The wide-awake local anesthesia no tourniquet (WALANT) technique in thumb injuries: a systematic review.

Human hands have a complex anatomical structure. The thumb, being an integral part of the hand, has an essential function in gripping. In this sense, thumb fractures account for 4% of all hand fractures (it may occur in association with fractures of the trapezium). The majority of hand fractures should be treated non-surgically and surgeons must avoid unnecessary surgery. Historically, hand surgery has used a combination of local/regional/general anaesthesia and a tourniquet. This study aims to carry out a systematic review to determine whether the WALANT technique is an advantageous alternative to conventional anaesthesia for surgical procedures on thumb injuries, in terms of patient function and pain. METHOD: We conducted a search in the following databases: Pubmed/Medline, EBSCOhost, Web of Science, Scopus, ScienceDirect and Google Scholar, using the equation "WALANT" OR "Wide Awake Local Anesthesia No Tourniquet" AND "thumb pathology". RESULTS: In five of the 584 articles included, two studied trapeziometacarpal osteoarthritis, one De Quervain's disease and the remaining two flexor injuries. WALANT showed good results in active movements, but with similar levels of pain between anaesthetics. Patients were more anxious during general anaesthesia, plus the fact that they were fasting and suspending medication. CONCLUSION: WALANT is a convenient and favourable option in several studies. It has been demonstrated the benefits in terms of return to function and pain.

Psychometric properties of the Spanish version of the Activities Scale for Kids (ASK): reliability, validity and the Rasch model.

AIMS: To evaluate the psychometric properties of the Spanish version of the Activities Scale for Kids capability (ASKc) and ASK performance (ASKp) questionnaires. DESIGN: It includes an analysis of different types of reliability (internal consistency, test-retest, inter-rater, Rasch model) and validity (convergent and discriminant) values. SETTINGS: The sample was recruited in schools, associations and one hospital in Spain. PARTICIPANTS: The main sample comprised 448 children (114 with disabilities); and 96 parents of the group of 114 children with disabilities, along with 2 therapists. METHODS AND PROCEDURE: Children with physical disabilities completed questionnaires at two different time points; while healthy children only once. Both ASK questionnaires were also administered to parents. Therapists observed 69 children in 15 of the 30 activities listed in the ASKc. PRIMARY AND SECONDARY OUTCOME MEASURES: ASKc and ASKp were used to measure physical disability among children. The Childhood Health Assessment Questionnaire (CHAQ), The Screening For and Promotion of Health-Related Quality of Life in Childrenand Adolescents - a European Public Health perspective (KIDSCREEN), Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS) and Functional Mobility Scale (FMS) were used to analyse convergent validity. RESULTS: Excellent values were obtained for the reliability of the scale. Internal consistency was >0.95 (Cronbach's α) for both questionnaires. The intraclass correlation coefficient test-retest reliability was 0.94 (ASKc) and 0.93 (ASKp). Correlations between parents' and children's scores were 0.91(ASKc) and 0.90 (ASKp); and the correlation between therapists' and children's scores was 0.78. The Rasch analysis indicated that the Spanish version had a unidimensional structure. Furthermore, the results revealed adequate validity indices. Both ASK questionnaires correlated significantly with the CHAQ, three dimensions of the KIDSCREEN and the GMFCS, MACS and FMS. Finally, children without disabilities had higher ASKc and ASKp scores than children with disabilities (p=0.0001). CONCLUSIONS: Both the ASKc and the ASKp versions are reliable and valid instruments that can be used to measure the capabilities of Spanish-speaking children, whose responses also demonstrate their own reliability as informants of the impact of disability on the activities of daily living.

Development of a Novel Peptide Nucleic Acid Probe for the Detection of Legionella spp. in Water Samples.

Legionella are opportunistic intracellular pathogens that are found throughout the environment. The Legionella contamination of water systems represents a serious social problem that can lead to severe diseases, which can manifest as both Pontiac fever and Legionnaires' disease (LD) infections. Fluorescence in situ hybridization using nucleic acid mimic probes (NAM-FISH) is a powerful and versatile technique for bacterial detection. By optimizing a peptide nucleic acid (PNA) sequence based on fluorescently selective binding to specific bacterial rRNA sequences, we established a new PNA-FISH method that has been successfully designed for the specific detection of the genus Legionella. The LEG22 PNA probe has shown great theoretical performance, presenting 99.9% specificity and 96.9% sensitivity. We also demonstrated that the PNA-FISH approach presents a good signal-to-noise ratio when applied in artificially contaminated water samples directly on filtration membranes or after cells elution. For water samples with higher turbidity (from cooling tower water systems), there is still the need for further method optimization in order to detect cellular contents and to overcome interferents' autofluorescence, which hinders probe signal visualization. Nevertheless, this work shows that the PNA-FISH approach could be a promising alternative for the rapid (3-4 h) and accurate detection of Legionella.

The role of Nucleic Acid Mimics (NAMs) on FISH-based techniques and applications for microbial detection.

Fluorescent in situ hybridization (FISH) is a powerful tool that for more than 30 years has allowed to detect and quantify microorganisms as well as to study their spatial distribution in three-dimensional structured environments such as biofilms. Throughout these years, FISH has been improved in order to face some of its earlier limitations and to adapt to new research objectives. One of these improvements is related to the emergence of Nucleic Acid Mimics (NAMs), which are now employed as alternatives to the DNA and RNA probes that have been classically used in FISH. NAMs such as peptide and locked nucleic acids (PNA and LNA) have provided enhanced sensitivity and specificity to the FISH technique, as well as higher flexibility in terms of applications. In this review, we aim to cover the state-of-the-art of the different NAMs and explore their possible applications in FISH, providing a general overview of the technique advancement in the last decades.

Naphthoquinone as a New Chemical Scaffold for Leishmanicidal Inhibitors of Leishmania GSK-3.

More than 1 billion people live in areas endemic for leishmaniasis, which is a relevant threat for public health worldwide. Due to the inadequate treatments, there is an urgent need to develop novel alternative drugs and to validate new targets to fight this disease. One appealing approach is the selective inhibition of protein kinases (PKs), enzymes involved in a wide range of processes along the life cycle of Leishmania. Several PKs, including glycogen synthase kinase 3 (GSK-3), have been validated as essential for this parasite by genetic or pharmacological methods. Recently, novel chemical scaffolds have been uncovered as Leishmania GSK-3 inhibitors with antiparasitic activity. In order to find new inhibitors of this enzyme, a virtual screening of our in-house chemical library was carried out on the structure of the Leishmania GSK-3. The virtual hits identified were experimentally assayed both for leishmanicidal activity and for in vitro inhibition of the enzyme. The best hits have a quinone scaffold. Their optimization through a medicinal chemistry approach led to a set of new compounds, provided a frame to establish biochemical and antiparasitic structure-activity relationships, and delivered molecules with an improved selectivity index. Altogether, this study paves the way for a systemic search of this class of inhibitors for further development as potential leishmanicidal drugs.

Activities of Daily Living, Playfulness and Sensory Processing in Children with Autism Spectrum Disorder: A Spanish Study.

The purposes of the study were to identify whether differences exist between Spanish children with ASD and neurotypical development in relation to Activities of Daily Living (ADL), playfulness, and sensory processing; as well as to confirm whether a relation exists between those areas and sensory processing. STUDY DESIGN: A descriptive cross-sectional study. METHODS: Forty children, 20 with a diagnosis of ASD and 20 with neurotypical development, were recruited. The measurement tools used were the Pediatric Evaluation of Disability Inventory (PEDI), Test of Playfulness (ToP), and Sensory Processing Measure (SPM). RESULTS: The sensory processing of children with ASD were related to decreased functional skills performance of ADL (F = 94.4, p = 0.00) and playfulness (p = 0.00) than neurotypical children; in addition, the problems of sensory reactivity were associated with worse development in these occupational areas (p = 0.00 for both Spearman correlations). CONCLUSIONS: Children with ASD present worse performance of functional skills and playfulness than neurotypical ones. Likewise, sensory reactivity is related to the development in the occupational areas.

Influence of Confinement by COVID-19 on the Quality of Sleep and the Interests of University Students.

PURPOSE: To check for changes in sleep in three temporary times: before COVID-19 lockdown in university students, and also twenty days and forty days afterwards, as well as to see how it has influenced in their daily activities. MATERIALS AND METHODS: A longitudinal study was conducted with a sample of 75 participants from different Spanish universities. The Pittsburgh Sleep Quality Index and the Adapted Interest List were administered to evaluate the main variables of the study. RESULTS: About 70.7% of the sample showed worse sleep quality at 20 days, almost twice as much as before confinement (37.3%), there were more problems falling asleep (F(2, 75) = -3.14, p = 0.002), and more difficulty getting back to sleep when waking up at night (F(2.75) = 2.08, p = 0.037) at 40 days of lockdown. In addition, as confinement time went on, students showed less activities. Factors such as working, in addition to studying, and relaxing activities (reading, listening to music) were associated with better sleep quality. CONCLUSION: Sleep quality worsened during lockdown in university students, as well as both 20 and 40 days later. Staying busy during the day (not only studying but also working) and spending free time on relaxing activities are related to better sleep quality.

La conductancia de la piel para evaluar el dolor y el estrés durante el cribado de la retinopatía de la prematuridad / Skin conductance to assess pain and stress during retinopathy of prematurity screening

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Pain assessment during eye examination for retinopathy of prematurity screening: Skin conductance versus PIPP-R.

AIM: To assess changes in skin conductance during retinopathy of prematurity screening and to study the correlation between the skin conductance and a validated pain scale. METHODS: Prospective observational study. Fifty-three eye examinations were performed in 32 preterm infant candidates for retinopathy of prematurity screening. Outcome measures were changes in Premature Infant Pain Profile-Revised (PIPP-R) scale and number of skin conductance fluctuations. RESULTS: There was a significant increase from baseline in the number of skin conductance fluctuations and PIPP-R during the procedure. The maximum value of number of skin conductance fluctuations was 0.64 ± 0.44 peaks/sec, and the maximum value of PIPP-R was 10.8 ± 3.3. A correlation between the skin conductance and PIPP-R was not found at any time during the eye examination. Repeated measures correlation analyses showed only a moderate positive correlation between PIPP-R and number of skin conductance fluctuation values. CONCLUSION: There were significant changes in both PIPP-R and number of skin conductance fluctuations during retinopathy of prematurity screening, reaffirming that this procedure is painful and stressful. The number of skin conductance fluctuations and PIPP-R are not significantly correlated, which likely reflects that these parameters evaluate different but complementary aspects of neonatal pain responses.

Towards discovery of new leishmanicidal scaffolds able to inhibit Leishmania GSK-3.

Previous reports have validated the glycogen synthase kinase-3 (GSK-3) as a druggable target against the human protozoan parasite Leishmania. This prompted us to search for new leishmanicidal scaffolds as inhibitors of this enzyme from our in-house library of human GSK-3ß inhibitors, as well as from the Leishbox collection of leishmanicidal compounds developed by GlaxoSmithKline. As a result, new leishmanicidal inhibitors acting on Leishmania GSK-3 at micromolar concentrations were found. These inhibitors belong to six different chemical classes (thiadiazolidindione, halomethylketone, maleimide, benzoimidazole, N-phenylpyrimidine-2-amine and oxadiazole). In addition, the binding mode of the most active compounds into Leishmania GSK-3 was approached using computational tools. On the whole, we have uncovered new chemical scaffolds with an appealing prospective in the development and use of Leishmania GSK-3 inhibitors against this infectious protozoan.

Imidazo[2,1-a]isoindole scaffold as an uncharted structure active on Leishmania donovani.

The human protozoan parasites Leishmania donovani and L. infantum are the causative agents of visceral leishmaniasis, as such, responsible for approximately 30,000 deaths annually. The available chemotherapeutic treatments are reduced to a few drugs whose effectiveness is limited by rising drug resistance/therapeutic failure, and noxious side-effects. Therefore, new therapeutic hits are needed. Compounds displaying the imidazo[2,1-a]isoindole skeleton have shown antichagasic, anti-HIV, antimalarial and anorectic activities. Here, we report the leishmanicidal activity of thirty one imidazo[2,1-a]isoindol-5-ol derivatives on promastigotes and intracellular amastigotes of L. donovani. Eight out of thirty one assayed compounds showed EC50 values ranging between 1 and 2 µM with selectivity indexes from 29 to 69 on infected THP-1 cells. Six compounds were selected for further elucidation of their leishmanicidal mechanism. In this regard, compound 29, the imidazoisoindolol with the highest activity on intracellular amastigotes, induced an early decrease of intracellular ATP levels, as well as mitochondrial depolarization, together with a partial plasma membrane destructuration, as assessed by transmission electron microscopy. Consequently, the inhibition of the energy metabolism of Leishmania plays an important role in the leishmanicidal mechanism of this compound, even when other additional targets cannot be ruled out. In all, the results supported the inclusion of the imidazoisoindole scaffold for the development of new leishmanicidal drugs.

Structure-activity relationships and mechanistic studies of novel mitochondria-targeted, leishmanicidal derivatives of the 4-aminostyrylquinoline scaffold.

A new class of quinoline derivatives, bearing amino chains at C-4 and a styryl group at C-2, were tested on Leishmania donovani promastigotes and axenic and intracellular Leishmania pifanoi amastigotes. The introduction of the C-4 substituent improves the activity, which is due to interference with the mitochondrial activity of the parasite and its concomitant bioenergetic collapse by ATP exhaustion. Some compounds show a promising antileishmanial profile, with low micromolar or submicromolar activity on promastigote and amastigote forms and a good selectivity index.

Widening the antimicrobial spectrum of esters of bicyclic amines: In vitro effect on gram-positive Streptococcus pneumoniae and gram-negative non-typeable Haemophilus influenzae biofilms.

Antibiotic resistance is a global current threat of increasing importance. Moreover, biofilms represent a medical challenge since the inherent antibiotic resistance of their producers demands the use of high doses of antibiotics over prolonged periods. Frequently, these therapeutic measures fail, contributing to bacterial persistence, therefore demanding the development of novel antimicrobials. Esters of bicyclic amines (EBAs), which are strong inhibitors of Streptococcus pneumoniae growth, were initially designed as inhibitors of pneumococcal choline-binding proteins on the basis of their structural analogy to the choline residues in the cell wall. However, instead of mimicking the characteristic cell chaining phenotype caused by exogenously added choline on planktonic cultures of pneumococcal cells, EBAs showed an unexpected lytic activity. In this work we demonstrate that EBAs display a second, and even more important, function as cell membrane destabilizers. We then assayed the inhibitory and disintegrating activity of these molecules on pneumococcal biofilms. The selected compound (EBA 31) produced the highest effect on S. pneumoniae (encapsulated and non-encapsulated) biofilms at very low concentrations. EBA 31 was also effective on mixed biofilms of non-encapsulated S. pneumoniae plus non-typeable Haemophilus influenzae, two pathogens frequently forming a self-produced biofilm in the human nasopharynx. These results support the role of EBAs as a promising alternative for the development of novel, broad-range antimicrobial drugs encompassing both Gram-positive and Gram-negative pathogens.

Molecular Basis of the Leishmanicidal Activity of the Antidepressant Sertraline as a Drug Repurposing Candidate.

Drug repurposing affords the implementation of new treatments at a moderate cost and under a faster time-scale. Most of the clinical drugs against Leishmania share this origin. The antidepressant sertraline has been successfully assayed in a murine model of visceral leishmaniasis. Nevertheless, sertraline targets in Leishmania were poorly defined. In order to get a detailed insight into the leishmanicidal mechanism of sertraline on Leishmania infantum, unbiased multiplatform metabolomics and transmission electron microscopy were combined with a focused insight into the sertraline effects on the bioenergetics metabolism of the parasite. Sertraline induced respiration uncoupling, a significant decrease of intracellular ATP level, and oxidative stress in L. infantum promastigotes. Metabolomics evidenced an extended metabolic disarray caused by sertraline. This encompasses a remarkable variation of the levels of thiol-redox and polyamine biosynthetic intermediates, as well as a shortage of intracellular amino acids used as metabolic fuel by Leishmania Sertraline killed Leishmania through a multitarget mechanism of action, tackling essential metabolic pathways of the parasite. As such, sertraline is a valuable candidate for visceral leishmaniasis treatment under a drug repurposing strategy.

Eficacia de la intervención con videoconsolas en pacientes con ictus: revisión sistemática / Efficacy of interventions with video games consoles in stroke patients: a systematic review

Introducción. En los últimos años se han desarrollado videoconsolas y videojuegos que son potencialmente útiles para la rehabilitación, lo que ha llevado a valorar el grado de eficacia de estos tratamientos para las personas tras un ictus. Objetivo. Analizar la bibliografía disponible relacionada con la efectividad de la aplicación de videoconsolas en la recuperación funcional del miembro superior en sujetos supervivientes a un ictus. Pacientes y métodos. Se ha realizado una búsqueda bibliográfica en las bases de datos CINHAL, Medline, PEDro, PsycArticles, PsycInfo, Science Direct, Scopus y Web of Science, utilizando como términos de búsqueda 'video game', 'stroke', 'hemiplegia', 'upper extremity' y 'hemiparesis'. Aplicados los criterios de inclusión (ensayos clínicos publicados entre 2007 y 2017, cuyos participantes fueron adultos con ictus con afectación en la extremidad superior y que utilizaron videojuegos), se valoró la calidad científica de los estudios seleccionados mediante la escala PEDro. Se han obtenido 11 ensayos clínicos válidos para la revisión sistemática. Resultados. Las investigaciones, todas ellas cuantitativas, seleccionadas presentan datos diferentes, y los resultados inferenciales indican distintos niveles de significación entre los grupos control y experimentales (82%) o entre los diferentes tipos de tratamiento (18%). Conclusiones. El uso de las videoconsolas es un complemento eficaz para la rehabilitación convencional del miembro superior de personas supervivientes a un ictus al incrementar el tiempo de rehabilitación y potenciar la recuperación de la función motora. No obstante, se requiere la implantación de protocolos de intervención homogéneos con el fin de estandarizar la intervención (AU)

Introduction. In recent years video games and games consoles have been developed that are potentially useful in rehabilitation, which has led to studies conducted to evaluate the degree of efficacy of these treatments for people following a stroke. Aim. To analyse the literature available related to the effectiveness of applying video games consoles in the functional recovery of the upper extremities in subjects who have survived a stroke. Patients and methods. A review of the literature was conducted in the CINHAL, Medline, PEDro, PsycArticles, PsycInfo, Science Direct, Scopus and Web of Science databases, using the query terms 'video game', 'stroke', 'hemiplegia', 'upper extremity' and 'hemiparesis'. After applying the eligibility criteria (clinical trials published between 2007 and 2017, whose participants were adults who had suffered a stroke with involvement of the upper extremity and who used video games), the scientific quality of the selected studies was rated by means of the PEDro scale. Eleven valid clinical trials were obtained for the systematic review. Results. The studies that were selected, all of which were quantitative, presented different data and the inferential results indicated different levels of significance between control and experimental groups (82%) or between the different types of treatment (18%). Conclusions. The use of video games consoles is a useful complement for the conventional rehabilitation of the upper extremities of persons who have survived a stroke, since it increases rehabilitation time and enhances the recovery of motor functioning. Nevertheless, homogeneous intervention protocols need to be implemented in order to standardize the intervention (AU)

Dextransucrase Expression Is Concomitant with that of Replication and Maintenance Functions of the pMN1 Plasmid in Lactobacillus sakei MN1.

The exopolysaccharide synthesized by Lactobacillus sakei MN1 is a dextran with antiviral and immunomodulatory properties of potential utility in aquaculture. In this work we have investigated the genetic basis of dextran production by this bacterium. Southern blot hybridization experiments demonstrated the plasmidic location of the dsrLS gene, which encodes the dextransucrase involved in dextran synthesis. DNA sequencing of the 11,126 kbp plasmid (pMN1) revealed that it belongs to a family which replicates by the theta mechanism, whose prototype is pUCL287. The plasmid comprises the origin of replication, repA, repB, and dsrLS genes, as well as seven open reading frames of uncharacterized function. Lb. sakei MN1 produces dextran when sucrose, but not glucose, is present in the growth medium. Therefore, plasmid copy number and stability, as well as dsrLS expression, were investigated in cultures grown in the presence of either sucrose or glucose. The results revealed that pMN1 is a stable low-copy-number plasmid in both conditions. Gene expression studies showed that dsrLS is constitutively expressed, irrespective of the carbon source present in the medium. Moreover, dsrLS is expressed from a monocistronic transcript as well as from a polycistronic repA-repB-orf1-dsrLS mRNA. To our knowledge, this is the first report of a plasmid-borne dextransucrase-encoding gene, as well as the first time that co-transcription of genes involved in plasmid maintenance and replication with a gene encoding an enzyme has been established.

Balance deficiencies in women with fibromyalgia assessed using computerised dynamic posturography: a cross-sectional study in Spain.

OBJECTIVES: Our aims were (1) to compare the sensory organisation of balance control and balance strategies between women with fibromyalgia (FM) and healthy women; (2) to investigate which sensory component, that is, vestibular, visual or somato-sensory, is the most affected in FM and (3) to determine the associations between the functional independence measure (FIM) and balance responses in FM. DESIGN: Cross-sectional observational study. SETTING: Urban regional hospital and university (Universidad Rey Juan Carlos, Madrid, Spain). PARTICIPANTS: Twenty women with FM and 20 matched healthy women. PRIMARY/SECONDARY OUTCOME MEASURES: The sensory organisation test (SOT) was used to determine postural sway and balance during six different conditions with subjects in a standing position. The FIM was used to determine the level of functional independence in daily life activities (ADL). Between-group differences were analysed with analysis of covariance, and the Spearman's test was used for correlations. RESULTS: Significant differences between-groups and between-conditions were found for all SOT conditions (all, p<0.001): women with FM showed lower scores being the vestibular score the most affected. Different correlations between SOT conditions and some specific ADL were observed in the FM group: bathing activity and balance condition 6 (rs=0.541; p<0.001), bed transfers activity and conditions 2 (rs=0.491; p<0.001) and 3 (rs=0.510; p<0.001), positioning strategy six and dressing the upper (rs=0.530; p<0.001) or lower (rs=0.562; p<0.001) body, and toileting (rs=0.521; p<0.001): the greater the loss of balance, the greater the interference on some daily life activities. CONCLUSIONS: Women with FM exhibited balance deficiencies and used different strategies for maintaining their balance in standing, which was associated with a negative impact on functional independence.

Dextran production by Lactobacillus sakei MN1 coincides with reduced autoagglutination, biofilm formation and epithelial cell adhesion.

In this work we have investigated two dextran-producing lactic acid bacteria, Lactobacillus sakei MN1 and Leuconostoc mesenteroides RTF10, isolated from fermented meat products. These bacteria synthesise dextran when sucrose, but not glucose, is present in the growth medium. The influence of dextran on bacterial aggregation, adhesion and biofilm formation was investigated in cultures challenged with sucrose or glucose. For Lb. sakei MN1, the synthesis of the dextran drastically impaired the three processes; in contrast it had no effect on Lc. mesenteroides RTF10. Therefore, the influence of dextran on probiotic properties of Lb. sakei MN1 was tested in vivo using gnotobiotic zebrafish models. The bacterium efficiently colonised the fish gut and inhibited the killing activity of Vibrio anguillarum NB10[pOT11]. Furthermore, under conditions of dextran synthesis, the adhesion of Lb. sakei MN1 to the epithelial cells decreased, without greatly affecting its anti V. anguillarum activity.