Blunted Pain Modulation Response to Induced Stress in Women with Fibromyalgia with and without Posttraumatic Stress Disorder Comorbidity: New Evidence of Hypo-Reactivity to Stress in Fibromyalgia?

There is evidence regarding the presence of alterations in both the stress response and the endogenous pain modulation systems of people with fibromyalgia (FM). However, research on pain modulation under induced stress on FM patients is scarce and contradictory. The present study analyzes stress-induced changes in pain and intolerance thresholds among FM patients, examining the possible existence of differences linked to PTSD comorbidity and gaining insights into the role of cardiovascular reactivity. Eighteen women diagnosed with FM and comorbid PTSD (FM + PTSD), 18 women diagnosed with FM and no PTSD (FM-PTSD), and 38 healthy women (HC) were exposed to the Social Stress Test task. Pressure pain thresholds and intolerance thresholds were measured before and during stress induction, and after a recovery period, while systolic blood pressure and heart rate were simultaneously recorded. Overall, while pain thresholds decreased during stress and recovery for HC, no significant changes were observed for women with FM. The intolerance threshold decreased for HC during stress, but was maintained at basal level during recovery. FM-PTSD women exhibited a delayed response, with a drop at recovery. For FM + PTSD, tolerance levels remained unchanged. In addition, cardiovascular reactivity did not seem to explain these results. This performance of the pain modulation system seems to follow the same pattern of hypoactive responsiveness under stressors that has previously been observed in FM patients on the autonomic and neuroendocrine axes. Such a hypoactive pattern may involve a non-adaptive response that may contribute to the development and maintenance of chronic pain.

[Adherence to healthy lifestyle behaviours in patients with type 2 diabetes in Spain]. / Adherencia a un estilo de vida saludable en pacientes con diabetes mellitus tipo 2 en España.

OBJECTIVES: The aim of this study was to report on the main lifestyle components and related factors in adults with diabetes type 2 treated in Primary Care clinics in Spain. MATERIAL AND METHODS: A cross-sectional and multicentre study was performed on a consecutive sample of patients with type 2 diabetes attending 25 Primary Care clinics between April 2018 and April 2019. Data were collected by auditing the computerised medical records, and an interview. An analysis was carried out on adherence to 4 healthy lifestyle trends (Mediterranean diet, regular exercise, not smoking, and emotional well-being). RESULTS: A total of 412 patients were included in the analysis (mean age 69 (SD 8.65) years; 50.2% men). Only a minority was highly adherent to the Mediterranean diet, 92 (22.3%). Regular physical activity was carried out by 189 (45.8%). A total of 361 (87.6%) were non-smoking, and 259 (62.8%) felt emotional well-being. A small number (9, 2.1%) of patients had not followed any of the healthy lifestyle recommendations, with 87 (21.1%) following one, 145 (35.1%) two, 128 (31%) three, and 43 (10.4%) all 4 healthy habits: diet, exercise, not smoking, and emotional well-being. Healthy lifestyle adherence was related to gender. Obesity is poorly associated with adherence to diet and physical activity. The results for age, time with the disease, socioeconomic status, and treatment regimen were not consistent. CONCLUSIONS: This study suggest that adherence to a healthy lifestyle pattern in DM2 is low. Less than a quarter follow a healthy diet, and less than a half practice regular exercise. Gender is the variable that most influences a healthy lifestyle in DM2, but not age, time with the disease, or treatment regimen.

Manejo de la diabetes mellitus tipo 2 en adolescentes y adultos jóvenes en atención primaria / Management of type 2 diabetes mellitus in adolescents and young adults in primary care

La prevalencia de la diabetes tipo 2 diagnosticada en la infancia/juventud está aumentando y se caracteriza por una disminución acelerada de la función de las células beta pancreáticas y resistencia a la insulina. Los principales factores de riesgo para su desarrollo son obesidad e inactividad física. Los criterios diagnósticos son similares a los utilizados en adultos, aunque la HbA1c como método diagnóstico está cuestionada. Las complicaciones son más agresivas que en la diabetes tipo 2 del adulto, siendo la nefropatía la más frecuente. Las complicaciones macrovasculares aparecen precozmente y su mortalidad es elevada. La alimentación saludable y el ejercicio físico continuado son los pilares básicos del tratamiento, y la metformina, insulina y liraglutide (aprobado por la FDA en Estados Unidos) las opciones farmacológicas con indicación en esta población. Es importante establecer modelos de transición de la atención pediátrica a la atención adulta para garantizar la continuidad asistencial y evitar pérdidas en el seguimiento de estos pacientes

The prevalence of type 2 diabetes (DM2) diagnosed in childhood and adolescence is currently increasing, and is characterised by a rapidly progressive decline in beta-cells and insulin resistance. Physical inactivity and obesity are the main risk factors for its development. Diagnostic criteria are similar to those used in adults, although HbA1c as a diagnostic method is questioned. Diabetes-related complications are more aggressive than in adults. Diabetic nephropathy is the most frequent complication in the young population and macrovascular complications appear early, leading to high mortality rates. Healthy lifestyles are the basis of the treatment, and metformin, insulin and liraglutide (approved by FDA for its use in the United States) are the pharmacological options indicated in this population. It is important to establish models of health care transition from paediatric to adult care to ensure continuity of care and avoid patient disengagements

[Management of type 2 diabetes mellitus in adolescents and young adults in primary care]. / Manejo de la diabetes mellitus tipo 2 en adolescentes y adultos jóvenes en atención primaria.

The prevalence of type 2 diabetes (DM2) diagnosed in childhood and adolescence is currently increasing, and is characterised by a rapidly progressive decline in beta-cells and insulin resistance. Physical inactivity and obesity are the main risk factors for its development. Diagnostic criteria are similar to those used in adults, although HbA1c as a diagnostic method is questioned. Diabetes-related complications are more aggressive than in adults. Diabetic nephropathy is the most frequent complication in the young population and macrovascular complications appear early, leading to high mortality rates. Healthy lifestyles are the basis of the treatment, and metformin, insulin and liraglutide (approved by FDA for its use in the United States) are the pharmacological options indicated in this population. It is important to establish models of health care transition from paediatric to adult care to ensure continuity of care and avoid patient disengagements.

Characteristics of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) from the ARIAM-SEMICYUC registry: development of a score for predicting MINOCA.

BACKGROUND: Acute myocardial infarction (AMI) with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA), has a prevalence of up to 14%. The various causes of MINOCA lead to damage of the myocardium, and there are marked differences in diagnoses, prognoses, and treatments. Although the number of patients affected is considerable owing to the high prevalence of acute coronary syndrome (ACS), the causes of MINOCA have received little attention with the result that some patients may not receive appropriate treatment. Awareness of this disease among clinicians has started only to improve since the beginning of the current century. The aim of this study was to develop a score that enables patients with MINOCA to be distinguished from patients with MI with coronary artery disease (MI-CAD) and thus to facilitate appropriate diagnosis and therapy. PATIENTS AND METHODS: A multicenter observational cohort study was designed. All patients aged ≥18 years from the ARIAM-SEMICYUC (Analysis of Delay in AMI-Spanish Society of Intensive Care Medicine and Coronary Unit) registry, diagnosed with AMI, and admitted to critical care units or coronary care units (CCUs) were included. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, comprising patients with lesions of the coronary artery tree. RESULTS: A score based on standard variables to assess the probability of MINOCA on admission was designed, showing a maximum value corresponding to a 40% probability of MINOCA. The discriminative power of the model was 0.756 (P-value for the Hosmer-Lemeshow test was >0.05). At 30-day follow-up, the mortality rate was higher for MI-CAD patients. CONCLUSION: Patients with MINOCA constitute a population that differs from other patients with AMI. Their differential characteristics require a certain diagnostic effort to align therapy with the disease causing the ischemic event. This score could prove useful in establishing additional diagnostic procedures.

Impacto de la inercia terapéutica y del grado de adherencia al tratamiento en los objetivos de control en personas con diabetes / The impact of therapeutic inertia and the degree of the medication adherence on the control goals for patients with diabetes

Objetivo: El objetivo de este estudio fue analizar el impacto de la baja adherencia terapéutica (AT) y la inercia terapéutica de los profesionales (IT) sobre el mal control glucémico y de los factores de riesgo cardiovasculares en personas con DM2. Material y métodos: Estudio transversal realizado en atención primaria. Se incluyeron 320 personas con DM2. Se valoró si cumplían los objetivos de control (HbA1c≤7%, PA≤130/80mmHg, LDL≤100mg/dl). Se consideró falta de AT la retirada de farmacia <80% de las recetas prescritas e IT la no modificación del tratamiento en personas mal controladas. Resultados: Presentaron buen control de HbA1c, PA y cLDL el 62,5, el 40,9 y el 35,9%, respectivamente. Las personas mal controladas presentaron cifras de AT menores y la IT no se relacionó con la AT. En sujetos mal controlados para HbA1c, presentaban IT el 25,8%, el 24,8% mala AT y el 11,9% estaban afectados por ambos comportamientos. Para cLDL, el 3,6% presentaban mala AT, el 70,4% IT y el 16,0% mala AT e IT (p<0,001). Respecto a la PA, el 3,5% tenían mala AT, el 54,6% IT y el 21,5% presentaban mala AT e IT (p<0,01). Conclusiones: La falta de AT y la IT han estado implicadas en un porcentaje elevado de personas con DM2 mal controladas. La IT ha resultado de gran relevancia en el presente estudio

Objective: The purpose of this study was to analyse both the impact of low therapeutic adherence (TA) and therapeutic inertia (TI) on poor blood glucose control and on risk factors for heart disease in patients with DM2. Material and methods: A cross-sectional study was conducted in a Primary Halth Care centre. A total of 320 patients with DM2 were included and an assessment was made of control goals (HbA1c≤7%, blood pressure ≤130/80mmHg, and LDL-cholesterol≤100mg/dl). A pharmacy retrieval <80% was considered as a lack of TA and the non-modification of treatment in badly controlled patient as TI. Results: The percentage of patients with good control of HbA1c, blood pressure and LDL-cholesterol was 62.5%, 40.9%, and 35.9%, respectively. Lower figures of TA were present in poorly controlled patients, and TI was not found to be related to TA. In the patients with poor HbA1c control, 25.8% had TI, 24.8% poor TA, and 11.9% had both of them. As regards LDL-cholesterol, 3.6% presented poor TA, 70.4% showed TI, and 16% with poor TA and TI (P<.001). As for blood pressure, 3.5% of patients had poor TA, 54.6% had TI, and 21.5% of them had poor TA as well as TI (P<.01). Conclusions: Lack of therapeutic adherence and therapeutic inertia were found in a high percentage of poorly-controlled DM2 patients with bad control. Therapeutic inertia was found to be of great relevance in this study

[The impact of therapeutic inertia and the degree of the medication adherence on the control goals for patients with diabetes]. / Impacto de la inercia terapéutica y del grado de adherencia al tratamiento en los objetivos de control en personas con diabetes.

OBJECTIVE: The purpose of this study was to analyse both the impact of low therapeutic adherence (TA) and therapeutic inertia (TI) on poor blood glucose control and on risk factors for heart disease in patients with DM2. MATERIAL AND METHODS: A cross-sectional study was conducted in a Primary Halth Care centre. A total of 320 patients with DM2 were included and an assessment was made of control goals (HbA1c≤7%, blood pressure ≤130/80mmHg, and LDL-cholesterol≤100mg/dl). A pharmacy retrieval <80% was considered as a lack of TA and the non-modification of treatment in badly controlled patient as TI. RESULTS: The percentage of patients with good control of HbA1c, blood pressure and LDL-cholesterol was 62.5%, 40.9%, and 35.9%, respectively. Lower figures of TA were present in poorly controlled patients, and TI was not found to be related to TA. In the patients with poor HbA1c control, 25.8% had TI, 24.8% poor TA, and 11.9% had both of them. As regards LDL-cholesterol, 3.6% presented poor TA, 70.4% showed TI, and 16% with poor TA and TI (P<.001). As for blood pressure, 3.5% of patients had poor TA, 54.6% had TI, and 21.5% of them had poor TA as well as TI (P<.01). CONCLUSIONS: Lack of therapeutic adherence and therapeutic inertia were found in a high percentage of poorly-controlled DM2 patients with bad control. Therapeutic inertia was found to be of great relevance in this study.

Diabetes mellitus: cuando las complicaciones preceden a la enfermedad / Diabetes mellitus: when the complications precede the disease

No disponible

Papel predictor de la rumiación y el mindfulness rasgo en el dolor y el estado de ánimo negativo tras una lesión deportiva: un estudio longitudinal / Predictor role of rumination and trait-mindfulness in pain and negative mood after a sports injury: a longitudinal study

Introducción: La actividad deportiva habitual puede ayudar a mantener una buena calidad de vida, aportando bienestar físico y emocional. No obstante, si dicha práctica no se lleva a cabo de manera adecuada, puede conllevar riesgos para la salud, como la producción de lesiones físicas. Una vez producida, la lesión puede conllevar dolor y alteraciones emocionales. Sin embargo, los factores psicológicos que influyen en su aparición son muy poco conocidos. Objetivo: El presente estudio se centró en analizar el papel predictor del estilo rumiativo y el mindfulness rasgo en el dolor experimentado y en los cambios en el estado de ánimo del deportista tras una lesión deportiva. Material y método: Se realizó un estudio longitudinal en el que se evaluó a 15 deportistas, mayores de edad, que habían sufrido una lesión moderada en los tres días anteriores al inicio del estudio. Todos ellos cumplimentaron una batería de cuestionarios de autoinforme en dos momentos temporales: a los tres días de producirse la lesión y una semana más tarde. Asimismo, durante toda la semana, cumplimentaron un diario de dolor en el que reflejaron la intensidad mínima, máxima y media diaria. Las variables dependientes evaluadas fueron: intensidad de dolor, ansiedad y sintomatología depresiva. Como variables independientes se evaluaron el estilo rumiativo, la rumiación sobre la lesión y el mindfulness rasgo. Resultados: Los análisis de regresión lineal efectuados mostraron un efecto significativo de la rumiación sobre la lesión sobre la intensidad de dolor y la ansiedad sufrida diez días después de la lesión. La depresión fue predicha únicamente por la propia depresión medida en un primer momento, y el mindfulness rasgo quedó fuera de todas las ecuaciones. Conclusiones: Los procesos rumiativos sobre la lesión aumentan las posibilidades de aparición de un estado negativo postlesión, principalmente los síntomas de ansiedad, y predicen la intensidad de dolor experimentada durante los 10 días posteriores. Por tanto, sería recomendable realizar intervenciones que disminuyeran o modificaran tales procesos de manera inmediata a la lesión, con el fin de disminuir la ansiedad y el dolor postlesión (AU)

Introduction: Daily sporting activity helps us to maintain a good quality of life, and physical and emotional well-being. However, if this practice is not carried out properly, can pose risks to health, such as physical injuries. When it occurs, the injury can lead to pain and emotional disturbances. The psychological factors that influence their occurrence are little known. Objective: This study focused on analyzing the predictive role of ruminative style and trait mindfulness in pain intensity and changes in mood after a sport injury. Method and equipment: We selected 15 athletes with a moderate sport injury, produced three days ago. They filled a battery of self-report questionnaires in two temporal moments: three days after the injury and a week later. Also, they completed, for a week, a pain diary in which reflected the average daily, minimum and maximum. As dependent variables were evaluated: pain intensity, anxiety and depressive symptoms. As independent variables: ruminative style, rumination about the injury and trait-mindfulness. Results: The data analysis was performed using linear regression, finding that rumination about the injury was predictor of pain intensity during the week after injury, and of anxiety level suffered ten days after the injury. Conclusions: The ruminative processes about the injury increase the chances of occurrence of a negative state after injury, mainly anxiety symptoms, and predict the intensity of pain experienced after sport injury. It would therefore be advisable to perform interventions that would reduce or modify such processes immediately to the injury in order to reduce anxiety and pain post injury (AU)

Recomendaciones de buena práctica en el tratamiento de la dislipemia en la diabetes / Consensus document on the treatment of dyslipidemia in diabetes

Las personas con diabetes mellitus tipo 2 tienen un riesgo de desarrollar enfermedad cardiovascular de 2 a 4 veces superior al observado en la población general de similar edad y sexo. Este riesgo se mantiene después de ajustar para otros factores clásicos de riesgo cardiovascular. La dislipidemia asociada a la diabetes mellitus tipo 2 se encuentra presente en hasta un 60% de las personas con diabetes y contribuye en gran medida al incremento de riesgo cardiovascular y de morbimortalidad que presentan estos pacientes. La dislipidemia diabética es una alteración del metabolismo lipídico que se caracteriza por un exceso de triglicéridos, un déficit del colesterol HDL y una alteración de la composición de las lipoproteínas que consiste sobre todo en un exceso de partículas LDL pequeñas y densas. Múltiples ensayos clínicos han demostrado los beneficios del tratamiento farmacológico de la dislipidemia (principalmente estatinas), para prevenir eventos cardiovasculares y mortalidad en personas con diabetes tanto en prevención primaria como secundaria. El presente documento de consenso elaborado por médicos de familia, integrantes del Grupo de Diabetes de la Sociedad Española de Médicos de Atención Primaria (SEMERGEN), pretende servir de ayuda en el manejo de las personas con diabetes y dislipidemia a la vista de las recomendaciones más actualizadas (AU)

People with type 2 diabetes mellitus have a 2 to 4 times higher risk of developing cardiovascular diseases when compared to general population of similar age and sex. This risk remains after adjustment of other traditional cardiovascular risk factors. The dyslipidemia associated with type 2 diabetes mellitus is present in up to 60% of people with diabetes and contributes greatly to increased cardiovascular, morbidity and mortality risk in these patients. Diabetic dyslipidemia is a disorder of lipid metabolism characterized by an excess of triglycerides, a decrease in HDL-cholesterol and altered lipoprotein composition, consisting mainly in an excess of small, dense LDL particles. Multiple clinical trials have demonstrated the benefits of drug treatment of dyslipidemia (mainly statins) to prevent cardiovascular events and mortality in people with diabetes, both in primary and secondary prevention. This consensus document, developed by general practitioners, members of the Diabetes Group of the Spanish Society of Primary Care Physicians (SEMERGEN), aims to assist in the management of patients with diabetes and dyslipidemia in accordance with the most recent recommendations (AU)

[Consensus document on the treatment of dyslipidemia in diabetes]. / Recomendaciones de buena práctica en el tratamiento de la dislipemia en la diabetes.

People with type 2 diabetes mellitus have a 2 to 4 times higher risk of developing cardiovascular diseases when compared to general population of similar age and sex. This risk remains after adjustment of other traditional cardiovascular risk factors. The dyslipidemia associated with type 2 diabetes mellitus is present in up to 60% of people with diabetes and contributes greatly to increased cardiovascular, morbidity and mortality risk in these patients. Diabetic dyslipidemia is a disorder of lipid metabolism characterized by an excess of triglycerides, a decrease in HDL-cholesterol and altered lipoprotein composition, consisting mainly in an excess of small, dense LDL particles. Multiple clinical trials have demonstrated the benefits of drug treatment of dyslipidemia (mainly statins) to prevent cardiovascular events and mortality in people with diabetes, both in primary and secondary prevention. This consensus document, developed by general practitioners, members of the Diabetes Group of the Spanish Society of Primary Care Physicians (SEMERGEN), aims to assist in the management of patients with diabetes and dyslipidemia in accordance with the most recent recommendations.

Aplicación de un programa de intervención psicológica en personas mayores con dolor crónico en el ámbito residencial / Older people with chronic pain in nursing homes: application of a psychological intervention

Objetivo: Aplicar y evaluar el impacto de un programa de tratamiento psicológico grupal destinado a personas mayores con dolor crónico articular que viven en residencias. Pacientes y método: El grupo de intervención contó con 53 participantes y el grupo control, con formato de mínimo contacto terapéutico, con 48 participantes. La intervención constó de nueve sesiones. Las técnicas de tratamiento fueron las propias de la Terapia de Aceptación y Compromiso y el entrenamiento en estrategias de selección, compensación y optimización. Resultados: Hallamos cambios significativos en la cualidad y frecuencia del dolor, selección de actividades, aceptación del dolor y depresión. Con un nivel del 96% hubo cambios en la capacidad de movilidad y en la interferencia del dolor. Todos los indicadores de satisfacción y calidad de la implementación fueron elevados. Conclusión: El tratamiento psicológico que combine la Terapia de Aceptación y Compromiso con el entrenamiento en estrategias de selección, optimización y compensación puede resultar de utilidad para mejorar la funcionalidad y el bienestar emocional de las personas mayores con dolor asociado a artrosis (AU)

Objective: The purpose of this study was the implementation and evaluation of a group psychological treatment for older people with chronic pain living in nursing homes. Patients and methods: The intervention group had 53 participants and the control group, with minimal therapist contact format, had 48 participants. The intervention consisted of nine sessions. Treatment techniques were typical of Acceptance and Commitment Therapy and selection, compensation and optimization strategy training. Results: Assuming a confidence level of 95%, significant changes in the quality and frequency of pain, range of activities, acceptance of pain and depression was found. Data showed significant changes in the capacity of mobility and pain interference. All indicators of satisfaction and quality of implementation were high. Conclusion: A group program that combines psychological treatment under acceptance and commitment therapy to training in screening strategies, optimization and compensation can be useful to improve the functionality and emotional wellbeing of older people with pain associated with osteoarthritis (AU)

Desarrollo de una herramienta de comunicación para la seguridad del paciente (Briefing). Experiencia en una unidad de cuidados intensivos de trauma y emergencias / Development of communication tool for patient safety (

Objetivo: Validar una herramienta de seguridad utilizada en sectores de alto riesgo (briefing de seguridad) en la medicina intensiva. Diseño: Estudio prospectivo, observacional y analítico. Ámbito: UCI de Trauma y Emergencias de un hospital terciario. Pacientes: Pacientes con trauma grave (Injury Severity Score-ISS>16). Intervención: Recogida de incidentes, relacionados con la seguridad del paciente (SP). Variables: Características de la población, estado de la unidad, incidentes de SP, aspectos de la herramienta e impacto sobre la cultura de seguridad. Resultados: Se incluyeron 441 pacientes (edad media 39,9±17,5 años), 75,15% hombres, 89% con trauma cerrado y un 10,5% de mortalidad. La herramienta se aplicó en 586 turnos de 798 posibles (73,4%) y se recogieron 942 incidentes (2,20 incidentes por paciente). Los incidentes más frecuentes se relacionaron con la medicación (20,7%), los dispositivos (colocación 4,03% y mantenimiento 17,8%) y la vía aérea y la ventilación mecánica (VM) (17,09%). Se estableció una correlación entre la presencia de incidentes y las características del enfermo (mayor Injury Severity Score, presencia de VM y terapias de reemplazo renal continuo) y con el estado de la unidad (más de 6 pacientes por turno sobre 8 posibles y el periodo vacacional). La herramienta influyó en diferentes aspectos de la cultura de seguridad de la unidad de manera significativa (frecuencia de comunicación, número de eventos, pérdida de carácter punitivo y trabajo de manera activa en SP). Conclusiones: El briefing es una herramienta para la recogida de los incidentes, simple, fácil de usar, útil para implantar mejoras e influir en la cultura de seguridad (AU)

Objective: To validate a safety tool used in high-risk sectors (safety briefing) in intensive care medicine. Design: A prospective, observational and analytical study was carried out. Setting: Trauma and emergency intensive care unit in a tertiary hospital. Patients: Patients with severe trauma (Injury Severity Score ISS>16). Intervention: Documentation of incidents related to patient safety (PS). Variables: Patients characteristics, state of the Unit, patient safety incidents, aspects of the tool (SP) and safety culture impact. Results: We included 441 patients (75.15% males, mean age 39.9±17.5 years), with blunt trauma in 89% and a 10.5% mortality rate. The tool was applied in 586 out of 798 possible shifts (73.4%), and documented 942 events (2.20 incidents per patient). The incidents were more frequently associated with medication (20.7%), devices (placement 4.03%, and maintenance 17.8%) and airway and mechanical ventilation (MV) (17.09%). A correlation was established between the occurrence of incidents and the characteristics of the patient (higher Injury Severity Score, presence of MV, and continuous renal replacement therapies) and the status of the Unit (more than 6 patients per shift out of 8 possible, and holiday period). The tool significantly influenced different aspects of the safety culture of the unit (communication frequency, number of events, punitive loss and active work in PS). Conclusions: Safety briefing is a tool for the documentation of incidents that is simple and easy to use, and is useful for implementing improvements and in influencing safety culture (AU)

Enfermedad de Lyme. ¿Es tan infrecuente? / Lyme disease. Is it so uncommon?

La enfermedad de Lyme, producida por Borrelia burgdorferi sensu lato, es una enfermedad multisistémica que puede cursar con manifestaciones reumáticas, dermatológicas, neurológicas y cardíacas. Su lesión más típica es el eritema migratorio, aunque no siempre está presente. El diagnóstico se basa en la clínica apoyada en la serología, y en jóvenes o adultos el tratamiento casi siempre es la tetraciclina. En niños y mujeres embarazadas se utiliza la amoxicilina, y en presencia de manifestaciones neurológicas, las cefalosporinas. El pronóstico, con tratamiento adecuado, es bueno. En cambio, si no se trata precozmente, pueden aparecer afectaciones crónicas, fundamentalmente neurológicas, que llegan a ser invalidantes. En España, donde la incidencia de la enfermedad es baja, después de una picadura de garrapata no está indicada la profilaxis con antimicrobianos (AU)

Lyme disease, caused by Borrelia burgdorferi sensu lato, is a multisystem disease that may occur with rheumatic, dermatological, neurological symptoms and heart diseases. Its most typical lesion is erythema migrans, although not always present. The clinical diagnosis is supported by serology, and treatment is almost always tetracycline in young people and adults. Amoxicillin is most often used in children and pregnant women, and cephalosporins in the presence of neurological signs. The prognosis, with the appropriate treatment, is good. But if not treated promptly, there may be chronic signs, particularly, neurological, which may be disabling. In Spain, where the incidence is low, antimicrobial prophylaxis is indicated the after a tick bite (AU)

[Development of communication tool for patient safety ("Briefing"). Experience in a trauma and emergency intensive care unit]. / Desarrollo de una herramienta de comunicación para la seguridad del paciente (Briefing). Experiencia en una unidad de cuidados intensivos de trauma y emergencias.

OBJECTIVE: To validate a safety tool used in high-risk sectors (safety briefing) in intensive care medicine. DESIGN: A prospective, observational and analytical study was carried out. SETTING: Trauma and emergency intensive care unit in a tertiary hospital. PATIENTS: Patients with severe trauma (Injury Severity Score ISS≥16). INTERVENTION: Documentation of incidents related to patient safety (PS). VARIABLES: Patients characteristics, state of the Unit, patient safety incidents, aspects of the tool (SP) and safety culture impact. RESULTS: We included 441 patients (75.15% males, mean age 39.9±17.5 years), with blunt trauma in 89% and a 10.5% mortality rate. The tool was applied in 586 out of 798 possible shifts (73.4%), and documented 942 events (2.20 incidents per patient). The incidents were more frequently associated with medication (20.7%), devices (placement 4.03%, and maintenance 17.8%) and airway and mechanical ventilation (MV) (17.09%). A correlation was established between the occurrence of incidents and the characteristics of the patient (higher Injury Severity Score, presence of MV, and continuous renal replacement therapies) and the status of the Unit (more than 6 patients per shift out of 8 possible, and holiday period). The tool significantly influenced different aspects of the safety culture of the unit (communication frequency, number of events, punitive loss and active work in PS). CONCLUSIONS: Safety briefing is a tool for the documentation of incidents that is simple and easy to use, and is useful for implementing improvements and in influencing safety culture.

[Lyme disease. Is it so uncommon?]. / Enfermedad de Lyme. ¿Es tan infrecuente?

Lyme disease, caused by Borrelia burgdorferi sensu lato, is a multisystem disease that may occur with rheumatic, dermatological, neurological symptoms and heart diseases. Its most typical lesion is erythema migrans, although not always present. The clinical diagnosis is supported by serology, and treatment is almost always tetracycline in young people and adults. Amoxicillin is most often used in children and pregnant women, and cephalosporins in the presence of neurological signs. The prognosis, with the appropriate treatment, is good. But if not treated promptly, there may be chronic signs, particularly, neurological, which may be disabling. In Spain, where the incidence is low, antimicrobial prophylaxis is indicated the after a tick bite.

Escalas predictivas de transfusión masiva en trauma. Experiencia de un registro de transfusiones / Massive transfusion predictive scores in trauma. Experience of a transfusion registry

Objetivo: Valorar la utilidad de diferentes escalas previamente descritas, en la predicción de transfusión masiva (TM) con un registro de transfusiones en trauma grave. Diseño: Estudio retrospectivo de cohortes. Ámbito: Unidad de Cuidados Intensivos de Trauma de un hospital terciario. Pacientes: Se incluyeron pacientes adultos con trauma grave (Injury Severity Score >15), admitidos desde octubre de 2006 hasta julio de 2009.Intervención: Ninguna. Variables: Se evaluaron las siguientes escalas y puntos de corte (PC): Trauma Associated Severe Haemorrhage (TASH) PC: ≥ 16 y ≥ 18; Assessment Blood Consumption (ABC) PC: ≥ 2 y Emergency Transfusion Score (ETS) PC: ≥ 3, ≥ 4 y ≥ 6. TM fue definida como la transfusión de 10 o más unidades de concentrados de hematíes (CH) en las primeras 24 horas del ingreso. Estudiamosla sensibilidad (S), especificidad (E), valor predictivo positivo y negativo (VPP y VPN), razones de verosimilitud positiva y negativa (RVP y RVN) y las curvas receiver-operating characteristics (ROC) y el área bajo las mismas (AUROC).Resultados: Se estudiaron 568 pacientes, el 77,6% hombres, con una edad media de 41,16 ± 18 años e ISS de 30 ± 13. El 93,8% con trauma cerrado. La frecuencia global de TM fue del 18,8%. La mejor S se obtuvo para el ETS ≥ 3 y la mejor especificidad con el TASH ≥ 18. El AUROC para los diferentes escalas fue: ABC: 0,779, ETS: 0,784 y el TASH: 0,889.Conclusiones: Estas escalas pueden ser útiles para caracterizar la población con TM, la exclusión de población de bajo riesgo, intentar ser objetivos en la resucitación con control de daños y apoyar las decisiones clínicas, con pocos datos y fáciles de obtener. (AU)

Objectives: Our purpose is to validate previously described massive transfusion (MT) scoring in our Transfusion Trauma Registry. Design: A retrospective cohort of adult trauma patients. Setting: Trauma and Emergency Intensive Care Unit of a tertiary hospital. Patients: Patients with severe trauma (injury severity score > 15) admitted from October 2006to July 2009.Interventions: None. Variables: The following MT scoring and cutoff points (CP) were evaluated: Trauma-Associated Severe Hemorrhage (TASH) CP: ≥ 16 and ≥ 18; Assessment Blood Consumption (ABC) CP: ≥ 2and Emergency Transfusion Score (ETS) CP: ≥ 3, ≥ 4, ≥ 6. MT was defined as the transfusion of10 units or more of packed red blood cells in the first 24 hours. We studied the sensivity (S),specifity (SP), and positive and negative predictive values (PPV, NPV), the positive and negative likehood ratios (LHR +, LHR-) and area under the receiver operating characteristic curve (ROC).Results: A total of 568 patients were available for analysis; 77.6% were men, with a mean age of 41.16 ± 18 years and an ISS of 30 ± 13. 93.8% with blunt trauma. The overall MT rate was18.8%. The best S was obtained with ETS ≥3 and best SP was obtained with TASH ≥18. ROC for different scores was: ABC: 0.779, ETS: 0. 784, TASH: 0.889.Conclusion: These scales can be useful for characterizing the TM population, for excluding low risk populations, and for attempting to be objective in hematological damage control and in supporting clinical decisions, based on fe1w and easily obtainable data (AU)

[Massive transfusion predictive scores in trauma. Experience of a transfusion registry]. / Escalas predictivas de transfusión masiva en trauma. Experiencia de un registro de transfusiones.

OBJECTIVES: Our purpose is to validate previously described massive transfusion (MT) scoring in our Transfusion Trauma Registry. DESIGN: A retrospective cohort of adult trauma patients. SETTING: Trauma and Emergency Intensive Care Unit of a tertiary hospital. PATIENTS: Patients with severe trauma (injury severity score>15) admitted from October 2006 to July 2009. INTERVENTIONS: None. VARIABLES: The following MT scoring and cutoff points (CP) were evaluated: Trauma-Associated Severe Hemorrhage (TASH) CP: ≥16 and ≥18; Assessment Blood Consumption (ABC) CP: ≥2 and Emergency Transfusion Score (ETS) CP: ≥3, ≥4, ≥6. MT was defined as the transfusion of 10 units or more of packed red blood cells in the first 24 hours. We studied the sensivity (S), specifity (SP), and positive and negative predictive values (PPV, NPV), the positive and negative likehood ratios (LHR +, LHR-) and area under the receiver operating characteristic curve (ROC). RESULTS: A total of 568 patients were available for analysis; 77.6% were men, with a mean age of 41.16 ± 18 years and an ISS of 30 ± 13. 93.8% with blunt trauma. The overall MT rate was 18.8%. The best S was obtained with ETS ≥3 and best SP was obtained with TASH ≥18. ROC for different scores was: ABC: 0.779, ETS: 0. 784, TASH: 0.889. CONCLUSION: These scales can be useful for characterizing the TM population, for excluding low-risk populations, and for attempting to be objective in hematological damage control and in supporting clinical decisions, based on fe1w and easily obtainable data.