Possible Influence of the Route of Treatment Administration on Treatment Adherence in Patients With Multiple Sclerosis.

PURPOSE: Multiple sclerosis is a chronic, demyelinating, and degenerative disease of the central nervous system with an immune-based pathologic origin. The present pilot study aimed to assess whether the change in the route of treatment administration is associated with a variation in adherence and whether there is a change in quality of life, treatment satisfaction, and fatigue. METHODS: Patients with relapsing-remitting multiple sclerosis who were >18 years of age and who used to receive immunomodulatory parenteral treatment and were ready to change administration route were eligible for the study. Data were collected at baseline and 3 months later. Adherence, quality of life, treatment satisfaction, and fatigue were measured via the following questionnaires: Morisky-Green questionnaire on patient-reported medication adherence, Multiple Sclerosis Quality of Life Instrument, Treatment Satisfaction Questionnaire for Medication, and Modified Fatigue Impact Scale. FINDINGS: The study sample included 30 patients (mean age, 43.2 years; age range, 24-71 years; 60% female and 40% male). There was a significant improvement in adherence (p = 0.048). Mean (SD) physical and mental health quality-of-life summary scores varied from 52.50 (24.15) and 54.13 (21.24) to 67.55 (20.92) and 62.30 (21.75) (p < 0.001 and p = 0.001, d = -0.426 and d = -0.643, respectively). In the Treatment Satisfaction Questionnaire for Medication, an improvement of the score was observed in effectiveness of the medication (p = 0.0041, d = -0.563), adverse effects of the medication (p < 0.001, d = -0.976), convenience of the medication (p < 0.001, d = -1.235), and global satisfaction (p = 0.006, d = -0.725). Patients had a higher mean (SD) score (45.13 [26.7]) on the Modified Fatigue Impact Scale while receiving injectable treatment compared with that obtained with oral treatment (34.86 [23.16]; p = 0.009, d = 0.41). IMPLICATIONS: When the route of administration changed from injectable to oral, there was an increase in adherence, quality of life, and degree of patient satisfaction with their treatment and a decrease in the degree of fatigue.

Correction: Marhuenda, J., et al. A Randomized, Double-Blind, Placebo Controlled Trial to Determine the Effectiveness a Polyphenolic Extract (Hibiscus sabdariffa and Lippia citriodora) in the Reduction of Body Fat Mass in Healthy Subjects. Foods 2020, 9(1), 55.

The authors wish to make the following correction to this paper [...].

A Randomized, Double-Blind, Placebo Controlled Trial to Determine the Effectiveness a Polyphenolic Extract (Hibiscus sabdariffa and Lippia citriodora) in the Reduction of Body Fat Mass in Healthy Subjects.

: The location and quantity of body fat determine the health risks, limiting people with obesity. Recently, polyphenols have attracted the attention of the scientific community because of their potential use for the reduction of obesity. A proprietary formula comprised of a blend of Lippia citriodora and Hibiscus sabdariffa has been recognized for its high content of polyphenols, powerful antioxidant molecules that may prevent weight gain and could be helpful for the treatment of obesity, as proven previously by in vivo models. The aim of the present study is to determine if the supplementation with Lippia citriodora and Hibiscus sabdariffa is useful for the treatment of obesity and/or weight control in subjects without a controlled diet. The intake of the extract for 84 days reduced body weight, the body mass index, and the fat mass measured with both bioimpedance and densitometry. This decrease in fat mass was observed to a greater extent, being significant, in the fat mass of the trunk (chest and torso).

What Pelvic Floor Muscle Training Load is Optimal in Minimizing Urine Loss in Women with Stress Urinary Incontinence? A Systematic Review and Meta-Analysis.

Pelvic floor muscle training is commonly used for urine loss. However, research studies have not determined which training load is the most effective for women with stress urinary incontinence (SUI). Moreover, none of the previous reviews or studies have described the total effectiveness of pelvic floor muscle training (PFMT) with an objective test such as the pad test. The objectives were to analyze the effectiveness of pelvic floor muscle training in women with SUI and to determine which training load produces the greatest adaptations for decreasing urine loss. The search was conducted in three databases (PubMed, Web of Science and Cochrane), for randomized controlled trials (RCTs) that evaluated the effects of PFMT. Studies were included if they met the following criteria: participants were women; were older than 18; had SUI; were treated with PFMT; and the assessments of the effects were measured with a pad test. Finally, 10 articles (293 women) analyzed the pad test in women with SUI who performed PFMT. The meta-analysis showed that PFMT, independent of the protocol used in the study, resulted in decreased urine loss in women suffering from SUI. However, for large effects, the program should last 6-12 weeks, with >3 sessions/week and a length of session <45 min.

Manejo del déficit de hierro y la anemia ferropénica en la enfermedad inflamatoria intestinal. Resultados de la encuesta "Gestiona Hierro-EII" / Managing iron deficiency and iron deficiency anemia in inflammatory bowel disease. The results of the "Gestiona hierro-EII" survey

Introducción: la anemia ferropénica es una manifestación común y muy relevante de la enfermedad inflamatoria intestinal (EII). Aunque se han publicado guías de práctica clínica y puestas al día sobre el tema, el manejo práctico de esta complicación dista de ser óptimo. Objetivo: conocer el manejo real, las necesidades y las limitaciones de la anemia en la EII mediante una encuesta a especialistas de digestivo. Material y métodos: encuesta telemática autoadministrada, realizada entre abril- mayo 2017, y dirigida a socios de la SEPD con actividad clínica. La encuesta incluye cuatro apartados: demografía de los participantes, monitorización, tratamiento y limitaciones/necesidades. Resultados: ciento veintidós encuestas evaluables procedentes de todas las comunidades autónomas. La anemia ferropénica se considera una manifestación frecuente de la EII y que se monitoriza en todos los pacientes mediante determinación de la hemoglobina y la ferritina. En caso de anemia, los encuestados consideran necesario descartar la existencia de actividad de la EII, aunque solo el 14,8% indica el hierro intravenoso si la EII está activa. La dosis necesaria de hierro intravenoso es mayoritariamente calculada según las necesidades del paciente, pero solo el 33,1% utiliza dosis por infusión de 1 g o más elevadas. Conclusiones: la encuesta "Gestiona Hierro EII" sobre el manejo de la anemia en la EII demuestra una alta calidad asistencial, pero con aspectos a mejorar como la indicación de hierro intravenoso en los pacientes con actividad, el uso de hierro intravenoso de altas dosis o la aplicación de algoritmos en la práctica asistencial (AU)

Introduction: iron deficiency anemia is a common and very relevant manifestation of inflammatory bowel disease (IBD). Although clinical practice guidelines have been published and updated on this subject, the management in the daily practice of this complication is far from optimal. Objective: to determine the actual management, needs and limitations of anemia in IBD by means of a survey of gastroenterology specialists. Material and methods: a self-administered telematic survey was carried out between April and May 2017 and was sent to SEPD members. The survey included four sections: participant demographics, monitoring, treatment and limitations/needs. Results: a total of 122 evaluable surveys were received from all Spanish autonomous communities. Iron deficiency anemia is considered as a frequent manifestation of IBD and is monitored in all patients via the measurement of hemoglobin and ferritin. In the case of anemia, the survey respondents found it necessary to rule out the presence of IBD activity. However, only 14.8% prescribed intravenous iron when IBD was active. The required dose of intravenous iron is mainly calculated according to patient needs but only 33.1% of clinicians infused doses of 1 g or more. Conclusions: the "Gestiona Hierro EII" survey on the management of anemia in IBD demonstrated a high quality of care, even though some aspects need to be improved. These included the prescription of intravenous iron for patients with disease activity, the use of high-dose intravenous iron and the implementation of algorithms into clinical practic (AU)

Managing iron deficiency and iron deficiency anemia in inflammatory bowel disease. The results of the "Gestiona hierro-EII" survey.

INTRODUCTION: iron deficiency anemia is a common and very relevant manifestation of inflammatory bowel disease (IBD). Although clinical practice guidelines have been published and updated on this subject, the management in the daily practice of this complication is far from optimal. OBJECTIVE: to determine the actual management, needs and limitations of anemia in IBD by means of a survey of gastroenterology specialists. MATERIAL AND METHODS: a self-administered telematic survey was carried out between April and May 2017 and was sent to SEPD members. The survey included four sections: participant demographics, monitoring, treatment and limitations/needs. RESULTS: a total of 122 evaluable surveys were received from all Spanish autonomous communities. Iron deficiency anemia is considered as a frequent manifestation of IBD and is monitored in all patients via the measurement of hemoglobin and ferritin. In the case of anemia, the survey respondents found it necessary to rule out the presence of IBD activity. However, only 14.8% prescribed intravenous iron when IBD was active. The required dose of intravenous iron is mainly calculated according to patient needs but only 33.1% of clinicians infused doses of 1 g or more. CONCLUSIONS: the "Gestiona Hierro EII" survey on the management of anemia in IBD demonstrated a high quality of care, even though some aspects need to be improved. These included the prescription of intravenous iron for patients with disease activity, the use of high-dose intravenous iron and the implementation of algorithms into clinical practice.

Digital periarterial sympathectomy in the management of post-traumatic Raynaud syndrome.

OBJECTIVE: Among Basque handball players, the repeated impact of a ball on the palms of their hands hundreds of thousands of times throughout their sporting careers produces Raynaud syndrome. Treating this patient group is complex. Our objective was to assess the efficacy of digital periarterial sympathectomy in this patient group. METHODS: The study included all of the federated amateur and professional Basque handball patients who presented with Raynaud syndrome assessed in the vascular surgery service between January 2005 and December 2012. The postoperative assessment included a physical examination, basal photoplethysmography and photoplethysmography after heat hyperemia, and arteriography or magnetic resonance angiography. RESULTS: All 182 digital periarterial sympathectomies in the 114 fingers of 60 patients were in Porter functional class III or IV. All patients were discharged within the first 48 hours. Follow-up results, with a mean of 2 years ± 5 months, were 100%. All patients presented immediate pain remission, recovery of comfort, normal nail growth, rapid healing of all ulcers, distal anhidrosis, and return to active sport participation. The results remain steady in 58 patients (93.5%). Mean time until return to sports activity was 9.95 ± 1.61 weeks. CONCLUSIONS: Digital periarterial sympathectomy is a simple, relatively nonaggressive technique without adverse side effects and with excellent medium-term results. In patients with Raynaud syndrome refractory to medical treatment and with threat to the viability of one or several fingers, digital periarterial sympathectomy can be the first treatment option, especially in cases of arteritis associated with very severe spasms.

Comparative study of the oral absorption of microencapsulated ferric saccharate and ferrous sulfate in humans.

PURPOSE: Our objective was to compare the absorption of microencapsulated ferric saccharate (MFS) and ferrous sulfate (FS) in a fortified milk product, using a crossover design. METHODS: Seventeen non-iron-deficient healthy adults from both sexes participated in the study. On each intervention day (days 1 and 8), after an overnight fast, the volunteers consumed one type of product (test or control) and blood sampling was carried out at different times. The interventions days were separated by 7-day washout periods. This study was double blinded, crossover and randomized for nature of the test meals. The primary outcomes of the study were total serum iron and transferrin saturation. RESULTS: No significant differences could be observed in serum iron concentration during the 6-h postprandial study due to the type of milk product consumed, and there was neither an effect of time nor an interaction between the type of milk product and time. Transferrin saturation significantly increased after the intake of both products (P < 0.005), reaching a peak value between hours 2 and 4. No significant differences were detected between MFS and FS, indicating that iron absorption from MFS is equivalent to absorption from FS. CONCLUSIONS: MFS is a new ingredient that allows the fortification of a wide range of food products, including heat-processed and non-acidic products with similar absorption to FS, designed to produce neither organoleptic changes nor off-color development during storage of fortified food.

Estudio comparativo de diferentes procedimientos de hidratación durante un ejercicio de larga duración / Comparative study of different procedures of hydration during an exercise of long duration

Introducción: La deshidratación es un factor importante en el descenso del rendimiento deportivo. En las estrategias derehidratación durante el ejercicio debe tenerse en cuenta que el vaciado gástrico de los líquidos ingeridos sea rápido y la absorción en duodeno lo más rápida posible. Objetivos: Valorar la capacidad de hidratarse adecuadamente, en condiciones de calor y humedad alta, en función de diversas estrategias basadas en ingerir distintos tipos de bebidas con diferentes sabores y condiciones de palatabilidad. Método: Estudio cruzado de intervención nutricional, unicéntrico, abierto, aleatorizado en la secuencia de ingesta de las bebidas del estudio. Se seleccionaron al azar a 26 corredores de fondo varones. Cada individuo realizó 4 pruebas de esfuerzo en ergómetro de cinta continua. En la primera prueba se determinó la carga del ergómetro de las siguientes. En la prueba nº 2 (con carga constante) se consumió agua exclusivamente; en la nº 3 se ingirieron bebidas con sabor elegidas entre un conjunto de 5 bebidas y una bebida elegida por el individuo. La prueba nº 4 consistió en tomar “adlibitum” cualquiera de las 5 bebidas con sabor anteriores, la bebida elegida por el individuo a estudio y agua. Análisis estadístico: Inicialmente se realizó estadística descriptiva; a las variables cuantitativas se les calculó media y desviación típica y a las variables cualitativas frecuencia absoluta y relativa. Para la comparación de las distintas variables se realizó ANOVA para medidas repetidas con dos factores intrasujeto (tiempo: antes y después de la prueba; prueba: prueba 1, prueba 2, prueba 3). Resultados: Durante la realización de la prueba 2, el individuo consumió únicamente agua en una cantidad media de 487 mL. Cuando el voluntario tuvo a su disposición un conjunto de bebidas (prueba 3), el consumo medio se incrementó hasta 642 ml, un 31,8% con respecto al inicial y este incremento fue estadísticamente significativo (p<0,021). Durante la realización de la prueba de esfuerzo4 en la que el sujeto podía consumir cualquiera de las bebidas existentes en la prueba 3 o agua (diversidad de bebidas), se incrementó el consumo de líquidos hasta 729 mL, un 49,7% con respecto al inicial y esta diferencia también fue estadísticamente significativa (p<0,005). La diferencia observada en el consumo de líquidos entre las pruebas 3 yen la 4, no resultó estadísticamente significativa. De todo ello se deduce que los sujetos estudiados consumieron mayor cantidad de líquidos en aquellas pruebas en las que disponían de un conjunto de bebidas con mayor diversidad, lo que hizo disminuir la pérdida de peso provocada por la deshidratación al tiempo que también disminuyó el consumo de líquidos en las 24 horas posteriores a la prueba de esfuerzo realizada en el laboratorio (AU)

Introduction: Dehydration plays an important part inperformance deterioration for sportsmen. When considering rehydration strategies during physical exercise, it is important to bear in mind that the gastric emptying of ingested liquids is fast and absorption into the duodenum as fast as possible. Objectives: To assess the capacity for adequate hydration, under conditions of heat and high humidity, with regard to various strategies based on the ingestion of different types of drinks with different flavours and palate conditions. Method: An open, single-centre, crossed study of nutritional measures which was randomized with respect to the order in which the drinks selected for the study were ingested. 26 male long-distance runners were randomly selected. Each individual performed four ergometric endurance tests on a continuous belt. In the first test the ergometric strain for the following ones was determined. In test number 2 (with constant load), only water was consumed; during number 3, flavored drinks, chosen from an assortment of 5 drinks in addition to one selected by the individual, were ingested. The fourth test consisted in consuming “ad libitum” any one of the five previous flavored drinks, the drink selected by the individual in the study, and also water. Statistical analysis: Initially a descriptive statistical analysis was carried out; with regard to the quantitative variables, the average plus typical deviation were calculated, and with respect to the qualitative variables, both the absolute and relative frequency. In order to compare the different variables ANOVA was performed for repeated measures with two intrasubject factors (time: before and after the test; test: test 1, test 2, test3) (AU). Results: During test 2, each individual consumed only water at an average quantity of 487 mL. When the volunteer had an assortment of drinks available (test 3), the average consumption increased to 642 mL, a 31.8% increase on the previous one, and this increase was statistically significant (p<0.021). During the carrying-out of the test for event 4 in which the subject was able to consume any of the existent drinks from test 3 or water (drink diversity), liquid consumption was increased to729 mL, an increase of 49.7% with respect to the first, and this difference was also statistically significant (p<0.005). The difference observed in the consumption of liquids between tests3 and 4, did not turn out to be significantly different. From all of this it is possible to deduce that the subjects in the study consumed a greater quantity of liquids during those events in which they had a greater diversity in the assortment of drinks available, which meant that weight loss caused by dehydration diminished and at the same time the consumption of liquids during the 24 hours posterior to the endurance test carried out in the laboratory also diminished (AU)