Intervención nutricional en niños y adolescentes con fibrosis quística. Relación con la función pulmonar

[email protected]; [email protected];Objetivo: Evaluar los efectos de la intervención nutricional precoz y continuada en pacientes pediátricos con fibrosis quística (FQ) y su posible implicación en la función pulmonar. Pacientes y métodos: Se incluyen el seguimiento de 19 pacientes con FQ (11 niñas, 8 niños) de 17 meses a 18 años de edad y promedio de 10 años de enfermedad. El genotipo de 16 pacientes es delta F 508 (10 homo, 6 heterocigotos). Cada 2-3 meses se les ha realizado: valoración clínica, dietética y antropométrica clasificando el estado de nutrición (EN) según Z pesto/talla, % peso para la talla, índice de masa corporal y Z talla/edad. Coincidentemente se obtuvo cultivo de secreciones respiratorias y espirometría; y anualmente determinaciones bioquímicas, hematológicas y de heces. La intervención nutricional incluyó: recomendaciones dietéticas, nutrición enteral (NE) oral o invasiva y tratamiento farmacológico con ezimas pancreáticos, vitaminas liposolubles, minerales y oligoelementos. Resultados y comentarios: La mayoría experimentaron mejoría antropométrica resultando significativa para el peso, relaciónpeso/talla y pliegue tricipital (p < 0,05). La puntuación Z se ha mantenido estable. Dieciséis pacientes (84%) han desarrollado insuficiencia pancreática exocrina y 3 (16%) intolerancia a la glucosa. Catorce (73%) se han colonizado por Pseudomonas aeuroginosa. Los valores promedio de la última espirometría fueron: FVC (%) 85,4 ± 18,6 y FEV1 (%) 85,9 ± 24,1 encontrándose unc orrelación positiva significativa entre el % del peso para la talla y FVC (coef 0,552, p = 0,022) y con FEV1 (coef. 0,625; p = 0,007). El 79% han requerido algún tipo de apoyo nutritional: 3 casos (16%) NE invasiva y el resto tratamiento con NE oral. Conclusiones: Sin soporte nutricional muchos pacientes con FQ no parecen cubrir su requerimientos. La monitorización del EN permite la actuación precoz y efectiva. Se demuestra una correlación estrecha entre el estado de nutrición y la función pulmonar.Objective: To assess the effects of early and continuous nutritional intervention in pediatric patients with cystic fibrosis (CF) and its possible implication in pulmonary function. Patients and methods: Included is the follow-up of 19 patients with CF (11 female and 8 male children), from 17 months to 18 years of age, and a mean disease duration of 10 years. Genotype from 16 patients is delta F 508 (10 homozygotic, 6 heterozygotic). The following items have been performed every 2-3 months: clinical, dietary and anthropometrical assessment, classifying nutritional status (NS) by Z scores of weight/height, % of weight to height, body mass index, and Z scores of height/age. Concurrently, respiratory secretions culture and spirometry were obtained; and annually, biochemistry, hematologic and feces determinations. Nutritional intervention included: dietary recommendations, oral or invasive enteral nutrition (EN) and pharmacologic treatment with pancreatic enzymes, fat-soluble vitamins, minerals and oligoelements. Results and commentaries: Most of them experienced anthropometrical improvement being significant for weight, the relationship of weight/height and the tricipital fold (p < 0.05). The Z score for height has remained steady. Sixteen patients (84%) have developed exocrine pancreatic failure, and 3 (16%) glucose intolerance. Fourteen (73%) have been colonized by Pseudomonas aeruginosa. Last mean spirometry values were: FVC (%) 85.4 ± 18.6 and FEV1 (%) 85.9 ± 24.1, with a significant correlation between % of weight to height and FVC (coefficient 0.552, p = 0.022) and FEV1 (coefficient 0.625, p = 0.007). Seventy nine percent have required some sort of nutritional support: 3 cases (16%) invasive EN, and the remaining oral EN. Conclusions: Without nutritional support, many patients with CF do not seem to meet their demands. EN monitoring allows for and early and effective intervention. A close correlation has been demonstrated between nutritional status and pulmonary function

The Qualitative Scoring MMSE Pentagon Test (QSPT): A New Method for Differentiating Dementia with Lewy Body from Alzheimer's Disease

The differential diagnosis across different variants of degenerative diseases is sometimes controversial. This study aimed to validate a qualitative scoring method for the pentagons copy test (QSPT) of Mini-Mental State Examination (MMSE) based on the assessment of different parameters of the pentagons drawing, such as number of angles, distance/intersection, closure/opening, rotation, closing-in, and to verify its efficacy to differentiate dementia with Lewy Body (DLB) from Alzheimer's disease (AD). We established the reliability of the qualitative scoring method through the inter-raters and intra-subjects analysis. QSPT was then applied to forty-six AD and forty-six DLB patients, using two phases statistical approach, standard and artificial neural network respectively. DLB patients had significant lower total score in the copy of pentagons and number of angles, distance/intersection, closure/opening, rotation compared to AD. However the logistic regression did not allow to establish any suitable modeling, whereas using Auto-Contractive Map (Auto-CM) the DLB was more strongly associated with low scores in some qualitative parameters of pentagon copying, i.e. number of angles and opening/closure and, for the remaining subitems of the MMSE, in naming, repetition and written comprehension, and for demographic variables of gender (male) and education (6–13 years). Twist system modeling showed that the QSPT had a good sensitivity (70.29%) and specificity (78.67%) (ROC-AUC 0.74). The proposed qualitative method of assessment of pentagons copying used in combination with non-linear analysis, showed to be consistent and effective in the differential diagnosis between Lewy Body and Alzheimer's dementia

Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session

[EN] Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p < 0.001) and systolic blood pressure (6.25 (0.04,12.47) mmHg; p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability.Funding included a research project (PID2019-108814RA-I00) supported by the Spanish Government 'Ministerio de Ciencia e Innovacion', a research prize awarded by the nonprofit organization Fundacion Renal Tomas de Osma, as well as from a research grant (IDOC 17-19 and PPC14/2017) awarded by the Universidad Cardenal Herrera CEU.García-Testal, A.; Martínez-Olmos, FJ.; Gil-Gómez, J.; López-Tercero, V.; Lahoz-Cano, L.; Hervás-Marín, D.; Cana-Poyatos, A.... (2023). Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session. Healthcare. 11(1). https://doi.org/10.3390/healthcare1101007911

Pla de Movilitat Urbana Sostenible en el municipi de Alberic (Valencia)

[ES] El objetivo del TFG es la redacción de un Plan de Movilidad Urbana Sostenible (PMUS) en el municipio de Alberic (Valencia). Para ello, se detectará la problemática existente en el municipio, centrando el análisis en el núcleo urbano, con el objetivo de implementar formas de desplazamiento más sostenibles en el espacio urbano, mejorando así la movilidad y la calidad de vida de los habitantes del municipio. Para realizarlo se hará uso de la Ley 6/2011, de 1 de abril, de Movilidad de la Comunitat Valenciana y Agenda Urbana Española. Conforme al diagnostico obtenido, se pretende al final realizar una serie de propuestas para conseguir el Objetivo 11: "Ciudades y Comunidades Sostenibles" de los Objetivos de Desarrollo Sostenible (ODS) de la Agenda 2030 y en definitiva una movilidad más sostenible en Alberic.[EN] The objective of this project is the drafting of a Sustainable Urban Mobility Plan (PMUS) in the municipality of Alberic (Valencia). To do this, the existing problems in the municipality will be detected, focusing the analysis on the urban core, with the aim of implementing more sustainable forms of travel in the urban space, thus improving mobility and the quality of life of the inhabitants of the municipality. In order to do this, we will make use of Law 6/2011, of 1 April, on Mobility of the Valencian Community and the Spanish Urban Agenda. According to the diagnosis obtained, the final aim is to make a series of proposals to achieve Goal 11: ''Sustainable Cities and Communities'' of the Sustainable Development Goals (SDGs) of the 2030 Agenda and ultimately a more sustainable mobility in Alberic.Vidal Maset, L. (2022). Plan de Movilidad Urbana Sostenible en el municipio de Alberic (Valencia). Universitat Politècnica de València. http://hdl.handle.net/10251/183907TFG

The Qualitative Scoring MMSE Pentagon Test (QSPT): A New Method for Differentiating Dementia with Lewy Body from Alzheimer’s Disease

The differential diagnosis across different variants of degenerative diseases is sometimes controversial. This study aimed to validate a qualitative scoring method for the pentagons copy test (QSPT) of Mini-Mental State Examination (MMSE) based on the assessment of different parameters of the pentagons drawing, such as number of angles, distance/intersection, closure/opening, rotation, closing-in, and to verify its efficacy to differentiate dementia with Lewy Body (DLB) from Alzheimer's disease (AD). We established the reliability of the qualitative scoring method through the inter-raters and intra-subjects analysis. QSPT was then applied to forty-six AD and forty-six DLB patients, using two phases statistical approach, standard and artificial neural network respectively. DLB patients had significant lower total score in the copy of pentagons and number of angles, distance/intersection, closure/opening, rotation compared to AD. However the logistic regression did not allow to establish any suitable modeling, whereas using Auto-Contractive Map (Auto-CM) the DLB was more strongly associated with low scores in some qualitative parameters of pentagon copying, i.e. number of angles and opening/closure and, for the remaining subitems of the MMSE, in naming, repetition and written comprehension, and for demographic variables of gender (male) and education (6–13 years). Twist system modeling showed that the QSPT had a good sensitivity (70.29%) and specificity (78.67%) (ROC-AUC 0.74). The proposed qualitative method of assessment of pentagons copying used in combination with non-linear analysis, showed to be consistent and effective in the differential diagnosis between Lewy Body and Alzheimer’s dementia

Occupational therapy integrated with a self-administered stretching program on systemic sclerosis patients with hand involvement

Objective. To evaluate the effect of occupational therapy (OT) intervention, integrated with a self-administered stretching program on the hands of patients with SSc, after one and three months of treatment. Methods. We enrolled 31 patients with SSc, randomly allocated to the occupational group (15 patients) or to the control group (16 patients). Each patient received specific outcome measures: Canadian Occupational Performance Measure (COPM), HAQ, Short-Form Health Survey (SF-36), Duruoz Hand Index (DHI), reassessed after 1 (T1) and three months (T2). Results. At T1 and T2 we found a statistically significant improvement from baseline values of COPM Performance and COPM Satisfaction in the OT group compared to baseline. At T2 HAQ values and Mental SF36 were also significantly improved. In the control group we found a statistically significant improvement of HAQ values and Mental SF36 at T1, confirmed at T2. COPM Performance was also significantly improved. The comparison between the two groups showed a greater improvement in the OT group concerning COPM Performance at T1 and T2. Mental SF-36 score greater improved in the control group at T1. Conclusion. Our results indicate that a rehabilitation program including OT and self-administered stretching exercises may be effective to improve and maintain hand function in patients with SSc

Hemodynamic Tolerance of Virtual Reality Intradialysis Exercise Performed during the Last 30 Minutes versus the Beginning of the Hemodialysis Session

Background: Exercise improves the physical function of people suffering from chronic kidney disease on hemodialysis (HD). Virtual reality is a new type of intradialysis exercise that has a positive impact on physical function. Intradialysis exercise is recommended during the first 2 h, but its safety in the last part of the dialysis session is unknown. Methods: This was a pilot sub-study of a clinical trial. Several hemodynamic control variables were recorded, including blood pressure, heart rate, and intradialytic hypotensive events. These variables were recorded during three different HD sessions, one HD session at rest, another HD session with exercise during the first two hours, and one HD session with exercise during the last 30 min of dialysis. The intradialysis virtual reality exercise was performed for a maximum of 30 min. Results: During exercise sessions, there was a significant increase in heart rate (6.65 (4.92, 8.39) bpm; p p < 0.05). There was no difference in hemodynamic control between the sessions with exercise during the first two hours and the sessions with exercise during the last 30 min. There was no association between intra-dialytic hypotensive events at rest (five events) or exercise at any point (two vs. one event(s), respectively). Conclusion: performing exercise with virtual reality at the end of a hemodialysis session is not associated with hemodynamic instability

Orientación educativa : procesos de innovación y mejora de la enseñanza

Resumen basado en el de la publicaciónSe aborda el papel del orientador en los procesos de innovación educativa y mejora. Como asesores psicopedagógicos, los orientadores desempeñan un papel importante en el impulso de estos procesos. Se ofrecen un conjunto de criterios y propuestas que definen dicho papel, entre las que se encuentran: el desarrollo de una enseñanza funcional y orientada a la adquisición de competencias, la mejora de la convivencia y el clima escolar, la utilización educativa de la tecnologías digitales, la transformación de las aulas en espacios de aprendizaje cooperativo, el trabajo conjunto del profesorado en procesos de docencia compartida, o la puesta en marcha de procesos de reflexión y mejora a partir de la evaluación de la calidad de la enseñanza en los centros.CataluñaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 planta; 28014 Madrid; Tel. +34917748000; [email protected]

Performance of the preliminary classification criteria for cryoglobulinaemic vasculitis and clinical manifestations in hepatitis C virus-unrelated cryoglobulinaemic vasculitis

Background: Cryoglobulinaemic vasculitis (CV) is often related to hepatitis C virus (HCV) infection, but it can develop in other diseases (e.g. other infections, connective tissue diseases, malignancies) in the absence of HCV infection. A comparison of the performance of the recently published classification criteria for the CV was made between HCV-positive and HCV negative patients with serum cryoglobulins. Patient and methods: 500 patients with serum cryoglobulins were studied. Their mean age was 60.77±13.75 years, they were 356 females (71.2%) and 144 males (28.8%). CV was diagnosed in 272 patients (54.4%), while other diseases associated with serum cryoglobulins without CV (CwV) were diagnosed in 228 patients (45.6%). Results: 117 HCV negative patients were collected (23.4%) and they were 42/272 (15.4%) among the CV group, while they were 75/228 (32.9%) among the CwV. In HCV negative patients the sensitivity and specificity of the classification criteria of CV were 89.5% CI 95% [79.5-99.5] and 90.3% CI 95% [82.8-97.8], respectively, while in HCV positive patients they were 88.3% CI 95% [83.6%-93.1%] and 96.1% CI 95% [91.8-100], respectively. The most frequent disease recognised among the HCV negative patients was Sjögren's syndrome (SS) (55/117, 47.0%), and the sensitivity and the specificity of the CV classification criteria were 88.9% CI 95% [76.5-100] and 91.3% CI 95% [79.2-100], respectively. Conclusions: The classification criteria for CV showed a good performance even in HCV-unrelated patients. A slightly lower specificity was observed for the classification of HCV-unrelated CV, since some clinical manifestations included in the clinical item for the classification criteria occurred more frequently in HCV-negative rather than HCV-positive controls with CWV. © Clinical and Experimental Rheumatology 2012.SCOPUS: ar.jinfo:eu-repo/semantics/publishe