IL-6/IL-10 and IL-1ß/IL-4 ratios associated with poor ovarian response in women undergoing in-vitro fertilization.

The aim of this work was to evaluate whether serum cytokines levels are associated with ovarian response in IVF. 149 patients were included in a retrospective study. Cytokines IL-2, IL-4, IL- 6, IL-8, IL-10, VEGF, IFNγ, TNFα, IL-1α, IL-1ß, MCP-1 and EGF were measured by sandwich immunoassay previously to ovarian stimulation. Performing hierarchical cluster analysis, we observed that the antral follicle count, the total oocytes recovered and the MII recovered are grouped in the same cluster as the cytokines IL-2-4-6-10-1α-1ß, IFNγ y TNFα. Then, we found that the ratio between IL and 6 and IL-10 was higher in low responder women (2.15 versus 1.55; p = 0.035). If we establish 0.9 as a cut-off for the IL-6/IL-10, we observed that above this value the risk of having a low response to ovarian stimulation was more than 3 times greater than below this value (22.9 % versus 6.0 %; p = 0.007). Also, the ratio IL-1ß/IL-4 was higher in patients with normal or suboptimal response (0.62 versus 0.34; p = 0.034) and any patient with low response had a value greater than 0.7 (p = 0.003). As a conclusion, the IL-6/IL-10 and IL-1ß/IL-4 ratios showed differences between normoresponder women and patients with low ovarian response.

[Comparison between extracorporeal shockwave therapy and radial pressure wave therapy in plantar fasciitis]. / Comparación de la terapia de ondas de choque extracorpóreas focales y presión radiales en la fascitis plantar.

OBJECTIVE: Plantar fasciitis is a common cause of heel pain. The aetiology of this condition remains unclear. Patients typically have pain upon palpation of the medial plantar calcaneal region. Extracorporeal shockwave therapy has shown favourable outcomes in various studies. The aim of this study was to compare the effect of focused extracorporeal shockwave therapy with radial pressure wave therapy. PATIENTS AND METHODS: Seventy-nine non-randomised patients diagnosed with plantar fasciitis were included between January 2017 and June 2018. Patients from the Arnau de Vilanova Hospital in Valencia were treated with focused extracorporeal shockwave therapy, and patients from Llíria Hospital with radial pressure wave therapy. Measured outcome variables were: visual analog scale; ultrasonographic measurement of plantar fascia thickness; self-reported foot-specific pain and disability using the Foot Function Index; self-reported health-related quality of life using the Euroqol-5D; self-reported pain and limitations of activity using the Roles & Maudsley Scale. RESULTS: At inclusion, the 2groups showed no significant differences in demographic or clinical characteristics. Three months after treatment completion, both groups showed improvement in all outcome variables, without statistically significant differences between the 2groups. No adverse effects or complications were observed. CONCLUSIONS: Both extracorporeal shockwave therapy and radial pressure wave therapy are effective treatments for plantar fasciitis.

[Treatment and evolution of chronic avulsion of the anterior tibial spine in the pediatric age]. / Tratamiento y evolución de la avulsión crónica de la espina tibial anterior en la edad pediátrica.

Tibial spine avulsion fractures (also called tibial eminence fractures) are bony avulsions of the anterior cruciate ligament (ACL) from its insertion in the intercondylar eminence. It is most commonly seen in children aged eight to 12 years, because LCA is more resistent than bone and physis. Furthermore, the union between epiphisys and LCA is very strong due to the collagen fibers. Meyers and McKeever classification defines three types: type I: non displaced; type II: partially dislaced; and type III: completely displaced. This classification is very important for the treatment. Arthroscopic treatment is the gold standard for displaced fractures. The association with other intraarticular injuries is frequent, and the anterior horn of the medial meniscus or the transverse meniscal ligament is frequently trapped within the fracture site. A miniarthrotomy may still be necessary in fractures that are irreducible by arthroscopic means. Its difficult to find chronic fractures in children in the literature. The treatment is similar to acute cases, but includes debridement of the scar tissue and reparation of intraarticular injuries. Loss of extension is the main problem we find in this patients, although acceptable results may be achieved. In this article we present a seven years old boy with a chronic tibial spine avulsion, the treatment and the outcome.

Las fracturas avulsión de la espina tibial anterior (también conocidas como fracturas de la eminencia tibial) son arrancamientos óseos del LCA (ligamento cruzado anterior) en su inserción en la eminencia intercondílea. Este tipo de lesión suele darse en pacientes de entre ocho y 12 años de edad, debido a que en el niño la resistencia del LCA es superior a la del hueso y el cartílago de crecimiento y a que éste está fuertemente unido a la epífisis. Se clasifican en tres tipos según Meyers y McKeever en función del grado de desplazamiento del fragmento. Dicha clasificación resulta fundamental para la decisión terapéutica. El tratamiento artroscópico es el estándar de oro para el tratamiento de fracturas desplazadas, ya que se debe tener en cuenta la frecuente asociación con otras patologías intraarticulares (como la interposición del cuerno anterior del menisco medial o del ligamento intermeniscal anterior). Complementariamente a la artroscopía, las miniartrotomías serán necesarias para la fijación con tornillos en los casos en los que la fractura sea irreductible por vía artroscópica. Son escasos los artículos publicados en la bibliografía sobre avulsiones crónicas en pacientes pediátricos. El tratamiento para estos casos es similar al de las fracturas agudas, otorgando mayor importancia al desbridamiento del tejido fibroso entre el fragmento óseo y el lecho y al tratamiento de patología intraarticular asociada. Se ha evidenciado en estos pacientes mayores dificultades para lograr la extensión completa de rodilla tras la cirugía pese a conseguirse una buena reducción. A pesar de ello, los resultados son satisfactorios a largo plazo. En este artículo se presenta el caso de un niño de siete años con una avulsión de la espina tibial anterior de larga evolución, así como el tratamiento realizado y el resultado funcional obtenido.

Phenol wastewater remediation: advanced oxidation processes coupled to a biological treatment.

Nowadays, there are increasingly stringent regulations requiring more and more treatment of industrial effluents to generate product waters which could be easily reused or disposed of to the environment without any harmful effects. Therefore, different advanced oxidation processes were investigated as suitable precursors for the biological treatment of industrial effluents containing phenol. Wet air oxidation and Fenton process were tested batch wise, while catalytic wet air oxidation and H2O2-promoted catalytic wet air oxidation processes were studied in a trickle bed reactor, the last two using over activated carbon as catalyst. Effluent characterisation was made by means of substrate conversion (using high liquid performance chromatography), chemical oxygen demand and total organic carbon. Biodegradation parameters (i.e. maximum oxygen uptake rate and oxygen consumption) were obtained from respirometric tests using activated sludge from an urban biological wastewater treatment plant (WWTP). The main goal was to find the proper conditions in terms of biodegradability enhancement, so that these phenolic effluents could be successfully treated in an urban biological WWTP. Results show promising research ways for the development of efficient coupled processes for the treatment of wastewater containing toxic or biologically non-degradable compounds.

Targeting Neuroinflammation to Treat Alzheimer's Disease.

Over the past few decades, research on Alzheimer's disease (AD) has focused on pathomechanisms linked to two of the major pathological hallmarks of extracellular deposition of beta-amyloid peptides and intra-neuronal formation of neurofibrils. Recently, a third disease component, the neuroinflammatory reaction mediated by cerebral innate immune cells, has entered the spotlight, prompted by findings from genetic, pre-clinical, and clinical studies. Various proteins that arise during neurodegeneration, including beta-amyloid, tau, heat shock proteins, and chromogranin, among others, act as danger-associated molecular patterns, that-upon engagement of pattern recognition receptors-induce inflammatory signaling pathways and ultimately lead to the production and release of immune mediators. These may have beneficial effects but ultimately compromise neuronal function and cause cell death. The current review, assembled by participants of the Chiclana Summer School on Neuroinflammation 2016, provides an overview of our current understanding of AD-related immune processes. We describe the principal cellular and molecular players in inflammation as they pertain to AD, examine modifying factors, and discuss potential future therapeutic targets.

Bimetallic catalysts for continuous catalytic wet air oxidation of phenol.

Catalytic wet oxidation has proved to be effective at eliminating hazardous organic compounds, such as phenol, from waste waters. However, the lack of active long-life oxidation catalysts which can perform in aqueous phase is its main drawback. This study explores the ability of bimetallic supported catalysts to oxidize aqueous phenol solutions using air as oxidant. Combinations of 2% of CoO, Fe2O3, MnO or ZnO with 10% CuO were supported on gamma-alumina by pore filling, calcined and later tested. The oxidation was carried out in a packed bed reactor operating in trickle flow regime at 140 degrees C and 900 kPa of oxygen partial pressure. Lifetime tests were conducted for 8 days. The pH of the feed solution was also varied. The results show that all the catalysts tested undergo severe deactivation during the first 2 days of operation. Later, the catalysts present steady activity until the end of the test. The highest residual phenol conversion was obtained for the ZnO-CuO, which was significantly higher than that obtained with the 10% CuO catalyst used as reference. The catalyst deactivation is related to the dissolution of the metal oxides from the catalyst surface due to the acidic reaction conditions. Generally, the performance of the catalysts was better when the pH of the feed solution was increased.

[Minimal intervention in smoking in the outpatient pneumonology consultation]. / Intervención mínima sobre el trabaquismo en la consulta neumológica extrahospitalaria.

Brief intervention (BI) in smoking has been shown to be an effective way of stopping smoking in the general population. BI involves medical advice given to each smoking patient, with complementary information on the effects of smoking on the body and methods of giving up the habit. Patients who come to the clinic with respiratory disease may be especially receptive to BI since the strong link between their symptoms and smoking may increase their motivation for cessation. A BI protocol on smoking was applied in 285 smokers seen in an outpatient pneumological clinic. Two hundred eight smokers (group A) received medical advice and health care education with the offer of follow up. Seventy-seven smokers (group B) received the same BI protocol, with the offer of support treatment with nicotine gum (2 mg) and an explanation as to its use. One year after BI the patients were contacted by telephone to determine the number of non-smokers, with the result adjusted according to the truth index (71.4%) known for telephone response in this context. A total of 71 (24.9%) smokers were not located by telephone due to change of address, wrong number, exitus or lack of telephone. The estimated number of non-smokers in group A was 31.5/160 (19.7%) and 8.6/54 (15.9%) (non significant difference, chi square test). Group B's use of nicotine gum was therapeutically significant in 11.0% of the cases. We conclude that the efficacy of BI in the outpatient pneumological clinic is high.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization and performance of carbonaceous materials obtained from exhausted sludges for the anaerobic biodecolorization of the azo dye Acid Orange II.

This work presents the preliminary study of new carbonaceous materials (CMs) obtained from exhausted sludge, their use in the heterogeneous anaerobic process of biodecolorization of azo dyes and the comparison of their performance with one commercial active carbon. The preparation of carbonaceous materials was conducted through chemical activation and carbonization. Chemical activation was carried out through impregnation of sludge-exhausted materials with ZnCl2 and the activation by means of carbonization at different temperatures (400, 600 and 800°C). Their physicochemical and surface characteristics were also investigated. Sludge based carbonaceous (SBC) materials SBC400, SBC600 and SBC800 present values of 13.0, 111.3 and 202.0m(2)/g of surface area. Biodecolorization levels of 76% were achieved for SBC600 and 86% for SBC800 at space time (τ) of 1.0min, similar to that obtained with commercial activated carbons in the continuous anaerobic up-flow packed bed reactor (UPBR). The experimental data fit well to the first order kinetic model and equilibrium data are well represented by the Langmuir isotherm model. Carbonaceous materials show high level of biodecolorization even at very short space times. Results indicate that carbonaceous materials prepared from sludge-exhausted materials have outstanding textural properties and significant degradation capacity for treating textile effluents.

Tratamiento y evolución de la avulsión crónica de la espina tibial anterior en la edad pediátrica / Treatment and evolution of chronic avulsion of the anterior tibial spine in the pediatric age

Resumen: Las fracturas avulsión de la espina tibial anterior (también conocidas como fracturas de la eminencia tibial) son arrancamientos óseos del LCA (ligamento cruzado anterior) en su inserción en la eminencia intercondílea. Este tipo de lesión suele darse en pacientes de entre ocho y 12 años de edad, debido a que en el niño la resistencia del LCA es superior a la del hueso y el cartílago de crecimiento y a que éste está fuertemente unido a la epífisis. Se clasifican en tres tipos según Meyers y McKeever en función del grado de desplazamiento del fragmento. Dicha clasificación resulta fundamental para la decisión terapéutica. El tratamiento artroscópico es el estándar de oro para el tratamiento de fracturas desplazadas, ya que se debe tener en cuenta la frecuente asociación con otras patologías intraarticulares (como la interposición del cuerno anterior del menisco medial o del ligamento intermeniscal anterior). Complementariamente a la artroscopía, las miniartrotomías serán necesarias para la fijación con tornillos en los casos en los que la fractura sea irreductible por vía artroscópica. Son escasos los artículos publicados en la bibliografía sobre avulsiones crónicas en pacientes pediátricos. El tratamiento para estos casos es similar al de las fracturas agudas, otorgando mayor importancia al desbridamiento del tejido fibroso entre el fragmento óseo y el lecho y al tratamiento de patología intraarticular asociada. Se ha evidenciado en estos pacientes mayores dificultades para lograr la extensión completa de rodilla tras la cirugía pese a conseguirse una buena reducción. A pesar de ello, los resultados son satisfactorios a largo plazo. En este artículo se presenta el caso de un niño de siete años con una avulsión de la espina tibial anterior de larga evolución, así como el tratamiento realizado y el resultado funcional obtenido.

Abstract: Tibial spine avulsion fractures (also called tibial eminence fractures) are bony avulsions of the anterior cruciate ligament (ACL) from its insertion in the intercondylar eminence. It is most commonly seen in children aged eight to 12 years, because LCA is more resistent than bone and physis. Furthermore, the union between epiphisys and LCA is very strong due to the collagen fibers. Meyers and McKeever classification defines three types: type I: non displaced; type II: partially dislaced; and type III: completely displaced. This classification is very important for the treatment. Arthroscopic treatment is the gold standard for displaced fractures. The association with other intraarticular injuries is frequent, and the anterior horn of the medial meniscus or the transverse meniscal ligament is frequently trapped within the fracture site. A miniarthrotomy may still be necessary in fractures that are irreducible by arthroscopic means. It's difficult to find chronic fractures in children in the literature. The treatment is similar to acute cases, but includes debridement of the scar tissue and reparation of intraarticular injuries. Loss of extension is the main problem we find in this patients, although acceptable results may be achieved. In this article we present a seven years old boy with a chronic tibial spine avulsion, the treatment and the outcome.

Detection and characterization of urinary metabolites of boldione by LC-MS/MS. Part I: Phase I metabolites excreted free, as glucuronide and sulfate conjugates, and released after alkaline treatment of the urine.

Boldione (1,4-androstadien-3,17-dione) is included in the list of prohibited substances, issued by the World Anti-Doping Agency (WADA). Endogenous production of low concentrations of boldione has also been reported. The objective of this study was to assess boldione metabolism in humans. Detection of boldione metabolites was accomplished by analysis by liquid chromatography coupled to tandem mass spectrometry of urine samples obtained after administration of the drug and subjected to different sample preparation procedures to analyze the different metabolic fractions (free, glucuronides, sulpfates and released in basic media). In addition to boldione, eight metabolites were detected in the free fraction. Four of them were identified by comparison with standards: 6ß-hydroxy-boldenone (M3), androsta-1,4,6-triene-3,17-dione (M5), (5α)-1-androstenedione (M6) and (5α)-1-testosterone (M8). Metabolite M7 was identified as the 5ß-isomer of 1-androstenedione, and metabolites M1, M2 and M4 were hydroxylated metabolites and tentative structures were proposed based on mass spectrometric data. After ß-glucuronidase hydrolysis, five additional metabolites excreted only as conjugates with glucuronic acid were detected: boldenone, (5ß)-1-testosterone (M9), and three metabolites resulting from reduction of the 3-keto group. Boldenone, epiboldenone, and hydroxylated metabolites of boldione, boldenone and 1-testosterone were detected as conjugates with sulfate. In addition, boldione and seven metabolites (boldenone, M2, M3, M4, M5, M7 and M9) increased their concentration in urine after treatment of the urine in alkaline conditions. In summary, 15 boldione metabolites were detected in all fractions. The longer detection time was observed for metabolite M4 after alkaline treatment of the urine, which was detected up to 5 days after boldione administration.

Immobilisation of horseradish peroxidase on EupergitC for the enzymatic elimination of phenol.

In this study, three different approaches for the covalent immobilisation of the horseradish peroxidase (HRP) onto epoxy-activated acrylic polymers (EupergitC) were explored for the first time, direct HRP binding to the polymers via their oxirane groups, HRP binding to the polymers via a spacer made from adipic dihydrazide, and HRP binding to hydrazido polymer surfaces through the enzyme carbohydrate moiety previously modified by periodate oxidation. The periodate-mediated covalent immobilisation of the HRP on hydrazido EupergitC was found to be the most effective method for the preparation of biocatalysts. In this case, a maximum value of the immobilised enzyme activity of 127 U/g(support) was found using an enzyme loading on the support of 35.2mg/g(support). The free and the immobilised HRP were used to study the elimination of phenol in two batch reactors. As expected, the activity of the immobilised enzyme was lower than the activity of the free enzyme. Around 85% of enzyme activity is lost during the immobilisation. However, the reaction using immobilised enzyme showed that it was possible to reach high degrees of phenol removal (around 50%) using about one hundredth of the enzyme used in the soluble form.

Comparación de la terapia de ondas de choque extracorpóreas focales y presión radiales en la fascitis plantar / Comparison between extracorporeal shockwave therapy and radial pressure wave therapy in plantar fasciitis

OBJETIVO: La fascitis plantar es una causa frecuente de dolor plantar, de etiología mal definida. Los pacientes presentan dolor a la palpación de la tuberosidad medial del calcáneo. Los tratamientos con ondas de choque extracorpóreas han demostrado resultados positivos. El objetivo de este estudio es comparar la efectividad de tratamientos con ondas de choque focales y ondas de presión radial. PACIENTES Y MÉTODOS: Setenta y nueve pacientes diagnosticados de fascitis plantar fueron incluidos entre enero del 2017 y junio del 2018, de manera no aleatorizada. Se aplicó un tratamiento por ondas de choque focales a los pacientes del Hospital Arnau de Vilanova de Valencia y un tratamiento por ondas de presión radiales a los pacientes de Hospital de Llíria. Las variables de resultado estudiadas fueron: dolor evaluado por escala visual analógica; grosor de la fascia plantar medido por ecografía; dolor, discapacidad, limitación de actividades y calidad de vida autoevaluadas mediante el Foot Function Index, el Euroqol-5D y la escala de Roles y Maudsley. RESULTADOS: Al inicio del estudio, los 2grupos no mostraban diferencias significativas en cuanto a variables sociodemográficas y clínicas. Tres meses tras finalizar el tratamiento, observamos una mejoría en ambos grupos en todas las variables de resultado, sin obtener diferencias significativas entre los 2 grupos. No registramos efectos adversos ni complicaciones. CONCLUSIONES: Tanto las ondas de choque focales como las ondas de presión radiales son terapias con un perfil de efectividad y seguridad equivalente en el tratamiento de la fascitis plantar

OBJECTIVE: Plantar fasciitis is a common cause of heel pain. The aetiology of this condition remains unclear. Patients typically have pain upon palpation of the medial plantar calcaneal region. Extracorporeal shockwave therapy has shown favourable outcomes in various studies. The aim of this study was to compare the effect of focused extracorporeal shockwave therapy with radial pressure wave therapy. PATIENTS AND METHODS: Seventy-nine non-randomised patients diagnosed with plantar fasciitis were included between January 2017 and June 2018. Patients from the Arnau de Vilanova Hospital in Valencia were treated with focused extracorporeal shockwave therapy, and patients from Llíria Hospital with radial pressure wave therapy. Measured outcome variables were: visual analog scale; ultrasonographic measurement of plantar fascia thickness; self-reported foot-specific pain and disability using the Foot Function Index; self-reported health-related quality of life using the Euroqol-5D; self-reported pain and limitations of activity using the Roles & Maudsley Scale. RESULTS: At inclusion, the 2groups showed no significant differences in demographic or clinical characteristics. Three months after treatment completion, both groups showed improvement in all outcome variables, without statistically significant differences between the 2 groups. No adverse effects or complications were observed. CONCLUSIONS: Both extracorporeal shockwave therapy and radial pressure wave therapy are effective treatments for plantar fasciitis

[Quality in compliance and prescription of nursing treatment orders for injectable drugs]. / Calidad en la cumplimentación y prescripción de las órdenes de tratamiento de enfermería para medicación inyectable.

OBJECTIVES: To analyse the quality of prescription and compliance with nursing treatment orders (NTOs) in primary care teams (PCTs), in order to identify potential problems and establish interventions. DESIGN: Observational, crossover study. SETTING: Three health districts in Santa Coloma de Gramenet. PATIENTS AND OTHER PARTICIPANTS: NTO forms for injectable medication referred to nursing from PCTs between March 1 and November 30, 1996. MEASUREMENTS AND MAIN RESULTS: 1,088 NTO sheets containing 1,119 prescriptions were evaluated. 64.61% of the NTOs came from PCTs. Compliance with the NTO on the length of treatment (63.33%), on length and guidelines taken together (58.00%) and on allergies to medicine (28.31%) was deficient. The most prescribed therapeutic groups were medicines for the locomotive apparatus (36.10%) and drugs for infections (24.66%). 56.03% of prescriptions had high intrinsic value. It was difficult to justify 72.48% of prescriptions. CONCLUSIONS: Deficiencies were detected in compliance with NTOs, due to the absence of information which was vital for correct administration. There was low-quality prescription and over-use of parenteral administration.

[Travelling immigrants]. / Los inmigrantes viajeros.

OBJECTIVES: To characterise travelling immigrants and the international movements they undertake. To identify the risk journeys that this population makes and to assess the international preventive activities for them compared with those for autochthonous travellers. DESIGN: Retrospective, observational study. SETTING: Unit of International Health (UIH) Santa Coloma de Gramenet (Barcelona), in the Barcelonès Nord i Maresme Health Area, Primary Care Division of the Catalan Institute of Health. PARTICIPANTS: Patients seen between June 1999 and June 2002 (n=1163) at the UIH. They were divided into two groups, depending on their origins: those born inside (autochthonous group; no=1019) or outside (immigrant group; n1=144) the European Union. MAIN MEASUREMENTS: Age, country of origin, length of residence in Spain, interval between consultation and journey, reason for journey, destination, duration of the journey, kind of journey, stay in rural or isolated area, exposure to malaria, vaccinations and anti-malaria chemoprophylaxis prescribed, and overall risk of journey. RESULTS: Immigrants spent more time abroad than autochthonous people (mean 43.5 days; 95% CI, 37.9-49.1; and 15.8 days, 95% CI, 14.9-16.7, respectively; P<.0001). Periods between the journey and the consultation at the UIH were generally similar in the two groups (mean of 26.8 days for immigrants and 30.41 days for autochthonous people; ns), although the immigrants consulted more often in periods of less than 15 and 7 days (P<.005). 31.9% of immigrants stayed in areas of high malaria transmission (95% CI, 24.4%-39.6%) vs 21.3% (95% CI, 18.8%-23.8%) of autochthonous people (P=.04). Overall, immigrants made more risk journeys than autochthonous people (54.8% vs 43.1%; P<.01). No significant differences between the two groups were found in terms of quality in the administration of the international vaccinations prescribed. Compliance with the guidelines for anti-malaria chemoprophylaxis was less in the immigrant group than in the autochthonous one (36% vs 84%; P<.005). CONCLUSIONS: The immigrant group in our environment needs to be thought of as a risk group for catching and importing tropical diseases during their international movements. They form a population for whom international preventive measures should be prioritized.

Drogas de abuso: evaluación de las unidades de conductas / Testing for drugs of abuse in the behaviour units

Los objetivos planteados en este trabajo son, contribuir a la verificación del uso de drogas de abuso y sustancias estupefacientes y evaluar el grado de dependencia en población drogadicta del Área Sanitaria nº 17 de la Comunidad Valenciana así como verificar el cumplimiento del tratamiento y la identificación de la dosis terapéutica eficaz del fármaco sustitutivo (metadona) a través de los programas establecidos en la Unidad de Conductas Adictivas (UCA). Los resultados que se presentan se obtuvieron del análisis de las muestras de orina procedentes de 5148 pacientes, durante el periodo anual comprendido entre octubre de 2000 a septiembre de 2001. A las muestras de orina de dichos pacientes se les practicaron un total de 7921 determinaciones de drogas de abuso de las que el 86,68 por ciento fueron negativas y el 13,32 por ciento fueron positivas. Según el tipo de sustancia ingerida se obtuvieron los siguientes resultados: Cocaína se practicaron 4220 determinaciones, resultando 88,65 por ciento negativas y 11,35 por ciento positivas. Opio se practicaron 2415 determinaciones, resultando 85,51 por ciento negativas y 14,41 por ciento positivas. Anfetaminas se practicaron 746 determinaciones, resultando 96,65 por ciento negativas y 3,35 por ciento positivas. Cannabinoides se practicaron 540 determinaciones, resultando 62,4 por ciento negativas y 37,59 por ciento positivas. Metadona se practicaron 238 determinaciones, resultando 10,92 por ciento negativas y 89,08 por ciento positivas. En conjunto de los individuos analizados 8 de cada 10 fueron negativos en los análisis que se practicaron en el consumo total de drogas de abuso. Los resultados de nuestro estudio, vienen a corroborar el informe del Observatorio Español sobre Drogas que presentó nuevos datos, en el que la cocaína fue en 1999 la droga más mencionada en las urgencias hospitalarias por consumo de sustancias psicoactivas, y además fue la droga que provocó más muertes por reacción aguda tras consumo, y su creciente impacto sanitario y epidemiológico corre parejo al debilitamiento de la heroína. (AU)

Contribución del análisis cinético de la marcha a la valoración de los trastornos del equilibrio de origen otorrinolaringológico / Contribution of kinetic analysis of the gain to the evaluation of otorhinolaryngology –originated balance disorders

Resumen.—Introducción. La inestabilidad en la marcha esuno de los síntomas presentes en los sujetos con trastornos del equilibrio. Sin embargo, todavía se desconoce qué parámetros se ven alterados en dichos pacientes. Este estudio pretende profundizar en el conocimiento de la contribución del análisis cinético de la marcha en la valoración funcional de pacientes con trastornos del equilibrio, a través de la comparaciónde dos parámetros globales de valoración de la marchaen seres humanos.Material y métodos. Se analizó la marcha de 349 pacientescon trastornos de equilibrio y 60 controles con el sistema NedAMH/IBV. Dicho sistema proporciona un índice de capacidad funcional de la marcha y otros parámetros como fuerzas verticales, anteroposteriores y mediolaterales, velocidad y tiempo de apoyo expresados como porcentaje de normalidad. El análisis de los parámetros medidos en la población con alteraciones del equilibrio mediante regresión logística binaria permitió obtener un nuevo índice clasificador (índicede equilibrio dinámico) entre pacientes y controles, que se comparó con el primero.Resultados y discusión. El nuevo índice clasificador ha resultado ser muy similar al índice de capacidad funcional de la marcha, por lo que concluimos que el sistema NedAMH/IBV permite valorar de forma objetiva el estado funcional de pacientes con trastornos del equilibrio

Introduction. Gait unsteadiness is one of thesymptoms reported by patients with balance disorders. However, it is still unknown as to which gait parameters are altered. This study aims to study in greater depth the knowledge regarding the contribution of kinetic analysis of gait to the functional assessment of patients with balance disorders by comparing two global parameters of evaluation of the human gait.Material and methods. The gait of 349 patients with balance disorders and 60 controls were analyzed with the NedAMH/ IBVÆÊ system. This system provides a functional capability index and other kinetics variables (vertical, anterior-posterior, media-lateral forces, velocity and time of support) on the gait expressed as a normality percentage. Analysis of the parametersmeasured in the population with balance disordersusing binary logistic regression made it possible to obtain a new classifying index (Dynamic Balance Index) between patients and controls that was compared with the first one.Results and discussion. The new classifying index is very similar to the Functional Capabilities Index of gait, so that we have concluded that the NedAMH/IBVÆÊ system makes it possible to evaluate objectively the functional status of patients with balance disorders (AU)

Contribución del análisis cinético de la marcha a la valoración de los trastornos del equilibrio de origen otorrinolaringológico / Contribution of kinetic analysis of the gain to the evaluation of otorhinolaryngology-originated balance disorders

Introducción. La inestabilidad en la marcha es uno de los síntomas presentes en los sujetos con trastornos del equilibrio. Sin embargo, todavía se desconoce qué parámetros se ven alterados en dichos pacientes. Este estudio pretende profundizar en el conocimiento de la contribución del análisis cinético de la marcha en la valoración funcional de pacientes con trastornos del equilibrio, a través de la comparación de dos parámetros globales de valoración de la marcha en seres humanos. Material y métodos. Se analizó la marcha de 349 pacientes con trastornos de equilibrio y 60 controles con el sistema NedAMH/IBV¿. Dicho sistema proporciona un índice de capacidad funcional de la marcha y otros parámetros como fuerzas verticales, anteroposteriores y mediolaterales, velocidad y tiempo de apoyo expresados como porcentaje de normalidad. El análisis de los parámetros medidos en la población con alteraciones del equilibrio mediante regresión logística binaria permitió obtener un nuevo índice clasificador (índice de equilibrio dinámico) entre pacientes y controles, que se comparó con el primero. Resultados y discusión. El nuevo índice clasificador ha resultado ser muy similar al índice de capacidad funcional de la marcha, por lo que concluimos que el sistema NedAMH/IBV¿ permite valorar de forma objetiva el estado funcional de pacientes con trastornos del equilibrio

Introduction. Gait unsteadiness is one of the symptoms reported by patients with balance disorders. However, it is still unknown as to which gait parameters are altered. This study aims to study in greater depth the knowledge regarding the contribution of kinetic analysis of gait to the functional assessment of patients with balance disorders by comparing two global parameters of evaluation of the human gait. Material and methods. The gait of 349 patients with balance disorders and 60 controls were analyzed with the NedAMH/ IBV¿ system. This system provides a functional capability index and other kinetics variables (vertical, anterior-posterior, media-lateral forces, velocity and time of support) on the gait expressed as a normality percentage. Analysis of the parameters measured in the population with balance disorders using binary logistic regression made it possible to obtain a new classifying index (Dynamic Balance Index) between patients and controls that was compared with the first one. Results and discussion. The new classifying index is very similar to the Functional Capabilities Index of gait, so that we have concluded that the NedAMH/IBV¿ system makes it possible to evaluate objectively the functional status of patients with balance disorders

Análisis de la demanda analítica y de los costes, como indicador de gestión de un laboratorio en un área sanitaria / Analysis of asistential activity and cost as a marker of laboratory management

The aims are raised in this work are, knowing the asistential activity from origin and planning depending on this activity, the human resources, technological resources and flow work, as well as the cost of this activity.233.481 patients were analized in a year and were practice da 2.640.032 amount of analitical tests. They were classified depending on the origin of the requests about: Normal hospitalization, emergency hospitalitation, emergencycares, medical revisions, Elda speciality centre, Villena speciality centre, primary attention, and other centres. The cost of biochemical determination in the 2001 was0,87 €. The laboratory cost represents a 8,29% regarding to the whole hospital cost. About data analysis we can mention that the main request of each 10 test were 6 from extra hospitalary patients. These samples are obtained from different centres outsidet he hospital, so the control of preanalitical phase from side of the laboratory is very important. It is important to mention that 13,63% of hospitalized patients there is a 13,72% of emergency tests and this involves a bad use emergency laboratory from medical doctors side. The global activity has increased in a 9,98% in patients and a 6,11% in laboratory tests regarding the previous year. The habitant/year cost in our health area is aproximately19,3 € being similar with european media based on EDMA(European Diagnostics Manufactures Association). The cost of the diagnostic represents the 10-12 of chapter II

Los objetivos que se plantean en el presente estudio son, conocerla actividad asistencial por orígenes y planificar en función de dicha actividad los recursos humanos, tecnológicos y las cargas de trabajo, así como conocer el coste de dicha actividad. Se analizaron 233.481 pacientes en un año a los que se les practicaron un total de 2.640.032 determinaciones. Se clasificaron según el origen de las peticiones en: Hospitalización ordinaria, Hospitalización urgente, Urgencias de Puerta, Consultas Externas, Centro de Especialidades de Elda, Centro de Especialidades de Villena, Atención Primaria y Remitidas a otros centros. El coste por determinación bioquímica en el año 2001 fue de0.87 €. El gasto del laboratorio representa un 8.29% respecto del total del gasto hospitalario. Del análisis de los datos cabe destacar que la mayor demanda de actividad analítica era la procedente de pacientes extrahospitalarios que generan 6 de cada 10 determinaciones analíticas. Estas muestras se obtienen en Centros de extracción periféricos, lo que implica la importancia por parte del laboratorio del control de la fase preanalítica. También cabe resaltar que de los pacientes hospitalizados, al 13,63%, se les solicitaron el 13,72% de las determinaciones urgentes, lo que pensamos que se está haciendo un mal uso del laboratorio de urgencias que por parte de los clínicos. La actividad global se ha incrementado en un 9,98% en pacientes y en un 6,11% en determinaciones respecto del año anterior. El gasto por habitante/año en diagnóstico en nuestra Área Sanitaria es aproximadamente de 19.3 € (3.212 pts), estando en línea con la media europea según datos de EDMA- European Diagnostics Manufactures Association. El gasto en diagnostic oscila entre el 10-12% del capítulo II según la misma fuente

Los inmigrantes viajeros / Travelling immigrants

Objetivos. Caracterizar a los inmigrantes viajeros y los desplazamientos internacionales que realizan. Identificar los viajes de riesgo que efectúa dicha población, así como valorar las actividades preventivas internacionales que reciben en relación con las aplicadas a viajeros autóctonos. Diseño. Estudio observacional retrospectivo. Emplazamiento. Unidad de Salud Internacional (USAI) de Santa Coloma de Gramenet (Barcelona). Ámbito Sanitario del Barcelonès Nord i Maresme. División de Atención Primaria. Institut Català de la Salut. Participantes. Pacientes visitados desde junio de 1999 a junio de 2002 (n = 1.163) en la USAI. Se definieron dos grupos según su procedencia: nacidos en la Unión Europea (grupo autóctono; n0 = 1.019) o fuera de ella (grupo inmigrante; n1 = 144).Medidas principales. Edad, país de origen, tiempo de residencia en España, intervalo entre consulta/viaje, motivo del viaje, destino, duración del viaje, tipo de viaje, estancia en zona rural o aislada, exposición a paludismo, vacunaciones y quimioprofilaxis antipalúdica prescritas y riesgo global del viaje. Resultados. Los inmigrantes residen en el extranjero durante más tiempo que los autóctonos (media, 43,5 días; intervalo de confianza [IC] del 95 por ciento, 37,9-49,1 y 15,8 días; IC del 95 por ciento, 14,9-16,7, respectivamente; p < 0,0001). Los períodos comprendidos entre el viaje y la consulta a la USAI son globalmente similares en ambos grupos (media de 26,8 días para inmigrantes y 30,41 días para autóctonos; p = NS), aunque los inmigrantes consultan con mayor frecuencia para períodos menores de 15 y 7 días (p < 0,005). Residieron en zonas de alta transmisión palúdica el 31,9 por ciento (IC del 95 por ciento, 24,4-39,6) de los inmigrantes frente al 21,3 por ciento (IC del 95 por ciento, 18,8-23,8) de los autóctonos (p = 0,04). En conjunto, los inmigrantes realizaron un mayor número de viajes de riesgo que los autóctonos (un 54,8 frente al 43,1 por ciento; p < 0,01). No se hallaron diferencias significativas entre ambos grupos en cuanto a la calidad en la administración de las vacunaciones internacionales prescritas. El cumplimiento de la pauta de quimioprofilaxis antipalúdica fue menor en el grupo de inmigrantes respecto al de autóctonos (el 36 frente al 84 por ciento; p < 0,005). Conclusiones. Cabe considerar el colectivo inmigrante de nuestro ámbito como un grupo de riesgo para la adquisición e importación de enfermedades tropicales durante sus desplazamientos internacionales. Conforman una población en la que se debería priorizar la recepción de medidas preventivas internacionales (AU)

Eficacia del tratamiento de la gonartrosis con Ácido Hialurónico intraarticular. Valoración funcional basada en parámetros cinéticos / Efficacy of the treatment of gonarthrosis with intraarticular Hyaluronic Acid. Functional assessment based on kinetic parameters

Numerosos trabajos avalan, utilizando escalas analógico-visuales y tests funcionales, la utilidad clínica del Ácido Hialurónico en el tratamiento de la gonartrosis. La finalidad de este trabajo es valorar de una manera objetiva y reproducible, basándose en la obtención de parámetros cinéticos, la mejoría funcional en la deambulación que se obtiene en este tipo de pacientes tras la administración intraarticular de Ácido Hialurónico. Para ello, utilizando una pista instrumentada con plataformas dinamométricas, comparamos la marcha de un grupo control con la de un grupo de mujeres gonartrósicas antes y después de ser tratadas con Ácido Hialurónico. Para ello, analizamos los picos más característicos de la fuerza de reacción contra el suelo. El tratamiento estadístico efectuado ha consistido en el análisis multifactorial de la varianza (ANOVA), para cada una de las variables analizadas, utilizando como covariable la cadencia y como factor de agrupamiento el grupo al que pertenece cada análisis (control, pretratamiento o postratamiento).Tras la administración de Ácido Hialurónico se constata un incremento significativo (p<0,05) de los tres picos de la componente vertical de la fuerza de reacción contra el suelo. En todos los parámetros analizados, a excepción del valor mínimo de la fuerza medio-lateral, se observa, tras el tratamiento, un acercamiento a los valores del grupo control. Por todo ello, basándonos en los resultados obtenidos, podemos concluir que, tras la administración de Ácido Hialurónico hemos registrado una mejoría funcional en los pacientes tratados (AU)