Documento de expertos sobre el uso apropiado de los SYSADOA en situaciones clínicas controvertidas / Experts Document About an Adequate Utilization of SYSADOAs in Controversial Clinical Situations

Antecedentes y objetivo: Los SYSADOA (del inglés, symptomatic slow-acting drugs for osteoarthritis) orales son compuestos naturales que han demostrado ser útiles y seguros en el tratamiento de la artrosis (AO). Sin embargo, su uso en ciertas situaciones clínicas carece aún de evidencia científica y recomendaciones claras. El objetivo de este trabajo fue conocer la opinión de un grupo de expertos sobre el uso de los SYSADOA en el tratamiento de la AO en situaciones clínicas controvertidas. Materiales y métodos: Siguiendo el método del uso apropiado mediante la técnica Delphi, se valoraron 206 consultas concretas, estructuradas en 24 preguntas clínicas. Un panel de expertos, compuesto por un total de 15 especialistas, respondió a las dos rondas de consulta a través de una plataforma online. Los resultados se analizaron y debatieron en una reunión presencial con los coordinadores y el comité científico. Según el porcentaje de panelistas que coincidieron en los mismos, se clasificaron los resultados en términos de unanimidad, consenso, mayoría y discrepancia. Resultados: Se consensuaron los siguientes puntos: (1) el fenotipo del paciente condiciona el uso de los SYSADOA orales; (2) los SYSADOA orales se consideran adecuados en la AO primaria (rodilla, mano y cadera) y en algunos tipos de AO secundaria; no se consideran adecuados en AO erosiva de manos, hombro, columna y tobillo; (3) los SYSADOA orales pueden ser prescritos a pacientes con riesgo o enfermedad cardiovascular, enfermedad digestiva, hipertensión, dislipemia, enfermedad vascular periférica, diabetes tipo 2 y, a excepción de diacereína, en pacientes con reflujo esofágico. No se obtuvo acuerdo en la prescripción de los SYSADOA orales en pacientes con enfermedad hepática y renal.(AU)

Background and objective: SYSADOAs (symptomatic slow-acting drugs for osteoarthritis) are natural compounds that have been shown to be useful and safe in the treatment of osteoarthritis (OA). However, their use in certain clinical situations still lacks scientific evidence and clear recommendations. The objective of this work was to learn the opinion of a group of experts regarding the appropriate use of SYSADOA in the treatment of OA in controversial clinical situations. Materials and methods: Following the Delphi technique, 206 specific consultations, structured in 24 clinical questions, were evaluated. A panel of experts composed of a total of 15 specialists, answered the two rounds of consultation through an online platform. The results were analysed and discussed in a face-to-face meeting with the coordinators and the scientific committee. According to the percentage of panellists who agreed on their findings, the results were classified in terms of unanimity, consensus, majority and discrepancy. Results: The following points were agreed upon: (1) the patient's phenotype determines the use of SYSADOAs; (2) SYSADOAs are considered appropriate in primary OA (knee, hand and hip) and in some types of secondary OA; they are not considered appropriate in OA of the shoulder, spine, ankle and erosive OA of the hands; (3) SYSADOAs may be prescribed for patients at risk of or with cardiovascular disease, digestive disease, hypertension, dyslipaemia, peripheral vascular disease, type 2 diabetes and, excluding diacerein, for patients with oesophageal reflux. No agreement was obtained on the prescription of SYSADOAs for patients with hepatic and renal disease. Conclusions: There is limited literature on the use of SYSADOAs for the treatment of OA in controversial situations. Through this work it has been possible to establish the position of a group of experts regarding clinical situations for which there is no scientific evidence concerning their use.(AU)

Experts document about an adequate utilization of SYSADOAs in controversial clinical situations.

BACKGROUND AND OBJECTIVE: SYSADOAs (Symptomatic Slow-Acting Drugs for Osteoarthritis) are natural compounds that have been shown to be useful and safe in the treatment of osteoarthritis (OA). However, their use in certain clinical situations still lacks scientific evidence and clear recommendations. The objective of this work was to learn the opinion of a group of experts regarding the appropriate use of SYSADOA in the treatment of OA in controversial clinical situations. MATERIALS AND METHODS: Following the Delphi technique, 206 specific consultations, structured in 24 clinical questions, were evaluated. A panel of experts composed of a total of 15 specialists, answered the two rounds of consultation through an online platform. The results were analysed and discussed in a face-to-face meeting with the coordinators and the scientific committee. According to the percentage of panellists who agreed on their findings, the results were classified in terms of unanimity, consensus, majority and discrepancy. RESULTS: The following points were agreed upon: (1) the patient's phenotype determines the use of SYSADOAs; (2) SYSADOAs are considered appropriate in primary OA (knee, hand and hip) and in some types of secondary OA; they are not considered appropriate in OA of the shoulder, spine, ankle and erosive OA of the hands; (3) SYSADOAs may be prescribed for patients at risk of or with cardiovascular disease, digestive disease, hypertension, dyslipaemia, peripheral vascular disease, type 2 diabetes and, excluding Diacerein, for patients with oesophageal reflux. No agreement was obtained on the prescription of SYSADOAs for patients with hepatic and renal disease. CONCLUSIONS: There is limited literature on the use of SYSADOAs for the treatment of OA in controversial situations. Through this work it has been possible to establish the position of a group of experts regarding clinical situations for which there is no scientific evidence concerning their use. This work may contribute towards improving the management protocols of SYSADOAs in the treatment of OA and offer a useful approach in uncertain situations.

Experts Document About an Adequate Utilization of SYSADOAs in Controversial Clinical Situations. / Documento de expertos sobre el uso apropiado de los SYSADOA en situaciones clínicas controvertidas.

BACKGROUND AND OBJECTIVE: SYSADOAs (symptomatic slow-acting drugs for osteoarthritis) are natural compounds that have been shown to be useful and safe in the treatment of osteoarthritis (OA). However, their use in certain clinical situations still lacks scientific evidence and clear recommendations. The objective of this work was to learn the opinion of a group of experts regarding the appropriate use of SYSADOA in the treatment of OA in controversial clinical situations. MATERIALS AND METHODS: Following the Delphi technique, 206 specific consultations, structured in 24 clinical questions, were evaluated. A panel of experts composed of a total of 15 specialists, answered the two rounds of consultation through an online platform. The results were analysed and discussed in a face-to-face meeting with the coordinators and the scientific committee. According to the percentage of panellists who agreed on their findings, the results were classified in terms of unanimity, consensus, majority and discrepancy. RESULTS: The following points were agreed upon: (1) the patient's phenotype determines the use of SYSADOAs; (2) SYSADOAs are considered appropriate in primary OA (knee, hand and hip) and in some types of secondary OA; they are not considered appropriate in OA of the shoulder, spine, ankle and erosive OA of the hands; (3) SYSADOAs may be prescribed for patients at risk of or with cardiovascular disease, digestive disease, hypertension, dyslipaemia, peripheral vascular disease, type 2 diabetes and, excluding diacerein, for patients with oesophageal reflux. No agreement was obtained on the prescription of SYSADOAs for patients with hepatic and renal disease. CONCLUSIONS: There is limited literature on the use of SYSADOAs for the treatment of OA in controversial situations. Through this work it has been possible to establish the position of a group of experts regarding clinical situations for which there is no scientific evidence concerning their use. This work may contribute towards improving the management protocols of SYSADOAs in the treatment of OA and offer a useful approach in uncertain situations.

Documento de consenso del uso clínico de la Polypill en la prevención secundaria del riesgo cardiovascular / Consensus document for the use of the Polypill in the secondary prevention of cardiovascular disease

La enfermedad cardiovascular suele estar en fase avanzada cuando aparecen los primeros síntomas. El hecho de que la presentación clínica inicial pueda ser letal o altamente incapacitante enfatiza la necesidad de la prevención primaria y secundaria. Se estima que la proporción de pacientes con buena adherencia en prevención secundaria de la enfermedad cardiovascular es baja y disminuye progresivamente en el tiempo. La Polypill para la prevención cardiovascular secundaria es el primer tratamiento combinado en dosis fija de ácido acetilsalicílico, atorvastatina y ramipril aprobada en España. El propósito de este documento de consenso fue definir y recomendar, a través de la evidencia en la literatura y la opinión clínica de expertos, el impacto de la adherencia al tratamiento de prevención cardiovascular secundaria y el uso en la práctica clínica de la Polypill integrado en una estrategia global que incluye modificaciones en el estilo de vida. Para la realización de este consenso se ha utilizado la metodología RAND/UCLA que está basada en la evidencia científica y en el juicio colectivo y experiencia clínica de un panel de expertos. Como resultado se ha elaborado un informe final de recomendaciones sobre el impacto de la falta de adherencia al tratamiento de la prevención cardiovascular secundaria y el efecto del uso de una Polypill en la adherencia terapéutica de los pacientes. Las recomendaciones de este documento se orientan a todos aquellos especialistas, cardiólogos, médicos internistas y médicos de atención primaria con competencia en la prescripción y seguimiento de los pacientes de alto y muy alto riesgo cardiovascular y que requieran prevención secundaria (AU)

Cardiovascular disease is a chronic disorder which is usually already at an advanced stage when the first symptoms develop. The fact that the initial clinical presentation can be lethal or highly incapacitating emphasizes the need for primary and secondary prevention. It is estimated that the ratio of patients with good adherence to secondary prevention of cardiovascular disease is low and also decreases gradually over time. The Polypill for secondary prevention of cardiovascular disease is the first fixed-dose combination therapy of salicylic acid, atorvastatin and ramipril approved in Spain. The purpose of this consensus document was to define and recommend, through the evidence available in the literature and clinical expert opinion, the impact of treatment adherence in the secondary prevention of cardiovascular disease and the use of the Polypill in daily clinical practice as part of a global strategy including adjustments in patient lifestyle. A RAND/UCLA methodology based on scientific evidence, as well as the collective judgment and clinical expertise of an expert panel was used for this assessment. As a result, a final report of recommendations on the impact of the lack of adherence to treatment of secondary prevention of cardiovascular disease and the effect of using a Polypill in adherence of patients was produced. The recommendations included in this document have been addressed to all those specialists, cardiologists, internists and primary care physicians with competence in prescribing and monitoring patients with high and very high cardiovascular risks (AU)

Low risk of concussions in top-level karate competition.

BACKGROUND: Although it is well known that injuries occur in combat sports, the true incidence of concussions is not clearly defined in the literature for karate competition. AIM: To determine the incidence of concussions in top-level (World Karate Federation World Championships) karate competition. METHODS: Injuries that took place in 4 consecutive World Karate Championships (from 2008 to 2014) were prospectively registered. A total of 4625 fights (2916 in the male category and 1709 in the female category) were scrutinised, and concussions were identified and analysed separately for frequency (rate per fight) and injury risk. RESULTS: A total of 4 concussions were diagnosed by the attending physicians after carrying out athlete examinations. Globally, there was 1 concussion in every 1156 fights, or 0.43/1000 athlete-exposures (AE). In male athletes, the rate of concussion was 1/5832 min of fighting, and in female athletes, it was 1/6836 min. OR for concussion in women is 0.57 (95% CI 0.06 to 5.47; z=0.489; p=0.6249) and risk ratio for concussions in men is RR 1.478 (95% CI 0.271 to 8.072), p=0.528, representing a higher risk of definite concussions in men than in women, but not statistically significant. There is not a significantly higher risk of concussions in team competition (no weight limit) when compared with individual competition (held with strict weight limits for each category). CONCLUSION: The risk of concussions in top-level karate competition is low, with a tendency for an increased risk for men and for competition without weight limits, but not statistically significant with respect to women or individual competition.

Consensus document for the use of the Polypill in the secondary prevention of cardiovascular disease. / Documento de consenso del uso clínico de la Polypill en la prevención secundaria del riesgo cardiovascular.

Cardiovascular disease is a chronic disorder which is usually already at an advanced stage when the first symptoms develop. The fact that the initial clinical presentation can be lethal or highly incapacitating emphasizes the need for primary and secondary prevention. It is estimated that the ratio of patients with good adherence to secondary prevention of cardiovascular disease is low and also decreases gradually over time. The Polypill for secondary prevention of cardiovascular disease is the first fixed-dose combination therapy of salicylic acid, atorvastatin and ramipril approved in Spain. The purpose of this consensus document was to define and recommend, through the evidence available in the literature and clinical expert opinion, the impact of treatment adherence in the secondary prevention of cardiovascular disease and the use of the Polypill in daily clinical practice as part of a global strategy including adjustments in patient lifestyle. A RAND/UCLA methodology based on scientific evidence, as well as the collective judgment and clinical expertise of an expert panel was used for this assessment. As a result, a final report of recommendations on the impact of the lack of adherence to treatment of secondary prevention of cardiovascular disease and the effect of using a Polypill in adherence of patients was produced. The recommendations included in this document have been addressed to all those specialists, cardiologists, internists and primary care physicians with competence in prescribing and monitoring patients with high and very high cardiovascular risks.

Un paso más allá en la prevención secundaria del riesgo cardiovascular. Documento de consenso del uso clínico del policomprimido / A step ahead in secondary prevention of cardiovascular risk. Consensus document on clinical use of the polypill

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Evaluación y tratamiento de la hipertensión arterial en España. Documento de consenso / No disponible

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Tratamiento de la neuralgia del trigémino por compresión percutánea con balón / Treatment of trigeminal neuralgia by percutaneous ballon compression

Se analizan 14 pacientes con neuralgia del trigémino tratados por micro microcompresión percutánea del gangleo de Gasser en el año 1991 en el Instituto de Neurocirugía Asenjo, mediante la técnica descrita por Mullan y Lichtor. Una sonda Fogarty del N§ 4 se insertó a través de un trocar hasta el agujero oval, bajo anestesia general y con control fluoroscópico. El balón se infló con 0,7-1 cc de una mezcla de 50% de agua destilada y Conray hasta obtener una forma de "pera" del balón a la visión radioscópica a nivel del cavum de Meckel. La compresión se mantuvo por 75 segundos. Todos los pacientes fueron inicialmente aliviados de su dolor. El control postoperatorio osciló entre 1 y 12 meses. No se observó recidiva del dolor, ni compromiso de la sensibilidad corneal

Parálisis de Bell: evaluación del tratamiento esteroidal / Bell's palsy: evaluation of steroidal treatment

Se realiza un estudio prospectivo, estratificado y randomizado en 120 pacientes portadores de parálisis facial periférica idiopática comparando la evolución de los casos con y sin tratamiento esteroidal. El tratamiento esteroidal se inició antes de 10- día de evolución con prednisona en dosis de 1 mg por kilógramo de peso y por día. El grupo control no recibió tratamiento. La motilidad facial fue evaluada según la escala de Adour modificada. A los 120 días la recuperación fue satisfactoria en el 91,1% de los casos del grupo control y en el 97,6% de los tratados con corticoides, lo que no tiene significación estadística. Sin embargo, según nuestros resultados el uso de corticoides favoreció la recuperación precoz (28 días) en las parálisis faciales periféricas idiopáticas completas si se las compara con el grupo control. Esta diferencia es estadísticamente significativa (63,6 versus 26,6% respectivamente y con p < 0.04). Como consecuencia del trabajo se concluye que: 1) No hay diferencia significativa en la evolución final de las parálisis faciales periféricas idiopáticas con y sin tratamiento esteroidal y 2) El uso de corticoides podría, sin embargo, favorecer la recuperación precoz de las parálisis completas. Esta afirmación requiere del estudio de una casuística más numerosa que permita llegar a conclusiones definitivas

Efecto de la helonías dioica en la glicemia, consumo de alimentos y H2O y peso en ratas diabéticas y sanas / Effects of helonias dioica on serum glucose levels, weight, water and food ingestion in normal and diabetic rats

Se estudió en forma experimental el efecto de la helonías dioica como fármaco hipoglicemiante en 20 ratas de la cepa Wister con diabetes inducida. La diabetes se indujo con aloxano administrado por vía endovenosa femoral y en dosis de 40 mgr por kilogramo. Estos animales se compararon con un grupo control de 20 ratas. El estudio duró 28 días, controlándose diariamente glicemia y consumo de alimento y de agua. El control de peso lo realizó día de por medio, siempre la misma persona. Las ratas diabéticas tuvieron un mayor consumo de agua al compararlas con las ratas sanas. Las ratas diabéticas tuvieron un mayor consumo de agua al compararlas con las ratas sanas. Se demostró un nivel menor de glicemia en las ratas diabéticas en tratamiento con helonías que en las diabéticas, que sólo recibieron solución fisiológica. La helonías dioica podría tener un efecto en los niveles plasmáticos de glucosa, pero se requiere mayor investigación al respecto

Parálisis de Bell: evolución natural / Bell's palsy: its natural clinical course

Se realiza un estudio descriptivo y prospectivo de la evolución natural de 115 pacientes con parálisis facial periférica idiopática sin tratamiento ni kinesiterapia específica, reunidos entre abril de 1986 y mayo de 1987. Se analizan los factores pronósticos, en base al protocolo de Adour modificado. Se efectuaron 762 controles. La recuperación fue satisfactoria en un 91,6%. No hubo diferencia en la evolución según edad, sexo, lado afectado y patología agregada. Analizando la evolución del compromiso de los músculos considerados por separado, se observa un gran sincronismo en su recuperación final. Sin embargo, los pacientes que tuvieron una parálisis facial incompleta lograron una mejoría precoz dentro del primer mes (p<0.001). Se concluye que en el material estudiado, la evolución natural fue altamente satisfactoria; que el tipo de parálisis incompleta o completa es un indicador pronóstico del tiempo necesario para obtener la recuperación de la motilidad facial y que el control de la recuperación funcional de un solo músculo puede ser suficiente indicador evolutivo de la parálisis facial periférica

Primer año de vida en hijos de adolescentes / First year of life in the children born of adolescents

Los hallazgos más importantes en el grupo de madres adolescentes y de sus hijos fueron: 1. Frecuencia significativamente mayor de soltería (53,9% contra sólo 19,1%). 2. Porcentaje significativamente mayor de casos con peso de nacimiento bajo (9% contra 0,6%). 3. Mayor proporción de niños con cumplimiento de todos los controles de salud (69% contra 46%). 4. Calendario de vacunaciones completo en el 79,4%. 5. Ausencia de morbilidad durante el primer año de vida en el 19%. Más de 6 episodios de morbilidad en el 29% lo que es significativamente superior a los niños controles (13,7%). 6 Necesidad de hospitalización en el 15% de los caso, porcentaje que es similar al de los controles. 7. Calificación de alto riesgo en el 91% de los casos y sólo en el 48% de los controles, diferencia que es significativa