Searching for the “Active Ingredients” in Physical Rehabilitation Programs Across Europe, Necessary to Improve Mobility in People With Multiple Sclerosis: A Multicenter Study

Background. Physical rehabilitation programs can lead to improvements in mobility in people with multiple sclerosis (PwMS). Objective: Identify which rehabilitation program elements are employed in real life and how they might impact mobility improvement in PwMS. Methods. Participants were divided into improved and non-improved mobility groups based on changes observed in the Multiple Sclerosis Walking Scale-12 following multimodal physical rehabilitation programs. Analyses were performed at group and subgroup (mild and moderate-severe disability) levels. Rehabilitation program elements included: setting; number of weeks; number of sessions; total duration, therapy format (individual, group, autonomous), therapy goals and therapeutic approaches. Results. The study comprised 279 PwMS from 17 European centers. PwMS in the improved group received more sessions of individual therapy in both subgroups. In the mildly disabled group, 60.9% of the improved received resistance training, whereas, 68.5% of the non-improved, received self-stretching. In the moderatelyseverely disabled group, 31.4% of the improved, received aerobic training, while 50.4% of the non-improved, received passive mobilization/stretching. Conclusions. We believe that our findings are an important step in opening the black-box of physical rehabilitation, imparting guidance and assisting future research in defining characteristics of effective physical rehabilitation

Impacto de la evolución científico-tecnológica en la Bioética neonatal-perinatal

Resumen: Los avances científico-tecnológicos en neonatología en los últimos 40 años han permitido una importante mejoría en la sobrevida de recién nacidos de extremo bajo peso al nacer, sin embargo la mortalidad neonatal aun representa un porcentaje muy grande de la mortalidad infantil. Esto esta principalmente relacionado a las muertes por prematuridad y sus complicaciones, anomalías congénitas y asfixia perinatal. La mayoría de los recién nacidos son tratados favorablemente en sala de partos y son admitidos a la Unidad de Cuidados Intensivos Neonatales (UCIN). La incertidumbre en el pronóstico de los prematuros extremos en el límite de la viabilidad con alto riesgo de morir en la UCIN o presentar alguna discapacidad, presenta un difícil dilema ético. Se deberá considerar cada caso en forma individual y evaluar el riesgo-beneficio entre las conductas a seguir y el “mejor interés para el niño” y los deseos de los padres que guiarán a decisiones éticas. Diferentes guías de cuidado y variaciones en la práctica médica en los límites de la viabilidad fetal se han descripto dentro y entre países. El objetivo es proveer a los padres una comunicación abierta, directa y transparente con suficiente entendimiento de los factores más relevantes en relación a la situación clínica, el pronóstico y las opciones de tratamiento para que ellos puedan tener una significativa participación en la toma de decisiones. Aceptar que en neonatología, hacer todo lo que uno puede hacer puede ser perjudicial, no útil o beneficioso. No todo lo técnicamente posible es éticamente correcto. El dilema afecta tanto al origen de la vida como a la terminación de la vida.Abstract: Scientific and technological advances in neonatology over the last 40 years has enabled many extremely low-birth-weight infants to survive; nevertheless neonatal mortality still represents the largest percentage of overall infants and childhood mortality. This is primarily related to death due to prematurity and its complications, congenital anomalies and perinatal asphyxia. Most of the babies are favorably treated in the delivery room and then admitted at the Neonatal Intensive Care Unit (NICU). The prognostic uncertainty of the extremely preterm infant at the threshold of viability with the highest risk of death in the NICU or the possibility of future disabilities pose a difficult ethical dilemma. Carefully considered judgment in each individual case is mandatory and the burden and benefit must be weighed against each other and the “best interest for the child” and parental preferences should guide ethical-decision- making. Different guidelines for care and medical practice modalities in regards to the limits of fetal viability have been described within and between countries. The goal is to provide parents an open, direct and transparent communication with sufficient understanding of the relevant facts with regard to the medical state, prognosis and treatment options so that they can meaningfully participate in the decision-making-process. Accept that in neonatology everything one can do may be harmful instead of helpful or beneficial. What is technically possible not always is ethically correct. The dilemma affects both the beginning and the end of life

Impacto de la pandemia por Covid-19 en la medicina neonatal, perinatal y pediátrica

Resumen: La pandemia producida por coronavirus 2019 (COVID-19) ha representado un impacto para los sistemas de salud del mundo ya que afecta a adultos, niños, lactantes y recién nacidos. Esta infección viral se presenta mayormente en 4 estadios: 1) cuadro leve símil gripal; 2) síndrome respiratorio moderado; 3) severa neumonía intersticial que puede acompañarse de síntomas gastrointestinales como diarrea; 4) enfermedad crítica donde el niño progresa rápidamente a un síndrome de dificultad respiratorio agudo (SDRA) o fallo respiratorio pudiendo presentar shock, encefalopatía, injuria miocárdica o fallo cardíaco, alteraciones de la coagulación y fallo renal agudo. El fallo multiorgánico pone en riesgo la vida. El Síndrome Inflamatorio multisistémico pediátrico (SIMP) temporalmente asociado al COVID-19 es una enfermedad nueva, extremadamente severa y rara que emerge como un fenotipo muy especial. La enfermedad por COVID-19 cursa en la mayoría de los niños en forma leve, generalmente sin complicaciones con cuadros menos agresivos. Niños, lactantes y recién nacidos con enfermedades preexistentes son grupos de alto riesgo de sufrir enfermedad grave y deben tener un control estricto. La prevalencia de enfermedad COVID-19 es significativamente menor en niños que en adultos, pero la enfermedad pediátrica es probablemente sub diagnosticada como resultado del alto número de casos asintomáticos o leves. Es poco probable que niños asintomáticos sean alguna vez diagnosticados o tratados. La internación en cuidados intensivos pediátricos es infrecuente y la mortalidad rara. Los adultos mayores y aquellos con enfermedad preexistente son susceptibles de infección por COVID-19 y propensos a resultados adversos asociados a síndrome de dificultad respiratoria aguda (SDRA) y a tormenta de citoquinas. El objetivo de este breve resumen es resaltar las diferencias que presenta la enfermedad por COVID-19 entre adultos, niños y recién nacidos evaluando el riesgo fetomaterno. Hay escasa información respecto de la mujer embarazada en los primeros meses de gestación, sin embargo, estudios preliminares de epidemias por SARS, MERS y otras infecciones respiratorias sugieren que la embarazada con infección COVID-19 podría ocasionalmente tener una evolución clínica severa. La información continua del estado de la gestante, así como la evaluación y registro de los resultados materno-fetales- neonatales, deben ser incluidos en todos los reportes en cada centro de atención de estos pacientesAbstract: The Coronavirus disease 2019 (COVID-19) pandemia has represented a major impact to healthcare systems worldwide as it affects adults, children and newborn infants. This viral infection runs in four mayor stages: 1) a mild cold-like illness; 2) a moderate respiratory syndrome; 3) a severe acute interstitial pneumonia that may be accompanied by gastrointestinal symptoms such as diarrhea; 4) a critical disease were children can quickly progress to acute respiratory distress syndrome (ARDS) or respiratory failure and may have shock, encephalopathy, myocardial injury or heart failure, coagulation dysfunction and acute kidney injury. Organ dysfunction can be life threatening. Pediatric multisystem inflammatory syndrome temporally associated with COVID-19 is a rare but severe newly emerging phenotype. COVID-19 disease seems to be milder with more benign evolution in children with low susceptibility and minor aggressivity in most cases. Young infants, children and newborn with pre-existing disease could be a high risk group for more significant illness and need careful monitoring. The prevalence of COVID-19 is significantly lower in children than adults but pediatric disease is likely underdiagnosed as a result of the high numbers of asymptomatic or milder cases. Many children who are asymptomatic are unlikely to be treated. Intensive care admissions and mortality are rare. The elderly and people with underlying disease are susceptible to infection and prone to serious outcomes associated with acute respiratory distress syndrome and cytokine storm. The aim of this brief review is to highlight the differences existing between COVID-19 cases in adult, children, newborn infants and assess maternal-fetal risk. Limited data are available on pregnant women during the first months of gestation however early reports and lessons from SARS, MERS and other respiratory infections suggest that pregnant women with COVID -19 infection could occasionally have a severe clinical course. Information on pregnant status as well as maternal and fetal outcomes are mandatory and need to be included in all case-series of COVID-19 infections

Structural Variation In The Brown Alga Sargassum Cymosum And Its Effects On Associated Amphipod Assemblages.

The presence of diverse biological substrates adds complexity to coastal landscapes and increases the number of ecological niches that can be used by the mobile epifauna. Studies on the influence of structural complexity have focused mainly on algal host species, but there is little information about the influence of intraspecific structural variation on the associated mobile epifauna. In this work, we examined whether intraspecific variation in the brown alga Sargassum cymosum influenced the structure of amphipod assemblages on two shores with different wave exposure. At least 15 fronds were randomly sampled at Fortaleza and Perequê-Mirim beaches, on the Atlantic coast of São Paulo state, southeastern Brazil, and 12 variables were measured for each alga. The amphipods were identified and counted. The greatest structural variation in S. cymosum occurred within shores, whereas the differences between shores were mainly related to algal size. These characteristics influenced amphipod assemblages differently on each shore, with the greatest effects being associated with variables related to morphological complexity, such as holdfast size, the number and size of branches, and the extent of cover by sessile colonial animals. These findings show that monospecific algal banks are not homogeneous, and that morphological differences and interactions with other biological substrates can influence the mobile epifaunal assemblages.67215-2

Diel density variation of amphipods associated with Sargassum beds from two shores of Ubatuba, Southeastern, Brazil

Densities of mobile epifaunal assemblages associated with macrophytes are very variable during the day and the activity of visually-oriented predators is thought to have an important influence on this pattern. Here we compared densities of amphipods associated with a common brown alga, Sargassum stenophyllum (Phaeophyceae), at sites contrasting in water turbidity. We expected that diel variation of amphipods would occur in a shore with clear waters (Perequê), whereas no variation was expected in a shore with turbid waters (Lamberto). Amphipod density varied during the day at both shores, with no indication of a larger variation at Perequê. Most species showed two density peaks, one at night and the other in the afternoon. These peaks occurred close the times of high tide, suggesting that tidal rhythms could influence more amphipod densities than the activity of predators. Thus, more studies are necessary to understand factors that influence short-term variation of epifaunal assemblages