Virtual reality to improve low-back pain and pelvic pain during pregnancy: a pilot RCT for a multicenter randomized controlled trial.

A significant proportion of women experience low back and pelvic pain during and after pregnancy, which can negatively impact their daily lives. Various factors are attributed to these complaints, and many affected women do not receive adequate healthcare. However, there is evidence to support the use of different physiotherapeutic interventions to alleviate these conditions. Virtual reality is a promising complementary treatment to physiotherapy, particularly in improving pain perception and avoidance. The primary objective of this study is to evaluate the efficacy of a four-week program combining VR and physiotherapy compared to standard physiotherapy in pregnant women with low back and pelvic pain, in terms of improving pain avoidance, intensity, disability, and functional level. The study also aims to investigate patient satisfaction with the VR intervention. This research will be conducted through a multi-center randomized controlled clinical trial involving pregnant patients residing in the provinces of Seville and Malaga with a diagnosis of low back and pelvic pain during pregnancy. The alternative hypothesis is that the implementation of a Virtual Reality program in combination with standard physiotherapy will result in better clinical outcomes compared to the current standard intervention, which could lead to the development of new policies and interventions for these pathologies and their consequences. Clinical trial registration: clinicaltrials.gov, identifier NCT05571358.

New-Onset Myasthenia Gravis Confirmed by Electrodiagnostic Studies After a Third Dose of SARS-CoV-2 mRNA-1273 Vaccine.

ABSTRACT: Coronavirus disease 2019 vaccine-related pathology is a rare occurrence with few reported cases. We report on a case of a 60-yr-old man experiencing symptoms of dysphagia, dysarthria, diplopia, and weakness with onset 6 days after receiving a third full dose of SARS-CoV-2 vaccine (mRNA-1273 vaccine) in August 2021, which he received outside of the Center for Disease Control recommended guidelines, at 4 mos after his second dose of the Moderna vaccination course in March 2021. The Food and Drug Administration Emergency Use Authorization for mRNA-1273 booster was established in October 2021.Over the next month, the patient's symptoms progressed including his inability to swallow, requiring hospitalization due to dehydration and malnutrition. Evaluation including laboratory prompted referral for electrodiagnostic studies consisting of repetitive nerve stimulation studies and needle electromyography, confirming a case of new onset bulbar myasthenia gravis.

Telerehabilitation Intervention in Patients with COVID-19 after Hospital Discharge to Improve Functional Capacity and Quality of Life. Study Protocol for a Multicenter Randomized Clinical Trial.

COVID-19 can cause important sequels in the respiratory system and frequently presents loss of strength, dyspnea, polyneuropathies and multi-organic affectation. Physiotherapy interventions acquire a fundamental role in the recovery of the functions and the quality of life. Regarding the recovery phases after hospital discharge, the current evidence available is very preliminary. Telerehabilitation is presented as a promising complementary treatment method to standard physiotherapy. The main objective of this research is to evaluate the effectiveness of a personalized telerehabilitation intervention after discharge from hospital for the improvement of functional capacity and quality of life compared to a program of health education and/or care in a rehabilitation center. As secondary objectives, to identify the satisfaction and perception of patients with the telerehabilitation intervention and the presence of barriers to its implementation, as well as to evaluate the cost-effectiveness from the perspective of the health system. This study protocol will be carried out through a single blind multicenter randomized clinical trial in the south of Spain. We hypothesize that the implementation of a telerehabilitation program presents results not inferior to those obtained with the current standard intervention. If the hypothesis is confirmed, it would be an opportunity to define new policies and interventions to address this disease and its consequences. Trial registration NCT04742946.

Efficacy, Feasibility, Adherence, and Cost Effectiveness of a mHealth Telerehabilitation Program in Low Risk Cardiac Patients: A Study Protocol.

Individual and group cardiac rehabilitation (CR) programs reduce cardiovascular morbidity and mortality by reducing recurrent events, improving risk factors, aiding compliance with drug treatment, and improving quality of life through physical activity and education. Home-based programs are equally effective in improving exercise capacity, risk factors, mortality, and health-related quality of life outcomes compared to hospital-based intervention. Cardio-telerehabilitation (CTR) programs are a supplement or an alternative to hospital rehabilitation programs providing similar benefits to usual hospital and home care. Despite this statement, implementation in the public and private healthcare environment is still scarce and limited. The main objective of this research was to evaluate the efficacy, feasibility, and adherence of a personalized eight-week mHealth telerehabilitation program in low-risk cardiac patients in the hospital of Melilla (Spain). The secondary aims were to investigate patient satisfaction, identify barriers of implementation and adverse events, and assess cost-effectiveness from a health system perspective. A study protocol for a single center prospective controlled trial was conducted at the Regional Hospital of Melilla (Spain), with a sample size of (n = 30) patients with a diagnosis of low-risk CVD with class I heart failure according to NYHA (New York Heart Association). Outcomes of this study, will add new evidence that could support the use of CTR in cardiac patients clinical guidelines.

The Effectiveness and Recommendation of Motor Imagery Techniques for Rehabilitation after Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Motor imagery (MI) reported positive effects in some musculoskeletal rehabilitation processes. The main objective of this study was to analyze the effectiveness of MI interventions after anterior cruciate ligament (ACL) reconstruction. A systematic review was conducted from November 2018 to December 2019 in PubMed, Scopus, Web of Science, The Cochrane Library, and Physiotherapy Evidence Database (PEDro). The methodological quality, degree of recommendation, and levels of evidence were analyzed. A total of six studies were included. Selected studies showed unequal results (positive and negative) regarding pain, anxiety, fear of re-injury, function, and activities of daily living. Regarding the range of motion, anthropometric measurements, and quality of life, the results were not conclusive. Muscle activation, strength, knee laxity, time to remove external support, and neurobiological factors showed some favorable results. Nevertheless, the results were based on a limited number of studies, small sample sizes, and a moderate-weak degree of recommendation. In conclusion, our review showed a broader view of the current evidence, including a qualitative assessment to implement MI after ACL surgery. There was no clear evidence that MI added to physiotherapy was an effective intervention after ACL surgery, although some studies showed positive results in clinical outcomes. More adequately-powered long-term randomized controlled trials are necessary.

[Vicissitudes of a humble inventor]. / Vicisitudes de un sencillo inventor.

Mechanized procedure for the treatment of female stress urinary incontinence. Retropubic fixation of the vagina with a stapler specifically designed, using the pubis' symphysis as the site for anchoring. We intend to demonstrate the physiopathologic rationale to achieve continence by anchoring the urethra. In our elementary conditions for research and development we could not design the suitable procedure, although the idea was presented to international companies. We summarize the development of the instrument until it was operative, filming one operation which was presented to the Hispanic-American Congress in Madrid 1992. The instrument was patented in the Spanish Office of Patents and Trademarks in July 1992 with the category of invention patent because there were no previous mechanized procedures for vaginal fixation.

Vicisitudes de un sencillo inventor / Vicissitudes of a humble inventor

Procedimiento mecanizado para el tratamiento de la Incontinencia Urinaria de Esfuerzo en la mujer. Fijación retropúbica de la vagina con una grapa disparada con grapadora diseñada con la forma apropiada, que utiliza la sínfisis del pubis como lugar de anclaje. Se pretende demostrar la razón fisiopatológica para devolver la continencia, por medio del anclaje de la uretra. En nuestras condiciones elementales de investigación y desarrollo no se pudo llegar a diseñar el procedimiento idóneo, aunque se presentó la idea mecanizada a Empresas de ámbito internacional. Se relata resumidamente el desarrollo del instrumento hasta conseguir hacerlo operativo, filmándose una intervención que se presentó al Congreso Hispanoamericano que se realizó en Madrid en 1992. El instrumento se patentó en la Oficina Española de Patentes y Marcas en julio de 1992 con categoría de Patente de Invención, al no existir antecedentes de procedimientos mecanizados para la fijación de la uretra a través de la vagina (AU)

Mechanized procedure for the treatment of female stress urinary incontinence. Retropubic fixation of the vagina with a stapler specifically designed, using the pubis’ symphysis as the site for anchoring. We intend to demonstrate the physiopathologic rationale to achieve continence by anchoring the urethra. In our elementary conditions for research and development we could not design the suitable procedure, although the idea was presented to international companies. We summarize the development of the instrument until it was operative, filming one operation which was presented to the Hispanic-American Congress in Madrid 1992. The instrument was patented in the Spanish Office of Patents and Trademarks in July 1992 with the category of invention patent because there were no previous mechanized procedures for vaginal fixation (AU)

Diagnosis of bladder cancer by analysis of urinary fibronectin.

OBJECTIVES: To evaluate the diagnostic efficacy of the analysis of fibronectin in the urine samples of patients with bladder cancer. METHODS: The study included 123 subjects: one group of 68 patients with bladder cancer confirmed by transurethral resection; a second group of 10 patients with benign urologic disease, and a third group of 45 healthy subjects. We carried out the analysis of bladder tumor fibronectin (BTF), cytology, and creatinine in urine, and calculated the BTF/creatinine (BTF/CREA) ratio. For the determination of BTF, we used a solid-phase chemoluminescent immunometric test. RESULTS: The receiver operating characteristic curves showed an optimal cutoff point of 25.6 microg/L and 36.9 microg/g for BTF and the BTF/CREA ratio, respectively, with a sensitivity of 78% and 75%, respectively, and specificity of 80% for both. The sensitivity of urinary cytology was only 55%, but the specificity was 100%. The patients with bladder cancer had significantly greater levels of BTF and the BTF/CREA ratio than did the healthy subjects (P <0.001) and, in the case of BTF without correcting for creatinine, than did the patients with benign urologic disease (P <0.05). We also found significant differences in the levels of BTF and the BTF/CREA ratio among tumor stages, degree of differentiation, tumor size, multifocal nature, and macroscopic appearance. CONCLUSIONS: Determination of fibronectin could be a useful test in the diagnosis of bladder tumors. The association between BTF and all known prognostic parameters implies its potential value in making therapeutic decisions. Nevertheless, the utility of BTF needs to be studied in a wider way in the presence of other pathologic features concurrent with bladder cancer.

Is it necessary to shave the pubic and genital regions of patients undergoing endoscopic urological surgery?

To determine whether postoperative urinary infections were related to shaving before undergoing endoscopic urological surgery, 90 patients were randomly assigned to shaving or not shaving. Urinary cultures revealed infection in 10 patients. Half of them had been shaved, suggesting that this practice does not affect the incidence of urinary infections.

[Spontaneous pre-vesical haematoma in a patient under anticoagulant treatment]. / Hematoma prevesical espontáneo en una paciente descoagulada.

OBJECTIVES: To report a case of perivesical hematoma without previous trauma in a patient under anticoagulant treatment. METHODS: A 70-year-old female admitted with a transitory ischemic cerebrovascular accident was given sodium heparin. Four days later she presented with abdominal distention and hypogastric discomfort. Abdominal ultrasound showed a big perivesical hematoma. RESULTS: CT scan confirmed the presence of a big hematoma. The hematoma was drained five days later after an optimal coagulation profile. Patient was discharged with normal ultrasound after an uneventful postoperative course. CONCLUSIONS: Spontaneous bleeding in patients with coagulation abnormalities is a well-known event, although there are few bibliographic references about primary perivesical blood collections. We opted for deferred drainage of the hematoma to avoid perivesical fibrosis.

Hematoma prevesical espontáneo en una paciente descoagulada / Spontaneous prevesical haematoma in a patient under anticoagulant treatment

OBJETIVO: Se presenta un caso de hematoma prevesical sin traumatismo previo en una paciente sometida a tratamiento anticoagulante. MÉTODO: Mujer de 70 años de edad que ingresó por un episodio isquémico cerebral transitorio, administrándole heparina sódica. A los cuatro días presentó distensión abdominal con molestias en hipogastrio. Una ecografía abdominal reveló la presencia de un gran hematoma prevesical. RESULTADOS: Se realizó estudio con TAC que confirmó la presencia de un gran hematoma. Se realizó drenaje del hematoma a los 5 días con una coagulación óptima. Postoperatorio sin incidentes, con ecografía al alta normal. CONCLUSIONES: El sangrado espontáneo en pacientes con alteración de la coagulación es una eventualidad conocida, aunque existen pocas referencias sobre colecciones primarias en el espacio prevesical. Ante la posibilidad de aparición de fibrosis perivesical se optó por un drenaje diferido del hematoma (AU)

Enfermedad mestastásica de larga evolución en el adenocarcinoma renal. Afectación suprarrenal / Adrenal metastasis from renal cell carcinoma with long survival

OBJETIVOS: Exponer dos casos de enfermedad metastásica suprarrenal metacrónica (en un caso contralateral y en otro bilateral) por adenocarcinoma renal de células claras, con larga evolución cronológica de las recidivas. MÉTODO: Se analiza el curso durante 8 años de dos casos clínicos de enfermedad metastásica limitada por adenocarcinoma renal de células claras que desarrollaron metástasis suprarrenal, así como el seguimiento y las múltiples cirugías por metástasis única de las que han sido tributarios en este tiempo (3 por cada caso). Se analiza la indicación quirúrgica de la metástasis solitaria, la morbilidad, el pronóstico y se evalúan respecto a la literatura posibilidad de últimos tratamientos al efecto en estos casos, hoy en día aún en el ámbito de la investigación. RESULTADOS: La exéresis de la metástasis solitaria por el adenocarcinoma de células renales en estos casos ha proporcionado una supervivencia de más de 8 años con una buena calidad de vida. No se presentaron complicaciones quirúrgicas significativas. El pronóstico final es ominoso. CONCLUSIONES: En un caso, la demostración de no existencia de afectación linfática y la no extensión fuera del parénquima renal del tumor, no eximió de la aparición de metástasis única pulmonar cuatro años después, ni de afectación suprarrenal contralateral a los 8 años del diagnóstico inicial. En el otro caso, la infiltración de la vena renal en la exéresis del tumor primitivo nos ha de hacer pensar en la posibilidad a largo plazo de metástasis suprarrenal por su común asociación, demostrándose tres años después en la suprarrenal contralateral. La no realización de la suprarrenalectomía en la primera cirugía (tumor renal derecho de polo inferior) involucró metástasis suprarrenal a los 8 años del diagnóstico inicial. En ambos casos el pronóstico es infausto para el paciente y la situación desalentadora para el urólogo (AU)