Estudio sobre la efectividad de la aplicación por vía epidural de un sistema adhesivo de fibrina frente a sangre autóloga para el tratamiento de la cefalea postpunción dural accidental

Faltan resúme

Design and preliminarily validation of a tool to assess the impact of chronic non-cancer pain on people’s daily life in Spanish-language: PAIN_Integral Scale

Aim: To build and preliminarily validate a Spanish-language instrument to assess the impact that CNCP has on the daily lives of people who suffer from it. Background: The experience of pain is multifactorial and a correct assessment of it helps to control the intensity of pain. Although there are instruments that evaluate areas on which Chronic Non-Cancer Pain impacts, it would be necessary to include other aspects that scientific literature identifies as relevant. Design: Instrument and construct cross-sectional study for psychometric validation. Methods: A total of 157 items based on items from validated questionnaires were evaluated by a group of 21 chronic pain experts using Delphi methodology in three evaluation rounds. A final questionnaire of 55 items with a 5-point Likert-type scale was formed. This questionnaire was piloted on a total of 30 patients to assess their understanding of the items and the psychometric validation process was carried out (January to March 2020) on a subsequent sample of 395 people, all of whom attended Pain Units and Primary Care Centres of the Public Health System in Spain. Results: The PAIN_Integral Scale© showed acceptable internal consistency scores measured by Cronbach's alpha. Exploratory Factor Analysis indicated a structure of nine factors that explain 71.02% of the total variance, from 157 to a final total of 36 items. Confirmatory Factor Analysis showing adequate values confirmed this structure. The effect size was used to calculate the cut-off points for the overall scale, setting them at scores of 130 and 135. Conclusion: This instrument would allow to assess other constructs and dimensions not included in the instruments previously available such as treatment compliance, proactivity, resilience, hopelessness due to pain and pain catastrophizing. However, despite the fact that the preliminary analysis shows good results, it is necessary to continue with its validation process in subsequent studies

Effects of High Intensity Interval or Continuous Moderate Training on Metabolic Thresholds: A Randomized Control Trial

High intensity interval training (HIIT) has been suggested to promote superior metabolic and cardiovascular adaptations than classical moderate continuous training (MCT) in athletes or sedentary people. However, less is known about the effects of HIIT in metabolic thresholds like anaerobic (AT) or respiratory compensation point (RCP) in active women. Moreover, former studies have not compared exercise protocols with same training internal load (similar energy expenditure), which must be a main concern in order to compare HIIT and MCT. PURPOSE: It was our aim to compare changes in AT and RCP between HIIT and MCT exercise training protocols with the same energy expenditure. METHODS: Forty-one healthy women accepted to participate in the study (42.587.53 years; fat mass percent (%FM) 35.87.0%; maximum oxygen uptake (VO2max), 30.787.66 ml/kg/min). Thirty-two were previously active (>3 days/week restructured exercise), and they were randomized in HIIT (95% VO2max reserve, 172 min/week) or MCT (61% VO2max reserve, 279 min/week) groups, a control group (CG) of 9 women with similar age and body composition was selected from the university community. Both exercise-training protocols were designed to result in similar energy expenditure and were performed 2-3 times per week during 24 weeks. AT and RCP were measured using indirect calorimetry (Ultima CCM, MedGraphics, USA) during a ramp exercise test (delta 15 watts/min) on bike. Data from exercise test were used to prescribe training load. Repeated measured analyses were carried out in order to compare AT and RCP before and after 24 weeks of training between HIIT, MCT and CG groups. RESULTS: After 24-week of training exercise, both groups increased VO2 at AT (1067404 vs 1207351 ml/min and 947293 vs. 1128351 ml/min, HIIT and MCT respectively; P<0.05 for both) and RCP (1529434 vs 1730403 ml/min and 1599496 vs. 1815529 ml/min; HIIT and MCT respectively, P<0.01 for both). Post Hoc analysis showed that VO2 at AT and RCP were significantly different among training groups and CG, which did not modify any variable. CONCLUSIONS: Our results suggests that both HIIT and MCT promote similar improvements of VO2 at AT and RCP in previously active women, when similar energy expenditures are performed.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Clonal heterogeneity and rates of specific chromosome gains are risk predictors in childhood high-hyperdiploid B-cell acute lymphoblastic leukemia

B-cell acute lymphoblastic leukemia (B-ALL) is the commonest childhood cancer. High hyperdiploidy (HHD) identifies the most frequent cytogenetic subgroup in childhood B-ALL. Although hyperdiploidy represents an important prognostic factor in childhood B-ALL, the specific chromosome gains with prognostic value in HHD-B-ALL remain controversial, and the current knowledge about the hierarchy of chromosome gains, clonal heterogeneity and chromosomal instability in HHD-B-ALL remains very limited. We applied automated sequential-iFISH coupled with single-cell computational modeling to identify the specific chromosomal gains of the eight typically gained chromosomes in a large cohort of 72 primary diagnostic (DX, n = 62) and matched relapse (REL, n = 10) samples from HHD-B-ALL patients with either favorable or unfavorable clinical outcome in order to characterize the clonal heterogeneity, specific chromosome gains and clonal evolution. Our data show a high degree of clonal heterogeneity and a hierarchical order of chromosome gains in DX samples of HHD-B-ALL. The rates of specific chromosome gains and clonal heterogeneity found in DX samples differ between HHD-B-ALL patients with favorable or unfavorable clinical outcome. In fact, our comprehensive analyses at DX using a computationally defined risk predictor revealed low levels of trisomies +18+10 and low levels of clonal heterogeneity as robust relapse risk factors in minimal residual disease (MRD)-negative childhood HHD-B-ALL patients: relapse-free survival beyond 5 years: 22.1% versus 87.9%, P < 0.0001 and 33.3% versus 80%, P < 0.0001, respectively. Moreover, longitudinal analysis of matched DX-REL HHD-B-ALL samples revealed distinct patterns of clonal evolution at relapse. Our study offers a reliable prognostic sub-stratification of pediatric MRD-negative HHD-B-ALL patients

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Çédille, revista de estudios franceses

Presentació

Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/ COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence

La Asociación Colombiana de Infectología (ACIN) y el Instituto de Evaluación de Nuevas Tecnologías de la Salud (IETS) conformó un grupo de trabajo para desarrollar recomendaciones informadas y basadas en evidencia, por consenso de expertos para la atención, diagnóstico y manejo de casos de Covid 19. Estas guías son dirigidas al personal de salud y buscar dar recomendaciones en los ámbitos de la atención en salud de los casos de Covid-19, en el contexto nacional de Colombia

Profiles of adult people in a Spanish sample with chronic pain: Cluster analysis.

To establish groups of people with chronic non-cancer pain according to the impairment caused by pain and to identify factors associated with the group with a higher level of impairment. Knowing the profiles of people who suffer from chronic non-cancer pain could make it possible to direct their treatment and to detect associated risks. A cross-sectional study. A sample of 395 people with chronic non-cancer pain was collected in Pain Units and Primary Healthcare Centres in southern Spain (January to March 2020). A cluster analysis was performed to divide the population into groups and a binary logistic regression model was established to determine factors associated with the group with a higher level of impairment. Two groups were identified: lower level of impairment due to pain, characterized by being 45-65 years old, not medicated with opioids or anxiolytics, employed and with a mild level of impact on daily life; and higher level of impairment characterized by being older than 65 years old, medicated with opioids and anxiolytics, retired or on medical leave and with a severe impact on daily life. In addition, among women, being widowed, single or a smoker are risk factors for belonging to the group with a higher level of impairment; being smokers or consuming alcohol three or less times a week would be risk factors in men. Age, chronic non-cancer pain impact on daily life, work situation and the consumption of opioid drugs and/or anxiolytics are factors that appear to influence the level of impairment due to chronic pain. These findings could help detect impairment due to pain in its early stages, determining the specific needs of each person

Evaluación del profesorado de Medicina en Práctica Clínica

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