Evolution and associated factors of hand hygiene compliance in a pediatric tertiary hospital.

BACKGROUND: The objective is to know the evolution of the Degree of Compliance with Recommendations (DCR) on hand hygiene (HH) and its associated factors in the pediatric care areas (PCAs) of a tertiary hospital. METHODS: Observational, cross-sectional study, repeated over time, with direct observation of the DCR on HH during the daily activity of health care workers. Over 13 years, 9226 HH opportunities were observed. Associations between DCR, PCA and other variables (eg, age, sex, and professional position) were examined using χ² and adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: DCR on HH in 9 PCAs was 64.3% (95% CI, 63.3-65.3), and in the group of non-pediatric areas it was 49.6% (95% CI, 49.1-50.1). The areas with the highest degree of compliance were Oncology 72.8% (95% CI, 69.2-76.4), Neonatology 73.2% (95% CI, 71.3-75.1), and Neonatal intensive care unit 70.0% (95% CI, 67.5-72.6). These were the areas with the strongest association with HH compliance, with aOR:2.8 (95% CI, 2.2-3.6); aOR, 3.0 (95% CI, 2.6-3.6) aOR:2.6 (95% CI, 2.1-3.1), respectively. Other associated factors were the indications "after an activity," aOR, 1.6 (95% CI, 1.5-1.8) and the availability of pocket-size alcohol-based solution, aOR, 2.1(95% CI, 1.9-2.3). CONCLUSIONS: The DCR on HH in PCAs is higher than in other areas, although there is still margin for improvement. We have identified modifiable factors that have an independent association with HH compliance in PCAs. Focusing on modifiable factors will increase compliance with HH with the ultimate goal of reducing healthcare associated infections.

Evolución histórica de la Enfermedad de Chagas. Prevención y Tratamiento / No disponible

La enfermedad de Chagas es todavía un importante problema de salud pública en América Latina, donde afecta especialmente a las personas con menos recursos económicos de las áreas rurales. Fue descubierta en 1909 por el médico brasileño Carlos Chagas y, aunque durante muchos años los resultados obtenidos en la lucha contra la enfermedad fueron limitados, a partir de 1991, gracias a las iniciativas llevadas a cabo por los países del Cono Sur, se logra-ron avances importantes. La prevención de la enfermedad se basa en tres pila-res fundamentales, la lucha contra el vector, la prevención centrada en los mecanismos de transmisión y la mejora de las viviendas de las áreas rurales y la realización precoz del diagnóstico y el tratamiento. En cuanto al tratamiento, se siguen utilizando toda-vía dos preparados, comercializados en los años 60-70 del siglo pasado, Nifurtimox y Benznidazol, que presentan con frecuencia reacciones adversas. Sería fundamental, disponer de preparados con mayor eficacia, menor coste y con menos efectos adversos

Chagas disease still is an important problem of public health in Latin America. It especially affects people in the rural areas and with restricted economic resources.Chagas disease was first discovered by a Brazilian medical doctor named Carlos Chagas in 1909. In spite of limited results for years, from 1991 on, and thanks to initiatives taken by the Southern Cone countries, some important advantages were obtained. Prevention of this disease is based on three fundamental pillars: fight against the vector; education of population regarding the different mechanisms of transmission and the symptoms presented by the disease.These educational measures should be complement-ed by the improvement of the housing in the rural areas and the early diagnosis and treatment.Regarding treatment, two preparations are still in use since the ́60 and ́70 decades of the last century: Nifurtinox and Benznidazul. Both present frequent adverse reactions. It would be of fundamental impor-tance to count on medications that would be more efficient, less expensive and with less adverse effects

[Evolution of treatment of syphilis through history]. / Evolución del tratamiento de la sífilis a lo largo de la historia.

In this article, we present a historical revision of syphilis treatment since the end of the XV century up until the current days. For centuries, it was understood that syphilis had been brought to Spain by Columbus after coming back from America. It became an epidemic soon after. Later on, it was spread all over Europe. The chronologic and geographic origin of this illness have been debated in recent years, however, there has been no agreement about it as yet. Mercury was the main used therapy for four and a half centuries, until the discovery of penicillin in 1943. This discovery changed the therapeutic approach to syphilis since then. Other remedies were used during this period. Guaiacum was one of them, but it was dismissed in the mid-sixteenth century. Iodides were also used, especially in the tertiary symptoms of the disease. The discovery of arsphenamine (Salvarsan) at the beginning of the XX century, used by itself at its onset and associated to mercury or bismuth later on, was a significant therapeutic contribution. Bismuth was in itself a great therapeutic asset. It displaced the use of mercury in an important way until 1943, when the appearance of penicillin became the treatment of choice.

Physiological and metabolic responses in newborn piglets associated with the birth order.

The objective of this study was to evaluate the effect of birth order on the physiological and metabolic responses of the newborn piglet the first hours after birth. A total of 281 randomly selected newborn piglets were included, classified according to birth order in 12 groups (L1-L12). The expulsion interval, neonatal vitality, latency in connecting to the maternal teat and physiological profile were recorded for each piglet. The number of piglets born alive and dead was also recorded. The blood gases, electrolytes and glucose levels of the neonates were obtained by means of an automatic blood gas and electrolyte analyzer. Groups L1, L2, L11, and L12 had the least score on the vitality scale, the longest expulsion intervals, and longest latency to connect with the maternal teat, as well as greater physiological alterations (hyperglycemia, hyperlactatemia and hypercapnia) compared to groups L4 to L9. Likewise, type-II stillbirths only occurred in the first and last quarter of the birth order of the litter. In conclusion, piglets born in the first and last quarter of the birth order of the litter had a greater risk of having physiological and behavioral alterations during farrowing.

Yellow-Cedar, Callitropsis (Chamaecyparis) nootkatensis, Secondary Metabolites, Biological Activities, and Chemical Ecology.

Yellow-cedar, Callitropsis nootkatensis, is prevalent in coastal forests of southeast Alaska, western Canada, and inland forests along the Cascades to northern California, USA. These trees have few microbial or animal pests, attributable in part to the distinct groups of biologically active secondary metabolites their tissues store for chemical defense. Here we summarize the new yellow-cedar compounds identified and their biological activities, plus new or expanded activities for tissues, extracts, essential oils and previously known compounds since the last review more than 40 years ago. Monoterpene hydrocarbons are the most abundant compounds in foliage, while heartwood contains substantial quantities of oxygenated monoterpenes and oxygenated sesquiterpenes, with one or more tropolones. Diterpenes occur in foliage and bark, whereas condensed tannins have been isolated from inner bark. Biological activities expressed by one or more compounds in these groups include fungicide, bactericide, sporicide, acaricide, insecticide, general cytotoxicity, antioxidant and human anticancer. The diversity of organisms impacted by whole tissues, essential oils, extracts, or individual compounds now encompasses ticks, fleas, termites, ants, mosquitoes, bacteria, a water mold, fungi and browsing animals. Nootkatone, is a heartwood component with sufficient activity against arthropods to warrant research focused toward potential development as a commercial repellent and biopesticide for ticks, mosquitoes and possibly other arthropods that vector human and animal pathogens.

El tifus epidémico. Prevención y tratamiento a través de la historia / No disponible

El tifus epidémico, está causado por Rickettsia Prowazekii, y es transmitido por el piojo del cuerpo. Durante siglos, ha producido epidemias devastadoras, considerándose que esta infección ha causado más muertes que todas las guerras juntas. La primera epidemia de la que existe constancia tuvo lugar durante el cerco de Granada por los Reyes Católicos, en 1489. Desde entonces hasta el siglo XX, ha acompañado en numerosas ocasiones a los ejércitos, habiendo sido la enfermedad decisiva en algunos casos, para el resultado de los conflictos, debido al número de fallecidos que ocasionó. Algunas situaciones concretas, como guerras, campamentos de refugiados, hacinamiento e inadecuadas condiciones higiénicas, favorecen el desarrollo de la enfermedad. El descubrimiento por Charles Nicolle (1856-1936) del vector de transmisión, el piojo del cuerpo, supuso un avance sustancial en el control de la misma y la llegada de los antibióticos hizo posible su curación

Epidemic typhus is caused by Rickettsia prowazekii and it is transmitted through body lice. For centuries, due to devastating epidemics it has caused more casualties than all wars known in humanity. The first epidemic of which we have record, took place during the siege of Granada by the Spanish Catholic King and Queen in 1489. Since then, and up to the 20th. century, typhus has been linked to armies in combat. Given the large number of deaths caused by this disease, its presence has been crucial in the results of certain conflicts. Certain situations favor the development of typhus epidemics such as wars, overcrowding, refugee camps and inadecuate hygienic conditions. The discovery by Charles Nicolle (1856-1936) of the transmission mechanism by body lice, was a substantial step towards controlling the disease. The appearance of antibiotics determined its definite healing

Retinopatía solar bilateral. Autofluorescencia y tomografía de coherencia óptica / Bilateral solar retinopathy. Autofluorescence and optical coherence tomography

CASO CLÍNICO: Varón de 33 años, que refiere disminución de agudeza visual bilateral desde hace 5 años. No presenta antecedentes de interés. Militar de profesión y probable exposición ocular solar previa. Se aprecian en el fondo de ojo lesiones pigmentadas focales maculares, con alteración de la capa de los fotorreceptores a nivel foveal, evidenciada por tomografía de coherencia óptica (OCT) en varios sectores de la fóvea. DISCUSIÓN: La retinopatía solar está asociada a profesiones con exposición solar de riesgo. El diagnóstico está basado en la autofluorescencia y OCT macular que nos va a aportar datos fundamentales para establecer la causa

CASE REPORT: A 33-year-old man referred decreased bilateral visual acuity for five years, with no history of interest. Military profession and probably previous sun exposure. Focal pigmented lesions in the macular area of the fundus were observed, with impairment of the photoreceptor layer in the fovea, observed by optical coherence tomography (OCT), in various sectors of the fovea. DISCUSSION: Solar retinopathy is associated with professions at risk of sun exposure. The diagnosis is based on autofluorescence and macular OCT, that later will provide key data to establish the cause

Bilateral solar retinopathy. Autofluorescence and optical coherence tomography. / Retinopatía solar bilateral. Autofluorescencia y tomografía de coherencia óptica.

CASE REPORT: A 33-year-old man referred decreased bilateral visual acuity for five years, with no history of interest. Military profession and probably previous sun exposure. Focal pigmented lesions in the macular area of the fundus were observed, with impairment of the photoreceptor layer in the fovea, observed by optical coherence tomography (OCT), in various sectors of the fovea. DISCUSSION: Solar retinopathy is associated with professions at risk of sun exposure. The diagnosis is based on autofluorescence and macular OCT, that later will provide key data to establish the cause.

La brucelosis humana, ayer y hoy / No disponible

La brucelosis es una zoonosis distribuida por la mayor parte del mundo. En España tuvo una incidencia importante, estimándose en 5.000 los casos anuales al final de la primera mitad del s.XX, llegando a 8.692 casos en 1984, lo que hizo que se pusieran en marcha programas de control, que contribuyeron a reducir el número de casos, hasta los 103 declarados en 2013. La enfermedad, ha tenido una importante repercusión sanitaria y socioeconómica por la afectación del hombre y de los animales. Su pronóstico en general, ha sido bueno, salvo complicaciones. El tratamiento en las primeras décadas del s. XX, era básicamente sintomático, al no disponerse de ningún remedio efectivo. Posteriormente, los arsenicales, las sales de oro y la vacuna intravenosa, entre otros, tuvieron una aportación destacable, hasta la llegada de los antibióticos, que supuso un cambio radical en la evolución de la enfermedad (AU)

Brucellosis is a zoonosis spread throughout the world. It had a rather important incidence in Spain. An estímate of of 5000 cases per year took place in Spain during the first half of the 20th. century, reaching a peak of 8,692 in 1984. This fact promoted the establishment of control mechanisms that contributed to gradually diminish the number of cases to 103 in 2013. Brucellosis has had a considerable importance both in the health and socioeconomic fields due to vulnerability in humans and animals. The disease had a good prognosis, putting aside possible complications. Treatment, in the first decades of the 20th. Century was basically symptomatic, given the lack of effective remedies. Later, arsenic components, gold salts and the intravenous vaccine, among others, had a relevant importance in treatment until the appearance of antibiotics. These had a radical influence in the natural evolution of the disease (AU)

Conocimientos sobre gripe en personal sanitario que acude a vacunarse / No disponible

INTRODUCCIÓN: El objetivo del trabajo, es conocer el nivel de conocimientos sobre la Gripe y sus determinantes en el personal sanitario (PS) que se vacuna de la gripe. Material y MÉTODOS: Estudio transversal, en el que se incluyó al PS que se vacunó de la gripe en la temporada 2011-12, y cumplimentó un cuestionario de 10 preguntas. Se consideró nivel adecuado de conocimientos cuando se contestaron correctamente cinco o más preguntas. Para cuantificar la magnitud de la asociación se calculó la Odds Ratio con sus IC al 95%. RESULTADOS: Se encuestaron 634 trabajadores sanitarios. El 75,7% tenía un nivel adecuado de conocimientos. El tener menos de 45 años OR: 3,3 (2,1-5,2), el ser facultativo o personal de enfermería, OR: 4,1 (2,3-7,3) y OR: 3,1 (1,8-5,3) respectivamente, se asociaron con disponer de un nivel adecuado de conocimientos. CONCLUSIONES: La edad y el estamento son las variables que se asocian de manera independiente con el nivel de conocimientos sobre la Gripe en el PS. Un número importante del personal sanitario, desconoce aspectos relevantes acerca de la Gripe

BACKGROUND: The objective of this work is to know the level knowledge on Influenza and its determinants on health personnel (HP). METHODS: Observational study, in which it included the PS that was vaccinated of the influenza in season 2011-12, and complimented a of 10 questions. Suitable level of knowledge, which was considered when well, answered five or more questions. For quantify the magnitude of the association was calculated Odds Ratio with its 95% CI. RESULTS: 634 HP surveyed them. 75.7% had a suitable level f knowledge. Having less than 4 years, OR: 3,3 (2,1-5,2), be physicians or nursing, OR: 4,1 (2,3-7,3) and OR: 3,1 (1,8-5,3) respectively, they were associated with having an suitable level of knowledge. Conclusions,: the age and the professional category are the variables that are associated of independent way, with the level of knowledge on Influenza in the HW. A significant number of health workers not known about important aspects of influenza

La tos ferina, pasado y presente / No disponible

La tos ferina es una enfermedad infecciosa, desconocida durante siglos, a la que no se hace referencia en la Grecia clásica y en Roma, habiéndose realizado su primera descripción en el s. XVI. En los últimos años, se ha observado un incremento en el número de casos, incluso en países que han logrado buenas en lactantes, especialmente en aquellos que no han iniciado o completado la primovacunación, ocupando de acuerdo con la OMS, el quinto lugar entre las causas de muerte prevenibles por vacuna. Aunque se dispone de una profilaxis eficaz desde hace más de medio siglo, no se ha logrado aún el control de la enfermedad, por lo que se han propuesto algunas estrategias, como la vacunación de adolescentes y adultos, de la embarazada y de los contactos del lactante, con el fin contribuir a mejorar el control de la misma

The whooping cough is an infectious disease. Unknown for centuries, there are no references of this disease in classic Greece nor in Rome, and its first description appears only in the WVI century. There has been an increase in the number of cases in the latter years, even in countries with good vaccine - coverage. This disease presents a high mortality rate in infants, especially in those that have not started or completed primal vaccination. According to WHO, this disease is fifth among the different causes of death that could be prevented by the use of the vaccine. In spite of having and efficient prophylaxis for oven fifty years, control of the disease has not been yet achieved. For this reason, some strategies have been proposed such as vaccination of adolescents and adults, pregnant women, and those in contact with infants so that these may contribute to the control of the disease

Catheter-related bloodstream infection: burden of disease in a tertiary hospital.

BACKGROUND: Surveillance programmes have become the most effective tool for controlling catheter-related bloodstream infections (CRBSI). However, few studies have investigated programmes covering all hospital settings. AIM: To describe the results of a control and prevention programme for CRBSI based on compliance with recommendations for insertion and maintenance, using annual burden of disease in a tertiary level hospital. METHODS: A CRBSI control and prevention programme involving all hospital settings was implemented. The programme consisted of CRBSI surveillance, direct observation of insertion and maintenance of catheters to determine performance, and education for healthcare workers. FINDINGS: In total, 2043 short-term catheters were inserted in 1546 patients for 18,570 catheter-days, and 279 long-term catheters were inserted in 243 patients for 40,440 catheter-days. The annual incidence density was 5.98 (first semester 6.40, second semester 5.64) CRBSI per 1000 catheter-days for short-term catheters, and 0.57 (first semester 0.66, second semester 0.43) CRBSI per 1000 catheter-days for long-term catheters. One hundred and forty insertion procedures were observed, with an average insertion time of 13 (standard deviation 7) min. Compliance with recommendations was as follows: hand hygiene, 86.8%; use of alcoholic chlorhexidine solution for skin disinfection, 35.5%; use of mask, 93.4%; use of gloves, 98.7%; use of gown, 75.0%; use of sterile cloth, 93.8%; use of cap, 92.2%; bandage application, 62.7%; and use of aseptic technique, 89.5%. Forty-five maintenance procedures were observed, and compliance rates were as follows: hand hygiene, 42.1%; use of gloves, 78.1%; and port disinfection with alcoholic chlorhexidine solution, 32.5%. CONCLUSION: The CRBSI control and prevention programme implemented at the study hospital has decreased the rate of CRBSI, provided important information about the total burden of disease, and revealed possible ways to improve interventions in the future.

Variabilidad interindividual y reproducibilidad de tres métodos de medida del espesor de la capa de fibras nerviosas / Variability and reproducibility of 3 methods for measuring the thickness of the nerve fiber layer

Objetivos: Calcular la variabilidad interindividual y reproducibilidad de la tomografía confocal (HRT), polarimetría láser (GDx) y tomografía de coherencia óptica (OCT Cirrus) para determinar el espesor de la capa de fibras ganglionares. Método: Se examinaron 2 veces 75 ojos normales. La variabilidad interindividual se analizó previa normalización de los resultados. Para medir la variabilidad entre exámenes se utilizó el coeficiente de variación y para analizar la correlación entre variables, el coeficiente de Pearson. Resultados: La variabilidad interindividual fue similar en GDx (8,9%) y en OCT (11,1%) pero muy elevada en HRT (30,0%). Ningún instrumento detectó cambios significativos con la edad. El coeficiente de variación del espesor total, entre 2 exámenes del mismo sujeto, fue significativamente inferior (p < 0,05) en GDx (1,4) que en OCT (2,0) y muy elevado en HRT (6,4). Lo mismo ocurrió al analizar las fibras superiores (GDx = 1,8; OCT = 2,9; HT = 6,6), pero no las inferiores, donde solo se observaron diferencias significativas con HRT (GDx = 2,2, OCT = 2,7, HRT = 7,0).Entre los resultados de OCT y GDx existió una correlación significativa al comparar los primeros (r = 0,46; p < 0,0001) y los segundos exámenes (r = 0,52; p < 0,0001). Sin embargo, no se observó ninguna correlación significativa entre los datos aportados por HRT respecto a los 2 instrumentos restantes (p > 0,05). Conclusiones: HRT presenta un exceso de dispersión interindividual y de variabilidad intertest en la estimación del espesor del haz de fibras nerviosas. GDx presenta, en este aspecto, ligeras ventajas respecto a OCT (AU)

Objective: To estimate the variability and reproducibility of confocal tomography (HRT), scanning laser polarimetry (GDx) and optical coherence tomography (OCT-Cirrus) to determine the thickness of the layer of ganglion fibers. Method: A total of 75 normal eyes were examined twice. Inter-individual variability was analyzed after standardizing the results. The coefficient of variation was used to measure the variability between tests, and the Pearson coefficient was used to analyze the correlation between variables. Results: The inter-individual variability was similar in GDx (8.9%) and OCT (11.1%), but very high in HRT (30.0%). No instrument detected significant changes with age. The coefficient of variation of the total thickness between the examinations of the same subject was significantly lower (P < 0.05) in GDx (1.4) than in OCT (2.0), but very high in HRT (6.4). The same was true when analyzing the upper fibers (GDx = 1.8, OCT = 2.9, HRT = 6.6), but not with the lower ones, where the only significant differences were observed with HRT (GDx = 2.2, OCT = 2.7, HRT = 7.0). Among the results of OCT and GDx, there was a significant correlation when comparing the first (r = 0.46, P < 0.0001) and second examinations (r = 0.52, P < 0.0001). However there was no significant relationship between the data provided by HRT for the two remaining instruments (P > 0.05). Conclusions: There is a wide variation in the inter-individual and inter-test measurement of the thickness of the of nerve fibers layers using HRT. GDx has, in this respect, slight advantages over OCT (AU)

[Variability and reproducibility of 3 methods for measuring the thickness of the nerve fiber layer]. / Variabilidad interindividual y reproducibilidad de tres métodos de medida del espesor de la capa de fibras nerviosas.

OBJECTIVE: To estimate the variability and reproducibility of confocal tomography (HRT), scanning laser polarimetry (GDx) and optical coherence tomography (OCT-Cirrus) to determine the thickness of the layer of ganglion fibers. METHOD: A total of 75 normal eyes were examined twice. Inter-individual variability was analyzed after standardizing the results. The coefficient of variation was used to measure the variability between tests, and the Pearson coefficient was used to analyze the correlation between variables. RESULTS: The inter-individual variability was similar in GDx (8.9%) and OCT (11.1%), but very high in HRT (30.0%). No instrument detected significant changes with age. The coefficient of variation of the total thickness between the examinations of the same subject was significantly lower (P<.05) in GDx (1.4) than in OCT (2.0), but very high in HRT (6.4). The same was true when analyzing the upper fibers (GDx=1.8, OCT=2.9, HRT = 6.6), but not with the lower ones, where the only significant differences were observed with HRT (GDx = 2.2, OCT = 2.7, HRT = 7.0). Among the results of OCT and GDx, there was a significant correlation when comparing the first (r=0.46, P<.0001) and second examinations (r=0.52, P<.0001). However there was no significant relationship between the data provided by HRT for the two remaining instruments (P>.05). CONCLUSIONS: There is a wide variation in the inter-individual and inter-test measurement of the thickness of the of nerve fibers layers using HRT. GDx has, in this respect, slight advantages over OCT.

Effect of plant sterols and tannins on Phytophthora ramorum growth and sporulation.

Elicitin-mediated acquisition of plant sterols is required for growth and sporulation of Phytophthora spp. This study examined the interactions between elicitins, sterols, and tannins. Ground leaf tissue, sterols, and tannin-enriched extracts were obtained from three different plant species (California bay laurel, California black oak, and Oregon white oak) in order to evaluate the effect of differing sterol/tannin contents on Phytophthora ramorum growth. For all three species, high levels of foliage inhibited P. ramorum growth and sporulation, with a steeper concentration dependence for the two oak samples. Phytophthora ramorum growth and sporulation were inhibited by either phytosterols or tannin-enriched extracts. High levels of sterols diminished elicitin gene expression in P. ramorum; whereas the tannin-enriched extract decreased the amount of 'functional' or ELISA-detectable elicitin, but not gene expression. Across all treatment combinations, P. ramorum growth and sporulation correlated strongly with the amount of ELISA-detectable elicitin (R (2) = 0.791 and 0.961, respectively).

Risk of advanced proximal neoplasms according to distal colorectal findings: comparison of sigmoidoscopy-based strategies.

BACKGROUND: Screening for colorectal cancer with sigmoidoscopy benefits from the fact that distal findings predict the risk of advanced proximal neoplasms (APNs). This study was aimed at comparing the existing strategies of postsigmoidoscopy referral to colonoscopy in terms of accuracy and resources needed. METHODS: Asymptomatic individuals aged 50-69 years were eligible for a randomized controlled trial designed to compare colonoscopy and fecal immunochemical test. Sigmoidoscopy yield was estimated from results obtained in the colonoscopy arm according to three sets of criteria of colonoscopy referral (from those proposed in the UK Flexible Sigmoidoscopy, Screening for COlon REctum [SCORE], and Norwegian Colorectal Cancer Prevention [NORCCAP] trials). Advanced neoplasm detection rate, sensitivity, specificity, and number of individuals needed to refer for colonoscopy to detect one APN were calculated. Logistic regression analysis was performed to identify distal findings associated with APN. All statistical tests were two-sided. RESULTS: APN was found in 255 of 5059 (5.0%) individuals. Fulfillment of UK (6.2%), SCORE (12.0%), and NORCCAP (17.9%) criteria varied statistically significantly (P < .001). The NORCCAP strategy obtained the highest sensitivity for APN detection (36.9%), and the UK approach reached the highest specificity (94.6%). The number of individuals needed to refer for colonoscopy to detect one APN was 6 (95% confidence interval [CI] = 4 to 7), 8 (95% CI = 6 to 9), and 10 (95% CI = 8 to 12) when the UK, SCORE, and NORCCAP criteria were used, respectively. The logistic regression analysis identified distal adenoma ≥10 mm (odds ratio = 3.77; 95% CI = 2.52 to 5.65) as the strongest independent predictor of APN. CONCLUSIONS: Whereas the NORCCAP criteria achieved the highest sensitivity for APN detection, the UK recommendations benefited from the lowest number of individuals needed to refer for colonoscopy.

[Pulsar perimetry. A review and new results]. / Pulsarperimetrie. Überblick und neue Ergebnisse.

We present a review and update on Pulsar perimetry, which combines temporal frequency, contrast and spatial frequency stimuli. The effects of age, visual acuity, and learning on results are described. Data on threshold fluctuation, signal-to-noise ratio, and the possibility of reducing noise with filtering techniques are provided. We describe its dynamic range and the possibility of compensating for profound defects. Finally, we show the results obtained in normal patients and in those with ocular hypertension or initial glaucoma, as well as an analysis of glaucoma progression.

[Comparing the ranges of defect measured with standard white on white and Pulsar perimetries]. / Comparación del rango de medida de defectos entre la perimetría estándar blanco/blanco y la perimetría Pulsar.

OBJECTIVES: Normal thresholds on Pulsar perimetry fall faster than those of standard perimetry in the peripheral visual field. Two related studies were performed. Firstly, the frequency distributions of glaucoma defects on standard automated perimetry (SAP) and the relationship of the centre and periphery (Study A) were studied first, followed by an attempt to establish the limits of pulsar perimetry (Study B). MATERIAL AND METHOD: A: frequency of defects was calculated in 78.663 SAP perimetries (G1-TOP, Octopus 1-2-3, Haag-Streit). Study B: 204 eyes with mean defect (MD-SAP) lower than 9 dB were examined 8.92 ± 4.19 times with SAP (TOP-32, Octopus 311) and temporal modulation perimetry (T30W, Pulsar Perimeter, Haag-Streit). RESULTS: Study A: 50.7% of the SAP examinations showed MD values lower than 9 dB and 32.7% bellow 6 dB. The MD correlation of the central 20° with the MD of the most peripheral points was r=0.933. Study B: in cases with MD-TOP-32 lower than 6 dB, SAP had the maximum possibility of detecting defect in 0.02% of points and Pulsar in 0.29%. In subjects with MD-TOP-32 between 6 and 9 dB frequencies were 0.38% in SAP and 3.5% in Pulsar (5.1% for eccentricities higher than 20°). CONCLUSIONS: Pulsar allows detecting defects, without range limitations, in the initial half of SAP frequencies expected on glaucoma patients. In order to study the progression of deeper defects the examination should focus on the central points, where the dynamic range of both systems is more equivalent.

Comparación del rango de medida de defectos entre la perimetría estándar blanco/blanco y la perimetría Pulsar / Comparing the ranges of defect measured with standard white on white and Pulsar perimetries

Objetivo: Los umbrales normales de la perimetría Pulsar caen más rápidamente en el campoperiférico que los estándar. Se han realizado dos estudios relacionados, en primer lugar seha investigado la distribución de frecuencias de los defectos glaucomatosos en perimetríaautomática estándar (SAP), y la relación de los periféricos con los centrales (estudio A). Acontinuación se han tratado de definir los límites de examen Pulsar (estudio B).Material y métodos: Estudio A: las frecuencias se calcularon en 78.663 perimetrías SAP (G1-TOP, Octopus 1-2-3, Haag-Streit). Estudio B: 204 ojos con defecto medio (MD-SAP) inferiora 9 dB se examinaron 8,92±4,19 veces con SAP (TOP-32, Octopus 311) y con perimetría demodulación temporal (T30W, Perímetro Pulsar, Haag-Streit).Resultados: Estudio A: el 50,7% de los estudios SAP presentaron valores de MD inferiores a9 dB y el 32,7% inferiores a 6 dB. La correlación delMDde los 20◦ centrales con respecto alMDde los más periféricos fue de r = 0,933. Estudio B: en los casos con valores de MD-TOP-32 inferioresa 6 dB, SAP alcanzó sus posibilidades máximas de detección de defecto en el 0,02% delos puntos y Pulsar en el 0,29%. En los sujetos con MD-TOP-32 situado entre 6 y 9dB las frecuenciasfueron 0,38% en SAP y 3,5% en Pulsar (5,1% para excentricidades superiores a 20◦).Conclusiones: Pulsar permite detectar defectos, sin limitación de rango, en la mitad inicialde las frecuencias de defecto SAP esperables en el paciente glaucomatoso. Para estudiar laprogresión de defectos más profundos el análisis deberá centrarse en los puntos centrales,donde el rango dinámico de ambos sistemas es más equivalente(AU)

Objectives: Normal thresholds on Pulsar perimetry fall faster than those of standard perimetryin the peripheral visual field. Two related studies were performed. Firstly, the frequencydistributions of glaucoma defects on standard automated perimetry (SAP) and the relationshipof the centre and periphery (Study A) were studied first, followed by an attempt toestablish the limits of pulsar perimetry (Study B).Material and method: A: frequency of defects was calculated in 78.663 SAP perimetries (G1-TOP, Octopus 1-2-3, Haag-Streit). Study B: 204 eyes with mean defect (MD-SAP) lower than9 dB were examined 8.92±4.19 times with SAP (TOP-32, Octopus 311) and temporal modulationperimetry (T30W, Pulsar Perimeter, Haag-Streit).Results: StudyA: 50.7% of the SAP examinations showedMDvalues lower than 9 dB and 32.7%bellow 6 dB. The MD correlation of the central 20◦ with the MD of the most peripheral pointswas r = 0.933. Study B: in cases with MD-TOP-32 lower than 6 dB, SAP had the maximumpossibility of detecting defect in 0.02% of points and Pulsar in 0.29%. In subjects with MDTOP-32 between 6 and 9 dB frequencies were 0.38% in SAP and 3.5% in Pulsar (5.1% foreccentricities higher than 20◦).Conclusions: Pulsar allows detecting defects, without range limitations, in the initial half ofSAP frequencies expected on glaucoma patients. In order to study the progression of deeperdefects the examination should focus on the central points, where the dynamic range ofboth systems is more equivalent(AU)

Fisioterapia tras primera intervención de osteoplastia miniinvasiva en atrapamiento femoroacetabular en un hospital universitario / Physiotherapy after the first treatment with mini-invasive osteoplasty for femoroacetabular impingement in a university hospital

La evolución de las técnicas quirúrgicas en ortopedia repercute en el tratamiento de fisioterapia que debe completar la buena recuperación funcional de los pacientes. El síndrome de atrapamiento o impingement femoroacetabular (AFA) en la articulación de la cadera es tratado con cirugía relativamente conservadora y rehabilitación posterior. Aquí presentamos el primer paciente tratado en nuestro servicio. A propósito de este hacemos una revisión de medidas de valoración y pautas de tratamiento en fisioterapia con el fin de divulgar la importancia del seguimiento escrupuloso de la cronología en la aplicación de técnicas analgésicas, antiinflamatorias, masoterapia y cinesiterapia (AU)

The evolution of the surgical techniques in orthopaedics reverberates in the physical therapy treatments that must complete the good functional recovery of the patients. The femoroacetabular impingement (FAI) or impingement syndrome of the hip joint is treated by relatively conservative surgery and later rehabilitation. Herein, we present the first patient treated in our service. Furthermore, speaking of this case, we make a review of the evaluation measurements and treatment guidelines in physiotherapy in order to spread the importance of meticulous monitoring of the chronology in the application of analgesics, anti-inflammatory drugs, massage therapy and kinesiotherapy (AU)