Factores asociados a la mejoría funcional en pacientes con lesión medular traumática cervical / Factors associated with functional improvement in patients with cervical spinal cord injuries

Objetivo Determinar los factores que influyen en la mejoría funcional de un lesionado medular cervical traumático durante la hospitalización. Material y métodos Se ha realizado un estudio retrospectivo donde se han incluido los pacientes que han sufrido una lesión medular cervical traumática aguda y que han concluido un programa de rehabilitación en la Unidad de Lesionados Medulares de Canarias entre 2001 y 2018. Para medir la mejoría funcional se ha realizado una valoración del SCIM III al ingreso y al alta. Resultados El 88% de los 141 pacientes de nuestra muestra han sido hombres: pacientes de edad avanzada, con antecedentes de consumo de alcohol, las lesiones completas y de mayor gravedad en la Escala de ASIA han tenido menores resultados funcionales. El tiempo desde la lesión hasta el ingreso en la unidad, el tiempo de estancia hospitalaria y el tiempo desde la lesión al alta hospitalaria han tenido una relación significativa con la mejoría funcional. Conclusiones En pacientes con edad avanzada y con antecedentes de consumo de alcohol las lesiones completas y de mayor gravedad en la Escala de ASIA han tenido menores resultados funcionales. Por otro lado, el ingreso precoz ha sido fundamental para obtener mejores resultados funcionales y se ha relacionado con estancias hospitalarias más cortas (AU)

Objective To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. Material and methods We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. Results Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. Conclusions Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays (AU)

[Factors associated with functional improvement in patients with cervical spinal cord injuries]. / Factores asociados a la mejoría funcional en pacientes con lesión medular traumática cervical.

OBJECTIVE: To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. MATERIAL AND METHODS: We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. RESULTS: Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. CONCLUSIONS: Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays.

Deaths in collective dwellings and inequalities in small-area mortality: an ecological study in the Madrid region (Spain).

BACKGROUND: Increasing numbers of elderly persons reside and die in institutions, yet there are few studies that analyse the effect of this on mortality in small areas and its ensuing effect on the association between material deprivation and mortality. METHODS: A cross-sectional, ecological study in the region of Madrid covering 3906 census tracts (median 1000 inhabitants), using mortality data for 1996-2003 and socioeconomic deprivation from the 2001 census. Standardised mortality ratios (SMR) were calculated for each census tract. Using the Besag-York-Mollié model, RR of dying and their 95% CI according to the deprivation index considered (with the fourth quartile, Q, being the most unfavourable situation) were calculated for deaths among: the total population and the population excluding residents who died in institutions. RESULTS: 6% of the deceased had been residing in institutions, which affected 16.5% of census sections (644) and accounted for 17% of the variability in SMR among men and 10% among women, p<0.001. Mortality increased with socioeconomic deprivation, whereas the RR for the total population in Q4 with respect to Q1 was 1.46 among men (95% CI 1.41 to 1.50) and 1.12 among women (95% CI 1.08 to 1.17), these figures rose to 1.48 (95% CI 1.43 to 1.53) and 1.14 (95% CI 1.10 to 1.18), respectively, for the population excluding residents who died in institutions. CONCLUSIONS: Deaths of residents in institutions affect the variation in small-area mortality, and confound the relationship between mortality and socioeconomic deprivation. This variable should be recorded in mortality statistics so that its effect can be controlled for in subsequent analyses.

Chronic liver disease and cirrhosis mortality and social deprivation: a spatial analysis in small areas of Madrid region.

OBJECTIVES: To study census-tract distribution of chronic liver disease and cirrhosis mortality in the Madrid Region and its association with socio-economic deprivation. METHODS: Cross-sectional, ecological (3906 census-tract) study, using mortality data for 1996-2003 and a deprivation index drawn up on the basis of 2001 census data. Standardised mortality ratios were calculated taking Spanish rates for 2001 as reference. Smoothed census-tract relative risks were computed using the Besag-York-Mollie model. Relative risks (RRs) of dying and their 95% credibility intervals (95% CIs) were calculated according to quartiles of the deprivation index (with the fourth quartile -Q- of the indicator being the most unfavourable situation). Maps were plotted depicting the distribution of the posterior probability of RR > 1. RESULTS: Census tracts with a high risk of mortality were detected, mostly located in the centre and on the eastern, south-eastern and south-western fringes of the city of Madrid. Mortality increased with deprivation. RRs of mortality according to quartíles of the deprivation index were: Q2 = 1.5 (CI: 1.3-1.6), Q3 = 1.9 (CI:1.7-2.2) and Q4 = 2.5 (CI:2.2-2.8) for men; and Q2 = 1.3 (CI:1.1-1.5), Q3 = 1.5 (CI:1.3-1.7) and Q4 = 1.6 (CI:1.3-1.8) for women. CONCLUSIONS: This small-area study enabled census tracts with excess mortality eligible for a special public health intervention to be identified, and their association with socio-economic deprivation to be confirmed.

Chronic liver disease and cirrhosis mortality and social deprivation: a spatial analysis in small areas of Madrid region / Mortalidad por cirrosis y otras hepatopatías crónicas y privación social: un análisis espacial por áreas pequeñas de la Comunidad de Madrid

Objectives: To study census-tract distribution of chronic liver disease and cirrhosis mortality in the Madrid Region and its association with socio-economic deprivation. Methods: Cross-sectional, ecological (3906 censustract) study, using mortality data for 1996-2003 and a deprivation index drawn up on the basis of 2001 census data. Standardised mortality ratios were calculated taking Spanish rates for 2001 as reference. Smoothed censustract relative risks were computed using the Besag-York-Mollie model. Relative risks (RRs) of dying and their 95% credibility intervals (95% CIs) were calculated according to quartiles of the deprivation index (with the fourth quartile -Q- of the indicator being the most unfavourable situation). Maps were plotted depicting the distribution of the posterior probability of RR > 1. Results: Census tracts with a high risk of mortality were detected, mostly located in the centre and on the eastern, south-eastern and south-western fringes of the city of Madrid. Mortality increased with deprivation. RRs of mortality according to quartíles of the deprivation index were: Q2 = 1.5 (CI: 1.3-1.6), Q3 = 1.9 (CI:1.7-2.2) and Q4 = 2.5 (CI:2.2-2.8) for men; and Q2 = 1.3 (CI:1.1-1.5), Q3 = 1.5 (CI:1.3-1.7) and Q4 = 1.6 (CI:1.3-1.8) forwomen. Conclusions: This small-area study enabled census tracts with excess mortality eligible for a special public health intervention to be identified, and their association with socio-economic deprivation to be confirmed (AU)

Objetivos: Estudiar la distribución por secciones censales de la mortalidad por cirrosis y hepatopatías crónicas de la Comunidad de Madrid y su asociación con la privación socioeconómica. Métodos: Estudio transversal y ecológico (3.906 secciones censales) utilizando los datos del registro de mortalidad de 1996-2003 y un índice de privación construido a partir de los datos del Censo de 2001. Se calcularon razones de mortalidad estandarizadas tomando como referencia las tasas de España del 2001. Los riesgos relativos suavizados de las secciones censales se calcularon siguiendo el modelo Besag-York-Molife. Se han estimado los riesgos relativos (RR) de morir, y su intervalo de credibilidad al 95% (ICI), según los cuartiles del índice de privación (siendo el cuarto cuartil -Q4- del indicador la situación más desfavorable). Se realizaron mapas representando la distribución de la probabilidad posterior de RR > 1. Resultados: Se han detectado secciones censales con alto riesgo de mortalidad localizadas en su mayoría en el centro y la periferia este, sureste y suroeste de la ciudad de Madrid. La mortalidad se incrementa con la privación social: El RR de mortalidad según cuartiles del índice de privación fue: Q2 = 1,5 (CI: 1,3-1,6); Q3 = 1,9 (CI: 1,7-2,2); Q4 = 2,5 (CI: 2,2-2,8), para los hombres; y Q2 = 1,3 (CI: 1,1-1,5); Q3 = 1,5 (CI: 1,3-1,7); Q4 = 1,6 (CI: 1,3-1,8), para las mujeres. Conclusiones: El estudio de áreas pequeñas ha permitido identificar secciones censales con sobremortalidad subsidiarias de una intervención especial de salud pública, así como confirmar su asociación con la privación socioeconómica (AU)

Census tract socioeconomic and physical environment and cardiovascular mortality in the Region of Madrid (Spain).

BACKGROUND: Features of the area might contribute to differences in cardiovascular mortality. The census tract distribution of ischaemic heart disease (IHD) and cerebrovascular disease mortality in the Region of Madrid and its association with deprivation and environmental variables were examined in this study. METHODS: Cross-sectional, ecological study covering 3906 census tracts (median of around 1000 inhabitants), using mortality data (population aged <75 years) for 1996-2003, as well as socioeconomic deprivation and other environmental indicators (subjective perceptions of pollution, background noise, lack of green spaces and delinquency) drawn from the 2001 census. Standardised mortality ratios were calculated. Smoothed census tract relative risks were calculated using the Besag-York-Mollié model. Relative risks (RRs) of dying and their 95% credibility intervals (95% CI) were calculated according to the indicators considered (with the fourth quartile, Q, being the most unfavourable situation). Maps were plotted depicting the distribution of the posterior probability of RR>1. RESULTS: Census tracts with excess mortality were mostly located in the city of Madrid. Mortality increased with deprivation: RRs of IHD and stroke mortality in Q4 with respect to Q1 were 1.42 (95% CI 1.31 to 1.54) and 1.66 (95% CI 1.45 to 1.88) for men, and 1.54 (95% CI 1.33 to 1.79) and 1.52 (95% CI 1.29 to 1.76) for women respectively. Associations with deprivation decreased only slightly when perceived lack of green spaces and delinquency were included in the model. In men, subjective perceptions of areas remained associated with cardiovascular mortality after adjustment for deprivation. CONCLUSION: Deprivation and subjective perceptions of physical environmental characteristics are ecologically associated with cardiovascular disease mortality.

Clinical evaluation of the efficacy and tolerability of ritonavir in combination with two reverse transcriptase inhibitors.

A retrospective study of 76 patients was carried out using ritonavir in an antiretroviral regimen combined with two reverse transcriptase inhibitors to treat outpatients from July, 1996, to April, 1998, with the objective of evaluating clinical efficacy and tolerability. Seventy-six percent of the patients had been diagnosed with AIDS, an average number of CD(4) cells = 233.7 cells/mm(3) and viral load = 144, 084 RNA copies/mm(3). The majority of patients (76.3% )were antiretroviral treatment-experienced, 21.4% having taken protease inhibitors. A positive clinical response was found in 86.7% (including an average weight gain of 4.4 kg in 58.5% ), an average CD(4) count increase of 169.5 cells/mm(3) in 83.3% and an average viral load decrease of approximately 2.28 log in 75% of patients. A high percentage of adverse effects (76.3% ) was detected, with most slight or moderate, but they significantly impacted adherence to treatment as 31.6% stopped taking the drug as a result. We conclude that this antiretroviral regimen has good clinical efficacy, but relatively poor tolerability.

Calcium channel blockers inhibit hydrogen peroxide-induced proliferation of cultured rat mesangial cells.

The present experiments were designed to assess a possible role of H2O2 in the proliferation of cultured rat mesangial cells, as well as to evaluate the effect of different calcium channel blockers and a platelet-activating factor antagonist on this proliferation. Cultured rat mesangial cells were plated at two densities (10,000 and 25,000 cells/well) in 24-well dishes, and proliferation was measured by analyzing [3H]thymidine incorporation and by directly counting the cells. Hydrogen peroxide, 100 microM, increased [3H]thymidine incorporation at the two densities tested (85 and 59%, respectively), as well as the number of cells (53 and 23%, respectively). This effect was dose dependent and it was blocked completely by verapamil and diltiazem, 10 microM, but not by TMB-8 [3,4,5-trimethoxybenzoic acid 8-(diethylamino) octyl ester] at the same concentration. BN 52021, a competitive antagonist of platelet-activating factor, only slightly blocked the H2O2-dependent proliferation. The inhibitory action of the two calcium antagonists tested started at concentrations as low as 1 nM, and inhibited completely the H2O2 stimulated proliferation at concentrations between 0.1 and 1 microM. These results establish that H2O2 is able to induce proliferation of mesangial cells. Although the pathophysiological implications of this finding remain to be proven, these data suggest a potential therapeutic action of calcium antagonist in inflammatory conditions such as glomerulonephritis.

Effects of reactive oxygen species on cultured rat mesangial cells and isolated rat glomeruli.

The effects of reactive oxygen species (ROS) on cultured rat mesangial cells were studied by measuring planar cell surface area (PCSA) after incubation with xanthine plus xanthine oxidase (XXO), in the presence of superoxide dismutase (SOD; 5 micrograms/ml) or catalase (CAT; 20 micrograms/ml), or after incubation with H2O2. Myosin light chain (MLC) phosphorylation was assessed in cells prelabeled with o-[32P]phosphoric acid and incubated with H2O2, after protein separation with sodium dodecyl sulfate-polyacrylamide gel electrophoresis. A possible intermediate role for platelet-activating factor (PAF) was analyzed by preincubation of the cells with a PAF antagonist BN 52021 (BN, 5 x 10(-5) M) and by measuring PAF-specific [3H]acetate incorporation and immunoassayable PAF. XXO significantly decreased PCSA (14%), an effect abolished by CAT but not by SOD. H2O2 induced a similar effect, in a dose-dependent and time-dependent manner. MLC phosphorylation increased by 81 +/- 15% after H2O2 incubation, and this effect was blocked by BN. BN also completely blocked the effect of H2O2 on PCSA. PAF-specific [3H]acetate incorporation increased in the presence of H2O2 (from 6,886 +/- 2,030 to 58,703 +/- 16,063 counts.min-1.mg-1) as well as the immunoassayable PAF production by cells (from 0.90 +/- 0.19 to 6.71 +/- 2.27 ng/mg). These results suggest that ROS, particularly H2O2, could modulate the surface area of mesangial cells, modifying the ultrafiltration coefficient, thus explaining the decrease in glomerular filtration rate in those pathological situations characterized by an increased ROS synthesis. PAF could be involved in the genesis of these effects.

Cellulose acetate membrane improves some aspects of red blood cell function in haemodialysis patients.

The present study was designed to evaluate the influence of two haemodialysis membranes of different biocompatibility on red blood cell function. Twelve patients were studied in two consecutive dialyses, with cuprophan and cellulose acetate. Blood was extracted at 0, 20 and 180 min after the beginning of the haemodialysis session and general haematological parameters, osmotic fragility, deformability, methaemoglobin concentration and malonyldialdehyde (MDA) red blood cell content were determined. Osmotic fragility improved with both membranes, but this improvement was more marked with cellulose acetate. MDA red blood cell content showed a tendency to increase after 3 h with cuprophan (114 +/- 11% of the basal value), whereas it tended to decrease with cellulose acetate (92 +/- 12%), the differences between the two groups being statistically significant. These results suggest that red cell function may improve by changing the characteristics of haemodialysis membranes. This phenomenon could be related to a better biocompatibility.