Validación de la escala EDMUR, una herramienta para cuantificar la evolución de la disfagia neurógena / Validation of the EDMUR scale, a tool to quantify the evolution of neurogenic dysphagia

Introducción: la disfagia es un síntoma frecuente y grave en las personas con daño cerebral y se necesita una herramienta que permita cuantificar y objetivar su evolución. Objetivo: desarrollar y validar una herramienta que mida la evolución de la disfagia en un paciente con daño cerebral adquirido a fin de facilitar la toma de decisiones durante el tratamiento multidisciplinar. Métodos: estudio retrospectivo que consta de dos fases con el objetivo de desarrollar una nueva herramienta. En la primera se desarrolla el instrumento y en la segunda se estudian las propiedades psicométricas tras su aplicación a 83 pacientes, la validez de contenido, la validez convergente, la validez de grupos conocidos, la fiabilidad y la sensibilidad al cambio. Resultados: se obtuvo la escala EDMUR, un instrumento compuesto por 5 dominios y 46 ítems. Tras el juicio de expertos, todos los ítems propuestos en la fase de diseño de la escala alcanzaron los valores mínimos de V de Aiken y CRV´. El valor de la alfa de Cronbach (α) mostró una buena consistencia interna. La correlación entre la escala FOIS y la EDMUR, obtenida a través del coeficiente de Spearman (rho), fue directa y significativa. La prueba H de Kruskal-Wallis reveló diferencias estadísticamente significativas entre todos los grupos establecidos según los niveles de la FOIS. Para la sensibilidad interna se empleó la suma de rangos con signo de Wilcoxon, obteniéndose una diferencia significativa entre las dos valoraciones. La sensibilidad externa de la escala obtuvo una correlación directa y significativa. Conclusiones: la escala EDMUR es una herramienta fiable, válida y sensible para la cuantificación de la evolución de la disfagia, mejorando la calidad de los tratamientos.(AU)

Introduction: dysphagia is a frequent and serious symptom in people with brain damage and a tool is needed to quantify and objectify its evolution. Objective: to develop and validate an instrument to measure the evolution of dysphagia in a patient with acquired brain damage in order to facilitate decision-making during multidisciplinary treatment. Methods: a longitudinal, retrospective cross-sectional study that consists of two phases with the aim of developing a new tool. In the first phase the instrument is developed and in the second psychometric properties, after application to 83 patients, is analyzed together with content validity, convergent validity, validity of known groups, reliability, and sensitivity to change. Results: an instrument, the EDMUR scale, composed of 5 domains and 46 items was obtained. After expert judgment, all the items proposed in the scale design phase reached the minimum values of Aiken's V and CRV'. Cronbach's alpha (〈) showed a good internal consistency. The correlation between the FOIS scale and the EDMUR obtained through Spearman's coefficient (rho) was direct and significant. The Kruskal-Wallis H-test revealed statistically significant differences between all the groups established according to the levels of the FOIS. For internal sensitivity, the Wilcoxon signed rank sum test was used, obtaining a significant difference between the two assessments. The external sensitivity of the scale obtained a direct and significant correlation. Conclusions: the EDMUR scale is a reliable, valid, and sensitive instrument for quantifying the evolution of dysphagia, thus improving the quality of treatments (AU)

[Validation of the EDMUR scale, a tool to quantify the evolution of neurogenic dysphagia]. / Validación de la escala EDMUR, una herramienta para cuantificar la evolución de la disfagia neurógena.

Introduction: Introduction: dysphagia is a frequent and serious symptom in people with brain damage and a tool is needed to quantify and objectify its evolution. Objective: to develop and validate an instrument to measure the evolution of dysphagia in a patient with acquired brain damage in order to facilitate decision-making during multidisciplinary treatment. Methods: a longitudinal, retrospective cross-sectional study that consists of two phases with the aim of developing a new tool. In the first phase the instrument is developed and in the second psychometric properties, after application to 83 patients, is analyzed together with content validity, convergent validity, validity of known groups, reliability, and sensitivity to change. Results: an instrument, the EDMUR scale, composed of 5 domains and 46 items was obtained. After expert judgment, all the items proposed in the scale design phase reached the minimum values of Aiken's V and CRV'. Cronbach's alpha (α) showed a good internal consistency. The correlation between the FOIS scale and the EDMUR obtained through Spearman's coefficient (rho) was direct and significant. The Kruskal-Wallis H-test revealed statistically significant differences between all the groups established according to the levels of the FOIS. For internal sensitivity, the Wilcoxon signed rank sum test was used, obtaining a significant difference between the two assessments. The external sensitivity of the scale obtained a direct and significant correlation. Conclusions: the EDMUR scale is a reliable, valid, and sensitive instrument for quantifying the evolution of dysphagia, thus improving the quality of treatments.

Introducción: Introducción: la disfagia es un síntoma frecuente y grave en las personas con daño cerebral y se necesita una herramienta que permita cuantificar y objetivar su evolución. Objetivo: desarrollar y validar una herramienta que mida la evolución de la disfagia en un paciente con daño cerebral adquirido a fin de facilitar la toma de decisiones durante el tratamiento multidisciplinar. Métodos: estudio retrospectivo que consta de dos fases con el objetivo de desarrollar una nueva herramienta. En la primera se desarrolla el instrumento y en la segunda se estudian las propiedades psicométricas tras su aplicación a 83 pacientes, la validez de contenido, la validez convergente, la validez de grupos conocidos, la fiabilidad y la sensibilidad al cambio. Resultados: se obtuvo la escala EDMUR, un instrumento compuesto por 5 dominios y 46 ítems. Tras el juicio de expertos, todos los ítems propuestos en la fase de diseño de la escala alcanzaron los valores mínimos de V de Aiken y CRV´. El valor de la alfa de Cronbach (α) mostró una buena consistencia interna. La correlación entre la escala FOIS y la EDMUR, obtenida a través del coeficiente de Spearman (rho), fue directa y significativa. La prueba H de Kruskal-Wallis reveló diferencias estadísticamente significativas entre todos los grupos establecidos según los niveles de la FOIS. Para la sensibilidad interna se empleó la suma de rangos con signo de Wilcoxon, obteniéndose una diferencia significativa entre las dos valoraciones. La sensibilidad externa de la escala obtuvo una correlación directa y significativa. Conclusiones: la escala EDMUR es una herramienta fiable, válida y sensible para la cuantificación de la evolución de la disfagia, mejorando la calidad de los tratamientos.

Secuelas del daño cerebral adquirido, estudio sobre las necesidades terapéuticas / Sequelae of acquired brain damage, study of therapeutic needs

Objetivos: conocer la etiología más común del daño cerebral adquirido, calcular el porcentaje de pacientes que necesitan neurorrehabilitación y examinar la sintomatología relacionada con el área de logopedia, permitiendo justificar la importancia de este profesional en el ámbito de la rehabilitación neurológica. Pacientes y método: en este estudio se realizó un análisis de los pacientes con alteraciones neurológicas ingresados en un hospital de media estancia, entre el 1 de enero de 2011 y el 1 de enero del 2017. Todos los pacientes eran mayores de 18 años, de ambos sexos, con daño cerebral adquirido. La muestra fue obtenida a través del software de gestión asistencial del Centro Hospitalario Benito Menni de Valladolid, seleccionando las unidades dedicadas a la rehabilitación: convalecencia y daño cerebral, leyendo cada historia para conocer las secuelas y la rehabilitación recibida. Resultados: del total de pacientes ingresados en este periodo 480 presentaban alteraciones neurológicas, de los cuales 39 fallecieron antes de recibir rehabilitación por su grave estado, y 10 empeoraron debiendo cesar las terapias. Finalmente, un 89.7% recibieron rehabilitación, presentando trastornos motores relacionados con los miembros superiores e inferiores en un 90.8%, un 39.8% problemas deglutorios y las alteraciones de la comunicación en un 39.6% de la muestra. La etiología del problema neurológico más común, con un 56.5%, fue el ictus isquémico, seguido del hemorrágico en un 16.9% de los casos y de los traumatismos craneoencefálicos en un 15.6%. Conclusión: la etiología más relevante dentro de un centro de media estancia es el ictus isquémico. Las secuelas más significativas son los trastornos motores, seguidos de los problemas deglutorios y de comunicación. El logopeda es un profesional destacado en la rehabilitación del paciente neurológico, debido a los porcentajes y relevancia de los síntomas tratados desde esta área. Es necesario establecer un método de evaluación de los pacientes con daño cerebral, fiable, estandarizado y validado

Objectives: to know the most common etiology of acquired brain damage, calculate the percentage of patients who need neurorehabilitation and examine the symptoms related to the area of speech therapy allowing to justify the importance of this professional in the field of neurological rehabilitation. Patients and method: in this study, an analysis of the patients with neurological alterations admitted to a half-stay hospital was carried out between January 1, 2011 and January 1, 2017. All patients were over 18 years old, of both sexes, with acquired brain damage. The sample was obtained through the care management software of the Centro Hospitalario Benito Menni in Valladolid, selecting the units active in rehabilitation: convalescence and brain damage, reading each story to know the sequelae and the rehabilitation received. Results: of the total number of patients admitted in this period, 480 presented neurological alterations, of which 39 patients died before receiving rehabilitation due to their serious condition, and 10 patients worsened due to the cessation of therapies. Finally, 89.7% received rehabilitation, presenting motor disorders related to the upper and lower limbs in 90.8%, 39.8% swallowing problems and communication alterations in 39.6% of the sample. The etiology of the most common neurological problem with 56.5% was ischemic stroke, followed by hemorrhagic in 16.9% of the cases and traumatic brain injuries in 15.6%. Conclusion: ischemic stroke is the most relevant etiology within a half-stay center. The most significant sequelae are motor disorders, followed by swallowing and communication problems. The speech therapist is a prominent professional in the rehabilitation of the neurological patient, due to the percentages and relevance of the symptoms treated in this area. It is necessary to establish a method of evaluating patients with brain damage, reliable, standardized and validated

The genetic audiogenic seizure hamster from Salamanca: The GASH:Sal.

The hamster has been previously described as a paroxysmal dystonia model, but our strain is currently recognized as a model of audiogenic seizures (AGS). The original first epileptic hamster appeared spontaneously at the University of Valladolid, where it was known as the GPG:Vall line, and was transferred to the University of Salamanca where a new strain was developed, named GASH:Sal. By testing auditory brainstem responses, the GASH:Sal exhibits elevated auditory thresholds that indicate a hearing impairment. Moreover, amplified fragment length polymorphism analysis distinguished genetic differences between the susceptible GASH:Sal hamster strain and the control Syrian hamsters. The GASH:Sal constitutes an experimental model of reflex epilepsy of audiogenic origin derived from an autosomal recessive disorder. Thus, the GASH:Sal exhibits generalized tonic-clonic seizures, characterized by a short latency period after auditory stimulation, followed by wild running, a convulsive phase, and finally stupor, with origin in the brainstem. The seizure profile of the GASH:Sal is similar to those exhibited by other models of inherited AGS susceptibility, which decreases after six months of age, but the proneness across generations is maintained. The GASH:Sal can be considered a reliable model of audiogenic seizures, suitable to investigate current antiepileptic pharmaceutical treatments as well as novel therapeutic drugs. This article is part of a Special Issue entitled "Genetic and Reflex Epilepsies, Audiogenic Seizures and Strains: From Experimental Models to the Clinic".

Decreased levels of GABA in the inferior colliculus of the epilepsy-prone hamster (GPG/Vall).

Abnormalities in GABA levels in the central nucleus of the inferior colliculus (CNIC) of the epilepsy-prone hamster (GPG/Vall) were evaluated by using immunohistochemistry, densitometry and high performance liquid chromatography (HPLC). These findings demonstrate a decrease both in GABA immunostaining (neuropil and neurons) and in GABA concentration (HPLC) in the CNIC of the epileptic hamster compared to control animals. These decreases may reflect a reduced availability of this neurotransmitter that may act as an audiogenic seizure-initiating factor.

TrkC: a new predictive marker in breast cancer?

Available data involve neurotrophins and their receptors in carcinomas. Quantitative evaluation of these molecules in these tumors might be useful as prognostic marker and eventual treatments. Our study on 40 mammary tumors tries to correlate expression of these molecules and prognosis. Immunohistochemistry for NGF, BDNF, NT3, TrkA, TrkB, TrkC, and p75 was used. Patient's age, histopathology, Bloom-Richardson grading, estrogen and progesterone receptors, Ki-67 index, HER-2, p53 were evaluated. Statistics found inverse relationship between grading and TrkC expression. We found significantly higher TrkC expression in Grade I than in Grade III tumors. Rise in TrkC expression could indicate good prognosis.

Morphologic and neurochemical alterations in the superior colliculus of the genetically epilepsy-prone hamster (GPG/Vall).

The GPG/Vall hamster is an animal model that exhibits seizures in response to sound stimulation. Since the superior colliculus (SC) is implicated in the neuronal network of audiogenic seizures (AGS) in other forms of AGS, this study evaluated seizure-related anatomical or neurochemical abnormalities in the SC of the GPG/Vall hamster. This involved calbindin (CB) and parvalbumin (PV) immunohistochemistry, densitometric analysis and high performance liquid chromatography in the superficial and deep layers of the SC in control and epileptic animals. Compared to control animals, a reduction in SC volume and a hypertrophy of neurons located in the deep layers of the SC were observed in the epileptic hamster. Although, analysis of CB-immunohistochemistry in the superficial layers did not show differences between groups, analysis of PV-immunostaining in the deep SC revealed an increase in the mean gray level within immunostained neurons as well as a decreased immunostained neuropil in the GPG/Vall hamster as compared to control animals. These alterations were accompanied by a decrease in the levels of GABA and increased levels of taurine in the epileptic animal. These data indicate that the deep SC of the GPG/Vall hamster is structurally abnormal; suggesting its involvement in the neuronal network for AGS.

Morphologic and neurochemical abnormalities in the auditory brainstem of the genetically epilepsy-prone hamster (GPG/Vall).

PURPOSE: This study was performed to evaluate whether audiogenic seizures, in a strain of genetically epilepsy-prone hamsters (GPG/Vall), might be associated with morphologic alterations in the cochlea and auditory brainstem. In addition, we used parvalbumin as a marker of neurons with high levels of activity to examine changes within neurons. METHODS: Cochlear histology as well as parvalbumin immunohistochemistry were performed to assess possible abnormalities in the GPG/Vall hamster. Densitometry also was used to quantify levels of parvalbumin immunostaining within neurons and fibers in auditory nuclei. RESULTS: In the present study, missing outer hair cells and spiral ganglion cells were observed in the GPG/Vall hamster. In addition, an increase was noted in the size of spiral ganglion cells as well as a decrease in the volume and cell size of the cochlear nucleus (CN), the superior olivary complex nuclei (SOC), and the nuclei of the lateral lemniscus (LL) and the inferior colliculus (IC). These alterations were accompanied by an increase in levels of parvalbumin immunostaining within CN, SOC, and LL neurons, as well as within parvalbumin-immunostained fibers in the CN and IC. CONCLUSIONS: These data are consistent with a cascade of atrophic changes starting in the cochlea and extending along the auditory brainstem in an animal model of inherited epilepsy. Our data also show an upregulation in parvalbumin immunostaining in the neuropil of the IC that may reflect a protective mechanism to prevent cell death in the afferent sources to this nucleus.