Analysis of the coexistence of gaming and viewing activities in Twitch users and their relationship with pathological gaming: a multilayer perceptron approach.

The enormous expansion of the video game sector, driven by the emergence of live video game streaming platforms and the professionalisation of this hobby through e-sports, has spurred interest in research on the relationships with potential adverse effects derived from cumulative use. This study explores the co-occurrence of the consumption and viewing of video games, based on an analysis of the motivations for using these services, the perceived positive uses, and the gamer profile. To that end, a multilayer perceptron artificial neural network is developed and tested on a sample of 970 video game users. The results show that the variables with a significant influence on pathological gaming are the motivation of a sense of belonging to the different platforms, as well as the positive uses relating to making friends and the possibility of making this hobby a profession. Furthermore, the individual effects of each of the variables have been estimated. The results indicate that the social component linked to the positive perception of making new friends and the self-perceived level as a gamer have been identified as possible predictors, when it comes to a clinical assessment of the adverse effects. Conversely, the variables age and following specific streamers are found to play a role in reducing potential negative effects.

Estudio observacional multicéntrico retrospectivo sobre el manejo clínico y terapéutico de los diferentes tipos de estatus epiléptico en la práctica clínica / Retrospective multicentre observational study on clinical management and treatment of different types of status epilepticus in clinical practice

Introducción: El estatus epiléptico es una urgencia neurológica asociada a una mortalidad y morbilidad significativa. Analizamos las características en nuestra población. Métodos: Se recogieron los datos de manera retrospectiva de la historia clínica electrónica de adultos con diagnóstico de estatus epiléptico en 5 centros hospitalarios durante 4 años. Resultados: Se obtuvieron datos de un total de 84 episodios en 77 pacientes, con edad media de 60,3 años. El 52,4% tenían historia previa de epilepsia. Clasificación según el tipo de estatus: 47,6% tónico-clónico; 21,4% parcial complejo; 17,9% parcial motor; 6% parcial simple; 3,6% mioclónico y 3,6% sutil. Si analizamos el momento que finalizó el estatus según las fases definidas para este estudio obtenemos: 13,1% precoz (hasta 30 min); 20,2% establecido (entre 30-120 min); 41,7% refractario (más de 120 min) y 13,1% superrefractario (continúan o recurren después de más de 24 h de anestesia). Diez casos (11,9%) fallecieron sin haberse controlado el estatus. El porcentaje acumulativo de éxito alcanzado con el primer tratamiento fue de 8,3%; segundo 27,3%; tercero 48,7%; cuarto 58,2%; quinto 70,1%; sexto 80,8%; séptimo 83,2% y octavo 84,4%. Conclusiones: En nuestro estudio encontramos que el estatus no se controló en las primeras 2 h en casi la mitad de los casos, y un 11,9% fallecieron sin controlarse, sin haber diferencias significativas entre el tipo de estatus. En casi la mitad se logró el control del estatus con el tercer tratamiento, pero en algún caso se precisó hasta 8. Son necesarios registros amplios que permitan analizar el manejo en los distintos tipos y fases (AU)

Introduction: Status epilepticus (SE) is a neurological emergency associated with significant mortality and morbidity. We analyse characteristics of this entity in our population. Methods: Data from electronic medical records of adults diagnosed with SE were collected retrospectively from 5 hospitals over 4 years. Results: Data reflected 84 episodes of SE in 77 patients with a mean age of 60.3 years. Of this sample, 52.4% had a previous history of epilepsy. Status classification: 47.6% tonic-clonic, 21.4% complex partial, 17.9% partial motor, 6% partial simple, 3.6% myoclonic, and 3.6% subtle SE. Based on the duration of the episode, SE was defined in this study as early stage (up to 30 min) in 13.1%, established (30-120 min) in 20.2%, refractory (more than 120 min) in 41.7%, and super-refractory (episodes continuing or recurring after more than 24h of anaesthesia) in 13.1%. Ten patients (11.9%) died when treatment failed to control SE. The cumulative percentage of success achieved was 8.3% with the first treatment, 27.3% for the second, 48.7% for the third, 58.2% for the fourth, 70.1% for the fifth, 80.8% for the sixth, 83.2% for the seventh, and 84.4% for the eighth. Conclusions: In our study, we found that SE did not respond to treatment within 2h in approximately half the cases and 11.9% of the patients died without achieving seizure control, regardless of the type of status. Half the patients responded by the third treatment but some patients needed as many as 8 treatments to resolve seizures. Using large registers permitting analysis of the different types and stages of SE is warranted (AU)

Effect of myofascial induction therapy on post-c-section scars, more than one and a half years old. Pilot study.

Myofascial Induction Therapy (MIT) is a manually-applied method used in physiotherapy and focused on restoring altered fascial tissue. In a healthy body, the fascial system maintains elasticity and coordination of movements. However, injuries and their after-effects, such as scars, may reduce this tissue role, causing a dysfunction. The aim of this study is to ascertain the effect of MIT on scars which have completed the repair process in healthy individuals without any associated pathology that might affect the healing process. In all 10 cases studied, changes were observed after applying MIT on the structure of the scar fold, both at deep (shown by ultrasound) and at superficial (shown by scar fold measurement) levels. Eight weekly MIT sessions were applied, establishing this number as a reference for future studies. Functional improvement was determined using Schober's Test and patient quality of life was measured with a specific questionnaire. These outcomes lay the groundwork for future research.

Use of QR and EAN-13 codes by older patients taking multiple medications for a safer use of medication.

BACKGROUND: Older persons following a prolonged complex drug regimen often make mistakes when taking their medication. Currently, the widespread use of tablets and smartphones has encouraged the development of applications to support self-management of medication. OBJECTIVE: The aim of this study was to design, develop and assess an app that transforms medication-associated ean-13 (barcodes) and Quick Response codes (QR) into verbal instructions, to enable safer use of medication by the elderly patients taking multiple medications. METHODS: Meetings were held in which participated a total of 61 patients. RESULTS: The results showed that patients appreciated the application and found it useful for safer use of medicines. CONCLUSIONS: The study results support the use of such technology to increase patient safety taking multiple medications safety.

Medidas de calidad en la atención a pacientes con epilepsia en la consulta de neurología / Quality measures in neurology consult care for epileptic patients

Introducción: La epilepsia es una de las afecciones que con más frecuencia atendemos en las consultas externas de neurología. Métodos: Analizamos la aplicación en nuestro centro de las 8 medidas sobre calidad en el cuidado de pacientes con epilepsia propuestas por la Academia Americana de Neurología: tipo de crisis y frecuencia de crisis, etiología de la epilepsia o síndrome epiléptico, resultados electroencefalograma, neuroimagen, aconsejar sobre efectos adversos de los fármacos antiepilépticos, remisión de los casos de epilepsia refractaria, consejos sobre cuestiones de seguridad y a mujeres en edad fértil. Resultados: En la mayoría de los casos estaba documentado adecuadamente las 4 primeras medidas de calidad. En el 66% se había preguntado sobre efectos adversos de los fármacos en todas las visitas. En casi todas las epilepsias intratables se había propuesto o remitido aun centro de referencia quirúrgico para la valoración en algún momento de la enfermedad, aunque generalmente hacía más de 3 a˜nos de la propuesta. Un 37% de los pacientes habían sido aconsejados sobre cuestiones de seguridad y menos de la mitad de las mujeres con epilepsia en edad fértil habían recibido consejos relativos a anticonceptivos y embarazo al menos una vez al año. Conclusiones: Realizamos una atención adecuada de acuerdo con las medidas de calidad en muchos de los aspectos clínicos, pero debemos mejorar la administración de consejos e información necesaria para el cuidado del paciente con epilepsia en las diferentes etapas de la vida

Introduction: Epilepsy is one of the most frequently observed diseases in neurology outpatient care. Methods: We analysed our hospital’s implementation of the 8 epilepsy quality measures proposed by the American Academy of Neurology: documented seizure types and seizure frequency, aetiology of epilepsy or the epilepsy syndrome, review of EEG, MRI, or CT results, counselling about antiepileptic drug side effects, surgical therapy referral for intractable epilepsy, and counselling about epilepsy-specific safety issues and for women of childbearing age. Results: In most cases, the first four quality measures were documented correctly. In 66% of the cases, doctors had asked about any adverse drug effects during every visit. Almost all patients with intractable epilepsy had been informed about surgical options or referred to a surgical centre of reference for an evaluation at some point, although referrals usually took place more than 3 years after the initial proposal. Safety issues had been explained to 37% of the patients and less than half of women of childbearing age with epilepsy had received counselling regardingcontraception and pregnancy at least once a year. Conclusions: The care we provide is appropriate according to many of the quality measures, but we must deliver more counselling and information necessary for the care of epileptic patients in different stages of life

Tratamiento quirúrgico del nevus melanocítico gigante: un cambio de objetivo / Surgical treatment of giant congenital melanocytic nevi: a change of aim

Objetivo. Revisión de la experiencia quirúrgica en Nevus Melanocítico Gigante Congénito (NMGC).Material y métodos. Revisión de los casos de NMGC que consultarona cirugía pediátrica desde 1994, recogiendo: año y edad en la 1ªconsulta, tipo de tratamiento, número de intervenciones, complicaciones, histología, RM de SNC y evolución. Resultados. Once pacientes con NMGC >10% de la superficie corporal consultaron entre el nacimiento y los 8 años y fueron sometidos a alguna intervención (2 a 19), desde exéresis hasta sólo biopsias. En 8 niños se utilizaron expansores y plastias, y en 3 de ellos injertos de piel sobre sustituto dérmico; en 6 hubo complicaciones: 4 extrusiones, 5 infecciones,3 necrosis de colgajo y 1 dehiscencia. En 6 niños se consiguió la exéresis total o subtotal del nevus, en 2 se ha interrumpido el tratamiento, quedando 20% y 50% del nevus; tres niños no se trataron del NMGC. Ningún paciente ha presentado melanoma cutáneo; uno falleció de melanoma intracraneal y otro presenta melanosis leptomeníngea. La media de intervenciones de los 4 primeros pacientes fue de 16 y en los 7 últimos fue de 5.Conclusiones. Los objetivos del tratamiento han variado: el tratamiento del NMGC es quirúrgicamente más conservador; las exéresis completas ya no se indican si no son técnicamente posibles en pocos pasos; no es aceptable un resultado cosmético inadecuado tras una infancia lastrada por múltiples intervenciones. La gravedad la confiere la afectación del SNC

Objective. To review the surgical experience in Giant Congenital Melanocytic Nevi (GCMN).Material and Methods. Review of GCMN cases consulting at the Department of Pediatric Surgery since 1994. Data registered were: year and age at 1st consultation, type of treatment, number of surgical procedures and complications, histology, central nervous system MRI and follow-up. Results. Eleven patients with GCMN >10% of body surface consulted at ages ranging from newborn to 8 years. All of them had multiple surgical procedures (2-19), from nevus removal to only biopsies. Eight patients had tissue expansion, completed in 3 of them with skin grafts on dermal substitute. Six patients had complications: 4 expander extrusions, 5 infections, 3 flap necrosis and 1 dehiscence. In 6 children a total or subtotal resection of the nevus was achieved; in 2 the treatment was interrupted, remaining 20% and 50% of the initial nevus; three patients had not had nevus treatment. None of the patients presented cutaneous melanoma; one died from intracranial melanoma; another one has leptomeningeal melanosis. The first 4 patients underwent an average of 16 surgical procedures each, the last 7 patients only 5. Conclusions. The aim of GCNM management has changed: GCNM treatment is now surgically conservative. Complete excision is now not the aim when technically unfeasible in few procedures; multiple surgical procedures with poor cosmetical results are not acceptable. The gravity is determined by CNS involvement

Factores predictivos de osteopenia en mujeres diagnosticadas de anorexia nerviosa: la importancia de la masa grasa corporal / Predictive factors for osteopenia in women with anorexia nervosa: importance of total body fat

Introducción La elevada prevalencia de baja densidad mineral ósea en mujeres con anorexia nerviosa es de origen multifactorial. Nuestro estudio analiza los factores implicados en esta pérdida del contenido óseo y se evalúa especialmente la influencia del estado nutricional. Pacientes y métodos Estudio transversal en 33 pacientes diagnosticadas de anorexia nerviosa (DSM IV), con recogida prospectiva de datos basales (antes del inicio del tratamiento y en amenorrea). Resultados La prevalencia de osteopenia (­1 desviación estándar >= Z-score > 2,5 desviaciones estándar) fue del 54% y la de osteoporosis (Z-score ¾ 2,5 desviaciones estándar) del 15% en la columna lumbar. La media de la densidad mineral ósea en la columna lumbar fue de 0,839 g/cm2 (intervalo de confianza [IC] del 95%, 0,798-0,880) y en el fémur, de 0,778 (IC del 95%, 0,737-0,819). La media de las Z-scores de la densidad mineral ósea fue de ­1,56 (IC del 95%, ­1,98 a ­1,14) en las vértebras lumbares y de ­1,57 (IC del 95%, ­1,97 a ­1,17) en el fémur. La evaluación nutricional demuestra una malnutrición grave, con un índice de masa corporal bajo (media = 16,5 kg/m2; IC del 95%, 15,9-17,1) y unos índices antropométricos con percentiles por debajo del 10%. La encuesta dietética revela un déficit de ingesta calórica (1.429 kcal/día, IC del 95%, 1.173-1.685), de calcio (783 mg/día; IC del 95%, 615-951) y una distribución alterada de la proporción de principios inmediatos (hidratos de carbono, 42%; grasas, 32%, y proteínas, 19,6%). En el estudio de regresión multilineal destaca la medida del pliegue subescapular como variable con mayor potencia predictiva de la reducción de la densidad mineral ósea (r2 = 0,79; p < 0,01), reflejo del bajo porcentaje en el contenido de masa grasa corporal. Otras variables predictivas han sido la albúmina plasmática (p < 0,01), el tiempo de evolución (p < 0,05) y la edad (p < 0,05). Conclusión La reducción del componente graso corporal es un factor determinante de la pérdida de densidad ósea que presentan las pacientes anoréxicas. Mejorar el déficit nutricional, con especial atención al componente graso, es probablemente un objetivo prioritario en la prevención y el tratamiento de la osteopenia de estas pacientes, junto con la reversión farmacológica del hipoestrogenismo (AU)

Introduction The high prevalence of low bone mineral density (BMD) in women with anorexia nervosa (AN) is due to multiple factors. This study analyses the factors involved in the loss of bone content, especially the influence of nutritional status. Patients and methods A cross-sectional study was performed in 33 women diagnosed with AN (DSM IV) with prospective collection of baseline data (before onset of amenorrhea and treatment initiation). Results The prevalence of osteopenia (-1SD >= Z-score > ­2.5SD) was 54% and that of osteoporosis (Z-score ¾ ­2.5SD) was 15% in lumbar spine. The mean BMD was 0.839 g/cm2 (95% CI 0.798-0.880) in lumbar spine and 0.778 g/cm2 (95% CI 0.737-0.819) in femoral neck. The mean Z-score of BMD was ­1.56 (95% CI 95% -1.98/-1.14) in lumbar spine and ­1.57 (95% CI -1.97/-1.17) in femoral neck. Nutritional evaluation demonstrated severe malnutrition with a low body mass index (mean: 16.5 Kg/m2 95% CI: 15.9-17.1) and anthropometric indices showed percentiles below 10%. Dietary records revealed insufficient intake of calories (1429 Kcal/day, 95% CI: 1173, 1685) and calcium (783 mg/day 95% CI: 615, 951) and an altered distribution of the proportion of immediate principles (carbohydrates 42%, fats 32% and proteins 19.6%). In multivariate regression analyses, the variable with greatest predictive power in reducing BMD was a low percentage in total body fat as measured by subscapular skinfold (r2 = 0.79 p < 0.01). Other predictive variables were serum albumin (p < 0.01), disease duration (p < 0.05), and age (p < 0.05). Conclusion Reduction of body fat is a determining factor for loss of bone density in anorexic patients. Improvement of nutritional deficiency, with special attention to the fat component, is probably a high-priority objective in the prevention and treatment of osteopenia in these patients, along with pharmacological treatment of low estrogen levels (AU)