Continuous PENG block in an oncologic patient with bilateral femoral avascular necrosis.

The PENG block (pericapsular nerve group) is a recently described technique to address the innervation of the hip, one of the most complex anatomical regions to treat at the locoregional level. We present the case of a patient with acute lymphoblastic leukaemia complicated by avascular necrosis of the bilateral femoral head and previous history of severe chronic pain with probable central sensitization to opioids and a severe thrombocytopenia due to myelotoxicity from chemotherapy treatment. Given the need for orthopaedic surgery to manage femoral necrosis and in anticipation of complex perioperative pain management, a multimodal strategy was planned including bilateral ultrasound-guided continuous PENG blocks to achieve proper pain control in the perioperative period and promote early recovery. The operation and initial recovery were uneventful and the patient was discharged to the ward within 24 h and started early rehabilitation as planned. The patient had a successful recovery with good functionality.

Técnica de radiofrecuencia pulsada en síndrome de ACNES invalidante en una paciente pediátrica / Pulsed radiofrequency in a paediatric patient with disabling ACNES

El dolor abdominal crónico es una entidad muy prevalente en la población pediátrica y supone todo un reto diagnóstico para los profesionales, siendo frecuentemente infradiagnosticada. Requiere un abordaje multidisciplinar y una minuciosa evaluación clínica para descartar otras enfermedades. El ACNES consiste en un atrapamiento de los nervios cutáneos anteriores de los nervios intercostales y origina un dolor abdominal intenso, unilateral, circunscrito y frecuentemente presenta un Pinch test y un test de Carnett positivos. El planteamiento terapéutico debería contemplarse desde un enfoque gradual, reservando las técnicas más invasivas para los pacientes con ACNES refractario. Entre los múltiples tratamientos posibles las infiltraciones locales presentan una alta tasa de éxito, reservando las técnicas quirúrgicas para los casos refractarios. Presentamos el caso clínico de una niña de 11 años, con ACNES de 6 meses de evolución, con grave afectación de su calidad de vida y con respuesta favorable a la técnica de radiofrecuencia pulsada.(AU)

Chronic abdominal pain is a highly prevalent entity in the paediatric population and represents a diagnostic challenge for professionals. It is frequently underdiagnosed, and must be treated by a multidisciplinary team after a detailed clinical evaluation has been performed to rule out other pathologies. Anterior cutaneous nerve entrapment syndrome (ACNES) occurs when the anterior cutaneous abdominal nerves become pinched or trapped, causing intense, unilateral, circumscribed abdominal pain. Patients often present a positive Pinch test or Carnett's sign. A stepwise therapeutic approach should be used, reserving the most invasive techniques for patients with refractory ACNES. Among the many different treatments available, local anaesthesia infiltration has shown a high success rate, and surgery should only be performed in the most refractory cases. We report the case of an 11-year old girl with a 6-month history of ACNES that severely affected her quality of life, who responded well to pulsed radiofrequency ablation.(AU)

Nut Consumption and Depression: Cross-Sectional and Longitudinal Analyses in Two Cohorts of Older Adults.

OBJECTIVES: To assess the cross-sectional and longitudinal associations between nut consumption and depression in two cohorts of older adults. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: The first cohort (Seniors-ENRICA-I or SE-I) included a representative sample of Spanish noninstitutionalized adults aged ≥65 years interviewed in 2010 and 2013. The second cohort (SE-II) included individuals from the Madrid region, Spain, aged ≥65 years interviewed in 2017 and in 2019. Nut consumption was estimated with a validated computer-based diet history. Depression was defined as self-reported physician-diagnosed depression or the use of antidepressants. Logistic regression models were adjusted for the main confounders. The DerSimonian and Laird random-effect method was used to meta-analyze the results from both studies. A participant-level pooled analysis was conducted to examine the robustness of our analyses. RESULTS: The SE-I included 2278 individuals (233 prevalent cases) in the cross-sectional analysis and 1534 (108 incident cases) in the longitudinal analysis; the corresponding figures for SE-II were 2726 (407 prevalent cases) and 1566 (74 incident cases). In the meta-analysis of cross-sectional results from the two studies, compared to consuming <1 serving (30 g) of nuts/week, the odds ratio (95% confidence interval) for depression was 0.90 (0.64, 1.16) for consuming 1 to <3 servings/week and 0.92 (0.70, 1.13) for consuming ≥3 servings/week; the corresponding figures for the longitudinal results were 0.90 (0.41, 1.38) and 0.66 (0.35, 0.97). CONCLUSION: Nut consumption was associated with a lower risk of depression in a pooled longitudinal analysis using data from two cohorts of older adults. Nuts should be recommended as part of a healthy diet in older adults.

Pulsed radiofrequency in a paediatric patient with disabling ACNES.

Chronic abdominal pain is a highly prevalent entity in the paediatric population and represents a diagnostic challenge for professionals. It is frequently underdiagnosed, and must be treated by a multidisciplinary team after a detailed clinical evaluation has been performed to rule out other pathologies. Anterior cutaneous nerve entrapment syndrome (ACNES) occurs when the anterior cutaneous abdominal nerves become pinched or trapped, causing intense, unilateral, circumscribed abdominal pain. Patients often present a positive Pinch test or Carnett's sign. A stepwise therapeutic approach should be used, reserving the most invasive techniques for patients with refractory ACNES. Among the many different treatments available, local anaesthesia infiltration has shown a high success rate, and surgery should only be performed in the most refractory cases. We report the case of an 11-year old girl with a 6-month history of ACNES that severely affected her quality of life, who responded well to pulsed radiofrequency ablation.

Atención y aspectos terapéuticos de la EPOC al final de la vida / Attention and therapeutic aspects of COPD at the end of life

En los últimos años, hemos asistido a un importante avance en el manejo de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), lo que ha llevado a un incremento de su supervivencia. Este hecho ha supuesto que tengamos que abordar nuevos retos a los que debemos dar respuesta, incluyendo la atención de estos enfermos al final de su vida. El problema está en la dificultad de detectar al grupo de individuos con EPOC subsidiarios de recibir un abordaje paliativo. Una de las aproximaciones clásicas para valorar la necesidad de esta aproximación es considerar que si el paciente falleciese en los próximos 12 meses no sería una sorpresa. Sin embargo, muchos autores consideran que el uso exclusivo de este criterio no es útil en los individuos con EPOC. En este sentido, se ha descrito que los cambios en ciertos parámetros a los largo del tiempo podrían ayudar a predecir mejor la mortalidad en ese periodo de tiempo. En cualquier caso, una correcta coordinación entre la consulta de EPOC, la planta de hospitalización de Neumología y la unidad de cuidados paliativos podría facilitar la toma de decisiones. En este artículo se abordan aspectos relacionados con la atención y los aspectos terapéuticos de la EPOC al final de la vida, incluyendo los criterios que ayudan a identificar a estos enfermos, los síntomas asociados a la EPOC avanzada y el abordaje de los mismos y cómo realizar el manejo terapéutico en los últimos días de vida del paciente con esta enfermedad

In recent years, we have witnessed an important advance in the management of patients with chronic obstructive pulmonary disease (COPD), which has led to an increase in their survival. This has meant that we have to address new challenges to which we must respond, including the care of these patients at the end of their lives. The problem lies in the difficulty of detecting the group of individuals with COPD that are subsidiary to receiving a palliative approach. One of the classic approaches to assess the need for this approach is to consider that if the patient died in the next 12 months it would not be a surprise. However, many authors consider that the exclusive use of this criterion is not useful in individuals with COPD. In this sense, it has been described that changes in certain parameters over time could help to better predict mortality in that period of time. In any case, a correct coordination between the COPD consultation, the Pneumology hospitalization unit and the palliative care unit could facilitate decision making. This article addresses aspects related to the care and therapeutic aspects of COPD at the end of life, including the criteria that help identify these patients, the symptoms associated with advanced COPD and the approach to them and how to perform therapeutic management in the last days of life of the patient with this disease

Deshabituación tabáquica en paciente con cáncer de colon / Smoking cessation in patients with colon cancer

El tabaquismo es una enfermedad adictiva y crónica, siendo la primera causa de muerte evitable en los países desarrollados y estando directamente relacionado con diversos tipos de cáncer.Continuar fumando disminuye la eficacia del tratamiento, aumenta las complicaciones y los efectos secundarios para muchos tipos de cáncer, por ello los tratamientos para deshabituación tabáquica en pacientes oncológicos son muy importantes. Entre ellos se encuentra la terapia sustitutiva con nicotina (TSN), que es la droga que produce dependencia física del tabaco.Contamos el caso de un paciente diagnosticado y tratado de cáncer de colon que consiguió dejar de fumar tras 2 intentos, con tratamiento con parches y chicles de nicotina (AU)

Smoking habit is a chronic and additive disease, it being the first cause of avoidable death in developed countries and it is directly related with different types of cancer. To continue smoking decreases the efficacy of the treatment, increases the complications and side effects for many types of cancer. Thus, smoking cessation treatments in oncology patients are very important. Among these are nicotine replacement therapy (NRT), which is the drug that produces physical dependence of tobacco. We are reporting the case of a patient diagnosed and treated of colon cancer who was successful in stopping smoking after 2 attempts, with nicotine patches and gum (AU)

Overweight parents are twice as likely to underestimate the weight of their teenage children, regardless of their sociodemographic characteristics.

AIM: It is unclear whether parents' weight affects their ability to recognise whether their teenage children are overweight. This study analysed whether overweight parents assessed their child's weight as well as normal weight parents. METHODS: This cross-sectional study was carried out in Londrina, Brazil, in 2011 and included teenagers between 14 and 17 years of age and their parents or guardians. We recorded the weight and height of the teenagers and asked the parents or guardians to fill in a questionnaire that included how they perceived their child's weight and demographic information. RESULTS: We studied 1231 teenagers - 58.2% girls - and 19.4% were overweight or obese. In 842 (68.4%) of cases both parents replied to the questionnaire. We found that 8.7% of the 1202 mothers and 10.0% of the 871 fathers underestimated how overweight their child was. The adjusted analyses confirmed they were twice as likely to underestimate their child's weight if they were overweight themselves, with an odds ratio of 1.96 for the mothers and 2.04 for the fathers. Sociodemographic characteristics did not affect the results. CONCLUSION: Overweight parents were twice as likely to underestimate the weight of their teenage children, regardless of the sociodemographic characteristics.

Obesity-related eating behaviours in the adult population of Spain, 2008-2010.

Knowledge of the socio-demographic distribution of eating behaviours can aid our understanding of their contribution to the obesity epidemic and help to address healthy eating interventions to those who can benefit most. This cross-sectional study assessed the frequency of self-reported eating behaviours among 11,603 individuals representative of the non-institutionalized Spanish population aged ≥ 18 years in the period 2008-2010. In the adult population of Spain, 24.3% had lunch and 18.2% had dinner away from home >3 times per month. About three-fourths of adults did not plan the amount of food to be eaten, and did not choose light foods and/or skim dairy products. Also, 26% did not trim visible fat from meat, and 74.7% usually ate while watching television. Compared with individuals with primary or less education, those with university studies were more likely to remove fat from meat (age- and sex-adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.08-1.44), and to choose light food and/or skim dairy (aOR 1.50; 95% CI 1.30-1.77), and less likely to eat while watching television (aOR 0.54; 95% CI 0.47-0.63). In conclusion, the prevalence of several obesity-related eating behaviours is high in Spain, which indicates a deficient implementation of dietary guidelines. Socioeconomic inequalities in eating behaviours should also be addressed.

Selected eating behaviours and excess body weight: a systematic review.

The relationship between obesity and the intake of macronutrients and specific foods is uncertain. Thus, there is growing interest in some eating behaviours because they may reflect the joint effect of several foods and nutrients and, thus, increase the likelihood of finding a link to obesity. This study examined the association between selected eating behaviours and excess weight in the general population throughout a systematic review of publications written in English, Spanish or Portuguese identified in a PubMed search up to 31 December 2010. We included 153 articles, 73 of which have been published since 2008. Only 30 studies had a prospective design; of these, 15 adjusted for sociodemographic variables, physical activity and energy or food intake. Moreover, definitions of eating behaviours varied substantially across studies. We found only small or inconsistent evidence of a relationship between excess weight and skipping breakfast, daily eating frequency, snacking, irregular meals, eating away from home, consumption of fast food, takeaway food intake, consumption of large food portions, eating until full and eating quickly. In conclusion, this review highlights the difficulty in measuring human behaviour, and suggests that a more systematic approach is needed for capturing the effects of eating behaviours on body weight.

Factores de riesgo de rehospitalización en pacientes ingresados por exacerbación de EPOC / No disponible

Objetivo: Identificar los factores predisponentes de futuros reingresas hospitalarios en los pacientes con EPOC, tras el alta hospitalaria por una agudización de su enfermedad. Material y métodos: Se trata de un estudio descriptivo y observacional. Se incluyeron pacientes que ingresaron con el diagnóstico de EPOC reagudizada. Se recogieron los antecedentes personales, las características clínicas, los resultados de las pruebas complementarias y el tratamiento pautado. Al alta se les siguió durante un periodo de 6 meses, evaluando el número de reingresos hospitalarios durante dicho periodo. Resultados: Se evaluaron 41 pacientes, 39 varones (95,1 %) y 2 mujeres (4,9%), con una edad media de 65,8+- 14,6 años y un valor medio de FEVI de 38,2+- 15,6%. De ellos, 12 eran fumadores activos (29,3%) y 29 exfumadores (70,7%). El número medio de hospitalizaciones en el año previo fue de 2,3 +- 2.3. Las patologías acompañantes más frecuentes fueron la cardiopatía isquémica (24,4%) y la diabetes mellitus (22%). Los tratamientos más comúnmente usados antes del ingreso fueron los agonistas beta~2 adrenérgicos de larga duración (87,8%) y los anticolinérgicos de acción prolongada (65,9%). Además, 18 enfermos (43,9%) seguían tratamiento con oxigenoterapia domiciliaria antes de ingresar. Respecto al tratamiento farmacológico pautado al alta, cabe destacar que al 85,4% de los enfermos se les pautó corticoides inhalados y al 56,1% corticoides orales. En relación con los reingresas hospitalarios, 14 enfermos (34,1 %) fueron nuevamente ingresados en los 6 meses posteriores al alta. En el análisis univariante se comprobó que los factores relacionados con el reingreso hospitalario fueron el número de hospitalizaciones en el año previo, la existencia de al menos una patología asociada, el tratamiento previo con oxigenoterapia, el grado de disnea al finalizar el ingreso y el tratamiento con corticoides orales al alta (p>0,05). Sin embargo en el análisis multivariante se observó que, de todos ellos, sólo la prescripción de corticoides orales al alta constituía un factor determinante independiente de rehospitalización en estos pacientes (p<0,05). Conclusiones: La prescripción de corticoides orales al alta es un factor predictivo independiente de la probabilidad de ingreso en los 6 meses siguientes al alta. Se necesitan nuevos estudios, con mayor número de pacientes y un tiempo de seguimiento más largo, para establecer la verdadera influencia de otros factores (AU)

Objective: Identify the predisposing factors of future hospital re-admissions in patients with COPD after hospital discharge due lo worsening of their disease. Material and methods: This is a descriptive and observational study. Patients admitted with the diagnosis of worsened COPD were included. Personal backgrounds, clinical characteristics, results of the complementary tests and treatment prescribed were collected. They were followed-up after discharge for a 6-month period, evaluating the number of re-admissions during that period. Results: A total of 41 patients, 39 men (95.1%) and 2 women (4.9%), with a mean age of65.8+- 14.6 years and mean value of FEVI of 38.2+- 15.6% were evaluated. Twelve of them were active smokers (29.3%) and 29 ex-smoker (70.7%). Mean number of hospitalizations during the previous year was 2.3 +- 2.3. The most frequent accompanying diseases were ischemic heart disease (24.4%) and diabetes mellitus (22%). The most commonly used treatments prior to admission were long-acting beta-2 adrenergic agonists (87.8%) and long-acting anticholinergics (65.9%). In addition, 18 patients (43.9%) were treated with home oxygen therapy before admission. Regarding drug treatment prescribed on discharge, it stands out that 85.4% of the patients were prescribed inhaled corticosteroids and 56.1% oral corticosteroids. Regarding hospital readmissions, 14 patients (34.1%) were readmitted during the six months following discharge. In the univariate analysis, it was verified that the factors related with hospital readmission were the number of hospitalizations in the previous year, existence of at least one associated disease, previous treatment with oxygen therapy, degree of dyspnea at the end of the hospitalization and treatment with oral corticosteroids on discharge (p>0.05). However, the multivariate analysis showed that out of all of these, only the prescription of oral corticosteroids on discharge was a determining independent factor in rehospitalization in these patients (p<0.05). Conclusions: Prescription of oral corticosteroids on discharge is an independent predictive factor of the like-lihood of admission during the six months following discharge. New studies are needed with a larger number of patients and longer follow-up time to establish the true influence of other factors (AU)

Fístula traqueoesofágica / Tracheoesophageal fistula

No disponible

Nódulos traqueales / Tracheal nodes

No disponible

Pulp response to direct capping with an adhesive system.

PURPOSE: To evaluate the pulp response following direct pulp capping with an adhesive system (Prime & Bond 2.0 - PB 2.0) and a zinc-oxide eugenol cement (ZOE) on pulp exposures in rat molar teeth. MATERIALS AND METHODS: Forty-eight Class I cavities were prepared on the occlusal surface of molar teeth of rats (Rattus Norvegicus, Holtzman). Pulp exposures performed on the cavity floor were capped either with the adhesive system P&B 2.0 or ZOE. After 7, 15, 30, and 60 days, the specimens were processed through H & E and Brown & Brenn staining techniques. RESULTS: Both pulp capping materials allowed pulp repair, characterized by reorganization of a new odontoblast cell layer underlying the dentin bridge formation. However, P&B 2.0 promoted a large zone of cell-rich fibrodentin matrix deposition between the pulp capping material and the dentin bridge, which was deposited far from the pulp exposure site. On the other hand, pulps capped with ZOE showed dentin bridging immediately subjacent to the pulp capping material. In those samples in which microleakage occurred between dental material and cavity walls there was a persistent inflammatory reaction and lack of complete pulp repair.

Physico-chemical characterization of atmospheric aerosols in a rural area affected by the Aznalcollar toxic spill, south-west Spain during the soil reclamation activities.

High levels of atmospheric contamination due to the re-suspension of pyrite particles from the mining waste slurry were recorded in the Guadiamar valley (the Guadiamar is a tributary of the Guadalquivir river) after the toxic spill of Aznalcóllar, north of the Doñana Natural Park (SW Spain). Major high-particulate events occurred during the extraction of the pyrite-rich mud layer, which covered an extensive area of the valley downstream of the confluence of the Agrio and Guadiamar rivers. This study deals with the monitoring of the ambient air quality at two stations near the village of Aznalcázar in the central part of the flooded area. Although the Spanish legal limit for atmospheric particles and lead in environmental air were not exceeded, high daily levels of total suspended particles (TSP) and of some elements with an environmental significance (As, Cd, Cu, Mn, Ni, Pb, Sn, Tl and Zn) were recorded at Aznalcázar and in the Guadiamar valley during soil reclamation (July-August 1998). Despite a progressive decrease in TSP levels through September-October 1998, background was higher than the levels for the May-June period. Evolution of levels for most of the elements studied showed a similar trend. The exceptions were copper, which was partially increased by other emission sources such as fumigation activities, and sodium, which remained at relatively constant levels during the study period because of its marine origin. The physico-chemical characterisation of the atmospheric particulates allowed us to determine the major grain size modes of the pyrite related elements and the solubility of the potentially toxic elements, and to identify the major particulate types present in the atmosphere in the area. Secondary and tertiary aromatic amines (i.e. alkyldiphenylamines and phenylcarbazoles, respectively) were identified in the suspended particles and in the vapour phase collected at the same station as the TSP samples. As some of these aromatic amines had been previously identified in the pyrite sludge, it is assumed that fine sludge particles containing aromatic amines were re-suspended in the atmosphere. The highest concentrations of aromatic amines in the particulate phase were recorded in August 1998 during the pyrite slurry extraction in the proximity of the Aznalcázar sampling site. Despite a sharp drop in the suspended particles of the aromatic amine concentrations, a significant concentration was detected in the vapour phase (< 1.2 mm) during autumn, probably because of longer residence time in the atmosphere. Although health hazards associated with the presence of these aromatic amines are unknown, their acute toxicity exceeded that of urban aerosols.