Risk factors for methicillin-resistant Staphylococcus aureus and extended-spectrum ß-lactamase producing Enterobacterales in patients with diabetic foot infections requiring hospital admission.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum ß-lactamase-producing Enterobacterales (ESBL-E) may complicate the treatment of diabetic foot infections (DFIs). The aim of this study was to determine the risk factors for these pathogens in DFIs. METHODS: This was a prospective observational study of 167 consecutive adult patients with DFIs. The diagnosis and severity of DFIs were based on the Infectious Disease Society of America (IDSA) classification system. Multivariate analyses were performed in order to identify risk factors for MRSA and ESBL-E infections. RESULTS: S. aureus was the most isolated pathogen (n=82, 37.9 %) followed by Escherichia coli (n= 40, 18.5%). MRSA accounted for 57.3% of all S. aureus and 70% of Klebsiella pneumoniae and 25% of E. coli were ESBL producers, respectively. Deep ulcer [OR 8,563; 95% CI (1,068-4,727)], previous use of fluoroquinolones [OR 2,78; 95% CI (1,156-6,685)] and peripheral vasculopathy [OR 2,47; 95% CI (1.068-4.727)] were the independent predictors for MRSA infections; and osteomyelitis [OR 6,351; 95% CI (1,609-25,068)] and previous use of cephalosporins [OR 5,824; 95% CI (1,517-22,361)] for ESBL-E infections. CONCLUSIONS: MRSA and ESBL-E have adquired a great clinical relevance in DFIs. The availability of their risk factors is very convenient to choose the empirical treatment in severe forms.

[Influence of initial protocolized treatment with steroids in length of stay and costs of community acquired pneumonia]. / Influencia de la protocolización del tratamiento inicial con corticoides en la estancia y costo de las neumonías adquiridas en la comunidad. Estudio prospectivo 2015.

OBJECTIVE: The aim of the study was to analyze the impact of steroid treatment in patients with community acquired pneumonia (CAP), both in length of stay and economical cost of admission at a clinical university hospital. METHODS: Prospective study of admitted patients with the diagnosis of CAP, both in Internal Medicine and Infectious diseases department. The study was conducted from January to march 2015; patients receiving steroids from diagnosis to end of antibiotic treatment were classified as group I; otherwise, they were considered in group II. Administration of steroids was done according to the criteria of the responsible. Cost was stablished according to CAP Diagnostic Related Group (DRG). RESULTS: Prevalence of patients younger than 65 year-old was higher in group I (p<0.05). In bivariate analyses, mean admission time was lower in group I (5.37 vs 8.88 days) (p<0.0005) and also economical cost (2,361 euros vs 3,907 euros) (p<0.0005). In multivariate analysis, factors independently associated to higher cost (>3,520 euros) were COPD (OR=2.602; 95% CI 1.074-6.305) and group II (patients with no steroids) (OR=6.2; p=0,007). CONCLUSIONS: No administration of steroids in patients with CAP was associated, together with COPD, with higher economical cost (evaluated by DRG/length of stay).

[Design and implementation of an outpatient parenteral antimicrobial therapy program in primary care: the experience at a second level hospital]. / Design and implementation of an outpatient parenteral antimicrobial therapy program in primary care: the experience at a second level hospital.

OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality. METHODS: Prospective study cohorts of patients admitted to the OPAT programme, from 1 January 2012 to 31 May 2015. RESULTS: During the period of study a total of 98 episodes were recorded. The average age of the cohort was 66 years. The most frequent comorbidity was immunosuppression (33.67 %), with an overall average of Charlson index of 5.21 ± 3.09. The most common source of infection was respiratory (33.67 %). Microbiological isolation was achieved in fifty-eight patients (59.18 %) being Escherichia coli the most frequently isolated (25%). The average number of days of antibiotics administration at home was 10.42 ± 6.02 (SD), being carbapenems (43.48%) the more administered. Eighty-six patients (87.75%) completed the treatment successfully. Thirty-two patients (32.65%) were readmitted within 30 days after being discharged and seven patients (7.14%) died. A statistically significant association was only found in the readmission with variables: elderly patients (p=0.03), being carriers of Porth-a-Cath (p=0.04) and treatment termination related with infection (p<0.05). CONCLUSIONS: This is the first programme of OPAT administration not dependent on Home Hospitalization Service in Spain, which could allow to optimize the hospital and primary care resources available. Nevertheless this pilot study results are poor in terms of optimization of antibiotics choice, transition to oral administration, de-escalation and duration.

Caries dental: influencia de los hábitos de higiene bucodental y de alimentación en niños en edad escolar / Dental decay: influence of oral hygiene and nutritional habits in the ambience of school children

Introducción: La salud bucodental es parte fundamental de la salud del niño. Para mantenerla es preciso instaurar unos correctos hábitos de higiene oral y de alimentación. El objetivo de este trabajo es conocer el estado actual de los hábitos de higiene bucodental y de alimentación en un grupo de niños en edad escolar y su relación con la caries dental. Material y método: Estudio observacional realizado en 130 escolares de edades comprendidas entre 3 y 12 años. Se entregaron encuestas a los padres en relación con los hábitos de higiene oral y de alimentación. Se les realizó a los niños un examen oral para el diagnóstico de caries. Resultados: La prevalencia de los niños con caries es del 33%. Hay una relación estadísticamente significativa (p <0,05) entre la caries y la nacionalidad (p= 0,004) y el nivel de estudios de los padres (p= 0,005). También existe una asociación estadísticamente significativa entre la caries y la presencia de placa (p= 0,002), el tiempo de cepillado (p= 0,005), el uso de chupete con azúcar (p= 0,015) y el bruxismo (p= 0,025). Respecto a los hábitos de alimentación, también se observa una relación estadísticamente significativa entre el consumo de chicles (p= 0,006), bollería (p= 0,009), lácteos (p= 0,093) y medicación y la aparición de caries (p= 0,005). Conclusiones: Se observan relaciones estadísticamente significativas entre determinados hábitos y la caries. La educación para la salud en la etapa de educación infantil es fundamental para que el niño adquiera unos hábitos de alimentación y salud bucodental adecuados (AU)

Introduction: Oral health is essential to children’s health. To maintain them it is necessary to establish a proper oral hygiene and nutritional habits. The aim of the present document is discover the current state of oral hygiene habits and nutritional habits that a group of school children and its relationship with decay. Patients and methods: An observational study was conducted on 130 school children, aged between 3 and 12 years old. Parents carried out surveys in relation to oral hygiene habits and nutrition. An oral exam was preformed on each child to diagnose decay. Results: The prevalence of children with caries is about 33%. There is a statistically significant relationship (p <0.05) between the nationality (p= 0.004) and the parents level of education (p= 0.005) with the presence of decay. There is a statistically significant relationship between the presence of plaque (p= 0.002), brushing time (p= 0.005), habit of covering the pacifier in sugar (p= 0.015) and bruxism (p= 0.025) with the occurrence of decay. In regard to nutritional habits, there is also a statistically significant relationship between the consumption of chewing gum (p= 0.006), pastries (p= 0.009), dairy products (p= 0.093) and medication with the presence of decay (p= 0.005). Conclusions: There is a statistically significant relationship between certain habits with the presence of decay. A health education in an early stage of childhood is essential for the child to acquire adequate oral health and nutritional habits (AU)

Toxicity of a dental adhesive compared with ionizing radiation and zoledronic acid

BACKGROUND: To determine the toxicity of aqueous dilutions of a universal self-priming dental adhesive (DA) and comparing these with those elicited by exposure to ionizing radiation (IR), Zoledronic acid (Z) treatment and the synergic effects of the combined treatment with IR+Z. MATERIAL AND METHODS: The genotoxic effect of DA was determined by the increase in the frequency of micronuclei in cytokinesis-blocked in cultured human lymphocytes before and after exposure to 2Gy of X-rays. The cytotoxic effect was studied by using the MTT cell viability test in normal prostate cell lines (PNT2) after exposure to different X-ray doses (0Gy-20Gy). The cell lines divided into different groups and treated with different test substances: DA in presence of O2 , DA in absence of O2 , Z-treated and control. RESULTS: An in vitro dose-dependent and time-dependent cytotoxic effect of DA, Z and IR on PNT2 cells (p > 0.001) was demonstrated. DA without-O2, following the recommendations of manufacturers, had a more pronounced effect of increasing cell death than DA with-O2 (p < 0.001). In the genotoxicity assay, DA at 25% of its original concentration significantly increased chromosome damage (p < 0.001). The samples studied were found to be toxic, and the samples photo-polymerized in absence of O2 showed a bigger cytotoxic effect comparable to the additive toxic effect showed by the combined treatment of IR+Z. CONCLUSIONS: Additional effort should be carried out to develop adhesives, which would reduce the release of hazardous substances; since toxic effects are similar to that reported by other agents whose clinical use is controlled by the health authorities

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Valoración de aspectos objetivos y subjetivos en las percepciones de la calidad de los pacientes con cervicalgia mecánica que han recibido fisioterapia en centros de atención primaria / Evaluation of objective and subjective aspects in the perception of quality among patients receiving physiotherapy for mechanical neck pain in primary care centers

ObjetivoValorar la influencia de aspectos objetivos y subjetivos en las percepciones de calidad de los pacientes con cervicalgia mecánica que han recibido fisioterapia en centros de atención primaria.Material y métodosUn estudio mixto (cuali-cuantitativo) fue llevado a cabo en dos fases. En una primera fase, se realizó un estudio cualitativo usando la técnica de grupo focal y se diseñó un cuestionario con 24 ítems. En una segunda fase, se entregó el cuestionario en mano a los pacientes. El método de reclutamiento fue de conveniencia. Se entregó un total de 176 cuestionarios y el número total de participantes que respondieron al cuestionario fue 142. Un análisis factorial con varimax fue aplicado para analizar el porcentaje de explicación de cada aspecto objetivo y subjetivo.ResultadosLa tasa de respuesta ha sido del 80,7%. El análisis factorial ha proporcionado 6 factores o componentes que explican la influencia objetiva y subjetiva de ciertos aspectos en las percepciones de calidad de los pacientes. Dos factores han sido claramente subjetivos, 3 factores han sido objetivos y subjetivos y 1 solo claramente objetivo. Estos aspectos han sido relacionados con la estructura y las instalaciones, con la organización y con la comunicación e información.ConclusionesLos aspectos subjetivos no pueden ser excluidos de las percepciones de los pacientes. Algunas de las medidas objetivas y subjetivas son independientes mientras que otras medidas están implicadas entre sí. Los fisioterapeutas deben considerar tanto aspectos objetivos como subjetivos cuando se tienen en cuenta las percepciones de los pacientes de la calidad del tratamiento que reciben(AU)

ObjectiveTo evaluate the influence of subjective and objective aspects on the perception of quality among patients with mechanical neck pain receiving physical therapy in primary care centers.Material and methodsA mixed study (qualitative and quantitative) was conducted in two phases. In the first phase, a qualitative study was performed using focus group techniques and a 24-item questionnaire was designed. In the second phase, the questionnaire was given to patients. Convenience recruitment was used. Of the 176 questionnaires provided, 142 were completed. To analyze the percentage of explanation for each objective and subjective aspect, a factorial analysis with varimax was applied.ResultsThe response rate was 80.7%. The factorial analysis provided six factors or components that explained the objective or subjective influence of certain aspects on patients¿ perceptions of quality. Of these six components, two included clearly subjective aspects, three included objective and subjective aspects and only one was clearly objective. These aspects were related to structure and installations, organization and communication and information.ConclusionsSubjective features cannot be excluded from patients¿ perceptions. Some objective and subjective measures are independent while others are interrelated. Physiotherapists should bear both objective and subjective aspects in mind when considering patients¿ perceptions of the quality of the treatment received (AU)

Lesiones en la mucosa oral en una muestra de pacientes con diabetes tipo 2: liquen plano oral / Oral mucosa lesions in a sample of patients with type 2 diabetes: oral lichen planus

Introducción: La relación existente entre diversas patologías de la cavidad oral y la diabetes ha sido motivo de numerosos estudios. En general, podemos encontrar un amplio espectro de lesiones en la cavidad oral que pueden darse con mayor frecuencia en los pacientes diabéticos. El objetivo de este estudio fue valorar la posible relación entre la presencia de liquen plano oral en una muestra de pacientes con diabetes tipo 2 con diversos parámetros de la diabetes, como el nivel de hemoglobina glucosilada (HbA1c), los años de evolución y el tipo de tratamiento. Material y métodos: Los resultados de la anamnesis, exploración intraoral y pruebas complementarias fueron evaluados mediante un análisis estadístico. Además, se realizó una revisión bibliográficaen PubMed de trabajos similares. Resultados: Se observó una prevalencia del liquen plano oral del 9,1% en los pacientes de la muestra, así como una relación estadísticamente significativa entre la presencia de liquen plano oral y los años de evolución de la diabetes (p= 0,021). Conclusiones: La presencia de liquen plano oral mantiene una relación significativa con la duración de la diabetes tipo 2, no observándose relación con el control metabólico ni con el tipo de tratamiento de la diabetes (AU)

Introduction: The relationship between diverse pathologies of oral cavity and diabetes has been motivated a great number of studies. In general, it can be found a wide variety of lesions in oral cavity, which are more frequent in diabetic patients. The aim of this study was to evaluate the relationship between the presence of oral lichen planus and different parameters of diabetes such glycated hemoglogin, years of duration of diabetes, an type of treatment in asample of type 2 diabetes patients. Material and methods: The results of the anamnesis, intraoral examination and complementary tests were evaluated by means of statistical analysis. In addition, a bibliographical review in PubMed was realized for similar works. Results: We found a prevalence for the oral lichen planus in 9.1% in our sample as well as a statistically significant relationship between oral lichen planus presence and the type 2 diabetes duration (p= 0.021). Conclusions: Oral lichen planus presence shows a significant relation with duration of type 2 diabetes, but not with neither the metabolic control nor the type of diabetes treatment (AU)

Evolución de mujeres con osteoporosis tratadas durante más de tres años / Evolution of women with osteoporosis treated for more than three years

Presentamos la evolución de 41 pacientes con osteoporosis posmenopáusica que han seguido tratamiento durante más de tres años (86 meses de media). Treinta y cinco pacientes (85%) presentaron incrementos de la densidad mineral ósea (DMO) en columna, con una ganancia media del 21%, siendo los cambios estadísticamente significativos (p < 0,005); el 63% mostró incrementos en cadera, pero no fueron significativos. Trece pacientes presentaron alguna fractura por fragilidad y 6 de ellas sufrieron más de un evento. Por orden de frecuencia fueron 8 fracturas vertebrales (19,5%), 5 de la extremidad distal de radio (12%), 3 de húmero (7,5%) y 2 de cadera (5%). El tratamiento más utilizado fue alendronato (71%), seguido de raloxifeno (58%) y risedronato (54%). Utilizando el test de Morisky, el 48% de las pacientes era buena cumplidora. Hemos encontrado correlación entre los aumentos de la DMO y la aparición de fractura, pero no con otros factores de riesgo analizados(AU)

We are going to show the progress of 41 postmenopausal patients who have followed treatment for more than three years (86 months). Assessing several factors such as: development of the bone mineral density (BMD), adherence to therapeutic treatment, incidence of fractures and risk factors. Thirty five patients (85%) showed increases of the BMD in the spine with an average increase of 21%, and presented statistic changes (p < 0.005); 63% presented statistic changes in the hip but with not significant increases. Thirteen patients showed some fracture through fragility and 6 of them suffered more than one episode. By order of frequency: vertebral (spinal) fractures 8 (19.5%), radius 5 (12%), epiphysis of humerus 3 (7, 5%) and hip 2 (5%). The most used treatment was alendronate (71%), followed by raloxifene (58%) and risedronate (54%). Using the Morisky test, the 48% of the patients were reliable. We have found correlation between increases of the BMD and risk of fracture, not being found related to other risk factors(AU)

Effects of frequency of static stretching on straight-leg raise in elementary school children.

AIM: The aim of this study was to evaluate the efficacy of different frequencies of a stretching exercise program on lower extremity range of motion (ROM) in prepubertal schoolchildren. METHODS: A total of 62 children were divided into 3 groups (experimental groups: A, B; control group: C). Experimental group A performed hamstring stretches for 5 min during the Physical Education classes over a full school term (9 months), 2 sessions per week (31 weeks, 62 sessions of Physical Education). Experimental group B performed hamstring stretches for 5 min during the Physical Education classes and during a specific extracurricular physical activity, over a full school term (9 months), 4 sessions per week (31 weeks, 62 sessions of Physical Education and 62 sessions of after-school physical activities). Control group followed the standard class program of Physical Education classes. Hamstring flexibility was measured using the straight leg raise test before and after the program. RESULTS: No significant differences were revealed in ROM before and after the Physical Education classes for the control group. However, significant improvements in ROM were shown in the two experimental groups (P<0.001). Four days per week produced a greater rate of gains in ROM (16.9 degrees) than 2 days per week (9.3 degrees). For all groups, the initial and the final ROM between the right and left sides were similar. CONCLUSION: This study indicates that a full school term (9 months) incorporating static stretching as part of the Physical Education classes and the extracurricular physical activities significantly increases the ROM of the hamstrings in prepubertal schoolchildren. The study also suggests that the increase of the frequency of stretching is effective for increasing ROM.

Perspectiva epidemiológica y asistencial de los ingresos hospitalarios por tuberculosis (200-2004) / Epidemiological and nursing perspective of hospital admissions for tuberculosis (2000-2004)

El objetivo de este trabajo es conocer la incidencia y los aspectos asistenciales de los ingresos por tuberculosis en el Hospital Virgen de la Arrixaca, centro de referencia de la Comunidad Autónoma de Murcia. Se contabilizaron 223 ingresos por tuberculosis durante los años 2000 al 2004, que representaron el 0,15% de los ingresos hospitalarios. El 28,3% de los pacientes fueron de nacionalidad extrajera. El 67,7% observaron factores o situaciones de riesgo que favorecen el desarrollo de esta enfermedad, los más frecuentes fueron ser inmigrante, fumador, tener hábito alcohólico, ser VIH positivo o ADVP. En más del 80% de los casos tuberculosis pulmonar la microscopía fue positiva, la baciloscopia y el cultivo de esputo. El 4,7% de las radiografías de tórax fueron normales, no tenían lesiones parenquimatosas. La elevada proporción de población inmigrante, la mayoría menor de cuarenta años, ocasiona una distribución por edades diferente a la que se observa en la distribución de esta enfermedad en la población europea, en la que es más frecuente la tuberculosis en los mayores de sesenta años. Observamos un aumento de las multirresistencias a los fármacos antituberculosos en relación a otros trabajos realizados en nuestro país a principios de la década de los noventa. Esta característica junto con la significativa proporción de casos de tuberculosis que son VIH positivos en nuestro país y el aumento de población inmigrante, aconsejan introducir con frecuencia modificaciones en las pautas de tratamiento. La tuberculosis continua siendo un problema sanitario y social importante en nuestro país agravado por la población inmigrante llegada en los diez últimos años, que en esta Comunidad Autónoma representa en torno al 10% de la población, que hacen necesario actualizar los programas de prevención y control de esta enfermedad endémica, y la coordinación entre los niveles asistenciales (AU)

The objective of this work is to find out the impact and nursing aspects of admissions for tuberculosis in the Hospital Virgen de la Arrixaca, reference centre in the Autonomous Community of Murcia. Tuberculosis continues to be an important health an social problem in our country aggravated by the immigrant population arriving over the last ten years, which represents around 10% of the population in this Autonomous Community. This fact makes it necessary to update the prevention and control programmes of this endemic disease, and the coordination between the nursing levels (AU)

[Clinical recurrence of multinodular goiter after surgery. A multivariate study on the risk factors]. / Recidiva clínica del bocio multinodular tras la cirugía. Estudio multivariante de los factores de riesgo.

INTRODUCTION: In multinodular goiter there is no consensus on which is the most adequate surgical technique, since although the techniques with partial resection show lower risk of complications they are associated with a higher risk of recurrences. The objective of this study is to define the risk factors for recurrence of multinodular goiters after surgery in a series with a mean postoperative follow-up higher than 12 years. PATIENTS AND METHOD: 231 multinodular goiters with partial thyroid surgery are analyzed. The recurrence is assessed through clinical exploration, and is confirmed with echography. The variables analyzed are age, sex, family history of thyroid pathology, residence in goitrogenic areas, asymptomatic hyperthyroidism, compression syndromes, intrathoracic extension of goiter, surgeon experience with endocrine surgery, weight of the thyroid, and surgical technique, chi2 test, Student's t test and a logistic regression test are applied. RESULTS: After a mean postoperative follow-up of 152 +/- 71 months 67 goiters (29%) showed recurrence with a mean time for recurrence of 85 +/- 67 months. Risk factors detected in the multivariate study were youngest age, surgeon's lack of experience in endocrine surgery, and the surgical technique. Forty-six patients (69%) were operated because of recurrence, most of them by surgeons experienced in endocrine surgery. Thyroidectomy was completed in all cases, and two definitive postoperative complications occurred. CONCLUSIONS: The index of clinical recurrences is high and increases with the progression; primary risk factors are age, surgeon's experience, and surgical technique. The implication is that partial resection techniques should be carried out by surgeons with experience and there should be avoided in young patients.

Recidiva clínica del bocio multinodular tras la cirugía. Estudio multivariante de los factores de riesgo / Clinical recurrence of multinodular goiter after surgery. A multivariate study on the risk factors

Introducción. En el bocio multinodular no existe consenso sobre cuál es la técnica quirúrgica más adecuada, pues, aunque las técnicas resectivas parciales presentan menor riesgo de complicaciones, conllevan un alto riesgo de recidivas. El objetivo es determinar los factores de riesgo de recidiva del bocio multinodular tras la cirugía en una serie con un seguimiento medio postquirúrgico superior a los 12 años. Pacientes y método. Se analizan 231 bocios multinodulares con cirugía tiroidea parcial. La recidiva se valora mediante exploración clínica y se confirma mediante ecografía. Las variables analizadas son edad, sexo, antecedentes familiares de patología tiroidea, residir en áreas bociógenas, asintomático, hipertiroidismo, síndromes compresivos, prolongación intratorácica del bocio, experiencia en cirugía endocrina del cirujano, peso del tiroides y técnica quirúrgica. Se aplica la prueba de χ2, la de la «t» de Student y una prueba de regresión logística. Resultados. Con un seguimiento medio de 152 ± 71 meses recidivaron 67 bocios (29%) con un tiempo medio de recidiva de 85 ± 67 meses. Los factores de riesgo detectados en el estudio multivariante fueron la edad más joven, la no experiencia en cirugía endocrina del cirujano y la técnica quirúrgica. Cuarenta y seis pacientes (69%) fueron intervenidos de la recidiva, la mayoría por cirujanos con experiencia en cirugía endocrina. En todos los casos se completó la tiroidectomía y se presentaron dos complicaciones postoperatorias definitivas. Conclusiones. El índice de recidivas clínicas es alto y aumenta con la evolución, siendo los principales factores de riesgo la juventud, la experiencia del cirujano y la técnica quirúrgica. Por lo que que estas técnicas resectivas parciales deben realizarse por cirujanos con experiencia y evitarse en pacientes jóvenes

Introduction. In multinodular goiter there is no consensus on which is the most adequate surgical technique, since although the techniques with partial resection show lower risk of complications they are associated with a higher risk of recurrences. The objective of this study is to define the risk factors for recurrence of multinodular goiters after surgery in a series with a mean postoperative follow-up higher than 12 years. Patients and method. 231 multinodular goiters with partial thyroid surgery are analyzed. The recurrence is assessed through clinical exploration, and is confirmed with echography. The variables analyzed are age, sex, family history of thyroid pathology, residence in goitrogenic areas, asymptomatic hyperthyroidism, compression syndromes, intrathoracic extension of goiter, surgeon experience with endocrine surgery, weight of the thyroid, and surgical technique, χ2 test, Student’s «t» test and a logistic regression test are applied. Results. After a mean postoperative follow-up of 152±71 months 67 goiters (29%) showed recurrence with a mean time for recurrence of 85 ± 67 months. Risk factors detected in the multivariate study were youngest age, surgeon's lack of experience in endocrine surgery, and the surgical technique. Forty-six patients (69%) were operated because of recurrence, most of them by surgeons experienced in endocrine surgery. Thyroidectomy was completed in all cases, and two definitive postoperative complications occurred. Conclusions. The index of clinical recurrences is high and increases with the progression; primary risk factors are age, surgeon's experience, and surgical technique. The implication is that partial resection techniques should be carried out by surgeons with experience and there should be avoided in young patients

[Importance of primary health-care professionals in the sanitary education about organ donation]. / Importancia de los profesionales de atención primaria en la educación sanitaria de la donación de órganos.

AIM: To determine the influence of the information on donation generated from primary health-care on the attitude towards organ donation. DESIGN: Descriptive transversal study. SETTING: 45 municipalities of Murcia Region, Spain. PARTICIPANTS: The population in this study was randomly selected and stratified according to age, sex, and geographic localization among people over > or =15 years of age (n=1887). INTERVENTIONS AND MEASURES: The attitude was evaluated according to a questionnaire psychosocial aspects of donation. There is valued the information transmitted on donation to the population from primary care (group A) or other informative sources (group B), and if this information was to favour or in opposition to the same one. STATISTICS: chi2 test, t Student, and logistic regression analysis. RESULTS: Of 1887 surveys, 129 cases (group A) (7%) had received information from primary care. In this group, the 89% is in favour of the donation. In 120 cases the received information was favourable, presenting an attitude in favour of the donation of 93%, whereas in all 9 remaining cases the information was in against, decreasing the attitude to favour up to 44% (P<.05). In the group B (n=1758) the attitude in favour of the donation was of 65% (P<.05, with regard to the group A). The 62% (n=1083) received favourable information, improving in them the favourable attitude towards the donation up to 74%. The rest (38%; n=675) had received also unfavourable information, decreasing his attitude to favour up to 51% (P<.05). CONCLUSIONS: Little information about organ donation is transmitted from primary care, but when it is realized a very positive impact has if it is favourable and very negative if it is unfavourable.

Importancia de los profesionales de atención primaria en la educación sanitaria de la donación de órganos / Importance of Primary Health-Care Professionals in the Sanitary Education About Organ Donation

Objetivo. Determinar la influencia de la información sobre donación generada desde atención primaria (AP) en la actitud poblacional. Diseño. Estudio descriptivo, transversal. Emplazamiento. Un total de 45 municipios de la Comunidad Autónoma de Murcia. Participantes. Muestra aleatoria y estratificada por edad, sexo y localización geográfica entre la población >= 15 años (n = 1.887). Mediciones principales. Encuesta psicosocial sobre donación y trasplante de órganos. Se valora la información transmitida desde AP (grupo A) u otras fuentes informativas (grupo B), y su impacto en la actitud hacia la donación. Se analizan diversas variables psicosociales. Se aplicaron los tests de la * 2 y de la t de Student y un análisis de regresión logística. Resultados. De los 1.887 encuestados, 129 del grupo A (7%) habían recibido información desde AP. En este grupo, el 89% está a favor de la donación. En 120 casos la información recibida fue favorable, con una actitud a favor del tema del 93%, mientras que en los 9 casos restantes la información fue en contra, con lo que dicha actitud favorable descendió al 44% (p < 0,05). En el grupo B (n = 1.758), la actitud a favor de la donación fue del 65% (p < 0,05, respecto al grupo A). El 62% (n = 1.083) recibió una información favorable, con una actitud a favor del 74%. El resto (38%; n = 675) había recibido también información desfavorable, por lo que su actitud favorable disminuyó hasta el 51% (p < 0,05). Conclusiones. Se transmite poca información sobre donación desde AP. Sin embargo, cuando se realiza, tiene un impacto muy positivo si es favorable y muy negativo si es desfavorable (AU)

Aim. To determine the influence of the information on donation generated from primary health-care on the attitude towards organ donation. Design. Descriptive transversal study. Setting. 45 municipalities of Murcia Region, Spain. Participants. The population in this study was randomly selected and stratified according to age, sex, and geographic localization among people over >=15 years of age (n=1887). Interventions and measures. The attitude was evaluated according to a questionnaire psychosocial aspects of donation. There is valued the information transmitted on donation to the population from primary care (group A) or other informative sources (group B), and if this information was to favour or in opposition to the same one. Statistics: * 2 test, t Student, and logistic regression analysis. Results. Of 1887 surveys, 129 cases (group A) (7%) had received information from primary care. In this group, the 89% is in favour of the donation. In 120 cases the received information was favourable, presenting an attitude in favour of the donation of 93%, whereas in all 9 remaining cases the information was in against, decreasing the attitude to favour up to 44% (P<.05). In the group B (n=1758) the attitude in favour of the donation was of 65% (P<.05, with regard to the group A). The 62% (n=1083) received favourable information, improving in them the favourable attitude towards the donation up to 74%. The rest (38%; n=675) had received also unfavourable information, decreasing his attitude to favour up to 51% (P<.05). Conclusions. Little information about organ donation is transmitted from primary care, but when it is realized a very positive impact has if it is favourable and very negative if it is unfavourable (AU)

[P. aeruginosa bacteremias: analysis of prognostic factors. A prospective study, 1992-1998]. / Bacteriemias por P. aeruginosa: análisis de los factores pronóstico. Estudio prospectivo 1992-1998.

INTRODUCTION: P. aeruginosa causes serious infections with high mortality. OBJECTIVES: Identify the prognostic factors associated with higher mortality in P. aeruginosa bacteremias (PAB). METHODS: 211 consecutive cases of PAB were analyzed prospectively between 1992-1998. Blood cultures, isolation, and antimicrobial sensitivity were carried out according to microbiology standard methodology. The variables analyzed as prognostic factors were: sex, age, source of infection, background, main disease, initial clinical severity, foci, presence of complications, leukocyte count, type of antibiotic treatment and adaptation. Bivariate and multivariate statistical analyses were carried out by the method of logistic regression. RESULTS: Global mortality was 27.96%; factors associated with higher mortality in the bivariate study were main disease rapidly and eventually fatal, diabetes, a situation of critical initial clinical severity, lung focus, complications, neutropenia and inadequate antibiotic treatment. The logistic regression study, the critical initial clinical severity, and the presence of complications were the variables associated with worse prognosis. We did not find significant differences in the evolution among the patients who received monotherapy and those on combinations of antimicrobial drugs against pseudomonas. CONCLUSION: Higher mortality of PAB is statistically associated to the situation of critical initial clinical severity and to the presence of complications; therefore, an early diagnosis and adequate treatment to improve the morbidity and mortality are recommended.

[Absence of chromosomic and genotoxic damage from the radiation dose administered in scintigraphic examinations]. / Ausencia de daño cromosómico y genotóxico inducido por la dosis de radiación administrada en las exploraciones gammagráficas.

INTRODUCTION: The cytokinesis-blocked (CB) micronucleus test (MN) on irradiated human lymphocytes is normally used to evaluate chromosomal and genotoxic damage produced by various physical and chemical agents. OBJECTIVE: Determine any possible genotoxic effect induced by the different types of ionizing radiation employed in medical diagnostic radiology and nuclear medicine. MATERIAL AND METHODS: The frequency of the MN appearance was determined in CB lymphocyte cultures of a total of 4 different groups of patients: (1) in 35 supposedly healthy volunteers to establish the MN spontaneous frequency in the medium; (2) in 9 volunteers to measure the in vitro dose-response curves in order to calculate the MN frequency following X-ray irradiation and gamma radiation; (3) in 25 patients in whom a specific diagnostic and/or therapeutic procedure employing diagnostic radiology techniques involving X-ray exposure was applied, and (4) in 26 patients in whom the diagnostic procedure in question involved nuclear medicine techniques (scintiscan). RESULTS: A lineal relationship was observed between the MN frequency and the dose of ionizing radiation administered in vitro, both in X-rays and gamma radiation. A significant increase in the MN is observed after radiation is given to patients during medical diagnostic radiology examinations when compared with the control values obtained from the same patients prior to being subjected to the radiological procedure (p < 0.01). No significant MN increase is observed following exposure to radiation involved in diagnostic examinations in patients studied in Nuclear Medicine. CONCLUSION: Ionizing radiation employed in complex medical diagnostic radiology examinations produces a significant increase in the MN appearance frequency and as such indicates both radiation induced chromosomal and genotoxic damage. However, the ionizing radiation used in diagnostic nuclear medicine examinations does not induce any significant increase in MN appearance frequency.

Ausencia de daño cromosómico y genotóxico inducido por la dosis de radiación administrada en las exploraciones gammagráficas / Absence Of Chromosomic And Genotoxic Damage From The Radiation Dose Administered In Scintigraphic Examinations

Introducción: El test de micronúcleos (MN) sobre linfocitos humanos irradiados con bloqueo citocinético (CB) se utiliza habitualmente para valorar el daño cromosómico y genotóxico de diferentes agentes físicos y químicos. Objetivo: Se pretende determinar un posible efecto genotóxic inducido por diferentes tipos de radiaciones ionizantes empleadas en radiodiagnóstico médico y en medicina nuclear. Material y métodos: Se ha determinado la frecuencia de aparición de MN en cultivos de linfocitos CB en 4 grupos de individuos diferentes: 1) en 35 voluntarios supuestamente sanos para establecer la frecuencia espontánea de MN en nuestro medio; 2) en 9 voluntarios para realizar las curvas dosis-respuesta “in vitro” para establecer la frecuencia de MN tras la irradiación con rayos X y con radiación gamma; 3) en 25 pacientes a los que se le ha realizado algún procedimiento diagnostico y/o terapéutico que precisa de la exposición a rayos X en radiodiagnóstico, y 4) en 26 pacientes a los que se le ha realizado algún procedimiento diagnóstico de medicina nuclear (gammagrafía). Resultados: Se ha obtenido una relación lineal entre la frecuencia de MN y la dosis de radiación ionizante administradas “in vitro” tanto para rayos X como para radiación gamma. Se aprecia un aumento significativo de MN tras la irradiación que suponen las exploraciones en los pacientes irradiados en radiodiagnóstico médico comparados con los valores controles obtenidos de los mismos pacientes antes del procedimiento radiológico (p < 0,01). No se aprecia un incremento significativo de MN tras la exposición a la radiación que suponen las exploraciones diagnósticas en los pacientes estudiados en Medicina Nuclear. Conclusión: La radiación ionizante utilizada en exploraciones complejas de radiodiagnóstico médico produce un aumento significativo en la frecuencia de aparición de MN por lo que supone un daño cromosómico y genotóxico inducido por la radiación. Las dosis de radiación ionizante utilizada en exploraciones diagnósticas de medicina nuclear no induce un aumento significativo en la frecuencia de aparición de MN (AU)

Introduction: The cytokinesis-blocked (CB) micronucleus test (MN) on irradiated human lymphocytes is normally used to evaluate chromosomal and genotoxic damage produced by various physical and chemical agents. Objective: Determine any possible genotoxic effect induced by the different types of ionizing radiation employed in medical diagnostic radiology and nuclear medicine. Material and methods: The frequency of the MN appearance was determined in CB lymphocyte cultures of a total of 4 different groups of patients: (1) in 35 supposedly healthy volunteers to establish the MN spontaneous frequency in the medium; (2) in 9 volunteers to measure the in vitro dose-response curves in order to calculate the MN frequency following X-ray irradiation and gamma radiation; (3) in 25 patients in whom a specific diagnostic and/or therapeutic procedure employing diagnostic radiology techniques involving X-ray exposure was applied, and (4) in 26 patients in whom the diagnostic procedure in question involved nuclear medicine techniques (scintiscan). Results: A lineal relationship was observed between the MN frequency and the dose of ionizing radiation administered in vitro, both in X-rays and gamma radiation. A significant increase in the MN is observed after radiation is given to patients during medical diagnostic radiology examinations when compared with the control values obtained from the same patients prior to being subjected to the radiological procedure (p < 0.01). No significant MN increase is observed following exposure to radiation involved in diagnostic examinations in patients studied in Nuclear Medicine. Conclusion: Ionizing radiation employed in complex medical diagnostic radiology examinations produces a significant increase in the MN appearance frequency and as such indicates both radiation induced chromosomal and genotoxic damage. However, the ionizing radiation used in diagnostic nuclear medicine examinations does not induce any significant increase in MN appearance frequency (AU)

[Influence of estrogen replacement therapy on atherogenic profile in postmenopausal women]. / Influencia del tratamiento hormonal sustitutivo en el perfil aterogénico de la mujer postmenopáusica.

OBJECTIVE: Postmenopausal women have higher risk of cardiovascular events compared with premenopausal. The aim of this clinical study was to evaluate the effect of hormone replacement therapy (HRT) on the atherogenic profile in apparently healthy postmenopausal women. METHOD: The subjects were 76 healthy postmenopausal women, aged 45 to 59 years, and 15 premenopausal women with regular cycles, aged 40 to 45 years. 63 postmenopausal women completed the study. None of the participating women had a history of hypertension, diabetes mellitus or medications known to affect the cardiovascular system. Twenty seven postmenopausal women received daily 50 micrograms of transdermal estradiol and 100 milligrams of oral progesterone. Thirty six dit not receive HRT. Checkups were preformed at baseline and after six months of treatment, except the group of premenopausal women (only at baseline). Examinations consisted in measurement of body weight, length, waist/hip ratio and plasma levels of biochemical parameters. RESULTS: Estradiol levels were higher among premenopausal women than among treated and non-treated postmenopausal women (83 +/- 78.47 versus 10 +/- 3.99; 12 +/- 4.56 mg/l, p < 0.0001). Levels of serum cholesterol (198 +/- 30.2 versus 236 +/- 33.7; 228 +/- 32.8 mg/dl; p < 0.002), LDL-cholesterol (120 +/- 25 versus 151 +/- 34.2; 144 +/- 31.5 mg/dl, p < 0.02), uric acid (3.98 +/- 0.5 versus 4.6 +/- 1; 4.8 +/- 1 mg/dl, p < 0.004) and homocysteine (9.8 +/- 3.3 versus 13 +/- 3.1; 11 +/- 1.7 mmol/l, p < 0.02) were higher among postmenopausal women than among premenopausal women. The treated women showed higher levels of serum estradiol (49 +/- 34.43 versus 10 +/- 3.99, p < 0.0001) and CRP (0.11 +/- 0.06 vs. 0.24 +/- 0.12 mg/l, p < 0.05), lower waist/hip ratio (0.82 +/- 0.06 versus 0.83 +/- 0.05, p < 0.03), glucose (78 +/- 15.4 versus 85 +/- 14.3 mg/dl, p < 0.03), cholesterol (215 +/- 33.2 versus 236 +/- 33.7 mg/dl, p < 0.03), triglycerides (90 +/- 30.1 versus 106 +/- 47 mg/dl, p < 0.003) and calcium (9.4 +/- 0.4 versus 9.5 +/- 0.4 mg/dl, p < 0.0005) than postmenopausal women without hormone replacement. CONCLUSION: That HRT may have a favourable effect on atherogenic profile in apparently healthy postmenopausal women.

Influencia del tratamiento hormonal sustitutivo en el perfil aterogénico de la mujer postmenopáusica / Influence of estrogen replacement therapy on atherogenic profile in postmenopausal women

Objetivo: El riesgo cardiovascular se eleva en la mujer tras la menopausia. Este estudio pretende comparar el perfil aterogénico de las mujeres postmenopáusicas respecto a las premenopáusicas y valorar la influencia que el tratamiento hormonal sustitutivo ejerce sobre dicho perfil aterogénico. Método: Se seleccionan 76 mujeres climatéricas de 45 a 59 años y 15 mujeres con ciclos menstruales regulares de 40 a 45 años. Concluyen el estudio 63 mujeres con menopausia natural, normotensas, no diabéticas que no habían recibido previamente tratamiento hormonal sustitutivo ni fármacos con efecto sobre el sistema cardiovascular. El grupo control lo forman 15 mujeres sanas con ciclos menstruales regulares, de 40 a 45 años. Reciben durante 6 meses tratamiento hormonal 27 mujeres (50 microgramos de estradiol transdérmico y 100 milígramos de progesterona oral) y no lo reciben 36 de ellas. Se realiza al inicio del estudio y a los 6 meses exploración física (peso, talla, índice cintura/cadera) y determinaciones analíticas (bioquímica general, estrógenos, homocisteína, cobre, fibrinógeno y proteína C reactiva). Al grupo control sólo se le realizan las exploraciones iniciales. Resultados: Los subgrupos de mujeres postmenopáusicas según reciban o no tratamiento hormonal, presentan al inicio del estudio niveles de estradiol inferiores al grupo control (10 ± 3,99; 12 ± 4,56 vs. 83 ± 78,47 mg/l, p<0,0001) mientras que los niveles de colesterol total (236 ± 33,7; 228 ± 32,8 vs. 198 ± 30,2 mg/dl, p<0,002), LDL-colesterol (151 ± 34,2; 144 ± 31,5 vs. 120 ± 25 mg/dl, p<0,02), ácido úrico (4,6 ± 1; 4,8 ± 1 vs. 3,98 ± 0,5mg/dl, p<0,04) y homocisteína (13 ± 3,1; 11 ± 1,7 vs. 9,8 ± 3,3 mmol/l; p<0,02) son más elevados. En el subgrupo que recibe tratamiento hormonal, a los 6 meses del mismo, disminuye significativamente el índice cintura/cadera (0,83 ± 0,05 vs. 0,82 ± 0,06; p<0,03), los niveles de glucemia (85 ± 14,3 vs. 78 ± 15,4 mg/dl, p<0,03), colesterol total (236 ± 33,7 vs. 215 ± 33,2 mg/dl, p<0,03), triglicéridos (106 ± 47 vs. 90 ± 30,1mg/dl, p<0,003) y calcio (9,5 ± 0,4 vs. 9,4 ± 0,4 mg/dl, p<0,0005), y aumentan los de estrógenos (10 ± 3,99 vs. 49 ± 34,43 mg/l, p<0,0001) y de PCR (0,11 ± 0,06 vs. 0,24 ± 0,12 mg/l, p<0,05). Conclusión: El tratamiento hormonal sustitutivo parece mejorar el perfil aterogénico de la mujer postmenopáusica (AU)

Objective: Postmenopausal women have higher risk of cardiovascular events compared with premenopausal. The aim of this clinical study was to evaluate the effect of hormone replacement therapy (HRT) on the atherogenic profile in apparently healthy postmenopausal women. Method: The subjects were 76 healthy postmenopausal women, aged 45 to 59 years, and 15 premenopausal women with regular cycles, aged 40 to 45 years. 63 postmenopausal women completed the study. None of the participating women had a history of hypertension, diabetes mellitus or medications known to affect the cardiovascular system. Twenty seven postmenopausal women received daily 50 micrograms of transdermal estradiol and 100 milligrams of oral progesterone. Thirty six dit not receive HRT. Checkups were preformed at baseline and after six months of treatment, except the group of premenopausal women (only at baseline). Examinations consisted in measurement of body weight, length, waist/hip ratio and plasma levels of biochemical parameters. Results: Estradiol levels were higher among premenopausal women than among treated and non-treated postmenopausal women (83±78.47 versus 10±3.99; 12±4.56 mg/l, p<0.0001). Levels of serum cholesterol (198±30.2 versus 236±33.7; 228±32.8 mg/dl; p<0.002), LDL-cholesterol (120±25 versus 151±34.2; 144±31.5 mg/dl, p<0.02), uric acid (3.98±0.5 versus 4.6±1; 4.8±1 mg/dl, p<0.004) and homocysteine (9.8±3.3 versus 13±3.1; 11±1.7 mmol/l, p<0.02) were higher among postmenopausal women than among premenopausal women. The treated women showed higher levels of serum estradiol (49±34.43 versus 10±3.99, p<0.0001) and CRP (0.11±0.06 vs. 0.24±0.12 mg/l, p<0.05), lower waist/hip ratio (0.82±0.06 versus 0.83±0.05, p<0.03), glucose (78±15.4 versus 85±14.3 mg/dl, p<0.03), cholesterol (215±33.2 versus 236±33.7 mg/dl, p<0.03), triglicerides (90±30.1 versus 106±47 mg/dl, p<0.003) and calcium (9.4±0.4 versus 9.5±0.4 mg/dl, p<0.0005) than postmenopausal women without hormone replacement. Conclusion: That HRT may have a favourable effect on atherogenic profile in apparently healthy postmenopausal women (AU)

[Selective sentinel node biopsy in melanoma using preoperative lymphoscintigraphy location and intraoperative detection gamma probe]. / Biopsia selectiva del ganglio centinela en el melanoma mediante localización con linfogammagrafía preoperatoria y sonda de detección gamma intraoperatoria.

BACKGROUND: The experience in detection of sentinel lymph node in melanoma using preoperative scintigraphy and intraoperative gamma probe is referred. PATIENTS AND METHODS: We studied 60 patients with stage I-II melanoma who underwent sentinel lymph node biopsy performed using 99m-Tc-labelled sulphur colloid as radioactive tracer. A preoperative scintigraphy was performed and intraoperative gamma probe was used to localize the sentinel node in all cases. Scintigraphy results, effectiveness of intraoperative detection (technical efficacy), pathological results, and follow-up have been studied. RESULTS: Preoperative detection was 98.3% and the mean basin detected was 1.17. There were multiple basins especially when melanomas were on the trunk. Technical efficacy was 98.4% and intraoperative detection was more difficult in parotid gland region. HMB-45 immunohistochemical staining was essential in pathological studies, in whom 10% were positives. Lymphadenectomy could be avoided in 90% of the patients. Recurrences were not detected during follow-up and metastases were found only in non biopsied cases. Sentinel node biopsy morbidity was significative lesser than that of lymphadenectomy. CONCLUSIONS: Preoperative scintigraphy and intraoperative gamma probe use to localize sentinel node in melanoma have a high efficacy. They can reveal multiple basins and they allow a more selective surgical approach and a minimal dissection.