Cancer-associated splanchnic vein thrombosis: Clinical features upon diagnosis and short-term outcomes.

INTRODUCTION: The incidence of splanchnic vein thrombosis (SVT) in cancer patients has increased in recent years and its real clinical significance and management can be challenging. This study aimed to describe the clinical presentation and short-term outcomes of patients with cancer-associated SVT. MATERIAL AND METHODS: This was a retrospective observational study of consecutive patients with cancer-associated SVT diagnosed during the period 2015-2020. The primary objective was to describe the clinical presentation of SVT. Patients were clinically classified into two groups based on the presence of symptoms on SVT diagnosis. The main outcomes were overall and SVT-related mortality, major and non-major bleeding rates, and the thrombosis recurrence rate in the first 30 days of follow-up. RESULTS: This study enrolled 203 patients. Intra-abdominal tumors (76 %) and metastatic disease (68 %) predominated. A total of 79 (39 %) patients without symptoms were diagnosed with SVT during a scheduled radiological test and were classified as "asymptomatic", while 124 (61 %) patients presented some potential SVT symptoms and were considered as "symptomatic". Although the 30-day outcomes showed no significant differences between the two groups, mortality in the asymptomatic group was slightly lower compared to the symptomatic group (3 % vs. 10 %, p = 0.085). CONCLUSIONS: Almost 40 % of cases of cancer-associated SVT are asymptomatic. There were no significant differences in short-term outcomes between the symptomatic and asymptomatic patients. More studies are required to better define long-term management and outcomes in these patients.

[Factors associated with the risk of hospitalization and death related to SARS-CoV-2 infection.] / Factores asociados al riesgo de hospitalización y muerte relacionados con la infección por SARS-CoV-2.

OBJECTIVE: COVID-19 has tried out global health causing high mortality. There are some risk factors that associate greater severity and mortality from COVID-19; but their individual impact is unknown yet. There are also no fixed criteria for hospital admission. For this reason, this study aimed to analyze the factors associated with the severity of COVID-19 and create predictive models for the risk of hospitalization and death due to COVID-19. METHODS: A descriptive retrospective cohort study was made in Talavera de la Reina (Toledo, Spain). Data were collected through computerized records of Primary Care, Emergencies and Hospitalization. The sample consisted of 275 patients over eighteen years old diagnosed with COVID-19 in a centralized laboratory from March 1st to May 31st, 2020. Analysis was carried on using SPSS, creating two predictive models for the risk of hospitalization and death using linear regression. RESULTS: The probability of hospitalization increased independently with polypharmacy (OR 1.086; CI95% 1.009-1.169), the Charlson index (OR 1.613; CI95% 1.158-2.247), the history of acute myocardial infarction (AMI) (OR 4.358; 95% CI 1.114-17.051) and the presence of COVID symptoms (OR 7.001; 95% CI 2.805-17.475). The probability of death was independently associated with age, increasing 8.1% (OD 1.081; 95% CI 1.054- 1.110) for each year of the patient. CONCLUSIONS: Comorbidity, polypharmacy, history of AMI and the presence of COVID-19 symptoms predict the risk of hospitalization. The age of individuals predicts the risk of death. Detecting patients at high risk of hospitalization and death allows us to define the target population and define measures to implement.

OBJETIVO: La COVID-19 ha puesto a prueba la sanidad mundial, provocando una elevada mortalidad. Existen factores de riesgo que asocian mayor gravedad y mortalidad por COVID-19, pero se desconoce su impacto individual. Tampoco existen criterios fijos para un ingreso hospitalario. Por ello, este estudio pretendió analizar los factores asociados a la gravedad de la COVID-19 y crear modelos predictivos de riesgo de hospitalización y exitus por COVID-19. METODOS: Se realizó un estudio descriptivo de cohorte retrospectiva en Talavera de la Reina (Toledo, España). Los datos fueron recogidos mediante registros informatizados de Atención Primaria, Urgencias y Hospitalización. La muestra estuvo compuesta por 275 pacientes mayores de dieciocho años diagnosticados de COVID-19 en un laboratorio centralizado del 1 de marzo al 31 de mayo de 2020. Se ejecutó el análisis mediante SPSS, creándose sendos modelos predictivos de riesgo de hospitalización y exitus mediante regresión lineal. RESULTADOS: La probabilidad de hospitalización aumentó de forma independiente con la polifarmacia (OR 1,086; IC95% 1,009-1,169), el índice de Charlson (OR 1,613; IC95% 1,158-2,247), el antecedente de infarto agudo de miocardio (IAM) (OR 4,358; IC95% 1,114-17,051) y la presencia de síntomas COVID (OR 7,001; IC95% 2,805-17,475). La probabilidad de exitus se asoció de forma independiente con la edad, aumentando un 8,1% (OD 1,081; IC95% 1,054-1,110) por cada año del paciente. CONCLUSIONES: La comorbilidad, la polifarmacia, el antecedente de IAM y la presencia de síntomas de COVID-19 predicen un riesgo de hospitalización. La edad de los individuos predice el riesgo de exitus. Detectar los pacientes con alto riesgo de hospitalización y exitus nos permite delimitar la población diana y definir las medidas a implementar.

Relationship between Oral Health Knowledge and Maternal Oral Health with Obstetric Risk and Breastfeeding.

The relationship between maternal gingival health status and low birth weight or preterm delivery is controversial. The aim of this study was to analyze the association between maternal oral knowledge and the level of oral health during pregnancy with the risk of obstetric complications and breastfeeding. A descriptive cross-sectional study was conducted after an oral health educational intervention in a consecutive sample of 97 pregnant women. Data collection consisted of a validated questionnaire, oral examination, the Caries Index (CAOD) and the Simplified Oral Hygiene Index (IHOS). The participants had a mean age of 32.5 ± 5.19 years and a predominantly university education (57.1%). The level of knowledge regarding oral health was fair (12.5 ± 3.56 correct answers). Older pregnant women (33.0 ± 4.80 years) practiced breastfeeding and had a higher number of correct answers to the questionnaire. Adequate IHOS was associated with higher birth-weight newborns (3333 ± 0.3), whereas poor oral hygiene control was associated with lower birth-weight newborns (2960 ± 0.1) (p < 0.05). A lower level of academic education was associated with worse oral hygiene (p < 0.05). In addition, the greater the number of children, the higher the CAOD. Finally, among non-smoking women, the weight of infants was 437 mg higher. Maternal oral hygiene and the week of delivery were associated with newborn weight (p < 0.05) in a multiple linear regression model. Smoking was also related to low birth weight (p < 0.05). Educational interventions in pregnancy are necessary to decrease the incidence of obstetric adverse effects and improve the oral health of mothers and their children.

Study of the Anatomical Association between Morton's Neuroma and the Space Inferior to the Deep Transverse Metatarsal Ligament Using Ultrasound.

Morton's neuroma (MN) is a common condition in clinical practice. The compressive etiology is the most accepted, in which compression occurs in the tunnel formed by the adjacent metatarsals, the deep transverse metatarsal ligament (DTML) and the plantar skin. Ultrasound (US) is a reliable method of study. The presence of insufficient space under the DTML may be related to the appearance of MN. OBJECTIVES: To verify the relationship between MN and the space under the DTML between the metatarsal heads of the third (M3) and the fourth (M4) metatarsals using US. METHODS: This is a cross-sectional epidemiological study. The research study using the ultrasound (US) technique was carried out on 200 feet belonging to 100 patients aged 18 to 65 of both sexes, with a control group formed by 62 patients and a study group formed by 38 patients diagnosed with MN. RESULTS: The presence of MN and the factors associated with it were studied in 100 patients using ultrasound (US). The assessment and comparison with US of the space inferior to the DTML between M3 and M4 in control groups and patients with MN show that patients with MN have a smaller size in the variable "h" (height or distance DTML-plantar skin), in the variable "b" (base or intermetatarsal distance M3 and M4) and in the variable "s" (surface of the parallelogram "h" × "b"). The predictors of MN are a decrease in dimension "b" and an increase in weight. Sitting in an office chair and the use of a bicycle, due to equinus, have an influence on the space below the DTML, reducing it and promoting the appearance of MN. CONCLUSIONS: The two US measurements ("h" and "b") in the space below the DTML are smaller in patients with MN than in the asymptomatic group. A shorter distance between M3 and M4, and an increase in BMI are predictors of MN.

Novel Ultrasound Anatomical Measurement of the Deep Transverse Metatarsal Ligament: An Intra-Rater Reliability and Inter-Rater Concordance Study.

Insufficient space below the Deep Transverse Metatarsal Ligament (DTML) could be an etiological factor for Morton's Neuroma (MN). To date, there is a lack of studies measuring the space below the DTML. For this reason, this study assesses the intra- and inter-rater concordance and reproducibility of measurements of the space below the DTML between the third and the fourth metatarsal heads (M3 and M4) using ultrasound imaging to assess and verify the reliability and reproducibility of measurements of the space under the DTML. Forty feet from twenty patients were examined using ultrasound by three trained evaluators at two different times. The two measurements taken on each foot were: base (b)­distance between M3 and M4, and height (h)­distance between the DTML and the plantar skin surface. This was a quantitative, observational, analytical study. The concordance rate between observers for measurements of height and base were 98.5% and 99.5%, respectively. The mean area obtained of the space was 54.6 mm2 and 57.2 mm2 for both the left and right foot (p > 0.05). Reproducibility over time calculated in pre- and post-measurements showed an intraclass correlation coefficient of 1.00 (95%CI: 0.99−1.00), which leads us to conclude that the measurements are perfectly reproducible. Both measurements (height and base) of the space under the DTML, performed by ultrasound, are reliable and reproducible.

Correlation between three assessment pain tools in subacromial pain syndrome.

OBJECTIVE: To compare the correlation of Visual Analog Scale with pain subsections of Shoulder Pain and Disability Index and Constant-Murley Score in subacromial pain syndrome patients. DESIGN: Single cross-sectional analysis. SETTING: Hospital Rehabilitation Department. METHODS: The assessment tools were applied at baseline. Correlations between Visual Analog Scale, Shoulder Pain and Disability Index and Constant-Murley Score pain subsections were assessed by Pearson correlation coefficient. Linear regression models were calculated between scales. Statistical significance was set at two-sided p < 0.05. RESULTS: Forty-three patients were included. Pearson's correlation between assessments was for Visual Analog Scale-Shoulder Pain Disability Index-pain (r = 0.61, p < 0.001) and for Visual Analog Scale-Constant Murley Score-pain were (r = -0.74, p < 0.001). Visual Analog Scale-Shoulder Pain and Disability Index-pain determination coefficient was r2 = 0.37 and r2 = 0.54 for Visual Analog Scale-Constant-Murley Score-pain. CONCLUSIONS: Visual Analog Scale showed better correlation with Constant Murley Score-pain than with Shoulder Pain and Disability Index-pain in subacromial pain syndrome patients.

How Health Habits Influence the Physiological Response During a Physical Activity in Extreme Temperatures?

BACKGROUND: The purpose of the study was to determine to what degree the health habits of university students influence their physiological response during a 10-min high-intensity exercise. METHODS: We conducted a cross-sectional cohort study with 59 health science students, in which we analyzed their adherence to a Mediterranean and low-fat diet, as well as their activity levels. We correlated these factors with the physiological response (lactic acid and heart rate) and a series of anthropometric parameters in intense physical activity (cardiopulmonary resuscitation (CPR) for 10 min) in three scenarios: extreme cold, extreme heat and a control situation at room temperature. RESULTS: The results of this study demonstrate that in university students, a greater adherence to the Mediterranean diet was associated with a better response to physical exercise, in this case, 10-min CPR, in hostile environments. CONCLUSIONS: Following healthy eating guidelines improves physical performance and delays the appearance of fatigue; both are important aspects for a better performance of CPR.

Long-term effect of high-intensity laser therapy for persistent shoulder pain: A case report.

BACKGROUND AND OBJECTIVE: This case report describes the long-term effect of the high-intensity laser therapy (HILT) in a patient with chronic shoulder pain refractory in comparison to other treatments. CASE DESCRIPTION: Ten sessions of HILT were applied in a thirty-one-year-old woman diagnosed with subacromial syndrome. Assessment was carried out through different tests: Shoulder Pain and Disability Index (SPADI), Numeric Pain Rating Scale (NPRS) and pressure pain threshold (PPT). All measurements were taken at four different points: at the end of the 10 sessions, after one month, three months after the intervention and nine months after the initial intervention. RESULTS: There was a clinically significant improvement in NPRS (decrease of 5 points), PPT (increase of 1.5 kg/cm2) and SPADI (decrease of 24 points) one month after the intervention. After three months, the increase of NPRS and SPADI required a 5-session intervention to support the clinical improvement. Six months after these booster sessions an increase in PPT and a decrease in NPRS and SPADI were observed. CONCLUSION: Results indicate the suitability of developing new research lines which will optimize the use of HILT.

Estado nutricional de una población escolar en España y su relación con hábitos de alimentación y actividad física / Nutritional status of a school population in Spain and its relationship to eating habits and physical activity

La obesidad infantil ha incrementado su prevalencia en España, y aunque se considera un problema multifactorial, es atribuible principalmente al aumento de la ingesta y la disminución de la actividad física por un ocio sedentario mayor. El objetivo de este estudio fue conocer la prevalencia de sobrepeso y obesidad infantil en la Zona Básica de Salud (ZBS) de Menasalbas (Toledo, España), y la influencia de los hábitos alimentarios, de actividad física y deporte, y de ocio sedentario. Se realizó un estudio transversal en la población escolarizada de 3 a 12 años de la ZBS de Menasalbas, tomando medidas de peso y talla a 725 menores, calculando su IMC y clasificando su estado ponderal según las tablas de Cole. También se recogieron datos referentes a sus hábitos alimentarios y cuestionario Kidmed de adherencia a la dieta mediterránea, y hábitos de actividad física y ocio sedentario, para estudiar su relación con el estado ponderal de los menores. La prevalencia de sobrecarga ponderal (suma de prevalencias de sobrepeso y obesidad) fue del 24,9%, con un 18,8% de sobrepeso y un 6,1% de obesidad, sin diferencias por edad y sexo. No se observaron diferencias respecto a los hábitos alimentarios, pero si una menor actividad física y un mayor ocio sedentario en aquellos con sobrecarga ponderal. La prevalencia de sobrepeso y obesidad en nuestra población es elevada, aunque menor a las de otros trabajos. La alimentación, la actividad física y el ocio sedentario influenciaron el sobrepeso y la obesidad infantil en este estudio(AU)

Childhood obesity has increased its prevalence in Spain, and although it´s considered a multifactorial problem, it is mainly attributable to increased intake and decreased physical activity due to increased sedentary leisure. The objective of this study was to know the prevalence of overweight and childhood obesity in the Basic Health Zone (ZBS) of Menasalbas (Toledo, Spain), and the influence of eating habits, physical activity and sport, and sedentary entertainment. A cross-sectional study was conducted in the school children of 3 to 12 years of age in the ZBS of Menasalbas, taking weight and height measurements for 725 minors, calculating their BMI and classifying their weight status according to Cole´s tables. Data regarding their eating habits and Kidmed questionnaire of adherence to the mediterranean diet, physical activity habits and sedentary leisure habits were also collected, to study its relationship with the weigh status of minors. The prevalence of weight overload (understood as the sum of the prevalence of overweight and obesity) was 24.9% , with 18.8% overweight and 6.1% of obesity, with no differences by age and sex. No differences were observed regarding eating habits, but less physical activity and a more sedentary leisure in those with weight overload was observed. The prevalence of overweight and obesity in our population is high, although lower than reported in other works. Diet, physical activity and sedentary leisure are confirmed as fundamental aspects in childhood overweight and obesity(AU)

Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial.

OBJECTIVES: To evaluate the effectiveness of high-intensity laser therapy on shoulder pain and function in subacromial impingement syndrome. DESIGN: Clinical controlled trial with alternate allocation. SETTING: Hospital Department of Rehabilitation. SUBJECTS: A total of 46 participants with subacromial impingement syndrome. INTERVENTION: Participants were sequence allocated to an intervention group (high-intensity laser therapy + exercise therapy) and control group (sham-laser + exercise therapy) and received 15 sessions (five days a week during three weeks). MAIN MEASURES: Patiens were evaluated at baseline, after 15 sessions, and at one month and at three months after completing the intervention. The main outcome variables were pain and functionality as measured by visual analogue scale; pressure pain threshold; Shoulder Pain and Disability Index; Constant-Murley Score; and QuickDASH. Secondary outcomes were number of sessions at discharge and drug use. RESULTS: A total of 21 patients in high-intensity laser therapy group (56.7 ± 8.9 years) and 22 patients in sham-laser group (61.3 ± 8.9 years) concluded the study. Visual analogue scale (cm) at baseline, one-month, and three-months were 6.2 ± 0.5, 3 ± 2.6, and 2.6 ± 2.4 for the control group and 5.4 ± 1.5, 3.6 ± 1.3, and 1.8 ± 1.7 for experimental group, respectively. Shoulder Pain and Disability Index (points) at baseline, one-month, and three-monts were 51.8 ± 16.1, 16.3 ± 16.1, and 13.6 ± 17.1 in the control group and 41.8 ± 20.6, 20.5 ± 19.7, 11 ± 14.5 in experimental group, respectively. No differences were found between groups ( P > 0.05). CONCLUSION: The effect of high-intensity laser therapy plus exercise is not higher than exercise alone to reduce pain and improve functionality in patients with subacromial syndrome.

Symptomatic pain and fibromyalgia treatment through multidisciplinary approach for primary care.

INTRODUCTION: Fibromyalgia is a chronic disease of unknown etiology characterized by widespread muscle pain, with occupational, familial, social, physical and psychological performance involvement. The multidisciplinary approach to the disease leads to improvement in quality of life and symptomatology. OBJECTIVES: To evaluate the improvement of activities of daily living (ADL) and quality of life following a multidisciplinary intervention (Health Primary Care and Occupational Therapy). MATERIAL AND METHODS: Pretest-posttest study performed with a simple random sample of 21 patients with fibromyalgia (range 16-55 years). The measurement was performed with the Barthel scale (ADL), the scale of Lawton and Brody (IADL), the FIQ questionnaire, and no standardized surveys to assess the pre and post intervention situation. An intervention on motor skills (basic motor skills, pool exercise, outdoor exercise, restructuring, occupational performance and graded activity and intervention in ADL) was performed, combining pharmacological control of their symptoms and treatment. RESULTS AND CONCLUSIONS: Fibromyalgia patients are not fully satisfied with their treatment; Primary Care receives a score of 6.89, and Hospital Care 5.79, improving the Barthel, Lawton and Brody and FIQ indexes, being statistically significant (p<.05). After the combined procedure the number of independent women in ADL and IADL increases.

[Contemporary relevance of the Spanish General Health Act after twenty five years]. / Vigencia de la Ley General de Sanidad tras veinticinco años.

Since its enactment in 1986, the General Health Law (Law 14/1986) has undergone several changes that have consolidated a model of National Health System. The law was embodied in 113 articles, ten Additional Provisions, five transitional arrangements, two Repeal and fifteen Final Provisions, has altogether 143 articles. After reviewing all legislation that appeared from 1986 to until today we can see that there are 106 articles (74.2%) that have lost regulatory effectiveness and merit analysis or reflection. All these items can be classified into four groups, the repealed and amended 26 articles (18.2%), 33 items of obsolete group (23.1%); the group of ill-developed are 6 articles (4.2%) and the critical (controversial and under ambiguous wording) group that has 41 articles (28.6%). After a quarter century of enforcement of the Act, two thirds of it to be reviewed. This legal weakness suggest the need of a new General Health Act for the Spanish National health System, being it a central objective of a political wide agreement.

[Mortality attributable to tobacco consumption in the years 1987 and 1997 in Castilla la Mancha, Spain]. / Mortalidad atribuible al consumo de tabaco en los años 1987 y 1997 en Castilla-La Mancha, España.

BACKGROUND: Smoking is an important public health problem and is one of the main avoidable causes of morbidity and early mortality. The aim of this work was to describe the mortality attributable to tobacco consumption in Castilla la Mancha between 1987 and 1997. METHOD: Deaths in relation to age, sex and cause of death were obtained from the Death's Register of Castilla la Mancha. From the National Health Surveys of 1987 and 1997, the percentages of non-smokers, smokers and ex-smokers in the population in relation to age and sex were recorded. The relative risks of death were obtained from the Cancer Prevention Study II, carried out in the United States. The proportion of deaths attributable to smoking was calculated for each year, and according to sex and age group, from the etiological fraction of the population. Likewise, loss of potential life in years and the mean number of years of potential life lost were also calculated. RESULTS: During the study period, 18% of all the deaths in Castilla la Mancha can be attributed to tobacco consumption. Mortality is higher in males than in females, and the most important diagnostic categories were tracheobronchopulmonary cancer (24.3%) in males and diseases of the cardiovascular system (24.28%) in females. These were also the conditions most responsible for years of potential life lost. CONCLUSIONS: Every day, in Castilla la Mancha, 8 people die from smoking-related conditions. The measures currently in practise to control tobacco consumption are insufficient.