Fecal immunochemical test for hemoglobin versus fecal calprotectin to monitor endoscopic activity in inflammatory bowel disease.

AIM: endoscopy identifies inflammatory activity, however, it is an unpleasant test and is not always accessible. The aim of the study was to compare the usefulness of quantitative fecal immunochemical test (FIT) versus fecal calprotectin (FC) to determine endoscopic activity in patients with inflammatory bowel disease (IBD). METHODS: cross-sectional prospective observational study. The stool samples were collected within three days before starting the preparation for the colonoscopy. We used the Mayo index for ulcerative colitis (UC) and the simplified endoscopic index for Crohn's disease (CD). Mucosal healing (MH) was defined as the score 0 points in each of the endoscopic indices. RESULTS: eighty-four patients were included, 40 (47.6 %) with UC. In patients with IBD, FIT and FC showed a significant correlation with the presence of inflammatory activity/MH on endoscopy, with no statistically significant differences between the two receiver-operating characteristic (ROC) curves. Both tests improved their diagnostic performance when assessing patients with UC; the Spearman correlations between FIT and FC and endoscopic inflammatory activity were r = 0.6 (p = 0.0001) and r = 0.7 (p = 0.0001), respectively. In Crohn's disease, the diagnostic utility of both tests was lower. CONCLUSIONS: FIT is an alternative to monitor endoscopic activity among ulcerative colitis patients. In Crohn's disease, more studies are needed to determine the role of fecal biomarkers.

Cost-effectiveness study of the microbiological diagnosis of tuberculosis using geneXpert MTB/RIF®. / Estudio de coste-efectividad del diagnóstico microbiológico de tuberculosis mediante geneXpert MTB/RIF®.

INTRODUCTION/OBJECTIVE: To perform a cost-effectiveness analysis of a molecular biology technique for the diagnosis of tuberculosis compared to the classical diagnostic alternative. METHODS: A cost-effectiveness analysis was performed to evaluate the theoretical implementation of a molecular biology method including two alternative techniques for early detection of Mycobacterium tuberculosis Complex, and resistance to rifampicin (alternative1: one determination in selected patients; alternative2: two determinations in all the patients). Both alternatives were compared with the usual procedure for microbiological diagnosis of tuberculosis (staining and microbiological culture), and was accomplished on 1,972 patients in the period in 2008-2012. The effectiveness was measured in QALYs, and the uncertainty was assessed by univariate, multivariate and probabilistic analysis of sensitivity. RESULTS: A value of €8,588/QALYs was obtained by the usual method. Total expenditure with the alternative1 was €8,487/QALYs, whereas with alternative2, the cost-effectiveness ratio amounted to €2,960/QALYs. Greater diagnostic efficiency was observed by applying the alternative2, reaching a 75% reduction in the number of days that a patient with tuberculosis remains without an adequate treatment, and a 70% reduction in the number of days that a patient without tuberculosis remains in hospital. CONCLUSION: The implementation of a molecular microbiological technique in the diagnosis of tuberculosis is extremely cost-effective compared to the usual method. Its introduction into the routine diagnostic procedure could lead to an improvement in quality care for patients, given that it would avoid both unnecessary hospitalisations and treatments, and reflected in economic savings to the hospital.

How is inflammatory bowel disease managed in Spanish gastroenterology departments? The results of the GESTIONA-EII survey.

INTRODUCTION: Not all national health centers include specialized units or clinicians devoted to inflammatory bowel disease. The goal of the survey was to gain an insight into the management of this disease within Spanish gastroenterology departments via a survey among their members. MATERIAL AND METHODS: An online survey was conducted in February and March 2015, among SEPD members (2017 clinician members), who were split into three categories: heads of department, general gastroenterologists, and experts in this disease. The results of the last two surveys are reported, including demography-related questions and specific questions on the strategies and resources available for the care of these patients. RESULTS: A total of 166 responses were received (response rate 8.19%), excluding those from heads of department (previously published). Sixty gastroenterologists considered themselves experts in inflammatory bowel disease, and 106 non-experts in it, the latter being either general gastroenterologists or specialists in other areas, mainly endoscopy. Twenty-eight percent of non-expert gastroenterologists said their hospitals had specific units, with a monographic clinic in 46%. However, 26% reported that they were treating affected patients themselves. Experts in inflammatory bowel disease reported that their institute had resources to support their work, but there was a lack of surgeons with expertise in this condition, particularly in county hospitals. CONCLUSIONS: At least, within SEPD members, 2 out of 3 experts in inflammatory bowel disease seem to have the resources available for their work (nurses, day unit, telephone line, database, referrals, joint sessions). Although there is room for improvement (email to contact patients, devoted surgeon, absence of referral protocols), and 2 out of 3 are concerned about pharmacy costs. Since a substantial number of patients remain treated by general practitioners, rapid referral programs might be helpful in this setting.

Management of the clinical issue of constipation with abdominal complaints in adults. A national survey of Primary Care physicians and gastroenterologists.

Irritable bowel syndrome and functional constipation represent a relevant and common health issue. However, real-world clinical practice includes patients with constipation who may or may not have other abdominal complaints (pain, bloating, abdominal discomfort) with variable frequency. The goal of the present study was to obtain information on the workload entailed by patients with constipation and associated abdominal complaints, predominant clinical behaviors, education needs, and potential daily practice aids both in Primary Care and gastroenterology settings. The clinical behavior of doctors is generally similar at both levels, despite differences in healthcare approach: use of empiric therapies and clinically guided diagnostic tests, with some differences in colonoscopy use (not always directly accessible from Primary Care). Regarding perceptions, general support and osmotic laxatives are most valued by PC doctors, whereas osmotic laxatives, combined laxatives, and linaclotide are most valued by GE specialists. Furthermore, over half of respondents considered differentiating both diagnoses as challenging. Finally, considerable education needs are self-acknowledged at both levels, as is a demand for guidelines and protocols to help in managing this issue in clinical practice. A strength of this study is its providing a joint photograph of the medical approach and the perceptions of constipation with abdominal discomfort from a medical standpoint. Weaknesses include self-declaration (no formal validation) and a response rate potentially biased by professional motivation.

Colorectal anastomosis facilitated by the use of the LigaSure(®) sealing device: comparative study in an animal model.

BACKGROUND: Recently, there has been speculation about the possibility of fusing intestinal tissue using bipolar sealing devices. In this study we compare in a porcine model the anastomoses created using the LigaSure(®) device with those created with a stapler after section and closure of a rectal stump. METHODS: Thirty pigs underwent laparoscopic colorectal anastomosis. In group A (n = 15), the division of the intestine and distal stump closure were done with a 10-mm LigaSure Atlas(®) device. In group B, these steps were carried out using an endoscopic stapler. Subsequently, the colorectal anastomosis was performed using circular stapling in both groups. The 4-week follow-up included health status, weight gain, blood tests, X-rays, and colonoscopy. Anastomotic tissue was processed to study the mechanical tensile strength and histopathology. RESULTS: There was no difference in the rate of conversion to open surgery or in average operating time between the groups. In the sealing device group, there was a significantly higher rate of failure in rectal stump closure (p = 0.042). There was one death in group B due to anastomotic leak. There was no difference in adhesion formation or stenosis. Mid-section anastomosis area was 89.7 mm(2) in group A compared with 100 mm(2) in group B (p = 0.52). In tensile strength studies, the maximum load resisted by the sample was 13.8 ± 4.9 N (group A) versus 15.7 ± 4.4 N (group B) (p = 0.17). There was no difference between the groups in degree of reepithelialization, number of inflammatory cells, or the presence of microabscesses. CONCLUSIONS: Division and sealing of the rectal stump with the LigaSure(®) device is feasible in the proposed experimental model, but it is less reliable than conventional closure with a stapler, since it has a significantly greater failure rate. Therefore, The LigaSure(®) device should not be used for this purpose in the clinical setting as this could lead to serious and dramatic complications.

Systematic review of the clinical prediction rules for the calculation of the risk of Down syndrome based on ultrasound findings in the second trimester of pregnancy.

OBJECTIVE: The objective of this article is to systematically review the various published clinical prediction rules used to calculate the risk of Down syndrome (DS) after carrying out an ultrasound in the second trimester of pregnancy. METHOD: A systematic search in the main bibliographic databases was carried out. Three independent observers identified the odds ratios and regression coefficients that allowed for the estimation of the risk of DS after ultrasound screening. Four of the clinical prediction rules were integrated into a computer application (ecodown 2.0(®) ). RESULTS: A total of ten clinical prediction rules were found. Three had been validated, two internally and one externally. We empirically checked the accuracy of the clinical prediction rule estimates obtained from 2216 ultrasound scans performed at our hospital. The application of the clinical prediction rules elaborated by Nicolaides and Zhong to the 2216 ultrasound scans showed a low concordance. CONCLUSIONS: Clinical prediction rules allow for the integration of second-trimester ultrasound findings to calculate the risk of DS. However, results from the different clinical prediction rules are not concordant and may generate situations of overestimation or underestimation of the risk of DS. It is thus necessary to validate these clinical prediction rules externally to decide which is most suitable for clinical use.

[25 years of laparoscopic surgery in Spain]. / 25 años de cirugía laparoscópica en España.

INTRODUCTION: The introduction of laparoscopic surgery (LS) can be considered the most important advancement in our specialty in the past 25 years. Despite its advantages, implementation and consolidation has not been homogenous, especially for advanced techniques. The aim of this study was to analyse the level of development and use of laparoscopic surgery in Spain at the present time and its evolution in recent years. MATERIAL AND METHODS: During the second half of 2012 a survey was developed to evaluate different aspects of the implementation and development of LS in our country. The survey was performed using an electronic questionnaire. RESULTS: The global response rate was 16% and 103 heads of Department answered the survey. A total of 92% worked in the public system. A total of 99% perform basic laparoscopic surgery and 85,2% advanced LS. Most of the responders (79%) consider that the instruments they have available for LS are adequate and 71% consider that LS is in the right stage of development in their environment. CONCLUSIONS: Basic laparoscopic surgery has developed in our country to be considered the standard performed by most surgeons, and forms part of the basic surgical training of residents. With regards to advanced LS, although it is frequently used, there are still remaining areas of deficit, and therefore, opportunities for improvement.

[Microalbuminuria and renal insufficiency in chronic hepatitis C virus infection]. / Microalbuminuria e insuficiencia renal en la infección crónica por el virus de la hepatitis C.

INTRODUCTION: Chronic hepatitis C virus (HCV) infection is associated with glomerular disease, which is manifested by proteinuria with or without renal dysfunction. METHOD: To determine the prevalence of HCV-associated renal injury and associated risk factors, we performed an observational, analytic, cross-sectional study of 120 HCV-positive patients and 145 HCV-negative controls. Data were gathered from medical records and history-taking and at least three blood and urine analyses were performed over a 1-year period. Renal insufficiency was defined as an estimated glomerular filtration rate of less than 60ml/min/1.73 m2 and/or microalbuminuria of more than 20mg/l or a microalbumin/creatinine ratio higher than 30 mcg/mg. RESULTS: The prevalence of microalbuminuria and renal insufficiency was 19.3% and 11.7% in HCV-positive patients versus 10.5% and 0.7% in HCV-negative controls (p 0.04), respectively. A total of 26.1% of HCV-positive patients had signs of renal injury compared with 11.8% of HCV-negative controls (p 0.003). HCV infection was independently and significantly associated with the probability of worsening of renal function. The prevalence of microalbuminuria and renal insufficiency progressively increased with greater age. CONCLUSION: HCV-positive patients show a high prevalence of microalbuminuria and renal insufficiency compared with HCV-negative individuals. The risk of HCV-associated renal insufficiency is independent of the presence of other predisposing factors such hypertension and diabetes.

[Interobserver agreement in detecting goitre in a school population between 6 and 14 years old]. / Concordancia entre observadores en la detección por palpación de bocio en población escolar de 6 a 14 años.

BACKGROUND: To estimate the agreement between observers on the detection of goitre by palpation in the school population because it is considered a variability test. METHODS: For five months, during 2001/2002, the presence of goitre was studied in across-section sample of 845 school children (for 6 to 14 years old) from 18 school centres in a Health Area in Valentian Community. The exploration was always carried out by the same two observers. The thyroid size was established in 6 degrees. It was considered goitre since 0B inclusive. The agreement was assessed in relation to age, sex, IBM, and the exploration date. The Kappa Index was used as a measure of agreement. RESULTS: The global prevalence of goitre was 40,4% according to the first observer and 36,8% to the second one. The agreement between observers was high, with a Kappa Index of 0.83 and it was similar in relation to sex, IBM, and the exploration date. It was smaller in the youngest children (six and seven years old) than in the oldest ones (from 12 to 14). CONCLUSIONS: An excellent interobserver agreement in clinic assessment of goitre by palpation in a school children population was achieved. The least concordance was seen in youngest group. It would be advisable to include the study of agreement in the protocol of endemic goitre study.

[Iodine deficiency and pregnancy. Current situation]. / Embarazo y déficit de yodo. Situación actual.

OBJECTIVE: Several studies performed in Spain have reported iodine deficiency in pregnant women but data from Valencia are lacking. The aim of the present study was to determine the degree of implantation of iodine supplementation in pregnant women in our health area. PATIENTS AND METHOD: A total of 232 pregnant women were studied in the first trimester of pregnancy. Thyroid-stimulating hormone (TSH), free thyroxine, and antiperoxidase antibodies were measured. A survey was performed on intake of iodized salt and pharmacological iodine supplements. Neonatal TSH concentrations were measured, based on screening of metabolopathies, in the newborns of participating women. RESULTS: Then mean age was 30.5+/-4.4 years. A total of 60.8% of the women consumed iodized salt, 51.3% took iodine polyvitamins and only 14.2% consumed potassium iodide. The median urinary iodine concentration was 100 microg/l; 66% had urinary iodine concentrations below the recommended level (150 microg/l). A positive association was found between pharmacological iodine intake and urinary iodine (p=0.016). Ten percent of the women had mild hypothyroxinemia, while 5.7% of the newborns had elevated TSH levels. CONCLUSIONS: Iodine intake in pregnant women in our health area is low, despite current recommendations. Our data support the need to promote the use of iodized salt in every home and to systematically administer potassium iodide supplements in all pregnant women.

[Validation and transcultural adaptation to spanish of the "Parental Supervision Attributes Profile Questionnaire"]. / Validación y adaptación transcultural al español del Parental Supervision Attributes Profile questionnaire: método de medición de la supervisión parental.

OBJECTIVE: Child accidents are the most important preventable cause of morbidity and mortality in pediatric age. The degree of parental supervision is a factor that can influence, among others, in these accidents. The aim of this study was to validate and cross-culturally adapt to Spanish the questionnaire Parental Supervision Attributes Profile Questionnaire (PSAPQ) as a method of measuring the degree of parental supervision. METHODS: Forward and back-translation methodology was applied using 4 bilingual spanish-english people to obtain version 1.0 of the questionnaire. Subsequently, the questionnaire was reviewed by a committee of experts, obtaining version 1.1, which was provided to 149 parents of children between 2-5 years old, randomly obtained, who attended consultation for the well child visits in several health centers in the province of Valencia. For the statistical study, the internal consistency was analyzed using Cronbach's α test and the test-retest reliability using Pearson correlations. RESULTS: A very good internal consistency was obtained, with Cronbach's α values greater than 0.7 in three of the four subscales that make up the test, with the remaining being 0.68. The reliability obtained was excellent, with values with Pearson correlations close to or higher than 0.7 for all subscales. CONCLUSIONS: The PSAPQ translated and validated into spanish shows very good psychometric results with respect to the original, so it can be said that an adequate instrument has been obtained to objectively measure one of the possible risk factors of child accidents.

OBJETIVO: Los accidentes infantiles son la causa prevenible más importante de morbi-mortalidad en edad pediátrica. El grado de supervisión parental es un factor que puede influir, entre otros, en su aparición. El objetivo de este estudio fue validar y adaptar transculturalmente al español el cuestionario Parental Supervision Attributes Profile Questionnaire (PSAPQ) como método de medida del grado de supervisión de los padres a sus hijos. METODOS: Se empleó una metodología de traducción/retrotraducción mediante 4 personas bilingües (españolinglés), obteniéndose la versión 1.0 del cuestionario. Posteriormente, fue revisada por un comité de expertos, obteniéndose la versión 1.1, que se proporcionó a 149 padres de niños de entre 2-5 años, reclutados de forma aleatoria, que acudían a las revisiones del programa de salud infantil de diversos centros de salud de la provincia de Valencia. En el estudio estadístico se analizó la consistencia interna mediante el test alfa de Cronbach y la fiabilidad test-retest mediante correlaciones de Pearson. RESULTADOS: Se obtuvo buena consistencia interna, con valores de alfa de Cronbach mayores de 0,7 en tres de las cuatro subescalas que forman el test. En la restante se consiguió un valor de 0,68. En cuanto a la fiabilidad, se obtuvieron correlaciones de Pearson cercanas o superiores a 0,7 para todas las subescalas. CONCLUSIONES: El PSAPQ traducido y validado al idioma español muestra muy buenos resultados psicométricos respecto al original, por lo que se puede afirmar que se ha obtenido un instrumento adecuado para medir objetivamente uno de los posibles factores de riesgo de accidentes infantiles.

Gastrointestinal lesions in chronic kidney disease patients with anaemia. / Lesiones gastrointestinales en pacientes con enfermedad renal crónica y anemia.

INTRODUCTION: Despite the frequency with which anaemia is present in patients with chronic kidney disease (CKD), its relationship with gastrointestinal lesions has not been studied. METHOD: A cross-sectional, analytical, observational study involving one year of recruitment was carried out to determine the prevalence of endoscopic gastrointestinal lesions and associated risk factors in asymptomatic patients with chronic kidney disease stages 1-5 and anaemia who had a positive qualitative immunochemical faecal occult blood test. RESULTS: A total of 9,658 patients with CKD were analysed, of which 286 (2.9%) had anaemia; 198 had a positive faecal occult blood test (47% male, 71.1±11.8 years). The endoscopic study revealed 255 lesions, with at least one lesion in 68.2% of patients, with the most prevalent being: adenomatous colorectal polyps (39.6%), acute lesions of the gastric mucosa (22.6%), neoplastic lesions 15.1%), angiodysplasia (14.4%), oesophagitis (8.4%), inflammatory bowel disease (4.8%) and ischaemic colitis (3.1%). Uraemia and acetylsalicylic acid were identified as risk factors for acute gastric mucosal lesions. Angiodysplasia was associated with alcoholism, a more advanced stage of chronic kidney disease, anaemia, and lack of response to erythropoiesis-stimulating agents. Age and refractory anaemia were risk factors for adenomatous polyps and colorectal cancer. CONCLUSION: Renal patients with anaemia could benefit from an endoscopic study due to their high prevalence of gastrointestinal lesions, particularly adenomatous polyps and colorectal cancer, which are more common in those over 50 years of age with CKD stages 3-5.

[Effects of levothyroxine replacement on lipid profile in patients with mild subclinical hypothyroidism]. / Efectos del tratamiento sustitutivo con levotiroxina en el perfil lipídico de pacientes con hipotiroidismo subclínico leve.

BACKGROUND AND OBJECTIVE: To evaluate the effects of levothyroxine (L-T4) replacement on lipoprotein profile in patients with mild subclinical hypothyroidism, defined as a serum TSH level between 5 to 10 mU/l with a normal serum free thyroxine level. PATIENTS AND METHOD: We have prospectively studied 89 patients with mild subclinical hypothyroidism -10 male, 79 female; mean (standard deviation) TSH: 7.9 (1.3) mU/l-. The thyroperoxidasa antibodies were positive in 46 subjects and were treated with L-T4. The 43 patients with thyroperoxidasa antibodies negative were used as controls. In both groups fasting lipid profiles were measured at baseline and 40 weeks. RESULTS: There were no significant differences in the age, serum concentrations of TSH, free thyroxine and lipid profile between 2 groups at baseline. After therapy, serum TSH levels had returned within the normal range in the L-T4 group and were now significantly lower than in the control group (p < 0.001). There were no significant differences in the changes from baseline to 40 weeks between patients in the L-T4 group and the control group for any of the lipid variables measured, expressed as the mean change in the L-T4 group minus the mean change in the control group and the 95% confidence interval (CI): total cholesterol, -0.27 mmol/l (95% CI, -0.69 to 0.16 mmol/l); LDLc, -0.27 mmol/l (95% CI -0.61 to 0.05 mmol/l). CONCLUSIONS: Forty weeks L-T4 treatment does not significantly improve the lipid profile in patients with mild subclinical hypothyroidism.

[Cardiovascular risk associated with the use of non steroidal anti-inflammatory drugs: cohort study]. / Riesgo cardiovascular asociado al consumo de antiinflamatorios no esteroideos: estudio de cohortes retrospectivo en un área de salud, 2008-2012.

BACKGROUND: Since the clinical trial VIGOR, in which the use of rofecoxib was proved to be connected to a larger number of cardiovascular accidents, an increase of cardiovascular diseases connected to the use of non Steroidal Anti-Inflammatory Drugs has been observed. This study intends to evaluate cardiovascular impact related to the use of non steroidal anti-inflammatory drugs in a Health Care Area in Castilla La Mancha (Spain). METHOD: A retrospective observational study of clinical cohort during 5 years is done in which all patients older than 18 years (n = 116 686) was included. The statistical analysis was done estimating the incidence of acute coronary syndrome in relation to the exposure time. The risk associated with the consumption of non-steroidal anti-inflammatory drugs was made by Poisson regression adjusting by sex and age. Calculation of the Daily Inhabitants Doses by means of the Defined Daily Doses, through DIGITALIS program of pharmaceutical consumption. RESULTS: The connection between acute coronary syndrome and the use of anti-inflammatory drugs was positive (RR 3,64; IC95% 2,94 a 4,52; p<0,001). The cardiovascular risk was higher en alkanones (RR 18; IC95% 2,53 a 127; p=0,004), followed by propionoicos as ibuprofen (RR 2,58; IC95% 2,16 a 3,69; p<0,001), it is also the only group that is time-dependent. Thirdly arylacetic (RR 1,88; IC95% 1,6 a 2,22; p<0,001) and finally the coxib (RR 1,55; IC95% 1,25 a 1,92; p<0,001), in others antiinflammatory no increased cardiovascular risk was observed. CONCLUSIONS: The use of non steroidal anti-inflammatory drugs has been connected to a higher risk of cardiovascular accidents, suggesting that not during prolonged or high-dose or should take.

[Appropriateness of the use of incontinence absorbent products in hospitalized adults]. / Adecuación del uso de absorbentes de incontinencia urinaria en pacientes adultos ingresados en un hospital.

BACKGROUNDS: Improper use of incontinence absorbent products in adults can negatively affect self-esteem, quality of life and independence of the patient, as well as increase the workload and cause adverse events. There are few studies evaluating the appropriateness of diapers using validated scales for it, or the justification of nurses for its use in elderly who are hospitalized. OBJECTIVE: To determine the frequency of diaper use in patients admitted to a hospital and to identify the criteria that determined their use and adequacy. METHOD: Observational, cross-sectional study of adult patients using diapers while admitted in Inpatient Units. For data collection cut day was held in April 2013, collecting data from nursing assessment records, patients themselves and their family. Barthel Index items were used as criteria of adequacy concerning mobility and disposal. RESULTS: 228 patients admitted. 83 (34.4%) of them had diapers and 25 (30.1%) of them had no criteria for using them. 28.8% (21) had not previously used diapers, the use of diapers in half of them was inappropriate. Factors associated with inappropriate use of diapers were older age, being female, more comorbidity and days of hospitalization. CONCLUSION: The results of this study show the often excessive use of incontinence absorbent products without proper application, not based on validated criteria.

Single-incision laparoscopic bariatric surgery: a systematic review.

BACKGROUND: Single-incision laparoscopic surgery has sparked a great deal of interest in the surgical community in recent years, including bariatric surgery. However, we still do not definitively know if this type of surgical approach provides benefits over conventional techniques without increasing morbidity and mortality. OBJECTIVE: To evaluate the safety and efficacy of single-incision laparoscopic bariatric surgery (SILBS) compared with conventional laparoscopic bariatric surgery (CLBS). MATERIALS AND METHODS: We searched the most important databases. Randomized clinical trials and observational studies comparing SILBS with CLBS were included. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. RESULTS: Fourteen studies complied with the inclusion criteria for our analysis, which included 2357 patients (1179 SILBS group versus 1178 CLBS group). The duration of surgery was longer in the SILBS group and no major intraoperative complications were observed in these series. A small improvement in postoperative pain was indicated in the SILBS group. The overall morbidity rate was 5% in the SILBS group and 4.8% in the CLBS. There was 1 perioperative death in 1 study, which occurred in an adjustable gastric banding (AGB) group, at .1% of all cases of AGB and .005% of all SILBS cases. When cosmesis was evaluated, patients in the SILBS group were more satisfied with the scar outcome. CONCLUSION: SILBS is a feasible technique to use in selected patients. However, there is insufficient evidence to recommend its widespread use compared with a conventional approach. More studies are needed to analyze the safety of this technique and its possible benefits.

Validación y adaptación transcultural al español del Parental Supervision Attributes Profile Questionnaire: método de medición de la supervisión parental / Validation and transcultural adaptation to spanish of the "Parental Supervision Attributes Profile Questionnaire"

OBJETIVO: Los accidentes infantiles son la causa prevenible más importante de morbi-mortalidad en edad pediátrica. El grado de supervisión parental es un factor que puede influir, entre otros, en su aparición. El objetivo de este estudio fue validar y adaptar transculturalmente al español el cuestionario Parental Supervision Attributes Profile Questionnaire (PSAPQ) como método de medida del grado de supervisión de los padres a sus hijos. MÉTODOS: Se empleó una metodología de traducción/retrotraducción mediante 4 personas bilingües (españolinglés), obteniéndose la versión 1.0 del cuestionario. Posteriormente, fue revisada por un comité de expertos, obteniéndose la versión 1.1, que se proporcionó a 149 padres de niños de entre 2-5 años, reclutados de forma aleatoria, que acudían a las revisiones del programa de salud infantil de diversos centros de salud de la provincia de Valencia. En el estudio estadístico se analizó la consistencia interna mediante el test alfa de Cronbach y la fiabilidad test-retest mediante correlaciones de Pearson. RESULTADOS: Se obtuvo buena consistencia interna, con valores de alfa de Cronbach mayores de 0,7 en tres de las cuatro subescalas que forman el test. En la restante se consiguió un valor de 0,68. En cuanto a la fiabilidad, se obtuvieron correlaciones de Pearson cercanas o superiores a 0,7 para todas las subescalas. CONCLUSIONES: El PSAPQ traducido y validado al idioma español muestra muy buenos resultados psicométricos respecto al original, por lo que se puede afirmar que se ha obtenido un instrumento adecuado para medir objetivamente uno de los posibles factores de riesgo de accidentes infantiles

OBJECTIVE: Child accidents are the most important preventable cause of morbidity and mortality in pediatric age. The degree of parental supervision is a factor that can influence, among others, in these accidents. The aim of this study was to validate and cross-culturally adapt to Spanish the questionnaire Parental Supervision Attributes Profile Questionnaire (PSAPQ) as a method of measuring the degree of parental supervision. METHODS: Forward and back-translation methodology was applied using 4 bilingual spanish-english people to obtain version 1.0 of the questionnaire. Subsequently, the questionnaire was reviewed by a committee of experts, obtaining version 1.1, which was provided to 149 parents of children between 2-5 years old, randomly obtained, who attended consultation for the well child visits in several health centers in the province of Valencia. For the statistical study, the internal consistency was analyzed using Cronbach's alfa test and the test-retest reliability using Pearson correlations. RESULTS: A very good internal consistency was obtained, with Cronbach's alfa values greater than 0.7 in three of the four subscales that make up the test, with the remaining being 0.68. The reliability obtained was excellent, with values with Pearson correlations close to or higher than 0.7 for all subscales. CONCLUSIONS: The PSAPQ translated and validated into spanish shows very good psychometric results with respect to the original, so it can be said that an adequate instrument has been obtained to objectively measure one of the possible risk factors of child accidents

Exocrine pancreatic insufficiency and chronic pancreatitis in chronic alcoholic liver disease: coincidence or shared toxicity?

OBJECTIVES: The aims of this study were to determine the prevalence of exocrine pancreatic insufficiency (EPI) and chronic pancreatitis (CP) in patients with chronic alcoholic liver disease and to analyze the possible associated factors. METHODS: This is an analytical observational study of cases and controls for a sample of patients with chronic alcoholic and nonalcoholic liver disease. Exocrine pancreatic insufficiency was diagnosed using the C mixed-triglyceride breath test. Patients with abdominal pain underwent endoscopic ultrasonography for CP evaluation using the Wiersema criteria. RESULTS: A total of 154 patients were included, 129 with alcoholic liver disease (83 with cirrhosis) and 25 with nonalcoholic liver disease. Exocrine pancreatic insufficiency was found in 55.2% versus 16.7% (P < 0.001), 70% of patients without cirrhosis compared with 46.2% of patients with cirrhosis had pancreatic insufficiency (P = 0.017), and 82.7% of patients with alcoholic liver disease and abdominal pain had CP (P < 0.001). Exocrine pancreatic insufficiency was associated with the male sex, alcohol intake, abdominal pain, degree of liver failure, and the absence of portal hypertension. Chronic pancreatitis was correlated with age younger than 55 years and abdominal pain. CONCLUSIONS: Patients with alcoholic liver disease had a high prevalence of EPI and CP; this prevalence was even higher in patients who have not yet developed cirrhosis with liver failure or portal hypertension.

Concordance and interchangeability of biometric measurements of ocular axial length in patients awaiting cataract surgery.

PURPOSE: To estimate in patients awaiting cataract surgery the concordance and interchangeability of axial eye length measurements performed with the aid of various biometric methods (optical or ultrasonic) by different operators (nurses) at different times during the period prior to surgery. METHODS: We selected 182 consecutive eyes from 91 patients.Ocular axial length was measured with the aid of 2 methods (IOLMaster® and Ocuscan®) by 9 randomly allocated technicians at 2 different times during the waiting period. The concordance between measurements was evaluated by means of the intraclass correlation coefficient (ICC); the interchangeability of the results was assessed with Bland Altman plots and Passing and Bablok regression. RESULTS: The measurements were consistent between biometric methods (ICC 0.975, 95% confidence interval [CI] 0.968 to 0.980) and measurement dates (ICC 0.996, 95% CI 0.995 to 0.997). Interobserver agreement was more heterogeneous (ICC range 0.844 to 0.998). No systematic errors were observed among the various biometric methods and measurement dates. CONCLUSIONS: Because measurement of axial length in phakic patients may be technician-dependent, the technician's experience should be noted in the protocols of ophthalmology services.