Ictericia congestiva desenmascarada con la ecografía clínica / Unmasking congestive jaundice with point-of-care ultrasound

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Frecuencia cardiaca y actividad física en niños con obesidad del Sur de Sonora / Heart rate and physical activity among obese children in south Sonora / Frequência cardíaca e atividade física em crianças com obesidade do Sul de Sonora

Introducción La obesidad infantil provoca una alteración en la modulación autonómica cardiaca. Se ha señalado que la reducción de la acción protectora del sistema nervioso parasimpático cardiaco, manifestada en una frecuencia cardiaca más acelerada tras la actividad física en este grupo de pacientes, podría representar un dato temprano de disfunción cardiovascular. Objetivo Determinar diferencias en la Frecuencia cardiaca en reposo y tras actividad física en escolares con y sin obesidad, adscritos al servicio de pediatría de un Hospital de Segundo Nivel de Atención. Material y método Bajo un diseño transversal, y un muestreo no probabilístico; se estudiaron niños en edad escolar que asistían a consulta externa de pediatría, se categorizó estado nutricional mediante score Z de IMC e índice cintura-estatura, se midió frecuencia cardiaca en tres momentos: reposo, posterior a actividad y en reposo tras actividad. Se realizó análisis descriptivo de las variables, coeficiente de correlación de Pearson, Kruskal Wallis y U de Mann Whitney, para medir asociación y diferencia de frecuencias cardiacas entre los grupos estudiados. Resultados Se estudiaron 106 niños en edad escolar, el 53% presentaba obesidad abdominal y el 66% sobrepeso/obesidad. Se encontraron diferencias de medias estadísticamente significativas en las frecuencias cardiacas post actividad y tras reposo post actividad, entre pacientes con y sin obesidad. Discusión y Conclusiones Los niños con sobrepeso y obesidad deberían tener un seguimiento estrecho, ya que el marcado aumento de la FC después de la actividad física, debe ser tomado en cuenta como signo de alarma temprano de disfunción cardiovascular.

Introduction Childhood obesity provokes alterations in the cardiac autonomic modulation; and it has been pointed that disturbances to cardiac parasympathetic system, manifested as faster heart rate after physical activity, in this group of patients, could represent an early sign of cardiovascular disfunction. Objective To determine differences in heart rate at rest and after physical activity among school children, with and without obesity, attending to a pediatric service in a Second Level of Attention Hospital. Materials and method Under a transversal study design, and non-probabilistic sampling, school children attending to pediatric service were studied. The nutritional status was assessed through BMI Z scores, and a waist/height index. Heart rate were measured at three times: rest, after some physical activity, and at rest after such physical activity. A descriptive analysis was performed, and Pearson correlation coefficient, and Kruskal-Wallis, and Mann-Whitney tests were calculated to assess cardiac-related associations and differences between the two groups. Results 106 school children were studied. 53% showed abdominal obesity and 66% overweight/obesity. Statistically significant mean differences were found in the cardiac frequencies post activity and at rest post activity between the patients with and without obesity. Discussion and conclusion Considering the notorious increases in cardiac frequencies after physical activity, children with overweight and obesity should to be closely monitored for possible signs of cardiovascular disfunction.

Introdução A obesidade infantil provoca uma alteração na modulação autonómica cardíaca. Foi apontado que a redução da ação protetora do sistema nervoso parassimpático cardíaco, manifestada em uma fre quência cardíaca mais acelerada após a atividade física neste grupo de pacientes, poderia representar um dado precoce de disfunção cardiovascular neles. Objetivo Determinar diferenças na Frequência cardíaca em repouso e após da atividade física em estu dantes com e sem obesidade, vinculados ao serviço de pediatria de um Hospital de Segundo Nível de Atenção. Material e método Sob um desenho transversal, e uma amostra não probabilística; estudaram-se crianças em idade escolar que assistiam a consulta externa de pediatria, categorizou-se estado nutricional mediante score Z de IMC e índice cinto-estatura, mediu-se frequência cardíaca em três momentos: repouso, posterior à atividade e em repouso após a atividade. Realizou-se análise descritiva das variáveis, coeficiente de correlação de Pearson, Kruskal Wallis e U de Mann Whitney, para medir associação e diferença de frequências cardíacas entre os grupos estudados. Resultados Estudaram-se 106 crianças em idade escolar, o 53% apresentava obesidade abdominal e o 66% sobrepeso/obesidade. Encontraram-se diferenças de médias estatisticamente significativas nas frequên cias cardíacas post atividade e após repouso post atividade, entre os pacientes com e sem obesidade. Discussão e Conclusões As crianças com sobrepeso e obesidade deveriam ter um acompanhamento maior, já que o marcado aumento da FC depois da atividade física é um signo de alarme, que deve ser tomado em conta como signo precoce de disfunção cardiovascular.

[The effect of age on the prognosis of patients with traumatic brain injury who undergo a craniotomy: analysis of a surgical series]. / Efecto de la edad en el pronostico de pacientes con traumatismo craneoencefalico sometidos a craneotomia: analisis de una serie quirurgica.

INTRODUCTION: In our setting, the ageing of the population has led to management of traumatic brain injury (TBI) in the later stages of life becoming an increasingly frequent problem. AIM: To evaluate the association between age and the functional and survival prognosis of patients who have undergone surgery due to TBI. PATIENTS AND METHODS: We performed a retrospective analysis of a series of 404 patients submitted to surgery between the years 2000 and 2015: 144 youngsters (12-44 years), 77 adults (45-64 years), 148 geriatric patients (65-79 years) and 26 'super geriatric' patients (> 80 years). We reviewed the demographic and nosological characteristics of the population, the survival and functional prognosis (Glasgow Outcome Scale, GOS) on discharge and at six months. RESULTS: Age presents a positive linear association with both intra-hospital mortality and the proportion of patients with an unfavourable prognosis (GOS 1-3) on hospital discharge and at six months (p < 0.001). Taking the population of youngsters as a reference, the relative risk for an unfavourable prognosis at six months was 1.5 (95% CI: 1.04-2.19) for adults; 2.37 (95% CI: 1.77-3.17) for the geriatric patients; and 3.5 (95% CI: 2.63-4.7) for the 'super geriatric' patients. These latter present a mortality rate while in hospital of 77.78% and a percentage of poor functional prognosis at six months of 94.44%. CONCLUSION: Increased age is a major negative determining factor in the prognosis of patients who undergo a craniotomy due to TBI. More precise knowledge of these outcomes and an adequate pre-operative discussion with the family will be an invaluable aid in the decision-making process.

TITLE: Efecto de la edad en el pronostico de pacientes con traumatismo craneoencefalico sometidos a craneotomia: analisis de una serie quirurgica.Introduccion. En nuestro entorno, el envejecimiento poblacional ha convertido el manejo del traumatismo craneoencefalico (TCE) en etapas avanzadas de la vida en un problema de frecuencia creciente. Objetivo. Valorar la asociacion entre la edad y el pronostico vital y funcional de pacientes intervenidos por TCE. Pacientes y metodos. Analizamos retrospectivamente una serie de 404 pacientes intervenidos en nuestro centro entre los años 2000 y 2015: 144 jovenes (12-44 años), 77 adultos (45-64 años), 148 pacientes geriatricos (65-79 años) y 26 supergeriatricos (> 80 años). Revisamos las caracteristicas demograficas y nosologicas de la poblacion, y el pronostico vital y funcional (escala pronostica de Glasgow, GOS) en el momento del alta y a los seis meses. Resultados. La edad presenta asociacion lineal positiva tanto con la mortalidad intrahospitalaria como con la proporcion de pacientes con pronostico desfavorable (GOS 1-3) en el alta y a los seis meses (p < 0,001). Tomando como referencia la poblacion de jovenes, el riesgo relativo para pronostico desfavorable a los seis meses fue de 1,5 (IC 95%: 1,04-2,19) para los adultos, 2,37 (IC 95%: 1,77-3,17) para los geriatricos y 3,5 (IC 95%: 2,63-4,70) para los supergeriatricos. Estos ultimos presentan una mortalidad durante el ingreso del 77,78% y un porcentaje de mal pronostico funcional a los seis meses del 94,44%. Conclusion. El aumento de la edad es un factor determinante negativo mayor en el pronostico de pacientes sometidos a craneotomia por TCE. Un conocimiento preciso de estos resultados y una adecuada discusion preoperatoria con la familia resultaran de gran ayuda en el proceso de toma de decisiones.

Contingent screening for Down syndrome completed in the first trimester: a multicenter study.

OBJECTIVE: To assess a new contingent screening strategy for Down syndrome completed in the first trimester. METHODS: First-trimester screening combining nuchal translucency thickness measurement and assessment of serum analytes (combined test) was offered to pregnant women who presented for prenatal care during the first trimester to nine health centers and community hospitals in the area served by the Catalan Public Health Service. If an intermediate risk (1/101-1/1000) for Down syndrome was identified, women were referred to the Hospital Clinic Barcelona for risk reassessment that included the use of secondary ultrasound markers (nasal bone, ductus venosus blood flow and tricuspid flow). Intermediate-risk women were divided into two subgroups for further analysis: high-intermediate risk (1/101-1/250) and low-intermediate risk (1/251-1/1000). We compared feasibility and efficacy of both combined and contingent screening strategies. RESULTS: The combined test, the first screening stage, was performed in 16 001 pregnant women, of whom 1617 (10.1%) were found to have an intermediate risk. Further division of this group showed that 1.8% (n = 289) of women were at high-intermediate risk and 8.3% (n = 1328) at low-intermediate risk. The contingent screening strategy significantly reduced the false-positive rate, from 3.0% to 1.3-1.8% (P < 0.001), without affecting the detection rate (which was 75-79% and 76%, with and without the contingent screening strategy, respectively). However, only 45% of intermediate-risk patients underwent the second screening step due to a preference among high-intermediate-risk (1/101-1/250) women for invasive testing and to low uptake among low-intermediate-risk (1/251-1/1000) women. CONCLUSIONS: The proposed first-trimester contingent strategy reduces the screen false-positive rate without impacting on the detection rate of Down syndrome. The low compliance observed in our study may prevent its use in certain populations.

Un caso raro de cervicalgia crónica: el síndrome de Klippel-Feil / A rare case of chronic cervical pain: the Klippel-Feil syndrome

Mujer de 36 años con dolor cervical mecánico y hombro izquierdo irradiado por extremidad superior, 4° y 5° dedos mano izquierda, crónico y discreta pérdida de fuerza y sensibilidad. No hay hipoacusia, síntomas urinarios ni cardiológicos. Exploración: orejas, implantación del pelo y longitud cervical normal. Dolor al palpar apófisis espinosas de vértebras y músculos cervicales. Disminución de sensibilidad táctil y dolorosa en zona cubital de mano izquierda, 4° y 5° dedos. Rx C. Cervical: fusión de vertebras C3-C4 y C7-D1. RMN C. Cervical: Fusión de vertebras C2-C3 y T1-T2. EMG: datos de atrapamiento del mediano en Túnel del Carpo. Diagnóstico: síndrome de Klippel-Feil. El síndrome de Klippel-Feil es una enfermedad rara, congénita del grupo de las malformaciones de la charnela craneocervical, que consiste en la fusión de dos o más vértebras cervicales; asociado a veces a defectos en sistema genitourinario, nervioso, cardiopulmonar y pérdida auditiva (AU)

A 36 year-old woman, with mechanical neck and left shoulder pain radiating to the arm, 4th and 5th fingers of the left hand, with a chronic and modest loss of strength and sensitivity. No loss of hearing; no urinary or cardiological symptoms. Physical Examination: Ears, hair implantation and neck length normal. Pain on palpation of vertebral spine apophyses and neck muscles. A decrease in tactile sensitivity and painful in the left hand cubital area, 4th and 5th fingers. Rx Spinal Column: Fusion of vertebrae C3-C4 y C7-D1. NMR Spinal Column: Fusion of vertebrae C2-C3 y T1-T2. EMG: signs of median nerve trapping in Carpal Tunnel. Diagnosis: Klippel-Feil Syndrome. Klippel-Feil Syndrome is a rare congenital disease of the group of craniocervical hinge malformation, which consists of the fusion of two or more vertebrae. It is occasionally associated with genitourinary system, nerve, cardiopulmonary defects and hearing loss (AU)

Modelo de regresión logística para estimar la dependencia según la escala de Lawton y Brody / Logistic regression model for the calculation of dependence according to the Lawton and Brody scale

Objetivo. Estimar mediante regresión logística la asociación de dependencia según escala de Lawton y Brody en mayores de 65 años y variables sociodemográficas. Material y métodos. Estudio transversal realizado en atención primaria en una zona de salud urbana de Badajoz, sobre una muestra de 125 personas mayores de 65 años mediante estratificación y muestreo aleatorio por sexo y grupos de edad. Las variables obtenidas son sociodemográficas (sexo y grupos de edad), estado civil, convivencia, vivienda, estudios y clase social. Clasificamos como dependientes para las actividades instrumentales de la vida diaria aquellos con menos de 8 puntos. Análisis estadístico: regresión logística multivariante por pasos hacia atrás. Resultados. Sexo: OR=1,276, el riesgo de dependencia en varones es mayor que en mujeres. El IC95% es muy preciso. Grupos de edad: OR=0,155–0,231 del cuarto paso indican menor riesgo en grupos de edad 1 y 2 frente a los mayores de 85 años. Resultados. Convivencia: es significativa (p=0,00) su asociación con la dependencia. Las categorías «En pareja» y «Vive solo/a» multiplican por 0,086 y 0,367 la probabilidad de dependencia comparadas con «Otros». Clase social: asociada a la dependencia y con mayor riesgo en la clase V. Vivienda, estudios y estado civil son eliminadas del modelo definitivo porque tienen coeficientes no significativos. Conclusiones. El modelo final incluye sexo, grupos de edad, convivencia y clase social, asociadas con la dependencia. Consideramos útil la escala en mayores de 65 años para detectar precozmente la dependencia (AU)

Objective. To calculate the association of dependence according to the Lawton and Brody scale in elderly subjects over 65 years of age and social-demographic variables using logistic regression. Material and methods. A cross-sectional study conducted in Primary Care in an urban health area of Badajoz in a sample of 125 elderly subjects over 65 years by stratification and random sampling by gender and age groups. The variables obtained are sociodemographic (gender and age groups), marital status, coexistence, housing, studies and social class. Subjects were classified as dependent by the Instrumental Activities of the Daily Living when they scored less than 8 points. Statistic analysis: binary logistic regression by backward step. Results. Gender: OR=1.267, risk of dependence is greater in men than in women. The 95% CI is very precise. Age groups: OR=0.155 and 0.231 from the fourth step indicates lower risk in the age groups 1 and 2 compared to those over 85 years. Results. Coexistence: its association with the dependence is significant (p=0.00). The categories “with partner” and “he/she lives alone” multiply by 0.086 and 0.367 the probabilities of dependence compared with “Others.” Social class: it is associated to dependence and with higher risk in class V. Housing, studies and marital status have been eliminated from the final model because there coefficients are non-significant. Conclusions. The final model includes gender, age groups, coexistence and social class, associated with dependence. We consider that the scale is useful in those over 65 years in order to detect dependence precociously (AU)

Prevalencia del síndrome metabólico y enfermedades clínicas asociadas en un grupo de población urbana del Centro de Salud Zona Centro de Badajoz / Prevalence of the metabolic syndrome and associated clinic diseases in a group of urban population of Central Area Health Center in Badajoz

INTRODUCCIÓN Y OBJETIVO. El síndrome metabólico (SM) comporta mayor morbilidad/mortalidad por enfermedades cardiovasculares, diabetes mellitus (DM) tipo 2 y mortalidad general. La prevalencia en España se estima en el 25%; la Encuesta Nutricional de Canarias (ENCA) encuentra una prevalencia del 24,4% y aumenta con la edad. El objetivo es conocer la prevalencia del SM definido por la combinación de 3 o más criterios en un cupo de población urbana. MATERIAL Y MÉTODO. Estudio descriptivo del SM en 907 pacientes mayores de 18 años. Variables: edad/sexo, antecedentes personales de DM tipo 2, cardiopatía isquémica (CI), enfermedad cerebrovascular (ECV), enfermedad vascular arterial periférica (EVAP) e hipertensión arterial (HTA); datos antropométricos/analíticos (perímetro abdominal [PA], índice de masa corporal [IMC], tensión arterial [TA], glucemia basal [GB], triglicéridos [TG] y lipoproteínas de alta densidad [HDL]). Se ha realizado estadística descriptiva de edad/sexo, comparación de proporciones e intervalo de confianza al 95% (IC 95%) de criterios diagnósticos y enfermedades clínicas asociadas (ECA) al SM aplicando la definición propuesta por la National Cholesterol Education Program (NCEP). RESULTADOS. Entre los criterios diagnósticos destacan: TA (16,3%), IMC (14%) y obesidad abdominal (OA) (12,2%); son más frecuentes en mujeres y GB y TG más frecuente en varones. Las ECA más prevalentes son HTA y DM tipo 2 en mujeres y CI, ECV y EVAP en varones. La prevalencia considerando 3 criterios es del 23,81%, con 4 del 5,84% y con 5 del 0,66%. CONCLUSIONES. El 25% de los pacientes que consultan en el centro de salud tienen SM; la prevalencia del 23,81% es similar a otros estudios. En hipertensos y diabéticos es donde más frecuentemente se presentan los criterios diagnósticos, principalmente OA, IMC, GB y TA. La prevalencia de la OA puede estar infravalorada. Es importante valorar qué combinaciones de criterios tienen más riesgo de asociarse a las ECA

INTRODUCTION AND OBJECTIVE. Metabolic syndrome (MS) has greater morbidity/mortality due to cardiovascular diseases, type 2 diabetes mellitus and general mortality. Its prevalence in Spain is estimated at 25%. The Canary Island Nutritional Survey (ENCA) has obtained a prevalence of 24.4% which increases with age. This study aimed to discover the prevalence of MS defined by the combination of 3 or more criteria in a quota of urban population. MATERIAL AND METHOD. Descriptive study of MS in 907 patients over 18 years. Variables: age/gender, personal backgrounds of type 2 diabetes mellitus, ischemic heart disease, cerebrovascular disease, peripheral arterial vascular disease and arterial hypertension; anthropometric/analytic facts (abdominal perimeter, body mass index, blood pressure, basal glycemia, triglyceride and high-density lipoprotein). Descriptive statistic was made on age/gender, comparison of proportions and 95% CI of diagnosis criteria and clinical diseases associated to the MS, applying the definition proposed by the National Cholesterol Education Program (NCEP). RESULTS. The following stand out among the diagnosis criteria: Blood pressure (16.3%), body mass index (14%) and abdominal obesity (12.2%), which are more frequent in women and basal glycemia and triglyceride which are more frequent in men. The most prevalent associated clinical diseases are arterial hypertension and type 2 diabetes mellitus in women, and ischemic heart disease, cerebrovascular disease and peripheral arterial vascular disease in men. Considering 3 criteria, prevalence is 23.81% with 4 (5.84%) and 5 (0.66%). CONCLUSIONS. A total of 25% of the patients who consult in the health center have MS. This prevalence of 23.81% is similar to others studies. The diagnosis criteria, mainly abdominal obesity, body mass index, basal glycemia and blood pressure, appeared more frequently among subjects with high blood pressure and diabetics. Prevalence of the abdominal obesity may be underestimated. It is important to evaluate what combinations of criteria have more risk of being associated to the ECA