An international consensus based on the Delphi method to define failure of medical treatment in pyogenic spinal infections.

BACKGROUND CONTEXT: Pyogenic spinal infections (PSIs) are severe conditions with high morbidity and mortality. If medical treatment fails, patients may require surgery, but there is no consensus regarding the definition of medical treatment failure. PURPOSE: To determine criteria for defining failure of medical treatment in PSI through an international consensus of experts. STUDY DESIGN: A two-round basic Delphi method study. SAMPLE: One hundred and fifty experts from 22 countries (authors or co-authors of clinical guidelines or indexed publications on the topic) were invited to participate; 33 answered both rounds defining the criteria. OUTCOME MEASURES: A scale of 1 to 9 (1: no relevance; 9: highly relevant) applied to each criterion. METHODS: We created an online survey with 10 criteria reported in the literature to define the failure of medical treatment in PSIs. We sent this survey via email to the experts. Agreement among the participants on relevant criteria (score ≥7) was determined. One month later, the second round of evaluations was sent. An extra criterion suggested by six responders in the first round was incorporated. The final version was reached with the criteria considered relevant and with high agreement. RESULTS: The consensus definition is: (1) There is an uncontrolled sepsis despite broad spectrum antibiotic treatment, and (2) There is an infection relapse, following a six-week period of antibiotics with clinical and laboratory improvement. CONCLUSIONS: Our definition of failure following nonsurgical treatment of PSI can offer a standardized approach to guide clinical decision-making. Furthermore, it has the potential to enhance scientific reporting within this field.

Phytochemical Characterization and In Vitro Anti-Inflammatory Evaluation in RAW 264.7 Cells of Jatropha cordata Bark Extracts.

The inflammatory process, although beneficial, can produce tissue damage and systemic damage when uncontrolled. Effective therapeutic alternatives with little or no side effects are of great therapeutic interest. This study aimed to determine the phytochemical composition of bark extracts from J. cordata, an endemic plant from México, and evaluate their in vitro anti-inflammatory activity. Hexane, ethyl acetate, and methanol extracts were characterized by qualitative phytochemical tests, and their bioactive groups were identified by 1H NMR and gas chromatography coupled to mass spectrometry (GC-MS). The extract's anti-inflammatory activity was evaluated as nitric oxide (NO) production and their cytotoxicity by an MTS cell proliferation assay in lipopolysaccharide (LPS)-activated RAW 264.7 cells at concentrations of 1-100 µg/mL. The hexane extract contained fatty acids, fatty esters, phytosterols, alkanes, vitamin E, and terpenoids; the ethyl acetate extract showed fatty acids, fatty esters, aromatic aldehyde, phytosterols, vitamin E, and terpenoids, while the methanolic extract showed fatty esters, fatty acid, aromatics aldehydes, and alcohol. The ethyl acetate extract showed the highest inhibition of NO production, followed by the methanolic extract and the hexane extract, without affecting the viability of RAW 264.7 macrophage cells. The results suggest that J. cordata extracts are a potential source of bioactive compounds with anti-inflammatory potential.

Chemoinformatic Analysis of Isothiocyanates: Their Impact in Nature and Medicine.

Isothiocyanates (ITCs) have a significant impact on food and natural product chemistry. Several dietary components and food chemicals contain the isothiocyanate moiety. In addition, many ITCs interact with macromolecules of biological relevance, making these compounds relevant for potential therapeutic applications and disease prevention. However, there is a lack of systematic analysis of ITCs in chemical and biological databases. Herein, we conducted a comprehensive analysis of ITCs present in public domain databases, including natural products, food chemicals, macromolecular targets of drugs, and the Protein Data Bank. A total of 154 ITCs were found, which can be classified into seven categories: acyclic, cyclic, polycyclic, aromatic, polyaromatic, indolic, and glycosylated. 24 ITCs were reported in 18 vegetable sources, mainly in cruciferous vegetables (Brassica oleracea L.). Calculated properties of pharmaceutical relevance indicated that 11 % of the 154 ITCs would be suitable to be orally absorbed and 48 % permeate the blood-brain-barrier. It was also found that seven molecular targets have been co-crystallized with ITCs and the most frequent is the macrophage migration inhibitory factor. It is expected that this work will contribute to the sub-disciplines of natural products and food informatics.

Health-Related Quality of Life in Levothyroxine-Treated Hypothyroid Women and Women without Hypothyroidism: A Case-Control Study.

The use of levothyroxine is not always related to the elimination of the symptoms of hypothyroidism. The aim of this study is to compare the health-related quality of life (HRQOL) of a group of hypothyroid women under levothyroxine treatment with that of a group of non-hypothyroid women. METHODOLOGY: A case-control study was performed. We used convenience sampling. The case group consisted of 152 levothyroxine-treated hypothyroid women; the control group consisted of 238 women without hypothyroidism disorders. All of the participants were euthyroid according to the clinical practice guidelines. We used as instruments the Short Form-12 questionnaire (SF-12v1) and a sociodemographic questionnaire. RESULTS: Hypothyroid women scored significantly lower in HRQOL in SF-12v1 mental and physical components than the control group (mental component summary: 41.23 ± 12.12 vs. 46.45 ± 10.22, p < 0.001; physical component summary: 49.64 ± 10.16 vs. 54.75 ± 5.76, p < 0.001). body mass index (BMI) and age showed an influence on the physical component (p < 0.001 in both variables). Adjusted for age and BMI, hypothyroidism was still related to worse scores (p < 0.001). CONCLUSION: Despite being euthyroid, women with hypothyroidism showed a poorer quality of life than women without hypothyroidism. Health professionals need to assess the HRQOL of women with hypothyroidism. Further research on HRQOL and hypothyroidism is needed.

Flexibility Services Based on OpenADR Protocol for DSO Level.

Nowadays, Distribution System Operators are increasing the digitalization of their smart grids, making it possible to measure and manage their state at any time. However, with the massive eruption of change-distributed generation (e.g., renewable resources, electric vehicles), the grid operation have become more complex, requiring specific technologies to balance it. In this sense, the demand-side management is one of its techniques; the demand response is a promising approach for providing Flexibility Services (FSs) and complying with the regulatory directives of the energy market. As a solution, this paper proposes the use of the OpenADR (Open Automated Demand Response) standard protocol in combination with a Decentralized Permissioned Market Place (DPMP) based on Blockchain. On one hand, OpenADR hierarchical architecture based on distributed nodes provides communication between stakeholders, adding monitoring and management services. Further, this architecture is compatible with an aggregator schema that guarantees the compliance with the strictest regulatory framework (i.e., European market). On the other hand, DPMP is included at different levels of this architecture, providing a global solution to Flexibility Service Providers (FSP) that can be adapted depending on the regulation of a specific country. As a proof of concept, this paper shows the result of a real experimental case, which implements a Capacity Bidding Program where the OpenADR protocol is used as a communication method to control and monitor energy consumption. In parallel, the proposed DPMP based on Blockchain makes it possible to manage the incentives of FSs, enabling the integration of local and global markets.

Poverty, quality of life and psychological wellbeing in adults with congenital heart disease in Chile.

The objective of this study was to assess the quality of life and psychological wellbeing of adults with congenital heart disease (CHD) in Chile, and to identify other associated factors. The study enrolled 68 patients aged between 18 and 72 (median 29), 35 being females. They completed a questionnaire, which included a quality of life assessment tool (the Medical Outcome Study 36-Item Short Form Health Survey), a number of psychological scales (the General Health Questionnaire, the Basic Psychological Needs Scales and the Beck Hopelessness Scale), a socioeconomic survey, and some clinical data. CHD patients reported worse scores in those scales assessing physical dimensions of quality of life (physical function (70.5), physical role functioning (64), vitality (65.3)), and general quality of life (58.6), than in emotional or social dimensions. Female gender was associated with lower scores in physical function (59.12 versus 82.66; p<0.01) and physical role functioning (53.68 versus 75; p<0.05); poverty was associated with worse results in physical function (61.92 versus 82.96; p<0.01), role physical (53.21 versus 79.63; p<0.01), vitality (60.89 versus 71.67; p<0.05), social role functioning (70.19 versus 82.87; p<0.05) and bodily pain (65.77 versus 81.2; p<0.05). Furthermore, we found that psychological scales had an association with quality of life, but clinical variables did not show significant correlations to any dimension. Poverty has an impact on the quality of life of CHD patients. This population only has a decrease in the quality of life physical dimensions, suggesting that quality of life depends on many different factors.

Sexual Function in Levothyroxine-Treated Hypothyroid Women and Women without Hypothyroidism: A Case-Control.

Background: Levothyroxine is the most common treatment to normalize thyroid hormones levels and to reduce primary hypothyroidism symptoms. Aim: To assess sexual function in women with levothyroxine-treated hypothyroidism and women without hypothyroidism. Methods: A case-control study was performed with 152 women with levothyroxine-treated hypothyroidism and 238 women without hypothyroidism. An online survey was used to collect socio-demographic data and the answers to the Women Sexual Function (WSF) questionnaire. Results: Women with levothyroxine-treated hypothyroidism showed a higher prevalence of sexual dysfunction than women in the control group (31.60% vs. 16.40%), furthermore the presence of hypothyroidism increased the risk of sexual dysfunction (p = 0.002, OR: 2.29 (1.36-3.88)). The most affected domains were 'desire' (p < 0.001), 'arousal' (p = 0.003) and 'penetration pain' (p = 0.020). In hypothyroid women, age increased the risk of sexual dysfunctions (p = 0.009, OR: 1.07 (1.01-1.12)), however when age was adjusted (ANCOVA) the sexual dysfunction remained in women with hypothyroidism in all domains. Conclusions: Hypothyroidism is associated with an increase in the prevalence of sexual dysfunction even if treated with levothyroxine and thyroid-stimulating hormone (TSH) levels are normalized. Relevance to clinical practice: Sexual function in hypothyroid women should be assessed before and after starting the treatment.

Mood Disorders in Levothyroxine-Treated Hypothyroid Women.

Background: Hypothyroidism has several symptoms (weight gain, arrhythmias, mood changes, etc.). The aims of this study were (1) to assess the prevalence of anxiety and depression in levothyroxine-treated hypothyroid women and in women without hypothyroidism; (2) to identify variables associated with anxiety and depression. Methods: A case-control study was performed with 393 women. Case-group: 153 levothyroxine-treated hypothyroid women. Control-group: 240 women without hypothyroidism. Convenience sampling. Instrument: The Hamilton Hospital Anxiety and Depression Scale (HADS), and a sociodemographic questionnaire. Results: The prevalence of anxiety in levothyroxine-treated hypothyroid women was higher than in women without hypothyroidism (29.4% vs. 16.7%, χ2p < 0.001). The prevalence of depression in the case group was higher than in the control group (13.1% vs. 4.6%, χ2p < 0.001). Levothyroxine-treated hypothyroid women were more likely to have anxiety (OR = 2.08, CI: 1.28-3.38) and depression (OR = 3.13, IC = 1.45-6.45). Conclusion: In spite of receiving treatment with levothyroxine, women with hypothyroidism are more likely to have depression and anxiety. Health professionals need to assess the mood of women with hypothyroidism. Although levothyroxine is a good treatment for the symptoms of hypothyroidism, it may not be enough to prevent development or persistence of depression and anxiety by itself.

Mannose-binding lectin promoter polymorphisms and gene variants in pulmonary tuberculosis patients from cantabria (northern Spain).

Mannose-binding lectin is a central molecule of the innate immune system. Mannose-binding lectin 2 promoter polymorphisms and structural variants have been associated with susceptibility to tuberculosis. However, contradictory results among different populations have been reported, resulting in no convincing evidence of association between mannose-binding lectin 2 and susceptibility to tuberculosis. For this reason, we conducted a study in a well genetically conserved Spanish population in order to shed light on this controversial association. We analysed the six promoter and structural mannose-binding lectin 2 gene variants in 107 patients with pulmonary tuberculosis and 441 healthy controls. Only D variant and HYPD haplotype were significantly more frequents in controls which would indicate that this allele could confer protection against pulmonary tuberculosis, but this difference disappeared after statistical correction. Neither the rest of alleles nor the haplotypes were significantly associated with the disease. These results would indicate that mannose-binding lectin promoter polymorphisms and gene variants would not be associated with an increased risk to pulmonary tuberculosis. Despite the slight trend of the D allele and HYPD haplotype in conferring protection against pulmonary tuberculosis, susceptibility to this disease would probably be due to other genetic factors, at least in our population.

[Meteorological variables do not explain the North-South gradient in mortality from multiple sclerosis in Spain]. / Las variables meteorológicas no explican el gradiente norte-sur en la mortalidad por esclerosis múltiple en España.

OBJECTIVES: To determine whether weather conditions explain the North-South gradient in multiple sclerosis (MS) mortality described in Spain. METHODS: The age-adjusted MS mortality rate by Spanish provinces from 1975 to 1998 was correlated with several climatic variables. RESULTS: MS mortality was negatively correlated with minimum, average and maximum temperatures, the mean number of hours of sunshine, and the mean number of sunny days. A positive correlation was found with the average amount of rain. Most correlations disappeared after adjusting by latitude. However, MS mortality was associated with latitude after adjusting by climatic factors. CONCLUSIONS: The North-South gradient in MS mortality in Spain cannot be fully explained by weather differences. Therefore, other hypotheses are required to explain this association.

Las variables meteorológicas no explican el gradiente norte-sur en la mortalidad por esclerosis múltiple en España / Meteorological variables do not explain the North-South gradient in mortality from multiple sclerosis in Spain

Objetivo: Comprobar si las variables meteorológicas justifican el gradiente norte-sur en la mortalidad por esclerosis múltiple (EM) en España. Métodos: La tasa de mortalidad por EM ajustada por edad en cada provincia de 1975 a 1998 se correlacionó con la media anual de diferentes variables meteorológicas. Resultados: Las temperaturas mínima, media y máxima, el número medio de horas de sol y el número de días soleados se correlacionaron negativamente con la mortalidad por EM, mientras que la cantidad de lluvia se correlacionó positivamente con la EM. La mayor parte de las correlaciones desaparecen al ajustar por latitud. En cambio, la mortalidad por EM está asociada con la latitud incluso después de ajustar por los factores meteorológicos. Conclusión: El gradiente norte-sur en la mortalidad por EM en España no puede explicarse completamente por factores meteorológicos. Son necesarias otras hipótesis para justicar esta asociación

Objectives: To determine whether weather conditions explain the North-South gradient in multiple sclerosis (MS) mortality described in Spain. Methods: The age-adjusted MS mortality rate by Spanish provinces from 1975 to 1998 was correlated with several climatic variables. Results: MS mortality was negatively correlated with minimum, average and maximum temperatures, the mean number of hours of sunshine, and the mean number of sunny days. A positive correlation was found with the average amount of rain. Most correlations disappeared after adjusting by latitude. However, MS mortality was associated with latitude after adjusting by climatic factors. Conclusions: The North-South gradient in MS mortality in Spain cannot be fully explained by weather differences. Therefore, other hypotheses are required to explain this association

Mortality trends of multiple sclerosis in Spain, 1951-1997: an age-period-cohort analysis.

Trends of multiple sclerosis mortality in Spain from 1951 to 1997 are examined. Age-adjusted mortality strongly decreased from 3.08 per 100,000 women in 1951-1967 to 0.59 in 1968-1980 (similar figures were obtained for men). This decrease seems to be due to an artifact produced by changes in codification of causes of death. An age-period-cohort analysis, limited to the period 1968-1997, showed that the mortality trend in Spain cannot be fully explained by year of death (period effect), but that a cohort (year of birth) effect is also necessary. An increase in mortality related with the cohort of birth was detected: people born after 1953 had double the risk of those born between 1938 and 1947, and four times the risk of those born between 1923 and 1932. Regarding the period effect, there is a decrease in mortality, probably due to improvements in life expectancy of multiple sclerosis patients.

Un nuevo método de evaluación diagnóstica y terapéuticade las patologías del pie basado en las plantillas instrumentadasBiofoot/IBV / A new diagnostic and therapeutic diagnostic method of the foot disease based on Biofoot/IBV instrumented insoles

Introducción: En este trabajo se realiza la puesta a punto y validación de un nuevo protocolo clínico de valoración diagnóstica de cuadros sindrómicos álgicos en el pie y de evaluación del tratamiento ortésico prescrito, basado en el uso de un sistema de registro de presiones plantares desarrollado a tal efecto Biofoot/IBV. Material y métodos: Se ha realizado un estudio prospectivo de pacientes adultos en tres etapas: una inicial en la que se estableció un protocolo clínico que fue evaluado durante la segunda etapa (piloto) y utilizado en la última fase (práctica clínica). El protocolo clínico utilizado incluye la escala de valoración funcional de Kitaoka et al1, y el sistema de medida de plantillas instrumentadas Biofoot/IBV para el diagnóstico clínico, prescripción y validación terapéutica, cuando ésta ha sido ortésica. Resultados y discusión: El 75 por ciento de los cuadros sindrómicos álgicos del pie correspondió a metatarsalgias. Se han identificado patrones de presiones tanto en la región metatarsiana como en el talón que, aunque no resultan efectivos en la detección de la presencia/ausencia de dolor (88 por ciento/ 47 por ciento), han contribuido a explicar las variaciones introducidas por el tratamiento ortésico aplicado. Los pacientes a quienes se les adjuntó a la prescripción a entregar a la ortopedia copia impresa del registro de presiones máximas presentaron evolución favorable en el 90 por ciento de los casos, frente al 50 por ciento de resultados favorables del grupo que no dispuso del registro. Conclusiones: La utilización del sistema de plantillas instrumentadas Biofoot/IBV asociado al protocolo de valoración clínica descrito es un método diagnóstico válido de cuadros sindrómicos álgicos en el pie y efectivo en la evaluación de tratamientos ortésicos (AU)

[Adenoid cystic carcinoma. Presentation of three clinical cases]. / Carcinoma adenoide quístico. Presentación de tres casos clínicos.

Adenoid cystic carcinomas are malignant epithelial tumors that originate in body regions containing exocrine and eccrine glands. Their most common location is the salivary glands. These tumors have specific, highly individualized histopathological and clinical features. Three cases of adenoid cystic carcinoma in different sites, palate, sublingual gland, and nasal cavity, are reported. The literature is reviewed for information about the fundamental clinical, diagnostic, and therapeutic aspects of these tumors.

[Laryngeal neuroendocrine carcinoma. Report of a clinical case]. / Carcinoma neuroendocrino de laringe. Presentación de un caso clínico.

A case of neuroendocrine small cell carcinoma is described in a 79 year-old male. This tumor is an unusual laryngeal carcinoma (the incidence is slightly lower than 1% of all carcinomas) with an aggressive biological behaviour. This work analyzes its clinical, pathological, therapeutical and evolutive aspects, and compare this case to those reported in the literature.