Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population.

BACKGROUND: Acute ischemic stroke patients not referred directly to a comprehensive stroke center (CSC) have reduced access to endovascular treatment (EVT). The RACECAT trial is a population-based cluster-randomized trial, designed to compare mothership and drip-and-ship strategies in acute ischemic stroke patients outside the catchment area of a CSC. AIMS: To analyze the evolution of performance indicators in the regions that participated in RACECAT. METHODS: This retrospective longitudinal observational study included all stroke alerts evaluated by emergency medical services in Catalonia between February 2016 and February 2020. Cases were classified geographically according to the nearest SC: local SC (Local-SC) and CSC catchment areas. We analyzed the evolution of EVT rates and relevant workflow times in Local-SC versus CSC catchment areas over three study periods: P1 (February 2016 to April 2017: before RACECAT initiation), P2 (May 2017 to September 2018), and P3 (October 2018 to February 2020). RESULTS: We included 20603 stroke alerts, 10,694 (51.9%) of which were activated within Local-SC catchment areas. The proportion of patients receiving EVT within Local-SC catchment areas increased (P1 vs. P3: 7.5% (95% confidence interval (CI), 6.4-8.7) to 22.5% (95% CI, 20.8-24.4) p < 0.001). Inequalities in the odds of receiving EVT were reduced for patients from CSC versus Local-SC catchment areas (P1: odds ratio (OR) 3.9 (95% CI, 3.2-5) vs. P3: OR 1.5 (95% CI, 1.3-1.7) In Local-SC, door-to-image (P1: 24 (interquartile range (IQR) 15-36), P2: 24 (15-35), P3: 21 (13-32) min, p < 0.001) and door-to-needle times (P1: 42 (31-60), P2: 41 (29-58), P3: 35 (25-50) p < 0.001) reduced. Time from Local-SC arrival to groin puncture also decreased over time (P1: 188 [151-229], P2: 190 (157-233), P3: 168 (127-215) min, p < 0.001). CONCLUSION: An increase in EVT rates in Local-SC regions with a significant decrease in workflow times occurred during the period of the RACECAT trial.

Psychological impact of the COVID-19 pandemic on primary care workers: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic has had a major impact on the mental health of healthcare workers, yet studies in primary care workers are scarce. AIM: To investigate the prevalence of and associated factors for psychological distress in primary care workers during the first COVID-19 outbreak. DESIGN AND SETTING: This was a multicentre, cross-sectional, web-based survey conducted in primary healthcare workers in Spain, between May and September 2020. METHOD: Healthcare workers were invited to complete a survey to evaluate sociodemographic and work-related characteristics, COVID-19 infection status, exposure to patients with COVID-19, and resilience (using the Connor-Davidson Resilience Scale), in addition to being screened for common mental disorders (depression, anxiety disorders, post-traumatic stress disorder, panic attacks, and substance use disorder). Positive screening for any of these disorders was analysed globally using the term 'any current mental disorder'. RESULTS: A total of 2928 primary care professionals participated in the survey. Of them, 43.7% (95% confidence interval [CI] = 41.9 to 45.4) tested positive for a current mental disorder. Female sex (odds ratio [OR] 1.61, 95% CI = 1.25 to 2.06), having previous mental disorders (OR 2.58, 95% CI = 2.15 to 3.10), greater occupational exposure to patients with COVID-19 (OR 2.63, 95% CI = 1.98 to 3.51), having children or dependents (OR 1.35, 95% CI = 1.04 to 1.76 and OR 1.59, 95% CI = 1.20 to 2.11, respectively), or having an administrative job (OR 2.24, 95% CI = 1.66 to 3.03) were associated with a higher risk of any current mental disorder. Personal resilience was shown to be a protective factor. CONCLUSION: Almost half of primary care workers showed significant psychological distress. Strategies to support the mental health of primary care workers are necessary, including designing psychological support and resilience-building interventions based on risk factors identified.

[Under-diagnosis of neuromuscular diseases in patients of 80 years and older]. / Infradiagnóstico de enfermedades neuromusculares en ancianos de 80 y más años.

Myasthenia gravis (MG), amyotrophic lateral sclerosis and Guillain-Barre syndrome (GBS) have been classically considered as exceptional or unusual diseases in people with a geriatric profile. Over the past 25 years, several population-based studies have been conducted in the Osona area (Barcelona), which, for the first time, has led to describing the high global incidences in the elderly, especially those over 80 years-old. The results suggest the possibility of underdiagnosis of these neuromuscular diseases in the elderly, a fact that could be especially relevant in the case of MG and GBS, since they are 2potentially reversible entities with high mortality in the event of underdiagnosis and absence of treatment.

[IgG4- and MPO-ANCA-associated hypertrophic pachymeningitis]. / Paquimeningitis hipertrófica relacionada con IgG4 y MPO-ANCA.

INTRODUCTION: Idiopathic hypertrophic pachymeningitis is a fibroinflammatory immune-mediated disease of the dura mater. Its diagnosis requires the preclusion of infectious, tumoral and other inflammatory diseases. In recent years new entities have been reported that can present with hypertrophic pachymeningitis, such as IgG4-associated disease and MPO-ANCA+ pachymeningitis, as a form of vasculitis limited to the central nervous system. CASE REPORT: We describe the case of a 64 years-old male with headaches and cervicalgia, predominantly at night, and clinical signs and symptoms of spinal cord compression. Following the diagnosis of craniocervical hypertrophic pachymeningitis provided by the magnetic resonance imaging study, an aetiological study was conducted. Infectious and tumoral diseases were precluded. The clinical features did not show any systemic involvement and high levels of IgG4 and MPO-ANCA+ were found in the results of the analyses. The clinical signs and symptoms quickly improved following treatment with corticoids. CONCLUSIONS: IgG4-related disease and MPO-ANCA-associated vasculitis limited to the central nervous system can account for a high percentage of the cases of hypertrophic pachymeningitis that were considered idiopathic, and their diagnosis requires a biopsy and a histological study.

TITLE: Paquimeningitis hipertrofica relacionada con IgG4 y MPO-ANCA.Introduccion. La paquimeningitis hipertrofica idiopatica es una enfermedad fibroinflamatoria de la duramadre. Su diagnostico requiere la exclusion de enfermedades infecciosas, tumorales y otras enfermedades inflamatorias. En los ultimos años se han descrito nuevas entidades que pueden presentarse con paquimeningitis hipertrofica: la enfermedad relacionada con IgG4 y la paquimeningitis MPO-ANCA+ como forma de vasculitis limitada al sistema nervioso central. Caso clinico. Varon de 64 años con cefalea y cervicalgia de predominio nocturno y clinica de compresion medular. Tras el diagnostico de paquimeningitis hipertrofica craneocervical facilitado por el estudio de resonancia magnetica, se realizo un estudio etiologico. Se descartaron enfermedades infecciosas y tumorales. La clinica no mostraba afectacion sistemica y en la analitica presentaba IgG4 elevada y MPO-ANCA+. Tras tratamiento con corticoides presento una rapida mejoria de la clinica. Conclusiones. La enfermedad relacionada con IgG4 y la vasculitis asociada a MPO-ANCA limitada al sistema nervioso central pueden representar un alto porcentaje de las paquimeningitis hipertroficas que se consideraban idiopaticas, y su diagnostico requiere biopsia y estudio histologico.

[Influence of meteorological and chronological factors in epilepsy]. / Influencia en la epilepsia de factores meteorológicos y cronológicos.

INTRODUCTION: The professionals who deal with medical emergencies observe peaks in the incidence of epileptic seizures. Some epileptic patients attribute their seizures to climatic and seasonal changes. AIMS. To analyse the relationship between meteorological, calendar-related and circadian variables and the appearance of epileptic seizures. PATIENTS AND METHODS: A retrospective study was conducted in a residential home for persons with intellectual disability. RESULTS: The 16 residents who were studied presented 855 epileptic attacks, including 159 in peaks or clusters, over the period 2009-2012. The predominance of seizures observed in autumn and during the fourth quarter of the year is not significant (p > 0.05). There is no statistically significant relation between the presence of epileptic seizures and the phases of the moon or days of the week. Most epileptic seizures (87.2%) occur during the daytime (p < 0.001). Findings showed that 36.3% occur in the morning between 08:00 and 10:59. There is no statistical correlation between the number of epileptic seizures and the atmospheric pressure, rainfall, degree of humidity or mean temperature (p > 0.05). CONCLUSIONS: The appearance of peaks or clustering of epileptic seizures was observed. Their presence shows a marked circadian component. The influence of meteorological factors, the phases of the moon and seasons of the year on epilepsy is not significant.

TITLE: Influencia en la epilepsia de factores meteorologicos y cronologicos.Introduccion. Los profesionales que atienden urgencias medicas observan picos de incidencia de crisis epilepticas. Algunos pacientes epilepticos atribuyen sus crisis a cambios climaticos y estacionales. Objetivo. Analizar la relacion de variables meteorologicas, de calendario y circadianas con la aparicion de crisis epilepticas. Pacientes y metodos. Estudio retrospectivo en un centro residencial de personas con discapacidad intelectual. Resultados. Los 16 residentes estudiados presentan 855 crisis epilepticas, entre ellas 159 en picos o cumulos, a lo largo del periodo 2009-2012. El predominio de crisis encontrado en otoño y durante el cuarto trimestre del año no es significativo (p > 0,05). No hay relacion estadisticamente significativa entre la presencia de crisis epilepticas con las fases lunares y los dias de la semana. La mayoria de crisis epilepticas (87,2%) se presenta en horario diurno (p < 0,001). El 36,3% aparece entre las 8:00 y las 10:59 h. No hay correlacion estadistica entre el numero de crisis epilepticas respecto a la presion atmosferica, la precipitacion, el grado de humedad y la temperatura media (p > 0,05). Conclusiones. Se constata la aparicion de picos o cumulos de crisis epilepticas. La presencia de estas presenta un marcado componente circadiano. La influencia en la epilepsia de los factores meteorologicos estudiados, fases lunares y estaciones del año no es significativa.

Revisión bibliográfica sobre la relación entre el síndrome de disfunción temporomandibular y el trabajo con pantallas de visualización de datos / Temporomandibular dysfunction syndrome and working with video display terminals: a review of the literature

El síndrome de disfunción temporomandibular (DTM) incluye una serie de condiciones clínicas que involucran la articulación temporo-mandibular (ATM), la musculatura masticatoria o ambas. Los síntomas de DTM incluyen disminución de movilidad, dolor en la musculatura masticatoria, dolor de ATM, alteración funcional acompañada de ruidos articulares, dolor miofascial y desviación de la obertura mandibular. El trabajo con pantallas de visualización de datos (PVD) se ha generalizado en los últimos años las y condiciones de trabajo asociadas a este tipo de actividad se han relacionado con la aparición de determinadas patologías musculo-esqueléticas. El objetivo de este trabajo es revisar la literatura científica sobre la asociación entre el síndrome deDTMy el trabajo con PVD. Método: Se efectuó una búsqueda bibliográfica en las bases de datos de MEDINE (PubMed), Biblioteca Cochrane Plus, CINHAL, Scielo y Google Academic. Se incluyeron aquellos estudios en los que participaran trabajadores usuarios de PVD y la medida del efecto debía incorporar referencias a la sintomatología de ATM. Resultados y discusión: Se identificaron un total de 112 artículos, de los que se incluyeron 11 en la revisión final. Dada la heterogeneidad de los resultados observado y el diseño de los estudios no existe suficiente evidencia sobre la relación entre la patología de ATM y el trabajo con PVD. Tampoco existe suficiente evidencia para asociar la presencia de DTM con aspectos ergonómicos y posturales, una asociación que no debería descartarse desde un punto de vista fisiopatológico y de plausibilidad biológica. Son precisos nuevos estudios para evaluarla con mayor precisión

Temporomandibular dysfunction syndrome (TMDS) includes a number of clinical conditions involving the temporomandibular joint (TMJ), the muscles involved in mastication, or both. The symptoms of TMDS include decreased mobility, masticatory muscle pain, TMJ pain, functional alteration accompanied by articular noises, myofascial pain or deviation of the mouth opening. Work with visual display terminals (VDTs) has become widespread in the past several years and the conditions associated with this type of work have been associated with the appearance of certain musculoskeletal pathologies. Our objective was to conduct a review of the scientific literature on the possible association between TMDS and work with VDTs. Method: A search of the literature in MEDLINE (PubMed), Cochrane Plus Library, CINHAL, Scielo and Google Academic was performed.We included those studies involving workers using VDTs and the outcome measures had to include references to TMDS symptoms. Results and Discussion: A total of 112 articles were identified, of which finally 11 were selected for in-depth review. Given the heterogeneity of the results and the nature of the studies, we conclude that currently there is insufficient evidence to support a consistent relationship between TMDS pathology and work with VDTs. There is insufficient evidence linking the presence of TMDS with ergonomic and postural aspects, an association that should not be totally ruled out from a pathophysiological point of view and biological plausibility. Further studies are needed to better assess this relationship

Arteritis temporal con velocidad de sedimentación globular normal / Temporal arteritis with normal erythrocyte sedimentation rate

No disponible

Infradiagnóstico de enfermedades neuromusculares en ancianos de 80 y más años / Under-diagnosis of neuromuscular diseases in patients of 80 years and older

La miastenia gravis (MG), la esclerosis lateral amiotrófica y el síndrome de Guillain-Barré (SGB) han sido clásicamente considerados como enfermedades excepcionales o inhabituales en las personas de perfil geriátrico. A lo largo de los últimos 25 años se realizaron diversos estudios de base poblacional en la comarca de Osona (Barcelona), que permitieron describir por primera vez en la literatura incidencias globales altas a expensas de los ancianos, especialmente en aquellos de más de 80 años. Los resultados encontrados indican la posibilidad de infradiagnóstico de estas enfermedades neuromusculares en el anciano, hecho que podría resultar especialmente relevante en el caso de la MG y el SGB, dado que son 2entidades potencialmente reversibles y con alta mortalidad en caso de infradiagnóstico y ausencia de tratamiento

Myasthenia gravis (MG), amyotrophic lateral sclerosis and Guillain-Barre syndrome (GBS) have been classically considered as exceptional or unusual diseases in people with a geriatric profile. Over the past 25 years, several population-based studies have been conducted in the Osona area (Barcelona), which, for the first time, has led to describing the high global incidences in the elderly, especially those over 80 years-old. The results suggest the possibility of underdiagnosis of these neuromuscular diseases in the elderly, a fact that could be especially relevant in the case of MG and GBS, since they are 2potentially reversible entities with high mortality in the event of underdiagnosis and absence of treatment

[Paroxysmal dyskinesia secondary to non-ketotic hyperglycaemia with a diabetic onset]. / Discinesia paroxística secundaria a hiperglucemia no cetogénica de inicio diabético.

TITLE: Discinesia paroxistica secundaria a hiperglucemia no cetogenica de inicio diabetico.

Cabeza caída como inicio de la miastenia en la enfermedad de Parkinson: ¿una asociación característica? / Dropped head as the presenting symptom of myasthenia in Parkinson's disease: a characteristic association?

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Metanálisis: Relación entre factores psicosociales en el trabajo y absentismo laboral / Meta-analyses: Relation between psychosocial factors in the work and labour absenteeism

Introducción: De acuerdo con el modelo de demada-control, la elevada demanda laboral, el bajo control sobre el mismo y de forma muy especial la combinación de ambos, supondría un importante riesgo para la salud. El equilibrio entre demanda y control depende, según este modelo, de la organización del trabajo y no de las características individuales de cada persona, aunque, por supuesto, la influencia del ambiente psicosocial de trabajo puede ser, y de hecho es, moderada por las características de la respuesta individual. Objetivos: El objetivo del estudio fue analizar de manera sistemática aquellos estudios que relacionaban los efectos que sobre el absentismo tienen los factores psicosociales en el seno de las organizaciones, utilizando como elemento principal de valoración el modelo de demanda-control de Karasek, y efectuar un metanálisis para valorar la relación entre ambos. Métodos: Se identificaron las publicaciones a partir de las bases de datos electrónicas Medline (2004 hasta julio de 2009), Embase (2004 hasta marzo de 2009), PsycInfo (2004 hasta julio de 2009) y en la Librería Cochrane (2004 hasta julio de 2009), sin restricciones por motivo de lenguaje. Las palabras claves utilizadas fueron absentismo ("absenteeism"), absentismo por enfermedad ("sickness absence"), psicosocial ("psychosocial"), laboral ("occupational") y combinaciones de las mismas, que se eligieron inicialmente para su inclusión en el metanálisis. Adicionalmente se revisaron las citas mencionadas en los originales seleccionados para detectar otros estudios potencialmente relevantes. De este modo se consideraron relevantes 51 artículos que parecían cumplir con los factores objeto de este análisis. De estos se excluyeron finalmente 2 (3,9%) por falta de datos para efectuar el análisis, 6 (11,7%) por tratarse de estudios repetidos o con doble publicación, 2 (3,9%) por tratarse de estudios con diseño transversal y los restantes 35 (68,6%) porque su información no era relevante para ser incluidos. Control: El gráfico Forest (Fig. 2) muestra el resultado del metanálisis: el riesgo relativo de sufrir un episodio de absentismo es estadísticamente significativo, con un valor de 1,36 (CI: 1,02-1,82) (Tabla 2). Demanda: El riesgo de sufrir un episodio de absentismo no es valorable, con un valor de 1,01 (IC: 0,91-1,11). (Tabla 3). Si bien la demanda, como dimensión propia de estos factores psicosociales, no parece una variable relacionada o que influencie el absentismo laboral, el control sí que se encuentra asociado a este, de manera reiterada y consistente (AU)

Introduction: In accordance with the model of demand-control, the overhead labour demand, the low control on itself and in a very special way the combination of both, it would suppose an important risk for health. The balance between demand and control depends, just as this model, on the organization of the work and not on the individual characteristics of each person, although, of course, the influence of the working psychosocial environment can be, and in fact is, moderated by the characteristics of the individual answer. Objectives: The study's objective was to analyse in a systematic way those studies that related the effects over absenteeism that the psychosocial factors have constituted in the enterprises, using as a main element of assessment, the model of demand-control of Karasek, and to make a meta-analyses to evaluated the relation between both of them. Methods: There were identified publications from the electronics data bases Medline (2004 to July 2009), Embase (2004 to March 2009), PsycInfo (2004 to July 2009) and in the Bookshop Cochrane (2004 to July 2009), without restrictions motivated by language. The keyboards used were absenteeism, sickness absence, psychosocial, occupational and combinations of them that were chosen initially by its inclusion on the meta-analyses. Additionally the appointments mentioned were reviewed in the selected originals to detect some other studies potentially relevant. In this way the ones considered relevant were 51 articles that seemed to fulfil with the object factors of this analyse. Finally there were excluded 2 (3,9%) because of no dates to effect the analyse, 6 (11,7%) to treat about repeated studies or with double publication, 2 (3,9%) to treat about repeated studies with transversal design and the rest 35 (68,6%) because its information was not relevant to be included. Control: The graphic Forest (Fig. 2) shows the meta-analyse result: the relative risk of suffering an episode of absenteeism is statistically significant, with a value of 1,36 (CI: 1,02-1,82) (Table 2). Demand: The risk of suffering an episode of absenteeism is valueless, with a value of 1,01 (IC: 0,91- 1,11). (Table 3). The demand, as an itself dimensioned of these psycho-socials factors, does not seem a related variable or an influence for the occupational absenteeism, the control is really associated to it, repeatedly and consistently (AU)

Paquimeningitis hipertrófica relacionada con IgG4 y MPO-ANCA / IgG4- and MPO-ANCA-associated hypertrophic pachymeningitis

Introducción. La paquimeningitis hipertrófica idiopática es una enfermedad fibroinflamatoria de la duramadre. Su diagnóstico requiere la exclusión de enfermedades infecciosas, tumorales y otras enfermedades inflamatorias. En los últimos años se han descrito nuevas entidades que pueden presentarse con paquimeningitis hipertrófica: la enfermedad relacionada con IgG4 y la paquimeningitis MPO-ANCA+ como forma de vasculitis limitada al sistema nervioso central. Caso clínico. Varón de 64 años con cefalea y cervicalgia de predominio nocturno y clínica de compresión medular. Tras el diagnóstico de paquimeningitis hipertrófica craneocervical facilitado por el estudio de resonancia magnética, se realizó un estudio etiológico. Se descartaron enfermedades infecciosas y tumorales. La clínica no mostraba afectación sistémica y en la analítica presentaba IgG4 elevada y MPO-ANCA+. Tras tratamiento con corticoides presentó una rápida mejoría de la clínica. Conclusiones. La enfermedad relacionada con IgG4 y la vasculitis asociada a MPO-ANCA limitada al sistema nervioso central pueden representar un alto porcentaje de las paquimeningitis hipertróficas que se consideraban idiopáticas, y su diagnóstico requiere biopsia y estudio histológico (AU)

Introduction. Idiopathic hypertrophic pachymeningitis is a fibroinflammatory immune-mediated disease of the dura mater. Its diagnosis requires the preclusion of infectious, tumoral and other inflammatory diseases. In recent years new entities have been reported that can present with hypertrophic pachymeningitis, such as IgG4-associated disease and MPO-ANCA+ pachymeningitis, as a form of vasculitis limited to the central nervous system. Case report. We describe the case of a 64 years-old male with headaches and cervicalgia, predominantly at night, and clinical signs and symptoms of spinal cord compression. Following the diagnosis of craniocervical hypertrophic pachymeningitis provided by the magnetic resonance imaging study, an aetiological study was conducted. Infectious and tumoral diseases were precluded. The clinical features did not show any systemic involvement and high levels of IgG4 and MPO-ANCA+ were found in the results of the analyses. The clinical signs and symptoms quickly improved following treatment with corticoids. Conclusions. IgG4-related disease and MPO-ANCA-associated vasculitis limited to the central nervous system can account for a high percentage of the cases of hypertrophic pachymeningitis that were considered idiopathic, and their diagnosis requires a biopsy and a histological study (AU)

Influencia en la epilepsia de factores meteorológicos y cronológicos / Influence of meteorological and chronological factors in epilepsy

Introducción. Los profesionales que atienden urgencias médicas observan picos de incidencia de crisis epilépticas. Algunos pacientes epilépticos atribuyen sus crisis a cambios climáticos y estacionales. Objetivo. Analizar la relación de variables meteorológicas, de calendario y circadianas con la aparición de crisis epilépticas. Pacientes y métodos. Estudio retrospectivo en un centro residencial de personas con discapacidad intelectual. Resultados. Los 16 residentes estudiados presentan 855 crisis epilépticas, entre ellas 159 en picos o cúmulos, a lo largo del período 2009-2012. El predominio de crisis encontrado en otoño y durante el cuarto trimestre del año no es significativo (p > 0,05). No hay relación estadísticamente significativa entre la presencia de crisis epilépticas con las fases lunares y los días de la semana. La mayoría de crisis epilépticas (87,2%) se presenta en horario diurno (p < 0,001). El 36,3% aparece entre las 8:00 y las 10:59 h. No hay correlación estadística entre el número de crisis epilépticas respecto a la presión atmosférica, la precipitación, el grado de humedad y la temperatura media (p > 0,05). Conclusiones. Se constata la aparición de picos o cúmulos de crisis epilépticas. La presencia de estas presenta un marcado componente circadiano. La influencia en la epilepsia de los factores meteorológicos estudiados, fases lunares y estaciones del año no es significativa (AU)

Introduction. The professionals who deal with medical emergencies observe peaks in the incidence of epileptic seizures. Some epileptic patients attribute their seizures to climatic and seasonal changes. Aims. To analyse the relationship between meteorological, calendar-related and circadian variables and the appearance of epileptic seizures. Patients and methods. A retrospective study was conducted in a residential home for persons with intellectual disability. Results. The 16 residents who were studied presented 855 epileptic attacks, including 159 in peaks or clusters, over the period 2009-2012. The predominance of seizures observed in autumn and during the fourth quarter of the year is not significant (p > 0.05). There is no statistically significant relation between the presence of epileptic seizures and the phases of the moon or days of the week. Most epileptic seizures (87.2%) occur during the daytime (p < 0.001). Findings showed that 36.3% occur in the morning between 08:00 and 10:59. There is no statistical correlation between the number of epileptic seizures and the atmospheric pressure, rainfall, degree of humidity or mean temperature (p > 0.05). Conclusions. The appearance of peaks or clustering of epileptic seizures was observed. Their presence shows a marked circadian component. The influence of meteorological factors, the phases of the moon and seasons of the year on epilepsy is not significant. (AU)

Discinesia bucolingual con alucinación justificativa / Buccolingual dyskinesia with justified hallucinations

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Discinesia paroxística secundaria a hiperglucemia no cetogénica de inicio diabético / Paroxysmal dyskinesia secondary to non-ketotic hyperglycaemia with a diabetic onset

No disponible

Epilepsia refleja cinetogénica asociada a movimientos masturbatorios / Kinetogenic reflex epilepsy associated to masturbatory movements

No disponible