[Gastrostomy tubes in patients with amyotrophic lateral sclerosis: indications, safety and experience in a tertiary care centre]. / Sondas de gastrostomía en pacientes con esclerosis lateral amiotrófica: indicaciones, seguridad y experiencia en un centro de tercer nivel.

AIM: The aim of this study is the clinical characterisation of patients diagnosed with amyotrophic lateral sclerosis (ALS), who were indicated for the placement of a gastrostomy tube (G-Tube) in the period 2007-2017 in the Complejo Asistencial Universitario de Salamanca, and to find possible associated prognostic factors. MATERIAL AND METHODS: It is a descriptive study of clinical cases. RESULTS: Between 2007 and 2017, 139 cases of ALS were assessed and a G-Tube was indicated in 29 of them. Of these 29, on two occasions it was not performed, one due to the patient refusing and the other because of clinical deterioration. Of the total number of G-Tubes, 21 were placed by endoscopy, four by interventional radiology and two by surgery. The main indications were: in 10 cases, for severe dysphagia; in eight cases, for weight loss >10%; and in nine cases, for reduced forced vital capacity <50%. Immediate complications (first 24 hours) included: two intraprocedural desaturations, one ostomy infection, one abdominal pain, one paralytic ileus and one respiratory failure resulting in death. Late complications (first month) include pneumonia, intestinal ischaemia, cellulitis and poor control of secretions. The main cause of death was respiratory failure. The median time elapsed between G-Tube placement and death was 7.89 months. An improvement in analytical nutritional parameters was observed, without showing statistical significance, as a prognostic factor. CONCLUSION: G-Tube placement is an effective and safe procedure to ensure enteral nutrition in ALS patients.

TITLE: Sondas de gastrostomía en pacientes con esclerosis lateral amiotrófica: indicaciones, seguridad y experiencia en un centro de tercer nivel.Objetivo. El objetivo es la caracterización clínica de los pacientes diagnosticados de esclerosis lateral amiotrófica (ELA) a los que se les indicó la colocación de una sonda de gastrostomía (SG) en el período 2007-2017 en el Complejo Asistencial Universitario de Salamanca, y encontrar posibles factores pronósticos asociados. Material y métodos. Es un estudio descriptivo de casos clínicos. Resultados. Entre 2007 y 2017 se evaluaron 139 ELA y se indicó SG en 29 casos. De esos 29, en dos ocasiones no se llevó a cabo, en una ocasión por negativa del paciente y en otra por deterioro clínico. Del total de SG, 21 se colocaron por endoscopia; cuatro, por radiología intervencionista; y dos, por cirugía. Las principales indicaciones fueron: en 10 casos, por disfagia grave; en ocho, por pérdida ponderal > 10%; y en nueve, por disminución de la capacidad vital forzada menor de 50%. Entre las complicaciones inmediatas (primeras 24 horas) se observaron: dos desaturaciones intraprocedimiento, una infección de la ostomía, un dolor abdominal, un íleo paralítico y una insuficiencia respiratoria con fallecimiento. Entre las complicaciones tardías (primer mes): una neumonía, una isquemia intestinal, una celulitis y un mal control de las secreciones. La principal causa de fallecimiento fue la insuficiencia respiratoria. La mediana de tiempo desde la colocación de la SG hasta el fallecimiento fue de 7,89 meses. Se constató mejoría de los parámetros analíticos nutricionales, sin demostrarse significación estadística, como factor pronóstico. Conclusión. La colocación de una SG es un procedimiento eficaz y seguro para asegurar la nutrición enteral en los pacientes con ELA.

Sondas de gastrostomía en pacientes con esclerosis lateral amiotrófica: indicaciones, seguridad y experiencia en un centro de tercer nivel / Gastrostomy tubes in patients with amyotrophic lateral sclerosis: indications, safety and experience in a tertiary care centre

Objetivo: El objetivo es la caracterización clínica de los pacientes diagnosticados de esclerosis lateral amiotrófica (ELA) a los que se les indicó la colocación de una sonda de gastrostomía (SG) en el período 2007-2017 en el Complejo Asistencial Universitario de Salamanca, y encontrar posibles factores pronósticos asociados. Material y métodos. Es un estudio descriptivo de casos clínicos. Resultados: Entre 2007 y 2017 se evaluaron 139 ELA y se indicó SG en 29 casos. De esos 29, en dos ocasiones no se llevó a cabo, en una ocasión por negativa del paciente y en otra por deterioro clínico. Del total de SG, 21 se colocaron por endoscopia; cuatro, por radiología intervencionista; y dos, por cirugía. Las principales indicaciones fueron: en 10 casos, por disfagia grave; en ocho, por pérdida ponderal > 10%; y en nueve, por disminución de la capacidad vital forzada < 50%. Entre las complicaciones inmediatas (primeras 24 horas) se observaron: dos desaturaciones intraprocedimiento, una infección de la ostomía, un dolor abdominal, un íleo paralítico y una insuficiencia respiratoria con fallecimiento. Entre las complicaciones tardías (primer mes): una neumonía, una isquemia intestinal, una celulitis y un mal control de las secreciones. La principal causa de fallecimiento fue la insuficiencia respiratoria. La mediana de tiempo desde la colocación de la SG hasta el fallecimiento fue de 7,89 meses. Se constató mejoría de los parámetros analíticos nutricionales, sin demostrarse significación estadística, como factor pronóstico. Conclusión: La colocación de una SG es un procedimiento eficaz y seguro para asegurar la nutrición enteral en los pacientes con ELA.(AU)

Aim: The aim of this study is the clinical characterisation of patients diagnosed with amyotrophic lateral sclerosis (ALS), who were indicated for the placement of a gastrostomy tube (G-Tube) in the period 2007-2017 in the Complejo Asistencial Universitario de Salamanca, and to find possible associated prognostic factors. Material and methods: It is a descriptive study of clinical cases. Results: Between 2007 and 2017, 139 cases of ALS were assessed and a G-Tube was indicated in 29 of them. Of these 29, on two occasions it was not performed, one due to the patient refusing and the other because of clinical deterioration. Of the total number of G-Tubes, 21 were placed by endoscopy, four by interventional radiology and two by surgery. The main indications were: in 10 cases, for severe dysphagia; in eight cases, for weight loss >10%; and in nine cases, for reduced forced vital capacity <50%. Immediate complications (first 24 hours) included: two intraprocedural desaturations, one ostomy infection, one abdominal pain, one paralytic ileus and one respiratory failure resulting in death. Late complications (first month) include pneumonia, intestinal ischaemia, cellulitis and poor control of secretions. The main cause of death was respiratory failure. The median time elapsed between G-Tube placement and death was 7.89 months. An improvement in analytical nutritional parameters was observed, without showing statistical significance, as a prognostic factor. Conclusion: G-Tube placement is an effective and safe procedure to ensure enteral nutrition in ALS patients.(AU)

The relationship between burnout and empathy in physiotherapists: a cross-sectional study.

BACKGROUND: There have been few studies carried out into empathy in physiotherapists. Burnout can debilitate the quality of care and the efficacy of treatment as the empathetic capacity of the professional diminishes. OBJECTIVE: The objective of the study was to examine the association between the construct burnout, empathy and sociodemographic aspects in Spanish physiotherapists. METHODS: A cross-sectional electronic survey including the Maslach Burnout Inventory (for burnout assessment), the Interpersonal Reactivity Index (for empathy assessment) and sociodemographic data was answered by 461 Spanish physical therapists. A descriptive, bivariate and lineal regression analysis was performed. RESULTS: There was an association between burnout and empathy. Specifically, higher levels of burnout are associated with lower levels of empathy, whilst years of work experience is associated with lower levels of burnout. CONCLUSIONS: The results of this study contribute to a greater understanding of the relationship between the level of burnout and the dimensions of empathy in physiotherapists. The influence of burnout, which causes difficulties in the mobilization of the professional towards the establishment of a quality therapeutic relationship, is highlighted.KEY MESSAGESEmotional exhaustion is associated to greater personal discomfort and less empathy.The depersonalization is associated to personal discomfort and less empathy.Depersonalization is negatively associated to the lack of perspective.

Recomendaciones clínicas para la realización de la diálisis peritoneal aguda en el recién nacido / Clinical recommendations for acute peritoneal dialysis in the new born

La incidencia de Insuficiencia Renal Aguda se observa hasta en 23% de los recién nacidos ingresados en las unidad desde cuidos intensivos, siendo el 70% de causa prerrenal. La diálisis peritoneal representa una técnica eficaz en la insuficiencia renal aguda neonatal, sobre todo tras una cirugía cardiaca extracorpórea. El objetivo del presente trabajo fue elaborar unas recomendaciones clínicas actualizadas sobre la diálisis peritoneal dentro del protocolo asistencial existente en la unidad de cuidados intensivos neonatal. Se recorren la fase preliminar, de ejecución, mantenimiento y retirada. Dentro de la fase de mantenimiento se abordan las intervenciones enfermeras que deben realizarse para los diagnósticos enfermeros y los problemas de colaboración que más frecuentemente pueden presentarte en los recién nacidos a los que se les realiza esta técnica (AU)

The incidence of acute renal insufficiency is seen in as many as 23% of newborns admitted to intensive care units, being 70% of these caused by a prerenal condition. Peritoneal dialysis represents an effective technique in neonatal acuterenal insufficiency, mainly following extracorporeal cardiac surgery. The objective of this work was to elaborate updated clinical recommendations about peritoneal dialysis currently in place at the neonatal intensive care unit. The phases examined include a preliminary phase, execution or implementation, maintenance and removal. In the maintenance phase, the nursing interventions that need to be carried out to establish nursing diagnoses as well as the collaboration problems that nurses encounter when treating newborns in whom the technique is applied are examined (AU)

Producción científica en Enfermería Infantil en el ámbito español (período 2000-2004) / Scientific production in Paediatric Nursing in the spanish territory (period 2000-2004)

Objetivo: el presente estudio pretende analizar las principales característicasde la producción científica en Enfermería Infantil en el ámbitoespañol y para el período 2000-2004.Material y métodos: estudio descriptivo retrospectivo de todos los artículosde ámbito infantil en cuatro revistas españolas: “EnfermeríaCientífica”, “Enfermería Clínica”, “Rol de Enfermería” y “Metas de Enfermería”durante el período de septiembre del 2000 hasta septiembredel 2004. Para cada artículo se diseñó una ficha que recogía: tipo de artículo,temática, titulación de los autores, institución y procedencia geográfica.El tratamiento de los datos se ha realizado con SPSS 11.0, computándoseíndices de estadística descriptiva.Resultados: se han revisado 75 revistas y un total de 1.097 artículos, delos cuales sólo un 10% eran de Enfermería Infantil y dentro de estos un7,1% trataban específicamente del período neonatal. El 46,4% eran trabajosde investigación. El 43,5% analizaban aspectos relacionados con lanecesidad básica de Evitar Peligros. Según la titulación, el 44% de artículosestaban publicados por docentes y el 42% por profesionales de Enfermería.La universidad era la institución donde más producción científica serealiza (53%) seguida del hospital (18,2%). Las Comunidades Autónomasque han publicado más artículos son Andalucía (16%) y Cataluña (9,5%).Conclusiones: el nivel de producción científica en Enfermería Infantil esescaso y por ello es necesario seguir promoviendo la formación e investigaciónen este campo

Objective: this study aims to analyse the main characteristics of scientificproduction in Paediatric Nursing in the Spanish territory and for theperiod of 2000-2004.Material and methods: retrospective descriptive study of all the articlesin paediatrics published in four Spanish magazines: “EnfermeríaCientífica”, “Enfermería Clínica”, “Rol de Enfermería”, and “Metas deEnfermería” during the period from September 2000 to September2004. A data collection index card was designed for each article, whichincluded: type of article, subject, authors credentials, institution, andgeographic origin. The SPSS 11.0 programme was used for the analysisof the data. Descriptive statistics indexes were also recorded.Results: 75 magazines were reviewed, totalling 1097 articles, 10% ofwhich were about Paediatric Nursing and of these, 7.1% dealt specificallywith the neonatal period. 46.4% were research jobs. 43.5%sought to analyse aspects relating to the basic need to avoid risks. Accordingto the author´s credentials, 44% of the articles were publishedby academics and 42% by nursing professionals. The university was theinstitution that generated most of the scientific production (53%), followedby the hospital (18.2%). The autonomous regions that publishedthe most were: Andalusia (16%) and Catalonia (9.5%).Conclusions: the level of scientific production in Paediatric Nursing islow and because of this it is necessary to continue promoting trainingand research in this field

Eficacia de la intervención mediante automedición de la presión arterial en el control de la hipertensión arterial / Efficacy of the intervention by self-measurement of blood pressure in arterial hypertension control

Introducción. Estudiar en condiciones de práctica clínica habitual el efecto de la automedición domiciliaria (AMPA) sobre el descenso de presión arterial (PA) en hipertensos. Material y métodos. Estudio experimental en Atención Primaria. Participaron 109 pacientes con hipertensión arterial (HTA) ligera, mal controlados en consulta, aleatorizados en grupo intervención (GI), que fue instruido para la AMPA, facilitándosele un automedidor electrónico validado, y grupo control (GC) que siguió el programa de HTA del área. Se controlaron sus PA con una monitorización ambulatoria de la presión arterial (MAPA), al inicio, 18 y 30 meses. Se consideró controlada la PA con media por MAPA de 24 horas menor de 130/80 mmHg. Se registró el consumo de fármacos por dosis diaria definida, el índice de bienestar psicológico y las visitas por HTA y totales al Centro de Salud y otras variables demográficas y factores de riesgo cardiovascular. Se realizó análisis bivariante y multivariante por regresión lineal múltiple y/o regresión logística. Resultados. El descenso de la PA fue similar en ambos grupos, con tendencia a ser menor en el GI que en el GC a los 30 meses (diferencia de 3,6 mmHg para la PA sistólica y 2,3 mmHg la diastólica en el MAPA de 24 horas; "p", respectivamente, de 0,036 y 0,052) a expensas de la presión nocturna, no habiendo diferencias significativas en la diurna. No hay diferencias significativas en el control de la PA. El GI consume menos fármacos (1,1 frente a 1,3; p = 0,010). Discusión. Constatamos un menor descenso de la PA en el grupo de AMPA, en cifras moderadas, a expensas de la presión nocturna. El impacto sobre el proceso asistencial es favorable con un menor consumo de fármacos

Introduction. Study the effect of home self-measurement (HSM) on decrease in blood pressure (BP) in hypertensive subjects under usual clinical practice conditions. Material and methods. Experimental study in Primary Health Care. A total of 109 patients with mild hypertension poorly controlled in the consultation, participated. They were randomized into intervention group (IG), that was instructed on the use of HSM, providing them with a validated electronic self-measurer, and the control group (CG) who followed the area hypertension program. Blood pressure (BP) was measured with ambulatory blood pressure monitoring (ABPM), at onset, 18 and 30 months. BP was considered to be controlled by ABPM with a mean of 24 hours less than 130/80 mmHg. Drug consumption was recorded by daily defined dose, psychological wellbeing index and visits due to hypertension and total visits to the Health Center and other demographic variables and cardiovascular risk factors. Bivariate and multivariate analysis were performed by multiple linear regression and/or logistic regression. Results. Decrease of BP was similar in both groups, with tendency to be less in the IG than in the CG at 30 months (difference of 3.6 mmHg for systolic BP and 2.3 mmHg for diastolic in the 24 hour ABPM, "p" respectively of 0.036 and 0.052) at expense of nocturnal pressure. There were no significant difference in the daytime pressure. There were no significant differences in the BP control. IG consumed fewer drugs (1.1 vs 1.3; p = 0.010). Discussion. We observe less BP decrease in the ABPM group, in moderate values, at expense of nocturnal pressure. The impact of the health care process is favorable with less drug usage

[Polymorphism of six Alu-insertions in residents of Morocco: comparative study in Arab and Berber populations and residents of Casablanca]. / Polimorfism shesti Alu-insertsii u zhitelei Marokko: sravnitel'noe izuchenie v populiatsiiakh Arabov, Berberov i zhitelei Kasablanki.

Alu elements are the largest family of short tandem interspersed elements (SINEs) in human who have arisen to a copy number with an excess of 500,000 copies per haploid human genome and mobilize through an RNAse polymerase III derived transcript in a process termed "retroposition." Several features make Alu insertions a powerful tool used in population genetic studies: the polymorphic nature of many Alu insertions, the stability of an Alu insertion event and, furthermore, the ancestral state of an Alu insertion is known to be the absence (complete and exact) of the Alu element at a particular locus and the presence of an Alu insertion at the site that forward mutational change. Here we report on the distribution of six polymorphic Alu insertions in a general Moroccan population and in the Arab and Berber populations from Morocco and their relationships with other populations previously studied. Our results show that there is a small difference between Arabs and Berbers and that the Arab population was closer to African populations than Berber population which is closest to Europeans.

A reevaluation of nystatin in prophylaxis and treatment of oropharyngeal candidiasis.

The incidence of oropharyngeal candidiasis is growing. The species of the genus Candida are extremely frequent among human colonizers. The changes in the yeast-human interaction by aging, debilitating, and immunosuppressive diseases, and the more aggressive medical interventions can explain this phenomenon. Antifungals are used both in prophylaxis and therapy, but the number of available agents remains scarce. Acquired resistance to the more commonly used antifungal agents, the azole compounds, is also an increasing threat, Policies for antifungal use should be established in order to maintain the therapeutic possibilities of the current compounds, The widespread use of systemic azoles, agents useful in deep mycosis, may increasingly exert a selective power for resistant variants. Superficial infections, such as oropharyngeal candidiasis, can be successfully controlled by nystatin, a classic polyene, which is very well tolerated and has very low rates of resistance. This review on the importance of oropharyngeal candidiasis emphasizes this therapeutic possibility, and is complemented by in vitro studies documenting the excellent activity of nystatin on both azole-susceptible and resistant strains.

Indoor 222Rn concentrations in Central Asturias.

A survey of the 222Rn concentrations in 106 homes in the four main towns of the Central Asturias region was carried out over three years. A total of 1,014 measurements was obtained using passive radon charcoal canisters. The 222Rn concentrations fit a log-normal distribution law, with a geometric mean of 23 Bq m(-3). There is a marked difference between the 222Rn concentration for the ground inhabited floors and first floors. For the other floors, the 222Rn concentrations remain practically constant. The 222Rn concentrations are lower in summer than in winter time. The annual equivalent dose for the general public due to the inhalation of 222Rn is equal to 0.81 mSv (81 mrem).