Search

BACKGROUND: Vertigo represents a vestibular disorder with a negative impact on the activities of the patients and is a special problem due to the difficulties in diagnosis and because it is a symptom of difficult assessment. Vestibular rehabilitation is an effective alternative for people suffering from vestibular disorders and have an instrument that evaluate the perception of the patient's disability upon admission of their treatment will allow the design of an appropriate therapy according to the degree of disability. The Dizziness Handicap Inventory (DHI) is a tool of American origin, useful for measuring the disability associated with vertigo. OBJECTIVE: To perform the translation and validation of DHI in Central Military Hospital patients. MATERIAL AND METHOD: An observational, analytical, prospective and longitudinal study was performed from March to October 2016 with patients referred by the Otorhinolaryngology department for vestibular rehabilitation. The translation and cultural adaptation of the DHI was carried out and it was applied to patients upon admission to the rehabilitation service. The internal consistency (Cronbach's alpha index) was assessed globally and in each of the dimensions. RESULTS: During the period study 73 patients were referred by the Otorhinolaryngology department to Rehabilitation service with symptoms of vertigo for beginning vestibular therapy, obtaining a total Cronbach's alpha of 0.92, for functional domain 0.83, for emotional domain 0.81 and for physical domain 0.80. There were no differences in the DHI coefficients with the original version. CONCLUSION: The Mexican version of the DHI is a reliable and valid tool to evaluate the impact of the perceived disability in patients with vertigo of the Central Military Hospital. [ABSTRACT FROM AUTHOR]

As the world becomes warmer and precipitation patterns less predictable, organisms will experience greater heat and water stress. It is crucial to understand the factors that predict variation in thermal and hydric physiology among species. This study focuses on investigating the relationships between thermal and hydric diversity and their environmental predictors in a clade of Hispaniolan anole lizards, which are part of a broader Caribbean adaptive radiation. This clade, the "cybotoid" anoles, occupies a wide range of thermal habitats (from sea level to several kilometers above it) and hydric habitats (such as xeric scrub, broadleaf forest, and pine forest), setting up the possibility for ecophysiological specialization among species. Among the thermal traits, only cold tolerance is correlated with environmental temperature, and none of our climate variables are correlated with hydric physiology. Nevertheless, we found a negative relationship between heat tolerance (critical thermal maximum) and evaporative water loss at higher temperatures, such that more heat-tolerant lizards are also more desiccation-tolerant at higher temperatures. This finding hints at shared thermal and hydric specialization at higher temperatures, underscoring the importance of considering the interactive effects of temperature and water balance in ecophysiological studies. While ecophysiological differentiation is a core feature of the anole adaptive radiation, our results suggest that close relatives in this lineage do not diverge in hydric physiology and only diverge partially in thermal physiology., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology.)

Objective: This study aimed to estimate the incidence of giant cell arteritis (GCA) in Spain and to analyse its clinical manifestations, and distribution by age group, sex, geographical area and season., Methods: We included all patients diagnosed with GCA between 1 June 2013 and 29 March 2019 at 26 hospitals of the National Health System. They had to be aged ≥50 years and have at least one positive results in an objective diagnostic test (biopsy or imaging techniques), meet 3/5 of the 1990 American College of Rheumatology classification criteria or have a clinical diagnosis based on the expert opinion of the physician in charge. We calculated incidence rate using Poisson regression and assessed the influence of age, sex, geographical area and season., Results: We identified 1675 cases of GCA with a mean age at diagnosis of 76.9±8.3 years. The annual incidence was estimated at 7.42 (95% CI 6.57 to 8.27) cases of GCA per 100 000 people ≥50 years with a peak for patients aged 80-84 years (23.06 (95% CI 20.89 to 25.4)). The incidence was greater in women (10.06 (95% CI 8.7 to 11.5)) than in men (4.83 (95% CI 3.8 to 5.9)). No significant differences were found between geographical distribution and incidence throughout the year (p=0.125). The phenotypes at diagnosis were cranial in 1091 patients, extracranial in 337 patients and mixed in 170 patients., Conclusions: This is the first study to estimate the incidence of GCA in Spain at a national level. We found a predominance among women and during the ninth decade of life with no clear variability according to geographical area or seasons of the year., Competing Interests: Competing interests: Disclosures that might be interpreted as constituting possible conflict(s) of interest for the study: Ed Research funding/consulting and conferences fees from: Abbvie, Novartis, Roche, Pfizer, Janssen, Lilly, MSD, BMS, UC Pharma, Grünenthal and Sanofi. JL had consultation fees/participation in company-sponsored speaker’s bureau from Roche, Galápagos, Novartis, UCB Pharma, MSD, Celgene, Astra Zeneca and Grünenthal and received support for attending meetings and/or travel from Janssen, Abbvie, Roche, Novartis, MSD, UCB Pharma, Celgene, Lilly, Pfizer, Galápagos. Patricia Moya Alvarado had consultation fees/participation in company-sponsored speaker’s bureau from Roche, Novartis, Abbvie, MSD, Lilly, Pfizer and Celgene and received support for attending meetings and/or travel from Novartis, Lilly and, Pfizer. SC has received research support from MSD and Pfizer and had consultation fees/participation in company-sponsored speaker’s bureau from Amgen, BMS, Eli-Lilly, MSD, Roche, Gedeon-Richter, Grünenthal Pharma and UCB. SC is also assistant professor of the cátedra EPID-Future, funded by UAM-Roche, Universidad Autónoma de Madrid (UAM), Spain. RB received grants/research support from AbbVie, MSD and Roche, and had consultation fees/participation in a company-sponsored speaker’s bureau from AbbVie, Pfizer, Roche, Lilly, UCB, Bristol-Myers, Janssen, and MSD. The following authors did not declare financial disclosure: DF-L, IH-R, JN, MD-Á, MS-D, JMB, CMM, JS, EG-A, VA, LA, NG-P, CL, VAN, JC, IC-S, FO-S and TCSM., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

A lab-scale Upflow Anaerobic Sludge Blanket (UASB) reactor was used as a model for evaluating synthetic and complex industrial wastewater treatment, using a solar heater to control temperature. Also, hydrodynamics was assessed using the Computational Fluid Dynamics (CFD) method. Initially, the UASB reactor was operated with synthetic wastewater at Hydraulic Retention Time (HRT) of 24 h in 20 ± 2 °C and 30 ± 2 °C to measure the biogas bubbles production for CFD study. COD removal efficiencies of 85 ± 3% and 95 ± 3%, respectively, with production of 27 and 39 ml CH 4 /h, correspondingly, were observed. After that, the reactor was fed with complex industrial wastewater. It was evaluated at 24 h in both temperatures. At 30 °C, low COD removal efficiency was observed, being 48 ± 13%, with methane production of 20 ± 3 ml CH 4 /h. The plug flow pattern was observed in the CFD modelling at HRT of 24 h and 20 °C without considering biogas bubbles interaction. Similar hydrodynamic behaviour was observed at HRT of 24 h and 30 °C. Nonetheless, when biogas bubbles were considered in the CFD modelling, hydrodynamics significantly changed, passing from a plug flow to a complete mix flow pattern.

Objectives: To apply the lupus low disease activity state (LLDAS) definition within a large cohort of patients and to assess the agreement between the LLDAS and the physician's subjective evaluation of lupus activity., Methods: We conducted a cross-sectional analysis of a prospective multicentre study of SLE patients. We applied the LLDAS and assessed whether there was agreement with the clinical status according to the physician's opinion., Results: A total of 508 patients [92% women; mean age 50.4 years (s.d. 3.7)] were recruited and 304 (62.7%) patients were in the LLDAS. According to physician assessment, 430 (86.1%) patients were classified as remission or low activity. Overall agreement between both evaluations was 71.4% (95% CI: 70.1, 70.5) with a Cohen's κ of 0.3 [interquartile range (IQR) 0.22-0.37]. Most cases (96.1%) in the LLDAS were classified as remission or low activity by the expert. Of the patients who did not fulfil the LLDAS, 126 (70.4%) were classified as having remission/low disease activity. The main reasons for these discrepancies were the presence of new manifestations compared with the previous visit and a SLEDAI 2K score >4, mainly based on serological activity., Conclusions: Almost two-thirds of SLE patients were in the LLDAS. There was a fair correlation between the LLDAS and the physician's evaluation. This agreement improves for patients fulfilling the LLDAS criteria. The discordance between both at defining lupus low activity, the demonstrated association of the LLDAS with better outcomes and the fact that the LLDAS is more stringent than the physician's opinion imply that we should use the LLDAS as a treat-to-target goal., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Introduction: Before the pandemic, suicide was already considered a global public health problem. The outbreak of COVID-19, a coronavirus-related infectious disease, began to impact people's physical and mental health. The factors that either contribute to or mitigate this risk need to be better understood, and this can only be accomplished through research. Therefore, this study aimed to study the prevalence of suicidal ideation and behavior in Tamaulipas, Mexico, during the COVID-19 pandemic., Methods: A quantitative, descriptive, and cross-sectional study was conducted. The sample consisted of 659 participants, of whom 194 (29.5%) were men and 465 (70.5%) participants were oldwomen, ranging in age between 16 and 68 years (M = 22.56, SD = 7.26). An adapted version of the Spanish version of the Columbia Suicidal Severity Rating Scale was used to assess the seriousness of suicidal ideation and behavior., Results: The higher rates of suicidal indicators were suicidal ideation with "wish to dead" (39.9%), while the lower was suicidal ideation with a specific plan (8.2%). A total of 18.2% of participants reported "suicidal attempts before COVID-19," of whom 40% reported "suicidal attempts in the last 3 months." Suicidal behavior rates were lower: 13.7% of participants reported "non-specific preparatory behavior" and 13.3% reported "actual suicide attempts." Women were more likely than men to exhibit almost all indicators of suicidal ideation and behavior (OR = 1.63-2.54; 95% CI = 1.11-2.41, 1.76-3.68), as well as confinement (OR = 2.60; 95% CI = 1.73-3.91). Confinement for more than 40 days (OR = 0.55-0.66; 95% CI = 0.40-0.75, 0.47-0.93) and knowing a person infected with COVID-19 (OR = 1.57-2.01; 95% CI = 1.02-2.42, 1.20-3.34) were associated with a higher risk of exhibiting several suicidal indicators and having previously attempted suicide., Conclusion: Being a woman, knowing a person infected with COVID-19, and being confined, especially for longer than 40 days, are all risk factors for suicidal ideation. Therefore, intervention programs are needed to reduce the suicide risk prevalence, especially these days because of the influence of the pandemic, and should be primarily focused on those who present the risk factors associated with suicidal behavior identified in this study., 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 Villarreal Sotelo, Peña Cárdenas, Zamorano González, Vargas Orozco, Hernández Rodríguez and Landero Pérez.)

Biometals are essential during the development of the central nervous system (CNS) since they participate in the organization and regulation of multiple processes related with the proper organization and functioning of brain structures. Neuronal differentiation is a specialized and complex process that occurs actively from embryonic development to the first years of life and is even maintained in specific areas of the mammalian adult brain. In this review, we focus on describing the cellular and molecular mechanisms of trace biometals such as iron (Fe), zinc (Zn), copper (Cu), and manganese (Mn) on neuronal specialization, comprising from brain uptake to effects on synaptogenesis, axonal outgrowth, myelination, and cellular and neurochemical phenotype determination. We highlight the relevance of biometals in the proper brain functioning by discussing some of the potentially detrimental effects when biometal dyshomeostasis occurs in the brain. Finally, future directions are proposed for exploring the relevance of biometals in brain function using pharmacological, molecular, and analytical approaches., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Iron deficiency anaemia is highly prevalent worldwide. In the surgical patient, anaemia of any cause implies higher morbidity and mortality in the post-operative period. This is especially important in patients with peripheral artery disease, as they have very high rates of anaemia due to iron deficiency or other causes. In intermittent claudication, anaemia is a predictor of death in the medium term. Patients with critical ischaemia have higher prevalence of anaemia and it is an indicator of amputation and death in the medium term. Specific protocols need to be developed for these patients since the natural history of their disease does not allow for the correction of anaemia before surgery., (Copyright © 2021 Elsevier España, S.L.U. All rights reserved.)

Introduction: The treatment of Rheumatoid Arthritis (RA) has changed dramatically in recent years, especially with the use of disease modifying drugs (DMARDs). Data on the management of this disease in clinical trials are abundant, but not so in real life. The aim of our study is to describe the management of an early RA cohort in daily clinical practice, especially DMARD discontinuations and reasons., Methods: A retrospective observational study of patients with RA diagnosed between 01/07 and 12/14 followed up to 01/17, using >1 DMARD ≥ 3 months., Variables: sociodemographic, clinical, treatment, DMARD discontinuation and reason. Descriptive analysis of sociodemographic, clinical and treatment characteristics. Discontinuation incidence rate (DIR) due to survival techniques, expressed in 100 patients*year with 95% confidence interval., Results: 814 patients were included with 2388 courses of treatment, 77% women, mean age 57.5 years. First course: monotherapy (92.75%), especially Methotrexate (56.06%). In later courses there was increased combined therapy and use of biologicals (mainly Etanercept). There were 1094 discontinuations (29.5 [27.8-31.3]). The DIR was higher for adverse events (15.9 [14.7-17.3]), biologicals (49.6 [43.1-57.2]) and combined therapy. The DMAR with the lowest DIR was MTX (25.8 [23.8-28.1])., Conclusion: Methotrexate was the most used drug, biologicals increased throughout the follow-up, the most frequent being Etanercept. The DMARD DIR was 29*100 patients per year, mainly due to adverse events. It seems to be higher in the therapies that include biologicals and combined therapies. MTX is the drug with the lowest DIR., (Copyright © 2021. Published by Elsevier España, S.L.U.)

The purpose of this work is to develop a hematocrit-independent method for the detection of beta-thalassemia trait (β-TT) and iron deficiency anemia (IDA), through the rheological characterization of whole blood samples from different donors. The results obtained herein are the basis for the development of a front microrheometry point-of-care device for the diagnosis and clinical follow-up of β-TT patients suffering hematological diseases and alterations in the morphology of the red blood cell (RBC). The viscosity is calculated as a function of the mean front velocity by detecting the sample fluid-air interface advancing through a microfluidic channel. Different viscosity curves are obtained for healthy donors, β-TT and IDA samples. A mathematical model is introduced to compare samples of distinct hematocrit, classifying the viscosity curve patterns with respect to the health condition of blood. The viscosity of the fluid at certain shear rate values varies depending on several RBC factors such as shape and size, hemoglobin (Hb) content, membrane rigidity and hematocrit concentration. Blood and plasma from healthy donors are used as reference. To validate their potential clinical value as a diagnostic tool, the viscosity results are compared to those obtained by the gold-standard method for RBC deformability evaluation, the Laser-Optical Rotational Red Cell Analyzer (LoRRCA)., 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. The handling editor declared a past collaboration with one of the author, J-LV-C., (Copyright © 2021 Méndez-Mora, Cabello-Fusarés, Ferré-Torres, Riera-Llobet, Krishnevskaya, Trejo-Soto, Payán-Pernía, Hernández-Rodríguez, Morales-Indiano, Alarcón, Vives-Corrons and Hernandez-Machado.)

Objective: To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD)., Methods: This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect., Results: We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25-3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6-36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P < 0.001) and a CS-sparing effect from a median 7.5 (5-10) to 5 (2.5-7.5) mg/day at the end of follow-up (P < 0.001) was also observed. ABA was withdrawn in 62 (23.6%) patients due to adverse events (n = 30), articular inefficacy (n = 27), ILD worsening (n = 3) and other causes (n = 2)., Conclusion: ABA may be an effective and safe treatment for patients with RA-ILD., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: The treatment of rheumatoid arthritis has changed dramatically in recent years, especially with the use of disease modifying drugs (DMARDs). Data on the management of this disease in clinical trials are abundant, but not so in real life. The aim of our study is to describe the management of an early rheumatoid arthritis cohort in daily clinical practice, especially DMARD discontinuations and reasons., Methods: A retrospective observational study of patients with rheumatoid arthritis diagnosed between 01/07 and 12/14 followed up to 01/17, using>1 DMARD≥3 months., Variables: sociodemographic, clinical, treatment, DMARD discontinuation and reason. Descriptive analysis of sociodemographic, clinical and treatment characteristics. Discontinuation incidence rate (DIR) due to survival techniques, expressed in 100 patients/year with 95% confidence interval., Results: 814 patients were included with 2,388 courses of treatment, 77% women, mean age 57.5 years. First course: monotherapy (92.75%), especially methotrexate (56.06%). In later courses there was increased combined therapy and use of biologicals (mainly etanercept). There were 1,094 discontinuations (29.5 [27.8-31.3]). The DIR was higher for adverse events (15.9 [14.7-17.3]), biologicals (49.6 [43.1-57.2]) and combined therapy. The DMAR with the lowest DIR was methotrexate (25.8 [23.8-28.1])., Conclusion: Methotrexate was the most used drug, biologicals increased throughout the follow-up, the most frequent being Etanercept. The DMARD DIR was 29/100 patients per year, mainly due to adverse events. It seems to be higher in the therapies that include biologicals and combined therapies. Methotrexate is the drug with the lowest DIR., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)

Direct sublimation of a Cu4Cl4 metal-organic cluster on Cu(110) under ultra-high vacuum allows the formation of ultra-large well-organized metal-organic supramolecular wires. Our results show that the large monomers assemble with each other by π-π interactions connecting dipyrimidine units and are stabilized by the surface.

Objectives: To analyze patients attending rheumatology units of the public health service in Galicia (Spain)., Patients and Methods: We performed a multicenter study. Outpatients from all rheumatology clinics of the Galician health service were included over a 1-week period., Results: A total of 1,357 outpatients were studied (422 new patients and 935 follow-up patients). The mean ages were 55.1±15.6 and 56.9 ± 16.7 years, respectively. Among new patients, 22.5% had inflammatory disease, and 77.5% had noninflammatory disorders. The main source of patient referral was primary care. The overall kappa index in the analysis of agreement between the diagnosis of the referring physician and that of the rheumatologist was 0.8 (95% CI: 0.73-0.86). Agreement was appreciably lower in the group with inflammatory diseases. Among follow-up patients, those with a diagnosis of inflammatory disorders represented 63.4% of the total. This group showed a higher score in the HAQ test and had a greater frequency of patients with permanent work disability. Overall, patients with inflammatory disease required longer consultations than the remaining patients, and their discharge rate was considerably lower., Conclusions: In rheumatology outpatient clinics, patients with inflammatory diseases are more numerous, spend longer in consultations, have greater disability, are more likely to show permanent work disability, and tend to accumulate with the passage of time. Agreement was high in the diagnosis of noninflammatory diseases, contrasting with the high referral rate., (Copyright © 2006 Elsevier España S.L. Barcelona. Published by Elsevier Espana. All rights reserved.)

Introduction: Primary pulmonary hypertension and its associated forms is a progressive and often fatal disease, the course of which has been favourably modified by prostacyclin therapy in the last decade., Objective: The aim of this study is to analize retrospectively the efficacy of continuous intravenous epoprostenol (synthetic prostacyclin) therapy in pulmonary arterial hypertension, and to compare it with conventional therapy (anticoagulants, digoxin and diuretics)., Methods: Between 1990-2000, 31 patients with severe precapillary pulmonary hypertension in functional class III or IV went on continuous intravenous epoprostenol therapy, administered by a portable infusion pump through a Hickman catheter. We compared their survival with a group of 16 patients treated with conventional therapy alone., Results: Time of follow-up was 33.25 months in the prostacyclin group and 20 months in the conventional group. The one- three- and five- year survival rates were 86%, 50% and 38% respectively for patients treated with epoprostenol compared with 40%, 40% and 8% survival rates at idetical periods for patients treated conventionally (p = 0,02). Functional class and the mean distance walked in the 6 minutes test were improved in patients treated with prostacyclin (p < 0,01). Serious complications attributable to the delivery system included 3 deaths, mainly due to infection., Conclusion: Continuous intravenous epoprostenol therapy improves survival and exercise capacity in patients with severe pulmonary arterial hypertension despite potentially serious complications attributable to the delivery system.

A patient with SLE whose initial manifestation was with a rare delirious disorder manifested as pseudocyesis is described. The psychiatric manifestations were considered to be due to SLE and treated with pulse steroid therapy. Special attention is focused on treatment and MRI.