Nervio mediano trífido. Una variante anatómica infrecuente en la exploración ecográfica del túnel del carpo / Trifid median nerve. A rare anatomical variant in sonographic evaluation of carpal tunnel

El estudio ecográfico para el diagnóstico del síndrome del túnel del carpo puede ponernos de manifiesto distintas variantes anatómicas. Una variante poco común es la presencia de un nervio mediano trífido, que puede ser de importancia en una posterior planificación quirúrgica. Varón de 52 años, con clínica compatible con síndrome del túnel del carpo bilateral. Se realiza una evaluación ecográfica, visualizándose un nervio mediano bífido en la muñeca derecha y un nervio mediano trífido en la izquierda como variantes de la normalidad. La aparición de un tercer elemento nervioso en el túnel del carpo debe ser diferenciado de una persistencia de la arteria mediana a nivel del túnel del carpo junto a un nervio mediano bífido, mucho más habitual. Para ello, es fundamental la visualización ecográfica de la zona de estudio mediante la utilización de la función Doppler, como vemos en el caso clínico que presentamos.(AU)

The ultrasound study for the diagnosis of carpal tunnel syndrome can reveal different anatomical variants. A rare variant is the presence of a trifid median nerve. The visualization of this anatomical variant may be of importance in the surgical planning of carpal tunnel syndrome. Fifty-two-year-old male, with a clinic compatible with bilateral carpal tunnel syndrome. In the ultrasound examination, a bifid median nerve appears as a finding in the right wrist and a trifid median nerve in the left wrist as anatomical variants. It is important to distinguish a trifid median nerve from a persistent median artery at the level of the carpal tunnel, much more frequent than the first. For this, the ultrasound visualization of the study area using the Doppler function is essential.(AU)

[Trifid median nerve. A rare anatomical variant in sonographic evaluation of carpal tunnel]. / Nervio mediano trífido. Una variante anatómica infrecuente en la exploración ecográfica del túnel del carpo.

The ultrasound study for the diagnosis of carpal tunnel syndrome can reveal different anatomical variants. A rare variant is the presence of a trifid median nerve. The visualization of this anatomical variant may be of importance in the surgical planning of carpal tunnel syndrome. Fifty-two-year-old male, with a clinic compatible with bilateral carpal tunnel syndrome. In the ultrasound examination, a bifid median nerve appears as a finding in the right wrist and a trifid median nerve in the left wrist as anatomical variants. It is important to distinguish a trifid median nerve from a persistent median artery at the level of the carpal tunnel, much more frequent than the first. For this, the ultrasound visualization of the study area using the Doppler function is essential.

Implantación de un nuevo modelo organizativo en la atención al proceso musculoesquelético: ¿mejora la capacidad de resolución de los procesos? / Implementation of a new referral model for the musculoskeletal care pathway: does it improve healthcare outcomes?

OBJETIVO: Evaluar el impacto de un cambio organizativo en la gestión del proceso musculoesquelético en nuestra Área de Gestión Sanitaria (AGS) estudiando los cambios en la capacidad de resolución de estos procesos mediante la derivación a la especialidad útil. DISEÑO: Estudio descriptivo prospectivo para evaluar las tendencias de las derivaciones de atención primaria (PAP) y atención hospitalaria (PAE) con procesos musculoesqueléticos en el periodo 2012-2018. MATERIAL Y MÉTODO: Se incluye a toda la población de referencia de nuestra AGS derivada a alguna de las 3 especialidades hospitalarias que atienden procesos musculoesqueléticos, sin determinación del tamaño muestral. Variables estudiadas: PAP, PAE, servicio de procedencia y de destino. Para el análisis estadístico se utilizó el programa SPSS; se presenta la evaluación de frecuencias absolutas. RESULTADOS: Las derivaciones totales realizadas desde atención primaria han pasado de 25.575 en 2012 a 24.871 en 2018. Las derivaciones PAE han pasado de 17.207 en 2012 a 9.803 en 2018. De las derivaciones PAP, el de mayor impacto ha sido el Servicio de Rehabilitación, que ha pasado de recibir el 8,2% de PAP en 2012 al 47% en 2018. De las derivaciones PAE por especialidad, la mayor reducción ha sido la del Servicio de Traumatología, que pasó de recibir 10.587 PAE en 2012 a 3.911 en 2018. CONCLUSIONES: El rediseño organizativo de la atención al proceso musculoesquelético ha conseguido mejorar la resolución de los procesos musculoesqueléticos. En este cambio organizativo, el Servicio de Rehabilitación ha asumido el liderazgo desde el punto de vista asistencial y de gestión del proceso musculoesquelético, lo que ha colaborado en la mejora de la resolución de estos procesos

OBJECTIVE: To evaluate the impact of an organisational change in the musculoskeletal referral pathway in our health management area (HMA) by identifying changes in the ability to improve healthcare outcomes by facilitating referral to the most suitable specialty. DESIGN: This prospective descriptive study aimed to evaluate referral trends from primary care services (PCS) and hospital care (PHS) to musculoskeletal services from 2012 to 2018. MATERIALS AND METHODS: We included all patients who were referred to any of the 3 musculoskeletal services from our HMA catchment area, without specifying sample size. The variables studied were PCS, PHS, service of origin and destination. We used the SPSS programme for the statistical analysis and obtained absolute frequency data. RESULTS: The total number of referrals from PCS increased from 25,575 in 2012 to 24,871 in 2018. PHS referrals decreased from 17,207 in 2012 to 9,803 in 2018. With regards to PCS referrals, the service most increasing the number of referrals to the musculoskeletal team was the Rehabilitation Service, from 8.2% in 2012 to 47% in 2018. Regarding PHSs referrals by specialty, the service that most reduced the number of referrals to the musculoskeletal team was the Traumatology Service, from 10,587 in 2012 to 3,911 in 2018. CONCLUSIONS: The redesign of the musculoskeletal referral pathway improved healthcare outcomes by improving the quality of the referral process. In this organisational change, the Rehabilitation Service took the leadership from the point of view of healthcare and management of the musculoskeletal process, collaborating in the improvement of the healthcare outcomes of these processes

[Implementation of a new referral model for the musculoskeletal care pathway: Does it improve healthcare outcomes?] / Implantación de un nuevo modelo organizativo en la atención al proceso musculoesquelético: ¿mejora la capacidad de resolución de los procesos?

OBJECTIVE: To evaluate the impact of an organisational change in the musculoskeletal referral pathway in our health management area (HMA) by identifying changes in the ability to improve healthcare outcomes by facilitating referral to the most suitable specialty. DESIGN: This prospective descriptive study aimed to evaluate referral trends from primary care services (PCS) and hospital care (PHS) to musculoskeletal services from 2012 to 2018. MATERIALS AND METHODS: We included all patients who were referred to any of the 3 musculoskeletal services from our HMA catchment area, without specifying sample size. The variables studied were PCS, PHS, service of origin and destination. We used the SPSS programme for the statistical analysis and obtained absolute frequency data. RESULTS: The total number of referrals from PCS increased from 25,575 in 2012 to 24,871 in 2018. PHS referrals decreased from 17,207 in 2012 to 9,803 in 2018. With regards to PCS referrals, the service most increasing the number of referrals to the musculoskeletal team was the Rehabilitation Service, from 8.2% in 2012 to 47% in 2018. Regarding PHSs referrals by specialty, the service that most reduced the number of referrals to the musculoskeletal team was the Traumatology Service, from 10,587 in 2012 to 3,911 in 2018. CONCLUSIONS: The redesign of the musculoskeletal referral pathway improved healthcare outcomes by improving the quality of the referral process. In this organisational change, the Rehabilitation Service took the leadership from the point of view of healthcare and management of the musculoskeletal process, collaborating in the improvement of the healthcare outcomes of these processes.

Frequency and risk factors for toxoplasmosis in ovines of various regions of the State of Colima, Mexico.

Infection of ewes by Toxoplasma gondii may induce abortions, thus it has consequences for sheep production. Colima, Western State of Mexico, has favourable climatic conditions for transmission and both domestic and wild cats live there. The aim of this study was to determine the frequency of specific antibodies in sheep from the coast, a mountain, and a hill of Colima. Serum samples from 351 sheep were tested by a previously standardized indirect ELISA. The frequency of infection was estimated and the farm location and flock size, as well as the animals' age and sex were analysed as risk factors for toxoplasmosis. The frequency of antibodies depended on the altitude, being higher at sea level than at 1200 metres above sea level (OR=3.77, 95% CI=1.79-7.94, P<0.0001), and the size of the flock, being higher in the large ones (OR=2.23, 95% CI=1.35-3.71, P=0.002). Older animals were more frequently positive and with a stronger response than young ones (OR=1.77, 95% CI=1.07-2.93, P=0.016). No differences were observed between male and female sheep. In conclusion, toxoplasmosis is present in sheep of Colima with variations related to altitude, flock size and age.