Effectiveness of an intervention in multicomponent exercise in primary care to improve frailty parameters in patients over 70 years of age (MEFAP-project), a randomised clinical trial: rationale and study design.

BACKGROUND: Physical activity may reverse frailty in the elderly, but we encounter barriers to the implementation of exercise programs in this population. Our main aim is to evaluate the effect of a multicomponent physical activity program, versus regular medical practice, on reverting pre-frailty status among the elderly, 12 months post-intervention. METHODS: Randomized parallel group multicenter clinical trial located in primary care setting, among non-dependent and pre-frail patients > 70 years old, including 190 patients (95 intervention, 95 control group). INTERVENTION: Multicomponent physical activity program (MEFAP, for its acronym in Spanish) with twelve 1.5 h-weekly sessions comprised of: 1. Informative session; 2. Exercises for improving aerobic resistance, muscle strength, propioception-balance and flexibility; and 3. Handing out of at-home exercise chart (twice/week). Main variable: pre-frailty according to the Fried phenotype. Secondary variables: sociodemographic, clinical and functional variables; exercise program adherence, patient satisfaction with the program and quality of life. We will perform an intention-to-treat analysis by comparing the retrogression from pre-frailty (1 or 2 Fried criteria) to robust status (0 Fried criteria) by the end of the intervention, 6 months and 12 months post-intervention. The accumulated incidence in each group will be calculated, as well as the relative risk (RR) and the number needed to treat (NNT) with their corresponding 95% confidence intervals. Protocol was approved by the Ethics Committee Hospital la Paz. DISCUSSION: Within the context of regular clinical practice, our results will provide evidence regarding the effects of exercise interventions on frailty among pre-frail older adults, a key population given their significant potential for functional, physical, and mental health improvement. TRIAL REGISTRATION: NCT03568084 . Registered 26 June 2018. Date of enrollment of the first participant to the trial: July 2nd 2018.

Evaluación de la efectividad de una intervención educativa para disminuir el peso de la mochila escolar en los alumnos de 3. ° y 4. ° de educación primaria / Evaluation of effectiveness of an educational intervention to decrease school backpack weight in 3rd and 4th year primary school children

Introducción El trabajo demuestra que una intervención educativa en las aulas, realizada por un fisioterapeuta, reduce el peso de las mochilas que deben transportar los escolares de 8 a 10 años. Conseguir que el peso de la mochila no supere el 10-15% del peso total del alumno evita la sobrecarga de la columna vertebral y, por tanto, uno de los factores de riesgo de presentar vertebrales. Cargas superiores modifican la curvatura espinal con una percepción de aumento de esfuerzo y aparición de dolor. Material y método Diseño: tipo ensayo clínico controlado aleatorizado abierto. Emplazamiento: colegios públicos de Alcobendas y San Sebastián de los Reyes. Participantes: un total de 357 niños entre 8 y 10 años. Mediciones principales: se pesaron los niños y las mochilas escolares antes de la intervención educativa, inmediatamente después y a los 3 meses de la intervención educativa. Resultados Respecto de la variable «peso excesivo en la mochila», observamos que los niños que recibieron la intervención tienen aproximadamente 3 veces más posibilidades, tanto al terminar dicha intervención como a los 3 meses (RR=2,63 y RR=2,96, respectivamente), de conseguir tener mochilas sin peso excesivo. Respecto de la variable principal del estudio, peso medio de la mochila, la diferencia entre los 2 grupos es superior a 1kg (diferencia señalada como relevante) tanto al acabar la intervención (diferencia de medias (DM)=2,28 kg) como a los 3 meses de la misma (DM=2,24kg), (p=<0,001) en ambos casos. Conclusiones El estudio demuestra que una intervención educativa con revisión del material escolar que transportan los estudiantes de 8 a 10 años consigue una disminución de más de 1 kg del peso de sus mochilas con respecto del grupo control (medias de 2,28kg al finalizar la primera intervención). Además, demuestra que estos resultados se mantienen en el tiempo (media de 2,24kg a los 3 meses) (AU)

Introduction This work shows that classroom educational orientation provided by a physiotherapist can lead to reduction in the weight of backpacks carried by 8-10 year old schoolchildren. The purpose was to have them limit backpack weight to no more than 10-15% of the total weight of the student and avoid some of the spinal cord overload and therefore one of the risk factors of suffering back pain. Higher loads can change spinal curvature with a perception of increased effort and onset of pain. Materials and method Design: randomized, open labeled, controlled clinical trial. Location: public schools in Alcobendas and San Sebastian de los Reyes. Participants: a total of 357 children, aged 8 to 10 years. Main measurements: children and their school backpacks were weighed prior to the educational intervention, immediately after and at three months of the educational intervention. Results Regarding the study primary endpoint, average weight of the backpack, the difference between the two groups was greater than 1kg (difference considered relevant) both at the end of the intervention (difference of means (SD)=2.28kg) and at 3 months of it (SD=2.24kg) (P=<.001). Regarding the endpoint “excess weight in the backpack”, it was observed that those children who received the intervention had approximately three times more likelihood both at the end of said intervention and at 3 months (RR=2.63 and RR=2.96, respectively) of carrying backpacks without excessive weight. Conclusions The study shows educational intervention with review of school supplies transported by students aged 8 to 10 achieves a decrease of more than onekg in weight of their backpacks versus the control group (mean 2.28kg at the end of the first intervention). It also shows that these results are maintained over time (mean 2.24kg at 3 months) (AU)

[Use of rifabutin in cases of toxicity to rifampicin]. / Uso de rifabutina en casos de toxicidad a rifampicina.

Rifampicin is an essential drug in the present treatment of tuberculosis. On some occasions, it cannot be used due to severe adverse effects. Rifabutin is a drug of the same family, with a similar activity and difference adverse effects. This study describes the beneficial results of the substitution of rifampicin with rifabutin in patients with severe toxicity.

Uso de rifabutina en casos de toxicidad a rifampicina / Use of rifabutin in cases of toxicity to rifampicin

La rifampicina es un fármaco esencial en el tratamiento actual de la tuberculosis. En algunas ocasiones no se puede utilizar por efectos adversos graves. La rifabutina es un fármaco de la misma familia, con una actividad similar y efectos adversos diferentes. En este estudio se describen los resultados beneficiosos de la sustitución de rifampicina por rifabutina en pacientes con toxicidad intensa (AU)

Rifampicin is an essential drug in the present treatment of tuberculosis. On some occasions, it cannot be used due to severe adverse effects. Rifabutin is a drug of the same family, with a similar activity and difference adverse effects. This study describes the beneficial results of the substitution of rifampicin with rifabutin in patients with severe toxicity (AU)

Enfermedad pulmonar por Mycobacterium scrofulaceum / Pulmonary disease caused by Mycobacterium scrofulaceum

No disponible

Artritis tuberculosa esternoclavicular / Sternoclavicular tubercular arthritis

No disponible

Trombosis venosa profunda y cáncer: actitud diagnóstica / Deep venous thrombosis and cancer

No disponible

Utilización de supresores de la secreción ácida en pacientes hospitalizados / Use of acid-suppresive medications in hospitalized patients

Introducción: Los fármacos supresores de la acidez gástrica son frecuentemente utilizados, pero algunos estudios evidencian su mal uso, sobretodo en la profilaxis de la úlcera de estrés en pacientes con bajo riesgo. Este estudio evalúa su frecuencia y utilización de en pacientes hospitalizados en una planta de Medicina Interna. Material y métodos: Revisión aleatoria y retrospectiva de 209 historias clínicas de 661 pacientes ingresados durante el año 2000 en el servicio de Medicina Interna V Hospital General Universitario Gregorio Marañón (Cantoblanco). Definiciones: Utilización: Al menos una vez, a cualquier dosis y de cualquier fármaco antiácido. Indicación correcta: Criterios endoscópicos: Ulcera activa, Esofagitis y Gastritis. Criterios clínicos: síntomas de reflujo, dispepsia, mantenimiento por proceso previo, hemorragia digestiva alta activa, ingesta de antiinflamatorios no esteroideos, profilaxis de úlcera de estrés en pacientes con alto riesgo. Indicación incorrecta: Cualquier otra utilización no incluida anteriormente. Resultados: De 209 pacientes, 75,1 por ciento (157) los utilizaron, edad media de 76 años (23-99), mujeres 89 (56,7 por ciento) y hombres 68 (43,3 por ciento).Los diagnósticos más frecuentes al ingreso: ICC 34 (21,7 por ciento), Neumonía 26 (16,6 por ciento), ITU 24 (15,3 por ciento) y EPOC 18 (11,5 por ciento). La utilización en planta fue de 84,7 por ciento (133), con uso incorrecto 72,2 por ciento (96), la causa de uso incorrecto "sin razones" en 52,1 por ciento(50) y la medicación inhibidores bomba 46,9 por ciento (45). Conclusiones: Este estudio evidencia una alta utilización de fármacos inhibidores de la secreción ácida, de manera incorrecta en pacientes hospitalizados (AU)

Introduction: The acid-suppressive medications are used frequently in hospitalized patients, but some studies suggests that their are overused, especially in the treatment of stress ulcer prophylaxis in low-risk patients. This research determine the frequency of use and indications of acid-suppressive medications in hospitalized patients in a internal medical service. Materials and methods: A at random and retrospective revision of 209 medical records of 661 hospitalized patients during the year 2000 in the V Internal Medical Service of the General University Hospital of Gregorio Marañón (Cantoblanco). Definitions: Use: any prescription of an acid-suppressive medication, regardless of dosage regimen, in which the patient received at least one dose. Appropriated indication: endoscopical criteria: treatment of active ulcer disease, esophagitis or gastritis. Medical criteria: symptomatic gastroesophageal reflux, dyspepsia, prolonging of previous treatment, as a part of a treatment regimen for H. pylori, relief of dyspepsia caused by nonsteroidal anti-inflammatory drugs, stress ulcer prophylaxis in high risk patients. Inappropriate indication: any other uses were considered not indicated. Results: Of the 209 patients, a total of 157 (75,1%) received acid-suppressive therapy, average age 76 years old, 89 women (56,7%) and 68 men (43,3%). The admitting diagnoses for the admission were: CHF 34 (21,7%), Pneumonia ( 16,6%), UTI (15,3%) y COPD 18 (11,5%). The use in hospital ward was 84,7% (133), with inappropriate use 72,2% (96), the cause of prescription "no reason" 52,1% (50), and received proton pump inhibitors 46, 9% (45). Conclusions: This study show a high frequency of incorrect use of acid-suppressive medications in hospitalized patients (AU)

Disfonía y tuberculosis laríngea: presentación de dos casos y revisión de la bibliografía / Dysphonia and laryngeal tuberculosis: presentation of two cases and review of the literature

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[Use of acid-suppressive medications in hospitalized patients]. / Utilización de supresores de la secreción ácida en pacientes hospitalizados.

INTRODUCTION: The acid-suppressive medications are used frequently in hospitalized patients, but some studies suggests that their are overused, especially in the treatment of stress ulcer prophylaxis in low-risk patients. This research determine the frequency of use and indications of acid-suppressive medications in hospitalized patients in a internal medical service. MATERIALS AND METHODS: A at random and retrospective revision of 209 medical records of 661 hospitalized patients during the year 2000 in the V Internal Medical Service of the General University Hospital of Gregorio Marañón (Cantoblanco). DEFINITIONS: Use: any prescription of an acid-suppressive medication, regardless of dosage regimen, in which the patient received at least one dose. Appropriated indication: endoscopical criteria: treatment of active ulcer disease, esophagitis or gastritis. Medical criteria: symptomatic gastroesophageal reflux, dyspepsia, prolonging of previous treatment, as a part of a treatment regimen for H. pylori, relief of dyspepsia caused by nonsteroidal anti-inflammatory drugs, stress ulcer prophylaxis in high risk patients. Inappropriate indication: any other uses were considered not indicated. RESULTS: Of the 209 patients, a total of 157 (75.1%) received acid-suppressive therapy, average age 76 years old, 89 women (56.7%) and 68 men (43.3%). The admitting diagnoses for the admission were: CHF 34 (21.7%), Pneumonia (16.6%), UTI (15.3%) y COPD 18 (11.5%). The use in hospital ward was 84.7% (133), with inappropriate use 72.2% (96), the cause of prescription "no reason" 52.1% (50), and received proton pump inhibitors 46.9% (45). CONCLUSIONS: This study show a high frequency of incorrect use of acid-suppressive medications in hospitalized patients.