Repercusión del ejercicio terapéutico en la mulculatura multífida en pacientes con dolor lumbar: una revisión bibliográfica

[Resumo] Introdución: A dor lumbar é un problema de saúde común, que provoca limitación nas actividades da vida diaria e ausencia no traballo, causando gastos económicos nos individuos. Na estabilidade e mobilidade desta rexión, xoga un papel primordial a musculatura multífida, polo que unha disfunción nestes músculos pode provocar a aparición ou a recorrencia dos problemas mecánicos de costas. Esta sintomatoloxía soe desaparecer en poucos días ou semanas coa aplicación dos tratamentos convencionais, nos que o exercicio terapéutico é a terapia con maior evidencia científica para a abordaxe deste tipo de pacientes. Obxectivo: Determinar a repercusión do exercicio terapéutico na musculatura multífida en pacientes con dor lumbar. Material e métodos: Realízase unha búsqueda nas bases de datos Cochrane Library, Pubmed, Scopus, SportDiscuss e PEDro, nos últimos 5 anos, os cales deben abordar a repercusión do exercicio terapéutico sobre os músculos multífidos en pacientes con dor lumbar. Esta revisión bibliográfica estuda as variables grosor da musculatura multífida, activación e fatiga muscular. Resultados: Analízanse un total de 13 estudos, 12 ensaios clínicos e 1 estudo piloto; observando diversos cambios na musculatura multífida en 12 deles: un aumento da área de sección transversal (CSA), un incremento da súa activación ou unha diminución da fatiga muscular. Conclusións: O exercicio terapéutico provoca un aumento no grosor e/ou na activación dos músculos multífidos, así como una diminución da fatiga muscular. O método máis empregado para avaliar esta musculatura é a ecografía, seguido da electromiografía (EMG) e por último da tomografía computorizada (TC). Os exercicios empregados con maior frecuencia e que obteñen mellores resultados, son os de estabilización lumbar.[Abstract] Background: The low back pain (LBP) is a problem of common health, which causes limitation in the activities of the daily life and absence in the work, causing economic costs to the individuals. In the stability and mobility of this region, it plays a paramount paper to muscles multifidus, by the that, a dysfunction in these muscles it can cause the apparition or the recurrence of the mechanical problems of the back. This symptomatology usually disappears in a few days or weeks, with the application of the conventional treatments, in which therapeutic exercise is the therapy with the greatest scientific evidence for the treatment of this type of patient. Objetive: To determinate the repercussion of the therapeutic exercise in the muscles multifidus in patients with LBP. Methods: A search is realized in the databases Cochrane Library, Pubmed, Scopus, SportDiscuss and PEDro, in the last 5 years, which must approach the repercussion of the therapeutic exercise on the muscles multifidus. This bibliographic review studies the variables thickness of the muscles multifidus and the muscular activation. Outcomes: Analyse a total 13 studies, 12 clinical essays and 1 pilot study; observing diverse changes in the muscles multifidus in 12 of them: an increase of the area of transversal section (CSA), an increase of this activation or a decrease of the muscular fatigue. Conclusions: The therapeutic exercise causes an increase in the thickness and in the activation of the muscles multifidus. The method most used to evaluate this musculature is the ulstrasound, followed by the electromiography (EMG) and finally of the computed tomography (TC). The exercises used with major frequency and they get better results, are those of lumbar stabilization.[Resumen] Introducción: El dolor lumbar es un problema de salud común, que provoca limitación en las actividades de la vida diaria y ausencia en el trabajo, causando gastos económicos en los individuos. En la estabilidad y la movilidad de esta región, juega un papel primordial la musculatura multífida, por lo que, una disfunción de estos músculos puede provocar la aparición o la recurrencia de los problemas mecánicos de espalda. Esta sintomatología suele desaparecer en pocos días o semanas, con la aplicación de los tratamientos convencionales, en los que, el ejercicio terapéutico es la terapia con más evidencia científica para el abordaje de este tipo de pacientes. Objetivos: Determinar la repercusión del ejercicio terapéutico en la musculatura multífida en pacientes con dolor lumbar. Material y métodos: Se realiza una búsqueda en las bases de datos Cochrane Library, Pubmed, Scopus, SportDiscuss y PEDro, en los últimos 5 años, los cuales deben abordar la repercusión del ejercicio terapéutico sobre los músculos multífidos. Esta revisión bibliográfica estudia las variables grosor de la musculatura multífida y la activación muscular. Resultados: Se analizan un total 13 estudios, 12 ensayos clínicos y 1 estudio piloto; observando diversos cambios en la musculatura multífida en 12 de ellos: un aumento del área de sección transversal (CSA), un incremento de su activación o una disminución de la fatiga muscular. Conclusiones: El ejercicio terapéutico provoca un aumento en el grosor y/o en la activación de los músculos multífidos. El método más empleado para evaluar esta musculatura es la ultrasonografía, seguido de la electromiografía (EMG) y por último de la tomografía computorizada (TC). Los ejercicios empleados con mayor frecuencia y que obtienen mejores resultados, son los de estabilización lumbar.Traballo fin de grao (UDC.FCS). Fisioterapia. Curso 2017/201

Evaluación y detección precoz del uso problemático de Internet entre adolescentes

Background:Problematic Internet use in adolescents has become an issue of concern for a growing number of researchers and institutions over the past years. Behavioural problems, social isolation, school failure and family problems are some of the consequences of psychological and behavioural impact on teenagers. Taking into account the interest that this issue has generated at many levels, the aim of this paper is to develop a screening tool for early detection of problematic Internet use in teenagers. Method: A survey of Compulsory Secondary School students from Galicia involving a total of 2,339 individuals was carried out. Results: The results obtained allow (1) gauging the magnitude of the problem, establishing the risk levels among the adolescents, and (2) presenting a new, simple and short screening instrument. Conclusions: The present scale has sufficient theoretical and empirical support, including good psychometric properties (a = .83; specificity = .81; sensitivity = .80; ROC curve = .90), making it an interesting applied toolAntecedentes: el uso problemático de Internet entre los adolescentes preocupa cada vez más a investigadores e instituciones. Problemas de conducta, aislamiento social, fracaso escolar y problemas familiares son algunas de las consecuencias del impacto a nivel psicológico y conductual que ello produce. Habida cuenta del interés que el tema suscita a diferentes niveles, el objetivo de este trabajo es desarrollar una herramienta de screening para la detección precoz de uso problemático de Internet entre adolescentes. Método: se realizó una encuesta a escolares de Enseñanza Secundaria Obligatoria de la comunidad gallega, en la que participaron un total de 2.339 individuos. Resultados: los resultados obtenidos permiten: (1) evaluar la magnitud del problema, permitiendo conocer los niveles de riesgo existente, y (2) presentar un nuevo instrumento de screening o cribado, breve y sencillo. Conclusiones: la presente escala cuenta con suficiente aval teórico y empírico y con unas buenas propiedades psicométricas (a = ,83; especificidad = ,81; sensibilidad = ,80; Curva COR = ,90), lo cual la convierte en una herramienta de interés a nivel aplicadoS

Meningococcal group B vaccine for the prevention of invasive meningococcal disease caused by Neisseria meningitidis serogroup B

Invasive meningococcal disease (IMD) is a major public health concern because of its high case fatality, long-term morbidity, and potential to course with outbreaks. IMD caused by Nesseira meningitidis serogroup B has been predominant in different regions of the world like Europe and only recently broadly protective vaccines against B serogroup have become available. Two protein-based vaccines, namely 4CMenB (Bexsero®) and rLP2086 (Trumenba®) are currently licensed for use in different countries against MenB disease. These vaccines came from a novel technology on vaccine design (or antigen selection) using highly specific antigen targets identified through whole-genome sequence analysis. Moreover, it has the potential to confer protection against non-B meningococcus and against other Neisserial species such as gonococcus. Real-world data on the vaccine-use are rapidly accumulating from the UK and other countries which used the vaccine for control of outbreak or as part of routine immunization program, reiterating its safety and efficacy. Additional data on real-life effectiveness, long-term immunity, and eventual herd effects, including estimates on vaccine impact for cost-effectiveness assessment are further needed. Given the predominance of MenB in Europe and other parts of the world, these new vaccines are crucial for the prevention and public health control of the disease, and should be considered.S

Development and Validation of a New Clinical Scale for Infants with Acute Respiratory Infection: The ReSVinet Scale

Background and Aims A properly validated scoring system allowing objective categorization of infants with acute respiratory infections (ARIs), avoiding the need for in-person assessment and that could also be used by non-health professionals is currently not available. We aimed to develop a new clinical assessment scale meeting these specifications. Methods We designed a clinical scale (ReSVinet scale) based on seven parameters (feeding intolerance, medical intervention, respiratory difficulty, respiratory frequency, apnoea, general condition, fever) that were assigned different values (from 0 to 3) for a total of 20 points.170 children under two years of age with ARI were assessed independently by three pediatricians using this scale. Parents also evaluated their offspring with an adapted version of the scale in a subset of 61 cases. The scale was tested for internal consistency (Cronbach’s alpha), Pearson correlation coefficient for the items in the scale, inter-observer reliability (kappa index) and floor-ceiling effect. Results Internal consistency was good for all the observers, with the lowest Cronbach’s alpha being 0.72. There was a strong correlation between the investigators (r-value ranged 0.76–0.83) and also between the results obtained by the parents and the investigators(r = 0.73). Light’s kappa for the observations of the three investigators was 0.74. Weighted kappa in the group evaluated by the parents was 0.73. The final score was correlated with length of hospital stay, PICU admission and Wood-Downes Score. Conclusions The ReSVinet scale may be useful and reliable in the evaluation of infants with ARI, particularly acute bronchiolitis, even with data obtained from medical records and when employed by parents. Although further studies are necessary, ReSVinet scale already complies with more score validation criteria than the vast majority of the alternatives currently available and used in the clinical practiceThis work was supported by the Spanish Government (Research Program Health Research Fund – [http://www.gendres.org] (FIS; PI10/00540 y PI13/02382) National Plan I + D + I and FEDER funds) and Regional Galician funds (Promotion of Research Project 10 PXIB 918 184 PR) (FMT), and Ministerio de Ciencia e Innovación (SAF2011-26983) and the Plan Galego IDT, Xunta de Galicia (EM 2012/045) (AS). MC’s research activities have been supported by grants from Instituto de Investigación Sanitaria de Santiago de Compostela. FMT’s research activities have been supported by grants from Instituto Carlos III (Intensificación de la actividad investigadora- ISCIII/INT14/00245/ Cofinanciado FEDER), Spanish National Plan I + D + i and FEDER funds. Investigators received funding from the European Union’s Seventh Framework Program under ECGA no. 279185 (EUCLIDS – [http://www.euclids-project.eu]) during the production of this paper. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscriptS

¿Se vacunaría con Janssen o AstraZeneca? Ocho expertos tienen clara la respuesta

La aparición de raros cuadros de trombos con plaquetas bajas en personas vacunadas contra la covid-19 con las soluciones de Janssen y AstraZeneca ha provocado que varios gobiernos hayan pausado las campañas o restringido los rangos de edad, lo que ha creado desconcierto y temor entre la población. Muchas personas ya han recibido la primera dosis y no saben cuándo van a recibir la segunda. Otras rechazan ponerse alguna de estas vacunas. Hemos sondeado a varios de los principales especialistas en epidemiología, inmunología, vacunología, virología y salud pública para preguntarles directamente qué harían ellos: ¿se vacunarían con las de Janssen y AstraZeneca

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

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

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2