DISE with CPAP: a useful procedure to evaluate upper airway collapsibility.

PURPOSE: Drug-induced sleep endoscopy (DISE) is commonly performed in patients suffering obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) intolerance. We aimed to evaluate the effects of adding CPAP to DISE to provide understanding of the reason of its failure and better guidance in future therapeutic decisions. METHODS: A retrospective observational descriptive study was conducted on CPAP-intolerant patients with moderate-severe OSA. DISE was used to evaluate upper airway collapsibility, and CPAP was tested to better describe anatomical sites of obstruction and to measure the opening pharyngeal pressure. RESULTS: Sample size consisted of 38 patients with a mean age of 49 ± 9 years. Mean BMI was 28.4 ± 2.4 kg/m2, mean apnea-hypopnea index (AHI) was 35.4 events per hour ± 20.1, and mean saturation under 90% (TSat90) was 14.5%. In DISE we found a collapse at Velum in 92% of patients, at Oropharyngeal level in 89%, at tongue in 42%, and at epiglottis in 36%. In the subgroup of patients with clinical failure with CPAP, we observed 100% of epiglottic collapse and 50% of tongue obstruction. In this specific population, we recommended personalized surgery and myofunctional therapy. CONCLUSION: DISE-CPAP is a useful tool to select the treatment that better fits to each patient taking care all information available. It improves our ability to prescribe a multilevel treatment with an exhaustive topographic evaluation of upper airway collapsibility that complements CPAP classic titration, and it can be helpful to distinguish better candidates for surgery, myofunctional therapy or CPAP.

Factor XIII in major burns coagulation.

BACKGROUND: In the days following a burn injury, major burn patients (MBP) present a multifactorial coagulation disorder known as acute burn-induced coagulopathy. Several studies have investigated coagulation in MBPs; however, Factor XIII (FXIII), which converts fibrin monomers into a stable clot and promotes wound healing, has not yet been studied. OBJECTIVE: To determine the kinetics of FXIII and other coagulation factors and cofactors in MBPs in order to clarify coagulopathy in these patients and its potential relationship with surgical bleeding. METHODS: Prospective observational pilot study of the kinetics of FXIII and other coagulation factors and cofactors in MBPs during the first 30 days of burn injury. RESULTS: FXIII levels show a significant decline of 75.10% in the interval between the burn injury and surgery, and a decline of 87.70% in the 24 h following surgery. Patients undergo surgery with a median antigenic FXIII of 32%. Plasma levels of most factors decrease significantly 24 h after the burn injury. CONCLUSION: MBPs experience a significant decrease in plasma levels of FXIII from the time of admission up to 24 h after surgery. Abnormally low levels were observed at the time of surgery that could not be detected by other coagulation tests. The decrease in most factors at 24 h seems to be associated with dilution due to intensive fluid resuscitation.

Pd-imidate@SBA-15: a multifunctional heterogeneous catalyst for the aqueous room temperature hydrogenation of CO2 to formic acid.

The incorporation of hydrophilic and basic sites from phosphotriazaadamantane and saccharine in a water-soluble Pd complex and the subsequent confinement into mesoporous silica support increases the activity and stability of the palladium catalytic species for the room-temperature aqueous hydrogenation of either bicarbonate or CO2 into formic acid. The use of low Pd loadings (<0.1mmolPd·g-1) of the well-dispersed complex on SBA-15 mesoporous silica allows performing the reaction under room temperature, and aqueous conditions, exhibiting TON of ca. 40-100, for the CO2 or bicarbonate hydrogenation, respectively, which is one order of magnitude higher than the homogeneous case, allowing the easy isolation and recycling of the solid catalyst.

RNA extended interventional nucleic acid longitudinal study: Clinical performance of Aptima messenger RNA HPV testing in cervical cancer screening with a 9-year follow-up.

BACKGROUND: There is a need for additional longitudinal studies with the Aptima messenger RNA human papillomavirus test (AHPV) to support the safety of extended screening intervals. RNA-based extended interventional nucleic acid (REINA) provides relevant information on the clinical performance of AHPV. METHODS: This is a longitudinal prospective analysis of 1538 participants after AHPV and liquid-based cytology (LBC) co-test complemented with REINA interventional protocol with a second co-test 4 years after negative screening on 2000 women. Diagnostic accuracy and cumulative risks for CIN2+ up to 9 years were calculated for all test combinations. RESULTS: Sensitivity and specificity for CIN2+ were 96.9% and 88.0% for AHPV and 72.3% and 92.0% for LBC. Negative predictive value (NPV) and positive predictive value (PPV) of AHPV were 99.9% and 23.6%. The 5- and 9-year risks of AHPV-negative women were 0.4% and 1.0% (CIN2+) and 0.3% and 0.7% (CIN3+), a 73% and 64% lower risk than with negative LBC (p ≤ .002). REINA participants with an AHPV-positive result at second co-test after a negative AHPV in first round had a significantly lower 5-year risk of CIN2+ (11.1%) than AHPV-positive women with unknown HPV history (29.5%). CONCLUSIONS: Currently, this constitutes the longest European longitudinal study with AHPV testing in screening population. It reveals 99.9% NPV and a significant protective effect of a previous negative test 5 years after a new HPV infection. These findings support the safety of Aptima for screening intervals beyond 5 years. The risk of disease is lower 9 years after a negative AHPV test than 3 years after a negative LBC. High specificity and PPV of Aptima may benefit controlling overtreatment and colposcopy referrals.

Modifications in Upper Airway Collapsibility during Sleep Endoscopy with a Mandibular Positioner: Study in Snorers and Obstructive Sleep Apnea Patients.

BACKGROUND: Mandibular advancement devices (MADs) are an effective treatment for patients with sleep-related breathing disorders, with variable response. Increasingly more research points to the predictive value of Drug-Induced Sleep Endoscopy (DISE) in patient selection. This study aims to analyze the changes in upper airway collapsibility using a titratable MAD simulator during DISE. METHODS: This study included 104 patients with simple snoring and obstructive sleep apnea (OSA). The VOTE scale was used to assess the presence of collapses during the DISE both without and with the MAD simulator. RESULTS: In snorers, there was a decrease in collapses at the level of the soft palate and oropharynx when the advancement was achieved. Patients with mild OSA also showed a decrease in collapses at the base of the tongue. Patients with moderate/severe OSA exhibited significant amelioration at all levels. The levels at which there were residual collapses despite the maneuver were, in order, the velopharynx, oropharynx, epiglottis, and tongue. CONCLUSIONS: The MAD simulator reduces collapsibility at all levels and in all severity groups. Residual collapses suitable for combined treatments were able to be identified. This highlights the need for individualized patient selection, as upper airway collapsibility exhibits variable improvement or worsening with the MAD simulator regardless of the severity of the condition.

Defective mitochondria remodelling in B cells leads to an aged immune response.

The B cell response in the germinal centre (GC) reaction requires a unique bioenergetic supply. Although mitochondria are remodelled upon antigen-mediated B cell receptor stimulation, mitochondrial function in B cells is still poorly understood. To gain a better understanding of the role of mitochondria in B cell function, here we generate mice with B cell-specific deficiency in Tfam, a transcription factor necessary for mitochondrial biogenesis. Tfam conditional knock-out (KO) mice display a blockage of the GC reaction and a bias of B cell differentiation towards memory B cells and aged-related B cells, hallmarks of an aged immune response. Unexpectedly, blocked GC reaction in Tfam KO mice is not caused by defects in the bioenergetic supply but is associated with a defect in the remodelling of the lysosomal compartment in B cells. Our results may thus describe a mitochondrial function for lysosome regulation and the downstream antigen presentation in B cells during the GC reaction, the dysruption of which is manifested as an aged immune response.

Ultrasound Cut-Off Values for Rectus Femoris for Detecting Sarcopenia in Patients with Nutritional Risk.

BACKGROUND: A nationwide, prospective, multicenter, cohort study (the Disease-Related caloric-protein malnutrition EChOgraphy (DRECO) study) was designed to assess the usefulness of ultrasound of the rectus femoris for detecting sarcopenia in hospitalized patients at risk of malnutrition and to define cut-off values of ultrasound measures. METHODS: Patients at risk of malnutrition according to the Malnutrition Universal Screening Tool (MUST) underwent handgrip dynamometry, bioelectrical impedance analysis (BIA), a Timed Up and Go (TUG) test, and rectus femoris ultrasound studies. European Working Group on Sarcopenia in Older People (EWGSOP2) criteria were used to define categories of sarcopenia (at risk, probable, confirmed, severe). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were used to determine the optimal diagnostic sensitivity, specificity, and predictive values of cut-off points of the ultrasound measures for the detection of risk of sarcopenia and probable, confirmed, and severe sarcopenia. RESULTS: A total of 1000 subjects were included and 991 of them (58.9% men, mean age 58.5 years) were evaluated. Risk of sarcopenia was detected in 9.6% patients, probable sarcopenia in 14%, confirmed sarcopenia in 9.7%, and severe sarcopenia in 3.9%, with significant differences in the distribution of groups between men and women (p < 0.0001). The cross-sectional area (CSA) of the rectus femoris showed a significantly positive correlation with body cell mass of BIA and handgrip strength, and a significant negative correlation with TUG. Cut-off values were similar within each category of sarcopenia, ranging between 2.40 cm2 and 3.66 cm2 for CSA, 32.57 mm and 40.21 mm for the X-axis, and 7.85 mm and 10.4 mm for the Y-axis. In general, these cut-off values showed high sensitivities, particularly for the categories of confirmed and severe sarcopenia, with male patients also showing better sensitivities than women. CONCLUSIONS: Sarcopenia in hospitalized patients at risk of malnutrition was high. Cut-off values for the better sensitivities and specificities of ultrasound measures of the rectus femoris are established. The use of ultrasound of the rectus femoris could be used for the prediction of sarcopenia and be useful to integrate nutritional study into real clinical practice.

In vitro antibacterial activity of antiretroviral drugs on key commensal bacteria from the human microbiota.

Introduction: Antiretroviral therapy has improved life expectancy in HIV-infected patients. However, people living with HIV under antiretroviral therapy are at higher risks of developing chronic complications and acquiring multidrug resistant bacteria than healthy population. These factors have been associated with shifts in gut microbiome composition and immune activation. It is unclear how antiretroviral drugs affect gut microbiota composition, but it has been observed that antiretroviral treatment is not able to fully restore gut health after HIV infection. Additionally, some antiretroviral drugs have shown antibacterial activity suggesting that these drugs could have a direct impact on the human microbiome composition. Methods: We determined the in vitro antibacterial activity of 16 antiretroviral drugs against a set of key clinically relevant and human commensal bacterial strains. Results: Our results demonstrate that 5 antiretroviral drugs have in vitro antibacterial activity against gut and vaginal human commensal bacteria. Zidovudine has antibacterial activity against Escherichia coli, Klebsiella pneumoniae and Prevotella bivia, abacavir against Gardnerella vaginalis, efavirenz against G. vaginalis and P. bivia and bictegravir against Enterococcus spp. and G. vaginalis. Moreover, we describe for the first time that elvitegravir has antibacterial activity against G. vaginalis and P. bivia and, most importantly, against vancomycin-resistant Enterococcus spp. and methicillin-resistant Staphylococcus aureus strains with MIC values of 4-16 and 4 µg/mL, respectively showing high level of effectiveness against the tested multidrug-resistant bacteria. Discussion: Our results underscore that some antiretroviral drugs may influence the human microbiota composition. In addition, we report the potential use of elvitegravir to treat multidrug-resistant Gram-positive bacteria warranting the need of clinical studies to repurpose this antiretroviral drug.

Depression and Suicide Risk in Mild Cognitive Impairment: The Role of Alzheimer’s Disease Biomarkers / Depresión y Riesgo de Suicidio en el Deterioro Cognitivo Leve: el Rol de los Biomarcadores de la Enfermedad de Alzheimer

Background: Patients with depression and mild cognitive impairment (MCI) are at greater risk of developing dementia. Depression involves a higher risk of suicidal ideation (SI) and suicide attempts (SA). Biomarkers of Alzheimer’s Disease (AD) could help to clarify the role of depression and SI in AD. Method: Fifty-nine participants aged > 50 with criteria of MCI positive (MCI-AD) (n=22) and negative (MCI-Non AD) (n=24) AD and healthy controls (HC) (n=13) were evaluated. We used the Geriatric Depression Scale (GDS-30) and the GDS-SI factor to measure depression and indirect risk for suicide, respectively. Additionally, AD biomarkers such as amyloid-ß (Aß), hyperphosphorilated tau (P-tau), and total tau (T-tau) in cerebrospinal fluid (CSF) were analyzed. Results: No significant differences between the groups were found in depression. However, in the MCI-AD group, lower P-tau and T-tau levels were related to higher GDS-SI scores, suggesting that MCI-AD patients with lower AD pathology are at a higher risk of suicide. Conclusions: The result highlights the importance of considering SI in the initial phases of AD, and the potential role of AD biomarkers in early detection of symptoms.(AU)

Antecedentes: Los pacientes con depresión y deterioro cognitivo leve (DCL) tienen un alto riesgo de desarrollar demencia. La depresión implica un alto riesgo de ideación suicida (IS) e intentos de suicidio (AS). Los biomarcadores de la enfermedad de Alzheimer (EA) pueden clarificar el papel de la depresión e IS en la EA. Método: Cincuenta y nueve participantes >50 años con criterios de DCL-EA positivo (DCL-EA; 22) y negativo (DCL-NoEA; 24) y 13 controles sanos. La depresión fue evaluada con la Escala Geriátrica de Depresión (GDS-30) y la IS con el factor GDS-IS. Además, se midieron los siguientes biomarcadores en el líquido cefalorraquídeo: ß-amiloide (ß-A), tau hiperfosforilada (H-tau) y total (T-tau). Resultados: No se encontraron diferencias significativas entre los tres grupos de participantes en depresión o en IS. Sin embargo, en el grupo DCL-EA, niveles más bajos de H-tau y T-tau, indicadores de menor patología EA, se relacionaron significativamente con mayor riesgo de suicidio indirecto. Conclusiones: Este resultado subraya la importancia de considerar la IS en fases iniciales de EA, y el potencial papel de los biomarcadores de EA para detectar sus síntomas.(AU)

Repercusiones del confinamiento por COVID-19 en pacientes crónicos de Andalucía / Consequences of the COVID-19 lockdown in patients with chronic diseases in Andalusia

Objetivo: Conocer las repercusiones del confinamiento por la pandemia de COVID-19 en los autocuidados de personas con enfermedades crónicas y en su salud percibida, e identificar factores para el manejo y la gestión de su enfermedad en situaciones de emergencia. Método: Estudio cualitativo realizado en marzo-abril de 2020, durante el confinamiento por la pandemia de COVID-19, en Andalucía (España), mediante grupos focales virtuales usando la herramienta telemática Zoom. Se realizaron tres grupos con 34 pacientes (17 hombres y 17 mujeres) con enfermedades crónicas: artritis, diabetes, enfermedad cardiovascular, enfermedad inflamatoria intestinal, cáncer de mama y fibromialgia. Resultados: Las personas con enfermedades crónicas refirieron repercusiones del confinamiento en relación con su vivencia emocional, sus recursos de afrontamiento, la información recibida, las dificultades para el autocuidado y el contacto/acceso a los servicios sanitarios, además de sugerir aprendizajes para el futuro. Más y mejor información, formación de pacientes, colaboración directa con asociaciones de pacientes por parte de los gestores y una mejora de la accesibilidad telemática a los servicios sanitarios destacan como las principales líneas de mejora para minimizar el impacto de futuros confinamientos en el autocuidado y en la salud de las personas con enfermedades crónicas. Conclusiones: Durante el confinamiento, las personas con enfermedades crónicas experimentaron dificultades más allá del riesgo de contagio: interferencias en el cuidado y en la atención sanitaria recibida. Es necesaria mayor información y más formación a los/las pacientes y mejoras en la accesibilidad a los servicios sanitarios en situaciones de crisis sanitaria. (AU)

Objective: To understand the consequences of the COVID-19 pandemic lockdown on the self-care of people living with chronic diseases and on their self-perceived health, and to identify factors that may influence the management of their disease in emergency situations. Method: A qualitative study conducted in 2020 (March and April) in Andalusia (Spain) during the COVID-19 pandemic lockdown, through virtual focus groups, using the Zoom telematics tool. Three virtual focus groups were conducted, including 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia. Results: People with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the contact or access to health services. They also suggested some lessons learned for the future. The need for more and better information, patient training, involving patient associations, and improving telematics access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases. Conclusions: Besides the risk of contracting COVID-19, the difficulties encountered by people with chronic diseases during the lockdown include interferences in the self-care and the health care received. Health crisis situations demand more information, training for patients and improvements in the health services accessibility for patients with chronic conditions. (AU)

Endoscopia bajo sueño inducido en la apnea obstructiva del sueño (DISE). Estudio comparativo entre las clasificaciones NOHLy VOTE / Drug Induced Sleep Endoscopy (DISE). A comparative study between NOHL and VOTE classifications

Introducción y objetivo: Varias clasificaciones han sido propuestas para expresar los resultados de la endoscopia bajo sueño inducido (DISE) en la apnea obstructiva del sueño (AOS), pero ninguna está globalmente aceptada. El objetivo del estudio es analizar las clasificaciones más utilizadas: NOHL y VOTE, para valorar cuál de ellas aporta más ventajas.Método: Se diseñó un estudio de cohortes prospectivo de 100 pacientes a los que se les realizó una DISE por AOS. Tres otorrinolaringólogos evaluaron de forma ciega los videos de las DISE y codificaron los resultados de acuerdo a las escalas NOHL y VOTE, anotando qué hallazgos determinaban la indicación de cirugía.Resultados: Según el investigador principal, en un 64% se indicó cirugía de un solo nivel, de estos, el paladar fue el más predominante, en el 26% se indicó cirugía multinivel y en un 10% se desestimó cirugía. La concordancia global para expresar los resultados de la DISE según las escalas NOHL y VOTE, en cuanto al grado de obstrucción es moderada / regular a nivel de la epiglotis (k = 0,467) y baja en el resto de estructuras (k = 0,097).Discusión: A pesar de que el grado de acuerdo interobservador es similar en ambas escalas, para VOTE es ligeramente superior.Conclusiones: La DISE es una prueba segura, reproducible y fácil de realizar. Recomendamos el uso de la escala VOTE porque ha demostrado tener un grado de acuerdo interobservador superior, es la escala más utilizada en la literatura y la recomendada en los documentos de consenso. (AU)

Introduction and objective: There is no standardized method to express DISE results. Several classifications have been proposed, but none are globally accepted. The objective of this study is to analyze the most used classifications: NOHL and VOTE to assess which of them provides more advantages. Method: A prospective cohort study of 100 patients who underwent DISE was carried out. Three otolaryngologists blindly evaluated the DISE videos and coded the results according to the NOHL and VOTE scales and at what level surgery was indicated. Results: According to the main researcher, in 64% of patients, surgery of only one level was indicated, being the palate the predominant level, followed by a 26% where multilevel surgery was indicated, and in 10% no surgery was indicated. The global agreement to express the DISE results according to the NOHL, VOTE scales regarding the degree of obstruction is moderate / regular at the level of the epiglottis (k = 0.467) and low in the rest of the structures (k = 0.097). Discussion: Although the degree of interobserver agreement is similar in both scales, for VOTE it is slightly higher. Conclusions: DISE is a safe, reproducible and easy to perform test. We recommend the use of the VOTE scale because it has been demonstrated to have a higher degree of interobserver agreement, it is not only the most widely used scale, but also recommended in consensus documents. (AU)

Repercusiones del confinamiento por COVID-19 en pacientes crónicos de Andalucía / Consequences of the COVID-19 lockdown in patients with chronic diseases in Andalusia

OBJETIVO: Conocer las repercusiones del confinamiento por la pandemia de COVID-19 en los autocuidados de personas con enfermedades crónicas y en su salud percibida, e identificar factores para el manejo y la gestión de su enfermedad en situaciones de emergencia. MÉTODO: Estudio cualitativo realizado en marzo-abril de 2020, durante el confinamiento por la pandemia de COVID-19, en Andalucía (España), mediante grupos focales virtuales usando la herramienta telemática Zoom. Se realizaron tres grupos con 34 pacientes (17 hombres y 17 mujeres) con enfermedades crónicas: artritis, diabetes, enfermedad cardiovascular, enfermedad inflamatoria intestinal, cáncer de mama y fibromialgia. RESULTADOS: Las personas con enfermedades crónicas refirieron repercusiones del confinamiento en relación con su vivencia emocional, sus recursos de afrontamiento, la información recibida, las dificultades para el autocuidado y el contacto/acceso a los servicios sanitarios, además de sugerir aprendizajes para el futuro. Más y mejor información, formación de pacientes, colaboración directa con asociaciones de pacientes por parte de los gestores y una mejora de la accesibilidad telemática a los servicios sanitarios destacan como las principales líneas de mejora para minimizar el impacto de futuros confinamientos en el autocuidado y en la salud de las personas con enfermedades crónicas. CONCLUSIONES: Durante el confinamiento, las personas con enfermedades crónicas experimentaron dificultades más allá del riesgo de contagio: interferencias en el cuidado y en la atención sanitaria recibida. Es necesaria mayor información y más formación a los/las pacientes y mejoras en la accesibilidad a los servicios sanitarios en situaciones de crisis sanitaria

OBJECTIVE: To understand the consequences of the COVID-19 pandemic lockdown on the self-care of people living with chronic diseases and on their self-perceived health, and to identify factors that may influence the management of their disease in emergency situations. METHOD: A qualitative study conducted in 2020 (March and April) in Andalusia (Spain) during the COVID-19 pandemic lockdown, through virtual focus groups, using the Zoom telematics tool. Three virtual focus groups were conducted, including 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia. RESULTS: People with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the contact or access to health services. They also suggested some lessons learned for the future. The need for more and better information, patient training, involving patient associations, and improving telematics access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases. CONCLUSIONS: Besides the risk of contracting COVID-19, the difficulties encountered by people with chronic diseases during the lockdown include interferences in the self-care and the health care received. Health crisis situations demand more information, training for patients and improvements in the health services accessibility for patients with chronic conditions

El tratamiento grupal de adolescentes con trastornos graves de la personalidad: Una aproximación contextual / Group therapy for adolescents with severe personality disorders: a contextual approach

El presente trabajo se centra en los trastornos mentales graves en la adolescencia, y más específicamente en los trastornos de personalidad. La Terapia Dialéctico Conductual (DBT) es uno de los tratamientos con más evidencia para adolescentes con este tipo de trastornos. Entre las terapias contextuales, la DBT se centra en la reducción de los trastornos de conducta graves, haciendo énfasis en el entrenamiento de habilidades. La relación terapéutica es uno de los componentes clave para tratar la patología de personalidad en adolescentes. Asimismo, la combinación con otras terapias contextuales, como la Psicoterapia Analítica Funcional (PAF), permite un mayor efecto de la DBT. El objetivo de este artículo es mostrar cómo la PAF, combinada con estrategias de otras psicoterapias contextuales, supone una mejora clínica en adolescentes con trastornos de personalidad graves. En este artículo se describe la intervención clínica ambulatoria realizada con cuatro adolescentes de entre 13 y 17 años de edad, diagnosticadas de enfermedad mental grave y con criterios de trastornos de personalidad. Los principales síntomas evaluados fueron la impulsividad, los intentos de suicidio, las autolesiones, la auto y heteroagresividad, los síntomas psicóticos y los problemas del yo. El instrumento de medida utilizado fue el Inventario Clínico para Adolescentes de Millon (MACI). Tras una intervención de cuatro meses, se observó un descenso en las escalas clínicas significativas del MACI. También se encontró una mejoría en cognición, tendencias suicidas, regulación emocional y experiencia del yo (AU)

The present work focuses on severe mental disorders in adolescence; and more specifically on personality disorders. Dialectical Behavioral Therapy (DBT) has proven effective in teenagers with these disorders. Among contextual therapies, DBT aims to reduce serious behaviour disorders, emphasizing skills training. The therapeutic relationship is one of the key components of successful treatment of personality pathology in adolescents. DBT has a greater effect combined with other contextual therapies, such as Functional Analytic Psychotherapy (FAP). The purpose of this paper is to show how FAP, in combination with the latest technical advances in other contextual therapies, brings about clinical improvement in adolescents with severe personality disorders. Four teenagers, between 13 and 17 years old, diagnosed with a severe mental disorder and meeting some criteria for personality disorders, received treatment in an outpatient setting. The main symptoms evaluated were: high impulsivity, suicide attempts, self-injury, self and heteroagressivity, psychotic symptoms, and problems of the self. Patients were assessed with the Millon Adolescent Clinical Inventory (MACI). After a four-month intervention, a decrease in the MACI Clinical scales was observed. We also found an improvement in cognition, suicidal tendencies, emotional regulation, and experience of self (AU)

Cronicidad y uso de servicios sanitarios: la formación entre iguales de la Escuela de Pacientes / Cronicidade e utilização de serviços de saúde: a formação entre iguais na Escola de Pacientes / Chronicity and use of health services: peer education of the School of Patients

RESUMEN Objetivo: Evaluar el impacto de la estrategia formativa de la Escuela de Pacientes en el uso de servicios sanitarios entre las personas con enfermedades crónicas. Método: Diseño cuantitativo de evaluación pretest y postest con una población de 3350 pacientes crónicos de la Escuela de Pacientes (Andalucía, 2013-2015). Se empleó un cuestionario adaptado de la Universidad de Stanford, que midió: salud autopercibida, número de visitas médicas y nivel de confianza y comunicación con el personal sanitario. Se realizó estudio descriptivo y bivariante, estudio de correlación y análisis de ganancias netas pretest/postest. Resultados: Participaron 964 pacientes (28,8% de la población): el 18,8% hombres, edad media 56 años. La formación aumentó la confianza en el personal de Atención Primaria (AP) y Atención Hospitalaria (AH) (0,44 y 0,65 puntos), descendieron las visitas médicas en un 25% y los ingresos hospitalarios en un 51%, con diferencias estadísticamente significativas por sexo y enfermedad. El índice de correlación entre confianza con profesionales y uso de servicios sanitarios fue de −0,215. Conclusión: La estrategia formativa tuvo un impacto positivo en el uso de servicios sanitarios y confianza con personal sanitario, detectándose áreas de mejora a partir de las cuales se establecen recomendaciones.

Resumo Objetivo: Avaliar o impacto da formação da Escola de Pacientes entre iguais sobre a utilização de serviços sanitários das pessoas com doenças crónicas. Método: Desenho quantitativo da avaliação pré-teste e pós-teste com uma população de 3.350 pacientes da Escola de Pacientes (Andaluzia, 2013-2015). Foi usado um questionário adaptado da Universidade de Stanford, que mediu: saúde autopercebida, visitas médicas, nível de confiança e comunicação com o pessoal sanitário. A análise estatística incluiu estudo estatístico descritivo e bivariado, estudo de correlação e análise de ganhos líquidos pré-teste/pós-teste. Resultados: Participaram 964 pacientes (28,8% da população do estudo), 18,8% homens, idade média de 56 anos. Depois da formação, a confiança no pessoal de Atenção Primária (AP) e Atenção Hospitalar (AH) aumentou (0,44 e 0,65 pontos, respectivamente), as visitas médicas decresceram em 25% e as entradas hospitalares em 51%, com diferenças estatisticamente significativas por sexo e doença. O índice de correlação entre confiança nos profissionais e utilização de serviços de saúde foi de −0,215. Conclusão: A estratégia formativa teve um impacto positivo na utilização dos serviços de saúde e na confiança no pessoal de saúde, detectando-se áreas de melhoria a partir das quais se estabelecem recomendações.

ABSTRACT Objective: To evaluate the impact of the training strategy of the Escuela de Pacientes (School of Patients) on the use of health services among people with chronic diseases. Method: Quantitative design study of pretest and posttest evaluation with a population of 3,350 chronic patients of the Escuela de Pacientes (Andalusia, 2013-2015). A questionnaire adapted from the Stanford University was used. It measured the self-perceived health, number of health visits, and level of trust and communication with health personnel. A descriptive and bivariate study, a correlation study and a pretest/posttest net gain analysis were performed. Results: Participation of 964 patients (28.8% of the population), of which 18.8% were men, mean age 56 years. Training increased trust in Primary Care (PC) and Hospital Care (HC) professionals (0.44 and 0.65 points), medical visits decreased by 25%, and hospital admissions fell by 51% with statistically significant differences by sex and disease. The correlation index between trust in professionals and use of health services was −0.215. Conclusion: The training strategy had a positive impact on the use of health services and trust in health professionals, and were identified areas of improvement from which recommendations are established.

Quistes y hamartomas biliares, no siempre son asintomáticos / Biliary cysts and hamartomas are not always asymptomatic

In daily clinical practice, we can find consultation reasons and exploratoryfindings that can guide us to a certain pathology. However, to avoid mistakes,we must remember that there are fewer common diseases, which could leadto an unexpected final diagnosis.Hepatic cystic lesions are usually found incidentally, having a wide differentialdiagnosis. Among them are biliary cysts and hamartomas, rare lesions, butwith not inconsiderable importance, as we will see in the case that is exposedbelow. (AU)

En la práctica clínica habitual nos podemos encontrar motivos de consulta yhallazgos exploratorios que nos pueden guiar a una determinada patología.Sin embargo, para no caer en errores, debemos recordar que existen enfermedades menos habituales, que podrían llevarnos a un diagnóstico finalinesperado.Las lesiones quísticas hepáticas se hallan generalmente de forma incidental, teniendo un amplio diagnóstico diferencial. Entre ellas se encuentranlos quistes y hamartomas biliares, lesiones poco frecuentes, pero con unaimportancia no desdeñable, como veremos en el caso que se expone a continuación. (AU)

Faringoplastia de expansión: utilidad de la somnoscopia (DISE) / Expansion sphincter pharyngoplasty: Usefulness of DISE

Objetivos: El objetivo de este estudio es presentar las indicaciones y resultados de la faringoplastia de expansión como tratamiento del síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). En segundo lugar, comparar los hallazgos de la somnoscopia (drug-induced sleep endoscopy -DISE-) antes y después de la cirugía. Material y métodos: El diseño del estudio fue una cohorte prospectiva de pacientes tratados quirúrgicamente de 2015 a 2016. Todos los pacientes fueron diagnosticados de SAHOS leve a grave y no toleraban la CPAP. Todos tenían DISE y polisomnografía previa a la cirugía, y posterior a la misma. Los criterios de inclusión fueron la edad, entre 18 años y 70 años, amígdalas pequeñas (tamaños 1 y 2), estadio clínico de Friedman II y III, y colapso lateral mayoritario en la DISE preoperatoria. Se les realizó únicamente cirugía del paladar, usando la técnica de faringoplastia de expansión. Resultados: Se incluyeron 17 pacientes, el 52,94% eran pacientes con SAHOS grave. La edad media fue de 42 años, el índice de masa corporal media fue de 28. La tasa de éxito quirúrgico según los criterios de Sher fue del 82,35%. El 41,17% presentó un índice de apnea-hipopnea postoperatoria inferior a 10. El 75% de los pacientes lograron no tener que usar la CPAP. Conclusión: La faringoplastia de expansión es una técnica segura como tratamiento del SAHOS en pacientes con amígdalas pequeñas, grado Friedman I y II y colapso de paredes laterales en somnoscopia, en ausencia de colapso multinivel. La DISE postoperatoria demostró la mejoría del colapso lateral obtenida con la expansión

Objectives: The aim of this study was first to present the indications and results using expansion sphincter pharyngoplasty to treat obstructive sleep apnoea-hypopnoea syndrome (OSAHS). And second, to compare the findings of drug-induced sleep endoscopy (DISE) before and after the surgery. Material and methods: The study design was a prospective cohort of patients surgically treated between 2015 and 2016. All patients were diagnosed with mild to severe obstructive sleep apnoea and did not tolerate CPAP. All had pre- and post-surgery DISE and polysomnography. The inclusion criteria were age, between 18 years and 70 years, small tonsils (sizes 1 and 2), Friedman II and III clinical stage, and lateral collapse in preoperative DISE. We performed surgery to the palate only, using expansion sphincter pharyngoplasty. Results: Seventeen patients were included, 52.94% had severe OSAHS. Average age was 42 years, average body mass index was 28. The surgical success rate according to Sher criteria was 82.35%. 41.17% had a postoperative apnoea-hypopnoea index of less than 10. Seventy-five percent of the patients had no further need for CPAP. Conclusion: Expansion sphincter pharyngoplasty is a safe technique for treating OSAHS, in patients with small tonsils, Friedman grade I and II and collapse of lateral walls in DISE, in the absence of multilevel collapse. The postoperative DISE showed improvement of the lateral collapse was achieved with the expansion

La publicidad de bebidas alcohólicas en España y su repercusión en la población adolescente / No disponible

Objetivos: El consumo de alcohol entre jóvenes es un problema de salud pública, condicionado en gran parte por los medios de comunicación y la publicidad. El objetivo de este estudio es analizar los mensajes publicitarios de alcohol difundidos en radio y televisión en España y conocer su potencial influencia en los adolescentes. Métodos: Análisis cuantitativo y cualitativo de la publicidad emitida en radio y TV, entre 1 de diciembre de 2006 y 9 de enero de 2007, a través de los siguientes pasos: seleccionar emisoras y canales TV; identificar y grabar la publicidad de programas de radio y TV dirigidos a los y las adolescentes; seleccionar y analizar los spots y cuñas radiofónicas. Las variables del estudio cuantitativo han sido: minutos dedicados a la publicidad de alcohol; análisis de audiencias en la población adolescente; y análisis del número de cuñas emitidas. La parte cualitativa se ha centrado en: marca y eslogan, público al que se dirige, estética, protagonistas del anuncio, valores que se transmiten, carga emocional del mensaje. Resultados: Se detectan 914 anuncios publicitarios de bebidas alcohólicas en TV. El 100% de los programas y eventos deportivos analizados presentan marcas de alcohol. El 26% de los spots y el 50% de las cuñas radiofónicas se dirigen específicamente a los jóvenes y todos muestran una imagen positiva del alcohol, valores de libertad, rebeldía y éxito. Conclusiones: Los adolescentes están expuestos a recurrentes mensajes positivos sobre el alcohol. La información y prevención son medidas claves para combatir la convivencia naturalizada con el alcohol

Objective: Alcohol drinking among adolescents is a problem of public health and it is highly conditioned by media and advertising. The objective of this study is to analyze Spanish television and radio alcohol advertising and promotions and to identify their potential influence on adolescents. Methods: A qualitative and quantitative analysis was made of radio and TV alcohol advertising, emitted between 1 December 2006 and 9 January 2007. The methodological steps were: channel and radio station selection; recording of radio and TV programmes directed to adolescents; selection and analysis of TV and radio spots. The variables in the quantitative analysis were: minutes of advertising, audience analysis in the young people; number of radio spots. The qualitative study referred to: brand and slogan, public to which it is directed, advertising protagonists, values and emotional content of the message. anuncio Results: There were identified 914 TV alcohol advertising. 100% of analyzed programs and sport events included alcohol advertise, with spots being the most usual strategy. 26% of spots were specifically directed to adolescents and all showed a positive image of alcohol. 50% of radio commercials sent values like freedom, diversion, social and sexual success. Conclusions: Adolescents are exposed to recurrent positive messages about alcohol, so information and prevention turn extremely important to reduce the naturalized image of alcohol drinking

Experience with "Fast track" postoperative care after deep brain stimulation surgery / Experiencia con el cuidado postoperatorio "Fast-Track" después de la cirugía de estimulación cerebral profunda

Background: A 24-h-stay in the post-anesthesia care unit (PACU) is a common postoperative procedure after deep brain stimulation surgery (DBS). Objective: We evaluated the impact of a fast-track (FT) postoperative care protocol. Methods: An analysis was performed on all patients who underwent DBS in 2 periods: 2006, overnight monitored care (OMC group), and 2007-2013, FT care (FT group). Results: The study included 19 patients in OMC and 95 patients in FT. Intraoperative complications occurred in 26.3% patients in OMC vs. 35.8% in FT. Post-operatively, one patient in OMC developed hemiparesis, and agitation in 2 patients. In FT, two patients with intraoperative hemiparesis were transferred to the ICU. While on the ward, 3 patients from the FT developed hemiparesis, two of them 48h after the procedure. Thirty eight percent of FT had an MRI scan, while the remaining 62% and all patients of OMC had a CT-scan performed on their transfer to the ward. One patient in OMC had a subthalamic hematoma. Two patients in FT had a pallidal hematoma, and 3 a bleeding along the electrode. Conclusions: A FT discharge protocol is a safe postoperative care after DBS. There are a small percentage of complications after DBS, which mainly occur within the first 6 h

Introducción: La estancia durante 24 h en una unidad de recuperación post-anestésica es una estrategia común de control post-operatorio después de la cirugía de estimulación cerebral profunda (DBS). Objetivo: Evaluamos el impacto de un protocolo Fast-track (FT) en el cuidado postoperatorio. Métodos: Analizamos todos los pacientes que se sometieron a cirugía DBS en 2 periodos: 2006, monitorización durante la noche (grupo OMC) y entre 2007 y 2013 (grupo FT). Resultados: Incluimos 19 pacientes en el grupo OMC y 95 pacientes en el FT. Se registraron incidentes intraoperatorios en el 26,3% de pacientes del grupo OMC vs. 35,8% del grupo FT. Postoperatoriamente, un paciente en el grupo OMC desarrollo hemiparesia y 2 pacientes agitación. En el grupo FT, 2 pacientes con hemiparesia intraoperatoria fueron trasladados a la UCI. Durante su ingreso en planta, 3 pacientes del grupo FT desarrollaron hemiparesia, 2 de ellos 48h después del procedimiento. Al 38% del FT se les realizó una resonancia, mientras que al 62% restante y a todos los pacientes del grupo OMC se les realizó un escáner antes del traslado a sala: un paciente del grupo OMC tuvo un hematoma subtalámico; 2 pacientes del grupo FT tuvieron un hematoma en el pálido y 3, sangrado en el trayecto del electrodo. Conclusiones: El protocolo FT es seguro después de la cirugía de DBS. Hay un pequeño porcentaje de complicaciones y la mayoría suceden en las primeras 6 h

La ira como factor comórbido a los problemas interpersonales y de desajuste emocional en pacientes con un trastorno de la conducta alimentaria / Anger as comorbid factor for interpersonal problems and emotional dysregulation in patients with eating disorders

Los objetivos de este trabajo fueron analizar el nivel general de ira que presentan las pacientes con un Trastorno de la Conducta Alimentaria (TCA) en relación a un grupo normativo; analizar las diferencias en el control de la ira en función del diagnóstico; explorar la relación entre las dimensiones de la ira y escalas específicas del EDI-3 (desajuste emocional, déficit interpersonal, baja autoestima y ascetismo); y con el Índice de Masa Corporal (IMC). Metodología: Participaron 58 mujeres diagnosticadas de un TCA, que eran atendidas en régimen de hospitalización en el Hospital General Universitario Reina Sofía de Murcia. La edad media fue de 25,68 años (dt=7,00). Un 27,58% estaban diagnosticadas de ANR; un 15,51% de ANP. Un 41,37% de BN, y el 15,51% restante de un TCANE. Para la evaluación del TCA se empleó el Inventario EDI-3 y para el estudio de la ira se aplicó el Inventario STAXI-2. Resultados: Los análisis mostraron que los niveles generales de ira de estas pacientes eran más elevados que los de la población normativa con la que se comparó. Las pacientes diagnosticadas de ANR presentaban puntuaciones significativamente superiores que las pacientes diagnosticadas de BN en la escala control interno de la ira. Las escalas desajuste emocional, déficit interpersonal, baja autoestima y ascetismo presentaron correlaciones significativas con diferentes dimensiones de la ira. No se encontró una relación significativa entre IMC e ira. Conclusiones. Estos resultados manifiestan la importancia de incluir en cualquier abordaje terapéutico de los TCA el manejo de la ira

This work was undertaken to analyze general levels of anger in patients with eating disorders (ED) compared to a normative group, diagnosis-dependent differences in expressing anger, and the relation between anger dimensions and specific items of the Eating Disorder Inventory, third revision (EDI-3) (emotional dysregulation, interpersonal deficit, low self-esteem, and asceticism) and body mass index (BMI). Methods: The study participants were 58 women with a diagnosis of ED hospitalized at the Reina Sofia General University Hospital in Murcia. The women had a mean age of25.68 (SD=7.00) years. The distribution of ED diagnoses was 27.58% anorexia nervosa with food restriction (AN-R), 15.51% anorexia nervosa with purging (AN-P), 41.37% bulimia nervosa (BN), and 15.51% eating disorder not otherwise specified (EDNOS). ED was evaluated using the EDI-3 and anger was assessed with the State-Trait AnxietyInventory-2 (STAXI-2). Results: The general anger levels of the patients with ED were higher than those of the normative group compared. Patients diagnosed of AN-R had significantly higher scores than patients diagnosed of BN on the internal control of anger scale. The emotional dysregulation, interpersonal deficit, low self-esteem, and asceticism scales correlated significantly with different anger dimensions. No significant relation was found between body mass index (BMI) an danger. Conclusions: These results show the importance of including anger management in any therapeutic approach to EDs