Valor diagnóstico y pronóstico de la evaluación de la capa de fibras nerviosas de la retina en la esclerosis múltiple

Introducción: El tema principal de las cuatro publicaciones internacionales que componen esta tesis doctoral se centra en el estudio de la capa de fibras nerviosas de la retina en pacientes con esclerosis múltiple como método para mejorar y acelerar el proceso diagnóstico así como el seguimiento y la monitorización de esta enfermedad. Material y Métodos: Se realizó un estudio observacional y prospectivo donde se incluyeron 150 sujetos con esclerosis múltiple y 150 sujetos sanos. El protocolo exploratorio se realizó de modo coordinado entre oftalmología, neurofisiología y neurología y constó de tres tipos de pruebas: una exploración oftalmológica completa; una exploración neurofisiológica, que incluyó los potenciales evocados visuales (PEV); y una exploración neurológica que incluyó la valoración neurológica. Se analizaron las diferencias en los distintos parámetros entre sujetos sanos y pacientes con esclerosis múltiple, y entre pacientes con antecedente de neuritis óptica y sin el antecedente de la misma. Conclusiones: El análisis de la capa de fibras nerviosas de la retina es un buen biomarcador de la degeneración axonal progresiva que se produce en la esclerosis múltiple y es útil para evaluar la progresión de la enfermedad y la eficacia de los tratamientos en la protección de la degeneración axonal. La función lineal discriminante que combina varios espesores de la capa de fibras nerviosas de la retina mejora la capacidad de la tomografía de coherencia óptica Spectralis para detectar esclerosis múltiple y distinguir entre ojos con antecedente y sin antecedente de neuritis óptica. La técnica estadística de redes neuronales artificiales puede identificar correctamente un alto porcentaje de sujetos con esclerosis múltiples y permite clasificar aquellos ojos que han presentado antecedente de neuritis ópticas, con mayor precisión diagnóstica que cualquier parámetro aislado de la capa de fibras nerviosas de la retina obtenido a partir de la tomografía de coherencia óptica La representación del espesor de la capa de fibras nerviosas de la retina utilizando el modelo de geometría en tres dimensiones nos permite observar la distribución del daño axonal en pacientes con esclerosis múltiple con una mayor afectación del sector temporal, especialmente en aquellos pacientes con neuritis óptica previa

Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial

Mat complBackground: Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult’s population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown efectiveness for reducing fall rates, evidence around their puta‑ tive cumulative efects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the efectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up. Methods: This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥1 criteria of the Frailty Phenotype) older adults (≥75 years) with high risk of falling (defned by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and fexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, efects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated. Discussion: This trial will provide new evidence about the efectiveness of an individualized multidomain interven‑ tion by studying the efect of additive efects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive efects in the reduction of the incidence of falls and associated adverse outcomes. Trial registration: NCT04911179 02/06/2021. © 2022, The Author(s).The present study is funded by a grant from the Spanish Ministry of Science and Innovation and the Instituto de Salud Carlos III (PI20/01546). Instituto de Salud Carlos III, PI20/01546, Alvaro Casas-Herrer

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Choroidal Hyperreflective Nodules Detected by Infrared Reflectance Images Are a Diagnostic Criterion for Neurofibromatosis Type 1 Patients Excluding Those with High Myopia

Neurofibromatosis type 1 (NF1) is one of the central nervous system’s most common autosomal dominant conditions. The diagnosis is based on the clinical diagnostic criteria and/or a molecularly confirmed mutation in the NF1 gene. This study investigated the possibility of substantiating choroidal nodules as a diagnostic criterion for the disease, including patients affected with and without high myopia. A cross-sectional study was carried out in 60 eyes of 30 adult patients diagnosed with NF1. A total of 30 healthy individuals of equivalent age and sex served as control. The Spectralis HRA+OCT MultiColor (Heidelberg Engineering GmbH, Heidelberg, Germany) evaluated the presence of choroidal abnormalities with near-infrared reflectance imaging. Secondly, the presence of iridian Lisch nodules was evaluated by slit lamp examination. Near-infrared reflectance imaging showed the presence of choroidal hyperreflective nodules in 83% of the patients diagnosed with NF1, while these choroidal abnormalities were not observed in any control subject. The patients diagnosed with NF1 associated with high myopia were the only ones who did not present the characteristic choroidal disorders. Therefore, when excluding patients diagnosed with high myopia, choroidal nodules were more frequent than Lisch nodules in a statistically significant proportion. Hyperreflective nodules detected by near-infrared reflectance imaging are as regular as Lisch nodules or even significantly more frequent when excluding high myope patients. Our observation of the mutual exclusion of choroidal hyperreflective nodules and high myopia in the NF1 patients seems a novel and interesting remark

Correction: Effect of a multicomponent exercise program and cognitive stimulation (VIVIFRAIL-COGN) on falls in frail community older persons with high risk of falls: study protocol for a randomized multicenter control trial

Correction: BMC Geriatrics 22, 612 (2022)After publication of this article [1], the authors reported that the statement in the Funding information section was incorrectly given as ’The present study is funded by a grant from the Spanish Ministry of Science and Innovation and the Instituto de Salud Carlos III (PI20/01546).’ and should have read ’The present study is funded by a grant from the Spanish Ministry of Science and Innovation and the Instituto de Salud Carlos III (PI20/01546), co-financed by FEDER funding’. The original article [1] has been corrected.1 págin