[Assessment of foetal nutrition status at birth using the CANS score]. / Valoración clínica del estado nutricional fetal al nacer mediante el Clinical Assessment of Nutritional Status score.

INTRODUCTION: Foetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study is to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. PATIENTS AND METHODS: Retrospective population of term infants was studied between 2003 and 2014 (n=14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score <25 and PI <2.2g/cm(3). RESULTS: Using the CANS score, 7.6% (n 1,101) of the population showed FM, 50.3% (n=538) of SGA, 76.2% (n=193) subgroup 24 in 49% with PI <2.2g/cm(3) (n=109) CONCLUSIONS: It is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term. CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age.

Spasticity in multiple sclerosis: results of a patient survey.

Information regarding the epidemiology of spasticity in patients with multiple sclerosis (MS) in Spain is limited. This cross-sectional survey-based study was undertaken to evaluate the symptoms, severity and consequences of MS-related spasticity (MSS) and to estimate the prevalence of MSS overall and according to the degree of severity (mild/moderate/severe). Adult MS patients (n = 8463) from the two main Spanish MS patients' associations were asked to complete a web-based questionnaire. Two thousand six hundred twenty seven responses were received, of which 2029 were valid for analysis. Two thirds were for women. The mean age of respondents was 40.2 years and the mean MS duration was 8.7 years. MSS was reported by 65.7% of respondents with 40% of these rating it as moderate/severe. MS patients with spasticity experienced more symptoms (including greater difficulty walking), consumed more healthcare resources (including care and rehabilitation sessions), and had a higher degree of disability than patients without spasticity. There was a significant correlation between increasing severity of spasticity and worsening of symptoms. Only 42.4% of patients with moderate spasticity and 52.6% of patients with severe spasticity were currently receiving antispasticity medication compared with 69% and 79%, respectively, reported in a similar survey-based study from the United States; this is likely to reflect regional variations in practice. Early and effective treatment of MSS is important to minimise the consequences of spasticity-related symptoms on patients' quality of life and the economic burden on healthcare systems. In appropriate patients, antispastic treatment, including pharmacotherapy and physiotherapy/rehabilitation, may provide such benefits.

Assessment of the thrombin generation assay in haemophilia: comparative study between fresh and frozen platelet-rich plasma.

The severity of haemophilia A has traditionally been classified by the dosage of factor VIII (FVIII) by one-step coagulation tests. However, an homogeneous group of patients with similar FVIII levels show clinical heterogeneity and 10-15% of the patients classified as severe haemophilia do not have a severe bleeding phenotype. Traditional tests used for measuring FVIII are not capable of detecting other prohaemorrhagic or prothrombotic factors. Global tests as the thrombin generation assay (TGA) may detect these haemostatic factors. So TGA may be an additional tool for classifying the actual severity of haemophilia. Our group is carrying out correlation tests between FVIII and TGA in platelet-poor and -rich plasmas (PPP and PRP, respectively). PRP has the inconvenience that must be done freshly soon after blood extraction. Our aim is to study the differences between TGA performed with fresh and frozen PRP and PPP and its implementation in multicenter studies. We included 70 patients with severe haemophilia A in prophylactic treatment. Venous blood drawing was obtained prior to administration of FVIII, at the trough levels. FVIII measurement and TGA were performed in fresh and frozen PRP and PPP. The platelet absence caused a significant decrease in TGA although PPP and PRP correlated well. Frozen samples gave different results in PPP, but there were no significant differences between fresh and frozen PRP. This fact enables using frozen PRP in multicenter studies with a TGA-specialized laboratory for reclassifying haemophilia severity and for pharmacokinetic studies with TGA.

Comparación entre apendicectomía por videolaparoscopía y por laparotomía / Appendectomy: laparoscopy versus laparotomy

Objetivo: comparar los resultados de apendicectomía por videolaparoscopía y laparotomía en niños con apendicitis aguda. Pacientes y métodos: se compararon los resultados registrados prospectivamente en 20 pacientes en que se realizó apendicectomía por vía laparoscópica por apendicitis aguda (casos) a contar del mes de mayo de 1996 y se compararon con los de las 20 más recientes apendicetomías que, por la mismo causa, fueron realizadas antes de la fecha recién mencionada (controles), por los mismos autores. La edad de los casos era promedio 9,6 (3 a 14) años y cuatro (20 por ciento) tenían signos de peritonitis. La edad de los controles era promedio 8,6 (2,5 a 14) años y cinco (25 por ciento) tenían signos clínicos de peritonitis. Resultados: Las únicas complicaciones de la laparoscopía fueron un hematoma en el sitio de punción y un neumoperitoneo. Las hospitalizaciones en las apendicitis agudas no complicadas duraron 1,5 y 2,2 días (p< 0.025), respectivamente, en casos y controles. En ningún caso en cuatro controles se registró infección de la herida operatoria (p< 0,005). El tiempo promedio de operación en la apendicectomía laparoscópica fue 60 minutos. Conclusión: la apendicectomía laparoscópica es segura y su costo no es significativamente mayor que por laparatomía si se reesteriliza parte del material empleado en ella y se considera el menor gasto de hospitalización

[Analysis of cost minimization of epidural anesthesia compared with general anesthesia in oncologic coloproctologic surgery]. / Análisis de minimización de costes de la anestesia epidural comparada con la anestesia general en la cirugía oncológica coloproctológica.

BACKGROUND: Combined general and epidural anaesthesia in abdominal surgery has shown, both, protective and no effect on final outcome. The aim of this study was to evaluate combined epidural and general anesthesia. METHODS: One hundred and eighty four patients, diagnosed of neoplastic process, in whom an elective procedure of coloproctologic resection and reconstruction was scheduled during the period between January-1993 and December 1994, were studied. In thirty consecutive patients a combined general-epidural anaesthesia (EA) was performed. These patients were compared to thirty general anaesthesia patients (GA), selected randomly from the same period. RESULTS: Both groups were comparable for demographic characteristics and for the type and duration of the surgical procedure. Red Blood Cells units transfused were 1.7 +/- 3 in the EA group and 1.4 +/- 1.9 in the GA group. After the operation, most of patients went to SICU. The length of the hospital stay was 13 +/- 6 days for GA group, while for EA group was .13 +/- 5. The hospital mortality for all operated patients (N = 184) was 1.1%, which were directly related to failure of surgical anastomosis. The need for mechanical ventilation and pulmonary complications were similar in both groups. When analyzing costs, EA group represented a value (pesetas) of 433,501 +/- 183,337 for GA group and 437,735 +/- 149,572 for EA group. CONCLUSIONS: As shown, in the actual context, we conclude that the anaesthetic technique did not have any influence on outcome or on cost.

[The demand for care and systems of access in primary health care]. / Demanda asistencial y sistemas de acceso en la Atención Primaria de Salud.

The aim of the investigation was to assess variations in the demand for medical care in the primary care centre of Ciudad Badia (Barcelona, Spain). The records of attendance were analysed over a period of seven years. During this period, some changes were made which affected the way the centre was used by patients, such as the creation of systems which required notice of medical and nursing appointments, the reduction of spontaneous attendance, and the introduction of a card for medication for the chronically sick. These changes were accompanied initially by a decrease, then a stabilisation, and afterwards a slight increase in total number of visits. All visits (with notice) rose from 5.3% in 1983 to 45.2% in 1989. Similarly, nursing visits (with notice) increased from 4% to 9.5 of total activity. Emergency visits in the same period rose from 3.4% to 8%. It is concluded that changes that were introduced raised the level of commitment of the staff to medical work-both preventive and therapeutic, as well as the improvement of the organisation of attendance at the centre and a higher satisfaction of users of the centre and the medical staff.