Aportación de la Fisioterapia al tratamiento del dolor pélvico crónico en endometriosis / Contribution of physiotherapy to the treatment of chronic pelvic pain in endometriosis

INTRODUCCIÓN: En 2010, el European Working Group on Sarcopenia in Older People (EWGSOP) publicó una definición de consenso para la sarcopenia. También desarrolló un algoritmo basado en la medición del rendimiento físico para la determinación de casos de sarcopenia. Se han publicado diversos estudios que determinan la prevalencia de sarcopenia con este algoritmo, pero hasta donde sabemos, no hay estudios publicados que comparen la prevalencia utilizando 3 métodos diferentes para la determinación del rendimiento físico. El objetivo de este estudio fue determinar la prevalencia de sarcopenia utilizando el algoritmo propuesto por el EWGSOP en 2010 y comparar los resultados utilizando 3 métodos diferentes para el rendimiento físico. MÉTODOS: Se trata de un estudio transversal de 97 personas de edad avanzada. Se obtuvieron medidas de masa muscular, fuerza muscular y rendimiento físico. Para diagnosticar la sarcopenia se utilizaron los puntos de corte y el algoritmo propuesto por el EWGSOP. El análisis de concordancia entre variables cualitativas utilizó el coeficiente kappa de Cohen. RESULTADOS: El coeficiente kappa encontrado comparando los resultados de los 3 métodos empleados para el rendimiento físico (Velocidad de la marcha; Timed Up & Go, Short Physical Performance Battery) indica que no existe concordancia entre ellos. El coeficiente kappa encontrado al comparar la prevalencia de la sarcopenia utilizando 3 métodos diferentes para el rendimiento físico indica que hay una concordancia casi perfecta (kappa ≥ 0,96). Al comparar los resultados del algoritmo propuesto por el EWGSOP en 2010 con un algoritmo simplificado donde no se tiene en cuenta el rendimiento físico, encontramos una concordancia casi perfecta (kappa ≥ 0,96). CONCLUSIONES: La igualdad obtenida para la prevalencia de la sarcopenia independientemente del rendimiento físico cuestiona la necesidad de tener que medir este parámetro para el diagnóstico de sarcopenia. Sería suficiente utilizar un algoritmo simplificado para obtener los mismos resultados en el diagnóstico de la sarcopenia. Los hallazgos encontrados son coherentes con la propuesta hecha por el EWGSOP2 en 2018

INTRODUCTION: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a definition for sarcopenia. They also developed an algorithm based on the measurement of physical performance to determine cases of sarcopenia. Several studies have already been published that determine the prevalence of sarcopenia with this algorithm, but as far as we know, there are no published studies comparing the prevalence using 3 different methods for determining physical performance. The objective of our study was to determine the prevalence of sarcopenia in a group of elderly people using the algorithm proposed by the EWGSOP in 2010, and to compare the results using 3 different methods for determining physical performance. METHODS: A cross-sectional study was conducted with 97 elderly people. Measurements were obtained of muscle mass, muscle strength, and physical performance. To diagnose sarcopenia, the cut-off points and the diagnostic algorithm proposed by the EWGSOP were used. Cohen's Kappa coefficient was used for the analysis of the agreement between qualitative variables. RESULTS: The kappa coefficient, found by comparing the results for the 3 methods used to determine physical performance (Gait speed; Timed Up & Go test, Short Physical Performance Battery), suggests that there is no concordance between them. When comparing the prevalence of sarcopenia using 3 different methods for the determination of physical performance, the kappa coefficient found suggests that there is an almost perfect agreement (kappa ≥ 0.96). An almost perfect agreement (kappa ≥ 0.96) was found when comparing the results of the algorithm proposed by the EWGSOP in 2010 with a simplified algorithm where physical performance for the diagnosis of sarcopenia is not taken into account. CONCLUSIONS: The equality in the results obtained for prevalence showed that the measurement of physical performance is not a necessary parameter for the diagnosis of sarcopenia. To obtain the same results in the diagnosis of sarcopenia, it is enough to use a simplified algorithm. The findings found are consistent with the proposal made by the EWGSOP in 2018

Comparación de la prevalencia de sarcopenia en personas de edad avanzada según el algoritmo propuesto por el EWGSOP en 2010 para la identificación de casos de sarcopenia utilizando tres métodos diferentes para la determinación del rendimiento físico / Comparison of the prevalence of sarcopenia in elderly people according to the algorithm proposed by the EWGSOP in 2010 for sarcopenia case-finding using three different methods for determining physical performance

INTRODUCCIÓN: En 2010, el European Working Group on Sarcopenia in Older People (EWGSOP) publicó una definición de consenso para la sarcopenia. También desarrolló un algoritmo basado en la medición del rendimiento físico para la determinación de casos de sarcopenia. Se han publicado diversos estudios que determinan la prevalencia de sarcopenia con este algoritmo, pero hasta donde sabemos, no hay estudios publicados que comparen la prevalencia utilizando 3 métodos diferentes para la determinación del rendimiento físico. El objetivo de este estudio fue determinar la prevalencia de sarcopenia utilizando el algoritmo propuesto por el EWGSOP en 2010 y comparar los resultados utilizando 3 métodos diferentes para el rendimiento físico. MÉTODOS: Se trata de un estudio transversal de 97 personas de edad avanzada. Se obtuvieron medidas de masa muscular, fuerza muscular y rendimiento físico. Para diagnosticar la sarcopenia se utilizaron los puntos de corte y el algoritmo propuesto por el EWGSOP. El análisis de concordancia entre variables cualitativas utilizó el coeficiente kappa de Cohen. RESULTADOS: El coeficiente kappa encontrado comparando los resultados de los 3 métodos empleados para el rendimiento físico (Velocidad de la marcha; Timed Up & Go, Short Physical Performance Battery) indica que no existe concordancia entre ellos. El coeficiente kappa encontrado al comparar la prevalencia de la sarcopenia utilizando 3 métodos diferentes para el rendimiento físico indica que hay una concordancia casi perfecta (kappa ≥ 0,96). Al comparar los resultados del algoritmo propuesto por el EWGSOP en 2010 con un algoritmo simplificado donde no se tiene en cuenta el rendimiento físico, encontramos una concordancia casi perfecta (kappa ≥ 0,96). CONCLUSIONES: La igualdad obtenida para la prevalencia de la sarcopenia independientemente del rendimiento físico cuestiona la necesidad de tener que medir este parámetro para el diagnóstico de sarcopenia. Sería suficiente utilizar un algoritmo simplificado para obtener los mismos resultados en el diagnóstico de la sarcopenia. Los hallazgos encontrados son coherentes con la propuesta hecha por el EWGSOP2 en 2018

INTRODUCTION: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a definition for sarcopenia. They also developed an algorithm based on the measurement of physical performance to determine cases of sarcopenia. Several studies have already been published that determine the prevalence of sarcopenia with this algorithm, but as far as we know, there are no published studies comparing the prevalence using 3 different methods for determining physical performance. The objective of our study was to determine the prevalence of sarcopenia in a group of elderly people using the algorithm proposed by the EWGSOP in 2010, and to compare the results using 3 different methods for determining physical performance. METHODS: A cross-sectional study was conducted with 97 elderly people. Measurements were obtained of muscle mass, muscle strength, and physical performance. To diagnose sarcopenia, the cut-off points and the diagnostic algorithm proposed by the EWGSOP were used. Cohen's Kappa coefficient was used for the analysis of the agreement between qualitative variables. RESULTS: The kappa coefficient, found by comparing the results for the 3 methods used to determine physical performance (Gait speed; Timed Up & Go test, Short Physical Performance Battery), suggests that there is no concordance between them. When comparing the prevalence of sarcopenia using 3 different methods for the determination of physical performance, the kappa coefficient found suggests that there is an almost perfect agreement (kappa ≥ 0.96). An almost perfect agreement (kappa ≥ 0.96) was found when comparing the results of the algorithm proposed by the EWGSOP in 2010 with a simplified algorithm where physical performance for the diagnosis of sarcopenia is not taken into account. CONCLUSIONS: The equality in the results obtained for prevalence showed that the measurement of physical performance is not a necessary parameter for the diagnosis of sarcopenia. To obtain the same results in the diagnosis of sarcopenia, it is enough to use a simplified algorithm. The findings found are consistent with the proposal made by the EWGSOP in 2018

Testing for mating isolation between ecotypes: laboratory experiments with lake, stream and hybrid stickleback.

Mating isolation is a frequent contributor to ecological speciation - but how consistently does it evolve as a result of divergent selection? We tested for genetically based mating isolation between lake and stream threespine stickleback (Gasterosteus aculeatus L.) from the Misty watershed, Vancouver Island, British Columbia. We combined several design elements that are uncommon in the studies of stickleback mate choice: (i) we used second-generation laboratory-reared fish (to reduce environmental and maternal effects), (ii) we allowed for male-male competitive interactions (instead of the typical no-choice trials) and (iii) we included hybrids along with pure types. Males of different types (Lake, Inlet, hybrid) were paired in aquaria, allowed to build nests and then exposed sequentially to females of all three types. We found that Lake and Inlet males differed in behaviours thought to influence stickleback mate choice (inter- and intra-sexual aggression, display and nest activities), whereas hybrids were either intermediate or apparently 'inferior' in these behaviours. Despite these differences, Lake and Inlet fish did not mate assortatively and hybrid males did not have a mating disadvantage. Our study reinforces the noninevitability of mating isolation evolving in response to ecological differences and highlights the need to further investigate the factors promoting and constraining progress towards ecological speciation.

Prevalence and characteristics of Sjögren's syndrome or Sicca syndrome in chronic hepatitis C virus infection: a prospective study.

OBJECTIVE: To describe the prevalence and clinical and laboratory characteristics of sicca syndrome and Sjögren's syndrome (SS) in chronic hepatitis C virus (HCV) infection. METHODS: Forty-five consecutive HCV infected patients referred for liver biopsy were enrolled in a prospective study. Subjective and objective criteria of xerophthalmia or xerostomia were systematically investigated and the patients classified according to 3 sets of criteria (European, Manthorpe, and Fox criteria) for the diagnosis of SS. RESULTS: Sicca syndrome was present in 28 (62%) patients; all had oral dryness and 14 had both oral and ocular dryness. Twenty-four (53%) patients had SS by the European criteria, 25 (56%) by Manthorpe criteria, and 4 (8%) by Fox criteria. Salivary gland biopsy was positive for SS (grade III or IV by Chishom classification) in 21 samples (47%); 9 samples (21%) were classified grade 0, and 15 (32%) grade I or II. No patient had anti-SSA or anti-SSB antibodies. The presence of SS or sicca syndrome was associated with older age and liver disease activity according to the METAVIR scoring system, but not with the presence of other extrahepatic manifestations or with HCV genotype. A high METAVIR activity score was only statistically associated with primary SS. CONCLUSION: HCV infection appears to account for a subgroup of patients with sicca syndrome in which half the cases meet the definition for SS according to European and Manthorpe criteria. This subgroup is characterized by the constant finding of xerostomia, the absence of classical systemic manifestations observed in primary SS, and the absence of anti-SSA or anti-SSB antibodies. Such characteristics delineate a distinctive, virus associated entity that differs from primary SS.

[Frequency of autoimmune diseases in 218 patients with autoimmune thyroid pathologies]. / Fréquence des maladies auto-immunes chez 218 patients atteints de pathologies thyroïdiennes auto-immunes.

PURPOSE: The aim of our study was to investigate the frequency of auto-immune diseases in patients suffering from autoimmune thyroid diseases. METHOD: We realised a retrospective study from 1981 to 1993 including 218 patients suffering from thyroiditis who were followed in the same hospital service. There were 202 women and 16 men with a mean age 49 at the moment their thyroid pathology was discovered. RESULTS: Thirty patients had one or more autoimmune disease associated to their thyroid disorders, representing 13.7% of total patients. The two most frequent autoimmune diseases were lupus and Sjögren's syndrome. In 17 cases the diagnosis of the associated autoimmune disease was made simultaneously. The systemic disease preceded with an 8-year delay the thyroid disease in five cases, and the thyroid disease was annunciatory in eight cases with a delay of 5 years. The frequency of autoimmune diseases seems to be higher in patients suffering from thyroid disorders than in the general population. They are probably common physiopathological mechanisms. CONCLUSION: The frequency of these associations suggests the need for a long-lasting survey of those patients having thyroid disorders. Initial evaluation and a regular checking in patients suffering from an autoimmune disease is recommenced.

[Raynaud syndrome complicated by digital gangrene during treatment with interferon-alpha]. / Syndrome de Raynaud compliqué de gangrène digitale au cours d'un traitement par l'interféron alpha.

In a 43-year old male suffering from idiopathic hypereosinophilic syndrome (HES) since 1984, successfully treated with alpha interferon (alpha IFN) for 32 months, a severe Raynaud's phenomenon of the four extremities occurred and eventually evolved into digital necrosis within a few weeks. The arterial echography/doppler and plethysmography patterns were suggestive of isolated small-to medium-size digital artery occlusions. An extensive search for an aetiology of digital necrosis, including complete tests of autoimmunity, remained negative. Two months later, despite alpha IFN withdrawal and intravenous infusions of ilomedin, the digital ischemia evolved to extensive necrosis that necessitated several amputations and a definitive spinal chord stimulation. Pathologic examination of arteries showed no vasculitis but diffuse arterial occlusions by thrombi.

[Are the anatomopathological classifications of primary Gougerot-Sjögren syndrome correlated with each-other and with clinical symptoms?]. / Les classifications anatomopathologiques du syndrome de Gougerot-Sjögren primitif sont-elles corrélées entre elles et à la clinique?

Seventy-two cases of primary Sjögren's syndrome, according to the European classification criteria, were studied looking for a correlation between anatomic criteria and clinico-biological signs in this disease. Labial salivary gland biopsy was performed in all patients and anatomic criteria were evaluated according to both Chisholm and Chomette scales. Work-up included recording of functional and clinical signs. Our study shows no clinico-histological correlation in Sjögren's syndrome. Moreover, we did not find any correlation between the two histological scales. We think, therefore, that labial salivary gland biopsy appears to be an important step in Sjögren's syndrome diagnosis according to European criteria. However, it does not present any benefit in patient treatment.

[Acquired hemophilia caused by autoantibodies against factor VIII coagulation activity. Clinical, biological study and therapeutic indications. Experience based on a study of 9 cases]. / Hémophilie acquise par auto-anticorps dirigé contre l'activité coagulante du facteur VIII. Etude clinique, biologique et indications thérapeutiques. Expérience ã partir d'une étude de 9 cas.

STUDY DESIGNS: To describe retrospectively the experience of the Internal Medicine and Clinical Hematology Departments of a University Hospital on adult acquired hemophilia (AH) caused by autoantibody against factor VIII coagulant (f.VIII:C) activity. Diagnosis, clinical datas, associated diseases, treatment and final outcome are described and compared to the published literature. MATERIAL AND METHODS: All cases admitted in both departments since 1989 were enrolled in the study. Clotting analyses comprised clotting times (activated partial thromboplastin time, prothrombin and thrombine times), measurements of f.VIII:C level, antifactor VIII detection and measurement by the Bethesda method assay, Search for an etiologic factor could not be standardized. All patients were followed until cure, sustained improvement, or death. RESULTS: From 1989 to 1996, AH was diagnosed in nine adult patients. Mean age was 76 +/- 24.6 years (range : 65-89) and sex ratio male to female was 2. Eight bleeding episodes occurred in seven patients, resulting consistently in severe hemorrhagic anemia and leading to hemodynamic failure in two, while two others remained asymptomatic for prolonged periods. The initial levels of f.VIII:C ranged from less than 1% to 20%, and the titers of inhibitors ranged from 0.5 to 100 Bethesda units. An underlying disease, to which the appearance of their inhibitor could be related, either concomitantly or up to 1 year later, was found in four cases including (one case each): rheumatoid arthritis, lupus erythematosus with antiphospholipid syndrome, followed by non-Hodgkin malignant lymphoma, relapsing carcinoma and, biliary tract surgery. Six acute bleeding episodes necessitated symptomatic measures, based on activated prothrombin complex concentrates in four instances, with a good response in all cases. Preparation to minor surgical operations was achieved in two asymptomatic subjects by either highly purified factor VIII concentrations infusion or intravenous 1-desamino-8-D-arginine vasopressin, with a good control of local hemostasis in each case. Three received intravenous immunoglobulins, which resulted in success in one, failure in one and, questionable response in the latter. Immunosuppression, mainly with corticosteroids, cyclophosphamid, or both, was given to seven, resulting in disappearance of inhibitor in five (delay to cure ranged from 2 weeks to 10 months), improvement in one, and failure in one (in this latter case, cure was eventually achieved with the anti-Hodgkin disease MOPP chemotherapy). After a 27-month mean follow-up, six patients experienced a sustained complete response and one a sustained partial response to immuno-suppression, two untreated patients remained asymptomatic, two died later from malignancy (carcinoma and myelodysplastic syndrome). CONCLUSION: AH usually presents as a severe or even a life-threatening disease, necessitating prompt and thorough symptomatic measures directed at the cessation of bleedings and prevention of their relapse. In our experience, no death was attributable to AH or its treatment. Immunosuppression is useful in selected cases, but must be carefully discussed, since it can be highly toxic, especially in the elderly. Given the possibility of a delayed onset of some etiologic factors, a prolonged surveillance of each case of idiopathic AH is mandatory.

[Dynamics of the nasal colonization by methicillin resistant Staphylococcus aureus in patients hospitalized in an intensive care unit]. / Dynamique de la colonisation nasale par Staphylococcus aureus résistant à la méticilline (SAMR) chez les malades hospitalisés dans un service de réanimation.

Prospective study on MRSA nasal cariage was done during two months in an intensive care unit in Limoges University Hospital. Nasal swab specimens were taken daily and cultured on selective and non selective media. Sixty eight patients were included in this study (878 swab collected, 575 MRSA isolated). Patients mean âge was 62 years and stay period mean was 12.3 days (median: 7 days). Among these patients, 16 were already carrying MRSA when entering in the unit and 26 became positive for MRSA during their stay. The mean colonisation delay was 5.5 days (median 4 days). All patients, except one, have shown a nasal carriage during all their stay. During the study period, 17 patients became infected and only two patients neither carried nasal MRSA before and during infection. In all cases, glycopeptide treatment did not affect nasal carriage. Colonisation and infection risk factors were discussed.

[Anticardiolipin antibodies and Horton disease]. / Anticorps anti-cardiolipine et maladie de Horton.

A prospective study, including 86 patients with giant cell arteritis proven by temporal artery biopsies, was performed to determine the prevalence of anticardiolipin antibodies, the antibody isotype, the relationship of antibodies to ischemic involvement and their evolution during corticosteroid treatment. Controls were obtained from 50 subjects without vasculitis or autoimmune disorders. Before treatment, 50% of patients' sera contained anti-cardiolipin antibodies (vs 8% in controls, p < 0.0001). These antibodies were IgG-ACL in 36% of patients and IgM-ACL in 17% of patients (vs respectively, 4% and 2% in controls). No significant association was observed between the incidence of ischemic ocular complications and the levels of anti-cardiolipin antibodies. During corticosteroid treatment, the level of anti-cardiolipin antibodies, mostly IgG class, decreased to become negative in 2 months. An increase of these antibodies was observed with the occurrence of relapses in four patients, after the end of corticosteroid therapy. The significance of IgG and IgM antibodies is different in giant cell arteritis. IgG antibodies may be markers of the course of this vasculitis.

[Systemic signs of primary Gougerot-Sjögren syndrome. 48 cases]. / Signes systémiques du syndrome de Goujerot-Sjögren primitif. 48 observations.

Forty-eight patients with primary Sjögren syndrome are documented together with the results of their baseline investigations. The majority of patients were female (44 out of 48) and mean age was 63.2 years. Common clinical features included 20 parenchymal lung disease, among which 4 had interstitial pulmonary fibrosis and 2 lymphocytic interstitial pneumonitis, 12 neurologic manifestations, 16 Raynaud's phenomenon, 12 arthritis, and 3 gastrointestinal involvement. Haematological features occurred in 15 patients and another autoimmune disease was encountered in 13 cases. These extraglandular manifestations were the dominating reasons for hospital referral in 43.5% of cases, the sicca syndrome were most often only mentioned by the patients after special questioning which explain considerable delay before the diagnosis.

[Periarteritis nodosa and parvovirus B19 infection]. / Périartérite noueuse et infection par le parvovirus B19.

The authors report a case of polyarteritis nodosa which coincide with serological conversion to parvovirus B19. After review of the literature, they recall the role of this virus in human pathology and also the role of different infectious agents in the PAN pathogenesis.