Riesgo de hemorragia cerebral en el traumatismo craneal leve y tratamiento antitrombótico / Risk of cerebral hemorrhage in mild traumatic brain injury and antithrombotic treatment

Objetivo El tiempo de observación en el traumatismo craneoencefálico leve (TCEL) es controvertido. Nuestro objetivo se basó en evaluar el riesgo de complicaciones neurológicas en el TCEL con y sin tratamiento antitrombótico. Método Evaluamos retrospectivamente los pacientes con TCEL atendidos en urgencias durante 3 años. Consideramos TCEL aquellos con Glasgow ≥13 al ingreso. Se realizó una TC craneal en todos los casos con >1 factor de riesgo al ingreso y a las 24h en aquellos con deterioro neurológico o TC craneal inicial patológica. Se revisó retrospectivamente las complicaciones en los siguientes 3 meses. Resultados Evaluamos 907 pacientes con una edad media de 73±19 años. El 91% presentaron factores de riesgo, con un 60% en tratamiento antitrombótico. Detectamos un 11% de hemorragia cerebral inicial, 0,4% a las 24h y ningún caso a los 3 meses. El tratamiento antitrombótico no se asoció con incremento de riesgo de hemorragia cerebral (9,9 con vs. 11,9% sin tratamiento; p=0,3). El 39% de las hemorragias presentaron síntomas neurológicos (18% amnesia postraumática, 12% cefalea, 8% vómitos, 1% convulsiones), siendo en un 78,4% síntomas leves. De las 4 hemorragias detectadas a las 24h, 3 fueron asintomáticas y un caso emporó la cefalea inicial. Ningún paciente asintomático sin lesión en la TC craneal inicial presentó clínica a las 24h. Conclusiones Nuestro estudio sugiere que los pacientes con TCEL asintomáticos, sin lesión en la TC craneal inicial no precisarían periodo de observación ni TC craneal de control, independientemente del tratamiento antitrombótico o nivel de INR (AU)

Introduction The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment. Method We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with >1 risk factor at admission and at 24h in those with neurological impairment or initial pathological cranial CT. Complications in the following 3 months were retrospectively reviewed. Results We evaluated 907 patients with a mean age of 73±19 years. Ninety-one percent presented risk factors, with 60% on antithrombotic treatment. We detected 11% of initial brain hemorrhage, 0.4% at 24h, and no cases at 3 months. Antithrombotic treatment was not associated with an increased risk of brain hemorrhage (9.9% with vs. 11.9% without treatment, P=.3). 39% of the hemorrhages presented neurological symptoms (18% post-traumatic amnesia, 12% headache, 8% vomiting, 1% seizures), with 78.4% having mild symptoms. Of the 4 hemorrhages detected at 24h, 3 were asymptomatic and one case that worsened the initial headache. No asymptomatic patient without lesion on initial clinical cranial CT presented at 24h. Conclusions Our study suggests that patients with asymptomatic mTBI, without a lesion on the initial cranial CT, would not require the observation period or CT control regardless of antithrombotic treatment or INR level (AU)

Risk of cerebral hemorrhage in mild traumatic brain injury and antithrombotic treatment.

INTRODUCTION: The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment. METHOD: We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with ≥1 risk factor at admission and at 24 h in those with neurological impairment or initial pathological cranial CT. Complications in the following 3 months were retrospectively reviewed. RESULTS: We evaluated 907 patients with a mean age of 73 ±â€¯19 years. Ninety-one percent presented risk factors, with 60% on antithrombotic treatment. We detected 11% of initial brain hemorrhage, 0.4% at 24 h, and no cases at 3 months. Antithrombotic treatment was not associated with an increased risk of brain hemorrhage (9.9% with vs 11.9% without treatment, p = 0.3). 39% of the hemorrhages presented neurological symptoms (18% post-traumatic amnesia, 12% headache, 8% vomiting, 1% seizures), with 78.4% having mild symptoms. Of the 4 hemorrhages detected at 24 h, 3 were asymptomatic and one case that worsened the initial headache. No asymptomatic patient without lesion on initial clinical cranial CT presented at 24 h. CONCLUSIONS: Our study suggests that patients with asymptomatic mTBI, without a lesion on the initial cranial CT, would not require the observation period or CT control regardless of antithrombotic treatment or INR level.

[Functional ability and social-care problems of the elderly in the Cáceres health area]. / Capacidad funcional y problemas socioasistenciales de los ancianos del área de salud de Cáceres.

OBJECTIVE: To describe the social environment and to identify the health problems and the functional and mental ability of the elderly in the community. DESIGN: Cross-sectional, observational study by means of a questionnaire. PATIENTS: 228 people over 71 and not living in an institution. SETTING: Cáceres Health Area. MAIN MEASUREMENTS: Questionnaire on social and demographic details, main pathologies, social assessment (Gijón scale), functional assessment (Barthel and Lawton-Brody scales), mental assessment (Pfeiffer test), geriatric problems and visits from health professionals. RESULTS: 67% of the 228 people in the sample were women, with an average age of 79. Comorbidity, present in over 70% of the elderly, was significantly related to multi-medication, falls, hospital admission, depression and insomnia. The most common social and family situation was of a person living with his/her partner (38.3%; CI, 6.31) or children, in a dwelling with architectural barriers (43.0%; CI, 6.43), with a good relationship to his/her social surroundings (61.0%; CI, 6.33). The Barthel test showed a significant relationship with all the geriatric problems declared. The Pfeiffer test showed a relationship with falls (t=3.10; P=.00214), with hearing problems (t=1.98; P=.048), with incontinence (t=3.59; P=.0040) and constipation (t=2.64; P=.0086). The Lawton-Brody test was related, in women, with falls (t=4.27; P=.00034), admissions (t=2.02; P=.044), constipation and sight and hearing problems; and in men, with depression and incontinence. CONCLUSIONS: Elderly people in the Cáceres Health Area showed good functional ability in their basic daily tasks, less ability in instrumental activities and high comorbidity.

[The debate on the organization, functions and efficiency of nursing in primary care: apropos of a qualitative study]. / El debate sobre la organización, las funciones y la eficiencia de enfermería en atención primaria: a propósito de un estudio cualitativo.

OBJECTIVE: To show the opinions that doctors and nurses express on the organisation and competences of primary care nursing, and on inter-professional relations. DESIGN: Qualitative research study based on the group discussion technique known as Philips 66. SETTING AND PARTICIPANTS: Three discussion groups, one of nurses, one of doctors and a third mixed, with 6 components each, half from Cáceres and the rest from other provinces, and all involved in primary care health delivery. MEASUREMENTS AND MAIN RESULTS: In the discussions, the three groups coincided in the importance given to nursing clinics and home visits, in the organisational advantages that the attachment as a norm of the population to a nursing clinic would bring, in the ability of nurses to perform the techniques they have habitually used, and in defence of one sole clinical record per patient. They blamed each other mutually for making few home visits. Doctors attributed to nurses under-use of records and nurses alleged doctors took no notice of their notes. On the question of their relations, doctors thought that nurses did not take on joint responsibility for the work-loads in health centres; and nurses thought that doctors did not wish to share tasks, but rather delegate or order them. CONCLUSIONS: The attachment of the population to nursing clinics would favour the extension of care, the commitment to the population and the real delivery of services, as well as professional autonomy and recognition.

El debate sobre la organización, las funciones y la eficiencia de enfermería en atención primaria: a propósito de un estudio cualitativo / The debate on the organisation, functions and efficiency of nursing in primary care: concerning a qualitative study

Objetivo. Mostrar las opiniones que manifiestan médicos y enfermeros sobre la organización y las competencias de enfermería en atención primaria (AP), así como sobre las relaciones interprofesionales. Diseño. Estudio de investigación cualitativa basado en la técnica de discusión en grupo denominada Philips 66. Emplazamiento y participantes. Tres grupos de discusión, uno de enfermeros otro de médicos y otro mixto, con 6 componentes cada uno, procedentes la mitad de Cáceres y el resto de otras provincias, todos ellos con actividad asistencial en AP. Mediciones y resultados principales. Del discurso producido cabe destacar la coincidencia en cuanto a la importancia que conceden los 3 grupos a la consulta de enfermería (CE) y a la visita domiciliaria, en las ventajas organizativas que supondría la adscripción normatizada de población a enfermería, en la capacidad de los enfermeros para realizar las técnicas que han desarrollado habitualmente y en la defensa de una sola historia clínica. Se culpan mutuamente de realizar pocas visitas domiciliarias. Los médicos achacan a los enfermeros la poca utilización que hacen de los registros y los enfermeros a los médicos que no tienen en cuenta sus anotaciones. En cuanto a las relaciones, los médicos piensan que los enfermeros no se corresponsabilizan con las cargas de trabajo de los centros de salud, y los enfermeros piensan que los médicos no quieren compartir tareas, sino delegarlas/ordenarlas. Conclusiones. La adscripción de población a enfermería favorecería la longitudinalidad de la atención, el compromiso con la población y la oferta real de servicios, así como la autonomía y el reconocimiento profesionales (AU)

[Scanning electron microscopy in gastric adenocarcinoma and intestinal metaplasia]. / Microscopía electrónica de barrido en adenocarcinoma gástrico y metaplasia intestinal.

In recent years scanning electron microscopy has been used in gastric biopsy studies, contributing to better recognition of intestinal metaplasia and carcinoma, as a complement to light and transmission electron microscopy. During the second half of 1983, 53 cases of gastric carcinoma were diagnosed at the Department of Pathology of Hospital Mexico, of which six were studied ultrastructurally. A pattern similar to that of intestinal epithelium was found in cases of intestinal metaplasia. Well differentiated adenocarcinomas showed marked tumor cell proliferation with irregular "projections". In poorly differentiated carcinomas, changes were limited to areas where tumor cells invaded the epithelial surface. In summary, scanning electron microscopy is of great help in research and diagnosis of pathologic changes occurring in mucosal surfaces.

Microscopia electrónica de barrido en adenocarcinoma gástrico y metaplasia intestinal / Scanning electron microscopy in gastric adenocarcinoma and intestinal metaplasia

En los últimos años se ha aplicado la microscopia electrónica de barrido al estudio de especímenes de mucosa gástrica, permitiendo el reconocimiento de alteraciones en algunas patologías como metaplasia intestinal y adenocarcinoma gástrico, que han complementado la información obtenida mediante microscopia de luz y electrónica de transmisión. Durante el segundo semestre de 1983 se diagnosticaron 51 casos de adenocarcinoma gástrico en el Servicio de Anatomía Patológica del Hospital México, de los cuales se analizaron ultraestructuralmente seis casos que presentaban diferentes patologías. En los pacientes con metaplasia intestinal se encontró un patrón similar al del epitelio intestinal. Los carcinomas bien diferenciados mostraron una gran proliferación de células tumorales, formando proyecciones irregulares; en los casos poco diferenciados las alteraciones estaban circunscritas a sitios localizados, donde posiblemente las células tumorales invadieron la superficie epitelial. En conclusión, la microscopia electrónica de barrido representa una valiosa ayuda en la investigación y diagnóstico de problemas patológicos a nivel de superficies mucosas