[Parsonage-Turner syndrome: Unknown but not infrequent. Apropos of 6 cases]. / Síndrome de Parsonage-Turner: desconocido pero no infrecuente. A propósito de 6 casos.

Shoulder pain is a common reason for seeking emergency, primary and specialist care. Parsonage-Turner syndrome should form part of the differential diagnosis of shoulder pain. Familiarity with the clinical and electrophysiological characteristics of this syndrome could help prevent iatrogenic disease. We present 6 cases of Parsonage-Turner syndrome, a syndrome of unknown etiology with a typical clinical picture. All patients had acute onset of the syndrome with intense shoulder pain of approximately 3 weeks' duration. After this phase ended, there was noticeable weakness of the affected arm, causing muscular atrophy depending on the muscles affected by the neuropathy. Winged scapula was present in all patients. One patient showed alteration of sensitivity and another showed hemidiaphragmatic paralysis. After a complete physical examination, the patients underwent electromyographic study that confirmed the diagnosis. Analgesic treatment and rehabilitation were prescribed.

Síndrome de Parsonage-Turner: desconocido pero no infrecuente. A propósito de 6 casos / Parsonage-Turner syndrome: unknown but not infrequent. Apropos of 6 cases

El hombro doloroso es un motivo de consulta habitual en Urgencias, Atención Primaria y algunas especialidades. El síndrome de Parsonage-Turner debe formar parte del diagnóstico diferencial de la omalgia aguda. Conocer sus características clínicas y electrofisiológicas nos permitirá evitar iatrogenia. Presentamos 6 casos de síndrome de Parsonage-Turner: un síndrome de etiología desconocida con un cuadro clínico muy característico. Todos comenzaron de forma aguda, con dolor muy intenso de hombro de unas 3 semanas de duración. Tras la resolución de esta primera fase, se evidencia una debilidad marcada del miembro superior con atrofia de los músculos afectados por la neuropatía. Una constante en todos fue el hallazgo de escápula alada. Un caso presentó alteración sensitiva y otro, parálisis hemidiafragmática. Tras la sospecha clínica y la exploración física completa, fueron sometidos a una exploración electromiográfica que confirmó el diagnóstico. Se pautó tratamiento analgésico y rehabilitador

Shoulder pain is a common reason for seeking emergency, primary and specialist care. Parsonage-Turner syndrome should form part of the differential diagnosis of shoulder pain. Familiarity with the clinical and electrophysiological characteristics of this syndrome could help prevent iatrogenic disease. We present 6 cases of Parsonage-Turner syndrome, a syndrome of unknown etiology with a typical clinical picture. All patients had acute onset of the syndrome with intense shoulder pain of approximately 3 weeks' duration. After this phase ended, there was noticeable weakness of the affected arm, causing muscular atrophy depending on the muscles affected by the neuropathy. Winged scapula was present in all patients. One patient showed alteration of sensitivity and another showed hemidiaphragmatic paralysis. After a complete physical examination, the patients underwent electromyographic study that confirmed the diagnosis. Analgesic treatment and rehabilitation were prescribed

Nuevo dispositivo de micronebulización con control continuo de la fracción inspirada de oxígeno ("CONTROLizer") / New micronebulizer device with continuous control of the inspired oxygen fraction ("CONTROLizer")

Resumen Una de las técnicas más comunes de tratamiento respiratorio es la nebulización de medicamentos para administrarlos por vía inhalada utilizando oxígeno como propelente, el cual a su vez es considerado un fármaco que puede generar efectos adversos relacionados con la dosificación. El objetivo de esta investigación fue diseñar, desarrollar y analizar un sistema dual de micronebulización con control preciso de la FIO2. Métodos: se diseñó, construyó y evaluó un modelo virtual y un prototipo funcional siguiendo la metodología de bioingeniería de un nuevo dispositivo de micronebulización con control de FIO2. Se evaluó el funcionamiento del dispositivo y su impacto en voluntarios sanos y pacientes hospitalizados mediante escalas psicométricas específicas. Resultados: se conceptualizó, diseñó y construyó un dispositivo que integra un micronebulizador (recipiente), que permite nebulizar suero fisiológico o soluciones de diversos fármacos basado en la presurización de un gas propelente (aire u oxígeno) junto a un mecanismo de ajuste de la fracción inspirada de O2 (mínimo 21%; máximo 99%). Los límites (máximo y mínimo) de flujo recomendado para generar el aerosol son 6-8 l/min. En ningún caso de uso se presentaron complicaciones. Conclusiones: CONTROLizer es un dispositivo integrado dual y no-invasivo para la micronebulización de soluciones respiratorias y control continuo de la fracción inspirada de oxígeno. Por sus cualidades y funcionamiento, el dispositivo fue percibido como adecuado y seguro para aplicarse en individuos sanos y pacientes ingresados tanto en salas de cuidados intensivos como de hospitalización convencional. (Acta Med Colomb 2018; 43: 90-99).

Abstract One of the most common techniques of respiratory treatment is the nebulization of medications to be administered by inhalation using oxygen as a propellant, which in turn is considered a drug that can generate adverse effects related to the dosage. The objective of this research was to design, develop and analyze a dual micronebulization system with precise control of FIO2. Methods: a virtual model and a functional prototype were designed, constructed and evaluated following the bioengineering methodology of a new micronebulizer device with FIO2 control. The functioning of the device and its impact on healthy volunteers and hospitalized patients were evaluated through specific psychometric scales. Results: a device that integrates a micronebulizer (container), which allows to nebulize physiological saline or solutions of diverse drugs based on the pressurization of a propellant gas (air or oxygen) along with a mechanism of adjustment of the fraction of inspired oxygen (minimum 21%, maximum 99%), was conceptualized, designed and constructed. The limits (maximum and minimum) of recommended flow to generate the aerosol are 6-8 l / min. In no case of use complications occurred. Conclusions: CONTROLizer is a dual and non-invasive integrated device for the micronebulization of respiratory solutions and continuous control of the fraction of inspired oxygen. Due to its qualities and functioning, the device was perceived as adequate and safe to be applied in healthy individuals and patients admitted in both intensive care and conventional hospitalization rooms. (Acta Med Colomb 2018; 43: 90-99).

Migrant children's health problems, care needs, and inequalities: European primary care paediatricians' perspective.

BACKGROUND: Primary care paediatricians' perception of migrant children's health in Europe has not been explored before. Our aim was to examine European paediatricians' knowledge on migrant children's health problems, needs, inequalities, and barriers to access health care. METHODS: European primary care paediatricians were invited by the European Academy of Paediatrics Research in Ambulatory Setting Network country coordinators to complete a web-based survey concerning health care of migrant children. A descriptive analysis of all variables was performed. RESULTS: The survey was completed by 492 paediatricians. Sixty-three per cent of the respondents reported that the general health of migrant children is worse than that of nonmigrants, chronic diseases cited by 66% of the respondents as the most frequent health problem. Sixty-six per cent of the paediatricians reported that migrant children have different health needs compared to nonmigrant children, proper oral health care mentioned by 86% of the respondents. Cultural/linguistic factors have been reported as the most frequent barrier (90%).to access health care. However, only 37% of providers have access to professional interpreters and cultural mediators. Fifty-two per cent and 32% do not know whether one or more of the family members are undocumented and whether they are refugees/asylum seekers, respectively. Updated guidelines for care of migrant children are available for only 35% of respondents, and 80% of them have not received specific training on migrant children's care. CONCLUSIONS: European primary care paediatricians recognize migrant children as a population at risk with more frequent and specific health problems and needs, but they are often unaware of their legal state. Lack of interpreters augments the existing language barriers to access proper care and should be solved. Widespread lack of guidelines and specific providers' training should be addressed to optimize health care delivery to migrant children.

Satisfacción percibida por pacientes y profesionales participantes de una vía clínica del ligamento cruzado anterior / Satisfaction perceived by outpatients and health professionals participating in a clinical pathway after anterior cruciate ligament reconstruction

Introducción. El propósito de este estudio fue evaluar el grado de satisfacción y la calidad asistencial percibida por los pacientes que finalizaron una vía clínica tras la reconstrucción del ligamento cruzado anterior y determinar el grado de satisfacción de los profesionales que participaron en ella. Material y métodos. Estudio observacional transversal. Se incluyeron 42 pacientes que finalizaron la vía clínica. Cumplimentaron una encuesta de satisfacción con 37 ítems: 32 recogían las respuestas en escala tipo Likert con puntuaciones de 1 «muy insatisfecho» a 5 «muy satisfecho», y el resto permitían responder «sí» o «no». Además se entregó una encuesta a los profesionales que participaron. Resultados. Los aspectos mejor valorados del servicio de traumatología fueron la percepción de mejoría de la inestabilidad de la rodilla tras la cirugía y el grado de satisfacción con el servicio (4,5±0,7). El servicio de rehabilitación destacó por la facilidad para conseguir una cita (4,3±0,7). El grado de confianza que transmite el médico rehabilitador y conocer su nombre fueron aspectos con buenas puntuaciones (4,5±0,7). Los ítems con mejor calificación para el fisioterapeuta fueron su preparación y el grado de confianza que transmite (4,5±0,7). El grado de satisfacción global fue del 88,1%; 23 ítems se correlacionaron estadísticamente con la satisfacción global (p<0,001). El 100% de los profesionales se manifestaron «ligeramente de acuerdo» y «muy de acuerdo» con el desarrollo de la vía clínica. Conclusiones. El estudio ha demostrado que existe un alto grado de satisfacción entre los usuarios y los profesionales participantes de la vía clínica (AU)

Introduction. The aim of this study was to evaluate patient satisfaction and perceived quality of care among patients undergoing a clinical pathway after reconstruction of the anterior cruciate ligament and to determine the degree of satisfaction health professionals participating in the pathway. Material and methods. Cross-sectional observational study. We included 42 patients who finished the clinical pathway. The patients completed a satisfaction survey with 37 items: 32 items elicited Likert-like responses with scores of 1 ‘very dissatisfied’ to 5 ‘highly satisfied’ and the rest elicited a ‘yes/no’ response. A survey was given to the professionals involved. Results. The most positively valued aspects of the Department of Orthopaedic Surgery were the perceived improvement in knee instability after surgery and the degree of satisfaction with the department (4.5±.7). The Rehabilitation Department scored highly on ease of obtaining an appointment (4.3±.7). The highest-rated aspects were the trust inspired by the physiatrist and knowing the patient's name (4.5±.7). The items most highly scored by physiotherapists were their training and the degree of trust they inspired (4.5±.7). Overall satisfaction was 88.1%, and 23 items were statistically correlated with overall satisfaction (P<.001). All of the health professionals reported they ‘slightly agreed’ or ‘strongly agreed’ with the development of the clinical pathway. Conclusions. This study shows that there is a high level of satisfaction between outpatients and health professionals involved in the clinical pathway (AU)

Efectos y resultados de una vía clínica en las lesiones del ligamento cruzado anterior / Effects and results of a clinical pathway for anterior cruciate ligament injuries

Introducción: Presentamos nuestra experiencia tras la implantación de una herramienta de gestión clínica con el objetivo de analizar los efectos y los resultados de una vía clínica en las lesiones del ligamento cruzado anterior (LCA) mediante la evaluación de la rehabilitación acelerada después de la reconstrucción del LCA. Material y métodos: Participaron los pacientes intervenidos de ligamentoplastia del LCA con autoinjerto tendinoso tetrafascicular de isquiotibiales con o sin reparación de lesiones meniscales entre enero de 2010 y diciembre de 2012. Los criterios de evaluación fueron el grado de cumplimiento, los indicadores de efectividad en la atención clínica, la densidad de variaciones y el indicador de satisfacción. Para estudiar la posible asociación entre las variables cualitativas usamos el test de Chi-cuadrado. Resultados: Se incluyeron 113 hombres y 15 mujeres con edades comprendidas entre 15 y 49 años. El 86,3% realizaban algún tipo de deporte, siendo el fútbol el más practicado. Encontramos que el 84,38% finalizaron la vía clínica, el 7,03% padecieron efectos adversos graves y el 11,35% presentaron alguna variación, causada en un 5,44% por la decisión del paciente. El 89,86% estuvieron satisfechos con el desarrollo del programa. Se halló una tendencia a la asociación estadística (p = 0,059) entre la realización de actividad deportiva previa y la cumplimentación de la vía clínica, lo que podría confirmarse aumentando el tamaño muestral. Conclusión: La evaluación de la vía clínica en las lesiones del LCA obtuvo resultados cercanos a los estándares propuestos en aspectos como el cumplimiento y la satisfacción del paciente (AU)

Introduction: We present our experience following the implementation of a clinical management tool. The aim of this study was to analyze the effects and results of a clinical pathway for anterior cruciate ligament (ACL) lesions by evaluating accelerated rehabilitation after ACL reconstruction. Material and methods: Patients who underwent ACL reconstruction with hamstring tendon autograft with or without repair of meniscal injuries participated in this study between January 2010 and December 2012. Evaluation criteria were the degree of compliance, effectiveness indicators in clinical care, the density of variations, and satisfaction indicators. The Chi-square test was used to study the possible association between qualitative variables. Results: We included 113 men and 15 women aged between 15 and 49 years. The 86.3% performed some type of sport, football being the most practiced. A total of 84.38% completed the clinical pathway, serious adverse effects occurred in 7.03%, and some variations took place in 11.35%; of these, 5.44% were due to the patient's decision. Most patients (89.86%) were satisfied with the program's development. A trend to a statistically significant association (P = .059) was found between the occurrence of previous sports activity and the completion of the clinical pathway. This association could be confirmed by increasing the sample size. Conclusion: The evaluation of the clinical pathway in ACL injuries found that the results were close to the proposed standards in aspects such as compliance and patient satisfaction (AU)

¿Es la actitud expectante en el síndrome de Gorham una opción terapéutica? / Is the wait-and-see approach in Gorham syndrome a therapeutic option?

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Síndrome de preexcitación en paciente pediátrico durante inducción anestésica / No disponible

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Administración de carboxipeptidasa tras altas dosis de metotrexato. Tratamiento e interacciones medicamentosas / Carboxypeptidase-G2 administration after high-dose methotrexate. Treatment and drug interactions

El metotrexato es un antineoplásico muy utilizado y eficaz en neoplasias como las leucemias, los linfomas y los osteosarcomas. La toxicidad renal es un efecto secundario indeseable que se pretende evitar con una alcalinización urinaria e hiperhidratación eficaz. En caso de intoxicación aguda se establece el uso de carboxipeptidasa G2, una enzima que provoca la hidrólisis del metotrexato en sus metabolitos inactivos. Por su parte, el uso de glutamina durante el tratamiento oncológico previene parte de los efectos indeseables secundarios a éste. Se presenta el caso clínico de un adolescente afectado de linfoma no hodgkiniano en tratamiento con glutamina, que tras la administración de un tercer ciclo de metotrexato (5g/m2) presentó un cuadro de insuficiencia renal que precisó la administración de carboxipeptidasa, con descenso no satisfactorio de las concentraciones de metotrexato en sangre, si bien no se pudo diferenciar la fracción activa del metabolito inactivo por carecer de esta técnica en España. Se revisó la bibliografía sobre la interacción de glutamina y metotrexato y se discutió su fisiopatología sobre un posible papel de la glutamina como favorecedora de la toxicidad por metotrexato (AU)

Methotrexate (MTX) is widely used as anticancer agent in various malignancies, including acute lymphoblastic leukaemia, lymphoma and osteosarcoma. High doses of MTX may cause acute renal dysfunction. Nephrotoxicity is prevented by the use of alkalinization and hydration. More recently Carboxypeptidase-G2, a recombinant bacterial enzyme that rapidly hydrolyzes MTX to inactive metabolites, has become available for the treatment of acute nephrotoxicity. On the other hand, glutamine is usually administered in oncology treatments to avoid other side effects. We report a case of an adolescent who was diagnosed with T lymphoblastic lymphoma. He was receiving treatment with glutamine when the third course of methotrexate was administered (5g/m2) and he suffered a deterioration in his renal function. Carboxypeptidase was used but the methotrexate serum concentration reduction was not satisfactory. The technique to assess the amount of enzyme-inactivated methotrexate by quantification of MTX metabolites is not available in our country, therefore, the concentrations of MTX may be overestimated. The literature was reviewed to study the influence of glutamine on delayed methotrexate elimination which may lead to acute toxicity (AU)

[Carboxypeptidase-G2 administration after high-dose methotrexate. Treatment and drug interactions]. / Administración de carboxipeptidasa tras altas dosis de metotrexato. Tratamiento e interacciones medicamentosas.

Methotrexate (MTX) is widely used as anticancer agent in various malignancies, including acute lymphoblastic leukaemia, lymphoma and osteosarcoma. High doses of MTX may cause acute renal dysfunction. Nephrotoxicity is prevented by the use of alkalinization and hydration. More recently Carboxypeptidase-G2, a recombinant bacterial enzyme that rapidly hydrolyzes MTX to inactive metabolites, has become available for the treatment of acute nephrotoxicity. On the other hand, glutamine is usually administered in oncology treatments to avoid other side effects. We report a case of an adolescent who was diagnosed with T lymphoblastic lymphoma. He was receiving treatment with glutamine when the third course of methotrexate was administered (5 g/m(2)) and he suffered a deterioration in his renal function. Carboxypeptidase was used but the methotrexate serum concentration reduction was not satisfactory. The technique to assess the amount of enzyme-inactivated methotrexate by quantification of MTX metabolites is not available in our country, therefore, the concentrations of MTX may be overestimated. The literature was reviewed to study the influence of glutamine on delayed methotrexate elimination which may lead to acute toxicity.

Síncope como primera manifestación de amiloidosis primaria / Syncope as onset of primary amyloidosis

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