Perception of the safety culture in a critical area.

INTRODUCTION: Critical care Area (CCA) is one of the most complex in the hospital system, requiring a high number of interventions and handling of amounts of information. Therefore, these areas are likely to experience more incidents that compromise patient safety (PS). AIM: To determine the perception of the healthcare team in a critical care area about the patient safety culture. METHOD: Cross-sectional descriptive study, September 2021, in a polyvalent CCA with 45 beds, 118 health workers (physicians, nurses, auxiliary nursing care technicians). Sociodemographic variables, knowledge of the person in charge in PS and their general training in PS and incident notification system were collected. The validated Hospital Survey on Patient Safety Culture questionnaire, measuring 12 dimensions was used. Positive responses with an average score ≥75%, were defined as an area of strength while ≥50% negative responses were defined as an area of weakness. Descriptive statistics and bivariate analysis: X2 and t-Student tests, and ANOVA. Significance p ≤ 0.05. RESULTS: 94 questionnaires were collected (79.7% sample). The PS score was 7.1 (1.2) range 1-10. The rotational staff scored the PS with 6.9 (1.2) compared to 7.8 (0.9) for non-rotational staff (p = 0.04). A 54.3% (n = 51) was familiar with the incident reporting procedure, 53% (n = 27) of which had not reported any in the last year. No dimension was defined as strength. There were three dimensions that behaved like a weakness: security perception: 57.7% (95% CI: 52.7-62.6), staffing: 81.7% (95% CI: 77.4-85.2) and management support: 69 .9% (95% CI: 64.3-74.9). CONCLUSIONS: The assessment of PS in the CCA is moderately high, although the rotational staff has a lower appreciation. Half of the staff do not know the procedure for reporting an incident. The notification rate is low. The weaknesses detected are perception of security, staffing and management support. The analysis of the patient safety culture can be useful to implement improvement measures.

Quartz crystal Microbalance with dissipation monitoring for biomedical applications: Open source and low cost prototype with active temperature control.

Advances in sensors have revolutionized the biomedical engineering field, having an extreme affinity for specific analytes also providing an effective, real-time, point-of-care testing for an accurate diagnosis. Quartz Crystal Microbalance (QCM) is a well-established sensor that has been successfully applied in a broad range of applications to monitor and explore various surface interactions, in situ thin-film formations, and layer properties. This technology has gained interest in biomedical applications since novel QCM systems are able to work in liquid media. QCM with dissipation monitoring (QCM-D) is an expanded version of a QCM that measures changes in damping properties of adsorbed layers thus providing information on its viscoelastic nature. In this article, an open source and low cost QCM-D prototype for biomedical applications was developed. In addition, the system was validated using different Polyethylene Glycol (PEG) concentrations due to its importance for many medical applications. The statistics show a bigger dissipation of the system as the fluid becomes more viscous, also having a very acceptable sensibility when temperature is controlled.

New Epidemiological Outcomes in Anthropophilic tinea capitis, a Case Series Study in Northwestern Spain.

Although zoophilic dermatophytes remain the predominant cause of tinea capitis in Spain, an increase due to anthropophilic species has been reported. We report a retrospective observational study that included twenty-four children, who were diagnosed with tinea capitis due to anthropophilic species between 2004 and 2019. 75% of the patients were males with a mean age of 4,88 years. We observed 83,3% of cases from Africa, 4,2% from South America and 12,5% from Spain. Clinically, 70,8% of the patients presented scaly patches and non-scaring alopecia. Trichophyton soudanense was the main dermatophyte of the series (45,8%), followed by Microsporum audouinii (20,8%), Trichophyton tonsurans (12,5%) and Trichophyton violaceum (12,5%). Although this pattern of infection appears to be linked to immigration from Africa, we saw three native cases. The easier transmission of anthropophilic rather than zoophilic dermatophytes could predict a rise in the incidence of tinea capitis and a public health problem.

New Epidemiological Outcomes in Anthropophilic tinea capitis, a Case Series Study in Northwestern Spain. / [Artículo traducido] Nuevos hallazgos epidemiológicos en la tinea capitis antropófila, un estudio de una serie de casos en el noroeste de España.

Although zoophilic dermatophytes remain the predominant cause of tinea capitis in Spain, an increase due to anthropophilic species has been reported. We report a retrospective observational study that included 24 children, who were diagnosed with tinea capitis due to anthropophilic species between 2004 and 2019. 75% of the patients were males with a mean age of 4,88 years. We observed 83,3% of cases from Africa, 4,2% from South America and 12,5% from Spain. Clinically, 70,8% of the patients presented scaly patches and non-scaring alopecia. Trichophyton soudanense was the main dermatophyte of the series (45,8%), followed by Microsporum audouinii (20,8%), Trichophyton tonsurans (12,5%) and Trichophyton violaceum (12,5%). Although this pattern of infection appears to be linked to immigration from Africa, we saw three native cases. The easier transmission of anthropophilic rather than zoophilic dermatophytes could predict a rise in the incidence of tinea capitis and a public health problem.

Perfil del estilo de vida y actividad inflamatoria en personas con artritis reumatoide / Lifestyle and inflammation profiles among persons with rheumatoid arthritis / Perfil do estilo de vida e atividade inflamatória em pessoas com artrite

Resumen Introducción: La artritis reumatoide es una enfermedad autoinmune, crónica, degenerativa. Su control está relacionado con la medicación y los factores ambientales, especialmente los estilos de vida, que son potencialmente modificables. Objetivo: Determinar el perfil del estilo de vida de las personas con artritis reumatoide y su relación con el grado de actividad de la enfermedad. Metodología: Estudio descriptivo, transversal y correlacional en adultos con artritis reumatoide. Con previo consentimiento informado, se aplicó clinimetría basada en el nivel de actividad de la enfermedad (DAS28) y el Perfil de Estilos de Vida (PEPS-II) de Nola J. Pender. Para el análisis se recurrió a la estadística descriptiva, correlación de Spearman. Se utilizó el paquete estadístico SPSS versión 22. Resultados: Se valoraron 110 personas, el promedio global del estilo de vida se ubica en un perfil saludable, la dimensión actividad física se clasificó como la más afectada (85.5%). No se encontró correlación entre la actividad de la enfermedad y estilo de vida. Discusión: Existen pocos estudios análogos, los resultados primordiales de estos coinciden con los encontrados. Se hace evidente la necesidad de seguir trabajando en los estilos de vida para lograr disminuir la presencia de actividad inflamatoria en las personas con artritis reumatoide. Conclusiones: No existe una correlación entre las dos variables, es decir, a medida que el perfil de estilo de vida es saludable, la actividad inflamatoria de la enfermedad está activa.

Abstract Introduction: Rheumatoid arthritis is a chronic-degenerative autoimmune illness whose control depends on medications and environmental factors, in particular the lifestyles. Objective: To determine the profiles of lifestyles among persons suffering from rheumatoid arthritis and their related illness severity. Methodology: This is a descriptive, transversal, and correlational study on adults with rheumatoid arthritis. After obtaining their corresponding informed consents, the Disease Activity Score of 28 joints test, and Nola J. Pender's Lifestyles Profile Questionnaire were given. SPSS version 22 was used to determine descriptive statistics with Spearman correlations. Results: 110 individuals were assessed, the global average of lifestyle scores was suggesting a healthy general profile, physical activity was found to be the most affected (85.5%). No correlation between the illness activity and the lifestyle was found. Discussion: There are few analogous studies and their results have been diverse. Therefore, it is important to continue analyzing the characteristics of lifestyles that can help reduce rheumatoid arthritis related inflammation in these patients. Conclusions: No correlation was found between the two studied variables; therefore, a lifestyle change does not necessarily imply a reduction in the level of inflammation.

Resumo Introdução: A artrite reumatoide é uma doença autoimune, crônica, degenerativa. Seu controle está relacionado com a medicação e os fatores ambientais, especialmente os estilos de vida, que são potencialmente modificáveis. Objetivo: Determinar o perfil do estilo de vida das pessoas com artrite reumatoide e sua relação com o grau de atividade da doença. Metodologia: Estudo descritivo, transversal e correlacional em adultos com artrite reumatoide. Com prévio consentimento informado, aplicou-se Clinimetria baseada no nível de atividade da doença (DAS28) e o Perfil de Estilos de Vida (PEPS-II) de Nola J. Pender. Para a análise recorreu-se à estatística descritiva, correlação de Spearman. Utilizou-se o pacote estatístico SPSS versão 22. Resultados: Foram avaliadas 110 pessoas, a média global do estilo de vida localizou-o em um perfil saudável, a dimensão atividade física classificou-se como a mais afetada (85.5%). Não se encontrou correlação entre a atividade da doença e o estilo de vida. Discussão: Existem poucos estudos análogos, os resultados primordiais destes coincidem com os encontrados. Fica evidente a necessidade de seguir trabalhando nos estilos de vida para atingir diminuir a presença de atividade inflamatória nas pessoas com artrite reumatoide. Conclusões: Não existe uma correlação entre as duas variáveis, quer dizer, à medida que o perfil de estilo de vida for saudável, a atividade inflamatória da doença estará ativa.

Visit of minors in an intensive care unit. What is the opinion of health staff? / Visita de los menores de edad en una unidad de cuidados intensivos. ¿Qué opina el personal sanitario?

AIM: To determine the opinion of healthcare staff (HS) on the presence of minors in an adult intensive care unit. METHOD: Transversal descriptive research study in an adult intensive care unit with 62 people, between September/December 2017. The Knutsson questionnaire was used with 10 closed questions with space for comments, and 2 open questions. Selection of the respondents was by means of convenience sampling. Descriptive statistics with absolute frequencies and percentages. Chi-squared-test or Fisher. Significance p<.05. RESULTS: 61 questionnaires were collected: 70.5% nursing staff (NS). Fifty percent of medical staff (MS) would restrict the entry of 0 to 6-year old minors versus 76.2% NS (p=.04). Of the MS, 16.7% would restrict the visits of minors between the ages of 7 and 12 versus 46.5% NS (p=.02). Seventy-five percent of HS thought that minors' access could entail a risk of infection for the children. Of the survey respondents, 60% believed that the environment could intimidate the minor, and 66.7% thought that the patient's condition could affect the child. They would permit 0-6-year-old minors to access the ICU if the patient was dying (70.6% MS/41% NS, p=.04), awake and alert (77.8% MS/57.5% NE) and close relatives (parents) (66.7% MS/60% NS). CONCLUSIONS: HS support minors visiting an adult adult intensive care unit if they are>6 years old. HS show a more positive attitude towards visits in special circumstances such as close relatives, awake patient, and death regardless of their age. The reasons for restriction of visits are: environment, patient's condition and risk of infection. NS show a less positive attitude in relation to visits.

Nivel de dependencia, autocuidado y calidad de vida del adulto mayor / Level of dependency, self-care, and quality of life in the elder adult / Nível de dependência, autocuidado e qualidade de vida do idoso

Introducción: El envejecimiento es un proceso natural. La calidad e independencia con que se vive esta etapa depende no solo de la estructura genética de los seres humanos, sino también de lo que se realiza durante el curso de vida. Objetivo: Establecer la relación entre calidad de vida del adulto mayor y su nivel de dependencia y autocuidado. Métodos: Estudio transversal, descriptivo y correlacional. Fueron entrevistados 116 adultos mayores que acudieron a consulta en una unidad de salud. Las variables estudiadas fueron: dependencia, autocuidado y calidad de vida. Se utilizaron la Escala de Barthel, la Escala de capacidades de autocuidado y el Cuestionario SF-36 de calidad de vida. Se realizó un análisis descriptivo de las variables y correlación de Pearson y Spearman. El presente proyecto fue revisado y aprobado por un Comité de Investigación. Resultados: El 54.3% de los participantes fueron mujeres. El 80.2% de los adultos mayores encuestados presentaron independencia para realizar las actividades de la vida diaria y el 19.8% presentaron dependencia leve. En la calificación global de las actividades de autocuidado el 22.4% tuvieron buena capacidad y el 76.6%, muy buena capacidad. En la percepción de calidad de vida en la dimensión física, el 24% de los entrevistados consideran que su salud es buena y el 56%, regular. En las pruebas de correlación se encontró mínima relación entre las variables de autocuidado y dependencia; escasa entre autocuidado y grado de escolaridad; correlación positiva entre la dependencia y la calidad de vida, así como la calidad de vida y la edad, aunque el valor de todas las correlaciones fue bajo.

Introduction: Getting old is a natural process. The quality of life and independency lived during this stage depend not only on the genetic structure, but also on what is done throughout the entire life. Objective: To explore the relationship among the levels of quality of life, dependency, and self-care in the elder adult. Methods: This is a transversal, descriptive, and correlational study. One hundred and sixteen elder adults who attended consultation visits at a health unit were interviewed. The variables studied were: dependency, self-care, and quality of life. The Barthel scale, the Self-Care Capacities Scale, and the SF-36 Quality of Life Questionnaire were used. The Pearson and Spearman correlations were calculated. This project was reviewed and approved by a Research Committee. Results: Fifty four point three percent of the participants were female. The 80.2% of the elder adults interviewed showed independence to perform their daily life activities, while the rest (19.8%) showed a mild level of dependency. In relation to the self-care activities, 22.4% showed a good capacity, while 76.6% showed a very good capacity. In relation to their perception of quality of life, in the physical dimension, 24% of the participants considered their health as good, while 56% consider it as more or less good. In the correlation tests, a minimal relationship was found between the variables of self-care and dependency, also, a low relationship was found between the self-care and the school levels. A positive correlation was found between dependency and quality of life, and also between quality of life and age, though their values were low.

Introdução: O envelhecimento é um processo natural. A qualidade e independência com que se vive esta etapa depende não só da estrutura genética dos seres humanos, senão também do que se realiza durante o curso de vida. Objetivo: Estabelecer a relação entre a qualidade de vida do idoso e o seu nível de dependência e autocuidado. Métodos: Estudo transversal, descritivo e de correlação. Foram entrevistados 116 idosos que acudiram a consulta em uma unidade de saúde. As variáveis estudadas foram: dependência, autocuidado e qualidade de vida. Utilizou-se a escala de Barthel, Escala de capacidades de autocuidado e Questionário SF-36 de qualidade de vida. Realizou-se uma análise descritiva das variáveis e correlação de Pearson e Spearman. O presente projeto foi revisado e aprovado por um Comité de Pesquisa. Resultados: 54.3% dos participantes era mulher. O 80.2% dos idosos respondentes apresentou independência para realizar as atividades da vida diária e o 19.8% apresentou dependência leve. Na qualificação global das atividades de autocuidado, 22.4% teve boa capacidade e 76.6% muito boa capacidade. Na percepção de qualidade de vida na dimensão física, 24% dos entrevistados considera que sua saúde é boa e o 56% regular. Nas provas de correlação encontrou-se mínima relação entre as variáveis de autocuidado e dependência, escassa entre autocuidado e grau de escolaridade, correlação positiva entre a dependência e a qualidade de vida, bem como a qualidade de vida e a idade, ainda assim, o valor de todas as correlações foi baixo.

Infliximab drug and antibody levels in patients with dermatological conditions.

BACKGROUND: In recent years, studies monitoring infliximab in rheumatoid arthritis and inflammatory bowel disease have confirmed the relationship between the clinical response and the infliximab and anti-infliximab antibodies serum levels. However, there is only limited evidence in the field of dermatology. OBJECTIVE: The aim of this study was to establish the correlation between plasma infliximab levels, the presence of anti-infliximab antibodies and the clinical response in dermatological conditions. SETTING: Retrospective observational study in a tertiary hospital (University Hospital of La Coruña, Spain). METHOD: Patients with dermatological conditions being treated with infliximab (5 mg/kg/8 weeks after the induction dose) were included in the study. The concentrations of infliximab and anti-infliximab antibodies were quantified by two sandwich-type ELISA immunoassays. The patients were classified into three groups based on the efficacy: good, partial or non-efficacy at the time of each blood assessment. The development of adverse reactions was also evaluated. MAIN OUTCOME MEASURES: Plasma levels of infliximab and anti-infliximab antibodies, clinical response and infusion reactions. RESULTS: 17 patients (45 assessments) were included. The good/partial efficacy rate was significantly higher in the case of >0.05 than <0.05 µg/mL infliximab concentration (93.3 vs. 40.0 %, p < 0.001). Anti-infliximab antibodies were only detected in five samples. Their presence was associated with a higher frequency of infusion reactions and a lower efficacy rate in comparison with the group without antiinfliximab antibodies (100.0 vs. 0.0 %, p < 0.001 and 0.0 vs. 85.0 %, p < 0.001 respectively). CONCLUSIONS: The results obtained show that the presence of infliximab concentrations higher than 0.05 µg/mL are correlated with a good clinical response and the absence of toxicity. The incidence of anti-infliximab antibodies is low, although a correlation was observed between the presence of antibodies, absence of infliximab concentration, loss of clinical response and the development of infusion reactions.

Obesity and psoriasis: inflammatory nature of obesity, relationship between psoriasis and obesity, and therapeutic implications.

Obesity, particularly abdominal obesity, is currently considered a chronic low-grade inflammatory condition that plays an active role in the development of the pathophysiologic phenomena responsible for metabolic syndrome and cardiovascular disease through the secretion of proinflammatory adipokines and cytokines. In recent years clear genetic, pathogenic, and epidemiologic links have been established between psoriasis and obesity, with important implications for health. The relationship between the 2 conditions is probably bidirectional, with obesity predisposing to psoriasis and psoriasis favoring obesity. Obesity also has important implications in the treatment of psoriasis, such as a greater risk of adverse effects with conventional systemic drugs and reduced efficacy and/or increased cost with biologic agents, for which dosage should be adjusted to the patient's weight.

Experiencias y conocimientos de los estudiantes de enfermería, ante la muerte del paciente hospitalizado / Nursing students' knowledge and experiences on death of hospitalized patients

Objetivo: Identificar conocimientos y experiencias de estudiantes de Licenciatura en Enfermería, sobre la muerte de pacientes hospitalizados. Métodos: Estudio transversal, descriptivo, exploratorio, en el que participaron 188 alumnos de 500, pertenecientes a 4°, 6° y 8° semestre (quienes tienen experiencia clínica). Se consideraron tanto hombres como mujeres, sin distinción de edad o experiencia previa ante la muerte. Se diseñó un instrumento ex profeso para el levantamiento de datos, el cual fue validado por expertos mediante técnica Delphi. El proyecto fue avalado por un Comité de Investigación y Bioética. Los resultados se procesaron en SPSS v. 17. Resultados: El 85% de los alumnos ha experimentado un proceso de muerte de un familiar o amigo, y el 75% de un paciente (en la práctica hospitalaria). El 46% no se consideran preparados para vivir esta experiencia. El 37.7% considera que el personal de las instituciones no está preparado para "manejar" la muerte de los pacientes. Hay opiniones divididas sobre el temor hacia este fenómeno. Los alumnos comprenden qué es la tanatología y qué es el duelo, aunque no se sienten competentes en el tema. Conclusiones: Es importante sensibilizar al futuro profesional de enfermería en competencias que permitan dar un trato digno al paciente, esto fundamentado en sólidos conocimientos en tanatología.

Objective: To identify knowledge and experiences of baccalaureate nursing students about death of hospitalized patients. Methods: Basic, descriptive, and exploratory study on 188 students of 4th, 6th, and 8th semester with clinical practices. Both men and women, regardless of age and previous experience with death, were considered. A Delphi technique expert validated specific instrument was designed. The project was approved by the Research and Bioethics Committee. Results were processed in SPSS v. 17. Results: The 85% of students have experienced the death of a relative or a friend, and 75% of a patient (at the hospital practice), while 46% do not consider themselves prepared to live this experience, and 37.7% consider that the institution staff are not prepared to "handle" the death of patients. There are divided opinions about the fear to this process. Although students understand tanatology and duel, they do not feel competent in the topic. Conclusions: It is important to sensitize the future nursing professional in skills which allow them offer the corresponding appropriate patient treatment.

Posttherapeutic cure criteria in Chagas' disease: conventional serology followed by supplementary serological, parasitological, and molecular tests.

We performed a critical study of conventional serology, followed by supplementary serological, parasitological, and molecular tests, to assess the response to etiologic treatment of Chagas' disease. A group of 94 Chagas' disease patients treated with benznidazole at least 10 years earlier were evaluated from the laboratory and clinical points of view. When conventional serology (enzyme-linked immunosorbent assay [ELISA], indirect immunofluorescence [IIF], and indirect hemagglutination [IHA]) and classic criteria (consistent results with any two of the three tests) or more rigorous criteria (consistent results from the three tests) were used, 10.6% and 8.5% of patients were considered treated and cured (TC) by classic and rigorous criteria, respectively. Patients were then evaluated using supplementary (recombinant ELISA and Trypanosoma cruzi excreted-secreted antigen blotting [TESA-blot]), parasitological (hemoculture), and molecular (PCR) tests. The results of recombinant ELISA were similar to those with the rigorous criterion (three consistent test results). The TESA-blot group showed a higher percentage (21.3%) of negative results than the groups defined by either cure criterion. Hemoculture and PCR gave negative results for all treated and cured (TC) patients, regardless of the criterion used. Recombinant ELISA and TESA-blot tests showed negative results for 70% and 87.5% of the patients categorized as TC by the classic and three-test criteria, respectively. For patients with discordant conventional serology, the supplementary serological and molecular tests were the decisive factor in determining therapeutic failure. Clinical evaluation showed that 62.5% of TC patients presented with the indeterminate form of the disease. Additionally, treated patients with negative TESA-blot results should be reevaluated later with all methodologies used here to verify whether TESA-blot is a reliable way to determine early parasitological cure of Chagas' disease.

Psoriasis in patients older than 65 years. A comparative study with younger adult psoriatic patients.

OBJECTIVES: To examine the clinical characteristics of psoriasis, prevalence of comorbidities and quality of life in psoriasis patients older than 65 years and to compare them with younger adult psoriatic patients. DESIGN: Prospective observational study of prevalence. SETTING AND PARTICIPANTS: Patients older than 18 years with diagnosis of psoriasis attended at the Dermatology Department of the University Hospital of A Coruña (Galicia, Spain). A total of 371 patients were included (218 males and 153 females) with ages ranging from 18 to 85 years, of whom 70 were older than 65 years. MEASUREMENTS: Demographic data, clinical characteristics and psoriasis treatment, history of hypertension, diabetes mellitus, smoking and alcohol consumption and quality of life impairment were registered. Body mass index, waist-hip ratio, left ventricular hypertrophy, average value of systolic and diastolic blood pressure, cholesterol, triglycerides and glucose blood levels were also measured. RESULTS: Patients older than 65 years have statistically significant higher prevalence of hypertension, left ventricular hypertrophy, waist-hip ratio, diabetes mellitus and raised blood glucose levels. There was also association between clinical severity of psoriasis and smoking and alcohol intake as well as between quality of life and type of psoriasis treatment. CONCLUSIONS: Psoriasis in patients older than 65 years represents a significant proportion of cases and its prevalence is expected to increase. Because these patients are more prone to suffer comorbidities and to develop adverse effects due to psoriasis treatment, attention to pharmacologic interactions and correction of cardiovascular risk factors and toxic habits should be especially taken in mind in this age group.

LC-ESI-MSD fast determination of residual mitomycin C in hen aqueous humour after corneal refractive surgery.

A simple, fast and reliable method has been developed for the assay of traces of mitomycin C (MMC) in hen aqueous humour samples. The determination was carried out by high-performance liquid chromatography with electrospray ionization mass spectrometric detection. In isocratic elution analysis, the mobile phase was a mixture of water-acetonitrile (78:22, v/v) and the chromatographic column was C(18) at 35 degrees C. The method has been validated over a range from 0.1 to 250 microg L(-1) in hen aqueous humour with correlation coefficients higher than 0.999. Limit of detection and limit of quantification for MMC based in signal to noise ratio of 3 and 10, respectively, were 20 and 71 ng L(-1). The developed method allows the analysis of MMC in hen aqueous humour samples obtained at different times and conditions in order to evaluate and compare the efficacy of the drug administration.

[Corneal biomechanics]. / Biomecánica de la córnea.

OBJECTIVE: To review the corneal biomechanic concepts and to analyse, clarify and understand their relevance in refractive surgery. MATERIALS AND METHODS: A literature review has been done using different databases. RESULTS: Corneal biomechanic concepts are not new and are applied implicitly in numerous surgical procedures. Their origin is related to tonometry studies, but they gained in popularity when they were linked to the treatment of keratoconus, a pathology in which the mechanical properties of the cornea are altered. Factors determining corneal stability were thus defined. Corneal biomechanics have also been used following refractive surgery to study post-operative keratectasia and to improve ablation patterns, which ignores the corneal response. The new ablation systems need to include the biomechanical factors, which motivate research conducted in physical-mathematical models and in corneal wound healing, improving our knowledge about the corneal biomechanical response. CONCLUSIONS: The corneal biomechanic concepts have gained in popularity with the advent of refractive surgery, although they did exist previously. Their relevance is linked to improvements in the ablation systems used in an attempt to obtain more accurate and reliable results.

Previous cognitive impairment and failure to thrive syndrome in patients who died in a geriatric convalescence hospitalization unit.

Cognitive impairment and depression are commonly associated with poor outcomes in geriatric patients. Both are part of the "failure to thrive syndrome" (FTS), that is a combined group of symptoms as a result from progressive functional, mental and nutritional impairment status in older patients. This paper was aimed at evaluating the presence of FTS in the patients who died in a geriatric convalescence unit (GCU) (intermediate care facility) and comparing the characteristics of patients with primary FTS (not associated with an evident identifiable disease) and secondary FTS (associated with an evident identifiable disease). Finally, we wanted to analyze if the presence of cognitive impairment before admission was associated with the type of FTS. We analyzed 78 patients retrospectively. The presence of the next three conditions was necessary to define the FTS: (i) Impaired functional status and malnutrition. (ii) Cognitive impairment and/or depression. (iii) Absence of improvement, after a specific geriatric intervention program during the hospitalization. Functional status for basic and instrumental activities of daily living (ADL and IADL) and the presence of symptoms cognitive impairment before admission were evaluated. Of the 78 analyzed patients, there were 30 (38.4%) with symptoms of FTS. Seventeen of them (56.6%) had a secondary FTS and 13 (43.3%) a primary one. This last group of patients had a significantly higher mean age (84.7 +/- 5.8 vs. 78.6 +/- 7.2; p < 0.02) and before admission they were significantly more dependent for ADL: 10 patients (76.9%) vs. 7 (41.0%) chi2 = 3.833, p < 0.05. A higher proportion of subjects with cognitive impairment before admission was found in the group of patients with primary FTS, than in those secondary FTS, although this difference did not reach statistical significance. Patients with primary FTS seem to be older and more dependent for ADL before admission, than those with secondary FTS.

Clinical impact of different scores of the mini nutritional assessment (MNA) in the diagnosis of malnutrition in patients with cognitive impairment.

It was aimed at evaluating the clinical usefulness of the mini nutritional assessment (MNA) to identify malnutrition in elderly patients with cognitive impairment, admitted to a geriatric convalescence unit (intermediate care facility). Sixty-three patients with cognitive impairment were studied. Cognitive impairment was considered when mini mental state examination (MMSE) scores were below 21. MNA and a nutritional evaluation according to the sequential model of the American Institute of Nutrition (AIN) were performed at admission. According to the AIN criteria, malnutrition was considered, if there were abnormalities in at least one of the following parameters: albumin, cholesterol, body mass index (BMI), and branchial circumference. Based on these criteria, 27 patients (42.8%) proved to be undernourished at admission, whereas if taking the original MNA scores, 39 patients (61.9%) were undernourished, 23 (36.5%) were at risk of malnutrition, and 1 (1.5%) was normal. The analyzed population was divided in four categories (quartiles) of the MNA scores: very low ( 13.5 and 16 and 18.5). Likelihood ratios of each MNA quartile were obtained by dividing the percentage of patients in a given MNA category who were undernourished (according to AIN) by the percentage of patients in the same MNA category who were not undernourished. In the very low MNA quartile, this likelihood ratio was 2.79 and for the low MNA quartile it was 0.49. For intermediate and high MNA categories, likelihood ratios were 1.0 and 0.07 respectively. In the present study, MNA identified undernourished patients with a high clinical diagnostic impact value only, when very low scores (

Validation of a modified version of the Gijon's social-familial evaluation scale (SFES): the "Barcelona SFES Version", for patients with cognitive impairment.

The aim was to validate an abbreviated version of the Gijon's social-familial evaluation scale (SFES) (Barcelona-SFES version), on patients with cognitive impairment. A group of 34 patients with cognitive impairment, admitted to an intermediate-long-term-care facility, were analyzed. Mean age was 80.2 +/- 7.4 years. Gijón's SFES was abbreviated and only the first three item groups corresponding to family conditions, social contacts and assistance from the social network were selected. Barcelona-SFES version had a range score between 3 to 15 points, in which low scores identify older patients who live with their family, have good contacts, and participate in community activities. In contrast, high scores identify older persons who live alone and have poor social support and little participation with community activities. Three social risk categories were established according to the Barcelona-SFES score: low social risk (>/= 7 points), intermediate social risk (8-9 points) and high social points). Validation criteria used in the present study were: predictive value of Barcelona-SFES score of post-discharge destination (home or institution), and patient's (or family's) request for a definitive institutionalization in a nursing home. There were 9 patients with low social risk (26.4 %), 8 with intermediate social risk (23.5 %) and 17 with high social risk (50 %). A significant relationship between Barcelona-SFES scores and post-discharge destination was found. Eighty percent of patients discharged to an institution(nursing and residential homes), they had high social risk SFES scores (>/= 10) Also, a significant correlation was found between the number of patients for which a definitive institutionalization request was performed and the Barcelona-SFES scores. Fifteen (88.2 %) of the 18 patients for whom the request was done, were in the high social risk group. The lowest scores from SFES were predictive of home discharge, while the highest scores were predictive of a definitive institutionalization.

Observational scale and geriatric depression scale of Yesavage to identify depressive symptoms in older patients.

The diagnosis of depression by clinical interview may be difficult in the patients with communication problems (aphasia, severe cognitive impairment or severe deafness). In these cases, depressive symptoms may be observed by others (nurses and caregivers). The aim of this study was to evaluate the clinical usefulness of an observational scale to identify depression in older patients. Seventy-six institutionalized patients in an intermediate-long-term care center were evaluated. Of them, 39 were excluded because they were unable to perform a clinical interview, needed to diagnose depression. Of the excluded patients, 18 had aphasia, 7 showed severe cognitive impairment: their mini mental state examination (MMSE) score < 14, and 14 collaborated very poorly. Thus 37 patients were analyzed, mean age was 83 +/- 0.86 years (30 women and 7 men). Diagnostic categories were: neurological 16 patients (43.2%), fractures/orthopedics 6 (16.2%), pulmonary/cardiology 5 (13.5%) and others 10 (27.1%). The mean Barthel index was 57.0 +/- 31.6 and mean MMSE score was 21.1 +/- 4.3. The observational scale (OS) designed with six items, was applied to all patients. Each item was scored as never (0 points), sometimes (1 point) and always (2 points). Thus total OS score ranged from 0 to 12. Two observers, who knew the patients (nurses), applied the OS. A trained geriatrician, using the 15-item geriatric depression scale (GDS) performed detection of depressive symptoms. There were 15 patients (40.5 %) with depression on the GDS. OS scale score with a cutoff point of 5 or more was present in 13 patients; nine of them had depression (69.2 %). In the remaining 24 patients with an OS score < 5, depression was present only in 6 cases (25%) (chi2 = 6.844; p < 0.01). The OS >/= 5, in the present study, obtained a sensitivity of 60 %, a specificity of 81 %, a positive predictive value of 69 %, and a negative predictive value of 75 %.We concluded that (i) the OS has been useful for identifying depressive symptoms with an acceptable sensitivity and specificity, and (ii) the OS may be an alternative to detect depression in patients who are unable to perform a clinical interview.

[Ocular presentation in Wegener granulomatosis]. / Presentación ocular de la granulomatosis de Wegener.

CASE REPORT: A 71 year-old female presented with bilateral conjunctivitis, scleritis and peripheral ulcerative keratitis. Ancillary tests showed presence of anti-neutrophil cytoplasmic antibodies, with diffuse granular cytoplasmic immunofluorescence staining (ANCAc). Conjunctival biopsy showed necrotizing vasculitis in small vessels. Diagnosis of Wegener Granulomatosis (WG) was established and upper respiratory affection detected. Treatment with megadoses of cyclophosphamide and corticoids was initiated and remission of the disease was obtained. DISCUSSION: WG is a potentially lethal systemic vasculitis in which ocular involvement may be the first clinical presentation. Scleritis and peripheral ulcerative keratitis indicate systemic involvement, highlighting the importance of prompt diagnosis and treatment.

[Ocular Behçet disease. Retrospective study]. / Enfermedad de Behçet ocular. Estudio retrospectivo.

OBJECTIVE: To study clinical features, visual prognosis and response to immunosuppressive drugs in patients with ocular Behçet Disease (BD). PATIENTS AND METHODS: clinical data of 17 patients (33 eyes) were retrospectively reviewed from May 1996 to May 2003. RESULTS: The male/female ratio was 12/5. The commonest manifestations were oral ulceration (100%) and skin lesions (88%). Anterior uveitis was present in 59%, posterior uveitis was in 76% and panuveitis was in 88.1%. Visual acuity improved in 11 (33.3%) eyes, remind stable in 18 (54.5%) eyes and four (12.1%) eyes lost two or more lines. Main drug therapy consisted of colchicine and cyclosporine (59%). Seven patients had received three drugs simultaneously. CONCLUSIONS: BD can lead to an irreversible visual loss; however, the visual prognosis is good (85%) if immunosuppressor treatment is implemented.