[Rapidly progressive intracranial large artery aterosclerosis, a rare stroke etiology]. / Arterioesclerosis intracraneal rápidamente progresiva, una rara etiología de ictus.

INTRODUCTION: Intracranial atheromatosis is one of the most frequent causes of stroke. It is usually a slowly progressive process and normally associated with the sum of vascular risk factors. CASE REPORT: In this case we present a rapidly progressive development of intracranial atheromatosis demonstrated by serial neuroimaging techniques and sample analysis in a 72-year-old female patient with high levels of interleukin-6 and C-reactive protein, with no signs of vasculitis. CONCLUSION: Rapidly progressive intracranial atheromatosis should be considered in adult patients over 50 years of age with recurrent stroke.

TITLE: Arterioesclerosis intracraneal rápidamente progresiva, una rara etiología de ictus.Introducción. La ateromatosis intracraneal es una de las causas más frecuentes de ictus. Suele ser un proceso lentamente progresivo y normalmente asociado a la suma de factores de riesgo vascular. Caso clínico. En este caso presentamos una evolución rápidamente progresiva de la ateromatosis intracraneal demostrada por técnicas de neuroimagen seriadas y análisis de la muestra en una paciente de 72 años con niveles altos de interleucina-6 y proteína C reactiva, sin signos de vasculitis. Conclusión. La ateromatosis intracraneal rápidamente progresiva se debe tener en cuenta en pacientes adultos mayores de 50 años con ictus de repetición.

Arterioesclerosis intracraneal rápidamente progresiva, una rara etiología de ictus / Rapidly progressive intracranial large artery aterosclerosis, a rare stroke etiology

Introducción: La ateromatosis intracraneal es una de las causas más frecuentes de ictus. Suele ser un proceso lentamente progresivo y normalmente asociado a la suma de factores de riesgo vascular. Caso clínico: En este caso presentamos una evolución rápidamente progresiva de la ateromatosis intracraneal demostrada por técnicas de neuroimagen seriadas y análisis de la muestra en una paciente de 72 años con niveles altos de interleucina-6 y proteína C reactiva, sin signos de vasculitis. Conclusión: La ateromatosis intracraneal rápidamente progresiva se debe tener en cuenta en pacientes adultos mayores de 50 años con ictus de repetición.(AU)

Introduction: Intracranial atheromatosis is one of the most frequent causes of stroke. It is usually a slowly progressive process and normally associated with the sum of vascular risk factors. Case report: In this case we present a rapidly progressive development of intracranial atheromatosis demonstrated by serial neuroimaging techniques and sample analysis in a 72-year-old female patient with high levels of interleukin-6 and C-reactive protein, with no signs of vasculitis. Conclusion: Rapidly progressive intracranial atheromatosis should be considered in adult patients over 50 years of age with recurrent stroke.(AU)

Randomized trial of individual reminiscence therapy for older adults with cognitive impairment: a 3-month responder analysis. / Ensayo aleatorio de terapia de reminiscencia individual para adultos mayores con deterioro cognitivo: un análisis de respuesta de tres meses.

INTRODUCTION: Non-pharmacological intervention options, including individual reminiscence therapy (iRT), have been effective in improving cognitive functioning, mood, and quality of life (QoL) in persons with neurocognitive disorders (NCD). OBJECTIVES: A 13-week randomized trial intervention utilizing iRT was conducted on older adults with NCD. We explored predictors of participants with positive and non-positive intervention responses using responder analysis, an analytic strategy that focuses on contributors to intervention response. PATIENTS AND METHODS: Re-analysis of a published single-blind, multicentre, randomised controlled trial on 251 older adult residents with NCD from residential facilities across Portugal. Participants received 13 weeks of biweekly iRT (26 sessions) or treatment/programming as usual. Outcomes included global cognition (Minimental State Examination), memory (MAT), executive functioning (FAB), depressive symptoms (GDS-15), and QoL (QoL-AD). RESULTS: There were more responders in the intervention than the control group on all five criteria, with significant differences for cognition (p = 0.001; f = 0.202; NNT = 5) and memory (p = 0.004; f = 0.184; NNT = 6). At baseline, intervention responders vs non-responders had: higher QoL-AD scores (30.23 vs 25.57; p < 0.001; d = -0.774) for cognition; lower FAB scores (1.41 vs -2.12; p < 0.001; d = 0.928) for executive functioning; higher GDS-15 scores for the depressive symptoms (7.57 vs 4.91; p < 0.001; d = -0.845), and for QoL (6.81 vs 5.33; p = 0.013; d = -0.443). CONCLUSIONS: The iRT intervention showed high response rates for cognition and memory. Those with worse executive dysfunction, mood, and QoL, benefitted most from the intervention for those respective outcomes. Therefore, the presented iRT has beneficial effects for people with NCD, with mood and QoL as important influential factors.

TITLE: Ensayo aleatorio de terapia de reminiscencia individual para adultos mayores con deterioro cognitivo: un análisis de respuesta de tres meses.Introducción. La terapia de reminiscencia individual (iTR) ha demostrado mejorar la cognición, el estado de ánimo y la calidad de vida (CdV) de personas con trastornos neurocognitivos (TNC). Objetivo. Se exploraron los predictores de la respuesta positiva a la iTR utilizando el análisis de respuesta, una estrategia analítica de los factores que contribuyen a una respuesta a la intervención. Pacientes y métodos. Reanálisis de un ensayo controlado aleatorizado de 251 adultos mayores portugueses con TNC. Los participantes recibieron dos sesiones de iTR durante 13 semanas (26 sesiones) o el tratamiento habitual. Las variables analizadas fueron la cognición global (Minimental State Examination), la memoria (test de alteración de la memoria), el funcionamiento ejecutivo ­batería de evaluación frontal (FAB)­, los síntomas depresivos ­escala de depresión geriátrica-15 (GDS-15)­ y la CdV ­escala de calidad de vida en la enfermedad de Alzheimer (QOL-AD)­. Resultados. Hubo más respondedores en el grupo de intervención que en el de control en los cinco criterios, con diferencias significativas para cognición (p = 0,001; f = 0,202; número necesario para tratar = 5) y memoria (p = 0,004; f = 0,184; número necesario para tratar = 6). En la línea de base, los respondedores tenían: puntuaciones más altas de QOL-AD (30,23 frente a 25,57; p menor de 0,001; d = ­0,774) para la cognición; puntuaciones FAB más bajas (1,41 frente a ­2,12; p menor de 0,001; d = 0,928) para el funcionamiento ejecutivo; y mayores puntuaciones en la GDS-15 para los síntomas depresivos (7,57 frente a 4,91; p menor de 0,001; d = ­0,845) y para la CdV (6,81 frente a 5,33; p = 0,013; d = ­0,443). Conclusiones. La iTR mostró altas tasas de respuesta para la cognición y la memoria. Los que tienen peor función ejecutiva, estado de ánimo y CdV se beneficiaron más de la intervención para esas respectivas variables. La iTR tiene efectos beneficiosos en los TNC, con el estado de ánimo y la CdV como factores influyentes.

Síntomas neuropsiquiátricos en personas con demencia relacionados con el confinamiento por la pandemia de la COVID-19. Revisión sistemática exploratoria / Neuropsychiatric symptoms in people living with dementia related to COVID-19 pandemic lockdown. Exploratory systematic review

Introducción: En pacientes con deterioro cognitivo leve y demencia, son frecuentes los síntomas neuropsiquiátricos, que pueden aparecer o exacerbarse ante los cambios en la rutina y el entorno habitual del paciente. La situación de confinamiento durante la pandemia de la COVID-19 ha supuesto un cambio en la vida cotidiana de la población general, con especial impacto en los grupos más vulnerables, como los pacientes con afectación cognitiva. Objetivo: Conocer la repercusión de las medidas de confinamiento y cuarentena impuestas por la pandemia de la COVID-19 en la sintomatología neuropsiquiátrica en personas con deterioro cognitivo leve (DCL) y demencia. Materiales y métodos: Revisión sistemática exploratoria, siguiendo las directrices PRISMA, de artículos en las bases datos PubMed y PsycINFO publicados entre enero de 2020 y abril de 2021, que relacionaron el confinamiento por la COVID-19 con la presentación o el empeoramiento de síntomas neuropsiquiátricos en pacientes con DCL o con demencia. Resultados: Se observó un empeoramiento de los síntomas neuropsiquiátricos en los pacientes con demencia y DCL, especialmente agitación/agresión, ansiedad, depresión y apatía. Los síntomas neuropsiquiátricos fueron más comunes en los pacientes con demencia que en los que presentaban DCL, aunque su tipología varió en función de la gravedad de la demencia. Conclusiones: Durante el confinamiento se ha objetivado un detrimento en la esfera psicoconductual en personas con DCL o demencia. Consecuentemente, surge la reflexión sobre la necesidad de fomentar el contacto social en las personas con DCL y demencia, evitando las situaciones de aislamiento y baja estimulación.(AU)

Introduction: Neuropsychiatric symptoms are common in patients with mild cognitive impairment and dementia. This symptomatology can appear or be exacerbated with changes in routine and in the patient’s usual environment. The lockdown situation during the COVID-19 pandemic has meant a drastic and unexpected change in the daily life of the general population, with a particular impact on the most physically and mentally vulnerable groups, including patients with cognitive impairment. Aim: To know the impact of lockdown measures imposed due to the COVID-19 pandemic on neuropsychiatric symptomatology in people with mild cognitive impairment and dementia. Materials and methods. Exploratory systematic review, in accordance with the PRISMA guidelines, of Pubmed and Psycinfo databases papers published from January 2020 to April 2021 which related confinement due to COVID-19 with the presentation or worsening of neuropsychiatric symptoms in patients with mild cognitive impairment mild or dementia. Results: Worsening of neuropsychiatric symptoms was observed in patients with dementia and mild cognitive impairment, especially agitation/aggression, anxiety, depression and apathy. Neuropsychiatric symptoms were more common in patients with dementia than in those with mild cognitive impairment, although their typology varied depending on the severity of dementia. Conclusions: During lockdown a worsening in the psychobehavioral area has been observed in people with mild cognitive impairment or dementia. Therefore, considerations arise on the need of promoting social contact in people with mild cognitive impairment and dementia, avoiding situations of isolation and low stimulation.(AU)

Ensayo aleatorio de terapia de reminiscencia individual para adultos mayores con deterioro cognitivo: un análisis de respuesta de tres meses / Randomized trial of individual reminiscence therapy for older adults with cognitive impairment: a 3-month responder analysis

Introducción: La terapia de reminiscencia individual (iTR) ha demostrado mejorar la cognición, el estado de ánimo y la calidad de vida (CdV) de personas con trastornos neurocognitivos (TNC). Objetivo: Se exploraron los predictores de la respuesta positiva a la iTR utilizando el análisis de respuesta, una estrategia analítica de los factores que contribuyen a una respuesta a la intervención. Pacientes y métodos: Reanálisis de un ensayo controlado aleatorizado de 251 adultos mayores portugueses con TNC. Los participantes recibieron dos sesiones de iTR durante 13 semanas (26 sesiones) o el tratamiento habitual. Las variables analizadas fueron la cognición global (Minimental State Examination), la memoria (test de alteración de la memoria), el funcionamiento ejecutivo –batería de evaluación frontal (FAB)–, los síntomas depresivos –escala de depresión geriátrica-15 (GDS-15)– y la CdV –escala de calidad de vida en la enfermedad de Alzheimer (QOL-AD)–. Resultados: Hubo más respondedores en el grupo de intervención que en el de control en los cinco criterios, con diferencias significativas para cognición (p = 0,001; f = 0,202; número necesario para tratar = 5) y memoria (p = 0,004; f = 0,184; número necesario para tratar = 6). En la línea de base, los respondedores tenían: puntuaciones más altas de QOL-AD (30,23 frente a 25,57; p < 0,001; d = –0,774) para la cognición; puntuaciones FAB más bajas (1,41 frente a –2,12; p < 0,001; d = 0,928) para el funcionamiento ejecutivo; y mayores puntuaciones en la GDS-15 para los síntomas depresivos (7,57 frente a 4,91; p < 0,001; d = –0,845) y para la CdV (6,81 frente a 5,33; p = 0,013; d = –0,443). Conclusiones: La iTR mostró altas tasas de respuesta para la cognición y la memoria. Los que tienen peor función ejecutiva, estado de ánimo y CdV se beneficiaron más de la intervención para esas respectivas variables. La iTR tiene efectos beneficiosos en los TNC, con el estado de ánimo y la CdV como factores influyentes.(AU)

Introduction: Non-pharmacological intervention options, including individual reminiscence therapy (iRT), have been effective in improving cognitive functioning, mood, and quality of life (QoL) in persons with neurocognitive disorders (NCD). Objectives: A 13-week randomized trial intervention utilizing iRT was conducted on older adults with NCD. We explored predictors of participants with positive and non-positive intervention responses using responder analysis, an analytic strategy that focuses on contributors to intervention response. Patients and methods: Re-analysis of a published single-blind, multicentre, randomised controlled trial on 251 older adult residents with NCD from residential facilities across Portugal. Participants received 13 weeks of biweekly iRT (26 sessions) or treatment/programming as usual. Outcomes included global cognition (Minimental State Examination), memory (MAT), executive functioning (FAB), depressive symptoms (GDS-15), and QoL (QoL-AD). Results: There were more responders in the intervention than the control group on all five criteria, with significant differences for cognition (p = 0.001; f = 0.202; NNT = 5) and memory (p = 0.004; f = 0.184; NNT = 6). At baseline, intervention responders vs non-responders had: higher QoL-AD scores (30.23 vs 25.57; p < 0.001; d = –0.774) for cognition; lower FAB scores (1.41 vs –2.12; p < 0.001; d = 0.928) for executive functioning; higher GDS-15 scores for the depressive symptoms (7.57 vs 4.91; p < 0.001; d = –0.845), and for QoL (6.81 vs 5.33; p = 0.013; d = –0.443). Conclusions: The iRT intervention showed high response rates for cognition and memory. Those with worse executive dysfunction, mood, and QoL, benefitted most from the intervention for those respective outcomes. Therefore, the presented iRT has beneficial effects for people with NCD, with mood and QoL as important influential factors.(AU)

[Neuropsychiatric symptoms in people living with dementia related to COVID-19 pandemic lockdown. Exploratory systematic review]. / Síntomas neuropsiquiátricos en personas con demencia relacionados con el confinamiento por la pandemia de la COVID-19. Revisión sistemática exploratoria.

INTRODUCTION: Neuropsychiatric symptoms are common in patients with mild cognitive impairment and dementia. This symptomatology can appear or be exacerbated with changes in routine and in the patient's usual environment. The lockdown situation during the COVID-19 pandemic has meant a drastic and unexpected change in the daily life of the general population, with a particular impact on the most physically and mentally vulnerable groups, including patients with cognitive impairment. AIM: To know the impact of lockdown measures imposed due to the COVID-19 pandemic on neuropsychiatric symptomatology in people with mild cognitive impairment and dementia. MATERIALS AND METHODS: Exploratory systematic review, in accordance with the PRISMA guidelines, of Pubmed and Psycinfo databases papers published from January 2020 to April 2021 which related confinement due to COVID-19 with the presentation or worsening of neuropsychiatric symptoms in patients with mild cognitive impairment mild or dementia. RESULTS: Worsening of neuropsychiatric symptoms was observed in patients with dementia and mild cognitive impairment, especially agitation/aggression, anxiety, depression and apathy. Neuropsychiatric symptoms were more common in patients with dementia than in those with mild cognitive impairment, although their typology varied depending on the severity of dementia. CONCLUSIONS: During lockdown a worsening in the psychobehavioral area has been observed in people with mild cognitive impairment or dementia. Therefore, considerations arise on the need of promoting social contact in people with mild cognitive impairment and dementia, avoiding situations of isolation and low stimulation.

TITLE: Síntomas neuropsiquiátricos en personas con demencia relacionados con el confinamiento por la pandemia de la COVID-19. Revisión sistemática exploratoria.Introducción. En pacientes con deterioro cognitivo leve y demencia, son frecuentes los síntomas neuropsiquiátricos, que pueden aparecer o exacerbarse ante los cambios en la rutina y el entorno habitual del paciente. La situación de confinamiento durante la pandemia de la COVID-19 ha supuesto un cambio en la vida cotidiana de la población general, con especial impacto en los grupos más vulnerables, como los pacientes con afectación cognitiva. Objetivo. Conocer la repercusión de las medidas de confinamiento y cuarentena impuestas por la pandemia de la COVID-19 en la sintomatología neuropsiquiátrica en personas con deterioro cognitivo leve (DCL) y demencia. Materiales y métodos. Revisión sistemática exploratoria, siguiendo las directrices PRISMA, de artículos en las bases datos PubMed y PsycINFO publicados entre enero de 2020 y abril de 2021, que relacionaron el confinamiento por la COVID-19 con la presentación o el empeoramiento de síntomas neuropsiquiátricos en pacientes con DCL o con demencia. Resultados. Se observó un empeoramiento de los síntomas neuropsiquiátricos en los pacientes con demencia y DCL, especialmente agitación/agresión, ansiedad, depresión y apatía. Los síntomas neuropsiquiátricos fueron más comunes en los pacientes con demencia que en los que presentaban DCL, aunque su tipología varió en función de la gravedad de la demencia. Conclusiones. Durante el confinamiento se ha objetivado un detrimento en la esfera psicoconductual en personas con DCL o demencia. Consecuentemente, surge la reflexión sobre la necesidad de fomentar el contacto social en las personas con DCL y demencia, evitando las situaciones de aislamiento y baja estimulación.

Debilidad como complicación del paciente crítico por COVID-19: características clínicas y factores pronósticos en una serie de casos / Weakness as a complication of COVID-19 in critically ill patients: clinical features and prognostic factors in a case series

Introducción: La debilidad es una complicación frecuente en el enfermo crítico por COVID-19. Se describen sus características, y los factores que pueden condicionarla y predecirla. Pacientes y métodos: Estudio observacional descriptivo prospectivo con pacientes ingresados en la unidad de cuidados intensivos (UCI) por COVID-19 entre abril y mayo de 2020 con debilidad muscular. Se consideró una afectación clínica grave un equilibrio motor igual o inferior a 3/5 según la escala de fuerza muscular modificada del Medical Research Council. Se han realizado 25 estudios analíticos, 16 estudios neurofisiológicos y una biopsia muscular; seguimiento telefónico al mes; análisis comparativo entre los grupos con y sin afectación grave, y determinación de puntos de corte de parámetros analíticos para predecir afectación grave mediante curvas ROC. Resultados: Se incluyó a 25 pacientes con 58 años (desviación estándar ± 9) de edad media. La mediana de estancia en la UCI fue de 27,5 días. Todos los electromiogramas mostraban un patrón miógeno y el 75%, también una neuropatía. El grupo con afectación clínica grave tenía mayores niveles de dímero-D (p = 0,08), lactato deshidrogenasa (p = 0,03) e interleucina 6 (p = 0,10), y la combinación de la alteración de dos cualquiera de estos tres parámetros pronosticaba la afectación grave con una sensibilidad del 100% y una especificidad del 76,9%. Al mes de seguimiento, el 36% no podía deambular autónomamente y el 92% seguía con debilidad muscular. Conclusiones: La debilidad en el enfermo por COVID-19 grave tiene una repercusión clínica importante. Su detección y estudio precoces mediante predictores de su desarrollo pueden permitir un mejor manejo. La ausencia en algunos casos de los factores de riesgo clásicos para la debilidad adquirida en la UCI sugiere una fisiopatología diferente.(AU)

Introduction: Weakness is a frequent complication in those critically ill due to COVID-19. This study describes its characteristics and the factors that can condition and predict it. Patients and methods: We conducted a prospective, descriptive, observational study of patients admitted to the intensive care unit (ICU) due to COVID-19 between April and May 2020 with muscle weakness. A motor balance equal to or lower than 3/5 according to the modified Medical Research Council muscle strength scale was considered to be severe clinical impairment. Altogether 25 analytical studies, 16 neurophysiological studies and one muscle biopsy were performed, with a telephone follow-up at one month, a comparative analysis between the groups with and without severe compromise, and determination of cut-off points for analytical parameters to predict severe involvement using ROC curves. Results: The sample consisted of 25 patients with a mean age of 58 years (standard deviation ± 9). The median length of stay in the ICU was 27.5 days. All the electromyograms exhibited a myogenic pattern and 75% also showed neuropathy. The group with severe clinical involvement had higher levels of D-dimer (p = 0.08), lactate dehydrogenase (p = 0.03) and interleukin-6 (p = 0.10), and the combination of the alteration of any two of these three parameters predicted severe involvement with a sensitivity of 100% and a specificity of 76.9%. At one month of follow-up, 36% were unable to walk autonomously and 92% continued with muscle weakness. Conclusions: Weakness in severe COVID-19 patients has a major clinical impact. Its early detection and study by means of predictors of its development may allow for better management. The absence in some cases of classical risk factors for ICU-acquired weakness suggests a different pathophysiology.(AU)

[Weakness as a complication of COVID-19 in critically ill patients: clinical features and prognostic factors in a case series]. / Debilidad como complicación del paciente crítico por COVID-19: características clínicas y factores pronósticos en una serie de casos.

INTRODUCTION: Weakness is a frequent complication in those critically ill due to COVID-19. This study describes its characteristics and the factors that can condition and predict it. PATIENTS AND METHODS: We conducted a prospective, descriptive, observational study of patients admitted to the intensive care unit (ICU) due to COVID-19 between April and May 2020 with muscle weakness. A motor balance equal to or lower than 3/5 according to the modified Medical Research Council muscle strength scale was considered to be severe clinical impairment. Altogether 25 analytical studies, 16 neurophysiological studies and one muscle biopsy were performed, with a telephone follow-up at one month, a comparative analysis between the groups with and without severe compromise, and determination of cut-off points for analytical parameters to predict severe involvement using ROC curves. RESULTS: The sample consisted of 25 patients with a mean age of 58 years (standard deviation ± 9). The median length of stay in the ICU was 27.5 days. All the electromyograms exhibited a myogenic pattern and 75% also showed neuropathy. The group with severe clinical involvement had higher levels of D-dimer (p = 0.08), lactate dehydrogenase (p = 0.03) and interleukin-6 (p = 0.10), and the combination of the alteration of any two of these three parameters predicted severe involvement with a sensitivity of 100% and a specificity of 76.9%. At one month of follow-up, 36% were unable to walk autonomously and 92% continued with muscle weakness. CONCLUSIONS: Weakness in severe COVID-19 patients has a major clinical impact. Its early detection and study by means of predictors of its development may allow for better management. The absence in some cases of classical risk factors for ICU-acquired weakness suggests a different pathophysiology.

TITLE: Debilidad como complicación del paciente crítico por COVID-19: características clínicas y factores pronósticos en una serie de casos.Introducción. La debilidad es una complicación frecuente en el enfermo crítico por COVID-19. Se describen sus características, y los factores que pueden condicionarla y predecirla. Pacientes y métodos. Estudio observacional descriptivo prospectivo con pacientes ingresados en la unidad de cuidados intensivos (UCI) por COVID-19 entre abril y mayo de 2020 con debilidad muscular. Se consideró una afectación clínica grave un equilibrio motor igual o inferior a 3/5 según la escala de fuerza muscular modificada del Medical Research Council. Se han realizado 25 estudios analíticos, 16 estudios neurofisiológicos y una biopsia muscular; seguimiento telefónico al mes; análisis comparativo entre los grupos con y sin afectación grave, y determinación de puntos de corte de parámetros analíticos para predecir afectación grave mediante curvas ROC. Resultados. Se incluyó a 25 pacientes con 58 años (desviación estándar ± 9) de edad media. La mediana de estancia en la UCI fue de 27,5 días. Todos los electromiogramas mostraban un patrón miógeno y el 75%, también una neuropatía. El grupo con afectación clínica grave tenía mayores niveles de dímero-D (p = 0,08), lactato deshidrogenasa (p = 0,03) e interleucina 6 (p = 0,10), y la combinación de la alteración de dos cualquiera de estos tres parámetros pronosticaba la afectación grave con una sensibilidad del 100% y una especificidad del 76,9%. Al mes de seguimiento, el 36% no podía deambular autónomamente y el 92% seguía con debilidad muscular. Conclusiones. La debilidad en el enfermo por COVID-19 grave tiene una repercusión clínica importante. Su detección y estudio precoces mediante predictores de su desarrollo pueden permitir un mejor manejo. La ausencia en algunos casos de los factores de riesgo clásicos para la debilidad adquirida en la UCI sugiere una fisiopatología diferente.

Multiple Perianal Ulcers Related to Use of a Hemorrhoidal Ointment With the Active Ingredients Triamcinolone Acetonide, Lidocaine, and Pentosan Polysulfate Sodium: A Series of 11 Spanish Patients. / Múltiples úlceras perianales en relación con el uso de una pomada antihemorroidal con acetónido de triamcinolona, lidocaína y pentosano polisulfato sódico como principios activos: una serie de 11 pacientes españoles.

The development of perianal ulcers related to the use of a hemorrhoidal ointment has not been reported in the literature. We describe a series of 11 patients who were treated for perianal ulcers in 10 Spanish hospitals after they used the same ointment containing the active ingredients triamcinolone acetonide, lidocaine, and pentosan polysulfate sodium. No prior or concomitant conditions suggesting an alternative cause for the condition could be identified, and after the patients stopped using the ointment, their ulcers cleared completely in 8 weeks on average. This case series shows the damage that can be caused by an over-the-counter pharmaceutical product used without medical follow-up. It also illustrates the need to ask patients with perianal ulcers about any topical agents used before the lesions appeared.

[Psychometric properties of Profile of Mood States (POMS) in people with dementia and its application in the evaluation of the effects of therapeutic creative dance]. / Propiedades psicometricas del Profile of Mood States (POMS) en personas con demencia y su aplicacion en la evaluacion de los efectos de la danza creativa terapeutica.

INTRODUCTION: There is a growing need for scientific studies and tools that allow the evaluation of the effects at an affective level of some non-pharmacological therapies for people with dementia such as the creative therapeutic dance. AIMS: To explore the validity and reliability of the Profile of Mood States (POMS) in people with dementia and to analyse the possible differences in the scores of the participants before and after sessions of creative therapeutic dance. PATIENTS AND METHODS: POMS was administered to 36 people with dementia before and after four group sessions of creative therapeutic dance. To verify the construct validity, PANAS and STAXI-2 were also administered. RESULTS: The POMS presented a good internal consistency for each factor and an excellent one for the total scale. The temporal stability was medium-high. Convergent validity results support construct validity. After the creative therapeutic dance sessions, POMS factors tension, depression and confusion were reduced, while vigour increased significantly. There was no effect on fatigue and anger. CONCLUSIONS: The validity and reliability of POMS have been demonstrated in a population with dementia. Creative therapeutic dance can offer emotional benefits for people with dementia.

TITLE: Propiedades psicometricas del Profile of Mood States (POMS) en personas con demencia y su aplicacion en la evaluacion de los efectos de la danza creativa terapeutica.Introduccion. Existe una creciente necesidad de estudios cientificos e instrumentos que permitan evaluar los efectos en el plano afectivo de algunas terapias no farmacologicas para personas con demencia, como la danza creativa terapeutica. Objetivos. Determinar la validez y fiabilidad del Profile of Mood States (POMS) en personas con demencia y analizar las posibles diferencias en las puntuaciones de los participantes antes y despues de sesiones de danza creativa terapeutica. Pacientes y metodos. El POMS se administro a 36 personas con demencia antes y despues de cuatro sesiones grupales de danza creativa terapeutica. Para comprobar la validez de constructo se administraron dos cuestionarios autoinformados (PANAS y STAXI-2). Resultados. El POMS presento una buena consistencia interna para cada factor y excelente para la escala total. La estabilidad temporal fue media-alta. Los resultados de validez convergente apoyan la validez de constructo. Despues de las sesiones de danza creativa terapeutica, los factores tension, depresion y confusion del POMS se redujeron, mientras que el factor vigor aumento significativamente. No hubo ningun efecto sobre la fatiga y la colera. Conclusiones. Se ha demostrado la validez y fiabilidad del POMS en una poblacion con demencia. La danza creativa terapeutica puede ofrecer beneficios emocionales para personas con demencia.

Bevacizumab for recurrent, persistent or advanced cervical cancer: reproducibility of GOG 240 study results in 'real world' patients

Purpose: Bevacizumab is the only therapeutic target approved for patients with persistent, recurrent or advanced cervical cancer from a phase III study that combined with chemotherapy; it proves a significant increase in overall survival. To retrospectively assess the efficacy and safety of bevacizumab as the first-line treatment in patients from usual clinical practice with recurrent/persistent or advanced cervical cancer. Patients and methods: Treatment consisted of cisplatin 50 mg/m2 or carboplatin AUC 5 plus paclitaxel 175 mg/m2 for 6-8 cycles and bevacizumab 15 mg/kg every 3 weeks up to progression or unacceptable toxicity. The endpoints were progression-free survival (PFS), overall survival (OS), response rates (RR) and toxicity. Results: Twenty-seven patients were included from January 2014 to June 2017, with a median follow-up 10, 1 months. Eleven percent had recurrent/persistent disease and 89% had metastatic disease at diagnosis. The prior exposition to platinum was 70%. The median PFS and OS were 9, 6 and 21, 5 months, respectively. There was an increase of fistula formation (22%). All of them had pelvic and peritoneal disease at the beginning of treatment and previous treatment with chemoradiotherapy; non-incidence differences were found according to the type of platinum agent used. There were two treatment-related deaths, one from intestinal perforation and another from severe sepsis. Conclusion: Finally, although our study does have certain limitations, we believe that it can provide useful information and encouraging evidence that the routine use of bevacizumab as part of first-line treatment of patients with advanced cervical cancer may be associated with outcomes comparable with those obtained in GOG240 study

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Hiponatremia grave en paciente con anorexia nerviosa: caso clínico y revisión de la literatura / Severe hyponatremia in a patient with anorexia nervosa: case report and review of literature

Electrolyte disorders are a not infrequent alteration in patients with anorexia nervosa. Itsmechanisms are multifactorial, depending on the electrolytic alteration. Hyponatremia is described in 7% of patients and generally does not reach serious values. We present the case of a female patient with difficult-to-manage anorexia nervosa who was hospitalized for hyponatremia with values not described in the literature, with a good final outcome. Literature and the main physiopathological mechanisms are reviewed.

CCL23: a new CC chemokine involved in human brain damage.

BACKGROUND: CCL23 role in the inflammatory response after acute brain injuries remains elusive. Here, we evaluated whether CCL23 blood levels associate with acquired cerebral lesions and determined CCL23 predictive capacity for assessing stroke prognosis. We used preclinical models to study the CCL23 homologous chemokines in rodents, CCL9 and CCL6. METHODS: Baseline CCL23 blood levels were determined on 245 individuals, including ischaemic strokes (IS), stroke mimics and controls. Temporal profile of circulating CCL23 was explored from baseline to 24 h in 20 of the IS. In an independent cohort of 120 IS with a 3-month follow-up, CCL23 blood levels were included in logistic regression models to predict IS outcome. CCL9/CCL6 cerebral expression was evaluated in rodent models of brain damage. Both chemokines were also profiled in circulation and histologically located on brain following ischaemia. RESULTS: Baseline CCL23 blood levels did not discriminate IS, but permitted an accurate discrimination of patients presenting acute brain lesions (P = 0.003). IS exhibited a continuous increase from baseline to 24 h in circulating CCL23 (P < 0.001). Baseline CCL23 blood levels resulted an independent predictor of IS outcome at hospital discharge (ORadj : 19.702 [1.815-213.918], P = 0.014) and mortality after 3 months (ORadj : 21.47 [3.434-134.221], P = 0.001). In preclinics, expression of rodent chemokines in neurons following cerebral lesions was elevated. CCL9 circulating levels decreased early after ischaemia (P < 0.001), whereas CCL6 did not alter within the first 24 h after ischaemia. CONCLUSIONS: Although preclinical models do not seem suitable to characterize CCL23, it might be a novel promising biomarker for the early diagnosis of cerebral lesions and might facilitate the prediction of stroke patient outcome.

Outcome of cancer-related seizures in patients treated with lacosamide.

OBJECTIVES: Lacosamide is an antiepileptic drug (AED), which has proven to be effective to control seizures, including acute conditions such as status epilepticus. The aim of this study is to describe the clinical experience with lacosamide in neuro-oncological patients. MATERIALS AND METHODS: Multicenter retrospective study in patients with cancer-related seizures, who received lacosamide as an add-on therapy. RESULTS: Forty-eight patients with benign and malignant tumors, including primary brain tumors, lymphomas, systemic cancer with central nervous system involvement, or paraneoplastic encephalitis, were included. Lacosamide was effective in the control of chronic seizures in patients with either benign or malignant tumors. The success rate was greater in malignant tumors, and drug-resistant epilepsies were more likely associated with benign tumors. Adverse events occurred in nearly 70% of patients, particularly in acute conditions and associated with the concomitant use of radio-/chemotherapy. Lacosamide-related adverse events were more likely somnolence and dizziness, which usually resolved after dose adjustment. After starting lacosamide, nearly half of the patients discontinued one of the baseline AEDs and decreased or discontinued dexamethasone. Fifteen patients with status epilepticus were treated with intravenous lacosamide, and 73% of them had their condition resolved without serious drug-related adverse events. CONCLUSION: Lacosamide is an AED to consider in cases of cancer-related seizures. Lacosamide pharmacodynamics and pharmacokinetics allow the achievement of responder rates over 50% with no serious adverse effects, amelioration of side effects from other AEDs or radio-/chemotherapy, and no significant drug interactions. Furthermore, the intravenous formulation shows clear benefits in acute conditions such as status epilepticus.

Bevacizumab for recurrent, persistent or advanced cervical cancer: reproducibility of GOG 240 study results in "real world" patients.

PURPOSE: Bevacizumab is the only therapeutic target approved for patients with persistent, recurrent or advanced cervical cancer from a phase III study that combined with chemotherapy; it proves a significant increase in overall survival. To retrospectively assess the efficacy and safety of bevacizumab as the first-line treatment in patients from usual clinical practice with recurrent/persistent or advanced cervical cancer. PATIENTS AND METHODS: Treatment consisted of cisplatin 50 mg/m2 or carboplatin AUC 5 plus paclitaxel 175 mg/m2 for 6-8 cycles and bevacizumab 15 mg/kg every 3 weeks up to progression or unacceptable toxicity. The endpoints were progression-free survival (PFS), overall survival (OS), response rates (RR) and toxicity. RESULTS: Twenty-seven patients were included from January 2014 to June 2017, with a median follow-up 10, 1 months. Eleven percent had recurrent/persistent disease and 89% had metastatic disease at diagnosis. The prior exposition to platinum was 70%. The median PFS and OS were 9, 6 and 21, 5 months, respectively. There was an increase of fistula formation (22%). All of them had pelvic and peritoneal disease at the beginning of treatment and previous treatment with chemoradiotherapy; non-incidence differences were found according to the type of platinum agent used. There were two treatment-related deaths, one from intestinal perforation and another from severe sepsis. CONCLUSION: Finally, although our study does have certain limitations, we believe that it can provide useful information and encouraging evidence that the routine use of bevacizumab as part of first-line treatment of patients with advanced cervical cancer may be associated with outcomes comparable with those obtained in GOG240 study.

Acousto-optic interaction in polyimide coated optical fibers with flexural waves.

Acousto-optic coupling in polyimide-coated single-mode optical fibers using flexural elastic waves is demonstrated. The effect of the polyimide coating on the acousto-optic interaction process is analyzed in detailed. Theoretical and experimental results are in good agreement. Although the elastic attenuation is significant, we show that acousto-optic coupling can be produced with a reasonably good efficiency. To our knowledge, it is the first experimental demonstration of acousto-optic coupling in optical fibers with robust protective coating.