Comorbidity and physical activity in people with paraplegia: a descriptive cross-sectional study.

STUDY DESIGN: Descriptive cross-sectional study. SETTING: The study was conducted in the Spinal Cord Injury Unit of the University Vall d'Hebron Hospital and in the Physical Education and Sports Department of the University of Valencia. OBJECTIVES: The aim of this study was to quantify the presence of comorbidities in spinal cord injury (SCI) subjects who did or did not perform regular physical activity (PA) and to identify the relationship between PA and the level of comorbidity. METHODS: The sample consisted of patients with complete motor SCI (T2-T12), who were fitted with an accelerometer attached to the non-dominant wrist for a period of 1 week. The clinical and blood analytic variables were selected by an expert panel. RESULTS: In the exploratory analysis, we have found differences in the total number of pathologies between active and inactive patients, with fewer total pathologies in the active patient group. An association was found between the PA level and diabetes mellitus (; P=0.047; φ=0.25). We also observed an association between the cardioprotector level of high-density lipoprotein (HDL)-cholesterol and PA level (; P=0.057; Φ0.24). CONCLUSIONS: Our results suggest that patients considered active showed lower total comorbidity than inactive patients and higher protection levels against developing cardiovascular comorbidity.

Alucinaciones visuales y auditivas secundarias a la interacción farmacológica entre tizanidina y ciprofloxacino / Visual and auditory hallucinations secondary to drug interaction between tizanidine and ciprofloxacin

No disponible

Descenso de la estancia media en la Unidad de Lesionados Medulares. Implicaciones éticas sobre la asistencia / Decrease in the mean stay in the spinal cord injury unit. Ethical implications on the care

La estancia media (EM) es un factor importante para determinar la actividad asistencial y un indicador para el pago en determinados sistemas de salud. Se ha demostrado que ha descendido drásticamente, durante los últimos años, en los pacientes ingresados en los Servicios de Rehabilitación. Hemos analizado la evolución de la EM y el grado de complejidad del proceso asistencial, en el período comprendido entre los años 1997 y 2009, determinando la tendencia que sigue y como se ha visto influida por los cambios en el modelo asistencial, para conocer las modificaciones que se han producido en la gestión del proceso lesión medular y las implicaciones éticas que puede tener sobre el modelo asistencial. El número de pacientes en el período 1997-2009, ha sido de 907 con una media anual de 69,7 pacientes/año. La edad media es de 44,8 años (DE: 18,2), con un rango que varía entre 15 y 84 años y una mediana de 41 años. La edad media se ha incrementado de forma significativa (p<0,001) cuando se comparan los períodos 1997-2002 y 2003-2009. La EM en la unidad de cuidados intensivos, en los pacientes que lo precisaron, antes del ingreso en la Unidad de Lesionados Medulares (ULM), ha sido de 12,3 días (DE: 18,2) para las tetraplejías y de 15 días (DE: 19,6) para los paraplejías. El promedio de EM en la ULM ha sido de 66,4 días, con un rango que varía de 85,2 en 1997 a 55,4 en 2003. Se observa una reducción significativa de la EM, ostensible a partir de 2001, con descensos progresivos hasta 2003, estabilizándose a partir de ese año, existiendo diferencias significativas (p<0,0001) entre el período 1997-2002 y el 2003-2009. El grado de complejidad del proceso leucemia mieloide agudase ha incrementado de forma notable a partir de 2004, teniendo una media los grupos relacionados por el diagnóstico (GRD)en el período estudiado, de 5,37, con un rango que varía entre 3,79 en 1997 y 9,4 en 2009. Más de un 40% de los pacientes tienen GRD elevados, superiores a 5 puntos y un 10% tienen valores excesivos, superiores a 20 puntos. Se ha objetivado correlación entre EM más altas y mayor número de lesiones asociadas y mayor gravedad de la lesión, con una correlación significativa (p<0,01; r=78) entre EM más alta y GRD más alto. En conclusión, los cambios detectados a través de este estudio en cuanto a la incidencia EM y morbilidad añadida a la lesión medular aguda, evaluada a través de los GRD, indica que es necesario trabajar con el gobierno y los compradores de la salud en las CC.AA., para demostrar que la reducción de la EM, tienen un límite situado en el equilibrio entre la atención eficiente y la tolerable éticamente y que no siempre representan una gestión más rentable, por lo que será preciso tener en cuenta el grado de discapacidad de los pacientes y el análisis continuo de los procesos (AU)

Mean stay (MS) is an important factor to determine the care activity and is an indicator for payment in some health care systems. It has been shown that it has dramatically decreased in patients admitted in rehabilitation services during the last years. We have analyzed the evolution of EM and the degree of complexity of the health care process from 1997 to 2009. We have determined the tendency it has been following and how it has been influenced by the changes in the care model in order to discover the modifications that have been made in the management of the spinal cord injury process and the ethical implications it may have on the care model. The number of patients in the period 1997-2009 was 907 with an annual average of 69.7 patients/year. Average age was 44.8 years (SD: 18.2), with a range that varied from 15 to 84 years and a median of 41 years. Mean age increased significantly (P<0.001) when the periods 1997-2002 and 2003-2009 are compared. Mean stay (MS) in the ICU was 12.3 days (SD: 18.2) for tetraplegia and 15 days (SD: 19.6) for paraplegia. Mean stay in the spinal cord injured unit (SCI) was 66.4 days, with a range varying from 85.2 in 1997 to 55.4 in 2003. We observed a significant reduction of MS, ostensibly from 2001, with a steady decline until 2003, it stabilizing after this year, and with significant differences (P<0.0001) between the period 1997-2002 and 2003-2009. The complexity degree of SCI has increased significantly since 2004, with an average 5.37 diagnostic related groups (DRG), during the period study, and a range that varied from 3.79 in 1997 to 9.4 in 2009. More than 40 percent of the patients have elevated GRDs, greater than 5 points, and 10 per cent of patients have excessive values, which are considered to be more than 20 points. Correlations have been observed between higher MS and increased number of associated lesions, and greater severity of the injury, with a significant correlation (P<0.01; r=78) between higher MS and higher DRG. In conclusion, the changes detected by this study in regards to incidence, MS and morbidity added to the acute spinal cord injury, evaluated through the GRD, indicate the need to work with the Government and health care purchasers in the Autonomous Communities to demonstrate that the reduction of MS has a limit. This limit is found within the balance between efficient and ethically tolerable care, which does not always mean a more profitable process. Thus, it will be necessary to take into account the degree of disability of patients and the continuous analysis of processes (AU)

Análisis de los factores que influyen en el gasto sanitario de los lesionados medulares agudos mediante los grupos relacionados diagnósticos / Analysis to the factors influencing the health-care costs for acute spinal cord injury by diagnosis-related groups

Objetivo. Analizar los factores que influyen en el gasto sanitario de los pacientes con lesión medular en la última década valorado a través de los grupos relacionados diagnósticos (GRD). Material y métodos. Estudio retrospectivo de pacientes dados de alta por la unidad de lesionados medulares desde el año 1997 hasta el año 2006. Se utilizan los datos obtenidos de la base de datos de los GRD de dicho hospital, que incluye los pacientes dados de alta en la unidad de lesionados medulares (n=698). El estudio investiga el número de altas, la estancia media (EM) total y el peso relativo del GRD. Se agrupó según si tenían EM normalizadas o eran outliers (pacientes con una estancia hospitalaria mayor que la media), y se estudiaron las mismas variables. Se realizó un estudio bivariable con el paquete estadístico SPSS® 15. Resultados. La EM fue de 70,3 días. El peso del GRD era de 4,65. La comparación de la EM de los outliers y no outliers mostró diferencias significativas (p<0,05). Existe una correlación entre la EM y el peso del GRD anual (–0,75). Existen 302 outliers. En los últimos 2 años ha habido un descenso importante en el número de outliers. Conclusiones. Descenso de la EM en los últimos años sin cambios en cuanto a la incidencia de ingresos, pero sí en el modelo de atención de la lesión medular aguda. Se ha producido un incremento del peso del GRD anual. Ha habido un descenso importante en el número de outliers en los últimos años (AU)

Objective. To analyze the factors influencing the health-care costs of the patients spinal cord injury in the last decade, valued through the Diagnosis-Related Groups (DRG). Material and methods. A retrospective study of given discharged patients by Spinal Cord Unit following 1997 to 2006. The collected data of the data base of the DRG are used of this hospital, and that includes the given discharged patients in the Spinal Cord Injury unit (ULM) (N=698). The study investigates the number of discharges, the mean of long of stay (LOS) and relative weight DRG's. It was grouped according to if they had LOS standardized or they were outliers, and the same variables studied. It was analyzed using a bivariate study with the statistical package SPSS® 15. Results. The LOS was 70.3 days. Weight DRG was 4,65. The comparison of LOS between of outliers and not outliers patients did not show significant differences (p<0,05). It exists a correlation between the LOS and weight DRG. The outliers were 302. In the last 2 years there has been an important reduction in the number of outliers. Conclusions. Decrease LOS in the last years, without changes as far as the incidence of SCI, but in the model of attention of the SCI patients. An increase of the weight of the annual DRG has taken place. There were important reductions in the number of outliers in the last years (AU)

[Quality of life evaluation in spinal cord injured patients comparing different bladder management techniques]. / Evaluación de la calidad de vida en pacientes con lesión medular comparando diferentes métodos de vaciado vesical.

OBJECTIVES: This study examines quality of life among patients with spinal cord injury requiring bladder management techniques, according to the validated King s Health Questionnaire (KHQ). MATERIAL AND METHODS: Prospective and observational study of 91 spinal cord-injured patients (21 women 23% and 70 men 77%). Mean age was 40 years (SD 13.4) and average time since spinal injury was 11.4 (SD 10.4) years. Patients completed the KHQ quality of life instrument and 10 additional questions related to urinary disturbance developed for the study, and filled in a form to subjectively rank their main concerns related to spinal injury. Patients were divided according to the bladder management techniques they regularly used: intermittent catheterization, condom catheter or indwelling catheter, and differences between the mean groups were assessed with de SPSS 13.0 statistic package. RESULTS: The overall KHQ score for the sample was 39.9 (SD 54.4) with higher scores (poorer QoL) in patients using an indwelling catheter. A thorough analysis of the test showed no significant differences between the groups other than in the physical role limitation item (p

Evaluación de la calidad de vida en pacientes con lesión medular comparando diferentes métodos de vaciado vesical / Quality of life evaluation in spinal cord injured patients comparing different bladder management techniques

Material y métodos: Estudio observacional y prospectivo con 91 pacientes (21 mujeres 23%, 70 hombres 77%) afectos de lesión medular que acudieron a la consulta durante marzo 2004 y diciembre del 2005, con media de edad 40 años (DS 13,4) y tiempo medio de evolución de la lesión 11,4 (DS 10,4) años. Los pacientes completaron el KHQ, así como una valoración subjetiva de los principales problemas relacionados con la lesión medular. Se clasificaron los pacientes en función del sistema de evacuación urinaria habitual en: Cateterismos Intermitentes (CI), Sondaje Vesical Permanente (SVP) y Colector Permanente (CP). Analizamos con el paquete estadístico SPSS 12.0 las diferencias entre las medias de las dimensiones del KHQ de los tres grupos. Resultados: La media de la puntuación total del KHQ fue de 39,9 puntos (DT 54,4), con mejor puntuación en el grupo portador de CP. Encontramos que no hay diferencias significativas, excepto en la dimensión de la limitación de los roles, donde obtienen mejor puntuación el grupo portador de CP que los de SVP y los CI (p=0,025).La sexualidad se presenta en primer lugar en la lista de problemas que más preocupa a los pacientes, seguidos de los trastornos de defecación y urinarios. Conclusión: El grupo con mejor puntuación global en el KHQ es el portador de CP, aunque no hay diferencias significativas entre los 3 grupos. Lo que más preocupa a nuestros pacientes son los problemas sexuales (AU)

Material and methods: Prospective and observational study of 91 spinal cord-injured patients (21 women 23% and 70 men 77%). Mean age was 40 years (SD 13.4) and average time since spinal injury was 11.4 (SD 10.4) years. Patients completed the KHQ quality of life instrument and 10 additional questions related to urinary disturbance developed for the study, and filled in a form to subjectively rank their main concerns related to spinal injury. Patients were divided according to the bladder management techniques they regularly used: intermittent catheterization, condom catheter or indwelling catheter, and differences between the mean groups were assessed with de SPSS 13.0 stadistic pakagge. Results: The overall KHQ score for the sample was 39.9 (SD 54.4) with higher scores (poorer QoL) in patients using an indwelling catheter. A thorough analysis of the test showed no significant differences between the groups other than in the physical role limitation item (p=0.025). Patients using a condom catheter reported lower physical limitation scores (better QoL) than patients using an indwelling catheter or intermittent catheterization. Sexuality was the main concern of most patients, followed by bowel dysfunction, urinary incontinence and ambulation or gait problems. Conclusion: Patients treated with condom catheters reported the best quality of life according to KHQ scores, although there were no significant differences versus the other urinary management techniques. The patients’ main concern was related to sexuality (AU)

Rotura traumática de aorta en paciente con lesión medular aguda. Tratamiento intravascular. A propósito de un caso / Traumatic rupture of the aorta in patients with acute spinal cord lesion. Endovascular treatment. A case report

Introducción. La lesión de aorta debida a traumatismo se presenta entre el 10-20 % de los politraumatizados graves. El objetivo del presente caso clínico es describir el procedimiento diagnóstico y las opciones terapéuticas de una rotura traumática de aorta en un sujeto con lesión medular. Paciente y métodos. Mostramos el caso de un paciente politraumatizado, que sufrió un accidente de moto, presentando una lesión medular a nivel sensitivo motor D1 derecha, C8 izquierda, American Spinal Card Injury Association (ASIA) A, producida por una hernia discal posteromedial C6-C7 además de un seudoaneurisma traumático de aorta. Tras ser intervenido de raquis, permaneció en la unidad de cuidados intensivos (UCI) por insuficiencia respiratoria e ingresó en planta con el diagnóstico de lesión medular incompleta ASIA B, nivel sensitivomotor C7. Discusión. Se decidió como tratamiento la colocación de una endoprótesis, lo que disminuyó los riesgos de morbimortalidad añadidos a la lesión medular, considerándose el método de elección en este tipo de pacientes

Introduction. The lesion of the aorta due to traumatism occurs in between 10 %-20 % of the serious multitraumatized patients. The objective of this clinical case is to describe the diagnostic procedure and therapeutic options of traumatic rupture of the aorta in a subject with spinal cord lesion. Patient and methods. We present the case of a multi-traumatized patient who suffered a motorcycle accident. He had a spinal cord lesion on motor sensory level right D1, left C8, ASIA A, produced by posteromedial disk herniation C6-C7 in addition to a traumatic pseudoaneurysm of the aorta. After the columna spinal was operated on, he remained in the ICU due to respiratory failure and was admitted to the ward with the diagnosis of ASIA B incomplete spinal cord lesion, C7 motor sensory level. Discussion. It was decided to place an endoprothesis as treatment. This decreased the morbidity-mortality risks added to the spinal cord lesion and was considered the method of choice in these types of patients

Methicillin-resistant Staphylococcus aureus: a four-year experience in a spinal cord injury unit in Spain.

Methicillin-Resistant Staphylococcus aureus (MRSA) infection poses a problem for both acute and long-term-care facilities, Spinal Cord Injury units included. This paper describes the 4-year evolution of MRSA outbreaks in a SCI unit in a university hospital where control measures were implemented from the first case detected. The protocol procedure was as follows: contact isolation, washing with antiseptic soap both those infected and those sharing the same room, contacts study and monitoring of MRSA patients up to the time when three consecutive negative cultures (sampled at time lapses of over 48 h) were obtained, antiseptic soap for the health-care personnel to wash their hands, and cultures of the nares done on the personnel in the event of an outbreak. Twenty-one (3.4%) MRSA positive cases were detected out of 550 admissions registered during the study period (November 1990 through October 1994). The evolution occurred in three outbreaks and six isolated MRSA positive patients without secondary cases. 71.5% of the cases were nosocomial. Seven (33%) were colonizated and 14 (67%) infected. The 14 patients infected presented 15 infections: nine with urinary tract infections, three surgical wound infections, two tracheostomy wound infections, and one patient with a decubitus ulcer infection. Two of those with urinary tract infections presented with secondary sepsis. No carriers were detected amongst the personnel. Urinary tract colonizations responded to treatment with cotrimoxazol except in two cases in which combined treatment was required (cotrimoxazol plus rifampicin). The patients with a MRSA positive tracheal aspirate were negative after combined treatment. Wounds and cultures of the nares responded favorably to initial treatment. One of the patients with a urinary tract infection and sepsis died the infection being a contributing cause. The prospective follow-up of the patients with MRSA positive cultures and the precocious implementation of isolation measures allow for the limitation of transmission, even although complete eradication is not possible.