Respiratory Complications of Adenotonsillectomy for Obstructive Sleep Apnea in the Pediatric Population.

OBJECTIVE: To determine the prevalence of respiratory complications in the early postoperative period of children with sleep apnea who required adenotonsillectomy at a tertiary pediatric hospital and to establish recommendations for postoperative monitoring. METHODS: Retrospective cohort study of children with obstructive sleep apnea (OSA) diagnosed by polysomnogram (PSG), who underwent adenotonsillectomy for treatment of OSA. The prevalence of respiratory complications in the first 24 postoperative hours was measured. Patients with craniofacial malformations, obesity, and severe cardiovascular comorbidities were excluded. The prevalence of postoperative respiratory complications was compared with the severity of OSA according to the Apnea Hypopnea Index (AHI) and NADIR. All data were taken in patients residing in Bogotá city, Colombia, at 2.640 meters above sea level (m.a.s.l). RESULTS: Between May 2014 and February 2017, 167 patients (108 males) required adenotonsillectomy for OSA, with an age range of 1 and 15 years (mean 5.3 years +/- 2.7). The prevalence of postoperative respiratory complications was 3.59% (6/167). There was a statistically significant relationship between the presence of respiratory complication and AHI greater than 44/h (p <0.04). There was an inverse correlation between the AHI and NADIR values. Risk groups of patients younger than 3 years and NADIR less than 70% had a higher prevalence of respiratory complications; however, this correlation was not statistically significant (p <0.08 and 0.89, respectively). CONCLUSIONS: The prevalence of respiratory complications in OSA patients undergoing adenotonsillectomy in high altitudes is similar to that reported in other heights. Preoperative AHI greater than 44/h could be considered a risk factor for early respiratory complication. We suggest ambulatory management after 6 hours in Postanesthetic Care Unit (PACU) observation in patients older than 3 years, with AHI less than 44/h and NADIR greater than 70% in altitudes higher than 2.500 m.a.s.l. Further research must be done to confirm this hypothesis.

Calidad de vida a los 6 meses tras un ictus / Quality of life 6 months after a stroke

Objetivo. Describir la calidad de vida (CV) de los pacientes a los 6 meses de evolución del ictus y su relación con variables sociodemográficas, clínicas y funcionales. Material y métodos. Estudio multicéntrico de cohortes longitudinal (n = 157). Los pacientes incluidos ingresaron en la fase subaguda tras un ictus en 2 Servicios de Rehabilitación. Se recogieron los siguientes datos a los 6 meses postictus: género, edad, riesgo social, comorbilidad, disfagia, afasia, estado cognitivo, depresión y grado de discapacidad evaluado mediante el índice de Barthel modificado. Se evaluó la influencia de estas variables en la CV, para lo que se empleó la escala específica de calidad de vida para el ictus ECVI-38. Resultados. La media de edad fue de 70,93 ± 11,85 años; fue significativamente superior en las mujeres. El paciente tipo presentó una elevada comorbilidad, un bajo riesgo social y dependencia moderada. La puntuación media total de la escala ECVI-38 fue de 35,30 ± 16,17 y los dominios más afectados los referentes a las actividades comunes y básicas de la vida diaria. Las variables que más se relacionan con la CV fueron el género, la afasia, la disfagia, la depresión, el déficit cognitivo y el estado funcional. El dolor de elevada intensidad estuvo presente en un 21% de los pacientes. Conclusión. Son muy diversas las variables que influyen en la CV del paciente con ictus que se deben considerar, para su potencial abordaje, en la planificación de las intervenciones rehabilitadoras (AU)

Objective. To describe quality of life (QoL) in patients at 6 months poststroke and its relationship with sociodemographic, clinical and functional characteristics. Material and method. This multicenter longitudinal cohort study (n = 157) included patients from 2 hospital rehabilitation services who were admitted for stroke in the subacute phase. The following data were gathered at 6 months poststroke: gender, age, social risk, comorbidity, dysphagia, aphasia, cognitive status, depression, and disability measured by the modified Barthel Index. The influence of these variables on QoL was evaluated using the stroke-specific quality of life scale, ECVI-38. Results. The mean age was 70.93 ± 11.85 years and was significantly higher in women. Most of the patients had high comorbidity, low social risk and moderate dependence. The mean total score on the ECVI-38 scale was 35.30 ± 16.17 and the most affected domains were those concerning common and basic activities of daily living. The variables associated with QoL were gender, aphasia, dysphagia, depression, cognitive impairment, and functional status. High-intensity pain was present in 21% of patients. Conclusion. Numerous variables influence QoL in patients with stroke and should be considered in the planning of rehabilitation interventions (AU)

Atención subaguda al paciente con ictus. Satisfacción y resultados / Subacute care of stroke-affected patients. Satisfaction and results

Objetivo: Conocer la satisfacción de los pacientes con ictus y sus cuidadores durante su hospitalización en rehabilitación y analizar la efectividad del tratamiento, el riesgo social y el destino del paciente al alta. Material y método: Estudio multicéntrico de cohorte longitudinal prospectivo. Se valoró el riesgo social (escala Gijón), la comorbilidad (índice de Charlson), la discapacidad (índice de Barthel), la efectividad del tratamiento rehabilitador, la satisfacción con la atención (cuestionario de Pound) y el destino al alta en 241 pacientes. De 119 cuidadores evaluados a los 6 meses postictus se recogieron la edad, el parentesco, las horas diarias dedicadas al cuidado y la satisfacción con la información/formación y con la accesibilidad del equipo rehabilitador. Resultados: El perfil del paciente era el de un varón de 71 años, con riesgo social bajo/intermedio, comorbilidad alta y dependencia total/severa. Un 27,1% vivían solos. El 96,6% referían estar satisfechos/muy satisfechos con el tratamiento, siendo menor la satisfación con la recuperación (80,3%). La efectividad fue de 32,5 ± 20,4. El 81,7% de los pacientes regresaron a su domicilio. La media de edad de los cuidadores fue de 58,8 ± 12,3 años y el 73,9% eran mujeres. La dedicación a los cuidados era superior a 6 h diarias en el 62%. El 89,9% de los cuidadores estaban satisfechos/muy satisfechos con la información recibida. Conclusiones: Los pacientes ingresados para tratamiento rehabilitador tras un ictus obtienen una ganancia funcional significativa durante su hospitalización y regresan a su domicilio en la mayoría de los casos. La satisfacción con el tratamiento rehabilitador y la información es elevada. Un campo especialmente mejorable es la formación del cuidador (AU)

Objective: To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. Material and method: Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. Results: The patient profile is a 71 year-old male, with low/intermediate social risk, high comorbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. Conclusions: Los pacientes ingresados para tratamiento rehabilitador tras un ictus obtienen una ganancia funcional significativa durante su hospitalización y regresan a su domicilio en la mayoría de casos. Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving

[Subacute care of stroke-affected patients. Satisfaction and results]. / Atención subaguda al paciente con ictus. Satisfacción y resultados.

OBJECTIVE: To determine the satisfaction of the stroke inpatients and their caregivers in Rehabilitation Service and to analyze the effectiveness, social risk, and discharge destination. MATERIAL AND METHOD: Prospective longitudinal cohort multicenter study. An analysis was made of the social risk (Gijón Scale), co-morbidity (Charlson Index), disability (Barthel Index), effectiveness of the rehabilitation treatment, satisfaction (Pound Questionnaire) and discharge destination of 241 patients. An evaluation was also made on 119 caregivers 6 months post-stroke, recording age, family relationship, time care-giving, satisfaction with the information/training, and accessibility to the rehabilitation team. RESULTS: The patient profile is a 71 year-old male, with low/intermediate social risk, high co-morbidity and total/severe dependence, with 27.1% living alone. Almost all (96.6%) of the patients claimed to be satisfied/very satisfied with the treatment, with satisfaction with the recovery being lower (80.3%). The effectiveness was 32.5 ± 20.4. Home was the discharge destination of 81.7% of the patients.The average age of the caregivers was 58.8 ± 12.3 years, and 73.9% were women. The time dedicated to care-giving was over 6 hours per day in the 62% of the cases. Being satisfied/very satisfied with the received information was recorded by 89.9% of the caregivers. CONCLUSIONS: Patients admitted for stroke rehabilitation achieve significant functional gain during hospitalization and return to their homes in most cases. The satisfaction with the rehabilitation treatment and received information is high. The training of the caregiver is an aspect that needs improving.

Rehabilitation efficiency and destination on discharge after stroke.

BACKGROUND: Predicting functional recovery of patients is key for setting the objectives of the rehabilitation programme and making decisions on their destination on discharge. Many variables have an impact on disability and quality of life after stroke, including patient age, comorbidity, severity of neurological deficit, state of mind and social risk. Accordingly, it is also essential from a care perspective to optimise the functional recovery and efficiency of rehabilitation programmes, exploring their relationship with these variables. AIM: To analyze the efficiency of post-stroke rehabilitation, identifying factors that most strongly influence functional recovery and destination on discharge. DESIGN: Multicentre prospective cohort study SETTING/POPULATION: All patients admitted to the Rehabilitation Units of the two hospitals after stroke over eight months METHODS: Collected data on sociodemographic characteristics, social risk (Gijón Scale), comorbidity (Charlson Index), neurological severity (National Institute of Health Stroke Scale), daily living functioning scale (Barthel Index), length of hospital stay and destination on discharge. RESULTS: We included 241 patients, with a mean stay of 35±22 days, 81.5% returning home on discharge. On admission 45.2% were totally dependent, and this figure fell to 12.8% on discharge, the mean Barthel Index score increasing by 32.5 points. Neurological severity, hemiparetic severity, impairment of deep sensation and trunk control on admission were the mayor variables influence on rehabilitation efficiency (P<0.001). Destination on discharge was most closely associated with civil status, social risk and Barthel Index score (P<0.001). The likelihood of transferring to residential care is 3- and 2.71-fold higher among patients with total dependence and high comorbidity scores, respectively. CONCLUSION: Many variables influence on outcomes of stroke inpatient rehabilitation. CLINICAL REHABILITATION IMPACT: Comprehensive assessments are required to predict patient recovery, efficiency and plan for discharge.

Relleno facial con ácido hialurónico: técnica de pilares y malla de sustentación. Principios básicos para obtener una remodelación facial / Facial filling with hyaloronic acid: pillars technique and supporting mesh. Basic principles to obtain a facial remodelling

Presentamos dos técnicas de relleno facial utilizando ácido hialurónico y los resultados obtenidos con este método desarrollado por nosotros en base a los principios físicos de sustentación, para optimizar y racionalizar el material de relleno y mejorar los resultados, especialmente la relación costo-beneficio. Hacemos también una presentación general de los principios básicos para conseguir remodelar el tejido cutáneo empleando técnicas de relleno facial. Señalamos la importancia de la evaluación clínica para llegar a un buen diagnóstico, haciendo hincapié en los límites de selección del paciente y enumeramos los puntos importantes y éticos en el uso de materiales de relleno (AU)

We present two techniques of facial injectable resorbable filling, using hyaluronic acid (HA), and the different results obtained with both methods, based on physical principles of sustentation, intending to demonstrate how these techniques can optimize and rationalize the use of the filling substance, contributing to enhance the results and cost-benefit relation. We also make a general presentation of the basic principles that remodel the cutaneous tissue using facial filling methods, as well as the importance of the clinical evaluation to achieve a fine diagnostic, emphasizing the limits when selecting the patient, listing the important and ethical points related to the use of facial filling procedures (AU)

Ictus y rehabilitación. Calidad metodológica de las guías de práctica clínica / Stroke and rthabilitation - Methodological quality of clinical practice guidelines

Objetivo. Las guías de práctica clínica (GPC) nos permiten disponer de recomendaciones basadas en las mejores evidencias científicas. La adhesión a GPC en la rehabilitación del ictus contribuye a mejorar la satisfacción de los pacientes y se asocia a una mayor recuperación funcional y calidad de vida. Valorar la calidad metodológica de las GPC relacionadas con el tratamiento rehabilitador del paciente tras un ictus es el objetivo de este estudio. Estrategia de búsqueda. Se ha realizado una revisión de las GPC publicadas en los últimos 4 años mediante búsqueda electrónica en páginas web de Organismos elaboradores o almacenadores de GPC, así como en Medline y en bases datos específicas de rehabilitación. La calidad metodológica de las guías fue valorada por tres autores, de forma independiente, utilizando la versión en castellano del instrumento AGREE. Síntesis de resultado. Un total de 10 guías fueron incluidas, destacando la buena calidad de la mayoría de ellas, y especialmente de la guía londinense RCP, la italiana SPREAD y la escocesa SIGN. En nuestro país destaca la guía catalana del ictus, la única de calidad en castellano. El área de claridad y presentación y la de aplicabilidad fueron las de mejor y peor calidad, respectivamente, en la mayoría de guías. Conclusiones. Disponemos en Internet de excelentes guías de práctica clínica relacionadas con el tratamiento rehabilitador del paciente con ictus a nivel internacional, y de una única guía nacional de buena calidad. Las áreas de aplicabilidad e independencia editorial son las que más deben mejorarse en las guías (AU)

Objective. Good Clinical Practice (GCP) guidelines make it possible for us to have the best scientific evidence based recommendations. Adherence to GCP in post-stroke rehabilitation contributes to the improvement of patient satisfaction and is associated with greater functional recovery and quality of life. This article has aimed to assess the methodological quality of existing guidelines for post-stroke rehabilitation. Search strategy. A review was made of the guidelines published over the last four years by means of an electronic search in different web pages of Medline and other rehabilitation database and through Guideline Clearinghouses. The methodological quality of the guidelines was assessed by three authors independently using the Spanish version of the AGREE instrument. Synthesis of results. A total of 10 guidelines were included. The good quality of most of them stands out, especially that of the London guideline RCP, the Italian SPREAD and the Scottish SIGN. In Spain, the Catalonia stroke guideline stands out, it being the only quality guideline published in Spanish. Most guidelines had excellent clarity and presentation. However, applicability had the worst score in the AGREE domain. Conclusions. Excellent clinical guidelines for post-stroke rehabilitation on an international level and only one Spanish guideline of good quality are available on the Internet. The domains of applicability and editorial independence are the areas that need the most improvement in the guidelines (AU)

Escuela de espalda. Nuestra experiencia / Back school. Our experience

Introducción. Los objetivos del presente trabajo son conocer el perfil clínico, funcional y de calidad de vida de los pacientes atendidos en la escuela de espalda (EE), su evolución a los 6 meses, su opinión y grado de satisfacción. Pacientes y métodos. Se realizó una valoración inicial a 220 pacientes que incluyó las siguientes variables: sociodemográficas, clínicas, escala analógica visual (EAV), situación funcional (escala Oswestry), y calidad de vida (test SF-36). Además se les entregó un cuestionario de satisfacción y opinión. A los primeros 116 pacientes que completaron el programa se les realizó de forma prospectiva una valoración clínica, funcional y de calidad de vida a los 6 meses. Resultados. Un 80 % de los pacientes tenían antecedente de lumbalgia previa. La puntuación media en la EAV fue 3,93 y de 3,54 a los 6 meses. No se obtuvo una variación significativa en las medias del Oswestry al sexto mes respecto a las iniciales, y sí en 5 categorías del SF-36. El 96 % de los pacientes refiere estar satisfecho tras su paso por la EE. Cuarenta pacientes aportaron sus opiniones y/o sugerencias en la encuesta. Conclusiones. Los pacientes atendidos en la EE refieren un alto nivel de satisfacción y cambio de actitud ante el dolor. Tras pasar por la EE no se objetiva una mejoría significativa en la intensidad del dolor o en la realización de las actividades de la vida diaria, y sí en algunas facetas de la calidad de vida

Introduction. This study aims to know the clinical and functional profile as well as the quality of life of patients attended in the back school, their evolution at six months, their opinion and degree of satisfaction. Patients and methods. An initial appraisal was carried out with 220 patients, which included, among others, the following variables: sociodemographic, clinical, visual analogue scale (VAS), functional state (Oswestry scale), and quality of life (SF-36 test). A satisfaction and opinion questionnaire was given to all of them. At six months a clinical, functional and quality of life prospective evaluation was carried out with the 116 patients who completed the program during the first year and a half after starting the back school activity. Results. 80 % of the patients had previous history of low back pain. Mean score in the VAS was 3.93 and 3.54 at six months. We did not obtain a significant change in the mean score of the Oswestry test at the sixth month, in relation to the initial score, but we obtained it in five categories of the SF-36 test. 96 % of the patients reported being satisfied after taking part in the back school. Forty patients gave their opinions and/or suggestions in the questionnaire. Conclusions. The patients attended in the back school report high level of satisfaction and a change in their attitude towards pain. After taking part in the back school, a significant improvement in the intensiveness of pain or in making their activities of daily living is not seen, but this improvement is shown in some facets of quality of life

Brachioplasty technique with the use of molds.

Over previous years many surgical techniques have been developed to correct lipodystrophy and brachial skin laxity while providing a natural, discreet contour and symmetrical scars, a goal that has not always been achieved. In this study, the authors classify the alterations of the arm into three degrees and propose a different surgical treatment, to be used alone or associated with another procedure, for each classification. They developed a new technique that uses a mold to mark the incision in an italic double S-shape. From 1996 to 1998, 20 patients who underwent this surgery showed symmetrical and smaller scars with better results and minimal complications.

Breast reduction: shortening scars with liposuction.

The authors describe a mammaplasty reduction technique they believe is safe due to modern cutaneous resection and adequate areolar nourishment. It is made possible by maintaining a large pedicule which is also versatile since it can be used on all kinds of breasts. Good results can be reproduced by other surgeons.