Search

Mario Juárez-Ortega,1 Oscar Rojas-Espinosa,1 Raquel Muñiz-Salazar,2 Enrique Becerril-Villanueva,3 Alejandro Hernández-Solís,4 Patricia Arce-Paredes,1 Sergio Islas-Trujillo,1 Raúl Cicero-Sabido4 1Department of Immunology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico; 2School of Health Sciences, Unidad Ensenada, Universidad Autónoma de Baja California, Ensenada, BC, Mexico; 3Laboratory of Psychoimmunology, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico; 4Pneumology Unit, Hospital General de México “Eduardo Liceaga”, UNAM, Mexico City, Mexico Background: Resident alveolar macrophages, dendritic cells, and immigrating neutrophils (NEU) are the first cells to contact Mycobacterium tuberculosis in the lung. These cells, and additional lymphoid cells in the developing granuloma, release a series of components that may concentrate in the serum and affect disease progression. Purpose: The aim of this study was to investigate the effect of the serum from tuberculosis (TB) patients and their household contacts (HHC) on the nuclear morphology of NEU. Materials and methods: NEU from healthy (HLT) people were incubated with sera from patients with active pulmonary TB, their HHC, and unrelated people. Changes in the nuclear morphology of NEU were analyzed by light and electron microscopy. Results: Sera from patients with TB induced changes in the nuclear morphology of NEU that included pyknosis, swelling, apoptosis, and netosis in some cases. Sera from some HHC induced similar changes, while sera from HLT people had no significant effects. Bacteria did not appear to participate in this phenomenon because bacteremia is not a recognized feature of nonmiliary TB, and because sera from patients that induced nuclear changes maintained their effect after filtration through 0.22 µm membranes. Neither anti-mycobacterial antibodies, TNFα, IL-6, IFNγ, or IL-8 participated in the phenomenon. In contrast, soluble mycobacterial antigens were likely candidates, as small quantities of soluble M. tuberculosis antigens added to the sera of HLT people led to the induction of nuclear changes in NEU in a dose-dependent manner. Conclusion: These results might help to detect subclinical TB within HHC, thus leading to a recommendation of prophylactic treatment. Keywords: tuberculosis, serum, neutrophils, pyknosis, apoptosis, netosis

Copyright of Motricidad: European Journal of Human Movement is the property of Asociacion Espanola de Ciencias del Deporte and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The handstand is an essential skill in acrobatic sports. This skill requires the athlete to maintain an inverted upright stance with only the hands supported, which requires a great effort of muscular coordination and motor control. Several factors influence the ability to control the posture, including fatigue, which is a bit studied constraint of handstand performance., Research Question: With the aim to find out whether variability in movement control can be an indicator of fatigue, the present study was carried out., Method: Fourteen male acrobatic gymnasts were required to perform handstands. The time series for analyzing variability were capturing using Force Platforms, which is a traditional laboratory instrument, and Inertial Measurement Units (IMU), which is a more recent and less widely used, but more accessible tool. For this purpose, an analysis of the amount of variability was carried out, using the standard deviation. And analysis of the structure of variability (or complexity), using Detrended Fluctuation Analysis (DFA) and Fuzzy Entropy (FuEn)., Results: Our results reveal that fatigue causes significant increases in the amount of variability in the medio-lateral axis on the force platform, and in the IMU located in the area of the L5 vertebra. These changes are accompanied by increased auto-correlation in the medio-lateral axis of the force platform, and more unpredictable behavior in the L5 IMU., (© 2024. The Author(s).)

Analysis of variability in physiological time series has been shown to be an indicator of the state of the organism. Although there is evidence of the usefulness of analysis of the amount and/or structure of variability (complexity) in cycling actions, there is limited knowledge about its application in resistance exercise. The aim of this study is to find out whether variability in acceleration signals can be an indicator of intensity level in a squat task. For this purpose, an experimental design was developed in which the following participated seventy-two participants (age = 25.7 ± 4.4 years; height = 169.2 ± 9.8 cm; body mass = 67.7 ± 11.2 kg; ratio 1RM/body mass = 1.4 ± 0.3). They performed four repetitions of back squat at loads of 10%, 30%, 50%, 70%, and 90% of 1RM. Acceleration during the exercise was recorded using an inertial measurement unit (IMU) and a force platform. The variability of the movement was then analyzed using Standard Deviation (SD), Detrended Fluctuation Analysis (DFA), Fuzzy Entropy (FuzzyEn), and Sample Entropy (SampEn). For the IMU and for the force platform, significant effects were observed in all variables (p < 0.001). In pairwise comparisons, IMU showed a significant increase in motor complexity with increasing intensity, among most intensities, in DFA, FuzzyEn and SampEn. Differences in force platform were more limited, and only DFA detected differences between most intensities. The results suggest that measures of signal and acceleration variability may be a useful indicator of the relative intensity at which a squat exercise is performed., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2024 López-Fernández et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Resistance training programs play a crucial role in optimizing soccer performance. The aim of this study is to compare performance outcomes in sport-specific tasks after implementing two different flywheel resistance training (FRT) programs: variable intensity (VI) and constant intensity (CI). Seventeen ( n = 17) amateur footballers were divided into VI and CI groups with the same training volume. For the VI group, a decrease in inertial load was implemented every four sessions, whereas the CI group maintained a constant load during the entire program. After different familiarization sessions and testing (sprint, change of direction, jump, one-repetition maximum and flywheel strength variables), ten sessions of FRT were performed over 5 weeks. Both groups showed similar improvements in the one-repetition maximum ( p < 0.01) but the CI group had significant improvements in the 10-m sprint ( p = 0.04; ES = 0.72), emphasizing the potential benefits of medium inertial loads to maximize power and specificity in sport tasks. However, no significant differences were observed in the countermovement jump, change of direction and 30-m sprint, possibly attributed to neuromuscular fatigue from a high-volume training schedule and friendly matches. The study highlights the importance of considering training load distribution in FRT programs. The findings emphasize the need for complementary training to maximize the jump and change of direction abilities and caution against high-volume training and friendly match scenarios. In conclusion, FRT programs, whether varying in intensity or not, can yield medium-term performance improvements for soccer players., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Asencio, Moreno, Hernández-Davó and Sabido.)

Movement control can be an indicator of how challenging a task is for the athlete, and can provide useful information to improve training efficiency and prevent injuries. This study was carried out to determine whether inertial measurement units (IMU) can provide reliable information on motion variability during strength exercises, focusing on the squat. Sixty-six healthy, strength-trained young adults completed a two-day protocol, where the variability in the squat movement was analyzed at two different loads (30% and 70% of one repetition maximum) using inertial measurement units and a force platform. The time series from IMUs and force platforms were analyzed using linear (standard deviation) and non-linear (detrended fluctuation analysis, sample entropy and fuzzy entropy) measures. Reliability was analyzed for both IMU and force platform using the intraclass correlation coefficient and the standard error of measurement. Standard deviation, detrended fluctuation analysis, sample entropy, and fuzzy entropy from the IMUs time series showed moderate to good reliability values (ICC: 0.50-0.85) and an acceptable error. The study concludes that IMUs are reliable tools for analyzing movement variability in strength exercises, providing accessible options for performance monitoring and training optimization. These findings have implications for the design of more effective strength training programs, emphasizing the importance of movement control in enhancing athletic performance and reducing injury risks.

Objectives: The purpose of this study was 1) to determine and compare kinetic parameters during the realization of a countermovement jump (CMJ) between footballers with cerebral palsy (CP) and non-impaired footballers, and 2) to analyze the differences in this action between different players' impairment profiles and a group of non-impaired footballers. Methods: This study involved 154 participants comprising 121 male footballers with CP from 11 national teams and 33 male non-impaired football players recruited as the control group (CG). The footballers with CP were described according to the different impairment profiles (bilateral spasticity = 10; athetosis or ataxia = 16; unilateral spasticity = 77; minimum impairment = 18). All participants performed three CMJs on a force platform to record kinetic parameters during the test. Results: The group of para-footballers presented significantly lower values than the CG in the jump height ( p < 0.01, d = -1.28), peak power ( p < 0.01, d = -0.84), and the net concentric impulse ( p < 0.01, d = -0.86). Concerning the pairwise comparisons between CP profiles and the CG, significant differences were found for the bilateral spasticity, athetosis or ataxia, and unilateral spasticity subgroups compared to the non-impaired players for jump height ( p < 0.01; d = -1.31 to -2.61), power output ( p < 0.05; d = -0.77 to -1.66), and concentric impulse of the CMJ ( p < 0.01; d = -0.86 to -1.97). When comparing the minimum impairment subgroup with the CG, only significant differences were found for jump height ( p = 0.036; d = -0.82). Footballers with minimum impairment presented higher jumping height ( p = 0.002; d = -1.32) and concentric impulse ( p = 0.029; d = -1.08) compared to those with bilateral spasticity. Also, the unilateral spasticity subgroup reports a higher jump height performance than the bilateral group ( p = 0.012; d = -1.12). Conclusion: These results suggest that the variables related to power production during the concentric phase of the jump are crucial for the performance differences between groups with and without impairment. This study provides a more comprehensive understanding of kinetic variables that would differentiate CP and non-impaired footballers. However, more studies are necessary to clarify which parameters better differentiate among different profiles of CP. The findings could help to prescribe effective physical training programs and support the classifier's decision-making for class allocation in this para-sport., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Henríquez, Sabido, Barbado, Roldan, Elvira, Yanci and Reina.)

Induced variability by the use of unstable surfaces has been proposed to enhance proprioceptive control to deal with perturbations in the support base better. However, there is a lack of evidence about its benefits facilitating motor adaptions in upper body skills. In this experiment, practice on an unstable surface was applied to analyze the adaptations in an upper limb precision throwing skill. After a pretest, twenty-one participants were randomly allocated into two groups: one group practiced the throwing task on a stable surface and the other group practiced the same task on an unstable support base. Differences in throwing performance between pre- and post-practice were analyzed in accuracy, hand movement kinematics and variability of the throw in both surface conditions. Fuzzy entropy of the horizontal force was calculated to assess the complexity dynamics of postural sway. Participants improved their performance on the stable and the unstable surface. Induced variability using an unstable surface reduced participants' variability and the complexity of postural sway, but it did not facilitate a superior adaptation of the throwing task. The results suggest that the variations induced by unstable surfaces would fall far from the family of specific motor solutions and would not facilitate additional motor performance of the throwing task., Competing Interests: The authors declare there are no competing interests., (©2023 Moreno et al.)

Introduction: Pulmonary aspergilloma is commonly associated with comorbidities that cause immunodeficiency such as diabetes mellitus, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome and/or a pre-existing parenchymal lung disease such as chronic obstructive pulmonary disease. Predisposing factors can further increase the risk of acquiring this mycosis. Our objective was to determine the frequency, clinical and microbiological characteristics of pulmonary aspergilloma in immunocompromised patients., Methodology: Retrospective case series of patients diagnosed with pulmonary aspergilloma in a respiratory care unit in Mexico City from 2000 to 2019 was studied. Bronchoalveolar lavage cultures on Sabouraud-dextrose agar and serum galactomannan determination were performed on each patient., Results: We identified twenty-four patients with pulmonary aspergilloma (sixteen male and eight female), thirteen had a history of tuberculosis (54%), seven of diabetes mellitus (29%), three of human immunodeficiency virus/acquired immunodeficiency syndrome (13%) and one of chronic obstructive pulmonary disease (4%). The most commonly reported symptoms were hemoptysis in eighteen patients (75%), dyspnea in sixteen patients (67%) and chest pain in thirteen patients (54%). Aspergillus fumigatus was identified in all cultures and galactomannan was positive in 21 serum samples (87%)., Conclusions: Coexistence of diseases that could suppress the immune system predispose to pulmonary aspergilloma; clinical presentation is often confused with other systemic diseases. A high degree of clinical suspicion is important for early detection., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Alejandro Hernandez-Solis; Pablo Alvarez-Maldonado, Javier Araiza-Santibanez, Kevin Cruz-Munoz, Raul Cicero-Sabido, Andrea Quintana Martinez.)

The purpose of the present meta-analysis was to examine the effect of flywheel resistance training (FRT) on main sport action (i.e., jumping performance, sprinting time and change of direction performance) improvements in athletes and healthy active people. A Boolean search strategy adapted for each of the databases employed was conducted to identify all studies measuring change in sport actions performance after FRT interventions up to July 2019. Outcomes were analysed using an average effect size (D + ) and a 95% confidence interval (CI), which was calculated assuming a random-effects model. A total of 9 studies with 283 participants met the inclusion criteria and were selected for the analysis. The mean quality score (PEDro scale) of the articles included in the meta-analysis was 5.67. The meta-analysis showed significant positive effects on jumping performance (SMC 0.65; 95% CI, 0.11-1.19; p = 0.02), sprinting time (SMC 1.33; 95% CI, 0.39-2.28; p < 0.01) and change of direction performance (SMC 1.36; 95% CI, 0.58-2.14; p < 0.01) after FRT interventions compared to control/traditional resistance training groups. The results of the present meta-analysis provide evidence of the usefulness of FRT to improve variables related to sport performance in both athletes and healthy population., (© 2021 Javier Raya-González, Amaya Prat-Luri, Alejandro López-Valenciano, Rafael Sabido, Jose Luis Hernández-Davó, published by Sciendo.)

Introduction: Lung ultrasound (LUS) implementation in patients with COVID-19 can help to establish the degree of pulmonary involvement, evaluate treatment response and estimate in-hospital outcome., Objective: To evaluate the application of a LUS protocol in patients with COVID-19 infection to predict in-hospital mortality., Methods: The study was carried out from April 1 to August 1, 2020 in patients with COVID-19 infection admitted to the Intensive Care Unit. Lung evaluation was carried out by physicians trained in critical care ultrasonography., Results: Most patients were males, median age was 56 years, and 59 % required mechanical ventilation. In-hospital mortality was 39.4 %, and in those with a LUS score ≥ 19, mortality was higher (50 %). The multiple logistic regression model showed that a LUS score ≥ 19 was significantly associated with mortality (hazard ratio = 2.55, p = 0.01)., Conclusions: LUS is a safe and fast clinical tool that can be applied at bedside in patients with COVID-19 infection to establish the degree of parenchymal involvement and predict mortality., (Copyright: © 2021 Permanyer.)

Background and objectives : Fatigue is one of the most disabling symptoms that limit daily life activities in persons with multiple sclerosis (pwMS). This study aimed to evaluate the effects of maximal strength training (MST) on perceived-fatigue and functional mobility in pwMS. Materials and Methods : 26 participants with MS were balanced according to their pre-intervention fatigue scores and distributed into an MST group ( n = 13) and a control group (CG; n = 13). The MST group completed eight weeks using high loads, evaluating detraining after ten weeks. Quadriceps and hamstring isokinetic (QPT IK ; HPT IK ) and isometric (QPT IM ; HPT IM ) peak torques were assessed using an isokinetic dynamometer. Effect size differences were estimated with the Hedges' g index ( d g ). Fatigue was evaluated through the Fatigue Severity Scale (FSS), while functional mobility was assessed via the Timed Up and Go Test (TUG). Results : The MST significantly improved all the strength measurements after the intervention (Δ6.43-29.55%; p < 0.05) compared to the control group. FSS showed a significant reduction (59.97%, d g = 5.41, large). The MST group also reduced the TUG time (19.69%; d g = 0.93, large) compared to the control group. Improvements caused by the intervention did not remain after a 10-week follow-up, with decreases in strength performance from 4.40% to 13.86% ( d g = 0.24-0.56, small to moderate), 112.08% in the FSS ( d g = -3.88, large), and 16.93% in TUG ( d g = -1.07, large). Conclusions : MST (up to 90% 1RM) seems to be a feasible and useful way to obtain clinically relevant improvements in the perceived-fatigue symptoms and functional mobility. Still, symptom improvements decrease after a 10-week detraining period.

The use of flywheel devices has increased in popularity within resistance training programs. However, little is known about modifiable variables which may affect power output responses, as the rope length and the height level used in a conical pulley device. The aim of this study was to assess the influence of using three different rope lengths (1.5, 2.5 and 3.5 meters) and four different height levels (L1, L2, L3 and L4) on concentric peak power (PPconc), eccentric peak power (PPecc) and eccentric overload (eccentric/concentric PP ratio; EO) during conical pulley exercises (i.e. seated and stand-up row). A total of 29 recreationally trained subjects (25.3±7.1 years; 1.74±0.06 m; 72.5±8.3 kg) took part in the study. Testing sessions consisted of 1 set of 10 repetitions under each condition; experiment 1: seated row exercise using the three different rope lengths; experiment 2: stand-up row exercise using four different height levels of the conical pulley. Results from experiment 1 did not show differences between rope lengths, although a trend for greater PPecc (ES=0.36-0.38) and EO (ES=0.40-0.41) was found when using longer rope lengths (2.5 and 3.5). Experiment 2 showed significant increases in both PPconc and PPecc as the height level used was closer to the cone base (L4). In contrast, EO values were significantly greater when using upper height levels (L1). These results suggest that the height level used during conical pulley exercises highly influences power output responses. Therefore, this variable should be carefully managed depending on the training goal (e.g. power vs hypertrophy)., (© 2020 Rafael Sabido, Jose Luis Hernández-Davó, Adrián García-Valverde, Pablo Marco, Pablo Asencio, published by Sciendo.)

This study aimed to analyze the influence of the inertial load on both concentric and eccentric power output production during the flywheel leg curl exercise, and to assess the reliability of power output variables. Sixteen participants (8 males, 8 females) attended 4 testing sessions. During testing, participants performed one set of eight repetitions using a specific inertial load (0.083, 0.132, 0.182, 0.266 and 0.350 kg·m 2 ) with a flywheel leg curl exercise. Concentric (CON) power, eccentric (ECC) power and the ECC/CON ratio were analyzed. The reliability analysis between sessions was performed. A significant interaction of inertia load x gender was found in CON power (p < 0.001) and in ECC power (p = 0.004), but not in the ECC/CON ratio (p = 0.731). A significant with-in (inertia loads) effect was found in CON power (p < 0.001) and in ECC power (p < 0.001), but not in the ECC/CON ratio (p = 0.096). CON power showed very high reliability scores, ECC power showed high to very high reliability scores, while the ECC/CON ratio ranged from poor to moderate. A significant between gender effect was found in CON power (p < 0.001) and in ECC power (p < 0.001), but not in the ECC/CON ratio (p = 0.752). This study is the first to report that power output in the flywheel leg curl exercise is altered by the inertia load used, as well as power output is different according to gender. CON and ECC power output presents high to very high reliability scores, and the ECC/CON ratio should not be used instead. These results can have important practical implications for testing and training prescription in sports., (© 2020 Francisco Piqueras-Sanchiz, Rafael Sabido, Javier Raya-González, Marc Madruga-Parera, Daniel Romero-Rodríguez, Marco Beato, Moisés de Hoyo, Fabio Yuzo Nakamura, Jose Luis Hernández-Davó, published by Sciendo.)

It is known that, in ancient Mexico, diseases of the respiratory system were a major cause of death in the population. Severe epidemics in the XVI Century ravaged and killed nine out of ten indigenous persons. Pre-Hispanic physicians served as medical sorcerers and dealt with the physical and spiritual diseases that afflicted the population. Important medical knowledge pertaining to each culture has been identified; this knowledge explained the diseases depending on the religious beliefs of each culture, and it tried to solve the health problems that afflicted the population at that time.

The use of flywheel devices has increased in popularity during the last few years. Flywheel training is an attractive alternative to traditional resistance exercise because it allows for the loading stimulus to be manipulated. Some of the benefits associated with flywheel training include increases in muscle hypertrophy, muscular strength and reductions in injury risk. Nevertheless, there is a lack of research about how basic training variables [i.e., rest intervals (RI) between sets], or variables associated with manipulation of the loading stimulus (i.e., different inertial loads), influence the acute responses during a flywheel session. Thus, the aim of this study was to assess the influence of three different RI between sets (1, 2, or 3 min), during a flywheel squat session with two different inertial loads: light (0.025 kg⋅m 2 ) and high (0.075 kg⋅m 2 ). Twenty-three participants performed six exercise sessions (two inertial loads × three RI) consisting of four sets of 11 repetitions. Concentric and eccentric power, lactate concentration ([La]) and ratings of perceived exertion (RPE) were measured during the exercise session, and delayed onset muscular soreness (DOMS) were recorded 24 h post-exercise. Both concentric (9.1 and 22.1% at light and high load respectively; p = 0.022 and 0.005) and eccentric peak power (17.5% at high load; p = 0.02) decreased across sets when the 1 min RI was used. Concentric peak power was decreased (11.1%, p = 0.041) from the 2 min RI only with the high inertial load. RPE was higher during the 1 min compared with the 3 min RI protocol when using the high inertial load ( p = 0.028). [La] was higher when using the 2 min RI compared with the 3 min RI at light load ( p = 0.03). In conclusion, during flywheel training sessions, a short RI (1 min) was insufficient to maintain power output across all four sets and was linked to greater perceptual variables. A 2 min RI allowed for power to be maintained, but only when training with light inertial loads. Based on these results, coaches should consider prescribing 3 min RI's when performing flywheel squat exercises regardless the inertial load. In contrast, when using 2 min RI's the inertial load should be light., (Copyright © 2020 Sabido, Hernández-Davó, Capdepon and Tous-Fajardo.)

Background: Diabetes mellitus is a public health problem in Mexico, and the trend of the disease is increasing. From 2000 to 2017, 7.32 million new cases were diagnosed, with pulmonary mycoses being one of the most serious complications., Aims: To describe the frequency and the clinical characteristics of patients diagnosed with pulmonary mycoses, and to identify the risk factors associated with this entity., Methods: Case-control study, paired by gender (1:1-3) and age (± 5 years), that analyzed patients with pulmonary mycosis (mucormycosis, histoplasmosis, coccidioidomycosis, blastomycosis, aspergillosis, cryptococcosis, paracoccidioidomycosis) and studied the risk factors present in each patient., Results: From the 162 patients studied, 56 suffered pulmonary mycosis and 106 were controls. The median of the age was 51 and 50 years for the cases and for the controls, respectively. Multiple logistic regression analysis showed that patients with diabetes mellitus had an odds ratio of 8,3 (p < 0.001), and patients with a history of tuberculosis had an odds ratio of 8,8 (p < 0.001)., Conclusions: Our results show that 52% of the patients with pulmonary mycoses had a history of diabetes mellitus. Diabetes mellitus is a relevant risk factor for pulmonary mycoses, which are usually diagnosed in advanced stages and have a high mortality., (Copyright © 2020 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: There is little information of intensive care unit (ICU) performance when it's relocated to a totally new and equipped area., Objective: To analyze the clinical performance and use of resources of a new respiratory-ICU (nRICU) in a large third-level care hospital., Method: Cross-sectional, comparative study using prospective data of patients admitted from July 17, 2017 to July 17, 2018. The Rapoport adjusted method was used to obtain the standardized clinical performance index (SCPI) and the standardized resource use index (SRUI)., Results: Out of 354 patients, those who were readmissions or remained hospitalized and those whose treatment was withheld or withdrawn where excluded from the analysis. In 301 patients, the observed survival at hospital discharge was 63% while the expected survival was 67.7%. Values of SCPI and SRUI were -1.03 and 0.05 respectively, placing results in coordinates within two standard deviations when plotted in the Rapoport chart. There was a statistically significant difference in survival when comparing the study period with outcomes obtained in the RICU before its relocation (63% vs. 55%, p = 0.01)., Conclusions: In its 1st year of operation, the nRICU had better clinical performance compared to the former RICU, with no change in the use of resources., (Copyright: © 2020 Permanyer.)

Non-tuberculous mycobacterial infection has increased significantly in recent years, especially in emerging countries. We present the case of a 25-year-old male patient, immunocompetent, with cervical lymphadenopathy, identifying Mycobacterium kumamotonense, a rare species in extrapulmonary forms and with a high drug resistance index., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2019 Alejandro Hernández Solis, Maribel González Villa, Ernesto Ramírez González, Yesenia Colin Muñoz, Raúl Cicero Sabido.)

Objective: To evaluate the occurrence of adverse events during a multifaceted program implementation., Design: Cross-sectional secondary analysis., Setting: The respiratory-ICU of a large tertiary care center., Participants: Retrospectively collected data of patients admitted from 1 March 2010 to 28 February 2014 (usual care period) and from 1 March 2014 to 1 March 2017 (multifaceted program period) were used., Interventions: The program integrated three components: (1) strategic planning and organizational culture imprint; (2) training and practice and (3) implementation of care bundles. Strategic planning redefined the respiratory-ICU Mission and Vision, its SWOT matrix (strengths, weaknesses, opportunities, threats) as well as its medium to long-term aims and planned actions. A 'Wear the Institution's T-shirt' monthly conference was given in order to foster organizational culture in healthcare personnel. Training was conducted on hand hygiene and projects 'Pneumonia Zero' and 'Bacteremia Zero'. Finally, actions of both projects were implemented., Main Outcome Measures: Rates of adverse events (episodes per 1000 patient/days)., Results: Out of 1662 patients (usual care, n = 981; multifaceted program, n = 681) there was a statistically significant reduction during the multifaceted program in episodes of accidental extubation ([Rate ratio, 95% CI] 0.31, 0.17-0.55), pneumothorax (0.48, 0.26-0.87), change of endotracheal tube (0.17, 0.07-0.44), atelectasis (0.37, 0.20-0.68) and death in the ICU (0.82, 0.69-0.97)., Conclusions: A multifaceted program including strategic planning, organizational culture imprint and care protocols was associated with a significant reduction of adverse events in the respiratory-ICU., (© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: The sputum smear or the culture are the definitive diagnosis of pulmonary tuberculosis. Only a fraction of clinical patients are culture-confirmed., Methodology: A total of 24 clinical cases (40 ± 14 years old) with positive smear and negative co-morbidity were studied. Cases were selected from 600 patients who attended the pneumology service over two years. A sputum sample was cultured in Löwenstein-Jensen medium with consequent amplification of the rrnA V2 promoter, the differentiation region 4, and the IS6110 insertion sequence of Mycobacterium tuberculosis. After the culture result, the patients were divided into negative (n = 14) or positive (n = 10) culture groups. In addition, 30 samples from healthy donors (45 ± 10 years) were studied. The numbers of CD4, CD8 and CD19 lymphocytes were determined by flow cytometry. Levels of IgA and IgG to M. tuberculosis were measured by ELISA., Results: IgG and IgA levels were detected in patients with positive culture, while only IgA was found in patients with negative cultures. The lymphocyte populations in the two groups were similar.  The presence of a pleural apical cap was found more frequently in patients with negative- (57%) than with positive cultures (10%)., Conclusions: The isotype profile in patients with positive cultures was both IgA and IgG positive, while in patients with negative culture, only IgA was found. The results will contribute to improve the diagnostic algorithm and appropriate treatment of patients with clinical tuberculosis. Further studies are needed to determine if this profile is predictive of the outcome of isolation., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2019 Jorge-Luis de-la-Rosa-Arana, Fernando-Renato Cázares-Sosa, Alejandro Hernández-Solís, Atenea-Estela Andrés-Dionicio, Heliodora González-González, Miguel Ibáñez-Hernández, Raúl Cicero-Sabido, Herón Huerta, Raquel Tapia-Romero.)

Introduction: In Mexico, there is an alarming increase in the number of cases of Mycobacterium bovis infection on pulmonary and extrapulmonary presentations. The lack of timely identification triggers complications and increases mortality., Objective: To know the frequency of M. bovis infections in clinical samples of patients with tuberculosis in the mycobacteria laboratory of a reference hospital in Mexico City., Method: Prospective, descriptive study. Strains isolated from biological material were studied in Löwestein-Jensen and MGITI960 cultures. M. bovis was identified by amplifying the RD9 fragment with end-point polymerase chain reaction (PCR)., Results: Eight-hundred and fifty tuberculosis-diagnosed patients were included; in 441 cases, Mycobacterium tuberculosis was confirmed by positive culture (250 pulmonary, 65 ganglionic, 39 renal, 34 meningeal, 25 miliary, 14 pleural, 8 peritoneal, 4 bone and 2 pericardial cases). Forty-eight strains (10.8%) were typified as M. bovis by amplification of the RD9 fragment with end-point PCR., Conclusions: M. bovis is not currently thought of a causative agent of tuberculosis, which could be the cause of pharmacological treatment failure. In this study, the main extrapulmonary form was observed to be cervical lymphadenopathy., (Copyright: © 2019 Permanyer.)

Introduction: New hospitals are replacing old facilities. There is little information on the performance of an intensive care unit (ICU) when it is relocated in a new and equipped area., Objective: To analyze the impact of the change of ICU facilities from a shared environment to individual beds on the occurrence of adverse events., Method: Cross-sectional, comparative study, with prospectively collected data from patients admitted from March 01, 2014 to February 28, 2017 to the former ICU (f-ICU) and from July 17, 2017 to January 17, 2019 to the new ICU (n-ICU) of a public teaching hospital. The rate of adverse events was measured in events per 1,000 patient-days., Results: Among 1,188 patients (f-ICU, n = 681 vs. n-ICU, n = 507), a reduction in the rate of unforeseen cardiac arrest (rate ratio: 0.31; 95% confidence interval [CI] = 0.12-0.80) and an increase in the rate of unplanned extubation (rate ratio: 2.49; 95% CI = 1.24-5.01) were observed, with both being statistically significant. The other nine monitored adverse events showed no changes., Conclusions: In comparison with the f-ICU, most of the monitored adverse events did not significantly change within the first 18 months of activities at the n-ICU., (Copyright: © 2019 Permanyer.)

Introduction: intracavitary electrocardiogram (IC-ECG) guidance has been recently proposed for peripherally inserted central catheter (PICC) placement since it may reduce the time of placement and avoid radiological control., Objective: to evaluate IC-ECG compared to conventional radiological control. METHOS: prospective study of 532 consecutive patients. Those with arrhythmias or on antiarrhythmic drugs were excluded. In all cases, PICC tip placement was checked by IC-ECG guidance and by a chest X-ray, which was considered as the reference test., Results: PICC placement with IC-ECG guidance was achieved in 96.8% of patients (applicability). PICC correct placement according to IC-ECG guidance was confirmed by chest X-ray in 94% of patients (accuracy). In 13 patients (2.7%) the catheter had to be repositioned after radiological control. The κ concordance index was 0.356 (p < 0.001). The IC-ECG sensitivity was 0.98, with a PPV of 0.97 and a positive likelihood ratio of 1.5. However, the specificity was only 0.35 with a NPV of 0.41 and a negative likelihood ratio of 0.06., Conclusion: PICC placement by IC-ECG guidance is plausible, safe, presents adequate indexes of validity and reliability, and allows reducing the time of catheter placement. However, radiological verification is still necessary, especially in cases of negative or uncertain ECG.

The appearance of new anti-tuberculosis drugs such as bedaquiline and delamanid makes it impossible not to remember that the first strictly controlled medical trials of tuberculosis treatment were published in two rigorously researched outstanding articles that can be qualified as historical. In 1948, streptomycin was formally studied as an efficacious anti-tuberculosis drug. In 1952, another trial compared streptomycin-paramino salicylic acid with isoniazid, by means of which the first bases of pharmacological tuberculosis treatment were established., (Copyright: © 2018 SecretarÍa de Salud.)

Background: Boccia is a paralympic sport played by athletes with severe neurological impairments affecting all four limbs. Impaired manual dexterity (MD) and intralimb coordination (ILC) may limit individuals' ability to perform certain activities such as grasping, releasing, or manipulating objects, which are essential tasks for daily life or to participate in para sports such as boccia. However, there are currently no specific instruments available to assess hand-arm coordination in boccia players with severe cerebral palsy (CP)., Purpose: To design new sport-specific coordination tests to assess impaired MD and ILC in boccia players; afterward, quantify to what extent their coordination is impaired compared to a control group (CG) without neurological impairments., Methods: Seventy-three recreational boccia players with severe CP (BC1: age = 34.01 ± 16.43 years; BC2: age = 33.97 ± 14.29 years), and 19 healthy adults (age = 27.89 ± 7.08 years) completed the test battery. The Box and Block test (BBT) and Box and Ball test (BBLT) were used to assess MD and four tapping tests to assess upper ILC., Results: Both MD tests were able to discriminate between sport classes. Boccia players obtained better scores in the BBLT in comparison to the BBT, showing that the BBLT had more appropriate testing features. On the other hand, only one of the ILC tests was able to discriminate between sport classes, displaying the highest practical significance ( d  = -1.12). Participants with CP scored significantly worse in all the coordination tests compared to the CG., Conclusion: Using sport-specific equipment facilitated grasp function during the MD assessment. Regarding the ILC, the type of movement (continuous vs. discrete) seems to be more relevant for classification than the movement direction (vertical vs. horizontal) or the presence of a ball.

Background: There is a progressive increase in nontuberculous mycobacteria (NTM) in pulmonary and extrapulmonary infections that might cause confusion with the Mycobacterium tuberculosis complex. To determine the frequency of finding NTM in clinical samples from patients diagnosed with active tuberculosis, with negative acid-alcohol-resistant bacilli (acid-fast bacillus [AFB]) in a third-level specialty hospital's mycobacterial laboratory between January 2013 and December 2014., Methods: This is a prospective, descriptive study where isolated strains of biological material were studied in Lowenstein-Jensen and BACTEC MGIT 960 cultures., Results: Clinical samples of 120 patients were studied, with pulmonary samples of 99/120 (82%) and extrapulmonary samples of 21/120 (18%). We identified NTM in 37/120 samples (30.8%), of which 16 in pulmonary, 13 in genitourinary, 3 in bone marrow, and 5 in various specimens. Mycobacterium avium was isolated in 20 samples, Mycobacterium intracellulare in seven samples, and various other species of NTM in the other 10 samples., Conclusion: To establish adequate treatment, we point out the importance of identifying the presence of NTM in the clinical samples of active tuberculosis patients with negative AFB, as possibly becoming confused with M. tuberculosis and which is essential in deciding which treatment is the most adequate.

Background: Pulmonary mucormycosis is a rare opportunistic infection with high mortality that is caused by species of Mucorales. The most common species involved are Rhizopus, Mucor, Lichtheimia, and Rhizomucor., Case Report: A 56 year-old woman presented with a clinical history of diabetes mellitus type 2 and chronic renal disease. She underwent a cadaveric kidney transplantation two years before her admission, for which immunomodulating therapy with thymoglobulin, tacrolimus, mofetil-microphenolate and prednisone was established. The patient suffered a pneumonic process with cough, expectoration, and dyspnoea. The computed tomography scan showed a cavitation in the right upper lobe. With all these findings an invasive broncopulmonary aspergillosis was suspected and the patient began an antifungal treatment with voriconazole without improvement. Rhizomucor pusillus was isolated from a clinical specimen obtained by fine needle aspiration, and its identification was confirmed by PCR. After this finding amphotericin B was administered, but the patient had an uncontrolled haemoptysis and died., Conclusions: Pulmonary mucormycosis is a rare infection, usually fatal in kidney transplant recipients with anti-rejection therapy. Mucorales species usually produce thrombotic phenomena, associated with necrosis and parenchymal destruction that caused a fatal uncontrolled haemoptysis in our patient. Early diagnosis is important in order to perform any surgical treatment and to administer amphotericin B., (Copyright © 2017 Asociación Española de Micología. Publicado por Elsevier España, S.L.U. All rights reserved.)