The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies.

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.

Evolución previsible en el número de profesores permanentes de Medicina del 2017 al 2026. La formación de los futuros médicos en situación crítica / Predicted change in the number of permanent medical teachers from 2017 to 2026. The training of future physicians in critical condition

La disminución significativa y progresiva en el número de profesores permanentes en las facultades de Medicina (catedrático, profesor titular y profesor contratado doctor) es motivo de preocupación para la Conferencia Nacional de Decanos. Esta disminución se intensificará en la próxima década (2017-2026). Se jubilará el 43% del profesorado permanente: un 55% del profesorado vinculado de áreas clínicas, un 34% del profesorado no vinculado de áreas clínicas y un 32% del profesorado de áreas básicas. Este déficit es importante en el momento actual y en pocos años la situación será insostenible, especialmente en áreas clínicas. Este informe pone de manifiesto la necesidad inaplazable de adoptar medidas urgentes que palíen la situación actual y que prevengan un mal mayor. La formación de los futuros médicos, responsables inmediatos de salud de nuestra sociedad, depende en gran parte de la enseñanza teórica y práctica que se imparte en las facultades de Medicina, con la colaboración esencial de las instituciones sanitarias. Paradójicamente, a la vez que disminuye sustancialmente el número de profesores, aumenta exponencialmente el número de facultades de Medicina y el número de alumnos que se admiten cada año sin justificación académica ni sanitaria

The significant and progressive reduction in the number of permanent teachers in medical schools (professor, associate professor and assistant professor) is a reason for concern for the National Conference of Deans. This reduction will intensify in the coming decade (2017-2026). Forty-three percent of the permanent faculty will retire, as will 55% of the faculty linked to clinical areas, 34% of the faculty not linked to clinical areas and 32% of the faculty of basic areas. This deficit is significant now, and, in a few years, the situation will be unsustainable, especially in the clinical areas. This report reveals the pressing need to adopt urgent measures to alleviate the present situation and prevent a greater problem. The training of future physicians, immediately responsible for the health of our society, depends largely on the theoretical and practical training taught in medical schools, with the essential collaboration of healthcare institutions. Paradoxically, while the number of teachers decreases substantially, there is an exponential increase in the number of medical schools and students who are admitted every year without academic or healthcare justification

Predicted change in the number of permanent medical teachers from 2017 to 2026. The training of future physicians in critical condition. / Evolución previsible en el número de profesores permanentes de Medicina del 2017 al 2026. La formación de los futuros médicos en situación crítica.

The significant and progressive reduction in the number of permanent teachers in medical schools (professor, associate professor and assistant professor) is a reason for concern for the National Conference of Deans. This reduction will intensify in the coming decade (2017-2026). Forty-three percent of the permanent faculty will retire, as will 55% of the faculty linked to clinical areas, 34% of the faculty not linked to clinical areas and 32% of the faculty of basic areas. This deficit is significant now, and, in a few years, the situation will be unsustainable, especially in the clinical areas. This report reveals the pressing need to adopt urgent measures to alleviate the present situation and prevent a greater problem. The training of future physicians, immediately responsible for the health of our society, depends largely on the theoretical and practical training taught in medical schools, with the essential collaboration of healthcare institutions. Paradoxically, while the number of teachers decreases substantially, there is an exponential increase in the number of medical schools and students who are admitted every year without academic or healthcare justification.

Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study

Background: The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors. Methods: In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012. Results: The mean age of participants was 24.9 ± 0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR) =2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR = 4.05; 95% CI 1.7-9.6), bronchitis (RR = 2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR = 0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed. Conclusions: A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found (AU)

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Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study.

BACKGROUND: The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors. METHODS: In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012. RESULTS: The mean age of participants was 24.9±0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR)=2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR=4.05; 95% CI 1.7-9.6), bronchitis (RR=2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR=0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed. CONCLUSIONS: A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found.

Incidence of allergic rhinitis in a cohort of young adults from 13-15 years old to 23-25 years old in Castellon (Spain)

BACKGROUND: The objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors. METHODS: A population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002-2012. RESULTS: Of the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23-25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9±0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person-years, and the incidence increased from 2002 (RR=1.42; 95% CI 1.15-1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR=1.77; 95% CI 1.16-2.68), atopic dermatitis (RR=1.51; 95% CI 1.11-2.06) and constant exposure to truck traffic (RR=1.88; 95% CI 1.12-3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor. CONCLUSIONS: An increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender

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Incidence of allergic rhinitis in a cohort of young adults from 13-15 years old to 23-25 years old in Castellon (Spain).

BACKGROUND: The objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors. METHODS: A population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002-2012. RESULTS: Of the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23-25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9±0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person-years, and the incidence increased from 2002 (RR=1.42; 95% CI 1.15-1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR=1.77; 95% CI 1.16-2.68), atopic dermatitis (RR=1.51; 95% CI 1.11-2.06) and constant exposure to truck traffic (RR=1.88; 95% CI 1.12-3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor. CONCLUSIONS: An increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender.

[Unilateral vocal fold paralysis: quality of voice after speech therapy]. / Parálisis de cuerda vocal unilateral: estudio de la calidad vocaldespués del tratamiento logopédico

BACKGROUND: To describe demographic factors and voice quality parameters of patients with unilateral vocal fold paralysis (UVFP) after a voice therapy protocol. METHODS: Forty-seven patients with a diagnosis of UVFP by video-laryngoscopy were included. Voice therapy was applied to all patients during 15 sessions that were structured in three progressive stages. The objective was to train patients in vocal techniques, phonic-breathing coordination,blow control, vocal exercises for glottic closure and vocal setting. Glottal closure, Voice Handicap Index-10 for perception of voice impairment and GRBAS scale were used before and after the speech therapy. RESULTS: The average age was 51 years (range 20-80), 60%women. Surgery was the most frequent cause (72%), and 40% had a profession related to voice use. Median time from diagnosis to treatment was 5 months (2-12). After voice therapy, 80% had complete glottal closure, previously this had been 34% (p<0.001), the score of VHI-10 decreased from 24.24 to 16.09 points (p<0.001) and GRBAS values improved in all the qualities of voice (p<0.001).Only 8.5% of the patients required surgical intervention after treatment. CONCLUSIONS: Voice therapy is effective as first line therapy in patients with UVFP, reserving medialization with non-absorbable material or thyroplasty surgery for those with a poor outcome. However, it is necessary to reduce the time it takes the patient to reach the Voice Unit after laryngoscopic diagnosis.

Parálisis de cuerda vocal unilateral: estudio de la calidad vocal después del tratamiento logopédico / Unilateral vocal fold paralysis: quality of voice after speech therapy

Fundamento: Describir los factores sociodemográficos de pacientes con parálisis de cuerda vocal unilateral (PCVU) a los que se aplica un tratamiento logopédico y analiza el impacto en la calidad vocal tras la terapia. Metodología: Se incluyeron 47 pacientes con PCVU diagnosticada mediante vídeo-laringoscopia. Todos recibieron intervención logopédica repartida en 15 sesiones y estructurada en tres etapas progresivas. Se instruyó al paciente en técnicas vocales, coordinación fono-respiratoria, control del soplo, tonificación glótica e impostación vocal. Los parámetros incluidos en el estudio antes y después de la terapia fueron: cierre glótico, Voice Handicap Index-10 (VHI-10) para medir la autopercepción de calidad vocal y escala GRABS para la calidad vocal. Resultados: La edad media fue 51 años (rango 20-80), 60% mujeres. La causa quirúrgica fue la más frecuente (72%). El 40% desempeñaban una profesión relacionada con la voz. El tiempo medio desde el diagnóstico hasta el inicio del tratamiento fue 5 meses (2-12). El cierre glótico completo aumentó de 34 a 80% (p<0,001), la puntuación en VHI-10 descendió de 24,24 a 16,09 puntos (p<0,001) y los valores de GRABS mejoraron en todas las cualidades de la voz (p<0,001). Solo un 8,5% requirió cirugía post-tratamiento. Conclusiones: La terapia de reeducación vocal es eficaz como primera indicación terapéutica en pacientes con PCVU, reservando la medialización con material no reabsorbible o cirugía de tiroplastia a aquéllos con mala evolución. No obstante, es necesario reducir el tiempo que se demora el paciente en llegar a la Unidad de Voz tras el diagnóstico laringoscópico (AU)

Background: To describe demographic factors and voice quality parameters of patients with unilateral vocal fold paralysis (UVFP) after a voice therapy protocol. Methods: Forty-seven patients with a diagnosis of UVFP by video-laryngoscopy were included. Voice therapy was applied to all patients during 15 sessions that were structured in three progressive stages. The objective was to train patients in vocal techniques, phonic-breathing coordination, blow control, vocal exercises for glottic closure and vocal setting. Glottal closure, Voice Handicap Index-10 for perception of voice impairment and GRBAS scale were used before and after the speech therapy. Results: The average age was 51 years (range 20-80), 60% women. Surgery was the most frequent cause (72%), and 40% had a profession related to voice use. Median time from diagnosis to treatment was 5 months (2-12). After voice therapy, 80% had complete glottal closure, previously this had been 34% (p<0.001), the score of VHI-10 decreased from 24.24 to 16.09 points (p<0.001) and GRBAS values improved in all the qualities of voice (p<0.001). Only 8.5% of the patients required surgical intervention after treatment. Conclusions: Voice therapy is effective as first line therapy in patients with UVFP, reserving medialization with non-absorbable material or thyroplasty surgery for those with a poor outcome. However, it is necessary to reduce the time it takes the patient to reach the Voice Unit after laryngoscopic diagnosis (AU)

Factores de Riesgo en el pie diabético / No disponible

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La edad no es una contraindicación para la cirugía en el paciente con patología vascular / No disponible

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Guía de actuación en técnicas y procedimientos endovasculares del sector infrainguinal / Guidelines on infraingual endovascular techniques and procedures

En los últimos años las técnicas de revascularización de los miembros inferiores (MMII) a nivel infrainguinal han cambiado y siguen cambiando a un ritmo considerable, debido al avance de los procedimientos endovasculares, gracias a la aparición de nuevos materiales y de diversos dispositivos, lo que hace que el cirujano vascular se enfrente a todo un arsenal variado que debe conocer, saber sus indicaciones, así como sus bondades e inconvenientes, de la misma forma que debe saber estar al día de los estudios que avalen los resultados de estas técnicas.Es por eso que el Capítulo Endovascular de la Sociedad Española de Angiología y Cirugía Vascular (SEACV) decidió elaborar una guía de los diferentes procedimientos endovasculares para la revascularización y tratamiento de los diferentes sectores del árbol vascular, coordinada por su comité científico. En el presente artículo se desarrolla esta guía, en referencia al sector infrainguinal, realizando una actualización y puesta al día de los diferentes procedimientos, vías de abordaje, técnicas, materiales y dispositivos. El objetivo es ofrecer al cirujano vascular una visión global y actualizada de los distintos procedimientos que se pueden llevar a cabo en los MMII, para poder así ofertar a los pacientes la mejor opción en cada caso y poder lograr la mejor tasa de éxitos posible, apoyados en el concepto de emplear el método de la medicina basada en la evidencia(AU)

In the last few years infrainguinal revascularisation techniques on the lower limbs have changed and continue to change at considerable speed due to advances in endovascular procedures. This is mainly due to the appearance of new and diverse materials and devices, which now means that vascular surgeons are currently faced with a varied armamentarium that they must be familiar with, know their indications, as well as their limits and disadvantages. Likewise, they must keep up to date with studies that support the results of these techniques.It is for these reasons that the Endovascular Chapter of the Spanish Angiology and Vascular Surgery (SEACV) decided to prepare a guide of the different endovascular procedures for the revascularisation and treatment of different sectors of the vascular tree, which was coordinated by its Scientific Committee. The present article describes this guide as regards the infrainguinal sector, reviewing and updating the different procedures, approaches, techniques, material and devices. The aim is to provide the vascular surgeon with an overall and updatedview of the different procedures that can be performed on the lower limbs, in order to offere patients the best option in each case and to achieve the best possible success rate, supported by the concept of using a medical evidence-based method(AU)

Epidemiología, formas de presentación, estadio radiológico y métodos diagnósticos de la sarcoidosis en el área de León (2001-2008) / Epidemiology, presentation forms, radiological stage and diagnostic methods of sarcoidosis in the area of Leon (2001-2008)

Antecedentes. Los estudios epidemiológicos de la sarcoidosis en España y otros países son de hace más de una década. Objetivos. Conocer la incidencia actual en el área sanitaria de León, los motivos de consulta, la afectación radiológica torácica, el retraso y los métodos diagnósticos. Pacientes y métodos. Revisamos los casos de sarcoidosis atendidos en nuestro hospital entre los años 2001-2008. El estudio es retrospectivo. Resultados. Ciento dieciocho pacientes cumplieron criterios de sarcoidosis con una incidencia de 4,51/100.000 hab/año. Cincuenta y tres (44,9%) fueron varones con una media de edad de 36,4±12,2 y 65 (55,1%) mujeres, con edad media de 42,6±17,2 años (p=0,029). La forma de presentación más frecuente fue el síndrome de Löfgren, 45,8%; seguido de síntomas respiratorios, 20,3%; hallazgo radiológico, 12,7%; síndrome general, 10,2% y miscelánea 11%. La afectación radiológica torácica en el momento del diagnóstico: estadio I, 59,3%; estadio II, 19,8%; estadio III, 10%; fibrosis, 3,4%, y estadio 0, 8,5%. La biopsia transbronquial fue el medio diagnóstico más frecuente. El tiempo hasta el diagnóstico fue muy variable con una mediana de 24,5 días, 10 días cuando debutaba como eritema nudoso, 80 en las formas menos frecuentes. Conclusiones. La incidencia de sarcoidosis fue superior a la demostrada previamente. Afectó a adultos jóvenes pero con un aumento de los casos en mayores de 50 años con claro predominio femenino. El síndrome de Löfgren fue la forma de presentación más frecuente con mayor incidencia primaveral. El retraso diagnóstico varió según las diferentes formas de presentación. La biopsia transbronquial fue la principal herramienta diagnóstica(AU)

Backgrounds. The epidemiological studies of sarcoidosis in Spain and other countries are from more than one decade ago. Objectives. To know the current incidence in the health care area of Leon, the reasons for consultation, the thoracic radiologyl involvement, delay and diagnostic methods. Patients and methods. We reviewed the cases of sarcoidosis seen in our hospital between the years 2001-2008. The study is retrospective. Results. 118 patients fulfilled the criteria for sarcoidosis with an incidence of 4.51/100,000 inhab./year. Of these, 53 (44.9%) were male with a mean age of 36.4±12.2 and 65 (55.1%) women, with a mean age of 42.6±17.2 years (P=0.029). The most frequent presentation form was Löfgren Syndrome with 45.8%, followed by respiratory symptoms 20.3%, radiological findings 12.7%, general syndrome 10.2% and miscellaneous 11%. Thoracic radiological affectations at the time of diagnosis were: stage I: 59.3%, stage II: 19.8%, stage III: 10%, fibrosis 3.4% and stage 0: 8.5%. Transbronchial biopsy was the most frequent diagnosis. Time to diagnosis was very variable with a median of 24.5 days, when it debuted as erythema nodosum, 80 in the less frequent forms. Conclusions. The incidence of sarcoidosis was superior to that previously demonstrated. It affected young adults, but with an increase in the number of cases in those over 50 years with clear female predominance. Löfgren syndrome was the most frequent presentation form, with a higher incidence in spring. Diagnostic delay varied according to the different presentation forms. Transbronchial biopsy was the main diagnostic tool(AU)

[Epidemiology, presentation forms, radiological stage and diagnostic methods of sarcoidosis in the area of Leon (2001-2008)]. / Epidemiología, formas de presentación, estadio radiológico y métodos diagnósticos de la sarcoidosis en el área de León (2001-2008).

BACKGROUNDS: The epidemiological studies of sarcoidosis in Spain and other countries are from more than one decade ago. OBJECTIVES: To know the current incidence in the health care area of Leon, the reasons for consultation, the thoracic radiologyl involvement, delay and diagnostic methods. PATIENTS AND METHODS: We reviewed the cases of sarcoidosis seen in our hospital between the years 2001-2008. The study is retrospective. RESULTS: 118 patients fulfilled the criteria for sarcoidosis with an incidence of 4.51/100,000 inhab./year. Of these, 53 (44.9%) were male with a mean age of 36.4 ± 12.2 and 65 (55.1%) women, with a mean age of 42.6 ± 17.2 years (P = 0.029). The most frequent presentation form was Löfgren Syndrome with 45.8%, followed by respiratory symptoms 20.3%, radiological findings 12.7%, general syndrome 10.2% and miscellaneous 11%. Thoracic radiological affectations at the time of diagnosis were: stage I: 59.3%, stage II: 19.8%, stage III: 10%, fibrosis 3.4% and stage 0: 8.5%. Transbronchial biopsy was the most frequent diagnosis. Time to diagnosis was very variable with a median of 24.5 days, when it debuted as erythema nodosum, 80 in the less frequent forms. CONCLUSIONS: The incidence of sarcoidosis was superior to that previously demonstrated. It affected young adults, but with an increase in the number of cases in those over 50 years with clear female predominance. Löfgren syndrome was the most frequent presentation form, with a higher incidence in spring. Diagnostic delay varied according to the different presentation forms. Transbronchial biopsy was the main diagnostic tool.

Endocarditis trombótica no bacteriana: revisión de una serie de casos / Non-bacterial thrombotic endocarditis: a review of a series of cases

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[Qualitative spectral evaluation of oesophagic voice]. / Evaluación espectral cualitativa de la voz esofágica.

OBJECTIVES: The aim of the study is to determine the accuracy of acoustic spectrography as an outstanding tool in the characterization and monitoring of esophageal voice. MATERIAL AND METHODS: Our subjects were comprised of 33 laryngectomized patients (all male) that underwent qualitative acoustic (spectrography of vowel /a/ and a sentence), quantitative acoustic (phonation time, fundamental frequency, maximun intensity sound level, speech rate) and perceptual protocol. RESULTS: There is a significant statistical relationship among Yanagihara-like spectrographic chart classification, psycho-acoustical perception and quantitative acoustic parameters. CONCLUSION: We consider that acoustic spectrography is an easy, effective method for studying esophageal voice, seeking for improving oral communication skills and rehabilitation in the laryngectomee population.