Predicting the response to methylprednisolone pulses in patients with SARS-COV-2 infection.

Introduction: Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6 mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment.Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge. Materials and methods: We presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves. Results: The analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO2 input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816. Conclusions: In patients with methylprednisolone pulses, the capacity of the predictive model for hospital discharge including variables collected at 5 days was (area under the curve) 0.816.

Introducción: Tratar la inflamación sistémica producida por el SARS-COV 2 (COVID-19) se ha convertido en un reto para el clínico. Los corticoides han sido el punto de inflexión en el tratamiento de esta enfermedad. Los datos preliminares del ensayo clínico Recovery alentan esperanza mostrando que con el tratamiento con dexametasona a dosis de 6 mg/día hay una disminución de la morbimortalidad en pacientes que requieren oxigenoterapia añadida. Sin embargo, tanto el día de inicio, o qué tipo de corticosteroide, son todavía preguntas por aclarar. Desde el inicio de la pandemia hemos observado grandes diferencias en cuanto al tipo de corticoide, dosis e inicio de tratamiento.Nuestro objetivo es valorar la capacidad predictiva de las características de los pacientes tratados con bolos de metilprednisolona para predecir el alta hospitalaria. Materiales y métodos: Presentamos un estudio unicéntrico observacional de cohorte retrospectiva. Incluimos a todos los pacientes ingresados entre el 06/03/2020 y el 15/05/2020 por COVID-19. Contamos con un número total de 1469 pacientes, de los cuales 322 recibieron pulsos de metilprednisolona. De estos pacientes se analizaron los datos clínicos, analíticos, radiográficos, enfermedades previas. El análisis univariante se realizó mediante Chi cuadrado y el test t de Student según la naturaleza cualitativa o cuantitativa de las variables respectivamente. Para el análisis multivariante hemos empleado la regresión logística binaria y las curvas ROC. Resultados: En el análisis resultó estadísticamente significativo la disnea, hipertensión arterial, dislipemia, accidente cerebrovascular, cardiopatía isquémica, deterioro cognitivo, tumor sólido, la proteína C reactiva (PCR), linfopenia y d-dímero a los 5 días de ingreso. La progresión radiológica y de aporte de FIO2 son factores que se asocian a peor pronóstico en la COVID-19 que reciben pulsos de metilprednisolona. En el análisis multivariante se observa que la edad, disnea y la proteína C reactiva son marcadores de alta hospitalaria con un área bajo la curva de 0,816. Conclusión: En pacientes con bolos de metilprednisolona, la capacidad del modelo predictivo del alta hospitalaria incluyendo variables recogidas a los 5 días ha sido (Área Bajo la Curva) de 0.816.

Predicting the response to methylprednisolone pulses in patients with SARS-COV-2 infection

Introduction: Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment.Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge.Materials and methodsWe presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves.ResultsThe analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO2 input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816. (AU)

Introducción: Tratar la inflamación sistémica producida por el SARS-COV 2 (COVID-19) se ha convertido en un reto para el clínico. Los corticoides han sido el punto de inflexión en el tratamiento de esta enfermedad. Los datos preliminares del ensayo clínico Recovery alentan esperanza mostrando que con el tratamiento con dexametasona a dosis de 6 mg/día hay una disminución de la morbimortalidad en pacientes que requieren oxigenoterapia añadida. Sin embargo, tanto el día de inicio, o qué tipo de corticosteroide, son todavía preguntas por aclarar. Desde el inicio de la pandemia hemos observado grandes diferencias en cuanto al tipo de corticoide, dosis e inicio de tratamiento.Nuestro objetivo es valorar la capacidad predictiva de las características de los pacientes tratados con bolos de metilprednisolona para predecir el alta hospitalaria.Materiales y métodosPresentamos un estudio unicéntrico observacional de cohorte retrospectiva. Incluimos a todos los pacientes ingresados entre el 06/03/2020 y el 15/05/2020 por COVID-19. Contamos con un número total de 1469 pacientes, de los cuales 322 recibieron pulsos de metilprednisolona. De estos pacientes se analizaron los datos clínicos, analíticos, radiográficos, enfermedades previas. El análisis univariante se realizó mediante Chi cuadrado y el test t de Student según la naturaleza cualitativa o cuantitativa de las variables respectivamente. Para el análisis multivariante hemos empleado la regresión logística binaria y las curvas ROC.ResultadosEn el análisis resultó estadísticamente significativo la disnea, hipertensión arterial, dislipemia, accidente cerebrovascular, cardiopatía isquémica, deterioro cognitivo, tumor sólido, la proteína C reactiva (PCR), linfopenia y d-dímero a los 5 días de ingreso. (AU)

Predicting the response to methylprednisolone pulses in patients with SARS-COV-2 infection.

INTRODUCTION: Treating systemic inflammation caused by SARS-COV 2 (COVID-19) has become a challenge for the clinician. Corticosteroids have been the turning point in the treatment of this disease. Preliminary data from Recovery clinical trial raises hope by showing that treatment with dexamethasone at doses of 6mg/day shows a reduction on morbidity in patients requiring added oxygen therapy. However, both the start day or what kind of corticosteroid, are still questions to be clarified. Since the pandemic beginning, we have observed large differences in the type of corticosteroid, dose and initiation of treatment. Our objective is to assess the predictive capacity of the characteristics of patients treated with methylprednisolone pulses to predict hospital discharge. MATERIALS AND METHODS: We presented a one-center observational study of a retrospective cohort. We included all patients admitted between 03/06/2020 and 05/15/2020 because of COVID-19. We have a total number of 1469 patients, of whom 322 received pulses of methylprednisolone. Previous analytical, radiographic, previous disease data were analyzed on these patients. The univariant analysis was performed using Chi-squared and the T test of Student according to the qualitative or quantitative nature of the variables respectively. For multivariate analysis, we have used binary logistic regression and ROC curves. RESULTS: The analysis resulted statistically significant in dyspnea, high blood pressure, dyslipidemia, stroke, ischemic heart disease, cognitive impairment, solid tumor, C-reactive protein (CRP), lymphopenia and d-dimer within 5 days of admission. Radiological progression and FIO2 input are factors that are associated with a worst prognosis in COVID-19 that receive pulses of methylprednisolone. Multivariate analysis shows that age, dyspnea and C-reactive protein are markers of hospital discharge with an area below the curve of 0.816. CONCLUSIONS: In patients with methylprednisolone pulses, the capacity of the predictive model for hospital discharge including variables collected at 5 days was (area under the curve) 0.816.

Validación al castellano de la escala Boston Carpal Tunnel Questionnaire / Spanish validation of the Boston Carpal Tunnel Questionnaire

Introducción y objetivo: Describir el proceso de adaptación cultural y validación al español del cuestionario Boston Carpal Tunnel Questionnaire (BCTQ) de intensidad de los síntomas, capacidad funcional y calidad de vida en pacientes con síndrome del túnel carpiano, e informar de sus propiedades psicométricas. Material y métodos: Un panel de 3 expertos supervisó el proceso de adaptación. Tras la traducción, revisión y retrotraducción del instrumento se obtuvo un cuestionario en español que fue administrado a 2 muestras de pacientes: una muestra piloto de 20 pacientes para valorar la comprensibilidad y una de 90 pacientes para comprobar la validez estructural (análisis factorial y fiabilidad), la validez de constructo y la sensibilidad al cambio. Se realizó medición retest a 21 pacientes. Se realizó seguimiento a 40 pacientes. Resultados: El cuestionario fue bien entendido por todos los participantes. Tres ítems presentaron efecto suelo. La fiabilidad fue muy buena, consistencia interna: αS = 0,91 y αF = 0,87; estabilidad temporal test-retest: rS = 0,939 y rF = 0,986. Se comprobó que ambas subescalas del cuestionario se ajustaban a una dimensión general. Las subescalas correlacionaron con las medidas del dinamómetro (rS = 0,77 y rF = 0,75) y mostraron relación con la discriminación anormal entre 2 puntos, la atrofia muscular y el nivel de afectación según electromiografía. Las puntuaciones correlacionaron adecuadamente con cuestionarios ya validados: Douleur Neuropatique 4 questions y Cuestionario Breve de Dolor. El BCTQ demostró ser sensible a los cambio clínicos, con tamaños del efecto grandes (dS = −3,3 y dF = −1,9). Conclusiones: La versión en castellano del BCTQ ha demostrado tener buenas propiedades psicométricas, lo que garantiza su uso en el ámbito clínico (AU)

Introduction and Objective: To describe the process of cultural adaptation and validation of the Boston Carpal Tunnel Questionnaire (BCTQ) measuring symptom intensity, functional status and quality of life in carpal tunnel syndrome patients and to report the psychometric properties of this version. Material and methods: A 3 expert panel supervised the adaptation process. After translation, review and back-translation of the original instrument, a new Spanish version was obtained, which was administered to 2 patient samples: a pilot sample of 20 patients for assessing comprehension, and a 90 patient sample for assessing structural validity (factor analysis and reliability), construct validity and sensitivity to change. A re-test measurement was carried out in 21 patients. Follow-up was accomplished in 40 patients. Results: The questionnaire was well accepted by all participants. Celling effect was observed for 3 items. Reliability was very good, internal consistency: αS = 0.91 y αF = 0.87; test-retest stability: rS = 0.939 and rF = 0.986. Both subscales fitted to a general dimension. Subscales correlated with dynamometer measurements (rS = 0.77 and rF = 0.75) and showed to be related to abnormal 2-point discrimination, muscle atrophy and electromyography deterioration level. Scores properly correlated with other validated instruments: Douleur Neuropatique 4 questions and Brief Pain Inventory. BCTQ demonstrated to be sensitive to clinical changes, with large effect sizes (dS = −3.3 and dF = −1.9). Conclusions: The Spanish version of the BCTQ shows good psychometric properties warranting its use in clinical settings (AU)

[Spanish validation of the Boston Carpal Tunnel Questionnaire]. / Validación al castellano de la escala Boston Carpal Tunnel Questionnaire.

INTRODUCTION AND OBJECTIVE: To describe the process of cultural adaptation and validation of the Boston Carpal Tunnel Questionnaire (BCTQ) measuring symptom intensity, functional status and quality of life in carpal tunnel syndrome patients and to report the psychometric properties of this version. MATERIAL AND METHODS: A 3 expert panel supervised the adaptation process. After translation, review and back-translation of the original instrument, a new Spanish version was obtained, which was administered to 2 patient samples: a pilot sample of 20 patients for assessing comprehension, and a 90 patient sample for assessing structural validity (factor analysis and reliability), construct validity and sensitivity to change. A re-test measurement was carried out in 21 patients. Follow-up was accomplished in 40 patients. RESULTS: The questionnaire was well accepted by all participants. Celling effect was observed for 3 items. Reliability was very good, internal consistency: αS=0.91 y αF=0.87; test-retest stability: rS=0.939 and rF=0.986. Both subscales fitted to a general dimension. Subscales correlated with dynamometer measurements (rS=0.77 and rF=0.75) and showed to be related to abnormal 2-point discrimination, muscle atrophy and electromyography deterioration level. Scores properly correlated with other validated instruments: Douleur Neuropatique 4 questions and Brief Pain Inventory. BCTQ demonstrated to be sensitive to clinical changes, with large effect sizes (dS=-3.3 and dF=-1.9). CONCLUSIONS: The Spanish version of the BCTQ shows good psychometric properties warranting its use in clinical settings.

Teriparatide (rh [1-34] PTH) improved osteointegration of a hemiarthroplasty with signs of aseptic loosening.

Incidences of osteoporosis and fragility fractures are constantly increasing, which are associated with increased morbidity and mortality. When these patients undergo surgery, a higher number of postoperative complications may be expected because of poor bone quality and delayed healing. As a result, poorer primary stability of the implant, initial loosening, and impaired fixation strength in different regions may be seen. In these patients, we can choose the most advanced implants, but it is necessary to stimulate bone biology to increase the stability of the implant. This article reports the result obtained in a patient diagnosed with osteoporosis with aseptic loosening of a hip hemiarthroplasty after treatment with teriparatide (rh [1-34] PTH). This drug is indicated for the treatment of osteoporosis in men and postmenopausal women with high fracture risk and glucocorticoid-induced osteoporosis, and is administered subcutaneously for 2 years. It has an anabolic effect through stimulation of the osteoblast population that increases trabecular connectivity, cortical thickness, and bone mineral content. In animal models, teriparatide improved implant fixation 2 to 4 weeks after administration, resulting in the thickening of bone trabeculae and increased bone mass in the peri-implant area. In this retrospective analysis of clinical data and radiographic and scintigraphic images, after 24 months of treatment, the patient experienced clinical improvement associated with the disappearance of radiographic signs of loosening and a decrease in pathological radiotracer uptake in the bone scan, which are signs of osteointegration after treatment with teriparatide.