Evaluación del focus group con farmacéuticos realizado en el proyecto “Igualdad y no discriminación en la atención farmacéutica a personas transexuales en España. Elaboración de un libro blanco” / Evaluation of the focus group with pharmaceuticals carried out in the project “Equality and non-discrimination in the pharmaceutical care of transsexual people in Spain. Preparation of a white paper”

En este artículo se presentan los resultados y la evaluación del focus group con farmacéuticos realizado en el colegio Oficial de Farmacéuticos de Madrid, como parte del proyecto “Igualdad y no discriminación en la atención farmacéutica a personas transexuales en España. Elaboración de un libro blanco”. El focus group ha permitido detectar actitudes, comportamientos y opiniones de los farmacéuticos comunitarios, evidenciándose el desconocimiento de numerosos aspectos relacionados con la realidad transexual, lo que lleva a pensar que se requiere de una formación adecuada del farmacéutico, tanto en los aspectos farmacológicos, como humanos y de comunicación. Sin embargo, no hay ninguna duda de que el farmacéutico comunitario, por su accesibilidad y cercanía, es un elemento de vital importancia para el asesoramiento, acompañamiento y ayuda de las personas transexuales y, en su caso, de sus familiares. (AU)

This article presents the results and the evaluation of the focus group with pharmacists carried out at the Official College of Pharmacists of Madrid, as part of the project “Equality and non-discrimination in pharmaceutical care for transgender people in Spain. Preparation of a white book”. The focus group has made it possible to detect attitudes, behaviors and opinions of community pharmacists, evidencing the ignorance of numerous aspects related to the transsexual reality, which leads to think that adequate training of the pharmacist is required, in both pharmacological aspects, as well as human and communication. However, there is no doubt that the community pharmacist, due to its accessibility and proximity, is an element of vital importance for the advice, accompaniment and help of transsexual people and, where appropriate, their families. (AU)

Microcirugía endodóntica: regeneración ósea guiada en defecto óseo tunelizado: caso clínico / Endodontic microsurgery: guided bone regeneration in a through-and-through bone defect: a clinical case

Se presentó a la Cátedra de Endodoncia de la Facultad de Odontología de la Universidad de Buenos Aires un paciente masculino de 62 años de edad que al examen clínico presentaba una fístula vestibular en la zona de la pieza 1.2 y dolor a la percusión. Al examen radiográ-fico se identificó una lesión apical extensa abarcando las piezas dentarias 1.2 y 1.1 endodónticamente trata-das con alteración severa de la anatomía del espacio endodóntico, así como la presencia de postes metáli-cos que no respetaban el eje del canal radicular. Ante el análisis tomográfico se observó una perforación de la pieza 1.2 y una lesión periapical extensa afectando ambas corticales (vestibular y palatina). Se decidió un abordaje microquirúrgico con técnicas de regenera-ción ósea guiada (ROG) y se realizaron los controles clínico-tomográficos a los 6, 12 y 24 meses. Por otro lado, se evaluó con micromografía de rayos X la ana-tomía de los ápices radiculares resecados. La lesión extirpada fue analizada histológicamente (AU)

A 62-year-old male patient attended the Endodontics department of the Buenos Aires University. He was examined clinically and a vestibular fistula in 1.2 area and pain under percussion were found. Radiographic examination identified an extended periapical lesion compromising teeth 1.2 and 1.1 with endodontic treatment severely altering the root canal anatomy, as well as metallic cast posts that did not preserve root canal axis. Regarding the tomographic analysis, a vestibular root perforation was observed (1.2), and both, vestibular and palatal corticals, were affected. We decided to perform a surgical approach with guided bone regeneration techniques (GBR). Clinical-CBCT controls were done at 6, 12 and 24 months. Furthermore, the anatomy of the resected root apex-es was evaluated with X ray microtomography. The removed lesion was histologically analyzed (AU)

Diseño y validación de un simulador para el entrenamiento en la capsulotomía circular continua en la facoemulsificación / Design and validation of a simulator for training in continuous circular capsulotomy for phacoemulsification

Introducción: Diseñar y validar un simulador para el aprendizaje y entrenamiento de la técnica de la capsulorrexis. Métodos: El sistema consiste en un soporte de metacrilato con inclinación de 15° para el apoyo de las manos del cirujano y una zona de papel aluminio comercial y otro de similares características donde el alumno realiza la técnica a través de unas hendiduras realizadas previamente en el soporte. Para evaluar la viabilidad de este simulador se toman los datos de 65 oftalmólogos que realizan la técnica durante actividades de formación, dividiéndolos aleatoriamente en un grupo de 30 especialistas que inician directamente su aprendizaje en ojos de cadáver de animal y en otro grupo de 35 especialistas que se inician previamente con este simulador. Resultados: Se desarrolla un simulador para entrenamiento de la técnica de capsulorrexis. El grupo de alumnos del grupo simulador consigue una reducción en el uso de ojos de cadáver y una mayor eficiencia en la realización de capsulorrexis correctas, a diferencia del grupo que se inicia directamente en ojos de cadáver. Conclusiones: Este simulador constituye una novedad en el entrenamiento de la técnica de capsulorrexis en cuanto a sencillez, coste y reutilización, frente a otros simuladores virtuales con equipos informáticos más costosos y más complicados de transportar. Es pieza clave como paso previo a la utilización de piezas de cadáver y de animales de experimentación, disminuyendo el número de ambos y, por tanto, el coste de la enseñanza (AU)

Introduction: To design and validate a simulator for learning and training in the capsulorhexis technique. Methods: The system consists of a methacrylate support inclined 15° for the surgeon's hand, an area of commercially available aluminum foil, and another one of similar characteristics, where the student performs the technique through some slots that are previously made in the support. In order to evaluate the feasibility of this simulator, data were collected from 65 ophthalmologists performing the technique during training activities. The ophthalmologists were randomly divided into one group of 30 specialists who start their learning on the eyes of an animal cadaver, and into another of 35 specialists who previously started with this simulator. Results: A simulator is developed for training in the capsulorhexis technique. The students from the simulator group achieved a reduction in the use of cadaver eyes, and a higher efficiency in correct capsulorhexis, unlike the group who started directly on the cadaver eyes. Conclusions: This simulator is an innovation in training of the capsulorhexis technique as regards simplicity, cost, and reuse, as compared to other virtual simulators with more expensive computer equipment (CE) equipment that are more difficult to transport. It is an important step prior to the use of cadaver parts and experimental animals, decreasing the number of both, and therefore the teaching costs (AU)

[Design and validation of a simulator for training in continuous circular capsulotomy for phacoemulsification]. / Diseño y validación de un simulador para el entrenamiento en la capsulotomía circular continua en la facoemulsificación.

INTRODUCTION: To design and validate a simulator for learning and training in the capsulorhexis technique. METHODS: The system consists of a methacrylate support inclined 15° for the surgeon's hand, an area of commercially available aluminum foil, and another one of similar characteristics, where the student performs the technique through some slots that are previously made in the support. In order to evaluate the feasibility of this simulator, data were collected from 65 ophthalmologists performing the technique during training activities. The ophthalmologists were randomly divided into one group of 30 specialists who start their learning on the eyes of an animal cadaver, and into another of 35 specialists who previously started with this simulator. RESULTS: A simulator is developed for training in the capsulorhexis technique. The students from the simulator group achieved a reduction in the use of cadaver eyes, and a higher efficiency in correct capsulorhexis, unlike the group who started directly on the cadaver eyes. CONCLUSIONS: This simulator is an innovation in training of the capsulorhexis technique as regards simplicity, cost, and reuse, as compared to other virtual simulators with more expensive computer equipment (CE) equipment that are more difficult to transport. It is an important step prior to the use of cadaver parts and experimental animals, decreasing the number of both, and therefore the teaching costs.

[Low birth weight is a risk factor for type 1 diabetes]. / El bajo peso al nacer es un factor de riesgo de diabetes mellitus tipo 1.

INTRODUCTION AND AIM: Over recent years, the increasing incidence of type 1 diabetes mellitus (T1DM) has been associated with different factors, particularly increased obesity in childhood. The aim of this study was to find out if there was any relationship between birth weight, body mass index (BMI) increase during the first two 3 years of life, and BMI at diabetes onset with age at diagnosis, in a cohort of children diagnosed with T1DM. MATERIAL AND METHOD: Data from 100 Caucasian children with T1DM of both sexes (57 boys, 43 girls) between 10 months and 16 years of age, mean age 84.45 months (SD; 52.4), were studied. We analysed the following variables: age at diagnosis, gestational age, weight and height at birth, at two years of age and at diabetes diagnosis, expressed as SD scores (SDS). RESULTS: All children were between 38-40 weeks of gestational age. Diabetic patients have lower birth weight (-2.88 ((-0.51)-(-0.066)) and lower BMI at birth compared with healthy children -0.5 ((-0.77)-(-0.23)). Diabetic children have a significant increase in BMI during the first two years of life (4.58 versus 2.17; P<0.001). Children with the lowest BMI at birth (12.77 versus 13.06; P<0.006) are the youngest at onset of the disease. BMI at diagnosis was not related to any of the variables studied. There were no gender differences either. CONCLUSIONS: The low BMI at birth and the later increase in the following years of life seem to be related to intrauterine environment as a risk factor for T1DM.

Incidence and prevalence of amyotrophic lateral sclerosis in Uruguay: a population-based study.

OBJECTIVE: To determine the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in the Republic of Uruguay. METHODS: The study was performed in Uruguay (3,241,003 inhabitants) during a 2-year period (2002-2003). To ensure complete case ascertainment, multiple sources of information were used, including all the neurologists, other medical specialties, general physicians, neurophysiology laboratories, hospital medical records and death certificates. ALS diagnosis was based on El Escorial criteria. Although all patients with motor neuron disease were enrolled in the follow-up, only probable and definite cases are included in the study. RESULTS: Between January 1st, 2002, and December 31st, 2003, 89 new patients were diagnosed with probable or definite ALS. The mean annual incidence rate was 1.37 per 100,000 persons. The incidence was higher for men (1.95) than for women (0.84) with a male to female ratio of 2:1. For both, the incidence increased throughout the years showing a peak in the 65-74 age group among men and the 55-64 age group among women. Mean age at onset of ALS disease was 58.7 years. The estimated mean annual incidence for ALS calculated by the capture recapture method was 1.42 (95% CI, 1.13-1.72). On December 31st, 2002, the crude prevalence was 1.9 per 100,000 inhabitants. CONCLUSIONS: ALS incidence is within a narrow range across countries despite the genetic, environmental and socioeconomic differences when similar prospective design, diagnosis criteria and data analyses are applied.

Unhealthy eating behaviour in adolescents.

In recent years, eating disorders (Anorexia and Bulimia Nervosa) have increased and are appearing at increasingly younger ages. They affect predominantly adolescent females 12 to 25 years of age. The objective of this study of adolescents is to detect and discuss unhealthy eating behaviour, defined by either of two factors: (1) following a slimming diet not advised or supervised by any person trained in health care; or (2) eating very large quantities at irregular times, not related to anxiety or stress. A transversal study has been undertaken of 630 school children of 14-18 years of age (average: 15.9 years) in Cádiz (Andalucia, Spain), using an anonymous self-reporting questionnaire to collect data on personal and educational situation, on eating habits, on nutritive intake and knowledge of nutrition, and on dieting and physical exercise. The study has considered averages, ratios, statistical significance (chi2) and, as a measure of risk, the Disequality Ratio of Prevalence (DRP). Anomalous eating behaviour was detected in 46.3% (292), with females predominant by a ratio of 2:1. Comparing groups with anomalous and with normal eating habits, significant differences were detected in respect of: perception of body image (p < 0.001), frequency of weighing oneself (p < 0.05), periods of abstinence from eating (DRP 1.66; 95% confidence interval (CI): 1.66-2.37), provocation of vomiting (DRP 2.02; 95% CI: 1.13-3.65), use of laxatives (DRP 4.25: 95% CI: 1.08-9.63), and the exclusion of certain meals and types of food, mainly bread and cereals, fats and sugars. Conclusions are drawn on the substantial scale of unhealthy eating behaviour among adolescents in Cadiz. More adequate education on personal health and related social issues should be provided.

[Level of knowledge about nourishment/nutrition among school adolescents in Cadiz]. / Nivel de conocimientos sobre alimentación/nutrición en adolescentes escolarizados de Cádiz.

OBJECTIVE: To determine the level of knowledge about nourishment/nutrition and how this knowledge is distributed among school adolescent population in the town of Cádiz. DESIGN: Descriptive and transversal study. SETTING: Schools. PARTICIPANTS: Sample of 630 subjects from the school adolescent population in the town of Cádiz. MEASUREMENTS AND MAIN RESULTS: The average level of knowledge about nourishment/nutrition is 6.63 (in a 0-13 scale). No significant differences were found according to the perception of proportion or disproportion in height and weight, level of concern about body fats and getting fat, diets, avoiding some food or taking some medication, dietary fibers and infusions or any other weight-reducing products and physical exercise and fitting. The relationship between the level of knowledge and the BMI is very close to statistical significance. CONCLUSIONS: We found a middle level of knowledge about nourishment/nutrition. We think this level of knowledge should be raised and other factors determining healthy habits should be considered. It is necessary to go on with research and contextualize nourishment habits.

Clinical profile of 128 subjects operated for primary hyperparathyroidism.

From 1960 to 1990, one hundred twenty eight (128) subjects with primary hyperparathyroidism were operated in the University Hospital. The medical records were reviewed. Serum and urine chemistries were done by conventional methods, serum PTH was done by RIA's (N-, C-, and midregion) and intact by IRMA and 1,25 dihydroxycholecalciferol by a non equilibrium receptor assay from calf thymus and preceded by double Sep-Pak chromatography. The distal third of the radius (nondominant arm) was used to evaluate radial bone density (RBD), using single photon absorptiometry (Norland) and the lumbar bone density (LBD) was measured by dual energy X Ray absorptiometry (DEXA). The RBD was done in 41 females and 15 males and the LBD in 12 females and 4 males. The series comprised 95 females, age range from 15 to 79 years, and 33 males, age range from 14 to 69 years. Prominent clinical features included nephrolithiasis in 72 subjects (56%), osteitis fibrosa cystica in 2, isolated familial hyperparathyroidism in 4 subjects in one family, 7 subjects with MEN-1 in 3 families, and 4 subjects with MEN-2 in one family. Only 7 subjects were asymptomatic. Serum calcium was elevated in all, serum alkaline phosphatase was elevated in 24% and urinary hydroxiproline was increased in 48%. Serum phosphorus was low in 92%. PTH assay was either elevated or inappropriately normal for the serum calcium in all patients tested. Serum 1,25 D was elevated in 57%. The PTH level was positively correlated with the serum calcium (r = 0.70), but had no significant correlation with the serum phosphorus and the 1,25 D. The RBD expressed as the standard deviation from that of the mean for age and sex matched controls was > or = 2 SD below the mean in 39% of females and in 40% of males. In contrast to the RBD none of the subjects tested had a LBD > or = 2 SD below the age and sex adjusted mean. 103 subjects had adenomas, 20 primary hyperplasia, 2 carcinomas and in 3 surgical exploration was unsuccessful. As to the outcome of Surgery, 117 (93%) were cured. Thus, in this series, successful surgery for primary hyperparathyroidism is the rule. Primary hyperparathroidism is rarely asymptomatic and appendicular bone disease and nephrolithiasis are commonly seen.