Shaping of Porous CeO2 Powders into Highly Active Catalyst Carriers.

CeO2 is attracting more and more attention because of its outstanding performance in heterogeneous catalysis, as an active support and a reaction promoter in reactions of industrial interest. We herein describe a novel and scalable manufacturing process of mm-sized CeO2 spheres by a combination of extrusion and spheronization of CeO2 porous powders. In this study, wet paste formulation and fabrication procedures were optimized, and as a result methylcellulose was identified as the best plasticizer for paste extrusion to provide well-defined spherical shapes and smooth surfaces, as well as reproducible batches. After nickel impregnation (10 wt %), the catalytic performance of CeO2 supports was evaluated in the CO2 methanation reaction (T = 250-350 °C, P = 5 bar·g) and compared with that of commercial Al2O3 spheres doped or not with CeO2. These novel CeO2-based catalysts are easily reduced at a moderate temperature and more active than the Al2O3 analogues, particularly at low reaction temperatures and small reactor volumes, properties that make their implementation in emerging reactor configurations very promising.

Asymptomatic endometrial thickening in postmenopausal women: predictor of malignant pathology?

It is not standardised what is the endometrial thickness that discriminates between normal and potentially malignant. The objective of this study was to determine the endometrial thickness cut-off point from which the risk of endometrial cancer (EC) increases in asymptomatic postmenopausal women; and to evaluate the risk factors linked to malignant endometrial pathology as well as other associated ultrasound findings.This was a retrospective observational study that included hysteroscopies performed at the Hospital Materno-Infantil on 267 asymptomatic menopausal women with an increase in endometrial thickness (AET) >5 mm, from 2015 to 2019. The results shows that the prevalence of malignant pathology in asymptomatic postmenopausal women with a casual finding of endometrial thickening was 3.7%. This percentage was 16.3% when the cut-off point of AET was established at 10 mm. There was a significant association for the diagnosis of malignant pathology with this cut-off point.There is a significant association between the 10 mm endometrial thickness cut-off point from which the risk of EC increases in asymptomatic postmenopausal women.Impact statementWhat is already known on this subject? Several studies have established the cut-off point for asymptomatic endometrial thickening (AET) for atypical endometrial hyperplasia and endometrial cancer at 10 mm. Although no cut-off point has optimal accuracy for the diagnosis of malignant endometrial pathology, it has been found that with a cut-off value of AET >10 mm no cases are missed. Likewise, a cut-off point of AET > 11 mm may provide a balance between cancer detection and histopathological workup extension.What do the results of this study add? A significant association was found at the cut-off point of AET > 10 mm, which suggests that screening postmenopausal women at this thickness is acceptable and unlikely to miss cases of endometrial hyperplasia and endometrial cancer.What are the implications of these findings for clinical practice and/or further research? After analysing our results we can conclude, like other published studies, that by establishing a cut-off point of 10 mm we obtain a good discrimination between benign and malignant pathology, which would allow us to diagnose 100% of malignant pathology. Above this cut-off point, the risk of endometrial cancer increases, and it would therefore be advisable to extend the study. A multicentre study is needed to confirm the cut-off point at which the risk of endometrial cancer increases in postmenopausal women with asymptomatic endometrial thickening.

Risk Factors for Acute Gastroenteritis Among Patients Hospitalized in 5 Veterans Affairs Medical Centers, 2016-2019.

Background: In the United States, ∼179 million acute gastroenteritis (AGE) episodes occur annually. We aimed to identify risk factors for all-cause AGE, norovirus-associated vs non-norovirus AGE, and severe vs mild/moderate AGE among hospitalized adults. Methods: We enrolled 1029 AGE cases and 624 non-AGE controls from December 1, 2016, to November 30, 2019, at 5 Veterans Affairs Medical Centers. Patient interviews and medical chart abstractions were conducted, and participant stool samples were tested using the BioFire Gastrointestinal Panel. Severe AGE was defined as a modified Vesikari score of ≥11. Multivariate logistic regression was performed to assess associations between potential risk factors and outcomes; univariate analysis was conducted for norovirus-associated AGE due to limited sample size. Results: Among 1029 AGE cases, 551 (54%) had severe AGE and 44 (4%) were norovirus positive. Risk factors for all-cause AGE included immunosuppressive therapy (adjusted odds ratio [aOR], 5.6; 95% CI, 2.7-11.7), HIV infection (aOR, 3.9; 95% CI, 1.8-8.5), severe renal disease (aOR, 3.1; 95% CI, 1.8-5.2), and household contact with a person with AGE (aOR, 2.9; 95% CI, 1.3-6.7). Household (OR, 4.4; 95% CI, 1.6-12.0) and non-household contact (OR, 5.0; 95% CI, 2.2-11.5) with AGE was associated with norovirus-associated AGE. Norovirus positivity (aOR, 3.4; 95% CI, 1.3-8.8) was significantly associated with severe AGE. Conclusions: Patients with immunosuppressive therapy, HIV, and severe renal disease should be monitored for AGE and may benefit from targeted public health messaging regarding AGE prevention. These results may also direct future public health interventions, such as norovirus vaccines, to specific high-risk populations.

Manejo del acceso vascular en tiempos de la COVID-19 / Vascular access management during the COVID-19 pandemic period

Antecedentes y objetivo: los pacientes en hemodiálisis crónica son un colectivo especialmente vulnerable a la COVID-19. El objetivo del presente estudio es analizar el impacto que la COVID-19 ha tenido en la actividad clínica y quirúrgica relacionada con el acceso vascular (AV) en nuestro centro. Métodos: estudio observacional retrospectivo en el que se compara la actividad y los resultados relacionados con el acceso vascular del año natural previo a la pandemia (2019) respecto al primer año de pandemia (2020). Resultados: tras el inicio de la pandemia adaptamos nuestras estrategias diagnóstico-terapéuticas a esta nueva situación para evitar la expansión del virus. Analizamos los resultados de 723 pacientes, que fueron evaluados en la consulta de AV (403 valorados en 2019 y 320 en 2020). El número de intervenciones realizadas en ambos periodos fue similar. Se objetivó un incremento en la realización de fístulas radiocefálicas en 2020 (51,2 % frente a 32,5 %) (p = 0,026), además de una reducción signifi cativa del tiempo en lista de espera (30 ± 23,2 días en 2019 frente a 15,2 ± 19,2 días en 2020; p = 0,001). Ninguno de los pacientes operados presentó infección por coronavirus en el primer mes tras la intervención. En 2020 destacó una mayor mortalidad de los pacientes valorados en la consulta de enfermedad renal crónica avanzada (ERCA) (37,5 % frente a 27,5 %) (p = 0,02). También se objetivó un ligero incremento no signifi cativo del uso de catéter venoso central (CVC), tanto en los pacientes que iniciaron hemodiálisis con CVC (CVC incidentes: 48,5 % en 2019 frente a 55,5 % en 2020, p = 0,440) como en el global de pacientes en hemodiálisis crónica (CVC prevalentes: 34,8 % en 2019 frente a 40,4 % en 2020, p = 0,380)

Interpopulation Plasticity in a Darkling Beetle Life-History along a Whole Oceanic Island Altitudinal Gradient.

Insects show remarkable phenotypic plasticity in response to changing environmental conditions. The abiotic factors that determine their phenotypes often vary in time and space, and oceanic islands harbour ideal environments for testing predictions on this matter. The ubiquitous beetle Pimelia laevigata costipennis Wollaston, 1864 (Tenebrionidae) is distributed over the entire altitudinal gradient of the island El Hierro (Canary archipelago), from 0 to 1501 m above sea level. Here, we examine how environmental factors (i.e., rainfall and temperature), associated with the altitudinal gradient, affect the body size, reproductive phenology, clutch size and egg volume, and population dynamics of this ectothermic flightless insect. Pimelia l. costipennis populations inhabiting upland localities, typified by lower temperatures, and greater precipitation and vegetation cover, were larger in body size and laid larger clutches with smaller eggs than those in the lowlands. Moreover, reproduction occurred earlier in the year at lower sites and later at higher sites, whereas activity density was highest in the uplands where it increases with temperature. This study first explores the changes in life history patterns along a whole insular altitudinal gradient, and finds interpopulation plasticity. It confirms that environmental factors associated with species spatial distribution act additively as drivers of phenological and phenotypic expression.

The Phenotype of Axial Spondyloarthritis: Is It Dependent on HLA-B27 Status?

OBJECTIVE: To describe the radiographic phenotype of axial spondyloarthritis (SpA) according to the presence of HLA-B27. METHODS: An international collaboration compared the radiographic phenotype of axial SpA according to HLA-B27 status. Patients with ankylosing spondylitis (AS) and axial psoriatic arthritis (PsA) were collected. Radiographs were read centrally, blinded to clinical details. The symmetry of the sacroiliac joints and lumbar syndesmophytes and the morphology of syndesmophytes (typical marginal versus atypical chunky), together with the modified Stoke Ankylosing Spondylitis Spine Score and the Psoriatic Arthritis Spondylitis Radiographic Index, were recorded. RESULTS: A total of 244 patients with PsA and 198 patients with AS were included. In PsA, 60 patients (25%) were HLA-B27 positive while in AS, 148 patients (75%) were HLA-B27 positive. Patients with HLA-B27 were younger and more often male and had a longer duration of disease. In multivariable logistic regression, HLA-B27 was significantly associated with syndesmophyte symmetry (odds ratio [OR] 3.02 [95% confidence interval (95% CI) 1.38, 6.61]) and marginal syndesmophytes (OR 1.97 [95% CI 1.16, 3.36]) but not with sacroiliac symmetry. Mean radiographic scores were higher for patients with HLA-B27. CONCLUSION: Patients with axial SpA who are positive for HLA-B27 have more severe radiographic damage, more marginal syndesmophytes, and more frequent syndesmophyte symmetry compared to patients who are negative for HLA-B27.

When organophosphorus ruthenium complexes covalently bind to ruthenium nanoparticles to form nanoscale hybrid materials.

A hybrid material made of mononuclear organophosphorus polypyridyl ruthenium complexes covalently bonded to ruthenium nanoparticles has been synthesized via a one-pot organometallic procedure and finely characterized. These results open new avenues to access unique hybrid transition metal nanomaterials.

Results and complications of carotid endarterectomy in a hospital from Madrid, Spain.

OBJECTIVE: To study the incidence of cerebrovascular (transient ischemic attacks and stroke) and myocardial events (myocardial infarction) as well as early survival related to carotid endarterectomy. Our secondary aim is to establish possible risk factors associated with complications. METHOD: Retrospective observational case-control study within a cohort. All patients who underwent carotid endarterectomy by the angiology and vascular surgery service at the Hospital Universitario La Paz, in Madrid (Spain), in the period between January 2011 and December 2017 were included. Chi square was used to calculate differences. Kaplan-Meier and Cox regression was used for the survival analysis and patency. RESULTS: 111 procedures were performed on 108 patients, 95 (87,9%) male with an average age of 68.5 ± 8.75. The mean time of follow-up was 2.9 years. There was no 30-day post-surgical mortality, with a 30-day postoperative cerebral vascular event rate of 2.7%. Statistically significant correlation was found between the presence of 30-day postoperative cerebral vascular event and primary closure (p = 0.005) as well as between the smoking habit and 30-day postoperative myocardial infarction (p = 0.036) and restenosis (p = 0.008). In mid-term follow-up, the event rate for cerebral vascular events and myocardial infarction was 1.8%. CONCLUSION: carotid endarterectomy is the procedure of choice in carotid stenosis. The low rates of perioperative mortality, morbidity and complications have been demonstrated.

OBJETIVO: Conocer la incidencia de eventos cerebrovasculares y miocárdicos, y la supervivencia temprana, relacionados con la endarterectomía carotídea, y como objetivo secundario establecer los posibles factores de riesgo asociados a las complicaciones. MÉTODO: Estudio observacional de casos y controles anidado en una cohorte retrospectiva. Se incluyeron todos los pacientes que se sometieron a endarterectomía carotídea en el servicio de angiología y cirugía vascular del Hospital Universitario La Paz, de Madrid (España), en el periodo de enero de 2011 a diciembre de 2017. Para la estimación de diferencias se utilizó la prueba de ji al cuadrado. El análisis de supervivencia y permeabilidad se realizó mediante Kaplan-Meier y regresión de Cox. RESULTADOS: Se realizaron 111 procedimientos en 108 pacientes, 95 (87.9%) de ellos varones, con una edad media de 68.5 ± 8.75 años. La media de seguimiento fue de 2.9 años. No hubo mortalidad posquirúrgica a 30 días, y la tasa global de eventos vasculares cerebrales posoperatorios a 30 días fue del 2.7%. Se encontró asociación entre la presencia de eventos vasculares cerebrales posquirúrgicos a 30 días y el cierre arterial primario (p = 0.005), y del infarto agudo de miocardio posoperatorio a 30 días y la reestenosis carotídea con el hábito tabáquico (p = 0.036 y p = 0.008, respectivamente). En el seguimiento a mediano plazo se encontró una tasa de enfermedad vascular cerebral y de infarto agudo de miocardio del 1,8%. CONCLUSIÓN: La endarterectomía carotídea es el procedimiento de elección en la estenosis carotídea por enfermedad aterosclerótica. En nuestro estudio se demuestran sus bajas tasas de mortalidad, de morbilidad y de complicaciones perioperatorias.

Mechanical and Surface-Chemical Properties of Polymer Derived Ceramic Replica Foams.

Polymer derived ceramic foams were prepared with the replica method using filler free and filler loaded polysiloxane containing slurries for the impregnation of open celled polyurethane foams. A significant change in mechanical strength, porosity and surface energy, i.e., wettability after thermal treatment between 130 °C (crosslinking) and 1000 °C (pyrolysis) in argon atmosphere was observed. While low-temperature pyrolyzed foams are elastic and hydrophobic, foams pyrolyzed at high temperatures are brittle and hydrophilic, and they possess higher compression strength. Changes of these properties were correlated with the polymer-to-ceramic transformation.

Vaginal approach in the repair of vesicovaginal fistula / Abordaje vaginal en la reparación de fístula vesicovaginal

Objective: We present our experience in the vaginal approach to repair of vesicovaginal fistula (VVF) without interposition of flaps in a series of 8 patients. Material and methods: We performed a retrospective descriptive study of patients who underwent surgery between January 2015 and August 2018. Eight patients were diagnosed with VVF and underwent surgical repair. We analyzed age, associated comorbidity, type of surgery performed, time to diagnosis, diagnostic sequence, and classification of the type of fistula. All patients underwent the same procedure. We analyzed operative time, complications, additional procedures, and final outcome. The surgical technique was performed transvaginally by the same surgical team in all 8 cases. Results: We repaired 8 VVFs. Mean age was 49 years. All patients had a simple fistula, with a good prognosis a priori. The fistulas measured between 10 and 15 mm. Time to repair ranged between 2 and 9 months. The average operative time was 123 minutes. There were no major intraoperative complications. The average hospital stay was 1.9 days. The success rate was 94.6% (7/8). One patient had to undergo additional surgery that was not completely successful. No recurrences were observed during a 12-month follow-up. Conclusions: The vaginal approach, without interposition flaps, has proven highly successful for the repair of uncomplicated simple VVFs, with results comparable to other routes of approach. Good preparation of the vaginal mucosa, adherence to the key principles of surgical repair of VVFs, and the experience of the surgeon are important variables that affect the success rate of the procedure

Objetivo: presentar nuestra experiencia en la reparación de las fístulas vesicovaginales mediante abordaje vaginal sin interposición de colgajos, en una serie de ocho pacientes. Material y métodos: estudio descriptivo retrospectivo de los casos intervenidos en el período de tempo comprendido entre enero 2015 a agosto 2018. Se diagnosticaron en nuestro centro un total de ocho pacientes con fístula vesicovaginal (FVV) que se sometieron a reparación quirúrgica. Se analizó la edad, comorbilidad asociada, tipo de cirugía realizada, tiempo de evolución desde la presentación de la clínica hasta el diagnóstico, secuencia diagnóstica y clasificación del tipo de fístula. Se realizó la misma cirugía reparativa para todas las pacientes y se analiza el tiempo quirúrgico, complicaciones, reintervenciones y resultado final. La técnica quirúrgica fue estrictamente reproducida vía transvaginal por el mismo equipo quirúrgico en todos los casos. Resultados: se repararon ocho fístulas vesicovaginales, con una edad media de las pacientes de 49 años. Todas ellas fueron clasificadas como fístula única simple, a priori de buen pronóstico. El tamaño de la fístula se estimó entre 10 mm y 15 mm. El tiempo de fistulización hasta la reparación osciló entre 2 y 9 meses. El tiempo operatorio promedio fue de 123 minutos. No se produjeron complicaciones mayores intraoperatorias. El tiempo de hospitalización promedio fue de 1,9 días. La tasa de éxito fue del 94.6% (7/8), hubo una persistencia que se reintervino sin éxito completo y no se observaron recidivas en un seguimiento de 12 meses. Conclusiones: el abordaje vaginal, sin interposición de colgajo, es un procedimiento con alta tasa de éxito en la reparación de FVV simple no complicada, con resultados equiparables a otras vías de abordaje. La buena preparación de la mucosa vaginal, respetar los principios claves en la reparación quirúrgica de las FVV y la experiencia del cirujano son variables importantes que condicionarán la tasa de éxito

Antimicrobial activity of ceftolozane-tazobactam against multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa clinical isolates from a Spanish hospita / Actividad de ceftolozano-tazobactam en aislados clínicos de Pseudomonas aeruginosa multirresistente y extremadamente resistente en un hospital español

Objectives: Our objective was to evaluate the in vitro activity of ceftolozane-tazobactam against multidrug resistant (MDR) and extensively drug-resistant (XDR) non metallo-ß-lactamase producing Pseudomonas aeruginosa clinical isolates at Hospital Universitario Miguel Servet (Zaragoza, Spain) from February 2016 to October 2017. Material and methods: We evaluated the in vitro activity of ceftolozane-tazobactam and other antipseudomonal antibiotics against 12 MDR and 117 XDR non metallo-ß-lactamase producing P. aeruginosa isolates. Ceftolozane-tazobactam minimal inhibitory concentrations (MICs) were determined by MIC gradient diffusion test strip. Results: Among the 129 MDR/XDR isolates included, 119 (92.2%) were susceptible to ceftolozane-tazobactam, and ten (7.8%) were resistant. MIC50 was 2 mg/L, and MIC90 4 mg/L. Ceftolozane-tazobactam was the second most active antibiotic after colistin, overtaking amikacin. Conclusions: Ceftolozane-tazobactam is a valuable treatment option for MDR and XDR P. aeruginosa infections in our setting

Objetivos: Nuestro objetivo fue evaluar la sensibilidad in vitro de ceftolozano-tazobactam en aislados clínicos de P. aeruginosa multirresistente (MDR) y extremadamente resistente (XDR) desde Febrero de 2016 a Octubre de 2017 en el Hospital Universitario Miguel Servet, Zaragoza (España). Material y métodos: Evaluamos la actividad in vitro de ceftolozano-tazobactam y otros antibióticos anti-pseudomónicos en 12 aislados de P. aeruginosa MDR y en 117 aislados XDR, no productores de metalo-ß-lactamasas. Se determinó la concentración mínima inhibitoria (CMI) de ceftolozano-tazobactam mediante tiras de difusión en gradiente. Resultados: Entre los 129 aislados MDR/XDR incluidos, 119 (92,2%) fueron sensibles a ceftolozano-tazobactam, y diez (7,8%) presentaron resistencia. La CMI50 fue de 2 mg/L, y la CMI90 de 4 mg/L. Ceftolozano-tazobactam fue el segundo antibiótico más activo después de colistina, superando a amikacina. Conclusiones: Ceftolozano-tazobactam es una opción de tratamiento válida para infecciones causadas por P. aeruginosa MDR y XDR en nuestro entorno

Lesiones cutáneas de muy larga evolución / Very long evolution skin injuries

No disponible

Producción de conocimiento en ocio, recreación y tiempo libre en América Latina / Making knowledge in leisure, recreation and free iime in Latin America

El presente artículo, primer resultado parcial de la investigación sobre ocio, recreación y tiempo libre en América Latina desarrollado por un equipo internacional, centra su atención en los diferentes asuntos que constituyen las condiciones de posibilidad generales para la producción de conocimiento en cada uno de los países participantes, es decir, Argentina, Uruguay, Brasil, Ecuador, Venezuela, Colombia Panamá y México. Asuntos como la formación de posgrado, los grupos de investigación, las publicaciones, los eventos, la colaboración entre pares tanto en el nivel nacional como regional, entre otros, son abordados para establecer tales condiciones generales en los diferentes países. Se hace evidente la diversidad de cada uno de los países en relación con el desarrollo de este campo de investigación.

This article, first partial resulted from the research on recent scholar productions about leisure, recreation and free time in Latin America, doing by an international team, draws upon different issues related with social conditions of making knowledge in Argentina, Uruguay, Brazil, Venezuela, Colombia, Panamá and Mexico. Issues as post-graduation, research?s groups, journals, congress and opportunities for scholar collaboration was approached for establishing the social conditions to making knowledge on recreation, leisure and free time in these countries. There is considerable diversity in the development of leisure studies among these countries.

Exclusion of fluoroscopy use in catheter ablation procedures: six years of experience at a single center.

BACKGROUND: Nonfluoroscopic mapping systems have demonstrated significant reduction of radiation exposure in radiofrequency (RF) catheter ablation procedures. However, their use as only imaging guide is still limited. OBJECTIVE: To evaluate the usefulness of a completely nonfluoroscopic approach to catheter ablation of supraventricular arrhythmias using the Ensite-NavX™ electroanatomical navigation system. METHODS: During 6 years, all consecutive patients referred for RF catheter ablation of regular supraventricular tachycardia (SVT) were admitted for a "zero-fluoroscopy" approach and studied prospectively. The only exclusion criterion was the need to perform a transseptal puncture. RESULTS: A total of 340 procedures were performed on 328 patients (179 men, age 55.7 ± 18.6 years). One hundred fifty-three patients had typical atrial flutter (AFL), 146 had AV nodal reentrant tachycardia (AVNRT), 35 had AV reciprocating tachycardia (AVRT), 4 patients had incisional atrial flutter (IAF), and 2 had focal atrial tachycardia (AT). Procedural success was achieved in 337 of the cases (99.1%). In 322 (94.7%), the procedure was completed without any fluoroscopy use. Mean procedure time was 110.5 ± 51.8 minutes. Mean RF application time was 9.8 ± 12.8 minutes and the number of RF lesions was 16.43 ± 15.8. Only 1 major complication related to vascular access was recorded. During follow-up, there were 12 recurrences (3.5%) (8 patients from the AVNRT group, 4 patients from the AP group). CONCLUSION: RF catheter ablation of SVT with an approach completely guided by the NavX system and without use of fluoroscopy is feasible, safe, and effective.

Calidad subjetiva de sueño en pacientes con Trastornos de la Conducta Alimentaria / Subjective quality of sleep in eating disorders patients

El presente estudio se centra en analizar la calidad de sueño de pacientes con trastornos de la conducta alimentaria (TCA). Para ello se compararon las puntuaciones de 13 pacientes con dichos diagnósticos y 15 controles en el Inventario de Calidad de Sueño de Pittsburg (PSQI), la Escala de Somnolencia de Epworth (ESS), la Escala de Creencias y Actitudes Disfuncionales sobre el Sueño (DBAS-18) y un diario de sueño. Se encontraron diferencias significativas con respecto a calidad subjetiva de sueño, consumo de medicación hipnótica y problemas durante el sueño, en los niveles de somnolencia diurna en la ESS y con respecto a creencias disfuncionales sobre el sueño. En conclusión, los pacientes con TCA manifiestan peor calidad de sueño y más problemas de sueño que los controles sanos. Estos resultados ponen de manifiesto la conveniencia de atender a los problemas de sueño en los programas terapéuticos con este tipo de pacientes (AU)

The present research focuses on the analysis of the quality of sleep in eating disorder patients (EDs). For this purpose, scores of 13 EDs patients and 15 controls on the Pittsburg Sleep Quality Inventory (PSQI), the Epworth Somnolence Scale (ESS), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-18) and a sleep diary were compared. Significant differences were found with regard to subjective quality of sleep, hypnotic medication use, and sleep problems in the PSQI; in addition significant differences were shown on daytime sleepiness levels in the ESS, and in relation to several dysfunctional beliefs about the sleep. In conclusion, EDs patients show less quality of sleep and more sleep problems than controls. These results show the need to be aware into to sleep problems in ED therapeutic interventions (AU)

[Rehabilitation in stroke]. / Rehabilitación en el ICTUS.

Stroke is one of the most common causes of death and disability in adults, it causes disability and participation restriction, depending on the location and size of the affected territory and cerebral vascular sequel, and the deficits will be different. Our objective is to improve the disability of patients to enable them to reintegrate fully into his personal life, work and social, and provide care and support to patients and their family. Therefore, it's important to establish a comprehensive care plan, individualized, and established early with a specific rehabilitation program continued, and with an intensity, duration and frequency adapted to the patient, to achieve functional goals raised. The rehabilitative treatment offers a variety of methods and approached from different points of view by the multidisciplinary team that deals with management. The patient and their caregivers are the most important piece of the equipment, so they should receive ongoing information, counseling and psychological support. On the other hand, the discharge should not result in an interruption of the rehabilitation program; we must adequately establish phases and areas for this healthcare. Patients who have suffered a stroke, as well as receiving the best care in the acute phase, should benefit from specific rehabilitation programs in chronic phase, we need to ensure continuity and appropriateness of care for patients and their caregivers, not in a situation of helplessness.

Rehabilitación en el ICTUS / Rehabilitation in stroke

El ictus representa una de las causas más frecuentes de muerte e invalidez en los adultos, produce discapacidad y restricción de la participación; dependiendo de la localización y tamaño del territorio vascular y cerebral afectado las secuelas y los déficits serán diferentes. Nuestro objetivo consistirá en mejorar la discapacidad de los pacientes para que puedan reintegrarse plenamente en su vida personal, laboral y social; y prestar atención y apoyo al paciente y su familia. Por ello, es importante establecer un plan de cuidados integral e individualizado e instaurar de forma precoz un programa específico de rehabilitación continuo, con una intensidad, duración y frecuencia adaptadas al propio paciente para conseguir los objetivos funcionales planteados. El tratamiento rehabilitador ofrece una gran diversidad de métodos y técnicas abordadas desde diferentes puntos de vista por el equipo multidisciplinar que se ocupa de su manejo. El propio paciente y sus cuidadores son la pieza más importante del equipo, por lo que deben recibir continua información, asesoramiento y apoyo psicológico. Por otro lado, el alta hospitalaria no debe suponer una interrupción del programa de rehabilitación, por lo que debemos establecer adecuadamente las fases y los ámbitos de esta asistencia sanitaria. Los pacientes que han sufrido un ictus, además de recibir la mejor atención en la fase aguda, deben beneficiarse de programas de rehabilitación específicos en su fase crónica, por lo que tenemos que asegurar la continuidad y adecuación de los cuidados, para que los pacientes y sus cuidadores no se encuentren en una situación de desamparo(AU)

Stroke is one of the most common causes of death and disability in adults, it causes disability and participation restriction, depending on the location and size of the affected territory and cerebral vascular sequel, and the deficits will be different. Our objective is to improve the disability of patients to enable them to reintegrate fully into his personal life, work and social, and provide care and support to patients and their family. Therefore, it’s important to establish a comprehensive care plan, individualized, and established early with a specific rehabilitation program continued, and with an intensity, duration and frequency adapted to the patient, to achieve functional goals raised. The rehabilitative treatment offers a variety of methods and approached from different points of view by the multidisciplinary team that deals with management. The patient and their caregivers are the most important piece of the equipment, so they should receive ongoing information, counseling and psychological support. On the other hand, the discharge should not result in an interruption of the rehabilitation program; we must adequately establish phases and areas for this healthcare. Patients who have suffered a stroke, as well as receiving the best care in the acute phase, should benefit from specific rehabilitation programs in chronic phase, we need to ensure continuity and appropriateness of care for patients and their caregivers, not in a situation of helplessness(AU)

Glucocorticoides en artritis reumatoide: ¿casi siempre o casi nunca? / Glucocorticoids in rheumatoid arthritis: almost always or hardly ever?

El uso de los glucocorticoides en la artritis reumatoide ha sido objeto de debate en las últimas décadas. Parece existir evidencia probada, en cuanto a su capacidad antiinflamatoria y su poder de disminuir la progresión radiológica, principalmente si se utiliza en artritis reumatoide de inicio reciente. Sin embargo, sigue cuestionándose su uso debido a sus potenciales efectos secundarios, sobre todo cuando se utilizan en altas dosis y/o durante periodos prolongados. En esta revisión, intentaremos resumir la evidencia existente sobre este aspecto desde los inicios, allá por los años cincuenta del siglo xx, hasta las últimas publicaciones (AU)

The use of glucocorticoids in rheumatoid arthritis has been the source of frequent debate in the last decades. There is evidence on its anti-inflammatory capacity and its power to decrease radiologic progression, particularly if used in recent onset rheumatoid arthritis. However, there are still some voices questioning its use. Their arguments are its potential side-effects, especially when the glucocorticoids are used in high doses and/or for extended periods of time. In this review, we will try to summarize the evidence regarding this issue, from the beginning of the discussion in the fifties to the last releases (AU)

[Glucocorticoids in rheumatoid arthritis: almost always or hardly ever?]. / Glucocorticoides en artritis reumatoide: ¿casi siempre o casi nunca?

The use of glucocorticoids in rheumatoid arthritis has been the source of frequent debate in the last decades. There is evidence on its anti-inflammatory capacity and its power to decrease radiologic progression, particularly if used in recent onset rheumatoid arthritis. However, there are still some voices questioning its use. Their arguments are its potential side-effects, especially when the glucocorticoids are used in high doses and/or for extended periods of time. In this review, we will try to summarize the evidence regarding this issue, from the beginning of the discussion in the fifties to the last releases.