Efecto de las ortesis plantares realizadas a medida versus ortesis plantares amortiguadoras realizadas sin molde en pacientes con artritis reumatoide. Ensayo clínico aleatorio

Introducción: La artritis reumatoide (en adelante, AR) afecta entre un 0,3-1,5 % del total de la población mundial. La afectación del pie se da en más del 85 % de todas las personas con AR y se relaciona con deformidades en antepié y retropié valgo. Se han realizado diversos estudios para comprobar el efecto de las ortesis plantares en pacientes con AR y sintomatología dolorosa en los pies. Los resultados de los mismos son contradictorios. Los objetivos de esta investigación son comprobar el efecto de las ortesis plantares realizadas a medida versus las ortesis plantares amortiguadoras realizadas sin molde sobre el dolor y la función del pie y en la calidad de vida en pacientes con AR. Pacientes y métodos: Se trata de un ensayo clínico aleatorio que se llevó a cabo en la Universidad de Sevilla y de A Coruña entre enero de 2016 y febrero de 2018. Previa firma del consentimiento informado, se comprometen a utilizar un calzado fisiológico y las ortesis plantares asignadas durante 7 días/semana, 8 horas como mínimo, durante 3 meses. Se asignaron aleatoriamente a uno de los grupos de estudio: Grupo A Experimental (soporte plantar con una cubierta de Rovalfoam® de media densidad, polipropileno de 2 mm retrocapital, refuerzo en talón de etil vinil acetato de 5 mm de alta densidad y cresta subdigital de Rovalfoam® de media densidad) y Grupo B Control (soporte plantar confeccionado con Rovalfoam® de 5 mm de grosor de media densidad sin adaptar). El Cuestionario de Salud SF-12, la Escala Visual Analógica del Dolor (EVA) autoadministrado, el Cuestionario de Manchester Modificado y el Foot Function Index (FFI) se administran en la primera visita y en la última revisión (a los 3 meses).Resultados: La muestra inicial está formada por un total de 68 pacientes con AR; el 50 % el grupo A y el 50 % el grupo B. Hay una pérdida de 15 pacientes, lo que supone un 22,1 % del total; 7 (20,6 %) del grupo A y 9 (26,5 %) del grupo B. La muestra final está compuesta por 53 pacientes; 28 (52,8 %) del grupo A y 25 (47,2 %) del grupo B. En ambos grupos hay una mejoría con respecto al dolor y la función del pie; esta mejoría no se refleja en la calidad de vida. Al comparar los valores iniciales y finales, en el grupo experimental existe una diferencia estadísticamente muy significativa respecto a la escala EVA y en el FFI (dolor y total); y una diferencia estadísticamente significativa respecto a los días de dolor, FFI discapacidad y en el cuestionario de Manchester Modificado Total. En el grupo control no existe diferencia estadísticamente significativa en los distintos cuestionarios, salvo en los días de dolor. Conclusiones: Las ortesis plantares hechas a medida y las amortiguadoras realizadas sin molde tienen un efecto positivo en el dolor y la función del pie en pacientes con AR. Este efecto es mayor con las ortesis hechas a medida. Ambos tratamientos no presentan beneficios en la calidad de vida de estos pacientes

Estudio descriptivo de los pacientes asistidos en el servicio de Pie de Riesgo del Área Clínica de Podología de la Universidad de Sevilla

El Área Clínica de Podología de la Universidad de Sevilla cuenta entre sus servicios con la Unidad de Pie de Riesgo. Donde se presta atención podológica integral a pacientes con lesiones podológicas o riesgo de padecerlas por enfermedades sistémicas que comprometen especialmente las funciones neurológicas y vasculares del pie, en especial la Diabetes. En el año 2012 se atendieron en este servicio un total de 117 pacientes. Se realiza un estudio descriptivo longitudinal retrospectivo de los principales datos registrados en las Historias clínicas de estos pacientes. Hay muchas variables que no están registradas en las Historias clínicas. Se propone la utilización de un registro especíi co para este servicio para intentar mejorar el grado de implementación de la Historia clínica.The Podiatry Clinic at the University of Seville among its services with risk foot unit. Where comprehensive podiatric care is provided to patients with podiatric injury or risk of suffering from systemic diseases especially involving neurological and vascular functions of the foot, especially diabetes. In 2012 this service was attended by a total of 117 patients. We performed a descriptive longitudinal retrospective study of the main data recorded in the medical records of these patients. There are many variables that are not recorded in medical records. We propose the use of a specii c register for this service to try to improve the level of implementation of the clinical history

Psychosocial Influence of Ehlers–Danlos Syndrome in Daily Life of Patients: A Qualitative Study

Ehlers–Danlos syndrome is a heterogeneous group of connective tissue disorders causing pain, fatigue, and disabilities; it has several implications for patients who suffer from this disease. The major clinical manifestations of EDS include joint hypermobility, skin hyperextensibility, and generalized conjunctive tissue fragility. This research aims to explore their perceptions and experiences about the phycological and social spheres. (2) Methods: Semistructured interviews were carried out. Participants were encouraged to talk about issues related to their disease by asking open-ended questions in one to one interview. The interview guide included questions to identify the syndrome’s influence on the social and psychological life of patients All interviews were audio recorded, fully transcribed, and analyzed using the phenomenological theoretical framework. The method of analysis was the thematic interpreting of perspectives and approaches. (3) Results: 31 individuals were proposed to participate in this study. Five patients refused to participate, so a total of 26 interviews were performed. Six themes ((1) Pain and its consequences on a daily basis; (2) The need to name the problem: the diagnosis; (3) Restructuring leisure and social relationships; (4) Limitations due to economic conditions; (5) Psychological impact of the disease situation; (6) Professional limitations) and four subthemes ((1) The value of partner support; (2) The weather influence on social plans; (3) Physical exercise and illness; (4) Support groups) emerged from the data. (4) Conclusions: This study revealed the impact of the syndrome on the social and daily life of patients, and not only in a physical level, but also in a psychological and social approach. These findings allow healthcare providers to know more about this disease in order to support and give advice to patients about the changes they will have to make.University of Seville “VI PLAN PROPIO DE INVESTIGACIÓN Y TRANSFERENCIA—US 2018

Custom-made foot orthoses reduce pain and fatigue in patients with Ehlers-Danlos Syndrome. A pilot study

Background: Pain and fatigue are major clinical manifestations in patients with Ehlers-Danlos Syndrome (EDS). The aim of this study is to measure change of the effects of custom-made foot orthotics on some manifestations related to EDS, such as foot pain, foot functionality, fatigue, and quality of life. Methods: Thirty-six patients with EDS wore foot orthoses for three months. Foot pain, foot-related disability, foot functionality, fatigue, and quality of life were measured using the 11-point Numeric Rating Scale, the Manchester Foot Pain and Disability Index, the Foot Function Index, the Fatigue Severity Score, and the 12-Item Short Form Health Survey questionnaires, respectively, at the beginning and after 3 months. Results: Participants demonstrated significantly improved foot pain (p = 0.002), disability related to foot pain (p < 0.001), foot functionality (p = 0.001), fatigue (p < 0.007), and mental health-related quality of life (p = 0.016). The physical health-related quality of life did not show significant changes. Conclusions: The use of custom-made foot orthoses help in the management of the symptoms by participants. This study could contribute to the foot specialists being considered as an additional member in multidisciplinary teams that are trying to develop an approach for patients with EDS

Foot Pain and Morphofunctional Foot Disorders in Patients with Rheumatoid Arthritis: A Multicenter Cross-Sectional Study

[Abstract] Foot problems are highly prevalent in people with rheumatoid arthritis. This study aims to explore the foot morphology, pain and function in rheumatoid arthritis patients and the relation with the time of disease debut. A cross-sectional study was designed. Footprint, the Foot Posture Index, the hallux valgus prevalence, foot pain and function in 66 rheumatoid arthritis patients and the association with time since diagnosis, were recorded. The Foot Function Index, the Manchester Foot Pain and Disability Index, the Visual Analogic Scale, and the Manchester Scale for hallux valgus were administered and analyzed in two groups, with less and more than 10 years of diagnosis of the disease. A high prevalence of pronated (right 36.8% and left 38.6%) and highly pronated (right 15.8% and left 15.8%) feet was observed, as well as an elevated percentage of low arched footprints (right 68.4 and left 66.7%) and hallux valgus (right 59.6% and left 54.4%). Hallux valgus prevalence, toe deformities and Foot Function Index (Functional limitation) factors were significantly associated with the time since RA diagnosed adjusted for the other factors. The adjusted odds ratio of Hallux valgus prevalence was 4.9 (1.2–19.7). In addition, the foot function was diminished, and foot pain was present in most participants. In conclusion, rheumatoid arthritis patients’ feet showed altered morphology and function, and with longer rheumatoid arthritis history, metatarsophalangical stability and foot function, but not pain and global foot posture, were likely to deteriorat

Resultados clínicos iniciales y variables pronósticas en la implementación de un Código Sepsis en un Hospital Universitario de alta complejidad

Objective: To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient´s epidemiological and clinical characteristics and prognostic factors. Methods: A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 - September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses. Results: A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p 65 years (OR 5.33, p 3 mmol/L (OR 5,85, p 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05). Conclusions: The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programsObjetivo. Evaluar el impacto de un programa educativo y organizativo llamado Código Sepsis, en los primeros siete meses de su aplicación en un hospital de alta complejidad. Material y métodos. Se realizó un estudio observacional durante un período consecutivo de siete meses (Febrero 2015-Septiembre 2015). Se analizó la relación con la mortalidad de los factores de riesgo y los valores analíticos usando análisis uni y multivariante. Resultados. Se incluyeron un total de 237 pacientes. La mortalidad intrahospitalaria a los 30 días fue del 24 % y del 27% a los 60 días. La mortalidad de los pacientes ingresados en Unidades de Cuidados Críticos fue del 30%. Se encontraron diferencias significativas entre los pacientes que murieron y los que sobrevivieron en sus valores medios de creatinina (2,30 vs 1,46 mg/dL, p <0,05), ácido láctico (6,10 vs 2,62 mmol/L, p <0,05) y procalcitonina (23,27 vs 12,73 mg/dL, p <0,05). Se encontró una tendencia lineal estadísticamente significativa entre los valores de la escala SOFA y la mortalidad (p <0,05). En el análisis multivariante se identificaron otros factores de riesgo independientes asociados con la muerte: edad > 65 años (OR 5,33, p 3 mmol/L (OR 5,85, p <0,05), creatinina > 1,2 mgr/dL (OR 4,54, p <0,05) y el shock (OR 6,57, P <0,05). Conclusiones. La mortalidad en este estudio se encuentra dentro de los límites de los ensayos clínicos más recientes de sepsis. El estudio ha identificado varios marcadores que podrían ser útiles a nivel local para estimar el riesgo en pacientes sépticos. Estudios como éste son necesarios para hacer mejoras en los programas de Código Sepsi

Study of the functional relationships between the buccinator muscle and the connective tissue of the cheek in humans

Background: The buccinator muscle derives from the mesenchyme of the second pharyngeal arch. In adults, it has a quadrilateral shape, occupying the deepest part of the cheek region. Its function is complex, being active during swallowing, chewing, and sucking. To our knowledge, there are no studies that have specifically analyzed the relationship of the buccinator muscle fibers and neighboring connective tissue of the cheek in humans, neither during development nor in adults. Such relationships are fundamental to understand its function. Thus, in this study the relations of the buccinator muscle with associated connective tissue were investigated. Methods: The buccinator muscle region was investigated bilaterally in 41 human specimens of 8–17 weeks of development. Moreover, four complete adult tissue blocks from human cadavers (including mucosa and skin) were obtained from the cheek region (between the anterior border of the masseter muscle and the nasolabial fold). All samples were processed with standard histological techniques. In addition, subsets of sections were stained with picrosirius red (PSR). Furthermore, immunoreactivity against type I and III collagen was also studied in adult tissues. Results: The buccinator muscle showed direct relationships with its connective tissue from 8 to 17 weeks of development. Collagen fibers were arranged in septa from the submucosa to the skin through the muscle. These septa were positive for type I collagen and presented elastic fibers. Fibrous septa that were positive for type III collagen were arranged from the lateral side of the muscle to the skin. Conclusions: The intimate relationship between buccinator muscle fibers and cheek connective tissue may explain the complex functions of this muscle

Desarrollo de un sistema interactivo para el estudio de la órbita y su contenido: anatomía microscópica

Se ha desarrollado un sistema interactivo para mejorar el proceso de enseñanza-aprendizaje en la docencia de la anatomía microscópica de la órbita y su contenido, a través de preparaciones histológicas. Se pretende facilitar el aprendizaje de forma autónoma en español e inglés y, la autoevaluación sobre los conocimientos adquiridos

Tomando medidas ante la COVID-19: Virtualización de las prácticas de Aparato Locomotor en las asignaturas que imparte el Departamento de Anatomía y Embriología en las titulaciones de Medicina, Fisioterapia, Podología y Terapia Ocupacional

desarrollo de un sistema interactivo para mejorar el proceso de enseñanza-aprendizaje en la docencia de las prácticas del Aparato Locomotor, que pudiera ser utilizado por los alumnos de Grado de Fisioterapia, Medicina, Podología y Terapia Ocupacional, titulaciones en las que el Aparato Locomotor tiene una importante presencia en sus temarios de prácticas

Risk factors and outcome of COVID-19 in patients with hematological malignancies

Background: Prognostic factors of poor outcome in patients with hematological malignancies and COVID-19 are poorly defned. Patients and methods: This was a Spanish transplant group and cell therapy (GETH) multicenter retrospective observational study, which included a large cohort of blood cancer patients with laboratory-confrmed SARS-CoV-2 infection through PCR assays from March 1st 2020 to May 15th 2020. Results: We included 367 pediatric and adult patients with hematological malignancies, including recipients of autologous (ASCT) (n=58) or allogeneic stem cell transplantation (allo-SCT) (n=65) from 41 hospitals in Spain. Median age of patients was 64 years (range 1-93.8). Recipients of ASCT and allo-SCT showed lower mortality rates (17% and 18%, respectively) compared to non-SCT patients (31%) (p=0.02). Prognostic factors identifed for day 45 overall mortality (OM) by logistic regression multivariate analysis included age>70 years [odds ratio (OR) 2.1, 95% con‑ fdence interval (CI) 1.2-3.8, p=0.011]; uncontrolled hematological malignancy (OR 2.9, 95% CI 1.6-5.2, p20 mg/dL (OR 3.3, 95% CI 1.7-6.4, p<0.0001). In multivariate analysis of 216 patients with very severe COVID-19, treatment with azithromycin or low dose corticosteroids was associated with lower OM (OR 0.42, 95% CI 0.2-0.89 and OR 0.31, 95% CI 0.11-0.87, respectively, p=0.02) whereas the use of hidroxycloroquine did not show signifcant improvement in OM (OR 0.64, 95% CI 0.37-1.1, P=0.1). Conclusions: In most patients with hematological malignancies COVID-19 mortality was directly driven by older age, disease status, performance status, as well as by immune (neutropenia) parameters and level of infammation (high CRP). Use of azithromycin and low dose corticosteroids may be of value in very severe COVID-19