Psicometric properties of an instrument for measuring patient’s satisfaction with physical therapy (medrisk) in spanish population: cultural diversity

The Spanish-language versión of the MedRisk Insttrument for Mesauring Partient Satisfaction with Physical therapy Care was validated in a simple of 203 Spanish-speakers patients in New York City. The purpose of this investigation is to adapt this instrument to Spanish population (patients who assist to physical therapy services in Spain); to corroborate if exist a psychometric equivalence and to identify if Spanish patients consider relevant the same dimensions as the preliminary validation. Relevance: At time to used a measurement instrument that has been validated in another country, it is necessary to assure that it is not only reliable and valid to the country where was developed, but also it needs to be appropriated to the patients subjects of the current investigation. Participants: A total of 300 patients of the Hospital of San Juan de Dios del Aljarafe (in Sevilla, Spain) participated in this study (44% men and 56% women between 13 and 93 years old). Methods: It has been done a cross-sectional descriptive study. Data were collected between April 2008 and November 2009.To the patients involved in the research, it was applied the original 20-item version of the MRPS (18 items and two global measures) and not the validated 12-item MRPS (10 items and two global measures). The main investigator randomly selected days during which the data were collected. The sample was taken finally on by convenience: all patients, in these selected days, who assist to medical care once they were done with their prescribed physiotherapy treatment. Analysis: Like Spanish version in New York, factor structure was investigated using item-correlation and exploratory factor analysis. Group-level reliability for single test administration was assessed using the Cronbach alpha. Results: Factor structure: the inter-item correlation matrix revealed that 3 items were not significantly correlated to both of the global measures . These 3 items were not included in the subsequent analysis. Principal components analysis revealed 4 eigenvalues greater than 2.0 explaining 67.93% of the cumulative variance. This suggested a 4-factor solutions. Following varimax rotation, a total of 14 items loaded on four factors were retained. Reliability: The Cronbach alpha was .87 Conclusions: Spanish version of MRPS that was validated with Spanish-speakers patients in New York is similar but not identical to the validation obtained with Spanish Population. In both of them, 9 of the 12 and 14 items finally selected in each other, have a coincidence. In the first one, there is a conclusion of two factors, internal and external. And in our investigation there were obtained 4 dimensions, 2 of them refer to internal factors (respect of the healthcare team and professional behavior of the therapist) and 2 that does it to external factors (adaptation of the center and accessibility)Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Auscultation of velcro crackles is associated with usual interstitial pneumonia

Auscultation of Velcro crackles has been proposed as a key finding in physical lung examination in patients with interstitial lung diseases (ILDs), especially in idiopathic pulmonary fibrosis (IPF). However, no studies have been carried out to assess the association of Velcro crackles with other clinical variables. We evaluated a cohort of 132 patients, prospectively and consecutively included in our ILD diagnostic program at a tertiary referral center. All patients were auscultated during the physical examination. The patients were divided into 2 groups: "presence" or "nonpresence" of bilateral Velcro crackles. Of all patients assessed, 83 (63%) presented Velcro crackles in the respiratory auscultation. Patients with Velcro crackles usually had more frequently cough and dyspnea at the moment of diagnosis. Forced vital capacity (P = 0.002) and lung diffusion capacity for carbon monoxide (P = 0.04) was lower in these patients. The ILD-GAP index was higher in the group with Velcro crackles (P = 0.01). All patients with usual interstitial pneumonia (UIP) in high-resolution computed tomography and all patients with final IPF diagnosis presented Velcro crackles. In multivariate analysis, the presence of Velcro crackles was independently associated with an UIP pattern. In patients suspected of having ILD, the auscultation of Velcro crackles was associated with UIP, a possibility which must be taken into consideration in early ILD detection in primary care

Amniotic membrane, review of its ophthalmic use and results in the last five years (2013-2017) in Granada. Preliminary study

Propósito: Analizar los resultados obtenidos del trasplante de membrana amniótica con fines oftalmológicos en la provincia de Granada entre los años 2013-2017 para identificar posibles variables que influyan en mayor o menor medida en un buen pronóstico postquirúrgico. Materiales y métodos: Estudio retrospectivo de serie de casos. Se estudiaron 44 pacientes con lesiones en la superficie ocular, los cuales recibieron trasplante de membrana amniótica entre 2013-2017 en la provincia de Granada (España) con un seguimiento mínimo de 8 meses. Los pacientes presentaron: abrasiones corneales, descematoceles, perforaciones, pterigium recidivantes, queratopatías en banda, queratitis numular, simbléfaron y úlceras recidivantes. Las variables recogidas en cada caso fueron las siguientes: sexo, edad, fecha del trasplante, técnica empleada, número de membrana amniótica implantadas en cada paciente, número de capas de membrana amniótica implantadas, tipo de membrana amniótica, motivo del trasplante, ¿hubo complicaciones?, ¿cuándo?, ¿se puso una segunda membrana amniótica?, ¿se realizó otra intervención?, ¿infecciones postquirúrgicas?,¿mejoría agudeza visual?,¿transparencia corneal ? y ¿éxito o fracaso global de la intervención?. Para el análisis estadístico, se compararon los resultados del grupo de éxito frente a los del grupo de fracaso mediante la prueba de Mann-Whitney, aplicándose el test de Kendall para identificar correlación entre grupos. Resultados: Respecto al éxito o fracaso del tratamiento, se encontraron diferencias estadísticamente significativas entre el grupo de éxito y el de fracaso para las siguientes variables: motivo de implante por perforación corneal (la mayoría fracasaban), existencia de complicaciones y la transparencia corneal, las cuales se correlacionaron de forma positiva o negativa con el éxito del trasplante. Con respecto a estos últimos dos parámetros (la ausencia de complicaciones y una buena trasparencia corneal) se relacionaron con el éxito postquirúrgico. Conclusión: El presente estudio preliminar sugiere que el trasplante de membrana amniótica podría ser útil en oftalmología, existiendo una clara asociación entre el éxito de esta técnica y ciertos factores relacionados con la evolución del paciente. Asimismo, la membrana amniótica no debería utilizarse de forma aislada en pacientes con perforación ocular, debido al elevado riesgo de fracaso de la técnica, siendo necesaria su realización junto a tratamientos coadyuvantes y recomendándose el estudio de tratamientos más definitivosPurpose: To analyze the results obtained from the amniotic membrane transplant for ophthalmological purposes in the province of Granada between the years 2013-2017 to identify possible variables that influence, to a greater or lesser extent, a good postoperative prognosis. Materials and methods: Retrospective study of case series. Forty-four patients with lesions on the ocular surface were studied, who received an amniotic membrane transplant between 2013-2017 in the province of Granada (Spain) with a minimum follow-up of 8 months. The patients presented: corneal abrasions, descemetoceles, perforations, recurrent pterygium, band keratopathies, nummular keratitis, symblepharon and recurrent ulcers. The variables collected in each case were: sex, age, date of transplant, technique used, number of amniotic membrane implanted in each patient, number of implanted amniotic membrane layers, type of amniotic membrane, reason for the transplant, were there complications?, when?, did you put a second amniotic membrane?, did you perform another intervention?, were there postoperative infections?, improvement in acuity visual, corneal transparency? and global success or failure of the intervention ?. For the statistical analysis, the results of the success group were compared with those of the failure group using the Mann-Whitney test, applying the Kendall test to identify correlation between groups. Results: Regarding the success or failure of the treatment, statistically significant differences were found between the success group and the failure group for the following variables: implant motive due to corneal perforation (most failed), existence of complications and corneal transparency, which correlated positively or negatively with the success of the transplant. With regard to these last two parameters (the absence of complications and a good corneal transparency) were related to postoperative success. Conclusion: This preliminary study suggests that amniotic membrane transplantation could be useful in ophthalmology, there being a clear association between the success of this technique and certain factors related to the evolution of the patient. Likewise, the amniotic membrane should not be used in isolation in patients with ocular perforation, due to the high risk of failure of the technique, being necessary to perform along with adjuvant treatments and recommended the study of more definitive treatments

Impact of a systematic evaluation of connective tissue disease on diagnosis approach in patients with interstitial lung diseases

To date, there is no clear agreement regarding which is the best method to detect a connective tissue disease (CTD) during the initial diagnosis of interstitial lung diseases (ILD). The aim of our study was to explore the impact of a systematic diagnostic strategy to detect CTD-associated ILD (CTD-ILD) in clinical practice, and to clarify the significance of interstitial pneumonia with autoimmune features (IPAF) diagnosis in ILD patients. Consecutive patients evaluated in an ILD Diagnostic Program were divided in 3 groups: IPAF, CTD-ILD, and other ILD forms. Clinical characteristics, exhaustive serologic testing, high resolution computed tomography (HRCT) images, lung biopsy specimens, and follow-up were prospectively collected and analyzed. Among 139 patients with ILD, CTD was present in 21 (15.1%), 24 (17.3%) fulfilled IPAF criteria, and 94 (67.6%) were classified as other ILD forms. Specific systemic autoimmune symptoms such as Raynaud phenomenon (19%), inflammatory arthropathy (66.7%), and skin manifestations (38.1%) were more frequent in CTD-ILD patients than in the other groups (all P< .001). Among autoantibodies, antinuclear antibody was the most frequently found in IPAF (42%), and CTD-ILD (40%) (P= .04). Nonspecific interstitial pneumonia, detected by HRCT scan, was the most frequently seen pattern in patients with IPAF (63.5%), or CTD-ILD (57.1%) (P< .001). In multivariate analysis, a suggestive radiological pattern by HRCT scan (odds ratio [OR] 15.1, 95% confidence interval [CI] 4.7-48.3, P< .001) was the strongest independent predictor of CTD-ILD or IPAF, followed by the presence of clinical features (OR 14.6, 95% CI 4.3-49.5, P< .001), and serological features (OR 12.4, 95% CI 3.5-44.0, P< .001). This systematic diagnostic strategy was useful in discriminating an underlying CTD in patients with ILD. The defined criteria for IPAF are fulfilled by a considerable proportion of patients referred for ILD

Intratumoral injection of dendritic cells engineered to secrete interleukin-12 by recombinant adenovirus in patients with metastatic gastrointestinal carcinomas.

PURPOSE: To evaluate the feasibility and safety of intratumoral injection of autologous dendritic cells (DCs) transfected with an adenovirus encoding interleukin-12 genes (AFIL-12) for patients with metastatic gastrointestinal carcinomas. Secondarily, we have evaluated biologic effects and antitumoral activity. PATIENTS AND METHODS: Seventeen patients with metastatic pancreatic (n = 3), colorectal (n = 5), or primary liver (n = 9) malignancies entered the study. DCs were generated from CD14+ monocytes from leukapheresis, cultured and transfected with AFIL-12 before administration. Doses from 10 x 10(6) to 50 x 10(6) cells were escalated in three cohorts of patients. Patients received up to three doses at 21-day intervals. RESULTS: Fifteen (88%) and 11 of 17 (65%) patients were assessable for toxicity and response, respectively. Intratumoral DC injections were mainly guided by ultrasound. Treatment was well tolerated. The most common side effects were lymphopenia, fever, and malaise. Interferon gamma and interleukin-6 serum concentrations were increased in 15 patients after each treatment, as well as peripheral blood natural killer activity in five patients. DC transfected with AFIL-12 stimulated a potent antibody response against adenoviral capsides. DC treatment induced a marked increase of infiltrating CD8+ T lymphocytes in three of 11 tumor biopsies analyzed. A partial response was observed in one patient with pancreatic carcinoma. Stable disease was observed in two patients and progression in eight patients, with two of the cases fast-progressing during treatment. CONCLUSION: Intratumoral injection of DC transfected with an adenovirus encoding interleukin-12 to patients with metastatic gastrointestinal malignancies is feasible and well tolerated. Further studies are necessary to define and increase clinical efficacy

Efecto de una cepa de Fusarium oxysporum y de diversas levaduras sobre la nutrición férrica de plantas de pepino y tomate

Trabajo presentado en el XVI Congreso Nacional de Ciencias Hortícolas, celebrado en Córdoba del 17 al 22 de octubre de 2021,El hierro (Fe) es un micronutriente esencial para las plantas. En suelos calizos se encuentra en su forma oxidada (Fe 3+), presentando baja solubilidad y disponibilidad para las plantas. Bajo deficiencia de Fe, las plantas dicotiledóneas inducen diversas respuestas fisiológicas y morfológicas en sus raíces para facilitar así su captación y paliar los efectos que produce su deficiencia. Existen evidencias de que determinados microorganismos rizosféricos, como los que provocan la Respuesta Sistémica Inducida (ISR), pueden facilitar la nutrición férrica de las plantas. El objetivo de este trabajo ha sido, por una parte, estudiar el efecto de la cepa no patogénica de Fusarium oxysporum (FO12), posiblemente inductora de ISR, sobre el crecimiento y clorosis de plantas de tomate (Solanum lycopersicum Mill.), y sobre la colonización de raíces de pepino (Cucumis sativus L.). Por otra parte, estudiar el efecto de determinadas levaduras (Debaryomyces hansenii, Saccharomyces cerevisiae y Hansenula polymorpha) sobre diversas respuestas a la deficiencia de Fe en plantas de pepino. Los experimentos con tomate se han desarrollado en suelo calizo y los de pepino en cultivo hidropónico. Los resultados obtenidos con FO12 han mostrado su capacidad para colonizar endofiticamente las raíces de pepino y su efecto promotor del crecimiento, la concentración de clorofila y de Fe (en hojas) en plantas de tomate. Las diferentes levaduras utilizadas han causado inducción de la capacidad reductora de Fe 3+, de la acidificación de la rizosfera, y de la proliferación de pelos radicales en la zona subapical de las raíces de pepino. Estos resultados sugieren que, tanto FO12 como las diferentes levaduras utilizadas, tienen potencial como biofertilizantes de Fe.Plan Propio de la Universidad de Córdoba y Ministerio de Ciencia e Innovación

Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry

Background & aims: Prospective drug-induced liver injury (DILI) registries are important sources of information on idiosyncratic DILI. We aimed to present a comprehensive analysis of 843 patients with DILI enrolled into the Spanish DILI Registry over a 20-year time period. Methods: Cases were identified, diagnosed and followed prospectively. Clinical features, drug information and outcome data were collected. Results: A total of 843 patients, with a mean age of 54 years (48% females), were enrolled up to 2018. Hepatocellular injury was associated with younger age (adjusted odds ratio [aOR] per year 0.983; 95% CI 0.974-0.991) and lower platelet count (aOR per unit 0.996; 95% CI 0.994-0.998). Anti-infectives were the most common causative drug class (40%). Liver-related mortality was more frequent in patients with hepatocellular damage aged ≥65 years (p = 0.0083) and in patients with underlying liver disease (p = 0.0221). Independent predictors of liver-related death/transplantation included nR-based hepatocellular injury, female sex, higher onset aspartate aminotransferase (AST) and bilirubin values. nR-based hepatocellular injury was not associated with 6-month overall mortality, for which comorbidity burden played a more important role. The prognostic capacity of Hy's law varied between causative agents. Empirical therapy (corticosteroids, ursodeoxycholic acid and MARS) was prescribed to 20% of patients. Drug-induced autoimmune hepatitis patients (26 cases) were mainly females (62%) with hepatocellular damage (92%), who more frequently received immunosuppressive therapy (58%).The present study has been supported by grants of Instituto de Salud Carlos III cofounded by Fondo Europeo de Desarrollo Regional – FEDER (contract numbers: PI19/00883, PI16/01748, PI18/00901, PI18/01804, PI-0285-2016, PI-0274-2016, PI-0310- 2018, PT17/0017/0020) and Agencia Española del Medicamento. CIBERehd and Plataforma ISCIII Ensayos Clinicos are funded by Instituto de Salud Carlos III. MRD holds a Joan Rodes (JR16/ 00015)/Acción B clinicos investigadores (B-0002-2019) and JSC a Rio Hortega (CM17/00243) research contract from ISCIII and Consejería de Salud de Andalucía. The funding sources had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report or in the de- cision to submit the manuscript for publication

Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry

[Background & Aims] Prospective drug-induced liver injury (DILI) registries are important sources of information on idiosyncratic DILI. We aimed to present a comprehensive analysis of 843 patients with DILI enrolled into the Spanish DILI Registry over a 20-year time period.[Methods] Cases were identified, diagnosed and followed prospectively. Clinical features, drug information and outcome data were collected.[Results] A total of 843 patients, with a mean age of 54 years (48% females), were enrolled up to 2018. Hepatocellular injury was associated with younger age (adjusted odds ratio [aOR] per year 0.983; 95% CI 0.974–0.991) and lower platelet count (aOR per unit 0.996; 95% CI 0.994–0.998). Anti-infectives were the most common causative drug class (40%). Liver-related mortality was more frequent in patients with hepatocellular damage aged ≥65 years (p = 0.0083) and in patients with underlying liver disease (p = 0.0221). Independent predictors of liver-related death/transplantation included nR-based hepatocellular injury, female sex, higher onset aspartate aminotransferase (AST) and bilirubin values. nR-based hepatocellular injury was not associated with 6-month overall mortality, for which comorbidity burden played a more important role. The prognostic capacity of Hy’s law varied between causative agents. Empirical therapy (corticosteroids, ursodeoxycholic acid and MARS) was prescribed to 20% of patients. Drug-induced autoimmune hepatitis patients (26 cases) were mainly females (62%) with hepatocellular damage (92%), who more frequently received immunosuppressive therapy (58%).[Conclusions] AST elevation at onset is a strong predictor of poor outcome and should be routinely assessed in DILI evaluation. Mortality is higher in older patients with hepatocellular damage and patients with underlying hepatic conditions. The Spanish DILI Registry is a valuable tool in the identification of causative drugs, clinical signatures and prognostic risk factors in DILI and can aid physicians in DILI characterisation and management.[Lay summary] Clinical information on drug-induced liver injury (DILI) collected from enrolled patients in the Spanish DILI Registry can guide physicians in the decision-making process. We have found that older patients with hepatocellular type liver injury and patients with additional liver conditions are at a higher risk of mortality. The type of liver injury, patient sex and analytical values of aspartate aminotransferase and total bilirubin can also help predict clinical outcomes.The present study has been supported by grants of Instituto de Salud Carlos III cofounded by Fondo Europeo de Desarrollo Regional – FEDER (contract numbers: PI19/00883, PI16/01748, PI18/00901, PI18/01804, PI-0285-2016, PI-0274-2016, PI-0310-2018, PT17/0017/0020) and Agencia Española del Medicamento. CIBERehd and Plataforma ISCIII Ensayos Clinicos are funded by Instituto de Salud Carlos III. MRD holds a Joan Rodes (JR16/00015)/Acción B clinicos investigadores (B-0002-2019) and JSC a Rio Hortega (CM17/00243) research contract from ISCIII and Consejería de Salud de Andalucía.Peer reviewe

Primary biliary cirrhosis

Primary biliary cirrhosis (PBC) is an immune-mediated chronic cholestatic liver disease with a slowly progressive course. Without treatment, most patients eventually develop fibrosis and cirrhosis of the liver and may need liver transplantation in the late stage of disease. PBC primarily affects women (female preponderance 9–10:1) with a prevalence of up to 1 in 1,000 women over 40 years of age. Common symptoms of the disease are fatigue and pruritus, but most patients are asymptomatic at first presentation. The diagnosis is based on sustained elevation of serum markers of cholestasis, i.e., alkaline phosphatase and gamma-glutamyl transferase, and the presence of serum antimitochondrial antibodies directed against the E2 subunit of the pyruvate dehydrogenase complex. Histologically, PBC is characterized by florid bile duct lesions with damage to biliary epithelial cells, an often dense portal inflammatory infiltrate and progressive loss of small intrahepatic bile ducts. Although the insight into pathogenetic aspects of PBC has grown enormously during the recent decade and numerous genetic, environmental, and infectious factors have been disclosed which may contribute to the development of PBC, the precise pathogenesis remains enigmatic. Ursodeoxycholic acid (UDCA) is currently the only FDA-approved medical treatment for PBC. When administered at adequate doses of 13–15 mg/kg/day, up to two out of three patients with PBC may have a normal life expectancy without additional therapeutic measures. The mode of action of UDCA is still under discussion, but stimulation of impaired hepatocellular and cholangiocellular secretion, detoxification of bile, and antiapoptotic effects may represent key mechanisms. One out of three patients does not adequately respond to UDCA therapy and may need additional medical therapy and/or liver transplantation. This review summarizes current knowledge on the clinical, diagnostic, pathogenetic, and therapeutic aspects of PBC