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Mixed oxides featuring perovskite-type structures (ABO3) offer promising catalytic properties for applications focused on the control of atmospheric pollution. In this work, a series of BaxMnO3 (x = 1, 0.9, 0.8 and 0.7) samples have been synthesized, characterized and tested as catalysts for CO oxidation reaction in conditions close to that found in the exhausts of last-generation automotive internal combustion engines. All samples were observed to be active as catalysts for CO oxidation during CO-TPRe tests, with Ba0.7MnO3 (B0.7M) being the most active one, as it presents the highest amount of oxygen vacancies (which act as active sites for CO oxidation) and Mn (IV), which features the highest levels of reducibility and the best redox properties. B0.7M has also showcased a high stability during reactions at 300 °C, even though a slightly lower CO conversion is achieved during the second consecutive reaction cycle. This performance appears to be related to the decrease in the Mn (IV)/Mn (III) ratio.
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AIM: To evaluate the efficacy, safety, structural and functional progression following the insertion of iStent inject ® implants in patients with open-angle glaucoma or ocular hypertension at a tertiary-level hospital. MATERIALS AND METHODS: A retrospective study included 98 eyes (57 males and 41 females) with open-angle glaucoma or ocular hypertension, which underwent iStent inject W® implantation (Glaukos, Corporation, CA) between December 2018 and December 2022. Differences in intraocular pressure (IOP), the number of hypotensive eye drops used, and structural and functional tests were assessed between preoperative values and subsequent reviews during a follow-up period of one (nâ¯=â¯98), two (nâ¯=â¯55), and three years (nâ¯=â¯15) after surgery. RESULTS: Among the 98 eyes studied, 85% were diagnosed with open-angle glaucoma (50% mild, 32% moderate, and 18% severe) and 15% with ocular hypertension. There was a statistically significant reduction in IOP compared to preoperative values for all visits except the 1-month (pâ¯=â¯0.36) and 3-year (pâ¯=â¯0.39) visits. Visual acuity increased from 0.39⯱â¯0.25 to 0.72⯱â¯0.24 (pâ¯<â¯0.01), considering that a significant portion of the interventions included cataract surgery. Before surgery, 66% of the sample used 2 or more hypotensive medications. Post-surgery, the number of hypotensive medications decreased (from 1.88⯱â¯0.84 to 0.21⯱â¯0.59 at 3 years) (pâ¯<â¯0.01), with an 88.9% reduction in the number of medications over three years. After surgery, 75% of cases did not require any medication. Regarding structural and functional tests, thickness of retinal nerve fiber layers (RNFL (pâ¯=â¯0.35), excavation / papilla ratio E/P (pâ¯=â¯0.31), visual function index (VFI (pâ¯=â¯0.06), and deviation mean (MD (pâ¯=â¯0.06) showed no statistically significant differences post-intervention. However, standard deviation of the pattern (DSM) did exhibit differences, decreasing from 5.46⯱â¯4.03â¯dB to 5.34⯱â¯3.48â¯dB (pâ¯=â¯0.02). CONCLUSION: The results of this study suggest that the iStent inject W® technique constitutes an effective and safe option for tension control and glaucoma treatment.
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Preoperative localization of parathyroid pathology, generally a parathyroid adenoma, can be difficult in some cases due to the anatomical variants that these glands present. The objective of this review is to analyse the different imaging techniques used for preoperative localization of parathyroid pathology (scintigraphy, ultrasound, CT, MRI and PET). There is great variability between the different tests for the preoperative localization of parathyroid pathology. The importance of knowing the different diagnostic options lies in the need to choose the most suitable test at each moment and for each patient for an adequate management of primary hyperparathyroidism (PHP) with surgical criteria.
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Neoplasias de las Paratiroides , Humanos , Neoplasias de las Paratiroides/diagnóstico por imagen , Ultrasonografía/métodos , Diagnóstico por Imagen/métodos , Hiperparatiroidismo Primario/diagnóstico por imagen , Glándulas Paratiroides/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Enfermedades de las Paratiroides/diagnóstico por imagenRESUMEN
BACKGROUND AND OBJECTIVES: cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. MATERIALS AND METHODS: Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. RESULTS: 112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, pâ¯=â¯0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, pâ¯=â¯0.001) and heart failure (adjusted OR 16; 95% CI: 3-84, pâ¯=â¯0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, pâ¯=â¯0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, pâ¯=â¯0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, pâ¯=â¯0.021). CONCLUSIONS: severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.
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Cardiopatías , Complicaciones Cardiovasculares del Embarazo , Trastornos Puerperales , Humanos , Femenino , Embarazo , Estudios Retrospectivos , Adulto , Estudios Transversales , Complicaciones Cardiovasculares del Embarazo/epidemiología , Adulto Joven , Adolescente , Trastornos Puerperales/epidemiología , Trastornos Puerperales/etiología , Recién Nacido , Edema Pulmonar/epidemiología , Edema Pulmonar/etiología , Periodo PospartoRESUMEN
OBJECTIVES: To evaluate if the tumour perfusion at the initial MRI scan is a marker of prognosis for survival in patients diagnosed with High Grade Gliomas (HGG). To analyse the risk factors which influence on the mortality from HGG to quantify the overall survival to be expected in patients. PATIENTS AND METHODS: The patients diagnosed with HGG through a MRI scan in a third-level hospital between 2017 and 2019 were selected. Clinical and tumour variables were collected. The survival analysis was used to determine the association between the tumour perfusion and the survival time. The relation between the collected variables and the survival period was assessed through Wald's statistical method, measuring the relationship via Cox's regression model. Finally, the type of relationship that exists between the tumour perfusion and the survival was analysed through the Lineal Regression method.Those statistical analysis were carried out using the software SPSS v.17. RESULTS: 38 patients were included (average age: 61.1 years old). The general average survival period was 20.6 months. A relationship between the tumour perfusion at the MRI scan and the overall survival has been identified, in detail, a group with intratumor values of relative cerebral blood volume (rCBV)>3.0 has shown a significant decline in the average survival period with regard to the average survival period of the group with values <3.0 (14.6 months vs. 22.8 months, p = 0.046). It has also been proved that variables like Karnofsky's scale and the response time since the intervention significantly influence on the survival period. CONCLUSIONS: It has become evident that the tumour perfusion via MRI scan has a prognostic value in the initial analysis of HGG. The average survival period of patients with rCBV less than or equal to 3.0 is significantly higher than those patients whose values are higher, which allows to be more precise with the prognosis of each patient.
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Encéfalo , Glioma , Humanos , Persona de Mediana Edad , Pronóstico , Perfusión , Glioma/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
Objetivos: Valorar si la perfusión tumoral en el estudio diagnóstico inicial de RM es un marcador pronóstico para la supervivencia en pacientes diagnosticados de gliomas de alto grado. Analizar los factores de riesgo que influyen en la mortalidad por gliomas de alto grado para poder cuantificar la supervivencia global esperada del paciente. Pacientes y métodos: Se seleccionaron las RM de todos los pacientes diagnosticados de glioma de alto grado en un hospital de tercer nivel entre los años 2017 y 2019. Se recogieron variables clínicas y tumorales. Se usó el análisis de supervivencia para determinar la asociación entre la perfusión tumoral y el tiempo de supervivencia. Se estudió la relación entre las variables recogidas y la supervivencia mediante el estadístico de Wald, cuantificando esta relación mediante la regresión de Cox. Por último, se analizó el tipo de relación existente entre la perfusión tumoral y la supervivencia a través del estudio de regresión lineal. Estos análisis estadísticos se realizaron con el software SPSS v.17. Resultados: Se incluyeron 38 pacientes (media de edad 61,1años). La supervivencia media global fue de 20,6meses. Se observó asociación entre la perfusión tumoral en la RM diagnóstica y la supervivencia global, mostrando el grupo con valores intratumorales de volumen sanguíneo cerebral relativo (rVSC) >3,0 una disminución significativa en el tiempo medio de supervivencia respecto al grupo con valores <3,0 (14,6meses vs 22,8meses, p=0,046). También han demostrado influir significativamente en la supervivencia media variables como la escala de Karfnosky y el tiempo de recidiva desde la intervención. Conclusiones: Se ha evidenciado que la perfusión tumoral por RM tiene valor pronóstico en el estudio inicial de los gliomas de alto grado.(AU)
Objectives: To evaluate if the tumour perfusion at the initial MRI scan is a marker of prognosis for survival in patients diagnosed with high grade gliomas (HGG). To analyse the risk factors which influence on the mortality from HGG to quantify the overall survival to be expected in patients. Patients and methods: The patients diagnosed with HGG through a MRI scan in a third-level hospital between 2017 and 2019 were selected. Clinical and tumour variables were collected. The survival analysis was used to determine the association between the tumour perfusion and the survival time. The relation between the collected variables and the survival period was assessed through Wald's statistical method, measuring the relationship via Cox's regression model. Finally, the type of relationship that exists between the tumour perfusion and the survival was analysed through the lineal regression method.Those statistical analysis were carried out using the software SPSS v.17. Results: Thirty-eight patients were included (average age: 61.1years old). The general average survival period was 20.6months. A relationship between the tumour perfusion at the MRI scan and the overall survival has been identified, in detail, a group with intratumor values of relative cerebral blood volume (rCBV) >3.0 has shown a significant decline in the average survival period with regard to the average survival period of the group with values <3.0 (14.6months vs. 22.8months, P=.046). It has also been proved that variables like Karnofsky's scale and the response time since the intervention significantly influence on the survival period. Conclusions: It has become evident that the tumour perfusion via MRI scan has a prognostic value in the initial analysis of HGG. The average survival period of patients with rCBV less than or equal to 3.0 is significantly higher than those patients whose values are higher, which allows to be more precise with the prognosis of each patient.(AU)
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Humanos , Masculino , Femenino , Quimioterapia del Cáncer por Perfusión Regional/métodos , Neoplasias Neuroepiteliales/diagnóstico por imagen , Espectroscopía de Resonancia Magnética , Pronóstico , Supervivencia , Radiología , España , Neoplasias Neuroepiteliales/radioterapiaRESUMEN
INTRODUCTION: Ataxia and hereditary spastic paraplegia are rare neurodegenerative syndromes. We aimed to determine the prevalence of these disorders in Spain in 2019. PATIENTS AND METHODS: We conducted a cross-sectional, multicentre, retrospective, descriptive study of patients with ataxia and hereditary spastic paraplegia in Spain between March 2018 and December 2019. RESULTS: We gathered data from a total of 1933 patients from 11 autonomous communities, provided by 47 neurologists or geneticists. Mean (SD) age in our sample was 53.64 (20.51) years; 938 patients were men (48.5%) and 995 were women (51.5%). The genetic defect was unidentified in 920 patients (47.6%). A total of 1371 patients (70.9%) had ataxia and 562 (29.1%) had hereditary spastic paraplegia. Prevalence rates for ataxia and hereditary spastic paraplegia were estimated at 5.48 and 2.24 cases per 100 000 population, respectively. The most frequent type of dominant ataxia in our sample was SCA3, and the most frequent recessive ataxia was Friedreich ataxia. The most frequent type of dominant hereditary spastic paraplegia in our sample was SPG4, and the most frequent recessive type was SPG7. CONCLUSIONS: In our sample, the estimated prevalence of ataxia and hereditary spastic paraplegia was 7.73 cases per 100 000 population. This rate is similar to those reported for other countries. Genetic diagnosis was not available in 47.6% of cases. Despite these limitations, our study provides useful data for estimating the necessary healthcare resources for these patients, raising awareness of these diseases, determining the most frequent causal mutations for local screening programmes, and promoting the development of clinical trials.
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Ataxia Cerebelosa , Paraplejía Espástica Hereditaria , Masculino , Humanos , Femenino , Persona de Mediana Edad , Paraplejía Espástica Hereditaria/epidemiología , Paraplejía Espástica Hereditaria/genética , Estudios Transversales , Estudios Retrospectivos , España/epidemiologíaRESUMEN
Purpose To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours. Methods A cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire. Results Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean 5511.59 vs 1457.22; P = 0.028) and ED costs (161.25 vs 14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS). Conclusion This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Costos de la Atención en Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/economía , Síndrome Carcinoide Maligno/economía , Síndrome Carcinoide Maligno/terapia , Tumores Neuroendocrinos/economía , Tumores Neuroendocrinos/terapia , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Costos Directos de Servicios , Hospitalización/estadística & datos numéricos , Estudios Retrospectivos , Estudios Transversales , Hospitalización/economíaRESUMEN
PURPOSE: To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours. METHODS: A cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire. RESULTS: Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean 5511.59 vs 1457.22; P = 0.028) and ED costs (161.25 vs 14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS). CONCLUSION: This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs.
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Costos de la Atención en Salud , Necesidades y Demandas de Servicios de Salud/economía , Síndrome Carcinoide Maligno/economía , Absentismo , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Costos Directos de Servicios , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Síndrome Carcinoide Maligno/patología , Síndrome Carcinoide Maligno/terapia , Persona de Mediana Edad , Tumores Neuroendocrinos/economía , Tumores Neuroendocrinos/patología , Tumores Neuroendocrinos/terapia , Presentismo/estadística & datos numéricos , Estudios Retrospectivos , España , Trabajo/estadística & datos numéricosRESUMEN
INTRODUCTION: CT-scan is the method of choice for major trauma assessment. However, it significantly increases radiation exposure in the pediatric population. The objective of this study was to analyze differences in clinical outcomes according to the preoperative use of CT-scan. MATERIALS AND METHODS: A retrospective observational study of pediatric patients admitted for trauma and requiring surgery was carried out. Patients were classified according to the previous use of CT-scan. ICU stay, re-admissions, and deaths were assessed. RESULTS: From 2011 to 2017, 737 patients under 18 years of age with external lesions were treated, 174 of whom required surgery. 48 patients (27.6%) underwent CT-scan prior to the procedure (Group 1), while the remaining 126 patients (72.4%) were directly scheduled for surgery (Group 2). Penetrating trauma occurred in 81% of patients, the proportion being significantly higher in Group 2 (p= 0.001). Median age was 15 years (interquartile range: 12-17), with no differences between groups. No significant differences were found in terms of hemodynamic instability at admission between groups (p= 0.596). At surgery, 3 out of 48 patients (6.3%) had no evident lesion. No significant differences were found in terms of re-admissions (p= 0.476), mortality (0.994), and ICU stay (0.466). CONCLUSION: The use of CT-scan as a diagnostic tool in pediatric trauma does not reduce mortality, ICU stay, or number of re-admissions. The use of tools such as ultrasound examination and simple X-ray should be protocolized to avoid unnecessary exposure to higher radiation doses. Prospective studies confirming this hypothesis are required.
INTRODUCCION: La tomografía axial computarizada (TAC) es el método de elección en la evaluación del trauma mayor, sin embargo, aumenta significativamente la exposición a radiación en la población pediátrica. El objetivo de este estudio es determinar diferencias en los desenlaces clínicos de acuerdo con el uso preoperatorio de la TAC. METODOS: Estudio observacional retrospectivo. Se incluyeron pacientes pediátricos ingresados por trauma que necesitaron manejo quirúrgico, y se clasificaron de acuerdo con el uso previo de TAC. Se evaluó tiempo en Unidad de Cuidados Intensivos (UCI), readmisiones, y muerte. RESULTADOS: Durante 2011 a 2017, 737 pacientes menores de 18 años consultaron por lesiones de causa externa, 174 requirieron intervención quirúrgica. A 48 (27,6%) se les realizó TAC previo al manejo quirúrgico (Grupo 1); los restantes 126 pacientes (72,4%) fueron llevados directamente a cirugía (Grupo 2). El trauma penetrante se presentó en un 81% de los pacientes, siendo significativamente mayor en el grupo 2 (p= 0,001). La mediana de edad fue 15 años (rango intercuartílico 12-17) sin diferencia entre los grupos. No hubo diferencias significativas en inestabilidad hemodinámica al ingreso entre los grupos (p= 0,596). Al momento de la cirugía, tres de 48 pacientes (6,3%) no presentaron ninguna lesión evidente. No hubo diferencias significativas en las readmisiones (p= 0,476), la mortalidad (0.994) y estancia en UCI (0,466). CONCLUSION: El uso de TAC como herramienta diagnóstica en trauma pediátrico no disminuye la mortalidad, días de estancia en UCI, ni el número de readmisiones. Debe protocolizarse el uso de herramientas como la ecografía y radiografía simple para evitar exposición innecesaria a dosis más altas de radiación. Se requieren estudios prospectivos que confirmen esta hipótesis.
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Traumatismos Abdominales , Centros Traumatológicos , Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/cirugía , Adolescente , Niño , Humanos , Estudios Prospectivos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Estados UnidosRESUMEN
Introducción: La tomografía axial computarizada (TAC) es el método de elección en la evaluación del trauma mayor, sin embargo, aumentasignificativamente la exposición a radiación en la población pediátrica.El objetivo de este estudio es determinar diferencias en los desenlacesclínicos de acuerdo con el uso preoperatorio de la TAC. Métodos: Estudio observacional retrospectivo. Se incluyeron pacientes pediátricos ingresados por trauma que necesitaron manejo quirúrgico, y se clasificaron de acuerdo con el uso previo de TAC. Se evaluótiempo en Unidad de Cuidados Intensivos (UCI), readmisiones, y muerte.Resultados: Durante 2011 a 2017, 737 pacientes menores de 18años consultaron por lesiones de causa externa, 174 requirieron intervención quirúrgica. A 48 (27,6%) se les realizó TAC previo al manejoquirúrgico (Grupo 1); los restantes 126 pacientes (72,4%) fueron llevadosdirectamente a cirugía (Grupo 2). El trauma penetrante se presentó enun 81% de los pacientes, siendo significativamente mayor en el grupo2 (p= 0,001). La mediana de edad fue 15 años (rango intercuartílico 12-17) sin diferencia entre los grupos. No hubo diferencias significativasen inestabilidad hemodinámica al ingreso entre los grupos (p= 0,596).Al momento de la cirugía, tres de 48 pacientes (6,3%) no presentaronninguna lesión evidente. No hubo diferencias significativas en las read-misiones (p= 0,476), la mortalidad (0,994) y estancia en UCI (0,466). Conclusión: El uso de TAC como herramienta diagnóstica en trau-ma pediátrico no disminuye la mortalidad, días de estancia en UCI, niel número de readmisiones. Debe protocolizarse el uso de herramientascomo la ecografía y radiografía simple para evitar exposición innecesariaa dosis más altas de radiación. Se requieren estudios prospectivos queconfirmen esta hipótesis.(AU)
Introduction: CT-scan is the method of choice for major traumaassessment. However, it significantly increases radiation exposure in thepediatric population. The objective of this study was to analyze differ-ences in clinical outcomes according to the preoperative use of CT-scan. Materials and methods: A retrospective observational study ofpediatric patients admitted for trauma and requiring surgery was carriedout. Patients were classified according to the previous use of CT-scan.ICU stay, re-admissions, and deaths were assessed. Results: From 2011 to 2017, 737 patients under 18 years of agewith external lesions were treated, 174 of whom required surgery. 48patients (27.6%) underwent CT-scan prior to the procedure (Group 1),while the remaining 126 patients (72.4%) were directly scheduled forsurgery (Group 2). Penetrating trauma occurred in 81% of patients, theproportion being significantly higher in Group 2 (p= 0.001). Median agewas 15 years (interquartile range: 12-17), with no differences betweengroups. No significant differences were found in terms of hemodynamicinstability at admission between groups (p= 0.596). At surgery, 3 outof 48 patients (6.3%) had no evident lesion. No significant differenceswere found in terms of re-admissions (p= 0.476), mortality (0.994),and ICU stay (0.466). Conclusion: The use of CT-scan as a diagnostic tool in pediatrictrauma does not reduce mortality, ICU stay, or number of re-admissions.The use of tools such as ultrasound examination and simple X-ray shouldbe protocolized to avoid unnecessary exposure to higher radiation doses.Prospective studies confirming this hypothesis are required.(AU)
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Unidades de Cuidado Intensivo Pediátrico , Heridas y Lesiones , Tomografía Computarizada de Emisión , Traumatismos Torácicos , Diagnóstico , Estudios Retrospectivos , Pediatría , Cirugía GeneralRESUMEN
INTRODUCTION: Ataxia and hereditary spastic paraplegia are rare neurodegenerative syndromes. We aimed to determine the prevalence of these disorders in Spain in 2019. PATIENTS AND METHODS: We conducted a cross-sectional, multicentre, retrospective, descriptive study of patients with ataxia and hereditary spastic paraplegia in Spain between March 2018 and December 2019. RESULTS: We gathered data from a total of 1.809 patients from 11 autonomous communities, provided by 47 neurologists or geneticists. Mean (SD) age in our sample was 53.64 (20.51) years; 920 patients were men (50.8%) and 889 were women (49.2%). The genetic defect was unidentified in 920 patients (47.6%). A total of 1371 patients (70.9%) had ataxia and 562 (29.1%) had hereditary spastic paraplegia. Prevalence rates for ataxia and hereditary spastic paraplegia were estimated at 5.48 and 2.24 cases per 100 000 population, respectively. The most frequent type of dominant ataxia in our sample was SCA3, and the most frequent recessive ataxia was Friedreich ataxia. The most frequent type of dominant hereditary spastic paraplegia in our sample was SPG4, and the most frequent recessive type was SPG7. CONCLUSIONS: In our sample, the estimated prevalence of ataxia and hereditary spastic paraplegia was 7.73 cases per 100 000 population. This rate is similar to those reported for other countries. Genetic diagnosis was not available in 47.6% of cases. Despite these limitations, our study provides useful data for estimating the necessary healthcare resources for these patients, raising awareness of these diseases, determining the most frequent causal mutations for local screening programmes, and promoting the development of clinical trials.
RESUMEN
Resumen Introducción: El envejecimiento poblacional ha impulsado a que su abordaje se convierta en un tema prioritario a nivel mundial, sobre la cual aún existen mitos y discriminación, siendo las personas adultas mayores en privación de libertad en un sistema penitenciario, una población con mayores riesgos de exclusión y que cuentan con características neuropsicológicas que ameritan su atención. Por lo tanto, se realizó en Costa Rica un primer abordaje en el Centro de Atención Institucional Adulto Mayor desde la neuropsicología forense, para mejorar los protocolos disponibles de evaluación de la población adulta mayor. Procedimiento: Se llevó a cabo un trabajo final de graduación en formato de práctica dirigida durante 858 horas tanto de forma presencial como a distancia, en el período de abril del 2017 a abril del 2018, participando de los procesos de evaluación neuropsicológica forense, elaboración de un protocolo de evaluación neuropsicológica forense y participación en procesos psicoeducativos sobre consumo de sustancias y violencia sexual. Resultados: En total se atendieron 40 personas hombres, entre 58 y 85 años de edad. Con variables sociodemográficas y de salud como una baja escolaridad (45%), con antecedentes de trauma craneoencefálico (67%) y en su mayoría cometieron abuso sexual (55%). Se elaboró un protocolo de evaluación neuropsicológica que incluye un módulo de entrevista y observación, evaluación del estado de ánimo y evaluación del funcionamiento cognitivo.
Abstract Introduction: Population ageing has become a priority between the attention and care systems but still deals with myths and discrimination, being the older adults incarcerated in the prison system a population with a greater risk of exclusion and that have neuropsychological characteristics that need attention. Therefore, a first approach was carried out in Costa Rica in the Institutional Adult Care Center from the forensic neuropsychology, to improve the available protocols for the evaluation of the older adult population. Method: A final graduation work was carried out in a guided practice format for 858 hours both in person and remotely, in the period from April 2017 to April 2018, participating in the processes of forensic neuropsychological evaluation, preparation of a protocol of forensic neuropsychological evaluation and participation in psychoeducational processes on substance use and sexual violence. Results: In total 40 male people, between 58 and 85 years of age, were attended. With sociodemographic and health variables such as low schooling (45%), with a history of cranioencephalic trauma (67%) and most of them committed sexual abuse (55%). A neuropsychological evaluation protocol was elaborated that includes an interview and observation module, evaluation of mood and evaluation of cognitive functioning module.
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Humanos , Anciano , Anciano de 80 o más Años , Prisiones , Prisioneros , Anciano , Estado de Salud , Costa Rica , Psicología Forense , NeuropsicologíaRESUMEN
BACKGROUND: Few studies have looked at the prevalence of substance use disorders (SUD) in people with intellectual disability (ID). The results range between 1% and 6.4% and go up to 20% in people with ID and psychiatric disorders, probably underestimating real prevalence due to several limitations in these studies. ID confers risk for the development of SUD, which in turn will involve negative psychosocial and clinical consequences. We aimed to study the prevalence of SUD in a sample of patients with ID admitted to a brief hospitalisation psychiatric unit, describing them by type and severity and analysing their relationship with clinical, prognostic and access to treatment variables. METHODS: We undertook a descriptive, cross-sectional and retrospective study by means of a review of clinical histories of all patients with a diagnosis of ID, admitted in a period of 10 years. RESULTS: Among the final sample of patients included, 52.3% had a mild ID, 40.9% an unspecified ID, 3.4% a moderate ID and another 3.4% a severe ID. More than one third of the sample met criteria for a SUD. The main SUD was cannabis use disorder (25%), followed by alcohol use disorder (22.7%) and cocaine use disorder (13.6%). The use of more than one substance was the most frequent pattern. Cannabis use disorder and cocaine use disorder were overrepresented in the group with mild ID. A greater number of psychiatric admissions was observed for the group with SUD. Specialised mental health services for ID and specialised addiction network facilities were much less involved in the care of these patients that could be expected according to good clinical practice recommendations. CONCLUSIONS: Substance use disorder in patients with ID and mental health disorders admitted to psychiatric hospitalisation are prevalent, which makes this issue an area of interest for future improvements in case identification, proper referring to specialised treatment resources and an increasing research focusing on specific therapeutic approaches.
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Hospitalización/estadística & datos numéricos , Discapacidad Intelectual/epidemiología , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Comorbilidad , Estudios Transversales , Femenino , Humanos , Discapacidad Intelectual/terapia , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Trastornos Relacionados con Sustancias/terapia , Adulto JovenRESUMEN
INTRODUCTION: There are few studies about preschool attention deficit hyperactivity disorder (ADHD) prevalence. AIM: To study the prevalence of ADHD in preschoolers using an specific scale (ADHD-RS-IV-P-Es) developed for this age range. SUBJECTS AND METHODS: We evaluated the prevalence of possible ADHD in a representative sample of preschoolers in Navarra and La Rioja, Spain. RESULTS: We find a range of prevalence between 2.5-4.1% depending on the criteria that was used (more or less strict). CONCLUSIONS: There are specific tools that can be use in preschool ADHD study. The prevalence of preschool ADHD in Spain is similar than in other countries. The frequency of symptoms in this age range is similar to the found in school age children.
TITLE: Trastorno por deficit de atencion/hiperactividad en niños en edad preescolar. Prevalencia epidemiologica en Navarra y La Rioja, España.Introduccion. La prevalencia del trastorno por deficit de atencion/hiperactividad (TDAH) esta en constante estudio, y hay pocas publicaciones sobre la prevalencia en niños preescolares. Objetivo. Estudiar la prevalencia de sintomas de TDAH en niños preescolares usando una escala especifica (ADHD Rating Scale-IV, version preescolar, validada para España) desarrollada para esta franja de edad. Sujetos y metodos. Se evalua la prevalencia de posible TDAH en una muestra representativa de preescolares en Navarra y La Rioja usando diferentes puntos de corte. Resultados. Se encuentra un rango de prevalencia de sintomas de TDAH del 2,5-4,1% segun el criterio usado (mas o menos estricto). Conclusiones. Existen herramientas especificas que pueden usarse para evaluar el TDAH en preescolares. La prevalencia de posible TDAH en preescolares en España es similar a la encontrada en otros paises. La frecuencia de sintomas en esta franja de edad no es mas alta que en otras edades, por lo que no es cierto que los sintomas de TDAH sean muy prevalentes en la poblacion general de niños preescolares.
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Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Niño , Preescolar , Femenino , Humanos , Masculino , Prevalencia , Muestreo , España/epidemiología , Evaluación de SíntomasRESUMEN
With the aim of studying delta-like protein 1 (DLK1) with respect to the relationship between adipocyte leptin and adenohypophyseal hormones, we carried out an immunohistochemical study analysing the presence of receptors for these hormones in the pituitary and adipose cells of male wild-type (WT) mice (Dlk1+/+ ) compared to knockout (KO) mice (Dlk1-/- ). The mRNA expression of these molecules was also determined using the reverse transcriptase-polymerase chain reaction. The results obtained showed that, in WT adipose cells, all of the adenohypophyseal hormone receptors were present, with a higher mRNA expression for growth hormone (GH) receptor and thyroid-stimulating hormone (TSH) receptor. Of the total cells in the anterior pituitary lobe, 17.09±0.9% were leptin receptor (LEPR) immunoreactive (-IR), mainly in GH-IR and prolactin (PRL)-IR cells (41.5±3.8%; 13.5±1.7%, respectively). In Dlk1-/- mice, adipocyte cells showed a significant increase in the TSH receptor mRNA expression level. Moreover, the percentage of LEPR-IR GH cells showed a statistically significant increase compared to controls, from 41.5±3.8% to 53.1±4.0%. By contrast, only 3.0±0.6% of LEP-IR anterior pituitary cells were detected in Dlk1 KO mice, as opposed to 6.8±1.1% observed in WT mice. The results suggest that relationships exist between adipocytes and pituitary GH, PRL and TSH cells, in addition to an influence with respect to the synthesis and release of pituitary leptin, particularly in PRL cells.
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Tejido Adiposo/metabolismo , Péptidos y Proteínas de Señalización Intracelular/metabolismo , Proteínas de la Membrana/metabolismo , Hipófisis/metabolismo , Animales , Péptidos y Proteínas de Señalización Intracelular/genética , Masculino , Proteínas de la Membrana/genética , Ratones , Ratones Noqueados , Hormonas Adenohipofisarias/metabolismo , Prolactina/metabolismo , ARN Mensajero/metabolismo , Receptores de Leptina/metabolismo , Receptores de Somatotropina/metabolismo , Receptores de Tirotropina/metabolismoRESUMEN
INTRODUCTION: ADHD symptoms begin to appear at preschool age. ADHD may have a significant negative impact on academic performance. In Spain, there are no standardized tools for detecting ADHD at preschool age, nor is there data about the incidence of this disorder. OBJECTIVE: To evaluate developmental factors and learning difficulties associated with probable ADHD and to assess the impact of ADHD in school performance. METHODS: We conducted a population-based study with a stratified multistage proportional cluster sample design. RESULTS: We found significant differences between probable ADHD and parents' perception of difficulties in expressive language, comprehension, and fine motor skills, as well as in emotions, concentration, behaviour, and relationships. Around 34% of preschool children with probable ADHD showed global learning difficulties, mainly in patients with the inattentive type. According to the multivariate analysis, learning difficulties were significantly associated with both delayed psychomotor development during the first 3 years of life (OR: 5.57) as assessed by parents, and probable ADHD (OR: 2.34) CONCLUSIONS: There is a connection between probable ADHD in preschool children and parents' perception of difficulties in several dimensions of development and learning. Early detection of ADHD at preschool ages is necessary to start prompt and effective clinical and educational interventions.
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Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Discapacidades para el Aprendizaje , Desempeño Psicomotor/fisiología , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Desarrollo Infantil , Preescolar , Femenino , Humanos , Masculino , Padres/psicología , España , Encuestas y CuestionariosRESUMEN
BACKGROUND: Evidence for the effectiveness of linezolid in neurosurgical infections (NSIs) is growing. The comfortable oral dosage and tolerance of linezolid opens the possibility for sequential antimicrobial treatment (SAT) in stable patients after a period of intravenous treatment. METHODS: To evaluate the efficacy and safety of SAT with oral linezolid in patients with NSI and to analyse the cost implications, an observational, non-comparative, prospective cohort study was conducted on clinically stable consecutive adult patients at the Neurosurgical Service. Following intravenous treatment, patients were discharged with SAT with oral linezolid. RESULTS: A total of 77 patients were included. The most common NSIs were: 41 surgical wound infections, 20 subdural empyemas, 18 epidural abscesses, and 16 brain abscesses. Forty-four percent of patients presented two or more concomitant NSIs. Aetiological agents commonly isolated were: Propionibacterium acnes (36 %), Staphylococcus aureus (23 %), Staphylococcus epidermidis (21 %) and Streptococcus spp. (13 %). The median duration of the SAT was 15 days (range, 3-42). The SAT was interrupted in five cases due to adverse events. The remainder of the patients were cured at the end of the SAT. A total of 1,163 days of hospitalisation were saved. An overall cost reduction of 516,188 was attributed to the SAT. Eight patients with device infections did not require removal of the device, with an additional cost reduction of 190,595. The mean cost saving per patient was 9,179. CONCLUSIONS: SAT with linezolid was safe and effective for the treatment of NSI. SAT reduces hospitalisation times, which means significant savings of health and economic resources.
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Antibacterianos/efectos adversos , Costos y Análisis de Costo , Linezolid/efectos adversos , Procedimientos Neuroquirúrgicos/efectos adversos , Infecciones Estafilocócicas/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/economía , Femenino , Humanos , Linezolid/administración & dosificación , Linezolid/economía , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/etiología , Infección de la Herida Quirúrgica/tratamiento farmacológicoRESUMEN
Phthalates and bisphenol A (BPA) have received special attention in recent years due to their frequent use in consumer products and potential for adverse effects on human health. BPA is being replaced with a number of alternatives, including bisphenol S, bisphenol B, bisphenol F and bisphenol AF. These bisphenol analogues have similar potential for adverse health effects, but studies on human exposure are limited. Accurate measurement of multiple contaminants is important for estimating exposure. This paper describes a sensitive and automated method for the simultaneous determination of 14 phthalate metabolites, BPA and four bisphenol analogues in urine using online solid phase extraction coupled with high-performance liquid chromatography/tandem mass spectrometry using a hybrid triple-quadrupole linear ion trap mass spectrometer (LC-QTRAP-MS/MS), requiring very little sample volume (50µL). Quantification was performed under selected reaction monitoring (SRM) mode with negative electrospray ionization. The use of SRM combined with an enhanced product ion scan within the same analysis was examined. Unequivocal identification was provided by the acquisition of three SRM transitions per compound and isotope dilution. The analytical performance of the method was evaluated in synthetic and human urine. Linearity of response over three orders of magnitude was demonstrated for all of the compounds (R(2)>0.99), with method detection limits of 0.01-0.5ng/mL and limits of reporting of 0.07-3.1ng/mL. Accuracy ranged from 93% to 113% and inter- and intra-day precision were <22%. Finally, the validated method has been successfully applied to a cohort of pregnant women to measure biomarker concentrations of phthalates and bisphenols, with median concentrations ranging from 0.3ng/mL (bisphenol S) to 18.5ng/mL (monoethyl phthalate).