Beneficios de la estandarización en el manejo de la apendicitis aguda / Benefits of standardization in the management of acute appendicitis

bjetivos. La apendicitis aguda (AA) es la patología quirúrgica pediátrica urgente más frecuente, pero su manejo postoperatorio es variable. La aplicación de protocolos minimiza esta variabilidad. Presentamos los resultados tras la optimización del protocolo de manejo en nuestro centro con objetivo de determinar su efectividad en cuanto a número de complicaciones infecciosas y optimización de recursos en nuestro medio. Material y métodos. Se realiza un estudio observacional retrospectivo en pacientes intervenidos de AA entre enero 2018 y agosto 2022. Comparamos dos cohortes, antes (1) y después del protocolo (2), subdividiéndolas según gravedad para un análisis por subgrupos: flemonosas (F), gangrenosas (G) y perforadas (P). Resultados. Incluimos 771 pacientes (1: 390/ 2: 381), con distribución homogénea, con mediana de edad 9,3 ± 2,8 años. La solicitud de analíticas previo al alta disminuyó de forma significativa (F: 3,9% vs. 0,5%; p= 0,026; G: 97,6% vs. 13,4%, p< 0,001). Los días de estancia hospitalaria se redujeron en los subgrupos F (1,2 IQR 0,7 vs. 1 IQR 0,36; p< 0,001), y G (4 IQR 1 vs. 3 IQR 1 días; p< 0,001). No se observaron diferencias en el número de abscesos entre los grupos (41 vs. 43 p= 0,73); sí en el subgrupo G (9 vs. 2; p= 0,029). Observamos una reducción del gasto de recursos en F y G. Conclusiones. En nuestro estudio, el subgrupo más beneficiado tras la optimización del protocolo fue el de las apendicitis gangrenosas con una reducción significativa en el número de complicaciones y en la utilización de recursos hospitalarios.(AU)

Objective. Acute appendicitis (AA) is the most frequent urgent surgical pathology in the pediatric population, but postoperative management is variable, with protocols minimizing variability. We present our results following the optimization of the management protocol in ourinstitution in order to establish its efficacy in terms of number of infectious complications and optimization of resources in our environment. Materials and methods. An observational, retrospective study of patients undergoing AA surgery from January 2018 to August 2022 was carried out. Two cohorts were compared, both before (1) and after (2) the implementation of the new protocol. They were divided according to severity in order to conduct a subgroup-based analysis –phlegmonous (PH), gangrenous (G), and perforated (P) appendicitis. Results. 771 patients (1: 390; 2: 381) were included, with a homogeneous distribution and a median age of 9.3 ± 2.8 years. Blood tests requested prior to discharge experienced a significant reduction (PH: 3.9% vs. 0.5%; p= 0.026; G: 97.6% vs. 13.4%, p< 0.001). Days of hospital stay decreased in the PH (1.2 IQR: 0.7 vs. 1 IQR: 0.36; p< 0.001) and G (4 IQR: 1 vs. 3 IQR: 1 days; p< 0.001) subgroups. No differences in the number of abscesses were found between groups (41 vs. 43; p= 0.73), but they were noted within subgroup G (9 vs. 2; p= 0.029). A reduction in resource expenses was detected in PH and G appendicitis. Conclusions. In our study, the most widely benefited subgroup following protocol optimization was the gangrenous appendicitis subgroup, with a significant reduction in the number of complications and the use of hospital resources.(AU)

Benefits of standardization in the management of acute appendicitis. / Beneficios de la estandarización en el manejo de la apendicitis aguda.

OBJECTIVE: Acute appendicitis (AA) is the most frequent urgent surgical pathology in the pediatric population, but postoperative management is variable, with protocols minimizing variability. We present our results following the optimization of the management protocol in our institution in order to establish its efficacy in terms of number of infectious complications and optimization of resources in our environment. MATERIALS AND METHODS: An observational, retrospective study of patients undergoing AA surgery from January 2018 to August 2022 was carried out. Two cohorts were compared, both before (1) and after (2) the implementation of the new protocol. They were divided according to severity in order to conduct a subgroup-based analysis -phlegmonous (PH), gangrenous (G), and perforated (P) appendicitis. RESULTS: 771 patients (1: 390; 2: 381) were included, with a homogeneous distribution and a median age of 9.3 ± 2.8 years. Blood tests requested prior to discharge experienced a significant reduction (PH: 3.9% vs. 0.5%; p= 0.026; G: 97.6% vs. 13.4%, p< 0.001). Days of hospital stay decreased in the PH (1.2 IQR: 0.7 vs. 1 IQR: 0.36; p< 0.001) and G (4 IQR: 1 vs. 3 IQR: 1 days; p< 0.001) subgroups. No differences in the number of abscesses were found between groups (41 vs. 43; p= 0.73), but they were noted within subgroup G (9 vs. 2; p= 0.029). A reduction in resource expenses was detected in PH and G appendicitis. CONCLUSIONS: In our study, the most widely benefited subgroup following protocol optimization was the gangrenous appendicitis subgroup, with a significant reduction in the number of complications and the use of hospital resources.

OBJETIVOS: La apendicitis aguda (AA) es la patología quirúrgica pediátrica urgente más frecuente, pero su manejo postoperatorio es variable. La aplicación de protocolos minimiza esta variabilidad. Presentamos los resultados tras la optimización del protocolo de manejo en nuestro centro con objetivo de determinar su efectividad en cuanto a número de complicaciones infecciosas y optimización de recursos en nuestro medio. MATERIAL Y METODOS: Se realiza un estudio observacional retrospectivo en pacientes intervenidos de AA entre enero 2018 y agosto 2022. Comparamos dos cohortes, antes (1) y después del protocolo (2), subdividiéndolas según gravedad para un análisis por subgrupos: flemonosas (F), gangrenosas (G) y perforadas (P). RESULTADOS: Incluimos 771 pacientes (1: 390/ 2: 381), con distribución homogénea, con mediana de edad 9,3 ± 2,8 años. La solicitud de analíticas previo al alta disminuyó de forma significativa (F: 3,9% vs. 0,5%; p= 0,026; G: 97,6% vs. 13,4%, p< 0,001). Los días de estancia hospitalaria se redujeron en los subgrupos F (1,2 IQR 0,7 vs. 1 IQR 0,36; p< 0,001), y G (4 IQR 1 vs. 3 IQR 1 días; p< 0,001). No se observaron diferencias en el número de abscesos entre los grupos (41 vs. 43 p= 0,73); sí en el subgrupo G (9 vs. 2; p= 0,029). Observamos una reducción del gasto de recursos en F y G. CONCLUSIONES: En nuestro estudio, el subgrupo más beneficiado tras la optimización del protocolo fue el de las apendicitis gangrenosas con una reducción significativa en el número de complicaciones y en la utilización de recursos hospitalarios.

Factors influencing cranial variation between prehistoric Japanese forager populations.

Understanding the factors shaping human crania has long been a goal of biological anthropology, and climate, diet, and population history are three of the most well-established influences. The effects of these factors are, however, rarely compared within a single, variable population, limiting interpretations of their relative contribution to craniofacial form. Jomon prehistoric foragers inhabited Japan throughout its climatic and ecological range and developed correspondingly varied modes of subsistence. We have previously demonstrated that a large sample of Jomon crania showed no clear climatic pattern; here, we examine variation in Jomon crania in more detail to determine if dietary factors and/or population history influence human intrapopulation variation at this scale. Based on well-established archaeological differences, we divide the Jomon into dietary groups and use geometric morphometric methods to analyse relationships between cranial shape, diet, and population history. We find evidence for diet-related influences on the shape of the neurocranium, particularly in the temporalis region. These shape differences may be interpreted in the context of regional variation in the biomechanical requirements of different diets. More experimental biomechanical and nutritional evidence is needed, however, to move suggested links between dietary content and cranial shape from plausible to well-supported. In contrast with the global scale of human variation, where neutral processes are the strongest influence on cranial shape, we find no pattern of population history amongst individuals from these Jomon sites. The determinants of cranial morphology are complex and the effect of diet is likely mediated by factors including sex, social factors, and chronology. Our results underline the subtlety of the effects of dietary variation beyond the forager/farmer dichotomy on cranial morphology and contribute to our understanding of the complexity of selective pressures shaping human phenotypes on different geographic scales. Supplementary Information: The online version contains supplementary material available at 10.1007/s12520-023-01901-6.

La anticoncepción oral de uso regular en España. ¿La necesidad de receta dificulta su acceso? / Oral contraception for regular use in Spain: Does the need for a prescription make it difficult to access?

JUSTIFICACIÓN: cada día acuden a la farmacia mujeres que desean iniciar o continuar su tratamiento con anticoncepción oral de uso regular (AO). Se plantea si la necesidad de prescripción representa una barrera de acceso para las mujeres y limita el papel del farmacéutico. OBJETIVOS: cuantificar las dificultades a las que se enfrentan las mujeres en el acceso a la AO en España y testar su percepción sobre la posibilidad de acceder a la misma sin prescripción. MATERIAL Y MÉTODOS: en 2021, se entrevistaron online a 1000 mujeres (18-45 años), residentes en España. Se realizó la ponderación por edad, comunidad autónoma, tamaño de hábitat y nivel socioeconómico. El error muestral se estima en ±3,10 % para el total de la muestra, considerando que p=q=50 % y un intervalo de confianza del 95% (muestreo aleatorio simple). RESULTADOS/DISCUSIÓN: el 64,9 % del total de las mujeres consultadas han tomado AO en algún periodo de su vida (38,3 % actualmente). De las que no la toman, al 25,7 % le frenaría tener que ir al médico a que se la receten. El 26 % han tenido que dejar de tomarlos en alguna ocasión por no poder acudir al médico a por la receta y un 23,7% por haberla perdido o no llevarla al ir a comprarlos. De estas, casi 6 de cada 10 considera haber estado en riesgo de embarazo debido a la interrupción (57,8 %). Y 1 de cada 10 ha tenido un embarazo no planeado por estas circunstancias (11,9 %). Más de la mitad (51.9 %) de las mujeres han intentado comprar la píldora sin receta en alguna ocasión, al 21,7 % no se la dispensaron, y al 24,9 % les pusieron impedimentos, pero acabaron vendiéndosela. Una amplia mayoría (64,4 %) cree que se reducirían los embarazos no deseados si se vendiera sin receta. Casi 9 de cada 10 (86,6 %) están muy/bastante de acuerdo en que sería más fácil acceder a ella. (AU)

De la reticencia a la recomendación. Caso de éxito de SPD en el manejo de paciente con dolor crónico polimedicada / From reluctance to recommendation. Successful case of SPD in the management of polymedicated chronic pain patients

ANTECEDENTES: paciente de 85 años altamente polimedicada (+10 medicamentos), vive sola y está algo despistada con su tratamiento. Se le ofrece la posibilidad de revisar su medicación y prepararle un Sistema Personalizado de Dosificación (SPD) para facilitarle el manejo.EVALUACIÓN: la paciente sufre de hipotiroidismo, hipertensión, diabetes, litiasis, hipercolesterolemia, edema en mm.ii., dolor crónico y glaucoma. Está tomando: 698089Eutirox 25mcg (1-0- 0-0), 658187Adalat Retard 20mg (1-0-0-0), 853895Enalapril 20mg (0-0-1-0), 661531Efficib 50/1000 (1-0-1-0), 700725Acalka 1080mg (0-0-0-2), 653040Simvastatina 10mg (0-0-0-1), 724007Furosemida 40mg (según necesidad),706467Pregabalina 75mg (1-0-1-0), 691748Tramadol Retard 200mg (0-0-1-0), 726005Paracetamol 1g (según necesidad) y 654561Gamfort 5/0.3mg/ml (0-0-0-1). En el histórico tiene Omeprazol 20mg pautado pero la paciente dice que no lo toma.INTERVENCIÓN: se contacta con la hija para confirmar la medicación del dolor. Nos indica que se la pautó el Reumatólogo hace un par de años. Desconoce si pregabalina y tramadol tenían carácter crónico o puntual para la ciática que padecía. Apareció el COVID-19 y dejó de tener seguimiento por su médico. Últimamente está más desorientada y lo achaca a la medicación. Se registra la pauta en BotPlus: la desorientación podría estar relacionada con con Tramadol y Pregabalina. Se revisa con el médico la medicación y los hallazgos. Nos confirma la pauta, pide que incluyamos Omeprazol 20mg (1-0-0-0) en el SPD pero que dejemos, fuera del blíster, el tramadol para observar evolución. Se entrega el SPD a la paciente y se la instruye sobre su uso, así como con la toma excepcional de tramadol o paracetamol solo si fuera necesario. (AU)

Caloric restriction attenuates aging-induced cardiac insulin resistance in male Wistar rats through activation of PI3K/Akt pathway.

BACKGROUND AND AIM: Caloric restriction (CR) improves insulin sensitivity and is one of the dietetic strategies most commonly used to enlarge life and to prevent aging-induced cardiovascular alterations. The aim of this study was to analyze the possible beneficial effects of caloric restriction (CR) preventing the aging-induced insulin resistance in the heart of male Wistar rats. METHODS AND RESULTS: Three experimental groups were used: 3 months old rats (3m), 24 months old rats (24m) and 24 months old rats subjected to 20% CR during their three last months of life (24m-CR). After sacrifice hearts were mounted in a perfusion system (Langendorff) and heart function in basal conditions and in response to accumulative doses of insulin (10-9-10-7 M), in the presence or absence of Wortmannin (10-6 M), was recorded. CR did not attenuate the aging-induced decrease in coronary artery vasodilation in response to insulin administration, but it prevented the aging-induced downregulation of cardiac contractility (dp/dt) through activation of the PI3K/Akt intracellular pathway. Insulin stimulated in a greater extent the PI3K/Akt pathway vs the activation of the MAPK pathway and increased the protein expression of IR, GLUT-4 and eNOS in the hearts of 3m and 24m-CR rats, but not in the hearts of 24m rats. Furthermore, CR prevented the aging induced increase in endothelin-1 protein expression in myocardial tissue. CONCLUSION: In conclusion CR partially improves cardiac insulin sensitivity and prevents the aging induced decrease in myocardial contractility in response to insulin administration through activation of PI3K/Akt pathway.

The Role of Occlusal Factors in the Presence of Noncarious Cervical Lesions in Young People: A Case-Control Study.

OBJECTIVE:: The aim of this retrospective case-control study was to evaluate the influence of different occlusal characteristics and self-referred bruxism in the presence of noncarious cervical lesions (NCCLs). METHODS AND MATERIALS:: The participants were 280 students (140 cases and 140 controls), with an average age of 24.5 years, from six schools of dentistry in Spain. Clinical examination was carried out to record the NCCLs and the static and dynamic occlusal characteristics. The side of mastication and bruxism was collected by questionnaire. Data variables were analyzed by means of univariate and multivariate logistic regression. Odds ratios and the respective 95% confidence intervals were calculated ( p<0.05). RESULTS:: The presence of NCCLs was significantly more likely in subjects with protrusive interferences (odds ratio [OR]=1.82); with lateral interferences, especially on the nonworking side (OR= 1.77); or who were self-reported bruxists (OR=1.72). In the multivariate analysis, protrusive interferences, bruxism, age, and the presence of attrition were risk factors for the development of NCCLs. These factors resulted in a model with an area under the receiver-operating characteristic curve of 0.667 and a positive predictive value of 61.43%. CONCLUSIONS:: There was no significant relationship between most occlusal factors and the presence of NCCLs. Only bruxism, protrusive interferences, age, and occlusal wear were risk factors. The predictive model was not sufficiently explanatory. Occlusal factors alone do not appear to be sufficient to explain the presence of NCCLs.

Altered liver expression of genes involved in lipid and glucose metabolism in mice with partial IGF-1 deficiency: an experimental approach to metabolic syndrome.

BACKGROUND: Insulin growth factor 1 (IGF-1) has multiple effects on metabolism. Much evidence suggests that the deficiency of this hormone increases insulin resistance, impairs lipid metabolism, augments oxidative damage and deregulates the neuro-hormonal axis. An inverse relationship between IGF-1 levels and the prevalence of Metabolic Syndrome (MetS) with its cardiovascular complications has been identified. However, the underlying mechanisms linking IGF-1 and MetS are still poorly understood. In order to elucidate such mechanisms, the aim of this work was to study, in mice with partial IGF-1 deficiency, liver expression of genes involved in glucose and lipid metabolism as well as serum levels of glucose, triglycerides and cholesterol, as well as liver malondialdehyde (MDA) levels, as a marker for oxidative damage. METHODS: Three experimental groups were studied in parallel: Controls (CO), wild type mice (igf-1 (+/+)); untreated heterozygous mice (Hz, igf-1 (+/-)) and Hz (igf-1 (+/-)) mice treated with low doses of IGF-1 for 10 days (Hz + IGF-1). RESULTS: A reduction of IGF-1 serum levels in the Hz group was found, which was normalized by IGF-1 therapy. Serum levels of glucose, triglycerides and cholesterol were significantly increased in the untreated Hz group as compared to both controls and Hz + IGF-1 groups. The expression of genes involved in gluconeogenesis, glycogenolysis, lipid synthesis and transport, and catabolism were altered in untreated Hz animals and the expression of most of them was normalized by IGF-1 therapy; MDA was also significantly increased in the Hz untreated group. CONCLUSIONS: The mere partial IGF-1 deficiency is responsible for the reduction in the expression of genes involved in glucose and lipid metabolism, resulting in dyslipidemia and hyperglycemia. Such genetic alterations may seriously contribute to the establishment of MetS.

Manejo anestésico de un niño con déficit de acetil-coA deshidrogenasa de cadena corta / Anesthetic management of a child with deficit of chain short acetyl-coA dehydrogenase

Los errores innatos del metabolismo de la betaoxidación de los ácidos grasos (déficit de acil-CoA deshidrogenasas) constituyen un nuevo grupo de enfermedades. El déficit de SCAD (Acil-CoA deshidrogenasa de ácidos grasos de cadena corta) es un fallo congénito de herencia autosómica recesiva de la oxidación mitocondrial de los ácidos grasos de cadena corta. Su incidencia probablemente esté subestimada, debiéndose tener un alto índice de sospecha diagnóstica para su detección. Esta enfermedad plantea importantes implicaciones anestésicas sobre todo en el uso de fármacos como el propofol o los bloqueantes neuromusculares por lo que es preciso conocer su fisiopatología (AU)

An inborn error of metabolism of beta-oxidation of fatty acids (acyl-coA deshydrogenasa deficiencies) is a new group of diseases. Short chain acylcoA deshydrogenasa deficiency (SCAD) is a congenital failure of autosomal recessive inheritance of mitochondrial oxidation of short chain fatty acids. The incidence is probably underestimated, whichever a high index of clinical suspicion is necessary for detection. This disease poses significant anesthetic implications especially in the use of drugs such propofol or neuomuscular blockers so it is necessary to understand its pathophisiology (AU)

Uso del videolaringoscopio Airtraq® en el manejo de la vía aérea difícil / No disponible

La vía aérea difícil continúa siendo una de las causas más importantes de morbimortalidad anestésica. En los últimos años han surgido numerosos dispositivos con el objetivo de facilitar el manejo de la vía aérea, especialmente la vía aérea difícil: los dispositivos extraglóticos y, más recientemente, los videolaringoscopios. Este continuo desarrollo ha obligado a una frecuente revisión de los algoritmos de abordaje de la vía aérea, acorde con el vertiginoso avance tecnológico que vivimos en la actualidad. La mayoría de estos algoritmos toman como punto de partida la dificultad de intubación traqueal convencional y se desarrollan en función de una óptima ventilación con máscara facial, pero ¿existe algún algoritmo que plantee la utilización de un dispositivo extraglótico como abordaje inicial de la vía aérea independientemente de la previsión o no de intubación traqueal difícil? Presentamos el caso de una paciente sin criterios de vía aérea difícil, sometida en un corto espacio de tiempo a dos cirugías de mama. En la primera de ellas presentó una intubación traqueal difícil con importante manipulación de la vía aérea, resuelta mediante el laringoscopio Airtraq®. En la segunda intervención, el abordaje inicial se realizó con una máscara laríngea, sin dificultad alguna (AU)

The difficult airway remains one of the most important reasons of anaesthetic comorbidity. Over the last few years many device shave been developed for the difficult airway. Extraglotic devices and more recently the video laryngoscopes have become part of the armamentarium of difficult airway trolleis. This has forced continuous reviews of the difficult airway protocols. Most of these algorithms take as their starting point, the difficulty of conventional tracheal intubation and they develop in terms of optimal facial mask ventilation, but, is there any algorithm arising from the use of a extraglotic device as the initial airway approach, irrespective of the forecast or not of difficult tracheal intubation? We present the case of a patient without criteria of difficult airway, undergone two breast surgeries in a short period of time. In the first one, she presented a difficult tracheal intubation with significant manipulation of the airway, resolved by the Airtraq® laryngoscope. In the second intervention, the initial approach was performed with a laryngeal mask, with no difficulty (AU)

Spinal and peripheral analgesic effects of the CB2 cannabinoid receptor agonist AM1241 in two models of bone cancer-induced pain.

BACKGROUND AND PURPOSE: The activation of CB(2) receptors induces analgesia in experimental models of chronic pain. The present experiments were designed to study whether the activation of peripheral or spinal CB(2) receptors relieves thermal hyperalgesia and mechanical allodynia in two models of bone cancer pain. EXPERIMENTAL APPROACH: NCTC 2472 osteosarcoma or B16-F10 melanoma cells were intratibially inoculated to C3H/He and C57BL/6 mice. Thermal hyperalgesia was assessed by the unilateral hot plate test and mechanical allodynia by the von Frey test. AM1241 (CB(2) receptor agonist), AM251 (CB(1) receptor antagonist), SR144528 (CB(2) receptor antagonist) and naloxone were used. CB(2) receptor expression was measured by Western blot. KEY RESULTS: AM1241 (0.3-10 mg.kg(-1)) abolished thermal hyperalgesia and mechanical allodynia in both tumour models. The antihyperalgesic effect was antagonized by subcutaneous, intrathecal or peri-tumour administration of SR144528. In contrast, the antiallodynic effect was inhibited by systemic or intrathecal, but not peri-tumour, injection of SR144528. The effects of AM1241 were unchanged by AM251 but were prevented by naloxone. No change in CB(2) receptor expression was found in spinal cord or dorsal root ganglia. CONCLUSIONS AND IMPLICATIONS: Spinal CB(2) receptors are involved in the antiallodynic effect induced by AM1241 in two neoplastic models while peripheral and spinal receptors participate in the antihyperalgesic effects. Both effects were mediated by endogenous opiates. The use of drugs that activate CB(2) receptors could be a useful strategy to counteract bone cancer-induced pain symptoms.

Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR).

BACKGROUND: The electronic Schizophrenia Treatment Adherence Registry (e-STAR) is a prospective, observational study of patients with schizophrenia designed to evaluate long-term treatment outcomes in routine clinical practice. METHODS: Parameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection (RLAI) (n=1345) or a new oral antipsychotic (AP) (n=277; 35.7% and 36.5% on risperidone and olanzapine, respectively) in Spain. Hospitalization prior to therapy was assessed by a retrospective chart review. RESULTS: At 24 months, treatment retention (81.8% for RLAI versus 63.4% for oral APs, p<0.0001) and reduction in Clinical Global Impression Severity scores (-1.14 for RLAI versus -0.94 for APs, p=0.0165) were significantly higher with RLAI. Compared to the pre-switch period, RLAI patients had greater reductions in the number (reduction of 0.37 stays per patient versus 0.2, p<0.05) and days (18.74 versus 13.02, p<0.01) of hospitalizations at 24 months than oral AP patients. CONCLUSIONS: This 2 year, prospective, observational study showed that, compared to oral antipsychotics, RLAI was associated with better treatment retention, greater improvement in clinical symptoms and functioning, and greater reduction in hospital stays and days in hospital in patients with schizophrenia. Improved treatment adherence, increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia.

Predictores del desempeño laboral de personas con discapacidad por trastorno mental severo. Revisión de estudios y análisis de evidencias / Variability of employment predictors for persons with severe mental illness. Studies review and research evidences

Este artículo presenta una revisión de la investigación sobre variables predictoras del desempeño laboral de personas con trastorno mental severo (TMS). Dentro del proceso de rehabilitación psicosocial de personas con discapacidad por TMS, la rehabilitación laborales un elemento importante del proceso, dado que la realización de actividad laboral es un indicativo del nivel de recuperación para este colectivo. Descritas la metodologías de rehabilitación laboral, se revisan los estudios que analizan las distintas variables predictoras del desempeño laboral en personas con TMS, exponiéndose a continuación las conclusiones que de los resultados de esta revisión, se pueden extraer (AU)

This article presents a review of research about variability predictors of employment for persons with severe mental illness. During the process of psychosocial rehabilitation of persons with severe disabilities caused by severe mental illness, an important issue is the employment rehabilitation, as an indicator of the recovering lever of these persons. Once we have seen the different methodology of vocational rehabilitation, we will review the possible variability employment predictors for persons with severe mental illness, explaining as follows the review results (AU)

Reconstruction of type II pelvic resection with a new peri-acetabular reconstruction endoprosthesis.

We report our early experience with a new peri-acetabular reconstruction endoprosthesis used for pelvic reconstruction after tumour resection. The outcome of 21 patients who underwent limb salvage following type II pelvic resection and reconstruction using the peri-acetabular reconstruction prosthesis between 2000 and 2006 was retrospectively reviewed. This prosthesis was designed to use the remaining part of the ilium to support a horizontally placed acetabular component secured with internal fixation and bone cement. Into this device a constrained acetabular liner is positioned which is articulates with a conventional femoral component to which a modular extension and modular head are attached. The mean follow-up was 20.5 months (1 to 77). The most common complications were deep infection, superficial wound infections, and dislocation. The mean musculoskeletal tumor society functional outcome score for the survivors was 20.1(11 to 27). We recommend the use of the peri-acetabular reconstruction prosthesis for reconstruction of large defects after type II pelvic resection, as this design has a greater inherent stability over other available prostheses.

De la ética del diagnóstico, al diagnóstico ético / No disponible

Presentamos a un paciente con diagnóstico fundamentalmente clínico, con el objetivo de mover a la reflexión sobre la necesidad de añadir un nombre o un diagnóstico preciso, a través de pruebas complementarias en algunas patologías complejas por su manejo y connotaciones psicosociales, como la trisomía XYY

We present a case report with a mainly clinical diagnosis, with the objective of moving to think about the necessity of adding a name or precise diagnosis, trough complementary exams in some complex handling conditions with psychosocial connotations, as in XYY trisomy

Seguimiento de una cohorte de pacientes con gammapatía monoclonal sérica en el Área Sanitaria de Guadalajara / Follow up of serum monoclonal gammopathy at Guadalajar health area

Objetivo: Conocer la evolución clínica de los pacientes del Área Sanitaria de Guadalajara en los que fue diagnosticada una paraproteína sérica. Material y métodos: Estudio prospectivo de 186 pacientes en los que durante los años 1999 y 2000 se detectó “de novo” una banda monoclonal sérica. Resultados: La probabilidad acumulada de progresión a enfermedad maligna fue del 4,99% a los 43 meses en los pacientes cuya paraproteína fue clínicamente soslayada y 2% a los 23 meses en pacientes diagnosticados de gammapatía monoclonal de significado incierto. La probabilidad acumulada de supervivencia en los pacientes con mieloma múltiple fue 66,7% a los 21 meses. La tasa condicionada de mortalidad (paciente/mes) a los 4 años debido a enfermedad hematológica fue de 4,48.10-4 en pacientes clínicamente soslayados, 0 en los diagnosticados de gammapatía monoclonal de significado incierto y 1,388.10-2 en los diagnosticados de mieloma múltiple. Discusión: El seguimiento de pacientes con banda monoclonal benigna es fundamental, al menos durante los cuatro primeros años, ya que con ello podría conseguirse una mayor supervivencia en relación con su transformación en maligna

Objective: To study the clinical course of patients with a serum monoclonal protein at Guadalajara Health Area. Material and methods: Prospective study of 186 patients with a newly diagnosed monoclonal component. They have been collected during the years 1999 and 2000. Results: The cumulative transformation probability at 43 months was 4.99% for those patients whose monoclonal gammopathy was overlooked, and 2% at 23 months for patients with monoclonal gammopathy of undetermined significance. The cumulative probability of survival for patients with multiple myeloma was 66.7% at 21 months. The conditional mortality rate (patients/months) at 4 years due to haematological disease was 4.48x10-4 for overlooked patients, 0 for diagnosed of monoclonal gammopathy of undetermined significance and 1.388x10-2 for multiple myeloma diagnosed. Discussion: A non malignant M component must be followed up due to it could increase patients’ survival rate in relation with transformation in malignant disease

Intercalary endoprosthetic reconstruction for diaphyseal bone tumours.

Custom-made intercalary endoprostheses may be used for the reconstruction of diaphyseal defects following the resection of bone tumours. The aim of this study was to determine the survival of intercalary endoprostheses with a lap joint design, and to evaluate the clinical results, complications and functional outcome. We retrospectively reviewed six consecutive patients, three of whom underwent limb salvage with intercalary endoprostheses of the tibia, two of the femur, and one of the humerus. Their mean age was 42 years (28 to 64). The mean follow-up was 21.6 months (9 to 58). The humeral prosthesis required revision at 14 months owing to aseptic loosening. There were no implant-related failures. Musculoskeletal Tumour Society functional outcome scores indicated that patients achieved 90% of premorbid function. Custom intercalary endoprostheses result in reconstructions comparable with, if not better than, those of allografts. Using this design of implant reduces the incidence of early complications and difficulties experienced with previous versions.

Survivorship and clinical outcome of modular endoprosthetic reconstruction for neoplastic disease of the lower limb.

We reviewed retrospectively the results in 211 consecutive patients who had undergone limb salvage for bone neoplasia with endoprosthetic reconstruction of the proximal femur (96), distal femur (78), proximal tibia (30) and total femur (7). Their mean age was 50 years (11 to 86) and the mean follow-up period was 37.3 months (1 to 204). A total of 35 (16.6%) prostheses failed. Overall, implant survival was 78% (95% confidence interval (CI) 0.29 to 0.54) at five years, 60% (95% CI 0.93 to 2.35) at ten years and 60% (95% CI 1.27 to 3.88) at 15 years. Survivorship of the limb was 97.6% (95% CI 1.73 to 3.35) at ten years. The gender, age, diagnosis and location of the tumour were not prognostic variables for failure. Modular endoprosthetic replacement in the lower limb is a durable long-term reconstructive option, with the implants generally outlasting the patient.

Impacto económico de los tratamientos compasivos sobre el gasto farmacéutico en un hospital / Economical impact of the compassionate treatments on the drug costs in a hospital

No disponible