Acute pulmonary tumour embolism and right systolic dysfunction in a hidden intrahepatic cholangiocarcinoma: case report.

Background: Pulmonary tumour embolism is a rare entity that can arise from a wide variety of neoplasms. It can initially manifest as a pulmonary embolism with right heart failure and be refractory to thrombolytic therapy. Cholangiocarcinoma is a rare malignancy that arises from the epithelium of the biliary tree, representing 3% of all the gastrointestinal malignancies, being the intrahepatic cholangiocarcinoma the second most common liver tumour after hepatocellular carcinoma. Case summary: This case regards a patient that presented to our centre with acute pulmonary embolism, deep vein thrombosis, and unrevealing previous medical history. Imaging studies revealed pulmonary embolism, an ovarian mass, and multiple hepatic hypodensities. Throughout the hospitalization, the patient's haemodynamic state and right heart failure worsened, eventually leading to multi-organ failure and death. Post-mortem evaluation revealed cholangiocarcinoma cells on the pulmonary arteries. Discussion: Pulmonary tumour embolism is a rare pathology that can present with acute right heart failure. The diagnosis of occult cancer can be challenging, and the appropriate treatment for this entity remains an unexplored subject.

Establishing Technical Values for Nursing Diagnoses in Primary Healthcare.

PURPOSE: To establish technical values for nursing diagnoses in primary healthcare with which to weight the delivery of care based on criteria of complexity and relevance. METHODS: A three-phase cross-sectional descriptive study: (1) establishing and weighting of the assessment criteria of technical values, (2) scoring of the assessment criteria per diagnosis, and (3) assigning technical values. FINDINGS: Diagnoses were ordered on the scoring scale obtained and a technical value of 1 to 4 was assigned according to their quartile. CONCLUSIONS: Having a technical value for each nursing diagnosis helps to measure the diversity and complexity of care. IMPLICATIONS FOR NURSING PRACTICE: Technical values may contribute to improving nursing management indicators, as they incorporate a quantitative view into the assessment process.

OBJETIVO: Definir un valor técnico para los diagnósticos enfermeros en Atención Primaria que permita ponderar la prestación de cuidados en base a criterios de complejidad y relevancia. MÉTODOS: Estudio descriptivo transversal realizado en 3 fases: 1) definición y ponderación de los criterios de valoración del valor técnico, 2) puntuación de los criterios de valoración por diagnóstico, 3) asignación del valor técnico. RESULTADOS: Se ordenaron los diagnósticos en la escala de puntuación obtenida y se asignó un valor técnico del 1 al 4 en función del cuartil. CONCLUSIONES: Disponer de un valor técnico de cada diagnóstico enfermero permite dimensionar la diversidad y la complejidad de los cuidados. IMPLICACIONES: El valor técnico puede contribuir a mejorar los indicadores de gestión de servicios enfermeros al añadir una visión cuantitativa al proceso evaluativo. PALABRAS CLAVE: diagnóstico de enfermería; terminología normalizada de enfermería; Atención Primaria de salud; indicadores de calidad de la atención de salud; indicadores de gestión.

Stenting for Inferior Vena Cava Stenosis After Liver Transplant.

OBJECTIVE. A case series analysis and meta-analysis were performed to assess the efficacy of stenting for inferior vena cava (IVC) stenosis after liver transplant; a secondary analysis assessed demographic factors as potential predictors of all-cause mortality. MATERIALS AND METHODS. Liver transplant recipients treated for symptomatic IVC stenosis at a major medical center from 1996 to 2017 were assessed. The main medical databases were searched for studies evaluating stenting in liver transplant recipients with IVC stenosis. Cox proportional hazards regression analysis was used to determine predictors of survival (age, sex, reason for transplant, stent size and number, publication year). Univariate and multivariable models were constructed. Because patients in the case series and meta-analysis had similar demographics and outcomes, the results were pooled. RESULTS. The case series included 40 patients (31 treated with stents; nine, without stents). Meta-analysis of 5277 records identified 17 eligible studies involving 73 patients. Stenting was effective in resolving the gradient in 100% of patients and in relieving symptoms in 85% of patients. Primary stent patency at latest follow-up (median, 556 days) was seen in 113 of 118 stents (96%; some patients had multiple stents). Reason for transplant was the only significant predictor of all-cause mortality; patients with hepatocellular carcinoma had a higher hazard of death than those undergoing transplant for other reasons (hazard ratio = 3.23; 95% CI, 1.40-7.42; p = 0.006). CONCLUSION. Stenting for IVC stenosis after liver transplant is clinically effective and durable, with 96% of stents showing long-term patency and 85% of patients experiencing symptom relief.

Obesidad y factores de riesgo cardiovascular en adolescentes. Asociación con factores de riesgo cardiovascular en familiares de primer grado / Obesity and cardiovascular risk factors in adolescents. Association with cardiovascular risk factors in first degree relatives

Fundamento y objetivo: La obesidad es uno de los principales problemas de salud pública. En la adolescencia existe una falta de contacto con el sistema sanitario que impide realizar un diagnóstico de la misma y de la morbilidad que asocia. El objetivo del presente estudio es conocer a los 18 años la prevalencia de obesidad, sobrepeso, factores de riesgo cardiovascular (FRCV) y su posible asociación con existencia de FRCV en padres y hermanos. Pacientes y método: Se realiza un estudio de 153 niños seguidos hasta los 18 años en un centro de salud, determinando índice de masa corporal (IMC), perímetro de cintura, FRCV y antecedentes familiares. Resultados: La prevalencia de obesidad es del 7,18% (intervalo de confianza del 95% [IC 95%] 3,0-11,0) (6,25% en varones y 7,86% en mujeres) y la de sobrepeso del 18,3% (IC 95% 11,9-24,0) (26,56% en varones y 12,35% en mujeres). Refieren antecedentes familiares de FRCV un 53,9% (IC 95% 46,1-61,9) de los casos: hipertensión arterial (25%), obesidad (23,6%), dislipidemia (21,7%) y diabetes (7,2%), globalmente más frecuentes (72,72%) en el grupo de obesidad que en el de sobrepeso (64,2%) y normopeso (49,59%). Existe asociación entre obesidad a los 18 años y obesidad y diabetes en sus familiares de primer grado, así como entre hipertensión arterial a dicha edad e hipertensión arterial en familiares de primer grado. Conclusiones: Con el fin de diagnosticar en jóvenes adultos situaciones de obesidad, sobrepeso y posibles complicaciones a ellas asociadas se debe realizar un seguimiento especial a hijos de padres y hermanos de personas con factores de riesgo, fundamentalmente hipertensos, diabéticos y obesos

Background and objetive: Obesity is a major concern in public health. The fact that most teenagers stop contacting the health system during this period of life prevents detection of this problem and its associated morbidity. The aim of this study is to measure the prevalence of obesity at 18. We also aimed to detect overweight, cardiovascular risk factors (CVRF) and association with CVRF in parents and siblings. Patients and method: The research includes 153 children followed up to 18years old in a community health center. Measures of body mass index (BMI), waist perimeter, CVRF, and familiar history were taken. Results: The prevalence of obesity in our study group was 7.18%, (IC: 3.0-11.0), (6.25% male and 7.86% female). The prevalence of overweight was 18.3% (IC: 11.9-24.0), (26.56% male and 12.35% female). A familiy history of CVRF was found in 53.9% (IC: 46.1-61.9) of cases, including high blood pressure (25%), obesity (23.6%), dyslipemia (21.7%), and diabetes (7.2%). This finding was more prevalent in the obesity group (72.72%) than in those with overweight only (64.2%), or with normal weight (49.59%). A family history of obesity and diabetes in first-degree relatives was associated to obesity in the study group. Also, a family history of high blood pressure was associated to the presence of high blood pressure in this group. Conclusions: In order to detect obesity, overweight, and associated complications in young adults, specific attention to children and siblings of persons who present risk factors is recommended. Those with high blood pressure, diabetes or obesity have the higher risk (AU)

[Obesity and cardiovascular risk factors in adolescents. Association with cardiovascular risk factors in first degree relatives]. / Obesidad y factores de riesgo cardiovascular en adolescentes. Asociación con factores de riesgo cardiovascular en familiares de primer grado.

BACKGROUND AND OBJECTIVE: Obesity is a major concern in public health. The fact that most teenagers stop contacting the health system during this period of life prevents detection of this problem and its associated morbidity. The aim of this study is to measure the prevalence of obesity at 18. We also aimed to detect overweight, cardiovascular risk factors (CVRF) and association with CVRF in parents and siblings. PATIENTS AND METHOD: The research includes 153 children followed up to 18 years old in a community health center. Measures of body mass index (BMI), waist perimeter, CVRF, and familiar history were taken. RESULTS: The prevalence of obesity in our study group was 7.18%, (IC: 3.0-11.0), (6.25% male and 7.86% female). The prevalence of overweight was 18.3% (IC: 11.9-24.0), (26.56% male and 12.35% female). A familiy history of CVRF was found in 53.9% (IC: 46.1-61.9) of cases, including high blood pressure (25%), obesity (23.6%), dyslipemia (21.7%), and diabetes (7.2%). This finding was more prevalent in the obesity group (72.72%) than in those with overweight only (64.2%), or with normal weight (49.59%). A family history of obesity and diabetes in first-degree relatives was associated to obesity in the study group. Also, a family history of high blood pressure was associated to the presence of high blood pressure in this group. CONCLUSIONS: In order to detect obesity, overweight, and associated complications in young adults, specific attention to children and siblings of persons who present risk factors is recommended. Those with high blood pressure, diabetes or obesity have the higher risk.

Oral ketamine for the treatment of type I complex regional pain syndrome.

Ketamine has been shown to be effective in the treatment of neuropathic pain. We present a case of severe complex regional pain syndrome type 1 that was treated with oral ketamine. The response and tolerability of this preparation suggest that further study is warranted.