Effectiveness of a telerehabilitation intervention using ReCOVery APP of long COVID patients: a randomized, 3-month follow-up clinical trial.

The main objective of this study is to analyze the clinical efficacy of telerehabilitation in the recovery of Long COVID patients through ReCOVery APP for 3 months, administered in the Primary Health Care context. The second objective is to identify significant models associated with an improvement in the study variables. An open-label randomized clinical trial was conducted using two parallel groups of a total of 100 Long COVID patients. The first group follows the treatment as usual methods established by their general practitioner (control group) and the second follows the same methods and also uses ReCOVery APP (intervention group). After the intervention, no significant differences were found in favour of the group intervention. Regarding adherence, 25% of the participants made significant use of the APP. Linear regression model establishes that the time of use of ReCOVery APP predicts an improvement in physical function (b = 0.001; p = 0.005) and community social support (b = 0.004; p = 0.021). In addition, an increase in self-efficacy and health literacy also contribute to improving cognitive function (b = 0.346; p = 0.001) and reducing the number of symptoms (b = 0.226; p = 0.002), respectively. In conclusion, the significant use of ReCOVery APP can contribute to the recovery of Long COVID patients. Trial Registration No.: ISRCTN91104012.

Uncommon case of Mycobacterium bovis brain abscess complicated by suppurative fistula, and review of the literature. / Caso insólito de absceso cerebral por Mycobacterium bovis complicado con fístula supurativa y revisión de la bibliografía.

INTRODUCTION: Mycobacterium bovis is an infrequent cause of central nervous system tuberculosis in Spain, with few cases described in the literature. Since compulsory pasteurization of milk and implementation of eradication programs on infected cattle, human sporadic illness with this organism has dramatically declined in developed countries. CASE REPORT: A 71-year-old immunocompromised male, who presented a calvarial lytic lesion. A craniotomy for the total resection of the lesion was performed and the microbiology results were positive for M. bovis, therefore antituberculous therapy was initiated. Despite of the correct treatment, the patient developed a tuberculous abscess that required an aggressive surgical management followed by a suppurative fistula. Based on the treatment of tuberculous lymphadenitis, we decided to perform a conservative management with antituberculous therapy (isoniazid + rifampicin + ethambutol + moxifloxacin + steroids during 12 months) and avoided new surgical cleanings of the surgical bed obtaining a good response and a good clinical evolution. CONCLUSIONS: As far as we know, this is the first case reported of a suppurative fistula after the resection of a cerebral abscess caused by M. bovis, therefore, there is no report in the literature about the treatment of this complication.

TITLE: Caso insólito de absceso cerebral por Mycobacterium bovis complicado con fístula supurativa y revisión de la bibliografía.Introducción. Mycobacterium bovis es una causa infrecuente de tuberculosis del sistema nervioso central en España, del cual existen pocos casos descritos en la bibliografía. Desde la pasteurización obligatoria de la leche y la implementación de programas de erradicación del ganado infectado, la enfermedad esporádica humana con este organismo ha disminuido drásticamente en los países desarrollados. Caso clínico. Varón inmunoafectado de 71 años, que presentaba una lesión lítica esporádica en la calota. Se realizó una craneotomía de la lesión y los resultados de microbiología fueron positivos para M. bovis, por lo que se inició tratamiento con terapia antituberculosa. A pesar del tratamiento correcto, el paciente desarrolló un absceso tuberculoso, que requirió un tratamiento quirúrgico agresivo, seguido de una complicación con una fístula supurativa. Sobre la base del tratamiento descrito para la linfadenitis tuberculosa, se decidió realizar un tratamiento conservador de la fístula supurativa, sin realizar nuevas limpiezas del lecho quirúrgico, y mantener de manera prolongada la terapia antituberculosa (isoniacida + rifampicina + etambutol + moxifloxacino + esteroides durante 12 meses), con lo que presentó una buena evolución clínica. Conclusiones. Hasta la fecha, éste es el primer caso descrito de una fístula supurativa después de la resección de un absceso cerebral causado por M. bovis, por lo que no existe en la bibliografía artículo alguno que describa el tratamiento adecuado de esta complicación.

Effect of respiratory Achromobacter spp. infection on pulmonary function in patients with cystic fibrosis.

PURPOSE: Cystic fibrosis (CF) patients are susceptible to infection with Achromobacter spp., although its clinical significance remains controversial. The aim of this study was to investigate the clinical impact of infection with Achromobacter spp. in CF patients. METHODS: CF outpatients with multiple sputum cultures and follow-up lung function tests were assigned to the case group (infected with Achromobacter spp.) or the control group (never infected with Achromobacter spp.) according to the isolation of Achromobacter spp. The Achromobacter spp. group included two subgroups, taking into consideration whether the isolation of Achromobacter spp. was intermittent or chronic. Baseline lung function tests and longitudinal behaviour were examined in relation to Achromobacter spp. status. RESULTS: A total of 190 CF patients were treated from January 2003 to December 2015 in the CF unit and 21 (11 %) had at least one positive culture for Achromobacter spp. Of these, 11/21 (52.4 %) patients were chronically infected with Achromobacter spp. An analysis of changes during follow-up showed the annual rate of FEV1 decline: -2.3±1.6 % in the Achromobacter spp. group compared to -1.1±0.9 % (P=0.02) in the control group. The chronically infected group also had a significantly greater decline in FEV1 compared to the control group (-2.9±1.9 vs -1.1±0.9; P=0.04). The mean number of annual pulmonary exacerbations during the study period was significantly higher in the case group (1.9±0.9 vs 1.1±0.8; P=0.03). CONCLUSIONS: The Achromobacter spp. status in CF shows a trend towards more severe airflow obstruction and an association with accelerated decline in lung function parameters.

Recession, employment and self-rated health: a study on the gender gap.

OBJECTIVES: Employment status and economic recession have been associated with negative effects on self-rated health, and this effect differs by gender. We analysed the effects of the Spanish economic recession in terms of self-rated health, its differential effect among genders and its influence on gender gap. STUDY DESIGN: Repeated cross-sectional study using Spanish health surveys (2001-2014). METHODS: Logistic regression models were conducted to explore the association between self-rated health and employment status and its evolution over time and gender. To test the impact of the economic recession, pooled data regression models were conducted. RESULTS: In this study, we considered 104,577 subjects. During the last 15 years, women have entered the labour market, leading to wide changes in the Spanish traditional family roles. Instead of an increasing proportion of women workers, gender employment differences persist. Therefore, in 2014, the prevalence of workers was 55.77% in men, whereas in women, it was 44.01%. Self-rated health trends during the economic recession differ by gender, with women improving slightly their self-rated health from a low self-rated health prevalence of 38.76% in 2001 to 33.78% in 2014. On the contrary, men seem more vulnerable to employment circumstances, which have led to substantial reduction in the gender gap. CONCLUSIONS: Although a gender gap persists, the change in socio-economic roles seems to increase women's self-rated health, reducing this gap. It is important to promote women's labour market inclusion, even in economic recession periods.

Organophosphorous pesticide exposure alters sperm chromatin structure in Mexican agricultural workers.

Our objective was to evaluate alterations in sperm chromatin structure in men occupationally exposed to a mixture of organophosphorus pesticides (OP) because these alterations have been proposed to compromise male fertility and offspring development. Chromatin susceptibility to in situ acid-induced denaturation structure was assessed by the sperm chromatin structure assay (SCSA). Urinary levels of alkylphosphates (DAP) were used to assess exposure. Diethylthiophosphate (DETP) was the most frequent OP metabolite found in urine samples indicating that compounds derived from thiophosphoric acid were mainly used. Chromatin structure was altered in most samples. About 75% of semen samples were classified as having poor fertility potential (>30% of Percentage of DNA Fragmentation Index [DFI%]), whereas individuals without OP occupational exposure showed average DFI% values of 9.9%. Most parameters of conventional semen analysis were within normality except for the presence of immature cells (IGC) in which 82% of the samples were above reference values. There were significant direct associations between urinary DETP concentrations and mean DFI and SD-DFI but marginally (P = 0.079) with DFI%, after adjustment for potential confounders, including IGC. This suggests that OP exposure alters sperm chromatin condensation, which could be reflected in an increased number of cells with greater susceptibility to DNA denaturation. This study showed that human sperm chromatin is a sensitive target to OP exposure and may contribute to adverse reproductive outcomes. Further studies on the relevance of protein phosphorylation as a possible mechanism by which OP alter sperm chromatin are required.

Caracterização farmacognóstica de Polygonum hydropiperoides Michaux e P. spectabile (Mart.) (Polygonaceae) / Pharmacognostic characterization of Polygonum hydropiperoides Michaux and P. spectabile (Mart.) (Polygonaceae)

Polygonum hydropiperoides e P. spectabile são espécies conhecidas como "ervade-bicho" e utilizadas como antiinflamatórias, anti-hemorroidais e antidiarréicas. As análises farmacognósticas indicaram teores de perda por dessecação, de cinzas totais e de cinzas insolúveis que variaram de 4,0 a 6,5 por cento; 5,0 a 10,0 por cento e 0,1 a 0,4 por cento, respectivamente. Através de cromatografia em camada delgada, foram detectados triterpenos e/ou esteróides, cumarinas, flavonóides, polifenóis, taninos e saponinas nas quatro amostras. Os teores de polifenóis totais, taninos e flavonóides foram de 7,0 por cento; 5,5 por cento e 0,4 por cento, respectivamente, para P. spectabile, e diferiram das três amostras de P. hydropiperoides, observando-se valores em torno de 5,0 por cento; 4,0 por cento e 0,6 por cento para duas delas e de 12,5 por cento; 11,3 por cento e 0,3 por cento para a outra. Estas espécies, morfologicamente muito semelhantes, são empregadas, indiscriminadamente, na produção de medicamentos fitoterápicos. Este estudo mostrou variações nos teores de polifenóis e taninos nas amostras de P. hydropiperoides, coletadas no outono e na primavera. Estes resultados representam os primeiros parâmetros obtidos para o controle de qualidade de P. hydropiperoides e P. spectabile.

Polygonum hydropiperoides and P. spectabile are, commonly known as "erva-de-bicho", and traditionally used as anti-inflammatory, antihaemorrhoidal and anti-diarrhea. The pharmacognostic analysis indicated the content of loss on drying, of total ash and acid-insoluble ash ranged from 4.0 to 6.5 percent, 5.0 to 10.0 percent and 0.1 to 0.4 percent, respectively. The TLC analysis revealed the presence of triterpenes and/or steroids, coumarins, flavonoids, polyphenols, tannins and saponins in the four samples. The content of total polyphenols, tannins and flavonoids were 7.0 percent, 5.5 percent and 0.4 percent, respectively for P. spectabile. They were different from the three samples of P. hydropiperoides. The values observed were around 5.0 percent, 4.0 percent and 0.6 percent for two of them and 12.5 percent, 11.3 percent and 0,3 percent for the other one. These species are morphologically very similar and they are used indiscriminately for the production of herbal medicines. This study showed variations on the contents of polyphenols and tannins in samples of P. hydropiperoides collected in autumn and spring. These results represent the first parameters obtained for the quality control of P. hydropiperoides and P. spectabile.

Effects of levonorgestrel implant upon TSH and LH levels in male infants during lactation.

OBJECTIVES: The objective of the study is to evaluate the effects of levonorgestrel transferred through breast milk on thyroid stimulating hormone (TSH) and luteinizing hormone (LH) levels in full breast-fed infants. METHODS: Forty healthy postpartum women and their male newborns were recruited for the study. Women were randomly allocated to two study groups: Group 1, IUD users and group 2, Norplant users. Blood and milk samples were collected on the day of IUD or Norplant insertion and 3 and 6 months later for TSH and levonorgestrel measurements. RESULTS: The results disclosed a significant decrease in TSH levels, and a negative relationship between LNG levels and TSH concentration in breast feeding infants at 3 months after implant insertion. The lowest TSH levels were observed at 6 months in the women from group 2. CONCLUSIONS: The overall data indicate that the LNG levels transferred to fully breast-fed infants through breast milk from Norplant users significantly modified their TSH levels.

Organophosphorous pesticide exposure increases the frequency of sperm sex null aneuploidy.

It has been estimated that 4 of 1,000 live births and 35% of spontaneous abortions are aneuploid and that an important proportion of embryo and newborn aneuploidy is of paternal origin. Exposure to organophosphorous pesticides (OP) has been associated with sperm hyperploidy/polyploidy. Therefore, we aimed to assess the frequency of sperm aneuploidy (X, Y, and 18) and its relationship with urinary OP metabolites in agricultural workers. We performed multicolor fluorescence in situ hybridization on samples from nine men obtained before and during the pesticide spraying season to assess sperm aneuploidy. We measured urinary OP metabolite levels by gas-liquid chromatography. Aneuploidies were found in 0.67% of total sperm nuclei. The most frequent aneuploidy was the lack of a sexual chromosome or sex null (0.19%), followed by XY18 (0.15%) and XY18-18 (0.06%). OP metabolites detected at higher concentrations were dimethylthiophosphate, dimethyldithiophosphate, and diethylphosphate (DEP). There were no differences in average aneuploidy frequency or urinary metabolite levels between samples collected before and after exposure. However, Poisson regression analysis adjusted for age, alcohol intake, and sperm concentration showed significant associations between OP metabolite concentrations and increased frequency of sperm aneuploidies. The association was more evident between DEP and sex null, and the risk increased further during the spraying season. Thus, OP exposure could interfere with sperm chromosome segregation and increase the risk for genetic syndromes, such as Turner's. Further studies are required to assess the prevalence of spontaneous abortions, birth defects, and genetic syndromes in agricultural communities.

Stress fracture of the femoral neck in a child. Case report and review of the literature.

Fatigue fractures generally appear in normal bone following increased repetitive activity or strenuous exercise, when imbalance occurs between applied force and elastic resistance. Femoral neck fatigue fractures are most common in athletes and young military recruits; such fractures in children with open physes are very rare. This paper reports a fatigue fracture of the femoral neck in an 8-year-old girl presenting with pain in the anterior aspect of the right thigh, of one month duration and without evidence of previous injury. Bed rest and relief of weight bearing are indicated for nondisplaced compression fractures. Surgical treatment is indicated for tension fractures. In most cases, the outcome is favorable, and complications are rarely reported.

Effects of oral buserelin on urinary LH secretion in male infants.

In recent years, several potent gonadotropin-releasing hormone (GnRH) analogues have become available for female contraception and one of them (buserelin) has been tested in lactating women. However, the possible effects on infants due to the transference of the analogue through breast milk have not been studied. The present work evaluated the effect of oral buserelin on urinary LH secretion in male infants. A total of 19 healthy full-term boys (aged 2-4 months) were included in the study. Infants received orally a single dose of a GnRH agonist mixed with breast milk. Urine samples were collected prior to, and 4-6 and 24 h after treatment for LH measurement. The results disclosed a significant increase in LH urine level in the sample taken 4-6 h after buserelin administration. Twenty-four hours after GnRH agonist ingestion, the LH level returned to baseline level. The present study demonstrated that GnRH analogue administered orally to infants escapes from gastrointestinal inactivation and induces a significant rise in LH levels 4-6 h after treatment.

PIP: An evaluation of the effects of oral buserelin on urinary luteinizing hormone (LH) secretion in 19 healthy breast-fed male infants 2-4 months of age indicated a need for further research on the effects of this agent on the hypothalamic-pituitary-gonad axis of infants. A single dose of 35 mcg of buserelin from a nasal spray was mixed with 20 ml of breast milk and fed to each infant, followed by a normal breast feed. A significant increase in urinary LH concentrations occurred between baseline (0.6 +or- 0.7 mUI/ml) and 4-6 hours after treatment (1.5 +or- 1.1 mUI/ml); however, 24 hours after agonist ingestion, LH levels returned to baseline levels. These findings suggest that a sufficient quantity of buserelin escapes from the gastrointestinal inactivation to stimulate the infant's pituitary, resulting in LH release. This phenomenon is probably due to an immaturity in the infants' gastrointestinal enzymes function.

Effects of low steroid doses administered in the mid and late follicular phase on the LH surge, ovarian steroids and follicular maturation in eumenorrheic women.

The effects of four low doses of synthetic steroids, administered orally and starting on day 8 (group I) or on day 10 of the menstrual cycle (group II), upon LH surge, ovarian steroidogenesis, follicular maturation and menstrual cycles were studied in 10 eumenorrheic women. The results revealed that the day before the LH surge, the highest level of estrone-3-glucuronide was observed in both groups. Twenty-four hours after the last dose, the maximum urinary LH levels were recorded in groups I (day 11), and II (day 13). Pregnanediol-3 alpha glucuronide remained low during the study in group I, whereas in group II a gradual rise of this hormone starting on day 13 was registered and the highest level was found at day 21 of the menstrual cycle. Follicular maturation and ovulation were observed only in women from group II. Short and normal length cycles were recorded in groups I and II, respectively. In summary, low doses of exogenous synthetic steroids administered on day 8, but not on day 10 of the cycle, inhibit follicular maturation and ovulation.

Effects of storage and temperature upon soft jelly capsules containing nonoxynol as spermicide.

Recently, adverse effects of long periods of storage and high temperature on physical characteristics of the soft jelly capsule wall were observed. In the present study, the effects of both parameters upon the mean rupture time of the capsule, and the release of the active compound were evaluated in vivo in 40 women. The results disclosed that the storage for long time and the exposure of the capsules to high temperatures, delays significantly the mean rupture time and the release of the active compound. A rapid distribution, adequate storage, as well as a delay of intercourse after vaginal insertion of the device are suggested.

PIP: In Coahuila, Mexico, 20 women vaginally inserted soft jelly capsules containing the spermicide nonoxynol-9 which had been stored for 90 days at 25-30 degrees Celsius (group I), and 20 more women inserted capsules of the same type which had been stored in an incubator for 90 days at 45 degrees Celsius (group II). All 40 women inserted the capsules during days 12-14 of the menstrual cycle to avoid physiological changes of vaginal humidity during the cycle. At the end of each study period (2-13 minutes), rupture/nonrupture and weight of the capsules were recorded. A loss of more than 15% of the capsule's weight constituted release of nonoxynol-9. The time for the capsule to rupture ranged from 4 to 12 minutes for group I and from 6 to 13 minutes for group II. The mean rupture time was greatest for those capsules stored at the higher temperature (i.e., group II) (10.2 vs. 5.6 minutes; p 0.001). The mean release time was also greatest for group II (12.1 vs. 6.7 minutes; p 0.02). Thus, long storage and high temperature delayed the minimum time for capsule rupture in the vagina by 4-6 minutes. Capsules stored for a long time and at a high temperature had a higher wall consistency than their counterparts. Capsules stored at a high temperature had a harder consistency than those stored at a lower temperature. These findings suggest the need to rapidly distribute capsules, to store them under controlled temperature, and to delay intercourse after insertion for more than 10 minutes.

Blockade of the neonatal rise in testosterone by a gonadotrophin-releasing hormone antagonist: effects on timing of puberty and sexual behaviour in the male marmoset monkey.

In primates, plasma testosterone concentrations are elevated for some 3 months from birth. The function of this rise is uncertain, but studies in rats suggest that its prevention by castration or administration of gonadotrophin hormone-releasing hormone (GnRH) analogues has effects on development and expression of social and sexual behaviours, and adverse long-term effects on fertility. The consequences of suppression of this rise in testosterone by treatment with the GnRH antagonist antide have been investigated in the marmoset monkey. Eight sets of male:male twins were used, one of each set receiving s.c. injections of antide (10 mg/kg), on days 0, 3 and 7, then weekly from birth to 98 days of age, with the twin receiving vehicle only. Plasma samples were taken at weekly intervals for the determination of testosterone concentrations from birth until 2 years of age. Treatment with antide completely abolished the neonatal rise in testosterone seen in control animals. The timing of the onset of the pubertal testosterone rise was not significantly affected by treatment; however, the subsequent pattern of circulating testosterone showed a tendency to decreased plasma concentrations in the neonatally treated group from weeks 25 to 42, relative to controls, and this difference was significant between 43 and 70 weeks. This was associated with a similar depression in bioactive LH concentrations around this time. Thereafter, the testosterone concentrations were similar between treated and control groups. There was no effect of treatment on growth, based on sequential body weight data. At 20 months the animals underwent behaviour tests with ovariectomized females.(ABSTRACT TRUNCATED AT 250 WORDS)

Safety and efficacy of a combined oral contraceptive: gestodene 75 micrograms plus ethinyl estradiol 30 micrograms in Mexican women.

An open prospective clinical trial designed to evaluate the efficacy and safety of the combined hormonal oral contraceptive (OC) containing 75 micrograms gestodene plus 30 micrograms ethinyl estradiol was undertaken in a Mexican population. Sixty-nine healthy women of reproductive age took part in the study for a total of 627 woman-months of observation. The combination of gestodene and ethinyl estradiol proved its effectiveness in preventing pregnancy during the study. Side-effects were minimal and regular endometrial bleeding patterns were observed during one year of continuous use of this OC preparation. The discontinuation rate for medical reasons was 11.6% at one year. Among a sample of 10 women, the gestodene/ethinyl estradiol combination did not induce significant changes in the serum concentration of total cholesterol and LDL cholesterol after 12 months of continuous administration. An increase in serum triglycerides and HDL cholesterol was observed; this effect could be attributed to a lack of androgenic and/or the intrinsic estrogenic behavior of gestodene. It can be concluded that this preparation is highly effective as a combined oral contraceptive; it is well tolerated and might offer some advantages with respect to other oral contraceptive combinations in its short- and medium-term impact on lipid metabolism.

Gonadotropin-releasing hormone antagonist for postpartum contraception: outcome for the mother and male offspring in the marmoset.

GnRH antagonists have potential for use in postpartum contraception, as it is likely that they would be effective in maintaining the inhibition of ovulation associated with lactation, but possible effects on the infant by transfer of antagonist via breast milk are unknown. The aim of this study was to establish whether chronic treatment with a GnRH antagonist would prevent ovulation throughout the period of lactation using the marmoset monkey as a model and to evaluate the effects of the presence of GnRH antagonist in breast milk on the postnatal rise in plasma testosterone concentrations in male infants. Mothers who had delivered male twins were selected. Starting within 3 days postpartum, mothers (n = 5/group) were treated with either 6.0 or 0.6 mg/kg of the GnRH antagonist antide, sc, once per week for 11 weeks. Ten postpartum lactating females acted as controls. All animals were housed in family groups with fertile males. To determine possible effects on the postnatal rise in testosterone, plasma samples were collected from the male infants of the high dose antide-treated mothers at weekly intervals for 12 weeks. Plasma progesterone concentrations were monitored in lactating mothers until establishment of pregnancy in both treated and control groups. Concentrations of antide were determined by RIA in plasma from mothers in the high dose group, in their milk, and in pooled plasma samples from their infants. Ovulation followed by pregnancy occurred in all of the control animals. No ovulations occurred during treatment with antide. Antide was present throughout treatment in plasma and breast milk in the mother. In male infants feeding from mothers receiving high dose treatment, antide was not detectable in infant plasma, and plasma testosterone concentrations were within the normal range for male neonates in our colony. These results indicate that the GnRH antagonist has potential as a method of contraception postpartum without affecting the postnatal rise in testosterone in male infants.

Assessment of a new modified soft jelly capsule containing nonoxynol as spermicide contraceptive.

The mean rupture time, after its vaginal insertion, of a new modified soft jelly capsule containing nonoxynol-9 (DF-486) was investigated in 40 women. The subjects were randomly allocated to 8 study groups. The capsules remained in the vagina from 2-13 minutes. Vaginal infection, vaginal dryness, and multiparity, were recorded. Capsule rupture was not observed at minute 2; 20% of capsules that remained in the vagina 3 minutes suffered rupture, as did 80% of capsules that remained 4, 5 and 7 minutes, and 100% of those remaining 9 minutes or more. The mean rupture time of the studied capsules was 8.2 minutes with 95% confidence limits of 6.2 and 8.8 minutes. At minutes 2-7, vaginal infection, dryness and tone diminution probably accounted for lack of rupture; after minute 7, these factors did not influence capsule rupture.