Adición de bloqueo serrato-intercostal/BRILMA para cirugía de acceso arteriovenoso: 2 casos clínicos / Addition of serratus-intercostal plane block/BRILMA for arteriovenous access surgery

La creación de un acceso arteriovenoso es obligatorio en pacientes con enfermedad renal terminal para tratamiento con hemodiálisis. Habitualmente implica disección a nivel axilar o en la parte superior de brazo, y la anestesia general es usada predominantemente debido a que la inervación axilar es compleja. Evitar la anestesia general podría ser beneficioso en estos pacientes de riesgo. Presentamos dos casos en los que se empleó el bloqueo serrato-intercostal/BRILMA, junto con bloqueo supraclavicular ecoguiado y analgesia multimodal para cirugía de acceso arteriovenoso axilar o de brazo proximal. La combinación de técnicas de anestesia regional mediante bloqueo supraclavicular y serrato-intercostal/BRILMA en cirugía de fístula arteriovenosa fue exitosa y debe ser considerada por el anestesiólogo con el fin de evitar la anestesia general

Arteriovenous access creation is mandatory in patients with end stage renal disease for hemodialysis treatment. It frequently involves upper arm or axillary dissection and general anesthesia is predominantly used as axillary compartment innervation is complex. Avoiding general anesthesia may be beneficial in these risk patients. We present two cases where serratus-intercostal plane block (SIPB/BRILMA) was used, along with ultrasound guided supraclavicular block and multimodal analgesia for proximal arm and axillary AV access surgery. Regional anesthesia combination of supraclavicular and serratus-intercostal/BRILMA block in arteriovenous fistula surgery was successful and should be considered by anesthesiologist in order to avoid general anesthesia

Addition of serratus-intercostal plane block/BRILMA for arteriovenous access surgery. / Adición de bloqueo serrato-intercostal/BRILMA para cirugía de acceso arteriovenoso: 2 casos clínicos.

ARTERIOVENOUS: access creation is mandatory in patients with end stage renal disease for hemodialysis treatment. It frequently involves upper arm or axillary dissection and general anesthesia is predominantly used as axillary compartment innervation is complex. Avoiding general anesthesia may be beneficial in these risk patients. We present two cases where serratus-intercostal plane block (SIPB/BRILMA) was used, along with ultrasound guided supraclavicular block and multimodal analgesia for proximal arm and axillary AV access surgery. Regional anesthesia combination of supraclavicular and serratus-intercostal/BRILMA block in arteriovenous fistula surgery was successful and should be considered by anesthesiologist in order to avoid general anesthesia.

The COBATEST network: monitoring and evaluation of HIV community-based practices in Europe, 2014-2016.

OBJECTIVE: The objective of this paper is to describe the data collected by the CBVCT services from the Community-based testing (COBATEST) network, from 2014 to 2016, in order to provide an insight into community-based voluntary counselling and testing (CBVCT) services' testing activity in Europe. METHODS: A descriptive analysis of HIV testing activity in CBVCT services that are using the COBATEST tools was performed for the period 2014-2016. RESULTS: During the study period, a total of 30 329 HIV tests were performed on 27 934 individuals, of which 1.8% were reactive. Of these reactive tests, 75.8% had a confirmatory test, 92.2% of those were confirmed as positive, and 90.38% of the confirmed positives were linked to care. The total number of tests performed over the study period increased 19.31%. The proportion of confirmatory tests increased from 63.0% to 90.0% and proportion linked to care increased from 84.1% to 93.8%. Most of the tested individuals were men (70.6%), aged between 21 and 35 years (58.5%) and non-foreign born (68.1%). A high proportion of individuals tested were men who have sex with men (MSM; 42.2%). The percentage of reactive screening tests was particularly high among transgender people (8.37%) and among male sex workers (6.38%). Repeat testers had a higher percentage of reactive tests (2.02%) than those tested for first time (1.1%). CONCLUSIONS: These results prove the feasibility of collecting standardized data from CBVCT services in different countries across Europe and demonstrate the usefulness of such data.

Experience and Security of the Hand-Assisted Laparoscopic Nephrectomy of a Living Donor in a Public Health Center.

BACKGROUND: Hand-assisted laparoscopic nephrectomy (HALDN) is currently the procedure of choice for obtaining living donor kidneys for transplantation. In our institution, it has been the standard procedure for 5 years. Previous studies have shown the same function of the graft as that obtained by open surgery, with a lower rate of bleeding and no differences in complications. We sought to demonstrate the experience and safety of HALDN compared with open donor nephrectomy in healthy donors for kidney transplantation. METHODS: A retrospective analytical observational study was conducted, reviewing the records of the living donors for kidney transplant undergoing open donor nephrectomy or HALDN in our center from March 1, 2009, to March 1, 2016. Renal function was assessed by the estimated glomerular filtration rate by the Modification of Diet in Renal Disease method before and after donation, as well as bleeding (mL), and complications (according to Clavien), performing a comparative analysis between the two techniques using parametric or nonparametric tests. RESULTS: A total of 179 living donor nephrectomies were performed during the study period-31 open donor nephrectomy (17.3%) and 148 HALDN (82.7%)-without relevant baseline differences, except for creatinine. HALDN has a shorter surgical time (156,473 ± 87.75 minutes vs 165,484 ± 69.95 minutes) and less bleeding (244.59 ± 416.08 mL vs 324.19 ± 197.986 mL) and a shorter duration of hospital stay (3.74 ± 1.336 days vs 4.75 ± 1.226 days). There were no significant differences in surgical complications at 30 days, or graft loss reported; there were 3 conversions (1.7%) from the HALDN to the open technique. There were no differences in renal function in the donors or recipients at the 5th day or the month after surgery. CONCLUSIONS: Laparoscopic nephrectomy has replaced open surgery as the gold standard for living kidney donors. HALDN is a safe and feasible procedure when compared with open donor nephrectomy, achieving a shorter surgical time with less bleeding, and no difference in the number of complications. This procedure lowers costs by decreasing the duration of the hospital stay, making is feasible to perform it at any institution with appropriately trained personnel.

Community-based screening of hepatitis C with a one-step RNA detection algorithm from dried-blood spots: Analysis of key populations in Barcelona, Spain.

Alternative strategies are required to enhance the diagnosis of silent hepatitis C virus (HCV) infections in key populations at risk. Among them, HCV prevalence and bio-behavioural data are scarce for HIV-negative men who have sex with men (MSM) and men and trans-women sex workers. We sought to describe and assess the potential benefits of a community-based one-step HCV screening and confirmatory strategy for these populations in Barcelona. The screening strategy based on a real-time RT-PCR assay for HCV-RNA detection in dried-blood spots (DBS) was validated and implemented in addition to an antibody point-of-care test in a community centre. HCV prevalence was assessed, and bio-behavioural data were collected. The molecular assay was precise, reproducible, sensitive and specific. Four HIV-negative MSM reported being currently infected (0.75% HCV self-reported prevalence). Implementation of DBS testing was easy, and acceptability was >95%, but no silent HCV case was diagnosed (N = 580). High-risk sexual practices and drug use for sex were reported frequently. HIV prevalence was 4.7% in MSM and 10% in sex workers. Self-reported prevalence of other STIs ranged from 11.3% to 36.2%. In conclusion, HCV-RNA testing in DBS showed a good performance, but the assessed one-step strategy does not seem beneficial in this setting. Although no silent HCV infections were detected, the observed high-risk behaviours and prevalence of other STIs suggest that HCV spread should be periodically monitored among these populations in Barcelona by means of behavioural surveillance, rapid antibody testing and molecular confirmation in DBS.

Terapia por microcorrientes (TMC) y su efecto sobre el dolor cervical posterior tras cirugía de tiroides y paratiroides / Microcurrent therapy (MCT) and its effect on posterior neck pain following thyroidectomy and parathyroidectomy

No disponible

La administración de ropivacaína durante el trabajo de parto: analgesia y bloqueo motor / Ropivacaine in obstetric labor: analgesia and motor block

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Differences between migrants and Spanish-born population through the HIV care cascade, Catalonia: an analysis using multiple data sources.

Migrants are considered a key group at risk for HIV infection. This study describes differences between migrants and the Spanish-born population as they progress through the HIV care cascade in Catalonia, Spain. This study found that among people reached by prevention activities, migrants had a higher number of barriers to access HIV testing services than Spanish-born people, driven primarily by shared risk factors. Between 2001 and 2013, 9829 new HIV diagnoses were reported in Catalonia, the proportion of migrants increasing from 24% in 2001 to 41% in 2013. Compared with Spanish-born people, migrants had a higher proportion of women at diagnosis (24·6% vs. 16·7%), and were younger (median age of 33 vs. 37). The most frequent at-risk population was MSM (men who have sex with men) in both migrants and Spanish-born people, (40% and 43%, respectively), although there were significant differences by region of origin. People from sub-Saharan Africa had the highest proportion of late diagnosis (63·7%). Compared with the Spanish-born population, migrants on follow-up had a lower proportion of people on antiretroviral therapy (ART) (93·7% vs. 90·8%, P < 0·001) and with viral suppression (87·2% vs. 82·9%, P < 0·001). Migrants have higher number of barriers to access HIV testing services, lower retention rates and proportions on ART as compared with Spanish-born people, these differences not being uniform between migrants from different regions.

Estudio de prevalencia del trastorno por déficit de atención e hiperactividad en niños en régimen de acogimiento residencial / Prevalence study of attention deficit hyperactivity disorder in children in residential care

INTRODUCCIÓN: Los niños que se encuentran en régimen de acogimiento residencial constituyen un colectivo de riesgo en el que los problemas médicos pueden alcanzar altas tasas, especialmente aquellos relacionados con la esfera psicológica, donde el trastorno por déficit de atención e hiperactividad (TDAH) es una de las alteraciones del neurodesarrollo más frecuentes. OBJETIVO: El propósito de este estudio fue determinar la prevalencia de TDAH en los niños de un centro de acogida en Albuñol (Granada) en 2016. Material y Métodos. En este estudio transversal se incluyeron los 106 niños de edades comprendidas entre los 5 y los 17 años del Centro Hogar "Cristo Rey". La evaluación psicométrica se basó en la Escala de Vanderbilt de TDAH. Las funciones ejecutivas se evaluaron mediante el Behavior Rating Inventory of Executive Function (BRIEF) en aquellos participantes que cumplieron los criterios de Vanderbilt, y también se aplicaron los criterios del DSM-5 en la entrevista clínica para reforzar el diagnóstico de TDAH. RESULTADOS: La prevalencia de TDAH fue del 17.9% en nuestro grupo, siendo el subtipo inatento el más frecuente. CONCLUSIONES: La prevalencia de TDAH en el centro de acogida "Cristo Rey" fue notablemente elevada en comparación con la prevalencia en niños de la población general. Es necesario seguir investigando acerca de las comorbilidades relacionadas con el TDAH en niños en régimen de acogimiento residencial. Deberían instaurarse programas de detección e intervención en centros de acogida por las repercusiones que puede llegar a tener el TDAH

INTRODUCTION: Children in residential care constitute a risk group in which medical problems can reach high rates, especially those concerned to the psychological sphere, including attention deficit hyperactivity disorder (ADHD), one of the most common neurodevelopmental disorders. OBJECTIVE: The purpose of this study was to determine the prevalence of ADHD in children in a foster care institution in Albuñol (Granada) in 2016. MATERIALS AND METHODS: This cross-sectional descriptive study included 106 children aged 5 to 17 years from "Cristo Rey" foster care institution. Psychometric evaluation was based on Vanderbilt ADHD Diagnostic Rating Scale. Executive functions were tested using the Behavior Rating Inventory of Executive Function (BRIEF) in participants who met Vandebilt criteria, as well Diagnostic and DSM- 5 criteria were applied in a clinical interview to strengthen ADHD diagnosis. RESULTS: The prevalence of ADHD was determined to be 17.9 % in our group, with innatentional subtype being the most important. CONCLUSION: Prevalence of ADHD in "Cristo Rey" foster care institution was visibly high in comparison with estimated prevalence in children general population. Research is needed to identify comorbidities in children in residential care suffering from ADHD. ADHD detection and intervention programmes in residential care must be developed because of its repercussion

The COBATEST network: a platform to perform monitoring and evaluation of HIV community-based testing practices in Europe and conduct operational research.

The European project "HIV community-based testing practices in Europe" (HIV-COBATEST) has contributed to the establishment of a network of community-based voluntary counselling and testing services (CBVCTs) that monitors and evaluates HIV testing activity in the communities. The objective of this paper is to describe the data that have been collected during 2014 by the COBATEST network in order to provide an insight into testing activity of CBVCTs in Europe. Members of the CBVCT network share common instruments for data collection and data entry. The network has a common database that allows global data analysis and comparison between different centres. In 2014, 40 CBVCTs of 18 European countries were participating in the network, and, from those, 20 CBVCTs were using the common COBATEST data collection tools. In these 20 CBVCTs, a total of 9266 HIV screening tests were performed on 8554 people, of which 1.58% (135/8554) were reactive and 51.1% (69/135) confirmed positive. Five cases were false positives, and 84.1% (58/69) of the confirmed positive cases were linked to care. Most of the tested individuals were men (70.8%), between 21 and 35 years of age (57.6%) and natives (67.1%). A higher proportion of men who had sex with men (MSM) (38.8%; 3267/8554) were tested compared to heterosexual men (27.7%) and women (23.5%). Rapid blood test was used in 78.5% of the cases and mostly performed in CBVCT offices (88.3%). Among sex workers (SWs), the percentage of reactive screening tests was particularly high (4.0%), especially among male SWs (7.7%) as compared to other risk groups, such as MSM (3.1%). The COBATEST network contributes to the availability of standardized information about the activity and impact of CBVCT centres in Europe. This information and standardized tools can help improve these services and inform decision-makers to better contextualize these interventions within their national HIV-prevention programmes.

Attitudes to rapid HIV testing among Spanish General Practitioners.

OBJECTIVES: The objectives of this study were to investigate the acceptability of rapid HIV testing among general practitioners in Spain and to identify perceived barriers and needs in order to implement rapid testing in primary care settings. METHODS: An anonymous questionnaire was distributed online to all members of the two largest Spanish scientific medical societies for family and community medicine. The study took place between 15th June and 31st October 2010. RESULTS: Completed questionnaires were returned by 1308 participants. The majority (90.8%) of respondents were General Practitioners (GP). Among all respondents, 70.4% were aware of the existence of rapid tests for the diagnosis of HIV but they did not know how to use them. Nearly 80% of participants would be willing to offer rapid HIV testing in their practices and 74.7% would be confident of the results obtained by these tests. The barriers most commonly identified by respondents were a lack of time and a need for training, both in the use of rapid tests (44.3% and 56.4%, respectively) and required pre- and post-test counselling (59.2% and 34.5%, respectively). CONCLUSIONS: This study reveals a high level of acceptance and willingness on the part of GPs to offer rapid HIV testing in their practices. Nevertheless, the implementation of rapid HIV testing in primary care will not be possible without moving from comprehensive pre-test counselling towards brief pre-test information and improving training in the use of rapid tests.

Acceptability of rapid HIV diagnosis technology among primary healthcare practitioners in Spain.

This study investigated the acceptability of rapid HIV testing among general practitioners (GP) and aimed to identify perceived barriers and needs in order to implement rapid testing in primary care settings. An anonymous questionnaire was distributed online to all members of the two largest Spanish scientific medical societies for family and community medicine. The study took place between 15 June 2012 and 31 October 2010. Completed questionnaires were returned by 1308 participants. The majority (90.8%) of respondents were GP. Among all respondents, 70.4% were aware of the existence of rapid tests for the diagnosis of HIV but they did not know how to use them. Nearly 80% of participants would be willing to offer rapid HIV testing in their practices and 74.7% would be confident of the result obtained by these tests. The barriers most commonly identified by respondents were a lack of time and a need for training, both in the use of rapid tests (44.3% and 56.4%, respectively) and required pre- and post-test counselling (59.2% and 34.5%, respectively). This study reveals a high level of acceptance and willingness on the part of GPs to offer rapid HIV testing in their practices. Nevertheless, the implementation of rapid HIV testing in primary care will not be possible without moving from comprehensive pre-test counselling towards brief pre-test information and improving training in the use of rapid tests.

Ancianos frágiles ¿Un nuevo objetivo terapéutico? / No disponible

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Impact of the introduction of rapid HIV testing in the Voluntary Counselling and Testing sites network of Catalonia, Spain.

Rapid HIV antibody tests, which provide results within 15-60 minutes, can help reduce the number of unrecognized infections by improving access to testing facilities and increase the number of people tested who know their results. After an acceptability study, rapid HIV testing was first implemented in Catalonia in 2007 within the community-based Voluntary Counselling and Testing sites network. One year after implementation, an increase of 102.9% has been observed in the number of tests performed, ranging from 8.4% to 328.3% according to the site. Despite the important immediate impact of rapid HIV testing on the number of tests performed, there was no significant change in the proportion of tests that were positive. Rapid HIV testing can help increase access to testing, but it should be complemented with specific outreach programmes targeting the most vulnerable subgroups.

Proteínas de fase aguda como marcadores biológicos de la psicopatología negativa en la esquizofrenia paranoide / Acute phase proteins as biological markers of negative psychopathology in paranoid schizophrenia

Introducción. La respuesta inflamatoria aguda es uno de los elementos fisiopatológicos que se pueden alterar en la psicosis esquizofrénica. El objetivo de este trabajo consiste en estudiar las relaciones existentes entre psicopatología y proteínas de fase aguda (PFA) en la esquizofrenia paranoide. Método. Se estudiaron 15 pacientes diagnosticados de esquizofrenia paranoide según el DSM-IV. A todos los sujetos se les administró la versión española de la Escala de síndromes Positivo y Negativo (PANSS) para cuantificar la psicopatología. Como PFA se midieron los niveles de ceruloplasmina y las fracciones 3 y 4 del complemento. Resultados. Cinco de los siete ítems de la subescala negativa de la PANSS se correlacionaron de manera positiva y significativa con las PFA. Dos ítems de la escala de psicopatología general, Atención deficiente y Evitación social activa, se correlacionaron positiva y significativamente con las PFA. Ningún ítem de la subescala positiva se correlacionó significativamente con los niveles sanguíneos de las PFA. Conclusiones. La cuantificación de los niveles plasmáticos de ceruloplasmina y las fracciones 3 y 4 del complemento puede consideralos como marcadores periféricos de la psicopatología negativa en la esquizofrenia paranoide aguda

Introduction. Acute inflammatory response is one of the pathophysiological elements involved in the etiology of schizophrenia. This paper aims to study the relationship between Acute Phase Proteins (APPs) and psychopathology in paranoid schizophrenia. Method. Fifteen physically healthy inpatients meeting DSM-IV criteria for paranoid schizophrenia took part in the study. The Spanish version of the Positive and Negative Syndrome Scale (PANSS) was used in order to rate psychopathology. Ceruloplasmin, Complement's fraction 3 (C3) and fraction 4 (C4) levels were measured as APPs. Results. Five out of seven items of the PANSS negative subscale showed a positive correlation with the APPs at a significant level. Poor Attention and Active Social Avoidance, two items of the general psychopathology subscale, correlated significantly with the APPs. No single item of the positive subscale correlated with the APPs. Conclusions. Ceruloplasmin, C3 and C4 blood levels are useful peripheral biological markers of negative acute paranoid schizophrenic symptoms

Acute phase proteins as biological markers of negative psychopathology in paranoid schizophrenia.

INTRODUCTION: Acute inflammatory response is one of the pathophysiological elements involved in the etiology of schizophrenia. This paper aims to study the relationship between Acute Phase Proteins (APPs) and psychopathology in paranoid schizophrenia. METHOD: Fifteen physically healthy inpatients meeting DSM-IV criteria for paranoid schizophrenia took part in the study. The Spanish version of the Positive and Negative Syndrome Scale (PANSS) was used in order to rate psychopathology. Ceruloplasmin, Complement's fraction 3 (C3) and fraction 4 (C4) levels were measured as APPs. RESULTS: Five out of seven items of the PANSS negative subscale showed a positive correlation with the APPs at a significant level. Poor Attention and Active Social Avoidance, two items of the general psychopathology subscale, correlated significantly with the APPs. No single item of the positive subscale correlated with the APPs. CONCLUSIONS: Ceruloplasmin, C3 and C4 blood levels are useful peripheral biological markers of negative acute paranoid schizophrenic symptoms.

Impacto del índice tobillo-brazo sobre la estratificación de riesgo cardiovascular de pacientes hipertensos / Importance of ankle-arm index in cardiovascular risk factor stratification for hypertensive patients

Introducción. El índice de presión arterial tobillo-brazo (ITB) es una prueba diagnóstica eficiente en la detección de vasculopatía periférica y predice la morbimortalidad cardiovascular. El objetivo de este estudio fue evaluar el impacto de la realización de ITB en la estratificación de riesgo de sujetos sin enfermedad cardiovascular (ECV) clínica. Material y métodos. Se incluyeron pacientes con hipertensión arterial esencial, mayores de 65 años, de ambos sexos y al menos con un factor de riesgo cardiovascular. A todos ellos se les calculó los ITB pedios y tibiales de ambos miembros inferiores, determinando la presión arterial sistólica en dichos territorios mediante un detector continuo de pulso por sistema doppler (Vasculascope Model 500, Hayashi Denki Co., Ltd). Se consideró diagnóstico anormal un ITB inferior a 0,9 o superior a 1,3. Se recogieron datos sobre presión arterial, peso, talla, antecedentes personales y familiares, uso de fármacos y hábitos tóxicos. También se tomaron muestras sanguíneas para la valoración del perfil lipídico, bioquímica sanguínea y hemograma. Se incluyeron 130 pacientes hipertensos (62 por ciento varones), con una edad media de 68 ñ 5 años, y un valor de presión arterial sistólica media en brazo dominante de 146 ñ15 mmHg. Resultados. Según la clasificación del riesgo cardiovascular, 59 (45 por ciento) pacientes presentaban un riesgo medio y 71 (55 por ciento) mostraban un riesgo cardiovascular elevado. De los 130 pacientes, 9 (6,9 por ciento; IC 95 por ciento: 2,6 por ciento-11,4 por ciento) presentaron un ITB anormal, dos (3,4 por ciento) en el grupo de riesgo medio y 7 (9,9 por ciento) entre los pacientes de riesgo elevado. Conclusión. La medición del ITB en pacientes hipertensos libres de ECV clínica y diabetes, con riesgo medioalto, no parece ser clínicamente útil debido al escaso número detectado de pacientes con ITB anormal y que podrían obtener beneficios de esta intervención al ser reclasificados como de riesgo muy alto (AU)

El mayor en la sala de urgencias / The old men in the urgencies' room

Se trata de una revisión acerca de las causas que motivan la consulta a urgencias en este grupo de edad y de las peculiaridades de las mismas, en base a la forma particular de enfermar las personas mayores y a la semiología de sus enfermedades. Se destaca la importancia de la situación social previa y posterior a la consulta, así como de las consecuencias que en esta esfera pudieran derivarse de ella. Se menciona la importancia del nivel de desarrollo funcional y de su pérdida como causa de este tipo de consultas. Se hace mención a la necesidad de un abordaje multidimensional para la adecuada valoración del mayor, en la propia sala de urgencias (AU)