Espiritualidad, vocación y sentido. Recursos generales de resistencia para profesionales de enfermería según la figura de San Juan de Dios / Espiritualidade, vocação e significado. Recursos gerais de resistência para profissionais de enfermagem segundo a figura de São João de Deus / Spirituality, vocation, and meaning. General resistance resources for nursing professionals according to the figure of Saint John of God

Este artículo tiene como objetivo elaborar una reflexión haciaaquellos elementos que actuaron como recursos espirituales enel proceso de formación de San Juan de Dios como enfermeroy elaborar una serie de aportaciones actuales para reforzar elsentido de coherencia de las enfermeras post pandemia. Seutilizó la metodología historiográfica aplicada a historia de laenfermería para la reconstrucción de la memoria profesional,tomando como referencia y ejemplo la figura de San Juan deDios y se recogieron los elementos siguiendo la herramientade valoración espiritual FICA. Los textos muestran a Juan deDios con un sentido de coherencia interna que se hizo posiblea través de los recursos psico-espirituales de la época. Éstosfacilitaron encontrar y desarrollar la vocación propia y lamotivación para desarrollarla y alcanzar la autorrealización.La propuesta es contemplar en la profesionalización enfermeraun cuidado por paraklesis, que implica presencia personal,actitud dialogal y palabra sapiencial, luminosa y alentadorasiguiendo el modelo de San Juan de Dios, y su relación conel modelo de valoración espiritual FICA.(AU)

This article aims to elaborate a reflection on the elementsthat were spiritual resources during the formation of SaintJohn of God as a nurse.It is also to elaborate a series of current contributions to reinforcethe nurses’sense of coherence within post-pandemic context.The historiographical methodology applied to nursing history was used for the reconstruction of professional memory, takingthe figure of Saint John of God as a reference and example.Thetexts show John of God with a sense of internal coherence.It was possible through the psycho-spiritual resources of thetime. These made it easier for him to find and develop hisown vocation and the motivation to develop it and achieveself-realization. Our proposal is to contemplate in nursingprofessionalization a care for paraklesis, which impliespersonal presence, dialogical attitude and wise, luminousand encouraging word following the model of Saint John ofGod and it relationship with FICA evaluation Model.(AU)

Este artigo tem como objetivo elaborar uma reflexão sobre oselementos que atuaram como recursos espirituais no processode formação de São João de Deus como enfermeiro e elaboraruma série de contribuições atuais para reforçar o sentidode coerência das enfermeiras pós-pandemia. Foi utilizada ametodologia historiográfica aplicada à história da enfermagempara a reconstrução da memória profissional, tendo comoreferência e exemplo a figura de São João de Deus, e oselementos foram coletados seguindo a ferramenta de avaliaçãoespiritual FICA. Os textos mostram São João de Deus comum sentido de coerência interna que se tornou possível pormeio dos recursos psico-espirituais da época. Estes facilitaramencontrar e desenvolver a vocação própria, bem como amotivação para desenvolvê-la e alcançar a autorrealização. Aproposta é contemplar na profissionalização da enfermeiraum cuidado por paraklesis, que implica presença pessoal,atitude dialógica e palavra sapiencial, luminosa e encorajadora,seguindo o modelo de São João de Deus e sua relação como modelo de avaliação espiritual FICA.(AU)

Nursing care in patients with dependency-related skin injuries in the community: a scoping review.

PURPOSE: Dependency-related skin injuries (DRSI) occur in people who need a high level of support to carry out day-to-day activities. Owing to the ageing population, the number of people at risk of DRSI is increasing. Most wound care is performed by nurses in the community. This scoping review aimed to identify the extent of literature on nursing care for patients with or at risk of developing DRSI living in their own home. MATERIALS AND METHODS: A scoping review was conducted. RESULTS: A total of 28 studies met the inclusion criteria and four main themes emerged: features of the community setting; wound types, causes and management; prevention strategies around aetiology and holistic care; care management and local wound care. CONCLUSION: Although most wounds occur in and are treated in the community, there is a paucity of research on wounds in this setting. The care of patients with DRSI in the community is complex and prevention according to the individual aetiology of each lesion is the key factor in wound care.

Using LEGO® Serious Play for students' Critical-Reflective Reasoning development in the construction of the nursing metaparadigm.

INTRODUCTION: In a nursing degree critical reasoning competency includes reasoning both inside and outside the clinical setting. One of the major challenges for nursing students is learning concepts at a high abstract level. In this sense, the LEGO® Serious Play method has the potential to improve thinking skills. AIMS: To describe a) which elements of thinking link to the learning of the nursing metaparadigm through the use of the LEGO® Serious Play "four Cs" method b) analyse how this method helps to generate critical reflective thinking in nursing students during the process of application of theoretical knowledge about the nursing metaparadigm in a new situation. METHODS: An interpretive phenomenological analysis, integrating qualitative research methods was implemented as a means of undertaking research facilitated using LEGO® Serious Play method as an innovative method of data collection. RESULTS: 280 participants were recruited. From the analysis of the contributions made to the students' forum, six categories emerged: Starting point, Consciousness, Process, Teamwork, Capacities and Limitations. CONCLUSION: LEGO® Serious Play is an effective method for teaching nursing metaparadigms and helps students acquire and generate new knowledge.

Percepciones de las enfermeras sobre el cuidado de pacientes con lesiones cutáneas relacionadas con la dependencia y otras heridas crónicas en la comunidad / Perceptions of nurses regarding the care of patients with dependency-related skin injuries and other chronic wounds in the community

Objetivos: Explorar las percepciones de las enfermeras de atención primaria en relación con los cuidados de los pacientes con lesiones cutáneas relacionadas con la dependencia y otras heridas crónicas en el ámbito comunitario. Metodología: Diseño cualitativo que empleó la técnica de grupo focal con una muestra de 8 participantes seleccionados mediante muestreo teórico. Para el análisis de los datos se utilizaron técnicas de análisis de contenido cualitativo. Resultados: Emergen 15 categorías que se presentan bajo los 4 conceptos del metaparadigma enfermero. Destacan la intervención de las enfermeras en el cuidado de heridas, los conocimientos profesionales insuficientes, la meta de los cuidados enfermeros, la vivencia única de cada paciente y la gran influencia del entorno. Conclusiones: El cuidado de pacientes con heridas en la comunidad es complejo e incluye un gran número de actividades de enfermería que, a menudo, se basan en la experiencia y no en la evidencia. Las heridas impactan profundamente en la calidad de vida de las personas provocando experiencias únicas y multifactoriales. El entorno que rodea a la persona, tanto la familia, los cuidadores, el domicilio como el nivel socioeconómico, político y cultural, influye enormemente en los cuidados.(AU)

Objectives: Exploring primary care nurses’ perceptions of caring for patients with dependency-related skin injuries and other chronic wounds in the community setting. Methodology: Qualitative design that employed the focus group technique with a sample of 8 participants selected through theoretical sampling. Qualitative content analysis techniques were used for data analysis. Results: A total of 15 categories emerge that are presented under the 4 concepts of the nursing metaparadigm. They highlight the intervention of nurses in wound care, insufficient professional knowledge, the goal of nursing care, the unique experience of each patient, and the great influence of the environment. Conclusions: The care of patients with wounds in the community is complex and involves a large number of nursing activities that often rely on experience rather than evidence. Wounds profoundly impact the quality of life of individuals, leading to unique and multifactorial experiences. The environment surrounding the individual, including family, caregivers, home, as well as socioeconomic, political, and cultural factors, greatly influences care.(AU)

Impacto de las lesiones por presión en un paciente post Covid-19 / Impact of pressure injuries in a post-Covid-19 patient

Objetivo principal: Explorar el impacto de las lesiones por presión (LPP) en las personas después de un ingreso en la UCI por Covid-19. Metodología: Estudio de caso bajo enfoque cualitativo. Se realizó una entrevista semiestructurada para explorar el fenómeno "padecer LPP en el contexto de la enfermedad por Covid-19" y un análisis temático mediante la teoría fundamentada. Resultados principales: El análisis resultó en las siguientes categorías: signos y síntomas, funcionamiento físico, bienestar psicológico, funcionamiento social, vivencia del proceso, ámbito de los cuidados, espiritualidad, tratamientos, elementos de cura experta, comunicación de la información, satisfacción de cuidados, proceso de alta, integración y déficits de conocimientos. Conclusión principal: El estudio destaca el gran impacto que las lesiones por presión causan en todas las dimensiones calidad de vida, además de en las esferas espiritual, económica y la necesidad de información. (AU)

Objective: To find out the impact of pressure injuries (PI) on individuals after ICU admission for Covid-19. Methods: Case study under qualitative approach. A semi-structured interview was conducted to explore the phenomenon "suffering PI in the context of Covid-19 disease" and a thematic analysis was performed through grounded theory. Results: the impact analysis resulted in the following categories: signs and symptoms, physical functioning, psychological well-being, social functioning, experience of the process, scope of care, spirituality, treatments, elements of expert care, communication of information, satisfaction with care, discharge process, integration, and knowledge deficits. Conclusions: The study highlights the great impact that pressure injuries cause in all dimensions of quality of life, as well as in the spiritual, economic and information needs spheres. (AU)

FleQ, FleN and c-di-GMP coordinately regulate cellulose production in Pseudomonas syringae pv. tomato DC3000.

The second messenger cyclic di-GMP (c-di-GMP) controls the transition between motility and sessility in many bacterial species by a variety of mechanisms, including the production of multiple exopolysaccharides. Pseudomonas syringae pv. tomato (Pto) DC3000 is a plant pathogenic bacteria able to synthesize acetylated cellulose under high c-di-GMP levels thanks to the expression of the wssABCDEFGHI operon. Increased cellulose production enhances air-liquid biofilm formation and generates a wrinkled colony phenotype on solid media. We previously showed that under low levels of c-di-GMP, the regulators FleQ and AmrZ bound to adjacent sequences at the wss promoter inhibiting its expression, but only FleQ responded to the presence of c-di-GMP by activating cellulose production. In the present work, we advance in the knowledge of this complex regulation in Pto DC3000 by shedding light over the role of FleN in this process. The distinctive features of this system are that FleN and FleQ are both required for repression and activation of the wss operon under low and high c-di-GMP levels, respectively. We have also identified three putative FleQ binding sites at the wss promoter and show that FleQ/FleN-ATP binds at those sites under low c-di-GMP levels, inducing a distortion of DNA, impairing RNA polymerase binding, and repressing wss transcription. However, binding of c-di-GMP induces a conformational change in the FleQ/FleN-ATP complex, which relieves the DNA distortion, allows promoter access to the RNA polymerase, and leads to activation of wss transcription. On the other hand, AmrZ is always bound at the wss promoter limiting its expression independently of FleQ, FleN and c-di-GMP levels.

Comunicar la Historia de la Enfermería en la universidad: motivación innovadora y co-creación / Communicating the History of Nursing at University: Innovative Motivation and Co-Creation

Objetivo principal: Conocer el desarrollo de las prácticas innovadoras educativas en la docencia de Historia de la Enfermería en el Grado de Enfermería de España, caracterizando los entornos docentes e identificando las necesidades para su potenciación. Metodología: Estudio descriptivo transversal de alcance exploratorio, con encuesta que se aplicó a docentes de esta materia de universidades españolas, tanto públicas como privadas o concertadas. Resultados principales: Se observa variabilidad de perfiles de profesorado, de horas de impartición y de competencias y metodologías docentes. Si bien las metodologías activas son utilizadas por la mayoría de los encuestados, se aprecia la falta de procesos innovadores. Conclusión principal: Es mayor la motivación del profesorado hacia la comunicación de la Historia de la Enfermería de una manera innovadora que el nivel de desarrollo alcanzado hasta ahora en las tecnologías empleadas, identificándose por tanto un importante margen de mejora de cara al futuro (Au)

Objective: To know the development of innovative educational practices in the teaching of Nursing History in the Nursing degree in Spain, characterizing the teaching environments and identifying the needs for their empowerment. Methods: Cross-sectional descriptive study with an exploratory scope, with a survey that was applied to teachers of this subject at Spanish universities, both public and private or concerted. Results: Variability in teacher profiles, teaching hours, and teaching skills and methodologies is observed. Although active methodologies are used by the majority of respondents, there is a lack of innovative processes. Conclusions: The motivation of the teaching staff towards the communication of the History of Nursing in an innovative way is greater than the level of development reached so far in the technologies used, thus identifying an important margin for improvement for the future (AU)

Construcción de la imagen profesional de enfermería durante la pandemia por Covid-19 a través de las noticias de prensa / Construction of nursing professional image during the Covid-19 pandemic through press news

Objetivo: Describir la imagen social de la enfermería durante la primera oleada de pandemia por Covid-19 a través de la prensa escrita generalista y especializada. Metodología: Estudio documental cualitativo descriptivo, análisis realizado bajo la teoría de Moscovici. Selección 95 noticias del 15 marzo a 15 de mayo. Se descartaron artículos con alusión puntual a las enfermeras o al personal sanitario general. Se incluyeron finalmente 37 noticias prensa general y 40 prensa especializada. Extracción de datos siguiendo 8 indicadores: lenguaje verbal, imágenes, grado trascendencia y difusión de la información, ámbito, personas implicadas, por qué trasciende la información, identificación de juicios por parte de los autores y elementos de construcción social. Resultados: Prensa general: 94,5% lenguaje periodístico frente 5,5% científico-divulgativo. Uso mayoritario del masculino, centradas en la actividad asistencial. Las principales categorías emergentes fueron: ámbito de trabajo/profesión (43,75%), contexto/entorno (34,71%), emociones (13,88%) y patrones de conocimiento (7,64%). Conclusiones: Las noticias publicadas en prensa generalista incorporan una visión reduccionista de la enfermera sobre su desempeño profesional, aunque le otorgan un gran valor social. Es necesario lograr el reconocimiento del rol autónomo, así como la visibilización de todos los campos de actuación. Se evidencia como un recurso necesario, a la vez que escaso, para la viabilidad del sistema de salud y los cuidados de la población.(AU)

Objective: Describe the image of nursing during the first wave of the Covid-19 pandemic through the generalist and specialized written press. Methods: Descriptive qualitative documentary study, analysis carried out under Moscovici's theory. 95 news items published from March 15 to May 15 were selected. Articles that made specific references to nurses or dealt with health personnel in general were discarded. In a second selection phase, 36 news from the general press and 40 from the specialized press were included for the analysis. Data were extracted taking into account 8 indicators: verbal language, images, degree of importance and dissemination of the information, scope, people involved, why the information transcends, identification of judgments by the authors and elements of social construction. Results: General press: 94.5% journalistic language compared to 5.5% scientific-informative. Majority use of masculine, focused on care activity. The main emerging categories were: field of work/profession (43.75%), context/environment (34.71%), emotions (13.88%) and knowledge patterns (7.64%). Conclusions: The news published in the general press incorporates a reductionist view of the nurse regarding their professional performance, although they give it great social value. It is necessary to achieve recognition of the autonomous role as well as the visibility of all fields of action. It is evidenced as a necessary resource, as well as scarce, for the viability of the health system and the care of the population.(AU)

Cecilio Eseverri Chaverri: semblanza del enfermero humanista / Cecilio Eseverri Chaverri: profile of the humanist nurse

Cecilio Eseverri Chaverri es enfermero, trabajador social y teólogo. En su dilatada actividad profesional ha alternado el cuidado a los pacientes con la administración de servicios de enfermería y una intensa actividad docente, incluso con la creación de una importante escuela de gerencia en Barcelona. En su trayectoria destaca la gran aportación que ha realizado a la historia de la Enfermería, siendo autor de numerosos artículos y varios libros que son de obligada lectura para conocer el verdadero pasado de nuestra profesión. El día 21 de octubre de 2022, el grupo Oseira de historia de la Enfermería, adscrito a la Fundación Index, en colaboración con el Colegio de Enfermería de Granada, le tributaron un homenaje a su trayectoria como enfermero y como historiador de la Enfermería, cuyo discurso de presentación se reproduce aquí. Como complemento se aporta el videoclip realizado a partir de los testimonios de historiadores de la Enfermería en España que quisieron adherirse a este homenaje (AU)

Cecilio Eseverri Chaverri is a nurse, social worker and theologian. In his extensive professional activity, he has alternated patient care with the administration of nursing services and an intense teaching activity, including the creation of an important management school in Barcelona. In his career, the great contribution he has made to the history of Nursing stands out, being the author of numerous articles and several books that are a must read to know the true past of our profession. On October 21, 2022, the Oseira Nursing History group, attached to the Index Foundation, in collaboration with the Granada College of Nursing, paid tribute to his career as a nurse and as a Nursing historian, whose introductory speech is reproduced here. As a complement, the video clip made from the testimonies of Nursing historians in Spain who wanted to join this tribute is provided (AU)

Efecto del confinamiento sobre los nacimientos pretérmino en la Comunidad Valenciana / Effect of lockdown on the preterm births in a Valencian Comunity

No disponible

Colestasis intrahepática del embarazo Un reto más para la obstetricia / Intrahepatic Cholestasis of Pregnancy. One More Challenge for Obstetrics

Resumen: La colestasis intrahepática del embarazo es el trastorno hepático específico más común durante la gestación; es una condición multifactorial que aparece en mujeres genéticamente susceptibles. Se caracteriza principalmente por prurito palmo-plantar de predominio nocturno, su importancia radica en su considerable morbimortalidad fetal y aunque su tratamiento es sencillo, se debe diagnosticar. Objetivo: Realizar una revisión actualizada y a detalle de la bibliografía nacional e internacional de la etiología, las pruebas diagnósticas, tratamiento, resultados perinatales y su asociación con otras patologías del embarazo. Metodología: Se realizó una búsqueda de la literatura publicada en inglés y en español en bases de datos como PubMed / MEDLINE, Ovid, MD Consult, entre otras, utilizando las palabras clave: colestasis intrahepática del embarazo, etiología, diagnóstico, tratamiento, efectos adversos perinatales, preeclampsia, embarazo múltiple. De la información obtenida se seleccionaron 64 artículos, los cuales fueron clasificados y utilizados como soporte para realizar esta revisión. Resultados: Se aporta una actualización en cuanto al diagnóstico y tratamiento de esta enfermedad para actuar como guía clínica a los profesionales de la salud. Conclusión: Esta enfermedad es una entidad importante de diagnosticar para evitar los efectos adversos fetales que implica, la principal limitación es la carencia de determinación de niveles de ácidos biliares séricos en nuestro país, por lo tanto, la sospecha clínica se convierte en la herramienta más factible para su diagnóstico e inicio oportuno de tratamiento.

Abstract: Intrahepatic cholestasis of pregnancy is the most common specific liver disorder during pregnancy, it is a multifactorial condition that appears in genetically susceptible women and it is mainly characterized by palmoplantar itching predominantly at night. Its importance lies in the considerable fetal morbidity and mortality. Although the treatment is simple, we must know how to make the diagnosis. Objective: To carry out an updated and detailed review of the national and international bibliography of etiology, diagnostic tests, treatment, perinatal results, and their association with other pregnancy pathologies. Methodology: A search of the literature published in English and Spanish was conducted in databases such as PubMed / MEDLINE, Ovid, MD Consult, and others, using the keywords: intrahepatic cholestasis of pregnancy, etiology, diagnosis, treatment, perinatal adverse effects, preeclampsia, tween pregnancy. 64 articles were selected from the obtained, which were classified and used as support to carry out this review. Results: An update regarding the diagnosis and treatment of this disease is provided, to act as a clinical guide for healthcare professionals. Conclusion: This disease is an important entity to diagnose in order to avoid the fetal adverse effects that implies. The main limitation is the lack of determination of serum bile acid levels in our country, therefore, clinical suspicion becomes the most useful tool for diagnosis and early treatment.

Effect of a surveillance system for decreasing neonatal nosocomial infections.

BACKGROUND: Nosocomial infection in very low birthweight (VLBW) infants is a common complication with high morbimortality. New strategies to reduce its occurrence have recently led to the development of neonatal surveillance programs. AIMS: To determine whether the NeoKissEs surveillance system implementation in our neonatal unit has been associated with a decrease in nosocomial infection in VLBW infants, as well as a reduction in the use of antibiotics and central venous catheters (CVC). STUDY DESIGN AND SUBJECTS: Retrospective and descriptive study of infants <1500 g admitted between January 2011 and December 2017. Rates of use of antibiotics and CVC were calculated, as well as late-onset sepsis incidence. Data were compared before and after the surveillance system implementation. RESULTS: 299 patients were recruited. We excluded seven patients, who died <72 h. Of the remainder (n = 292), 149 were in the pre-intervention period and 143 in the post-intervention period. We found a significant decrease in the incidence density of sepsis comparing these two periods (5.98 vs. 4.08) (p = 0.03). Although no differences in antibiotic and CVC rates of use between both groups were found, a significant decrease in antibiotic use was observed comparing the first and last year of the intervention (38% vs. 24%) (p = 0.03). A higher percentage of breastfed infants was observed (39% vs. 59%) (p = 0.001) in the post-intervention group. CONCLUSIONS: Surveillance systems are useful to reduce nosocomial infection in VLBW infants. Reduction in antibiotic and CVC use requires longer intervention time. Promotion of breastfeeding seems to be a very effective associated strategy.

Lesiones pulmonares quísticas en el neonato: no todo es enfermedad congénita pulmonar. Reporte de caso / Cystic lung lesions in neonate: they do not always represent pulmonary congenital disease. Case report

Resumen Los quistes pulmonares unilaterales son un hallazgo inusual en neonatos, desde el punto de vista del radiólogo es difícil distinguir los quistes pulmonares congénitos de los adquiridos. El diagnóstico definitivo es histológico. Se presenta un recién nacido prematuro de 28 semanas con síndrome de dificultad respiratoria en relación con múltiples quistes pulmonares. Las radiografías iniciales del tórax mostraron un quiste pulmonar solitario izquierdo. Requirió de forma escalonada asistencia respiratoria, junto con rayos X seriados donde se observa la presencia de neumotórax y el aumento del tamaño de la lesión quística inicial con presencia de nuevos quistes. La tomografía computarizada confirmó la presencia del quiste solitario del lóbulo inferior izquierdo y varias colecciones de gas intersticial con puntos centrales de tejidos blandos con relación a enfisema pulmonar intersticial y se planteó como diagnóstico diferencial malformación adenomatoidea quística. La lesión fue extirpada quirúrgicamente en vista del deterioro clínico. La histología confirmo la presencia de enfisema pulmonar intersticial persistente. MÉD.UIS. 2018;31(1):65-70.

Abstract Unilateral pulmonary cysts are an unusual finding in neonates, from the point of view of the radiologist it is difficult to distinguish congenital pulmonary cysts from those acquired. The definitive diagnosis is histological. A 28-week premature neonate with respiratory distress syndrome is present in relation to multiple pulmonary cysts. The initial chest X-rays showed a solitary left pulmonary cyst. It required a staggered respiratory assistance, along with serial X-rays where the presence of pneumothorax and the increase in the size of the initial cystic lesion with the presence of new cysts was observed. Computed tomography confirmed the presence of solitary left lower lobe cyst and several collections of interstitial gas with central soft tissue points in relation to interstitial pulmonary emphysema and was raised as a differential diagnostic cystic adenomatoidea malformation. The lesion was surgically removed in view of clinical deterioration. Histology confirmed the presence of persistent interstitial pulmonary emphysema. MÉD.UIS. 2018;31(1):65-70.

Involuntary movements of pelvic stump.

Although involuntary movements of stumps are less frequent than phantom sensation or other neurological sequelae of limb amputation, they represent a phenomenon that has been known for many years. The pathophysiology remains unknown, but it seems to be related to damage to the peripheral nervous system. Treatment is not standardized, but antimyoclonic drugs seem to be useful.

Descripción de una serie hospitalaria de pacientes con fístula espinal / Description of a series of hospital patients with a spinal fistula

Introducción. Aunque las fístulas espinales suponen el 70% de las malformaciones arteriovenosas espinales, son una entidad infradiagnosticada. El shunt arteriovenoso produce una congestión vascular que da lugar a una mielopatía progresiva, en ocasiones irreversible si no se trata de forma precoz. Objetivo. Describir las características clinicorradiológicas de una serie de pacientes con fístula espinal. Pacientes y métodos. Se realizó una búsqueda retrospectiva de pacientes con diagnóstico de fístula espinal ingresados en el área de neurociencias de un hospital de tercer nivel asistencial. Resultados. Se identificaron 19 pacientes (7 mujeres y 12 varones) con una edad media de 56 años. La fístula espinal fue de tipo I en un 79% de los pacientes y la localización dorsal fue la más frecuente. La mayoría de los casos presentó un curso progresivo (90%). Un 74% de los pacientes se diagnosticó mediante resonancia magnética. En cuatro casos fue necesaria la realización de una angiografía para llegar al diagnóstico, y en uno de ellos se precisó una biopsia intraoperatoria. Se realizaron tres punciones lumbares, en dos de las cuales se objetivó pleocitosis linfocitaria e hiperproteinorraquia. El retraso diagnóstico medio fue de nueve meses. Se trató a un 79% de los pacientes, y de ellos sólo mejoró el 10%. Conclusiones. Ante una clínica sugestiva de fístula espinal, debe realizarse una angiografía espinal diagnóstica aunque el paciente estudiado pueda presentar características licuorales atípicas y normalidad en la resonancia magnética medular (AU)

Introduction. Although spinal fistulas account for 70% of all spinal arteriovenous malformations, they are an underdiagnosed condition. The arteriovenous shunt produces vascular congestion that gives rise to a progressive myelopathy, sometimes irreversible if it is not treated in the early stages. Aim. To describe the clinicoradiological characteristics of a series of patients with spinal fistulas. Patients and methods. A retrospective search was conducted for patients diagnosed with a spinal fistula who were hospitalised in the neuroscience area of a tertiary care hospital. Results. A total of 19 patients (7 females and 12 males) were identified, with a mean age of 56 years. The spinal fistula was type I in 79% of patients, and a dorsal location was the most frequent. Most of the cases (90%) presented a progressive course. Magnetic resonance imaging was used in the diagnosis in 74% of the patients. In four cases angiography was required to reach a diagnosis, and in one of them it was necessary to perform an intraoperative biopsy. Three lumbar punctures were performed, two of which revealed lymphocytic pleocytosis and high protein levels in cerebrospinal fluid. The average diagnostic delay was nine months. Seventy-nine per cent of the patients were treated and only 10% of them improved. Conclusions. When faced with a clinical picture suggestive of a spinal fistula, a diagnostic spinal angiography must be carried out, although the patient under study may present atypical cerebrospinal fluid characteristics and normal results in magnetic resonance imaging of the spinal cord (AU)