Efecto de la aplicación de electrolisis percutánea musculoesquelética en el sistema nervioso autónomo.

La electrólisis percutánea musculoesquelética (EPM) ecoguiada es un nuevo abordaje mínimamente invasivo, que consiste en la aplicación de una corriente galvánica, o continua, a través de una aguja de acupuntura de forma ecoguiada. Sin embargo, se ha descubierto que la aplicación de la EPM ejerce una influencia en el sistema nervioso autónomo. Ante tal hallazgo, surge la necesidad de desarrollar la investigación en este ámbito, con el fin de conocer los efectos que desencadena esta técnica en el balance autonómico, y poder, así, aplicarla de una forma segura y eficaz para el paciente. Para ello, en esta tesis doctoral, se exponen los resultados de dos estudios que se resumen a continuación. El primer estudio tuvo como objetivo evaluar los cambios en la actividad autonómica de la mujer durante la aplicación de la técnica de EPM ecoguiada en tendones patelares sanos mediante la medición y el análisis de la variabilidad de la frecuencia cardiaca (VFC). El segundo estudio tuvo como fin analizar los cambios en la actividad simpática y parasimpática, a través de la VFC, durante la aplicación de la EPM ecoguiada y si estos cambios se deben al efecto de la punción con aguja solamente o a la aplicación de la EPM per sé que combina punción y la corriente galvánica. El primer estudio es un estudio de caso-control, sobre 24 mujeres futbolistas a quienes se les se registró la VFC durante 10 minutos, tanto en reposo como durante un examen exhaustivo del tendón rotuliano y estructuras adyacentes (grupo control), y un grupo experimental para el que se registró la VFC durante 10 minutos, tanto en reposo como durante la aplicación de EPM ecoguiada en el tendón rotuliano. Se evaluaron los parámetros de la VFC: intervalo NN medio, frecuencia cardiaca media, parámetros del dominio del tiempo (SDNN, rMSSD, pNN50), diámetros del gráfico de Poincaré (SD1, SD2), stress score (SS) Parasimpático (relación S / PS). Los resultados nos reflejan que no hubo diferencias entre los grupos en ninguna medida de referencia, ni diferencias significativas entre las mediciones basales del grupo control y experimental. El grupo experimental mostró aumentos estadísticamente significativos en el SDNN (p = 0,003), rMSSD (p = 0,004), SD1 (p = 0,004), SD2 (p = 0,003) y disminuciones estadísticamente significativas en SS (p = 0,01) y S / PS (P = 0,02), lo que indica un aumento parasimpático y una disminución de la actividad simpática. El segundo estudio es también un estudio caso-control, sobre 36 jugadores masculinos de futbol que fueron asignados aleatoriamente a tres grupos. Un grupo control (CG = 12 jugadores), para quienes la VFC se registró durante 10 minutos, tanto en reposo como durante un examen ecográfico exhaustivo del tendón rotuliano y estructuras adyacentes; Un primer grupo experimental (grupo EPM = 12 jugadores), para quienes la VFC se registró durante 10 minutos, tanto en reposo como durante la aplicación de EPM ecoguiada en el tendón rotuliano; Y un segundo grupo experimental (grupo punción = 12 jugadores), para quienes la VFC se registró durante 10 minutos, tanto en reposo como durante la aplicación de EPM ecoguiada sin corriente eléctrica en el tendón rotuliano. Se evaluaron los mismos parámetros de la VFC que en el estudio 1. Los resultados nos muestran que no hubo diferencias entre los grupos en ninguna medida de referencia, ni hubo diferencias significativas entre las mediciones de los grupos de control (control versus intervención). El grupo EPM mostró incrementos estadísticamente significativos en SD1 (p = 0,01) y SD2 (p = 0,004) y disminuciones estadísticamente significativas en la proporción SS y S / PS (p = 0,03, en ambos), lo que indica un aumento de la actividad parasimpática y una disminución de la actividad simpática, respectivamente. El grupo de punción mostró aumentos estadísticamente significativos en SD2 (p = 0,02) y disminuciones estadísticamente significativas en SS (p = 0,02), lo que indica una disminución de la actividad simpática. Como conclusión del primer estudio sobre las mujeres futbolistas, la EPM ecoguiada se asoció con un desequilibrio autonómico caracterizado por una mayor actividad parasimpática, lo que podría dar lugar a una reacción vasovagal. En el segundo estudio observamos que la aplicación de la EPM ecoguiada provoca un aumento mensurable de la actividad parasimpática (detectada por la VFC), que se debió a la combinación de punción con aguja y corriente eléctrica

Ultrasound imaging assessment of the diaphragm and abdominal muscles in people with a recent history of moderate Covid-19 infection and healthy participants:A cross-sectional pilot study

[Abstract] Coronavirus disease (Covid-19) is a highly infectious disease caused by the SARS-CoV-2 virus and is associated with a decrease of respiratory, physical, and sychological function, subsequently affecting quality of life. The aim of the present pilot study was to use ultrasound imaging (USI) to evaluate and compare the thickness of the diaphragm and abdominal muscles between individuals recently diagnosed with moderate Covid-19 infection and healthy individuals. Methods: A cross-sectional observational pilot study was performed. A total sample of 24 participants were recruited from a private medical center (Madrid, Spain): Covid-19 (n = 12) and healthy controls (n = 12). The external oblique (EO), internal oblique (IO), transversus abdominis (TrA), rectus abdominis (RA), interrecti distance (IRD) and diaphragm thickness were assessed using USI during inspiration, expiration and during contraction. Results: USI measurements of the thickness of EO, IO, TrA, RA, IRD and the diaphragm did not differ significantly between groups during inspiration, expiration or during contraction (all P > 0.05). Conclusions: These preliminary results suggest that the morphology of the abdominal muscles and diaphragm is not altered in people with a recent history of moderate Covid-19 infection

Ultrasonographic features of the intrinsic foot muscles in patients with and without plantar fasciitis: a novel case-control research study

Introduction: The aim of the present study was to compare by ultrasound imaging (USI) the thickness and cross-sectional area (CSA) of the flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), abductor hallucis brevis (AHB) and quadratus plantae (QP) muscles between individuals with and without plantar fasciitis (PF). Material and methods: A case-control study was performed with 64 participants divided into two groups: A, PF group (n = 32) and B, healthy group (n = 32). Results: USI measurements for FHB CSA (p = 0.035) decreased, showing statistically significant differences for the PF group, while the QP CSA (p = 0.40) increased, showing statistically significant differences for the PF group with respect to the healthy group. The rest of the intrinsic foot muscles (IFM) did not show statistically significant differences; however in FHB, FDB, QP and AHB thicknesses and FDB CSA showed a slightly decrease for the PF group. Conclusions: USI measurements showed that the CSA of the FHB muscle is reduced in patients with PF while the CSA of the QP muscle is increased in patients with PF

Features of Extrinsic Plantar Muscles in Patients with Plantar Fasciitis by Ultrasound Imaging: A Retrospective Case Control Research

[Abstract] The present study aimed to compare by ultrasound imaging (USI) the tibial posterior (TP), medial gastrocnemius (MG) and soleus muscle in patients with and without plantar fasciitis (PF). A sample of 42 individuals was recruited and divided into two groups: PF and a healthy group. The thickness, cross-sectional area (CSA), echointensity and echovariation were assessed in both groups by USI. TP, soleus and MG variables did not report differences (p > 0.05) for thickness and CSA. For the echotexture parameters significant differences were found for MG echointensity (p = 0.002), MG echovariation (p = 0.002) and soleus echointensity (p = 0.012). Non-significant differences (p > 0.05) were reported for soleus echovariation, TP echointensity and TP echovariation variables. The thickness and CSA of the TP, GM and soleus muscle did not show significant differences between individuals with and without PF measured by USI. Muscle quality assessment reported an increase of the MG echointensity and echovariation, as well as a decrease of echointensity of the soleus muscle in the PF group with respect to the healthy group. Therefore, the evaluation of the structure and muscle quality of the extrinsic foot muscles may be beneficial for the diagnosis and monitoring the physical therapy interventions

Survival of dogs with pituitary‐dependent hyperadrenocorticism treated twice daily with low doses of trilostane

Background Twice daily low trilostane doses have proven to be effective to manage canine Cushing's syndrome. However, survival and prognostic factors in dogs treated with this protocol have not been evaluated. The aim of the study was to evaluate survival and prognostic factors, including systolic blood pressure (SBP) at diagnosis, in dogs with pituitary-dependent hypercortisolism (PDH) treated with low trilostane doses. Methods Medical records of 91 dogs newly diagnosed with PDH initially treated with 0.2–1.1 mg/kg of trilostane twice daily were retrospectively included. Survival times were calculated using the Kaplan–Meier estimator. Univariable and multivariable analysis were performed using the Cox proportional hazard regression analysis. Results Overall, median survival was 998 days (range 26–1832 days, 95% confidence interval = 755–1241 days). In the multivariable analysis, age (hazard ratio [HR] = 1.337, p < 0.001), presence of calcinosis cutis (HR = 5.271, p < 0.001), body condition score (BCS) ≤3/9 (HR = 8.100, p < 0.001) and higher platelet count (HR = 1.002, p = 0.022) were negatively correlated with survival. SBP was not associated with survival. Conclusions Low-dose trilostane treatment twice daily provides slightly longer survival than previously reported for dogs with PDH treated once or twice daily at higher doses. Older age, presence of calcinosis cutis, low BCS and higher platelet count, but not systemic hypertension, are predictive of poorer prognosis in dogs with PDH

Seguimiento del alga Rugulopteryx okamurae en la costa del mar de Alborán.

Rugulopteryx okamurae is a macroalgae native to the Pacific Ocean, which has established itself on the northern and southern coasts of the Alborán Sea, becoming a serious problem due to its rapid growth, being included in the list of invasive species in Spain in 2020. The main problems are related to loss of biodiversity, as well as loss of money in fishing and tourism. BLUEMARO project focuses on the monitoring of the brown algae R. okamurae along the Andalusian coastline. The main objective is to increase the knowledge about this species, its ecologic strategies of adaptation to the environment to try to predict its continuous expansion. Within the project, there are different branches of study (oceanographic, ecophysiology, biotechnological), and here, we will focus on the benthic studies of the algae, as well as the chemical and photobiological analysis of the compounds present in it. These marine studies have been carried out during the different seasons of the year 2022-2023, in three different locations (Maro, Estepona and Tarifa). In each of these samplings, we monitored the cover of R. okamurae and other species in different transects. Likewise, specimens of R. okamurae were collected for subsequent analysis in the laboratory, to establish the existence of differences between the different settled populations, as well as their variability throughout the year. Preliminary sampling results show differences for the populations studied, and seasonal changes for the same location. Likewise, biochemical, and photosynthetic preliminary results show differences in the same terms.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients

To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3-15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01-1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06-1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26-2.69), asthma (OR: 1.52; 95% CI: 1.04-2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86-0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76-0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00-1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission

Viral RNA load in plasma is associated with critical illness and a dysregulated host response in COVID‑19

Background. COVID-19 can course with respiratory and extrapulmonary disease. SARS-CoV-2 RNA is detected in respiratory samples but also in blood, stool and urine. Severe COVID-19 is characterized by a dysregulated host response to this virus. We studied whether viral RNAemia or viral RNA load in plasma is associated with severe COVID-19 and also to this dysregulated response. Methods. A total of 250 patients with COVID-19 were recruited (50 outpatients, 100 hospitalized ward patients and 100 critically ill). Viral RNA detection and quantification in plasma was performed using droplet digital PCR, targeting the N1 and N2 regions of the SARS-CoV-2 nucleoprotein gene. The association between SARS-CoV-2 RNAemia and viral RNA load in plasma with severity was evaluated by multivariate logistic regression. Correlations between viral RNA load and biomarkers evidencing dysregulation of host response were evaluated by calculating the Spearman correlation coefficients. Results. The frequency of viral RNAemia was higher in the critically ill patients (78%) compared to ward patients (27%) and outpatients (2%) (p < 0.001). Critical patients had higher viral RNA loads in plasma than non-critically ill patients, with non-survivors showing the highest values. When outpatients and ward patients were compared, viral RNAemia did not show significant associations in the multivariate analysis. In contrast, when ward patients were compared with ICU patients, both viral RNAemia and viral RNA load in plasma were associated with critical illness (OR [CI 95%], p): RNAemia (3.92 [1.183–12.968], 0.025), viral RNA load (N1) (1.962 [1.244–3.096], 0.004); viral RNA load (N2) (2.229 [1.382–3.595], 0.001). Viral RNA load in plasma correlated with higher levels of chemokines (CXCL10, CCL2), biomarkers indicative of a systemic inflammatory response (IL-6, CRP, ferritin), activation of NK cells (IL-15), endothelial dysfunction (VCAM-1, angiopoietin-2, ICAM-1), coagulation activation (D-Dimer and INR), tissue damage (LDH, GPT), neutrophil response (neutrophils counts, myeloperoxidase, GM-CSF) and immunodepression (PD-L1, IL-10, lymphopenia and monocytopenia). Conclusions. SARS-CoV-2 RNAemia and viral RNA load in plasma are associated with critical illness in COVID-19. Viral RNA load in plasma correlates with key signatures of dysregulated host responses, suggesting a major role of uncontrolled viral replication in the pathogenesis of this disease.This work was supported by awards from the Canadian Institutes of Health Research, the Canadian 2019 Novel Coronavirus (COVID-19) Rapid Research Funding initiative (CIHR OV2 – 170357), Research Nova Scotia (DJK), Atlantic Genome/Genome Canada (DJK), Li-Ka Shing Foundation (DJK), Dalhousie Medical Research Foundation (DJK), the “Subvenciones de concesión directa para proyectos y programas de investigación del virus SARS‐CoV2, causante del COVID‐19”, FONDO–COVID19, Instituto de Salud Carlos III (COV20/00110, CIBERES, 06/06/0028), (AT) and fnally by the “Convocatoria extraordinaria y urgente de la Gerencia Regional de Salud de Castilla y León, para la fnanciación de proyectos de investigación en enfermedad COVID-19” (GRS COVID 53/A/20) (CA). DJK is a recipient of the Canada Research Chair in Translational Vaccinology and Infammation. APT was funded by the Sara Borrell Research Grant CD018/0123 funded by Instituto de Salud Carlos III and co-fnanced by the European Development Regional Fund (A Way to Achieve Europe programme). The funding sources did not play any role neither in the design of the study and collection, not in the analysis, in the interpretation of data or in writing the manuscript

HCV-coinfection is related to an increased HIV-1 reservoir size in cART-treated HIV patients: a cross-sectional study

In HIV-1/HCV-coinfected patients, chronic HCV infection leads to an increased T-lymphocyte immune activation compared to HIV-monoinfected patients, thereby likely contributing to increase HIV-1 reservoir that is the major barrier for its eradication. Our objective was to evaluate the influence of HCV coinfection in HIV-1 viral reservoir size in resting (r) CD4+ T-cells (CD25-CD69-HLADR-). Multicenter cross-sectional study of 97 cART-treated HIV-1 patients, including 36 patients with HIV and HCV-chronic co-infection without anti-HCV treatment, 32 HIV patients with HCV spontaneous clearance and 29 HIV-monoinfected patients. rCD4+ T-cells were isolated and total DNA was extracted. HIV viral reservoir was measured by Alu-LTR qPCR. Differences between groups were calculated with a generalized linear model. Overall, 63.9% were men, median age of 41 years and Caucasian. Median CD4+ and CD8+ T-lymphocytes were 725 and 858 cells/mm 3 , respectively. CD4+ T nadir cells was 305 cells/mm 3 . Proviral HIV-1 DNA size was significantly increased in chronic HIV/HCV-coinfected compared to HIV-monoinfected patients (206.21 ± 47.38 vs. 87.34 ± 22.46, respectively; P = 0.009), as well as in spontaneously clarified HCV co-infected patients when compared to HIV-monoinfected individuals (136.20 ± 33.20; P = 0.009). HIV-1/HCV co-infected patients showed a larger HIV-1 reservoir size in comparison to HIV-monoinfected individuals. This increase could lead to a greater complexity in the elimination of HIV-1 reservoir in HIV-1/HCV-coinfected individuals, which should be considered in the current strategies for the elimination of HIV-1 reservoir.Financial support was provided by the Instituto de Salud Carlos III to VB (PI15CIII/00031), by the Spanish Ministry of Economy and Competitiveness to MC (SAF2016–78480-R) and The SPANISH AIDS Research Network RD16CIII/0002/0001, RD16CIII/0002/0002 and RD16/0025/0013 - ISCIII – FEDER. MRLP is supported by ISCIII - Subdirección General de Evaluacion and European Funding for Regional Development (FEDER) (PIE 13/00040 and RD12/0017/0017 RETIC de SIDA). C.P. is supported by the Portuguese Fundação para a Ciência e Tecnologia (FCT) (grant number SFRH/ BPD/77448/2011 is part of the EDCTP2 programme supported by the European Union). V.B., A.F.R. and N.R. are supported by the Miguel Servet programme from Fondo de Investigación Sanitaria (ISCIII) (grant number CP13/00098, CP14/CIII/00010 and CP14/00198, respectively)

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation