Evolución funcional y del estado de ánimo de pacientes tras ingreso por COVID-19 en una unidad de Cuidados Intensivos / Functional evolution and mood of patients after admission for COVID-19 to intensive care unit

Objetivo: Describir la situación funcional de los pacientes al mes y a los dos meses tras el ingreso por neumonía COVID-19 en una unidad de cuidados intensivos (UCI) y afectación del estado de ánimo al mes del alta hospitalaria. Diseño: Estudio de cohortes prospectivo. Pacientes: Ingresados en UCI por neumonía COVID-19 durante los meses de febrero a julio de 2020. Variables de interés: Datos demográficos, mortalidad, estancia media en UCI y hospitalización, destino al alta, situación funcional (índice de Barthel) basal, tras el alta, al mes y a los dos meses, fisioterapia realizada y repercusión en el estado de ánimo (Escala Hospitalaria de Ansiedad y Depresión). Resultados: Ingresaron en la UCI 89 pacientes. La mortalidad en UCI fue del 48,3%. Entre los supervivientes, 42 pacientes completaron seguimiento a los dos meses. Se objetivó un deterioro funcional al alta de UCI en el 97,6% y al alta hospitalaria en el 76,2%. En el seguimiento, un 66,7% había recuperado su nivel funcional basal al mes de salida del hospital y un 85,7% lo había hecho a los dos meses. Al mes del alta, el 12% presentaban resultados compatibles con ansiedad y un 20% compatibles con depresión. Conclusiones: Los pacientes ingresados en UCI por neumonía COVID-19 presentan una mortalidad hospitalaria elevada y los supervivientes presentan un deterioro funcional severo. A los dos meses del alta, la mayoría recupera su situación funcional basal y estado emocional previos al ingreso.(AU)

Objective: Describe the functional situation of patients one and two months after admission for COVID-19 pneumonia in an intensive care unit (ICU) and affect their mood one month after hospital discharge. Design: Prospective cohort study was carried out. Patients: Patients admitted to the ICU for COVID-19 pneumonia during the months of February to July 2020.Primary variables of interest: Demographic data, mortality, ICU stay and hospital stay, destination at discharge, functional status at baseline (Barthel Index), after discharge, at one month and two months, physiotherapy treatment and impact on mood (Hospital Anxiety and Depression Scale). Results: 89 patients were admitted in ICU with a mortality rate of 48.3% in the ICU. Among the survivors, 42 patients completed the follow-up at two months. Functional deterioration was observed at ICU discharge in 97.6% and at hospital discharge in 76.2%. At follow-up, 66.7% of patients had recovered their baseline functional level one month after leaving the hospital and 85.7% had done so after two months. One month after discharge, 12% of the patients had results compatible with anxiety and 20% had results compatible with depression. Conclusions: Patients admitted to the ICU for COVID-19 pneumonia have high hospital mortality, and those who survive show severe functional deterioration after admission. Two months after hospital discharge, most survivors recover their baseline functional status and mood prior to admission.(AU)

[Functional evolution and mood of patients after admission for COVID-19 to intensive care unit]. / Evolución funcional y del estado de ánimo de pacientes tras ingreso por COVID-19 en una unidad de Cuidados Intensivos.

OBJECTIVE: Describe the functional situation of patients one and two months after admission for COVID-19 pneumonia in an intensive care unit (ICU) and affect their mood one month after hospital discharge. DESIGN: Prospective cohort study was carried out. PATIENTS: Patients admitted to the ICU for COVID-19 pneumonia during the months of February to July 2020. PRIMARY VARIABLES OF INTEREST: Demographic data, mortality, ICU stay and hospital stay, destination at discharge, functional status at baseline (Barthel Index), after discharge, at one month and two months, physiotherapy treatment and impact on mood (Hospital Anxiety and Depression Scale). RESULTS: 89 patients were admitted in ICU with a mortality rate of 48.3% in the ICU. Among the survivors, 42 patients completed the follow-up at two months. Functional deterioration was observed at ICU discharge in 97.6% and at hospital discharge in 76.2%. At follow-up, 66.7% of patients had recovered their baseline functional level one month after leaving the hospital and 85.7% had done so after two months. One month after discharge, 12% of the patients had results compatible with anxiety and 20% had results compatible with depression. CONCLUSIONS: Patients admitted to the ICU for COVID-19 pneumonia have high hospital mortality, and those who survive show severe functional deterioration after admission. Two months after hospital discharge, most survivors recover their baseline functional status and mood prior to admission.

[Impact of the Covid-19 pandemic on specialized healthcare training in a teaching center]. / Impacto de la pandemia COVID-19 en la formación sanitaria especializada en un centro docente.

OBJECTIVE: Evaluation of the impact of the health crisis caused by the Covid-19 pandemic on specialized healthcare training in a teaching center. METHODS: Cross-sectional descriptive study, by means of an electronic questionnaire sent to 167 residents in June 2020, to evaluate the burden of care, suspension of rotations and Covid-19 symptoms. The impact on the acquisition of professional competencies was measured using a four-level Likert scale (none, a little, quiet, a lot). The profile of acquired competencies was constructed and its association with the professional profile was studied using Generalized Linear Models. The qualitative approach was carried out through an open question on how it influenced their learning and the different categories were extracted through triangulation. RESULTS: The impact on learning was important for 94.8% of the residents. A total of 81.4% left the rotations they were doing and reported high workload, loss of training opportunities, uncertainty and ethical conflicts. They appreciated significant learning in the competencies of teamwork (93.2%), professionalism (86.2%), ethics (79.9%) and communication (78%). Technical competencies were deficient. The final balance of learning was perceived as positive by 54.4%, especially residents in central services and medical specialties. A total of 67.8% felt overwhelmed at times due to fatigue-emotional impact, care overload, ethical conflicts and lack of resources. CONCLUSIONS: The Covid-19 pandemic had an exceptional impact on specialized health care training. It is necessary to re-evaluate training programs to ensure the acquisition of the technical competencies that are lacking.

Biodistribution and radiation dosimetry of [64Cu]copper dichloride: first-in-human study in healthy volunteers.

BACKGROUND: In recent years, Copper-64 (T1/2 = 12.7 h) in the chemical form of copper dichloride ([64Cu]CuCl2) has been identified as a potential agent for PET imaging and radionuclide therapy targeting the human copper transporter 1, which is overexpressed in a variety of cancer cells. Limited human biodistribution and radiation dosimetry data is available for this tracer. The aim of this research was to determine the biodistribution and estimate the radiation dosimetry of [64Cu]CuCl2, using whole-body (WB) PET scans in healthy volunteers. Six healthy volunteers were included in this study (3 women and 3 men, mean age ± SD, 54.3 ± 8.6 years; mean weight ± SD, 77.2 ± 12.4 kg). After intravenous injection of the tracer (4.0 MBq/kg), three consecutive WB emission scans were acquired at 5, 30, and 60 min after injection. Additional scans were acquired at 5, 9, and 24 h post-injection. Low-dose CT scan without contrast was used for anatomic localization and attenuation correction. OLINDA/EXM software was used to calculate human radiation doses using the reference adult model. RESULTS: The highest uptake was in the liver, followed by lower and upper large intestine walls, and pancreas, in descending order. Urinary excretion was negligible. The critical organ was liver with a mean absorbed dose of 310 ± 67 µGy/MBq for men and 421 ± 56 µGy/MBq for women, while the mean WB effective doses were 51.2 ± 3.0 and 61.8 ± 5.2 µSv/MBq for men and women, respectively. CONCLUSIONS: To the best of our knowledge, this is the first report on biodistribution and radiation dosimetry of [64Cu]CuCl2 in healthy volunteers. Measured absorbed doses and effective doses are higher than previously reported doses estimated with biodistribution data from patients with prostate cancer, a difference that could be explained not just due to altered biodistribution in cancer patients compared to healthy volunteers but most likely due to the differences in the analysis technique and assumptions in the dose calculation.

Derrame pleural tras tratamiento intravesical con bacilo de Calmette-Guérin / Pleural effusion after intravesical administration of bacillus Calmette-Guérin

No disponible

Revisión sistemática de los cuestionarios autocumplimentados adaptados al español para la valoración funcional de pacientes con afecciones de rodilla / A systematic review of self-administered questionnaires for the functional assessment of patients with knee disabilities adapted into Spanish

Objetivo. Realizar una revisión sistemática de cuestionarios autocumplimentados de valoración funcional para afecciones de rodilla adaptados al español analizando la calidad de la adaptación transcultural y las propiedades psicométricas. Material y métodos. Se realizó una búsqueda en las principales bases de datos biomédicas para localizar escalas de valoración funcional de rodilla adaptadas al español, evaluando el proceso de adaptación y sus propiedades psicométricas. Resultados. Se identificaron 10 escalas; 3 fueron para miembro inferior: 2 para cualquier tipo de afección (Lower Limb Functional Index [LLFI]; Lower Extremity Functional Scale [LEFS]) y una específica para artrosis (Arthrose des Membres Inférieurs et Qualité de vie [AMICAL]); otras 3 para patologías de rodilla y cadera (Western Ontario and McMaster Universities Osteoarthritis [WOMAC] index; Osteoarthritis Knee and Hip Quality of Life [OAKHQOL] questionnaire; Hip and Knee Questionnaire[HKQ]), y otras 4 para rodilla: 2 generales (Knee Injury and Osteoarthritis Outcome Score [KOOS]; Knee Society Clinical Rating System [KSS]) y 2 específicas (Victorian Institute of Sport Assessment [VISA-P] questionnaire para pacientes con tendinopatía rotuliana y Kujala Score para el dolor femoropatelar). El procedimiento de adaptación transcultural fue satisfactorio, aunque algo menos riguroso para los cuestionarios HKQ y LLFI. En ningún estudio se evaluaron todas las propiedades psicométricas. La fiabilidad se analizó en todos los casos, menos en el KSS. La validez se midió en todos los cuestionarios. Conclusión. Las propiedades psicométricas analizadas fueron aceptables y similares a la versión original y a otras versiones adaptadas a otros idiomas (AU)

Objective. The aim of this study was to conduct a systematic review of self-administered knee-disability functional assessment questionnaires adapted to Spanish, analysing the quality of the transcultural adaptation procedure and the psychometric properties of the new version. Material and methods. A search was conducted in the main biomedical databases to find knee-function assessment scales adapted into Spanish, in order to assess their questionnaire adaptation process as well as their psychometric properties. Results. Ten scales were identified; 3 for lower limb: 2 for any type of pathologies (Lower Limb Functional Index [LLFI]; Lower Extremity Functional Scale [LEFS]) and 1 specific for arthrosis (Arthrosis des Membres Inférieurs et Qualité de vie [AMICAL]); Other 3 for knee and hip pathologies (Western Ontario and McMaster Universities Osteoarthritis [WOMAC] index; Osteoarthritis Knee and Hip Quality of Life [OAKHQOL] questionnaire; Hip and Knee Questionnaire [HKQ]), and other 4 for knee: 2 general scales (Knee Injury and Osteoarthritis Outcome Score [KOOS]; Knee Society Clinical Rating System [KSS]) and 2 specifics (Victorian Institute of Sport Assessment [VISA-P] questionnaire for patients with patellar tendinopathy and Kujala Score for patellofemoral pain). The transcultural adaptation procedure was satisfactory, albeit somewhat less rigorous for HKQ and LLFI. In no study were all psychometric properties assessed. Reliability was analyzed in all cases, except in KSS. Validity was measured in all questionnaires. Conclusions. The transcultural adaptation procedure was satisfactory and the psychometric properties analysed were similar to both the original version and other versions adapted to other languages (AU)

A systematic review of self-administered questionnaires for the functional assessment of patients with knee disabilities adapted into Spanish. / Revisión sistemática de los cuestionarios autocumplimentados adaptados al español para la valoración funcional de pacientes con afecciones de rodilla.

OBJECTIVE: The aim of this study was to conduct a systematic review of self-administered knee-disability functional assessment questionnaires adapted to Spanish, analysing the quality of the transcultural adaptation procedure and the psychometric properties of the new version. MATERIAL AND METHODS: A search was conducted in the main biomedical databases to find knee-function assessment scales adapted into Spanish, in order to assess their questionnaire adaptation process as well as their psychometric properties. RESULTS: Ten scales were identified; 3 for lower limb: 2 for any type of pathologies (Lower Limb Functional Index [LLFI]; Lower Extremity Functional Scale [LEFS]) and 1 specific for arthrosis (Arthrosis des Membres Inférieurs et Qualité de vie [AMICAL]); Other 3 for knee and hip pathologies (Western Ontario and McMaster Universities Osteoarthritis [WOMAC] index; Osteoarthritis Knee and Hip Quality of Life [OAKHQOL] questionnaire; Hip and Knee Questionnaire [HKQ]), and other 4 for knee: 2 general scales (Knee Injury and Osteoarthritis Outcome Score [KOOS]; Knee Society Clinical Rating System [KSS]) and 2 specifics (Victorian Institute of Sport Assessment [VISA-P] questionnaire for patients with patellar tendinopathy and Kujala Score for patellofemoral pain). The transcultural adaptation procedure was satisfactory, albeit somewhat less rigorous for HKQ and LLFI. In no study were all psychometric properties assessed. Reliability was analyzed in all cases, except in KSS. Validity was measured in all questionnaires. CONCLUSIONS: The transcultural adaptation procedure was satisfactory and the psychometric properties analysed were similar to both the original version and other versions adapted to other languages.

Effectiveness of radiolabelled somatostatin analogues (90Y-DOTATOC and 177Lu-DOTATATE) in patients with metastatic neuroendocrine tumours: a single centre experience in Mexico. / Eficacia de los análogos de somatostatina radiomarcados (90Y-DOTATOC y 177Lu-DOTATATE) en pacientes con tumores neuroendocrinos metastásicos, experiencia de centro único en México.

OBJECTIVE: To determine the effectiveness of therapy with the radiolabelled somatostatin analogues, 90Y-DOTATOC and 177Lu-DOTATATE, in the treatment of metastatic neuroendocrine tumours with progression to first-line treatment. MATERIAL AND METHODS: A study was conducted on 30 patients diagnosed with neuroendocrine tumours (gastroenteropancreatic, bronchopulmonary, MEN2A, MEN2B, phaeochromocytoma, and paraganglioma) with metastatic disease diagnosed by the pathology department, with progression to first-line treatment, and recruited from December 2014 to February 2016. Efficacy was analysed using computed tomography (CT) according RECIST 1.1 criteria, and the molecular changes using the SUVmax of PET/CT with 68Ga-DOTATOC. Safety was carried out with a renal scan with 99mTc-MAG3. RESULTS: The 30 patients received a total of 49 cycles 90Y-DOTATOC (21 doses) and 177 Lu-DOTATATE (28 doses), with a mean of 1.5 cycles per patient. Of these, 17 (56.7%) showed a partial morphological response, 22 (73.3%) molecular and biochemical response, and 23 (76.6%) clinical response. One patient died during the median follow-up of 13 months. The median overall survival from diagnosis was 54 months (95% CI; 31.18-76.81), and median progression-free survival was 32 months (95% CI; 15.00-48.99). CONCLUSION: Therapy with 90Y-DOTATOC and 177Lu-DOTATATE is a promising therapy for patients with well and moderately differentiated neuroendocrine tumours. The efficacy is better the larger the number of cycles administered, inversely proportional to the number of metastases (<10), and is associated with the level of uptake according to the SUVmax by the metastases, regardless of metabolically active tumour volume.

Eficacia de las alternativas de rehabilitación tras el alta hospitalaria en pacientes intervenidos de prótesis total de rodilla. Revisión sistemática / Efficacy of alternatives for post-discharge rehabilitation in patients undergoing total knee replacement. Systematic review

Objetivo. Comparar la eficacia y la seguridad de las distintas alternativas de rehabilitación tras el alta hospitalaria en prótesis total de rodilla (PTR). Material y métodos. Se realizó una búsqueda bibliográfica sistematizada en las bases de datos Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Embase, Physiotherapy Evidence Database y Pubmed hasta febrero de 2016. Se seleccionaron ensayos clínicos aleatorizados (ECA) que comparaban distintas alternativas de rehabilitación: tratamiento en régimen de ingreso hospitalario, fisioterapia individual en el domicilio del paciente, fisioterapia ambulatoria con supervisión individual o en grupo, tele-rehabilitación y ejercicios realizados en domicilio sin supervisión directa. Las medidas de resultados analizadas fueron: movilidad de rodilla, estado funcional y seguridad. Resultados. Se incluyeron 17 ECA de suficiente calidad metodológica. Se agruparon, según las comparaciones realizadas, en 4 grupos: A)fisioterapia ambulatoria supervisada individual frente a ejercicios realizados en domicilio (9ECA); B)fisioterapia ambulatoria supervisada individual frente a tele-rehabilitación (2ECA); C)fisioterapia domiciliaria frente a otras modalidades (4ECA), y D)fisioterapia ambulatoria supervisada en grupo frente a otras modalidades (4ECA). Dos ECA comparaban más de 2 alternativas. No se encontraron diferencias significativas en la eficacia y la seguridad entre las distintas modalidades. Conclusión. Las diferentes alternativas de rehabilitación tras el alta hospitalaria en PTR tienen una eficacia similar. La selección de la modalidad más adecuada para cada paciente debería realizarse en función de parámetros como comorbilidad, nivel cultural, capacidad de colaboración del paciente en el tratamiento y consumo de recursos (AU)

Objective. To compare the safety and efficacy of different alternatives for total knee replacement (TKR) rehabilitation after discharge. Material and methods. A systematic review was performed through the following databases: Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Embase, Physiotherapy Evidence Database and Pubmed until February 2016. Only randomized clinical trials (RCT) comparing different treatment options were selected: inpatient hospital care, supervised home physiotherapy, supervised one-to-one or group physiotherapy, tele-rehabilitation and unsupervised home-based exercises. Outcomes assessed were: knee range of motion, functional performance and adverse events. Results. Seventeen RCT of sufficient methodological quality were included and divided into four groups according to the previous comparisons made: (A)supervised one-to-one physiotherapy versus home-based exercises (9RCT); (B)supervised one-to-one physiotherapy versus tele-rehabilitation (2RCT); (C)supervised home physiotherapy versus other modalities (4RCT), and (D)supervised group physiotherapy versus other modalities (4RCT). In 2RCT more than two alternatives were compared. No significant differences in safety and efficacy were found amongst the different therapies. Conclusion. The efficacy of all the post-discharge rehabilitation alternatives analyzed was similar. The choice of the most suitable method for each patient should be made according to criteria such as comorbidity, cultural level, the patient's ability to cooperate in the treatment and resource use (AU)

Enhanced nonreciprocal effects in magnetoplasmonic systems supporting simultaneously localized and propagating plasmons.

Perforated magnetoplasmonic Au/Co/Au multilayers support both localized and propagating surface plasmon resonances. The presence of holes produces an enhancement of the magnetic field modulation of the propagating surface plasmon wavevector with respect to the isostructural continuous film in the spectral region corresponding to the hole associated localized plasmon resonance. This is due to the increased electromagnetic field in the surrounding area of the resonant hole, and the subsequent additional contribution to the magnetic modulation of the continuous film. This novel concept that gives rise to enhanced magnetic field induced nonreciprocal effects can be of interest in the development of innovative platforms for sensing applications, optical isolators and modulators.

Long-term safety and efficacy of tobramycin in the management of cystic fibrosis.

Cystic fibrosis (CF) is a fatal inherited disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene whose mortality is conditioned by a progressive decline in lung function. Bacterial infections play a key role in this decline. Chronic bacterial infection in CF patients varies over time and the presence of Pseudomonas aeruginosa in sputum is a marker of poor prognosis. P. aeruginosa is eradicated from the airways using inhaled antibiotics administered in various formulations and devices. Antipseudomonal antibiotics have extended the survival of CF patients to 40 years. Tobramycin is a bactericidal aminoglycoside antibiotic with demonstrated activity against gram-negative microorganisms. Initially, the drug was administered as an inhaled parenteral solution. Subsequently, a specific tobramycin inhalation solution was developed. PulmoSphere™ technology enables dry tobramycin powder to be formulated for inhalation (tobramycin inhalation powder) using a small and portable capsule-based breath-activated device (T-326). Chronic colonization by P. aeruginosa is the main indication for aerosol antibiotic therapy. The American Cystic Fibrosis Foundation, European guidelines, and Spanish consensus guidelines provide different recommendations for eradication.

Paciente con síncope y disnea / Patient with syncope and dyspnea

Resumen. La hipertensión pulmonar (HP) es una condición hemodinámica que se define por un aumento de la presión media de la arteria pulmonar mayor de 25 mmHg en reposo, medida por cateterismo cardíaco derecho. El aumento progresivo de la resistencia vascular pulmonar (RVP) conduce al fallo del ventrículo derecho y a la muerte prematura, con una esperanza de vida media con tratamiento convencional de 2,8 años. Se ha producido una modificación en la clasificación de la HP, en cinco subgrupos, clínicos basadas, fundamentalmente, en las características clínicas de las mismas y en las opciones terapéuticas para cada grupo. El diagnóstico de esta enfermedad es difícil debido a su rareza, con una prevalencia de 15 casos por millón de habitantes, y a lo inespecífico de los síntomas, lo que produce un retraso en el mismo de meses o años. Por ese motivo se ha propuesto un algoritmo diagnóstico. La estrategia en el tratamiento es distinto según los diferentes grupos y el perfil “de riesgo”. Los avance logrados en el tratamiento, las nuevas perspectivas terapéuticas en investigación, la aplicación en la práctica clínica de consensos y guías, nos permitirán un manejo homogéneo y multidisciplinario, para poder llegar al tan esperado cambio en el pronóstico de esta enfermedad (AU)

Summary. Pulmonary hypertension is an hemodynamic condition defined as an increase in mean pulmonary arterial pressure major that 25 mmHg at rest as assessed by right heart catheterization. This progressive increase of pulmonary vascular resistance (PVR) leads to right heart failure and premature death with an average life expectancy with conventional treatment of 2.8 years. There has been a change in classification, into five subgroups, of those different clinical conditions that have pulmonary hypertension, based mainly on clinical features and the treatment options for each group. The diagnosis of this disease is difficult because of its rarity, with a prevalence of 15 cases per million population, and poor specificity of symptoms leading to delayed it for months or years. For that reason we have proposed a diagnostic algorithm. The treatment strategy is different for each groups, and we also divide them into two groups according to the profile “of risk” in an attempt to define the steps to follow in each. The progress made in treatment, new therapeutic perspectives in research, application in clinical practice and consensus guidelines, that allow us an homogeneous and multidisciplinary management in order to reach the long-awaited change in the prognosis of this disease (AU)

Patogenia de la hipertensión arterial pulmonar / Pathogeny of pulmonary arterial hypertension

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Escala de incapacidad por dolor lumbar de Oswestry / Oswestry low back pain disability questionnaire

En la valoración del paciente con dolor lumbar es importante medir su repercusión funcional. Las pruebas complementarias, de laboratorio y de imagen no informan sobre la situación clínica del paciente ni de los cambios que se producen. Las escalas de valoración son otras pruebas complementarias que, aunque menos utilizadas, aportan información sobre la intensidad del dolor y su repercusión en las actividades de la vida cotidiana. Su desconocimiento y el esfuerzo que supone calcular la puntuación, interpretar y registrar los resultados son los principales factores que limitan su incorporación a la práctica clínica diaria. La escala de incapacidad por dolor lumbar de Oswestry es, junto con la escala de Roland-Morris, la más utilizada y recomendada a nivel mundial. En este artículo los autores hacen una revisión de la escala, desde su publicación en 1980, con información de la versión adaptada a la población española, características métricas, ventajas e inconvenientes. Su utilización permitirá al clínico obtener información desde la perspectiva del paciente, conocer el grado de eficacia de las distintas técnicas de tratamiento empleadas y comparar resultados con otros estudios publicados en la literatura

In the evaluation of patients with low back pain, it is important to measure their functional repercussion. The complementary laboratory and imaging tests do not inform on the clinical situation of the patient or on the changes that are produced. The evaluation scales are other complementary tests which, although less used, supply information on the intensity of pain and its repercussion in the daily life activities. Lack of knowledge of it and the effort that calculating the score, interpreting and recording the results entail are the main factors that limit its incorporation into the daily clinical practice. The Oswestry low back pain disability questionnaire is, together with the Roland-Morris questionnaire, the most used and recommended worldwide. In this article, the authors make a review of the scale since its publication in 1980, with information of the version adapted to the Spanish population, metric characteristics, advantages and disadvantages. Its use will allow the clinician to obtain information from the patient's perspective, know the grade of efficacy of the different treatment techniques used and compare results with other studies published in the literature

Diseño y desarrollo de una aplicación informática para la escala de incapacidad por dolor lumbar de Oswestry / Design and development of computer-aided application for the Oswestry Disability Index

No disponibleIntroducción: La escala de Oswestry es un cuestionario autoaplicadoque permite medir la repercusión funcional del dolor lumbar.El esfuerzo que representa calcular la puntuación e interpretar y registrarlos resultados limita su incorporación a la práctica diaria.Objetivo: Diseñar una aplicación informática, sobre la versiónen castellano de la escala, que permita: 1) calcular automáticamentela puntuación; 2) clasificar al paciente en una categoría delimitación funcional; 3) generar alertas clínicas; 4) facilitar al pacientenormas posturales personalizadas (adaptadas a sus limitacionesy a su edad y sexo); 5) crear gráficos para ver la evoluciónen el tiempo de las puntuaciones; y 6) escribir automáticamenteun informe del resultado.Resultados y Discusión: Se ha desarrollado una aplicación web,accesible a través de un navegador, con las funciones señaladas. Laestructura es flexible, escalable y está conectada a una base de datos(Access). El proceso de evaluación interna demostró una disminuciónsignificativa del tiempo empleado en puntuar la escala (se reduce aun 25% del requerido con el método manual). La evaluación externaindicó que la aplicación es percibida por los usuarios potenciales(médicos y fisioterapeutas) muy útil, fácil de manejar y atractiva yque consigue ampliamente los objetivos planteados

Introduction: The Oswestry scale is a self applied questionnairewhich allows to measure the functional consequences of the low backpain. The effort to calculate the score of the test and the interpretationof the results it is a real limit to be incorporate to the daily practice.Objective: To design a computer application, based on theSpanish version of the scale, which allows: 1) automatic calculationof the score; 2) patient classification based on the functionallimitation category; 3) to generate clinic alerts; 4) to provide to thepatient personalize postural norms (adapted to the own limitations,age and gender); 5) to generate graphic presentations to visualizethe time dependence of the score and 6) the automaticgeneration of the report with the results.Results and Discussion:We have developed a web application, accessiblefrom the navigator programme, with the above mentionedfunctions. The structure is flexible, easy to scale and connected to adata base (in Access). The internal validation process shows a clear decreasein the working time used to calculate the score of the scale (thefinal time is only a 25% of the time requested in the manual mode).The external evaluation shows that the application is considered bythe potential users (medicals and physiotherapists) as useful, easy touse and attractive, so that we clearly achieve the proposed objectives

Importancia del ejercicio físico en el tratamiento del dolor lumbar inespecífico / Importance of physical exercise in the treatment of non-specific low back pain

El ejercicio es una modalidad terapéutica muy utilizada en pacientes con lumbalgia. Optimizar la gestión de unos recursos sanitarios limitados obliga a decidir a qué pacientes y en qué momento evolutivo prescribir determinados ejercicios, asociándolos o no a otras terapias. En este artículo revisamos el papel de la cinesiterapia en el tratamiento del dolor lumbar inespecífico. Nos hemos basado en publicaciones de la mayor validez científica para realizar una síntesis de las mejores evidencias disponibles sobre el efecto del ejercicio físico en la prevención y en el tratamiento del dolor lumbar idiopático agudo, subagudo y crónico, así como tras cirugía lumbar. Existen evidencias consistentes de que el ejercicio parece ser la única medida preventiva eficaz del dolor de espalda. No hay evidencias que sustenten la recomendación de ejercicios en lumbalgias agudas ni subagudas, ya que no parecen más útiles que otros tratamientos. En el dolor lumbar crónico la cinesiterapia parece ser más efectiva, a largo plazo, que las modalidades pasivas, siendo los ejercicios más útiles en el seno de programas multidisciplinarios, sobre todo si van dirigidos a facilitar la vuelta a las actividades cotidianas y la reincorporación al trabajo. No parece haber superioridad de un tipo de ejercicios frente a otros. Conviene tener claro cuáles son los objetivos que se pretenden alcanzar con ellos, para seleccionar un determinado tipo de programa, instruir al paciente y estimular a que los haga de modo regular. Sería deseable poder recomendar pautas específicas pero, con los datos actuales, sólo es factible dar orientaciones generales que habrán de adaptarse e individualizarse para cada paciente concreto con lumbalgia crónica. Hay evidencia fuerte de que programas de ejercicio intensivo, iniciados 4-6 semanas después de una cirugía discal, son más eficaces a corto plazo que programas de ejercicios más suaves. No está aún completamente esclarecido el modo concreto por el que el ejercicio produce su efecto terapéutico en los pacientes con lumbalgia. (AU)

Conducción de vehículos en personas con secuelas por ictus / Driving vehicles in persons with stroke sequels

En la sociedad moderna conducir un automóvil puede ser muy importante para un discapacitado físico ya que incrementa su independencia funcional. La información, valoración y entrenamiento que recibe un discapacitado físico sobre la capacidad de conducir es nula o muy escasa en nuestro país. Para que un paciente con hemiparesia conduzca un coche se requieren algunas sencillas modificaciones mecánicas sobre los mandos usuales del vehículo, adaptando éstos para su manejo con el hemicuerpo no afectado. Pero, debido al ictus, son frecuentes otros déficit: sensoriales, visuales o cognitivos que, en muchos casos, determinarán que el paciente no pueda mantener una capacidad de conducir segura y sin riesgos. Cualquier médico rehabilitador que trate con pacientes con secuelas por ictus debe conocer los requisitos y las contraindicaciones para conducir automóviles, la normativa expresada en la legislación vigente para obtener o prorrogar el permiso de conducción ordinario (de clase B), las adaptaciones que puede precisar el coche y otros recursos disponibles para informar de manera completa y veraz sobre la capacidad de conducción.Para obtener la necesaria autorización legal será precisa, en ocasiones, una evaluación detallada con el concurso de otros profesionales y, otras veces, un adiestramiento con técnicas específicas para mejorar las capacidades de conducción, incluyendo el entrenamiento con equipos adaptados, que sería deseable incorporar a algunos servicios hospitalarios de nuestra especialidad. Este artículo proporciona claves para que el médico rehabilitador pueda cumplir con esta demanda de sus pacientes con secuelas por ictus (AU)

[Skin metastases of primary transitional cell carcinoma of the prostate. Apropos of a case]. / Metástasis cutánea de carcinoma transicional primario de próstata. A propósito de un caso.

OBJECTIVE: To report on a rare case of cutaneous metastasis from primary transitional cell carcinoma of the prostate. METHODS: A 70-year-old patient with transitional cell carcinoma of the prostate presented with cutaneous metastasis in the left leg. RESULTS: The cutaneous lesion was resected. Pathological analysis of the specimen demonstrated cutaneous metastasis from transitional cell carcinoma. CONCLUSIONS: Primary transitional cell carcinoma of the prostate is an uncommon and aggressive tumor that can metastasize to distant, atypical sites, as in the case described herein.