Cerebral and cerebellar pseudoatrophy associated with valproic acid. Report of three pediatric cases. / Pseudoatrofia cerebral y cerebelosa asociada a ácido valproico. Descripción de tres casos pediátricos.

INTRODUCTION: Cerebral and cerebellar pseudoatrophy is a rare adverse effect of valproic acid (VPA) that we need to be aware of, due to its diagnostic and therapeutic implications. CASE REPORT: We report three cases of children between 5 and 9 years old, with epilepsy and previous normal brain magnetic resonance imaging, who were taking the drug at correct doses. Pseudoatrophy manifests subacutely with symptoms and images of cerebral and/or cerebellar atrophy, reversible after drug withdrawal. DISCUSSION AND CONCLUSIONS: This is a type of VPA-related encephalopathy, different from dose-dependent toxic encephalopathy, hyperammonaemic encephalopathy or encephalopathy related to liver failure. In children, it causes cognitive, motor, mood and behavioral deterioration, and may be accompanied by epileptic decompensation. Withdrawing the drug leads to complete clinical-radiological recovery, and reducing the dose leads to improvement.

TITLE: Pseudoatrofia cerebral y cerebelosa asociada a ácido valproico. Descripción de tres casos pediátricos.Introducción. La pseudoatrofia cerebral y cerebelosa es un efecto adverso infrecuente del ácido valproico (VPA) que debemos conocer por sus implicaciones diagnósticas y terapéuticas. Caso clínico. Presentamos tres casos de niños de entre 5 y 9 años, con epilepsia y resonancia magnética craneal previa normal, que llevaban el fármaco con dosis correctas. La pseudoatrofia se manifiesta de forma subaguda con síntomas e imagen de atrofia cerebral y/o cerebelosa, reversible tras la retirada del fármaco. Discusión y conclusiones. Se trata de un tipo de encefalopatía relacionada con VPA diferente a la encefalopatía tóxica dependiente de la dosis, la encefalopatía hiperamoniémica o la relacionada con fallo hepático. En niños, cursa con deterioro cognitivo, motor, anímico y conductual, y puede acompañarse de descompensación epiléptica. La retirada del fármaco conlleva una recuperación completa clinicorradiológica, y la disminución de dosis, una mejoría.

Pseudoatrofia cerebral y cerebelosa asociada a ácido valproico. Descripción de tres casos pediátricos / Cerebral and cerebellar pseudoatrophy associated with valproic acid. Report of three pediatric cases

Introducción La pseudoatrofia cerebral y cerebelosa es un efecto adverso infrecuente del ácido valproico (VPA) que debemos conocer por sus implicaciones diagnósticas y terapéuticas. Caso clínico Presentamos tres casos de niños de entre 5 y 9 años, con epilepsia y resonancia magnética craneal previa normal, que llevaban el fármaco con dosis correctas. La pseudoatrofia se manifiesta de forma subaguda con síntomas e imagen de atrofia cerebral y/o cerebelosa, reversible tras la retirada del fármaco. Discusión y conclusiones. Se trata de un tipo de encefalopatía relacionada con VPA diferente a la encefalopatía tóxica dependiente de la dosis, la encefalopatía hiperamoniémica o la relacionada con fallo hepático. En niños, cursa con deterioro cognitivo, motor, anímico y conductual, y puede acompañarse de descompensación epiléptica. La retirada del fármaco conlleva una recuperación completa clinicorradiológica, y la disminución de dosis, una mejoría. (AU)

INTRODUCTION Cerebral and cerebellar pseudoatrophy is a rare adverse effect of valproic acid (VPA) that we need to be aware of, due to its diagnostic and therapeutic implications. CASE REPORT We report three cases of children between 5 and 9 years old, with epilepsy and previous normal brain magnetic resonance imaging, who were taking the drug at correct doses. Pseudoatrophy manifests subacutely with symptoms and images of cerebral and/or cerebellar atrophy, reversible after drug withdrawal. Discussion and conclusions. This is a type of VPA-related encephalopathy, different from dose-dependent toxic encephalopathy, hyperammonaemic encephalopathy or encephalopathy related to liver failure. In children, it causes cognitive, motor, mood and behavioral deterioration, and may be accompanied by epileptic decompensation. Withdrawing the drug leads to complete clinical-radiological recovery, and reducing the dose leads to improvement. (AU)

Realización y comunicación de resultados de test de autodiagnóstico de antígenos SARS- CoV-2 bajo supervisión en farmacia de Cantabria / Performance and communication of results of self-diagnostic test for SARS-CoV-2 antigens under supervision in pharmacies in Cantabria

JUSTIFICACIÓN: la Consejería de Sanidad del Gobierno de Cantabria y el Colegio Oficial de Farmacéuticos de Cantabria colaboran en estrategias para asegurar la trazabilidad de resultados positivos de test de autodiagnóstico de antígenos SARS-COV-2 a través de las farmacias comunitarias. En enero de 2022, ambas entidades han iniciado un procedimiento mediante el cual la realización del test bajo supervisión por el profesional farmacéutico en farmacia es considerado para el diagnóstico de confirmación de infección activa, y los resultados positivos del test se consideran casos COVID-19 confirmados.OBJETIVOS: •Realizar in situ en la farmacia, o acompañar a la población que lo solicite, test de autodiagnóstico de antígenos SARS-COV-2 •Comunicar el resultado obtenido a la Consejería de Sanidad mediante la Aplicación móvil Plataforma CAÑIA. •Informar a los usuarios sobre la actuación a seguir según el resultado obtenido.MATERIAL Y MÉTODOS: la población susceptible de solicitar el test es toda persona que en riesgo de haber adquirido infección por SARS-COV-2 por presentar síntomas compatibles de COVID-19 o haber tenido contacto con un positivo. Las farmacias que participan voluntariamente se identifican con un cartel informativo, y comunican los resultados al Servicio Cántabro de Salud (SCS) mediante la aplicación móvil Cañía, de uso exclusivo para profesionales sanitarios, que mediante tecnología de inteligencia artificial realiza la lectura del resultado del test y de la identidad de la persona y la carga automáticamente en el sistema del SCS. Si el resultado es positivo, el paciente entra directamente en el circuito de Atención Primaria y de Farmacovigilancia del SCS. Si el resultado es negativo, el paciente puede descargar durante 48 horas un certificado a través del SCS. (AU)

Comunicación de incidencias con la medicación entre farmacias de Cantabria y Servicios de Farmacia de Atención Primaria del Servicio Cántabro de Salud / Communication of medication incidents between pharmacies in Cantabria and the Primary Care Pharmacy Services of the Cantabrian Health Service

INTRODUCCIÓN: el Colegio Oficial de Farmacéuticos de Cantabria (COF Cantabria) ha colaborado con la Consejería de Sanidad del Gobierno de Cantabria para crear un sistema de comunicación directo entre las 279 farmacias comunitarias de Cantabria y los Servicios de Farmacia de Atención Primaria del Servicio Cántabro de Salud (SFAP). El protocolo de comunicación, que comenzó en octubre de 2020 y en marzo de 2022 continúa en activo, constituye una herramienta que las OF han integrado en su práctica diaria para informar y solucionar incidencias relacionadas con la medicación prescrita en receta electrónica.OBJETIVOS: desarrollar e implantar un sistema de comunicación entre las farmacias comunitarias y los SFAP, para resolver incidencias relacionadas con la receta electrónica de los pacientes, asegurando la adherencia al tratamiento farmacológico y contribuyendo a descongestionar la Atención Primaria.MATERIAL Y MÉTODOS: se creó un grupo de trabajo para desarrollar un protocolo de comunicación de incidencias con la medicación, con participantes del COF Cantabria, de la Consejería de Sanidad y de la Gerencia de Atención Primaria del Servicio Cántabro de Salud.RESULTADOS Y DISCUSIÓN: los resultados del seguimiento del protocolo se presentaron a los farmacéuticos/as en febrero de 2021 mediante una conferencia online, durante la cual se debatieron las incidencias más frecuentes y las propuestas para mejorar la comunicación de las mismas. El grado de satisfacción de los farmacéuticos/as con el funcionamiento del protocolo se evaluó mediante una encuesta online de seis preguntas. En las respuestas se observó que un 35,4 % de los farmacéuticos se muestra satisfecho con el funcionamiento y un 29,2 % valora positivamente el tiempo de resolución de incidencias por parte de SFAP. En cuanto a la utilidad para resolver la incidencia respecto al paciente, un 25 % se muestra bastante satisfecho. (AU)

Dispensación colaborativa entre los servicios de farmacia hospitalaria y farmacias comunitarias en el contexto de la COVID-19 / Collaborative dispensing between hospital pharmacy services and community pharmacies in the context of COVID-19

JUSTIFICACIÓN: de marzo a mayo de 2020, se desarrolló una experiencia piloto de continuidad asistencial en la atención farmacéutica de pacientes externos hospitalarios, en la que la medicación hospitalaria se entregaba en la farmacia comunitaria de elección del paciente. En septiembre de 2020 se consolidó dicho procedimiento, según el protocolo “Entrega de Medicación Hospitalaria de Dispensación Ambulatoria -MHDA- por la farmacia comunitaria en el contexto de la COVID-19”, elaborado por la Consejería de Sanidad del Gobierno de Cantabria, el Colegio de Farmacéuticos de Cantabria y la distribución farmacéutica que opera en Cantabria.OBJETIVOS: establecer un protocolo para limitar la presencia en centros hospitalarios de pacientes que recogen sus medicamentos hospitalarios (MH) en los Servicios de Farmacia Hospitalaria (SFH), y sustituirlo por el envío, a través del Distribuidor Farmacéutico (DF), de los MH a Farmacias de Cantabria (FC) que harán la entrega a los pacientes.MATERIAL Y MÉTODOS: las FC reciben, a través del DF, la medicación de cada paciente desde los SFH. Los pacientes seleccionados son previamente contactados e informados por el SFH correspondiente, al que indican la farmacia a la que quieren que se envíe su medicación.RESULTADOS Y DISCUSIÓN: se analizan los datos de febrero a diciembre de 2021. El número total de pacientes a los que se ha entregado MH, a través de las FC es 6832. (El 80 % reside en la provincia y el 20 % en Santander capital).El número de FC que han entregado MH es 222. (El 72 % en la provincia y el 28 % en Santander capital).El número total de entregas de MH realizadas por los SFH ha sido 5644, correspondiendo 5066 al Hospital Universitario Marqués de Valdecilla, 565 al Hospital Sierrallana y 13 al Hospital de Laredo. En cuanto a la DF, Centro Farmacéutico del Norte (CENFARTE) ha realizado 2.447 repartos, Cooperativa Farmacéutica Española (COFARES) 1809 y Cooperativa Farmacéutica Asturiana (COFAS) 1213. (AU)

Ser víctima de bullying: prevalencia y factores de vulnerabilidad en adolescentes / Being a victim of bullying: prevalence and vulnerability factors in adolescents

FUNDAMENTOS: La elevada prevalencia del bullying y sus consecuencias lo convierten en un problema de salud pública. OBJETIVO: Evaluar la prevalencia de ser víctima de bullying entre adolescentes de 15 a 18 años y analizar los factores sociodemográficos y de salud que se asocian con la victimización. MÉTODOS: Estudio transversal en 844 estudiantes matriculados en 5 institutos de educación secundaria de Cuenca (España) en el curso académico 2015-2016. Se utilizó un cuestionario autoadministrado que incluía variables sociodemográficas y de salud (afecciones clínicas, discapacidad, peso y talla). Ser víctima de bullying y el resto de variables se midieron mediante subescalas del instrumento KIDSCREEN-52, que mide la calidad de vida relacionada con la salud. RESULTADOS: La prevalencia de bullying fue 29,5 %. Las víctimas de acoso respecto a las no víctimas presentaron puntuaciones inferiores en todas las subescalas de KIDSCREEN-52. El análisis multivariante mostró que ser chico, tener discapacidad/problema de salud (β=2,349), presentar peor estado de ánimo (β=0,952), peor autopercepción (β=0,967), peor relación con los pares (β=0,978), menores recursos económicos (β=0,976) y percibir menor calidad de vida (β=0,892) fueron variables que se asociaron con aumento del riesgo de ser víctima de bullying. CONCLUSIONES: Los adolescentes más vulnerables son aquellos que presentan problemas físicos, psicológicos o sociales y por tanto son los más desprotegidos. Ser acosado tiene efectos nocivos sobre la salud y el desarrollo socioemocional, por lo que es necesario identificar a los adolescentes con un riesgo mayor

FUNDAMENTALS: The higher prevalence of bullying and its consequences make it a public health problem. OBJECTIVE: To evaluate the prevalence of being a victim of school bullying among adolescents aged 15 to 18 years and analyze the sociodemographic and health factors associated with victimization. METHODS: Cross-sectional study in 844 students enrolled in 5 Secondary Schools of Cuenca (Spain) in the academic year 2015-2016. It is a self-administered questionnaire that includes sociodemographic and health variables (clinical conditions, disability, weight and height). Being a victim of intimidation and the rest of the variables were measured using subscales of the KIDSCREEN-52 instrument, which measures the quality of life related to health. RESULTS: The prevalence of bullying was 29.5%. Victims of harassment regarding non-victims presented lower scores in all subscales of KIDSCREEN-52. The multivariate analysis showed that being boy, having a disability / health problem (β = 2,349), worse mood (β = 0,952), worse self-perception (β = 0,967), worse relation with the pairs (β = 0.978), the lowest economic resources (β = 0.976) and the lowest quality of life (β = 0.892) were variables that were associated with an increase in the risk of being a victim of harassment. CONCLUSIONS: The most vulnerable adolescents are those who present physical, psychological or social problems and therefore are more unprotected. Being harassed has harmful effects on health and socio-emotional development, which is why it is necessary to identify adolescents with a higher risk

[Profile of drug use in adolescents. Protective factors]. / Perfil de consumo de drogas en adolescentes. Factores protectores.

OBJECTIVE: To determine the patterns of drug use in an adolescent population and to analyse the role of personal and social protective factors in alcohol consumption. MATERIAL AND METHODS: A descriptive cross-sectional study was carried out in five secondary schools in the city of Cuenca (Spain) in the period 2015-2016. The groups were randomly selected (3rd - 4th GCSE and 1st - 2nd GCE), with a total of 844 students giving their consent. A self-administered questionnaire was used, which included sociodemographic variables, consumption data, CD-RISC 10 scale to evaluate resilience, and KIDSCREEN-52 questionnaire to measure individual and social aspects associated with health-related quality of life in adolescents. Descriptive bivariate and multivariate analyses were performed. RESULTS: Just over half (55.7%) of the pupils selected were girls, and the mean age was 16.3±1.01 years. The pupils began consumption when they became 13-14 years old. The percentages of habitual consumption were 70.9% for alcohol, 26.4% for tobacco, and 14.2% for cannabis. Multiple drug use was also found in 35%. The regression model for alcohol showed that non-consumers showed better values in emotional moods, self-perception, relationships with their parents, and their school environment. CONCLUSIONS: Adolescents start using drugs, especially cannabis, at an earlier age. Availability and the perception of low-risk make alcohol the most widespread drug. Actions aimed at fostering emotional well-being and family support provides security for adolescents, as well as the resources that help them overcome the pressures of the group.

¿Es posible detectar casos de acoso escolar a través de la presencia de problemas psicosomáticos? / Is it possible to detect cases of bullying through the presence of psychosomatic problems?

Introducción: la elevada prevalencia del acoso escolar y sus consecuencias lo convierten en un problema de salud pública. Objetivo: analizar, en una población de adolescentes escolarizados, la prevalencia de acoso escolar y su asociación con problemas psicosomáticos. Material y métodos: estudio transversal de una muestra representativa de 844 estudiantes en cinco institutos de educación secundaria (IES) de Cuenca (España). Mediciones principales: acoso escolar mediante la subescala aceptación social del KIDSCREEN-52 y problemas psicosomáticos con la escala PSP. Resultados: la prevalencia de acoso escolar fue del 29,5%, sin deferencias significativas por sexo ni edad. Las chicas y los adolescentes de mayor edad presentaron problemas psicosomáticos significativamente más altos. Tanto en chicas como en chicos, una mayor presencia de estos se asoció con ser víctima de acoso escolar. Las ecuaciones de regresión realizadas para cada uno de los problemas psicosomáticos mostraron que, además de la influencia del sexo y la edad, ser víctima de acoso escolar es un predictor de peor salud psicosomática y de peor calidad de vida. Los modelos que explicaron mayor porcentaje de la varianza fueron el índice de psicosomáticos (21%), sentirse triste (15%), dolor de cabeza (10%) y dolor de estómago (11%). Conclusiones: los problemas psicosomáticos son frecuentes en adolescentes y especialmente entre las víctimas de acoso escolar. Es aconsejable que los profesionales de la salud, especialmente médicos y enfermeras, consideren seriamente la posibilidad de estar ante una víctima de acoso cuando un adolescente exhibe sintomatología psicosomática, especialmente la relacionada con tristeza, dolor de cabeza o de estómago sin causa orgánica aparente

Introduction: the high prevalence of school bullying and its consequences make it a public health problem. Objective: to analyse the prevalence of school bullying and its association with psychosomatic problems in a population of adolescent students. Materials and methods: we conducted a cross-sectional study in a representative sample of 844 students enrolled in 5 secondary education schools (SESs) in the city of Cuenca (Spain). The main assessment instruments were the social acceptance subscale of the KIDSCREEN-52 (bullying) and the PSP scale (psychosomatic problems). Results: the prevalence of being subject to school bullying was 29.5%, with no differences based on age or sex. We found a higher frequency of psychosomatic problems in female and older adolescents. In students of both sexes, a higher frequency of these problems was associated with being bullied. The regression models built for each of the psychosomatic problems showed that, correcting for the influence of sex and age, being bullied is a predictor of psychosomatic problems and a poorer quality of life. The models that explained the largest percentages of the variance where those for the total score in the psychosomatic problem scale (21%), feelings of sadness (15%), headache (10%) and stomach ache (11%). Conclusions: psychosomatic problems are frequent in adolescents, especially those who are victims of school bullying. Health care professionals, especially doctors and nurses, should strongly consider the possibility of bullying when an adolescent exhibits psychosomatic symptoms, especially sadness, headache or stomach ache, with no apparent organic cause

Metformin-associated hyperlactacidaemia acidosis: Diagnosis rate in standard clinical practice and its relationship with renal failure. / Acidosis con hiperlactacidemia por metformina: frecuencia de su diagnóstico en la práctica clínica habitual y relación con la insuficiencia renal.

BACKGROUND AND OBJECTIVES: Observational study on the difference between the number of cases of acidosis with hyperlactacidaemia suspected of being caused by metformin diagnosed in standard clinical practice and the incidence of this condition according to the datasheet. The study also explored the relationship between renal function and metformin-associated hyperlactacidaemia acidosis. PATIENTS: We identified cases of acidosis between 2013 and 2014 by analysing the minimum basic data set and laboratory requests. We selected patients who presented venous lactate levels >2.7 mmol/L at the time they were treated and for whom the use of outpatient metformin was confirmed. The causal relationship with metformin was independently evaluated by several researchers. The incident cases were calculated based on the number of patients who had been dispensed a drug containing metformin during the same period in the study area. RESULTS: We identified 476 cases of acidosis. Metformin was suspected of causing the condition of acidosis with hyperlactacidaemia in 20 of these cases, which represents an incidence rate of 6.57/10,000 patients. Eighty-five percent of the cases presented acute renal failure. CONCLUSIONS: The apparent incidence of acidosis with hyperlactacidaemia in patients treated with metformin is greater than that established in the datasheet (<1/10,000). The onset of metformin-associated hyperlactacidaemia acidosis is related to acute renal impairment.

Síntomas psicosomáticos como expresión del deterioro de la calidad de vida relacionada con la salud en adolescentes / Psychosomatic symptoms as an expression of the deterioration of the health-related quality of life in adolescents

Objetivo: Analizar, en una población de adolescentes escolarizados, la relación entre síntomas psicosomáticos y calidad de vida relacionada con la salud (CVRS) diferenciando por sexo y grupo de edad. Diseño: Estudio transversal. Emplazamiento: Cinco Institutos de Educación Secundaria. Participantes: Ochocientos cuarenta y cuatro adolescentes de entre 15 y 18 años que cursaban 3.° y 4.° de Educación Secundaria Obligatoria y Bachillerato. Mediciones principales: CVRS mediante KIDSCREEN-52 y síntomas psicosomáticos con la escala de problemas psicosomáticos (PSP). Resultados: Las chicas y los adolescentes de 17-18 años presentaron síntomas psicosomáticos significativamente más altos, ambos grupos también puntuaron peor en todas las dimensiones de CVRS aunque solo alcanzaron significación las dimensiones relacionadas con bienestar físico, bienestar mental y estado de ánimo y estrés. Todos los síntomas psicosomáticos se asociaron de forma inversa con las 10 dimensiones del KIDSCREEN-52. Los modelos de regresión realizados mostraron que tristeza, dificultad de concentración y dificultad para dormir fueron los predictores de peor CVRS en ambos sexos y grupos de edad, y estas variables explicaron entre un 30 y un 41% de la varianza de la CVRS de los adolescentes. Conclusiones: Los síntomas psicosomáticos son más frecuentes en las chicas y en los adolescentes mayores, y predictores de peor CVRS. Es importante diferenciarlos de afecciones médicas para evitar intervenciones innecesarias. Como expresiones de malestar emocional deben ser evaluados y tratados de forma integral porque interfieren en la vida cotidiana y aumentan la vulnerabilidad propia de la adolescencia

Aim: To analyze, in a population of adolescents in school, the relationship between psychosomatic symptoms and the perception of health-related quality of life (HRQoL), differentiating by gender and age group. Design: Transversal study. Location: Five Secondary Schools. Participants: Eight hundred and forty four adolescents between the ages of 15 and 18 in secondary school. Main measurements: HRQoL using KIDSCREEN-52 and psychosomatic symptoms with the psychosomatic problems scale (PSP). Results: Girls and adolescents aged 17-18 years presented significantly higher psychosomatic symptoms, both groups also scored worse in all dimensions of HRQoL, although only the dimensions related to physical and mental wellness, mood and stress reached significance. All psychosomatic symptoms were inversely associated with the ten dimensions of KIDSCREEN-52. The regression models showed that sadness, concentrating difficulties and sleeping difficulties were the predictors of worse HRQoL in both sexes and age groups and these variables explained between 30 and 41% of the HRQoL variance of the adolescents. Conclusions: Psychosomatic symptoms are frequent especially in girls and in older adolescents and predictors of worse HRQoL. It is important to distinguish them from medical conditions to avoid unnecessary interventions. As expressions of emotional discomfort they must be evaluated and treated in an integral way because they interfere with daily life and increase the vulnerability proper of adolescence

Prevalence and associated risk factors of latent tuberculosis infection in a Spanish prison.

AIM: To determine the prevalence of latent tuberculosis infection (LTI) in a Spanish prison, analyze the main sociodemographic and clinical variables associated with this condition and estimate the percentage of individuals with LTI who have received chemoprophylactic treatment. MATERIALS AND METHODS: Cross-sectional study including inmates hosted in the Madrid VI Prison on 16/07/2016. Exclusion criteria: history of tuberculosis; non-updated tuberculin test according to the Tuberculosis Prevention and Control Program in Prisons protocol. Information of the variables was collected from SANIT and SIP programs, and by checking the clinical records of inmates. Description of the participant population and comparison between the frequency of distribution of the independent variables in LTI present and absent groups were performed, the last calculating the p value with Ji2 and Mann-Whitney U tests. Bivariate and multivariate analysis have been carried out with a logistic regression model. RESULTS: 936 individuals have been included. The prevalence of LTI in prison is 54.6%. This condition has been linked to the sociodemographic variables age, sex and nationality of origin, being age the one that has shown the strongest association. Among the other factors analyzed, only HCV infection behaves as a predictor of LTI. 30.3% of the individuals with LTI have completed or are receiving chemoprophylactic treatment in the moment of the study. DISCUSSION: LTI prevalence is high in the Spanish current prison population. The results of the study emphasize the relevance of the LTI screening in the prison setting, specially among high risk groups, and point out the need of a greater effort in the indication and completion of the chemoprophylactic treatment.

[Psychosomatic symptoms as an expression of the deterioration of the health-related quality of life in adolescents]. / Síntomas psicosomáticos como expresión del deterioro de la calidad de vida relacionada con la salud en adolescentes.

AIM: To analyze, in a population of adolescents in school, the relationship between psychosomatic symptoms and the perception of health-related quality of life (HRQoL), differentiating by gender and age group. DESIGN: Transversal study. LOCATION: Five Secondary Schools. PARTICIPANTS: Eight hundred and forty four adolescents between the ages of 15 and 18 in secondary school. MAIN MEASUREMENTS: HRQoL using KIDSCREEN-52 and psychosomatic symptoms with the psychosomatic problems scale (PSP). RESULTS: Girls and adolescents aged 17-18 years presented significantly higher psychosomatic symptoms, both groups also scored worse in all dimensions of HRQoL, although only the dimensions related to physical and mental wellness, mood and stress reached significance. All psychosomatic symptoms were inversely associated with the ten dimensions of KIDSCREEN-52. The regression models showed that sadness, concentrating difficulties and sleeping difficulties were the predictors of worse HRQoL in both sexes and age groups and these variables explained between 30 and 41% of the HRQoL variance of the adolescents. CONCLUSIONS: Psychosomatic symptoms are frequent especially in girls and in older adolescents and predictors of worse HRQoL. It is important to distinguish them from medical conditions to avoid unnecessary interventions. As expressions of emotional discomfort they must be evaluated and treated in an integral way because they interfere with daily life and increase the vulnerability proper of adolescence.

Novedades en cirugía de hombro y codo / Update in shoulder and elbow surgery 2016

La cirugía del hombro y el codo ha experimentado un crecimiento importante en los últimos años, debido al aumento de las indicaciones quirúrgicas tanto en patología degenerativa como postraumática de ambas articulaciones. En este artículo, revisaremos las novedades publicadas al respecto, revisando temas como la artroplastia de hombro y codo, fracturas de clavícula, húmero, cabeza radial, capsulitis adhesiva de hombro, suplementos biológicos en sutura de manguito, codo reumático, epicondilitis, artroscopia de codo y neuropatía del nervio cubital en codo

Shoulder and elbow surgery has undergone significant growth in recent years, due to increased surgical indications in both degenerative and post-traumatic pathology of both joints. In this article, we will review the published news about it, reviewing topics such as shoulder and elbow arthroplasty, clavicle fractures, humerus fractures, radial head fractures, shoulder adhesive capsulitis, biologic supplements in cuff suture, rheumatic elbow, epicondylitis, elbow arthroscopy and ulnar nerve neuropathy in elbow

Median raphe cysts in men. Presentation of our experience and literature review. / Quistes de rafe medio en el varón. Presentación de nuestra experiencia y revisión de la literatura.

OBJECTIVES: To present our experience with the diagnosis and treatment of median raphe cysts treated in our department in the last 25years. MATERIAL AND METHOD: We conducted a retrospective study of 28men with median raphe cysts who underwent surgery in our department from June 1990 to March 2015. We analysed the age of presentation, reason for consultation, clinical manifestations, histological findings, treatment and outcome after exeresis. RESULTS: The majority of the patients (22; 79%) were asymptomatic and consulted for the aesthetic defect. Four cases (14%) presented urinary abnormalities, and 2 cases (7%) reported discomfort during sexual intercourse. In all cases, the treatment consisted of surgical extirpation of the cysts, with excellent aesthetic and functional results and no lesion recurrence in any of the patients during a mean follow-up of more than 10years. The most common histological type was the transitional cell type in 15 cases (54%), followed by the mixed type (transitional and squamous) in 11 cases (39%). One case (6%) was pure squamous type, and in another case (6%) the epithelium was glandular. CONCLUSIONS: Median raphe cysts are an uncommon type of disembryoplasia that can occur in any location of the median raphe, from the balanic meatus to the edges of the anus. These cysts are generally asymptomatic and their treatment of choice is surgical extirpation.

Circulation of a novel human respiratory syncytial virus Group B genotype during the 2014-2015 season in Catalonia (Spain).

Human respiratory syncytial virus (HRSV) is one of the most common viral aetiological agents in the youngest population. In the present study a novel HRSV-B BA genotype is first described based on the phylogenetic analysis of the coding hypervariable region 2 sequences of G protein from strains detected during the 2014-2015 season. Among all strains detected in the last season, 44% belonged to this new genotype. Therefore, it highlights the importance of a continuous HRSV surveillance to monitor the emergence and spread of new genotypes or variants with genetic changes that may affect antigenic and tropism features.

Characterisation of genetic structure of the Mayan population in Guatemala by autosomal STR analysis.

BACKGROUND: Currently, the Guatemalan population comprises genetically isolated groups due to geographic, linguistic and cultural factors. For example, Mayan groups within the Guatemala population have preserved their own language, culture and religion. These practices have limited genetic admixture and have maintained the genetic identity of Mayan populations. AIM: This study is designed to define the genetic structure of the Mayan-Guatemalan groups Kaqchiquel, K'iche', Mam and Q'eqchi' through autosomal short tandem repeat (STR) polymorphisms and to analyse the genetic relationships between them and with other Mayan groups. SUBJECTS AND METHODS: Fifteen STR polymorphisms were analysed in 200 unrelated donors belonging to the Kaqchiquel (n = 50), K'iche' (n = 50), Mam (n = 50) and Q'eqchi' (n = 50) groups living in Guatemala. Genetic distance, non-metric MDS and AMOVA were used to analyse the genetic relationships between population groups. RESULTS: Within the Mayan population, the STRs D18S51 and FGA were the most informative markers and TH01 was the least informative. AMOVA and genetic distance analyses showed that the Guatemalan-Native American populations are highly similar to Mayan populations living in Mexico. CONCLUSIONS: The Mayan populations from Guatemala and other Native American groups display high genetic homogeneity. Genetic relationships between these groups are more affected by cultural and linguistic factors than geographical and local flow. This study represents one of the first steps in understanding Mayan-Guatemalan populations, the associations between their sub-populations and differences in gene diversity with other populations. This article also demonstrates that the Mestizo population shares most of its ancestral genetic components with the Guatemala Mayan populations.

Estudio de prevalencia sobre el síndrome de Burnout o Desgaste Profesional en los Cirujanos Ortopédicos de Andalucía / Prevalence study on burnout syndrome or Professional Burnout in Andalusia Orthopaedic Surgeons

Objetivo: Determinar la incidencia de desgaste profesional en los cirujanos ortopédicos de Andalucía en el año 2014. Determinar la posible asociación con una serie de factores sociodemográficos y laborales así como conocer las razones a las que los profesionales lo atribuyen y las medidas que propondrían para paliarlo. Material y método: Se diseña un estudio transversal descriptivo entre los 450 cirujanos ortopédicos de Andalucía, socios de la SATO y que tenían facilitada una dirección de email en dicha sociedad. Se envía a través de un enlace de Google Drive, anónimo que constaba de 3 partes: el cuestionario Maslach Burn Out Inventory para medir el grado de burnout, una serie de variables sociodemográficas y laborales y una última parte que constaba de preguntas abiertas sobre lo más negativo de su servicio, lo más positivo y lo que cambiarían para mejorar. Como criterio de inclusión se daba el tener el título de Especialista en Cirugía Ortopédica y Traumatología, estar en activo ejerciendo en la Comunidad Autónoma Andaluza y estar en activo. Resultados: Contestaron la encuesta 106 especialistas (23,5%), hombres el 83% y mujeres el 17%, el mayor grupo se encontraba entre los 30 y los 55 años (55%). El 86% se encontraban casados o con pareja estable y solo el 27% no tenía ningún hijo. El 68% tenían un contrato laboral estable bien con estatutarios del SAS o como laboral indefinido de las Agencias Públicas. El 38% realizaba entre 5-10 guardias al mes ya sea de presencia o de 1º localizado. El 29% presentaba un alto nivel de Burnout y en sus tres dimensiones el 41,5% presentaban un alta nivel de cansancio emocional, el 48,9% un alto nivel de despersonalización y el 37,2% presentaban un bajo nivel de realización personal. El trabajar cerca del lugar de residencia (p=0,018), el tener guardias de presencia física (p=0,007) y el trabajar en una Agencia Pública (p=0,03) se relaciona con un mayor nivel de desgaste profesional. Como factores subjetivos por parte de los encuestados de este desgaste resaltaban la presión asistencial (19,2%), la mala relación sueldo/responsabilidad (17,3%) y el poco reconocimiento del trabajo desempeñado tanto por la administración como por los usuarios (12,5%). El 77% volverían continuarían trabajando de Traumatólogos pero cambiarían el Hospital donde trabajan y solo el 4% estaría dispuesto a cambiar de especialidad con tal de continuar en el mismo centro de trabajo. Conclusiones: El nivel de desgaste profesional de los Traumatólogos de Andalucía en 2014 es moderado y similar al estudio realizado entre los Traumatólogos españoles en 2005 a pesar de estar atravesando por un momento socioeconómico más delicado que en esa fecha. Existe un mayor nivel de desgaste profesional entre los profesionales que viven cerca de su lugar de trabajo, en los que trabajan en las Agencias Públicas y en los que hacen guardias de presencia. Sin embargo no existe relación entre el desgaste profesional y la edad, sexo, tipo de contrato ni número de guardias. El 77% de los profesionales cambiaría de Hospital pero no de especialidad médica

Objective: To determine the incidence of burnout in orthopedic surgeons of Andalusia in 2014. To determine the possible association between burnout and a number of sociodemographic and occupational factors and to know the reasons argued and the measures proposed to alleviate it. Material and methods: A transversal descriptive study was designed. A test was electronically sent to all orthopaedic surgeons working in Andalusia that were members of the Andalusian orthopaedic society (SATO). The test consisted of Maslach burn inventory, some demographic data and some proposals for better well being during work. Inclusion criteria were to be a licensed orthopaedic surgeon, to work in Andalusia and to be active (not retired). Results: Answers were received from 106 specialists (23.5%), 83% men and 17% women, the largest group was between 30 and 55 years (55%). 86% were married or in a stable relationship and only 27% had no son. 68% had a stable employment contract statutory well with SAS or permanent employment with Public Agencies. 38% performed 5-10 on call full-day working activities per month. 29% had a high level of burnout and in its three dimensions 41.5% had a high level of emotional exhaustion, 48.9% a high level of depersonalization and 37.2% had a low level of personal fulfillment . The work near the place of residence (p = 0.018), to have on-call full-day working physically present (p = 0.007) and work on a Public Agency (p = 0.03) were associated with a higher level of burnout. As subjective factors for this burnout, respondents emphasized the workload (19.2%), poor relationship salary / liability (17.3%) and little recognition of the work performed by both the employer and by users (12.5%). 77% would continue working but would change the Hospital where they work and only 4% were willing to change their specialty with such proceeding in the same workplace. Conclusions: The level of burnout of orthopaedic surgeons of Andalusia in 2014 is moderate and similar to a previous study among Spanish Orthopedists performed in 2005, despite being having a poorer socioeconomic scenario. There is a higher level of burnout among professionals who live near their workplace, work in Public Agencies and have on-call full-day working activities. However there is no relationship between burnout and age, sex, type of contract and number of days on-call per month. 77% of professionals would change Hospital but not medical specialty

The role of plasma IDO activity as a diagnostic marker of patients with colorectal cancer.

High levels of indoleamine 2,3-dioxygenase (IDO) are involved in tumour escape mechanisms. The aim of this study is the evaluation of L-kynurenine of plasma as marker of diagnostic and prognostic in patients with colorectal cancer. The study included 78 patients with colorectal cancer, of whom 15 % were in stage I/II, 30 % in stage III, and 55 % in stage IV, and was compared with a control group of 70 healthy subjects. The receiver operating characteristic (ROC) curve analysis showed an area under the curve of 0.917, with a specificity of 100 % and with a sensitivity to detect cancer of the colon of 85.2 %, taking 1.83 µM as a cut-off point. The overall survival analysis also indicated that patients with low levels of L-kynurenine in plasma increased survival rate after 45 months of follow-up (P = 0.032). These results show that the plasma levels of L-kynurenine could be a good biomarker to differentiate individuals with colorectal cancer from healthy individuals.

La consulta telefónica en Atención Primaria, ¿está justificada? / Primary care telephone consultations: are they justified?

Las llamadas telefónicas al pediatra de Atención Primaria han aumentado mucho en los últimos años. Cada vez es mayor el número de pacientes que reclama una atención inmediata para aclarar sus dudas. La llamada telefónica supone un medio inmediato, de fácil acceso, que en muchas ocasiones puede evitar visitas al centro de salud. En nuestro trabajo analizamos todas las llamadas realizadas al Servicio de Pediatría de nuestro centro de salud durante dos meses. Se registran un total de 109 llamadas, lo que supone un 3,6% de la actividad asistencial. Soluciona las dudas en el 84,4% de los casos. Los pacientes valoran con una media de 9,4 la atención recibida por el profesional que les atendió. Este sistema, por lo general, asesora, informa y permite realizar triage de casos que necesiten atención médica urgente. La consulta telefónica evita un alto porcentaje de visitas innecesarias al centro de salud, beneficiando tanto al médico como al paciente (AU)

Primary care telephone calls to the paediatrician have increased greatly in the last few years. The number of patients requesting immediate attention to clear up any doubts they have is always increasing. A telephone call is an immediate, easily accessible way that may often save visits to the health centre. We analysed all calls made to our Primary Healthcare Centre’s paediatric service during 2 months. A total of 109 calls were received what makes up 3.6% of the care provided. Patient’s doubts were solved in 84.4% of cases. Patients rated the service received by the professional who answered the calls at an average of 9.4. This system, in general, advices, informs and classifies those cases that require urgent medical attention. Telephone consultations avoid a high percentage of unnecessary visits to the Primary Healthcare Centre, benefiting both the doctor and the patient (AU)