Fracaso de un anticuerpo monoclonal anti-CGRP en el tratamiento de la migraña. ¿Tiene sentido probar otro? / Failure of an anti-CGRP monoclonal antibody in the treatment of migraine. Is it worthwhile trying another one?

Introducción: La migraña es una enfermedad neurológica altamente prevalente y la búsqueda de un tratamiento eficaz que mejore la calidad de vida del paciente es fundamental. En 2018 se aprobaron en España los anticuerpos monoclonales anti-CGRP como tratamiento preventivo, y han demostrado eficacia al reducir el número de crisis de migraña al mes frente a placebo. Pacientes y métodos: Estudio descriptivo y retrospectivo de 14 pacientes con migraña episódica de alta frecuencia y crónica, en seguimiento en nuestra unidad de cefaleas, en los que se ha realizado el cambio de un monoclonal anti-CGRP por ineficacia. Se han recogido datos epidemiológicos y variables relacionadas con la respuesta a ambos fármacos, como los días de cefalea al mes y los días de migraña al mes, además de escalas validadas de calidad de vida (Migraine Disability Assessment Scale y Headache Impact Test-6). Resultados: El 50% de los pacientes son varones, con una mediana de edad de 46,5, y el 92% estaba diagnosticado de migraña crónica. Se realizó un seguimiento de entre seis y 12 meses tras el cambio de tratamiento en el 91,6%, y se observó mejoría significativa en el 33% de los pacientes. Además, en el 50% se objetivó respuesta inicial tras tres dosis con el primer monoclonal. Conclusiones: En nuestra serie, el 66% de los pacientes que no respondieron a un primer fármaco respondió inicialmente al cambio, y esta mejoría se mantuvo en el 36%. Se precisan estudios más amplios para aclarar esta diferencia de respuesta a los distintos anticuerpos monoclonales anti-CGRP.(AU)

Introduction: Migraine is a highly prevalent neurological disease and the search for an effective treatment to improve the patient’s quality of life is essential. In 2018, anti-CGRP monoclonal antibodies were approved in Spain as a preventive treatment, and have proved to be effective in reducing the number of migraine crisis per month compared to placebo. Patients and methods: We conducted a descriptive and retrospective study of 14 patients suffering from high-frequency or chronic episodic migraine, under follow-up in our headache unit, in whom an anti-CGRP monoclonal was changed due to its ineffectiveness. Epidemiological data and variables related to the response to both drugs were collected, such as headache days per month and migraine days per month, as well as validated quality of life scales (Migraine Disability Assessment Scale and Headache Impact Test-6). Results: 50% of patients were males, with a median age of 46.5 years and 92% were diagnosed with chronic migraine. A follow-up of 6 to 12 months after the change of treatment was performed in 91.6% and significant improvement was observed in 33% of the patients. In addition, 50% had an initial response after three doses of the first monoclonal drug. Conclusions: In our series, 66% of patients who did not respond to a first drug responded initially to the switch and this improvement was maintained in 36% of them. Larger studies are needed to clarify this difference in response to different anti-CGRP monoclonal antibodies.(AU)

[Failure of an anti-CGRP monoclonal antibody in the treatment of migraine. Is it worthwhile trying another one?] / Fracaso de un anticuerpo monoclonal anti-CGRP en el tratamiento de la migraña. ¿Tiene sentido probar otro?

INTRODUCTION: Migraine is a highly prevalent neurological disease and the search for an effective treatment to improve the patient's quality of life is essential. In 2018, anti-CGRP monoclonal antibodies were approved in Spain as a preventive treatment, and have proved to be effective in reducing the number of migraine crisis per month compared to placebo. PATIENTS AND METHODS: We conducted a descriptive and retrospective study of 14 patients suffering from high-frequency or chronic episodic migraine, under follow-up in our headache unit, in whom an anti-CGRP monoclonal was changed due to its ineffectiveness. Epidemiological data and variables related to the response to both drugs were collected, such as headache days per month and migraine days per month, as well as validated quality of life scales (Migraine Disability Assessment Scale and Headache Impact Test-6). RESULTS: 50% of patients were males, with a median age of 46.5 years and 92% were diagnosed with chronic migraine. A follow-up of 6 to 12 months after the change of treatment was performed in 91.6% and significant improvement was observed in 33% of the patients. In addition, 50% had an initial response after three doses of the first monoclonal drug. CONCLUSIONS: In our series, 66% of patients who did not respond to a first drug responded initially to the switch and this improvement was maintained in 36% of them. Larger studies are needed to clarify this difference in response to different anti-CGRP monoclonal antibodies.

TITLE: Fracaso de un anticuerpo monoclonal anti-CGRP en el tratamiento de la migraña. ¿Tiene sentido probar otro?Introducción. La migraña es una enfermedad neurológica altamente prevalente y la búsqueda de un tratamiento eficaz que mejore la calidad de vida del paciente es fundamental. En 2018 se aprobaron en España los anticuerpos monoclonales anti-CGRP como tratamiento preventivo, y han demostrado eficacia al reducir el número de crisis de migraña al mes frente a placebo. Pacientes y métodos. Estudio descriptivo y retrospectivo de 14 pacientes con migraña episódica de alta frecuencia y crónica, en seguimiento en nuestra unidad de cefaleas, en los que se ha realizado el cambio de un monoclonal anti-CGRP por ineficacia. Se han recogido datos epidemiológicos y variables relacionadas con la respuesta a ambos fármacos, como los días de cefalea al mes y los días de migraña al mes, además de escalas validadas de calidad de vida (Migraine Disability Assessment Scale y Headache Impact Test-6). Resultados. El 50% de los pacientes son varones, con una mediana de edad de 46,5, y el 92% estaba diagnosticado de migraña crónica. Se realizó un seguimiento de entre seis y 12 meses tras el cambio de tratamiento en el 91,6%, y se observó mejoría significativa en el 33% de los pacientes. Además, en el 50% se objetivó respuesta inicial tras tres dosis con el primer monoclonal. Conclusiones. En nuestra serie, el 66% de los pacientes que no respondieron a un primer fármaco respondió inicialmente al cambio, y esta mejoría se mantuvo en el 36%. Se precisan estudios más amplios para aclarar esta diferencia de respuesta a los distintos anticuerpos monoclonales anti-CGRP.

European consensus statement on essential colposcopy.

This European consensus statement on essential colposcopy provides standards for the general colposcopist seeing women referred for colposcopy with an abnormal cervical screening test (including cytology and HPV tests) or with a clinically suspicious cervix. The article gives guidance regarding the aims and conduct of colposcopy. Recommendations are provided on colposcopy technique, the management of common colposcopy issues, treatment and follow-up of after treatment of CIN or early stage cervical. Colposcopists should make an informed decision on the management of each individual that is referred and organize appropriate follow-up. Cervical cancer is still a major health issue and the quality of care can only improve if there is a structured guidance for women with an abnormal smear or suspicious cervix.

Case fatality of COVID-19 in patients with neurodegenerative dementia. / Análisis de letalidad por COVID-19 en pacientes con demencia neurodegenerativa.

INTRODUCTION: The elderly population is the group most threatened by COVID-19, with the highest mortality rates. This study aims to analyse the case fatality of COVID-19 in a cohort of patients with degenerative dementia. METHODS: We conducted a descriptive case-control study of a sample of patients diagnosed with primary neurodegenerative dementia. RESULTS: Twenty-four of the 88 patients with COVID-19 included in the study died: 10/23 (43.4%) patients diagnosed with dementia and 14/65 (21.5%) controls; this difference was statistically significant. DISCUSSION: Our results suggest that case fatality of COVID-19 is significantly higher among patients with primary degenerative dementia than in other patients with similar mean ages and comorbidities.

[Case fatality of COVID-19 in patients with neurodegenerative dementia]. / Análisis de letalidad por COVID-19 en pacientes con demencia neurodegenerativa.

Introduction: The elderly population is the group most threatened by COVID-19, with the highest mortality rates. This study aims to analyse the case fatality of COVID-19 in a cohort of patients with degenerative dementia. Methods: We conducted a descriptive case-control study of a sample of patients diagnosed with primary neurodegenerative dementia. Results: Twenty-four of the 88 patients with COVID-19 included in the study died: 10/23 (43.4%) patients diagnosed with dementia and 14/65 (21.5%) controls; this difference was statistically significant. Discussion: Our results suggest that case fatality of COVID-19 is significantly higher among patients with primary degenerative dementia than in other patients with similar mean ages and comorbidities.

Autoconcepto, actividad física y sustancias nocivas: un modelo de ecuaciones estructurales / Self-Concept, Physical Activity and Harmful Substances: A Model of Structural Equations

La presente investigación pretende definir y contrastar un modelo explicativo del consumo de alcohol y tabaco, y la práctica de actividad física en función de las cinco dimensiones del autoconcepto en una muestra de 2.134 adolescentes de la provincia de Granada (España). Los instrumentos empleados fueron el Cuestionario de Autoconcepto Forma-5, Test para la Identificación de Trastornos en el Uso de Alcohol-AUDIT, Test para la Dependencia a la Nicotina-FTND y un cuestionario ad-hoc para controlar la práctica de actividad física. En esta investigación se planteó un modelo de ecuaciones estructurales que se ajustó de forma adecuada (χ2 = 79,476; gl = 8; p = 0,000; CFI = 0,968; NFI = 0,964; IFI = 0,968; RMSEA = 0,065). Los resultados obtenidos muestran una relación positiva entre el consumo de alcohol y el consumo de tabaco, y relaciones negativas entre el autoconcepto familiar, emocional y académico con el consumo de alcohol

The present research aims to define and contrast an explanatory model of alcohol and tobacco consumption, and the practice of physical activity according to the five dimensions of self-concept in a sample of 2.134 adolescents from the province of Granada (Spain). The instruments used were the Self-concept Questionnaire Form-5, Test for the Identification of Disorders in the Use of Alcohol-AUDIT, Test for the Nicotine-FTND Unit and an ad-hoc questionnaire to control the practice of physical activity. In this research, a model of structural equations was presented that was adjusted appropriately (χ2 = 79.476, gl = 8, p = 0,000, CFI = 0,968, NFI = 0,964, IFI = 0,968, RMSEA = 0,065). The results obtained show a positive relationship between alcohol consumption and tobacco consumption, and negative relationships between family, emotional and academic self-concept with alcohol consumption

Motivación en la práctica del judo en deportistas no profesionales / Motivation of judo practice in non-professional athlete

El presente estudio tiene como objetivo determinar y analizar las relaciones y diferencias existentes entre el clima motivacional, en base al nivel competitivo en judocas no profesionales. Participaron un total de 121 judocas chilenos no profesionales (70 hombres y 51 mujeres) con edades comprendidas entre los 18 y 40 años, provenientes de siete clubes de judo. Completaron una hoja de autoregistro de variables sociodemográficas y un cuestionario de clima motivacional (PMCSQ-2). Los resultados indican que en los judocas aficionados predomina el clima tarea y a medida que se asciende en el nivel, en deportistas amateurs cobra una mayor importancia el clima ego. Como principal conclusión destaca que los judocas amateurs distinguen en mayor proporción la diferencia entre la superación personal y el esfuerzo (clima tarea) y demuestran mayor habilidad física que los demás. Al contrario que sucede en los aficionados, donde la correlación entre ambos es inferior, aunque sigue siendo negativa

The aim of this study is to determine and analyse the relationships and differences in the motivational climate, based on the competitive level in non-professional judokas. A sample of 121 non-professional Chilean judokas (70 men and 51 women) aged between 18 and 40, coming from seven different judo clubs took part. They completed a self-registration sheet of sociodemographic variables and a motivational climate questionnaire (PMCSQ-2). The results indicate that the task goal orientation prevails in non-professional judokas and as the level rises, in amateur athletes the ego goal orientation takes on greater importance. The main deduction is that amateur judokas distinguish in a greater proportion between personal improvement and effort (task goal orientation) and show a greater physical ability than others.This is opposed to what happens with non-professionals, where the correlation between both is lower, although still negative

Estudio comparativo de la incidencia de abscesos de pared abdominal en niños intervenidos quirúrgicamente por apendicitis aguda: tratamiento convencional vs con suturas recubiertas de antiséptico o con apósitos impregnados de antibiótico / Prospective study comparing the incidence of wound infection following appendectomy for acute appendicitis in children: conventional treatment versus using reabsorbable antibacterial suture or gentamicin impregnated collagen fleeces

La infección de la herida, tras la apendicectomía en la infancia, esun problema frecuente y que produce trastornos muy molestos. Revisamos prospectivamente a los niños operados por apendicitis aguda, con técnicas quirúrgicas convencionales, durante un período consecutivo de 9 meses (Grupo Control: 58 pacientes), y a los niños intervenidos durante los 9 meses siguientes, bajo las mismas circunstancias quirúrgicas excepto utilizar, de manera aleatoria, sutura recubierta de antiséptico (Vicryl Plus®, Ethicon Johnson & Johnson Medical), para el cierre de la pared abdominal en un Subgrupo o esponja de colágeno impregnada en gentamicina (Collatamp EG®, Acuña Fombona, S.A.;Schering-Plough, S.A.), introducida entre la musculatura de la incisión, en el otro Subgrupo (Grupo Estudio: 101 pacientes).Estudiamos en los dos grupos, fundamentalmente, la incidencia de abscesos de pared y la estancia media hospitalaria. La introducción de suturas recubiertas de antiséptico y/o esponja de colágeno impregnada en gentamicina, en el cierre de la herida quirúrgica postapendicectomía, ha contribuido a reducir de manera estadísticamente significativa la incidencia de abscesos de pared y de la estancia media hospitalaria de los niños incluidos en el Grupo Estudio, con respecto a los pertenecientes al Grupo Control (AU)

Postappendectomy wound infection is frequent in the pediatric age. It causes them important discomfort. We have conducted a prospective clinical study to evaluate this incidence under different surgical management. The subjects were children undergoing appendectomy for acute appendicitis. The patients belonging to the Control Group were operated, by standard surgical technique, along the first 9 months of the study period (n: 58).The Study Group was constituted by 101 children operated during the 9 consecutive months, identical on the basis of demographics and operations undergone, except for the use of, in an aleatory manner, sutures with antiseptic impregnation (Vicryl Plus®, Ethicon Johnson& Johnson Medical), to close the incision in children included in Study Sub-Group A, or gentamycin-containing collagen sponge (CollatampEG®, Acuña Fombona, S.A.; Schering-Plough, S.A.), placed within the muscles before wound closure,. In the children belonging to the Study Sub-Group B. We have analyzed in the two Groups the incidence of postoperative wound infection and the mean Hospital stay. The use of sutures with antiseptic impregnation and/or gentamycin containing collagen sponge, significantly reduced the wound infection rates in the children operated on for appendectomy included in the Study Group, compared with the ones in the Control Group, therefore contributing to decrease the Hospital length of stay (AU)

Extracción de dispositivos intrauterinos (DIU) con control histeroscópico / Hysteroscopic retrieval of intrauterine device (IUD)

Cuando los hilos guía del Dispositivo intrauterino (DIU) no son visibles, el primer paso es la localización ecográfica, que será resolutiva en la mayoría de los casos; a veces será preciso recurrir a la radiografía. La localización y extracción histeroscópica es considerada hoy el método mas seguro y efectivo para la retirada del DIU. En caso de embarazo con DIU con hilos no visibles, se recomienda retirar el DIU, la histeroscopia es el mejor método, la guía ecográfica puede ser útil para mejorar los resultados de la extracción del DIU. La fragmentación del DIU puede ocurrir espontáneamente o durante su extracción. Se recomienda el diagnóstico y extracción de los fragmentos por histeroscopia

If the thread of intrauterine advice is not visible in the cervical canal, ultrasonography is capable of localizing the IUD in most of the cases, in some positive identification will be necesary radiography. The hysteroscopic localization and extraction was found to be the safest and most effective method of retrieval. In case of pregnancy with intrauterine advice is recommended to remove the advice, hysteroscopic is the best method, ultrasonic guidance can be useful to improve the hysteroscopic remove. Fragmentation of the intrauterine contraceptive device was observd during spontaneous expulsion and during extraction. Hysteroscopic diagnosis and extacction of the fragment is recommended. Odl intrauterine device embebed in the wall of the uterus can be the origing of abdominal pain, abnormal uterine bleeding and infertility, hysteroscopy have a first line role in retrieval of misplaced IUD

Histeroscopia diágnostica y hemorragia uterina disfuncional / Diagnostic hysteroscopy and disfunctional uterine bleeding

La hemorragia uterina disfuncional suponeun tercio de las consultas ginecológicas. La histeroscopiamejora el diagnóstico, disminuye loscostes y las molestias a la paciente con consultassucesivas.La histeroscopia diagnóstica tiene ventajassobre otras técnicas de imagen: Posibilita unavisión directa de la cavidad permite realizarbiopsias dirigidas. para asegurar el diagnóstico.Frente al legrado tradicional: Biopsia dirigida,visualización directa de la cavidad y posibilidadde tratamiento de algunas patologías organicasen le mismo acto (pequeños pólipos ymiomas), ténica ambulatoria y no precisa anestésia.El empleo mas frecuente de la histeroscopiapodría disminuir las histerectomías (20% se realizanpor hemorragia uterina disfuncional).Frente al legrado tiene la ventaja de realizarla biopsia dirigidas, no precisa anestesia, técnicaambulatoria y permite la extirpación de pequeñaslesiones intracavitarias. La histeroscopia tiene mayor sensibilidad yespecificidad que la histerosonografía. La evaluaciónde la hemorragia uterina disfuncionalse basa en la historia clínica, explación, ecografíay/o hiateroscopiay biopsia dirigida de endometrio.Cada centro adecuará a sus medios y experienciaen las diferentes técnicas, el protocolo aseguir en el estudio de la HUD.Lo más aceptado es el cribado previo con histerosonografía.Las imágenes histeroscópicas deben ser confirmadaspor biopsia dirigida. Aunque la histeroscopiaes invasiva, tiene un coste, es dificultosacuándo existe sangrado activo y requiereuna curva de aprendizaje; con experiencia, elcoste-beneficio es positivo para el manejo de laHUD

Dysfuntional uterine bleeding cause onethird of gynecologic consultation.Diagnostic hysteroscopy can improve thediagnosis, saving cost and disturbances to thepatiens.A wider use of dignostical hysteroscopy canget a significant reduction in the number of hysterectomies performed ( 20% indications aredysfuntional bleeding).Hysteroscopy have same advantages in frontof other image thecniques: Direct vision of endometrialcavity, and the possibility of guidedbiopsy, for histologycal diagnostic. Advantagesin front traditional curettage: Guided endometrialbiopsy, intrauterine image, posssibility oftreatment of same organic patologies,smallmyomas and endometrial polyps, ambulatoryand doesn’t need anaesthesia.A wide use of dignostical hysteroscopy canget a significant reduction in the number ofhysterectomies performed (20% indications aredysfuntional bleeding).Diagnostic hysteroscopy have higher sensitivityand specifity than sonohysterography.Evaluation of patients with dysfuntional uterinebleeding is achieved with, history, physicalexamination, uterine imagine with sonographictechniques and/or hysteroscopy and endometrialsampling. Diagnostic work-up is based ussualyin vaginal ultrasound. Each work centerdependding of the skills and accesibility to hysteroscopyor sonohysteroscopy should decidefirst elective technique.Visual hysteroscopy diagnosctic must be confirmedby guided endometrial sampling.Even if diagnostic hysteroscopy is invasive,and have a economical cost, skills nedded, andlearning curve; with experience, profit-cost hasa positive resault in a work up of dysfuntionaluterine bleedind

[Cantrell's pentalogy: complete treatment, step by step]. / Pentalogía de Cantrell: tratamiento completo, paso a paso.

Since MAYOR and CANTRELL described in 1953 and in 1958 the ectopia cordis associated to other four anomalies, few cases have been reported, and only a small part of them have survived. We report the case of a neonate who presented with the features of the pentalogy. On the 3rd day we found at operation the heart laying over the left hepatic lobe, no pericardium could be identified and diaphragm was absent at its anterior edge. We made an "isolating sac" with duramadre fixed to the anterior thoracic wall, to both sides and to the posterior diaphragmatic defect. The initial management of the ventral defect is described. At the age of two years we initiated the definitive treatment aiming to: 1. To protect the heart. 2. To correct the huge abdominal eventration following the closure of the omphalocele. We described in details the technic employed to cover the precordial defect, to reconstruct the diaphragm, and finally as we treated in three consecutives stages the huge abdominal eventration.

[Volvulus of the small intestine. Contribution of abdominal echography to early diagnosis]. / Volvulo de intestino delgado. Contribucion de la ecografia abdominal al diagnostico precoz.

We report six cases of small intestine volvulus associated to malrotation, out of a whole of 11 volvulus managed by us in the last six years. None of them were diagnosed with the only help of clinical and conventional radiological explorations. In the other three cases the diagnosis was made through ultrasounds explorations: It showed the mesenteric vein on the left side of the mesenteric artery. Confirmation and resolution of the cases were reached with a laparotomy.

[Ectopic gastric mucosa in the proximal esophagus]. / Mucosa gástrica ectópica en esófago proximal.

Gastric mucosa is not found often in the proximal and medial esophagus. Hematemesis and dysphagia are the most frequent symptoms. We report a six year-old child who complained of difficulty in swallowing. A filling defect was detect in the esophagogram. We biopsied the suspected area, through an endoscopy and the pathological examination informed of ectopic gastric mucosa. We performed a 99Tc isotopic study. The child is on ambulatory controls and at the moment is asymptomatic.