Brief Acceptance and Commitment Therapy for Fibromyalgia: Feasibility and Effectiveness of a Replicated Single-Case Design.

Objective: Overall, the literature on the effectiveness of psychological treatments in general and those for fibromyalgia in particular has been dominated by research designs that focus on large groups and explore changes on average, so the treatment impact at the individual level remains unclear. In this quasi-experimental, replicated single-case design, we will test the feasibility and effectiveness of a brief acceptance and committed therapy intervention using ecological momentary assessment supported by technology. Methods: The sample comprised 7 patients (3 in the individual condition and 4 in the group condition) who received a brief, 5-week psychological treatment. Patient evolution was assessed one week prior to treatment onset and during the whole study with a smartphone app. Because ecological momentary assessment and the use of an app are not frequent practices in routine care, we also evaluated the feasibility of this assessment methodology (i.e., compliance with the app). Change was investigated with a nonoverlap of all pairs index. Outcomes were pain interference with sleep and social activities, fatigue, sadness, and pain intensity. Results: Patient change was not uniform across outcomes. Four patients (two in each condition) showed relatively moderate levels of change (approximately 60% nonoverlap in several outcomes). The remaining patients showed more modest improvements which affected a reduced number of outcomes. Based on nonoverlapping indices, there was no clear evidence in favor of any treatment format. Conclusions: An alternative design to large-scale trials, one that focuses on the individual change, exists and it can be implemented in pain research. The use of technology (e.g., smartphones) simplifies such designs by facilitating ecological momentary assessment. Based on our findings showing that changes were not homogeneous across patients or outcomes, more single-case designs and patient-centered analyses (e.g., responder and moderation analyses) are required.

Differential analysis of executive functions in children from disadvantaged families vs. children with autistic spectrum disorder / Análisis diferencial de las funciones ejecutivas en niños pertenecientes a familias desfavorecidas vs. niños con trastorno del espectro autista

Executive Functions (EF) are considered necessary for dealing with new situations and for controlling one's behavior. Studies have confirmed EF difficulties in children with autism spectrum disorder (ASD) and in children from disadvantaged families (DF). This study aimed to examine EF difficulties in the two populations -ASD and DF children- with respect to EF in children who show typical development (TD). A total of 89 children between the ages of 7 and 12 years participated, divided into three groups: 28 with ASD, 36 from DF and 25 with TD. Assessments were made with different measures of EF (executive attention, cognitive flexibility, inhibition and working memory) and central coherence. In general, the children from DF obtained the lowest scores in all measures, although differences were not significant with respect to the other groups in all cases. Children with ASD obtained similar scores to the TD group in executive attention and working memory, and higher scores in central coherence. In comparison to the children from DF, the ASD children did better on all measures. These results would indicate that intervention programs designed for the two groups must be focus on different kind of tasks

Las Funciones Ejecutivas (FE) se consideran necesarias para afrontar nuevas situaciones y para controlar la propia conducta. Diversos estudios han confirmado que poblaciones tan diferentes como niños con Trastorno del Espectro Autista (TEA) y niños de familias desfavorecidas (FD) muestran dificultades en las FE. Este estudio pretende examinar las dificultades en FE en esas dos poblaciones con respecto a las FE en niños que muestran un desarrollo típico (DT). Un total de 89 niños de edades comprendidas entre los 7 y 12 años, divididos en tres grupos, participaron en el estudio: 28 con TEA, 36 de FD y 25 con DT. La evaluación se realizó con diferentes medidas de FE (memoria de trabajo, flexibilidad cognitiva, inhibición, planificación y autorregulación) y coherencia central. Los resultados muestran que, en general, los niños de FD obtuvieron las menores puntuaciones en todas las medidas, aunque las diferencias no fueron significativas en todos los casos. Los niños con TEA obtuvieron puntuaciones similares al grupo DT en planificación y memoria de trabajo, y mayores puntuaciones en coherencia central. Además, cuando se les compara con los niños de FD, los niños con TEA obtuvieron una ejecución mayor en todas las medidas. Estos resultados indican que existen diferencias entre grupos y, por tanto, que los programas de intervención diseñados para cada uno de ellos deben centrarse en diferentes tipos de tareas

[Unicornuate uterus with cavitary non-communicating rudimentary horn: magnetic resonance characterization]. / Útero unicorne con cuerno rudimentario cavitado no comunicante: caracterización por resonancia magnética.

Mullerian duct or paramesonephric anomalies are a group of congenital malformations of the female genital tract that result from the alteration in one or more stages of embryonic development. The prevalence has increased, probably due to the progress of diagnostic imaging methods and the relevance that it has acquired in young women with infertility problems. Magnetic resonance imaging (MRI) is currently the method of choice for characterizing the different types of Mullerian anomalies, its complications and associated pathology. Unicornuate uterus correspond to class II of classification of Mullerian duct anomalies developed by the American Society for Reproductive Medicine. According to this, four subtypes have been identified, each with different clinical implications. A cavitated, non-communicating rudimentary horn in a unicornuate uterus is associated with an increased incidence of gynecological problems and obstetric complications that sometimes threaten the lives of patients, reason why its suspicion, diagnosis and treatment is necessary. We report the case of a patient with infertility in which this subtype of congenital malformation was discovered.

Las anomalías de los ductos müllerianos o paramesonéfricos son un conjunto de malformaciones congénitas del tracto genital femenino que resultan de la alteración en una o más fases del desarrollo embriológico. La prevalencia ha incrementado, probablemente debido al progreso de los métodos diagnósticos de imagen y a la relevancia que han adquirido en mujeres jóvenes con problemas de infertilidad. Actualmente la resonancia magnética es el método de elección para caracterizar los diferentes tipos de anomalías müllerianas, sus complicaciones y la patología asociada. El útero unicorne corresponde a la clase II de la clasificación de anomalías de los ductos müllerianos desarrollada por la Sociedad Americana de Medicina Reproductiva. Según esta, se identifican cuatro subtipos, cada uno con diferente implicación clínica. El útero unicorne con cuerno uterino rudimentario cavitado no comunicante está asociado con una incidencia incrementada de problemas ginecológicos y complicaciones obstétricas que en ocasiones amenazan la vida de las pacientes, razón por la que es necesaria su sospecha, diagnóstico y tratamiento oportunos. Presentamos el caso de una paciente con problemas de infertilidad en la que se descubrió este subtipo de malformación congénita.

Analysis of veterinary drug and pesticide residues in animal feed by high-resolution mass spectrometry: comparison between time-of-flight and Orbitrap.

The use of medium-high-resolution mass spectrometers (M-HRMS) provides many advantages in multi-residue analysis. A comparison between two mass spectrometers, medium-resolution (MRMS) time-of-flight (TOF) and high-resolution (HRMS) Orbitrap, has been carried out for the analysis of toxic compounds in animal feed. More than 300 compounds belonging to several classes of veterinary drugs (VDs) and pesticides have been determined in different animal feed samples using a generic extraction method. The use of a clean-up procedure has been evaluated in both instruments, and several validation parameters have been established, such as the matrix effect, linearity, recovery and sensitivity. Finally, both instruments have been used during the analysis of 18 different feed samples (including chicken, hen, rabbit and horse). Some VDs (sulfadiazine, trimethoprim, robenidine and monensin sodium) and one pesticide (chlorpyrifos) have been identified. In general, better results were obtained using the Orbitrap, such as sensitivity (1-12.5 µg kg(-1)) and recovery values (60-125%). Moreover, this analyser had several software tools, which reduced the time for data processing and were easy to use, performing quick screening for more than 450 compounds in less than 5 min. However, some disadvantages such as the high cost and a decrease in the number of detected compounds at low concentrations must be taken into account.

Identification of transformation products of pesticides and veterinary drugs in food and related matrices: use of retrospective analysis.

Retrospective analysis has been applied in different samples, including honey, meat, feed and nutraceutical products from ginkgo biloba, soya, royal jelly and green tea, with the aim of searching transformation products of pesticides and veterinary drugs, which were not included in an initial analysis. Generic extraction and analytical procedures based on high resolution mass spectrometry (Exactive-Orbitrap analyser was used) have been applied. All obtained data have been reprocessed and some compounds as anhydroerythromycin in honey and 3,5,6-trichloro-2-pyridinol in feed have been detected, demonstrating the applicability and the utility of the procedure. Advantages and disadvantages of retrospective approach have been highlighted.

Localización inusual de lesiones líticas de mieloma múltiple con resonancia magnética. Reporte de dos casos / Unusual location of multiple myeloma lytic lesions with magnetic resonance imaging. Report of two cases

Resumen: El mieloma múltiple (MM) es una enfermedad maligna hematológica que se caracteriza por la proliferación de células plasmáticas monoclonales en la médula ósea. La prueba de diagnóstico estándar de oro para MM es un aspirado y/o biopsia de médula ósea (MO), que define la cantidad de células plasmáticas atípicas y constituye la base del sistema de clasificación diagnóstica del Grupo de Trabajo Internacional del Mieloma. Las lesiones del MM en tejido óseo son líticas y su localización más frecuente es en la columna vertebral, pelvis, cráneo y costillas. Aunque las lesiones óseas predominan en estas regiones del esqueleto y en las extremidades proximales también se presentan en menor proporción en codos, rodillas y escápula. En los estudios por imagen la radiografía simple es el principal estudio diagnóstico en la detección de cambios óseos destructivos por MM, sin embargo tiene baja sensibilidad. El estudio de resonancia magnética (RM) es el estudio de elección por tener mayor sensibilidad y especificidad para el diagnóstico de esta enfermedad. Objetivo: Informar 2 casos con infiltración por mieloma múltiple en regiones inusuales.

Abstract: Multiple myeloma (MM) is an hematologic malignancy characterized by the proliferation of malignant monoclonal plasma cells in the bone marrow. The diagnostic test for MM is a bone marrow aspirate or biopsy to define the amount of atypical plasma cells and it is the basis of the diagnostic classification system of the International Working Group Myeloma. MM lesions are lytic bone tissue and are most frequently located in the spine, pelvis, skull and ribs. Bone lesions predominate in these regions of the skeleton and proximal extremities but may occur to a lesser extent on elbows, knees and scapula. In imaging studies plain radiography remains the primary diagnostic study in detecting destructive bone changes multiple myeloma, however the MRI study is the study of choice because the sensitivity and specificity for the diagnosis of this disease. Objectives: Report two cases with multiple myeloma infiltration in unusual regions.

Analysis of pesticide and veterinary drug residues in baby food by liquid chromatography coupled to Orbitrap high resolution mass spectrometry.

Pesticide and veterinary drug residues have been simultaneously determined in several baby foods as meat, fish and vegetable-based baby food. A generic extraction method without clean-up step was applied. Moreover, the use of a representative matrix for proper quantification of all target compounds was studied and the best results were obtained when vegetable-based baby food was used as representative matrix, allowing the reliable quantification of more than 300 compounds. The method was validated and good recoveries were obtained for most of compounds at concentrations higher than 50 µg kg(-1). Limits of detection (LOD) ranged from 0.5 to 50 µg kg(-1), whereas limits of quantification (LOQ) were established between 10 and 100 µg kg(-1). Limits of identification (LOIs) ranged from 0.5 to 50 µg kg(-1). This method was applied to the analysis of 46 different baby food samples and no positive samples were found.

Child with temporal lobe hamartoma: A to Z images and a case report.

Gelastic seizure was first described by Trousseau in 1877 and comes from the Greek word gelos (laughs), as laughter is the main feature [1]. Normal laughter is a reactive emotional behaviour and motor action that involves the limbic system, hypothalamus, temporal cortex, and several regions of the brainstem. A female patient, six years old, left-handed, with gelastic seizures, uncontrolled despite being treated with two antiepileptic drugs at high doses, was treated. A simple axial tomography was done, where a hypodense lesion that shapes the inner table of the skull temporal level was observed; later, magnetic resonance imaging was requested, better characterising an intraxial lesion in the right second temporal gyrus cystic appearance.

Evaluation of the potential of GC-APCI-MS for the analysis of pesticide residues in fatty matrices.

A method based on gas chromatography-atmospheric pressure chemical ionization-mass spectrometry (GC-APCI-MS) has been developed for the analysis of pesticides in meat by using quadrupole-time of flight mass spectrometry (QTOF-MS). Ionization and MS conditions were studied for 71 compounds, although only 51 showed acceptable performance. The protonated form of the analytes was mainly found ([M + H]⁺), although some compounds generated the molecular ion (M⁺(•)). A fast and generic extraction procedure was applied in sample pretreatment. The analytical method was suitable for qualitative analysis, and it was also evaluated for quantitative analysis, obtaining adequate recovery and precision values for most of the studied analytes at two concentration levels (50 and 150 µg/kg). Several operational drawbacks were found with this instrument, such as slow stabilization and moderate sensitivity, although the fast switching between LC and GC allows the increase of its applicability.

Wide-scope analysis of pesticide and veterinary drug residues in meat matrices by high resolution MS: detection and identification using Exactive-Orbitrap.

A multiresidue and multiclass method for the simultaneous determination of more than 350 compounds including pesticides, biopesticides and veterinary drugs in different meat matrices (beef, pork and chicken) by ultra-high performance liquid chromatography coupled to Orbitrap MS has been developed. In the present study, the determination of fragments was accomplished as an essential tool for a reliable identification of compounds using high resolution MS. To obtain these fragments, different strategies have been carried out in order to ensure an appropriate fragment assignment and identification. The analytical method is suitable for qualitative analysis, and it was also evaluated for quantitative analysis. Generic extraction conditions were optimized, obtaining adequate recovery and precision values for most of the studied analytes (>290). The limits of detection ranged from 2 to 16 µg kg(-1). Limits of quantification were 10 µg kg(-1) with the exception of few compounds with a higher value (50 or 100 µg kg(-1)). Limits of identification were also established, and they ranged from 2 to 150 µg kg(-1). This method was applied to the analysis of 18 meat samples and some veterinary drugs as enrofloxacin and sulfadiazine were detected and further identified/quantified (with triple quadrupole) in two different samples at 33 µg kg(-1) and trace levels, respectively. No pesticides were detected in the analyzed samples.

Self-reported quality of life in pharmacoresistant temporal lobe epilepsy: correlation with clinical variables and memory evaluation.

AIM: This work explores the effects of clinical variables on self-reported quality of life (QoL) in pharmacoresistant temporal lobe epilepsy (TLE), correlating this information with results from the Quality of Life in Epilepsy questionnaire (QOLIE-31) and selective memory tests of the Barcelona Battery and the Rey-Osterrieth figure. METHODS: We retrospectively analysed the records of 60 TLE patients and correlated patient variables (e.g. gender, aetiology; mesial TLE with hippocampal sclerosis [HS] versus lesional TLE, side of ictal onset, age, age at onset, duration of epilepsy, seizure frequency, and use of AEDs) with selective memory test scores and self-reported QoL. RESULTS: Right ictal onset was associated with lower emotional well-being scores. MTLE-HS patients had lower QOLIE-31 scores for seizure worry, social function, overall QoL, energy/fatigue, cognitive function, and obtained a lower overall score, compared to those with lesional TLE. Older age at epilepsy onset was associated with worse emotional well-being, energy/fatigue, medication effects, and seizure worry outcomes. Higher seizure frequency and older age at time of evaluation were associated with lower cognitive function scores. Generalised seizures were associated with lower scores based on the variables: seizure worry, overall quality of life, emotional well-being, and cognitive function. Regarding memory tests, only visuospatial memory correlated positively with cognitive function score. Patients with MTLE-HS underwent evaluation for pharmacoresistant epilepsy, on average, 10 years later than those with lesional TLE. CONCLUSIONS: MTLE-HS, right-sided epileptogenic zone, late onset, and higher seizure frequency were associated with worse QoL. Objective testing revealed specific memory deficits that were not reflected in self-reported QoL scores.

Analysis of veterinary drug residues in cheese by ultra-high-performance LC coupled to triple quadrupole MS/MS.

A simple, reliable, and fast multiresidue method has been developed for the determination of 17 veterinary drugs belonging to several families (macrolides, sulfonamides, and anthelmintics) in cheese at trace levels. Ultra-high-performance LC coupled to MS/MS has been used for the analysis of these compounds in less than 9 min. Veterinary drug residues have been extracted from cheese samples using a QuEChERS (quick, easy, cheap, effective, rugged, and safe)-based extraction procedure without applying any further clean-up step. Matrix-matched calibration was used for quantification and recoveries were calculated at three concentration levels (10, 50, and 100 µg/kg). The obtained values ranged from 70 to 110% for the selected compounds except for tylosin and josamycin at 100 µg/kg (111.7 and 112.7%, respectively). Intra- and interday precision were also evaluated and RSDs were lower than 25% in all the cases. LOQs ranged from 0.3 µg/kg (for thiabendazole, oxfendazole, mebendazole, josamycin, and fenbendazole) to 10.5 µg/kg (abamectin), whereas decision limit and detection capability ranged from 2.3 (thiabendazole) to 11.3 (abamectin) and 4.2 (thiabendazole) to 14.3 µg/kg (abamectin), respectively. Finally, 13 samples were analyzed and traces of thiabendazole were detected in two different cheeses.

Comprehensive qualitative and quantitative determination of pesticides and veterinary drugs in honey using liquid chromatography-Orbitrap high resolution mass spectrometry.

A database has been created for the simultaneous analysis of more than 350 pesticides and veterinary drugs (including antibiotics) using ultra-high performance liquid chromatography coupled to high resolution Orbitrap mass spectrometry (UHPLC-Orbitrap-MS). This is a comprehensive exact mass database built using the Exactive-Orbitrap analyzer. The developed database includes exact masses of the target ions and retention time data, and allows the automatic search of the included compounds. Generic chromatographic and MS conditions have been applied. The presented database is suitable for qualitative analysis, and it was also evaluated for quantitative purposes in routine analysis, after the optimization and validation of a generic extraction method in honey samples. Adequate recovery and precision values for most of the studied analytes were obtained and the limits of detection (LOD) ranged from 1 to 50 µg kg(-1). For pesticides, LODs were always lower than the MRLs established by European Union in honey, except for a few compounds. This method was applied to the analysis of 26 real honey samples and some pesticides (azoxystrobin, coumaphos, dimethoate and thiacloprid) were detected in 4 samples. Azoxystrobin and coumaphos were determined in two different samples (organic honey) at 1.5 µg kg(-1) and 5.1 µg kg(-1). Veterinary drugs were not detected in the analyzed samples.

Multi-mycotoxin analysis in eggs using a QuEChERS-based extraction procedure and ultra-high-pressure liquid chromatography coupled to triple quadrupole mass spectrometry.

A reliable and rapid method has been developed for the determination of 10 mycotoxins (beauvericin, enniatin A, A1, B1, citrinin, aflatoxin B1, B2, G1, G2 and ochratoxin A) in eggs at trace levels. Ultra-high-pressure liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS) has been used for the analysis of these compounds in less than 7 min. Mycotoxins have been extracted from egg samples using a QuEChERS-based extraction procedure (Quick, Easy, Cheap, Effective, Rugged and Safe) without applying any further clean-up step. Extraction, chromatographic and detection conditions were optimised in order to increase sample throughput and sensitivity. Matrix-matched calibration was used for quantification. Blank samples were fortified at 10, 25, 50 and 100 µg kg(-1), and recoveries ranged from 70% to 110%, except for ochratoxin A and aflatoxin G1 at 10 µg kg(-1), and aflatoxin G2 at 50 µg kg(-1). Relative standard deviations were lower than 25% in all the cases. Limits of detection ranged from 0.5 µg kg(-1) (for aflatoxins B1, B2 and G1) to 5 µg kg(-1) (for enniatin A, citrinin and ochratoxin A) and limits of quantification ranged from 1 µg kg(-1) (for aflatoxins B1, B2 and G1) to 10 µg kg(-1) (for enniatin A, citrinin and ochratoxin A). Seven samples were analyzed and aflatoxins B1, B2, G1, G2, and beauvericin were detected at trace levels.

Parir en Amsterdam / Giving birth in Amsterdam

Con este artículo queremos compartir nuestra experiencia en Ámsterdam, donde realizamos prácticas clínicas electivas como residentes de matronas. El programa de formación tiene como finalidad informar a matronasy residentes sobre el Sistema de Maternidad en Holanda y demostrar cómo los partos naturales están integrados en el sistema general de salud. Presentamos concretamente la vivencia como estudiantes de un parto en casa. Pudimos experimentar y conocer un enfoque del partomás humanizado y una forma diferente de organizar un sistema de maternidad. Exponemos cómo, con un trabajo cooperativo entre las matronas, se puede ofrecer a las mujeres una forma de parir distinta en la que ella es en todo momento la protagonista, la que lleva las riendas.Donde un parto en casa es seguro y ofrece beneficios para gestantes de bajo riesgo. Nos gustaría que este artículo animar a residentes de matronas a vivir la experiencia de participar en otros sistemas diferentes de maternidad y de salud

The aim of this article is to share our experience in Amsterdam, where we performed elective clinical practices as midwifery residents. The objectiveof the training program is to inform midwives and residents on issues regarding the Maternity System in Holland and to demonstrate how natural childbirth has been incorporated into the general health system.Specifically, we present our experience as students after witnessing a home birth. We were able to experience and learn about a more humanizeddelivery approach and a different way of organizing a maternity system. We present how cooperation among midwives can provide women with a different way of giving birth. Delivering their child at home, where home birth is safe and beneficial to low risk infants, makeswomen feel more in control, making decisions together with the midwife, as to how to progress during labour and delivery. The purpose of this article is to encourage midwifery residents to participate in differentMaternity and Health System settings

Quilotórax congénito: presentación de un caso / Congenital chylothorax: a case report

Se presenta el caso de una recién nacida con dificultad respiratoria y derrame pleural lechoso. La concentración de lípidos totales mayor en el líquido pleural que en suero confirmó el diagnóstico de quilotórax. La paciente fue tratada con una dieta baja en grasa basada en 3% de caseína, 7.5% de sacarosa, aceite de coco y sales minerales. Cinco días después de que la dieta fue iniciada, desapareció el derrame pleural y seis semanas más tarde, se reinició leche de vaca sin recurrir el quilotórax. Se discute la etiología y manejo del quilotórax congénito