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Carod-Artal F.J.,Raigmore Hospital | Carod-Artal F.J.,International University of Catalonia | Wichmann O.,Robert Koch Institute | Farrar J.,National University of Singapore | Gascon J.,University of Barcelona
The Lancet Neurology | Year: 2013

Dengue is the second most common mosquito-borne disease affecting human beings. In 2009, WHO endorsed new guidelines that, for the first time, consider neurological manifestations in the clinical case classification for severe dengue. Dengue can manifest with a wide range of neurological features, which have been noted-depending on the clinical setting-in 0·5-21% of patients with dengue admitted to hospital. Furthermore, dengue was identified in 4-47% of admissions with encephalitis-like illness in endemic areas. Neurological complications can be categorised into dengue encephalopathy (eg, caused by hepatic failure or metabolic disorders), encephalitis (caused by direct virus invasion), neuromuscular complications (eg, Guillain-Barré syndrome or transient muscle dysfunctions), and neuro-ophthalmic involvement. However, overlap of these categories is possible. In endemic countries and after travel to these regions, dengue should be considered in patients presenting with fever and acute neurological manifestations. © 2013 Elsevier Ltd.


Nart J.,International University of Catalonia
The International journal of periodontics & restorative dentistry | Year: 2012

Limited evidence is available regarding the effect of the subepithelial connective tissue graft (SCTG) on root coverage in the mandibular anterior region. A technique is described using an SCTG with a coronally advanced flap (CAF) for the treatment of Miller Class II and III gingival recessions in mandibular central incisors. Fourteen Miller Class II and III recessions were treated in 10 patients using an SCTG with a CAF. After a mean follow-up of 11.7 months, 90.22% ± 12.36% root coverage was achieved. There were no statistically significant differences in root coverage for Miller Class II and III recession defects. Complete root coverage was achieved at five (71.42%) Miller Class II sites compared with three (42.85%) Class III defects. These results suggest that the combination of an SCTG and CAF is an effective technique to obtain root coverage in mandibular incisors with Class II and III recession defects, with excellent patient satisfaction regarding the esthetic appearance of the treated teeth.


Balaguer A.,International University of Catalonia
The Cochrane database of systematic reviews | Year: 2013

A variety of body positions other than the standard supine position have been used in patients undergoing intensive care with hopes of reducing the incidence of pressure ulcers of the skin, contractures or ankylosis and improving the patients' well being. In patients from different age groups undergoing mechanical ventilation (MV) it has been observed that particular positions, such as the prone position, may improve some respiratory parameters. Benefits from these positions have not been clearly defined in critically ill newborns who may require mechanical ventilation for extended periods of time. To assess the effects of different positioning of newborn infants receiving MV on short-term respiratory outcomes and complications of prematurity. Databases searched (up to December 2012) were the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 3), Oxford Database of Perinatal Trials, MEDLINE, CINAHL and EMBASE. Handsearches of proceedings of the Society for Pediatric Research from 1990 to July 2011 were used to identify unpublished studies. Clinicaltrials.gov was searched for any ongoing studies. Randomised or quasi-randomised clinical trials comparing different positions in newborns receiving mechanical ventilation. Three independent and unblinded review authors assessed the trials for inclusion in the review and extracted the data. Data were double-checked and entered into the Review Manager software (RevMan). Risks of bias of the included studies were assessed using methods of randomisation and allocation concealment, completeness of follow-up and blinding of outcome measurements. Twelve trials involving 285 participants were included in this review. One of the included studies (N = 79) was not evaluated in the previous review. Several positions were compared: prone versus supine, prone versus lateral right, lateral right versus supine, lateral left versus supine, lateral alternant versus supine, lateral right versus lateral left, and good lung dependent versus good lung uppermost. Apart from one of the two studies that compared lateral right versus lateral left positions, one comparing lateral alternant versus supine, and one comparing prone versus the supine position, all the included studies had a crossover design. Comparing prone versus supine position, an increase in arterial oxygen tension (PO2) in the prone position of between 2.75 and 9.72 mm Hg (95% confidence interval (CI)) was observed (one trial). When % haemoglobin oxygen saturation was measured with pulse oximetry, the improvement in the prone position was from 1.18% to 4.36% (typical effect based on four trials). In addition, there was a slight improvement in the number of episodes of desaturation. It was not possible to establish whether this effect remained once the intervention was stopped. Negative effects from the interventions were not described, although these were not studied in sufficient detail. Effects of position on other outcomes were barely investigated. Only one study analysed tracheal cultures of neonates after five days of mechanical ventilation, finding lower bacterial colonization in the alternating l ateral position than in those neonates kept in the supine posture. Other effects, either positive or negative, cannot be excluded considering the small numbers of neonates that were studied. The prone position was found to slightly improve the oxygenation in neonates undergoing mechanical ventilation. However, we found no evidence concerning whether particular body positions during the mechanical ventilation of the neonate are effective in producing sustained and clinically relevant improvements.


Carod Artal F.J.,International University of Catalonia
Current Neurology and Neuroscience Reports | Year: 2012

Cerebral schistosomiasis and spinal schistosomiasis are severe underrecognized complications of Schistosoma sp. infection, and can occur at any time during the parasitic infection. Neuroschistosomiasis has been increasingly reported not only in endemic areas but also in Western countries owing to immigration and international travel. Immunogenic interaction between schistosome egg deposition and the delayed hypersensitivity reaction of the host are the main neuropathogenic mechanisms involved. Eggs induce a periovular granulomatous reaction in the tissues. In some cases, schistosome adult worms may aberrantly migrate to the central nervous system via the vertebral venous plexus and place the ova at an ectopic site. Headache and seizures are common in cerebral schistosomiasis, and intracranial hypertension and hydrocephalus may occur in tumour-like and cerebellar schistosomiasis. Spinal schistosomiasis may manifest itself as acute myelitis and/or myeloradiculopathy. Recognition of neuroschistosomiasis is important so that early treatment with praziquantel and steroids can be started in an attempt to prevent severe disability. © Springer Science+Business Media, LLC 2012.


Asensio Acevedo R.,International University of Catalonia
The European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry | Year: 2013

The evolution of restorative dental materials has led to the development of more direct or indirect conservative techniques to solve both functional and esthetic problems in anterior and posterior teeth. Several authors have concluded that indirect restorations are the technique of choice in complex cases where shape and colour are difficult to achieve and function has to be restored. Even though there is no clinical evidence of the appropriateness of indirect composites in these treatments, the latest generation of composites used indirectly in the anterior teeth exhibits some interesting characteristics: it supports mechanical stress adequately, has an excellent esthetic result and can be repaired intraorally.


Valentin-Gudiol M.,International University of Catalonia
Cochrane database of systematic reviews (Online) | Year: 2011

Delayed motor development may occur in children with Down syndrome, cerebral palsy or children born preterm, which in turn may limit the child's opportunities to explore the environment. Neurophysiologic and early intervention literature suggests that task-specific training facilitates motor development. Treadmill intervention is a good example of locomotor task-specific training. To assess the effectiveness of treadmill intervention on locomotor motor development in pre-ambulatory infants and children under six years of age who are at risk for neuromotor delay. In March 2011 we searched CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE (1948 to March Week 2, 2011), EMBASE (1980 to Week 11, 2011), PsycINFO (1887 to current), CINAHL (1937 to current), Science Citation Index (1970 to 19 March 2011), PEDro (until 7 March 2011), CPCI-S (1990 to 19 March 2011) and LILACS (until March 2011). We also searched ICTRP, ClinicalTrials.gov, mRCT and CenterWatch. We included randomised controlled trials, quasi-randomised controlled trials and controlled clinical trials that evaluated the effect of treadmill intervention in children up to six years of age with delays in gait development or the attainment of independent walking or who were at risk of neuromotor delay. Four authors independently extracted the data using standardised forms. Outcome parameters were structured according to the "Body functions" and "Activity and Participation" components of the International Classification of Functioning, Disability and Health, Children & Youth version (ICFCY), which was developed by the World Health Organization. We included five studies, which reported on treadmill intervention in 139 children. Of the 139 children, 73 were allocated to treadmill intervention groups, with the other children serving as controls. The studies varied in the type of population studied (children with Down syndrome, cerebral palsy or who were at risk for neuromotor delay); the type of comparison (for example, treadmill versus no intervention, high intensity treadmill versus low intensity); the time of evaluation (during the intervention or at various intervals after intervention), and the parameters assessed. Due to the diversity of the studies, we were only able to use data from three studies in meta-analyses and these were limited to two outcomes: age of onset of independent walking and gross motor function.Evidence suggested that treadmill intervention could lead to earlier onset of independent walking when compared to no treadmill intervention (two studies; effect estimate -1.47; 95% confidence interval (CI): -2.97, 0.03), though these trials studied two different populations and children with Down syndrome seemed to benefit while it was not clear if this was the case for children at high risk of neuromotor disabilities. Another two studies, both in children with Down syndrome, compared different types of treadmill intervention: one compared treadmill intervention with and without orthotics, while the other compared high versus low intensity treadmill intervention. Both were inconclusive regarding the impact of these different protocols on the age at which children started to walk.There is insufficient evidence to determine whether treadmill intervention improves gross motor function (two studies; effect estimate 0.88; 95% CI: -4.54, 6.30). In the one study evaluating treadmill with and without orthotics, results suggested that adding orthotics might hinder gross motor progress (effect estimate -8.40; 95% CI: -14.55, -2.25).


Cano-Batalla J.,International University of Catalonia
The International journal of oral & maxillofacial implants | Year: 2012

This study evaluated the effects of abutment height, airborne-particle abrasion, and type of cement on the tensile resistance to dislodgement of cement-retained implant restorations. Three groups of 12 standardized abutments each were prepared with different heights (4 mm, 5 mm, and 6 mm) using a milling machine. Crowns were cast in cobalt-chrome using the lost-wax technique, airborne particle-abraded using 50-Μm aluminum oxide, and cleaned with acetone. Restorations were cemented using a noneugenol acrylic urethane cement, a resin-modified glass ionomer, or a zinc oxide-noneugenol cement. A 5-kg load was applied for 10 minutes. Samples were kept at 37°C and 100% humidity overnight. A tensile force was applied to the crown using a testing machine at a crosshead speed of 5 mm/minute until failure occurred. Next, the abutments were airborne particle-abraded with 50-Μm aluminum oxide, and the cementation and testing procedures were repeated. The effects of cement, abutment height, and surface treatment were evaluated statistically. There were significant differences among the cements. The resin-modified glass ionomer provided the greatest retention in all the tested conditions, while the zinc oxide-noneugenol cement produced the lowest retention values. Significant differences were also detected between 4-mm and 6-mm abutments, with the 6-mm abutments being more retentive. No differences were found between 4-mm and 5-mm abutments or between 5-mm and 6-mm abutments. The effect of airborne-particle abrasion was also found to be significant. A maximum increase of 90 N in retention force was observed after airborne-particle abrasion for the 5-mm abutments cemented with the acrylic urethane cement. Cement, airborne-particle abrasion, and abutment height can significantly influence retention of implant-supported crowns. Different parameters, including those specific to the patient, should be considered in the selection of a luting agent.


Carod-Artal F.J.,Raigmore Hospital | Carod-Artal F.J.,International University of Catalonia
Expert Review of Anti-Infective Therapy | Year: 2015

As the current Zaire ebolavirus disease outbreak in West Africa fades, the health problems of the more than 16,500 survivors have come to light. A wide range of mental and physical symptoms may occur during the convalescence stage. Reported symptoms of "post-Ebolavirus disease syndrome" (PEVDS) include chronic joint and muscle pain, fatigue, anorexia, hearing loss, blurred vision, headache, sleep disturbances, low mood and short-term memory problems. PEVDS has been associated with a decrease in functionality and difficulties to return to work. Further studies are needed to fully categorize the clinical spectrum of PEVDS. Diagnostic criteria and surrogate markers for the early diagnosis of PEVDS, and implementation of specialized health services to treat and follow-up survivors are also needed. © 2015 © Informa UK, Ltd.


Carod-Artal F.J.,International University of Catalonia
Handbook of Clinical Neurology | Year: 2013

American trypanosomiasis is a parasitic disease caused by the flagellate protozoan Trypanosoma cruzi. Chagas disease is endemic in Latin America, where an estimated 10-14 million people are infected, and an emerging disease in Europe and the USA. Trypanosoma cruzi is transmitted by blood-sucking bugs of the family Reduviidae. Rhodnius prolixus, Panstrongylus megistus, Triatoma infestans, and T. dimidiata are the main vectors in the sylvatic cycle. Non vector-borne transmission includes blood transfusion, congenital and oral transmission, transplantation, and accidental infections. Most cases of acute infection occur in childhood and are usually asymptomatic, although severe myocarditis and meningoencephalitis may occur. Approximately 30% of T. cruzi-infected people will develop the chronic stage of the disease. Chronic chagasic cardiomyopathy is characterized by progressive heart failure, arrhythmias, intraventricular conduction defects, sudden death, and peripheral thromboembolism. Acute exacerbation can occur in individuals with involvement of cellular immunity such as advanced AIDS (acquired immunodeficiency syndrome), and transplant-associated immunosuppression. Neurological involvement may present with encephalitis, meningoencephalitis, or a space-occupying cerebral lesion called chagoma. Chagas disease is a major cause of ischemic stroke in Latin America. Several epidemiological studies have found an association between T. cruzi infection and cardioembolic ischemic stroke. Benznidazole and nifurtimox are the two available trypanocide drugs against T. cruzi. © 2013 Elsevier B.V.


Balaguer A.,International University of Catalonia
Cochrane database of systematic reviews (Online) | Year: 2012

Recurrent endobronchial infection in cystic fibrosis requires treatment with intravenous antibiotics for several weeks usually in hospital, affecting health costs and quality of life for patients and their families. To determine whether home intravenous antibiotic therapy in cystic fibrosis is as effective as inpatient intravenous antibiotic therapy and if it is preferred by individuals or families or both. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Most recent search of the Group's Trials Register: 01 September 2011. Randomized and quasi-randomized controlled studies of intravenous antibiotic treatment for adults and children with cystic fibrosis at home compared to in hospital. The authors independently selected studies for inclusion in the review, assessed methodological quality of each study and extracted data using a standardised form. Eighteen studies were identified by the searches. Only one study could be included which reported results from 17 participants aged 10 to 41 years with an infective exacerbation of Pseudomonas aeruginosa. All their 31 admissions (18 hospital and 13 at home after two to four days of hospital treatment) were analysed as independent events. Outcomes were measured at 0, 10 and 21 days after initiation of treatment. Home participants underwent fewer investigations than hospital participants (P < 0.002) and general activity was higher in the home group. No significant differences were found for clinical outcomes, adverse events, complications or change of intravenous lines,or time to next admission. Home participants received less low-dose home maintenance antibiotic.Quality of life measures showed no significant differences for dyspnoea and emotional state, but fatigue and mastery were worse for home participants, possibly due to a higher general activity and need of support. Personal, family, sleeping and eating disruptions were less important for home than hospital admissions.Home therapy was cheaper for families and the hospital. Indirect costs were not determined. Current evidence is restricted to a single randomized clinical trial. It suggests that, in the short term, home therapy does not harm individuals, entails fewer investigations, reduces social disruptions and can be cost-effective. There were both advantages and disadvantages in terms of quality of life. The decision to attempt home treatment should be based on the individual situation and appropriate local resources. More research is urgently required.

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