Psychological and functional impacts associated with restrictions in long-term care facilities (LTCF) due to the COVID-19 pandemic: A multicentre study.

Objectives: To analyze the impacts of the restrictions implemented in LTCF during the COVID-19 pandemic on the psychological and functional status of older adults. Design: A retrospective multicentre study is designed. We hypothesize that the negative effects of the restrictions will lead to a higher rate of decline between the measures taken immediately before and after the lockdown than between the two measures taken before the lockdown. Setting and participants: 365 participants recruited in four Spanish LTCFs in Galicia and Valencia.Methods: Impacts of restrictions on cognitive (MMSE), affective (GDS) and functional status (Barthel index, Tinetti) were analyzed by Linear Mixed Models with random intercepts, random slopes, and personal and contextual factors as covariates.Results: Social measures covaried significantly with the cognitive and functional status but did not predict longitudinal change. MMSE, Barthel index and Tinetti scores decreased significantly across pre- and post-lockdown measurement times, but only the Tinetti scores showed a specific impact of the restrictions.Conclusions: Only performance-based functional measures showed the real impact of restrictions. The findings highlight the importance of having data from several pre-lockdown measurements to enable identification of changes that can be causally attributed to the restrictions. The findings also support the resilience of older adults in mitigating the effect of the restrictions.

Perfil enfermera referente de ganglio centinela: descripción, validación y aplicación en la práctica asistencial / Sentinal lymph node reference nurse model: description, validation, and application in clinical practice

Introducción En 2019 se genera la oportunidad de integrar un enfermero en el equipo de cirugía radioguiada (CRG), adaptando el modelo de enfermera referente a las exploraciones de ganglio centinela (GC). Objetivos Describir el procedimiento adoptado para definir el perfil enfermera referente de ganglio centinela (ERGC), validar su aplicación práctica y establecer su implementación asistencial. Material y métodos Metodología de análisis y mejora continua en gestión de procesos (ciclo PDCA): definición y planificación de las funciones de ERGC en el protocolo de cáncer de mama, realización prueba piloto con 20 pacientes y análisis de los datos de cara a validar el circuito y establecer su implementación asistencial. Resultados Se elaboraron flujos del procedimiento, integrando la figura de ERGC. En la prueba piloto, un 15% de las mujeres presentaron un resultado positivo de ansiedad frente a un 60% de valoración subjetiva positiva de ansiedad. Tras las intervenciones enfermeras realizadas, se obtuvo una reducción del 58,3% en valoración subjetiva de ansiedad, un 100% de conocimiento de la prueba y una valoración del dolor en la administración del radiotrazador aceptable en las pacientes. En el nivel de calidad técnica, 8/10 ítems valorados consiguieron el objetivo previamente establecido por el equipo de CRG. Conclusiones La creciente complejidad de la técnica de biopsia de GC ha creado la oportunidad de implementar cuidados enfermeros en el procedimiento de localización prequirúrgica del GC. El perfil ERGC es el idóneo para llevarlo a cabo y ha conllevado mejoras objetivas en los diagnósticos enfermeros e ítems evaluados (AU)

Introduction In 2019 the opportunity to add a nurse within the radioguided surgery (RGS) team was generated. The referent nurse model was adapted to, the sentinel node (SN) preoperative approaches. Objectives To describe the process performed to define the sentinel node referentnurse (SNRN) profile, to validate its practical application and to establish its clinical implementation. Material and methods Methodology of analysis and continuous improvement in the management of processes (cycle PDCA): Definition and planning of the SNRN functions in the breast cancer protocol, performance of a pilot test with 20 patients and analysis of the data in order to validate the circuit and establish its final clinical implementation. Results New procedure flows-charts were elaborated, adding the figure of the SNRN, its function and nursing interventions during the process. In the pilot test a 58.3% reduction in subjective anxiety, a 75% decrease of the overall anxiety level, a 100% knowledge of the test and an acceptable patient perception of pain's level during the radiotracer administration were obtained. Regarding technical quality, 8/10 items assessed reached the level previously established by the RGS team. Conclusions The increasing complexity of the SN biopsy technique has created the opportunity to implement nursing care in the presurgical SN localization process. The profile of the SNRN is ideal for carrying it out and has led to improvements in the nursing diagnoses and assessed items (AU)

Sentinel node referent nurse: Description, validation and application in clinical practice.

INTRODUCTION: In 2019 the opportunity to add a nurse within the radioguided surgery (RGS) team was generated. The referent nurse model was adapted to, the sentinel node (SN) preoperative approaches. OBJECTIVES: To describe the process performed to define the sentinel node referent nurse (SNRN) profile, to validate its practical application and to establish its clinical implementation. MATERIAL AND METHODS: Methodology of analysis and continuous improvement in the management of processes (cycle PDCA): definition and planning of the SNRN functions in the breast cancer protocol, performance of a pilot test with 20 patients and analysis of the data in order to validate the circuit and establish its final clinical implementation. RESULTS: New procedure flows-charts were elaborated, adding the figure of the SNRN, its function and nursing interventions during the process. In the pilot test a 58.3% reduction in subjective anxiety, a 75% decrease of the overall anxiety level, a 100% knowledge of the test and an acceptable patient perception of pain's level during the radiotracer administration were obtained. Regarding technical quality, 8/10 items assessed reached the level previously established by the RGS team. CONCLUSIONS: The increasing complexity of the SN biopsy technique has created the opportunity to implement nursing care in the presurgical SN localization process. The profile of the SNRN is ideal for carrying it out and has led to improvements in the nursing diagnoses and assessed items.

Análisis del temperamento infantil relacionado con el uso de pantallas / Analysis of infant temperament related to screen use

Introducción: el objetivo del estudio fue describir el tiempo de uso de pantallas y relacionarlo con los rasgos temperamentales y del comportamiento del niño. Material y métodos: estudio observacional descriptivo mediante cuestionario estructurado entregado a los progenitores para saber el tiempo de exposición de su hijo/a a las pantallas y valoración del temperamento infantil con el cuestionario Emotionality Sociability and Activity Temperament (EAS) de niños con edades comprendidas entre 0 y 10 años del centro de salud Revolería y Torrero-La Paz de Zaragoza (España) durante los meses de junio de 2019 hasta febrero de 2020. El estudio fue aprobado por el Comité de Ética e Investigación de la Comunidad Autónoma de Aragón (PI 19/00260). Resultados: participación de 212 niños. El 54,1% fueron niñas. Edad media: 5,3±2,7 años; peso medio: 21,2±9,6 kg; talla media: 1,11±0,20 m; el 62,9% se clasificó en peso normal. Un 76,1% realiza ejercicio físico. Edad de inicio a la exposición a las pantallas: el 39,0% fue con una edad superior a 24 meses; el 42,4% se expone un tiempo medio de 60-120 minutos al uso de pantallas. Evaluación del temperamento infantil con la escala EAS (sociabilidad: 18,1±3,1; actividad 19,0±4,2; emocionalidad 13,9±4,0 y timidez: 12,3±4,1). Conclusiones: en la muestra estudiada, los niños con edades superiores presentaron un tiempo mayor de uso a la exposición y uso de pantallas. No se hallaron diferencias significativas entre el tiempo de uso de las pantallas y los cambios del temperamento infantil (AU)

Introduction: the aim of this study was to describe the screen time in children and analyse its association with personality traits and behaviour.Methods: observational and descriptive study through a structured, self-administered questionnaire completed by parents to assess screen time in their children and the Emotionality, Activity and Sociability (EAS) questionnaire to assess traits and behaviours in children aged 0 to 10 years in the caseloads of the Revolería and Torrero-La Paz primary care centres in Zaragoza (Spain) between June 2019 and February 2020. Research Ethics Committee of the Autonomous Community of Aragón (PI 19/00260).Results: the sample included 212 children, 54.1% female. The mean age was 5.3 ± 2.7 years; the mean weight 21.2 ± 9.6 kg, the mean height 1.1 ± 0.2 m, and 62.9% had a normal weight. Of the total, 76.1% reported physical activity. The age at which exposure to screens started was greater than 24 months in 39%; and 42.4% used screens between 60 and 120 minutes on average. The assessment of traits with the EAS survey yielded the following mean scores: sociability, 18.1 ± 3.1; activity, 19.0 ± 4.2; emotionality, 13.9 ± 4.04; shyness, 12.3 ± 4.1.Conclusion: in the sample under study, screen time and use were greater in older children. There were no statistically significant differences in screen time associated with differences in temperament. (AU)

Effects of the age/rage axis in the platelet activation.

Platelet activity is essential in cardiovascular diseases. Therefore our objective was to evaluate the main effects of activating RAGE in platelets which are still unknown. A search for RAGE expression in different databases showed poor or a nonexistent presence in platelets. We confirmed the expression in platelets and secreted variable of RAGE (sRAGE). Platelets from elderly adults expressed in resting showed 3.2 fold more RAGE from young individuals (p < 0.01) and 3.3 fold with TRAP-6 (p < 0.001). These results could indicate that the expression of RAGE is more inducible in older adults. Then we found that activating RAGE with AGE-BSA-derived from methylglyoxal and subthreshold TRAP-6, showed a considerable increase with respect to the control in platelet aggregation and expression of P-selectin (respectively, p < 0.01). This effect was almost completely blocked by using a specific RAGE inhibitor (FSP-ZM1), confirming that RAGE is important for the function and activation platelet. Finally, we predict the region stimulated by AGE-BSA is located in region V of RAGE and 13 amino acids are critical for its binding. In conclusion, the activation of RAGE affects platelet activation and 13 amino acids are critical for its stimulation, this information is crucial for future possible treatments for CVD.

[Late-onset migraine equivalent with prolonged aura and altered brain perfusion]. / Equivalente migrañoso de inicio tardío con aura prolongada y alteración de la perfusión cerebral.

TITLE: Equivalente migrañoso de inicio tardío con aura prolongada y alteración de la perfusión cerebral.

Hiperplasia suprarrenal congénita virilizante simple, a propósito de un caso / Simple Virilizing Congenital Adrenal Hyperplasia, a case report

La hiperplasia suprarrenal congénita (HSC) es un grupo de trastornos genéticos del metabolismo del cortisol. Su forma clásica y más frecuente, incluye una forma perdedora de sal que evoluciona de forma grave con shock hipovolémico en periodo neonatal; y una forma virilizante simple, que en neonatos de sexo femenino puede generar trastornos del desarrollo sexual, antes llamados, genitales ambiguos. En el sexo masculino puede manifestarse sólo como macrogenitosomía, lo que muchas veces retrasa el diagnóstico. Éste se confirma objetivando la elevación de niveles plasmáticos de 17 Hidroxiprogesterona, asociado a niveles elevados de andrógenos adrenales; una vez hecho el diagnóstico, es necesario iniciar terapia de reemplazo esteroidal con hidrocortisona, y si existe déficit de mineralocorticoides, fludrocortisona. Presentamos un paciente preescolar de sexo masculino, con diagnóstico tardío de HSC, correspondiente a la forma virilizante simple y sus consecuencias sobre su estatura.

Congenital adrenal hyperplasia (CAH) includes a wide group of genetic cortisol metabolism disorders. The most frequent form, the classic one, may present as a severe salt wasting syndrome, with hypovolemic shock during the neonatal period; or as a simple virilizing form. In girls, this may produce a disorder of sexual development, formerly called, ambigous genitalia. In boys, clinical manifestations can be subtle, with penile enlargement and small testes, which can delay the diagnosis. The elevated serum levels of 17-OH Progesterone, along with elevated adrenal androgens, allow to confirm the diagnosis. Once confirmed, it is imperative to initiate steroid treatment, with Hydrocortisone, and mineralocorticoid if needed. We present a case of simple virilizing CAH in a preeschool male, who had a late diagnosis que comprometió su estatura.

Safety and Efficacy of Ultrasound-Guided Radiofrequency Ablation of Recurrent Colorectal Cancer Liver Metastases after Hepatectomy.

INTRODUCTION: To assess the results and outcome of radiofrequency ablation in the treatment of recurrent colorectal liver metastases. PATIENTS AND METHODS: Between January 2005 and September 2012, we treated 59 patients with recurrent colorectal metastases not amenable to surgery with 77 radiofrequency ablation procedures. Radiofrequency was indicated if oncologic resection was technically not possible or the patient was not fit for major surgery. A total of 91 lesions were treated. The mean number of liver tumors per patient was 1.5, and the mean tumor diameter was 2.3 cm. In 37.5% of the cases, lesions had a subcapsular location, and 34% were close to a vascular structure. RESULTS: The morbidity rate was 18.7%, and there were no post-procedural deaths. Distant extrahepatic recurrence appeared in 50% of the patients. Local recurrence at the site of ablation appeared in 18% of the lesions. Local recurrence rate was 6% in lesions less than 3 cm and 52% in lesions larger than 3 cm. The size of the lesions (more than 3 cm) was an independent risk factor for local recurrence (p < 0.05). Survival rates at 1, 3, and 5 years were 94.5%, 65.3%, and 21.7%, respectively. DISCUSSION: Radiofrequency ablation is a safe procedure and allows local tumor control in lesions less than 30 mm (local recurrence of 6%) and provides survival benefits in patients with recurrent colorectal liver metastases.

Tratamiento del craneofaringioma quístico con 90Y-coloide. Presentación de 4 casos clínicos / Treatment of cystic craniopharyngioma with 90Y-Colloid. Four clinical cases

El craneofaringioma es un tumor intracraneal histológicamente benigno y frecuentemente quístico que puede presentar un comportamiento agresivo por compresión de estructuras vecinas. Su manejo terapéutico es complicado ya que si bien el tratamiento de elección suele ser la cirugía, esta no está exenta de una gran morbimortalidad y recidiva tumoral frecuente. En aquellos craneofaringiomas con un componente quístico importante la irradiación interna del tumor con isótopos radiactivos supone una alternativa a los tratamientos convencionales. Se presentan 4 casos de pacientes con craneofaringiomas quísticos tratados mediante administración intraquística con 90Y-coloide y su evolución después del tratamiento(AU)

Craniopharyngioma is a histologically benign and frequently cystic intracranial tumor. It may present aggressive behavior due to compression of nearby structures. Its therapeutic management is complicated because, although surgery is the usual treatment of choice, it is not exempt of high morbidity and mortality, and frequent tumor recurrence. In craniopharyngiomas with a significant cystic component, internal irradiation with radioactive isotopes is a therapeutic alternative to conventional treatments. We present the cases of four patients with cystic craniopharyngiomas who were treated with intracystic administration of 90Y-colloid, and their evolution after the therapy(AU)

Treatment of cystic craniopharyngioma with 90Y-Colloid. Four clinical cases.

Craniopharyngioma is a histologically benign and frequently cystic intracranial tumor. It may present aggressive behavior due to compression from nearby structures. Its therapeutic management is complicated because although surgery is the usual treatment of choice, it is not exempt of high morbidity and mortality and frequent tumor recurrence. In craniopharyngiomas with a significant cystic component,internal irradiation with radioactive isotopes is a therapeutic alternative to conventional treatments. We present the cases of four patients with cystic craniopharyngiomas who were treated with intracystic administration of 90Y-colloid, and their evolution after the treatment.

Enlarged lymph nodes in the upper abdomen after liver transplantation: imaging features and clinical significance.

PURPOSE: Our aim was to review our single-centre experience regarding imaging features and pathological conditions arising from enlarged lymph nodes following orthotopic liver transplantation (OLD) and identify imaging features that may allow narrowing the differential diagnosis. MATERIALS AND METHODS: Between January 1997 and September 2008, 715 OLTs were performed at our Institution in 585 patients. In 19 patients (2.6 %) ultrasound (US) showed enlarged lymph nodes in the upper abdomen, and abdominal computed tomography (CT) was performed RESULTS: Histological results showed posttransplantation lymphoproliferative disorder (PTLD) in six patients (31.5 %), hepatic tumoral disease in six (31.5 %), disseminated systemic tuberculosis in one (5.2%) and sarcoidosis in one (5.2%). Histological results showed nonspecific reactive lymph node hyperplasia in five patients (26%). CONCLUSIONS: Detecting enlarged lymph nodes in the upper abdomen after liver transplantation is and infrequent occurrence; however, thorough imaging is required to detect and characterise a wide variety of disorders. Most of the time, enlarged lymph nodes will be related to posttransplantation lymphoproliferative disorder or tumoral recurrence.

Multiple response optimization of vegetable oils fatty acid composition to improve biodiesel physical properties.

The effect of fatty acids chain length (LC) and its interaction with unsaturation degree (UD) on important biodiesel quality parameters was studied. Low calorific value, kinematic viscosity, flash point, cetane number and cold filter plugging point of biodiesel blends covering a wide range of fatty acids were analyzed. Analytical results were processed with statistical regression to obtain a prediction model for each property, combining LC and UD. Due to the antagonistic effects of the chemical composition over quality properties, the Derringer desirability function was proposed to allow the most suitable fatty acid composition. This target was achieved considering an average of 1.26 double bounds and 17 carbon atoms. A set of combinations of LC and UD values that provides a biodiesel that fits the European standard EN 14214 was proposed. It was found that a reduction of FAME LC allows a lower UD while keeping biodiesel specifications under the standard limits.

The neurochemistry of mania: a hypothesis of etiology and rationale for treatment.

1. The author delineates the emergence of an important concept in the Neurochemistry of mental illness, that of a Cholinergic Factor in Mania. This concept which evolved steadily over a period of 22 years from 1950-1972, the author believes has given us our first significant insight into the etiology and treatment of the Manic state. 2. In addition, the author examines the Adrenergic-Cholinergic hypothesis of Mania and Depression and the Brain Cholinergic-Adrenergic Balance hypothesis for Mania and Schizophrenia. 3. Also described in this article are some successful preliminary attempts by others, to treat Mania with Phosphatidyl Choline and the author will present, for the first time, data relating to success with the use of Phosphatidyl Choline in bringing about permanent remission of mania in 10 treatment subjects since 1983. 4. In conclusion the author proposes a Cholinergic Insufficiency Hypothesis as a primary factor in the causation of Mania and comments on a presumptive role in the modulation and balance of Adrenergic Dominance by Presynaptic Receptors positioned on the Nerve Terminals of Adrenergic Neurons.