Corrección de arrugas perioculares con plasma rico en plaquetas / Correction of periocular wrinkles with platelet-rich plasma

Las arrugas son surcos o pliegues en la piel, que aparecen principalmente por efecto del envejecimiento. Este artículo describe el caso de un paciente masculino de 47 años de edad, piel blanca, que acudió a consulta de cirugía plástica ocular por inconformidad con el aspecto envejecido de su rostro a causa de las arrugas perioculares. Se le aplicó plasma rico en plaquetas intradérmico en el trayecto de las arrugas a razón de 3 dosis con intervalo promedio de 30 días entre cada una. Se logró la corrección total de las arrugas, con buenos resultados estéticos. No se encontró reacción adversa. Se reafirma el criterio planteado por estudios de que el plasma rico en plaquetas es una opción terapéutica de primera línea para rejuvenecer la región periocular(AU)

Wrinkles are a creases or folds which appear in the skin mainly as a result of aging. A case is described of a male 47-year-old patient of white skin color who attended ocular plastic surgery consultation for dissatisfaction with the periocular wrinkles on his face, which gave it an aged appearance. Intradermal platelet-rich plasma was applied along the course of the wrinkles at three doses with an average separation of 30 days between them. Total wrinkle correction was achieved, with good esthetic results. There was not any adverse reaction. The case confirms the criterion contained in previous studies that platelet-rich plasma is a first-line therapeutic option to rejuvenate the periocular region(AU)

Alternativas terapéuticas de la úlcera corneal infecciosa / Therapeutic alternativesfor the infectious corneal ulcer

Introducción: La úlcera corneal infecciosa es una afección frecuente en la consulta de oftalmología. Su resolución es un problema de salud a resolver, pues los tratamientos convencionales no siempre garantizan una evolución favorable de los casos diagnosticados debido a la resistencia microbiana, por lo que se siguen buscando alternativas terapéuticas. Objetivo: Describir las alternativas de tratamiento en la úlcera corneal infecciosa para minimizar sus secuelas y disminuir la ceguera por esta enfermedad. Desarrollo: La administración tópica de antibióticos de amplio espectro sigue siendo el método preferido para el tratamiento farmacológico de las úlceras corneales infecciosas, a pesar de los informes de fracasos clínicos por la resistencia a los antibióticos, por lo que se investiga acerca del uso de nuevas alternativas terapéuticas que minimicen las secuelas de esta enfermedad.Se realizó una revisión sistemática de la evidencia científica en los últimos diez años en diversos artículos, en los que se constató la aplicación de diferentes sustancias como tratamiento alternativo. Conclusiones: En la úlcera corneal infecciosa el tratamiento protocolizado combinado con sustancias alternativas, que tienen en común una actividad de amplio espectro, resultaría ser ventajoso por ser productos económicos y seguros, que han demostrado un gran poder bactericida. Se propone generalizar el uso de estos compuestos, dada la resistencia de los microorganismos al tratamiento convencional; lo que hace que la úlcera corneal sea un problema de salud a resolver.

Introduction: The infectious corneal ulcer is a frequent disorder in the ophthalmology outpatient department, its solution is a health problem to be solved, as the conventional treatments don't always guarantee a favorable clinical course of the diagnosed cases. Because of the microbial resistance, so that therapeutic alternatives are still looked for. Objective: To describe the treatment alternatives in the infectious corneal ulcer for minimizing their sequelae and to decrease blindness due to this disease. Development: The topical administration of wide spectrum antibiotics continues being the favorite method for the pharmacological treatment of the infectious corneal ulcers, in spite of the clinical failures reports caused by the resistance to antibiotics, that is why the use of new therapeutic alternatives minimizing the sequels of this disease is investigated. Method: A systematic review of the scientific evidence in the last ten years was carried out on several works, in which it was evidenced the use of different substances as alternative treatment. Conclusions: In the infectious corneal ulcer the protocolized treatment combined with alternative substances which have in common a wide spectrum activity would turn out to be advantageous as they are economic and sure products which have demonstrated a great power against bacteria. The use of these compounds could be generalized, given the resistance of organisms to the conventional treatment; what makes the corneal ulcer a health problem to be solved.

Validation of a Sagittal Section Technique for Measuring Clitoral Blood Flow. Volume Flow: A New Parameter in Clitoral Artery Doppler.

BACKGROUND: Clitoral artery Doppler has been used as an objective technique to measure changes in genital women response. However, the technique has not been fully validated, and arterial volume flow has never been used as an outcome measure. AIMS: To validate the technique clitoral artery Doppler measured in a sagittal section and explore arterial volume flow as a new parameter in clitoral Doppler. METHODS: We examined 90 healthy volunteers by clitoral artery Doppler using the sagittal section approach described by Battaglia et al in 2008. We calculated intraobserver, interobserver, and intraobserver intersession variability and reliability for all Doppler parameters and described and validated arterial volume flow as a new parameter in clitoral artery Doppler. OUTCOMES: We calculated peak systolic velocity (PSV), time-averaged maximum velocity, time-averaged mean velocity, end-diastolic velocity, pulsatility index, resistance index, and volume flow (v-flow) in all groups. We conducted reliability analyses using the intraclass correlation coefficient for agreement. We explored differences between and within observers and calculated agreement limits using the Bland-Altman test. RESULTS: The intraclass correlation coefficient analysis showed correlation values higher than 0.75 (good reliability) for most of the variables and higher than 0.60 (moderate reliability) for the remaining ones. There were statistically significant differences between PSV and time-averaged maximum velocity in the intraobserver intersession measurements. For the remaining groups and variables, no statistically significant differences were observed. Bland-Altman analyses showed that the limits of agreement were acceptable and the regressions were not significant. The v-flow parameter also showed good reliability and low variability between groups. CLINICAL IMPLICATIONS: We found that PSV was not a good outcome measure because of its high intraobserver and intersession variability. Moreover, it is possible to measure v-flow in the clitoral artery using the sagittal technique described by Battaglia et al, and it seems that this measure is reliable and reproducible. This could be the best parameter to assess clinical changes. STRENGTHS & LIMITATIONS: This study provided full validation of the sagittal section approach and of a new parameter, v-flow, which could beuseful for assessing clitoral blood flow. The main limitation of the study is its retrospective nature for validating v-flow. CONCLUSION: We found that clitoral artery Doppler measured using a sagittal approach is a valid and reliable technique for studying clitoral blood flow in women. The v-flow variable is a promising and reliable parameter for measuring changes in clitoral blood flow. Pérez MF, Agís IF, La Calle Marcos P, et al. Validation of a Sagittal Section Technique for Measuring Clitoral Blood Flow: Volume Flow - A New Parameter in Clitoral Artery Doppler. J Sex Med 2020;17:1109-1117.

Características de los pacientes con EPOC tratados en neumología en España según grupos GOLD y fenotipos clínicos GesEPOC / Characteristics of COPD Patients Managed in Respiratory Medicine Departments in Spain, According to GOLD Groups and GesEPOC Clinical Phenotypes

Introducción: El objetivo de este estudio ha sido analizar las características clínicas de los pacientes con EPOC vistos en las consultas generales de neumología, el seguimiento de las guías clínicas y la adecuación en la categorización y en el manejo terapéutico. Método: Estudio multicéntrico, transversal, cuyo objetivo primario es describir el número, intensidad y variabilidad de los síntomas en los pacientes con EPOC. La recogida de los datos fue realizada en 2015 por 300 neumólogos que evaluaron un total de 3.010 pacientes, de los cuales 2.669 (88,6%) fueron válidos para el análisis. Resultados: El 22% eran fumadores activos, destacando un 21 y 17% en los grupos C y D de GOLD y un 17 y 19% en los pacientes exacerbadores de GesEPOC. El 62,3% presentaba comorbilidades asociadas. En el proceso diagnóstico destaca el bajo uso de pruebas como el test de difusión o la medición de volúmenes pulmonares, incluso en los grupos más graves de GOLD o en los fenotipos exacerbadores de GesEPOC. También es minoritario el uso de escalas multidimensionales como BODE (12%) o programas específicos de rehabilitación. El tratamiento se basa en el uso de broncodilatadores y corticoides inhalados, en diferentes combinaciones. El uso de metilxantinas fue minoritario (7%). Conclusiones: En consultas de neumología existe una elevada proporción de pacientes EPOC con baja complejidad y un escaso uso de pruebas neumológicas. Se constata un leve cambio en las pautas terapéuticas y la frecuente asociación con comorbilidades que pueden modificar la presentación clínica del paciente

Introduction: The objective of this study was to analyze the clinical characteristics of COPD patients attending general respiratory clinics, adherence to clinical guidelines, classification accuracy, and therapeutic management. Method: Multicenter, cross-sectional study, with the primary objective of describing the number, intensity, and variability of symptoms in COPD patients. Data were collected in 2015 by 300 pulmonologists who evaluated a total of 3,010 patients, of which 2,669 (88.6%) were eligible for analysis. Results: A total of 22% were active smokers, notably 21% and 17% of GOLD groups C and D, and 17% and 19% of exacerbators in the GesEPOC classification; 62.3% had associated comorbidities. The diagnostic process was characterized by limited use of tests such as diffusion capacity or lung volumes, even in the more severe GOLD groups or the GesEPOC exacerbator phenotypes. The use of multidimensional scales, such as BODE (12%), and specific rehabilitation protocols was also rare. Treatment was based on different combinations of bronchodilators and inhaled corticosteroids. Methylxanthines were used in very few patients (7%). Conclusions: A large proportion of COPD patients seen in respiratory clinics have non-complex disease and pulmonology tests are rarely performed. Our study confirms a slight change in treatments and the frequent association with comorbidities that can modify the clinical presentation of the patient

Characteristics of COPD Patients Managed in Respiratory Medicine Departments in Spain, According to GOLD Groups and GesEPOC Clinical Phenotypes. / Características de los pacientes con EPOC tratados en neumología en España según grupos GOLD y fenotipos clínicos GesEPOC.

INTRODUCTION: The objective of this study was to analyze the clinical characteristics of COPD patients attending general respiratory clinics, adherence to clinical guidelines, classification accuracy, and therapeutic management. METHOD: Multicenter, cross-sectional study, with the primary objective of describing the number, intensity, and variability of symptoms in COPD patients. Data were collected in 2015 by 300 pulmonologists who evaluated a total of 3,010 patients, of which 2,669 (88.6%) were eligible for analysis. RESULTS: A total of 22% were active smokers, notably 21% and 17% of GOLD groups C and D, and 17% and 19% of exacerbators in the GesEPOC classification; 62.3% had associated comorbidities. The diagnostic process was characterized by limited use of tests such as diffusion capacity or lung volumes, even in the more severe GOLD groups or the GesEPOC exacerbator phenotypes. The use of multidimensional scales, such as BODE (12%), and specific rehabilitation protocols was also rare. Treatment was based on different combinations of bronchodilators and inhaled corticosteroids. Methylxanthines were used in very few patients (7%). CONCLUSIONS: A large proportion of COPD patients seen in respiratory clinics have non-complex disease and pulmonology tests are rarely performed. Our study confirms a slight change in treatments and the frequent association with comorbidities that can modify the clinical presentation of the patient.

El examen estatal teórico en la especialidad de Medicina General Integral / The theoretical state examination in the specialty of family medicine

Introducción: La Atención Primaria de Salud constituye un importante escenario de formación de profesionales, al desarrollarse la especialidad de Medicina General Integral. Objetivo: Analizar los resultados de exámenes teóricos estatales de Medicina General Integral (MGI). Facultad de Ciencias Médicas Manuel Fajardo. 2014-2016. Métodos: se realizó un estudio observacional, descriptivo, retrospectivo, cuanticualitativo, de los exámenes estatales teóricos en la especialidad de MGI en tres convocatorias. Mediante la operacionalización de variables se calculó valores totales y porcientos. Resultados: El 97,7 por ciento de los residentes resultaron aprobados en las convocatorias: oct 2014 - oct 2016, aportan suspensos el 2014 con 2,24 por ciento. La categoría bien, predominó en las convocatorias 2014 y 2015 con 53,65 por ciento y 48 por ciento respectivamente, sin embargo prevaleció el regular en el 2016 con 52,38 por ciento. En las tres convocatorias, las enfermedades crónicas y el adulto mayor fueron los temas de resultados más bajos. Las enfermedades infecciosas fue el tema que reflejó mayor dominio en dos convocatorias. Conclusiones: La mayoría de los residentes resultaron aprobados, predominó la categoría de bien en las respuestas en los tres cursos académicos(AU)

Introduction: Primary health care is an important setting for the training of professionals, as the specialty of family medicine is developed. Objective: To analyze the results of the state theoretical examinations for family medicine (FM) at Manuel Fajardo School of Medical Sciences, from 2014-2016. Methods: An observational, descriptive, retrospective, quantitative and qualitative study of the theoretical state examinations in the specialty of FM was carried out in three calls. Through the operationalization of variables, total and percent values ​​were calculated. Results: 97.7 percent of the residents were approved in the calls from October 2014 to October 2016, and represented the failings in 2014, with 2.24 percent. The category was good, prevailing in the 2014 and 2015 calls with 53.65 percent and 48 percent, respectively. However, the regular outcome prevailed in 2016, with 52.38 percent. In the three calls, chronic diseases and the senior adults were the subjects with the lowest results. Infectious diseases were the subject that reflected the greatest dominance in two calls. Conclusions: The majority of the residents were approved, the category of good prevailed in the answers in the three academic years(AU)

El examen estatal teórico en la especialidad de Medicina General Integral / The theoretical state examination in the specialty of family medicine

Introducción: La Atención Primaria de Salud constituye un importante escenario de formación de profesionales, al desarrollarse la especialidad de Medicina General Integral. Objetivo: Analizar los resultados de exámenes teóricos estatales de Medicina General Integral (MGI). Facultad de Ciencias Médicas Manuel Fajardo. 2014-2016. Métodos: se realizó un estudio observacional, descriptivo, retrospectivo, cuanticualitativo, de los exámenes estatales teóricos en la especialidad de MGI en tres convocatorias. Mediante la operacionalización de variables se calculó valores totales y porcientos. Resultados: El 97,7 por ciento de los residentes resultaron aprobados en las convocatorias: oct 2014 - oct 2016, aportan suspensos el 2014 con 2,24 por ciento. La categoría bien, predominó en las convocatorias 2014 y 2015 con 53,65 por ciento y 48 por ciento respectivamente, sin embargo prevaleció el regular en el 2016 con 52,38 por ciento. En las tres convocatorias, las enfermedades crónicas y el adulto mayor fueron los temas de resultados más bajos. Las enfermedades infecciosas fue el tema que reflejó mayor dominio en dos convocatorias. Conclusiones: La mayoría de los residentes resultaron aprobados, predominó la categoría de bien en las respuestas en los tres cursos académicos(AU)

Introduction: Primary health care is an important setting for the training of professionals, as the specialty of family medicine is developed. Objective: To analyze the results of the state theoretical examinations for family medicine (FM) at Manuel Fajardo School of Medical Sciences, from 2014-2016. Methods: An observational, descriptive, retrospective, quantitative and qualitative study of the theoretical state examinations in the specialty of FM was carried out in three calls. Through the operationalization of variables, total and percent values calculated. Results: 97.7 percent of the residents were approved in the calls from October 2014 to October 2016, and represented the failings in 2014, with 2.24 percent. The category was good, prevailing in the 2014 and 2015 calls with 53.65 percent and 48 percent, respectively. However, the regular outcome prevailed in 2016, with 52.38 percent. In the three calls, chronic diseases and the senior adults were the subjects with the lowest results. Infectious diseases were the subject that reflected the greatest dominance in two calls. Conclusions: The majority of the residents were approved, the category of good prevailed in the answers in the three academic years(AU)

Genetic susceptibility to invasive pneumococcal disease.

BACKGROUND: The pathogenesis of IPD remains unknown, especially among middle-aged individuals without risk factors (WRF). OBJECTIVES: The aim of the present study was to investigate the role of single nucleotide polymorphisms (SNP) within key genes involved in innate immune response on IPD susceptibility. METHODS: Forty-three SNPs within 10 immunological genes were investigated in a cohort of 144 Caucasian IPD patients and 280 ethnically matched controls. RESULTS: The allele distribution of the NFKBIA rs1050851 and NFKBIE rs2282151 variants were associated with IPD susceptibility (χ2 = 4.23, p = 0.04 and χ2 = 5.13, p = 0.02, respectively). Additionally, the genotype distribution of NFKBIZ rs645781 (χ2 = 8.25, p = 0.02) and IL1R1 rs3917254 (χ2 = 6.70, p = 0.04) were also associated with IPD risk. When only IPD-WRF patients were considered; the allele distribution of IL1R1 rs2160227 (χ2 = 5.62, p = 0.03), rs13020778 (χ2 = 5.73, p = 0.02), rs3917267 (χ2 = 3.72, p = 0.05) and IL4 rs2227284 (χ2 = 3.76, p = 0.05) and the genotype distribution of IL10 rs3024509 (χ2 = 7.70, p = 0.02), IL1R1 rs3917254 (χ2 = 13.40, p = 0.001), NFKBIZ rs645781 (χ2 = 13.86, p = 0.001) and rs677011 (χ2 = 9.06, p = 0.01) variants were associated with IPD risk. CONCLUSIONS: We found several associations between variants in the IL1R1, IL4, IL10, NFKBIE, NFKBIA, and NFKBIZ genes and risk of IPD. If validated, these biomarkers may help to identify people with higher risk of IPD.

Evaluación final del internado rotatorio de Medicina General Integral / Final evaluation of the rotational internship in Family Medicine

Introducción: el proceso evaluativo brinda retroalimentación acerca de la efectividad de la enseñanza y resultado del aprendizaje. Objetivo: caracterizar la evaluación final del internado de Medicina General Integral durante un curso académico. Métodos: se realizó estudio observacional descriptivo, cuanti-cualitativo, retrospectivo en la asignatura Medicina General Integral sexto año, Facultad "Manuel Fajardo" durante el curso escolar 2014-2015. El dato primario se obtuvo de información documental. Las variables se trabajaron en una hoja de cálculo Excel y su operacionalización se realizó con el sistema operativo Windows Xp; se calculó frecuencias absoluta y relativa, se realizó triangulación de información, se definió composición del instrumento y contenidos evaluativo evaluados. Resultados: el 76,3 por ciento obtuvo excelente en evaluación final y 1,1 por ciento resultó reprobado con promoción cualitativa de 93,5 por ciento. En evaluación frecuente el 81,8 por ciento obtiene excelente y 15 por ciento. En examen práctico el 71 por ciento obtiene excelente y 23,6 por ciento bien. En evaluación teórica 60,2 por ciento logra excelente y el 24,7 por ciento de los evaluados obtiene bien. El instrumento evaluativo corresponde a un test objetivo de siete preguntas. La pregunta con mayor error pertenece al contenido prevención y las de mejores resultados relacionados con familia y enfermedades transmisibles. El escenario docente con dificultades en la promoción correspondió al Policlínico Rampa. Conclusiones: predominó un buen índice de calidad en la evaluación final. En evaluación frecuente, examen práctico y teórico predominan las categorías excelente y bien. El contenido prevención aporta mayor error y las mejores respuestas fueron: familia y enfermedades transmisibles. El escenario docente con resultados inferiores fue el Policlínico Rampa(AU)

Introduction: The evaluation process provides feedback about the effectiveness of teaching and the outcomes of learning. Objective: To characterize the final evaluation of the internship in Family Medicine during an academic year. Methods: A descriptive, quantitative and qualitative, retrospective and observational study was carried out in the subject Family Medicine of the sixth academic year at Manuel Fajardo Medical School in 2014-2015. The primary data was obtained from documentary information. The variables were processed in an Excel worksheet operated in Windows XP. Absolute and relative frequencies were calculated, triangulation of information was carried out, together with the composition of the instrument, while the contents of the evaluation were defined. Results: 76.3 percent obtained excellent in the final evaluation and 1.1 percent failed with a qualitative promotion of 93.5 percent. In the frequent evaluation, 81.8 percent obtained excellent and 15 percent, good. In the practical examination, 71 percent obtained excellent and 23.6 percent, good. In the theoretical evaluation, 60.2 percent obtained excellent and 24.7 percent, good. The evaluative instrument is correspondent with an objective test of seven questions. The question with the greatest number of errors belongs to the prevention content and the best results were related to the family and the communicable diseases. The teaching setting with difficulties in the promotion corresponded to La Rampa Outpatient Polyclinic. Conclusions: A good quality index predominated in the final evaluation. In frequent evaluation, the practical and theoretical examination, there is a predominance of the categories excellent and good. The content about prevention provides more errors and the best answers were related to the contents about family and communicable diseases. The teaching setting with the lowest results was La Rampa Outpatient Polyclinic(AU)

Evaluación final del internado rotatorio de Medicina General Integral / Final evaluation of the rotational internship in Family Medicine

Introducción: el proceso evaluativo brinda retroalimentación acerca de la efectividad de la enseñanza y resultado del aprendizaje. Objetivo: caracterizar la evaluación final del internado de Medicina General Integral durante un curso académico. Métodos: se realizó estudio observacional descriptivo, cuanti-cualitativo, retrospectivo en la asignatura Medicina General Integral sexto año, Facultad "Manuel Fajardo" durante el curso escolar 2014-2015. El dato primario se obtuvo de información documental. Las variables se trabajaron en una hoja de cálculo Excel y su operacionalización se realizó con el sistema operativo Windows Xp; se calculó frecuencias absoluta y relativa, se realizó triangulación de información, se definió composición del instrumento y contenidos evaluativo evaluados. Resultados: el 76,3 por ciento obtuvo excelente en evaluación final y 1,1 por ciento resultó reprobado con promoción cualitativa de 93,5 por ciento. En evaluación frecuente el 81,8 por ciento obtiene excelente y 15 por ciento. En examen práctico el 71 por ciento obtiene excelente y 23,6 por ciento bien. En evaluación teórica 60,2 por ciento logra excelente y el 24,7 por ciento de los evaluados obtiene bien. El instrumento evaluativo corresponde a un test objetivo de siete preguntas. La pregunta con mayor error pertenece al contenido prevención y las de mejores resultados relacionados con familia y enfermedades transmisibles. El escenario docente con dificultades en la promoción correspondió al Policlínico Rampa. Conclusiones: predominó un buen índice de calidad en la evaluación final. En evaluación frecuente, examen práctico y teórico predominan las categorías excelente y bien. El contenido prevención aporta mayor error y las mejores respuestas fueron: familia y enfermedades transmisibles. El escenario docente con resultados inferiores fue el Policlínico Rampa(AU)

Introduction: The evaluation process provides feedback about the effectiveness of teaching and the outcomes of learning. Objective: To characterize the final evaluation of the internship in Family Medicine during an academic year. Methods: A descriptive, quantitative and qualitative, retrospective and observational study was carried out in the subject Family Medicine of the sixth academic year at Manuel Fajardo Medical School in 2014-2015. The primary data was obtained from documentary information. The variables were processed in an Excel worksheet operated in Windows XP. Absolute and relative frequencies were calculated, triangulation of information was carried out, together with the composition of the instrument, while the contents of the evaluation were defined. Results: 76.3 percent obtained excellent in the final evaluation and 1.1 percent failed with a qualitative promotion of 93.5 percent. In the frequent evaluation, 81.8 percent obtained excellent and 15 percent, good. In the practical examination, 71 percent obtained excellent and 23.6 percent, good. In the theoretical evaluation, 60.2 percent obtained excellent and 24.7 percent, good. The evaluative instrument is correspondent with an objective test of seven questions. The question with the greatest number of errors belongs to the prevention content and the best results were related to the family and the communicable diseases. The teaching setting with difficulties in the promotion corresponded to La Rampa Outpatient Polyclinic. Conclusions: A good quality index predominated in the final evaluation. In frequent evaluation, the practical and theoretical examination, there is a predominance of the categories excellent and good. The content about prevention provides more errors and the best answers were related to the contents about family and communicable diseases. The teaching setting with the lowest results was La Rampa Outpatient Polyclinic(AU)

The variability of respiratory symptoms and associated factors in COPD.

Few studies have investigated the variability of COPD-related symptoms or factors related to symptom variability. This observational, prospective, multicentre study was conducted to describe the number and intensity of morning and night-time respiratory symptoms and their variability over one week using the Night-time and Early Morning Symptoms of COPD Instruments (NiSCI and EMSCI) to evaluate stable COPD patients. Logistic regression analyses were performed to investigate factors associated with symptom variability. A total of 2669 patients were evaluated (mean age, 67.7 years; 80.9% men; mean FEV1 50.6%). Of these, 48% reported night-time symptoms and 71% reported morning symptoms. Of the 2293 patients who completed the NiSCI and EMSCI, 90% showed variability in either symptom number (89.6%) or symptom intensity (15.8%). More severe dyspnoea, more exacerbations during the previous year and the exacerbator or mixed COPD-asthma phenotypes were associated with variability in symptom number or intensity. Anxiety was significantly associated with variability in symptom number and intensity. Most COPD patients showed symptom variability over a weeklong period, especially in terms of symptom number. Several COPD-related factors, mainly factors related to more severe disease and more frequent exacerbations, were associated with increased symptom variability.

Control de la enseñanza tutelar: su caracterización en la Disciplina Medicina General Integral. Facultad de Ciencias Médicas "Manuel Fajardo", 2012-2015 / Control of the tutelary teaching: its characterization in the Integral General Medicine discipline. Faculty of Medical Sciences "Manuel Fajardo", 2012-2015

Introducción: El contexto actual en el que se desarrolla la educación médica superior nos reta a elevar continuamente la preparación pedagógica de nuestros profesores/tutores, quienes afrontan la enseñanza tutelar en sus consultorios médicos de familia donde se incorporan estudiantes a partir del primer año de la carrera de Medicina. Objetivo: Caracterizar el control de la enseñanza tutelar en la disciplina Medicina General Integral durante los cursos 2012-2013, 2013-2014 y 2014-2015 en la Facultad de Ciencias Médicas Comandante Manuel Fajardo. Material y Métodos: Se realizó estudio observacional, descriptivo, cuanticualitativo, retrospectivo de la disciplina Medicina General Integral en tres cursos escolares. El dato primario se obtuvo de información documental aportada por el departamento docente, relacionada con los controles a las actividades docentes de educación en el trabajo. Se calcularon frecuencias absolutas y relativas. Se aplicó Técnica de Ranqueo, Campo de fuerzas y se elaboró el árbol de problemas. Resultados: El curso 2012-2013 se caracterizó por el de menos controles realizados y mayor porciento de cumplimiento con 86,3 por ciento. En la evaluación del control predomina la evaluación de Bien en el curso 2012-2013 y Excelente en 2013-2014 y 2014-2015. En 57,1 por ciento de los controles no existe pirámide docente y donde está, predomina la presencia de estudiantes de dos años académicos. Conclusiones: En el curso 2012- 2013 se realizó menor número de controles con un mayor porcentaje de cumplimiento. Predominó la evaluación Bien en el curso 2012- 2013 y Excelente en los otros cursos, mientras que prevaleció la ausencia de pirámide docente. Se definió como problema central la deficiente preparación pedagógica de profesores/tutores(AU)

Introduction: The current context in which the superior medical education is developed challenges us to continuously raise the pedagogic preparation of our professors/tutors who have to confront the tutelary teaching in their medical family clinics where the students incorporate starting from the first year of the Medicine career. Objective: To characterize the control of the tutelary teaching in the Integral General Medicine discipline during the courses 2012-2013, 2013-2014 and 2014-2015 in the Faculty of Medical Sciences Comandante Manuel Fajardo. Material and Methods: It was carried out an observational, descriptive, retrospective, quantitative and qualitative study of the Integral General Medicine discipline in three school courses. The primary fact was obtained from documental information provided by the teaching department, related with the controls to the teaching activities of education at work. Absolute and relative frequencies were calculated. Ranking and Field of forces techniques were applied and the tree of problems was elaborated. Results: The course 2012-2013 was characterized by being the one where less controls carried out and it had the bigger execution percent with 86, 3 percent. In the control the evaluation prevails of well in the course 2012-2013 and Excellent in 2013-2014 and 2014-2015. In the 57, 1 percent of the controls the educational pyramid doesn't exist and where it does, prevails the presence of two academic years students. Conclusions: In the course 2012 - 2013 were carried out a smaller number of controls with a bigger execution percentage. The evaluation of well prevailed in the course 2012 - 2013 and the evaluation of Excellent prevailed in the other courses, while the absence of educational pyramid prevailed. It was defined as central problem the deficient pedagogic preparation of professors/tutors(AU)

Cost-Effectiveness of Drug Treatments for Advanced Melanoma: A Systematic Literature Review.

BACKGROUND: Until recently, advanced melanoma (unresectable and metastatic) has had a poor prognosis and has been treated with chemotherapy. The introduction of new treatments (BRAF and MEK inhibitors and immunotherapy) has improved overall survival and progression-free survival of some patients. OBJECTIVE: The objective of this study was to review the published evidence on the cost-effectiveness of pharmacological treatments for advanced melanoma. METHODS: A systematic literature search was conducted, without date or language restrictions, in PubMed, EMBASE, Scopus, the Cochrane Library, the UK National Institute for Health and Care Excellence databases and the Health Technology Assessment journal. Internet searches were also made to identify possible grey literature. Main study characteristics, methods and outcomes were extracted and critically assessed. The quality of health economic studies was assessed by the Quality Assessment of Economic Evaluation in Health Care checklist. RESULTS: The search identified nine full-text pharmacoeconomic analyses of advanced melanoma treatments. According to the economic analyses published in the articles, the new treatments have been shown to be more effective (with more life-years and quality-adjusted life-years) than chemotherapy, although generally the cost per quality-adjusted life-year gained was above the commonly accepted threshold. Because of the variability of the available analyses comparing the new treatments, we cannot determine which treatment is the most cost-effective. CONCLUSIONS: From the available data, it cannot be concluded that the new drugs (BRAF and MEK inhibitors and immunotherapy) are cost effective compared with chemotherapy or which is the most cost-effective new treatment.

Prevalencia y percepción de la variabilidad diaria de los síntomas en pacientes con enfermedad pulmonar obstructiva crónica estable en España / Prevalence and Perception of 24-Hour Symptom Patterns in Patients With Stable Chronic Obstructive Pulmonary Disease in Spain

Introducción: Hay pocos estudios sobre la distribución circadiana de los síntomas de la enfermedad pulmonar obstructiva crónica (EPOC) durante las 24h del día. El objetivo principal fue conocer la variabilidad diaria de los síntomas en pacientes con EPOC estable en España en comparación con otros países europeos. Métodos: Estudio observacional realizado en 8 países europeos. Se presentan resultados de pacientes españoles (n = 122) versus resto de europeos (n = 605). Se incluyeron pacientes con EPOC, sin modificaciones en el tratamiento en los 3 meses anteriores. Los pacientes rellenaron: cuestionario de síntomas matutinos, diurnos y nocturnos de la EPOC, cuestionario COPD Assessment Test (CAT), escala de ansiedad y depresión hospitalaria (HADS) y escala del impacto del sueño por asma y EPOC (CASIS). Resultados: Edad media: 69 (DE = 9) años; FEV1 posbroncodilatador medio: 50,5 (DE = 19,4) % (similar en españoles y europeos). La proporción de hombres entre los españoles fue superior (91,0% versus 60,7%, p < 0,0001). El 52,5% experimentaron algún tipo de síntomas durante todo el día (57,5% resto europeos, p < 0,001). Los pacientes con síntomas durante todo el día tuvieron peor calidad de vida relacionada con la salud (CVRS) y niveles mayores de ansiedad/depresión que los pacientes sin síntomas. Los pacientes con síntomas nocturnos tenían peor calidad del sueño. Los pacientes españoles con síntomas durante todo el día mostraron una mejor puntuación en el CAT (16,9 versus 20,5 resto europeos, p < 0,05). Conclusiones: A pesar de recibir tratamiento, más de la mitad de los pacientes refieren síntomas durante todo el día. Estos pacientes presentan peor CVRS, peor calidad del sueño y niveles aumentados de ansiedad/depresión. A igual función pulmonar, los españoles son menos sintomáticos y refieren mejor CVRS en comparación con otros europeos

Introduction: Few studies have examined the 24-hour symptom profile in patients with chronic obstructive pulmonary disease (COPD). The main objective of this study was to determine daily variations in the symptoms of patients with stable COPD in Spain, compared with other European countries. Methods: Observational study conducted in 8 European countries. The results from the Spanish cohort (n = 122) are compared with the other European subjects (n = 605). We included patients with COPD whose treatment had been unchanged in the previous 3 months. Patients completed questionnaires on morning, day-time, and night-time symptoms of COPD, the COPD assessment test (CAT), the hospital anxiety and depression scale (HADS), and the COPD and asthma sleep impact scale (CASIS). Results: Mean age: 69 (standard deviation [SD] = 9) years; mean post-bronchodilator FEV1: 50.5 (SD = 19.4)% (similar in Spanish and European cohorts). The proportion of men among the Spanish cohort was greater (91.0% versus 60.7%, P < .0001). A total of 52.5% patients experienced some type of symptom throughout the day, compared to 57.5% of the other Europeans, P < .001). Patients with symptoms throughout the day had poorer health-related quality of life (HRQoL) and higher levels of anxiety/depression than patients without symptoms. Patients with night-time symptoms had a poorer quality of sleep. Spanish patients with symptoms throughout the day had higher CAT scores (16.9 versus 20.5 in the other Europeans, P < .05). Conclusions: Despite receiving treatment, more than half of patients report symptoms throughout the day. These patients have poorer HRQoL and higher levels of anxiety/depression. Among patients with similar lung function, the Spanish cohort was less symptomatic and reported better HRQoL than other Europeans

Prevalence and Perception of 24-Hour Symptom Patterns in Patients With Stable Chronic Obstructive Pulmonary Disease in Spain. / Prevalencia y percepción de la variabilidad diaria de los síntomas en pacientes con enfermedad pulmonar obstructiva crónica estable en España.

INTRODUCTION: Few studies have examined the 24-hour symptom profile in patients with chronic obstructive pulmonary disease (COPD). The main objective of this study was to determine daily variations in the symptoms of patients with stable COPD in Spain, compared with other European countries. METHODS: Observational study conducted in 8 European countries. The results from the Spanish cohort (n=122) are compared with the other European subjects (n=605). We included patients with COPD whose treatment had been unchanged in the previous 3months. Patients completed questionnaires on morning, day-time, and night-time symptoms of COPD, the COPD assessment test (CAT), the hospital anxiety and depression scale (HADS), and the COPD and asthma sleep impact scale (CASIS). RESULTS: Mean age: 69 (standard deviation [SD]=9) years; mean post-bronchodilator FEV1: 50.5 (SD=19.4)% (similar in Spanish and European cohorts). The proportion of men among the Spanish cohort was greater (91.0% versus 60.7%, P<.0001). A total of 52.5% patients experienced some type of symptom throughout the day, compared to 57.5% of the other Europeans, P<.001). Patients with symptoms throughout the day had poorer health-related quality of life (HRQoL) and higher levels of anxiety/depression than patients without symptoms. Patients with night-time symptoms had a poorer quality of sleep. Spanish patients with symptoms throughout the day had higher CAT scores (16.9 versus 20.5 in the other Europeans, P<.05). CONCLUSIONS: Despite receiving treatment, more than half of patients report symptoms throughout the day. These patients have poorer HRQoL and higher levels of anxiety/depression. Among patients with similar lung function, the Spanish cohort was less symptomatic and reported better HRQoL than other Europeans.

La desprescripción de fármacos sintomáticos de acción lenta para el tratamiento de la artrosis / Deprescribing symptomatic slow acting drugs for osteoarthritis

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Urban-rural differences in Spanish menopausal women.

INTRODUCTION: Most women spend one-third to half of their lifespan in the postmenopausal phase. As menopause involves biological and psychosocial changes that may significantly impair quality of life, the objectives of this study were to: (1) evaluate the prevalence of risk factors for osteoporosis and cardiovascular disease and the prevalence and severity of the appearance of menopausal symptoms among rural and urban Spanish menopausal women; (2) identify the main factors responsible for severity of symptoms; and (3) detect symptom differences between rural and urban women. METHODS: This cross-sectional descriptive study included 10,514 random-sampled women aged 45-65 years from Spain. Sociodemographic information, medical history and lifestyle data were assessed by survey. The Kupperman scale was used to assess severity of menopausal symptoms. RESULTS: Urban women had a higher prevalence of cardiovascular and osteoporosis risk factors than rural women, although this was not statistically significant. There was a greater frequency of menopausal symptoms in urban women although rural women experienced more hot flushes (p<0.05), depression, joint pain and tingling. In rural women menopausal symptoms were less severe (p<0.01). CONCLUSIONS: A high prevalence of risk factors for osteoporosis, and cardiovascular disease in particular, was observed. There were statistically significant differences between urban and rural women for some cardiovascular risk factors, frequency of hot flushes and severity of menopausal symptoms.

Impact of overactive bladder treatment on the quality of life of patients over 60 with associated pathologies.

OBJECTIVES: To study the impact of treatments prescribed in usual practice to control Overactive Bladder (OAB) on health-related quality of life (HRQoL) of patients with associated pathologies. METHODS: 1.434 patients over 60 years with newly diagnosed OAB and at least one associated pathology (urinary or genital-skin infections, sleep disorders, depression, hypertension) were recruited in 300 urological/gynecological practices in Spain. During the first visit, socio-demographic and basic clinical information were registered and the therapeutic strategy for OAB was prescribed following usual clinical practice The patients filled out the HRQoL SF-12 questionnaire. On the second visit (4-6 months later) the HRQoL was re-evaluated. HRQoL was compared between sexes (Mann-Whitney) and between visits (Wilcoxon for related samples). Multiple regression models were performed in order to study the variables independently associated with HRQoL. RESULTS: Valid data is given for 1,274 patients for visit 1 and 1,153 for visit 2. 71.51% of the sample were female. Mean age was 68.17 (6.19). A significant improvement in the HRQoL was found on the second visit. Factors independently associated with lower score in both summary index of SF-12: first visit, female gender and Charlson Index. Additional factors associated with reduction of the physical component score: age, all associated pathologies and treatment using vaginal pessaries. Additional factors associated with the mental component score: treatment for depression, sleep disorders, use of vesical reeducation and the modification of treatment using diuretics. CONCLUSIONS. The treatments prescribed in usual clinical practice to alleviate OAB are effective in notably improving the HRQoL of patients in general, both physically and mentally.

Impacto del tratamiento de la vejiga hiperactiva en la calidad de vida de los pacientes mayores de 60 años con patologías asociadas / Impact of overactive bladder treatment on the quality of patients over 60 with associated pathologies

OBJETIVO: Estudio del impacto de los tratamientos pautados en práctica habitual para el manejo de la Vejiga Hiperactiva (VH) en la calidad de vida relacionada con la salud (CVRS) de los pacientes con patologías asociadas. MÉTODOS: Se reclutaron 1.434 pacientes mayores de 60 años con VH de nuevo diagnóstico y al menos una patología asociada (infecciones urinarias o de la piel del área genital, trastornos del sueño, depresión, hipertensión) en 300 consultas de urología/ginecología de nuestro país. En la primera visita se recogieron datos socio-demográficos y clínicos básicos y se pautó la estrategia terapéutica para VH según práctica clínica habitual. Los pacientes cumplimentaron el cuestionario de CVRS SF-12. En la segunda visita (4-6 meses después) se reevaluó la CVRS. Se comparó la CVRS entre sexos (Mann-Whitney) y entre visitas (Wilcoxon para muestras relacionadas). Se realizaron modelos de regresión múltiple para estudiar las variables que se asocian independientemente a la CVRS. RESULTADO: Se presentan datos para 1.274 pacientes válidos para la visita 1 y 1.153 para la visita 2. El 71,51% de la muestra fueron mujeres. La edad media fue 68,17 (6,19) años. Se encontró mejora significativa en la CVRS en la segunda visita. En el análisis de regresión múltiple, el sexo femenino, la primera visita y el índice de Charlson se asociaron a una calidad de vida inferior en ambas puntuaciones sumario del SF-12. Adicionalmente la edad, las patologías asociadas y el tratamiento con pesario vaginal también redujeron la puntuación sumario física. El tratamiento para los trastornos del sueño y para la depresión, la re-educación vesical y la modificación del tratamiento con diuréticos fueron por su parte predictores independientes de menor puntuación sumario mental. CONCLUSIONES. Los tratamientos pautados en práctica clínica habitual para paliar la VH son efectivos en cuanto a la mejora notable en la CVRS de los pacientes a nivel general, tanto física como mental(AU)

OBJECTIVES: To study the impact of treatments prescribed in usual practice to control Overactive Bladder (OAB) on health-related quality of life (HRQoL) of patients with associated pathologies. METHODS: 1.434 patients over 60 years with newly diagnosed OAB and at least one associated pathology (urinary or genital-skin infections, sleep disorders, depression, hypertension) were recruited in 300urological/gynecological practices in Spain. During the first visit, socio-demographic and basic clinical information were registered and the therapeutic strategy for OAB was prescribed following usual clinical practice. The patients filled out the HRQoL SF-12 questionnaire. On the second visit (4-6 months later) the HRQoL was re-evaluated. HRQoL was compared between sexes (Mann-Whitney) and between visits (Wilcox on for related samples). Multiple regression models were performed in order to study the variables independently associated with HRQoL. RESULTS: Valid data is given for 1,274 patients for visit1 and 1,153 for visit 2. 71.51% of the sample were female. Mean age was 68.17 (6.19). A significant improvement in the HRQoL was found on the second visit. Factors independently associated with lower score in both summary index of SF-12: first visit, female gender and Charlson Index. Additional factors associated with reduction of the physical component score: age, all associated pathologies and treatment using vaginal pessaries. Additional factors associated with the mental component score: treatment for depression, sleep disorders, use of vesical reeducation and the modification of treatment using diuretics. CONCLUSIONS. The treatments prescribed in usual clinical practice to alleviate OAB are effective in notably improving the HRQoL of patients in general, both physically and mentally(AU)