Frailty assessment to individualize treatment in older patients with lymphoma.

PURPOSE: A study analyzing the application of a protocol of comprehensive geriatric assessment (CGA) in older patients with lymphoma was carried out to allow frailty-based patient classification and individualized treatment. METHODS: Lymphoma patients older than 70 years referred to the Geriatric Clinic at a tertiary hospital between May 2016 and March 2021 were included. The assessment protocol included comorbidity, polypharmacy, nutritional, functional, and mental status, geriatric syndromes, and life expectancy. CGA enabled patient classification into four groups (Type I to Type IV) based on frailty assessment instrument scoring and clinical, functional, and mental status. Variables were compared using parametric and non-parametric statistical tests and Kaplan-Meier survival curves. RESULTS: Ninety-three patients (55.9% women) were included. Median age was 81.1 years (± 5.7). 23 patients (24.7%) were classified as robust (type I), 30 (32.3%) as pre-frail (type II) with potentially reversable deficits, 38 (40.9%) as frail (type III), and 2 (2.2%) as requiring palliative care (type IV). Patients received oncospecific treatment with modifications carried out in 64.5% of cases based on CGA results. Differences in overall survival (p = 0.002), response to treatment (p < 0.001) and likelihood of increased frailty (p = 0.024) were observed, with type III-IV patients showing significantly worse outcomes. CONCLUSION: Performance of standardized, systematic CGA by geriatricians permits older lymphoma patients to be classified according to frailty, with significant differences in terms of clinical outcomes across groups. We propose incorporating CGA performed by geriatricians as part of the multidisciplinary care team to optimize therapeutic strategy for these patients.

Effect of Cognitive-Behavioral Therapy on Nocturnal Autonomic Activity in Patients with Fibromyalgia: A Preliminary Study.

Objective: fibromyalgia is a complex chronic pain syndrome characterized by widespread musculoskeletal pain, insomnia and autonomic alterations. Cognitive-behavioral therapy (CBT) is regarded as a promising treatment in fibromyalgia, but its impact on autonomic function remains uncertain. In this research, we studied the effect of CBT on autonomic functions in fibromyalgia. Methods: Twenty-five participants underwent overnight polysomnographic recordings before and after CBT programs focused on pain (CBT-P) or a hybrid modality focused on pain and insomnia (CBT-C). Sleep quality, daily pain, depression and anxiety were assessed by self-reported questionnaires. We analyzed heart rate variability (HRV) using high-frequency power (HF) as a marker for parasympathetic activity, and low-frequency power (LF) and the LF/HF ratio as relative sympathetic markers during wakefulness and at each sleep stage. Results: After treatment, 14 patients (/25, 58.0%) reported improvement in their sleep: 6 in the CBT-P condition (/12, 50%), and 8 in the CBT-C condition (/13, 61.5%). We found that, regardless of the type of CBT, patients who reported improvement in sleep quality (n = 14, 58%) had an increase in HF during stages N2 (p < 0.05) and N3 (p < 0.05). These changes were related to improvement in sleep quality (N2, r = −0.43, p = 0.033) but not to pain, depression or anxiety. Conclusions: This study showed an improvement in parasympathetic cardiac control during non-rapid-eye-movement sleep following CBT in fibromyalgia participants who reported better sleep after this therapy. CBT may have a cardio-protective effect and HRV could be used as a sleep monitoring tool in fibromyalgia.

Levels and trends of perfluoroalkyl acids (PFAAs) in water (2013-2020) and fish from selected riverine basins in Spain.

The aim of the present study was to assess the presence of perfluoroalkyl acids (PFAAs), namely perfluoroalkane sulfonates and perfluoroalkyl carboxylic acids, in Spanish river basins in order to: identify potential spatiotemporal variations; evaluate the effectiveness of the measures implemented for the reduction/elimination of these pollutants; verify the fulfillment of the Environmental Quality Standards (EQSs) in the European Union. PFOS and PFOA were determined in 116 water samples from four sites in the Duero basin, the largest in the Iberian Peninsula, collected seasonally from 2013 to 2020. In addition, 30 fish sample composites from the sample banks of Duero, Tagus, Ebro, Eastern Cantabrian and Catalonian basins were analyzed for 15 PFAAs. Median PFOS and PFOA concentrations were 0.72 and 0.42 ng/L, ranging from values below the limit of quantification (LOQ) to 81 and 22 ng/L, respectively. During the studied period, 51% of water samples were above the EQS of 0.65 ng/L for PFOS. In the case of fish, the PFOS range was

Fibromyalgia as a Heterogeneous Condition: Subgroups of Patients Based on Physical Symptoms and Cognitive-Affective Variables Related to Pain.

Fibromyalgia (FM) is a chronic syndrome characterized by heterogeneous clinical manifestations, and knowing this variability can help to develop tailored treatments. To understand better the heterogeneity of FM the present cross-sectional study analyzed the role of several physical symptoms (pain, fatigue and poor sleep quality) and cognitive-affective variables related to pain (pain catastrophizing, pain vigilance, self-efficacy in pain management, and pain acceptance) in the configuration of clinical profiles. A sample of 161 women with FM fulfilled an interview and several self-report measures to explore physical symptoms, cognitive-affective variables, disability and psychopathology. To establish FM groups a hierarchical cluster analysis was performed. The findings revealed three clusters that differed in the grouping variables, Wilks' λ = .17, F(14, 304) = 31.50, p < .001, ηp2 = .59. Group 1 (n = 72) was characterized by high physical and psychological affectation, Group 2 (n = 19) by low physical affectation and high pain self-efficacy, and Group 3 (n = 70) by moderate physical affectation and low pain catastrophizing. The external validation of the clusters was confirmed, Wilks' λ = .72, F(4, 314) = 14.09, p < .001, ηp2 = .15, showing Group 1 the highest levels of FM impact and psychopathological distress. Considering the distinctive clinical characteristics of each subgroup therapeutic strategies addressed to the specific needs of each group were suggested. Assessing FM profiles may be key for a better understanding and approach of this syndrome.

Psychopathology as a Moderator of the Relationship Between Physical Symptoms and Impairment in Fibromyalgia Patients.

BACKGROUND: Fibromyalgia (FM) is a chronic pain syndrome that is accompanied by notable psychological distress. However, little research has been done on how the psychopathological profile of FM patients may influence their functional status. METHOD: Using the Symptom Checklist-90-Revised the study examined the psychopathological dimensions of 181 women with FM, and the role of psychopathology as a moderator of the relationship between physical symptoms and impairment of functioning. RESULTS: FM patients exhibited T-scores above the cutoff point ≥60) in all dimensions, and 76.2% were identified as "clinical cases". Somatization was a significant predictor of pain intensity, somatization and obsession-compulsion contributed significantly to predicting poor sleep quality, while somatization, depression and anxiety were significant predictors of impairment. Psychopathology was a statistically significant moderator that increased the impact of poor sleep quality on impairment. CONCLUSIONS: The dysfunctional psychological style is key in the impairment associated with FM. The evaluation of psychopathological profiles can allow the early identification of the patients who are most vulnerable to impaired functioning due to the presence of possible psychopathology, as well facilitating therapeutic adaptations.

Psychopathology as a Moderator of the Relationship Between Physical Symptoms and Impairment in Fibromyalgia Patients / Psicopatología Como Moderador de la Relación Entre Síntomas Físicos y Discapacidad en Pacientes con Fibromialgia

Background: Fibromyalgia (FM) is a chronic pain syndrome that is accompanied by notable psychological distress. However, little research has been done on how the psychopathological profi le of FM patients may infl uence their functional status. Method: Using the Symptom Checklist90-Revised the study examined the psychopathological dimensions of 181 women with FM, and the role of psychopathology as a moderator of the relationship between physical symptoms and impairment of functioning. Results: FM patients exhibited T-scores above the cutoff point (≥ 60) in all dimensions, and 76.2% were identifi ed as “clinical cases”. Somatization was a signifi cant predictor of pain intensity, somatization and obsessioncompulsion contributed signifi cantly to predicting poor sleep quality, while somatization, depression and anxiety were signifi cant predictors of impairment. Psychopathology was a statistically signifi cant moderator that increased the impact of poor sleep quality on impairment. Conclusions: The dysfunctional psychological style is key in the impairment associated with FM. The evaluation of psychopathological profi les can allow the early identifi cation of the patients who are most vulnerable to impaired functioning due to the presence of possible psychopathology, as well facilitating therapeutic adaptations. (AU)

Antecedentes: la fibromialgia (FM) es un síndrome de dolor crónico que se acompaña de importante malestar psicológico. Sin embargo, se ha investigado poco cómo el perfi l psicopatológico de los pacientes con FM puede infl uir en su estado funcional. Método: utilizando el Cuestionario de Síntomas-90- Revisado, se examinaron las dimensiones psicopatológicas de 181 mujeres con FM, y el papel de la psicopatología como moderador de la relación entre síntomas físicos y deterioro del funcionamiento. Resultados: las pacientes presentaron puntuaciones-T superiores al punto de corte (≥ 60) en todas las dimensiones, siendo el 76,2% de ellas identifi cadas como “caso clínico”. La somatización fue un predictor signifi cativo de la intensidad del dolor, la somatización y la obsesión-compulsión contribuyeron signifi cativamente a predecir la mala calidad del sueño, y la somatización, la depresión y la ansiedad fueron predictores signifi cativos del deterioro. La psicopatología fue un moderador estadísticamente signifi cativo que intensifi có el impacto de la mala calidad del sueño sobre el deterioro. Conclusiones: el estilo psicológico disfuncional es clave en el deterioro asociado a la FM. La evaluación del perfil psicopatológico puede permitir la identifi cación precoz de los pacientes más vulnerables al deterioro funcional debido a la presencia de posible psicopatología, así como facilitar las adaptaciones terapéuticas. (AU)

Combined cognitive-behavioral therapy for fibromyalgia: Effects on polysomnographic parameters and perceived sleep quality / Terapia cognitivo-conductual combinada para la fibromialgia: efectos sobre parámetros polisomnográficos y calidad del sueño percibida

BACKGROUND/OBJECTIVE: Cognitive-behavioral therapy (CBT) is one of the first-line treatments in the management of fibromyalgia (FM) and it has been applied with considerable success to treat the psychological processes associated with pain and insomnia. We hypothesized that treating sleep and pain jointly with new combined modalities of CBT may offer greater sleep-related benefits to patients. METHOD: Thirty-nine female patients with FM and insomnia were randomly allocated to receive CBT centered on pain (CBT-P) or combined CBT focused on pain and insomnia (CBT-C). Participants were assessed at baseline and post-treatment with the Pittsburgh Sleep Quality Index and an ambulatory polysomnography. RESULTS: Participants who received CBT-P showed increases in time in bed and total sleep time and decreases in light sleep, but there was no improvement in perceived sleep quality. Participants who received combined CBT-C showed more meaningful improvements related to refreshing sleep (i.e., higher sleep efficiency and less time awake and longer time in Stage 4 sleep), and these changes were concordant with a significant improvement in self-perceived sleep quality. CONCLUSIONS: This study suggests that new CBT-C approaches can improve insomnia-related clinical aspects

ANTECEDENTES/OBJETIVO: La terapia cognitivo-conductual (TCC) es un tratamiento de primera línea para abordar la fibromialgia (FM) que se ha aplicado con cierto éxito para el tratamiento del dolor y el insomnio. Se hipotetiza que intervenir sobre el sueño y el dolor con una modalidad combinada de TCC (TCC-C) puede mejorar el sueño de estos pacientes. MÉTODO: Treinta y nueve mujeres con FM e insomnio fueron aleatorizadas para recibir TCC centrada en dolor (TCC-D) o TCC-C. Se evaluaron al inicio y en el post-tratamiento con el Índice de Calidad del Sueño de Pittsburgh y polisomnografía ambulatoria. RESULTADOS: Las participantes en la TCC-D mostraron aumentos del tiempo en cama y del tiempo total de sueño, y un descenso del sueño ligero, pero no hubo una mejora en la calidad del sueño percibida. Las participantes en la TCC-C mostraron mejoras significativas relacionadas con el sueño reparador (mayor eficiencia del sueño, menos tiempo de vigilia y más tiempo en fase 4 del sueño), y estos cambios fueron congruentes con una mejora en la calidad del sueño percibida. CONCLUSIONES: Este estudio sugiere que nuevos enfoques TCC-C en FM pueden mejorar aspectos clínicos relacionados con el insomnio

Combined cognitive-behavioral therapy for fibromyalgia: Effects on polysomnographic parameters and perceived sleep quality.

Background/Objective: Cognitive-behavioral therapy (CBT) is one of the first-line treatments in the management of fibromyalgia (FM) and it has been applied with considerable success to treat the psychological processes associated with pain and insomnia. We hypothesized that treating sleep and pain jointly with new combined modalities of CBT may offer greater sleep-related benefits to patients. Method: Thirty-nine female patients with FM and insomnia were randomly allocated to receive CBT centered on pain (CBT-P) or combined CBT focused on pain and insomnia (CBT-C). Participants were assessed at baseline and post-treatment with the Pittsburgh Sleep Quality Index and an ambulatory polysomnography.Results: Participants who received CBT-P showed increases in time in bed and total sleep time and decreases in light sleep, but there was no improvement in perceived sleep quality. Participants who received combined CBT-C showed more meaningful improvements related to refreshing sleep (i.e., higher sleep efficiency and less time awake and longer time in Stage 4 sleep), and these changes were concordant with a significant improvement in self-perceived sleep quality. Conclusions: This study suggests that new CBT-C approaches can improve insomnia-related clinical aspects.

Antecedentes/Objetivo: La terapia cognitivo-conductual (TCC) es un tratamiento de primera línea para abordar la fibromialgia (FM) que se ha aplicado con cierto éxito para el tratamiento del dolor y el insomnio. Se hipotetiza que intervenir sobre el sueño y el dolor con una modalidad combinada de TCC (TCC-C) puede mejorar el sueño de estos pacientes. Método: Treinta y nueve mujeres con FM e insomnio fueron aleatorizadas para recibir TCC centrada en dolor (TCC-D) o TCC-C. Se evaluaron al inicio y en el post-tratamiento con el Índice de Calidad del Sueño de Pittsburgh y polisomnografía ambulatoria. Resultados: Las participantes en la TCC-D mostraron aumentos del tiempo en cama y del tiempo total de sueño, y un descenso del sueño ligero, pero no hubo una mejora en la calidad del sueño percibida. Las participantes en la TCC-C mostraron mejoras significativas relacionadas con el sueño reparador (mayor eficiencia del sueño, menos tiempo de vigilia y más tiempo en fase 4 del sueño), y estos cambios fueron congruentes con una mejora en la calidad del sueño percibida. Conclusiones: Este estudio sugiere que nuevos enfoques TCC-C en FM pueden mejorar aspectos clínicos relacionados con el insomnio.

Clinical Manifestations of Trauma Exposure in Fibromyalgia: The Role of Anxiety in the Association Between Posttraumatic Stress Symptoms and Fibromyalgia Status.

Little research has investigated how traumatic experiences relate to fibromyalgia (FM). We explored the presence of trauma exposure in a sample of Spanish participants with FM and examined the associations between (a) the number and type of traumatic experiences and posttraumatic stress disorder (PTSD) symptoms and (b) the severity of clinical manifestations in FM, testing for possible mediation models. Participants were 173 FM patients and 53 healthy controls aged 24 to 66 years. Traumatic event type (physical trauma, physical and sexual abuse, psychological trauma), PTSD symptoms, pain intensity, sleep disturbance, anxiety, depression, coping style, and daily functioning were evaluated via self-report. Fibromyalgia patients reported a higher percentage of trauma exposure than controls, more traumatic experiences (mainly emotional and physical trauma), and more PTSD symptoms, Hedges' gs/Cohen's ds = 0.42-0.76. Most FM patients reported having experienced their most distressing traumatic experience and PTSD symptoms before FM diagnosis. PTSD symptom severity was associated with more pain, sleep disturbances, anxiety, depression, coping style, and functional impairment, rs = .23-.33, ps = .025-.008. A multiple mediation analysis showed a significant indirect effect of anxiety in the association between PTSD symptoms and daily functioning. In a subset of FM patients, PTSD symptoms were associated with major clinical symptoms. The results suggest future research should explore the effectiveness of trauma-focused therapy compared to standard cognitive behavioral therapy for these patients.

PLGA Nanoparticles for the Intraperitoneal Administration of CBD in the Treatment of Ovarian Cancer: In Vitro and In Ovo Assessment.

The intraperitoneal administration of chemotherapeutics has emerged as a potential route in ovarian cancer treatment. Nanoparticles as carriers for these agents could be interesting by increasing the retention of chemotherapeutics within the peritoneal cavity. Moreover, nanoparticles could be internalised by cancer cells and let the drug release near the biological target, which could increase the anticancer efficacy. Cannabidiol (CBD), the main nonpsychotropic cannabinoid, appears as a potential anticancer drug. The aim of this work was to develop polymer nanoparticles as CBD carriers capable of being internalised by ovarian cancer cells. The drug-loaded nanoparticles (CBD-NPs) exhibited a spherical shape, a particle size around 240 nm and a negative zeta potential (-16.6 ± 1.2 mV). The encapsulation efficiency was high, with values above 95%. A controlled CBD release for 96 h was achieved. Nanoparticle internalisation in SKOV-3 epithelial ovarian cancer cells mainly occurred between 2 and 4 h of incubation. CBD antiproliferative activity in ovarian cancer cells was preserved after encapsulation. In fact, CBD-NPs showed a lower IC50 values than CBD in solution. Both CBD in solution and CBD-NPs induced the expression of PARP, indicating the onset of apoptosis. In SKOV-3-derived tumours formed in the chick embryo model, a slightly higher-although not statistically significant-tumour growth inhibition was observed with CBD-NPs compared to CBD in solution. To sum up, poly-lactic-co-glycolic acid (PLGA) nanoparticles could be a good strategy to deliver CBD intraperitoneally for ovarian cancer treatment.

Immunodeficiency in a Patient with 22q11.2 Distal Deletion Syndrome and a p.Ala7dup Variant in the MAPK1 Gene.

The genetic basis for sporadic immunodeficiency in patients with 22q11.2 distal deletion syndrome is unknown. We report an adult with a type 1 (D-F) 22q11.2 distal deletion syndrome and recurrent severe infections due to herpes zoster virus, presenting mild T cell lymphopenia and diminished frequency of naive CD4+ T cells, but increased frequencies of central, effector, and terminally differentiated memory T cells. Antigen-specific CD4+ and CD8+ T cells to influenza, rotavirus, and SEB were conserved in the patient, but responses to tetanus toxoid were temporarily undetectable. Exomic sequencing identified the c.20_22dupCGG (NM_002745.4) variant in the remaining MAPK1 gene of the patient, which adds 1 alanine to the polyalanine amino-terminal tract of the protein (p.Ala7dup). The mother, unlike the father, was heterozygote for the variant. Western blot analysis with the patient's activated PBMCs showed a 91% reduction in the MAPK1 protein. Further studies will be necessary to determine whether or not the variant present in the remaining MAPK1 gene of the patient is pathogenic.

Phenotypic Characteristics and Copy Number Variants in a Cohort of Colombian Patients with VACTERL Association.

VACTERL association (OMIM 192350) is a heterogeneous clinical condition characterized by congenital structural defects that include at least 3 of the following features: vertebral abnormalities, anal atresia, heart defects, tracheoesophageal fistula, renal malformations, and limb defects. The nonrandom occurrence of these malformations and some familial cases suggest a possible association with genetic factors such as chromosomal alterations, gene mutations, and inherited syndromes such as Fanconi anemia (FA). In this study, the clinical phenotype and its relationship with the presence of chromosomal abnormalities and FA were evaluated in 18 patients with VACTERL association. For this, a G-banded karyotype, array-comparative genomic hybridization, and chromosomal fragility test for FA were performed. All patients (10 female and 8 male) showed a broad clinical spectrum: 13 (72.2%) had vertebral abnormalities, 8 (44.4%) had anal atresia, 14 (77.8%) had heart defects, 8 (44.4%) had esophageal atresia, 10 (55.6%) had renal abnormalities, and 10 (55.6%) had limb defects. Chromosomal abnormalities and FA were ruled out. In 2 cases, the finding of microalterations, namely del(15)(q11.2) and dup(17)(q12), explained the phenotype; in 8 cases, copy number variations were classified as variants of unknown significance and as not yet described in VACTERL. These variants comprise genes related to important cellular functions and embryonic development.

Intervención clínica desde la psicología motivacional en una gimnasta joven de alta competición / Clinical intervention from motivational psychology in a highly competitive young gymnast / Intervenção clínica da psicologia motivacional numa jovem ginasta de alta competição / Intervention clinique de la psychologie motivationnelle dans une jeune gymnaste de haute compétition

Resumen Objetivo: Comprobar si se producen mejoras en las variables psicológicas de bienestar psicológico, autoeficacia y autoestima, en una gimnasta joven, aplicando una intervención psicológica basada en el modelo de coaching motivacional "La Jirafa de Cantón" Se espera que las mejoras se reflejen en datos cuantitativos de cuestionarios que recoge dichas variables, así como de forma cualitativa mediante la valoración de la gimnasta sobre la intervención realizada y sus efectos. Materiales y Métodos: Se empleó un diseño de caso único, con una joven de 12 años que practica gimnasia rítmica. La demanda vino de su entrenadora, quien percibía riesgos para su bienestar y salud mental. Se utilizó una metodología de triangulación metodológica, al combinar aspectos cuantitativos (medición pre y post de bienestar psicológico, autoeficacia y autoestima) y análisis cualitativo de las sesiones. Se empleó un protocolo de intervención, diseñado para el modelo, con las fases de identificación, intervención y seguimiento. Se realizaron un total de 11 sesiones. Resultados: Los resultados cuantitativos muestran un aumento de la puntuación en los cuestionarios de bienestar psicológico, autoestima y autoeficacia, apoyado por el análisis cualitativo favorable de las respuestas de la paciente. Conclusión: La intervención realizada se ha mostrado eficaz para mejorar las variables psicológicas medidas, en la percepción de la deportista de su ejecución deportiva, y en las percepciones de sus progenitores y su entrenadora. Intervenciones de este tipo se estiman necesarias para prevenir riesgos para la salud mental, sobre todo en deportes tan exigentes como es la gimnasia rítmica.

Abstract Objective: To demonstrate if there are improvements in the psychological variables of psychological well-being, selfefficacy and self-esteem, in a young gymnast, applying a psychological intervention based on the motivational coaching model the "Cantón's Giraffe". It is expected that the improvements will be reflected in quantitative data of questionnaires that include these variables, as well as qualitatively by the evaluation of the gymnast on the intervention performed and its effects. Method: A unique case design was used, with a 12-year-old girl who practices rhythmic gymnastics. The demand came from his coach, who perceived risks to his well-being and mental health. A methodology of methodological triangulation was used, combining quantitative aspects (pre and post measurement of psychological well-being, self-efficacy and self-esteem) and qualitative analysis of the sessions. An intervention protocol was used, designed for the model, with the identification, intervention and follow-up phases. A total of 11 sessions were made. Results: The quantitative results show an increase in the scores in the psychological well-being, self-esteem and self-efficacy questionnaires, supported by the favorable qualitative analysis of the patient's responses. Conclusion: The intervention carried out has been shown to be effective in improving the psychological variables measured, in the athlete's perception of her sport performance, and in the perceptions of her parents and her coach. Interventions of this type are considered necessary to prevent risks to mental health, especially in sports as demanding as rhythmic gymnastics.

Resumo Objetivo: Verificar a existência de melhorias nas variáveis psicológicas de bem-estar psicológico, autoeficácia e autoestima, numa jovem ginasta, após aplicação de uma intervenção psicológica baseada no modelo de coaching motivacional "La Jirafa de Cantón". Espera-se que as melhorias se refletem quantitativamente nas variáveis dos questionários, bem como qualitativamente pela perspetiva da ginasta sobre a valorização da intervenção realizada e os seus efeitos. Método: Foi utilizado um estudo de caso único, com uma jovem de 12 anos que pratica ginástica rítmica. A solicitação veio da sua treinadora, que percebeu os riscos para o bem-estar e a saúde mental. Utilizou-se uma metodologia de triangulação metodológica, combinando aspetos quantitativos (pré e pós-mensuração do bem-estar psicológico, autoeficácia e autoestima) e análise qualitativa das sessões. Elaborou-se um protocolo de intervenção com base no modelo, com as fases de identificação, intervenção e acompanhamento. Realizaram-se no total 11 sessões. Resultados: Os resultados quantitativos mostram um aumento nos escores de bem-estar psicológico, autoestima e autoeficácia, apoiados pela análise qualitativa favorável das respostas da participante. Conclusão: A intervenção realizada mostrou-se eficaz na melhoria das variáveis psicológicas medidas, na perceção do desempenho desportivo da atleta e nas perceções de seus pais e da sua treinadora Intervenções deste tipo são consideradas necessárias para prevenir os riscos à saúde mental, especialmente nos desportos exigentes como é o caso da ginástica rítmica.

Résumé Objectif: Vérifier si des améliorations se produisent dans les variables du bien-être psychologique, l'auto-efficacité et l'estime de soi, chez un jeune gymnaste, à travers l'application d'une intervention psychologique basée sur le modèle de coaching motivationnel "La Jirafa de Cantón". Les améliorations devraient être reflétées dans les données quantitatives des questionnaires contenant ces variables, ainsi que qualitativement par l'évaluation de la gymnaste sur l'intervention réalisée et ses effets. Méthode: Un design de caisse unique a été utilisé, avec une fille de 12 ans qui pratique la gymnastique rythmique. La demande émanait de son entraîneur, qui percevait des risques pour son bien-être et sa santé mentale. Résultats: Les résultats quantitatifs montrent une augmentation du score dans les questionnaires sur le bien-être psychologique, l'estime de soi et l'efficacité personnelle, étayées par l'analyse qualitative favorable des réponses du patient. Conclusion: L'intervention réalisée s'est révélée efficace pour améliorer les variables psychologiques mesurées, dans la perception de l'athlète de sa performance sportive, et dans les perceptions de leurs parents et de leur entraîneur. Des interventions de ce type sont jugées nécessaires pour prévenir les risques pour la santé mentale, en particulier dans les sports aussi exigeants tels que la gymnastique rythmique.

Feohifomicosis cutánea por Exophiala oligosperma / Cutaneous phaeohyphomycosis caused by Exophiala oligosperma

No disponible

Mutational analysis of the LDLR gene in a cohort of Colombian families with familial hypercholesterolemia.

BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is characterized by elevated serum cholesterol levels due to high low-density lipoprotein (LDL) cholesterol levels. FH is an autosomal dominant genetic disorder and one of the most common dominant hereditary diseases in the world. However, the frequency of mutations in Colombia is unknown. The purpose of this preliminary study was to identify mutations in the LDL receptor (LDLR) gene in a Colombian population with FH. METHODS: The study included 24 families with clinical diagnosis of sure/probable FH. The 18 exons of the LDLR were sequenced by Sanger method. RESULTS: Among 18 variants identified, 3 were known pathogenic mutations and were identified in nine individuals in five unrelated families. Five affected individuals were heterozygous for one mutation each. They were the p.W4X in two, the p.D139G in two and the p.G396D in one. Two affected individuals were homozygous for p.G396D. The variant c.1187-1G > T, which has uncertain significance in FH pathogenesis, was present in all the individuals with the p.D139G mutation. CONCLUSIONS: In total, 18 variants were identified, of which 14 correspond to known nonpathogenic variants. Three pathogenic variants were identified in the LDLR. No pathological mutations were identified in the LDLR in 79% of the study population.

Catastrophizing, Acceptance, and Coping as Mediators Between Pain and Emotional Distress and Disability in Fibromyalgia.

Catastrophizing, acceptance, and coping have an important predictive value in chronic pain; however, it is not known which of these variables has the greatest contribution in fibromyalgia (FM). This study explored the mediating role of catastrophizing, acceptance, and coping in the relationship between pain and emotional distress/disability in a FM sample. Ninety-two FM patients and 51 healthy participants controls were evaluated on pain- and psychological-related variables. Catastrophizing, acceptance, behavioral coping, and emotional coping were significantly correlated with emotional distress and/or disability. Catastrophizing had a significant effect as a mediator on the relationship between pain and depression/anxiety. The current management of FM could improve by including cognitive techniques aimed at modifying the negative appraisal of pain.

Sleep quality, clinical and psychological manifestations in women with systemic lupus erythematosus.

AIM: Sleep problems are a common complaint in systemic lupus erythematosus (SLE) patients. We analyzed sleep quality with subjective and objective measures in a sample with SLE and its possible relationships with the main manifestations of the disease. METHODS: Twenty-one women with SLE and 20 healthy women participated in the study. All participants were evaluated with actigraphy for a week and they completed self-report instruments of sleep quality, quality of life, fatigue, anxiety, depression and perceived stress. Comparison analyses between the two groups were done using Chi-square and Student's t-tests. The association between sleep quality and the remaining variables was explored using Pearson correlation coefficients. RESULTS: SLE patients had higher fragmentation index in the actigraphic analysis and a perception of poorer sleep quality, more fatigue, anxiety and depression than the control group. Bivariate analyses showed that the perception of more sleep disturbance and daytime dysfunction was associated with a lower health-related quality of life, more fatigue, emotional discomfort and more perceived stress. Also, the fragmentation index in the actigraphy was significantly related to the perception of poorer quality of sleep. CONCLUSION: SLE women had a poorer sleep quality (objective and subjective). These alterations could play a modulatory role in clinical and psychological manifestations of the disease and affect the quality of life in this population. More research is needed to clarify these relations and to determine the potential benefits of interventions directed to improve sleep in the clinical managing of the patients with SLE.

Using Actigraphy and mHealth Systems for an Objective Analysis of Sleep Quality on Systemic Lupus Erythematosus Patients.

INTRODUCTION: Although sleep alterations can be an important factor contributing to the clinical state of Systemic Lupus Erythematosus, there are no studies to adequately assess sleep quality in this type of disease. OBJECTIVES: The aim of this work is to analyse the sleep quality of Systemic Lupus Erythematous (SLE) patients based on more objective information provided by actigraphy and mobile systems. The idea is to carry out a comprehensive study by analysing how environmental conditions and factors can affect sleep quality. METHODS: In traditional methods the information for assessing sleep quality is obtained through questionnaires. In this work, a novel method is proposed by combining these questionnaires that provide valuable but subjective information with actigraphy and a mobile system to collect more objective information about the patient and their environment. The method provides mechanisms to detect how sleep hygiene could be associated directly with the sleep quality of the subjects, in order to provide a custom intervention to SLE patients. Moreover, this alternative provides ease of use, and non-intrusive ICT (Information and Communication Technology) through a wristband and a mHealth system. The mHealth system has been developed for environmental conditions sensing. This consists of a mobile device with built-in sensors providing input data about the bedroom environment during sleep, and a set of services of the Environmental Monitoring System for properly managing the configuration, registration and fusion of those input data. In previous studies, this information has never been taken into account. However, the information could be relevant in the case of SLE patients. The sample is composed of 9 women with SLE and 11 matched controls with a mean age of 35.78 and 32.18, respectively. Demographic and clinical variables between SLE patients and healthy controls are compared using the Fisher exact test and the Mann-Whitney U test. Relationships between psychological variables, actigraphy measures, and variables related to environmental conditions are analysed with Spearman's rank correlation coefficient. RESULTS: The SLE group showed poorer sleep quality, and more pain intensity, fatigue and depression than the healthy controls. Significant differences between SLE women and healthy controls in measures of actigraphy were not found. However, the fusion of the measures of the environmental conditions that were collected by the mobile system and actigraphy, has shown that light, and more specifically temperature have a direct relation with several measures of actigraphy which are related to sleep quality. It should be emphasize this result because usually the sleep problems are assessment through self-reported measures which had not revealed this association. Moreover, there are no previous studies that analyse these aspects in bedroom environments of SLE patients directly from objective measures. CONCLUSIONS: The results indicate the need to complement the subjective evaluation of sleep with objective measures. The use of actigraphy in combination with a new mHealth system provides a complete assessment especially relevant to chronic conditions as SLE. Both systems incorporate this objective information directly from objective measures in a non-intrusive way. Moreover, the measures of bedroom environmental variables provide useful and relevant clinical information to assess what is happening daily and not occasionally. This could lead to more customized interventions and adapt the treatment to each individual.