Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement : a post-hoc analysis

Bilateral regional brain oxygen saturation (rSO) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the potential utility of rSO values as a warning sign for the development of different types of decline in postoperative psychological function. Observational post-hoc analysis of data for the patient sample (n = 125) of a previously conducted clinical trial in patients over the age of 65 years undergoing total knee replacement under spinal anesthesia. Demographic, hemodynamic and bilateral rSO intraoperative values were recorded. An absolute rSO value of 20% or >25% below baseline were chosen as relevant cutoffs. Composite function test scores were created from baseline to three months for each patient and adjusted for the mean (SD) score changes for a control group (n = 55). Tests were used to assess visual-motor coordination and executive function (VM-EF) (Wechsler Digit Symbol-Coding and Visual Reproduction, Trail Making Test) and memory (Auditory Verbal Learning, Wechsler Memory Scale); scales were used to assess psychological symptoms. We observed no differences in baseline rSO values; rSO decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034). Detection of a trend to asymmetry in rSO values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement in our patients over the age of 65 years

Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis

Background Bilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the potential utility of rSO2 values as a warning sign for the development of different types of decline in postoperative psychological function. Methods Observational post-hoc analysis of data for the patient sample (n = 125) of a previously conducted clinical trial in patients over the age of 65 years undergoing total knee replacement under spinal anesthesia. Demographic, hemodynamic and bilateral rSO2 intraoperative values were recorded. An absolute rSO2 value of 20% or >25% below baseline were chosen as relevant cutoffs. Composite function test scores were created from baseline to three months for each patient and adjusted for the mean (SD) score changes for a control group (n = 55). Tests were used to assess visual-motor coordination and executive function (VM-EF) (Wechsler Digit Symbol-Coding and Visual Reproduction, Trail Making Test) and memory (Auditory Verbal Learning, Wechsler Memory Scale); scales were used to assess psychological symptoms. Results We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO2 values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034). Conclusions Detection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement in our patients over the age of 65 years

High incidence of PTSD diagnosis and trauma-related symptoms in a trauma exposed bipolar I and II sample

Post-traumatic stress disorder (PTSD) is an established comorbidity in Bipolar Disorder (BD), but little is known about the characteristics of psychological trauma beyond a PTSD diagnosis and differences in trauma symptoms between BD-I and BD-II. (1) To present characteristics of a trauma-exposed BD sample; (2) to investigate prevalence and trauma symptom profile across BD-I and BD-II; (3) to assess the impact of a lifetime PTSD diagnosis vs. a history of trauma on BD course; and (4) to research the impacts of sexual and physical abuse. This multi-center study comprised 79 adult participants with BD with a history of psychological trauma and reports baseline data from a trial registered in Clinical Trials (; ref: NCT02634372). Clinical variables were gathered through clinical interview, validated scales and a review of case notes. The majority (80.8%) of our sample had experienced a relevant stressful life event prior to onset of BD, over half of our sample 51.9% had a lifetime diagnosis of PTSD according to the Clinician Administered PTSD scale. The mean Impact of Event Scale-Revised scores indicated high levels of trauma-related distress across the sample, including clinical symptoms in the PTSD group and subsyndromal symptoms in the non-PTSD group. Levels of dissociation were not higher than normative values for BD. A PTSD diagnosis (vs. a history of trauma) was associated with psychotic symptoms [2(1) = 5.404, p = 0.02] but not with other indicators of BD clinical severity. There was no significant difference between BD-I and BD-II in terms of lifetime PTSD diagnosis or trauma symptom profile. Sexual abuse significantly predicted rapid cycling [2(1) = 4.15, p = 0.042], while physical abuse was not significantly associated with any clinical indicator of severity. Trauma load in BD is marked with a lack of difference in trauma profile between BD-I and BD-II. Although PTSD and sexual abuse may have a negative impact on BD course, in many indicators of BD severity there is no significant difference between PTSD and subsyndromal trauma symptoms. Our results support further research to clarify the role of subsyndromic PTSD symptoms, and highlight the importance of screening for trauma in BD patients

High incidence of PTSD diagnosis and trauma-related symptoms in a trauma exposed bipolar I and II sample

Background: Post-traumatic stress disorder (PTSD) is an established comorbidity in Bipolar Disorder (BD), but little is known about the characteristics of psychological trauma beyond a PTSD diagnosis and differences in trauma symptoms between BD-I and BD-II. Objective: (1) To present characteristics of a trauma-exposed BD sample; (2) to investigate prevalence and trauma symptom profile across BD-I and BD-II; (3) to assess the impact of a lifetime PTSD diagnosis vs. a history of trauma on BD course; and (4) to research the impacts of sexual and physical abuse. Methods: This multi-center study comprised 79 adult participants with BD with a history of psychological trauma and reports baseline data from a trial registered in Clinical Trials (https://clinicaltrials.gov; ref: NCT02634372). Clinical variables were gathered through clinical interview, validated scales and a review of case notes. Results: The majority (80.8%) of our sample had experienced a relevant stressful life event prior to onset of BD, over half of our sample 51.9% had a lifetime diagnosis of PTSD according to the Clinician Administered PTSD scale. The mean Impact of Event Scale-Revised scores indicated high levels of trauma-related distress across the sample, including clinical symptoms in the PTSD group and subsyndromal symptoms in the non-PTSD group. Levels of dissociation were not higher than normative values for BD. A PTSD diagnosis (vs. a history of trauma) was associated with psychotic symptoms [2(1) = 5.404, p = 0.02] but not with other indicators of BD clinical severity. There was no significant difference between BD-I and BD-II in terms of lifetime PTSD diagnosis or trauma symptom profile. Sexual abuse significantly predicted rapid cycling [2(1) = 4.15, p = 0.042], while physical abuse was not significantly associated with any clinical indicator of severity. Conclusion: Trauma load in BD is marked with a lack of difference in trauma profile between BD-I and BD-II. Although PTSD and sexual abuse may have a negative impact on BD course, in many indicators of BD severity there is no significant difference between PTSD and subsyndromal trauma symptoms. Our results support further research to clarify the role of subsyndromic PTSD symptoms, and highlight the importance of screening for trauma in BD patients

Revisión bibliográfica sobre el tratamiento de la imagen corporal en trastornos de la conducta alimentaria

Introducción: Una discrepancia entre el yo percibido y el yo ideal puede repercutir en el desarrollo y curso de los trastornos alimentarios, ya que las alteraciones de la Imagen Corporal (IC) encontrada en estos pacientes se consideran un factor de riesgo y conlleva a una persistencia y cronicidad del problema si no se interviene correctamente. Dada la importancia que tiene la IC en los criterios diagnósticos de la Anorexia Nerviosa, Bulimia Nerviosa y Trastorno por Atracón, el objetivo del presente trabajo es realizar una búsqueda bibliográfica sobre los distintos tratamientos que incorporan la IC como componente específico en la intervención con trastornos alimentarios. Metodología: Para la búsqueda de artículos científicos se hizo uso de las bases de datos: Pubmed, EBSCO y Dialnet, y otras fuentes documentales de interés: manuales, Google Académico y la International Journal of Eating Disorders. Se excluyeron los artículos publicados antes del 2000 y los que no incluyeron a población clínica. Resultados: Se seleccionaron un total de 8 artículos científicos. La inclusión de un componente de IC producía una mejora significativa y una remisión total o parcial de la psicopatología alimentaria asociada. Conclusión: Conseguir una mejora y normalización de la IC es clave tanto para la recuperación total como para la prevención de posibles recaídas en los TCA. Sin embargo, aunque los resultados obtenidos resultaban prometedores, eran escasos los estudios y se necesitaba más investigación para encontrar qué tipo de tratamientos son más eficaces para acortar en la mayor medida posible, la enfermedad.Introduction: A discrepancy between the perceived self and the ideal self can have an impact on the development and course of eating disorders, since the alterations of body image (BI) found in these patients are considered a risk factor and lead to a persistence and chronicity of the problem if not properly intervened. Given the importance of BI in the diagnostic criteria of Anorexia Nervosa, Bulimia Nervosa and Binge Disorder, the objective of this work is to conduct a bibliographic search on the different treatments that incorporate the specific component BI in the intervention with eating disorders. Methodology: For the search of scientific articles was made use of the databases: Pubmed, EBSCO and Dialnet, and other documentary sources of interest: manuals, Google Academic and the International Journal of Eating Disorders. Articles published before 2000 and articles that did not include a clinical sample were excluded. Results: A total of 8 scientific articles were selected. The inclusion of an BI component produced a significant improvement and total or partial remission of associated disordered eating. Conclusion: Achieving an improvement and standardization of BI is key both for the total recovery and prevention of possible relapses in the eating disorders. However, while the results are promising, studies are scarce and more research is needed to find which type of treatments are most effective at shortening the disease as much as possible.Psicologí

La entrevista como recurso didáctico. Un proyecto intergeneracional

Treball de Final de Grau en Mestre o Mestra d'Educació Primària. Codi: MP1040. Curs acadèmic 2014-2015El presente TFG muestra la utilización de la entrevista como recurso didáctico en un aula de primaria. En nuestro caso concebimos la entrevista como una herramienta a través de la cual se pueden fomentar las relaciones intergeneracionales entre niños de educación primaria y personas mayores. En primer lugar se ha realizado una revisión bibliográfica sobre el término de “entrevista” para conocer sus definiciones y características. En segundo lugar se ha hecho una búsqueda sobre el concepto de “Programas Intergeneracionales” ya que nuestro trabajo presenta algunas de las características de este tipo de programas. El trabajo consta de 8 sesiones en las cuales se trabaja la entrevista de manera activa y donde los niños son los protagonistas de su aprendizaje. Para poder llevar a cabo la experiencia contamos con 18 alumnos de 3º de Primaria del C.E.I.P Cervantes Dualde de Betxí y 9 alumnos del Centro Público Municipal de Formación de Personas Adultas de la misma localidad. A lo largo de las 8 sesiones se trabajó con los niños y se les preparó para realizar una entrevista a las personas mayores. Los resultados obtenidos a través de los grupos de discusión y la observación, muestran los efectos positivos que tienen estos proyectos tanto para los niños, que estuvieron motivados y participativos desde un principio, como para las personas mayores, las cuales se sintieron valoradas y activas. Aunque no podemos hablar de nuestro proyecto como “Programa Intergeneracional” por no cumplir algunas de sus características se concluye que, tras realizar esta actividad, surge la motivación e iniciativa por parte del claustro por plantear uno en la escuela y mantener las relaciones entre los más pequeños y los más mayores

Identificación del origen de la contaminación fecal en aguas con Bifidobacterium spp. y/o Bacteroides spp. específicas de huéspedes

[spa] El agua es un recurso renovable y fundamental para el sustento y desarrollo de la vida en el planeta. Debido al crecimiento de la población humana junto con la expansión de la actividad industrial, la agricultura y ganadería intensivas y el cambio climático han provocado un gran deterioro en la calidad del agua. La contaminación de origen fecal es una de las fuentes más relevantes de la polución del agua, ya que puede comportar la presencia de microrganismos patógenos, los cuales implican un alto riesgo sanitario y grandes pérdidas económicas. La discriminación del origen de la contaminación fecal es por tanto esencial para la actuación directa sobre la fuente, conocer el impacto y los riesgos derivados de dicha contaminación. Existen diversos métodos para la determinación del origen de la contaminación fecal. En primer lugar los métodos químicos, los cuales consisten en la detección de compuestos como la cafeína o los esteroles y estanoles fecales. En segundo lugar, los métodos microbiológicos (Microbial Source Tracking). Estos están enfocados a encontrar microrganismos capaces de discriminar el origen de la contaminación fecal. Se asume que estos microrganismos están relacionados con la flora gastrointestinal de cada uno de los huéspedes y que son diferentes unos de otros debido a las condiciones intestinales de cada hospedador, a la selección natural, y a que la progenie producida por subsiguientes replicaciones es genéticamente idéntica. Los primeros microrganismos utilizados (E. coli, coliformes fecales, enterococos o clostridios reductores de sulfitos) no eran capaces de determinar el origen contaminante. Por ello se desarrollaron otras metodologías con nuevos indicadores. La primera utilizada para los estudios de MST fueron la determinación de bacteriófagos que infectaban cepas de Bacteroides específicas de huésped (humano, bovino, porcino y aviar). En este primer estudio se comprueba que las cepas seleccionadas para cada origen muestran una alta detección de fagos en las muestras con carga fecal elevada de su mismo origen, no detectando fagos (salvo alguna excepción) en muestras de origen distinto. También identificaron con éxito la fuente contaminante en muestras de agua con carga fecal moderada. En el segundo estudio se diseñaron cuatro sets (cebadores comunes y sondas específicas) de qPCRs específicas de Bifidobacterium asociados a huésped. Se comprobó que los pasos previos de extracción y purificación del ADN de la muestra eran necesarios para su correcto análisis, que cada uno de los sets era capaz de discriminar su origen contaminante sin producirse reacciones cruzadas en aguas tanto de elevada como moderada carga fecal. En el tercer estudio se aplicaron estas técnicas junto con las metodologías de PCR del ADN mitocondrial y una PCR multiplex de Bif. adolescentis y Bif. dentium para la puesta a punto de un programa de aprendizaje inductivo (Ichnaea) capaz de establecer modelos predictivos para su aplicación en muestras ambientales con bajos niveles de contaminación. Para ello se estudiaron tres tipos de muestra: de elevada y moderada carga fecal, donde todos los métodos resultaron efectivos; y de baja carga fecal (canal de riego del Delta del Ebro), donde en muchos casos la diana de las metodologías se encontraba por debajo de su límite de detección. Este programa informático también estableció qué parámetros poseían mayor relevancia según el nivel de la dilución y la antigüedad de la muestra. En el último estudio se diseñó un set de qPCRs específicas de Bacteroides asociados a huésped (a partir de las bandas predominantes del ADN 16S analizadas por DGGE de cada origen fecal). Esta nueva metodología continúa en estudio. La conclusión principal de este trabajo es que no existe una metodología única y universal capaz de discriminar el origen de la contaminación fecal, si no que para una mayor fiabilidad en la discriminación es necesario el análisis conjunto de diversos indicadores y que los programas de aprendizaje inductivo indican cuáles son los más relevantes en cada caso.[eng] Due to the growing human population along with the expansion of industrial activity, intensive agriculture and animal husbandry and climate change have led to a severe deterioration in water quality. Faecal pollution is one of the most important sources of water pollution because it can involve the presence of pathogenic microorganisms, which involve a high health risk and large economic losses. The discrimination of the origin of faecal pollution is so essential for the direct action on the source, knowing the impact and risks of such contamination. There are several methods for determining the source of faecal contamination, such as chemical methods and microbiological methods, which are known as Microbial Source Tracking. MST is focused on finding microorganisms capable of discriminating the source of faecal contamination. The first used microorganisms (E. coli, faecal coliforms, etc.) were not able to determine the contaminant source. Therefore, other methodologies with new indicators were developed. The first study was determining bacteriophages which infect host-specific Bacteroides strains for each faecal origin. They successfully identified the contaminating source in water samples with high and moderate faecal load. In the second study, four sets of qPCRs associated to host-specific Bifidobacterium were designed. It was found that the previous steps of extraction and purification of DNA from the sample were needed for proper analysis; each set was able to discriminate its own origin without crossed-reactions in contaminated water samples with high or moderate faecal load. In the third study, these techniques were applied together with the methodologies of mitochondrial DNA PCR and multiplex PCR of Bif. adolescentis and Bif. dentium for the development of inductive learning program (Ichnaea) able to establish predictive models for use in environmental samples and to establish which parameters showed greater relevance according to the level of dilution and aged pollution. In the last study, four sets of host-specific Bacteroides qPCRs were designed (from the predominant 16S DNA bands analysed by DGGE of each faecal origin). This new methodology is still under study. The main conclusion is that there is no single and universal methodology able to discriminate the origin of faecal pollution. For increased reliability in discriminating, sets of different indicators and their analysis are necessary and that the inductive learning programs indicate which the most relevant ones in each case are

Neuropsychological dysfunction after cardiac surgery. Cerebral saturation and bispectral index: A longitudinal study Disfunción cognitiva después de cirugía cardiaca. Saturación cerebral e índice biespectral: Estudio longitudinal

Background: Neuropsychological dysfunction is a major cause of morbidity and mortality after cardiac surgery. Aim: To evaluate if intraoperative cerebral desaturation and depth of anesthesia measured by bispectral index are related to postoperative cognitive dysfunction in cardiac surgery. Material and Methods: Prospective study in patients undergoing elective cardiac surgery with cardiopulmonary bypass. A comprehensive neuropsychological assessment was applied preoperatively and 3 months after surgery. Postoperative dysfunction was defined as a decrease of at least one standard deviation in two or more neuropsychological tests. Cerebral oxygenation and bispectral index were continuously recorded and corrected throughout surgery. Cerebral oxygenation data were analyzed by the mean value and at three thresholds: 50%, 40% and &lt; 25% of the basal value. Bispectral index was analyzed at threshold of 45. Results: Fifty-six patients were initially enrolled and 48 completed the study. Nine o