Retinal neurodegeneration in patients with type 2 diabetes mellitus without diabetic retinopathy.

In diabetes mellitus (DM) patients retinal complications were typically considered part of a vascular process. Recent research suggests that retinal degeneration in DM might also be caused by a neuropathy that could precede microvascular alterations. The present work reviews the currently available bibliography about neurodegeneration in patients with type 2 DM (DM2) without diabetic retinopathy (DR). In patients with non-severe, early DM2 without DR and good metabolic control visual function parameters show early abnormalities that precede clinical DR (in which we diagnose with a conventional ophthalmological examination). Using optical coherence tomography (OCT) technology, a reduction in macular and peripapillary thickness has been observed in different studies. Recent researches suggest that systemic complications (especially ischaemia) and a possible microvascular alteration eventually contributes to retinal neurodegeneration, which opens the door to new studies that include new techniques for evaluating the microvascularization of the retinal layers.

Neurodegeneración retiniana en pacientes diabéticos tipo 2 sin retinopatía diabética / Retinal neurodegeneration in patients with type 2 diabetes mellitus without diabetic retinopathy

La retinopatía diabética (RD) tradicionalmente se ha considerado parte de un proceso vascular. Investigaciones recientes sugieren que la degeneración de la retina en la diabetes mellitus (DM) podría ser causada también por una neuropatía y que la neurodegeneración retiniana precedería a las alteraciones microvasculares. El presente artículo revisa la bibliografía existente sobre neurodegeneración en pacientes con DM tipo 2 (DM2) sin RD. En los pacientes con DM2 no severa, temprana, con buen control metabólico y sin RD, las pruebas de función visual muestran anormalidades precoces que anteceden a la aparición de la RD clínica (la que diagnosticamos con una exploración oftalmológica convencional). Utilizando la tomografía de coherencia óptica (OCT) se observa que en estos pacientes existe una disminución en el espesor de distintas capas de la retina, tanto en el área macular como peripapilar. Recientes estudios sugieren que las complicaciones sistémicas (especialmente la isquemia) y una posible alteración microvascular contribuyen a la neurodegeneración retiniana, lo que abre la puerta a nuevos estudios que incluyan nuevas técnicas de evaluación de la microvascularización de las capas internas de la retina como la angio-OCT (AU)

In diabetes mellitus (DM) patients retinal complications were typically considered part of a vascular process. Recent research suggests that retinal degeneration in DM might also be caused by a neuropathy that could precede microvascular alterations. The present work reviews the currently available bibliography about neurodegeneration in patients with type 2 DM (DM2) without diabetic retinopathy (DR). In patients with non-severe, early DM2 without DR and good metabolic control visual function parameters show early abnormalities that precede clinical DR (in which we diagnose with a conventional ophthalmological examination). Using optical coherence tomography (OCT) technology, a reduction in macular and peripapillary thickness has been observed in different studies. Recent researches suggest that systemic complications (especially ischaemia) and a possible microvascular alteration eventually contributes to retinal neurodegeneration, which opens the door to new studies that include new techniques for evaluating the microvascularization of the retinal layers (AU)

SEOR SBRT-SG survey on SRS/SBRT dose prescription criteria in Spain

Aim Stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS) are essential tools in radiation oncology. In Spain, the use of these techniques continues to grow as older linear accelerators (linacs) are replaced with modern equipment. However, little is known about inter-centre variability in prescription and dose heterogeneity limits. Consequently, the SBRT-Spanish Task Group (SBRT-SG) of the Spanish Society of Radiation Oncology (SEOR) has undertaken an initiative to assess prescription and homogeneity in SRS/SBRT treatment. In the present study, we surveyed radiation oncology (RO) departments to obtain a realistic overview of prescription methods used for SBRT and SRS treatment in Spain. Methods A brief survey was developed and sent to 34 RO departments in Spain, mostly those who are members of the SEOR SBRT-SG. The survey contained seven questions about the specific prescription mode, dose distribution heterogeneity limits, prescription strategies according to SRS/SBRT type, and the use of IMRT–VMAT (Intensity Modulated Radiation Therapy–Volumetric Modulated Arc Therapy). Results Responses were received from 29 centres. Most centres (59%) used the prescription criteria D95% ≥ 100%. Accepted dose heterogeneity was wide, ranging from 107 to 200%. Most centres used IMRT–VMAT (93%). Conclusions This survey about SRS/SBRT prescription and dose heterogeneity has evidenced substantial inter-centre variability in prescription criteria, particularly for intended and accepted dose heterogeneity. These differences could potentially influence the mean planning target volume dose and its correlation with treatment outcomes. The findings presented here will be used by the SEOR SBRT-SG to develop recommendations for SRS/SBRT dose prescription and heterogeneity (AU)

SEOR SBRT-SG survey on SRS/SBRT dose prescription criteria in Spain.

AIM: Stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS) are essential tools in radiation oncology. In Spain, the use of these techniques continues to grow as older linear accelerators (linacs) are replaced with modern equipment. However, little is known about inter-centre variability in prescription and dose heterogeneity limits. Consequently, the SBRT-Spanish Task Group (SBRT-SG) of the Spanish Society of Radiation Oncology (SEOR) has undertaken an initiative to assess prescription and homogeneity in SRS/SBRT treatment. In the present study, we surveyed radiation oncology (RO) departments to obtain a realistic overview of prescription methods used for SBRT and SRS treatment in Spain. METHODS: A brief survey was developed and sent to 34 RO departments in Spain, mostly those who are members of the SEOR SBRT-SG. The survey contained seven questions about the specific prescription mode, dose distribution heterogeneity limits, prescription strategies according to SRS/SBRT type, and the use of IMRT-VMAT (Intensity Modulated Radiation Therapy-Volumetric Modulated Arc Therapy). RESULTS: Responses were received from 29 centres. Most centres (59%) used the prescription criteria D95% ≥ 100%. Accepted dose heterogeneity was wide, ranging from 107 to 200%. Most centres used IMRT-VMAT (93%). CONCLUSIONS: This survey about SRS/SBRT prescription and dose heterogeneity has evidenced substantial inter-centre variability in prescription criteria, particularly for intended and accepted dose heterogeneity. These differences could potentially influence the mean planning target volume dose and its correlation with treatment outcomes. The findings presented here will be used by the SEOR SBRT-SG to develop recommendations for SRS/SBRT dose prescription and heterogeneity.

Heavy metal transport and evolution of atmospheric aerosols in the Antarctic region.

Suspended particulate matter (SPM) measurements and backward air mass trajectory analysis using the HYSPLIT model were performed to better understand the main sources and transport pathways of heavy metals in atmospheric aerosols reaching the Antarctic region. Field campaigns were carried out during the austral summer 2016-2017 at the "Gabriel de Castilla" Spanish Antarctic Research Station, located on Deception Island. Aerosols were deposited in an air filter through a low-volume sampler and chemically analysed using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). The study of air masses and high enrichment factor values of several elements (Hf, Zr, As, Cu, Sn, Zn, Pb) together with their correlations (Hf/Zr, V/As, Ti/Mn and Cu/Sn) suggests a potentially significant role of three main sources in this area: remote maritime traffic, local petrol combustion (generators and/or tourist cruises), and remote/local crust. Additionally, the investigation of atmospheric flow patterns through backward trajectory analysis revealed that Hf/Zr correlation was related to a remote crustal origin, V/As to anthropogenic local pollution, Ti/Mn to terrestrial inputs on the island and Cu/Sn to remote anthropogenic sources. Overall, the present study demonstrates the existence of anthropogenic pollution at this remote site from distant as well as local sources following the Antarctic circumpolar wind pattern.

Quantification of particulate matter, tracking the origin and relationship between elements for the environmental monitoring of the Antarctic region.

The present work reports on the analysis of atmospheric aerosols in the Antarctic region, Deception Island, collected during austral summer 2016-2017 by field measurements carried from Gabriel de Castilla Spanish Research Station. A low-volume sampler was used to capture the aerosols depositing them onto the air filters. A chemical analysis of the samples using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) and Inductively Coupled Plasma-Atomic Emission Spectroscopy (ICP-AES) provided the total carbon (TC), organic carbon (OC), elemental Carbon (EC) and elements such as Al, Ca, Fe, K, Mg, Na, P, S, Cu, Pb, Sr, Ti, Zn and Cr. The average mass concentration of particulate matter (PM10) originated by natural and anthropogenic activities was calculated as 10 ±â€¯4 µg/m3, although values such as 28.2 µg/m3 were also obtained which is very high even when compared to other places in the coast of the Antarctic region. In addition, high enrichment factors have been found for elements such as Pb, Cr, Cu and Zn showing a remote anthropogenic contribution to particulate matter in this region. Correlations were found between Na, Mg, Ca, Al, Ti and S, where Na/Mg displayed the influence of marine environments, S correspond to volcanic activities, Ca to penguin colonies and influence of sea whereas Al/Ti indicated the crustal origin. Polar contour graphical maps were obtained from meteorological data using chemometrics methods, which allowed reproducing wind maps revealing the distribution of the aerosols and possible emission sources of different elements in the area. Given that this island has not been previously studied for atmospheric contamination, this work provides an interesting insight about the site-specific characteristics of particulate matter.

Changes in dietary intake, plasma carotenoids and erythrocyte membrane fatty acids in breast cancer survivors after a lifestyle intervention: results from a single-arm trial.

BACKGROUND: The influence of nutrition on breast cancer prognosis is still inconclusive and therefore dietary interventions incorporating dietary biomarkers are needed to confirm compliance with dietary goals and clarify biological mechanisms. The present study assessed whether a lifestyle intervention in breast cancer survivors could affect dietary biomarkers of fruit and vegetables and fatty acids. METHODS: In this phase II single-arm trial, 37 overweight/obese early stage breast cancer patients completed a 12-week diet and exercise intervention. The intervention involved 1-h weekly diet sessions delivered by a dietician and 75-min bi-weekly physical activity sessions of moderate-to-high intensity led by trained monitors. Before and after the intervention, three 24-h dietary recalls were carried out to calculate nutrient intakes and, in addition, blood samples were taken to measure plasma carotenoids, vitamin E and retinol concentrations and erythrocyte membrane fatty acid (EFA) composition. Wilcoxon signed rank tests were used to assess changes in dietary and biomarkers measurements over the intervention period. RESULTS: After the intervention, there was a significant increase in the intake of dietary carotenoids (+15.1% compared to baseline) but not plasma carotenoids levels (+6.3%). Regarding the EFA levels, we observed a significant decrease in percentage of saturated fatty acids (-1.4%) and n-6 polyunsaturated fatty acids (-2.9%) and an increase in monounsaturated fatty acids (1.7%) and total and long-chain n-3 polyunsaturated fatty acids (by 13.1% and 13.7%, respectively). A favourable decrease in the ratio of long-chain n-6 to n-3 polyunsaturated fatty acids (-9.1%) was also observed. CONCLUSIONS: After a short-term diet and exercise intervention in overweight/obese breast cancer survivors, we observed significant changes in dietary nutrients and fatty acid biomarkers, suggesting positive dietary changes that could be relevant for breast cancer prognosis.

Sarcopenic obesity: hidden muscle wasting and its impact for survival and complications of cancer therapy.

Body composition, defined as the proportions and distribution of lean and fat tissues in the human body, is an emergent theme in clinical oncology. Severe muscle depletion (sarcopenia) is most easily overlooked in obese patients; the advent of secondary analysis of oncologic images provides a precise and specific assessment of sarcopenia. Here, we review the definitions, prevalence and clinical implications of sarcopenic obesity (SO) in medical and surgical oncology. Reported prevalence of SO varies due to the heterogeneity in the definitions and the variability in the cut points used to define low muscle mass and high fat mass. Prevalence of SO in advanced solid tumor patient populations average 9% (range 2.3%-14.6%) overall, and one in four (24.7%, range 5.9%-39.2%) patients with body mass index ≥ 30 kg/m2 are sarcopenic. SO is independently associated with higher mortality and higher rate of complications in systemic and surgical cancer treatment, across multiple cancer sites and treatment plans. These associations remain unexplained, however, it has been hypothesized that patients with sarcopenia are generally unfit and unable to tolerate stress. Another proposed mechanism relates to increased exposure to antineoplastic therapy, i.e. a large fat mass would be expected to inflate drug dose in BSA-based treatments, causing an increased rate of dose-limiting toxicity. Pharmacokinetic data are needed to confirm or refute this hypothesis. Old age, deconditioning, cancer progression, acute or chronic nonmalignant disease and drug side-effects are suggested causes of muscle loss, and it is unknown the degree to which this can be reversed. Sarcopenia can be readily detected before start of cancer treatment, however, clinical management protocols for SO patients require development. Studies of cancer treatment dose-modulation are in progress.

Sarcopenic obesity: hidden muscle wasting and its impact for survival and complications of cancer therapy.

Body composition, defined as the proportions and distribution of lean and fat tissues in the human body, is an emergent theme in clinical oncology. Severe muscle depletion (sarcopenia) is most easily overlooked in obese patients; the advent of secondary analysis of oncologic images provides a precise and specific assessment of sarcopenia. Here, we review the definitions, prevalence and clinical implications of sarcopenic obesity (SO) in medical and surgical oncology. Reported prevalence of SO varies due to the heterogeneity in the definitions and the variability in the cut points used to define low muscle mass and high fat mass. Prevalence of SO in advanced solid tumor patient populations average 9% (range 2.3%-14.6%) overall, and one in four (24.7%, range 5.9%-39.2%) patients with body mass index ≥ 30 kg/m2 are sarcopenic. SO is independently associated with higher mortality and higher rate of complications in systemic and surgical cancer treatment, across multiple cancer sites and treatment plans. These associations remain unexplained, however, it has been hypothesized that patients with sarcopenia are generally unfit and unable to tolerate stress. Another proposed mechanism relates to increased exposure to antineoplastic therapy, i.e. a large fat mass would be expected to inflate drug dose in BSA-based treatments, causing an increased rate of dose-limiting toxicity. Pharmacokinetic data are needed to confirm or refute this hypothesis. Old age, deconditioning, cancer progression, acute or chronic nonmalignant disease and drug side-effects are suggested causes of muscle loss, and it is unknown the degree to which this can be reversed. Sarcopenia can be readily detected before start of cancer treatment, however, clinical management protocols for SO patients require development. Studies of cancer treatment dose-modulation are in progress.

El Cuestionario de Capacidades y Dificultades (SDQ) como herramienta de cribado para el Trastorno por Déficit de Atención e Hiperactividad / The Strengths and Difficulties Questionnaire (SDQ) as a screening tool for Attention Deficit and Hyperactivity Disorder

INTRODUCCIÓN: El Trastorno por déficit de atención e hiperactividad (TDAH) es uno de los trastornos del neurodesarrollo más prevalentes en la infancia y motivo de consulta frecuente en Atención Primaria. OBJETIVO: Valorar si el Cuestionario de capacidades y dificultades (SDQ) es una herramienta útil para discriminar a niños con TDAH de niños sin esta patología, con el propósito de optimizar las derivaciones a Atención Especializada. MÉTODOS: Estudio observacional descriptivo prospectivo, autorizado por el Comité de Ética de Investigación de Galicia. Se incluyeron 305 sujetos entre 4 y 16 años, siendo reclutados 226 pacientes en salud mental y 79 en pediatría. RESULTADOS: La versión del SDQ para padres alcanzó globalmente una sensibilidad y especificidad mayores que la versión para profesores o la autoevaluada. En la versión para padres obtuvimos una sensibilidad del 81,00% (IC95% 72,81-89,19), con una especificidad del 53,66% (IC95% 46,59-60,73) y un área bajo la curva de 0,71 (IC95% 0,65-0,77). La sensibilidad alcanzada fue superior (en las diferentes versiones del SDQ, según el sexo y la edad) cuando analizamos los datos con un punto de corte de 6 puntos. CONCLUSIONES: El SDQ es una herramienta útil para discriminar a niños con TDAH en una población española. Este cuestionario podría facilitar la valoración de los niños con sintomatología compatible con TDAH en Atención Primaria, previa a su derivación a Atención Especializada. La detección precoz de los trastornos del neurodesarrollo repercutirá positivamente en la calidad de vida de nuestros pacientes y sus familias

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in childhood and a reason for frequent consultation in primary care. OBJECTIVE: To assess whether the Strengths and Difficulties Questionnaire (SDQ) is a useful tool to discriminate children with ADHD from children without this condition, with the purpose of optimizing referrals to Specialized Care. METHOD: Prospective descriptive observational study, authorized by the Research Ethics Committee of Galicia. We included 305 subjects between 4 and 16 years, 226 patients were recruited in mental health and 79 in pediatrics. RESULTS: The version of the SDQ for parents globally reached a greater sensitivity and specificity than the version for teachers or the self-evaluated one. In the parent version we obtained a sensitivity of 81.00% (95% CI 72.81-89.19), with a specificity of 53.66% (95% CI 46.59-60.73) and an area under the curve of 0.71 (95% CI 0.65-0.77). The sensitivity reached was higher (in the different versions of the SDQ, according to sex and age) when we analyzed the data with a cut-off point of 6 points. CONCLUSIONS: The SDQ is a useful tool to discriminate children with ADHD in a Spanish population. This questionnaire could facilitate the assessment of children with symptoms compatible with ADHD in Primary Care, after referral to Specialized Care. The early detection of neurodevelopmental disorders will have a positive impact on the quality of life of our patients and their families

Radioterapia para la oligorrecurrencia en cáncer de próstata. Resultados preliminares en nuestro centro / Radiation therapy for oligorecurrence in prostate cancer. Preliminary results of our centre

Introducción y objetivo: Existe un interés creciente por el uso de modalidades terapéuticas más agresivas en el cáncer de próstata metastásico. En el presente estudio abordamos el uso de la radioterapia estereotáctica (SBRT) en pacientes con cáncer de próstata oligorecurrente. Analizamos la respuesta bioquímica y la toxicidad de los pacientes a quienes se les administró en nuestro centro. Material y método: Se seleccionaron los pacientes que padecieron una oligorrecurrencia desde enero de 2015 hasta diciembre de 2016 y se administro?? SBRT. La asociación de privación androgénica (DA) quedo?? a decisión de cada caso en el comité de tumores. Describimos la situación clínica al diagnóstico de las oligorrecurrencias, el tratamiento administrado y la respuesta bioquímica. Consideramos respuesta bioquímica un descenso del 50% en las cifras absolutas del PSA. Resultados: Se administró SBRT a 11 pacientes con oligometástasis óseas (82%) y/o ganglionares (18%). El esquema de tratamiento en las óseas fue de 27 Gy repartidos en 3 sesiones, mientras que en las ganglionares se llegó a 70 Gy. Siete pacientes no tenían ningún tratamiento en el momento del diagnóstico, 2 estaban en fase de resistencia a la castración, un paciente estaba con DA intermitente fase OFF y un paciente con DA adyuvante por pN1. Siete pacientes presentaron una respuesta bioquímica con disminución de PSA entre el 75% y el 100%. En 4 pacientes la respuesta no fue valorable por persistir con DA adyuvante. Con un seguimiento medio de 10,5 meses solo han progresado 2 pacientes. Únicamente se detectó toxicidad gastrointestinal grado i en un paciente. Conclusión: Nuestros datos sugieren que el uso de la SBRT en pacientes cuidadosamente seleccionados oligorrecurrentes metastásicos de cáncer de próstata puede lograr respuesta bioquímica y potencialmente retrasar la progresión y el uso de tratamientos sistémicos

Introduction and objective: There is growing interest in the use of more aggressive therapeutic modalities for treating metastatic prostate cancer. In this study, we examine the use of stereotactic body radiation therapy (SBRT) for patients with oligorecurrent prostate cancer. We analysed the biochemical response and toxicity of patients who underwent this therapy at our centre. Material and method: We selected patients who experienced oligorecurrence between January 2015 to December 2016 and were administered SBRT. The association of androgen deprivation (AD) was left in each case to the decision of the tumour committee. We describe the clinical situation at diagnosis of oligorecurrence, the treatment administered and the biochemical response. We considered a biochemical response to be a 50% reduction in the absolute prostate-specific antigen (PSA) readings. Results: SBRT was administered to 11 patients with bone (82%) and/or lymph node oligometastasis (18%). The treatment regimen for bone oligometastasis was 27 Gy divided into 3 sessions, while the treatment for lymph node oligometastasis reached 70 Gy. Seven patients had no treatment at the time of diagnosis, 2 were in the castration-resistant phase, 1 patient was in the off phase of intermittent AD, and 1 patient had adjuvant AD for pN1. Seven patients presented a biochemical response with a PSA reduction of 75-100%. The response was not assessable in 4 patients due to the continuing adjuvant AD. With a mean follow-up of 10.5 months, only 2 patients had progressed. Grade 1 gastrointestinal toxicity was detected in only 1 patient. Conclusion: Our data suggest that the use of SBRT in carefully selected patients with metastatic oligorecurrence of prostate cancer can achieve biochemical response and potentially delay progression and the use of systemic treatments

Nutritional changes in patients with locally advanced head and neck cancer during treatment.

OBJECTIVE: The purpose of the study is to evaluate changes in body composition and nutritional status that occur throughout the oncological treatment in head and neck cancer patients. METHODS: A prospective cohort observational study in patients diagnosed with head and neck squamous cell carcinoma (HNSCC) that underwent treatment with induction chemotherapy (iCT) followed by chemoradiotherapy or bioradiotherapy were invited to participate. All patients had dietetic counseling from the diagnosis and a close monitoring throughout the treatment implementing nutritional support as needed. RESULTS: From June 2011 until October 2012, 20 patients were included. Nutritional and anthropometric parameters were collected at diagnosis, post iCT, after radiotherapy, 1 and 3months post radiotherapy. According to Patient Generated Subjective Global Assessment, 30% of patients were malnourished at diagnosis. After iCT there was an increase in weight, body mass index (BMI) and fat free mass (FFM) with almost complete improvement in dysphagia and odynophagia. Nevertheless a significant nutritional deterioration (p=0.0022) occurred at the end of radiotherapy with 95% of patients becoming severe or moderate malnourished. Nutritional parameters such as weight, BMI and hand grip strength also decrease significantly during treatment. CONCLUSIONS: Despite an intensive nutritional support from the diagnosis throughout the oncological treatment in advanced HNSCC cancer patients, nutritional status deteriorates during radiotherapy. Our findings suggest that iCT may help improve nutritional status by ameliorating the symptoms that limit the oral intake. This improvement in the nutritional status could contribute to minimize further deterioration. Further investigations are needed involving novel approaches to avoid nutritional deterioration.

Radiation therapy for oligorecurrence in prostate cancer. Preliminary results of our centre. / Radioterapia para la oligorrecurrencia en cáncer de próstata. Resultados preliminares en nuestro centro.

INTRODUCTION AND OBJECTIVE: There is growing interest in the use of more aggressive therapeutic modalities for treating metastatic prostate cancer. In this study, we examine the use of stereotactic body radiation therapy (SBRT) for patients with oligorecurrent prostate cancer. We analysed the biochemical response and toxicity of patients who underwent this therapy at our centre. MATERIAL AND METHOD: We selected patients who experienced oligorecurrence between January 2015 to December 2016 and were administered SBRT. The association of androgen deprivation (AD) was left in each case to the decision of the tumour committee. We describe the clinical situation at diagnosis of oligorecurrence, the treatment administered and the biochemical response. We considered a biochemical response to be a 50% reduction in the absolute prostate-specific antigen (PSA) readings. RESULTS: SBRT was administered to 11 patients with bone (82%) and/or lymph node oligometastasis (18%). The treatment regimen for bone oligometastasis was 27Gy divided into 3 sessions, while the treatment for lymph node oligometastasis reached 70Gy. Seven patients had no treatment at the time of diagnosis, 2 were in the castration-resistant phase, 1 patient was in the off phase of intermittent AD, and 1 patient had adjuvant AD for pN1. Seven patients presented a biochemical response with a PSA reduction of 75-100%. The response was not assessable in 4 patients due to the continuing adjuvant AD. With a mean follow-up of 10.5 months, only 2 patients had progressed. Grade 1 gastrointestinal toxicity was detected in only 1 patient. CONCLUSION: Our data suggest that the use of SBRT in carefully selected patients with metastatic oligorecurrence of prostate cancer can achieve biochemical response and potentially delay progression and the use of systemic treatments.

Trastorno por Déficit de Atención e Hiperactividad (TDAH), ¿se mantiene el diagnóstico de sospecha realizado en Atención Primaria en la Unidad de Salud Mental InfantoJuvenil? / Attention deficit / hyperactivity disorder (ADHD), Is the presumptive diagnosis carried out in Paediatric Primary Care maintained in Child and Adolescent Mental Health Unit?

INTRODUCCIÓN: El TDAH es uno de los trastornos del neurodesarrollo más frecuentes. Los pediatras de Atención Primaria (AP) reciben a menudo pacientes que presentan síntomas cardinales de esta entidad. OBJETIVOS: Analizar la concordancia entre la sospecha diagnóstica realizada en AP y el diagnóstico emitido en la Unidad de Salud Mental Infanto-Juvenil (USMIJ). MATERIAL Y MÉTODOS: Estudio observacional descriptivo prospectivo en el que se reclutaron 374 pacientes menores de 16 años, derivados a la USMIJ del área sanitaria de Pontevedra durante el año 2016. Se analizó el índice Kappa global y específico para los diferentes diagnósticos. RESULTADOS: De los 374 pacientes, 233 fueron remitidos con sospecha de TDAH, confirmándose el diagnóstico en 102 pacientes. El índice kappa global de concordancia es de 0.29. En general para la mayoría de los diagnósticos la concordancia fue débil. La concordancia fue buena para el Trastorno del espectro autista (0.61) y muy buena para el Trastorno de conducta alimentaria (1.00). En relación al TDAH, la sensibilidad fue del 95.33% (índice de confianza (IC) 95% 90.86-99.79), la especificidad del 50.94% (IC95% 44.75-57.12), valor predictivo positivo del 43.78% (IC95% 37.19-50.36), y valor predictivo negativo del 96.45% (IC95% 93.05-99.86). CONCLUSIONES: La concordancia obtenida entre AP y la USMIJ es baja en nuestra área sanitaria. La correlación diagnóstica medida con el índice kappa es débil para el TDAH, sin embargo, es buena tanto para el diagnóstico del Trastorno del espectro autista como para los trastornos de conducta alimentaria. La validez diagnóstica para TDAH es moderada, con una sensibilidad alta y una especificidad baja

INTRODUCTION: ADHD is one of the most common neurodevelopmental disorders. Primary care (PC) pediatricians often receive patients who show cardinal symptoms of this entity. OBJECTIVE: To analyze the concordance between the presumptive diagnosis performed in PC and the definitive diagnosis of the Child and Adolescent Mental Health Unit (CAMHU). MATERIALS AND METHODS: Prospective descriptive observational study in which 374 patients under 16 years were recruited from the CAMHU of Pontevedra health area during 2016. The Kappa index was analyzed globally and specific for the different diagnoses. RESULTS: 374 patients were included, 233 were referred with suspected ADHD, confirming the diagnosis in 102 patients. The global kappa concordance index is 0.29. For most diagnoses, agreement was weak. Concordance was good for Autism (0.61) and very good for Eating Disorder (1.00). For ADHD, the sensitivity was 95.33% (95% confidence interval (CI) 90.86-99.79), specificity 50.94% (CI95% 44.75-57.12), positive predictive value 43.78% (CI95% 37.19-50.36) and negative predictive value 96.45% (95% CI 93.05-99.86). CONCLUSIONS: The concordance obtained between PC and CAMHU is low in our health area. The diagnostic concordace measured with the kappa index is weak for ADHD, however, it is good for both autism and eating disorders. The diagnostic validity for ADHD is moderate, with a high sensitivity and low specificity

Contact topical anesthesia versus general anaesthesia in strabismus surgery.

OBJECTIVE: To evaluate the anesthetic block provided by contact topical anesthesia (CTA) in strabismus surgery in adult patients. To analyze postoperative pain and surgical outcome obtained by CTA compared with general anesthesia (GA). METHODOLOGY: Prospective longitudinal cohort study of adult patients undergoing strabismus surgery by CTA or GA. The intensity of pain perceived by patients during the course of surgery and in the postoperative period was measured using Numerical Pain Scale. The success of the surgical outcome, considered as a residual ocular deviation<10 prism diopters, was evaluated. RESULTS: Twenty-three patients were operated using CTA and 26 using AG. During the course of surgery, pain intensity experienced by patients in ATC group was 3.17±2.44. There were no differences between CTA group and AG group in the intensity of pain in the immediate postoperative period (2.13±2.39 vs. 2.77±2.18, respectively; P=.510) and during the first postoperative day (3.22±2.84 vs. 3.17±2.73; P=.923). Surgical success was significantly higher in the CTA group than in the GA group (78.3 vs. 73.1%; P=.019). CONCLUSIONS: CTA provides adequate sensory block to perform strabismus surgery. The control of postoperative pain is similar to that obtained with AG. Conservation of ocular motility providing CTA enables better surgical outcome.

Contact topical anesthesia for strabismus surgery in adult patients.

OBJECTIVE: To analyze the effectiveness and usefulness of contact topical anesthesia in strabismus surgery in adult patients. MATERIAL AND METHODS: A prospective study was conducted on 20 patients undergoing strabismus surgery using contact topical anesthesia and sedation with remifentanil. The intensity of pain was recorded using a numeric pain rating scale at the time of anesthesia implementation, during the surgical procedure, 30 min afterwards, and during the first postoperative day. The incidence of oculocardiac reflex, postoperative nausea and vomiting, corneal ulcers, patient satisfaction (numerically from 0 to 10) and the degree of residual ocular deviation were also assessed. RESULTS: The operation was performed successfully in all patients. Average pain intensity was 1.40 ± 1.73 during anesthesia implementation, 4.20 ± 2.57 during the surgical procedure, 2.50 ± 2.54 30 min after surgery, and 3.55 ± 2.89 during the first postoperative day. Oculocardiac reflex was observed in 7 patients (35%), postoperative nausea and vomiting in 4 (20%), and corneal ulcer in 4 (20%). The patient satisfaction was 9.53 ± 2.51. More than two-thirds (70%) of patients had a residual ocular deviation less than 10 prism diopters. CONCLUSIONS: Contact topical anesthesia is a safe and effective alternative for strabismus surgery in adult patients. Contact topical anesthesia provides adequate pain control, lower incidence of postoperative nausea and vomiting and oculocardiac reflex, and optimal setting of ocular alignment.

Candidiasis cutánea congénita, ¿una entidad poco frecuente o infradiagnosticada? / Congenital cutaneous candidiasis. An infrequent or underdiagnosed entity?

La candidiasis cutánea congénita es una infección poco frecuente, producida por Candida spp., que se desarrolla en la primera semana de vida. Su curso es habitualmente benigno y autolimitado, aunque existen casos graves de infección diseminada. Se presentan 2 casos de recién nacidos con eritema generalizado y rápida evolución a exantema papulopustular. En los cultivos de las lesiones se aisló Candida albicans. Ambos recibieron tratamiento tópico y presentaron una evolución favorable y sin complicaciones. Se revisan los factores de riesgo, la fisiopatología, las formas de presentación y la evolución de la candidiasis cutánea congénita (AU)

Congenital cutaneous candidiasis is an uncommon infection due to Candida spp. which develops within the first week of life. It has usually a benign and self-limited course although there are serious cases of systemic disease. We review the cases of two newborns with disseminate erythema present at birth. Both of them showed a rapid evolution to a papulo-pustular rash. Candida Albicans was isolated in cultures of the cutaneous lesions. After topical treatment, newborns presented a favourable outcome without any complications. Risk factors, physiopathology, clinical presentation and outcome of congenital cutaneous candidiasis are revised (AU)

Effect of a diet and physical activity intervention on body weight and nutritional patterns in overweight and obese breast cancer survivors.

Energy restriction from a low-calorie diet and increased energy expenditure induced by physical activity (PA) could promote weight loss/maintenance and be important determinants of breast cancer (BC) prognosis. The aim of this study was to assess participation and adherence of overweight and obese BC survivors to a lifestyle intervention and to demonstrate the capacity of this intervention to induce weight loss and nutritional changes. This single-arm pre-post study, which involved one-hourly weekly diet sessions delivered by a dietician and 75-min bi-weekly PA sessions of moderate-to-high intensity led by PA monitors, was offered to overweight and obese BC survivors shortly after treatment. Before and after the intervention, anthropometry, dietary information, quality of life (QoL) and cardiorespiratory fitness (CRF) were collected. A total of 112 BC survivors were invited to participate: 42 of them started the intervention and 37 completed it. Participants attended more than 90 % of the sessions offered and showed a significant weight loss of 5.6 ± 2.0 kg, as well as significant decreases in body mass index, fat mass and waist circumference. Significant decreases in total energy (-25 %), fat (-35 %), saturated fat (-37 %) and carbohydrate (-21 %) intakes were observed while QoL and CRF showed significant increases. This feasibility study demonstrated the success of a short-term diet and PA intervention to induce weight loss and promote healthful changes in BC survivors. Assessing the long-term effects of these changes, and in particular their possible impact of BC prognosis, and designing interventions reaching a wider number of BC survivors are still issues to be addressed.