Parameters for delivering ethnically and gender-sensitive primary care in cardiovascular health through telehealth. Systematic review.

OBJECTIVE: To determine the parameters for providing primary care in cardiovascular health, with an ethnic and gender focus through telemedicine. STUDY DESIGN: Systematic Literature Review. METHODS: A systematic review was conducted using databases including PUBMED, Cochrane Library, CINAHL, EMBASE VHL, and other relevant sources. We included articles published in the last 15 years on parameters of telemedicine care with a differential approach focusing on ethnicity and gender. Screening, full-text reading, and information extraction were performed in duplicate and independently, though methodological quality assessment was not conducted. RESULTS: Twenty-eight studies were included, with 46.43% originating from Australia and 50.00% employing a qualitative approach. Thirty-five point seventy-one percent provided operational recommendations, and 32.14% related to the ethnic approach. Seven operational categories were identified: holistic approach to health, flexible approach to health, accessible health services, continuous improvement in service quality, culturally appropriate and qualified workforce, self-determination and empowerment, and community participation. Additionally, five categories were identified pertaining to the ethnic approach: public policy in favor of ancestral knowledge in primary health care, training of community agents and health personnel from an intercultural perspective, complementarity between traditional and western health practices, and the recognition of telehealth's value in intercultural approaches. CONCLUSIONS: There is a need to adjust operational aspects related to the implementation of indigenous public policy, and to increase the number of qualified community human resources to provide holistic, comprehensive, and culturally appropriate care. Regarding gender, there is a necessity to implement public policy based on health determinants that will dismantle barriers to accessing gender-specific services and comprehensively assess cardiovascular risk.

Methodological evaluation of systematic reviews based on the use of artificial intelligence systems in chest radiography.

INTRODUCTION: In recent years, systems that use artificial intelligence (AI) in medical imaging have been developed, such as the interpretation of chest X-ray to rule out pathology. This has produced an increase in systematic reviews (SR) published on this topic. This article aims to evaluate the methodological quality of SRs that use AI for the diagnosis of thoracic pathology by simple chest X-ray. MATERIAL AND METHODS: SRs evaluating the use of AI systems for the automatic reading of chest X-ray were selected. Searches were conducted (from inception to May 2022): PubMed, EMBASE, and the Cochrane Database of Systematic Reviews. Two investigators selected the reviews. From each SR, general, methodological and transparency characteristics were extracted. The PRISMA statement for diagnostic tests (PRISMA-DTA) and AMSTAR-2 were used. A narrative synthesis of the evidence was performed. Protocol registry: Open Science Framework: https://osf.io/4b6u2/. RESULTS: After applying the inclusion and exclusion criteria, 7 SRs were selected (mean of 36 included studies per review). All the included SRs evaluated "deep learning" systems in which chest X-ray was used for the diagnosis of infectious diseases. Only 2 (29%) SRs indicated the existence of a review protocol. None of the SRs specified the design of the included studies or provided a list of excluded studies with their justification. Six (86%) SRs mentioned the use of PRISMA or one of its extensions. The risk of bias assessment was performed in 4 (57%) SRs. One (14%) SR included studies with some validation of AI techniques. Five (71%) SRs presented results in favour of the diagnostic capacity of the intervention. All SRs were rated "critically low" following AMSTAR-2 criteria. CONCLUSIONS: The methodological quality of SRs that use AI systems in chest radiography can be improved. The lack of compliance in some items of the tools used means that the SRs published in this field must be interpreted with caution.

Feather corticosterone is lower in translocated and historical populations of the endangered Laysan duck (Anas laysanensis).

Identifying reliable bioindicators of population status is a central goal of conservation physiology. Physiological stress measures are often used as metrics of individual health and can assist in managing endangered species if linked to fitness traits. We analysed feather corticosterone, a cumulative physiological stress metric, of individuals from historical, translocated, and source populations of an endangered endemic Hawaiian bird, the Laysan duck (Anas laysanensis). We hypothesized that feather corticosterone would reflect the improved reproduction and survival rates observed in populations translocated to Midway and Kure Atolls from Laysan Island. We also predicted less physiological stress in historical Laysan birds collected before ecological conditions deteriorated and the population bottleneck. All hypotheses were supported: we found lower feather corticosterone in the translocated populations and historical samples than in those from recent Laysan samples. This suggests that current Laysan birds are experiencing greater physiological stress than historical Laysan and recently translocated birds. Our initial analysis suggests that feather corticosterone may be an indicator of population status and could be used as a non-invasive physiological monitoring tool for this species with further validation. Furthermore, these preliminary results, combined with published demographic data, suggest that current Laysan conditions may not be optimal for this species.

Is resilience a unifying concept for the biological sciences?

There is increasing interest in applying resilience concepts at different scales of biological organization to address major interdisciplinary challenges from cancer to climate change. It is unclear, however, whether resilience can be a unifying concept consistently applied across the breadth of the biological sciences, or whether there is limited capacity for integration. In this review, we draw on literature from molecular biology to community ecology to ascertain commonalities and shortcomings in how resilience is measured and interpreted. Resilience is studied at all levels of biological organization, although the term is often not used. There is a suite of resilience mechanisms conserved across biological scales, and there are tradeoffs that affect resilience. Resilience is conceptually useful to help diverse researchers think about how biological systems respond to perturbations, but we need a richer lexicon to describe the diversity of perturbations, and we lack widely applicable metrics of resilience.

Multitissue transcriptomics demonstrates the systemic physiology of methionine deficiency in broiler chickens.

Methionine (Met) supplementation is common practice in broilers to support nutrition, yet there are gaps in the understanding of its role in systemic physiology. Furthermore, several different Met sources are available that may have different physiological effects. This study evaluated the mode of action of Met deficiency (no Met-supplementation) and supplementation (0.25% DL- or L-Met, 0.41% liquid methionine hydroxy analog-free acid (MHA-FA)), and of Met source (DL-, L- or MHA-FA) in broiler chickens, via host transcriptomics. Biological pathway activation modeling was performed to predict the likely phenotypic effects of differentially expressed genes (DEGs) in tissue samples from the jejunum, liver and breast obtained at 10, 21 and 34/35 d of age from three experiments in a combined analysis. Animal performance data showed that Met deficiency reduced BW, daily BW gain, daily feed intake, and breast yield, and increased feed conversion ratio in all experiments (P < 0.05). Effects of Met deficiency on gene expression were least evident in the jejunum and most evident in the liver and breast, as evidenced by the number of DEG and activated pathways. Activated pathways suggested Met deficiency was associated with inhibited protein turnover, gut barrier integrity, and adaptive immunity functions in the jejunum, that predicted reduced breast yield. There was an interaction with age; in Met-deficient birds, there were 333 DEGs in the jejunum of starter vs finisher birds suggesting young birds were more sensitive to Met deficiency than older birds. In the liver, Met deficiency activated pathways associated with lipid turnover, amino acid metabolism, oxidative stress, and the immune system, whereas in breast, it activated pathways involved in metabolic regulation, hemostasis, the neuronal system, and oxidative stress, again predicting a negative impact on breast yield. In the starter phase, supplementation with DL-Met compared to MHA-FA inhibited gamma-aminobutyric acid activity and oxidative stress in breast tissue. When data from all tissues were integrated, increased expression of a liver gene (ENSGALG00000042797) was found to be correlated with the expression of several genes that best explained variation due to the Met deficiency in jejunum and breast muscle. Some of these genes were involved in anti-oxidant systems. Overall, the findings indicate that impaired growth performance due to Met deficiency results from an array of tissue-specific molecular mechanisms in which oxidative stress plays a key systemic role. Young birds are more sensitive to Met-deficiency and DL-Met was a preferential source of Met than L- or MHA-FA during the starter phase.

Comparative study of biomodels manufactured using 3D printing techniques for surgical planning and medical training.

OBJECTIVES: To obtain 3D printed bone models with a haptic sensation similar to that of the real bone, which will help the surgeon to learn and improve based on practice. METHODS: From computed tomography, 3 digital anatomical models of the human proximal femur were created and, by modifying the printing parameters, both cortical and trabecular tissues were simulated, which were combined in a different cortico-cancellous interface depending on the bone segment. The 3 equivalent models obtained were compared with a commercial Sawbone synthetic model and subjected to a series of blind surgical practice trials performed by 5 TOC specialists from a hospital, each of them with different degrees of expertise. A statistical analysis of the qualitative data collected based on the Wilcoxon test, the Spearman correlation matrix, and the Validity Ratio Coefficient was performed. RESULTS: The deviations observed in the dimensional study are less than 0.2 millimeter, which confirms the validity of the 3DP-FFF technology to geometrically recreate personalized biomodels with high anatomical precision. CONCLUSIONS: The reproductions obtained have given rise to a reliable method that professionals can refine to plan operations with the consequent reduction of time and risks for the patient, as well as for medical training.

Investigating the effects of acute and chronic stress on DNA damage.

A hallmark of the vertebrate stress response is a rapid increase in glucocorticoids and catecholamines; however, this does not mean that these mediators are the best, or should be the only, metric measured when studying stress. Instead, it is becoming increasingly clear that assaying a suite of downstream metrics is necessary in stress physiology. One component of this suite could be assessing double-stranded DNA damage (dsDNA damage), which has recently been shown to increase in blood with both acute and chronic stress in house sparrows (Passer domesticus). To further understand the relationship between stress and dsDNA damage, we designed two experiments to address the following questions: (1) how does dsDNA damage with chronic stress vary across tissues? (2) does the increase in dsDNA damage during acute stress come from one arm of the stress response or both? We found that (1) dsDNA damage affects tissues differently during chronic stress and (2) the hypothalamic-pituitary-adrenal axis influences dsDNA damage with acute stress, but the sympathetic-adreno-medullary system does not. Surprisingly, our data are not explained by studies on changes in hormone receptor levels with chronic stress, so the underlying mechanism remains unclear.

Resumen ejecutivo del documento de consenso para la formación y el desarrollo de la ecografía clínica en Medicina Interna: recomendaciones desde el Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECO-SEMI) / Executive summary of the consensus document for the training and development of clinical ultrasound in internal medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI)

Introducción Dada la creciente adopción de la ecografía clínica en medicina, es fundamental estandarizar su aplicación, su formación y su investigación. Objetivos y métodos El propósito de este documento es proporcionar recomendaciones de consenso para responder cuestiones sobre la práctica y el funcionamiento de las unidades de ecografía clínica. Participaron 19 expertos y responsables de unidades avanzadas de ecografía clínica. Se utilizó un método de consenso Delphi modificado. Resultados Se consideraron un total de 137 declaraciones de consenso, basadas en la evidencia y en la opinión experta. Las declaraciones fueron distribuidas en 10 áreas. Un total de 99 recomendaciones alcanzaron consenso. Conclusiones Este consenso define los aspectos más importantes de la ecografía clínica en el ámbito de la Medicina Interna, con el objetivo de homogeneizar y promover este avance asistencial en sus diferentes vertientes. El documento ha sido elaborado por el Grupo de Trabajo de Ecografía Clínica y avalado por la Sociedad Española de Medicina Interna. (AU)

Introduction Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. Objectives and methods The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. Results A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. Conclusions This consensus defines the most important aspects of clinical ultrasound in the field of internal medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine. (AU)

Resumen ejecutivo del documento de consenso para la formación y el desarrollo de la ecografía clínica en Medicina Interna: recomendaciones desde el Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna (GTECO-SEMI) / Executive summary of the consensus document for the training and development of clinical ultrasound in internal medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI)

Introducción Dada la creciente adopción de la ecografía clínica en medicina, es fundamental estandarizar su aplicación, su formación y su investigación. Objetivos y métodos El propósito de este documento es proporcionar recomendaciones de consenso para responder cuestiones sobre la práctica y el funcionamiento de las unidades de ecografía clínica. Participaron 19 expertos y responsables de unidades avanzadas de ecografía clínica. Se utilizó un método de consenso Delphi modificado. Resultados Se consideraron un total de 137 declaraciones de consenso, basadas en la evidencia y en la opinión experta. Las declaraciones fueron distribuidas en 10 áreas. Un total de 99 recomendaciones alcanzaron consenso. Conclusiones Este consenso define los aspectos más importantes de la ecografía clínica en el ámbito de la Medicina Interna, con el objetivo de homogeneizar y promover este avance asistencial en sus diferentes vertientes. El documento ha sido elaborado por el Grupo de Trabajo de Ecografía Clínica y avalado por la Sociedad Española de Medicina Interna. (AU)

Introduction Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. Objectives and methods The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. Results A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. Conclusions This consensus defines the most important aspects of clinical ultrasound in the field of internal medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine. (AU)

Principales aplicaciones de la ecografía clínica en cuidados paliativos / Main applications of point-of care ultrasound in palliative care

El uso de la ecografía clínica, entendida como una extensión de la exploración física que ayuda a la toma de decisiones clínicas en tiempo real, se ha generalizado en diversas especialidades médicas y quirúrgicas. En los últimos años, los avances tecnológicos han permitido disponer de ecógrafos de bolsillo, económicamente asequibles, que pueden ser utilizados en el propio domicilio del paciente. En esta revisión se describen las principales aplicaciones de la ecografía clínica en cuidados paliativos, un escenario de potencial utilidad tanto para mejorar la certeza en el diagnóstico de procesos agudos intercurrentes, que producen un impacto en la calidad de vida del paciente, como para guiar la realización de procedimientos invasivos sin necesidad de desplazamientos al medio hospitalario. Para la implantación de la ecografía clínica en cuidados paliativos son necesarios programas formativos con objetivos concretos, definiendo curvas de aprendizaje y estableciendo alianzas con sociedades científicas de reconocida trayectoria docente, asistencial e investigadora para la acreditación de competencias (AU)

Combined with a physical examination, clinical ultrasound offers a valuable complement that can help guide clinical decision-making. In various medical and surgical specialties, it is increasingly used for diagnostic and therapeutic purposes. Due to recent technological advances, smaller and more affordable ultrasound machines are now being developed for use in home hospice care. The purpose of this paper is to describe how clinical ultrasound may be applied in Palliative Care, where it can be a valuable tool to assist the clinician in making better clinical decisions and to assist in accurately guiding palliative procedures. Furthermore, it can be used to identify unnecessary hospitalizations and prevent them from occurring. Training programs with specific objectives are necessary to implement clinical ultrasound in Palliative Care, as well as defining learning curves and promoting alliances with scientific societies that recognize the teaching, care and research trajectory for accreditation of competencies (AU)

Effect of Materials For Interim Restoration on Estimation of Working Length Using Electronic Apex Locator: in vitro Study

ABSTRACT: The aim of this in vitro study was to evaluate measurement accordance using an electronic apex locator for estimation of working length in endodontics when different restorative materials for interim crown restoration are utilized. For this study, 13 single-rooted premolars with endodontic occlusal access cavity were prepared. To establish the working length of each tooth, these were mounted in alginate and with the help of an electronic foramen locator and endodontic file K-file # 15, the working length was established. This length was later compared to the estimated working lengths using different intermediate restoration materials. These materials were: Superior Chemfil, Ketac ™ Molar Easymix and Filtek z350 resin. In the electronic measurements, an acceptable tolerance range of variation up to ± 0.5 mm was considered. Highest discrepancies were considered erroneous. For these measurements, central tendency and dispersion were analyzed. The Bland-Altman method was used, and the ANOVA test with a significance level of p <0,05 for statistic difference. Regarding measurements' acceptability and the type of interim restoration material utilized, 7 were acceptable, and 6 were unacceptable for ChemFil Superior, 12 were acceptable and 1 unacceptable for Ketac™ Molar Easymix, and 11 were acceptable and 2 were unacceptable for Filtek Z350 composite resin. The average difference between all electronic measurements was 0.29 (± 0.44). Chemfill Superior showed the most prominent variation between measurements 0.58 (± 0.45). When using an electronic apex locator, measurements showed statistically significant differences depending on the interim restoration material of choice (p<0.05). In conclusion, the measurement accordance using electronic apex locator to estimation the working length is higher, however the electronic estimation of working length can be significatively affected by the material chosen for interim temporary restoration.

RESUMEN: El objetivo de este estudio in vitro, fue evaluar la concordancia de las estimaciones de longitud de trabajo mediante localizador electrónico de foramen, utilizando diferentes materiales de restauración intermedia coronaria. Para tales fines fueron preparados 13 premolares uniradiculares con cavidad de acceso oclusal endodóntico. Para establecer la a longitud de trabajo de cada diente, estos fueron montados en alginato y con la ayuda de un localizador electrónico de foramen y lima de endodoncia K-file #15 fue establecida la longitud de trabajo. Esta longitud fue comparada posteriormente con las longitudes de trabajo estimadas utilizando diferentes materiales de restauración in- termedia. Estos materiales fueron: Chemfil superior, Ketac™ Molar Easymix y resina Filtek z350. En las mediciones electrónicas, se consideró un rango de tolerancia aceptable de variación hasta ± 0,5 mm. Las discrepancias mayores se consideraron erróneas. Se calcularon medidas de tendencia central y la dispersión. Se utilizó el método de Bland- Altman y la prueba ANOVA con un nivel de significancia de p <0,05. Con respecto a la aceptabilidad de las mediciones y el tipo de material de restauración intermedia, 7 fueron aceptables y 6 fueron inaceptables para ChemFil Superior, 12 fueron aceptables y 1 inaceptable para Ketac ™ Molar Easymix, y 11 fueron aceptables y 2 fueron inaceptables para el compuesto Filtek Z350 resina. La diferencia promedio entre todas las mediciones electrónicas fue de 0,29 (± 0,44). Chemfil Superior mostró la mayor variación entre medicio- nes 0,58 (± 0,45). Las mediciones mostraron diferencias estadísticamente significativas dependiendo del material de restauración intermedio elegido (p <0,05). En conclusión, la concordancia en la estimación de la longitud de trabajo usando localizador electrónico de foramen es alta, sin embargo, puede verse afectada significativamente por el material de obturación intermedio.

Anaphylaxis to Vespa velutina nigrithorax: Pattern of Sensitization for an Emerging Problem in Western Countries

Objective: To define the sensitization pattern of patients with anaphylaxis to Vespa velutina nigrithorax (VVN). Methods: We studied 100 consecutive Spanish patients with anaphylaxis to Hymenoptera venom and systematically determined specific IgE (sIgE) to whole venoms (Vespula species, Polistes dominula, Apis mellifera, Vespa crabro, and Dolichovespula maculata) and their molecular components (rApi m 1, rApi m 5, rApi m 10, rVes v 1, rVes v 5, rPol d 5, and cross-reactive carbohydrates). Specific IgE to VVN venom and its antigen 5 (nVesp v 5) were measured in a subsample. Results: Seventy-seven patients had anaphylaxis to VVN. Of these, only 16 (20.8%) reported previous VVN stings, but were stung by other Hymenoptera. Positive sIgE (>0.35 kUA/L) to each of the whole venoms was detected in >70% of patients (Vespula species in 100%). The components showing >50% positivity were rApi m 5 (51.4%), rPol d 5 (80.0%), and rVes v 5 (98.7%). This pattern was similar to that of Vespula species anaphylaxis (n=11) but different from that of A mellifera anaphylaxis (n=10). Specific IgE to nVesp v 5 was positive in all patients (n=15) with VVN anaphylaxis and was correlated with sIgE to both rVes v 5 (R=0.931) and rPol d 5 (R=0.887). Conclusions: VVN has become the commonest cause of Hymenoptera anaphylaxis in our area. Most cases report no previous VVN stings. Their sensitization pattern is similar to that of patients with anaphylaxis to other Vespidae. Specific IgE to antigen-5 from VVN, Vespula species, and P dominula are strongly correlated in patients with VVN anaphylaxis (AU)

Paraganglioma del órgano de Zuckerkandl: reporte de dos casos pediátricos / Paraganglioma of Zuckerkandl’s organ. Report of two pediatric cases

Introducción: El feocromocitoma es un tumor neuroendocrino infrecuente. El 10% son extraadrenales en los ganglios simpáticos, conocidos como paragangliomas(1,2). El sitio más común es el órgano de Zuckerkandl. Son malignos en un 10 a 26%(4) con una mortalidad del 26%(5). Reporte de casos: Presentamos dos casos de paraganglioma del órgano de Zuckerkandl en adolescentes, que debutan con hipertensión arterial, diaforesis y disnea. Se realizó resección completa del tumor; durante ambas cirugías presentaron crisis hipertensiva y posterior a la ligadura del pedículo vascular del tumor presentaron hipotensión, con normalización progresiva de las cifras tensionales en el postoperatorio. Conclusiones: El paraganglioma del órgano de Zuckerkandl es una patología infrecuente en la población pediátrica, representa un importante reto diagnóstico y terapéutico. La cirugía difiere de las de otros tumores ya que la secreción de catecolaminas genera cambios hemodinámicos transoperatorios que exigen al cirujano y anestesiólogo un manejo rápido, eficaz y oportuno

Introduction: Pheochromocytoma is an infrequent neuroendocrine tumor, originated from neural crest cells. 10% of them are extra adrenal, located at sympathetic nodules and are known as paragangliomas(1,2). The most common place is the Zuckerkandl organ, 10 to 26% are malign(4) and has a mortality around de 26% of the cases(5). Case report: We present two cases of teenagers with Zuckerkandl’s organ paraganglioma, who debut with high blood pressure, diaphoresis and dyspnea. Complete tumor resection was performed in both cases, during which they presented hipertensive crisis and, after vascular pedicle ligation, hypotension. Conclusions: Zuckerkandl’s organ paraganglioma is a rare pathology in pediatric population, therefore represents an important diagnostic and therapeutic challenge. Surgery differs from other tumors because of catecholamine secretion that produces hemodynamic changes and demands prompt and accurate management from surgeon and anesthetist

Prevalencia de aneurisma de aorta abdominal en pacientes con alto riesgo cardiovascular / Prevalence of abdominal aortic aneurysm in patients with high cardiovascular risk

Objetivo: Determinar la prevalencia de aneurisma de aorta abdominal (AAA), definido por un diámetro arterial ≥30mm, en pacientes con alto o muy alto riesgo cardiovascular (RCV) y evaluar sus características clínicas. Pacientes y métodos: Estudio observacional, transversal y multicéntrico realizado en servicios de Medicina Interna del país a varones con edad >55años y mujeres >65años que tenían un RCV alto o muy alto reclutados durante 24meses. Resultados: Se incluyeron 659 pacientes. La prevalencia de AAA fue del 8% (53 pacientes). El 76,9% fueron varones, con edad media de 71±8,7años. El análisis multivariante demostró asociación entre AAA y la edad (OR: 1,06; IC95%: 1,02-1,1; p<0,01), el sexo masculino (OR: 5,6; IC95%: 1,6-18,8; p=0,01), el tabaquismo activo (OR: 3,22; IC95%: 1,16-8,93; p=0,024) y la arteriopatía periférica (OR: 3,51; IC95%: 1,73-7,09; p<0,01), siendo la diabetes mellitus un factor protector independiente (OR: 0,41; IC95%: 0,22-0,78; p=0,06). Los pacientes con dilatación subaneurismática de la aorta (diámetro de la aorta abdominal 25-29,9mm) presentaban similares características que los pacientes con AAA. Conclusiones: La prevalencia de AAA en pacientes de alto RCV es elevada. El cribado ecográfico puede ser realizado por médicos generalistas. Pueden beneficiarse de un cribado oportunista los varones de más de 65años, con RCV elevado, especialmente si presentan tabaquismo activo o arteriopatía periférica

Background: To determine the prevalence of abdominal aortic aneurysm (AAA) (arterial diameter ≥30mm), in patients with high or very high cardiovascular risk (CVR) and to evaluate their clinical features. Patients and methods: Observational, cross-sectional and multicentric study conducted in Spanish Internal Medicine Services. We enrolled men with age >55years and women >65years who had a high or very high CVR. Results: The study included 659 patients. The prevalence of AAA was 8% (53 patients). 76.9% were male with a mean age of 71±8.7years. The multivariate analysis showed an association between AAA and age (OR: 1.06; 95%CI: 1.02-1.1; P<.01), male sex (OR: 5.6; 95%CI: 1.6-18.8; P=.01), active smoking (OR: 3.22; 95%CI: 1.16-8.93; P=.024) and peripheral arterial disease (OR: 3.51; 95%CI: 1.73-7.09; P<.01). Diabetes mellitus was an independent protective factor (OR: 0.41; 95%CI: 0.22-0.78; P=.06). Those with subaneurysmal dilatation of the abdominal aorta (diameter 25-29.9mm) presented similar features as patients with AAA. Conclusions: The prevalence of AAA in patients with high CVR is high. Ultrasound screening can be performed by general practitioners. Men >65years with elevated CVR could benefit, particularly in the presence of active smoking or peripheral arterial disease

Efectividad de los miniplatos inestables para la mejora del equilibrio en pacientes geriátricos institucionalizados con síndrome de desequilibrio posterior. Ensayo clínico aleatorizado / Effectiveness of unstable mini-boards to improve balance in institutionalised elderly people diagnosed with backward disequilibrium syndrome. Randomised controlled trial

Introducción y objetivos: El síndrome de desequilibrio posterior es un problema común entre los adultos mayores que los predispone a sufrir caídas. El objetivo del estudio es comprobar si el tratamiento con miniplatos inestables propuesto mejora la marcha y el equilibrio en pacientes geriátricos institucionalizados y diagnosticados de síndrome de desequilibrio posterior. Materiales y métodos: Ensayo clínico controlado aleatorizado, con ciego simple y 2 grupos. Los participantes fueron ancianos institucionalizados de entre 68 y 97 años diagnosticados de síndrome de desequilibrio posterior (n=77). La intervención consistió en un protocolo de ejercicios de propiocepción y equilibrio durante 12 semanas. El grupo control recibió el tratamiento habitual que venía recibiendo en el centro hasta el momento. La medición de resultados se basó en la escala del test Timed Up and Go (TUG), cuyos resultados se registraron al inicio y a las 6, 8 y 12 semanas de la intervención. Resultados: Se obtuvo una muestra equilibrada respecto a todos los factores del análisis de 48 individuos para el grupo de miniplatos y 29 para el grupo control. El tratamiento con miniplatos ofreció como media una disminución en el TUG de 2,80s respecto al método de tratamiento habitual. Conclusiones: Los miniplatos se han mostrado como un método más eficaz que el tratamiento convencional, siendo mayor la mejora del equilibrio. La mejora del tiempo de ejecución del TUG es satisfactoria dadas las características de la población diana. Las puntuaciones bajas de partida en el test TUG han condicionado una menor capacidad de mejora del equilibrio

Introduction and objectives: Backward disequilibrium syndrome is a postural disorder that involves a posterior shift of a person's centre of gravity relative to their base of support, which increases falling risks. This study aimed to determine whether a specific protocol with the use of unstable mini-boards can improve balance and motion in institutionalised elderly people diagnosed with backward disequilibrium syndrome. Materials and methods: Single-blinded, 2-group, randomised controlled clinical trial. The patients were institutionalised adults, aged between 68 and 97, diagnosed with backward disequilibrium syndrome (n=77). The intervention group underwent a specific 12-week proprioception and balance exercise programme. The control group continued receiving the treatment they had been receiving so far. Outcomes were assessed using the Timed Up and Go (TUG) scale, at baseline, weeks 6, 8 and 12. Results: Size was 48 for the intervention group and 29 for the control group, which was considered well-balanced, for all the analysis factors. The results showed a mean reduction of 2.80s for the TUG in the intervention group in comparison with the control group. Conclusions: The use of mini-boards proved to be a more effective method of treatment than conventional therapy, achieving greater improvements in balance. Results for TUG were satisfactory, given the characteristics of the target population. The low baseline TUG ratings determined less capacity to improve balance

Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna / Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments

Este documento de posicionamiento describe los aspectos más importantes de la ecografía clínica en el ámbito de la Medicina Interna, desde sus indicaciones fundamentales hasta el período de formación recomendado. Actualmente ya no quedan dudas sobre la gran utilidad de esta herramienta para la práctica clínica habitual del internista en múltiples escenarios clínicos y ámbitos de actuación (urgencias, planta de hospitalización, consulta general y específica y atención domiciliaria). Su uso tiene un impacto relevante en la capacidad de resolución del profesional, al aumentar su fiabilidad y seguridad diagnóstica, además de proporcionar información pronóstica y evolutiva importante. Además, en los últimos años se ha incorporado como una herramienta en la enseñanza pregrado con excelentes resultados. Por tanto, es necesario generalizar su uso y para ello se debe fomentar la formación estructurada y la adquisición de equipos. El documento ha sido elaborado por el Grupo de Trabajo de Ecografía Clínica y avalado por la Sociedad Española de Medicina Interna

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine

Evaluación de la asistencia telefónica a demanda en cuidadores de pacientes con enfermedad de Alzheimer / An assessesment of telephone assistance systems for caregivers of patients with Alzheimer's disease

Introducción: La asistencia telefónica a demanda (ATAD) es una práctica habitual en las consultas de Neurología; no obstante, los estudios que valoran dicha modalidad de asistencia sanitaria son escasos. Hemos evaluado la ATAD en cuidadores de pacientes con enfermedad de Alzheimer (EA) desde el punto de vista económico y de la satisfacción percibida por el cuidador principal. Pacientes y métodos: Se seleccionó a 97 pacientes con diagnóstico de EA según criterios NINCDS-ADRDA y sus respectivos 97 cuidadores principales. Estudiamos los gastos diferenciales entre las modalidades asistenciales presencial y a demanda a lo largo de 12 meses. A los 12 meses se valoró la satisfacción de los cuidadores principales mediante un cuestionario autoadministrado. Resultados: El ahorro que supuso la ATAD frente la asistencia presencial fue de 80,05 ± 27,07 euros por usuario. Al 73,6% de los cuidadores que usaron la ATAD les parece mejor o mucho mejor esta que la asistencia presencial, mientras que al 2,6% de los cuidadores les parece peor o mucho peor. Conclusiones: La ATAD supone un servicio de salud eficiente en el seguimiento de los usuarios con EA en las consultas de Neurología y la satisfacción de los usuarios fue alta, por lo que consideramos que debería incluirse en la cartera de servicios del sistema sanitario (AU)

Introduction: Telephone assistance is a common practice in neurology, although there are only a few studies about this type of healthcare. We have evaluated a Telephone Assistance System (TAS) for caregivers of patients with Alzheimer's disease (AD) from 2 points of view: financially and according to the level of satisfaction of the caregiver. Patients and methods: 97 patients with a diagnosis of AD according to NINCDS-ADRDA criteria and their 97 informal caregivers were selected. We studied cost differences between on-site assistance and telephone assistance (TAS) for 12 months. We used a self-administered questionnaire to assess the level of satisfaction of caregivers at the end of the study period. Results: TAS savings amounted to 80.05 ± 27.07 euros per user. 73.6% of the caregivers consider TAS a better or much better system than on-site assistance, while only 2.6% of the caregivers considered TAS a worse or much worse system than on-site assistance. Conclusions: Telephone assistance systems are an efficient healthcare resource for monitoring patients with AD in neurology departments. Furthermore, the level of user satisfaction was high. We therefore consider that telephone assistance service should be offered by healthcare services (AU)