Effect of growing forage legumes on the migration and survival in the pasture of gastrointestinal nematodes of sheep.

In order to identify types of forage that inhibit pasture contamination, an evaluation was performed of the effect of the forage legumes Trifolium repens (white clover), Trifolium pratense (red clover) and Lotus corniculatus (bird's-foot-trefoil) on the survival and migration of infective larvae (L3) of gastrointestinal nematodes (GIN) of sheep. An experimental area of 441 m2 was divided into four blocks, subdivided into areas of 1.20 × 1.20 in which the three forage legumes were separately overseeded. After growth of the forage in each subdivision, experimental units were established that were later artificially contaminated with sheep faeces containing GIN eggs. Between October and December 2018, pasture, faecal and soil samples were collected on four occasions during weeks 1, 2, 4 and 8 after the deposition of faeces. In week 6, the forage legumes in all the experimental units were mown to simulate grazing. The number of L3 was quantified to determine their survival in the pasture, faeces and soil. In addition, the horizontal migration of L3 was measured at two distances from the faecal pellets (10 and 30 cm), as well as their vertical migration at two heights of the plant stems, that is, lower half and upper half. Larvae vertical migration was affected by the forage species (P < 0.001), in that bird's-foot-trefoil contained fewer larvae in the upper stratum. Bird's-foot-trefoil restricted the migration of L3 to the upper stratum of the plant, which could potentially decrease the risk of infection by intestinal nematodes in grazing sheep.

Telemedicina en retinopatía del prematuro: Atravesando fronteras en la salud visual pediátrica. Estudio TELEROP / Telemedicine in retinopathy of prematurity: Crossing borders in pediatric vision health. TELEROP study

Objetivo general Evaluar la precisión y validez de imágenes vía teléfono inteligente en comparación con el sistema RetCam® para el diagnóstico de retinopatía del prematuro (ROP). Metodología Estudio observacional, de corte longitudinal y enmascarado realizado en el hospital Dr. Elías Santana. Se incluyeron infantes con peso al nacer ≤ 1.500 g, edad gestacional ≤ 30 semanas y/o pacientes expuestos a factores de riesgo o complicaciones ligadas a ROP. Estos sujetos fueron tamizados empleando imágenes vía teléfono inteligente o RetCam®, ambos comparados con la fondoscopía convencional. Se utilizó la clasificación de ICROP para la estadificación. Los resultados principales analizados fueron sensibilidad, especificidad, valores predictivos e índice kappa. Resultados Se obtuvieron 915 imágenes (n = 121), distribuidas en grupo teléfono inteligente (50,4%) y grupo RetCam® (49,6%) entre agosto del 2020 y marzo del 2021. Los sujetos que presentaron ROP tuvieron menor edad gestacional (30,2 sem ± 2.8), peso al nacer (1.361 g ± 398) y mayor exposición a oxigenoterapia (12,8 días ± 11,3). El grupo RetCam® presentó sensibilidad = 80%, especificidad = 78%, valor predictivo positivo = 90% e índice kappa = 0,70. El grupo teléfono inteligente presentó sensibilidad = 88%, especificidad = 90%, valor predictivo positivo = 93,75% e índice kappa = 0,81. Conclusiones Ambos métodos diagnósticos fueron precisos para identificar ROP. El grupo teléfono inteligente obtuvo resultados superiores con una excelente resolución, representando un método costo-efectivo para crear un impacto global en la reducción de la ceguera prevenible en población pediátrica (AU)

General objective To evaluate the accuracy and validity of images with smartphone compared to the RetCam® system for the diagnosis of retinopathy of prematurity (ROP). Methodology Observational, longitudinal and masked study carried out at the Dr. Elías Santana hospital. Infants with birth weight ≤ 1500 g, gestational age ≤ 30 weeks and/or patients exposed to risk factors or complications linked to ROP were included. These subjects were screened using images with smartphone or RetCam®, both compared to conventional fundoscopy. The ICROP classification was used for staging. The main results analyzed were sensitivity, specificity, positive predictive values and kappa index. Results 915 images (n = 121) were obtained, distributed in smartphone group (50.4%) and RetCam® group (49.6%) between August 2020 and March 2021. Subjects with ROP had lower gestational age (30.2 sem ± 2.8), birth weight (1361 g ± 398), and greater exposure to oxygen therapy (12.8 days ± 11.3). The RetCam® group presented sensitivity = 80%, specificity = 78%, positive predictive value = 90% and kappa index = 0.70. The smartphone group presented sensitivity = 88%, specificity = 90%, positive predictive value = 93.75% and kappa index = 0.81. Conclusions Both diagnostic methods were accurate to identify ROP. The smartphone group obtained superior results with excellent resolution, representing a cost-effective method to create a global impact on reducing preventable blindness in the pediatric population (AU)

Telemedicine in retinopathy of prematurity: Crossing borders in pediatric vision health. TELEROP study.

GENERAL OBJECTIVE: To evaluate the accuracy and validity of images with smartphone compared to the RetCam® system for the diagnosis of retinopathy of prematurity (ROP). METHODOLOGY: Observational, longitudinal and masked study carried out at the Dr. Elías Santana hospital. Infants with birth weight ≤1500 g, gestational age ≤30 weeks and/or patients exposed to risk factors or complications linked to ROP were included. These subjects were screened using images with smartphone or RetCam®, both compared to conventional fundoscopy. The ICROP classification was used for staging. The main results analyzed were sensitivity, specificity, positive predictive values and kappa index. RESULTS: 915 images (n = 121) were obtained, distributed in smartphone group (50.4%) and RetCam® group (49.6%) between August 2020 and March 2021. Subjects with ROP had lower gestational age (30.2 sem ± 2.8), birth weight (1361 g ± 398), and greater exposure to oxygen therapy (12.8 days ± 11.3). The RetCam® group presented sensitivity = 80%, specificity = 78%, positive predictive value = 90% and kappa index = 0.70. The smartphone group presented sensitivity = 88%, specificity = 90%, positive predictive value = 93.75% and kappa index = 0.81. CONCLUSIONS: Both diagnostic methods were accurate to identify ROP. The smartphone group obtained superior results with excellent resolution, representing a cost-effective method to create a global impact on reducing preventable blindness in the pediatric population.

[Results of pulmonary embolism treatment in a tertiary hospital short stay unit. Is this the right place?]. / Resultados del tratamiento médico de la embolia de pulmón en una unidad de corta estancia de un hospital de tercer nivel: ¿es el lugar adecuado?

OBJECTIVES: To determine the mean stay (MS) of patients with pulmonary embolism (PE) in a thrombosis unit (TU) with a short stay unit (SSU) in a tertiary hospital. To compare the data collected with those of other hospitals in the same region, of other regions (Autonomous Communities [AACC]), and within the same hospital in the year before the SSU opened. MATERIAL AND METHODS: A descriptive retrospective observational study that included patients with a diagnosis of PE in the University Hospital Virgen de la Arrixaca (HCUVA) in 2012. These data were classified by hospital department, and used for calculating the mean stay. This was then compared with that of other hospitals in our region, with the rest of the regions, and with the data in 2007 (the last year without a TU). RESULTS: A total of 113patients with PE were included, 60 (53%) in the TU with an MS of 4.39, in Oncology, 7.45, and Internal Medicine (IM), 15.38days. There were no deaths in the TU and only 3 (5%) readmissions. Published data showed that the MS in all hospitals in our region was 8.25, 5.18 in our hospital, and higher in the rest of hospitals. The best AACC was the Basque Country with an MS of 6.85days. In 2007, there were 70patients with PE in the HCUVA, 34 (49%) in IM, with an MS of 8.50, Oncology 11 (31%) with an MS 9.64, and Chest Diseases 3 (4.3%) with an MS 19days, and with an overall mortality of 11% and a rate of readmissions in IM of 6%. CONCLUSION: The mean stay for a PE in the SSU of a TU was lower than in the rest of the hospital departments, lower than the rest hospitals of our region, lower than the rest of the regions, and lower than any department of our hospital before the SSU existed, without increasing the readmission or mortality rate.

Rhabdomyolysis after initial session of indoor cycling: analysis of 11 patients.

AIM: The aim of this paper was to highlight the special frequency of cases of rhabdomyolysis related to the practice of indoor cycling and to define the characteristics, course, and outcome of this disease. METHODS: Retrospective review of clinical histories of patients diagnosed with rhabdomyolysis after indoor cycling in our unit from January 2012 to April 2013. RESULTS: Eleven patients were analyzed. All patients, regardless of the degree of previous physical training, were diagnosed after a first session of indoor cycling. Mean age was 27.63 years (SD=5.74). Fifty-four percent were women. Creatine kinase (CK) levels gradually decreased in response to rest and intensive intravenous hydration. Only in two cases was renal failure observed, and in none were electrolyte disorders, disseminated intravascular coagulation (DIC) or compartmental syndrome detected. CONCLUSION: A first session of indoor cycling has become a common cause of rhabdomyolysis secondary to the physical exercise in recent years, which should alert those responsible for teaching this sport of the need for a gradual start under adequate hydration and environmental conditions, because although the condition has a benign course with adequate treatment and the complication rate is low, there are patients with increased susceptibility to very high CK blood levels requiring hospitalization for treatment and follow-up of possible complications.

Sensibilidad y especificidad del examen físico para el diagnóstico de apendicitis / Sensitivity an specificity of physical exam for the diagnosis of appendicitis

La apendicitis aguda es la emergencia quirúrgica más común en todo el mundo. En nuestra sala de emergencias, la discriminación inicial para el diagnóstico de la apendicitis se realiza basada únicamente en el examen físico del paciente. El objetivo del estudio es determinar la precisión del examen físico estandarizado para el diagnóstico de apendicitis aguda en el servicio de emergencia del Hospital General San Juan de Dios Diseño, lugar y partcipantes: todos los pacientes mayores de 12 años prospectvamente evaluados de abril a junio 2015 en el servicio de emergencia,cuyo motvo de consulta fue dolor abdominal y sospecha de apendicits. Se documentó la impresión clínica del examinador en base a la anamnesis y elexamen fsico estandarizado, la histopatología de los pacientes operados y el seguimiento a las 48h y a los 30 días de todos los pacientes.Resultados: se evaluaron 85 pacientes. El 61% de los pacientes fueron clasifcados por el investgador sin cuadro clínico de apendicits aguda. La sensibilidaddel examen fsico estandarizado para el diagnóstco de apendicits es de 75%, la especifcidad de 93%, el valor predictvo positvo de 92%, el valorpredictvo negatvo de 79%. El porcentaje de falsos positvos es de 3% y el porcentaje de falsos negatvos es del 12%.Conclusiones: el examen fsico estandarizado no es lo sufcientemente sensible para hacer el diagnóstco de apendicits aguda, por lo que es necesarioagregar estudios complementarios, así como considerar un período de observación intrahospitalaria antes de dar egreso a los pacientes basados únicamenteen el examen fisico.(AU)

Acute appendicits is the most common surgical emergency visit worldwide. In our emergency department, the inital evaluaton for thediagnosis of appendicits is made based solely on the physical examinaton. The aim of the study is to determine the accuracy of standardized physicalexaminaton for the diagnosis of acute appendicits in the emergency department of San Juan de Dios General Hospital.Design, Setng, and Partcipants: All patents over 12 evaluated from April to June 2015 in the emergency department, whose main complaint wasabdominal pain and suspected appendicits. Clinical diagnosis, histopathology and follow-up at 48h and 30 days for all patents were collected.Results: A total of 85 patents were studied, 61% were negatve for appendicits by clinical diagnosis. Standardized physical examinaton for the diagnosisof appendicits has 75% sensitvity, 93%specifcity, 92%positve predictve value, 79% negatve predictve value. The false positve rate is 3% andfalse negatve rate is 12%.Conclusions: the standardized physical examinaton is not sensitve enough for the diagnosis of acute appendicits. It is necessary to consider addingfurther studies as well as an observaton period before hospital discharge.

Limited (L4-S1, L5-S1) selective dorsal rhizotomy for reducing spasticity in cerebral palsy.

Selective posterior rhizotomy is effective for relieving spasticity associated with cerebral palsy. In current techniques dorsal roots from L1/L2 to S1/S2 are selectively divided. With transoperative electromyography (EMG) significant sensory loss has been prevented, but postoperative hypotonia following excessive reduction of the fusimotor drive is still of concern for surgeons and therapists. To decrease the volume of deafferentiated rootlets we proposed a limited selective posterior rhizotomy (LPSR) that limits the extent of the surgery to three (L4-S1) or two (L5-S1) dorsal roots. We present the results of two group of spastic children; group 1 (n = 59, 32 quadriplegic and 27 diplegic) who had a L4-S1 LPSR, and group 2 (n = 12) in whom L5 and S1 were selectively rhizotomized. Posture, passive movilization, range of joint movement, and muscle tone in hip flexors, adductors, leg flexors and plantar flexors were graded according to the method proposed by Sindou and Jeanmonod. In all groups these was a significant reduction of the mentioned parameters (Friedman test p < 0.001) at 6, 12 and 18 months after surgery. The preoperative and postoperative ability to ambulate was classified into five grades. In all groups there was a significant (chi 2 between p < 0.01 and p < 0.001) improvement in the quality of their gait. A third of the patients achieved some form of independent ambulation. Our results suggest that extensive selective deafferentation of the lower limbs is not an absolute requisite for reducing muscle tone or achieving functional improvement in spastic children.

[Reasons for anxiety in primary care professionals. A resident-tutor comparison]. / Motivos de ansiedad en los profesionales de atención primaria. Comparación residentes-tutores.

OBJECTIVES: 1) To find the reasons for PC professionals' anxiety when going about their normal work. 2) To check whether training and experience affect the assessment of the reasons of Family Doctors for anxiety. DESIGN: A descriptive study using a questionnaire. SETTING: PC health centres with second-year family and community medicine (FCM) residents from the Murcia Teaching Unit. PARTICIPANTS: All second-year FCM residents from the Teaching Unit (28) in December 1995 and their tutors. MEASUREMENTS: Open questionnaire based on three points: Causes of anxiety in on-demand consultations; causes of anxiety in scheduled consultations; other reasons for anxiety connected with the Health Centre. RESULTS: The three most anxiety-producing causes in relation to each question were: a) on-demand consultation: residents (R)--unfinishable consultations, lack of time, clinical problems; tutors (T)--unfinishable consultations, a lot of patients waiting outside, manipulative patients. b) Scheduled consultation: R--clinical problems, consultation too long, difficulties in reaching a solution; T--consultation too long, patients without an appointment and interruptions in the middle of the consultation. c) Other reasons for anxiety: R--not being off the day after being on call, having to do research work, and emergency calls; T--emergency calls, research work and temperature problems. CONCLUSIONS: Clinical problems are the causes of anxiety with the greatest difference between tutors and residents. Regulated training in the health centre and professional experience seem to act positively on some of the causes of anxiety.

[Research in action. How to assist the integration of residents of family and community medicine in health centers]. / Investigación en la acción. Cómo facilitar la incorporación de los residentes de MFyC al centro de salud.

OBJECTIVES: To find the causes of worry in second-year family and community medicine (FCM) residents on their arrival at health centres. DESIGN: A descriptive study. A survey with 4 questions on difficulties found in the on-demand clinic, in consultations by appointment, other causes of anxiety and problems foreseen a priori. SETTING: Health centres in the Murcia Region with second-year FCM residents. PARTICIPANTS: All the second-year FCM residents (28) on their arrival at health centres in November, 1995. RESULTS: The three points of most concern to residents were: 1. On-demand clinic: unfinishable consultations, lack of time and clinical problems. 2. Consultations by appointment: clinical problems, over-long consultations and difficulties in resolving the consultations. 3. Other causes of anxiety: not having the day off after being on call, research work and emergencies. 4. Problems foreseen a priori: a lot of patients in a short time, not creating problems for the tutor and unemployment at the end of the residency. CONCLUSIONS: The short time to attend each patient and clinical problems are what cause most difficulty. This was the first time the difficulties residents had to integrate into Health Centres were surveyed. The initiative was greatly appreciated by them.

Limited selective posterior rhizotomy for the treatment of spasticity secondary to infantile cerebral palsy: a preliminary report.

A limited selective posterior rhizotomy was performed on 30 children suffering from spasticity secondary to infantile cerebral palsy. As opposed to standard techniques that stimulate and divide the dorsal rootlets from L2 to S1, we dissected L4, L5, and S1 dorsal roots through an L5 to S1 laminectomy. Eight to 12 rootlets from each root were electrically stimulated with two unipolar electrodes (pulse width, 50 microseconds; 10-50 V). The muscle responses were observed visually and registered by electromyography. Those rootlets associated with an abnormal motor response as evidenced by sustained muscular contraction or by prolonged electromyographic response were divided. Spasticity was scored from 0 to +. The muscular groups assessed were those involved in the flexion of the shoulder, elbow and wrist in the upper limbs, and those involved in flexion and adduction of the hip, flexion of the leg, and plantar flexion in the lower limbs. The patients were assessed 1 week before and 6 months after the operation. Reduction of spasticity was observed in all the muscular groups, and all the patients presented functional improvement of motor abilities. These preliminary results indicate that a limited procedure that reduces the extension of the laminectomy and the length of the operation could be effective for treating spasticity secondary to infantile cerebral palsy.

[Selective limited posterior rhizotomy at 3 dorsal levels. A variant for the neurosurgical treatment of spasticity]. / Rizotomía selectiva posterior limitada a tres niveles dorsales. Una variante para el tratamiento neuroquirúrgico de la espasticidad.

INTRODUCTION: Selective posterior rhizotomy (SPR) is effective for reducing spasticity associated to infantile cerebral palsy (ICP). To avoid excessive muscular hypotone a different surgical technique is proposed. PATIENTS AND METHODS: Sixteen children with spasticity secondary to ICP were evaluated before and after rhizotomy. The degree of spasticity was compared in the lower an in the upper limbs. Dorsal roots of levels L4, L5, and S1 were analyzed and sectioned according to the results yielded by intraoperative electrical stimulation. RESULTS: Spasticity was reduced in all the muscular groups analyzed. One of the patients had bladder incontinence. CONCLUSIONS: The limited surgical procedure is sufficient for reducing spasticity.