Efectos del feedback visual de la terapia del espejo sobre el dolor y la funcionalidad del miembro superior en el síndrome del túnel carpiano bilateral: ensayo clínico aleatorizado / Effects of visual feedback from mirror therapy on pain and upper limb functionality in bilateral carpal tunnel syndrome: A randomized clinical trial

Introducción y objetivos: La alta prevalencia del síndrome del túnel carpiano (STC), y la evidencia de no ser meramente una compresión local, implica considerar nuevos tratamientos. El catastrofismo asociado al dolor se relaciona con la intensidad del dolor en enfermedades con dolor crónico. Los objetivos planteados son evaluar los efectos que tiene la terapia del espejo (TE) en el dolor y la funcionalidad de las extremidades superiores, determinar si el catastrofismo se relaciona con la intensidad del dolor y comprobar si es un factor pronóstico de los efectos de la TE en los pacientes con STC bilateral. Material y métodos: Ensayo clínico aleatorizado, doble ciego. Participaron 18 sujetos que fueron divididos en 2 grupos: TE y grupo control. Realizaron un tratamiento de 8 semanas con ejercicios de dificultad progresiva, pero solo el grupo TE tuvo el feedback visual del espejo. Se evaluó el dolor (cuestionario del dolor McGill) y la funcionalidad de las extremidades superiores (cuestionario de discapacidad hombro, brazo y mano DASH) al inicio, la 2.a-4.a-8.a semana y el catastrofismo asociado al dolor (cuestionario del catastrofismo asociado al dolor) a nivel basal. Resultados: Se observó disminución del dolor (p=0,038), pero no mejoría de la funcionalidad de las extremidades superiores (p=0,062). Se encontró relación estadísticamente significativa entre el catastrofismo y la intensidad del dolor (p=0,018). Conclusiones: La TE disminuye el dolor, pero no mejora la función en las extremidades superiores; el catastrofismo se relaciona con la intensidad del dolor pero no es un factor pronóstico de los efectos de la TE en los pacientes con STC bilateral

Introduction and objectives: The high prevalence of carpal tunnel syndrome (CTS), and the evidence that it is not merely local compression, implies that new treatments should be considered. Pain catastrophizing is associated with diseases that involve chronic pain. The aims of this study were to assess the effects of mirror therapy (MT) on pain and upper extremity functionality, determine whether catastrophizing is related to the intensity of pain, and identify it as a prognostic factor for the effects of MT in patients with bilateral CTS. Material and methods: Double-blind randomized trial. The 18 participants were divided into two groups: MT and control group. All the participants underwent eight-week treatment with progressive difficulty exercises but only the MT group had visual feedback from the mirror. Pain (McGill pain questionnaire) and disability (Disabilities of the arm, shoulder and hand questionnaire DASH) were assessed at baseline, at the 2nd-4th-8th weeks, and pain-related catastrophizing (Pain catastrophizing questionnaire) was assessed at baseline. Results: A decrease in pain was observed (P=.038), but no improvement in the functionality of the upper limbs (P=.062). A statistically significant relationship was found between catastrophizing and intensity of pain (P=.018). Conclusions: MT decreases pain but does not improve upper limb function, catastrophizing is related to pain intensity, but it is not a prognostic factor after treatment with MT in patients with bilateral CTS

Estapedotomía mediante láser CO2: nuestra experiencia y resultados en régimen de Cirugía Mayor Ambulatoria / CO2 laser stapedotomy: our experience and results in a Day Care Surgery procedure

Introducción: El uso del láser en cirugía de la otosclerosis muestra buenos resultados de seguridad y eficacia en la literatura. Mostramos nuestra experiencia en esta cirugía. Métodos: Presentamos un estudio retrospectivo de 5 años (2010 a 2014) comparando la cirugía instrumental con estapedectomía y la estapedotomía láser CO2 , y la evolución del procedimiento a Cirugía Mayor Ambulatoria (CMA). Resultados: Revisamos 50 cirugías (28 estapedectomías instrumentales y 22 estapedotomías láser CO2 ; relación mujeres/hombres 1,17; edad media 44,95; umbral aéreo medio en 0,5 a 4 khz prequirúrgico de 62,02 decibelios (db) y Rinne medio 34,75 db. Los resultados audiométricos obtenidos fueron Rinne de 10 db o menor en el grupo instrumental frente a láser del 78,6 % y 77,3 %, con cierre del Rinne del 67,3 % frente un 74,5 % (p 0,67 y 0,35). Recogimos vértigo como complicación más prevalente y trascendente para la ambulatorización, con 35,7 % frente a 22,7 % (p 0,36). Iniciamos la ambulatorización de la estapedotomía láser con 16 casos de CMA (Grupo 1) frente 34 casos con ingreso (28 instrumentales y 6 láser, Grupo 2), con un índice de ambulatorización del 62,5 y 80 % en 2013 y 2014; tasa de ingresos 16,67 y 20 %, sin reingresos, y una estancia media hospitalaria de 0,2 días en el Grupo 1 frente a la 1,3 en el Grupo 2 (p < 0,001). Conclusiones: A pesar de la baja casuística los resultados son alentadores en seguridad y eficacia de la cirugía láser estapedial, con buena eficiencia para conversión a cirugía sin ingreso (AU)

Introduction: Laser in stapes surgery could improve in security and efficacy in reported studies. We expose our experience. Methods: A 5 years (2010 to 2014) retrospective study to assess instrumental stapedectomy versus CO2 laser stapedotomy in otosclerosis patients and evolution to in day surgery procedure. Results: We review 50 procedures (28 instrumental stapedectomy and 22 CO2 laser stapedotomy), ratio women/men 1,17, mean age 44.95 years, air threshold mean in 0.5 to kHz before surgery of 62.02 decibels (db) and mean of air/bone gap of 34.75 db. The audiologic results were an air/bone gap closure of 10 db or less in stapedectomy group versus laser stapedotomy group of 78.6 % and 77.3 %, with a air/bone gap mean closure of 67,3 % and 74.5 % (p 0.67 and 0.35 respectively). We compile vertigo as the most prevalent and important for day-care surgery possibility, with 35,7 % in first group versus 22.7 % (p 0,36). We reported 16 cases of day care stapedotomy (Group 1) and 34 cases with minimum one day hospitalization (28 instrumental stapedectomy and 6 laser stapedotomy, group 2), with a day-care index of 62,5 % y 80 % in 2013 and 2014 respectively, hospitalization index of 16.67 % and 20 %, without re-hospitalization, and a hospitalization day mean of 0,2 in Group 1 versus 1,3 in Group 2 (p < 0.001). Conclusions: Despite our low casuistry the results are encouraging regarding security and efficacy of laser stapedotomy and efficiency for its convertion to day-care surgery (AU)

Variablidad en las practices de higiene de manos entre profesionales y áreas asistenciales de un hospital comarcal / No disponible

OBJETIVO: Medir la adherencia a las recomendaciones en higiene de manos (HM) por categorías profesionales y servicios asistenciales en el hospital de Poniente de Almería. MÉTODOS: Estudio observacional descriptivo. Se observaron las prácticas en HM de los profesionales por evaluadores anónimos, según la metodología de la Organización Mundial de la Salud. RESULTADOS: Se estudiaron 332 profesionales. Se realizaron 1.018 observaciones. La tasa media de adherencia fue 23,6%. La UCI y la hemodiálisis obtuvieron 6,5 (OR ajustada: 0,15, IC 95% (0,08-0,27) y 3,2 veces (OR ajustada: 3,1, IC 95% (0,14-0,68)) más posibilidades respectivamente de realizar una correcta HM comparando con medicina interna. El momento 'después de contacto con fluidos' obtuvo 5,3 veces más probabilidades de HM (OR ajustada: 0,19; IC 95% (0,09-0,40)) comparado con 'tras contacto con el paciente'. CONCLUSIONES: La baja tasa de adherencia a las recomendaciones en HM supone dirigir campañas de concienciación a los profesionales de la mayoría de servicios asistenciales

OBJECTIVE: Measure the adherence to hand higiene (HH) recommendations among different healthcare workers and units in Poniente hospital of Almeria. METHODS: An cross-sectional study was developed. The research consisted in observing the hand hygiene practices of staff by anonymous observers, with the methodology proposed in WHO Guidelines on Hand Hygiene. RESULTS: A total of 1018 opportunities for hand hygiene were observed in 332 professionals. The mean compliance was 23,6% ICU and haemodialysis had 6,5 (adjusted OR: 0,15, IC 95% (0,08-0,27) and 3,2 (adjusted OR: 3,1, IC 95% (0,14-0,68)) higher a likely to comply with HH guidelines than medicine wards. The moment 'after contact with fluids' had 5,3 more likelihood to performance HH in comparison with 'after contact with patient' (adjusted OR: 0,19; IC 95% (0,09-0,40)). CONCLUSIONS: The low adherence observed of compliance to HH practices suggests that motivational campaigns focused on professional groups in the majority of wards could improve this situation

Basiliximab: a comparative study between the use of the recommended two doses versus a single dose in living donor kidney transplantation.

Basiliximab (Simulect) is a high-affinity chimeric and humanized monoclonal antibody, directed against the alpha chain of human interleukin-2 receptor (CD25). The administration of two doses (20 mg intravenously per dose), one given 2 hours before transplantation and the second on day 4 posttransplant, provides suppression of the interleukin-2 receptor for up to 45 days, reducing the rate of acute rejection in kidney transplantation. This study was designed to compare the efficacy of a single dose of Simulect to the recommended two doses. The other objective was the reduction of the costs related to the standard two dose protocol. Fifty-two patients were included: group I (32 patients) received two doses of Simulect; group II (20 patients) received one dose. There were 39 living related donors and 13 living unrelated. All patients were followed for 1 year. Maintenance immunosuppression consisted of tacrolimus or cyclosporine, mycophenolate mofetil, and steroids. The diagnosis of rejection was made clinically. All episodes were treated with intravenous steroids. The incidence of rejection was similar in both groups; there was no graft loss to rejection. There were two deaths in group I, and one death in group II, yielding graft and patient actual survival rates at 1 year of 93% and 95%, respectively. These results suggest that Simulect is equally effective when administered in two doses or in a single dose in kidney transplantation. The reduction of cost by giving a single dose is significant, especially in developing countries without national health insurance.

Expression of ICAM-1 and HLA-DR by human conjunctival epithelial cultured cells and modulation by nedocromil sodium.

It is unclear whether conjunctival epithelial cells participate in the development of immune-mediated events. Using a previously reported in vitro system of human conjunctival epithelium, we determined whether conjunctival epithelial cells express two relevant markers in the antigenic presentation process. Moreover, the potential capability of nedocromil sodium, an antiallergic and antiinflammatory drug, to modulate such expression was investigated. Primary cultures of human conjunctival epithelium and Chang conjunctival cells, incubated with or without 100 U/ml IL-1beta and/or IFNgamma for 1, 3 or 6 h, were simultaneously exposed to 10(-5) M nedocromil sodium. The expression of the intercellular adhesion molecule-1 (ICAM-1) and the human leukocyte antigen-DR (HLA-DR) was determined immunocytochemically. Constitutive expression of ICAM-1 and HLA-DR was observed in primary cultures and Chang cells and was minimally affected by incubation with IL-1beta and/or IFNgamma. The addition of nedocromil sodium resulted in complete abolition of HLA-DR expression and a notable reduction in ICAM-1 expression in primary cultures and Chang cells. These results suggest that epithelial cells from human conjunctiva constitutively express ICAM-1 and HLA-DR in vitro and that such expression is downregulated by nedocromil sodium. This may indicate that conjunctival epithelial cells may be another target for this drug.

A randomized comparison of surfactant dosing via a dual-lumen endotracheal tube in respiratory distress syndrome. The Spanish Surfactant Collaborative Group.

AIM: To determine if 1-minute instillation of Curosurf via a dual-lumen endotracheal tube without interruption of mechanical ventilation could decrease the incidence of hypoxia (drop in oxygen saturation [SaO2] to <80%, or of transcutaneous partial pressure of oxygen [PtcO2] to <50 mm Hg [6.6 kPa]) and bradycardia (heart rate below 80 beats/minute) at dosing, without affecting the efficacy of the standard bolus delivery. DESIGN: Prospective, multicenter, randomized, nonblinded clinical trial. SETTING: Neonatal intensive care units of the Spanish Surfactant Collaborative Group. PATIENTS AND METHODS: One hundred ninety-eight infants (birth weight 600-2000 g) with respiratory distress syndrome needing mechanical ventilation with a fraction of inspired oxygen [FIO2] 0.40 were randomized before 24 hours to receive 200 mg/kg of Curosurf, either by bolus instillation (n = 99) or by a simplified dosing technique (n = 99), giving the full dose in 1 minute via a dual-lumen endotracheal tube without positioning, interruption of mechanical ventilation, or bagging. Two additional doses (100 mg/kg) were given within 12 and 24 hours of first dose, by the same method, if the infant still needed mechanical ventilation and had a FIO2 0.30. The effects of both procedures on the incidence of acute adverse events at dosing, gas exchange, ventilator requirements, and outcome at 28 days were compared. RESULTS: Fewer episodes of hypoxia (18 vs 40% of doses), and a smaller decrease in heart rate and SaO2 were observed in the dual-lumen group. Efficacy of surfactant, based on improvement of oxygenation, ventilator requirements, and number of doses required, was similar in both groups. Infants in the dual-lumen group had a lower total time exposure to supplemental oxygen (195+/-199 vs 266+/-221 hours). No differences in the incidence of air leaks, intraventricular hemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia, or survival were observed. CONCLUSION: A simplified 1-minute Curosurf dosing procedure via a dual-lumen endotracheal tube without fractional doses, ventilator disconnection, changes in the infant's position, or manual bagging was found to reduce the number of dosing-related adverse transient episodes of hypoxia. Although the simplified method appeared to be as effective as bolus delivery, this should be confirmed in a larger trial.

Bilateral anophthalmia, esophageal atresia, and right cryptorchidism: a new entity?

We report on a child with bilateral anophthalmia, esophageal atresia, and cryptorchidism. This is the first case observed in the Spanish Collaborative Study of Congenital Malformations (ECEMC) with this constellation of congenital anomalies, and it is similar to that described in 1988 by Rogers. We think that it may constitute a new syndrome.

Effects of maternal bilateral adrenalectomy and betamethasone administration on fetal rat encephalic development.

The present study examined the effects of maternal bilateral adrenalectomy and betamethasone treatment on fetal encephalic development, in terms of fetal body weight, brain weight, DNA, protein and lipid content and morphological development. Both influenced the developmental time patterns of fetal brain and cerebellum. Fetuses of adrenalectomized rats had decreased body weights, whereas brain weight was not affected. Maternal adrenalectomy produces in fetal brain a decreased number of cells and increased cell size, while betamethasone treatment of adrenalectomized rats increased cell number, which was not different from control values; cell size remained lower than in control fetuses. Lipid content was increased in the fetuses of betamethasone-treated rats. In terms of morphological development, laminated structures (hippocampus and brain and cerebellar cortex) were the ones most affected.