Complicaciones asociadas a la nutrición parenteral en los enfermos con infección por SARS-CoV-2 / Parenteral nutrition-associated complications in patients with SARS-CoV-2 infection

Introducción: se desconoce si los pacientes diagnosticados de infección respiratoria aguda por SARS-CoV-2 (COVID-19) presentan más riesgo de complicaciones asociadas a la nutrición parenteral (NP). Objetivo: conocer la incidencia, los factores de riesgo y la mortalidad de las complicaciones asociadas a la NP en esta población. Métodos: estudio de cohortes prospectivo de 87 pacientes diagnosticados de infección por SARS-CoV-2. Se analizan la tasa de incidencia de las complicaciones y las odds ratio (OR) de diferentes factores. Resultados: la edad ≥ 65 años (OR: 2,52, IC 95 %: 1,16 a 5,46), los antecedentes de obesidad (OR: 3,34, IC 95 %: 2,35 a 4,33) y el tratamiento con propofol (OR: 2,45, IC 95 %: 1,55 a 3,35) o lopinavir/ritonavir (OR: 4,98, IC 95 %: 3,60 a 6,29) se asociaron al desarrollo de hipertrigliceridemia. Los pacientes con obesidad (OR: 3,11, IC 95 %: 1,10 a 8,75) o dislipemia (OR: 3,22, IC 95 %: 1,23 a 8,40) y los tratados con propofol (OR: 5,47, IC 95 %: 1,97 a 15,1) presentaron mayor riesgo de infección asociada al catéter (IAC). No se observó ningún factor de riesgo relacionado con el desarrollo de hiperglucemia. La mortalidad fue mayor en los pacientes con IAC (46,7 % vs. 10,8 %, p = 0,014). El riesgo de mortalidad fue superior en los enfermos de ≥ 65 años (OR: 2,74, IC 95 %: 1,08 a 6,95) o con IAC (OR: 3,22, IC 95 %: 1,23 a 8,40). Conclusiones: la incidencia de complicaciones asociadas a la NP en pacientes diagnosticados de infección por SARS-CoV-2 es elevada. El riesgo de mortalidad es superior en los enfermos mayores de 65 años o con IAC (AU)

Background: it is unknown whether patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 are at greater risk of developing complications associated with parenteral nutrition (PN). Aim: to describe the incidence, risk factors, and clinical impact of complications in patients with ARDS-COVID-19 receiving PN. Methods: a prospective cohort study of 87 patients with ARDS-COVID-19 infection. The incidence of complications and odds ratios of risk factors were analysed. Results: age ≥ 65 years (OR, 2.52, 95 % CI: 1.16 to 5.46), obesity (OR, 3.34, 95 % CI: 2.35 to 4.33) and treatment with propofol (OR, 2.45, 95 % CI: 1.55 to 3.35) or lopinavir/ritonavir (OR, 4.98, 95 % CI: 3.60 to 6.29) were risk factors for hipertriglyceridemia. Obesity (OR, 3.11, 95 % CI: 1.10 to 8.75), dyslipidemia (OR, 3.22, 95 % CI: 1.23 to 8.40) or treatment with propofol (OR, 5.47, 95 % CI: 1.97 to 15.1) were risk factors for intravascular catheter-related infection. No risk factors were described for hiperglycemia. Mortality was higher in patients with intravascular catheter-related infection (46.7 % vs 10.8 %, p = 0.014). Mortality risk was higher in older patients (OR, 2.74, 95 % CI: 1.08 to 6.95) or patients with intravascular catheter-related infection (OR, 3.22, 95 % CI: 1.23 to 8.40). Conclusions: the incidence of complications associated with PN in patients with COVID-19-related ARDS is frequent. The mortality risk is higher in older patients or those with catheter-related infection (AU)

[Diagnosis of cardiac rhabdomyoma in the first trimester of pregnancy]. / Diagnóstico de un rabdomioma intracardiaco en el primer trimestre de la gestación.

BACKGROUND: Rhabdomyoma is the most common cardiac tumor detected during fetal life and childhood; despite of this, its incidence is very low. CLINICAL CASE: cardiac rhabdomyoma diagnosed at first trimester ultrasound. CONCLUSION: Early diagnosis is important for performing further studies to detect the possible presence of associated anomalies, including TS (tuberous sclerosis). Prognosis is conditioned by number, size and location. In our case, the presence of early hypoplastic right ventricle and pulmonar and tricuspid atresia (probably because of tumor size) conditioned a very bad prognosis, so the patient decided termination of pregnancy.

Análisis de los niveles de burnout en deportistas en función del nivel de inteligencia emocional percibida: el papel moderador de la personalidad / Analysis of burnout's levels in athletes in function of emotional intelligence perceived: role moderator of personality / A análise dos níveis burnout's em atletas em função da inteligência emocional percebida: o papel moderador da personalidade

El constructo psicológico «Inteligencia Emocional» (IE) hace referencia a la capacidad de las personas para integrar eficazmente aspectos cognitivos y emocionales. La personalidad, entendida como un sistema psicológico que emerge de la interacción-adaptación entre individuo y ambiente, media entre el funcionamiento intrapsíquico (autopercepción, autoestima, autoconocimiento y autorregulación) y evoluciona permanenmente con el medio. Por otro lado, la consolidación teórica del burnout en el ámbito de la psicología del deporte, es cada vez más evidente. Por ello, yante la escasez de trabajos dirigidos a analizar la existencia de relación entre constructos, el objetivo del presente trabajo ha consistido en comprobar si los niveles de Inteligencia Emocional Percibida (IEP) en una muestra de201 deportistas, se relaciona con sus niveles de burnout, considerando el papel moderador que desempeña la personalidad. Se han utilizado el TraitMeta-Mood Scale (TMMS-24) para la medida de la IE, el NEO-FFI parala medida de la personalidad, y el IBD-R para la medición de burnout. Los resultados obtenidos en nuestro trabajo muestran que los factores neuroticismo y responsabilidad, moderan la relación existente entre atención emocionaly el agotamiento emocional (AU)

Emotional Intelligence (IE) is a psychological construct that refers to the individuals’ capacity to integrate cognitive and emotional aspects effectively. Personality could be understood as a psychological system that emerges from the interaction between individual and environment, which evolves permanently mediating the intrapersonal functioning (such as self-perception, self-esteem, self-knowledge and self-regulation) and personal adaptation. On the other hand, the theoretical consolidation of the burnout in sport's psychology field is increasing. However, there is still relatively scarce investigation about the relationship between is study aims at analyzing the existence of the relation between levels of Perceived Emotional Intelligence (PEI) and burnout's symptoms, considering the moderator role of personality. Participants were 201 athletes that completed the TMMS-24 for the measurement of PEI, the Neo FFI for personality assessment, and IBD-R to establish burnout's levels. The results of this research suggest that the relationship between emotional attention and emotional exhaustion is mediated by neuroticism and conscientiousness factors (AU)

A construção psicológica «Inteligência Emocional» (EI) refere-seà capacidade das pessoas de integrar efetivamente os aspectos cognitivo se emocionais. Personalidade, entendido como um sistema psicológico que emerge da interação entre adaptação individual e meio ambiente, faz a mediação entre o intrapsíquico funcionamento ( auto- percepção, auto-estima, auto-conhecimento e auto-regulação) e em constante evolução médio.Além disso, a consolidação teórica do burnout no campo da psicologia do esporte, é cada vez mais evidente. Por isso, e devido à falta de estudos que visam analisar a existência de relação entre os construtos, o objetivo deste trabalho foi testar se os níveis de Inteligência Emocional Percebida (IEP),em uma amostra de 201 atletas, está relacionado com os seus níveis de Burout, considerando o papel moderador da personalidade. Usamos o TraitMeta- Mood Scale (TMMS -24) para a medição de EI, o NeoFFI para medir a personalidade, e IBD -R para medir burnout. Os resultados do nosso estudo mostram que fatores de neuroticismo e responsabilidade, moderou arelação entre o cuidado emocional e exaustão emocional (AU)

A clinical predictive score for mood disorder risk in low-income primary care settings.

BACKGROUND: Despite availability of validated screening tests for mood disorders, busy general practitioners (GPs) often lack the time to use them routinely. This study aimed to develop a simplified clinical predictive score to help screen for presence of current mood disorder in low-income primary care settings. METHODS: In a cross-sectional study, 197 patients seen at 10 primary care centers in Santiago, Chile completed self-administered screening tools for mood disorders: the Patient Health questionnaire (PHQ-9) and the Mood Disorder Questionnaire (MDQ). To determine participants' current-point mood disorder status, trained clinicians applied a gold-standard diagnostic interview (SCID-I). A simplified clinical predictive model (CM) was developed based on clinical features and selected questions from the screening tools. Using CM, a clinical predictive score (PS) was developed. Full PHQ-9 and GP assessment were compared with PS. RESULTS: Using multivariate logistic regression, clinical and demographic variables predictive of current mood disorder were identified for a simplified 8-point predictive score (PS). PS had better discrimination than GP assessment (auROC-statistic=0.80 [95% CI 0.72, 0.85] vs. 0.58 [95% CI 0.52, 0.62] p-value <0.0001), but not as good as the full PHQ-9 (0.89 [95% CI 0.85, 0.93], p-value=0.03). Compared with GP assessment, PS increased sensitivity by 50% at a fixed specificity of 90%. Administered in a typical primary care clinical population, it correctly predicted almost 80% of cases. LIMITATIONS: Further research must verify external validity of the PS. CONCLUSION: An easily administered clinical predictive score determined, with reasonable accuracy, the current risk of mood disorders in low-income primary care settings.

The hare (Lepus granatensis) as potential sylvatic reservoir of Leishmania infantum in Spain.

Xenodiagnosis of Leishmania infection in hares (Lepus granatensis) from a focus of human leishmaniasis in Fuenlabrada at southwestern Madrid region (Spain) proved that they are infective to Phlebotomus perniciosus. Molecular characterization of isolates obtained from sand flies infected after xenodiagnosis demonstrates that hares were infected by Leishmania infantum. This is the first evidence of the transmission of L. infantum from hares to sand flies. Moreover the results confirm the role that these animals can play as wild reservoirs of leishmaniasis for the recent outbreak of visceral leishmaniasis in Madrid.

Efficacy of 65% permethrin applied to dogs as a spot-on against Phlebotomus perniciosus.

Leishmania infantum is a protozoan parasite causing leishmaniosis, a visceral disease transmitted by the bites of sand flies. As the main reservoir of the parasite, dogs are the principal targets of control measures against this disease, which affects both humans and dogs. Several studies have revealed the usefulness of topical insecticide treatment (collars, spot-ons and sprays) in reducing the incidence and prevalence of L. infantum. The present study was designed to test the efficacy of 65% permethrin applied to dogs as a spot-on against the sand fly vector Phlebotomus perniciosus. The duration of the desired effects was also estimated to help design an optimal treatment regimen. Twelve dogs assigned to treatment (n=6) and control (n=6) groups were exposed to sand flies once a week over a seven-week period. Repellent and insecticidal efficacies were estimated and compared amongst the groups. Our findings indicate satisfactory repellent, or anti-feeding, effects lasting 3 weeks and short-term insecticidal effects lasting 2 weeks after initial application. Accordingly, we recommend the use of this product every 2-3 weeks during the active phlebotomine sand fly period to protect dogs against the bites of P. perniciosus.

Analgesia epidural obstétrica: fallos y complicaciones neurológicas de la técnica / No disponible

Objetivos: Estudiar la incidencia de fallos y complicaciones neurológicas de la analgesia epidural en obstetricia, así como hacer un seguimiento y análisis de las mismas. Pacientes y método: Estudio observacional prospectivo de gestantes que recibieron analgesia epidural para el trabajo de parto en un hospital terciario durante 2009 y 2010. Se registraron los datos demográficos maternoinfantiles, del trabajo de parto y el tipo de parto así como las complicaciones que se produjeron tanto durante la realización de la técnica como durante el peri- y postparto. Se siguieron a todas las pacientes hasta su alta hospitalaria identificándose y tratándose las posibles complicaciones hasta su resolución. Resultados: Se incluyeron 438 gestantes. Se dividieron las complicaciones en 2 etapas: peripartum y postpartum. En el periparto se identificaron, de mayor a menor frecuencia, las siguientes complicaciones: analgesia lateralizada (16,4%), punción hemática (8,7%), parestesias (8,2%), técnica dificultosa (5,2%), analgesia ineficaz (2,7%), hipotensión arterial (2,5%) y bloqueo subdural (0,2%). En el postparto: lumbalgia (18,5%), retención urinaria (3,4%), cefalea postpunción dural (1,4%), neuropatías periféricas (0,9%) e hipoestesia prolongada (0,2%). Todas las complicaciones se resolvieron ad integrum con tratamiento conservador salvo un caso de cefalea que precisó la realización de un parche hemático. Conclusiones: La alta tasa de fallos de la analgesia epidural en obstetricia así como la posibilidad de complicaciones neurológicas pueden resolverse siguiendo unas normas de buena práctica que incluyen la aspiración previa a la inyección, la dosis test y la revisión periódica del catéter. Resulta imprescindible conocer dichas complicaciones para su evaluación y tratamiento precoz (AU)

Objectives: To determine the incidence of failures and neurological complications related to the epidural analgesia for labour and to analyze their evolution and pathogenesis. Patients and methods: Prospective and descriptive study in pregnant women who received an epidural analgesia for labour in a third level hospital over a 11-month period. The following data were registered: demographic mother and child information, labour, type of childbirth and complications during the procedure and during the peripartum and postpartum periods. All women were followed up to their hospitable discharge with an identification and treatment of the observed complications up to their resolution. Results: We enrolled 438 patients. Complications were separated in 2 phases: peripartum and postpartum. In the peripartum period were identified, from bigger than minor frequency, the following complications: unilateral analgesia (16,4%), hematic punction (8.7%), paresthesias (8.2%), difficult technique (5.2%), ineffective analgesia (2.7%), hypotension (2.5%) and subdural block (0.2%). In the postpartum period: lumbar pain (18.5%), urinary retention (3.4%), post-dural puncture headache (1.4%), peripheral neurophaty (0.9%) and prolonged hypoesthesia (0.2%). All complications were resolved ad integrum by a conservative treatment except one patient who needed an epidural blood patching because of a refractory headache. Conclusions: The high frequency of failure of the epidural analgesia in obstetrics as well as the possibility of neurological complications can be solved following several norms of a good practice that include the previous aspiration to the injection, the test-dose and the continuous inspection of the catheter. It´s essential to know these complications for their evaluation and precocious treatment (AU)

Hemangioma del labio superior tratado con éxito con propranolol / Hemangioma of the upper lip treated successfully with propranolol

Los hemangiomas son los tumores benignos más frecuentes de la infancia, suelen localizarse en cabeza y tronco, y en la mayoría de los casos tienden a involucionar espontáneamente. Los hemangiomas labiales tienen mayor riesgo de producir deformidades, cicatrices residuales o ulceraciones. Una minoría de casos, bien por su tamaño, su ubicación o su evolución complicada, requieren tratamiento, empleándose tradicionalmente corticoides orales. En los últimos años han aparecido casos tratados con propranolol oral con excelentes resultados. Presentamos un lactante varón de tres meses, sin antecedentes de interés, que presentaba un hemangioma en el labio superior que le dificultaba la succión y le provocaba una deformidad estética. Tras descartar patología asociada, a los cuatro meses comenzó tratamiento ambulatorio con propranolol oral en dosis inicial de 1,5 mg/kg/día, con buenos resultados y sin complicaciones. La evolución fue satisfactoria, disminuyendo el tamaño y el color de la lesión. Consideramos que el propranolol es una opción terapéutica eficaz y segura, y aunque son necesarios estudios clínicos amplios en los que el mecanismo de acción, la dosis y la duración del tratamiento queden aclarados, queremos destacar la figura del pediatra de Atención Primaria en la detección de posibles efectos adversos, en el seguimiento del paciente y en el apoyo a la familia (AU)

Hemangiomas are the most common benign tumours in childhood, usually located in the head and neck, and most of them suffer a spontaneous regression. Lip hemangiomas have a higher risk of causing deformities, residual scarring or ulceration. A minority of cases, either because of size, location or their complicated evolution, require therapy, traditionally using oral corticosteroids. In recent years, excellent results have been obtained in cases treated with oral propranolol. We present the case of a 3-month-old male infant, with no history of interest, who had a hemangioma in his upper lip that made suction difficult and produced an aesthetic deformity. After ruling out associated pathology, at the age of 4 months our patient began outpatient treatment with oral propranolol with an initial dose of 1.5 mg/kg/day, with good results and without complications. The evolution was satisfactory, and the size and colour of the injury were reduced. We believe that propranolol is an effective and safe therapeutic option, and although comprehensive clinical studies are needed in which the mechanism of action, dosage and duration of treatment are clarified, we would like to highlight the important role of the primary care pediatrician in the detection of possible adverse effects, in patient monitoring, and in family support (AU)

Lesión de nervios periféricos en anestesia obstétrica: descripción de cuatro casos / No disponible

El abordaje neuroaxial es de elección para el control del dolor en obstetricia, pero no está exento de riesgos. Las neuropatías periféricas posparto pueden producirse por diferentes condiciones médicas, quirúrgicas y anestésicas, por lo que debemos tenerlas presentes para diagnosticarlas y tratarlas precozmente y así evitar que se atribuyan, por defecto, a la técnica anestésica. Presentamos cuatro casos que se diagnosticaron en el periodo periparto, 2 meralgias parestésicas, 1 neuropatía del femoral y 1 lumbociatalgia, de las cuales solo la lumbociatalgia pudo ser atribuida parcialmente a la técnica anestésica. Tras confirmar su diagnóstico se instauró tratamiento conservador que resolvió ad integrum, dentro de los primeros siete días, todas las neuropatías salvo la lumbociatalgia. La baja incidencia de neuropatías periféricas tras técnicas neuroaxiales en obstetricia puede ser superior a la que se diagnostica. Resulta imprescindible una buena anamnesis preanestésica y conocer los diferentes mecanismos fisiopatológicos que pueden desencadenar neuropatías periféricas (AU)

A neuroaxial approach is of choice for the management of pain in obstetrics but is not exempt of risks. Postpartum peripheral neuropathy may occur because of various medical, surgical, and anesthetic conditions, hence we should have them in mind in order to recognize them and treat them early enough to prevent their deffault attribution to the anesthetic technique. We report four cases diagnosed during the peripartum – 2 paresthetic meralgias, 1 femoral neuropathy, and 1 lumbosciatalgia, of which only the lumbosciatalgia could be partly attributed to the anesthetic technique. Once the diagnosis was confirmed a conservative therapy was initiated that solved ad integrum all neuropathies, except for the lumbosciatalgia episode, within seven days. The low incidence of peripheral neuropathy following neuroaxial techniques in obstetrics may be higher than diagnosed. Adequate history taking before anesthesia is crucial, as is an understanding of the various pathophysiological mechanisms that may trigger peripheral neuropathy (AU)

[Epidural analgesia in obstetrics: is there an effect on labor and delivery?]. / Analgesia epidural en obstetricia: cómo afecta al desarrollo y finalización del parto?

BACKGROUND AND OBJECTIVE: Epidural analgesia is routinely used in obstetrics but has been blamed for possible effects on labor that lead to greater use of instruments or conversion to cesarean delivery. We aimed to assess this possibility in a cohort of obstetric patients receiving or not receiving epidural analgesia. PATIENTS AND METHODS: Prospectively enrolled full-term obstetric patients were distributed in 2 groups according to whether they received epidural analgesia or not. We compared maternal and fetal characteristics, obstetric variables, and type of delivery between groups to record the likely causes of difficult labor and delivery and detect a possible influence of epidural analgesia. RESULTS: Of a total of 602 patients, 462 received epidural analgesia and 140 did not. Epidural analgesia was related to a higher rate of use of instruments but not cesareans (P < .01) and more frequent need for oxytocin (30.7% of the epidural analgesia group vs 0% of the group receiving no epidural analgesia, P < .001). The women receiving analgesia also had a longer mean (SD) duration of the dilatation phase of labor (6.4 [4.2] hours in the epidural group vs 4.7 [3.5] hours in the no-epidural group, P < .01) and of the expulsion phase (1.0 [0.6] hours vs 0.7 [0.6] hours, respectively; P<.01). We observed no effects on the incidence of tearing, rate of episiotomy, or other variables. Predictors of instrumentation or conversion to cesarean delivery were longer duration of the first phase (odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1-1.3), longer duration of the second phase (OR 2.3; 95% CI, 1.3-3.9), and maternal obesity (OR, 1.1; 95% CI, 0.9-1.2). Previous deliveries and initiation of epidural analgesia after the fetus has reached Hodge's first plane decreased risk 2.7-fold and 3.03-fold, respectively. CONCLUSIONS: Although epidural analgesia has traditionally been associated with a higher incidence of difficult labor and delivery, this association was not unequivocally evident in this cohort of patients. The apparent increase seems to be attributable to such obstetric factors as longer duration of stages of labor, higher body mass index, and first delivery.

Analgesia epidural en obstetricia: ¿cómo afecta al desarrollo y finalización del parto? / Epidural analgesia in obstetrics: Is there an effect on labor and delivery?

Introducción: La analgesia epidural es el estándar de la analgesia obstétrica, pero se le atribuye una posible influencia en la dinámica del parto que puede provocar un aumento de los partos instrumentados y cesáreas. Nuestro objetivo fue valorar en una cohorte de pacientes obstétricas la finalización del parto en relación con el tipo de analgesia empleado. Pacientes y método: Estudio prospectivo de cohorte de gestantes a término divididas en 2 grupos. El grupo A recibió analgesia epidural y el grupo B no recibió analgesia epidural. Se compararon las variables demográficas materno-fetales, obstétricas y tipo de parto en cada grupo y se estudiaron la influencia de la analgesia epidural y las causas probables que provocaron partos distócicos. Resultados: Se incluyeron 602 pacientes: 462 en grupo A y 140 en grupo B. La analgesia epidural se relacionó con una mayor tasa de partos instrumentales pero no de cesáreas (p < 0,01), mayor necesidad de oxitócicos (30,7% en grupo A vs 0% en grupo B, p < 0,001) y una mayor duración de las fases del parto (fase de dilatación 6,4 ± 4,2 h en grupo A frente a 4,7 ± 3,5 h en grupo B y fase expulsivo 1,0 ± 0,6 h frente a 0,7 ± 0,6 h, p < 0,01), sin influir en la tasa de desgarros, episiotomías ni otras variables. La mayor duración del primer (OR 1,2 IC95% 1,1-1,3) y segundo estadios del parto (OR 2,3 IC95% 1,3-3,9) del trabajo de parto y la obesidad materna (OR: 1,1 IC95% 0,9-1,2) se relacionaron con aumento del riesgo de partos distócicos, mientras que la multiparidad e iniciar la analgesia epidural con una presentación en el I plano de Hodge o superior lo disminuyeron 2,7 y 3,03 veces respectivamente. Discusión: Pese a que clásicamente se ha relacionado la analgesia epidural con un aumento de partos distócicos, en nuestra cohorte dicha influencia es discutible. El posible incremento pareció deberse a factores obstétricos como mayor duración de los estadios del parto, mayor índice de masa corporal y la primiparidad(AU)

Background and objective: Epidural analgesia is routinely used in obstetrics but has been blamed for possible effects on labor that lead to greater use of instruments or conversion to cesarean delivery. We aimed to assess this possibility in a cohort of obstetric patients receiving or not receiving epidural analgesia. Patients and methods: Prospectively enrolled full-term obstetric patients were distributed in 2 groups according to whether they received epidural analgesia or not. We compared maternal and fetal characteristics, obstetric variables, and type of delivery between groups to record the likely causes of difficult labor and delivery and detect a possible influence of epidural analgesia. Results: Of a total of 602 patients, 462 received epidural analgesia and 140 did not. Epidural analgesia was related to a higher rate of use of instruments but not cesareans (P<.01) and more frequent need for oxytocin (30.7% of the epidural analgesia group vs 0% of the group receiving no epidural analgesia, P<.001). The women receiving analgesia also had a longer mean (SD) duration of the dilatation phase of labor (6.4 [4.2] hours in the epidural group vs 4.7 [3.5] hours in the no-epidural group, P<.01) and of the expulsion phase (1.0 [0.6] hours vs 0.7 [0.6] hours, respectively; P<.01). We observed no effects on the incidence of tearing, rate of episiotomy, or other variables. Predictors of instrumentation or conversion to cesarean delivery were longer duration of the first phase (odds ratio [OR] 1.2; 95% confidence interval [CI], 1.1-1.3), longer duration of the second phase (OR 2.3; 95% CI, 1.3-3.9), and maternal obesity (OR, 1.1; 95% CI, 0.9-1.2). Previous deliveries and initiation of epidural analgesia after the fetus has reached Hodge’s first plane decreased risk 2.7-fold and 3.03-fold, respectively. Conclusions: Although epidural analgesia has traditionally been associated with a higher incidence of difficult labor and delivery, this association was not unequivocally evident in this cohort of patients. The apparent increase seems to be attributable to such obstetric factors as longer duration of stages of labor, higher body mass index, and first delivery(AU)

Abordaje de la analgesia postoperatoria en cirugía de cadera: comparativa de 3 técnicas / Post-operative analgesia in hip surgery: a comparison of 3 techniques

Introducción. Resulta indispensable tratar el dolor postoperatorio de cirugía de cadera para iniciar una rehabilitación precoz y para disminuir la morbimortalidad. Dada la pluripatología y la edad de los pacientes, la analgesia locorregional se revela como el arma más eficaz para tratarlo. Objetivos. Valorar la eficacia del bloqueo iliofascial y del bloqueo de los nervios obturador y femorocutáneo frente a analgesia intravenosa, así como registrar el grado de satisfacción, las complicaciones, el inicio de rehabilitación y los costes económicos en cada grupo. Pacientes y método. Estudio prospectivo con 90 pacientes sometidos a cirugía de cadera. Se dividieron en tres grupos aleatorios: A: solo analgesia intravenosa; B: bloqueo iliofascial, y C: bloqueo de los nervios obturador y femorocutáneo lateral. Se investigó el grado de dolor y la satisfacción con la analgesia, el tiempo transcurrido hasta el inicio de la sedestación, el consumo total de analgésicos postoperatorios, los efectos secundarios y los costes económicos farmacéuticos en cada grupo. Resultados. La eficacia analgésica y el grado de satisfacción fueron significativamente mayores en los pacientes con bloqueos nerviosos (escala visual analógica [EVA] media 2,14±1,24, satisfacción 3,75±0,8) que en los que solo recibieron analgesia intravenosa (EVA media 5,57±0,64, satisfacción 2,83±0,7) (p<0,001), con una duración superior a las 24h (p<0,01) y un menor consumo de analgésicos suplementarios y otros fármacos que en el grupo A, por lo que tuvieron menos reacciones adversas (p<0,01), iniciaron la rehabilitación más precozmente (31,2±5,01h frente a 44,62±7,9h) (p<0,001) y supusieron un menor coste económico farmacéutico (13,26±6,34€/paciente frente a 30,26±1,88€/paciente), no encontrándose complicaciones en la realización de los bloqueos. No se encontraron diferencias significativas entre la eficacia de ambos bloqueos, evolución de las EVA media, grado de satisfacción ni gasto económico entre los pacientes que recibieron algún tipo de bloqueo. Conclusiones. Los bloqueos realizados son una técnica efectiva, fácil y segura, que proporciona numerosas ventajas: analgesia postoperatoria prolongada, recuperación más rápida, menor coste y escasas complicaciones (AU)

Introduction. The treatment of postoperative pain after hip surgery is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Objectives. Our aim was to compare the efficacy of the fascia iliaca compartment block, the obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation and cost in each group. Patients and methods. A prospective study of 90 patients undergoing hip surgery. Patients were randomised to receive intravenous analgesia only, fascia iliaca compartment block or blockade of the obturator and femoral cutaneous nerves. In each group we recorded visual analogue scale (VAS) pain scores, satisfaction with postoperative analgesia, time elapsed until start of rehabilitation, need for postoperative analgesics, side effects, and the cost of drugs. Results. Analgesia and level of patient satisfaction were significantly more effective in patients with nerve blocks than in those who received only intravenous analgesia (mean [SD] VAS scores, 2.14 [1.24], mean [SD] satisfaction scores 3.75 [0.8] and mean [SD] VAS scores, 5.57 [0.64], mean [SD] satisfaction scores 2.83 [0.7], respectively) (p<0.001). Patients with nerve blocks also had a pain-free period of more than 24h (p<0.01), needed fewer doses of supplementary analgesics or other drugs, had fewer side effects (p<0.01), started rehabilitation earlier (31.2 [5.01] hours vs. 44.62 [7.9] hours) (p<0.001), generated less expenditure (€13.26 [€6.34]/patient vs. €30.26 [€1.88]/patient), with no complications in the blocking techniques. No significant differences were found between the efficacy of both blocks, VAS scores, level of satisfaction or cost between the patients who received a block. Conclusions. The nerve blocks were effective, easy to perform, and safe. They afforded numerous advantages: extended period of postoperative analgesia, fast recovery, lower costs, and no complications (AU)

[Local and regional analgesia after pediatric surgery: study in 116 patients]. / Técnicas locorregionales para analgesia perioperatoria en anestesia pediátrica: estudio en 116 pacientes.

OBJECTIVES: Pain control is essential to patient comfort and reduced stress response, morbidity, and mortality after pediatric anesthesia. We assessed analgesic quality and the incidence of complications of regional blocks in combination with general anesthesia. MATERIAL AND METHODS: Prospective study of 116 patients under 3 years of age who underwent surgery in our hospital over a period of 2 years. The studied patients were classified in 3 groups according to whether they received general anesthesia only, a regional block by single injection, or a caudal nerve block via catheter. We recorded demographic and intraoperative variables, postoperative analgesic requirements, and the time the first postoperative analgesic dose was needed. RESULTS: Analgesia was significantly more effective in the patients who received either type of regional block. The patients who received general anesthesia alone needed supplemental analgesia earlier than the others (P < .001); patients with nerve blocks required fewer doses of rescue analgesics (P < .001). The incidence of complications was low and all were minor. No case of caudal catheter contamination occurred. CONCLUSIONS: Regional nerve blocks combined with general anesthesia in children are effective and safe. Advantages of providing nerve blocks include hemodynamic stability, prolonged postoperative analgesia, lower consumption of analgesics, and few complications.

Técnicas locorregionales para analgesia perioperatoria en anestesia pediátrica: estudio en 116 pacientes / Local and regional analgesia after pediatric surgery: study in 116 patients

OBJETIVOS: El tratamiento del dolor es imperativopara mejorar el confort del paciente y disminuir la respuestaal estrés y la morbi-mortalidad durante el periodopostoperatorio en anestesia pediátrica. En este estudioevaluamos la calidad analgésica y la incidencia decomplicaciones de los bloqueos regionales, asociados aanestesia general.MATERIAL Y MÉTODOS: Estudio prospectivo de 116pacientes menores de 3 años, intervenidos en nuestrohospital en un periodo de 2 años. Los pacientes se dividieronen 3 grupos: (A) sólo anestesia general, (B) bloqueoregional de punción única y (C) catéter caudal. Serecogieron las variables demográficas e intraoperatorias,la necesidad de analgésicos en el postoperatorio y elmomento en que se precisó la primera dosis analgésica.RESULTADOS: La eficacia analgésica fue significativamentemayor en los grupos B y C. Los pacientes del grupoA precisaron analgesia suplementaria más precozmenteque los de los grupos B y C (p < 0,001) y elnúmero de dosis de analgésicos de rescate fue significativamentemenor (p < 0,001). Se produjo una baja incidenciade complicaciones, todas ellas leves y ningunacontaminación de catéter caudal.CONCLUSIONES: Los bloqueos regionales asociados a laanestesia general en niños son efectivos y seguros puesproporcionan numerosas ventajas: estabilidad hemodinámica,analgesia postoperatoria prolongada, menorconsumo de analgésicos y escasas complicaciones(AU)

OBJETIVES: Pain control is essential to patient comfort and reduced stress response, morbidity, and mortality after pediatric anesthesia. We assessed analgesic quality and the incidence of complications of regional blocks in combination with general anesthesia. MATERIAL AND METHODS: Prospective study of 116 patients under 3 years of age who underwent surgery in our hospital over a period of 2 years. The studied patients were classified in 3 groups according to whether they received general anesthesia only, a regional block by single injection, or a caudal nerve block via catheter. We recorded demographic and intraoperative variables, postoperative analgesic requirements, and the time the first postoperative analgesic dose was needed. RESULTS: Analgesia was significantly more effective in the patients who received either type of regional block. The patients who received general anesthesia alone needed supplemental analgesia earlier than the others (P<.001); patients with nerve blocks required fewer doses of rescue analgesics (P<.001). The incidence of complications was low and all were minor. No case of caudal catheter contamination occurred. CONCLUSIONS: Regional nerve blocks combined with general anesthesia in children are effective and safe. Advantages of providing nerve blocks include hemodynamic stability, prolonged postoperative analgesia, lower consumption of analgesics, and few complications(AU)

Abordaje de la analgesia postoperatoria en cirugía de cadera: comparativa de 3 técnicas / Post-surgical analgesia in hip surgery: a comparison of three techniques

Introducción. Resulta indispensable tratar el dolor postoperatorio de cirugía de cadera para iniciar una rehabilitación precoz y para disminuir la morbimortalidad. Dada la pluripatología y edad de los pacientes, la analgesia locorregional se revela como el arma más eficaz para tratarlo. Objetivos. Valorar la eficacia del bloqueo iliofascial y del bloqueo de los nervios obturador y femorocutáneo frente a analgesia intravenosa, así como registrar el grado de satisfacción, las complicaciones, inicio de rehabilitación y costes económicos en cada grupo. Pacientes y método. Estudio prospectivo con 90 pacientes sometidos a cirugía de cadera. Se dividieron en 3 grupos aleatorios: A: solo analgesia intravenosa, B: bloqueo iliofascial y C: bloqueo de los nervios obturador y femorocutáneo lateral. Se investigó el grado de dolor y satisfacción analgésica, tiempo transcurrido hasta el inicio de la sedestación, necesidad de analgésicos postoperatorios, efectos secundarios y los costes económicos farmacéuticos en cada grupo. Resultados. La eficacia analgésica y el grado de satisfacción fueron significativamente mayores en los pacientes con bloqueos nerviosos (EVA medio 2,14±1,24, satisfacción 3,75±0,8) que en los que solo recibieron analgesia intravenosa (EVA medio 5,57±0,64, satisfacción 2,83±0,7) (p<0,001), con una duración superior a las 24h (p<0,01) y un menor consumo de analgésicos suplementarios y otros fármacos que en el grupo A, por lo que tuvieron menos reacciones adversas (p<0,01), iniciaron la rehabilitación más precozmente (31,2±5,01h vs 44,62±7,9h) (p<0,001) y supusieron un menor coste económico farmacéutico (13,26±6,34€/paciente vs 30,26±1,88€/paciente) no encontrándose complicaciones en la realización de los bloqueos. No se encontraron diferencias significativas entre la eficacia de ambos bloqueos, evolución de los EVAs medio, grado de satisfacción ni gasto económico entre los pacientes que recibieron algún tipo de bloqueo...(AU)

Introduction. The treatment of postoperative pain after hip surgery is essential for an early start of rehabilitation and for reducing morbidity and mortality. Given that patients are elderly and have multiple medical conditions, local-regional analgesia can be an effective approach. Objectives. Our aim was to compare the efficacy of the fascia iliaca compartment block, the obturator and femoral cutaneous nerve blocks and total intravenous analgesia in terms of level of patient satisfaction, complications, start of rehabilitation and cost in each group. Patients and methods. Prospective study of 90 patients undergoing hip surgery. Patients were randomised to receive intravenous analgesia only, fascia iliaca compartment block or blockade of the obturator and femoral cutaneous nerves. In each group, we recorded visual analogue scale (VAS) pain scores, satisfaction with postoperative analgesia, time elapsed until start of rehabilitation, need for postoperative analgesics, side effects, and the cost of drugs. Results. Analgesia and level of patient satisfaction were significantly more effective in patients with nerve blocks than in those who received intravenous analgesia only (mean [SD] VAS scores, 2.14 [1.24], mean [SD] satisfaction scores 3.75 [0.8] and mean [SD] VAS scores, 5.57[0.64], mean [SD] satisfaction scores 2.83[0.7], respectively) (p<0.001). Patients with nerve blocks also had a pain-free period of more than 24h (p<0.01), needed fewer doses of supplementary analgesics or other drugs, had fewer side effects (p<0.01), started rehabilitation earlier (31.2 [5.01]h vs 44.62 [7.9]h) (p<0.001), generated less expenditure (€13.26 [€6.34]/patient vs €30.26 [€1.88]/patient), with no complications in the blockade techniques. No significant differences were found between the efficacy of both blockades, VAS scores, level of satisfaction, or the cost between the patients who received a blockade...(AU)

Descripción de un caso de síndrome de hipoventilación-apnea alveolar central adquirido / No disponible

No disponible

Seasonal trends and spatial relations between environmental/meteorological factors and leishmaniosis sand fly vector abundances in Central Spain.

This paper reports on an entomological survey performed over the period 2006-2008 in Central Spain (mainly in the Madrid province) where canine leishmaniosis (CanL) is endemic. The study area was selected on the grounds of its wide altitude range, which determines both broad climate and vegetation ranges that could affect sand fly distributions. This area was surveyed from NE to SW across its mountain range (Sistema Central) and plateau area using sticky traps mainly on embankments. In 2006 and 2007, 123 sites were sampled (9557 sand flies captured) to establish possible relations between environmental or meteorological factors and vector densities (Phlebotomus perniciosus and Phlebotomus ariasi). The factors correlated with higher vector densities were: a sample site between villages or at the edge of a village, the lack of a paved road, a rural habitat, an east or south-facing wall or wall sheltered from the wind, the presence of livestock or birds, a holm-oak wood vegetation, a lower summer mean temperature and lower annual mean precipitation. This study was followed by a seasonal survey conducted at 16 selected sites (14,353 sand flies) sampled them monthly from May to November 2008. P. perniciosus showed a diphasic seasonal trend with two abundance peaks in July and September whereas P. ariasi showed a monophasic trend with one peak in August. Comparing with data from studies performed in 1991 in the same area, vector densities are significantly higher. A possible explanation for this is that the vectors (mainly P. ariasi) are moving towards higher altitudes perhaps because of global change. This increasing trend could have an impact on CanL and its geographical distribution.

Eficacia del bloqueo de los nervios obturador y femorocutáneo para analgesia postoperatoria en cirugía de cadera / Efficacy of obturator and femoral cutaneous nerve blocks for postoperative analgesia in hip surgery

OBJETIVOS: Tratar el dolor postoperatorio de fracturade cadera es imperativo para iniciar una rehabilitaciónprecoz y para disminuir la morbimortalidad. Dada la pluripatologíay edad de los pacientes, la analgesia locorregionalpuede ser eficaz para tratarlo. Los objetivos planteadosfueron valorar la eficacia analgésica del bloqueo delos nervios obturador y femorocutáneo frente a analgesiaintravenosa total, así como registrar el grado de satisfacción,las complicaciones, inicio de rehabilitación y costeseconómicos en cada grupo.PACIENTES Y MÉTODO: Estudio prospectivo en 75pacientes sometidos a cirugía de fractura de cadera. Sedividieron en 3 grupos distribuidos aleatoriamente, grupoA, recibió sólo analgesia intravenosa; grupo B, recibiódoble bloqueo, y grupo C recibió bloqueo del nervioobturador. Se investigó el grado de dolor y satisfaccióncon la analgesia postoperatoria, el tiempo transcurridohasta el inicio de la rehabilitación, necesidad de analgésicospostoperatorios, efectos secundarios y los costeseconómicos farmacéuticos en cada grupo.RESULTADOS: La eficacia analgésica fue significativamentemayor en los pacientes con bloqueos nerviosos(EVA medio 2,6±1,4) que en los que recibieron sólo analgesiaintravenosa (5,6±0,7), mostrando además un periodolibre de dolor de más de 24 horas (p<0,001), un menorconsumo de analgésicos suplementarios y otros fármacos,menos reacciones adversas (p<0,01), un inicio de la rehabilitaciónmás precoz (32,6±5,4h frente a 45,7±8,2h), unmenor coste económico (2,6±1,5 frente a 7,0±0,4 €/paciente)y una ausencia total de complicaciones de las técnicas.CONCLUSIONES: Los bloqueos realizados son una técnicaefectiva, fácil y segura que proporciona numerosasventajas: analgesia postoperatoria prolongada, recuperaciónmás rápida, menor coste y escasas complicaciones(AU)

OBJECTIVES: The treatment of pain after surgery torepair a hip fracture is essential for an early start ofrehabilitation and for reducing morbidity and mortality.Given that patients are elderly and have multiplemedical conditions, local-regional analgesia can be aneffective approach. Our aim was to compare the efficacyof obturator and femoral cutaneous nerve blocks andtotal intravenous analgesia in terms of level of patientsatisfaction, complications, start of rehabilitation, andcost.PATIENTS AND METHODS: Prospective study of 75patients undergoing surgery to repair hip fractures.Patients were randomized to receive intravenousanalgesia only, blockade of both nerves, or blockade ofonly the obturator nerve. In each group we recordedvisual analog scale (VAS) pain scores, satisfaction withpostoperative analgesia, time elapsed until start ofrehabilitation, need for postoperative analgesics, sideeffects, and the cost of drugs.RESULTS: Analgesia was significantly more effective inpatients with nerve blocks than in those who receivedonly intravenous analgesia (mean [SD] VAS scores, 2.6[1.4] and 5.6 [0.7], respectively). Patients with nerveblocks also had a pain-free period of more than 24 hours(P<.001), needed fewer doses of supplementaryanalgesics or other drugs, had fewer side effects (P<.01),started rehabilitation earlier (32.6 [5.4] hours vs 45.7[8.2] hours), generated less expenditure (€2.6[€1.5]/patient vs €7.0 [€0.4]/patient). The testedtechniques had no complications.CONCLUSIONS: The nerve blocks were effective, easy toperform, and safe. They afforded numerous advantages:extended period of postoperative analgesia, fastrecovery, lower costs, and no complications(AU)