Una experiencia docente universitaria en Pediatría, aceptación por alumnos y docentes / University teaching experience in Pediatrics, acceptance by students and teachers

La educación médica debe ser reflexiva, interactiva y debe promover la proactividad personal y profesional como elemento de aprendizaje. Describimos una experiencia docente en los estudios del Grado de Medicina, en la asignatura de Pediatría, con la participación activa de los estudiantes. Un estudiante propuso preparar y exponer un tema, eligiendo "tosferina y paperas". Este permite un abordaje de aspectos clínicos, epidemiológicos y comunitarios. En el modelo de clase invertida se promueve la lectura de documentos previos a la hora docente

Medical education training should be interactive and should promote personal and professional proactivity as a learning element. We describe a teaching experience in the studies of the Degree of Medicine (subject of Pediatrics) with the active participation of the students. A student proposed to prepare the theme "whooping cough and mumps, and that was the chosen one. This item allows an approach of clinical, epidemiological and community aspects. With the flipped classroom the reading of documents prior to teaching time is promoted

Expectativas de parto de las gestantes de La Ribera: una aproximación cualitativa / Childbirth expectations of La Ribera pregnant women: a qualitative approach

Objetivo: El cambio de modelo asistencial en la atención al parto normal, el interés por parte de las autoridades sanitarias en que se exploren las expectativas de parto de las gestantes, y su especificidad cultural y social, hacen que el estudio de tales expectativas sea pertinente en este momento. El objetivo del presente estudio es conocer cuáles son las expectativas de parto de una muestra de gestantes españolas y estudiar las diferencias entre las expectativas de las gestantes primíparas y multíparas. Metodología: Estudio cualitativo basado en una pregunta de respuesta libre sobre expectativas de parto. Se recogieron datos a gestantes de tercer trimestre del área de salud de La Ribera (Alzira, Valencia) durante 2014-2015. Se analizaron los datos mediante análisis del contenido. Resultados: Muestra de 213 gestantes cuyas principales expectativas de parto fueron tener un parto rápido, con buen resultado obstétrico, sin dolor y con apoyo de los profesionales. Las expectativas relacionadas con los protocolos de atención al parto normal supusieron un 5.2% del total de las respuestas. No se encontraron diferencias estadísticamente significativas entre gestantes primíparas y multíparas. Conclusiones: El conocimiento de las expectativas resulta importante, ya que las gestantes miden su satisfacción con el parto en base al cumplimiento de tales expectativas. Ayudarlas a desarrollar expectativas realistas aumentará su satisfacción. Las matronas tienen un importante papel a través de la formación que imparten (educación maternal) y del apoyo en el momento del parto (fundamental para que las gestantes se sientan protagonistas del mismo) (AU)

Objective: Change of healthcare model in normal childbirth, health authorities interest in exploring childbirth expectations of pregnant women, and their cultural and social specificity make relevant the study of these expectations at this moment. The aim is to know what are the childbirth expectations from a sample of Spanish pregnant women and to study the differences between primiparous and multiparous pregnant women expectations. Methodology: Qualitative study based on an open-ended question about childbirth expectations. Data were collected during 2014-2015 to third trimester pregnant women in La Ribera health area (Alzira, Valencia). Data were analyzed using content analysis. Results: Sample of 213 pregnant women whose main expectations were to have a fast delivery, with good obstetric outcome, painlessly and with professional support. Expectations regarding normal childbirth protocols accounted for 5.2% of total responses. No statistically significant differences between primiparous and multiparous pregnant women were found. Conclusions: Knowledge about childbirth expectations is highly relevant because pregnant women measure their satisfaction with childbirth through the fulfillment of these expectations. Helping them to develop realistic expectations will increase their satisfaction. Midwives play an important role through the training they give (maternal education) and through the support during delivery (this is essential for the pregnant women in order to feel themselves protagonist of their delivery) (AU)

Diseño de un servicio de nutrición en una farmacia comunitaria de Sevilla (España) y análisis descriptivo de los resultados del primer año / Design of a nutritional service at a community pharmacy in Seville (Spain) and descriptive analysis of the results from the first year

Introducción: Un alto porcentaje de pacientes registrados en la base de datos de la farmacia mostraron sobrepeso asociado a malas prácticas alimentarias. Por ello, nos propusimos instaurar un servicio de nutrición para contribuir a mejorar sus hábitos nutricionales. Material y métodos: Durante noviembre-diciembre 2014, se impartieron charlas explicativas y se publicitó el servicio entre los usuarios. En enero de 2015 se inauguró la consulta. Con los datos registrados durante el primer año, a través de entrevistas personalizadas, se realizó un estudio observacional-descriptivo y longitudinal, analizando los hábitos alimentarios del paciente, sus parámetros antropométricos: índice de masa corporal (IMC) y perímetro de la cintura (PC) y clínicos: presión arterial (PA), así como su evolución en controles sucesivos. Resultados: La muestra (n=77, 25-64 años), 66 mujeres (85,7%) y 11 varones (14,3%), presentaba un IMC=33,2±5,6 kg/m2 y un PC=97,2±13,9 cm. El 24,1% mostró sobrepeso, el 57,5% algún tipo de obesidad (I o II) y el 11,5% obesidad mórbida (IMC>40). Ansiedad, estreñimiento y enfermedades del tiroides predominaron entre las mujeres (56,6%, 38,2% y 19,7%) y la HTA en los varones (54,5% p<0,05); no hubo diferencia en el porcentaje de dislipémicos (27,3% y 27,6%), diabéticos (9,1% y 6,6%) ni fumadores (18,2% y 15,8%), pero sí entre los consumidores de bebidas alcohólicas (63,6% hombres y 36,8% mujeres, p<0,05). Una mayoría de entrevistados reconocieron no realizar ejercicio físico Se registraron 8,6±5,5 visitas/paciente consiguiéndose una pérdida de 4,5±3,8 kg de peso, 1,7±1,5 kg/m2 de IMC (p<0,05) y 4,8±3,8 cm de PC (p<0.05). El 71,4% de ellos alcanzaron los objetivos de peso propuestos. Algunos aceptaron adherirse a otros servicios de la farmacia: seguimiento farmacoterapéutico (SFT) (5%) y prevención de riesgo cardiovascular (RCV) (6%). Conclusiones: Después de un año, el servicio está claramente instaurado, ha beneficiado a gran parte de sus usuarios y ha permitido algunas derivaciones a otros servicios farmacéuticos (AU)

Introduction: A high percentage of patients registered in the database of a pharmacy in Seville (Spain) were overweight, in association with poor dietary practices. In order to help improving their health status, we undertook the implementation of a nutrition service. Materials and methods: During the months of November-December 2014, the service was publicized, and explanatory talks were given. The service was inaugurated in January 2015. With the data recorded between January 2015 and January 2016, based on personalized interviews, we made an observational-descriptive and longitudinal study, analyzing the nutritional habits of the patient, their anthropometric parameters (Body Mass Index, BMI and waist circumference, WC) and clinical parameters (Blood Pressure, BP), controlling them in successive visits. Results: The sample (n = 77, 25-64 years), 66 women (85.7%) and 11 men (14.3%) had a BMI= 33.2 ±5.6 kg/m2 and a BW = 97.2±13.9 cm. 24.1% were overweight, 57.5% presented some type of obesity (I or II), and 11.5% were morbidly obese (BMI> 40). Anxiety, constipation and thyroid diseases predominated among women (56.6%, 38.2% and 19.7%) and HTA in males (54.5% p <0.05); there were no differences in the percentage of dyslipemics (27.3% and 27.6%), diabetics (9.1% and 6.6%) or smokers (18.2% and 15.8%), but there was in the percentage of consumers of alcoholic beverages (63.6% men and 36.8% women, p<0.05). A majority of interviewees admitted not to do exercise. We registered 8.6±5.5 visits/year/patient, achieving a loss of 4.5±3.8 kg of weight, 1.7±1.5 kg/m2 of BMI (p<0.05) and 4.8±3.8 cm WC (p<0.05). 71.4% of the patients reached the proposed weight goals. Some of them agreed to join other pharmacy services: pharmacotherapeutic follow-up (PF) (5%) and cardiovascular risk (CVR) prevention (6%). Conclusions: After a year, the service is clearly established, has benefited a large part of its users and has allowed some referrals to other pharmaceutical services (AU)

La caracterización de pacientes como herramienta útil para ofertar servicios profesionales personalizados en farmacia comunitaria / Patient characterization as a useful tool for offering personalized professional services in the community pharmacy

Introducción: El futuro inmediato de la farmacia requiere la incorporación de servicios profesionales orientados a optimizar la gestión personalizada del paciente. Objetivos del trabajo: Determinar las características de los pacientes/usuarios registrados en la base de datos de una farmacia comunitaria con el fin de detectar sus necesidades sanitarias para establecer las pautas de intervención más adecuadas y eficaces. Material y métodos: Se diseñó un cuestionario adaptado al ámbito de la farmacia comunitaria que facilitara el almacenamiento y tratamiento de los datos de los pacientes/usuarios seleccionados a través de entrevistas personales. Resultados: En la muestra predominan los pacientes pluripatológicos (80,5%) y polimedicados (72,2%) de edad avanzada (70,6±9,8 años) con bajo nivel de estudios (86,1%). Dislipemia (63,9%), HTA (61,1%), artrosis (56,6%), enfermedades vasculares periféricas (38,9%) y diabetes II (30,6%) fueron las patologías más prevalentes. Aunque el 69,4% realizaba ejercicio físico regularmente, el 81,8% tenía exceso de peso y no realiza dietas adecuadas. El fármaco más consumido fue omeprazol (97,0%) seguido de paracetamol (50,0%), estatinas (47,2%), benzodiacepinas, hidroclorotiazida y metformina. Conclusión: La caracterización de pacientes a través de cuestionarios estructurados y consensuados pueden ayudar al farmacéutico a localizar los grupos más vulnerables a los que ofrecer servicios profesionales adaptados a sus necesidades y a elaborar programas de prevención y protocolos de actuación más eficientes (AU)

Introduction: The immediate future of the pharmacy requires the incorporation of professional services aimed to optimizing personalized patient management. Aims of the study: To determine the characteristics of patients registered in the database of a community pharmacy in order to detect their health needs, from these, establish guidelines most appropriate and effective intervention. Material and methods: A questionnaire adapted to the field of community pharmacy was designed to facilitate the storage and processing of data of patients / users, who were registered in the pharmacy database, through personal interviews. Results: Pluripatological (80.5%) and polypharmacy patients (72.2%), older (70.6 ± 9.8 years) with low educational level (86.1%) predominate in the study. Dyslipidemia (63.9%), hypertension (61.1%), arthritis (56.6%), peripheral vascular disease (38.9%) and diabetes II (30.6%) were the most prevalent diseases. Although 69.4% performed physical exercise regularly, almost 82% were overweight and do not perform adequate diets. The most consumed drug was omeprazole (97.0%), followed by acetaminophen (50.0%), statins (47.2%), benzodiazepines, hydrochlorothiazide and metformin. Conclusion: The patients’characterization through structured and agreed questionnaires can help the pharmacist to locate the most vulnerable groups of the population studied in order to provide professional services adapted to their needs and develop prevention programs and more efficient protocols of action (AU)

Enfermedad tiroidea autoinmunitaria materna: repercusión en el recién nacido / Maternal autoimmune thyroid disease: Relevance for the newborn

Fundamento y objetivo: La enfermedad tiroidea autoinmunitaria es uno de los problemas endocrinológicos más frecuentes del embarazo. Se asocia a mayor morbilidad perinatal, malformaciones, daño neurológico y disfunción tiroidea neonatal. Las hormonas tiroideas maternas son claves en el neurodesarrollo fetal. Evaluamos la función tiroidea, en los primeros meses, de los hijos de mujeres con enfermedad tiroidea autoinmunitaria, para intentar establecer el seguimiento óptimo. Pacientes y método: Se controló la función tiroidea, durante los primeros meses, en 81 hijos de mujeres con enfermedad tiroidea autoinmunitaria (16 casos de hipertiroidismo y 65 de tiroiditis autoinmunitaria). Resultados: El 4,93% de los neonatos presentaron malformaciones, y el 8,64% recibieron tiroxina por un valor de tirotropina (TSH) comprobada mayor de 9,5 μUI/ml en el primer mes. En el 85,7% de estos, el cribado neonatal fue negativo, por un aumento tardío de la TSH. Se asoció a TSH elevada en el niño: menor peso al nacimiento, mayor edad materna y mayor título de anticuerpos antiperoxidasa tiroidea (anti-TPO) en la gestación. Se asoció a una tiroxina libre (T4L) más alta en el niño: tener menos edad y que la madre tuviera hipertiroidismo. Conclusiones: Se recomienda determinar en todas las gestantes los valores de TSH, T4 y anticuerpos anti-TPO antes de la semana 10, y seguimiento o tratamiento si hubiera alteraciones. Asimismo, se recomienda controlar a las 48 h de vida la TSH y la T4L en hijos de mujeres con enfermedad tiroidea autoinmunitaria y, si la TSH fuera mayor de 6 μUI/l, repetir el control entre las semanas 2-4. Es recomendable efectuar un control cuidadoso de la gestante con hipertiroidismo y de su hijo (AU)

Background and objective: Autoimmune thyroid disease is amongst the most frequent endocrine disorders during pregnancy. It is associated with an increase in perinatal morbidity, congenital defects, neurological damage, fetal and neonatal thyroid dysfunction. Maternal thyroid hormones play a key role in child neurodevelopment. We aimed to evaluate the thyroid function and the clinical course of neonates born from mothers with autoimmune thyroid disease during the first months of life in order to define the follow-up. Patients and method: We monitored thyroid function and clinical status during the first months in 81 newborns of mothers with autoimmune thyroid disease; 16 had Graves disease and 65 autoimmune thyroiditis. Results: A percentage of 4.93 newborns had congenital defects, and 8.64% neonates showed an increase in thyrotropin (TSH) (> 9.5 μUI/mL 2 times) and required thyroxin within the first month of life. A 85.7% of these showed a negative newborn screening (due to a later increase of TSH). A higher TSH value in the newborn was related to an older age of the mother, higher levels of thyroid peroxidase (TPO) antibody during pregnancy and lower birth weight. A higher free thyroxine (FT4) value in the newborn was related to fewer days of life and mothers with Graves disease. Conclusions: We recommend the evaluation of TSH, T4 and TPO antibodies before 10 weeks in all pregnant women with follow-up if maternal thyroid autoimmunity or disorders is detected. It is also recommended to test children's serum TSH and FT4 at 48 h of life in newborns of mothers with autoimmune thyroid disease and repeat them between the 2nd and 4th week in children with TSH > 6 μUI/mL. Careful endocrine follow-up is advised in pregnant women and children if hyperthyroidism is detected (AU)

[Maternal autoimmune thyroid disease: relevance for the newborn]. / Enfermedad tiroidea autoinmunitaria materna: repercusión en el recién nacido.

BACKGROUND AND OBJECTIVE: Autoimmune thyroid disease is amongst the most frequent endocrine disorders during pregnancy. It is associated with an increase in perinatal morbidity, congenital defects, neurological damage, fetal and neonatal thyroid dysfunction. Maternal thyroid hormones play a key role in child neurodevelopment. We aimed to evaluate the thyroid function and the clinical course of neonates born from mothers with autoimmune thyroid disease during the first months of life in order to define the follow-up. PATIENTS AND METHOD: We monitored thyroid function and clinical status during the first months in 81 newborns of mothers with autoimmune thyroid disease; 16 had Graves disease and 65 autoimmune thyroiditis. RESULTS: A percentage of 4.93 newborns had congenital defects, and 8.64% neonates showed an increase in thyrotropin (TSH) (>9.5 µUI/mL 2 times) and required thyroxin within the first month of life. A 85.7% of these showed a negative newborn screening (due to a later increase of TSH). A higher TSH value in the newborn was related to an older age of the mother, higher levels of thyroid peroxidase (TPO) antibody during pregnancy and lower birth weight. A higher free thyroxine (FT4) value in the newborn was related to fewer days of life and mothers with Graves disease. CONCLUSIONS: We recommend the evaluation of TSH, T4 and TPO antibodies before 10 weeks in all pregnant women with follow-up if maternal thyroid autoimmunity or disorders is detected. It is also recommended to test children's serum TSH and FT4 at 48 h of life in newborns of mothers with autoimmune thyroid disease and repeat them between the 2nd and 4th week in children with TSH>6 µUI/mL. Careful endocrine follow-up is advised in pregnant women and children if hyperthyroidism is detected.

[Neurological examination in patients undergoing sedation with propofol: a descriptive study]. / Exploracion neurologica en pacientes sometidos a sedacion con propofol: estudio descriptivo.

INTRODUCTION: The neurological examination is a resource used in evaluating patients who are in coma. Anaesthesia can be a factor that exerts an influence on the findings. We evaluated the examination of the comatose patient in the case of patients anaesthetised with propofol in order to define its clinical value. PATIENTS AND METHODS: A prospective study was conducted among those who had undergone heart surgery in the intensive care unit of a tertiary hospital during the months of April and May 2011. Aspects that were analysed were the examination of the anaesthetic coma, pharmacological or medical factors that can have an influence and a full neurological examination following recovery. Patients with previous neurological symptoms were excluded. RESULTS: Thirty patients were selected (16 males and 14 females); mean age: 72 ± 10 years. All the patients were sedated with propofol. During sedation, 17 (46.7%) presented unreactive pupils. No spontaneous eye movements were observed in 100% of the sample. Ocular alterations in primary position were observed in 23.3% of them. Oculocephalic reflexes were absent in 93.3% and oculovestibular reflexes, in 100%; the corneal reflex, was absent in 70% (with asymmetry), as was the ciliospinal reflex, in 83.3%. The algesic motor response was absent in 93.3%, as were the cutaneous plantar extensor reflexes, in 20%; and 66.7% were indifferent. Following anaesthesia, the neurological examination was normal in 80%, there were slight orientation impairments in 16.7% and a hemispheric syndrome was found in one patient. CONCLUSIONS: Anaesthesia with propofol alters the reversible cutaneous-plantar, pupillary, trunk and motor response reflexes on withdrawing sedation. The alterations may be asymmetrical. Neurological examinations should not be used in the case of patients sedated with propofol in order to make clinical decisions.

TITLE: Exploracion neurologica en pacientes sometidos a sedacion con propofol: estudio descriptivo.Introduccion. La exploracion neurologica es un recurso en la evaluacion de los pacientes en coma. La anestesia puede ser un factor influyente en los hallazgos. Evaluamos la exploracion del paciente en coma en pacientes anestesiados con propofol para definir su valor clinico. Pacientes y metodos. Estudio prospectivo en sometidos a cirugia cardiaca en los cuidados intensivos de un hospital terciario durante los meses de abril y mayo de 2011. Se analiza la exploracion del coma anestesico, factores farmacologicos o medicos que pueden influir y exploracion neurologica completa tras la recuperacion. Se excluyeron pacientes con sintomas neurologicos previos. Resultados. Se seleccionan 30 pacientes (16 hombres y 14 mujeres); edad media: 72 ± 10 años. Todos los pacientes estaban sedados con propofol. Durante la sedacion, 17 (46,7%) presentaban pupilas arreactivas. En el 100% no se observaron movimientos espontaneos de los ojos. El 23,3% presentaba alteracion ocular en posicion primaria. Los reflejos oculocefalicos estaban ausentes en el 93,3%, y los oculovestibulares, en el 100%; el reflejo corneal, en el 70% (con asimetria); el espinociliar, en el 83,3%. La respuesta motora algesica estaba ausente en el 93,3%; en un 20%, los reflejos cutaneoplantares extensores; e indiferentes, en el 66,7%. Tras la anestesia, la exploracion neurologica fue normal en el 80%, hubo leves alteraciones de orientacion en un 16,7% y se encontro un sindrome hemisferico en un paciente. Conclusiones. La anestesia con propofol altera los reflejos pupilares, del tronco, respuestas motoras y reflejo cutaneoplantar reversibles al retirar la sedacion. Las alteraciones pueden ser asimetricas. No se deberia utilizar la exploracion neurologica en el paciente sedado con propofol para la toma de decisiones clinicas.

Exploración neurológica en pacientes sometidos a sedación con propofol: estudio descriptivo / eurological examination in patients undergoing sedation with propofol: a descriptive study

Introducción. La exploración neurológica es un recurso en la evaluación de los pacientes en coma. La anestesia puede ser un factor influyente en los hallazgos. Evaluamos la exploración del paciente en coma en pacientes anestesiados con propofol para definir su valor clínico. Pacientes y métodos. Estudio prospectivo en sometidos a cirugía cardíaca en los cuidados intensivos de un hospital terciario durante los meses de abril y mayo de 2011. Se analiza la exploración del coma anestésico, factores farmacológicos o médicos que pueden influir y exploración neurológica completa tras la recuperación. Se excluyeron pacientes con síntomas neurológicos previos. Resultados. Se seleccionan 30 pacientes (16 hombres y 14 mujeres); edad media: 72 ± 10 años. Todos los pacientes estaban sedados con propofol. Durante la sedación, 17 (46,7%) presentaban pupilas arreactivas. En el 100% no se observaron movimientos espontáneos de los ojos. El 23,3% presentaba alteración ocular en posición primaria. Los reflejos oculocefálicos estaban ausentes en el 93,3%, y los oculovestibulares, en el 100%; el reflejo corneal, en el 70% (con asimetría); el espinociliar, en el 83,3%. La respuesta motora algésica estaba ausente en el 93,3%; en un 20%, los reflejos cutaneoplantares extensores; e indiferentes, en el 66,7%. Tras la anestesia, la exploración neurológica fue normal en el 80%, hubo leves alteraciones de orientación en un 16,7% y se encontró un síndrome hemisférico en un paciente. Conclusiones. La anestesia con propofol altera los reflejos pupilares, del tronco, respuestas motoras y reflejo cutaneoplantar reversibles al retirar la sedación. Las alteraciones pueden ser asimétricas. No se debería utilizar la exploración neurológica en el paciente sedado con propofol para la toma de decisiones clínicas (AU)

Introduction. The neurological examination is a resource used in evaluating patients who are in coma. Anaesthesia can be a factor that exerts an influence on the findings. We evaluated the examination of the comatose patient in the case of patients anaesthetised with propofol in order to define its clinical value. Patients and methods. A prospective study was conducted among those who had undergone heart surgery in the intensive care unit of a tertiary hospital during the months of April and May 2011. Aspects that were analysed were the examination of the anaesthetic coma, pharmacological or medical factors that can have an influence and a full neurological examination following recovery. Patients with previous neurological symptoms were excluded. Results. Thirty patients were selected (16 males and 14 females); mean age: 72 ± 10 years. All the patients were sedated with propofol. During sedation, 17 (46.7%) presented unreactive pupils. No spontaneous eye movements were observed in 100% of the sample. Ocular alterations in primary position were observed in 23.3% of them. Oculocephalic reflexes were absent in 93.3% and oculovestibular reflexes, in 100%; the corneal reflex, was absent in 70% (with asymmetry), as was the ciliospinal reflex, in 83.3%. The algesic motor response was absent in 93.3%, as were the cutaneous plantar extensor reflexes, in 20%; and 66.7% were indifferent. Following anaesthesia, the neurological examination was normal in 80%, there were slight orientation impairments in 16.7% and a hemispheric syndrome was found in one patient. Conclusions. Anaesthesia with propofol alters the reversible cutaneous-plantar, pupillary, trunk and motor response reflexes on withdrawing sedation. The alterations may be asymmetrical. Neurological examinations should not be used in the case of patients sedated with propofol in order to make clinical decisions (AU)

Fibroma osificante juvenil, presentación de un caso clínico y revisión de la literatura / Juvenil ossifying fibroma, case report and review of the literature

Se presenta el caso de una paciente de seis años, de sexo femenino sin antecedentes mórbidos ni familiares de importancia, quien consulta por proptosis izquierda en abril de 2011. Se realiza resonancia magnética de cerebro evidenciándose un tumor de seno etmoidal con compromiso de órbita izquierda que ocasiona exoftalmo. La biopsia endoscópica nasal fue compatible con fibroma osificante juvenil. Posteriormente se realiza antrostomía con etmoidectomía en dos tiempos, con resultados satisfactorios para la paciente. Aunque el fibroma osificante juvenil es un tipo de lesión benigna poco frecuente, puede llegar a ser muy agresiva y con una alta tasa de recidiva en ciertas ocasiones, por lo que se debe tener en cuenta para realizar un diagnóstico y tratamiento precoz, con un seguimiento programado a largo plazo.

This paper presents the case of a patient of six years old female without background or important morbidly in her family, who consults for left-sided proptosis in April of 2011. It performs brain magnetic resonancebeing demonstrated a tumor of theethmoid sinus with commitment to the left orbit that causes exophthalmus. Nasal endoscopic biopsy was compatible with juvenile ossifying fibroma. It was subsequently performed ananthrostomy whitethmoidectomy in two times, with satisfactory results for the patient. Although the Juvenile ossifying fibroma is a rare type of benign lesion, can be very aggressive and have a high recurrence rate in certain occasions, by what should be taken into account to make an early diagnosis and treatment, with a scheduled follow up in the long term.

Atresia de coanas, revisión y una mirada desde la evidencia / Choanal atresia, review and a look from the evidence

La atresia de coanas es la anomalía congénita nasal más común. Cuando es bilateral, se presenta con dificultad respiratoria desde el nacimiento. La atresia unilateral se manifiesta con insuficiencia ventilatoria y rinorrea unilateral, pudiendo pasar inadvertida. El diagnóstico se sospecha ante la ausencia de paso de aire en las fosas nasales y la imposibilidad de hacer progresar una sonda nasogástrica. Se confirma mediante examen endoscópico y tomografía computarizada. El tratamiento definitivo es quirúrgico, existiendo diferentes técnicas y vías de abordaje. Se presenta una revisión de la literatura, con especial énfasis en el tratamiento pos-quirúrgico con stents y mitomicina-C a través de una mirada desde la evidencia.

Choanal atresia is the most common congenital nasal anomaly. When bilateral, it presents with respiratory distress at birth. Unilateral atresia is manifested by respiratory failure and unilateral rhinorrhea, and may go along unnoticed. Diagnosis is suspected in the absence of airflow in the nasal cavity and for the inability to advance a nasogastric tube. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and there are different techniques and surgical approaches. A review of the literatureis presented, with special emphasis onthepost-surgical treatmentwithstents and Mitomycin-Cview from the evidence.

Síndrome de Lemierre, secundario a otitis media aguda: revisión a partir de un caso / Lemierre syndrome secondary to acute otitis media: review from a case

El síndrome de Lemierre (SL), una grave complicación, generalmente de las infecciones orofaríngeas. Se caracteriza por una inflamación agresiva del espacio parafaríngeo lateral, aparición de tromboflebitis de la vena yugular interna y el desarrollo de émbolos sépticos a distancia. Con un diagnóstico clínico y radiológico para su confirmación y posterior seguimiento, debe ser tratado con antibioterapia precoz y parenteral, además de debridación, drenaje quirúrgico de las posibles colecciones purulentas que presente y eventual anticoagulació. En el siguiente trabajo, reportamos el caso de un paciente con esta rara, pero nuevamente emergente entidad, en donde se profundiza su estudio y se resume la literatura.

Lemierre's syndrome (SL), generally, a serious complication of the oropharyngeal infections.Its characterized by an aggressive inflammation of the lateral parapharyngeal space, thrombophlebitis of the yugular internal vein and metastasic abscesses in different organs. With a clinical and radiological diagnosis for his confirmation and later follow-up, it must be treatedwith iv antibiotics and surgical drainage of the possible purulent collections that he presentsand eventual anticoagulation. In the following work, we bring the case of a patient with this rare, but again emergent entity, where his study is deepened and the literature is summarized.

Pólipo esfenonasal como causa de mucocele esfenoidal: un diagnóstico a considerar / Sphenoidal sinus polips

The sphenoidal sinus mucocele is a pseudocystic lesion of paranasal cavity (CPN). These injuries are probably underdiagnosed as they may be asymptomatic or cause nonspecific symptoms. The CT scan and the MRI increase the precision of the preoperative evaluation. We present a case of sphenoid sinus mucocele in a patient of 69 years old, who was admitted at our institution with 1 month evolution of persistent headache. Clinical presentation, diagnosis and treatment of this case are discussed as well as the review of the literature...

Dermatofibrosarcoma protuberans pigmentado: tumor de Bednard / Dermatofibrosarcoma protuberans: bednar tumor

El Tumor de Bednard es una rara forma de presentación del Dermatofibrosarcoma Protuberans, clasificado como un sarcoma de bajo grado con alta agresividad local y tendencia a la recurrencia cuando no presenta márgenes quirúrgicos adecuados. Presenta una difícil aproximación inicial y notoria demora en el correcto diagnóstico, lo que muchas veces influye negativamente en su pronóstico. Presentamos en el siguiente reporte un paciente de 24 años con diagnóstico de Tumor de Bednard, que se presentó como un tumor sólido subcutáneo de larga data.

Bednard tumor is a rare form of presentation of dermatofibrosarcoma protuberans. It is classified as a low-grade sarcoma with high local aggressiveness and relapse tendency when inadequate surgical margins are present after surgery. Diagnosis is difficult and shows a marked delay in the correct diagnosis, affecting the prognosis. We present a case-report of a patient with the diagnosis of Bednard tumor presented as a subcutaneous long standing solid tumor.

Gastrointestinal tolerability of metamizol, acetaminophen, and diclofenac in subchronic treatment in rats.

The gastrointestinal tolerability of metamizol and acetaminophen [weak cyclooxygenase (COX) inhibitors] in comparison with diclofenac (nonselective cyclooxygenase inhibitor) was evaluated in subchronic treatments in rats. Wistar rats received 60 mg/kg body weight of metamizol and acetaminophen, and 3 mg/kg body weight of diclofenac by oral route twice daily for 14 days. Myeloperoxidase activity, an index of neutrophil infiltration, COX expression and the effects on blood parameters used as indicators of liver and renal functions were also studied. Metamizol and acetaminophen did not cause apparent gastrointestinal lesions; in contrast diclofenac showed swelling and an increased thickness on the distal intestinal mucosa. Myeloperoxidase activity was significantly increased in the small bowel with diclofenac treatment. In gastric mucosa the expression of the cyclooxygenase-1 was not affected and the expression of cyclooxygenase-2 was not observed. Diclofenac treatment significantly diminished hematocrit, hemoglobin, and corpuscular volume and increased the number of platelets. Aspartate aminotransferase and gamma-glutamyltransferase activity were also altered and, regarding the renal biochemical parameters, the animals treated with diclofenac had increased urea values. In contrast, acetaminophen treatment did not affect either of these parameters and metamizol increased only the alanine aminotransferase activity. Under our experimental conditions, metamizol and acetaminophen seem to be safe drugs. In contrast, with diclofenac treatment blood loss and anemia are observed which could stem from the small intestinal injury. Moreover, this drug could to impair kidney function.

Eficacia de la psicocirugía en el trastorno obsesivo-compulsivo. Resultados preliminares (septiembre, 2002) / Effectiveness of psychosurgery in obsessive-compulsive disorder.

Tras una concisa introducción al trastorno obsesivo-compulsivo (T.O.C.) resistente, a la historia de la psicocirugía y en concreto a la técnica neuroquirúrgica de la capsulotomía bilateral anterior, se describe el Protocolo de Psicocirugía del T.O.C. resistente del Hospital de Mutua de Terrassa. Dicho protocolo se halla en marcha desde 1998, habiéndose valorado 38 solicitudes y dando lugar a 18 intervenciones de psicocirugía mediante capsulotomía bilateral anterior por termocoagulación, hasta Septiembre de 2002 y de su seguimiento durante un año. Se informa de los resultados preliminares valorándose: La Escala de Yale-Brown para Obsesiones-Compulsiones (Y-BOCS) total y las subescalas para obsesiones y compulsiones, los cuestionarios de Hamilton y Beck para depresión y STAI-estado para la ansiedad y la Escala de Evolución de la Actividad Global (E.E.A.G.) del Eje V del DSM-IV. Así como de una batería básica de evolución neuropsicologica compuesta por: los cubos de Kohs, la medida de la memoria visual inmediata y a medio plazo (WMS-R) del test del trazo A y B (TMT). Como medida principal de respuesta la escala Y-BOCS basal de 29,4 paso a 19,1 al mes y al 17,3 al año, con una mejoría media del 332 por ciento al mes. Un 53 por ciento de pacientes mejoraron, tomando como criterio de respuesta la disminución del 33 por ciento de su puntuación basal en la Y-BOCS total. No se objetivó empeoramiento en ninguna de las escalas neuropsicologicas utilizadas. Tan sólo 3 pacientes presentaron complicaciones tras la capsulotomía (AU)

Cáncer basocelular en poblaciones expuestas y no expuestas a arsénico / Basal cell carcinoma in arsenic exposed and non exposed population

Se presenta un estudio de incidencia de CBC por exposición a arsénico, entre enero de 1990 y diciembre de 1999. El grupo expuesto está constituído por residentes en Chuquicamata y Calama (provincia de El Loa), operados de CBC en el Hospital de Chuquicamata y el grupo de no expuestos comprende a los residentes en los valles interiores de la IV región (Vicuña, Limari y Choapa). Hubo 247 pacientes en el primer grupo y 205 en el segundo. La radiación UVB en la IV región fue de 1382 erg/cm2/año y de 1556 erg/cm2/año en Calama (12,2 por ciento mayor en ésta). La localización más frecuente del tumor en ambas áreas fue en la cara. En El Loa, el tumor fue más frecuente en áreas no expuestas del cuerpo a UVB en relación a la IV región p=0,0001. La edad media de aparición del tumor fue similar en ambas áreas, p=0,24 y no hay diferencia de incidencia por sexo entre las regiones, p=0,566. La tasa de incidencia en la IV región fluctuó entre 9,1 y 28,9 x 100.000 en los diez años y en la provincia. El Loa fluctúa entre 49,1 y 119,2 x 100.000. El RR para el desarrollo de CBC fue en los diferentes años, entre 3 y 8 veces mayor en la provincia de El Loa. En conclusión, este estudio muestra que existe una fuerte asociación y una probable relación causal entre la exposición a arsénico en suspensión aérea y la aparición de CBC en el área de Chuquicamata y Calama

Gastric damage induced by subchronic administration of preferential cyclooxygenase-1 and cyclooxygenase-2 inhibitors in rats.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are well known to induce gastrointestinal damage including bleeding, ulceration and perforation in humans and animals. The aim of this study was to compare the effects of two oxicams, preferential cyclooxygenase (COX)-1 or COX-2 inhibitors, on both gastric mucosa and some biological parameters (hematological, hepatic and renal) after subchronic administration (14 and 28 days) in rats. Neutrophil infiltration was also assessed. Equipotent doses of meloxicam (3.75 and 7.5 mg/kg) and piroxicam (5 and 10 mg/kg) were administered. Both drugs dose-dependently caused multiple gastric erosions and hemorrhage in rats after 14 and 28 days of administration. Treatment with meloxicam led to a higher gastric damage than with piroxicam on day 14 although these results were not significant. The levels of myeloperoxidase activity (as an index of neutrophil infiltration) were not changed compared with control after drug treatment. All the hematological parameters obtained after drugs administration for 14 and 28 days were in the range of normal values, and a significant increase in platelet levels could be observed in the group treated with 5 mg/kg of piroxicam for 14 days. Aspartate aminotransferase (AST or GOT) increased significantly after 14 days, but after 28 days the values returned to normality. Creatinine and urea did not undergo significant changes except for the piroxicam 14-day 5 mg/kg group, in which uremia increased significantly over normal values. In conclusion, our results show that meloxicam, a preferential COX-2 inhibitor, causes rates of gastric lesion comparable to those seen with traditional NSAIDs, without inducing important changes in biological parameters.

Effects of dipyrone on inflammatory infiltration and oxidative metabolism in gastric mucosa: comparison with acetaminophen and diclofenac.

In the last several years, it has been proposed that neutrophil- and oxygen-dependent microvascular injuries may be important factors in the gastrointestinal toxicity of nonsteroidal antiinflammatory drugs (NSAIDs). In addition, after oral administration, reduced levels of gastric mucosal adenosine triphosphate in response to mitochondrial damage constitute the earliest event on topical mucosal erosions. In these experiments, we compared the implication of active oxygen, lipid peroxidation levels and neutrophil infiltration in gastric mucosal injury induced by the analgesic-antipyretic drugs, dipyrone (pyrazolone derivative) and acetaminophen (nonacidic drug), both with relatively weak antiinflammatory effects, with diclofenac (an acidic NSAID). After 6 hr of oral administration, dipyrone (120 and 500 mg/kg) did not provoke macroscopic lesions on rat gastric mucosa. Only the highest dose (1000 mg/kg) induced slight erosions similar to the same dose of acetaminophen without modifications in lipid peroxidation levels or myeloperoxidase activity. The area of mucosa with lesions, the increase in neutrophil infiltration, and concentration of TBA-reactive substances was significantly higher with diclofenac (50 mg/kg). By contrast, inhibition in superoxide dismutase activity was observed. In a dose-dependent manner, dipyrone and diclofenac decreased the levels of endogenous gluthatione, and the highest dose (1000 mg/kg) also inhibited glutathione peroxidase activity. None of treatments induced changes in xanthine oxidase activity, an index of ischemic condition. These findings confirm the favorable gastric tolerability of dipyrone, since only the highest dose produced weak mucosal lesions similar to that obtained with acetaminophen, and this effect only could be related to a diminished glutathione metabolism. In contrast, diclofenac induced significant erosions, and the data obtained indicate that the enhancement of oxidative stress plays an important role in the pathogenesis of damage.

Mechanisms involved in protection afforded by L-arginine in ibuprofen-induced gastric damage: role of nitric oxide and prostaglandins.

L-Arginine (L-arg) exhibits multiple biological properties and plays an important role in the regulation of different functions in pathological conditions. Many of these effects could be achieved on this amino acid serving as a substrate for the enzyme nitric oxide synthase (NOS). At the gastrointestinal level, recent reports revealed its protective activities involving a hyperemic response increasing the gastric blood flow. The aim of this study was to characterize the relationship between NOS activity/expression and prostaglandin changes (PGs) in rats gastric mucosa, with L-arg associated resistance to the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen (IBP). The protective effect of oral L-arg (100 mg/kg body wt), administerred together with IBP (100 mg/kg body wt, per os), was evident enough 90 min after drug administration, although a significant protection persisted for more than 6 hr. Pretreatment with N(G)-nitro-L-arginine (L-NNA) (40 mg/kg body wt, intraperitoneally), a competitive inhibitor of constitutive NOS, partly altered the protection afforded by the amino acid. In contrast, no changes could be observed after inducible NOS inhibition [aminoguanidine (AG) 50 mg/Kg body wt, intraperitoneally). L-arg, plus IBP, produced a significant increase of the cyclic GMP (cGMP) response in tissue samples from rat stomach, 90 min and 6 h after drug administration. iNOS activity and mRNA expression were higher in IBP-treated rats, and no differences were observed in inducible responses in the L-arg plus IBP group. No variations in the cNOS activity and expression were found among the different groups of animals assayed. The measurement of mucosal PGE2 content confirmed that biosynthesis of the eicosanoid is maintained by L-arg for over 90 min after IBP, while a total inhibition was observed 6 hr later. The mechanisms of the L-arg protective effect on the damaged induced by IBP could be explained by the different period after drug administration. The early phase is mediated by cyclooxygenase/prostaglandins pathway (COX/PGs) although NO liberated by cNOS and the guanylate cyclase/cGMP pathway could be also relevant. The later phase implicates inhibition of the iNOS/NO response.

Estudio de la personalidad en estudiantes de enfermería / A study of nursing students' personality

Se valoran diversas variables psicológicas de los estudiantes de enfermería de tercer año (n = 35). Se estudia la personalidad según las teorías de Eysenck, a través del cuestionario E.P.Q., se evalúa la conducta asertiva con el cuestionario de asertividad de Gambrill y Richey y también se mide el conjunto hostilidad utilizando el cuestionario de Buss-Durkee. Así mismo, a través de los resultados obtenidos, se apunta la necesidad de trabajar el tema de la asertividad en los alumnos de enfermería (AU)