Quality of Life Following Cochlear Implantation in Patients With Menière's Disease

Background: Menière's disease (MD) is a disorder characterized by auditory and vestibular dysfunction that significantly deteriorates patients' quality of life (QoL). In addition to the management of vestibular symptoms, some patients with bilateral hearing loss meet criteria for cochlear implantation (CI). Objectives: (1) To assess hearing results and QoL outcomes following CI in patients with MD. (2) To compare these results to a matched control group of patients who had undergone CI. (3) To analyse differences in MD patients who have undergone simultaneous or sequential labyrinthectomy or previous neurectomy. Methods: A retrospective analysis of a study group of 18 implanted patients with MD and a matched control group of 18 implanted patients without MD, who had CI at a tertiary referral center. Hearing and speech understanding were assessed via pure-tone audiometry (PTA) and disyllabic perception tests in quiet. QoL was assessed via the Nijmegen Cochlear Implant Questionnaire (NCIQ), the Glasgow Benefit Inventory (GBI), the Speech, Spatial and Qualities of Hearing Scale (SSQ12), and the Hearing Implant Sound Quality Index (HISQUI19). The impact of MD ablative surgeries was analyzed in the study group (MD group). Results: Mean pre-operative PTA thresholds were significantly lower in the MD group (103 vs. 121 dB). A significant improvement in hearing outcomes was observed following CI in both groups (p < 0.001), with a maximum Speech Discrimination Score of 64 and 65% disyllables at 65 dB for the MD and control group, respectively. Subjective outcomes, as measured by the NCIQ, GBI, SSQ12, and HISQUI19 did not significantly differ between groups. In the MD group, despite achieving similar hearing results, QoL outcomes were worse in patients who underwent simultaneous CI and labyrinthectomy compared to the rest of the MD group. Post-operative NCIQ results were significantly better in patients who had undergone a previous retrosigmoid neurectomy when compared to those who had undergone only CI surgery in the subdomains “basic sound perception” (p = 0.038), “speech” (p = 0.005), “activity” (p = 0.038), and “social interactions” (p = 0.038). Conclusion: Patients with MD and severe hearing loss obtain hearing results and QoL benefits similar to other CI candidates. Delayed CI after labyrinthectomy or vestibular neurectomy can be performed with similar or better results, respectively, to those of other cochlear implanted patients. Patients who undergo simultaneous CI and labyrinthectomy may achieve similar hearing results but careful pre-operative counseling is neede

PROCESO DE HUMANIZACIÓN DE LA ATENCIÓN A LAS CESÁREAS: INSTAURACIÓN DE UN PROCEDIMIENTO PARA ACOMPAÑAMIENTO DE LAS GESTANTES E INICIO DE LA LACTANCIA MATERNA EN QUIRÓFANO

Introduction The humanization of labour places women at the centre of medical attention. In September 2013, a process of humanization of caesarean sections was launched at the Hospital General de Hospitalet. This process included the presence of a companion in low-risk caesareans, early initiation of breastfeeding and skin-to-skin contact in the operating room. Objective The aim of this article is to expose the steps that were followed to launch the initiative and asses the results of a satisfaction survey conducted on the first sample of women and their companions who benefited from the procedure. Materials and methods Description of the procedure followed in the first phase and analysis of the satisfaction survey conducted during the second phase. Results The results of the satisfaction survey reveal that the initiative was highly gratifying both for women and their companions. Conclusions The fact that the delivery entails a caesarean section is no reason to deprive families of the opportunity of living together such an exciting experience. IntroducciónLa humanización del trabajo de parto se define como aquella asistencia que sitúa a la mujer en el centro de la atención. En Septiembre de 2013 se puso en marcha un procedimiento de humanización de las cesáreas en el Hospital General de L´Hospitalet, en el cual se incluye la presencia de un acompañante en las cesáreas de bajo riesgo, el inicio precoz de la lactancia materna y el contacto piel a piel en el quirófano.ObjetivoEl objetivo del presente artículo es divulgar los pasos que se siguieron para poner en marcha el procedimiento y valorar la satisfacción de la primera muestra de mujeres y sus acompañantes que se beneficiaron del procedimiento.Material y métodoEn la primera fase, se realiza la descripción del procedimiento; en la segunda, se administra la encuesta de satisfacción.ResultadosLos resultados de la encuesta de satisfacción realizada evidencian que la iniciativa fue altamente gratificante, tanto para las mujeres como para sus acompañantes.ConclusionesEl hecho de que la vía del nacimiento deba ser una cesárea no es motivo para que privemos a las familias de vivir juntas una experiencia tan emocionante

INYECCIONES INTRACUTÁNEAS DE AGUA ESTÉRIL EN EL ROMBO DE MICHAELIS PREVIA ANESTESIA LOCAL: UNA TERAPIA COMPLEMENTARIA PARA EL ALIVIO DE DOLOR DURANTE EL PARTO

IntroductionSterile water injections in the Rhombus of Michaelis are used as a simple technique to alleviate back pain during childbirth. However, the technique itself is painful and requires two professionals to carry it out. ObjectiveTo assess the level of pain associated with the technique of sterile water injection after the injection of lidocaine, compared to the technique of sterile water injection without lidocaine. The aim was also to assess whether both techniques (with and without lidocaine) reduce back pain during childbirth. Material and Methods A semi-experimental study was carried out. The level of pain was assessed using the VAS scale before the technique, during the technique, and 30 minutes after the technique in two groups of expectant mothers (with and without lidocaine). The expectant mothers were divided randomly into two groups. The SPSS programme was used for the data analysis. Results The results showed that the technique with lidocaine could be undertaken by one professional and was significantly less painful than the technique without the anesthetic. In both cases, the level of pain stated prior to the sterile water injection was reduced 30 minutes after the injection. The reduction in pain was clinically relevant. Conclusions Sterile water injection in the Rhombus of Michaelis is an effective technique for reducing back pain during childbirth. The injection of lidocaine prior to the technique enables its use without the main disadvantage: pain on injection of sterile water.IntroducciónLas inyecciones de agua estéril en el Rombo de Michaelis se usan como técnica simple para aliviar el dolor lumbar durante el parto. Pero la técnica es dolorosa y requiere de dos profesionales para su realización.ObjetivoEvaluar el nivel de dolor de la técnica de la inyección de agua estéril previa inyección de lidocaína respecto de la técnica de inyección de agua estéril sin lidocaína. Así mismo, se pretendía evaluar si ambas técnicas (sin lidocaína y con lidocaína) disminuían el dolor lumbar durante el parto.Material y MétodosSe llevó a cabo un estudio cuasi-experimental. Se evaluó el nivel de dolor mediante la escala EVA antes de la técnica, durante la técnica y a los 30 minutos de la técnica en dos grupos de gestantes (sin lidocaína y con lidocaína). Las gestantes fueron asignadas a ambos grupos de forma aleatoria. Para el análisis de los datos, se utilizó el programa estadístico SPSS.Resultados Los resultados mostraron que la técnica con lidocaína es significativamente menos dolorosa que sin lidocaína y la puede realizar un solo profesional. Así mismo, el nivel de dolor referido antes de la técnica disminuyó en ambos casos a los 30 minutos de forma clínicamente relevante.ConclusionesLas inyecciones de agua estéril en el Rombo de Michaelis constituyen una técnica efectiva para la reducción del dolor lumbar durante el parto. Además, la inyección de lidocaína previa a la técnica permite su uso evitando su principal inconveniente, el dolor al inyectar el agua estéril

Riesgo quirúrgico tras resección pulmonar anatómica en cirugía torácica. Modelo predictivo a partir de una base de datos nacional multicéntrica

Introduction: the aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). Methods: data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. Results: the incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. Conclusions: the risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection

Grupo español de cirugía torácica asistida por videoimagen: método, auditoría y resultados iniciales de una cohorte nacional prospectiva de pacientes tratados con resecciones anatómicas del pulmón

Introduction: our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). Methods: we conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for '90-day mortality' and 'Grade IIIb-V complications'. Results: the series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR=0.61 (p=0.081), 90-day mortality OR=0.46 (p=0.051). Conclusions: more than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: Study protocol of a cluster randomized clinical trial (Multi-PAP project)

Background: Multimorbidity is associated with negative effects both on people''s health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (=3 chronic diseases) and polypharmacy (=5 drugs prescribed in =3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT0286679

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC &gt; 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3

Identification of PDE5A-regulated genes in BRAF mutant melanoma cells

Dissertação de Mestrado em Investigação Biomédica apresentada à Faculdade de Medicina da Universidade de Coimbra.Melanoma is the most aggressive type of skin cancer and the leading cause of death from skin disease. This disease shows a very poor prognosis when progressing to a metastatic stage. Our laboratory previously discovered a key role for the cGMP phosphodiesterase PDE5A in inhibiting melanoma cell invasion. We found that PDE5A was mostly downregulated via oncogenic BRAF in a panel of highly invasive human melanoma cell lines. Following those findings, our aim was to identify PDE5A regulated genes in BRAF mutant melanoma cells. In the present study, two previously published A375M2 melanoma cell clones genetically modified to stably re-express PDE5A were analysed using gene expression microarrays and compared to parental control cells. We identified 24 downregulated and 587 upregulated genes in common between the two A375M2 stably re-expressing PDE5A clones compared to control cells. For further validation, from the list of downregulated genes, TFPI2 (Tissue factor pathway inhibitor 2) and SERPINB2 (Plasminogen activator inhibitor type 2) were selected. Among the upregulated genes, MUC15 (mucin 15, cell surface associated), SERPINA5 (serpin peptidase inhibitor, clade A (alpha-1 antiproteinase, antitrypsin), member 5) and SERPINF1 (serpin peptidase inhibitor, clade F (alpha-2 antiplasmin, pigment epithelium derived factor), member 1) were chosen for further validation. Our data show that PDE5A regulates expression of a large number of genes in melanoma cells. The identification of these differentially expressed genes will facilitate improved understanding of metastatic melanoma biology and could lead to the identification of new therapeutic targets that could inhibit metastatic dissemination.O melanoma é o tipo de cancro da pele mais agressivo, sendo a principal causa de morte por doenças da pele. Esta doença demonstra um pobre prognóstico quando progride para um estado metastático. O nosso laboratório descobriu previamente o papel chave da cGMP fosfodiesterase PDE5A na inibição da invasão celular. Foi descoberto que a PDE5A era maioritariamente regulada negativamente pelo oncogene BRAF num painel de linhas celulares de melanoma que demonstram uma grande capacidade de invasão. No seguimento destes factos, o nosso principal objetivo foi então identificar genes regulados pela PDE5A em linhas celulares que possuem BRAF mutado. Neste estudo, dois clones da linha celular A375M2 geneticamente modificados de modo a expressar estavelmente a PDE5A foram analisados usando microarrays de forma a verificar a expressão genética e comparados com os controlos parentais. Foram identificados 24 genes regulados negativamente e 587 regulados positivamente em comum entre os dois clones que expressam PDE5A, em comparação com o controlo. Para futura validação, da lista dos 24 genes regulados negativamente, TFPI2 (Tissue factor pathway inhibitor 2) e SERPINB2 (Plasminogen activator inhibitor type 2) foram selecionados. Quanto aos genes positivamente regulados pela PDE5A, MUC15 (mucin 15, cell surface associated), SERPINA5 (serpin peptidase inhibitor, clade A (alpha-1 antiproteinase, antitrypsin), member 5) e SERPINF1 (serpin peptidase inhibitor, clade F (alpha-2 antiplasmin, pigment epithelium derived factor), member 1) foram escolhidos para validação. Os resultados demonstram que a fosfodiesterase PDE5A regula a expressão de um grande número de genes em células de melanoma. A identificação desses genes, expressos de forma diferencial, irá facilitar uma melhoria na compreensão da biologia do melanoma mestastático e poderá permitir a identificação de novos alvos terapêuticos que poderão inibir a metastização