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Fundamento: La deficiencia de vitamina D es muy frecuente, y se ha puesto en evidencia en múltiples estudios realizados tanto en la población general como en pacientes con diferentes patologías. Sin embargo, ha sido poco estudiada en los pacientes afectos de lesión medular. Objetivo: Estudiar la prevalencia de hipovitaminosis D y el posible desarrollo de un hiperparatiroidismo secundario en una población de pacientes con lesión medular. Material y método: Estudio descriptivo transversal realizado en 104 pacientes afectos de lesión medular. A todos se les efectuó una historia clínica y una exploración física detallada, y se les extrajo sangre en ayunas, con la menor compresión posible. Los parámetros analíticos fueron analizados por técnicas automatizadas y la determinación de la 25-hidroxivitamina D (25HCC) y la hormona paratiroidea (PTH) se efectuó por electroinmunoquimioluminiscencia (EIQL). Resultados: El valor medio global de 25-hidroxivitamina D fue 20,1 ± 11,6 ng/ml. El 84,6% de los pacientes tenían unos valores séricos de 25-hidroxivitamina D inferiores a 30 ng/ml y el 62,5% del total de pacientes, mostraron valores inferiores a 20 ng/ml. La prevalencia de insuficiencia de vitamina D fue similar en hombres y mujeres. Sin embargo, aunque encontramos una correlación inversa entre los niveles de PTH y de 25-hidroxivitamina D, sólo el 5,8% de los pacientes llegaron a desarrollar un hiperparatiroidismo secundario. Conclusiones: Existe una elevada prevalencia de hipovitaminosis D en los pacientes con lesión medular. Es aconsejable, por tanto, la inclusión del estudio de este metabolito en el protocolo de atención de estos pacientes para corregir las deficiencias en cuando se objetiven.

Background: vitamin D deficiency is very common, and has been demonstrated in multiple studies in both the general population and in patients with different pathologies. However, it has been little studied in patients affected by spinal injury. Objective: to study the prevalence of hypovitaminosis D and the possible development of secondary hyperparathyroidism in a population of patients with spinal injury. Material and method: transverse descriptive study carried out in 104 patients affected by spinal injury. A clinical history was taken, a detailed physical examination carried out and a blood sample while fasting taken, with the least possible compression, from all patients. The analytical parameters were analysed using automated techniques and the determination of 25-hydroxyvitamin D (25HCC) and parathyroid hormone (PTH) was performed using electroimmunochemiluminescence (ECLIA). Results: the global mean value of 25-hydroxyvitamin D was 20.1 ± 11.6 n/ml. 84.6% of the patients had blood values of 25-hydroxyvitamin D lower than 30 ng/ml and 62% of all patients showed values lower than 20 ng/ml. The prevalence of vitamin D deficiency was similar in men and women. However, although we found an inverse correlation between levels of PTH and hydroxyvitamin D, only 5.8% of patients ended up developing secondary hyperparathyroidism. Conclusions: there is a high prevalence of hypovitaminosis D in patients with spinal injury. It is advisable, therefore, to include a study of this metabolite in the care protocol of these patients to correct these deficiencies as and when they are found. [ABSTRACT FROM AUTHOR]

Study design:A 3-month follow-up, observational, prospective, multicenter, study in traumatic spinal cord-injured (SCI) patients with neuropathic pain (NP).Objectives:To assess the effectiveness and safety of oxycodone treatment in SCI patients with anticonvulsants-refractory NP.Setting:'Spinal injury follow-up units' throughout Spain.Methods:Data regarding NP characteristics were collated from male and female adults with traumatic SCI and difficult-to-control central NP of moderate-to-severe intensity (visual analog scale (VAS) 4) persisting 1 month, who had been para- or tetraplegic for 2 months, had been previously treated with anticonvulsants and were now treated with oxycodone.Results:In all, 54 out of the 57 patients recruited were assessable. A total of 81% were men and the mean age was 46.4. Patients were treated with oxycodone, 83% combined with anticonvulsant. Pain intensity (VAS: 7.1±1.3-4.3±1.7) and Lattinen total score (13.2±3-7.7±3.4) decreased significantly (P<0.001) along the study. No patient got worse regarding pain impact on physical activity and on sleep (Lattinen scale). EQ-5D VAS showed a trend to increase (P=0.061) and the index of preference values increased significantly from baseline to month 3 (0.26-0.62; P<0.001). A total of 53.7% patients showed at least one treatment-related adverse event, with constipation being the most frequent one (33.3%).Conclusion:Oxycodone treatment, mostly in combination with anticonvulsants, in SCI patients with NP decreases pain intensity, improves health-related quality of life and diminishes the impact of pain on physical activity and sleep.Sponsorship:This study has been sponsored by Mundipharma, SL, Madrid, Spain. [ABSTRACT FROM AUTHOR]

Study design: Prospective, open-label, comparative study, to assess the effects of sildenafil on blood pressure in a population of patients with spinal cord injury (SCI). Objectives: To determine the effect of sildenafil on blood pressure in patients with erectile dysfunction secondary to SCI by comparing changes in blood pressure in SCI patients with a neurologic level below T5 versus higher levels. To establish a relationship between the potential hypotensive effect and protective muscle spasm against blood pressure reduction. To assess the effects of age, complexity and duration of SCI on changes in blood pressure. To record any adverse effects occurring during the study. Setting: Spinal Cord Injury Unit, Insular University Hospital of Gran Canaria, Canary Islands, Spain. Subjects: In total, 22 male SCI patients aged 18 years or older with a history of SCI greater than 3 months in duration. Methods: Patients with erectile dysfunction secondary to SCI were induded in the study, without excluding patients with a neurologic level above 75 or asymptomatic low blood pressure. Patients with specific contraindications for use of the drug were excluded. A personal history was obtained, and the level of injury (ASIA/IMSOP scales of international standards), impairment grade (ASIA impairment scale), spasticity grade (modified Ashworth scale) and baseline sitting and supine blood pressure values were determined. A single dose of 50 mg of sildenafil was administered, and patients remained sitting at 45 degrees . Blood pressure was monitored every 10 min for 4 h and whenever the patient reported symptoms. Any relevant signs and symptoms manifested during the study period were also recorded. Analysis of the changes in blood pressure values was performed using a paired t-test in each group of patients according to neurologic level and spasticity grade. Results: A decrease in blood pressure was observed in all patients, although patients with a level of injury at T5 or above and those with a complete SCI showed a less intense decrease (P<0.05). The spasticity grade of the patients was protective against the fall in blood pressure, as it was less significant in patients with grade 3 (P>0.1) than in those with grade 0. Adverse effects were few and transient. None were related to hypotension. Conclusion: Sildenafil caused a decrease in blood pressure in SCI patients with a neurologic level of injury above T5 and complete injuries (grade A), but did not have clinical implications in the patients studied. A higher spasticity grade tends to protect the patient from the fall in blood pressure. Age and duration of injury do not appear to influence this decrease. [ABSTRACT FROM AUTHOR]

Study design:Prospective, open-label, comparative study, to assess the effects of sildenafil on blood pressure in a population of patients with spinal cord injury (SCI).Objectives:To determine the effect of sildenafil on blood pressure in patients with erectile dysfunction secondary to SCI by comparing changes in blood pressure in SCI patients with a neurologic level below T5 versus higher levels. To establish a relationship between the potential hypotensive effect and protective muscle spasm against blood pressure reduction. To assess the effects of age, complexity and duration of SCI on changes in blood pressure. To record any adverse effects occurring during the study.Setting:Spinal Cord Injury Unit, Insular University Hospital of Gran Canaria, Canary Islands, Spain.Subjects:In total, 22 male SCI patients aged 18 years or older with a history of SCI greater than 3 months in duration.Methods:Patients with erectile dysfunction secondary to SCI were induded in the study, without excluding patients with a neurologic level above 75 or asymptomatic low blood pressure. Patients with specific contraindications for use of the drug were excluded. A personal history was obtained, and the level of injury (ASIA/IMSOP scales of international standards), impairment grade (ASIA impairment scale), spasticity grade (modified Ashworth scale) and baseline sitting and supine blood pressure values were determined. A single dose of 50 mg of sildenafil was administered, and patients remained sitting at 45°. Blood pressure was monitored every 10 min for 4 h and whenever the patient reported symptoms. Any relevant signs and symptoms manifested during the study period were also recorded. Analysis of the changes in blood pressure values was performed using a paired t-test in each group of patients according to neurologic level and spasticity grade.Results:A decrease in blood pressure was observed in all patients, although patients with a level of injury at T5 or above and those with a complete SCI showed a less intense decrease (P<0.05). The spasticity grade of the patients was protective against the fall in blood pressure, as it was less significant in patients with grade 3 (P>0.1) than in those with grade 0. Adverse effects were few and transient. None were related to hypotension.Conclusion:Sildenafil caused a decrease in blood pressure in SCI patients with a neurologic level of injury above T5 and complete injuries (grade A), but did not have clinical implications in the patients studied. A higher spasticity grade tends to protect the patient from the fall in blood pressure. Age and duration of injury do not appear to influence this decrease.Spinal Cord (2006) 44, 301–308. doi:10.1038/sj.sc.3101846; published online 11 October 2005 [ABSTRACT FROM AUTHOR]

Study Design: Survey study., Objectives: People living with spinal cord injury (SCI) are major healthcare and rehabilitation services consumers and have unmet healthcare needs. This study aimed to describe the socioeconomic characteristics of people living with SCI in Spain and to determine the level of use and satisfaction with the public healthcare system., Methods: We conducted a survey (the Spanish version of the International Spinal Cord Injury Community Survey) consisting of 134 questions. We analyzed the age, sex, neurological classification of the injury on the American Spinal Injury Association Impairment Scale, time of injury, socio-occupational and socioeconomic status, and level of use and satisfaction with the public health system., Results: 472 people responded to the survey [68.9% male; mean age 51.2 years (standard deviation: 13.9 years); 61.7% with paraplegia and 38.3% with tetraplegia]. 89.2% of those surveyed were unemployed and 77.1% received a disability pension. The number of medical visits was 2.3/year, and 19.8% of the patients required at least 1 hospital admission during the previous year. 94.7% of the people with SCI considered the health care received as good or very good., Conclusions: Respondents with SCI in Spain considered they had good access to primary and specialized care and were satisfied with the healthcare system. Notably, we observed a high average of annual visits to medical professionals but a low rate of hospitalizations. Technical aids and state services related to disability should be the most important elements to be improved., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Recently, an antimicrobial effect on Mycoplasma agalactiae (Ma), the main etiological agent of contagious agalactia (CA), was reported in vitro with strains of Enterococcus spp. from ovine and caprine milk. The aim of this work was to evaluate the interaction of Ma with the same Enterococcus spp. isolated from other anatomical locations (vagina) and other bacterial populations present in milk, such as coagulase-negative staphylococci (CNS). The vaginal Enterococcus strains and the raw milk CNS were isolated from sheep and goats. Experimental in vitro conditions were prepared to assess the growth of Ma with and without the presence of these strains. The selected vaginal strains were identified as Enterococcus (E.) hirae and E. mundtii, and the strains of CNS were identified as Staphylococcus petrasii . Different interactions of Ma with ovine and caprine wild vaginal strains of Enterococcus and dairy strains of CNS are described for the first time: Ma can grow exponentially during 15 h with the selected strains, although with certain strains, its optimal growth can be negatively affected ( p < 0.05). The colonization and/or excretion of Ma could, therefore, be influenced by certain endogenous bacterial strains. Our results increase the knowledge about possible bacterial ecology dynamics surrounding CA.

Introduction: The complexity of fighting contagious agalactia (CA) has raised the necessity of alternative antimicrobial therapies, such as probiotics. Lactic acid bacteria (LAB) are present in the mammary gland of small ruminants and their antimicrobial effect have been previously described against species like Mycoplasma bovis but never against Mycoplasma agalactiae (Ma). This in vitro study aims to evaluate the antimicrobial activity against Ma of ovine and caprine LAB strains and a human commercial probiotic (L2) of Lactobacillus spp., Methods: A total of 63 possible LAB strains were isolated from nine ovine and caprine farms in Spain, three isolates (33B, 248D, and 120B) from the 63 strains were selected, based on their capacity to grow in a specific medium in vitro , for an in vitro experiment to assess their antimicrobial activity against Ma in Ultra High Temperature (UHT) processed goat milk (GM). A women commercial vaginal probiotic was also included in the study. The inoculum of L2 was prepared at a concentration of 3.24 × 10 8   CFU/mL and the average concentration of the inoculum of the wild LAB varied from 7.9 × 10 7 to 8.4 × 10 8   CFU/mL., Results: The commercial probiotic L2 significantly reduced the concentration of Ma to 0.000 log CFU/mL ( p  < 0.001), strain 33B reduced it from 7.185 to 1.279 log CFU/mL ( p  < 0.001), and 120B from 6.825 to 6.466 log CFU/mL ( p  < 0.05). Strain 248D presented a bacteriostatic effect in GM. Moreover, the three wild strains and the commercial probiotic produced a significative reduction of the pH ( p  < 0.001)., Discussion: This is the first in vivo report of the antimicrobial potential of LAB strains against Ma and its interaction. Our results support possible future alternative strategies to antibiotic therapy, previously not contemplated, to fight CA in small ruminants. Further studies are necessary to elucidate the action mechanisms through which these LAB are able to inhibit Ma and to assess the safety of using these strains in possible in vivo studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Toquet, Bataller, Gomis, Sánchez, Toledo-Perona, De la Fe, Corrales and Gómez-Martín.)

Objectives: To assess the postsurgical sonographic parameters of a readjustable sling (RAS) according to urinary incontinence (UI) symptoms after surgery and compare this RAS sonographic pattern with mid-urethral slings (MUS)., Methods: Observational, prospective multicenter study, including women undergoing stress urinary incontinence (SUI) surgery with RAS (Remeex®). The primary outcome was the association between UI symptoms and sonographic parameters measured by two-dimensional transperineal and high-frequency endovaginal ultrasound. We measured static parameters (bladder neck funneling, RAS position, symmetry, distance to the urethral lumen), and the movement of the sling on Valsalva. UI symptoms were measured with the postsurgical Incontinence Questionnaire-Short Form (ICIQ-UI-SF) questionnaire. We created two control groups including patients with transobturator-MUS (TOT-MUS) and retropubic-MUS (RT-MUS) to compare postsurgical sonographic parameters of RAS with MUS., Results: Among the 55 women with RAS included, the postoperative ICIQ-UI-SF scores were significantly higher in patients with bladder neck funneling (15.0 (3.9) vs 10.6 (6.7); P = .020) and in those with discordant movement of RAS on Valsalva (14.6 (5.7) vs 10.3 (6.7); P = .045). Compared with the 109 women with TOT-MUS and the 55 with RT-MUS, RAS was more often located in the proximal urethra and farther from the urethral lumen., Conclusions: Postsurgical pelvic floor ultrasound demonstrated that in women with complex SUI and hypomobile urethra who underwent RAS (Remeex®) surgery, the presence of bladder neck funneling and discordant movement on Valsalva correlate with the persistence of UI symptoms. In these women, RAS is more often located in the proximal urethra and farther from the urethral lumen at rest in comparison with MUS., (© 2022 American Institute of Ultrasound in Medicine.)

Introduction: Surgical treatment for stress urinary incontinence (SUI) with mid-urethral sling (MUS) is considered to have a high success rate. However, between 5% and 20% of MUS fail, with inadequate surgical implantation being a possible cause of SUI persistence or recurrence. Misplacement of a MUS can be determined by pelvic floor ultrasound (PF-US). The aim of this study was to investigate the role of PF-US in patients with persistent or recurrent urinary incontinence (UI) symptoms after MUS surgery for SUI with a midterm follow-up., Materials and Methods: A historical cohort study including women undergoing MUS surgery for SUI between 2013 and 2015 was designed. The primary outcome was to correlate the sonographic parameters of MUS with SUI cure (negative International Continence Society-Uniform Cough Stress Test, Incontinence Questionnaire-Short Form < 5 points and no symptoms of SUI), at 5 years postsurgery. Secondary outcomes were changes of maximum urethral closure pressure (MUCP) and symptoms of urgency urinary incontinence (UUI) at 1 and 5 years after surgery., Results: Eighty-seven patients (80 transobturator-MUS, 7 retropubic-MUS) were included. At 5 years all patients referred improvement of UI and objective cure of SUI was demonstrated in 81.2%. The MUS was sonographically correct in 67 (98.5%) of the 68 patients with cure of SUI. The MUS was considered incorrectly placed in only 4 (28.6%) of the 14 patients with noncured SUI. MUCP decreased from 61.9 to 48.8 cmH 2 O at 5 years of follow-up (p < 0.01) and up to 53% of women had UUI symptoms after surgery, with a nonsignificant decrease compared to baseline., Conclusion: Patients cured of SUI had sonographically correct MUS by PF-US. Less than one-third of cases of SUI persistence or recurrence after MUS surgery could be explained by a sonographically incorrect sling. Low urethral resistance and/or UUI symptoms could help to explain the remaining failures. Complete functional and anatomic studies, including urodynamics and PF-US, should be performed before deciding on the next management strategy in patients with SUI persistence or recurrence after MUS., (© 2022 Wiley Periodicals LLC.)