Influencia da dieta sen glute sobre un programa de tratamento fisioterápico en persoas con fibromialxia

[Resumen] La fibromialgia (FM) es un síndrome de dolor musculoesquelético crónico que se caracteriza por un amplio espectro de manifestaciones, cuyos criterios diagnósticos vigentes fueron establecidos en 1990 por el American College of Rheumatology (ACR). La enfermedad se caracteriza fundamentalmente por dolorimiento generalizado espontáneo cuyo diagnóstico se confirma a través de la exploración de múltiples puntos dolorosos e hipersensibilidad a la palpación. Además del dolor, otros síntomas, como fatiga intensa, alteraciones del sueño, parestesias en extremidades, depresión, ansiedad, rigidez articular, cefaleas y manifestaciones gastrointestinales, se encuentran entre las manifestaciones clínicas más comunes. Las manifestaciones gastrointestinales, frecuentemente sufridas por los pacientes con fibromialgia, se atribuyeron inicialmente a la comorbilidad común del síndrome de la fibromialgia del intestino irritable. Existe una superposición considerable en el espectro sintomatológico de la FM y la sensibilidad al gluten, se encontró una notable similitud en las manifestaciónnes gastrointestinales y extraintesnitales entre los pacientes con fibromialgia y pacientes con enfermedad celíaca. Aquí recada la importancia de este estudio. Objetivos. Analizar la eficacia de una dieta libre de gluten acompañada de un programa de fisioterapia en personas que sufren fibromialgia. Material y métodos. El presente proyecto se trata de un ensayo clínico aleatorio en paralelo a simple ciego que se realizará cpon personas fibromialgia que estén acudiendo a la Asociación de Fibromialgia y Fatiga Crónica de Coruña. Serán seleccionados 52 pacientes y se formarán 2 grupos de 26 personas: control activo y experimental. Todos los pacientes recibirán un total de 12 sesiones repartidas en 3 sesiones por semana durante 4 semanas y dos días, impartidas por el fisioterapeuta de la Asociación. El grupo experimental incluirá la dieta sin gluten a su vida diaria. Se valoraran pre y post-intervención las capacidades generales del paciente, el dolor y la hiperalgesia. Recogeremos también datos demográfcios de sexo y edad, así como los años de diagnóstico.[Abstract] FM is a chronic musculoskeletal pain syndrome characterized by a wide spectrum of manifestations, whose current diagnostic criteria were established by the American College of Rheumatology (ACR) in 1990. The disease is mainly characterized by generalized spontaneous pain whose diagnosis is confirmed by scanning multiple distressing points and hypersensivity to palpation. In addition to pain, other symptoms, such as severe fatigue, sleep disturbances, paresthesia in extremities, depression, anxiety, joint stiffness, headaches and gastrointestinal manifestations, are among the most common clinical manifestations. Gastrointestinal manifestations, often suffered by patients with fibromyalgia, initially attributed to common comorbidity of fibromyalgia irritable bowel syndrome. There is considerable overlap in the symptomatic spectrum of FM and sensitivity to gluten, a remarkable similarity in the gastrointestinal and extra-intestinal manifestations among patients with fibromyalgia and patients with celiac disease was found. Here is where the importance of this study relapses. Objectives. To analyze the effectiveness of a gluten-free diet accompanied by a program of physiotherapy in people with fibromyalgia. Material and methods. This project is a randomized clinical trial in parallel single-blind to be held with fibromyalgic people who are flocking to the Association of Fibromyalgia and Chronic Fatigue of A Coruña. 52 patients will be selected, and 2 groups of 26 people will be formed: active and experimental control. All patients will receive a total of 12 sessions, over 3 sessions per week for 4 weeks and two days, taught by the Association's physiotherapist. The experimental group will include gluten-free diet to their daily life. The general abilities of the patient, pain and hyperalgesia will be valued pre- and post-intervention. We also will collect demographic data of sex and age, and years of diagnosis too.[Resumo] Introducción. A fibromialxia (FM) é un síndrome de dor musculoesquelético crónico que se caracteriza por un ampolo espectro de manifestacións, cuxos criterios diagnósticos vixentes foron establecidos no 1990 polo American College of Rheumatology (ACR). A enfermidade caracterizase fundamentalmente polo dolorimento xeneralizado espontáneo cuxo diagnóstico confírmase a través da exploración de múltiples puntos dolorosos e hipersensibilidade á palpación. Ademais da dor, outros síntomas, como fatiga intensa, alteracións do sono, parestesias en extremidades, depresión, ansiedade, rixidez articular, cefaleas e manifestacións gastrointestinais, atópanse entre as manifestacións clínicas máis comúns. As manifestacións gastrointestinais, frecuentemente sufridas polos pacientes con fibromialxia,, atribuíronse inicialmente á comorbilidade común do síndrome da fibromialxia do intestino irritable. Existe unha superposición considerable no espectro sintomatolóxico da FM e a sensibilidade ó glute, atopouse unha notable similitude nas manifestacións gastrointestinais e extraintestinais entre os pacientes con fibromialxia e pacientes con enfermidade celíaca. Aquí recada a importancia deste estudo. Obxetivos. Analizala eficacia dunha dieta libre de glute acompañada dun programa de fisioterapia en persoas que sufren fibromialxia. Material e métodos. O presente proxecto trátase dun ensaio clínico aleatorio en paralelo a simple cego que se realizará con persoas fibromialgia que estén acudindo á Asociación de Fibromialxia e Fatiga Crónica da Coruña. Serán seleccionados 52 pacientes e formaranse 2 grupos de 26 persoas: control activo e experimental. Tódolos pacientes recibirán un total de 12 sesións repartidas en 3 sesións por semana durante 4 semanas e 2 días, impartidas polo fisioterapeuta da Asociación. O grupo experimental incluíra a dieta sen gluten á súa vida diaria. Valoraranse pre e post-intervención as capacidades xerais do paciente, a dor e a hiperalxesia. Recolleremos tamén datos demográficos de sexo e idade, así como os anos de diagnóstico.Traballo fin de grao (UDC.FCS). Fisioterapia. Curso 2015/2016

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

Introduction: Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. Methods: Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. Results: The median [p25–p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO < 80% and 24% having DLCO < 60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO < 60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions. Conclusion: Age and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection are often non-specific, and there is no definitive test for the accurate diagnosis of infection. The 'omics' approaches to identifying biomarkers from the host-response to bacterial infection are promising. In this study, lipidomic analysis was carried out with plasma samples obtained from febrile children with confirmed bacterial infection (n = 20) and confirmed viral infection (n = 20). We show for the first time that bacterial and viral infection produces distinct profile in the host lipidome. Some species of glycerophosphoinositol, sphingomyelin, lysophosphatidylcholine and cholesterol sulfate were higher in the confirmed virus infected group, while some species of fatty acids, glycerophosphocholine, glycerophosphoserine, lactosylceramide and bilirubin were lower in the confirmed virus infected group when compared with confirmed bacterial infected group. A combination of three lipids achieved an area under the receiver operating characteristic (ROC) curve of 0.911 (95% CI 0.81 to 0.98). This pilot study demonstrates the potential of metabolic biomarkers to assist clinicians in distinguishing bacterial from viral infection in febrile children, to facilitate effective clinical management and to the limit inappropriate use of antibiotics

Plasma lipid profiles discriminate bacterial from viral infection in febrile children

Fever is the most common reason that children present to Emergency Departments. Clinical signs and symptoms suggestive of bacterial infection ar

The Spanish gut microbiome reveals links between microorganisms and Mediterranean diet

Despite the increasing evidence of links between human gut and health, the number of gut microbiomes that have been studied to date at a country level are surprisingly low. Mediterranean countries, including some of the most long-lived and healthy countries in the world, have not been considered so far in those studies at a large scale. The main objective of this work is to characterize the gut microbiome of a healthy adult population of a Mediterranean, paradigmatically healthy country: Spain. Stool samples from 530 healthy volunteers were collected, total metagenomic DNA extracted, and the microbial profiles determined through 16S rRNA metataxonomic sequencing. Our results confirm the associations between several microbial markers and different variables, including sex, age, BMI and diet choices, and bring new insights into the relationship between microbiome and diet in the Spanish population. Remarkably, some of the associations found, such as the decrease of Faecalibacterium with age or the link of Flavonifractor with less healthy dietary habits, have been barely noticed in other large-scale cohorts. On the other hand, a range of links between microorganisms, diet, and lifestyle coincide with those reported in other populations, thus increasing the robustness of such associations and confirming the importance of these microbial markers across different countries. Overall, this study describes the Spanish “normal” microbiome, providing a solid baseline for future studies investigating the effects of gut microbiome composition and deviations in the adherence to the Mediterranean diet.This study was funded by Instituto Central Lechera Asturiana de Nutrición Personalizada (ICLANP). Instituto de Desarrollo Económico del Principado de Asturias (IDEPA) also funded this work through "PROGRAMA RIS3-EMPRESA" (reference IDE/2020/000363). AL-P is a recipient of a Doctorado Industrial fellowship from the Spanish Ministerio de Ciencia, Innovación y Universidades (reference DI-17-09613).Peer reviewe

Engineering Bacteria to Form a Biofilm and Induce Clumping in <i>Caenorhabditis elegans</i>

Bacteria are needed for a vast range of biotechnological processes, which they carry out either as pure cultures or in association with other bacteria and/or fungi. The potential of bacteria as biofactories is hampered, though, by their limited mobility in solid or semisolid media such as agricultural or domestic waste. This work represents an attempt toward overcoming this limitation by associating bacterial biotechnological properties with the transport ability of the nematode <i>Caenorhabditis elegans</i>. We report here biofilm formation on <i>C. elegans</i> by engineered <i>Escherichia coli</i> expressing a <i>Xhenorhabdus nematophila</i> adhesion operon and induction of nematode social feeding behavior (clumping) through an <i>E. coli</i>-mediated iRNA blocking on the expression of FLP-21, a neuropeptide involved in worm solitary behavior