Anthropometric measures and breast cancer risk among Hispanic women in Puerto Rico.

INTRODUCTION: Increased risk of postmenopausal breast cancer associated with anthropometric measures including Body Mass Index (BMI), adult weight gain, and waist circumference has been observed in North American and European populations, but little evidence is available for Hispanic women. Breast cancer is the leading type of cancer, and leading cause of cancer-related deaths among Hispanic women in Puerto Rico (PR). However, compared with the United States, breast cancer incidence rates are lower but increasing more rapidly. PURPOSE: To examine associations between anthropometric characteristics and breast cancer risk in Hispanic women in PR. METHODS: Data from a population-based case-control study in the San Juan metropolitan region (cases = 315; controls = 348) were used to examine associations between anthropometric measures and breast cancer risk, also considering menopausal status and hormone therapy (HT). RESULTS: Among premenopausal participants, there was a significant trend for lower odds of breast cancer with higher BMI and borderline significant with higher waist to height ratio (WHtR). For postmenopausal participants, a significant trend for lower odds of breast cancer was observed with higher WHtR, and waist to hip ratio (WHR), borderline significant with higher BMI, and higher odds with height. Among postmenopausal participants using HT, a significant trend for lower odds of breast cancer was observed with higher waist circumference, WHtR, WHR, and body shape index. CONCLUSION: Our study provides evidence of anthropometric differences in relation to breast cancer risk in PR compared to previous studies. Future studies should include analyses of fat and lean mass distribution, and hormone receptor status to further understand anthropometry and breast cancer risk among Hispanic women.

Adherence to the DASH dietary pattern is associated with blood pressure and anthropometric indicators in Mexican adults / La adherencia al patrón alimentario DASH se relaciona con la presión arterial y los indicadores antropométricos en adultos mexicanos

Background: adherence to Dietary Approach to Stop Hypertension (DASH) has demonstrated to be effective in lowering blood pressure and other cardiovascular risk markers in different populations, but has never been evaluated in the Mexican population. Objective: to assess adherence to the DASH dietary pattern by using an adapted DASH adequacy index (DASH-AI), and to evaluate its association with cardiovascular risk markers in an adult Mexican population. Methods: we conducted a cross-sectional analysis of data of 1,490 adults aged 20-50 years. Diet was assessed with a Food Frequency Questionnaire and sodium intake by 24-hour urinary sodium excretion; the DASH-AI score was calculated based on the DASH nutrient targets. Multivariable linear and logistic regression analyses were performed to estimate the association between the DASH-AI score and cardiovascular risk markers (body mass index [BMI], waist circumferences, systolic (SBP) and diastolic blood pressure (DBP), glucose, triglycerides, total cholesterol, and high- and low-density lipoproteins). Results: we observed an association of the DASH-AI score with BMI, WC and DBP in the linear (BMI, β: -0.55, 95 % CI: -0.77, -0.33; WC, β: -1.66, 95 % CI: -2.19, -1.13; DBP, β: -0.65, 95 % CI: -1.07, -0.24), and logistic (BMI > 25 kg/m2, OR: 0.82, 95 % CI: 0.74, 0.93; elevated WC, OR: 0.72, 95 % CI: 0.64, 0.81; DBP, OR: 0.83, 95 % CI: 0.72, 0 .95) models. Conclusion: compliance to the DASH-style diet was inversely associated with BMI, WC and DBP in this Mexican population. Promoting adherence to this dietary pattern in the context of Mexican diet is needed to improve cardiovascular health in this population (AU)

Antecedentes: la adherencia al patrón de alimentación DASH ha mostrado ser eficaz para reducir la presión arterial y los marcadores de riesgo cardiovascular en diferentes poblaciones, pero nunca en la mexicana. Objetivo: evaluar la adherencia al patrón de alimentación DASH mediante un índice adapatado a los lineamientos DASH (DASH-AI) y evaluar su asociación con marcadores de riesgo. Métodos: análisis transversal de datos de 1490 adultos de entre 20 y 50 años de edad. La ingesta dietética se evaluó utilizando un cuestionario de frecuencia de consumo de alimentos y el sodio a través de la excresión urinaria en 24 horas; la puntuación DASH-AI se calculó de acuerdo con la adherencia a las recomendaciones DASH. Se realizaron modelos logísticos y lineales para estimar la asociación entre el puntaje DASH-AI y los marcadores de riesgo cardiovascular (índice de masa corporal [IMC], circunferencia de cintura (CC), presión arterial sistólica (PAS) y diastólica (PAD), glucosa, triglicéridos, colesterol total, lipoproteínas de alta y baja densidad). Resultados: observamos una asociación del DASH-AI con el IMC, la CC y la PAD en los modelos lineales (IMC β: -0,55, IC del 95 %: -0,77, -0,33; CC β: -1,66, IC del 95 %: -2,19, -1,33; PAD, β: -0,65, IC del 95 %: -1,07, -0,24) y logístico (IMC > 25 kg/m2, OR: 0,82, IC del 95 %: 0,74, 0,93; CC elevado, OR: 0,72; IC del 95 %: 0,64, 0,81; PAD, OR: 0,83, IC del 95 %: 0,72, 0,95). Conclusión: la adherencia a la dieta DASH se asoció inversamente con el IMC, la CC y la PAD en la población estudiada. Es necesario promover la adherencia a este patrón dietético para mejorar la salud cardiovascular (AU)

Tríada találgica. Una nueva entidad clínica a partir de una serie de casos / Thalalgic triad. A new clinical entity from a case series

Introducción: El dolor crónico en el talón es un cuadro frecuente en la patología del pie. Este tipo de cuadros no están causados por una sola lesión, sino que es el resultado de la combinación de una serie de cuadros clínicos, especialmente por una neuropatía de Baxter y una fascitis plantar. Desde hace varios años, y tras analizar una serie de casos clínicos, se observa que los pacientes con dolor crónico en el talón cursan con un proceso de fasciosis plantar, edema óseo de calcáneo o síndrome congestivo de calcáneo y neuropatía del nervio de Baxter. A raíz de este hallazgo concluimos en una nueva entidad clínica denominada tríada találgica, la cual no presenta referencias bibliográficas anteriores en la literatura científica. Pacientes y métodos: Se ha llevado a cabo una serie de casos de 10 pacientes a los que se les diagnostica una combinación de 3 patologías, denominada tríada találgica, que cursa con aparición de fasciosis plantar, edema óseo de calcáneo (congestión calcánea) y neuropatía compresiva de Baxter. Cada una de estas patologías se trata de forma independiente con distintas terapias, tales como soportes plantares, infiltraciones, tratamiento farmacológico o cirugía. Resultados: Un total de 10 mujeres con una edad media de 53 años fueron diagnosticadas de fasciosis plantar, edema óseo de calcáneo y neuropatía compresiva de Baxter mediante diferentes pruebas, como la ecografía. Estas pacientes fueron tratadas mediante infiltraciones de colágeno, extracción del líquido sanguinolento del calcáneo, terapia electrolisis percutánea intratisular, soportes plantares, tratamiento farmacológico y ondas de choque. El 40 % de la muestra se encontraba de baja laboral debido al dolor incapacitante de esta tríada y el 10 % en situación de jubilación. Conclusiones: La tríada találgica es una entidad clínica desconocida, con un diagnóstico complejo que combina pruebas complementarias con diagnóstico clínico...(AU)

Introduction: Chronic heel pain is a frequent condition in foot pathology. These types of pictures are not caused by a single injury, but are the result of a combination of a series of clinical pictures, especially Baxter's neuropathy and plantar fasciitis. For several years and after analyzing a series of clinical cases, it has been observed that patients with chronic pain in the heel present with a process of plantar fasciosis, calcaneal bone edema or congestive calcaneal syndrome and Baxter nerve neuropathy. As a result of this finding, we conclude on a new clinical entity called thatalgic triad, which does not present previous bibliographic references in the scientific literature. Patients and methods: A series of cases of 10 patients who were diagnosed with a combination of 3 pathologies, called the thatalgic triad, has been carried out, with the appearance of plantar fasciosis, calcaneal bone edema (calcaneal congestion) and neuropathy Baxter compression. Each of these pathologies is treated independently with different therapies, such as plantar supports, infiltrations, drug treatment or surgery. Results: A total of 10 women with a mean age of 53 years were diagnosed with plantar fasciosis, calcaneal bone edema and Baxter's compressive neuropathy by different tests, such as ultrasound. These patients were treated by collagen infiltrations, removal of bloody fluid from the calcaneus, intratissular percutaneous electrolysis therapy, plantar supports, pharmacological treatment, and shock waves. 40 % of the sample was on sick leave due to the disabling pain of this triad and 10 % were in retirement. Conclusions: The thatalgic triad is an unknown clinical entity with a complex diagnosis that combines complementary tests with clinical diagnosis. Likewise, there are very few bibliographic references on this subject.(AU)

A novel experimental immunomodulatory therapy against Nocardia brasiliensis in a BALB/c murine model.

BACKGROUND: Mycetoma is recognized as a neglected tropical disease and there are still therapeutic challenges, especially in cases recalcitrant to standard therapy or with high risk of dissemination. Subcultures have been used previously to decrease the virulence of human pathogens. Previous reports have demonstrated that after carrying out 200 subcultures of Nocardia brasiliensis, a decrease in virulence was observed. AIM: To evaluate the effect of attenuated N. brasiliensis strains on the development of lesions in an established mycetoma infection. METHODS: Female 8-12-week-old BALB/c mice were injected with N. brasiliensis suspension to establish a mycetoma. Sixty mice were selected and divided into three groups: two of these groups were inoculated in the dorsum with N. brasiliensis subcultured 200 and 400 times, respectively, while the third group served as control. The thickness of each lesion was measured with calipers every week for 12 weeks. RESULTS: After 12 weeks, we observed that inoculation of 1 × 105 colony-forming units of attenuated N. brasiliensis strains was able to modify the natural history of the infection, with a decrease in the size of the lesions, particularly with P400, compared with the control group (P < 0.01). CONCLUSION: In this experimental evaluation of an immunomodulatory therapy with attenuated N. brasiliensis strains in a murine model, there was a greater stability in the size of the lesion over time in BALB/c mice inoculated with the P400 strain. This treatment could open the possibility of using the attenuated strain as immunomodulatory therapy in patients recalcitrant to standard therapy, with high risk of dissemination or who develop drug-related adverse effects.

Diarrea crónica como manifestación de un tumor neuroendocrino / Chronic diarrhea as a manifestation of a neuroendocrine tumor

Resumen Las neoplasias neuroendocrinas (Neuroendocrine Neoplasms, NEN) constituyen un grupo heterogéneo de neoplasias poco frecuentes, que se originan en las células endocrinas, con la capacidad de secretar aminas y polipéptidos hormonales. Las NEN de localización pancreática (pNEN) pueden ser funcionales o no funcionales. Las pNEN funcionales secretan hormonas como la gastrina, la insulina y el glucagón y otras menos frecuentes como el péptido intestinal vasoactivo (PIV), por lo que sus características sindromáticas dependen del péptido secretado. Los vipomas se manifiestan con diarrea crónica de características secretoras, que usualmente conducen a trastornos hidroelectrolíticos e incluso a complicaciones serias asociadas como la falla renal. A continuación, se describe el caso de un hombre de 37 años con diarrea crónica de 6 meses de evolución y frecuentes hospitalizaciones por trastornos hidroelectrolíticos, generados por hipocalemia severa y lesión renal aguda por deshidratación. Después de múltiples estudios, se considera el diagnóstico de una diarrea secretora por NEN funcional, secretora de PIV. Por tanto, se inicia una terapia empírica con octreotida y se logra controlar la diarrea, así como corregir el trastorno hidroelectrolítico. Además, se amplían los estudios, para documentar las pNEN tratadas mediante intervención quirúrgica, con respuesta clínica favorable y remisión completa de la sintomatología.

Abstract Neuroendocrine tumors (NETs) are a heterogeneous group of rare neoplasms that originate in endocrine cells with the ability to secrete amines and hormonal polypeptides. Pancreatic neuroendocrine tumors (PNETs) can be functional or non-functional. Functional PNETs secrete common hormones such as gastrin, insulin and glucagon and much less frequent hormones such as vasoactive intestinal peptide (VIP). Their characteristics depend on the peptide secreted. Vipomas are characterized by chronic diarrhea of ​​secretory characteristics that usually lead to hydroelectrolytic disorders and can lead to serious complications associated with renal failure. This article describes the case of a 37-year-old man who had suffered chronic diarrhea with frequent hospitalization for hydroelectrolytic disorders for six months due to severe hypokalemia and acute renal damage due to dehydration. After multiple studies, a diagnosis of secretory diarrhea due to a VIP secretory functional NET was considered. Empirical therapy with Octreotide was begun to control diarrhea and correct the hydroelectrolytic disorder. More studies of PNETS are being published. They have been treated surgically intervention with favorable clinical results and complete remission of symptoms.

Assessment of quality of life of oral cancer survivors compared with Spanish population norms.

This study evaluated the quality of life (QL) of patients who survived oral cancer more than 5 years after treatment, using the Short-Form 36 questionnaire (SF-36), and assessed the impact of factors influencing QL compared with the Spanish population norms. 60 oral cancer patients (65.41 years; 49 males) with cancer-free survival after surgery of >5 years were enrolled. The outcomes of every dimension of the SF-36 questionnaire in every patient were compared with those of a reference Spanish population. Females had statistically significant negative differences in the dimensions of role-emotional, social functioning and vitality. Patients under 65 years had statistically significant negative differences in the dimensions of physical functioning and general health. In the other variables analysed the differences between groups were only clinically relevant. The QL of patients with oral cancer who survive more than 5 years, when assessed with the SF-36 questionnaire, presented similar values to those of the general population, even exceeding these reference values in some dimensions. It is necessary to evaluate QL in the long-term since patients may need a long time to recover from the disease, and to complement QL assessment with other specific questionnaires.

Medida de autoeficacia en pacientes con enfermedad de Parkinson / No disponible

Objetivos: Este estudio tuvo como propósito determinar si la edad o el sexo afectan la autoeficacia de pacientes con enfermedad de Parkinson (EDP). La autoeficacia se consideró una medida indirecta de motivación en este estudio. Se postuló que pacientes femeninas jóvenes obtendrían un puntaje mayor que sus contrapartes masculinas y mayores en el cuestionario modificado de autoeficacia de acuerdo con la literatura científica. Materiales y métodos Un total de 40 cuestionarios fueron distribuidos en un período de 3 meses. El instrumento utilizado en este estudio fue una versión modificada del cuestionario general de autoeficacia percibida (GPSEQ por sus siglas en inglés). El GPSEQ original consiste en 10 preguntas; la versión modificada incluyó 5 preguntas adicionales relacionadas con la motivación. Se utilizó un método de muestreo de conveniencia. Pacientes con EDP fueron seleccionados en el área suroeste del estado de la Florida, EE. UU. El protocolo investigativo y la forma modificada del cuestionario fueron aprobados por la Junta de Revisión Institucional de Florida Gulf Coast University. Resultados La versión modificada del GPSEQ mostró una consistencia interna excelente (alfa de Cronbach alta; R=0,936) entre el instrumento original y las preguntas adicionales relacionadas a la motivación para esta población. No se encontró ninguna diferencia significativa entre los grupos diferentes de edad o sexo (p=0,356 y 0,578, respectivamente).Discusión y conclusión Se propone el GPSEQ como alternativa de evaluación de autoeficacia para pacientes con EDP. No se encontraron diferencias significativas en autoeficacia en esta población, ni tampoco diferencias significativas en términos de edad o sexo (AU)

Objectives: The purpose of this study was to determine if the factors of sex or age affect the self-efficacy of patients with Parkinson’s Disease (PD). Self-efficacy was considered to be an indirect measure of motivation in this study. It was postulated that young female patients. would obtain a higher score than their masculine counterparts as well as higher ones on the modified self-efficacy questionnaire in accordance with the scientific literature reviewed. Materials and methods: A total of 40 surveys were collected in a 3-month period. The instrument used in this study was the Modified version of the General Perceived Self-Efficacy Questionnaire (GPSEQ). The original GPSEQ consisted of 10 questions; a modified version of the questionnaire was used, including 5 additional questions related to motivation. A convenience sampling method was used. Patients with PD were identified in clinical settings located in Southwest Florida (USA). Both the research protocol and modified questionnaire were approved by the Florida Gulf Coast University Institutional Review Board. Results: The modified version of the GPSEQ was found to have excellent internal reliability between the original questionnaire and the modified version, with a high Cronbach’s alpha(R=.936). There were no significant differences among sex or age groups in self-efficacy scores(P=.356 and .578, respectively).Discussion and conclusion: GPSEQ was proposed as an assessment alternative for self-efficacyin this population. This study found no significant differences in self-efficacy in either sex orage groups (AU)

Amnesia global transitoria en el contexto de una anestesia general / Transient global amnesia after general anaesthesia

La amnesia global transitoria es un síndrome neurológico en el que se produce una pérdida abrupta y pasajera de la capacidad para crear nuevos recuerdos, así como una amnesia retrógrada de intensidad variable, permaneciendo, sin embargo, preservadas la conciencia, la identidad personal y la atención. Se trata de una entidad poco frecuente tras un proceso anestésico. Existen distintas hipótesis etiopatogénicas (base epiléptica, migrañosa o isquémica) y desencadenantes (dolor, la ansiedad, los cambios de temperatura, el ejercicio, las maniobras de Valsalva, las pruebas diagnósticas o determinados medicamentos). Describimos el caso de una paciente con alto grado de ansiedad preoperatoria que sufrió un episodio de amnesia global transitoria tras una intervención quirúrgica otorrinolaringológica. Ante un episodio de amnesia aguda y mantenida tras una anestesia general debemos plantear, en primer lugar, un adecuado diagnóstico diferencial que incluya la amnesia global transitoria, puesto que, en la mayoría de los casos, se trata de un diagnóstico de exclusión. La ansiedad preoperatoria puede ser un desencadenante a tener en cuenta en esta entidad, siendo importante el tratamiento ansiolítico previo a la intervención(AU)

Transient global amnesia is a neurological syndrome in which there is a sudden and brief inability to form new memories, as well as an intense retrograde amnesia. However, awareness, personal identity and attention remain intact. It is an uncommon condition seen after an anaesthetic procedure. There are several aetiopathogenic hypotheses (epileptic, migrainous or ischaemic origin) and triggering factors (pain, anxiety, temperature changes, exercise, Valsalva manoeuvres, diagnostic tests or certain drugs). We describe the case of a patient with a high level of pre-operative anxiety who suffered an episode of transient global amnesia after undergoing otolaryngology surgery. With an acute and continued amnesia after general anaesthesia, the first thing that must be done is to establish a suitable differencial diagnosis, which should include transient global amnesia, as this is mainly an exclusion diagnosis. Preoperative anxiety may be a triggering factor to take into account in this condition, with anxiolytic treatment prior to the surgery being important(AU)

[Transient global amnesia after general anaesthesia]. / Amnesia global transitoria en el contexto de una anestesia general.

Transient global amnesia is a neurological syndrome in which there is a sudden and brief inability to form new memories, as well as an intense retrograde amnesia. However, awareness, personal identity and attention remain intact. It is an uncommon condition seen after an anaesthetic procedure. There are several aetiopathogenic hypotheses (epileptic, migrainous or ischaemic origin) and triggering factors (pain, anxiety, temperature changes, exercise, Valsalva manoeuvres, diagnostic tests or certain drugs). We describe the case of a patient with a high level of pre-operative anxiety who suffered an episode of transient global amnesia after undergoing otolaryngology surgery. With an acute and continued amnesia after general anaesthesia, the first thing that must be done is to establish a suitable differencial diagnosis, which should include transient global amnesia, as this is mainly an exclusion diagnosis. Preoperative anxiety may be a triggering factor to take into account in this condition, with anxiolytic treatment prior to the surgery being important.

First histological and virological report of fibropapilloma associated with herpesvirus in Chelonia mydas at Príncipe Island, West Africa.

Marine turtle fibropapillomatosis is an emerging disease that affects marine turtles worldwide. This report describes the histopathological features and involvement of chelonid fibropapilloma-associated herpesvirus in marine turtle fibropapillomatosis detected in the green turtle Chelonia mydas at Príncipe Island, Gulf of Guinea. The histopathological findings confirmed the presence of fibropapillomas with both verrucous and fibromatous subtypes. Quantitative real-time PCR was used for detection of chelonid fibropapilloma-associated herpesvirus in tissue samples (n = 18) collected from afflicted (n = 10) and apparently healthy turtles (n = 2), revealing 94.4% positive samples, confirming the presence of viral sequences not only in fibropapillomatosis lesions but also in the skin of apparently healthy animals.

Osteonecrosis de los maxilares asociada al uso de bifosfonatos: revisión de ocho casos / Bisphosphonate-related jaw osteonecrosis: review of eight cases

Introducción: A finales de 2003 se comienzan a publicar en forma creciente los primeros casos de exposición ósea en los maxilares con evolución tórpida, asociados al uso de bifosfonatos por vía intravenosa. Estos fármacos son usados en pacientes con osteoporosis, mieloma múltiple, hipercalcemia maligna y cáncer de pulmón, mama y próstata, principalmente por su capacidad de inhibir la resorción ósea. Material y método: Estudio prospectivo de los pacientes en el Hospital Virgen Macarena que presentaban lesiones maxilares asociadas al uso de bifosfonatos desde el año 2006 hasta la actualidad. Las variables que valoramos en el paciente son: sexo, edad, tratamiento con bifosfonatos, inicio de la osteonecrosis, relación con tratamientos dentales, tratamiento realizado y evolución. Resultados: Se estudiaron 8 pacientes con osteonecrosis maxilar secundaria a tratamiento con bifosfonatos intravenosos u orales por su patología previa oncológica u osteoporótica que fueron tratados según su estadio clínico-radiológico con antibioterapia, legrado y/o exéresis del secuestro según el caso. Presentamos los resultados con un seguimiento mínimo de 15 meses. Conclusiones: El aumento en la incidencia de la osteomielitis maxilar en los pacientes asociados al uso de bifosfonatos y la dificultad para su tratamiento hacen necesario establecer pautas terapéuticas estandarizadas. En nuestra experiencia, el tratamiento conservador basado en la antibioterapia además del legrado de la zona bajo anestesia local permite el control y la curación del proceso en algunos de los pacientes con OMRB grado II(AU)

Background: In late 2003, an increasing number of case reports began to appear on bone exposure of the jaw with a torpid evolution in association with intravenous bisphosphonate use. Bisphosphonates are used to inhibit bone resorption in patients with osteoporosis, multiple myeloma, hypercalcemia of malignancy, lung cancer, breast cancer and prostate cancer. Material and methods: A prospective study was made of patients from Hospital Virgen Macarena who presented bisphosphonate associated jaw lesions from 2006 to the present. The patient variables examined were: sex, age, bisphosphonate treatment, onset of osteonecrosis and its relation to dental treatment, treatment, and outcome. Results: Eight patients with osteonecrosis of the jaw secondary to treatment with intravenous or oral bisphosphonates for oncologic or osteoporotic pathology were treated according to their clinical and radiological findings with antibiotics and curettage and/or excision of sequestered bone, as needed. Results with a minimum follow up of 15 months are reported. Conclusions: The increased incidence of maxillary osteomyelitis in patients treated with bisphosphonates and the difficulty of treatment make it necessary to establish standard therapeutic guidelines. In the authors' experience, conservative treatment based on antibiotic therapy and/or curettage of the area under local anesthesia can adequately control and resolve the process in some patients with stage II BRJO(AU)

Aplicación de la telemedicina a la Cirugía Mayor Ambulatoria / Application of telemedicine and major out-patient surgery

La Cirugía Mayor Ambulatoria es uno de los pilares donde se sustenta la eficacia de una Unidad de Cirugía. La Telemedicina utiliza al máximo las posibilidades que le ofrece la transmisión de imágenes y datos pero sobre todo aporta un elemento primordial en la continuidad asistencial: proximidad entre el paciente y el equipo de profesionales que se ocupan de su salud tanto en el ámbito hospitalario como de Atención Primaria. La Zona de Levante/Alto Almanzora cuenta con un equipo de Telemedicina conectando un Hospital de Huércal-Overa (Almería) con los diferentes Centros de Salud. Hemos aplicado dicha tecnología en la Cirugía Mayor Ambulatoria y una valoración de sus posibilidades basadas en su posible utilidad para cirujanos, médicos de familia y para los pacientes. Fueron sometidos 108 pacientes a una intervención de CMA: 74 hernias de la pared abdominal, 18 colelitiasis y 16 intervenciones proctológicas. A las 24 horas eran citados en la consulta de su médico de familia para realizar una teleconsulta con su cirujano. La calidad de la comunicación fue del paciente muy alto (97%), sin embargo, para el 77,7% de los médicos de familia este procedimiento interfiere en su trabajo diario frente al 15,3% del personal hospitalario implicado. La aplicación de la Telemedicina a la CMA aporta las siguientes ventajas: reduce las desigualdades en la población para beneficiarse de los programas de Cirugía Ambulatoria, acerca la asistencia especializada a la Medicina de Familia permitiéndole un contacto más cercano y participar en proyectos comunes, colabora en la formación continuada de los profesionales de los Centros de Salud e incrementa el grado de satisfacción y de confianza en la asistencia en régimen de cirugía ambulatoria (AU)

Major Out- patient Surgery is one of the pillars on which the efficiency of a Surgery Unit is based. As this article explains, Telemedicine brings an essential element in nursing continuity in these services: proximity between the patient and the team of professionals taking care of his health both in the hospital and in the Primary Healthcare Centre, collaborating in the on-going training of Health Centre professionals and increasing the level of satisfaction and confidence of the patient in the out-patient surgery system (AU)

Hematoma en el compartimento braquial fascial tras anestesia del plexo braquial con neuroestimulación a nivel axilar / No disponible

No disponible

Rupture of the lesser gastric curvature after a Heimlich maneuver.

BACKGROUND: We present a case of lesser gastric curvature injury after a Heimlich maneuver due to obstruction of the breathing tract that was repaired by laparoscopic surgery. METHODS: A patient with perforation of the lesser gastric curvature as a result of closed abdominal traumatism was operated on using the laparoscopic approach with the use of four trocars as work openings. With this technique, the diagnosis was confirmed, the injury repaired, and the abdominal cavity washed. RESULTS: The postoperative period was favorable and the patient was released from the hospital on day 7 without any complications. CONCLUSIONS: Laparoscopic surgery can be technically reproduced in the treatment of gastric injury as a result of closed abdominal traumatism.

[Hyperfrequent consultations: is there a relationship with the mother's personality?]. / Hiperfrecuentación en las consultas: hay relación con la personalidad de la madre?

OBJECTIVES: To study the psychological profile of mothers who overuse pediatric services and associated social and demographic characteristics, as well as to evaluate the association between maternal personality profile and greater use of pediatric services. MATERIAL AND METHOD: Cross-sectional descriptive study, at the Basic Health Areas of Granollers Sud and Granollers Oest-Canovelles in Barcelona (Spain). SUBJECTS: Forty-four mothers, representing 21.5 % of the population meeting the inclusion criteria were studied. The population consisted of mothers of children who visited the center on an equal or higher number of occasions as two standard deviations. PROCEDURE: One-hour interviews were conducted. A data sheet to assess social and demographic variables, Milton's Multiaxial Inventory II, and Goldberg's Anxiety and Depression Scale to detect symptoms of depression and anxiety were administered. RESULTS: Forty-four mothers (21.5 %) attended the interviews. The mean age was 36.6 years. Most of the mothers (90.9 %) were married, 73 % had completed primary studies, 5 % were housewives, and 75 % had no family support. Fifty percent of the children were the youngest in their family, and 30 % were only children. Concerning personality disorders, 55.8 % of overusing mothers showed compulsive personality, 30.23 % schizoid personality, and 14 % dependent personality while 47.7 % of mothers presented significant symptoms of anxiety. CONCLUSIONS: Sociodemographic profile, anxiety, and maternal personality profile are related to overuse of pediatric services. Compulsive, schizoid and dependent personality disorders seem to be associated with overuse.

Hiperfrecuentación en las consultas: ¿hay relación con la personalidad de la madre? / Hyperfrequent consultations: is there a relationship with the mother's personality

Objetivos: Estudiar el perfil psicológico materno de los niños hiperfrecuentadores de diferentes consultas. Estudiar las características sociodemográficas asociadas. Medir el grado de asociación entre el tipo de personalidad materna y un perfil de mayor demanda de consulta pediátrica. Material y métodos Estudio descriptivo transversal, en las áreas básicas de salud Granollers Sud y Granollers Oest-Canovelles (Barcelona).Se incluyeron 44 madres, que representan el 21,5 per cent de la población con criterios de inclusión. La población eran 205 madres de niños que habían acudido al centro un número de veces igual o superior a dos desviaciones estándar.Se realizaron entrevistas de una hora donde se administrando una hoja de datos para estudiar las variables sociodemográficas, el Inventario Clínico Multiaxial de Millon II (Millon Clinical Multiaxial Inventory Manual II, MCMI-II) y la Escala de Ansiedad y Depresión de Goldberg para la detección de síntomas de depresión y ansiedad. Resultados Asistieron 44 madres, el 21,5 per cent citado. La edad media era de 36,6 años. El 90,9 per cent de las madres estaban casadas, el 73 per cent tenían estudios primarios completos, el 5 per cent eran amas de casa y el 75 per cent no recibía apoyo familiar. Respecto a los hijos, el 50 per cent eran los hermanos pequeños y el 30 per cent eran hijos únicos. En relación con los trastornos de personalidad, el 55,8 per cent de las madres hiperfrecuentadoras presentaban una personalidad compulsiva, el 30,23 per cent personalidad esquizoide y el 14 per cent personalidad dependiente.El 47,7 per cent de las madres mostraban síntomas significativos de ansiedad. Conclusiones Existe relación entre el perfil sociodemográfico antes citado, la ansiedad y el perfil de personalidad materna con la hiperfrecuentación. Parece existir relación entre los trastornos de personalidad compulsiva, esquizoide y dependiente con la hiperdemanda pediátrica materna (AU)

Management of hepatitis C in HIV-infected persons.

The life expectancy of HIV-infected persons has extended significantly since the introduction of highly active antiretroviral therapies. Although classical opportunistic infections are now rarely seen, the toxicity of antiretroviral drugs as well as liver disease caused by hepatitis viruses represent an increasing cause of morbidity and mortality among HIV-positive persons. Since the rate of hepatitis C virus (HCV) infection is high among HIV carriers (up to 75% among intravenous drug users), HCV/HIV coinfection is widely prevalent. Predisposing liver damage favors a higher rate of hepatotoxicity of antiretroviral drugs, which can limit the benefit of HIV treatment in some individuals. Overall, severe hepatotoxicity appears in around 10% of subjects who began triple combinations including either protease inhibitors or non-nucleosides. The progression to cirrhosis seems to occur faster in the setting of HIV infection, and conversely recent data demonstrate that HCV infection can accelerate the progression to AIDS in HIV-positive persons. Although clinicians have been reluctant to treat hepatitis C in HIV-infected people, this therapeutic nihilism is unwarranted. The availability of new more successful regimens to treat hepatitis C, in particular using the new pegylated forms of interferon in combination with ribavirin, open new hopes for the care of HIV-HCV-coinfected persons.