Occupational Therapy Task Observation Scale (OTTOS) and Comprehensive Occupational Therapy Evaluation Scale (CO-TES): Italian translation, adaptation, and validation.

Background: In literature there is a lack of specific evaluation tools for behavior in intellectual disabilities in general and during an activity, this is one of the most important field of the Occupational Therapy intervention. Objective: Authors developed an Italian version of the Occupational Therapy Task Observation Scale (OTTOS) and an Italian version of the Comprehensive Occupational Therapy Evaluation Scale (COTES) and examined their reliability and validity. Methods: The original scales were translated from English to Italian using the "Translation and Cultural Adaptation of Patient Reported Outcomes Measures-Principles of Good Practice" guidelines. Both scales were administered to adults with mild and moderate intellectual disabilities. People under eighteen years, with severe and profound intellectual disabilities and deaf people were excluded from the study. Their reliability and validity have been examined. Relia-bility was analyzed via internal consistency (Cronbach's alpha) and stability (intra/inter-rater coefficient), while validity was investigated via construct validity (p-value) and criterion validity using Pearson's correlation coefficients between them and with the Mini Mental State Examination and the Barthel Index Scale. Results: The OTTOS and the COTES were administered to 30 subjects. Cronbach's α for the COTES was 0,91 and Cronbach's α for the OTTOS was 0,92. Regarding the criterion of validity, the two scales have numerous statistically positive correlations, particularly with the Mini Mental State Examination in the Orientation and total part. Furthermore, the correlation with the Barthel scale is present in the total scores, the COTES's third subscale, and the OTTOS's first. Conclusions: The OTTOS and the COTES were reliable and valid outcome measures for assessing behavior in the Italian population.

Nitrous oxide versus lidocaine versus no analgesic for in-office hysteroscopy: a randomised clinical trial.

OBJECTIVE: To compare the effect of inhaled nitrous oxide (INO) on pain control during in-office hysteroscopy with 1% lidocaine paracervical infiltration and no analgesic. DESIGN: Single-blind stratified randomised clinical trial with masked assessment by a third party. SETTING: Department of Obstetrics and Gynaecology in a Spanish hospital. POPULATION: Women who underwent hysteroscopy. METHODS: Patients were stratified into three groups according to the purpose of the hysteroscopy (biopsy, polypectomy or tubal sterilisation) and then assigned to different treatment groups through a permuted-blocks randomisation within strata. Pain scale was provided by a gynaecologist totally blinded to procedures and treatments. Effects were assessed using a one-way analysis of variance following an intention-to-treat approach. MAIN OUTCOME MEASURES: Visual analogue scale (VAS) from 0 to 100 mm. RESULTS: A total of 314 women were included: 105 to INO, 104 to 1% lidocaine and 105 to no analgesic. Baseline characteristics were comparable. Mean VAS score after the procedure was 34.7 ± 25.8 mm, 36.1 ± 22.9 mm (P = 1.0) and 47.3 ± 28.2 mm (P = 0.001) for INO, 1% lidocaine and no analgesic, respectively. No adverse events were reported in 91 (86.7%) patients in the INO group compared with 79 (76%) in the 1%-lidocaine group (P = 0.04) and 85 (81%) in the no-analgesic group (P = 0.26). CONCLUSION: INO was as effective as 1% lidocaine in pain control for in-office hysteroscopy and was better tolerated. The no-analgesic group presented the poorer results, so was the least recommended clinical option.

[Diagnosis of atherogenic dyslipidaemia by primary care physicians in Spain]. / Diagnóstico de la dislipidemia aterogénica por los médicos de atención primaria en España.

OBJECTIVE: To describe the diagnostic management of patients with atherogenic dyslipidaemia (AD) by primary care physicians (PC). METHODOLOGY: An observational, descriptive, cross-sectional study was conducted based on a structured questionnaire. The content of the questionnaire was based on a review of the literature, and was validated by 3 AD experts. It included 23 questions, and was addressed to primary care physicians (PC). This sub-study will analyse questions related to the detection and diagnosis of AD. RESULTS: A total of 1,029 PC participated in the study. Almost all (96.99%) said that DA is a determining factor for cardiovascular risk (CVR), even with LDL-C targets. Residual CVR was evaluated by 88.43% in their clinical practice, but only 27.89% in secondary prevention. Most of the PCs used LDL-c-non-HDL-c (55.49% vs 20.02%) in AD as a control objective, and 15.35% used TG, and 9.14% HDL-C. For the diagnosis of AD, 82.22% used TC, TG, HDL-C, and non-HDL-C. PC physicians used the TC / HDL-C atherogenic ratio (53.06%) and LDL-C / HDL-C ratio (49.56%), considering them useful / very useful (86.30% and 85.04%, respectively), with only 28.08% using the TG / HDL-C index, with 69.29% considering it useful / very useful. CONCLUSIONS: The PCs have a high level of knowledge of the guidelines. Underdiagnosis continues, with heterogeneity in determining objectives, and low use of the TG / HDL-C index to evaluate these patients. Greater awareness is needed for the detection and diagnosis of AD.

[Early treatment of idiopathic vasculitis, aneurysms and neuroretinitis (IRVAN). A case report]. / Tratamiento precoz de vasculitis idiopática, aneurismas y retinitis (IRVAN). A propósito de un caso.

CASE REPORT: A 55 year old woman presented with retinal vasculitis, multiple aneurysms, macular exudation and widespread retinal nonperfusion and was diagnosed with IRVAN. She was treated with panretinal laser photocoagulation. After 3 years of follow up visual acuity remains stable and there are no complications due to ischaemic sequelae. DISCUSSION: IRVAN syndrome with neovascularisation can progress rapidly despite laser treatment. Panretinal laser photocoagulation has to be considered in the early stages as it is effective in stopping the progression of ischaemia.

[Clinical and functional outcome of unicompartmental knee arthroplasty: influence of the mechanical axis correction]. / Valoración clínico funcional tras artroplastia unicompartimental de rodilla. Influencia de la corrección del eje mecánico.

OBJECTIVES: Clinical and functional outcome of the knee after Unicompartmental Knee Arthroplasty (UKA) and its correlation with lower limb mechanical axis correction. MATERIAL AND METHODS: We have reviewed the outcome of 29 UKA, corresponding to 29 patients, with an average follow-up of 4.5 years (3-6 years). The distribution was, 21 women and 8 men, 11 unicompartmental osteoarthritis, 17 femoral condyle necrosis and 1 tibial plateau necrosis, and 27 medial versus 2 lateral affected compartments. The clinical-functional situation of the knees was assessed through the Knee Society Score (KSS), and the mechanical axis through long standing film. To calculate the statistical non-parametric correlation between the different parameters, Spearman's coefficient was used. RESULTS: In the last review, the increases in the mean clinical KSS and functional KSS were significantly different, with +31.24 (±15.7) and +43.66 (±18.4) points, respectively. The mean change in the femorotibial angle was 2°±4°. We did not find any correlation with statistical significance between the average increases obtained in KS scores and: the alignment of the knee before and after the surgery; the thickness of the inserted polyethylene; the variation of the posterior tibial inclination; Insall-Salvati's index. There was no statistically significant association between the variation in the total KS score and the type of implant or the surgical technique used. CONCLUSION: We did not find any correlation between the clinical results and the radiological measurements in this population.

Valoración clínico funcional tras artroplastia unicompartimental de rodilla. Influencia de la corrección del eje mecánico / Clinical and functional outcome of unicompartmental knee arthroplasty: influence of the mechanical axis correction

Objetivos. Valoración clínica y funcional de la rodilla tras artroplastia unicompartimental de rodilla (AUR) y su relación con la corrección del eje mecánico del miembro inferior y otros parámetros quirúrgicos. Material y métodos. Hemos revisado la evolución de 29 AUR en 29 pacientes, con un seguimiento medio de 4,5 años (3-6 años). La distribución fue de 21 mujeres por 8 varones, 11 gonartrosis unicompartimentales postmeniscectomía por 17 necrosis condíleas femorales y 1 necrosis tibial, 27 AUR mediales y dos laterales. Se evaluó el estado clínico-funcional de las rodillas intervenidas mediante el índice de la sociedad americana de rodilla (KSS) y los ejes mediante radiografía en carga y se calculó su correlación estadística. Resultados. En el último control, la ganancia fue estadísticamente significativa, en los índices KSS clínico (31,24±15,7) y en KSS funcional (43,66±18,4) puntos. La corrección media del ángulo femorotibial fue de 2°±4°. No se encontró asociación significativa entre la variación en el KSS y el grado de alineación de la rodilla pre y postoperatorio, el grosor del polietileno elegido, la variación de la caída posterior tibial, el índice de Insall-Salvati ni el implante o técnica empleada. Conclusiones. Se observa la mejora clínica y funcional sin correlación con la corrección angular u otros parámetros quirúrgicos en esta serie (AU)

Objectives. Clinical and functional outcome of the knee after Unicompartmental Knee Arthroplasty (UKA) and its correlation with lower limb mechanical axis correction. Material and methods. We have reviewed the outcome of 29 UKA, corresponding to 29 patients, with an average follow-up of 4.5 years (3-6 years). The distribution was, 21 women and 8 men, 11 unicompartmental osteoarthritis, 17 femoral condyle necrosis and 1 tibial plateau necrosis, and 27 medial versus 2 lateral affected compartments. The clinical-functional situation of the knees was assessed through the Knee Society Score (KSS), and the mechanical axis through long standing film. To calculate the statistical non-parametric correlation between the different parameters, Spearman‘s coefficient was used. Results. In the last review, the increases in the mean clinical KSS and functional KSS were significantly different, with +31.24 (±15.7) and +43.66 (±18.4) points, respectively. The mean change in the femorotibial angle was 2°±4°. We did not find any correlation with statistical significance between the average increases obtained in KS scores and: the alignment of the knee before and after the surgery; the thickness of the inserted polyethylene; the variation of the posterior tibial inclination; Insall-Salvati‘s index. There was no statistically significant association between the variation in the total KS score and the type of implant or the surgical technique used. Conclusion. We did not find any correlation between the clinical results and the radiological measurements in this population (AU)

The patellar thinning osteotomy in patellofemoral arthritis: four to 18 years' follow-up.

Isolated patellofemoral osteoarthritis can be a disabling disease. When conservative treatment fails, surgical options can be unpredictable and may be considered too aggressive for middle-aged and active people. We analysed the clinical and radiological results of a new coronal osteotomy involving thinning of the patella in a selected group of patients with isolated patellofemoral osteoarthritis. Since 1991, 31 patients (35 knees) have been treated, of whom 34 were available for follow-up at a mean of 9.1 years. The Knee Society Score, the Patellar score and the Short-form-36 questionnaire were used for clinical evaluation. We also examined the radiological features to confirm bone consolidation and assess the progression of osteoarthritis. A significant improvement in the functional scores and radiological parameters was noted. All patients except one were satisfied with the operation. Radiological progression of the patellofemoral osteoarthritis was slowed but radiological femorotibial osteoarthritis progressed in 23 (65%) cases, with a total knee replacement becoming necessary in four cases without technical problems in resurfacing the patella. We compared the results with other forms of surgical treatment reported in the literature. This treatment offers good clinical and radiological results, presenting an alternative method of managing patellofemoral osteoarthritis.

[Benign concentric annular macular dystrophy]. / Distrofia macular anular benigna concéntrica.

CASE REPORT: A case of benign concentric annular macular dystrophy is described. A 32-year-old woman presented with loss of quality in visual acuity. Ophthalmologic examination, fluorescein angiogram, electrophysiologic tests and visual field measurements were performed. DISCUSSION: It is very important to include in the differential diagnosis other dystrophies which present a <> pattern on fluorescein angiography, given that preservation of relatively good visual acuity is a special feature of this disease.

[Patient with severe corneal disease in KID syndrome]. / Paciente con enfermedad corneal severa en el contexto del síndrome kid.

CASE REPORT: A 33-year-old woman with superficial and deep bilateral corneal vascularization and keratoconjunctivitis sicca, keratoerythema and neurosensory deafness, was diagnosed with keratitis-ichthyosis-deafness (KID) syndrome. DISCUSSION: KID syndrome is a congenital ectodermal dysplasia characterized by the association of vascularizing keratitis, hyperkeratotic skin lesions and sensorineural hearing loss. Recently, limbal stem cell deficiency was recognized as a possible major pathogenetic factor.

Paciente con enfermedad corneal severa en el contexto del síndrome KID / Patient with severe corneal disease in KID syndrome

Caso clínico: Mujer de 33 años con neovascularizacióncorneal bilateral superficial y profunda yqueratopatía punteada superficial de distribucióndifusa, queratoeritema y sordera neurosensorial,que es diagnosticada de síndrome KID.Discusión: El síndrome KID es una displasia congénitaectodérmica caracterizada por la asociaciónde queratitis vascularizante, lesiones cutáneashiperqueratósicas y sordera neurosensorial. Recientemente,la deficiencia de stem cell limbares ha sidoreconocida como posible factor patogenético clave

Case report: A 33-year-old woman with superficial ;;and deep bilateral corneal vascularization and ;;keratoconjunctivitis sicca, keratoerythema and neurosensory ;;deafness, was diagnosed with keratitisichthyosis- ;;deafness (KID) syndrome. ;;Discussion: KID syndrome is a congenital ectodermal ;;dysplasia characterized by the association of ;;vascularizing keratitis, hyperkeratotic skin lesions ;;and sensorineural hearing loss. Recently, limbal ;;stem cell deficiency was recognized as a possible ;;major pathogenetic factor

p16Ink4a or p19Arf loss contributes to Tal1-induced leukemogenesis in mice.

Analysis of the INK4A/ARF locus in human T-ALL patients revealed frequent deletions in exon 2, the exon common to both p16(INK4A) and p14(ARF). Other studies have described selective deletion of exon 1beta of p14(ARF) or methylation of the p16(INK4A) promoter. Therefore, it is unclear from these studies whether loss of p16(INK4A) and/or p14(ARF) contributes to the development of T-ALL. To elucidate the relative contribution of the ink4a/arf locus to T-cell leukemogenesis, we mated our tal1 transgenic mice to ink4a/arf-/-, p16(ink4a)-/-, and p19(arf)-/- mice and generated tal1/ink4a/arf+/-, tal1/p16(ink4a)+/-, and tal1/p19(arf)+/- mice. Each of these mice developed T-cell leukemia rapidly, indicating that loss of either p16(ink4a) or p19(arf) cooperates with Tal1 to induce leukemia in mice. Preleukemic studies reveal that Tal1 expression stimulates entry into the cell cycle and thymocyte apoptosis in vivo. Interestingly, mice expressing a DNA-binding mutant of Tal1 do not exhibit increases in S phase cells. The S phase induction is accompanied by an increase in thymocyte apoptosis in tal1 transgenic mice. Whereas apoptosis is reduced to wild-type levels in tal1/ink4a/arf-/- mice, S phase induction remains unaffected. Thus, Tal1 stimulates cell cycle entry independent of the ink4a/arf locus, but its ability to induce apoptosis is Ink4a/Arf-dependent.

[Light-induced maculopathy in cataract surgery]. / Ototraumatismo macular en cirugía de catarata.

CASE REPORT: Case 1: An 82-year-old man who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis Z 9000 lens) in his right eye under topical anaesthesia. Surgery lasted 14 minutes. Case 2: A 60-year-old woman with bilateral advanced primary open angle glaucoma who underwent an uncomplicated phacoemulsification and IOL implantation (Tecnis Z 9000 lens) in her right eye under peribulbar anaesthesia. Surgery lasted 36 minutes. One month after surgery both patients noted a para-central scotoma and impaired vision. Fluorescein angiography in both cases revealed retinal pigment epithelial changes compatible with intra-operative light-induced maculopathy. DISCUSSION: Light-induced maculopathy has been reported following cataract surgery. Whether physical properties of these new polysiloxane lenses contribute to retinal susceptibility to phototoxicity under certain light conditions needs to be elucidated.

[Acute posterior multifocal placoid pigment epitheliopathy associated with Graves-Basedow's disease]. / Epiteliopatía pigmentaria placoide multifocal posterior aguda asociada a enfermedad de Graves-Basedow.

CLINICAL CASE: We present a case of a 40-years-old woman with an acute posterior multifocal placoid pigment epitheliopathy (APMPPE) associated with recent instauration hyperthyroidism symptoms. A Graves' disease was diagnosed and the patient was initially controlled with antithyroid drugs. The epitheliopathy evolution was relatively favourable without relapse. Two years later a thyroidectomy was performed. DISCUSSION: We have not found in the literature any APMPPE case associated with Graves' disease. We only found an APMPPE case associated with a subacute thyroiditis. Little is known about the APMPPE causes, it could be that placoid epitheliopathy and Graves' disease had a common autoimmune origin. We can not forget that our finding could be only a matter of chance.

Epiteliopatía pigmentaria placoide multifocal posterior aguda asociada a enfermedad de graves-basedow / Acute posterior multifocal placoid pigment epitheliopathy associated with graves-basedow's disease

Caso clínico: Paciente mujer de 40 años de edad que presentó una epiteliopatía pigmentaria placoide multifocal posterior aguda (EPPMPA) asociada a un cuadro de hipertiroidismo de instauración reciente. La paciente fue diagnosticada de enfermedad de Graves y fue controlada inicialmente con tratamiento antitiroideo. La epiteliopatía evolucionó de forma relativamente favorable sin recidivas. A los dos años se practicó tiroidectomía subtotal. Discusión: No hemos encontrado en la bibliografía ningún caso de EPPMPA asociada a enfermedad de Graves. Sólo hallamos un caso de EPPMPA asociada a una tiroiditis subaguda. Poco se conoce sobre las causas de la EPPMPA, podría ser que la epiteliopatía placoide y la enfermedad de Graves tuvieran un origen autoinmune común. No podemos descartar la posibilidad de que nuestro hallazgo sea sólo casual (AU)

[The demand for health education among the teachers at nonuniversity teaching centers]. / Demanda en educación para la salud entre los profesores de centros docentes no universitarios.

OBJECTIVE: To assess the demand for training in health education (HE) from non-university teachers, how it could be integrated into the school curriculum and other relevant items. DESIGN: A descriptive study of a crossover type. SETTING: Public, private and church schools in the city of Granada. PATIENTS AND OTHER PARTICIPANTS: A sample chosen by random sampling of clusters, composed of 303 teachers at 36 private and public schools. MEASUREMENTS AND MAIN RESULTS: The demand from teachers for HE courses was 94.2%. They considered it would be good to include HE in the school curriculum (89.1%). To give HE as a "complementary activity" was the most favoured method (38.2%). Public schools were more interested than private or church ones in teaching environmental health (p < 0.005). There was a close association between the teacher's qualifications, the level he/she teaches and greater concern about questions which directly affect the child or adolescent. Therefore EGB (basic) teachers are more interested in gambling (p < 0.0001) and BUP-COU and FP teachers in drugs (p < 0.015). CONCLUSIONS: Among secondary (BUP-COU) and vocational training (FP) teachers there is considerable interest in Health education, although there is no one opinion on how to present it to their pupils. The close relationship between the HE aspects of most interest to the teacher and the level he/she teaches should be noted.

Bonding of amalgam to composite: tensile strength and morphology study.

OBJECTIVES: The present study was based on the premise that it may be possible to produce useful dental restorations by bonding freshly triturated amalgam to a cured composite restoration (Group 1 specimens), or by bonding uncured composite to hardened amalgam (Group 2 specimens). METHODS: To determine the validity of this premise, a phosphonate adhesive resin cement was used to produce simulated, layered dental restorations for each test group. RESULTS: The mean tensile bond strength of 24 hour-old Group 1 specimens (6.74 MPa +/- 1.63 MPa) was almost twice that of 24 hour-old Group 2 specimens. Cohesive failure of the amalgam-substrate layer was a prominent feature of the fracture pattern of Group 1 specimens. On the other hand, rupture of all Group 2 specimens occurred mainly along the adhesive-amalgam interface. Findings from SEM examination of the layers of amalgam, adhesive cement, and resin composite of intact Group 1 specimens suggested that inclusions of adhesive resin cement may be the cause of the persistent cohesive failure of the amalgam layer. SIGNIFICANCE: It may be possible to improve the strength of bonded couples made from freshly triturated amalgam and cured resin composite by minimizing the thickness of the adhesive layer.