Randomized clinical trial of nutritional counseling for malnourished hospital patients. / Ensayo clínico aleatorizado del asesoramiento nutricional en pacientes desnutridos hospitalizados.

INTRODUCTION: Malnutrition is associated with an increased risk of mortality and morbidity, longer hospital stays and general loss of quality of life. The aim of this study is to assess the impact of dietary counseling for malnourished hospital patients. PATIENTS AND METHODS: Prospective, randomized, open-label study of 106 hospital patients with malnutrition (54 in the control group and 52 in the intervention group). The intervention group received dietary counseling, and the control group underwent standard treatment. We determined the patients' nutritional state (body mass index, laboratory parameters, malnutrition universal screening tool), degree of dependence (Barthel index), quality of life (SF-12), degree of satisfaction (CSQ-8), the number and length of readmissions and mortality. RESULTS: The patients who underwent the "intervention" increased their weight at 6 months, while the controls lost weight (difference in body mass index, 2.14kg/m(2); p<.001). The intervention group had better results when compared with the control group in the Malnutrition Universal Screening Tool scores (difference, -1.29; p<.001), Barthel index (difference, 7.49; p=.025), SF-12 (difference, 13.72; p<.001) and CSQ-8 (difference, 4.34, p<.001) and required fewer readmissions (difference, -0.37; p=.04) and shorter stays for readmissions (difference, -6.75; p=.035). Mortality and laboratory parameters were similar for the 2 groups. CONCLUSIONS: Nutritional counseling improved the patients' nutritional state, quality of life and degree of dependence and decreased the number of hospital readmissions.

[Vaccines and preventive activities in patients with inflammatory arthritis]. / Vacunas y actividades preventivas en pacientes con artritis inflamatorias.

Patients with inflammatory arthritis and eligible for immunosuppressive therapy account for more than 1% of general population, and represents a significant workload on family doctors. They are prone to other comorbidities, with an increased cardiovascular risk and a higher incidence of infections than the general population, especially skin infections and pneumonitis. This comorbidity can be considered vulnerable to a prevention program-prevention of cardiovascular risk, cancer screening, vaccination schedule for adults. As for prevention through vaccination, importance should be given to pneumococcal infection - significant in adults aged 50 or over, especially amongst immunosuppressed patients. The 13-valent conjugate vaccine, which has been recently approved for adults, must be considered. An attempt has been made to write a simple, applicable document on preventive measures that should be implemented both at primary and secondary care level for those adults.

Anisakiasis intestinal diagnosticada por enteroclisis / Intestinal anisakiasis diagnosed by enteroclysis

La anisakiasis es una parasitación frecuente en nuestro medio y que da lugar a cuadros de dolor abdominal que pueden simular otras patologías, incluyendo situaciones quirúrgicas (apendicitis o peritonitis), pero generalmente autolimitadas. Presentamos un caso de una paciente de 48 años con dolor abdominal agudo, febrícula y hallazgos patológicos en TAC (propios de un cuadro inflamatorio intestinal), en la que la realización de una enteroclisis fue capaz de identificar larvas de Anisakis. La paciente evolucionó favorablemente con tratamiento conservador y el patrón radiológico volvió a la normalidad. En nuestro caso, la posibilidad de contar con una técnica radiológica objetiva que sirvió de ayuda al diagnóstico proporcionó datos muy útiles en el manejo de la paciente. Se revisan las características clínicas y radiológicas de la enfermedad (AU)

Anisakiasis is a common infestation in our setting that produces abdominal pain that can simulate other diseases including surgical conditions (symptoms of acute abdomen, mimicking appendicitis or peritonitis), but it is generally a self-limiting process. We report a case of a 48-year-old female with acute abdominal pain, fever and pathological findings on the CT scan (inflammatory bow condition). Anisakis larvae could be identified by the enteroclysis. The patient evolved favorably with conservative treatment and radiologic intestinal pattern returned to normal. The possibility of a radiological technical to assist in the diagnosis provided very useful data in the management of our patient. The radiological and clinical features of the disease are reviewed (AU)

Utilización de los servicios sanitarios por las embarazadas seguidas en un centro de salud / Use of the health care services for pregnancies followed-up in a Health Care Center

Introducción: Nuestros objetivos son describir el perfil sociodemográfico de las embarazadas seguidas en el centro de salud, estimar la frecuencia de la utilización de los servicios sanitarios y analizar los factores que puedan influir en la diferente utilización. Pacientes y Métodos: Estudio descriptivo transversal con una segunda fase analítica. Centro de salud urbano. Población: embarazadas que hayan parido durante el año 2005. Variables: utilización de los servicios sanitarios, sociodemográficas, psicosociales, obstétricas y de morbilidad. Análisis estadístico: tablas de frecuencia para las variables cualitativas y resúmenes numéricos para las variables cuantitativas; análisis bivariante para relacionar cada variable independiente con cada una de las variables dependientes y creación de un modelo de regresión lineal multivariante para controlar los posibles factores de confusión. Resultados. Cuatrocientos diecinueve partos. El 64% de los embarazos se siguió en el centro, 25% en el segundo nivel y 11% en la medicina privada. La utilización media de los servicios sanitarios fue de 38,6 visitas (IC95% 37,31-39,89). Todas las mujeres acudieron al programa de control de embarazo: 7,37 visitas (IC95%: 7,24-7,50). El 98% acudió a la matrona (7,86 visitas; IC95% 15,03-16,93). El 99,6% utilizó los servicios de apoyo (media de 5,79 visitas; IC 95% 5,60-5,98). El 52% acudió a las urgencias hospitalarias (media de 0,84; IC95% 0,72-0,96). El 61% de las mujeres acudió en alguna ocasión al ginecólogo privado (media de 1,26; IC95% 1,08-1,44). Conclusiones. Se encuentra un elevado porcentaje de embarazos seguidos en Atención Primaria y una alta utilización de los servicios sanitarios durante el embarazo. La experiencia obstétrica previa parece disminuir la utilización (AU)

Introduction: We have aimed to describe the socidemographic profile of pregnant women followed-up in the health care center, estimate frequency of their use of the health care services and analyze the factors that may influence the different use. Patients and methods. Descriptive, cross-sectional study with the second analytic phase. Urban health care center. Population: pregnant women who gave birth in the year 2005. Variables: use of the health care, sociodemographics, psychosocial, obstetrics services and morbidity. Statistical analysis: frequency tables for qualitative variables and numeric summaries for the quantitative variables; bivariant analysis to compare each independent variable with each one of the dependent ones and creation of a multivariant linear regression model to control possible compounding factors. Results: Four-hundred and nineteen deliveries. A total of 64% of them were followed-up in the center, 25% were seen on the second level and 11% in private medicine. Mean use of the health care services was 38.6 visits (CI 95% 37.31-39.89). All the women came to a pregnancy control program: 7.37 visits (CI 95%: 7.24-7.50). A total of 98% came to the midwife (7.86 visits; CI 95% 15.03-16.93) and 99.6% used the support services (mean of 5.79 visits; CI 95% 5.60-5.98). A total of 52% came to the hospital emergency service (mean of 0.84; CI 95% 0.72-0.96). At some time, 61% of the women went to a private gynecologist (mean 1.26; CI 95% 1.08-1.44). Conclusions: A high percentage of pregnant women are followed-up in Primary Care. There is high use of the health care services during pregnancy. Previous obstetrics experience seems to decrease its use (AU)

De la evidencia a la práctica clínica: manejo de la artrosis, II parte / No disponible

No disponible

Recomendaciones de buena práctica clínica en artrosis / No disponible

La artrosis constituye, como todos sabemos, una patología de alta prevalencia y de gran consumo de recursos sanitarios tanto en Atención Primaria como a nivel hospitalario. La presente Guía de “Recomendaciones de buena práctica clínica en artrosis” pretende dar a conocer conocimientos básicos en esta patología y alcanzar los objetivos idóneos tanto a nivel diagnóstico como terapéutico para plasmarlos en nuestra actuación clínica diaria. Dichas opciones han de estar basadas en pruebas avaladas de forma categórica y que se irán señalando dentro del contexto y desarrollo de esta Guía. Aún así, la artrosis presenta líneas abiertas de investigación en actuación sobre los factores de riesgo y sobre el uso de fármacos, que sólo desde la historia natural de la enfermedad y desde un seguimiento largo y de años, es decir desde Atención Primaria, se pueden ir desarrollando

Arthrosis is, as we all know, a disease having high prevalence that uses a large amount of health care resources in both Primary Health Care and in the Hospital. The present “Good clinical practice recommendations in arthrosis” Guide aims to provide basic knowledge in this disease and to help to reach the best objectives on the diagnostic and therapeutic levels to incorporate them into our daily clinical activity. These options should be based on tests supported categorically and that will be indicated within the context and development of this Guide. Even so, the lines of research for arthrosis regarding action on the risk factors and on the use of drugs that can only be developed from the natural history of the disease and from the long term follow-up over years, that is from Primary Health Care

Necesidades de calcio y vitamina D en ancianos con osteoporosis / Calcium and vitamin D needs in the elderly with osteoporosis

En la persona anciana es fundamental el mantener un aporte adecuado de calcio y vitamina D para conseguir un equilibrio en el balance mineral óseo, o al menos, evitar un desequilibrio muy acentuado. Cuando la persona anciana es, además, un enfermo de osteoporosis, este aporte adecuado se vuelve una necesidad fundamental. En el presente trabajo se revisan las dosis de calcio y vitamina D que recibían los grupos control e intervención en los principales ensayos clínicos en pacientes con osteoporosis. En estos trabajos, independientemente de otros medicamentos que se ensayaran, se aseguró un aporte adecuado de calcio, o de calcio y vitamina D. En consecuencia, e independientemente de otras medidas terapéuticas, debe asegurarse un aporte adecuado de estos elementos, a través de la dieta o, en la mayoría de los casos, mediante un aporte farmacológico

In the elderly person, it is essential to maintain an adequate intake of calcium and vitamin D to achieve a balance in bone mineral balance or, at least, to avoid great unbalance. When the elderly person also suffers from osteoporosis, this intake becomes a fundamental need. In this paper, the calcium and vitamin D dose received in the control and intervention groups in the main clinical trials in patients with osteoporosis are reviewed. In these trials, independently of the other drugs that are being tested, an adequate intake of calcium, or of calcium and vitamin D, was assured. Therefore, and independently of other therapeutic measures, an adequate intake of these elements should be assured through diet or, in most of the cases, through drugs

[Paratesticular solitary fibrous tumor]. / Tumor fibroso solitario paratesticular.

OBJECTIVE: To describe an additional case of paratesticular solitary fibrous tumor. METHODS/RESULTS: A 67-year-old man presented a paratesticular mass lasting for one year. Histological examination showed a well-circumscribed lesion comprised of spindle cells proliferation without atypia, arranged in a fascicular pattern, intimately intertwining with thick collagen fibers. Tumor cells were strongly positive for vimentine and CD-34. Diagnostic criteria, clinical features and treatment of this condition are discussed. CONCLUSION: Solitary fibrous tumors are spindle cell neoplasm originally described in the pleura, but may occur in many different sites. Intrascrotal solitary fibrous tumors are uncommon and few cases have been reported.

[Nursing diagnosis of risks. Analysis of cost effectiveness]. / Diagnósticos de enfermería sobre riesgos. Análisis coste-efectividad.

BACKGROUND: Today, there is a discussion on the importance of the utilization of the nursing diagnosis: This makes convenient to evaluate the principal two existing methodological alternatives, that they are: 1) the problems identification, 2) the diagnoses statement of the NANDA within process nursing. The study is centered on the risk diagnoses. OBJECT: 1) To know which the two work methodologies is more effective. 2) To know if exist economic differences. METHODS: It is accomplished a cohorts study, in a population of user included in Program of Handicapped. These were studied during a year. RESULTS: In the group of patients without diagnoses the incidence rate was of 0.64 conversions/person-year), in the group with diagnoses was of 0.22 (p < 0.001). The mean of visits after that the is made real, in the group with diagnoses was of 0.35, in the group without diagnoses of 1.69 (p = 0.012). DISCUSSION: The analysis cost-efficiency of the two work methodologies is clearly more favorable for the methodology than states nursing diagnosis of the taxonomy of the NANDA.

[Pigmented villonodular synovitis with polyarticular presentation]. / Sinovitis villonodular pigmentada de presentación poliarticular.

Pigmented villonodular synovitis (PSV) rarely involves more than one joint, and its occurrence in children is uncommon. One case of PSV with polyarticular involvement in a child is presented, and the differential diagnoses with other polyarthritis are offered. Synovial biopsy of both knees at different ages showed the presence of PSV in a fourteen years old boy with a nine years history of painless swelling of wrist, knees and ankles. Painless polyarticular swelling with few inflammatory signs, negative acute-phase laboratory tests, normal synovial fluid, periarticular soft tissue swelling on plain films and a mandatory synovial biopsy are the diagnostic clues of this rare presentation.

[Clinical activity and serum immunoglobulin concentrations in patients with ankylosing spondylitis]. / Estudio de la actividad clínica y de las concentraciones séricas de inmunoglobulinas en pacientes con espondilitis anquilosante.

Several authors have suggested that immunoglobulin A plays a pathogenic role in ankylosing spondylitis. We have determined the levels of immunoglobulins in 30 patients, observing higher levels than in control patients (248 vs 176 mg/dl); p less than 0.01) and a relation between the increase of immunoglobulin A and the presence of clinical activity in the subgroup of patients B27-negative (163 vs 398 mg/dl, p less than 0.005), but not in B27-positive patients. We think that these e results support the hypothesis that ankylosing spondylitis is an heterogeneous disease, with different pathogenic mechanisms depending on the presence or absence of the serological marker HLA-B27.

[Acute pancreatitis: an infrequent complication of cystic fibrosis (mucoviscidosis)]. / Pancreatitis aguda: una complicación poco frecuente de la fibrosis quística (mucoviscidosis).

We comment the case of a 25-year-old woman, diagnosed since the age of 7 as cystic fibrosis, who presented acute pancreatitis, an exceptional complication of the underlying disease. In the ultrasonographic exploration and endoscopic retrograde cholangiopancreatography was appreciated dilation of the pancreatic ducts, with mobile echoes and filling defects, respectively, compatible with mucus plugs. The etiopathogenesis of this type of acute pancreatitis and the procedure for reaching an etiological diagnosis are discussed. Although the patient presented moderate grade pancreatic failure, there is presently no agreement as to whether pancreatitis secondary to cystic fibrosis can be considered as chronic pancreatitis.