Celiac patient satisfaction with nursing consultations in a gastroenterology department.

The assessment of the personal care received is an indicator of the quality of the health care system. The diagnosis of celiac disease generates concern in the patient and limits the quality of life, and adherence to treatment determines symptomatic improvement. For this reason, a nursing consultation for health and nutritional education for celiac patients has been set up in our hospital. The objectives were to know the degree of patient´s satisfaction of this health program regarding technical and communicative aspects, as well as to assess the influence of adherence to the gluten-free diet (GFD) on health through clinical and analytical parameters. This is a descriptive cross-sectional observational study in patients diagnosed of celiac disease from January 2019 to June 2021 according to the Catassi criteria and who have attended the nursing consultation. Subsequently, the satisfaction survey was carried out and the clinical and analytical results were analyzed descriptively and statistically using the Student's t-test. The satisfaction of the nursing consultation was higher than 90%, highlighting aspects such as the clarity of the information, the interest and the kindness of the healthcare professionals. About 94.5% of the patients showed clinical improvement after the health education and the levels of hemoglobin, ferritin and vitamin B12 increased significantly in the analytical control after the GFD.

Cytomegalovirus associated rectal ulcer as a manifestation of primary HIV infection.

We present the case of a 40-year-old male sent for fatigue, mild weight loss and rectal bleeding for 2 months, neither fever nor diarrhea. He referred unprotected intercourse. Blood test revealed mild elevation of transaminases. We requested serologies, with positive CMV IgG and CMV plasma levels of 47UI/ml (PCR), and a negative result of the rest of hepatotropic viruses. Abdominal ultrasound was normal and during colonoscopy we observed an ulcer in lower rectum, with negative biopsies for malignancy and a positive immunohistochemistry (IHC) for CMV. We amplified the serologic analysis and detected positive antibodies for the human immunodeficiency virus (HIV), with a viral load of 50500 copies/ml, negative p24 antigen and CD4+ cell count of 900 cells/mm3 (30%). Rest of serologies and triple-site testing were negative. We referred the patient to the infectious disease consultation and they started antiretroviral therapy (ART). We decided a watchful waiting approach for the rectal ulcer with close endoscopic follow-up, with early healing and complete resolution.

[Esofagitis eosinofílica, eficacia de las alternativas terapéuticas en el adulto: revisión sistemática.] / Eosinophilic esophagitis, efficacy of therapeutic alternatives in adults: a systematic review.

OBJECTIVE: Eosinophilic esophagitis is actually the main cause of dysphagia in adults. The choise of therapy must be agreed with the patient. The objective of this study was to review the scientific literature to determine the efficacy of the different therapeutic options for eosinophilic esophagitis in adults. METHODS: A search for articles was carried out during the month of February 2023 in the databases PubMed, Web of Science, Scopus and Scielo using the search terms: eosinophilic esophagitis, therapeutics and treatment. Clinical trials and observational studies published in the last ten years in adults were selected. RESULTS: A total of 1,138 articles were obtained, of which 41 were selected after applying the eligibility criteria. Of the available therapies, the most frequently analyzed treatment was swallowed corticosteroids, followed by elimination diets and proton pump inhibitors. Clinical trials predominated. The studies show results on the efficacy of these therapies in histological and clinical remission, both in induction and in the long-term. CONCLUSIONS: There are basically three therapies for eosinophilic esophagitis in adults, all of them are superior to placebo in histological and clinical response.

OBJETIVO: La esofagitis eosinofílica es hoy en día la principal causa de disfagia en el adulto. La elección de la terapia se debe consensuar con el paciente. El objetivo de este trabajo fue revisar la bibliografía científica para conocer la eficacia de las distintas opciones terapéuticas de la esofagitis eosinofílica en el adulto. METODOS: Se realizó una búsqueda de artículos durante el mes de febrero de 2023 en las bases de datos de PubMed, Web of Science, Scopus y Scielo, empleando los términos de búsqueda eosinophilic esophagitis, therapeutics y treatment, seleccionándose los ensayos clínicos y estudios observacionales publicados en los últimos diez años en adultos. RESULTADOS: Se obtuvieron un total de 1.138 artículos, de los cuales 41 fueron seleccionados tras aplicar los criterios de elegibilidad. De las terapias disponibles, el tratamiento más frecuentemente analizado fueron los corticoides deglutidos, seguido de las dietas de eliminación y de los inhibidores de la bomba de protones, predominando los ensayos clínicos. Los estudios arrojan resultados sobre la eficacia de estas terapias en la remisión histológica y clínica, tanto en la inducción como a largo plazo. CONCLUSIONES: Existen fundamentalmente tres terapias en la esofagitis eosinofílica en el adulto, siendo todas superiores frente a placebo en respuesta histológica y clínica.

Esofagitis eosinofílica, eficacia de las alternativas terapéuticas en el adulto: revisión sistemática / Eosinophilic esophagitis, efficacy of therapeutic alternatives in adults: a systematic review

Fundamentos: La esofagitis eosinofílica es hoy en día la principal causa de disfagia en el adulto. La elección de la terapia se debeconsensuar con el paciente. El objetivo de este trabajo fue revisar la bibliografía científica para conocer la eficacia de las distintasopciones terapéuticas de la esofagitis eosinofílica en el adulto. Métodos: Se realizó una búsqueda de artículos durante el mes de febrero de 2023 en las bases de datos dePubMed, Web ofScience, Scopus yScielo, empleando los términos de búsquedaeosinophilic esophagitis,therapeutics ytreatment, seleccionándoselos ensayos clínicos y estudios observacionales publicados en los últimos diez años en adultos.Resultados: Se obtuvieron un total de 1.138 artículos, de los cuales 41 fueron seleccionados tras aplicar los criterios de elegibilidad. De las terapias disponibles, el tratamiento más frecuentemente analizado fueron los corticoides deglutidos, seguido de las dietasde eliminación y de los inhibidores de la bomba de protones, predominando los ensayos clínicos. Los estudios arrojan resultadossobre la eficacia de estas terapias en la remisión histológica y clínica, tanto en la inducción como a largo plazo. Conclusiones: Existen fundamentalmente tres terapias en la esofagitis eosinofílica en el adulto, siendo todas superiores frentea placebo en respuesta histológica y clínica.(AU)

Background: Eosinophilic esophagitis is actually the main cause of dysphagia in adults. The choise of therapy must be agreedwith the patient. The objective of this study was to review the scientific literature to determine the efficacy of the different therapeuticoptions for eosinophilic esophagitis in adults.Methods: A search for articles was carried out during the month of February 2023 in the databasesPubMed, Web of Science,Scopus andScielo using the search terms:eosinophilic esophagitis,therapeutics andtreatment. Clinical trials and observational studiespublished in the last ten years in adults were selected. Results: A total of 1,138 articles were obtained, of which 41 were selected after applying the eligibility criteria. Of the availabletherapies, the most frequently analyzed treatment was swallowed corticosteroids, followed by elimination diets and proton pump inhibitors. Clinical trials predominated. The studies show results on the efficacy of these therapies in histological and clinical remission,both in induction and in the long-term. Conclusions: There are basically three therapies for eosinophilic esophagitis in adults, all of them are superior to placebo inhistological and clinical response.(AU)

María Rafols Bruna, ¿conspiradora o heroína de la caridad? / Maria Rafols Bruna, conspirator or heroine of charity?

En el despertar del mundo moderno cobra protagonismo una mujer con una personalidad arrolladora: María Rafols, fundadora de las Hermanas de la Caridad de Santa Ana. Fue protagonista de actos heroicos durante los Sitios de Zaragoza; aunque sus verdaderos actos memorables los realizó en la lucha cotidiana en el cuidado de pobres, enfermos y niños expósitos. Sin embargo, años después, las intrigas y sospechas políticas motivaron la detención de la María Rafols por una supuesta conspiración contra la Reina. La aprobación de las Constituciones de las Hermanas de la Caridad del Hospital de Nuestra Señora de Gracia de 1824, constituyeron un verdadero cuerpo de doctrina de actuación de enfermería (AU)

Human adipose tissue as a source of Flk-1+ cells: new method of differentiation and expansion.

OBJECTIVE: The low number of postnatal endothelial progenitor cells (EPC) in the circulation limits their therapeutic application in cardiovascular medicine. Processed lipoaspirate (PLA) cells differentiate into osteoid, adipose, muscle, and cartilaginous cells. This study examines the potential of PLA cells as a source of EPCs. METHODS: PLA cells obtained from human lipoaspirates were cultured for 1 week in serum-depleted medium to form three-dimensional cell clusters (3DCC). The phenotype of 3DCC-derived cells was assessed by immunofluorescence staining and FACS analysis. RESULTS: Flow cytometry showed that 45+/-5% of cells derived from the 3DCC expressed Flk-1, a marker of early EPC, whilst only 4+/-0.5% of freshly isolated PLA were Flk-1+. The proportion of Flk-1+ cells increased to 98+/-2% during culture in hematopoietic stem cell medium. When cultured in an endothelial cell (EC)-specific medium, Flk-1+ cells also expressed Ve-cadherin, von Willebrand's factor (vW), and a lectin receptor, and took up low-density lipoprotein. Incorporation into an endothelial cell tubular network confirmed their functional activity. CONCLUSION: This report describes the first isolation and culture of Flk-1+ cells from human adipose tissue. The feasibility of the extraction and culture of these cells in increased numbers suggests that such autologous cells will be useful for applications ranging from basic research to cell-based therapies.

Carcinosarcoma of the prostate: two cases with distinctive morphologic and immunohistochemical findings.

Carcinosarcomas (CS) of the prostate are very uncommon neoplasms defined by the admixture of malignant epithelial and mesenchymal components. We describe here two new examples of CS in two patients aged 66 and 77 years, the first without previous history of prostate adenocarcinoma and the second with a 5-year history of acinar type prostate adenocarcinoma. The diagnosis of CS was made on the cystoprostatectomy specimen in the first case and transurethral resection in the second case. Both biphasic tumours exhibited papillary areas of ductal differentiation and conventional adenocarcinoma in the epithelial component, as well as malignant fibrous histiocytoma and angiosarcomatous areas in the first case and solid, poorly differentiated epithelial areas with neuroendocrine features in the second case. Immunohistochemistry revealed over-expression of c-erb B2 in the papillary epithelial component of both cases, whereas the solid undifferentiated epithelial areas in the second patient expressed c-kit, CD10 and synaptophysin, thus conforming a very undifferentiated cell population. The angiosarcomatous component of the first case expressed CD31 and CD10. The clinical course of the cases was divergent; the first patient is free of disease after radical surgery and adjuvant therapy and the other died 5 months after the diagnosis of CS, having already developed liver metastases.

Low p27 expression predicts biochemical relapse after radical prostatectomy in patients with clinically localised prostate cancer.

OBJECTIVE: To assess the prognostic value of p27 protein expression in clinically localised prostate cancer with respect to biochemical recurrence after radical prostatectomy. PATIENTS AND METHODS: Fifty-two patients (median age 63 years) with prostate cancer were treated by radical prostatectomy in an 18-month period. Data recorded: preoperative PSA level, histopathological Gleason grade, pathological stage and status of surgical margins. p27 expression was evaluated in this group of tumors by immunohistochemistry (positivity was defined as > or = 30% positive cells). Biochemical relapse (BR) was defined by a serum PSA level > or = 0.3 ng/ml. RESULTS: Twenty-two out of 47 patients (47%) with available follow-up showed a low p27 protein expression. p27 expression did not correlate with pathological stage, Gleason score, serum PSA levels or the status of the surgical margins. Patients presented with BR during the follow-up (risk of BR (RBR) at 36 months: 40%). Patients with low p27 expression showed a higher RBR than the others (RBR 36-month 59% vs. 18%, respectively; p = 0.02). In a multivariate analysis, only p27 along with stage maintained the predictive value for biochemical relapse. CONCLUSION: p27 expression is a promising prognostic factor in prostate cancer, since it has proved to be a predictor of biochemical relapse.

Satisfacción de los pacientes celíacos de la Consulta de Enfermería de un Servicio de Digestivo / Kaposi's sarcoma with gastric and rectal involvement in HIV patient

La valoración de la atención recibida es un indicador del funcionamiento de los Servicios Sanitarios (1). El diagnóstico de celiaquía genera en el paciente preocupación y limitación de la calidad de vida, y la adherencia al tratamiento condiciona mejoría sintomática (2-4). Por ello, se ha puesto en marcha una Consulta de Enfermería de educación sanitaria y nutricional al paciente celíaco en nuestro hospital. El objetivo principal busca conocer el grado de satisfacción de esta Consulta respecto a aspectos técnicos y comunicativos, y valorar la influencia en la salud de la adherencia a la dieta sin gluten (DSG) a través de parámetros clínicos y analíticos. Se trata de un estudio observacional transversal descriptivo en pacientes diagnosticados de enfermedad celíaca desde enero de 2019 a junio de 2021 según los criterios de Catassi (5) y que han asistido a la Consulta de Enfermería. Posteriormente se realizó la encuesta de satisfacción (Tabla) y se analizaron los resultados clínicos y analíticos de forma descriptiva y estadística mediante la prueba t de Student. La satisfacción de la Consulta fue superior al 90%, destacando parámetros como la claridad de la información, el interés y la amabilidad del personal sanitario. El 94,5% de los pacientes mostraron mejoría clínica tras la realización de la educación sanitaria y los niveles de hemoglobina, ferritina y vitamina B12 aumentaron significativamente en el control analítico tras la DSG. (AU)

Caracterización de las escuelas de Ayudantes Técnicos Sanitarios en España entre 1953 y 1980 / Characterization of schools of Technical Sanitary Assistants in Spain between 1953 and 1980

La particularidad política y social de la España franquista hizo que el desarrollo de la Enfermería no siguiera la misma trayectoria que en otros países, hecho que se constató con la aparición, en 1953, del título de Ayudante Técnico Sanitario (ATS), titulación única en el mundo que estaría vigente hasta 1980. En este trabajo se describen las Escuelas de ATS, su distribución y dependencia, ahondando en cómo fue el aprendizaje, el contexto social en el que se desarrollaron, cuáles fueron las peculiaridades de la enseñanza, y a qué intereses respondió la creación de las 194 escuelas fundadas por toda la geografía española, en las que privaba el papel técnico y en las que se fomentó la asistencia a los enfermos bajo la obediencia y sumisión estricta de las órdenes médicas (AU)

Political and social characteristics in Spain under Franco led to a different development of Nursing than in other countries, and this fact was confirmed with the creation in 1953 of the Degree in Technical Sanitary Assistant (TSA), unique in the world, and that would exist until 1980. This article describes TSA Schools, their distribution and affiliation, exploring the type of knowledge, the social context where they were developed, their characteristics of learning, and the interests met by the creation of the 194 schools founded throughout the Spanish geography, where patient care was encouraged under strict obedience and submission to medical orders (AU)

Medicinas alternativas y complementarias en el ámbito sociocultural actual / Alternative and complementary medicines in the current sociocultural setting

La medicina tradicional, tanto las medicinas complementarias como las alternativas, suscita un amplio abanico de reacciones, que van desde el entusiasmo no crítico hasta el escepticismo no informado. Sin embargo, su uso está aumentando rápidamente en los países desarrollados y cada vez existen más estudios basados en la evidencia a favor del empleo de estas terapias. Los profesionales enfermeros tienen un papel importante en esta realidad, ya que conociendo estas técnicas pueden ofrecer un asesoramiento equilibrado acerca de las opciones terapéuticas existentes y así mejorar la relación de confianza con los pacientes, en muchos casos perdida por la tecnificación y deshumanización de la medicina convencional, a la vez de disminuir el uso de drogas sintéticas, cuestión cada vez más demandada por los usuarios de los servicios sanitarios, debido a que muchos pacientes son reacios a ellas. El objetivo de este artículo es aportar información sobre la situación de las medicinas alternativas y complementarias en la actualidad y mostrar algunos de los beneficios que pueden resultar de su aplicación al ámbito de los cuidados de salud. Para ello, se llevó a cabo una revisión bibliográfica de la literatura al respecto, trabajándose aspectos relativos a la demanda y tipos usuarios de estas terapias, así como a las características que pudieran resultar más idóneas para aplicar mediante cuidados enfermeros (AU)

Traditional medicine, in both its forms as complementary medicine and alternative medicine, raises a wide range of reactions, ranging from uncritical enthusiasm to uninformed skepticism. However, its use is increasing rapidly in developed countries and there is increasing evidence-based studies that favor use of these therapies. Nursing professionals have an important role in this reality, since knowing these techniques can provide balanced advice about therapeutic options and improve the relationship of trust with patients, in many cases lost by the mechanization and dehumanization of conventional medicine, while decreasing the use of synthetic drugs, an issue increasingly demanded by users of health services, because many patients are reluctant to take them. The aim of this paper is to provide information on the status of complementary and alternative medicine today and show some of the benefits that may result from their application to health care. For this purpose, a bibliographic review of the literature was conducted, focusing on aspects relating to demand and types of users of these therapies, aswell as the characteristics that may be best suited to be applied by nursing car e (AU)