[Translated article] Medial gastrocnemius proximal fasciotomy in patients with chronic plantar fasciitis: A systematic review.

INTRODUCTION: Plantar fasciitis is the main cause of heel pain in middle-aged patients. In chronic cases, limited ankle dorsiflexion caused by isolated gastrocnemius contracture is considered the main risk factor for suffering it. Therefore, in recent years the number of patients operated on by proximal fasciotomy of the medial gastrocnemius (FPGM) has increased to treat chronic plantar fasciitis. MATERIAL AND METHODS: Systematic review following the PRISMA guidelines. We have carried out a bibliographic search in Pubmed, Science Direct, Cochrane Library and Web of Science databases. One hundred and eighty-four articles were found. Data extraction was performed using the Covidence software, and a quality and risk of bias analysis of the included articles was performed based on the Cochrane risk of bias Tool 2.0. RESULTS: Three articles were included in the review: two randomised clinical trials and one cohort study with a total of 138 patients. In the analysed studies, patients after proximal fasciotomy of the medial gastrocnemius showed significant improvements in pain and in the AOFAS score with high levels of patient satisfaction. Increases in ankle dorsiflexion angle were found after 12 months of follow-up, with no loss of gastrocnemius strength. The complication rate was low and fewer occurred in the proximal fasciotomy compared to plantar fasciotomy. CONCLUSION: Proximal fasciotomy of the medial gastrocnemius provides clinical benefit in patients with chronic plantar fasciitis, with a low probability of complications and high patient satisfaction.

Red flags for clinical suspicion of eosinophilic granulomatosis with polyangiitis (EGPA).

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA), is a rare ANCA-associated systemic vasculitis. Its overlapping features with other vasculitic or eosinophilic diseases, and the wide and heterogeneous range of clinical manifestations, often result in a delay to diagnosis. OBJECTIVE: To identify red flags that raise a suspicion of EGPA to prompt diagnostic testing and to present an evidence-based clinical checklist tool for use in routine clinical practice. METHODS: Systematic literature review and expert consensus to identify a list of red flags based on clinical judgement. GRADE applied to generate a strength of recommendation for each red flag and to develop a checklist tool. RESULTS: 86 studies were included. 40 red flags were identified as relevant to raise a suspicion of EGPA and assessed by the experts as being clinically significant. Experts agreed that a diagnosis of EGPA should be considered in a patient aged ≥6 years with a blood eosinophil level >1000 cells/µL if untreated and >500 cells/µL if previously treated with any medication likely to have altered the blood eosinophil count. The presence of asthma and/or nasal polyposis should reinforce a suspicion of EGPA. Red flags of asthma, lung infiltrates, pericarditis, cardiomyopathy, polyneuropathy, biopsy with inflammatory eosinophilic infiltrates, palpable purpura, digital ischaemia and ANCA positivity, usually anti-myeloperoxidase, among others, were identified. CONCLUSION: The identification of a comprehensive set of red flags could be used to raise a suspicion of EGPA in patients with eosinophilia, providing clinicians with an evidence-based checklist tool that can be integrated into their practice.

Advancing ocular safety research: A comprehensive examination of benzocaine acute exposure without animal testing.

Benzocaine is a widely employed local anaesthetic; however, there is a notable dearth of preclinical and clinical evidence regarding its safety in ophthalmological products. To address this, a comprehensive strategy incorporating in silico and in vitro methodologies was proposed for assessing benzocaine's ocular toxicity without animal testing. To collect the in silico evidence, the QSAR Toolbox (v4.5) was used. A single exposure to two benzocaine concentrations (2% and 20%) was evaluated by in vitro methods. Hen's Egg Chorioallantoic Membrane Test (HET-CAM) was performed to evaluate the effects on the conjunctiva. To study corneal integrity, Short Time Exposure test (STE) and Bovine Corneal Opacity and Permeability (BCOP) assay, followed by histopathological analysis, were carried out. Results from both in silico and in vitro methodologies categorize benzocaine as non-irritating. The histopathological analysis further affirms the safety of using benzocaine in eye drops, as no alterations were observed in evaluated corneal strata. This research proposes a useful combined strategy to provide evidence on the safety of local anaesthetics and particularly show that 2% and 20% benzocaine solutions do not induce eye irritation or corneal damage, supporting the potential use of benzocaine in the development of ophthalmic anesthetic products.

Aplicación de la telemedicina en la asistencia a pacientes con cefaleas: situación actual y recomendaciones del Grupo de Estudio de Cefaleas de la Sociedad Española de / NeurologíaTelemedicine in the management of patients with headache: current situation and recommendations of the Spanish Society of Neurology's Headache Study Group

Introducción: La pandemia COVID-19 ha provocado un inusitado impulso a la telemedicina(TM). Analizamos el impacto de la pandemia en la TM aplicada en las consultas de cefaleasespañolas, revisamos la literatura y lanzamos unas recomendaciones para implantar la TM enlas consultas. Método: Tres fases: 1) Revisión de la base Medline desde el año 1958 (primera experienciade TM); 2) Formulario Google Forms enviado a todos los neurólogos del Grupo de Estudio de Cefaleas de la Sociedad Espa˜nola de Neurología (GECSEN), y 3) Consenso on-line de expertosGECSEN para emitir recomendaciones para implantar la TM en España. Resultados: La pandemia por COVID-19 ha empeorado los tiempos de espera presenciales,incrementando el uso de todas las modalidades de TM antes y después de abril de 2020: teléfonofijo (del 75% al 97%), teléfono móvil (del 9% al 27%), correo electrónico (del 30% al 36%) yvideoconsulta (del 3% al 21%). Los neurólogos son conscientes de la necesidad de ampliar laoferta con videoconsultas, claramente in crescendo, y otras herramientas de e-health y m-health. Conclusiones: Desde el GECSEN recomendamos y animamos a todos los neurólogos que asis-ten a pacientes con cefaleas a implantar recursos de TM, teniendo como objetivo óptimo lavideoconsulta en menores de 60-65 a˜nos y la llamada telefónica en mayores, si bien cada casodebe individualizarse. Se deberá contar previamente con la aprobación y asesoramiento de losservicios jurídicos e informáticos y de la dirección del centro. La mayoría de los pacientes concefalea y/o neuralgia estable son candidatos a seguimiento mediante TM, tras una primeravisita que tiene que ser siempre presencial.(AU)

Introduction: The COVID-19 pandemic has caused an unexpected boost to telemedicine. Weanalyse the impact of the pandemic on telemedicine applied in Spanish headache consultations,review the literature, and issue recommendations for the implementation of telemedicine inconsultations. Method: The study comprised 3 phases: 1) review of the MEDLINE database since 1958 (firstreported experience with telemedicine); 2) Google Forms survey sent to all members of theSpanish Society of Neurology’s Headache Study Group (GECSEN); and 3) online consensus ofGECSEN experts to issue recommendations for the implementation of telemedicine in Spain.Results: COVID-19 has increased waiting times for face-to-face consultations, increasing theuse of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after),mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3%to 21%). Neurologists are aware of the need to expand the availability of video consultations,which are clearly growing, and other e-health and m-health tools. Conclusions: The GECSEN recommends and encourages all neurologists who assist patients withheadaches to implement telemedicine resources, with the optimal objective of offering videoconsultation to patients under 60-65 years of age and telephone calls to older patients, althougheach case must be considered on an individual basis. Prior approval and advice must be soughtfrom legal and IT services and the centre’s management. Most patients with stable headacheand/or neuralgia are eligible for telemedicine follow-up, after a first consultation that mustalways be held in person.(AU)

Impacto de las nuevas tecnologías en la neurología en España. Revisión del Comité Ad-Hoc de Nuevas Tecnologías de la Sociedad Española de Neurología / Impact of new technologies on neurology in Spain. Review by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology

Introducción: Las nuevas tecnologías (NT) están cada vez más presentes en el ámbito biomédico. Utilizando la definición de consenso de NT del Comité Ad-Hoc de Nuevas Tecnologías de la Sociedad Española de Neurología (SEN), se evalúa su impacto en la neurología española a través de las comunicaciones de las reuniones anuales de la SEN. Material y métodos: Se define el concepto de NT en neurología como una tecnología novedosa o aplicación de una tecnología anterior, caracterizada por un cierto grado de coherencia persistente en el tiempo, con potencial de tener impacto en el presente y futuro de la neurología. Se plantea un estudio descriptivo tomando como fuente las comunicaciones de las reuniones de la SEN desde 2012 hasta 2018 y analizando los tipos de NT empleadas, la subespecialidad, así como su distribución territorial. Resultados: De las 8.139 comunicaciones presentadas, 299 estaban relacionadas con NT (3,7%), incluyendo 120 pósteres y 179 comunicaciones orales, variando desde el 1,6% en 2012 hasta el 6,8% en 2018. Los tipos de tecnología mayormente representados fueron neuroimagen avanzada (24,7%), biosensores (17,1%), electrofisiología y neuroestimulación (14,7%) y telemedicina (13,7%). Las áreas neurológicas con mayor empleo de NT fueron trastornos del movimiento (18,4%), enfermedades cerebrovasculares (15,7%) y demencias (13,4%). Madrid fue la comunidad que presentó más comunicaciones (32,8%), seguida por Cataluña (26,8%) y Andalucía (9,0%). Conclusiones: Las comunicaciones sobre NT siguen una tendencia creciente. El número de NT empleadas ha ido aumentando de manera paralela a la disponibilidad tecnológica. Se encontraron comunicaciones en todas las subespecialidades neurológicas, con una distribución geográfica heterogénea.(AU)

Introduction: New technologies (NT) are increasingly widespread in biomedicine. Using the consensus definition of NT established by the New Technologies Ad-Hoc Committee of the Spanish Society of Neurology (SEN), we evaluated the impact of these technologies on Spanish neurology, based on communications presented at Annual Meetings of the SEN. Material and methods: We defined the concept of NT in neurology as a novel technology or novel application of an existing technology, characterised by a certain degree of coherence persisting over time, with the potential to have an impact on the present and/or future of neurology. We conducted a descriptive study of scientific communications presented at the SEN's annual meetings from 2012 to 2018, analysing the type of NT, the field of neurology, and the geographical provenance of the studies. Results: We identified 299 communications related with NT from a total of 8,139 (3.7%), including 120 posters and 179 oral communications, ranging from 1.6% of all communications in 2012 to 6.8% in 2018. The technologies most commonly addressed were advanced neuroimaging (24.7%), biosensors (17.1%), electrophysiology and neurostimulation (14.7%), and telemedicine (13.7%). The neurological fields where NT were most widely employed were movement disorders (18.4%), cerebrovascular diseases (15.7%), and dementia (13.4%). Madrid was the region presenting the highest number of communications related to NT (32.8%), followed by Catalonia (26.8%) and Andalusia (9.0%). Conclusions: The number of communications addressing NT follows an upward trend. The number of NT used in neurology has increased in parallel with their availability. We found scientific communications in all neurological subspecialties, with a heterogeneous geographical distribution.(AU)

Íleo biliar como causa e obstrucción intestinal / Gallstone ileus as a cause of intestinal obstruction

Introducción. Comunicar un caso clínico poco habitual y revisar el manejo. Material y Métodos. Presentación de un caso clínicoResultados. El íleo biliar es una etiología poco habitual de obstrucción intestinal, aunque su incidencia aumenta con la edad. Sudiagnóstico requiere una alta sospecha clínica ya que menos del 50% de los pacientes tienen clínica biliar previa. La cirugía urgentees mandatoria para la resolución del cuadro obstructivo. Conclusiones. La resucitación del paciente y la extracción quirúrgicaurgente del cálculo biliar es el tratamiento de elección. Existe controversia sobre el manejo de la fístula colecistoduodenal. (AU)

Introduction. Report an unusual clinical case and review the management. Material and methods. Presentation of a clinical case.Results. Gallstone ileus is an unusual etiology of intestinal obstruction, although its incidence increases with age. Its diagnosisrequires a high clinical suspicion since less than 50% of patients have previous biliary symptoms. Urgent surgery is mandatory forthe resolution of the obstructive condition. Conclusions. Patient resuscitation and urgent surgical removal of the gallstone is thetreatment of choice. There is controversy about the management of cholecystoduodenal fistula. (AU)

Open Emergent Groin Hernia Repair: Anterior or Posterior Approach?

Introduction: The current literature has not yet provided a definitive conclusion on the best emergency groin hernia repair. The aim of this study was first to compare the short and long-term outcomes between open preperitoneal and anterior approach in emergency groin hernia repair and second to identify risk factors for postoperative complications, mortality, and recurrence. Materials and Methods: This retrospective cohort study included patients who underwent emergency groin hernia repair between January 2010 and December 2018. Short and long-term outcomes were analyzed comparing approach and repair techniques. The predictors of complications and mortality were investigated using multivariate logistic regression. Cox regression multivariate analysis were used to explore risk factors of recurrence. Results: A total of 316 patients met the inclusion criteria. The most widely used surgical techniques were open preperitoneal mesh repair (34%) and mesh plug (34%), followed by Lichtenstein (19%), plug and patch (7%) and tissue repair (6%). Open preperitoneal mesh repair was associated with lower rates of recurrence (p = 0.02) and associated laparotomies (p < 0.001). Complication and 90-day mortality rate was similar between the techniques. Multivariable analysis identified patients aged 75 years or older (OR, 2.08; 95% CI, 1.14-3.80; p = 0.016) and preoperative bowel obstruction (OR, 2.11; 95% CI, 1.20-3.70; p = 0.010) as risk factors for complications and Comprehensive Complication Index ≥26.2 as risk factor for 90-day mortality (OR, 44.76; 95% CI, 4.51-444.59; p = 0.01). Female gender was the only risk factor for recurrence. Conclusion: Open preperitoneal mesh repair may be superior to other techniques in the emergency setting, because it can avoid the morbidity of associated laparotomies, with a lower long-term recurrence rate.

Interacción con pantalla táctil de smartphone en pacientes con temblor esencial y sujetos sanos / Interaction with touchscreen smartphones in patients with essential tremor and healthy individuals

Introducción: El uso de smartphones en investigación biomédica está creciendo rápidamente en diferentes entornos clínicos. Realizamos un estudio piloto para obtener información sobre el uso de smartphones en pacientes con temblor esencial (TE) y en sujetos sanos, con el objetivo de evaluar si la realización de diversas tareas con las pantallas táctiles difiere entre grupos y describir factores de esta interacción.MétodoSe administró un cuestionario sobre el uso de smartphones a 31 pacientes con TE y 40 sujetos control apareados por edad y sexo. Acto seguido, los participantes interactuaron con una aplicación Android en desarrollo y realizaron 4 test basados en diferentes modos de interacción típicos con pantallas táctiles, con 5 repeticiones de cada tarea.ResultadoLos tipos de uso de smartphones así como su interacción no fueron significativamente diferentes entre pacientes y controles. La edad y el número de usos del smartphone son factores clave en esta interacción con pantallas táctiles.ConclusiónEstas observaciones apoyan el uso de las pantallas táctiles de los smartphones para investigación en TE, pero se requieren más estudios. (AU)

Introduction: Smartphones use in biomedical research is becoming more prevalent in different clinical settings. We performed a pilot study to obtain information on smartphone use by patients with essential tremor (ET) and healthy controls, with a view to determining whether performance of touchscreen tasks is different between these groups and describing touchscreen interaction factors.MethodA total of 31 patients with ET and 40 sex- and age-matched healthy controls completed a descriptive questionnaire about the use of smartphones. Participants subsequently interacted with an under-development Android application, and performed 4 tests evaluating typical touchscreen interaction gestures; each test was performed 5 times.ResultThe type of smartphone use and touchscreen interaction were not significantly different between patients and controls. Age and frequency of smartphone use are key factors in touchscreen interaction.ConclusionOur results support the use of smartphone touchscreens for research into ET, although further studies are required. (AU)

Tratamiento mediante neurólisis ecoguiada con fenol 6 % acuoso del componente álgico por neuromas postamputación: a propósito de un caso / Treatment by ultrasound-guided neurolysis with 6 % aqueous phenol of the pain component for post-amputation neuromas: report of a clinical case

Introducción: El tratamiento del dolor producido por neuromas es en sí complejo. Las opciones de tratamiento una vez se ha descartado la vía quirúrgica son pocas, si bien el impacto que dicho dolor produce en la vida de los pacientes obliga a buscar en estos casos alternativas que ofrezcan un control aceptable del mismo. El objetivo es presentar la neurólisis como una alternativa eficaz para el dolor por neuromas. Caso clínico: Reporte de caso, descriptivo y retrospectivo, de paciente perteneciente al Sistema Nacional de Salud, llevado a cabo por la Unidad de Dolor del Servicio de Anestesiología y Reanimación del Hospital Universitario Joan XXIII.Paciente de 59 años a quien, tras rechazar la cirugía, se le realizó neurólisis ecoguiada con fenol al 6 % acuososo para el tratamiento del dolor por neuromas derivados de la amputación de ambos miembros superiores. Discusión: La infiltración con fenol 6 % acuoso puede llegar a disminuir considerablemente el dolor durante un tiempo igual o superior a los 6 meses, otorgando una mejoría significativa en la calidad de vida de los pacientes.(AU)

Introduction: Magement of pain caused by neuromas is in itself complex. The treatment options once the surgical route has been ruled out are few, although the impact that this pain produces in the lives of patients makes it necessary to look for alternative cases that offer acceptable control of it. The objective is to present neurolysis as an effective alternative for pain due to neuromas. Case report: Descriptive and retrospective case report of a patient belonging to the National Health System, carried out by the Pain Unit of the Anesthesiology and Resuscitation Service of the Hospital Universitario Joan XXIII. 59-year-old patient who, after refusing surgery, underwent ultrasound-guided neurolysis with 6 % aqueous phenol for the treatment of pain due to neuromas derived from the amputation of both upper limbs. Discusion: Infiltration with 6 % aqueous phenol can considerably reduce pain, for a time equal to or greater than 6 months, granting a significant improvement in the quality of life of patients.(AU)

COVID-19 asociada a nistagmo / COVID-19 presenting with nystagmus

Presentamos el caso de una mujer de 20años que se encontraba en el norte de Italia cuando se decretó el estado de alarma el 31 de enero de 2020 y volvió a España. A los 15 días de su regreso presentó un cuadro respiratorio de vías altas con fiebre, cefalea y anosmia que fue tratado como una sinusitis y a las 3semanas comenzó con sensación de mareo y un nistagmo horizontal en ambos ojos con componente rotatorio. La exploración otorrinolaringológica y neurológica con resonancia magnética fueron normales. Las pruebas serológicas para COVID-19 dieron un resultado positivo para anticuerpos IgG. En el contexto actual de pandemia, los síntomas y signos en esta paciente asociados a un test serológico IgG positivo nos permite considerar como causa del nistagmo adquirido la infección por SARS-CoV-2 (AU)

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus (AU)

[COVID-19 presenting with nystagmus]. / COVID-19 asociada a nistagmo.

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15 days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus.

Reivindicando la validez del oftalmólogo general. Homenaje al Dr. Li Wenliang (1986-2020) / Vindicating the general ophthalmologist. Tribute to Dr. Li Wenliang (1986-2020)

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Lesión duodeno-ureteral compleja por herida de arma de fuego: diagnóstico y resolución quirúrgica / COMPLEX DUODENAL-URETERAL LESION DUE TO FIREARM INJURY, DIAGNOSIS AND SURGICAL RESOLUTION

Las lesiones traumáticas duodenales son infrecuentes pero producen una tasa de morbi-mortalidad significativa. Se debe tener presente la elevada frecuencia de lesiones asociadas, siendo las de uréter superior las más frecuentes. Masculino de 50 años ingresa por HAF paravertebral derecha. Al ingreso OTE, lucido, vigil, con dolor y defensa abdominal generalizada. En la TC toracobdominal con cte EV y VO se objetiva extravasación de contraste oral a nivel duodenal y en fase excretora renal derecha.Se decide Laparotomía de urgencia objetivando lesión transfixiante de 2da porción de duodeno de < 50% de su circunferencia y sección de uréter derecho proximal. Se realiza rafia en dos planos de duodeno, colocación de pig tail y anastomosis T-T de uréter derecho mas drenaje. Buena evolución postquirúrgica con control tomográfico a las 72 hs sin objetivar fuga. Alta hospitalaria al 6to día. El traumatismo duodenal es una patología rara que se asocia con una tasa considerable de morbimortalidad, su localización retroperitoneal puede hacer que los clásicos signos de peritonismo no estén presentes en el momento de la evaluación, por lo que se recomienda la realización de exámenes clínicos seriados y de estudios complementarios con contraste VO y EV. Las lesiones ureterales asociadas son las más frecuentes. La mayoría tienen una pérdida mínima de tejido, siendo usualmente reparadas mediante desbridación y anastomosis.

Duodenal traumatic injuries are rare but produce a significant morbidity and mortality rate. The high frequency of associated lesions should be kept in mind, with those of the upper ureter being the most frequent. 50-year-old male enters for right paravertebral HAF. At hospital admission, lucid patient and vigil. Thoracoabdominal CT with intravenous and oral contrast show extravasation of oral contrast at the duodenal level and in the right renal excretory phase. Emergency laparotomy is decided by objectifying transfixing lesion of the 2nd portion of the duodenum of <50% of its circumference and proximal right ureter section. Raffia is performed in two planes of the duodenum, placement of pig tail and TT anastomosis of the right ureter plus drainage. Good post-surgical evolution with tomographic control at 72 hours without objectifying leakage. Hospital discharge on the 6th day. Duodenal trauma is a rare pathology that is associated with a considerable morbidity and mortality rate, its retroperitoneal location may make the classic signs of peritonism not present at the time of the evaluation, so clinical exams are recommended series and complementary studies with VO and EV contrast. Associated ureteral lesions are the most frequent, Most have minimal tissue loss, usually repaired by debridement and anastomosis.

COVID-19 asociada a nistagmo / COVID-19 presenting with nystagmus

Presentamos el caso de una mujer de 20 años que se encontraba en el norte de Italia cuando se decretó el estado de alarma el 31 de enero de 2020 y volvió a España. A los 15 días de su regreso presentó un cuadro respiratorio de vías altas con fiebre, cefalea y anosmia que fue tratado como una sinusitis y a las 3semanas comenzó con sensación de mareo y un nistagmo horizontal en ambos ojos con componente rotatorio. La exploración otorrinolaringológica y neurológica con resonancia magnética fueron normales. Las pruebas serológicas para COVID-19 dieron un resultado positivo para anticuerpos IgG. En el contexto actual de pandemia, los síntomas y signos en esta paciente asociados a un test serológico IgG positivo nos permite considerar como causa del nistagmo adquirido la infección por SARS-CoV-2

This case reports a 20-year-old female patient who was in northern Italy when the state of emergency was declared on the 31st of January 2020, developing 15days after return to Spain upper respiratory symptoms characterized by fever, headache and anosmia that was treated as sinusitis. Three weeks later presented with dizziness and an intermittent horizontal nystagmus with rotatory component. Otorhinolaryngology and neurological examination including MRI were normal. COVID-19 IgG antibodies where positive. In the context of the ongoing pandemic, and associating the symptoms with positive IgG antibodies, we can consider the infection of SARS-CoV-2 as a probable cause of the acquired nystagmus

Evaluación de la actualización de los criterios STOPP-START en atención primaria / Updated report on STOPP-START criteria in Primary Care

Introducción: El objetivo de este trabajo es averiguar la prevalencia de prescripción potencialmente inapropiada (PPI) en población mayor de 64 años en Avilés, Asturias. Material y métodos: Estudio descriptivo transversal multicéntrico en seis centros de salud. Se seleccionó una muestra de 400 personas obtenida por muestreo aleatorio proporcional a la población adscrita a cada centro de salud. Se revisaron las historias clínicas informatizadas y se aplicaron los criterios STOPP-START (versión 2014 con 114 ítems) para evaluar la PPI. Resultados: Se estudiaron 378 (95,5%) pacientes, con una media de edad de 75,4 años (DE: 7,4) y una proporción de 57,7% mujeres. El 94,2% (IC95%:91,7-96,7) presentaban alguna PPI. Atendiendo solo a los criterios STOPP un 52,4% (IC95%:47,2-57,6) de pacientes presentaba al menos un incumplimiento y en los START un 90,5% (IC95%:87,4-93,6) que se reducía a 40,5% (IC95%: 36,4-45,6) si se eliminaban los criterios referidos a vacunaciones. Entre los criterios STOPP, la PPI más frecuente fue la toma de benzodiacepinas seguido del uso de medicamentos sin indicación basada en la evidencia; entre los START fueron la vacunación antineumocócica y la ausencia de la toma de suplementos de vitamina D y calcio en osteoporosis. Conclusiones: Nivel elevado de PPI, muy superior al resultante en la versión previa especialmente para los criterios START. Existe un elevado nivel de PPI en relación con el uso de benzodicepinas y el empleo de medicamentos sin evidencia clínica. Los criterios STOPP-START son útiles en atención primaria para evaluar la PPI

Introduction: The aim of this study is to determine the rate of potentially inappropriate prescriptions (PIP) in people older than 64 years of age in Avilés, Asturias, Spain. Materials and methods: A descriptive cross-sectional study was conducted in six Health Care Centres. A sample of 400 people was selected, obtained by a random sampling proportional to the population registered in each Health Centre. A review was made of the computerised clinical records, and the STOPP-START (version 2014 with 114 items) criteria were applied to evaluate the PIP. Results: The study contained 378 (95.5%) patients with a mean age of 75.4 (SD: 7.4) and of which 57.7% were women. Almost all (94.2%: 95% CI; 91.7-96.7) met some PIP criteria. Taking only the STOPP criteria into consideration, 52.4% (95%CI: 47.2-57.6) met at least one breach, and in the START criteria a 90.5% (95%CI; 87.4-93.6), which was reduced to 40.5% (95%CI; 36.4-45.6) if criteria on vaccination were removed. In the STOPP criteria, the most frequent PIP was taking benzodiazepines followed by the use of medication without indications based on the evidence; in the START, the criteria was the anti-pneumococcus vaccination, and the lack of taking vitamin D supplements and calcium in osteoporosis. Conclusions: There were high levels of PIP, very superior to the previous version, especially for the START criteria. There is a high level of PIP related to the use of benzodiazepines and the use of medication without any clinic evidence. The STOPP-START criteria are useful in Primary Care to assess the PIP

General recommendations paper on the management of older patients with cancer: the SEOM geriatric oncology task force’s position statement

Population aging is associated with greater numbers of older people with cancer. Thanks to treatment advances, not only are more seniors diagnosed with cancer, but there are also more and more older cancer survivors. This upward trend will continue. Given the heterogeneity of aging, managing older patients with cancer poses a significant challenge for Medical Oncology. In Spain, a Geriatric Oncology Task Force has been set up within the framework of the Spanish Society for Medical Oncology (SEOM). With the aim of generating evidence and raising awareness, as well as helping medical oncologists in their training with respect to seniors with cancer, we have put together a series of basic management recommendations for this population. Many of the patients who are assessed in routine clinical practice in Oncology are older. CGA is the basic tool by means of which to evaluate older people with cancer and to understand their needs. Training and the correct use of recommendations regarding treatment for comorbidities and geriatric syndromes, support care, and drug-drug interactions and toxicities, including those of antineoplastic agents, as detailed in this article, will ensure that this population is properly managed

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La regla nemotécnica POUNDing en el diagnóstico de pacientes con migraña / The mnemonic POUNDing rule in the diagnosis of patients with migraine

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Geriatric oncology in Spain: survey results and analysis of the current situation

Introduction: Geriatric oncology (GO) is a discipline that focuses on the management of elderly patients with cancer. The Spanish Society of Medical Oncology (SEOM) created a Working group dedicated to geriatric oncology in February 2016. Objectives: The main goal of this study was to describe the current situation in Spain regarding the management of elderly cancer patients through an online survey of medical oncologists. Methods: A descriptive survey was sent to several hospitals by means of the SEOM website. A personal e-mail was also sent to SEOM members. Results: Between March 2016 and April 2017, 154 answers were collected. Only 74 centers (48%) had a geriatrics department and a mere 21 (14%) medical oncology departments had a person dedicated to GO. The vast majority (n = 135; 88%) had the perception that the number of elderly patients with cancer seen in clinical practice had increased. Eighteen (12%) oncologists had specific protocols and geriatric scales were used at 55 (31%) centers. Almost all (92%) claimed to apply special management practices using specific tools. There was agreement that GO afforded certain potential advantages. Finally, 99% of the oncologists surveyed believed it and that training in GO had to be improved. Conclusions: From the nationwide survey promoted by the Spanish Geriatric Oncology Working Group on behalf of SEOM, we conclude that there is currently no defined care structure for elderly cancer patients. There is an increasing perception of the need for training in GO. This survey reflects a reality in which specific needs are perceived

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Síndrome de Pisa agudo tras tratamiento con betahistina en un paciente con deterioro cognitivo leve / Acute Pisa syndrome secondary to betahistine treatment in a patient with mild cognitive impairment

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Bloqueantes neuromusculares en el manejo de la vía aérea difícil / Neuromuscular blockade in the management of the difficult airway

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