Calidad de vida en personas con lesión medular de más de 10 años de evolución. La implicación de las complicaciones secundarias / Quality of life in patients with spinal cord injury for at least 10years: Importance of secondary health complications

Objetivo: Determinar la calidad de vida que presentan los lesionados medulares con más de 10 años de evolución. Valorar la prevalencia de complicaciones secundarias y su relación con la calidad de vida y el tiempo desde la lesión. Pacientes y método Diseño: Estudio epidemiológico transversal. Sujetos del estudio Pacientes: con lesión medular traumática, de más 10 años desde la lesión, y que cumplían los criterios de inclusión.Método: calidad de vida se valoró mediante el International spinal cord injury quality of life basic data set. Como variables se incluyeron: factores individuales, déficit neurológico, nivel de lesión y complicaciones secundarias. Resultados: Ciento treinta y un sujetos fueron incluidos en el estudio con edad media de 49 años y un tiempo desde la lesión de 21 años (11-53 años). La media de complicaciones secundarias fue de 2, siendo la más frecuente las urológicas, en 76 sujetos (58%). No existieron diferencias significativas entre el número de complicaciones y el tiempo transcurrido desde la lesión medular. La calidad de vida fue significativamente menor en aquellos que presentaban un mayor número de complicaciones (p = 0,003). Las complicaciones urológicas (p=0,04, IC del 95%, –1,02-2), el dolor musculoesquelético (p=0,01, IC del 95% IC, 1-6), las complicaciones respiratorias (p=0,05, IC del, –3-0,1) y el dolor neuropático que interfería con actividades básicas de la vida (p=0,01, IC del 95%, 1-5) se relacionaban significativamente con una menor calidad de vida. Conclusiones : Las complicaciones secundarias son frecuentes tras la lesión medular, aunque su número no aumenta con el tiempo desde la lesión. La calidad de vida sí está condicionada por la existencia de distintas complicaciones, como la existencia de dolor musculoesquelético.(AU)

Objective: To determine the quality of life of spinal cord injuries with more than 10 years of evolution. Assess the prevalence of secondary complications, and their relationship with quality of life and time since the injury. Patients and method Design: Cross-sectional epidemiological study. Study subjects: Patients with traumatic spinal cord injury, more than 10 years after the injury, and who met the inclusion criteria. Method: Quality of life was assessed using the International spinal cord injury quality of life basic data set. Variables included: individual factors, neurological deficit, level of injury and secondary complications. Results: 131 subjects were included in the study with a mean age of 49 years, and a time since the injury of 21 years (11–53 years). The mean number of secondary complications was 2, the most frequent being urological, in 76 subjects (58%). There were no significant differences between the number of complications and the time elapsed since the spinal cord injury. The quality of life was significantly lower in those with a higher number of complications (P=.003). Urological complications (P=.04, 95% CI: −1.02 to 2), musculoskeletal pain (P=.01, 95% CI: 1–6), respiratory complications (P=.05, 95% CI: −3 to 0.1) and neuropathic pain that interfered with basic life activities (P=.01, 95% CI: 1–5) were significantly related to a lower quality of life. Conclusions: Secondary complications are common after spinal cord injury, although their number does not increase over time after injury. Quality of life is conditioned by the existence of different complications such as the existence of musculoskeletal pain.(AU)

[Quality of life in patients with spinal cord injury for at least 10years: Importance of secondary health complications]. / Calidad de vida en personas con lesión medular de más de 10 años de evolución. La implicación de las complicaciones secundarias.

OBJECTIVE: To determine the quality of life of spinal cord injuries with more than 10 years of evolution. Assess the prevalence of secondary complications, and their relationship with quality of life and time since the injury. PATIENTS AND METHOD DESIGN: Cross-sectional epidemiological study. STUDY SUBJECTS: Patients with traumatic spinal cord injury, more than 10 years after the injury, and who met the inclusion criteria. METHOD: Quality of life was assessed using the International spinal cord injury quality of life basic data set. Variables included: individual factors, neurological deficit, level of injury and secondary complications. RESULTS: 131 subjects were included in the study with a mean age of 49 years, and a time since the injury of 21 years (11-53 years). The mean number of secondary complications was 2, the most frequent being urological, in 76 subjects (58%). There were no significant differences between the number of complications and the time elapsed since the spinal cord injury. The quality of life was significantly lower in those with a higher number of complications (P=.003). Urological complications (P=.04, 95% CI: -1.02 to 2), musculoskeletal pain (P=.01, 95% CI: 1-6), respiratory complications (P=.05, 95% CI: -3 to 0.1) and neuropathic pain that interfered with basic life activities (P=.01, 95% CI: 1-5) were significantly related to a lower quality of life. CONCLUSIONS: Secondary complications are common after spinal cord injury, although their number does not increase over time after injury. Quality of life is conditioned by the existence of different complications such as the existence of musculoskeletal pain.

Severity and duration of allergic conjunctivitis: are they associated with severity and duration of allergic rhinitis and asthma?

Summary: Objective. The association of allergic conjunctivitis (AC) with rhinitis and/or asthma is poorly understood. The objective of this study was to apply the Consensus Document for Allergic Conjunctivitis (DECA) criteria for the classification of AC to a population of patients with AC to assess the association between the severity and duration of AC and rhinitis and/or asthma. Methods. Patients with ocular symptoms of AC who participated in the 'Alergológica 2015' study were included. The demographics, classification according to the DECA criteria, etiology, and comorbidities were evaluated by age groups (less or equal than 14 and greater than 14 years). Results. A total of 2,914 patients (age range, 1-90 years) were included in the "Alergológica 2015" study. Of these, 965 patients (33.1%) were diagnosed with AC (77.5% > 14 years). AC was classified as severe, moderate, or mild in 1.8%, 46.4%, and 51.8%, respectively; and as intermittent or persistent in 51.6% and 48.4% of the patients. AC alone occurred in 4% of patients. AC was mainly associated with rhinitis (88.4%), asthma (38.2%), food allergy (8.3%) and atopic dermatitis (3.5%). In allergic respiratory disease rhinitis preceded AC and asthma developed later. The severity and duration of AC was significantly associated with severity and duration of rhinitis (p less than 0.001 for both age groups) and asthma (p less than 0.001 only in adults). Conclusions. The application of the new DECA classification for AC reveals a direct relationship between AC, rhinitis and asthma respect to severity and duration. These relationships suggest that AC should be considered an integral part of the "one airway, one disease" hypothesis.

Height difference between the vestibular and palatal walls and palatal width: a cone beam computed tomography approach.

BACKGROUND: The objective of this study was to measure two parameters involved in tri-dimensional implant planning: the position of the buccal and palatal bone wall and the palatal thickness. METHODS: Cone beam computed tomography (CBCT) images (Planmeca ProMax 3D) of 403 teeth (208 upper teeth and 195 lower teeth) were obtained from 49 patients referred to the Dental School of Seville from January to December 2014. The height difference between the palatal and buccal walls was measured on the most coronal point of both walls. The thickness of the palatal wall was measured 2 mm from the most coronal point of the palatal wall. RESULTS: The mean values in the maxilla were 1.7 ± 0.9 mm for central and lateral incisors, 2.2 ± 1.7 mm for canines, 1.6 ± 0.9 mm for premolars and 1.9 ± 1.5 mm for molars. In the lower jaw, the mean values were 1.3 ± 0.8 mm for incisors, 1.7 ± 1.2 mm for canines, 2.3 ± 1.3 mm for premolars, and 2.6 ± 1.7 mm for molars. In the upper jaw, more than 55% of maxillary teeth (excluding second premolars and molars) presented mean height differences greater than 1 mm. In the mandible, more than 60% of incisors showed a buccal bone thickness of 1 mm from the apical to lingual aspect. All teeth except the second premolar presented a buccal wall located more than 1 mm more apically than the lingual bone wall. CONCLUSIONS: The buccal bone wall is located more apically (greater than 1 mm) than the palatal or lingual table in most of the cases assessed. The thickness of the palatal or lingual table is also less than 2 mm in the maxilla and mandible, except in the upper canines and premolars and the lower molars.

Malmström vacuum or Kielland forceps: which causes more damage to pelvic floor?

OBJECTIVE: To determine whether differences exist in the rate of levator ani muscle (LAM) avulsion between women who had undergone either Malmström vacuum delivery (MVD) or Kielland forceps delivery (KFD), allowing for potential confounding factors. METHODS: This was a prospective observational study of nulliparous women undergoing instrumental delivery using Malmström vacuum extractor or Kielland forceps, at two hospital centers in Spain. Fetal head position (anterior, posterior or transverse) and fetal head station (low or mid) were assessed by ultrasound and digital examination, respectively. Avulsion was defined on tomographic ultrasound imaging as an abnormal insertion of the LAM in the three central slices from the plane of minimal hiatal dimensions. RESULTS: In total, 414 patients were included in the study (212 MVD and 202 KFD). We observed a higher rate of LAM avulsion in the KFD group (KFD 49.5% vs MVD 32.5%; P = 0.001). When the results were evaluated according to fetal head position and station, we observed no differences in LAM avulsion. The crude odds ratio (OR) for the difference in avulsion between women in the KFD and MVD groups was 2.03 (95% CI, 1.36-3.03). However, when adjusted for duration of second stage of labor, fetal head circumference and fetal head station, the OR was no longer statistically significant (OR, 2.14 (95% CI, 0.95-4.85); P = 0.068). CONCLUSION: When potential confounding factors are taken into account, the rate of LAM avulsion does not differ between women according to whether they have undergone KFD or MVD. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Online learning for 3D/4D transperineal ultrasound of the pelvic floor.

Introduction. To evaluate the feasibility of an online learning process for performing and analyzing 3D/4D transperineal ultrasound imaging of the pelvic floor.Materials and methods: A prospective study was conducted with 20 patients. The learning process of three inexperienced examiners (IEs) performing and analyzing 3D/4D transperineal ultrasound volumes was evaluated. The learning process for the IEs was conducted online by an expert examiner (EE); no face-to-face tutoring was provided. The IEs' competency and analysis of the volumes were estimated using the intraclass correlation coefficient (ICC).Results: The interobserver analysis of the levator hiatus dimensions provided by the EE and those from each IE (for the 20 studied cases) had ICCs ranging from 0.81 to 0.96. The dimensions of the levator hiatus performed by the IEs for the first 10 patients showed ICCs ranging from 0.55 to 0.9. However, when the IEs proceeded with the next 10 patients, they obtained ICCs ranging from 0.81 to 0.96.Conclusions: Conducting 3D/4D transperineal ultrasound of the pelvic floor is a technique that can be learned online in a short period of time. A learning programme designed specifically for this purpose provides excellent reliability.Key Message: Conducting 3D/4D transperineal ultrasound of the pelvic floor is a technique that can be learned online in a short period of time.

Repeatability of the resonance frequency analysis values in implants with a new technology.

BACKGROUND: Assess the reliability (by means of reproducibility and repeatability) of the PenguinRFA system, analyse the ISQ values of different implant types and correlate the ISQ with the insertion torque during the placement of the implant. MATERIAL AND METHODS: 120 rough surface implants were placed in bovine bone (type II and III). The implants were divided into groups, according to its design. Once the implants were in place, the exact insertion torque was registered. Then, primary stability was measured by means of the resonance frequency analysis with the PenguinRFA and the Osstell ISQ devices. In each implant two transducers of each device were used. Three measurements were obtained with each transducer. RESULTS: The mean ISQ (implant stability quotient) of the whole sample is 67,70 ± 5,51. The Intraclass Correlation Coefficient (ICC) is 0,933 and 0,944 for transducers 1 and 2 respectively. The reproducibility is 0,906. The mean insertion torque is 24,54 ± 8,96N. The correlation between the ISQ and the insertion torque is 0,507 p<0,000 (MultiPeg 1) and 0,468 p<0,000 (MultiPeg 2) for bone type II and 0,533 p<0,801 (MultiPeg 1) and 0,193 p<0,140 (MultiPeg 2) for bone type III. CONCLUSIONS: The results of the present trial suggest that the PenguinRFA presents excellent reproducibility and repeatability, so it could be very useful in the monitoring of the stability of implants over time. Additionally, according to the results, the correlation between the IT and the RFA is low and there are no statistically significant differences in between implant types.

Placental levels of metals and associated factors in urban and sub-urban areas of Seville (Spain).

Environmental exposure to metals among women, revealed their adverse effects on pregnancy. The fetus is exposed to these toxic elements only via the placenta which are able to accumulate there or cross it, compromising the protective functions of this organ. Numerous studies have shown associations between the prenatal exposition to some metals and an impact on cognitive, motor and intellectual development of the child. Sixty two placental samples were taken at delivery to determine the mineral content (Al, B, Ba, Ca, Cd, Cr, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, Pb, Sr, V, Zn) by ICP-OES. Among these metals, essential ones (B, Ca, Cu, Fe, Mg, Mn, Mo, Na, Zn) can have health beneficial effects at low levels however, in high concentration are potentially toxic. On the other hand, elements such as Al, Cd, Pb, are classified as toxic metals, no matter what its concentration is. The aim of this study is to find the potential relationships between these metals levels, newborn's parameters, pregnancy details and the epidemiologic information obtained using a questionnaire data from the participant pregnant women from Seville (Spain). The main maternal determinant of detectable placenta Cd levels was smoking during pregnancy. Other maternal factors that may affect placenta metal levels were gestational age (Al, B, Ba, and Pb) or dietary supplement (Fe). It has to be stressed that our results have to be interpreted with caution, because of the small study group and the low exposure levels, along with the lack of information on potential sources of exposure to these metals. The use of placenta samples obtained at delivery can be considered strength of this study since the concentration of some metals in placenta can indicate the extent of maternal exposure during gestation.

Unravelling the effect of macro and microscopic design of dental implants on osseointegration: a randomised clinical study in minipigs.

Several dental implants are commercially available and new prototype design are constantly being fabricated. Nevertheless, it is still unclear what parameters of the design affect most the osseointegration of dental implants. The purpose of this study is to assess the effects of the microscopic and macroscopic design of dental implants in the osseointegration by comparing three macroscopic designs (Straumann tissue level (STD), essential cone (ECD) and prototype design (PD)) and six surface treatments. A total of 96 implants were placed in 12 minipigs. The implant stability quotient (ISQ), was assessed at the time of implantation, as well as at 2, 4 and 8 weeks. Histomorphometric and statistical analyses were conducted at the different sacrifice times, being 2, 4 and 8 weeks, to analyse the bone to implant contact (BIC), the bone area density (BAT) and the density of bone outside the thread region (ROI). The macroscopic design results showed higher ISQ values for the ECD, whereas the histomorphometric analysis showed higher ossoeintegration values for the STD. Regarding the microscopic design, both Sandblasted plus acid etching (hydrochloric/sulphuric acid) in a nitrogen atmosphere (SLActive) and Shot-blasted or bombarded with alumina particles and posterior alkaline immersion and thermal treatment (ContacTi) showed superior results in terms of osseointegration and reduced the osseointegration times from 8 weeks to 4 weeks compared to the other analysed surfaces. In conclusion, each of the macroscopic and microscopic designs need to be taken into account when designing novel dental implants to enhance the osseointegration process.

Levator ani muscle injuries associated with vaginal vacuum assisted delivery determined by 3/4D transperineal ultrasound.

OBJECTIVES: To determine the rate of pelvic floor trauma, levator ani muscle (LAM) avulsion as well as the mean difference in levator hiatus area, after normal vaginal deliveries (NVD) and vacuum assisted deliveries (VD), assessed with three-dimensional transperineal ultrasound (3D-TpUS). MATERIALS AND METHODS: Prospective observational study with 151 nulliparous women with NVD or VD at ≥37 weeks between 9-2012 and 6-2013. 3D-TpUS was performed six months after every patient's delivery, during which LAM, anteroposterior diameter, transverse diameter and levator hiatus area were assessed. RESULTS: A total of 146 nulliparous were studied, comprising 73 NVD and 73 VD. No differences in obstetric, intrapartum or neonatal characteristics were observed between study groups, with the following exceptions: maternal age (28.1 ± 5.4 versus 30.4 ± 5.5; p = 0.008, OR = 1.1) and episiotomy rate (35.6% versus 97.3%; p = 0.011, OR = 4.3). LAM avulsion rate was 9.6% in NVD versus 34.2% in VD (p = 0.001, OR 3.99), while levator hiatus area at rest was 16.5 ± 3.2 versus 18.2 ± 3.9 (p = 0.016). CONCLUSIONS: Vacuum assisted deliveries present a higher rate of LAM avulsion, as well as a greater increase in levator hiatal area than in NVD.

Effect of irrigation and stainless steel drills on dental implant bed heat generation.

The objective of this study is assessing the influence of the use of different drill types and external irrigation on heat generation in the bone. In-vitro study to compare two different sequences for implant-bed preparation by means of two stainless steels: precipitation-hardening stainless steel (AISI 420B) (K drills), and martensitic stainless steel (AISI 440) (S drills). Besides, the drilled sequences were realized without irrigation, and with external irrigation by means of normal saline solution at room temperature. The study was realized on bovine ribs using: K without irrigation (KSI) and with irrigation (KCI) and S without irrigation (SSI) and with irrigation (SCI) with five drills for each system. Each drill was used 100 times. Bone temperature was measured with a thermocouple immediately after drilled. Average bone temperature with irrigation was for K drills 17.58±3.32 °C and for S drills 16.66±1.30 °C. Average bone temperature without irrigation was for K drills 23.58±2.94 °C and for S drills 19.41±2.27 °C. Statistically significant differences were found between K without irrigation versus S with irrigation and K with irrigation (p<0.05, Bonferroni correction). Lower temperature variation coefficient throughout the 50 measurements was observed in irrigated groups (K=5.6%, S=5.1% vs. without irrigation groups K=9.4%, S=9.3%). The first K drill generated more heat than the remaining drills. No significant differences were detected among temperature values in any of the analyzed drill groups. Unlike irrigation, drill use and type were observed to have no significant impact on heat generation. The stainless steel AISI 420B presents better mechanical properties and corrosion resistance than AISI440.

Comparative analysis of 2 resonance frequency measurement devices: Osstell Mentor and Osstell ISQ.

OBJECTIVE: Comparing reliability of Osstell Mentor and Osstell ISQ in implant stability measurement, and assessing whether their measurements are comparable. MATERIALS AND METHOD: Implant stability was measured with both devices on 58 implants in 15 patients. Six measurements were completed with each device with 2 different transducers (3 measurements with each transducer), that is, 12 measurements for each implant. RESULTS: Mean implant stability quotient (ISQ) value with Osstell ISQ was 72.59, 72.47, and 73.17 in the first measurements, respectively. With Osstell Mentor, the results were 72.43, 72.60, and 73.26, respectively; mean ranges were 3.37, 3.60, and 3.75, respectively. However, mean value with Osstell ISQ and Osstell Mentor was 72.87 and 72.04, respectively. The intraclass correlation coefficient was 0.98. This means an almost perfect degree of concordance between both devices. CONCLUSIONS: Resonance frequency analysis systems in Osstell Mentor and Osstell ISQ show almost perfect reproducibility and repeatability.

Valoración del impacto del tratamiento cognitivo, dentro del programa de rehabilitación, en pacientes con traumatismo craneoencefálico / Evaluation of the impact of cognitive treatment within the rehabilitation program in patients with traumatic brain injury

Introducción. El objetivo es determinar el impacto del tratamiento de rehabilitación cognitiva, sobre el déficit cognitivo y la capacidad funcional, en pacientes con traumatismo craneoencefálico (TCE). Material y método. Diseño del estudio cuasiexperimental, con grupo control. Sujetos del estudio. 34 pacientes con TCE moderado o severo que cumplen los criterios de inclusión. Los pacientes fueron asignados a 1) grupo experimental: realizan tratamiento cognitivo, con programa de estimulación cognitiva SMARTBRAIN, y rehabilitación funcional, o a 2) grupo control: realizan programa de tratamiento de rehabilitación funcional. La duración del tratamiento fue de 4 meses. Instrumentos de medidas. La valoración cognitiva se hace por el test Minimental y la escala Neurobehavioral Functioning Inventory, y son clasificados según la escala de nivel de función cognitiva Rancho los Amigos. La valoración funcional se realiza con el Functional Independence Measure (FIM), en el momento de la inclusión en el estudio, y al finalizar el tratamiento. Resultados. Se observó recuperación del déficit cognitivo, en el grupo experimental, con valores superiores en el test Minimental (p < 0,001; IC 95%: 2-7) y en cada una de las áreas que este instrumento evalúa. También se observaron diferencias en los valores obtenidos en las 6 subescalas de la escala Neurobehavioral Functioning Inventory, principalmente en atención, memoria (p < 0,04; lC 95%: −21-−4), y comunicación (p < 0,001; IC 95%: −17-−3). El grupo experimental también presentó valores superiores en la subescala cognitiva del FIM (p < 0,008; IC 95%: 1-6), pero no en el nivel funcional, valorado por el FIM. Conclusiones. En pacientes con TCE, el tratamiento cognitivo mejora la recuperación del déficit cognitivo, no existiendo deferencias en los resultados funcionales de estos pacientes (AU)

Introduction. This study has aimed to determine the impact of Cognitive Rehabilitation treatment on cognitive deficits and functional capacity in patients with traumatic brain injury (TBI). Material and method. The study has a quasi-experimental design, with a control group. Study subjects. 34 patients with moderate or severe TBI who fulfilled the inclusion criteria. The patients were assigned to 1) an experimental group: cognitive therapy was performed using the SMARTBRAIN stimulation cognitive program, and functional rehabilitation, 2) control group: functional rehabilitation treatment program was performed. The treatment duration was 4 months. Measurement instruments. The cognitive assessment was performed using the Minimental test, Neurobehavioral Functioning Inventory Scale and classification was done according to the Rancho de los Amigos levels of cognitive functioning scale. Functional assessment was performed using the Functional Independence Measure (FIM) both during enrolment in the study and at the end of the treatment. Results. Recovery of cognitive deficit was observed in the experimental group, with high values in Minimental test (P < .001; 95% CI: 2-7) and in each of the areas evaluated by this instrument. Differences were also observed in the values obtained in the six subscales of Neurobehavioral Functioning Inventory scale. These were mainly in attention, memory (P < .04, 95 CI: −21-−4%) and communication (P < .001; 95% CI: −17-−3). The experimental group also had high values in the FIM cognitive subscale (P < 0,008; 95% CI: 1-6), but not at the functional level, valued by FIM. Conclusions. In TBI patients, cognitive treatment improves recovery of cognitive deficit. There are no differences in functional outcomes of these patients (AU)

Desarrollo y validación de un modelo predictivo para la identificación de pacientes infectados por el VIH con problemas relacionados con los medicamentos. Estudio predictor / Development and validation of a prediction model to identify HIV+ patients with drug-related problems. A prediction study

Objetivo: Desarrollar y validar un modelo predictivo para la detección de problemas relacionados con los medicamentos (PRM) en pacientes con tratamiento antirretroviral (TAR), durante su seguimiento periódico en consultas de atención farmacéutica (AF) y previamente a la dispensación. Método Para encontrar factores pronósticos de PRM, se realizó un modelo de regresión logística binaria tras un análisis univariante, el cual identificó variables independientes relacionadas con PRM que fueron introducidas en el modelo multivariante para la selección final. La validez del modelo se determinó por el método Shrinkage y la capacidad discriminatoria por el estadístico C-Harrell. Estudio multicéntrico, abierto, prospectivo. Se incluyeron pacientes infectados por el VIH con y sin PRM. Para el diseño del modelo se incluyeron variables demográficas, clínicas y farmacoterapéuticas (relacionadas o no con el TAR).Resultados Se incluyeron 733 pacientes. Las variables «adherencia», «prescripción de fármacos con necesidad de ajuste posológico» y «número de medicamentos totales prescritos (al margen del TAR)» se relacionaban de manera independiente con la aparición de PRM. Las probabilidades predichas por el modelo, personalizando los coeficientes por el método shrinkage uniforme mostraron un valor R2=0,962 para la muestra de construcción y R2=0,872 para la de validación. La capacidad discriminatoria del modelo fue de 0,816 para la muestra de construcción y 0,779 para la de validación. Conclusiones El modelo predictivo desarrollado y validado permite la detección de pacientes con tratamiento antirretroviral y con mayor riesgo de sufrir un PRM. Las variables predictoras utilizadas se corresponden con las manejadas habitualmente en la historia farmacoterapéutica del paciente, permitiendo su empleo sistemático en la práctica asistencial (AU)

Objective: To develop and validate a prediction model for the detection of drug-related problems (DRP) in patients on antiretroviral treatment during their regular monitoring in Pharmaceutical Care Clinics before dispensing drugs. Method: Open multicentre prospective study. HIV patients with and without DRP were included. Demographic, clinical and pharmacotherapy variables (related and unrelated to antiretroviral treatment) were included in the model design. To find prognostic factors for DRP, a binary logistic regression model was created after performing a univariate analysis that identified independent variables related to DRP these variables were introduced in the multivariate model for the final selection. Model validity was determined by the shrinkage method and the discriminatory power by Harrell’s C-index. Results: 733 patients were included. The variables ‘‘adherence’’, ‘‘prescription of drugs needing dosage adjustment’’, and ‘‘total number of drugs prescribed (apart from the antiretroviral treatment)’’ were independently related to the appearance of DRP. Probabilities predicted by the model, customising the coefficients using the uniform shrinkage method, showed aR2= 0.962 for the construction sample and a R2= 0.872 for the validation sample. The discriminatory capacity of the model was 0.816 for the construction sample and 0.779 for the validationsample. Conclusions: The developed and validated model enables detection of patients on antiretroviral treatment who are at a higher risk for experiencing a DRP. The prediction variables employed are commonly used in patient’s pharmacotherapy record, allowing the model to be used in routine clinical practice (AU)

[Development and validation of a prediction model to identify HIV+ patients with drug-related problems. A prediction study]. / Desarrollo y validación de un modelo predictivo para la identificación de pacientes infectados por el VIH con problemas relacionados con los medicamentos. Estudio predictor.

OBJECTIVE: To develop and validate a prediction model for the detection of drug-related problems (DRP) in patients on antiretroviral treatment during their regular monitoring in Pharmaceutical Care Clinics before dispensing drugs. MEHOD: Open multicentre prospective study. HIV patients with and without DRP were included. Demographic, clinical and pharmacotherapy variables (related and unrelated to antiretroviral treatment) were included in the model design. To find prognostic factors for DRP, a binary logistic regression model was created after performing a univariate analysis that identified independent variables related to DRP these variables were introduced in the multivariate model for the final selection. Model validity was determined by the shrinkage method and the discriminatory power by Harrell's C-index. RESULTS: 733 patients were included. The variables "adherence", "prescription of drugs needing dosage adjustment", and "total number of drugs prescribed (apart from the antiretroviral treatment)" were independently related to the appearance of DRP. Probabilities predicted by the model, customising the coefficients using the uniform shrinkage method, showed a R(2)=0.962 for the construction sample and a R(2)=0.872 for the validation sample. The discriminatory capacity of the model was 0.816 for the construction sample and 0.779 for the validation sample. CONCLUSIONS: The developed and validated model enables detection of patients on antiretroviral treatment who are at a higher risk for experiencing a DRP. The prediction variables employed are commonly used in patient's pharmacotherapy record, allowing the model to be used in routine clinical practice.

[A prevalence study of dysphagia and intervention with dietary counselling in nursing home from Seville]. / Estudio de prevalencia de disfagia e intervención con consejo dietético, en residencias de mayores de Sevilla.

INTRODUCTION: The prevalence of swallowing disorders widely varies depending on age and comorbidity. OBJECTIVES: To determine the prevalence of dysphagia and feeding disorders in elderly people living in nursing homes from the province of Seville and assess the effectiveness of dietary counselling. METHODS: We carried out a cross-sectional descriptive study on a population of 3921 residents distributed among 86 nursing homes. At the first phase of the study, we pretended to estimate the prevalence of dysphagia so that we selected 373 residents in 23 nursing homes. At the second phase, a sample of residents with dysphagia was selected, being reassessed a month later after receiving dietary counselling and basic measures for managing dysphagia. RESULTS: The median age was 80 (73.86) years, 60 (17.3%) had dysphagia and 50 (13.4%) had feeding difficulties. Both conditions were significantly (p < 0.05) associated with neurological diseases. Forty (11.3%) presented cerebrovascular accident and 123 (34.8%) dementia. Twelve patients with dysphagia were studied at the second phase, the mean age being 80.6+/-11.9 years, MNA 19 +/- 3, Barthel 24 +/- 27, and dysphagia Karnell level of 3-4 in 75% of the cases. These patients, receiving dietary counselling and basic measures for managing dysphagia, did not improve their intake level, dysphagia or dependency. CONCLUSIONS: The prevalence of dysphagia and feeding difficulties is high among nursing homes residents. The standard measures for controlling dysphagia are little effective in patients with severe dependence or advanced dementia.

Estudio de prevalencia de disfagia e intervención con consejo dietético, en residencias de mayores de Sevilla / A prevalence study of dysphagia and intervention with dietary councelling in nursing home from Seville

Introducción: La prevalencia de las alteraciones de la deglución varia ampliamente según la edad y comorbilidad. Objetivos: Determinar la prevalencia de disfagia y alteraciones de la alimentación en personas mayores que viven en residencias de la provincia de Sevilla, valorando la efectividad del consejo dietético. Métodos: Se realizó un estudio descriptivo transversal sobre una población de 3.921 residentes distribuidos en 86 residencias. En una primera fase del estudio se pretendía estimar la prevalencia de disfagia, para lo cual se seleccionaron 373 residentes en 23 residencias. En una segunda fase se seleccionó una muestra de residentes con disfagia, siendo reevaluados un mes después tras recibir consejo dietético y medidas básicas para control de disfagia. Resultados: La mediana de edad fue 80 (73-86) años, presentaron disfagia 60 (17,3%), y dificultades de alimentación 50 (13,4%). Ambas se asociaron de forma significativa (p < 0,05) con enfermedades neurológicas. Presentaron accidente cerebrovascular (AVC) 40 (11,3%), y demencia 123 (34,8%). En la segunda parte se estudiaron 12 pacientes con disfagia, de edad media 80,6 ± 11,9 años, MNA 19 ± 3, Barthel 24 ± 27, y grado de disfagia Karnell 3-4, en un 75% de los casos. Estos pacientes a los que se sometió a consejo dietético y medidas básicas para control de disfagia no mejoraron el nivel de ingesta, disfagia o dependencia. Conclusiones: La prevalencia de disfagia y dificultades de la alimentación es muy elevada en residencias. Las medidas estándar para el control de la disfagia son poco efectivas en pacientes con dependencia severa o demencia avanzada (AU)

Introduction: The prevalence of swallowing disorders widely varies depending on age and comorbidity. Objectives: To determine the prevalence of dysphagia and feeding disorders in elderly people living in nursing homes from the province of Seville and assess the effectiveness of dietary counselling. Methods: We carried out a cross-sectional descriptive study on a population of 3921 residents distributed among 86 nursing homes. At the first phase of the study, we pretended to estimate the prevalence of dysphagia so that we selected 373 residents in 23 nursing homes. At the second phase, a sample of residents with dysphagia was selected, being reassessed a month later after receiving dietary counselling and basic measures for managing dysphagia. Results: The median age was 80 (73.86) years, 60 (17.3%) had dysphagia and 50 (13.4%) had feeding difficulties. Both conditions were significantly (p < 0.05) associated with neurological diseases. Forty (11.3%) presented cerebrovascular accident and 123 (34.8%) dementia. Twelve patients with dysphagia were studied at the second phase, the mean age being 80.6±11.9 years, MNA 19 ± 3, Barthel 24 ± 27, and dysphagia Karnell level of 3-4 in 75% of the cases. These patients, receiving dietary counselling and basic measures for managing dysphagia, did not improve their intake level, dysphagia or dependency. Conclusions: The prevalence of dysphagia and feeding difficulties is high among nursing homes residents. The standard measures for controlling dysphagia are little effective in patients with severe dependence or advanced dementia (AU)

Radiological assessment of periapical status using the periapical index: comparison of periapical radiography and digital panoramic radiography.

AIM: To compare the use of periapical radiographs and digital panoramic images displayed on monitor and glossy paper in the assessment of the periapical status of the teeth using the periapical index (PAI). METHODOLOGY: A total of 86 subjects were examined. All participants underwent a full-mouth radiographic survey (14 periapical radiographs) and a panoramic radiography. The periapical status, using the PAI score, of all appraised teeth was assessed. RESULTS: Periapical radiographs allowed the assessment of the periapical status of 87% of teeth using the PAI. On the contrary, digital radiography had a significantly reduced potential to allow assessment of the periapical status (P<0.01). Only 57.6% and 34.1% of teeth could be appraised using digital panoramic images displayed on monitor and glossy paper respectively (P<0.01). The total percentage of teeth with periapical pathosis was five fold higher when assessed with digital panoramic images displayed on glossy paper compared with periapical radiographs (P<0.01). CONCLUSIONS: Teeth were best viewed on periapical radiographs except maxillary second and third molars, which were better viewed in orthopantomograms. Orthopantomograms on screen were scorable more often than when on printed images. Apical periodontitis was scored more often on paper than on screen, and more often on screen than in periapical radiographs.

Escala de valoración funcional para consultas externas en medicina de rehabilitación. Escala de Valoración Funcional Virgen del Rocío (EVFvr) / Reliability and validity study of a functional assessment scale for out-patient visits in rehabilitation medicine. Functional Assessment Scale Virgen del Rocío (FASvr)

Nuestro objetivo era diseñar una escala funcional, para la valoración de los pacientes que son atendidos en las consultas externas de rehabilitación. En su diseño se ha considerado que la escala debía proporcionar información, no sólo al clínico, sino ayudar a documentar la efectividad del tratamiento. Por lo tanto, esta escala consta de cuatro subescalas o áreas de evaluación: dolor, deformidad, valoración de actividades de la vida diaria y valoración de la incapacidad, que forman la Escala de Valoración Funcional Virgen del Rocío (EVFvr). En este estudio, se han comenzado a evaluar las características clinimétricas de este instrumento. Pacientes y métodos. Para ello se han valorado a 98 pacientes que acudieron a consultas externas de nuestro hospital, pacientes que fueron evaluados en 2 ocasiones por diferentes médicos rehabilitadores. La valoración de la fiabilidad interobservador se realizó aplicando el coeficiente de correlación intraclase. La valoración de homogeneidad se estableció al comprobar la relación existente entre cada uno de los ítems que componen el instrumento, y la escala a la que pertenece, mientras que la consistencia interna, se evaluó utilizando el de Cronbach. Posteriormente, se analizó la validez del instrumento, aplicando el análisis factorial, con extracción de componentes principales y la rotación varimax. Resultados. En la valoración de la fiabilidad, el valor del coeficiente intraclase obtenido en la escala EVFvr fue de 0,89.Siendo este coeficiente superior a 0,75 en las distintas subescalas que componen este instrumento. En el estudio de la homogeneidad, se comprobó, en todos los casos, una relación ítem con el total de la escala superior a 0,20, mientras que en el análisis de la consistencia interna se obtuvo un coeficiente de de Cronbach de 0,92, para la escala global, y superior a 0,90, para las distintas subescalas que la componen, con la excepción de la subescala del dolor (0,77). Tras la realización del análisis factorial, se comprobó la extracción de 4 factores principales, que explicaban el 83 por ciento de la varianza. Conclusión. Los resultados obtenidos en el estudio, soportan las características de fiabilidad y validez del nuevo instrumento, considerándose que es posible la utilización de la escala EVFvr en las consultas externas de rehabilitación. Sin embargo, es necesario el desarrollo de nuevos estudios que aumenten la valoración de las características de la escala, con la comprobación de la dimensionalidad del instrumento (AU)