Development of a core domain set for nailfold capillaroscopy reporting.

BACKGROUND: The peripheral microangiopathy may be well evaluated and studied by nailfold capillaroscopy (NFC) which is a safe and non-invasive technique. NFC has been reported to have both diagnostic and prognostic values in patients presenting with Raynaud's phenomenon. OBJECTIVE: The overarching objective of this work was to make a consensus on what domains should be included in a capillaroscopy report and that it can be used in daily clinical practice and clinical research in the area of rheumatology. METHODS: A Delphi questionnaire was developed regarding capillaroscopy report from a literature review and expert consensus. The first Delphi round included 14 core areas, its 18 domains with 50 subdomains, derived from a systematic literature review. The level of evidence was determined for each core set using the Oxford Centre for Evidence-based Medicine (CEBM) system. Nine response categories have been set per each item ranging between 1 and 9. Round 2, aimed to reach preliminary consensus "in" or "out" for domains. It included all items that were rated "critical" by at least 80% of the participants as well as any new domains proposed in round 1. RESULTS: The participants to the first, and second round were 11 experts. Fourteen domains were discussed in the two rounds. At the end of the survey, the final report template of NFC in rheumatology reached a consensus. CONCLUSION: A nailfold capillaroscopy report template has been developed by this study, based on outcomes of a Delphi process, by international participants panel. All domains met the 80% voting threshold set in this work. The reporting template can be used for both clinical research as well as day to day practice to provide guidance and standardize the NFC reporting.

State of art of robotic prostatectomy: the way we do it in Catalonia, Spain.

INTRODUCTION AND OBJECTIVE: Robotic-assisted laparoscopic prostatectomy (PLAR) seems to improve functional outcomes, however there is not a consensus of a standard procedure. The aim of this study was to identify the PLAR "state of art" in Catalonia, Spain. MATERIAL AND METHODS: This was a cross-sectional survey-based study conducted among urologists across Catalonia, Spain. The survey was distributed through online platforms and the professional urology society. All statistical analyses were performed using Stata software, v20. RESULTS: 59 urologists completed the survey, revealing PLAR as the most commonly used technique (79.7%). Most urologist (70%) create the pneumoperitoneum using a controlled incision with direct access and 78.3% use the Airseal technology. The intraperitoneal approach is performed in >90% of cases. Endopelvic fascia preservation is not routinely performed. 34.5% of the survey not perform the dorsal vein complex suture. All preserves the bladder neck when oncologically safe. Nerve-vascular bundles bleeding control is performed using standard coagulation or suturing. 34% performed posterior reconstruction. Only use hemostatic devices when evident bleeding and 70% does not routinely left a drainage. Multivariable analysis showed that center volume had a significant independent association with dorsal venous complex suturing (OR 0.073, 95%CI 0.07-0.826), nerve-vascular bundles suturing hemostasis (OR 11.67, 95%CI 1.07-127.60) and endopelvic fascia preservation (OR 13.64, 95%CI 1.087-201.27), but there was no correlation with time the bladder catheter or days hospitalized. CONCLUSIONS: The study provides an overview of the state of PLAR in Catalonia, Spain, showing significant variability and reflecting a commitment to advancing surgical technology and patient care.

HL7 un estándar de interoperabilidad en salud: Revisión sistemática de la literatura

Introducción: Las aplicaciones informáticas en la práctica médica han permitido el desarrollo de novedosas formas de comunicación en la atención del Sistema de Salud. La estandarización representa un elemento necesario para la sostenibilidad y escalabilidad del software desarrollado. En sistemas para la salud existen diversas aplicaciones del estándar HL7. Objetivo: Realizar una Revisión Sistemática de la Literatura (RSL) sobre el estándar de interoperabilidad HL7. Materiales y métodos: Para la definición y ejecución del presente estudio se empleó la propuesta metodológica establecida por Petersen la cual plantea cinco pasos secuenciales: definición de las preguntas de investigación; definición de los criterios de búsqueda; definición de los criterios de selección de estudios primarios; determinación del esquema de clasificación; y extracción de datos y mapeo de estudios. Resultados: Se obtuvieron como resultado preliminar 428 569 entradas posibles. Aplicando el primer filtro de inclusión y exclusión sobre el título, resumen y palabras clave, quedaron 864 documentos, de los cuales solo 276 cumplieron con haber sido publicados en el período que se analiza (2017-2022). De ellos sólo 72 permitían acceso completo a la documentación y al ser analizados se descartan 51 por no ofrecer información acorde al tema de investigación. Resultaron un total de 21 artículos para un análisis a mayor profundidad. Conclusiones: A partir de la revisión sistemática se pudo constatar que en la optimización de los procesos comunicativos es preciso el uso de estándares que armonicen el intercambio de información y provean un lenguaje común para todos los agentes involucrados.

Introduction: Computer applications in medical practice have allowed the development of novel forms of communication in the Health Care System. Standardization represents a necessary element for the sustainability and scalability of the developed software. In health systems there are various applications of the HL7 standard. Objective: To perform a Systematic Review of Literature (RSL) on the HL7 interoperability standard. Methods: The methodological proposal established by Petersen, which proposes five sequential steps such as: definition of research questions, definition of search criteria, definition of the selection criteria of primary studies, determination of the classification scheme, and data extraction and mapping study, was used for the definition and implementation of this study. Results: A total of 428,569 possible entries were obtained as a preliminary result. Applying the first inclusion and exclusion filter on the title, abstract and keywords, 864 documents remained, of which only 276 complied with having been published in the period under analysis (2017-2022). Only 72 of them allowed full access to the documentation and when analyzed, 51 were excluded for not offering information according to the research topic. A total of 21 articles were selected for further analysis. Conclusions: Based on the systematic review, it was possible to verify that in the optimization of communication processes, standards must be used to harmonize the exchange of information and provide a common language for all the agents involved.

[Prevalence and pattern of alcohol consumption in patients with hepatocellular carcinoma]. / Prevalencia y patrón de consumo de alcohol en pacientes con carcinoma hepatocelular.

AIM: Prospective cross-sectional study conducted to determine the prevalence and pattern of alcohol consumption (AC) in patients with hepatocellular carcinoma (HCC) and to assess the utility of the AUDIT in HCC patients. METHODS: One hundred and two consecutive patients form our HCC monographic outpatient clinic visited between February and March 2022 were included. Patients with hepatic encephalopathy at the time of the interview, on the waiting list for liver transplantation and those undergoing post-transplant follow-up were excluded. RESULTS: The prevalence of AC in patients diagnosed with HCC is 35%, although less than 10% consume more than 100g per week. AC was more frequent in males, in an urban environment, with a diagnosis of HCC more than a year ago, and in patients in early/very early stages of BCLC. AUDIT score greater than or equal to 3 (AUROC 0.849) predicts any AC with a sensitivity of 75% (95% CI: 59.47-90.53%) and a specificity of 84% (95% CI: 74.70-94.05%). CONCLUSIONS: Despite the diagnosis of HCC, more than a third of the patients consume alcohol. An AUDIT score equal to or greater than 3 discriminates any AC with a sensitivity of 75% and a specificity of 84% in this population.

Aluminum blood concentration in adult patients: effect of multichamber-bag versus hospital-compounded parenteral nutrition.

Introduction: Background: the administration of aluminum-contaminated parenteral nutrition (PN) leads to an accumulation of aluminum. The aim of this study was to assess blood aluminum concentrations (BACs) of inpatients receiving multichamber-bag (MCB) PN compared to those receiving compounded PN. Methods: available BACs were retrospectively gathered from patient charts of adult inpatients receiving PN from 2015 to 2020, and compared depending on the type of PN administered. Long-term PN patients, defined as ≥ 20 days of PN, receiving at least > 10 days of compounded PN, were compared to long-term patients receiving only MCB. Results: a total of 160 BACs were available from 110 patients. No differences were found according to type of PN (mean BAC: 3.11 ± 2.75 for MCB versus 3.58 ± 2.08 µg/L for compounded PN). Baseline total bilirubin, surgery and days with PN were related to higher BACs (coefficient: 0.30 [95 % CI, 0.18-0.42], 1.29 [95 % CI, 0.52-2.07], and 0.06 [95 % CI: 0.01-0.11], respectively). Regarding long-term PN, patients receiving only MCB (n = 21) showed lower BACs compared to the compounded PN (n = 17) [2.99 ± 1.55 versus 4.35 ± 2.17 µg/L, respectively; p < 0.05]. Conclusions: although there were no differences in BAC according to type of PN administered, in long-term PN, MCB PN was associated with lower BACs as compared to compounded PN.

Introducción: Antecedentes: la administración de nutrición parenteral (NP) contaminada con aluminio conduce a su acumulación. El objetivo de este estudio fue evaluar las concentraciones de aluminio en sangre (CAS) en pacientes hospitalizados que recibieron NP elaboradas en el hospital o bolsas tricamerales. Métodos: se recogieron retrospectivamente las CAS disponibles de los pacientes hospitalizados con NP durante el período entre 2015 y 2020, comparándose los valores en función del tipo de NP administrada. Se comparan igualmente los valores de pacientes de larga duración, definida como ≥ 20 días de NP, que recibieron al menos > 10 días de NP elaborada frente aquellos de larga duración que recibieron solo NP tricameral. Resultados: se incluyeron un total de 160 CAS de 110 pacientes. No se encontraron diferencias con respecto al tipo de NP (CAS media: 3,11 ± 2,75 para la tricameral frente a 3,58 ± 2,08 µg/L para la elaborada). La bilirrubina total basal, la cirugía y los días con NP se relacionaron con un mayor valor de CAS (coeficiente: 0,30 [IC 95 %: 0,18-0,42], 1,29 [IC 95 %: 0,52-2,07] y 0,06 [IC 95 %: 0,01-0,11], respectivamente). En la NP a largo plazo, los pacientes que recibieron solo NP tricameral (n = 21) mostraron una CAS menor en comparación con el grupo que recibió al menos 10 NP elaboradas (n = 17) [2,99 ± 1,55 versus 4,35 ± 2,17 µg/L, respectivamente; p < 0,05]. Conclusiones: aunque no hubo diferencias de CAS con respecto al tipo de NP administrada, en la NP a largo plazo, la administración de NP tricameral se asoció con CAS menores en comparación con la NP elaborada.

¿Qué es el test de latencia múltiple de sueño y cuál es su uso en pediatría? / What is the multiple sleep latency test and what is its use in pediatrics?

La prueba de latencia múltiple del sueño nos permite evaluar objetivamente las variaciones normales y patológicas en la somnolencia y el estado de alerta. Es una prueba que evalúa qué tan rápido una persona se duerme en condiciones estandarizadas que facilitan el sueño, y se repite a intervalos de 2 horas durante todo el día. Es el estándar para documentar el inicio del sueño REM (SOREMP), que es un síntoma de narcolepsia y en la somnolencia idiopática podría ser útil. Su uso está ampliamente descrito en adultos, pero la prueba no es tan común en niños. En esta revisión, se analizan los valores en adultos y niños, y su utilidad, a partir de la historia de la prueba.

The multiple sleep latency test allows us to objectively assess normal and pathological variations in sleepiness and alertness. It is a test that assesses how quickly a person falls asleep under standardized conditions that facilitate sleep and is repeated at 2-h intervals throughout the day. is the standard for documenting sleep onset REM (SOREMP), which is a symptom of Narcolepsy and idiopathic sleepiness could be useful. Its use is widely described in adults, but the test is not so common in children. In this review, we analyze the values in adults and children, and their usefulness, based on from the history of the test.

Estimación de brechas de geriatras en Chile / Estimation of geriatrician gaps in Chile

Antecedentes: el envejecimiento de la población chilena y la transición epidemiológica que atraviesa el país, ha incrementado la necesidad de formar, entre otros especialistas, a médicos geriatras. Objetivo: estimar la brecha de geriatras en Chile de acuerdo con necesidades epidemiológicas de la población de 65 años y más. Método: se realizó una estimación de brecha de horas de geriatra para la red de salud, a partir de una consulta a 57 geriatras de laboralmente activos de un total de 156 geriatras registrados a enero del 2021. En dicha consulta se indagó sobre tiempo de duración de consulta y frecuencia de consultas ideales de acuerdo con la capacidad funcional de las personas mayores a nivel nacional y por región obtenida de la encuesta Casen 2017. Resultados: a febrero del 2022 existe un total de 162 geriatras en Chile, cifra que equivale a un geriatra por cada 15.806 personas de 65 años y más. De acuerdo con la estimación realizada, se requeriría en Chile, un total de 1.244.689 horas de geriatra anual, equivalentes a la existencia de 589 geriatras a nivel nacional. Conclusión: según los resultados del estudio, a nivel nacional se necesitarían de un total de 589 geriatras para cubrir las necesidades de atención de las personas mayores con algún nivel de dependencia. De acuerdo con estas cifras, al primer trimestre del 2022 el país presentaría una brecha de 427 geriatras. Ante lo elevada de esta brecha, se cree necesario avanzar en estrategias de formación general en geriatría y gerontología en los equipos de salud y socio-sanitarios.

Background:The ageing between the Chilean population and the epidemiological transition that the country is going through has increased the need to train, among other specialists, geriatric doctors.Objective: To estimate the gap between geriatricians in Chile according to the epidemiological needs of the population aged 65 years and over. Method:An estimate of the gap in geriatrician hours was made for the health network based on a consultation of 57 active geriatricians out of 156 registered as of January 2021. In this consultation, the duration and frequency of ideal consultations were inquired according to the functional capacity of the elderly at the national level and by region obtained from the Casen 2017 survey.Results: as of February 2022, there are 162 geriatricians in Chile, equivalent to one geriatrician for every 15,806 people aged 65 years and over. According to the estimate, a total of 1,244,689 hours of annual geriatrician would be required in Chile, equivalent to 589 geriatricians nationwide. Conclusion:According to the study's results, at the national level, a total of 589 geriatricians would be needed to cover the care needs of older people with some level of dependen-ce. According to these figures, in the first quarter of 2022, the country would present a gap of 427 geriatricians. Given the highness of this gap, it is believed necessary to advance general training strategies in geriatrics and gerontology in health and socio-health teams

Standardizing health outcomes for chronic kidney disease. Adaptation of the international consortium for health outcomes measurement standard set to the Spanish setting.

BACKGROUND AND OBJECTIVES: We aim to adapt the International Consortium for Health Outcomes Measurements standard set for chronic kidney disease (CKD) patients to the Spanish setting and supplement it with those variables agreed upon through initiatives proposed by the Spanish Society of Nephrologists (S.E.N.). MATERIAL AND METHODS: The working group defined a first standard set of variables based on a literature review. The S.E.N. members then assessed the suitability of each variable for inclusion (Consensus≥75%). A second draft of the standard set was generated and evaluated by the Patient advocacy group Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón (ALCER). Lastly, the working group established the final standard set of variables (Consensus≥75%). RESULTS: The standard set targets patients with very high-risk CKD (G3a/A3 and G3b/A2-G5) in pre-end-stage kidney disease (pre-ESKD), hemodialysis (HD), peritoneal dialysis (PD), kidney transplantation (KT) or conservative care (CC). The essential follow-up variables agreed for all patients (All) were patient survival, hospitalizations, cardiovascular events, smoking status, health-related quality of life, pain, fatigue, physical function, daily activities, depression, renal function and hemoglobin. Additionally, it was agreed to collect PD survival (in PD patients), peritonitis (PD), infection/bacteremia (PD, HD, KT), vascular access type (HD), vascular access survival (HD), acute rejection (KT), post-transplant cancer (KT), albuminuria (KT) and kidney allograft survival (KT). The optional variables agreed were phosphorus (All), potassium (All), diabetes control (All with diabetes), and albuminuria (pre-ESKD). CONCLUSIONS: This standard set may constitute a highly efficient tool allowing the evaluation of patient outcomes and helping to define strategies to enhance CKD patients' quality of care in the Spanish healthcare system.

Os desafios de pessoas com transtorno do espectro autista na vida adulta: uma revisão integrativa / The challenges of people with autistic spectrum disorder in adulthood: an integrative review / Los retos a los que se enfrentan las personas con trastorno del espectro autista en la edad adulta: una revisión integradora

Este estudo teve como objetivo identificar os principais desafios enfrentados por pessoas com Transtorno do Espectro Autista (TEA) na vida adulta. Trata-se de uma revisão integrativa abrangendo artigos publicados entre os anos de 2017 e 2022, disponíveis nas bases de dados: Scopus, PubMed e a Biblioteca Virtual em Saúde. Após a seleção e a organização dos estudos, o corpus foi constituído por oito artigos que abordavam esses desafios de pessoas adultas com TEA e suas experiências no âmbito da saúde, polifarmácia, socialização e a correlação com outros transtornos psiquiátricos. Os estudos contribuíram para um entendimento sobre as problemáticas enfrentadas pelo grupo, somado às suas necessidades e percepções, apontando a carência de apoio na transição para a vida adulta, a escassez de qualificação profissional na assistência a pessoas com TEA e a ausência de adaptações do ambiente para com os indivíduos, coadjuvando com o aumento de transtornos mentais e isolamento social.

This study aimed to identify the main challenges faced by people with Autistic Spectrum Disorder (ASD) in adulthood. This is an integrative review covering articles published between the years 2017 and 2022, available in the databases: Scopus, PubMed and the Virtual Health Library. After the selection and organization of the studies, the corpus consisted of eight articles that addressed these challenges of adult people with ASD and their experiences in the realm of health, polypharmacy, socialization, and the correlation with other psychiatric disorders. The studies contributed to an understanding of the problems faced by the group, in addition to their needs and perceptions, pointing out the lack of support in the transition to adulthood, the lack of professional qualification in assisting people with ASD, and the lack of adaptations of the environment for individuals, contributing to the increase of mental disorders and social isolation.

Este estudio tuvo como objetivo identificar los principales desafíos que enfrentan las personas con trastorno del espectro autista (TEA) en la edad adulta. Se trata de una revisión integradora que abarca artículos publicados entre los años 2017 y 2022, disponibles en las bases de datos: Scopus, PubMed y Biblioteca Virtual de Salud. Tras la selección y organización de los estudios, el corpus quedó compuesto por ocho artículos que abordaron estos retos de las personas adultas con TEA y sus experiencias en el contexto de la salud, la polifarmacia, la socialización y la correlación con otros trastornos psiquiátricos. Los estudios contribuyeron para la comprensión de los problemas enfrentados por el grupo, sumados a sus necesidades y percepciones, señalando la falta de apoyo en la transición para la edad adulta, la falta de cualificación profesional en la asistencia a las personas con TEA y la falta de adaptaciones del ambiente para los individuos, contribuyendo para el aumento de los trastornos mentales y del aislamiento social.

Determinantes das irregularidades na gestão pública municipal: o caso dos municípios do estado de São Paulo / Determinantes de las irregularidades en la gestión pública municipal: el caso de los municipios del estado de São Paulo / Determinants of irregularities in municipal public management: the case of municipalities in the state of São Paulo

Resumo O controle externo municipal exercido pelos Tribunais de Contas permite, por meio da divulgação dos relatórios de auditoria, conhecer as irregularidades encontradas nas contas dos governos municipais. Elas têm sido analisadas empiricamente, do ponto de vista de sua classificação em termos de gravidade, mas poucos são os estudos que visam identificar os fatores que influenciam tais falhas. Constatada essa lacuna, o principal objetivo deste estudo é identificar fatores que possam influenciar lapsos na gestão pública municipal apontados pela auditoria do Tribunal de Contas. Este artigo contribui para aprofundar a pesquisa em torno desse tema e para a melhoria da gestão nos municípios. Trata-se de uma análise exploratória, baseada em modelos econométricos para dados em painel. A amostra inclui 179 municípios paulistas, com dados relativos aos anos de 2011, 2013, 2015, 2017 e 2019. Os resultados sugerem que as recomendações e as determinações do Tribunal de Contas, bem como lacunas nos controles internos, influenciam irregularidades em municípios pequenos, médios e grandes. O volume de transferências legais e constitucionais recebidas influenciam os municípios pequenos e médios, ao passo que o produto interno bruto (PIB) municipal tem influência nos municípios médios.

Resumen El control municipal externo que ejercen los Tribunales de Cuentas permite, a través de la divulgación de informes de auditoría, conocer las irregularidades encontradas en las cuentas de los gobiernos municipales. Estas han sido analizadas empíricamente, desde el punto de vista de su clasificación en términos de gravedad, pero existen pocos estudios que tengan como objetivo identificar los factores que influyen en tales fallas. Verificada esta brecha, el objetivo principal de este estudio es identificar factores que puedan influir en las fallas en la gestión pública municipal señalados por la auditoría del Tribunal de Cuentas. Este artículo contribuye a profundizar en la investigación sobre este tema y a mejorar la gestión en los municipios. Se trata de un análisis exploratorio, basado en modelos econométricos para datos de panel. La muestra incluye 179 municipios de São Paulo, con datos de los años 2011, 2013, 2015, 2017 y 2019. Los resultados sugieren que las recomendaciones y determinaciones del Tribunal de Cuentas, así como las lagunas en los controles internos, influyen en las irregularidades en los municipios, pequeños, medianos y grandes. El volumen de transferencias legales y constitucionales recibidas influye en los municipios pequeños y medianos, mientras que el producto interno bruto (PIB) municipal influye en los municipios medianos.

Abstract The municipal external control exercised by the Courts of Accounts reveals the irregularities found in the accounts of municipal governments through the disclosure of audit reports. They have been empirically analyzed from the point of view of their classification in terms of severity, but few studies aim to identify the factors that influence such failures. Having verified this gap, the main objective of this study is to identify factors that may influence lapses in municipal public management pointed out by the audit of the Court of Accounts. This article contributes to further research on this topic and to improving management in municipalities. This is an exploratory analysis based on econometric models for panel data. The sample includes 179 municipalities in São Paulo, with data for 2011, 2013, 2015, 2017, and 2019. The results suggest that the recommendations and determinations of the Court of Accounts and gaps in internal controls influence irregularities in small, medium, and large municipalities. The volume of legal and constitutional transfers received influences small and medium-sized municipalities, while the municipal gross domestic product (GDP) influences medium-sized municipalities.

Historical perspective of two technical standards developed in the 2ist century that gave rise to profound changes in Peruvian anesthesiology / Perspectiva histórica de dos normas técnicas desarrolladas en el siglo XXI que generaron cambios profundos en la anestesiología peruana

Abstract The technical standards in anesthesiology govern the professional practice and allow for the provision of safer anesthesia and surgery. This article gives a historical perspective on the creation, main content, and consequences of the implementation of the Peruvian standards in anesthesiology.

Resumen Las normas técnicas de anestesiología rigen el ejercicio profesional y permiten ofrecer una anestesia y una cirugía más seguras. El presente artículo brinda una perspectiva histórica sobre la creación, el contenido principal y las consecuencias de la implementación de las normas de anestesiología peruanas.

[Process of medical nutrition therapy]. / Proceso de tratamiento médico nutricional.

Introduction: Medical nutrition therapy is a very useful tool in maintaining and recovering the health of patients with disease-related malnutrition, although its implementation can be complex and is not without risks. Quality processes are understood as sets of activities that are related or interact to transform input elements into results. From the SENPE Management Work Group we present the process of medical nutrition therapy (PMNT), which aims to facilitate the management of clinical nutrition of a multidisciplinary nutrition support team in a hospital setting. This paper describes the seven sub-processes PMNT is comprised of, in addition to a previous nutritional screening sub-process. Each sub-process is divided into a first section with a technical sheet detailing its general aspects, while a second section proposes key objectives, quality indicators, and standards for their evaluation. .

Introducción: El tratamiento médico nutricional es de gran utilidad en el mantenimiento y recuperación de la salud de los pacientes con desnutrición relacionada con la enfermedad, aunque su implementación puede ser compleja y no está exenta de riesgos. Se entiende por proceso aquel conjunto de actividades que están mutuamente relacionadas o que interactúan para transformar elementos de entrada en resultados. Desde el Grupo de Trabajo de Gestión de la SENPE presentamos el Proceso de Tratamiento Médico Nutricional (PTMN), que tiene por objetivo facilitar la gestión de la nutrición clínica, pensando en un equipo de soporte nutricional multidisciplinar de atención al paciente hospitalizado. En este documento se describen los siete subprocesos que constituyen el PTMN, además de un subproceso previo de cribado nutricional. Cada subproceso se divide en una primera sección con una ficha técnica en la que se detallan sus aspectos generales, mientras que en la segunda sección se proponen objetivos clave, indicadores de calidad y estándares para su evaluación.

Contact Dermatitis to Allergens in the Spanish Standard Series: Patch Test Findings in the South of Gran Canaria. / Dermatitis de contacto a alérgenos de la Batería Estándar Española en población del sur de Gran Canaria.

BACKGROUND AND OBJECTIVES: Contact dermatitis is a common reason for consultation in dermatology. Sensitization levels and frequency, however, vary from one population to the next. The aim of this study was to review patch test results showing sensitization to allergens in the Spanish standard series in the Canary Islands, where a large proportion of the population works in tourism. MATERIAL AND METHODS: Retrospective, descriptive study of data from the dermatology department's contact dermatitis unit at Complejo Hospitalario Universitario Insular in Las Palmas de Gran Canaria, Spain. We studied results recorded for patients patch tested with the Spanish standard series between January 2005 and June 2018. RESULTS: Data for 1568 patients were studied; 71.6% were women, and overall rates of atopy (14.2%) and occupational dermatitis (15.8%) were low. Most patients with a positive test (65.2%) were older than 40years. The main allergens eliciting positive reactions were nickel (36.5%), methylchloroisothiazolinone/methylisothiazolinone (11.9%), methylisothiazolinone (11.8%), paraphenylenediamine (7.5%), and potassium dichromate (6.3%). CONCLUSIONS: Contact sensitization rates were higher than those reported elsewhere in Spain for most of the allergens studied. The differences were particularly notable for nickel, methylchloroisothiazolinone/methylisothiazolinone, and paraphenylenediamine.

Aclaramiento de lactato y déficit de base estándar como pronóstico de mortalidad en choque séptico / Lactate clearance and standard base deficit as a prognosis of mortality in septic shock / Depuração de lactato e deficiência de base padrão como prognóstico de mortalidade no choque séptico

Resumen: Introducción: la asociación del nivel de lactato con la mortalidad en pacientes con sospecha de infección y sepsis está bien establecida. La sensibilidad es entre 66 y 83%, con especificidad de 80 y 85%. Sin embargo, el lactato no es sensible ni lo suficientemente específico para detectar o descartar el diagnóstico por sí solo, ya que el lactato sérico es un biomarcador importante de la hipoxia y disfunción tisular, pero no es una medida directa de la perfusión tisular. El lactato y la base estándar medidos al ingreso a la Unidad de Cuidados Intensivos (UCI) son de utilidad pronóstica en los pacientes críticamente enfermos, pues sus niveles séricos predicen mortalidad a través de la puntuación en sí misma. Pero la importancia real va más allá de un valor absoluto, pues es mejor medir su aclaramiento a través de un tiempo determinado. Objetivo: demostrar que el aclaramiento de lactato y déficit de base estándar registrados al ingreso y a las 24 h se relacionan con mejor pronóstico y disminución de mortalidad en choque séptico. Material y métodos: se utilizó estadística descriptiva (medidas de tendencia central y dispersión; así como frecuencias y porcentajes). Asimismo, se ocupó estadística inferencial con la prueba t de Student, χ2, curva ROC, área bajo la curva e índice de Youden, con un intervalo de confianza de 95%. Resultados: la asociación estadística con la mortalidad se presentó en el aclaramiento de déficit de base estándar y en aclaramiento de lactato. Conclusión: se demostró que el aclaramiento de lactato y déficit de base estándar registrados al ingreso y a las 24 h se relacionaron con mejor pronóstico y disminución de mortalidad en pacientes con choque séptico.

Abstract: Introduction: the association of lactate level with mortality in patients with suspected infection and sepsis is well established. Sensitivity is between 66 and 83%, with specificity between 80 and 85%. However, lactate is neither sensitive nor specific enough to detect or rule out the diagnosis on its own as serum lactate is an important biomarker of tissue hypoxia and dysfunction but is not a direct measure of tissue perfusion. Lactate and standard base measured on admission to the Intensive Care Unit (ICU) are useful for prognosis in critically ill patients since their serum levels predict mortality through the score itself. But the real importance goes beyond an absolute value, since it is better to measure its clearance over a given time. Objective: to demonstrate that lactate clearance and standard base deficit recorded at admission and at 24 hours are related to a better prognosis and decreased mortality in septic shock. Material and methods: descriptive statistics were used (measures of central tendency and dispersion, as well as frequencies and percentages). Likewise, inferential statistics were used with the Student's t test, χ2, ROC curve, area under the curve and Youden index, with a confidence interval of 95%. Results: the statistical association with mortality was presented in the clearance of standard base deficit and in lactate clearance. Conclusion: it was shown that lactate clearance and standard base deficit recorded at admission and at 24 hours were related to a better prognosis and decreased mortality in patients with septic shock.

Resumo: Introdução: a associação do nível de lactato com mortalidade em pacientes com suspeita de infecção e sepse está bem estabelecida. A sensibilidade está entre 66 e 83%, com especificidade de 80 e 85%. No entanto, o lactato não é sensível nem específico o suficiente para detectar ou descartar o diagnóstico por si só, uma vez que o lactato sérico é um importante biomarcador de hipóxia e disfunção tecidual, mas não é uma medida direta da perfusão tecidual. O lactato e a base padrão medidos na admissão na UTI são de utilidade prognóstica em pacientes críticos, uma vez que seus níveis séricos predizem a mortalidade pelo próprio escore. Mas a real importância vai além de um valor absoluto, pois é melhor medir sua depuração em um determinado tempo. Objetivo: demonstrar que a depuração de lactato e o déficit de base padrão registrados na admissão e em 24 horas estão relacionados a um melhor prognóstico e diminuição da mortalidade no choque séptico. Material e métodos: foi utilizada estatística descritiva (medidas de tendência central e dispersão, bem como frequências e percentagens). Da mesma forma, foi utilizada estatística inferencial com teste t de Student, χ2, curva ROC, área sob a curva e índice de Youden, com intervalo de confiança de 95%. Resultados: a associação estatística com a mortalidade foi apresentada na depuração do déficit de base padrão e na eliminação do lactato. Conclusão: foi demonstrado que a depuração de lactato e o déficit de base padrão registrados na admissão e em 24 horas foram relacionados a um melhor prognóstico e diminuição da mortalidade em pacientes com choque séptico.

Correlación entre las estrategias SITA Estándar 24 -2 y SITA Faster 24 -2 para evaluar el daño campimétrico en pacientes con Glaucoma Primario de Ángulo Abierto

RESUMEN Introducción: Las estrategias de SITA Estándar fueron aprovechadas por más de dos décadas, pero buscando aun mejorar el tiempo sin perder la calidad, se volvió a crear una nueva estrategia más corta, a la cual llamaron estrategia FASTER. Objetivo: Determinar la correlación entre las estrategias SITA Estándar 24 -2 y SITA Faster 24 -2 para evaluar el daño campimétrico en pacientes con Glaucoma Primario de Angulo Abierto. Metodología: Estudio observacional analítico. RESULTADOS: Se analizó 74 resultados de análisis del campo visual utilizando dos técnicas SITA Estándar 24 - 2 y SITA Faster 24 - 2. El tiempo de prueba para la estrategia SITA Estándar fue de 379,64 ± 72,75 segundos y para la estrategia SITA Faster 170,93 ± 49,17 (p<0,0001), probando una reducción de tiempo del 55% para la segunda. Los valores de desviación media, desviación patrón estándar y el índice de campo visual no mostraron diferencias estadísticamente significativas entre ambas pruebas. La Prueba de Hemicampo de glaucoma con el cálculo del índice Kappa de Cohen arroja un valor de 0,316 con un intervalo de confianza del 95 % de (0,098 - 0,534) lo que indica que es estadísticamente significativo. Discusión: Los resultados generales indican que es posible reemplazar la estrategia SITA Estándar 24 -2 con la estrategia SITA Faster 24 - 2. Este cambio será especialmente útil para aumentar la frecuencia de exámenes campimétricos, determinante para una detección más temprana de la progresión del glaucoma y así mejorar las conductas terapéuticas que se toman con los pacientes que acuden a nuestro servicio.

ABSTRACT Introduction: SITA Standard strategies were used for more than two decades, but still seeking to improve time without losing quality, a new shorter strategy was created again, which they called the FASTER strategy. Objective: To determine the correlation between the SITA Standard 24-2 and SITA Faster 24-2 strategies to evaluate the visual field damage in patients with Primary Open Angle Glaucoma. Methodology: Analytical observational study. Results: 74 visual field analysis results were analyzed using two techniques SITA Standard 24 - 2 and SITA Faster 24 - 2. The test time for the SITA Standard strategy was 379.64 ± 72.75 seconds and for the SITA strategy Faster 170.93 ± 49.17 (p <0.0001), proving a 55% time reduction for the second. The mean deviation, standard deviation and visual field index values do not show statistically significant differences between both tests. The Glaucoma Hemifield Test with the calculation of the Cohen's Kappa index gives a value of 0.316 with a 95% confidence interval of (0.098 - 0.534) which indicates that it is statistically significant. Discussion: The overall results indicate that it is possible to replace the SITA Standard 24-2 strategy with the SITA Faster 24-2 strategy. This change will be especially useful to increase the frequency of campimetric examinations. A greater frequency of examinations is important for earlier detection of glaucoma progression and thus improve the therapeutic behaviors that are taken with the patients who come to our service.

Implementation of contact isolation strategy for the containment of extended-spectrum ß-lactamase carriers in a University Hospital positively affects the epidemiology of carbapenemase-producing Enterobacterales.

INTRODUCTION: The lack of consensus of control measures to prevent extended-spectrum ß-lactamase producing Enterobacterales (ESBL-E) transmission in the hospital setting is of great concern. We describe the prevalence and species distribution of ESBL-E and carbapenemase producing Enterobacterales (CPE) in patients admitted in a tertiary Hospital during an active surveillance screening program for detecting ESBL-E carriers and reducing the ESBL-E transmission (R-GNOSIS Project). METHODS: From March-2014 to March-2016, 15,556 rectal swabs were collected from 8209 patients admitted in two medical (Gastroenterology, Pneumology) and two surgical (Neurosurgery, Urology) wards. Swabs were seeded onto ChromoID-ESBL and -CARB/OXA-48 agar plates. Growing colonies were identified by MALDI-TOF MS. ESBL and carbapenemases were phenotypically detected. Changes in species diversity (SDI) and distribution over time were analyzed. RESULTS: ESBL-E incidence (8.4%) tended to decrease over time (p=0.003) and CPE carrier prevalence remained unchanged during the study (2%). The contact isolation strategy targeted to reduce ESBL-E transmission was ineffective in reducing ESBL-E carriers but significant differences were observed with CPE (p=0.017). SDI did not change among ESBL-E and E. coli was predominant (78.5%) during the study. K. pneumoniae (54%) was the most frequent CPE species, followed by E. coli (19%). SDI decreased among the CPE population over time mainly due to K. pneumoniae dominance and increased E. coli prevalence in the last part of the study. CONCLUSIONS: During the R-GNOSIS project, contact precautions were not effective in reducing the ESBL-E transmission but may have had a positive collateral effect on the CPE containment.

Cribado neonatal en atrofia muscular espinal: un desafío para cambiar la historia natural / Neonatal screening in spinal muscular atrophy: a challenge to change the natural history

Introducción: la atrofia muscular espinal (AME) es la primera causa de origen genético de muerte en la infancia. En los últimos 20 años han sido excepcionales los avances en el conocimiento de su base genética, de su historia natural y se han desarrollado estándares de cuidado y nuevas terapias. Este veloz aumento del conocimiento ha llevado al desarrollo de terapias eficaces para esta devastadora enfermedad, pero el tiempo son neuronas, y esa frase nos lleva a pensar la importancia del diagnóstico precoz y, por qué no, del diagnóstico presintomático mediante pesquisa neonatal. Métodos: revisión de la bibliografía disponible, a través de búsqueda en PubMed y Google para trabajos no indexados o publicaciones de organismos de Salud. Resultados: varios estudios clínicos han mostrado la mayor eficacia del tratamiento en pacientes presintomáticos, por lo que lograrlo en estos pacientes llevaría a cambiar radicalmente la historia de esta enfermedad. Conclusión: es importante analizar y promover el desarrollo de pilotos para pesquisa neonatal en vistas a lograr experiencia para, a partir de ello, pensar en la posibilidad de incorporarlo a programas nacionales. (AU)

Introduction: spinal muscular atrophy (SMA) is the first cause of genetic origin of death in childhood. Throughout the last 20 years, we have witnessed exceptional advances in the knowledge of its genetic base, the history of its nature and several standards of care and new therapies have been developed. This rapid increase in knowledge has led to the development of effective therapies for this devastating disease. However, time is neurons, and that phrase reminds us of the importance of early diagnosis, and, why not, of pre-symptomatic diagnosis by means of neonatal screening. Methods: review of scientific papers searching in Pubmed or Google for non-indexed articles or publications of Health organisms. Results: several clinical studies have shown the greatest effectiveness of treatment in pre-symptomatic patients, so achieving the same in these patients would result in radically changing the history of this disease. Discussion: it is important to analyze and promote the development of pilots for neonatal screening in order to gain experience, so from there on to be able to think about the possibility of incorporating it into national programs. (AU)

Candidate Allergens for Inclusion in the Spanish Standard Series Based on Data from the Spanish Contact Dermatitis Registry. / Alérgenos candidatos para ser incluidos en la serie estándar española a partir de los datos del Registro Español de Dermatitis de Contacto.

BACKGROUND: Standard patch test series must be updated using objective data on allergen sensitization. The Spanish standard series was last updated in 2016 and the European series in 2019, and the inclusion of several emerging allergens needs to be evaluated. MATERIAL AND METHODS: We conducted a prospective, observational, multicenter study of consecutive patients from the registry of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) who were patch tested in 2019 and 2020 with linalool hydroperoxide, limonene hydroperoxide, 2-hydroxyethyl-methacrylate, benzisothiazolinone, octylisothiazolinone, textile dye mix (TDM), sodium metabisulfite, propolis, bronopol, Compositae mix II, diazolidinyl urea, imidazolidinyl urea, decyl glucoside, and lauryl glucoside. RESULTS: We analyzed data for 4654 patients tested with diazolidinyl urea, imidazolidinyl urea, and bronopol, and 1890 tested with the other allergens. The values for the MOAHLFA index components were 30% for male, 18% for occupational dermatitis, 15% for atopic dermatitis, 29% for hand, 6.5% for leg, 23% for face, and 68% for age > 40 years. Sensitization rates above 1% were observed for 7 allergens: linalool hydroperoxide, 2-hydroxyethyl-methacrylate, benzisothiazolinone, limonene hydroperoxide, TDM, sodium metabisulfite, and propolis. Three allergens had a current relevance rate of over 1%: linalool hydroperoxide, 2-hydroxyethyl-methacrylat, and limonene hydroperoxide. Benzisothiazolinone and TDM had a relevance rate of between 0.9% and 1%. CONCLUSIONS: Our results indicate that 7 new allergens should be considered when extending the Spanish standard patch test series. The data from our series could be helpful for guiding the next extension of the European baseline series.

Opinión de estudiantes de kinesiología relacionado con precauciones estándar, vista de enfermería / Opinion of kinesiology students related to standard precautions, nursing view

INTRODUCCIÓN: Las precauciones estándar corresponden a un grupo de prácticas de prevención de infecciones que se aplican en la atención a todos los pacientes, tiene como objetivo prevenir la transmisión cruzada de microorganismos entre pacientes. OBJETIVO: Develar la opinión de las/os estudiantes de Kinesiología de la Universidad Mayor-Temuco con relación a las Precauciones Estándar. METODOLOGÍA: Estudio cualitativo, descriptivo y exploratorio, estudio intrínseco de caso, la muestra no probabilística, intencionada: 12 sujetos estudiante de kinesiología 2018; criterio de inclusión: haber aprobado la asignatura de Cuidados Básicos del Enfermo; recogida de datos: entrevistas en profundidad, se utilizaron notas de campo y se manejó el método de comparación constante, además esquema de la reducción progresiva. RESULTADOS: Para la categoría de significado de precauciones estándar surge medida de protección y seguridad para usuario y tratante; para precauciones estándar utilizadas en prácticas clínicas emerge las subcategorías de elementos y técnicas de barrera en forma análoga nace como categoría aplicabilidad de precauciones estándar de ella se desprenden campos clínicos, eventos clínicos del usuario y técnicas y procedimientos; para la categoría factores facilitadores: docente y estudiantes; en tanto factores obstaculizadores: curriculum. CONCLUSIONES: En los estudiantes existe un conocimiento deficiente y conceptos aislados sobre PE, utilizan principalmente guantes y lavado de manos; menor grado uso de mascarilla y pechera. Destaca positivamente conocimiento docente; factores obstaculizadores: aspectos teóricos deficientes curriculares; considerar modificaciones curriculares en aspectos conceptuales y procedimentales.

BACKGROUND: the standard precautions correspond to a group of infection prevention practices that are applied in the care of all patients, it aims to prevent the cross-transmission of microoganisms between patiens. OBJETIVE: to reveal the opinion of Kinesiology students at the Universidad Mayor-Temuco regarding standard precautions. METHODOLOGY: Qualitative, descriptive, and exploratory study, intrinsic case study, non-probabilistic sample, intentional: 12 subjects, kinesiology student of the year 2018; For data collection, in-depth interviews were used, field notes and the constant comparison method were used, in addition to the progressive reduction scheme. RESULTS: 173 units of meaning emerge, for the category of meaning of standard precautions, protection and security measure for user and trafficker arises; For standard precautions used in clinical practices, the subcategories of barrier elements and techniques emerge, the most mentioned, in an analogous way, the applicability of standard precautions is born as a category of clinical fields, clinical events of the user and techniques and procedures; for the category facilitating factors: teacher and student are the least mentioned; as impeding factors: curriculum. CONCLUSIONS: There is a deficient knowledge and isolated concepts about SP, mainly use gloves and hand washing; less degree the use of masks and scrubs. It is positively highlighted teacher's knowledge, and some of the hindering factors are the lack of theoretical aspects of the curriculum and the consideration for curriculum modifications to compensate conceptual and procedural aspects.

Medicalização e normalização da sociedade / Medicalization and normalization of society / Medicalización y normalización de la sociedade

Este artigo é um ensaio temático e teórico sobre as práticas de medicalização, a partir das análises de Michel Foucault sobre poderes e saberes da disciplina e da biopolítica, em um campo da bio-história e da normalização da sociedade. O texto apresenta alguns aspectos que sustentam processos de medicalização por meio da racionalidade patologizadora dos corpos e das relações sociais, culturais e subjetivas. A docilização da existência e a gerência da vida passaram a fazer parte dos cálculos no biopoder, se tornando dispositivos de governo das condutas, na sociedade contemporânea. Governar a vida em nome da expansão da mesma e do aumento da saúde implica um ato permanente de organizar os corpos e a saúde deles, de acordo com os critérios do Estado sobre saúde.

This article is a thematic and theoretical essay on the practices of medicalization, based on Michel Foucault's analysis of the powers and knowledges of discipline and biopolitics, in a field of bio-history and the normalization of society. The text presents some aspects that support processes of medicalization through the pathological rationality of bodies and social, cultural and subjective relations. The docilization of existence and the management of life became part of the calculations in biopower, becoming devices of governance of the conduct in contemporary society. Governing life in the name of expanding it and increasing health implies a permanent act of organizing their bodies and their health, according to the state's health points.

Este artículo es un ensayo temático y teórico sobre prácticas de medicalización, basado en el análisis de Michel Foucault de los poderes y el conocimiento de la disciplina y la biopolítica, en un campo de la biohistoria y la normalización de la sociedad. El texto presenta algunos aspectos que apoyan los procesos de medicalización a través de la racionalidad patologizante de los cuerpos y las relaciones sociales, culturales y subjetivas. La docilización de la existencia y el manejo de la vida se convirtieron en parte de los cálculos en biopoder, convirtiéndose en dispositivos para conducir conductas en la sociedad contemporánea. Gobernar la vida en nombre de expandirla y aumentar la salud implica un acto permanente de organizar sus cuerpos y su salud, de acuerdo con los criterios de salud del Estado.