MCQ-Balance: a method to monitor patients with balance disorders and improve clinical interpretation of posturography

Background An estimated 20% to 30% of the global population has suffered a vertiginous episode. Among them, 20% do not receive a clear diagnosis. Improved methods, indicators and metrics are necessary to assess the sensory systems related to balance, especially when patients are undergoing treatment for vertiginous episodes. Patients with balance disorders should be monitored for changes at the individual level to gather objective information. In this study, we evaluate the use of the MCQ-Balance (Measure, Classify and Qualify) assessment for examining a patient’s balance progression using tests to measure static balance control and dynamic postural balance with a stabilometric platform. Materials and Methods The MCQ-Balance assessment comprises three stages: (i) measuring the progression of each variable between two separate and consecutive days (called sessions) using the Magnitude-Based Decision analysis; (ii) classifying the progression of the patient’s balance with a score; and (iii) qualifying the progression of the patient’s balance from the resulting scores using a set of rules. This method was applied to 42 patients with balance disorders of peripheral or central origin characterised by vertigo as the cardinal symptom. Balance progression was measured using the MCQ-Balance assessment over the course of three months, and these results were compared with the assessment of a clinical expert. Results The MCQ-Balance assessment showed an accuracy of 83.4% and a Cohen’s Kappa coefficient of 0.752 compared to the assessment of a clinical expert. Conclusion The MCQ-Balance assessment facilitates the monitoring of patient balance and provides objective information that has the potential to improve medical decision making and the adjustment of individual treatment

Variation in assignment of the COPD patients into a GOLD group according to symptoms severity

Introduction: The Global Organization of Lung Disease (GOLD) classifies patients with chronic obstructive pulmonary disease (COPD) taking into account the symptoms. The modified Medical Research Council’s dyspnea scale (mMRC) and the COPD assessment test (CAT) are used to assess these symptoms. In this study, we analyze the concordance of GOLD classification using mMRC and CAT. Patients and Methods: This is an observational study of a cohort of 169 patients with COPD, who were classified following the GOLD 2017 recommendations, using both mMRC and CAT. A concordance analysis was applied, and a ROC curve was generated to identify the CAT score that best concorded with the mMRC scale. Results: The concordance for the GOLD groups classified by CAT and mMRC was moderate (kappa 0.492). For mMRC score of 1 and 2, a CAT score of =9 and =16 showed the maximum value of the Youden index, respectively. By reclassifying the patients with the new cut-off points obtained, the best concordance was obtained between the cut-off point for CAT of 16 and for mMRC of 2, followed by CAT of 9 and mMRC of 1. Conclusion: Because of the deficient concordance between CAT and mMRC, we propose the use of new cut-off points in future updates of the GOLD strategy

Human Antimicrobial RNases inhibit intracellular bacterial growth and induce Autophagy in Mycobacteria-Infected Macrophages

The development of novel treatment against tuberculosis is a priority global health challenge. Antimicrobial proteins and peptides offer a multifaceted mechanism suitable to fight bacterial resistance. Within the RNaseA superfamily there is a group of highly cationic proteins secreted by innate immune cells with anti-infective and immune-regulatory properties. In this work, we have tested the human canonical members of the RNase family using a spot-culture growth inhibition assay based mycobacteria-infected macrophage model for evaluating their anti-tubercular properties. Out of the seven tested recombinant human RNases, we have identified two members, RNase3 and RNase6, which were highly effective against Mycobacterium aurum extra- and intracellularly and induced an autophagy process. We observed the proteins internalization within macrophages and their capacity to eradicate the intracellular mycobacterial infection at a low micro-molar range. Contribution of the enzymatic activity was discarded by site-directed mutagenesis at the RNase catalytic site. The protein induction of autophagy was analyzed by RT-qPCR, western blot, immunofluorescence, and electron microscopy. Specific blockage of auto-phagosome formation and maturation reduced the protein's ability to eradicate the infection. In addition, we found that the M. aurum infection of human THP1 macrophages modulates the expression of endogenous RNase3 and RNase6, suggesting a function in vivo. Overall, our data anticipate a biological role for human antimicrobial RNases in host response to mycobacterial infections and set the basis for the design of novel anti-tubercular drugs

HIV/STI co-infection among men who have sex with men in Spain

In Spain, neither the HIV nor the STI national surveillance systems collect information on HIV/STI co-infection. However, there are two networks based on HIV/STI clinics which gather this data. We describe HIV prevalence in men who have sex with men (MSM) diagnosed with infectious syphilis and/or gonorrhoea in 15 STI clinics; and concurrent diagnoses of STI in MSM newly diagnosed with HIV in 19 HIV/STI clinics. In total, 572 MSM were diagnosed with infectious syphilis and 580 with gonorrhoea during 2005-2007. HIV prevalence among syphilis and gonorrhoea cases was 29.8% and 15.2% respectively. In the multivariate analysis, HIV/syphilis co-infection was associated with being Latin American; having a history of STI; reporting exclusively anal intercourse; and having sex with casual or several types of partners. HIV and gonorrhoea co-infection was associated with age older than 45 years; having no education or only primary education completed; and having a history of STI. In total, 1,462 HIV infections were newly diagnosed among MSM during 2003-2007. Of these, 31.0% were diagnosed with other STI at the same time. Factors associated with STI co-infection among new HIV cases in MSM were being Latin American; and having sex with casual partners or with both steady and casual partners. In Spain, a considerable proportion of MSM are co-infected with HIV and STI.This work was funded by two grants (36646/07; 36794/08) from the Foundation for Research and Prevention of AIDS in Spain (Fundación para la Investigación y la Prevención del SIDA en España–FIPSE).S

Reliability of goniometric measurements in children with cerebral palsy: A comparative analysis of universal goniometer and electronic inclinometer. A pilot study

<p>Abstract</p> <p>Background</p> <p>Even though technological progress has provided us with more and more sophisticated equipment for making goniometric measurements, the most commonly used clinical tools are still the universal goniometer and, to a lesser extent, the inclinometer. There is, however, no published study so far that uses an inclinometer for measurements in children with cerebral palsy (CP). The objective of this study was two-fold: to independently assess the intra and inter-examiner reliability for measuring the hip abduction range of motion in children with CP using two different instruments, the universal two-axis goniometer and electronic inclinometer. A pool of 5 examiners with different levels of experience as paediatric physiotherapists participated. The study did not compare both instruments because the measurement procedure and the hip position were different for each.</p> <p>Methods</p> <p>A prospective, observational study of goniometery was carried out with 14 lower extremities of 7 children with spastic CP. The inclinometer study was carried out with 8 lower extremities of 4 children with spastic CP. This study was divided into two independent parts: a study of the reliability of the hip abduction range of motion measured with a universal goniometer (hip at 0° flexion) and with an electronic inclinometer (hip at 90° flexion). The Intraclass Correlation Coefficient (ICC) was calculated to analyse intra and inter-examiner agreement for each instrument.</p> <p>Results</p> <p>For the goniometer, the intra-examiner reliability was excellent (>0.80), while the inter-examiner reliability was low (0.375 and 0.475). For the inclinometer, both the intra-examiner (0.850-0.975) and inter-examiner reliability were excellent (0.965 and 0.979).</p> <p>Conclusions</p> <p>The inter-examiner reliability for goniometric measurement of hip abduction in children with CP was low, in keeping with other results found in previous publications. The inclinometer has proved to be a highly reliable tool for measuring the hip abduction range of motion in children with CP, which opens up new possibilities in this field, despite having some measurement limitations.</p

Acute Exercise Increases Plasma Total Antioxidant Status and Antioxidant Enzyme Activities in Untrained Men

Antioxidant defences are essential for cellular redox regulation. Since free-radical production may be enhanced by physical activity, herein, we evaluated the effect of acute exercise on total antioxidant status (TAS) and the plasma activities of catalase, glutathione reductase, glutathione peroxidase, and superoxide dismutase and its possible relation to oxidative stress resulting from exercise. Healthy untrained male subjects (=34) performed three cycloergometric tests, including maximal and submaximal episodes. Venous blood samples were collected before and immediately after each different exercise. TAS and enzyme activities were assessed by spectrophotometry. An increase of the antioxidant enzyme activities in plasma was detected after both maximal and submaximal exercise periods. Moreover, under our experimental conditions, exercise also led to an augmentation of TAS levels. These findings are consistent with the idea that acute exercise may play a beneficial role because of its ability to increase antioxidant defense mechanisms through a redox sensitive pathway

Trends in HIV testing, prevalence among first-time testers, and incidence in most-at-risk populations in Spain: the EPI-VIH Study, 2000 to 2009

During 2000 to 2009, data on people undergoing HIV testing and on those newly diagnosed with HIV were collected in a network of 20 Spanish clinics specialising in sexually transmitted infections and/or HIV testing and counselling. The number of tests performed, overall and disaggregated by different variables, was obtained. HIV prevalence among first-time testers and HIV incidence among repeat testers were calculated. To evaluate trends, joinpoint regression models were fitted. In total, 236,939 HIV tests were performed for 165,745 individuals. Overall HIV prevalence among persons seeking HIV testing was 2.5% (95% CI: 2.4 to 2.6). Prevalence was highest in male sex workers who had sex with other men (19.0% (95% CI: 16.7 to 21.4)) and was lowest in female sex workers (0.8% (95% CI: 0.7 to 0.9)). Significant trends in prevalence were observed in men who have sex with men (MSM) (increasing) and heterosexual individuals (decreasing). The incidence analysis included 30,679 persons, 64,104 person-years (py) of follow-up and 642 seroconversions. The overall incidence rate (IR) was 1.0/100 py (95% CI: 0.9/100 to 1.1/100). Incidence was significantly higher in men and transgender females than in women (1.8/100 py (95% CI: 1.6 to 1.9), 1.2/100 py (95% CI: 0.5 to 2.8) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively) and increased with age until 35¿39 years. IRs in MSM and people who inject drugs were significantly greater than in heterosexual individuals (2.5/100 py (95% CI: 2.3 to 2.7), 1.6/100 py (95% CI: 1.1 to 2.2) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively), and an upward trend was observed in MSM. Our results call for HIV prevention to be reinforced in MSM and transgender women in Spain

Funtional Assessment of Subacute or Chronic Low Back Pain by Subjetive and Objetive Measures

Due to its high incidence, low back pain is a major problem from a social, health, and labor perspective. It is considered one of the most common causes of medical consultations in primary care, and one of the main reasons for temporary disability. A correct diagnostic approach and adequate therapeutic management will allow for better control of the clinical condition and its evolution. To do this, there are functional assessment techniques, both objective and subjective, which will provide fundamental information to perform appropriate management of the pathology, as well as to assess the effectiveness of the treatment. Within the subjective techniques, the Oswestry disability index is the most widely questionnaire used in hospitals, while the Roland Morris scale is used mainly in primary care.The results provided by the isokinetic and isoinertial techniques assess the functional capacity of the lumbar spine in an easy and convenient way for the patient.The main objective of this study is to present different subjective questionnaires and objective techniques to make a correct valuation of lumbar pain, improving access to adequate treatment and reducing work time

Diferencias según origen en nuevos diagnóticos de VIH. Estudio EPIVIH

ANTECEDENTES Y OBJETIVOS El EPI-VIH es un estudio centrado en la vigilancia centinela de la infección por VIH mediante la monitorización de la prevalencia de VIH en personas que se realizan voluntariamente la prueba en centros de diagnóstico de ITS y/o VIH. A partir del año 2003 se recoge información detallada sobre los pacientes recién diagnosticados de infección por el VIH en los centros participantes. El objetivo de este estudio es describir las características epidemiológicas y clínicas de los nuevos diagnósticos de VIH según el lugar de origen en una red de centros específicos. MÉTODOS Estudio descriptivo de los nuevos diagnósticos de VIH en 19 centros situados en 11 Comunidades Autónomas. El periodo de estudio abarca desde el 2003 al 2006. Se recogieron variables sociodemográficas y clínicas mediante un cuestionario estandarizado y anónimo. Para evaluar la asociación entre variables cualitativas se utilizó la prueba de chi-cuadrado. RESULTADOS En el periodo de estudio se diagnosticaron 1.595 nuevos casos de VIH, siendo en su mayoría hombres (80,4%), con una edad media de 32,5 años (DE: 7,9) y el 64,3% tenían estudios secundarios o superiores. 681 casos (42,7%) procedían de otros países, principalmente de Latinoamérica (422 casos, 62%) y África Sub-sahariana (122, 18%). Comparando ambos grupos, se encontró que la proporción de mujeres entre los extranjeros fue mayor (23,1% frente a 9,3%) mientras que la edad media al diagnóstico fue inferior (31 años (DE:7,3) frente a 34 (DE:8,1)). (Tabla 1). Tanto entre los casos extranjeros como en los españoles el mecanismo de transmisión más frecuente fueron las relaciones sexuales entre hombres; sin embargo, mientras que el uso de drogas intravenosas fue superior en los españoles (7,3% frente a 4,1%), las relaciones heterosexuales fueron mayores en los extranjeros (32,9% frente al 16,1%) (Figura 1). El 61% de los extranjeros tenían una prueba del VIH anterior negativa, menos que los españoles (66,2%). No se encontraron diferencias significativas en la cifra de CD4 al diagnóstico. En los casos en los que la transmisión se atribuye a relaciones sexuales, el 30,8% de los extranjeros presentaron una ITS concurrente al diagnóstico de VIH frente al 25,8% en españoles. Se detectaron diferencias en el perfil de riesgo en el grupo de pacientes cuya transmisión fue sexual: los contactos con parejas ocasionales fueron superiores entre los españoles (70,9% frente al 59,0%) y el ejercicio de prostitución en los extranjeros (3,3 % frente al 26,3%) (Figura 2). CONCLUSIONES Los nuevos diagnósticos de VIH en personas de otros países son más jóvenes y la proporción de mujeres es superior que en los españoles. El mecanismo de transmisión más común en ambos fueron las relaciones sexuales, pero hay que señalar la elevada proporción de nuevos diagnósticos debidas a relaciones heterosexuales dentro de los extranjeros. En este grupo destaca la prostitución como situación de riesgo en los casos atribuidos a transmisión sexual al comparar con los españoles