Uric acid and acute kidney injury in high-risk patients for developing acute kidney injury undergoing cardiac surgery: A prospective multicenter study.

PURPOSE: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI. DESIGN: Multicenter prospective international cohort study. SETTING: Fourteen university hospitals in Spain and the United Kingdom. PARTICIPANTS: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37). CONCLUSIONS: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI.

Botulinum toxin type A infiltration in spasticity and cervical dystonia. Muscle morphology: an overlooked factor.

INTRODUCTION: Botulinum toxin type A is used to treat spasticity and dystonia. However, its relationship with muscle morphology has not been studied. The action mechanism of botulinum toxin is based on the inhibition of acetylcholine release. Therefore, larger doses of toxin would be needed to treat larger muscles. This study aims to establish whether there is a discrepancy between muscle morphology and the botulinum toxin doses administered. METHODS: We dissected, and subsequently measured and weighed, muscles from the upper and lower limbs and the head of a fresh cadaver. We consulted the summary of product characteristics for botulinum toxin type A to establish the recommended doses for each muscle and calculated the number of units infiltrated per gramme of muscle. RESULTS: Different muscles present considerable morphological variability, and the doses of botulinum toxin administered to each muscle are very similar. We observed great variability in the amount of botulinum toxin administered per gramme of muscle, ranging from 0.3 U/g in the biceps femoris to 14.6 U/g in the scalene muscles. The mean dose was 2.55 U/g. The doses administered for nearly all lower limb muscles were below this value. CONCLUSIONS: There are significant differences in morphology between the muscles of the lower limbs, upper limbs, and head, but similar doses of botulinum toxin are administered to each muscle. These differences result in great variability in the number of units of botulinum toxin administered per gramme of muscle.

Incidence of falls in long-stay hospitals: risk factors and strategies for prevention.

INTRODUCTION: Falls are a major health problem in elderly institutionalised patients, due to the associated high morbidity and mortality rates and the impact on future quality of life. OBJECTIVE: To analyse the incidence and patient profile for falls, and to identify potential causes and effects. We also assess the efficacy of intervention in selected patients in preventing further falls. METHODS: We performed a prospective study at a long-term care centre for 12 months. Data were collected via fall reports. The falls committee drafted a monthly data collection form. RESULTS: A total of 155 falls were recorded in 80 patients, with 40% presenting more than one fall. Patients aged over 70 years accounted for 84.5% of falls; 42.7% of patients are able to walk independently; 55.5% of falls occurred in the bedroom; 74.8% of patients had been prescribed sedatives or psychoactive, or antihypertensive drugs; 27.7% of falls were due to loss of balance and 22.5% were due to patients performing an activity for which they did not have the capacity. Fractures occurred in 1.9% of patients. CONCLUSIONS: Patients aged over 70 years, walking independently, receiving sedatives or psychoactive or antihypertensive drugs, and with history of falls were at greatest risk. The majority of falls occurred in the bedroom. Physiotherapy interventions were highly effective in cases selected by the falls committee.

Neurorehabilitation in the times of Covid-19: insights from the Spanish Neurorehabilitation Society (SENR).

The entire world is experiencing an unprecedented global health crisis and Spain has been one of the most heavily affected countries within Europe. Unexpected rapid changes and reorganization of medical services that occurred during the pandemic lead to an impact in the practice of neurorehabilitation. The idiosyncrasies typical of neurorehabilitation management, specially in acute facilities, that makes it susceptible as a vector of dissemination of Covid but also because of the need of finding new wards and intensive care units for Covid patients, the interventions in neurorehabilitation has suffered enormous changes. There is a need for rethinking the future to treat a new wave of patients with neurorehabilitation necessities such as those recovering from Covid 19 with neurological sequelae but also of those neurorehab patients who were unable to access the health system during the locke down period. This article is intended to invite to reflect on and discuss the redesign of our current neurorehabilitation plans after the experience on the Covid 19 pandemic.

Neurorrehabilitación del ictus en España, comparativa con Europa / Comparison of stroke neurorehabilitation in Spain and in Europe

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Incidence of falls in long-stay hospitals: risk factors and strategies for prevention. / Incidencia de caídas en el hospital de larga-media estancia. Factores de riesgo y estrategias para la prevención.

INTRODUCTION: Falls are a major health problem in elderly institutionalised patients, due to the associated high morbidity and mortality rates and the impact on future quality of life. OBJECTIVE: To analyse the incidence and patient profile for falls, and to identify potential causes and effects. We also assess the efficacy of intervention in selected patients in preventing further falls. METHODS: We performed a prospective study at a long-term care centre for 12 months. Data were collected via fall reports. The falls committee drafted a monthly data collection form. RESULTS: A total of 155 falls were recorded in 80 patients, with 40% presenting more than one fall. Patients aged over 70 years accounted for 84.5% of falls; 42.7% of patients are able to walk independently; 74.8% of patients had been prescribed sedatives or psychoactive, or antihypertensive drugs; 55.5% of falls occurred in the bedroom; 27.7% of falls were due to loss of balance and 22.5% were due to patients performing an activity for which they did not have the capacity. Fractures occurred in 1.9% of patients. CONCLUSIONS: Patients aged over 70 years, walking independently, receiving sedatives or psychoactive or antihypertensive drugs, and with history of falls were at greatest risk. The majority of falls occurred in the bedroom. Physiotherapy interventions were highly effective in cases selected by the falls committee.

La rehabilitación del ictus en las mujeres / Stroke rehabilitation in women

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Poststroke checklist: un cuestionario para detectar las necesidades de rehabilitación después del ictus / The poststroke checklist: a questionnaire to detect rehabilitation needs after stroke

Introducción. El Poststroke checklist (PSC) es un cuestionario breve y fácil de usar que pretende estandarizar el seguimiento de los pacientes con ictus crónico y asegurar el acceso a intervenciones de rehabilitación basadas en la evidencia. El objetivo de este trabajo es describir la metodología seguida para elaborar el cuestionario y su validación preliminar. Material y métodos. Se describe la elaboración del PSC original y de la versión en castellano (retrotraducción y adaptación al lenguaje clínico local). Se realizó una validación preliminar para evaluar su comprensibilidad en 20 pacientes con ictus de más de 6 meses de evolución (tiempo de latencia de respuesta y grado de comprensión de cada ítem). Por último, se evaluó la satisfacción de los pacientes con el PSC en cuanto a la capacidad de identificar los problemas que afectaban su vida después del ictus. Resultados. El tiempo medio de respuesta fue < 2 seg para todas las preguntas del PSC. Respecto a la interpretación del cuestionario, la comprensión fue buena para la mayoría de pacientes. La comprensión fue parcial en la pregunta sobre movilidad en 5 pacientes, actividades de la vida diaria, comunicación, cognición y vida tras el ictus en 4 y sobre espasticidad en 3. Solo un paciente no comprendió la cuestión sobre prevención secundaria. Los 20 pacientes se mostraron satisfechos con el cuestionario. Conclusiones. El PSC es una herramienta de uso rápido y comprensible para los pacientes, y puede ser útil para detectar necesidades de rehabilitación a largo plazo después de un ictus (AU)

Introduction. The Poststroke checklist (PSC) is a short, easy-to-use questionnaire, intended to facilitate a standardized approach to identifying long-term problems in stroke survivors and ensure access to evidence-based rehabilitation interventions. The aim of this study was to describe the methodology used to develop the questionnaire and its preliminary validation. Material and methods. The development of the original PSC and the Spanish version (back-translation and adaptation to the local clinical language) is described. Preliminary validation was performed to assess its comprehensibility in 20 stroke patients over a 6-month period (latency of response and degree of understanding of each item). Finally, patients’ satisfaction with the PSC regarding its ability to identify problems affecting their lives after stroke was evaluated. Results. The average response time was < 2 sec for all questions in the PSC. Concerning the interpretation of the questionnaire, understanding was good for most patients. Understanding was partial in the question on mobility in 5 patients, activities of daily living, communication, cognition and life after stroke in 4, and spasticity in 3. Only one patient did not understand the question on secondary prevention. The 20 patients were satisfied with the questionnaire. Conclusions. The PSC is a brief tool that is easily understood by patients and could be useful for detecting long term needs after stroke and to facilitate appropriate referrals (AU)

An international study of the quality of national-level guidelines on driving with medical illness.

BACKGROUND: Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised. AIM: To systematically evaluate the quality of selected national guidelines about driving with medical illness. DESIGN: A literature search of bibliographic databases and Internet resources was conducted to identify the guidelines, each of which was formally appraised. METHODS: Eighteen physicians or researchers from Canada, Australia, Ireland, USA and UK appraised nine national guidelines, applying the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. RESULTS: Relative strengths were found in AGREE II scores for the domains of scope and purpose, stakeholder involvement and clarity of presentation. However, all guidelines were given low ratings on rigour of development, applicability and documentation of editorial independence. Overall quality ratings ranged from 2.25 to 5.00 out of 7.00, with modifications recommended for 7 of the guidelines. Intra-class coefficients demonstrated fair to excellent appraiser agreement (0.57-0.79). CONCLUSIONS: This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.