Posoperatorio del donante vivo de riñón: diferencia con pacientes sometidos a nefroctomías laparoscópicas por otras causas / No disponible

Debido al incremento de la nefrectomía laparoscópica para trasplante renal de donantes vivos en nuestro hospital en los últimos años (en 2017, 332 trasplantes renales de donante vivo, de los que 47 se hicieron en Andalucía y 17 de ellos en nuestro centro), se ha realizado un estudio prospectivo en el cual se analizaron, con 6 variables, el impacto que tiene el posoperatorio de la nefrectomía laparoscópica en los donantes vivos con respecto al resto de pacientes que se someten al mismo procedimiento por otras causas en nuestra unidad. El objetivo principal del estudio es analizar las implicaciones y el impacto que tiene el posoperatorio de la nefrectomía laparoscópica en los diferentes procesos. Se parte de la hipótesis de que las implicaciones que tiene el donante vivo afectarán al desarrollo de su posoperatorio (mayor dolor, mayor estancia hospitalaria...), comparado con el resto de pacientes que se someten a la misma intervención por otros motivos. Se identificó en este estudio que este tipo de cirugía implica mayor estancia hospitalaria, con respecto a la misma cirugía por otros motivos, pero no existe un resultado en el número de pacientes estudiados de mayor dolor en estos pacientes con respecto a los otros citados. Mostraremos los cuidados enfermeros que seguimos en nuestra unidad con estos pacientes. Para ello tomaremos como referencia los patrones funcionales de Gordon, determinando los diagnósticos enfermeros, así como los criterios de resultados (NOC) y las intervenciones de enfermería (NIC)

Due to the increase of laparoscopic nephrectomy in live donors for renal transplantation during the last years in our hospital (in 2017, 332 live donor renal transplants, of these 47 were done in Andalusia, and 17 in our hospital). A prospective study was conducted to analyse 6 variables, the Impact of postoperative laparoscopic nephrectomy in live donors compared to those patients who underwent the same procedure for different reasons in our unit. The primary aim of the study is to examine the implications and impact of postoperative laparoscopic nephrectomy in different processes. It is assumed that the live donor's implications will affect the postoperative period (pain, length of hospital stay...), compared to the rest of the patients who undergo the same procedure for different reasons. A study identified that this type of surgery involves unnecessarily prolonged stay in hospital, with regards to the same surgery but for different reasons. However, there is no evidence of difference between the number of patients studied with severe pain and the aboye mentioned. We will show the nursing care that we follow with these patients in our unit. We will take as reference Gordon's functional health patterns, identifying nursing diagnosis as well as the nursing outcomes classification (NOC) and nursing interventions

Plan de cuidados en la ablación percutánea por radiofrecuencia de tumores renales / No disponible

La atención sanitaria basada en la evidencia y su aplicación a través de herramientas para la disminución de la variabilidad de la práctica clínica es fundamental en la práctica diaria. Con esta comunicación mostramos el uso de la técnica de la ablación percutánea por radiofrecuencia de tumores renales. Mostraremos los cuidados enfermeros seguidos en la unidad para mejorar la calidad de los cuidados. Tomamos como muestra tres casos clínicos de nuestro servicio. Describiremos todos los cuidados que se realizan para la atención integral de enfermería, realizando un seguimiento de los mismos. Para ello tomaremos como referencia los patrones funcionales de Gordon, determinando los diagnósticos enfermeros, así como los criterios de resultados (NOC) y las intervenciones de enfermería (NIC)

Evidence base-health care and its application through tools to decrease the variability of the clinical practice is of pivotal importance in the daily practice. The aim is to show percutaneous ablation technique by means of radiofrequency of renal tumours. Nursing care plan followed in the unit is shown. As an example, three clinical cases are presented. Comprehensive nursing care is described with a close monitoring of the situation. Gordon is the method used in the nursing process to provide a more comprehensible nursing assessment of the patient (diagnosis, nursing outcomes classification and Nursing Interventions Classification)

Tapones de desinfección pasiva con alcohol. Implantación en la unidad de Urología / No disponible

Debido al incesante aumento de las infecciones asociadas a los catéteres de acceso venosos periféricos y centrales que enfermería utiliza, añadiendo la importancia de la prevención de las mismas como línea de actuación dentro de las guías FASE (Fáciles y Seguras basadas en la Evidencia), vemos importante la introducción de cambios en el hacer de nuestra profesión. Por ello se implantó en nuestra unidad el uso de tapones protectores impregnados en alcohol que, colocándolos en los puertos denominados bioconectores, los dejaban no solo aislados del medio, sino que se consideran desinfectados. Durante 21 días hicimos un seguimiento de quiénes de los pacientes candidatos de usarlo lo tenían y quiénes no. Y finalmente pasamos unas encuestas de valoración para evaluar el rendimiento global del producto en comparación con el sistema anterior de desinfección. Para observar si nuevas medidas de asepsia en el uso de dispositivos venosos eran aceptadas y valoradas. Observando un gran nivel de adhesión

Because of the ever-increasing infections associated with peripheral and central venous catheters, added the importance of prevention which constitutes a line of action of the simple and safety guides based on Evidence (FASE guides), used by nursing staff it is important to introduce changes in this profession. Therefore, a policy of port protectors which are alcohol-impregnated caps is also necessary since they are a physical barrier to contamination and guarantee disinfection compliance. For 21 days we conducted a study to determine the appropriate candidates. Finally, we conducted an assessment survey to evaluate the overall performance of the product in comparison with the previous method of disinfection to be able to check is new measures of asepsis with regards to the use of venous access devices were well accepted and valued. Noting great level of satisfaction

Síntomas de ansiedad, depresión y factores psicosociales en hombres que solicitan atención de salud en el primer nivel / Symptoms of anxiety, depression and psychosocial factors in men applying for health care at the first level

Antecedentes: Los trastornos de ansiedad y del estado de ánimo son causa de deterioro psicológico. En el caso específico de los hombres, pueden presentar sintomatología clínica somática de depresión y ansiedad, pero, debido a la socialización masculina, pueden sentirse inclinados a ocultar o minimizar su sufrimiento psicológico o imponerse barreras que les impidan identificar y comunicar emociones internas y mucho menos a valorar estas manifestaciones como indicadores de un problema de salud mental.Objetivo: El presente trabajo tiene como objetivo determinar las relaciones existentes entre síntomas de ansiedad y depresión, factores psicosociales y el motivo de consulta en población adulta masculina que demanda atención de salud en primer nivel.Método: Los participantes fueron 276 sujetos masculinos de 18 a 65 años atendidos en consulta externa de diversas instituciones de salud de Ciudad Victoria, Tamaulipas. Se aplicó a esta muestra la Escala de Ansiedad y Depresión de Goldberg y la Escala de Funcionamiento Psicosocial.Resultados: Se encontró una prevalencia para síntomas de ansiedad de 57% (n=157) y de síntomas de depresión de 49% (n=135). Los resultados mostraron que entre los factores predictores de esta sintomatología se encuentran el estrés de vida, el intercambio negativo en sus interacciones, los hábitos negativos de salud y un ingreso económico menor a 1 000 pesos.Discusión y conclusion: La presente investigación viene a confirmar una relación entre síntomas de ansiedad, depresión, factores psicosociales y el deterioro de la salud.

Background: Anxiety and mood disorders are the cause of psychological deterioration in the world. In the case of men, specific somatic symptomatology can be present that indicate depression or anxiety but, because of their masculine socialization, they tend to suppress or minimize their psychological suffering or impose barriers that keep them from identifying their internal emotions and the symptoms of a serious mental issue.Objective: The purpose of this was to determine whether there are significant relationships between symptoms of anxiety, depression and other psychosocial factors along with the consultation motive of the adult male population who demand first level health care.Method: The sample considered for this study was 276 male subjects aged 18 to 65 who were attended as outpatients in various health institutions in Ciudad Victoria, Tamaulipas. With this sample, the Goldberg Scale of Anxiety and Depression and the Scale of Psychosocial Operation were used.Results: It was found that 57% (n=157) were diagnosed with a prevalence of anxiety symptoms and 49% (n=135) were diagnosed with symptoms of depression. The results obtained confirm that among the factors that cause these symptoms are life stress, negative exchange among interactions, negative health habits and an economic income lower than 1 000 pesos.Discussion and conclusion: These results also confirm the relationship among symptoms of anxiety, depression, psychosocial factors and deteriorating health.

Obesidad e indicadores antropométricos en una muestra de varones con Síndrome Coronario Agudo, en un Área de Salud que incluye reclusos: estudio caso-control / Obesity and anthropometric indicators in a sample of males with acute coronary syndrome in a health area with inclusion of inmates: case-crontrol study

Objetivos: la obesidad es un factor de riesgo cardiovascular con alta prevalencia, y relacionado con la cardiopatia isquemica. El objetivo fue analizar mediante antropometria, una muestra de varones con Sindrome Coronario Agudo (SCA) diagnosticado en un hospital de referencia penitenciaria, y un grupo control. Material y metodo: estudio caso-control en un Area de Salud que integraba a un Centro Penitenciario. Los participantes fueron 204 varones, 102 infartados y un control por cada caso. Se midio peso, talla, cintura minima (CC), cintura umbilical (CU) y cadera. Se calcularon el IMC y otros indicadores. Se realizo un analisis descriptivo y se obtuvieron las areas bajo la curva (ABC) greceiver operating characteristich, las odds ratio (OR), y las correlaciones en SCA. Resultados: la obesidad presento mayor prevalencia en SCA (31,4% vs 9,1%; OR: 4,7), otros indicadores mostraron asociacion discriminatoria: IMC (ABC: 0,699; OR: 3,9), CC (ABC: 0,750; OR: 6,3), CU (ABC: 0,777; OR: 10), talla inversa (ABC: 0,619; OR: 2,1), indice cintura/cadera (ABC: 0,832; OR: 11,6); indice CU/cadera (ABC: 0,857; OR: 15,6), indice CU/talla (ABC: 0,800; OR: 8,9). Las correlaciones entre las cinturas y los indices cintura-talla fueron fuertes (todas r .0,90; p <0,001). Discusion: los indicadores antropometricos de obesidad estan asociados al SCA. La CU es la medida simple mas asociada. El IMC presenta una asociacion debil; el indice CU/talla presenta alto poder discriminatorio y la mejor correlacion antropometrica de riesgo, apoyando su uso en la identificacion de varones con riesgo de infarto de miocardio tanto en la poblacion general como penitenciaria (AU)

Objectives: Obesity is a cardiovascular risk factor with a high epidemic burden on ischemic heart disease. The aim of this study was to analyze the anthropometric indicators of obesity in a sample of males who have had an Acute Coronary Syndrome (ACS) diagnosed in a prison referral hospital, and a control group. Material and methods: Cross-sectional case-control study in a Health Area with inclusion of a penitentiary center. The participants in this study were 204 males, 102 cases and one control selected for each case (n=102). We measured weight, height waist circumference (WC), umbilical waist (UW) and hip circumference. We calculated body mass index (BMI) and other anthropometric indicators: waist to-hip-ratios (WHR and UWHR), waist to-height-ratios (WHtR and UWHtR). We obtained the areas under the receiver operating characteristic curves (AUC), the odds ratio (OR) and the correlations in the infarcted people. Results: Obesity was more prevalent in ACS (31.4% vs 9.1%; OR: 4.7). Other indicators show a discriminatory association. BMI (AUC: 0.699; OR: 3.9), WC (AUC: 0.750; OR: 6.3), UW (AUC: 0.777; OR: 10), inverse height (AUC: 0.619; OR: 2.1), WHR (AUC: 0.832; OR: 11.6); UWHR (AUC: 0.857; OR: 15.6), UWHtR (AUC: 0.800; OR: 8.9). In ACS the correlations for both WC and UW with waist to-height-ratios (WHtR and UWHtR) were strong (all r .0.90; p < 0.001). Discussion: The anthropometric indicators of obesity are clearly associated with ACS. UW is the simple measurement with the best association. BMI is most weakly associated. UWHtR presents high discriminatory power and the best anthropometric correlation of risk that supports its use for the identification of males at risk of myocardial infarction in the general population and prison (AU)

Indirect comparison for Anti-TNF drugs in moderate to severe ulcerative colitis / Fármacos anti-TNF en colitis ulcerosa moderada-grave: comparación indirecta

Objective: To compare the relative efficacy of infliximab, adalimumab and golimumab through adjusted indirect treatment comparisons (ITCs). Methods: An exhaustive search was performed until October 2013. Databases consulted were MEDLINE, EMBASE, the Cochrane Library, the Centre for Reviews and Dissemination and the Web of Science. Randomized control trials (RCTs) comparing the efficacy of infliximab, adalimumab or golimumab versus placebo, in terms of clinical remission, clinical response and mucosal healing, were included. In the case that more than one RCT fulfilled the inclusion criteria for the same drug, a metanalysis was undertaken using a fixed effects model. ITCs were carried out using the method proposed by Bucher et al. Results: 6 RCTs published in 5 papers were included: 2 for infliximab (ACT 1 and ACT 2), 2 for adalimumab (ULTRA 1 y ULTRA 2) and 2 for golimumab (PURSUIT-SC y PURSUIT-M).In these RTCs, each biological agent was superior in efficacy to placebo. The results of the adjusted ITC are the following. In relation to the clinical remission, in the induction and maintenance period, there are no statistically significant differences between the three anti-TNF drugs. In relation to the clinical response and mucosal healing, in the induction period, there are statistically significant differences between infliximab and adalimumab. Conclusion: In view of the results obtained, infliximab, adalimumab and golimumab appear to be similarly effective the rapeutic alternatives. Therefore, other considerations such as safety, tolerance and cost-effectiveness should be taken into account in order to select the most appropriate treatment (AU)

Objetivo: Comparar la eficacia relativa de infliximab, adalimumab y golimumab mediante comparaciones indirectas (CI) ajustadas. Métodos: Se realizó una búsqueda bibliográfica que abarcó hasta Octubre 2013. Las bases de datos consultadas fueron: MEDLINE, EMBASE, the Cochrane Library, the Centre for Reviews and Dissemination y the Web of Science. Se incluyeron ensayos clínicos aleatorizados (ECA) que compararan la eficacia de infliximab, adalimumab o golimumab frente a placebo en términos de remisión clínica, respuesta clínica y curación de la mucosa. En el caso de que se incluyera más de un ECA para un mismo fármaco se llevó a cabo un metanálisis utilizado el modelo de efectos fijos. Las CI se realizaron utilizando el mé- todo de Butcher et al. Resultados: Se incluyeron 6 ECA publicados en 5 artículos: 2 para infliximab (ACT 1 y ACT 2), 2 para adalimumab (ULTRA 1 y ULTRA 2) y 2 para golimumab (PURSUIT-SC y PURSUIT-M). Los tres agentes biológicos presentaron mayor eficacia que placebo. Los resultados de las CI fueron los siguientes: en relación a la remisión clínica, en el período de inducción y en el período de mantenimiento, no hubo diferencias estadísticamente significativas entre los tres fármacos anti-TNF. En relación a la respuesta clínica y a la curación de la mucosa, en el período de inducción hay diferencias estadísticamente significativas entre infliximab y adalimumab. Conclusiones: En base a los resultados obtenidos (eficacia similar), infliximab, adalimumab y golimumab parecen ser alternativas terapéuticas. Así, otras consideraciones como la seguridad, la tolerancia y el coste-efectividad deben considerarse a la hora de seleccionar el tratamiento más adecuado (AU)

Health-related quality of life in individuals with metabolic syndrome: a cross-sectional study / Calidad de vida relacionada con la salud en individuos con síndrome metabólico: un estudio descriptivo

INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is a combination of various cardiovascular risk factors with a major impact on morbidity and premature mortality. However, the impact of MetS on self-reported health-related quality of life (HRQoL) is unknown. This study evaluated the HRQoL in a Spanish adult population aged 55 years and older with MetS. METHOD: A cross-sectional analysis was performed with baseline data from the PREDIMED-Plus multicentre randomized trial. The participants were 6430 men and women aged 55-75 years with overweight/obesity (body mass index ≥27 and ≤40kg/m2) and MetS. The SF-36 questionnaire was used as a tool to measure HRQoL. Scores were calculated on each scale of the SF-36 by gender and age. RESULTS: Participants showed higher scores in the social function (mean 85.9, 95% CI; 85.4-86.4) and emotional role scales (mean 86.8, 95% CI; 86.0-87.5). By contrast, the worst scores were obtained in the aggregated physical dimensions. In addition, men obtained higher scores than women on all scales. Among men, the worst score was obtained in general health (mean 65.6, 95% CI; 65.0-66.2), and among women, in body pain (mean 54.3, 95%CI; 53.4-55.2). A significant decrease was found in the aggregated physical dimensions score among participants 70-75 years old, but an increased one in the aggregated mental dimensions, compared to younger participants. CONCLUSIONS: Our results reflect that the MetS may negatively affect HRQoL in the aggregated physical dimensions, body pain in women, and general health in men. However, this adverse association was absent for the psychological dimensions of HRQoL, which were less affected

INTRODUCCIÓN Y OBJETIVOS: El síndrome metabólico (SM) es la combinación de diversos factores de riesgo cardiovascular que pueden derivar en un mayor impacto en la morbimortalidad prematura. Sin embargo, el impacto del SM en la calidad de vida relacionada con la salud (CVRS) es desconocido. El objetivo de este estudio es evaluar la CVRS en la población adulta española de 55 años o más con SM. MÉTODOS: Se realizó un análisis transversal con los datos del ensayo PREDIMED-Plus. Seis mil cuatrocientos treinta varones y mujeres entre 55-75 años con sobrepeso/obesidad y SM. El instrumento de medida de la CVRS fue el cuestionario SF-36. Cada escala del SF-36 fue descrita y estratificada por sexo. RESULTADOS: Los participantes mostraron valores más altos en las escalas función social (media: 85,9; IC 95%: 85,4-86,4) y rol emocional (media: 86,8; IC 95%: 86,0-87,5). En los varones, la peor puntuación fue en la dimensión salud general (media: 65,6; IC 95%: 65,0-66,2) y en las mujeres el dolor corporal (media: 54,3; IC 95%: 53,4-55,2). Además, los varones obtuvieron puntuaciones más altas en todas las escalas. En la escala función física en varones se encontró una disminución significativa de la CVRS en los participantes entre 70 y 75 años en comparación con los más jóvenes. Las peores puntuaciones se obtuvieron en las dimensiones físicas agregadas. CONCLUSIONES: El SM afecta de manera negativa a la CVRS en las dimensiones agregadas físicas, haciendo especial hincapié en la esfera dolor corporal en mujeres y salud general en varones. Sin embargo, las esferas psicológicas se encuentran menos afectadas por el SM

Adaptación y validación psicométrica del Cuestionario de Consecuencias Funcionales del Dormir (Functional Outcomes Sleep Questionnaire [FOSQ]) en habitantes de la Ciudad de México / Adaptation and psychometric validation of the functional outcomes sleep questionnaire (FOSQ) in México City habitants

Excessive daytime sleepiness (EDS) is a highly disabling sleep disorder related to alterations in behavioral performance, work injuries and vehicle accidents. A high prevalence of EDS (from 16% to 32%) in the general population has been reported. The Functional Outcomes Sleep Questionnaire (FOSQ) is an instrument that measures the impact of EDS in a patient's functional state in different sleep disorders. This questionnaire has been validated in different countries (Norway, Turkey, Spain). Therefore, the objective of this study was to obtain the cultural validation, the internal consistency, construct validity and factor congruence of the adapted questionnaire for the inhabitants of Mexico City (FOSQ-México). In the first part of the study we translated the questionnaire using the standard methodological process. The FOSQ cultural adaptation was made by the Natural Modified Semantic Networks technique in a sample of 78 participants. In the second part, the adapted FOSQ was applied to 152 participants to test items discrimination, internal consistency, factor analysis by principal-components and factorial congruence with the original version. The principal-components analysis of the FOSQ yielded six meaningful factors that explained 67.2% of the total variance, an average a coefficient between 0.85 to 0.94 for the six factors. The factorial congruence coefficients ranged from 0.360 to 0.969 between the original and the FOSQ-México version. This study demonstrated that the FOSQ version for inhabitants of Mexico City is reliable, valid and conceptually equivalent to the American version.

La Somnolencia Diurna Excesiva (SDE) es uno de los problemas de sueño más incapacitantes ya que se relaciona con déficits en la ejecución conductual, accidentes laborales y vehiculares. Se estima una prevalencia en la población general de entre 16% y 32%. El Functional Outcomes Sleep Questionnaire (FOSQ) es el cuestionario más utilizado para medir el impacto de la SDE en el estado funcional de pacientes con diferentes trastornos del dormir, el cual se ha validado en distintos países. Por lo tanto, el objetivo de este estudio fue adaptar culturalmente el FOSQ y obtener la confiabilidad, la validez de constructo y los coeficientes de congruencia factorial para la versión FOSQ-México. En una primera fase se tradujo el cuestionario utilizando el procedimiento metodológico estándar. También se hizo la adaptación cultural de los reactivos mediante la técnica de Redes Semánticas Naturales Modificadas en una muestra de 78 participantes. En una segunda fase, el cuestionario adaptado se aplicó a 152 participantes para determinar la discriminación entre reactivos, la consistencia interna, el análisis factorial con rotación ortogonal con un método de componentes principales y comprobar la congruencia factorial. Los resultados indicaron que los 30 reactivos del FOSQ se agruparon en seis factores que explican el 67.2% de la varianza total, con un coeficiente a total de 0.94 y de 0.85 promedio para los factores. Se obtuvieron coeficientes de congruencia factorial de 0.360 a 0.969 entre la versión original y el FOSQ-México. Se demostró que la versión adaptada del FOSQ para habitantes de la Ciudad de México es confiable, válida y equivalente conceptualmente con la versión norteamericana.

Maculopatía pseudoviteliforme asociada a pliegues coroideos bilaterales. Diagnóstico diferencial / Pseudo-vitelliform maculopathy and bilateral choroidal folds: differential diagnosis

Mujer de 64 años, agudeza visual en ojo derecho (OD) 0,5 y 0,7 en ojo izquierdo (OI). Pseudofaquia bilateral. No signos inflamatorios. PIO normal. Funduscópicamente en la retinografía el OD evidencia un depósito subfoveal amarillento, redondeado, sobreelevado y autofluorescente. Abundantes drusas ecuatoriales y pliegues coroideos bilaterales. En angiofluoresceinografía, el OD muestra hipofluorescencia foveal inicial con hipercaptación tardía. La tomografía de coherencia óptica muestra un depósito hiperrefringente sobre epitelio pigmentario foveal. Campos visuales, ecografías oculares y electrooculogramas: normales. Alteración inespecífica del test de colores. Conclusión: Las distrofias maculares viteliformes y los pliegues coroideos son entidades poco frecuentes y su asociación es excepcional(AU)

A 64 year old woman. Best corrected acuity right eye (RE) 0.5 and 0.7 left eye (LE). Bilateral pseudophakia. No inflammatory signs. Normal IOP. RE fundus showed a rounded, yellow and excessive subfoveal deposit with positive autofluorescence. Multiple equatorial drusen and choroidal folds in both eyes. Fluorescein angiography of RE showed early foveal hypofluorescence and delayed hyperluorescence. Optical coherence tomography revealed a hiperreflective deposit over the foveal epithelium pigment. Visual fields, ocular ultrasounds and electrooculograms were normal. Non-specific alterations in colour tests. Conclusión: Vitelliform maculopathy and choroidal folds are very rare diseases and, exceptionally, appear together(AU)

Comparación de resultados previos y posteriores a la aplicación de un protocolo de actuación en cirugía bariátrica / Effect of a multidisciplinar protocol on the clinical results obtained after bariatric surgery

Introducción: La cirugía bariátrica ha demostrado ser un tratamiento eficaz para la pérdida de peso en pacientes con obesidad severa, recomendándose la aplicación de un protocolo de actuación multidisciplinar. Objetivos: Evaluar la utilidad de la implantación de un protocolo de actuación en cirugía de la obesidad basado en el Documento de consenso español de la SEEDO. Métodos: Estudio restrospectivo comparativo de resultados de pacientes intervenidos previamente (51 pacientes) y tras la implantación del protocolo (66 pacientes). Se recogieron datos de: antropometría , comorbilidades pre y postcirugía, complicaciones nutricionales y quirúrgicas postcirugía, test de Calidad de Vida validado, y hábitos alimentarios. Resultados: Los abandonos (17,6%) y el alcoholismo (5,8%) fueron mayores en pacientes preprotocolo frente postprotocolo (4,5% y 3% respectivamente) con diferencias estadísticamente significativas. La mortalidad fue del 2% en los preprotocolo y del 0% en los postprotocolo. Los hábitos alimentarios fueron mejores en los postprotocolo, presentando mayor porcentaje de trastornos de conducta alimentaria los preprotocolo (5,1%) aunque sin significación estadística. La mejoría de la calidad de vida fue superior en los postprotocolo en todos los items, pero solo con significación estadística en la actividad sexual (p 0,004). El 70,5% de los pacientes preprotocolo tenían más de una complicación nutricional frente al 32,8% de los postprotocolo (p < 0,05). No hubo diferencias en cuanto a porcentaje de sobrepeso perdido a los dos años (superior al 50% en el 81,3% de los casos preprotocolo y en el 74,8% de los postprotocolo) ni evolución de comorbilidades. Conclusiones: La cirugía bariátrica consigue excelentes resultados en: pérdida de peso, comorbilidades y calidad de vida, pero presenta complicaciones nutricionales, quirúrgicas y psiquiátricas que exigen un abordaje multidisciplinar y protocolizado. Nuestro protocolo mejora resultados de tasa de abandonos, trastornos de conducta alimentaria, hábitos alimentarios, complicaciones nutricionales y mejoría de calidad de vida (AU)

Introduction: Bariatric surgery has been shown to be an effective therapy for weight loss in patients with severe obesity, and the implementation of a multidisciplinar management protocol is recommended. Objectives: To assess the usefulness of the implementation of a management protocol in obesity surgery based on the Spanish Consensus Document of the SEEDO. Methods: Retrospective comparative study of the outcomes in patients previously operated (51 patients) and after the implementation of the protocol (66 patients). The following data were gathered: anthropometry, pre-and post-surgery comorbidities, post-surgical nutritional and surgical complications, validated Quality of Life questionnaire, and dietary habits. Results: Withdrawals (l7.6%) and alcoholism (5.8%) were higher in patients pre- versus post-implementation of the protocol (4.5% vs. 3%, respectively), the differences being statistically significant. The mortality rate was 2% in the pre-protocol group and 0% in the postprotocol group. The dietary habits were better in the post-protocol group, the pre-protocol group presenting a higher percentage of feeding-behavior disorders (5.1%) although not reaching a statistical significance. The improvement in quality of life was higher in the post-protocol group for all items, but only reaching statistical significance in sexual activity (p = 0.004). In the pre-protocol group, 70.5% of the patients had more than one nutritional complication vs. 32.8% in the post-protocol group (p < 0.05). There were no differences regarding the percentage of weight in excess lost at two years (> 50% in 81.3% in the pre-protocol group vs. 74.8% in the pos-protocol group) or the comorbidities. Conclusions: Bariatric surgery achieves excellent outcomes in weight loss, comorbidities, and quality of life, but presents nutritional, surgical, and psychiatric complications that require a protocol-based and multidisciplinary approach. Our protocol improves the outcomes regarding the withdrawal rates, feeding-behavior disorders, dietary habits, nutritional complications, and quality of life (AU)

Pericarditis purulenta y neoplásica en un paciente con leucemia aguda linfoblástica. Reporte de un caso y revisión de la literatura / Purulent and neoplasic pericarditis in a patient with acute lymphoblastic leukemia: case report and literature

Introducción. La leucemia aguda linfoblástica (LAL) es la neoplasia maligna más frecuente en los niños y constituye el 25% de todos los tipos de cáncer. Actualmente, la supervivencia en estos niños es superior al 70% debido al mejor entendimiento de su fsiopatología, al desarrollo de nuevos agentes de quimioterapia y a la mejoría de los cuidados de soporte y manejo de las complicaciones propias de la enfermedad y secundarias al tratamiento. Caso clínico. Reportamos un caso de septicemia y pericarditis purulenta por estafilococo dorado en el cuadro inicial de una LAL. La pericarditis en el curso de una leucemia en niños es una manifestación inusual y puede representar la muerte del paciente. Hay 18 casos reportados en el mundo de niños con leucemia y pericarditis. En 6 de ellos se encuentra una etiología infecciosa incluyendo S. aureus, Phytum insidiosum, Candida sp., S. pneumoniae y dos por Aspergillus. Conclusiones. Éste es el segundo caso de pericarditis purulenta por estafilococo reportado en la literatura. Representa el tercer caso de infltración pericárdica publicado en nuestro hospital. Es importante resaltar que la vía de entrada del estafilococo pudo ser mediante un procedimiento de acupuntura previo al diagnóstico. Estos recursos de medicina alternativa son ampliamente utilizados por nuestra población.

Background. Acute lymphoblastic leukemia (ALL) represents the most common cause of childhood cancer, accounting for 25% of all malignancies. Overall survival has improved remarkably due to the better understanding of its pathophysiology, the creation of new chemotherapy regimes and the improvement of the supportive care and the management of the disease complications as well as to complications secondary to treatment. Case report. We report a case of septicemia and purulent pericarditis secondary to Staphylococcus aureus in the initial presentation of ALL. Pericarditis in the course of leukemia in children is an unusual presentation. There are 18 cases reported worldwide of children with leukemia and pericarditis. In six cases an infectious etiology was found including S. aureus, Candida sp, Phytum insidiosum, S. pneumonia and two by Aspergillus. Conclusions. This is the second case of purulent pericarditis secondary to S. aureus reported in the literature. It represents the third case of pericardial infltration of leukemia reported by our hospital. It is important to note that S. aureus may have entered the bloodstream through an acupuncture procedure performed prior to diagnosis. These alternative resources are widely used in the Mexican population.

Prevalence of signs and symptoms of temporomandibular disorders in children in the state of Puebla, Mexico, evaluated with the research diagnostic criteria for temporomandibular disorders (RDC/TMD)

The aim of this work was to describe the prevalence of signs and symptoms of temporomandibular disorders (TMD) in children of the State of Puebla, Mexico. A descriptive observational study was performed. After calculating sample size, children who met the following selection criteria were included: registered at an official elementary school, either sex, ages between 8 and 12 years, who accept to participate in the study and whose parents have signed the informed consent forms. The Research Diagnostic Criteria for Temporomandibular Disorders were used by calibrated researchers (Kappa.90) under the same conditions. Descriptive statistics were applied by using SPSSv15 software. The study included 235 children, 129 (54.9%) female and 106 (45.1%) male, of average age 9.31+1.2 years. Prevalence of signs and symptoms was 33.2%, and predominately muscular (82%), 48.1% showed signs of muscular pain and 19.1% joint pain. 63.4% showed signs of alteration in the mouth opening pattern, 39.1% presented joint sounds on opening or closing the mouth and 20.4% on mandibular excursions. The high prevalence of signs and symptoms related to temporomandibular disorders, in particular in children with mixed dentition, shows the importance of TMD evaluation during this period, when morphological changes associated to growth and craniofacial development prevail.

El objetivo del presente trabajo fue describir la prevalencia de signos y sintomas de los trastornos temporomandibulares (TTM) en ninos del estado de Puebla, Mexico. Se realizo un estudio observacional descriptivo. Previo calculo de tamano de muestra, se incluyeron ninos que cumplieron con criterios previos de seleccion: inscriptos en escuela primaria oficial, de cualquier sexo, en edades de 8 a 12 anos, que aceptaron participar en el estudio y cuyos padres firmaron el consentimiento informado. Se utilizaron los Criterios de Investigacion Diagnostica para los TTM, aplicados por investigador estandarizado (Kappa .90) bajo las mismas condiciones. Se calculo estadistica descriptiva con el programa SPSS v15. Se incluyeron 235 ninos, 129 (54.9%) mujeres y 106 (45.1%) varones con promedio de edad de 9.31}1.2 anos. La prevalencia de signos y sintomas de TTM fue del 33.2% predominantemente musculares (82%), 48.1% presentaron dolor muscular y 19.1% articular. El 63.4% presento alteraciones en el patron de apertura bucal, 39.1% presento ruidos articulares en apertura o cierre y 20.4% a las excursiones mandibulares. Las altas prevalencias de los signos y sintomas relacionadas con los Trastornos Temporomandibulares, particularmente en ninos con denticion mixta, demuestran la importancia de la evaluacion de los TTM durante este periodo, donde prevalecen los cambios morfologicos asociados al crecimiento y al desarrollo craneofacial.

Trastorno depresivo mayor en México: la relación entre la intensidad de la depresión, los síntomas físicos dolorosos y la calidad de vida

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SUMMARY Background: Major Depressive Disorder (MDD) is a disease associated to emotional, vegetative and physical symptoms, including for the latter those pain-related symptoms. MDD has a high prevalence rate with a substantial burden of illness, and it expected that by 2020 it will become the second cause of world disability. The diagnosis of MDD is difficult due to the high prevalence of painful physical symptoms, and also due to the fact these symptoms are more evident that the embedded emotional ones. Over 76% of patients with MDD, report painful physical symptoms observed, like headache, abdominal pain, back pain and unspecific-located pain; observing these symptoms can even predict depression severity. In addition, the likelihood of psychiatric disease increases, importantly, with the number of physical symptoms observed; moreover, the remission of physical symptoms predicts the complete remission in MDD. We present an observational, prospective study to examine the clinical profile of Mexican outpatients suffering MDD and determine the relationship between depression severity, painful physical symptoms in quality of life and depression. Methods: Adult patients with current episodes of MDD, treated with antidepressants were included. MDD was defined according to the criteria of the Statistical Manual of Mental Disorders - 4th Edition (DSM-IV) or in the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Patients should have been free of depression symptoms prior to the current episode for at least 2 months. Duration of current episode should not exceed two years. Treatment-resistant patients and those with other psychiatric diagnosis were excluded. Treatment-resistance was defined as: a) a failure to respond to treatment when two different antidepressants were employed at therapeutic doses for at least four weeks each, b) when the subject was previously treated with IMAO inhibitors, c) when electro-convulsive therapy (ECT) was previously employed. Other exclusion criteria comprise previous or current diagnosis of schizophrenia, schizophreniform or schizoaffective disorder, bipolar disorder, dementia or mental impairment. Patients were selected in 34 centers in Mexico. Patients were classified according to the presence (SFD+) or absence (SFD-) of painful physical symptoms using the Somatic Symptom Inventory (SSI); SFD+ was defined as scores ≥ 2 for the pain-related items in the SSI (items 2, 3, 9, 14, 19, 27 and 28). Visual Analogue Scale (VAS) quantified pain severity (cervical pain, headache, back pain, shoulder pain, interference of pain in daily activities and vigil-time with pain). HAMD17 and CGI-S determined depression severity, while the Quality of Life in Depression Scale (QLDS) quantified subjective well-being. Linear regression models were employed to compare groups for VAS, HAMD17, CGI-S, and QLDS, to fit the confusions or clinical predictors when needed. Proportions between groups were established with Fisher exact test or logistic regression. Significance levels were established at 0.005 due to the observational nature of the study. In the result tables, standard deviation (SD) is reported as a variation around the mean value as Mean ± SD, and 95% confidence intervals are denoted 95% IC. Results: A total of 313 patients were enrolled in the study. All of the enrolled patients were Mexican, almost them were women and had at least a previous MDD episode. Painful physical symptoms were reported by 73.7% of patients, these patients were classified into the SFD+ group. Neither statistical nor clinical significant differences between the SFD+ and SFD- groups were found when analyzing socio-demographic variables (age, gender, ethnical origin) and disease history variables (number of previous episodes of MDD, in the last 24 months, duration of current episode). At baseline, patients had a CGI-S mean score of 4.6 and HAMD17 of 26.3. HAMD17 mean score (27.1) in SFD+ patients was significantly higher (p<0.0001) than the SFD- patients (23.8), but nonsignificant differences between groups were found for the subscales central, Maier & retard. CGI-S scores were similar between SFD+ and SFD-; 4.6 and 4.5 respectively (p>0.05). Prevalent painful physical symptoms were also the most painful, when a five-point scale was employed to measure severity, and comprised muscular pain (84.9%), cervical pain (84.2%) and headache (83.5%). SFD+ patients had higher pain severity in all VAS scales (p<0.0001), with perceived severity scores twice as large when compared to SFDgroup. In particular, the global pain VAS reported average values of 49.0 and 19.7 for the SFD+ and SFD- groups respectively. Patients came to the first psychiatric consultation treated with psychotherapy (27.9%), antidepressants (37.3%), anxiolytics (28.6%) and analgesics (9.7%); more than 50% of all patients were not taking any drugs or receiving psychotherapy for treatment of MDD at baseline. Analgesics were used only by 9.7% of patients for the treatment of painful physical symptoms in their current MDD episode. No significant differences between groups were found when comparing the use of psychotherapy, antidepressants, anxiolytics, antipsychotics, mood stabilizers or analgesics. Quality of life was poor for all patients, but significantly worse in the SFD+ group than in the SFD- group (QLDS scores of 23.2 and 20.0 respectively, p<0.001). Discussion: The diagnosis and symptoms manifestation can be influenced by local socio-cultural factors, in particular cultural differences are associated with the prevalence of painful physical symptoms, but this finding is not consistent. The results of this study can be extrapolated to the MDD Mexican population, as selection criteria comprised only operative diagnosis criteria, and not enrollment into the study took place due to the presence of painful physical symptoms. Patients included into the study presented a moderate to severe disease as measured with the HAMD17 scores. The high prevalence of painful physical symptoms in patients with depression was confirmed in this study; it has been reported the patients report pain-related symptoms as the main (even the only) symptom when consulting general practitioners. Painful physical symptoms in MDD include headache, cervical pain, back pain or neck pain; the presence of painful physical symptoms in depression is associated to higher intakes medication, but in this study more than 50% of subjects were not receiving any treatment, including psychotherapy. The treatment of MDD is by no means optimal, as only 30%- 40% of these patients reach complete remission of symptoms with their first antidepressant. Psychological symptoms respond to antidepressant treatment, but in general, this is not the case for the physical symptoms. The lack of efficacy can be explained as a failure in the treatment of these painful physical symptoms. Resolving these symptoms is even a predictor for the complete remission of MDD; the evidence might suggest that treatment of emotional and physical manifestations of depression could improve successful-treatment rates. Conclusion: As found in other reports, a high prevalence of painful physical symptoms was found in MDD patients. Increase in pain severity is associated with higher HAMD17 scores but not CGI-S scores; this discrepancy in the final rates obtained with both scales suggests that both emotional and physical dimensions of MDD should be considered when the clinical assessment is performed. We concluded that clinical judgment of Mexican psychiatrists differs between their global impression and a semi-structured interview in the same patient and therefore is fundamental that the clinical evaluation consists of both emotional and physical manifestations as important components of MDD.

Psicopatología y uso de tabaco en estudiantes de secundaria

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Abstract: When we talk about drugs, we usually think about illicit substances. However some substances apparently innocuous such as caffeine and other legal ones like tobacco and alcohol, are considered as abuse substances. Nicotine has not been studied as extensively as other drugs. It is known that the pharmacological and behavioural processes that determine the addiction to nicotine are similar to those that determine the addiction to other drugs such as cocaine or heroine. The main adverse effect of nicotine is death. According to the Global Burden of Disease study of the World Health Organization, the World Bank, and Harvard University, in 2020, tobacco will be the first individual cause of death in the world even over AIDS. Nicotine dependence can appear at any age, though it generally begins during adolescence, and it acts on the brain mechanisms of reward, indirectly by endogenous opioid activity and directly by dopaminergic pathways. In the researches on drugs consumption among adolescents conducted in Mexico City during 1989, 1991 and 1993, it was observed that tobacco consumption has increased lightly but systematically, from 4.8% to 4.2%. The percentage of current users (in the last month) is 21.9%. At junior high school level it is 13.7%, and at high school level 34.4%. Attention Déficit Disorder With Hyperactivity (ADDH). Altough the relationship between ADDH and drugs consumption has been recognized none of the studies conducted in our country has included this variable. ADDH is a disorder with a frequency of 1.7% to 18.9%. The difference between the reported percentages is attributed to the fact that definitions and methods used in the studies are not the same. When the disorder is not treated, there is usually a gradual accumulation of adverse processes that increase the risk of pathology. The relationship between ADDH and drug consumption is complex. In a study of adolescents who received treatment for drug abuse, it was observed that 50% of them met the criteria for ADDH. As well, this disorder was a bad prognosis factor, either to the addiction evolution and its treatment. Another complex relationship is the one between ADDH and cigarette smoking. In a study conducted among adult smokers, the subjects with ADDH had an earlier onset of the tobacco addiction, compared to those who did not had ADDH. This finding was confirmed by Milberger, who in a four years follow up study, discovered that ADDH is a significant predictor on the early tobacco consumption. ADDH can be considered as a risk factor in developing other addictions. Although the relationship between ADDH and drug consumption has been studied, the reviewed researches show up some limitations : Only clinical samples have been studied. Most of the follow up studies have included just male individuals with ADDH. In our country the effect of the clinical variables on drugs use have not been studied. In ADDH as well as in drug consumption, it has been observed a remarkable influence of cultural variables, this emphasize the need of evaluating both problems in our country. The following study was conducted under the hypothesis that ADDH and general pathology symptoms are higher among adolescents that have consumed tobacco than those who have not. Material and methods A comparative, cross-sectional survey of adolescent with and without tobacco usage was performed. Fifteen junior high schools in Puebla City were randomly selected. First year junior high school students who agreed to answer the questionnaires were included. The studied variables were: symptoms of ADDH and general psychopathology symptoms. ADDH symptoms were dimensionally evaluated with the Conners-Wells Self Report Scale (long version). General psychopathology was rated with the SCL-90 which evaluates the intensity of symptoms in 9 subscales. Tobacco consumption was determined by the Junior High school Students Questionnaire, developed at the National Institute of Psychiatry, which was used in the Drug, Alcohol and Tobacco consumption surveys in Mexico City. Tobacco consumption was considered positive when the questions about lifetime, and last month consumption were affirmative. From the 15 junior high schools selected, a first year group was chosen at the beginning of the school term. A written authorization from the parents was requested, so the students could answer to the questionnaires. It was inferred that all of them accepted because none of the parents refused explicitely. The questionnaire about drug consumption was applied the first day. Before the application, it was explained to the adolescents, that the information would be confidentially handled; the questionnaire answers would be only known by the researchers and that the information would not be given to their parents or their teachers. The second day of evaluation, the Conners questionnaire was applied. The third day the students answered to the SCL-90. All the questionnaires were applied at the beginning of the daily activities. The 19 psychopathology subscales were compared between male and women and between the students with and without tobacco consumption in the last month and during lifetime. Although the statistical significance was determined with non parametric tests (Wilcoxon test), on the tables, means and standard deviations are shown. The analysis were done with the SAS 6.12. program. The significance level was determined at 0.05. Results From 590 students registered on the selected groups, 544 (92%) were evaluated, the rest of them did not show up during the week in which the evaluations were performed. The mean age was 12 years with a standard deviation of 1, 57.3% (n=295) were males. Twenty children (3.9%) have used tobacco during the last month. On the Conners-Wells Questionnaire, they had higher scores on all ten subscales. These differencies were statistically significant in seven subscales: Familial problems, Conduct problems, Cognitive problems, anger management problems, hyperactivity, Global index, and distractibility DSM IV. General psychopathology symptoms also were higher in those individuals who used tobacco during the last month, compared to those who did not, in seven of the nine subscales the differences were statistically significant. Regarding the experimental usage of tobacco (ever in lifetime), 84 children (15%) answered affirmatively. The scores of these children were higher than the scores of children who denied ever smoked in all subscales of the Conners-Wells Questionnaire. The differences were statistically significant in nine of the ten subscales. In the SCL-90 the scores of the children who have used tobacco during lifetime, were higher in all subscales, except in phobic anxiety. Discussion Our results confirm the proposed hypothesis that the students who consume tobacco present higher levels of psychopathology, compared to those students who have never used this substance. It is necessary to underline the fact that this is the first study in our country that correlates the tobacco consumption with psychopathology symptoms, evaluated in a structured way with valid and reliable instruments.

Violencia autodirigida en la adolescencia: el intento de suicidio / Self-inflicted violence in adolescence: the suicide attempt

Introducción. Objetivo: comparar el grado de depresión con el grado de impulsividad en una muestra clínica de adolescentes con intento de suicidio. Material y métodos. Se estudió a un grupo de adolescentes de 12 a 17 años de edad, hombres y mujeres, llevados en forma consecutiva durante un semestre al Hospital Psiquiátrico Infantil Juan N. Navarro de la Secretaría de Salud por haber realizado un intento de suicidio. Sus diagnósticos clínicos fueron catalogados en 3 grupos: grupo I (conductual), grupo II (afectivo) y grupo III (mixto). Los pacientes también respondieron a escalas que miden depresión y otros tipos de problemas psicológicos. Resultados. De 65 adolescentes (56 mujeres y 9 hombres), con intentos suicidas de primera vez o repetidos, 75% tenían diagnósticos con depresión y 42% tenían diagnósticos con impulsividad. La impulsividad se encontró significativamente más elevada en hombres que en mujeres. En éstas, el medio más empleado fue la sobredosis de medicamentos. Todos los tipos de problemas psicológicos fueron más graves entre los adolescentes que estaban deprimidos. Conclusiones. Hubo mayor frecuencia de depresión que de impulsividad en adolescentes que intentaron el suicidio. Los pacientes deprimidos mostraron más psicopatología de otro tipo que los no deprimidos, y más problemas familiares. Hasta hoy éste es el estudio con más pacientes en población clínica de adolescentes con intento suicida realizado en México.

Introduction. Objective: our aim was to compare degrees of depression and impulsivity in a clinical sample of adolescents with suicide attempts. Material and methods. We studied adolescents of both sexes who attempted suicide and were brought to a psychiatric hospital in Mexico City in a semester. Clinical diagnosis was included in 3 possible groups: group I (behavioral disorders), group II (affective disorders) and group III (mixed disorders). Patients also responded scales in order to measure depression and other types of psychological problems. Results. A total of 65 patients (56 girls and 9 boys), with first or repeated suicide attempts, were evaluated. Depressive type diagnosis was present in 75% and impulsiveness in 42%. Impulsivity was significantly higher in boys than in girls. Overdosing was the most employed method in the suicide attempts of female patients. Psychopathology was more severe among depressed adolescents. Conclusions. There is more depression than impulsivity among adolescents who attempt suicide. Depressed adolescents show more psychopathology and family problems than non-depressed adolescents, with statistical significance. So far, this is the largest study in a clinical sample of Mexican adolescents who attempted suicide.

Láserterapia en cirugía ortognática / Laser Therapy in Orthognatic Surgery

Se describen losresultados de un estudio clínico observacional sobre laserterapia en la fase postoperatoria de 26 pacientes sometidos a reducción de prognatismo mandibular con osteotomía sagital bilateral de rama ascendente (OSBMKS). Todos los procedimientos de cirugía ortognática fueron realizados de enero a diciembre de 2002, en el Servicio de Cirugía Maxilofacial del CMN SXXI del IMSS aplicando en el lado derecho de la región intervenida hasta 10 sesiones de láser diódico, siendo el izquierdo el lado control, observando mejoría en disminución del dolor y del cuadro inflamatorio agudo en relación a los pacientes a quienes no se aplicó esta terapia. Se evaluaron los resultados con medición clínica del edema postoperatorio a las 24 horas, 72 horas, 8 días, 15 días y se verificaron los cambios histológicos y radiográficos ocurridos en el proceso de cicatrización ósea a los 30 días, 6 y 8 semanas posterior a la cirugía ortognática.

This study describes the prevalence of patients with dentofacial deformities attended in the Maxillofacial Surgery Department of Hospital de Especialidades del Centro Médico Nacional Siglo XXI of the IMSS, during January to December 2002. Twenty-six patients received postoperative laser therapy in the right area of the mandible ramus, after bilateral sagittal modified osteotomy (BSMKSO). The results with laser therapy showed less pain and edema in comparison other patients without this therapy. The results were carried out after 24 hours, 3 days, 8 days and 15 days, and after 10 treatments of laser therapy. The X-Ray and biopsy showed bone healing 30 days, six and eight weeks after orthognatic surgery procedures.

Micrometástasis en el ganglio centinela y macrometástasis ganglionares axilares en el cáncer de mama / Micrometastasis in the sentinel node and axillary lymph node macrometastasis in breast cancer

ObjetivoEl estudio del ganglio centinela ha permitido tener un conocimiento más preciso del grado de afectación axilar en el cáncer de mama, disminuyendo a su vez la morbilidad quirúrgica asociada a la exploración de la axila. El uso sistemático de técnicas inmunohistoquímicas y de biología molecular permite detectar la presencia de micrometástasis o de células aisladas en un porcentaje relevante de casos, como único signo de extensión linfática de la enfermedad. Actualmente, se plantea la posibilidad de evitar la linfadenectomía axilar completa en aquellas enfermas que solo presentan micrometástasis, dada la baja incidencia de afectación en el resto de los ganglios axilares.Material y métodoSe incluyeron 159 enfermas con cáncer de mama en estadio T1 o T2, en las que se identificó mediante gammagrafía y se localizó intraoperatoriamente el ganglio centinela, practicándoseles una linfadenectomía axilar completa en el caso de observarse afectación por micro o macrometástasis, con el fin de determinar el grado de extensión axilar.ResultadosUn total de 40 enfermas (25%) mostraron afectación del ganglio centinela, siendo en 17 de ellas (10,7%) invasión sólo por micrometástasis. De entre estas 17 enfermas, solo 2 (11,8%) mostraron invasión por macrometástasis en la linfadenectomía, no modificándose en el resto la estadificación alcanzada tras el estudio del ganglio centinela.ConclusiónCabe conjeturar que en el futuro pueda evitarse la disección axilar en las enfermas con afectación por micrometástasis, a la espera de los resultados que arrojen los estudios multicéntricos actualmente en marcha(AU)

AimThe study of the sentinel node has made it possible to obtain more comprehensive knowledge about the extent of axillary involvement in breast cancer. It has also decreased the surgical morbidity associated to the surgical examination of the axilla. The systematic use of immunohistochemical staining and molecular biology techniques improves the ability to detect the presence of micrometastasis or isolated tumor cells in a significant number of cases when this is the only sign of the lymph node extension of the disease. The possibility of avoiding complete axillary lymphadenectomy in those patients who are only affected by micrometastasis is proposed because of the low incidence of further involvement of the remaining lymph nodes.Material and method159 patients diagnosed of stage T1 or T2 breast cancer, in which the sentinel node had been identified by scintigraphy and intraoperative localization, were included in the study. Complete axillary lymphadenectomy was performed when micro- or macrometastases were found in the sentinel node, in order to determine the degree of axillary involvement.ResultsA total of 40 patients (25%) showed infiltration of the sentinel node. This infiltration was only by micrometastasis in 17 of them (10.7%). Of these 17 patients, only 2 (11.8%) showed macrometastasis in the lymphadenectomy. In the remaining subjects, the final staging reached after the sentinel node study was not modified.ConclusionIt is possible to speculate that, in the future, axillary dissection can be avoided in those patients diagnosed of micrometastasis in the sentinel node, pending the conclusions of the on-going multicenter studies(AU)

Evaluación del desarrollo organizacional en enfermería / Evaluation of the organizational development of nursing

Introducción: es relevante para el departamento de enfermería evaluar los subsistemas técnico, humano y organización al como parte fundamental para el crecimiento de las instituciones de salud. El responsable de la administración del trabajo en las áreas operativas es el directivo de enfermería, quien participa en la toma de decisiones, liderazgo, manejo de conflictos y comunicación; por tanto, resulta importante conocer cómo evalúa la enfermera el desarrollo organizacional del departamento de enfermería. Objetivo: evaluar el Desarrollo Organizacional (D.O.) del departamento de enfermería en un hospital de tercer nivel. Material y métodos: Estudio descriptivo y transversal, muestreo por conveniencia, n=43 enfermeras, con la utilización del "Modelo Socio técnico" de la organización. Resultados: En la evaluación del desarrollo organizacional en el departamento de enfermería, procesos sociales obtuvo mayor promedio (87.18) y el menor estructura organizacional (8608). Discusión y conclusiones: el Departamento de Enfermería como sistema abierto, susceptible de administrarse bajo la modalidad de D.O. evaluado por el instrumento "Modelo Sociotécnico", puede mejorar su administración sustantiva mediante la mejora continua y de acuerdo a resultados dicho instrumento puede emplearse en las Instituciones de Salud.

Introduction: it is excellent the nursing department, to evaluate the subsystems technician, human and organizational as fundamental part for the growth of the institutions of health. Being responsable for the administration of the work in the operativo areas, the nursing directiva who participates in taking of decisions, leadership, handling of conflicts and communication. It is important to know like the nurse floor boss evaluates the organizational development of the department of de nursing of the HECMR. Objetive: to evaluate the Organizational Development (DO.) of the nursing department in a hospital of third level. Material and methods: I Study descriptive and traverse, sampling for convenience, n=43 nurses, with the use of the "Model Technical Partner of the organization. Results: in the evaluation of the organizational development in the nursing department, social processes obtained bigger average (87.18) and the smallest organizational structure (86.08). Discussion and conclusions: the Department of nursing like open system, susceptible of being administered under the modality of D.O. evaluated by the instrument "Model Sociotécnico", It can improve their administration substantive by means of the continuous improvement and according to results this instrument it can be used in the Institutions of Health.

La satisfacción del usuario como indicador de calidad en un servicio de Medicina Nuclear / Patient satisfaction as quality indicator in a nuclear medicine department

Objetivo. Valorar el grado de satisfacción e insatisfacción del paciente con el servicio de Medicina Nuclear. Material y métodos. Se diseñó un cuestionario compuesto por 9 preguntas cerradas, una de escala numérica y otra pregunta abierta que recogió comentarios y sugerencias. Las preguntas consideraron diferentes dimensiones de calidad del servicio relacionadas con el tiempo de espera en la realización de la exploración, información, instalaciones, trato recibido por el personal del servicio y satisfacción global (escala numérica 1-10). El grado de insatisfacción se estableció mediante el análisis de quejas escritas recibidas en los últimos 6 años. Resultados. Se obtuvieron 671 cuestionarios. El 58 % de los encuestados fueron mujeres. La edad media fue de 56,5 años (DE: 16,26). La información suministrada fue correcta para el 81,7 % de los encuestados. El equipamiento y las instalaciones fueron satisfactorios para el 74,5 % de los pacientes. La lista de espera y el tiempo de espera fueron correctos para el 70 % y el 66,4 % respectivamente. El trato correcto fue el parámetro más favorablemente valorado (98,7 %). La satisfacción global fue positiva (mas menos 7 sobre 10) para el 82,8 % de los pacientes. Se recibieron un total de 29 quejas. La mayoría se basó en aspectos relacionados con la lista de espera (12) y disconformidad con la asistencia (9). Conclusiones. El grado de satisfacción fue alto en la mayoría de los pacientes. El tiempo de espera constituyó el parámetro con menor satisfacción y, por lo tanto, subsidiario demejora. La principal queja espontánea referida por nuestros pacientes fue la lista de espera

Objective. To assess patient satisfaction and dissatisfaction with a Nuclear Medicine department.Material and methods. A questionnaire was designed with 9 closed questions, 1 with a numerical scale (1-10) and 1 with an open question for suggestions. The questions included different quality dimensions of the department related with waiting time for the scan, information, facilities, attention manner with department staff and global satisfaction (numerical scale, 1-10). Dissatisfaction was determined by analyzing the written complaints for the last 6 years. Results. A total of 671 questionnaires were obtained, 58% of those surveyed being women. The mean age of patients was 56.5 (mas menos 16.26). The information provided was correct in 81.7 % of cases. Equipment and facilities were correct for 74.5 % of patients. Waiting list and waiting time were correct for 70 % and 66.4% respectively. The attention manner of the department staff was the most satisfactory dimension (98.7 %). Global satisfaction was positive (7 out of 10) in 82.8 % of the patients. 29 complaints were received. Most of them were based on waiting list (12) and disagreement with assistance (9). Conclusions. Global satisfaction was high in most of patients. Waiting time was the dimension with the lowest level of satisfaction and subsidiary of improvement plans. The primary spontaneous complain by our patients was due to the waiting list