useful to identify diabetic patients at high risk of developing renal complications. In this review, we focus on the key role of inflammation in the genesis and progression of DN, with a special interest in effector molecules and activated intracellular pathways leading to renal damage, as well as a comprehensive update of new therapeutic strategies targeting inflammation to prevent and/or retard renal injury.The authors work has been supported by grants from Instituto de Salud Carlos III (ISCIII, FIS-FEDER PI17/00130, PI17/01495, PI19/00588, ERA-PerMed-JTC2018-PERSTIGAN AC18/00071), Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM) and Cardiovascular (CIBERCV), Fondecyt Project (No. 1160465), Spanish Ministry of Science and Innovation (RTI2018-098788-B-100, DTS17/00203, DTS19/00093, RYC-2017-22369), and Spanish Societies of Cardiology (SEC), Nephrology (SEN) and Atherosclerosis (SEA). The “PFIS” and “Sara Borrell” training program of the ISCIII supported the salary of MGH (FI18/00310), SR-M (CD19/00021) and CH-B (CP16/00017). Córdoba University supported the salary of C.G.C

Temporal distribution and genetic variants in influenza A(H1N1)pdm09 virus circulating in Mexico, seasons 2012 and 2013

The 2012 and 2013 annual influenza epidemics in Mexico were characterized by presenting different seasonal patterns. In 2012 the A(H1N1)pdm09 virus caused a high incidence of influenza infections after a two-year period of low circulation; whereas the 2013 epidemic presented circulation of the A(H1N1)pdm09 virus throughout the year. We have characterized the molecular composition of the Hemagglutinin (HA) and Neuraminidase (NA) genes of the A(H1N1)pdm09 virus from both epidemic seasons, emphasizing the genetic characteristics of viruses isolated from Yucatan in Southern Mexico. The molecular analysis of viruses from the 2012 revealed that all viruses from Mexico were predominantly grouped in clade 7. Strikingly, the molecular characterization of viruses from 2013 revealed that viruses circulating in Yucatan were genetically different to viruses from other regions of Mexico. In fact, we identified the occurrence of two genetic variants containing relevant mutations at both the HA and NA surface antigens. There was a difference on the temporal circulation of each genetic variant, viruses containing the mutations HA-A141T / NA-N341S were detected in May, June and July; whereas viruses containing the mutations HA-S162I / NAL206S circulated in August and September. We discuss the significance of these novel genetic changes

Revista de Vertebrados de la Estación Biológica de Doñana

Descripción de un nuevo género y de una nueva especie Iberocypris palaciosi N.GEN.N.SO (Pisces, cyprinidae).Resultados de los censos d e aves acuáticas en Andalucía Occidental durante el invierno1978-79Interacciones en la alimentación de las larvas de dos especies de tritones. (Triturus marmoratus y Triturus boscai).Utilización del espacio en una comunidad de lacertidos del matorral mediterráneo en la Reserva Biológica de DoñanaMorfología dentaria de las liebres europeas (Lagomorpha, leporidae).El conejo, Oryctolagus cuniculus en Andalucía Occidental: Parámetros corporales y curva de crecimientoObservaciones de foca monje (Monachus monachus Herm.) en las costas del sureste de la Península Ibérica.Presencia de pejerrey Atherina (Hepsetia) boyeri, Risso 1810; Pisces ( Atherinidae) en la laguna de Zoñar (Córdoba, SO de España).Nuevas citas de la "loina" Chondrostoma (Machaerochilus) toxostoma arrigonis Stein. (pisces, cyprinidae) en EspañaRelativa subalimentación de Falco naumanni durante el periodo no reproductor en el valle del GuadalquivirComadrejas alimentandose de carroña.Agrupamientos de Alytes cisternasii bajo el mismo refugioDescripción de un nuevo género de quiróptero neotropical de la familia MolossidaeAlgunas notas sobre Platalea leucorodia en GaliciaInicidencia del murciélago hematófago Desmodus rotundus sobre los indígenas Yanomani de VenezuelaRitmo de actividad de algunos ratones de los llanos de Apure (Venezuela)Presencia del topillo campesino ibérico, Microtus arvalis asturianus Miller, 1908 en la meseta del DueroFalco columbarius EsmerejónCiconia ciconia CigüeñaNycticorax nycticorax MartinetePeer reviewe

Descomposición de la capa de hojarasca de diferentes especies perennifolias y caducifolias

Las hojarascas de las especies caducifolias y perennifolias presentan procesos diferenciales de descomposición, debidos, en gran parte, a las diferencias en su composición químic

Psychometric characteristics of the Spanish version of instruments to measure neck pain disability

[EN] Background. The NDI, COM and NPQ are evaluation instruments for disability due to NP. There was no Spanish version of NDI or COM for which psychometric characteristics were known. The objectives of this study were to translate and culturally adapt the Spanish version of the Neck Disability Index Questionnaire (NDI), and the Core Outcome Measure (COM), to validate its use in Spanish speaking patients with non-specific neck pain (NP), and to compare their psychometric characteristics with those of the Spanish version of the Northwick Pain Questionnaire (NPQ). Methods. Translation/re-translation of the English versions of the NDI and the COM was done blindly and independently by a multidisciplinary team. The study was done in 9 primary care Centers and 12 specialty services from 9 regions in Spain, with 221 acute, subacute and chronic patients who visited their physician for NP: 54 in the pilot phase and 167 in the validation phase. Neck pain (VAS), referred pain (VAS), disability (NDI, COM and NPQ), catastrophizing (CSQ) and quality of life (SF-12) were measured on their first visit and 14 days later. Patients' self-assessment was used as the external criterion for pain and disability. In the pilot phase, patients' understanding of each item in the NDI and COM was assessed, and on day 1 test-retest reliability was estimated by giving a second NDI and COM in which the name of the questionnaires and the order of the items had been changed. Results. Comprehensibility of NDI and COM were good. Minutes needed to fill out the questionnaires [median, (P25, P75)]: NDI. 4 (2.2, 10.0), COM: 2.1 (1.0, 4.9). Reliability: [ICC, (95%CI)]: NDI: 0.88 (0.80, 0.93). COM: 0.85 (0.75,0.91). Sensitivity to change: Effect size for patients having worsened, not changed and improved between days 1 and 15, according to the external criterion for disability: NDI: -0.24, 0.15, 0.66; NPQ: -0.14, 0.06, 0.67; COM: 0.05, 0.19, 0.92. Validity: Results of NDI, NPQ and COM were consistent with the external criterion for disability, whereas only those from NDI were consistent with the one for pain. Correlations with VAS, CSQ and SF-12 were similar for NDI and NPQ (absolute values between 0.36 and 0.50 on day 1, between 0.38 and 0.70 on day 15), and slightly lower for COM (between 0.36 and 0.48 on day 1, and between 0.33 and 0.61 on day 15). Correlation between NDI and NPQ: r = 0.84 on day 1, r = 0.91 on day 15. Correlation between COM and NPQ: r = 0.63 on day 1, r = 0.71 on day 15. Conclusion. Although most psychometric characteristics of NDI, NPQ and COM are similar, those from the latter one are worse and its use may lead to patients' evolution seeming more positive than it actually is. NDI seems to be the best instrument for measuring NP-related disability, since its results are the most consistent with patient's assessment of their own clinical status and evolution. It takes two more minutes to answer the NDI than to answer the COM, but it can be reliably filled out by the patient without assistanceS

Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

<p>Abstract</p> <p>Background</p> <p>Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial.</p> <p>Methods/Design</p> <p>This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.</p> <p>The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.</p> <p>Discussion</p> <p>Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.</p